Effectiveness and safety of moxibustion for primary insomnia: a systematic review and meta-analysis

Effect of Moxibustion Combined with Other Interventions on Body Weight Reduction in the Treatment of Obesity: A Systematic Review and Meta-Analysis

Background: Moxibustion has been used in the treatment and prevention of obesity. However, there has been no systematic review or meta-analysis conducted on the use of moxibustion on obesity treatment. This study aimed to evaluate the role of moxibustion in the treatment of obesity. Methods: The Cochrane Central Register of Controlled Trials, EMBASE, and MEDLINE/PubMed databases were searched to identify all randomized controlled trials (RCTs) that evaluated the effect of moxibustion on obesity. The primary outcome was body weight. The secondary outcomes were the body mass index (BMI), waist circumference (WC), hip circumference (HC), and waist-to-hip ratio (WHR). The risk of bias assessment and meta-analysis were conducted using the Cochrane Collaboration tool. Results: Eleven RCTs involving 761 participants were included in this systematic review and meta-analysis. Other interventions that were included in the analyses were manual acupuncture, electroacupuncture, embedding therapy, herbal medicine, and diet control. Moxibustion combined with other interventions resulted in a significant improvement in body weight reduction (mean difference [MD] -3.32, 95% confidence interval [CI: -4.25 to -2.38]; I2 = 17%), BMI (MD -1.51, 95% CI [-1.88 to -1.14]; I2 = 76%), and WC (MD -2.82, 95% CI [-3.50 to -2.13]; I2 = 75%), but did not improve HC (MD -2.05, 95% CI [-4.21 to 0.11]; I2 = 0%) or WHR (MD -0.01, 95% CI [-0.03 to 0.01]; I2 = 57%). Conclusions: Moxibustion can be used with other interventions to improve body weight, BMI, and WC in people with obesity. However, the conclusions of this review should be cautiously applied to clinical practice because most of the included studies had a high or unclear risk of bias.

Bibliometric Analysis of Brain Stimulation Technologies in Sleep Disorders

BACKGROUND Sleep disorders are a common disease faced by people today and can lead to fatigue, lack of concentration, impaired memory, and even death. In recent years, the development of brain stimulation techniques has provided a new perspective for the treatment of sleep disorders. However, there is a lack of bibliometric analyses related to sleep disorders and brain stimulation techniques. Therefore, this study analyzed the application status and trend of brain stimulation technology in sleep disorder research. MATERIAL AND METHODS Articles and reviews published between 1999 and 2023 were retrieved from the Web of Science. CiteSpace was used to visually analyze the publications, countries, institutions, journals, authors, references, and keywords. RESULTS A total of 459 publications were obtained. The number of studies was shown to be on a general upward trend. The country with the largest number of publications was the United States; UDICE-French Research Universities had the highest number of publications; Neurology had the highest citation frequency; 90% of the top 10 references cited were from Journal Citation Reports Q1; Brigo was the author with the highest number of publications; and the most frequent keywords were "transcranial magnetic stimulation", "deep brain stimulation", and "Parkinson disease". CONCLUSIONS Our study used CiteSpace software to analyze 459 studies published since 1999 on brain stimulation techniques for the treatment of sleep disorders, revealing research trends and the current state of the field. Our results will help researchers to understand the existing research quickly and provide direction for future research.

Moxibustion for medical personnel with negative emotion and insomnia during COVID-19 pandemic: A randomized, controlled trial

Background

We conducted this randomized controlled trial (RCT) to evaluate the effectiveness and safety of moxibustion at Sanyinjiao (SP6) acupoint for treatment of negative mood and sleep quality in healthcare workers during the 2019 coronavirus disease (COVID-19).

Methods

A total of 180 participants were divided in a 1:1 ratio into two groups, the treatment group (for moxibustion) and the control group (for no treatment). The treatment group had a 30-minute moxibustion therapy once a day for two weeks, followed by a two-week follow-up. The Hamilton Anxiety Scale (HAMA) was used to assess the degree of the participants' anxiety, and the Patient Health Questionnaire-9 (PHQ-9) was utilized to examine their depressed condition. The Maslach Burnout Inventory-General Survey (MBI-GS) was used to measure the level of burnout among healthcare workers. To determine the severity of insomnia, the Sleep Dysfunction Rating Scale (SDRS) was utilized. At baseline, week 2, and week 4, all scales were evaluated.

Results

Compared to the control group, The treatment group improved more significantly in the HAMA at week 2 (MD = -19.01, 95% CI: -21.89 to -16.14; P<0.001) and at week 4 follow-up visits (MD = -8.96, 95% CI: -11.19 to -6.73; P<0.001). A subgroup study of HAMA scores revealed that position and education had significant impact on treatment effectiveness. During the 2-week intervention period, the treatment group showed more significant improvements in depressive symptoms measured by PHQ-9 (13.00±2.41 vs. 15.60±3.65; P<0.001), work burnout symptoms measured by MBI-GS (MD = -11.88, 95% CI, -15.73 to -8.03; P<0.001), and insomnia symptoms measured by SDRS (MD = -2.45, 95% CI, -4.24 to -0.66; P<0.01). There were no significant adverse effects reported.

