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Clinical efficacy observation of comprehensive ying needling therapy for mumps
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World Journal of Acupuncture – Moxibustion 0 0 0 (2018) 1–4
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Clinical Research
Clinical efficacy observation of comprehensive ying needling therapy for mumpsR Haiyan TIAN () a,∗, Mengbo XU () b Acupuncture-Moxibustion Department, Third Affiliated Hospital of Nanchang University, Nanchang 330008, Jiangxi Province, China ( , 330008, ) b Moxibustion School, Jiangxi University of Traditional Chinese Medicine, Nanchang 330004, Jiangxi Province, China (, 330004, ) a
a r t i c l e
i n f o
Article history: Available online xxx Keywords: Mumps Comprehensive ying needling therapy Ribavirin injection Randomized controlled trial
a b s t r a c t Objective: To compare the clinical efficacy difference between comprehensive ying needling therapy and intramuscular injection with ribavirin for mumps. Methods: One hundred patients with mumps were randomly divided into comprehensive ying needling therapy group (group A, 52 cases) and western medicine group (group B, 48 cases), then 8 cases were eliminated and drop out from group A and 4 cases were eliminated and drop out from group B respectively, actual inclusion 44 cases in group A 44 cases in group B. Point bloodletting was performed at ¯ parotid gland (Saixiàn) and Threeshang acupoints of the patients in group A for once every other day, treatment for 7 days was considered as 1 course of treatment, and 2 courses were needed. Intramuscular injection with ribavirin was given to the patients in group B for twice a day, treatment for 7 days was considered as 1 course, and 2 courses were needed. The parotid gland swelling score, fever score, orifice parotid duct swelling score, score of difficulty in opening mouth and the clinical efficacy of the patients in the two groups were compared before and after treatment. Results: The cured and markedly effective rate in group A was 90.9% (40/44), which was superior to 68.2% in group B (30/44) (P < 0.05). The symptom scores were all improved significantly in the two groups after treatment (all P < 0.05), and the improvement in group A was superior to that in group B (all P < 0.05). Conclusion: The curative effect of comprehensive ying needling therapy for treatment of mumps was superior to that of conventional western medicine therapy. © 2018 Published by Elsevier B.V. on behalf of World Journal of Acupuncture Moxibustion House.
Mumps is a kind of acute and systemic infection caused by mumps virus, and it is a kind of respiratory infectious disease commonly seen in children and teenagers. Its common complications include meningitis and orchitis [1]. The latent period of mumps is 8–30 days with an average of 18 days. Its initial sign includes enlargement of parotid gland, without premonitory symptoms. In western medicine, mumps is often treated by using antiviral and symptomatic treatment which are difficult to adapt to the rapid changes of the disease in children. The authors adopted comprehensive ying needling therapy for mumps, and compared with the curative effect of intramuscular injection with ribavirin. The details are reported as follows.
R Supported by Science-Technology Support Plan Project of Jiangxi Province: 20151BBG70194. ∗ Corresponding author. E-mail address: [email protected] (H. TIAN).
Clinical data General information The total 88 patients with mumps were selected from the outpatients of pediatric department and internal medicine department of the Third Affiliated Hospital of Nanchang University from September 2014 to September 2016. One hundred patients who conformed to the inclusion criteria were selected and then randomly divided into comprehensive ying needling therapy group (group A, 52 cases) and western medicine group (group B, 48cases) according to the random number table [2]. Then 8 cases were eliminated and drop out from group A and 4 cases were eliminated and drop out from group B respectively. The actual number of included cases was 88, with 44 cases in each group. Per-protocol analysis was adopted in this study. In group A, there were 28 males and 16 females; the youngest was 4 years old, the oldest was 17 years old, and the average was (9.59 ± 4.03) years old; the shortest course of disease was 2 days, the longest was 6 days, and the aver-
https://doi.org/10.1016/j.wjam.2018.03.004 1003-5257/© 2018 Published by Elsevier B.V. on behalf of World Journal of Acupuncture Moxibustion House.
