- Email: [email protected]
Comparison of efficacy between electroacupuncture and the combination of collateral bloodletting, cupping, and acupoint application for cervical spondylosis radiculopathy (CRS)
ELSEVIER
World Journal ofAcupuncture-Moxibustion (WJAM) Vol. 24, No.3, 30th Sep. 2014
·25 •
Clinical Research Comparison of efficacy between electroacupuncture and the combination of collateral bloodletting, cupping, and acupoint application for cervical spondylosis radiculopathy (CRS) Jt!Ug-*f£ffii~ir1C1iLmlif1~~$t1itrT:fEJI~1&m~ft~EBrT~t~~ HU Ai-e (j}]1t~), YANG Hui-qin (~~l!J) Rehabilitation Department ofYunfu People's Hospital, Yunfu 527300, Guangdong, China ()*11f~1¥rPA ~~~*~U4, ~Y!f. 527300)
ARTICLE INFO
ABSTRACT
Author: HU Ai-e, (1971-), female, associate
Objective To observe the efficacy of treating young patients with cervical spondylosis radiculopathy (CRS) by collateral bloodletting, cupping, and acupoint application. Methods Sixty-one CRS patients were randomly divided into an acupoint application group (group A, 31 cases) and an electroacupuncture group (group B, 30 cases). Both sides of the spine and scapula were treated with collateral bloodletting, cupping, and acupoint application over Ash; points in group A. The following points received electroacupuncture in group B: JiajT (~lf EX-B2), Fengchf ())(\.¥t!! GB 20), Jlanjlng ()ijjt GB 21), Jianyu ()ijM LI 15), Waiguan (;9~* TE 5), Houxl (J§ SI 3) and Dazhul t:k* GV 14). Patients in the two groups were compared in terms of scores for total symptoms and signs, and the theraputic effect of each method was analyzed. Results Total score of symptoms and signs of the two groups were both more significantly improved compared to that before treatment (9.96 ± 2.02 vs 15.87 ± 1.84, P<0.05 in group A; 10.02 ± 1.76 vs 13.59 ± 1.52, P<0.05 in group B). The differences in two groups before and after treatment were 5.91 ± 1.95 in group A, 3.53 ± 1.68 in group B, they were statistically significant (P<0.05). The total effective rate of group A [93.6% (29/31)] was better than that of group B [83.3% (25/30)), and the differences were statistically significant (P<0.05). Conclusion Good therapeutic effects can be achieved in treating young CRS patients with collateral bloodletting, cupping, and acupoint application.
chief physician. Research field: The combination of acupuncture and herbs in the treatment of nervous system disease and pain. E-mail: [email protected] Accepted on February 24, 2014
m
KEY WORDS: cervical spondylosis radiculopathy (CRS); collateral bloodletting; cupping; acupoint application; young patients; clinical observation
PA review of the literature shows [I] that the incidence of cervical spondylosis radiculopathy (CRS) amongst pateinets with cervical diseases is quite high (from 50 % to 60%) [2]. Over the past decade, the prevalence of CRS in younger populations has grown significantly [3-5]. The World Health Organization (WHO) issued a recent standard forage ranges with individuals aged 18 to 44 classified as "youth" [6]. This study aimed to observe the efficacy of treating CRS patients with bleeding collaterals and cupping
combined with herbal patches on acupuncture points to address the challenge of an increasing number of young patients with cervical spondylosis.
CLINICAL DATA
General data Sixty-one young CRS patients were selected from inpatient and outpatient department ofYunfu People's Hospital between July 2010 and July 2012, including
·26·
World Journal ofAcupuncture-Moxibustion (WJAM) Vol.24, No.3, 30th Sep. 2014
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34 males and 27 females. Patients were aged 18 to 44 with an average age of 31.5; the shortest course of disease lasted for five days and the longest lasted for four years, with an average of 73.5 days. 61 patients were divided into an acupoint application group (group A, 31 cases) and an electroacupuncture group (group B, 30 cases) based on a random number table. All subjects signed Informed Consent and the study program were approved by the Ethics Committee. The differences of gender, age, course of disease and pre-treatment symptom scores were not statistically significant (all P>0.05) between two groups and were comparable.
or psychoneurosis and mental illness; ® currently receiving other treatments at the same time; @ pregnancy or breast feeding, drug allergies; ® diseases such as fracture of cervical vertebrae, dislocation, tuberculosis, tumor, infections and so on, and brokenskin or wounds around the treatment area; CD failed to receive relevant therapy on schedule to a degree that affected efficacy observation, or did not complete course of treatment or provide other relevant data necessary for evaluation of efficacy.
