Wang Boyu (王博禹), Sun Libo (孫利波), Chen Qiang (陳 強)

Department of Internal Medicine, Shang Hai Metallurgy Hospital, 200941

Clinical research of acupuncture combined with TCM fumigation on pain and active function improvement in patients with ankylosing spondylitis

ABSTRACT OBJECTIVE: To investigate clinical effect of acupuncture combined with TCM fumigation on pain and active function improvement in patients with ankylosing spondylitis. METHODS: 42 patients with ankylosing spondylitis were selected in hospital from October 2016 to October 2017, who were randomly divided into 2 groups by number table method. 21 patients received conventional treatment as control group. 21 patients combined with acupuncture,TCM fumigation treatment as observation group. Clinical indicators, activity function, pain scores were evaluated before and after treatment. RESULTS: Erythrocyte sedimentation rate, C reactive protein, alkaline phosphatase, macrophage migration inhibitory factor, BASDAI score, BASFI score, VAS score after treatment decreased in two groups compared with before treatment (P＜0.05). Chest mobility, lumbar pitch, Schober test, occipital wall distance, lumbar lateral flexion after treatment increased in two groups compared with before treatment (P＜0.05). Refers to distance, morning stiffness time, rump length after treatment reduced in two groups compared with before treatment (P＜0.05). Erythrocyte sedimentation rate, C reactive protein, alkaline phosphatase, macrophage migration inhibitory factor, BASDAI score,BASFI score, VAS score in observation group were lower than control group after treatment (P＜0.05). Chest mobility,lumbar pitch, Schober test, occipital wall distance, lumbar lateral flexion in observation group were higher than control group after treatment (P＜0.05). Refers to distance, rump length in observation group were smaller than control group after treatment (P＜0.05). Morning stiffness time in observation group was less than control group after treatment (P＜0.05).CONCLUSIONS: Acupuncture combined with TCM fumigation can significantly improve pain and active function in patients with ankylosing spondylitis, which is worthy of clinical promotion.

KEY WORDS: Acupuncture; Chinese Medicine fuming and steaming; Ankylosing spondylitis; Pain; Active function

Ankylosing spondylitis is a common disease of orthopedics and belongs to chronic inflammatory disease of immunology. Its lesions mainly consist of chronic progressive inflammation of the axial joints. It can gradually affect the ankle joint and spine, lowering the daily life of patients. According to many researches[3-4], the incident of the disease is 0.3%, which is a common cause of disability. Therefore, the clinical diagnosis of patients with ankylosing spondylitis is particularly important. In this study, a total of 21 patients with ankylosing spondylitis were treated with acupuncture and Chinese medicine fuming and steaming, on the basis of routine treatment.Remarkable results were obtained. Reports are as follows:

CLINICAL INFORMATION

General information

From October 2016 to October 2017, a total of 42 cases of ankylosing spondylitis were diagnosed and treated in the hospital. The selection criteria: the patients were in according to the criteria of Guideline of Diagnosis and Treatment of Ankylosing Spondylitis, by Rheumatology Branch of China Medical Association.After laboratory and iconographic check, doctors made a definite diagnosis. All the patients were above 18 years old, informed with the research, which was approved by the Hospital Ethics Committee. Exclusion criteria:patients with severe hepatic and renal insuf ficiency, late joint function loss, and mental illness were excluded. The random number table was used to divide the patients into two groups. The control group is consisted of 21 patients,11 males and 10 females aged 31 to 76 (53.4±10.1)years. The duration is 4 to 17 (6.8±2.6) years, while observation group is consisted of 21 cases, 10 males and 11 females, aged 30 to 78 (52.9±11.3) years. The duration is 3 to 16 (6.7±2.8) years. The genders, age,duration of the two groups were comparable (P＞0.05).

METHODS

The control group was given routine treatment,taking orally sulfasalazine tablets (Shanghai Zhongxi Three-Dimensional Pharmaceutical Co., Ltd., SFDA Approval number H31020450) 0.5g/time, 3 times/d;Semifilab Capsules (Dalian Pfizer Pharmaceutical Co.,Ltd., SFDA Approval number J20080059) 0.2g/Times, 1 times/d. The efficacy of medication was 30 days.

