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J Acupunct Res > Volume 32(3); 2015 > Article
Choi, Kim, Kim, Park, Yook, and Kim: A Review on Clinical Studies of Acupuncture and Moxibustion Therapy for Acute Herpes Zoster※
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Abstract

Objectives:

The purpose of this study was to review the effectiveness of acupuncture and moxibustion therapy for the treatment of acute herpes zoster.

Methods:

Data was collected by two researchers. Clinical trials on PubMed were retrieved using MeSH terms including “herpes zoster” combined with “acupuncture therapy”, “moxibustion”, “bloodletting”, “electroacupuncture”, and related keywords. We excluded irrelevant studies and included randomized and non-randomized controlled trials, case series and case reports. Finally, we selected a total of thirteen studies and conducted a literature analysis and an object quality assessment.

Results:

Twelve of thirteen studies were about acupuncture and moxibustion combined therapy. Only one study suggested that a single acupuncture therapy is expected to be equally as effective as a common western medicine therapy. There was some evidence related to the effectiveness of moxibustion, venesection and electroacupuncture, but it dealt with combining therapy and was insufficient, and with an inclusion of potential risk factors. Only one study was conducted under approval from an institutional review board. No severe treatment-related adverse events were observed. A quality assessment suggested that there was some weakness in the areas of blinding and concealment.

Conclusions:

There is some evidence that suggests the effectiveness and safety of acupuncture and moxibustion combined therapy as a treatment for acute herpes zoster.

