Traditional Chinese medicine interventions based on meridian theory for pain relief in patients with primary dysmenorrhea: a systematic review and network meta-analysis.

Objective: To determine the comparative effects and safety of traditional Chinese medicine (TCM) interventions based on meridian theory for pain relief in patients with primary dysmenorrhea (PD). Methods: This is a systematic review with network meta-analysis. Randomized controlled trials (RCTs) comparing meridian-based TCM interventions with waitlist, placebo, western medicine, and conventional therapies for PD pain. A SUCRA was used to estimate the probability ranking for the effects of interventions. Results: 57 RCTs involving 3,903 participants and 15interventions were included. Thirty-two RCTs were rated as low risk of bias. A network diagram was drawn with 105 pairs of comparisons. Compared with NSAIDs and waitlist, significantly better effects were found in acupressure [SMD = -1.51, 95%CI (-2.91, -0.12)/SMD = -2.31, 95%CI (-4.61, -0.02)], warm needling [SMD = -1.43, 95%CI (-2.68, -0.18)/SMD = -2.23, 95%CI (-4.43, -0.03)], moxibustion [SMD = -1.21, 95%CI (-1.85, -0.57)/SMD = -2.10, 95%CI (-3.95, -0.07)], and acupuncture [SMD = -1.09, 95%CI (-1.62, -0.55)/SMD = -1.89, 95%CI (-3.67, -0.11)]. No adverse events were detected. Conclusion: For PD pain, the effects of acupressure, acupuncture, warm needling, and moxibustion were superior to those of NSAIDs and waitlist. Oral contraceptive pill, electro-acupuncture, acupressure, and warm needling demonstrated higher probabilities of being better interventions. More high-quality clinical trials are needed to provide more robust evidence of this network. Systematic review registration: PROSPERO CRD42022373312.

Comparative study on curative effect and recurrence rate of chronic scapulohumeral periarthritis treated with different acupuncture techniques. / ä¸åŒé’ˆæ³•æ²»ç–—æ ¢æ€§è‚©å ³èŠ‚å‘¨å›´ç‚Žçš„ç–—æ•ˆåŠå¤å‘çŽ‡çš„å¯¹æ¯”ç ”ç©¶.

OBJECTIVES: To observe the effects of the local stimulation with 3 acupuncture techniques, i.e. Canggui Tanxue (needle insertion method like dark tortoise detecting point) technique, electroacupuncture (EA) and warm needling (WN) with filiform needles on shoulder pain, shoulder joint function, quality of life, inflammatory indicators and recurrence rate in the patients with chronic scapulohumeral periarthritis (CSP), so as to explore the optimal needling method of acupuncture for the predominant symptoms of CSP during the attack stage in the patients. METHODS: A total of 108 patients with CSP were randomly divided into a manual acupuncture (MA) group (36 cases, one case dropped off), a WN group (36 cases, 3 cases dropped off) and an EA group (36 cases, 1 case dropped off). In the three groups, Jianqian (EX-UE12), Jianyu (LI15), Jianzhen (SI9), Ashi (Extra) and Yanglingquan (GB34) on the affected side were selected. Canggui Tanxue needling technique, WN technique and EA were delivered in the MA group, the WN group and the EA group, respectively, 30 min each time, 3 times weekly for 4 weeks. The Neer test scores were compared；the visual analogue scale (VAS) was used to assess the degree of shoulder joint pain；the daily life activity abilities was evaluated using the activities of daily living (ADL) scale；the serum prostaglandin E2 (PGE2) content was measured using ELISA before and after treatment. The effectiveness rate and recurrence rate were calculated, and the occurrences of adverse reactions were recorded. RESULTS: Compared with the scores before treatment, the scores of pain, joint function, and range of motion as well as the total score of Neer test were all increased after treatment in the three groups (P<0.05)；the VAS score, ADL score and the content of serum PGE2 were decreased (P<0.05). After treatment, the pain score of Neer test in the EA group and the WN group were higher than those of the MA group (P<0.05), the joint function score of Neer test in the MA group and the WN group were higher than that of the EA group (P<0.05), and the range of motion score of Neer test in the MA group was higher when compared with the EA and WN groups (P<0.05). There was no statistical difference in the total score of Neer score among the three groups. VAS score in the EA group was lower than that of either the WN group or the MA group (P<0.05). ADL score in the MA group was lower compared with that of the WN group (P<0.05). PGE2 levels in both the WN group and the MA group were lower than that of the EA group (P<0.05). The total effective rate was 85.71% (30/35) in the MA group, 91.43% (32/35) in the EA group and 90.91% (30/33) in the WN group, there was no statistical differences among the three groups. At the end of the 6-month follow-up visit after treatment, there was no significant difference in the recurrence rate among three groups. No serious adverse reaction was found. CONCLUSIONS: In the treatment of CSP, the short-term effect is equivalent among EA, WN and MA. But, the analgesic effect is the best in the EA group, the treatment for anti-inflammation is the most effective in the MA and WN groups, and the needling technique of Canggui Tanxue in the MA group obtains the most favorable effect of releasing adhesion and recovering the range of motion in the shoulder joint.

