Li Zi-yong, Lao Jin-xiong

Acupuncture Department, Foshan Hospital of Traditional Chinese Medicine, Guangdong 528000, China

Warm Needling at Back-Shu Acupoints for Melasma in Women

Li Zi-yong, Lao Jin-xiong

Acupuncture Department, Foshan Hospital of Traditional Chinese Medicine, Guangdong 528000, China

Objective: To observe the clinical effect of warm needling at the Back-Shu acupoints for melasma in women.

Methods: A total of 100 cases who met the inclusion criteria were randomly allocated into a treatment group of 52 cases and a control group of 48 cases. Cases in the treatment group were treated with warm needling at the Back-Shu acupoints, whereas cases in the control group were treated with conventional acupuncture therapy. The therapeutic efficacies were then evaluated after three courses of treatment.

Results: The total effective rate in the treatment group was 96.2%, versus 85.4% in the control group, showing a statistical difference (P＜0.05).

Conclusion: Warm needling at the Back-Shu acupoints works well for melasma in women.

Acupuncture-moxibustion Therapy; Acupuncture Therapy; Warm Needling Therapy; Melanosis; Female

Melasma is a common hyperpigmentation skin problem on the face. It causes irregular patches on the cheeks, bilateral sides of the nose and lower part of the forehead. This condition is also known as butterfly patch because the yellow-brown pigmentation patches often symmetrically appear on the cheeks, resembling the shape of a butterfly. Melasma is seen more in young and middle-aged women, especially women after puberty or during pregnancy. We’ve treated 52 cases with warm-needling at the Back-Shu acupoints. The results are now summarized as follows.

1 Clinical Materials

1.1 Diagnostic criteria

This is made according to the clinical diagnostic criteria for melasma stipulated by the Group for Pigmentation Skin Problems Dermatology Branch, Chinese Society of Integrated Traditional Chinese and Western Medicine[1]: Symmetrical light-brown to dark-brown patches on the face with clear borderlines, absence of inflammation or scaliness, absence of subjective symptoms, mainly occurring in women after puberty; severer in summer than winter; absence of endocrine disorders and exclusion of pigmentation due to other medical conditions; and the average optical density value in the pigmentation area is 20% more than that of the face.

1.2 General data

A total of 100 melasma cases were enrolled from the Acupuncture Cosmetology Outpatient Department, Foshan Hospital of Traditional ChineseMedicine. Organic diseases such as tuberculosis and organ tumors were excluded by ultrasound and CT scan. The 100 cases were randomly allocated into a treatment group of 52 cases and a control group of 48 cases by drawing lots. As for the treatment group, the youngest was 22 and the oldest was 65, with an average age of 34 years. The shortest duration was 3 months and the longest was 35 years, with an average duration of 5.28 years. In addition, 28 cases had irregular menstruation or dysmenorrhea, 16 cases had insomnia, 10 cases had intolerance of cold, cold limbs, lumbar soreness and frequent night urination and some cases had mixed symptoms. As for the control group, the youngest was 25 and the oldest was 58, with an average age of 32 years. The shortest duration was 2 months and the longest was 33 years, with an average duration of 5.08 years. In addition, 26 cases had irregular menstruation or dysmenorrhea, 16 cases had insomnia, 9 cases had intolerance of cold, cold limbs, lumbar soreness and frequent night urination and some cases had mixed symptoms. There were no between-group statistical differences in age and duration (P＞0.05), indicating that the two groups were comparable.

2 Treatment Methods

2.1 Treatment group

2.1.1 Acupuncture

Major acupoints: Feishu (BL 13), Xinshu (BL 15), Ganshu (BL 18), Pishu (BL 20), Shenshu (BL 23), Quchi (LI 11), Xuehai (SP 10), Sanyinjiao (SP 6) and Zusanli (ST 36).

