Moxibustion for human immunodeficiency virus and acquired immunodeficiency syndrome and its complications: a systematic review of randomized controlled trials

doi:10.19852/j.cnki.jtcm.20250923.001

Abstract

Abstract:

OBJECTIVE: To comprehensively evaluate randomized controlled trials (RCTs) investigating the effects of moxibustion on people with human immunodeficiency virus (HIV) disease.

METHODS: A systematic search was conducted across eight electronic databases up to August 20, 2024. The primary outcome were all-cause mortality and acquired immunodeficiency syndrome (AIDS)-related mortality. Two authors independently screened titles and abstracts, and extracted data onto a pre-designed datasheet. Discrepancies were resolved through consensus. The Cochrane risk-of-bias tool 2.0 was used to assess methodological quality, Meta-analysis was performed when appropriate, and the quality of evidence was assessed through Grading of Recommendations, Assessment, Development and Evaluations approach.

RESULTS: Eleven RCTs (n = 834) on moxibustion for HIV/AIDS were included, focusing on individuals with HIV infection (5 RCTs, n = 426), AIDS patients (3 RCTs, n = 223), or both (3 RCTs, n = 185). Complications identified included diarrhea (5 RCTs), pulmonary infection (1 RCT), anxiety and depression (1 RCT) and peripheral neuropathy (1 RCT). The risk of bias in the included RCTs was assessed as either high or uncertain. No trial reported mortality or the incidence of AIDS-related complications following treatment. Wheat-grain sized cone moxibustion was associated with increased CD4+ counts in patients with lung infections [1 RCT, n = 36, mean difference (MD) = 78.83 cells/μL]. Individual studies reported improvements of quality of life, as measured by the World Health Organization Quality of Life-Brief Version (WHOQOL-BREF) and WHOQOL HIV instrument, with various moxibustion types, but clinical heterogeneity prevented data pooling. Additionally, some studies reported symptom improvement, each using different criteria for symptom improvement. Moxa stick moxibustion plus Western Medicine compared with Western Medicine alone showed a non-significant trend towards improved symptom resolution [2 RCTs, n = 125, risk ratio = 1.19, 95% confidence interval (0.99, 1.43)]. Moxibustion plus antiretroviral therapy (ART) may reduce gastrointestinal adverse events compared to ART alone [1 RCT, n = 100 14% vs 32%, P < 0.05]. The quality of evidence was low to very low.

CONCLUSION: This systematic review suggests that moxibustion as an adjunct therapy may have potential benefits in improving immune function and quality of life for HIV/AIDS patients. Limited quality of evidence precludes definitive conclusions, and further high-quality research is needed.

Key words: moxibustion, HIV, acquired immunodeficiency syndrome, complications, systematic review

KONG Lingyao, ZHANG Xiaowen, WANG Xuehui, WANG Zhijie, Robinson Nicola, LIU Jianping. Moxibustion for human immunodeficiency virus and acquired immunodeficiency syndrome and its complications: a systematic review of randomized controlled trials[J]. Journal of Traditional Chinese Medicine, 2025, 45(6): 1201-1214.