The observation group was treated for the diseases with acupuncture combined with Chinese Medicine fuming and steaming. When acupuncture is used, we help the patient to take a prone position and expose the skin of the neck, back and waist. After routine disinfection,40-50 mm needles were used in Fengchi (GB 20),Weishu (BL21), Dazhui (DU 14), Mingmen (DU4),Changqiang (DU 1), Shenshu (BL 23), Yaoyangguan (DU 3), Jiaji (EX-B2), pierceing 1 to 1.5 inches. The needle tip was inserted into the direction of the spine. Even supplementation and drainage were used to allow the patient to have a soreness at the acupuncture point. For each treatment, 10 to 15 points were selected. The same side acupoints were treated with electroacupuncture,and the low frequency was set to 100 beats/min for 30 minutes. The patient was given local irradiation with a TDP lamp once per day. The course of treatment is 30 days. The drug matching is as follows: wine 200ml, white vinegar 50ml, common clubmoss herb 30g, common burr reed tuber30g, sparganium、curcumae rhizome 30g, common heron's bill herb30g, Himalayan blueberry herb30g, Sichuan lovage root30g, Chinese angelica 30g,double teeth pubescent angelica root 20g, cassia twig 20g, ephedra herb 20g, angelica root 20g, coronarious gingerlily rhizome20g. The drug was placed in a HHQL type instrument basin for fumigation, and boiled after adding appropriate amount of water. The temperature was below 40℃. The patient was instructed to sit in it and fumigated for 30 minutes/time, once a day, for 30 days.

Before and after treatment, clinical indicators were compared. (Clinical indicators are as follows: erythrocyte sedimentation rate, C-reactive protein, alkaline phosphatase,macrophage migration inhibitory factor) test, activity function(thoracic activity, lumbar spine, Schober test, occipital distance, lumbar side Curvature, finger-to-ground distance,morning stiffness time, and hip-to-heel distance assessment,pain score (BASDAI score, BASFI score, VAS score)

Evaluation criteria

BASDAI Evaluation Criteria[6]: The activity index of the BASDAI ankylosing spondylitis was used. The higher the score, the more serious the condition is.

BASFI Evaluation Criteria[6]: Functional index table of ankylosing spondylitis was used.

The higher the score is, the more severe the condition is.

VAS Evaluation Criteria[8]: The Evaluation criteria of visual simulation were adopted.

The higher the score, the more obvious the pain is.

Statistical methods

Statistical analysis was carried by SPSS19.0 software and measurement information was expressed as mean±standard deviation (x–±s) and tested by t. P＜0.05 was considered statistically significant.

RESULTS

Comparison of clinical indicators of the 2 groups

After treatment, the erythrocyte sedimentation rate,C-reactive protein, alkaline phosphatase, and macrophage migration inhibitory factor decreased after treatment(P＜0.05) were lower than those before the treatment. The erythrocyte sedimentation rate, C-reactive protein, alkaline phosphatase, and macrophage migration inhibitory factor were lower of the observation group were lower than those in the control group (P＜0.05). See Table 1.

Comparison of functional activities of the 2 groups

After treatment, thorax activity, lumbar spine,Schober test, occipital distance, and lumbar lateral flexion increased than those before treatment (P＜0.05) and fingerto-ground distance, morning stiffness time, and hip-toheel distance decreased, compared with those before treatment (P＜0.05). After treatment, the thorax activity,lumbar spine, Schober test, occipital distance, and lumbar lateral flexion of the observation group were higher than those of the control group (P＜0.05) and the finger distance, morning stiffness time, and hip-to-heel distance of the observation group after treatment were smaller than those in the control group (P＜0.05). See Table 2.

Comparison of pain scores of the 2 groups

After treatment, BASDAI score, BASFI score,and VAS score decreased than those before treatment(P＜0.05), while BASDAI score, BASFI score, and VAS score were lower in the observation group than those in the control group (P＜0.05). See Table 3.

Table 1. Comparison of clinical indicators of the 2 groups

Table 2. Comparison of functional activities of the 2 groups

DISCUSSION

It is believed by Chinese medicine that[9-10],ankylosing spondylitis belongs to the category of arthralgia, and the causes of the disease can be divided into internal and external causes. Because of the windcold and pathogenic dampness, the external pathogenicity affects the endosomal body, and it can be found in the du mai, making the body blood stagnating, causing the bone to be unfavorable, weak and not functional. Theinternal cause is the congenital deficiency, and acquired dystrophy, leads to liver-kidney deficiency, which is the key to disease. Therefore, it is believed that the cause of ankylosing spondylitis lies in the bone and du mai. The treatment is mainly based on supplementing kidneys and strengthening du mai, and supplemented with dissipating wind and dampness, invigorating blood, dissolving stasis, actively invigorating collateral channels, and strengthening sinew and bone.

Table 3. Comparison of pain scores in the 2 groups (minutes)

In the acupuncture and acupoint selection program,Fengchi can stimulate yang and boost Qi, relieve pain pain relief; Weishu Weishu (BL21) can dissipate heat from stomach and phlegm; Dazhui (DU 14) can bene fit Qi and impotence; Mingmen Mingmen (DU4)) can be connected to Du Mai mai blood; Chang Qiang Changqiang DU 1 can be transferred to Governor Duan free and regulat du mai, Qi boost boost qi Sun Yang raise yang; Shenshu Shenshu (BL 23) Cocoa boost kidney yang qi, with Insufficient congenital deficiency; Yaoyangguan (DU 3)can smooth Dumai mai, relieve pain relief pain; Jiaji (EXB2) can adjust Du Mai qi channel qi, improve the body's blood circulation, promote patency and reduce pain.Supplemented by electro acupuncture electrotherapy,local heating, can play the role of Wentong meridians,playing a multiplier effect[11-12].

