Ma Xiao-peng, Yang Ling, Qi Li-zhen, Wei Kai, Zhang Lin-lin, Hong Jue

1 Shanghai Research Institute of Acupuncture and Meridian, Shanghai 200030, China

2 Shanghai University of Traditional Chinese Medicine, Shanghai 201203, China

Selected Study on Zhao Cui-ying’s Moxibustion Methods

Ma Xiao-peng1, Yang Ling2, Qi Li-zhen1, Wei Kai2, Zhang Lin-lin2, Hong Jue1

1 Shanghai Research Institute of Acupuncture and Meridian, Shanghai 200030, China

2 Shanghai University of Traditional Chinese Medicine, Shanghai 201203, China

Famous Doctor’s Experience; Moxibustion Therapy; Lung Tuberculosis; Aging; Kidney Diseases

Zhao Cui-ying, researcher, female, born in 1940, doctoral supervisor, is an instructor at the research studio of Shanghai famous and senior Chinese medical practitioners’ academic experience, used to enjoy the special allowance of State Council. She graduated in 1964 from the Department of Medicine, Shanghai Second Medical University, and at the same year came to work in Shanghai Research Institute of Acupuncture and Meridian up to today, used to be a director of the Immunology Research Room of Shanghai Research Institute of Acupuncture and Meridian, and a consultant of Grade 3 Laboratory of Acupuncture Immunology of State Administration of Traditional Chinese Medicine, and is a vice chairwoman and deputy secretary general of Shanghai Professional Committee for the Respiratory Diseases of Integrated Chinese and Western Medicine. Zhao Cui-ying has been engaged in the clinical, research and teaching work in the field of immune-related diseases treated by acupuncture and moxibustion for over 40 years, with abundant and distinguished experience, has undertaken over 10 state and provincial subjects and offered many important viewpoints in the research of acupuncture treatment of immune-related diseases, and has obtained several scientific and technological achievements, and published totally 80 academic papers, and has been honored with 10 awards, including 6 provincial awards. As a tutor or instructor, she has trained 7 doctoral students and 16 master students.

Researcher Zhao Cui-ying has been practicing medicine for over 40 years and mainly engaged in the research, clinical and teaching work on acupuncture treatment of immune-related diseases, making outstanding achievements in the clinical and basic study on moxibustion methods in particular, and has summed up the mature plans of moxibustion therapy and obtained satisfied clinical effects in the treatment of intractable tuberculosis, chronic renal insufficiency, and tumors, and anti-aging by moxibustion, and also has made a series of achievements in the explanation of its mechanism from regulating the immunity. In this article, Zhao Cui-ying’s experience in the study on moxibustion methods is summed up.

1 Advocating Moxibustion and Postponing Aging by Herb-separated Moxibustion

Currently, moxibustion methods in the clinical service by traditional Chinese medicine have not been fully emphasized, and it is quite common to emphasize herbal drugs and neglect moxibustion and to emphasize acupuncture and neglect moxibustion. With the social development, and the awareness of common people in self-healthcare and in the treatment of subclinical conditions, the good functions of moxibustion in regulating the health of the organism and its advantage of easy operation initiate the extensive concern once again. This is an unprecedented opportunity for the development and popularization of moxibustion therapy. Since the ancient times, moxibustion therapy has been an important means to prevent diseases and postpone aging. Relatively to acupuncture, moxibustion therapy can be operated by the patients themselves under the guidance of the doctors, and is easier to be popularized in the community and family for displaying its advantages of “easy operation and low cost”. Therefore, Zhao Cui-ying advocates postponing aging by moxibustion and positively conducts the clinical study and explains its immune and endocrine mechanism.

Acupoints: Danzhong (CV 17), Zhongwan (CV 12), Shenque (CV 8), Guanyuan (CV 4) and bilateral Zusanli (ST 36) as one group, Dazhui (GV 14), bilateral Shenshu (BL 23), and Pishu (BL 20) as another group. Two groups of the acupoints are used in alternation.

