Urinary Metabolomics Study on Acupuncture plus Wet Cupping Therapy for Post-Stroke Depression: A Pilot Study

INTRODUCTION: This study aimed to investigate urinary metabolomics alterations associated with acupuncture plus wet cupping (AC) therapy in patients with post-stroke depression (PSD). METHODS: A total of 40 subjects were randomly allocated to either the acupuncture plus wet cupping group (AC group, n = 20) or the acupuncture group (Acu group, n = 20). Morning urine samples were collected at baseline and after 4 weeks of treatment, yielding a total of 80 samples. An additional 20 healthy volunteers served as a blank control group, from whom urine samples were also obtained. Urinary metabolites were analyzed using gas chromatography-mass spectrometry. Differential metabolites and related metabolic pathways were identified. Clinical efficacy was assessed using the Hamilton Depression Rating Scale-24 items (HAMD-24) at baseline and post-treatment. Correlation analysis was performed to assess the relationship between metabolic changes and clinical improvement. RESULTS: After 4 weeks of treatment, the HAMD-24 scores in the AC group (median: 10.00, IQR: 9.00-13.00) were significantly lower than those in the Acu group (median: 18.00, IQR: 15.25-19.00), with a statistically significant between-group difference (p < 0.01). Metabolomic profiling revealed significant differences between healthy volunteers and untreated PSD patients, with 21 differential metabolites identified. Caffeine metabolism emerged as the most significantly altered pathway (FDR-P