Taihe Hospital, Hubei University of Medicine, Shiyan 442000, China

CLINICAL STUDY

Role of Combining Spreading Moxibustion and Point Injection in Reducing ECP and LPO Levels and Improving Lung Function

Xu Jing, Zheng Su, Fang Wei

Taihe Hospital, Hubei University of Medicine, Shiyan 442000, China

Author:Xu Jing, nurse

Objective:To observe the effect of combining spreading moxibustion and point injection on serum eosinophil cationic protein (ECP), lipid peroxidase (LPO) and cellular immunity in patients with cough-variant asthma.

Methods:A total of 150 cases who met the inclusion criteria were randomized into three groups, 50 in each group. Spreading moxibustion and point injection were employed in the observation group, spreading moxibustion alone in the spreading moxibustion group and point injection alone in the point injection group. Then the therapeutic efficacies were evaluated after one course of treatment.

Results:The recovery rate and total effective rate were 50.0% and 98.0% respectively in the observation group, versus 18.0% and 86.0% in the spreading moxibustion group and 14.0% and 82.0% in the point injection group, showing a statistically significant difference (P＜0.01). Before treatment, there were no inter-group statistically significant differences in levels of ECP, LPO, CD3+,CD4+, CD4+/CD8+and CD8+, forced vital capacity (FCV), forced expiratory volume 1 (FEV1), and peak expiratory flow (PEF) (P＞0.05). After treatment, the ECP and LPO levels in the observation group were more significantly reduced than those in the other two groups, showing statistically significant difference (P＜0.01); the levels of CD3+, CD4+and CD4+/CD8+in the observation group were significantly elevated but CD8+was significantly reduced, showing statistically significant differences compared with those in the other two groups (P＜0.01); and the lung function indexes (FVC, FEV1 and PEF) in the observation group were more significantly elevated than those in the other two groups (P＜0.05).

Conclusion:Combining spreading moxibustion and point injection could remarkably reduce the contents of ECP and LPO in patients with cough-variant asthma, improve cellular immunity, increase the contents of CD3+, CD4+and CD4+/CD8+, reduce the content of CD8+and improve the lung function.

Moxibustion Therapy; Acupuncture Therapy; Eosinophil Cationic Protein; Respiratory Hypersensitivity; Asthma; Cough

Cough-variant asthma (CVA) is a type of special concealed asthma and clinically characterized by cough. CVA patients often have no classic asthma symptoms such as wheezing and difficulty breathing. Due to its atypical symptoms, CVA can be misdiagnosed as upper respiratory tract infection orchronic bronchitis. As a result, patients do not respond to symptom-oriented medications for cough and phlegm. This in turn results in unnecessary medical expense and delayed treatment. Clinical studies have shown that other than bronchial hyperresponsiveness (BHR), CVA can also cause abnormalities in eosinophil cationic protein (ECP), lipid peroxidase (LPO) and cellular immunity[1-2]. We’ve treated 150 CVA cases and observed the changes in ECP, LPO, cellular immunity indexes and lung function. The results are now summarized as follows.

1 Clinical Materials

1.1 Diagnostic criteria

They were made by referring to the diagnostic criteria for CVA stipulated in theGuidelines for Diagnosis and Treatment of Cough(2009 Edition) by the Asthma Workgroup of the Chinese Society of Respiratory Diseases[3]: recurrent or persistent cough longer than 1 month, coupled with irritable cough at night; a positive result of bronchial provocation test and positive result of bronchial relaxation test or PEF diurnal variation ＞20%; response to bronchialdilating agents and glucocorticoids but poor response to standard anti-infective therapy; and exclusion of chronic coughs due to other causative factors (mycoplasma infections, esophageal reflux and enlarged thymus gland, etc.).

1.2 Inclusion criteria

Those who met the above diagnostic criteria; aged between 17 and 65; having a clear consciousness; a good understanding of this study protocol and willing to sign the informed consent.

1.3 Exclusion criteria

Local skin lesion or allergic to needles and moxibustion; hematological system diseases, mental disorders or other life threatening conditions; severe respiratory tract conditions such as chronic obstructive pulmonary disease (COPD), lung cancer, lung tuberculosis; and pregnant, ready-to-be pregnant or breast feeding women.

1.4 General data

A total of recruited 150 CVA cases were treated at our hospital between January 2011 and April 2013. They were randomly allocated into three groups (a spreading moxibustion group, a point injection group and an observation group), 50 in each group. There were no statistically significant differences in gender, age, duration and levels of ECP and LPO among three groups before treatment (P＞0.05), showing that the three groups were comparable.

