[An auxiliary device for double-blind placebo acupuncture research]

This device is an auxiliary device with reasonable design for placebo acupuncture research, so as to make double-blind placebo acupuncture control possible. This new auxiliary acupuncture device includes an acupuncture device and a placebo acupuncture device with exactly the same appearance. Both of them are composed of a hemispherical base and a telescopic tube. Through the rotation of the telescopic tube in the notch of the base, the insertion angle of needles can be adjusted from 15 degrees to 165 degrees. The operation of twisting and lifting and inserting can be carried out through the horizontal rotation and vertical sliding of the telescopic tube. A silicone needle pad is arranged in the base, which can simulate the blocking feeling of skin and muscle during needle insertion. The bottom of the base is attached with hydrogel, which has good fixity. The auxiliary device is applicable to multiple parts of the human body and can effectively reduce the risk of unblinding.

The efficacy and safety of fire needle for cervical spondylotic radiculopathy: A protocol for systematic review and meta-analysis

BACKGROUND

Cervical spondylotic radiculopathy (CSR) is one of the most common types of cervical spondylosis, and its treatments are mainly for relieving radicular pain and improving dysfunction. The existing randomized controlled trials (RCTs) suggest that fire needle may be a potential therapy in the treatment of CSR, but there is no evidence-based medical evidence to date. Therefore, this study will systematically evaluate the efficacy and safety of fire needle in the treatment of CSR.

METHODS

We will search for 7 electronic databases (PubMed, EMBASE, Cochrane library, China National Knowledge Infrastructure, Chinese Scientific Journals Database, Sinomed, and Wanfang Database) and 2 trial registration platforms (ClinicalTrials.gov and Chinese Clinic Trials.gov) to collect eligible studies. The RCTs related to fire needle for CSR and published up to June 30, 2021 will be included, regardless of language. We will consider the visual analogue scale as the primary outcome and the secondary outcome will include cervical range of motion, assessment of muscle strength, neck disability index, the MOS item short from health survey, activities of daily living, total efficiency, and adverse reactions. We will use the standard proposed in Cochrane Handbook 5.1.0 to assess the quality and bias risk of every RCT, and all analyses will be conducted through RevMan software V5.3 (Copenhagen: Nordic Cochrane Center, Cochrane, Collaborative Organization, 2014).

RESULTS

This systematic review and meta-analysis will provide a convincing synthesis of existing evidences on the efficacy and safety of fire needle for CSR, and the results will be submitted to a peer-reviewed journal for publication.

CONCLUSION

The results of this study will provide high-quality evidence of fire needle in the treatment of CSR for clinical decision-making.

INPLASY REGISTRATION NUMBER

INPLASY202170041.

Electrophysiologically verified effects of acupuncture on diabetic peripheral neuropathy in type 2 diabetes: The randomized, partially double-blinded, controlled ACUDIN trial

BACKGROUND

Acupuncture is commonly used in Traditional Chinese Medicine for treatment of diabetic peripheral neuropathy (DPN), but data from randomized controlled trials are rare.

METHODS

This randomized, placebo-controlled, partially double-blinded clinical trial randomly assigned adults with confirmed type 2 diabetes-induced DPN to receive 10 sessions of needle acupuncture, laser acupuncture, or placebo laser acupuncture for 10 consecutive weeks. Treatment was provided at bilateral acupoints Ex-LE-10 (Bafeng), Ex-LE-12 (Qiduan), and ST-34 (Lianqiu). Neurological assessments, including nerve conduction studies (NCS) of sural and tibial nerves, were performed at baseline and weeks 6 and 15. Primary outcome was delta of sural sensory nerve action potential (SNAP). Secondary outcomes included further NCS values, clinical scores, and patient-reported outcome measures (PROMs).

RESULTS

Of 180 participants, 172 completed the study. Sural SNAP and sural and tibial nerve conduction velocities improved significantly after 10 treatments when comparing needle acupuncture to placebo. Needle acupuncture showed earlier onset of action than laser acupuncture. PROMs showed larger improvements following needle and laser acupuncture than placebo, reaching significant differences for hyperesthesia and cramps following needle acupuncture and for heat sensation following laser acupuncture.

CONCLUSIONS

Classical needle acupuncture had significant effects on DPN. Improvement in NCS values presumably indicates structural neuroregeneration following acupuncture.

The efficacy and safety of silver needle in the treatment of rheumatoid arthritis: A protocol of randomized controlled trial

BACKGROUND

Rheumatoid arthritis is a kind of chronic crippling disease, the condition is complex, the course of the disease is repeated, seriously affecting the quality of life of patients. Adverse reactions and drug resistance associated with conventional treatment can no longer meet the clinical need. Therefore, complementary and alternative therapies need to be explored. The evidence shows that silver needle therapy has advantages in the treatment of rheumatoid arthritis, but there is a lack of standard clinical studies to verify this conclusion.

METHODS

This is a prospective randomized controlled trial to study the efficacy and safety of silver needles in the treatment of rheumatoid arthritis. Approved by the Clinical Research Ethics Committee of our hospital. The patients are randomly divided into a treatment group (silver needle treatment group) or control group (routine western medicine treatment group). The patients are followed up for 2 months after 4 weeks of treatment. Observation indicators include: TCM symptom score, HAQDI score, DAS-28 score, laboratory indicators, adverse reactions and so on. Data will be analyzed using the statistical software package SPSS version 18.0 (Chicago, IL).

DISCUSSION

This study will evaluate the clinical efficacy of a silver needle in the treatment of rheumatoid arthritis. The results of this study will provide a reliable reference for the clinical use of a silver needle in the treatment of rheumatoid arthritis.

TRIAL REGISTRATION

OSF Registration number: DOI 10.17605/OSF.IO/4X5QB.

Acupuncture for blunt chest trauma: A protocol for a double-blind randomized control trial

INTRODUCTION

Blunt chest trauma (BCT) accounts for up to 65% of polytrauma patients. In patients with 0 to 2 rib fractures, treatment interventions are typically limited to oral analgesics and breathing exercises. Patients suffering from BCT experience symptoms of severe pain, poor sleep, and inability to perform simple daily life activities for an extended period of time thereafter. In this trial, we aim to investigate the efficacy of acupuncture as a functional and reliable treatment option for blunt chest trauma patients.

METHODS

The study is designed as a double-blind randomized control trial. We will include 72 patients divided into 2 groups; the acupuncture group (Acu) and placebo group (Con). The acupuncture group will receive true acupuncture using a uniquely designed press tack needle. The control group will receive placebo acupuncture treatment through the use of a similarly designed press tack needle without the needle element. The acupoints selected for both groups are GB 34, GB 36, LI 4, LU 7, ST 36, and TH 5. Both groups will receive 1 treatment only following the initial visit to the medical facility and upon diagnosis of BCT. Patient outcome measurements include: Numerical Rating Scale, Face Rating Scale, respiratory function flowmeter, Verran Snyder-Halpern sleep scale, and the total amount of allopathic medication used. Follow-up time will be scheduled at 4 days, 2 weeks, and lastly 3 months.

EXPECTED OUTCOME

The results of this study can potentially provide a simple and cost-effective analgesic solution to blunt chest trauma patients. This novel study design can serve as supporting evidence for future double-blind studies within the field of acupuncture.

OTHER INFORMATION

The study will be conducted in the thoracic surgical department and acupuncture department in China Medical University Hospital, Taichung, Taiwan. The study will be conducted on blunt chest trauma patients and is anticipated to have minimum risk of adverse events. Enrollment of the patients and data collection will start from March 2020. Study completion time is expected in March 2022.

PROTOCOL REGISTRATION

(CMUH109-REC1-002), (NCT04318496).

Fire needle therapy for blood stasis syndrome of plaque psoriasis: A protocol for systematic review and meta-analysis

BACKGROUND

Plaque psoriasis (PSO) is a common clinical chronic inflammatory skin disease. The incidence rate is increasing year by year due to the fast pace of work and unhealthy diet. Fire needle has been widely used in the treatment of PSO. However, the efficacy of fire needle for PSO is uncertain. Thus, the purpose of this systematic review is to evaluate the effectiveness and safety of fire needle for PSO (blood stasis syndrome).

