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Rheumatoid arthritis (RA) is an autoimmune disease primarily affecting the joints and requires various treatments, including medication, injection, and physiotherapy. Wu tou decoction (WTD) is a traditional Chinese medicine prescribed for RA, with several articles documenting its effectiveness in RA treatment. This systematic review and meta-analysis aimed to evaluate the efficacy and safety of WTD for RA. We searched for randomized controlled trials (RCTs) comparing WTD with conventional treatments (including medication, injection, and physiotherapy) from its inception to May 2024. Primary outcomes were disease activity scores, including effective rate, tender joint count, and morning stiffness. Secondary outcomes comprised blood test results (erythrocyte sedimentation rate, C-reactive protein, and rheumatoid factor) and adverse events. Nineteen RCTs involving 1794 patients were included. Statistically, WTD demonstrated better improvement than conventional treatments (18 medications and 1 injection) across the effective rate, joint scale, and blood tests, regardless of the treatment type (monotherapy or combination therapy). Adverse events were reported in 11 studies, with no statistical differences observed between them. The numerical results showed that WTD may offer potential benefits for managing RA. However, the significant discrepancy between clinical practice and the low quality of the RCTs remains a limitation. Therefore, further well-designed studies with larger patient cohorts are needed to draw definitive conclusions. [ABSTRACT FROM AUTHOR]

In situations where death by suicide is a major global issue and effective prevention and management approaches are lacking, acupuncture improves some risk factors for suicide, including depression, and it has been used for a long time in clinical settings. Herein, we aimed to assess the effectiveness and safety of acupuncture in the treatment of suicidal behaviors. Fourteen electronic databases were searched for studies published up to 7 September 2022. Original interventional studies of acupuncture in suicide prevention were included. The primary outcome was the validated measure of suicidal ideation. The risk of bias in the included studies was assessed using an appropriate assessment tool. Due to the heterogeneity of the included studies, only qualitative analyses were conducted. Eight studies on manual acupuncture (50%), electro-acupuncture (37.5%), and acupressure (12.5%) were included. In particular, three studies (37.5%) used the National Acupuncture Detoxification Association protocol to stimulate the bilateral sympathetic, Shenmen, kidney, liver, and lung auricular points. Acupuncture was effective in direct and indirect outcomes related to suicidal behavior, not only for participants with suicidal behavior, but also for those with other conditions, including depression. A decrease in salivary cortisol was the only biological indicator of acupuncture in patients with suicidal ideation. However, the methodological quality of the included studies was not optimal. In conclusion, acupuncture may reduce the risk of suicidal behavior in clinical and non-clinical populations. Owing to clinical heterogeneity, low methodological quality, and the small number of included studies, further high-quality studies should assess the effectiveness of acupuncture. [ABSTRACT FROM AUTHOR]

• Total 38 SRs of CIM modalities for BPSD management were analyzed. • For BPSD, aromatherapy has been the most studied, with mixed results. • Some studies on herbal medicines supported its benefits in BPSDs. • Other CIM interventions had insufficient clinical evidence. Behavioral and psychological symptoms of dementia (BPSDs) are major contributing factors to disease burden in dementia patients. Complementary and integrative medicine (CIM) has received attention in the management of dementia in patients with BPSDs. This overview aimed to comprehensively and critically review previous systematic reviews (SRs) of CIM modalities for BPSD management. Thirteen databases were searched in November 2021 to identify SRs on CIM for BPSDs. The methodological quality of the included studies was assessed using A MeaSurement Tool to Assess systematic Reviews 2. Among 38 SRs, aromatherapy was the most commonly studied intervention, followed by herbal medicine (HM), acupuncture/acupressure, mindfulness-based interventions, relaxation, and Taichi. Half of the studies on aromatherapy reported significantly improved BPSDs, especially agitation, while the remainder reported mixed results/insufficient evidence. Most studies (85.71%) on HM supported its significant benefits in BPSDs. Yokukansan, an individual HM, was most frequently studied for BPSDs, with a significant beneficial effect on delusions, hallucinations, and agitation/aggression. Moreover, some meta-analyses supported the benefits of HM as an adjunct to psychotropic drugs in BPSD management. Other CIM interventions had insufficient clinical evidence. The methodological quality of the included studies was poor, and most were rated low or critically low (92.11%). Aromatherapy, the most frequently investigated CIM for BPSD, had mixed results or insufficient evidence. HM, as an adjunct to psychotropic drugs including antipsychotics, exhibited additional benefits regarding the efficacy and safety for BPSDs. This overview emphasizes the requirement for greater quantity and quality of research in this field. Open Science Framework registry (g5f3m) (https://osf.io/g5f3m), PROSPERO (CRD42020211009) (https://www.crd.york.ac.uk/prospero/display_record.php?ID=CRD42020211009) [ABSTRACT FROM AUTHOR]