Operation: Herbal cake-separated moxibustion is applied. The herbal cake is made of herbal drugs that can reinforce the kidney, refill in essence, benefit qi, strengthen the spleen, activate blood and disperse blood stasis [includingHuang Qi(Radix Astragali),Dang Gui(Radix Angelicae Sinensis),Bu Gu Zhi(Fructus Psoraleae),Xian Ling Pi(Herba Epimedii),Da Huang(Radix et Rhizoma Rhei),Dan Shen(Radix Salviae Miltiorrhizae), etc.] after ground into powder and filtered through 120-mesh sieve. Before application, herbal powder is mixed with 80.0% alcohol and pressed with a mould into a herbal cake of 3 cm in diameter and 0.8 cm in thickness. Then, herbal cake is put on the acupoint and a moxa cone of 2 cm in diameter, 1.5 cm in height (about 1.5 g in weight) is put on the herbal cake for treatment. Three cones are applied to each acupoint. Three treatments are given per week. Twenty four sessions make one course.

After 223 cases of old people were treated with the above method for one course, the aging integral decreased obviously and the total effective rate was 83.4%. While the clinical symptoms were improved in the subjects, their cellular immune functions were strengthened, and the total count of T-lymphocytes was increased, and CD4+/CD8+ratio was restored to the normal level, and the activity of Natural Killer (NK) was intensified, and the synthesis and secretion of Interleukin-2 (IL-2) were increased, and the content of serum Soluble Interleukin-2 Receptor (sIL-2R) decreased. In addition, as the neurotransmitter of immune regulation, β-endorphin (β-EP) was obviously elevated after moxibustion. The results indicate that moxibustion can correct the abnormal immune status of the aging organism, stabilize the internal environment of the organism, and postpone the aging of the pituitary-thymus axis, so as to postpone aging[1]. Based upon the research results, Zhao Cui-ying believes that the better immune functions of the organism is the key to longevity, and moxibustion has a better regulatory effect on the cellular immune functions and can postpone aging. At the same time, Zhao Cui-ying also observes the influence of herbal cake-separated moxibustion on the pituitary-thyroid and pituitarygonadal function in old people. It has been found out in the studies that the content of Thyroid Stimulating Hormone (TSH) and T3in peripheral blood were obviously lower than those in the normal control group, and T4was higher than that in the normal control group. After the treatment with moxibustion, TSH and T3concentration was elevated, with statistical difference in comparison of before the treatment (P＜0.05), indicating that the thyroid functions decreased in the old people and moxibustion could strengthen the synthesis and secretion of pituitary and thyroid, and promote the metabolism of old organism. Follicle Stimulating Hormone (FSH) increased and T content declined in the old people, with the statistical differences in comparison with those in the control group (P＜0.01). After moxibustion, FSH declined and T was increased, with the statistical differences in comparison with those before moxibustion (P＜0.01). Although Luteinizing Hormone (LH) and Estradiol (E2) were decreased, there were no statistical differences in comparison with those before the treatment (P＞0.05), indicating that the pituitary and gonadal hormone were in metabolic disorders, and moxibustion could regulate FSH and Tcontents in plasma of the old people, and correct the metabolic disorders of the FSH and sex hormones appearing with aging[2].

Besides, in the observation of the influence of moxibustion on the cardiovascular functions in the old people, Zhao Cui-ying found out that after herbal cake-separated moxibustion, the cardiocerebrovascular functions were obviously improved in 29 cases of old people, manifested by obvious elevation in Stroke Volume (SV), Cardiac Output (CO), Stroke Index (SI), and Cardiac Index (CI), indicating that the cardiac functions were improved, cardiac blood supply was good, and Total Peripheral Resistance (TPR) and Viscosity (V) remarkably declined, and indicating that the peripheral resistance decreased and the blood viscosity declined[3].

2 Initiate Studies on Different Moxibustion Methods for Intractable Diseases

Zhao Cui-ying believes that moxibustion therapy could produce the effects that acupuncture and herbal drugs could not. Therefore, she tries to treat intractable diseases with moxibustion methods. For the therapeutic features of different moxibustion methods, in the treatment of intractable pulmonary tuberculosis with garlic-separated moxibustion, chronic renal insufficiency with herbal cake-separated moxibustion, and chronic viral hepatitis B with wheat-grain moxibustion, she sums up and crystallizes the effective plans for the treatment of those intractable diseases with moxibustion and explains its immune mechanism.

