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Background Cancer-related fatigue (CRF) is a pervasive, persistent, and distressing symptom experienced by cancer patients, for which few treatments are available. We investigated the efficacy and safety of infrared laser moxibustion (ILM) for improving fatigue in breast cancer survivors. Methods A three-arm, randomized, sham-controlled clinical trial (6-week intervention plus 12-week observational follow-up) was conducted at a tertiary hospital in Shanghai, China. The female breast cancer survivors with moderate to severe fatigue were randomized 2:2:1 to ILM ( n  = 56) sham ILM ( n  = 56), and Waitlist control (WLC)( n  = 28) groups. Patients in the ILM and sham ILM (SILM) groups received real or sham ILM treatment, 2 sessions per week for 6 weeks, for a total of 12 sessions. The primary outcome was change in the Brief Fatigue Inventory (BFI) score from baseline to week 6 with follow-up until week 18 assessed in the intention-to-treat population. Results Between June 2018 and July 2021, 273 patients were assessed for eligibility, and 140 patients were finally enrolled and included in the intention-to-treat analysis. Compared with WLC, ILM reduced the average BFI score by 0.9 points (95% CI, 0.3 to 1.6, P  = .007) from baseline to week 6, with a difference between the groups of 1.1 points (95% CI, 0.4 to 1.8, P  = .002) at week 18. Compared with SILM, ILM treatment resulted in a non-significant reduction in the BFI score (0.4; 95% CI, -0.2 to 0.9, P  = .206) from baseline to week 6, while the between-group difference was significant at week 18 (0.7; 95% CI, 0.2 to 1.3, P  = .014). No serious adverse events were reported. Conclusion While ILM was found to be safe and to significantly reduce fatigue compared with WLC, its promising efficacy against the sham control needs to be verified in future adequately powered trials. Trial registration Clinicaltrials.gov: NCT04144309. Registered 12 June 2018.

Objective To observe the effects of acupoints, cone numbers and durations of moxibustion with different moxibustion methods on skin surface and inside temperature, and to provide references for the clinical standardization of moxibustion amount. Methods The 42 big-ear white rabbits were divided into 6 groups according to the random number table method, a 1-cone direct moxibustion group, a 2-cone direct moxibustion group, a 3-cone direct moxibustion group, a 1-cone herbal cake-partitioned moxibustion group, a 2-cone herbal cake-partitioned moxibustion group, and a 3-cone herbal cake-partitioned moxibustion group, with 7 rabbits in each group. Shenque (CV 8), Shenshu (BL 23) and Zusanli (ST 36) were used in each group, but the moxibustion methods, cone numbers and durations of moxibustion were different. Rabbits in each group received moxibustion once every other day for 5 times in total. During the intervention, a thermoelectricity coupled probe and a temperature recorder were used to record the real-time acupoint skin temperature and the temperature at different time points, so as to observe, analyze and process the real-time changes in the temperature difference between the surface and inside of acupoint skin. Results For herbal cake-partitioned moxibustion, the best temperature for cone changing was (46.38±0.51) °C when the highest surface temperature was (49.20±0.52) °C; the multi-factor comparison of acupoint × cone number × time and acupoint × moxibustion method × time showed that time × acupoint, time × moxibustion method and cone number × acupoint had interactive effects (all P <0.05). Comparing skin temperature differences between different cone numbers at the same acupoint, Shenque (CV 8) on the 1st and the 5th days, Shenshu (BL 23) on the 3rd and the 7th days, Zusanli (ST 36) on the 1st and the 9th days of experiment showed statistically significant differences (all P <0.05). The skin temperature comparison of different moxibustion methods at the same acupoint all had statistical differences (all P <0.05), except for Shenque (CV 8) before moxibustion, Shenshu (BL 23) before moxibustion and on the 5th day; Zusanli (ST 36) only showed statistical differences on the 5th and 7th days (both P <0.05). The skin temperature differences of different acupoints after moxibustion in the 1-cone, 2-cone and 3-cone groups were statistically different (all P <0.05); direct moxibustion and herbal cake-partitioned moxibustion at different acupoints were all statistically different (all P <0.05). Conclusion Cone changing temperature under the same specifications of herbal cake-partitioned moxibustion was confirmed. Temperature difference between surface and inside of different acupoint skin at the same maximum temperature was significantly different due to the cone numbers and moxibustion methods, which showed the highest at Shenshu (BL 23), the second at Shenque (CV 8), and the lowest at Zusanli (ST 36). The influence of acupoint factor should be considered to determine the quantitative indicators of moxibustion.

