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Moxibustion for Treating Pain: A Systematic Review
Abstract
The objective of this study was to assess the evidence for or against the effectiveness of moxibustion as a treatment option for pain. Fourteen electronic databases were searched. Randomized clinical trials (RCTs) testing moxibustion in human patients with pain of any type were considered. Trials using direct or indirect moxibustion were included. Studies comparing moxibustion with other treatments of unproven effectiveness, studies testing moxibustion together with other treatments of unproven efficacy and trials where pain was not a central symptom of the condition were all excluded. The selection of studies, data extraction, and validation were performed independently by two reviewers. Four RCTs met all the inclusion criteria. Others were of poor methodological quality. Two RCTs suggested significant pain reductions for indirect moxibustion in osteoarthritis as compared with drug therapy (n = 200, RR, 1.11; 95% CI of 1.02 to 1.21, p = 0.02, heterogeneity: chi2 = 1.03, p = 0.31, I2 = 3%). The other two RCTs suggested positive effects of indirect or direct moxibustion on pain in scleroma or herpes zoster compared to drug therapy, respectively. We conclude that few RCTs are available that test the effectiveness of moxibustion in the management of pain, and most of the existing trials have a high risk of bias. Therefore, more rigorous studies are required before the effectiveness of moxibustion for the treatment of pain can be determined.
... To date, there have been 3 related systematic reviews about moxibustion regarding health supervision for KOA, 8,27,28 all of which have clarified that moxibustion was significantly beneficial to relieving pain and improving function for patients with KOA. However, nearly all of the trials regarding KOA included in the above systematic reviews had a high risk of bias and low methodological quality. ...
... At present, the AEs announced in the published literature concerning moxibustion therapy primarily involve burns, allergies, infections, nausea, loose lower eyelids, ectropion, death, and so on. 6,27 However, the issue of whether moxibustioninduced burns are, in fact, an AE is still controversial. 27 In Chinese traditional moxibustion, also known as scarring moxibustion, local minor burns, scarring, and purulence during treatment were taken for granted because many of the components take effect after entering the human body through burndamaged skin. ...
... 6,27 However, the issue of whether moxibustioninduced burns are, in fact, an AE is still controversial. 27 In Chinese traditional moxibustion, also known as scarring moxibustion, local minor burns, scarring, and purulence during treatment were taken for granted because many of the components take effect after entering the human body through burndamaged skin. 23,35 Additionally, in term of burns, some patients accepted these scars as the natural conclusion of moxibustion therapy. ...
... To date, there have been 3 related systematic reviews about moxibustion regarding health supervision for KOA, 8,27,28 all of which have clarified that moxibustion was significantly beneficial to relieving pain and improving function for patients with KOA. However, nearly all of the trials regarding KOA included in the above systematic reviews had a high risk of bias and low methodological quality. ...
... At present, the AEs announced in the published literature concerning moxibustion therapy primarily involve burns, allergies, infections, nausea, loose lower eyelids, ectropion, death, and so on. 6,27 However, the issue of whether moxibustioninduced burns are, in fact, an AE is still controversial. 27 In Chinese traditional moxibustion, also known as scarring moxibustion, local minor burns, scarring, and purulence during treatment were taken for granted because many of the components take effect after entering the human body through burndamaged skin. ...
... 6,27 However, the issue of whether moxibustioninduced burns are, in fact, an AE is still controversial. 27 In Chinese traditional moxibustion, also known as scarring moxibustion, local minor burns, scarring, and purulence during treatment were taken for granted because many of the components take effect after entering the human body through burndamaged skin. 23,35 Additionally, in term of burns, some patients accepted these scars as the natural conclusion of moxibustion therapy. ...
To determine whether the administration of moxibustion is an effective treatment for knee osteoarthritis (KOA).
We conducted a search of relevant articles using Medline, EMBASE, the Web of Science, and the Cochrane Library published before October 2015. The Western Ontario and McMaster Universities’ Osteoarthritis Index (WOMAC scale) and the short form 36 questionnaire (SF-36 scale) were assessed. Evidence grading was evaluated according to the Grading of Recommendations, Assessment, Development and Evaluation system.
Four studies containing 746 participants fulfilled the inclusion criteria in the final analysis. In terms of quality of life (QOL), the meta-analysis of 2 randomized clinical trials (RCTs) showed significantly effects of moxibustion only in bodily pain (BP) compared with those in the control group (n = 348; weighted mean difference [WMD], 4.36; 95% confidence intervals [CIs], 2.27–6.44; P < 0.0001; heterogeneity: χ² = 1.53, P = 0.22, I² = 34%) in all of the subcategories of the SF-36 scale, with moderate quality. The meta-analysis of the 2 included trials showed that there was not a statistically significant difference in the pain or function subscale for the WOMAC scale when the 2 groups were compared (n = 322; WMD, 17.63; 95% CI, −23.15–58.41; P = 0.40; heterogeneity: χ² = 19.42, P < 0.0001, I² = 95%), with low or moderate quality separately.
The administration of moxibustion can to some extent alleviate the symptoms of KOA. More rigorous, randomized controlled trials are required in the future.
... [9][10][11] The analgesic mechanism of moxibustion is associated with local blood flow, endogenous opioids, diffuse noxious inhibitory controls, and 510025I CTXXX10.1177/1534735413510025Integrative Cancer Therapies XX(X)Lee and Yoon 11,12 Although the effectiveness was not clearly demonstrated, some clinical studies have reported the potential effects of moxibustion in pain conditions, including osteoarthritis, scleroma, and herpes zoster, 13 and in supportive cancer care including chemotherapyinduced nausea and vomiting. 14 However, a clinical trial of moxibustion for cancer pain has not yet been explored. ...
... Clinical studies on the analgesic effects of moxibustion were reported in patients with osteoarthritis of the knee, herpes zoster, and scleroma. 13 Murase and Kawakita 26 reported that diffuse noxious inhibitory controls were closely related to the analgesic mechanism of moxibustion. Okada and Kawakita 11 and Noguchi et al 12 indicated that moxibustion is related to the action of endogenous opioids and induced local inflammatory responses, such as vasodilatation and extravasation, by releasing neuropeptides. ...
. Moxibustion has been traditionally used to manage pain related to chronic diseases, including cancer. This study aims to investigate the efficacy and safety of moxibustion for relieving cancer pain in patients with metastatic cancer.
. A total of 16 patients were randomly divided into a true moxibustion (TM) group or a sham moxibustion (SM) group. In both groups, moxibustion was applied for 10 minutes, once daily for 7 consecutive days. In the SM group, the moxa cone was removed earlier than in the TM group, so as not to deliver heat stimulation completely into the skin. The changes of pain severity using the Brief Pain Inventory (BPI) and quality of life measured by the Functional Assessment of Cancer Therapy-General (FACT-G) were observed. A blinding credibility test was done to validate the sham moxibustion procedure.
. The total BPI score significantly decreased in the TM group compared with the SM group (TM vs SM: -0.97 ± 1.05 vs 0.35 ± 0.60, : = .025). The 2 subsets of BPI, pain intensity score and pain interference score, also significantly decreased in the TM group (TM vs SM: intensity, -0.82 ± 0.93 vs 0.46 ± 0.87, : = .020; interference, -1.12 ± 1.31 vs 0.24 ± 0.61, : = .047). Even after adjusting for the values of opioid consumption, these results remained significant. FACT-G did not significantly improve in the TM group. The blinding to sham moxibustion was credible and no serious adverse events occurred.
. We suggest that moxibustion could be a safe and potential modality for cancer-related pain in patients with metastatic cancer. With the limitation of small sample size, a larger and long-term follow-up study is necessary to determine more definitely the efficacy of moxibustion.
... 20 Among the currently available clinical studies on moxibustion for pain, most of them suggest that moxibustion is beneficial for pain patients. [21][22][23] Moreover, the analgesic effects of moxibustion have also been demonstrated by evidence from several systematic reviews and meta-analyses. [24][25][26] However, these studies focused on diseases including osteoarthritis, low back pain, and cervical spondylosis, and no studies involving cancer pain. ...
Purpose:
Pain is one of the most common and feared symptoms among cancer patients. Unrelieved pain denies patients comfort and greatly affects their overall quality of life. Moxibustion is commonly used to manage chronic pain. However, its efficacy on cancer pain remains inconclusive. This study aimed to evaluate the efficacy of moxibustion for cancer pain.
Methods:
We searched seven databases to obtain articles about moxibustion combined with pharmacotherapy for cancer pain published before November 2022. All data extraction was carried out independently by two investigators. RevMan 5.4 software was used for data analysis.
Results:
A total of ten trials involving 999 cases were included. The results of the meta-analysis revealed that moxibustion combined with pharmacotherapy was significantly better than drug therapy alone in improving pain relief rate (RR =1.16, 95% CI = [1.04, 1.30], P = 0.01), reducing pain scores (SMD = -1.43, 95% CI = [-2.09, -0.77], P < 0.0001), Shortening the onset of analgesia (MD = -12.07, 95% CI = [-12.91, -11.22], P < 0.00001), prolonging the duration of analgesia (MD = 3.69, 95% CI = [3.21, 4.18], P < 0.00001), and improving quality of life (SMD = 2.48, 95% CI = [0.67, 4.29], P = 0.007). In addition, moxibustion combined with pharmacotherapy can effectively reduce adverse reactions of drugs (RR =0.35, 95% CI = [0.21, 0.57], P < 0.0001).
Conclusion:
The evidence in this review supports moxibustion as an effective adjuvant therapy for cancer pain management. However, high-quality RCTs are needed to further confirm these findings.
Registration number:
PROSPERO CRD42022370942.
... Its therapeutic mechanism has been studied [6,7] and it is widely used to treat various disorders [8] including correcting breech presentation [9], treating dysmenorrhea [10], constipation [11], prostatitis [12], chronic fatigue syndrome [13], osteoarthritis [14][15][16][17][18][19][20] and pain, [21,22] including low-back pain [23,24] and peripheral neuropathy [25]. ...
Traditional Chinese Medicine (TCM) has evolved over thousands of years. TCM practitioners use various approaches (such as acupuncture and tai chi) as well as herbal products to address health problems. Though lesser known in the west, the practice of Moxibustion is an integral part of Traditional East Asian Medicine. Moxibustion is an important non-invasive treatment that has shown to be beneficial in treating painful syndromes including neuropathy. It has been suggested that moxibustion may alleviate neuroinflammation by inhibiting NF-kB and by activating Nrf2. These anti-inflammatory and protective mechanisms could be key to exploring the use of moxibustion in treating other etiologies of neuropathy including HIV. There is ample scope for future study in this area and consideration of the history, development and practical applications of moxibustion therapy may be of help in this regard. This article seeks to explore the background, principles, and application of moxibustion in the clinical setting with particular emphasis on its potential for symptom management in the treatment of neuropathy and pain.
... In this way, moxibustion can be used to treat and prevent illness as well chronic pain. 12,17,21 Acupuncture points are anatomically defined areas on the skin relative to certain landmarks on the body. There have been studies done on the effectiveness 28 and stimulation of neurons by acupoint therapy. ...
Acupoint stimulation has proven to be of significant importance for rehabilitation and preventive therapy. Moxibustion, a kind of acupoint therapy, has mainly been performed by practitioners relying on manual localization and positioning of acupoints, leading to variance in the accuracy owing to human error. Developments in the automatic detection of acupoints using deep learning techniques have proven to somewhat tackle the problem. But the current methods lack depth-based localization and are thus confined to two-dimensional (2D) localization. In this research, a new approach towards 3D acupoint localization is introduced, based on a fusion of RGB and depth convolutional neural networks (CNN) to guide the manipulator. This research aims to tackle the challenge of real-time 3D acupoint localization in order to provide guidance for robot-controlled moxibustion. In the first step, the 3D sensor (Kinect v1) is calibrated and transformation matrix is computed to project the depth data into the RGB domain. Secondly, a fusion of RGB-CNN and depth-CNN is employed, in order to obtain 3D localization. Lastly, 3D coordinates are fed to the manipulator to perform artificially controlled moxibustion therapy. Furthermore, a 3D acupoint dataset consisting of RGB and depth images of hands, is constructed to train, validate and test the network. The network was able to localize 5 sets of acupoints with an average localization error of less than 0.09. Further experiments prove the efficacy of the approach and lay grounds for development of automatic moxibustion robots.