[An anti-scald device for warm needling].

Warm needling, i.e. acupuncture with the needle warmed by burning moxa stick or cone, is frequently employed in the treatment of cold and dampness type disorders. During treatment, accidental skin scald may occur if the burning moxa drops on the skin due to slight changes in patient's body position. Thus, we designed and developed an anti-scald device for warm needling which is suitable for any part of the body. This device is made up of two parts, a stainless steel-grid moxa cartridge (including half cylinder, hinge shaft, lug, limit bar, clamping arm, connecting arm, torsion spring, heat insulation pad, through holes) and a clamp holder which is in an integrated structure. The grid moxa cartridge can be used to wrap the burning mugwort cone in all directions to prevent the ignited moxa-cone from falling and skin scalding, and effectively collect the burned moxa ash. At the same time, the clamp holder can be used to help fix the moxa-cone to increase the stability of warm needling operation. The device is convenient to operate and novel in design, can effectively reduce the occurrence of scald accidents in clinical treatment, save time and manpower, and has both economic and ecological benefits, being helpful to the promotion and use of warm needling.

Systematic Review and Meta-Analysis of Efficacy and Safety of Fire Needling and Warm Needling on Acute Gout.

Objectives: This study aimed to evaluate the efficacy and safety of heat stimuli (e.g., fire needling, warm needling) in acupuncture for acute gout. Methods: Four international online databases (PubMed, Cochrane, Embase, and Chinese National Knowledge Infrastructure) were searched to identify randomized, controlled trials (RCTs) that used fire needling and warm needling for acute gout. The methodological quality of the RCTs was evaluated using the Cochrane risk-of-bias (RoB) tool. Thirteen RCTs (840 patients) were included and analyzed. Three evaluation tools (total effective rate, uric acid level, and pain score) were mainly used. Comparisons were made between Western medicine (WM) and i) fire needling or warm needling treatment alone, ii) fire needling and bloodletting combination treatment, iii) combination of fire needling, bloodletting, and herbal medicine, iv) warm needling (concurrently). Heat stimuli in acupuncture alone or in combination treatment were more effective in terms of the total efficacy rates, uric acid levels, and pain scores than WM alone. Results: In all the evaluation tools, the treatment effects in the fire needling alone or warm needling alone treatment group and the fire needling and bloodletting combination intervention group were significantly better than those in the WM control group. The warm needling and WM combination intervention groups also experienced significantly better treatment effects in terms of total efficacy rates and uric acid levels. Only the pain scores in the fire needling, bloodletting, and herbal medicine combination groups demonstrated significant improvement. Only four studies mentioned adverse reactions one reported loss of appetite; three studies reported none. According to the Cochrane RoB tool, most studies showed either high or uncertain RoB. Conclusion: Heat stimuli during acupuncture could be effective for acute gout. However, as the included studies were regionally biased, more high-quality studies are needed to confirm the level of evidence.

[Clinical observation of acupotomy combined with warm needling for cervical spondylotic radiculopathy of qi and blood stagnation syndrome].

