Search

Acupuncture is one of the most effective complementary therapies for allergic rhinitis (AR) and has been recommended by several clinical practice guidelines (CPGs) for AR. However, these CPGs mentioned acupuncture without making recommendations for clinical implementation and therapeutic protocols, therefore limiting the applicability of acupuncture therapies for AR. Hence, for the benefit of acupuncture practitioners around the world, the World Federation of Acupuncture-moxibustion Societies have initiated a project to develop the CPG for the use of acupuncture and moxibustion to treat AR. This CPG was developed according to the Grading of Recommendations 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. The clinical questions, recommendations and therapeutic protocols were all formulated by the GDG using the modified Delphi method. The CPG contains recommendations for 15 clinical questions about the use of acupuncture and moxibustion interventions. These include one strong recommendation for the intervention based on high-quality evidence, three conditional recommendations for either the intervention or standard care, and 11 conditional recommendations for the intervention based on very low quality of evidence. The CPG also provides one filiform needle acupuncture protocol and five moxibustion protocols extracted based on the protocols presented in randomized controlled trials reviewed by the GDG. Please cite this article as: Du SH, Chen S, Wang SZ, Wang GQ, Du S, Guo W, Xie XL, Peng BH, Yang C, Zhao JP. Clinical practice guideline for acupuncture and moxibustion: Allergic rhinitis. J Integr Med. 2024; 22(3): 245-257., (Copyright © 2024 Shanghai Yueyang Hospital Affiliated to Shanghai University of Traditional Chinese Medicine. Published by Elsevier B.V. All rights reserved.)

Urinary incontinence (UI) is a common problem worldwide. It has a major impact on physical and social activities and interpersonal relationships. UI is common in women, but is under-reported and under-treated. It affects the quality of life of female patients severely. Acupuncture and moxibustion have been proposed as potentially effective interventions for female UI. Hence, for the benefit of acupuncture practitioners around the world, the World Federation of Acupuncture-moxibustion Societies initiated a project to develop a clinical practice guideline (CPG) for the use of acupuncture and moxibustion to treat female UI. This CPG was developed according to the Grading of Recommendations 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. The clinical questions, recommendations and therapeutic protocols were all formulated by GDG using the modified Delphi method. This CPG contains ten recommendations about the use of acupuncture and moxibustion interventions for ten clinical questions, which include nine conditional recommendations for the intervention and one conditional recommendation for either the intervention or the comparison. This CPG also provides one protocol for conventional filiform needle therapy, two therapy protocols for deep needling stimulation on lumbosacral acupoints, and four moxibustion therapy protocols, based on the protocols presented in randomized controlled trials reviewed by the GDG. Please cite this article as: Yang C, Wang SZ, Chen S, Du S, Wang GQ, Guo W, Xie XL, Peng BH, Du SH, Zhao JP. Clinical practice guideline for acupuncture and moxibustion: Female urinary incontinence. J Integr Med. 2024; 22(3): 258-269., (Copyright © 2024 Shanghai Yueyang Hospital Affiliated to Shanghai University of Traditional Chinese Medicine. Published by Elsevier B.V. All rights reserved.)

Taking the recommendations development of the World Federation of Acupuncture-Moxibustion Societies (WFAS) standard Clinical Practice Guideline for Female Urinary Incontinence as an example, this study analyzed the consensus expert composition, specific consensus process, and results in the development of the guideline's recommendations. It systematically examined the advantages of using the modified Delphi method in the formation of recommendations for acupuncture and moxibustion clinical practice guideline, with the aim of providing reference for the development of acupuncture and moxibustion guidelines in the same field.

Objective: To observe the meridian-acupoint reactions of foot three yin meridians in primary dysmenorrhea(PD) and secondary dysmenorrhea(SD) patients, so as to summarize the rules of meridian-acupoint reaction and acupoints selection., Methods: Thirty-five patients with PD (PD group), 34 patients with SD (SD group) and 35 healthy subjects (healthy group) were recruited. The compression method was used to examine the lower leg segment of the foot three yin meridians. Positive reactions(palpable skin changes, including cords, nodules, depressions) and tenderness of meridians and acupoints were recorded. The visual analogue scale (VAS) was used to evaluate the tenderness severity of acupoints., Results: Compared with the healthy group, the probability of positive reactions and tenderness in foot three yin meridians were higher in PD and SD groups ( P <0.01, P <0.05). Compared with the PD group, the probability of positive reactions in Spleen and Liver Meridians were higher in the SD group, with higher probability of tenderness in Liver Meridian( P <0.05). The probability of positive reactions and tenderness in the Spleen Meridian of PD and SD groups was significantly higher than that in the Kidney Meridian ( P <0.01), while the probability of tenderness in the Spleen Meridian of the PD group was significantly higher than that in the Liver Meridian ( P <0.05). Positive reactions and tenderness were concentrated at Yinlingquan (SP9), Diji (SP8) and Sanyinjiao (SP6) of Spleen Meridian and Xiguan (LR7) and Ligou (LR5) in Liver Meridian of PD and SD groups. In comparison with the PD group, the probability of positive reactions, tenderness and VAS score of SP8 and LR5 of the SD group were higher ( P <0.05, P <0.01)., Conclusion: The positive reaction occurs most frequently in the Spleen Meridian, followed by the Liver Meridian, and least frequently in the Kidney Meridian. The acupoints with positive reaction are different between PD and SD, which suggests that the Spleen Meridian acupoints should be the main acupoints when treating the two kinds of dysmenorrhea, and acupoints should also be selected according to the meridian and acupoint examination results.

