Effect observation on heat-sensitive moxibustion for cervical spondylosis of vertebral artery type

Gao Feng (高峰), Yang Fan (楊帆), Zhan Dao-wei (占道偉)

Jiaxing Hospital of Chinese Medicine, Zhejiang 314000, China

Effect observation on heat-sensitive moxibustion for cervical spondylosis of vertebral artery type

Gao Feng (高峰), Yang Fan (楊帆), Zhan Dao-wei (占道偉)

Jiaxing Hospital of Chinese Medicine, Zhejiang 314000, China

Objective:To observe the difference of the therapeutic effect between heat-sensitive moxibustion and warm needling therapy for cervical spondylosis of vertebral artery type (CSA).

Moxibustion Therapy; Warm Needling Therapy; Heat-sensitive Moxibustion; Spondylosis; Neck Pain; Vertigo

Cervical spondylosis of vertebral artery type (CSA) is a common type of cervical spondylosis. Its main clinical manifestations including dizziness, headache, nausea and (or) vomiting, neck discomfort or pain, or sudden collapse in severe cases. Generally speaking, the symptoms can disappear after a few hours or days after rest. As to patients with severe symptoms or long time duration, symptoms such as insufficient blood supply to the brain stem, pharyngeal foreign body sensation, unclear enunciation, and temporary deafness or blindness may be present[1]. In addition, it has been found that patients who manifested only with vertigo have a higher risk for cerebral infarction; some patients complicated with lacunar cerebral infarction presented the lesions mainly in the posterior circulation blood supplying region, but there was no clear localization signs[2]. Therefore, the treatment for this disease is very important. We used heat-sensitive moxibustion in treating patients with CSA between June 2011 and June 2013, which is summarized as follows.

1 Clinical Materials

1.1 Diagnostic criteria

These were based on the diagnostic criteria of CSA in theCriteria of Diagnosis and Therapeutic Effects of Diseases and Syndrome in Traditional Chinese Medicine[3]: symptoms such as dizziness and headache; symptom worsening when position changes; change of posture may cause aggravation, temporary dizziness, nausea, and even faint with neck rotation or extension; cervical vertebra tenderness, and positive Spurling test, Eaton test might be positive; cervical X-ray digital radiography (DR) showed change of cervical physiological curvature, or intervertebral space stenosis, or bone hyperplasia; transcranial Doppler (TCD) examination indicated abnormality of vertebral-basilar artery blood supply.

1.2 Inclusion criteria

In accordance with the diagnostic criteria of CSA; aged 18-70 years old, male or female; vertigo and headache as main symptoms, and limited neck movement as the main sign, TCD ultrasound indicated vertebra-basilar artery insufficiency; patients were mentally healthy, and could cooperate with the researchers, and they were able to express clearly so that they could tell the researcher when there is moxibustion sensation; they agreed to participate in the clinical study and signed the informed consent forms.

1.3 Exclusion criteria

Patients complicated with severe diseases of heart, lung, liver, kidney and severe metal diseases; with acute disc herniation or cervical fractures, dislocations, tuberculosis, cancer or infection; with vertigo induced by ear, eye, hypertension or atherosclerosis.

1.4 Statistical methods

The SPSS 11.0 version statistical software was used for data processing. Chi-square test was used for the comparison of rate.P＜0.05 indicates that the difference is statistically significant.

1.5 Subjects

Sixty patients were from the Acupuncture Outpatient and Inpatient of Jiaxing Hospital of Chinese Medicine. They were randomly divided into a heat-sensitive moxibustion (HSM) group and a warm needling therapy (WNT) group, 30 cases in each group. There were no significant differences in gender, age and disease duration between the two groups (P＞0.05), which showed that the two groups were comparable (Table 1).

Table 1. Comparison of general materials between the two groups

2 Therapeutic Methods

2.1 HSM group

Moxibustion site: Neck and shoulder blade where the heat-sensitive acupoint prone to appear.

Method: Meridian-qi’s sensation and transfer in acupoints were stimulated by circling moxibustion, bird-pecking moxibustion, mild-warm moxibustion as well as back and forth moxibustion along meridians. The heat-sensitive sensation was indicated by heat penetration, thermal expansion, heat transfer, distant heat without local heat, deep heat without surface heat, or soreness, distention, numbness and pain sensation in the moxibustion part or non-moxibustion part. Then suspended moxibustion was performed on the heat-sensitized acupoints or parts till the sensation and transfer phenomenon stopped, which was considered as one treatment.

2.2 WNT group

Acupoints: Fengchi (GB 20), Wangu (GB 12), Tianzhu (BL 10) and Baihui (GV 20).

Methods: Let the patient take a sitting or prone position. After routine disinfection, filiform needles of 0.25 mm in diameter and 40 mm in length were selected for acupuncture. Inserted needles into Fengchi (GB 20) 1.0-1.2 cun toward nose tip, and inserted into Baihui (GV 20) to reach the subgaleal and push the tip of the needle 1.0-1.2 cun toward the occipital, then manipulated reducing method by twisting and rotating. Inserted into Wangu (GB 12) and Tianzhu (BL 10) acupoints 0.8 cun toward nose tip. After arrival of qi, put moxa stick of 2 cm on the handles of needles in Fengchi (GB 20) and Tianzhu (BL 10), lit them from the bottom, and removed the needles after burnout.

