[This corrects the article DOI: 10.3389/fmed.2025.1698983.].

BackgroundPost-COVID-19 condition (PCC), commonly called long COVID, is a prevalent sequela of SARS-CoV-2 infection and can affect multiple organ systems. Cognitive dysfunction is one of the most common symptoms in PCC, with a prevalence of 22%. It can persist for years and significantly reduce patients’ quality of life. The brain network is the neural basis underlying human cognitive processes. Diffusion tensor imaging (DTI) and functional magnetic resonance imaging (fMRI) studies have revealed that cognitive impairments across attention, memory, executive function, and language are associated with alterations in network characteristics for PCC. Currently, there is no accepted therapy for cognitive impairment in PCC. Acupuncture has the potential to improve cognitive deficits in PCC. This trial aims to investigate the effect of acupuncture on cognitive functions in patients with PCC, and to explore the underlying mechanism of its effects on cognition in this condition using DTI and fMRI.MethodsIn this three-armed, randomized controlled trial, 117 PCC patients with cognitive symptoms will be randomly assigned in a 1:1:1 ratio to verum acupuncture (VA), sham acupuncture (SA), or a waitlist control group. Participants in the VA and SA groups will receive three sessions of treatment per week for 8 weeks. The primary outcome measures are the changes in Addenbrooke’s Cognitive Examination-III (ACE-III) total score and phonemic fluency test score at week 8. The secondary outcome measures include the Digit Span Test (DST), Symbol Digit Modality Test (SDMT), Trail Making Test (TMT), Rey’s Auditory Verbal Learning Test (RAVLT), Rey-Osterrieth Complex Figure Test (RCFT), Stroop Color Word Test (SCWT), category fluency test, action fluency test, and Boston Naming Test (BNT-30), as well as global and regional topological measures of structural and functional brain networks constructed from DTI and fMRI data. Additionally, the Fatigue Severity Scale (FSS), the Generalized Anxiety Disorder-7 (GAD-7), the 24-item Hamilton Depression Scale (HAMD-24), and the MOS 36-item Short Form Health Survey (SF-36) will also be measured.DiscussionThe results of this study will reveal the effect of acupuncture treatment on cognitive functions for PCC and provide insights into the mechanisms by which acupuncture may improve cognition in PCC.Clinical trial registrationClinicalTrials.gov (www.clinicaltrials.gov), identifier: NCT07355751.

Myalgic encephalomyelitis/chronic fatigue syndrome (ME/CFS) is a complex disorder marked by persistent fatigue and cognitive impairments, often termed "brain fog." Emerging evidence suggests that immunosenescence, age- or stress-related deterioration of immune function, plays a pivotal role in the pathogenesis of cognitive dysfunction in ME/CFS. Immunosenescence induces chronic low-grade inflammation (inflammaging); alters T-, NK-, and B-cell function; and promotes the release of senescence-associated secretory phenotype (SASP) factors. These changes are proposed to cerebral blood flow (CBF) regulation, may impair endothelial nitric oxide production, and may contribute to blood-brain barrier (BBB) breakdown. Consequently, brain hypoperfusion and oxidative stress are associated with impaired neuronal energy metabolism and synaptic plasticity, particularly in memory-related networks such as the default mode and fronto-hippocampal systems. This results in reduced ATP availability, excitotoxicity, and neurotransmitter imbalance, contributing to cognitive decline. The review proposes an "immune-vascular-cognitive axis" linking peripheral immune aging to central neural dysfunction. It further highlights therapeutic strategies-such as cytokine blockade, nitric oxide enhancement, immune modulation, and acupuncture-that may ameliorate neurovascular impairments and cognitive symptoms. Understanding this integrative mechanism may offer new pathways for targeted intervention in ME/CFS.

