To critically evaluate and summarize the methodological quality of systematic reviews (SRs) and present objective and important outcomes on the effectiveness of traditional Chinese medicine (TCM) therapies, including Chinese herbal medicine (CHM), acupuncture, and moxibustion, for diarrhea-predominant irritable bowel syndrome (IBS-D).

We conducted a comprehensive literature search for SRs in 7 databases until April 16, 2022. Two reviewers independently extracted data and assessed the methodological quality of the reviews according to the Assessing the Methodological Quality of Systematic Reviews 2 (AMSTAR-2), the Risk of Bias in Systematic reviews (ROBIS) tool, and the Preferred Reporting Item for Systematic Review and Meta-analysis (PRISMA) statement. The Grading of Recommendations, Assessment, Development, and Evaluation (GRADE) was used to rate the quality of evidence.

IBS-D patients included in 12 reviews were diagnosed in accordance with the Rome criteria, 9 reviews focused on CHM, 2 articles observed moxibustion and heat-sensitive moxibustion, 1 article studied acupuncture and CHM. The outcomes of the SRs were the effectiveness rate, the total effectiveness rate, global symptom improvement, and adverse effects. Based on AMSTAR-2, which measures the quality of methodology, all of the included studies were of low or critically low quality. According to the ROBIS tool, 10 SRs (83.33%) had a high risk of bias. With the PRISMA checklist, only 3 SRs reached over 90% compliance. Based on GRADE, most evidence was of low quality, and there was a moderate quality of evidence that the effectiveness rate of modified-Tongxie Yaofang was superior to Western medicine in the treatment of IBS-D.

Given the suboptimal reporting and methodological quality of existing SRs, more studies are needed to clarify whether TCM therapies are more effective or safe than pharmacological medicine. Future studies should combine evidence-based medicine with TCM research according to the characteristics of TCM.

To determine whether electro-acupuncture (EA) therapy could improve the cognitive functions of amyloid precursor protein Swedish mutation (APPswe)/presenilin 1 deleted in exon 9 (PS1dE9) mice and examine whether EA treatment could attenuate neuroinflammation by targeting the toll-like receptor 4 (TLR4)/myeloid differentiation primary response factor 88 (MyD88) signaling pathway.

Twenty-seven double transgenic APPswe/PS1dE9 mice were randomly allocated into three groups: an Alzheimer's disease model group (AD group), a medication group (M group) and an EA treatment group (EA group). Each group contained nine mice, and nine wild-type mice were used in a normal group (N group). The animals in the M group were treated with oral administrations of 0.92 mg/kg donepezil hydrochloride for 15 days. For animals in the EA group, EA treatments were used on the Yintang (GV 29) and Baihui (GV 20) acupoints for 20 minutes, and the Shuigou (GV 26) acupoint was pricked without needle retention following EA treatments. Following treatments, the spatial learning and memory of the mice were measured using the Morris water maze test. The expression levels of TLR4, MyD88, nuclear factor kappa B (NF-κB) and inducible nitric oxide synthase (iNOS) were analyzed by immunohistochemical staining and western blot.

The escape latencies of the M and EA groups were significantly lower than those of the AD group (vs M, P = .002; vs EA, P < .001). Moreover, compared with the AD group, the numbers of platform crossings was higher (vs M, P = .038; vs EA, P = .008) and the latency time for target quadrants was longer (vs M, P = .002; vs EA, P = .001) in the M and EA groups (P < .05). Furthermore, in the M and EA groups, the expression levels of TLR4, MyD88, NF-κB and iNOS decreased significantly compared with those of the AD group (all P < .01).

EA treatment enhanced the memory and learning abilities of APPswe/PS1dE9 mice by regulating the TLR4/MyD88 inflammatory signaling pathway.