Safety of 4-week indirect-moxibustion therapy at CV4 and CV8

Effects of Acupuncture and Moxibustion on Heart Rate Variability in Chronic Fatigue Syndrome Patients: Regulating the Autonomic Nervous System in a Clinical Randomized Controlled Trial

BACKGROUND

This study investigates the effects of various acupuncture techniques, specific acupuncture points, and their combinations on symptom improvement in chronic fatigue syndrome (CFS) patients as well as their influence on heart rate variability (HRV) indicators.

METHODS

We recruited 35 healthy subjects as a healthy control group (Group A) and 175 patients with CFS, who were randomly divided into a fake acupuncture group (Group B), an acupuncture group targeting the Zusanli (ST36) point (Group C), an acupuncture group targeting the Guanyuan (CV4) point (Group D), a dual-acupoint acupuncture group (Group E), and a moxibustion group (Group F), with 35 patients in each group. Group B received fake acupuncture at both the bilateral Zusanli and Guanyuan points simultaneously. Group C received acupuncture at the bilateral Zusanli points along with fake acupuncture at the Guanyuan point. Group D received acupuncture at the Guanyuan point along with fake acupuncture at the bilateral Zusanli points. Group E received acupuncture at both the bilateral Zusanli and Guanyuan points simultaneously, and Group F received moxibustion at both the bilateral Zusanli and Guanyuan points simultaneously. Each group received a total of 10 treatments, administered every other day. Before treatment, the Qi-deficiency Syndrome Score, CFS Score, and SF36 Score were assessed for all subjects. HRV was measured before treatment, after the first treatment, after the fourth treatment, and at the end of treatment.

RESULTS

The results showed that both acupuncture and moxibustion can effectively alleviate fatigue symptoms in patients suffering from CFS, with combined acupuncture and moxibustion demonstrating greater effectiveness.

CONCLUSION

Acupuncture excelled in regulating the immediate effects of HRV, while moxibustion excelled in regulating long-term effects. Acupuncture targeting both the Zusanli and Guanyuan points proved more effective than acupuncture targeting a single point, with this difference reflected in the distinct regulatory effects on the sympathetic and parasympathetic nervous systems. The intervention mechanism of Zusanli may involve the parasympathetic nervous system, whereas Guanyuan may operate through the sympathetic nervous system.

TRIAL REGISTRATION

Approved by the Medical Ethics Committee of Hubei Provincial Hospital of Traditional Chinese Medicine (Approval number: HBZY2016-C24-01), and registered with the North American Clinical Trials Data Center (Clinical Trials.gov) (05/10/2016) (registration number: NCT02924831).

Effectiveness and safety of electrical moxibustion for knee osteoarthritis: A multicenter, randomized, assessor-blinded, parallel-group clinical trial

BACKGROUND

The prevalence of knee osteoarthritis (KOA) is increasing, and it has emerged as a major health issue. Studies have been reported that moxibustion is effective for treating KOA, but conventional moxibustion is difficult to control the intensity of stimulation and causes smoke, harmful gases, or odors. An electrical moxibustion (EM) device was developed to solve these problems, so we conducted this study to evaluate the effectiveness and safety of EM as a treatment for KOA.

METHODS

This is a multicenter, randomized, assessor-blinded, parallel-group clinical trial. Participants with KOA were randomly allocated into EM, traditional indirect moxibustion (TIM), or usual care groups. The moxibustion groups were received 12 sessions of moxibustion treatment at six acupuncture points (ST36, ST35, ST34, SP9, EX-LE4, SP10) over a period of 6 weeks. The usual care group was received usual treatment and self-care. The primary outcome was the degree of pain measured by numerical rating scale (NRS). The second outcomes were measured using visual analog scale, Korean version of the Western Ontario and McMaster Universities osteoarthritis index, patient global assessment, European quality of life five dimension five level scale, and warm sense threshold and heat pain threshold. For safety assessment, laboratory test and adverse events (AEs) were recorded.

