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Current Tracking on Effectiveness and Mechanisms of Acupuncture Therapy: A Literature Review of High-Quality Studies

  • Fu-ming Yang
  • Lin Yao
  • Shen-jun Wang
  • Yi Guo
  • Zhi-fang XuEmail author
  • Chien-Hung Zhang
  • Kuo Zhang
  • Yu-xin Fang
  • Yang-yang Liu
Review

Abstract

The scientific evidence of acupuncture studies has been improved in recent years, and one of the important manifestations is that more and more acupuncture clinical trials and mechanism researches have been published in the source periodicals of Science Citation Index (SCI). This study summarized the dominant diseases of acupuncture focusing on of acupuncture efficacy and mechanisms, and discussed the existing problems, highlighting the direction of future developments. Most clinical studies were published in journals with journal impact factor (JIF) score of 10 or above, and majority of the basic researches had JIF scores of 5 to 10. The above literature were further divided according to the International Classification of Diseases (ICD). The most concerned diseases in these articles were neurological diseases, musculoskeletal system and connective tissue diseases, tumor and digestive system diseases. The therapeutic effect and mechanism of acupuncture on each kind of disease were summarized. The results showed that the therapeutic effect of acupuncture on nerve injury focused on the anti-oxidation pathway, neuroprotective and anti-inflammatory processes. The antiinflammatory effect also played an important role in the treatment of musculoskeletal diseases. The analgesic effect was underlined in most of these studies. Clinical trials were well carried out on acupuncture curative effect of tumor complications and side effects of chemo-radiotherapy, but the potential mechanisms have not been clarified. Somato-visceral reflex was suggested to be strongly associated with the effects of acupuncture changing the motor activity of the gastrointestinal tract. Functional magnetic resonance imaging studies indicated that non-specific effects play important roles in acupuncture analgesia. Lines of evidence have pointed out that the regulation of neuro-endocrine-immune networks may be a common switch of acupuncture on different nerve system diseases.

Keywords

acupuncture clinical trials mechanism anti-inflammation neuro-endocrine-immune network 

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Current Tracking on Effectiveness and Mechanisms of Acupuncture Therapy: A Literature Review of High-Quality Studies

