Copyright
©The Author(s) 2025. Published by Baishideng Publishing Group Inc. All rights reserved.
Effect of electroacupuncture combined with Tuina therapy on gut microbiota in patients with knee osteoarthritis
Xiao Guo, Liang Guo, Qing-Ze Lu, Hui Xie, Juan Chen, Wen-Li Su, Yuan Tian, Xiao-Hua Li, Hong-Lei Miao, Yi Zhang, Yan Yang, Cai Liao, Jun-Yuan Deng, Yun-Hao Yang, Cheng-Lin Tang, He-Jing Liu
Xiao Guo, Yan Yang, Cai Liao, Jun-Yuan Deng, Yun-Hao Yang, Cheng-Lin Tang, He-Jing Liu, College of Traditional Chinese Medicine, Chongqing Medical University, Chongqing 400016, China
Xiao Guo, Yan Yang, Cai Liao, Jun-Yuan Deng, Yun-Hao Yang, He-Jing Liu, Chongqing Key Laboratory of Traditional Chinese Medicine for Prevention and Cure of Metabolic Diseases, Chongqing Medical University, Chongqing 400016, China
Liang Guo, Qing-Ze Lu, Hui Xie, Juan Chen, Wen-Li Su, Yuan Tian, Xiao-Hua Li, Hong-Lei Miao, Yi Zhang, Department of Jinshang, Chongqing Orthopedic Hospital of Traditional Chinese Medicine, Chongqing 400012, China
Cheng-Lin Tang, College of Acupuncture and Tuina, Chongqing University of Chinese Medicine, Chongqing 402760, China
Co-first authors: Xiao Guo and Liang Guo.
Author contributions: Guo X and Guo L designed the research study; Guo X, Li XH, Zhang Y, Xie H, Tian Y, Su WL, Chen J, Lu QZ, and Miao HL performed the research; Yang YH, Yang Y, Liu HJ, and Liao C analyzed the data; Deng JY validated the results; Tang CL supervised the study and acquired funding.
Supported by Chongqing Municipal Health and Family Planning Commission and Chongqing Municipal Science and Technology Commission Jointly Funded Key Research Projects in Traditional Chinese Medicine, No. ZY201801007.
Institutional review board statement: The study was reviewed and approved by the Medical Ethics Review Committee of Chongqing Orthopedic Hospital of Traditional Chinese Medicine (No. GKYYIRB202309001).
Clinical trial registration statement: This study is registered at chictr.org.cn. The registration identification number is ChiCTR2300076904.
Informed consent statement: All study participants, or their legal guardian, provided informed written consent prior to study enrollment.
Conflict-of-interest statement: All the authors have no conflict of interest related to the manuscript.
CONSORT 2010 statement: The authors have read the CONSORT 2010 statement, and the manuscript was prepared and revised according to the CONSORT 2010 statement.
Data sharing statement: Technical appendix, statistical code, and dataset available from the corresponding author at
tangchenglin@cqmu.edu.cn. Participants gave informed consent for data sharing.
Open Access: This article is an open-access article that was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution NonCommercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See:
https://creativecommons.org/Licenses/by-nc/4.0/ Corresponding author: Cheng-Lin Tang, Professor, College of Traditional Chinese Medicine, Chongqing Medical University, No. 1 Medical School Road, Yuzhong District, Chongqing 400016, China.
tangchenglin@cqmu.edu.cn
Received: February 18, 2025
Revised: March 14, 2025
Accepted: April 21, 2025
Published online: May 14, 2025
Processing time: 84 Days and 0.8 Hours
BACKGROUND
Knee osteoarthritis (KOA) is a chronic condition characterized by joint pain and dysfunction, driven by aging and obesity. Research indicates that the gut microbiota significantly influences KOA, potentially affecting inflammation and disease progression through the gut-joint axis. Traditional treatments like non-steroidal anti-inflammatory drugs offer symptom relief but have adverse effects. Emerging therapies like electroacupuncture (EA) and Tuina (TN) have shown promise in alleviating pain and improving joint function by targeting the gut microbiota.
AIM
To clarify the efficacy of EA with TN in treating KOA and its effect on gut microbiota regulation.
METHODS
Sixty patients with KOA were allocated to EA or EA + TN (ET) group (n = 30 each). Seven acupoints were punctured. The ET group received TN after each EA session. Both groups completed 12 sessions. The visual analog scale (VAS) for assessing pain and the Western Ontario and McMaster Universities osteoarthritis index (WOMAC) for measuring pain intensity, joint stiffness, and functional capacity were employed to assess clinical outcomes. Pre- and post-treatment fecal specimens underwent 16S ribosomal RNA sequencing to analyze the gut microbiota.
RESULTS
The ET group showed higher rates of “effective” and “markedly effective” outcomes. The VAS score of the ET group remained significantly lower than that of the EA group (P < 0.001) immediately after treatment and 1 week post-treatment. The total WOMAC score (P < 0.001), pain (P = 0.191), stiffness (P = 0.015), and function scores (P < 0.001) decreased significantly in the ET group post-treatment. The gut microbiota analysis revealed no significant changes in alpha diversity in either group. Beta-diversity analysis indicated distinct patterns in the ET group before and after treatment. Significant changes in microbial abundance were detected in both groups, highlighting variations in Firmicutes, Actinobacteria, Proteobacteria, and Bacteroidetes.
CONCLUSION
ET outperforms EA alone in improving KOA pain, stiffness, and function, potentially via gut microbiota modulation, intestinal barrier protection, and inflammation reduction.
Core Tip: This study introduces a novel therapeutic approach combining electroacupuncture and Tuina therapy to alleviate pain and enhance joint flexibility in knee osteoarthritis (KOA). It highlights the significant role of the gut microbiota in this process, demonstrating how electroacupuncture combined with Tuina can reduce pathogenic bacteria and increase beneficial ones to mitigate inflammatory responses, indirectly suggesting the influence of the gut-joint axis on KOA. This innovative perspective opens new avenues for understanding and treating inflammatory joint diseases, offering fresh therapeutic targets and strategies.
