Review on Clinical and Mechanism Studies of Moxibustion Therapy for Chronic Gastritis

Zhu Hui-wen, Ruan Chun-xun2, Cao Shu-fei, Wu Huan-gan3, Li Jing

1 Yueyang Hospital of Integrated Traditional Chinese and Western Medicine, Shanghai University of Traditional Chinese Medicine, Shanghai 200437, China

2 Shanghai University of Traditional Chinese Medicine, Shanghai 201203, China

3 Shanghai Research Institute of Acupuncture and Meridian, Shanghai 200030, China

SPECIAL TOPIC STUDY

Review on Clinical and Mechanism Studies of Moxibustion Therapy for Chronic Gastritis

Zhu Hui-wen1, Ruan Chun-xun2, Cao Shu-fei1, Wu Huan-gan3, Li Jing1

1 Yueyang Hospital of Integrated Traditional Chinese and Western Medicine, Shanghai University of Traditional Chinese Medicine, Shanghai 200437, China

2 Shanghai University of Traditional Chinese Medicine, Shanghai 201203, China

3 Shanghai Research Institute of Acupuncture and Meridian, Shanghai 200030, China

Author: Zhu Hui-wen, master of medicine, resident

By computer research, the literature of clinical and experimental studies on moxibustion therapy for chronic gastritis in the recent fifteen years was collected, sorted and analyzed, in order to understand the general situation about the clinical and experimental studies on moxibustion therapy for chronic gastritis, summarize the regularity of moxibustion therapy for chronic gastritis, so as to guide the treatment of chronic gastritis.

Moxibustion Therapy; Direct Moxibustion; Indirect Moxibustion; Warm Needling Therapy; Gastritis; Literature; Review

Chronic gastritis is a commonly and frequently encountered disease and its incidence rate ranks number one in various types of gastric diseases. Currently, it is believed that chronic gastritis is mainly divided into two major types of non-atrophic and atrophic condition. Besides, there are some specific types of gastritis induced by chemical, radioactive, lymphoblastic, and granulomatous factors. Chronic gastritis is mainly induced by infection of Helicobacter pylori (HP), and the infective rate of HP is roughly equivalent to the prevalence rate of chronic gastritis[1]. Clinically, 70%-80% patients with chronic gastritis do not present any symptoms. The patients with symptoms are mainly manifested by non-specific indigestion, such as discomfort, full and distending sensation, dull pain and burning pain in the epigastric region. These symptoms are generally irregular and will be aggravated or relieved after food ingestion. Additionally, there are also symptoms of poor appetite, belching, pantothenic acid, and nausea. Currently, the therapeutic strategy for chronic gastritis is to eradicate HP on one hand and to give the treatments to resist acid, improve the gastric motility and protect the gastric mucosa for the symptoms of indigestion on the other hand.

As early as in 1979, World Health Organization (WHO) recommended 43 indications to be treated by acupuncture therapy, including chronic gastritis. In recent years, it has been proven in many experimental and clinical studies that herbal medicine, acupuncture and moxibustion are effective for chronic gastritis[2-5]. Among them, moxibustion therapy is applied with moxa wool as the main burning material, to burn, fumigate and iron certain parts or acupoints on the body surface, so as to prevent and treat diseases through meridians and acupoints. Because of its simple and easy operation and reliable therapeutic effect, it has been extensively applied in the treatment of chronic gastritis. There are many types of moxibustion methods. In accordance with the materials used for moxibustion, it can be divided into moxibustion with moxa and moxibustion with other materials. Regarding moxibustion with moxa, there are moxa-cone moxibustion,moxa-stick moxibustion, warm needling moxibustion, and moxibustion-device moxibustion, etc[6]. In order to understand the general situation about the clinical and experimental studies on moxibustion therapy for chronic gastritis, summarize the regularity of moxibustion therapy for chronic gastritis, so as to guide the treatment of chronic gastritis, the review about moxibustion therapy for chronic gastritis in the recent fifteen years is given as follows.

