Comparison of therapeutic effects of different acupuncture and moxibustion therapies on irritable bowel syndrome: A protocol for systematic review and network meta-analysis

BACKGROUND

Irritable bowel syndrome (IBS) is a functional gastrointestinal disorder with recurrent abdominal pain and changes in bowel habits. Many pieces of evidence show that acupuncture and moxibustion therapy has advantages in the treatment of IBS, but there are many acupuncture and moxibustion therapy options, each of which has different therapeutic effects. This study will evaluate the clinical efficacy of different acupuncture and moxibustion therapies in the treatment of IBS by means of a network meta-analysis.

METHODS

According to the retrieval strategy, we retrieved the randomized controlled trials of acupuncture and moxibustion treatment of IBS from China National Knowledge Infrastructure, Wanfang, VIP, Chinese biomedical databases, PubMed, Embase, Web of Science, and the Cochrane Library databases from the database establishment to July 2021. We assessed the quality of the studies using the Cochrane Risk Bias Assessment Tool and assessed the strength of the evidence using the Grading of Recommendation Assessment, Development, and Evaluation methodology. All data analyses were performed by RevMan5.3, Gemtc 0.14.3, and Stata 14.0.

RESULTS

This study evaluated the efficacy of different acupuncture and moxibustion therapies in the treatment of IBS by evaluating the clinical efficacy rate, symptom scores, quality of life scores, adverse reactions, etc, and further explore the mechanism of action of each therapy.

CONCLUSION

This study will provide a reliable evidence-based basis for selecting the best acupuncture and moxibustion therapy for IBS.

ETHICS AND DISSEMINATION

Private information from individuals will not be published.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

OSF REGISTRATION NUMBER

DOI 10.17605/OSF.IO/3278Y.

Acupuncture and moxibustion combined with cupping for the treatment of post-herpetic neuralgia: A meta-analysis

BACKGROUND

There are still controversies between the curative effect of acupuncture combined with cupping therapy and western medicine for post-herpetic neuralgia (PHN). Our meta-analysis fully incorporates the research of acupuncture combined with cupping therapy versus Western medicine for PHN, aiming to explore the difference in the efficacy of the 2 therapies, so as to provide guidance for clinical treatment.

METHODS

We searched PubMed, Embase, Cochrane Library, CNKI, Wanfang, CQVIP, CBM, from establishment of the database to September, 2020. Include studies that are clearly defined as PHN or herpes zoster, and exclude duplicate publications; studies with no full text, incomplete information, or inability to extract data; the definition of exposure is quite different from most literature; animal experiments.

RESULTS

The total effective rate (relative ratio [RR] = 1.21, 95% confidence interval [CI]: 1.12-1.31) and the rate of remarkable effect (RR = 1.46, 95% CI: 1.30-1.63) of acupuncture and moxibustion combined with cupping in the treatment of PHN were significantly higher than that of conventional western medicine. The visual analogue scale score of acupuncture and moxibustion combined with cupping for PHN was significantly lower than that of conventional western medicine treatment (WMD = -1.77, 95% CI [-2.79, -0.75]). In addition, acupuncture and moxibustion combined with cupping therapy significantly reduced the occurrence of PHN compared with conventional western medicine treatment after treatment of acute herpes zoster (RR = 0.30, 95% CI: 0.20-0.45). In order to explore the differences in the efficacy and preventive effects of different types of acupuncture and cupping therapy, we have further conducted a subgroup analysis.

CONCLUSION

The effect of acupuncture and moxibustion combined with cupping in the treatment of PHN is significantly higher than that of conventional western medicine, and it can significantly prevent the occurrence of PHN. Chinese medicine should be used more widely in the treatment of PHN.

Moxibustion therapy on lumbar disc herniation: An evidence-based clinical practice guideline

BACKGROUND

Lumbar disc herniation (LDH), as a disease with great disturbance to life and work, is known as the origin of the severe and disabling forms of nerve root pain. Recognized as an increasingly widely accepted treatment, the efficacy of moxibustion on LDH has been affirmed. However, clinical practice guidelines (CPG) for the treatment of LDH with moxibustion have not been developed. Therefore, we will carry out this work following the accepted methodological quality standards.

METHODS

The new CPG will be developed according to the Institute of Medicine (IOM), the Appraisal of Guidelines for Research & Evaluation II (AGREE II) and WHO guideline handbook. And then determine recommendations based on high-level evidence. We will set up a Guideline Working Group and define clinical issues according to the PICO principles (Population, Intervention, Comparison, Outcomes). After evidence syntheses and several rounds of Delphi process, we will reach the consensus. In making the guideline, Patient values or preferences, results of peer review, and interest statements are all within the bounds of what we must consider.

RESULTS

As the study is not yet complete, no results can be reported.

CONCLUSION

So far, we will develop the first CPG for moxibustion of LDH strictly based on systematic methodologies in China. This CPG will establish the standard of LDH in moxibustion therapy.

REGISTRATION NUMBER

IPGRP-2020CN034.

Effectiveness and safety of fire needle for knee osteoarthritis: A protocol of systematic review and meta-analysis

BACKGROUND

There is a lack of curative medical treatment for patients with knee osteoarthritis (KOA). Acupuncture represents an important alternative therapy. In various forms of acupuncture and moxibustion, the fire needle is an indispensable part. Knee osteoarthritis (KOA) is a series of symptoms and signs of knee joint caused by local injury and inflammation and chronic strain of the knee joint resulting in cartilage degeneration of the articular surface and reactive bone loss of the subchondral bone plate. The results of clinical trial indicated that the fire needle therapy has obvious curative effect in treating KOA. This protocol is intended to describe how to collate and accumulate evidence for the current efficient and safe treatment of KOA with fire needle.