Please cite this article as: H. TIAN, M. XU, Clinical efficacy observation of comprehensive ying needling therapy for mumps, World Journal of Acupuncture – Moxibustion (2018), https://doi.org/10.1016/j.wjam.2018.03.004
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H. TIAN, M. XU / World Journal of Acupuncture – Moxibustion 000 (2018) 1–4
age was (4.09 ± 1.38) days. In group B, there were 19 males and 25 females; the youngest was 4 years old, the oldest was 15 years old, and the average was (8.95 ± 3.37) years old; the shortest course of disease was 3 days, the longest was 7 days, and the average was (5.07 ± 1.47) days. According to the statistical analysis of gender, age and course of disease in the two groups, the differences were not statistically significant (all P > 0.05), and the results were comparable. This study was approved by the Ethics Committee of the Third Affiliated Hospital of Nanchang University. Diagnostic criteria By reference to the diagnostic criteria of mumps in the Guidelines of Clinical Research on Chinese New Herbal Medicine [3] in 2002: 1 Fever, diffuse swelling centering the ear lobe, undefined margin, without change in the skin color, with resilience and tenderness. The symptom appears from one side generally, and is seen on the other side successively, possibly associated with headache and body pain, red and swollen parotid duct was seen in the mouth. 2 The disease often attacks people in winter and spring. The patient has contact with other people who are suffering from mumps. 3 Normal or slightly reduced WBC level, relatively increased classified counted lymphocyte, and increased amylase level in blood and urine [4]. Inclusion criteria
1 The patients who conformed to the above-mentioned diagnostic criteria of mumps; 2 with the age of 4–18 years old; 3 with pain in the 1 day to 7 days; 4 the patients who signed the informed consent form by themselves or their family members. Exclusion criteria
(2) Manipulations: the patient was asked in sitting position, and the hands of doctor were disinfected conventionally. The enlargement of parotid gland under the ear lobe was also disinfected conventionally, then fixed by the doctor’s left hand. Hwato 0.35 mm × 40 mm disposable filiform needle was held by the doctor’s right hand, and perpendicular insertion was performed at Parotid gland with a depth of 8–10 mm. Then lifting and thrusting and twirling needle was manipulated for 2–3 times, which was followed by rapid withdrawal. About 0.1 mL of blood flowed from Parotid gland and iodophor disinfection was conducted after wiping the blood with sterilized dry cotton ball. The patient’s arm in the affected side was stroked from the upper arm to the forearm until the distal end of thumb for 2– 3 times, making the thumb congestion. After routine disinfection of the thumb, the root of thumb was held by the left hand of the doctor, and a 0.30 mm × 25 mm disposable filiform needle was held by the right hand of the doctor to conduct rapid point bloodletting at the Three-shang acupoints with a depth of 1–2 mm. With rapid insertion and withdrawal, the manipulation should be light, shallow and fast with uniform force. Then the acupoints were squeezed for bloodletting, 1–2 drops per acupoint. Iodophor disinfection was conducted after wiping the blood with sterilized dry cotton ball. (3) Acupuncture time point: the patient should be treated after three days since the disease onset, and symptomatic treatment should be performed in the first three days since the disease onset by adopting physical cooling. The first three days since the disease onset was the swelling period, that is the peak period for heat toxin formation, with local swelling and heat pain. After acupuncture bloodletting, the fever was brought down because the pathogenic heat reached to the exterior along with the needles. The local swelling would be more sever after acupuncture if the pathogenic heat did not form to the peak with the first three days.
1 The patients with complications of meningitis or orchitis; 2 the patients who accepted other treatment during the study; 3 the patients who were afraid of needles or rejected acupuncture-moxibustion.
The treatment was carried out for once every other day, treatment for 7 days was considered as 1 course of treatment, and 2 courses were needed.
Elimination criteria
Western medicine group (group B)
1 The patients who conformed to the inclusion criteria but did not accept treatment, or who accepted treatment but did not complete the whole course; 2 the patients who took medicine independently after inclusion.
Intramuscular injection with ribavirin (Hubei Tianyao Pharmaceutical Co., Ltd., SFDA approval number H19993162) was applied. Usage and dosage: ribavirin was diluted to one milligram per milliliter with 0.9% sodium chloride injection, then the diluent was injected intramuscularly and slowly. For children, the dosage of 10 mg/kg/d was followed, and the injection was given in 2 times a day. Injection for 7 days was considered as 1 course of treatment, and 2 courses were needed.
Drop-out criteria
1 The patients who suffered from adverse events or complications, and were not suitable for further treatment; 2 the patients who dropped out from the study by themselves; 3 the patients who quit from the study due to other reasons; 4 the patients with incomplete data records which may affect the efficacy evaluation. Treatment methods Comprehensive ying needling therapy group (group A) ¯ (1) Acupoint selection: Parotid gland (Saixiàn) is located at the induration of the highest point of the enlargement of parotid ¯ ¯ gland under the ear lobe. Shàoshang (LU 11), La˘ oshang ( ¯ ¯ ang (), these three points are located in the ) and Zhongsh root of the nail of thumb, LU 11 is located at the radial margin, ¯ ¯ ¯ ang La˘ oshang is located at the ulnar margin, and Zhongsh is lo¯ cated at midpoint of LU 11 and La˘ oshang. The three points are called Three-shangacupoints.
