Clinical practice guideline for acupuncture and moxibustion: Allergic rhinitis.

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.

Clinical practice guideline for acupuncture and moxibustion: Female urinary incontinence.

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.

[From the body-mind holism to psychosomatic medicine: theory and practice of acupuncture and moxibustion].

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".

[Effect of acupuncture intervention at different time points on the pregnancy rate of frozen embryo transfer].

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.

[Using modified Delphi method to determine the clinical questions in the Practice Guideline of Acupuncture and Moxibustion for Urinary Incontinence in Women].

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.

[Acupoint selection rules of acupuncture and moxibustion for stroke-related pneumonia].

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).

[Consideration on the construction of acupuncture and moxibustion clinical diagnosis and treatment system with the core of "differentiation of disease location": taking "treatment" of Science of Acupuncture and Moxibustion as an example].

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".

[Study on positive reaction of foot three yin-meridians in patients with typeâ ¢ chronic prostatitis based on meridian diagnosis].

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.

[Analysis on specific effect of acupoints at the upper arms in treatment of scrofula and goiter].

Through analyzing the indication distribution of the different acupoints located at the upper limbs recorded in Science of Acupoints and Science of Meridians and Acupoints, the industry planning teaching materials of traditional Chinese medicine, it is discovered that the acupoints located at the upper arms are commonly selected for the treatment of scrofula and goiter, while the acupoints below the elbow at the hand meridians and those at the lower limbs of the foot meridians which running through the neck, do not have the similar indications. Based on a further analysis on the literature at ancient and modern times, it is believed that the acupoints located on the lateral side of the upper arms, especially those at the large intestine meridian of hand-yangming perhaps have the specific effect in treatment of scrofula and goiter.

[Quchi (LI 11) for treatment of allergic diseases based on coincidence of key therapeutic characteristics of acupoints and pathogenesis of allergic diseases].

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.

Cigarette smoke suppresses Th1 cytokine production and increases RSV expression in a neonatal model.

Respiratory syncytial virus (RSV) infects approximately 90% of young children by the age of 2 yr, with peak rates occurring during 2-6 mo of age. Exposure to side-stream cigarette smoke (SS) may increase the incidence or manifestation of an RSV infection. We hypothesized that exposure to SS would alter the subsequent immune response to RSV infection in neonatal mice. BALB/c mice were exposed to air or 1.5 mg/m3 of SS from day (d) 1 up to 35 d of age. A subset was intranasally infected with 4x10(4) PFU of RSV/g body wt on d 7 and rechallenged at 28 d of age. Immune responses were assessed on d 4 and 7 after RSV rechallenge. Both air- and SS-exposed mice responded to RSV rechallenge with neutrophilia and decreased Clara cell secretory protein levels within the lung. However, an increase in bronchoalveolar lavage fluid eosinophils, in addition to reduced levels of Th1 cytokines (IFN-gamma and IL-12), decreased lung tissue inflammation, and decreased mucus production was observed in SS-exposed mice compared with air-exposed mice after RSV rechallenge. Ultimately changes in cytokine and inflammatory responses due to SS exposure likely contributed to increased viral gene expression. These results suggest that SS exposure plays a significant role in shaping the neonatal response to RSV infection.

IL-12p40 and IL-18 modulate inflammatory and immune responses to respiratory syncytial virus infection.

Respiratory syncytial virus-induced bronchiolitis has been linked to the development of allergy and atopic asthma. IL-12 and possibly IL-18 are central mediators orchestrating Th1 and/or Th2 immune responses to infection. To determine a possible role for IL-12 in regulating the immune response to acute respiratory syncytial virus infection, IL-12p40 gene-targeted (IL-12p40-/-) and wild-type mice were intratracheally infected with respiratory syncytial virus, and lung inflammatory and immune responses were assessed. Lung inflammation and mucus production were increased in the airways of IL-12p40-/- mice as compared with those of wild-type mice, concurrent with increased levels of the Th2 effector cytokines IL-5 and IL-13. Respiratory syncytial virus clearance and levels of Th1 effector cytokine IFN-gamma were not altered. Interestingly, IL-18, another mediator of IFN-gamma production, was significantly increased in the lungs of IL-12p40-/- mice early during the course of infection. Abrogation of IL-18-mediated signaling in IL-12p40-/- mice further enhanced Th2 immune response and mucus production in the airways during respiratory syncytial virus infection but failed to modulate IFN-gamma production or viral clearance. These findings implicate a role for IL-12 and IL-18 in modulating respiratory syncytial virus-induced airway inflammation distinct from that of viral clearance.