Conclusion

Moxibustion at SP6 may be an effective treatment to improve anxiety, depression, sleep quality, and quality of life for healthcare workers during COVID-19.

Trial registration

Chinese Clinical Trial Registry (ChiCTR): ChiCTR-2200059327.

Similarities and differences between kaiy in Persian medicine and moxibustion in Chinese medicine

Kaiy (medieval cautery) is an ancient method of heat therapy in traditional Persian medicine (TPM). Some of its important applications have been neglected during the medical revolution. Meanwhile, different treatment modalities that incorporate heat, including moxibustion, have progressed in traditional Chinese medicine. In this study, we reviewed the main TPM textbooks that were written specifically in the field of kaiy. We considered the traditional teachings in the context of contemporary information, gathered from the scientific literature about moxibustion and modern cauterization. Some surgical therapeutic indications of kaiy (e.g., debridement and coagulative procedures) have been advanced by the innovation of electro-cauterization. However, those therapeutic applications that were based on the TPM humoral theory for relieving body coldness or myofascial pains-which are similar to moxibustion usages-have not received the same attention. Apart from the broad similarities of kaiy and moxibustion as thermal therapies with similar indications, there is a striking correspondence between kaiy point mapping and acupoints. Therefore, further research on different kaiy aspects is recommended. Please cite this article as: Jaladat AM, Alizadeh Vaghasloo M, Atarzadeh F, Ayati MH, Kazemi AH, Akin E, Hashempur MH. Similarities and differences between kaiy in Persian medicine and moxibustion in Chinese medicine. J Integr Med. 2023; Epub ahead of print.

Acupuncture and moxibustion in patients with cancer-related insomnia: A systematic review and network meta-analysis

OBJECTIVES

Cancer-related insomnia (CRI) is one of the most common and serious symptoms in patients with cancer. Acupuncture and moxibustion have been widely applied in the treatment of CRI. Nevertheless, the comparative efficacy and safety of different acupuncture and moxibustion techniques remain unclear. This study aimed to evaluate and compare the efficacy and safety of different acupuncture and moxibustion techniques in the treatment of CRI.

METHODS

Eight medical databases were comprehensively searched for relevant randomized controlled trials (RCTs) as of June 2022. Two independent reviewers assessed the risk of bias and conducted the research selection, data extraction, and quality assessment of the included RCTs. A network meta-analysis (NMA) was performed using frequency models, combining all available direct and indirect evidence from RCTs. The Pittsburgh Sleep Quality Index (PSQI) was set as the primary outcome, and adverse events and effective rates were set as the secondary outcomes. The efficacy rate was calculated as the ratio of patients with insomnia symptom relief to the total number of patients.

RESULTS

Thirty-one RCTs with 3,046 participants were included, including 16 acupuncture- and moxibustion-related therapies. Transcutaneous electrical acupoint stimulation [surface under the cumulative ranking curve (SUCRA) 85.7%] and acupuncture and moxibustion (SUCRA 79.1%) were more effective than Western medicine, routine care, and placebo-sham acupuncture. Furthermore, Western medicine showed significantly better effects than placebo-sham acupuncture. In the NMA, the acupuncture and moxibustion treatments with the best therapeutic effects for CRI were transcutaneous electrical acupoint stimulation (SUCRA 85.7%), acupuncture and moxibustion (SUCRA 79.1%), auricular acupuncture (SUCRA 62.9%), routine care combined with intradermal needling (SUCRA 55.0%), and intradermal needling alone (SUCRA 53.3%). No serious acupuncture- or moxibustion-related adverse events were reported in the included studies.

CONCLUSION

Acupuncture and moxibustion are effective and relatively safe in treating CRI. The relatively conservative recommended order of acupuncture- and moxibustion-related therapies for CRI is as follows: transcutaneous electrical acupoint stimulation, acupuncture and moxibustion, and auricular acupuncture. However, the methodological quality of the included studies was generally poor, and further high-quality RCTs are needed to strengthen the evidence base.

Effectiveness and safety of moxibustion for vascular dementia: A systematic review and meta-analysis

BACKGROUND

Vascular dementia (VD) is the only type of dementia that can be prevented and treated. Compared to conventional treatment methods, moxibustion therapy is more effective for VD. This study evaluated the effectiveness and safety of moxibustion in the treatment of VD through a meta-analysis, to provide a complete overview to the advantages of traditional Chinese medicine and provide guidance for clinical application.

METHODS

Clinical trials on the therapeutic effects of moxibustion or moxibustion combined with acupuncture on VD were retrieved from the VIP information database, Wanfang, CNKI, PubMed, EMBase, and other resources. The included studies were conducted from January 2000 to October 2020. Among the retrieved studies, the content met the standards upon being collated and extracted, and RevMan5.3 was used for meta-analysis.