METHODS

Seven electronic databases were used to retrieve the literature for the KOA randomized controlled trials, including 3 English databases (PubMed, EMBASE, the Cochrane Central Register of Controlled Trials [Cochrane Library]), and 4 Chinese databases (Chinese National Knowledge Infrastructure, Chinese VIP Information, Wanfang Database, and Chinese Biomedical Literature Database). This systematic review will include all randomized controlled clinical trials using fire needle therapy for KOA. The observation Index is the Change of Western Ontario and McMaster Universities Osteoarthritis Index Total, first proposed by Bellamy in 1988. The selection of the study will be completed independently by 2 reviewers, extract the data, and evaluate the quality of the study before selecting the title, abstract, and full text. Revman 5.4 software will be used to perform meta-analyses of randomized controlled trials, where risk ratios for dichotomous data and standardized or weighted mean differences for continuous data are the results.

RESULT

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

CONCLUSION

This systematic review will provide the latest evidence to evaluate the safety and efficacy of fire needle therapy in patients with KOA.

TRIAL REGISTRATION NUMBER

INPLASY202080030.

Effectiveness and safety of warm needle acupuncture for sciatica: A protocol for systematic review and meta-analysis

BACKGROUND

Sciatica is a syndrome characterized by sciatic nerve path and distribution area pain. Many kinds of literature reported the definite effect of warm needle acupuncture (WNA) on sciatica. However, there is no systematic review or meta-analysis on WNA for sciatica. Therefore, this study will design a protocol to comprehensively and systematically evaluate the effectiveness and safety of WNA on sciatica.

METHODS

The two researchers in this study will search the electronic database for randomized controlled trials, (RCTs) of WNA on sciatica, The databases we will search include PubMed, EMBASE, Cochrane Library, Web of Science, Chinese national knowledge infrastructure (CNKI), China Science and Technology Journal Database (VIP), Wanfang Database, and Chinese biomedical literature database (CBM). Review Manager 5.4 software and Cochrane risk bias tool will be us used for data analysis and to evaluate research quality. The main clinical indicators will include visual analogue scale (VAS) and Oswestry Disability Index (ODI).

RESULTS

This study will evaluate the efficacy and safety of WNA for sciatica.

CONCLUSION

This study will provide a reliable scheme for objectively and comprehensively evaluating the efficacy and safety of WNA on sciatica.

TRIAL REGISTRATION NUMBER

INPLASY2020110074.

Efficacy and safety of warm acupuncture in the treatment of ankylosing spondylitis: A protocol for systematic review and meta-analysis

BACKGROUND

Ankylosing spondylitis refers to a type of autoimmune disease, which is commonly characterized by joint pain and stiffness, since the disease progression can exhibit joint deformity and other activities limited symptoms. Has significantly impacts on people's work and life. Warm acupuncture as a traditional Chinese therapy, showing several advantages (eg, safety, economy, and less side effects), has been extensively used to treat ankylosing spondylitis. However, its curative effect is supported by limited evidence. Accordingly, the present study aims to comprehensively assess the reliability of warm acupuncture in ankylosing spondylitis treatment.

METHODS

Randomized controlled trials were searched from the Chinese Biomedical Literature Database, Chongqing VIP Database for Chinese Technical Periodicals, China National Knowledge Infrastructure, Wanfang, Web of Science, Cochrane Library, PubMed, and EMBASE, regardless of their publication status. The deadline was November 6th, 2020. Two experienced researchers adopted RevMan V.5.3 software for literature selection, data collection, data analysis, and synthesis, respectively. In addition, the quality of the trials involved in this study was measured with the Cochrane Bias risk assessment tool, regardless of language or publication status.

RESULTS

The protocol will be used to assess the efficacy and safety of warm acupuncture in ankylosing spondylitis treatment.

CONCLUSION

This review reliably evidences whether warm acupuncture is a reliable method for the intervention of ankylosing spondylitis.

INPLASY REGISTRATION NUMBER

INPLASY2020110096.

Treatment of vitiligo with fire needle: A protocol for systematic review and meta analysis

BACKGROUND

We aim to study the treatment of vitiligo with fire needle.

METHODS

We will search PubMed, Embase, the Cochrane Library, the China National Knowledge Infrastructure, Chinese Science and Technology Periodical Database, Wanfang Database, and Chinese Biomedical Literature Database of randomized controlled trials beginning from their inception to August 2020. The primary outcomes is that Complex area of white spot and Percentage of Clinical Effectiveness will be accepted as the primary outcomes. Additional outcome is the safety assessment will be considered a secondary outcome. Two independent authors will based on the Cochrane system evaluation manual 5.1.0 version of randomized controlled trial bias risk assessment tool to evaluate the risk of bias among the final included studies. And we will use the RevMan 5.3 software to analysis data.

CONCLUSION

This study will provide evidence to judge whether fire needle is an effective therapy for vitiligo.

INPLASY REGISTRATION NUMBER

INPLASY2020120012.

An update of fire needle acupuncture for acute herpes zoster and prevention of postherpetic neuralgia in adults: A protocol for systematic review and meta-analysis

BACKGROUND

Herpes zoster, is one of the most familiar skin diseases in conducted a systematic review and meta-analysis in 2018 showed that fire needle acupuncture can relieve the pain caused by herpes zoster quickly and prevent the outcome of postherpetic neuralgia (PHN), with little side effects. The purpose of this study is to update the systematic review with the latest evidence.