With three representative types of gynecological diseases (dysmenorrhea, pelvic inflammation, polycystic ovary syndrome) as examples, the application methods of meridian and acupoint diagnosis for gynecological diseases treated with acupuncture and moxibustion are discussed. During clinical diagnosis and treatment, it is recommended to examine the patient's leg segment along the three yin meridians of foot, aiming to explore the positive reactions of the meridians and acupoints (color, shape, skin temperature, sensory abnormalities, etc.). Acupuncture and moxibustion treatment at this positive reaction place can improve the clinical efficacy. Meridian and acupoint diagnosis could provide basis for meridian syndrome differentiation, thus guiding the selection of acupoint prescriptions; it is also helpful to clarify the deficiency, excess, cold and heat of the disease nature, thus guiding the selection of acupuncture and moxibustion methods. In addition, it is an auxiliary method to estimate the prognosis and outcome of the disease.

The traditional life concept of "body-mind holism" in Chinese medicine has drawn a special attention with the development of modern psychosomatic medicine. The "body-mind holism" is valuable in the guidance for clinical acupuncture practice, but, it is only remained on the theoretical significance by the medical masters in the past dynasties. In the paper, based on the understanding of Huangdi Neijing ( Yellow Emperor's Internal Classic ), the similarities and differences are compared between the body-mind theory and psychosomatic medicine. In association with clinical observation, from three aspects, i.e. body-mind pathogenesis, acupoint detection and observing the mind, and body-mind treatment, the guidance of "body-mind holism" is explored for the clinical diagnosis and treatment of acupuncture and moxibustion; the referents of "body" and "mind" are clarified in views of disease, diagnosis and treatment; and the treatment strategies of acupuncture and moxibustion are discussed in the perspective of "body-mind holism".

Background: Peripheral facial paralysis (PFP) results in functional disorder and social dysfunction, when it is under a severe condition at onset, long-term poor outcomes do occur. Different acupuncture methods have been reported to be potentially effective for shortening the disease course and reducing the occurrence of sequelae when they are applied at an early stage. Neuro edema is a common pathological feature in the acute phase, and many clinical studies have suggested its effect of reducing facial nerve edema. It is of value to estimate the effectiveness and safety of acupuncture treatment at the onset, and to assess the most suitable acupuncture method for the acute period., Methods and Analysis: All the RCTs and quasi-RCTs on acupuncture therapy for patients who is during acute stage of PFP will be included. The recovery rate of facial function, the time it takes to restore facial function and the odds of sequelae occurring will be the key parts we focus on. Psychological well-being and quality of life will also be evaluated. Literature searching will be conducted until December 31th, 2022 from eight databases systematically. Two reviewers will screen the literature and extract the data independently. RevMan software will be used for data analysis, and the version 2 of the Cochrane risk-of-bias tool (RoB 2) will be used to assess the certainty of evidence. Forest plots and summary findings will be generated. If data permits, a meta-analysis will be conducted., Ethics and Dissemination: Since this study will not involve clinical treatment of patients, ethics approval is not required. The result of this study will be submitted to a peer-reviewed journal for publication and as a proposal for clinical practice and further study on acupuncture treatment at the early stage of PFP., Discussion: This review will summarize the evidence on the different type of acupuncture therapy for acute Bell's palsy and Ramsay-Hunt syndrome. We anticipate that it would be safe and effective when applied to the acute phase of PFP, and some specific suitable acupuncture methods would be found resulting from this review., Systematic Review Registration: International Prospective Register for Systematic Reviews (PROSPERO) number CRD42020205127., (© 2023. The Author(s).)

Objective: To observe the clinical efficacy of acupuncture for prevention of moderate to severe seasonal allergic rhinitis., Methods: A total of 105 patients with moderate to severe seasonal allergic rhinitis were randomly divided into an observation group (53 cases, 3 cases dropped off) and a control group (52 cases, 4 cases dropped off). The patients in the observation group were treated with acupuncture at Yintang (GV 24 + ), Yingxiang (LI 20), Hegu (LI 4), Zusanli (ST 36), Fengchi (GB 20), Feishu (BL 13), etc. 4 weeks before the seizure period, once every other day, 3 times a week for 4 weeks. The patients in the control group were not given any intervention before the seizure period. Emergency drugs can be given appropriately during the seizure period in both groups. After seizure period, the seizure rate was recorded in the two groups; before treatment and on week 1, 2, 4, 6 of seizure period after treatment, the rhinoconjunctivitis quality of life questionnaire (RQLQ) score and total nasal symptom score (TNSS) were observed in the two groups; the rescue medication score (RMS) was recorded on week 1-6 of seizure period in the two groups., Results: The seizure rate of the observation group was 84.0% (42/50), which was lower than 100.0% (48/48) in the control group ( P <0.05). After treatment, the scores of RQLQ and TNSS at each time point of seizure period were decreased compared with before treatment in the observation group ( P <0.01), which were lower than the control group ( P <0.01). The RMS score at each time point of seizure period in the observation group was lower than the control group ( P <0.05, P <0.01)., Conclusion: Acupuncture can reduce the incidence of moderate to severe seasonal allergic rhinitis, relieve the symptoms, improve the quality of life and reduce the use of emergency drugs.

