Xie Kai, Li Hai-zhou

1 Acupuncture Department, Zhenhai Lianhua Hospital of Ningbo, Zhejiang 315207, China

2 Ningbo Tianyi Vocational and Technical College, Zhejiang 315104, China

Combined Acupuncture and Bloodletting on Chize (LU 5) and Weizhong (BL 40) for Chronic Eczema

Xie Kai1, Li Hai-zhou2

1 Acupuncture Department, Zhenhai Lianhua Hospital of Ningbo, Zhejiang 315207, China

2 Ningbo Tianyi Vocational and Technical College, Zhejiang 315104, China

Objective: To observe the clinical effect of combined acupuncture with bloodletting on Chize (LU 5) and Weizhong (BL 9) for chronic eczema.

Methods: A total of 40 cases were randomly allocated into an observation group and a control group, 20 in each. Cases in the observation group were treated with acupuncture plus bloodletting on Chize (LU 5) and Weizhong (BL 9), whereas cases in the control group were treated with acupuncture alone. The acupuncture was conducted once a day, bloodletting twice a week. The therapeutic efficacy was statistically analyzed after one month of consecutive treatment.

Results: The recovery and total effective rates in the observation group were significantly higher than that in the control group (P＜0.05).

Conclusion: Combined acupuncture and bloodletting on Chize (LU 5) and Weizhong (BL 40) could obtain a better effect than acupuncture alone.

Acupuncture Therapy; Bloodletting Therapy; Eczema; Points, Chize (LU 5); Points, Weizhong (BL 40)

Chronic eczema is a common allergic skin condition. In Chinese medicine, this tardive allergic disorder falls under the category of ‘shi chuang (wet sore)’. Other than symptom-oriented management, no guaranteed treatments are available now in Western medicine. We’ve treated 20 cases with combined acupuncture and bloodletting and compared with acupuncture alone within the same period. The results are now summarized as follows.

1 Clinical Material

1.1 Diagnostic criteria

This is made according to the diagnostic criteria for chronic criteria in theClinical Dermatology[1]: Thickening infiltrated brownish red or gray skin lesions, along with pigmentation, a rough surface covered with scaliness, lichenification, presence of dark-red papules or papulovesicles and itching, the localized lesion can occur in any parts of the body; showing a chronic progression.

1.2 Inclusion criteria

Those who have met the above diagnostic criteria; ＞2 months of duration; men or women aged between 18 and 70; having discontinued other therapies during the treatment.

1.3 Exclusion criteria

1.4 General data

A total of 40 outpatients were included. Twenty cases had skin lesion on lower limbs, 6 cases had on dorsum of the feet, and 14 cases had on the torso; the smallest lesion was 0.5 cm × 1 cm and the biggest lesion was 8.5 cm × 10 cm; the least lesion number was 1 and the most lesion numbers was as much as 10. They were randomly allocated into an observation group and a control group. Of 20 cases in the observation group, there were 12 males and 8 females, aged between 18 and 70 years, with an average age of 34 years; the shortest duration was 2 months and the longest duration was 10 years, with an average duration of 2.0 years. Of 20 cases in the control group, there were 11 males and 9 females, aged between 19 and 69 years, with an average age of 34 years; the shortest duration was 3 months and the longest duration was 11 years, with an average duration of 2.3 years.

2 Treatment Methods

2.1 Observation group

2.1.1 Acupuncture

Acupoints: Quchi (LI 11), Hegu (LI 4), Xuehai (SP 10) and Sanyinjiao (SP 6).

Method: Punctured above acupoints and conducted even reinforcing-reducing manipulation upon arrival of qi. The needles were retained for 30 min.

2.1.2 Bloodletting

Acupoints: Chize (LU 5) and Weizhong (BL 40).

Method: First, found the notable veins around Chize (LU 5) and Weizhong (BL 40) and selected 2 sites. Then sterilized the local skin using Iodophors, pressed the selected site with the left hand and pricked fast for bloodletting using a three-edged needle in the right hand. It’s advisable not to prick deep to prevent internal hematoma but not too shallow either to get enough blood. Pathologically, the blood often appeared dark-red or dark-gray. The blood could be spurting at first but slowed down after 15 min. After bleeding stopped, clean the area with dry cotton ball and re-disinfect with Iodophors. Acupoints on one side was used for one treatment, the other side was used alternately for next treatment. The blood volume was controlled around 10 mL.

Acupuncture was conducted once a day and bloodletting twice a week. The therapeutic efficacy was statistically analyzed after one month of consecutive treatment.

2.2 Control group

Cases in the control group were treated with same acupuncture method (acupoints and courses of treatment) as the observation group.

2.3 Cautionary notes

During treatment, patients were asked to maintain a peaceful mind, have bland diet, avoid contact with cold water, be optimistic and get plenty of sleep.

3 Therapeutic Efficacy Observation

3.1 Observation indexes[2]

The subjective symptoms and skin lesion severity were classified into 4 levels.

3.1.1 Red bumps

0 point: No red bumps.

1 point: Dark-red bumps.

2 points: Red bumps.

3 points: Bright red bumps.

3.1.2 Papules

0 point: No papules.

1 point: A few papules.

2 points: Moderate papules.

3 points: Multiple clustered papules.

3.1.3 Infiltration and thickening

0 point: No infiltration or thickening.

1 point: Mild infiltration and thickening.

2 points: Moderate infiltration and thickening.

3 points: Notable infiltration and thickening.

3.1.4 Scope of skin lesion

0 point: No skin lesion.

1 point: One localized lesion.

2 points: Lesion in one body part.

3 points: Lesions in two or more body parts.

3.1.5 Severity of clinical symptoms

0 point: No clinical symptoms.