1 Clinical Study

1.1 Chronic non-atrophic gastritis

1.1.1 Moxa-cone moxibustion

Moxa-cone moxibustion is to put moxa cones on the acupoints for moxibustion and can be divided into two types, direct moxibustion and indirect moxibustion. The direct moxibustion is also termed on-skin moxibustion. In accordance with difference in stimulating degree to the skin after moxibustion, it can be divided into two types, non-scaring moxibustion and scaring moxibustion, i.e. a method to apply moxibustion with certain material between moxa cone and skin. In modern clinical practice, there are commonly ginger-partitioned moxibustion, salt-partitioned moxibustion, garlic-partitioned moxibustion, and herbal cake-partitioned moxibustion, etc.

Wang JZ[7]treated 58 cases with chronic superficial gastritis with non-scaring moxibustion, two cones for each acupoint: Shangwan (CV 13), Zhongwan (CV 12), Xiawan (CV 10), and Zusanli (ST 36), in comparison with oral administration ofXiang Sha Yang Weipills. The results showed that the total effective rate was 96.6% in the treatment group and was significant higher than 80.7% in the control group (P＜0.05). Jiang B, et al[8]treated 45 cases of chronic gastritis with ginger-partitioned moxibustion, by using Zhongwan (CV 12), Tianshu (ST 25) and Zusanli (ST 36), two cones for each acupoint in each session, one session every other day. The control group was given oral administration of Rabeprazole sodium entric-coated capsules andWei Fu Chuntablets. The course in the two groups was 3 months. The results showed that the total effective rate was respectively 95.6% and 84.4% in the treatment group and the control group, with a statistical significant difference (P＜0.05). Moreover, the clinical effects and the functions in reliving poor appetite, belching, pantothenic acid, and nausea were obviously better in the treatment group than those in the control group (P＜0.05). Zhou XX, et al[9]treated 50 cases with chronic superficial gastritis in pattern of spleen and stomach deficiency with ginger-partitioned moxibustion, in comparison with oral administration of Ranitidine. The total effective rate was 96% in the treatment group, better than that in the control group (P＜0.01).

1.1.2 Moxa-stick moxibustion

This is a method to wrap moxa wool with a piece of fine straw paper or mulberry paper into a moxa stick in cylindrical shape and ignite its one end to apply moxibustion toward an acupoint or sick area. In accordance with different applying methods, it can be divided into suspending moxibustion and pressing moxibustion. Depending upon the applying methods, suspending moxibustion can be further divided into mild moxibustion, sparrow-pecking moxibustion, and circular moxibustion. Zeng QL, et al[10]treated 60 cases of chronic gastritis by applying mild moxibustion to Weishu (BL 21), Neiguan (PC 6), Zhongwan (CV 12) and Zusanli (ST 36), in comparison with the control group treated with oral administration of Ranitidine, etc. After continuous treatment for one month, the total effective rate was 93.3% in treatment group and was 73.3% in the control group, with significant differences between the two groups (P＜0.05), and the treatment group was better than the control group in relieving the main symptoms.

1.1.3 Warm needling moxibustion

This is a commonly-used acupuncture method in the clinic. After the arrival of the needling sensation, the needle is retained in a proper depth and a segment of moxa stick of about 2 cm in length is applied to the needle handle for moxibustion, or a little moxa wool is applied to the needle handle for moxibusiton, till moxa wool is burnt down and ashes are then removed. Clinically, warm needling moxibustion is often used on the major acupoints.

Xin YH, et al[11]treated 52 cases of chronic superficial gastritis due to spleen and stomach deficiency with warm needling moxibustion, with bilateral Zusanli (ST 36) and Neiguan (PC 6) as major acupoints, and Zhongwan (CV 12) and Tianshu (ST 25) as adjunct acupoints, in comparison with acupuncture alone. The results showed that the total effective rate was 92% in the treatment group and 65% in the acupuncture group, with a significant difference in comparison between the two groups (P＜0.05).

