Dingyi Xie

Heat-sensitive moxibustion in patients with osteoarthritis of the knee: a three-armed multicentre randomised active control trial

Background In China, heat-sensitive moxibustion (HSM) is used for knee osteoarthritis (KOA) to reduce pain and improve physical activity. However, there is little high-quality evidence of its effectiveness. Objective To evaluate the effectiveness of HSM in the treatment of KOA compared with usual care. Methods We performed a multicentre, randomised controlled trial. In total, 432 patients with KOA were randomly assigned to one of three groups (HSM, conventional moxibustion, or conventional injection with sodium hyaluronate). The primary end point was the guiding principle of clinical research on new drugs in the treatment of KOA (GPCRND-KOA). Measurements were obtained at baseline and after 1 and 6 months (month 7) of study. Result For GPCRND-KOA, there were significant differences among the three groups after treatment at months 1 and 7. Pairwise comparisons showed that HSM was more effective than the conventional drug. There was no difference in any measures between conventional moxibustion and the conventional drug. Compared with conventional moxibustion, HSM resulted in greater improvement in all outcomes. Conclusions This trial provided some evidence of the superiority of HSM in patients with KOA, suggesting that the observed differences might be due to superiority effects of a heat-sensitive point, although the effect of expectation cannot be ruled out. Trial Registration Number The trial was registered at Controlled Clinical Trials: ChiCTR-TRC-09000600.

Heat sensitisation in suspended moxibustion: features and clinical relevance

We have observed a ‘heat-sensitisation’ phenomenon in a large proportion of patients receiving suspended moxibustion treatment. Patients become thermally sensitised to moxibustion stimulation at certain locations on the body, indicated by sensations of strong warmth or heat penetrating into the body (heat penetration), warmth spreading around the stimulation site (heat expansion), warmth conducting in certain directions and reaching some body regions or even internal organs remote from stimulation sites (heat transmission), or other non-thermal sensations such as aching, heaviness, pressure etc. These heat-sensitised locations are not fixed, but may, during the progression of disease, dynamically change within a certain range centred on acupuncture points. Each condition seems to have its specific set of such sensitised acupuncture points and such phenomena are not commonly observed in other body regions or in healthy subjects. A number of clinical trials have shown that the appearance of heat sensitisation is correlated with better therapeutic effects in various diseases, indicating the clinical significance of such responses. Further investigation is required to elucidate the epidemiological characteristics and biological mechanisms of the heat sensitisation in suspended moxibustion.

Stroke treatment in rats with tail temperature increase by 40-min moxibustion.

The distant heat induced by suspended moxibustion (SM) for 40 min is confirmed to have a favorable effect in treating diseases such as ischemic brain injury in the clinical setting, but its precise mechanism remains to be explained. Since a similar reaction to the phenomenon of distant heat is found in some transient middle cerebral artery occlusion (tMCAO) rats treated by a 40-min SM session with tail temperature increase (TTI), we hereby study its mechanism by comparing the neuroprotective effect of 40 mins SM with TTI to those without. The experimental results show that 40 mins SM with TTI can significantly reduce the infarct volume and neurological deficit score in tMCAO rats. Western blot demonstrates that a reduction in the levels of cyclooxygenase-2 (COX-2), inducible nitric oxide synthase (iNOS) expression in tMCAO rats with TTI is more striking than that of the rats without TTI. The expression of caspase-3 protein is inhibited in tMCAO rats with TTI. The results suggest that the efficacy of SM for 40 min with TTI is higher than that without. Although neuroprotective effects present in tMCAO rats with and without TTI, those with TTI revealed a higher level of anti-inflammation effect and exhibited an anti-apoptosis effect.

