- Email: [email protected]
Efficacy observation on degenerative gonitis treated with triple needling combined with thunder-fire moxibustion
WorldJournal ofAcupuncture-Moxibustion (WJAM) Vol. 24, No.3, 30th Sep. 2014
·30·
ELSEVIER
Clinical Research
Efficacy observation on degenerative gonitis treated with triple needling combined with thunder-fire moxibustion *J1!Ur!~~~-*~1it1J:ll!1-rJt1:JJ*~-=P~1J%(~~~ XU Ying-ying H~1l; 1l;), HU Bing-cheng (;;J] ~ A) Heilongjiang Academy of TCM, Harbin 150001, China (~:JtU1!P:P~~~...j.~~, Pft~~ 150001,
9=tOO)
ARTICLE INFO
ABSTRACT
First author: XU Ying-ying (1979-), female,
Objective To evaluate the clinical efficacy of degenerative gonitis treated with triple needling combined with thunder-fire moxibustion for better promotion and clinical application. Methods Ninety-eight patients with degenerative gonitis were randomly divided into a thunder-fire moxibustion group (group A) and an acupuncture group (group B) according to randon number table, with forty-nine cases in each group. In group A, Neixiyan (I*J JJ*~i EX-LE 4), Dubf (~ .. ST 35), Yanglfngquan (~~* GB 34), Xuehai tIfil#J SP 10), LiangqiO (~Ji ST 34), ZusanlT OE =:.!f ST 36), Ylnllngquan (IDj~* SP 9) and Xiyangguan (JJ*~S 7k GB 33) were selected to accept triple and needling thunder-fire moxibustion for 20 min after the needles were retained for 40 min. The patients in group B were only treated with acupuncture. Thunder-fire moxibustion was not applied in the group B. The treatment was given once a day for four weeks. Knee function score and knee stiffness score in both groups were recorded before and after treatment, and the therapeutic effect was assessed. Results After four weeks' treatment, the total effective rate of group A was 93.9% (46/49), which was superior to 71.4% (35/49) in group B (P<0.05). Improvement in knee stiffness in group A was superior to that in group B (P
attending physician, doctor. Researchfield: acupuncture in the treatment of nerve system disease. E-mail: [email protected] Accepted on February 9, 2014.
KEY WORDS: gonitis; triple needling; thunder-fire moxibustion
Degenerative gonitis, namely knee osteoarthritis, characterized by j oint pain and dysfunction, is common in middle aged and elderly people with a higher morbidity in women than in men [11• In the study, triple needling combined with thunder-fire moxibustion was applied at local acupoints for the treatment of knee osteoarthritis to explore the safety, effectiveness and reliability of the therapy, which is reported as follows.
CLINICAL DATA
General data Ninety-eight cases of inpatients and outpatients were from the department of acupuncture and
moxibustion in Heilongjiang Academy of TCM from January 2011 to December 2012. According to the random number table, they were divided into a thunder-fire moxibustion group (group A) and an acupuncture group (group B) based on the time sequence of being treated. There were eighteen males and thirty-one females (forty-nine in total) in the group A, aged from 39 to 75 years and sick for 17 to 60 months. In the group B, there were nineteen males and thirty females (forty-nine in total), aged from 41 to 77 years and sick for 19 to 60 months. There was no statistically significant difference in age, sex and course of disease between both groups (all P>0.05), which was comparable (Table 1).
, World Journal ofAcupuncture-Moxibustion (WJAM) Vol. 24, No.3, 30th Sep. 2014
...-t:lBll1ilO'
• 31 •
ELSEVIER
Table 1
Comparison of general data of patients with gonitis in the two groups Female
Age (X±s, years)
18
31
19
30
Groups
Patients
Male
A
49
B
49
Average course (X±s, months)
One knee (cases)
Both knees (cases)
58±9
37.7± 11.9
31
18
58±1O
36.2± 10.2
32
17
Diagnostic criteria Knee osteoarthritis was diagnosed according to the Diagnostic Criteria for Knee Osteoarthritis revised by American Rheumatism Association (ARA) in 1995 [1]: CD knee pain during most of time in recent one month; ® crepitus on active motion; @morning stiffness ~30 min; @ aged~38 years old; @ bony hypertrophy verified by knee examination; ® joint marginal osteophyte revealed by X-ray. Patients conforming to CD®@@orCD®@orCD@@ were diagnosed as knee osteoarthritis.
Inclusive criteria CD Those being in compliance with the diagnostic criteria; ® those voluntarily received treatment and examination for 4 weeks; @ those who did not take any analgesics or hormone within one month before and during treatment.
