Effect of tuina on sleep quality, psychological state and neurotransmitter level in patients with insomnia: a systematic review and meta-analysis

Background

Abnormal psychological state and neurotransmitter levels are important factors affecting sleep quality. Numerous studies have shown that tuina can improve the symptoms of sleep disorders in patients with insomnia while relieving anxiety and depression and regulating neurotransmitter levels. However, there have been no meta-analyses on the effect of tuina on psychological states and neurotransmitter levels.

Objectives

A meta-analysis was performed to systematically evaluate the effects of massage on sleep quality, psychological state, and neurotransmitter levels in patients with insomnia.

Methods

A comprehensive literature search was conducted from inception to July 2023 using eight electronic databases to identify randomized controlled trials (RCTs) on tuina therapy for insomnia. Gray literature was also searched. The methodological quality of the included studies was assessed using the Cochrane Handbook. Reviewer Manager 5.4 and Stata 16.0 were employed for statistical analysis.

Results

A total of 23 studies were included, including 1780 patients with insomnia, of whom 892 and 888 were in the experimental and control groups, respectively. Meta-analysis indicated that tuina therapy was superior to other therapies for the treatment of insomnia in increasing the total effective rate [OR = 4.12, 95%CI (2.80, 6.06), p < 0.00001] and 5-hydroxytryptamine (5-HT) level [MD = 16.03, 95% CI (13.40, 18.65), p < 0.00001], while reducing the Pittsburgh Sleep Quality Index score [MD = -2.34, 95% CI (-2.94, -1.74), p < 0.00001], Athens Insomnia Scale score [MD = -2.10, 95% CI (-2.67, -1.52), p < 0.00001], self-rating anxiety scale score [MD = -6.77, 95% CI (-8.34, -5.20), p < 0.00001] and self-rating depression scale score [MD = -6.60, 95% CI (-8.82, -4.37), p < 0.00001]. Subgroup analysis showed that tuina alone or in combination with other therapies was superior to drugs or acupuncture alone in improving all outcomes (p < 0.05). Only two studies reported minor adverse events.

Conclusion

Tuina for insomnia has certain therapeutic advantages and can significantly improve sleep quality, relieve anxiety-depressive states, and increase 5-HT levels with high safety. Due to the limitations of the quality of the included studies, additional high-quality clinical trials are required for further verification.

Systematic review registration

https://www.crd.york.ac.uk/PROSPERO/display_record.php?RecordID=447839, identifier CRD42023447839.

Effect of Traditional Chinese Non-Pharmacological Therapies on Knee Osteoarthritis: A Narrative Review of Clinical Application and Mechanism

Knee osteoarthritis (KOA) stands as a degenerative ailment with a substantial and escalating prevalence. The practice of traditional Chinese non-pharmacological therapy has become a prevalent complementary and adjunctive approach. A mounting body of evidence suggests its efficacy in addressing KOA. Recent investigations have delved into its underlying mechanism, yielding some headway. Consequently, this comprehensive analysis seeks to encapsulate the clinical application and molecular mechanism of traditional Chinese non-pharmacological therapy in KOA treatment. The review reveals that various therapies, such as acupuncture, electroacupuncture, warm needle acupuncture, tuina, and acupotomy, primarily target localized knee components like cartilage, subchondral bone, and synovium. Moreover, their impact extends to the central nervous system and intestinal flora. More perfect experimental design and more comprehensive research remain a promising avenue in the future.

Exploring the Mechanism of Immediate Analgesia Induced by Tuina Intervention on Minor Chronic Constriction Injury in Rats Using LC-MS

Purpose

This study aimed to investigate changes in metabolomic expression in the spinal dorsal horn (SDH) and thalamus during a Tuina session, aiming to elucidate the mechanism of immediate analgesia.

Methods

The rats were randomly divided into three groups: the Sham group, the Model group, and the Tuina group. A minor chronic constriction injury (minor CCI) model was established in both the Model group and the Tuina group. The therapeutic effect of Tuina was determined using the mechanical withdrawal threshold (MWT) and thermal withdrawal latency (TWL) tests. Differential metabolites of the SDH and thalamus were detected using liquid chromatography-tandem mass spectrometry (LC-MS/MS). Bioinformatic analysis was performed using CV, PCA, Venn, and KEGG.

Results

The therapeutic effect of MWT and TWL after instant Tuina intervention was significant. The therapeutic effect of Tuina instant was significantly better compared to the Model group. In the Veen analysis, it was found that Tuina instantly regulates 10 differential metabolites in the SDH and 5 differential metabolites in the thalamus. In the KEGG enrichment analysis, we found that differential metabolites were enriched in 43 pathways in the thalamus and 70 pathways in the SDH.

Conclusion

Tuina therapy may have analgesic effects by metabolizing neurotransmitters such as 2-Picolinic Acid, 5-Hydroxy-Tryptophan Glutathione Betaine-aldehyde-chloride Leucine Lysine Methionine Sarcosine Succinic Acid Histidine Acetylcholine and 5-Hydroxyindoleacetic Acid through the cAMP pathway. It also affects pathways of neurodegeneration-multiple diseases, butanoate metabolism, tyrosine metabolism.

Effect of acupuncture at neck-Jiaji (EX-B 2) and tuina on the cognitive function in the patients with subjective cognitive decline

OBJECTIVES

To observe the effects on cognitive function, sleep quality and hemodynamics in the patients with subjective cognitive decline (SCD) after treated with acupuncture at neck-Jiaji (EX-B 2) and tuina on the base of healthy lifestyle education and meta-memory training.

METHODS

Sixty SCD patients were randomly divided into an observation group (30 cases, 1 case dropped out) and a control group (30 cases, 3 cases dropped out). In the control group, the healthy lifestyle education and meta-memory training was performed, twice daily, 15 min each time; the 5-day intervention was delivered a week, lasting consecutively 4 weeks. On the base of the intervention as the control group, in the observation group, acupuncture at neck-Jiaji (EX-B 2) and tuina was conducted. First, one-finger pushing and plucking method of tuina was exerted on the neck region along the running courses of the bladder meridian of foot-taiyang and the governor vessel, for 10 min to 15 min; afterwards, acupuncture was delivered at bilateral neck-Jiaji (EX-B 2), from C1 to C7; and the needles were retained for 30 min. This intervention was given once daily, 5 times a week, for consecutive 4 weeks. Before and after treatment, the score of the mini-mental state examination (MMSE), the score of full scale memory quotient (FSMQ) were assessed by Wechsler memory scale-fourth edition (WMS-Ⅳ) and the score of the Pittsburgh sleep quality index (PSQI) was compared between the two groups. Using transcranial Doppler ultrasound, the hemodynamic indexes (the mean velocity [Vm] and pulsatility index [PI] of the left vertebral artery [LVA], the right vertebral artery [RVA] and the basilar artery [BA]) were determined in the two groups.

RESULTS

After treatment, the scores of MMSE and FSMQ increased compared with those before treatment in the two groups (P<0.05, P<0.001), PSQI score was lower (P<0.05) and Vm of BA was higher (P<0.001) in the observation group when compared with those before treatment. The scores of MMSE and FSMQ, as well as Vm of BA were higher (P<0.05, P<0.001), and PSQI score was decreased (P<0.05) in the observation group when compared with the control group.

CONCLUSIONS

The combined therapy of acupuncture at neck-Jiaji (EX-B 2) and tuina is more advantageous to improving cognitive function, relieving chronic emotional stress and ameliorating sleeping quality in the patients with subjective cognitive decline, which may be achieved by improving the blood supply of the basilar artery.

Short-term and long-term effectiveness of acupuncture and Tuina on knee osteoarthritis: study protocol for a randomized controlled trial

Background

The effectiveness of acupuncture and tuina in treating knee osteoarthritis (KOA) is still controversial, which limits their clinical application in practice. This study aims to evaluate the short-term and long-term effectiveness of acupuncture and tuina on KOA.

Methods/design

This parallel-group, multicenter randomized clinical trial (RCT) will be conducted at the outpatient clinic of five traditional Chinese medicine hospitals in China. Three hundred and thirty participants with KOA will be randomly assigned to acupuncture, tuina, or home-based exercise group with a ratio of 1:1:1. The primary outcome is the proportion of participants achieving a minimal clinically important improvement defined as a ≥ 12% reduction on the Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC) pain dimension on short term (week 8) and long term (week 26) compared with baseline. Secondary outcomes are knee joint conditions (pain, function, and stiffness), self-efficacy of arthritis, quality of life, and psychological conditions, which will be evaluated by the WOMAC score and the Patient Global Assessment (PGA), and in addition, the respondents index of OMERACT-OARSI, Short Form 12 Health Survey (SF-12), arthritis self-efficacy scale, and European five-dimensional health scale (EQ-5D). Adverse events will be collected by self-reported questionnaires predefined.

Clinical trial registration

https://www.chictr.org.cn.

Acupuncture combined with Tuina in the treatment of cervical longus tendinitis: A case report

INTRODUCTION

Cervical longus tendonitis is a type of disease with neck pain as the main clinical manifestation. Because the front of the cervical longus muscle is adjacent to the esophagus and pharynx, this disease is often accompanied by pharyngeal pain and pain when swallowing. Clinical and imaging doctors often have an incomplete understanding of it, and this disease is often confused with other diseases that cause neck pain.

PATIENT CONCERNS

A 33-year-old Chinese woman was the patient. Suffering from severe neck pain and significantly limited activity, accompanied by left shoulder pain, occasionally dizziness, headache and other symptoms, the pain is significantly aggravated when doing swallowing action.

DIAGNOSIS

Tendonitis of the long neck muscle.

INTERVENTIONS

Given the patient's condition, we used acupuncture combined with massage therapy as a symptomatic treatment.