Efficacy observation Outcomes (1) Parotid gland swelling score: without swelling, scoring 0 point; parotid gland swelling in one side without submandibular gland enlargement, scoring 3 points; parotid gland swelling in one side associated with submandibular gland enlargement, scoring 6 points; parotid gland swelling in the both sides with hard and hot texture, scoring 9 points. (2) Fever score: without fever, scoring 0 point; with a temperature between 37.3 °C and 38.5 °C, scoring 1 point; with a temperature between 38.6 °C and 39.5 °C, scoring 2 points; with a temperature not lower than 39.6 °C, scoring 3 points. (3) Orifice parotid duct swelling score: not red, scoring 0 point; slightly red without swelling, scoring 1 point; light red and
Please cite this article as: H. TIAN, M. XU, Clinical efficacy observation of comprehensive ying needling therapy for mumps, World Journal of Acupuncture – Moxibustion (2018), https://doi.org/10.1016/j.wjam.2018.03.004
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0.76 ± 0.75 1.07 ± 0.93a
After treatment
0.57 ± 0.45a 1.02 ± 0.73a 44 44 Group A Group B
Before treatment Cases Groups
Difficulty in opening mouth
1.01 ± 0.64b 0.68 ± 0.82 Compared with the same group before treatment, P < 0.05. Compared with the difference value of group B, P<0.05. b
a
a
b
1.91 ± 1.02 1.71 ± 1.05 5.31 ± 0.78 3.97 ± 0.72 1.45 ± 0.67 2.79 ± 0.81a 7.76 ± 1.03 6.96 ± 1.08
1.56 ± 0.43 1.71 ± 0.52
Difference value
2.59 ± 0.71 2.21 ± 0.70 1.05 ± 0.56 1.59 ± 0.84 0.41 ± 0.22 0.88 ± 0.56a
Difference value After treatment
a b
Difference value After treatment Fever
Before treatment Difference value
44 44
It showed that the cured and markedly effective rate in group A was higher than that in group B (χ 2 =4.49, P<0.05), see Table 2.
Group A Group B
(1) Comparison of clinical efficacy on patients in the two groups
After treatment
It was indicated that the difference in symptom scores of patients in the two groups before treatment was not statistically significant (all P>0.05), and the results were comparable. The symptom scores of patients in the two groups were all obviously reduced after treatment. The curative effect in group A was superior to that in group B in terms of parotid gland swelling, pain, fever, orifice parotid duct swelling and difficulty in opening mouth. The differences in total symptom scores of patients in the two groups before and after treatment were statistically significant (t = 3.996, P<0.05), indicating that the symptom improvement in group A was superior to that in group B, see Table 1.
Before treatment
(1) Comparison of symptom scores of patients in the two groups before and after treatment
Parotid gland swelling
Results
Cases
After efficacy evaluation, SPSS 21.0 software was adopted by statisticians for statistical analysis. Measurement data were expressed as mean ± standard deviation (x¯ ± s), and intra-group comparison was performed via paired-samples t test. Intergroup comparison was conducted by using independent-sample t test, and enumeration data were analyzed through Chi-square test. P < 0.05 indicated that the difference was statistically significant.
Groups
Statistical analysis
Table 1 Comparison of symptom scores and total score of patients with mumps in the two groups before and after treatment (x¯ ± s).
By reference to the efficacy evaluation criteria of mumps in Criteria of Diagnosis and Therapeutic Effect of Diseases and Syndromes in Traditional Chinese Medicine [5]: reduced score rate = [(total score before treatment − total score after treatment) ÷ total score before treatment] × 100%. Clinically cured: with normal temperature, parotid gland swelling and difficulty in opening mouth disappeared completely, other relevant symptoms and signs also disappeared, reduced score rate more than or equal to 90%; markedly effective: with normal body temperature, parotid gland swelling and difficulty in opening mouth were alleviated, other relevant symptoms and signs disappeared, reduced score rate was between 60% and 90%; effective: body temperature declined, parotid gland swelling, difficulty in opening mouth and other relevant symptoms and signs were alleviated, reduced score rate was between 30% and 60%; ineffective: parotid gland swelling, difficulty in opening mouth and other relevant symptoms and signs were not alleviated, reduced score rate less than 30%.
Orifice parotid duct swelling
Efficacy evaluation criteria
Before treatment
The sum of each symptom score was the total score, and the symptom scores and total scores of patients in the two groups before and after treatment were observed.
a
slight swelling, scoring 2 points; bright red and swelling, scoring 3 points. (4) Score of difficulty in opening mouth: without difficulty in opening mouth, scoring 0 point; full opening of mouth with a little difficulty, scoring 1 point; half opening of mouth: scoring 2 points; less than half opening of mouth: scoring 3 points.
3
2.01 ± 0.73b 1.04 ± 0.76
H. TIAN, M. XU / World Journal of Acupuncture – Moxibustion 000 (2018) 1–4
Discussion Mumps virus is easily transmitted through body contact, saliva, droplet and so on. It is easy to break out among children [6]. Please cite this article as: H. TIAN, M. XU, Clinical efficacy observation of comprehensive ying needling therapy for mumps, World Journal of Acupuncture – Moxibustion (2018), https://doi.org/10.1016/j.wjam.2018.03.004
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H. TIAN, M. XU / World Journal of Acupuncture – Moxibustion 000 (2018) 1–4 Table 2 Comparison of the efficacy on the patients with mumps in the two groups cases. Groups
Cases
Clinically cured
Markedly effective
Effective
Ineffective
Cured and markedly effective rate (%)
Group A Group B
44 44
34 25
6 5
2 7
2 7
40 (90.9)a 30 (68.2)
a b c
Groups
Cases
Total score Before treatment
After treatment
Difference value
Group A Group B
44 44
22.58 ± 2.08 21.29 ± 2.73
3.87 ± 2.53b 5.24 ± 2.42b
19.26 ± 1.75c 14.41 ± 1.28
Compared with group B, P < 0.05. Compared with the same group before treatment, P<0.05. Compared with the difference value of group B, P<0.05.
