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The formulation of recommendations is a crucial step in the development of clinical practice guidelines, which requires tools provided by the GRADE methodology. These tools include the evidence quality assessment tool, the evidence summary tool, and the evidence-to-decision (EtD) framework. Although there is a methodologically guided standard pathway for formulating recommendations in clinical practice guidelines, it remains unclear how to translate this theoretical pathway into the practical process for formulating recommendations and what the specific steps in this process entail. Therefore, this paper takes the World Federation of Acupuncture-Moxibustion Societies Clinical Practice Guidelines on Acupuncture and Moxibustion: Allergic Rhinitis as an example to detail the full process of formulating recommendations and summaries it into a three-step method. Step one : Collect original materials from different sources to create EtD table. Step two : Distribute and collect EtD table, and preliminarily gather the recommendation voting results. Step three : Organize "salami-slicing pattern" guideline development group consensus meeting to formulate recommendations. The three-step method for formulating recommendations in clinical practice guidelines fully utilizes the GRADE EtD table to provide guideline development group with decision-making foundation and reference from multiple dimensions, including the importance of clinical questions, balance of benefits and harms, quality of evidence, resource required, values and preferences, health equity, acceptability, and feasibility. This approach enhances the scientific and practical nature of guideline recommendations. This paper provides a standard operating procedure to formulate recommendations for the incoming clinical practice guidelines, which aims to establish a standard pathway for the formulation of acupuncture clinical practice guideline recommendations. [ABSTRACT FROM AUTHOR]

Urinary incontinence (UI) is common in women and affects the quality of life in female patients severely. But the clinical consideration and treatment are insufficient. Acupuncture and-moxibustion has been proposed as a potentially effective intervention for female UI. Hence, the World Federation of Acupuncture-moxibustion Societies (WFAS) have initiated a project to develop the clinical practice guideline (CPG) on acupuncture and moxibustion for female UI towards global acupuncture practitioners. The CPG was developed according to the Grades of Recommendation, Assessment, Development, and Evaluation (GRADE) methodology, referring to the principles of the World Health Organization Handbook for Guideline Development. During the development of the CPG, the guideline development group (GDG) played an important role, which is composed of multi-national and multi-disciplinary experts. The clinical questions, recommendations and therapeutic protocols were all formulated by GDG using the modified Delphi method and basing on the results of the latest systematic review. This article focuses on the recommendations in the CPG. The CPG contains ten recommendations for ten clinical questions, including nine conditional recommendations for the intervention, one conditional recommendations for either the intervention or the comparison. The CPG also provides one conventional filiform needle therapy protocol, two deep puncturing stimulation on lumbosacral acupoints therapy protocols, and four moxibustion therapy protocols, extracted from the included clinical evidence of this CPG. [ABSTRACT FROM AUTHOR]

Clinical Practice Guideline on Acupuncture and Moxibustion: Migraine (WFAS 007.9-2023) is a clinical practice guideline officially released by the World Federation of Acupuncture-Moxibustion Societies (WFAS) on October 9, 2023, and is the first international guideline on the treatment of migraine with acupuncture. This international standard was developed under the guidance of rigorous evidence-based methodology, and it contains guideline purpose, scope, applicable population, applicable settings, overview of acupuncture for migraine, guideline development process and recommendations. For promoting the understanding and application of this guideline, this article summarizes a total of 18 recommendations in order to assist clinical decisions for migraine with acupuncture. [ABSTRACT FROM AUTHOR]

Clinical Practice Guideline on Acupuncture and Moxibustion: Allergic Rhinitis was revised and released by the Standards Working Committee of World Federation of Acupuncture-Moxibustion Societies (WFAS) on October 9, 2023. This is the first clinical practice guideline (CPG) on acupuncture and moxibustion for allergic rhinitis approved by an international academic organization, which provides evidence-based recommendations and the practical therapeutic protocols for acupuncture practitioners globally. This CPG was developed by following Grades of Recommendation, Assessment, Development, and Evaluation (GRADE) methodology, and the principles of the World Health Organization Handbook for Guideline Development. The members in the guideline development group (GDG) were from different countries, with different professions, and they played a critical role in the development of clinical questions, recommendations, and therapeutic protocols. Recommendations are the core of a CPG and the direct answers to clinical questions, due to which this article focuses on the recommendations of this CPG. The recommendations were developed by using the modified Delphi method and the GRADE grid rules, based on the updated systematic reviews of clinical evidence. A total of 15 recommendations for 15 clinical questions were developed in this CPG, including one strong recommendation for intervention based on high-quality evidence, three conditional recommendations for either the intervention or the comparison based on very low quality of evidence, and 11 conditional recommendations for the intervention based on very low quality of evidence. [ABSTRACT FROM AUTHOR]