OUTCOMES

After 10 days of treatment, the symptoms were better than before, and no pain was seen in the swallowing movements such as drinking water (Fig. 2C and D).

LESSONS

Because the clinical reports of diseases are rare, the treatment methods are limited, and acupuncture combined with massage is an effective method for the treatment of tendonitis of the cervical long muscle, to dredge the meridians, promoting blood circulation, removing blood stasis and relieving pain.

Tuina therapy promotes behavioral improvement and brain plasticity in rats with peripheral nerve injury and repair

INTRODUCTION

Tuina is currently one of the popular complementary and alternative methods of rehabilitation therapy. Tuina can improve patients' pain and mobility function. However, the underlying physiological mechanism remains largely unknown, which might limit its further popularization in clinical practice. The aim of this study is to explore the short-term and long-term changes in brain functional activity following Tuina intervention for peripheral nerve injury repair.

METHODS

A total of 16 rats were equally divided into the intervention group and the control group. Rats in the intervention group received Tuina therapy applying on the gastrocnemius muscle of the right side for 4 months following sciatic nerve transection and immediate repair, while the control group received nerve transection and repair only. The block-design functional magnetic resonance imaging scan was applied in both groups at 1 and 4 months after the surgery. During the scan, both the injured and intact hindpaw was electrically stimulated according to a "boxcar" paradigm.

RESULTS

When stimulating the intact hindpaw, the intervention group exhibited significantly lower activation in the somatosensory area, limbic/paralimbic areas, pain-regulation areas, and basal ganglia compared to the control group, with only the prefrontal area showing higher activation. After 4 months of sciatic nerve injury, the control group exhibited decreased motor cortex activity compared to the activity observed at 1 month, and the intervention group demonstrated stronger bilateral motor cortex activity compared to the control group.

CONCLUSION

Tuina therapy on the gastrocnemius muscle of rats with sciatic nerve injury can effectively alleviate pain and maintain the motor function of the affected limb. In addition, Tuina therapy reduced the activation level of pain-related brain regions and inhibited the decreased activity of the motor cortex caused by nerve injury, reflecting the impact of peripheral stimulation on brain plasticity.

Current Status of Research on Tuina for Analgesia: A Bibliometric and Visual Analysis

Purpose

Tuina is a nonpharmacological modality for pain relief that has found applications in the treatment of several pain disorders. Tuina analgesia has been increasingly studied; however, few studies have focused on the previous publication trends, prevalent research areas, collaborations, and other factors. This study aimed to systematically analyze research trends and hot topics in the field of tuina analgesia over the past 30 years, using bibliometric analysis, to inform future research.

Methods

The web of science database was searched for literature on tuina analgesia from 1992-2023. VOSviewer and CiteSpace were used to analyze annual publication volumes, countries, institutions, journals and CO-cited journals, authorship, articles, and keywords and their relevance, and to perform co-occurrence and clustering analyses.

Results

A total of 621 literature elements were included in the analysis. The annual volume of publications has increased steadily in recent years. The top three high-yielding countries were the United States, China, and Canada, respectively. The top three institutional outputs were from Shanghai University of Chinese medicine, Beijing University of Chinese medicine, and McMaster University, respectively. Notably, there was an imbalance between national outputs and centrality, with higher centrality in the United States (0.35) and lower in China (0.01). Cochrane Database of Systematic Reviews was the journal with the most publications (22), and PAIN was the most influential co-cited journals (publications=306). Moreover, current research in this field was dominated by studies on Tuina for relieving postoperative pain, the effectiveness of Tuina analgesia, and Tuina treatment for pain accompanied by anxiety.

Conclusion

This study employed bibliometrics to analyze the literature on Tuina for pain treatment over a 30-year period, identifying potential collaborators, institutions, hot topics, and future research trends that will inform potential future directions.

The effect of Tuina based on the concept of hip-knee-ankle conjugation in patients with chronic ankle instability: study protocol for a randomized controlled trial

Background

Chronic ankle instability (CAI) is a common sports injury disease and characterized by limited mobility, perceived instability and muscle weakness, combined treatment of hip-knee-ankle is a common rehabilitation method. Tuina, as a traditional Chinese manual therapy, is usually used for CAI, but many of them only focus on the local ankle joint rather than the combination of hip and knee joint. Therefore, we have designed a randomized controlled trial (RCT) to investigate the effects of Tuina base on the concept of hip-knee-ankle conjugation on the stability and balance of lower limbs and ankle function in patients with CAI.

Methods

We have designed a randomized controlled trial. A total of 72 participants with CAI will be randomly divided into functional training groups and hip-knee-ankle Tuina combined with functional training group in a 1:1 ratio. Participants in control group will receive 8 sessions of functional training (30 min per session, twice a week for 4 weeks). Participants in intervention group will receive 8 sessions of Tuina combined with functional training (twice a week for 4 weeks). The primary outcomes include the Y-Balance Test (YBT) and Cumberland Ankle Instability Tool (CAIT). The Secondary outcomes include the Foot and Ankle Ability Measure (FAAM) and ankle range of motion (ROM). The outcome assessments will be conducted before the first intervention and after the last intervention.

Discussion

The aim of this study is to explore a safe and effective manipulation program and serve as reference for clinical treatment of CAI and expect to provide the necessary theoretical and practical support to our future research.

Clinical Trial Registration

Chinese Clinical Trail Registry ChiCTR2300068274.

Bibliometric Analysis of Research Trends on Tuina Manipulation for Neck Pain Treatment Over the Past 10 Years

Tuina is an effective treatment for neck pain (NP). However, there has been no bibliometric analysis of the global application and emerging trends of tuina performed for NP. Therefore, this study aimed to provide an overview of the current state and future trends in the field. Articles about tuina for NP, published from January 1, 2013, to January 1, 2023, were searched in the Web of Science Core Collection database. CiteSpace (6.1.R6) and VOSviewer (1.6.18) software were used to analyze annual trends in literature posts, countries, institutions, authors, cited references, and knowledge graphs of keyword co-occurrence, clustering, and burst using standard bibliometric indicators. The final analysis comprised 505 valid documents. The results demonstrate that the number of articles in the field of tuina therapy for NP has gradually increased over the years, showing the most active countries, institutions, journals, and authors. There were 323 keywords in the field, 322 research authors, and 292 research institutions, with the USA having the most publications (n = 140). The most published institution is Vrije University Amsterdam, and the most published journal is the Cochrane Database of Systematic Reviews. Peter R Blanpied is the most influential and most-cited author. Interventions (dry needling, massage therapy, and muscle energy techniques), common treatment sites for NP (upper trapezius), and complications (cervicogenic headache) are the top three frontiers mentioned in the field of tuina research for NP. The bibliometric study showed the current status and trends in clinical research on treating patients with NP using tuina, which may help researchers identify topics of interest and scope for future research in this field.

Combined Tui na and Western medicine treatment improves pulmonary function and quality of life in patients with amyotrophic lateral sclerosis: A case report

RATIONALE

Amyotrophic lateral sclerosis is a rare disease that cannot be cured. We report a case of a patient with amyotrophic lateral sclerosis whose pulmonary function and quality of life were improved by a combined tui na treatment and Western medicine.

PATIENT CONCERNS

A 48-year-old male was diagnosed with ALS 1 year ago and was treated with western medicine and herbal medicine with no significant effect. This time, he was admitted to our department because of slurred speech, coughing and choking, and weakness of the left upper limb for more than 1 year.

INTERVENTION AND OUTCOME

After 1 month of treatment with tui na and traditional western medicine, the patient's lung function and quality of life improved and he was discharged from the hospital.

DIAGNOSES

Motor neuron disease. Amyotrophic lateral sclerosis.

LESSONS

The physiological function of ALS patients can be improved through the intervention of tui na.

Clinical outcome measures reporting in randomized trials evaluating Tuina therapy for chronic nonspecific low back pain: A systematic review

BACKGROUND

Tuina has gained widespread attention and utilization for the management of chronic nonspecific low back pain (CNLBP). However, evidence-based guidance for choosing accurate and appropriate outcome measures of Tuina is lacking. The objective of this study is to systematically synthesize the existing outcome measures reported in randomized controlled trials (RCTs) evaluating Tuina therapy in CNLBP.

METHODS

Electronic literature searches were conducted in multiple English and Chinese databases from their inception to May 2022. RCTs were included if they involved clinical outcome measures in Tuina treatment for patients with CNLBP. Outcome instruments for each study were extracted and analyzed. Evidence from included studies were assessed using the Cochrane risk-of-bias tool.

RESULTS

Of the 735 identified articles, 17 articles with 1628 participants were included. Measurement domains in these RCTs were mainly reported in terms of pain (94%) and physical activity (71%), followed by safety (41%), Chinese medicine outcome (35%), and quality of life (12%). Moreover, several limitations with existing outcomes were reported, including lack of emphasis on the evaluation of quality of life, inadequate safety monitoring, as well as insufficient and vague Chinese medicine outcome measures. All trials were deemed to be of poor methodological quality.

CONCLUSION

Pain and physical disability were the most frequently studied outcome domains in CNLBP treated by Tuina therapy. More rigorous and high-quality trials with appropriately selected outcome measures are needed in the future.

Multiple traditional Chinese medicinal approaches in collaboration with conservative conventional medicine for lumbar herniated intervertebral discs: A systematic review and meta-analysis

BACKGROUND

This review aimed to verify the clinical effects of traditional Chinese medicine in collaboration with conservative conventional medicine for lumbar herniated intervertebral discs (LHIVD).

METHODS

The CENTRAL, EMBASE, MEDLINE/PubMed, JMAS, CNKI, and seven Korean databases were searched using pre-planned strategies. The risk of bias was assessed using the Cochrane Collaboration tool and a meta-analysis was conducted accordingly.