METHODS

The following electronic databases will be searched from inception to October 2020:PubMed, Web of Science, Embase, Cochrane Library, China National Knowledge Infrastructure, WangFang Database, Chinese Science Journal Database, Chinese Biomedical Literature Database. In addition, other documents that meet the requirements will be manually searched, including conference papers, dissertations, etc. All randomized controlled trials using fire needle to treat PSO (blood stasis syndrome) that meet the criteria for inclusion will be included. The primary outcomes are clinical efficacy, Psoriasis area and severity index. Secondary outcomes include Itchy, TCM evaluation standard syndrome score, Dermatological quality of life index, and adverse events. To complete data synthesis and assess the risk of bias, we will use the RevMan V.5.3 software.

RESULTS

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

CONCLUSION

This study will provide high-quality evidence based medicine to evaluate the effectiveness and safety of fire needle for PSO (blood stasis syndrome), and further seek its scientific and effective chinese medicine treatment methods.

INPLASY REGISTRATION NUMBER

INPLASY202120007.

Little needle-scalpel for piriformis syndrome: A protocol for systematic review and meta-analysis

BACKGROUND

Piriformis syndrome (PS) is a condition in which the sciatic nerve is compressed when passing through the inferior mouth of the piriformis muscle, mainly caused by pain in one hip and leg. In severe cases, patients may experience severe buttock and lower limb pain, discomfort, difficulty walking, and claudication. It is estimated that the annual incidence of low back pain and sciatica is about 40 million cases, and the annual incidence of piriformis syndrome is about 2.4 million cases. The aim of this systematic review is to assess the effectiveness and safety of Little needle-scalpel therapy for Piriformis syndrome.

METHODS

Two reviewers will electronically search the following databases: the Cochrane Central Register of Controlled Trials (CENTRAL); PubMed; EMBASE; China National Knowledge Infrastructure (CNKI); Chinese Biomedical Literature Database (CBM); Chinese Scientific Journal Database (VIP database); and Wan-Fang Database from the inception, without restriction of publication status and languages. Additional searching including researches in progress, the reference lists, and the citation lists of identified publications. Study selection, data extraction, and assessment of study quality will be performed independently by 2 reviewers. If it is appropriate for a meta-analysis, RevMan 5.4 statistical software will be used; otherwise, a descriptive analysis will be conducted. Data will be synthesized by either the fixed-effects or random-effects model according to a heterogeneity test. The results will be presented as risk ratio (RR) with 95% confidence intervals (CIs) for dichotomous data and weight mean difference (WMD) or standard mean difference (SMD) 95% CIs for continuous data.

RESULTS

This study will provide a comprehensive review of the available evidence for the treatment of Little needle-scalpel with piriformis syndrome.

CONCLUSIONS

The conclusions of our study will provide an evidence to judge whether Little needle-scalpel is an effective and safe intervention for patients with piriformis syndrome.

ETHICS AND DISSEMINATION

This systematic review will be disseminated in a peer-reviewed journal or presented at relevant conferences. It is not necessary for a formal ethical approval because the data are not individualized.

TRIAL REGISTRATION NUMBER

INPLASY2020110092.

Design and Implementation of an Intelligent Analgesic Bracelet Based on Wrist-ankle Acupuncture

A flexible, multifunctional, and intelligent analgesic bracelet was proposed in this article to alleviate symptoms of pain. Based on the theory of wrist-ankle acupuncture in traditional Chinese medicine, transcutaneous electrical nerve stimulation is the technical basis of the method. A set of targeted circuit system capable of generating adjustable electrical stimulation signals to simulate filamentary acupuncture was designed. The system architecture includes a wireless communication module, a signal control module, a stimulus signal generation module, and a wearable, flexible bracelet. In addition, a pain assessment interface with a visual analog scale was designed to assess pain levels. Two comparative experiments were designed, involving a custom pain assessment scale and hand-held dolorimeter that were performed before and after wearing the bracelet to verify the analgesic effect of the bracelet. The results showed that the wrist-worn analgesic bracelet is significantly effective in alleviating pain in various parts of the human body.

Plum-blossom needle for coronavirus disease 2019-related headache: A protocol for systematic review and meta-analysis

BACKGROUND

Assessing the effectiveness and safety of plum-blossom needle for (COVID-19) related headache is the main purpose of this systematic review protocol.

METHODS

We will search the following sources for the identification of trials: The Cochrane Library, PubMed, EMBASE, Chinese Biomedical Literature Database (CBM), Chinese National Knowledge Infrastructure Database (CNKI), Chinese Science and Technique Journals Database (VIP), and the Wanfang Database. The searches were limited to articles published in 2020, but no language restrictions were imposed. Only include randomised controlled trials (RCTs), with or without blinding, and participant or observer reported outcomes, will be included.The primary outcome is the time and rate of appearance of headache induced by COVID-19. The secondary outcome is the length of hospital stay. Two independent reviewers will conduct the study selection, data extraction and assessment. Review Manager Software V.5.3 will be used for the assessment of risk of bias and data synthesis.

RESULTS

The results will provide a high-quality synthesis of current evidence for researchers in this subject area.

CONCLUSION

The conclusion of our study will provide an evidence to judge whether plum-blossom needle is effective and safe for COVID-19-related headache.

ETHICS AND DISSEMINATION

This protocol will not evaluate individual patient information or affect patient rights and therefore does not require ethical approval. Results from this review will be disseminated through peer-reviewed journals and conference reports.

PROSPERO REGISTRATION NUMBER

CRD42020199508.

Effect of plum-blossom needling versus tropicamide eye drops on adolescent myopia: protocol for a randomized crossover trial

OBJECTIVE

Myopia is the most common eye problem and affects an estimated 28.3% of the global population. Its incidence is increasing annually. Myopia treatment is limited to correcting visual acuity. Acupuncture is one of the main therapies in traditional Chinese medicine and includes plum-blossom needling, which has been widely used for both the prevention and treatment of adolescent myopia. We hypothesized that plum-blossom needling would be effective in treating myopia compared with a tropicamide eye drops control.

METHODS

This is a crossover randomized controlled trial involving adolescents with myopia. Participants will be randomized 1∶1 to plum-blossom needle or tropicamide eye drops arms. Subjects in each arm will be treated for 20 d, followed by a 1-month washout period and treatment change for another 20 d. The primary outcome is uncorrected distance and cycloplegic refractive errors. The secondary outcomes comprise corneal curvature, lens thickness, axial length, ciliary body thickness, accommodation amplitude, the NRA/PRA (negative/positive relative accommodation), flexible adjustment, and near point of convergence. The outcome measures will be assessed at baseline, after the first treatment course (the first month), at the end of the washout period (the second month), after the second treatment course (the third month), and at follow-up (the sixth month).

DISCUSSION

The results of the trial will help to provide evidence for the efficacy of plum-blossom needling for myopia in China.

Evaluating the international standards gap for the use of acupuncture needles by physiotherapists and chiropractors: A policy analysis

BACKGROUND

Acupuncture needles have become an increasingly-popular treatment tool used by multiple health professions. However, the World Health Organization (WHO)'s 1999 training guidelines for acupuncture address only medical doctors and licensed acupuncturists, leaving a gap as to appropriate training standards for other professions.

AIMS AND METHODS

With reference to an extensive document analysis, and interviews with seventeen acupuncture educators from across several professions in Ontario, Canada, this work uses a critical qualitative policy analytic approach to: a) present a comprehensive account of statutory training requirements for acupuncture-needling physiotherapists and chiropractors in the United States, Canada, and Australia; and b) evaluate competing stakeholder discourses pertaining to recent related controversies.

