- Email: [email protected]
Clinical research on postherpetic neuralgia treated by floating-acupuncture combined with collateral-bloodletting puncture and cupping
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World JournalofAcupuncture-Moxibustion (WJAM) Vol. 24, No.3, 30th Sep.2014
·35 •
Clinical Research
Clinical research on postherpetic neuralgia treated by floating-acupuncture combined with collateral-bloodletting puncture and cupping ¥~$t~Jf!Ug!f£ffil1ittTw~~~ mJ!~Ef:I~~8"JJI{b*M'9i: LID Min-juan (:M~·1ji:j) Department of Acupuncture and Moxibustion, Taihe Hospital Affiliated to Hubei University of Medicine, Shiyan 442000 Hubei province, China (~~t~~~~~~*fIl~~trfkf4, +11442000, 9=lOO)
ARTICLE INFO
ABSTRACT
Author: L1U Min-juan (1973- ), female,
Objective To observe the clinical efficacy of treating postherpetic neuralgia (PHN) by combining floating-acupuncture laser with cupping following collateral bloodletting, and to analyze its mechanism. Method One hundred and thirty cases of PHN were randomly divided into a floating-acupuncture laser with cupping following collateral bloodletting group (group A) and an electroacupuncture group (group B) based on the treatment sequence and according to the random number table, with 65 cases in each group. In the group B, G-6805 electroacupuncture apparatus was adopted after the arrival of qi through even reinforcing and reducing (even method) in such acupoints as HegLi (il'1§'- LI 4), Talh6ng (*{lj:t LR 3), ZhTg6u cst~ TE 6}, Quchf (1I±irt!! LI 11) and ZusanlT (,lE.:=:ltl. ST 36); in the group A, the treatment combining f1oatingacupuncture laser with cupping following collateral bloodletting was adopted, and the score of VAS and clinical efficacy before and after treatment in the two groups were compared. Result The differences of VAS scores of the two groups between the time points of after one course of treatment, after the entire treatment, follow up visit three months after the treatment and before treatment were statistically significant (all P
associate chief physician, master. Research field: clinical research and teaching on dermatosis E-mail: [email protected] Accepted on March 10, 2014
KEY WORDS: floating-acupuncture; laser; cupping following collateral bloodletting; postherpetic neuralgia (PHN)
Herpes zoster is a kind of viral skin disease caused by infection of chicken pox-herpes zoster virus and characterized by cluster herpes and neuralgia distributed with peripheral nerve [I]. The virus can lurk inside the nerve cell in back part of spinal cord, and when the human body suffers from reducing immunity, tiredness and infection, can reproduce and transplant skin along the nerve fiber, thus causing inflammation and pain in the affected part [2]; so it is called herpes zoster sequela. While suffering from the lightning or
tearing pain, patients always feel uneasy even when eating and sleeping; the course of disease can last several months even several years, which substantially influence the living quality of patients. The incidence will increase with the age, the probability of PNH in patients with herpes zoster is 100/0-70% [31• The author has adopted the floating-acupuncture laser, together with cupping following collateral bloodletting, gained good effect in treatment of postherpetic neuralgia (PHN). It is reported as follows.
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WorldJournal ofAcupuncture-Moxibustion (WJAM) Vol. 24, No.3, 30th Sep. 2014
CLINICAL DATA General data Herpes zoster patients from in-patient department, as well as Department of Acupuncture and Moxibustion in Taihe Hospital Affiliated to Hubei University of Medicine from December 2011 to December 2013 were selected. All the patients were divided into a floating-acupuncture laser with cupping following collateral bloodletting group (group A) and an electro acupuncture group (group B) based on the treatment sequence and according to the random number table, with 65 cases in each group. Of which, 30 male patients and 35 female patients were in the group A, whose ages ranged from 28 to 81, with an average of 47.6 years old; and the course of disease was from 5 days to 6.3 months, with an average of 5.3 weeks. While in the group B, there were 29 male patients and 36 female patients, whose ages were from 28 to 79, with an average age of 45.5; the course of disease ranged from 7 days to 5.7 months, with an average course of 5.1 weeks. There was no obvious difference between the two groups in gender, age, course of disease (all P>0.05) through t test analysis, and the result was comparable.
Diagnostic criteria The diagnostic criteria for PHN were formulated in accordance with Dermatology of Integrated Chinese and Western Medicines", CD Suffer from pain for 1 month to 2 years after clinical cure, with a past medical history of herpes zoster; ® a sense of pain distributed in line with the innervation area, and the sense of touch is abnormal, with chromatosis in local part; @ the pain is paroxysmal or lightning pain, or constant burning pain and packing pain; @ obvious discomfort after nerve damage in affected area: tickle, packing feeling and formication, etc.; @ the patient is depressed, with heavy psychological burden.
Inclusive criteria
CD Patients who
got neuralgia one month after treatment in acute-phase, with obvious pain seriously influencing daily life, such as sleeping, etc.; ® patients whose skin lesions caused by herpes zoster, blister and papule have faded, with light brown macula or light red macula left on the primary skin lesions; @ all the patients have signed the Informed Consent.