Exclusive criteria CD Those who did not comply with the inclusive criteria above; ® those who complicated with severe cardiovascular diseases, liver diseases, kidney diseases and diseases of hematopoietic system and psychosis; @ those who had diseases with manifestation of arthritis such as rheumatoid arthritis , ankylosing spondylitis and gout; those who had joint complications of psoriasis, syphilitic neuropathy, ochronosis and metabolic bone diseases, etc.; @ those who complicated with bone tumor, bone tuberculosis or meniscus injury, ligament rupture and neurovascular injury due to obvious acute trauma and those who had a history of varus deformity and valgus deformity of the knee; @ those who had bony ankylosis caused by severe knee joint space stenosis or bone bridge between the bones of the joint; ® pregnant or lactating women; CD those who dropped out of the study or turned to another treatment method during the study, which led to inability to determine the efficacy or those whose data was incomplete, which affected the determination of efficacy.
36), Yinlingquan (IDj~:& SP 9) at both sides and Xlyangguan (~~~ GB 33) were selected. Manipulation: after regular sterilization, the 0.35 mmX40 mm disposable filiform needles were first inserted at EX-LE 4 and ST 35 about 25-40 mm in depth. After deqi, two needles were obliquely inserted at both sides of ST 35 and EX-LE 4 respectively. The even needling technique was applied after the deqi. The needles were retained for 40 min. The filiform needles were perpendicularly inserted at GB 34, SP 10, ST 34, ST 36, SP 9 and GB 33 about 25-40 mm in depth. The needles were retained for 40 min after qi was obtained. Thunder-fire moxibustion: after acupuncture, thunder-fire moxa stick was burned and put into the moxa box. According to patient's tolerance, suspended moxibustion was applied at the above-mentioned acupoints till the appearance of erubescence for 20 min. Be careful not to burn the skin during the treatment. Excessive weight-bearing and movement of joints should be avoided.
GroupB The acupuncture and manipulation applied in group B were the same as those in the group A. The thunder-fire moxibustion was not applied. The treatment was given once a day for a course with four weeks of above treatment constituting a course.
Observation indices
Group A
Knee function assessment: according to Knee Function Scale [2], efficacy in patients was assessed and knee function was evaluated. Knee function score was recorded before and after treatment respectively. The Knee Function Scale was composed of seven items such as pain, walking, joint flexion, instability, swelling, ascending and descending stairs and joint twist. The Knee Function Scale score ranged from 0 to 100. The higher the score was, the better knee function would be. Score of Knee Function Scale <70 showed that the patient suffered from severe knee dysfunction.
Neixiyan (i*J~D~ EX-LE 4), Dubi (~. ST 35), Yanglingquan (~S~:& GB 34), Xuehai (1fn.~ SP 10), Liangqiu (~Ji ST 34), Zusanl] O?:--=:..m. ST
N -rating scale [3] method was applied to assess knee stiffness of the patients. The score was recorded
METHODS
WorldJournal ofAcupuncture-Moxibustion (WJAM)
·32·
Vol. 24, No.3, 30th Sep.2014
before and after treatment respectively. Morning stiffness: 1 point: severe, stiffness for 20-30 min; 2 points: serious, stiffness for lO-20 min; 3 points: mild, stiffness for less than lO min; 4 points: without stiffness. Evaluation of therapeutic effects for knee stiffness'"; markably effective, the score increased by 2 points; effective, the score increased by 1 point; ineffective, the score after treatment was the same as that before treatment. The score of 4 points before treatment indicated there was no stiffness; the score was still 4 points after treatment, which was not considered as ineffective or included into the statistics.
Evaluation standard of clinical efficacy Knee function assessment: Guidelines for Clinical Research on New Traditional Chinese Medicine was used as reference to formulate the criteria. Clinical control: symptoms and signs such as pain and swelling disappeared, knee joint motion was in normal range and the improvement rate was >90%; markably effective: symptoms and signs such as pain and swelling disappeared, range of knee joint motion was not limited and the improvement rate was >70% but ~90%; effective: symptoms and signs such as pain and swelling almost disappeared, range of knee joint motion was slightly limited and the improvement rate was >30% but ~70%; ineffective: symptoms and signs showed no obvious improvement and the improvement rate was ~30%. Improvemen t ra te= [( score s be fore treatment - scores after treatment) -;- scores before treatment] X 100%.