Background: Filiform needle acupuncture (FNA), the most classical and widely applied acupuncture method based on traditional Chinese medicine theory, has shown a promising effect in the treatment of allergic rhinitis (AR)., Objective: To evaluate the efficacy, safety, cost-effectiveness, and patient preference of FNA in the treatment of AR by comparing FNA with sham acupuncture, no treatment, and conventional medication., Search Strategy: Eight electronic databases were systematically searched from inception to October 14, 2021. Additional studies were acquired from clinical trial registration platforms and reference lists., Inclusion Criteria: Randomized controlled trials were included if they compared FNA with either sham acupuncture, no treatment or conventional medication for AR., Data Extraction and Analysis: Two researchers extracted data independently of each other using a predesigned data acquisition form, and results were cross-checked after completion. The primary outcome was symptom score (Total Nasal Symptom Score or Visual Analogue Scale), and the secondary outcomes were the AR control questionnaire, quality of life (QoL) score (Different versions of Rhinoconjunctivitis Quality of Life Questionnaire), medication score (use of rescue medication), mental health score, total IgE, adverse event rate, clinical economic indicators, and patient satisfaction score. Standardized mean difference (SMD) or mean difference (MD) with 95% confidence interval was used to calculate the effect size for continuous data, while risk ratio with 95% CI was used for dichotomous data., Results: Thirty studies were included in this review. Compared with sham acupuncture, FNA significantly reduced the symptom score (SMD: -0.29 [-0.43, -0.15]), AR's impact on QoL (SMD: -0.23 [-0.37, -0.08]) and medication score (SMD: -0.3 [-0.49, -0.11]). Compared with no treatment, FNA dramatically reduced the symptom score (SMD: -0.8 [-1.2, -0.39]) and AR's impact on QoL (SMD: -0.82 [-1.13, -0.52]). There were no increased rates of adverse events with FNA compared to sham acupuncture and no treatment. FNA increased patient satisfaction and may be cost-effective. Most pieces of evidence from the above two comparisons were of high confidence. Moreover, FNA significantly outperformed conventional medication in reducing the symptom score (SMD: -0.48 [-0.85, -0.1]) and displayed a lower rate of adverse events, but the quality of evidence was very low., Conclusion: FNA is an effective and safe intervention for AR and can help with symptom relief, QoL improvement, reducing medication usage, and increasing patient satisfaction. Further studies are needed to verify its cost-effectiveness and superiority over conventional medication and the best therapeutic strategies., Competing Interests: Declaration of competing interest The authors have no conflicts of interest to declare., (Copyright © 2022 Shanghai Yueyang Hospital Affiliated to Shanghai University of Traditional Chinese Medicine. Published by Elsevier B.V. All rights reserved.)

Objective: To explore the relationship between typeⅢ chronic prostatitis and the positive reaction of foot three yin -meridians based on meridian diagnosis., Methods: Using the traditional meridian diagnosis combined with tenderness meter detection, the positive reaction rate of meridians and acupoints of crural foot three yin -meridians and tenderness pain threshold of standard acupoint location were compared in the typeⅢ chronic prostatitis patients (prostatitis group, 32 cases) and healthy subjects (health group, 30 cases)., Results: The positive reaction rate of the spleen meridian was higher than those in the kidney meridian and the liver meridian in the prostatitis group ( P <0.001). The positive reaction rates of the spleen meridian, the kidney meridian and the liver meridian and the total positive reaction rate of foot three yin -meridians in the prostatitis group were higher than those in the health group ( P <0.001). In the prostatitis group, the positive reaction rates of Sanyinjiao (SP 6), Yinlingquan (SP 9), Taixi (KI 3), Ligou (LR 5), Diji (SP 8), Ququan (LR 8), Shangqiu (SP 5) and Zhongfeng (LR 4) were higher than those in the health group ( P <0.001), the tenderness pain threshold of acupoints of crural foot three yin -meridians was lower than the health group ( P <0.001). The positive reaction rate of the spleen meridian was positively correlated with the pain score and the total score of National Institute of Health chronic prostatitis symptom index (NIH-CPSI), and the positive reaction rate of the kidney meridian was positively correlated with age and international prostate symptom score (IPSS) in the prostatitis group., Conclusion: The positive reactions of foot three yin -meridians, especially the spleen meridian, are closely related to the pathological state of typeⅢ chronic prostatitis, pain and urination symptom are significantly correlated with the spleen meridian and the kidney meridian respectively.

