Acupoint catgut embedding is a useful therapy for weight management and widely applied in China. This review aimed to systematically evaluate the effects of acupoint catgut embedding on abdominal obesity. The combination subject terms of abdominal obesity or central obesity and acupoint catgut embedding or catgut implantation, catgut embedding were used. We found 15 studies involving individuals. Mean values of body weight by acupoint catgut embedding were 1. Less adverse events were reported in all included articles.
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Two researchers extracted and evaluated the information independently. RevMan V. As a novel treatment, ACET shows the potential of effectiveness and deserves further high quality of well-designed study. Postmenopausal osteoporosis PMOP is a common clinical disease characterized by bone mass reduction and microarchitecture degradation [ 1 , 2 ] that contributes to an increased risk of bone fragility and fracture. Approximately million women have been diagnosed with osteoporosis worldwide [ 4 ], and 1.
The health care costs directly related to osteoporosis are currently estimated to range from PMOP is caused by a decrease in ovarian function and levels of oestrogen in postmenopausal women, which causes bone mass reduction, increases bone brittleness, and leads to an increased prevalence of osteoporosis [ 7 ]. High morbidity, a high incidence of pain, and high disability rates are hallmarks of the disease. These symptoms seriously affect the quality of life of many postmenopausal women [ 8 ].
There are currently many therapeutic options available for the disease; commonly used medications include alendronic acid, risedronic acid, vitamin D, and calcium, among others [ 9 ]. However, the long-term use of these drugs represents an economic burden for affected patients. Additionally, these medications have serious side effects in the gastrointestinal tract, even leading to endometrialgia, breast cancer, oesophageal cancer, kidney stones, and other issues [ 10 ].
Studies have shown that kidney deficiency is the pathological basis of PMOP. After menopause, bones lack necessary nourishment because of a deficiency in kidney functionality, which contributes to the atrophic debilitation of bones [ 13 , 14 ]. Hence, the treatment of TCM should ideally be based on tonifying the kidney. Acupuncture is one of the characteristic therapies of TCM. Meta-analysis of acupuncture for the treatment of osteoporosis has indicated that warm acupuncture, electroacupuncture, and traditional acupuncture can improve clinical symptoms and provide pain relief in osteoporosis [ 15 , 16 ].
Moreover, most of the clinical studies of ACET have utilized small sample sizes, and large-scale RCTs have not been carried out due to the long duration of treatments and subsequent visits, which may affect the measurement of the observed indicators.
As a specialized form of acupuncture therapy, ACET can cause continuous needling effects at specific points through the insertion of catgut.
This therapy is characterized by rapid short-term effects and sustained long-term effects [ 17 ]. Compared with other treatments, ACET has marked advantages in terms of overcoming the high cost of health care, reducing the toxicity and side effects of drugs, shortening the frequency and duration of traditional acupuncture treatments, and improving patient compliance [ 12 , 18 ]. Additionally, compared with other acupuncture therapies, ACET has significant sustained stimulation effects; however, the positive effects of other clinical indicators remain to be confirmed.
Therefore, this study systematically evaluated the effectiveness and safety of existing RCTs of ACET in the treatment of PMOP, to optimize acupoint interventions for the treatment of osteoporosis and provide a basis for clinical treatment. We used the preferred reporting items for systematic reviews and meta-analysis PRISMA statement to guide our systematic evaluation report [ 19 ].
The retrieval strategies combined subjects and free words, which were determined after multiple presearches. Whenever necessary, we contacted the original study authors to obtain additional information.
Manual searches of relevant core journals, books, and references were also conducted to supplement the relevant studies. Studies involving RCTs in which subjects were diagnosed with PMOP and an experimental group was treated with ACET alone or in combination with other adjunct interventions, such as calcium supplements e. Trials must have reported at least one outcome indicator of improvement of osteoporosis, such as E2 levels or BMD, and the trial must have been published in English or Chinese.
Studies with the following characteristics were excluded: non-English or Chinese-language studies; studies without consistent diagnostic criteria or relevant outcome indicators; studies with other treatments used in the experimental group in addition to ACET; duplicate reports; studies with data that could not be extracted or merged because the samples or efficiencies were unspecified; studies enrolling participants with other diseases in addition to PMOP; case reports, comments, or review articles.
After the search, two independent researchers Fan Huang and Siyi Zhao reviewed the retrieved articles to filter and extract information according to the inclusion and exclusion criteria. A third researcher Zitong Feng was consulted to resolve disagreements to ensure that all included studies were consistent.
The extracted data included the study title, first author, year of publication, literature sources, baseline of patients in each group, intervention methods, outcomes, randomization methods, allocation and concealment methods, blinding methods, follow-up, and patient loss to follow-up or withdrawal, among other factors.