1 point: Mild pain or itching.

2 points: Disturbing symptoms that do not affect one’s work.

3 points: Severe symptoms that affect one’s work.

The total score was calculated by scores in each item and the symptom score reducing index was then calculated to assess the therapeutic efficacy.

3.2 Criteria for therapeutic efficacy[2]

The therapeutic efficacy was evaluated according to the symptom score reducing index (SSRI).

SSRI = (Pre-treatment score – Post-treatment score) ÷ Pre-treatment total score × 100%.

Recovery: SSRI ≥90%.

Marked effect: SSRI between 60% and 90%.

Improvement: SSRI between 20% and 60%.

Failure: SSRI ＜20%.

3.3 Treatment results

The recovery and marked effect rate in the observation group was 80.0%, versus 30.0% in the control group, showing a statistical significance by Chi-square test (P＜0.05); there was between-group statistical significance in the total effective rate (P＜0.05), indicating a better effect in the observation group than that in the control group (table 1).

Table 1. Between-group comparison of clinical effect (case)

4 Discussion

In Chinese medicine, chronic eczema occurs as a result of stagnation of dampness and stasis. Contributing factors of chronic eczema include congenital deficiency, acquired malnourishment and retention of wind, dampness and heat in the skin. Toxic dampness plays a major role in eczema. Despite the location in the skin, chronic eczema can also affect the blood phase, and it is therefore necessary to remove toxins in the blood phase. Of the acupoints selected in this study, Quchi (LI 11) and Hegu (LI 4) remove wind and regulate qi activity; Xuehai (SP 10) circulates qi, invigorates and nourishes blood, harmonizes the Ying-Nutrient and exterior and works well for chronic skin conditions[3-6]; Sanyinjiao (SP 6) harmonizes the ying-nutrients and invigorates blood. Since wind is often associated with skin problems involved itching, the treatment principle in Chinese medicine says ‘a(chǎn)ctivating blood flow before removing wind and wind may stop spontaneously afterwards’[7]. There are three reasons for bloodletting in this study: bloodletting can directly reach the pathogenic factors in the blood phase; bloodletting can drive the pathogenic factors out with blood; and bloodletting can help to remove toxins in the blood, as quoted in theHuang Di Nei Jing:Su Wen(Yellow Emperor’s Classic of Internal Medicine:Essential Questions) ‘when the disease is in the vessels, regulate it through the blood; when the disease is in the blood, regulate it through the collaterals (vessels)’[8]. Chize (LU 5) is the He-Sea acupoint of the Lung Meridian. Since the Lung Meridian is external-internally connected with the Large Intestine Meridian, needling Chize (LU 5) can remove pathogenic factors in both meridians. Weizhong (BL 40) is the He-Sea acupoint of Bladder Meridian. Since the Bladder Meridian guards the Wei-Defensive qi of the body, needling Weizhong (BL 40) can remove wind, regulate qi activity of the bladder, and promote diuresis to remove dampness. In addition, abundant veins around Chize (LU 5) and Weizhong (BL 40) made it easier for bloodletting to dispel pathogenic qi and regulate meridian qi and blood[9-10], and thus clear heat, resolve dampness, remove wind and stop itching.

This study has proven that combined acupuncture and bloodletting could obtain better effect for chronic eczema than acupuncture alone. It is worthy of being popularized in clinical treatment.

[1] Zhao B. Clinical Dermatology. 2nd Edition. Nanjing: Jiangsu Science and Technology Press, 1993: 512.

[2] Wu SZ, Wu M. Criteria of Diagnosis and Therapeutic Efficacy for Common Diseases. Beijing: China Press of Traditional Chinese Medicine, 1999: 641-645.

[3] Xie CC, Fu WB, Sun J. Clinical observation on needling Quchi (LI 11) and Xuehai (SP 10) for chronic urticaria. Hubei Zhongyi Zazhi, 2009, 31(1): 51-52.

[4] Wu JM, Zhou ZJ. Combined point injection of auto-blood and compound Danshen injection for 48 cases of acne. Henan Zhongyi, 2008, 28(11): 81.

[5] Li TC, Liu MX. Point injection for 48 cases of skin itching. Jilin Zhongyiyao, 2008, 28(4): 283.

[6] Wang Q, IIKO Atanassov, Zhao HX. Clinical observation on treatment of eczema by acupuncture plus collateralpricking and cupping: a report of 54 cases. J Acupunct Tuina Sci, 2004, 2(1): 37-38.

[7] Cheng ZM. Completed Formulae for Gynecological Problems. Beijing: People’s Medical Publishing House, 1985: 2.

[8] Huang Di Nei Jing Su Wen (Yellow Emperor’s Classic of Internal Medicine: Essential Questions). Beijing: People’s Medical Publishing House, 1963: 1.

[9] Xie HH, Zheng B. Observations on the efficacy of point Weizhong blood-letting puncture and cupping plus acupuncture for treating 50 sciatica patients. Shanghai Zhenjiu Zazhi, 2007, 26(3): 19-20.

[10] Zhang Y, Li Y, Li P. Case studies on bloodletting on Chize (LU 5) for skin conditions. Shanghai Zhenjiu Zazhi, 2007, 26(2): 29.

Translator: Han Chou-ping

Received Date: May 15, 2013

R246.7

A

have

local and other corticosteroid hormones or antihistamines over the past two weeks; having complications of severe primary conditions involving the heart, liver, kidney and hematopoietic system; having chronic widespread eczema; those who didn’t stick with the treatment and having incomplete data and lost to follow-up.

Author: Xie Kai, M.M., associate chief physician

Li Hai-zhou, M.M., lecturer.

E-mail: zjtnyx@126.com