Objective: To observe the difference in the efficacy of acupuncture intervention at different time points on the pregnancy rate of in vitro fertilization-frozen embryo transfer (IVF-FET)., Methods: Ninety-nine patients with secondary infertility who were going to receive IVF-FET were divided into a transplantation-day acupuncture group, a transplantation cycle acupuncture group, and a non-acupuncture group according to their wishes, with 33 cases in each group. All three groups of patients received conventional IVF-FET treatment. The transplantation-day acupuncture group received acupuncture treatment 1 h before and 30 min after the embryo transfer, and the transplantation cycle acupuncture group received acupuncture treatment 5 weeks before the FET (once a week, 5 times) and on the day of transplantation, Zigong (EX-CA 1), Guanyuan (CV 4), Taichong (LR 3), Hegu (LI 4), etc. were selected in the two groups. The biochemical pregnancy rate and clinical pregnancy rate in the three groups were compared., Results: The biochemical pregnancy rate and clinical pregnancy rate in the transplantation cycle acupuncture group were higher than those in the non-acupuncture group ( P <0.05). There was no statistical difference in the biochemical pregnancy rate and clinical pregnancy rate between the transplantation cycle acupuncture group and the transplantation-day acupuncture group, and between the transplantation-day acupuncture group and the non-acupuncture group ( P >0.05)., Conclusion: Acupuncture during the transplantation cycle can effectively improve the pregnancy rate of secondary infertility patients receiving IVF-FET.

With the expert consensus during the clinical questions determination in the World Federation of Acupuncture and Moxibustion Societies (WFAS) standard Practice Guideline of Acupuncture and Moxibustion for Urinary Incontinence in Women as an example, this paper focused on the specific process and results of three rounds of Delphi survey on clinical issues by experts of the guideline development group, and systematically analyzed the consistency of the modified Delphi method with the consensus of acupuncture and moxibustion experts, as well as the reflection and limitation of this consensus process, hoping to provide reference for the development of acupuncture guidelines in the same field.

Based on the clinical needs and examination requirements of standardized training students, the China national standardized training textbook Acupuncture and Moxibustion for residents of traditional Chinese medicine has made innovations in the textbook content and form. In the part of meridians and acupoints, the classic original text is introduced and the main indications and operation methods of 200 commonly-used acupoints are summarized in the form of tables. In the part of acupuncture and moxibustion technique, the operating procedures are standardized and the core technical points of 20 commonly-used acupuncture and moxibustion techniques are summarized in the form of flow chart. In the part of acupuncture and moxibustion treatment, 48 typical diseases are introduced in the form of case discussion, highlighting the problem orientation and demonstrating the diagnosis and treatment procedures.

Using data mining technology, the rules of acupoint selection of acupuncture and moxibustion were explored in treatment of stroke-related pneumonia. The clinical articles of acupuncture and moxibustion in treatment of stroke-related pneumonia were retrieved from CNKI, SinoMed, Wanfang and VIP databases from their inception through to January l 2021, and then, the acupuncture-moxibustion prescription database was set up for stroke-related pneumonia. SPSS Modeler 18.0 Apriori algorithm was adopted to analyze the association rules of acupoints and draw complex network diagrams. SPSS26.0 was used in clustering analysis of acupoints. Finally, a total of 44 articles were included, with 51 acupoint prescriptions and 82 acupoints extracted. The total frequency of acupoints was 340 times. The high-frequency acupoints in treatment with acupuncture and moxibustion for stroke-related pneumonia were Feishu (BL 13), Fenglong (ST 40), Hegu (LI 4), etc. These acupoints were mainly distributed on the limbs and back and mostly from yang meridians. Of these extracted acupoints, the five- shu points, convergent points and back- shu points were selected specially. Regarding acupoint combination, the association of Quchi (LI 11) had the highest support with Hegu (LI 4) and Zusanli (ST 36). The core prescription of acupuncture-moxibustion treatment for stroke-related pneumonia could be composed of Quchi (LI 11), Hegu (LI 4), Zusanli (ST 36), Fenglong (ST 40) and Taichong (LR 3).

Objective: To analyze the main factors affecting the positive results of acupuncture for chronic pain in English literature of randomized controlled trial (RCT), in order to provide reference for the design of acupuncture clinical research., Methods: The RCTs of acupuncture for chronic pain published before March 26, 2020 were searched in PubMed, EMbase and Cochrane Library by computer. A total of 21 factors were analyzed by single-factor analysis, and the factors with statistically significant difference were selected for multivariate Logistic regression analysis., Results: A total of 69 RCTs were included, including 47 RCTs (68.12%) with positive results and 22 RCTs (31.88%) with non-positive results. The multivariate Logistic regression analysis was performed with the three screened factors (publication year, treatment frequency and intervention form) selected by single-factor analysis, and the results showed that the positive results were related to the frequency of acupuncture treatment. The positive rate of RCT with frequency≥2 times a week was 3.24 times of that with frequency<2 times a week ( OR =3.24, 95% CI =[1.07,9.83], P <0.05)., Conclusion: Acupuncture frequency may be the main factor affecting the positive results of RCT in English literature of acupuncture for chronic pain. More researches are needed in the future to explore the influence of acupuncture frequency on the curative effect.

Based on the difference between disease and syndrome differentiation of acupuncture and moxibustion and each department of TCM, i.e. internal medicine, external medicine, gynecology and pediatrics, it is believed that "differentiation of disease location" is the key of disease and syndrome differentiation of acupuncture and moxibustion. According to the disease location, in the section "treatment" of Science of Acupuncture and Moxibustion , the disorders/illness are classified as zangfu disorder, disorders of limbs and meridians, dermatological disorder, ophthalmological and otorhinolaryngological disorder, gynecological disorder, as well as qi , blood and body fluid disorder. Besides, the rules of disease and syndrome differentiation, as well as treatment characteristics of each category are explained separately. It is considered that the clinical diagnosis and treatment system of acupuncture and moxibustion should be constructed by focusing on "differentiation of disease location".