Urinary incontinence (UI) is a common condition that bothers women's lives, including stress urinary incontinence (SUI), urgency urinary incontinence (UUI) and mixed urinary incontinence (MUI). The current non-surgical treatment of Western medicine includes pelvic floor muscle training (PFMT), medication, electric stimulation, etc., all of which have varied limitations. For instance, the patients are poor in compliance with PFMT and medication results in frequent adverse effects. Being one of the featured treatments of TCM, moxibustion has several merits including safety, low cost and simple operation. In recent years, the clinical evidences prove increasingly that moxibustion may be effective for women with UI. However, there is no high-quality systematic review of moxibustion for this disease. To evaluate the effect and safety of moxibustion on UI (including SUI, UUI and MUI) among women. From the inception to October 13, 2022, the data of the randomized controlled trials (RCTs) of moxibustion on UI among women were collected from CNKI, WanFang Data, VIP, SinoMed, Web of Science, Pubmed, EMBASE and Cochrane Library databases. Two investigators screened the articles independently and extracted the data according to the inclusion and exclusion criteria developed in advance. Using the risk of bias assessment tool of Cochrane Handbook, the included RCTs were evaluated. With RevMan 5.3 software, meta-analysis was performed, and the GRADE tool was adopted to assess evidence certainty of different outcomes. A total of 1176 articles were retrieved and 19 of them with 1397 patients were eligible and included in the review. In experimental groups, moxibustion combined with PFMT was used, while in control groups PFMT was applied alone. And the subjects were all women with SUI. Meta-analysis showed that compared with PFMT alone, moxibustion combined with PFMT reduced the urine leakage volume (1-hour pad test) (MD = -1.95g, 95% CI [-2.32, -1.57], P < 0.001), the frequency of UI in 24-hour (MD = -0.64, 95% CI [-0.88, -0.40], P < 0.001) and the score of the short form of International Consultation on Incontinence Questionnaire (ICIQ-SF) of women with SUI (MD = -2.53, 95% CI [-3.43, -1.63], P < 0.001); and this combined intervention measure did not increase significantly the adverse events (RR = 0.82, 95% CI [0.15, 4.6], P = 0.82). GRADE assessment showed that the UI frequency in 24-hour and the incidence of adverse events were rated as low quality, the urine leakage volume of 1-hour pad test and ICIQ-SF score were very low quality. Compared with PFMT alone, the intervention combined with moxibustion greatly reduced the urine leakage volume and UI frequency and improved the quality of life (QoL) among women with SUI with favorable safety. Moxibustion could be effective supplementary therapy on SUI among women. However, due to the high risk of bias of the included trials and low certainty of evidence, more high-quality clinical studies are needed to verify the above findings. Registered on PROSPERO: CRD42022297643. [ABSTRACT FROM AUTHOR]

Formulating critical clinical questions and outcomes is essential for developing clinical practice guidelines (CPGs). This study aims to formulate the key clinical questions and outcomes for the CPG on acupuncture and moxibustion for allergic rhinitis (AR). PICO (patient, intervention, comparator, and outcome) question survey, Delphi survey, and consensus conference of the guideline development group (GDG) were employed. PICO questionnaires were used to gather and analyze the target users' key demands and interests. The GDG then selected the critical clinical questions and outcomes via a mixed method of Delphi survey and consensus conference. Fifteen potential clinical questions and ten types of outcomes were formulated based on the analysis of 123 responses from seventeen countries on five continents. After two rounds of the Delphi survey and complete discussions, a consensus was reached by the GDG that all potential questions were included. After three rounds of the Delphi survey and complete debate, the consensus was reached that nine outcomes were considered important. Fifteen key clinical questions and nine important outcomes were formulated for the CPG. These covered issues elicited the most attention from global users in acupuncture therapy and AR. The results will contribute to the CPGs development and future clinical studies. [ABSTRACT FROM AUTHOR]

The survey aims to collect clinical questions for the clinical practice guideline on acupuncture and moxibustion in treating urinary incontinence in women. The survey is consisted of multiple-choice questions, ranking questions and open questions. We hope you can help us to complete the questions using PICO (Patients, Intervention, Comparator and Outcome) framework referring to the examples. The survey might take about 30 min, and the responses from you will greatly contribute to the formation of this guideline. [ABSTRACT FROM AUTHOR]

