Rixin Chen

The design and protocol of heat-sensitive moxibustion for knee osteoarthritis: a multicenter randomized controlled trial on the rules of selecting moxibustion location

BackgroundKnee osteoarthritis is a major cause of pain and functional limitation. Complementary and alternative medical approaches have been employed to relieve symptoms and to avoid the side effects of conventional medication. Moxibustion has been widely used to treat patients with knee osteoarthritis. Our past researches suggested heat-sensitive moxibustion might be superior to the conventional moxibustion. Our objective is to investigate the effectiveness of heat-sensitive moxibustion compared with conventional moxibustion or conventional drug treatment.MethodsThis study consists of a multi-centre (four centers in China), randomised, controlled trial with three parallel arms (A: heat-sensitive moxibustion; B: conventional moxibustion; C: conventional drug group). The moxibustion locations are different from A and B. Group A selects heat-sensitization acupoint from the region consisting of Yin Lingquan(SP9), Yang Lingquan(GB34), Liang Qiu(ST34), and Xue Hai (SP10). Meanwhile, fixed acupoints are used in group B, that is Xi Yan (EX-LE5) and He Ding (EX-LE2). The conventional drug group treats with intra-articular Sodium Hyaluronate injection. The outcome measures above will be assessed before the treatment, the 30 days of the last moxibustion session and 6 months after the last moxibustion session.DiscussionThis trial will utilize high quality trial methodologies in accordance with CONSORT guidelines. It will provide evidence for the effectiveness of moxibustion as a treatment for moderate and severe knee osteoarthritis. Moreover, the result will clarify the rules of heat-sensitive moxibustion location to improve the therapeutic effect with suspended moxibustion, and propose a new concept and a new theory of moxibustion to guide clinical practices.Trial RegistrationThe trial is registered at Controlled Clinical Trials: ChiCTR-TRC-00000600.

Comparison of heat-sensitive moxibustion versus fluticasone/salmeterol (seretide) combination in the treatment of chronic persistent asthma: design of a multicenter randomized controlled trial

BackgroundAsthma is a major health problem and has significant mortality around the world. Although the symptoms can be controlled by drug treatment in most patients, effective low-risk, non-drug strategies could constitute a significant advance in asthma management. An increasing number of patients with asthma are attracted by acupuncture and moxibustion. Therefore, it is of importance that scientific evidence about the efficacy of this type of therapy is regarded. Our past researches suggested heat-sensitive moxibustion might be effective in treatment of asthma. Our objective is to investigate the effectiveness of heat-sensitive moxibustion compared with conventional drug treatment.Methods/DesignThis study is comprised of a multi-centre (12 centers in China), randomized, controlled trial with two parallel arms (A: heat-sensitive moxibustion; B: conventional drug). Group A selects heat- sensitive acupoints from the rectangle region which consist of two outer lateral lines of dorsal Bladder Meridian of Foot-Taiyang, and two horizontal lines of BL13(Fei Shu) and BL17 (Ge Shu);6 inch outer the first and second rib gap of anterior chest. Group B treats with fluticasone/salmeterol (seretide). The outcome measures will be assessed over a 3-month period before each clinic visit at days 15, 30, 60, and 90. Follow-up visit will be at 3, 6 months after the last treatment session. Adverse event information will be collected at each clinic visit.DiscussionThis trial will utilize high quality trial methodologies in accordance with CONSORT guidelines. It may provide evidence for the effectiveness of heat-sensitive moxibustion as a treatment for chronic moderate persistent asthma. Moreover, the result may propose a new type moxibustion to control asthma.Trial RegistrationThe trial is registered at Chinese Clinical Trials Registry: ChiCTR-TRC-09000599

Heat-sensitive moxibustion for lumbar disc herniation: a meta-analysis of randomized controlled trials

OBJECTIVEnTo assess the efficacy and safety of heat-sensitive moxibustion in the treatment of lumbar disc herniation (LDH).nnnMETHODSnRandomized controlled trials (RCTs) involving heat-sensitive moxibustion in the treatment of LDH were retrieved from the Chinese Biological Medical Literature database (1978-20011), Weipu database (1989-2011), Wanfang digital journal (1998-2011), China National Knowledge Internet (1979-2011), PubMed (1966-2011), EMBASE (1980-2011), and Cochrane Library (Issue 1,2011). Hand-search of the relevant journals from the Library of Jiangxi University of Traditional Chinese Medicine was also adopted for the collection of data. Data were extracted and evaluated by two reviewers independently with a specially designed extraction form. The Cochrane Collaborations RevMan 5.0.20 software was used for data analyses.nnnRESULTSnA total of 6 trials involving 580 patients were included. Meta-analysis showed that the total effectiveness rate in the heat-sensitive moxibustion group was significantly different when compared with conventional moxibustion [RR=1.19, 95% CI [1.06, 1.33)] and diclofenac sodium [RR=1.47, 95% CI [1.17, 1.85)], but similar to that of acupuncture. The cure rate in the heat-sensitive moxibustion group was significantly different when compared with conventional moxibustion [RR=1.58, 95% CI (1.04, 2.40)] and diclofenac sodium [RR-1.91, 95% CI (1.01, 3.60)], but similar with that of acupuncture. In terms of the Japanese Orthopaedic Association scores, significant differences were noted in subjective indices, objective indices, and daily life subscales. Two trials reported that there were no adverse events over the duration of treatment.nnnCONCLUSIONnCompared with conventional moxibustion, acupuncture, and diclofenac sodium, heat-sensitive moxibustion in the treatment of LDH is superior in efficacy. Further large-scale trials are required to define the role of heat-sensitive moxibustion in the treatment of this disease.