METHODS

Four English (PubMed, Embase, the Cochrane Library, the Web of Science) and 4 Chinese databases (CNKI, Wanfang, VIP, and CBM) will be searched dating until 30 June 2020 for randomized controlled trials with no language restrictions. In addition, a hand search of the reference lists of included studies will also be done. Adults (aged 18-70) with acute herpes zoster (less than 7 days) using fire needle acupuncture will be included. Pairs of researchers will independently conduct the search, screen titles and abstracts, retrieve full texts of potentially eligible studies, assess the risk of bias, and conduct date extraction and synthesis. If there is any discrepancy in the whole process, consult a third researcher. For meta-analysis, the primary outcome is the pain intensity (visual analogue scale [VAS] pain scale; pain relieve of 30%, duration of pain), and the second outcome is incidence of PHN. A sequential analysis will be done to test the robustness of results of meta-analysis. The quality of evidence will be assessed using GRADE system.

RESULTS

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

CONCLUSION

This study will provide the latest systematic review and meta-analysis of fire needle acupuncture for acute herpes zoster and prevention of PHN.

Efficacy and safety of Tian moxibustion in treating allergic rhinitis: A protocol for a systematic review and meta-analysis

BACKGROUND

Allergic rhinitis, abbreviated AR, modern medicine considers AR to be a chronic inflammatory reactive disease of the nasal mucosa mediated by exposure to allergens such as pollen and mites immunoglobulin E. AR not only affects patients' daily life, sleep, work, and study, but also brings huge economic burden to patients and society. At present, desensitization therapy, antiallergic drugs, antihistamines, hormones, and other drugs are used to improve symptoms or immune regulation, but the clinical short-term and long-term efficacy is general, the symptoms are easy to be repeated after drug withdrawal, and the long-term toxicity and side effects of drugs are obviously insufficient. Tian moxibustion therapy has a good effect on AR. Therefore, this paper will carry out a systematic evaluation and meta-analysis of the efficacy and safety of moxibustion in the treatment of allergic rhinitis.

METHODS

Eight electronic databases will be searched, including PubMed, Embase, Web of Science, Cochrane Library, the China National Knowledge Infrastructure (CNKI), Chinese Science and Technology Periodical Database (VIP), Wanfang Database (WF), and Chinese Biomedical Literature Database (CBM). We will search above electronic databases from the beginning to November 2020, without any language restriction, but involving only the human subjects. Clinical efficacy, including total effective rate or cure rate, and recurrence rate will be accepted as the primary outcomes. The Rhinoconjunctivitis quality of life questionaire (RQLQ) score, symptom score (nasal congestion, snot, continuous sneezing) will be used as secondary outcomes. The Cochrane Handbook of Systematic Review (5.3.0) randomized controlled trials (RCT) risk assessment tool will be used to evaluate the risk of bias by 2 independent researchers.

RESULTS

After the completion of this study, the results will be reported, so it is not possible to give accurate results at present.

CONCLUSIONS

The results of this study will provide reliable evidence for the efficacy and safety of Tian moxibustion in the treatment of allergic rhinitis.

ETHICS AND DISSEMINATION

This paper does not need to be approved by the Ethics Committee, because this paper is a systematic review and quality evaluation of relevant literature. The results of this study will be disseminated in the form of a paper to help better guide the clinical practice of Tian moxibustion in the treatment of allergic rhinitis.

INPLASY REGISTRATION NUMBER

INPLASY2020110058.

Moxibustion therapy for chronic spontaneous urticaria: A protocol for systematic review and meta-analysis

BACKGROUND

Chronic spontaneous urticaria (CSU) is a common disease in clinical, and often recrudescent. However, sometimes Western medicine treatments such as antihistamines cannot completely control the symptoms of CSU; therefore, more effective and optimized treatments are needed. Numerous studies have confirmed that moxibustion therapy is effective in treating CSU. Given that no relevant systematic reviews and meta-analysis have been carried out, we set out to prove the effect of moxibustion therapy for CSU.

METHODS

This protocol will be conducted based on the PRISMA-P guidelines and comply with the recommendations of the Cochrane Collaboration Handbook for Systematic Reviews. We plan to search the subsequent databases: PubMed, Web of Science, EMBASE.com and Cochrane Library, China National Knowledge Infrastructure, WanFang Database, Chinese Science Journal Database, and China Biomedical Literature Database. The studies will be screened under the eligibility criterion. The quality of the studies will be assessed based on the Cochrane risk bias tool. Ultimately, Review Manager 5.3 will be used for statistical analysis.

RESULTS

This research will comprehensively evaluate the effectiveness of moxibustion therapy for CSU, and provide a more reasonable and effective treatment plan for CUS.

CONCLUSION

This research will bring new evidence for the efficacy of moxibustion therapy in the treatment of CSU and provide a basis for future clinical applications.

INPLASY REGISTRATION NUMBER

INPLASY2020100045.

Moxibustion for the side effects of surgical therapy and chemotherapy in patients with gastric cancer: A protocol for systematic review and meta-analysis

BACKGROUND

Side effects after surgical therapy and chemotherapy of gastric cancer substantially reduce patients' quality of life. This systematic review aims to investigate whether moxibustion, as a complementary treatment, is effective in alleviating side effects in patients with gastric cancer who underwent surgical therapy or chemotherapy.