Mumps viruses usually exist in the saliva of child patients during the 6 days before parotid gland swelling and 9 days after the parotid gland swelling [1]. During the 15 days, the mumps virus is highly contagious and infectious [7]. At present, antiviral drugs and symptomatic treatment are mostly adopted in western medicine. The antiviral drug ribavirin is a kind of synthetic nucleoside drug which can inhibit the mumps virus by the way of preventing DNA from producing through interfering with the synthesis of virus DNA polymerase. Antiviral drugs do have a certain effect of mumps, but it may cause many adverse effects such as headache, lack of strength, chest pain, fever, chill, nausea, attention deficit, hair loss, etc. Conventional acupuncture [8–10] for mumps can rapidly relieve swelling and pain, but there are some shortcomings, such as small sample size and absence of control group. Traditional Chinese medicine decoction for treating mump is timeconsuming and slow-acting. While comprehensive ying needling therapy applied in this study is a characteristic therapy on the basis of long time clinic practice. It is characterized by rapid pain and swelling relief, good curative effect, safety and reliability, no side effect. ¯ ¯ıngyànshu¯ ( Mumps is firstly seen in Chuangyángj , Complete Manual of Experience in the Treatment of Sores). It is recorded that “the pathogen of mumps is in the sulcus auriculae posterior and cerumen, which is connecting to the liver and kidney. The qi stagnation and blood stasis may obstruct in the cheek, which is wind-toxin syndrome.” [11] This disease is associated with wind-warmth and pathogenic toxin. The pathogenic toxin obstructs the shaoyang meridians, and combats with qi and blood. Qi stagnation and blood stasis may stagnate in the cheek, so the swelling diffuses in the local concomitantly with pain. Comprehensive ying needling therapy is based on the treatment principle of "sthenia requiring purgation, and treating heat should withdraw the needle rapidly". Reducing acupuncture manipulation is conducted at Parotid gland and Three-shang acupoints without needle retention for a little bloodletting. Needling ying is acupuncture for bloodletting. The pathogenic toxin stagnates locally. After acupuncture, the pathogenic heat reaches to the exterior along with the needle and blood, so as to release toxic heat, unblock the meridians and collaterals, thus eliminating parotid gland congestion and edema, quickly relieving clinical symptoms, and preventing pathogen transmission and change.
By tightly focusing on the principle of "release of fire constraint", comprehensive ying needling therapy can rapidly relieve clinical symptoms and prevent pathogen transmission and change, and is characterized by rapid swelling and pain relief, short course of treatment, and good curative effect, providing normative acupoint selection, manipulations and rational acupuncture time point to this disease. When antiviral therapy was clinically applied in most regions of our country, comprehensive ying needling therapy has broken through the previous antiviral therapy. It is a kind of new treatment idea and an emerging technology in China. This therapy is an external treatment method on the basis of transmission of traditional medicine, which is safe and reliable, easy to operate, and worthy of clinical popularization and application. Supplementary materials Supplementary material associated with this article can be found, in the online version, at doi:10.1016/j.wjam.2018.03.004. References [1] Wang Q. Efficacy observation of Tanreqing injection for treatment of 60 cases of mumps associated with meningitis. Contemp Med 2012;18(15):17–18. [2] He SL, Wang J, Wang JJ. TCM research design & statistics. Changsha: Hunan Science & Technology Press; 2003. p. 252–3. [3] CFDA. Guidelines of clinical research on Chinese new herbal medicine (trial). Beijing: China Medical Science Press; 2002. p. 333–7. [4] Tian H. Mumps. Hebei J Tradit Chin Med 2012;32(3):57–8. [5] State Administration of Traditional Chinese Medicine of the People’s Republic of China. Criteria of diagnosis and therapeutic effect of diseases and syndromes in traditional Chinese medicine. Nanjing: Nanjing University Press; 1994. p. 254–65. [6] Xing XW, Li J. Clinical analysis of the complications of 84 cases of pediatric mumps. Contemp Med 2011;17(15):42–3. [7] Pan SH, Zhang HY, Yi LY. Efficacy observation of Tanreqing injection for treatment of mumps associated with meningitis. Chin J Prim Med Pharm 2009;16(6):1116–17. [8] Tang XF. Auricular acupuncture combined with ultrashort wave for treatment of 100 cases of mumps. Central Plains Med J 2008;28(3):39. [9] Lu YB, Cheng JJ. Clinical observation of electro-acupuncture treatment for mumps. Hubei J Tradit Chin Med 2008;30(3):53. [10] Huang QH. Flick-bloodletting as an adjunctive therapy for treatment of fever caused by mumps. Zhongguo Zhenjiu 2004;24(1):45. [11] Yin DQ. Study of TCM guidelines for diagnosis and treatment of mumps. Med Tech 2011;1:56–78.
