Research Article Acupuncture and Related Therapies for Obesity: A Network Meta-Analysis

21 Pages·2017·1.86 MB·English

Hindawi
Evidence-Based Complementary and Alternative Medicine
Volume 2018, Article ID 9569685, 20 pages
https://doi.org/10.1155/2018/9569685
Research Article
Acupuncture and Related Therapies for Obesity:
A Network Meta-Analysis
YanjiZhang ,1JiaLi ,1,2,3 GuoyanMo,4 JingLiu,1
HuishengYang,5XianglinChen ,1HuiLiu ,1 TengCai ,1 XianZhang ,1
XiangminTian ,1ZhongyuZhou ,2,3 andWeiHuang 2,3
1CollegeofAcupunctureandOrthopedics,HubeiUniversityof
ChineseMedicine/HubeiProvincialCollaborativeInnovationCenterofPreventiveTreatmentby
AcupunctureandMoxibustion,Wuhan,China
2DepartmentofAcupuncture,HubeiProvincialHospitalofTraditionalChineseMedicine,Wuhan,China
3HubeiProvinceAcademyofTraditionalChineseMedicine,Wuhan,China
4ChinaKeyLaboratoryofTCMResourceandPrescription,HubeiUniversityofChineseMedicine,
MinistryofEducation,Wuhan,China
5InstituteofAcupunctureandMoxibustionofChinaAcademyofChineseMedicalSciences,Beijing,China
CorrespondenceshouldbeaddressedtoZhongyuZhou;[email protected];[email protected]
Received 21 August 2018; Accepted 9 September 2018; Published 30 September 2018
AcademicEditor:MariangelaRondanelli
Copyright©2018YanjiZhangetal.ThisisanopenaccessarticledistributedundertheCreativeCommonsAttributionLicense,
whichpermitsunrestricteduse,distribution,andreproductioninanymedium,providedtheoriginalworkisproperlycited.
Obesity is a worldwide public health problem. Currently, increasing evidence suggests acupuncture and related therapies are
effectiveforobesity.Thisnetworkmeta-analysis(NMA)wasperformedtocomparetheeffectivenessofdifferentacupunctureand
relatedtherapies.Wesearchedpotentialrandomizedcontrolledtrials(RCTs)inthreeinternationaldatabases.Thirty-fourtrials
involving2283participantswereincluded.Pairwisemeta-analysisshowedthatacupunctureandrelatedtherapiesweresuperiorto
lifestylemodificationandplaceboinreducingweightandbodymassindex(BMI).Basedondecreasesinbodyweight,results
from NMA showed that acupoint catgut embedding (standard mean difference [SMD]: 1.26; 95% credible interval [95% CI],
0.46–2.06),acupuncture(SMD:2.72;95%CrI,0.06–5.29),andcombinationofacupunctureandrelatedtheories(SMD:3.65;95%
CrI,0.96–6.94)weremoreeffectivethanplacebo.AnotherNMAresultindicatedthatacupointcatgutembedding (SMD:0.63;
95%CI,0.25–1.11),acupuncture(SMD:1.28;95%CrI,0.43–2.06),combinationofacupunctureandrelatedtherapies(SMD:1.44;
95%CrI,0.64–2.38),andelectroacupuncture(SMD:0.60;95%CrI,0.03–1.22)weresuperiortolifestylemodificationindecreasing
BMI.CombinationofacupunctureandrelatedtherapieswasrankedtheoptimalmethodforbothreducingweightandBMI.Further
studieswillclarifywhichcombinationofacupunctureandrelatedtherapiesisbetter.
1.Introduction mellitus,cardiovasculardisease,andcancer,whichincreased
individualsandsocieties’medicalburden[5].