Table 2 Comparison of knee function score of patients with degenerative gonitis in both groups (X±s, point)
RESULTS Comparison of knee function score of patients with degenerative gonitis in both groups (Table 2) As shown in Table 2, the difference in knee function score was not statistically significant in the two groups before treatment (P>0.05), which was comparable. Knee function score of both groups
P
Groups Patients Before teatment After teatment
A
49
49.50±8.17
77.43±1O.49 1) 2)
B
49
48.21±7.00
67.54±11.37 ')
14.69
< 0.01
10.13
< 0.01
Notes: compared with that before treatment in the same group,
l)P
significantly increased after treatment compared with that before treatment (both P
Comparison of knee stiffness of patients with degenerative gonitis in both groups (Table 3, 4) Table 3 Comparison of knee stiffness score of patients with degenerative gonitis in both groups (X±s, point) Groups
Morning stiffness
A
1.93±1.03
1.94±0.93
B
1.86±1.04
2.00±1.00
Patients
39
48
Tvalue
0.335
0.308
Pvalue
>0.05
>0.05
Morning stiffness aftet a while
Table 4 Comparison of improvement in knee stiffness of patients with degenerative gonitis in both groups Cases . Markab1y Gr oups C on diti tion symptoms Patients effective E ffecti ective me ffecti ective
A
Statistical analysis SPSS 13.0 statistical software was applied in data analysis. The data was expressed as mean ± standard deviation (X±s). The measurement data was compared by adopting t test, enumeration data was compared via i test, and ranked data was compared through Ridit test. When P<0.05, the difference was statistically significant.
ELSEVIER
B
Morning stiffness
20
5
13
2
Morning stiffness after a while
24
8
14
2
Morning stiffness
19
4
8
7
Morning stiffness after a while
24
5
11
8
As shown in Table 3, the difference in knee stiffness score was not statistically significant in the two groups (P>0.05), which is comparable. As Table 4 showed, i test was used for comparison of improvement in knee stiffness between the two groups after treatment. Improvement in knee stiffness in group A was superior to that in group B after treatment (P
Comparison of the clinical effect of patients with degenerative gonitis in both groups (Table 5) As shown in Table 5, the total effective rate of group A was 93.9%, which was superior to 71.4% in
ELSEVIER
World Journal ofAcupuncture-Moxibustion (WJAM) Vol. 24, No.3, 30th Sep. 2014
Table 5
° 33 °
Comparison of clinical efficacy of knee function score of patients with degenerative gonitis in both groups Cases (%)
Groups
Patients
Clinical controll
Markedly effective
Effective
Ineffective
Total effective
A
49
10 (20.5)
18 (36.7)
18 (36.7)
3 (6.1)
93.9%1)
B
49
5 (10.2)
11 (22.4)
19 (38.8)
14 (28.6)
71.4%
Note: compared with that in group B, 1)P<0.05.
the group B (P
DISCUSSION In TCM, degenerative gonitis pertains to "bi syndrome", "bone bi", "gonyalgia" or "arthroncus of knee". In the view of TCM, it is caused by kidney qi deficiency, striae and interstices empty, deficiency of qi and blood, sinew and bone malnutrition and invasion of pathogenic wind, cold and dampness, which result in the obstruction of meridians, qi stagnation and blood stasis and lead to soreness and numbness. The disease located at knee. As "knee is the house of tendons" and "the disease of the tendons is treated by acupuncture applied at the acupoints where there is a feeling of pain", local acupoints, EX-LE 4 and ST 35, were selected. GB 34 was selected as it is hesea point of foot shaoyang gallbladder meridian, the lower he-sea acupointts of the gallbladder and one of the eight confluent points associating with tendons. SP lOis belonged to foot taiyin spleen meridian. Zhenjiu Jiayijing ( tr~ ftI Z~» A-B Classic ofAcupuncture and Moxibustion) said: SP 10 is used for the treatment of abdominal distension and upward flow of qi caused by poor blood flow. ST 34 is cleft points of foot yangming stomach meridian. The spleen is a zangorgan, pertaining to yin, and the stomach is ajU-organ, pertaining to yang, which were selected together to move qi and invigorate blood, relax the sinews and quicken the collaterals, as well as reduce swelling and ease pain. The spleen and stomach are the foundation of acquired (postnatal) constitution and the source of qi and blood production. Water-dampness can be eliminated by healthy transformation of spleen and stomach. SP 9 was selected to fortify the spleen and eliminate dampness and unblock the collaterals and relieve pain. The foot yangming stomach meridian is the meridian full of qi and blood. ST 36 was selected to supplement and boost qi and blood as well as unblock the meridians and quicken the collaterals. The acupoints above constitute the prescription widely used for the treatment of degenerative gonitis. Method for selecting points for the treatment of bi syndrome
«
in Ling Shu °Guang Zhen (<<.~m o-gtr» The Miraculous Pivot °Official Needling Techniques) is to select acupoints located in the affected area aiming to achieve balance between yin and yang, eliminate pathogenic qi and eliminate block in meridians by local regulation yin and yang in organs and tendons. Triple needling, first documented in Ling Shu «(~m» The Miraculous Pivot), is an ancient method
of acupuncture for bi syndrome caused by invasion of cold into meridians, which is one of the twelve methods of needling. One needle is perpendicularly inserted into focal area with an other two beside it, the three needles are in a line. Lingshu - Guangzhen ( «~ m--gtr» The Miraculous Pivot-Official Needling Techniques) said: there are twelve methods of needling corresponding to twelve meridians··· in triple needling method, one needle is perpendicularly inserted with the other two beside it to treat bi syndrome with limited range and deep location caused by invasion of cold. As knee obstruction is caused by stagnation of qi and blood as well as invasion of pathogenic wind, cold and dampness, triple needling for knee obstruction conforms to the guiding ideology in Neijing I*J~» The Inner Classic), which is to treat bi syndrome with limited range and deep location caused by invasion of cold. Moreover, three needles are inserted toward focal area, strengthening stimulation of acupuncture and dredging the meridians.
