ObjectiveTo systematically summarise acupuncture-related Clinical Practice Guidelines (CPGs)’s clinical and methodological characteristics and critically appraise their methodology quality.DesignWe summarised the characteristics of the guidelines and recommendations and evaluated their methodological quality using the Appraisal of Guidelines Research and Evaluation II (AGREE II) instrument.Data sourcesNine databases were searched from 1 January 2010 to 20 September 2020.Eligibility criteria for selecting studiesWe included the latest version of acupuncture CPGs, which must have used at least one systematic review addressing the benefits and harms of alternative care options to inform acupuncture recommendations.Data extraction and synthesisReviewers, working in pairs, independently screened and extracted data. When there are statistical differences among types of CPGs, we reported the data by type in the text, but when not, we reported the overall data.ResultsOf the 133 eligible guidelines, musculoskeletal and connective tissue diseases proved the most commonly addressed therapeutic areas. According to the AGREE II instrument, the CPG was moderate quality in the domain of clarity of scope and purpose, clarity of presentation, the rigour of development, stakeholder involvement and low quality in editorial independence, and applicability. The study identified 433 acupuncture-related recommendations; 380 recommended the use of acupuncture, 28 recommended against the use of acupuncture and 25 considered acupuncture but did not make recommendations. Of the 303 recommendations that used Grading of Recommendations Assessment, Development and Evaluation to determine the strength of recommendations, 152 were weak recommendations, 131 were strong recommendations, of which 104 were supported by low or very low certainty evidence (discordant recommendations).ConclusionIn the past 10 years, a large number of CPGs addressing acupuncture interventions exist. Although these guidelines may be as or more rigorous than many others, considerable room for improvement remains.

National Natural Science Foundation of ChinaAcupuncture is the most widely used traditional and complementary medicine, used in 113 of 120 countries according to a 2019 World Health Organization report. 3 In addition to registered acupuncturists, medical doctors, nurse practitioners, and chiropractors occasionally deliver acupuncture treatment. 4 Despite its widespread use and considerable available evidence, until recently, clinical practice guidelines from conventional medical organisations rarely included recommendations on acupuncture. Clinical practice guidelines aim to optimise patient care, 1 and must meet standards of trustworthiness to avoid misleading clinicians, patients, and other stakeholders. 2 We begin by summarising the progress made then address deficiencies that limit the clinical usefulness of acupuncture guidelines, examine the barriers to inclusion of acupuncture in guidelines, and suggest how to overcome them.

Background This study aims to assess clinical characteristics in FD with spleen deficiency syndrome and metabolic perturbations involved in FD progress. We combined metabolic biomarkers and clinical features into a better prediction for FD with Spleen Deficiency syndrome. Methods A total of 276 people were recruited, including 215 FD patients and 61 healthy control group (HC). The clinical characteristics and gastric emptying rate were compared between spleen deficiency-FD group and non-spleen deficiency-FD. The serum lipids metabonomics analysis was performed to determine the metabolic differences in spleen deficiency-FD group and HC. Results The symptoms of postprandial discomfort in Spleen Deficiency group were more severe (P < 0.05), and delayed gastric emptying was more pronounced (P < 0.05) vs. non-Spleen deficiency. Decreased motilin (OR = 0.990, 95% confidence interval (CI) 0.982–0.997) was independent risk factor related to Spleen Deficiency group. We identified 15 metabolites for spleen deficiency group vs. HC, majority of those biomarkers belonged to the glycerophospholipid metabolic pathway. The combination of 15 metabolics could diagnose spleen deficiency-FD, with the AUC of 0.9943, 95% CI 0.9854–1.0000), and the combination of 15 metabolics and motilin could diagnose spleen deficiency-FD, with the AUC of 0.9615, 95% CI 0.9264–9967). Conclusions This study provides supportive evidence that Spleen deficiency syndrome was associated with delayed gastric emptying and the glycerophospholipid metabolic pathway was perturbed in FD patients. The combination of metabolic biomarkers and clinical features provided us with new ideas for multidimensional diagnosis of FD. Trial registration http://www.chictr.org.cn , no: ChiCTR-TRC-13003200. clinicaltrials.gov, no: NCT02762136 Electronic supplementary material The online version of this article (10.1186/s13020-019-0238-9) contains supplementary material, which is available to authorized users.

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