Clara cell secretory protein modulates lung inflammatory and immune responses to respiratory syncytial virus infection.

Clara cell secretory protein (CCSP) has been shown to have anti-inflammatory and immunomodulatory functions in the lung. Respiratory syncytial virus (RSV) is the most common cause of respiratory infection in infants and young children. RSV usually infects small airways and likely interacts with the Clara cells of bronchioles. To determine a possible role for CCSP during acute RSV infection, CCSP-deficient (CCSP(-/-)) and wild-type (WT) mice were intratracheally infected with RSV and the lung inflammatory and immune responses to RSV infection were assessed. RSV-F gene expression was increased in the lungs of CCSP(-/-) mice as compared with WT mice following RSV infection, consistent with increased viral persistence. Lung inflammation was significantly increased in CCSP(-/-) mice as compared with WT mice after infection. Moreover, although the levels of Th1 cytokines were similar, the levels of Th2 cytokines and neutrophil chemokines were increased in the lungs of CCSP(-/-) mice following infection. Physiologic endpoints of exacerbated lung disease, specifically airway reactivity and mucus production, were increased in CCSP(-/-) mice after RSV infection. Importantly, restoration of CCSP in the airways of CCSP(-/-) mice abrogated the increased viral persistence, lung inflammation, and airway reactivity. These findings suggest a role for CCSP and Clara cells in regulating lung inflammatory and immune responses to RSV infection.

Increased susceptibility to RSV infection by exposure to inhaled diesel engine emissions.

Although epidemiologic data strongly suggest a role for inhaled environmental pollutants in modulating the susceptibility to respiratory infection in humans, the underlying cellular and molecular mechanisms have not been well studied in experimental systems. The current study assessed the impact of inhaled diesel engine emissions (DEE) on the host response in vivo to a common pediatric respiratory pathogen, respiratory syncytial virus (RSV). Using a relatively resistant mouse model of RSV infection, prior exposure to either 30 microg/m3 particulate matter (PM) or 1,000 microg/m3 PM of inhaled DEE (6 h/d for seven consecutive days) increased lung inflammation to RSV infection as compared with air-exposed RSV-infected C57Bl/6 mice. Inflammatory cells in bronchoalveolar lavage fluid were increased in a dose-dependent manner with regard to the level of DEE exposure, concomitant with increased levels of inflammatory mediators. Lung histology analysis indicated pronounced peribronchial and peribronchiolar inflammation concordant with the level of DEE exposure during infection. Mucous cell metaplasia was markedly increased in the airway epithelium of DEE-exposed mice following RSV infection. Interestingly, both airway and alveolar host defense and immunomodulatory proteins were attenuated during RSV infection by prior DEE exposure. DEE-induced changes in inflammatory and lung epithelial responses to infection were associated with increased RSV gene expression in the lungs following DEE exposure. These findings are consistent with the concept that DEE exposure modulates the lung host defense to respiratory viral infections and may alter the susceptibility to respiratory infections leading to increased lung disease.

Local T-cell activation after segmental allergen challenge in the lungs of allergic dogs.

Dogs with immunoglobulin E (IgE) allergy for ragweed that are sensitized by intrapulmonary exposure to ragweed can be used to study the pulmonary immune response that is important in allergic asthma. Using this model, we tested the hypothesis that T lymphocytes are activated locally in the airways shortly after allergen exposure of the lungs. The airways of six allergic dogs and three non-allergic dogs were exposed to ragweed by segmental allergen challenge (SAC). T-cell subsets and T-cell activation in blood and bronchoalveolar lavage (BAL) fluid were measured by flow cytometry before SAC and at 4, 24 and 72 hr thereafter. SAC caused a statistically significant increase in the percentage of major histocompatibility complex (MHC) class II-positive CD4 and CD8 T cells in BAL fluid and a significant increase in the mean fluorescent activity of MHC class II from 4 hr after SAC onward. This activation was significantly different from that found in cells from lung lobes challenged with saline, or from lung lobes in non-allergic dogs challenged with ragweed. The percentage of CD45RA(bright) CD8 cells increased significantly in allergic dogs after both ragweed and saline challenges. This was significantly higher than in non-allergic dogs. We conclude that T-cell activation in the airways of dogs can be measured after in vivo activation of the cells by measuring MHC class II and CD45RA expression in BAL fluid T cells. Furthermore, in allergic dogs, T cells are activated locally in the lungs within 4 hr after exposure to ragweed allergen. These results suggest a role for T lymphocytes in the development of late-phase allergic reactions in the airways.