Clinical observation on warm needling in canicular days for knee osteoarthritis

Objective: To observe the efficacy of warm needling in canicular days in treating knee osteoarthritis (KOA).

Knee osteoarthritis (KOA) is a chronic articular disorder characterized by degeneration and impairment of articular cartilage, and bone hyperplasia, also known as degenerative knee arthritis. KOA usually affects middle-aged and old people, severely impairing the quality of life of patients. It’s become a major factor in causing physical disability in older people[1]. KOA falls under the range of Bi-impediment syndrome or bone Bi-impediment syndrome in traditional Chinese medicine (TCM). In the early stage, it’s mainly manifested by discomfort around the knee joints, with progressed pain, maybe accompanied by motor dysfunction; the knees will become deformed because of swelling in the later stage. The domestic epidemiological study showed that the incidence rate of KOA approached 8.3% in China[2]. Nearly 100% of people over 60 present histological degeneration of knee joint, while 60%-80% of people show signs of degenerative osteoarthritis on X-ray, and 20% of them are suffering from pain and limited movement[3]. There is no cure for KOA yet, but acupuncture- moxibustion bears the specific advantage in treating the histological alterations of KOA. During July 2012 and August 2013, we had treated KOA patients with warm needling in the canicular days, and the report is given as follows.

1 Clinical Materials

1.1 Diagnostic criteria

The diagnosis was made according to the criteria for KOA from the Diagnostic and Treatment Guidelines of Osteoarthritis stipulated by Chinese Orthopaedic Association in 2007[4]. Recurrent pain in knee joint in the recent one month; X-ray (at standing or weight-bearing position) shows joint space narrowing, subchondral sclerosis and/or cyst formation, and osteophytes around the joint; joint fluid is clear and sticky (at least 2 times), and white blood count (WBC)＜2 000/mL; age≥40; morning stiffness ≤30 min; bone crepitus (or feeling). KOA can be diagnosed when the first and second items, or the first, third, fifth, and sixthitems, or the first, fourth, fifth, and sixth items were met, plus the evidence of clinical, laboratory, and X-ray examinations.

1.2 Inclusion criteria

Conforming to the above diagnostic criteria of KOA; age 40-75 years old; obvious knee joint pain, stiffness, and decreased movement; without obvious heart, dermatological, or hematological diseases; willing to accept the involved treatment and sign the informed consent form.

1.3 Exclusion criteria

Severe cardiopulmonary diseases, hypertension, mental disorders; rupture of meniscus, joint bodies, and the subsequent joint blocking; rheumatoid arthritis, gout, and other types of knee joint pain; a history of knee joint surgery or severe trauma of knee.

1.4 Statistical method

The SPSS 19.0 version statistical software was used for all data processing. The comparison of numeration data was analyzed by Chi-square test, and P＜0.05 was considered having a statistical significance.

1.5 General data

The subjects were included from the Acupuncture Outpatient of Xianyang Hospital of Yan’an University. The 68 subjects, 23 male and 45 female, were randomized into a treatment group and a control group, 34 in each group. There were no significant differences in comparing the gender, age, and disease duration between the two groups (all P＞0.05), indicating the comparability (Table 1).

Table 1. Comparison of general data

2 Treatment Methods

2.1 Treatment group

Acupoints: Liangqiu (ST 34), Xuehai (SP 10), Neixiyan (EX-LE 4), Dubi (ST 35), Heding (EX-LE 2), Yinlingquan (SP 9), Yanglingquan (GB 34), Zusanli (ST 36), and Taixi (KI 3).

Operation: The patient took a supine position with a thin cushion under the knee joint. After routine sterilization, filiform needles of 0.30 mm in diameter and 40 mm in length were perpendicularly inserted into the above acupoints with even reducing-reinforcing manipulations performed following qi arrival. Afterwards, a segment of moxa roll of 1-2 cm long was put on the handle of needle and then ignited from the bottom. The temperature should be within the patient’s tolerance. During moxibustion, a piece of thick paper can be put on the treated acupoint to prevent from burning of skin by the fallen fire and from too much heat. The moxa roll shall be replaced by a new one when it’s burnt out. The needle was removed when the second moxa roll was burnt out.