Diagnostic criteria
collateral bloodletting, cupping: patients lay in prone position, and the practitioner coated the patient's muscles on both sides of the spine and both scapula with liquid paraffin, and then applied "moving cupping" from top to bottom 10 to 15 times. Paraffin was wiped off, and the skin was routinely disinfected. Then, Dazhui (:Am GV 14), Ashi points and areas with ecchymosis were needled rapidly with threeedged needles to the depth of 1 to 2 mm, after which cups were applied so that 0.5-3 mL of blood was obtained in the glass cups. Cups were retained for 10 min. After cupping, blood was cleaned from the skin and band-aids were applied to disinfected skin. Patients were treated once every 5 days, and two treatments were the total course of treatment.
Diagnostic criteria for cervical diseases in Criteria ofDiagnosis and Therapeutic Effect of Diseases and Syndromes in Traditional Chinese Medicine (ZY/ TOO1.9-94) stipulated by the State Administration of Traditional Chinese Medicine of the People's Republic of China were used as our standard [7]. The criteria include: CD Chronic strain or trauma, or congenital cervical abnormality, cervical degenerative change. ® Prevalent in those that work with heads lowered for a long time or those accustomed to watching TV or using a computer for long hours, resulting in chronic diseases. ® Symptoms include pain in the neck, shoulders and back, headache and dizziness, stiff neck, and numbness in the upper limbs. ® Neck dysfunction, disk herniation, tenderness in the upper comer of the scapula, palpable cord-like indurations, weakness and atrophy of muscles in the upper limbs, positive test of brachial plexus traction, and a positive spurling test. @ Straight-view X-ray reveals hyperplasia of uncovertebral joint; open-mouth view X-ray shows odontoid disorientation; lateralview X-ray shows straighting of the normalcervical curvature, narrowing intervertebral space, and hyperostosis or calcification of ligaments, and the oblique X-ray shows narrowing of the intervertebral foramen. CT and magnetic resonance imaging (MRI) may allow more localizeddiagnosis.
Inclusion criteria
CD Fitdiagnostic criteria above; ® aged 18 to 44 years, willing and able to complete clinical study; ® signed Informed Consent. Exclusion criteria
CD Do not match diagnostic criteria and inclusion criteria above; ® previous adverse reactions (e.g., fainting) to acupuncture; ® concomitant diseases of the heart, brain , kidneys or digestive system,
METHODS
Group A
Acupoint application.: Hanci moxibustion patches manufactured by Jinan Hanci Biotechnology Co., Ltd. were applied over the areas of the most obvious pain in the neck. Patients were asked to take them off after 12 h. Patients were treated daily and 10 times constituted a course of treatment.
GroupB Acupoints: Jiaji [~~ EX-B 2 (C4-C7) ] , Fengchi (R¥t!! GB 20), Jianjfng UFHt: GB 21), Jianyu ()jijM LI 15), Waiguan (~~~ TE 5), Houxi (j§~ SI 3) and GV 14. After acupoints were accurately located and the skin was routinely disinfected, Huanqiu brand acupuncture needles with a diameter of 0.25 mm and a length of 40-50 mm were applied quickly to the acupoints to depth of 20 to 30 mm. A mild reinforcingreducing method was applied until the patients felt a needling response (de qi). The site with the most obvious tenderness and GB 20 were connected to G6805 II electroacupuncture apparatus and treated with dilatational wave with the frequency of 2 Hz/lOO Hz for 30 min to the degree patients could tolerate. Patients were treated once per day with 10 times as a course of treatment.
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WorldJournal ofAcupuncture-Moxibustion(WJAM) Vol. 24, No.3, 30th Sep. 2014
Efficacy evaluation Criteria of score of overall symptoms and signs: refered to "Scale of Symptoms and Function of Cervical Spondylosis Radiculopathy" developed by Tanaka Furuhara, a Japanese scholar, recommended by Chinese Journal ofOrthopaedics [8] (Table 1).
·27· group comparison, and statistical analysis was made by SPSS 17.0 software.