Background The dose–effect relationship of Long-snake-like moxibustion for chronic fatigue syndrome (CFS) remains poorly understood. In order to address this gap, we designed this trial to assess the association between different treatment duration of Long-snake-like moxibustion and its effects on CFS based on the combination measurements of the subjective patient-reported scales with objective medical infrared imaging technology─Thermal Texture Maps (TTM). Methods From December 2020 to January 2022, 60 female CFS patients were recruited and equally allocated to two groups: Group A, receiving 60-min Long-snake-like moxibustion per treatment, and Group B, receiving 30-min Long-snake-like moxibustion per treatment. The treatment was administered 3 times per week for a total of 4 weeks. The primary outcome was defined as the improvement of symptoms measured by the Fatigue scale-14 (FS-14), and secondary outcomes were designated as the improvement in Symptoms Scale of Spleen-Kidney Yang Deficiency, Self-rating depression scale, and Self-rating anxiety scale. TTM scanning was employed twice for CFS patients (before and after 4-week treatment) and once for Healthy control subjects (HCs). Results At week 4, the scores of FS-14 and Symptoms Scale of Spleen-Kidney Yang Deficiency in Group A were significantly lower than those in Group B (physical fatigue: 5.00 vs. 6.00, with 95%CI − 2.00 to 0.00, p  = 0.003; FS-14 total score: 8.00 vs. 9.00, with 95%CI − 3.00 to 0.00, p  = 0.012; total score of Symptoms Scale of Spleen-Kidney Yang Deficiency: 9.80 vs. 13.07, with 95%CI − 5.78 to − 0.76, P  = 0.012). All thermal radiation values of the two groups increased, and statistical differences in ΔTs between Group A and HCs were not obtained. More significant correlations between symptoms improvements and ΔT changes were observed in Group A, and its ΔT changes in Upper Jiao, Shenque (CV8), Zhongwan (CV12), Danzhong (CV17), Zhiyang (GV9), Dazhui (GV14), upper arm, thoracic segments, lumbar segments, renal region, popliteal fossa strongly correlated with the improvement of Spleen-Kidney Yang Deficiency symptoms. Conclusions In the same course of treatment, the positive dose–effect relationship was found between the treatment duration of Long-snake-like moxibustion and CFS effect assessment. 60-min Long-snake-like moxibustion per treatment were associated with optimal clinical response and TTM improvement. Trial registration Chinese Clinical Trail Registry (No. ChiCTR2000041000, date of registration: 16 December 2020), http://www.chictr.org.cn/showproj.aspx?proj=62488