RESULTS

Twenty-eight randomized controlled trials (RCTs) were included in this systematic review and meta-analysis. All RCTs included 2746 participants. The experimental group showed more significant improvements in VAS (Mean differences (MD) -1.61, 95% Confidence Intervals (CI) [-2.44, -0.79]; I2 = 98%), Oswestry Disability Index (ODI) (MD -8.52, 95% CI [-11.71, -5.34]; I2 = 96%), and Japanese Orthopaedic Association (JOA) scores (MD 4.83, 95% CI [3.49, 6.17]; I2 = 85%) than the control group. However, the difference in the incidence of adverse events between the experimental and control groups was not significant (Relative Risk (RR) 0.05, 95% CI [0.23, 1.10]; I2 = 46%).

CONCLUSION

Traditional Chinese medicine in collaboration with conservative conventional medicine can be used to relieve pain and facilitate better function of the lumbar spine in lumbar herniated intervertebral disc cases. However, this conclusion should be applied with caution in clinical practice owing to the low quality of the included studies.

Efficacy and safety of Tuina for chronic nonspecific low back pain: A PRISMA-compliant systematic review and meta-analysis

OBJECTIVE

Chronic nonspecific low back pain (CNLBP) is a serious medical and social problem resulting in functional decline and decreased work ability. Tuina, a form of manual therapy, has been sparsely used to treat patients with CNLBP. To systematically assess the efficacy and safety of Tuina for patients with CNLBP.

METHODS

Multiple English and Chinese literature databases were searched until September 2022 for randomized controlled trials (RCTs) of Tuina in the treatment of CNLBP. The methodological quality was assessed using the Cochrane Collaboration's tool, and certainty of the evidence was determined with the online Grading of Recommendations, Assessment, Development and Evaluation tool.

RESULTS

Fifteen RCTs with 1390 patients were included. Tuina demonstrated a significant effect on pain (SMD: -0.82; 95% CI -1.12 to -0.53; P < .001; I2 = 81%) and physical function (SMD: -0.91; 95% CI -1.55 to -0.27; P = .005; I2 = 90%) when compared to control. However, Tuina resulted in no significant improvement for quality of life (QoL) (SMD: 0.58; 95% CI -0.04 to 1.21; P = .07; I2 = 73%;) compared to control. The Grading of Recommendations, Assessment, Development and Evaluation evidence quality was determined to be low level for pain relief, physical function, and QoL measurements. Only six studies reported adverse events; none were serious.

CONCLUSION

Tuina might be an effective and safe strategy for treating CNLBP in terms of pain and physical function, but not for QoL. The study results should be interpreted with caution for their low-level evidence. More multicenter, large-scale RCTs with a rigorous design are required to further confirm our findings.

A systematic review with meta-analysis: Traditional Chinese tuina therapy for insomnia

Background

With changes in the way of life and work, an increasing number of people are suffering from insomnia. In China, a traditional Chinese medicine method tuina is widely used for the treatment of insomnia. However, the evidence for tuina therapy for insomnia remains controversial. Therefore, this systematic review aimed to evaluate the effect of tuina therapy on the symptoms of patients with primary insomnia.

Methods

From establishment to January 2022, a comprehensive literature search was conducted using seven electronic databases to identify randomized controlled trials of tuina therapy for insomnia. We used RevMan 5.4 software and the GRADEpro Guideline Development Tool to evaluate the quality of the included randomized controlled trials and perform the meta-analysis. The methodological quality of the included studies was assessed using the Cochrane risk-of-bias tool. Subgroup analysis was performed according to the different intervention methods. The I2 statistic was used to assess the heterogeneity.

Results

Eighteen studies conducted from 2011 to 2021 were included, with a total of 1,471 patients. In terms of efficacy, tuina alone was superior to other treatments [odds ratio (OR), 3.46; 95% confidence interval (CI), 2.15, 5.55; P < 0.00001]; tuina combined with other treatments (acupuncture, scraping, auricular acupuncture, Suanzaoren decoction, estazolam) was more effective than other single therapies (OR, 3.99; 95% CI, 2.84, 5.61; P < 0.00001). In terms of Pittsburgh Sleep Quality Scale score, the improvement in insomnia patients by tuina alone was better than that of other treatments [standardized mean difference (SMD), -2.57; 95% CI, -2.98, -2.17; P < 0.00001], and tuina combined with other treatments (acupuncture, scraping, auricular point pressing, Suanzaoren decoction, estazolam) was better than other single therapies (SMD, -2.83; 95% CI, -2.98, -2.68; P < 0.00001).

Conclusion

This meta-analysis revealed that tuina can significantly improve the clinical efficacy and sleep quality of patients with primary insomnia. This study provides a theoretical basis and treatment guidance for patients with primary insomnia.

Systematic review registration

https://www.crd.york.ac.uk/prospero/, identifier CRD42022355742.

Effects of Tuina Combined With Moxibustion on Breast Cancer-Related Lymphedema: A Randomized Cross-Over Controlled Trial

The objective of this study is to evaluate the effect of Tuina combined with moxibustion on relieving breast cancer-related lymphedema (BCRL). A randomized cross-over controlled trial was conducted at our institution. All patients with BCRL were assigned to 2 groups: Group A and Group B. In the first period (weeks 1-4), tuina and moxibustion were performed in Group A and pneumatic circulation and compression garment in Group B. The washout period took place from weeks 5 to 6. In the second period (weeks 7-10), pneumatic circulation and compression garment were performed in Group A, and tuina and moxibustion in Group B. Therapeutic efficacy was evaluated by measuring the affected arm volume, circumference, and Visual Analog Scale for swelling. Regarding the results, a total of 40 patients were included, and 5 cases were dropped. After treatment, both the traditional Chinses medicine (TCM) treatment and complete decongestive therapy (CDT) was found to reduce the volume of the affected arm (P < .05). At the endpoint (visit 3), compared with CDT, the effect of the TCM treatment was more evident than that of CDT (P < .05). After the TCM treatment, the arm circumference at the elbow crease and proximal 10 cm to elbow crease was reduced, which was statistically different from that before treatment (P < .05). Post-CDT treatment, the arm circumference at proximal 10 cm to wrist crease and the elbow crease and proximal 10 cm to elbow crease decreased, which was statistically different from that before treatment (P < .05). At the endpoint (visit 3), the arm circumference at proximal 10 cm to elbow crease of the patients treated with TCM was less than that of CDT (P < .05). Moreover, the VAS scores for swelling were better after compared with before TCM treatment and CDT (P < .05). At the endpoint (visit 3), the subjective relief of swelling by TCM treatment was greater than CDT (P < .05). Ultimately, tuina combined with moxibustion can alleviate BCRL symptoms, which is primarily reflected in reducing the affected arm volume and circumference and relieving swelling.Trial registration: Chinese Clinical Trial Registry (Registration Number ChiCTR1800016498).

A systematic review and meta-analysis of acupuncture combined with Tuina in the treatment of insomnia

BACKGROUND

Insomnia is a sleep disorder with insufficient sleep time or/and poor sleep quality. Relevant epidemiological studies have shown that insomnia symptoms occur in about 35% to 50% of the adult population, and it is one of the most common diseases in the elderly. Patients who often suffer from insomnia are prone to symptoms such as fatigue, weakened cognitive function, depression, and even mental illness, which bring serious physical and mental damage to individuals and a heavy economic burden to social medical care and families. Traditional Chinese medicine and modern medicine have their own advantages in the treatment of insomnia, and there is currently a lack of reports on the comparison of acupuncture combined with massage and conventional medicine.

OBJECTIVE

To evaluate the clinical efficacy of acupuncture combined with Tuina in the treatment of insomnia.

METHODS

Search for clinical randomized controlled trials (RCTs) of acupuncture combined with Tuina in the treatment of insomnia from PubMed, Cochrane Library, Web of Science, China National Knowledge Infrastructure, Wan Fang Database, and China Science and Technology Journal Database. The RevMan5.4 software was used for Meta- analysis after literature screening, data extraction and quality evaluation.

RESULTS

A total of 29 studies were included with a total of 2688 cases. Compared with drugs or acupuncture alone, acupuncture combined with Tuina has advantages in the total clinical effectiveness, as well as the Pittsburgh Sleep Quality Index (PSQI) and Statistical Self-Rating Anxiety Scale score (SAS) (OR = 3.59, 95% confidence interval [CI] [2.77, 4.66], Z = 9.62 [P < .00001]) (MD = -2.44, 95% CI [-2.93, -1.95], Z = 9.72 [P < .00001]) (MD = -8.42, 95% CI [-10.23, -6.61], Z = 9.09 [P < .00001]). There was no statistically significant difference in Statistical Self-rating Depression Scale score (SDS) (MD = -5.26, 95% CI [-11.29, 0.78], Z = 1.71 [P > .05]).

CONCLUSION

Acupuncture combined with Tuina has obvious clinical advantages in the treatment of insomnia. This result is expected to provide a reference for the clinical treatment of insomnia, but the long-term effect of clinical efficacy still needs further study.

Tuina for peripherally-induced neuropathic pain: A review of analgesic mechanism

Peripherally-induced neuropathic pain (pNP) is a kind of NP that is common, frequent, and difficult to treat. Tuina, also known as massage and manual therapy, has been used to treat pain in China for thousands of years. It has been clinically proven to be effective in the treatment of pNP caused by cervical spondylosis, lumbar disc herniation, etc. However, its analgesic mechanism is still not clear and has been the focus of research. In this review, we summarize the existing research progress, so as to provide guidance for clinical and basic studies. The analgesic mechanism of tuina is mainly manifested in suppressing peripheral inflammation by regulating the TLR4 pathway and miRNA, modulating ion channels (such as P2X3 and piezo), inhibiting the activation of glial cells, and adjusting the brain functional alterations. Overall, tuina has an analgesic effect by acting on different levels of targets, and it is an effective therapy for the treatment of pNP. It is necessary to continue to study the mechanism of tuina analgesia.

