Acupuncture and moxibustion for chronic fatigue syndrome in traditional Chinese medicine: a systematic review and meta-analysis

Background

As the etiology of chronic fatigue syndrome (CFS) is unclear and the treatment is still a big issue. There exists a wide range of literature about acupuncture and moxibustion (AM) for CFS in traditional Chinese medicine (TCM). But there are certain doubts as well in the effectiveness of its treatment due to the lack of a comprehensive and evidence-based medical proof to dispel the misgivings. Current study evaluated systematically the effectiveness of acupuncture and moxibustion treatments on CFS, and clarified the difference among them and Chinese herbal medicine, western medicine and sham-acupuncture.

Methods

We comprehensively reviewed literature including PubMed, EMBASE, Cochrane library, CBM (Chinese Biomedical Literature Database) and CNKI (China National Knowledge Infrastructure) up to May 2016, for RCT clinical research on CFS treated by acupuncture and moxibustion. Traditional direct meta-analysis was adopted to analyze the difference between AM and other treatments. Analysis was performed based on the treatment in experiment and control groups. Network meta-analysis was adopted to make comprehensive comparisons between any two kinds of treatments. The primary outcome was total effective rate, while relative risks (RR) and 95% confidence intervals (CI) were used as the final pooled statistics.

Results

A total of 31 randomized controlled trials (RCTs) were enrolled in analyses. In traditional direct meta-analysis, we found that in comparison to Chinese herbal medicine, CbAM (combined acupuncture and moxibustion, which meant two or more types of acupuncture and moxibustion were adopted) had a higher total effective rate (RR (95% CI), 1.17 (1.09 ~ 1.25)). Compared with Chinese herbal medicine, western medicine and sham-acupuncture, SAM (single acupuncture or single moxibustion) had a higher total effective rate, with RR (95% CI) of 1.22 (1.14 ~ 1.30), 1.51 (1.31–1.74), 5.90 (3.64–9.56). In addition, compared with SAM, CbAM had a higher total effective rate (RR (95% CI), 1.23 (1.12 ~ 1.36)). In network meta-analyses, similar results were recorded. Subsequently, we ranked all treatments from high to low effective rate and the order was CbAM, SAM, Chinese herbal medicine, western medicine and sham-acupuncture.

Conclusions

In the treatment of CFS, CbAM and SAM may have better effect than other treatments. However, the included trials have relatively poor quality, hence high quality studies are needed to confirm our finding.

Electronic supplementary material

The online version of this article (doi:10.1186/s12906-017-1647-x) contains supplementary material, which is available to authorized users.

The role of acupuncture and moxibustion in the treatment, prevention, and rehabilitation of patients with COVID-19: A scoping review

Introduction

This study aims to summarize the available evidence and guideline/consensus recommendations for acupuncture and moxibustion in the treatment, prevention and rehabilitation of patients with coronavirus disease 2019 (COVID-19).

Methods

A scoping review was performed. Eight electronic databases and other related websites were searched. All studies related to acupuncture and moxibustion for COVID-19 were considered. Descriptive analysis was applied to analyze the all included studies and guideline recommendations.

Results

We ultimately included 131 eligible studies. The main topics of the included studies were the treatment (82.4%) and prevention (38.9%) of COVID-19. The most included studies were literature reviews (65, 49.6%), protocols of systematic reviews (20, 15.3%), and guidelines and consensuses (18, 13.7%). The 18 (13.7%) COVID-19 guidelines and consensuses included 47 recommendations on acupuncture and moxibustion, which focused on the treatment (21/47, 44.7%), rehabilitation (17/47, 36.2%) and prevention (6, 12.8%) of COVID-19 patients. Zusanli (ST36), Feishu (BL13), Guanyuan (RN4) were recommended mostly for the treatment, rehabilitation and prevention respectively.

Conclusion

Acupuncture and moxibustion are effective in the treatment of COVID-19 patients to some extent. However, more high-quality of clinical trials still needed to determine the feasibility of acupuncture and moxibustion in COVID-19 patients to better guide clinical practice.

Study registration

Open Science Framework Registries (Registration DOI: 10.17605/OSF.IO/Z35WN; https://osf.io/z35wn).

[Possibility of acupuncture treatment of ischemic stroke via regulating intestinal flora-immune response]

At present, intestinal flora has attracted more and more attention from scholars in China and foreign countries, and its association with ischemic stroke (IS) has gradually become a new research hotspot in the field of stroke. Studies also showed that intestinal flora may be a risk factor which directly or indirectly affects the occurrence and development of IS through bacterial metabolites and immune activities. In the present paper, we review the positive effect of acupuncture and moxibustion in alleviating the symptoms of limb locomotor, speech, swallowing dysfunction, cognition, etc. to improve the IS patients' daily life ability and in strengthening the cellular immune function of the body. In addition, acupuncture and moxibustion have a positive effect in regulating intestinal flora and immune inflammation. Hence, in the present paper, we discuss their relationship and the possibility of application of acupuncture and moxibustion therapies to the treatment of IS according to the theory of "intestinal flora-immune response". It is thus reasonable to speculate that acupuncture and moxibustion can be used to promote the recovery of brain tissue injury and neurological function after stroke via correcting intestinal flora disturbance and reducing immune inflammatory response. In-depth exploration of the role of "intestinal flora-immune response" in the treatment of IS and the specific regulatory function of acupuncture and moxibustion will provide new ideas and research approaches to reveal their mechanisms in the treatment of stroke from a new perspective.