Background:Myalgic encephalomyelitis/chronic fatigue syndrome (ME/CFS) is a common sequela following COVID-19. Although cognitive dysfunction is one of the most debilitating symptoms in ME/CFS, effective therapies are limited. Acupuncture is an important complementary and alternative therapy for ME/CFS and has been shown to have positive effects on cognitive dysfunction in other diseases. However, the effect and mechanism of acupuncture in treating cognitive dysfunction in post-COVID-19 ME/CFS(PCME/CFS) remain unclear. In this study, we designed a randomized controlled trial to evaluate the efficacy of acupuncture treatment in improving cognitive function in PCME/CFS and to investigate the neural mechanisms of acupuncture using multimodal magnetic resonance imaging (MRI) techniques. Methods:A total of 129 patients and 30 healthy controls (HCs) will be enrolled. The 129 patients with PCME/CFS will be randomly assigned in a 1:1:1 ratio to a verum acupuncture (VA), sham acupuncture (SA), or a waitlist control group. Participants in the VA and SA groups will receive three sessions of treatment per week for 8 weeks, while patients in the waitlist control group will be treated after the 8-week waiting period. The primary outcome is the change in the Symbol Digit Modalities Test (SDMT) score from baseline to week 8. The secondary outcome measures include changes from baseline to endpoint (week 8) in cognitive performance as assessed by the Digit Span Test (DST), Trail Making Test (TMT), Rey Auditory Verbal Learning Test (RAVLT), Rey-Osterrieth complex figure test (RCFT), Stroop Color and Word Test (SCWT), phonemic fluency test, category fluency test, action fluency test, and 30-item Boston Naming Test (BNT-30). In addition, changes in hippocampal metabolites and resting-state functional connectivity(RSFC) will be examined using 1H-magnetic resonance spectroscopy(1H-MRS) and functional MRI (fMRI), respectively. Moreover, the Multidimensional Fatigue Inventory (MFI-20), Pittsburgh Sleep Quality Index (PSQI), Generalized Anxiety Disorder 7-item scale (GAD-7), 24-item Hamilton Depression Scale (HAMD-24), and 36-Item Short Form Survey (SF-36) will also be assessed at baseline and week 8. Discussion:The results of this study will provide preliminary evidence regarding the efficacy of acupuncture therapy in improving cognitive function in PCME/CFS and will explore whether acupuncture improves cognitive function in this disease by modulating metabolism and RSFC in the hippocampus. Clinical trial registration:www.clinicaltrials.gov, identifier: NCT07357688.

Chronic fatigue syndrome (CFS) is a neurological disorder primarily characterized by persistent fatigue, post-exertional malaise, and cognitive dysfunction. Mitochondrial dysfunction is considered as a core mechanism underlying its pathological changes. Acupuncture and moxibustion therapy has been shown to be a safe and effective treatment for CFS, with part of its therapeutic effects achieved through the regulation of mitochondrial function. This review summarized the research progress on acupuncture and moxibustion in regulating mitochondrial function for the treatment of CFS. The findings indicated that acupuncture and moxibustion can modulate mitochondrial quality control systems through multiple pathways, including repairing mitochondrial morphology and structure, promoting mitochondrial biogenesis, restoring mitochondrial dynamics balance, enhancing autophagy of damaged mitochondria, regulating calcium homeostasis, and modulating the activity of the electron transport chain (ETC) complexes, thereby improving mitochondrial function. In addition, acupuncture and moxibustion can further promote mitochondrial function recovery through reducing oxidative stress and inhibiting immune-inflammatory responses. Future research may further reveal the mechanisms of acupuncture and moxibustion in regulating ETC complex activity, explore the role of alleviating endoplasmic reticulum stress in acupuncture and moxibustion treatment of CFS, investigate potential synergistic effects among different mechanisms, and elucidate the differential effect mechanisms among various acupuncture and moxibustion treatment protocols, so as to optimize clinical treatment strategies and improve the clinical efficacy of acupuncture and moxibustion for CFS.