Combined effect of external treatment of herbal medicine and tuina in congenital muscular torticollis: Systematic review and meta-analysis

BACKGROUND

Congenital muscular torticollis (CMT) is the third most common musculoskeletal disease in children. With no standardized treatment method hence, so it is necessary to find an effective treatment method that can be received comfortably by children. This review assessed the efficacy of an external treatment of herbal medicine (ETHM) with tuina for CMT in children.

METHODS

This study searched the English, Chinese, and Korean databases (total of 10) until June 7 2022, without any language restrictions. All included studies were randomized clinical trials (RCTs) of ETHM with tuina as an intervention comparted to the same tuina alone according to the inclusion and exclusion criteria. The mean differences (MD), standardized mean differences (SMD), risk ratio (RR) with the 95% confidence interval (CI), and risk of bias (ROBs) were calculated using Review Manager Version 5.4 software. The Grading of Recommendations Assessment, Development, and Evaluation (GRADE) rating system was used to assess the quality of evidence. The publication bias was evaluated using a funnel plot, the Egger test, the fail-safe N test, and the Duval and Tweedle's trim and fill method using Review Manager Version 5.4 software, the software R Version 4.1.1 and R studio Version 1.4.1106 program.

RESULTS

Nineteen RCTs with 1710 patients were included in the meta-analysis. ETHM plus tuina improved the outcomes of the total effective rate (TER) [RR 1.21, 95% CI:1.15 to 1.26, P < .001], sternocleidomastoid (SCM) muscle thickness [MD: -1.82, 95% CI: -2.23 to -1.41, P < .001], cervical rotation range [MD: 13.43, 95% CI: 10.41-16.45, P < .001] and lateral flexion range [MD: 8.50, 95% CI: 6.15-10.85, P < .001], tissue elasticity grade [SMD: -0.46; 95% CI: -0.71 to -0.22, P = .0002], muscle elasticity scores [RR: 1.56; 95% CI: 1.04 to 2.34, P = .03], and clinical symptom and sign scores [SMD: -0.78; 95% CI: -1.09 to -0.47, P < .001].

CONCLUSIONS

ETHM plus tuina have a combined effect on CMT children. However, further studies with high-quality clinical trials are needed to obtain more robust clinical evidence.

The effect of tuina on ulcerative colitis model mice analyzed by gut microbiota and proteomics

Tuina can effectively alleviate ulcerative colitis-related symptoms, but the mechanism of action is unknown. The purpose of this research is to explore potential pathways for the treatment of tuina through gut microbiota and proteomics techniques. Thirty-two male BALB/c mice were divided into four groups, the control, model, mesalazine, and tuina groups. The ulcerative colitis model was established by freely drinking a 3% dextran sulphate sodium solution for 7 days. The mesalazine group and the tuina group, respectively, received 7 days of mesalazine and tuina treatment. Subsequently, their body weights, feces properties, colon length, histomorphological changes, gut microbiota, and colon proteomics were determined. Body weights, disease activity index score, colon histological scores, and microbiota diversity were restored in the tuina group. At the phylum level, Firmicutes was increased and Bacteroidota decreased. At the family level, Lachnospiraceae increased and Prevotellaceae decreased. At the genus level, the Lachnospiraceae_NK4A136_group was increased. Proteomics detected 370 differentially expressed proteins regulated by tuina, enriched to a total of 304 pathways, including biotin metabolism, Notch signaling pathway, linoleic acid metabolism, and autophagy. Tuina can effectively improve the symptoms of weight loss, fecal properties, and colon inflammation in ulcerative colitis mice and restore the gut microbiota diversity, adjusting the relative abundance of microbiota. The therapeutic effects of tuina may be achieved by modulating the signaling pathways of biotin metabolism, Notch signaling pathway, linoleic acid metabolism, and autophagy.

Tuina for shoulder pain after stroke: A protocol for systematic review and meta-analysis

BACKGROUND

Post-stroke shoulder pain is a relatively common complication in stroke patients, with an incidence of 16% to 84% and poor outcomes with anti-inflammatory or sedative medications. This study will evaluate the results of a randomized controlled trial to determine the effectiveness and safety of Tuina in the treatment of post-stroke shoulder pain.

METHODS

The Chinese and English search strategies were used to search China National Knowledge Infrastructure, Chinese Scientific Journal Database, Cochrane Central Register of Controlled Trials, EMBASE, MEDLINE, PubMed, Wanfang Database, and Web of Science were used to search seven databases. All eligible studies published on or before September 15, 2022, will be selected. To improve the validity of this study, only clinical randomized controlled trials related to the use of Tuina for post-stroke shoulder pain will be included. The screening will be performed by 2 independent reviewers and data synthesis, bias analysis, subgroup analysis, and meta-analysis will be performed using RevMan (V.5.4) software.

RESULTS

The study will provide a high-quality evaluation of the effectiveness and safety of Tuina in the treatment of post-stroke shoulder pain.

CONCLUSION

This systematic review will provide evidence to determine whether Tuina is an effective and safe intervention for treating patients with post-stroke shoulder pain.PROSPERO registration number: CRD42022360401.

A systematic review of Tuina for cervical hypertension: A protocol for systematic review and meta-analysis

BACKGROUND

Cervical hypertension is a secondary form of hypertension with a high incidence rate. As the main etiology of cervical hypertension is related to cervical spondylosis, commonly used antihypertensive drugs have poor efficacy in the treatment of cervical spondylosis, and improving the symptoms of cervical spondylosis can effectively reduce blood pressure. Massage can effectively improve the symptoms of patients with cervical hypertension, but there has been no systematic review of massage treatment for cervical hypertension. This study aimed to evaluate the efficacy and safety of massage in patients with cervical hypertension.

METHODS

Before February 10, 2022, a systematic literature search was conducted using the following databases: Embase, SinoMed (previously called the Chinese Biomedical Database), China Science and Technology Journal Database for Chinese Technical Periodicals, Chinese National Knowledge Infrastructure, and Wanfang Data. Review Manager software (version 5.3) will be used for statistical analysis. Quality and risk assessments of the included studies were performed, and the outcome indicators of the trials were observed.

RESULTS

This meta-analysis further confirmed the beneficial effects of massage in patients with cervical hypertension.

CONCLUSION

This study investigated the efficacy and safety of massage therapy in patients with cervical hypertension, providing clinicians and patients with additional options for the treatment of this disease.

Effects of Tuina on newborns with jaundice: A meta-analysis

BACKGROUND

The impact of Tuina on neonatal jaundice is not yet comprehensively understood, and its clinical application is rather limited. This study systematically assessed the relevant literature and conducted a meta-analysis to study the influence of Tuina on neonatal jaundice and provide convincing clinical evidence for promoting its clinical application.

METHODS

We searched Pubmed, Embase, Cochrane Library, CNKI, Wanfang, CQVIP, and CBM from the establishment of the database up to July 2021. Studies that are randomized controlled trials were included. However, duplicate publications; manuscripts with no full text, incomplete information, or inability to extract data; animal experiments; and reviews and systematic reviews were excluded. STATA 15.1 was used to analyze the data.

RESULTS

The pooled results showed that compared with the treatment of neonatal jaundice solely with blue light, Tuina combined with blue light significantly improved the total effective rate and frequency of defecation on days 1, 2, 3, 4, and 5 and significantly decreased the traditional Chinese medicine syndrome score; the third serum total bilirubin on days 3, 4, and 7; and duration of jaundice. Moreover, the incidence of adverse events in neonatal jaundice treated with Tuina combined with blue light was significantly lower than that with blue light alone.

CONCLUSION

Tuina combined with blue light for treating neonatal jaundice can increase the effect of clinical treatment and reduce the adverse events caused by blue light therapy. Thus, the clinical application of traditional Chinese medicine Tuina in neonatal jaundice should be further promoted.

[Analysis on "the essence of tuina, arrival of qi ensuring curative effect"]

In reference with the systematic review of the thought of deqi (arrival of qi) put forward in Huangdi Neijing (Internal Classic of Yellow Emperor) and other classic books of traditional Chinese medicine, in view of detecting qi and identifying qi before treatment, as well as the prerequisites of deqi in tuina, meaning the accurate syndrome differentiation and manipulations, the importance of deqi in treatment with tuina is expounded. In association with clinical experience, the specific manifestations of deqi in patients during tuina are summarized, e.g. soreness, distention, pain, numbness, warm feeling and slight sweating, local changes in intestinal sound and skin color, as well as mind regulation. It is anticipated that deqi of tuina may be drawn the attention in clinical practice, and the relevant study be expanded.

Exploration of Tuina Effect and Mechanism in Chronic Atrophic Gastritis Rats

BACKGROUND

Chronic atrophic gastritis is a very common condition in the general clinical practice of gastroenterology. Tuina treatment is widely used clinically. The aim of our study was to investigate the mechanisms of tuina in rats with chronic atrophic gastritis.

METHODS

Fifty-six specific pathogen-free grade rats were employed for our study. They were divided into 5 groups and treated differ- ently. Body weight was recorded every week, and their small intestine propulsive ratio was measured after intragastric administration of carbon powder. Histopathological observation of gastric tissues was performed using hematoxylin and eosin staining. The levels of motilin and gastrin in serum were detected by enzyme-linked immunosorbent assay, and the expression levels of Bcl-2 and cytochrome C were measured by the western blot assay.

RESULTS

There was no significant difference in body weight and small intestine propulsive ratio between the chronic atrophic gastritis model group and the tuina group (P > .05). However, we can see some significant changes in histomorphology after treatment with tuina. For example, the atrophy of gastric mucosal epithelium and glands had improved, and the inflammatory cells infiltrating the lamina propria were decreased significantly. Moreover, the level of gastrointestinal hormone GAS was increased (P < .001), and there was no statistically significant difference in motilin, Bcl-2, and cytochrome-c after treatment with tuina (P > .05).