[Acupuncture and Moxibustion Improves Learning-memory Ability of Alzheimer's Disease Rats Possibly by Up-regulating Serum Aβ Internalization Enzyme Contents]

OBJECTIVE

To observe the effect of acupuncture and moxibustion (AM) on learning-memory ability and expression of amyloid beta (Aβ) in the hippocampal dentate gyrus (DG) of Alzheimer's disease (AD) rats, so as to explore its mechanism underlying improvement of AD.

METHODS

Forty male Wistar rats were randomly divided into normal, sham operation, model and AM groups (n＝10 in each). The AD model was established by bilateral hippocampal injection of Aβ_1-42(5 µL). The AM was applied at "Baihui" (GV 20) and "Shenshu" (BL 23) for 15 min, once daily for 12 times. Morris water maze tests were used to assess the rats' learning-memory ability. The levels of serum Aβ_1-42 and Aβ internalizing enzymes including transthyretin (TTR), lipoprotein lipase (LPL), alpha 2 macroglobulin (α ₂M) and apolipoprotein E (ApoE) were detected by ELISA. The expression of Aβ_1-42 in the hippocampal DG was detected by immunohistochemistry.

RESULTS

Compared with the sham operation group, the average escape latency of location navigation test was significantly prolonged in the first 5 days and the last 3 days (P<0.01), and the residence time of the target-quadrant and the platform crossing times of special probing task were significantly reduced in the model group (P<0.01). After the intervention, the average escape latency was obviously shortened in the first 5 days and the last 3 days (P<0.01), and both the residence time and the platform crossing times were significantly increased in the AM group relevant to the model group (P<0.01, P<0.05). After modeling, the contents of TTR, LPL, α ₂M and ApoE in the serum were significantly lower in the model group than in the sham operation group (P<0.01, P<0.05), while the levels of serum Aβ_1-42 and hippocampal Aβ_1-42 expression were considerably increased relevant to the sham operation group (P<0.01). Following the intervention, the TTR, LPL, α₂M and ApoE contents in the serum were significantly increased (P<0.01, P<0.05), and both serum Aβ_1-42 and hippocampal Aβ_1-42 expression were notably down-regulated in comparison with the model group (P<0.05). No significant differences were found between the normal and sham operation groups in the levels of all the above-mentioned indexes (P>0.05).

CONCLUSION

AM can improve the learning-memory ability of AD rats, which may be related to its effects in up-regulating the contents of serum Aβ internalizing enzymes and promoting the clearance of hippocampal Aβ. It suggests a protective role of AM on hippocampal neurons.

[Research advances in the mechanism of acupuncture and moxibustion in regulating gastrointestinal motility and related thinking]

Gastrointestinal motility dysfunction is not only a pathogenic factor but also a pathological manifestation. The authors summarize the recent studies on the mechanism of acupuncture and moxibustion in regulating gastrointestinal motility and analyze the effect of acupuncture and moxibustion on the brain-vagus-enteric nervous system, interstitial cells of Cajal, gastrointestinal peptides, gastrointestinal smooth muscle, and signaling pathways. The authors also put forward some suggestions for future research, including the research centering on gastrointestinal motility to explore the role of acupuncture and moxibustion in regulating gastrointestinal motility for disease prevention and treatment, specificity of acupoints, and dual-directional regulation of acupuncture and moxibustion, and the research focusing on intestinal microflora and influential factors for excitability of enteric neurons to explore the potential mechanism of acupuncture and moxibustion in regulating gastrointestinal motility, in order to provide a reference for future research.

[Association between skin microecology and acupoint sensitization]

The skin microecology interacts with the immune system for a lifetime, and the skin microecology is in dynamic balance in the physiological state. The flora with the same physical and chemical properties on the surface of the skin can maintain a relatively stable state in a certain period of time, and there are dynamic changes of microflora in both physiology and disease state. Combined with the study of the relationship among skin microorganisms, skin diseases and visceral diseases, the relationship between skin microecological changes and visceral pathological state is explored. On this basis, it is proposed that the sensitized acupoint is an abnormal manifestation of the body homeostasis imbalance on the body surface, and the local substance variation on the sensitization acupoint may induce microbial changes. In terms of treatment, moxibustion and other surface treatments that function through immunity may also involve microorganisms.

[Effect characteristics and mechanism of acupuncture in autonomic nerve regulation]

OBJECTIVE

To investigate the effect characteristics and mechanism of acupuncture in autonomic nerve regulation through a comprehensive literature analysis.

METHODS

CNKI and PubMed databases were searched for the studies on acupuncture in autonomic nerve regulation in the past 30 years, and Excel was used to perform a descriptive analysis of research subjects, intervention methods, intervention sites (acupoint selection), intervention parameters, and effect mechanism of acupuncture.

RESULTS

A total of 202 studies were included, among which there were 51 clinical studies, mostly on the nervous system and the circulatory system; Neiguan (PC6), Zusanli (ST36), Fengchi (GB20), and Hegu (LI4) were the most frequently used acupoints, manual acupuncture was the most common intervention method, most of the acupoints selected were in the extremities, head, face, and neck, and heart rate variability was the main parameter for evaluation. Among the 151 animal experimental studies, there were many studies on the digestive system and the circulatory system; "Zusanli" (ST36), "Neiguan" (PC6), and "Shenmen" (HT7) were the most frequently used acupoints, electroacupuncture was the most common intervention method, most of the acupoints selected were in the extremities, and the main effect mechanism was to regulate the central vagus nerve activity and the cholinergic anti-inflammatory pathway (CAP).

