Evidence-based Evaluation Of Clinical Research On Acupoint Sticking Therapy For "winter Disease And Summer Cure"

Background and aims:Sanfu acupoint herbal patching(SAHP)is a unique traditional Chinese medicine therapy,which becomes more popular for preventing acute attack of respiratory diseases such as asthma,chronic obstructive pulmonary disease,in many regions of mainland China.However,the evidence available is scarce and the knowledge about its users is lacking,especially the characteristics of the users and their experience and perspectives.This study firstly aims to provide a comprehensive review of the characteristics of clinical studies on SAHP for any condition;and secondly aims to evaluate the preventive and therapeutic effect and safety of SAHP in people with stable asthma;thirdly aims to investigate the demographics of users,conditions for its use and the previous experience of SAHP,as well as users' perspectives to provide baseline information for its practice.Methods:Biliometrics analysis:We included clinical studies such as randomized clinical trials(RCTs),controlled clinical studies(CCTs),case series(CSs),case reports(CRs),and cross-sectional studies on SAHP for any condition.Six databases were searched from date of inception to March 2015.Bibliometric information and study details such as study type,characteristics of participants,details of the intervention and comparison,and outcome were extracted and analyzed.Systematic review:We searched seven electronic databases for randomised controlled trials(RCTs).The Cochrane risk of bias tool was utilised to evaluate the methodological quality of the included studies and RevMan 5.3 and GRADEpro 3.6.1 were applied to perform data analyses.Survey:A cross-sectional survey with consecutive sample was conducted at outpatient departments from three traditional Chinese medicine hospitals in northern China.Each participant completed a questionnaire,after informed consent.Data description and analyses were done using SPSS 20.0.Results:1.Characteristics of clinical studies of summer acupoint herbal patching:a bibliometric analysisA total of 937 clinical studies were identified and which were published between 1977 and 2015.This included 404 RCTs,52 CCTs,458 CSs,19 CRs and 4 cross-sectional studies and involved 232,138 participants aged 2 to 90 years from two countries.Almost all studies were from China(936,99.89%).The five conditions most commonly treated by SAHP were asthma(401,42.80%),chronic bronchitis(146,15.58%),allergic rhinitis(117,12.49%),chronic obstructive pulmonary disease(73,7.79%),and recurrent respiratory tract infection(42,4.48%).Among 502 controlled studies,the majority compared SAHP alone with different controls(16 categories,275 comparisons).The most commonly used controls were Western medicine(187),placebo(41),traditional Chinese medicine(36),no treatment(28)and non-pharmaceutical traditional Chinese therapies(24).Composite outcome measures were the most frequently reported outcome(512,69.19%).2.Sanfu acupoint herbal patching for stable asthma a systematic review and meta-analysis of randomised controlled trialsA total of 30 RCTs involving 3313 participants were included in the systematic review.The overall methodological quality of the trials was of high risk of bias.SAHP plus conventional therapy(CT)decreased the mean frequency(times per year)of asthma exacerbations compared with CT alone(times/3 months:MD:-0.79;95%CI:-1.27 to-0.31;REM;IZ=92%;times/6 months:MD:-0.62;95%CI:-1.14 to-0.10;times/12 months:MD:-1.95;95%CI:-2.83 to-1.07;REM;I2=92%;n=4),and similar effect was found for SAHP versus sham SAHP(MD:-1.85;95%CI:-2.33 to-1.37;n=1).For lung function(including PEF%,FEV1%and FEVi/FVC),SAHP plus CT showed better effect than CT alone,and so did SAHP versus sham SAHP on PEF and PEF%.Adverse effects in the SAHP groups were reported to be mild and well tolerated.3.The Characteristics of sanfu AHP users in respiratory department:a multicenter descriptive studyAmong 949 SAHP users from three hospitals,female was predominant(n=592;62.4%);aged from 2 to 96 years(median=52 years).64.7%(380/587)of regular users applied consecutively for three years or over,and the self-perceived satisfactory rates of respiratory diseases were from 45.9%to 77.7%.Positive attitude toward traditional Chinese medicine was the top reason of choosing SAHP.42.4%of users hold a motivation of being cured by SAHP and with great outcome expectancy on SAHP(70.8%).Conclusion:A substantial amount of research on SAHP has been published in China and which predominantly focuses on respiratory conditions.The findings from this study can be used to inform further research by highlighting areas of greatest impact for SAHP.SAHP alone or combined with CT appears to be more effective than sham SAHP or CT on reduction of asthma exacerbations,improving lung function,and SAHP seems to be safe.However,the findings should be interpreted with caution due to limitations in trial quality.Further,rigorously designed,large-scale trials are warranted for robust evidence.SAHP users were mainly female adults or elderly population;more than half were regular users;predominantly used SAHP for various chronic respiratory diseases on their stable stage.The majority of users expressed satisfactory to previous SAHP for their respiratory diseases.42.4%of users hold a motivation of being cured by SAHP and with great outcome expectancy on SAHP(70.8%).The findings from this survey deserve further clinical trials for their clinical effectiveness.