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Ye Z, Lai H, Ning J, Liu J, Huang J, Yang S, Jin J, Liu Y, Liu J, Zhao H, Ge L. Traditional Chinese medicine for insomnia: Recommendation mapping of the global clinical guidelines. JOURNAL OF ETHNOPHARMACOLOGY 2024; 322:117601. [PMID: 38122913 DOI: 10.1016/j.jep.2023.117601] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/21/2023] [Revised: 11/07/2023] [Accepted: 12/13/2023] [Indexed: 12/23/2023]
Abstract
ETHNOPHARMACOLOGICAL RELEVANCE Traditional Chinese Medicine (TCM) represents a rich repository of empirically-developed traditional medicines. The findings call for more rigorous study into the efficacy, safety, and mechanisms of action of TCM remedies to strengthen the evidence base. AIM OF THE STUDY To systematically review the quality of insomnia clinical practice guidelines that involve TCM recommendations and to summarize the certainty of evidence supporting the recommendations, strength, and consistency of recommendations, providing valuable research references for the development of future insomnia guidelines. MATERIALS AND METHODS We systematically searched PubMed, Web of Science, Embase, CNKI, Wanfang, Chinese Biomedical Literature Database, Chinese Medical Association, Chinese Sleep Research Society, Medsci, Medlive, British National Institute of Health and Clinical Excellence (NICE), and the International Guidelines Collaboration Network (GIN) for clinical practice guidelines on insomnia from inception to March 5, 2023. Four evaluators conducted independent assessments of the quality of the guidelines by employing the AGREE II tool. Subsequently, the guideline recommendations were consolidated and presented as evidence maps. RESULTS Thirteen clinical practice guidelines addressing insomnia, encompassing 211 recommendations (consisting of 127 evidence-based and 84 expert consensus recommendations), were deemed eligible for inclusion in our analysis. The evaluation results revealed an overall suboptimal quality, with the "scope and purpose" domain achieving the highest score (58.1%), while the "applicability" domain garnered the lowest score (13.0%). Specifically, it was observed that 74.8% (n = 95) of the evidence-based recommendations were supported by evidence of either very low or low certainty, in contrast to the expert consensus recommendations, which accounted for 61.9% (n = 52). We subsequently synthesized 44 recommendations into four evidence maps, focusing on proprietary Chinese medicines, Chinese medicine prescriptions, acupuncture, and massage, respectively. Notably, Chinese herbal remedies and acupuncture exhibited robust support, substantiated by high-certainty evidence, exemplified by interventions such as Xuefu Zhuyu decoction, spleen decoction, body acupuncture, and ear acupuncture, resulting in solid recommendations. Conversely, proprietary Chinese medicines needed more high-certainty evidence, predominantly yielding weak recommendations. As for other therapies, the level of certainty was predominantly categorized as low or very low. Recommendations about magnetic therapy, bathing, and fumigation relied primarily on expert consensus, needing more substantive clinical research evidence, consequently forming weak recommendations. Hot ironing and acupoint injection recommendations were weakly endorsed, primarily based on observational studies. Furthermore, interventions like qigong, gua sha, and moxibustion displayed a relatively limited number of clinical studies, necessitating further exploration to ascertain their efficacy. CONCLUSIONS Our analysis revealed a need for substantial improvement in the quality of all the included guidelines related to insomnia. Notably, recommendations for Traditional Chinese Medicine (TCM) treatments predominantly rely on low-certainty evidence. This study represents a pioneering effort in the utilization of recommendation mapping to both present and identify existing gaps in the evidence landscape within TCM therapies, thus setting the stage for future research initiatives. The evidence supporting TCM therapy recommendations must be fortified to achieve a more substantial level of recommendation and higher certainty. Consequently, there exists a critical and pressing demand for high-quality clinical investigations dedicated to TCM, with a specific focus on ascertaining its long-term efficacy, safety, and potential side effects in the context of insomnia treatment. These endeavors are poised to establish a robust scientific foundation to inform the development of TCM therapy recommendations within the insomnia guidelines.
