How does moxibustion possibly work?

Moxibustion for Managing Postoperative Urinary Retention After Hemorrhoidectomy and Anorectal Surgeries: A Systematic Review and Meta-Analysis of Randomized Controlled Trials

PURPOSE

Common surgical procedures for conditions affecting the anus and rectum such as hemorrhoidectomy are associated with high risks of postoperative urinary retention (POUR). Little is known about the efficacy of moxibustion in managing POUR after such surgical procedures. This systematic review and meta-analysis aimed to review the related literature and synthesize data on the effectiveness of moxibustion in managing POUR after common anorectal surgeries.

DESIGN

A systematic review and meta-analysis of randomized controlled trials (RCTs).

METHODS

PubMed, EMBASE, CENTRAL, Chinese National Knowledge Infrastructure (CNKI), VIP information, and Wanfang databases were searched to October 1, 2021 using the keywords urinary retention, moxibustion, and moxa. Randomized controlled trials (RCTs) investigating patients who had developed POUR after hemorrhoidectomy or other anorectal surgeries were eligible for inclusion. Patients receiving moxibustion formed the intervention group and the control group received usual care alone. Primary outcomes were markedly effective rate, defined as spontaneous voiding with complete symptom relief within 30 to 60 minutes after treatment; and total effective rate (ie, markedly effective rate plus effective rate, defined as spontaneous voiding with partial relief of symptoms within 60 minutes to 4 hours after treatment). Secondary outcome was time to first urination after treatment.

FINDINGS

Thirty-four RCTs met the eligibility criteria. Pooled analysis revealed that the markedly effective rate was significantly higher in the moxibustion group than that in the control group (pooled RR = 2.53, 95% CI = 2.17-2.95), and the total effective rate in the moxibustion group was also higher than that in the control group (pooled RR = 5.02, 95% CI = 4.01-6.28). The intervention group had significantly shorter times to first urination than controls (pooled effect = -2.81, 95% CI = -2.06 to -3.56).

CONCLUSIONS

Moxibustion appears superior to usual care in relieving POUR after common anorectal surgeries. Future studies are still warranted to confirm these findings.

Effect of acupuncture therapy on vaccine-induced immune response in d-galactose-induced aging rats

Objective

This study aimed to explore whether acupuncture and moxibustion can enhance the immune response by increasing the expression of the endogenous adjuvant HSP70 mRNA.

Method

Forty Wistar rats were divided into four groups: model immune acupuncture group (A), model immune control group (B), normal immune acupuncture group (C), and normal immune control group (D). Model immune groups A and B were induced by injecting d-galactose for 6 weeks. Rats in groups A and C were then treated with low-frequency electroacupuncture (EA) at Zusanli (ST36), Guanyuan (CV4), and Baihui (GV20) and moxibustion for 3 weeks. Subsequently, all rats were observed for 2 more weeks. At the 12th week, diphtheria antitoxin titers were determined using the Vero cell trace neutralization method, CD4+T/CD8+T cell ratios in peripheral blood were examined by flow cytometry, and the relative expression of spleen cell HSP70 mRNA was measured by RT-PCR.

Results

Compared with the normal immune control, the diphtheria antitoxin titer, CD4+T/CD8+T cell ratio, and expression of spleen cell HSP70 mRNA significantly decreased in the model immune control group (P < 0.01). However, the model immune acupuncture group showed a significant increase in antitoxin titer (P < 0.01) and elevated CD4+T/CD8+T cell ratio and HSP70 mRNA expression (P < 0.05) after EA and moxibustion intervention.

Conclusion

Acupuncture and moxibustion may enhance the humoral immune response (diphtheria antitoxin titer) and cellular immune response (peripheral blood CD4+T/CD8+T cell ratio) by increasing the expression of the endogenous adjuvant HSP70 mRNA, suggesting that acupuncture may serve as a new vaccine adjuvant.

Moxibustion for the Treatment of Cancer and its Complications: Efficacies and Mechanisms

Cancer treatment remains a significant challenge for the medical community, and improved therapies are necessary to treat cancer and its associated complications. Current anticancer therapies often have significant side effects, underscoring the need for new treatment options. Moxibustion is a representative external therapy used in traditional Chinese medicine. This review examines clinical studies demonstrating moxibustion's ability to improve the efficacy of radiotherapy and chemotherapy and control tumor progression. Moxibustion can prevent and treat various complications of cancer, including cancer-related or therapy-induced gastrointestinal symptoms, myelosuppression, fatigue, pain, and postoperative lymphedema. has also been shown to enhance the quality of life for cancer patients. However, very few studies have investigated the underlying mechanisms for these effects, a topic that requires systematic elucidation. Evidence has shown that moxibustion alone or combined with chemotherapy can improve survival and inhibit tumor growth in cancer-bearing animal models. The anticancer effect of moxibustion is associated with alleviating the tumor immunosuppressive and vascular microenvironments. Additionally, the therapeutic effects of moxibustion may originate from the heat and radiation produced during the combustion process on acupoints or lesions. This evidence provides a scientific basis for the clinical application of moxibustion in anticancer treatment and reducing the side effects of cancer therapies and helps promote the precise application of moxibustion in cancer treatment.

Research Trends of Moxibustion Therapy for Pain Treatment Over the Past Decade: A Bibliometric Analysis

Background

Accumulate evidence indicated that moxibustion has a positive effect on pain treatment. However, the bibliometric analysis of moxibustion on pain remains uncertain. Herein, this study aimed to explore the current hotspots and the research trends over the past decade to bring a great panorama in this field.

Methods

Publications were retrieved from the database Web of Science Core Collection (WoSCC) related to moxibustion therapy for pain treatment from January 1, 2012, to December 31, 2021. CiteSpace and Excel were applied to analyze the volume of publications, journals, cited journals, dual-map analysis, countries, institutes, authors, references, and keywords with citation bursts.

Results

A total of 360 publications were retrieved from 2012 to 2021. The annual number of publications increased steadily with some fluctuations over the past 10 years. "The Evid Based Complement Alternat Med" and "the Gut" were the top-cited journals in frequency and centrality. China and Shanghai University of Traditional Chinese Medicine were the most prolific country and institutions, respectively. Among authors, Huangan Wu was the most active author with the highest cited frequency. Jun Xiong, Fanrong Liang and Guixing Xu held the articles with higher centrality. In the ranking of frequency and centrality in cited references, the top one was the article published by Shamseer L and Deng HY, respectively. "Acupuncture" was the keyword with the highest frequency. Pain disease (including rheumatoid arthritis, knee osteoarthritis, herpes zoster), research method (including randomized controlled trial), and risk (including quality of life, economic burden, physical and psychological problems) were the hotspots and frontier trends in this field.

Conclusion

This bibliometric study reveals the current status and research trend in the treatment of pain with moxibustion. The formulation with bibliometric analysis further elicits hot spots and frontier issues in this field.

