Clinical research on Tai Chi:a review of health benefits

Tai Chi,a traditional Chinese martial art and health exercise,has gained significant global attention and recognition.The clinical benefits of Tai Chi have been studied extensively in recent decades.We conducted a systematic search of PubMed,Web of Science,EMBASE databases,and the China National Knowledge Infrastructure,identifying and reviewing 241 clinical trials on the benefits of Tai Chi from their inception to June 1,2023.Most of these studies have consistently demonstrated the positive impact of Tai Chi on balance,cognitive function,mood regulation,sleep quality,pain relief,cardiorespiratory function,and overall health.In the future,the key to fostering the ongoing development of this field lies in comprehensive research on standardized study designs and reporting,the scope of Tai Chi applications,and the core factors influencing its efficacy.

Disease-Related Factors Associated with Acupuncture Response in Patients with Chronic Tension-Type Headache:A Secondary Analysis of A Randomized Controlled Trial

Objective: To explore the demographic and disease-related factors associated with acupuncture response in patients with chronic tension-type headache(CTTH). Methods: Using data from the randomized clinical trial(218 cases) consisting of 4 weeks of baseline assessment, 8 weeks of treatment, and 24 weeks of follow-up, participants were regrouped into responders(at least a 50% reduction in monthly headache days at week 16 compared with baseline) and non-responders. Twenty-three demographic and disease-related factors associated with acupuncture response in 183 participants were analyzed by multivariable logistic regression. Results: One hundred and nineteen(65.0%) participants were classified as responders. Four factors were significantly independently associated with acupuncture response, including treatment assignment, headache intensity at baseline, and 2 domains [general health(GH) and social functioning(SF)] from the 36-Item Short Form Health Survey quality of life questionnaire. Treatment assignment was associated with nonresponse: participants receiving true acupuncture were 3-time more likely to achieve a CTTH response than those receiving superficial acupuncture [odds ratio(OR) 0.322, 95% confidence interval(CI) 0.162 to 0.625, P=0.001]. Compared with patients with mild-intensity headache, patients with moderate-intensity headache were twice as likely to respond to acupuncture(OR 2.001, 95% CI 1.020 to 4.011, P=0.046). The likelihood of non-response increased by 4.5% with each unit increase in the GH grade(OR 0.955, 95% CI 0.917 to 0.993, P=0.024) while decreased by 3.8% with each unit increase in the SF grade(OR 1.038, 95% CI 1.009 to 1.069, P=0.011). Conclusions: Greater headache intensity, lower GH score, and higher SF score were associated with better acupuncture responses in CTTH patients. These 3 factors require independent validation as predictors of acupuncture effectiveness in CTTH.

The neuroprotection of electro-acupuncture via the PGC-1α/TFAM pathway in transient focal cerebral ischemia rats

ATP depletion is one of the pathological bases in cerebral ischemia.Electro-acupuncture(EA)is widely used in clinical practice for ischemia.However,the mechanism of EA remains unclear.The purpose of this study was to investigate whether EA could activate the AMPK/PGC-1α/TFAM signaling pathway and,consequently,increase the preservation of ATP in rats with ischemia.In this study,48 rats were randomly divided into four groups as a sham-operation control group(sham group),a middle cerebral artery occlusion group(MCAO group),an EA group,and an EA group blocked by the AMPK inhibitor compound C(EA+CC group)(N=12/group).The rats of the EA group and EA+CC group received the EA treatment for 7 days.The rats that belonged in the two remaining groups were only grasped in the same condition.Then,their brain tissues were collected for further detection.When compared with other groups,EA significantly reduced neurological deficits score and increased motor function.The cerebral infarction volume was significantly reduced in the EA group according to TTC staining.With western blot,we found that EA improved the ratio of p-AMPKα/AMPKα(P<0.05),however,there is no difference between the MCAO group and sham group(P>0.05).In addition,EA also increased the expression of PGC-1αand TFAM(all P<0.05).By Elisa,we observed that EA increased the preservation of ATP(P<0.05)and mitochondrial respiratory enzymes,including Complex I(P<0.05),Complex IV(P<0.05),but not Complex III(P>0.05).In summary,we conclude that EA may protect against ischemic damage in MCAO rats,improve the preservation of ATP and mitochondrial respiratory enzymes.This effect may be positively regulated by the activation of the PGC-1α/TFAM signaling pathway.