Background:The global prevalence of diabetes mellitus (DM) has exceeded 589 million, with the proportion of type 2 diabetes mellitus (T2DM) patients with comorbid cognitive impairment (CI) as high as 49.1%, which has a serious impact on disease management and quality of life. While acupuncture has been shown to improve cerebral glucose metabolism and synaptic plasticity, existing clinical trials are plagued by critical limitations: small sample sizes (often <100 participants) fail to detect subtle treatment effects, methodological heterogeneity in acupuncture protocols (e.g., varying acupoint selections, stimulation intensities, and treatment durations) hinders evidence synthesis, and insufficient blinding (e.g., sham acupuncture controls with low plausibility) introduces performance bias. These limitations have constrained the generalizability of findings and created a significant evidence gap in defining acupuncture's role in diabetic cognitive impairment (DCI). The aim of this study is to assess the efficacy and safety of acupuncture for DCI through a systematic review with Bayesian network meta-analysis (NMA), addressing these methodological flaws via rigorous evidence synthesis. Methods and analysis:Following PRISMA-NMA and STRICTA-2010 guidelines, we will systematically search 10 databases (PubMed, Cochrane Library, CNKI, etc.) from inception to 30 June 2025 and gray literature (January 1, 1995, to June 30, 2025) for randomized controlled trials (RCTs) comparing acupuncture with pharmacotherapy, sham acupuncture, or standard care. Inclusion criteria: adults (≥18 years) with T2DM and CI diagnosed via validated scales such as Montreal Cognitive Assessment (MoCA), and Mini-Mental State Examination (MMSE). Primary outcomes include cognitive function scores; secondary outcomes assess adverse events (CTCAE v5.0). The risk of bias will be evaluated using Cochrane RoB 2.0 and GRADE. Bayesian NMA will synthesize direct and indirect evidence to simultaneously assess the relative efficacy and safety of acupuncture. Expected findings and conclusion:The study will clarify the relative efficacy and safety of acupuncture in improving DCI and provide evidence-based treatment options for clinical use. The results of Bayesian analyses may support acupuncture as a low-cost, low-risk adjunctive therapy, especially for patients intolerant of conventional medications. The results of the study will fill the current evidence gap and promote the standardized use of acupuncture in the management of DCI. Systematic review registration:CRD42021275161.

BackgroundOrthopedic patients often present with significant pain symptoms, which can impact both the physical and mental well-being of patients, emerging as a significant concern. Given its safety, effectiveness, and absence of side effects, acupoint therapy is being increasingly utilized in the pain management of orthopedic patients. This study conducted a network meta-analysis to compare analgesic efficacy, safety, and effectiveness of acupuncture (AP), electroacupuncture (EA), moxibustion, and acupressure, so as to provide a reference for the clinical application of acupoint therapies in managing orthopedic pain.MethodsEight databases, including PubMed, Embase, Cochrane Library, Web of Science, CNKI, Wanfang Data, and VIP, were searched for clinical randomized controlled trials (RCTs) investigating the effects of AP, EA, moxibustion, and acupressure on orthopedic pain. The quality of the included documents was evaluated using the Cochrane Risk of Bias Tool, and graphs regarding the risk of bias and network meta-analysis were drawn by Revman 5.2, Stata 18.0 and R software (v4.3.2). Intervention ranking probabilities were quantified using SUCRA values derived from a Bayesian random-effects model.Results1) For decreasing Visual Analogue Scale (VAS) scores in patients with orthopedic pain, moxibustion therapy was identified as the optimal intervention (SUCRA=94.84%); 2) For decreasing VAS scores in patients with orthopedic pain undergoing surgical intervention, AP therapy was identified as the optimal intervention (SUCRA=76.99%); 3) For decreasing VAS scores in patients with orthopedic pain not undergoing surgical intervention, moxibustion therapy was identified as the optimal intervention (SUCRA=90.26%); 4) AP therapy (SUCRA=83.73%) demonstrated the most favorable safety profile; 5) Acupressure therapy (SUCRA=77.93%) was identified as the most effective therapeutic method.ConclusionIt is recommended to select differentiated acupoint therapies tailored to the type of orthopedic pain. Specifically, post-operative patients with orthopedic pain should prioritize AP, while moxibustion is advised for non-surgical patients.

Myalgic encephalomyelitis/chronic fatigue syndrome (ME/CFS) has garnered substantial scientific and clinical interest, due to its rising global prevalence and significant pathophysiological overlap with post-acute COVID-19 syndrome (PACS). This review systematically elucidates the prevailing diagnostic criteria, summarizes recent advances in understanding the potential pathophysiological mechanisms, and evaluates pharmacological and non-pharmacological interventions, and symptom-based assessment and management strategies. A comprehensive literature search was conducted across PubMed, Web of Science, Embase, and the Cochrane Library for articles published from inception to August 2025. Current diagnostic frameworks for ME/CFS rely primarily on clinical symptomatology and lack definitive biomarkers. Immune dysregulation, oxidative stress, mitochondrial dysfunction, and neuroinflammation are central to its pathology. Pharmacological management includes immunomodulatory treatments, antioxidant therapies, mitochondrial support, and neuroinflammation intervention. Non-pharmacological strategies such as cognitive behavioral therapy (CBT), graded exercise therapy (GET), activity pacing, and traditional Chinese medicine (TCM) complement biomedical approaches by alleviating symptom severity and promoting energy conservation. Among these approaches, CBT serves as an adjunctive therapy for symptom management rather than a curative one, whereas GET is contraindicated due to its potential for harm. Comprehensive clinical assessment and management of ME/CFS requires being symptom oriented and the recognition of individual differences. Recommended directions for future research include developing biomarker-based diagnostic tools, optimizing combination therapies that target multiple pathophysiological pathways simultaneously, and integrating real-world data and digital health technologies for precise monitoring and management of ME/CFS.