Obesity, aworldwidepublichealth problem,isdescribed as Lifestyle modification, pharmacotherapy, and bariatric
anadiposity-based chronicdisease[1].Currently,guidelines surgery are considered the mainstay of therapy for obesity
recommended using body mass index (BMI) to classify [2]. Although diet and exercise playan essential role in the
individualsashavingobesity(BMI⩾30kg/m2)[2].Basedon weight management, their precise mode of action remains
thesurveyconductedpreviously,thestandardizedprevalence controversial [6]. Five long-term medicines (naltrexone-
rates for obesity in adult were 34.9% in United States and bupropion,phentermine-topiramate orlistat, lorcaserin, and
17.7% in China [3, 4]. Moreover, it is associated with other liraglutide) have been approved by US Food and Drug
health concerns, such as insulin resistance, type 2 diabetes Administration (FDA) for the treatment of obesity [7]. The
2 Evidence-BasedComplementaryandAlternativeMedicine
latest research suggested that phentermine-topiramate was published in. The complete search strategies are shown in
associatedwiththehighestpossibilityofachievingatleast5% Appendix2.
weightloss[7].However,littleisknownaboutthelong-term
safetyprofileofpharmacotherapyforweightloss.Theeffec- 2.2. Study Selection. Two researchers (XC and HL) inde-
tivenessofbariatricproceduresfortreating obesityhasbeen pendently identified irrelevant research based on titles and
reportedinseveralrandomized controlled trials (RCTs)[8– abstracts. Additionally, full-text articles were scanned by
10].Nevertheless,theevidenceoncardiovasculardiseaseand thesetworesearcherstoidentifyeligiblestudies.Alldisagree-
mortalityremainstobevalidated [11].Therefore,itisneces- ments were resolved by consensus and adjudged by a third
sarytoexploreotherformsofalternativetherapieswhichare reviewer(TC)ifnecessary.Incaseofduplicatecitations, the
bothsafeandeffectiveinpreventinggainingweight. mostupdatedstudieswereselectedfordataextraction.
In reviewing the literature, it became evident that acu-
punctureandrelatedtherapieshavebeenwildlyusedforobe- 2.3.InclusionandExclusionCriteria. Thestudiesincludedin
sitytreatment.Asmentionedinthemeta-analysis,combina- theNMAmetthefollowingcriteria:(1)thestudydesignmust
tionofacupunctureandlifestylemodificationismoreeffec- bearandomizedcontrolled clinicaltrial(RCT);(2)patients
tivecompared withlifestylemodification alone[12].Results diagnosedwithsimpleobesityirrespectiveofagesandsexas
ofYeh’sresearchsuggestedthatearacupointstimulationhad studysubjects;diagnosticcriteriamustbeclearandinclusion
remarkableimprovementsintheanthropometricparameters and exclusion criteria were explicit; (3) at least one of the
of Body Weight (BW), BMI, and so on [13]. In addition, followingefficacyoutcomesorsafetyendpointswasincluded:
anothersystematicreviewperformedin2015hasalsoshown BW,BMI,andadverseevents;(4)participantsintheexperi-
that clinical efficacy of acupoint catgut embedding therapy mental group have received acupuncture and related treat-
wasbetter than that of thecontrol groupfor simple obesity ments (specifically, classical body acupuncture; electroacu-
[14].However,amajorproblemisthatwhetheracupuncture puncture auricular acupoint stimulation; acupoint catgut
oracupuncture-relatedtherapiesaloneorcombinedtherapy embeddingandwarmingacupuncture)aloneorincombina-
is more effective than lifestyle modification management tion;(5)EnglishorChineselanguagestudies.
remainsdisputable. The following were excluded: (1) self-control and non-
Byusingthetechniqueofnetworkmeta-analysis(NMA), RCTs;(2)preclinicalstudies,systematicreviews,casereports,
both direct and indirect randomized data can be analyzed, and meta-analyses; (3) reports without sufficient and clear
and recommended rankings of different treatments can be originaldata;(4)participantshavingreceivedotherformsof
provided[15,16].Therefore,weconductedthisBayesiannet- acupuncture such as transcutaneous electrical nerve stimu-
lationorlaseracupuncture;(5)duplicatestudiesandstudies
workmeta-analysistoanalysebothdirectandindirectcom-
reportingthesameresults.
parisons of acupuncture and related methods for treating
obesity. Inthis paper,changes inBW,BMI, andthe ratesof
complicationsofincludedstudieswereanalyzed. 2.4. Data Collection and Quality Assessment. According to
a standard data collection sheet, two investigators (TC and
XZ) independently extracted the following data: (1) main
2.Methods
characteristicsofincludedrandomizedcontrolledtrials(i.e.,
year of publication, type of intervention, patients charac-
OurresearchwasconductedfollowingthePreferredReport-
teristics, types of outcome, and reported adverse events);
ingItemsforSystematicReviewsandMeta-AnalysesforNet- (2) details of acupuncture and related interventions (i.e.,
work Meta-Analysis (PRISMA-NMA) checklist [17] (see
frequency and duration of acupuncture sessions, names of
Appendix1).