References

  1. 1.
    Lehmann H. Acupuncture in ancient China: how important was it really. J Integr Med 2013;11:45–53.Google Scholar
  2. 2.
    Highfield ES, Kaptchuk TJ, Ott MJ, et al. Availability of acupuncture in the hospitals of a major academic medical center: a pilot study. Complement Ther Med 2003;11:177–183.Google Scholar
  3. 3.
    Kim KH, Kim YR, Noh SH, et al. Use of acupuncture for pain management in an academic Korean medicine hospital: a retrospective review of electronic medical records. Acupunct Med 2013;31:228–234.Google Scholar
  4. 4.
    Qaseem A, Barry MJ, Kansagara D. Nonpharmacologic versus pharmacologic treatment of adult patients with major depressive disorder: a clinical practice guideline from the american college of physicians. Ann Intern Med 2016;164:350–359.Google Scholar
  5. 5.
    Seidman MD, Gurgel RK, Lin SY, et al. Clinical practice guideline: allergic rhinitis. Otolaryngol Head Neck Surg 2015;152:S1–S43.Google Scholar
  6. 6.
    Cooney MF. Postoperative pain management: clinical practice guidelines. J Perianesth Nurs 2016;31:445–451.Google Scholar
  7. 7.
    Guichard JL, Hage FG. Guidelines in review: 2015 ACR/ACC/ AHA/AATS/ACEP/ASNC/NASCI/SAEM/SCCT/SCMR/SCPC/ SNMMI/STR/STS Appropriate Utilization of Cardiovascular Imaging in Emergency Department Patients with Chest Pain: A joint document of the American College of Radiology Appropriateness Criteria Committee and the American College of Cardiology Appropriate Use Criteria Task Force. J Nucl Cardiol 2016;23:1142–1146.Google Scholar
  8. 8.
    Burgess SM, Gauthier M, Cala ML. Comparison of patientreported outcomes requirements in medical guidelines for pain, migraine, rheumatoid arthritis, and systemic lupus erythematosus: Europe vs. United States. Value Health 2015;18:A743.Google Scholar
  9. 9.
    Cressey D. Acupuncture for mice. Nature 2010;465:538.Google Scholar
  10. 10.
    Proceedings of the National Academy of Sciences of the United States of America. Annual subject and author indexes. Proc Natl Acad Sci U S A 1990;87 Suppl:10069-10240.Google Scholar
  11. 11.
    Shanta A, Pradhan AS, Sharma SD. Impact factor of a scientific journal: is it a measure of quality of research. J Med Phys 2013;38:155–157.Google Scholar
  12. 12.
    Raj RG, Zainab AN. Relative measure index: a metric to measure the quality of journals. Scientometrics 2012;93:305–317.Google Scholar
  13. 13.
    Lesi G, Razzini G, Musti MA, et al. Acupuncture as an integrative approach for the treatment of hot flashes in women with breast cancer: a prospective multicenter randomized controlled trial (AcCliMaT). J Clin Oncol 2016;34:1795–1802.Google Scholar
  14. 14.
    Mao JJ, Bowman MA, Xie SX, et al. Electroacupuncture versus gabapentin for hot flashes among breast cancer survivors: a randomized placebo-controlled trial. J Clin Oncol 2015;33:3615–3620.Google Scholar
  15. 15.
    MacPherson H, Tilbrook H, Richmond S, et al. Alexander technique lessons or acupuncture sessions for persons with chronic neck pain a randomized trial. Ann Intern Med 2015;163:653–662.Google Scholar
  16. 16.
    Hinman RS, McCrory P, Pirotta M, et al. Acupuncture for chronic knee pain: a randomized clinical trial. JAMA 2014;312:1313–1322.Google Scholar
  17. 17.
    Teoh AYB, Chong CCN, Leung WW, et al. Electroacupuncture analgesia for endoscopic ultrasound: a prospective, randomized, double-blinded, sham-controlled study. Gastroenterology 2014;146:S902.Google Scholar
  18. 18.
    Ee C, Xue C, Chondros P, et al. Acupuncture for menopausal hot flashes: a randomized trial. Ann Intern Med 2016;164:U146–U135.Google Scholar
  19. 19.
    Kim SK, Lee H, Kuo B, et al. Does realistic clinical acupuncture treatment have an effect on functional dyspepsia. Gastroenterology 2015;148:S820–S821.Google Scholar
  20. 20.
    Anonymous. Clinical practice points: acupuncture for chronic severe functional constipation. A randomized trial. Ann Intern Med 2017;165(11) (no pagination).Google Scholar
  21. 21.
    Garcia PEJDJLA. Randomized double-blind placebocontrolled pilot study of acupuncture in idiopathic gastroparesis. Gastroenterology 2015;148:S514.Google Scholar
