Sun Yi-jun, Wu Yao-chi, Zhang Jun-feng, Li Yan2, Wang Ying

1 Shanghai Jiao Tong University Affiliated Sixth People’s Hospital, Shanghai 200233, China

2 Tianshan Hospital of Traditional Chinese Medicine, Changning District, Shanghai, Shanghai 200051, China

SPECIAL TOPIC STUDY

Therapeutic Efficacy Observation on ‘Setting Fire on the Mountain’ Manipulation by Lu Shou-yan for Cervical Radiculopathy

Sun Yi-jun1, Wu Yao-chi1, Zhang Jun-feng1, Li Yan2, Wang Ying1

1 Shanghai Jiao Tong University Affiliated Sixth People’s Hospital, Shanghai 200233, China

2 Tianshan Hospital of Traditional Chinese Medicine, Changning District, Shanghai, Shanghai 200051, China

Author:Sun Yi-jun, master of medicine, resident

Objective: To observe the clinical effect of ‘setting fire on the mountain’manipulation by Lu Shou-yan for cervical radiculopathy as well as the infrared thermographic changes of the cervical area before and after treatment.

Methods: A total of 120 eligible cases with cervical radiculopathy were randomly allocated into an observation group and a control group, 60 in each group. Cases in the observation group were treated with Lu Shou-yan’s ‘setting fire on the mountain’ manipulation, whereas cases in the control group were treated with even reinforcing-reducing manipulation. After two courses of treatment, the infrared thermographic changes and overall therapeutic efficacies in the two groups were compared.

Results: The recovery rate and total effective rate in the observation group were 68.3% and 98.3% respectively, versus 28.3% and 81.7% in the control group, showing statistical differences in recovery rate and total effective rate (bothP＜0.01). There was between-group statistical significance in comparing the infrared thermography after treatment (P＜0.01).

Conclusion: ‘Setting fire on the mountain’ manipulation by Lu Shou-yan is better than even reinforcing-reducing manipulation for cervical radiculopathy.

Acupuncture Therapy; Setting Fire on the Mountain (Shao Shan Huo); Method of Reinforcing-reducing; Spondylosis; Neck Pain

Cervical spondylosis refers to signs and symptoms resulting from degeneration of cervical spine and secondary involvement of adjacent tissues. As a common pattern (＞60%) of cervical spondylosis with high incidence, cervical radiculopathy is clinically characterized by pain and numbness in the neck, shoulder and arms, and tender, radiating pain in the nape, restricted neck movement, and weakness and heaviness of the upper limbs. This condition is often associated with degeneration of the cervical spine, vertebral hyperplasia and subluxated cervical facet joints. Other contributing factors include aging and over use of cell phone and computer.

To observe the clinical effect of ‘setting fire on the mountain’manipulation for cervical radiculopathy, we treated patients with cervical radiculopathy with Lu Shou-yan’s ‘setting fire on the mountain’manipulation and compared with even reinforcing-reducing manipulation. The results are now summarized as follows.

1 Clinical Materials

1.1 Diagnostic criteria

This is based on the diagnostic basis for cervical radiculopathy stipulated in the Second National Symposium on Cervical Spondylosis[1]: neck pain coupled with radiating pain along the upper limb; decreased sensation in the area where the nerve that is irritated travels; abnormal tendon reflex, muscular atrophy and decreased muscle strength; positive brachial plexus tension test or Spurling sign; cervical X-ray examination suggests vertebral bone hyperplasia, hyperplasia of uncovertebral joint, narrowing of intervertebral spaces and smaller intervertebral foramen; CT or MRI scan shows vertebral outgrowth and nerve root canal stenosis.

Diagnosis can be confirmed if the patient presents the first and the fourth items.

1.2 Inclusion criteria

Those who met the above criteria; those who met the neck pain due to wind-cold obstructing the meridians in theCriteria of Diagnosis and Therapeutic Effects of Diseases and Syndromes in Traditional Chinese Medicine[2]; aged between 20 and 70 years; having a duration of ≤5 years; those who were willing to sign the informed consent; and having received other therapies but experienced a 30-day washout period.