2.1 Treating intractable pulmonary tuberculosis with garlic-separated moxibustion

Pulmonary tuberculosis is a pulmonary infectious disease caused by mycobacterium tuberculosis and seriously threatens the health of mankind. Intractable pulmonary tuberculosis is one of the difficult diseases in pulmonary tuberculosis. Due to immune dysfunctions, the patient’s resistance to the pathogens declines, and at the same time due to the tolerance of mycobacterium tuberculosis to multiple anti-tuberculosis drugs, no satisfactory effects could be achieved with anti-tuberculosis drugs. Therefore, the treatment is quite difficult. How to effectively treat intractable pulmonary tuberculosis is a major clinical difficulty. It is believed in Chinese medicine that pulmonary tuberculosis is caused by infection of “tuberculosis bacterium”, corroding the lung, due to weakness and deficiency in the anti-pathogenic ability. Garlicseparated moxibustion has the effects of clearing away heat, dissolving toxin, killing bacteria, strengthening the stomach, diminishing tumefaction and dispersing accumulation. Therefore, Zhao Cui-ying tries to treat intractable pulmonary tuberculosis with garlic-separated moxibustion and achieves the satisfactory clinical effects. The protocol of garlic-separated moxibustion for pulmonary tuberculosis is given in the following.

Acupoints: Bilateral Jingbailao (EX-HN 15), Feishu (BL 13), and Gaohuang (BL 43) as one group; Danzhong (CV 17), Guanyuan (CV 4), bilateral Zhongfu (LU 1) and Zusanli (ST 36) as another group.

Operation: Two groups of the acupoints are used in alternation. Garlic-separated moxibustion is used. Seven cones of moxa are applied to each acupoint. Each cone of moxa cone is 0.25 g. The treatment is given three sessions per week. Three-month treatments make one course.

Zhao Cui-ying observed the therapeutic effects after the treatment with the above method for one course. After the treatment by moxibustion, the clinical symptoms and signs were all improved in different degrees in 80 cases and the total effective rate was 65.0%. At the same time, the patient’s body weight was increased, Erythrocyte Sedimentation Rate (ESR) slowed down, and hemoglobin content and red blood cell count were elevated, indicating that moxibustion could improve the general condition of the patients in the treatment of tuberculosis by moxibustion. Simultaneously, cellular immune dysfunctions of the patients were also corrected, manifested by the elevated amount of T Helper cells (Th), and correction of abnormal ratio of Th and T Suppressor cells (Ts), and intensification of IL-2 and NK activities. These findings indicate that moxibustion can promote IL-2 synthesis, increase its release, and promote NK activity and regulate Th/Ts ratio via intensifying Th cell functions for therapeutic effect[4].

2.2 Treating chronic renal insufficiency with herbal cake-separated moxibustion

Chronic renal insufficiency is a late stage of continuous deterioration of pathogenic situation in the patients with chronic renal disease. With the development of medicine, although the patient’s survival duration can be lengthened, by the application of dialysis technology and kidney transplantation in particular, there is still no effective measures to improve the renal functions and reduce the clinical symptoms. Based upon dialysis of Western medicine, Zhao Cui-ying treats chronic renal insufficiency by auxiliary herbal cake-separated moxibustion, and believes that this disease belongs to deficient body constitution and excessive symptoms in Chinese medicine, with deficiency in both the spleen and kidney as causative reason, and with internal excess of dampness and turbidity as manifestations. Therefore, the therapeutic method is set up in herbal cake-separated moxibustion to reinforce the kidney, strengthen the spleen, activate blood, disperse blood stasis, support yang and remove dampness, for the treatment by selecting Dazhui(GV 14), Pishu (BL 20), Shenshu (BL 23), Danzhong (CV 17), Zhongwan (CV 12), Shenque (CV 8), Guanyuan (CV 4), and Zusanli (ST 36), etc. Because the therapeutic principle for this disease is as same as that for postponing aging by moxibustion, both the method is set up to reinforce the kidney and strengthen the spleen. Therefore, different diseases are treated with the similar therapy. So, the similar interference plan is used, and the concrete plan is as the previous one.