The survey aims to collect clinical questions for the clinical practice guideline on acupuncture and moxibustion in treating allergic rhinitis. The survey is consisted of multiple-choice questions, ranking questions, and open questions. Readers are recommended to complete the open questions using PICO (Patients, Intervention, Comparator and Outcome) framework, referring to the examples. The survey might take about 30 min, and the responses from readers will greatly contribute to the formation of this guideline. [ABSTRACT FROM AUTHOR]

Professor Jiping ZHAO has unique thoughts on the diagnosis and treatment of peripheral facial paralysis. She pays the great attention to clinical differentiation in treatment with acupuncture, especially meridian differentiation. She believes that the differentiation of lesion is core and the early judgment is critical for the better therapeutic effects on intractable facial paralysis. The local acupoints are selected in the guide of the theory of meridian sinew and stimulated on the base of three-needling theory. The distal acupoints are decided in light of the syndrome differentiation, of which, Hégŭ (合谷 LI 4), Zúsānlĭ (足三里 ST 36) and Tàichōng (太冲 LR 3) are the basic acupoints. Additionally, Professor ZHAO lays the emphasis on the 5th branch of facial nerve (cervical branch) in diagnosis and treatment. [ABSTRACT FROM AUTHOR]

Abstract Objective To explore the tenderness response at the acupoints on the medial crus in the patients of pelvic inflammatory disease. Methods A total of 30 patients of pelvic inflammation and 30 healthy people were included. WAGNER FDX body mechanics algometer was used to determine the score of the visual analogue scale (VAS) and tenderness threshold value at Yīnlíngquán (阴陵泉 SP 9), Sānyīnjiāo (三阴交SP 6) and Lígōu (蠡沟 LR 5). The changes in the tenderness on the body surface at the relevant acupoints were compared and analyzed in the patients of pelvic inflammation. Results The occurrence rate of tenderness at LR 5 at the pelvic inflammation group was higher significantly than the health group (86% Vs 42%, P <0.01). In SP 9, SP 6 and LR 5,the VAS scores at the acupoints in the pelvic inflammation group were higher significantly than the health group (test 1:55.00 ± 15.12 vs 27.25 ± 10.31, 47.07 ± 18.38 vs 29.75 ± 14.30, 47.16 ± 19.4 vs 20.16 ± 10.76; test 2:53.40 ± 17.23 vs 33.42 ± 13.07, 45.95 ± 15.74 vs 29.15 ± 11.97, 42.50 ± 21.67 vs 21.05 ± 11.97; test 3: 48.50 ± 14.97 vs 40.08 ± 13.20, 38.24 ± 15.29 vs 29.29 ± 12.37, 37.93 ± 19.17 vs 23.09 ± 12.26) , P < 0.01, P < 0.05.In SP 9, SP 6 and LR 5,the tenderness threshold values at the acupoints in the pelvic inflammation group were higher significantly than the health group (test 1:0.86 ± 0.95 vs 0.53 ± 0.39, 0.86 ± 0.95 vs 0.53 ± 0.39, 0.85 ± 0.77 vs 0.47 ± 0.47; test 2:0.88 ± 0.81 vs 0.44 ± 0.32, 0.98 ± 0.83 vs 0. 44 ± 0. 32, 0.85 ± 0.77 vs 0.47 ± 0.47; test 3:0.98 ± 0.80 vs 0.36 ± 0.26, 1.11 ± 0.92 vs 0. 36 ± 0. 26, 0.85 ± 0.77 vs 0.47 ± 0.47), P < 0.01, P < 0.05 (P < 0.05). Conclusion The VAS scores and tenderness threshold values at SP 9, SP 6 and LR 5 in the patients of pelvic inflammation are higher significantly than those in the healthy people. The occurrence rate of tenderness at LR 5 is higher significantly as compared with the healthy people. [ABSTRACT FROM AUTHOR]