Table 1. Inter-group comparison of general data

Table 1. Inter-group comparison of general data

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2 Treatment Methods

2.1 Observation group

2.1.1 Spreading moxibustion

Points: Fengmen (BL 12), Feishu (BL 13), Pishu (BL 20), Shenshu (BL 23) and the points along the pathway of Governor Vessel from Dazhu (GV 14) to Yaoshu (GV 2).

Method: Ask the patient to take a prone position and expose the back. After routine sterilization, apply garlic juice to the local area and place Chinese herbal powder (that acts to circulate qi, break stasis, remove cold, resolve dampness and alleviate pain) over the juice. Then apply smashed ginger and place moxa wool (approximately 2 mm in thickness) over the juice. Ignite the moxa wool and exchange with new one when it’s fully burnt, 3-4 times in general. After this, keep the smashed ginger for 15 min and remove it when the patient has no warm sensation. Finally wipe the local area with wet warm gauze.

Cautionary notes: During the process of spreading moxibustion, a burning sensation is normal. In case of intolerable burning sensation, tap the surrounding skin gently or remove the moxa. Keep the moxa fire away from the skin to prevent skin burn.

The spreading moxibustion was conducted once every other day, and 10 d made up a course of treatment.

2.1.2 Point injection

Points: Dingchuan (EX-B 1), Zusanli (ST 36), Fenglong (ST 40), Shenshu (BL 23) and Pishu (BL 20).

Method: Extract 4 mLYu Xing Cao(Herba Houttuyniae) injection using a 5 mL syringe. After routine sterilization, apply fast insertion to the above points (1-2 cm), lift and thrust the needle to induce the sensations of soreness, numbness and distension. After making sure that there are no air bubbles orblood in the syringe, inject approximately 1 mL for each point. Press about 1 min after removing the needle and then cover with aseptic adhesive plaster.

Points on both sides were used alternately, once every other day and 10 d made up a course of treatment.

2.2 Spreading moxibustion group

Same spreading moxibustion method (alone) as in the observation group was used in this group.

2.3 Point injection group

Same point injection method (alone) as in the observation group was used in this group.

3 Treatment Effects

3.1 Criteria for therapeutic efficacy

This was based on the Criteria of Diagnosis and Therapeutic Effects of Diseases and Syndromes in Traditional Chinese Medicine issued by the State Administration of Traditional Chinese Medicine[4].

Recovery: Complete absence of coughing.

Marked effect: Slight alleviation of coughing, cough at night or in the early morning.

Failure: No obvious improvement.

3.2 Observation indexes

3.2.1 Assays of ECP, LPO and cellular immunity

The fasting peripheral venous blood was extracted respectively before and after treatment for assays of ECP, LPO and cellular immunity. ELISA kit was used for serum ECP and LPO detection[5]; flow cytometer was used for cellular immunity indexes, including CD3+, CD4+, CD4+/CD8+and CD8+[6].

3.2.2 Tests of lung function

A lung function instrument was used to record FVC, FEV1 and PEF three times and calculate the average value[7].

3.3 Statistical method

The SPSS 17.0 version software was employed for statistical management,for expression of measurement data, t-test for intra-group comparison, Q-test for inter-group comparison, Chi-square test for rate of sample of numeration data and rank sum test for ranked data. P＜0.05 indicated a statistical significance.

3.4 Treatment results

3.4.1 Inter-group comparison of clinical effects

As shown in Table 2, the recovery rate and total effective rate in the observation group were 50.0% and 98.0% respectively, versus 18.0% and 86.0% in the spreading moxibustion group and 14.0% and 82.0% in the point injection group, showing statistically significant differences (P＜0.01).

Table 2. Inter-group comparison of clinical effects (case)

3.4.2 Inter-group comparison of ECP and LPO levels

After treatment, the levels of ECP and LPO in all three groups were significantly reduced (P＜0.01). Before treatment, there were no statistically significant differences in ECP and LPO levels among the three groups (P＞0.05); however, after treatment, the ECP and LPO levels in the observation group were more significantly reduced than the other two groups, showing statistically significant differences (P＜0.01), (Table 3).

3.4.3 Inter-group comparison of cellular immunity

After treatment, the CD3+, CD4+, CD4+/CD8+and CD8+in all three groups showed significant changes (P＜0.05). Before treatment, there were no statistically significant differences in CD3+, CD4+, CD4+/CD8+and CD8+among the three groups (P＞0.05); however, after treatment, the CD3+, CD4+and CD4+/CD8+were significantly elevated but CD8+significantly reduced in the observation group when compared with the other two groups (P＜0.01), (Table 4).