RESULTS

A wide range of educational requirements are evident across the jurisdictions under study (most below the 200-hour WHO guideline for physicians); and there is considerable disagreement among stakeholders as to what constitutes sufficient training in various forms of acupuncture, including 'dry needling'. Organizations defending brief post-graduate training for needling physiotherapists and chiropractors are generally associated with these two professions, and contend that their 'dry needling' practices differ substantially from traditional acupuncture. Characterizing such brief training as insufficient, opportunistic and unsafe, and 'dry needling' as a subset of acupuncture practice, are the voices of all acupuncture educators interviewed, as well as professional organizations representing physicians, licensed acupuncturists, and some physiotherapists and chiropractors.

DISCUSSION AND CONCLUSION

Critiquing claims on both sides of the debate, this work calls for the development of independent, international safety-geared training guidelines that explicitly address the recent, evidence-informed trend towards biomedicalized acupuncture needling. Findings also suggest a need for additional research regarding the current shift towards overlapping-rather than exclusive-health professional practice scopes in industrialized countries.

[Exploration into the simplex reinforcing-reducing manipulation of acupuncture]

Four controversial types of simplex reinforcing-reducing manipulation of acupuncture and their possible meanings were summarized to explore several key elements of reinforcing-reducing manipulation of acupuncture, in addition, the simplex reinforcing-reducing manipulation of acupuncture was classified by single factor. It is concluded that the definition of simplex reinforcing-reducing manipulation of acupuncture should try not to include other non-manipulative elements. According to single factor, it can be divided into: needle-oriented reinforcing-reducing manipulation, twisting reinforcing-reducing manipulation, lifting and interpolating reinforcing-reducing manipulation, fast and slow reinforcing-reducing manipulation, breathing reinforcing-reducing manipulation, opening and closing reinforcing-reducing manipulation. In addition, after considering the effect and principle of number reinforcing-reducing manipulation, it can be considered.

Therapeutic effects of acupuncture plus fire needle versus acupuncture alone in lateral epicondylitis: A randomized case-control pilot study

BACKGROUND

The aim of this study was to compare the short-term and intermediate-term efficacy of acupuncture plus fire needle therapy with that of acupuncture alone in the treatment of lateral epicondylitis (LE).

METHODS

Thirty-eight patients with LE who had persisted for at least 2 months were enrolled in this prospective, assessor-blinded, randomized controlled pilot trial. Twenty-one patients were randomized to the acupuncture plus fire needle group and 17 to the acupuncture-only group. The primary outcome was the visual analog scale pain score for the previous 24 hours and the secondary outcomes were the maximum grip strength, Patient-rated Forearm Evaluation Questionnaire score, and Medical Outcomes Study 36-Item Short-form Health Survey score. The values at baseline (pretreatment), at the end of treatment, and at 3 months after treatment were used to assess the short-term and intermediate-term effects of treatment. The data were analyzed using the Chi-square test and t test.

RESULTS

Within-group analyses showed better results for acupuncture plus fire needle therapy in the short term and intermediate term. Differences in the severity of pain and secondary outcomes were significant in the intermediate term in the acupuncture group. At the end of treatment, none of the differences in outcome scores were significant, except for maximum grip strength in the affected hand in the acupuncture group. No significant between-group differences in short-term or intermediate-term outcomes were observed.

CONCLUSION

Acupuncture plus fire needle therapy was effective in the short term in patients seeking improvement of LE. Twelve treatments were effective for relieving pain and improving disability in the intermediate term in patients with chronic LE in both study groups. The findings of the pilot study confirm the feasibility of proceeding to a larger randomized controlled study of the longer-term effects of acupuncture plus fire needle therapy in patients with LE.

Electrospray Generated from the Tip-Sealed Fine Glass Capillary Inserted with an Acupuncture Needle Electrode

In electrospray, excess charges are supplied to a sample solution by the occurrence of electrochemical reactions. Recently, different versions of electrospray, e.g., dielectric barrier electrospray ionization, inductive desorption electrospray ionization, and electrostatic-ionization driven by dielectric polarization, have been reported in which the sample solution was not in direct contact with the metal electrode but separated by dielectric materials. The objective of the current work is to elucidate the mechanism of dielectric barrier electrospray. A sealed borosilicate glass capillary inserted with a fine acupuncture needle was used as a probe. A sample solution (~ 400 nL) was captured on the glass capillary tip and a positive high voltage (HV) pulse (+ 4.5 kV) was applied to the internal metal electrode. Mass spectra were measured as a function of the HV pulse width from μs to 10 s. Ions started to be detected with the pulse width of ~ 5 ms. The ion intensities increased slowly with time and reached a plateau in a few seconds. The charge distribution of cytochrome c [M + nH]ⁿ⁺ shifted to higher n values from a few ms to seconds. In addition to cone-jet mode normal electrospray that lasted until all the liquid sample was depleted from the glass tip, the polarization-induced electrospray ionization was observed at the early stage of the HV application. Graphical Abstract ᅟ.

Electrical dry needling as an adjunct to exercise, manual therapy and ultrasound for plantar fasciitis: A multi-center randomized clinical trial

Study Design

Randomized, single-blinded, multi-center, parallel-group trial.

Objectives

To compare the effects of adding electrical dry needling into a program of manual therapy, exercise and ultrasound on pain, function and related-disability in individuals with plantar fasciitis (PF).

Background

The isolated application of electrical dry needling, manual therapy, exercise, and ultrasound has been found to be effective for PF. However, no previous study has investigated the combined effect of these interventions in this population.

Methods

One hundred and eleven participants (n = 111) with plantar fasciitis were randomized to receive electrical dry needling, manual therapy, exercise and ultrasound (n = 58) or manual therapy, exercise and ultrasound (n = 53). The primary outcome was first-step pain in the morning as measured by the Numeric Pain Rating Scale (NPRS). Secondary outcomes included resting foot pain (NPRS), pain during activity (NPRS), the Lower Extremity Functional Scale (LEFS), the Foot Functional Index (FFI), medication intake, and the Global Rating of Change (GROC). The treatment period was 4 weeks with follow-up assessments at 1 week, 4 weeks, and 3 months after the first treatment session. Both groups received 6 sessions of impairment-based manual therapy directed to the lower limb, self-stretching of the plantar fascia and the Achilles tendon, strengthening exercises for the intrinsic muscles of the foot, and therapeutic ultrasound. In addition, the dry needling group also received 6 sessions of electrical dry needling using a standardized 8-point protocol for 20 minutes. The primary aim was examined with a 2-way mixed-model analysis of covariance (ANCOVA) with treatment group as the between-subjects variable and time as the within-subjects variable after adjusting for baseline outcomes.

Results

The 2X4 ANCOVA revealed that individuals with PF who received electrical dry needling, manual therapy, exercise and ultrasound experienced significantly greater improvements in first-step morning pain (F = 22.021; P<0.001), resting foot pain (F = 23.931; P<0.001), pain during activity (F = 7.629; P = 0.007), LEFS (F = 13.081; P<0.001), FFI Pain Subscale (F = 13.547; P<0.001), FFI Disability Subscale (F = 8.746; P = 0.004), and FFI Total Score (F = 10.65; P<0.001) than those who received manual therapy, exercise and ultrasound at 3 months. No differences in FFI Activity Limitation Subscale (F = 2.687; P = 0.104) were observed. Significantly (X² = 9.512; P = 0.023) more patients in the electrical dry needling group completely stopped taking medication for their pain compared to the manual therapy, exercise and ultrasound group at 3 months. Based on the cutoff score of ≥+5 on the GROC, significantly (X² = 45.582; P<0.001) more patients within the electrical dry needling group (n = 45, 78%) achieved a successful outcome compared to the manual therapy, exercise and ultrasound group (n = 11, 21%). Effect sizes ranged from medium to large (0.53<SMD<0.85) at 3 months in favor of the electrical dry needling group.

Conclusion

The inclusion of electrical dry needling into a program of manual therapy, exercise and ultrasound was more effective for improving pain, function and related-disability than the application of manual therapy, exercise and ultrasound alone in individuals with PF at mid-term (3 months).

Level of evidence

Therapy, Level 1b.