Numerical Simulation of Temperature Distribution during Mild Moxibustion

Mild moxibustion is a treatment approach belonging to moxa-hanging moxibustion. The burning end of the moxa stick is kept at a fixed distance from the moxibustion skin, aiming to make the patient feel warm without burning pain. The appropriate temperature distribution is critical for the mild moxibustion treatment. The purpose of this paper is to improve the efficacy of mild moxibustion on human tissues. By combining the radiative and conductive models with surface-to-surface heat transfer, biological heat transfer simulations are realized based on biological tissues in particular media. A finite element model of mild moxibustion was established to obtain the characteristics of skin tissue temperature distribution under various conditions. The model considers multiple factors, such as the moxa-burning temperature, the stick-to-skin distance, the moxa stick sizes, and the ambient temperature. The results show that the temperature distribution under various conditions is centered at the moxibustion point and the temperature decreases in the surrounding direction. The higher the moxa-burning temperature, the higher the skin surface temperature and the worse the stability in heating. The stick-to-skin distance is inversely proportional to the skin surface temperature. The moxa stick diameter is proportional to the skin surface temperature. The longer the moxibustion time, the higher the skin surface temperature. And the temperature change gradually flattened in the late stage of mild moxibustion. Finally, a set of moxibustion conditions with optimal temperature distribution was obtained by comparing the data of all groups.

Effect of Chinese herbal topical medicine, acupuncture, and moxibustion on pressure ulcer wound healing: A meta-analysis

We performed a meta-analysis to evaluate the effect of Chinese herbal topical medicine, acupuncture, and moxibustion on pressure ulcer wound healing. A systematic literature search up to January 2022 was done and 13 studies included 1073 subjects with pressure ulcer wound at the start of the study; 593 of them were using traditional Chinese medicine treatments, and 480 were control for pressure ulcer wound. We calculated the odds ratio (OR) with 95% confidence intervals (CIs) to evaluate the effect of Chinese herbal topical medicine, acupuncture, and moxibustion on pressure ulcer wound healing by the dichotomous methods with a random or fixed-influence model. Traditional Chinese medicine treatments had significantly higher complete healing (OR, 5.94; 95% CI, 3.94-8.95, P < .001), and curative ratio post-treatment (OR, 4.79; 95% CI, 2.62-8.76, P < .001) compared with control for subjects with pressure ulcer wound. Traditional Chinese medicine treatments had a significantly higher complete healing and curative ratio post-treatment compared with control for subjects with pressure ulcer wounds. Further studies are needed to validate these findings.

The Case for Moxibustion for Painful Syndromes: History, principles and rationale

Traditional Chinese Medicine (TCM) has evolved over thousands of years. TCM practitioners use various approaches (such as acupuncture and tai chi) as well as herbal products to address health problems. Though lesser known in the west, the practice of Moxibustion is an integral part of Traditional East Asian Medicine. Moxibustion is an important non-invasive treatment that has shown to be beneficial in treating painful syndromes including neuropathy. It has been suggested that moxibustion may alleviate neuroinflammation by inhibiting NF-kB and by activating Nrf2. These anti-inflammatory and protective mechanisms could be key to exploring the use of moxibustion in treating other etiologies of neuropathy including HIV. There is ample scope for future study in this area and consideration of the history, development and practical applications of moxibustion therapy may be of help in this regard. This article seeks to explore the background, principles, and application of moxibustion in the clinical setting with particular emphasis on its potential for symptom management in the treatment of neuropathy and pain.

Electroacupuncture and moxibustion-like stimulation activate the cutaneous and systemic hypothalamic-pituitary-adrenal axes in the rat

OBJECTIVE

To determine whether electroacupuncture (EA) or moxibustion-like stimulation (MLS) can affect the cutaneous and/or systemic hypothalamic-pituitary-adrenal (HPA) axes.

METHODS

Rats were divided into Control, EA, 37°C MLS and 43.5°C MLS groups. EA and MLS were performed at bilateral ST36 or LI4. The expression of corticotropin-releasing factor (CRF), adrenocorticotropic hormone (ACTH) and the glucocorticoid receptor (GR) was detected in local cutaneous tissues at the site of ST36 and LI4 by immunohistochemical staining. In addition, levels of CRF, ACTH and corticosterone (CORT) in cutaneous tissue and plasma were determined.

RESULTS

Cutaneous expression of CRF, ACTH and GR significantly increased after EA at ST36, while only GR increased after 43.5°C MLS at ST36. The results of EA and MLS at LI4 were in parallel with those at ST36. In plasma, compared with the control group, the level of CORT increased after EA at ST36, while both ACTH and CORT were markedly increased after 43.5°C MLS. For LI4, plasma CRF and CORT increased after EA, while the levels of all three hormones increased following 43.5°C MLS. Notably, compared with the effect of EA, 43.5°C MLS at ST36 produced a more substantial increase in plasma CORT, and 43.5°C MLS at LI4 induced a more dramatic increase in plasma CRF and CORT.

CONCLUSION

Both EA and 43.5°C MLS can activate the cutaneous and systemic HPA axes of the rat. EA tended to activate the local cutaneous HPA, while 43.5°C MLS was more likely to activate the systemic HPA axis.

Moxibustion for Chronic Fatigue Syndrome: A Systematic Review and Meta-Analysis

Objective

This review aimed at systematically evaluating the efficacy and safety of moxibustion for chronic fatigue syndrome (CFS).

Methods

Relevant trials were searched in seven digital databases up to January 2021. After literature screening, data extraction, and literature quality evaluation, the included studies were meta-analyzed using RevMan 5.4 software. The evidence level was assessed using the Grading of Recommendations, Assessment, Development, and Evaluation (GRADE).

Results

Fifteen studies involving 1030 CFS participants were included. Meta-analyses showed a favorable effect of moxibustion on the total effective rate compared with acupuncture (OR = 4.58, 95%CI = [2.85, 7.35], P < 0.00001) and drugs (OR = 6.36, 95%CI = [3.48, 11.59], P < 0.00001). Moxibustion also appeared to significantly reduce fatigue severity measured by fatigue scale-14 (FS-14) (WMD = -2.20, 95% CI = [-3.16, -1.24], P < 0.00001) and fatigue assessment instrument (FAI) (WMD = -16.36, 95% CI = [-26.58, -6.14], P=0.002) compared with the control group. In addition, among the 15 included studies, only two studies reported adverse events related to moxibustion, and the symptoms were relatively mild. The quality of evidence based on the 15 included trials was assessed as moderate to very low.

Conclusions

Based on limited evidence, moxibustion might be an effective and safe complementary therapy for CFS, which can be recommended to manage CFS. Because of the limited level of evidence in this review, further high-quality trials are still needed to confirm these findings.

The Therapeutic Strategies for Uremic Toxins Control in Chronic Kidney Disease

Uremic toxins (UTs) are mainly produced by protein metabolized by the intestinal microbiota and converted in the liver or by mitochondria or other enzymes. The accumulation of UTs can damage the intestinal barrier integrity and cause vascular damage and progressive kidney damage. Together, these factors lead to metabolic imbalances, which in turn increase oxidative stress and inflammation and then produce uremia that affects many organs and causes diseases including renal fibrosis, vascular disease, and renal osteodystrophy. This article is based on the theory of the intestinal-renal axis, from bench to bedside, and it discusses nonextracorporeal therapies for UTs, which are classified into three categories: medication, diet and supplement therapy, and complementary and alternative medicine (CAM) and other therapies. The effects of medications such as AST-120 and meclofenamate are described. Diet and supplement therapies include plant-based diet, very low-protein diet, probiotics, prebiotics, synbiotics, and nutraceuticals. The research status of Chinese herbal medicine is discussed for CAM and other therapies. This review can provide some treatment recommendations for the reduction of UTs in patients with chronic kidney disease.

