The Systematic Effect Of Randomized Controlled Trials On The Clinical Efficacy Of Different Interventions With Acupuncture

Background:Acupuncture is a kind of medical technology,which can stimulate acupoints by needling instruments such as filiform needles,relieve clinical symptoms,promote to cure diseases and then restore the body to health.Mainly including needle thickness,needling depth,acupuncture manipulation and so on,acupuncture manipulation techniques are a major component of treat-ment methods,are a significant means to get Qi,and deqi is key to therapeutic effect of acu-puncture treatment.Dredging channels and collaterals,strengthening healthy Qi to eliminate pathogens,and regulating Yin and Yang can be achieved through performing a variety of acu-puncture intervention.In recent years,with the development of acupuncture research,there has been more and more studies on effects of acupuncture intervention methods on clinical efficacy.How to choose the appropriate kind of acupuncture intervention to achieve the desired thera-peutic effect is an urgent clinical problem to be solved currently,and there still lacks systematic research on clinical effects of acupuncture intervention methods both at home and abroad.The following two reasons are why to choose primary dysmenorrhea and lumbar disc herniation to carry out systematic reviews individually:(1)Primary dysmenorrhea is a main disease of early studies of our research group,which has got a relatively profound understanding.(2)According to the literatures screening,the lumbar disc herniation is the pain disease which has the largest number of studies on effects of acupuncture intervention methods.Objective:1.To evaluate the effect of different methods of acupuncture intervention(including needle thickness,needling depth and acupuncture manipulation)on clinical efficacy individually;2.To evaluate the effect of acupuncture comprehensive intervention methods on clinical effi-cacy individually;3.To evaluate the effect of deqi on clinical efficacy after acupuncture intervention in patients with primary dysmenorrhea or lumbar disc herniation individually;Try to provide the basis for choosing the appropriate acupuncture intervention methods to achieve the ideal clinical efficacy from the perspective of evidence-based medicine.Method:The following 10 electronic databases:CNKI,CBM,VIP,the Wanfang Database,MEDLINE,CENTRAL,CINAHL,AMED,Embase,PsycINFO,and 5 mainstream registries for ongoing trials:WHO International Clinical Trial Registration Platform search portal;Chinese Clinical Trial Register;Clinical trials.gov;Australian and New Zealand Clinical Trial Regis-try(ANCTR);International Standard Randomized Controlled Trial Number(ISRCTN)were searched.We also handsearched the reference lists of all relevant articles found electronically.All the searches ended in March 2016.There was no language restriction.We included all ran-domized controlled trials that studied the effect of different methods of acupuncture interven-tion on clinical efficacy in patients with primary dysmenorrhea or lumbar disc herniation.Data was extracted independently by two reviewers.We used the Review Manager software V.5.3 to carry out statistical analysis.Results:1.8 RCTs(a total of 644 patients)of primary dysmenorrhea were contained,including 7 studies of acupuncture manipulation and 1 study of comprehensive intervention methods.Research results showed that in the treatment of primary dysmenorrhea,the effect of deep needling com-bined with strong stimulation of acupuncture manipulation was better than shallow needling combined with weak stimulation of acupuncture manipulation,the effect of application of acu-puncture manipulation was better than non-application of acupuncture manipulation,the effect of acupuncture applied with special manipulation was better than that with uniform reinforcing-reducing method;The effect of deqi after the intervention of deep needling combined with strong stimulation of acupuncture manipulation was better than that of shallow needling com-bined with weak stimulation of acupuncture manipulation,the effect of deqi after the interven-tion of application of acupuncture manipulation was better than that of non-application of acu-puncture manipulation,the effect of deqi after the intervention of application of special acu-puncture manipulation was better than that of uniform reinforcing-reducing method;The effect of acupuncture intervention containing a certain special sensation of deqi was superior to acu-puncture deqi without a certain special sensation.2.32 RCTs(a total of 2,066 patients)of lumbar disc herniation were contained,including 9 studies of needling depth,22 studies of acupuncture manipulation and 1 study of comprehensive intervention methods.Research results showed that in the treatment of lumbar disc herniation,the effect of deep needling was better than shallow needling,the effect of application of acu-puncture manipulation was better than non-application of acupuncture manipulation,the effect of acupuncture manipulation with strong stimulation was better than that with weak stimulation,the effect of acupuncture applied with special manipulation was better than that with uniform reinforcing-reducing method,the effect of deep needling combined with special manipulation was better than shallow needling combined with uniform reinforcing-reducing method;The effect of deqi after the intervention of deep needling was better than that of shallow needling,the effect of deqi after the intervention of application of acupuncture manipulation was better than that of non-application of acupuncture manipulation,the effect of deqi after the interven-tion of acupuncture manipulation with strong stimulation was better than that with weak stim-ulation,the effect of deqi after the intervention of acupuncture applied with special manipula-tion was better than that with uniform reinforcing-reducing method,the effect of deqi after the intervention of deep needling combined with special manipulation was better than that of shal-low needling combined with uniform reinforcing-reducing method;The effect of acupuncture intervention containing a certain special sensation of deqi was superior to acupuncture deqi without a certain special sensation.Conclusion:Preliminary view is that needling depth and acupuncture manipulation have an impact on therapeutic effect of primary dysmenorrhea and lumbar disc herniation,different kinds of acu-puncture intervention methods have different influences on deqi,and acupuncture intervention containing a certain special sensation of deqi is better for treatment effect.Because of low meth-odological quality and small sample size,the evidence is insufficient,and randomized,blinded,placebo-controlled trials in the above areas are urgently needed to further conform the results.