RESULTS

A total of 138 participants were assigned. While there was no significant NRS change in the usual care, EM and TIM showed significant decrease after treatment. Compared to the usual care, the mean change of NRS in the EM and TIM was significantly different, but there was no significance between two groups. Regarding secondary outcomes, EM and TIM also showed significant difference compared to the usual care, but there was no significance between two groups. Regarding safety assessment, while usual care showed significant safety among three groups, EM showed seven treatment-related AEs by four participants compared TIM's 10 events by 10 participants. In addition, there was no blister caused by burns in the EM, which occurred four cases in the TIM.

CONCLUSION

This study shows that EM is effective to improve the pain and function by KOA with a certain level of safety.

Treatment of intradialytic hypotension with an herbal acupoint therapy in hemodialysis patients: A randomized pilot study

OBJECTIVE

Hypotension during hemodialysis (HD) is the most common complication that negatively affects the quality of life of patients. The objective of the current study was to evaluate the preliminary efficacy and safety of herbal acupoint therapy (HAT) for intradialytic hypotension (IDH).

METHODS

A randomized, placebo-controlled trial was performed in 32 HD patients to determine whether HAT was more effective than a sham treatment for the treatment of IDH. The outcomes were frequency of IDH episodes and number of nursing interventions during HD sessions, pre- and post-dialysis BP, subjective change in fatigue as measured by the Visual Analogue Scale (VAS), and recovery time from fatigue after dialysis at the 0th and 4th week. Data analyses were performed using per-protocol population.

RESULTS

In all, 27 patients (84%) completed the entire study. At the end of the intervention, the patients in the HAT group were found to have a significantly lower frequency of IDH episodes, fewer nursing interventions, a lower intervention failure rate, and earlier discontinuation of dialysis than those in the sham group (p < .05). The improvement in degree of fatigue (p = .001) was greater and recovery time from fatigue after dialysis (p = .03) was shorter in the group treated with HAT than in the sham group. HAT was safe, with 2 withdrawal cases due to local erythema caused by the patch.

CONCLUSIONS

HAT appears to be safe and efficacious for improving IDH-related symptoms and intervention in HD patients. Larger studies are needed to confirm the benefit of this technique for IDH.

Quality Assessment of Randomized Controlled Trials of Moxibustion Using STandards for Reporting Interventions in Clinical Trials of Moxibustion (STRICTOM) and Risk of Bias (ROB)

OBJECTIVES

To assess the quality and completeness of published reports of randomized controlled trials (RCTs) of moxibustion.

METHOD

We searched six databases to retrieve eligible RCTs of moxibustion published from 2000 to December 2015. We used the STandards for Reporting Interventions in Clinical Trials of Moxibustion (STRICTOM) and Risk of Bias (ROB) tool to assess the completeness of reporting of RCTs of moxibustion and evaluate the reporting quality of included RCTs.

RESULTS

Thirty-four studies of moxibustion were analyzed using STRICTOM and ROB. Of the 34 studies, the completeness percentage of STRICTOM varied from 33% to 100% (mean 68%, median 67%). The completeness of STRICTOM items showed a rising tendency along with the publication year. The STRICTOM items of setting and context (14.7%), rationale for the control (17.6%), and response (26.4%) showed incomplete reporting. The number of RCTs that rated a low risk of bias for allocation concealment (n=6), blinding of participants and personnel (n=1), and blinding of outcome assessment (n=4) appeared to be small.

CONCLUSION

The quality of reporting of RCTs of moxibustion remains incomplete according to the STRICTOM and ROB tool at present. Researchers should consider the STRICTOM and ROB for improving not only the completeness of reporting but also the study design. General guidelines for RCTs of moxibustion are also required.