Clinically, in the observation of interference measure for 33 cases of chronic renal insufficiency, the results showed that the clinical symptoms of the patients were improved in varying degrees after moxibustion. Before the treatment, most patients suffered from low spirit, lassitude, weakness and soreness in the low back and knee, poor appetite, loose stool or constipation, and poor sleep. After the treatment, the patients generally responded that low back became warm and comfortable, and soreness in the low back disappeared or relieved, and appetite was better, and abdominal distension, loose stool or constipation, and insomnia and dreamful sleep were obviously improved. In some patients, urine volume was increased, and serum creatinine, urea nitrogen content and medium molecular substances were all obviously decreased and testosterone was elevated. These findings indicate that moxibustion can enhance the effect of dialysis treatment, promote the release of metabolic products and poisons, intensify the synthesis and secretion of hormones, and can reduce injury of the renal tissues and improve the renal functions[5].

2.3 Treating chronic viral hepatitis B with wheat grain moxibustion

Chronic viral hepatitis B is a commonly encountered clinical disease. Although extensive and profound studies on this disease had been conducted in modern medicine, still there is no specific drugs and therapy for it. In accordance with the important effect of immune factor in the morbidity of chronic viral hepatitis B and moxibustion effect, Zhao Cui-ying’s team initiated the clinical study on the treatment of chronic viral hepatitis B by wheat grain moxibustion. Wheat grain moxibustion is a therapeutic method to apply moxa cone as small as wheat grain to the acupoints for treatment of diseases. Wheat grain moxibustion is characterized by more precise effect of the acupoints and more penetrating ability of warm and heating powder and is easy to be accepted by the patients[6]. In the treatment by wheat grain moxibustion, mainly Back-Shu points and Front-Mu points of the liver and spleen are selected, in combination of tonic and qi-benefiting acupoints of Dazhui (GV 14), Danzhong (CV 17), Zusanli (ST 36) and Zhongwan (CV 12), assisted by Zhiyang (GV 9) and Shizitou [Extra, 3 cun above Taiyuan (LU 9)], etc., the experience acupoints of the ancient people for gangrene and jaundice to clear away heat of the liver and gallbladder, in order to support the body constitution and expel pathogens and relieve illness. The concrete therapeutic protocol is as follows.

Acupoints: Dazhui (GV 14), Zhiyang (GV 9), and bilateral Ganshu (BL 18), Pishu (BL 20) and Zusanli (ST 36) as one group; Zhongwan (CV 12), Danzhong (CV 17) and bilateral Qimen (LR 14), Zhangmen (LR 13) and Shizitou [(Extra, 3 cun above Taiyuan (LU 9)] as another group.

Operation: Two groups of the acupoints are used in alternation. About 1.5 mg moxa wool is made into moxa cone in size of wheat grain. Seven cones are applied to each acupoint each time. The treatment is given once every other day. Three months make one course.

After one-course treatment, the main symptoms of the patients were improved. Various symptoms of the digestive tract were improved most obviously. Regarding signs, mainly percussion tenderness in the liver area was relieved. In the laboratory examination, the hepatic functions were improved, and Glutamic Pyruvic Transaminase (GPT) declined remarkably, and Prealbumin (PA) was remarkably elevated. In the moxibustion group, r-Glutamyl Transpeptidase (r-GT) showed an obvious improving tendency[7].

