Effect of Electroacupuncture on Insomnia in Patients With Depression: A Randomized Clinical Trial.

Importance: Electroacupuncture (EA) is a widely recognized therapy for depression and sleep disorders in clinical practice, but its efficacy in the treatment of comorbid insomnia and depression remains uncertain. Objective: To assess the efficacy and safety of EA as an alternative therapy in improving sleep quality and mental state for patients with insomnia and depression. Design, Setting, and Participants: A 32-week patient- and assessor-blinded, randomized, sham-controlled clinical trial (8-week intervention plus 24-week observational follow-up) was conducted from September 1, 2016, to July 30, 2019, at 3 tertiary hospitals in Shanghai, China. Patients were randomized to receive EA treatment and standard care, sham acupuncture (SA) treatment and standard care, or standard care only as control. Patients were 18 to 70 years of age, had insomnia, and met the criteria for depression as classified in the Diagnostic and Statistical Manual of Mental Disorders (Fifth Edition). Data were analyzed from May 4 to September 13, 2020. Interventions: All patients in the 3 groups were provided with standard care guided by psychiatrists. Patients in the EA and SA groups received real or sham acupuncture treatment, 3 sessions per week for 8 weeks, for a total of 24 sessions. Main Outcomes and Measures: The primary outcome was change in Pittsburgh Sleep Quality Index (PSQI) from baseline to week 8. Secondary outcomes included PSQI at 12, 20, and 32 weeks of follow-up; sleep parameters recorded in actigraphy; Insomnia Severity Index; 17-item Hamilton Depression Rating Scale score; and Self-rating Anxiety Scale score. Results: Among the 270 patients (194 women [71.9%] and 76 men [28.1%]; mean [SD] age, 50.3 [14.2] years) included in the intention-to-treat analysis, 247 (91.5%) completed all outcome measurements at week 32, and 23 (8.5%) dropped out of the trial. The mean difference in PSQI from baseline to week 8 within the EA group was -6.2 (95% CI, -6.9 to -5.6). At week 8, the difference in PSQI score was -3.6 (95% CI, -4.4 to -2.8; P < .001) between the EA and SA groups and -5.1 (95% CI, -6.0 to -4.2; P < .001) between the EA and control groups. The efficacy of EA in treating insomnia was sustained during the 24-week postintervention follow-up. Significant improvement in the 17-item Hamilton Depression Rating Scale (-10.7 [95% CI, -11.8 to -9.7]), Insomnia Severity Index (-7.6 [95% CI, -8.5 to -6.7]), and Self-rating Anxiety Scale (-2.9 [95% CI, -4.1 to -1.7]) scores and the total sleep time recorded in the actigraphy (29.1 [95% CI, 21.5-36.7] minutes) was observed in the EA group during the 8-week intervention period (P < .001 for all). No between-group differences were found in the frequency of sleep awakenings. No serious adverse events were reported. Conclusions and Relevance: In this randomized clinical trial of EA treatment for insomnia in patients with depression, quality of sleep improved significantly in the EA group compared with the SA or control group at week 8 and was sustained at week 32. Trial Registration: ClinicalTrials.gov Identifier: NCT03122080.

[Effect of acupuncture-moxibustion on negative emotions and plasma tryptophan metabolism in patients with Crohn's disease at active stage].