The published literature of insomnia in the elderly treated with acupuncture was retrieved in CNKI, Wanfang and VIP from the date of establishment to December 31, 2019. Association rule analysis and cluster analysis were used to summarize the acupoint selection rules of insomnia in the elderly treated with acupuncture. A total of 37 articles were included, involving 60 acupuncture prescriptions. The most commonly used acupoints were Sanyinjiao (SP 6), Shenmen (HT 7), Anmian (Extra), Baihui (GV 20), Sishencong (EX-HN 1), Neiguan (PC 6), Xinshu (BL 15) and Taixi (KI 3). The most commonly used acupoint combinations were Sanyinjiao (SP 6)-Anmian (Extra)-Baihui (GV 20)-Sishencong (EX-HN 1)-Shenting (GV 24)-Shenmen (HT 7)-Xinshu(BL 15), Xinshu(BL 15)-Pishu (BL 20)-Shenshu (BL 23)-Shenting (GV 24), Zhaohai (KI 6)-Shenmai (BL 62), Taichong (LR 3)-Ganshu (BL 18), Daling (PC 7)-Taixi (KI 3), Neiguan (PC 6)- Zusanli (ST 36) and Guanyuan (CV 4)-Qihai (CV 6)-Zhongwan (CV 12). On the basis of acupoint selection according to disease differentiation, the acupoint selection rules and characteristics of insomnia in the elderly treated with acupuncture are regulating and supplementing the spleen and kidney and treating according to spleen-kidney.

With reference to international guidelines for the development of tools-Grading of Recommendations Assessment, Development and Evaluation (GRADE) system approach and reasoning, this practice guideline has been drafted reflecting the characteristics of acupuncture to improve effectiveness and safety of acupuncture treatment for allergic rhinitis. This guideline includes outlining the acupuncture diagnosis and treatment principles for allergic rhinitis, suggesting recommendations and related evidence for the acupuncture treatment of allergic rhinitis, and defining operating methods and precautions for the acupuncture treatment of allergic rhinitis.

According to the etiology, allergic diseases are related to wind and heat; according to the pathogenesis, most of allergic diseases are qi -blood diseases; from the theory of zangfu , allergic diseases are closely related to the depressed heat of yangming and stomach-intestine, and the common elements of the pathogenesis of allergic diseases are wind, heat, qi , blood and yangming . With reviewing the ancient literature and modern research, the key therapeutic effect of Quchi (LI 11) and its special treatment effect on allergic diseases are summarized. It is suggested that the key therapeutic characteristics of Quchi (LI 11), including dispelling the wind, clearing the heat, cooling the blood and regulating stomach-intestine function, are in accordance with the common causes and pathogenesis of allergic diseases. Therefore, Quchi (LI 11) is considered an important acupoint for the treatment of allergic diseases.

Background: Essential hypertension remains an enormous public health concern, imposing a major burden of morbidity and mortality worldwide. Relevant studies showed that acupuncture therapy might be effective in treating essential hypertension. However, there is no consistent conclusion so far. The aim of this study was to assess the efficacy and safety of acupuncture therapy for patients with essential hypertension., Methods: We searched the PubMed, Embase, the Cochrane Library, Web of Science, the Chinese National Knowledge Infrastructure (CNKI), and the Wan-fang databases from inception through November 29, 2019. Randomized controlled trials investigating acupuncture therapy for hypertension were included. We will use Endnote software X8 for studies selection, Review Manager software 5.3 for the data analysis., Results: We will synthesize current studies to evaluate the safeties and effectiveness of acupuncture for essential hypertension., Conclusions: Our study will provide the evidence of acupuncture therapy for essential hypertension.

Objective: To observe the clinical effect of acupuncture by stages on secondary dysmenorrhea of adenomyosis through prospective case-series study., Methods: A total of 36 cases of adenomyosis patients with moderate-to-severe dysmenorrhea were treated with acupuncture by stages. The acupoints of Diji (SP 8), Sanyinjiao (SP 6), Ciliao (BL 32) and Shiqizhui (EX-B 8) were selected and acupuncture was given once a day during menstrual period; the acupoints of Guanyuan (CV 4), Zigong (EX-CA1), Sanyinjiao (SP 6) and Zusanli (ST 36) ect. were selected and acupuncture was given twice per week during non-menstrual period. All the treatment was given for three menstrual cycles. The visual analogue scale (VAS), Cox menstrual symptom scale (CMSS), Endometriosis Health Profile-5 (EHP-5) scores and the menstrual blood volume of pictorial blood loss assessment chart (PBAC) were observed before treatment and at the 1st, 2nd and 3rd menstrual cycle into treatment. Before treatment and at the 3rd menstrual cycle into treatment, the volume of uterus was measured by transvaginal ultrasound and the correlation among the quality of life, the severity of pain and symptoms was analyzed., Results: The VAS, CMSS and EHP-5 scores at the 1st, 2nd and 3rd menstrual cycle into treatment were lower than those before treatment ( P <0.01, P <0.05), and the PBAC scores were reduced but without statistical different ( P >0.05). Compared before treatment, at the 1st, 2nd and 3rd menstrual cycle into treatment, the PBAC scores were reduced in patients with PBAC>100 points ( P <0.01). Compared between 2nd and 1st menstrual cycle into treatment, between 3rd and 2nd menstrual cycle into treatment, the VAS, CMSS scores were all decreased ( P <0.01, P <0.05). There was a significant positive correlation between the severity score of CMSS and EHP-5 at the corresponding time points of the 1st, 2nd and 3rd menstrual cycle into treatment ( P <0.01)., Conclusion: The acupuncture by stages has significant analgesic effect in patients with secondary dysmenorrhea of adenomyosis, and has the advantages of relieving the menstruation-related symptoms, regulating menstrual blood volume and improving the quality of life.