2.2 Control group

For the control group, the same acupoints were selected and punctured with even reinforcing- reducing manipulations applied following qi arrival. The needles were remained for 30 min.

The two groups were both treated during the canicular days, once each day, 10 sessions as a treatment course, totally for 3 courses.

3 Observation of Therapeutic Efficacy

3.1 Criteria of therapeutic efficacy

The criteria of therapeutic efficacy were made according to the relevant criteria of KOA from the Criteria of Diagnosis and Therapeutic Effects of Diseases and Syndromes in Traditional Chinese Medicine[5]stipulated by the State Administration of Traditional Chinese Medicine.

Recovery: Pain and swelling were diminished, normal motor function of knee joint, and patellar compression test was negative.

Improved: Pain and swelling were reduced, the motor function of knee joint was substantially recovered, and patellar compression test showed improvement.

Invalid: The pain and the motor function were not improved, and the patellar compression test was positive.

3.2 Result

Three treatment courses later, the total effective rate was 91.2% in the treatment group versus 67.6% in the control group, and the difference was statistically significant (P ＜ 0.05), indicating that the treatment group has a higher efficacy than the control group (Table 2).

Table 2. Comparison of therapeutic efficacy (case)

4 Discussion

KOA is a chronic progressive joint disease, often seen in the middle-aged and old people. TCM holds thatit’s caused by deficiency of qi and blood and insufficiency of liver and kidney due to aging. The etiology and pathology of Bi-impediment syndrome has been recorded by Huang Di Nei Jing (Yellow Emperor’s Classic of Internal Medicine). In Ling Shu (Spiritual Pivot), it’s pointed out that the knee pain is related to the Stomach Meridian. Zhu Bing Yuan Hou Lun (Treatise on the Pathogenesis and Manifestations of All Diseases) holds that Bi-impediment is caused by insufficiency of qi and blood, weakness of collaterals, and invasion and accumulation of wind pathogen. Gu Jin Yi Jian (Medical Classic of the Ancient and the Modern) holds that insufficiency of kidney yang is the cause of Bi-impediment, and Zhang Shi Yi Tong (Master Zhang’s Comprehensive Medicine) also holds this view of point. Therefore, KOA should be treated by both expelling the pathogen and tonifying the liver and kidney.

The canicular days appear between the Lesser Heat and the beginning of autumn according to the solar terms, and are the hottest days during which human being should bear the strongest yang energy. During this period, the skin is loose and qi and blood are circulating smoothly, which are good for infiltration and absorption of herbal medicine. Treating KOA during the canicular days is to treat the cold disease in summer, which is consistent with the TCM theory of connecting human with nature via the same qi. Moreover, to treat cold disease in summer is also based on the theory of cultivating yang in spring and summer from Huang Di Nei Jing (Yellow Emperor’s Classic of Internal Medicine)[6].

Treatment during the canicular days is effective for Bi-Impediment due to wind cold and damp and deficient cold diseases, as it can not only boost the yang energy in human body, but also can expel the pathogens[7-8]. Besides, canicular days belong to the late summer season. Late summer belongs to earth, while winter belongs to water, and earth restricts water according to the rules of the five elements. Therefore, it also makes sense to treat winter diseases in canicular days from the perspective of the five elements[9].

