Observation on clinical effect of acupuncture for cervical spondylosis of vertebral artery type

He Xi-jun (何?？?, Huang Na-na (黃娜娜), Liang Li-hong (梁麗紅)

Zhongshan Hospital Affiliated to Guangzhou University of Traditional Chinese Medicine, Guangdong 528400, China

Clinical Study

Observation on clinical effect of acupuncture for cervical spondylosis of vertebral artery type

He Xi-jun (何希俊), Huang Na-na (黃娜娜), Liang Li-hong (梁麗紅)

Zhongshan Hospital Affiliated to Guangzhou University of Traditional Chinese Medicine, Guangdong 528400, China

Objective:To observe the clinical effect of acupuncture therapy to support yang and consolidate the constitution for cervical spondylosis of vertebral artery type (CSA).

Acupuncture-moxibustion Therapy; Acupuncture Therapy; Moxibustion Therapy; Moxibustion with Seed-sized Moxa Cone; Spondylosis; Neck Pain; Vertigo; Cervical Spondylosis

Cervical spondylosis of vertebral artery type (CAS) is a common type of cervical spondylopathy and its pathogenesis is related to compression or stimulation of the cervical artery due to mechanical and dynamic factors, leading to stenosis, torsion or spasm of the blood vessels, and hence causing symptoms due to vertebral and basilar arterial insufficiency[1]. CSA can influence the learning and job of the patients. Therefore, it is extremely important to seek a safe and effective therapeutic plan for CSA. We treated CSA by acupuncture therapy to support yang and consolidate constitution, in comparison with routine acupuncture therapy. Now, the report is given as follows.

1 Clinical Materials

1.1 Diagnostic criteria

In conformity with CSA diagnostic criteria stipulated at the Second National Seminar on Cervical Spondylopathy in 1993[2]: cataplexy seizure, accompanied by cervical vertigo; positive in the revolve-cervix test, mostly accompanied by cranial symptoms, including blurring of vision, tinnitus and hearing disorder; cervical segmental instability orhyperplasia of the uncovertebral joint shown in X-ray film; exclusion of ocular, cardiac, cerebral and aural vertigo; limited stenosis or torsion in the second segment of the vertebral artery in MRI or colored ultrasonic scan of the vertebral artery; exclusion of basilar arterial insufficiency caused by compression of the first segment (the cervical arterial segment before entering the sixth cervical transverse foramen) and third segment (the cervical arterial segment before the cervical vertebra enters the skull) of the cervical artery. MRI or digital subtraction angiography (DSA) is beneficial to the confirmation of the diagnosis.

1.2 Inclusion criteria

In conformity with the above CSA diagnostic criteria, with the age ranged 18-70 years old, unlimited gender, without any therapeutic plan in the recent one week, willing to participate in this study and sign the informed consent.

1.3 Exclusion criteria

Those with vertigo caused by ocular, aural reason, intracranial tumor, or arteriosclerosis; basilar arterial insufficiency caused by compression of the first segment of the vertebral artery (the vertebral artery before entering the sixth cervical transverse foramen); those unable to cooperate with the treatment due to unconsciousness or serious mental disorder, and those complicated with primary diseases severely threatening the life in the cardiocerebrovascular, hepatic, renal and hematopoietic system.

1.4 Statistical methods

All data were statistically managed by SPSS 19.0 statistical software. The measuring data were processed byt-test and the counting data were processed by Chi-square test. APvalue ＜0.05 expresses a statistical significance in difference.

1.5 General data

Totally, 72 cases were recruited into the study and were outpatients treated in the preventive treatment center of the hospital from February of 2013 to December of 2014. Randomly divided by the random digital table, there were 36 cases in the acupuncturemoxibustion group, with the age ranged between 25 and 70 years old and the duration ranged from 7 d to 20 years. There were 36 cases in the acupuncture group, with the age ranged from 27 to 69 years old and the duration ranged from 5 d to 25 years. By the statistical management of all data in the two groups, the differences were not statistically significant (P＞0.05), indicating that the two groups were comparable (Table 1).

Table 1. Comparison of general data between the two groups

2 Therapeutic Methods

2.1 Acupuncture-moxibustion group

The patients in the acupuncture-moxibustion group were treated by acupuncture and moxibustion to support yang and consolidate constitution.