Ultrasonic device developed for non-invasive moxibustion therapy

Background

Recently, some adverse effects of moxibustion has been reported such as burns, smoke, allergies, and so on. To overcome the adverse effects of traditional moxibustion, an ultrasonic moxibustion device (UMD) was designed, simulated, fabricated, and tested. The objective of this study is to provide detailed information about the main design parameters, simulation outcome, and performance-test results.

Methods

The main components of the UMD are a 1-MHz ultrasonic transducer (UT) with concave lens, and its applicator. The acoustic pressure and temperature distribution of the UT was simulated and described graphically using COMSOL software, which is based on the finite element method (FEM). Experimental verification of the temperature distribution was performed on the skin of pork. The temperature-change profiles of pork in relation to increase of therapy time were obtained at an unfocused point (2 mm) and at a focal distance of 13 mm. For the performance test, moxibustion therapy was conducted on the abdominal skin of mice for 120 min using the new UMD and its histological images were acquired to analyze the skin-tissue damage.

Results

The FEM simulation of temperature distribution and acoustic pressure agreed with the experimental outcome. Histological images showed that there was no skin-tissue damage to the mouse abdomens after therapy. The results clearly show that the newly developed UMD can overcome the disadvantages of traditional moxibustion therapy and achieve the proposed design parameters.

Conclusion

The FEM simulation and performance tests provided valuable information about developing future UMDs. In addition, its performance can be compared with traditional moxibustion therapy for future study.

The Beneficial Effects of Moxibustion on Overweight Adolescent Girls

Among adolescent girls, overweight or obesity has both physical and psychological involvement. We conducted a randomized controlled trial of moxibustion using a moxa burner. Fifty-four eligible girls aged 15-18 years with a body mass index (BMI) greater than 25.3 were enrolled in the study. The girls were randomly allocated to the treatment (n = 27) and control (n = 27) groups. The girls underwent treatment three times per week for 8 weeks (24 treatments). Moxibustion was applied to the RN12, RN6, ST25, ST36, and SP6 acupoints. Physical assessments were BMI, waist-to-hip ratio (WHR), and body fat ratio (BFR). Psychological outcomes were measured using the Rosenberg Self-Esteem Scale (RSE). Data were collected at the beginning of the study (baseline), week 4, and week 8. Of the 54 participants, 46 completed the trial. The difference in mean BMI from baseline between the two groups was 0.097 (p=0.655) at week 4 and -0.794 (p=0.001) at week 8. The mean WHR of the treatment group was significantly reduced compared with baseline, with a -0.011 (p=0.017) and -0.035 (p < 0.001) mean change at weeks 4 and 8, respectively. The mean BFR was slightly reduced (-0.253;p=0.474 ) at week 4 compared with baseline in the treatment group. At week 8, it was significantly reduced (-2.068; p < 0.001) from baseline in the treatment group. The mean RSE in the treatment group showed no significant increase from baseline at week 4 (0.155 points, p=0.803), but it improved significantly from baseline at week 8 (1.606 points, p=0.021) compared to that in the control group. No obvious adverse effect was reported during this study. Moxibustion using a moxa burner may be an effective and safe intervention for overweight adolescent girls, having both physical and psychological benefits.

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

BACKGROUND

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

METHODS

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

RESULTS

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

CONCLUSION

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

INPLASY REGISTRATION NUMBER

INPLASY202140063.

Moxibustion for stable chronic obstructive pulmonary disease: A protocol for systematic review and meta-analysis

BACKGROUND

There is no optimal treatment to alleviate the decline of lung function in the stable phase of chronic obstructive pulmonary disease (COPD). The effectiveness of moxibustion as an adjunctive treatment for COPD in the stable phase has been reported clinically, but the conclusions on efficacy and safety have not been unified. This study will systematically evaluate the efficacy and safety of moxibustion on the treatment of COPD in the stable phase, providing clinical-based evidence.

METHODS

We will systematically search 7 literature databases and 2 clinical trial registration platforms. The searching time will be conducted from the establishment of databases to March 31, 2021, regardless of language. We will include the randomized controlled trial (RCT) evaluation of moxibustion combined with basic therapy vs basic therapy alone for the treatment of stable COPD. We will assess the risk of bias for individual RCTs using the Cochrane Handbook 5.1.0 evaluation tool. The primary outcome is forced expiratory volume in 1 second/forced vital capacity. The secondary outcomes include forced expiratory volume in 1 second, forced vital capacity, six-minute walking distance, COPD assessment test score, maximum ventilation, response to treatment, and incidence of adverse events. We will collect the effective data of individual RCT through systematic analysis of the random effect model. Heterogeneity will be tested by Cochran Q test and I-squared statistics. Two subgroup analyses will be performed to explore the sources of heterogeneity based on clinical experience. Excluding RCTs with a high risk of bias, fixed-effect model will be used for sensitivity analysis to test the robustness of the meta-analysis results. The publication bias will be assessed by funnel plot and Egger test.

RESULTS

This study will provide systematic evidence on the efficacy and safety of moxibustion on the treatment of patients with stable COPD through strict quality assessment and reasonable data synthesis. We hope that the results will be submitted to a peer-reviewed journal for publication.

CONCLUSION

This systematic review will provide the best current evidence for the adjuvant treatment of stable COPD with moxibustion.

INPLASY REGISTRATION NUMBER

INPLASY202140047.

The efficacy of moxibustion and acupuncture therapy for ankylosing spondylitis: A protocol for an overview of systematic reviews and meta-analysis

BACKGROUND

Ankylosing spondylitis is a complex and progressive autoimmune inflammatory disease with a worldwide prevalence ranging up to 0.9%. Several systematic reviews and meta-analyses of traditional Chinese medicine alternative therapies, such as acupuncture or moxibustion, have demonstrated the effectiveness of moxibustion and acupuncture in the treatment of ankylosing spondylitis. However, there is no relevant literature to comprehensively evaluate the evidence. The purpose of this overview is to synthesize and evaluate the reliability of evidence generated in the systematic review (SR) and meta-analysis of moxibustion and acupuncture as a primary or complementary therapy for patients with ankylosing spondylitis.

METHODS

PubMed, EMBASE, the Cochrane Central Register of Controlled Trials, Chinese National Knowledge Infrastructure, Chinese VIP Information, Wanfang Database, and Chinese Biomedical Literature Database were searched for systematic reviews and meta-analysis that review the efficacy of acupuncture or moxibustion as the primary treatment for patients with Ankylosing Spondylitis. The literature published before August 2020 will be selected. Additionally, the relevant SRs and meta-analyses that unpublished or ongoing will be searched in PROSPERO and INPLASY. The methodological guidelines for overviews will be used to review and extract data by 2 reviewers, and their will do it independently. Methodology quality will be analyzed by the assessment of multiple systematic reviews-2and the risk of bias by POBIS. For the included studies, we will adopt the following results as primary evaluation indicators: effective rate, visual analogue scale and bath AS disease activity index. Reviewers will assess the certainty of evidence by Grading of Recommendations Assessment, Development and Evaluation.

