Acupuncture and Moxibustion have Different Effects on Fatigue by Regulating the Autonomic Nervous System: A Pilot Controlled Clinical Trial

Qing Shu, Hua Wang, Daniela Litscher, Song Wu, Li Chen, Ingrid Gaischek, Lu Wang, Wenjuan He, Huanjiao Zhou, Gerhard Litscher, Fengxia Liang, Qing Shu, Hua Wang, Daniela Litscher, Song Wu, Li Chen, Ingrid Gaischek, Lu Wang, Wenjuan He, Huanjiao Zhou, Gerhard Litscher, Fengxia Liang

Abstract

In order to investigate the different effects of acupuncture and moxibustion on chronic fatigue syndrome (CFS) and alterations in the autonomic nervous system by measuring heart rate variability (HRV). Forty-five participants were recruited and randomly divided into 3 groups using a randomization schedule. The control group (CG, n = 15) and the acupuncture group (AG, n = 15) were treated by manipulation acupuncture, and the moxibustion group (MG, n = 15) was treated by indirect moxibustion. Primary outcomes were the scores of the Fatigue Assessment Instrument (FAI). Secondary outcomes were the HRV parameters which can reflect activity of the autonomic nervous system. This trial considered both instantaneous changes and long-term effectiveness. FAI scores decreased after the 4th and 10th treatments in the 3 groups. The decrease in FAI in the MG was greater than that in the AG. Acupuncture was more effective in instantaneous changes of HRV and moxibustion in long-term aspects. Both acupuncture and moxibustion improved fatigue in CFS patients, but moxibustion was more effective. The possible mechanism of the intervention may be through activation of the vagus nerve. Moxibustion was more effective than acupuncture in long-term treatment of CFS.

Figures

Figure 1. Acupoint locations.
Figure 1. Acupoint locations.
Figure 2. Flow of participants.
Figure 2. Flow of participants.
Figure 3. Procedure of Treatment & Measurement.
Figure 3. Procedure of Treatment & Measurement.
Figure 4. correlation between FAI scores and…
Figure 4. correlation between FAI scores and HRV parameters.
(A) The difference between healthy volunteers and CFS patients in FAI and HRV indices. Compared with the healthy volunteers, the quantitative value of total HRV was significantly lower and FAI scores was significantly higher in CFS patients (P < 0.05). (B) The correlation coefficient between HRV indices and FAI scores. All the HRV indices had a weak correlation with the level of fatigue either in the CFS patients or health volunteers. Total HRV and HF in CFS patients as well as HF in health volunteers showed a closer correlation than other parameters. (PCC: Pearson correlation coefficient, X axis in Figure (4b) represent the FAI scores).
Figure 5. Changes in FAI.
Figure 5. Changes in FAI.
(A) FAI scores before and after 4th and 10th treatments. FAI decreased after the 4th and 10th treatments in the 3 groups. FAI value at the 10th treatment was lower than that at the 4th (P < 0.05). (B) The decrease in FAI value of 3 groups. There were no significant differences in decrease value after 4th treatment (P > 0.05). After the 10th treatment, decrease value in MG were more pronounced than that in AG, while decrease value in AG were more pronounced than that in CG (P < 0.05).
Figure 6. Instantaneous Changes of HRV parameters…
Figure 6. Instantaneous Changes of HRV parameters during the 1st treatment.
During the 1st treatment, the mean HR in CG and AG decreased after the needle was inserted and increased after the needle was removed, and it did not change in MG. SDNN in CG and AG increased after the needle was inserted and decreased after the needle was removed, and it only increased between 30 minutes and 35 minutes in MG. Total HRV decreased in CG and increased in AG after the needle was inserted, and it did not change in MG. LF and HF both increased after the needle was inserted and decreased after the needle was removed in AG, and did not change in MG. lg LF/HF did not show regular changes during the st treatment.
Figure 7. Long-term effectiveness of HRV parameters…
Figure 7. Long-term effectiveness of HRV parameters before and after the 4th and 10th treatments.
Mean HR decreased after the 10th treatment in MG. Total HRV and LF increased significantly after the 4th or 10th treatment in MG (P < 0.05). The increase in HF in MG was not significant (P = 0.09). There was no significant effectiveness in CG and AG.

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