3 Positively Practicing “Moxibustion Serum”

“Moxibustion serum” is a new research idea and method Prof. Chen Han-ping put forward in his acupuncture research and realized the innovation in the experimental methodology with acupuncture and moxibustion in vitro[8]. It has been proved by the experimental study that “moxibustion serum” might contain multiple immune active factors, with the non-specific immune functions[9-15]. Guided by this idea, Zhao Cui-ying’s team initiated a series of studies on“moxibustion serum”. Because “moxibustion serum”could greatly and objectively reflect the general immune status of the host after moxibustion, “moxibustion serum” [serum prepared from the normal rats after moxibustion on Dazhui (GV 14)] from the normal rats were used as the subjects, to observe the effect of“moxibustion serum” to mouse EL-4 lymphocyte and Tumor Infiltrating Lymphocyte (TIL) in the experiment in vitro, for exploring the immune regulatory function and mechanism of moxibustion to tumors. In the observation of the functions of EL-4 lymphocyte, it has been found out that “moxibustion serum” could induce EL-4 apoptosis, leading to typical apoptosis change in the morphology of the tumor cells and influencing the transforming process of tumor cells from S phase to G2/M phase[16]. It has been found out in the further study that “moxibustion serum” could shiftdown EL-4 cells, bcl-2 mRNA and protein expressions, and shift up Fas mRNA and protein expressions. This functions might be the important mechanism to induce EL-4 cell apoptosis[17]. In the discovery of TIL functions, it has been found out that “moxibustion serum” could obviously promote TIL proliferation, and accelerate it into the index-growing stage. “Moxibustion serum”could cooperate cell factors rIL-2 to raise the count of CD3+positive cells in TIL continuously, to maintain CD4+positive cells and remarkably elevate CD8+positive cells, so as to invert CD4+/CD8+[18].“Moxibustion serum” could obviously elevate the killing activity of Cytotoxic Lymphocyte (CTL) in TIL of the index-growing stage. T cell clones with specific killing to allogeneic tumors exist in TIL cultured by“moxibustion serum”. “Moxibustion serum” could promote TIL cells to induce the production of Tumor Necrosis Factor-α (TNF-α) and Interferon-γ (IFN-γ), indicating that “moxibustion serum” could in certain degrees promote the specific killing activity of TIL[19]. At the same time, with “moxibustion serum” prepared from tumor- bearing mice after moxibustion as the subject, in the observation of its influence on the immune cells, it is found out that the lymphocytestimulating index, NK activity, and the activity of Lymphokine Activated Killer (LAK) cells in the group of tumor-bearing mice serum was obviously decreased than those in the control group of normal serum. In comparison between the serum group with moxibustion on Dazhui (GV 14) and the serum group of tumor-bearing mice, NK activity and LAK activity were obviously elevated, with significant differences, indicating that the elimination of immune inhibiting factors of tumor origin might be the important mechanism of moxibustion in the tumor-inhibiting immune reaction[20].

It has been proved by a series of studies by Zhao Cui-ying’s team that moxibustion has better regulatory effects on the immune functions of tumor organism. This offers the effective research ideas and methods to the prevention and treatment of this intractable diseasetumor.

In summary, in advocating the clinical application and scientific study of moxibustion methods, Zhao Cui-ying has conducted a series of missions in the field of moxibustion methods. By learning from the ancient people but not copying what the ancient people said, based upon inheritance, she fully incorporates into the modern scientific and technological achievements, makes innovation boldly and fully displays the therapeutic features of different moxibustion methods like herbal cake-separated moxibustion, garlicseparated moxibustion, and wheat grain moxibustion for different diseases, forming the special programs of moxibustion therapies for treating intractable diseases and postponing aging and offering the beneficial references to the clinical treatment of those diseases. At the same time, she has also introduced the modern scientific and technological methods to explore its effect mechanism from the angle of immune endocrine, providing the scientific evidence to the application of moxibustion for those diseases and promoting the application and development of moxibustion in the field of immune-related diseases.

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[2] Zhao CY, Hong X, Zhang YY, Wang HY. Influence of herbal cake-separated moxibustion on pituitary-thyroid, gonadal functions in old people. Shanghai Zhenjiu Zazhi, 2000, 19(Suppl): 9-11.

[3] Zhao CY, Ju XS, Wu HJ, Ding JY, Zhang YY, Wang HY. Influence of moxibustion on cardiovascular functions in the elders. Shanghai Zhenjiu Zazhi, 1994, 13(2): 51-52.

[4] Zhao CY, Cheng HP, Yan H, Gu FL, Chen DL, Wang HY, Hong X, Zhang XC, Shen HY, Wang AQ, Zhou GB. Clinical observation on treatment of refractory tuberculosis with garlic moxibustion. Zhongguo Zhenjiu, 1996, 16(3): 1-3.

