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Acupuncture And Moxibustion Pdf

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Acupuncture and moxibustion have been accepted as treatment options for primary dysmenorrhea PD. So far, several systematic reviews SRs and meta-analyses MAs have reported on the efficacy and safety of acupuncture and moxibustion in treating PD.

Observation on therapeutic effects of acupuncture and moxibustion for primary dysmenorrhea

Acupuncture and moxibustion have been accepted as treatment options for primary dysmenorrhea PD. So far, several systematic reviews SRs and meta-analyses MAs have reported on the efficacy and safety of acupuncture and moxibustion in treating PD.

The aim of this study was to critically summarize the evidence from relevant SRs and MAs reporting on the efficacy and safety of acupuncture and moxibustion in treatment of PD. A total of 28 SRs and MAs, original studies, reporting on 26, female patients were analyzed. The majority of the SRs were of moderate reporting quality and poor methodological quality.

Moderate-quality evidence suggested that acupuncture and moxibustion were more effective compared to indomethacin or Fenbid in treating PD. Low-quality evidence suggested that, compared to NSAIDs, acupuncture and moxibustion could relieve pain with less adverse effects.

Acupuncture and moxibustion seem to be effective and safe approaches in treatment of PD; yet, the methodological quality of most of the studies and the quality of evidence were low. Thus, additional studies are required to further confirm these results. Primary dysmenorrhea PD is a common gynecological disorder, mainly characterized by cramping pain in the lower abdomen that occurs before or during menstruation.

Headache, nausea, vomiting, fatigue, irritability, diarrhea, and an overall feeling of discomfort are the common symptoms accompanying PD [ 1 ]. The disorder can significantly affect women's physical health and life quality [ 2 ]. In the USA, PD is responsible for the loss of million work hours and two million dollars each year [ 3 ]. Nonsteroidal anti-inflammatory drugs NSAIDs , oral contraceptive pills, or acupuncture are commonly used to alleviate the menstrual pain.

Yet, drug therapy may lead to some adverse events, such as digestive disorders, headache, and drowsiness. As nonpharmaceutical therapy, acupuncture stimulates the nervous system and release of endogenous substances, such as opioid peptides and serotonin, to improve symptoms [ 6 , 7 ]. Moreover, moxibustion can regulate the levels of reproductive hormones to reduce the pain of dysmenorrhea [ 8 ]. Some studies have reported that the combination of acupuncture and moxibustion at SP6 could effectively improve the uterine artery hemodynamics and hemorheology in patients, as well as regulate blood viscosity and erythrocyte aggregation degree to relieve the pain [ 9 — 12 ].

Systematic reviews SRs , especially those combined with meta-analyses MAs , are of essential importance in evaluating clinical efficacy and formulating clinical guidelines [ 13 , 14 ]. In their SR, Smith et al.

Moreover, Zhang et al. They concentrated on acupuncture and acupressure, without referring to the moxibustion and quality of the available evidence. In addition, the results from SRs are conflicting, and the conclusions are limited.

To overcome the limitations of an individual SR and to provide comprehensive evidence, an overview of multiple SRs, which is a new approach designed to synthesize the available results, is needed.

We enlarged the research source from seven databases and also considered the intervention of moxibustion so as to provide comprehensive evidence. Review articles, letters, conference papers, abstracts, protocols, and network meta analyses were excluded.

We included female patients of reproductive age suffering from PD. The definition of PD was based on cyclic pelvic pain during menstruation without any gynecological pathology, such as endometriosis, adenomyosis, or uterine myoma. Patients with secondary dysmenorrhea or serious medical conditions were excluded. The interventions included needle acupuncture, electro-acupuncture, auricular acupuncture, moxibustion, acupressure, point injection, or any combination of the above.

We included western medicine, placebo, sham acupuncture, no treatment, or any combination of these. The total effective rate [ 20 ] was selected as a primary outcome. It was calculated based on the ratio of the total number of those who were effectively cured and the total number of sick people [ 20 ]. Secondary outcomes were the following: clinical effective rate, visual analogue scale VAS , adverse effects, quality of life, and symptom of dysmenorrhea.