Exclusive criteria
CD
Special types of herpes zoster: eye or ear herpes zoster, viscera herpes zoster, meninx herpes zoster, or generalized herpes zoster; ® patients whose herpes zoster is still in the acute-phase, and the herpes
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has not faded; @ patients with serious diseases in heart, brain, kidney and hematopoietic system, as well as patients with malignant tumor, diabetes mellitus or psychosis; @ women in gestation period or lactation period.
METHODS
Group A (1) Floating-acupuncture laser: the patient was in a comfortable position, with his pain sites exposed, then the pain points were accurately targeted and marks were made. The disposable floating needle (manufactured by Nanjing Paifu Medical Technology Co., Ltd) was adopted as the tool for floatingacupuncture in author's department. The number of needle were decided based on the area of pain site, with a general retaining needle of 1-2. The symmetric points around the pain site were taken as the entry points, with a distance of 6-10 mm from upper or lower part of the pain point. The patient's skin was disinfected first, the needle was held in operator's right hand and the skin was tightened with thumb and forefinger of his/her left hand, and then the needle was penetrated into the skin with angle in 150 - 2 5 0 • The needle tips pointed to the exit of nerve root; after the needle was completed penetrated into skin, the needle bed was held by the right hand of operator, and the needle was vacillated to the left and right for even and smooth injection; the manipulation was slow and smooth, and the operator asked the patient about the needling sensation during the process. After the needle was retained for 10 min, it was taken out, and then the laser acupotome therapeutic apparatus was connected, and the laser current was switched on, with a wave length of 670 A, output power of 60-80 mW, spot diameter of 3.0 mm, power density of 30 mW/mm2 and energy density of 960 X 10-1 Jzmm'; the teleflex left in sub-skin was tightly fixed with infusion band after irradiation for 20 min and the needle hole was plugged with small cotton balls, and then the floating needle was pulled out after retaining for 24 h. Treatment was performed every other day, with 7 times as a course. During the needle retention period, the patient was asked to keep the sealing of needle hole and fixation of needle body; the aggravating activities and bath were avoided, clean and dry was kept in local part. (2) Cupping following collateral bloodletting: common disinfection was conducted around the neuropathic pain site after completion of floatingacupuncture laser therapy, and then disposable sevenstar needle (manufactured by Suzhou Medical Supplies Co., Ltd.) was adopted to repeatedly acupuncture in
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WorldJournal ofAcupuncture-Moxibustion (WJAM) Vol. 24, No.3, 30th Sep. 2014
the skin, with local blooding or slight exudation as the degree; then flash cupping method plus retention cupping method were carried out for 5-8 min, and local blood stasis, foam or faint yellow liquid were pulled out. After the cupping, the skin was cleaned with dry cotton ball and disinfected with iodine to prevent infection. For tapping and cupping next time, unhealed wound should be avoided. This manipulation was conducted once a day, and seven times as a course, two courses were given.
GroupB Electroacupuncture was applied. Acupoints selection: for patients with pain on head acupuncture be conducted at local pain point and Hegu (il-~ LI 4) and Taichong C~JtPLR 3); for patients with pain on shoulder, back, chest and hypochondrium or waist, farend pain point or Jiajr (~lf EX-B 2) in affected side of nerve segment corresponding to diseased region and Zhlgou C3t¥tJ TE 6) were selected; for patients with pain on limbs, Qiichi (aa ¥I!!. LI 11) was added for upper limbs, Zusanll ("@'.=:.m. ST 36) was added for lower limbs. Specific manipulation: LI 4, LR 3, TE 6, LI 11 and ST 36 were perpendicularly needled; surround needling for local pain point in head; penetration needling from nerve root towards the sub-sin for farend pain point by acupuncture in shoulder, back, chest and hypochondrium or waist; oblique needling towards spine for EX-B 2; penetration needling from far-end pain point towards the trunk for acupuncture in limbs. After even supplementation and drainage (even method) was carried out, the electroacupuncture apparatus was connected, with dilatational wave of 30 Hz and output intensity within tolerance of the patient; the needle was put out after powering on for 30 min. The manipulation was conducted once a day, with 7 times as a course of treatment, 2 courses were given.
Observational indices Visual analogue scale (VAS) [5] was adopted in the pain rating; 10 em straight line or ruler, with both end marking "0" or "10", was adopted. "0" stands for painfree, while "10" represents the strongest pain. The pain intensity value (rating) was measured with ruler after the patient marked out the pain in corresponding position; the scores of VAS before treatment, one course after the treatment, end of the treatment and 3 months after the treatment in the two groups were recorded.
Criteria for therapeutic effect The criteria for therapeutic effect of herpes
·37 • zoster in Criteria ofDiagnosis and Therapeutic Effect of Diseases and Syndromes in Traditional Chinese Medicine'" stipulated by State Administration of Traditional Chinese Medicine were taken for reference. Cured: local skin pain disappeared, the cutaneous sensation was normal, and sleep, diet and daily life returned to be normal; markedly effective: slight pain in local skin, the cutaneous sensation was normal, with significant improvement in sleep, diet and daily life; effective: the pain in local skin was relieved, with improvement in sleep, diet and daily life; ineffective: pain in local skin was not relieved, with poor condition of sleep, diet and daily life.