1.1.4 Combination of moxibustion and acupuncture

Wang BJ[12]treated 53 cases with superficial gastritis confirmed by gastroscopy in the treatment group, by selecting Zhongwan (CV 12), Xiawan (CV 10), Jianli (CV 11), Zusanli (ST 36), Sanyinjiao (SP 6), Yinlingquan (SP 9), Pishu (BL 20), and Weishu (BL 21), with perpendicular insertion of the needles for 1.2-1.5 cun and retaining of the needles for 30 min. Zhongwan (CV 12), Xiawan (CV 10), and Zusanli (ST 36) were applied with electroacupuncture apparatus. After withdrawal of the needles, Zhongwan (CV 12),Weishu (BL 21), Pishu (BL 20), Jianli (CV 11), and Xiawan (CV 10) were applied with ginger-partitioned moxibustion, five cones for each acupoint. Ten days made one course and the next course was given after a rest of three days.Xiang Sha Yang Weipills were used in the control group. The clinical effects were observed after two courses in both groups. The results showed that 28 cases were cured clinically, accounting for 52.9%, and 20 cases were improved, accounting for 37.7% in the treatment group, and 18 cases were cured clinically, accounting for 45.0%, and 15 cases were improved, accounting for 37.5% in the control group. The total effective rate was better in the treatment group than that in the control group (P＜0.05).

1.1.5 Combination of moxibustion and medications

Lu YB, et al[13]observed 60 cases with chronic superficial gastritis, confirmed by gastroscopy and pathological diagnosis of HP negative. The control group was ordered with oral administration of Hydrotalcite tablets. In the treatment group, based upon oral administration of Hydrotalcite tablets, Weishu (BL 21), Neiguan (PC 6), Zusanli (ST 36), Taichong (LR 3) and Zhongwan (CV 12) were selected and moxibustion was applied 15-25 mm away from the selected acupoints downward in turns for five minutes, once every day. The course of the treatment was four weeks in both groups. The results showed that the total effective rate was 91.7% in the treatment group and 73.3% in the control group. The total effective rates were significantly different between the two groups (P＜0.05).

1.1.6 Combination of moxibustion and wrist-ankle acupuncture

Liu H[14]treated 60 cases of chronic superficial gastritis with warm needling acupuncture plus wrist-ankle acupuncture, by selecting Zusanli (ST 36), Neiguan (PC 6), Taichong (LR 3), Zhongwan (CV 12), and Tianshu (ST 25). Zusanli (ST 36) and Neiguan (PC 6) were treated with warm needling moxibustion and the needles were retained for 30 min. Bilateral Point Lower 1 and Point Lower 2 on the right side were used in wrist-ankle acupuncture. The control group was treated with warm needling moxibustion as same as the treatment group. In both groups, the treatment was given once every other day and ten sessions made one course. Totally, three courses were given. The results showed that the total effective rate was 93.8% in the treatment group of warm needling acupuncture plus wrist-ankle acupuncture and was 85.7% in the control group. By statistics, the clinical effects were significantly different between the two groups (P＜0.05).

1.2 Chronic atrophic gastritis

Chronic atrophic gastritis refers to atrophy and even disappearance of mucosal inherent glands induced by repeated damage of the gastric mucosal surface, often seen as the pathological change of thickened mucosal muscularis. Due to atrophy or disappearance of the glands, the gastric mucosa becomes thin in varying degrees, often accompanied by intestinal metaplasia, inflammatory reaction and atypical hyperplasia. By the treatment with moxibustion, the patient’s symptoms could be effectively relieved. In some reports, the gastroscopic examinations showed that moxibustion treatments are effective.