  22. 22.
    Zhao L, Chen J, Li Y, et al. The long-term effect of acupuncture for migraine prophylaxis a randomized clinical trial. JAMA Intern Med 2017;177:508–515.Google Scholar
  23. 23.
    MacPherson H, Richmand S, Bland M, et al. Acupuncture and counselling for depression in primary care: a randomised controlled trial. PLoS Med 2015;10:e1001518.Google Scholar
  24. 24.
    Comachio J, Magalhaes M, Burke TN, et al. Effect of acupuncture and electroacupuncture in pain, disability and depression in patients with chronic nonspecific low back pain: a randomized controlled trial. Ann Rheum Dis 2015;74:1347.Google Scholar
  25. 25.
    Liu ZS, Yan SY, Wu JN, et al. Acupuncture for chronic severe functional constipation: a randomized trial. Ann Intern Med 2016;165:761–769.Google Scholar
  26. 26.
    Torres-Rosas R, Yehia G, Pena G, et al. Dopamine mediates vagal modulation of the immune system by electroacupuncture. Nat Med 2014;20:291–295.Google Scholar
  27. 27.
    National Clinical Guideline for Stroke, 4th ed. In: Physicians RCo, ed. Intercollegiate Stroke Working Party; 2012.Google Scholar
  28. 28.
    Zhang SH, Wu B, Liu M, et al. Acupuncture efficacy on ischemic stroke recovery multicenter randomized controlled trial in China. Stroke 2015;46:1301–1306.Google Scholar
  29. 29.
    Fang JQ, Chen LF, Ma RJ, et al. Comprehensive rehabilitation with integrative medicine for subacute stroke: a multicenter randomized controlled trial. Sci Rep 2016;6:25850.Google Scholar
  30. 30.
    Jiang C, Yang SL, Tao J, et al. Clinical efficacy of acupuncture treatment in combination with RehaCom cognitive training for improving cognitive function in stroke: a 2 x 2 factorial design randomized controlled trial. J Am Med Dir Assoc 2016;17:1114–1122.Google Scholar
  31. 31.
    Lu CY, Huang HC, Chang HH, et al. Acupuncture therapy and incidence of depression after stroke. Stroke 2017;48:1682–1684.Google Scholar
  32. 32.
    Yu N, Wang Z, Chen Y, et al. The ameliorative effect of bloodletting puncture at hand twelve Jing-well points on cerebral edema induced by permanent middle cerebral ischemia via protecting the tight junctions of the blood-brain barrier. BMC Complement Altern Med 2017;17:470.Google Scholar
  33. 33.
    Wang Q, Li X, Chen Y, et al. Activation of epsilon protein kinase C-mediated anti-apoptosis is involved in rapid tolerance induced by electroacupuncture pretreatment through cannabinoid receptor type 1. Stroke 2011;42:389–396.Google Scholar
  34. 34.
    Hu S, Du MH, Luo HM, et al. Electroacupuncture at Zusanli (ST 36) prevents intestinal barrier and remote organ dysfunction following gut ischemia through activating the cholinergic anti-inflammatorydependent mechanism. Evid Based Complement Alternat Med 2013;2013:592127.Google Scholar
  35. 35.
    Wang Q, Wang F, Li X, et al. Electroacupuncture pretreatment attenuates cerebral ischemic injury through a7 nicotinic acetylcholine receptor-mediated inhibition of high-mobility group box 1 release in rats. J Neuroinflammation 2012;9:24.Google Scholar
  36. 36.
    Liao ET, Tang NY, Lin YW, et al. Long-term electrical stimulation at ear and electro-acupuncture at ST 36-ST 37 attenuated COX-2 in the CA1 of hippocampus in kainic acidinduced epileptic seizure rats. Sci Rep 2017;7:472.Google Scholar
  37. 37.
    Yang EJ, Cai M, Lee JH. Neuroprotective Effects of electroacupuncture on an animal model of bilateral common carotid artery occlusion. Mol Neurobiol 2016;53:7228–7236.Google Scholar
  38. 38.
    Han B, Lu Y, Zhao H, et al. Electroacupuncture modulated the inflammatory reaction in MCAO rats via inhibiting the TLR4/NF-?B signaling pathway in microglia. Int J Clin Exp Pathol 2015;8:11199–11205.Google Scholar
  39. 39.
    Wang XR, Shi GX, Yang JW, et al. Acupuncture ameliorates cognitive impairment and hippocampus neuronal loss in experimental vascular dementia through Nrf2-mediated antioxidant response. Free Radic Biol Med 2015;89:1077–1084.Google Scholar
  40. 40.
    Guo J, Chen Y, Yuan B, et al. Effects of intracellular superoxide removal at acupoints with TAT-SOD on obesity. Free Radic Biol Med 2011;51:2185–2189.Google Scholar
