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2TMR Integrative Medicine  2018, Vol. 2 Issue (4): 175-191     DOI: 10.12032/TMRIM201802033
Review     
Efficacy of blood-letting puncture and cupping in the treatment of periarthritis of shoulder: a systematic review
Li-Hui Zhang1,Li-Xin Wang1,Qian Cui1,Guo-Wei Zhang1()
1College of Chinese Medicine, Hebei University, Baoding, Hebei province, China.
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Highlights:

The application of blood-letting puncture and cupping in the treatment of scapulohumeral periarthritis can provide strong evidence for future clinical treatment.

Abstract

Objective: To systematically evaluate the clinical efficacy and safety of blood-letting puncture and cupping in the treatment of periarthritis of shoulder. Methods: We electronically searched databases including CNKI, VIP, PubMed, WanFang Data, EMbase Cochrane Library and to collect randomized controlled trials (RCTs) and quasi-randomized controlled trials about blood-letting puncture and cupping for periarthritis of shoulder and evaluated the quality of the documents collected by the Cochrane collaboration, provided by Review Manager 5 software for statistical analysis. Then the quality of the included trials was assessed using the Jadad scale and GRADE system was used to score the quality and grade recommendation. Results: Thirty RCTs involving 2556 patients were included. The results of meta-analysis showed that: Total effective rate OR = 6.21 [OR = 6.21, 95%CI (4.69, 8.21), P < 0.001]. The results of GRADE system evaluation showed that the level of evidence was B, and the recommendation level was weak recommendation. Conclusion: Blood-letting puncture and cupping shows better effects than other treatments and preferably security in the treatment of periarthritis of shoulder. We do not find any serious adverse reaction reports. Due to limited quality of the included studies, more high quality studies are needed to verify the above conclusion.



Key wordsTraditional Chinese Medicine      Blood-letting Puncture and Cupping      Periarthritis of shoulder      Meta-analysis      Systematic review      GRADE system     
Published: 14 December 2018
Cite this article:

Li-Hui Zhang, Li-Xin Wang, Qian Cui, Guo-Wei Zhang. Efficacy of blood-letting puncture and cupping in the treatment of periarthritis of shoulder: a systematic review. 2TMR Integrative Medicine, 2018, 2 (4): 175-191.  

URL:

https://www.tmrjournals.com/im/EN/10.12032/TMRIM201802033     OR     https://www.tmrjournals.com/im/EN/Y2018/V2/I4/175