1.2.1 Moxa-stick moxibustion

Zhao H[15]treated 5 cases of chronic atrophic gastritis with moxa-stick moxibustion, with major acupoints of Guanyuan (CV 4), Danzhong (CV 17), Zhongwan (CV 12), Zusanli (ST 36), Liangmen (ST 21) and Sanyinjiao (SP 6). The treatment was given once every day and one month made one course. The results showed that in 5 cases, 1 case was cured clinically, 3 cases showed remarkably effective and 1 case was effective, and the effective rate was 100%.

1.2.2 Warm needling moxibustion

Yang RC, et al[16]treated 45 cases of chronic atrophic gastritis with warm needling moxibustion on Pishu (BL 20), Weishu (BL 21), Zhongwan (CV 12), Zusanli (ST 36), Ganshu (BL 18) and Danshu (BL 19), in comparison with the control group treated with oral administration of Vitacoenzyme tablets and Motilium tablets. The results showed that the total effective rate in symptom-complex of traditional Chinese medicine and the total effective rate in gastroscopic examinations were better than those in the control group, with significant differences (P＜0.01). Gu W, et al[17]observed warm needling acupuncture for 40 cases of chronic atrophic gastritis, in comparison with oral administration of Omeprazole capsules, Amoxicillin capsules, Metronidazole tablets, and Folic Acid tablets. The results showed that the total effective rate was 92.5% in the clinical symptoms in the acupuncture group, better than 75.0% in the control group, and the scores under the gastroscopy examinations in the two groups were remarkably reduced than those before the treatment (allP＜0.01), lower in the treatment group than in the control group (P＜0.01), indicating that the two therapies can improve the pathological degrees of mucosa under the gastroscopy in the patients with chronic atrophic gastritis, but faster in the effects in the treatment group.

1.2.3 Moxibustion plus herbal drugs

Xie WS[18]believes that chronic atrophic gastritis is a syndrome of deficiency in constitution and excess in clinical manifestations and mixture of deficiency and excess, characterized by deficiency of qi and yin as root cause, and qi stagnation and blood stasis as clinical symptoms. Therefore, herbal decoction was given to reinforce the spleen and stomach, and expel blood stasis and dredge the collaterals, assisted by moxibustion to warm and reinforce qi of middle jiao to support the pharmaceutical actions for both internal and external treatment. In the observation of 46 cases of chronic atrophic gastritis treated by ginger-partitioned moxibustion at Zusanli (ST 36), plus herbal decoction composed ofRen Shen(Radix Ginseng),Bai Zhu(Rhizoma Atractylodis Macrocephalae),Shan Yao(Rhizoma Dioscoreae),Dan Shen(Radix Salviae Miltiorrhizae),Ji Nei Jin(Endothelium Corneum Gigeriae Galli),Bai Shao(Radix Paeoniae Albae), etc. The results showed remarkable effect in 41 cases, accounting for 89.1% and the total effective rate in 95.6%. Xu JN, et al[19]observed 90 cases of chronic atrophic gastritis treated by herbal cake-partitioned moxibustion plusWei Yan He Ji. In herbal cake-partitioned moxibustion,Dang Shen(Radix Codonopsis Pilosulae),Huang Qi(Radix Astragali),Shi Hu(Herba Dendrobii), andRou Gui(Cortex Cinnamomi), etc., were selected and ground into powder. Every day, 5 g of herbal power was mixed with ginger juice or smashed garlic into paste, for making herbal cakes. Moxa-stick moxibustion was applied to Zusanli (ST 36), Tianshu (ST 25), and Zhongwan (CV 12), one acupoint every day, for 20 min each time.Wei Yan He Jiwas taken orally, 10 mL each time, twice a day. After 2-month treatment, the therapeutic effects were assessed. In comparison between the group of single herbal cake-partitioned moxibustion and the group ofWei Yan He Ji, the remarkable effective rates and pathological gastroscopic examinations were better in the treatment group (P＜0.05). Qiu WD[20]observed 72 cases of chronic atrophic gastritis in deficient cold pattern. The treatment group was given oral administration of herbal decoction,Wen Wei Jian Pidecoction, one dose a day separated into two times, composed ofHuang Qi(Radix Astragali) 15 g,Bai Zhu(Rhizoma Atractylodis Macrocephalae) 10 g,Gui Zhi(Ramulus Cinnamomi) 6 g,Gao Liang Jiang(Rhizoma Alpiniae Officinarum) 10 g,Bai Shao(Radix Paeoniae Albae) 10 g,Chuan Lian Zi(Fructus Meliae Toosendan) 10 g,Yan Hu Suo(Rhizoma Corydalis) 10 g,Chen Pi(Pericarpium Citri Reticulatae) 6 g,Fu Ling(Poria) 10 g,Zhi Gan Cao(Radix Glycyrrhizae Praeparata) 6 g, and 5Da Zao(Fructus Jujubae). At the same time, ginger-partitioned moxibustion was given at Zusanli (ST 36) and Zhongwan (CV 12), in comparison with oral administration of Vitacoenzyme tablets and Motilium tablets. The treatment for 30 d was taken as one course in the two groups and the treatment was given continuously for two courses. The total effective rate was 88.9% in the treatment group and 69.4% in the control group, with the statistical significance in comparison between the two groups (P＜0.05). The treatment group was better than the control group.