Figures/Tables 6

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Study ID	Country	Condition	Course of condition (month, T/C)	Sample size (T/C)	Gender (%) (male, T/C)	Age (years, T/C)	Intervention	Control	Outcome	Duration	Funding	Follow up
Guo Y, Qian BY 2005⁴⁰	Eritrea	HIV-related diarrhea	120 d- 5 years/ 150 d- 5 years	60/30	60/70	21-53 (range)/19-58 (range)	Moxa stick moxibustion+ginger/salt-insulated moxibustion (ST36, CV8, CV4, ST25; Qi deficiency of the spleen and lung pattern: BL13, BL25. Deficiency of the spleen and stomach pattern: BL20, BL21, CV12. Yang deficiency of the spleen and kidney pattern: BL23, GV4. Watery stools occurring 5 to 10 times per day: CV8 (ginger-insulated moxibustion). Stool with mucus, CV8 (salt-insulated moxibustion). 5-10 min, QD)	Western Medicine (oral administration of berberine tablets and oral sugar-salt solution for fluid replenishment. Fluid replenishment should be adjusted based on the severity of the condition, with a daily dosage ranging from 500 to 2500 mL. Each 500 mL of solution should contain 25 g of glucose and 4.5 g of sodium chloride.)	Symptom resolution	7 d	NR	NR
Wang JD et al 2006⁴⁴	China	HIV-related diarrhea	NR	50/50	47	43.1 (15-66)	Moxa stick moxibustion (ST36, CV8, CV4. 10 min, BID)+Western Medicine	Western Medicine (conventional treatment (anti-pathogenic therapy, fluid resuscitation, electrolyte and fluid replacement))	Symptom resolution	15 d	Yes	NR
Zhou LH et al 2007⁴³	China	HIV-related diarrhea	11.75 years/ 11.75 years	41/34	54/21	45.24± 9.13/ 42.79± 11.65	Moxa stick moxibustion (ST36, CV4, CV8. 20 min, QD)+Western Medicine	Western Medicine (Flupentixol 0.2 g, TID; Smecta, 1 sachet, TID. Treatment duration is 1 week. Discontinue flupentixol and continue taking Smecta for 2 months.)	NHP, symptom resolution, adverse events	2 months	Yes	4 months
Liu ZW et al 2013⁴¹	China	HIV-positive	32.52±18.29 /33.68±17.57	50/50	46/48	35.0±0.5/ 34.0±0.6	Moxa stick moxibustion (ST36, SP6, BL18, KI3, LR3, IL4 Moxibustion therapy done with a partner, once daily for the first 3 days, then 3 times per week.)	Health education (including television lectures on HIV prevention and control, and distribution of informational pamphlets)	KPS, CD4+	3 months	Yes	9 months
Zhang X et al 2014⁴²	China	HIV patients with peripheral neuropathy	5.9/6.6	30/30	40/53	45 months/ 44 months	Moxibustion (ST36, ST37, GB34. QD)+Western Medicine	Western Medicine (ART+methylcobalamin tablets, vitamin B1 tablets, and gabapentin capsules.)	symptom resolution	1 month	Yes	NR
Nkomo O et al 2016³⁹	Gabon	AIDS lung infection	NR	18/18	58	42.67±12.68/ 41.80±15.20	Wheat-grain sized cone moxibustion (GV14, ST36. 10 Zhuang. 2 times one week)+Western Medicine	Western Medicine (routine anti-infection treatment, ART)	CD4+, WHOQOL-HIV, symptom resolution	4 weeks	NR	NR
Nong HL, Shi ZZ et al 2016³⁰	China	HIV-related diarrhea	5.7± 1.9 years/ 6.5±1.5 years	26/26	65/69	40.4±10.2/ 39.6±11.3	Ginger-insulated moxibustion (CV8, CV4, ST25, CV12. 10 min, BID)	Western Medicine (oral berberine tablets and oral sugar-saline rehydration solution (each 500 mL of rehydration solution contains 25 g of glucose and 4.5 g of sodium chloride) are given. Depending on the severity of the condition, 500 to 2000 mL of rehydration solution is given daily.)	MOS-HIV, symptom resolution	14 d	Yes	NR
Yuan HZ et al 2017²⁷	China	HIV-related diarrhea	NR	25/25	52/56	43.3±10.8/ 45.1±10.3	Moxa stick moxibustion (ST36, CV8, CV4, ST25, CV12. 10 min, BID) + Western Medicine	Western Medicine (pathogenic treatment should be given as appropriate, while oral berberine tablets and oral sugar-salt water rehydration are administered. The amount of fluid supplementation should be 500-2500 mL/d depending on the severity of the patient's condition, with each 500 mL solution containing 25 g of glucose and 4.5 g of sodium chloride.)	symptom resolution	14 d	NR	NR
Liu ZW et al 2018²⁹	China	HIV-positive	33.5± 17.3/ 34.7±17.5	50/50	52/54	36.5±4.5/ 35.6±5.6	Moxa stick moxibustion (ST36, CV8, CV4, ST25, SP6, BL20, BL18, CV12 once a day for the first 3 d, then once every 3d)+ Western Medicine	Western Medicine (the following 3 types: ①TDF: 0.3 g, once a night, 3TC: 0.3 g, once a night, EFV: 0.6 g, once a night; ②AZT: 0.3 g, once every 12 h, 3TC: 0.3 g, QD, NVP: 0.2 g, Once every 12 h; ③AZT: 0.3 g, once every 12 h, 3TC: 0.3 g, QD, LPV/r: 0.5 g every 12 h)	CD4+, CD4+/CD8+, IL-2, IL-7, WHOQOL-BREF, adverse events	1.5 years	Yes	NR
Liu ZW et al 2018²⁸	China	People with HIV with negative emotions	28.25±9.12/30.68±8.76	50/50	48/46	35.5±1.5/ 34.5±1.6	Moxa stick moxibustion (ST36, SP6, BL18, KI13, LR3, LI4. 5-10 min, TID)	Health education (including the explanation of AIDS related knowledge, the latest progress of AIDS prevention and treatment)	CD4+, CD4+/CD8+,	6 months	Yes	NR
Ao Wen et al 2024⁴⁵	China	HIV-positive	NR	35/36	83/86	42.31± 11.05/ 51.25± 7.88	Moxa stick moxibustion (RN6, RN4, 15 min, QD)	Tenofovir disoproxil fumarate tablets, 0.3 g, QD; Lamivudine tablets, 0.3 g, QD; Efavirenz tablets, 600 mg, QD	CD4+, WHOQOL-BREF, adverse events	12 weeks	Yes	3 months

