Traditional Chinese Medicine Constitution Identification Based on Objective Facial and Tongue Features: A Delphi Study and a Diagnostic Nomogram for Blood Stasis Constitution.

Objective: The aim of this study was to systematically summarize and form an expert consensus on the theoretical experience of tongue and facial features for the identification of nine types of traditional Chinese medicine (TCM) constitution. Additionally, we sought to explore the feasibility of TCM constitution identification through objective tongue and facial features. Methods: We used Delphi method to investigate the opinions of experts on facial and tongue feature items for identifying TCM constitution. We developed and validated a diagnostic nomogram for blood stasis constitution (BSC) based on objective facial and tongue features to demonstrate the reliability of expert consultation. Results: Eleven experts participated in two rounds of expert consultation. The recovery rates of the two rounds of expert consultation were 100.0% and 90.9%. After the first round, 39 items were screened out from 147 initial items, and 2 items were supplemented by experts. In the second round, 7 items were eliminated, leaving 34 items for 8 types of TCM constitution. The coefficient of variation in the first round was 0.11-0.49 for the 147 items and 0.11-0.29 for the included items. The coefficient of variation in the second round was 0.10-0.27 for the 41 items and 0.10-0.20 for the included items. The W value was 0.548 (P < 0.001) in the first round and 0.240 (P < 0.001) in the second round. Based on expert consultation, we selected BSC as an example and developed and validated a diagnostic nomogram consisting of six indicators: sex, hair volume, lip color-dark purple, susceptibility-facial pigmentation/chloasma/ecchymosis, zygomatic texture-red blood streaks, and sublingual vein-varicose and dark purple. The nomogram showed good discrimination (AUC: 0.917 [95% confidence interval [CI], 0.877-0.956] for the primary dataset, 0.902 [95% CI, 0.828-0.976] for the validation dataset) and good calibration. Decision curve analysis demonstrated that the nomogram was clinically useful. Conclusion: This is the first study to systematically summarize the existing knowledge and clinical experience to form an expert consensus on the tongue and facial features of nine types of TCM constitution. Our results will provide important prior knowledge and expert experience for future constitution identification research. Based on expert consultation, this study presents a nomogram for BSC that incorporates objective facial and tongue features, which can be conveniently used to facilitate the individualized identification of BSC.

Effect of Knowledge/Practice of COVID-19 Prevention Measures on Return-to-Work Concerns; Attitudes About the Efficacy of Traditional Chinese Medicine: Survey on Supermarket Staff in Huanggang, China.

Objective: The objective of this study was to investigate how knowledge and practice of coronavirus disease 2019 (COVID-19) prevention measures affected concerns about returning to work among supermarket staff. Attitudes about the ability of traditional Chinese medicine (TCM) to prevent COVID-19 were also assessed. Methods: A cross-sectional study was conducted in Huanggang, Hubei Province, China from April 23 to 25, 2020. Participants were invited to fill out an electronic questionnaire on their cell phones. Results: The results showed that from 2,309 valid questionnaires, 61.5% of participants were concerned about resuming work. Major concerns included asymptomatic infection (85.01%) and employees gathering in the workplace (78.96%). Multivariate logistic regression indicated that the female gender, having school-aged children and pregnancy were risk factors for being concerned about resuming work, while good knowledge and practice of preventive measures were protective factors. Knowledge and practice of preventive measures were positively correlated. Among preventive measures, the highest percentage of participants knew about wearing masks and washing hands. Meanwhile, 65.8% of participants expressed confidence in the ability of TCM to prevent COVID-19, where 74 and 51.3% thought there was a need and a strong need, respectively, for preventive TCM-based products. Among them, 71.5% preferred oral granules. Regarding TCM as a COVID-19 preventative, most were interested in information about safety and efficacy. Conclusion: These findings suggested that promoting knowledge and practices regarding COVID-19 prevention can help alleviate concerns about returning to work. Meanwhile, TCM can feasibly be accepted to diversify COVID-19 prevention methods. Clinical Trial Registration:http://www.chictr.org.cn/, identifier: ChiCTR2000031955.

Electroacupuncture vs Prucalopride for Severe Chronic Constipation: A Multicenter, Randomized, Controlled, Noninferiority Trial.

