Clinical efficacy of acupoint embedment in weight control: A systematic review and meta-analysis
Cho, William C., PhD (a), Li, Ching, MD (b); Chen, Hai-Yong, PhD (c)
Medicine: September 2018 - Volume 97 - Issue 36 - p e12267
a Department of Clinical Oncology, Queen Elizabeth Hospital, Hong Kong
b School of Chinese Medicine, The Chinese University of Hong Kong
c School of Chinese Medicine, The University of Hong Kong, Hong Kong.
Abstract:
Introduction: Acupoint embedment, a modified acupuncture technique, is gaining its popularity in weight control in adult obesity or overweight nowadays. The objective of this study was to investigate the clinical efficacy of acupoint embedment in weight control of adult obesity or overweight by systematically assess available randomized controlled trials (RCTs) and analyze the integrated findings. A total of 529 literatures were initially searched from the databases. Five RCTs in assessing the effect of acupoint embedment versus sham control group were identified.
Results: A total of 219 subjects in the intervention group and 206 subjects in the control group from 5 eligible studies were eventually included in this meta-analysis. Mean body mass index (BMI) decreased 0.94 kg/m2 (95% confidence interval [CI]: -1.56 to -0.32, P = .003) more in acupoint embedment group than the sham control group. Meanwhile, subjects received acupoint embedment had 2.97 kg (95% CI: -4.44 to -1.49, P < .0001) decrease in mean body weight more than in sham control group. Both parameters were statistically significant. Adverse events including bruise, soreness and cramp, patchy skin induration, erythema were reported, yet none involved hospitalization or mortality. Interestingly, stomach meridian and spleen meridian involved in all 5 studies.
Conclusion: This meta-analysis showed that acupoint embedment was more effective in weight control than the sham control group. Together with its convenience and low cost, acupoint embedment may be considered as an alternative treatment in weight control.
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https://journals.lww.com/md-journal/Fulltext/2018/09070/Clinical_efficacy_of_acupoint_embedment_in_weight.107.aspxExcerpts:
"There are several subtypes of obesity in TCM. It involves dysfunctional organs, including spleen, stomach, liver, kidney or any combination of them. A single or multi-organs dysfunction results in disturbance in Qi, imbalance between Yin and Yang. This leads to an accumulation of pathological by-products, a unique concept in Chinese medicine, which include phlegm, wet, and bruise. To treat obesity, these pathological by-products must be got rid of. TCM practitioners then focus on restoration of organ function and equilibrium of Yin and Yang by prescribing Chinese herb and acupuncture. Both have been practiced from generations to generations. Acupoint embedment, a modified acupuncture technique, on the other hand, is gaining its popularity in weight control since 21st century. Instead of inserting needles for a short period of time into specific acupoints that can regulate Yin Yang and Qi, a short segment of absorbable suture thread is implanted into designated acupoints according to the subtype of obesity. Absorbable thread is burrowed under the skin under aseptic procedure and is then left till it naturally dissolves in situ. The thread takes 1 to 2 weeks to be absorbed. Acupoints chosen are distributed in anterior abdominal wall, thighs and legs for the majority of cases."
[Discussion]
"Statistically significant decreases in both BMI and body weight significantly decreased after acupoint embedment. Mean BMI decreased 0.95 kg/m2 (95% CI: 0.3–1.61, P = .004) more in the acupoint embedment group than the sham control group. Meanwhile, subjects received acupoint embedment had 3 kg (95% CI: 1.47–4.52, P = .0001) decrease in mean body weight more than in the sham control group."
"Acupoints chosen consistently followed the line of thought in treating obesity in Chinese Medicine's perspective. ST [stomach meridian] and SP [spleen meridian] were employed in every treatment regimen among the included studies. These 2 meridians worked closely with each other in the absorption and transport of nutrients. CV and GB were involved in 3 out of 5 treatment regimens. They were compatible with the concept of Qi regulation in treating obesity.
"Although the pathogenesis of obesity in TCM is different from that in Western medicine, the mechanism of acupuncture in weight control has been studied in a scientific way. A large number of experiments were carried out in animal models in weight control by different acupuncture techniques, including auricular acupuncture, electroacupuncture (EA) or manual acupuncture. The mechanism of catgut implantation for weight control may be associated with rebalancing peripheral and hypothamic leptin in obesity and enhancing insulin sensitivity, in turn, increasing the glucose metabolism.[28,29] Gao et al found that EA and acupoint catgut-embedding could regulate the lipid metabolic disorders in rats with obesity through enhancing the expression of peroxisome proliferator-activated receptor (PPAR)-gamma mRNA in adipose tissues, activating the activities of lipoprotein lipase and hepatic lipase, as well as decreasing the levels of total cholesterol and low-density lipoprotein cholesterol in serum.[30] Further study reported that EA stimulation of ST36 and SP6 could reduce body weight in rats with simple obesity, EA intervention could downregulate the suppressor of cytokine signaling 3 and PPAR-gamma mRNA expression in epididymis adipose tissue.[31] On the other hand, a beneficial neuro-hormonal changes were demonstrated which influenced the body's homeostatic mechanisms, suggesting a decrease in appetite might account for weight reduction mediated by the neuro-hormonal pathway.[32–35]
"Promising results were also shown in human studies. Acupuncture was proven to be associated with a decrease in leptin, a hormone produced physiologically to regulate energy balance by inhibiting hunger.[36–40] Chen et al also reported that both acupoint catgut-embedding and acupuncture had a definite therapeutic effect in the treatment of simple obesity, which is closely associated with the decline of serum insulin, glucose and TNF-a levels, as well as the decrease of insulin resistance.[41] These reports were compatible with the clinical findings in this meta-analysis."
"On the other hand, there were few limitations of this study. Though with much effort in literature search, it is obvious that those unpublished studies and publications not in English and Chinese language were not included. Besides, it is possible that the published studies were different from unpublished studies. Inadequacy in concealment of treatment allocation and failure in the management of missing data are some concerns. Acupoint embedment procedure, such as the length of absorbable thread used and the depth of implantation, were not properly mentioned and should be standardized...The longest treatment received was 12 weeks and no further follow-up data was collected. Persistency of the beneficial effect was not certain. The long term effect of acupoint embedment in weight reduction in adult obesity or overweight should be further studied. Recording risk or adverse effects of acupoint embedment, apart from mortality and hospitalization, was incomplete."
"A cost-benefit analysis showed that catgut-embedding had lower cost and fine economics benefit, yet its effectiveness was comparable to EA [electroacupuncture] in treating obesity.[44] Catgut was once the only material used in acupoint embedment. PGLA, a synthetic absorbable suture material, is going to replace catgut for its comparably same efficacy and less side effect caused.[45] Regardless of the suture material being used, it intends to exert a continuous, long-lasting and more intensive stimulation at acupoints when comparing to simple acupuncture. It takes 1 to 2 weeks for the suture thread to be absorbed in situ."
[Conclusion]
"However, it is not easy to draw a definitive conclusion on the clinical efficacy of acupoint embedment in the weight control of adult overweight and obesity due to the limitations of the small sample sizes in the studies."