RESULTS Comparison of score of overall symptoms and signs (Table 2) Table 2 Comparison of total score of symptoms and signs of the CRS patients between the two groups before and after the treatment (X±s)
Criteria of efficacy evaluation: referred to the efficacy evaluation of cervical spondylosis in Criteria ofDiagnosis and Therapeutic Effect of Diseases and Syndromes in Traditional Chinese Medicine issued by the State Administration of Traditional Chinese Medicine of the People's Republic of China [9]. Cured: Initial symptoms disappeared and patient has normal muscle strength, the neck and limbs function properly, and patients are able to labor and work; Improved: Initial symptoms are alleviated, pain in shoulders, neck and back is alleviated, and functions of neck and limbs are improved; Ineffective: neither improvement in symptoms nor pain relief is found.
Groups
Patients Before treatment After treatment
Difference value
A
31
9.96±2.02
15.87±1.84 ')
5.91±1.95
B
30
10.02±1.76
13.59±1.52 ')
3.53±1.682)
Notes: comparison of scores before and after the treatment in the same group, 1)P<0.05; comparison of difference value in the two groups, 2) P<0.05.
Table 2 shows that clinical signs and symptoms of patients in group A were more improved compared to group B.
Statistical analysis
Comparison of overall efficacy between the two groups (Table 3)
Numerical data were compared via chi-square test or rank sum test; level data were analyzed with Ridit; measurement data were expressed as mean ± standard deviation (x±s), t test was used for inter-
Table 3 shows that the total effective rate was 93.6% in group A and 83.3% in group B. Treatments adopted in the two groups were effective overall, and the difference of total effective rate of two groups was
Table 1
Evaluation form of symptoms and functions of cervical spondylosis radiculopathy (CRS)
Item
Item
Score
m. Hand functions
I . Symptoms and chief complaint A. Pain and discomfort in neck and shoulder
Score
A. Normal
o
None
3
B. Weakness and discomfort
-I
Occasionally
2
C. Dysfunction
-2
o
A. Spurling test (foramen intervertebrale crushed test)
N. Signs
Often or severe sometimes Severe often
B. Pain and numbness in upper limbs None
3
Occasionally
2
Often or severe Severe very often
Negative
3
Pain in neck and shoulder without restricted motion of cervical vertebra
2
Pain in upper limbs and fingers without restricted motion of cervical vertebra Pain in neck and shoulder with restricted motion of cervical vertebra
o
C. Pain and numbness in fingers
Pain in upper limbs and fingers with restricted motion of cervical vertebra
o
B. Feeling
No
3
Normal
Occasionally
2
Mild dysfunction
Often or severe
I
Obvious dysfunction
Severe very often
o
IT.Ability to work or live
2 I
o
C. Muscle strength Normal
2 I
Normal
3
Mild dysfunction
Non-sustainable
2
Obvious dysfunction
Mild dysfunction
I
D. Tendon reflexes
Disability
o
Normal Diminished or vanished
o o
WorldJournal ofAcupuncture-Moxibustion (WJAM)
Vol. 24, No.3, 30th Sep.2014
·28· Table 3
Comparison of overall efficacy among CRS patients between the two groups
Groups Patients
Cured
Improved Ineffective
Total effective rate (%)
A
31
17
12
2
93.6%
B
30
13
12
5
83.3%1)
Note: compared with group B, 1) P<0.05.
statistically significant (P<0.05), indicating that the efficacy of bleeding collaterals and cupping combined with herbal patches on acupuncture points was better than that of electroacupuncture.