Statistical analysis All data were processed through SPSSI9.0 software, measurement data were expressed by mean ± standard deviation (x±s); control of the measurement data itself was conducted by adopting t test, while inter-group comparison was conducted by adopting the analysis of variance. P<0.05 means that the difference was statistically significant.
RESULTS VAS score comparison for PHN patients before and after treatment between the two groups It was seen from Table 1 that the differences of VAS score after one course of the treatment, end of the treatment and 3 months after the treatment in the two groups in comparison with that in the same group before treatment were statistically significant (all P
65
8.4±O.7
3.7±O.91)
1.4± 1.11)
1.2±O.81)2)
B
65
8.3±O.8
5.8±l.OI)
2.8±O.91)
3.2±O.7')
Notes: compared with that in the same group before treatment, P
1)
Comparison in clinical effect of patients between the two groups It was seen from Table 2 that the rate of markedly effective and total effective rate in group A were respectively 38.5% and 98.5%; while in group B, they were respectively 30.8% and 78.5%. The differences between the two groups were all statistically significant through Ridit analysis (P<0.05), indicating
WorldJournal ofAcupuncture-Moxibustion (WJAM) Vol. 24, No.3, 30th Sep. 2014
° 38 °
that both the rate of markedly effect and total effective rate in group A were superior to those in group B. Table 2
Comparison of clinical effect of PHN patients in the two groups Cases (%)
Groups Patients
Cured
Total Mffiarkte.dlY Effective Ineffective effective e ec rve rate (%)
A
65
31 (47.7) 25 (38.5)
8 (12.3)
1 (1.5)
B
65
16 (20.5) 20 (30.8) 15 (23.1) 14 (21.5)
98.5 1) 78.5
Note: compared with that in group B, I) P
DISCUSSION PHN refers to the protracted neuralgia with constant burning pain and stabbing pain in the infected part caused by herpes zoster after the fading of skin lesions has completely disappeared. 90/0-13% herpes zoster patients may get the complication. Its danger will increase with the age, and 15%-75% patients aged above 50 can get PHN, which may lasts for more than one year [71• The disease is characterized by spreading along the invaded nerve and being presented in belted and unilateral pain [81• It is pointed out in modem medicine that the virus invades into human body through respiratory tract infection, and then lurk in back roots of spinal nerve or the nerve cell of other pathogenic sites; morbidity of the virus is low in general, but may become high under the condition of tiredness and decline in immunity caused by disease. At present, analgesics, anti-depressant, anti-convulsant and therapeutic method of regional nerve block are generally adopted in western medicine to treat the disease, but the therapeutic effect, without attaching the root cause, is unsatisfactory [91• Being the newly-developed therapy in recent 10 years, floating-acupuncture therapy is a kind of modem acupuncture therapy [10] with theory of cutaneous regions, adjacent point selection, theory of "painful locality taken as an acupoint", and acupuncture methods in Neijing ( pg f£» The Yellow Emperor's Inner Classic) as the basis. The entry point for floating-acupuncture should be selected around the pain site, with needle body in the sub-skin and needle tip directly reaching the focus; this conforms to the adjacent point selection and the theory of "painful locality taken as an acupoint". A number of clinical applications proved that floating-acupuncture, marked by immediate effect, has relatively good analgesic effect; its curative effect can be maintained after needling retention, and its analgesic effect may be associated with nerve system regulation and humoral factors [11]. In some cases, there may be nidus swelling or limitation of motion after the pain disappeared,
«
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which is mainly caused by local inflammation and edema stimulation, adhesion or dislocation and disorder of facet joints [12]. Therefore, the author, based on the floating-acupuncture therapy, added the laser irradiation and compared with therapeutic effect of e1ectroacupuncture, curative effect of the former was obvious better than the latter. Apart from the basic therapeutic effect, floating-acupuncture therapy also has such characteristics as laser heat effect, mechanical effect, photochemical effect and electromagnetic effect, as well as expanding the blood vessel, contributing to metabolism and improving the circulation, etc., to achieve the effect of antiinflammation, analgesia and detumescence. Laser irradiation has positive effects on regulating local physiological function, reinforcing or improving local blood circulation, regulating the metabolism, changing pathological state of the tissue, as well as recovering the tissue health [131• Emphasis should be laid on preventing fainting during acupuncture treatment, for the patient in initial treatment, the doctor should first eliminate his tension and, at the same time, select appropriate position, with light manipulation, the doctor should also, during the treatment, observe the patient's expression and ask him for the sensation. Once the patient feels uncomfortable, such as fainting, proper treatment measures shall be taken as soon as possible [14]• Collateral bloodletting was originated from "collateral needling" of nine needling methods in Lingshu °Guangzhen ( «~~ o-gtf» The Miraculous Pivot °Official Needling Techniques): "Collateral needling is to needle the blood vessel of small collateral". Bleeding to discharge the pathogenic qi is based on the principle of "when there is exuberance, treat it with drainage; collateral bloodletting is used for eliminating pent diseases", to make a direction for pathogenic qi. Collateral bloodletting, in traditional recognition, was from the perspective of "dispelling stasis" and "bad blood letting", for the purpose of dispelling blood stasis and creating new blood, as well as dredging the channel. It was recorded in Xuezhenglun (<<1fn. ii.Ei~» Treatise on Blood Syndromes): "extravasated blood cannot be mixed with healthy blood, for it will hinder the growth of new blood; so all mass formed by blood stasis should take eliminating the blood stasis as the essential". Being able to achieve improvement in blood stasis obstruction and return the qi-b100d circulation to normal, collateral bloodletting can realize the purpose of dredging the qi of viscera along channel, regulate yin and yang of qi-b100d, and make the qi blood smooth and stable, with yin and yang in equilibrium [15].