acupuncturepointsused,andretentiontime);(3)clinicalout-
come (i.e., summaries of mean, standard difference, and
2.1.DataSourcesandSearchStrategy. Threeelectronicinter- sample size between treatment groups). In some trials, the
national databases (PubMed/Medline,Embase, andtheCo- changebetweenbaselineandaftertreatmentwasfailedtopre-
chraneLibrary)weresearchedforpotential RCTs(random- sent. Using the methods recommended in the Cochrane
izedcontrolled trials). Weidentified articlespublishedfrom HandbookforSystematic ReviewsofInterventions (version
initiation to December 2017 with a limit to studies of RCT 5.1)[18],themissingdatawasestimated usingthefollowing
and without limitations on language or the form they are formula:
𝑋𝑐ℎ𝑎𝑛𝑔𝑒 =𝑋𝑝𝑜𝑠𝑡−𝑡𝑟𝑒𝑎𝑡𝑚𝑒𝑛𝑡−𝑋𝑏𝑎𝑠𝑒𝑙𝑖𝑛𝑒 (1)
𝑆𝐷 =√(𝑆𝐷 )2+(𝑆𝐷 )2−2×𝑟×𝑆𝐷 ×𝑆𝐷 (2)
𝑐ℎ𝑎𝑛𝑔𝑒 𝑏𝑎𝑠𝑒𝑙𝑖𝑛𝑒 𝑝𝑜𝑠𝑡−𝑡𝑟𝑒𝑎𝑡𝑚𝑒𝑛𝑡 𝑏𝑎𝑠𝑒𝑙𝑖𝑛𝑒 𝑝𝑜𝑠𝑡−𝑡𝑟𝑒𝑎𝑡𝑚𝑒𝑛𝑡
where r is a correlation coefficient with a value of 0.5 independently assessed their risk of bias by the Cochrane
[19]. For each included RCT, two researches (XT and XC) Collaborationtool[20].Biasrisksofeachstudywereassessed
Evidence-BasedComplementaryandAlternativeMedicine 3
from six aspects: random sequence generation, allocation [36],Egypt[48],andChina.Ageofparticipantsrangedfrom
concealment, blinding of participants and investigators, 15 to 70 years, while the sample size of the studies ranged
blinding of outcome assessment, incomplete outcome data from 12 to 86. Among the included RCTs, there were one
addressed,andselectiveoutcomereporting,whilerankedin four-arm trials, 5 three-arm trials, and 28 two-arm trials.
highrisk,lowrisk,andunclearrisk. Fourteen studies compared acupuncture to placebo. Ten
studies compared acupuncture to lifestyle intervention. Six
studiescomparedcombinedtherapiestoacupuncturealone.
2.5.StatisticalAnalysis. Firstly,standardpairwisemeta-anal-
Details about acupuncture points used, retention time, fre-
ysis was initially performed using the Review Manager
quency,anddurationofacupuncturesessionswereshownin
(Version 5.3, Cochrane Collaboration, Oxford, UK). We
2 Table2.Intheseresearch, 30articles [26–30,32,34–38,41–
calculated I-square (I ) test to assess heterogeneity among
RCTs[21].Tobespecific,whentherewasI2 >50%,theywere 59] reported the weight loss, while 25 articles reported the
change in BMI. The details of mean, standard difference
analysed using a random effects model; otherwise, a fixed
(SD), and sample size between different groups for eligible
effectmodelwaschosen.Subgroupanalyseswereconducted
studiesaresummarizedinAppendix3.TheCochraneriskof
accordingtothetypeofacupuncturetreatmentandthetreat-
bias assessment was presented in Table3. Furthermore, the
mentofcontrolgroup.Meandifference(MD)with95%con-
networkplotofincludedcomparisonswasshowninFigure2.
fidence intervals (CI) was used to analyze continuous data.