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Affiliation(s)
- Ziying Ye
- Evidence-Based Social Science Research Center, School of Public Health, Lanzhou University, Lanzhou, China; Department of Social Medicine and Health Management, School of Public Health, Lanzhou University, Lanzhou, China
| | - Honghao Lai
- Evidence-Based Social Science Research Center, School of Public Health, Lanzhou University, Lanzhou, China; Department of Social Medicine and Health Management, School of Public Health, Lanzhou University, Lanzhou, China
| | - Jinling Ning
- Evidence-Based Social Science Research Center, School of Public Health, Lanzhou University, Lanzhou, China; Department of Social Medicine and Health Management, School of Public Health, Lanzhou University, Lanzhou, China
| | - Jianing Liu
- School of Nursing, Gansu University of Chinese Medicine, Lanzhou, China
| | - Jiajie Huang
- School of Nursing, Gansu University of Chinese Medicine, Lanzhou, China
| | - Sihong Yang
- Institute of Basic Research of Clinical Medicine, China Academy of Chinese Medical Sciences, Beijing, China; China Center for Evidence Based Traditional Chinese Medicine, Beijing, China
| | - Jiayue Jin
- Guang'anmen Hospital, China Academy of Chinese Medical Sciences, Beijing, China; Beijing University of Chinese Medicine, Beijing, China
| | - Yajie Liu
- Guang'anmen Hospital, China Academy of Chinese Medical Sciences, Beijing, China
| | - Jie Liu
- Guang'anmen Hospital, China Academy of Chinese Medical Sciences, Beijing, China
| | - Hui Zhao
- Institute of Basic Research of Clinical Medicine, China Academy of Chinese Medical Sciences, Beijing, China; China Center for Evidence Based Traditional Chinese Medicine, Beijing, China.
| | - Long Ge
- Evidence-Based Social Science Research Center, School of Public Health, Lanzhou University, Lanzhou, China; Department of Social Medicine and Health Management, School of Public Health, Lanzhou University, Lanzhou, China; Key Laboratory of Evidence Based Medicine and Knowledge Translation of Gansu Province, Lanzhou, China; World Health Organization Collaborating Centre for Guideline Implementation and Knowledge Translation, Lanzhou, China.
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Meng X, Sun J, Liu Q, Huang Y, Qiu X, Seto DJ, Li Y, Wang L, Li C, Gao S, Yu H, Zhao J, Zhao B. Efficacy and Safety of a Novel Plum Blossom Needling with Mild Moxibustion Device for Upper Limb Pain Disorder and Motor Dysfunction in Patients with Stage 1 Post-Stroke Shoulder-Hand Syndrome: Study Protocol for a Multi-Center, Single-Blind, Randomized Sham-Controlled Trial. J Pain Res 2023; 16:407-420. [PMID: 36817867 PMCID: PMC9936879 DOI: 10.2147/jpr.s396195] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/04/2022] [Accepted: 01/19/2023] [Indexed: 02/15/2023] Open
Abstract
Background Post-stroke shoulder-hand syndrome (PS-SHS), a common neurological comorbidity after stroke episodes, poses a grave threat on patients' functional recovery. Preliminary trials have demonstrated that the acupuncture and moxibustion treatment, including a dermal acupuncture tapping method known as plum blossom needling (PBN) can improve pain and motor dysfunctions in patients with PS-SHS. However, there are few reports describing simultaneous moxibustion treatment in combination with PBN. Hence, a novel plum blossom needle device with mild moxibustion (PBNMM) was developed to evaluate its potential efficacy and safety in patients with stage 1 PS-SHS. Materials and Methods This multicenter, sham-controlled, randomized controlled trial (RCT) will recruit 102 eligible patients with stage 1 PS-SHS from three clinical centers, randomly allocated in a ratio of 1:1:1 to the PBNMM group, PBNMM with no moxa smoke (PBNMM-NMS) group and sham control group. Patients in each group will receive a 30-minute treatment once per day for 4 weeks, with 5 consecutive sessions per week, for a total of 20 sessions. The primary outcome measure will be defined as the decreased scores from baseline in the visual analog scale (VAS) assessment at week 4. Secondary outcome measures will include scores on the Fugl-Meyer Assessment of the Upper Extremity Scale (FMA-UE), the Modified Barthel Index (MBI), and the somatosensory evoked potential (SEP) records. All outcomes will be evaluated at baseline and weeks 4, 5, 6 and 10, and the intention-to-treat analysis will be applied. Conclusion This study aims to provide robust evidence for the efficacy and safety of the PBNMM for PS-SHS treatment, as well as the specific impact of moxibustion smoke itself in dealing with PS-SHS. Clinical Trial Registration Chinese Clinical Trial Registry No. ChiCTR2200062441. Registered on 7 August 2022.