RESULTS

Thirteen randomized controlled trials (RCTs) were included with 997 patients. The RevMan bias risk assessment revealed that the quality of the studies was generally low. The meta-analysis showed that compared to conventional treatments, moxibution therapy in terms of effective rate, posttreatment Hasegawa Dementia Scale, Mini-Mental State Examination (MMSE), Activity of Daily Living Scale (ADL), Somatostatin (SS), Arginine Vasopressin (AVP), and Syndrome Differentiation Scale of VD were more favorable, and the difference in efficacy was statistically significant. Furthermore, no adverse events were observed in either group. Sensitivity analysis showed strong homogeneity and stable results, whereas funnel plot analysis revealed no significant publication bias.

CONCLUSIONS

Moxibustion is effective and safe in the treatment of VD, but more high-quality evidence from further studies is required to support this.

Effects of Acupuncture, Moxibustion, Cupping, and Massage on Sports Injuries: A Narrative Review

With the evolution of society, an increasing number of people have realized the importance of sports on human health. However, participation in sports is a double-edged sword as improperly exercising can lead to injury. Many athletes and patients with sports injuries choose traditional Chinese medicine (TCM) when modern medicine fails to relieve their musculoskeletal symptoms. TCM is a splendid legacy of Chinese civilization whose therapies are effective, economical, and convenient, with some administration by trained patients at home. This review analyzes the literature on the application of acupuncture, moxibustion, massage, and cupping in sports injuries to provide novel ideas for the application of TCM in sports medicine.

Effects of moxibustion for obesity: A protocol for systematic review and meta-analysis

BACKGROUND

Obesity is a chronic disease associated with lethal health conditions. Moxibustion, a frequently used treatment in traditional Chinese medicine, is effective and safe for the treatment of obesity. However, the evidence has not been systematically collected and combined to date. This systematic review and meta-analysis will analyze the effects of moxibustion on obesity.

METHODS

The following databases will be searched: Cochrane Central Register of Controlled Trials, MEDLINE/PubMed, EMBASE, 1 Chinese database (Chinese National Knowledge Infrastructure), 1 Japanese database (Citation Information by the National Institute of Informatics), and 3 Korean databases (Oriental Medicine Advanced Searching Integrated System, ScienceON, and KoreaMed). The quality of the included studies will be assessed according to the Cochrane Assessment Tool for Risk of Bias. Data from the included studies will be synthesized for meta-analysis. The primary outcome will be body weight, and the secondary outcomes will be body mass index, waist-hip ratio, waist circumference, hip circumference, and effective rate.

RESULTS AND CONCLUSION

Ethical approval is not necessary for this study because it will not include any patient information. The results of this systematic review and meta-analysis will be publicly available and published in a peer-reviewed journal.

REGISTRATION NUMBER

DOI 10.17605/OSF.IO/NTKDF (https://osf.io/ntkdf).

Effectiveness and safety of moxibustion for Parkinson disease: A protocol for systematic review and meta-analysis

BACKGROUND

Parkinson disease (PD) is a common neurodegenerative disease among middle-aged and elderly people. Clinically, it is a movement disorder characterized mainly by static tremors, kinesia, myotonia, and postural balance disorder. In recent years, an increasing number of clinical reports on moxibustion therapy for PD have been published. Despite this, no systematic review of moxibustion therapy for PD has been undertaken.

METHODS

Two reviewers will search the following 7 English and Chinese databases online: the Cochrane Library; PubMed; EMBASE; the China National Knowledge Infrastructure; the Wan Fang databases; the China Science and Technology Journal Database; and the Chinese Biomedical Literature Database. Reviewers will search each electronic database for studies published from journal inception to May 2021. Two reviewers will independently conduct clinical study inclusion, data extraction, and risk bias assessment. Any differences in the above process will be resolved through discussion with a third reviewer. If the data are sufficient, RevMan software 5.3 (Cochrane Community, London, UK) will be used for the meta-analysis of the extracted data.

RESULTS

In this systematic review, the effectiveness and safety of moxibustion therapy in PD treatment will be evaluated.

CONCLUSION

This systematic review may provide further evidence to encourage clinicians to use moxibustion in the treatment of PD.

INPLASY REGISTRATION NUMBER

INPLASY202140097.

The efficacy and safety of moxibustion for chronic fatigue syndrome: A protocol for systematic review and meta-analysis

BACKGROUND

The pathogenesis of chronic fatigue syndrome (CFS) is not clear. The main purpose of treatment is to improve autoimmune function and relieve fatigue symptoms. Moxibustion is often used to treat diseases caused by low autoimmunity, especially in relieving fatigue symptoms. It is a superior therapy for CFS in traditional Chinese medicine. At present, there is a lack of the high level clinical evidence to support the moxibustion in the treatment of CFS, so this study will systematically review and analyze the currently available randomized controlled trials to evaluate the efficacy and safety of moxibustion in the treatment of CFS.

