Evidence-based acupuncture: Methodological insights and challenges in gastroenteroscopy recovery research

This editorial published in the World Journal of Gastroenterology presents a comprehensive critical analysis of research methodologies in acupuncture for post-gastroenteroscopy recovery, focusing on a 2025 randomized controlled trial that investigated the combination of meridian flow injection (MFI) with transcutaneous electrical acupoint stimulation (TEAS). The analyzed study involved 120 patients undergoing gastroenteroscopy for benign or precancerous lesions, randomized into two groups: one receiving MFI-TEAS combined with routine care, and the other receiving routine care plus basic acupoint application. The MFI intervention used an herbal paste composed of Qingpi (青皮), Houpu (厚朴), and rhubarb (2:2:1 ratio) applied at specific points such as Shenque (CV-8), Zhongwan (CV-12), Tianshu (ST-25), and Zusanli (ST-36), following the Ziwu Liuzhu (子午流注) theory of traditional Chinese medicine chronobiology. TEAS was administered bilaterally at Zusanli, using biphasic waves at 2/100 Hz for 30 minutes daily over three days.

The results demonstrated significant benefits in the intervention group, including reduced time to first defecation (3.20 ± 1.04 days versus 3.98 ± 1.27 days, P < 0.001), improvement in stress biomarkers (reduction of cortisol and norepinephrine, elevation of gastrin), greater clinical efficacy (93.33% versus 75.00%, P = 0.006), and reduced complication rates (16.67% versus 38.33%, P = 0.008). The editorial critically examines six fundamental methodological aspects: trial design and registration, adherence to reporting guidelines, intervention methods, application of traditional Chinese medicine theory, adverse event reporting, and credibility of conclusions. Identified strengths include the use of stratified block randomization, appropriate sample size calculation, and ethical compliance with the Declaration of Helsinki. The analysis also highlights the innovative integration between ancient traditional Chinese medicine principles and contemporary evidence-based practices, especially through Five Element theory and Ziwu Liuzhu chronobiological timing.

However, the editorial identifies significant methodological limitations that compromise the quality of the evidence. The main problem is the lack of prospective trial registration, a deficiency that affects only 26.7% of acupuncture studies and may lead to selective reporting bias and inflation of effect sizes by up to 25%. Other limitations include incomplete adherence to STRICTA guidelines for acupuncture reporting, a single-center design that limits external validity, follow-up of only three days that prevents assessment of long-term effects, and a combination of interventions that hinders identification of specific active components. The editorial particularly criticizes the absence of systematic adverse-event monitoring using standardized criteria such as CTCAE, and the non-blinded nature of the providers that may introduce performance bias.

The authors propose essential future directions to strengthen the evidence base of traditional Chinese medicine. They recommend multicenter double-blind trials with appropriate sham controls, dismantling designs to isolate specific effects of TEAS versus combined interventions, and long-term follow-up of at least 30 days. They also suggest the use of advanced tools such as multi-omics and functional magnetic resonance imaging to elucidate mechanistic pathways, including modulation of the gut-brain axis and microbiota-immune interactions. The analysis emphasizes the need for mandatory prospective registration on platforms such as ClinicalTrials.gov, complete adherence to updated CONSORT and STRICTA guidelines, and implementation of rigorous safety monitoring protocols.

The editorial concludes that, although the results are promising, the evidence remains of low to moderate quality due to the identified methodological limitations. The authors advocate a balanced approach that preserves the valuable insights of traditional Chinese medicine while maintaining rigorous standards of scientific research, facilitating the global integration of these practices into perioperative medicine.