METHODS

We will systematically search nine English and Chinese electronic databases to find relevant randomized controlled trials (RCTs) that compare basic treatment with and without moxibustion for treating the side effects induced by surgical therapy or chemotherapy in patients with gastric cancer. The time frame of the search will be from inception to July 1, 2020, and the publication language will not be limited. The literature screening and data extraction will be completed independently by 2 reviewers. The Cochrane risk of bias tool will be used to assess the risk of bias. For the analyses of the side effects of both surgical therapy and chemotherapy, the primary outcomes are defined as the incidence of any side effect, response rate, and quality of life. For the analyses of the side effects of surgical therapy, the secondary outcomes include the incidence of each individual side effect, time to first flatus/defecation/bowel sounds, and length of in-hospital stay. For the analysis of the side effects of chemotherapy, the secondary outcomes include incidence of each individual side effect, white blood cell/red blood cell/platelets counts, and hemoglobin level. R v3.6.2 software will be used to perform the meta-analyses. The quality of evidence will be classified using the Grading of Recommendations Assessment, Development and Evaluation system.

RESULTS

This study will provide the first systematic review evidence on the efficacy of moxibustion as adjuvant management for gastric cancer by rigorous quality assessment and appropriate data synthesis. The results will be submitted to a peer-reviewed journal for publication.

CONCLUSION

The findings of this study will provide currently best evidence on moxibustion for patients with gastric cancer who underwent surgical therapy or chemotherapy and may impact clinical practice.PROSPERO registration number: CRD42020169511.

Acupuncture and moxibustion for primary osteoporosis: An overview of systematic review

Primary osteoporosis (PO) is a common disease that was characterized by a systemic impairment of bone mass and microarchitecture that results in fragility fractures and constitutes a pressing public health problem. But the effect of acupuncture or moxibustion treatment for PO is controversial.To provide a comprehensive systematic overview of current evidence from systematic reviews (SR)/Meta-analysis of acupuncture treatment for PO pertaining to risk of bias, quality of evidence and report quality.A total of 9 international and Chinese databases were searched for SR/meta-analysis of randomized controlled trials (RCTs). The risk of bias of SR/meta-analysis was appraised using the risk of bias in systematic reviews (ROBIS) instrument, the quality of the evidence was evaluated via Grading of Recommendations Assessment, Development and Evaluation (GRADE), and the report quality of the included studies are estimated by Preferred Reporting Items for Systematic Reviews and Meta-analyses (PRISMA).According to ROBIS, only 2 articles were with risk of low bias; according to PRISMA, and most articles were reported incomplete, mainly in Q2, Q7, Q24, and Q27; according to GRADE, a total of 28 outcome indicators were evaluated under 4 different interventions of experimental group and control group: the evidence quality of bone mineral density (BMD) from treatment of acupuncture and moxibustion/acupuncture and moxibustion plus was high or moderate; Visual Analogue Score (VAS) of acupuncture plus moxibustion or acupuncture plus moxibustion plus other was low or very low; clinical effectiveness of acupuncture plus moxibustion or acupuncture plus moxibustion plus other was uncertain.Acupuncture and moxibustion can improve the BMD of PO patients according to high-quality evidence, and may benefit VAS, pain score, clinical efficacy based on moderate or low-quality evidence. Further research that provides higher quality evidence of SR/RCTs of acupuncture and moxibustion treatment for PO is required.

[Exploration on Whether to Standardize Acu-moxibustion]

Acu-moxibustion is the important component and inseparable in Chinese medicine with its unique characteristics. Just due to the distinct characteristics of acu-moxibustion, whether to standardize acu-moxibustion has been highlighted among the people in consideration of its development. In the present paper, the author introduces the characteristics of acu-moxibustion, the existence situation of its characteristics after being standardized, and the function, substance, feasibility, practice and effect, plan and strategy of acu-moxibustion standardization.

Effectiveness and safety of moxibustion for primary insomnia: a systematic review and meta-analysis

BACKGROUND

Primary insomnia is a widespread and refractory disease. Moxibustion therapy for insomnia shows some advantages compared with conventional therapies. This systematic review and meta-analysis of randomized controlled trials (RCTs) was conducted to evaluate the effectiveness and safety of moxibustion therapy for insomnia.

METHODS

We conducted a comprehensive literature review of the CENTRAL, PubMed, EMBASE, Web of science, CNKI, VIP, and Wanfang Data databases from their inception to July 2015 for RCTs that compared moxibustion with western medications, oral Chinese medicine, or other methods of traditional Chinese medicine (TCM) in patients with primary insomnia. The primary outcome measure was effective rate and secondary outcome measure was adverse events. Data collection and analysis included risk of bias evaluation, meta-analysis, sensitivity analysis, publication bias and adverse events analysis according to corresponding criteria.

RESULTS

The study included 22 RCTs (1,971 patients). The quality of the studies was low. The overall meta-analysis demonstrated that moxibustion was more effective for insomnia than western medications, oral Chinese medicine and other TCM therapies (RR = 1.17, 95 % CI 1.12 to 1.23, P < 0.00001). Subgroup analyses demonstrated that moxibustion was more effective for insomnia than western medications (RR = 1.16, 95 % CI 1.09 to 1.24, P < 0.00001), oral Chinese medicine (RR = 1.11, 95 % CI 1.04 to 1.18, P = 0.002), and other TCM therapies (RR = 1.22, 95 % CI 1.15 to 1.30, P < 0.00001). There were no serious adverse effects associated with moxibustion therapy for insomnia, and the rate of adverse events was low.

CONCLUSION

It is difficult to get the conclusion regarding the effectiveness and safety of moxibustion for primary insomnia due to insufficient evidence, such as the high risk of bias in the included studies, small sample sizes, and few reports on adverse effects. Moxibustion should be considered as a novel therapeutic option for insomnia, and more rigorous clinical trials of moxibustion therapy for insomnia are needed to assess its effects.