Background: Anorexia is a common obstacle to adequate nutrition in childhood, a critical period for physical growth. East Asian traditional medicine treatment modalities including herbal medicine (HM) a re considered an attractive therapeutic option, especially in East Asian countries. The purpose of this systematic review was to comprehensively examine the efficacy and safety of HM for anorexia in children. Methods: A total of 12 electronic databases from their inception date to June 2021 were searched for randomized controlled trials (RCTs) assessing the efficacy of HM for the treatment of anorexia in children. The primary outcome was an improvement in anorexia clinical symptoms after treatment. In this meta-analysis, continuous and binary outcomes were assessed, and the data are presented as the mean difference or standardized mean difference and risk ratio (RR) with their 95% confidence intervals (CIs). The risk of bias and quality of evidence were assessed using the Cochrane Collaboration's risk of bias tool and Grading of Recommendations, Assessment, Development, and Evaluations tool. Results: A total of 205 RCTs were included. A comparison of HM with placebo revealed that the total effective rate based on anorexia symptom improvement was significantly higher in the HM group (RR 1.58, 95% CI 1.34, 1.85). In comparison with controls, HM as monotherapy or adjunctive therapy to dietary supplements or conventional medications led to significant improvements in anorexia symptoms, body measurements, levels of blood biomarkers related to gastrointestinal function, and nutrition indices, with a lower recurrence rate of anorexia. No serious adverse events related to HM were reported. The risk of bias of the included studies was generally unclear, and the quality of evidence was generally low to moderate. Conclusion: Our study showed that HM could improve clinical symptoms, some anthropometric outcomes, and some biological markers related to appetite and growth in children with anorexia. However, considering the high risk of bias of the included studies and the heterogeneity of the HMs used, future research should focus on the use of standardized HMs and the implementation of methodologically robust clinical trials. Systematic Review Registration : https://www.crd.york.ac.uk/prosperodisplay%5frecord.php?ID=CRD42021274376, identifier CRD42021274376 [ABSTRACT FROM AUTHOR]

Chronic obstructive pulmonary disease (COPD) is a respiratory disease characterized by irreversible airflow limitation. Many COPD patients use complementary and alternative modalities, including herbal medicines (HMs). This systematic review investigated the effectiveness and safety of HM in managing COPD symptoms compared to placebo. Nine electronic databases were searched to identify relevant randomized controlled trials (RCTs) up to February 12, 2021. The Cochrane risk of bias tool was used to assess the methodological qualities of the included studies. Primary outcomes were lung function parameters and exercise capacity. A meta-analysis was conducted to determine the effect size for homogeneous outcomes. Fourteen studies were included. There was low to very low quality evidence that HM significantly improved forced expiratory volume in 1 s (FEV1) (L), FEV1 (%) and 6-minute walk distance, as well as moderate quality evidence that HM significantly improved forced vital capacity (FVC) (L) compared to placebo. However, according to low quality evidence, there was no significant difference in FEV1/FVC (%) or vital capacity (L) between the groups. Low to moderate evidence suggests that HM has the potential to help improve some respiratory functions, COPD symptoms, and some aspects of quality of life in COPD patients compared to placebo. However, these findings are challenged by the poor methodological quality of the included studies, the heterogeneity of HMs used, and potential publication bias. Therefore, the findings could be significantly influenced by further larger, more rigorous RCTs on this topic. Moreover, it may also be recommended to develop standardized HMs focused on some individual herbs that are frequently used or expected to play an important role in patients with COPD, and to elucidate the underlying mechanisms. [ABSTRACT FROM AUTHOR]