Background:Military personnel face elevated risks of chronic sciatica due to repetitive mechanical loading during combat training. Conventional therapies, such as nonsteroidal anti-inflammatory drugs (NSAIDs) and physical therapy, often fall short in addressing the urgent need for rapid functional recovery. Acupotomy, a minimally invasive technique that integrates acupuncture with microsurgical dissection, has the potential to alleviate both central and peripheral nerve compression; however, its efficacy within military populations remains inadequately studied. Methods:This single-center, parallel-group randomized controlled trial will enroll 80 active-duty military personnel (aged 18-45 years) with MRI-confirmed L4-S1 lumbar disc herniation and sciatica for at least three months. Participants will be randomly assigned in a 1:1 ratio to receive either ultrasound-guided acupotomy (administered once a week for a total of four sessions) or sham acupotomy. The primary outcomes will include leg pain intensity, measured using the Visual Analogue Scale (VAS), and functional disability, assessed via the Oswestry Disability Index (ODI). Secondary outcomes include lumbar function (as measured by the Japanese Orthopaedic Association scale), blinding efficacy, and adverse events. Conclusion:This study aims to provide high-quality evidence for the treatment of military training-related sciatica with acupotomy via a rigorous RCT design. If the results confirm its efficacy and safety, it could address multiple levels of nerve compression in ≤4 weeks, thereby redefining nonsurgical therapies in direct support of combat readiness. Future studies should expand the scope of the study and deepen the mechanism exploration to promote its application in a wider range of clinical scenarios. Trial Registration:This protocol has been registered at ITMCTR (No. 2025000628. Registered on: 1 April 2025).

OBJECTIVE:This study aims to characterize the time-domain features and functional network properties from Tai Chi Yunshou across four states (rest, observation, imagination, and motion) using functional near-infrared spectroscopy (fNIRS), thereby discriminating the neural mechanisms underlying the mental regulation and integrative body-mind harmony of Tai Chi Yunshou. METHODS:100 healthy participants were included and administered with rest, observation, imagination and motion states of Tai Chi Yunshou. The forty-channel wearable fNIRS system was utilized to evaluate the real-time cortical responses during four states. Brain network properties were analyzed with MATLAB and the GRETNA toolbox. Machine learning models, including random forest, AdaBoost, and gradient boosting, were applied for classification. RESULTS:Small-world network properties (γ>1 and λ≈1) across four states were detected. Compared to states of rest and observation, the motion state exhibited significantly higher γ, λ, Cp, and Eloc (P < 0.01). Additionally, λ and Cp were significantly greater in the motion state than that of the imagination state (P < 0.01). The motion state had increased betweenness centrality and nodal efficiency hubs of the dorsolateral prefrontal cortex and frontopolar area. Gradient boosting outperformed both AdaBoost and random forest across all evaluation metric. CONCLUSION:The motion of Tai Chi Yunshou enhances regulatory capacity in the dorsolateral prefrontal cortex and frontopolar area, boosts local brain processing, and improves network integration. Machine learning models can effectively capture and differentiate the neural features between mental regulation and integrative body-mind harmony.