METHODS

We will systematically search PubMed, EMBASE, Cochrane library, Sinomed, CNKI, VIP, and Wanfang Database, ClinicalTrials.gov and Chinese Clinical Trial Registry will also be searched. The time range for the search will be from database activation to March 31, 2021. The randomized controlled trials (RCTs) associated with moxibustion for CFS will be included, regardless of language.We will use the standard proposed in Cochrane Handbook 5.1.0 to assess the bias risk of a single RCT. The main outcome index of the study is Fatigue Assessment Instrument (FAI), secondary outcome indexes will include Fatigue Scale -14 (FS-14), Fatigue Severity Scale (FSS), Pittsburgh sleep quality index (PSQI), natural killer (NK) cells, interleukin- 2 (IL-2), T lymphocyte subsets (CD4+, CD8+), cure rate, total efficiency and adverse reactions. The random effect model meta was used to analyze the effect data of a single RCT. Heterogeneity will be measured by Cochran Q test and I-squared statistics. We will use 2 subgroup analyses to explore the source of heterogeneity. RCTs with high bias risk was excluded and adjustment effect model was used for sensitivity analysis to test the robustness of the meta-analysis results. The publication bias included in RCTs will be assessed by funnel plot and Egger test.

RESULTS

This study will objectively and comprehensively evaluate the efficacy and safety of randomized controlled trials of moxibustion in the treatment of chronic fatigue syndrome, and the results will be submitted to peer-reviewed journals for publication.

CONCLUSION

This systematic review will provide clinicians with the latest high-quality evidence for the use of moxibustion in the treatment of chronic fatigue syndrome.

INPLASY REGISTRATION NUMBER

INPLASY202140063.

Acupuncture combined with moxibustion for insomnia after stroke: A protocol for systematic review and meta analysis

BACKGROUND

Stroke is the main cause of death and disability in the world and insomnia is a common complication of stroke patients. Insomnia will not only seriously affect the prognosis and quality of life of patients with stroke, but even cause the recurrence of stroke. Many studies have proved that acupuncture and moxibustion can effectively improve insomnia symptoms. This study will systematically evaluate the effectiveness and safety of acupuncture combined with moxibustion in treating insomnia after stroke.

METHODS

The following 8 databases will be searched from the inception to October 31, 2020, including China National Knowledge Infrastructure Database (CNKI), Chinese Scientific Journal Database (VIP database), China Biomedical Literature Database (CBM), Wanfang Data Chinese Database, PubMed, the Cochrane Central Register of Controlled Trials (CENTRAL), Allied and Alternative Medicine Database (AMED), Excerpt Medica Database (Embase). We will also search for ongoing trials from the World Health Organization International Clinical Trial Registration Platform search portal, Chinese Clinical Trial Register, Clinical trials.gov. In addition, the reference lists of studies meeting the inclusion criteria will also be searched for achieving the comprehensive retrieval to the maximum. All randomized controlled trials of acupuncture and moxibustion in treating insomnia after stroke will be included. Two reviewers will conduct literature screening, data extraction, and quality evaluation respectively. The main outcome is the Pittsburgh sleep quality index (PSQI), and the secondary outcomes include clinical efficacy, quality of life, and safety. RevMan V.5.4.1 will be used for meta-analysis. We will express the results as risk ratio (RR) with 95% confidence intervals (CIs) for dichotomous data and mean difference (MD) or standard mean difference (SMD) 95% CIs for continuous data.

RESULTS

This study will provide a comprehensive review of the available evidence of acupuncture combined with moxibustion in treating insomnia after stroke.

CONCLUSION

The conclusion of our study will provide the updated evidence to judge the effectiveness and safety of acupuncture combined with moxibustion for the treatment of insomnia after stroke.

TRIAL REGISTRATION NUMBER

PROSPERO CRD42020216720.

Efficacy and safety of moxibustion for patients with functional constipation: A protocol for systematic review and meta analysis

INTRODUCTION

The objective of this review is to assess the efficacy and safety of moxibustion for treating patients with functional constipation (FC).

METHODS AND ANALYSIS

We will electronically search the following databases: OVID MEDLINE, EMBASE, PubMed, Web of Science, the Cochrane Central Register of Controlled Trials, Cochrane library, CINAHL, AMED, China Network Knowledge Infrastructure, Wan-fang Database, China Biomedical Literature Database, and other resources from inception to October 2019, without any language restrictions. Randomised-controlled trials will be included. The primary outcome is the improvement in mean complete spontaneous bowel movements and stool form (utilize the Bristol Stool Form Scale [BSFS]). Secondary outcomes involve the degree of difficulty in defecation, proportion of responders, mean transit time, health-related quality of life, and adverse events rate. The methodological quality will be assessed using the Cochrane risk of bias tool.

RESULTS

This work will summarize clinical evidence to assess the effectiveness and safety of moxibustion treatment for FC patients.

CONCLUSION

This systematic review and meta-analysis will provide current evidence of the efficacy and safety of moxibustion treating FC.

SYSTEMATIC REVIEW REGISTRATION

PROSPERO, CRD42020157955.