Fig 1
Flow-diagram of trials selection process
acupunct-32-3-147f1.gif
Table 1
Treatment Methods and Points Used in Intervention Group
Treatment Ref No Zhang8) Pan9) Dai10) Tian11) Liu12) Li13) Huo14) Zhang15) Liu16) Ouyang17) Yang18) Huang19) Ursini20) Total
Body acupuncture Ashi-points 7
EX-B2 2
EX-HN5 1
BL2 1
CV4 1
CV12 1
GB20 1
GB34 2
KI3 1
LI4 2
LI11 4
LR2 1
LR3 4
PC6 1
SP6 2
SP7 1
SP9 1
SP10 1
ST36 4
ST44 1
TE5 2
TE6 2
Electroacupuncture Ashi-points 1
EX-B2 4
TE6 2
SI3 2
Moxibustion Ashi-points 5
ST36 1
CV4 1
Bloodletting Ashi-points 7
Fire needling Ashi-points 1
Ultra-violet Ashi-points 2
Table 2
Summary of Characteristics and Results of Studies
First author Total N(I, C), age(I, C)
days of illness(I, C)
days of Treatment dropouts
Intervention group Control group Outcome assessment Results Authors’s Conclusion
Zhang8) 34(17, 17)
mean(49, 50)
mean(3.3, 3.1)
10 days
0
W/M+EA+UV W/M (Acy Vit B12)
+TDP
BRT, IT, VAS, LAB(IL-2, IL-6, IL-10) BRT, IT : I earlier than C(p<0.05)
VAS reducing amplitude : I larger than C(p<0.01)
TER : I higher than C(p<0.05), Reduction of IL-6&10 : I>C(p<0.05)
I>C
Intervention more significantly relief pain, shorten the duration of sickness, improve the body immunity, reduce nerve injury.
Pan9) 86(43, 43)
mean(50.1, 49.3)
mean(13.6, 14.1)
7+7 days
0
AC(acupoints selection based on syndrome differentiation) + VTx VTx only Symptoms score*, TER, PHN incidence TER : I higher than C(p<0.01)
TER of damp retention and spleen deficiency
: I higher than C(p<0.05), TER of qi deficiency and blood stasis
: I higher than C(p<0.05)
PHN incidence : I lower than C(p<0.05)
I>C
Intervention is high pertinent and effective, PHN can be reduced significantly and the curative effect is superior to that of control.
Dai10) 200(100, 100)
mean(52.29, 51.71)
mean(4.63, 3.69)
7 days
0
MCEI diagnosis and treatment + VTx W/M (Acy) MER, BRT, IT, PRT, PHN incidence(after 1month) MER : I higher than C(p<0.0001)
PRT, BRT, IT in I obviously shorter than C(p<0.0001)
PHN incidence : I 0 % C 26 %
I>C
Intervention can effectively relieve pain and prevent from PHN promptly.
Tian11) 80(42, 38)
mean(49.0, 48.5)
mean(7.4, 7.0)
10 days
0
sAC + MTx W/M (Acy) MER, SOP, color, quantity, erosion and exudation changes MER : I superior to C(p<0.05)
All the symptom scores : I better than C(all p<0.05)
I>C
The therapeutic effect of Intervention is superior to that of routine W/M.
Liu12) 53(31, 22)
mean(48.65, 47.91)
mean(5.14, 4.76)
10 days
0
EA + VTx W/M (Val, indomethacin, Vit B1, B12) TER, score of pain relief, pruritus, burning, sleep TER : I better than C(p<0.05)
All the symptom scores : I superior to C(all p<0.01)
I>C
Intervention is a better therapy and its effect is better than that of routine W/M therapy
Li13) 80(40, 40)
mean(46.36, 44.79)
unknown
10 days
0
EA + sAC W/M (Val, Vit B1, B12) TER, VAS, Time (scabbing area was equal or over 50 %), TER : I superior to C(p<0.01), VAS reduction : I better than C(p<0.01) I>C
Intervention is effective in facilitating the crust formation and pain relief, better than medication.
Huo14) 240(120, 120)
mean(48.45, 47.32)
mean(3.05, 2.95)
10 days
0
AC+VTx W/M (Acy) TER, PRT, BRT, IT TER : I>C difference(p<0.01), All the time : I shorter than C(All p<0.01) I≥C Intervention is an effective therapy for herpes zoster
Zhang15) 72(38, 34)
mean(54.55, 54.95)
mean(2.81, 5.09)
10 days
0
sAC+sMTx sAC TER(within 3 days), PRT, BRT, IT TER : I better than C(p<0.05)
Time : I shorter than C
(PRT : p=0.0042<0.01, BRT : p<0.05, IT : p<0.05)
PHN incidence cases : I 0, C 3
I>C Intervention has obvious therapeutic effect on herpes zoster
Liu16) AIDS patients
60(30, 30)
mean(44, 46)
I+C mean(3.0±1.5)
7+7 days
0
Thread MTx+sAC +Ointment W/M (Famci, Nimesulide, Vit B1, ribavirin) TER, MER, VAS, QS, BRT, IT, SRT, PHN incednce(after 1year) TER : I better than C(p>0.05)
MER : I better than C(p<0.01)
VAS(p<0.05), QS(p<0.01), BRT(p<0.05), IT(p<0.05), SRT(p<0.05), 1yr PHN incidence rate(p<0.01) : I lower than C
I≥C
Intervention is effective therapy. It relieved pain quickly, shortened course of disease, and improved quality of sleep.
Ouyang17) 130(65, 65)
mean(54.1 55.4)
mean(4.1 3.7)
7 days
0
VTx + UV W/M (Acy and other) Cured rate, TER, PHN incidence, Symptom scores(pain, rash and sleep) BRT, IT, SRT, PRT Cured rate(p<0.01), TER(p<0.01) : I higher than C
PHN incidence : I lower than C(p<0.05), Pain(p<0.01), Sleep(p<0.05), Affected skin(p<0.05) reduction : I larger than C BRT(p<0.05), IT(p<0.05), SRT(p<0.05), PRT(p<0.01) : I shorter than C
I≥C
Intervention has rapid therapeutic effect, effectively shortens duration of illness, decreases the incidence rate of HPN. And it is a safe remedy.
Yang18) 120(60, 60)
mean(47.1±10.7, 46.3±10.7)
mean(5.1±4.8, 5.2±4.9)
7 days
0
VTx+MTx + Plaster W/M (Val, Vit B1) MER, TER, PRI, PPI, VAS, symptom score, BRT, IT, SRT, PRT, recurrence rate(after 1 month) MER(p<0.01), TER(p<0.05) : I higher than C Reduction of PPI, PRI, VAS(all p<0.01) : I larger than C
Reduction of symptom scores(all p<0.05) : I larger than C
BRT(p<0.05), IT(p<0.05), SRT(p<0.05), PRT(p<0.01) : I shorter than C
Recurrence rate : I lower than C(p<0.01)
I>C
Intervention is quick effect and short-time treatment for HZ. It is safe and effective therapy.
Huang19) 183(36,35,43,39,36)
mean(44.1, 46.7, 44.9, 47.3, 46.0)
mean(3.6, 3.1, 3.8, 3.9, 3.3)
10 days
6
(A : sAC B : MTx C : fire needle D : VTx) +EA, sAC E : W/M (Val, Vit B1) BRT, IT, DcT, TER, VAS, BRT, IT, DcT, TER among the 5 groups : no significant differences(p>0.05).
VAS : A·B·C·D significantly lower from the 7th day than E(p<0.05).
I≥C
Intervention of A,B,C,D are effective, being comparable to the E in the curative effect and improvement of blisters, and better than E in pain relief.
Ursini20) 102(52, 50)
mean(67.1±12.8 65.5±12.8)
Unknown
28 days
36(rapid recovery 28)
AC(twice weekly) W/M(pregabali n, local anaesthesia, peridural neural blockade, opioid) Response rates, VAS, MPQ, mean changes in pain, differences in PHN incidence(after 3 month). Both(I,C) were largely effective.
Response rates(p=0.8>0.05) mean reduction of VAS p=0.12>0.05), MPG(p=0.9>0.05), PHN Incidence(p=0.5>0.05) mean Area-under-the-curve(AUC) during follow-up(p=0.4>0.05),: no significant differences,
I=C
This controlled and randomized trial provides the first evidence of a potential role of AC for the treatment of acute herpetic pain.

