Therapeutic Efficacy Observation on Combining Herbal Cake-partitioned Moxibustion with Plumblossom Needle Therapy for Cervical Radiculopathy

Liu Min-juan, Wang Kui

1 Taihe Hospital Affiliated to Hubei Medical College, Shiyan 442000, China

2 The People’s Hospital Affiliated to Hubei Medical College, Shiyan 442000, China

Therapeutic Efficacy Observation on Combining Herbal Cake-partitioned Moxibustion with Plumblossom Needle Therapy for Cervical Radiculopathy

Liu Min-juan1, Wang Kui2

1 Taihe Hospital Affiliated to Hubei Medical College, Shiyan 442000, China

2 The People’s Hospital Affiliated to Hubei Medical College, Shiyan 442000, China

Objective: To observe the clinical effect of combining Herbal cakepartitioned moxibustion with plum-blossom needle therapy for cervical radiculopathy.

Methods: A total of 150 cases with cervical radiculopathy were randomly allocated into a treatment group (n=90) and a control group (n=60) at ratio of 3:2. Cases in the treatment group were treated with combining herbal cake-partitioned moxibustion with plum-blossom needle therapy, whereas cases in the control group were treated with combiningDan Shen(Radix Salviae Miltiorrhizae) injection with traction. The therapeutic efficacies were evaluated by the third party after three courses of treatments.

Results: The recovery and total effective rates in the treatment group were 51.1% and 97.8% respectively, versus 18.3% and 78.3% in the control group, showing statistically significant differences (bothP＜0.05). And there was a between-group statistical difference in the number of recovery cases in different courses of treatments (P＜0.05).

Conclusion: Combining herbal cake-partitioned moxibustion with plum-blossom needle therapy was more effective than combiningDan Shen(Radix Salviae Miltiorrhizae) injection with traction for cervical radiculopathy, and it took effect more quickly. It is worth further popularization in clinic.

Moxibustion Therapy; Indirect Moxibustion; Plum-blossom Needle Therapy; Neck Pain; Spondylosis

Cervical Spondylosis is a common problem today. Approximately 60%-71%[1-2]of cervical spondylosis are cervical radiculopathy, which affects 1.7%-17.6%[3]of the general population and up to 3.5%[4]of normal people. This condition often affects people aged between 30 and 60. However it tends to affect younger people today[5], especially those work with computer or sleep in a high pillow[6]. Cervical radiculopathy can be induced by fatigue, cold and trauma.

Cervical radiculopathy refers to a series of symptoms due to chronic degenerative changes of cervical disc, osteophytes on the cervical vertebrae, subluxated cervical joints or ligaments that irritate or compress one or more nerve roots. This condition is clinically characterized by pain, numbness and weakness in the neck, shoulder and back that may radiate to the upper limbs and fingers. It’s mainly managed by non-surgical therapy[7-8], primarily to release symptoms due to nerve root compression[9]. We treated cervical radiculopathy by combining herbal cake-partitioned moxibustion with plum-blossom needle therapy. The results are now summarized as follows.

1 Clinical Materials

1.1 Diagnostic criteria

This was based on the diagnostic criteria for cervical radiculopathy stipulated in theCriteria of Diagnosis and Therapeutic Effects of Diseases and Syndromes in Traditional Chinese Medicine[10]. It is commonly seen in elderly population or young and middle-aged people with a history of trauma/strain, cervical malformation or other inducing factors; slow onset (or acute attack from trauma or strain) with a chronic duration; typical radicular symptoms (numbness, pain) in the area where the nerve that is irritated travels; positive brachial plexus tension test and Spurling test; and cervical X-ray showed unstable cervical vertebrae or osteophytes, hyperplasia of uncovertebral joint and sagittal stenosis of the spinal canal.

1.2 Inclusion criteria

Those who met the above criteria; aged between 35 and 70; numbness and pain in the area where the nerve that is irritated travels; positive results of brachial plexus tension test, Spurling sign and crushing test of intervertebral foramen; cervical X-ray showed unstable cervical vertebrae or osteophytes, hyperplasia of uncovertebral joint and sagittal stenosis of the spinal canal; cooperative during treatment and willing to sign the informed consent.