Please cite this article as: H. TIAN, M. XU, Clinical efficacy observation of comprehensive ying needling therapy for mumps, World Journal of Acupuncture – Moxibustion (2018), https://doi.org/10.1016/j.wjam.2018.03.004
JID: WJAM
[m5G;April 3, 2018;23:58]
World Journal of Acupuncture – Moxibustion 0 0 0 (2018) 1–4
Contents lists available at ScienceDirect
World Journal of Acupuncture – Moxibustion journal homepage: www.elsevier.com/locate/wjam
Clinical Research
Clinical efficacy observation of comprehensive ying needling therapy for mumpsR Haiyan TIAN () a,∗, Mengbo XU () b Acupuncture-Moxibustion Department, Third Affiliated Hospital of Nanchang University, Nanchang 330008, Jiangxi Province, China ( , 330008, ) b Moxibustion School, Jiangxi University of Traditional Chinese Medicine, Nanchang 330004, Jiangxi Province, China (, 330004, ) a
a r t i c l e
i n f o
Article history: Available online xxx Keywords: Mumps Comprehensive ying needling therapy Ribavirin injection Randomized controlled trial
a b s t r a c t Objective: To compare the clinical efficacy difference between comprehensive ying needling therapy and intramuscular injection with ribavirin for mumps. Methods: One hundred patients with mumps were randomly divided into comprehensive ying needling therapy group (group A, 52 cases) and western medicine group (group B, 48 cases), then 8 cases were eliminated and drop out from group A and 4 cases were eliminated and drop out from group B respectively, actual inclusion 44 cases in group A 44 cases in group B. Point bloodletting was performed at ¯ parotid gland (Saixiàn) and Threeshang acupoints of the patients in group A for once every other day, treatment for 7 days was considered as 1 course of treatment, and 2 courses were needed. Intramuscular injection with ribavirin was given to the patients in group B for twice a day, treatment for 7 days was considered as 1 course, and 2 courses were needed. The parotid gland swelling score, fever score, orifice parotid duct swelling score, score of difficulty in opening mouth and the clinical efficacy of the patients in the two groups were compared before and after treatment. Results: The cured and markedly effective rate in group A was 90.9% (40/44), which was superior to 68.2% in group B (30/44) (P < 0.05). The symptom scores were all improved significantly in the two groups after treatment (all P < 0.05), and the improvement in group A was superior to that in group B (all P < 0.05). Conclusion: The curative effect of comprehensive ying needling therapy for treatment of mumps was superior to that of conventional western medicine therapy. © 2018 Published by Elsevier B.V. on behalf of World Journal of Acupuncture Moxibustion House.
Mumps is a kind of acute and systemic infection caused by mumps virus, and it is a kind of respiratory infectious disease commonly seen in children and teenagers. Its common complications include meningitis and orchitis [1]. The latent period of mumps is 8–30 days with an average of 18 days. Its initial sign includes enlargement of parotid gland, without premonitory symptoms. In western medicine, mumps is often treated by using antiviral and symptomatic treatment which are difficult to adapt to the rapid changes of the disease in children. The authors adopted comprehensive ying needling therapy for mumps, and compared with the curative effect of intramuscular injection with ribavirin. The details are reported as follows.
R Supported by Science-Technology Support Plan Project of Jiangxi Province: 20151BBG70194. ∗ Corresponding author. E-mail address: [email protected] (H. TIAN).
Clinical data General information The total 88 patients with mumps were selected from the outpatients of pediatric department and internal medicine department of the Third Affiliated Hospital of Nanchang University from September 2014 to September 2016. One hundred patients who conformed to the inclusion criteria were selected and then randomly divided into comprehensive ying needling therapy group (group A, 52 cases) and western medicine group (group B, 48cases) according to the random number table [2]. Then 8 cases were eliminated and drop out from group A and 4 cases were eliminated and drop out from group B respectively. The actual number of included cases was 88, with 44 cases in each group. Per-protocol analysis was adopted in this study. In group A, there were 28 males and 16 females; the youngest was 4 years old, the oldest was 17 years old, and the average was (9.59 ± 4.03) years old; the shortest course of disease was 2 days, the longest was 6 days, and the aver-
https://doi.org/10.1016/j.wjam.2018.03.004 1003-5257/© 2018 Published by Elsevier B.V. on behalf of World Journal of Acupuncture Moxibustion House.