... Nevertheless, the safety of TFM cannot be definitively concluded due to a relative lack of studies providing details of the adverse events. However, the issue of whether moxibustion-induced burns are actually considered an adverse event still remains controversial [63]. Traditional Chinese moxibustion is also known as scarring moxibustion. ...
Background:
Low back pain (LBP) is considered the leading cause of people living with years of disability worldwide. Notably, thunder-fire moxibustion (TFM) is a new type of moxibustion, which has been widely applied to treat pain syndromes for thousands of years. This study aims to provide evidence to evaluate the effect and safety of TFM in treating LBP.
Methods:
A systematic search of PubMed, Web of Science, the Cochrane Library, Embase, EBSCO, CNKI, Wanfang Data, CBM, and VIP (until April 2021) was used to identify studies reporting pain intensity, disability, Japanese Orthopedic Association (JOA) score, and quality of life in patients with LBP. Randomized controlled trials (RCTs), which compared TFM and other therapies in LBP, were included. Meanwhile, methodological quality was evaluated using the Cochrane criteria for risk of bias, and the level of evidence was rated utilizing the GRADE approach.
Results:
Twenty-one RCTs, including 2198 patients, satisfied the inclusion criteria. Compared with other therapies, the effect of TFM was statistically significant, pain intensity decreased (SMD = 0.94; 95% CI (0.74, 1.14); p < 0.00001), disability improved (SMD = 1.39; 95% CI (0.19, 2.59); p=0.02), and the JOA score increased (SMD = -1.34; 95% CI (-1.88, -0.80); p < 0.00001). It was also reported that the patient's quality of life improved after treatment for a period of 4 weeks (SMD = -0.29; 95% CI (-0.42, -0.16); p < 0.0001) and after a follow-up of 1 month (SMD = -0.20; 95% CI (-0.34, -0.07); p=0.003). The evidence level of the results was determined to be very low to low.
Conclusions:
Based on the existing evidence, it can be concluded that TFM may have a better effect than other treatments on LBP. However, it is not yet possible to assess the safety level of TFM therapy. Due to the universal low quality of the eligible trials and low evidence level, rigorously designed large-scale RCTs must be conducted in order to further confirm the results in this review.
... As important modalities of Traditional Chinese Medicine (TCM), acupuncture and moxibustion are recommended as safe options with fewer AEs and have been widely used to alleviate pain (Lee et al., 2010;Shen et al., 2019;Zhao, 2008). Previous publications reported that acupuncture and moxibustion treatments are effective for PD (Cho & Hwang, 2010;Gou et al., 2016); however, recent studies have shown that the reporting and methodological quality are suboptimal, limiting their results' conviction Zhang et al., 2018). ...
Acupuncture and moxibustion have been accepted as add-on options for primary dysmenorrhea (PD); however, the clinical evidence is still inadequate. We searched AMED, CENTRAL, EMBASE, PubMed, Web of Science, CBM, CNKI, VIP, Wangfang database, ANZCTR, ClinicalTrials.gov, and the WHO ICTRP, from their inception to February 2021. The pooled analysis of 13 RCTs with 675 participants for VAS showed that acupuncture and moxibustion were more effective in managing PD than the control group with the MD of −1.93 (95% CI [−2.80, −1.06] and −2.67 (95% CI [−4.96, −0.38]). With the CMSS, seven studies with 487 participants showed that these modalities were more effective than the control group with the MD of −7.58 (95% CI [−10.97, −4.19]) and −3.78 (95% CI [−6.90, −0.66]). The findings indicated that acupuncture and moxibustion could relieve pain effectively and has fewer adverse events (AEs) in managing PD.
... Moxibustion is an East Asian treatment technique that produces heat by burning herbal formulae enclosing Artemisia vulgaris, applied next to the acupuncture points. 38 Moxibustion management was reported to have assistances for pressure ulcers, 39 pain, 40 and cancer care. 41 The popular of pressure ulcers occurs from other illnesses for example, stroke, [27][28][29]34 heart disease, [27][28][29]34 sequelae of traumatic brain injury, [26][27][28][29]34 paraplegia, [27][28][29]34 bone fracture, 26,29 diabetes 28,34 and renal failure. ...
We performed a meta‐analysis to evaluate the effect of Chinese herbal topical medicine, acupuncture, and moxibustion on pressure ulcer wound healing. A systematic literature search up to January 2022 was done and 13 studies included 1073 subjects with pressure ulcer wound at the start of the study; 593 of them were using traditional Chinese medicine treatments, and 480 were control for pressure ulcer wound. We calculated the odds ratio (OR) with 95% confidence intervals (CIs) to evaluate the effect of Chinese herbal topical medicine, acupuncture, and moxibustion on pressure ulcer wound healing by the dichotomous methods with a random or fixed‐influence model. Traditional Chinese medicine treatments had significantly higher complete healing (OR, 5.94; 95% CI, 3.94–8.95, P < .001), and curative ratio post‐treatment (OR, 4.79; 95% CI, 2.62–8.76, P < .001) compared with control for subjects with pressure ulcer wound. Traditional Chinese medicine treatments had a significantly higher complete healing and curative ratio post‐treatment compared with control for subjects with pressure ulcer wounds. Further studies are needed to validate these findings.
... Moxibustion has been widely applied in pain-related diseases, including cervical spondylosis (Li, 2020), lumbar disc herniation (Chen, 2021), and central NP . NP is one of the major domains of moxibustion analgesia research (Lee et al., 2010;Shao, 2014). ...
Background
Direct moxibustion (DM) is reported to be useful for cervical spondylotic radiculopathy (CSR), but the analgesic mechanism remains unknown. Autophagy plays a protective role in neuronal apoptosis, Act A/Smads signaling pathway has been confirmed to be associated with the activation of autophagy. The study aimed to explore the effect of DM on autophagy in rats with CSR and the involvement of Act A/Smads signaling pathway.
Methods
Rats were randomly divided into Sham, CSR, CSR + DM, CSR + DM + 3‐MA (PI3K inhibitor), and CSR + DM + SB (Act A inhibitor) group. Three days after establishment of CSR model with a fish line inserted under the axilla of the nerve roots, DM at Dazhui (GV14) was performed six times once for seven consecutive days. Western blot and immunofluorescence staining were used to observe the expression of the neuronal autophagy molecule LC3II/I, Atg7, and Act A/Smads signaling molecule Act A, p‐Smad2, and p‐Smad3. Bcl‐2/Bax mRNA expression was measured by real time PCR.
Results
DM improved the pain threshold and motor function of CSR rats and promoted the expression of Act A, p‐Smad2, p‐Smad3, LC3II/I, and Atg7 in the entrapped‐nerve root spinal dorsal horn. DM reduced the expression of Bax mRNA and decreased the number of apoptotic neurons. 3‐MA and Act A inhibitor SB suppressed the expression of above‐mentioned proteins and reduced the protective effect of DM on apoptotic neurons.
Conclusion
DM exerts analgesic effects by regulating the autophagy to reduce cell apoptosis and repair nerve injury, and this feature may be related to the Act A/Smads signaling pathway.
... Moxibustion is a traditional method of burning moxa sticks (usually made from herbal preparations containing Artemisia vulgaris) near an acupoint to cause a warm and painless sensation [9]. Moxibustion showed desirable merits in managing menstrual pain [10][11][12][13][14][15][16], given their treatment effects and economic costs. However, the mechanisms of action of moxibustion therapy are still largely unknown [17]. ...
Objective:
Primary dysmenorrhea (PD) is a common and high incidence disease in gynecology, which seriously affects the quality of life in young women. Our previous study found that mild moxibustion could treat abdominal pain of PD patients, but the mechanism is still unclear. Therefore, this study aims to partly investigate the treatment mechanism of moxibustion for PD, especially on uterine microcirculation.
Methods:
Forty 3-month-old Sprague Dawley female rats were randomly divided into four groups, including group A (saline control group, n = 10), group B (control plus moxibustion group, n = 10), group C (PD model group, n = 10), group D (PD. model plus moxibustion group, n = 10). The PD rat model was established by injecting estradiol benzoate and oxytocin. Mild moxibustion on Sanyinjiao (SP6) and Guanyuan (CV4) acupoints was once a day, 20 minutes per time, for 10 consecutive days. A vaginal smear was used to test the estrous cycle of rats. Uterine microvascular thickness was observed by stereomicroscope. And we detected the content of prostaglandin F2α (PGF2α ) and prostaglandin E2 (PGE2) in uterine tissue by enzyme-linked immunosorbent assay.
Results:
Mild moxibustion can enlarge the microvessels, improve the microcirculation disturbance, and relieve the swelling of the uterus in PD rats. During the mild moxibustion intervention, the contents of PGF2α and PGE2 in uterus issues were synchronous increases or decreases and the changes of PGE2 were more obvious, but the changes of uterine microvasculature and morphology caused by the decrease of PGF2α were greater than PGE2.
Conclusion:
Mild moxibustion at SP6 and CV4 acupoints may relax uterine microvascular obstacle by reducing the content of PGF2α in uterine tissue, improve the microcirculation disorder, and then alleviate the PD rat's uterine swelling.
... [12] Indirect moxibustion combines the effects of moxa and the medium, and the synergistic effect can be achieved by transdermal administration of moxa heat. Studies have shown that moxibustion can effectively relieve fatigue, [13,14] and improve sleep quality, [15] pain and paresthesia, [16] gastrointestinal dysfunction, [17] and other CFS-related symptoms. ...
Background:
The pathogenesis of chronic fatigue syndrome (CFS) is not clear. The main purpose of treatment is to improve autoimmune function and relieve fatigue symptoms. Moxibustion is often used to treat diseases caused by low autoimmunity, especially in relieving fatigue symptoms. It is a superior therapy for CFS in traditional Chinese medicine. At present, there is a lack of the high level clinical evidence to support the moxibustion in the treatment of CFS, so this study will systematically review and analyze the currently available randomized controlled trials to evaluate the efficacy and safety of moxibustion in the treatment of CFS.
Methods:
We will systematically search PubMed, EMBASE, Cochrane library, Sinomed, CNKI, VIP, and Wanfang Database, ClinicalTrials.gov and Chinese Clinical Trial Registry will also be searched. The time range for the search will be from database activation to March 31, 2021. The randomized controlled trials (RCTs) associated with moxibustion for CFS will be included, regardless of language.We will use the standard proposed in Cochrane Handbook 5.1.0 to assess the bias risk of a single RCT. The main outcome index of the study is Fatigue Assessment Instrument (FAI), secondary outcome indexes will include Fatigue Scale -14 (FS-14), Fatigue Severity Scale (FSS), Pittsburgh sleep quality index (PSQI), natural killer (NK) cells, interleukin- 2 (IL-2), T lymphocyte subsets (CD4+, CD8+), cure rate, total efficiency and adverse reactions. The random effect model meta was used to analyze the effect data of a single RCT. Heterogeneity will be measured by Cochran Q test and I-squared statistics. We will use 2 subgroup analyses to explore the source of heterogeneity. RCTs with high bias risk was excluded and adjustment effect model was used for sensitivity analysis to test the robustness of the meta-analysis results. The publication bias included in RCTs will be assessed by funnel plot and Egger test.
Results:
This study will objectively and comprehensively evaluate the efficacy and safety of randomized controlled trials of moxibustion in the treatment of chronic fatigue syndrome, and the results will be submitted to peer-reviewed journals for publication.