CONCLUSION

Acupuncture has a good effect on autonomic nerve regulation. The acupoints in extremities, head, and face are mainly used in studies. The main action pathways are central vagus nerve activity and CAP, as demonstrated in the animal experiments. Acupuncture has specific effect characteristics, which are closely associated with the acupoints, methods, and parameters of stimulation.

Acupuncture and moxibustion for treatment of chronic atrophic gastritis: A Meta-analysis

AIM: To evaluate the efficacy of acupuncture and moxibustion in the treatment of chronic atrophic gastritis (CAG).

METHODS: Electronic searches of relevant randomized controlled trials (RCTs) on acupuncture and moxibustion for chronic atrophic gastritis in PubMed, WanFang Data, WeiPu Data and CNKI were performed. Studies were selected based on strict inclusive and exclusive criteria. All reviewed articels were assessed using Cochrane quality scale. Statistical analyses were performed with RevMan5.0 software.

RESULTS: A total of 11 trials involving 772 patients were included. Meta-analysis showed that compared with the medicine group, the acupuncture and moxibustion group had superiority in many aspects such as the total effective rate as well as improvements in gastroscopic findings, pathological changes, symptoms, hemoglobin and serum gastrin.

CONCLUSION: Acupuncture and moxibustion have advantages over conventional drug treatment in the management of CAG. More high-quality studies are needed to prove our finding.

[Progress of researches on acupuncture and moxibustion for treating post-traumatic stress disorder in the past five years]

Post-traumatic stress disorder (PTSD) is a kind of chronic mental disorder after severe traumatic events. In this paper, the author reviewed the development of clinical and mechanism research of acupuncture and moxibustion for treating PTSD in the past 5 years. Clinical studies have shown that acupuncture could alleviate the symptoms of PTSD, and is an effective therapy for PTSD. The underlying mechanisms may include regulating neural circuit, neurotransmitters and receptors expression, signal pathway, apoptosis, immune cytokines and endocannabinoid system, et al. It could provide scientific basis of acupuncture and moxibustion for treating PTSD, and provide references for further study.

[Regularities of acupoint combinations and characteristics of core acupoint application for acupuncture-moxibustion treatment of mammary gland hyperplasia based on complex network analysis]

OBJECTIVE

To analyze the acupoint combination regularities and application characteristics of core acupoints in acupuncture-moxibustion treatment of mammary gland hyperplasia (MGH) by using complex network technology, so as to provide reliable evidence for clinical selection of acupoints and treatment ideas.

METHODS

The articles related to acupuncture treatment of MGH published from January of 1981 to May of 2020 were collected from databases as China National Knowledge Infrastructure (CNKI), Wanfang Data Knowledge Service Platform (Wanfang), Chinese Journal of Science and Technology of VIP (VIP), PubMed, the Excerpta Medica Database (EMBASE), Cochrane Library, and Web of Science and Ovid database (OVID) according to the set inclusion and exclusion criteria of the present paper and by using keywords of "mammary gland hyperplasia", "mastalgia" or "fibrocystic breast change", "breast cystic hyperplasia ", etc. plus "acupuncture", "moxibustion", etc. Then, a correlative database model was established by using SPSS Modeler 18.0 to analyze their association regularities, followed by conducting a complex network analysis with Gephi 0.9.2 software.

RESULTS

A total of 312 eligible articles containing 343 acupoint prescriptions and 113 acupoints were collected. The total frequency of use of the 113 acupoints was 1 998. The association regularity analysis showed a top relativity between Danzhong(CV17) and Zusanli(ST36). The analysis of the complex network topology revealed that CV17, Qimen(LR14), Sanyinjiao(SP6), Taichong(LR3), ST36, Jianjing(GB21), Rugen(ST18), Wuyi(ST15), Neiguan(PC6), Ashi-points, Fenglong (SP40), Guanyuan(CV4), Taixi(KI3), Tianzong(SI11), Ganshu (BL18), and Hegu(LI14) are the core acupoints for treatment of MGH. The principle for composing acupoint prescriptions is mainly the combination of acupoints on the left and right sides, the upper and lower parts, front and back parts of the body, respectively, and those of the outer and inner meridians, and those of the same name meridians and Zangfu-organ syndrome differentiation. The needle-insertion direction is mostly toward the focus.

CONCLUSION

The composition of acupoint prescriptions for treating MGH with acupuncture and moxibustion is mainly based on the combination of specific acupoints among which the confluent acupoints are most frequently used, followed by the combination of acupoints distributing at the chest, back, upper and lower limbs, and the local acupoints.