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WorldJournal ofAcupuncture-Moxibustion(WJAM) Vol. 24, No.3, 30th Sep.2014
Cupping following collateral bloodletting helps to make an outlet for pathogenic qi, elimination of which can cure the disease; in other words, eliminating pathogenic qi can dredge the channel and stop pain, and remove blood stasis for creating new blood [16]. In modem medicine, it is believed that cupping following collateral bloodletting can produce non-specific immunity reaction, which can help strengthen the body immunity, lower the allergic reaction, quickly eliminate the stimulations, such as pressure on the peripheral nerve herpes, and have an analgesic effect.
PHN main manifestations are insufficient healthy qi in the anaphase of the disease, syndrome of interior damp-heat, and congestion accumulation at skin, all of these symptoms cause qi stagnation and blood stasis, as well as stagnation of channel, and then they shall manifest themselves outside along the liver and gallbladder meridian, thus, it is appropriate to dredge the channels, dispel stasis to relieve pain, and regulate qi and blood when treating the disease. The dilatational wave of electroacupuncture has a good effect of analgisia, and it can also make the muscle to shrink rhythmically and motion along with the electroacupuncture by using electric current to stimulate acupoint tissue, thus increasing and maintaining the function of acupuncture, and achieving better analgesic effect.
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[5]
[6]
[7] [8]
[9] [10] [11]
[12]
[13]
[14]
REFERENCES [1]
[2]
[3]
[4]
Zhang JH, Fan JZ, Peng N. Clinical observation on treatment of herpes zoster by ultraviolet therapy. Chin J Rehabil (Chin) 2005; 20 (2): 87-88. Ni JX, Fan BF, Xue FS. Clinical Pain Treatment Technology. Beijing: Scientific and Technical Documentation Press; 2003: 375. Hombetger J, Robertus K. cost-effectiveness of a vaccine to prevent herpes zoster and postherpetic neuralgia in older adults. Ann Intern Med 2006; 145(5): 317-325. Bian TY, Yu XC. Dermatology of Integrated Chinese
[15]
[16]
and Western Medicine. Tianjin: Tianjin Science and Technology Press; 1987: 156-159. Miao HS, Zhu YL. Rehabilitation evaluation and treatment of cerebral apoplexy. Beijing: Huaxia Publishing House; 1996: 79-83. State Administration of Traditional Chinese Medicine. Criteria of Diagnostic and Therapeutic Effect of Diseases and Syndromes in Traditional Chinese Medicine. Nanjing: Nanjing University Press; 1994: 259-260. Peng WW. Lemology. 6th edition. Beijing: People's Medical Publishing House; 2005: 50-53. Liang D, Dai LY, Shen W. Clinical observation of treating PHN by combining Gabapentin with transcutaneous electrical nerve stimulation. Mod Med J Chin (Chin) 2011; 13(2): 61-63. Shao JB. Pathogenetic characteristics and treatment of herpes zoster. Med Innovat Chin (Chin) 2011; 8(8): 179. Fu ZH. Floating-acupuncture therapy. Beijing: People's Military Medical Press 2000: 9-12. Fu ZH, Huang Y, Xia DB. Initial discussion on characteristics offloating-acupuncture-response to readers concerned about floating-acupuncture. J Clin Acup-Mox (Chin) 1997; 13(2): 1. Zhang YP. Floating-acupuncture: a new acupuncture analgesia therapy. J Clin Acup-Mox (Chin) 1998; 14(12): 37-40. Cheng JM, Mu JP, Peng L. Clinical effect observation on laser needle-knife therapy of degenerative arthritis. Chin J Laser Med Surg (Chin) 2007; 16(5): 16-21. Liu BH, Zhu XW. Simple analysis on floatingacupuncture therapy. J Clin Acup-Mox (Chin) 1998; 14 (4): 290-291. Zhang B, Peng L, Zhou LZ. Observation on curative effect of treating chronic eczema by combining tabbing and bloodletting with thermal moxibustion. Shanghai J Acup-Mox (Chin) 2013; 32(11): 927-928. Liu YN, Zhang HX, Huang GF. Observation on curative effect of treating herpes zoster by combining electroacupuncture in Jiliji (*:ll EX-B 2) with cupping following collateral bloodletting. Shanghai J Acup-Mox (Chin) 2009; 28(9): 523-525.