Conclusion:
This systematic review will provide clinicians with the latest high-quality evidence for the use of moxibustion in the treatment of chronic fatigue syndrome.
Inplasy registration number:
INPLASY202140063.
... [14] So far, many systematic reviews have shown that moxibustion therapy in traditional Chinese medicine has a good effect on the treatment of painful diseases. [15,16] Our research group has repeatedly checked the literature and found that moxibustion has a certain effect on the treatment of low back pain in terms of clinical efficacy and alleviating the development of pain. Therefore, moxibustion may become an effective treatment to delay the progression of low back pain. ...
Background:
Low back pain is a common clinical chronic disease with symptoms of back soreness, numbness, and pain. The incidence of low back pain is high, and gradually increases with age. It is mainly middle-aged and has a high recurrence rate. It is considered to be one of the common diseases with the highest disability rate. The aim of this systematic review is to assess the effectiveness and safety of moxibustion therapy for low back pain.
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 moxibustion with low back pain.
Conclusions:
The conclusions of our study will provide an evidence to judge whether moxibustion is an effective and safe intervention for patients with low back pain.
Trial registration number:
INPLASY202080027.
... In moxibustion, wormwood or other drugs are used to place acupoints or pain points on the body surface for warming meridians and stimulating acupuncture points [1]. As people pay more attention to health, the use of moxibustion to treat diseases in China and other Asian countries is growing [2]. Heat and moxa smoke are produced during moxibustion. ...
Moxibustion plays an important role in the prevention and treatment of diseases and the promotion of human health. In this study, the components in moxa smoke from Jiangxi Poai Biotechnology Co., Ltd., namely, Qing moxa sticks, were absorbed by five solvents (cyclohexane, ethyl acetate, n-butanol, anhydrous ethanol, and water) and identified by gas chromatography-mass spectrometry. The identification results of the smoke from the Qing moxa sticks that was absorbed in liquid are as follows: a total of 294 compounds were identified, including 139 in cyclohexane, 145 in ethyl acetate, 60 in n-butanol, 89 in anhydrous ethanol, and 77 in water, and of those, 112 toxic compounds were identified. Furthermore, Ingenuity Pathway Analysis software and the PubChem database were successfully applied to analyze the toxic compounds. There were 812 target proteins related to the toxic components, 25 molecular networks, and 54 biological pathways. The results showed that the toxic compounds of moxa smoke may have some side effects on the heart, liver, and kidney of humans. This study revealed that the components of moxa smoke are complex and diverse. Due to the findings of toxic compounds in moxa smoke, we recommend that moxibustion rooms should be equipped with ventilation equipment or enough artificial ventilation to ensure the health of patients and practitioners.
... Moxibustion is one of the conventional thermal therapies in traditional Chinese medicine, which has been widely used in clinical practice to treat various disorders in China and other Asian countries for thousands of years [1,2]. Although many studies have demonstrated that moxibustion has certain effects on the immune system [3], analgesia [4,5], gastrointestinal diseases [6], etc., little is known about the initiation mechanism on conversion process of thermal stimulation induced by moxibustion. In traditional Chinese medicine theory, thermal stimulation produced during moxibustion is considered to be a vital factor in treating diseases. ...
Objectives:
To study how thermal energy is converted after moxibustion at local skin from the view of mitochondrial respiratory chain and its key regulatory elements of sirtuins 1 (SIRT1) and sirtuins 3 (SIRT3).
Methods:
Two moxibustion temperatures usually used in clinical practice (38°C and 46°C) were applied to Zusanli (ST36) acupoint for 30 minutes in C57BL/6J mice. Local skin samples were harvested at 30 min and 72 h after moxibustion intervention, respectively. The activity of mitochondrial respiratory chain complexes I-V was detected by spectrophotometry. The expression of SIRT1 and SIRT3 protein was detected by immunofluorescence staining or western blot.
Results:
Moxibustion at 38°C triggered more significant increase of mitochondrial respiratory chain complexes I-V expression. However, the protein expression of SIRT1 and SIRT3 at 46°C showed more obvious enhancement. In addition, the effect of mitochondrial respiratory chain complexes I-V activity on local skin of ST36 acupoint was more obvious at 30 min after moxibustion, while the expression of SIRT1 and SIRT3 protein was more significant at 72 h after moxibustion.
Conclusion:
Mitochondrial respiratory chain and its key regulatory element proteins SIRT1 and SIRT3 play important role in the initial process of thermal energy conversion stimulated by different moxibustion temperatures in local skin.
... 9,10 A large amount of research has focused on the role of moxibustion in treating rheumatic conditions, 12 including rheumatoid arthritis, 13 osteoarthritis, 14 and knee osteoarthritis. 15,16 Several systematic reviews of interventional studies have been conducted to detect evidence of the efficacy of moxibustion in the treatment of cancer-related fatigue, 17,18 inflammatory bowel disease, 19 primary dysmenorrhea, 20 cancer care, 21 irritable bowel syndrome, 22,23 stroke rehabilitation, 24 pain, 25 and ulcerative colitis. 26 Moxibustion can effectively treat the symptoms of patients with knee osteoarthritis. ...
Objective:
To evaluate the effectiveness and safety of moxibustion therapy in the treatment of lumbar disc herniation (LDH).
Methods:
Four Chinese databases and three English databases were searched from their inception to April 2018.Randomized controlled trials (RCTs) were included if moxibustion was used as the sole treatment or as a part of combination therapy with other treatments in patients with LDH. Two reviewers independently extracted the data and assessed the methodological quality using the Cochrane criteria for the risk of bias. The Meta-analysis was performed using Review Manager 5.3 software.
Results:
In total, 16 RCTs including 1186 patients with LDH were analyzed. The Meta-analysis showed favorable effects of moxibustion in combination with massage therapy on the visual analog scale score compared with massage therapy alone [mean difference (MD) = -1.32, 95% confidence interval (CI) (-2.12, -0.51), P = 0.001]. The subgroup Meta-analysis failed to show favorable effects of electro-acupuncture plus moxibustion on the efficacy rate compared with electro-acupuncture alone [relative risk (RR) = 1.06, 95% CI (0.98, 1.14), P = 0.15]. However, acupuncture or massage therapy plus moxibustion improved the efficacy rates compared with acupuncture or massage therapy alone [RR = 1.33, 95% CI (1.18, 1.49), P < 0.000 01] [χ2 = 2.76, P = 0.25, I2 = 27%], [RR = 1.15, 95% CI (1.06, 1.25), P = 0.001] [χ2 = 0.00, P = 0.95, I2 = 0%]. With respect to the Japanese Orthopaedic Association (JOA) scores, acupuncture or massage therapy in addition to moxibustion produced results different from those of acupuncture or massage therapy alone [MD = 5.58, 95% CI (4.15, 7.00), P < 0.000 01] [χ2 = 0.58, P = 0.45, I2 = 0%], [MD = 3.61, 95% CI (3.01, 4.21), P < 0.000 01].There were no significant differences in the JOA score for subjective symptoms, objective symptoms, daily living ability, and other parameters. In six RCTs, no adverse reactions occurred during moxibustion.
Conclusion:
Whether moxibustion is an effective intervention for LDH is unclear because of the small sample size of qualified RCTs and the high risk of bias. More high-quality RCTs that overcome the methodological shortcomings of the existing evidence are needed.
... Moxibustion is one of the traditional Chinese medicine (TCM) therapies that use the heat generated by burning herbal preparations containing Artemisia vulgaris (mugwort) to stimulate acupuncture points [1]. In China and some other Asian countries, moxibustion has been used to treat various diseases such as painful disease [2], knee osteoarthritis [3,4], gastrointestinal diseases [5], antiaging [6], immunomodulatory [7], primary dysmenorrhea [8], primary insomnia [9], chronic fatigue syndrome [10], and cancer-related fatigue [11]. Nowadays, moxibustion is being increasingly accepted as an alternative treatment for correct nonvertex presentation [12], irritable bowel syndrome [13], inflammation bowel disease [14], and neurological symptoms [15], and so on. ...
Objectives:
To evaluate the safety of moxa smoke, especially to provide quantitative information and details for the occupational prevention of acupuncturists.
Methods:
We combined the questionnaire-based cross-sectional survey and lung function testing-based historical retrospective cohort research to investigate the safety of moxa smoke exposure (MSE) among acupuncturists. A mathematical regression model was established to quantitatively evaluate the relationship between moxa smoke exposure and the respiratory health of the acupuncturist. The smoke exposure time of the acupuncturist and the prevalence of abnormal respiratory symptoms or diseases were also evaluated.
Results:
(1) The cross-sectional research showed that the incidence of expectoration (18.7%) and rhinitis (22.7%) was the most common respiratory symptom and disease after MSE. No statistical difference was found between smoke exposure time of the acupuncturist and the prevalence of abnormal respiratory symptoms or diseases, except the prevalence of rhinitis and shortness of breath (P < 0.01). Regression model for the incidence of first three symptoms (expectoration, shortness of breath, and wheezing) from the cross-sectional survey indicated that the weight coefficients of factors associated with moxa smoke were lower than those of factors unrelated to moxa smoke, such as gender and personal history of respiratory diseases. (2) Historical retrospective cohort research showed that there was no significant difference in the % predicted PEF. No statistic difference was found between the exposed and nonexposed group in large airway function indexes (% predicted FEV1, % predicted FVC, and % predicted FEV1/FVC) and small airway function indexes (% predicted FEF25, % predicted FEF50, % predicted FEF75, and % predicted MMEF), either. Especially, the % predicted MVV among males (106.23 ± 2.92 vs. 95.56 ± 1.92, P < 0.01 and % predicted VC among females (100.70 ± 1.59 vs. 95.91 ± 1.61, P < 0.05) between the two groups had statistical significance, but did not cause pulmonary ventilation dysfunction.
Conclusions:
MSE has no significant effect on the respiratory health of acupuncturists.
... This is an integral therapeutic modality of acupuncture that uses ignited moxa floss to apply heat to certain points or areas of the body surface for treating diseases [19]. Moxibustion, which includes warm needling, is an effective treatment option in traditional Chinese medicine for acute and chronic pain [20,21]. During warm needling, heat from the burning of moxa is transmitted to the corresponding acupuncture point by radiation as well as by conduction via the shaft of the needle, thereby stimulating deep tissue within the acupuncture point while warming the acupuncture point on the surface [22]. ...
Background:
Heel pain is a common foot disorder that causes pain and functional limitations. The prevalence of disabling foot pain will increase as the population ages. Previous studies have reported the positive therapeutic effects of electroacupuncture, warm needling, or the combination of both for heel pain but with limitations in the study methodologies. The current study is a rigorously designed randomized controlled trial that aims to evaluate the clinical efficacy and safety of electroacupuncture plus warm needling therapy in patients with heel pain.
Methods/design:
The study protocol describes a prospective, open-label, parallel-group, randomized controlled trial to be conducted in Hong Kong. Eighty patients aged 50-80 years who have reported heel pain and first-step pain equal to or exceeding 50 mm on the 100-mm visual analog scale (VAS) will be recruited. They will be randomly assigned (1:1 ratio) to the electroacupuncture plus warm needling therapy (i.e., treatment) group or the waitlist (i.e., control) group. The treatment group will undergo six treatment sessions in 4 weeks. The control group will receive no treatment during the study period. The primary outcome measure is a mean change in the first-step pain VAS score from the baseline to week 4. Secondary outcome measures include a mean change in first-step pain VAS score from the baseline to week 2, a mean change in Foot Function Index (FFI) subscale scores and the total score from the baseline to week 2 and week 4, and patients' self-reported level of improvement at week 4. Additional week 8 follow-up assessments with first-step pain VAS and FFI measurements will be arranged for the treatment group. Any adverse events will be recorded throughout the study to evaluate safety. An intention-to-treat approach will be used to analyze the study results.
