| Objective:Using the network Meta analysis method based on Frequency Principles theory,the efficacy and safety of different moxibustion methods in the treatment of cancer-related fatigue were evaluated from three aspects:fatigue scale score,KPS score and EORTC QLQ-C30 total health score,and the efficacy of each intervention was ranked according to the relevant statistical results,providing diagnosis and treatment ideas and evidence-based basis for subsequent clinical practice.At the same time,based on the ancient and modern medical case cloud platform,data mining of relevant clinical studies was conducted to analyse the pattern of moxibustion point selection for the treatment of cancer-related fatigue and to summarise the core prescriptions to provide guidance for optimising clinical protocols.Methods:The computer searched seven Chinese and English databases of CNKI,Wanfang,Vip Database,PubMed,Embase,The Cochrance Library and Web of Science to comprehensively collect randomized controlled trials(RCTs)on moxibustion in the treatment of cancer-induced fatigue,and the search period was from the establishment of the library to December 31,2022.Two reviewers independently screened studies,extracted data,and used the Cochrane Risk of bias tool for randomized trials(RoB)recommended by the Cochrane Handbook 5.1.0 to assess risk of bias for the included studies,used the network,mvmeta package in Stata 16.0 software to analyse the data and plot the associated graphs.Selected clinical studies related to the treatment of cancer-related fatigue with moxibustion,used the ancient and modern medical case cloud platform to mine the acupoint prescriptions involved in the study,the clinical selection rules of moxibustion in the treatment of cancer-induced fatigue were studied from various aspects such as acupuncture point frequency,acupoint attribution,acupoint distribution,and acupoint association analysis.Results:The network meta-analysis included 42 studies with a total of 3229 patients with cancer-related fatigue,involving 11 interventions:gentle moxibustion,sparrow-pecking moxibustion,spaced ginger moxibustion,spaced salt moxibustion,spaced medicine moxibustion,wheat grain moxibustion,heat-sensitive moxibustion,thunder fire moxibustion,fire dragon moxibustion,warm moxibustion apparatus moxibustion,and conventional symptomatic treatmen.Of these,39 papers reported Fatigue Scale scores,17 papers reported KPS scores,6 papers reported EORTC QLQ-C30 total health status scores and 5 papers reported adverse event occurrence.The network meta analysis results show:In terms of fatigue scale scores,gentle moxibustion,bird-pecking moxibustion,inter-ginger moxibustion,inter-salt moxibustion,inter-medicated moxibustion,wheat-grain moxibustion,heat-sensitive moxibustion,thunderbolt moxibustion,fire dragon moxibustion,and warming apparatus moxibustion are all superior to conventional allopathic treatment;among them,thunder fire moxibustion(SMD=-2.81,95%CI[-4.16,-1.46]),warm moxibustion device moxibustion(SMD=-2.29.95%CI[-3.75,-0.83]),spaced ginger moxibustion(SMD=-1.81,95%CI[-3.59,-0.02])and wheat grain moxibustion(SMD=-1.93,95%CI[-3.53,-0.33]),were superior to the conventional allopathic group,with statistically significant differences;the SUCRA values were ranked as follows:thunderbolt moxibustion>warm moxibustion device moxibustion>thermosensitive moxibustion>wheat grain moxibustion>isolated ginger moxibustion>isolated salt moxibustion>isolated medicine moxibustion>gentle moxibustion>fire dragon moxibustion>bird pecking moxibustion>conventional symptomatic treatment.In terms of KPS scores,gentle moxibustion,bird-pecking moxibustion,moxibustion with ginger,moxibustion with salt,wheat-grain moxibustion,heat-sensitive moxibustion,thunderbolt moxibustion,fire dragon moxibustion and warming apparatus moxibustion are all superior to conventional allopathic treatment;among them,ginger interval moxibustion(MD=21.43,95%CI[12.57,30.29]),wheat grain moxibustion(MD=15.30,95%CI[9.14,21.45]),salt interval moxibustion(MD=11.38,95%CI[2.79,19.97]),thunderbolt