Effectiveness of Stimulation of Acupoint KI 1 by Artemisia vulgaris (Moxa) for the Treatment of Essential Hypertension: A Systematic Review of Randomized Controlled Trials
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Objective. A systematic review of randomized controlled trials has been performed to assess the effectiveness of stimulation of acupoint KI 1 by Artemisia vulgaris (the Japanese name is moxa) to lower blood pressure compared to antihypertensive drugs. Methods and Findings. Articles published from 1980 to August 2013 in databases of CENTRAL, Pubmed, CBM, CNKI, VIP, and online clinical trial registry websites were searched. Studies included were randomized controlled trials (RCTs); moxibustion-type intervention on KI 1 compared with antihypertensive drugs; meta-analysis showed superior effects of moxibustion plus antihypertensive drugs on systolic blood pressure (WMD: −4.91 [−7.54, −2.28]; P = 0.0003) but no superior effects on diastolic blood pressure (WMD: −6.38 [−17.17, 4.41]; P = 0.25). Conclusions. Our systematic review of the current literature shows a beneficial effect of using moxibustion interventions on KI 1 to lower blood pressure compared to antihypertensive drugs. However, the results are influenced by the existing differences in design of the current trials.
Essential hypertension (EH) remains a major public health problem in developed and developing countries alike. It is predicted that the number of adults with hypertension will be 1.56 billion worldwide by 2025 . In spite of the strength of evidence supporting the efficacy of antihypertensive agents and their wide endorsement in national and international guidelines, only about one-half of those patients are compliant with drug therapy . Effective control of hypertension is limited by treatment cost, complexity, and adverse effects of antihypertensive medications [3, 4]. Perhaps, for this reason, there has been a growing interest in alternative therapies for blood pressure control [5–12].
The increasing prevalence of hypertension creates a broad market for acupuncture-type therapies to aid in the management of blood pressure . The acupuncture-type therapies including moxibustion, acupuncture, electroacupuncture, and et al. are commonly used for controlling hypertension-related symptoms. Several studies have also demonstrated that acupuncture and moxibustion have good effects on the cardiovascular system, including excitation of somatic afferent input, activating sympathetic inhibitory systems in the brain related to endogenous opioids, nociceptin, γ-aminobutyric acid, and serotonin [14–16]. In traditional Chinese medicine, although there are many syndromes for a type of disease with complicated pathological processes, they can be classified into deficiency and excess and cold and heat. Therefore, the therapeutic principles for any disease can be summarized into four aspects, namely, supplementation, drainage, clearing, and warming.
Moxibustion is another important traditional East Asian medical intervention that involves the burning of a roll of specially prepared herbs containing Artemisia vulgaris or mugwort directly or indirectly at the acupuncture points [17, 18]. KI 1 is located on the points of 1/3 and 2/3 intersection of plantar (Figure 1). In the theory of traditional Chinese medicine, KI 1 has the function of opening the orifices, directing qi downward, relieving hiccup, discharging heat, clearing heart heat, and restoring yang to save from collapse. In 1963, a cohort trial in China reported that the efficacy rate of moxibustion for the treatment of hypertension was 82.8% in the intervention group. Since this Chinese study, various studies have been performed, using acupuncture point-moxibustion, acupuncture, or electroacupuncture, to lower blood pressure . In antihypertensive treatment, acupoint KI 1 is commonly used in conjunction with heat through moxibustion or electric stimulation.