Discussion:
This study will provide evidence on the efficacy and safety of electroacupuncture plus warm needling therapy as an alternative treatment method for heel pain. The findings will determine whether the treatment protocol is efficacious in relieving pain and improving foot function among older adults with heel pain. The study will also provide information for subsequent large-scale randomized controlled trials in the future.
Trial registration:
Chinese Clinical Trial Registry, ChiCTR1800014906 . Registered on 12 February 2018.
... [9,10] There are 2 types of moxibustion in clinical practice: direct moxibustion, which directly applies heat simulation to the skin, and indirect moxibustion, which insulates heat simulation by various materials (e.g., ginger, garlic, or salt). [11] Moxibustion is widely used in East Asia and is recommended for treating chronic inflammation and pain diseases, including osteoarthritis, lumbago, allergic asthma, dysmenorrhea, and CP/CPPS, by the World Health Organization Advisory Committee on Acupuncture and Moxibustion. [12] ...
Background:
Chronic prostatitis/chronic pelvic pain syndrome (CP/CPPS) is a common urogenital disease. Moxibustion is a complementary treatment option for CP/CPPS. This systematic review will assess the efficacy and safety of moxibustion as a sole or add-on therapy for CP/CPPS.
Methods:
We will retrieve randomized controlled trials (RCTs) of moxibustion for CP/CPPS from the following databases: PubMed, EMBASE, Cochrane Central Register of Controlled Trials, VIP, Chinese Biomedical Database, China National Knowledge Infrastructure Database, Wanfang Data, Chinese Medicine Database System, Google Scholar, Clinicaltrials.gov, and China Clinical Trial Registry from their inception to March 9, 2019, without language restrictions. RCTs comparing moxibustion with active drugs or moxibustion + drugs with these same drugs alone will be included. Primary outcomes will be the change in the total score of the National Institutes of Health's Chronic Prostatic Inflammatory States Index (NIH-CPSI) after moxibustion treatment. Secondary outcomes will include the scores of the individual NIH-CPSI domains, response to treatment of CP/CPPS, leucocyte and phosphatidylcholine corpuscle count in prostatic fluid, incidence of adverse events (AEs), and incidence of moxibustion-related AEs. The Cochrane risk of bias tool will be used for evaluating the risk of bias of individual trials. Heterogeneity will be detected by the Cochran Q test and I-square test. A random-effects model will be used to pool data in the meta-analysis. Risk ratio and weighted or standardized mean difference will be used as the effect measures. Three sets of subgroup analyses will be performed to explore the sources of heterogeneity. Where appropriate, we will assess the likelihood of publication bias based on funnel plots and quantitative tests.
Results:
This study will produce the systematic review evidence regarding moxibustion for treating CP/CPPS based on current RCTs.
Conclusion:
This study will provide a clear basis for understanding the efficacy and adverse reactions of moxibustion treatment for CP/CPPS.
Prospero registration number:
CRD42019121338.
... Moxibustion was more frequently used in the non-infection group for pain relief in cancer patients. Some studies have shown that moxibustion is effective in reducing pain associated with osteoarthritis and herpes zoster [16]. Herbal medicine is a main treatment modality in traditional Oriental medicine and is prescribed to most patients. ...
Background
Traditional Oriental medicine is used in many Asian countries and involves herbal medicines, acupuncture, moxibustion, and cupping. We investigated the incidence and causes of hospital-acquired fever (HAF) and the characteristics of febrile inpatients in Oriental medical hospitals (OMHs). Methods
Patients hospitalized in two OMHs of a university medical institute in Seoul, Korea, were retrospectively reviewed from 2006 to 2013. Adult patients with HAF were enrolled. ResultsThere were 560 cases of HAF (5.0%). Infection, non-infection, and unknown cause were noted in 331 cases (59.1%), 109 cases (19.5%), and 120 cases (21.4%) of HAF, respectively. Respiratory tract infection was the most common cause (51.2%) of infectious fever, followed by urinary tract infection. Drug fever due to herbal medicine was the most common cause of non-infectious fever (53.1%), followed by procedure-related fever caused by oriental medical procedures. The infection group had higher white blood cell count (WBC) (10,400/mm3 vs. 7000/mm3, p < 0.001) and more frequent history of antibiotic therapy (29.6% vs. 15.1%, p < 0.001). Multivariate analysis showed that older age (odds ratio (OR) 1.67, 95% confidence interval (C.I.) 1.08–2.56, p = 0.020), history of antibiotic therapy (OR 3.17, C.I. 1.85–5.41, p < 0.001), and WBC > 10,000/mm3 (OR 2.22, C.I. 1.85–3.32, p < 0.001) were associated with infection. Conclusions
Compared to previous studies on HAF in Western medicine, the incidence of HAF in OMHs was not high. However, Oriental medical treatment does play some role in HAF. Fever in patients with history of antibiotic therapy, or high WBC was more likely of infectious origin.
... Moxibustion could induce heat shock protein (HSP) (Kobayashi, 1995). Numerous clinical studies (Chen et al., 2012;Lee et al., 2010a;2010b;Ren et al., 2011) demonstrated that moxibustion can relieve pain of muscle and joint. Also laboratory studies suggest that moxibustion has anti-inflammatory effect. ...
The objective of this study was to investigate the effects of suspended moxibustion upon tender point on delayed onset muscle soreness. The study was a randomized double-blind controlled trial with 50 subjects in each group. Subjects in moxibustion group received suspended moxibustion upon tender point (by palpation) twice. The controls received no treatment. Each subject received treatments twice, 24 hr and 48 hr after the delayed onset muscle soreness induction. The measurements of Pain Visual Analog Scale, maximum isometric muscle strength and circumference were made immediately after delayed onset muscle soreness induction, before and after every treatment session and 72 hr after delayed onset muscle soreness induction. There were no significantly statistical differences between two groups at all measurement time points on maximum isometric muscle strength and circumference. However, the Pain Visual Analog Scale scores after first treatment session and 72 hr after delayed onset muscle soreness induction in moxibustion group was less than the control group, with significant difference (p < 0.05). The suspended moxibustion failed to show the effect on delayed onset muscle soreness. However, results need to be cautiously interpreted because of the pilot character of this study. The suspended moxibustion has a potential effect of pain relief on DOMS from the analysis of the data of this study. A large sample size trial is needed to confirm the effect of the suspended moxibustion on DOMS in the future.
... In fact, moxibustion alone, or in combination with acupuncture, may be effective for impaired circulation, cold and damp conditions, and yang deficiency in the body. Indeed, moxibustion has widely been used for the treatment of pain, 14 cancer, 15 stroke, 16 ulcerative colitis, 17 constipation, 18 and hypertension. 19 Patients living with cancer often have a low body temperature. ...
Background: Body temperature is an important indicator of health and illness. However, a single temperature measurement is not always reliable. Such measurements can be made using meridians, which are energy channels with acupoints being the nodes. To date, there is no published reference of meridian acupoint temperatures applicable to human health, and there is no clear digitalized indicator that could be utilized to evaluate human health by way of meridian acupoints up to now.
Methods: Our study recruited 100 healthy medical college students for the measurement of acupoint temperature. The temperatures of 135 acupoints of 14 main meridians were measured using infrared thermometers in order to provide a comprehensive body temperature reading of each study participant.
Results: The degree of the acupoint temperature consistently ranged from 34.88°C to 36.14°C. The gross thermograph was concentric, with high degree readings around the heart and low degree readings originating from the feet. The left and right body sides had significant correlation between the degrees of bilateral same name acupoint temperatures of 12 regular meridians (correlation coefficient, 0.367–0.985; p < 0.0001). There was also a significant correlation between the acupoint temperature for the governor vessel and the conception vessel (correlation coefficient, 0.083; p = 0.006).
Conclusion: These findings indicate that meridian acupoint temperature is characterized by a consistently narrow range, as well as concentricity and symmetry in body temperature degree readings in college students. Meridian acupoint temperature may be a sensitive and valuable indicator to assist in the accurate evaluation of meridian and general human health, and the significance and changes of acupoint temperature in clinical conditions warrants future exploration.
... Moxibustion involves the burning of the herb Artemesia vulgaris L. close to the skin, usually near acupuncture points. A systematic review of moxibustion for pain found moxibustion reduced pain associated with osteoarthritis and may reduce pain in scleroma and herpes zoster (Lee, Choi, Kang, Lee, & Ernst, 2010). Acupuncture and moxibustion are recommended in Chinese medicine clinical practice guidelines for treating the acute symptoms of herpes zoster (Liu et al., 2013), and are frequently used in combination in clinical practice. ...
Herpes zoster is an acute inflammatory condition which can have a significant impact on quality of life. Antiviral therapies are effective, but do not meet patients' expectations of symptomatic relief. Acupuncture and moxibustion have been used for herpes zoster; this systematic review evaluated their efficacy and safety. Nine English and Chinese databases were searched from their inceptions to March 2016. Randomized controlled trials evaluating the combination of acupuncture plus moxibustion in adult herpes zoster were included. Outcomes included pain intensity and duration, quality of life and adverse events. Meta-analysis was performed using RevMan software (version 5.3). Nine studies (945 participants) were included. Studies were of low to moderate methodological quality based on risk of bias assessment. Pain intensity (visual analogue scale) was lower among those who received acupuncture plus moxibustion compared with pharmacotherapy (one study; MD −8.25 mm, 95% CI −12.36 to −4.14). The clinical significance of this result is yet to be established. Some benefits were seen for other pain and cutaneous outcomes, and global improvement in symptoms. Mild adverse events were reported in the intervention groups. Acupuncture plus moxibustion may improve pain and cutaneous outcomes, although current evidence is limited by the number of studies and methodological shortcomings.
... It is used widely in acupuncture clinics throughout China and other Asian countries as a form of treatment for various diseases. There, institutes for traditional Chinese medicine and acupuncture-moxibustion, conduct research on the clinical uses of moxibustion, such as breech presentation [7,8], ulcerative colitis [9,10], cancer [11], stroke rehabilitation [12], pain conditions [13], constipation [14] and hypertension [15]. ...
Moxibustion is commonly used as a traditional Chinese medicine treatment. The aim was to investigate how the exposure of moxa smoke influences sperm parameters, testis index and serum sex hormones in Wistar male rats.
... The moxibustion sensation might last as long as 3-4 h after treatment. 10 In contrast, acupoints cannot accept more than 30 min of mechanical stimulation from needles before treatment intolerance occurs. Most of the acupuncture sensation (De Qi) quickly disappears after needle removal. ...
To investigate the effect of different heat-stimulating time lengths on lower back pain.
Forty participants were randomly assigned to four groups of various heating time lengths. The short heating time length group (SL), moderate heating time length group (ML), and long heating time length group (LL) respectively received 15, 30, and 60 min of moxibustion therapy stimulating the acupoint Guanyuan (CV 4). The conventional acupuncture group (CA) received needle acupuncture treatment as a control group. The participants were treated continuously over a 2-week treatment period for a total of 10 sessions, with five sessions given per week. Participants were assessed weekly by blinded assessors,using the visual analogue scale (VAS) and Roland Morris Questionnaire (RMQ).
The VAS and RMQ scores reduced in all four groups during treatment. There were significant differences in VAS scores (P < 0.01) and RMQ scores (P < 0.01) between before treatment and after 2 weeks of treatment in the LL group. After treatment, the LL group reported significantly lower VAS scores compared with the CA group, ML group, and SL group (P < 0.05).
The long and moderate lengths of heat-stimulating time of 30 and 60 min may be more effective for relieving lower back pain than that of short stimulating time lengths.