1.2.4 Moxibustion plus topical application of herbal drugs at acupoints

Wu WZ[21]treated 31 cases of chronic atrophic gastritis with moxibustion plus topical application of herbal drugs at acupoints, by selecting Zusanli (ST 36) (bilateral), Zhongwan (CV 12), Tianshu (ST 25) (bilateral), and Shenque (CV 8), 2-3 acupoints each time, used in alternation. Two grams of self-made herbal paste [Dang Shen(Radix Codonopsis Pilosulae),Huang Qi(Radix Astragali),Shi Hu(Herba Dendrobii),Pu Gong Ying(Herba Taraxaci), andSha Ren(Fructus Amomi) as main ingredient] was applied to the acupoints for mild moxibustion. The treatment was given once a day and ten sessions made one course. The treatment was given totally for two months, in comparison with single topical application of herbal drugs at the acupoints, with same acupoints and herbal drugs. By statistical management, the therapeutic effects were significantly better in the group with moxibustion plus topical application of herbal drugs at acupoints than in the group with single topical application of herbal drugs at the acupoints (P＜0.01).

2 Mechanism Study

The etiology and pathogenesis of chronic gastritis are still unknown. The occurrence of the disease may result from comprehensive actions of multiple factors. It has been known that the disease is closely related to HP infection. In terms of other factors, the disease may be induced by excessive drinking, smoking, regurgitation of duodenal juice, medications and dietary factors. The immune factors and hereditary factors may also be certainly correlated to this disease. The pathological changes of chronic gastritis result from the contradiction of damage and repair of the gastric mucosa. It is believed currently that further aggravation of non-atrophic gastritis may present the affection of atrophic gastritis. The past studies mostly focused on acute and chronic damage of the gastric mucosa and moxibustion mechanism. Some scholars developed their observation on mechanism of the therapeutic effects in treating atrophic gastritis.

2.1 Possible mechanism of moxibustion therapy for acute and chronic damage of the gastric mucosa

2.1.1 Increasing blood flow of the gastric mucosa

Sufficient blood flow to the gastric mucosa can promptly eliminate the local metabolites, toxins, oxygen free radicals and the reversed diffusion of H+, to prevent the gastric mucosa from injury. The integrity of the microcirculatory structure of the gastric mucosa and maintenance of its blood flow are the most important protective mechanism of the gastric mucosa. Jiang QQ, et al[22], and Yi SX, et al[23]respectively observed that moxibustion at the specific acupoints in rats could remarkably reduce the subsequent indexes in stress-induced damage of the gastric mucosa, so as to obviously increase the blood flow volume of the gastric mucosa in the rats, showing the statistical significance in comparison with the control group and with non-meridian and non-acupoints group (P＜0.01), and showing the relevant specificity of the acupoints.

