Hematology Department, Zhejiang

Provincial Hospital of Traditional

Chinese Medicine, Hangzhou 310006, China

SPECIAL TOPIC STUDY

Acupoint Sticking at Shenque (CV 8) with Ginger-prepared Ban Xia (Rhizoma Pinelliae) for Nausea and Vomiting Induced by Amifostine

Wang Li-na, Hu Hong-yan, Qiu Yi-ling, Zhou Yu-hong

Hematology Department, Zhejiang

Provincial Hospital of Traditional

Chinese Medicine, Hangzhou 310006, China

Author: Wang Li-na, bachelor, nurse.

E-mail: azhenliu@163.com

Objective: To observe the treatment effect of acupoint sticking at Shenque (CV 8) with ginger-preparedBan Xia(Rhizoma Pinelliae) on nausea and vomiting induced by Amifostine for myelodysplastic syndromes (MDS).

Methods: Totally 124 eligible subjects intervened by Amifostine were randomized into 2 groups by the visiting order,an observation group and a control group,62 in each group. The control group was intervened by conventional treatment, while the observation group was by acupoint sticking at Shenque (CV 8) with ginger-preparedBan Xia(Rhizoma Pinelliae) in addition to the same conventional treatment. The occurrence rate of nausea and vomiting in the two groups were observed.

Results: After intervention, the occurrence rate of nausea and vomiting in the observation group was significantly lower than that in the control group (P＜0.01).

Conclusion: Acupoint sticking at Shenque (CV 8) with ginger-preparedBan Xia(Rhizoma Pinelliae)can produce a content effect on nausea and vomiting induced by Amifostine for MDS.

Myelodysplastic Syndromes; Amifostine; Drug-related Side Effects and Adverse Reactions; Nausea; Vomiting; Acupoint Sticking Therapy; Point, Shenque (CV 8)

Myelodysplastic syndromes (MDS) are clonal hematopoietic stem-cell disorders, characterized by progressive pancytopenia or evolution to acute leukemia due to excessive apoptosis of hematopoietic progenitor cell and inefficient hematopoiesis. Its manifestations vary from simple moderate anemia with normal granulocyte and blood platelet, hypocellular bone marrow or hypercellulor bone marrow, to leukemia, and the disease duration also ranges from months to years. Therefore, it’s defined as a syndrome instead of a disease[1]. Currently, Amifostine is considered to be an effective method for managing MDS, as it’s found to improve hematopoiesis, reduce transfusion, enhance resistance, and decrease the risk of infection[2]. However, this medication can also produce some adverse effects, commonly present as gastrointestinal reactions such as nausea and vomiting. From July 2011 to December 2013, our department had preventively given acupoint sticking with preparedBan Xia(Rhizoma Pinelliae) at Shenque (CV 8) to MDS patients who were using Amifostine. The report is given as follows.

1 Clinical Materials

1.1 Diagnostic criteria

The subjects all conformed to the diagnostic criteria of MDS made at the Vienna conference[3], meeting the 2 essential items and at least 1 of the confirmative items. Essential items: Cytopenia ≥6 months; hemoglobin (Hb) ＜110 g/L, absolute neutrophils count (NAC) ＜1.5 × 109/L, blood platelet ＜100 × 109/L; other hematological or non-hematological diseases that may cause cytopenia or abnormal blood cells can be excluded. Confirmative items: dysplasia, i.e. dysplastic myeloid cells occupying over 10% of total cells from the same lineage; increased myeloblasts, i.e. the percentage of myeloblasts approaches 5%-19%; characteristic chromosomal abnormalities detected by karyotype analysis or fluorescence in situ hybridization analysis.

1.2 Inclusion criteria

Conforming to the above diagnostic criteria of MDS; receiving Amifostine; age ≥18 years old; having signed the consent form and willing to participate in the study.

1.3 Exclusion criteria

Against the above diagnostic or inclusion criteria; complicated with other severe diseases or patients in acute stage.

1.4 Statistical method

The SPSS 17.0 statistical software was used for data analysis. The measurement data were expressed by mean ± standard deviationand analyzed byt-test; the comparison of rate was conducted by Chi-square test.

1.5 General data

Totally 124 subjects were included and divided into two groups by their visiting sequence, 62 in each group. There were no significant differences in comparing the general data between the two groups (P＞0.05), indicating the comparability (Table 1).

Table 1. Comparison of general data between the two groups

2 Intervention Methods

The included subjects were all given Amifostine 500 mg mixed into 100 mL normal saline by intravenous injection, once per day, successive 5 d each week, with a 2-day interval, for 4 weeks in total.

