Therapeutic observation of acupuncture plus heat-sensitive moxibustion for chronic pelvic inflammatory disease

Zhang Shao-yun (张少芸), Wang Ling (王玲), Gou Yan-hua (缑燕华)

Shenzhen Hospital of Traditional Chinese Medicine, Guangdong 518033, China

Therapeutic observation of acupuncture plus heat-sensitive moxibustion for chronic pelvic inflammatory disease

Zhang Shao-yun (张少芸), Wang Ling (王玲), Gou Yan-hua (缑燕华)

Shenzhen Hospital of Traditional Chinese Medicine, Guangdong 518033, China

Objective:To observe the therapeutic efficacy of acupuncture plus heat-sensitive moxibustion in treating chronic pelvic inflammatory disease (CPID), for selecting an effective acupuncture-moxibustion method in treating chronic pelvic inflammation.

Acupuncture Therapy; Acupuncture-moxibustion Therapy; Moxibustion Therapy; Heat-sensitive Moxibustion; Thermal Box Moxibustion; Pelvic Inflammatory Disease; Adnexitis

Chronic pelvic inflammatory disease (CPID) is a common gynecological condition, referring to a chronic inflammation of female reproductive organs, the surrounding connective tissues, and pelvic peritoneum, involving the uterus, ovaries, and fallopian tubes. It seriously impairs the reproductive and psychosomatic fitness and the quality of life in women, as it’s refractory and may result in complications such as infertility, ectopic pregnancy, and even neurosis[1]. During recent years, CPID has been affecting more and more women, and the affected age has become younger[2]. Of the large amount of studies on CPID treated with acupuncture-moxibustion, including using acupuncture alone, acupuncture plus Chinese herbal medication, and acupuncture plus thunder-fire moxibustion[3-5], there are no reports about using acupuncture plus heatsensitive moxibustion. During 2012-2013, we had observed the efficacy of using acupuncture plus heat-sensitive moxibustion in treating 40 CPID patients, to provide a better acupuncture-moxibustion treatment protocol for this disease. The study is presented as follows.

1 Clinical Materials

1.1 Diagnostic criteria

It’s made by referring the diagnostic criteria of CPID in theGynecology and Obstetrics[6].

Symptoms: Lower abdominal heaviness or pain and lumbosacral pain, aggravated by fatigue and before and after menstruation; irregular vaginal discharge; irregular menstruation, dark menstrual blood with clots, and alleviated pain after discharge of blood clots.

Gynecological examinations: Uterine tenderness; cord-like thickening or immobile lump was palpable on one or both sides of the uterus. Ultrasound examination showed abnormal echo or dark field, or fluid in cavum douglasi.

1.2 Inclusion criteria

Conforming to the above diagnostic criteria; aged between 20 and 55 years; willing to cooperate and strictly following the treatment involved in the study and having signed the informed consent forms.

1.3 Exclusion criteria

Against the diagnostic criteria; pregnant or breastfeeding women; adenomyosis, endometriosis, primary dysmenorrhea, pelvic inflammation in acute stage, pelvic venous congestion, tubercular pelvic inflammatory disease or hysteromyoma; severe cardiovascular diseases or other serious primary diseases involving liver, kidney, and/or hematopoietic system; mental disorders; those who failed to cooperate or strictly follow the treatment protocol during the study, which would influence the data collection and efficacy evaluation.

1.4 Statistical method

All data were processed using SPSS 13.0 statistical software. The measurement data were expressed by mean ± standard deviationand analyzed usingt-test; the comparison of rate was performed using Chisquare test.P＜0.05 presents a statistical significance.

1.5 General data

Eighty eligible subjects were enrolled from the Acupuncture Department of Shenzhen Hospital of Traditional Chinese Medicine between 2012 and 2013. The subjects were randomized into an observation group and a control group following their visiting sequence and using the random number table, 40 cases in each group. Considering the credibility, all of the patients were blinded to the grouping.

The age ranged from 21 to 55 years old in the observation group versus 22 to 53 years old in the control group. According to the statistical analyses, there were no significant differences in comparing the data of age and disease duration (P＞0.05), indicating the comparability (Table 1).

Table 1. Comparison of general data

2 Treatment Methods

2.1 Observation group

The observation group was intervened by acupuncture plus heat-sensitive moxibustion[7].

2.1.1 Acupuncture treatment

Major points: Zhongwan (CV 12), Tianshu (ST 25), Guanyuan (CV 4), Zhongji (CV 3), Zigong (EX-CA 1), Shuidao (ST 28), Sanyinjiao (SP 6), Zusanli (ST 36), Shenshu (BL 23), Ciliao (BL 32), and Zhibian (BL 54).