Figure 1 Literature screening process
Study Sample size
EG / CG
Effective size EG / CG Treatment protocols (CG) Treatment protocols (EG) Outcome Duration
Shen 2011 [4] 44 / 42 31 / 39 Intra-articular injection of lidocaine Blood-letting puncture and cupping + herbal fomentation 1 clinical effect
2 VAS score
3 JOY score
5w
Chen 2009 [5] 28 / 30 21 / 25 Routine Electro acupuncture Routine Electro acupuncture + blood-letting puncture and cupping 1 Total effective rate
2 VAS score
3 Improvement of shoulder range of motion
40d
Zhang 2015 [6] 90 / 90 83 / 86 Routine Electro acupuncture Routine Electro acupuncture + Ashi points + blood-letting puncture and cupping 1 clinical effect
2 Degree of pain improvement
3 Onset time and treatment time
7w
Li 2015 [7] 60 / 60 44 / 53 Routine Electro acupuncture Routine Electro acupuncture + blood-letting puncture and cupping Clinical effect 28d
Zhao 2013 [8] 60 / 60 50 / 56 Point injection Transdermal administration by electroporation + blood-letting puncture and cupping Clinical effect 15w
Lin 2005 [9] 40 / 30 / 31 17 / 13 / 37 General acupuncture/Ashi points General acupuncture + blood-letting puncture and cupping clinical effect 1y
Wang 2015 [10] 27 / 27 22 / 27 Ultrashort wave therapy + intermediate frequency therapy Blood-letting puncture and cupping + Electro acupuncture + Infrared polarized light Clinical effect 42d
Huang 2010 [11] 40 / 56 32 / 56 General acupuncture+ blood-letting puncture and cupping Sharp-hooked needle + blood-letting puncture and cupping Clinical effect 5d
Lu 2013 [12] 42 / 42 34 / 41 General acupuncture Fire needle + blood-letting puncture and cupping Clinical effect 20d
Zhang 2012 [13] 40 / 40 37 / 40 General acupuncture+ Cupping Electro acupuncture +blood-letting puncture and cupping 1 clinical effect
2 Comparison of the relationship between course of treatment and recovery
20d
Bao 2016 [14] 52 / 52 37 / 48 General acupuncture Mongolian medicine blood-letting puncture and cupping Clinical effect 15d
Zhang 2018 [15] 59 / 59 45 / 54 Asimexin Sustained Release Capsules Mongolian Medicine blood-letting puncture and cupping 1 clinical effect
2 AROM
3VAS score
30d
Ye 2013 [16] 34 / 34 28 / 33 Routine Electro acupuncture Functional exercise + blood-letting puncture and cupping Clinical effect 20d
Chen 2012 [17] 30 / 30 21 / 29 General acupuncture+ functional exercise Electro acupuncture + blood-letting puncture and cupping + functional exercise Clinical effect 4w
Huang 2006 [18] 24 / 28 21 / 27 Massage + blood-letting puncture and cupping Massage Clinical effect 20d
Wang 2012 [19] 45 / 45 37 / 44 General acupuncture + moxibustion General acupuncture + moxibustion + blood-letting puncture and cupping Clinical effect 45d
Huang 2014 [20] 40 / 40 29 / 38 Warming Acupuncture + kinetic needling Warming Acupuncture + kinetic needling + blood-letting puncture and cupping Clinical effect
JOY score
10d
Cheng 2005 [21] 31 / 30 / 40 30 / 29 / 38 General acupuncture/ point injection Kinetic needling + blood-letting puncture and cupping Clinical effect 14d
Li 2015 [22] 31 / 30 / 40 30 / 29 / 38 General acupuncture/ point injection Kinetic needling + blood-letting puncture and cupping Clinical effect 2y
Zhu 2003 [23] 43 / 43 36 / 43 Short and weak acupuncture stimulation Strong stimulation + Short and weak acupuncture stimulation + blood-letting puncture and cupping Clinical effect 20d
Meng 2003 [24] 28 / 58 17 / 56 Voltaren + massage Blood-letting puncture and cupping + massage Clinical effect 10d
Liu 2014 [25] 25 / 25 18 / 23 General acupuncture Dong's extra-ordinary points + blood-letting puncture and cupping Clinical effect 0.5y
Pan 2011 [26] 18 / 18 14 / 17 General acupuncture General acupuncture
+ Ashi points +
blood-letting puncture and cupping
Clinical effect 20d
Zhang 2010 [27] 60 / 60 37 / 59 General acupuncture General acupuncture + blood-letting puncture and cupping Clinical effect 20d
Chen 2015 [28] 38 / 38 33 / 37 General acupuncture General acupuncture + blood-letting puncture and cupping Clinical effect VAS score 4w
Kang 2013 [29] 38 / 42 32 / 40 General acupuncture shoulder tri-needles General acupuncture Yanglingquan (GB34), Ashi points + blood-letting puncture and cupping Clinical effect
Score before and after treatment
28d
Chen 2015 [30] 36 / 40 28 / 38 Western medicine treatment General acupuncture + blood-letting puncture and cupping Clinical effect
Relapse rate
0.5y
Ren 2016 [31] 30 / 30 22 / 29 Asimexin Sustained Release Capsules General acupuncture + blood-letting puncture and cupping Clinical effect
JOY score
Relapse rate
21m
Huang 2017 [32] 26 / 26 24 / 21 General acupuncture General acupuncture + blood-letting puncture and cupping Clinical effect 10w
Wang 2018 [33] 42 / 42 34 / 39 Filiform needle + fire needle Filiform needle + fire needle + blood-letting puncture and cupping Clinical effect 1m
Table 1 General information of included literature
Figure 2 Risk of bias graph
Figure 3 Risk of bias summary
Study Randomization Hidden Double blinding Withdraws and dropouts Possibility of bias Jadad scale quality grade
Shen 2011 Random number table Not mentioned Not mentioned Not mentioned moderate degree 1 B
Chen 2009 Random number table Not mentioned Not mentioned Not mentioned moderate degree 1 B
Zhang 2015 Random number table Not mentioned Not mentioned mentioned moderate degree 2 B
Li 2015 Randomization Not mentioned Not mentioned mentioned moderate degree 2 B
Zhao 2013 Randomization Not mentioned Not mentioned Not mentioned moderate degree 1 B
Lin 2005 Randomization Not mentioned Not mentioned Not mentioned moderate degree 1 B
Wang 2015 Randomization Not mentioned Not mentioned Not mentioned moderate degree 1 B
Huang 2010 Randomization Not mentioned Not mentioned Not mentioned moderate degree 1 B
Lu 2013 Randomization Not mentioned Not mentioned Not mentioned moderate degree 1 B
Zhang 2012 visiting sequence Not mentioned Not mentioned Not mentioned moderate degree 1 B
Bao 2016 Randomization Not mentioned Not mentioned Not mentioned moderate degree 1 B
Zhang 2018 Randomization Not mentioned Not mentioned Not mentioned moderate degree 1 B
Ye 2013 Randomization Not mentioned Not mentioned Not mentioned moderate degree 1 B
Chen 2012 Random number table Not mentioned Not mentioned Not mentioned moderate degree 1 B
Huang 2006 Randomization Not mentioned Not mentioned mentioned moderate degree 2 B
Wang 2012 Randomization Not mentioned Not mentioned mentioned moderate degree 2 B
Huang 2014 parity group Not mentioned Not mentioned Not mentioned moderate degree 1 B
Cheng 2005 Randomization Not mentioned Not mentioned Not mentioned moderate degree 1 B
Li 2015 Randomization Not mentioned Not mentioned mentioned moderate degree 2 B
Zhu 2003 Randomization Not mentioned Not mentioned mentioned moderate degree 2 B
Meng 2003 visiting sequence Not mentioned Not mentioned Not mentioned moderate degree 1 B
Liu 2014 Random number table Not mentioned Not mentioned Not mentioned moderate degree 1 B
Pan 2011 visiting sequence Not mentioned Not mentioned Not mentioned moderate degree 1 B
Zhang 2010 Randomization Not mentioned Not mentioned Not mentioned moderate degree 1 B
Chen 2015 simple Randomization Not mentioned Not mentioned Not mentioned moderate degree 1 B
Kang 2013 Randomization Not mentioned Not mentioned Not mentioned moderate degree 1 B
Chen 2015 Randomization Not mentioned Not mentioned Not mentioned moderate degree 1 B
Ren 2016 Randomization Not mentioned Not mentioned Not mentioned moderate degree 1 B
Huang 2017 Randomization Not mentioned Not mentioned Not mentioned moderate degree 1 B
Wang 2018 Randomization Not mentioned Not mentioned mentioned moderate degree 2 B
Table 3 Jadad quality assessment scale
Figure 4 Total effective rate of blood-letting puncture and cupping in the treatment of periarthritis of shoulder
Figure 5 Meta-analysis funnel diagram of total effective rate in experimental group and control group
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