Abstract
BackgroundAs the etiology of chronic fatigue syndrome (CFS) is unclear and the treatment is still a big issue. There exists a wide range of literature about acupuncture and moxibustion (AM) for CFS in traditional Chinese medicine (TCM). But there are certain doubts as well in the effectiveness of its treatment due to the lack of a comprehensive and evidence-based medical proof to dispel the misgivings. Current study evaluated systematically the effectiveness of acupuncture and moxibustion treatments on CFS, and clarified the difference among them and Chinese herbal medicine, western medicine and sham-acupuncture.MethodsWe comprehensively reviewed literature including PubMed, EMBASE, Cochrane library, CBM (Chinese Biomedical Literature Database) and CNKI (China National Knowledge Infrastructure) up to May 2016, for RCT clinical research on CFS treated by acupuncture and moxibustion. Traditional direct meta-analysis was adopted to analyze the difference between AM and other treatments. Analysis was performed based on the treatment in experiment and control groups. Network meta-analysis was adopted to make comprehensive comparisons between any two kinds of treatments. The primary outcome was total effective rate, while relative risks (RR) and 95% confidence intervals (CI) were used as the final pooled statistics.ResultsA total of 31 randomized controlled trials (RCTs) were enrolled in analyses. In traditional direct meta-analysis, we found that in comparison to Chinese herbal medicine, CbAM (combined acupuncture and moxibustion, which meant two or more types of acupuncture and moxibustion were adopted) had a higher total effective rate (RR (95% CI), 1.17 (1.09 ~ 1.25)). Compared with Chinese herbal medicine, western medicine and sham-acupuncture, SAM (single acupuncture or single moxibustion) had a higher total effective rate, with RR (95% CI) of 1.22 (1.14 ~ 1.30), 1.51 (1.31–1.74), 5.90 (3.64–9.56). In addition, compared with SAM, CbAM had a higher total effective rate (RR (95% CI), 1.23 (1.12 ~ 1.36)). In network meta-analyses, similar results were recorded. Subsequently, we ranked all treatments from high to low effective rate and the order was CbAM, SAM, Chinese herbal medicine, western medicine and sham-acupuncture.ConclusionsIn the treatment of CFS, CbAM and SAM may have better effect than other treatments. However, the included trials have relatively poor quality, hence high quality studies are needed to confirm our finding.
Highlights
As the etiology of chronic fatigue syndrome (CFS) is unclear and the treatment is still a big issue
Exclusion criteria The exclusion criteria included the following: (1) nonRCTs or duplicate publications; (2) animal studies; (3) case reports and reviews; (4) clinical research studies that compared different kinds of acupuncture or moxibustion; (5) the treatment was combined with others treatments than acupuncture and moxibustion; (6) the study with western medicine which were clearly not recommended according to the latest NICE guideline, such as glucocorticoids, mineralocorticoids; (7) the criteria of invalid evaluation was not based on syndrome score reduction by less than 30% or 1/3
After screening the full texts of the included articles, 158 studies were excluded for the following reasons: no relevant data (n = 35), inapposite treatments set (n = 73), patients with tuberculosis (n = 1), duplicate reports (n = 12), not randomized controlled trials (RCTs) (n = 3), unclear diagnose criteria (n = 7), inapposite criteria of invalid evaluation (n = 24), inappropriate western medicine (n = 3)
Summary
As the etiology of chronic fatigue syndrome (CFS) is unclear and the treatment is still a big issue. There exists a wide range of literature about acupuncture and moxibustion (AM) for CFS in traditional Chinese medicine (TCM). Current study evaluated systematically the effectiveness of acupuncture and moxibustion treatments on CFS, and clarified the difference among them and Chinese herbal medicine, western medicine and sham-acupuncture. Though many theories are used to explain CFS, the aetiology is still unclear and no major progress has been made in therapy. In treatment of CFS, cognitive behavior [7,8,9] and graded exercise therapies [10, 11] are thought to be effective in relief of symptoms, and the curative effect of western medicines isn’t promising. Suggestions on treatment have been made in a number of countries [13, 14], but their effect still needs to be further studied [15]
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