Adjunct points: Taichong (LR 3) and Ganshu (BL 18) were added for qi stagnation and blood stasis; Yinlingquan (SP 9) and Quchi (LI 11) for damp-heat obstructing the collaterals; Diji (SP 8) and Pishu (BL 20) for cold-damp retention; Xuehai (SP 10) and Guilai (ST 29) for blood stasis due to kidney deficiency.

Method: First, the patient was asked to take a supine position. After sterilization with 75% alcohol, Zhongwan (CV 12), Tianshu (ST 25), Guanyuan (CV 4), Zhongji (CV 3), Zigong (EX-CA 1), Zusanli (ST 36), and Sanyinjiao (SP 6) were perpendicularly punctured by 0.5-0.8 cun. Of the points, Zhongwan (CV 12), Guanyuan (CV 4), and Zusanli (ST 36) were applied with reinforcing needling manipulation, while the rest points were with even reinforcing-reducing manipulation. The needles were retained for 30 min. Afterwards, the patient took a prone position. After sterilization, Shenshu (BL 23), Ciliao (BL 32), and Zhibian (BL 54) were perpendicularly punctured. Shenshu (BL 23) was punctured with reinforcing manipulation and the rest were with even reinforcing-reducing manipulation. The needles were retained for 20 min.

2.1.2 Heat-sensitive moxibustion

The heat-sensitive points were detected by following two steps: from gross locating to refine locating.

The gross locating was for determining the possible areas of the heat-sensitive points in CPID.

The refine locating was for confirming the exact locations of the heat-sensitive points in the possible areas. Stimulated by moxibustion, 6 types of moxibustion sensations would be produced at the heat-sensitive points. The sensitive points were confirmed when one or more of the following sensations occurred.

Heat penetration: Heat produced by moxibustion penetrated through tissues till internal organs.

Heat expansion: The moxibustion heat expanded or radiated taking the point as the center.

Heat transmission: The heat transmitted from the treated point along meridians to the diseased area.

No/slight topical heat but distal heat: The heat was only produced in areas away from the treated point, but no/slight heat was produced in the treated area.

No/slight superficial heat but underlying heat: No/slight heat was produced on the surface of thetreated area, but heat was produced in deep underlying tissues or even internal organs.

Other non-heat sensations: Non-heat sensations such as distending, pressing, heavy, numb, and cold feelings were generated in the treated area or the areas away from the treated point.

The detection scope for heat-sensitive points was limited to the locations of the above punctured points, majorly were Ciliao (BL 32), Guanyuan (CV 4), Zigong (EX-CA 1), Sanyinjiao (SP 6), and Yinlingquan (SP 9).

Operation of heat-sensitive moxibustion: While the needles were retained, heat-sensitive points were treated with heat-sensitive moxibustion with swirling, bird-pecking, and returning manipulations, followed by mild moxibustion. The swirling manipulation was performed for 2 min first to warm and unblock the topical qi-blood circulation; followed by bird-pecking manipulation for 1 min to strengthen the sensitization; along-meridian returning manipulation was then performed for 2 min to activate meridian qi; finally, mild moxibustion was operated to unblock and regulate meridians and collaterals, for promoting the transmission of sensations.

2.2 Control group

Patients in the control group were intervened by acupuncture plus box-moxibustion, with the same points and method for acupuncture treatment. The box-moxibustion was performed on the lower abdomen.

For both groups, the intervention was given once every other day, 10 sessions as a treatment course, for 3 months in total.

3 Therapeutic Efficacy

3.1 Criteria of therapeutic efficacy

It’s made by referring the criteria of therapeutic efficacy for CPID in theGuiding Principles for Clinical Study of New Chinese Medicines[8]andDiagnostic and Recovery Criteria for Gynemetric Diseases[9].

Recovery: Symptoms and body signs were gone, and gynecological examinations showed normal.

Markedly effective: Symptoms were gone, and gynecological examinations showed significant improvement.

Improved: Symptoms and topical body signs were reduced, and gynecological examinations showed improvement.

Invalid: Symptoms and body signs were not improved.

3.2 Treatment result

The recovery rate and total effective rate of the observation group were significantly higher than that of the control group (P＜0.05), andχ2values were 5.70 and 4.11 respectively, indicating that the clinical efficacy of the observation group was superior to that of the control group (Table 2).

Table 2. Comparison of clinical efficacy (case)

4 Discussion

In traditional Chinese medicine, CPID falls under the scopes of leukorrheal, abdominal mass, or dysmenorrhea, caused by accumulation of damp, heat, phlegm, or stasis in the Thoroughfare and Conception Vessels and uterus. Damp, heat, and stasis are the key pathogenic factors, and the patterns are majorly differentiated to qi stagnation and blood stasis, damp-heat obstructing the collaterals, cold-damp retention and blood stasis due to kidney deficiency[10-12]. Despite the causes, chronic blood stagnation in pelvic cavity would be the final result, to which medications are difficult to reach. By following the treatment principle to activate qi-blood circulation, unblock meridians, and warm to resolve cold-damp, acupuncture therapy and acupuncture plus mild moxibustion have achieved good efficacies[3,13-15].