CONCLUSION

Our research demonstrated the effectiveness of tuina treatment on chronic atrophic gastritis with a possible underlying mechanism that affected the secretion of gastric acid, which could provide some useful information for clinical application.

[Warming acupuncture combined with "three steps and seven methods" of tuina for chronic nonspecific low back pain of yang deficiency and cold-dampness blockage: a randomized controlled trial]

OBJECTIVE

To compare the clinical efficacy and possible mechanism of warming acupuncture combined with "three steps and seven methods" of tuina and simple "three steps and seven methods" of tuina in treatment of chronic nonspecific low back pain (NLBP) of yang deficiency and cold-dampness blockage.

METHODS

A total of 138 patients were randomized into an observation group (69 cases, 5 cases dropped off) and a control group (69 cases, 7 cases dropped off). In the control group, "three steps and seven methods" of tuina was applied. On the basis of the treatment in the control group, warming acupuncture was applied at Shenshu (BL 23), Yaoyangguan (GV 3), Mingmen (GV 4), Weizhong (BL 40) and ashi points. The treatment was given once a day, 6 times a week for 3 weeks in both groups. Before and after treatment, the short form of McGill pain questionnaire (SF-MPQ) score, Oswestry disability index (ODI) score, finger-to-floor distance (FFD), Schober test distance, fear-avoidance beliefs questionnaire (FABQ) score and yang deficiency and cold-dampness blockage score were observed, the serum levels of tumor necrosis factor-α (TNF-α), interleukin (IL)-1β, IL-6 and thromboxane B₂ (TXB₂) were detected in both groups. The recurrence rate was evaluated in follow-up of 6 months after treatment.

RESULTS

After treatment, the scores of PRI, PPI, VAS, ODI, FABQ and FFD, yang deficiency and cold-dampness blockage scores were decreased compared before treatment in both groups (P<0.01), and those in the observation group were lower than the control group (P<0.01); the Schober test distances were increased compared before treatment in both groups (P<0.01), and that in the observation group was larger than the control group (P<0.01). After treatment, the serum levels of TNF-α, IL-1β, IL-6 and TXB₂ were decreased compared before treatment in both groups (P<0.01), and those in the observation group were lower than the control group (P<0.01). In follow-up, the recurrence rate was 12.8% (6/47) in the observation group, which was lower than 34.3% (12/35) in the control group (P<0.05).

CONCLUSION

Warming acupuncture combined with "three steps and seven methods" of tuina can effectively alleviate pain in patients with chronic NLBP of yang deficiency and cold-dampness blockage, improve activity and dysfunction of waist, the clinical efficacy is superior to simple "three steps and seven methods" of tuina, its mechanism may be relate to the inhibition of inflammatory reaction.

Efficacy and safety of external therapy of TCM for primary dysmenorrhea: A protocol for systematic review and meta-analysis

BACKGROUND

Primary dysmenorrhea (PD) is a painful disease that severely affects the daily lives of young women. External therapy using traditional Chinese medicine (TCM) is widely used in the clinical treatment of this disease and has achieved a good effect. There are many kinds of TCM external therapies, but the effectiveness, safety, and advantages of various methods have not been confirmed by high-quality meta-analyses. The purpose of this study was to evaluate the efficacy and safety of representative TCM external therapies in patients with PD.

METHODS

Published randomized controlled trials that assessed the efficacy of these interventions in patients with PD were included. We searched the following electronic databases: PubMed, Cochrane Library, Embase, Web of Science, China Science and Technology Journal, China National Knowledge Infrastructure, Wanfang, and Chinese Biomedical Literature Database and other sources. The main outcomes included menstrual pain intensity and the clinical effectiveness rate. The secondary outcomes were the quality of life and safety. The meta-analysis will be performed using the Review Manager version 5.3 software.

RESULTS

We will provide more practical results investigating the efficacy of external TCM therapy with high clinical frequency for PD patients in several respects, including the improvement of menstrual pain intensity, quality of life, and safety.

CONCLUSION

This review systematically reviews the effectiveness and safety of common TCM external therapies for PD and provides clinicians with the best treatment options.

ETHICS AND DISSEMINATION

This systematic review aimed to evaluate the efficacy and safety of external TCM therapy for PD. Since all data included were published, the systematic review did not require ethical approval.

REGISTRATION NUMBER

CRD42021297078.

External treatment of herbal medicine with tuina in congenital muscular torticollis: A protocol for systematic review and meta-analysis

BACKGROUND

This study is the protocol to evaluate the clinical evidence for external treatments using herbal medicine (ETHM) with tuina as a congenital muscular treatment (CMT) in pediatrics.

METHODS

Eleven databases will be searched until June 2022, without any language restrictions: four English databases (MEDLINE, Pubmed, EMBASE, and The Cochrane Central Register of Database of Controlled Trials), three Chinese databases (China National Knowledge Infrastructure, Chinese Scientific Journal Database, and Wan Fang Database), and four Korean electronic databases (Oriental Medicine Advanced Searching Integrated System, Korean Studies Information Service System, National Digital Science Links, and Research Information Sharing Service). This review will include randomized clinical trials (RCTs) of ETHM with tuina as an intervention versus the same tuina. All published RCTs for any ETHM for CMT will be included. Non-RCTs, RCT protocol, animal studies, case reports, reviews, and surveys will be excluded. The methodological quality assessment will be performed using the Cochrane risk of bias (ROBs). Review Manager version 5.4. will be used for the data synthesis and quantitative analysis.

RESULTS AND DISCUSSIONS

The systematic review and meta-analysis will provide evidence for ETHM as a treatment of CMT. The evidence can help clinicians and patients recognize more effective therapeutic and safe inventions.

INPLASY REGISTRATION NUMBER

INPLASY202210017.

Efficacy and safety of tuina for senile insomnia: A protocol for systematic review and meta-analysis

BACKGROUND

Insomnia is a common diseases of the elderly, tuina is a widely used treatment. At present, there is a lack of supportive evidence on efficacy and safety of tuina for senile insomnia. The purpose of this systematic review is to assess the effectiveness and safety of tuina therapy in the treatment of senile insomnia.

METHODS

Literature on tuina for senile insomnia in the PubMed, EMBASE, Web of Science, Cochrane, China National Knowledge Infrastructure Database, Wanfang, Chinese Scientific and Journal Database, Japanese medical database, Korean Robotics Institute Summer Scholars, and Thai-Journal Citation Index Center will be conducted to search from the creation of these databases. We will search the databases from the beginning to January 2022. The primary outcome was the Pittsburgh Sleep Quality Index score, and the secondary outcomes included clinical efficacy and safety. RevMan 5.4.1 will be used for the meta-analysis.

RESULTS

This study aimed to will prove the effectiveness and safety of tuina therapy for the treatment of insomnia in the elderly.

CONCLUSION

This study provides up-to-date evidence of the effectiveness and safety of tuina for the treatment of senile insomnia.

INPLASY REGISTRATION NUMBER

INPLASY2021110063.

ETHICS AND COMMUNICATION

This systematic review will evaluate the effectiveness and safety of massage therapy for insomnia in the elderly population. As all the included data have been published, systematic reviews do not require ethical approval.

The effectiveness of Tuina in managing chronic non-specific low back pain: A protocol of a multicenter international randomized controlled trial

BACKGROUND

Chronic non-specific low back pain (CNLBP) is a common complaint about medical care and carries a heavy social burden. The efficacy of Tuina (TN) or physiotherapy (PT) for CNLBP has been evaluated in previous systematic reviews. However, there is no high-quality evidence to support the efficacy of Tuina. Therefore, this study aims to conduct a large-scale, multicenter, high-quality clinical trial to provide evidence for Tuina to treat CNLBP.

METHODS

This is a multicenter, assessor-, and analyst-blinded, randomized controlled trial with 3 parallel arms: TN, PT, and TN combined with PT (Tuina combined with physiotherapy) group. Six hundred twelve eligible CNLBP patients will be randomly assigned to the groups in a 1:1:1 ratio in 3 centers. The TN intervention includes 9-step routine techniques, while the PT intervention includes a physiotherapy treatment plan based on a patient's symptoms. The interventions for both groups will last for 30 minutes and will be carried out for 6 sessions in 8 weeks. The primary outcome will be the visual analog scale pain score. And the secondary outcomes will include the Oswestry Disability Index, spinal range of motion, 36-item short-form health survey. Safety evaluation will be recorded during the whole study. All data in this randomized controlled trial will be analyzed by SAS 9.4.

DISCUSSION

The results of this trial will provide evidence to evaluate the efficacy of Tuina's value as a treatment for CNLBP.

TRIAL REGISTRATION

Chinese Clinical Trial Registry (ChiCTR2000040288, November 27, 2020).

Tuina combined with diet and exercise for simple obesity: A protocol for systematic review

BACKGROUND

The incidence of simple obesity is increasing annually, with the number of obese people in all age groups increasing significantly. Obesity has become an important public health concern. Simple obesity affects not only appearance but also health. Obesity has an increasing impact on individuals, families, and society. Therefore, the treatment of obesity is becoming increasingly important. Prior studies have shown that Tuina combined with diet and exercise is capable of producing improvements in body weight and fasted health markers. In recent years, there are many clinical studies on the intervention of simple obesity by Tuina combined with diet and exercise, however, no study systematically evaluated the clinical efficacy. The purpose of this study is to evaluate its effects of Tuina combined with diet and exercise on people with simple obesity.