Background: Identifying the characteristics of behavioral and psychological symptoms of dementia (BPSD) associated with different dementia types may be a promising strategy to effectively deal with BPSD. We aimed to synthesize the prevalence rates of BPSD characteristics in community-dwelling dementia patients. Methods: We searched Medline, EMBASE, and PsycARTICLES databases for original clinical studies published until December 2020 that enrolled at least 300 community-dwelling dementia patients. The methodological qualities of prevalence studies were assessed using the Joanna Briggs Institute's critical appraisal checklist. Results: Thirty studies were included. The prevalence of the BPSD characteristic ranged from 4 (elation and mania) to 32% (apathy) in the pooled samples. The prevalence of delusions, anxiety, apathy, irritability, elation and mania, and aberrant motor behavior in Alzheimer's disease patients was 1.72–2.88 times greater than that in vascular dementia (VD) patients, while the prevalence of disinhibition in VD patients was 1.38 times greater. The prevalence of anxiety, irritability, and agitation and aggression, delusion, hallucinations, apathy, disinhibition, and aberrant motor behavior tended to increase as the severity of dementia increased, while that of depression, eating disorder, sleep disorders, and elation and mania tended to stable. In community-dwelling patients with dementia, the pooled prevalence of apathy, depression, anxiety, irritability, agitation and aggression, sleep disorders, and eating disorder was higher than 20%, while that of disinhibition and elation and mania was lower than 10%. Conclusion: Overall, the pooled prevalence of apathy, depression, anxiety, irritability, agitation and aggression, sleep disorders, and eating disorder was generally high in patients with dementia. Also, the prevalence of some BPSD characteristics differed according to the type and the severity of dementia. The methodological quality of the included studies is not the best, and high heterogeneity may affect the certainty of the findings. However, the results of this review can deepen our understanding of the prevalence of BPSD. Systematic Review Registration: https://osf.io/dmj7k, identifier: 10.17605/OSF.IO/DMJ7K. [ABSTRACT FROM AUTHOR]

Background: Dementia is a global health concern, causing serious health and socioeconomic burdens with population aging. The associated symptoms of dementia, called behavioral and psychological symptoms of dementia (BPSD), are factors contributing to the socioeconomic burden of dementia. Recently, herbal medicine (HM) has attracted attention as a potential complementary therapy for BPSD. Therefore, this systematic review was aimed at analyzing the effectiveness (or efficacy), safety, and research status of HM in BPSD management through a comprehensive review. Methods: Thirteen electronic databases were searched comprehensively. Related clinical studies published until December 28, 2020, were collected. The methodological quality was evaluated using tools such as the Cochrane Collaboration's risk of bias tool according to the study design. The effectiveness (or efficacy) was analyzed for randomized controlled trials (RCTs) only, and when sufficient homogeneity was assured, effect estimates were presented as mean difference (MD) and risk ratio (RR), with 95% confidence interval (CIs), through a meta-analysis. Results: A total of 52 clinical studies, including 36 RCTs, were included in this review. As an adjunctive therapy, HM showed statistically significant benefits in BPSD severity assessed by the Behavior Pathology in Alzheimer's Disease Rating Scale (combined with psychotropic drugs: MD = −3.48, 95% CI: −3.96 to −2.99; with anti-dementia drugs: MD = −2.81, 95% CI: −3.17 to −2.45) and Neuropsychiatric Inventory (with anti-dementia drugs: MD = −3.23, 95% CI: −4.06 to −2.40). Adverse events were significantly less frequent in the HM group (RR = 0.50; 95% CI: 0.28 to 0.88). However, the methodological quality of the RCTs included in this systematic review was not optimal overall. Conclusion: According to the findings of this review, HM may be associated with additional benefits in BPSD treatment, particularly when used as an adjunct to conventional medications, including psychotropic and anti-dementia drugs. However, considering the methodological quality of the included RCTs, this clinical evidence is not robust. Nevertheless, dementia is a global health concern, and considering the limitations of conventional psychotropic drugs for BPSD, a major cause of the disease burden, HM appears to be a promising complementary therapy that warrants further research. [ABSTRACT FROM AUTHOR]

This systematic review analysed the effectiveness of mind-body modalities (MBMs) in Hwa-byung (HB). Ten electronic databases were searched. Intervention studies using MBMs for individuals with HB, published up to July 2023, were included. The methodological quality of the included studies was assessed using the Cochrane RoB and ROBINS-I tools. Meta-analysis of continuous variables was presented as mean differences (MDs) and their 95% confidence intervals (CIs). Nine studies including five randomized controlled clinical trials, were included. The MBM types were meditation, relaxation, biofield therapy, art therapy, and forest-based MBM, and comprehensive HB programs. Most studies used an MBM group, with 5–6 sessions delivered during an average of 4–5 weeks. As a result of the meta-analysis, art therapy showed a statistically significantly better effect on improving the Hwa-Byung Scale (HB-S) score compared to the waitlist control (MD = −7.74; 95% CI = −9.81 to −5.66). In the before-and-after comparison, MBMs were frequently reported to have significant benefits for improving the HB-S total score (7/7, 100%), depressive mood (4/5, 80%), and state anxiety (6/8, 75%). Some methodological flaws were identified in the included studies, including the reliability of diagnosis, non-implementation of assessor blinding, and inappropriate control groups. This review identified potentially promising MBMs that were not previously recommended in the current HB clinical practice guidelines. In the future, high-quality clinical studies that include the use of standardized HB diagnostic criteria, homogeneous interventions, appropriate control groups, standard assessment tools such as the HB-S, and assessor blinding are needed. • Hwa-byung (HB) is a suppressed anger syndrome (Korean cultural syndrome). • Nine interventional studies of mind-body modality (MBM) were included and analyzed. • The positive effects of MBM on the Hwa-Byung Scale (HB-S) have been frequently reported. • Meta-analysis found that art therapy significantly improved HB-S score compared to the waitlist control. • Future challenges include the use of standardized HB diagnostic criteria and homogeneous interventions. [ABSTRACT FROM AUTHOR]