«(
Gonitis pertains to bi syndrome in TCM. Suwen - Bilun ~ rPJ - i-i» Plain Questions - Bi Syndrome) said bi syndrome is caused by repeated invasion of pathogenic wind, cold and dampness in the season each organ corresponds to. Moreover, it is caused by invasion of pathogenic wind, cold and dampness that block the meridians. Therefore, acupuncture plus moxibustion are applied to dispel wind and eliminate dampness, dissipate cold and relieve pain and dredge the meridian. Thunderfire moxa sticks comprise of a variety of Chinese herbal which are matched according to diseases and syndromes in order to dredge the channel, subside swelling and relieve pain, invigorate blood and dissolve stasis, dispel wind and dampness, warm the meridians and dissipate cold as well as
«(
m
World Journal ofAcupuncture-Moxibustion (WJAM)
Vol. 24, No.3, 30th Sep.2014
·34·
reinforce healthy qi and eliminate pathogenic factors. Moxibustion is characterized by drastic effect of drug, strong firepower, high penetrability and wide application scope. Local acupuncture plus thunderfire moxibustion leads to free motion of joint as wind and dampness is dispelled and pain is relieved due to unblocking in channel. Moxibustion aims to achieve prevention and treatment of diseases and health care by warming and unblocking qi and blood as well as strengthening healthy qi and eliminating pathogenic factors in virtue of heat and effect of Chinese herbal medicine circulating in meridians. In ancient books and records as well as in modem researches, moxibustion has an important advantage in treatment for bi syndrome. The study shows that triple needling combined with thunder-fire moxibustion has significant therapeutic effect on degenerative gonitis. In conclusion, according to this study, it was confirmed that triple needling combined with thunderfire moxibustion was an effective therapeutic method for gonitis, which significantly improved the clinical
ELSEVIER
symptoms of knee stiffness of the patients and increased knee function score with remarkable efficacy in relieving clinical symptoms and delaying the development of disease. The therapeutic method was a good option which improved knee function, relieved symptoms and enhanced quality of life. The therapy was safe and effective without adverse reactions, holding the value of promotion and application.
REFERENCES [1]
[2]
[3]
[4]
Shi DY. Arthritis Overview. Beijing: China MedicoPharmaceutical Sciences and Technology Publishing House 2000: 331,339. Wang YB, Wang HF, Li GP, Xu H, Zhu WHo Clinical research on knee function scale. Chin J Rehabil Med (Chin) 2005; 20(2): 103-104. Guan JZ, Zhou JS. Clinical experience in sodium hyaluronate for treatment of knee osteoarthritis. J Bengbu Med ColI (Chin) 2006; 31(1): 23-24. Fu J, Yuan JB. Clinical observation on knee osteoarthritis treated with sodium hyaluronate injection. Food and medicine (Chin) 2005; 7(11): 30-31.
