A novel sham moxibustion device: a randomized, placebo-controlled trial

OBJECTIVES

(1) Develop a sham moxibustion device; (2) determine whether volunteer participants and practitioners can distinguish the sham procedure from real moxibustion during treatment for prevention of the common cold; and (3) assess the feasibility of conducting a larger clinical trial of the device.

DESIGN

Double-blinded, randomized, placebo-controlled clinical trial.

SETTING

A community outpatient health station in Chaoyang district, Beijing, China, from early November through late December 2003.

METHODS

Sham and real moxibustion pillars were made by affixing moxa cones onto special collar bases. These pillars resemble each other in appearance, burning procedure and residue, but the base of the sham pillar isolates the moxa-produced heat and smoke and prevents them from radiating to the skin. These devices were tested in a pilot clinical trial in which patients received moxibustion at Zusanli (ST 36) for prevention of the common cold. Volunteers (n = 71) aged 55-75 years were given pre-treatment questionnaires to assess their knowledge of moxibustion and their expectations and motives for participating in the trial, randomized into treatment (n = 36) and placebo-controlled (n = 35) groups, and treated once every 2 days for 1 month. Questionnaires assessing the effectiveness of the blinding were given to the volunteers at the end of the trial and to practitioners after each treatment session.

RESULT

There were no significant differences between the two groups of patients in past moxibustion experience, knowledge of moxibustion, expectations and motivation. The number of volunteers in the treatment group and the placebo group who believed they received: (1) real moxibustion; (2) sham moxibustion; and (3) were uncertain as to which they received is 30, 0, 5; 29, 0, 4, respectively. The results show no significant statistical differences (P = 1.000). The number of volunteers in the treatment group and the placebo group who were believed, by the two practitioners who provided the treatments, to have received: (1) real moxibustion; (2) sham moxibustion; and (3) and an undisclosed treatment were 10, 6, 19; 9, 4, 20 and 11, 7, 17; 12, 5, 16, respectively. There were no statistically significant differences between the practitioners (P = 0.811 and 0.840).

CONCLUSION

The sham moxibustion device was successfully validated in the present study. The results demonstrate that these specially designed real and sham moxibustion pillars can be used together to provide an effective placebo-control in moxibustion research and can successfully fulfill the double blinding protocol in moxibustion clinical trials.

Bioengineering assessment of acupuncture, part 8: innovative moxibustion

The actual Chinese character for acupuncture, translated literally, means "acupuncture-moxibustion." This shows the enormous importance of moxibustion in Asia for thousands of years. In this review article, the history of the burning of mugwort (moxatherapy) is briefly described. In addition, new technical methods such as new infrared-moxa or laser-moxa devices, electrobian stone moxibustion, and the investigations of a new needle-moxa system using high-tech methods such as thermography, laser Doppler flowmetry, and laser Doppler imaging are presented.

The efficacy of jade moxibustion in knee osteoarthritis

INTRODUCTION

This study aims to compare clinical effect between Jade moxibustion and traditional moxibustion, and to determine the clinical effect of Jade moxibustion on knee osteoarthritis (KOA).

METHODS/DESIGN

This is a 2-parallel-group, randomized controlled trial. A total of 148 subjects with KOA (Kellgren-Lawrence grade II or III) will be recruited and randomized to receive Jade moxibustion treatment or a traditional moxibustion treatment in a 1:1 ratio. Jade moxibustion group: The affected knee of the subjects will be covered with jade kneepad. Traditional moxibustion group: Chosen the ST35, ST34, EX-LE4, SP10 and Ashi points at the affected knee. The subjects will receive treatment three times a week, altogether 12 times in 4 weeks. The main outcomes are WOMAC knee pain score, knee function score and SF-36 quality of life questionnaire changes at the 4th week. Secondary outcomes include WOMAC knee pain score and knee function score, overall clinical efficacy evaluation, medication, safety evaluation at the 2nd, 12th, and 24th week, and cytokines related to osteoarthritis in serum.

DISCUSSION

This randomized controlled trial used traditional moxibustion as a control group to provide rigorous evidence for the clinical efficacy and safety of Jade moxibustion in treatment of KOA.

TRIAL REGISTRATION

ISRCTN registry, No 21174552. Registered on 28 February 2020.

Moxibustion therapy on myofascial pain syndrome: An evidence-based clinical practice guideline

BACKGROUND

Myofascial pain syndrome (MPS) is a chronic systemic pain disorder. Among the common treatments, moxibustion has an irreplaceable therapeutic effect and is an effective Traditional Chinese Medicine therapy for MPS. However, the lack of clinical practice guidelines (CPGs) has prompted the publication of guidelines on the use of moxibustion in the treatment of MPS.

METHODS

The clinical practice guideline will base on the Institute of Medicine, the World Health Organization guideline handbook, the Grade of Recommendations Assessment, Development, and Evaluation the Appraisal of Guidelines for Research & Evaluation II, Reporting Items for practice, Guideline in Healthcare and recommendations thereof will be made on the basis of systematic reviews. We will establish a guidelines development team that will draft clinical questions in the form of population, intervention, comparison, results and conduct a literature search and quality of evidence assessment. The experts will make recommendations after 2 or 3 rounds of Delphi investigations. We will carefully consider the patient's values and preferences and conduct a peer review.

ETHICS AND DISSEMINATION

The guidelines will not contain any personal data and will not prejudice individual rights, so no ethical approval will be required. The guidelines will be subject to rigorous peer review and may be published in a journal or circulated at relevant conferences.

RESULTS

The guidelines will be published in relevant peer-reviewed journals.

CONCLUSION

This guideline will make it easier for clinicians to treat MPs in the clinical setting and improve the effectiveness of treatment for MPS.