RESULTS

The results will be published in a peer-reviewed journal.

CONCLUSION

This overview will provide comprehensive evidence of moxibustion and acupuncture for patients with Ankylosing Spondylitis.

Effectiveness and Safety of Moxibustion Robots on Primary Dysmenorrhea: A Randomized Controlled Pilot Trial

OBJECTIVE

To conduct a pilot trial to explore the effectiveness and safety of moxibustion robots in treating primary dysmenorrhea (PD) and evaluate its feasibility in clinic.

METHODS

A total of 70 participants with PD were allocated to either moxibustion robot (MR) group (35 cases) or manual moxibustion (MM) group (35 cases) using computer-generated randomization. One acupoint Guanyuan (CV 4) was selected to receive moxa heat stimulation. Two groups of participants were given 3 menstrual cycles of MM and MR treatment respectively (once a day, 5 days a session) and received another 3 menstrual cycles follow-up. The degree of pain was evaluated by short-form McGill pain questionnaire (SF-MPQ) and the symptoms of dysmenorrhea were evaluated by Cox Menstrual Symptom Scale (CMSS). The safety was measured by the occurrence rate of adverse events (AEs), including burns (blisters, red and swollen), itching, bowel changes, menstrual cycle disorder, menorrhagia and fatigue, etc. RESULTS: A total of 62 patients completed the trial, 32 in MR group and 30 in MM group. Compared with baseline, scores of SF-MPQ and CMSS significantly decreased in both groups (P<0.05), and no significant difference was observed between the two groups in the 3rd and 6th menstrual cycles (P>0.05). The total occurrence rate of AEs in MR group was 2.1%, which was significantly lower than MM group (7.2%, P<0.05).

CONCLUSIONS

MR has the same effect as MM at SF-MPQ and CMSS in patients with PD. However, MR is safer than MM (Trial registration No. ChiCTR1800018236).

Understanding Traditional Chinese Medicine Therapeutics: An Overview of the Basics and Clinical Applications

Traditional Chinese medicine (TCM) is a systematic healthcare system developed from clinical experience based on a scientific model of regulation. TCM relies on unique theories and practices to treat diseases and enhance health. These practices include Chinese herbal medicine and dietetics, acupuncture and moxibustion, and other non-medication therapies such as Chinese bodywork or manual therapy, known as "Tuina", and traditional biofeedback exercises, known as "Qigong" and "Taijiquan". The integration of TCM in Western health systems and research requires a rational communicable theory, scientific proof of efficacy and safety, and quality control measures. Understanding the structural concepts of the TCM language makes possible the parallelism to Western physiology, and the inherent rational use of the reflex therapeutic systems, anti-inflammatory mechanisms and mental training involved, for example, in acupuncture and "Qigong". The results of TCM clinical trials and fundamental research on its nature and mechanisms have encouraged the development and application of well-designed research strategies such as double blinding in acupucture to overcome limitations and resistances in integrating these practices into the existing biomedical paradigms of the West. This review aims to overview some TCM theoretical concepts and the evidence-based clinical application of TCM's leading practices to create an easy-to-consult and condensed source of information, available for the healthcare community, facilitating the understanding and communication between conventional health professionals and TCM practitioners and acupuncturists.

The treatment of intervertebral disc degeneration using Traditional Chinese Medicine

ETHNOPHARMACOLOGICAL RELEVANCE

Intervertebral disc degeneration (IDD) is one of the most common causes of chronic low back pain that spending a lot of workforces and financial resources, seriously affecting human physical and mental health. Clinically used drug treatments and surgical treatments cannot fundamentally relieve the disease and have a risk of recurrence. Traditional Chinese Medicine (TCM) has a history of more than a thousand years in the prevention and treatment of IDD. However, so far, there are few reviews on the treatment of IDD by TCM. Therefore, it is crucial and necessary to systematically mine the existing literature on the treatment of IDD with TCM. This paper strives to systematically describe the modern medicine and TCM theoretical research on IDD, progress in the treatment of IDD and focuses on the treatment of IDD by TCM, which would lay some theoretical foundation and provide new directions for future research.

MATERIALS AND METHODS

Information on clinical observations, animal experiments and relevant pharmacology data about the treatment of IDD were gathered from various sources including traditional Chinese books and Chinese Pharmacopoeia, scientific databases (Elsevier, PubMed, Science Direct, Baidu Scholar, CNKI, Spring Link, Web of Science) and from different professional websites.

RESULTS

This review mainly introduces the current research on the theoretical research on IDD, the combination principle of the TCM formula, and the underlying mechanism of the formula and active ingredients.

CONCLUSIONS

At present, domestic and foreign scholars have carried out a lot of research in different ways, such as the molecular mechanism and predisposing factors of IDD, which provides theoretical development and clinical practice significance for future research. TCM, as a multi-component and multi-targeted drug, can produce synergistic effects to exert its efficacy. Therefore, the development of TCM with more specific functions and practical data will not only become a significant trend in the world market but also has an irreplaceable role in the future treatment of IDD.

Analysis of the Components in Moxa Smoke by GC-MS and Preliminary Discussion on Its Toxicity and Side Effects

Moxibustion plays an important role in the prevention and treatment of diseases and the promotion of human health. In this study, the components in moxa smoke from Jiangxi Poai Biotechnology Co., Ltd., namely, Qing moxa sticks, were absorbed by five solvents (cyclohexane, ethyl acetate, n-butanol, anhydrous ethanol, and water) and identified by gas chromatography-mass spectrometry. The identification results of the smoke from the Qing moxa sticks that was absorbed in liquid are as follows: a total of 294 compounds were identified, including 139 in cyclohexane, 145 in ethyl acetate, 60 in n-butanol, 89 in anhydrous ethanol, and 77 in water, and of those, 112 toxic compounds were identified. Furthermore, Ingenuity Pathway Analysis software and the PubChem database were successfully applied to analyze the toxic compounds. There were 812 target proteins related to the toxic components, 25 molecular networks, and 54 biological pathways. The results showed that the toxic compounds of moxa smoke may have some side effects on the heart, liver, and kidney of humans. This study revealed that the components of moxa smoke are complex and diverse. Due to the findings of toxic compounds in moxa smoke, we recommend that moxibustion rooms should be equipped with ventilation equipment or enough artificial ventilation to ensure the health of patients and practitioners.

Moxibustion as an Adjuvant Therapy for Chronic Kidney Disease: A Systematic Review and Meta-Analysis of 23 Randomized Controlled Trials

OBJECTIVE

This systematic review aims to investigate the efficacy and safety of moxibustion for chronic kidney disease (CKD).

METHODS

Nine databases were searched to identify relevant evidence up to March 8, 2020. Randomized controlled trials (RCTs) that tested moxibustion + basic treatments versus basic treatments alone for patients with CKD and reported, at least, one of the outcomes of interest were included. In the meta-analyses, the mean differences (MDs) and 95% confidence intervals (CIs) were used to measure the effect size.