2.3 Treatment course

Both of the two groups were treated once every other day, 10 times made up a course of treatment. The therapeutic effect was observed after 1 course.

3 Therapeutic Observation

3.1 Observation measurements

Before and after treatment, calculated scores on base of the CSA symptom and function assessment scale. Vertigo: 16 points; neck and shoulders pain: 4 points; headache: 2 points; daily life and work: 4 points; psychological and social adaptation: 4 points; the total score is 30 points. The lower the score, the more serious the illness.

3.2 Therapeutic effect criteria

It was referred to the therapeutic effect criteria of CSA in theCriteria of Diagnosis and Therapeutic Effects of Diseases and Syndromes in Traditional Chinese Medicine[3]. According to the CSA symptom and function assessment scale, recorded the scores before and after treatment and calculated the score effect value.

Score effect value ＝ (Total score after treatment -Total score before treatment) ÷ Total score before treatment ×100%.

Cure: Neck can move normally, and patient’s work was not affected by the disease, and the score effect value increased by ≥90%.

Remarkable effect: There was no uncomfortable sensation in neck, and patient’s work was not affected by the disease, and the score effect value increased by≥80%, but ＜90%.

Improvement: There was some improvements in clinical symptoms and signs, and the score effect value increased by ≥30%, but ＜80%.

Failure: There was no significant change in clinical symptoms and signs compared to before treatment, and the score effect value increased by ＜30%.

3.3 Results

3.3.1 Changes of scores of CSA symptom and function assessment scale

Before treatment, there was no significant difference between the two groups in the scores of CSA symptom and function assessment scale (P＞0.05). After treatment, scores of the two groups increased significantly comparing with those before treatment (P＜0.05); and score added value of the HSM group was significantly different from that of the WNT group (P＜ 0.05), suggesting that patients’ symptom improvement in the HSM group was more significant than those in the WNT group (Table 2).

Table 2. Comparison of the score of CSA symptom and function assessment scale

Table 2. Comparison of the score of CSA symptom and function assessment scale

Note: BT=Before treatment, AT=After treatment; intra-group comparison, 1) P＜0.01; inter-group comparison, 2) P＜0.05

Group n BT AT Difference value HSM 30 11.37±3.28 19.93±3.971) 8.57±2.822)WNT 30 10.27±3.55 17.40±4.251) 7.13±2.51

3.3.2 Comparison of therapeutic effect

After a course of treatment, the total effective rate of the HSM group was 93.3%, versus 83.3% in the control group, and Chi-square test result were χ2=9.105, P=0.028, indicating a statistically significant betweengroup difference (Table 3).

Table 3. Comparison of total effective rate between the two groups (case)

4 Discussion

Cervical spondylosis belongs to the category of vertigo and neck Bi-impediment in traditional Chinese medicine. It’s mainly due to wind, cold and dampness pathogen invasion or overstrain, leading to disharmony of Ying-nutrient and Wei-defensive as well as obstruction of the meridians and collaterals[4].

Modern medicine believes that complex anatomic relationship of vertebra-basilar artery determines the diversity of CSA’s pathogenesis[5]. However, the main reason leading to CSA is cervical intervertebral disc degeneration, cervical vertebra hyperplasia or strain, cervical spine and surrounding soft tissue injury, which can mechanically stimulate the vertebral artery and sympathetic nerve fibers and cause vertebral artery spasm and narrowing. In addition, other factors such as arteriosclerosis, stenosis and high blood viscosity finally cause basilar artery insufficiency, tissue ischemia and hypoxia, which in turn lead to a series of symptoms like vertigo. CSA can be treated with many methods. Western medicine mainly aims at improving the vertebral artery blood supply in short term to relieve dizziness, however, they may cause fatigue, lethargy, depression and other complications or some other unpredictable side effects, which may affect patient's life[6]. Therefore, more and more CSA patients prefer conservative treatment of traditional Chinese medicine. Acupuncture therapy can expell wind and cold, circulate qi and blood as well as nourish blood and unblock collaterals. It also has advantages of easy manipulation, less pain and rapid effect. The heat-sensitive moxibustion is a new therapy which is different from the traditional moxibustion therapy, and it is based on meridian and collateral theory, using moxa stick to apply warm moxibustion to heat-sensitized aqupoints or areas. It is manipulated appropriately when there are heat sensitization phenomena such as diathermy, thermal expansion, and heat transfer. The heat-sensitive moxibustion can stimulate meridian and collateral sensation and transmission, and promote meridian qi movement and circulation, so that the meridian qi can reach disease location and improve clinical therapeutic effect[7-8].

Modern research indicates that the heat-sensitive moxibustion can produce effects of medicine permeation, light and thermal radiation by burning moxa stick, effectively dilating the vertebral basilar artery, improving blood supply to the brain, relieving the neck and shoulder muscle spasm, and eliminating periodic soft tissue edema to stop dizziness and pain[9]. Besides, heat-sensitive moxibustion has many advantages such as no needles, no contact with the human body, no harm, no pain, and no side effect. Almost all the patients can accept this therapy, thus can solve the problem of patients’ fear of acupuncture[10].