We generated forest plots to illustrate the relative strength
ofcurativeeffects. 3.3.PairwiseMeta-Analyses
Second, to indirectly compare the effectiveness among
treatments of acupuncture and related therapies, we did a 3.3.1.Body Weight. Adirectpairwise meta-analysis showed
randomeffectsmodelNMAwithinaBayesianframework,by thatacupunctureandrelatedtherapiesshowedagreaterBW
usingWinBUGS(Version1.4.3,MRCBiostatisticsUnit,Cam- reductionthanlifestylemodification (MD:1.66;95%Confi-
bridge, UK) [22, 23]. Models were computed with Markov dence interval, 0.63to2.70) and placebo (MD: 1.15; 95% CI,
chainMonteCarlo(MCMC)simulationmethods,usingfour 0.67to1.63). When compared to acupuncture, combination
chains with overdispersed initial values. We utilized the of acupuncture and related theories showed a marginally
Markov chains for 50,000 simultaneous iterations after the strongereffectinweightloss(MD:1.56;95%CI,0.07to3.05).
first20000iterations werediscardedbecausetheymayhave There was no statistically significant difference between
aninfluenceonthearbitraryvalue.Inthisprocess,thecon- combination of acupunctureand related theories and phar-
vergenceofthemodelwasassessed bytheBrooks-Gelman- macotherapyintheireffectivenessinBW(MD:2.44;95%CI,
Rubin (BGR) method; a value of potential scale reduction -1.98to6.86).(Table4)
factor(PSRF)closeto1indicatedthebetterconvergence[24].
Thecontinuous outcomewasmeasuredbyastandard mean BMI. As for the comparison in reducing BMI, acupuncture
difference(SMD)witha95%credibleintervals (CrI)forin- and related therapies were found to be marginally superior
directcomparisons. tolifestylemodification (MD:1.17;95%CI, 0.09to2.26)and
Finally, plot of surface under the cumulative ranking placebo(MD:0.57;95%CI,0.40to0.74).Theremainingdirect
curve (SUCRA) was generated using the STATA software comparisonsdidnotshowsignificantdifferences(Table4).
(Version 13.0; Stata Corporation, College Station, Texas,
USA), which indicated the probability of each intervention 3.4.NetworkMeta-Analysis
ofbeingrankedbest[25].Inourstudy,higherSUCRAscores
meanthehigherrankofthetreatment[15].AZvalueandits 3.4.1. Body Weight. The NMA showed that all treatments
corresponding p-value were calculated, and an R value less otherthanacupuncturecombinedlifestylemodificationwere
more efficacious than lifestyle modification. Three treat-
than0.05indicatedastatisticallysignificantdifference.
mentsweresignificantlymoreeffectivethanplacebo.Specif-
ically, acupoint catgut embedding (SMD: 1.26;95%credible
3.Results
interval, 0.46to2.06), acupuncture (SMD: 2.72; 95% CrI,
0.06to5.29), and combination of acupuncture and related
3.1.StudySearch. WeperformedthisresearchonDec262017.
therapies (SMD: 3.65; 95% CrI, 0.96to6.94). Furthermore,
As shown in Figure1, a total of 1050 records were initially
moxibustion with warming needle was associated with a
identifiedfromthedatabases.675studiesleftafterduplicates
significantlyimprovementthanlifestylemodification(SMD:
wereremoved.577recordswereexcludedaftercarefullyscan-
-5.24;95%CrI,-10.15to-0.55)(Table5).
ning titles and abstracts. Finally, 34trials with 2283partici-
pantswereincludedinourNMA[26–59],covering8groups,
3.4.2. BMI. Four treatments showed superiority over
manualacupuncture;electroacupuncture;auricularacupoint
placebo, including acupoint catgut embedding (SMD: 1.31;
stimulation; acupoint catgut embedding; pharmacotherapy;
95% CrI, 0.36to2.06), acupuncture (SMD: 1.94; 95% CrI,
warmingacupuncture;lifestylemodification;placebo.