ABSTRACT IN CHINE SE [mi~]
13 tl
if-11r1i-~tl *M~t" :J(~~l1i!At't1.$-*"1 ~fr!J IJ~4.113tt,
I'AJ9J~:llf~$r
ELm TI)~4.o
""Jj)t;;: ¥f-9811~ i!At·t1.$-*"1 ~,~=t-1~-iiF.ttJt.~~~?}-7{] ~.t$-iJl~~.lH\ill~4911~, ~.t$-ill3Zt.Jf5t~~J;-, P-l$o~, Fa&;Jl, kilt, *.tt., Jt~.£, m&;Jl, $-Fa*, 4t~tl40 minJ6~R*-1tt":J(~20min, ~.lH\ill.R #~, ~*fft":J(~o~11.al~,~~114~o~11.J6~.~*ff$-*"1~ftif-?}-,$-*"1.~. ltif-?}-**-1tl13ttif-11r 0 !i!i~: ~114~J6, ~f;11 ill$-* "1~~~if-?}-.~;ff3tt.f.7{]93.9% (46/49), ~JRt
ill,~;ff3tt.f.7{]71.4% (35/49), ~.t$-ill1ftT~,lH\ill(P
L~miWJ]
$-*"1 ~
1i-~tl *
t":J(~
·30·
ELSEVIER
Clinical Research
Efficacy observation on degenerative gonitis treated with triple needling combined with thunder-fire moxibustion *J1!Ur!~~~-*~1it1J:ll!1-rJt1:JJ*~-=P~1J%(~~~ XU Ying-ying H~1l; 1l;), HU Bing-cheng (;;J] ~ A) Heilongjiang Academy of TCM, Harbin 150001, China (~:JtU1!P:P~~~...j.~~, Pft~~ 150001,
9=tOO)
ARTICLE INFO
ABSTRACT
First author: XU Ying-ying (1979-), female,
Objective To evaluate the clinical efficacy of degenerative gonitis treated with triple needling combined with thunder-fire moxibustion for better promotion and clinical application. Methods Ninety-eight patients with degenerative gonitis were randomly divided into a thunder-fire moxibustion group (group A) and an acupuncture group (group B) according to randon number table, with forty-nine cases in each group. In group A, Neixiyan (I*J JJ*~i EX-LE 4), Dubf (~ .. ST 35), Yanglfngquan (~~* GB 34), Xuehai tIfil#J SP 10), LiangqiO (~Ji ST 34), ZusanlT OE =:.!f ST 36), Ylnllngquan (IDj~* SP 9) and Xiyangguan (JJ*~S 7k GB 33) were selected to accept triple and needling thunder-fire moxibustion for 20 min after the needles were retained for 40 min. The patients in group B were only treated with acupuncture. Thunder-fire moxibustion was not applied in the group B. The treatment was given once a day for four weeks. Knee function score and knee stiffness score in both groups were recorded before and after treatment, and the therapeutic effect was assessed. Results After four weeks' treatment, the total effective rate of group A was 93.9% (46/49), which was superior to 71.4% (35/49) in group B (P<0.05). Improvement in knee stiffness in group A was superior to that in group B (P
attending physician, doctor. Researchfield: acupuncture in the treatment of nerve system disease. E-mail: [email protected] Accepted on February 9, 2014.
KEY WORDS: gonitis; triple needling; thunder-fire moxibustion
Degenerative gonitis, namely knee osteoarthritis, characterized by j oint pain and dysfunction, is common in middle aged and elderly people with a higher morbidity in women than in men [11• In the study, triple needling combined with thunder-fire moxibustion was applied at local acupoints for the treatment of knee osteoarthritis to explore the safety, effectiveness and reliability of the therapy, which is reported as follows.
CLINICAL DATA
General data Ninety-eight cases of inpatients and outpatients were from the department of acupuncture and
moxibustion in Heilongjiang Academy of TCM from January 2011 to December 2012. According to the random number table, they were divided into a thunder-fire moxibustion group (group A) and an acupuncture group (group B) based on the time sequence of being treated. There were eighteen males and thirty-one females (forty-nine in total) in the group A, aged from 39 to 75 years and sick for 17 to 60 months. In the group B, there were nineteen males and thirty females (forty-nine in total), aged from 41 to 77 years and sick for 19 to 60 months. There was no statistically significant difference in age, sex and course of disease between both groups (all P>0.05), which was comparable (Table 1).
, World Journal ofAcupuncture-Moxibustion (WJAM) Vol. 24, No.3, 30th Sep. 2014
...-t:lBll1ilO'
• 31 •
ELSEVIER
Table 1
Comparison of general data of patients with gonitis in the two groups Female
Age (X±s, years)
18
31
19
30
Groups
Patients
Male
A
49
B
49
Average course (X±s, months)
One knee (cases)
Both knees (cases)
58±9
37.7± 11.9
31
18
58±1O
36.2± 10.2
32
17
Diagnostic criteria Knee osteoarthritis was diagnosed according to the Diagnostic Criteria for Knee Osteoarthritis revised by American Rheumatism Association (ARA) in 1995 [1]: CD knee pain during most of time in recent one month; ® crepitus on active motion; @morning stiffness ~30 min; @ aged~38 years old; @ bony hypertrophy verified by knee examination; ® joint marginal osteophyte revealed by X-ray. Patients conforming to CD®@@orCD®@orCD@@ were diagnosed as knee osteoarthritis.
Inclusive criteria CD Those being in compliance with the diagnostic criteria; ® those voluntarily received treatment and examination for 4 weeks; @ those who did not take any analgesics or hormone within one month before and during treatment.