Methodological quality assessment was performed according to the Cochrane evaluation manual version 5. The main items of the Cochrane evaluation manual version 5. According to the evaluation criteria of the Jadad scale, the included clinical trials were graded from 0 to 5 points. The detailed scoring criteria were as follows: 1 application of a randomized method, 2 application of blinding method, and 3 application of withdrawal and loss to follow-up.
A trial sequential analysis was performed with TSA 0. Otherwise, the sources of heterogeneity were further analyzed. After excluding the influence of marked clinical heterogeneity, a random effects model was adopted to perform the meta-analysis. Sensitivity and bias risk analyses were also performed. Subsequently, the use frequency of acupoints was statistically analyzed using a column graph, and a trial sequential analysis of the total effectiveness rate was conducted [ 22 ].
Finally, we reported a general descriptive analysis of adverse reactions. We obtained relevant studies through preliminary searches. After multiple filtering steps, 12 RCTs with a total of participants were ultimately included in this systematic review [ 23 — 34 ]. Figure 1 is a flow diagram summarizing the selection of the included studies. In the remaining trials [ 28 — 34 ], ACET combining calcium supplements served as the experimental group, and calcium supplements alone served as the control group.
The duration of intervention in these trials was either three months [ 23 , 25 — 27 ] or six months [ 24 , 28 — 34 ]. All the characteristics of the included studies are shown in Table 1.
Bias risk assessment results of the included studies are shown in Figure 2. Eight RCTs reported a total effectiveness rate [ 24 — 26 , 29 — 32 , 34 ]. We identified the source of heterogeneity by performing sensitivity analysis; after removing one trial Chen et al. By contacting the author, the accuracy of the data in this paper was confirmed without publication bias. We consider it may be related to the small sample size only three. Subgroup analysis of the included studies was performed based on the different duration of treatment to compare the total effectiveness rate between the experimental and control groups.
The experimental groups of the three trials Liu et al. However, the experimental group of the outlying trial Wang et al. Eight RCTs reported the levels of E2 [ 23 — 27 , 29 — 31 ]. We performed a sensitivity analysis by removing two trials Gu et al.
The source of heterogeneity may be related to the different acupoints selected in the various studies. The heterogeneity may result from the different units used to calculate the levels of E2 among the trials. There were three RCTs reporting patient quality of life [ 28 , 30 , 31 ]. Two trials reported quality of life after three months of treatment [ 28 , 30 ]. All three trials reported patient quality of life after six months of treatment.
The high heterogeneity may have resulted from the differences in acupoint selection. Three RCTs used a VAS with a point index: ranging from 0 to 10, the larger the number, the greater the degree of pain to evaluate the degree of pain at the and month after treatment [ 29 — 31 ].
The high heterogeneity may be related to differences in acupoint selection. The other three trials used a pain score, which includes the evaluation of resting pain i. As a result of high heterogeneity, sensitivity analysis was adopted, and we obtained a lower heterogeneity by removing one trial Lu et al. The high heterogeneity may result from differences in the calcium supplements used.
Six of the twelve RCTs reported adverse reactions to the interventions [ 23 , 25 , 28 — 31 ]. Two trials only descriptively reported that there was no infection, fainting during acupuncture, haematoma formation, or foreign-body reaction in either the experimental or control group [ 24 , 25 ].
Four trials specifically reported the number of participants and the symptoms and solutions of adverse reactions [ 23 , 28 — 31 ]. The main adverse reactions of the experimental group included fainting, haematoma formation, and foreign-body reactions, among others; the control group reactions included nausea, drowsiness, and breast distention, among others. The incidence of adverse reactions was The adverse reactions of the two groups were mild to moderate in severity and easy to tolerate.
Our TSA analysis depicted that cumulative Z curve crossed the trial monitoring boundary after the inclusion of the fourth trial. However, the effects of ACET alone on the effectiveness rate were similar to those observed with medication alone, while ACET combining medicine supplementation was superior on it. As we can see from the forest plot, only Chen [ 25 ] declared that there was no statistical difference between the experimental and control group.
It is well known that the effectiveness of estrogen for PMOP is recognized internationally. In addition, Chen [ 25 ] adopted Kuppermann to evaluate the effectiveness, including four levels: absolutely clinical relief, obvious improvements, some improvements, and no improvement. In meta-analysis, the effective number was defined as the total number minus the invalid number, and there was no grading score.
However, absolutely clinical relief and obvious improvement are still the ideal therapeutic effects in clinical treatment. Meanwhile, effectiveness rate is a subjective indicator, and most patients still believe that the treatment of PMOP is medicine-based. As a new treatment, ACET has not been approved by the majority and there may be expectation bias on the result [ 35 ]. It is well known that pain relief is the greatest feature of acupuncture therapy. Four RCTs suggested that the pain relief effect of a number 9 syringe needle the primary tool for ACET in painful areas was similar to that of dry needling [ 28 — 31 ], which relieves pain by releasing muscle adhesions [ 36 ].