Abstract Background Allergic rhinitis (AR) is defined as an immunoglobulin led atopic disorder that affects the nasal mucosa. Moxibustion on herbs, a common complementary and alternative medicine approach, is frequently used for treating AR in clinical practice. Western medicine is good at quick symptomatic relief, while offer little or no sustainable and steady long-term effect. Little established evidence is available to support the long-term effectiveness of moxibustion on herbs for AR. Objective This study is a randomized controlled trial to assess the long-term effectiveness of moxibustion on herbs in moderate-severe persistent AR population. Methods The study sample size is 56 patients. Eligible patients with moderate-severe persistent AR will be randomized into a moxibustion on herbs combined with conventional treatment group (MOHCT group) and a conventional treatment group (CT group) in a 1:1 ratio. Patients in the MOHCT group will receive a 30-min moxibustion on herbs treatment on Zhìyáng (至阳 GV 9), Dàzhuī (大椎 GV 14) and bilateral Shènshū (肾俞 BL 23), Fèishū (肺俞 BL 13) for a total of 12 times on the basis of conventional treatment, while those in the CT group will receive conventional treatment alone. The primary outcome measure is VAS score for total nasal symptoms, which will be obtained via a self-recorded AR diary. The secondary outcome measures include the average occurrence of symptoms per week, use of medication and Rhinoconjunctivitis Quality of Life Questionnaire (RQLQ). Discussion The objectives of this study include (1) to evaluate the long-term effectiveness and safety of moxibustion on herbs for treating AR; (2) to evaluate whether moxibustion on herbs can reduce the frequency of AR symptoms in patients with moderate-severe persistent allergic rhinitis. The finding of this study will provide evidence on the long-term effectiveness of moxibustion on herbs for moderate-severe persistent AR. [ABSTRACT FROM AUTHOR]

Since acupuncture came to western countries, research has been done to try and prove whether or not it is effective. Current Acupuncture research is most often based on the sham needle which was first designed by K Streitberger and J Kleinhenz in 1998. The sham acupuncture needles are developed for the control group and do not penetrate the skin. Sham acupuncture has been used in randomized controlled trial (RCT) for diseases which normally benefit from acupuncture treatment. The sham needle is not the best placebo needle though. Because of the use of sham acupuncture, the result of those research shows acupuncture having no effect or it shows there is no significant difference between real acupuncture (verum) and sham acupuncture (placebo). However, a detailed introduction of the Nine Classical Needles (ancient) and the Nine Modern Needles (SHI's nine needles) shows that the use of sham acupuncture in RCT research is flawed by design. This then casts doubt on the findings and conclusions reached by using sham acupuncture in RCT acupuncture research. [ABSTRACT FROM AUTHOR]

This systematic review is aim to comprehensively evaluate the efficacy of acupoint stimulation in managing of post-stroke spasticity. The eligible randomized controlled clinical trials (RCTs) and quasi-randomized controlled clinical trials (quasi-RCTs) will be searched from the following databases: the Cochrane Central Register of Controlled Trials (CENTRAL), MEDLINE, EMBASE, China National Knowledge Infrastructure (CNKI), Chinese Scientific Journal Database (VIP), Wanfang Database, Chinese BioMedical Literature Database (CBM). The Cochrane risk of bias tool will be used to assess the trials. No patients or their family will be bothered in this systematic review, so there is no need for the permission of institutional review board (IRB). The completed systematic review will be published in a peer-reviewed journal. [ABSTRACT FROM AUTHOR]

Abstract: Insufficient clinical trial data were available to prove the efficacy of acupuncture for migraine prophylaxis. A multicenter, double-dummy, single-blinded, randomized controlled clinical trial was conducted at the outpatient departments of acupuncture at 5 hospitals in China to evaluate the effectiveness of acupuncture. A total of 140 patients with migraine without aura were recruited and assigned randomly to 2 different groups: the acupuncture group treated with verum acupuncture plus placebo and the control group treated with sham acupuncture plus flunarizine. Treated by acupuncture 3 times per week and drugs every night, patients from both groups were evaluated at week 0 (baseline), week 4, and week 16. The primary outcome was measured by the proportion of responders (defined as the proportion of patients with a reduction of migraine days by at least 50%). The secondary outcome measures included the number of migraine days, visual analogue scale (VAS, 0 to 10 cm) for pain, as well as the physical and mental component summary scores of the 36-item short-form health survey (SF-36). The patients in the acupuncture group had better responder rates and fewer migraine days compared with the control group (P<.05), whereas there were no significant differences between the 2 groups in VAS scores and SF-36 physical and mental component summary scores (P>.05). The results suggested that acupuncture was more effective than flunarizine in decreasing days of migraine attacks, whereas no significantly differences were found between acupuncture and flunarizine in reduction of pain intensity and improvement of the quality of life. [Copyright &y& Elsevier]