0.83to3.00),combinationofacupunctureandrelatedtheories
(SMD: 3.65; 95% CrI, 0.96to6.94), and electroacupuncture
3.2.StudyDescription. MaincharacteristicsofincludedRCTs (SMD: 1.28; 95% CrI, 0.43to2.11). Four treatments were
wereshowninTable1.TheparticipantswerefromAustralia significantly more effective than lifestyle modification,
[28], the United States [26], Turkey [46], Korea [51], Iran including acupoint catgut embedding (SMD: 0.63; 95% CI,
4 Evidence-BasedComplementaryandAlternativeMedicine
n Records identified through
o
ati database searching
c
fi (n = 1050)
nti
e
d
I
Recordsafter duplicates removed
(n =675)
g
n
eni Records excluded after reading
e
cr titles and abstracts (n = 577)
S
Full-text articles assessed
for eligibility
y (n =98)
bilit
gi Full-text articles excluded, with
Eli reasons(n =63)
Duplicates(n =8)
Non-RCTs(n=23)
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Obesity with complications
(n = 8)
Not included outcome (n = 7)
d Other(n = 6)
e
d
clu Studies included in
In quantitative synthesis
(meta-analysis)
(n =34)
Figure1:PRISMAflowchart.
Acupuncture
AR+LM
Acupuncture AR+LM
Combined theories
ACE
ACE
Combined theories
EA
AAS
AAS
EA
WA
LM
Placebo
Pharmacotherapy LM
Pharmacotherapy
Placebo
Body weight BMI
Figure2:Networkplot.BMI:bodymassindex;LM:lifestylemodification;AAS:auricularacupointstimulation;EA:electroacupuncture;
ACE:acupointcatgutembedding;WA:warmingacupuncture;AR:acupunctureandrelatedtherapies;combinedtherapies:combinationof
acupunctureandrelatedtherapies.
Evidence-BasedComplementaryandAlternativeMedicine 5
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e B B B BBBB B BBB
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AdverseeventsreportedR/ARedness,pain,bleeding(2)cchymosis,abdominal(1)discomfort/Noneintercurrentillnessand(1)discontinued/NoneNR NR AdverseeventsVAS(1)Minor-inflammation,mildtenderness(7)/mild(2)tendernessNRNRNoneNoneNR(1)Dizziness/None None NRNRNRNR
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l
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plesize 35/34 24/22 28/32 40/4026/3029/3076/42 23/22 26/2627/2886/8343/4330/3024/2320/2020/2036/3440/4030/3033/32
m
a
S
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ali
StudyIDandCountry Allisonetal.[17]1995,USA Hsuetal.[18]2005,Taiwan Richardsetal.[19]1998,Austr Heetal.[20]2008,China Lietal.[21]2006,China Tongetal.[22]2011,China Hsuetal.[23]2009,Taiwan Hsiehetal.[24]2010,TaiwanHsiehetal.[25]2011,TaiwanAbdietal.[26]2012,IranDarbandietal.[27]2012,IranHeetal.[28]2012,ChinaLienetal.[29]2012,Taiwan Darbandietal.[30]2014,Iran Yehetal.[31]2015,TaiwanChenetal.[32]2007,ChinaHuangetal.[33]2011,ChinaTangetal.[34]2009,China
6 Evidence-BasedComplementaryandAlternativeMedicine
comes MI MI MI MIMI MIMI MI uncture
peofout BW,B BW,B BW,B BW BW,BBW,BBMIBW,BBW,BBWBW BW BW BW BW,BBMI AR:acup
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AdverseeventsreporteR/ANRmildEcchymosis(3),abdominal(1)discomfort/NoneNR NR NRNRNRNRNRNRNR NR NR NR NRNR edding;WA:warmingacu
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Tabl Age:mean(SD)orrangeR/A17-49/18-51 40.0(11.5)/41.3(9.9) ±±34.66.3/36.87.832(7)/33(7)32(7)/33(8)45.00(9.32)/43.47(9.59)NR31(10)/32(12)34.7(11.9)/42.7(10.2)32.1(1.1)/33.4(1.3)∼∼1958/1856∼∼1842/184839.8(5.3)/43.3(4.3)39.8(5.3)/42.7(3.9)42.1(4.4)/41.8(4.6)42.1(4.4)/42.9(4.3)40.55(5.30)/41.47(4.61)40.55(5.30)/42.91(4.02)36.50(9.26)/36.48(8.69)>18 AS:auricularacupointstimules.