Acupuncture and Moxibustion have Different Effects on Fatigue by Regulating the Autonomic Nervous System: A Pilot Controlled Clinical Trial

In order to investigate the different effects of acupuncture and moxibustion on chronic fatigue syndrome (CFS) and alterations in the autonomic nervous system by measuring heart rate variability (HRV). Forty-five participants were recruited and randomly divided into 3 groups using a randomization schedule. The control group (CG, n = 15) and the acupuncture group (AG, n = 15) were treated by manipulation acupuncture, and the moxibustion group (MG, n = 15) was treated by indirect moxibustion. Primary outcomes were the scores of the Fatigue Assessment Instrument (FAI). Secondary outcomes were the HRV parameters which can reflect activity of the autonomic nervous system. This trial considered both instantaneous changes and long-term effectiveness. FAI scores decreased after the 4th and 10th treatments in the 3 groups. The decrease in FAI in the MG was greater than that in the AG. Acupuncture was more effective in instantaneous changes of HRV and moxibustion in long-term aspects. Both acupuncture and moxibustion improved fatigue in CFS patients, but moxibustion was more effective. The possible mechanism of the intervention may be through activation of the vagus nerve. Moxibustion was more effective than acupuncture in long-term treatment of CFS.

Comparative effects of artemisia vulgaris and charcoal moxa stimulating Zhongwan (CV 12) on body temperature in healthy participants: a cross-over single-blind randomized study

OBJECTIVE

To evaluate the efficacy, safety, satisfaction, discomfort and patient preference of moxa cones of artemisia vulgaris and charcoal moxa.

METHODS

This comparative study of moxibustion treatment with Artemisia vulgaris and charcoal moxa cone stimulating Zhongwan (CV 12) is a cross-over single-blinded, randomized clinical trial. A total of 40 healthy subjects (24 males and 16 females) participated in this study. Two subjects dropped out of the trial. Thirty-eight subjects were treated with Artemisia vulgaris and charcoal moxa cones for 30 min in a cross-over design. After treatment, the patients underwent a 30 minute waiting period, and then the temperatures at Tanzhong (CV 17), Zhongwan (CV 12) and Guanyuan (CV 4) were measured using digital infrared thermal imaging.

RESULTS

After the use of Artemisia vulgaris moxa, the patients' body temperatures were slightly lowered at Tanzhong (CV 17), Zhongwan (CV 12) and Guanyuan (CV 4), but the changes were not statistically significant. After the use of charcoal moxa, the patients' body temperatures were somewhat increased at Zhongwan (CV 12) and Guanyuan (CV 4), but the changes were not statistically significant. After Artemisia vulgaris moxa use, the body temperature difference between Zhongwan (CV 12) and Guanyuan (CV 4) was significantly increased. After charcoal moxa use, the body temperature difference between Tanzhong (CV 17) and Zhongwan (CV 12) was significantly decreased in males and in the whole group. This change was caused by the difference in the moxibustion type and by gender differences.

CONCLUSION

This pilot study found that moxibustion did not raise the body temperature, but temperature differences between acupoints were affected. Further large-scale randomized controlled trials are needed for the effect of moxibustion on body temperature.

Extending the CONSORT Statement to moxibustion

The STandards for Reporting Interventions in Clinical Trials Of Moxibustion (STRICTOM), in the form of a checklist and descriptions of checklist items, were designed to improve reporting of moxibustion trials, and thereby facilitating their interpretation and replication. The STRICTOM checklist included 7 items and 16 sub-items. These set out reporting guidelines for the moxibustion rationale, details of moxibustion, treatment regimen, other components of treatment, treatment provider background, control and comparator interventions, and precaution measures. In addition, there were descriptions of each item and examples of good reporting. It is intended that the STRICTOM can be used in conjunction with the main CONSORT Statement, extensions for nonpharmacologic treatment and pragmatic trials, and thereby raise the quality of reporting of clinical trials of moxibustion. Further comments will be solicited from the experts of the CONSORT Group, the STRICTA Group, acupuncture and moxibustion societies, and clinical trial authors for optimizing the STRICTOM.