INTRODUCTION: This multicenter, randomized, noninferiority trial compared electroacupuncture with prucalopride for the treatment of severe chronic constipation (SCC). METHODS: Participants with SCC (≤ 2 mean weekly complete spontaneous bowel movements [CSBMs]) were randomly assigned to receive either 28-session electroacupuncture over 8 weeks with follow-up without treatment over 24 weeks or prucalopride (2 mg/d before breakfast) over 32 weeks. The primary outcome was the proportion of participants with ≥3 mean weekly CSBMs over weeks 3-8, based on the modified intention-to-treat population, with -10% as the noninferior margin. RESULTS: Five hundred sixty participants were randomized, 280 in each group. Electroacupuncture was noninferior to prucalopride for the primary outcome (36.2% vs 37.8%, with a difference of -1.6% [95% confidence interval, -8% to 4.7%], P < 0.001 for noninferiority); almost the same results were found in the per-protocol population. The proportions of overall CSBM responders through weeks 1-8 were similar in the electroacupuncture and prucalopride groups (24.91% vs 25.54%, with a difference of -0.63% [95% confidence interval, -7.86% to 6.60%, P = 0.864]). Except during the first 2-week treatment, no between-group differences were found in outcomes of excessive straining, stool consistency, and quality of life. Adverse events occurred in 49 (17.69%) participants in the electroacupuncture group and 123 (44.24%) in the prucalopride group. One non-treatment-related serious adverse event was recorded in the electroacupuncture group. DISCUSSION: Electroacupuncture was noninferior to prucalopride in relieving SCC with a good safety profile. The effects of 8-week electroacupuncture could sustain for 24 weeks after treatment. Electroacupuncture is a promising noninferior alternative for SCC (see Visual Abstract, http://links.lww.com/AJG/B776).

[Investigation on sea of marrow and the application of Naohu (GV 17)].

The theory on four seas is a kind of view to explain the longitudinal and horizontal distribution relationship of meridians and collaterals by ancient scholars. The authors were attempted to explore it by taking the theory on sea of marrow as example in terms of literature analysis. In Lingshu: Hailun (Chapter 33 of Miraculous Pivot), it is recorded that sea of marrow flows into two locations, but they are not the acupoint sites for treatment. Based on the comprehensive literature investigation, it is known that such two sites to which sea of marrow flows refer to a kind of boundaries so that the range of sea of marrow is determined, the function of it explored, and the controversy on "heart dominating mind" and "brain governing spirit" solved. It is defined that the function of sea of marrow is the macro-conception of shen (mind, spirit) that is modulated by vital movement information. Additionally, in association with meridian literature analysis, as well as acupoint textual research, it finally focuses on Naohu (GV 17) that is the critical point in the application of the theory on sea of marrow. In clinical application of such theory, the importance should be attached to the governor vessel, Naohu (GV 17) and their spatial system of bone.

[Comparative Observation on Electroacupuncture and Manual Acupuncture in Rabbits with Facial Nerve Injury by Electron Microscope].

OBJECTIVE: To observe the effect of manual acupuncture and electroacupuncture (EA) on ultrastructure of facial nerve Schwann cells, myelin sheath and mitochondria in facial nerve injury rabbits, so as to explore its mechanism underlying improving facial palsy. METHODS: A total of 50 New Zealand rabbits were randomly divided into normal, sham-operation, model, MA and EA groups (n=10 in each group). Facial nerve injury model was made by clamping the facial nerve for 5 min using a pair of forceps. Manual needle stimulation (mild reinforcing-reducing) or EA (continuous wave, 20 Hz) was applied to "Dicang" (ST 4), "Xiaguan" (ST 7), "Taiyang" (EX-HN 5) and "Yangbai" (GB 14) on the injured sides for 4 weeks, 30 min each day. The facial nerve motion score was performed every 7 days. The ultrastructure of facial nerve was observed by electron microscope after 28 days' treatment. RESULTS: There were no significant differences in behavioral score and ultrastructure in normal and sham-operation groups (P<0.05). Compared with the normal group, facial nerve motion scores, ultrastructural morphological changes and the number of axons per unit area, myelin sheath thickness and axon area were worse in the model group (P<0.05). After treatment, facial nerve motion scores, ultrastructural morphological changes and the number of axons per unit area, myelin sheath thickness and axon area in the two treatment groups were better than those in the model group (P<0.05), and EA worked better than MA (P<0.05). CONCLUSIONS: In the treatment of facial nerve injury, EA can promote axoplasmic mitochondrial proliferation, myelin sheath recovery and axonal regeneration more effectively than MA, which may be one of the mechanisms that EA therapy is superior to MA.