Acupoints: Baihui (GB 20), Fengchi (GB 20), C4-6Jiaji (EX-B 2), Shenshu (BL 23) and Mingmen (GV 4).

Method: The patient took a supine position. After routine disinfection, acupuncture was given by disposable filiform needles of 0.30 mm in diameter and 50 mm in length. Fengchi (GB 20) was punctured obliquely toward the nose tip for 1.0-1.5 cun. The needles were manipulated by moderate needling technique after the arrival of the needling sensation once every 10 min. C4-6Jiaji (EX-B 2) points were punctured obliquely toward the spine for 0.8-1.2 cun. After the arrival of the needling sensation by twisting the needles, the needles were connected with G06805-I EA apparatus, with the positive probe at C4Jiaji (EX-B 2) and negative probe at C6Jiaji (EX-B 2) on the same side, continuous wave and intensity of stimulation within the patient’s tolerance. The needles were retained for 30 min. During the retaining of the needles, moxa roll was used to Baihui (GB 20), about 2-3 cm above the skin, for moxibustion, so that the patient had a warm sensation but without burning pain in the local area, for 15 min. Then, fine moxa wool was made into grain-sized moxa cones and grain-sized moxibustion was given by igniting the moxa cones with fine incense at Shenshu (BL 23) and Mingmen (GV 4) after a little Vaseline was applied. When moxa cone burnt to its 1/4 or the patient felt slight pain, the rest moxa cone was taken off quickly with a forceps. Each acupoint was applied with 5 cones continuously for each session.

2.2 Acupuncture group

Acupoints: Fengchi (GB 20), cervical Jiaji (EX-B 2), Tianzhu (BL 10), Jianjing (GB 21), Houxi (SI 3), Hegu (LI 4) and Waiguan (TE 5)[3].

Method: The disposable filiform needles of 0.30 mm in diameter and 50 mm in length were used. After routine disinfection and the needles were inserted with the arrival of the needling sensation, the needles were connected with G06805-I EA apparatus at C4and C6Jiaji(EX-B 2), Jianjing (GB 21) and Waiguan (TE 5) of the same side, two pairs on each side, by continuous wave and intensity of stimulation within the patient’s tolerance. The needles were retained for 30 min.

The treatment was given once every day for both groups and continuous six sessions made one course. After two courses of treatments, the therapeutic effects were observed.

3 Observation of Therapeutic Effects

3.1 Observed items

In accordance with the clinical assessment table of CSA in thePractical Rehabilitation Medicine[4]and actual situation, the self-made table of the clinical symptoms was to assess the symptoms of the patients (Table 2). The assessment was given to the patients of the two groups before and after the treatment, and the total scores were 70 points. The higher the scores, the more serious the patient’s symptoms.

Table 2. Assessment table of clinical symptoms (point)

3.2 Criteria of therapeutic effects

In reference to the criteria of the therapeutic effects for CSA in theCriteria of Diagnosis and Therapeutic Effects of Diseases and Syndromes in Traditional Chinese Medicine[5].

Cure: The original clinical symptoms and signs disappeared, with normal muscle force and normal functions of the neck and limbs, and with ability to join the normal labor and work.

Improvement: The original clinical symptoms and signs were relieved, with the pain in the neck, shoulder and back alleviated and the functions of neck and limbs improved.

Failure: No improvement in symptoms.

3.3 Results

3.3.1 Changes of clinical symptoms

After treatment, the scores in the assessment table of the clinical symptoms obviously decreased in the patients of the two groups, statistically different from the scores of the same group before treatment (P＜0.01). The differences between the two groups were statistically significant (P＜0.05), indicating that the clinical symptoms were improved in the two groups, it is better in the acupuncture-moxibustion group than that in the acupuncture group (Table 2).

Table 2. Comparison of scores of clinical symptoms before and after treatment between the two groups (point)

Table 2. Comparison of scores of clinical symptoms before and after treatment between the two groups (point)

Note: Compared with the same group before treatment, 1) P＜0.01; compared with the acupuncture group, 2) P＜0.05

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3.3.2 Clinical effects of the two groups

After treatment for two courses, the total effective rate was 91.7% in the acupuncture-moxibustion group and 61.1% in the acupuncture group. The difference in the total effective rate between the two groups were statistically significant (P＜0.05), indicating that the therapeutic effect was better in the acupuncturemoxibustion group than that in the acupuncture group (Table 3).