A large number of studies have indicated that ACET has analgesic effects, which may be related to the regulatory effects of ACET on phenylalanine, glycine, and endocannabinoid levels [ 37 ].
The major cause of PMOP is the reduction of oestrogen secretion in postmenopausal women whose hypothalamic-pituitary-ovarian axis function is in decline.
The activity of osteoclasts cannot be inhibited by low levels of oestrogen, leading to imbalances in bone resorption and bone formation. In addition, the abnormal differentiation of bone marrow mesenchymal stem cells BMMSCs can also cause this disease [ 38 ]. ACET has similar oestrogen-like effects and can regulate bone mass extensively through the three hypothalamic-pituitary axes: the hypothalamus-pituitary-ovarian axis, the hypothalamus-pituitary-adrenal axis, and the hypothalamus-pituitary-thyroid axis [ 39 , 40 ].
The treatment principle should tonify the liver and kidney to strengthen bone and tendon. Therefore, the major acupoints are related to the three meridians of the liver, spleen, and kidney. Shenshu BL23 and Ganshu BL18 are the Back-shu acupoints, which the Qi of viscera and bowels transport and infuse into, and they can treat disease of the corresponding viscera and bowels.
Sanyinjiao SP6 is the point at which the three meridians of the liver, spleen, and kidney connect and can adjust the three meridians simultaneously. Hence, the combination of these acupoints could tonify the roots of innate endowment and acquired constitution together.
However, this review has the following limitations: 1 Only twelve RCTs were included in this meta-analysis and the methodological quality of existing clinical RCTs was generally low due to lack of the description of randomized method, blinding method, allocation and concealment methods, and reports of the loss to follow-up or withdrawal.
An intention-to-treat ITT analysis was also not performed.
The Therapeutic Effect of Catgut Embedding in Obesity
Two researchers extracted and evaluated the information independently. RevMan V. As a novel treatment, ACET shows the potential of effectiveness and deserves further high quality of well-designed study. Postmenopausal osteoporosis PMOP is a common clinical disease characterized by bone mass reduction and microarchitecture degradation [ 1 , 2 ] that contributes to an increased risk of bone fragility and fracture. Approximately million women have been diagnosed with osteoporosis worldwide [ 4 ], and 1. The health care costs directly related to osteoporosis are currently estimated to range from PMOP is caused by a decrease in ovarian function and levels of oestrogen in postmenopausal women, which causes bone mass reduction, increases bone brittleness, and leads to an increased prevalence of osteoporosis [ 7 ].
Acupoint catgut embedding therapy with moxibustion reduces the risk of diabetes in obese women
This is an open access article distributed under the terms of Creative Commons Attribution License. Polycystic ovary syndrome PCOS is a comprehensive syndrome with the characteristics of chronic anovulation and polycystic ovary, and with low menstruation or amenorrhea, obesity, crinosity and infertility as main clinical features 1 , 2. It not only involves the genital system, but also directly influences the fertility function of women, and is a type of metabolic syndrome with hyperinsulinemia, hyperlipidemia, diabetes and frequent cardiovascular diseases. It involves multi-disciplinary problems in treatment, e. Therefore, with the deepening of research, PCOS has gone beyond the range of gynecology. Its pathomechanism involves multiple systems including heredity, internal secretion, immunity and metabolism, and its physical and mental damage to patients have raised the attention, which has become the difficulty and focus of gynecological field 3 , 4.
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Obesity is a major health problem worldwide for which conventional therapy efficacy is limited. Traditional Chinese medicine, particularly body acupoint stimulation, provides an alternative, effective, and safe therapy for this medical challenge. The present study was designed to compare the effects of distinct methods to stimulate the same set of acupoints, on anthropometric and biochemical parameters in obese women. Ninety-nine obese women were randomly assigned to six groups of treatment: Acupuncture with moxibustion, long needle acupuncture with moxibustion, electroacupuncture EA , EA with moxibustion, embedded catgut with moxibustion CGM and sham acupuncture as control. Body weight and BMI were significantly reduced in response to all treatments. Interestingly, acupoint catgut embedding therapy combined with moxibustion was the only treatment that produced a significant reduction in body weight 3.
Study record managers: refer to the Data Element Definitions if submitting registration or results information. After inform consent, they will be randomly assigned into two groups. In group A, catgut embedding will be applied to six acupuncture points on the abdomen including Qihai Ren-6 , Shuifen REN-9 , bilateral shuidao ST and Siman ST , which have been proved to be effective on obesity in our previous study, once each week for six times. In group B, sham catgut embedding will be applied on the same acupoints once each week for six weeks.
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