DISCUSSION Cervical spondylosis radiculopathy is a common and frequently-occurring disease in clinical medicine, and falls into the category of "bone bi", "blood bi" or "stiff neck" in traditional Chinese medicine, and is mostly found among the elderly. With development of society and transformation of many peoples' lifestyles in recent years, the prevalence of CRS has been occurring in younger and younger patients. This is mainly caused by poor posture in their daily life, study and work, such as working at the desk for long hours, watching TV in an improper posture, frequent driving, prolonged use of computer, use of air conditioning for long hours at too low of a temperature and so on. Data [10] shows that 80% of cervical lordosis among the youth is caused by incorrect posture while writing. According to Chinese medicine, cervical disease is a symptom of deficient root and excessive branch with deficiency of liver and kidney and insufficiency of vital energy and blood, represented by invasion by exogenous pathogenic wind, cold and dampness, stagnated main and collateral channels and qistagnation and blood stasis. However, most young CRS patients suffer from cold-dampness and blood stasis rather than deficiency, with pain caused by stagnation. They were treated by eliminating pathogen via dispelling cold and removing dampness and promoting blood circulation to remove blood stasis. Suwen (<<~r'ii]» Plain Questions) said, "Long-
term stagnation can be deemed to be blood stasis, which can be treated by letting blood out". GV 14, as the confluence of all yang-channels and the main acupoint of the covemor vessel, can boost the yang. Bleeding collaterals can eliminating evil and boost the yang, and cupping can warm and activate meridianchannels, promote blood circulation to remove blood stasis and warm channels and expel cold. By combining the two methods, the ability to let out blood and eliminate pathogen can be improved via
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the negative pressure of cupping. Meanwhile, the warmth enters into the body through the path to clear and activate the channels and collaterals, and promote blood circulation to remove blood stasis. According to modern medical theory, bleeding collaterals and cupping can eliminate subcutaneous blood stasis and reduce the pressure of local adhesions, be conducive to circulation of blood and lymph, and promote transportation and absorption of pathological by-products in the body. It can inspire the body's readjustment of injured and disordered functions of nerves and vessels by directly stimulating locally damaged peripheral nerves and capillary walls [Ill. Besides, Hand moxibustion is for external use with magnetic and infrared effects, which can promote cell metabolism, activate cells, promote blood circulation, improve microcirculation status, repel inflammation, eliminate inflammation swelling and pain, relieve fatigue and promote physical recovery, and exert a continuing warming effect, supplementing the effect of cupping. It was found in this study that though both of the two treatments were effective for cervical spondylosis radiculopathy, the therapy of bleeding collaterals and cupping combined with herbal patches on acupuncture points was more advantageous in terms of score improvement and overall effects. Moreover, most young patients are too busy to visit the hospital for the daily treatments required for electroacupuncture, making the two treatment course with treatments separated by five days for the bleeding, cupping and herbal patches treatment more practical. Patients may also be asked to do herbal patches on acupuncture points on their own so as to reduce commuting, which goes in line with the work style of young patients, and can relieve its impact on their life. Thus, the therapy is of clinical and practical significance.
REFERENCES [1] [2] [3]
[4]
Shi Q. Orthopedics and traumatology of TCM. Beijing: China Press of Traditional Chinese Medicine; 2005: 395. Wu ZD, WU ZH. Surgery (7th Edition) [M] Beijing: People's Medical Publishing House; 2008: 855-859. Zhong WH, Feng JP, Chen SJ, Song HM, Wang SZ. Epidemiological investigation and study of risky factors of cervical diseases among the young and the middle-aged who tend to work at the desk for long hours in Fuzhou. Chin J Tradit Med Traumatol Orthop (Chin) 2010; 18(2): 50-51. Sun FQ, Li YJ, Zhao BS, Wu JQ, Li SH. Treating cervical spondylosis radiculopathy (CRS) with integrated Chinese and Western medicines. Med Inf (Chin) 2011; 24 (23):
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[5]
[6] [7]
[8]
World Journal ofAcupuncture-Moxibustion (WJAM) Vol. 24, No.3, 30th Sep. 2014
252-253. Wang WB, Xue YL, Zhang JZ. Recent situation of treating cervical spondylosis radiculopathy with traditional Chinese medicine. J Gansu ColI Tradit Chin Med (Chin) 2011; 28(1): 68-70. Tong YT. Anti-aging. Beijing: People's Medical Publishing House; 2000: 36. The 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: 186-189. Jiang H, Shi Q. Introduction to a method of efficacy
·29· evaluation of cervical spondylosis radiculopathy [1] Chin J Orthop (Chin) 1998; 18(6): 381. [9] Chen VB. Criteria of diagnosis and therapeutic effect of diseases and syndromes in traditional Chinese medicine (1st version). Nanjing: Nanjing University Press; 1994: 186. [10] Wang YW. Prevention and massage therapy of cervical diseases among adolescents. Chin J Clinical Healthc (Chin) 2009; 12(1): 109-110. [11] CUI JX. Treating 64 cases of arthralgia syndrome with the therapy of bleeding colIaterals and cupping. J Extern TherTradit Chin Med (Chin) 1996; (10): 16-16.