* The results of symptoms were not reported in the study.(Pan 2011)

W/M : western medicine. AC : acupuncture. sAC : surrounding acupuncture or encircled-acupuncture. MTx : moxibustion. VTx : venesection. EA : electroacupuncture.

MCEI : meridian-collateral electric information. Acy : acyclovir. Val : valaciclovir, Famci : famciclovir. BRT : blister relief time. IT : incrustation time. PRT : pain relief time. SRT : skin repair time.

DcT : decrustation time, TER : total effective rate(the cured and markedly cured rate). MER : markedly effective rate. PHN : post-herpetic neuralgia. VAS : visual analogue scale. SOP : score of pain.

QS : sleep quality score. PRI : pain rating index. PPI : present pain intensity, MPG : McGill pain qustionnaire. IRB : institutional review board. Co : consents. AE : adverse event.

Table 3
The Conditions of IRB Approval and Obtaining Informed Consents
First author year IRB approval Informed consents Adverse events
Zhang8) × ×
Pan9) × Mild(I1 C1)
Dai10) × × ×
Tian11) × ×
Liu12) × ×
Li3) × ×
Huo14) × × Mild(C2)
Zhang15) × × ×
Liu16) × ×
Ouyang17) × Mild(I1 C4)
Yang18) × Mild(C6)
Huang19) × ×
Ursini20) ×
Total 1(7.7 %) 10(76.9 %) 4(30.7 %)

* I : intervention group. C : control group.

Table 4
Assessment of Risk of Bias
First author year 1 2 3 4 5 6 7
Zhang8) L U U L L L U
Pan9) L U U L L H U
Dai10) L U U L L L U
Tian11) L U U L U L U
Liu12) L U U L L L U
Li13) L U U L L L U
Huo14) U U U L L L U
Zhang15) L U U L L L L
Liu16) L U U L L L U
Ouyang17) L U U L L L L
Yang18) L L U L U L L
Huang19) L L U L H L U
Ursini20) L L U L L L U
VI.
VI.

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