[Acupuncture combined with moxibustion plaster for nerve-root type cervical spondylosis].

OBJECTIVE: To compare the clinical efficacy differences between acupuncture combined with moxi-bustion plaster and electroacupuncture (EA) for nerve-root type cervical spondylosis. METHODS: A total of 60 casesof nerve-root type cervical spondylosis were randomly divided into a plaster group and an EA group, 30 cases ineach one. Patients in the plaster group were treated with regular acupuncture at Jiaji(EX-B 2) points and ashipoints, combined with moxibustion plaster at Gaohuang (BL 43); patients in the EA group were treated with EAat identical acupoints as plaster group. The treatment was given once a day, and 5 days were taken as one course;there was an interval of 2 days between courses and totally 2 courses were performed. The pain questionnaires andquantitative score of signs and symptoms were observed before and after treatment in the two groups. The clinicalefficacy of the two groups was compared. RESULTS: The total effective rate was 96. 7% (29/30) in the plastergroup, which was not significantly different from 93. 3% (28/30) in the EA group (P>0. 05). After treatment,PRI, VAS and PPI were all reduced in the two groups (all P

[Clinical observation of peripheral facial palsy treated with electro-acupuncture based on surface electromyography].

OBJECTIVE: To observe the difference in the clinical efficacy on peripheral facial palsy between electro-acupuncture (EA) assisted with surface electromyography (sEMG) and conventional EA. METHODS: Sixty cases of peripheral facial palsy were randomized into an observation group and a control group, 30 cases in each one. EA was applied during the first 15 days of sickness in the two groups, at Xiaguan (ST 7), Jiache (ST 6), Dicang (ST 4), Yangbai (GB 14), Taiyang (EX-HN 5), Quanliao (SI 18) and Hegu (LI 4), once a day. In the observation, group, 15 days after sickness, according to the situation in sEMG, on the basis of the acupoints in the previous treatment, the corresponding acupoints were reselected for EA. In the control group, the conventional EA was kept on. The treatment was given once every two days till the 35th day of sickness. Separately, on the 5th, 15th and 35th days of sickness, according to the detection of sEMG in the patients of two groups, the means ratios of: root mean square (RMS) of musculi buccinators, orbicularis oris, frontalis and nasalis on the healthy and affected sides were recorded and analyzed. RESULTS: The differences of ratio in RMS of musculi buccinators, orbicularis oris, frontalis and nasalis on the healthy and affected sides were significant statistically in comparison between the, 15th day and the 5th day, and between the 35th day and the 15th day of sickness within each group (all P<0. 01). The differences of ratio in RMS of the muscles on the healthy and affected sides were significant statistically on the 15th and 35th days between the two groups (all P<0. 05). CONCLUSION: EA assisted with sEMG achieves the significant efficacy on peripheral facial palsy, better than the conventional EA.

Appraisal of the Deqi Concept among Contemporary Chinese Acupuncturists.

Deqi, an important component of the traditional theory of acupuncture and moxibustion, is the key factor in determining clinical therapeutic effect of acupuncture. In this paper, based on the digging up, arrangement, and in-depth analysis of the famous contemporary Chinese acupuncturists' perspectives of deqi, the authors summarize the concept and manifestation, as well as the properties of deqi, and correlativity of deqi with acupuncture manipulation through reviewing modern clinical research. Proposals for more scientific and standardized acupuncture research are introduced to reexamine and restore the implication of deqi in combination with the clinical practice.

[Comparison on efficacy and the safety evaluation on peripheral facial paralysis treated with electroacupuncture of different waveforms].

OBJECTIVE: To use electroacupuncture (EA) of different waveforms to treat peripheral facial paralysis and assess the clinical efficacies of 3 kinds of EA waveforms (continuous wave, disperse-dense wave and intermittent wave). METHODS: One hundred and twenty-nine cases of Bell's palsy were randomly divided into a continuous wave group (45 cases), a disperse-dense wave group (40 cases) and an intermittent wave group (44 cases). The acupoints were Dicang (ST 4), Jiache (ST 6), Taiyang (EX-HN 5), Xiaguan (ST 7), Hegu (LI 4), etc. The House-Brackmann (H-B) scale was used in the assessment on the day of the inclusion, in the 1st, 2nd, 3rd and 4th sessions of treatment and in 1st and 3rd months of the follow-up visit after the end of treatment separately. RESULTS: The cured rates were 68.9% (31/45), 60.0% (24/40) and 65.9% (29/44) in the continuous wave group, the disperse-dense wave group and the intermittent wave group separately. The results of the rank sum test showed that the efficacy comparison among the groups did not present the statistically significant difference (P > 0.05). CONCLUSION: Electroacupuncture achieves the significant clinical efficacy on peripheral facial paralysis and there are no any significant differences in the efficacy among the different waveforms. It is suggested that the clinical efficacy of electroacupuncture on the disease has nothing significant correlation with the waveforms.