  41. 41.
    Siu FK, Lo SC, Leung MC. Electro-acupuncture potentiates the disulphide-reducing activities of thioredoxin system by increasing thioredoxin expression in ischemia-reperfused rat brains. Life Sci 2005;77:386–399.Google Scholar
  42. 42.
    Shi GX, Wang XR, Yan CQ, et al. Acupuncture elicits neuroprotective effect by inhibiting NAPDH oxidase-mediated reactive oxygen species production in cerebral ischaemia. Sci Rep 2015;5:17981.Google Scholar
  43. 43.
    Qin W, Tian J, Bai L, et al. FMRI connectivity analysis of acupuncture effects on an amygdala-associated brain network. Mol Pain 2008;4:55–72.Google Scholar
  44. 44.
    Wang Q, Peng Y, Chen S, et al. Pretreatment with electroacupuncture induces rapid tolerance to focal cerebral ischemia through regulation of endocannabinoid system. Stroke 2009;40:2157–2164.Google Scholar
  45. 45.
    Sun SS, Chen XY, Gao Y, et al. Mn-SOD upregulation by electroacupuncture attenuates ischemic oxidative damage via CB1R-mediated STAT3 phosphorylation. Mol Neurobiol 2016;53:331–343.Google Scholar
  46. 46.
    Guo F, Jiang T, Song WY, et al. Electroacupuncture attenuates cerebral ischemia-reperfusion injury in diabetic mice through adiponectin receptor 1-mediated phosphorylation of GSK-3 beta. Mol Neurobiol 2015;51:685–695.Google Scholar
  47. 47.
    Wei HD, Yao X, Yang LF, et al. Glycogen synthase kinase-3 beta is involved in electroacupuncture pretreatment via the cannabinoid CB1 receptor in ischemic stroke. Mol Neurobiol 2014;49:326–336.Google Scholar
  48. 48.
    Liu ZY, Chen XY, Gao Y, et al. Involvement of GluR2 up-regulation in neuroprotection by electroacupuncture pretreatment via cannabinoid CB1 receptor in mice. Sci Rep 2015;5:9490.Google Scholar
  49. 49.
    Ahn SM, Kim YR, Kim HN, et al. Electroacupuncture ameliorates memory impairments by enhancing oligodendrocyte regeneration in a mouse model of prolonged cerebral hypoperfusion. Sci Rep 2016;6:28646.Google Scholar
  50. 50.
    Deng B, Bai FH, Zhou H, et al. Electroacupuncture enhances rehabilitation through miR-181b targeting PirB after ischemic stroke. Sci Rep 2016;6:38997.Google Scholar
  51. 51.
    Ye Y, Li H, Yang JW, et al. Acupuncture attenuated vascular dementia-induced hippocampal long-term potentiation impairments via activation of D1/D5 receptors. Stroke 2017;48:1044–1051.Google Scholar
  52. 52.
    Cerezo-Tellez E, Torres-Lacomba M, Fuentes-Gallardo I, et al. Effectiveness of dry needling for chronic nonspecific neck pain: a randomized, single-blinded, clinical trial. Pain 2016;157:1905–1917.Google Scholar
  53. 53.
    Fan AY. The methodology flaws in Hinman's acupuncture clinical trial, part I: design and results interpretation. J Integr Med 2015;13:65–68.Google Scholar
  54. 54.
    Fan AY. The methodology flaws in Hinman's acupuncture clinical trial, Part III: sample size calculation. J Integr Med 2015;13:209–211.Google Scholar
  55. 55.
    Fan AY. The methodology flaws in Hinman's acupuncture clinical trial, Part II: zelen design and effectiveness dilutions. J Integr Med 2015;13:136–139.Google Scholar
  56. 56.
    Vase L, Baram S, Takakura N, et al. Specifying the nonspecific components of acupuncture analgesia. Pain 2014;154:1659–1667.Google Scholar
  57. 57.
    Lee IS, Lee B, Park HJ, et al. A new animal model of placebo analgesia: involvement of the dopaminergic system in reward learning. Sci Rep 2015;5:17140.Google Scholar
  58. 58.
    Liao HY, Hsieh CL, Huang CP, et al. Electroacupuncture attenuates CFA-induced inflammatory pain by suppressing Nav1.8 through S100B, TRPV1, opioid, and adenosine pathways in mice. Sci Rep 2017;7:42531.Google Scholar
  59. 59.
    Wang YQ, Cao XD, Wu GC. Role of dopamine receptors and the changes of the tyrosine hydroxylase mRNA in acupuncture analgesia in rats. Acupunct Electrother Res 1999;24:81–88.Google Scholar
  60. 60.
    Dai JL, Xu SF. The attenuation effect of chlorpromazine on electro-acupuncture analgesia: involvement of dopamine system. Acupunct Electrother Res 1991;16:101–109.Google Scholar
  61. 61.