Approximately half of lung cancer patients (LCP) receiving chemotherapy are experiencing cancer‐related fatigue (CRF). In East Asia, herbal medicines (HMs) have been used as tonics due to their anti‐fatigue effect. This systematic review evaluated the effectiveness and safety of HMs for CRF in LCP. We comprehensively searched 12 electronic medical databases to search randomized controlled trials (RCTs) and quasi‐RCTs investigating HMs for CRF in LCP, published up to September 2019. The primary outcome was the fatigue severity. Secondary outcomes included patients' quality of life (QOL), activities of daily life (ADL), and incidence of adverse events. Cochrane's risk of bias tool assessed the methodological quality of included RCTs. The risk ratio or mean difference was estimated with 95% confidence intervals by performing a meta‐analysis. Twelve RCTs with 861 participants were included. Compared to conventional medicine alone, HM combined with conventional medicine significantly improved fatigue level, QOL, and ADL. As monotherapy, HM significantly improved ADL compared with megestrol. No serious HM‐related adverse events were reported. Limited evidence suggests that HM could be effective and safe for CRF in LCP. However, further high‐quality RCTs are needed to confirm these findings owing to the small number and low methodological quality of the included studies. [ABSTRACT FROM AUTHOR]

Background: Insomnia causes a huge socioeconomic burden among the elderly, and is not simply a health problem. This study aimed to determine the comparative advantage of the effectiveness and acceptability of non-pharmacological interventions available for elderly individuals with insomnia. Methods: Comprehensive searches in 13 medical databases were performed to find relevant randomized controlled trials (RCTs) up to August 2019. Two independent reviewers performed study selection, data extraction, and quality assessment of included RCTs using the Cochrane Collaboration's risk of bias. A network meta-analysis within the frequentist model was performed by combining direct and indirect evidence from all available RCTs. The primary outcomes were effectiveness as measured by the Pittsburgh Sleep Quality Index (PSQI) total score and acceptability by the incidence of all-cause drop-out. Results: Twenty-eight RCTs involving 2,391 participants were included. Compared to wait-list, acupuncture (standardized mean difference −4.37, 95% confidence interval −8.53 to −0.12), acupuncture combined with benzodiazepines (−5.20, −9.82 to −0.57), behavioral therapy (−10.44, −17.31 to −3.58), benzodiazepines (−4.28, −8.45 to −0.11), benzodiazepines combined with cognitive behavioral therapy (CBT) (−7.18, −12.17 to −2.19), and CBT (−4.93, −8.63 to −1.22) showed significant superiority in their effectiveness. No significant comparative superiority or inferiority was found in terms of acceptability. Conclusions: In terms of effectiveness as indicated by the PSQI total score, compared to wait-list, superior benefits were observed for acupuncture, acupuncture combined with benzodiazepines, behavioral treatment, benzodiazepines, benzodiazepines combined with CBT, and CBT. Importantly, combined treatments, including benzodiazepines combined with CBT or with acupuncture, were generally superior to other monotherapies. In terms of acceptability, there was not enough data to draw conclusions. However, most RCTs included had methodological problems related to the lack of blinding procedure, suggesting a risk of effect size overestimation. Registration: CRD42019145518. [ABSTRACT FROM AUTHOR]