[Doubting the twirling angle of filiform needle in Science of Acupuncture and Moxibustion textbooks and National Standards]

In National Standards (GB) as well as the textbooks used in TCM universities, the twirling angles of acupuncture manipulation vary a lot. By reviewing the previous editions of textbooks from 3 publication houses and comparing the relevant contents, the author calculated the arc lengths of various twirling angles based on the specification of filiform needle in National Standards (GB) and International Standards (ISO). The conclusion is that the twirling angles mentioned in National Standards (GB) and textbooks are too small and not in compliance with the clinical practice. Hence, it is not advisable to propose a rigid specific provision of twirling angle in acupuncture manipulation.

[Explanation of Evidence-based Guidelines of Clinical Practice with Acupuncture and Moxibustion: Adult Bronchial Asthma]

The development and compilation of Evidence-based Guidelines of Clinical Practice with Acupuncture and Moxibustion: Adult Bronchial Asthma are introduced from three aspects, named the guideline methodology, the guideline structure and the guideline content. Based on the acupuncture-moxibustion practice and clinical research, the evidence-based medicine method is adopted. During the development and compilation of the guideline, the characteristics and advantages of acupuncture and moxibustion are specially considered in the treatment of this disease; the latest optimum evidences at home and abroad, experts' experience and patients' value are closely integrated with each other. Additionally, the worldwide accepted assessments of evidence quality and the recommendation (GRADE system) are combined with the clinical evidences of the ancient and modern famous acupuncture-moxibustion experts, and the clinical research evidences are with the experts' consensus to the large extent. The purpose of the guideline is to provide the maximal guidance to the clinical physicians.

[Science of Acupuncture and Moxibustion should include standards related to acupuncture and moxibustion]

The development of Science of Acupuncture and Moxibustion should be in accord with the trend of standardization and internationalization of the science of acupuncture and moxibustion. Based on the arrangement of chapters and sections in the textbook, 29 national standards, 6 standards or guidelines made by World Health Or- ganization(WHO) and 1 standard out of International Standardization Organization (ISO) are classified and intro- duced. It is suggested that the above contents should be considered as the evidence when the textbook is reedited. Also, it is proposed that humanization should be supplemented and the newest research findings should be traced.

[Application of minimum clinically important difference in the clinical study of acupuncturej and moxibustion]

The current clinical efficacy evaluation system and evaluation methods of acupuncture have several limitations, and the application status is not optimistic. According to long-term observation, minimum clinically important difference (MCID) is consistent with the characteristics of clinical acupuncture, and has objective quanti- tative standard and wide applicability. Incorporating MCID into acupuncture clinical efficacy evaluation of tradition- al Chinese medicine can truly reflect the clinical effect of acupuncture and improve the disadvantages and shortcom- ings of acupuncture clinical evaluation, which could provide certain reference for building clinical efficacy evaluation system featured with TCM.

[Discussion on moxibustion with different dose]

Moxibustion dose, closely related to moxibustion methods and sensations, directly influences the efficacy. Moxibustion dose is affected by quantity factors and patients' sensations. Quantity factors are volume and number of moxa cones, and moxibustion time and frequency, etc. The relationship between moxibustion dose and efficacy is discussed from quantity factors and sensations in the paper.

[Interpretation of Clinical Practice Guideline for Low Back Pain Treated with Acupuncture and Moxibustion]

Based on entire literature retrieval about low back pain treated with acupuncture and moxibustion, Clinical Practice Guideline for Low Back Pain Treated with Acupuncture and Moxibustion was drafted according to method of evidence quality and recommended intensity grading system(GRADE). This article specificly introduces the aim and available diseases of the guideline. The principle and recommended plans are also detailedly explained.

[Evidence-based medicine and real world study in clinical study of acupuncture and moxibustion]

Evidence-based medicine (EBM) has been widely applied in clinical study of acupuncture and moxibustion, and the real-world study (RWS) has gradually become an important way of clinical research in the world in recent years. It is worthy of our in-depth study and discussion that how to evaluate the advantages and limitations of EBM and RWS as well as their reasonable application in clinical study of acupuncture and moxibustion. The characteristics and difference between RWS and EBM, and the situation of acupuncture clinical research methods are discussed in this paper. It is proposed that we should understand the advantages of RWS in acupuncture clinical research, fully realize the limitations of EBM and RWS, recognize the complexity and particularity of RWS, and apply EBM and RWS into acupuncture clinical research. Meanwhile acupuncture clinical manipulation standardization should be further promoted, which is benefit to develop clinical study, improve clinical efficacy and promote the popularization of acupuncture and moxibustion.

[Report quality of randomized controlled trials of moxibustion for knee osteoarthritis based on CONSORT and STRICTOM]

The report quality of randomized controlled trials (RCTs) of moxibustion for knee osteoarthritis (KOA) in China was evaluated by Consolidated Standards for Reporting of Trials (CONSORT) and Standards for Reporting Interventions in Controlled Trials of Moxibustion (STRICTOM). Computer and manual retrieval was used. Four databases of China National Knowledge Infrastructure (CNKD, China Biomedicine (CBM), VIP and WNFANG were searched in combination with manual retrieval for relevant journals to screen the literature that: met the inclusive criteria, and CONSORT and STRICTOM were used to assess the report quality. A total of 52 RCTs were included. It was found that unclear description of random methods, low use of blind methods, no allocation concealment, no sample size calculation, no intention-to-treat analysis,inadequate report of moxibustion details and no mention of practitioners background existed in the majority of the RCTs. Although the quality of RCTs of moxibustion for KOA was generally low, reducing the reliability and homogeneous comparability of the reports ,the quality of heat-sensitive moxibustion RCTs was high. It was believed that in order to improve the reliability and quality of RCTs of moxibustion, CONSORT and STRICTOM should be introduced into the RCT design of moxibustion and be strictly performed.