Clinical effective rate was calculated based on the ratio of the total number of people who responded well to therapy and the total number of sick people who continued to be sick [ 20 ]. VAS was analyzed according to a previously described approach [ 21 ]. Adverse effects were measured as incidence of side effects and types of side effects.

Quality of life [ 22 ] was measured using a validation scale, for example, the Short Form SF Symptoms of the dysmenorrhea were analyzed according to a previously described approach [ 23 ]. Two reviewers JY and TY separately searched the aforementioned databases and listed the titles of all articles.

According to the inclusion criteria, by looking through the title and abstract, they excluded papers that were not eligible. Next, they screened the contents of the unclear articles further. If articles contained insufficient information to make a decision on eligibility, authors of the original reports were contacted so as to obtain further details.

Any disagreements were resolved by discussion or consulting with a third reviewer XJ , until reaching a consensus. The investigators systematically studied the relevant data and known evaluation methods. Two reviewers YJ and YT independently assessed the quality of the research; disagreements were solved by discussion or consulting with a third reviewer JX. The 3 levels were scored as 1, 0.

The rating included four levels: high, moderate, low, and very low, according to the quality of the evidence. Two reviewers TY and XW separately conducted the assessment process, any disagreement was resolved through discussion and consultation with a third author JX until a consensus was reached.

The summary table of the evidence for different SRs and MAs was prepared. We performed a re-meta-analysis of the data where two or more reviews reported on the same or similar intervention for outcomes relevant to our review.

Risk indices RRs or odds ratios ORs were standardized for dichotomous outcomes; mean difference MD or standard mean difference SMD was used for continuous outcomes by using equations published in the Cochrane Handbook for Systematic Reviews of Interventions.

We obtained relevant citations from seven electronic databases and manual searches. Before screening, 62 duplicates were excluded. After reading the title and abstract, seven records were rejected, including one article that has been published two times, three papers published in different languages, two conference papers, and 2 network meta-analyses.

Full texts of the remaining 39 citations were retrieved for further assessment, and 18 citations were eliminated. Finally, 28 articles were included in this study.

Exclusion list is described in additional file 1. The flowchart of literature selection is represented in Figure 1. Among these, 12 [ As for main outcomes, 17 [ The characteristics of the literature search are shown in Table 2. The mean score was 8. AMSTAR-2 score showed that the key factors affecting the quality of the literature included item 2 2 studies explained their review methods before conducting the review , item 4 1 study provided an comprehensive literature search strategy , item 7 4 studies provided a list of excluded studies and justified the exclusions , item 9 19 studies used a satisfactory technique for assessing RoB , item 11 24 researches applied meta-analytical methods appropriately and gave explaining reasons; 2 studies did not provide the explanation of the heterogeneity , item 13 25 studies accounted for RoB in individual studies in the results , and item 15 22 studies took funnel plots or Egger's test and Begger's test to investigate the publication bias, and 9 of the studies gave explanation to discuss the potential impact on the results of the review.

Considering that the common problem of the included studies was lack of protocol and list of excluded studies, we adjusted the items 2 and 7 as the second line of the key factors in the process of the assessment. Our results revealed that more than half of the studies were graded as of critically low quality, 9 of low, 3 of moderate, and 1 of high quality. Based on the quality results, most reviews followed the principle of PICO to carry on research and build framework.

More than 2 reviewers performed study selection and extraction in duplicate. Reviewers evaluated the risk of bias of the included and providing satisfactory explanation for the results, while less attention was paid to the protocol and explanation for selection design, exclusion, or heterogeneity.

The mean score was We found that most included reviews were of high reporting quality, with the part of the title, information sources, data collection process, risk of bias, and conclusion all being well reported.

Some of the weaknesses of the reporting included lack to provide proper report in included studies, synthesis of the results, funding, and registration.

In the method section, more than half of the studies provided search strategy for one database, while only one study provided a comprehensive literature search strategy. Thirteen studies did not make additional analysis, and twelve reviews did not refer to the funding. Sixteen SRs [ Furthermore, 17 SRs [ Moreover, 12 SRs encompassing [ Also, 5 SRs [ Seven SRs [ In addition, 5 SRs [ Moreover, four SRs [ The quality of evidence for 3 outcomes total effective rate, VAS and adverse events is shown in Table 5.