[Research progress on the mechanism of acupuncture and moxibustion in treatment of endometriosis]

The clinical and experimental researches of acupuncture and moxibustion on endometriosis during past 15 years were collected. The research progress underling the mechanism of acupuncture and moxibustion on endometriosis was summarized. By taken Chinese characters, i.e. "acupuncture-moxibustion" and "endometriosis" as well as the English words, i.e. "acupuncture therapy" and "endometriosis" as the searching words, the relevant articles were retrieved from Pubmed, Embase, Chinese China National Knowledge Infrastructure, Wanfang Database, Chongqing VIP and the China Biology Medicine Disc etc. The retrieval time was from January 2003 to October 2018. As a result, 41 articles of clinical studies and 18 articles of animal experiments were screened. Of them, 20 articles (including 18 articles of animal experiments and 2 articles of clinical trial) are related to the mechanism underling acupuncture and moxibustion on endometriosis. In term of the impacts on growth factors, enzymes and enzyme inhibitors, the mechanism of acupuncture and moxibustion was explored on the analgesia for endometriosis, the inhibition of ectopic tissue angiogenesis and invasive adhesion, as well as the regulation of immune function and endocrine. Moreover, the limitation and prospect on the current researches were proposed so as to provide the more reliable evidence for clinical treatment of endometriosis with acupuncture and moxibustion.

[Effect of moxibustion and acupuncture on gastric mucosal cell apoptosis and expression of NF-κB, Bcl-2 in chronic atrophic gastritis rats]

OBJECTIVE

To observe the effect of moxibustion and acupuncture on apoptosis in gastric mucosal cell and expression of NF-κB, Bcl-2 in chronic atrophic gastritis (CAG) rats, so as to explore its mechanisms underlying improvement of CAG.

METHODS

Forty-eight male SD rats were randomly divided into normal, model, moxibustion and acupuncture groups, with 12 rats in each group. The CAG model was established by gavage of N-methyl-N'-nitro-N-nitroso-guanidine (MNNG) solution and irregular diet for 12 weeks. Moxibustion or acupuncture was applied to "Zusanli" (ST36) and "Zhongwan" (CV12) for 15 min, once daily for two weeks in the moxibustion or acupuncture group. The histopathological changes of the gastric mucosa were observed by HE staining. The apoptosis index of gastric mucosa was measured by TUNEL method. The gene expression levels of NF-κB and Bcl-2 were detected by real-time PCR.

RESULTS

After modeling, the color of gastric mucosa was pale and dark, with low folds and significant bleeding points. The glands in lamina propria were atrophied, arranged disorderly, and the numbers were significantly reduced, with inflammatory cells infiltrated. Those histopathological changes were evidently milder in the moxibustion and acupuncture groups. Compared with the normal group, the apoptosis index, NF-κB and Bcl-2 gene expression of the model group were significantly increased (P<0.01). After the treatment, the apoptosis index, NF-κB and Bcl-2 gene expression were significantly reduced in the moxibustion and acupuncture groups (P<0.05，P<0.01). The NF-κB expression was lower in the acupuncture group than that of moxibustion group (P<0.01).

CONCLUSION

Moxibustion and acupuncture therapy can improve the injury of gastric mucosa in CAG rats, which may be associated with its function in down-regulating the expression of NF-κB and Bcl-2 genes in the gastric mucosa.

[Meta analysis of acupuncture and moxibustion for anxiety and depression in irritable bowel syndrome]

OBJECTIVE

To evaluate the effectiveness of acupuncture and moxibustion in the treatment of anxiety and depression in irritable bowel syndrome (IBS) by meta-analysis.

METHODS

China National Knowledge Infrastructure (CNKI), Wanfang Data, China Scientific Journal Database (VIP), China Biomedical Literature Service System (SinoMed), PubMed, Embase, and Cochrane Library were searched for randomized controlled trials (RCTs) on acupuncture and moxibustion in the treatment of IBS anxiety and depression from database inception to June 30, 2021. RevMan5.3 and Stata16.0 were used to conduct Meta-analysis of relevant outcome indicators.

RESULTS

A total of 11 RCTs were included in this study, involving 774 IBS patients (431 in the intervention group and 343 in the control group). Eight of them used manual acupuncture (MA) intervention, and the other three used electroacupuncture (EA) intervention. Meta-analysis showed that compared with the western medicine, MA improved the sedation-agitation scale (SAS) scores (MD=5.24, 95%CI=［3.49, 7.00］, P<0.000 01) and self-rating depression scale (SDS) scores (MD=8.50, 95%CI=［4.68, 12.32］, P<0.000 1) in IBS patients, and there was no significant difference between MA or EA and western medicine in the improvement of Hamilton anxiety rating scale (HAMA) scores (MD=1.10, 95%CI=［0.36, 2.56］, P=0.14) and Hamilton depression rating scale (HAMD) scores (MD=0.53, 95%CI=［0.89, 1.94］, P=0.47). In terms of total effective rates (RR=1.21, 95%CI=［1.12, 1.31］, P<0.000 01) and the irritable bowel syndrome severity scoring system (IBS-SSS) scores (MD=42.16, 95%CI=［27.40, 56.91］, P<0.000 01), both MA and EA therapy was superior to western medicine in alleviating gastrointestinal symptoms of IBS patients.

CONCLUSION

MA and EA can improve the anxiety and depression of IBS patients, while the influence of other acupuncture and moxibustion interventions needs to be deeply explored with more high-quality RCTs.

[Synergistic effect of acupuncture and moxibustion on expression of renal Fas and FasL mRNAs and proteins in contrast-induced nephropathy diabetic rats]

OBJECTIVE

To observe the effect of acupuncture and moxibustion on renal Fas and Fas ligand (FasL) expression in contrast-induced nephropathy (CIN) diabetic rats, so as to explore its protective mechanisms.