[Standardizing the manipulation procedure of acupuncture-moxibustion, reinforcing the training of' clinical skill: learning experience of Acupuncture-moxibustion Clinical Skills Training: Chapter of Commonly Used Needling and Moxibustion Techniques]

The book Acupuncture-moxibustion Clinical Skills Training is one of "Twelfth Five-Year Plan" in novative teaching materials, which is published by People's Medical Publishing House. Through learning the first half of the book commonly used needling and moxibustion techniques, it is realized that the selection of book content is reasonable and much attention is paid to needling and moxibustion techniques; the chapter arrangement is well-organized, and the form is novel, which is concise and intuitive; for every technique, great attention is paid to standardize the manipulation procedure and clarify the technique key, simultaneously the safety of acupuncture and moxibustion is also emphasized. The characteristics of the book, including innovativeness, practicability, are highlighted, and it greatly helps to improve students' clinical skills and examination ability.

[How to establish a good acupuncture-moxibustion standard?]

At the beginning of a standard item, the standardized objects and involved contents should be demonstrated thoroughly, which is the precondition of establishing a good standard. After the proposal of this standard, a high-level drafting group should be built, led by top specialists who also draft the standard, which is essential to guarantee the quality of the standard. Before drafting the standard, literature regarding this standard should be searched completely, and Directives for Standardization should be learned to understand the basic requirements of establishing a standard; in the meanwhile, selections on standardized contents and quantitative boundaries of technical indices should be comprehensively and deeply studied. At the stage of consultation, focus should be paid on the scope of the consultation departments, level and personnel quality. As for standard review, it should be precise and truth-seeking. At the stage of submitting and authorization, it is necessary to have timely communication. Only by full cooperations of all parties, and by strictly following the procedure, method and rule of standard establishment, can a high-quality acupuncture-moxibustion standard be established.

[Practice and diversion of acupuncture-moxibustion scientization in modern times: taking ZHU Lian as the center]

By following the acupuncture scholar ZHU Lian's academic thought in modern times, and comparing with other contemporary acupuncture scholars, it is found that since the Republic of China, there has been an obvious practice tendency of scientization among academic thoughts of acupuncture, especially in ZHU Lian. This tendency of scientization continues until the early stage of New China. Accompanied with the process of acupuncture high education, academic thoughts represented by acupuncture-moxibustion textbook are different from scientization that is represented by ZHU Lian, and the basic path of acupuncture-moxibustion education and academic theory changed from here.

[The development of World Federation of Acupuncture-Moxibustion Societies]

From cooperation between World Federation of Acupuncture-Moxibustion Societies (WFAS) and World Health Organization, works of academics and standardization, acupuncture-moxibustion education, technique service, organization development, etc., the 27-year development of WFAS since 1987 was summarized and reviewed in details. The growth of WFAS witnesses and promotes the development of acupuncture and moxibustion in the world, so by learning the experience and lessons, WFAS could have a wider path, becoming a core organization for communicating and promoting the development of acupuncture, even the traditional medicine in the world.

[On the interrelationship between standardization and intellectual property rights of acu-moxibustion therapy]

Under the condition of knowledge economy, the acu-moxibustion standardization definitely involves intellectual property rights. Then, what is the relationship between the standardization and the intellectual property rights of acu-moxibustion? The authors of the present paper hold that it is not only exclusive, but also syncretic. If their relationship cannot be handled properly, their own respective development will be affected adversely. Therefore, a proper handling of the relationship between the two is of great practical significance. The present paper makes a comprehensive analysis about their interaction (mutual promotion and mutual inhibition), similarities (systemic composition, dynamic implementation course, standardization-rated order and ultimate targets) and differences (in properties, working components, secret requirement, effectiveness-time limitation, usage cost, etc).

[On the necessity of intellectual property rights involving standardization of acupuncture and moxibustion therapies]

In the process of working out and implementing standardization of acupuncture-moxibustion (acu-moxi) therapy, the issue of intellectual property rights has been frequently involved. Whether is the standardization inevitably involved in intellectual property rights? A reasonable answer to this question is definitely of important realistic guiding value and significance for acu-moxi standardization work. For this reason, authors of the present paper sum up historical development of correlation between acu-moxi standardization and intellectual property rights, and fully analyze the related causes under the conditions of knowledge economy from 1) increasing protection of acu-moxi intellectual property rights, 2) intrinsic requirements for raising the standardization level of acu-moxi, 3) profits drive of the intellectual property rights owners, and 4) increasing impetuous international economic trade competition.

[Quality assessment on guidelines of clinical practice in acupuncture and moxibustion: a study based on AGREE]

The quality of guidelines of clinical practice in acupuncture and moxibustion was evaluated with AGREE II tool. After retrieval of officially-issued guidelines of clinical practice in acupuncture and moxibustion from 2004 to 2013, totally 5 types of evidence-based guidelines of clinical practice in acupuncture and moxibustion were acquired, including depression, herpes zoster, pseudobulbar palsy after stroke, migraine and Bell's palsy. With AGREE II tool, independent score in six areas, including guideline's scope and purpose, participants and personnel, preciseness, clarity and readability, applicability and editorial independence were analyzed to perform a comprehensive evaluation in the end. The assessment results indicated that the score of editorial independence in evidence-based guidelines of clinical practice in acupuncture and moxibustion was the highest, averagely 97.9%, which was followed by clarity and readability (83.3%), participants and personnel (78.1%), preciseness (75.6%), the scope and purpose (68.1%) and the applicability (62.5%). The total evaluation score was all 6 points in the five guidelines with recommended as comprehensive evaluation advice. This study results indicate that although the guideline of clinical practice in acupuncture and moxibustion is low in number, the total quality is considerable.