Api
SamplesizeR/A 40/42 22/20 20/2030/3030/3021/3028/2845/4522/1532/2336/3231/3022/1222/2120/1520/1520/1520/2342/4419/16 M:lifestylemodification;unctureandrelatedthera
Lup
StudyIDandCountry Shietal,[35]2006,China Hsuetal.[36]2005,Taiwan G¨uc¸eletal.[37]2012,Turkey Dengetal.[38]2014,China Hassanetal.[39]2014,EgyptHeetal.[40]2014,ChinaWangetal.[41]2013,ChinaSujungetal.[42]2014,SouthKoreaBuetal.[43]2007,ChinaShietal.[44]2005,ChinaYangetal.[45]2010,China Cabiogluetal.[46]2005,Turkey Cabiogluetal.[47]2006,Turkey Cabiogluetal.[48]2008,Turkey Darbandietal.[49]2013,IranFogartyetal.[50]2015,Australia BW:bodyweight;BMI:bodymassindex;andrelatedtherapies;#combinationofac
Evidence-BasedComplementaryandAlternativeMedicine 7
Frequency&durationofAcupuncturesessions3sessionsdailyfor12weeks 2sessionsweeklyfor6weeks 2sessionsdailyfor4weeks Earacupressure:1sessionevery3dayswithatotalof10sessionsBodyacupuncture:Thefirst5daysoftreatment1time,5daysaftertreatment1,1month,foracourseoftreatment. 1sessiondailywithatotalof60sessions,2daysrestin-between10sessions 1sessiondailywithatotalof10sessionsfor10weeks,2dayrestin-between10sessions 1sessioneveryotherdayforatotalof5weekswith12sessions 2sessionsweeklyforatotalof6weekswith12sessions 1sessionweeklyfor10sessions1sessionweeklyforatotalofeightweeks
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elate aracac
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Descriptionsoftheincludedacupun Namesofacupuncturepointsused NRQiai(REN9),Shuifen(REN9)Shuidao(ST28),Siman(K14)Zusanli(ST26),Fenglong(ST40)Sanginjao(SP6) Shenmen(TF4),Stomach(CO4) Earacupressure:Shenmen(TF4),Neifenmi(CO18),Pi(CO13),Wei(CO14),Sanjiao(CO17),Dachang(CO7),NaodianBodyacupuncture:Tianshu(ST25),Guanyuan(RN4)Sanyinjiso(SP9),Fenglong(ST40)Zusanli(ST36)Sanginjao(SP6),Tianshu(ST25)Zusanli(ST36),Quchi(LI11)Fenglong(ST40),Neiting(ST44)Zhongwan(CV12),Pishu(BL20)Shenshu(BL23),Qihai(CV6)Yinlingquan(SP9),Shangjuxu(ST37)Taichong(LR3)HungerpointPizhixia(AT4)Shenmen(TF4),Shenshangxian(TG2P)Sanjiao(CO17),Pi(CO13)Wei(CO14),Fei(CO14)Kou(CO1),Dachang(CO7)Zhichangxiduan(HX2)Zhongwan(CV12),Zhongji(CV3)Daheng(SP15),Xiawan(CV10)Shimen(CV5),Tianshu(ST25)Liangqiu(ST34),Zusanli(ST36)Yinlingquan(SP9)Hungerpoint,Shenmenpoint(TF4)Stomachpoint(CO4),Endocrinepoint(CO18)NR NR
2:
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l
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upuncture AS A AS therapies# A AS ncture AS AS AS
ac A E A ed E A pu A A A
Styleof Combin Acu
StudyID(Country) Allisonetal.1995,USA Hsuetal.2005,Taiwan Richardsetal.1998,Australia Heetal.2008,China Lietal.2006,China Tongetal.2011,China Hsuetal.2009,Taiwan Hsiehetal.2010,Taiwan Hsiehetal.2011,Taiwan
8 Evidence-BasedComplementaryandAlternativeMedicine