Comparative Effectiveness of the Deqi Sensation and Non-Deqi by Moxibustion Stimulation: A Multicenter Prospective Cohort Study in the Treatment of Knee Osteoarthritis

Substantial evidence has supported that moxibustion stimulates a unique phenomenon of Deqi, heat-sensitive moxibustion sensation. This study consisted of a multicenter, prospective cohort study with two parallel arms (A: heat-sensitive moxibustion sensation group; B: nonheat-sensitive moxibustion sensation group). All forms of moxibustion were applied unilaterally on the right leg with a triangle shape of three acupuncture points simultaneously (bilateral Xi Yan (EX-LE5) and He Ding (EX-LE2)). After one month the primary outcome parameter GPCRND-KOA showed significant differences between groups: trial group 5.23 ± 2.65 (adjusted mean ± SE) 95% CI [4.44~6.01] versus control group 7.43 ± 2.80 [6.59~8.26], P = 0.0001. Significant differences were manifested in total M-JOA score during the follow-up period (P = 0.0006). Mean knee circumference indicated significant difference between the groups (P = 0.03; P = 0.007). Overall, this evidence suggested that the effectiveness of the Deqi sensation group might be more superior than the non-Deqi sensation one in the treatment of KOA. This study was aimed at providing scientific evidence on the Deqi sensation of moxibustion and at showing that heat-sensitive moxibustion sensation is essential to achieve the preferable treatment effects of KOA.

Influence of the deqi sensation by suspended moxibustion stimulation in lumbar disc herniation: study for a multicenter prospective two arms cohort study.

Moxibustion stimulates the Deqi (Qi arrival) phenomenon. Many clinical observations have documented that the character of the Deqi was a composite heat-sensitive moxibustion sensation. In this prospective multicentre comparative observational nonrandomized study, 92 patients with moderate to severe LDH were included. This study consisted of two parallel arms (A: heat-sensitive moxibustion sensation group; B: nonheat-sensitive moxibustion sensation group). Moxibustion was applied in the following three acupuncture points simultaneously: Da Changshu (BL25), Wei Zhong (BL40), and A-Shi acupuncture point (tenderness). The adjusted mean total Modified-JOA score showed significant differences between the groups in the first week (10.32 ± 4.27 95% CI [9.23 ~ 11.40] versus control group 12.42 ± 5.02 [11.62 ~ 13.69], P = 0.03). The outcome in the second week also presented significant differences in both groups (7.62 ± 4.80 [6.46 ~ 8.77] versus 10.56 ± 4.75 [9.35 ~ 11.76], P = 0.005). Significant differences were also manifested in the follow-up period (P = 0.007). It can be inferred that the existence of the Deqi (heat-sensitive moxibustion sensation) phenomenon in the process of suspended moxibustion is closely related to the curative effect, and arrival of heat-sensitive moxibustion sensation could improve the clinical curative effect of moxibustion.

Study on the thermesthesia features of heat-sensitive acupoints in patients with knee osteoarthritis