OBJECTIVE: To observe the clinical effect of acupotomy combined with warm needling on cervical spondylotic radiculopathy (CSR) of qi and blood stagnation syndrome. METHODS: A total of 90 CSR patients were randomly divided into an acupotomy group, a warm needling group and a combined treatment group, with 30 cases in each group. The patients in the acupotomy group were treated with acupotomy, once every 7 days, consecutively for 3 times. The patients in the warm needling group received warm needling, once daily, at the interval of 2 days after consecutive treatments for 5 days, 7 days as one session of treatment and 3 consecutive sessions were required. The patients in the combined treatment group were treated with acupotomy and warm needling, and the methods and the treatment session were same as the the previous two groups. Before and after the treatment, the pain rating index (PRI) of McGill pain questionnaire (MPQ) and the 20-point scale of CSR developed by Yasuhisa Tanaka (CSR20) were adopted in the assessment. The changes of clinical symptoms and functions of patients were observed and the clinical efficacy was assessed in each group. RESULTS: After the treatment, the PRI score was decreased (P<0.05) and the CSR20 score was increased (P<0.05) in the 3 treatment groups when compared with those before the treatment. After the treatment, compared with the acupotomy group and the warm needling group, the PRI score was decreased (P<0.05) and the CSR20 score was increased (P<0.05) in the combined treatment group. The total effective rate was 83.3% (25/30) in the acupotomy group, 76.7% (23/30) in the warm needling group and 93.3% (28/30) in the combined treatment group. The total effective rate in the combined treatment group was higher than those in the acupotomy group and the warm needling group (P<0.05). CONCLUSION: The combined treatment with acupotomy and warm needling may obviously improve the clinical symptoms and physical signs, e.g. pain and numbness in the patients with CSR of qi and blood stagnation syndrome. Its efficacy is remarkably higher than that of the simple application of acupotomy or warm needling.

[Effect of balance acupotomy combined with warm needling in treatment of cervical spondylosis of vertebral artery type].

OBJECTIVE: To observe the clinical efficacy of balance acupotomy combined with warm needling in treatment of cervical spondylopathy of vertebral artery type (CSA). METHODS: Ninety patients were randomly divided into a warm needling group, a balance acupotomy group and a combined treatment group, 30 cases in each one. In the warm needling group, warm needling was given, once daily, for 5 days consecutively, with the interval of 2 days every week, and the treatment was conducted for 3 weeks. In the combined treatment group, on the base of the treatment as the warm needling group, the balance acupotomy was exerted, for consecutive 3 weeks. In the balance acupotomy group, the balance acupotomy was adopted, once a week, for 3 weeks consecutively. Clinical efficacy, the mean blood flow velocity of left vertebral artery (LVA), right vertebral artery (RVA) and basilar artery (BA), the pulse index (PI) and the resistance index (RI) were observed in 3 groups separately. The score of vertigo symptom and function was compared before and after treatment in 3 groups. RESULTS: In comparison with before treatment, the score of evaluation scale for cervical vertigo (ESCV) and the mean blood flow velocity of LVA, RVA and BA were all increased (P<0.05). while PI and RI reduced (P<0.05) in each group after treatment. In comparison with those in the warm needling group and the balance acupotomy group, ESCV score and the mean blood flow velocity of LVA, RVA and BA were increased (P<0.05), while PI and RI decreased (P<0.05) in the combined treatment group after treatment. Compared with the balance acupotomy group, the mean blood flow velocity of LVA, RVA and BA was increased (P<0.05), and PI and RI reduced (P<0.05) in the warm needling group after treatment. The total effective rate was 73.3% (22/30) in the warm needling group, 70.0% (21/30) in the balance acupotomy group and 93.3% (28/30) in the combined treatment group respectively. The total effective rate in the combined treatment group was higher than that either in the warm needling group or in the balance acupotomy group (P<0.05). CONCLUSION: Balance acupotomy combined with warm needling may restore the mechanical equilibrium state of the neck, and effectively improve the change of vertebral-basilar artery blood flow and relieve vertigo symptoms in patient with of cervical spondylosis of vertebral artery type.

A systematic review and meta-analysis of the comparative curative effects of warm acupuncture and other traditional Chinese medicines in the treatment of knee osteoarthritis.

BACKGROUND: Knee osteoarthritis (KOA) is more common in middle-aged and elderly people, and seriously affects the quality of life of those affected. Traditional Chinese medicine (TCM) treatment of KOA has been widely recognized. In recent years, warm needling acupuncture (WNA) has been used to treat KOA and has achieved good results. However, there is a lack of comparison of the efficacy of WNA and other TCM treatments for KOA. METHODS: We conducted a search for reports of WNA and/or TCM treatment of KOA in English- and Chinese-language databases. The data was retrieved from inception of the database until October 2021. The Cochrane risk of bias tool was used to evaluate the quality of the included studies, and the network meta-analysis was performed using the software RevMan 5.20. RESULTS: A total of 8 articles met the inclusion criteria, including 399 patients treated with WNA (WNA group), and 396 patients treated with other TCM (TCM group). The results of meta-analysis showed that compared with patients in the TCM group, the effective rate [relative risk (RR)] was 1.18, 95% confidence interval (CI): 1.06 to 1.33, the last follow-up osteoarthritis index [mean difference (MD)] was -6.93, 95% CI: -12.14 to -1.72, and the last follow-up knee pain visual analogue scale (VAS) MD was -1.06, 95% CI: -1.61 to -0.51, which were all statistically significant. However, the difference in daily activities (MD: -4.31, 95% CI: -10.90 to 2.28) was not statistically significant. DISCUSSION: Compared with other TCM treatments for KOA, WNA has better overall patient efficacy. However, further randomized controlled studies are needed to compare WNA and other TCM treatments individually to confirm the efficacy of WNA.