ABSTRACT IN CHINE SE [flt~] § (j{J: 5lJt$-i-f-4titt}I[J!iLf;->il1~~;tJ~{H'l 't ;Jk.~7f-Jf7i!;ff~~~ l)tt'*-113&.o ""Jj)'1;;: ¥f13017~ 't;Jk. ~7f-Jf7i!#~~ .~:t-, t~tJk~~4t~~§tt1t7t.Jf7)'lWJf~~7}i-f-4tittJe.iJiLf;->il1~~;tJill (Aill) ~ ~# ill (Bill) , ~6517~ 0 Bill~~f;-~" :k.i'f" i..~t]" 1lf1~" Jt..=..y ~ R.1T-t:tr-t~-t*~.fq.Jf7.t:l-G-6805~ 4t1X.~f; 11, Aill*-m i-f-#ittJe. iJiLf;->il1 ~~;tJ ~f; 11, 2+11 ~j,Jf7 ~t~~ ill ~f; 11itJf7VAS~7}~ I)tt '*-113&. 0 ~ ~: ~.&:t-~111+11.Jf7,,~11M.~~~11M.3+AW#VM~7}~~11it~~.*~~~~#
!!f"l;5t (all P<0.05) 0 Aill~3&.~~.~~3&.~7}jj'JjI;38.5% (25/65) ~98.5% (64/65), Bill7}jjlJjI;30.8% (20/65) ~78.5% (51/65), ~Ridit7}tJf, ~ill~t~.*~~~~it!!f"l;5t(P<0.05)0~i~: i-f-4tittJe. iJiLf;->il1 ~~;tJ ~f; 11't ;Jk.~7f-Jf7 i!;ff ~ ~ 113&.~;f L~miWJ] i-f-4t ittJe. >il1~~;tJ 't;Jk.~7f-Jf7i!;ff~~ 0
World JournalofAcupuncture-Moxibustion (WJAM) Vol. 24, No.3, 30th Sep.2014
·35 •
Clinical Research
Clinical research on postherpetic neuralgia treated by floating-acupuncture combined with collateral-bloodletting puncture and cupping ¥~$t~Jf!Ug!f£ffil1ittTw~~~ mJ!~Ef:I~~8"JJI{b*M'9i: LID Min-juan (:M~·1ji:j) Department of Acupuncture and Moxibustion, Taihe Hospital Affiliated to Hubei University of Medicine, Shiyan 442000 Hubei province, China (~~t~~~~~~*fIl~~trfkf4, +11442000, 9=lOO)
ARTICLE INFO
ABSTRACT
Author: L1U Min-juan (1973- ), female,
Objective To observe the clinical efficacy of treating postherpetic neuralgia (PHN) by combining floating-acupuncture laser with cupping following collateral bloodletting, and to analyze its mechanism. Method One hundred and thirty cases of PHN were randomly divided into a floating-acupuncture laser with cupping following collateral bloodletting group (group A) and an electroacupuncture group (group B) based on the treatment sequence and according to the random number table, with 65 cases in each group. In the group B, G-6805 electroacupuncture apparatus was adopted after the arrival of qi through even reinforcing and reducing (even method) in such acupoints as HegLi (il'1§'- LI 4), Talh6ng (*{lj:t LR 3), ZhTg6u cst~ TE 6}, Quchf (1I±irt!! LI 11) and ZusanlT (,lE.:=:ltl. ST 36); in the group A, the treatment combining f1oatingacupuncture laser with cupping following collateral bloodletting was adopted, and the score of VAS and clinical efficacy before and after treatment in the two groups were compared. Result The differences of VAS scores of the two groups between the time points of after one course of treatment, after the entire treatment, follow up visit three months after the treatment and before treatment were statistically significant (all P
associate chief physician, master. Research field: clinical research and teaching on dermatosis E-mail: [email protected] Accepted on March 10, 2014
KEY WORDS: floating-acupuncture; laser; cupping following collateral bloodletting; postherpetic neuralgia (PHN)
Herpes zoster is a kind of viral skin disease caused by infection of chicken pox-herpes zoster virus and characterized by cluster herpes and neuralgia distributed with peripheral nerve [I]. The virus can lurk inside the nerve cell in back part of spinal cord, and when the human body suffers from reducing immunity, tiredness and infection, can reproduce and transplant skin along the nerve fiber, thus causing inflammation and pain in the affected part [2]; so it is called herpes zoster sequela. While suffering from the lightning or
tearing pain, patients always feel uneasy even when eating and sleeping; the course of disease can last several months even several years, which substantially influence the living quality of patients. The incidence will increase with the age, the probability of PNH in patients with herpes zoster is 100/0-70% [31• The author has adopted the floating-acupuncture laser, together with cupping following collateral bloodletting, gained good effect in treatment of postherpetic neuralgia (PHN). It is reported as follows.
·36·
WorldJournal ofAcupuncture-Moxibustion (WJAM) Vol. 24, No.3, 30th Sep. 2014
CLINICAL DATA General data Herpes zoster patients from in-patient department, as well as Department of Acupuncture and Moxibustion in Taihe Hospital Affiliated to Hubei University of Medicine from December 2011 to December 2013 were selected. All the patients were divided into a floating-acupuncture laser with cupping following collateral bloodletting group (group A) and an electro acupuncture group (group B) based on the treatment sequence and according to the random number table, with 65 cases in each group. Of which, 30 male patients and 35 female patients were in the group A, whose ages ranged from 28 to 81, with an average of 47.6 years old; and the course of disease was from 5 days to 6.3 months, with an average of 5.3 weeks. While in the group B, there were 29 male patients and 36 female patients, whose ages were from 28 to 79, with an average age of 45.5; the course of disease ranged from 7 days to 5.7 months, with an average course of 5.1 weeks. There was no obvious difference between the two groups in gender, age, course of disease (all P>0.05) through t test analysis, and the result was comparable.