[Acupuncture and moxibustion for peripheral facial palsy at different stages: multi-central large-sample randomized controlled trial].

OBJECTIVE: To explore the best intervention time of acupuncture and moxibustion for peripheral facial palsy (Bell's palsy) and the clinical advantage program of selective treatment with acupuncture and moxibustion. METHODS: Multi-central large-sample randomized controlled trial was carried out. Nine hundreds cases of Bell's palsy were randomized into 5 treatment groups, named selective filiform needle group (group A), selective acupuncture + moxibustion group (group B), selective acupuncture + electroacupuncture (group C), selective acupuncture + line-up needling on muscle region of meridian group (group D) and non-selective filiform needle group (group E). Four sessions of treatment were required in each group. Separately, during the enrollment, after 4 sessions of treatment, in 1 month and 3 months of follow-up after treatment, House-Brackmann Scale, Facial Disability Index Scale and Degree of Facial Nerve Paralysis (NFNP) were adopted for efficacy assessment. And the efficacy systematic analysis was provided in view of the intervention time and nerve localization of disease separately. RESULTS: The curative rates of intervention in acute stage and resting stage were 50.1% (223/445) and 52.1% (162/311), which were superior to recovery stage (25.9%, 35/135) separately. There were no statistical significant differences in efficacy in comparison among 5 treatment programs at the same stage (all P > 0.05). The efficacy of intervention of group A and group E in acute stage was superior to that in recovery stage (both P < 0.01). The difference was significant statistically between the efficacy on the localization above chorda tympani nerve and that on the localization below the nerve in group D (P < 0.01). The efficacy on the localization below chorda tympani nerve was superior to the localization above the nerve. CONCLUSION: The best intervention time for the treatment of Bell's palsy is in acute stage and resting stage, meaning 1 to 3 weeks after occurrence. All of the 5 treatment programs are advantageous to Bell's palsy. In the condition of the limited medical sources, the simple filiform needle therapy is recommended in acute stage. For the patients with the disorder above chorda tympani nerve, the line-up needling on muscle region of meridian is not recommended.

[Comparison of therapeutic effects of peripheral facial paralysis in acute stage by different interventions].

OBJECTIVE: To compare the therapeutic effects of peripheral facial paralysis in acute stage by different interventions and explore the better treatments of peripheral facial paralysis. METHODS: One hundred and thirty one cases of Bell's facial paralysis were randomly divided into three groups. In acupuncture group (44 cases), Dicang (ST 4), Jiache (ST 6), Hegu (LI 4), Yangbai (GB 14) and Taiyang (EX-HN 5), etc. were applied; in electroacupuncture group (45 cases), the selection of acupoints and needling method were same as those in acupuncture group, and the electroacupuncture therapy was applied on Dicang (ST 4), Xiaguan (ST 7), Yangbai (GB 14) and Taiyang (EX-HN 5) in acute stage; in medication and acupuncture group (42 cases), Prednisone and Acyclovir were taken by oral administration, Vitamin B1 and Vitamin B12, were applied by intramuscular injection in acute stage, and acupuncture was applied by the way which was same as that in acupuncture group during quiescent and recovery stages. The curative effects were evaluated by House-Brackmann Grading Scale, and the failed rates were observed by follow-up after one and three months. RESULTS: The cured and markedly effective rates were 79.6% (35/44), 93.4% (42/45) and 78.6% (33/42) respectively in acupuncture group, electroacupuncture group and medication and acupuncture group, and the result in electroacupuncture group was superior to those in acupuncture group and medication and acupuncture group (P < 0.05). The cured rates above tympanichord were 54.2% (13/24), 85.2% (23/27) and 48.0% (12/25) in acupuncture group, electroacupuncture group and medication and acupuncture group, and the result in electroacupuncture group was superior to those in acupuncture group and medication and acupuncture group (P < 0.01). There was no significant differences of cured rates below tympanichord among three groups (P > 0.05); and the failed rate in electroacupuncture group was much lower than those in acupuncture group and medication and acupuncture group by follow-up after one and three months (all P < 0.01). CONCLUSION: The peripheral facial paralysis is effectively treated by electroacupuncture in acute stage, and it suggests that electroacupuncture should be applied early during the acupuncture treatment of peripheral facial paralysis.