Development of a survey form through Delphi study about adverse events associated with the miniscalpel needle, for application in prospective observational studies regarding safety of miniscalpel needles: Study protocol

BACKGROUND

Despite the wide usage of miniscalpel-needles (MSNs), information about MSN treatment-related adverse events (AEs) is insufficient. As the definition of AE might vary among physicians, without an exact definition for pain and hemorrhage, it is difficult to provide accurate information about AEs in MSN treatment to physicians, researchers, and patients. The aim of our study is to reach a consensus about the items and definitions of AEs that should be included in the survey form for prospective observational multicenter studies to record MSN treatment-related AEs. We will especially focus on obtaining a consensus on the definition of pain and hemorrhage caused by MSN treatment.

METHODS

Our study protocol is composed of 6 steps. First, we will identify the aim of the study. Next, we will conduct a systematic review to investigate MSN treatment-related AEs reported till date in Korea. Third, we will conduct a pilot observational prospective single-center study on AEs in MSN treatment. We will develop a standardized case report form to record MSN treatment-related AEs, including the causality, severity, and details of the MSN procedure at every site. Next, based on the pilot study, the Delphi study questionnaire will be developed by a panel composed of 13 physicians. The Delphi study will have 4 rounds with open questions and 4-point Likert-scale closed questions. Through these rounds, we will develop a consensus about the items and definitions of AEs that should be included in the survey form for future multicenter studies about MSN treatment-related AEs. Following this, a face-to-face consensus meeting will be held for a final agreement of survey form. The final survey form will then be approved by the related academic society for dissemination.

DISCUSSION

The aim of this protocol is to develop a survey form for future prospective observational multicenter studies on MSN treatment-related AEs. This protocol will present the research methodology for developing a survey form, which will improve consistency and reliability between MSN treatment studies. We believe that this protocol can evaluate the safety of MSN treatment.

TRIAL REGISTRATION

Clinical Research Information Service: KCT0002849.

Warm needle acupuncture in primary osteoporosis management: a systematic review and meta-analysis

BACKGROUND

Warm needle acupuncture (WNA) is commonly used in primary osteoporosis (OP) management in China. The evidence of its effectiveness needs to be systematically reviewed.

OBJECTIVE

The aim of the meta-analysis was to evaluate whether using WNA alone or combined with conventional medicine benefits primary OP.

METHODS

PubMed, Embase, the Cochrane Central Register, Medline, China National Knowledge Infrastructure, Wanfang and VIP databases were searched from their inception through 30 June 2016. RCTs applying WNA independently or as an adjunct to conventional medicine, compared with conventional medicine alone, were included. Primary outcomes were bone mineral density (BMD) of the lumbar vertebrae, femoral neck, Ward's triangle and greater trochanter. The secondary outcome was chronic pain measured by VAS score. Meta-analysis was conducted using RevMan V.5.3 software.

RESULTS

Nine RCTs involving 572 participants were included. When WNA was used as an adjunct to conventional medicine, meta-analysis revealed a statistical difference in favour of increasing BMD of the lumbar vertebrae (mean difference (MD)=0.06, 95% CI 0.03 to 0.08, P<0.001). WNA increased BMD of the femoral neck (MD 0.14, 95% CI 0.08 to 0.21, P<0.001) and greater trochanter (MD 0.09, 95% CI 0.04 to 0.15, P<0.001) when used alone, and additionally decreased VAS scores (MD=-1.10, 95% CI -1.14 to -1.06, P<0.001) when used as an adjunct to conventional medicine. However, the safety of WNA was not specifically reported.

CONCLUSIONS

WNA may have beneficial effects on BMD and VAS scores of patients with primary OP. However, all included trials were at high risk of bias and of low quality. Further rigorous studies are needed to determine the effectiveness of WNA for primary OP treatment.

New Perspectives on the Origin of Korean Acupuncture: Based on Materials from Xiaoyingzi Tomb, Yanji and Neighbouring Region

This article discusses the development of early acupuncture needles as demonstrated by the artifacts excavated from the Northern part of the Yanji district, Jilin, China, during the Japanese colonial era (reported in 1941). Numerous bone needles, stone needles, and other medical devices were found in the Xiaoyingzi excavation. The stone needles from Xiaoyingzi can be categorized into three grades, based on length, of 8cm, 12-15cm, and 18cm. A set of round stones for massage were also discovered, along with obsidian blades. These relics were carefully stored in the middle of the body in the stone coffin. In addition to Xiaoyingzi, stone needles were also excavated along the lower valley region of the Tuman (Tumen, ) River. These facts indicate that the owner was involved in medical practice, and that medical procedures using stone needles were quite popular at the time. This article carefully investigates that the relics have nothing to do with weaving textile or military use. Current research on the origin of acupuncture has been confined either to stone needles from the prehistoric age or to bronze needles, as well as to literature from the Warring States period to the Han China, during which acupuncture technology was considerably expanded. However, substantial knowledge on the "gap" between stone needles and metal needles has been procured through the analysis of Xiaoyingzi, Yanji. The findings of Xiaoyingzi are also significant in providing a more detailed reconstruction of the development of acupuncture in East Asia and emergence of acupuncture throughout history. A large amount of medical items (stone and bone needles, cases for needles, massage stone type bianshi, and etc.), have been excavated from Xiaoyingzi and other neighbouring sites, Along with geographic and ecological factors, this archeological data strongly suggests the medical tradition of using acupuncture needles was practiced around Tumen River basin in the Bronze Age (10th century B.C.).

[Effect of heat-reinforcing needling on serum metabolite profiles in rheumatoid arthritis rabbits with cold syndrome]

OBJECTIVE

To explore heat-reinforcing needling for the metabolite profiling changes in serum of rheumatoid arthritis (RA) rabbits with liquid chromatograph-mass spectrometer (LC-MS) technique, and to investigate its mechanisms.

METHODS

Forty clean purple blue rabbits were randomized into a normal group, a model group, a reinforcing-reducing needling (RRN) group, a twirling-reinforcing needling (TRN) group, and a heat-reinforcing needling (HRN) group, 8 cases in each group. RA rabbits with cold syndrome were made with ovalbumin and freezing except those in the normal group. No treatment was given in the normal and model groups. The corresponding manipulations for 7 days were applied at "Zusanli" (ST 36) in the three acupuncture groups, 30 min a time, once a day. After intervention the pain threshold and the local skin temperature of each group were observed. Fresh serum from heart was collected for metabonomics detection. Principal component analysis (PCA) and partial least squares-discriminant analysis (PLS-DA) were adopted. Several metabolites were screened by the variable importance in the projection values (VIP>1) and P value (P<0.05).

RESULTS

The pain threshold and the local skin temperature in the model group were lower than those in the normal group (both P<0.05). The pain threshold and the local skin temperature in the three acupuncture groups were higher than those in the model group after intervention (all P<0.05), which were better in the HRN group than those in the RRN and TRN groups (all P<0.05). The serum metabolites of carnitine, LysoPC (14∶0), LysoPC (18∶3), LysoPE (0∶0/20∶5), LysoPE (0∶0/22∶1), decylic acid, stearic acid and lactic acid in the model group increased compared with those in the normal group, and other metabolites decreased, including leucine, valine, glutamine, pyroglutamic acid, α-ketoglutaric acid, succinic acid, fumaric acid, malic acid, galactose, mannose. Those metabolites were correlated fatty acid, amino acid, citric acid cycle, and glucose metabolism. The metabolites above-mentioned in the three acupuncture groups were regulated in various degrees (all P<0.05). Lactic acid decreased and succinic acid, fumaric acid, malic acid, galactose, mannose increased more obviously in the HRN group than those in the RRN and TRN groups.

CONCLUSION

The specificity of heat-reinforcing needling for RA presents the regulation for citric acid cycle and glucose metabolism.