OBJECTIVE: To observe the effect of acupuncture-moxibustion on negative emotions and plasma tryptophan (Trip)-kynurenine (Kyn) metabolism in the patients with Crohn's disease (CD) at the mild and moderate active stage. METHODS: A total of 66 CD patients were randomized into an observation group (33 cases, 1 case dropped off) and a control group (33 cases, 2 cases dropped off). In the observation group, acupuncture was applied in combination with moxibustion. In the control group, the sham-acupuncture was used in combination with sham-moxibustion. In both of the observation group and the control group, acupuncture was applied to Zhongwan (CV 12), Shangjuxu (ST 37), Sanyinjiao (SP 6), Gongsun (SP 4), Hegu (LI 4), Quchi (LI 11), Taixi (KI 3) and Taichong (LR 3), and moxibustion was applied to Tianshu (ST 25) and Zusanli (ST 36). The treatment was given once every two days, 3 times a week, totally for 12 weeks. Separately, before and after treatment, the score of the hospital anxiety-depression scale (HADS) and the score of intestinal core symptoms (degree of abdominal pain and frequency of diarrhea) were observed in the patients of the two groups. The concentration of plasma indoleamine 2,3-dioxygenase 1 (IDO1) and the ratios of Kyn/Trp, QuinA/Kyn, KynA/Kyn and KynA/QuinA were compared between the two groups. RESULTS: Compared with before treatment, the scores of HADS-A and HADS-D in the observation group and the score of HADS-A in the control group were all reduced after treatment (P<0.01, P<0.05). The scores of abdominal pain degree in the two groups and score of diarrhea frequency in the observation group were all reduced after treatment (P<0.001). After treatment, the reducing ranges of the score of HADS-A and the scores of abdominal pain degree and diarrhea frequency in the observation group were all larger than the control group (P<0.01, P<0.05). Compared with before treatment, the plasma IDO1 concentration in the two groups and the ratios of plasma Kyn/Trp and QuinA/Kyn in the observation group were all reduced after treatment (P<0.001, P<0.05, P<0.01), the ratios of plasma KynA/Kyn and KynA/QuinA were increased after treatment in the observation group (P<0.05, P<0.01). After treatment, the changes in IDO1 concentration and the ratios of plasma QuinA/Kyn and KynA/QuinA in the observation were larger than the control group (P≤0.01, P<0.05). In the observation group, the difference in the ratio of plasma KynA/Kyn before and after treatment was negatively related to the improvement value of HADS-D (r =-0.67, P<0.05). After treatment, plasma IDO1 concentration was positively related to HADS-A in the observation group (r =0.65, P<0.05). CONCLUSION: Acupuncture and moxibustion relieve the negative emotions of anxiety and depression in CD patients at mild and moderate active stage, which is probably related to the regulation of plasma Trp-Kyn metabolic pathway.

[Tongdu Tiaoshen acupuncture method for mild cognitive impairment: a randomized controlled trial].

OBJECTIVE: To observe the clinical efficacy of Tongdu Tiaoshen acupuncture method for mild cognitive impairment in the elderly. METHODS: A total of 96 patients were randomly divided into an observation group, a control group and a waiting group, 32 cases in each group. The patients in the observation group were treated with acupuncture at Baihui (GV 20), Shenting (GV 24), Yintang (GV 29) and Sishencong (EX-HN 1), etc, while the patients in the control group were treated with non-penetrating sham acupuncture at the same acupoints as the observation group. The treatment was given once every other day, three times a week for 8 weeks. The patients in the waiting group only received health guidance for 8 weeks. Montreal cognitive assessment scale (MoCA) and mini-mental state examination (MMSE) were used before and after 8-week treatment in all three groups. The observation group and the control group were followed up for 2 months and evaluated with MoCA and MMSE. RESULTS: The MoCA scores in the observation group after treatment and during follow-up were higher than before treatment (P<0.01), but there was no significant difference between follow-up and after treatment (P>0.05). The MoCA scores in the control group after treatment and during follow-up were higher than before treatment (P<0.01, P<0.05), and the MoCA score during follow-up was lower than after treatment (P<0.01). There was no significant difference before and after treatment in the waiting group (P>0.05). The difference before and after treatment in the observation group was higher than the control group and waiting group (P<0.01), while that in the control group was higher than the waiting group (P<0.01). The difference between follow-up and before treatment in the observation group was higher than the control group (P<0.01), and the improving between follow-up and after treatment was superior to the control group (P<0.01). The MMSE scores after treatment and during follow-up were higher than before treatment in the observation group (P<0.01), but there was no significant difference between the follow-up and after treatment (P>0.05). The MMSE scores after treatment and during follow-up were higher than before treatment in the control group (P<0.01), and the MMSE score during follow-up was lower than after treatment (P<0.01). There was no significant difference before and after treatment in the waiting group (P>0.05). The difference before and after treatment the observation group and control group was not significant (P>0.05), and those in the two groups were higher than the waiting group (P<0.01). The difference between follow-up and before treatment in the observation group was higher than the control group (P<0.01), and the difference between follow-up and after treatment was lower than the control group (P<0.01). CONCLUSION: Tongdu Tiaoshen acupuncture method could improve cognitive impairment in elderly patients with mild cognitive impairment.