Background: This systematic review aimed to evaluate the effectiveness (functional outcomes and clinical symptoms) and safety (incidence of adverse events) of herbal medicine (HM) as monotherapy or adjunctive therapy to conventional treatment (CT) for traumatic brain injury (TBI). Methods: We comprehensively searched 14 databases from their inception until July 2019. Randomized controlled trials (RCTs) using HM as monotherapy or adjunctive therapy to treat TBI patients were included. The primary outcome was functional outcomes, consciousness state, morbidity, and mortality. Meta-analysis was performed to calculate a risk ratio (RR) or mean difference (MD) with 95% confidence intervals (CIs), when appropriate data were available. Methodological quality of RCTs and the strength of evidence were also assessed. Results: Thirty-seven RCTs with 3,374 participants were included. According to meta-analysis, HM as a monotherapy (RR 1.29, 95% CI: 1.21–1.37) or an adjunctive therapy to CT (RR 1.21, 95% CI: 1.16–1.27) showed significantly better total effective rate based on clinical symptoms, compared to CT alone. Subgroup analysis showed that HM had significantly improved post-concussion syndrome, dizziness, headache, epilepsy, and mild TBI, but not traumatic brain edema, compared to CT. Moreover, HM combined with CT had significantly improved post-concussion syndrome, mental disorder, headache, epilepsy, and mild TBI-like symptoms, but not cognitive dysfunction and posttraumatic hydrocephalus, compared to CT alone. When HM was combined with CT, functional outcomes such as activities of daily living and neurological function were significantly better than in patients treated using CT alone. In terms of the incidence of adverse events, HM did not differ from either CT (RR 0.88, 95% CI: 0.33–2.30) or placebo (RR 2.29, 95% CI: 0.83–6.32). However, HM combined with CT showed better safety profile than CT alone (RR 0.64, 95% CI: 0.44–0.93). Most studies had a high risk of performance bias, and the quality of evidence was mostly rated "very low" to "moderate," mostly because the included studies had a high risk of bias and imprecise quantitative synthesis results. Conclusion: The current evidence suggests that there is insufficient evidence for recommending HM for TBI in clinical practice. Therefore, further larger, high-quality, rigorous RCTs should be conducted. [ABSTRACT FROM AUTHOR]

Acupotomy is a modern type of acupuncture that uses a blade-needle combined with a flat surgical scalpel at its tip. This study was conducted to summarize and critically evaluate the current evidence on acupotomy. All relevant studies up to February 19, 2019, were included, through comprehensive searches in 11 electronic databases without language restrictions. Eleven systematic reviews (SRs) comprising of 69 randomized controlled trials were included, and the methodological quality was medium-to-high in AMSTAR. All the included studies reviewed musculoskeletal disorders and reported a significantly higher total effective and cure rates in the acupotomy group for frozen shoulder, cervical spondylosis, third lumbar vertebrae transverse process syndrome, trigger finger, knee osteoarthritis, and lumbar spinal stenosis, compared to the other active control groups. Acupotomy showed promising results for some musculoskeletal disorders; however, additional high-quality evidence is required to make clinical recommendations regarding this procedure. • In this review, current evidences of eleven systematic reviews comprising 69 randomized controlled trials regarding acupotomy were overviewed. • In trigger finger, acupotomy showed superiority to nerve block on cure rate and total effective rate. (GRADE, moderate level). • In knee osteoarthritis, acupotomy showed superiority to other treatments (e.g. electro-acupuncture, massage, etc.) on total effective rate. (GRADE, high level). [ABSTRACT FROM AUTHOR]

Abstract The study was conducted to investigate the efficacy and safety of herbal medicine (HM) for post-stroke anxiety (PSA). Through comprehensive searches, twenty randomized controlled trials were included. Meta-analysis showed that compared to the HM group, the conventional pharmacotherapy group showed significantly lower Hamilton anxiety rating scale (HAMA) score after 1 week of treatment, but not after 2, 4, and 6 weeks of treatment, and higher HAMA score after 8 weeks and 3 months of treatment. Meanwhile, compared to the conventional pharmacotherapy alone group, the HM plus conventional pharmacotherapy group showed significantly better results in HAMA score after 2, 4, 6, and 8 weeks of treatment. HM group was associated with lower incidence of adverse events. Current evidence suggests that HM or HM plus conventional pharmacotherapy may be safe and effective in PSA patients within a certain time period. However, due to limited strength of evidence, definite conclusions are not possible. Highlights • Twenty randomized controlled trials (RCTs) assessing the efficacy of oral herbal for post-stroke anxiety (PSA) were analyzed. • The methodological quality of included studies was generally low. • Herbal medicine alone or combined with conventional pharmacotherapy significantly reduced anxiety of PSA patients in a certain time-period. • Standardizations of diagnostic criteria and herbal medicine treatment strategies for PSA, and rigorous large-scale RCTs are needed on this topic. [ABSTRACT FROM AUTHOR]