Warm-needling acupuncture and medicinal cake-separated moxibustion for hyperlipidemia: study protocol for a randomized controlled trial

BACKGROUND

Acupuncture and moxibustion has been widely applied to hyperlipidemia treatment in clinical practice in China, serving as an alternative treatment to statins. Warm-needling acupuncture and medicinal cake-separated moxibustion have been separately reported with potential therapeutic effects on hyperlipidemia treatment in several studies but with limitations in study methodology. Combining these two modalities may provide a more advantageous strategy in treating hyperlipidemia. Therefore, a strict evaluation through well-designed randomized controlled trials (RCT) is necessary to determine their efficacy and safety on hyperlipidemia.

METHODS

The study a multicenter, open-label, randomized, stratified, active-controlled, noninferiority trial with two parallel groups. Subjects with hyperlipidemia will be stratified into different groups by risk levels of heart diseases. They then will be instructed to the Therapeutic Lifestyle Change (TLC) diet. Those who have not reached the target lipid level will be randomly assigned to the treatments of either acupuncture and moxibustion or simvastatin with a 1:1 allocation. One hundred and thirty subjects are aimed to be recruited. The duration of intervention for this study will be 12 weeks, followed by another 4 weeks for post-treatment assessment. The primary outcome is percentage change from baseline to the end of the study in low-density lipoprotein cholesterol (LDL-C). Other indicators in lipid change, safety and adherence will also be assessed secondarily. The repeated measures, linear mixed-effects model will be applied to the analysis.

DISCUSSION

Acupuncture and moxibustion could be a potentially effective treatment alternative for hyperlipidemia. A study with careful design is developed to evaluate the efficacy and safety of combined acupuncture and moxibustion, by integrating the traditional Chinese Medicine (TCM) regimens with the standardized Western medicine appraisal approach.

TRIAL REGISTRATION

ClinicalTrials.gov, NCT02269046 . Registered on 26 September 2014.

The effectiveness of long-needle acupuncture at acupoints BL30 and BL35 for CP/CPPS: a randomized controlled pilot study

BACKGROUND

The chronic prostatitis/chronic pelvic pain syndrome (CP/CPPS) is one of the commonest chronic inflammatory diseases in adult men, for which acupuncture has been used to relieve related symptoms. The present study aimed to evaluate the therapeutic effect of the long-needle acupuncture on CP/CPPS.

METHODS

A randomized traditional acupuncture-controlled single blind study was conducted on 77 patients who were randomized into long-needle acupuncture (LA) and traditional acupuncture (TA) groups. The patients received six sessions of acupuncture for 2 weeks and a follow-up was scheduled at week 24. The primary outcome was measured by the total National Institutes of Health-Chronic Prostatitis Symptom Index (NIH-CPSI) score at week 2. Four domains of the NIH-CPSI (urination, pain or discomfort, effects of symptoms, and quality of life) and the clinical efficacy score served as the secondary outcome.

RESULTS

The total NIH-CPSI score at week 2 and week 24 was significantly improved in the LA group compared with the TA group. LA significantly improved urination, pain or discomfort, the effects of symptoms, and the quality of life at week 2 and week 24 and patients undergoing LA treatment had a higher clinical efficacy score.

CONCLUSION

Needling at the BL30 and BL35 using LA benefits patients with CP/CPPS.

TRIAL REGISTRATION

The study was registered at the Chinese Clinical Trial Register ( ChiCTR-ICR-15006138 ).

[Qi Runs Through Acupuncture Needle Stimulation and Pulse Diagnosis:Our Considerations About Connotations of Qi in Acupuncture-Diagnosis-Treatment Scriptures in Yellow Emperor's Inner Canon]

The ancient classic work Yellow Emperor's Inner Canon has abundant expositions about the relationship between the acupuncture needle manipulation and pulse diagnosis. However, the relevant imparting and inheritance situations are relatively weaker nowadays probably due to the rapid development of modern diagnosis-therapeutic techniques and some faults or careless omission in understanding classical medical works. Qi, a core concept of the abundant expositions in Inner Canon, has seldom been thoroughly interpreted about its connotations. For this reason, in the present paper, the authors make a careful explanation about the connotations of Qi in Inner Canon from 1) the concept of Qikou (a superficial window of the body reflecting the functional state of internal organs), 2) pulse conditions, 3) its relationship with meridian-collateral diagnosis, and 4) the link between acupuncture needle stimulation and pulse diagnosis based on the scriptures and words description in combination with many scholars' doctrines, trying to explore its profound significance. In addition, the authors also expound its association with the effectiveness of distant treatment of acupuncture and the characteristics in relation to ancient medical scholars' thoughts.

[Differences on Acupuncture Reinforcing and Reducing Theory Between Neijing and Nanjing]

Reinforcing and reducing manipulation is the elite of traditional acupuncture needling methods. Abundant records could be found in Neijing(The Yellow Emperor's Inner Canon) and Nanjing (The Classic on Medical Problems) at early times. In the present paper, the author collates and compares the recordation of reinforcing and reducing acupuncture manipulation in these two classics on the basis of the principle and connotation of the two manipulations and from three key factors as stimulus location,manipulation technique and needling time. Based on objective analysis of the original text,distinct differences were found in above three aspects. Therefore, the conclusion is that Neijing and Nanjing resemble different medical school of thoughts at an early phase of acupuncture theories.

[Randomized Controlled Clinical Trials of Eye-acupuncture Therapy for Patients with Post-stroke Insomnia]

OBJECTIVE

To observe the therapeutic effect of eye-acupuncture therapy for post-stroke insomnia.

METHODS

Sixty patients (45-70 years in age) with post-stroke insomnia were randomized into eye-acupuncture group and routine acupuncture (body acupuncture) group (30 cases in each). Patients of the eye-acupuncture group were treated by acupuncture stimulation of bilateral Shangjiao (Upper-energizer) and Xin (Heart) regions and those of the routine acupuncture group treated by acupuncture stimulation of Baihui (GV 20), Sishencong (EX-HN 1), Anmian (EX-HN 16), etc. After Deqi, the filiform needles were retained for 20 min, and the treatment in both groups was conducted once a day, with 15 days being one therapeutic course and 2 courses altogether. The Pittsburgh Sleep Quality Index (PSQI) including the subjective sleep quality, sleep latency, sleep duration, habitual sleep efficiency, sleep disturbances, daytime dysfunction, and total PSQI score was used to evaluate the overall sleep quality. The clinical efficacy was assessed according to the "Guiding Principles of Clinical Trials for New Drugs of Traditional Chinese Medicine" formulated by Chinese Ministry of Health.

RESULTS

Following the treatment, of the two 30 cases in the eye-and routine acupuncture groups, 21 and 9 experienced a marked improvement in their symptoms, 8 and 17 were effective, and 1 and 4 invalid, with the effective rate being 96.7% and 86.7%, respectively. The PSQI scores of the subjective sleep quality, sleep latency, sleep duration, habitual sleep efficiency, sleep disturbances, daytime dysfunction, and the total PSQI score were all significantly decreased in comparison with pre-treatment in each group (P<0.01). The therapeutic effect of the eye-acupuncture was markedly superior to those of routine acupuncture in reducing sleep latency, sleep disturbances and daytime dysfunction (P<0.05), but without significant differences between the two groups in the effective rate, sleep quality, sleep duration, sleep efficiency and total PSQI score (P>0.05).

CONCLUSIONS

Both eye-acupuncture and routine acupunture are effective in the treatment of post-stroke insomnia, and the eye-acupuncture is better than routine acupuncture in reducing sleep latency, improving sleep disturbances and daytime dysfunction.

[An Introduction to A Newly-developed "Acupuncture Needle Manipulation Training-evaluation System" Based on Optical Motion Capture Technique]

In the present paper, the authors introduce a newly-developed "Acupuncture Needle Manipulation Training-evaluation System" based on optical motion capture technique. It is composed of two parts, sensor and software, and overcomes some shortages of mechanical motion capture technique. This device is able to analyze the data of operations of the pressing-hand and needle-insertion hand during acupuncture performance and its software contains personal computer (PC) version, Android version, and Internetwork Operating System (IOS) Apple version. It is competent in recording and analyzing information of any ope-rator's needling manipulations, and is quite helpful for teachers in teaching, training and examining students in clinical practice.