Frequency&durationofAcupuncturesessions Twiceaweekforatotalof6weeks Twiceaweekforatotalof6weeks 3timesadayfor4weeks 3sessionweeklywithatotalof12sessionsfor4weeks 3sessionsweeklywithatotalof12sessionsfor4weeks 2sessionsweeklyforatotalof6weeks 2sessionsweeklyforatotalof6weeks NR 1sessionweeklywithatotalof30sessionsfor4weeks Thefirst5daysare1timesaday,and1timeafter5days,1monthis1courseoftreatment. 1sessionweeklywithatotalof7sessionsfor60days 3sessionsweeklywithatotalof12sessionsfor60days
e
m
entionti 3days 3days 3days NR NR 20min 3days 20min Aweek 45min 24hour 30min
et
R
Table2:Continued. Namesofacupuncturepointsused Shenmen(TF4),Stomach(CO4)HungerpointMouth(CO1)Centreofear(HX1),Sanjiao(CO17)Shenmen(TF4),Stomach(CO4)HungerpointMouth(CO1)Centreofear(HX1),Sanjiao(CO17)HungerpointStomach(CO4)Spleen(CO14),LargeIntestine(CO7)Endocrine(CO18),Shenmen(TF4)Shenmenpoint(TF4),Stomachpoint(CO4)Hungerpoint,Endocrinepoint(CO18)Shenmenpoint(TF4),Stomachpoint(CO4)Hungerpoint,Endocrinepoint(CO18)Tianshu(ST-25),Weidao(GB28)Zhongwan(REN12),Shuifen(REN9)Guanyuan(REN4),Sanyinjiao(SP6)Quchi(LI11),Fenlong(ST40)Qihai(REN6),Yinlingquan(SP9)Shenmen(TF4),Stomach(CO4)Hungerpoint,Mouth(CO1)Centerofear(HX1),Sanjiao(CO17)Shenmen(TF4),StomachCO4)Endocrine(CO18)HungerpointLiangqiu(ST34),Zhongwan(CV12)Tianshu(ST25),Shuifen(CV9)Fenglong(ST40)Liangqiu(ST34),Zhongwan(CV12)Tianshu(ST25),Shuifen(CV9)Fenglong(ST40)OnesetisTianshu(ST25)Zhongwan(CV12),Guanyuan(CV4)Zusanli(ST36),Weishu(BL21)AshixueZhongwan(CV12),Tianshu(ST25)Daheng(SP15),Shuifen(CV9)QIhai(CV6),Guanyuan(CV4)Zusanli(ST36),Ashixue
e
r
u
ofacupunct AAS AAS AAS AAS Placebo EA AAS EA ACE cupuncture ACE EA
e A
yl
St
n n
StudyID(Country) Abdietal.2012,Iran Darbandietal.2012,Ira Heetal.2012,China Lienetal.2012,Taiwan Darbandietal.2014,Ira Yehetal.2015,Taiwan Chenetal.2007,China Huangetal.2011,China
Evidence-BasedComplementaryandAlternativeMedicine 9
Frequency&durationofAcupuncturesessions EA:Thefirst3daysare1timesaday,and1timeafter3days,15daysis1courseoftreatment.ACE:Afterthefirstacupointcatgutembeddingfor3consecutivetimes,theintervalisburiedforthesecondtimeafter15days,andtheacupunctureisperformedforthethirdtimeaftertheendofthetreatmentperiod. Thefirst3daysare1timesaday,and1timeafter3days,15daysis1courseoftreatment. EA:Thefirst3daysare1timesaday,and1timeafter3days,15daysis1courseoftreatment.ACE:Afterthefirstacupointcatgutembeddingfor3consecutivetimes,theintervalisburiedforthesecondtimeafter15days,andtheacupunctureisperformedforthethirdtimeaftertheendofthetreatmentperiod. Thefirst3daysare1timesaday,and1timeafter3days,15daysis1courseoftreatment. 2sessionsweeklywithatotalof12sessionsfor6weeks
e
m
n
ti mi n n n n
on 0 mi mi mi mi
etenti EA:3 30 30 30 40
R
d.