METHODS

A total of 40 diabetic male SD rats were randomly divided into control, model, acupuncture, moxibustion and combined treatment (acupuncture combined with moxibustion) groups (n＝8 rats in each group). The diabetic model was established by i．p. injection of Streptozotocin (60 mg/kg), followed by regular raising for 9 weeks. Then, the manual acupuncture, moxibustion or acupuncture plus moxibustion at "Sanyinjiao"(SP6) "Shenshu"(BL23) and "Pishu"(BL20) was given to the diabetic rats, once daily for 7 days. On the 8th day, these diabetic rats received i．p. injection of compound Meglumine Diatrizoate Injection (10 mL/kg) for establishing CIN model. Then, the venous blood specimens were collected for detecting contents of serum urine nitrogen (BUN, with urease method) and creatinine (Scr, with picric acid method). The kindey tissues were exteriorized for detecting nitricoxide synthase (NOS, with oxidation-reduction method), malondialdehyde (MDA, with thiobarbituric acid method), superoxide dismutase (SOD, with xanthine oxidase technique) and total antioxidant capacity (T-AOC, with colorimetric technique). The expression levels of Fas and FasL in the kidney tissues were detected by quantitative real-time PCR and Western blot separately. The histopathological and ultrastructural changes of the kidney were observed under microscope (after H．E. staining) and transmission electron microscope, respectively.

RESULTS

Following modeling and compared with the control group, the BUN, Scr and renal MDA contents, and Fas and FasL mRNA and protein expression levels were significantly increased (P<0.01, P<0.05), and renal NOS, SOD and T-AOC levels considerably decreased in the model group (P<0.05). After the interventions and compared with the model group, serum BUN and Scr contents and renal Fas mRNA and protein expression levels in both acupuncture group and combined treatment group, BUN in the moxibustion group, and renal MDA content and FasL mRNA and protein expression levels in the 3 treatment groups were obviously down-regulated (P<0.05，P<0.01), while renal NOS in the 3 treatment groups, and SOD and T-AOC levels in the combined treatment group were considerably up-regulated (P<0.01，P<0.05). The effects of the combined treatment were significantly superior to those of simple acupuncure and simple moxibustion in down-regulating serum BUN contents, and Fas and FasL mRNA and protein expression levels, and in up-regulating renal NOS, SOD and T-AOC activity (P<0.05). No significant differences were found between the acupuncture and moxibustion groups in down-regulating serum BUN, Scr and renal MDA contents, and Fas and FasL mRNA and protein levels, as well as in up-regulating NOS content (P>0.05). H．E. staining showed lobular changes of glomeruli, many local necrosis and vascular degeneration in the model group, and transmission electron microscope displayed thickened basement membrane of the glomerular blood loop, many vacuoles in the cytoplasm of renal tubular epithelial cells, severely swollen mitochondria with disordered, broken or disappeared cristae, and some apoptotic cells in the model group, which were relatively milder in the combined treatment group.

CONCLUSION

Joint application of acupuncture and moxibustion can reduce the oxidative stress and renal injury in CIN diabetic rats, which may be associated with its function in down-regulating the expression of renal Fas and FasL genes and proteins. Acupuncture and moxibustion has a synergistic effect.

[Analysis on rules of acupoint compatibility and application characteristics in acupuncture treatment of migraine based on complex network technique]

OBJECTIVE

To analyze the compatible rules of acupoints in the treatment of migraine with acupuncture and moxibustion based on complex network technique so as to provide a reference for composing best acupoint recipes.

METHODS

Clinical papers about acupuncture treatment of migraine published from January of 2010 to October of 2020 were searched from Chinese and English databases including CNKI, Wanfang, VIP and Pubmed by using keywords of acupuncture, moxibustion and migraine. According to our inclusive and exclusive criteria, the collected papers were screened out to set up a database. The SPSS Modeler 18.0 software was used to analyze the association rules of acupoints, and the Gephi 0.9.2 software was used to conduct a complex network analysis about the compatibility rules of acupoints and their application characteristics of moxibustion and needling methods in the treatment of migraine.

RESULTS

In the end, 572 articles meeting the conclusive criteria were selected, and a total of 1 091 acupoint prescriptions for the treatment of migraine were extracted, including 230 acupoints with a total appea-rance frequency of 7 902. Those acupoints most frequently used were mainly attributed to the Gallbladder Meridian, with Fengchi (GB20) being the highest in the cumulative frequency. The association rule analysis showed that the highest supporting degree acupoints was GB20-Taiyang(EX-HN5). The highest levels of confidence were EX-HN5-Touwei(ST8), GB20-Baihui(GV20), and GB20-ST8. The analysis of complex network topology showed that a total of 17 acupoints including GB20, EX-HN5, Shuaigu(GB8), Taichong(LR3), GV20, Ashi point, etc. were the core node acupoints for acupuncture treatment of migraine.

CONCLUSION

In the treatment of migraine, the acupoints selected are mainly distributed in the head region. When the specific acupoints chosen, the five Shu acupoints, Yuan (source) acupoints and the confluent acupoints of eight meridians are frequently used. In terms of composing acupoint recipes, the acupoints in the local and distant part of the body are often used in combination. These outcomes may have a certain guiding significance for clinical treatment of migraine.