... Recently, a bibliometric analysis of papers published from 1954 to 2007 in China, showed that 364 kinds of diseases, including rheumatoid arthritis, were being treated with moxibustion [16]. Various systematic reviews have investigated the effects of moxibustion on rheumatic conditions [17], osteoarthritis [18], and pain conditions [19]. Nevertheless, there have been no systematic reviews specifically focusing on the moxibustion treatment of RA. ...
Introduction
Moxibustion is widely used in China and other East Asian countries to manage the symptom of rheumatoid arthritis (RA) and to lessen the adverse effects of western medicine.The purpose of this systematic review was to evaluate the available evidencefrom randomized controlled trials (RCTs) of moxibustion for treating patients with rheumatoid arthritis (RA).
Methods
Seven Chinese and English databases were searched to November 2013 from their inception. Eligible RCTs were included if moxibustion was used either alone or in combination with Western medicine for treating rheumatoid arthritis. Study selection, data extraction, and validation was performed independently by two reviewers. Cochrane criteria for risk of bias was used to assess the methodological quality of the trials.
Results
Eight RCTs met the inclusion criteria, and most were of low methodological quality. Meta-analysis showed favorable effects of moxibustion on the response rate, either alone [RR = 1.18, 95%CI (1.03,1.35), p = 0.02; heterogeneity: Chi2 = 1.11, p = 0.77, I2 = 0%] or the combination with Western medicine therapy [RR = 1.28, 95%CI (1.12,1.47), p = 0.0004; heterogeneity: Chi2 = 1.96, p = 0.58, I2 = 0%]. When compared with Western medicine therapy, Western medicine plus moxibustion therapy showed a favorable statistically significant effect on a reduction on American College of Rheumatology (ACR) 50 [RR = 1.57, 95%CI (1.25,1.99), p = 0.0001; heterogeneity: Chi2 = 2.87, p = 0.58, I2 = 0%], whereas it failed to do so on American College of Rheumatology (ACR) 20. Additionally, when compared with western medicine therapy alone, meta-analysis of three RCTs suggested favorable but no statistically significant effects of moxibustion plus western medicine on the control of disease activities of rheumatoid arthritis.
Conclusions
It is difficult to draw firm conclusions on whether moxibustion is an effective intervention for treating RA due to the small sample size of eligible RCTs and the high risk of bias among the available RCTs. Further rigorous RCTs are warranted but need to overcome methodological shortcomings of the existing evidence
... Moxibustion has been practiced along with acupuncture in China for thousands of years. Widely used to treat various disorders [5][6][7], it is reported to be effective for arthritis and pain [8][9][10][11][12]. However, well-designed, randomized, placebo-controlled clinical trials (RCTs) of moxibustion are scarce. ...
Our objective was to compare the effectiveness and safety of traditional Chinese moxibustion to that of sham moxibustion in patients with chronic knee osteoarthritis (KOA) pain.
We conducted a randomized placebo-controlled trial involving 110 patients with KOA who met the inclusion criteria. These patients randomly received either active moxibustion (n = 55) or sham moxibustion control (n = 55) at acupoints Dubi (ST 35), extra-point Neixiyan (EX-LE 4), and an Ashi (tender) point three times a week for 6 weeks. Effects were evaluated with Western Ontario and McMaster Universities’ Osteoarthritis Index (WOMAC VA 3.1) criteria at the end of the course of treatment and 3, 12, and 24 weeks after the initial treatment.
The WOMAC pain scores showed greater improvement in the active treatment group than in control at weeks 3 (P = 0.012), 6 (P <0.001), 12 (P = 0.002), and 24 (P = 0.002) as did WOMAC physical function scores of the active treatment group at week 3 (P = 0.002), 6 (P = 0.015), and 12 (P <0.001) but not 24 (P = 0.058). Patients and practitioners were blinded successfully, and no significant adverse effects were found during the trial.
A 6-week course of moxibustion seems to relieve pain effectively and improve function in patients with KOA for up to 18 weeks after the end of treatment. Moxibustion treatment appears to be safe, and the usefulness of the novel moxa device was validated.
Trial registration
Current controlled trial: ISRCTN68475405. Registered 4 April 2014.
... Moreover, many hypotheses have been proposed to address the physiological mechanisms mediated by the action of acupuncture and moxibustion. In general, a large number of scientific studies have recently established strong evidence on the higher efficacy of acupuncture and moxibustion based on their clinical use over millenniums of years than that of the traditional treatment [13][14][15]. ...
In human beings or animals, ischemia/reperfusion (I/R) injury of the liver may occur in many clinical conditions, such as circulating shock, liver transplantation and surgery and several other pathological conditions. I/R injury has a complex pathophysiology resulting from a number of contributing factors. Therefore, it is difficult to achieve effective treatment or protection by individually targeting the mediators. This study aimed at studying the effects of local somatothermal stimulation preconditioning on the right Qimen (LR14) on hepatic I/R injury in rats.
Eighteen male Sprague-Dawley rats were randomly divided into three groups. The rats were preconditioned with thermal tolerance study, which included one dose of local somatothermal stimulation (LSTS) on right Qimen (LR14) at an interval of 12 h, followed by hepatic ischemia for 60 min and then reperfusion for 60 min. Serum aspartate aminotransferase (AST) and alanine aminotransferase (ALT) have been used to assess the liver functions, and liver tissues were taken for the measurements such as malondialdehyde (MDA), glutathione (GSH), catalase (CAT), superoxidase dismutase (SOD), and myeloperoxidase (MPO).
The results show that the plasma ALT and AST activities were higher in the I/R group than in the control group. In addition, the plasma ALT and AST activities decreased in the groups that received LSTS. The hepatic SOD levels reduced significantly by I/R injury. Moreover, the hepatic MPO activity significantly increased by I/R injury while it decreased in the groups given LSTS.
Our findings show that LSTS provides a protective effects on the liver from the I/R injury. Therefore, LSTS might offer an easy and inexpensive intervention for patients who have suffered from I/R of the liver especially in the process of hepatotomy and hepatic transplantation.
... Moxibustion is a traditional Chinese medical intervention that utilizes the heat generated by burning herbal preparations containing Artemisia vulgaris (mugwort) to stimulate acupuncture points [1]. It is also believed to be effective in the treatment of stroke rehabilitation [2], pain [3], cancer care [4], ulcerative colitis [5], hypertension [6], osteoarthritis [7], constipation [8], child chronic cough [9], and breech presentation [10]. In China, moxibustion on the Zhiyin (BL67) point, located on the outer corner of the fifth toenail, has long been used to correct nonvertex presentation in obstetrics [11,12]. ...
Objectives. This study aims to assess the effectiveness and safety of moxibustion for the correction of nonvertex presentation. Methods. Records without language restrictions were searched up to February 2013 for randomized controlled trials (RCTs) comparing moxibustion with other therapies in women with a singleton nonvertex presentation. Cochrane risk of bias criteria were used to assess the methodological quality of the trials. Results. Seven of 392 potentially relevant studies met the inclusion criteria. When moxibustion was compared with other interventions, a meta-analysis revealed a significant difference in favor of moxibustion on the correction of nonvertex presentation at delivery (risk ratio (RR) 1.29, 95% confidence interval (CI) 1.12 to 1.49, and I (2) = 0). The same findings applied to the cephalic presentation after cessation of treatment (RR 1.36, 95% CI 1.08 to 1.71, and I (2) = 80%). A subgroup analysis that excluded two trials with a high risk of bias also indicated favorable effects (RR 1.63, 95% CI 1.42 to 1.86, and I (2) = 0%). With respect to safety, moxibustion resulted in decreased use of oxytocin. Conclusion. Our systematic review and meta-analysis suggested that moxibustion may be an effective treatment for the correction of nonvertex presentation. Moreover, moxibustion might reduce the need for oxytocin.
... Since the late 20th century, it has been suggested that moxibustion increases fetal activity during the treatment period, cephalic presentation after the treatment period, and cephalic presentation at delivery [6,[15][16][17]. However, metaanalysis of a large number of investigations over the past two decades has failed to demonstrate that moxibustion effectively produces cephalic inversion during breech presentation [18][19][20] or is a useful treatment for stroke [21], hypertension [22], rheumatic conditions [23], ulcerative colitis [24], constipation [25], pain relief [26], and cancer support [27]. There is consensus that well-designed randomized controlled trials are needed in order to evaluate the safety and efficacy of moxibustion. ...
"Acupmoxa" is a hybrid word of "acupuncture" and "moxibustion" that more closely resembles the Chinese ideograph for this treatment. People in Western countries are more familiar with acupuncture, while moxibustion is less popular, partially due to the paucity of scientific studies. Although the evidence-based efficacy of moxibustion needs to be further clarified, the mechanisms by which moxibustion may work include temperature-related and nontemperature-related ones. Local somatothermal stimulation (LSTS), one type of moxibustion, is achieved by application of a heat source to and above the acupoint. Such mild heat stimulation of the acupoint induces little skin damage, in contrast to the burning effect of moxibustion, but does provoke mild oxidative stress in the viscera. Thus, preconditioned LSTS at the peripheral acupoints LR 14 and PC 6 of animals is able to induce visceral HSP70 expression and to protect the liver and the heart against ischemia-reperfusion injury. Nontemperature-related mechanisms include smoke, herbs, and biophysical (far infrared) stimulation. We conclude that LSTS, a remote preconditioning method, has potential clinical usefulness. However, evidence-based efficacy and safety studies involving large-scaled clinical trials are needed in order that this approach will pass muster with Western scientists.
Objectives
To determine the effectiveness of a simple, self-administrable moxibustion-cum-massage intervention for relieving chronic pain and improving psychological well-being for older adults in the community.
Design
A randomized controlled trial.
Setting
Seventy-eight participants with chronic pain were randomly assigned to the intervention and waitlist control groups.
Interventions
Participants received two moxa sticks a day to use the moxibustion-cum-massage procedure with the help of trained volunteers or caregivers for five consecutive days.
Main outcome measures
Participates’ pain level, sleep quality, depression and subjective well-being were measured before the intervention (T0), immediately after the intervention (T1), and one week after the intervention (T2).
Results
Repeated measures ANOVA revealed a significant group × time interaction effect in subjective well-being with a medium effect size. Regarding within-group effects in the intervention group at post-intervention (T1), the subjective pain level was significantly reduced with a small effect size, while sleep quality and depression significantly improved with large effect sizes. The control group showed no significant within-group effects in these variables. Maintenance effects at follow-up (T2) were not significant.
Conclusion
Despite the short intervention timeframe of five days, the study revealed preliminary evidence that the moxibustion-cum-massage intervention can be an effective, self-administrable pain relief regime for older adults. A longer period of intervention time is suggested for future studies.
Trial registration
The study was registered in the Hong Kong University Clinical Trial Register (Registration no. HKUCTR-2056).
Numerous alternative treatments are physical by nature. They often require a hands-on approach of an alternative practitioner. In this chapter, I discuss treatments that fall into this category.
The intent of this chapter is to provide the readers a focused clinical review assessing the current literature on a variety of complementary and alternative medicine treatments for musculoskeletal conditions. This chapter will assess acupuncture techniques, moxibustion, low-level laser therapy (LLLT), prolotherapy, and ozone injections. These treatment methods are growing in popularity by the public and are being utilized with much greater regularity. It is incumbent that providers become aware of the existing literature regarding the efficacy of these alternative methods for the treatment of a variety of musculoskeletal (MSK) conditions to adequately counsel and respond to the inquiries of our patients.