Among the fumigation and steamingChinese medicines, white wine has the functions of relieving pain, facilitating shit, expelling worm. and strengthening the kidneys. White vinegar has the effect dissipating stasis, stanching bleeding, resolving toxins and killing worms. Common clubmoss herb has the function of dispelling wind, dissipating coldness, eliminating dampness and swelling, relaxing sinews and quickening the collaterals. Common burr reed tuber has the function of brokening blood and regulating Qi, resolving accumulation and relieving pain. Curcumae rhizome has the function of moving qi, resolving constraint, breaking up stasis and relieving pain. Common heron's bill herb has the function of dispelling wind dampness, drying dampness, unblocking collaterals, invigorating blood,and arresting diarrhea. Himalayan blueberry herb has the function of invigorating blood, dissolving stasis,facilitating urine, resolving toxins, unblocking channels through bone, Sichuan lovage root has the function of invigorating blood and dissolving stasis, opening qi,dispelling wind and relieving pain , Chinese angelica has the function of supplementing and harmonizing blood, regulating menstruation, relieving pain,moistening dryness, lubricating gut and immunology.Double teeth pubescent angelica root has the function of dispelling wind, overcoming dampness, dissipating cold and relieving pain. Cassia twig has the function of supplementing original Yang, unblocking blood vessel,warming spleen and stomach, ephedra herb has the function of inducing sweating, dissipating coldness,diffuse the lung, relieving cough and panting, draining water, and eliminating apocatastasis, angelica root has the function of dissipating rheumatism, evacuating pus,promoting granulation and relieving pain. Manchurian wild ginger has the function of dispelling wind,dissipating cold, relieving stuffy orifices, relieving pain,warming the lung and dissolving rheum. Coronarious gingerlily rhizome has the function of dissipating exterior cold and wind-damp, benefiting joint and relieving pain.

The fumigation of Chinese medicine can be effected by drug vapor, so that the active ingredient in the drug can penetrate into the skin in an ionic condition. It has a thermal effect, and can expand into the local pores,so that the active ingredients of the medicine can be absorbed to the maximum extent, thereby exerting the their efficacy and improving the local activity function of the patients[13-15].

The results of the study shows that after treatment,the erythrocyte sedimentation rate, C-reactive protein,alkaline phosphatase, and macrophage migration inhibitory factor were lower than those before treatment.After treatment, the erythrocyte sedimentation rate,C-reactive protein, alkaline phosphatase, and macrophage migration inhibitory factor of the observation group were lower than those in the control group, which shows that acupuncture comibined with traditional Chinese medicine fuming and steaming was an effective for the treatment of ankylosing spondylitis. And it can significantly reduce the level of in flammation of patients, regulate the rate of erythrocyte sedimentation. Reducing alkaline phosphatase and macrophage migration inhibitory factors can help to improve the body's immune system and improve killing activity of cell.

After treatment, thorax activity, lumbar spine,Schober test, occipital distance, and lumbar lateral flexion increased than those before treatment. After the treatment, finger-to-ground distance, morning stiffness time, and hip-to-heel distance decreased, compared with those before treatment. After treatment, the thorax activity, lumbar spine, Schober test, occipital distance,and lumbar lateral flexion of the observation group were higher than those of the control group. After the treatment, finger-to-ground distance and hip-to-heel distance of the observation group were lower than those of the control group. The morning stiffness time after treatment of the observation group was shorter than that in the control group. Those showed that acupuncture combined with Chinese Medicine fuming and steaming can significantly improve the active function of patients with ankylosing spondylitis, which were reflected in the above indicators.

After the treatment, BASDAI score, BASFI score,and VAS score decreased than those before treatment.After treatment, BASDAI score, BASFI score, and VAS score of the observation group were lower than those in the control group. Those showed that acupuncture combined with Chinese medicine fuming and steaming in the treatment of ankylosing spondylitis can significantly relieve the pain, improve the patient's activities and their quality of life, and has clinical significance.

In conclusion, acupuncture combined with Chinese medicine fuming and steaming is effective in relieving the pain and improving the functional activity of patients with ankylosing spondylitis, which is worthy of clinical application. However, the study also has certain drawbacks. The sample size is small, and it needs further expansion and re-research. observation time is comparatively short, which requires to further prolong the study.