Warm needling combines both acupuncture and moxibustion. Acupuncture is good at unblocking meridians and collaterals, while moxibustion can unblock and tonify. The combined warm needling method works to warm and unblock meridians and collaterals, expel cold and damp, activate blood flow and kill pain[10-11]. The origin of warm needling is not clearly recorded, but it had become quite popular ever since the East Han Dynasty. For example, it’s often mentioned in Shang Han Lun (Treatise on Cold Damage Diseases) by the holy master Zhang Zhong-jing. Modern studies show that the thermal effect of moxibustion can evoke the regulation of nervous system, and it can accelerate the local blood circulation, improve metabolism, nourish nerves, and release the nonbacterial inflammation when combined with acupuncture[12]. Moreover, the thermal effect on acupoints can promote the circulation of qi and blood, which strengthens the effect in warming meridians and expelling cold, and regulating qi and blood[13]. Meanwhile, the points around the knee joint, Neixiyan (EX-LE 4), Dubi (ST 35), and Heding (EX-LE 2), function to tonify blood and qi, relieve spasm and stop pain, supplement both the prenatal and postnatal. Xuehai (SP 10) acts to expel wind and nourish blood, as the wind vanishes when blood is functioning well; as the He-Sea point of the Spleen Meridian, Yinlingquan (SP 9) works to reinforce spleen and release damp, and expel cold and ease pain. Zusanli (ST 36) and Liangqiu (ST 34), respectively the He-Sea point and Xi-Cleft point of the Stomach Meridian, can tonify qi and blood, unblock meridians and collaterals. Yanglingquan (GB 34), the He-Sea point of the Gallbladder Meridian and the Tendon Influential point of the Eight Influential Points, acts to relax tendons and unblock collaterals. As the Yuan-Primary point of the Kidney Meridian, Taixi (KI 3) can tonify the liver and kidney. The above points work together to expel wind and damp, unblock meridians and collaterals, supplement qi and blood, and tonify the liver and kidney.

Generally speaking, based on the theory of connecting human being with nature and considering the influence of seasons on human body, this treatment method works to expel the hidden cold in human body with the natural heat and the changes of human body, including increased yang energy, sufficient qi-blood and essence. We are going to study the effect of warm needling during the coldest days for KOA, for proving its effect by statistical analysis and making it used regularly in clinic. All in all, it’s for improving the efficacy in the treatment of KOA, and fully benefiting the patients.

Conflict of Interest

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

Acknowledgments

This work was supported by Xianyang Hospital of Yan’an University.

Statement of Informed Consent

All of the patients signed the informed consent.

Received: 25 August 2014/Accepted: 12 October 2014

[1]Li XJ, Liu YT, Lǚ JB, Wang RP. Clinical observation of 212 cases of knee osteoarthritis treated with Chinese medicine comprehensive treatment. Liaoning Zhongyiyao Daxue Xuebao, 2013, 15(5): 173-174.

[2]Zeng QY, Huang SB, Xiao ZY, Chen SM, Liu XD, Zhou XG. Osteoarthritis: clinical and epidemiological investigation. Zhonghua Neike Zazhi, 1995, 34(2): 88-90.

[3]Chen BC, Zhang J. Osteoarthritis. Beijing: People’s Medical Publishing House, 2004: 18.

[4]Chinese Orthopaedic Association. Diagnostic and Treatment Guidelines of Osteoarthritis (2007). Zhonghua Guanjie Waike Zazhi: Electronic Version, 2007, 1(4): 218-285.

[5]State Administration of Traditional Chinese Medicine. Criteria of Diagnosis and Therapeutic Effects of Diseases and Syndromes in Traditional Chinese Medicine. Nanjing: Nanjing University Press, 1994: 201.

[6]Xu RQ. On treatment of cold asthma with the winter diseases treated in summer time with external application of Chinese medicine therapy. Zhonghua Zhongyiyao Zazhi, 2011, 26(6): 1338-1339.

[7]Wu YJ, Yang M, Ouyang BS. Thirty-two cases of bronchial asthma treated with warm needling in canicular days. Hunan Zhongyi Zazhi, 2009, 25(6): 53.