1.3 Exclusion criteria

Those who failed to meet the above criteria; those who met the above criteria but had other patterns of cervical spondylosis; having complications of hypertension, heart disease, arteriosclerosis and dysfunctional blood supply; asymptomatic (only abnormal findings in X-ray); acute traumatic cervical disc herniation or cervical spondylosis involving the vertebral artery, sympathetic nerve and spinal cord; pain in the upper limbs due to tennis elbow, scapulohumeral periarthritis and biceps tendonitis; having an allergic constitution, schizophrenia or other mental disorders; pregnant or breast-feeding women; those having taken non-steroid anti-inflammatory pain-killers or glucocorticoids that may affect efficacy evaluation; having incomplete data and those who failed to stick to the treatment.

1.4 General data

A total of 150 outpatients and inpatients with cervical radiculopathy in our hospital were randomly allocated into a treatment group (n=90) and a control group (n=60) at 3:2. The 90 cases in the treatment group were aged between 37 and 68, and their disease duration lasted from 1 week to 11 years. The 60 cases in the control group were aged between 38 and 69, and their duration lasted from 9 d to 10 years. There were no statistical significances in gender, age and duration between the two groups (P＞0.05), indicating that the two groups are comparable (table 1).

Table 1. Between-group comparison of general data ()

Table 1. Between-group comparison of general data ()

Treatment 904644 52±2.4 5.6±2.3 Control 602931 51±2.1 5.4±2.4

2 Treatment Methods

2.1 Treatment group

2.1.1 Herbal cake-partitioned moxibustion

Points: Jiaji (EX-B 2) points in the affected and adjacent cervical segments.

Method: First, grind 50 g ofSan Qi(Radix et Rhizoma Notoginseng),30 g ofYan Hu Suo(Rhizoma Corydalis),Bai Jie Zi(Semen Sinapis),Ding Xiang(Flos Caryophylli) andRou Gui(Cortex Cinnamomi) respectively, 20 g ofRu Xiang(Olibanum),Mo Yao(Myrrha),Chuan Shan Jia(Squama Manitis),Fang Feng(Radix Saposhnikoviae),Du Huo(Radix Angelicae Pubescentis) respectively and 15 g ofChuan Jiao(Fructus Zanthoxyli),Xi Xin(Radix et Rhizoma Asari) andGan Sui(Radix Kansui) respectively into an extremely fine powder. Next, mix the powder with honey and fresh ginger juice (1:1) into an herbal cake of 2-3 cm in diameter and 0.5-1 cm in thickness with several holes. Then place the herbal cake over the points and ignite the moxa cone above the cake. In case the patient feels hot, slightly move the herbal cake. When the herbal cake is burnt dry, add some ginger juice or replace it with another one. Conduct 3 cones for each point until the skin becomes red (no blisters).

2.1.2 Plum-blossom needle therapy

After the herbal cake-partitioned moxibustion, plum-blossom needle therapy was applied to a 3-cm radius around the above Jiaji (EX-B 2) points. After the local area was disinfected, tap the area perpendicularly, 3 min for each point, 3-5 points for each treatment. Clean and disinfect the hemorrhagic area.

2.2 Control group

2.2.1 Treatment of medicine

Cases in the control group were given intravenous dripping of 40 mL compoundDan Shen(Radix Salviae Miltiorrhizae) injection in 250 mL 5% glucose solution (manufactured by Chiatai Qingchunbao Pharmaceutical Co., Ltd., No. 1104213), once a day.

2.2.2 Traction

The Y2-01 neck traction chair (manufactured by Jiangsu Rixin Medical Equipment Co., Ltd.) wasemployed for traction, using 15-30° for neck flexion angle and 10%-20% body weight for traction force (gradually increased according to the patient’s tolerance), 20-30 min for each traction.

2.3 Course of treatment

The treatment in both groups was done once every day, 7 times for a course of treatment. There was a 1-day interval between two courses. The therapeutic efficacy was statistically analyzed by the third party after three courses of treatment.

3 Results

3.1 Criteria for therapeutic efficacy

This was based on the criteria for cervical spondylosis stipulated in theCriteria of Diagnosis and Therapeutic Effects of Diseases and Syndromes in Traditional Chinese Medicine[10].

Recovery: Absence of major symptoms or signs, good functional recovery and can return to normal work.

Marked effect: Almost absence of major symptoms or signs, fairly good functional recovery and can manage mild physical work.