Objective The impact of acupuncture and moxibustion on postoperative complications and adverse events (AEs) of chemotherapy in patients with gastric cancer (GC) has been investigated. Through a meta-analysis of existing randomized controlled trials (RCTs), this study sought to strengthen the evidentiary basis to help investigators further understand the effects of moxibustion and acupuncture on postoperative complications and AEs of chemotherapy among GC patients. Methods Embase, Web of Science, PubMed, The Cochrane Library, China National Knowledge Infrastructure (CNKI), Wanfang Database, and VIP Database for Chinese Technical Periodicals were searched to collect RCTs on effects of acupuncture and moxibustion on gastrointestinal function and AEs among GC patients undergoing surgery and chemotherapy. Outcome measures included postoperative gastrointestinal recovery (bowel sound recovery time, time to first flatus/defecation/feeding), the incidence of AEs (nausea and vomiting, abdominal distension, and diarrhea), myelosuppression (white blood cells, hemoglobin, and platelet), and immune function indicators (CD3 + and CD4 + ). To assess quality, the Cochrane Risk of Bias Tool was utilized. Review Manager 5.4 was implemented to do the meta-analysis. Results Fifteen eligible RCTs involved 1259 patients. Meta-analysis results showed that the experimental group had a significantly shorter bowel sound recovery time (MD =  − 14.57, 95% CI = [− 18.97, − 10.18], P  < 0.00001), time to first flatus (MD =  − 17.56, 95% CI = [− 22.23, − 12.88], P  < 0.00001), time to first defecation (MD =  − 17.05, 95% CI = [− 21.02, − 13.09], P  < 0.00001), and time to first feeding (MD =  − 23.49, 95% CI = [− 28.81, − 18.17], P  < 0.00001) than the control group. There were significant decreases in the incidence of nausea and vomiting (RR = 0.46, 95% CI = [0.21, 1.02], P  = 0.05) and abdominal distension (RR = 0.45, 95% CI = [0.27, 0.75], P  = 0.002) observed in the experimental group in comparison with the control group. The experimental group demonstrated a significant increase in white blood cell counts in comparison with to the control group (MD = 0.89, 95% CI = [0.23, 1.55], P  = 0.008). The experimental group showed significantly higher levels of CD3 + (MD = 7.30, 95% CI = [1.86, 12.74], P  = 0.009) and CD4 + (MD = 2.75, 95% CI = [1.61, 3.90], P  < 0.00001) than the control group. Conclusion Among GC patients, acupuncture and moxibustion can aid in gastrointestinal function recovery, reduce the incidence of AEs of surgery and chemotherapy, and improve immune function.

Background Knee osteoarthritis (KOA) is a significant health issue because it causes pain and functional limitation. Many studies have reported that moxibustion, a treatment in traditional Korean medicine, is effective in treating KOA. However, conventional moxibustion produces smoke, harmful gases, and odors that can adversely affect the eyes, skin, and throat. It is also difficult to control the intensity of stimulation in conventional moxibustion. An electrical moxibustion device was developed to circumvent these problems, but there are few studies of that device. We will evaluate the efficacy and safety of electrical moxibustion as a treatment for KOA, and compare it with traditional indirect moxibustion and usual care. Methods This is a multicenter, randomized, open, assessor-blinded, parallel-group clinical trial. A total of 138 eligible participants with KOA will be randomly allocated into three groups (electrical moxibustion, traditional indirect moxibustion, or usual care) with a 1:1:1 ratio. Participants in each moxibustion group will receive 12 sessions of moxibustion treatment at 6 acupoints (ST36, ST35, ST34, SP9, EX-LE4, SP10) plus up to 2 points of “ashi”, if needed, over a period of 6 weeks (2 sessions per week). A specifically designed device that provides thermal stimulation using electrical energy will be used for the electrical moxibustion group. Participants in the usual care group will receive usual treatment and self-care. The primary outcome measure is change in pain on a numerical rating scale (NRS) from week 1 to week 6. The secondary outcome measures are pain assessed on a visual analog scale (VAS), the Korean version of the Western Ontario and McMaster osteoarthritis index (K-WOMAC), patient global assessment (PGA), and the European quality of life five dimension five level scale (EQ-5D-5 L). Safety will be assessed by monitoring adverse events at each visit. Follow-up measurements will be performed at 12 weeks after baseline measurements. Discussion This trial will provide evidence on the efficacy and safety of electrical moxibustion as a treatment for KOA. Trial registration ClinicalTrials.gov, NCT03287570 . Registered on 19 September 2017.

As a crucial component of acupuncture-moxibustion therapy, moxibustion has been extensively propagated and used with its significant efficacy, simple operation, inconspicuous adverse effects and less sufferings. There are a variety of factors that influence the therapeutic efficacy of moxibustion. The influencing factors, including moxibustion dose (moxibustion duration, distance between moxa and skin, size and number of moxa cone), selection of points, moxibustion sensations, and the type of moxibustion were analyzed and summarized, to provide references for approaching the maximum efficacy of moxibustion in clinic.