RESULTS

Twenty-three RCTs (n = 1571) with a moderate to high risk of bias were included. The pooled estimates showed that compared with the controls, patients after moxibustion had a significant reduction in serum creatinine (MD -17.34 μmol/L, 95% CI -28.44 to -6.23; I 2 = 87%), 24-hour urine protein excretion (MD -0.75 g/h, 95% CI -1.07 to -0.42; I 2 = 84%), and blood urea nitrogen (MD -0.63 mmol/L, 95% CI -1.09 to -0.18; I 2 = 37%) and a significant improvement in the quality of life (MD 10.18, 95% CI 3.67 to 16.69; I 2 = 57%). Moxibustion did not show a significant effect on the estimated glomerular filtration rate (eGFR), creatinine clearance, or hemoglobin. The subgroup analyses showed that a longer course of moxibustion (>8 weeks) and indirect moxibustion had a greater effect on reducing serum creatinine. The effect of moxibustion on blood urea nitrogen changed to be nonsignificant after excluding RCTs with a high risk of bias (MD -0.96 mmol/L, 95% CI -2.96 to 1.03). Only one adverse event of burn was reported.

CONCLUSIONS

This systematic review suggests that, as an adjuvant therapy, moxibustion may improve serum creatinine, urinary protein excretion, blood urea nitrogen, and quality of life in patients with CKD. Moxibustion may not have effects on eGFR, creatinine clearance, or hemoglobin. The quality of evidence is weakened by the limitations of risk of bias, heterogeneity, and imprecision.

Experimental and Numerical Study on the Temperature Elevation in Tissue during Moxibustion Therapy

Moxibustion is a thermal therapy in traditional Chinese medicine that relies on the heat from burning moxa to be transferred beneath the skin surface. Although moxibustion has long been in widespread practice, the mechanism of heat transfer modality and temperature distribution during this treatment is not yet well understood. The current paper presents the first examination by magnetic resonance imaging (MRI) of the three-dimensional temperature elevation during moxibustion treatment. A mathematical model for the prediction of temperature elevation during moxibustion therapy has been constructed and compared with the experimental data. Good agreement between the measured temperature and the results of numerical calculations has been found. Tissue up to 3 cm deep can be heated during the treatment. It was revealed that both heat conduction and radiation heat transfer play important roles during the treatment. The results presented in the current paper can be used for understanding the mechanisms of Chinese medicine and developing useful guidelines for Chinese medicine doctors.

Effects of Moxibustion and Moxa Smoke on Behavior Changes and Energy Metabolism in APP/PS1 Mice

Objective

To investigate the antiaging effects of moxibustion and moxa smoke on APP/PS1 mice and to illustrate the mechanism of moxibustion improving Alzheimer's disease (AD).

Methods

36 male APP/PS1 mice were randomly assigned into three groups (n = 12), including a model control group, a moxibustion group, and a moxa smoke group. In addition, 12 C57BL/6 normal mice served as a normal (negative) control group. Mice in the moxibustion group received moxibustion intervention using Guanyuan (RN4) acupoint. Mice in the moxa smoke group received moxa smoke exposure with the same frequency as the moxibustion group. Behavioral tests were implemented in the 9th week, 3 days after the completion of the intervention. Tricarboxylic acid cycle and fatty acid metabolomics assessments of the mice were determined after behavioral tests.

Results

In this study, relative to normal mice, we found that AD mice showed altered tricarboxylic and fatty acid metabolism and showed behavioral changes consistent with the onset of AD. However, both the moxibustion and moxa smoke interventions were able to mitigate these effects to some degree in AD mice.

Conclusions

The data suggest that tricarboxylic acid cycle and unsaturated fatty acid metabolomics changes may be a target of AD, and the beneficial effects of moxibustion on cognitive behaviors may be mediated by the energy metabolism system.

Psychophysical and psychophysiological effects of heat stimulation by electric moxibustion

OBJECTIVES

Traditional moxibustion might be not safe due to the excessive heat stimulation or toxic chemical components involved. Electric moxibustion (EM), which has been recently developed as an alternative, offers adjustable and constant heat stimulation. This study aimed to investigate the psychophysical and psychophysiological responses to EM heat stimulation.

METHODS

Twenty-seven healthy volunteers received two different levels of heat stimulation using EM. High-temperature (HT) and medium-temperature (MT) heat stimulations were randomly delivered at the TE5 acupoint on the left or right arm. Participants rated the intensity and the spatial information of the heat sensations immediately after each EM stimulation. Local blood flow around the acupoint was measured with Laser Doppler perfusion imaging before and after heat stimulation.

RESULTS

Both HT-EM and MT-EM induced considerable heat sensations and enhanced local blood flow around the acupoints. HT-EM resulted in greater heat sensation compared to MT-EM. HT-EM induced a higher increase in local blood flow around the stimulation site compared to MT-EM. No remarkable adverse effects were noted.

CONCLUSION

Two different levels of EM heat stimulation induced two different levels of heat sensations and enhanced local blood flow. This preliminary study suggests that the newly developed EM can be further applied to examine the effectiveness of moxibustion in clinical trials.

Gut microbiota was modulated by moxibustion stimulation in rats with irritable bowel syndrome

Background

The pathogenesis of irritable bowel syndrome (IBS) is closely related to intestinal dysbacteriosis and can be controlled by moxibustion treatment. However, the mechanism underlying the therapeutic value of moxibustion in IBS treatment remains unknown.

Methods

An IBS rat model was established by colorectal distention (CRD) stimulus and mustard oil clyster. Sixty-five male rats were randomly divided into six groups: normal, IBS model, moxibustion, electroacupuncture (EA), Bifid-triple Viable Capsule (BTVC) and Pinaverium Bromide (PB) groups. The moxibustion group was treated with mild moxibustion at the bilateral Tianshu (ST25) and Shangjuxu (ST37) for 10 min/day for 7 days, the EA group was given EA at ST25 and ST37 once daily for 7 days, while the BTVC group and PB groups received Bifid-triple Viable Capsule and Pinaverium Bromide solution (at the proportion of 1:0.018) respectively by gavage once daily for 7 days. After the treatment, abdominal withdrawal reflex (AWR) scores were determined based on CRD stimulus, gut microbiota profiling was conducted by 16S rRNA high-throughput sequencing.

Results

Irritable bowel syndrome model rats had significantly increased AWR scores at all intensities (20, 40, 60 and 80 mmHg) compared with the normal group. Moxibustion treatment significantly reduced AWR scores compared with the IBS model group at all intensities. Across all groups the most abundant phyla were Bacteroidetes and Firmicutes followed by Proteobacteria and Candidatus Saccharibacteria. At genus level IBS model rats had a higher abundance of Prevotella, Bacteroides and Clostridium XI and a lower abundance of Lactobacillus and Clostridium XIVa compared with normal rats. These changes in microbiota profiles could however be reversed by moxibustion treatment. Alpha diversity was decreased in IBS model rats compared with normal rats, yet significantly increased in moxibustion- and PB-treated rats compared with IBS rats.

Conclusion

Our findings suggest that moxibustion treats IBS by modulating the gut microbiota.