Diagnostic criteria The diagnostic criteria for PHN were formulated in accordance with Dermatology of Integrated Chinese and Western Medicines", CD Suffer from pain for 1 month to 2 years after clinical cure, with a past medical history of herpes zoster; ® a sense of pain distributed in line with the innervation area, and the sense of touch is abnormal, with chromatosis in local part; @ the pain is paroxysmal or lightning pain, or constant burning pain and packing pain; @ obvious discomfort after nerve damage in affected area: tickle, packing feeling and formication, etc.; @ the patient is depressed, with heavy psychological burden.
Inclusive criteria
CD Patients who
got neuralgia one month after treatment in acute-phase, with obvious pain seriously influencing daily life, such as sleeping, etc.; ® patients whose skin lesions caused by herpes zoster, blister and papule have faded, with light brown macula or light red macula left on the primary skin lesions; @ all the patients have signed the Informed Consent.
Exclusive criteria
CD
Special types of herpes zoster: eye or ear herpes zoster, viscera herpes zoster, meninx herpes zoster, or generalized herpes zoster; ® patients whose herpes zoster is still in the acute-phase, and the herpes
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has not faded; @ patients with serious diseases in heart, brain, kidney and hematopoietic system, as well as patients with malignant tumor, diabetes mellitus or psychosis; @ women in gestation period or lactation period.
METHODS
Group A (1) Floating-acupuncture laser: the patient was in a comfortable position, with his pain sites exposed, then the pain points were accurately targeted and marks were made. The disposable floating needle (manufactured by Nanjing Paifu Medical Technology Co., Ltd) was adopted as the tool for floatingacupuncture in author's department. The number of needle were decided based on the area of pain site, with a general retaining needle of 1-2. The symmetric points around the pain site were taken as the entry points, with a distance of 6-10 mm from upper or lower part of the pain point. The patient's skin was disinfected first, the needle was held in operator's right hand and the skin was tightened with thumb and forefinger of his/her left hand, and then the needle was penetrated into the skin with angle in 150 - 2 5 0 • The needle tips pointed to the exit of nerve root; after the needle was completed penetrated into skin, the needle bed was held by the right hand of operator, and the needle was vacillated to the left and right for even and smooth injection; the manipulation was slow and smooth, and the operator asked the patient about the needling sensation during the process. After the needle was retained for 10 min, it was taken out, and then the laser acupotome therapeutic apparatus was connected, and the laser current was switched on, with a wave length of 670 A, output power of 60-80 mW, spot diameter of 3.0 mm, power density of 30 mW/mm2 and energy density of 960 X 10-1 Jzmm'; the teleflex left in sub-skin was tightly fixed with infusion band after irradiation for 20 min and the needle hole was plugged with small cotton balls, and then the floating needle was pulled out after retaining for 24 h. Treatment was performed every other day, with 7 times as a course. During the needle retention period, the patient was asked to keep the sealing of needle hole and fixation of needle body; the aggravating activities and bath were avoided, clean and dry was kept in local part. (2) Cupping following collateral bloodletting: common disinfection was conducted around the neuropathic pain site after completion of floatingacupuncture laser therapy, and then disposable sevenstar needle (manufactured by Suzhou Medical Supplies Co., Ltd.) was adopted to repeatedly acupuncture in
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WorldJournal ofAcupuncture-Moxibustion (WJAM) Vol. 24, No.3, 30th Sep. 2014
the skin, with local blooding or slight exudation as the degree; then flash cupping method plus retention cupping method were carried out for 5-8 min, and local blood stasis, foam or faint yellow liquid were pulled out. After the cupping, the skin was cleaned with dry cotton ball and disinfected with iodine to prevent infection. For tapping and cupping next time, unhealed wound should be avoided. This manipulation was conducted once a day, and seven times as a course, two courses were given.
GroupB Electroacupuncture was applied. Acupoints selection: for patients with pain on head acupuncture be conducted at local pain point and Hegu (il-~ LI 4) and Taichong C~JtPLR 3); for patients with pain on shoulder, back, chest and hypochondrium or waist, farend pain point or Jiajr (~lf EX-B 2) in affected side of nerve segment corresponding to diseased region and Zhlgou C3t¥tJ TE 6) were selected; for patients with pain on limbs, Qiichi (aa ¥I!!. LI 11) was added for upper limbs, Zusanll ("@'.=:.m. ST 36) was added for lower limbs. Specific manipulation: LI 4, LR 3, TE 6, LI 11 and ST 36 were perpendicularly needled; surround needling for local pain point in head; penetration needling from nerve root towards the sub-sin for farend pain point by acupuncture in shoulder, back, chest and hypochondrium or waist; oblique needling towards spine for EX-B 2; penetration needling from far-end pain point towards the trunk for acupuncture in limbs. After even supplementation and drainage (even method) was carried out, the electroacupuncture apparatus was connected, with dilatational wave of 30 Hz and output intensity within tolerance of the patient; the needle was put out after powering on for 30 min. The manipulation was conducted once a day, with 7 times as a course of treatment, 2 courses were given.