Exclusive criteria CD Those who did not comply with the inclusive criteria above; ® those who complicated with severe cardiovascular diseases, liver diseases, kidney diseases and diseases of hematopoietic system and psychosis; @ those who had diseases with manifestation of arthritis such as rheumatoid arthritis , ankylosing spondylitis and gout; those who had joint complications of psoriasis, syphilitic neuropathy, ochronosis and metabolic bone diseases, etc.; @ those who complicated with bone tumor, bone tuberculosis or meniscus injury, ligament rupture and neurovascular injury due to obvious acute trauma and those who had a history of varus deformity and valgus deformity of the knee; @ those who had bony ankylosis caused by severe knee joint space stenosis or bone bridge between the bones of the joint; ® pregnant or lactating women; CD those who dropped out of the study or turned to another treatment method during the study, which led to inability to determine the efficacy or those whose data was incomplete, which affected the determination of efficacy.
36), Yinlingquan (IDj~:& SP 9) at both sides and Xlyangguan (~~~ GB 33) were selected. Manipulation: after regular sterilization, the 0.35 mmX40 mm disposable filiform needles were first inserted at EX-LE 4 and ST 35 about 25-40 mm in depth. After deqi, two needles were obliquely inserted at both sides of ST 35 and EX-LE 4 respectively. The even needling technique was applied after the deqi. The needles were retained for 40 min. The filiform needles were perpendicularly inserted at GB 34, SP 10, ST 34, ST 36, SP 9 and GB 33 about 25-40 mm in depth. The needles were retained for 40 min after qi was obtained. Thunder-fire moxibustion: after acupuncture, thunder-fire moxa stick was burned and put into the moxa box. According to patient's tolerance, suspended moxibustion was applied at the above-mentioned acupoints till the appearance of erubescence for 20 min. Be careful not to burn the skin during the treatment. Excessive weight-bearing and movement of joints should be avoided.
GroupB The acupuncture and manipulation applied in group B were the same as those in the group A. The thunder-fire moxibustion was not applied. The treatment was given once a day for a course with four weeks of above treatment constituting a course.
Observation indices
Group A
Knee function assessment: according to Knee Function Scale [2], efficacy in patients was assessed and knee function was evaluated. Knee function score was recorded before and after treatment respectively. The Knee Function Scale was composed of seven items such as pain, walking, joint flexion, instability, swelling, ascending and descending stairs and joint twist. The Knee Function Scale score ranged from 0 to 100. The higher the score was, the better knee function would be. Score of Knee Function Scale <70 showed that the patient suffered from severe knee dysfunction.
Neixiyan (i*J~D~ EX-LE 4), Dubi (~. ST 35), Yanglingquan (~S~:& GB 34), Xuehai (1fn.~ SP 10), Liangqiu (~Ji ST 34), Zusanl] O?:--=:..m. ST
N -rating scale [3] method was applied to assess knee stiffness of the patients. The score was recorded
METHODS
WorldJournal ofAcupuncture-Moxibustion (WJAM)
·32·
Vol. 24, No.3, 30th Sep.2014
before and after treatment respectively. Morning stiffness: 1 point: severe, stiffness for 20-30 min; 2 points: serious, stiffness for lO-20 min; 3 points: mild, stiffness for less than lO min; 4 points: without stiffness. Evaluation of therapeutic effects for knee stiffness'"; markably effective, the score increased by 2 points; effective, the score increased by 1 point; ineffective, the score after treatment was the same as that before treatment. The score of 4 points before treatment indicated there was no stiffness; the score was still 4 points after treatment, which was not considered as ineffective or included into the statistics.
Evaluation standard of clinical efficacy Knee function assessment: Guidelines for Clinical Research on New Traditional Chinese Medicine was used as reference to formulate the criteria. Clinical control: symptoms and signs such as pain and swelling disappeared, knee joint motion was in normal range and the improvement rate was >90%; markably effective: symptoms and signs such as pain and swelling disappeared, range of knee joint motion was not limited and the improvement rate was >70% but ~90%; effective: symptoms and signs such as pain and swelling almost disappeared, range of knee joint motion was slightly limited and the improvement rate was >30% but ~70%; ineffective: symptoms and signs showed no obvious improvement and the improvement rate was ~30%. Improvemen t ra te= [( score s be fore treatment - scores after treatment) -;- scores before treatment] X 100%.