Adjunct acupoints: Combine with Hegu (LI 4) and Taichong (LR 3) for liver-qi stagnation; combine with Tianshu (ST 25), Zhongwan (CV 12) and Shangjuxu (ST 37) for food retention; combine with Guanyuan (CV 4) for deficiency of the spleen and kidney; and combine with Anmian (EX-HN 22), Shenmen (HT 7) and Zhaohai (KI 6) for insomnia.

Method: After routine sterilization, punctured the Back-Shu acupoints using filiform needles of 0.30 mm in diameter and 40 mm in length and the remaining points using filiform needles of 0.25 mm in diameter and 40 mm in length. The needles were retained for 30 min upon arrival of qi.

2.1.2 Warm needling

Upon arrival of qi, placed a moxa stick approximately 2 cm in length onto the needle handles, ignited and replaced once.

The treatment was conducted twice a week, 8 times for a course of treatment, and 3 courses of treatment in total. The therapeutic efficacy was observed after 1 month of follow-up.

2.2 Control group

Acupuncture alone was employed in the control group. The points, method and course of treatment were the same as the treatment group.

3 Treatment Results

3.1 Criteria for therapeutic efficacy[1]

The area of skin lesion can be classified into four levels.

0 point: No skin lesion.

浙江省國(guó)土資源關(guān)鍵信息平臺(tái)風(fēng)險(xiǎn)防范體系建設(shè)的幾點(diǎn)思考（路雄英） ........................................................7-45

1 point: Skin lesion ＜2 cm2.

2 points: Skin lesion ≥2 cm2but ＜4 cm2.

3 points: Skin lesion ＞4 cm2.

The color of skin lesion can also be classified into four levels.

0 point: Normal color.

1 point: Light tan color.

2 points: Brown color.

3 points: Dark brown color.

The total score = Score of skin lesion area + Score of skin lesion color.

Basic recovery: Decrease of the lesion by naked eye observation ＞90%, almost normal skin color and the score decrement index ≥80%.

Marked effect: Decrease of the lesion by naked eye observation ＞60%, noticeable lighter lesion color and the score decrement index ≥50% but ＜80%.

Improvement: Decrease of the lesion by naked eye observation ＞30%, lighter lesion color and the score decrement index ≥30% but ＜50%.

Failure: Decrease of the lesion by naked eye observation ＜30%, no apparent change of the lesion color and the score decrement index ＜30%.

3.2 Treatment results

After treatment, the total effective rate in the treatment group was 96.2%, versus 85.4% in the control group, showing a statistical difference (P＜0.05 by Chi-square test), indicating that the total effective rate in the treatment group was better than that in the control group.

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

3.3 Case study

A 35-year old female teacher.

Chief complaints and history of present illness: Two years of melasma on the face that occurred afterchildbirth, the melasma aggravated over the last 4 months and appeared butterfly-shaped in dark brown color, especially on the cheeks before period. The patient didn’t respond well to Chinese and Western medicine, face pack and photon therapy. Other signs and symptoms include emotional irritability, irregular menstruation, dark menstrual color coupled with clots, mental fatigue, poor appetite, loose stools, normal sleep, a pale swollen tongue with teeth marks and a white coating and a deep pulse. The ultrasound did not show any abnormal findings.

Diagnosis: Melasma.

Treatment: Feishu (BL 13), Ganshu (BL 18), Pishu (BL 20) and Shenshu (BL 23) were adopted for warm needling. Quchi (LI 11), Xuehai (SP 10), Sanyinjiao (SP 6), Zusanli (ST 36), Guanyuan (CV 4) and Tianshu (ST 25) were punctured with filiform needles alone. The needles were retained 30 min after arrival of qi. The patient was treated twice a week. After 1-course treatment, the melasma color became lighter and the patient was happy. In addition, she regained her appetite and good sleep as well as regular period. After another course, the melasma almost completely disappeared. Then the patient was treated once a week continuously 3 weeks for consolidation. Afterwards, one month of follow-up didn’t show relapse.