[Status of diagnosis and treatment devices of acupuncture based on SooPAT and bibliometrics in China]

OBJECTIVE

To perform a bibliometrics analysis on patent literature regarding diagnosis and treatment devices of acupuncture in China, aiming to provide references for the development of diagnosis and treatment devices of acupuncture.

METHODS

Based on SooPAT, a patent database, the patent literature regarding diagnosis and treatment devices of acupuncture in China was collected. With bibliometrics methods, the annual distribution of type, quantity, classification and content of diagnosis and treatment devices of acupuncture were analyzed.

RESULTS

The number of acupuncture diagnosis and treatment devices reached its peak in 2012 and 2013 in China. The A61N in patent and utility model patent were the most, which were mainly related to electrotherapy, magnetic therapy, radioactive therapy and ultrasound therapy, etc. The main content was acupuncture treatment devices and meridian treatment devices. The 24-01 in design patent was the most, involving fixation devices used by doctors, hospitals and laboratories, etc.

CONCLUSIONS

Currently the majority of diagnosis and treatment devices of acupuncture is therapeutic apparatus, while the acupuncture diagnosis devices are needed.

[A Newly-made Rat Holder for Convenient Acupuncture Needle Insertion]

In the present article, the authors introduce a newly-made rat holder device for easily inserting acupuncture needles into the acupoints at any parts of the body. This device is easy in operation and higher in applicability, being worthy of popularization for researchers engaging in experimental studies.

[Pneumothorax following dry needling treatment: legal and ethical aspects]

Trigger point "dry needling" is a technique used to treat myofascial pain. It involves using filiform needles which are inserted into muscles to give local pain relief. Few cases of serious adverse events following this treatment have been reported in the literature. In this paper we describe the case of a professional swimmer who developed pneumothorax after dry needling treatment and discuss the medicolegal and ethical aspects related to competencies and responsibilities of medical doctors and physiotherapists performing the procedure.

[Influence of Heat-reinforcing Needling on Expression of Plasma Atp 5 O mRNA and Atp 6 V 1 B 2 mRNA in Patients with Rheumatoid Arthritis of Wind-cold-damp Retention Type]

OBJECTIVE

To observe influences of heat-reinforcing needling (HRN) on scores of traditional Chinese medicine (TCM) symptoms and expression of plasma ATP synthase subunit O (Atp 5 O) mRNA and lysosomal V 1 subunit B 2 (Atp 6 V 1 B 2) mRNA in patients with wind-cold-damp retention type rheumatoid arthritis (RA), so as to investigate its biological mechanisms in "heat production".

METHODS

Sixty wind-cold-damp retention type RA patients were randomly allocated to HRN group (n=30) and control group (n=30). Guanyuan (CV 4), Qihai (CV 6), bilateral Zusanli (ST 36), and local acupoints near the knee-joint were selected for needling stimulation. Patients of the HRN group were treated by manipulating the acupuncture needle with HRN, and those of the control group treated by manipulating the needle with uniform reinforcing-reducing method. The treatments were performed once daily, 5 days a week, and two weeks altogether. The other 30 healthy volunteers were recruited as the normal control group. The TCM symptom scoring system (0-31 points, 11 items as the severities of pain, swelling and tenderness of the knee-joint) was used to evaluate the status of RA, and quantitative real-time PCR (RT-PCR) was used to detect the expression of plasma Atp 5 O mRNA and Atp 6 V 1 B 2 mRNA following removal of red blood cells.

RESULTS

After the treatment, the TCM scores of both the HRN and control groups were significantly decreased (P<0.05), and that of the HRN group was significantly lower than that of the control group (P<0.05). Before the treatment, the expression levels of plasma Atp 5 O mRNA and Atp 6 V 1 B 2 mRNA in RA patients were significantly lower than those of the normal group (P<0.05), and after the treatment, the expression levels of plasma Atp 5 O mRNA and Atp 6 V 1 B 2 mRNA were significantly increased in both HRN and control groups compared to pre-treatment in the same one group (P<0.05), and the up-regulated Atp 5 O mRNA and Atp 6 V 1 B 2 mRNA levels were remarkably higher in the control group than in the HRN group (P<0.05).

CONCLUSIONS

Both heat-producing needling and uniform reinforcing-reducing needling can improve RA patients' clinical symptoms, which may be associated with their actions in up-regulating expressions of plasma Atp 5 O mRNA and Atp 6 V 1 B 2 mRNA.

Effect of ultrasound-guided acupotomy vs electro-acupuncture on knee osteoarthritis: a randomized controlled study

OBJECTIVE

To investigate the effect of acupotomy on knee osteoarthritis (KOA), compared to electro- acupuncture (EA).

METHODS

Sixty KOA patients were randomly divided into 2 groups: ultrasound-guided acupotomy group and EA group; each had 3 weeks' therapy. After the treatment, by contrast before and after therapy, by comparing curative effects among groups, we looked into disease improvement degree through activities of daily living score (ADL), hospital for special surgery index (HSS), visual analogue scales score (VAS) and knee joint's infrared thermal imaging detection .

RESULTS

Graded by ADL, the excellent rate in acupotomy group was much higher than EA group; both acupotomy group and EA group had obvious changes in HSS index before and after the therapy (P < 0.01). And there was remarkable difference in HSS index variation between the groups (P < 0.01). Acupotomy group and EA group showed big difference in pain index before and after treatment (P < 0.01). Apparent difference also existed in the comparison among groups (P < 0.01). Both acupotomy group and EA group had apparent changes in infrared thermal imaging detection before and after the treatment (P < 0. 01).

CONCLUSION

Acupotomy and EA both have significant effects in KOA treatment; the former is better than the latter in relieving pain and improving knee functions.

[Objective reasons and the strategies on pain during the needle insertion and the key points in teaching program]

Retrieving literature and summarizing the experience in lecturing acupuncture and clinical practice, the authors analyzed the objective reasons of pain during the needle insertion. Three factors are considered, including needles, skin tissue of inserting site and technique of insertion. The teaching program was discussed on how to alleviate or avoid pain during the concrete manipulation. It is viewed that no matter in teaching program of acupuncture or clinical operation, for alleviating pain during needle insertion, the key points must be on the rapid insertion through skin surface and the coordination of the puncture hand and pressing hand.

Development of Automatic Manipulation Device for Acupuncture (AMDA)

Needle lifting and thrusting manipulation is one of common skills in acupuncture. However, there exists artificial error in frequency and amplitude due to individual difference when performing lifting and thrusting during acupuncture. For providing stable and quantified effects and higher frequency when doing lifting and thrusting manipulation, a well controlled device is needed. The aim of this article is to report the preliminary results of the development of Auto Manipulation Device for Acupuncture (AMDA) and characterization of its functional parameters. A tissue-simulating Agar gel phantom with 4.8%, 5.2%, and 5.4% concentrations was prepared and used for characterization of the AMDA. Tests of the linearity, reliability and safety of the AMDA were implemented with conditions of different drive voltages, frequencies, and simulated tissues. Our preliminary results have demonstrated the developed AMDA its plausibility in the clinical application of acupuncture.

[Present situation and development direction of microacupuncture therapy]

There have been many reports of clinical and experimental researches of microacupuncture therapy, the relevant systematic works, teaching materials and national standards in recent decades. It shows that microacupuncture system has been formed and its influence has been promoted. While the rapid development of microacupuncture therapy, there are the problems and contradictions on nomenclature, explanation of theoretical basis, optimal indications, and multiple systems and schools, etc. All the above have blocked the clinical application and development. It is considered that we need to unify the nomenclature, condense the theoretical basis, clear the optimal indications, promote the exchange and blend among different schools and sum up the outcomes by systematic review and data mining technique.