Please cite this article as: H. TIAN, M. XU, Clinical efficacy observation of comprehensive ying needling therapy for mumps, World Journal of Acupuncture – Moxibustion (2018), https://doi.org/10.1016/j.wjam.2018.03.004
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age was (4.09 ± 1.38) days. In group B, there were 19 males and 25 females; the youngest was 4 years old, the oldest was 15 years old, and the average was (8.95 ± 3.37) years old; the shortest course of disease was 3 days, the longest was 7 days, and the average was (5.07 ± 1.47) days. According to the statistical analysis of gender, age and course of disease in the two groups, the differences were not statistically significant (all P > 0.05), and the results were comparable. This study was approved by the Ethics Committee of the Third Affiliated Hospital of Nanchang University. Diagnostic criteria By reference to the diagnostic criteria of mumps in the Guidelines of Clinical Research on Chinese New Herbal Medicine [3] in 2002: 1 Fever, diffuse swelling centering the ear lobe, undefined margin, without change in the skin color, with resilience and tenderness. The symptom appears from one side generally, and is seen on the other side successively, possibly associated with headache and body pain, red and swollen parotid duct was seen in the mouth. 2 The disease often attacks people in winter and spring. The patient has contact with other people who are suffering from mumps. 3 Normal or slightly reduced WBC level, relatively increased classified counted lymphocyte, and increased amylase level in blood and urine [4]. Inclusion criteria
1 The patients who conformed to the above-mentioned diagnostic criteria of mumps; 2 with the age of 4–18 years old; 3 with pain in the 1 day to 7 days; 4 the patients who signed the informed consent form by themselves or their family members. Exclusion criteria
(2) Manipulations: the patient was asked in sitting position, and the hands of doctor were disinfected conventionally. The enlargement of parotid gland under the ear lobe was also disinfected conventionally, then fixed by the doctor’s left hand. Hwato 0.35 mm × 40 mm disposable filiform needle was held by the doctor’s right hand, and perpendicular insertion was performed at Parotid gland with a depth of 8–10 mm. Then lifting and thrusting and twirling needle was manipulated for 2–3 times, which was followed by rapid withdrawal. About 0.1 mL of blood flowed from Parotid gland and iodophor disinfection was conducted after wiping the blood with sterilized dry cotton ball. The patient’s arm in the affected side was stroked from the upper arm to the forearm until the distal end of thumb for 2– 3 times, making the thumb congestion. After routine disinfection of the thumb, the root of thumb was held by the left hand of the doctor, and a 0.30 mm × 25 mm disposable filiform needle was held by the right hand of the doctor to conduct rapid point bloodletting at the Three-shang acupoints with a depth of 1–2 mm. With rapid insertion and withdrawal, the manipulation should be light, shallow and fast with uniform force. Then the acupoints were squeezed for bloodletting, 1–2 drops per acupoint. Iodophor disinfection was conducted after wiping the blood with sterilized dry cotton ball. (3) Acupuncture time point: the patient should be treated after three days since the disease onset, and symptomatic treatment should be performed in the first three days since the disease onset by adopting physical cooling. The first three days since the disease onset was the swelling period, that is the peak period for heat toxin formation, with local swelling and heat pain. After acupuncture bloodletting, the fever was brought down because the pathogenic heat reached to the exterior along with the needles. The local swelling would be more sever after acupuncture if the pathogenic heat did not form to the peak with the first three days.
1 The patients with complications of meningitis or orchitis; 2 the patients who accepted other treatment during the study; 3 the patients who were afraid of needles or rejected acupuncture-moxibustion.
The treatment was carried out for once every other day, treatment for 7 days was considered as 1 course of treatment, and 2 courses were needed.
Elimination criteria
Western medicine group (group B)
1 The patients who conformed to the inclusion criteria but did not accept treatment, or who accepted treatment but did not complete the whole course; 2 the patients who took medicine independently after inclusion.
Intramuscular injection with ribavirin (Hubei Tianyao Pharmaceutical Co., Ltd., SFDA approval number H19993162) was applied. Usage and dosage: ribavirin was diluted to one milligram per milliliter with 0.9% sodium chloride injection, then the diluent was injected intramuscularly and slowly. For children, the dosage of 10 mg/kg/d was followed, and the injection was given in 2 times a day. Injection for 7 days was considered as 1 course of treatment, and 2 courses were needed.
Drop-out criteria
1 The patients who suffered from adverse events or complications, and were not suitable for further treatment; 2 the patients who dropped out from the study by themselves; 3 the patients who quit from the study due to other reasons; 4 the patients with incomplete data records which may affect the efficacy evaluation. Treatment methods Comprehensive ying needling therapy group (group A) ¯ (1) Acupoint selection: Parotid gland (Saixiàn) is located at the induration of the highest point of the enlargement of parotid ¯ ¯ gland under the ear lobe. Shàoshang (LU 11), La˘ oshang ( ¯ ¯ ang (), these three points are located in the ) and Zhongsh root of the nail of thumb, LU 11 is located at the radial margin, ¯ ¯ ¯ ang La˘ oshang is located at the ulnar margin, and Zhongsh is lo¯ cated at midpoint of LU 11 and La˘ oshang. The three points are called Three-shangacupoints.