Exploring the Relationship between Blood Flux Signals and HRV following Different Thermal Stimulations using Complexity Analysis

To investigate the relationship between local blood flux and heart rate variability following different thermal stimulations, healthy subjects were recruited and subject to different thermal stimulations on the right forearm. Multiscale entropy and multiscale fuzzy entropy were used to measure the complexity of the local blood flux, and the approximate entropy was calculated to evaluate the HRV complexity. The results indicated that thermal stimulation significantly increased local blood flux and that different temperature stimulations resulted in different complexities in local blood flux. A 42 °C or 44 °C thermal stimulation, other than stimulations below 42 °C, resulted in a moderate correlation between local blood flux and heart rate variability complexity. The results provide a new perspective in terms of complexity to explore the relationship between skin blood flux signals and cardiac function.

Moxibustion (Artemisia Plant at Acupuncture Point) as Alternative Therapy in Hypertension: A Promising Approach

Hypertension is a pathological condition in which the blood pressure is higher than under normal physiological conditions, i.e., 140/90 mmHg or higher. Blood pressure is measured as the force exerted by the blood pumped by the heart against the walls of arteries (aorta) and distributed throughout the body. Use of complementary and alternative medicine as a cure for hypertension is a common phenomenon because of the high risk of cardiovascular complications and kidney diseases caused by conventional Western medicine. It is reported that high blood pressure causes ~49% of myocardial infarction and 62% of strokes. Effective treatment of hypertension is restricted by adverse effects and cost of the medication. Moxibustion is the application of heat by burning a small bundle of tightly bound moxa, to targeted acupoint, and sometimes it is used along with acupuncture. Encouraging results have been reported on randomized trials indicating the efficacy of moxibustion. But more controlled clinical trials are required to further establish the potential efficacy of moxibustion approach in hypertension.

An In Vitro and Numerical Study of Moxibustion Therapy on Biological Tissue

OBJECTIVE

Moxibustion therapy achieves satisfactory therapeutic effects largely depending on the heat stimulation of burning moxa. Understanding the thermal characteristics of heating process is an effective way to reveal the underlying mechanisms of moxibustion therapy.

METHODS

This paper performs experimental study on temperature distributions of burning moxa sticks and fresh in vitro porcine abdominal tissue using an infrared camera and thermocouples. Meanwhile, a moxibustion model incorporating moxa stick burning model and tissue heat transfer model was established with consideration of radiation propagation and water evaporation.

RESULTS

The burning features of moxa sticks were acquired and the radiation energy generated by the burning moxa stick was absorbed and scattered in biological tissue, resulting in a large temperature gradient in the skin layer. And the water evaporation led to a mass loss and reduced skin surface temperature. The numerical model was verified by experimental results and the effects of moxibustion treatment distance and duration can be quantified based on model calculation.

CONCLUSION

The detailed heat transfer process of moxibustion was obtained experimentally and numerically. During moxibustion, the radiation attenuation and water evaporation have a significant influence on the energy transport in biological tissue which cannot be ignored. The treatment distance of 3 cm is the recommended value to achieve the treatment efficacy without thermal damage and pain.

SIGNIFICANCE

This research would reveal the underlying mechanisms of moxibustion therapy. Besides, the developed models are expected to establish a guideline for moxibustion clinical treatment.

Moxibustion in Early Chinese Medicine and Its Relation to the Origin of Meridians: A Study on the Unearthed Literatures

Moxibustion is an integral part of Traditional Chinese Medicine (TCM). It achieved higher level of recognition and had more general application in ancient times than in contemporary life. As the vital historical sources, the records of unearthed literatures offered precious insights to Chinese social life pattern and medical practice in Qin and Han dynasties (221 BC–220 AD). There was no surprise that the bamboo and silk documents excavated from Mawangdui (马王堆) tomb, Hantanpo (旱滩坡) tomb, and other relics had a large amount of texts relevant to moxibustion. This research sorted moxibustion recordings from seven unearthed literatures and discovered that moxibustion had been developed into different modalities and utilized to treat many diseases at that time. In addition, the indications, contraindications of moxibustion, and the method of postmoxibustion care were also discussed. On this basis, some hints were provided to support the hypothesis that the practice of moxibustion led to the discovery of meridians. All our preliminary results in the research have drawn attention for this old therapy and given a new source for its application in clinic and scientific research.

Moxibustion for pain relief in patients with primary dysmenorrhea: A randomized controlled trial

BACKGROUND

Though moxibustion is frequently used to treat primary dysmenorrhea in China, relevant evidence supporting its effectiveness is still scanty.

METHODS

This study was a pragmatic randomized, conventional drug controlled, open-labeled clinical trial. After initial screen, 152 eligible participants were averagely randomized to receive two different treatment strategies: Moxibustion and conventional drugs. Participants and practitioners were not blinded in this study. The duration of each treatment was 3 months. The primary outcome was pain relief measured by the Visual Analogue Scale. The menstrual pain severity was recorded in a menstrual pain diary.

RESULTS

152 eligible patients were included but only 133 of them eventually completed the whole treatment course. The results showed that the menstrual pain intensity in experimental group and control group was reduced from 6.38±1.28 and 6.41±1.29, respectively, at baseline, to 2.54±1.41 and 2.47±1.29 after treatment. The pain reduction was not significantly different between these two groups (P = 0.76), however; the pain intensity was significantly reduced relative to baseline for each group (P<0.01). Three months after treatment, the effectiveness of moxibustion sustained and started to be superior to the drug's effect (-0.87, 95%CI -1.32 to -0.42, P<0.01). Secondary outcome analyses showed that moxibustion was as effective as drugs in alleviating menstrual pain-related symptoms. The serum levels of pain mediators, such as PGF2α, OT, vWF, β-EP, PGE2, were significantly improved after treatment in both groups (P<0.05). No adverse events were reported in this trial.

CONCLUSIONS

Both moxibustion and conventional drug showed desirable merits in managing menstrual pain, given their treatment effects and economic costs. This study as a pragmatic trial only demonstrates the effectiveness, not the efficacy, of moxibustion for menstrual pain. It can't rule out the effect of psychological factors during treatment process, because no blind procedure or sham control was used due to availability. In clinical practice, moxibustion should be used at the discretion of patients and their physicians.

TRIAL REGISTRATION

ClinialTrials.gov NCT01972906.

Moxibustion for Primary Dysmenorrhea at Different Interventional Times: A Systematic Review and Meta-Analysis

Primary dysmenorrhea (PD) is one of the most common diseases in gynecology at present. Some clinical trials have reported the effects of moxibustion and confirmed temporal factors are the important elements influencing the efficacy of moxibustion. However, no systematic review has yet been conducted. In this study, we assessed the effects of moxibustion in patients with PD enrolled in randomized controlled trials (RCTs) and the difference among different intervention times to start moxibustion. We extracted data for studies searched from 10 electronic databases and evaluated the methodological quality of the included studies. We discussed three outcomes: effective rate, pain remission, and the level of PGF2α in serum. Current clinical researches showed that, compared with nonmoxibustion treatments for PD, moxibustion leads to higher effective rate and lower level of PGF2α in serum. However, there was no difference in using moxibustion to treat PD at different intervention times. Based on the theory of Chinese medicine and the results of this study, choosing 5 ± 2 days before menstruation to start moxibustion can achieve good efficacy for PD patients. However, more high-quality RCTs are needed to confirm the conclusions.