Study on stability of DMS meridian detector

The stability of meridian detector was the basis to study meridian through conductance method. Ancient documents mentioned that the human body's blood could change with the time and meridians. When qi and blood came, the qi and blood would be full of that place; when qi and blood gone, the local skin shining could fade and recess. It liked the tidal fluctuation, then caused the corresponding acupuncture points conductance value changes. Modern studies had reported that meridian detector instrument the skin area of twelve meridians acupuncture points could change along with time within 24 hours. In this circumstance, whether the conductance values changes in human acupuncture points had statistical significance was vital important. DMS meridian detector instruction was adopt to measure the twelve meridian jingyuan acupuncture point in order to analyze the acupuncture point conductance value changes within one day.

[Teaching design of mastering scalp acupuncture fast]

Scalp acupuncture is a method of treating whole-body diseases. The author takes the easy positioning of scalp acupuncture as starting point, covers the positioning of scalp acupuncture and needle insertion points, acupuncture manipulation and the selection of acupoints, so as to introduce the design of teaching the international standardized scalp acupuncture with texts and illustrations. The positions of scalp acupuncture are 4 lines in frontal area, 5 lines in parietal area, 2 lines in temporal area and 3 lines in occipital area. The needle insertion angle is 30° to the skin. Acupoints can be selected crossly and correspondingly in clinic.

[Considerations about Acupuncture Treatment during Menstruation]

A dispute about whether women are suitable to receive acupuncture treatment in the period of menstruation has existed for many years. There are some reports about acupuncture treatment induced abnormal menstruation in women experiencing menstruation. However, according to long-term clinical practice and current development of acupuncture therapy, the authors of the present paper hold that there are no absolute contradictions for acupuncture treatment of women during menstruation. Additionally, acupuncture induced menstrual disorder has no enough data support of large size example clinical trials. The key points of acupuncture administration for women during menstruation are: (1) reasonable selection of acupoints prescriptions, and (2) appropriate acupuncture needle manipulations, particularly avoiding strong stimulation.

[Clinical Trials for Observing the Influence of Acupuncture Needle-stimulation Induced Sharp Pain on Curative Effect in Primary Dysmenorrhea Patients]

OBJECTIVE

To observe the influence of acupuncture needle stimulation-induced sharp pain on the curative effect of acupuncture therapy for primary dysmenorrhea (PD) patients with cold damp stagnation syndrome (CDSS).

METHODS

A total of 87 PD patients with CDSS experiencing abdominal pain (> or =40 mm in visual analogue scale, VAS) were randomly asigned to deqi-expectation group and no-deqi-expectation group which were further divided into deqi-expectation + sharp pain (n = 31), deqi-expectation + no-sharp pain (n = 12), no-deqi-expectation + sharp pain (n = 17), no-deqi-expectation + no- sharp pain (n =27) groups. On the first day of abdominal pain attack, bilateral Sanyinjiao (SP 6) were punctured respectively with thicker needles with deeper insertion for deqi-expectation patients and thin filiform needles with shallow insertion for no-deqi-expectation patients. The needles were manipulated for 30 s with uniform reinforcing-reducing method for all the deqi-expectation patients, which was repeated once again every 10 min during 30 min of needle retention. The VAS was used to evaluate the patients' abdominal pain severity before treatment and 0, 10 min after acupuncture needle withdrawal.

RESULTS

Following acupuncture stimulation of SP 6, the VAS scores of menstrual pain at both 0 min and 10 min after withdrawing acupuncture needles were significantly decreased in the deqi-expectation + sharp pain group, deqi-expectation + no-sharp pain group, no-deqi-expectation+sharp pain group and no-deqi-expectation + no-sharp pain group (P<0. 05), and that of 10 min post-needle withdrawal was markedly lower than that of 0 min in the deqi-expectation + sharp pain group ( P<0. 05). No significant differences were found in the VAS difference values at different time-points between deqi-expectation plus sharp pain and deqi- expectation + no-sharp pain groups, and between no-deqi-expectation + sharp pain and no-deqi-expectation + no-sharp pain groups (P>0.05).

CONCLUSION

Acupuncture stimulation of SP 6 has an immediate analgesic effect in PD women with cold damp stagnation syndrome, which was not affected by needling-induced sharp pain, deqi-expectation, and thicker or thinner needle with shallow and deeper insertion.

[Clinical Therapeutic Effect of Oblique Needling with Tuina in Relieving Sacroiliac Joint Injury]

OBJECTIVE

To observe the therapeutic effect of oblique needling in combination with Tuina at the sacroiliac joint for patients experiencing sacroiliac joint injury.

METHODS

One hundred and twenty patients with sacroiliac joint injury were randomized into routine Tuina group and oblique needling combined with Tuina (Acu+ Tuina) group (n = 60 in each group). For patients of the Tuina group, routine Tuina as rotating, pressing-rubbing, digital pressing, articular moving, etc. was manipulated at Shangliao (BL 31), Ciliao (BL 32), Zhongliao (BL 31), Xialiao (BL 30), Huantiao (GB 30), Zhibian (BL 54), Weizhong (BL 40) and sacroiliac joint area. For patients of the Acu+Tuina group, the anatomical points between the bilateral iliac crests and the sacral joints were punctured obliquely with disposable acupuncture needles. The treatment was conducted for 30 min every time, once daily for 3 weeks except weekends. The Visual Analogue Scale (VAS) and Oswestry Disability Index (ODI, concerning intensity of pain, lifting, ability to care for oneself, ability to walk, ability to sit, sexual function, ability to stand, social life, sleep quality, and ability to travel) were employed to evaluate the patients' reactions and functional activity changes before and after the treatment.

RESULTS

Following the treatment, of the two 60 patients in the Tuina and Acu + Tuina groups, 12 and 26 cases were cured, 20 and 20 experienced marked improvement, 16 and 11 were effective, 12 and 3 invalid, with the effective rates being 80% and 95%, respectively. The effective rate of the Acu+ Tuina group was significantly superior to that of the Tuina group (P<0.05). The VAS scores and OD were considerably decreased in both groups after the treatment and were significantly lower in the Acu+Tuina group than in the Tuina group (P<0.01).

CONCLUSION

Oblique needling the anatomical points in the sacroiliac joint region combined with Tuina manipulation is evidently better than simple Tuina in reducing pain and in improving functional activity and life quality in sacroiliac joint injury patients.

[Basic Regularities and Characteristics of Compound Reinforcing--reducing Manipulation of Acu- puncture Revealed by Data Mining]

OBJECTIVE

To explore the regularities and features of compound reinforcing-reducing manipulation of acupuncture filiform needles in the treatment of clinical conditions or diseases by using data mining technique, so as to guide clinical practice.

METHODS

At first, the data base about the reinforcing-reducing manipulation (CRRM) of filiform needles for different clinical problems was established by collection, sorting, screening, recording, collation, data extraction of the related original papers published in journals and conferences and related academic dissertations from Jan. 1 of 1950 to Jan. 31 of 2015 by using key words of "acupuncture" "moxibustion" "needling" "filiform needle", and according to the included and excluded standards.

RESULTS

A total of 130 835 papers met the included standards were collected. Outcomes of data mining in the present study showed that (1) the ORRM is most frequently applied in the internal medicine, followed by surgery, gynecology, ophthalmology and otorhinolaryngology, dermatology, and pediatrics, successively, mostly for lumbago and leg pain; (2) the heat-producing needling manipulation is the most frequently applied technique, followed by cool-producing needling, dragon-tiger warring, yang occluding in yin, yin occluding in yang techniques; (3) the highest effective rate of CRRM is for problems of the pediatrics, followed by those of the internal medicine, surgery, ophthalmology and otorhinolaryngology, dermatology, and gynecology; (4) the most fre- quently used acupoints are Zusanli (ST 36), then Sanyinjiao (SP 6), stimulated by heat-producing needling, and Zusanli (ST 36), then Quchi (LI 11), stimulated by cool-producing needling, and Huantiao (GB 30), stimulated by dragon-tiger warring needling.

CONCLUSION

The compound reinforcing-reducing manipulation of acupuncture is most frequently applied to problems in the inter- nal medicine, predominately for lumbago and leg pain, and the best effectiveness is for pediatric conditions. The heat-producing needling and cool-producing needling are most frequently applied at Zusanli (ST 36) and the dragon-tiger warring manipulation is most frequently applied at Huantiao (GB 30).