Research progress on insomnia treated by traditional Chinese medicine and acupuncture based on microbial-gut-brain axis theory

Insomnia, as one of the emotional diseases, has been increasing in recent years, which has a great impact on people's life and work. Therefore, researchers are eager to find a more perfect treatment. The microbiome-gut-brain axis is a new theory that has gradually become popular abroad in recent years and has a profound impact in the field of insomnia. In recent years, traditional Chinese medicine (TCM) has played an increasingly important role in the treatment of insomnia, especially acupuncture and Chinese herbal medicine. It is the main method of TCM in the treatment of insomnia. This paper mainly reviews the combination degree of "microorganism-gut-brain axis" theory with TCM and acupuncture under the system of TCM. To explore the mechanism of TCM and acupuncture in the treatment of insomnia under the guidance of "microorganism-gut-brain axis" theory, in order to provide a new idea for the diagnosis and treatment of insomnia.

[Progression and reflection on the mechanism study of acupuncture and moxibustion in treatment of Crohn's disease]

Crohn's disease (CD) is a common chronic non-specific gastrointestinal inflammatory disease. Studies showed that acupuncture-moxibustion (A&M) can effectively relieve the symptoms of CD and its clinical efficacy has been confirmed in patients. In this paper, by reviewing the relevant articles for the mechanism studies on CD treated with A&M in recent years, it is discovered that the effect mechanism of A&M on CD includes two aspects, i.e. the local regulation inside the intestines and the neuromodulation outside intestines. The former one refers to the regulation of intestinal microflora, intestinal epithelial cell function and the regulation of intestinal local immune cells. The latter points to the modulation of brain function effect and the modulation of "brain-gut axis" related neurotransmitters. This paper also introduces the differences in intervention modes and acupoint selection between clinical trial and animal experiment, the suggestions on elucidating the nerve-immunity mechanism for CD treatment with A&M in view of "brain-gut axis" system, and its prospects. It is anticipated that this review may be conductive to the effect mechanism research of A&M for CD so that the evidences may be provided for optimizing the clinical regimen of A&M in treatment of this disease.

[Clinical observation of acupuncture combined with moxibustion on college students with depression]

OBJECTIVE

To observe the clinical efficacy of acupuncture combined with moxibustion with seed-sized moxa cone in the treatment of depression in college students, and explore its effect on serum 5-hydroxytryptamine (5-HT).

METHODS

Sixty undergraduates with depression were divided into acupuncture-moxibustion group and medication group according to the random number table, with 30 patients in each group. The patients in acupuncture-moxibustion group received acupuncture and moxibustion with seed-sized moxa cone at acupoints on Shaoyang meridian according to the method of "rotating the pivot and regulating the qi", one time every other day. The patients in medication group received oral administration of fluoxetine hydrochloride capsule 20 mg once a day, and both groups were treated continuously for 8 weeks. The scores of Hamilton depression (HAMD-17) scale, self-rating depression scale (SDS) and serum 5-HT content before and after treatment were compared between the two groups.

RESULTS

Compared with before treatment, the HAMD-17 and SDS scores of the acupuncture-moxibustion group began to decrease after 2 weeks of treatment (P<0.05); while the HAMD-17 and SDS scores of the the medication group began to decrease after 4 weeks of treatment (P<0.05). After 2, 4 and 8 weeks of treatment, the HAMD-17 and SDS scores of the acupuncture-moxibustion group decreased more significantly than the medication group (P<0.05). The 5-HT contents of the two groups were significantly higher than those before treatment (P<0.05)，and there was no significant difference in serum 5-HT content between the two groups (P>0.05). The adverse reaction score of the acupuncture-moxibustion group was lower than that of the medication group (P<0.05). The total effective rate of the acupuncture-moxibustion group was 92.86%（26/28）, better than the medication group 81.48% (22/27,P<0.05).

CONCLUSION

Acupuncture combined with seed-sized moxa cone moxibustion is more effective than oral administration of fluoxetine hydrochloride in treating college students' depression, and acupuncture combined with moxibustion has a faster onset and fewer adverse reactions in the treatment of college students' depression.

[Analysis on combination regularities of Houxi (SI3) in ancient times of China based on latent structure model]

OBJECTIVE

To explore the feasibility and application value of combination regularities of acupoint Houxi (SI3) in Chinese ancient times based on latent structure model.

METHODS

Relevant articles about SI3 for treating various diseases with acupuncture, moxibustion, acupoint application, etc. were mainly searched from book Chinese Medical Classics (5th edition), followed by establishment of a Database of Houxi Acupoint Recipes. The Lantern 5.0 software was used to construct and analyze the latent structure model of high-frequently-used acupoints.

RESULTS

A total of 46 high frequently-used acupoints contained in 240 articles of 26 medical books were collected. The top 7 acupoints are Shenmai (BL62), Hegu (LI4), Qiangu (SI2), Fengchi (GB20), Jianshi (PC5), Wangu (SI4) and Quchi (LI11) in sequence. After modeling the 46 high-frequently used adjunct acupoints, 12 latent variables (Y0-Y11) and 24 latent classes were obtained by setting the cumulative coverage threshold ratio to be 95%. According to the Bayesian information criterion (BIC) measure, the model score was -2 170.68 points. Seven comprehensive clustering models were summarized up according to the latent structure. Compared with the yin meridians, the yang meridians played a more significant role. The multiple combinations of SI3 with specific acupoints provided a reference for clinical practice. The supplementary acupoints mainly distribute in the upper and lower limbs, head, face, neck, etc. and the SI3 acupoint recipes function mainly in dredging and activating meridians and collaterals, clearing away pathologic heat and wind, improving eyesight, and relieving swelling and pain.