OBJECTIVE:Post-exertional malaise (PEM) is a common and debilitating symptom of post-acute COVID-19 syndrome (PACS), and it is also included in the core outcome set for PACS. Our aims are to determine the prevalence of PEM in patients with PACS, and to review the measurement tools utilized in studies assessing PEM among these patients. METHODS:A systematic literature search was conducted up to 29 February 2024 across four databases: PubMed, EMBASE, Web of Science, and Cochrane Library. Studies were included if they evaluated PACS individuals who had at least one persistent symptom, with the mean or median follow-up duration of at least 3 months after COVID-19 diagnosis or hospital discharge, and specially reported on PEM or any measurement tools utilized to assess PEM. Data extraction and quality assessment were performed independently by two authors. RESULTS:After screening 953 articles, 12 studies comprising 2665 patients were included in the meta-analysis, and 16 studies were included in the narrative review. The pooled prevalence of PEM among PACS patients at 3 months or more after COVID-19 diagnosis was 0.55 (95 % CI, 0.38, 0.71). Moreover, narrative review identified seven questionnaires used to assess PEM in PACS individuals, with the DePaul Symptom Questionnaire-Post Exertional Malaise (DSQ-PEM) being the most frequently utilized instrument. CONCLUSION:Our findings indicate that over half of the PACS individuals experience PEM, and seven questionnaires have been identified for researchers to assess PEM. It is imperative to develop effective intervention strategies to treat and alleviate the burden of PEM.

Introduction: Acupuncture is effective for patients with chronic low back pain (CLBP), which can relieve pain intensity and regulate negative emotional states such as pain-related anxiety and depression. Previous studies mainly discuss the analgesic mechanism of acupuncture treatment of CLBP, but there are multiple dimensions to pain, including sensation, emotion and cognition. Therefore, this study aims to investigate the central mechanism of acupuncture for CLBP from the perspective of emotional regulation by functional magnetic resonance imaging (fMRI). Methods and Analysis: A total of 72 patients with CLBP will be recruited in the study and randomly assigned to the verum acupuncture group or the sham acupuncture group. The trail will last for 18 weeks including a 2-week baseline, a 4-week treatment and a 12-week for follow-up period. The primary outcomes are the visual analog scale (VAS) and the Japanese Orthopaedic Association Scores (JOA) score. The secondary outcomes are the 12 -item short form health survey (SF -12), the state trait anxiety inventory (STAI), the self -rating anxiety scale (SAS) and self -rating depression scale (SDS). The VAS, JOA, STAI SAS and SDS will be collected at baseline, week 2, week 4, and after follow-up. The SF -12 will be evaluated at baseline, week 2 and week 4. Functional magnetic resonance imaging (MRI) data will be collected at baseline and the end of treatment. Emotion-related brain regions will be chosen as regions of interest (ROIs). The gray matter volume (GMV), amplitude of low-frequency fluctuation (ALFF), regional homogeneity (ReHo), functional connectivity (FC), and large-scale functional brain network based on these ROIs will be analyzed within and between the two groups. Discussion: This study will verify the emotional regulation of acupuncture and explore the mechanism of acupuncture for emotion regulation in patients with CLBP.

BACKGROUND:Abnormalities of structural and functional brain regions might influence the persistence of knee pain, the progression, and the response to treatments in knee osteoarthritis (KOA). These complex alterations present a challenge to the understanding of its mechanism. OBJECTIVES:To meta-analyze the concurrence across structural and functional magnetic resonance imaging studies. STUDY DESIGN:Systematic review and meta-analysis. SETTING:This meta-analysis examined all voxel-based morphometric (VBM) and amplitude of low-frequency fluctuation (ALFF) studies involving the whole-brain alterations of KOA. METHODS:VBM and ALFF studies published up to May 7, 2023, were searched in the Web of Science, PubMed, EMBASE, Cochrane Library (CENTRAL), China National Knowledge Infrastructure (CNKI), Chinese Biomedical Literature Database, Chongqing VIP, Wanfang Database. Two independent researchers carried out study screening, quality assessment, clinical data extraction, and neuroimaging data extraction. The whole-brain voxel-based gray matter (GM) and brain activity data of KOA were collected from eligible studies and meta-analyzed using the anisotropic effect size-signed differential mapping (AES-SDM). RESULTS:Fourteen studies were included in this study. In VBM meta-analyses, a total of 481 patients were enrolled in this study (252 KOA and 229 healthy patients). In the ALFF meta-analysis, a total of 518 patients were enrolled in this study (265 KOA and 253 healthy patients). According to the meta-analysis, KOA had increased GM volume in the right inferior frontal gyrus and decreased GM volume in the bilateral superior frontal gyrus, as well as increased brain activity in the left inferior frontal gyrus and inferior temporal gyrus, and decreased brain activity in the left middle occipital gyrus, right supramarginal gyrus, right superior frontal gyrus, and right superior parietal gyrus compared with healthy patients. LIMITATIONS:Most of the ALFF studies included in this meta-analysis were conducted in China. Our findings are exclusively addressed by the VBM and ALFF studies. The meta-regression between the duration of KOA, pain intensity and abnormal gray matter, and functional activity of brain regions in patients with KOA were unable to be analyzed. CONCLUSION:The results of this meta-analysis indicate that patients with KOA present significant abnormalities in GM volume and functional activity. These findings contribute to a better understanding of the structural and functional abnormalities seen in patients with KOA.