METHODS

We will search the following electronic databases: PubMed, EMBASE, MEDLINE, Web of science, Cochrane Library, WanFang Data, CBM, CNKI, and VIP from the inception of the coverage of these databases to December 2021. Randomized controlled clinical trials related to Tuina combined with diet and exercise intervention on simple obesity will be included. Cochrane's collaboration tool will be used to assess the quality of the studies. RevMan 5.3 software will be used for the data analysis.

RESULTS

This study will provide a standardized evaluation for the efficacy of Tuina combined with diet and exercise for simple obesity.

CONCLUSION

The conclusion of this study will provide evidence for the safety and effectiveness of Tuina combined with diet and exercise on weight loss.

ETHICS AND DISSEMINATION

Ethical approval is not required for systematic review and meta- analysis. The results of this review will be disseminated in a peer-review journal.

PROSPERO REGISTRATION NUMBER

INPLASY202210079.

Tuina combined with physical therapy for spasticity of poststroke: A protocol for systematic review and meta-analysis

BACKGROUND

Limb spasms are a common complication of stroke. It not only affects the quality of life of stroke survivors, but also brings an economic burden. Tuina combined with physical therapy is widely used in the rehabilitation of poststroke spasticity. However, there is no supporting evidence for its efficacy and safety. This study aimed to evaluate the effectiveness and safety of Tuinas combined with physical therapy in the treatment of spasticity after stroke.

METHODS

Literature will be collected from the following databases: China Biology Medicine (CBM), Wanfang Database, China National Knowledge Infrastructure (CNKI), Chinese Scientific Journal Database (VIP), PubMed, Embase, Cochrane Library, and Web of Science; We will include randomized controlled trials of Tuina combined with physical therapy for poststroke spasticity range from the establishment to May 1, 2021. There were no limitations to the publication time, and the language was limited to Chinese and English. The primary outcome was evaluated using the Modified Ashworth scale, and the secondary outcomes were the simplified Fugl-Meyer Assessment scale, Modified Barthel Index, Functional Independence Measurement (FIM), and Visual Analog Scale. RevMan V.5.4.1 software was used for the meta-analysis. The Cochrane Intervention System Evaluation Manual analyzes the risk of bias, and the recommended grading assessment, development and evaluation are used to assess the quality of evidence.

ETHICS AND DISSEMINATION

This study will be based on published systematic review studies, no ethical approval is required and the results of the study will be published in a peer-reviewed scientific journal.

SYSTEMATIC REVIEW REGISTRATION

INPLASY2021110064.

Acupuncture combined tuina for oculomotor paralysis: A protocol for systematic review and meta-analysis

BACKGROUND

Oculomotor paralysis (OP) is a neurologic syndrome with multiple causes of oculomotor nerve and its dominant tissue and muscle dysfunction. Acupuncture combined with tuina is a wide-ranging used rehabilitation therapy, although there is short of supporting evidence for its efficacy and safety in patients with OP. The purpose of this systematic review was to estimate and synthesize evidence of the efficacy and safety of acupuncture combined with tuina in the treatment of OP.

METHODS

Electronic databases, including PubMed, Web of Science, Cochrane Library, EMBASE, Technology Journal and China Science, China National Knowledge Infrastructure, Chinese Biomedical Literature Database, and Wanfang,adopt an appropriate search strategy. RevMan V.5.3.5 software will be used for data synthesis, bias risk, and subgroup analyses.

RESULTS

This study provides high-quality evidence to assess the effectiveness and safety of acupuncture combined with tuina for OP.

CONCLUSION

This systematic review explores whether acupuncture combined with tuina is an effective and safe intervention for OP.

ETHICS AND DISSEMINATION

Private information from individuals will not publish. This systematic review does not involve endangering participant rights. Ethical approval was not obtained. The results may be published in a peer-reviewed journal or disseminated at relevant conferences.

PROSPERO REGISTRATION NUMBER

PROSPERO CRD42021266447.

Tuina for perimenopausal insomnia: A protocol for systematic review and meta-analysis

BACKGROUND

Insomnia in perimenopausal women has a negative impact on quality of life and increases health care costs. With the increasing incidence of the disease, Tuina has been accepted by perimenopausal women. The purpose of this study is to explore the effectiveness and safety of Tuina for perimenopausal insomnia.

METHODS

We will search 9 electronic databases: Chinese Biomedical Literature Database, Cochrane Library, China National Knowledge Infrastructure, EMBASE, MEDLINE, Web of Science, PubMed, Wan fang, Chinese Scientific Journal Database, and 1 clinical trials register platform: WHO International Clinical Trials Registry Platform. All relevant randomized controlled trial using Tuina for perimenopausal insomnia will be included. Two reviewers will independently screen date, and meta-analysis will be performed with RevMan (V5.3.5) software.

RESULTS

This study will provide an evidence of Tuina for perimenopausal insomnia.

CONCLUSION

This study will provide a reliable evidence for the evaluation of the efficacy and side effects of Tuina in the treatment of perimenopausal insomnia.

PROSPERO REGISTRATION NUMBER

CRD42021259017.

ETHICS AND DISSEMINATION

This systematics review will evaluate the efficacy and safety of tuina in the treatment of perimenopausal insomnia. Since all the data included were published, the systematic review did not require ethical approval.

Efficacy and safety of Tuina for treatment of pediatric recurrent respiratory tract infections: A protocol for systematic review and meta-analysis

BACKGROUND

Recurrent respiratory tract infections (RRTIs) are common respiratory ailments in children. RRTIs are often difficult to control and thus generally have a long-term disease course. Children who receive ineffective treatments or those that experience poor treatment outcomes are prone to developing complications such as edema, cough and asthma. Such complications can seriously hinder a child's growth and development, while also adversely affecting the child's physical and mental health. Tuina massage, a traditional Chinese technique that has been practiced in China for >5000 years, has recently been used to treat RRTIs, with good effect. However, no systematic review of research studies focusing on massage as a treatment for RRTIs can be found in the literature to date. The purpose of this study will be to evaluate the efficacy and safety of Tuina massage for the treatment of pediatric patients who experience RRTIs.

METHODS

We will search the following databases using electronic methods: the Chinese Biomedical Literature Database (CBM), the China National Knowledge Infrastructure (CNKI), Wanfang Data (WAN FANG), VIP Information (VIP), MEDLINE, PUBMED, EMBASE, and CINAHL. For each database search, the scope will include articles published between the date of database inception to September 2021. Revman5.4 software will be used to conduct this systematic review and meta-analysis.

RESULTS

This meta-analysis will confirm whether Tuina massage is of clinical benefit to pediatric patients who experience RRTIs.

CONCLUSION

The results of our systematic review and meta-analysis will be used to formulate conclusions as to whether massage therapy is an effective treatment for children suffering from RRTIs.

ETHICS AND DISSEMINATION

This systematic review will evaluate the efficacy and safety of tuina in the treatment of recurrent respiratory tract infections. Since all the data included were published, the systematic review did not require ethical approval.

INPLASY REGISTRATION NUMBER

INPLASY202190107.

Acupuncture combine with Tuina for diabetic peripheral neuropathy: A protocol for a systematic review and meta-analysis

BACKGROUND

Diabetic peripheral neuropathy (DPN) is one of the most common microvascular complications of diabetes mellitus, with an incidence ranging from 60% to 90%. With the change in modern dietary structure, the incidence of diabetes is increasing year by year, and DPN is also on the rise. Acupuncture and Tuina treatments are often combined to treat DPN; however, there has been no meta-analysis on their synergistic effect; therefore, we aimed to perform a systematic review and meta-analysis to estimate the effectiveness of acupuncture combined with Tuina in DPN treatment.

METHODS

Nine electronic databases were retrieved for this study. The English databases mainly retrieved PubMed, Web of Science, Embase, AMED, and the Cochrane Library, while the CNKI, VIP, CBM, and Wanfang databases were used to retrieve the Chinese literature; there was no definite time limit for the retrieval literature, and the languages were limited to Chinese and English. We will consider articles published between database initiation and November 2021. We used Review Manager 5.4 software provided by the Cochrane Collaborative Network for statistical analysis. We then assessed the quality and risk of the included studies and observed the outcome measures.

RESULTS

This study provides a high-quality synthesis to assess the effectiveness and safety of acupuncture combined with Tuina for treating DPN.

CONCLUSION

This systematic review provided evidence to determine whether acupuncture combined with Tuina is an effective and safe intervention for patients with DPN.

ETHICS AND DISSEMINATION

The protocol for this systematic review does not require ethical approval because it does not involve humans. This article will be published in peer-reviewed journals and presented at relevant conferences.

SYSTEMATIC REVIEW REGISTRATION

INPLASY2021110017.

Therapeutic effect and safety of Tuina on sciatica: A protocol for systematic review and meta-analysis∗

BACKGROUND

Sciatica is one of the common pain symptoms in the human body, also known as radiating leg pain. Sciatica is increasingly occurring due to poor posture and lack of physical exercise all over the world. At present, many studies have indicated that Tuina can improve the clinical symptoms and functional status of sciatica. However, there is currently no relevant systematic review to evaluate and report this clinical scientific issue. Consequently, this study will conduct a meta-analysis on the effectiveness and safety of Tuina therapy for sciatica.

METHODS AND ANALYSIS

Randomized controlled trials (RCTs) related to Tuina treatment of sciatica will be retrieved from the Chinese and English databases and Clinical Trial Register. These databases include China National Knowledge Infrastructure, Wan Fang Database, Chinese Biomedical Literature Database, VIP Database for Chinese Technical Periodicals, PubMed, Embase, Web of Science, Cochrane Library, and Medline, etc. We will consider articles published in English or Chinese between database initiation and October 2021. Our team will use Review Manager Software 5.3 software provided by the Cochrane Collaborative Network to conduct this systematic review and meta-analysis.

RESULTS

This study provides a comprehensive evaluation of the effectiveness and safety of Tuina therapy for sciatica.