Pharmacological interventions for the treatment of insomnia: quantitative comparison of drug efficacy

PURPOSE

Although different forms of pharmacological intervention are often prescribed for insomnia disorder, the comparative efficacies among various drugs remain unclear. We therefore conducted this study to quantitatively compare the efficacy of various pharmacotherapies for insomnia by modeling.

METHODS

We searched PubMed, EMBASE and Cochrane Library databases for randomized placebo-controlled trials of insomnia medications that were conducted within a designated time period (from the inception dates to May 16, 2019). Pharmacodynamic models were established to describe the time course of changes from baseline in selected sleep parameters. Sleep quality and dropout rates were also compared by a single-arm meta-analysis.

RESULTS

In sum, 43 studies covering 44 trials (14,535 patients) were included in the analysis. The drugs evaluated included flurazepam, quazepam, temazepam, triazolam, eszopiclone, zaleplon, zolpidem, extended-release zolpidem, suvorexant, ramelteon and doxepin. The established models revealed eszopiclone had the highest efficacy in terms of sleep latency (SL), total sleep time (TST), and sleep quality, and was also associated with the lowest dropout rates. The effect of suvorexant on the parameter 'wake after sleep onset' (WASO) was significantly higher than that of the other drugs analyzed.

CONCLUSIONS

Each drug has its own characteristics in the treatment of insomnia, and this needs to be taken into consideration to meet individual clinical needs. These results serve as a quantitative supplement for clinical practice by reflecting the difference in efficacy of various drugs in the treatment of insomnia.

Guizhi Gancao Longgu Muli decoction for insomnia: A protocol for a systematic review

BACKGROUND

Insomnia is a prevalent and bothersome disorder of sleep initiation and maintenance. Although efficacious treatments for insomnia have been available for decades, they all have their own limitations. Guizhi Gancao Longgu Muli Decoction (GGLMD), a popular complementary and alternative therapy, has been widely applied to treat insomnia in some Asian countries for centuries. Yet no systematic reviews have comprehensively assessed the efficacy and safety of GGLMD as a treatment for insomnia.

METHODS

A comprehensive search up to November, 2019 will be conducted in the following electronic databases: the Cochrane Library, Embase, PubMed, Web of Science, the Chinese National Knowledge Infrastructure (CNKI), the Chinese Biomedical Literature Database (CBM), the Chinese Scientific Journal Database (VIP), and the Wanfang Database. The primary outcomes will be sleep quality including Pittsburgh Sleep Quality Index (PSQI) and polysomnography (PSG). Stata 15 will be used for data analysis as well.

RESULTS

This study will provide the current evidence of insomnia treated with GGLMD from the several points including PSQI and PSG.

CONCLUSION

The consequence of this summary will furnish proof to evaluate if GGLMD is effective in the treatment of insomnia.

ETHICS AND DISSEMINATION

Without personal information involved, ethical approval and informed consent form is no need. The review will be submitted to a peer-reviewed journal prospectively to spread our findings.

PROSPERO REGISTRATION NUMBER

PROSPERO CRD42018118336.

Traditional Chinese medicine non-pharmaceutical therapies for chronic adult insomnia: A Bayesian network meta-analysis protocol

BACKGROUND

Traditional Chinese medicine (TCM) non-pharmaceutical therapies are frequently used for chronic insomnia in China, but in clinical practice, most practitioners choose appropriate treatments based on personal experience. In our study, Bayesian network meta-analysis will be used to identify differences in efficacy and safety between diverse non-pharmaceutical therapies for chronic adult insomnia.

METHODS

The authors will totally retrieve seven electronic databases from their establishment to August 2019 in accordance with relevant strategies. After a series of screening, the 2 researchers will employ the Aggregate Data Drug Information System (ADDIS) and R software to analyze the data extracted from enclosed Randomized Controlled Trials (RCTs). Ultimately, the evidentiary grade of the results will be evaluated.

RESULTS

This study will provide reliable evidence for different non-pharmaceutical therapies on chronic insomnia in adults.

CONCLUSIONS

The findings will be an available reference to evaluate the efficacy and safety of different non-pharmaceutical therapies on chronic insomnia in adults and may provide decision-making reference on which method to choose for clinicians.

TRIAL REGISTRATION NUMBER

PROSPERO CRD42019141496.

Does Moxa Smoke Have Significant Effect on the Acupuncturist's Respiratory System? A Population-Based Study

OBJECTIVES

To evaluate the safety of moxa smoke, especially to provide quantitative information and details for the occupational prevention of acupuncturists.

METHODS

We combined the questionnaire-based cross-sectional survey and lung function testing-based historical retrospective cohort research to investigate the safety of moxa smoke exposure (MSE) among acupuncturists. A mathematical regression model was established to quantitatively evaluate the relationship between moxa smoke exposure and the respiratory health of the acupuncturist. The smoke exposure time of the acupuncturist and the prevalence of abnormal respiratory symptoms or diseases were also evaluated.

