Network meta-analysis of moxibustion-based therapies for lumbar disc herniation pain and function

ObjectiveMoxibustion, a widely utilized external therapeutic technique in traditional Chinese medicine, has become an integral part of non-surgical management for lumbar disc herniation (LDH). This study seeks to perform a systematic review and network meta-analysis (NMA) to evaluate and compare the efficacy of different moxibustion-based combination therapies in the treatment of LDH.MethodsThis study employs NMA to evaluate randomized controlled trials (RCTs) published up to January 14, 2026. A systematic search of the literature was conducted across multiple databases, including PubMed, EMBASE, the Cochrane Library, Web of Science, and Chinese databases such as CNKI and Wanfang Medical Database. The interventions assessed include moxibustion alone, as well as combinations of moxibustion with acupuncture (ACU), tuina (TUINA), lumbar traction (REHAB), traditional Chinese medicine therapy (TCM), and conventional intervention (CT). The primary outcomes include the Visual Analog Scale (VAS) score for pain, the Oswestry Disability Index (ODI) score for functional improvement, and the Japanese Orthopedic Association (JOA) score for clinical symptoms. Statistical analysis was conducted using Stata 17.0 MP, with a random-effects model applied to calculate mean differences (MD) and risk ratios (RR). The quality of evidence was assessed using the GRADE framework.ResultsA total of 50 studies involving 4,399 patients were included in the analysis. The results suggest that, for the JOA score, low to moderate-quality evidence indicates that MOXI+CT (MD = 11.93, 95% CI: 8.88 to 14.98) and MOXI+TUINA (MD = 7.81, 95% CI: 4.4 to 11.23) significantly improved the JOA score compared to CT. For the ODI score, low to moderate-quality evidence indicates that MOXI+ACU (MD = −10.11, 95% CI: −11.92 to −8.3) and MOXI+TUINA (MD = −6.52, 95% CI: −8.58 to −4.46) significantly reduced the ODI score compared to CT. In the case of the VAS score, very low to low-quality evidence suggests that MOXI+ACU (MD = −1.99, 95% CI: −3.06 to −0.92) and MOXI+TUINA (MD = −2.2, 95% CI: −3.4 to −0.99) significantly reduced the VAS score compared to CT. Regarding the cure rate, moderate-quality evidence shows that MOXI+TUINA (RR = 2.45, 95% CI: 1.55 to 3.86) and MOXI+TCM (RR = 1.75, 95% CI: 1.31 to 2.33) significantly improved the cure rate compared to CT.ConclusionModerate to very low evidence indicates that the combination of TUINA+MOXI significantly reduces pain, enhances functional recovery, and promotes overall rehabilitation in patients with LDH. These results suggest that combining moxibustion with other therapeutic approaches may provide an effective non-surgical alternative for the management of LDH.