Objective To observe the effects of different moxibustion time on cartilage morphology, tumor necrosis factor (TNF)-α and interleukin (IL)-10 of the knee joint in rats with knee osteoarthritis (KOA), and to explore the best treatment time of moxibustion for KOA. Methods Healthy male Wistar rats were randomly divided into a blank group, a model group, a 15-minute-moxibustion group, a 30-minute-moxibustion group, and a 60-minute-moxibustion group, with 10 rats in each group. Except for the blank group, the KOA model was established in all groups by injecting sodium iodoacetate solution into the knee joint cavity of rats. Rats in the 15-minute-moxibustion group, the 30-minute-moxibustion group, and the 60-minute-moxibustion group were all treated with mild moxibustion intervention for 15 min, 30 min, and 60 min, respectively at Neixiyan (EX-LE4) and Dubi (ST35) points near the patella, 3 times a week for 4 weeks, 12 times in total. Rats in the blank group and the model group were fixed for 30 min without moxibustion intervention. Macroscopic observation for the smoothness of knee cartilage surface was performed after the intervention. Hematoxylin-eosin staining, toluidine blue staining, and Mankin score were used to evaluate the pathological changes in the cartilage. The expression levels of TNF-α and IL-10 in the serum were detected by enzyme-linked immunosorbent assay. Results Compared with the blank group, the articular cartilage surface in the model group was rough, the chondrocyte arrangement was irregular, the Mankin score and the serum TNF-α expression were significantly increased ( P <0.05), while the expression of serum IL-10 was significantly decreased ( P <0.05). Compared with the model group, the articular cartilage surface was smoother, the chondrocytes were arranged neatly, the Mankin score and serum TNF-α expression level were significantly lower in the three moxibustion intervention groups ( P <0.05); the serum IL-10 level in the 30-minute-moxibustion group and the 60-minute-moxibustion group was increased significantly ( P <0.05). Compared with the 15-minute-moxibustion group, the articular cartilage surface in the 30-minute-moxibustion group and the 60-minute-moxibustion group was smoother, the chondrocyte arrangement was more regular, the Mankin score and the serum TNF-α level were decreased significantly ( P <0.05), and the serum IL-10 level was increased ( P <0.05). There was no significant difference in the serum TNF-α or IL-10 level between the 30-minute-moxibustion group and the 60-minute-moxibustion group ( P >0.05). Conclusion Moxibustion can obviously improve the morphology and structure of KOA articular cartilage, protect articular cartilage, inhibit cartilage inflammation, and delay KOA cartilage degeneration. Moxibustion’s effect is closely related to moxibustion time; the therapeutic effect of the 30-minute-moxibustion and the 60-minute- moxibustion is better than that of the 15-minute-moxibustion.

Cancer‐related fatigue (CRF) is one of the most common chronic symptoms experienced by cancer patients. As moxibustion is a popular traditional therapy for managing fatigue, it can be an alternative strategy to treat CRF as well. Therefore, we rigorously designed a full‐scale, multicenter, assessor‐blinded, randomized controlled trial to evaluate the efficacy and safety of moxibustion treatment for CRF. Ninety‐six subjects suffering from CRF were recruited and randomly assigned to moxibustion group, sham moxibustion group, or usual care group. Both the moxibustion group and the sham group received moxibustion treatment for 8 weeks and the usual care group did not. Brief fatigue inventory (BFI) score and Functional Assessment of Cancer Therapy‐Fatigue score were used to assess CRF at baseline and weeks 5, 9, and 13. Questionnaires for the assessment of cognitive impairment, quality of life, and Cold–Heat and Deficiency–Excess patterns were also evaluated. BFI scores significantly decreased in moxibustion group compared to the usual care group (mean difference of −1.92, p < 0.001 at week 9 and mean difference of −2.36, p < 0.001 at week 13). Although the sham group also showed significant improvement during the treatment period, only the moxibustion group showed improvement after 4 weeks of follow‐up period (mean difference of −1.06, p < 0.001). There were no serious adverse events. Our findings confirmed the efficacy and safety of moxibustion for CRF compared to usual care. We also found that moxibustion has a prolonged treatment effect during 4 weeks of follow‐up period. Moxibustion is widely used treatment method for stimulating acupuncture points and has been used for symptom management in cancer patients in East Asia. However, scientific evidence of moxibustion for the treatment of cancer‐related fatigue is still lacking. Through this full‐scale, multicenter, assessor‐blinded, randomized controlled trial, we found that 8 weeks of moxibustion treatment decreased cancer‐related fatigue more effectively than usual care.