针刺临床试验中假针刺对照报告指南与清单(SHARE)

目的假针刺对照是针刺临床试验中常用的评价针刺特异性效应的对照方式。然而由于缺乏相应的报告规范,目前针刺临床试验中假针刺对照的报告质量较差。为规范假针刺对照的报告,提高其报告质量,项目组制订了针刺临床试验中假针刺对照报告指南与清单(sham acupuncture reporting guidelines and a checklist in clinical trials,SHARE)。方法研制过程包括四个部分:通过文献研究形成假针刺对照报告初始条目;开展两轮德尔菲调查评价假针刺对照报告初始条目的报告必要性;召开两次专家共识会议进一步讨论、共识德尔菲调查的结果,确定假针刺对照报告清单;最后,进行清单预测试以评价假针刺对照报告清单的可操作性与实用性,形成假针刺对照报告清单。结果SHARE清单包括10个方面,19个报告条目,主要从假针刺对照细节要素和相关背景因素等方面对假针刺对照提出了规范化报告要求。结论SHARE指南是专门针对假针刺对照的报告指南,为全面、清晰地报告假针刺对照提供了明确的指导。

Mechanism of electroacupuncture on inflammatory pain: neural-immune-endocrine interactions

Nociceptive signals are transmitted by peripheral afferents to the central nervous system under pain condition, a process that involves various neurotransmitters and pathways. Electroacupuncture (EA) has been widely used as a pain management technique in clinical practice. Emerging studies have shown that EA can inhibit the induction and transmission of pain signals and, consequently, mediate anti-nociceptive and anti-inflammatory effects by rebalancing the neural-immune-endocrine interactions. This review summarizes the neural-immune- endocrine circuit including peripheral afferent and central efferent, contributing to EA-induced neuroimmune and neuroendocrine modulation in inflammatory pain models. The peripheral afferent circuit includes crosstalk among immune cells, inflammatory cytokines, peripheral nociceptors. In central efferent primarily involves the neuroinflammatory interactions between spinal nociceptive neurons and glial cells. Furthermore, the hypothalamic- pituitary-adrenal axis, sympathetic and vagal nervous may serve as an essential pathway involved in the mechanism of acupuncture-mediated analgesia within the interactions of the central, immune and endocrine systems. Overall, this review focuses on the interactions of neural-immune-endocrine in inflammatory pain, which may be underlying the mechanism of EA-induced anti-inflammatory and antinociceptive effect.

Effect of moxa smoke produced during combustion of Aiye(Folium Artemisiae Argyi) on behavioral changes in mice inhaling the smoke

OBJECTIVE: To evaluate the effects that inhalation of the combustion products of the traditional Chinese herb Aiye(Folium Artemisiae Argyi) has on the central nervous system.METHODS: Forty Kunming mice(half male) were randomly assigned(n = 10/group) to a control group(C) or one of three moxa smoke concentration groups(% opacity): low(L1; 0.4%), medium(M1; 2%), and high(H1; 15%). Mice in the latter three groups were exposed to moxa smoke in a dynamic gas exposure cabinet for 20 min per day for7 days. Mice in control group were placed in the same cabinet without any intervention. For the sleep experiments, another 50 mice were divided into five groups of 10 mice each: a saline-injected control group, L1 + pentobarbital sodium(PS)-injected group, M1+PS group, H1(15%)+PS group,and a positive control group(10 mg/kg, chlorpromazine, p.o.). The weight, general activities, locomotor activities, rotarod performance, sleep duration,and sleeping rate induced by a subthreshold dose of pentobarbital sodium were recorded in the mice,and the composition of moxa smoke was analyzed using headspace gas chromatography(GC-HS).RESULTS: A low concentration of smoke significantly decreased the frequency of locomotor activities and the time for which the mice remaining on the rotarod; however, a high smoke concentration significantly prolonged the pentobarbital-induced sleeping time and sleeping rate.CONCLUSION: The concentration-dependent relaxing effects of moxa smoke on the Central Nervous System(CNS) were confirmed. Moreover, GC-HS analysis showed that the component present in the highest concentration in moxa smoke was eucalyp-tol, an essential oil well recognized for its soothing effects on the CNS. This may therefore be accountable for the sedative effects of moxa smoke.