    Han JS, Terenius L. Neurochemical basis of acupuncture analgesia. Annu Rev Pharmacol Toxicol 1982;22:193–220.Google Scholar
  62. 62.
    Sekido R, Ishimaru K, Sakita M. Corticotropin-releasing factor and interleukin-1beta are involved in the electroacupunctureinduced analgesic effect on inflammatory pain elicited by carrageenan. Am J Chin Med 2004;32:269–279.Google Scholar
  63. 63.
    Su TF, Zhao YQ, Zhang LH, et al. Electroacupuncture reduces the expression of proinflammatory cytokines in inflamed skin tissues through activation of cannabinoid CB2 receptors. Eur J Pain 2012;16:624–35.Google Scholar
  64. 64.
    Lee JH, Jang KJ, Lee YT, Choi YH, Choi BT. Electroacupuncture inhibits inflammatory edema and hyperalgesia through regulation of cyclooxygenase synthesis in both peripheral and central nociceptive sites. Am J Chin Med 2006;34:981–988.Google Scholar
  65. 65.
    Jhaveri MD, Richardson D, Chapman V. Endocannabinoid metabolism and uptake: novel targets for neuropathic and inflammatory pain. Br J Pharmacol 2007;152:624–632.Google Scholar
  66. 66.
    Wang Y, Lei JX, Gupta M, et al. Electroacupuncture in conscious free-moving mice reduces pain by ameliorating peripheral and central nociceptive mechanisms. Sci Rep 2016;6:34493.Google Scholar
  67. 67.
    Chen XM, Xu J, Song JG, Zheng BJ, Wang XR. Electroacupuncture inhibits excessive interferon-gamma evoked up-regulation of P2X4 receptor in spinal microglia in a CCI rat model for neuropathic pain. Br J Anaesth 2015;114:150–157.Google Scholar
  68. 68.
    Hu, Klein JD, Hassounah F, et al. Low-frequency electrical stimulation attenuates muscle atrophy in CKD—a potential treatment strategy. J Am Soc Nephrol 2015;26:626–635.Google Scholar
  69. 69.
    Salazar TE, Richardson MR, Beli E, et al. Electroacupuncture promotes central nervous system-dependent release of mesenchymal stem cells. Stem Cells 2017;35:1303–1315.Google Scholar
  70. 70.
    Zhang J, Yong Y, Li X, et al. Vagal modulation of high mobility group box-1 protein mediates electroacupuncture-induced cardioprotection in ischemia-reperfusion injury. Sci Rep 2015;5:15503.Google Scholar
  71. 71.
    2008 GP. The International Agency for Research on Cancer (IARC) (2010). available at: http://globocan.iarc.fr/.Google Scholar
  72. 72.
    Rheingold SR NAI, Meadows AT, eds. Chapter 156: secondary cancers: incidence, risk factors, and management. Hamilton: BC Decker; 2000:2399.Google Scholar
  73. 73.
    Mao JJ, Farrar JT, Bruner D, et al. Electroacupuncture for fatigue, sleep, and psychological distress in breast cancer patients with aromatase inhibitor-related arthralgia: a randomized trial. Cancer 2014;120:3744–3751.Google Scholar
  74. 74.
    Lesi G, Razzini G, Musti MA, Stivanello E, Petrucci C, Benedetti B, et al. Acupuncture as an integrative approach for the treatment of hot flashes in women with breast cancer: a prospective multicenter randomized controlled trial (AcCliMaT). J Clin Oncol 2016;34:1795–1802.Google Scholar
  75. 75.
    Minchom A, Punwani R, Filshie J, et al. A randomised study comparing the effectiveness of acupuncture or morphine versus the combination for the relief of dyspnoea in patients with advanced non-small cell lung cancer and mesothelioma. Eur J Cancer 2016;61:102–110.Google Scholar
  76. 76.
    Mao JJ, Xie SX, Farrar JT, et al. A randomised trial of electroacupuncture for arthralgia related to aromatase inhibitor use. Eur J Cancer 2014;50:267–276.Google Scholar
  77. 77.
    Shen YH, Liu LM, Chiang JS, et al. Randomized, placebocontrolled trial of k 1 acupoint acustimulation to prevent cisplatin-induced or oxaliplatin-induced nausea. Cancer 2015;121:84–92.Google Scholar
  78. 78.
    Ding SS, Hong SH, Wang C, et al. Acupuncture modulates the neuro-endocrine-immune network. QJM Int J Med 2014;107:341–345.Google Scholar
  79. 79.
    Xu Y, Hong S, Zhao X, et al. Acupuncture alleviates rheumatoid arthritis by immune-network modulation. Am J Chin Med 2018;46:997–1019.Google Scholar
  80. 80.
    Zhang K, Guo XM, Yan YW, et al. Applying statistical and complex network methods to explore the key signaling molecules of acupuncture regulating neuroendocrine-immune network. Evid Based Complement Alternat Med 2018;2018:9260630.Google Scholar