4 Discussion

In Chinese medicine, melasma falls under the category of ‘black facial patch’ or ‘liver spotting’. It often occurs as a result of qi and blood failing to nourish the face[2]. Contributing factors include emotional distress, liver-qi stagnation, internal dampness due to spleen deficiency, kidney essence insufficiency and external contraction of wind. The etiology and pathogenesis of melasma are not yet clear in modern medicine. It’s generally believed that endocrine changes should play a major role. Other related factors may include genetic factor, sun exposure, serum enzyme, trace elements, pregnancy, medication, cosmetics, microstructure imbalance of the skin and diet[3]. Modern studies have suggested that oxygen radicals are associated with the generation of melanin pigment and pigmentation[4]. Some researchers believe that melasma is associated with blood stagnation and microcirculation disturbance due to elevated blood viscosity.

According to theYi Lin Gai Cuo(Correction of Errors in Medical Classics), melasma is caused by internal blood stagnation. Although it manifests in the exterior, the root cause is in the interior. As a result, the principle of acupuncture treatment is to soothe the liver, circulate qi, invigorate blood, strengthen the spleen, boost digestion, and nourish kidney yin. Since the spleen (stomach) is the acquired base and source of producing qi and blood, Xuehai (SP 10) was used to regulate and tonify blood. Feishu (BL 13) was used to tonify qi, Quchi (LI 11) and Zusanli (ST 36) to circulate qi and invigorate blood, Sanyinjiao (SP 6) to regulate qi activities of the Liver, Spleen and Kidney Meridians. In addition, modern laboratory and clinical trials have proven that the near infra-red radiation can directly permeates into the deeper tissue and further spread extensively through the capillary network to be absorbed by the body. Since the Back-Shu acupoints are reaction sites where qi and blood of the five Zang organs distribute on the back, warm needling at the Back-Shu acupoints can regulate the Zang-fu organs, circulate qi and blood, resolve stasis and eliminate facial patches[5-6].

Body needles, ear acupuncture, point injection, Guasha (scraping), cupping after bloodletting and fire needle are often used for melasma[7-10]. Our research findings have shown a better treatment effect in the treatment group than that in the control group (P＜0.05). No adverse reactions have occurred in two groups, it can be concluded that warm needling at Back-Shu acupoints is safe, convenient and effective for melasma.

[1] Group for Pigmentation Skin Problems Dermatology Branch, Chinese Society of Integrated Traditional Chinese and Western Medicine. Clinical diagnosis and criteria of therapeutic efficacy for melasma (draft). Zhongguo Pifu Xingbing Xue Zazhi, 1999, 13(4): 209.

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[5] Yang HY, Liu TY. Preliminary investigation on bio-physical mechanism of moxibustion therapy. Zhongguo Zhenjiu, 1996, 16(10): 17-18.

[6] Wu HG, Yan J, Yu SG, Xu B, Chang XR, Ma XP, Mu JP, Liu HR. Research current situation and development trend of moxibustion therapy. Shanghai Zhenjiu Zazhi, 2009, 28(1): 1-6.

[7] Liu GX. Treatment of facial melasma by auricular pressure in 41 cases. J Acupunct Tuina Sci, 2003, 1(2): 37-39.

[8] Shi HF, Wang YF. Clinical observations on the treatment of 45 melasma cases by the combination of acupuncture and herbs. Shanghai Zhenjiu Zazhi, 2001, 20(6): 17-18.

[9] Zhang BM, Xu SW, Zhang W. Clinical observation of auricular bloodletting therapy for melasma in 30 cases. J Acupunct Tuina Sci, 2011, 9(3): 152-153.

[10] Wang Q, Sun YN. Acupuncture treatment advance for melasma. Zhongguo Meirong Yixue, 2012, 21(12): 72-73.

Translator: Han Chou-ping

R246.7

A

Date: June 18, 2013

Author: Li Zi-yong, associate chief physician.

E-mail: zjtnyx@126.com