Efficacy of electroacupuncture plus warm needling therapy for plantar heel pain: a randomised waitlist-controlled trial.

OBJECTIVE: To investigate the therapeutic effects of electroacupuncture plus warm needling (EAWN) therapy on pain and foot function in adults with plantar heel pain (PHP). METHODS: This prospective, randomised, parallel-group, waitlist-controlled trial was conducted at a Chinese medicine centre in Hong Kong between May 2018 and February 2019. Eighty eligible community-dwelling subjects with PHP (mean age 59.7 years; 85% female) were equally randomised to receive EAWN therapy or remain on a waitlist. The treatment group received six 30-min sessions of standardised EAWN therapy over 4 weeks; the control group received no treatment. The outcome measures were the visual analogue scale (VAS) score for first-step pain, foot function index (FFI) scores and global rating of change (GRC) scale scores. Assessments were made at baseline, week 2 and week 4 (primary endpoint). The treatment group underwent additional assessments at week 8. Outcomes were evaluated by intention-to-treat analysis. RESULTS: Patients who received EAWN therapy exhibited greater improvements in the mean first-step pain VAS and all FFI scores than did those in the control group at weeks 2 and 4, with significant between-group differences (all P < 0.001). Compared with baseline, there were significant decreases in mean first-step pain VAS scores at weeks 2 and 4, and FFI scores at week 4, in the treatment group but not in the control group. The improvements in the treatment group continued until week 8. GRC scores at week 4 indicated improvement in all treated patients and only 22.5% of the control group patients (P < 0.001). There were no study-related adverse events. CONCLUSION: EAWN therapy could be an effective treatment for PHP in middle-aged and older adults. TRIAL REGISTRATION NUMBER: ChiCTR1800014906 (Chinese Clinical Trials Registry).

Different kinds of acupuncture treatments for knee osteoarthritis: a multicentre, randomized controlled trial.

INTRODUCTION: Knee osteoarthritis (KOA) is a chronic disease with symptoms of persistent pain or resting pain, joint stiffness, numbness, limitation of activity and even disability, with significant associated costs and effects on individuals' life quality. The use of acupuncture for the management of chronic pain is receiving increasing recognition from both the public and professionals. The aim of this study is to identify the effects of three commonly used acupuncture treatments for KOA. METHODS/ANALYSIS: In a prospective trial involving six hospitals in Zhejiang Province (China), 360 patients with KOA will be included. Eligible patients will be randomized into six groups: Acupuncture, Electro-acupuncture, Mild moxibustion, Warm-needling, Sham acupuncture and Celebrex treatment. Twelve treatment sessions will be performed over a 4-week period. The primary outcome will be the visual analogue scale and Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC) function scores (the average of the past 3 days) at weeks 2 and 4 and at 3-month and 6-month follow-up. Secondary outcome measures will be as follows: the WOMAC pain score and WOMAC stiffness score (the average of the past 3 days); the Physical Activity Scale of the Elderly (PASE); knee joint swelling measurement; the WHO Quality Of Life-BREF (WHOQOL-BREF) life quality scale; and the incidence of adverse events. TRIAL REGISTRATION: ClinicalTrials.gov, NCT03563690. Registered on 2rd July 2018.

Efficacy and safety of electroacupuncture plus warm needling therapy for heel pain: study protocol for a randomized controlled trial.

