[Different moxibustion therapies for primary dysmenorrhea: a network Meta-analysis]

To compare the clinical efficacy of different moxibustion therapies for primary dysmenorrhea (PD) using network Meta-analysis.

A total of 8 databases, including the CNKI, Wanfang, VIP, SinoMed, PubMed, Cochrane Library, EMbase, and Web of Science, were searched by computer to collect randomized controlled trials (RCTs) on moxibustion therapy for PD published from database inception to September 1, 2025. The Cochrane risk of bias tool was used to evaluate the quality of the included literature, and R4.1.0 software and Stata15.0 software were used for data analysis.

A total of 64 RCTs involving 5 814 PD patients and 11 kinds of moxibustion therapies were finally included. The network Meta-analysis showed that: ① regarding improving the total clinical effective rate, 9 moxibustion therapies (traditional suspended moxibustion, moxibustion with warming devices, herb-partitioned moxibustion, ginger-partitioned moxibustion, warm needling moxibustion, wheat-grain sized cone moxibustion, thunder-fire moxibustion, heat-sensitive moxibustion, and spreading moxibustion) were superior to conventional western medication, and wheat-grain sized cone moxibustion had the best effect [OR=8.91, 95%CI (2.55, 31.14)]; ② regarding improving pain visual analogue scale (VAS) score, 3 moxibustion therapies (herb-partitioned moxibustion, thunder-fire moxibustion, and heat-sensitive moxibustion) were superior to conventional western medication, and herb-partitioned moxibustion had the best effect [MD=-4.19, 95%CI (-6.32, -2.16)]; ③ regarding reducing Cox menstrual symptom scale (CMSS) score, 4 moxibustion therapies (herb-partitioned moxibustion, wheat-grain sized cone moxibustion, thunder-fire moxibustion, and heat-sensitive moxibustion) were superior to conventional western medication, and heat-sensitive moxibustion had the best effect [MD=-11.13, 95%CI (-16.78, -5.42)]; ④ regarding reducing prostaglandin F2α (PGF2α) level, 2 moxibustion therapies (herb-partitioned moxibustion and heat-sensitive moxibustion) were superior to conventional western medication, and heat-sensitive moxibustion had the best effect [MD=-24.94, 95%CI (-42.24, -7.42)]; ⑤ regarding safety, the incidence of adverse events of moxibustion therapies was lower than that of conventional western medication (P<0.05).

Based on the current evidence, wheat-grain sized cone moxibustion has the best efficacy in improving the total clinical effective rate, herb-partitioned moxibustion has the best efficacy in improving VAS score, and heat-sensitive moxibustion has the best efficacy in improving CMSS score and PGF2α level. Limited by the quality and quantity of the included original studies and the quality of the current evidence, the conclusions of this study still require further verification by more high-quality RCTs.