ABSTRACT IN CHINE SE [~J!J §~: ~.w..$~~~~l.J~~K1.iJjJ6It~;ff~1rt~~*-~-k-+.~;f-~113lto 155!: 6117~;ff~1rt~ ~*-~,~;f-.#(-F.it;.fJL4t~'!'*~)l;K~UlI. (311f~) ~tAt~ll (3017~) , K~Ull~:tJi,iFf hi!J'f'f""~~~1!i!1
*-*-*-m
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~~~;ffaJ31f.a.~ (K~Ull: 9.96±2.02 vs 15.87±1.84, P<0.05; t.4till: 10.02±1.76 vs 13.59±1.52, P<0.05) , KJjJ6~lI.~~a.~~ t.#~lI.~)l; llJ31f. ( ~ ~ll;:{211 ~ ~ it {i: K~UlI.)l; 5.91 ± 1.95, t.4t~lI.)l; 3.53 ± 1.68, P<0.05) , K~UlI..~;ff3lt.!f.)l;93.6% (29/31), #~-r-t.#~1l~83.3%(25/30), it.ff-;ff#t3t ~-I;5l (P<0.05) 0 .i.~: ~~t~~l.J~~K1.iIt~6~#~1rt~~*-~-k-+.~;f-;ffJt*;:{2113lt*-o
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World Journal ofAcupuncture-Moxibustion (WJAM) Vol. 24, No.3, 30th Sep. 2014
·25 •
Clinical Research Comparison of efficacy between electroacupuncture and the combination of collateral bloodletting, cupping, and acupoint application for cervical spondylosis radiculopathy (CRS) Jt!Ug-*f£ffii~ir1C1iLmlif1~~$t1itrT:fEJI~1&m~ft~EBrT~t~~ HU Ai-e (j}]1t~), YANG Hui-qin (~~l!J) Rehabilitation Department ofYunfu People's Hospital, Yunfu 527300, Guangdong, China ()*11f~1¥rPA ~~~*~U4, ~Y!f. 527300)
ARTICLE INFO
ABSTRACT
Author: HU Ai-e, (1971-), female, associate
Objective To observe the efficacy of treating young patients with cervical spondylosis radiculopathy (CRS) by collateral bloodletting, cupping, and acupoint application. Methods Sixty-one CRS patients were randomly divided into an acupoint application group (group A, 31 cases) and an electroacupuncture group (group B, 30 cases). Both sides of the spine and scapula were treated with collateral bloodletting, cupping, and acupoint application over Ash; points in group A. The following points received electroacupuncture in group B: JiajT (~lf EX-B2), Fengchf ())(\.¥t!! GB 20), Jlanjlng ()ijjt GB 21), Jianyu ()ijM LI 15), Waiguan (;9~* TE 5), Houxl (J§ SI 3) and Dazhul t:k* GV 14). Patients in the two groups were compared in terms of scores for total symptoms and signs, and the theraputic effect of each method was analyzed. Results Total score of symptoms and signs of the two groups were both more significantly improved compared to that before treatment (9.96 ± 2.02 vs 15.87 ± 1.84, P<0.05 in group A; 10.02 ± 1.76 vs 13.59 ± 1.52, P<0.05 in group B). The differences in two groups before and after treatment were 5.91 ± 1.95 in group A, 3.53 ± 1.68 in group B, they were statistically significant (P<0.05). The total effective rate of group A [93.6% (29/31)] was better than that of group B [83.3% (25/30)), and the differences were statistically significant (P<0.05). Conclusion Good therapeutic effects can be achieved in treating young CRS patients with collateral bloodletting, cupping, and acupoint application.
chief physician. Research field: The combination of acupuncture and herbs in the treatment of nervous system disease and pain. E-mail: [email protected] Accepted on February 24, 2014
m
KEY WORDS: cervical spondylosis radiculopathy (CRS); collateral bloodletting; cupping; acupoint application; young patients; clinical observation
PA review of the literature shows [I] that the incidence of cervical spondylosis radiculopathy (CRS) amongst pateinets with cervical diseases is quite high (from 50 % to 60%) [2]. Over the past decade, the prevalence of CRS in younger populations has grown significantly [3-5]. The World Health Organization (WHO) issued a recent standard forage ranges with individuals aged 18 to 44 classified as "youth" [6]. This study aimed to observe the efficacy of treating CRS patients with bleeding collaterals and cupping
combined with herbal patches on acupuncture points to address the challenge of an increasing number of young patients with cervical spondylosis.