[Effects of Linggui Bafa on the therapeutic effect and quality of life in patients of post-stroke depression].

OBJECTIVE: To probe into effects of Linggui Bafa (method for picking eight points linked with extraordinary meridians according to time) on the therapeutic effect and quality of life in patients of post stroke depression. METHODS: One hundred and twenty cases were randomly divided into 3 groups, an observation group 1, an observation group 2 and a control group, 40 cases in each group. All patients were given routine clinical treatments and second level medical prevention. Patients in the observation group 1 received Linggui Bafa acupuncture treatment 2 weeks after stroke; at the same time the observation group 2 was treated with oral administration of Sertraline. The control group did not receive any form of either acupuncture or oral medication, but early rehabilitative intervention and psychological treatment were initiated. Curative effects were evaluated with Hamilton Depression Scale (HAMD), Function Independent Measure (FIM), National Institutes of Health Stroke Scale (NIHSS) and SF-36 after the treatment and 6 months later, respectively. RESULTS: The scores of HAMD, FIM (cognition function) and general health, role-physical, role-emotional, social function, vitality, mental health in SF-36 in the observation group 1 were significantly higher than those in the control group after treatment and 6 months later (P<0.01, P<0.05). The scores of physical function in SF-36 after treatment and NIHSS 6 months later in the observation group 1 were significantly improved than those in the control group (P<0.01, P<0.05). The scores of FIM (cognition function) and role-physical, social function, mental health in SF-36 after treatment and HAMD and general health, social function, mental health in SF-36 6 months later in the observation group 2 were significantly better than those in the control group (P<0.01, P<0.05). The scores of HAMD, FIM (cognition function) and general health, role-emotional, social function, vitality, mental health in SF-36 in the observation group 1 were significantly improved than those in the observation group 2 after treatment and 6 months later (P<0.01, P<0.05). The scores of NIHSS and role-physical in SF-36 in the observation group 1 were significantly higher than those in the observation group 2 6 months later (P<0.05). CONCLUSION: Acupuncture can improve depression symptoms and quality of life of patients with post stroke depression and the effects were better than Sertraline.

[Long-term effect of acupuncture on quality of life in patients with early stage of stroke].

OBJECTIVE: To study the long-term effects of acupuncture on quality of life in patients with early stage of stroke. METHODS: Eighty patients were randomly assigned to the acupuncture group and the control group, 40 in each. All received conventional Western medical treatment, but for patients in the acupuncture group, acupuncture was applied additionally immediately from 48 h after patients' life signs were stabilized. Curative effects were evaluated with scores of SF-36, function independent measure (FIM) and NIHSS. RESULTS: Effect evaluated immediately after acupuncture operation showed that all the scores in the acupuncture group, except score of recognition function in FIM, and scores of body pain and physical function in SF-36, were improved more significantly than those in the control group (P < 0.05). The effectiveness improved continuously in the 6-month period after stroke in both groups, but more superiority was shown in the acupuncture group in aspects of emotional function, social function and mental health by SF-36 (P < 0.05). CONCLUSION: Early applying acupuncture could raise the physical, social, and psychological functions of stroke patients. Although the effects might decrease to some extent later, acupuncture still showed markedly effect on patients' psychological and social functions as well as on their life satisfaction.

[Advances of clinical studies on acupuncture and moxibustion for treatment of periodontitis].

Periodontitis is a chronic inflammatory disease of multiple causes with easy relapse. It is difficult to be cured completely and permanently. The effectiveness of acupuncture and moxibustion therapy is rapid and reliably in treatment of pain and gingival swelling complicated by periodontitis. Combination of acupuncture and moxibustion with scaling, gargle had better effects in eliminating gingival inflammation, relieving periodontal packet and teeth mobility, which need to be confirmed by more clinical control researches with standard periodontal parameters and criteria of therapeutic effects.