Clinical Practice Guidelines and Experts’Consensuses for Treatment of Coronavirus Disease 2019(COVID-19)Patients with Chinese Herbal Medicine:A Systematic Review

Objective:To systematically review the clinical practice guidelines for the treatment of coronavirus disease 2019(COVID-19)patients with Chinese herbal medicine(CHM),summarize their recommendations and evaluate their qualities.Methods:Electronic databases,websites of governments,academic associations or organizations for eligible guidelines were searched up to April 2020.Information were extracted to summarize recommendations for the use of Chinese herbal formulae and Chinese patent medicine(CPM)for COVID-19 patients.The methodological quality and reporting quality of the included guidelines were independently evaluated,using the Appraisal of Guidelines for REsearch and Evaluation(AGREE)Ⅱtool and Reporting Items for Practice Guidelines in healthcare(RIGHT)statement,respectively.Results:Totally 45 guidelines were identififi ed:42(93%)suggested specific CM formulae for treating COVID-19 patients;and 35(78%)assigned patients diagnosed with COVID-19 to 4 stages(early,development,critical and recovery).The recommended formulae and CPMs for each stage with diverse syndrome types have been summarized.Most of the included guidelines were of low methodological quality,with only one achieving moderate quality of AGREEⅡ.The frequency with which the 35 items in the Reporting Items for Practice Guidelines in Healthcare(RIGHT)checklist were reported averaged 36.5%across the 45 guidelines.Conclusions:This systematic review has summarized current recommendations for treating COVID-19 patients with CHM and shows that the general quality of present guidelines is quite low.The development of future guidelines should include increased awareness of the features of good quality guidelines.

Electroacupuncture Attenuated Phenotype Transformation of Vascular Smooth Muscle Cells via PI3K/Akt and MAPK Signaling Pathways in Spontaneous Hypertensive Rats

Objective:To investigate whether the antihypertensive mechanism of electroacupuncture(EA)is associated with attenuating phenotype transformation of vascular smooth muscle cells(VSMCs)via phosphoinositide3-kinase(PI3K)/protein kinase B(Akt)and mitogen-activated protein kinase(MAPK)signaling pathways.Methods:Eight Wistar-ktoyo(WKY)rats were set as normal blood pressure group(normal group).A total of 32 spontaneous hypertensive rats(SHRs)were randomly divided into 4 groups using random number tables:a model group,an EA group,an EA+PI3K antagonist group(EA+P group),and an EA+p38 MAPK agonist+extracellular signal-regulated kinase(ERK)agonist group(EA+M group)(n=8/group).SHRs in EA group,EA+P group and EA+M group received EA treatment 5 sessions per week for continuous 4 weeks,while rats in the normal and model groups were bundled in same condition.The systolic blood pressure(SBP),diastolic blood pressure(DBP),and mean arterial pressure(MAP)of each rat was measured at 0 week and the 4th week.After 4-week intervention,thoracic aorta was collected for hematoxylin-eosin(HE)staining,immunohistochemistry[the contractile markersα-smooth muscle actin(α-SMA)and calponin and the synthetic marker osteopontin(OPN)]and Western blot[α-SMA,calponin,OPN,PI3K,phosphorylated-Akt(p-Akt),Akt,p-p42/44 ERK,total p42/44 ERK,p-p38 MAPK and total p38 MAPK].Results:EA significantly reduced SBP,DBP and MAP(P<0.01).HE staining showed that the wall thickness of thoracic aorta in EA group was significantly decreased(P<0.01).From results of immunohistochemistry and Western blot,EA increased the expression ofα-SMA and calponin,and decreased the expression of OPN(P<0.01).In addition,the expression of PI3K and p-Akt increased(P<0.01),while the expression of p-p42/44 ERK and p-p38 MAPK decreased in EA group(P<0.01).However,these effects were reversed by PI3K antagonist,p38 MAPK agonist and ERK agonist.Conclusions:EA was an effective treatment for BP management.The antihypertensive effect of EA may be related with inhibition of phenotypic transformation of VSMCs,in which the activation of PI3K/Akt and the repression of MAPK pathway were involved.

Effectiveness and safety of acupuncture for treating functional constipation: An overview of systematic reviews