The miniscalpel-needle (MSN) acupuncture combines acupuncture and microinvasive surgery and is used extensively in China and Korea for the management of several painful conditions. Given the potential for this technique to cause damage to nerves and blood vessels, the aim of this systematic review was to investigate adverse events' (AEs) characteristics associated with MSN treatment in Korea, and summarize the reporting of safety procedural guidelines. Nine electronic databases were searched. Clinical studies reporting MSN treatment associated AEs in Korea were selected by two independent authors. Severity and causality of each AEs was assessed. Safety precautions and infection prevention measures of each study were summarized. Of the 45 relevant studies included in this review, 15 reported adverse events. The quality of AE data was generally poor. Most AEs associated with MSN treatment reported mild symptoms (local pain having certain causality and grade 1 severity with highly heterogeneous incidence), while few reported moderate-to- severe and systemic AEs (headache, dizziness, or tiredness, having probable/likely causality and grade 2 or 3 severity). The checklist drafts of safety precautions and infection preventions consisting of 10 and 11 sub-items, respectively, were established. Due to the high heterogeneity and poor quality of AE data, the definite characteristics of the AEs were undetermined. The heterogeneity may have occurred from differences in the strictness of AE report and safety procedural guidelines. To improve this, we summarized the drafts of safety procedural guidelines. Our findings could be used in further studies to establish MSN treatment safety. [ABSTRACT FROM AUTHOR]

Oriental herbal medicine (OHM) has been widely used in pediatric neurological disorders and has attracted attention as a safe and effective treatment. We aim to summarize and evaluate the evidence for OHM in pediatric neurological disorders for evidence-based decision-making. Without language restrictions, up-to-date research data were obtained from nine electronic databases. Systematic reviews (SRs) assessing the efficacy of OHM for pediatric neurological disorders were included. The methodological quality of each review was assessed using the AMSTAR instrument. The quality of evidence for the main findings was evaluated using the GRADE approach. Sixteen SRs comprising 169 randomized controlled trials with 19,542 participants were included. In epilepsy (six SRs, n = 5 , 3 4 1), OHM as an adjunctive or alternative therapy to antiepileptic drugs showed higher clinical symptom improvements than did antiepileptic drugs alone. The Activities of Daily Living scale score was significantly higher in children with cerebral palsy (one SR, n = 5 0 8) when OHM was added to rehabilitation. There were inconsistent results for tic disorder (four SRs, n = 9 , 8 7 0) and enuresis (two SRs, n = 1 , 9 9 5) and unclear results for attention deficit hyperactivity disorder (two SRs, n = 1 , 2 6 1) and autism spectrum disorder (one SR, n = 5 6 7). Eleven SRs reported adverse events, but no fatal adverse reaction was reported. The methodological quality of the included reviews was medium-to-high. The overall quality of evidence ranged from "very low" to "moderate." In conclusion, the efficacy of OHM is promising for some pediatric neurological disorders such as epilepsy and cerebral palsy. However, more high-quality evidence is needed to make clinical recommendations on OHM use. [ABSTRACT FROM AUTHOR]

Abstract Introduction Conventional pharmacotherapy on hypertension has some issues including its side effects, resistant hypertension, withdrawal, and polypharmacy. Bloodletting on ear apex (BEA) is a non-pharmacological treatment known to be useful in lowering high blood pressure in oriental medicine. This study was conducted to explore the evidence base to investigate whether this technique could help in the treatment of hypertension. Methods We conducted a systematic review and meta-analysis for randomized controlled trials (RCTs) evaluating the antihypertensive effect of BEA. The methodological quality of included studies was assessed by using Cochrane Collaboration's risk of bias tool. Results Eight RCTs comprising 543 participants were included. Compared with pharmacotherapy alone, BEA as a monotherapy or adjunctive therapy to pharmacotherapy showed significant results at 5 min to 1 h after intervention in lowering systolic blood pressure, but not for diastolic blood pressure. BEA as a monotherapy showed no favorable long-term antihypertensive effects compared with pharmacotherapy. However, the long-term antihypertensive effect of combination therapy was better than the pharmacotherapy alone. Only one study reported adverse events and these were not serious. The methodological quality of included studies was generally low. Conclusion BEA as monotherapy or adjuvant therapy might have benefits in treating primary hypertension. Therefore, this treatment has the potential of non-pharmacological methods that can be used in patients attempting to withdraw antihypertensives or not responding to the conventional pharmacotherapy. However, since the number of studies included and the sample sizes were small, and the methodological quality was poor, these findings should be interpreted with great caution. Further well-designed studies need to be conducted to confirm these results. [ABSTRACT FROM AUTHOR]

