Treating acute low back pain with acupuncture:A randomized controlled study protocol to compare the effectiveness between distal and local acupoints

Objective To compare the efficacy of using“distal acupoints only”vs.“local acupoints mainly combined with distal acupoints”in cases of acute low back pain(ALBP).Methods A total of 102 eligible patients aged 18–65 years with ALBP lasting less than 6 weeks will be randomized in a 1:1 ratio to the distal acupoints only group(DPOG)and the local acupoints mainly combined with the distal acupoints group(LPMG).During a 4-week treatment period,patients in the DPOG will receive acupuncture at distal acupoints only(Houxi[SI 3]and Yaotongxue[EX-UE 7])twice a week,while those in the LPMG group will receive acupuncture at local acupoints(mainly Shenshu[BL 23]and Dachangshu[BL 25])combined with distal points(Weizhong[BL 40]).The patients in both groups will be evaluated at every session of treatment,and the follow-up will be performed for 3 months.The primary outcome measure will be the change in ALBP intensity,assessed using visual analogue scale scores before and after treatment.The secondary outcome measure will be the evaluation of functional disability using the Oswestry Disability Index.Discussion This study compares the DPOG and LPMG to explore the feasibility of the DPOG in the treatment of ALBP.

Modified Zhibai Dihuang pill,a traditional Chinese medicine formula,on steroid withdrawal in systemic lupus erythematosus:A systematic review and meta-analysis

Background:Zhibai Dihuang pill(ZBDH),a Chinese herbal formula,has been widely used as an adjunctive therapy to help reduce the patient’s steroid dose and maintain low disease activity in systemic lupus erythematosus(SLE).Objective:This systematic review evaluates the therapeutic effect of modified ZBDH in reducing steroid use in patients with SLE.Search strategy:A systematic literature search was carried out using seven databases,including PubMed,Embase,Cochrane Central Register of Controlled Trials,Chinese Biomedical Literature Database,Chinese National Knowledge Infrastructure,Chinese VIP Information and Wanfang Database,from their inception to June 1 st,2019.The search terms included‘‘systemic lupus erythematosus,"‘‘Chinese medicine"and‘‘clinical trial,"and their synonyms.Subject headings matching the above terms were also used.Inclusion criteria:This meta-analysis included randomized controlled trials that evaluated the reduction of steroid dose in patients with SLE.Traditional Chinese medicine(TCM)formulas in experimental group should be prescribed based on ZBDH and used as adjunctive therapy and the comparator should contain steroids.Data extraction and analysis:Two authors independently conducted database search,study selection,data extraction and quality assessment.The extracted information contained study design,sample size,recruitment mode,diagnostic criteria,inclusion and exclusion criteria,participant characteristics,TCM patterns,TCM formulas and treatment outcomes.The primary outcome was the change of steroid dose.Secondary outcomes included SLE Disease Activity Index(SLEDAI),biomarkers of disease activity and clinical response rate.STATA 15.0 was used to analyze the pooled effects reported as weighted mean difference(WMD)or odds ratio,with a 95%confidence interval(CI).Results:In total,20 trials involving 1470 SLE patients were included.The pooled result showed that modified ZBDH taken in combination with standard care led to a larger reduction in steroid dose,compared to standard care alone(WMD:3.79;95%CI:2.58–5.01;P<0.001).Favorable outcomes were also seen in secondary outcome criteria,such as SLEDAI and complement 3.The modified ZBDH treatments were well tolerated without increasing adverse effects.Conclusion:The systematic review provided preliminary evidence supporting the use of ZBDH as a cotherapy to aid steroid dose reduction in patients with SLE.However,more rigorous studies should be conducted to validate these findings,and explore the mechanisms of ZBDH’s relevant bioactive constituents.