The results showed that the quality of the evidence was low and all the outcomes were biased in allocation concealment or inadequate blinding; the outcomes of the VAS and adverse events were inconsistent, which was caused by course or treatment of the patient. The funnel plot of the total effective rate acupuncture and moxibustion vs. Somiton and VAS acupuncture and moxibustion vs.

This overview provided a comprehensive overview of the evidence on the effectiveness and safety of acupuncture and moxibustion for PD. Evidence of moderate quality suggested that acupuncture and moxibustion had a positive effect on indomethacin or Fenbid in treating PD. Low-quality evidence showed that compared to NSAIDs, acupuncture and moxibustion could relieve PD related pain with less adverse effects, which needs to be further researched.

The adverse effects related to the acupuncture and moxibustion were mild, and they included dizziness, fainting, or minimal bleeding after acupuncture. Most of the studies followed the principle of PICO to carry on research and build framework, select proper assessment tool or appropriate methods for statistical combination of results, while they fail to provide registration, and assess the potential impact of individual ROB studies on the results of the meta-analysis or other evidence synthesis.

Most of the RCTs did not explain the treatment allocation concealed and blinding. The quality of the reporting of the SRs was limited by lack of data on registration and funding, comprehensive search strategy, and explanation of the heterogeneity. With reference to the abstract, although many studies reported structured abstract, they failed to fully report the synthesis of results, the risk of basis, funding, and registration.

Following is the brief summary of the present research: 1 comprehensive search strategies were applied to seven databases to ensure that all relevant reviews were identified; 2 before assessment, we have systematically learned some related courses on methodology and reporting evaluation and consulted relevant methodological experts, professors so as to gain deep understanding, and ensure the accuracy of the evaluation process; 3 during the process, we adopted AMSTAR 2 and PRISMA to evaluate the methodological and reporting quality of the qualified studies, and we combined PRISMA-A to the part of abstract in PRISMA, thus making the evaluation more precise; 4 we excluded the overlapping RCTs and conducted a quantitative analysis of the primary RCTs, with the help of the GRADE approach so as to evaluate the quality of the outcomes with different comparisons; 5 Cochrane Collaboration guidelines were followed for data synthesis.

More than two reviewers were engaged so as to minimize potential bias in the overview process. There are some limitations in the present study: 1 The methodological quality of both included SRs and primary RCTs was not high, and the quality of evidence for the outcomes was unsatisfactory; thus, the conclusions from this overview should be interpreted with caution.

The increase of complex factors led to less reliance in our overview. Through this overview, we found that current evidence is of low quality; hence, further research is needed.

In conclusion, the current evidence suggests that acupuncture and moxibustion is more effective than ibuprofen or Fenbid in the treatment of PD.

World Journal of Acupuncture - Moxibustion

Once production of your article has started, you can track the status of your article via Track Your Accepted Article. The focus of the journal includes, but is not confined to, clinical research, summaries of clinical experiences, experimental research and clinical reports on needling techniques, moxibustion techniques, acupuncture analgesia and acupuncture anesthesia. Article types considered for publication include reviews, academic discussion, education and academic lectures, research on historical documents, introduction to typical cases, meridian-collaterals and acupoints, proved acupoint or prescriptions of acupoints, and news reports. We also provide many author benefits, such as special discounts on Elsevier publications and much more. Please click here for more information on our author services. Please see our Guide for Authors for information on article submission.

Skip to search form Skip to main content You are currently offline. Some features of the site may not work correctly. Corpus ID: Chinese acupuncture and moxibustion. Lu Published Medicine Indian medical journal. Of course, from childhood to forever, we are always thought to love reading. It is not only reading the lesson book but also reading everything good is the choice of getting new inspirations.

acupuncture and moxibustion pdf

The task of acupuncture-moxibustion treatment is to select a few meridian points, insert a needle, and give appropriate stimulus at the appropriate depth.

Metrics details. Acupuncture and moxibustion are more integrated in the Chinese healthcare system than in the national healthcare systems of other countries. Development of acupuncture and moxibustion in China is making progress in this field. For overseas researchers, this commentary offers perspectives on the current status of acupuncture and moxibustion in China and examines relevant opportunities and challenges in healthcare reforms.


  1. Lukas F.

    02.06.2021 at 20:52

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