The therapeutic effect of grain-sized moxibustion (GS-Moxi) on inflammatory pain has been well recognized clinically, but the mechanism remains unclear. STIM1/ORAI1 is a sensible temperature channel, therefore; this study aimed to investigate the analgesic effect of GS-Moxi and the association with STIM1/ORAI1 expression. CFA-induced inflammatory pain model was established and was treated with GS-Moxi after 3 days of CFA injection. The behavioral test was measured after the GS-Moxi; then, serum was prepared for IL-1β, IL-6, and TNF-α, and the stimulated skin was used for measuring STIM1 and ORAI1 expression. The results indicated GS-Moxi had an analgesic effect on inflammatory pain and the heat variation was significant for the analgesia. GS-Moxi decreased the expression of IL-1β, IL-6, and TNF-α. Immunofluorescence and western blot analysis illustrated that heat change was associated with the stimulation of STIM1 and ORAI1. Suggesting that heat variation created by GS-Moxi could be crucial in this therapy and STIM1 and ORAI1 were potential enhancers in regulating analgesia of GS-Moxi.
Based on the data from the World Health Organisation (WHO), primary dysmenorrhea is prevalent among 55-75% adolescent girls and women of reproductive age. Threequarters of these women experienced mild-moderate dysmenorrhea. One of the non-pharmacological treatments for dysmenorrhea is moxibustion therapy. The heat from moxa is able to stimulate sensory nerve cells around the acupoints and can affect the endocrine system to release endorphins and also inhibit pain impulses in spinal cord. This research design was quasi-experiment with non-equivalent control group design, using non-probability with purposive sampling technique, which obtained 54 samples consisting of 27 in each intervention and control groups. Mean was used in univariate analysis and t-dependent also t-independent tests was used in bivariate analysis. This research occured at Cimahi Negeri 2 Junior High School. In the intervention group the therapy was given in one-time, 1 inch above the 9 acupoints within 15 minutes long, while in the control group no intervention was given. The results of the study proved the differences in the mean pain scale values of primary dysmenorrhea in the intervention group and the control group (p-value = 0.000) so that there is an effect of moxibustion therapy on the intensity of primary dysmenorrhea in adolescents. Moxibustion therapy can be recommended to be applied as a non-pharmacological action to treat dysmenorrhea and can be done independently. Keywords: Acupoints, Moxibustion Therapy, Primary Dysmenorrhea
Skin of color is generally used to identify individuals of South and East Asian, African, Native American, and Pacific Island descent. As the population of the world and the United States continues to grow, globalization has allowed cultures to extend geographical boundaries and diversify. Hence, the ability to recognize the vast clinical presentations of skin and hair disorders in individuals with skin of color is critical. If population-based differences in skin disorders do in fact exist, it is reasonable to assume that defining and understanding those differences will lead to better care and better treatment outcomes. This chapter will provide an overview on the current literature addressing differences in skin of color including special considerations on the dermatological implications of cultural practices by individuals with skin of color, variations in normal pigmentation, variations in the clinical presentation of skin disorders in skin of color and non-skin of color, and prevalent skin disorders in patients with skin of color.
Akupressur ist die Stimulation spezifischer Punkte, auf der Körperoberfläche durch Druck zu therapeutischen Zwecken. Der erforderliche Druck kann manuell oder mit einer Reihe von Instrumenten ausgeübt werden.
Background
Moxibustion treatment involves a combination of thermal and chemical stimulation applied by the combustion of moxa wool. The quality of moxa wool is considered to be an important factor in moxibustion treatment traditionally and clinically. However, despite its importance, quantitative and objective methods for determining moxa wool quality are lacking.
Methods
Moxa wool and commercial indirect moxibustion (CIM) device specimens were randomly collected, dried and strained through sieves of various sizes for 10 h. After sieving, the residues remaining on each sieve were collected. The collected samples were weighed and microscopically observed.
Results
In this study, we observed that fibres mainly remained on sieves sized 425 μm, and particles were smaller than 300 μm. The residues between 425 and 300 μm varied between the products. In addition, moxa wool for direct moxibustion (DMW) exhibited significantly more fibres than moxa wool for indirect moxibustion (IMW). Most of the CIM devices using moxa wool had a quality similar to IMW, except for one CIM brand using moxa wool that contained three times more waste particles than IMW.
Conclusion
Based on the results of this study, we conclude that the sieving method is useful for testing the quality of moxa wool even after the CIM manufacturing process. The sieve sizes of 425 and 300 μm could be used as a yardstick to determine the quality of moxa wool. Although this approach requires larger scale validation against existing standard methodologies, we believe it has great potential to be used to improve and safeguard the quality of moxa wool contained in commercial moxibustion devices.
The aim of traditional Chinese medicine (TCM) in acupuncture is sometimes to restore and regulate energy balance by stimulating specific points along the specific meridians traced on the human body via different techniques such as mechanical pressure, moxibustion and others. Hence, physicians have struggled to improve treatment for common diseases such as migraine and headaches. Heat stimulation and some pharmacological effects from moxa have been attributed to the therapeutic efficacy of such techniques. As heat can diffuse through the tissue, skins temperature will rise in the surrounding tissue. In this work, heat diffusion on a simple, 5-layer model of human skin is presented. Based on this, and by using Monte Carlo techniques, a photon or a photon package is launched into the tissue for mimicking the propagation of such photons at two different wavelengths through the tissue. The method generally describes the scholastic nature of radiation interactions. Most of the laser energy is deposited within a volume which cross-sectional area is the size of the beam itself. As could be seen, in the epidermis layer of the model, the heat does not go deep and nearly all the heat diffusion occurs on the edges of the beam, causing losses. Heat dissipation occurs faster and goes down to 2°C in the adipose tissue since there is low water content in this region. On the contrary, there is a fast heat increase in the muscle layer, up to 6°C at the most superficial layer. Since melanin is the most important epidermal chromophore, it can be noted that light shows strong absorption via melanin, at 690nm laser wavelength. In the papillary dermis the heat decreases and spreads out to the surrounding tissue. Once it reaches the adipose tissue, the heat is not absorbed enough; therefore, it is transmitted into the muscle, where the temperature rise is higher and reaches nearly 40 °C. Finally, photo-dynamics in a simple 5-layer skin model were explored at two laser wavelengths: 690nm and 1069nm, where no thermal damage would be expected, given the energy level of the employed pulses. Such pulsed laser energy levels remain to be tested in living tissue.
Introduction
To systematically review and meta-analyze the efficacy of moxibustion in treating patients with chronic low back pain (CLBP).
Methods
A systematic search of the Cochrane Library, Web of Science, PubMed, Embase, EBSCO, CBM, Wanfang, CNKI and VIP (until November, 2019) was used to identify studies reporting pain intensity (VAS or NRS), disability (ODI or RMDQ), JOA score, and quality of life (SF-36) in patients with CLBP. Study selection, data extraction was performed critically and independently by two reviewers. Cochrane criteria for risk of bias was used to assess the methodological quality of the trials. The Grading of Recommendations Assessment, Development, and Evaluation Methodology (GRADE) was applied to test the quality of evidence from the quantitative analysis.
Results
Ten RCTs, including 987 patients, met the inclusion criteria. Moxibustion had a superior effect on VAS score when compared with western medicine [RR = −1.69, 95%CI(-2.40, −0.98), p < 0.00001] and acupuncture [RR = −0.47, 95%CI(-0.92, −0.02), p=0.04], but it failed to do so when compared with core stability training [RR = −0.41, 95%CI(-0.87, 0.05), p=0.08]. The result showed that moxibustion plus other active treatments (including western medicine, massage, acupuncture and core stability training) had better effects on low back pain relief compared with active treatments alone. Moxibustion showed favourable effects on disability [SMD = −3.80, 95%CI (−5.49, −2.11), p < 0.0001], JOA score [MD = 4.10, 95%CI(2.30, 5.90), p < 0.00001], and SF-36 score [MD = 13.41, 95%CI(9.68, 17.14), p < 0.00001]. The evidence level of the results from the ten studies was determined to be very low to low.
Conclusions
It is difficult to draw firm conclusions that moxibustion is an effective intervention for treating CLBP due to the small sample size of eligible trails and the high risk of bias among the available articles. Rigorously designed large-scale RCTs are required to further confirm the results in this review.
Acupressure is the stimulation of specific points, called acupoints, on the body surface by pressure for therapeutic purposes. The required pressure can be applied manually of by a range of devices. Acupressure is based on the same tradition and assumptions as acupuncture. Like acupuncture, it is often promoted as a panacea, a ‘cure all’.
Recent advances in oncological acupuncture research provide evidence to support the use of acupuncture and moxibustion for symptom management in cancer patients. Studies in tumor-bearing animals demonstrate that acupuncture significantly enhances immune function by decreasing the percentage of CD4+ CD25+ regulatory T cells and increasing natural killer (NK) cell activity. The modality’s effect on NK cells has been shown to be mediated by β-endorphins. Acupuncture also has been shown to inhibit spinal interleukin-1β, dynorphin, and substance P to suppress cancer-induced pain, as well as to activate spinal opioids that alleviate chemotherapy-induced pain. Data from animal studies support the use of acupuncture for chemotherapy-induced emesis and suggest that it can improve cancer-induced depression. Moxibustion has also been shown to improve immune cell function by increasing NK cell activity, and it may alleviate cancer-induced pain. Although animal studies do not mimic human studies exactly, they reveal mechanisms by which these complementary therapies improve cancer-related symptoms. Most cancer patients experience multiple symptoms related either to cancer itself or to treatment effects. Since acupuncture and moxibustion alleviate some of these symptoms, use of these modalities has the potential to improve the patients’ quality of life.
Acupuncture and moxibustion is increasingly utilized in cancer management. Recent research has continued to provide new evidence to support the use of these complementary treatment modalities for the supportive care of cancer patients during and after conventional therapies. Apart from nausea and vomiting, for which the strongest evidence exists to support acupuncture treatment, there are multiple other symptoms that have been shown to benefit from acupuncture and moxibustion. These symptoms are commonly encountered by patients in their cancer journey and include the very debilitating cancer pain syndrome to the least apparent symptoms like anxiety, depression and cancer-related fatigue. The alleviation of these symptoms is essential to ensure better patients’ quality of life. Adoption of these acupuncture-related treatment modalities into clinical practice should be based on best evidence that ideally derived from well designed randomized controlled clinical trials. Non-invasive form of acupuncture point stimulation using transcutaneous electrical stimulation is also being investigated and the results of recent studies are promising. This chapter reviewed the current evidence from published laboratory and clinical trials to inform proper recommendation, utilization and further research of acupuncture and moxibustion management for cancer-related symptoms.
The use of acupuncture and moxibustion can date back to primitive Chinese societies. Today, they are sometimes used in Western medicine, mainly in cancer patients, as a complementary treatment. Scientific evidence has shown their effects on various diseases and cancer treatment. This chapter discusses different acupuncture and moxibustion techniques and their applications in oncology. Acupuncture points can be stimulated through needles, pressure, electric stimulus, laser and local heat applications using herbs. Moxibustion techniques involve stimulating the points by burning herbs directly or indirectly. Scientific evidence demonstrates the action mechanisms of acupuncture and moxibustion that benefit cancer patients, relieving various collateral treatment effects and disease symptoms. Quality of life (QoL) assessments are meant to improve care for cancer patients and expand the parameters of the benefits provided by conventional and unconventional treatments, apart from assessing the disease-free survival and overall survival. There are several measures to evaluate QoL. The European Organization for Research and Treatment of Cancer—Quality of Life Questionnaire-Core30 (EORTC—QLQ-C30) and Functional Assessment Cancer Therapy-General (FACT-G) are the most commonly used tools. As QoL measure provides important information about treatment impact on patients, specific tools for measuring health-related QoL (HRQoL) should be used to assess the impact of acupuncture and moxibustion. Acupuncture and moxibustion may be used as complementary treatments for cancer patients because they can help with symptom control and enhance patients’ physical and emotional aspects.