Objective: To observe the therapeutic effect of herb-separated moxibustion combined with budesonide nasal spray (rhinocort) on moderate to severe persistent allergic rhinitis (AR) of kidney- yang deficiency type, and to explore the correlation between nasal temperature and condition of allergic rhinitis., Methods: A total of 70 patients with moderate to severe persistent AR were randomized into an observation group (35 cases) and a control group (35 cases, 3 cases dropped off). Both groups were treated with rhinocort, one spray on each side of the nostril (approximately 64 μg each spray), once in the morning and once in the evening, for 4 weeks. On the basis of the above treatment, the observation group was treated with herb-separated moxibustion at Shenshu (BL 23), Feishu (BL 13), Zhiyang (GV 9), Dazhui (GV 14), 3 moxibustions per acupoint, a single treatment lasting about 30 min. This treatment was given once every other day, 3 times every week, and totally continuous 4 weeks. The changes of AR symptom visual analogue scale (VAS) scores were observed before and after treatment and at 3 months follow-up after treatment. The heat variation (temperature, range) on projection areas of the nose, lungs, large intestine and kidneys of the two groups' patients before and after treatment were detected by the infrared thermal imaging diagnostic system, and the correlation between the VAS scores and nasal temperature before and after treatment was analyzed. The clinical effects of both groups were evaluated according to the VAS score., Results: The total effective rate in the observation group after treatment was 85.7% (30/35), which was higher than 71.9% in the control group (23/32, P <0.05). After treatment and at follow-up, the VAS scores of both groups were lower than those before treatment ( P <0.05), and the VAS score of the observation group was lower than that of the control group at follow-up ( P <0.05). After treatment, the nasal temperature, pulmonary range, large intestinal range and renal range of the observation group were all lower than those before treatment ( P <0.05), the nasal temperature and nasal range of the control group were lower than before treatment ( P <0.05), and the reduction of nasal temperature, nasal range and renal range in the observation group was greater than that of the control group ( P <0.05). Before and after treatment, there was a correlation between VAS score and nasal temperature ( P <0.05)., Conclusion: The herb-separated moxibustion combining western medication has a better effect and long-term effect than western medication alone for moderate to severe persistent AR, which can improve heat variation on projected areas of the nose, lung, large intestine and kidney of patients. In addition, nasal temperature can reflect the severity of the symptoms of patients with moderate to severe persistent AR, or it can be used as a secondary indicator to evaluate condition of AR.

Evidence - based Clinical Practice Guideline of Acupuncture and Moxibustion for Primary Dysmenorrhea ( Guideline ) is clarified from three aspects: the development method, contents and clinical application, which could provide clinical practical strategies suitable for most patients for clinicians. Based on comprehensive literature search and summary of acupuncture practice, the best clinical research evidence is obtained according to the evidence-based method, the evidence-quality evaluation and recommendation grading are introduced. With ancient literature, famous experts' experience and expert consensus, the recommendations of acupuncture-moxibustion for primary dysmenorrhea are developed, which are safe, effective and applicable for clinical treatment. The Guideline could standardize the acupuncture treatment plan for primary dysmenorrhea.

Background: Patients with moderate and severe persistent allergic rhinitis (AR) have long-term physical and mental stress, leading to dysfunction of the hypothalamus-pituitary-adrenal (HPA) axis, which results in recurrence of AR. Previous research has proved acupuncture can regulate the function of the neuron-endocrine-immune system and contribute to improving the quality of life of patients with AR. This research aims to investigate the mechanism of acupuncture on the HPA axis in patients with moderate or severe persistent AR., Methods/design: This randomized controlled trial aims to study the impact of acupuncture on the HPA axis of patients with moderate and severe AR. This research also aims to compare the curative effects of different treatments in three groups of patients: those receiving western medicine, western medicine and conventional acupuncture, or western medicine and mind-regulating acupuncture. We will study the therapeutic effect of acupuncture and the correlation between the changes of therapeutic indexes and experimental indexes after the treatments. Therapeutic indexes include the Visual Analog Scale (VAS) of nasal symptoms and the Rhinoconjunctivitis Quality of Life Questionnaire (RQLQ) for AR patients; experimental indexes include corticotropin releasing hormone (CRH), adreno-corticotropic hormone (ACTH), cortisol (CORT), interleukin 4 (IL-4), and interferon-γ (IFN-γ)., Discussion: The results of this trial will provide evidence for the influence of chronic, long-term, repeated stimulation in patients with moderate and severe persistent AR and the impact of acupuncture on the HPA axis of these patients., Trial Registration: Acupuncture-Moxibustion Clinical Trial Registry, AMCTR-IOR-16000009 . Registered on 22 August 2016.