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Affiliation(s)
- Xiaonan Meng
- Department of Acupuncture and Moxibustion, Dongzhimen Hospital, Beijing University of Chinese Medicine, Beijing, People’s Republic of China,Department of Acupuncture and Moxibustion, Beijing Huguosi TCM Hospital, Affiliated with Beijing University of Chinese Medicine, Beijing, People’s Republic of China
| | - Jie Sun
- Department of Integrated Chinese and Western Medicine Rehabilitation, Beijing Xiaotangshan Hospital, Beijing, People’s Republic of China
| | - Qi Liu
- Department of General Internal Medicine, Guang’anmen Hospital, China Academy of Chinese Medical Sciences, Beijing, People’s Republic of China
| | - Yueping Huang
- School of Acupuncture-Moxibustion and Tuina, Beijing University of Chinese Medicine, Beijing, People’s Republic of China
| | - Xianwen Qiu
- Department of Acupuncture and Moxibustion, Beijing Shichahai Community Healthcare Center, Beijing, People’s Republic of China
| | - David Jung Seto
- Division of Integrative Medicine, Department of Medicine, Veterans Affairs Greater Los Angeles Healthcare System, Los Angeles, CA, USA,Department of Medicine, David Geffen School of Medicine, University of California, Los Angeles, CA, USA
| | - Ying Li
- Department of Integrated Chinese and Western Medicine Rehabilitation, Beijing Xiaotangshan Hospital, Beijing, People’s Republic of China
| | - Liping Wang
- Department of Acupuncture and Moxibustion, Beijing Huguosi TCM Hospital, Affiliated with Beijing University of Chinese Medicine, Beijing, People’s Republic of China
| | - Chunying Li
- Department of Acupuncture and Moxibustion, Beijing Huguosi TCM Hospital, Affiliated with Beijing University of Chinese Medicine, Beijing, People’s Republic of China
| | - Sen Gao
- Department of Rehabilitation, Beijing Huguosi TCM Hospital, affiliated with Beijing University of Chinese Medicine, Beijing, People’s Republic of China
| | - Haikuo Yu
- Rehabilitation Department, Xuanwu Hospital Capital Medical University, Beijing, People’s Republic of China
| | - Jiping Zhao
- Department of Acupuncture and Moxibustion, Dongzhimen Hospital, Beijing University of Chinese Medicine, Beijing, People’s Republic of China,Correspondence: Jiping Zhao; Baixiao Zhao, Email ;
| | - Baixiao Zhao
- Department of Acupuncture and Moxibustion, Dongzhimen Hospital, Beijing University of Chinese Medicine, Beijing, People’s Republic of China
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He L, Chen X, Zhang Y. Clinical Effect of Hufu Copper Scraping on Shoulder-Hand Syndrome after Stroke. Emerg Med Int 2022; 2022:9165141. [PMID: 36059563 PMCID: PMC9436584 DOI: 10.1155/2022/9165141] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/03/2022] [Accepted: 07/14/2022] [Indexed: 11/25/2022] Open
Abstract
Objective To explore the clinical effect of Hufu copper scraping on shoulder-hand syndrome after stroke. Methods A total of 60 patients with shoulder-hand syndrome after stroke admitted to the First Affiliated Hospital of Hunan University of Traditional Chinese Medicine were enrolled between January 2020 and June 2021. According to the random number table method, they were divided into the control group (n = 30) and the intervention group (n = 30). The control group was given routine rehabilitation intervention, while the intervention group was additionally given Hufu copper scraping. The intervention effect, occurrence of adverse reactions during the intervention, pain, swelling degree of affected hands, serum calcitonin gene-related peptide (CGRP), substance P (SP), and Barthel index before and after 2 months of intervention were compared between the two groups. Results After intervention, the total response rate of the intervention group was significantly higher than that of the control group (96.67% vs 80.00%) (P < 0.05). After intervention, the score of the visual analogue scale (VAS) and water displacement in the intervention group were lower than those in the control group (P < 0.05). After intervention, levels of CGRP and SP in the intervention group were lower than those in the control group, while the Barthel index was higher compared to the control group (P < 0.05). Conclusion The intervention effect of Hufu copper scraping is good, which can promote the recovery of related symptoms, relieve pain and swelling of affected hands, downregulate levels of disease-promoting markers, and accelerate recovery of related function in patients with shoulder-hand syndrome after stroke.
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Affiliation(s)
- Lianyi He
- Department of Cadre Health Care, The First Hospital of Hunan University of Chinese Medicine, Changsha, Hunan 410007, China
| | - Xinyu Chen
- Department of Cardiovascular Medicine, The First Hospital of Hunan University of Chinese Medicine, Changsha, Hunan 410007, China
| | - Yuejuan Zhang
- Hospital of Hunan University of Chinese Medicine, Changsha, Hunan 410007, China
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