CLINICAL DATA
General data Sixty-one young CRS patients were selected from inpatient and outpatient department ofYunfu People's Hospital between July 2010 and July 2012, including
·26·
World Journal ofAcupuncture-Moxibustion (WJAM) Vol.24, No.3, 30th Sep. 2014
ELSEVIER
34 males and 27 females. Patients were aged 18 to 44 with an average age of 31.5; the shortest course of disease lasted for five days and the longest lasted for four years, with an average of 73.5 days. 61 patients were divided into an acupoint application group (group A, 31 cases) and an electroacupuncture group (group B, 30 cases) based on a random number table. All subjects signed Informed Consent and the study program were approved by the Ethics Committee. The differences of gender, age, course of disease and pre-treatment symptom scores were not statistically significant (all P>0.05) between two groups and were comparable.
or psychoneurosis and mental illness; ® currently receiving other treatments at the same time; @ pregnancy or breast feeding, drug allergies; ® diseases such as fracture of cervical vertebrae, dislocation, tuberculosis, tumor, infections and so on, and brokenskin or wounds around the treatment area; CD failed to receive relevant therapy on schedule to a degree that affected efficacy observation, or did not complete course of treatment or provide other relevant data necessary for evaluation of efficacy.
Diagnostic criteria
collateral bloodletting, cupping: patients lay in prone position, and the practitioner coated the patient's muscles on both sides of the spine and both scapula with liquid paraffin, and then applied "moving cupping" from top to bottom 10 to 15 times. Paraffin was wiped off, and the skin was routinely disinfected. Then, Dazhui (:Am GV 14), Ashi points and areas with ecchymosis were needled rapidly with threeedged needles to the depth of 1 to 2 mm, after which cups were applied so that 0.5-3 mL of blood was obtained in the glass cups. Cups were retained for 10 min. After cupping, blood was cleaned from the skin and band-aids were applied to disinfected skin. Patients were treated once every 5 days, and two treatments were the total course of treatment.
Diagnostic criteria for cervical diseases in Criteria ofDiagnosis and Therapeutic Effect of Diseases and Syndromes in Traditional Chinese Medicine (ZY/ TOO1.9-94) stipulated by the State Administration of Traditional Chinese Medicine of the People's Republic of China were used as our standard [7]. The criteria include: CD Chronic strain or trauma, or congenital cervical abnormality, cervical degenerative change. ® Prevalent in those that work with heads lowered for a long time or those accustomed to watching TV or using a computer for long hours, resulting in chronic diseases. ® Symptoms include pain in the neck, shoulders and back, headache and dizziness, stiff neck, and numbness in the upper limbs. ® Neck dysfunction, disk herniation, tenderness in the upper comer of the scapula, palpable cord-like indurations, weakness and atrophy of muscles in the upper limbs, positive test of brachial plexus traction, and a positive spurling test. @ Straight-view X-ray reveals hyperplasia of uncovertebral joint; open-mouth view X-ray shows odontoid disorientation; lateralview X-ray shows straighting of the normalcervical curvature, narrowing intervertebral space, and hyperostosis or calcification of ligaments, and the oblique X-ray shows narrowing of the intervertebral foramen. CT and magnetic resonance imaging (MRI) may allow more localizeddiagnosis.
Inclusion criteria
CD Fitdiagnostic criteria above; ® aged 18 to 44 years, willing and able to complete clinical study; ® signed Informed Consent. Exclusion criteria
CD Do not match diagnostic criteria and inclusion criteria above; ® previous adverse reactions (e.g., fainting) to acupuncture; ® concomitant diseases of the heart, brain , kidneys or digestive system,
METHODS
Group A
Acupoint application.: Hanci moxibustion patches manufactured by Jinan Hanci Biotechnology Co., Ltd. were applied over the areas of the most obvious pain in the neck. Patients were asked to take them off after 12 h. Patients were treated daily and 10 times constituted a course of treatment.
GroupB Acupoints: Jiaji [~~ EX-B 2 (C4-C7) ] , Fengchi (R¥t!! GB 20), Jianjfng UFHt: GB 21), Jianyu ()jijM LI 15), Waiguan (~~~ TE 5), Houxi (j§~ SI 3) and GV 14. After acupoints were accurately located and the skin was routinely disinfected, Huanqiu brand acupuncture needles with a diameter of 0.25 mm and a length of 40-50 mm were applied quickly to the acupoints to depth of 20 to 30 mm. A mild reinforcingreducing method was applied until the patients felt a needling response (de qi). The site with the most obvious tenderness and GB 20 were connected to G6805 II electroacupuncture apparatus and treated with dilatational wave with the frequency of 2 Hz/lOO Hz for 30 min to the degree patients could tolerate. Patients were treated once per day with 10 times as a course of treatment.