BACKGROUND: Heel pain is a common foot disorder that causes pain and functional limitations. The prevalence of disabling foot pain will increase as the population ages. Previous studies have reported the positive therapeutic effects of electroacupuncture, warm needling, or the combination of both for heel pain but with limitations in the study methodologies. The current study is a rigorously designed randomized controlled trial that aims to evaluate the clinical efficacy and safety of electroacupuncture plus warm needling therapy in patients with heel pain. METHODS/DESIGN: The study protocol describes a prospective, open-label, parallel-group, randomized controlled trial to be conducted in Hong Kong. Eighty patients aged 50-80 years who have reported heel pain and first-step pain equal to or exceeding 50 mm on the 100-mm visual analog scale (VAS) will be recruited. They will be randomly assigned (1:1 ratio) to the electroacupuncture plus warm needling therapy (i.e., treatment) group or the waitlist (i.e., control) group. The treatment group will undergo six treatment sessions in 4 weeks. The control group will receive no treatment during the study period. The primary outcome measure is a mean change in the first-step pain VAS score from the baseline to week 4. Secondary outcome measures include a mean change in first-step pain VAS score from the baseline to week 2, a mean change in Foot Function Index (FFI) subscale scores and the total score from the baseline to week 2 and week 4, and patients' self-reported level of improvement at week 4. Additional week 8 follow-up assessments with first-step pain VAS and FFI measurements will be arranged for the treatment group. Any adverse events will be recorded throughout the study to evaluate safety. An intention-to-treat approach will be used to analyze the study results. DISCUSSION: This study will provide evidence on the efficacy and safety of electroacupuncture plus warm needling therapy as an alternative treatment method for heel pain. The findings will determine whether the treatment protocol is efficacious in relieving pain and improving foot function among older adults with heel pain. The study will also provide information for subsequent large-scale randomized controlled trials in the future. TRIAL REGISTRATION: Chinese Clinical Trial Registry, ChiCTR1800014906 . Registered on 12 February 2018.

[Therapeutic effects on primary dysmenorrhea treated with moxibustion at Shenque (CV 8) and warm needling at Guanyuan (CV 4) and Sanyinjiao (SP 6)].

OBJECTIVE: To explore the clinical effects on primary dysmenorrhea treated with moxibustion at Shenque (CV 8) and warm needling at Guanyuan (CV 4) and Sanyinjiao (SP 6). METHODS: A total of 120 patients with primary dysmenorrhea were randomized into an observation group and a control group, 60 cases in each one. In the control group, the warm needling technique was used at Guanyuan (CV 4) and Sanyinjiao (SP 6). In the observation group, besides the same treatment as the control group, moxibustion was added at Shenque (CV 8). The treatment was given for 4 menstrual cycles consecutively. Before and after treatment, the score of the severity and the score of the total frequency in the retrospective scale of dysmenorrhea symptoms as well as the score of the visual analog scale (VAS) were recorded and compared in the patients between the two groups. Additionally, the safety of the two therapeutic methods was evaluated. RESULTS: After treatment, the score of severity and the score of total frequency as well as VAS score of menstrual pain were all reduced as compared with those before treatment in the patients of the two groups (all P<0.05). The scores in the observation group were more obvious as compared with the control group (all P<0.05). Regarding the safety evaluation, the difference was not significant between the two groups (P>0.05). CONCLUSION: The combined treatment of moxibustion at Shenque (CV 8) with the warm needling technique at Guanyuan (CV 4) and Sanyinjiao (SP 6) achieves the better clinical effects on primary dysmenorrhea as compared with the simple application of the warm needling technique at Guanyuan (CV 4) and Sanyinjiao (SP 6). This therapy is safety in clinical practice.

[Analysis on the temperature-time curve in warm needling manipulation with acupuncture needles of different materials].