2.1.2 Regulating gastrointestinal hormones

The gastrointestinal hormones are peptides with life activity, produced by the gastrointestinal neuroendocrine cells, playing an important regulatory effect in the gastrointestinal secretion, motion, absorption, transportation of water and electrolytes, immunity and proliferation. The gastrointestinal peptide hormones can be divided into 11 families, totally over 50 species. Recently, the studies about the gastrointestinal hormones mostly focused on the indexes of gene-related peptides of gastrin, prostaglandins, motilin, somatostatin, epidermal growth factor, transforming growth factor, angiogenesis factor, leptin, and calcitonin.

It was found out in the study by Yi SX, et al[24]that heat stimulation and pharmaceutical property from moxibustion and specificity of Shenque (CV 8) could increase blood flow volume of the gastric mucosa and the contents of transforming growth factor-α (TGF-α) in the gastric mucosal tissues, and could also promote the release of calcitonin gene-related protein in the gastric mucosa, so as to protect the gastric mucosa and promote the repair of the gastric mucosa. Zeng QL, et al[10]believe that moxibustion could promote the repairing effect of the damaged gastric mucosa, by reducing the concentration of serum epidermal growth factor (EGF) in the patients with gastritis. Liu M, et al[25]observed that aforehand moxibustion applied to Zusanli (ST 36), Zhongwan (CV 12), Pishu (BL 20), and Weishu (BL 21) in rats could elevate the contents of EGF and TGF-α and the receptor expression of epidermal growth factor of the gastric mucosa in the rats with stress-induced gastric mucosal damage, so as to play a protective role for the gastric mucosa.

2.1.3 Regulating the cell factors

Cell factors are produced by low molecular weight soluble protein by inducing a variety of cells with immunogen, mitogen or other irritant agents. The cell factors develop the extensive and multiple biological functions by combining the receptors on the surface of the target cell membranes and transmitting the signals to the interior of the cells, and have the multiple effects to regulate the inherent immunity and adaptive immunity, hematopoiesis, cell growth and tissue repair, etc. Cell factors can be divided into interleukins, interferons, tumor necrosis factors, hematopoietic cytokine receptor superfamilies, colony stimulating factors, chemokines and growth factors, etc.

Interleukin-1 (IL-1), as important proinflammatory factors and in two types of IL-1α and IL-1β, can strongly inhibit the secretion of gastric acid, promote the generation of cyclooxygenase-2 (COX-2), and play an important role in promoting or aggravating the gastric mucosal damage during the occurrence and development of chronic gastritis. In the damage of the gastric mucosa, interleukin-6 (IL-6) is mediated by inducing the generation of chemokines with IL-8 in predominance. IL-8 can induce the migration of neutrophils and go through the gastric epithelial cells, obviously increase the reversed diffusion of sodium ions, combine with glycogen and glycosaminoglycan in tissue matrix, and form and maintain the concentration of bioactive gradient, so as to be incurred by the local accumulation of the chemotactic and activated inflammatory cells, with neutrophils in predominance, and further induce the respiratory burst of the granulocyte and generate active oxygen, causing inflammation of the tissues. Moreover, the activated neutrophils can also secrete the cell factors of IL-8, IL-1, and tumor necrosis factor-α (TNF-α), structuring the complicated cellular network and jointly participating in the damage of the gastric mucosa. Du Y, et al[26]observed that moxibustion at Zusanli (ST 36) and Zhongwan (CV 12) in rats could obviously decrease IL-1, IL-6, and TNF-α, so as to protect the gastric mucosa.