Study ID	Country	Condition	Course of condition (month, T/C)	Sample size (T/C)	Gender (%) (male, T/C)	Age (years, T/C)	Intervention	Control	Outcome	Duration	Funding	Follow up
Guo Y, Qian BY 2005⁴⁰	Eritrea	HIV-related diarrhea	120 d- 5 years/ 150 d- 5 years	60/30	60/70	21-53 (range)/19-58 (range)	Moxa stick moxibustion+ginger/salt-insulated moxibustion (ST36, CV8, CV4, ST25; Qi deficiency of the spleen and lung pattern: BL13, BL25. Deficiency of the spleen and stomach pattern: BL20, BL21, CV12. Yang deficiency of the spleen and kidney pattern: BL23, GV4. Watery stools occurring 5 to 10 times per day: CV8 (ginger-insulated moxibustion). Stool with mucus, CV8 (salt-insulated moxibustion). 5-10 min, QD)	Western Medicine (oral administration of berberine tablets and oral sugar-salt solution for fluid replenishment. Fluid replenishment should be adjusted based on the severity of the condition, with a daily dosage ranging from 500 to 2500 mL. Each 500 mL of solution should contain 25 g of glucose and 4.5 g of sodium chloride.)	Symptom resolution	7 d	NR	NR
Wang JD et al 2006⁴⁴	China	HIV-related diarrhea	NR	50/50	47	43.1 (15-66)	Moxa stick moxibustion (ST36, CV8, CV4. 10 min, BID)+Western Medicine	Western Medicine (conventional treatment (anti-pathogenic therapy, fluid resuscitation, electrolyte and fluid replacement))	Symptom resolution	15 d	Yes	NR
Zhou LH et al 2007⁴³	China	HIV-related diarrhea	11.75 years/ 11.75 years	41/34	54/21	45.24± 9.13/ 42.79± 11.65	Moxa stick moxibustion (ST36, CV4, CV8. 20 min, QD)+Western Medicine	Western Medicine (Flupentixol 0.2 g, TID; Smecta, 1 sachet, TID. Treatment duration is 1 week. Discontinue flupentixol and continue taking Smecta for 2 months.)	NHP, symptom resolution, adverse events	2 months	Yes	4 months
Liu ZW et al 2013⁴¹	China	HIV-positive	32.52±18.29 /33.68±17.57	50/50	46/48	35.0±0.5/ 34.0±0.6	Moxa stick moxibustion (ST36, SP6, BL18, KI3, LR3, IL4 Moxibustion therapy done with a partner, once daily for the first 3 days, then 3 times per week.)	Health education (including television lectures on HIV prevention and control, and distribution of informational pamphlets)	KPS, CD4+	3 months	Yes	9 months
Zhang X et al 2014⁴²	China	HIV patients with peripheral neuropathy	5.9/6.6	30/30	40/53	45 months/ 44 months	Moxibustion (ST36, ST37, GB34. QD)+Western Medicine	Western Medicine (ART+methylcobalamin tablets, vitamin B1 tablets, and gabapentin capsules.)	symptom resolution	1 month	Yes	NR
Nkomo O et al 2016³⁹	Gabon	AIDS lung infection	NR	18/18	58	42.67±12.68/ 41.80±15.20	Wheat-grain sized cone moxibustion (GV14, ST36. 10 Zhuang. 2 times one week)+Western Medicine	Western Medicine (routine anti-infection treatment, ART)	CD4+, WHOQOL-HIV, symptom resolution	4 weeks	NR	NR
Nong HL, Shi ZZ et al 2016³⁰	China	HIV-related diarrhea	5.7± 1.9 years/ 6.5±1.5 years	26/26	65/69	40.4±10.2/ 39.6±11.3	Ginger-insulated moxibustion (CV8, CV4, ST25, CV12. 10 min, BID)	Western Medicine (oral berberine tablets and oral sugar-saline rehydration solution (each 500 mL of rehydration solution contains 25 g of glucose and 4.5 g of sodium chloride) are given. Depending on the severity of the condition, 500 to 2000 mL of rehydration solution is given daily.)	MOS-HIV, symptom resolution	14 d	Yes	NR
Yuan HZ et al 2017²⁷	China	HIV-related diarrhea	NR	25/25	52/56	43.3±10.8/ 45.1±10.3	Moxa stick moxibustion (ST36, CV8, CV4, ST25, CV12. 10 min, BID) + Western Medicine	Western Medicine (pathogenic treatment should be given as appropriate, while oral berberine tablets and oral sugar-salt water rehydration are administered. The amount of fluid supplementation should be 500-2500 mL/d depending on the severity of the patient's condition, with each 500 mL solution containing 25 g of glucose and 4.5 g of sodium chloride.)	symptom resolution	14 d	NR	NR
Liu ZW et al 2018²⁹	China	HIV-positive	33.5± 17.3/ 34.7±17.5	50/50	52/54	36.5±4.5/ 35.6±5.6	Moxa stick moxibustion (ST36, CV8, CV4, ST25, SP6, BL20, BL18, CV12 once a day for the first 3 d, then once every 3d)+ Western Medicine	Western Medicine (the following 3 types: ①TDF: 0.3 g, once a night, 3TC: 0.3 g, once a night, EFV: 0.6 g, once a night; ②AZT: 0.3 g, once every 12 h, 3TC: 0.3 g, QD, NVP: 0.2 g, Once every 12 h; ③AZT: 0.3 g, once every 12 h, 3TC: 0.3 g, QD, LPV/r: 0.5 g every 12 h)	CD4+, CD4+/CD8+, IL-2, IL-7, WHOQOL-BREF, adverse events	1.5 years	Yes	NR
Liu ZW et al 2018²⁸	China	People with HIV with negative emotions	28.25±9.12/30.68±8.76	50/50	48/46	35.5±1.5/ 34.5±1.6	Moxa stick moxibustion (ST36, SP6, BL18, KI13, LR3, LI4. 5-10 min, TID)	Health education (including the explanation of AIDS related knowledge, the latest progress of AIDS prevention and treatment)	CD4+, CD4+/CD8+,	6 months	Yes	NR
Ao Wen et al 2024⁴⁵	China	HIV-positive	NR	35/36	83/86	42.31± 11.05/ 51.25± 7.88	Moxa stick moxibustion (RN6, RN4, 15 min, QD)	Tenofovir disoproxil fumarate tablets, 0.3 g, QD; Lamivudine tablets, 0.3 g, QD; Efavirenz tablets, 600 mg, QD	CD4+, WHOQOL-BREF, adverse events	12 weeks	Yes	3 months