[Acupoint position and manipulation of needle knife treating shoulder bi syndrome]

With Jianyu (LI 15), Jianliao (TE 14) and Jianzhen (SI 9) for instance, the three acupoints used to treat shoulder bi syndrome by needle knife, and through traceability and researching constant structure, the acupoint position, insertion trace, manipulation and clinical significance of needle knife medicine were discussed. Accurate position is one of the characteristics of acupoints selection of needle knife medicine. As for the acupoints selection method, the mean of body surface localization is always used. The phanerous or palpable bone processes, muscles and tendons are taken as positioning marks; pressing areas where appear sour, numb, or distensible and other sensations is considered as the principle of press positioning. So acupoints position method is the combination of observation and palpation. Different insertion methods can effectively relieve the accretive bursae synovialis, tendon, joint capsule and the compressed nerve, so that shoulder bi syndrome is relieved.

[Discussion on different methods of painless needle insertion based on positions]

Based on multiple painless needle insertion skills in clinic combined with own experience, the authors propose the opinion that different painless needle insertion methods need to be used according to the positions where acupoints are. The appropriate needle insertion mean must be selected in accord with the anatomical characteristic of acupoint position, namely, tapping insertion is applied in scalp part, skin-pinching up needle insertion is used in forehead and superficial nerve trunk, fingernail-pressure needle insertion in ocular region and positions where large blood vessels distribute, flying acupuncture insertion in face and finger tip, vibrating needle in occipitonuchal region, quivering insertion in abdomen, quick pricking by single hand in the four limbs and back, and chop acupuncture in palm and pelma. The insertion methods are systematically discussed in terms of preparation, acupoint position, manipulation and attention, etc, so that to provide the reference for painless needle insertion.

[Correlation between spirit-qi acupuncture and lifting-thrusting twirling method for spirit in Huangdi Neijing]

By analyzing the articles in Huangdi Neijing (Inner Canon of Yellow Emperor), combined with the verification of consciousness in vitro in clinic and modern science, it is found Huangdi Neijing has made special requirements of treating spirit for physicians using spirit-qi acupuncture. The physicians consciously use different methods to motivate the spirit of physician and patients, especially patients, to transform it to the physiological effect of patients, which could minimize the psychological factors that make negative influence on treatment; also the psychotherapy is considered as the most important principle of treating spirit. The reinforcing and reducing methods in later generations, mainly lifting-thrusting twirling method, unintentionally lead patients into a basic or strong status of treating spirit or keeping spirit during the process of achieving stimulation and needle sensation. To partially perform the special role of treating spirit for physicians in Huangdi Neijing on patients could cause the chages including patient-based using spirit to move qi. It not only inspires the body's natural resistance to disease and self-healing, but also motivates the self-protection mechanism of keeping spirit.

[Primary varicose veins treated with HE's fire needle therapy: a randomized controlled trial]

OBJECTIVE

To evaluate the clinical efficacy on primary varicose veins treated with He's fire needle therapy.

METHODS

Fifty patients of primary varicose veins were randomized into an observation group (25 cases) and a control group (25 cases). In the observation group, He's fire needle therapy was applied for 8 weeks. The fire needling was done on the sites of varicose veins till the bleeding stopped automatically. Additionally, acupuncture with filiform needle was applied to Heyang (BL 55), Chengjin (BL 56), Chengshan (BL 57) and Kunlun (BL 60) on the affected side. In the control group, no intervention was given. The follow-up visit was conducted regularly and since the 8th week, the same treatment as the observation group was provided in the control group. The revised venous clinical severity score (RVCSS) was used for the evaluation of the primary outcomes. The methods for the evaluation of the secondary efficacy outcomes included the venous insufficiency epidemiologic and economic study of quality of life questionnaire scale (VEINES-QOL/sym questionnaire), the venous insufficiency epidemiologic and economic study of symptom score (VEINES-Sym score), the venous insufficiency epidemiologic and economic study of quality of life scale (VEINES-QOL score) and the Homburg varicose vein severity score (HVVSS). The evaluation was conducted at the baseline, at the end of the 4th week and the 8th week separately. The follow-up evaluation was done at the end of the 16th week in the observation group.

RESULTS

During the study, 5 cases were dropped out, accounting for 10%. RVCSS score in the observation group was lower than that in the control group at the end of the 4th and 8th weeks separately (both P < 0.05). VEINES-QOL score and HVVSS score in the observation group were higher than those in the control group at the end of the 4th and 8th weeks separately (P < 0.05, P < 0.01). VEINES-Sym score in the observation group was increased as compared with that of the control group at the end of the 4th and 8th weeks, but the difference was significant at the end of the 8th week (P < 0.01). HVVSS score at the end of the 8th and 16th weeks was reduced as compared with that at the end of the 4th week in the observation group (both P < 0.05).

CONCLUSION

HE's fire needle therapy is effective on primary varicose veins. It significantly reduces the severity of disease, the severity of symptoms and the attack frequency of symptoms so that the quality of life is improved in the patients. Additionally, the good long-term efficacy is maintained in 8 weeks after treatment. When the duration of treatment is increased from 4 weeks to 8 weeks, HE's fire needle therapy remarkably improves the efficacy for reducing the symptom severity.

[Pestle needle at Yaoyangguan bazhen and Heche-mingqiang section for 31 cases of bi syndrome at low back]

OBJECTIVE

To observe the clinical effect of pestle needle at Yaoyangguan bazhen and Heche-mingqiang section for bi syndrome (cold dampness type) at low back.

METHODS

Thirty-one patients of bi syndrome (cold dampness type) at low back were treated with pestle needle at Yaoyangguan bazhen and Heche-mingqiang section. After the treatment of pestle needle, traditional acupuncture was used at Shenshu (BL 23), Dachangshu (BL 25), Huantiao (GB 30), Weizhong (BL 40), Chengshan (BL 57), Kunlun (BL 60), etc., followed by TCM washing at low back and legs. Once daily, five days of treatment were taken as one course, and there was an interval of 2 days between two courses. Totally 4 courses were given. The visual analogue scale (VAS) before and after treatment was observed, and the clinical efficacy was evaluated.

RESULTS

The total effective rate was 90.3% (28/31) in 31 patients; the VAS after treatment was (2.42 ± 0.78), which was significantly, different from (5.59 ± 1.17) before treatment (P < 0.01). CONCLUSION The pestle needle at Yaoyangguan bazhen and Heche-mingqiang section is effective, noninvasive, painless for low-back bi syndrome (cold dampness type), and it is convenient for operation and easily accepted.

[Effect observation of conical stone needle on foot combined with bian anvil for insomnia]

OBJECTIVE

To observe the effect of conical atone needle on foot combined with Nan anvil at Yintang (CV 29) for insomnia.

METHODS

Seventy patients were randomly divided into a ibian technique group and an acupuncture group,35 cases in each one. In the Sian technique group, conical stone needle on foot combined with bias anvil at Yintang(GV 29) were used,and the therapy was applied at Yongquan(KI 1), Taichong(LR 3) and Gongsun(SP 4), etc. In the acupuncture group, common acupuncture was implemented at Sanyinjiao(SP 6), Shenmen (HT 7) and Sishencong(EX-HN 1), etc. In the two groups, treatment was given for 2 weeks,once a day. There were two days to have a rest between 5-time treatment. The change of Pittsburgh sleep quality index(PSQI) before and after treatment was recorded and the clinical effect was observed after 10-time treatment and in two weeks aftet treatment.

RESULTS

After treatment,the total scores of PSQI were declined significantly compared with those before treatment in the two groups(both P<0. 01). The total PSQI scores after treatment,the curative and effective rates and total effective rates when followed up bad no statistical significance(all P>0. 05).

CONCLUSION

Conical stone needle on foot combined with Sian anvil at Yintang(GV 29) treating insomnia is safe and effective,and this treatment acquires similar efficacy with less suffering.