[8]Jiang WQ, Zhang YJ, Fang Y, Lin N, Chen YB. Therapeutic observation of warm needling in canicular days for yang-deficient patients of perimenopausal period. Shanghai Zhenjiu Zazhi, 2014, 33(5): 410-411.

[9]Wang YY, Zhong L, Feng F. Research review of moxibustion therapy in canicular days. Shiyong Zhongyiyao Zazhi, 2013, 29(4): 320-323.

[10]Liu XQ. Therapeutic observation of rheumatoid arthritis treated with warm needling in canicular days. Xiandai Zhongyiyao, 2012, 32(4): 52-53.

[11]Lu YY, Wang ZL, Wu SD. Academic collection of Lu Shou-yan and Zhu Ru-gong in acupuncture and moxibustion. Shanghai: Press of Shanghai University of Traditional Chinese Medicine, 1994: 93-99.

[12]Zhu Y, Chen RL, Miao FR, Ji L. Clinical observation on the therapeutic effect of drugs-paste separated moxibustion combined with electroacupuncture for knee osteoarthritis patients of cold-damp type. Zhen Ci Yan Jiu, 2010, 35(4): 293-297.

[13]Wu YC, Zhang JF, Li SS. Clinical observation on treatment of knee osteoarthritis by warm needling method. J Acupunct Tuina Sci, 2009, 7(6): 349-351.

Translator: Hong Jue (洪玨)

三伏天溫針灸治療膝骨關(guān)節(jié)炎的臨床觀察

Qu Hong-yan (屈紅艷)1, Wang Rui-hui (王瑞輝)1, Liu Jing (劉靜)2
1 Shaanxi University of Chinese Medicine, Xianyang 712046, China
2 Xianyang Hospital of Yan’an University, Xianyang 712000, China

目的：觀察三伏天溫針灸療法對膝關(guān)節(jié)骨性關(guān)節(jié)炎(KOA)的臨床療效。方法：將 68 例 KOA 患者隨機(jī)分為治療組和對照組，每組 34例，治療組給予溫針灸治療，對照組給予常規(guī)針刺治療。兩組均在三伏天的第一天開始治療，每日治療 1次，10次為 1療程，共治療 3個(gè)療程，療程結(jié)束后觀察患者恢復(fù)情況并進(jìn)行療效統(tǒng)計(jì)。結(jié)果：治療組總有效率 91.2%，對照組 67.6%,治療組總有效率明顯高于對照組，兩組差異有統(tǒng)計(jì)學(xué)意義(P＜0.05)。結(jié)論：三伏天溫針灸治療 KOA 的療效優(yōu)于常規(guī)針刺治療。

針刺療法; 針灸療法; 溫針灸; 間接灸; 骨關(guān)節(jié)炎, 膝; 節(jié)氣和醫(yī)學(xué)

R246.2

A

Author: Qu Hong-yan, master of medicine, lecturer. E-mail: 19694522@qq.com

Qu HY, Wang RH, Liu J. Clinical observation on warm needling in canicular days for knee osteoarthritis. J Acupunct Tuina Sci, 2015,13 (1): 63-66

10.1007/s11726-015-0825-y

Methods: Sixty-eight KOA patients were randomized into a treatment group and a control group, 34 in each group. The treatment group was intervened by warm needling, while the control group was by conventional acupuncture. The intervention started from the first day of the canicular days, once every day, 10 sessions as a treatment course. The improvement and therapeutic efficacy were evaluated after 3 courses of treatment.

Results: The total effective rate was 91.2% in the treatment group versus 67.6% in the control group, and the difference was statistically significant (P＜0.05).

Conclusion: Warm needling in canicular days can produce a better efficacy in treating KOA than conventional acupuncture. Keywords: Acupuncture Therapy; Acupuncture-moxibustion Therapy; Warm Needling Therapy; Indirect Moxibustion; Osteoarthritis, Knee; Solar Terms & Medicine