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Acupuncture and Moxibustion have Different Effects on Fatigue by Regulating the Autonomic Nervous System: A Pilot Controlled Clinical Trial

In order to investigate the different effects of acupuncture and moxibustion on chronic fatigue syndrome (CFS) and alterations in the autonomic nervous system by measuring heart rate variability (HRV). Forty-five participants were recruited and randomly divided into 3 groups using a randomization schedule. The control group (CG, n = 15) and the acupuncture group (AG, n = 15) were treated by manipulation acupuncture, and the moxibustion group (MG, n = 15) was treated by indirect moxibustion. Primary outcomes were the scores of the Fatigue Assessment Instrument (FAI). Secondary outcomes were the HRV parameters which can reflect activity of the autonomic nervous system. This trial considered both instantaneous changes and long-term effectiveness. FAI scores decreased after the 4th and 10th treatments in the 3 groups. The decrease in FAI in the MG was greater than that in the AG. Acupuncture was more effective in instantaneous changes of HRV and moxibustion in long-term aspects. Both acupuncture and moxibustion improved fatigue in CFS patients, but moxibustion was more effective. The possible mechanism of the intervention may be through activation of the vagus nerve. Moxibustion was more effective than acupuncture in long-term treatment of CFS.

Methods This was a controlled clinical trial, which was conducted at Hubei University of Chinese Medicine and the TCM Research Center Graz, Medical University of Graz. The study protocol was approved by the Medical Ethics Committee of Hubei University of Chinese Medicine on July 5, 2014. The trial included patients with CFS that were 18 to 65 years old, who met the diagnostic criteria for CFS that were published by the Centers for Disease Control and Prevention in the United States1 and had no skin injuries at the acupoints ST36 (Zusanli), CV4 (Guanyuan).

Interventions. We use the TCM style of acupuncture and moxibustion. Two acupuncturists, who had at least 10 years of acupuncture and moxibustion experience, participated in the trial. Both of the acupuncturists were members of the College of Acupuncture and Moxibustion, Hubei University of Chinese Medicine, and were registered as medical practitioner acupuncturists by the National Health and Family Planning Commission of China.
We selected acupoints ST36 (bilateral) and CV4 which can reinforce qi in TCM theories and ameliorate fatigue in Western medical systems29,30. In the CG and AG, 3 acupoints were stimulated by single-use stainless steel needles (0.30 mm ×  40 mm, Global, Su Zhou Acupuncture Goods Co., Ltd, Suzhou, China). Each intervention session lasted 15 minutes, and the sessions were performed identically in both groups. The acupuncturist manipulated the needle by lifting-thrusting and twirling-rotating every 5 minutes to maintain the Deqi sensation, which means that the participants felt soreness, aching, and deep pressure as described in the Massachusetts General Hospital acupuncture sensation scales (MASS)31. The moxibustion group received warming from indirect moxibustion using a commercially available moxibustion box. The box had a cylindrical opening to hold a pillar of moxa stick and an elastic cord to affix it to the acupoint. The moxa stick (Φ 18 ×  200 mm) was wrapped with moxa floss, which is white, soft, cotton-like fibers prepared from moxa leaves. During the treatment, participants were asked to roll up their pants and lie on a bed in a supine position. Moxa boxes containing a pillar of moxa stick were affixed to the acupoints. The moxa was burned about 1 to 2 cm above the acupoint skin for 15 minutes, which can make the patient feel warm continuously. Burning injury was carefully avoided in the process by the acupuncturist focusing his attention and whisking away the burning ash in a timely manner. Every participant in the 3 groups received 10 sessions, which were administered every other day .

Results In all, 64 CFS patients and 25 healthy volunteers were willing to participate in the trial. Thirty-one CFS patients (48.4%) were ineligible according to the inclusion and exclusion criteria; 8 healthy volunteers (32%) could not participate on schedule. Thus, 50 participants were recruited to participate in this trial. Three CFS patients and 2 healthy volunteers were lost during the treatment because they could not adapt to acupuncture or they lost contact. Forty-five participants completed the trial on schedule, and each group had 15 participants .There were no significant differences in age and sex ratio between the 3 groups, and no significant differences in FAI scores were observed between AG and MG, which were similar at baseline .

Autoren: Qing Shu1,2,*, Hua Wang1,2,*, Daniela Litscher3, Song Wu1,2, Li Chen1,2, Ingrid Gaischek3, Lu Wang3, Wenjuan He1,2, Huanjiao Zhou1,2, Gerhard Litscher1,2,3,* & Fengxia Liang1,2,*

Quelle: www.nature.com/scientificreports

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