  81. 81.
    Fang JF, Fang JQ, Shao XM, et al. Electroacupuncture treatment partly promotes the recovery time of postoperative ileus by activating the vagus nerve but not regulating local inflammation. Sci Rep 2017;7:39801.Google Scholar
  82. 82.
    Xu JJ, Zheng XJ, Cheng KK, et al. NMR-based metabolomics reveals alterations of electro-acupuncture stimulations on chronic atrophic gastritis rats. Sci Rep 2017;7:45580.Google Scholar
  83. 83.
    Bai L, Qin W, Tian J, et al. Acupuncture modulates spontaneous activities in the anticorrelated resting brain networks. Brain Res 2009;1279:37–49.Google Scholar
  84. 84.
    Huang W, Pach D, Napadow V, et al. Characterizing acupuncture stimuli using brain imaging with FMRI—a systematic review and meta-analysis of the literature. PLoS One 2012;7:e32960.Google Scholar
  85. 85.
    Yang MX, Yu Z, Deng SF, et al. A targeted metabolomics MRMMS Study on identifying potential hypertension biomarkers in human plasma and evaluating acupuncture effects. Sci Rep 2016;6:25871.Google Scholar
  86. 86.
    Zhang AH, Yan GL, Sun H, et al. Deciphering the biological effects of acupuncture treatment modulating multiple metabolism pathways. Sci Rep 2016;6:19942.Google Scholar
  87. 87.
    Chen XY, Spaeth RB, Retzepi K, Ott D, Kong J. Acupuncture modulates cortical thickness and functional connectivity in knee osteoarthritis patients. Sci Rep 2014;4:6482.Google Scholar
  88. 88.
    Li ZJ, Liu ML, Lan L, et al. Altered periaqueductal gray resting state functional connectivity in migraine and the modulation effect of treatment. Sci Rep 2016;6:20298.Google Scholar
  89. 89.
    Jung WM, Lee IS, Wallraven C, Ryu YH, Park HJ, Chae Y. Cortical activation patterns of bodily attention triggered by acupuncture stimulation. Sci Rep 2015;5:12455.Google Scholar
  90. 90.
    Bao CH, Liu P, Liu HR, et al. Different brain responses to electro-acupuncture and moxibustion treatment in patients with Crohn's disease. Sci Rep 2016;6:36636.Google Scholar
  91. 91.
    Li ZJ, Lan L, Zeng F, et al. The altered right frontoparietal network functional connectivity in migraine and the modulation effect of treatment. Cephalalgia 2017;37:161–176.Google Scholar
  92. 92.
    Napadow V, Li A, Loggia ML, et al. The brain circuitry mediating antipruritic effects of acupuncture. Cereb Cortex 2014;24:873–882.Google Scholar
  93. 93.
    Maeda Y, Kim H, Kettner N, et al. Rewiring the primary somatosensory cortex in carpal tunnel syndrome with acupuncture. Brain 2017;140:914–927.Google Scholar
  94. 94.
    Chao DM, Wang QY, Balboni G, Ding GH, Xia Y. Attenuating ischemic disruption of k+ homeostasis in the cortex of hypoxicischemic neonatal rats: DOR activation vs. acupuncture treatment. Mol Neurobiol 2016;53:7213–7227.Google Scholar
  95. 95.
    Mao JJ. A randomized placebo-controlled trial of acupuncture and gabapentin for hot flashes among breast cancer survivors. Cancer Res 2015;75:PD4–7–PD4–7.Google Scholar
  96. 96.
    Garcia MK, Cohen L, Guo Y, et al. Electroacupuncture for thalidomide/bortezomib-induced peripheral neuropathy in multiple myeloma: a feasibility study. J Hematol Oncol 2014;7:41.Google Scholar

Copyright information

© Chinese Association of the Integration of Traditional and Western Medicine 2019

Authors and Affiliations

  • Fu-ming Yang
    • 1
  • Lin Yao
    • 1
    • 2
  • Shen-jun Wang
    • 1
    • 3
  • Yi Guo
    • 1
    • 4
  • Zhi-fang Xu
    • 1
    • 3
    Email author
  • Chien-Hung Zhang
    • 1
  • Kuo Zhang
    • 1
  • Yu-xin Fang
    • 1
    • 3
  • Yang-yang Liu
    • 1
    • 3
  1. 1.Acupuncture Research CenterTianjin University of Traditional Chinese MedicineTianjinChina
  2. 2.Department of Acu-moxibustion and TuinaChangchun University of Traditional Chinese MedicineJilinChina
  3. 3.Department of Acu-moxibustion and TuinaTianjin University of Traditional Chinese MedicineTianjinChina
  4. 4.Department of Traditional Chinese MedicineTianjin University of Traditional Chinese MedicineTianjinChina

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