Suicide attempts by consuming poisonous native plants are more frequent in Asia than in the West. In East Asian traditional medicine (EATM), herbal materials are routinely used as the primary treatment method; however, some medicinal herbs are toxic and can cause death. This review investigated the herbal materials used in EATM for suicide. Fourteen databases were searched for articles published on suicidal use of EATM until September 7, 2022. Observational studies reporting the suicidal use of EATM herbal medicines were included. Study Quality Assessment Tools developed by the National Heart, Lung, and Blood Institute were used to assess methodological quality of included studies. Due to substantial heterogeneity a meta-analysis was not conducted and the results are narrated. Nine case reports and one retrospective cohort study involving 81 patients were included in the analysis. One suicide attempt resulted in death, but all the other patients survived. The suicide attempts involved the use of topical medications, such as Red Flower Oil; herbal compositions, such as Kyushin and Niuhuang-Jiedu-Pian; and single herbs, such as Mylabris, Aconiti Tuber, Pruni Semen, and Ephedrae Herba. In most cases, gastrointestinal symptoms, an increase in the blood concentration of a specific substance, or an abnormal electrocardiography finding were reported. The methodological quality of included studies was generally poor. Access to toxic herbs that can be consumed to attempt suicide should be regulated through government-level management. Further research should be conducted to properly monitor and strategize safe use of herbal materials. [ABSTRACT FROM AUTHOR]

Introduction Generalized anxiety disorder (GAD) requires long-term pharmacotherapy, and its recurrence rate is high. Due to several limitations of Western medicine (WM), there are increasing needs for complementary and alternative medicine. The purpose of this review is to examine the effectiveness and safety of Oriental herbal medicine (OHM), medicinal herbs or decoctions prescribed based on Eastern Asian medicine, for GAD. Method We conducted a systematic review and meta-analysis of randomized controlled trials (RCTs) assessing the efficacy of OHM for GAD. Twelve electronic databases were searched from inception to 29 January 2018. Results A total 109 RCTs were included. Methodological assessments found unclear risks of bias in most the studies. OHM as an alternative monotherapy or adjunctive therapy showed favorable effects: 1) The OHM group had lower Hamilton Rating Scale of Anxiety (HAMA) score than the placebo group, with a mean difference (MD) of −8.35 (95% confidence interval: −12.21 to −4.49; P < 0.0001). 2) The OHM group had lower HAMA score than the WM group, with a MD of −1.46 (−2.25 to −0.66; P = .003). 3) The OHM plus WM group had lower HAMA score than the WM group, with a MD of −2.90 (−3.54 to −2.27; P < 0.00001). There were fewer adverse events in the OHM group than in the WM group. Conclusions The results suggest that OHM may have benefits for treating GAD, however, the reliability is severely limited by the overall low quality and marked heterogeneity of the included studies. RCTs of higher quality and longer follow-up periods should be performed. [ABSTRACT FROM AUTHOR]

This systematic review and meta-analysis aimed to investigate the status of emotional labor and its related factors among nurses in general hospital settings in Korea. A total of seven electronic databases were comprehensively searched to find relevant cross-sectional studies published up to 28 January 2021. The meta-analysis was performed using Stata version 13.1. In total, 131 studies were included. The population showed a standardized mean difference of 3.38 (95% confidence interval, 3.34 to 3.42) in emotional labor assessed by a 1–5 Likert scale. The level of emotional labor had significant negative correlations with job satisfaction, social support, organizational engagement, coworker support, resilience, and nurses' work environment, while it had significant positive correlations with emotional labor and burnout, turnover intention, and job stress. Although the methodological quality of the included studies was generally good, 24 of the included studies (18.32%) were evaluated as lacking generalization potential or otherwise as unclear. In conclusion, nurses in general hospital settings in Korea experience mild-to-moderate levels of emotional labor. There is some evidence that the emotional labor of nurses and its detrimental effects can be buffered at both the individual and hospital levels, and future research should focus on developing targeted interventions and evaluating their effectiveness. [ABSTRACT FROM AUTHOR]

Background: Manual therapy (MT) is considered a promising adjuvant therapy for chronic obstructive pulmonary disease (COPD). Comparing the effectiveness among different Western and Eastern MTs being used for the management of COPD could potentially facilitate individualized management of COPD. This systematic review attempted to estimate the comparative effectiveness of Western and Eastern MTs for COPD patients using a network meta-analysis (NMA) methodology. Methods: Nine electronic databases were comprehensively searched for relevant randomized controlled trials (RCTs) published up to February 2021. Pair-wise meta-analysis and NMA were conducted on the outcomes of COPD, which included lung function and exercise capacity. Results: The NMA results from 30 included RCTs indicated that the optimal treatment for each outcome according to the surface under the cumulative ranking curve was massage, acupressure, massage, and tuina for forced expiratory volume in 1 s (FEV1), forced vital capacity (FVC), FEV1/FVC, and 6 min walking distance, respectively. Conclusions: MTs such as massage, acupressure, and tuina have shown comparative benefits for lung function and exercise capacity in COPD. However, the methodological quality of the included studies was poor, and the head-to-head trial comparing the effects of different types of MTs for COPD patients was insufficient. Therefore, further high-quality RCTs are essential. [ABSTRACT FROM AUTHOR]