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.

Characterizing Heat-Sensitization Responses in Suspended Moxibustion with High-Density EEG

OBJECTIVEnWe have reported heat-sensitization responses during suspended moxibustion, whose occurrence is associated with significantly better therapeutic effects. The present study aimed to characterize the electrophysiological features of this interesting phenomenon with high-density electroencephalography (EEG).nnnMETHODSnWe performed EEG recording in a group of patients with chronic low back pain before, during, and after moxibustion treatment at DU3.nnnRESULTSn12 out of 25 subjects experienced strong heat-sensitization during moxibustion, which was accompanied by increased power spectral densities (PSDs) at the theta, alpha, and beta frequency bands. The scalp topographies of averaged power indicated that the theta and beta PSD changes were most obvious in fronto-central regions, whereas those of the alpha band were more global. In addition, nonsensitized and sensitized groups showed distinct activity patterns, with heat-sensitization inducing increased phase coherence at the theta and beta ranges.nnnCONCLUSIONSnThese data were the first objective evidence of heat-sensitization responses during suspended moxibustion, which were characterized by widespread oscillatory changes in scalp EEG.

Effectiveness of heat-sensitive moxibustion in the treatment of lumbar disc herniation: study protocol for a randomized controlled trial

BackgroundLumbar disc herniation is a common and costly problem. Moxibustion is employed to relieve symptoms and might therefore act as a therapeutic alternative. Many studies have already reported encouraging results in heat-sensitive moxibustion for lumbar disc herniation. Hence, we designed a randomized controlled clinical trial to investigate the effectiveness of heat-sensitive moxibustion compared with conventional moxibustion.MethodsThis trial is a multicenter, prospective, randomized controlled clinical trial. The 316 eligible patients are randomly allocated to two different groups. The experimental group is treated with heat-sensitive moxibustion (n = 158); while the control group (n = 158) is treated with conventional moxibustion. The moxibustion locations are different for the groups. The experimental group selects heat-sensitization acupoints from the region which consists of bilateral Da Changshu (BL25) and Yao Shu (Du2). Meanwhile, fixed acupoints are used in control group; patients in both groups receive 18 sessions in 2 weeks.DiscussionThe study design guarantees a high internal validity for the results. It is one large-scale randomized controlled trial to evaluate the efficacy of heat-sensitive moxibustion compared to conventional moxibustion and may provide evidence for this therapy as a treatment for moderate and severe lumbar disc herniation. Moreover, the result may uncover the inherent laws to improve the therapeutic effect with suspended moxibustion.Trial RegistrationThe trial is registered at Chinese Clinical Trials Registry: ChiCTR-TRC-09000604. The application date was 27 November 2009. The first patient was randomized on the 16 June 2011.

Cortical activities of heat-sensitization responses in suspended moxibustion: an EEG source analysis with sLORETA

Moxibustion is under active research as a complementary and alternative treatment for various diseases such as pain. “Heat-sensitization” responses have been reported during suspended moxibustion, whose occurrence is associated with significantly better therapeutic effects. The present study aimed to investigate the cortical activities of this interesting phenomenon by a standardized low-resolution brain electromagnetic tomography. We performed electroencephalography recording in a group of patients with chronic low back pain before, during, and after moxibustion treatment at Yaoyangguan (DU3) areas. 11 out of 21 subjects experienced strong heat-sensitization during moxibustion, which were accompanied with significant decreases of current densities in the beta frequency bands in prefrontal, primary and second somatosensory, and cingulate cortices, as well as increased current densities in the alpha2 band in the left insula. No changes were detected in patients without sensitization responses, or in the post-moxibustion phase of either group. These data indicated widespread activity changes across different frequency bands during heat-sensitization. Cortical oscillatory activities could be used to evaluate the “heat-sensitization” responses during suspended 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。

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。