CONCLUSION

The latent structure model is applicable in analysis of the regularities of SI3 acupoint combination for treating some diseases. Comprehensive clustering is employed to determine the primary acupoint SI3 and adjunct acupoint matching, revealing the common regularity and logical progressive relationship between the primary and secondary points, which may be helpful for teaching, clinical and scientific research.

Promoting high-quality development of acupuncture and moxibustion

In the past 20 years, the acupuncture-moxibustion discipline has made a great progress in clinical research, method construction, standard formulation, guideline promotion, basic theory and key scientific issue research. Internationally, the development of acupuncture and moxibustion has gradually begun to pay more attention to the basic issues of the discipline itself from focusing on clinical evidence. The National Institute of Health of USA pays close attention to the construction of acupoint knowledge base and database and to the transformation of peripheral nerve stimulation techniques, which brings forth opportunities and challenges for the development of acupuncture-moxibustion discipline. In the present paper, we analyze the shortcomings of the current development of acupuncture and moxibustion, put forward some strategies for high-quality development in the future, and sort out the basic scientific issues to form an academic consensus. We should employ modern scientific language to express the scientific connotations of the basic theory of acupuncture and moxibustion, and build an open and self-consistent modern theoretical system. In addition, we also should attract more multidisciplinary talents to harmoniously and assiduously work together, insist on continuous innovation to open up a new situation in the transformation of basic scientific research achievements, and establish a new theoretical system of "somato-medicine" represented by acupuncture and moxibustion. In this way, we will guide the acupuncture-moxibustion discipline to make an original contribution to the modern life science and future medicine.

Rules of acupoint selection in treatment of cancer-related insomnia with acupuncture and moxibustion based on data mining technology

OBJECTIVES

To analyze the rules of acupoint selection in treatment of cancer-related insomnia with acupuncture and moxibustion by data mining technology.

METHODS

The articles of cancer-related insomnia treated with acupuncture and moxibustion were searched from CNKI, Wanfang, VIP, SinoMed, PubMed, WOS, Cochrane, and Embase databases, from the inception of each database to January 5, 2024. The prescription database of acupuncture and moxibustion for cancer-related insomnia was established. The descriptive analysis was conducted on the use frequency, meridian tropism and distribution of acupoints. Using SPSS Modeler 18.0 Apriori algorithm, the association rules of acupoint prescriptions were analyzed. With Cytoscape3.9.1 software used, the complex network diagram was plotted, and the cluster analysis of high-frequency acupoints was performed by SPSS26.0 software.

RESULTS

Forty-one articles were included, and 67 prescriptions were extracted with 89 acupoints involved, and the total use frequency was 447 times. The top 4 acupoints of the high use frequency were Baihui (GV20), Sanyinjiao (SP6), Shenmen (HT7) and Shenting (GV24). The included meridians were the governor vessel, the spleen meridian, the bladder meridian, the conception vessel, the heart meridian and the stomach meridian. The selected acupoints were mostly distributed on the head, the neck and and the upper and lower limbs. The special acupoints of the high use frequency included the five-Shu points, the crossing points and yuan-primordial points. Regarding acupoint combination, GV24, SP6, HT7, and GV20 were highly correlated. The three effective clusters were categorized among the top 12 acupoints of the high use frequency.

CONCLUSIONS

In treatment of cancer-related insomnia with acupuncture and moxibustion, the principle focuses on supporting the healthy qi, eliminating pathogens, regulating yin and yang, promoting the circulation of the governor vessel for regulating the spirit, and tranquilizing the mind. The core acupoint prescription may includes GV24, SP6, HT7 and GV20；combined with Zusanli (ST36) and Yintang (GV4+) to enhance the therapeutic effect.

Analysis of mechanism of core points in acupuncture and moxibustion treatment for epilepsy based on data mining

OBJECTIVES

To explore the mechanism of core points in acupuncture and moxibustion treatment for epilepsy by using data mining technique, so as to provide a reference for clinical practice and experimental research.

METHODS

The data comes from relevant documents collected from CNKI, Wanfang, SinoMed, VIP, PubMed, Embase, Cochrane Library, EBSCO, Web of Science databases. The selected acupoints were analyzed in descriptive statistics, high-frequency acupoints group and core acupoint prescription. Further, potential target mining, "core acupoint prescription-target-epilepsy" network construction, protein-protein interactions (PPI) network establishment and core target extraction, gene ontology (GO) and KEGG gene enrichment analysis of the core acupoint prescription were carried out to predict its anti-epileptic potential mechanism.

RESULTS

A total of 122 acupoint prescriptions were included. The core acupoint prescriptions were Baihui (GV20), Hegu (LI4), Neiguan (PC6), Shuigou (GV26) and Taichong (LR3). 277 potential targets were identified, among which 134 were shared with epilepsy. The core targets were extracted by PPI network topology analysis, including signal transducer and activator of transcription 3, tumor necrosis factor (TNF), interleukin (IL)-6, protein kinase B1, c-Jun N-terminal kinase, brain-derived neurotrophic factor, tumor protein 53, vascular endothelial growth factor A, Caspase-3, epidermal growth factor receptor, etc. The main anti-epileptic pathways of the core acupoints were predicted by KEGG enrichment, including lipid and atherosclerosis, neurodegeneration, phosphatidylinositol-3-kinase/protein B kinase signaling pathway, mitogen-activated protein kinase signaling pathway, cyclic adenosine monophosphate signaling pathway, TNF signaling pathway, IL-17 signaling pathway, hypoxia-inducible factor-1 signaling pathway, apoptosis, etc., involving neuronal death, synaptic plasticity, oxidative stress, inflammation and other related biological process.