CONCLUSION

The conclusion of our study will provide scientific evidence and reference to determine whether Tuina is an effective and safe intervention for patients with sciatica.

REGISTRATION NUMBER

INPLASY2021100034.

The efficacy and safety of Tuina for diabetic gastroparesis: A protocol for systematic review and meta-analysis

BACKGROUND

Diabetic gastroparesis (DGP) is one of the most common complication of diabetes. At present, despite the increasing number of clinical researches of treatment with Tuina have been reported, there are no systematic reviews of Tuina therapy for DGP. Therefore, it is of great significance to evaluate its safety and efficacy as a complementary and alternative therapy.

METHODS AND ANALYSIS

Randomized controlled trials (RCTs) of Tuina therapy in the treatment of DGP will be retrieved from PubMed, Embase, Web of Science, Cochrane Library, China National Knowledge Infrastructure (CNKI), Wan Fang Database (Wan Fang), Chinese Biomedical Literature Database (CBM), VIP Database for Chinese Technical Periodicals (VIP), Medline, and Clinical Trial Register (CTR). We will consider articles published in English or Chinese between database initiation and October 2021. Research selection, data extraction, risk of bias assessment, and meta-analyses will be independently completed by 2 researchers. Our researchers will use Revman 5.3 software, provided by the Cochrane Collaborative Network for conducting systematic reviews and meta-analysis.

RESULTS

This systematic review provides a high-quality synthesis to assess the effectiveness and safety of Tuina therapy for treating DGP.

CONCLUSION

The conclusions of our study will provide evidence to determine whether Tuina therapy is an effective and safe intervention for patients with DGP.

SYSTEMATIC REVIEW REGISTRATION

: INPLASY2021110019.

Acupuncture plus Tuina for chronic insomnia: A protocol of a systematic review and meta-analysis

BACKGROUND

Insomnia is a common sleep disorder. It refers to a subjective feeling of dissatisfaction with sleep duration and quality that affects social functioning, even though there are appropriate opportunities and environments for sleep. The disease for a long time can easily cause physical and mental fatigue, anxiety, depression, and other symptoms. Anxiety, depression, and insomnia can worsen the condition. Acupuncture and Tuina therapy has been widely used in the treatment of chronic insomnia, and this study aimed to conduct a meta-analysis of acupuncture plus Tuina in the treatment of chronic insomnia to clarify its efficacy.

METHODS

The following databases will be searched: Web of Science, PubMed, Cochrane Library, Embase, and Medline databases. In addition, we will also collect 4 databases of China: China National Knowledge Infrastructure, China Biomedical Literature Database, VIP Database, and Wan-fang Database. We selected eligible studies published up to October 2021. We used Review Manager 5.4, provided by the Cochrane Collaborative Network for statistical analysis. Clinical randomized controlled trials related to acupuncture plus Tuina for chronic insomnia were included in this study. Language is limited to both Chinese and English languages. Study selection, data extraction, and study quality assessment were independently performed by 2 researchers. We then assessed the quality and risk of the included studies and observed the outcome indicators.

RESULTS

This study provides a high-quality synthesis to assess the effectiveness and safety of acupuncture plus Tuina for treating chronic insomnia.

CONCLUSION

This systematic review will provide evidence to determine whether acupuncture plus Tuina is an effective and safe intervention for patients with chronic insomnia.

ETHICS AND DISSEMINATION

The protocol of the systematic review does not require ethical approval because it does not involve humans. This article will be published in peer-reviewed journals and presented at relevant conferences.

REGISTRATION NUMBER

INPLASY2021100115.

A systematic review of Tuina for women with primary dysmenorrhea: A protocol for systematic review and meta-analysis

BACKGROUND

Primary dysmenorrhea (PD) occurs most often in adolescent girls. Tuina, a kind of Chinese massage, can effectively relieve women's pain and is widely used in clinical practice. However, there is no relevant systematic review show its effectiveness and safety. The study aims to assess the effectiveness and safety of Tuina for PD.

METHODS

The following electronic databases will be searched from the respective dates of database inception to September 1st, 2021: The Cochrane Library, Web of Science, EMBASE, Springer, MEDLINE, China National Knowledge Infrastructure, the Chinese Biomedical Literature Database, the World Health Organization International Clinical Trials Registry Platform, the Chinese Scientific Journal Database, Wanfang database, and other sources.

RESULTS

This study will provide a high quality comprehensive and/or descriptive analysis of existing evidence on Tuina therapy for PD.

CONCLUSION

This study will provide the evidence of whether Tuina is an effective and safe intervention for women with PD.

PROSPERO REGISTRATION NUMBER

CRD42021257392.

The effects of traditional Chinese manual therapy (Tuina) for chronic fatigue syndrome: A protocol for systematic review and meta-analysis

BACKGROUND

Chronic fatigue syndrome (CFS) is a common disease and characterized by fatigue, exhaustion, heavy limbs, and dizziness. Tuina, as a traditional Chinese manual therapy, is usually used for CFS in China. Several studies have reported that Tuina can improve fatigue exhaustion, and dizziness of patients with CFS. However, the effects of Tuina for CFS still remain controversial. Therefore, the current systematic review and meta-analysis will be conducted to investigate the effects of Tuina in the management of CFS.

METHODS

The comprehensive electronic search of PubMed, Web of Science, Chinese National Knowledge Infrastructure, Wanfang Database, Embase, Cochrane Library, Chinese Science Citation Database, Technology Periodical Database from their inception to October 2021 will be conducted. Randomized controlled trials of Tuina for CFS will be included in the review. Two independent reviewers will complete the study selection, data extraction, and the risk of bias. The meta-analysis will be conducted using the Review Manager Version 5.3 software. The heterogeneity will be assessed using the I2 statistic and Q statistic. The standardized mean difference and 95% confidence intervals will be calculated based on different heterogeneity. The subgroup analysis will be conducted based on the duration of treatment, age, gender, duration of CFS. Quality of evidence will be assessed using the Grades of Recommendation, Assessment, Development and Evaluation.

RESULTS

The current systematic review and meta-analysis will be to investigate the effects of Tuina in the management of CFS.

CONCLUSION

The conclusion of this study will provide the evidence for the treatment of CFS in the future. It is expected that the conclusions drawn from this review will benefit patients, clinical practitioners and policy makers.

Chinese massage (Tuina) combline with paraffin therapy versus tuina or paraffin therapy alone for the treatment of congenital muscular torticollis: A protocol for systematic review and Bayesian network meta-analysis

BACKGROUND

Current studies in patients with congenital muscular torticollis (CMT) have predominantly focused on the role of tuina or paraffin therapy alone. This systematic review with Bayesian network meta-analysis will be performed to sum up the existing evidence on the effects and safety of tuina plus paraffin therapy for CMT in infants and children.

METHODS

The Preferred Reporting Items for Systematic Reviews and Meta-Analyzes reporting guidelines will be followed to conduct this study. The electronic databases of PubMed, Cochrane Library, PsycINFO, EMBASE, the Chinese Scientific Journal Database, China National Knowledge Infrastructure, WanFang Data, Taiwan Electronic Periodical Services, and Web of Science will be searched from the inception to November 2021 using the following key terms: "Tuina," "traditional Chinese medicine massage," "paraffin," and "congenital muscular torticollis," for all relevant studies. We impose no language restrictions. We include reports on randomized controlled trials (RCTs) and quasi-RCTs of Tuina combline with paraffin therapy for the treatment of CMT in children and adolescents. We include studies that assessed effective rate, symmetry, improvements of range of motion, muscle length, and sternocleidomastoid tumor thickness, quality of life, and adverse events. The Cochrane Bias Risk Tool, which considers sequence generation, allocation concealment, and blinding and other aspects of bias, will be used to assess the risk of bias in studies.

RESULTS

A Bayesian network meta-analysis is an appropriate statistical method to compare all treatment options by statistically simulating the estimated results of a comprehensive trial, and to compare treatments by common and associated comparators. In addition, Bayesian network meta-analysis can produce ranking probabilities of treatments, which may contribute to clinicians' clinical decision-making.

REGISTRATION NUMBER

10.17605/OSF.IO/K5EGN.

[Systematic review and Meta analysis on the effectiveness and safety of tuina in treatment of functional constipation]

OBJECTIVE

To review systematically the effectiveness and safety of tuina (Chinese massage)in treatment of functional constipation.

METHODS

The articles on functional constipation treated with tuina were collected by computer retrieval from 7 databases from the date of establishment to March 28, 2020, including Chinese biomedical literature database (SinoMed), China journal full-text database (CNKI), full-text database of Wanfang academic journals (Wanfang), VIP Chinese science and technology journal database(VIP), PubMed, Dutch medical literature database (EMbase) and the Cochrane Library. After data extraction and quality evaluation of the included articles, Meta analysis was conducted with RevMan5.3 software.

RESULTS

A total of 16 articles were included, with 1424 cases involved. Meta analysis results showed: ①The total effective rate in the treatment group was higher than that in the control group (RR=1.28, 95%CI: 1.16-1.42, P<0.000 01). ②The effective rate for the symptoms of functional constipation in traditional Chinese medicine in the treatment group was higher than that in the control group (RR=1.38, 95%CI :1.25-1.52, Z=6.31, P<0.000 01). ③Adverse reactions in the treatment group in the treatment of functional constipation were less than those in the control group (RR=0.10, 95%CI: 0.02-0.49, Z=2.81, P=0.005).④The effective rate of functional constipation treated on the base of syndrome differentiation in the treatment group was higher than that of the control group (RR=1.50, 95%CI: 1.08-2.10, Z=2.39, P=0.02).⑤The improvements in fecal characteristics, defecation time and defecation frequency of the patients with functional constipation in the treatment group were better than those in the control group (P<0.05).