RESULTS

(1) The cross-sectional research showed that the incidence of expectoration (18.7%) and rhinitis (22.7%) was the most common respiratory symptom and disease after MSE. No statistical difference was found between smoke exposure time of the acupuncturist and the prevalence of abnormal respiratory symptoms or diseases, except the prevalence of rhinitis and shortness of breath (P < 0.01). Regression model for the incidence of first three symptoms (expectoration, shortness of breath, and wheezing) from the cross-sectional survey indicated that the weight coefficients of factors associated with moxa smoke were lower than those of factors unrelated to moxa smoke, such as gender and personal history of respiratory diseases. (2) Historical retrospective cohort research showed that there was no significant difference in the % predicted PEF. No statistic difference was found between the exposed and nonexposed group in large airway function indexes (% predicted FEV1, % predicted FVC, and % predicted FEV1/FVC) and small airway function indexes (% predicted FEF25, % predicted FEF50, % predicted FEF75, and % predicted MMEF), either. Especially, the % predicted MVV among males (106.23 ± 2.92 vs. 95.56 ± 1.92, P < 0.01 and % predicted VC among females (100.70 ± 1.59 vs. 95.91 ± 1.61, P < 0.05) between the two groups had statistical significance, but did not cause pulmonary ventilation dysfunction.

CONCLUSIONS

MSE has no significant effect on the respiratory health of acupuncturists.

Efficacy Comparison of Different Acupuncture Treatments for Primary Insomnia: A Bayesian Analysis

BACKGROUND

Acupuncture treatments are used frequently in the treatment of primary insomnia considering its less side effect. However, most treatment choices are made just based on personal experience among different forms of acupuncture. This study compared the effectiveness of different forms of acupuncture for primary insomnia by using network meta-analysis.

METHODS

All randomized controlled trials (RCTs) of acupuncture treatments for primary insomnia were searched in seven databases from the date of database inception to January 6, 2019, including PubMed, Web of Science, Embase, Cochrane Library, Wanfang database, China National Knowledge Infrastructure (CNKI) database, and VIP Chinese Science and Technique Journals (CQVIP) database. After screening, the effectiveness rate was extracted from the included RCTs as primary outcomes. The network meta-analysis was performed by Review Manager 5.3, Stata13.0, and GeMTC 0.14.3.

RESULTS

Forty-two studies were included, which contained 3304 participants among 6 interventions. Based on the ranking probability and compared to western medicine, scalp acupuncture (OR = 8.12, 95% CI (4.07,16.81)) is considered to be the most effective method, followed by electroacupuncture (OR = 6.29, 95% CI (3.36, 12.67)), electroacupuncture combined scalp acupuncture (OR = 5.20, 95% CI (2.43,11.28)), warm acupuncture (OR = 3.79, 95% CI (1.85,8.16)), and conventional acupuncture (OR = 2.86, 95% CI (2.05,3.95)). There was no significant difference between the results of direct and indirect comparisons.

CONCLUSIONS

The finding indicated that five acupuncture methods may be all effective in the treatment of primary insomnia, and scalp acupuncture seems to be the best treatment. However, the overall quality of the included trials could only be ranked as medium to low quality, and higher quality RCTs are warranted for sufficient evidence.

Effect of Mongolian warm acupuncture on the gene expression profile of rats with insomnia

BACKGROUND

The mechanism of Mongolian warm acupuncture (MWA) for the treatment of insomnia has not been previously reported.

OBJECTIVE

To investigate the effect of MWA on gene expression profile in the p-chlorophenylalanine (PCPA)-induced rat model of insomnia.

METHODS

A rat model of insomnia was established and the animals were divided into five groups: control, PCPA (untreated), PCPA+estazolam, PCPA+MA (manual acupuncture), and PCPA+MWA. The rats were euthanased at 7 days after treatment, and hypothalamic tissue was harvested to extract total RNA for the analysis of gene expression profile. Micro-array and Partek Genomics Suite analysis system were used to analyse differential expression of genes between groups. Furthermore, ingenuity pathways analysis was used to analyse the main regulators.

RESULTS

After treatment, in rats with improved sleep, micro-array data from the follow-up phase compared with baseline showed that MWA down-regulated 11 genes compared with the control group and 16 genes compared with the PCPA group. Six genes were selected following the micro-array detection to perform quantitative polymerase chain reaction (qPCR) verification, and the results showed that the coincidence rate was up to 90%, which verified the reliability of the microarray results. Compared with the PCPA group, transcription levels of Egr 1, Btg2 and BDNF in the PCPA+MWA group were up-regulated (P<0.05).

CONCLUSION

In combination, the findings of this study suggests that MWA is efficacious at improving sleep in an experimental rat model of insomnia.

Effectiveness of Chinese herbal medicine for patients with primary insomnia: A PRISMA-compliant meta-analysis

BACKGROUND

Traditional medicine is widely used for patients with primary insomnia, but the studies showed inconsistent results. We performed a meta-analysis of randomized controlled trials (RCTs) to evaluate the effectiveness of Chinese herbal medicine (CHM) versus placebo for primary insomnia patients.