Table 2 Comparison of knee function score of patients with degenerative gonitis in both groups (X±s, point)
RESULTS Comparison of knee function score of patients with degenerative gonitis in both groups (Table 2) As shown in Table 2, the difference in knee function score was not statistically significant in the two groups before treatment (P>0.05), which was comparable. Knee function score of both groups
P
Groups Patients Before teatment After teatment
A
49
49.50±8.17
77.43±1O.49 1) 2)
B
49
48.21±7.00
67.54±11.37 ')
14.69
< 0.01
10.13
< 0.01
Notes: compared with that before treatment in the same group,
l)P
significantly increased after treatment compared with that before treatment (both P
Comparison of knee stiffness of patients with degenerative gonitis in both groups (Table 3, 4) Table 3 Comparison of knee stiffness score of patients with degenerative gonitis in both groups (X±s, point) Groups
Morning stiffness
A
1.93±1.03
1.94±0.93
B
1.86±1.04
2.00±1.00
Patients
39
48
Tvalue
0.335
0.308
Pvalue
>0.05
>0.05
Morning stiffness aftet a while
Table 4 Comparison of improvement in knee stiffness of patients with degenerative gonitis in both groups Cases . Markab1y Gr oups C on diti tion symptoms Patients effective E ffecti ective me ffecti ective
A
Statistical analysis SPSS 13.0 statistical software was applied in data analysis. The data was expressed as mean ± standard deviation (X±s). The measurement data was compared by adopting t test, enumeration data was compared via i test, and ranked data was compared through Ridit test. When P<0.05, the difference was statistically significant.
ELSEVIER
B
Morning stiffness
20
5
13
2
Morning stiffness after a while
24
8
14
2
Morning stiffness
19
4
8
7
Morning stiffness after a while
24
5
11
8
As shown in Table 3, the difference in knee stiffness score was not statistically significant in the two groups (P>0.05), which is comparable. As Table 4 showed, i test was used for comparison of improvement in knee stiffness between the two groups after treatment. Improvement in knee stiffness in group A was superior to that in group B after treatment (P
Comparison of the clinical effect of patients with degenerative gonitis in both groups (Table 5) As shown in Table 5, the total effective rate of group A was 93.9%, which was superior to 71.4% in
ELSEVIER
World Journal ofAcupuncture-Moxibustion (WJAM) Vol. 24, No.3, 30th Sep. 2014
Table 5
° 33 °
Comparison of clinical efficacy of knee function score of patients with degenerative gonitis in both groups Cases (%)
Groups
Patients
Clinical controll
Markedly effective
Effective
Ineffective
Total effective
A
49
10 (20.5)
18 (36.7)
18 (36.7)
3 (6.1)
93.9%1)
B
49
5 (10.2)
11 (22.4)
19 (38.8)
14 (28.6)
71.4%
Note: compared with that in group B, 1)P<0.05.
the group B (P
DISCUSSION In TCM, degenerative gonitis pertains to "bi syndrome", "bone bi", "gonyalgia" or "arthroncus of knee". In the view of TCM, it is caused by kidney qi deficiency, striae and interstices empty, deficiency of qi and blood, sinew and bone malnutrition and invasion of pathogenic wind, cold and dampness, which result in the obstruction of meridians, qi stagnation and blood stasis and lead to soreness and numbness. The disease located at knee. As "knee is the house of tendons" and "the disease of the tendons is treated by acupuncture applied at the acupoints where there is a feeling of pain", local acupoints, EX-LE 4 and ST 35, were selected. GB 34 was selected as it is hesea point of foot shaoyang gallbladder meridian, the lower he-sea acupointts of the gallbladder and one of the eight confluent points associating with tendons. SP lOis belonged to foot taiyin spleen meridian. Zhenjiu Jiayijing ( tr~ ftI Z~» A-B Classic ofAcupuncture and Moxibustion) said: SP 10 is used for the treatment of abdominal distension and upward flow of qi caused by poor blood flow. ST 34 is cleft points of foot yangming stomach meridian. The spleen is a zangorgan, pertaining to yin, and the stomach is ajU-organ, pertaining to yang, which were selected together to move qi and invigorate blood, relax the sinews and quicken the collaterals, as well as reduce swelling and ease pain. The spleen and stomach are the foundation of acquired (postnatal) constitution and the source of qi and blood production. Water-dampness can be eliminated by healthy transformation of spleen and stomach. SP 9 was selected to fortify the spleen and eliminate dampness and unblock the collaterals and relieve pain. The foot yangming stomach meridian is the meridian full of qi and blood. ST 36 was selected to supplement and boost qi and blood as well as unblock the meridians and quicken the collaterals. The acupoints above constitute the prescription widely used for the treatment of degenerative gonitis. Method for selecting points for the treatment of bi syndrome
«
in Ling Shu °Guang Zhen (<<.~m o-gtr» The Miraculous Pivot °Official Needling Techniques) is to select acupoints located in the affected area aiming to achieve balance between yin and yang, eliminate pathogenic qi and eliminate block in meridians by local regulation yin and yang in organs and tendons. Triple needling, first documented in Ling Shu «(~m» The Miraculous Pivot), is an ancient method
of acupuncture for bi syndrome caused by invasion of cold into meridians, which is one of the twelve methods of needling. One needle is perpendicularly inserted into focal area with an other two beside it, the three needles are in a line. Lingshu - Guangzhen ( «~ m--gtr» The Miraculous Pivot-Official Needling Techniques) said: there are twelve methods of needling corresponding to twelve meridians··· in triple needling method, one needle is perpendicularly inserted with the other two beside it to treat bi syndrome with limited range and deep location caused by invasion of cold. As knee obstruction is caused by stagnation of qi and blood as well as invasion of pathogenic wind, cold and dampness, triple needling for knee obstruction conforms to the guiding ideology in Neijing I*J~» The Inner Classic), which is to treat bi syndrome with limited range and deep location caused by invasion of cold. Moreover, three needles are inserted toward focal area, strengthening stimulation of acupuncture and dredging the meridians.