[A further discussion on acupuncture treatment plan of facial neuritis in Evidence-based Guidelines of Clinical Practice in Acupuncture and Moxibustion]

The treatment plan of facial neuritis in Evidence-based Guidelines of Clinical Practice in Acupuncture and Moxibustion (2011 edition) is discussed, and case information of facial neuritis during the recent five years in department of acupuncture and moxibustion, PLA General Hospital, is retrospectively analyzed. In accordance with anatomy of the facial nerve to form the acupuncture prescription, the detailed diagnosis and treatment method for facial neuritis are introduced. The advantages of the diagnosis and treatment method for facial neuritis are summarized, hoping to establish a more comprehensive, standardized and unified treatment plan.

Current status of standardization of acupuncture and moxibustion in China

With the wide-spread and application of acupuncture and moxibustion, the demand of its standardization construction is increasingly prominent. On the basis of further investigation into the standards of acupuncture and moxibustion in China, this article summarize the research status of Chinese standardization of acupuncture and moxibustion, analyse some problems existing in current construction of acupuncture and moxibustion standardization, and put forward several strategies for moving forward, in order to show an overall and objective understanding of acupuncture and moxibustion standardization.

[Standardized management of acupuncture-moxibustion clinic in Singapore General Hospital]

The standardized management of acupuncture-moxibustion in Singapore General Hospital is introduced. With gradual improvement of outpatient infrastructure, re-training of medical staff, strict disinfection of manipulation, periodical inspection of medical instruments, unified management of writing, saving and processing in medical records and public education of TCM knowledge, a standardized management system in accordance with modernized hospital is gradually established. As a result, efficiency and quality of clinical treatment is continuously increasing. From April of 1998 to December of 2012, a total of 74 654 times of treatment were performed, and treatment amount per day is gradually increased. The unusual condition of acupuncture is avoided. Periodical strict inspection of joint committee authenticated by domestic and overseas medical health organization is repeatedly passed and accepted. Additionally, three clinical researches funded by Singapore Health-care Company are still in progress in acupuncture-moxibustion department.

[Feasibility analysis on the discipline of acupuncture-moxibustion and Tuina to be the top-grade discipline]

By reviewing the historical evolution of the major catalogue adjustment of the discipline of acupuncture-moxibustion and Tuina for the graduate students, the current situation of the development of the discipline of acupuncture-moxibustion and Tuina is analyzed deeply in this paper. Based on the basic requirements of the setup and the adjustment of the top-grade discipline in the Discipline Catalogue Setup and Administrative Measures for the Academic Degree Award and Personnel Training (Academic Degree [2009] No. 10 Document) issued by the Academic Degree Committee of the State Council and the Ministry of Education, with the strictly analysis, the author proposed that the discipline of acupuncture-moxibustion and Tuina should be set up to be the top-grade discipline. The author stated that the discipline of acupuncture-moxibustion and Tuina possessed the explicit study object and had many assignable second-grade disciplines. It could be acknowledged extensively in the academic field in terms of the setup of the top-grade discipline. The author expounded adequately the necessity of the stable and urgent requirements for the talents of the discipline of acupuncture-moxibustion and Tuina in the society, which provided the reference evidences for the adjustments of the discipline and major catalogue in the future.

[Development of standard on acupuncture and moxibustion in Japan: current status and thinking]

The current development situation of acupuncture and moxibustion standard in Japan is introduced from three aspects including State Standard, Industry Standard and Enterprise Standard. Now there are one State Standard (Standard of Acupuncture Needle for Single Use), nine Industry Standards and several Enterprise Standards in Japan. Yet there are some problems in the current standardization research, such as inadequate numbers, no related standards in some important fields, moreover, because Japanese government does not give enough attention, supports from the state is also less. In a word, the standardization of acupuncture and moxibustion in Japan has just started, and it needs further development.

[Current situation of the standardization of acupuncture and moxibustion in Taiwan]

The current situation of the standardization of acupuncture and moxibustion in the Taiwan region is introduced in this paper from the three aspects, named the development state of standard of acupuncture and moxibustion in Taiwan, the implementation of Taiwan district standard and the standardization of acupuncture and moxibustion in Taiwan. At present, the relevant standards of acupuncture and moxibustion in Taiwan just include the standard operation procedure of acupuncture and moxibustion, the reference guideline of the safe operation in the medical service centers of traditional Chinese medicine, and the faculty standard of Chinese medicine hospital, etc. It is concluded that the current situation of the standardization of acupuncture and moxibusiton presented the weak awareness of the standardization of acupuncture and moxibustion in the industry, insufficient enterprise standard, less-quantity of the implemented standards and narrow coverage.

[Experience and discussion on the national standard Standardized Manipulation of Acupuncture and Moxibustion. Part 8: Intradermal Needle]

Standardized Manipulation of Acupuncture and Moxibustion Part 8: Intradermal Needle was compiled with the following principles. The compiling standard, technical features and clinic manipulations of intradermal needle were taken as the basic principle for compiling. Literature research, expert survey and clinic practice verification were applied as the drafting methods. The key issues were focused on the relationship between standardization and individualization, normalization and effectiveness, qualification and quantification. And the postural selection, reinforcing and reducing manipulations, fixing materials and embedding duration involved in intradermal needling were emphasized particularly. At the same time, details and the future way of thinking of intradermal needle were expounded in this article as well.