Interleukin-10 (IL-10) is the immunomodulatory cell factor, mainly as the immunosuppressive factor. The obviously increased IL-10 expression level can result in the increase of negative immune-regulating functions of the gastric mucosa and the inhibition of the patient’s immune-stimulating functions, so that the local infection cannot be effectively controlled and the atrophic degrees of the gastric mucosa can be progressively aggravated on one hand, and the disease can be aggravated and cancerous due to escape of the immune supervision of the organism on other hand. Liu M, et al[27]observed that after pre-management of Zusanli (ST 36) and Zhongwan(CV 12) with moxibustion, the content of serum IL-10 was obviously elevated and the contents of IL-1β and TNF-α were obviously reduced in the rats, indicating that the pre-management with moxibustion can promote the generation of the anti-inflammatory factor, IL-10, by stimulating the acupoints, so as to realize the effect to protect the gastric mucosa.

2.1.4 Inducing the expression of heat shock protein (HSP)

Heat shock protein participates in some important physiological activities of the cells, such as folding, assembly, transportation and repair of protein, playing an important role in maintaining the cells and functions. Therefore, it is also termed ‘molecular chaperone’ and is the material foundation for protecting the cells[28]. Heat shock protein can be divided into different families, mainly calcium proteins and small heat shock proteins of HSP 90, HSP 100, HSP 70, HSP 60, HSP 47[29].

Yi SX, et al[30-32]and Chang XR, et al[33]found out by experiments that moxibustion at Zusanli (ST 36) and Liangmen (ST 21) in rats can increase HSP 70 expression in the gastric mucosal cells in rats, so as to function on the relevant target of the transduction pathways of apoptotic mitochondria signals, promote the synthesis of TNF-α, stimulate the proliferation of the gastric mucosa, and inhibit the apoptosis of the gastric mucosal cells, to realize the effect to protect the gastric mucosa. When the synthesis of HSP 70 is blocked by Quercetin, the function of moxibustion pre-management in inhibiting cell apoptosis of acute gastric mucosal damage is cancelled, proving that the protective effect of the gastric mucosa by moxibustion pre-management is certainly related to the elevation of HSP 70 expression by moxibustion. Moreover, this type of the protective effect has certain specificity of the acupoints.

It is indicated in the studies by Yu J, et al[34]that moxibustion on Zhongwan (CV 12) and Zusali (ST 36) could induce the high expression of HSP 60 in the gastric mucosa of the rats with acute gastric mucosal damage, and inhibit Smac expression of apoptotic factor, so as to protect the gastric mucosa. Feng YS, et al[35]observed by the experiments that the pre-management at Zusanli (ST 36), Zhongwan (CV 12), Guanyuan (CV 4), Pishu (BL 20) and Weishu (BL 21) by moxibustion in the rats with HP inflammatory damage of the gastric mucosa can induce the numerous expression of serum eHSP72, initiate and regulate the immune system of organism to eliminate HP, and inhibit serum IgG contents in HP-modeled rats, so as to realize the effect to protect the gastric mucosa.

2.1.5 Regulating the immunity

By clinical observation, Wang XY[36]treated 18 cases of stomachache due to deficiency cold with herbal cake-partitioned moxibustion. After treatment, the lymphocyte transformation rate was increased averagely by 14.2% than before the treatment, serum IgG contents were averagely increased by 1.59 mg/mL, and the differences of the content indexed in remarkable significance by statistical management (P＜005,P＜0.01). CD3, CD4, CD4/CD8 were all remarkably elevated (P＜0.05,P＜0.01). CD3 and CD4 were the central part to decide the environmental stability inside the immunity. The remarkable elevation of CD3, CD4, CD4/CD8 indicated that the immunity of the body was regulated, the cellular immune functions in particular, showing that moxibustion has the effects to protect the gastric mucosa, and strengthen the immunity and enhance the anti-damaging ability of the gastric mucosa.

