Background This study evaluated the robustness of real-world data (RWD)–based observational studies of acupuncture to unmeasured confounding using the E-value as a quantitative index. We examined how data source, exposure specification, and methodological characteristics influence robustness across published literature. Methods A systematic MEDLINE search identified observational RWD studies of acupuncture (2000–2025) reporting effect estimates with confidence intervals. Minimum E-values were computed to quantify the strength of unmeasured confounding needed to nullify observed associations. Study-level variables—including country, data source, disease category, treatment parameters, and analytic methods—were extracted. Group comparisons used nonparametric tests, while segmented temporal regression and ordinary least squares (OLS) meta-regression identified determinants of robustness. Results Sixty-five studies met inclusion criteria, mainly using national insurance claims and medical records. Mean minimum E-values ranged from 1.2 to 2.9. Although no continuous temporal trend was observed (Spearman’s ρ = −0.07, p = 0.60), segmented regression revealed a structural break at 2021, showing gradual improvement until 2021 followed by a marked decline. In OLS models, higher minimum session counts were inversely associated with E-values (p = 0.037), suggesting potential selection bias from longer exposures. Studies using electronic medical records were more robust than claims-based studies, and specification of treatment initiation increased robustness. Propensity score methods were not significantly associated with E-values. Conclusion Robustness of acupuncture RWD studies depends more on data richness and exposure definition than analytic complexity. Post-2021 declines highlight the need for standardized exposure definitions, data integration, and design-based control strategies to strengthen causal validity in nonpharmacological RWD research.
Background Artificial intelligence chatbots (AICs) are increasingly being integrated into scholarly publishing, with the potential to automate routine editorial tasks and streamline workflows. In traditional, complementary, and integrative medicine (TCIM) publishing, editorial and peer review processes can be particularly complex due to diverse methodologies and culturally embedded knowledge systems, presenting unique opportunities and challenges for AIC adoption. Methods An anonymous, online cross-sectional survey was distributed to the editorial board members of 115 TCIM journals. The survey assessed familiarity and current use of AICs, perceived benefits and challenges, ethical concerns, and anticipated future roles in editorial workflows. Results Of 5119 invitations, 217 eligible participants completed the survey. While approximately 70% of respondents reported familiarity with AI tools, over 60% had never used AICs for editorial tasks. Editors expressed strongest support for text-focused applications, such as grammar and language checks (81.0%) and plagiarism/ethical screening (67.4%). Most respondents (82.8%) believed that AICs would be important or very important to the future of scholarly publishing; however, the majority (65.3%) reported that their journals lacked AI-specific policies and training programs to guide editors and peer reviewers. Conclusions Most TCIM editors believe that AICs have potential to support routine editorial functions but also have limited adoption into editorial and peer review processes due to practical, ethical, and institutional barriers. Additional training and guidance are warranted by journals to direct responsible and ethical use if AICs are to be adopted in TCIM academic publishing.
Background Acupuncture treatment typically involves the coordinated selection of multiple acupoints across the body; however, the spatial organization of their use remains poorly understood. Variation across the distal–proximal ordering of limb acupoints may provide a useful basis for examining acupoint selection. The Five-Shu system offers a structured model for testing this possibility, yet it remains unclear how its categorical sequence relates to the anatomical spacing of the corresponding acupoints. Methods Five-Shu acupoint usage and recommended needling depth were mapped onto standardized ordinal coordinates. The ordinal representation of the Five-Shu sequence was compared with anatomical coordinates derived from cumulative inter-point distances. Patterns of acupoint usage and recommended needling depth were then analyzed across the Five-Shu categories in Yin and Yang meridians. Results The categorical order of the Five-Shu sequence differed from the anatomical spacing of the corresponding acupoints. Selection frequency peaked at intermediate positions in Yin meridians but shifted proximally in Yang meridians, whereas recommended needling depth generally increased proximally. Usage and depth profiles aligned closely in Yin meridians but diverged in Yang meridians. Conclusions Acupoint selection varied systematically across the Five-Shu system. These findings support the use of the Five-Shu sequence as an ordinal analytical framework, without implying an equally spaced anatomical model.