[5] Zhao CY, Chen HP, Xie XZ, Shen Y, Zhang XY, Hong X. Clinical observation of herbal cake-separated moxibustion for chronic renal insufficiency. Shanghai Zhenjiu Zazhi, 1995, 14(3): 101-103.

[6] Cai YM, Zheng JF, Huang WY. Research progress of clinical application and experimental study of wheat-grain moxibustion. Zhenjiu Linchuang Zazhi, 2008, 24(9): 61-62．

[7] Xia WJ, Chen HP, Gu HM, Zhao CY, Xu ZY, Sakamoto Koji, Kasahara Takako, Mayumi Ymauchi, Wu GC, Shen CL, Liu LY. Clinical study on treatment of chronic viral hepatitis B by moxibustion. Shanghai Zhenjiu Zazhi, 1988, 7(1): 3-4.

[8] Zhou CL, Zhang SJ, Zhang D, Zhang CH, Wu HG, Cui YH. Current situation and thinking of moxibustion serum. Zhonghua Zhongyiyao Xuekan, 2011, 29(3): 484-486.

[9] Chen HP, Pei J. Study and application of acupuncture serum methods. Shanghai Zhenjiu Zazhi, 1998, 17(1): 1-2.

[10] Zhao YX, Wang J, Qin YR, Yu AS. General view of the studies on the effect of acupuncture-moxibustion serum. Shanghai Zhenjiu Zazhi, 2005, 24(12): 40-42.

[11] Chen HP. Ideas on several issues of acupuncturemoxibustion science. J Acupunct Tuina Sci, 2009, 7(1): 13-15.

[12] Sun SL, Wang Y, Song XJ, Zhang HM. Effects of moxibustion-serum on synapse of dorsal root neuroganglions in vitro. Shanghai Zhenjiu Zazhi, 2003, 22(7): 19-23.

[13] Wang Y, Yang YQ, Ma SL, Cui JM, Liu YY. SDS-PAGE analysis of components in serum with anti-asthma activity derived from rats treated by acupuncture. J Acupunct Tuina Sci, 2009, 7(1): 8-12.

[14] Chen YF, Zhao CY, LǚQY. Experimental observation on anti-tumor effects of murine moxibustion serum (MS). Shanghai Zhenjiu Zazhi, 2000, 19(6): 39-41.

[15] Wang Y, Cui JM, Ma SL, Liu YY, Yin LM, Yang YQ. Proteomics analysis of component in serum with anti-asthma activity derived from rats treated by acupuncture. J Acupunct Tuina Sci, 2009, 7(6): 326-331.

[16] Chen YF, Zhao CY, Chen HP, Qin HL, Fang F. Experimental study on murine moxibustion serum inducing apoptosis of tumor cells. Zhenci Yanjiu, 2000, 25(1): 38-41.

[17] Ma XP, Zhao CY, Chen YF, Wu HG, Shi Z, Hong X, Yang L. Influence of moxibustion serum on the expression of Fas bcl-2 mRNA and protein of EL-4 lymphoma cells. J Acupunct Tuina Sci, 2008, 6(6): 331-333.

[18] Chen YF, Zhao CY, Chen HP, Qin HL. Effect of moxibustion serum on activity of specific lysis of tumor-infiltrating lymphocytes (TIL). Zhongguo Mianyi Xue Zazhi, 2001, 17(10): 553-556．

[19] Chen YF, Zhao CY, Chen HP, Qin HL, Fang F. Effect of moxibustion serum on proliferation and phenotypes of tumor-infiltrating lymphocytes. Zhongguo Zhenjiu, 2002, 22(4): 261-264．

[20] Pei J, Chen HP, Zhao CY, Sun LJ. The influence of“moxa-serum” on the functions of immune competent cells. Shanghai Zhenjiu Zazhi, 1999, 18(1): 38-40.

Translator: Huang Guo-qi

R246.2

B

Date: October 20, 2012

Author: Ma Xiao-peng, M.D., researcher.

E-mail: pengpengma@163.com