CONCLUSIONS

The core acupoint prescription of acupuncture and moxibustion intervention for epilepsy can act on multiple targets and multiple pathways to exert anti-epileptic effects, which can provide a theoretical basis for further clinical application and mechanism research.

[Regularity of Clinical Application of Lianquan (CV 23) in Chinese Ancient Times According to Literature of Traditional Chinese Medicine]

OBJECTIVE

To summarize the regularity of application of Lianquan (CV 23) in clinical practice in Chinese ancient times through analysis of ancient traditional Chinese medical (TCM) literature.

METHODS

A total of 60 books involving CV 23 from the 1 156 ancient TCM books listed in the fifth edition of Encyclopedia of Traditional Chinese Medicine were collected by using CV 23 as the main keyword and "Sheben" "Benchi", and "Jieben" (the other names of CV 23 in TCM)as the supplementary keywords and analyzed systematically. A database was then constructed from the collected data, including the related types of disorders or symptoms, acupoint recipes, and methods of needling and moxibustion, contraindications, etc.

RESULTS

A total of 196 articles related to the application of CV 23 from 60 ancient classical books were collected in accordance with the inclusive criteria. Among them, 155 articles are referred to the indications of CV 23, 35 to types of disorders such as asthma, cough, tongue swelling with difficulty in speaking, protracted tongue, acute contraction of tongue root, vomiting, spasm syndrome, stroke, aphtha, problems of mouth and teeth, throat problems, etc. of the internal medicine, surgery, pediatrics, and five-sense organs; 64 items are referred to the application of single CV 23, 91 to CV 23-included recipes containing 111 adjunct acupoints, and 78 to stimulation of CV 23 with acupuncture needle, moxibustion, pricking blood, and fire needle. Moreover, of the 111 adjunct acupoints, the most commonly used are Shaoshang (LU 11), Tiantu (CV 22), Hegu (LI 4), Yuye (EX-HN 13), Zhongchong (PC 9), etc.

CONCLUSION

Lianquan (CV 23) is mainly used for glossopharyngeal problems chiefly by syndrome-meridian differentiation. The supplement of complementary acupoints or five-shu points in combination with CV 23 has a synergistic effect. Moxibustion (3 moxa- cones in general) is often employed, and the needling depth is usually about 7.5 mm. The common contraindication of CV 23 is severe tongue swelling.

[Impact of Japanese Medical Acupuncture Literature Introduced Before 1949 on Development of Chinese Acupuncture-moxibustion]

The literature of Japanese medical acupuncture introduced before 1949 has a definite impact on Chinese acupuncture and moxibustion in the period of Republic of China and the early period of the establishment of the People's Republic of China. In the present paper, the authors introduce its impact from: 1) Chinese medical works on acupuncture and moxibustion absorbed a lot of western medicine knowledge, and interpreted some underlying mechanisms chiefly according to the theory of nerve, blood and endocrine, including the meridian-collateral theory based on the structures of blood vessels, lymph vessels, nerves, etc.; 2) In some Chinese clinical books, some Japanese new techniques as "tube-needling" (sparrow-pecking needling, etc.) were introduced, the acupuncture treatment of disorders was discussed from the nomenclature of western medicine and some operative standards (dissection of acupuncture needles, etc.) in clinical practice were accepted; 3) Some western medicine courses, and subject settings were introduced in Chinese acupuncture education. In general, Japanese acupuncture literature introduced before 1949 promotes integration of traditional acupuncture theory and western medicine in the early period of new China, enriches practical techniques in clinical practice and accelerates the development of acupuncture education in some way.

[Progress of researches on acupuncture-moxibustion treatment of cartilage damage of osteoarthritis]

Cartilage damage is the key pathological mechanism in the progressive development of osteoarthritis(OA). Slowing down cartilage damage and accelerating cartilage repair are strategies for effective treatment of OA. Acupuncture and moxibustion therapies are widely used in relieving symptoms of OA and have a protective effect on cartilage. In this paper, we reviewed the mechanisms of acupuncture and moxibustion underlying relieving cartilage damage from three aspects: 1) promoting chondrocyte homeostasis by inhibiting apoptosis and improving cellular autophagy, 2) regulating extracellular matrix (ECM) metabolism (inhibiting decomposition and promoting synthesis) by suppressing the release of inflammatory factors and the activity of proteolytic enzymes, and 3) improving OA microenvironment by reducing the number of macrophagocyte 1 (M1) and increasing the ratio of M2/M1 in the local inflammatory locus. In addition, most studies on the mechanisms of acupuncture and moxibustion underlying remission of OA focus on the improvement of pathological changes, such as joint histopathology, cartilage morphology, synovial inflammatory reaction and infiltration, subchondral bone remodeling, etc., thus, the exact functions of acupuncture and moxibustion in ameliorating cartilage injury remain unknown. In view of the important role of mitochondrial dysfunction in promoting OA development and cartilage damage and the current use of tissue engineering methods of chondrocytes and mesenchymal stem cells to repair articular cartilage injury, it is highly recommended that future studies should pay more attention to these aspects.