Dementia is an important health issue worldwide, and non-pharmacological strategies for the management of behavioral and psychological symptoms of dementia (BPSD) are considered to be important. This review analyzes the effectiveness and safety of acupuncture for BPSD. Thirteen electronic databases were comprehensively searched to find clinical studies using acupuncture on BPSD, published up to December 2020. Five randomized controlled clinical trials and two before-after studies, mainly on Alzheimer's disease (AD), were included. Meta-analysis suggested that the total effective rate based on BPSD symptoms in the acupuncture combined with psychotropic drugs group was significantly higher than that in the psychotropic drugs group (risk ratio, 1.27; 95% confidence interval, 1.11 to 1.45; I2 = 51%). In terms of other outcomes related to BPSD, acupuncture as an adjunctive therapy, but not as monotherapy, was associated with significant benefits in most included studies. However, the included studies did not have optimal methodological quality. Our review highlights the limited evidence proving the effectiveness and safety of acupuncture for BPSD in patients with AD. Although some clinical studies have reported the potential benefits of adjuvant acupuncture in managing BPSD, the evidence is not robust and is based on small studies. Therefore, high-quality research in this field is needed. [ABSTRACT FROM AUTHOR]

Acupoint herbal patching (AHP) has been used for recurrent respiratory tract infection (RRTI) in children. This systematic review aimed to analyze the safety and efficacy of AHP in pediatric RRTI. Eleven databases were comprehensively searched up to January 2020. Randomized controlled trials (RCTs) using AHP as a monotherapy or adjunctive therapy in pediatric patients with RRTI were included. Twenty-two RCTs with 3579 participants were included. Meta-analyses showed that outbreaks and disease duration of respiratory tract infection (RTI) per year significantly decreased in the AHP group compared with the placebo group, when follow-up was conducted after 1, 2, or 3 years. Moreover, AHP as a monotherapy or adjunctive therapy significantly decreased outbreaks and disease duration of RTI without serious adverse events. This review provides promising evidence that AHP may reduce the frequency and duration of RTI and improve immune function in pediatric patients with RRTI. • This is the first study to evaluate the safety and efficacy of AHP in pediatric RRTI using systematic review methodology. • Results showed promising evidence that AHP may reduce the frequency and duration of RTI and improve immune function. • GRADE shows that quality of evidence is very low to moderate. [ABSTRACT FROM AUTHOR]

Herbal medicine (HM) may be beneficial for geriatrics with multiple pathological conditions. The objective of this study was to systematically analyze the effectiveness and safety of HM for insomnia in the hypertensive elderly. Thirteen databases were comprehensively searched from their inception dates to August 28, 2018, to identify relevant randomized control trials (RCTs). The results of meta-analyses were presented as relative risk (RR) or mean difference (MD) with 95% confidence intervals. The quality of evidence (QoE) was evaluated using the GRADE approach. Eight RCTs were included in this review. Based on routine antihypertensive therapies in most cases, compared to the hypnotics group, HM group had a significantly higher total effective rate (TER) for improvement of insomnia (RR 1.24 [1.12, 1.39]). Compared to no intervention group, HM group showed a significantly higher TER for improving insomnia (RR 1.70 [1.25, 2.33]), and lowering systolic (MD -5.63 mmHg [-7.18, -4.09]) and diastolic blood pressures (MD -4.40 mmHg [-5.63, -3.18]). Pittsburgh sleep quality index (MD -4.11 [-5.72, -2.50]), Zung self-rating anxiety scale (MD -6.60 [-7.79, -5.41]), and Zung self-rating depression scale (MD -6.15 [-7.43, -4.87]). There was no significant difference in the incidence of adverse events between the HM and no intervention groups. The QoE ranged from "Very low" to "Moderate." HM might have some beneficial effects including improving insomnia, blood pressure, and mental health, for the hypertensive elderly with insomnia. Since the methodological quality of the included studies and QoE were not high, well-designed RCTs are important to confirm these results. [ABSTRACT FROM AUTHOR]