Improvement: Alleviation of signs and symptoms, improved functions of the neck, shoulder and limbs but inability to manage mild physical work.

Failure: The signs and symptoms remain unchanged after treatment.

3.2 Statistical method

The SPSS 17.0 version software was used for statistical management, thet-test for measurement data (), analysis of variance for inter-group comparison, the Chi-square test for numeration data, andRiditanalysis for ranked data.P＜0.05 indicates a statistical significance.

3.3 Treatment results

3.3.1 Between-group comparison of clinical effects

The recovery and total effective rates were 51.1% and 97.8% respectively in the treatment group, versus 18.3% and 78.3% in the control group, showing statistical significances (P＜0.05) and indicating a better effect in the treatment group (table 2).

Table 2. Between-group comparison of clinical efficacies (case)

3.3.2 Between-group comparison of treatment course and efficacy in recovery cases

The Chi-square test has shown a statistical significance in different courses of treatment for recovery cases (P＜0.05) between the two groups, indicating a faster and better effect in the treatment group than that in the control group (table 3).

Table 3. Between-group comparison of recovery cases in different courses of treatment (case)

3.3.3 Between-group follow-up comparison of recovery cases after 6 months

Six months after treatment, 46 recovery cases in the treatment group had no experience of pain in the neck, shoulder and back or finger/upper limb numbness and weakness (100% recovery rate), whereas 11 recovery cases in the control group experienced shoulder discomfort coupled with numbness and weakness of upper limbs (72.7% recovery rate), showing a statistical significance (P＜0.05) and indicating a more stable effect in the treatment group.

4 Discussion

Cervical spondylosis is directly associated with an extended period of neck flexion in computer use[11]. Modern medicine holds that contributing factors of cervical spondylosis include nerve compression, vertebral instability, nerve irritation, stress changes and humoral factor stimulation. Most of these factors are reversible. Non-surgical therapies including acupuncture are safe, low-cost and effective in managing this condition.

Although the mechanism of herbal cake-partitioned moxibustion is not yet clear, it does alleviate pain in clinical practice. It’s believed that moxibustion can activate meridian qi, regulate qi and blood, balance yin and yang and increase the pain threshold to alleviate pain. With double effect from moxa stick and herbal medicine, herbal cake-partitioned moxibustion is indicated for chronic conditions[12]. Directly reaching theaffected area, this method can increase blood circulation, benefit metabolism, boost the immune system and alleviate pain[12-13]. Moxibustion on neck Jiaji (EX-B 2) points can tonify the liver and kidney, strengthen Governor Vessel and the spleen, warm meridians, dissipate cold and relieve pain and stiffness of the spine. Of ingredients for the herbal cake,San Qi(Radix et Rhizoma Notoginseng) andYan Hu Suo(Rhizoma Corydalis) can activate blood, circulate qi, resolve swelling and alleviate pain.Ding Xiang(Flos Caryophylli),Rou Gui(Cortex Cinnamomi),Chuan Jiao(Fructus Zanthoxyli) andXi Xin(Radix et Rhizoma Asari) can warm meridians, dissipate cold and alleviate pain.Fang Feng(Radix Saposhnikoviae) andDu Huo(Radix Angelicae Pubescentis) can remove wind, resolve dampness and dissipate cold.Ru Xiang(Olibanum),Mo Yao(Myrrha) andChuan Shan Jia(Squama Manitis) can activate blood, resolve stasis and alleviate pain. Numerous studies have proven that herbal cake-partitioned moxibustion is effective for pain syndrome[14]. This method can warm and dredge meridians, supplement qi, improve clinical effect and also benefit the immune system.

Developed from the ancient technique of ‘shallow needling’, plum-blossom needle therapy enables the affected area to become warm and congested. This can dilate blood vessels, dredge meridians, increase local circulation of blood, accelerate metabolism of pain-producing substance, block pain conduction, release adhesion and restore mobility of the spine. Combined herbal cake-partitioned moxibustion and plum-blossom needle can unblock meridians, remove wind, dissipate cold, resolve dampness and alleviate pain[15-17], thus achieving a remarkable effect for cervical radiculopathy.

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Translator: Han Chou-ping

R245.8

A

Date: August 12, 2013

Author: Liu Min-juan, technician-in-charge

Wang Kui, technician-in-charge.

E-mail: zhengsu0413@126.com