CONCLUSION

Tuina therapy presents a certain advantages on its curative effect on functional constipation, has less adverse reactions and relieves the relevant symptoms of functional constipation. But more randomized controlled trials with high quality and large sample are required to provide further verification of its effect.

Tuina for diabetic peripheral neuropathy: A protocol for a systematic review and meta-analysis

BACKGROUND

Diabetic peripheral neuropathy (DPN) is one of the most common microvascular complications of diabetes mellitus, with an incidence ranging from 60% to 90%. With the change in modern dietary structure, the incidence of diabetes is increasing year by year, and DPN is also on the rise. Tuina therapy has been widely used in the treatment of DPN, but there is no systematic review on the treatment of DPN. Therefore, this study aimed to conduct a meta-analysis of Tuina in the treatment of DPN to clarify its efficacy.

METHODS

The following electronic databases will be searched: PubMed, the Cochrane Library, Embase, Web of Science, Medline, CNKI, Chinese Biomedical Literature Database, VIP, and Wan Fang databases. We will consider articles published between database initiation and May 2021. We will use Review Manager 5.4, provided by the Cochrane Collaborative Network for statistical analysis. Clinical randomized controlled trials related to Tuina for diabetic peripheral neuropathy were included in this study. Language is limited to both Chinese and English. Research selection, data extraction, and research quality assessments were independently completed by two researchers. We then assessed the quality and risk of the included studies and observed the outcome measures.

RESULTS

This study provides a high-quality synthesis to assess the effectiveness and safety of Tuina for treating diabetic peripheral neuropathy.

CONCLUSION

This systematic review will provide evidence to determine whether Tuina is an effective and safe intervention for patients with diabetic peripheral neuropathy.

ETHICS AND DISSEMINATION

The protocol of the systematic review does not require ethical approval because it does not involve humans. This article will be published in peer-reviewed journals and presented at relevant conferences.

REGISTRATION NUMBER

INPLASY202150027.

Assessment of the efficacy of tuina on treating cervicogenic headache: A protocol for systematic review and meta-analysis

BACKGROUND

Cervicogenic headache is a secondary headache characterized by unilateral headache, symptoms, and signs of neck involvement. It is often worsened by neck movement, sustained awkward head position, or external pressure over the upper cervical or occipital region on the symptomatic side. In this systematic review, we aimed to evaluate the efficacy and safety of massage therapy for the treatment of cervicogenic headache.

METHODS

We searched the China National Knowledge Infrastructure, Chinese Scientific Journal Database, Wanfang Database, China Doctoral Dissertations Full-Text Database, China Master's Theses Full-Text Database, Cochrane Central Register of Controlled Trials, PubMed, and Embase. We will select all eligible studies published on or before April 1, 2021. We will use Review Manager 5.4, provided by the Cochrane Collaborative Network for statistical analysis. We then assessed the quality and risk of the included studies and observed the outcome measures.

RESULTS

This meta-analysis further confirmed the benefits of tuina in the treatment of cervicogenic headache.

CONCLUSION

The purpose of this meta-analysis was to explore the effect of tuina on patients with cervicogenic headache and to provide more options for clinicians and patients to treat cervicogenic headache.

ETHICS AND DISSEMINATION

This systematic review will evaluate the efficacy and safety of tuina in the treatment of cervicogenic headache. Since all the data included were published, the systematic review did not require ethical approval.

REGISTRATION NUMBER

INPLASY202150053.

Tuina plus acupuncture for post-stroke depression: A protocol for systematic review and meta-analysis

BACKGROUND

Post-stroke depression (PSD) is the most common mental health issue, affecting approximately 33% of stroke survivors. Tuina and acupuncture treatments are often combined to treat PSD; however, there has been no meta-analysis on their synergistic effect. Therefore, we aimed to perform a systematic review and meta-analysis to estimate the effectiveness of Tuina and acupuncture in PSD treatment.

METHODS

The following electronic databases will be searched: PubMed, the Cochrane Library, Embase, Web of Science, Medline, CNKI, Chinese Biomedical Literature Database, VIP, and Wan Fang databases. We will consider articles published between database initiation and April 2021. Clinical randomized controlled trials related to Tuina combined with acupuncture for post-stroke depression will be included in the study. Language is limited to Chinese and English. Research selection, data extraction, and research quality assessment were independently completed by 2 researchers. Data were synthesized using a fixed effect model or random effect model, depending on the heterogeneity test. The Hamilton depression rating scale (HDRS) and effective rate were the primary outcomes. The post-stroke depression rating scale (PSDRS), patient health questionnaire-9 (PHQ-9), and the incidence of adverse events will also be assessed as secondary outcomes. RevMan V.5.4 statistical software will be used for meta-analysis. If it is not appropriate for a meta-analysis, a descriptive analysis will be conducted. Data synthesis uses the risk ratio and the standardized or weighted average difference of continuous data to represent the results.

RESULTS

This study provides a high-quality synthesis to assess the effectiveness and safety of Tuina for post-stroke depression.

CONCLUSION

This systematic review will provide evidence to determine whether Tuina plus acupuncture is an effective and safe intervention for patients with post-stroke depression.

ETHICS AND DISSEMINATION

The protocol of the systematic review does not require ethical approval because it does not involve humans. This article will be published in peer-reviewed journals and presented at relevant conferences.

SYSTEMATIC REVIEW REGISTRATION

INPLASY202140098.

[Professor SHAO Ming-xi's experience in differentiation and treatment of arthralgia in breast cancer with acupuncture, moxibustion and tuina]

Professor SHAO Ming-xi 's experience in treatment of arthralgia in breast cancer is summarized. Professor SHAO believes that the dysfunction of liver, spleen and kidney is the primary and the invasion of the exogenous wind, cold and damp is the secondary in arthralgia in breast cancer. Emphasized on syndrome/pattern differentiation, this disorder is identified as 4 patterns, i.e. liver qi stagnation, blockage by phlegm and stasis, qi and blood deficiency and obstruction by wind, cold and damp. Acupuncture-moxibustion is applied to Hegu (LI 4), Taichong (LR 3) and Waiguan (TE 5). The supplementary acupoints are selected on the base of syndrome/pattern differentiation. Tuina is combined with acupuncture-moxibustion and the reinforcing and reducing techniques are used appropriately. Shaoyang meridian is specially considered, due to which, Waiguan (TE 5) and Zhongzhu (TE 3) of triple energizer meridian of hand-shaoyang and Yanglingquan (GB 34) and Zulinqi (GB 41) of gallbladder meridian of foot-shaoyang are combined. Additionally, it stresses the combination of the local and distal acupoints and the coordination of various therapies of TCM to achieve the better effect.

[Development of handshape tuina-cupping instrument based on pulsating airflow technology]

A new type of handshape tuina-cupping instrument is developed to overcome the shortcomings of traditional cupping therapy, such as indentation and pain, and simulates the tuina manipulation, so as to realize the combination of cupping therapy and tuina manipulation. The handshape tuina-cupping instrument has a trumpet-shaped, silica gel edge. At the same time, the finger-belly shape is added at the cupping edge to simulate the shape of fingers during tuina. Under the action of air suction and deflation of pulsating airflow, the purpose of simulating tuina manipulation is achieved, and the indentation and pain caused by the handshape tuina-cupping instrument is significantly less than that of the traditional cupping instrument.

Massage for simple obesity: A protocol for systematic review

BACKGROUND

Obesity has become the most serious public health problem in developed and developing countries, and simple obesity accounts for approximately 95% of the total cases. This study aims to assess the effects and safety of massage therapy for the treatment of simple obesity.

METHODS

We will search foreign and Chinese databases, including PubMed, EMBASE, MEDLINE, CENTRAL, CNKI, WanFang Data, CBM, and VIP from the inception of the coverage of these databases to July 2020. Cochrane's collaboration tool will be used to assess the quality of the studies. RevMan 5.3 software will be used for the data analysis.

RESULTS

This study will evaluate whether massage therapy is an effective intervention for simple obesity.

CONCLUSION

This study will provide evidence regarding whether massage therapy is beneficial for treating simple obesity in humans.

PROSPERO REGISTRATION NUMBER

NO.CRD42020197635.

Tuina therapy for temporomandibular joint disorder syndrome: A protocol for systematic review and meta-analysis

BACKGROUND

Temporomandibular joint disorders (TMD) is common in clinic at present, which seriously affects the mental health and quality of life of patients. With the development of society, the incidence of TMD is gradually increasing. At present, there are many treatment methods, Tuina as a characteristic traditional Chinese medicine therapy, clinical treatment of TMD has a significant effect. In recent years, there are many clinical studies on Tuina in the treatment of TMD, but the clinical efficacy of Tuina in the treatment of TMD has not been systematically evaluated. In this study, we systematically evaluated the relevant literature of Tuina in the treatment of TMD by using the method of evidence-based medicine, in order to provide reference for clinical research in this direction in the future.

METHODS

VIP Chinese database, China knowledge Network, Wanfang, China Biomedical Database, PubMed, Embase, Cochrane Library and Web of Science were searched for clinical randomized controlled trials of Tuina in the treatment of TMD from the establishment of the database to December 2020. The 2 researchers independently screened the literature and carried out quality assessment and data extraction for the included study, and used RevMan5.3 software for risk assessment and Meta analysis.

RESULTS

In this study, the efficacy and safety of Tuina in the treatment of TMD were evaluated by effective rate, visual analog score (VAS) of temporomandibular joint pain, dysfunction index ((DI), palpation index (PI), craniomandibular index (CMI), maximum mouth opening (MMO), incidence of adverse reactions and so on.

CONCLUSION

This protocol can provide evidence-based basis for the treatment of TMD, with Tuina to significantly improve the symptoms and function of patients with TMD.

OSF REGISTRATION NUMBER

DOI 10.17605/OSF.IO/J75A8.