1.3 Exclusion criteria

Having extra-spinal disorders of the cervical vertebrae, vertebral or intra-spinal tumor and bone and joint tuberculosis; having complication of mental disorders; having severe heart, brain, lung and kidney diseases; having cervical myelopathy; and those who were reluctant to take part in this study.

1.4 Dropout criteria

Those who failed to continue with this study due to severe adverse events or complications; having sudden severe diseases; having a poor compliance and failed to follow the study protocol.

1.5 Statistical method

The SPSS 17.0 version software was used for data processing, the Chi-square test for enumeration data and independent-samplet-test for inter-group comparison of measurement data. APvalue of＜0.05 indicates a statistical significance.

1.6 General data

A total of 120 eligible outpatients treated in Shanghai Jiao Tong University Affiliated Sixth People’s Hospital between March 2012 and September 2013 were randomly allocated into an observation group and a control group, 60 cases in each group. There were no between-group statistically significant differences in gender, age and duration (allP＞0.05), indicating that the two groups were comparable.

Table 1. Between-group comparison of general data

2 Treatment Methods

2.1 Observation group

Points: Jiaji (EX-B 2) points from C4to C7.

Method: With a quiet environment and room temperature of 25-26℃, the patient took a prone sitting or lying position. After routine sterilization, bilateral Jiaji (EX-B 2) points of C7were punctured using filiform needles of 0.30 mm in diameter and 40 mm in length. Upon arrival of qi, the needle was inserted to the heaven layer first (upper 1/3 of the point depth)[3]during patient’s inhalation, followed by 9 times of slow lifting and fast thrusting and rotating to the left at the time of thrusting; then the needle was further inserted to the man layer (middle 1/3 of the point depth), followed by the same procedure; and finally the needle was inserted to the earth layer (lower 1/3 of the needle depth), followed by the same procedure. After this, withdrew the needle directly to the heaven layer to finish one cycle. Repeated three cycles until the warm sensation occurs. Retained the needle for 20 min and pressed the needle pole after removing the needle. Then bilateral Jiaji (EX-B 2) points of C4-6were punctured perpendicularly, followed by even reinforcingreducing manipulation, 20-minute retaining and pressing of the needle pole after needle removal.

2.2 Control group

Points: Same as the observation group.

Method: After routine sterilization, above points were punctured perpendicularly using filiform needles of 0.30 mm in diameter and 40 mm in length. Upon arrival of qi, even reinforcing-reducing manipulation was conducted. Needles were retained for 20 min. The needle was pressed after removal of needles.

Patients in both groups were treated once a day, 10 times made up a course of treatment. The therapeutic efficacies were observed after two courses of treatment.

3 Therapeutic Efficacy Observation

3.1 Observation indexes

The temperature and humidity of the shield room free of cross ventilation was (25.0±0.5)℃ and (60±5)%. Fluke Ti30 Uncooled IRFPA camera was adopted for this study. The patient was asked to expose the neck to eliminate infrared radiation isolation of the clothes, and sit by turning his/her back to the thermal imager (2 m away). The thermography was conducted after sitting peacefully for 15 min, using the central area of the neck pain as temperature-measuring point to collect thermogram and save the data to computer. The corresponding colors of thermogram from high to low temperature are deep red, red, pale red, yellow, green, pale blue, deep blue and black. Patients in both groups were measured using thermograph before treatment and after two courses of treatment to analyze thermogram changes after treatment.

3.2 Criteria for therapeutic efficacy

They are based on theCriteria of Diagnosis and Therapeutic Effects of Diseases and Syndromes in Traditional Chinese Medicine[4].

Recovery: Absence of clinical symptoms, complete improvement of positive signs and normal neck movement.

Marked effect: Alleviation of clinical symptoms, normal neck movement, absence of main positive signs and return to normal life and work.

Improvement: Alleviation of clinical symptoms, improved neck movement and absence of some positive signs.

Failure: Clinical signs and symptoms remain unchanged.

3.3 Treatment results

3.3.1 Comparison of basal body temperature and thermographic temperatures before and after treatment

Before and after treatment, there were no between-group statistical significances in basal body temperature (bothP＞0.05). Before treatment, there was no between-group statistical significance in thermographic temperatures (P＞0.05). After treatment, there was intra-group statistical significance in comparing thermographic temperature in the observation group (P＜0.01) as well as between-group statistical significance (P＜0.05). This indicates that ‘setting fire on the mountain’manipulation is better than even reinforcing-reducing manipulation in increasing local thermographic temperature (Table 2).