ObjectiveTo observe the thermesthesia thresholds of the heat-sensitive acupoints in patients with knee osteoarthritis (KOA), and to provide scientific evidence for acupoint selection based on acupoint sensitization.MethodsForty-six patients with KOA of swelling type were recruited. By using the quantitative thermesthesia testing, the thermal sensation threshold, thermal pain threshold, and threshold of thermal pain tolerance at Xuehai (SP 10), Neixiyan (EX-LE 4) and Yinlingquan (SP 9) were detected. The subjects were then divided into heat-sensitive groups and non-heat-sensitive groups according to whether there was a phenomenon of heat-sensitive moxibustion sensation at each acupoint, to compare the thermesthesia thresholds between the two groups.ResultsThe thermal sensation threshold, thermal pain threshold, and threshold of thermal pain tolerance were respectively (38.21±2.03) °C (44.47±1.8,) °C and (48.59±0.74) °C in the heat-sensitive group of Xuehai (SP 10), versus (36.76±1.93) °C, (42.91±2.05) °C and (46.95±1.14) °C in the non-heat-sensitive group of Xuehai (SP 10); the thermal sensation threshold, thermal pain threshold, and threshold of thermal pain tolerance were respectively (37.47±1.77) °C, (44.55±1.63) °C, and (47.48±0.47) °C in the heat-sensitive group of Neixiyan (EX-LE 4), versus (35.92±1.69) °C, (42.72±1.94) °C and (45.53±0.41) °C in the non-heat-sensitive group of Neixiyan (EX-LE 4); the thermal sensation threshold, thermal pain threshold, and threshold of thermal pain tolerance were respectively (37.30±2.23) °C, (44.39±1.92) °C and (47.76±0.58) °C in the heat-sensitive group of Yinlingquan (SP 9), versus (36.06±1.86) °C, (42.63±1.88) °C and (45.91±0.72) °C in the non-heat-sensitive group of Yinlingquan (SP 9). The statistical analyses showed that the thermal sensation threshold, thermal pain threshold, and threshold of thermal pain tolerance of each heat-sensitive group (all the three acupoints) were significantly higher than those of each corresponding non-heat-sensitive group (P<0.01).ConclusionThere were differences in the thermesthesia thresholds between heat-sensitized and non-heat-sensitized acupoints in patients with KOA of swelling type; and the thermal sensation threshold, thermal pain threshold, and threshold of thermal pain tolerance of the heat-sensitized points were significantly higher than those of the non-heat-sensitized ones.摘要目的观察膝骨关节炎(knee osteoarthritis, KOA)患者热敏态腧穴温度觉阈值特征, 为临床依据腧穴敏化状态取穴提供科学依据。方法纳入肿胀型KOA 患者4, 例, 应用温度觉定量测定技术, 分别测定患者血海、内膝眼、阴陵泉的热觉阈、热痛阈、热耐痛阈, 根据每个腧穴是否出现热敏灸感分为热敏组和非热敏组, 比较两组温度觉阈值差异。结果血海热敏组的热觉阈、热痛阈和热耐痛阈值分别为(38.21±2.03) °C、 (44.47±1.86) °C 和 (48.59±0.74) °C, 非热敏组分别为(36.76±1.93) °C、(42.91±2.05) °C和(46.95±1.14) °C; 内膝眼穴热敏组的热觉阈、热痛阈和热耐痛阈值分别为(37.47±1.77) °C、(44.55±1.63) °C和(47.48±0.47) °C, 非热敏组为(35.92±1.69) °C、(42.72±1.94) °C和(45.53±0.41) °C; 阴陵泉穴热敏组的热觉阈、热痛阈和热耐痛阈值分别为(37.30±2.23) °C、(44.39±1.92) °C和(47.76±0.58) °C, 非热敏组为(36.06±1.86) °C、(42.63±1.88) °C和(45.91±0.72) °C; 经统计学处理,热敏组三个穴位(血海、内膝眼和阴陵泉)的热觉阈值、热痛阈值和热耐痛阈值均高于非热敏组同名穴位的相应测量值, 差异均具有统计学意义(P<0.01)。结论肿胀型KOA 患者热敏态腧穴与非热敏态腧穴具有不同温度觉阈值特征, 热敏态腧穴热觉阈、热痛阈和热耐痛阈值均高于非热敏态腧穴。

A 3-Arm, Randomized, Controlled Trial of Heat-Sensitive Moxibustion Therapy to Determine Superior Effect among Patients with Lumbar Disc Herniation.