La acupuntura, un componente fundamental en la medicina china, tiene una historia de más de dos mil años, siendo desde entonces útil para mantener una buena salud y para el tratamiento de diversas enfermedades, especialmente el dolor. Según la teoría de la acupuntura clásica, existe una red de canales (los meridianos) en el cuerpo humano con puntos de acupuntura, situados sobre la piel y los tejidos más profundos. La punción en los puntos de acupuntura modula la fisiología del cuerpo a través de esa red de canales o meridianos. Las estructuras anatómicas y las funciones fisiológicas de los puntos de acupuntura, según la medicina china y la acupuntura tradicional, a través de la teoría de los meridianos o canales no han demostrado equivalentes en la ciencia biomédica moderna, pero la neurociencia moderna y los ensayos clínicos muestran un alto potencial terapéutico en el tratamiento del dolor crónico.
Traditional Chinese medicine (TCM) may be integrated with conventional Western medicine to enhance the care of patients with cancer. Recent evidence confirms a scientific basis for the use of acupuncture, herbs, diet and energy therapies. We suggest a holistic care plan based on the concepts of biological response modification, enhancement of psychoimmunological function, better symptom control and improvement of psychospiritual wellbeing. There is enough preliminary evidence to encourage good quality clinical trials to evaluate the efficacy of integrating TCM into Western cancer care.
Objective
To analyze moxibustion reports published in the journals of Science Citation Index (SCI), so as to grasp the current publication development of researches on moxibustion and to provide submission reference to such studies in the future.
Methods
Moxibustion reports were searched on PubMed and ISI web of knowledge, and 2 reviewers extracted data independently for analysis. Studies qualified were analyzed from eight aspects: publishing amount, research type, source journal, impact factor (IF), source country, source academy, indication and effect evaluation, comparison of studies between China and other countries.
Results and Conclusion
Fifty-three associated reports published in journals of SCI were selected. The publishing amount of moxibustion reports increased year by year, and majority of these reports were clinical researches and system reviews. IFs of most journals were less than 5. Diseases involved were various; however, the curative effect of moxibustion was still uncertain worldwide. The mechanism of moxibustion was not fully described, either. Further high-quality and convictive researches were still needed to define the curative effect of moxibustion and to increase the SCI publishing amounts.
Therapeutic benefits of acupuncture for chronic pain patients have been clearly identified in recent clinical trials. Underlying mechanisms of acupuncture action mediated by endogenous opioids have been well demonstrated. The existence of pain inhibitory systems in the central nervous system has also been clarified and acupuncture seems to be a potent stimulus for activating the analgesic systems, although the pain mechanisms in acute and chronic states are essentially different. On the other hand, the exact nature of the acupuncture point still remains unclear. Here, we propose a key role of polymodal receptors (PMR) in acupuncture and moxibustion and offer a rational explanation of the acupuncture point as a sensitised PMR.
Moxibustion (burning of moxa) therapy has been shown by medical historians to predate the use of acupuncture, and the meridian theory developed in association with moxibustion treatment. A variety of sensory receptors are activated by acupuncture and/or moxibustion, but there are very few that can be excited by both stimuli. PMRs are one of the most promising candidates. The functional characteristics of PMRs correspond with those of acupuncture action in the periphery; and tender or trigger points, one of the primitive features of acupuncture points, are assumed to be the sites of sensitised PMRs. Diffuse noxious inhibitory control (DNIC) is proposed as a possible mechanism of immediate action of acupuncture, and inputs for the development of DNIC seem to be the PMRs.
In our experimental model, repeated eccentric contractions of muscle produced local tenderness at the palpable band and induced a typical referred pain pattern on application of pressure. Repeated indomethacin injections inhibited the production of the experimental trigger point.
These lines of evidence suggest that the acupuncture points are the sites where the PMRs are sensitised and that such conditions might be repeatedly produced by various biomechanical stressors, insufficient blood supply and metabolic products.
The mechanism of acupuncture analgesia (AA) is one of the most widely researched topics in complementary and alternative medicine (CAM) based on modern medical methodology. Endogenous opioid-mediated mechanisms of acupuncture have been well established since the 1970s. In this review, we have covered the progress of AA research by Japanese investigators. In particular, we have reviewed the physiological basis of analgesic effects induced by acupuncture and moxibustion, including the actions of endogenous opioid and diffuse noxious inhibitory controls (DNICs), and the afferent fibers participating in acupuncture and moxibustion stimuli are discussed.
Acupuncture and electroacupuncture (EA) as complementary and alternative medicine have been accepted worldwide mainly for the treatment of acute and chronic pain. Studies on the mechanisms of action have revealed that endogenous opioid peptides in the central nervous system play an essential role in mediating the analgesic effect of EA. Further studies have shown that different kinds of neuropeptides are released by EA with different frequencies. For example, EA of 2 Hz accelerates the release of enkephalin, beta-endorphin and endomorphin, while that of 100 Hz selectively increases the release of dynorphin. A combination of the two frequencies produces a simultaneous release of all four opioid peptides, resulting in a maximal therapeutic effect. This finding has been verified in clinical studies in patients with various kinds of chronic pain including low back pain and diabetic neuropathic pain.
The mechanisms of action of acupuncture and moxibustion as reported by Japanese researchers are reviewed. The endogenous opioid-mediated mechanisms of electroacupuncture (EA) as used in China are well understood, but these are only one component of all mechanisms of acupuncture. These studies emphasize the similarity of the analgesic action of EA to various sensory inputs to the pain inhibition mechanisms. In Japanese acupuncture therapy, careful detection of the acupuncture points and fine needling technique with comfortable subjective sensation are considered important. The role of polymodal receptors (PMR) has been stressed based on the facts that PMRs are responsive to both acupuncture and moxibustion stimuli, thermal sensitivity is essential in moxibustion therapy, and the characteristics of acupuncture points and trigger points are similar to those of sensitized PMRs. Acupuncture and moxibustion are also known to affect neurons in the brain reward systems and blood flow in skin, muscle, and nerve. Axon reflexes mediated by PMRs might be a possible mechanism for the immediate action of acupuncture and moxibustion. Reports on the curative effects of acupuncture on various digestive and urological disorders are also reviewed briefly.
Publication bias is the tendency to decide to publish a study based on the results of the study, rather than on the basis of its theoretical or methodological quality. It can arise from selective publication of favorable results, or of statistically significant results. This threatens the validity of conclusions drawn from reviews of published scientific research. Meta-analysis is now used in numerous scientific disciplines, summarizing quantitative evidence from multiple studies. If the literature being synthesised has been affected by publication bias, this in turn biases the meta-analytic results, potentially producing overstated conclusions. Publication Bias in Meta-Analysis examines the different types of publication bias, and presents the methods for estimating and reducing publication bias, or eliminating it altogether. Written by leading experts, adopting a practical and multidisciplinary approach. Provides comprehensive coverage of the topic including: • Different types of publication bias, • Mechanisms that may induce them, • Empirical evidence for their existence, • Statistical methods to address them, • Ways in which they can be avoided. • Features worked examples and common data sets throughout. • Explains and compares all available software used for analysing and reducing publication bias. • Accompanied by a website featuring software, data sets and further material. Publication Bias in Meta-Analysis adopts an inter-disciplinary approach and will make an excellent reference volume for any researchers and graduate students who conduct systematic reviews or meta-analyses. University and medical libraries, as well as pharmaceutical companies and government regulatory agencies, will also find this invaluable.
Acupuncture and electroacupuncture (EA) as complementary and alternative medicine have been accepted worldwide mainly for the treatment of acute and chronic pain. Studies on the mechanisms of action have revealed that endogenous opioid peptides in the central nervous system play an essential role in mediating the analgesic effect of EA. Further studies have shown that different kinds of neuropeptides are released by EA with different frequencies. For example, EA of 2 Hz accelerates the release of enkephalin, β-endorphin and endomorphin, while that of 100 Hz selectively increases the release of dynorphin. A combination of the two frequencies produces a simultaneous release of all four opioid peptides, resulting in a maximal therapeutic effect. This finding has been verified in clinical studies in patients with various kinds of chronic pain including low back pain and diabetic neuropathic pain.
Context.—
Research both in the United States and abroad suggests that significant
numbers of people are involved with various forms of alternative medicine.
However, the reasons for such use are, at present, poorly understood.Objective.—
To investigate possible predictors of alternative health care use.Methods.—
Three primary hypotheses were tested. People seek out these alternatives
because (1) they are dissatisfied in some way with conventional treatment;
(2) they see alternative treatments as offering more personal autonomy and
control over health care decisions; and (3) the alternatives are seen as more
compatible with the patients' values, worldview, or beliefs regarding the
nature and meaning of health and illness. Additional predictor variables explored
included demographics and health status.Design.—
A written survey examining use of alternative health care, health status,
values, and attitudes toward conventional medicine. Multiple logistic regression
analyses were used in an effort to identify predictors of alternative health
care use.Setting and Participants.—
A total of 1035 individuals randomly selected from a panel who had agreed
to participate in mail surveys and who live throughout the United States.Main Outcome Measure.—
Use of alternative medicine within the previous year.Results.—
The response rate was 69%.The following variables emerged as predictors
of alternative health care use: more education (odds ratio [OR], 1.2; 95%
confidence interval [CI], 1.1-1.3); poorer health status (OR, 1.3; 95% CI,
1.1-1.5); a holistic orientation to health (OR, 1.4; 95% CI, 1.1-1.9); having
had a transformational experience that changed the person's worldview (OR,
1.8; 95% CI, 1.3-2.5); any of the following health problems: anxiety (OR,
3.1; 95% CI, 1.6-6.0); back problems (OR, 2.3; 95% CI, 1.7-3.2); chronic pain
(OR, 2.0; 95% CI, 1.1-3.5); urinary tract problems (OR, 2.2; 95% CI, 1.3-3.5);
and classification in a cultural group identifiable by their commitment to
environmentalism, commitment to feminism, and interest in spirituality and
personal growth psychology (OR, 2.0; 95% CI, 1.4-2.7). Dissatisfaction with
conventional medicine did not predict use of alternative medicine. Only 4.4%
of those surveyed reported relying primarily on alternative therapies.Conclusion.—
Along with being more educated and reporting poorer health status, the
majority of alternative medicine users appear to be doing so not so much as
a result of being dissatisfied with conventional medicine but largely because
they find these health care alternatives to be more congruent with their own
values, beliefs, and philosophical orientations toward health and life.
IN 1993 Eisenberg and colleagues1 reported
that 34% of adults in the United States used at least 1 unconventional form
of health care (defined as those practices "neither taught widely in U.S.
medical schools nor generally available in U.S. hospitals") during the previous
year. The most frequently used alternatives to conventional medicine were
relaxation techniques, chiropractic, and massage. Although educated, middle-class
white persons between the ages of 25 and 49 years were the most likely ones
to use alternative medicine, use was not confined to any particular segment
of the population. These researchers estimated that Americans made 425 million
visits to alternative health care providers in 1990, a figure that exceeded
the number of visits to allopathic primary care physicians during the same
period.
Recent studies in the United States2
and abroad3- 4 support the prevalent
use of alternative health care. For example, a 1994 survey of physicians from
a wide array of medical specialties (in Washington State, New Mexico, and
Israel) revealed that more than 60% recommended alternative therapies to their
patients at least once in the preceding year, while 38% had done so in the
previous month.2 Forty-seven percent of these
physicians also reported using alternative therapies themselves, while 23%
incorporated them into their practices.
When faced with the apparent popularity of unconventional medical practices
and the fact that people seem quite willing to pay out-of-pocket for these
services,1 the question arises: What are the
sociocultural and personal factors (health status, beliefs, attitudes, motivations)
underlying a person's decision to use alternative therapies?
At present, there is no clear or comprehensive theoretical model to
account for the increasing use of alternative forms of health care. Accordingly,
the goal of the present study was to develop some tentative explanatory models
that might account for this phenomenon.