2.1.6 Others

Superoxide dismutase (SOD) is the protective factor for the gastric mucosal cells and can remove oxygen free radicals, resist the epithelial lipid peroxidation of the gastric mucosa, so as to maintain the low level of oxygen free radicals and avoid causing damage to the epithelial cells of the gastric mucosa. By clinical observation of changes of SOD activities before and after treatment, Yi Z, et al[37]treated 45 patients with superficial gastritis due to deficiency cold by ginger-partitioned moxibustion, and the results showed that the increase of SOD contents after treatment in the group by ginger-partitioned moxibustion for 40 min, in comparison with the changes of SOD content after treatment in the group by ginger-partitioned moxibustion for 20 min and Ranitidine group, was significantly different (P＜0.05), showing certain dose-dependant relationship.

2.2 Possible mechanism of moxibustion therapy for chronic atrophic gastritis

Currently, due to the long modeling period and complicated pathological mechanism of chronic atrophic gastritis, there have been fewer studies on its mechanism. Gao XY, et al[38]observed that after acupuncture at Zusanli (ST 36), Zhongwan (CV 12) and Tianshu (ST 25) for the rats with chronic atrophic gastritis, blood flow volume of the gastric mucosa in rats was obviously increased, indicating that acupuncture could increase blood flow volume at the bottom of the stomach, and reduce effusion, so as to maintain the completeness of the gastric mucosa, inhibit the reversed diffusion of H+, and decrease the net outflow of Na+. Cheng YA[39]proved that byacupuncture and moxibustion for rat models of chronic atrophic gastritis, the output of total acid of gastric juice and the activity of the pepsin could be effectively reduced, the superoxide anion was significantly removed, and SOD activity was elevated, and thus the gastric mucosa was protected.

3 Review and Prospect

Judging from the literature used in this study, moxibustion has remarkable therapeutic effects in treating chronic gastritis, and it is more effective than non-moxibustion therapies. Some scholars[40]pointed out that various effects and actions produced by warm and heat stimulation by moxibustion can be mainly generalized into two major types: warmingdredging and warming-reinforcing. But, single application of moxibustion therapy is not common for chronic gastritis in clinics, and is often used together with herbal medicine and acupuncture.

But, the following issues still exist in the current study. First, in the clinical diagnosis, some scholars treated epigastric pain by pattern identification of‘epigastric pain’ and ‘stomachache’. ‘Epigastric pain’discussed in Chinese medicine includes many diseases, e.g. acute and chronic gastritis, and gastric and duodenal ulcer characterized by epigastric pain. The lack of clear diagnosis in Western medicine will easily lead to differences in evaluating the therapeutic effects. Therefore, further clinical studies in the future should combine pattern identification with disease differentiation. Secondly, the criteria of the therapeutic effects are not unified. The criteria of the therapeutic effects are mainly based on the self-defined improvement of main symptoms, very seldom upon the objective indexes of gastroscope, electrogastrogram or pathological effective criteria. Therefore, it is very important to establish a unified assessment scale of gastrointestinal symptoms for objective assessment. Thirdly, it is commonly believed that chronic gastritis is mainly induced by HP infection. But, extremely fewer clinical literature reports that moxibustion is effective for eradication of HP. Fourthly, the literature is uneven in quality. The randomized grouping was not adopted in lots of literature, and blind method and control method were not used in optimistic. In some literature, the therapeutic methods were not explained clearly, and the time and course of the treatment were not clear. Fifthly, in the included literature, the clinical and mechanism studies were majorly focusing on chronic superficial gastritis. Therefore, the key is to developing the study on moxibustion for chronic atrophic gastritis in the further study.

Conflict of Interest

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

Acknowledgments

This work was supported by Project of Shanghai Municipal Health Bureau (No. 20124071).

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Translator: Huang Guo-qi

Li Jing, master of medicine, chief physician.

E-mail: wenwennal@163.com

R245.8

: A

Date: January 15, 2014