Efficacy observation Outcomes (1) Parotid gland swelling score: without swelling, scoring 0 point; parotid gland swelling in one side without submandibular gland enlargement, scoring 3 points; parotid gland swelling in one side associated with submandibular gland enlargement, scoring 6 points; parotid gland swelling in the both sides with hard and hot texture, scoring 9 points. (2) Fever score: without fever, scoring 0 point; with a temperature between 37.3 °C and 38.5 °C, scoring 1 point; with a temperature between 38.6 °C and 39.5 °C, scoring 2 points; with a temperature not lower than 39.6 °C, scoring 3 points. (3) Orifice parotid duct swelling score: not red, scoring 0 point; slightly red without swelling, scoring 1 point; light red and
Please cite this article as: H. TIAN, M. XU, Clinical efficacy observation of comprehensive ying needling therapy for mumps, World Journal of Acupuncture – Moxibustion (2018), https://doi.org/10.1016/j.wjam.2018.03.004
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0.76 ± 0.75 1.07 ± 0.93a
After treatment
0.57 ± 0.45a 1.02 ± 0.73a 44 44 Group A Group B
Before treatment Cases Groups
Difficulty in opening mouth
1.01 ± 0.64b 0.68 ± 0.82 Compared with the same group before treatment, P < 0.05. Compared with the difference value of group B, P<0.05. b
a
a
b
1.91 ± 1.02 1.71 ± 1.05 5.31 ± 0.78 3.97 ± 0.72 1.45 ± 0.67 2.79 ± 0.81a 7.76 ± 1.03 6.96 ± 1.08
1.56 ± 0.43 1.71 ± 0.52
Difference value
2.59 ± 0.71 2.21 ± 0.70 1.05 ± 0.56 1.59 ± 0.84 0.41 ± 0.22 0.88 ± 0.56a
Difference value After treatment
a b
Difference value After treatment Fever
Before treatment Difference value
44 44
It showed that the cured and markedly effective rate in group A was higher than that in group B (χ 2 =4.49, P<0.05), see Table 2.
Group A Group B
(1) Comparison of clinical efficacy on patients in the two groups
After treatment
It was indicated that the difference in symptom scores of patients in the two groups before treatment was not statistically significant (all P>0.05), and the results were comparable. The symptom scores of patients in the two groups were all obviously reduced after treatment. The curative effect in group A was superior to that in group B in terms of parotid gland swelling, pain, fever, orifice parotid duct swelling and difficulty in opening mouth. The differences in total symptom scores of patients in the two groups before and after treatment were statistically significant (t = 3.996, P<0.05), indicating that the symptom improvement in group A was superior to that in group B, see Table 1.
Before treatment
(1) Comparison of symptom scores of patients in the two groups before and after treatment
Parotid gland swelling
Results
Cases
After efficacy evaluation, SPSS 21.0 software was adopted by statisticians for statistical analysis. Measurement data were expressed as mean ± standard deviation (x¯ ± s), and intra-group comparison was performed via paired-samples t test. Intergroup comparison was conducted by using independent-sample t test, and enumeration data were analyzed through Chi-square test. P < 0.05 indicated that the difference was statistically significant.
Groups
Statistical analysis
Table 1 Comparison of symptom scores and total score of patients with mumps in the two groups before and after treatment (x¯ ± s).
By reference to the efficacy evaluation criteria of mumps in Criteria of Diagnosis and Therapeutic Effect of Diseases and Syndromes in Traditional Chinese Medicine [5]: reduced score rate = [(total score before treatment − total score after treatment) ÷ total score before treatment] × 100%. Clinically cured: with normal temperature, parotid gland swelling and difficulty in opening mouth disappeared completely, other relevant symptoms and signs also disappeared, reduced score rate more than or equal to 90%; markedly effective: with normal body temperature, parotid gland swelling and difficulty in opening mouth were alleviated, other relevant symptoms and signs disappeared, reduced score rate was between 60% and 90%; effective: body temperature declined, parotid gland swelling, difficulty in opening mouth and other relevant symptoms and signs were alleviated, reduced score rate was between 30% and 60%; ineffective: parotid gland swelling, difficulty in opening mouth and other relevant symptoms and signs were not alleviated, reduced score rate less than 30%.
Orifice parotid duct swelling
Efficacy evaluation criteria
Before treatment
The sum of each symptom score was the total score, and the symptom scores and total scores of patients in the two groups before and after treatment were observed.
a
slight swelling, scoring 2 points; bright red and swelling, scoring 3 points. (4) Score of difficulty in opening mouth: without difficulty in opening mouth, scoring 0 point; full opening of mouth with a little difficulty, scoring 1 point; half opening of mouth: scoring 2 points; less than half opening of mouth: scoring 3 points.
3
2.01 ± 0.73b 1.04 ± 0.76
H. TIAN, M. XU / World Journal of Acupuncture – Moxibustion 000 (2018) 1–4
Discussion Mumps virus is easily transmitted through body contact, saliva, droplet and so on. It is easy to break out among children [6]. Please cite this article as: H. TIAN, M. XU, Clinical efficacy observation of comprehensive ying needling therapy for mumps, World Journal of Acupuncture – Moxibustion (2018), https://doi.org/10.1016/j.wjam.2018.03.004
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JID: WJAM 4
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H. TIAN, M. XU / World Journal of Acupuncture – Moxibustion 000 (2018) 1–4 Table 2 Comparison of the efficacy on the patients with mumps in the two groups cases. Groups
Cases
Clinically cured
Markedly effective
Effective
Ineffective
Cured and markedly effective rate (%)
Group A Group B
44 44
34 25
6 5
2 7
2 7
40 (90.9)a 30 (68.2)
a b c
Groups
Cases
Total score Before treatment
After treatment
Difference value
Group A Group B
44 44
22.58 ± 2.08 21.29 ± 2.73
3.87 ± 2.53b 5.24 ± 2.42b
19.26 ± 1.75c 14.41 ± 1.28
Compared with group B, P < 0.05. Compared with the same group before treatment, P<0.05. Compared with the difference value of group B, P<0.05.