Condition	Study	Criterion	Source
HIV-related diarrhea	Nong HL, Shi ZZ 2016³⁰ Wang JD et al 2006⁴⁴ Guo Y, Qian BY 2005⁴⁰	Criteria A: reduction in stool frequency by at least 2 times compared to before treatment, but stools remain unformed; slight improvement in other associated symptoms.	Guiding Principle of Clinical Research on New Drugs of Traditional Chinese Medicine
HIV-related diarrhea	Yuan HZ et al 2017²⁷ Zhou LH et al 2007⁴⁴	Criteria B: slight improvement in stool consistency and frequency, partial improvement in TCM symptoms, and a reduction in symptom score of ≥ 30% and < 70%.	Guiding Principle for Treating Diarrhea with New Drugs of Traditional Chinese Medicine
AIDS lung infection	Baptiste O 2016³⁹	Criteria C: clinical symptoms have significantly improved, with a symptom score improvement rate of ≥ 30% and < 70%	NR
HIV patients with peripheral neuropathy	Zhang X et al 2014⁴²	Criteria D: clinical symptoms and signs show improvement, with a symptom score reduction of > 30%.	NR

Condition	Study	Criterion	Source
HIV-related diarrhea	Nong HL, Shi ZZ 2016³⁰ Wang JD et al 2006⁴⁴ Guo Y, Qian BY 2005⁴⁰	Criteria A: reduction in stool frequency by at least 2 times compared to before treatment, but stools remain unformed; slight improvement in other associated symptoms.	Guiding Principle of Clinical Research on New Drugs of Traditional Chinese Medicine
HIV-related diarrhea	Yuan HZ et al 2017²⁷ Zhou LH et al 2007⁴⁴	Criteria B: slight improvement in stool consistency and frequency, partial improvement in TCM symptoms, and a reduction in symptom score of ≥ 30% and < 70%.	Guiding Principle for Treating Diarrhea with New Drugs of Traditional Chinese Medicine
AIDS lung infection	Baptiste O 2016³⁹	Criteria C: clinical symptoms have significantly improved, with a symptom score improvement rate of ≥ 30% and < 70%	NR
HIV patients with peripheral neuropathy	Zhang X et al 2014⁴²	Criteria D: clinical symptoms and signs show improvement, with a symptom score reduction of > 30%.	NR

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