ELSEVIER
WorldJournal ofAcupuncture-Moxibustion(WJAM) Vol. 24, No.3, 30th Sep. 2014
Efficacy evaluation Criteria of score of overall symptoms and signs: refered to "Scale of Symptoms and Function of Cervical Spondylosis Radiculopathy" developed by Tanaka Furuhara, a Japanese scholar, recommended by Chinese Journal ofOrthopaedics [8] (Table 1).
·27· group comparison, and statistical analysis was made by SPSS 17.0 software.
RESULTS Comparison of score of overall symptoms and signs (Table 2) Table 2 Comparison of total score of symptoms and signs of the CRS patients between the two groups before and after the treatment (X±s)
Criteria of efficacy evaluation: referred to the efficacy evaluation of cervical spondylosis in Criteria ofDiagnosis and Therapeutic Effect of Diseases and Syndromes in Traditional Chinese Medicine issued by the State Administration of Traditional Chinese Medicine of the People's Republic of China [9]. Cured: Initial symptoms disappeared and patient has normal muscle strength, the neck and limbs function properly, and patients are able to labor and work; Improved: Initial symptoms are alleviated, pain in shoulders, neck and back is alleviated, and functions of neck and limbs are improved; Ineffective: neither improvement in symptoms nor pain relief is found.
Groups
Patients Before treatment After treatment
Difference value
A
31
9.96±2.02
15.87±1.84 ')
5.91±1.95
B
30
10.02±1.76
13.59±1.52 ')
3.53±1.682)
Notes: comparison of scores before and after the treatment in the same group, 1)P<0.05; comparison of difference value in the two groups, 2) P<0.05.
Table 2 shows that clinical signs and symptoms of patients in group A were more improved compared to group B.
Statistical analysis
Comparison of overall efficacy between the two groups (Table 3)
Numerical data were compared via chi-square test or rank sum test; level data were analyzed with Ridit; measurement data were expressed as mean ± standard deviation (x±s), t test was used for inter-
Table 3 shows that the total effective rate was 93.6% in group A and 83.3% in group B. Treatments adopted in the two groups were effective overall, and the difference of total effective rate of two groups was
Table 1
Evaluation form of symptoms and functions of cervical spondylosis radiculopathy (CRS)
Item
Item
Score
m. Hand functions
I . Symptoms and chief complaint A. Pain and discomfort in neck and shoulder
Score
A. Normal
o
None
3
B. Weakness and discomfort
-I
Occasionally
2
C. Dysfunction
-2
o
A. Spurling test (foramen intervertebrale crushed test)
N. Signs
Often or severe sometimes Severe often
B. Pain and numbness in upper limbs None
3
Occasionally
2
Often or severe Severe very often
Negative
3
Pain in neck and shoulder without restricted motion of cervical vertebra
2
Pain in upper limbs and fingers without restricted motion of cervical vertebra Pain in neck and shoulder with restricted motion of cervical vertebra
o
C. Pain and numbness in fingers
Pain in upper limbs and fingers with restricted motion of cervical vertebra
o
B. Feeling
No
3
Normal
Occasionally
2
Mild dysfunction
Often or severe
I
Obvious dysfunction
Severe very often
o
IT.Ability to work or live
2 I
o
C. Muscle strength Normal
2 I
Normal
3
Mild dysfunction
Non-sustainable
2
Obvious dysfunction
Mild dysfunction
I
D. Tendon reflexes
Disability
o
Normal Diminished or vanished
o o
WorldJournal ofAcupuncture-Moxibustion (WJAM)
Vol. 24, No.3, 30th Sep.2014
·28· Table 3
Comparison of overall efficacy among CRS patients between the two groups
Groups Patients
Cured
Improved Ineffective
Total effective rate (%)
A
31
17
12
2
93.6%
B
30
13
12
5
83.3%1)
Note: compared with group B, 1) P<0.05.
statistically significant (P<0.05), indicating that the efficacy of bleeding collaterals and cupping combined with herbal patches on acupuncture points was better than that of electroacupuncture.