Table2:Continue Namesofacupuncturepointsused EA:Zhongwan(CV12),Xiawan(CV10)Guanyuan(CV4),Tianshu(ST25)Shuifen(CV9),Sanyinjiao(SP6)Zusanli(ST36),Xuehai(SP10)Xinshu(BL15),Geshu(BL17)Pishu(BL20)ACE:Zhongwan(CV12),Tianshu(ST25)Qihai(CV6),Tianshu(ST25)Liangqiu(ST34),Zusanli(ST36)Gongsun(SP4),Xinshu(BL15)Pishu(BL20)Zhongwan(CV12),Xiawan(CV10)Guanyuan(CV4),Tianshu(ST25)Shuifen(CV9),Sanyinjiao(SP6)Zusanli(ST36),Xuehai(SP10)Xinshu(BL15),Geshu(BL17)Pishu(BL20)Zhongwan(CV12),Xiawan(CV10)Qihai(CV6),Zhongji(CV3)Tianshu(ST25),Daheng(SP15)Liangmen(ST21),Huaroumen(ST24)Shuidao(ST28),Quchi(CV6)Zhigou(TE6),Hegu(LI4)Liangqiu(ST34),Zusanlli(ST36)Shangjuxu(ST37),Fenglong(ST40)Sanyinjiao(SP6),Gongsun(SP4)Neiting((ST44)Zhongwan(CV12),Xiawan(CV10)Qihai(CV6),Zhongji(CV3)Tianshu(ST25),Daheng(SP15)Liangmen(ST21),Huaroumen(ST24)Shuidao(ST28),Quchi(CV6)Zhigou(TE6),Hegu(LI4)Liangqiu(ST34),Zusanlli(ST36)Shangjuxu(ST37),Fenglong(ST40)Sanyinjiao(SP6),Gongsun(SP4)Neiting((ST44)Qihai(REN-6),Shuifen(REN-9)Shuidao(ST-28),Siman(K-14)Zusanli(ST-26),Fenglong(ST-40)Sanginjao(SP-6)
e s s
r e e
ctu api api
n r r
acupu nedthe EA nedthe EA EA
of bi bi
e m m
yl o o
St C C
a n
StudyID(Country) Tangetal.2009,Chin Shietal.2006,China Hsuetal.2005,Taiwa
10 Evidence-BasedComplementaryandAlternativeMedicine
Frequency&durationofAcupuncturesessions 2sessionsweeklywithatotalof10sessionsfor5weeks Acupuncture:1sessionevery3dayswithatotalof21sessionsfor4weeks,3daysrestbetweeneverysessionAcupointcatgutEmbedding:1sessionweeklywithatotalof3sessionsfor3weeks sessionevery3dayswithatotalof21sessionsfor4weeks,3daysrestbetweeneverysession 1sessionweeklywithatotalof3sessionsfor3weeks NRNR 1sessiondailywithatotalof21sessionsfor3weeks sessionevery2dayswithatotalof12sessionsfor3weeks sessionevery2dayswithatotalof12sessionsfor3weeks 1sessionweeklywithatotalof8sessionsfor8weeks
1 1 1
e
m
ti n n n n n
on mi R mi R RR mi mi mi R
enti 20 N 30 N NN 30 30 30 N
et
R
Table2:Continued. Namesofacupuncturepointsused Hegu(LI4),Shenmen(HT7)Zusanli(ST36),Neiting(ST44)Sanyinjiao(SP6)Zhongwan(CV12),Xiawan(CV10)Qihai(CV6),Guanyuan(CV4)Huaroumen(ST24),Wailing(ST26)Daheng(SP15),Tianshu(ST25)Yinjiao(CV7),Zhigou(TE6)Zusanll(ST36)Zhongwan(CV12),Xiawan(CV10)Qihai(CV6),Guanyuan(CV4)Huaroumen(ST24),Wailing(ST26)Daheng(SP15),Tianshu(ST25)Zhongwan(CV12),Tianshu(ST25)Yinjiao(CV7),Zhigou(TE6)Guanyuan(CV4),Zusanli(ST36)NRNRTianshu(ST25),Liangmen(ST21)Daheng(SP15),Zusanli(ST36)Sanyinjiao(SP6),Quchi(LI11)Zhigou(SJ6),Zhongwan(RN12)Qihai(RN06)Neiting(ST44),Shangjuxu(ST37)Xiajuxu(ST39),Fenglong(ST40)Tianshu(ST25),Zusanli(ST36)Quchi(LI11)Neiting(ST44),Shangjuxu(ST37)Xiajuxu(ST39),Fenglong(ST40)Tianshu(ST25),Zusanli(ST36)Quchi(LI11)Shen-men(TF4),Stomach(CO4)Spleen(CO13),HungerpointEndocrine(C018)
g
n
re es ddi
eofacupunctu Acupuncture mbinedtherapi Acupuncture ntcatgutembe ARAR acupuncture EA Acupuncture AAS
yl o oi
St C up
c
A
ID(Country) etal.2012,Turkey etal.2014,China netal.2014,Egypt al.2014,China etal.2013,China getal.2014,South
Study G¨uc¸el Deng Hassa Heet Wang SujunKorea