The imbalance of autonomic nervous function after myocardial ischemia (MI) accelerates the development of ischemic myocardial injury. The beta-adrenergic receptor (β-AR) and muscarinic acetylcholine receptor (M-AChR) are the main receptor types of the cardiomyocyte and the binding sites of the cardiac sympathetic and parasympathetic transmitters. In the present paper, the authors review recent progress of experimental researches on the mechanisms of acupuncture therapy in the prevention and treatment of MI, mainly focusing on the signaling of β 1 -AR and M 2 -AChR subtypes. Results showed that acupuncture could attenuate the injury of myocardial ischemia via down-regulating the over expression of β 1 -AR and up-regulating the expression of M 2 -AChR protein. Correspondingly, acupuncture intervention could reverse the abnormal expression of the intracellular stimulatory G protein and inhibitory G protein caused by MI, and suppress the activity of cellular adenylate cyclase. In addition, acupuncture could also enhance the activity of nitric oxide synthase and the level of nitric oxide in the ischemic cardiomyocytes, and increase the synthesis of cyclic guanosine monophosphate, ultimately reducing the level of cyclic adenosine 3', 5'monophosphate, and lowering the activity of protein kinase A and the inward flow of Ca 2+ in cardiomyocytes. In this way, the ischemic myocardial injury is improved at last. However, some results of acupuncture intervention are not identical and need being confirmed further by more approaches.

Objective: To observe the clinical therapeutic effects of acupuncture at single point Shiqizhui (EX-B8) and multi-points in time-varying treatment for primary dysmenorrhea., Methods: 600 patients with primary dysmenorrhea were randomly assigned to the single point group (n=200) including group A (treating before the menstruation, n=100) and group B (immediately treating as soon as pain occurrence, n=100), the multi-points group (n=200) including group C (treating before the menstruation, n=100) and group D (immediately treating as soon as pain occurrence, n=100), or the control group, group E (n=200, no treatment). The therapeutic effects were analyzed after treatment for three menstrual cycles and interviewed for three follow-up periods., Results: Acupuncture could effectively relieve menstrual pain for primary dysmenorrhea compared with the control group (P<0.05, P<0.01). Immediate pain relief occurred following acupuncture within 5 min in group B (P<0.01) and group D (P<0.01), and the two groups obviously relieved menstrual pain for VAS scores. Both group A and group C obviously relieved menstrual pain (P<0.01), and group C was better than group A (P<0.05). Compared with group D, Group C was much better for CMSS scores in cycle 1., Conclusion: Treating before the menstruation is better than immediately treating as soon as pain occurrence at the improvement in symptoms of dysmenorrheal at multi-points. And single point is better than multi-points when immediately treating as soon as pain occurrence. The present trial suggest Shiqizhui (EX-B8) should be chosen as a convenient point., (Copyright © 2013 Elsevier Ireland Ltd. All rights reserved.)

Objective: To observe the improvement of the quality of life (QOL) of patients with bronchial asthma treated with acupuncture based on the interior-exterior relationship of the lung and large intestine, in terms of meridian-collateral theory and through the lung and large intestine meridians., Methods: According to the random number table, 52 cases of bronchial asthma at chronic persistent stage of the middle degree in accordance with the inclusive criteria were divided into a lung meridian acupoint group (group A), a large intestine meridian acupoint group (group B), a lung and large intestine meridian acupoint group (group C) and a control group at the ratio of 1:1:1 = 1, 13 cases in each one. In the control group, according to the requirement, Ventolin aerosol was used, one spray/time, < or = 4 times/day. The treatment of 12 weeks was required. In the first 3 groups, on the basis of the treatment as the control group, acupuncture was supplemented. In group A, Chize (LU 5), Kongzui (LU 6), Lieque (LU 7), etc. were selected. In group B, Quchi (LI 11), Hegu (LI 4), Tianshu (ST 25), etc. were selected. In group C, Chize (LU 5), Kongzui (LU 6), Lieque (LU 7), Quchi (LI 11), Hegu (LI4), etc. were selected. Acupuncture was given once every two days, 3 times a week. Totally, 12 treatments made one session and 3 sessions (12 weeks) were required. The Asthma Quality of Life Questionnaire (AQLQ) was adopted to assess the total score and four subscales, named activity limitation, environment stimulation, emotion and symptom, and determine the efficacy., Results: In comparison before and after treatment in the same group, AQLQ total score, emotion score and symptom score were all increased significantly in group A and group C separately (P < 0.05, P < 0.01). The environment stimulation score was increased in group C (P < 0.05). In group B, AQLQ total score and the activity score were increased remarkably (both P < 0.05). In comparison among groups: compared with the control group, AQLQ total score and symptom score in group A and group C were improved obviously (P < 0.05, P < 0.01); the emotion score was increased obviously in group B and group C (both P < 0.01) and the environment stimulation score was increased obviously in group C (P < 0.05). Compared with group B, the symptom score was improved much obviously in group C (P < 0.05)., Conclusion: Acupuncture improves the quality of life much more obviously for the patients with bronchial asthma in terms of the lung and large intestine theory.