[Thinking on teaching reform of acupuncture and moxibustion science]

The current problem of acupuncture and moxibustion education is that incomplete and unsystematic content, simple and boring teaching method, and poor-level training in clinical practice. Therefore, students lack study initiative, dedication and passion for their professional study. The complete and systematic educational contents and innovative teaching methods of Acupuncture and Moxibustion Science are proposed. It also proposes innovative educational reform which is student-centered to foster students' professional skills in clinical practices.

[Elucidation of the national standard for Standardized Manipulation of Acupuncture and Moxibustion, Part VII: Skin needle]

The importance of standardization, the main content and important cautions in the Standardized Manipulation of Acupuncture and Moxibustion, Part VII: Skin Needle are introduced briefly in this paper. It standardizes the stimulation intensity, the tapped needling location, the course of treatment and the interval between treatments. It elucidates the key points, the difficulty and the important cautions in clinical practices. In order to promote the standardization and its implementation, it also states the experiences of establishing the national standard of acupuncture and moxibustion manipulations.

[Problems and countermeasures of assessment standard on manipulative skill in Acupuncture and Moxibustion Manipulations]

In order to construct a scientific, objective and quantitative assessment standard of operating skills, characteristics of operation test in Acupuncture and Moxibustion Manipulations are analyzed and problems of assessment standard in appendix of the textbooks of various types and levels are discussed. It is concluded that improvement should be made through compiling an operation manual, drawing up a specification operation steps and quantitative indices. At the same time, a problem-oriented test on people-oriented service should be added as well. And it is held that only through the innovation of assessment standard of skills operation in Acupuncture and Moxibustion Manipulations, the comprehensive quality and application ability of students can be promoted.

[Debating on the formulation of standardized manipulation of acupuncture and moxibustion, Part I: Moxibustion]

Main difficulties and solutions in working out the national standard Standardized Manipulation of Acupuncture and Moxibustion, Part I: Moxibustion are explained in this paper so as to promote the implementation and application of this national standard, including the definition of moxibustion, selection of pertinent literature, expiration date of moxa stick, quantification of moxibustion amount and the problems needing attention.

[Compilation experience of national standard Standardized Manipulation of Acupuncture and Moxibustion, Part 11, Electroacupuncture]

The main structure and content of the national standard Standardized Manipulation of Acupuncture and Moxibustion, Part 11, Electroacupuncture are analyzed in retrospection of its compilation process. Discussions are made concerning arguments on the central idea and problems appeared during the compilation. Meanwhile, key points which should be noticed in clinical application are advanced as well.

[Application of expertise-based randomized controlled trials in acupuncture studies]

Conventional randomized controlled trial is considered as the gold standard of clinical trials in evalua ting pharmacologic effectiveness. Whereas, it still has some faults in the non-pharmacy interventions, such as surgery, acupuncture, massage, etc. Expertise-based randomized controlled trial makes up for some deficiencies of conventional randomized controlled trial, which has made better developments in the field of surgery, however, there is no any relevant retrieval literature found in the acupuncture field. It is feasible and practical of the expertise-based randomized controlled trial to be applied and promoted in the acupuncture-moxibustion clinical research for a further degree. Expertise-based randomized controlled trials might become the trend of acupuncture-moxibustion clinical stu dies in the future.

[Investigation on the real herb of Mugwort leaf and the standard of its processing for moxibustion]

Mugwort leaf is the traditional herb being used for moxibustion. Although its place of production and the course of making Mugwort floss have been described in detail, there is no unified standard about the quality and processing of Mugwort floss until now, which seriously affect on the popularity and application of moxibustion. In accordance with the real herb of Mugwort leaf and floss as well as its processing and quality judgment, this paper thoroughly analyze the related data including ancient documents, modern research results and clinical applications. The authors consider that the Mugwort floss in the market is lack of regulations for its processing, and it needs to be discussed the way to judge the quality of Mugwort leaf by volatile oil, suggesting that the further study on the quality control of Mugwort leaf and floss has to be carried out from multiple aspects, such as physical attributes and chemical characteristics.

[Perspective on the national standard standardized manipulation of acupuncture and moxibustion part II: scalp acupuncture]

Major difficulties and problems in composing the national standard Standardized Manipulation of Acupuncture and Moxibustion Part II: Scalp Acupuncture are discussed in this paper. The difficulties, including the importance of standards, selection of terminology, standardization and characteristics of traditional Chinese medicine, instructions of inserting and manipulating needle, basis and science of the standards, are elaborated as well as the further research and improvements are proposed in the present paper.

[Debating some issues on the national standard Standardized Manipulation of Acupuncture and Moxibustion, part 3: Auricular Acupuncture]

The main difficulties and disputable problems on develping the national standard Standardized Manipulation of Acupuncture and Moribustion, Part 3: Auricular Acupuncture are debated in this paper from the three aspects of its meaning, scientific basis and key point. The difficult points mainly include manipulation standandization of auricular acupuncture, basis and science of the standards stipulated, selection of technical terms and definition, and why only the four kinds of manipulations are used for auricular acupuncture. Finally, the authors suggest that the Standardized Manipulation of Acupuncture and Moxibustion, Part 3: Auricular Acupuncture needs further to be studied and improved.

[Debating some issues on the formulation and application of standardized manipulations of acupuncture and moxibustion-part 6: acupoint injection]

Some issues on the formulation of Standardized manipulations of acupuncture and moxibustion-part 6: acupoint injection are debated in this paper, including the definition of acupoint injection, characteristics of the standard and application of technical index etc. In the paper, the authors suggest that the issues on the selecting acupoints and drugs should be paid attention during the standard in use. Finally, the authors propose that the technical description of the acupoint injection in the reported literatures needs to be improved in order to better serve for clinical and scientific research.