METHODS

The electronic databases including PubMed, EmBase, Cochrane library, and China National Knowledge Infrastructure were searched to identify the RCTs published from inception till July 2018. The summary weighted mean difference (WMD) with its 95% confidence interval (CI) for Pittsburgh sleep quality index (PSQI), sleep onset latency, total sleep duration, Athens insomnia scale (AIS), and sleep efficiency were calculated using random-effects model.

RESULTS

Fifteen RCTs comprising 1500 patients were finally included in the meta-analysis. Overall, patients who received CHM had lower levels of PSQI (WMD: -2.36; 95% CI: -4.02 to -0.70; P = .005), sleep onset latency (WMD: -11.54; 95% CI: -20.55 to -2.54; P = .012), and AIS (WMD: -0.59; 95% CI: -0.97 to -0.22; P = .002) as compared with placebo. Moreover, the summary WMDs of CHM versus placebo were associated with higher total sleep duration (WMD: 0.79; 95% CI: 0.56-1.02; P < .001), and sleep efficiency (WMD: 9.72; 95% CI: 6.49-12.96; P < .001). The treatment effect on PSQI might be affected by publication year, sample size, mean age, percentage male, diagnostic tool, duration of insomnia, treatment duration, and study quality.

CONCLUSION

The findings of this meta-analysis indicated that CHM could significantly improve the symptoms of insomnia than placebo for patients with primary insomnia.

Effectiveness of integrative medicine program for dementia prevention on cognitive function and depression of elderly in a public health center

Background

This study investigated the effectiveness of an integrative medicine program (IMP) for dementia prevention on cognitive function, depression and quality of life (QOL) of elderly in a public health center.

Methods

This study employed a before-after study design to assess effectiveness of the IMP for dementia prevention for community dwelling elderly over 60 without diagnosis of dementia. Cognitive function was measured using the Mini Mental State Examination for Dementia screening (MMSE-DS), digit span test (DST) and trail making test (TMT). The Geriatric Depression Scale Short Form- Korean version (GDSSF-K) and EQ-5D were used to evaluate depression and health-related quality of life. The IMP composed of acupuncture, moxibustion, physical activities, meditation, laughter therapy and music therapy was held once a week over 8 weeks. A paired t-test was used to compare the pre and post-test results.

Results

After screening 93 people, a total of 48 were included in the analysis. Evaluation of the cognitive function revealed that TMT-A (p = 0.028) and TMT-B (p = 0.0013) were significantly reduced, but MMSE-DS (p = 0.309) and DST (DSF: p = 0.855, DSB: p = 0.176) were not statistically significant. Depression (p < 0.01) and preventive behavior for dementia (p < 0.0001) of the participants were improved after the IMP.

Conclusion

The IMP for dementia prevention may have beneficial effects on cognitive function and depression of elderly. However, a well-designed follow-up study is needed to confirm this conclusion.

Effect of Thunder-Fire Moxibustion on Pain, Quality of Life, and Tension of Multifidus in Patients with Primary Osteoporosis: A Randomized Controlled Trial

Background

Primary osteoporosis is a common disease among postmenopausal women and the elderly; low back pain is the most typical clinical manifestation an is the primary reason for a clinic visit, and directly affects patients’ quality of life. Anti-osteoporosis medications have undesirable side effects, and many kinds of special traditional Chinese moxibustion methods have been widely used in the clinical treatment of osteoporosis low back pain. The purpose of this study was to observe whether thunder-fire moxibustion therapy, compared to calcium supplements alone, can ease osteoporosis low back pain, improve quality of life, and reduce tension of the multifidus.

Material/Methods

Sixty-three eligible patients were enrolled in the study (7 of these patients did not finish the study and are not included in analysis). Participants were randomly divided into 2 groups: a moxibustion group that received calcium carbonate D3 and thunder-fire moxibustion therapy, and a control group that received calcium carbonate D3 only. Level of pain experienced, assessed using the visual analogue scale (VAS), and quality of life (SF-36) were measured pre-treatment, at the end of 4 weeks of treatment, and at a 1-month post-treatment evaluation. Changes in values of Young’s modulus of the multifidus were also collected before and after treatment.

Results

After 4 weeks of treatment and at 1 month after treatment had ended, low back pain in both groups was reduced relative to pre-treatment levels. The moxibustion group was significantly improved at BP, GH, SF, and MH dimensions compared to pre-treatment levels. The control group improved in BP dimensions, but not to the same extent as the moxibustion group. Similarly, after treatment for 4 weeks with moxibustion, multifidus tension was significantly reduced.

Conclusions

Thunder-fire moxibustion is an effective method for treating low back pain due to primary osteoporosis.

Wendan decoction for primary insomnia: Protocol for a systematic review and meta-analysis

BACKGROUND

Insomnia is a widespread complaint in the general population. Wendan decoction has been widely applied in the treatment of primary insomnia. However, to our knowledge, there has been no systematic review or meta-analysis of randomized controlled trails regarding the effectiveness of this treatment. Here, we provide a protocol to evaluate the efficacy and safety of Wendan decoction for primary insomnia.

