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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., Competing Interests: Declaration of competing interest No conflict of interests declared., (Copyright © 2020 Elsevier Ltd. All rights reserved.)

Objective: To analyze document features and current research status of applying proteomics technology in acupuncture and moxibustion research, thereby further providing reference for further research and development in this area., Methods: CNKI, Wangfang Data, CBM, PubMed, and Medline were included. Retrieved were literatures involving applying proteomics technology in acupunc- ture and moxibustion from January 2004 to December 2015. Document features and current research features were statistically analyzed using bibliometrics., Results: Totally 91 articles were included, 60 from journals, 8 conference theses, and 23 dissertations. The 60 articles were published in 47 kinds of journals, and 56 of them were published in core journals. Theories of acupuncture and moxibustion (correlated with meridians, zang-fu organs) and mechanism research were hotspots, involving 19 kinds of disease models (dominated as gastric mucosal lesion, cerebral ischemia, and spinal cord injury). Two- dimensional gel based electrophoresis technology was used in 51 articles (69. 86%)., Conclusions: Proteomics technology has been widely applied in the field of acupuncture and moxibustion research. It could promote researches on meridians and zang-fu organs correlated theories and mechanisms. The depth and breadth of the study is worth further widening.

Objective: To examine the possible impact of moxibustion on the serum proteome of the collagen-induced arthritis (CIA) rat model., Materials and Methods: Thirty-six male Sprague-Dawley rats were included in this experiment. The CIA animal model was prepared by injection of type II bovine collagen in Freund's adjuvant on the first and seventh day. The 36 rats were randomly divided into two groups: the untreated CIA group (control), and the CIA plus treatment with moxibustion (CIA+moxi) group. Moxibustion was administered daily at ST36 and BL23 for 7, 14 or 21 days (n=12 rats each). Arthritis score was used to assess the severity of arthritis. At the end of each 7 day treatment, blood samples from the control group and the CIA+moxi group were collected. After removal of high abundance proteins from serum samples, two-dimensional gel combined with matrix-assisted laser desorption ionisation time-of-flight MS/MS (MALDI-TOF-MS/MS) techniques were performed to examine serum protein expression patterns of the CIA rat model with and without moxibustion treatment. In addition, the relevant proteins were further analysed with the use of bioinformatics analysis., Results: Moxibustion significantly decreased arthritis severity in the rats in the CIA+moxi group, when compared with the rats in the CIA group 35 days after the first immunisation (p=0.001). Seventeen protein spots which changed >1.33 or <0.77 at p<0.05 using Bonferonni correction for multiple testing were found to be common to all three comparisons, and these proteins were used for classification of functions using the Gene Ontology method. Consequently, with the use of the Ingenuity Pathway Analysis, the top canonical pathways and a predicted proteomic network related to the moxibustion effect of CIA were established., Conclusions: Using the proteomics technique, we have identified novel candidate proteins that may be involved in the mechanisms of action underlying the beneficial effects of moxibustion in rats with CIA. Our findings suggest that immune responses and metabolic processes may be involved in mediating the effects of moxibustion. Moreover, periodxiredoxin I (PRDX1) and inositol 1,4,5-triphosphate receptor (IP3R) may be potential targets., (Published by the BMJ Publishing Group Limited. For permission to use (where not already granted under a licence) please go to http://www.bmj.com/company/products-services/rights-and-licensing/)

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. [ABSTRACT FROM AUTHOR]

• We have indicated moxibustion treatment is able to resist inflammation in CIA rats effectively. • Using GC–MS metabolomics technique, we detect novel metabolites in the moxibustion antiarthritic process, which may aid in advanced understanding of arthritis and therapeutic mechanism of moxibustion. To demonstrate the rheumatoid arthritis (RA) mechanisms by determining the biochemical changes. To investigate the therapeutic mechanism of moxibustion in RA-model rats using a gas chromatography-mass spectrometry (GC–MS) metabolomics approach. A total of 24 rats were divided into three groups as follows: normal control group, model group and moxibustion group. Rats in model group and moxibustion group were set up collagen-induced arthritis (CIA) model. Rats in moxibustion group were treated by moxibustion. After 3 weeks of intervention, right ankle joint, serum and articular synovium samples were collected. Right ankle joint samples were used for histopathological evaluation between 3 groups to get the pathological changes of tissues and cells. Serum and articular synovium samples were used to analyze the changed metabolites of moxibustion on RA rats by the GC–MS based metabolomics. Treatment of moxibustion not only significantly increased the weight of CIA rats, reduced the swelling of hind paw, arthritic scores, IL-1β, TNF-α but also improved histopathological evaluation in right ankle joint samples. Sixteen significantly altered metabolites were found in RA rats as potential biomarkers of arthritis. Thirteen metabolites, significantly adjusted by moxibustion to help relieve arthritis, were selected out as biomarkers of antiarthritic mechanism of moxibustion, which were mainly involved in phenylalanine, tyrosine and tryptophan biosynthesis, glycine, serine and threonine metabolism, phenylalanine metabolism, alanine, aspartate and glutamate metabolism, glyoxylate and dicarboxylate metabolism and aminoacyl-tRNA biosynthesis. We have indicated moxibustion treatment is able to resist inflammation in CIA rats effectively. Using GC–MS metabolomics technique, we detect novel metabolites in the moxibustion antiarthritic process, which may aid in advanced understanding of arthritis and therapeutic mechanism of moxibustion. [ABSTRACT FROM AUTHOR]

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 evidence from 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: Chi 2 = 1.11, p = 0.77, I 2 = 0%] or the combination with Western medicine therapy [RR = 1.28, 95%CI (1.12, 1.47), p = 0.0004; heterogeneity: Chi 2 = 1.96, p = 0.58, I 2 = 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: Chi 2 = 2.87, p = 0.58, I 2 = 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. [ABSTRACT FROM AUTHOR]

Rheumatoid arthritis (RA) is a global disease with a high disability rate. Moxibustion, a well-known traditional Chinese medicine (TCM) therapy that has a long history in the treatment of RA, has attracted increasing clinical attention. However, little is known about its therapeutic mechanism. This study aimed to investigate the mechanism of moxibustion in the treatment of RA in rats through metabolomics. In this study, rats with collagen-induced arthritis (CIA) were treated with moxibustion daily for three weeks at the Shenshu (BL 23) and the Zusanli acupoints (ST 36). Their weight, swelling of the hind paw, arthritic scores, histopathological parameters, and inflammatory factors were assessed. The urine samples of the rats in each group were collected after each course of moxibustion treatment. Gas chromatography–mass spectrometry was used to explore the changes in the urine metabolism spectrum at different courses of moxibustion treatment and analyze the relevant targeted metabolic pathways. Results showed that moxibustion alleviated the severity of arthritis and changed 33 metabolites in the urine of rats. These metabolites are involved in glycolysis/gluconeogenesis; tricarboxylic acid (TCA) cycle; and phenylalanine, tryptophan, butanoate, and purine metabolism. The levels of these metabolites in the moxibustion group showed trends similar to those in the control group. Moxibustion treatment effectively inhibited inflammation in rats with CIA by regulating glycolysis/gluconeogenesis; TCA cycle; phenylalanine, tryptophan, purine and butanoate metabolism; and other biological pathways. Metabolomics may be an effective way to explain the mechanisms of moxibustion for RA. [ABSTRACT FROM AUTHOR]