Observational indices Visual analogue scale (VAS) [5] was adopted in the pain rating; 10 em straight line or ruler, with both end marking "0" or "10", was adopted. "0" stands for painfree, while "10" represents the strongest pain. The pain intensity value (rating) was measured with ruler after the patient marked out the pain in corresponding position; the scores of VAS before treatment, one course after the treatment, end of the treatment and 3 months after the treatment in the two groups were recorded.
Criteria for therapeutic effect The criteria for therapeutic effect of herpes
·37 • zoster in Criteria ofDiagnosis and Therapeutic Effect of Diseases and Syndromes in Traditional Chinese Medicine'" stipulated by State Administration of Traditional Chinese Medicine were taken for reference. Cured: local skin pain disappeared, the cutaneous sensation was normal, and sleep, diet and daily life returned to be normal; markedly effective: slight pain in local skin, the cutaneous sensation was normal, with significant improvement in sleep, diet and daily life; effective: the pain in local skin was relieved, with improvement in sleep, diet and daily life; ineffective: pain in local skin was not relieved, with poor condition of sleep, diet and daily life.
Statistical analysis All data were processed through SPSSI9.0 software, measurement data were expressed by mean ± standard deviation (x±s); control of the measurement data itself was conducted by adopting t test, while inter-group comparison was conducted by adopting the analysis of variance. P<0.05 means that the difference was statistically significant.
RESULTS VAS score comparison for PHN patients before and after treatment between the two groups It was seen from Table 1 that the differences of VAS score after one course of the treatment, end of the treatment and 3 months after the treatment in the two groups in comparison with that in the same group before treatment were statistically significant (all P
65
8.4±O.7
3.7±O.91)
1.4± 1.11)
1.2±O.81)2)
B
65
8.3±O.8
5.8±l.OI)
2.8±O.91)
3.2±O.7')
Notes: compared with that in the same group before treatment, P
1)
Comparison in clinical effect of patients between the two groups It was seen from Table 2 that the rate of markedly effective and total effective rate in group A were respectively 38.5% and 98.5%; while in group B, they were respectively 30.8% and 78.5%. The differences between the two groups were all statistically significant through Ridit analysis (P<0.05), indicating
WorldJournal ofAcupuncture-Moxibustion (WJAM) Vol. 24, No.3, 30th Sep. 2014
° 38 °
that both the rate of markedly effect and total effective rate in group A were superior to those in group B. Table 2
Comparison of clinical effect of PHN patients in the two groups Cases (%)
Groups Patients
Cured
Total Mffiarkte.dlY Effective Ineffective effective e ec rve rate (%)
A
65
31 (47.7) 25 (38.5)
8 (12.3)
1 (1.5)
B
65
16 (20.5) 20 (30.8) 15 (23.1) 14 (21.5)
98.5 1) 78.5
Note: compared with that in group B, I) P
DISCUSSION PHN refers to the protracted neuralgia with constant burning pain and stabbing pain in the infected part caused by herpes zoster after the fading of skin lesions has completely disappeared. 90/0-13% herpes zoster patients may get the complication. Its danger will increase with the age, and 15%-75% patients aged above 50 can get PHN, which may lasts for more than one year [71• The disease is characterized by spreading along the invaded nerve and being presented in belted and unilateral pain [81• It is pointed out in modem medicine that the virus invades into human body through respiratory tract infection, and then lurk in back roots of spinal nerve or the nerve cell of other pathogenic sites; morbidity of the virus is low in general, but may become high under the condition of tiredness and decline in immunity caused by disease. At present, analgesics, anti-depressant, anti-convulsant and therapeutic method of regional nerve block are generally adopted in western medicine to treat the disease, but the therapeutic effect, without attaching the root cause, is unsatisfactory [91• Being the newly-developed therapy in recent 10 years, floating-acupuncture therapy is a kind of modem acupuncture therapy [10] with theory of cutaneous regions, adjacent point selection, theory of "painful locality taken as an acupoint", and acupuncture methods in Neijing ( pg f£» The Yellow Emperor's Inner Classic) as the basis. The entry point for floating-acupuncture should be selected around the pain site, with needle body in the sub-skin and needle tip directly reaching the focus; this conforms to the adjacent point selection and the theory of "painful locality taken as an acupoint". A number of clinical applications proved that floating-acupuncture, marked by immediate effect, has relatively good analgesic effect; its curative effect can be maintained after needling retention, and its analgesic effect may be associated with nerve system regulation and humoral factors [11]. In some cases, there may be nidus swelling or limitation of motion after the pain disappeared,