This study shows that the heat-sensitive moxibustion can relieve CSA symptoms. Its short-term curative effect is exact, and operation is simple without pain. Therefore, it is especially appropriate to promote application in primary hospitals or at home. However, the long-term effect of the heat-sensitive moxibustion in treating CSAand the recurrence rate will be our future research direction.

Conflict of Interest

The authors declared that there was no conflict of interest in this article.

Acknowledgments

This work was supported by Zhejiang Province Cultivation and Promotion Research Plan of Traditional Chinese Medicine Appropriate Technology for Primary Levels (浙江省中醫基層適宜技術培育和推廣研究計劃, No. 2011ZS005); Project of Jiaxing City Science and Technology Bureau, Zhejiang Province (浙江省嘉興市科技局項目, No. SA2011AY1179).

Statement of Informed Consent

Informed consent was obtained from all individual participants included in this study.

Received: 21 January 2015/Accepted: 26 February 2015

[1] Jing HS, Wang HD. Summary of cervical spondylosis of vertebral artery type according to traditional Chinese medicine differentiation. Henan Zhongyi, 2013, 33(10): 1705-1707.

[2] Lee CC, Su YC, Ho HC, Hung SK, Lee MS, Chou P, Huang YS. Risk of stroke in patients hospitalized for isolated vertigo: a four-year follow-up study. Stroke, 2011, 42(1): 48-52.

[3] State Administration of Traditional Chinese Medicine. Criteria of Diagnosis and Therapeutic Effects of Diseases and Syndromes in Traditional Chinese Medicine. Nanjing: Nanjing University Press, 1994: 186.

[4] Fan BH, Wang P, Xu QZ, Gu HY. Study on vertigo discussion in Huang Di Nei Jing. Zhejiang Zhongyi Zazhi, 2007, 42(12): 687-688.

[5] Ni M, Zeng SP. Banxia Baizhu Tianma Decoction combined with positive spinal manipulation treating 42 cases with cervical spondylosis of vertebral artery type. Anmo Yu Kangfu Yixue, 2010, 1(8): 31-32.

[6] Yu SH, Ji XQ, Xue L, Zhang ZL. Therapeutic effect observation of acupuncture method of regulating spleen and stomach in treating 33 cases with cervical vertigo. Tianjin Zhongyi, 2005, 22 (3): 211-212.

[7] Chen RX, Chen MR, Huang JH, Fu Y, Zhang B. Clinical observation of relationship between moxibustion sensation and moxibustion effect in heat-sensitive moxibustion treatment for cervical spondylosis of vertebral artery type. Jiangxi Zhongyiyao, 2011, 42(1): 48-49.

[8] Chen RX, Kang MF. Acupoint heat-sensitization and its clinical significance. JTCM, 2006, 47(12): 905-906.

[9] Gui SQ. Clinical observation and caring on treating cervical vertebral artery disease by Xuanti methods plus moxibustion. CJCM, 2012, 4(3): 61-62.

[10] Gao F, Mao LY, Yang XB, Ni CC. Heat-sensitive moxibustion in treating 39 cases with cervical spondylosis of vertebral artery type. Zhongyi Zhenggu, 2011, 23(12): 56-57.

Translator:Deng Ying (鄧櫻)

熱敏灸治療椎動脈型頸椎病的療效觀察

目的：觀察熱敏灸和溫針灸治療椎動脈型頸椎病(cervical spondylosis of vertebral artery type, CSA)的療效差異。方法：將60例符合納入標準的CSA患者按就診先后順序隨機分為熱敏灸組和溫針灸組, 每組30例。熱敏灸組采用熱敏灸治療, 溫針灸組采用溫針治療。兩組均隔日治療1次, 治療10次為1個療程, 治療1個療程后評價療效。結果：治療1個療程后, 熱敏灸組總有效率為93.3%, 溫針灸組總有效率83.3%, 兩組總有效率差異有統計學意義(P＜0.05)。結論：熱敏灸治療CSA療效優于溫針灸治療。

灸法; 溫針療法; 熱敏灸; 椎關節強硬; 頸痛; 眩暈

R246.2 【

】A

Author: Gao Feng, master of medicine, attending physician.

E-mail: gaofeng8331@163.com

Methods:A total of 60 cases with CSA who met the inclusion criteria were randomly divided into a heat-sensitive moxibustion (HSM) group and a warm needling therapy (WNT) group according to the visiting sequences, with 30 cases in each group. Patients in the former group were treated by heat-sensitive moxibustion, while patients in the latter group were treated by warm needling therapy. Both groups were treated once every other day, with 10 times as 1 course of treatment, and the therapeutic effects were evaluated after 1 course of treatment.

Results:After 1 course of treatment, the total effective rate of the HSM group was 93.3%, versus 83.3% in the WNT group. There was a statistically significant difference between the two groups (P＜0.05).

Conclusion:Heat-sensitive moxibustion has better therapeutic effect for CSA than warm needling therapy.