Table 3. Comparison of clinical effect between the two groups (case)

4 Discussion

CSA belongs to the scope of ‘vertigo’ in traditional Chinese medicine. Vertigo is first seen inNei Jing(Classic of Internal Medicine). In an overall view of the theories of the medical practitioners in ancient and modern times, the pathogenic factors of vertigo are numerous. But, its pathological change is no more than deficient or excessive pattern, mostly in deficient pattern. Its pathogenesis is mainly related to emptiness and deficiency in meridians and insufficiency of meridian qi, subsequently qi and blood are unable to ascend to nourish the brain.

By learning and referring the theories of the ancient medical practitioners, in combination with the analysis of the clinical cases, the author believes that CSA is caused by yang deficiency, kidney yang deficiency in particular, so as to establish acupuncture treatment to support yang and consolidate constitution for CSA. ‘To support yang’ means to dredge, protect, warm, assist and regulate yang qi, so as to disperse and strengthen yang qi of the human body, briefly, to dredge on onehand, and to reinforce and warm on the other hand. ‘To consolidate the constitution’ means to consolidate and protect the prenatal and postnatal foundation. In this study, under the guidance of the theory to ‘support yang and consolidate the constitution’, the treatment is given by treating yang deficiency in predominance, in combination of the method to support yang and consolidate the constitution with local acupuncture plus moxibustion at Baihui (GB 20), Shenshu (BL 23) and Mingmen (GV 4). Fengchi (GB 20) is a crossing acupoint of Foot Shaoyang Meridian and Yang Link Vessel. Yang Link Vessel is able to link with all yang meridians. Acupuncture on Fengchi (GB 20) is able to regulate qi of yang meridians in the whole body. Jiaji (EX-B 2) points are situated between the Governor Vessel and Bladder Meridian of Foot Taiyang and can be used to dredge and regulate qi and blood of Governor Vessel and excite yang qi. Additionally, electric stimulation can effectively relieve the tense status of the neck muscles, alleviate the stimulation on the nerve root and mechanical compression on blood vessels from degeneration, decrease the excitement of the sympathetic nerve, and enlarge the inner diameter of the vertebral artery, accelerate the velocity of blood flow, and improve blood supply to the brain[6-8]. Baihui (GV 20) is an important acupoint of the Governor Vessel. The Governor Vessel is the sea of yang meridians. Moxibustion at Baihui (GV 20) has the effects to warm up and dredge yang qi, and reinforce and benefit the brain marrow. It has been found out in the modern research that Baihui (GV 20) is situated in the center of the vertex, with the emissarium parietale from the skull to link with the veins of the vertex and the venous diploe of the skull, so as to communicate with the intracranial dural sinus[9]. Therefore, moxibustion above it can directly influence the intracranial blood flow and improve blood supply in the head. Shenshu (BL 23) is a Back-Shu point of the kidney. Mingmen (GV 4) is an important acupoint of the Governor Vessel and is situated between the two kidneys. Moxibustion at Shenshu (BL 23) and Mingmen (GV 4) can warm up the kidney, assist yang, build up the primary essence and strengthen the primordial energy[10]. Grain-sized moxibustion can be used to enhance the therapeutic effects.

Acupuncture therapy to ‘support yang and consolidate the constitution’ is based upon the idea to support yang and consolidate the constitution as the theory, individual pattern identification and meridian identification as the method, and acupuncture and moxibustion as the means, in order to dredge the meridians by the needles and warm and reinforce yang qi by moxibustion, for finally realizing the goal to support the primary yang on the basis of the governance of the postnatal qi[11].

It has been proven by the findings from this study that acupuncture therapy can remarkably improve the clinical symptoms of CSA patients, with its therapeutic effect better than traditional acupuncture therapy, and is worthy of the clinical popularization.

Conflict of Interest

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

Statement of Informed Consent

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

Received: 15 March 2015/Accepted: 23 April 2015

[1] Zhao DL. Modern Osteology. Beijing: Science Press, 2004: 1071.

[2] Sun Y, Chen Q. Proceedings of second national seminar on cervical spondylopathy. Zhonghua Waike Zazhi, 1993, 31(8): 472.

[3] Shi XM. Science of Acupuncture and Moxibustion. Beijing: China Press of Traditional Chinese Medicine, 2002: 208.