Background Agastache rugosa (Korean mint) has been used traditionally in Korea to alleviate nausea, poor appetite, and inflammatory symptoms, suggesting its potential for treating cancer cachexia, which involves anorexia, systemic inflammation, and the loss of skeletal muscle and adipose tissue. In this study, we evaluated the therapeutic effects of a standardized hot water extract of A. rugosa (ARE) in BALB/c mice with cancer-induced cachexia, focusing on improvements in anorexia, inflammation, muscle atrophy, and fat wasting. Methods Cachexia was induced by subcutaneous inoculation of CT26 colon carcinoma cells. Subsequently, ARE (100 or 250 mg/kg) was administered once daily for 18 days. Changes in skeletal muscle and adipose tissue mass, as well as anorexia-related hormone levels, were evaluated, and the underlying molecular mechanisms of ARE were investigated. Results ARE administration significantly prevented body weight loss, restored muscle and fat mass, enhanced grip strength, and improved food intake, without altering tumor growth. The serum levels of pro-inflammatory cytokines and appetite-related hormones, including leptin and ghrelin, were modulated in ARE-treated mice. At the molecular level, ARE inhibited the activation of the Janus kinase (JAK)/signal transducer and activator of transcription 3 (STAT3) pathway, a key mediator of inflammation-induced catabolism. Consequently, ARE downregulated E3 ubiquitin ligases involved in skeletal muscle proteolysis and inhibited lipolysis and thermogenesis in adipose tissue. Conclusion ARE mitigates cancer cachexia by reducing systemic inflammation, anorexia, and JAK/STAT3-mediated catabolic responses in skeletal muscle and adipose tissue, suggesting its potential as a plant-based therapeutic candidate for the treatment of cancer cachexia.
Background Evidence regarding the effectiveness of acupuncture for cancer-related fatigue (CRF) in breast cancer survivors (BCS) remains inconsistent, warranting large pragmatic randomized controlled trials (RCTs). Methods The AcuBreast trial was a pragmatic, two-arm RCT comparing acupuncture plus usual care versus usual care alone. Inclusion criteria required CRF lasting 6 months post-treatment, written informed consent, and sufficient Norwegian proficiency. Exclusion criteria included conditions known to contribute to fatigue, ongoing acupuncture, pregnancy, and bleeding disorders. The acupuncture group received 10–12 treatments over 8–12 weeks alongside usual care. Control group received usual care only. The primary outcome was CRF measured by the Chalder Fatigue Questionnaire (CFQ14/11). Secondary outcomes included fatigue severity (FSS), adverse events, and quality-adjusted life years (QALYs). Results Of 221 randomized survivors (acupuncture n=112, control n=109; mean age 52.5 years [SD=8.9]), retention at 3 months was 106 versus 85, and at 6 months was 102 versus 83. At 3 months, CFQ14 scores were significantly lower in the acupuncture group (mean difference: −6.9, 95% CI: −8.8 to −4.9, p0.001), sustained at 6 months (−3.5, 95% CI: −5.5 to −1.6, p0.001). FSS scores were also significantly lower at 3 months (−4.2, 95% CI: −7.2 to −1.3, p=0.005) and 6 months (−4.2, 95% CI: −7.1 to −1.2, p=0.006). Adverse events were mild and self-limiting. Conclusions Acupuncture significantly reduces CRF in BCS with effect sizes exceeding minimal clinically important differences for both CFQ14/11 and FSS. Treatment is safe with only mild, transient adverse events. Trial registration ClinicalTrials.gov Identifier: NCT04418115.
Research ethics and integrity are foundational to the credibility, safety, and societal trust of scientific inquiry. As the use of traditional, complementary, and integrative medicine (TCIM) grows globally, concerns about research misconduct (including fabrication, falsification, and plagiarism) have become increasingly salient. With up to 80% of populations in certain countries utilizing TCIM, the field’s expansion underscores the need for rigorous, ethically grounded evidence to guide practice and policy. However, around 470 TCIM-related articles have been retracted to date, as indicated on the Retraction Watch database, which may be due to ethical or non-ethical concerns. This educational article critically examines the state of ethics and integrity in TCIM research, drawing on case studies of misconduct and highlighting the broader consequences for patient safety, scientific credibility, and healthcare integration. In addition, the educational article explores emerging ethical dilemmas posed by artificial intelligence (AI), including risks of automated fabrication, falsification, plagiarism, and opacity in research reporting. To strengthen ethical conduct, we propose strategies spanning four domains: 1) improving education and fostering interdisciplinary collaboration to enhance research literacy, 2) embedding open science practices to promote transparency and reproducibility, 3) leveraging meta-research to monitor and advance research quality, and 4) developing policies and safeguards for responsible AI use. Upholding high ethical standards in TCIM research is essential not only to ensure reliable evidence but also to protect patients, sustain public trust, and enable meaningful integration of TCIM within evidence-based healthcare systems.