Table 3. Inter-group comparison of ECP and LPO before and after treatment

Table 3. Inter-group comparison of ECP and LPO before and after treatment

Note: BT＝Before treatment; AT＝After treatment; intra-group comparison, 1) P＜0.01; inter-group comparison with the observation group after treatment, 2) P＜0.01

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3.4.4 Inter-group comparison of lung function indexes

After treatment, the lung function indexes in all three groups were significantly improved (P＜0.05). Before treatment, there were no statistically significant differences in lung function indexes (FVC, FEV1 and PEF) among three groups (P＞0.05); however, after treatment, the lung function indexes in the observation group were more significantly elevated than those in the other two groups(P＜0.05), (Table 5).

Table 4. Inter-group comparison of cellular immunity before and after treatment

Table 4. Inter-group comparison of cellular immunity before and after treatment

Note: Compared with intra-group result before treatment, 1) P＜0.05; compared with the observation group after treatment, 2) P＜0.01

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Table 5. Inter-group comparison of pulmonary function parameters before and after treatment

Table 5. Inter-group comparison of pulmonary function parameters before and after treatment

Note: Compared with intra-group result before treatment, 1) P＜0.05; compared with the observation group after treatment, 2) P＜0.01

4 Discussion

CVA is atypical asthma characterized by unproductive cough with scanty phlegm that persists from one to six months or even longer period of time and aggravates at night or in the early morning. People with CVA often have no other classic inflammation asthma symptoms or abnormal chest X-ray findings. They often do not respond to antibiotics and medications for cough and sputum. However, bronchial-dilating agents can substantially alleviate or eliminate cough. Studies have suggested that cellular immunity is a key parameter during the process of immunological stress reaction[8]. As a chronic inflammation of the airway, CVA involves multiple cells and cytokines, especially the CD3+, CD4+and CD8+. The level of ECP is highly correlated with bronchial asthma[9]. The Level of LPO is closely related to the oxidative stress in patients with CVA[10]. It is of great significance to detect LPO, ECP and cellular immunity to predict the disease prognosis[11]. In Chinese medicine, CVA falls under the category of‘cough’ and ‘dyspnea’. Manifesting as intractable recurrent cough, this condition is located in the lung, closely associated with the spleen and kidney and caused by phlegm. As a result, the treatment principles are to tonify the lung, strengthen the spleen, benefit the kidney and boost the immune system. Through warming the surface of the body, moxibustion can balance yin and yang, strengthen the body resistance, remove pathogenic factors, dredge meridians, regulate Zang-fu organs, promote metabolism, boost the immune system and produce remarkable effects on healthcare and treatment of chronic, intractable problems[12]. Modern researches have proven that moxibustion can regulate the contents and actions of mononuclear macrophage, NK lymphocytes and red blood cells. It can also regulate cytokines, immunoglobulin release, and subsequently, cellular and humoral immunity[13-14]. Spreading moxibustion covers an extensive area. In Chinese medicine, the Governor Vessel is known as the ‘sea of yang meridians’. Moxibustion on the Governor Vessel activates yang qi and helps to resolve intractable conditions. Fresh ginger acts to circulate blood, remove cold, resolve dampness, reduceinflammation and boost immunity[15]. Moxibustion on Fengmen (BL 12), Feishu (BL 13), Pishu (BL 20) and Shenshu (BL 23) can remove pathogenic factors, resolve phlegm, disperse the lung, stop coughing, improve ventilation and relieve chronic cough[16]. Point injection helps to reduce inflammation, alleviate body reaction to allergens, regulate the immune function, levels of cyclic nucleotide and endocrine, improve lung function and lessen pathological changes of the bronchus[17-20]. This study adopted spreading moxibustion and point injection for CVA. Results have shown that this combined method can significantly improve the clinical effect, reduce the ECP and LPO levels, increase CD3+, CD4+and CD4+/CD8+, decrease CD8+, improve the lung function indexes (FVC, FEV1 and PEF) and thus help to recover from CVA.

Conflict of Interest

There is no potential conflict of interest.

Acknowledgments

This work was supported by Taihe Hospital, Hubei University of Medicine.

Statement of Informed Consent

All of the patients in the study signed the informed consent.

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Translator: Han Chou-ping

Zheng Su, resident physician.

E-mail: zhengsu0413@126.com

R245.8

A

Date:September 20, 2013