«(
Gonitis pertains to bi syndrome in TCM. Suwen - Bilun ~ rPJ - i-i» Plain Questions - Bi Syndrome) said bi syndrome is caused by repeated invasion of pathogenic wind, cold and dampness in the season each organ corresponds to. Moreover, it is caused by invasion of pathogenic wind, cold and dampness that block the meridians. Therefore, acupuncture plus moxibustion are applied to dispel wind and eliminate dampness, dissipate cold and relieve pain and dredge the meridian. Thunderfire moxa sticks comprise of a variety of Chinese herbal which are matched according to diseases and syndromes in order to dredge the channel, subside swelling and relieve pain, invigorate blood and dissolve stasis, dispel wind and dampness, warm the meridians and dissipate cold as well as
«(
m
World Journal ofAcupuncture-Moxibustion (WJAM)
Vol. 24, No.3, 30th Sep.2014
·34·
reinforce healthy qi and eliminate pathogenic factors. Moxibustion is characterized by drastic effect of drug, strong firepower, high penetrability and wide application scope. Local acupuncture plus thunderfire moxibustion leads to free motion of joint as wind and dampness is dispelled and pain is relieved due to unblocking in channel. Moxibustion aims to achieve prevention and treatment of diseases and health care by warming and unblocking qi and blood as well as strengthening healthy qi and eliminating pathogenic factors in virtue of heat and effect of Chinese herbal medicine circulating in meridians. In ancient books and records as well as in modem researches, moxibustion has an important advantage in treatment for bi syndrome. The study shows that triple needling combined with thunder-fire moxibustion has significant therapeutic effect on degenerative gonitis. In conclusion, according to this study, it was confirmed that triple needling combined with thunderfire moxibustion was an effective therapeutic method for gonitis, which significantly improved the clinical
ELSEVIER
symptoms of knee stiffness of the patients and increased knee function score with remarkable efficacy in relieving clinical symptoms and delaying the development of disease. The therapeutic method was a good option which improved knee function, relieved symptoms and enhanced quality of life. The therapy was safe and effective without adverse reactions, holding the value of promotion and application.
REFERENCES [1]
[2]
[3]
[4]
Shi DY. Arthritis Overview. Beijing: China MedicoPharmaceutical Sciences and Technology Publishing House 2000: 331,339. Wang YB, Wang HF, Li GP, Xu H, Zhu WHo Clinical research on knee function scale. Chin J Rehabil Med (Chin) 2005; 20(2): 103-104. Guan JZ, Zhou JS. Clinical experience in sodium hyaluronate for treatment of knee osteoarthritis. J Bengbu Med ColI (Chin) 2006; 31(1): 23-24. Fu J, Yuan JB. Clinical observation on knee osteoarthritis treated with sodium hyaluronate injection. Food and medicine (Chin) 2005; 7(11): 30-31.
ABSTRACT IN CHINE SE [mi~]
13 tl
if-11r1i-~tl *M~t" :J(~~l1i!At't1.$-*"1 ~fr!J IJ~4.113tt,
I'AJ9J~:llf~$r
ELm TI)~4.o
""Jj)t;;: ¥f-9811~ i!At·t1.$-*"1 ~,~=t-1~-iiF.ttJt.~~~?}-7{] ~.t$-iJl~~.lH\ill~4911~, ~.t$-ill3Zt.Jf5t~~J;-, P-l$o~, Fa&;Jl, kilt, *.tt., Jt~.£, m&;Jl, $-Fa*, 4t~tl40 minJ6~R*-1tt":J(~20min, ~.lH\ill.R #~, ~*fft":J(~o~11.al~,~~114~o~11.J6~.~*ff$-*"1~ftif-?}-,$-*"1.~. ltif-?}-**-1tl13ttif-11r 0 !i!i~: ~114~J6, ~f;11 ill$-* "1~~~if-?}-.~;ff3tt.f.7{]93.9% (46/49), ~JRt
ill,~;ff3tt.f.7{]71.4% (35/49), ~.t$-ill1ftT~,lH\ill(P
L~miWJ]
$-*"1 ~
1i-~tl *
t":J(~