METHODS AND ANALYSIS

Relevant randomized controlled trials in 5 English databases [EMBASE, the Cochrane Central Register of Controlled Trials (Cochrane Library), PubMed, the Allied and Complementary Medicine Databases (AMED), and the Cumulative Index to Nursing and Allied Health Literature (CINAHL)], 4 Chinese databases [Chinese Biomedical Literature Database (CBM), Chinese Medical Current Content (CMCC), China National Knowledge Infrastructure (CNKI), and Wanfang Database] will be comprehensively searched by 2 researchers in October 2017. The therapeutic effects according to the Pittsburgh Sleep Quality Index (PSQI) will be accepted as the primary outcomes. We will use RevMan V.5.3 software as well to compute the data synthesis carefully when a metaanalysis is allowed.

RESULTS

This study will provide a high-quality synthesis of current evidence of Wendan decoction for primary insomnia from several aspects including PSQI, the total scores of the Insomnia Severity Index (ISI), syndrome according to standards for assessing Traditional Chinese medicine and adverse events.

CONCLUSION

The conclusion of our systematic review will provide evidence to judge whether Wendan decoction is an effective intervention for patient with primary insomnia.

ETHICS AND DISSEMINATION

The outcomes of this systematic review will offer implications of the use of Wendan decoction treatment for primary insomnia patients. This knowledge informing recommendations will be provided by researchers who are interested in the treatment of primary insomnia. The results of this study will be disseminated through presentation at a conference and publication of the data in a peer-reviewed journal.

PROSPERO REGISTRATION NUMBER

PROSPERO CRD 42017065664.

Effectiveness and safety of moxibustion treatment for non-specific lower back pain: protocol for a systematic review

INTRODUCTION

Many patients experience acute lower back pain that becomes chronic pain. The proportion of patients using complementary and alternative medicine to treat lower back is increasing. Even though several moxibustion clinical trials for lower back pain have been conducted, the effectiveness and safety of moxibustion intervention is controversial. The purpose of this study protocol for a systematic review is to evaluate the effectiveness and safety of moxibustion treatment for non-specific lower back pain patients.

METHODS AND ANALYSIS

We will conduct an electronic search of several databases from their inception to May 2017, including Embase, PubMed, Cochrane Central Register of Controlled Trial, Allied and Complementary Medicine Database, Wanfang Database, Chongqing VIP Chinese Science and Technology Periodical Database, China National Knowledge Infrastructure Database, Korean Medical Database, Korean Studies Information Service System, National Discovery for Science Leaders, Oriental Medicine Advanced Searching Integrated System, the Korea Institute of Science and Technology, and KoreaMed. Randomised controlled trials investigating any type of moxibustion treatment will be included. The primary outcome will be pain intensity and functional status/disability due to lower back pain. The secondary outcome will be a global measurement of recovery or improvement, work-related outcomes, radiographic improvement of structure, quality of life, and adverse events (presence or absence). Risk ratio or mean differences with a 95% confidence interval will be used to show the effect of moxibustion therapy when it is possible to conduct a meta-analysis.

ETHICS AND DISSEMINATION

This review will be published in a peer-reviewed journal and will be presented at an international academic conference for dissemination. Our results will provide current evidence of the effectiveness and safety of moxibustion treatment in non-specific lower back pain patients, and thus will be beneficial to patients, practitioners, and policymakers.

TRIAL REGISTRATION NUMBER

CRD42016047468 in PROSPERO 2016.

Moxibustion treatment for primary osteoporosis: A systematic review of randomized controlled trials

Primary osteoporosis (POP) has a serious impact on quality of life for middle-aged and elderly, which particularly increase the risk of fracture. We conducted the systematic review to evaluate the effects of moxibustion for POP in randomized controlled trials (RCTs).Eight databases were searched from their inception to July 30, 2016. The RCTs reporting the moxibustion as a monotherapy or in combination with conventional therapy for POP were enrolled. The outcomes might be fracture incidence, quality of life, clinical symptoms, death attributed to osteoporosis, adverse effect, bone mineral density (BMD), and biochemical indicators. Literature selection, data abstraction, quality evaluation, and data analysis were in accordance with Cochrane standards.Thirteen trials including 808 patients were included. Meta-analysis was not conducted because of the obvious clinical or statistical heterogeneity. Limited evidence suggested that moxibustion plus anti-osteoporosis medicine might be more effective in relieving the pain (visual analogue scale scores average changed 2 scores between groups, 4 trials), increasing the BMD of femoral neck (average changed 0.4 g/cm2 between groups, 3 trials), and improving the level of bone gla protein, osteoprotegerin and bone alkaline phosphatase (2 trials) compared with anti-osteoporosis medicine alone. However, the quality of previous studies was evaluated as generally poor. The safety evidence of moxibustion was still insufficient. Due to the paucity of high-quality studies, there was no definite conclusion about the efficacy and safety of moxibustion treating POP although parts of positive results were presented. Future research should pay attention to the dose-response relation and fracture incidence of moxibustion for POP.