Rapid recommendation is a novel methodological framework for developing clinical practice guidelines and this framework shares the basic features of classical guidelines but differs from classical clinical practice guidelines in its `rapid’ development process (typically within 90 days) with an aim of translating practice-changing studies to recommendations. A recent global innovation of guideline development methodology is the proposal of a rapid recommendation framework for Traditional Chinese Medicine (TCM), which has the potential to add value to the translation of evidence to practice for TCM interventions. Up to now, more than 180 rapid recommendations have been published, but none of them is pertaining to TCM interventions. Due to the nature of multi-dimensional evidence sources for TCM interventions, including classical randomized controlled trials and real world evidence, a more sophisticated methodological approach to synthesize and evaluate the totality of evidence about effects of TCM interventions is required. Therefore, appropriate modification to the rapid recommendation framework is necessary. In the efforts to respond to these needs, we have proposed a specific approach to developing rapid recommendations for TCM interventions the Multi-dimensional Evidence Synthesis, Evaluation and Recommendations for TCM interventions (MESERT).

Despite the widespread clinical use of acupuncture in the treatment of pruritus caused by psoriasis, urticaria, uremic, and other diseases, insights into the mechanism of action of acupuncture are still emerging. For the above reasons, a beneficial effect of acupuncture on pruritus was not recommended or reported in recent clinical practice guidelines. Acupuncture is a kind of physical stimulation, which has the characteristics of multi-channel and multi-target effects. The biomechanical stimulation signal of acupuncture needling can be transformed into bioelectric and chemical signals; interfere with kinds of cells and nerve fibers in the skin and muscle; alter signaling pathways and transcriptional activity of cells, mediators, and receptors; and result in inhibition of peripheral and central transmission of pruritus. Available mechanistic data give insights into the biological regulation potency of acupuncture for pruritus and provide a basis for more in-depth and comprehensive mechanism research.

Traditional Chinese medicine (TCM) has been widely applied as a supplementary therapy of human immunodeficiency virus infection and acquired immunodeficiency syndrome (HIV/AIDS) in China. TCM has a positive effect on improving the quality of life, prolonging life, and ameliorating the symptoms of HIV/AIDS patients. Yang deficiency of spleen and kidney (YDSK) syndrome is a typical deficient TCM syndrome in AIDS patients, and accumulation of heat-toxicity (AHT) syndrome is a common excessive syndrome in the earlier stage of AIDS. Thus, accurate diagnosis of these two syndromes can improve the targeted treatment effect, and predict the prognosis of the disease. However, the scientific basis of TCM syndromes remains lacking, greatly hindering the accuracy of diagnosis and effectiveness of treatment. In this research, microRNA (miRNA) microarray and quantitative real-time polymerase chain reaction combined with bioinformatics were used for comparative analysis between YDSK and AHT patients. Significantly differential expressed miRNAs (SDE-miRNAs) of each TCM syndrome were identified, including hsa-miR-766-3p and hsa-miR-1260a and so on, as well hsa-miR-6124, hsa-let-7g-5p and so on, for YDSK and AHT, respectively. Biological differences were found between their SDE-miRNAs based on bioinformatics analyses, for example, ErbB signaling pathway mainly linked to AHT, while focal adhesion dominated in YDSK. Syndrome-specific SDE-miRNAs were further identified as potential biomarkers, including hsa-miR-30e-5p, hsa-miR-144-5p for YDSK and hsa-let-7g-5p, hsa-miR-126-3p for AHT, respectively. All of them have laid biological and clinical bases for TCM diagnosis and treatment of AIDS syndrome at the miRNA level, offering potential diagnostic indicators of immune reconstitution.