Systematic reviews of moxibustion for LDH have identified ponderable evidence, especially for heat-sensitive moxibustion (HSM). Therefore, we designed and carried out the large sample trial to evaluate it. 456 patients were recruited from 4 centers in China and were randomly divided into three groups by the ratio of 1 : 1 : 1 to HSM (152) group, conventional moxibustion (152) group, and conventional drug plus acupuncture (152) group. Compared with usual care, there was a statistically significant reduction in mean M-JOA score at 2 weeks and 6 months for HSM (3.8 ± 2.6 versus 8.5 ± 2.9; 3.7 ± 2.2 versus 10.1 ± 2.9) and conventional moxibustion (7.9 ± 3.0 versus 8.5 ± 2.9; 8.9 ± 3.1 versus 10.1 ± 2.9). Compared with conventional moxibustion group, HSM group showed greater improvement in all the outcomes. The mean dose of moxibustion was 41.13 ± 5.26 (range 21–60) minutes in the HSM group. We found that HSM was more effective in treating patients with LDH, compared with conventional moxibustion and conventional drug plus acupuncture. This finding indicated that the application of moxibustion on the heat-sensitive points is a good moxibustion technique in treating disease.

Study on the thermesthesia features of heat-sensitive acupoints in patients with knee osteoarthritis@@@膝骨关节炎患者热敏腧穴温度觉特征的研究

ObjectiveTo observe the thermesthesia thresholds of the heat-sensitive acupoints in patients with knee osteoarthritis (KOA), and to provide scientific evidence for acupoint selection based on acupoint sensitization.MethodsForty-six patients with KOA of swelling type were recruited. By using the quantitative thermesthesia testing, the thermal sensation threshold, thermal pain threshold, and threshold of thermal pain tolerance at Xuehai (SP 10), Neixiyan (EX-LE 4) and Yinlingquan (SP 9) were detected. The subjects were then divided into heat-sensitive groups and non-heat-sensitive groups according to whether there was a phenomenon of heat-sensitive moxibustion sensation at each acupoint, to compare the thermesthesia thresholds between the two groups.ResultsThe thermal sensation threshold, thermal pain threshold, and threshold of thermal pain tolerance were respectively (38.21±2.03) °C (44.47±1.8,) °C and (48.59±0.74) °C in the heat-sensitive group of Xuehai (SP 10), versus (36.76±1.93) °C, (42.91±2.05) °C and (46.95±1.14) °C in the non-heat-sensitive group of Xuehai (SP 10); the thermal sensation threshold, thermal pain threshold, and threshold of thermal pain tolerance were respectively (37.47±1.77) °C, (44.55±1.63) °C, and (47.48±0.47) °C in the heat-sensitive group of Neixiyan (EX-LE 4), versus (35.92±1.69) °C, (42.72±1.94) °C and (45.53±0.41) °C in the non-heat-sensitive group of Neixiyan (EX-LE 4); the thermal sensation threshold, thermal pain threshold, and threshold of thermal pain tolerance were respectively (37.30±2.23) °C, (44.39±1.92) °C and (47.76±0.58) °C in the heat-sensitive group of Yinlingquan (SP 9), versus (36.06±1.86) °C, (42.63±1.88) °C and (45.91±0.72) °C in the non-heat-sensitive group of Yinlingquan (SP 9). The statistical analyses showed that the thermal sensation threshold, thermal pain threshold, and threshold of thermal pain tolerance of each heat-sensitive group (all the three acupoints) were significantly higher than those of each corresponding non-heat-sensitive group (P<0.01).ConclusionThere were differences in the thermesthesia thresholds between heat-sensitized and non-heat-sensitized acupoints in patients with KOA of swelling type; and the thermal sensation threshold, thermal pain threshold, and threshold of thermal pain tolerance of the heat-sensitized points were significantly higher than those of the non-heat-sensitized ones.摘要目的观察膝骨关节炎(knee osteoarthritis, KOA)患者热敏态腧穴温度觉阈值特征, 为临床依据腧穴敏化状态取穴提供科学依据。方法纳入肿胀型KOA 患者4, 例, 应用温度觉定量测定技术, 分别测定患者血海、内膝眼、阴陵泉的热觉阈、热痛阈、热耐痛阈, 根据每个腧穴是否出现热敏灸感分为热敏组和非热敏组, 比较两组温度觉阈值差异。结果血海热敏组的热觉阈、热痛阈和热耐痛阈值分别为(38.21±2.03) °C、 (44.47±1.86) °C 和 (48.59±0.74) °C, 非热敏组分别为(36.76±1.93) °C、(42.91±2.05) °C和(46.95±1.14) °C; 内膝眼穴热敏组的热觉阈、热痛阈和热耐痛阈值分别为(37.47±1.77) °C、(44.55±1.63) °C和(47.48±0.47) °C, 非热敏组为(35.92±1.69) °C、(42.72±1.94) °C和(45.53±0.41) °C; 阴陵泉穴热敏组的热觉阈、热痛阈和热耐痛阈值分别为(37.30±2.23) °C、(44.39±1.92) °C和(47.76±0.58) °C, 非热敏组为(36.06±1.86) °C、(42.63±1.88) °C和(45.91±0.72) °C; 经统计学处理,热敏组三个穴位(血海、内膝眼和阴陵泉)的热觉阈值、热痛阈值和热耐痛阈值均高于非热敏组同名穴位的相应测量值, 差异均具有统计学意义(P<0.01)。结论肿胀型KOA 患者热敏态腧穴与非热敏态腧穴具有不同温度觉阈值特征, 热敏态腧穴热觉阈、热痛阈和热耐痛阈值均高于非热敏态腧穴。