2.1 Observation group

2.1.1 Conventional treatment

During the treatment with Amifostine, Ondansetron 4 mg was added into 10 mL normal saline via intravenous injection, to prevent nausea and vomiting.

2.1.2 Acupoint sticking

Acupoints: Shenque (CV 8).

Operation: The ginger-preparedBan Xia(Rhizoma Pinellia) was ground into powder first, and then mixed with warm water into paste. Place the medicinal paste as big as a 1-yuan coin on gauze. Before application, the to-be-treated area should be sterilized by 75% alcohol or cleaned by warm water in those who were allergic to alcohol. Afterwards, the medicinal paste was applied to Shenque (CV 8) (the center of umbilicus), then fixed by medical tape and covered by transparent plaster. It’s applied for 5-6 h and changed once a day, 5 d a week with 2-day interval, for 4 weeks in total.

2.2 Control group

3 Observation of the Results

3.1 Criteria of therapeutic efficacy

The evaluation of nausea and vomiting was by the criteria recommended on the European Society for Medical Oncology (ESMO) in 1990[4]. The symptoms were graded according to the patients’ subjective feelings.

Grade 0: In absence of nausea and vomiting.

Grade 1: Nausea was present but didn’t interfere with diet and daily life, vomiting at 1-2 times a day.

Grade 2: Nausea interfered with diet and daily life, vomiting at 3-5 times a day.

Grade 3: Patients could not get up from bed, vomiting ＞5 times a day.

3.2 Results

The occurrence rate of nausea and vomiting was 48.4% in the observation group, significantly lower than 93.5% in the control group (P＜0.01), indicating that the therapeutic efficacy of the observation group was higher than that of the control group (Table 2).

Table 2. Comparison of therapeutic efficacies (case)

4 Discussion

Amifostine is the first cytoprotective agent approved to be on American market by the Food and Drug Administration (FDA) in 1995. It selectively protects normal cells over neoplastic cells from chemotherapy[5]. As a sulfhydryl compound, Amifostine was initially used to prevent adverse reactions induced by cytotoxic drugs and radiation. In vitro studies have found that Amifostine promotes hematopoiesis and the survival of primitive hematopoietic progenitors in MDS patients[2]. It’s found in clinical studies that the adverse reactions occurred with the use of Amifostine majorly cover hypopressure, nausea, vomiting, fever, sneeze, dizziness, chills, etc[6]. Among which, nausea and vomiting are the most suffering symptoms, leading to poor appetite, malnutrition, dehydration, even interfering with the treatment. Patients who experienced vomiting in the previous treatment will develop a conditional reflex, which will make patients scared of the future treatment, and even seeing or hearing the name of the drug will stimulate nausea and vomiting. Therefore, medical staff should pay enough attention to these patients.

Ban Xia(Rhizoma Pinellia) is spicy in flavor and warm in nature, going into the Spleen, Stomach, and Lung Meridians. It works to resolve dampness and phlegm, down-regulate the qi and terminate vomiting, disperse the abdominal mass and resolve accumulation. Fresh ginger is admired as the holy medication for vomiting, also spicy in flavor and warm in nature, going into the Lung, Spleen, and Stomach Meridians. It functions to stimulate perspiration and release the exterior syndrome, warm the middle and arrest vomiting, warm lungs and stop cough, detoxicate, promote appetite and the recovery of primary qi. Processed by fresh ginger and alum,Ban Xia(Rhizoma Pinellia) will significantly lose its toxicity and irritant but work better in descending the reverse qi and arresting vomiting[6]. Shenque (CV 8) is located in the center of umbilicus, with thin stratum corneum and without fat tissues, thus easy to penetrate. It’s discovered that sticking therapy used at Shenque (CV 8) alone can treat digestive and respiratory diseases[7-13].

In the current study, the total recurrence rate of nausea and vomiting in the observation group was significantly lower than that in the control group (P＜0.01), indicating that the therapeutic efficacy of the observation group is better than that of the control group. Thus we can see that acupoint sticking at Shenque (CV 8) with ginger-preparedBan Xia(Rhizoma Pinellia) is effective in preventing nausea and vomiting induced by Amifostine. This easy-tooperate method has brought a novel idea to the prevention of nausea and vomiting caused by the use of Amifostine in MDS, worth more profound investigations.

Conflict of Interest

The authors declared that there was no conflict of interest in this article.

Acknowledgments

This work was supported by Zhejiang Provincial Hospital of Traditional Chinese Medicine.

Statement of Informed Consent

Informed consent was obtained from all individual participants included in this study.

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Translator: Hong Jue

Received Date: March 8, 2014

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