Moxibustion Treatment for Knee Osteoarthritis: A Systematic Review and Meta-Analysis

To determine whether the administration of moxibustion is an effective treatment for knee osteoarthritis (KOA).We conducted a search of relevant articles using Medline, EMBASE, the Web of Science, and the Cochrane Library published before October 2015. The Western Ontario and McMaster Universities' Osteoarthritis Index (WOMAC scale) and the short form 36 questionnaire (SF-36 scale) were assessed. Evidence grading was evaluated according to the Grading of Recommendations, Assessment, Development and Evaluation system.Four studies containing 746 participants fulfilled the inclusion criteria in the final analysis. In terms of quality of life (QOL), the meta-analysis of 2 randomized clinical trials (RCTs) showed significantly effects of moxibustion only in bodily pain (BP) compared with those in the control group (n = 348; weighted mean difference [WMD], 4.36; 95% confidence intervals [CIs], 2.27-6.44; P < 0.0001; heterogeneity: χ = 1.53, P = 0.22, I = 34%) in all of the subcategories of the SF-36 scale, with moderate quality. The meta-analysis of the 2 included trials showed that there was not a statistically significant difference in the pain or function subscale for the WOMAC scale when the 2 groups were compared (n = 322; WMD, 17.63; 95% CI, -23.15-58.41; P = 0.40; heterogeneity: χ = 19.42, P < 0.0001, I = 95%), with low or moderate quality separately.The administration of moxibustion can to some extent alleviate the symptoms of KOA. More rigorous, randomized controlled trials are required in the future.

Additional Effects of Back-Shu Electroacupuncture and Moxibustion in Cardioprotection of Rat Ischemia-Reperfusion Injury

Many preclinical studies show that electroacupuncture (EA) on PC6 and ST36 can reduce infarct size after ischemia-reperfusion (IR) injury. Yet studies to enhance the treatment effect size are limited. The purpose of this study was to explore whether EA has additional myocardial protective effects on an ischemia-reperfusion (IR) injury rat model when back-shu EA and moxibustion are added. SD rats were divided into several groups and treated with either EA only, EA + back-shu EA (B), or EA + B + moxibustion (M) for 5 consecutive days. Transthoracic echocardiography and molecular and immunohistochemical evaluations were performed. It was found that although myocardial infarct areas were significantly lower and cardiac function was also significantly preserved in the three treatment groups compared to the placebo group, there were no additional differences between the three treatment groups. In addition, HSP20 and HSP27 were expressed significantly more in the treatment groups. The results suggest that adding several treatments does not necessarily increase protection. Our study corroborates previous findings that more treatment, such as prolonging EA duration or increasing EA intensity, does not always lead to better results. Other methods of increasing treatment effect size should be explored.

PM2.5 and ash residue from combustion of moxa floss

BACKGROUND

Moxibustion, a Traditional Chinese Medicine technique, involves burning moxa floss to apply heat to certain points or areas of the body surface to treat disease. Moxibustion releases a considerable amount of smoke into the environment. There remains controversy over the safety of moxa smoke and its potential effects on human health.

METHODS

We measured the PM2.5 (particulate matter with aerodynamic diameter <2.5 μm) mass concentration in moxa smoke and the oxidative capacity of PM2.5 and moxa ash (using a plasmid scission assay in whole and water-soluble fractions) in the by-products of moxibustion produced from burning moxa floss of different ratios (3:1 or 15:1) and duration of storage (3 or 10 years) in three simulated moxibustion clinics.

RESULTS

PM2.5 mass concentration was 224.28, 226.39  and 210.56 μg/m(3) for samples A (3 years and 3:1 ratio), B (3 years and 15:1 ratio), and C (10 years and 3:1 ratio), respectively. Average D500 oxidative damage of PM2.5 was 29.42%, 29.16% and 27.01% and that of moxa ash was 22.78%, 20.60% and 21.42% for samples A, B and C, respectively. PM2.5 demonstrated a significantly greater oxidative capacity than moxa ash (p<0.05).

CONCLUSIONS

The oxidative DNA damage induced by individual PM2.5 following moxibustion was lower than that reported in other environments. However, PM2.5 mass concentration after moxibustion is still relatively high. We would recommend ensuring adequate ventilation during moxibustion to reduce any possible risks. Further studies are needed to better define the potential impact of particles in moxibustion by-products on human health.

Moxibustion relieves visceral hyperalgesia via inhibition of transient receptor potential vanilloid 1 (TRPV1) and heat shock protein (HSP) 70 expression in rat bone marrow cells

OBJECTIVE

To investigate the effects of moxibustion on visceral hyperalgesia (VH) and bone marrow cell transient receptor potential vanilloid type 1 (TRPV1) and heat shock protein (HSP) 70 expression in a rat model of VH.

METHODS

Mechanical colorectal distension was performed to induce VH in neonatal Sprague-Dawley rats. Eight-week-old VH rats were treated with moxibustion at acupuncture point BL25 or an ipsilateral non-acupuncture point. Abdominal withdrawal reflex (AWR) scoring and pain threshold pressure assessment were performed before and after moxibustion treatment for 7 consecutive days. The expression of TRPV1 and HSP70 in bone marrow cells was quantified by real-time quantitative PCR.

RESULTS

The expression of TRPV1 and HSP70 in bone marrow cells was increased in rats with VH. Moxibustion at BL25 significantly decreased AWR scores and increased pain threshold pressure in rats with VH. Furthermore, moxibustion at BL25 significantly inhibited the VH-induced increase in the expression of TRPV1 and HSP70 in bone marrow cells.

CONCLUSIONS

The up-regulation of TRPV1 and HSP70 expression in bone marrow cells may be involved in visceral pain development and the analgesic effect of moxibustion on VH may be mediated through down-regulation of TRPV1 and HSP70 expression in bone marrow cells.

Effects of Different Local Moxibustion-Like Stimuli at Zusanli (ST36) and Zhongwan (CV12) on Gastric Motility and Its Underlying Receptor Mechanism. Evid Based Complement Alternat Med. 2015;2015:486963. [PMID: 26246837 PMCID: PMC4515267 DOI: 10.1155/2015/486963]

The aim of this study was to explore the "intensity-response" relationship in local moxibustion-like stimuli- (LMS-) modulated gastric motility and its underlying receptor mechanism. Based on the thermal pain threshold (43°C), 41°C, 43°C, and 45°C LMS were separately applied to ST36 or CV12 for 180 s among ASIC3 knockout (ASIC3-/-) mice, TRPV1 knockout (TRPV1-/-) mice, and their homologous wild-type C57BL/6 mice (n = 8 in each group). Gastric motility was continuously measured by an intrapyloric balloon, and the amplitude, integral, and frequency of gastric motility during LMS were compared with those of initial activities. We found that both 43°C and 45°C LMS at ST36 induced significantly facilitated effect of gastric motility (P < 0.05), while LMS at CV12 induced inhibited effects (P < 0.05). 41°C LMS had no significant impact on gastric motility. Compared with C57BL/6 mice, the facilitatory effect at ST36 and inhibitive effect of LMS at CV12 were decreased significantly in TRPV1-/- mice (P < 0.05; P < 0.01) but not changed markedly in ASIC3-/- mice (P > 0.05). These results suggest that there existed an "intensity-response" relationship between temperature in LMS and its effects on gastric motility. TRPV1 receptor played a crucial role in the LMS-modulated gastric motility.