BACKGROUND:Chronic fatigue syndrome (CFS) is a debilitating chronic disease of unknown etiology that is recognized by the World Health Organization (WHO) and the United States Center for Disease Control and Prevention (US CDC) as a disorder of the brain. CFS affects 1% (17-24 million people) of the world's population and is a major and costly public health problem. In traditional Chinese medicine (TCM), acupuncture can achieve a certain effect in the treatment of chronic fatigue syndrome, but evidence-based medicine is controversial. This protocol aims to multi-evaluate the literature quality and evidence quality of the current systematic reviews (SRs)/meta-analyses (MAs) of acupuncture treatment for chronic fatigue syndrome, and provide intuitive and reliable evidence synthesis and decision-making basis for clinical treatment.METHODS:Eight databases will be searched from their inception to 1 June, 2020: the Chinese Biomedical Literature Database (CBM), China Science and Technology Journal Database (VIP), China National Knowledge Infrastructure (CNKI), WanFang Database (WF), Web of Science, Embase, PubMed, and Cochrane Library. Published systematic reviews that were reported in Chinese or English, and the included studies were randomized controlled clinical trials (RCTs) for acupuncture in people with CFS will be included. Reviews selection, data extraction and management, and assessment of the study quality will be completed independently by 2 or more reviewers. The quality of evidence, methodological quality, and reporting quality will be evaluated by using the Grading of Recommendations Assessment, Development, and Evaluation (GRADE), A Measurement Tool to Assessment of Multiple Systematic Reviews-2 (AMSTAR-2), Preferred Reporting Items for Systematic Reviews and Meta-analyses (PRISMA), and Adobe Illustrator Creative Cloud (Adobe Illustrator CC) will be used to draw and optimize the radar plot.RESULTS:The article in this overview will be submitted for publication in a peer-reviewed journal.CONCLUSION:We hope to collect evidence from accessible and useful systematic reviews of acupuncture treatment for chronic fatigue syndrome, to provide visual and scientific decision-making methods for more clinical practice and medical research.SYSTEMATIC REVIEW REGISTRATION:INPLASY 202060052.

Supplemental Digital Content is available in the text Abstract Background: Chronic fatigue syndrome (CFS) is a debilitating chronic disease of unknown etiology that is recognized by the World Health Organization (WHO) and the United States Center for Disease Control and Prevention (US CDC) as a disorder of the brain. CFS affects 1% (17–24 million people) of the world's population and is a major and costly public health problem. In traditional Chinese medicine (TCM), acupuncture can achieve a certain effect in the treatment of chronic fatigue syndrome, but evidence-based medicine is controversial. This protocol aims to multi-evaluate the literature quality and evidence quality of the current systematic reviews (SRs)/meta-analyses (MAs) of acupuncture treatment for chronic fatigue syndrome, and provide intuitive and reliable evidence synthesis and decision-making basis for clinical treatment. Methods: Eight databases will be searched from their inception to 1 June, 2020: the Chinese Biomedical Literature Database (CBM), China Science and Technology Journal Database (VIP), China National Knowledge Infrastructure (CNKI), WanFang Database (WF), Web of Science, Embase, PubMed, and Cochrane Library. Published systematic reviews that were reported in Chinese or English, and the included studies were randomized controlled clinical trials (RCTs) for acupuncture in people with CFS will be included. Reviews selection, data extraction and management, and assessment of the study quality will be completed independently by 2 or more reviewers. The quality of evidence, methodological quality, and reporting quality will be evaluated by using the Grading of Recommendations Assessment, Development, and Evaluation (GRADE), A Measurement Tool to Assessment of Multiple Systematic Reviews-2 (AMSTAR-2), Preferred Reporting Items for Systematic Reviews and Meta-analyses (PRISMA), and Adobe Illustrator Creative Cloud (Adobe Illustrator CC) will be used to draw and optimize the radar plot. Results: The article in this overview will be submitted for publication in a peer-reviewed journal. Conclusion: We hope to collect evidence from accessible and useful systematic reviews of acupuncture treatment for chronic fatigue syndrome, to provide visual and scientific decision-making methods for more clinical practice and medical research. Systematic Review Registration: INPLASY 202060052.