Three theories that have been proposed to explain the use of alternative
medicine were tested:
Dissatisfaction: Patients are dissatisfied with
conventional treatment because it has been ineffective,5- 6
has produced adverse effects,6- 7
or is seen as impersonal, too technologically oriented, and/or too costly.6- 15Need for personal control: Patients seek alternative
therapies because they see them as less authoritarian16
and more empowering and as offering them more personal autonomy and control
over their health care decisions.14,16- 19Philosophical congruence: Alternative therapies
are attractive because they are seen as more compatible with patients' values,
worldview, spiritual/religious philosophy, or beliefs regarding the nature
and meaning of health and illness.19- 24
In addition to testing the validity of these 3 theoretical perspectives,
this study also sought to determine on an exploratory basis how the decision
to seek alternative therapies is affected by patients' health status and demographic
factors.
Keywords:Complementary and alternative medicine;Education;Pain;textbooks
Introduction Effectiveness Risks Conclusion References
To determine whether clinical trials originating in certain countries always have positive results.
Abstracts of trials from Medline (January 1966-June 1995).
Two separate studies were conducted. The first included trials in which the clinical outcome of a group of subjects receiving acupuncture was compared to that of a group receiving placebo, no treatment, or a nonacupuncture intervention. In the second study, randomized or controlled trials of interventions other than acupuncture that were published in China, Japan, Russia/USSR, or Taiwan were compared to those published in England.
Blinded reviewers determined inclusion and outcome and separately classified each trial by country of origin.
In the study of acupuncture trials, 252 of 1085 abstracts met the inclusion criteria. Research conducted in certain countries was uniformly favorable to acupuncture; all trials originating in China, Japan, Hong Kong, and Taiwan were positive, as were 10 out of 11 of those published in Russia/USSR. In studies that examined interventions other than acupuncture, 405 of 1100 abstracts met the inclusion criteria. Of trials published in England, 75% gave the test treatment as superior to control. The results for China, Japan, Russia/USSR, and Taiwan were 99%, 89%, 97%, and 95%, respectively. No trial published in China or Russia/USSR found a test treatment to be ineffective.
Some countries publish unusually high proportions of positive results. Publication bias is a possible explanation. Researchers undertaking systematic reviews should consider carefully how to manage data from these countries.
Research both in the United States and abroad suggests that significant numbers of people are involved with various forms of alternative medicine. However, the reasons for such use are, at present, poorly understood.
To investigate possible predictors of alternative health care use.
Three primary hypotheses were tested. People seek out these alternatives because (1) they are dissatisfied in some way with conventional treatment; (2) they see alternative treatments as offering more personal autonomy and control over health care decisions; and (3) the alternatives are seen as more compatible with the patients' values, worldview, or beliefs regarding the nature and meaning of health and illness. Additional predictor variables explored included demographics and health status.
A written survey examining use of alternative health care, health status, values, and attitudes toward conventional medicine. Multiple logistic regression analyses were used in an effort to identify predictors of alternative health care use.
A total of 1035 individuals randomly selected from a panel who had agreed to participate in mail surveys and who live throughout the United States.
Use of alternative medicine within the previous year.
The response rate was 69%. The following variables emerged as predictors of alternative health care use: more education (odds ratio [OR], 1.2; 95% confidence interval [CI], 1.1-1.3); poorer health status (OR, 1.3; 95% CI, 1.1-1.5); a holistic orientation to health (OR, 1.4; 95% CI, 1.1-1.9); having had a transformational experience that changed the person's worldview (OR, 1 .8; 95% CI, 1 .3-2.5); any of the following health problems: anxiety (OR, 3.1; 95% CI, 1.6-6.0); back problems (OR, 2.3; 95% CI, 1 .7-3.2); chronic pain (OR, 2.0; 95% CI, 1.1 -3.5); urinarytract problems (OR, 2.2; 95% CI, 1.3-3.5); and classification in a cultural group identifiable by their commitment to environmentalism, commitment to feminism, and interest in spirituality and personal growth psychology (OR, 2.0; 95% CI, 1.4-2.7). Dissatisfaction with conventional medicine did not predict use of alternative medicine. Only 4.4% of those surveyed reported relying primarily on alternative therapies.
Along with being more educated and reporting poorer health status, the majority of alternative medicine users appear to be doing so not so much as a result of being dissatisfied with conventional medicine but largely because they find these health care alternatives to be more congruent with their own values, beliefs, and philosophical orientations toward health and life.
Acupuncture is an ancient Chinese method to treat diseases and relieve pain. We have conducted a series of studies to examine the mechanisms of this ancient method for pain relief. This article reviews some of our major findings. Our studies showed that acupuncture produces analgesic effect and that electroacupuncture (EA) is more effective than manual acupuncture. Furthermore, electrical stimulation via skin patch electrodes is as effective as EA. The induction and recovering profiles of acupuncture analgesia suggest the involvement of humoral factors. This notion was supported by cross-perfusion experiments in which acupuncture-induced analgesic effect was transferred from the donor rabbit to the recipient rabbit when the cerebrospinal fluid (CSF) was transferred. The prevention of EA-induced analgesia by naloxone and by antiserum against endorphins suggests that endorphins are involved. More recent work demonstrated the release of endorphins into CSF following EA. In addition, low frequency (2 Hz) and high frequency (100 Hz) of EA selectively induces the release of enkephalins and dynorphins in both experimental animals and humans. Clinical studies suggesting its effectiveness for the treatment of various types of pain, depression, anxiety, spinally induced muscle spasm, stroke, gastrointestinal disorders, and drug addiction were also discussed.
Unlabelled:
To systematically investigate location bias of controlled clinical trials in complementary/alternative medicine (CAM).
Methods:
Literature searches were performed to identify systematic reviews and meta-analyses, which were used to retrieve controlled clinical trials. Trials were categorised by whether they appeared in CAM-journals or mainstream medical (MM)-journals, and by their direction of outcome, methodological quality, and sample size.
Results:
351 trials were analysed. A predominance of positive trials was seen in non-impact factor CAM- and MM-journals, (58) / (78) (74%) and (76) / (102) (75%) respectively, and also in low impact factor CAM- and MM-journals. In high impact factor MM-journals there were equal numbers of positive and negative trials, a distribution significantly (P < 0.05) different from all other journal categories. Quality scores were significantly lower for positive than negative trials in non-impact factor CAM-journals (P < 0.02). A similar trend was seen in low-impact factor CAM journals, but not to a level of significance (P = 0.06). There were no significant differences between quality scores of positive and negative trials published in MM-journals, except for high impact factor journals, in which positive trials had significantly lower scores than negative trials (P = 0.048). There was no difference between positive and negative trials in any category in terms of sample size.
Conclusion:
More positive than negative trials of complementary therapies are published, except in high-impact factor MM-journals. In non-impact factor CAM-journals positive studies were of poorer methodological quality than the corresponding negative studies. This was not the case in MM-journals which published on a wider range of therapies, except in those with high impact factors. Thus location of trials in terms of journal type and impact factor should be taken into account when the literature on complementary therapies is being examined.
Numerous studies have demonstrated that acupuncture and moxibustion induce analgesic effects. This study examined whether diffuse noxious inhibitory controls (DNIC) participated in acupuncture and moxibustion induced-analgesia. Single unit extracellular recordings from neurons in the trigeminal nucleus caudalis of urethane-anesthetized Wistar rats were obtained with a glass micropipette. A total of 52 single units, including 36 wide dynamic range (WDR), 5 nociceptive specific (NS) and 11 low-threshold mechanoreceptive (LTM) units were examined. During noxious test stimulation (cutaneous pinch or electrical stimulation), acupuncture, moxibustion or pinch stimulation was applied as the conditioning stimulus to the remote area of the receptive fields. When the conditioning stimulation induced rapid suppression of noxious receptive field stimulation response, examination revealed that various areas of the entire body were affected and suppression increased in an intensity-dependent manner. These features resemble DNIC phenomena. The suppression was observed on both WDR and NS neurons but not on LTM neurons. Eight of 16 WDR neurons examined were inhibited by acupuncture, five of 14 by moxibustion, and seventeen of 21 by pinching stimulation. Of the NS neurons, one of 2 units examined was suppressed by acupuncture, one of 2 by moxibustion, and two of 3 by pinch stimulation. Pinch stimulation induced the most profound suppression followed by manual acupuncture. Moxibustion induced moderate suppression with a long induction time. These results suggest that DNIC may be involved in the analgesic mechanism of acupuncture and moxibustion.
(1) Develop a sham moxibustion device; (2) determine whether volunteer participants and practitioners can distinguish the sham procedure from real moxibustion during treatment for prevention of the common cold; and (3) assess the feasibility of conducting a larger clinical trial of the device.
Double-blinded, randomized, placebo-controlled clinical trial.
A community outpatient health station in Chaoyang district, Beijing, China, from early November through late December 2003.
Sham and real moxibustion pillars were made by affixing moxa cones onto special collar bases. These pillars resemble each other in appearance, burning procedure and residue, but the base of the sham pillar isolates the moxa-produced heat and smoke and prevents them from radiating to the skin. These devices were tested in a pilot clinical trial in which patients received moxibustion at Zusanli (ST 36) for prevention of the common cold. Volunteers (n = 71) aged 55-75 years were given pre-treatment questionnaires to assess their knowledge of moxibustion and their expectations and motives for participating in the trial, randomized into treatment (n = 36) and placebo-controlled (n = 35) groups, and treated once every 2 days for 1 month. Questionnaires assessing the effectiveness of the blinding were given to the volunteers at the end of the trial and to practitioners after each treatment session.
There were no significant differences between the two groups of patients in past moxibustion experience, knowledge of moxibustion, expectations and motivation. The number of volunteers in the treatment group and the placebo group who believed they received: (1) real moxibustion; (2) sham moxibustion; and (3) were uncertain as to which they received is 30, 0, 5; 29, 0, 4, respectively. The results show no significant statistical differences (P = 1.000). The number of volunteers in the treatment group and the placebo group who were believed, by the two practitioners who provided the treatments, to have received: (1) real moxibustion; (2) sham moxibustion; and (3) and an undisclosed treatment were 10, 6, 19; 9, 4, 20 and 11, 7, 17; 12, 5, 16, respectively. There were no statistically significant differences between the practitioners (P = 0.811 and 0.840).
The sham moxibustion device was successfully validated in the present study. The results demonstrate that these specially designed real and sham moxibustion pillars can be used together to provide an effective placebo-control in moxibustion research and can successfully fulfill the double blinding protocol in moxibustion clinical trials.
To observe the effect of Aconite cake-separated moxibustion on primary knee osteoarthritis of liver and kidney deficiency type.
Fifty-six cases of such disease (80 knees) were randomly divided into a cake-separated moxibustion group (41 knees) with Neixiyan (EX-LE 5), Dubi (ST 35), Yinlingquan (SP 9) etc. selected, and a western medicine group (39 knees) were treated with oral administration of Sodium Diclofenate Slow-released Tablet.
The cumulative score for symptoms and signs was (37.41 +/- 6.61) points before treatment and (9.37 +/- 8.15) points after treatment in the cake-separated moxibustion group and (37.64 - 6.00) points before treatment and (12.05 +/- 8.83) points after treatment in the western medicine group, with a very significant difference before and after treatment in the two groups (P < 0.01); two months after treatment, it was (11.71 +/- 8.69) points in the cake-separated moxibustion group and (15.95 +/- 9.96) points in the western medicine group, the former being better than the latter (P < 0.05). After the end of treatment, there was no significant difference in the comprehensive therapeutic effect between the two groups (P > 0.05), the cured and markedly effective rate was 63.4% in the cake-separated moxibustion group and 48.7% in the western medicine group, but two months after treatment, the cured and markedly effective rate of 56.1% in the cake-separated moxibustion group was better than 33.3% in the western medicine group (P < 0.05).
Aconite cake-separated moxibustion has an ideal therapeutic effect on primary knee osteoarthritis of liver and kidney deficiency type, and the therapeutic effect at anaphase is better than that of Sodium Diclofenate Slow-released Tablet.
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