Background: Functional constipation(FC) is one of the most prevalent functional gastrointestinal disorders. Dissatisfaction with medications prescribed to treat FC may lead patients to seek alternative treatments. Numerous systematic reviews(SRs) examining the use of acupuncture to treat FC have reported inconsistent results, and the quality of these studies has not been fully evaluated.Objective: In this overview, we evaluated and summarized clinical evidence on the effectiveness and safety of acupuncture for treating FC and evaluated the quality and bias of the SRs we reviewed.Search strategy: The search strategy was structured by medical subject headings and search terms such as‘‘acupuncture therapy" and ‘‘functional constipation." Electronic searches were conducted in eight databases from their inception to September 2020.Inclusion criteria: SRs that investigated the effectiveness and safety of acupuncture for managing FC were included.Data extraction and analysis: Two authors independently extracted information and appraised the methodology, reporting accuracy, quality of evidence, and risk of bias using the following critical appraisal tools:(1) A Measurement Tool to Assess Systematic Reviews 2(AMSTAR 2);(2) Risk of Bias in Systematic Reviews(ROBIS);(3) Preferred Reporting Items for Systematic Reviews and Meta-analyses for Acupuncture(PRISMA-A);and(4) the Grading of Recommendations, Assessment, Development and Evaluations(GRADE). A j index was used to score the level of agreement between the 2 reviewers.Results: Thirteen SRs that examined the clinical utility of acupuncture for treating FC were identified.Using the AMSTAR 2 tool, we rated 92.3%(12/13) of the SRs as ‘‘critically low" confidence and one study as ‘‘low" confidence. Using the ROBIS criteria, 38.5%(5/13) of the SRs were considered to have ‘‘low risk"of bias. Based on PRISMA-A, 76.9%(10/13) of the SRs had over 70% compliance with reporting standards.The inter-rater agreement was good for AMSTAR 2, ROBIS, and PRISMA-A. Using the GRADE tool, we classified 22.5%(9/40) of the measured outcomes as ‘‘moderate" quality, 57.5%(23/40) as ‘‘low" quality, and 20.0%(8/40) as ‘‘very low" quality. The inter-rater agreement was moderate when using GRADE.Descriptive analyses indicated that acupuncture was more efficacious than sham acupuncture for improving weekly complete spontaneous bowel movements(CSBMs) and for raising the Bristol Stool Form Scale(BSFS) score. Acupuncture appeared to be superior to anti-constipation drugs for improving weekly spontaneous bowel movements, the total effective rate, and the Patient Assessment of Constipation Quality of Life score. Although ten SRs mentioned the occurrence of adverse events, serious adverse events were not associated with acupuncture treatment.Conclusion: Acupuncture may be more efficacious than sham acupuncture for improving CSBMs and BSFS scores and may be superior to anti-constipation drugs for improving bowel movement frequency, as well as quality of life. Limitations to current studies and inconsistent evidence suggest a need for more rigorous and methodologically sound SRs to draw definitive conclusions.

Influence of electroacupuncture on ghrelin and the phosphoinositide 3-kinase/protein kinase B/endothelial nitric oxide synthase signaling pathway in spontaneously hypertensive rats

Objective To investigate the influence of electroacupuncture(EA)on ghrelin and the phosphoinositide 3-kinase/protein kinase B/endothelial nitric oxide synthase(PI3K/Akt/eNOS)signaling pathway in spontaneously hypertensive rats(SHRs).Methods Eight Wistar-Kyoto rats were used as the healthy blood pressure(BP)control(normal group),and 32 SHRs were randomized into model group,EA group,EA plus ghrelin group(EA+G group),and EA plus PF04628935 group(a potent ghrelin receptor blocker;EA+P group)using a random number table.Rats in the normal group and model group did not receive treatment,but were immobilized for 20 min per day,5 times a week,for 4 continuous weeks.SHRs in the EA group,EA+G group and EA+P group were immobilized and given EA treatment in 20 min sessions,5 times per week,for 4 weeks.Additionally,1 h before EA,SHRs in the EA+G group and EA+P group were intraperitoneally injected with ghrelin or PF04628935,respectively,for 4 weeks.The tail-cuff method was used to measure BP.After the 4-week intervention,the rats were sacrificed by cervical dislocation,and pathological morphology of the abdominal aorta was observed using hematoxylin-eosin(HE)staining.Enzyme-linked immunosorbent assay(ELISA)was used to detect the levels of ghrelin,nitric oxide(NO),endothelin-1(ET-1)and thromboxane A2(TXA2)in the serum.Isolated thoracic aortic ring experiment was performed to evaluate vasorelaxation.Western blot was used to measure the expression of PI3K,Akt,phosphorylated Akt(p-Akt)and eNOS proteins in the abdominal aorta.Further,quantitative real-time polymerase chain reaction(qRT-PCR)was conducted to measure the relative levels of mRNA expression for PI3K,Akt and eNOS in the abdominal aorta.Results EA significantly reduced the systolic BP(SBP)and diastolic BP(DBP)(P<0.05).HE staining showed that EA improved the morphology of the vascular endothelium to some extent.Results of ELISA indicated that higher concentrations of ghrelin and NO,and lower concentrations of ET-1 and TXA2 were present in the EA group(P<0.05).The isolated thoracic aortic ring experiment demonstrated that the vasodilation capacity of the thoracic aorta increased in the EA group.Results of Western blot and qRT-PCR showed that EA increased the abundance of PI3K,p-Akt/Akt and eNOS proteins,as well as expression levels of PI3K,Akt and eNOS mRNAs(P<0.05).In the EA+G group,SBP and DBP decreased(P<0.05),ghrelin concentrations increased(P<0.05),and the concentrations of ET-1 and TXA2 decreased(P<0.05),relative to the EA group.In addition,the levels of PI3K and eNOS proteins,the p-Akt/Akt ratio,and the expression of PI3K,Akt and eNOS mRNAs increased significantly in the EA+G group(P<0.05),while PF04628935 reversed these effects.Conclusion EA effectively reduced BP and protected the vascular endothelium,and these effects may be linked to promoting the release of ghrelin and activation of the PI3K/Akt/eNOS signaling pathway.