The Study Of Optimization On The Biased Constitutions Of Chinese Medicine With Acupuncture And Moxibustion By Network Meta-analysis

ObjectiveTo find the optimal acupuncture treatment of various biased constitution of Chinese Medicine by using network meta-analysis of previous studies.MethodsBy searching CNKI,VIP,Wanfang,Pub Med,EMBASE,Cochrane and other databases,we can obtain Chinese and English study articles on acupuncture and moxibustion treatment of biased constitution of Chinese Medicine.According to the pre-defined inclusion criteria and exclusion criteria,first step Randomized Control Trials(RCT)studies were selected,then basic information extraction and methodology quality evaluation of the included studies were performed.According to the modified JADAD scale,high quality studies were included into the network meta-analysis.Mainly use ADDIS software to perform network meta-analysis of different acupuncture treatments in the selected studies,and screen out the treatments with the best effect after probability-based ranking.According to relevant article information,qualitatively summarize the acupuncture point selection and the process of acupuncture and moxibustion,and formulate optimized acupuncture treatment plan for treating various biased constitution of Chinese Medicine.ResultsBased on the basic information of the included RCT studies,research patient,sample size,intervention measures,treatment period,outcome indicators,etc.,an information extraction table was developed,and the basic information of 143 RCT studies was included.The results show that,141articles' publication language are Chinese,accounting for 99%,and there are only 2 articles in English,and the authors are all Chinese.97% of RCT authors are fromhospitals,universities or research institutes,and only 3%of RCT authors are from community health service centers.22 RCTs(25%)are funded,most of which are funded by government or scientific research funds.80% RCTs' sample size is less than 100.84% of RCT patients have informed consent to the research content.Among the 143 selected RCT articles,18 are Qi-deficiency constitution,54 are Yang-deficiency constitution,14 are Yin-deficiency constitution,29 are Phlegm-dampness constitution,4 are damp-heat constitution,12 are Stagnant Blood constitution,11 are Stagnant Qi constitution,Inherited Special constitution has 1 article.After evaluating the methodology quality of the included 143 RCT documents,it was found that all RCT documents mentioned randomization,and 79 implemented randomization methods correctly,accounting for 55.2%,of which 53 used random number tables,13 used sealed-envelope methods,and 7 articles used random numbers generated by computer software,and 4 used Doll's clinical case random table.38 RCT articles mentioned hidden groups.Only 12 RCT articles mentioned blinding,of which only 8 RCT articles described blinding in detail.In order to ensure the robustness of the network meta-analysis,the improved JADAD scale was selected to further screen the included RCTs,and RCTs with ?3 points were selected.Finally,64 RCT articles of various constitutions were included in the network meta-analysis,including: 8articles on Qi-deficiency,24 articles on Yang-deficiency,8 articles on Yin-deficiency,9 articles on Phlegm-dampness,3 articles on Damp-heat,and7 articles on Stagnant Blood,5 articles on Qi-depression,0 articles on Inherited Special constitution.Use ADDIS software to quantitatively rank the acupuncture treatments of the included RCT studies based on Constitution Chinese Medicine Questionnaire,and screen out the better interventions.The ranked acupuncture treatment of various biased constitution scores are(top three): 1.Qi-deficiency consitution,long snake moxibustion > Moxa mild moxibustion+ear pressure>bloodletting + warm needle + acupuncture;2.Yang-deficiency constitution,warm needle + salt moxibustion> acupuncture + warm needle>acupuncture + salt moxibustion;3.Yin-deficiency constitution,bloodletting+ cupping + smokeless moxa stick moxibustion>Moxamoxibustion> acupuncture +warm needle;5.Phlegm-dampness constitution,snake moxibustion or warm needle;6.Stagnant Blood constitution,acupuncture + salt moxibustion> needle puncture + bloodletting + cupping> push meridian + bloodletting;7.Stagnant Qi,acupuncture + body adjustment and point selection> acupuncture + warm needle> fire needle + acupuncture.Based on the qualitative analysis and summary of relevant articles,the following are the optimized acupuncture treatment plans for various biased constitution of Chinese Medicine.Qi-Deficiency consitution: Moxa mild moxibustion for Shenque,Guanyuan,and Zusanli;press Wangbuliuxing seeds on ear points(heart,lung,liver,spleen,kidney,sympathetic,subcortical,endocrine,Shenmen);Yang-deficiency quality: salt-separated moxibustion for Shenque,warm acupuncture moxibustion for Guanyuan,Qihai,Shenshu,Pishu;Yin Deficiency consitution: First Fengmen,Feishu puncture and cupping,then smokeless moxa sticks are applied to Fengmen,Feishu,and ointment;Phlegm-dampness consitution: warm acupuncture at Zhongwan,Honglong,Zusanli,Taibai;Stagnant Blood constitution: salt-separated moxibustion at Shenque;acupuncture at Geshu,Ganshu,Taichong,Sanyinjiao;Stagnant Qi consitution: acupuncture at Tanzhong,Qimen,Taichong,Ganshu,Qihai;Damp-heat consitution,Inherited Special constitution: unavailable.ConclusionThe acupuncture and moxibustion treatment studies of biased constitution of Chinese Medicine included in this study has been evaluated and found that there are generally unclear random methods,no concealed grouping,no mention of blinding,no description of the number of people dropping out and reasons,and lack of safety evaluation and sample size estimation.As a result,the quality of clinical evidence in the studies decreased,which affects doctors' clinical choice of interventions.In this study,a network meta-analysis was used to quantitatively rank the clinical effectiveness of different acupuncture methods on the treatment of biased constitution of Chinese Medicine,and combine qualitative analysis to formulate an optimized plan for acupuncture treatment of various constitution of Chinese Medicine,such that it provides evidence to Chinese Medicine theory of "Treatment by body differentiation" through Evidence-based Medicine method.