In clinic, topical points such as Zigong (EX-CA 1), Qihai (CV 6), Guanyuan (CV 4), Zhongji (CV 3), Shuidao (ST 28), and Guilai (ST 29) are punctured to regulate local qi-blood circulation. The Thoroughfare and Conception Vessels originate from uterus, the Belt Vessel is connected with uterus, and the points from the Belt and Conceptions Vessels function to regulate the qi activities and promote blood circulation; Ciliao (BL 32) boosts the blood circulation in pelvic cavity, tonifies kidney and lower back, activates blood circulation and dissolves stasis; Sanyinjiao (SP 6) is the crossing point of the Liver, Kidney, and Spleen Meridians, working to reinforce spleen and stomach, regulate qi and blood, and dispel damp and heat; as the Yuan-Primary point of the Liver Meridian, Taichong (LR 3) can regulate the liver function.

When the needles are retained in the acupoints, the performance of box-moxibustion on the lower abdomen can transmit the moxibustion heat to thediseased area, to warm and unblock meridians and collaterals, promote qi-blood circulation, and dissolve stasis, thus further strengthening the efficacy of acupuncture for CPID. However, this static suspended moxibustion method can only produce hot sensation in local area on the body surface, which can hardly activate the transmission of meridian qi, and it’s difficult for the medication and heat to reach to the diseased location. Besides, as it’s not individualized, this moxibustion may cause insufficient or over moxibustion, either to decrease the treatment efficacy or to result in discomforts, e.g. scorching feeling.

Heat-sensitive moxibustion is performed at the heat-sensitized acupoints. The treatment dose can be dynamically adjusted according to patients, diseases, and acupoints during the operation. It emphasizes the six types of moxibustion sensations, including heat penetration, heat expansion, heat transmission, no/slight topical heat but distant heat, no/slight superficial heat but underlying heat, and non-heat sensations, for effectively controlling the pathological features of heat-sensitive points: small stimulation but great response. Heat produced by this moxibustion method is easier to activate meridian qi, pass along meridians, and reach to the diseased area, thus reinforcing and optimizing the efficacy of moxibustion. The current study indicated that the efficacy of acupuncture plus heat-sensitive moxibustion is higher than acupuncture plus mild moxibustion, exactly conforming to the above theories. However, because the sample size adopted in this study is rather small, the treatment protocol still requires more profound and overall exploration in future clinical work.

Conflict of Interest

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

Statement of Informed Consent

All of the patients in the study signed the informed consent.

Received: 28 August 2014/Accepted: 20 October 2014

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Translator:Hong Jue (洪珏)

针刺结合热敏灸治疗慢性盆腔炎疗效观察

目的：观察针刺结合热敏灸治疗慢性盆腔炎的疗效, 筛选治疗慢性盆腔炎的有效针灸治疗方案。方法：选取慢性盆腔炎患者80例, 采用随机单盲法分成两组, 每组40例。观察组采用针刺结合热敏灸治疗, 对照组采用针刺结合灸盒治疗, 隔日治疗1次, 10次为1疗程, 月经期暂停治疗, 共治疗3个疗程后观察疗效。结果：观察组治愈率为45.0%, 总有效率为95.0%; 对照组治愈率为20.0%, 总有效率为 80.0%, 两组治愈率及总有效率均有统计学差异(P＜0.05)。结论：针刺结合热敏灸治疗慢性盆腔炎疗效优于针刺结合灸盒治疗, 且操作简便, 无不良反应。

针刺疗法; 针灸疗法; 灸法; 热敏灸; 温灸器灸; 盆腔炎性疾病; 附件炎

R246.3 【

】A

Author: Zhang Shao-yun, master degree candidate, attending physician of traditional Chinese medicine.

E-mail:103215933@qq.com

Methods:Eighty CPID subjects were enrolled and divided into two groups by randomized single-blind method, 40 in each group. The observation group was intervened by acupuncture plus heat-sensitive moxibustion, while the control group was by acupuncture plus box-moxibustion, once every other day, 10 sessions as a treatment course, but the period time was skipped. The therapeutic efficacy was observed after 3 treatment courses.

Results:The recovery rate was 45.0% and the total effective rate was 95.0% in the observation group, versus 20.0% and 80.0% in the control roup. There were significant differences in comparing the recovery rate and the total effective rate between the two groups (P＜0.05).

Conclusion:Acupuncture plus heat-sensitive moxibustion can produce a higher therapeutic efficacy in treating CPID than acupuncture plus box-moxibustion, and this is an easy-to-operate and safe method without adverse effect.