3.3.2 Comparison of clinical efficacy

After two courses of treatment, the recovery rate and total effective rate of the observation group were 68.3% and 98.3% respectively, versus 28.3% and 81.7% in the control group, showing statistical significances in recovery rate and total effective rate (bothP＜0.01), indicating a better effect in the observation group than the control group (Table 3).

Table 2. Between-group comparison of basal body temperature and infrared thermography temperature changes before and after treatment ()

Table 2. Between-group comparison of basal body temperature and infrared thermography temperature changes before and after treatment ()

Note: Intra-group comparison before and after treatment, 1)P＜0.01; compared with the control group, 2)P＜0.05

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Table 3. Between-group comparison of clinical effects (case)

4 Discussion

Acupuncture master Lu Shou-yan was good at using needling manipulation of ‘setting fire on the mountain’ and achieved excellent results. This manipulation can warm and unblock meridians, dissipate cold and alleviate pain. The name of ‘setting fire on the mountain’ was first recorded in theJin Zhen Fu(Poetic Assay on Gold Needles)[5]. It was based on the divinatory symbols of heaven qi and earth qi[6]. No matter the needle depth was, two (heaven and earth) or three (heaven, man and earth) layers, yang-attributed manipulation were conducted by fast thrusting and slow lifting or rotating to left.What’s more, the number of above manipulation was 9, the maximal yang number. Modern studies on Lu Shou-yan’s needling manipulation of ‘setting fire on the mountain’ have indicated that this manipulation can increase blood circulation of the upper limbs, induce dilation of capillaries and thus enable the patients to feel warm sensation along the meridians, which is an objective physiological effect instead of a psychological hint[7]. In terms of Chinese medicine, manipulation of ‘setting fire on the mountain’ can produce warm sensation because it can rapidly balance yin and yang through special qi-regulation technique. Current studies on this manipulation focus on its functions, such as warm sensation of the patients and changes of blood pressure. However, there are few studies on objective temperature changes on the surface of the body. Temperature is a key parameter of human pathophysiological state. Through infrared radiation imaging, the infrared thermography can allow us to see variations in temperature related to local circulation and metabolism[8], and therefore can be used as reference for therapeutic efficacy evaluation of cervical radiculopathy. Contributing factors of cervical radiculopathy include insufficiency of the liver and kidney and deficiency of qi and blood, coupled with wind, cold and dampness obstructing meridians. Specifically, internal cause is deficiency of qi, blood, liver and kidney. External causes include wind, cold and dampness, especially cold. Consequently, it’s important to needle cervical Jiaji (EX-B 2) points to unblock the Governor Vessel[9-10], followed by the manipulation of ‘setting fire on the mountain’ to induce yang qi on the surface of the body layer by layer and subsequent warm sensation in the patients, thus to warm meridians, dissipate cold, resolve dampness, circulate qi and blood, balance yin and yang and treat both the root cause and symptoms.

This study has suggested that the total effective rate of Lu Shou-yan’s ‘setting fire on the mountain’manipulation was significantly higher than that by even reinforcing-reducing manipulation group (P＜0.01). In addition, infrared thermography showed a higher temperature in the observation group than that in the control group (P＜0.05). This indicates that Lu Shou-yan’s ‘setting fire on the mountain’manipulation is better than even reinforcing-reducing manipulation for cervical radiculopathy. In the future study, parameters of simulated needling technique instrument can be combined to quantify the manipulation degree, evaluate the correlation between therapeutic efficacy and manipulation parameters and thus standardize the manipulation procedure and improve clinical effect.

Conflict of Interest

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

Acknowledgments

This work was supported by Lu’s Acupuncture Inheritance Study of Shanghai Schools of Traditional Chinese Medicine (No. ZYSNXD-CC-HPGC-JD-004); Specialty of Bone and Joint Disorders (No. 2011204001).

Statement of Informed Consent

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

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Translator: Han Chou-ping

Wu Yao-chi, master of medicine, professor, doctorate supervisor, chief physician.

E-mail: wuyaochi11238@hotmail.com

R246.2

: A

Date:July 29, 2014