Background Focused attention is traditionally considered essential for eliciting deqi during acupuncture; however, objective evidence supporting this association remains limited. Methods In this exploratory randomized controlled trial, 90 healthy participants were assigned to one of three attentional states during acupuncture: Focus Needling State (FNS), Music Needling State (MNS) and Conversation Needling State (CNS). Deqi sensations were assessed using the Chinese version of the Massachusetts General Hospital Acupuncture Sensation Scale (C-MASS). Electrooculogram (EOG) signals were continuously recorded, and the correlation dimension (D2) was calculated to quantify task-induced attentional state. The primary outcome was deqi intensity, and secondary outcomes included D2 and its association with deqi. Results The MASS index and fullness were highest in FNS and decreased with distraction (P < 0.01). D₂ values differed significantly across groups, with the lowest values observed in FNS (P < 0.01). Profile analysis showed a decreasing trend in primary deqi sensations across attentional states, and D₂ was negatively correlated with the MASS index (r = −0.406) and fullness (r = −0.300) (both P < 0.01). Receiver operating characteristic (ROC) analysis showed good discrimination of deqi response (defined as MASS index > 3), with an AUC of 0.832 (95% confidence interval 0.73 to 0.93), cutoff of 1.28, sensitivity of 65.8%, and specificity of 88.2%. Conclusion Task-induced attentional states were associated with differences in deqi intensity. Exploratory complementary analyses suggested that D2 may serve as a physiological index related to attentional engagement and outcomes involving deqi.Trial registration: International Traditional Medicine Clinical Trial Registry (No. ITMCTR2024000659).
Background The global burden of chronic neck pain is rising, increasing the importance of cost-effective pain management. Manual therapy may reduce economic and societal burden by preventing chronic pain recurrence, but supporting evidence is limited. This study evaluates the long-term cost-effectiveness of manual therapy compared with standard care for chronic neck pain. Methods A Markov model with three-month cycles is used to simulate health-state transitions over three years. Treatment alternatives include Chuna manual therapy (10 sessions twice weekly for five weeks) and usual care (oral medication and physical therapy, administered with the same frequency as Chuna). Clinical and economic data were sourced from pragmatic randomized controlled trials and official public documents. Costs (medical and non-medical) and utilities were estimated from the healthcare system and societal perspectives, and utility weights derived from the EuroQol five-dimension five-level scale. Sensitivity analyses assessed parameter uncertainty, including one-way and probabilistic sensitivity analyses. Results Over three years, Chuna manual therapy involved an additional cost of only $407, yielding 0.03 more quality-adjusted life years (QALY) compared to usual care, resulting in an incremental cost-effectiveness ratio of $14,125/QALY. Sensitivity analyses confirm cost-effectiveness at a willingness-to-pay threshold of $26,375/QALY in most scenarios. Probabilistic sensitivity analyses reveal cost-effectiveness probabilities of 77.2% and 98.5% from the healthcare and societal perspective, respectively. Conclusions Chuna manual therapy is a cost-effective intervention with clinical and economic advantages over usual care. The findings support policy decisions on extending health insurance coverage for long-term manual therapy and provide a foundation for future studies.