Mumps viruses usually exist in the saliva of child patients during the 6 days before parotid gland swelling and 9 days after the parotid gland swelling [1]. During the 15 days, the mumps virus is highly contagious and infectious [7]. At present, antiviral drugs and symptomatic treatment are mostly adopted in western medicine. The antiviral drug ribavirin is a kind of synthetic nucleoside drug which can inhibit the mumps virus by the way of preventing DNA from producing through interfering with the synthesis of virus DNA polymerase. Antiviral drugs do have a certain effect of mumps, but it may cause many adverse effects such as headache, lack of strength, chest pain, fever, chill, nausea, attention deficit, hair loss, etc. Conventional acupuncture [8–10] for mumps can rapidly relieve swelling and pain, but there are some shortcomings, such as small sample size and absence of control group. Traditional Chinese medicine decoction for treating mump is timeconsuming and slow-acting. While comprehensive ying needling therapy applied in this study is a characteristic therapy on the basis of long time clinic practice. It is characterized by rapid pain and swelling relief, good curative effect, safety and reliability, no side effect. ¯ ¯ıngyànshu¯ ( Mumps is firstly seen in Chuangyángj , Complete Manual of Experience in the Treatment of Sores). It is recorded that “the pathogen of mumps is in the sulcus auriculae posterior and cerumen, which is connecting to the liver and kidney. The qi stagnation and blood stasis may obstruct in the cheek, which is wind-toxin syndrome.” [11] This disease is associated with wind-warmth and pathogenic toxin. The pathogenic toxin obstructs the shaoyang meridians, and combats with qi and blood. Qi stagnation and blood stasis may stagnate in the cheek, so the swelling diffuses in the local concomitantly with pain. Comprehensive ying needling therapy is based on the treatment principle of "sthenia requiring purgation, and treating heat should withdraw the needle rapidly". Reducing acupuncture manipulation is conducted at Parotid gland and Three-shang acupoints without needle retention for a little bloodletting. Needling ying is acupuncture for bloodletting. The pathogenic toxin stagnates locally. After acupuncture, the pathogenic heat reaches to the exterior along with the needle and blood, so as to release toxic heat, unblock the meridians and collaterals, thus eliminating parotid gland congestion and edema, quickly relieving clinical symptoms, and preventing pathogen transmission and change.
By tightly focusing on the principle of "release of fire constraint", comprehensive ying needling therapy can rapidly relieve clinical symptoms and prevent pathogen transmission and change, and is characterized by rapid swelling and pain relief, short course of treatment, and good curative effect, providing normative acupoint selection, manipulations and rational acupuncture time point to this disease. When antiviral therapy was clinically applied in most regions of our country, comprehensive ying needling therapy has broken through the previous antiviral therapy. It is a kind of new treatment idea and an emerging technology in China. This therapy is an external treatment method on the basis of transmission of traditional medicine, which is safe and reliable, easy to operate, and worthy of clinical popularization and application. Supplementary materials Supplementary material associated with this article can be found, in the online version, at doi:10.1016/j.wjam.2018.03.004. References [1] Wang Q. Efficacy observation of Tanreqing injection for treatment of 60 cases of mumps associated with meningitis. Contemp Med 2012;18(15):17–18. [2] He SL, Wang J, Wang JJ. TCM research design & statistics. Changsha: Hunan Science & Technology Press; 2003. p. 252–3. [3] CFDA. Guidelines of clinical research on Chinese new herbal medicine (trial). Beijing: China Medical Science Press; 2002. p. 333–7. [4] Tian H. Mumps. Hebei J Tradit Chin Med 2012;32(3):57–8. [5] State Administration of Traditional Chinese Medicine of the People’s Republic of China. Criteria of diagnosis and therapeutic effect of diseases and syndromes in traditional Chinese medicine. Nanjing: Nanjing University Press; 1994. p. 254–65. [6] Xing XW, Li J. Clinical analysis of the complications of 84 cases of pediatric mumps. Contemp Med 2011;17(15):42–3. [7] Pan SH, Zhang HY, Yi LY. Efficacy observation of Tanreqing injection for treatment of mumps associated with meningitis. Chin J Prim Med Pharm 2009;16(6):1116–17. [8] Tang XF. Auricular acupuncture combined with ultrashort wave for treatment of 100 cases of mumps. Central Plains Med J 2008;28(3):39. [9] Lu YB, Cheng JJ. Clinical observation of electro-acupuncture treatment for mumps. Hubei J Tradit Chin Med 2008;30(3):53. [10] Huang QH. Flick-bloodletting as an adjunctive therapy for treatment of fever caused by mumps. Zhongguo Zhenjiu 2004;24(1):45. [11] Yin DQ. Study of TCM guidelines for diagnosis and treatment of mumps. Med Tech 2011;1:56–78.
Please cite this article as: H. TIAN, M. XU, Clinical efficacy observation of comprehensive ying needling therapy for mumps, World Journal of Acupuncture – Moxibustion (2018), https://doi.org/10.1016/j.wjam.2018.03.004