Standardisation of Moxibustion: Challenges and Future Development

International organisations such as WHO and the International Organization for Standardization are increasingly committed to the development of traditional Chinese medicine (TCM). Moxibustion is an integral modality of acupuncture that has been in use for thousands of years. It stands out as a health choice due to its potential effects in disease prevention, health promotion and maintenance, as well as affordability and accessibility. As the use of moxibustion increases, concerns are being raised regarding its safety and quality. The need to establish standards to protect patient safety is paramount in all medical fields. As a form of medical practice, it is essential to develop moxibustion standards in the areas of terminology, moxibustion products, treatment rooms and practice to ensure its harmonisation and safe usage. The evidence base guiding policy and decision making has to be based on evidence from basic and clinical research. Promoting strategic basic and clinical research on the safety and effectiveness of moxibustion will answer some of the fundamental questions surrounding moxibustion, create a climate of awareness and acceptance and, in turn, drive its standardisation.

Moxibustion Activates Macrophage Autophagy and Protects Experimental Mice against Bacterial Infection

Moxibustion is one of main therapies in traditional Chinese medicine and uses heat stimulation on the body surface from the burning of moxa to release pain or treat diseases. Emerging studies have shown that moxibustion can generate therapeutic effects by activating a series of signaling pathways and neuroendocrine-immune activities. Here we show moxibustion promoted profound macrophage autophagy in experimental Kunming mice, with reduced Akt phosphorylation and activated eIF2α phosphorylation. Consequently, moxibustion promoted bacterial clearance by macrophages and protected mice from mortality due to bacterial infection. These results indicate that moxibustion generates a protective response by activating autophagy against bacterial infections.

Effectiveness of moxibustion treatment as adjunctive therapy in osteoarthritis of the knee: a randomized, double-blinded, placebo-controlled clinical trial

Introduction

Our objective was to compare the effectiveness and safety of traditional Chinese moxibustion to that of sham moxibustion in patients with chronic knee osteoarthritis (KOA) pain.

Methods

We conducted a randomized placebo-controlled trial involving 110 patients with KOA who met the inclusion criteria. These patients randomly received either active moxibustion (n = 55) or sham moxibustion control (n = 55) at acupoints Dubi (ST 35), extra-point Neixiyan (EX-LE 4), and an Ashi (tender) point three times a week for 6 weeks. Effects were evaluated with Western Ontario and McMaster Universities’ Osteoarthritis Index (WOMAC VA 3.1) criteria at the end of the course of treatment and 3, 12, and 24 weeks after the initial treatment.

Results

The WOMAC pain scores showed greater improvement in the active treatment group than in control at weeks 3 (P = 0.012), 6 (P <0.001), 12 (P = 0.002), and 24 (P = 0.002) as did WOMAC physical function scores of the active treatment group at week 3 (P = 0.002), 6 (P = 0.015), and 12 (P <0.001) but not 24 (P = 0.058). Patients and practitioners were blinded successfully, and no significant adverse effects were found during the trial.

Conclusions

A 6-week course of moxibustion seems to relieve pain effectively and improve function in patients with KOA for up to 18 weeks after the end of treatment. Moxibustion treatment appears to be safe, and the usefulness of the novel moxa device was validated.

Trial registration

Current controlled trial: ISRCTN68475405. Registered 4 April 2014.

Somatosensory Nerve Fibers Mediated Generation of De-qi in Manual Acupuncture and Local Moxibustion-Like Stimuli-Modulated Gastric Motility in Rats. Evid Based Complement Alternat Med. 2014;2014:673239. [PMID: 24876876 PMCID: PMC4021835 DOI: 10.1155/2014/673239]

The aim of this study was to reveal the somatosensory nerve fibers mediated generation of De-qi in manual acupuncture stimuli (MAS) and local moxibustion-like stimuli (LMS). The effects of strong and slight MAS, as well as 41°C, 43°C, and 45°C LMS at ST36 and CV12 on gastric motility were observed in rats. Gastric motility was continuously measured by an intrapyloric balloon, and the average amplitude, integral, and frequency of gastric motility during LMS were compared with those of background activity. Gastric motility was facilitated by MAS and LMS at ST36 and inhibited at CV12. The modulatory effects induced by strong MA with potent De-qi (needle grasp feeling) were markedly higher than those by slight MA with mild De-qi sensation (P < 0.05). The nociceptive 43°C and 45°C LMS, rather than nonnociceptive 41°C LMS, produced significant regulatory effects on gastric motility. Based on the afferent fibers activated in the present study, these results support the hypothesis that Aδ- and C-afferent fibers were more likely to be involved in the generation of De-qi sensation.

Effectiveness study of moxibustion on pain relief in primary dysmenorrhea: study protocol of a randomized controlled trial

Dysmenorrhea is a prevalent problem in menstruating women. As a nonpharmacologic and free of relevant side effects intervention, moxibustion is considered as a safe treatment and has long been recommended for dysmenorrhea in China. However, the exact effects of moxibustion in PD have not been fully understood. Therefore we designed this random clinical trial aiming to (1) investigate whether moxibustion is safe and effective for pain relief in primary dysmenorrhea when compared to conventional pain-killers and (2) assess the acceptability and side effects associated with moxibustion. The results of this trial will contribute to a better understanding of the different effects of moxibustion in pain relief in primary dysmenorrhea when compared to conventional pharmacologic pain treatment.

The complementary and alternative medicine for endometriosis: a review of utilization and mechanism

Endometriosis (EM) is one of the common gynecological conditions causing menstrual and pelvic pain and affects 10%-15% of women of reproductive age. In recent years, the complementary and alternative medical (CAM) treatment for EM has become popular due to the few adverse reactions reported. The CAM therapy for EM includes several different treatments such as herbs (herbal prescription, extract, and patent), acupuncture, microwave physiotherapy, and Chinese herb medicine enema (CHM enema). These CAM therapies are effective at relieving dysmenorrhoea, shrinking adnexal masses, and promoting pregnancy, with less unpleasant side effects when compared to hormonal and surgical treatments. In this review, we focus on the status quo of CAM on EM and try to identify therapeutic efficacy and mechanisms based on some clinical and experimental studies. We hope to provide some instructive suggestions for clinical treatment and experimental research in the future.

Gene Expression Profiles at Moxibustioned Site (ST36): A Microarray Analysis

As a major alternative therapy in Traditional Chinese Medicine, it has been demonstrated that moxibustion could generate a series of molecular events in blood, spleen, and brain, and so forth. However, what would happen at the moxibustioned site remained unclear. To answer this question, we performed a microarray analysis with skin tissue taken from the moxibustioned site also Zusanli acupoint (ST36) where 15-minute moxibustion stimulation was administrated. The results exhibited 145 upregulated and 72 downregulated genes which responded immediately under physiological conditions, and 255 upregulated and 243 downregulated genes under pathological conditions. Interestingly, most of the pathways and biological processes of the differentially expressed genes (DEGs) under pathological conditions get involved in immunity, while those under physiological conditions are involved in metabolism.