[4] Nan DK, Huang XL. Practical Rehabilitative Medicine. Beijing: People’s Medical Publishing House, 1992: 946.

[5] 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: 175.

[6] Bu YQ. Acupuncture and moxibustion combined with massage for treatment of cervical spondylosis of vertebral artery type. Zhongguo Zhen Jiu, 2004, 24(2): 97-98.

[7] An GH, Zhao Y, Sun P. Mechanism and application of Jiaji point in the treatment of cervical spondylosis. Zhongguo Linchuang Kangfu, 2006, 10(31): 129-131.

[8] Tang S, Luo XJ, Shi QD, Lin YP, Lai L, He L. Observation on the efficacy of electroacupuncture at Jiaji points in treating cervical spondylosis. Shanghai Zhenjiu Zazhi, 2014, 33(9): 840-842.

[9] Wang Z. Chinese Compendium of Pricking and Bleeding Therapy. Hefei: Anhui Science and Technology Publishers, 2011: 79-80.

[10] Yang L, Huang QF, Wu HG, Liu XX, Ding GH, Ma XP, Feng XM, Dou CZ. Analysis of the frequency of clinical acupoint use based on ‘traditional Chinese medical acupuncture-moxibustion information databank’. J Acupunct Tuina Sci, 2014, 12(2): 80-88.

[11] Nie RR, Fu WB. Thinking on method to support yang and consolidate the constitution in acupuncture treatment of cerebral diseases. Zhongguo Laonianxue Zazhi, 2012, 9(17): 3861-3863.

Translator: Huang Guo-qi (黃國琪)

針灸治療椎動脈型頸椎病療效觀察

目的：觀察扶陽固本針灸療法治療椎動脈型頸椎病(cervical spondylosis of vertebral artery type, CSA)的臨床療效。方法：將72例CSA患者按隨機數字表隨機分為針灸組和針刺組, 每組36例。針灸組予電針雙側風池、C4-6夾脊配合艾灸百會、腎俞、命門的扶陽固本針灸療法治療。針刺組予電針雙側風池、頸夾脊、天柱、肩井、后溪、合谷、外關的常規針刺治療。每日治療1次, 連續6次為1療程, 治療2個療程后觀察兩組患者臨床癥狀改善情況及臨床療效。結果：針灸組總有效率為91.7%, 針刺組為61.1%, 兩組總有效率差異有統計學意義(P＜0.05)。治療后, 兩組臨床癥狀評分均較本組治療前明顯下降(P＜0.01); 兩組評分差異亦有統計學意義(P＜0.05)。結論：扶陽固本針灸療法治療CSA的療效優于常規針刺療法。

針灸療法; 針刺療法; 灸法; 麥粒灸療法; 椎關節強硬; 頸痛; 眩暈; 頸椎病

R246.2 【

】A

Author: He Xi-jun, chief physician, tutor of master students.

Email: hexijun18@aliyun.com

Methods:A total of 72 patients with CSA were randomly divided upon the random digital table into an acupuncturemoxibustion group and an acupuncture group, 36 cases in each group. The acupuncture-moxibustion group was treated by electroacupuncture (EA) at bilateral Fengchi (GB 20) and C4-6Jiaji (EX-B 2), in combination of moxibustion at Baihui (GV 20), Shenshu (BL 23) and Mingmen (GV 4) to support yang and consolidate constitution. The acupuncture group was given by routine EA at bilateral Fengchi (GB 20), cervical Jiaji (EX-B 2), Tianzhu (BL 10), Jianjing (GB 21), Houxi (SI 3), Hegu (LI 4) and Waiguan (TE 5). The treatment was given once every day and continuous six sessions made one course. After 2-course treatment, the improved situation of clinical symptoms and clinical effect were observed in the two groups.

Results:The total effective rate was 91.7% in the acupuncture-moxibustion group and 61.1% in the acupuncture group. The difference of the total effective rate between the two groups was statistically significant (P＜0.05). After treatment, the scores of the clinical symptoms in the two groups were obviously decreased than those of the same group before treatment (P＜0.01). The differences in the scores between the two groups were statistically significant (P＜0.05).

Conclusion:Acupuncture-moxibustion treatment to support yang and consolidate constitution is better than the routine acupuncture therapy in the therapeutic effect for CSA.