moxibustion(MD=10.39,95%CI[3.03,17.75]),gentle moxibustion(MD=6.64,95%CI[2.27,11.00])and warm moxibustion apparatus moxibustion(MD=9.82,95%CI[2.79,16.85])were superior to the conventional symptomatic treatment group,with statistically significant differences;In addition,spaced ginger moxibustion was superior to warm moxibustion(MD=11.61,95%CI[0.30,22.92]),bird-pecking moxibustion(MD=14.24,95%CI[1.84,26.64]),gentle moxibustion(MD=14.79,95%CI[4.92,24.67]),and fire dragon moxibustion(MD=16.32,95%CI[6.09.26.54]),with statistically significant differences in efficacy;wheat grain moxibustion was superior to gentle moxibustion(MD=8.66,95%CI[1.11,16.21])and fire dragon moxibustion(MD=10.18,95%CI[2.18,18.19]),with statistically significant differences;the SUCRA values were ranked as follows:intermittent ginger moxibustion>wheat grain moxibustion>intermittent salt moxibustion>thunderbolt moxibustion>heat sensitive moxibustion>warm moxibustion device moxibustion>bird pecking moxibustion>gentle moxibustion>fire dragon moxibustion>conventional symptomatic treatment.In terms of the total health score of EORTC QLQ-C30,mild moxibustion,wheat moxibustion,thunderbolt moxibustion and fire dragon moxibustion are all superior to conventional allopathic treatment;wheat-grain moxibustion(MD=17.05,95%CI[2.62,31.48])and mild moxibustion(MD=11.22.95%CI[3.87.18.58])were superior to the conventional symptomatic treatment group,with a statistically significant difference;SUCRA values are ranked as:wheat grain moxibustion>gentle moxibustion>thunder fire moxibustion>fire dragon moxibustion>conventional allopathic treatment.A total of 106 clinical publications were included in the study on the pattern of acupuncture point selection,including 106 moxibustion prescriptions,involving 58 relevant acupoints.The top ten acupuncture points in descending order of application frequency were:ST36(58),REN4(56),REN6(51),REN12(37),REN8(34),DU14(22),UB23(19),UB20(18),DU4(16)and SP6(15).The top four most frequently used acupoint meridians were:Ren meridians(191),Du meridians(158),Bladder meridian of foot taiyang(141)and Stomach meridian of foot yangming(67).The frequency of use of acupoints in each area,from highest to lowest,was:lower back(305),chest and abdomen(193),lower limbs(87),upper limbs(9),head and neck(6).As for the frequency statistics of acupoint combinations,REN4-REN6 was the most frequent,with 44 occurrences.For the grouping pattern,the core acupoint combinations with a confidence level≥0.6 and a support level≥ 0.2 included REN4,REN6,ST36,REN 12,REN8.According to the complex network relationship between acupoints,the core prescription is obtained "ST36-REN4-REN6-REN12-REN8".Conclusions:1.Moxibustion therapy can increase the clinical benefit of patients with cancer-related fatigue and outperform conventional symptomatic treatment in improving fatigue,functional status,and quality of life.Thunder moxibustion,ginger-spaced moxibustion and wheat grain moxibustion may be the best interventions for the treatment of CRF,among them,thunderbolt moxibustion may be the best moxibustion intervention in terms of improving fatigue status,ginger-spaced moxibustion may be the best moxibustion intervention in terms of improving functional status,and wheat grain moxibustion may be the best moxibustion intervention in terms of improving total health status in terms of quality of life.However,due to the poor methodological quality of the included articles,some intervention studies were rare,and the final efficacy ranking may be affected,and it is recommended to combine comprehensive clinical considerations.2.Moxibustion for cancer-caused fatigue is based on selected points on the abdomen,back and lower extremities,and attaches importance to the application of Ren meridians,Du meridians,Bladder meridian of foot taiy’ang and Stomach meridian of foot yangming.The most commonly used core acupuncture group in clinical practice is ST36-REN4-REN6REN12-REN8,and it is recommended to choose reasonably based on the actual clinical situation and TCM differentiation. |
PDF Full Text Request