«
ELSEVIER
which is mainly caused by local inflammation and edema stimulation, adhesion or dislocation and disorder of facet joints [12]. Therefore, the author, based on the floating-acupuncture therapy, added the laser irradiation and compared with therapeutic effect of e1ectroacupuncture, curative effect of the former was obvious better than the latter. Apart from the basic therapeutic effect, floating-acupuncture therapy also has such characteristics as laser heat effect, mechanical effect, photochemical effect and electromagnetic effect, as well as expanding the blood vessel, contributing to metabolism and improving the circulation, etc., to achieve the effect of antiinflammation, analgesia and detumescence. Laser irradiation has positive effects on regulating local physiological function, reinforcing or improving local blood circulation, regulating the metabolism, changing pathological state of the tissue, as well as recovering the tissue health [131• Emphasis should be laid on preventing fainting during acupuncture treatment, for the patient in initial treatment, the doctor should first eliminate his tension and, at the same time, select appropriate position, with light manipulation, the doctor should also, during the treatment, observe the patient's expression and ask him for the sensation. Once the patient feels uncomfortable, such as fainting, proper treatment measures shall be taken as soon as possible [14]• Collateral bloodletting was originated from "collateral needling" of nine needling methods in Lingshu °Guangzhen ( «~~ o-gtf» The Miraculous Pivot °Official Needling Techniques): "Collateral needling is to needle the blood vessel of small collateral". Bleeding to discharge the pathogenic qi is based on the principle of "when there is exuberance, treat it with drainage; collateral bloodletting is used for eliminating pent diseases", to make a direction for pathogenic qi. Collateral bloodletting, in traditional recognition, was from the perspective of "dispelling stasis" and "bad blood letting", for the purpose of dispelling blood stasis and creating new blood, as well as dredging the channel. It was recorded in Xuezhenglun (<<1fn. ii.Ei~» Treatise on Blood Syndromes): "extravasated blood cannot be mixed with healthy blood, for it will hinder the growth of new blood; so all mass formed by blood stasis should take eliminating the blood stasis as the essential". Being able to achieve improvement in blood stasis obstruction and return the qi-b100d circulation to normal, collateral bloodletting can realize the purpose of dredging the qi of viscera along channel, regulate yin and yang of qi-b100d, and make the qi blood smooth and stable, with yin and yang in equilibrium [15].
ELSEVIER
WorldJournal ofAcupuncture-Moxibustion(WJAM) Vol. 24, No.3, 30th Sep.2014
Cupping following collateral bloodletting helps to make an outlet for pathogenic qi, elimination of which can cure the disease; in other words, eliminating pathogenic qi can dredge the channel and stop pain, and remove blood stasis for creating new blood [16]. In modem medicine, it is believed that cupping following collateral bloodletting can produce non-specific immunity reaction, which can help strengthen the body immunity, lower the allergic reaction, quickly eliminate the stimulations, such as pressure on the peripheral nerve herpes, and have an analgesic effect.
PHN main manifestations are insufficient healthy qi in the anaphase of the disease, syndrome of interior damp-heat, and congestion accumulation at skin, all of these symptoms cause qi stagnation and blood stasis, as well as stagnation of channel, and then they shall manifest themselves outside along the liver and gallbladder meridian, thus, it is appropriate to dredge the channels, dispel stasis to relieve pain, and regulate qi and blood when treating the disease. The dilatational wave of electroacupuncture has a good effect of analgisia, and it can also make the muscle to shrink rhythmically and motion along with the electroacupuncture by using electric current to stimulate acupoint tissue, thus increasing and maintaining the function of acupuncture, and achieving better analgesic effect.
·39 •
[5]
[6]
[7] [8]
[9] [10] [11]
[12]
[13]
[14]
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ABSTRACT IN CHINE SE [flt~] § (j{J: 5lJt$-i-f-4titt}I[J!iLf;->il1~~;tJ~{H'l 't ;Jk.~7f-Jf7i!;ff~~~ l)tt'*-113&.o ""Jj)'1;;: ¥f13017~ 't;Jk. ~7f-Jf7i!#~~ .~:t-, t~tJk~~4t~~§tt1t7t.Jf7)'lWJf~~7}i-f-4tittJe.iJiLf;->il1~~;tJill (Aill) ~ ~# ill (Bill) , ~6517~ 0 Bill~~f;-~" :k.i'f" i..~t]" 1lf1~" Jt..=..y ~ R.1T-t:tr-t~-t*~.fq.Jf7.t:l-G-6805~ 4t1X.~f; 11, Aill*-m i-f-#ittJe. iJiLf;->il1 ~~;tJ ~f; 11, 2+11 ~j,Jf7 ~t~~ ill ~f; 11itJf7VAS~7}~ I)tt '*-113&. 0 ~ ~: ~.&:t-~111+11.Jf7,,~11M.~~~11M.3+AW#VM~7}~~11it~~.*~~~~#
!!f"l;5t (all P<0.05) 0 Aill~3&.~~.~~3&.~7}jj'JjI;38.5% (25/65) ~98.5% (64/65), Bill7}jjlJjI;30.8% (20/65) ~78.5% (51/65), ~Ridit7}tJf, ~ill~t~.*~~~~it!!f"l;5t(P<0.05)0~i~: i-f-4tittJe. iJiLf;->il1 ~~;tJ ~f; 11't ;Jk.~7f-Jf7 i!;ff ~ ~ 113&.~;f L~miWJ] i-f-4t ittJe. >il1~~;tJ 't;Jk.~7f-Jf7i!;ff~~ 0