Repeated exposure to moxa-burning smoke: its acute and chronic toxicities in rats

OBJECTIVE: To assess toxicities of the air in Chi-nese medicine clinics polluted by moxa-burning smoke due to moxibustion-derived burning products(MBP).METHODS: Both acute and chronic toxicity studies were conducted. For the acute toxicity study, five groups of Wistar rats(n = 16/group, male: female =1∶1) were exposed to five different concentrations(95%, 90%, 85%, 80% and 75%, respectively) of MBP for 2 h. For the chronic toxicity study, another three groups of male rats(n = 21/group) were exposed to MBP in three concentrations(10%, 40%and 70%, respectively) and one control group exposed to clean air 20 min/d for 144 d. Routine examinations were performed and analyzed by analysis of variance and dose-response relationship.RESULTS: In the acute toxicity study, the number of dead rats in the 95%, 90%, 85%, 80% and 75%groups were 16, 13, 7, 6 and 3, respectively, with LD50 of 86.274% after or during the 2 h exposure.In the chronic toxicity study, MBP exposure induced a decline in activity of the rats. Rats in the10% group showed no signs of toxicity, while those in the 40% MBP group showed toxicity effects on the body weights(P < 0.05) and lung. Rats in the70% MBP group also presented with reversible damage in the blood coagulation system(P < 0.05).CONCLUSION: Exposure to 10% MBP, which is equivalent to 27.45 mg/m3, was under the critical threshold for male rats' safety. Exposure to MBP above that limit induced lung damage. MBP in clinics need to be reduced to a safe level with enhanced ventilation.

Acupuncture for low back pain:a clinical practice guideline from the Hong Kong taskforce of standardized acupuncture practice

OBJECTIVE:To develop a clinical practice guideline to guide the treatment of low back pain by acupuncture.METHODS:An integrative approach of systematic review of literature,clinical evidence classification,expert opinion surveying,and consensus establishing via a Delphi program was utilized during the developing process.Both evidence-based practice standards and the personalized features of acupuncture were taken into considerations.RESULTS:Based on clinical evidence and expert opinions,we developed a clinical practice guideline for the treatment of low back pain with acupuncture.These recommendations have a wide coverage spanning from Western Medicine diagnosis and Traditional Chinese Medicine syndrome differentiation,to acupuncture treatment procedures,as well as post treatment care for rehabilitation and follow-ups.The recommendations for acupuncture practice included treatment principles,therapeutic regimens,and operational procedures.The levels of evidence and strength of recommendation were rated for each procedure of practice.CONCLUSION:A clinical practice guideline for acupuncture treating low back pain was developed based on contemporary clinical evidence and experts'consensus to provide best currently agreeable practice guideline for domestic and international stakeholders.

Twelve-week study of moxa smoke: occupational exposure in female rats

OBJECTIVE: To assess the toxicity of moxa smoke in rats.METHODS: Forty-eight female Wister rats were randomly divided into 4 groups(n = 12/group) to simulate moxa smoke exposure in Chinese medicine clinics(CMCs): the control group, and three moxa-smoke exposed groups of PM10 mass concentrations 3-5, 7-9 and 27-30 mg/m^3, respectively.These concentrations were 1 ×, 2-3 ×, and 7-9 ×fold the concentrations found in CMCs. Exposures continued for 12 weeks(200 min/d, 5 d/week).RESULTS: No deaths were noted. After the exposure, the body weights, ratios of organ weight to body weight, urinary parameters, hematological parameters, clinical chemistry parameters and microscopic examinations revealed no obvious toxicity.CONCLUSION: Moxa smoke did not induce toxic effects in female rats in the study. These findings provide new evidence to the toxicity of moxa smoke.