Effectiveness and safety of heat-sensitive moxibustion on bronchial asthma: a Meta-analysis of randomized control trials

OBJECTIVE To systematically evaluate the effectiveness and safety of heat-sensitive moxibustion (HSM) on asthma. METHODS Large databases in China and overseas were searched by electronic and manual means to collect information on randomized controlled trials (RCTs). Two evaluators independently extracted data and evaluated the quality of RCTs according to Cochrane Review Handbook v5.0. RevMan v5.0.20 was used for statistical analyses. RESULTS Fourteen RCTs involving 637 patients were collected. Thirteen RCTs compared the effects of HSM and Western Medicine. After 3-month treatment and after 6-month follow-up, there was no significant difference in effective rate [relative risk (RR) = 1.01, 95% CI (0.92, 1.12), and 1.12, (0-93, 1.36), respectively], in the asthma control test score of asthma symptoms [weighted mean difference (WMD) = - 1.54, 95% CI (- 3.54, 0.47), and 1.41, (- 0.48, 3.29), respectively] and in the forced expiratory volume in 1 second (FEV1) and peak expiratory flow (PEF). One RCT compared the effect of HSM with warm-suspended moxibustion. After 6-month follow-up, there was a significant difference in FEV1 and PEF [WMD = 0.51, 95% CI (0.10, 0.92), and 1.78, (1.06, 2.50), respectively]. After 3-month treatment, there was no significant difference between the two groups. One RCT compared the effect of HSM with acupoint application. After 3-month treatment, there was no significant difference in the effective rate [RR = 0.68, 95% CI (0.42, 1.12)]. CONCLUSION HSM did not show superiority to conventional Western Medicine and acupoint application in terms of curative effects, and may be superior to warm-suspended moxibustion with regard to long-term curative effects. Because of low quality of the included RCTs, this conclusion must be bolstered with higher-quality RCTs.

The Characterization of Deqi during Moxibustion in Stroke Rats

The efficacy of acupuncture and moxibustion is closely related to Deqi phenomenons, which are some subjective feelings. However, no one has reported the objective characterization of Deqi. Our preliminary research has found a phenomenon of tail temperature increasing (TTI) obviously in some stroke rats by suspended moxibustion at the acupoint dà zhuī (DU 14), which is similar to one characterization of Deqi during moxibustion that moxibustion heat is transferred from the original moxibustion acupoint to the other areas of the body. We wonder whether TTI is the objective indicator of Deqi characterization in animals. The present study showed that the stroke rats recovery was also associated with TTI phenomenon. This suggests that TTI phenomenon is one objective characterization of the Deqi in stroke rats. Application of the TTI phenomenon contributes to explore the physiological mechanism of Deqi.