Objective: We aim to investigate the efficacy of acupuncture for acute migraine attacks comparing with sham acupuncture., Design: The study was designed as a multicenter, single-blinded, randomized controlled clinical trial., Setting and Patients: From March 2007 to February 2009, 150 patients were randomly allocated to verum or sham acupuncture group in a ratio of 1:1., Interventions: Every patient received a verum or sham acupuncture treatment when having a migraine attack and, medications were allowed if the pain failed to be relieved two hours after the acupuncture., Outcome Measures: The primary outcome was visual analog scale (VAS) scores for pain, ranging from 0 (no pain) to 10 (worst pain ever)., Results: The mean VAS scores 24 hours after treatment decreased from 5.7 ± 1.4 to 3.3 ± 2.5 in the verum acupuncture group, and from 5.4 ± 1.3 to 4.7 ± 2.4 in the sham acupuncture group. Significant differences existed between the two groups (P = 0.001)., Conclusions: This trial suggested that verum acupuncture group was superior to sham acupuncture group on relieving pain and reducing the usage of acute medication., (Wiley Periodicals, Inc.)

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 © 2011 International Association for the Study of Pain. Published by Elsevier B.V. All rights reserved.)

In the present paper, the authors review the development of experimental and clinical studies on acupuncture treatment of bronchial asthma in recent 10 years. Regarding clinical studies, results showed that acupuncture could (1) regulate cardiac-pulmonary function; and (2) adjust immune state and relieve inflammatory reactions in bronchial asthma patients. Animal experiments showed that acupuncture could function in (1) improving pulmonary function; (2) reducing accumulation of the peripheral eosinophile granulocytes (EOS), relieving the infiltration of inflammatory cells in the air-passage mucosa and promoting the apoptosis of EOS in the lung and air-passages; (3) down-regulating the expression of air-passage remodeling-related protein insulin growth factor-1; (4) suppressing the secretion of tumor necrosis factor and endothelin; (5) attenuating allergic reaction; (6) regulating neuroendocrine activity; and (7) modulating intracellular second messenger activities. However, rigorous clinical study design is not enough, so that the reliability of the results is limited. In spite of many indicators of animal experiments have been selected, but their correlations are not in close association, resulting in poor complementation and mutual identification of the acquired findings. For this reason, its clinical efficacies need to be researched further according to principles of evidence-based medicine.

Based on the optimum clinical evidence, consulting the international guide, the outstanding guidelines of acupuncture clinical practices is formulated in order to promote the process of acupuncture modernization and internationalization. According to consensus of experts, using the questionnaire method, integrating the characteristics and requirements for acupuncture clinical practices, the guidelines reflect the characteristics of acupuncture, for instance, applicability, inheritance, holism, and the discipline characteristics. Thus, the guidelines will standardize the treatments in acupuncture clinical practices, strengthen medical service quality management, control medical costs, and promote the process of acupuncture modernization and internationalization.

Objective: To observe clinical effects of acupuncture combined with blood-letting by a three-edged needle for treating Bell's palsy of wind-heat syndrome at the acute stage., Methods: One hundred patients were randomly divided into a treatment group (50 cases) treated by acupuncture plus blood-letting and a control group (50 cases) treated by simple acupuncture. Four courses of treatments were given in both groups. The main symptoms and signs were observed and clinical effects evaluated with scores after one week, 2 weeks and one month of treatments respectively., Results: After treatment, the scores for symptoms and signs were significantly different from those before treatment in both groups (P<0.05 or P<0.01). After one month of treatment, the improvement of the symptoms and signs in the treatment group was more than that in the control group with a significant difference (P<0.05). : Acupuncture plus blood-letting can produce good therapeutic effects on Bell's palsy of wind-heat syndrome at the acute stage.

The acupoint is one of the basic elements of the acupuncture prescription. Just as thinking over different properties of every Chinese materia medica in a prescription, we should also sufficiently consider the characteristics of each acupoint in a prescription of acupuncture or moxibustion. Chinese materia medica have their own action-tendencies of lifting, lowering, floating and sinking, properties of cold, hot, warm and cool, five flavors of sour, bitter, sweet, acrid and salty, target-meridian distribution, different toxicity and actions, etc. What are the properties of acupoints? The authors of the present paper summarize them by simulating the characters of Chinese materia medica. It is found that acupoints also have functions in regulating lifting, lowering, floating and sinking of Qi, inducing cold and heat effects, producing different needling sensations; and pertain to different meridians (meridian distribution). And acupoint stimulation may produce adverse effects under certain specific conditions, etc. Full understanding of the properties of acupoints is definitely helpful in improving clinical therapeutic effects and shortening therapeutic courses by reasonably selecting and combining related acupoints.

Objective: To observe the therapeutic effect of He's Santong needling method on neurological functional deficit in the patient of ischemic apoplexy, and search for an effective method for treatment of ischemic apoplexy., Methods: According to the randomized and multi-central trial principle, 319 cases enrolled were randomly assigned to an observation group of 161 cases and a control group of 158 cases. The observation group were treated with He's Santong needling method, i. e. blood letting, puncturing with a red-hot needle and filiform needle therapy by stages, and the control group were treated with acupuncture at 12 points of the hand and foot routinely selected in the department, once daily. After treatment of 30 days, changes of neurological functional deficit score were investigated in the two groups., Results: The total effective rate was 91.93% in the observation group and 70. 25% in the control group with a significant difference between the two groups (P<0.05); there was no significant difference in changes of the neurological functional deficit score between the patients at the acute stage and the convalescence (P > 0.05)., Conclusion: The therapeutic effect of He's Santong needling method on ischemic apoplexy at acute stage or convalescence is better than that of the routine point selection.