Background:The reliability of meta-analyses on Chinese herbal medicine (CHM) largely depends on the methodological quality of the included randomized controlled trials (RCTs). This study assessed the risk of bias (RoB) among Chinese-language CHM RCTs embedded in meta-analyses (MAs) published between 2021 and 2022. Methods:Chinese-language CHM MAs were identified through literature searches across seven databases (three international and four Chinese databases). RCTs were extracted from the eligible MAs and their methodological quality was appraised using the Cochrane Risk of Bias (RoB) tool. Logistic regression analyses were conducted to explore associations between bibliographical characteristics and quality. Results:Of 2060 RCTs (published between 1997-2021), 93.0% (n = 1916) had low RoB in incomplete data, but only 43.98% (n = 906) in random sequence generation. No RCTs had low RoB in selective outcome reporting. Non-patent CHM RCTs performed poorly in sequence generation, allocation concealment, and outcome assessment blinding but well in incomplete data. Government-funded RCTs showed better performance in sequence generation and outcome assessment but worse in incomplete data. No analysis was conducted for selective reporting due to lack of low RoB RCTs. Conclusion:The methodological quality of Chinese-language RCTs embedded in recently published MAs was found to be unsatisfactory, indicating their limited utility in informing clinical decision-making. There is an urgent need for enhancing clinical trial training for researchers, reviewers, and editors in China.
Background Chinese medicine (CM), notably acupuncture, Chinese herbal medicine (CHM), and moxibustion, is commonly used alongside rehabilitation therapy (RT). This study aims to summarize evidence on the effects of CM interventions, when used adjunctively with RT, on motor function, swallowing function, activities of daily living, neurological deficits, mood disorders, quality of life, and cognitive function after stroke. Methods We systematically searched five databases and eight standards-related websites (up to August 2025) for clinical practice guidelines (CPGs), systematic reviews (SRs), and randomized controlled trials (RCTs). The study addressed 21 clinical questions (CQs) regarding integrated Chinese-Western medicine in stroke rehabilitation, evaluating CHM, acupuncture, and moxibustion combined with RT, and presented evidence summaries for two specific CQs. Quality was assessed using AGREE II, AMSTAR 2, and ROBUST-RCT, respectively. Results A total of 4,316 unique studies were included, predominantly RCTs (92.9%), with acupuncture being the most frequently investigated intervention (51.7%). Methodological quality varied, with nearly a quarter of the CPGs showing moderate to high quality and most SRs demonstrate acceptable methodological standards. Across two representative CQs, evidence from CPGs, SRs, and RCTs generally suggested that integrating acupuncture or CHM with RT may improve functional outcomes compared with RT alone. Relevant guidelines also provided specific CM treatment approaches for different clinical conditions and complications. Conclusion This study provided an overview of the current evidence landscape in stroke rehabilitation. The volume of available evidence is relatively substantial, particularly for acupuncture and CHM; however, the overall quality of the evidence remains in need of improvement.
Background:Despite growing interest, evidence on integrated Chinese-Western medicine for depressive disorder (DD) remains fragmented, with no comprehensive summary across treatment modalities and evidence levels. Therefore, we summarized evidence to systematically delineate and visualize the scope, distribution, methodological quality, and results of clinical evidence on integrated Chinese-Western medicine for DD. Methods:Adhering to the AI-empowered Clinical Evidence for Integrated Chinese-Western Medicine (ACE-iMed) framework, a dedicated database for DD was established. Four major categories of traditional Chinese medicine intervention were included, namely Chinese herbal medicine, acupuncture, moxibustion, and Chinese movement exercise. Eight clinical questions (CQs) with predefined outcomes were formulated, each undergoing a systematic process of targeted searching, screening, and rigorous methodological quality assessment. The search strategy involved comprehensive querying of databases and regulatory websites up to September 6, 2025. Eligible evidence types were restricted to clinical practice guidelines/consensus statements (CPGs/CSs), systematic reviews (SRs) and randomized controlled trials (RCTs). Results:From an initial 41,137 records, 1402 studies were analyzed, with RCTs constituting the majority (n = 1232; 87.9%). While comprehensive evidence summaries for all eight CQs are presented on the ACE-iMed platform, this study focused on two representative CQs (CQ1 and CQ7). Overall, Chinese medicine treatment modalities, whether as monotherapy or in combination with conventional Western therapy, demonstrated enhanced efficacy and a favorable safety profile for DD. Conclusion:Using ACE-iMed, we summarized comprehensive evidence on integrated Chinese-Western medicine for DD, demonstrating favorable efficacy and safety and calling for high-quality studies to validate these findings and enable clinical translation in Hong Kong and beyond.