OBJECTIVE: To analyze the characteristics of the temperature-time curve in warm needling manipulation with the acupuncture needles made of copper, silver, gold and stainless steel and explore the applicable temperature range and most suitable needle materials of warm needling manipulation in clinical practice. METHODS: A total of 10 healthy subjects were included. Using the digital thermometer, with different moxibustion dose (1.2 g or 1.5 g, moxa), the temperature was measured at the site where the skin contacts with the needle body during the warm needling manipulation with stainless steel needle, copper needle, gold needle and sliver needle separately. The initial heat pain threshold (the temperature when hot feeling started) and the burning pain threshold (feeling very hot but tolerable) were recorded when using the different needles mentioned above. Through the subject questionnaire, the comfort degree, the heat sensation, the adverse reaction and the acceptability to warm needling manipulation with the different needles were investigated. RESULTS: During the warm needling manipulation, the initial heat pain threshold was (42.8±2.7) ℃ and the burning pain threshold was (46.7±2.9) ℃. The strongest warm stimulation was presented in the warm needling manipulation with 1.5 g moxa and silver needle and the highest temperature was (55.5±6.3) ℃, followed by (52.9±4.2) ℃ with 1.2 g moxa and silver needle, (46.6±3.7) ℃ with 1.5 g moxa and gold needle, (46.6±1.9) ℃ with 1.5 g moxa and copper needle, (43.1±1.5) ℃ with 1.2 g moxa and copper needle and (41.7±0.9) ℃ with 1.5 g moxa and stainless steel needle. The sequence of the maintaining time of the initial heat pain threshold over 43℃ was 480 s with silver needle and 1.5 moxa, 325 s with silver needle and 1.2 g moxa, 270 s with gold needle and 1.5 g moxa, 185 s with copper needle and 1.5 g moxa, 42 s with copper needle and 1.2 g moxa and 0 s with stainless steel needle and 1.5 g moxa successively. The heat score graded by the subjects to the warm needling manipulation with different needles, from high to low, was presented in the manipulation with 1.5 g moxa and silver needle, 1.2 g moxa and silver needle, 1.5 g moxa and copper needle, 1.5 g moxa and gold needle, 1.2 g moxa and copper needle and 1.5 g moxa and stainless steel needle. The VAS score was different significantly in comparison among the six needles in warm needling manipulation (P<0.001). The comfort degree of the subjects in the warm needling manipulation with silver needle and 1.5 g moxa was significantly lower than the warm needling manipulation with the other 5 materials (P<0.05). Three subjects complained that the warm needling manipulation with silver needle and 1.5 g moxa was too hot to be tolerable and the most of subjects were willing to accept warm needling manipulation with these 6 materials (acceptability 70.0% to 100.0%). Except blisters presented in 9 subjects after warm needling manipulation with silver needle and 1.5 g moxa, no severe adverse reaction occurred in warm needling manipulation with 6 materials. CONCLUSION: In the warm needling manipulation in the human body, the initial heat pain and the burning pain threshold were 43 ℃ and 47 ℃ respectively, which is the applicable temperature range of moxibustion in clinical practice. The warm needling manipulation with silver needle induces a quite strong heat stimulation and the discomfort may be caused when the temperature is exceeded to some threshold. The warm needling manipulation with copper needle generates the onset temperature, without inducing adverse reactions, e.g. discomfort and burning in the subjects.

[The effect of warm needling pretreatment for endometrial receptivity of frozen embryo transfer].

OBJECTIVE: To explore the effect of warming needling pretreatment for endometrial receptivity before frozen-thawed embryo transfer (FET). METHODS: Fifty-six repeatedly embryo transfer (ET) failure patients with ultrasound showing follicular phase endometrium of C type, hysteroscopy examination presenting endometritis were randomly assigned into an observation group (25 cases) and a control group (31 cases). The patients in the observation group three months before ET were treated with antibiotics in the menstrual period, warming needle (once a day) at Zhongwan (CV 12), Tianshu (ST 25), Guanyuan (CV 4), Zhongji (CV 3), Zigong (EX-CA 1), Liangqiu (ST 34), Zusanli (ST 36), Shangjuxu (ST 37), Xiajuxu (ST 39) after menstruation until the ovulation stopped, and oral administration of progesterone was applied after ovulation. The patients in the control group three months before ET were treated with antibiotics in the menstrual period, and oral administration of progesterone was applied after ovulation. Continuous three menstrual periods were carried out for the both groups. The changes of endometrial thickness, type and endometrial blood flow and the outcome of FET were observed. RESULTS: Endometrial morphology and blood flow were improved after treatment in the two groups (all P<0.01), with better results in the observation group (both P<0.01). The embryo transplantation rate and pregnancy rate in the observation group were higher than those in the control group (both P<0.01), and the early abortion rate decreased (P<0.01). CONCLUSIONS: Warm needling may improve endometrial receptivity, embryo transplantation rate and pregnancy rate and decrease early abortion rate by regulating endometrial morphology and blood flow.

Warm-needling acupuncture and medicinal cake-separated moxibustion for hyperlipidemia: study protocol for a randomized controlled trial.