[Discussion on the direction of moxibustion].

The types of moxibustion are various and its therapeutic effect could be influenced by many factors. The clinical manipulation of moxibustion usually involves sequential order, indicating the significance of direction in moxibustion. From the relationship between moxibustion direction and propagated sensation along channel, moxibustion direction and directional supplementation and reducing and others, this article proposes moxibustion direction could be one of the key factors to influence the clinical efficacy of moxibustion. It is hoped to improve moxibustion and increase clinical efficacy.

[Active Crohn's disease treated with acupuncture and moxibustion:a randomized controlled trial].

OBJECTIVE: To observe the effects and safety of clinical common symptoms of active Crohn's disease at the mild and moderate stages treated with acupuncture and moxibustion. METHODS: One hundred and two patients were randomly divided into an observation group and a control group, 51 cases in each one. Herb-partition moxibustion and acupuncture were used in the observation group. Herbal cakes with Huanglian (coptis chinensis), Fuzi (radix aconiti carmichaeli), Rougui (cinnamomum cassia), Muxiang (radices saussureae), Honghua (carthamus tinctorious), Danshen (the root of red-rooted salvia) and Danggui (angelica sinensis) as the main ingredients were used on Tianshu (ST 25), Qihai (CV 6) and Zhongwan (CV 12); acupuncture was used at Zusanli (ST 36), Shangjuxu (ST 37), Sanyinjiao (SP 6), Taixi (KI 3), Gongsun (SP 4) and Taichong (LR 3). Bran-partition moxibustion and shallow acupuncture were applied in the control group. Wheat bran-partition moxibustion in the shape of cake was implemented on the same acupoints as the observation group; shallow acupuncture was used 1~2 cm next to the acupoints. Treatment was given three times a week for 12 weeks, 36 times totally. Clinical effects of eight symptoms were evaluated by TCM symptom score, and the symptoms included abdominal pain (degree, frequency, time), diarrhoea (number, shape and frequency), fatigue, anorexia, borborygmus andflatus, fear of cold, soreness and weakness of waist and knees, tenesmus. RESULTS: After 12-week treatment, the eight symptoms were improved apparently (all P<0.05), with the scores of abdominal pain (degree, frequency, time), diarrhoea (shape and frequency), fatigue and anorexia in the observation group decreasing more obviously (all P<0.01). There was no statistical significance about the other symptom scores between the two groups (all P>0.05). CONCLUSIONS: Herb-partition moxibustion combined with acupuncture achieve safety and efficacy for mild and moderate Crohn's disease, and can improve the clinical common symptoms. Furthermore, their effects on abdominal pain (degree, frequency, time), diarrhoea (shape and frequency), fatigue and anorexia are better than those of bran-partition moxibustion and shallow acupuncture.

[Advances and thinking about prevention and treatment of inflammatory bowel diseases by acupuncture and moxibustion].

OBJECTIVE: To provide scientific foundations for clinical and acupoints researches on acupuncture for treatment of inflammatory bowel diseases. METHODS: Review the correlated documents of clinical experimental researches issued from 1995 to 2005, and the clinical and experimental documents about remedy of inflammatory bowel diseases by acupuncture and moxibustion were summarized and analyzed. RESULTS: Acupuncture and moxibustion had significant therapeutic effects on inflammatory bowel diseases, and the studies on the mechanisms have achieved some progresses, but the designs and the methods of these studies need to be improved. CONCLUSION: Afterwards, the specificity of acupoints, and factors of influencing the specificity should be studied via effective diseases treated with acupuncture and moxibustion, so as sum up common regularity, rich and develop the theory about specificity of acupoints to guide clinical treatment of acupuncture and moxibustion.