DISCUSSION Cervical spondylosis radiculopathy is a common and frequently-occurring disease in clinical medicine, and falls into the category of "bone bi", "blood bi" or "stiff neck" in traditional Chinese medicine, and is mostly found among the elderly. With development of society and transformation of many peoples' lifestyles in recent years, the prevalence of CRS has been occurring in younger and younger patients. This is mainly caused by poor posture in their daily life, study and work, such as working at the desk for long hours, watching TV in an improper posture, frequent driving, prolonged use of computer, use of air conditioning for long hours at too low of a temperature and so on. Data [10] shows that 80% of cervical lordosis among the youth is caused by incorrect posture while writing. According to Chinese medicine, cervical disease is a symptom of deficient root and excessive branch with deficiency of liver and kidney and insufficiency of vital energy and blood, represented by invasion by exogenous pathogenic wind, cold and dampness, stagnated main and collateral channels and qistagnation and blood stasis. However, most young CRS patients suffer from cold-dampness and blood stasis rather than deficiency, with pain caused by stagnation. They were treated by eliminating pathogen via dispelling cold and removing dampness and promoting blood circulation to remove blood stasis. Suwen (<<~r'ii]» Plain Questions) said, "Long-
term stagnation can be deemed to be blood stasis, which can be treated by letting blood out". GV 14, as the confluence of all yang-channels and the main acupoint of the covemor vessel, can boost the yang. Bleeding collaterals can eliminating evil and boost the yang, and cupping can warm and activate meridianchannels, promote blood circulation to remove blood stasis and warm channels and expel cold. By combining the two methods, the ability to let out blood and eliminate pathogen can be improved via
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the negative pressure of cupping. Meanwhile, the warmth enters into the body through the path to clear and activate the channels and collaterals, and promote blood circulation to remove blood stasis. According to modern medical theory, bleeding collaterals and cupping can eliminate subcutaneous blood stasis and reduce the pressure of local adhesions, be conducive to circulation of blood and lymph, and promote transportation and absorption of pathological by-products in the body. It can inspire the body's readjustment of injured and disordered functions of nerves and vessels by directly stimulating locally damaged peripheral nerves and capillary walls [Ill. Besides, Hand moxibustion is for external use with magnetic and infrared effects, which can promote cell metabolism, activate cells, promote blood circulation, improve microcirculation status, repel inflammation, eliminate inflammation swelling and pain, relieve fatigue and promote physical recovery, and exert a continuing warming effect, supplementing the effect of cupping. It was found in this study that though both of the two treatments were effective for cervical spondylosis radiculopathy, the therapy of bleeding collaterals and cupping combined with herbal patches on acupuncture points was more advantageous in terms of score improvement and overall effects. Moreover, most young patients are too busy to visit the hospital for the daily treatments required for electroacupuncture, making the two treatment course with treatments separated by five days for the bleeding, cupping and herbal patches treatment more practical. Patients may also be asked to do herbal patches on acupuncture points on their own so as to reduce commuting, which goes in line with the work style of young patients, and can relieve its impact on their life. Thus, the therapy is of clinical and practical significance.
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[4]
Shi Q. Orthopedics and traumatology of TCM. Beijing: China Press of Traditional Chinese Medicine; 2005: 395. Wu ZD, WU ZH. Surgery (7th Edition) [M] Beijing: People's Medical Publishing House; 2008: 855-859. Zhong WH, Feng JP, Chen SJ, Song HM, Wang SZ. Epidemiological investigation and study of risky factors of cervical diseases among the young and the middle-aged who tend to work at the desk for long hours in Fuzhou. Chin J Tradit Med Traumatol Orthop (Chin) 2010; 18(2): 50-51. Sun FQ, Li YJ, Zhao BS, Wu JQ, Li SH. Treating cervical spondylosis radiculopathy (CRS) with integrated Chinese and Western medicines. Med Inf (Chin) 2011; 24 (23):
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World Journal ofAcupuncture-Moxibustion (WJAM) Vol. 24, No.3, 30th Sep. 2014
252-253. Wang WB, Xue YL, Zhang JZ. Recent situation of treating cervical spondylosis radiculopathy with traditional Chinese medicine. J Gansu ColI Tradit Chin Med (Chin) 2011; 28(1): 68-70. Tong YT. Anti-aging. Beijing: People's Medical Publishing House; 2000: 36. The 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: 186-189. Jiang H, Shi Q. Introduction to a method of efficacy
·29· evaluation of cervical spondylosis radiculopathy [1] Chin J Orthop (Chin) 1998; 18(6): 381. [9] Chen VB. Criteria of diagnosis and therapeutic effect of diseases and syndromes in traditional Chinese medicine (1st version). Nanjing: Nanjing University Press; 1994: 186. [10] Wang YW. Prevention and massage therapy of cervical diseases among adolescents. Chin J Clinical Healthc (Chin) 2009; 12(1): 109-110. [11] CUI JX. Treating 64 cases of arthralgia syndrome with the therapy of bleeding colIaterals and cupping. J Extern TherTradit Chin Med (Chin) 1996; (10): 16-16.
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