BACKGROUND: Acupuncture and moxibustion has been widely applied to hyperlipidemia treatment in clinical practice in China, serving as an alternative treatment to statins. Warm-needling acupuncture and medicinal cake-separated moxibustion have been separately reported with potential therapeutic effects on hyperlipidemia treatment in several studies but with limitations in study methodology. Combining these two modalities may provide a more advantageous strategy in treating hyperlipidemia. Therefore, a strict evaluation through well-designed randomized controlled trials (RCT) is necessary to determine their efficacy and safety on hyperlipidemia. METHODS: The study a multicenter, open-label, randomized, stratified, active-controlled, noninferiority trial with two parallel groups. Subjects with hyperlipidemia will be stratified into different groups by risk levels of heart diseases. They then will be instructed to the Therapeutic Lifestyle Change (TLC) diet. Those who have not reached the target lipid level will be randomly assigned to the treatments of either acupuncture and moxibustion or simvastatin with a 1:1 allocation. One hundred and thirty subjects are aimed to be recruited. The duration of intervention for this study will be 12 weeks, followed by another 4 weeks for post-treatment assessment. The primary outcome is percentage change from baseline to the end of the study in low-density lipoprotein cholesterol (LDL-C). Other indicators in lipid change, safety and adherence will also be assessed secondarily. The repeated measures, linear mixed-effects model will be applied to the analysis. DISCUSSION: Acupuncture and moxibustion could be a potentially effective treatment alternative for hyperlipidemia. A study with careful design is developed to evaluate the efficacy and safety of combined acupuncture and moxibustion, by integrating the traditional Chinese Medicine (TCM) regimens with the standardized Western medicine appraisal approach. TRIAL REGISTRATION: ClinicalTrials.gov, NCT02269046 . Registered on 26 September 2014.

[Warm-needling moxibustion for knee osteoarthritis:a randomized controlled trial].

OBJECTIVE: To evaluate the clinical efficacy of warm-needling moxibustion for knee osteoarthritis (KOA), and to explore its effects on isokinetic strength of lower limb muscle. METHODS: Fifty cases of KOA were randomly divided into an observation group (25 cases) and a control group (21 cases), but 4 cases lost contact. The observation group was treated with warm-needling moxibustion at Dubi (ST 35), Neixiyan (EX-LE 4), Xuehai (SP 10), Liangqiu (ST 34), Yinlingquan (SP 9), Yanglingquan (GB 34), Weizhong (BL 40), Heyang (BL 55) and Fengshi (GB 31) for 40 min per treatment. The first 6 treatments were given once a day, and the last 6 treatments were given once every other day. 12 treatments were taken as one course, and totally 3-week treatment was given. No treatment was given in the control group for 3 weeks. The isokinetic strength of extensor muscle and flexor muscle, including the total work, absolute peak torque (aPT) and relative peak torque (rPT), and Western Ontario and McMaster Universities Arthritis Index (WOMAC), and comprehensive efficacy were observed and compared in the two groups. RESULTS: Compared before treatment, the total work, aPT and rPT of the extensor and flexor muscle increased significantly after treatment in the observation group (P<0.01, P<0.05), but the flextion/extention ratio was lowered (P<0.05). In the control group, aPT and rPT of flexor muscle were reduced after treatment (P<0.05, P<0.01). The total work, aPT and rPT of the extensor muscle in the observation group were higher than those in the control group after treatment (P<0.05, P<0.01), but the flextion/extention ratio was lowered (P<0.05). The item score and total score of WOMAC were reduced in the observation group after treatment (all P<0.01), but no significant change was observed in the control group (all P>0.05). The pain score, stiffness scores and total score of WOMAC in the observation group were lower than those in the control group (P<0.01, P<0.05); the score of daily function activities was declined in the observation group, but not significantly different from that in the control group (P>0.05). The total effective rate was 88.0% (22/25) in the observation group. CONCLUSIONS: Warm-needling moxibustion could relieve pain, improve function and muscle balance, strengthen extensor and flexor muscle power, especially extensor, which has superior clinical efficacy.

Efficacy and safety of using a warming needle for persistent allergic rhinitis: study protocol for a randomized controlled trial.

BACKGROUND: Many previous studies have shown the potential therapeutic effect of acupuncture for allergic rhinitis. Most of these studies, however, were limited by the short duration of observations and lack of sham acupuncture as the control group. Our preliminary experiments showed that the use of a warm needling achieved a much more persistent effect in the treatment of allergic rhinitis (AR) compared with simple acupuncture therapy. Hence, we have designed a multicenter, randomized controlled trial (RCT) in which the first-line medication loratadine will be used as the control group, and the effect of warm needling therapy will be evaluated through long-term observation. METHODS/DESIGN: The trial is designed as a multicenter, parallel-group, randomized, single-blinded (outcome assessors), non-inferiority trial. A total of 98 patients with persistent AR will be randomly assigned into two groups. Patients in the treatment group will be treated with warm needling at GV14 and acupuncture at EX-HN3, ST2, LI20, EX-HN8, GV23, LU7, LU5 and LI4 three times a week, for a total of 4 weeks. Patients in the control group will be treated with oral loratadine 10 mg/day for 4 weeks. The primary outcome will be the change in the Total Nasal Symptom Score (TNSS) from baseline to that at 6 months after treatment during the follow-up period. The secondary outcomes will include the Total Non-nasal Symptom Score and the Rhinoconjunctivitis Quality of Life Questionnaire, changes in the TNSS from baseline to that at 2 and 4 weeks during treatment, and 3 months after treatment during the follow-up period. Outcomes will be measured at 2 and 4 weeks, and 3 and 6 months after treatment. Any side effects of treatment will be observed and recorded. DISCUSSION: We expect that the study results will provide evidence to determine the effects of warm needling compared with loratadine. Our final goal of the study is to evaluate the difference in the short-term and long-term effects between the two therapeutic methods, especially the long-term effect of warm needling. TRIAL REGISTRATION: ClinicalTrials.gov NCT02339714 . Registered on 14 January 2015.

[Long-snake moxibustion for rheumatoid arthritis:a randomized controlled trial].

OBJECTIVE: To observe the clinical efficacy differences among long-snake moxibustion, warm needling and western medication on rheumatoid arthritis and explore its effect mechanism. METHODS: One hundred and twenty patients were randomized into a long-snake moxibustion group, a warm needling group and a western medication group, 40 cases in each one. In the long-snake moxibustion group, the long-snake moxibustion was used. The ginger-isolated moxibustion was applied along the governor vessel, from Dazhui (GV 14) to Yaoshu (GV 2), once a month, for 2 months. In the warm needling group, the main points included Dazhui (GV 14), Ganshu (BL 18), Pishu (BL 20), Shenshu (BL 23), Zhiyang (GV 9), Mingmen (GV 4) and Yaoyangguan (GV 3). The warm needling technique was used at 4 to 5 points each time, and 3 moxa cones were required at each points. The treatment was given once every two days, for 2 months. In the western medication group, methotrexate was prescribed for oral administration, 10 mg each time, once a week. If the joint pain score or joint swelling score was up to 6, diclofenac sodium was combined, 25 mg each time, 3 times a day, for 2 months. The symptom score, physical sign score, the visual analogue scale (VAS) score, levels of rheumatoid factor (RF), erythrocyte sedimentation rate (ESR) and C-reactive protein (CRP), immunoglobulin M (IgM) and immunoglobulin G (IgG) were observed before and after treatment in the patients of the three groups. RESULTS: The treatments relieved the symptoms and physical signs of rheumatoid arthritis and improved VAS score and the levels of serum RF, ESR, CRP, IgM and IgG in all of the three groups (all P<0.01). The efficacy in the long-snake moxibustion group was significantly better than that in the warm needling group and the western medication group (P<0.05, P<0.01). CONCLUSIONS: The long-snake moxibustion achieves the significant clinical efficacy on rheumatoid arthritis, better than warm needling therapy and methotrexate. This therapy much better reduces immune response and alleviates the sickness.

On the hazard caused by the heat of acupuncture needles in warm needling (wen zhen).

Due to its simplicity and convenience, acupuncture has become popular as a complementary therapy. In this Chinese medicine, doctors have to find the traditional meridian acupuncture points before puncturing the needles into them. Moxibustion ( Ài Jiǔ) is also an important part of the acupuncture remedy. Treatment by acupuncture can be classified roughly into two types - direct moxibustion and indirect moxibustion. Warm-needling acupuncture ( Wen Zhen Jiǔ) is classified under the method of indirect moxibustion. In the present study, 10 standard stainless steel acupuncture needles with 10 pieces of cylinder-shaped moxa cone ( Ài Zhù) as the heat source of warm needles were used. In order to prevent the practitioners from getting burns, it is necessary to study the temperature changes in some designated parts of the needles. Two sizes, 0.6 g and 1.0 g, of moxa cones were used for comparison of the measured temperatures. The needles are typically divided into two parts - the handle part and the needle body. In our experiment, the temperatures of WNA at different parts of the needles were measured. The larger the size of moxa cone is, the longer is the burning time. Based on the observations we suggest that when 0.6 g moxa is used, the physicians should better pick out the needles around 9 min after ignition; however, while using the 1 g moxa, it might be safer to pick out the needles around 13 min after ignition.