STUDY REGISTRATION

The study is registered with the International Practice Guideline Registry Platform (IPGRP): IPGRP-2020CN030.

The Effects of Laser Moxibustion on Knee Osteoarthritis Pain in Rats

Background: Although chronic pain affects the quality of life of patients with osteoarthritis, current medical treatments are either ineffective or have long-term side effects. Recently, low-intensity laser irradiation of corresponding acupoints was demonstrated to alleviate pain. Objective: The aim of the present study was to investigate the effects of 10.6 μm laser moxibustion on a monosodium iodoacetate (MIA)-induced knee osteoarthritis pain model. Methods: Thirty-two rats were randomly assigned to four groups: Saline, MIA, MIA+Laser, and MIA+Sham Laser. The 10.6 μm laser was used to irradiate the ST35 for 10 min once a day for a total of seven applications. The paw withdrawal mechanical threshold and weight-bearing difference were performed to evaluate the analgesic effects of laser moxibustion. At the end of the experiment on days 28, the joint histology, the levels of metalloproteinases-13 (MMP-13) in the cartilage, and TNF-α, IL-1β, and IL-6 in the synovial membrane were measured to determine the chondroprotection and anti-inflammatory effect of laser moxibustion. Results: Early laser moxibustion significantly reversed the MIA-induced mechanical hyperalgesia and weight-bearing difference, especially on the 28th day (p < 0.001). Moreover, laser moxibustion prevented the articular pathological lesions and cartilage destruction on days 28 (p < 0.01). Remarkably, the levels of cartilage MMP-13, and synovial TNF-α, IL-1β, and IL-6 also decreased on day 28 (p < 0.05) after the early treatment of laser moxibustion. Conclusions: 10.6 μm laser moxibustion may have long-lasting analgesic, anti-inflammatory, and chondroprotection effects, suggesting that it may emerge as a potential therapeutic strategy for the chronic pain treatment of osteoarthritis.

Efficacy of warming needle moxibustion in the treatment of ankylosing spondylitis: A protocol of a randomized controlled trial

BACKGROUND

Ankylosing spondylitis is a recurrent autoimmune disease, which has a high disability rate and seriously affects patients' daily life. Conventional treatment cannot effectively solve the clinical problems of patients, and long-term medication is accompanied by adverse reactions. The evidence shows that warming needle moxibustion has advantages in the treatment of ankylosing spondylitis, but there is still a lack of clinical studies on warm acupuncture alone and long-term follow-up.

METHODS

This is a prospective randomized controlled trial to study the efficacy and safety of needle warming through moxibustion in the treatment of ankylosing spondylitis. It was approved by the Ethics Committee of Clinical Research of our hospital. Patients were randomly assigned to an observation group or a control group. The patients were followed up for 6 months after 30 days of treatment. Observation indicators include; activity index, functional ability, Bath Ankylosing Spondylitis Metrology Index, inflammatory indicators, adverse reactions, and so on. Finally, SPASS 22.0 software is used for statistical analysis of the data.

DISCUSSION

This study will evaluate the clinical efficacy of warming needle moxibustion in the treatment of ankylosing spondylitis. The results of this study will provide a reference basis for the clinical use of warm needle moxibustion in the treatment of ankylosing spondylitis.

TRIAL REGISTRATION

OSF Registration number: DOI 10.17605/OSF.IO/GWPX3.

Comparative effects of artemisia vulgaris and charcoal moxa stimulating Zhongwan (CV 12) on body temperature in healthy participants: a cross-over single-blind randomized study

OBJECTIVE

To evaluate the efficacy, safety, satisfaction, discomfort and patient preference of moxa cones of artemisia vulgaris and charcoal moxa.

METHODS

This comparative study of moxibustion treatment with Artemisia vulgaris and charcoal moxa cone stimulating Zhongwan (CV 12) is a cross-over single-blinded, randomized clinical trial. A total of 40 healthy subjects (24 males and 16 females) participated in this study. Two subjects dropped out of the trial. Thirty-eight subjects were treated with Artemisia vulgaris and charcoal moxa cones for 30 min in a cross-over design. After treatment, the patients underwent a 30 minute waiting period, and then the temperatures at Tanzhong (CV 17), Zhongwan (CV 12) and Guanyuan (CV 4) were measured using digital infrared thermal imaging.

RESULTS

After the use of Artemisia vulgaris moxa, the patients' body temperatures were slightly lowered at Tanzhong (CV 17), Zhongwan (CV 12) and Guanyuan (CV 4), but the changes were not statistically significant. After the use of charcoal moxa, the patients' body temperatures were somewhat increased at Zhongwan (CV 12) and Guanyuan (CV 4), but the changes were not statistically significant. After Artemisia vulgaris moxa use, the body temperature difference between Zhongwan (CV 12) and Guanyuan (CV 4) was significantly increased. After charcoal moxa use, the body temperature difference between Tanzhong (CV 17) and Zhongwan (CV 12) was significantly decreased in males and in the whole group. This change was caused by the difference in the moxibustion type and by gender differences.

CONCLUSION

This pilot study found that moxibustion did not raise the body temperature, but temperature differences between acupoints were affected. Further large-scale randomized controlled trials are needed for the effect of moxibustion on body temperature.

[Design and application of a cake-shaping apparatus for drug-separated moxibustion]

Acupuncturist makes herbal cakes with traditional manual way, with such disadvantages as slow in making, varying in thickness and size of the cake. When the patients are treated with medical cake-separated moxibustion, they will be unevenly affected by the heat and the patient easily suffers from burning. These hinder clinically wide application of cake-separated moxibustion. With practice of many years, the authors design and make a kind of manual cake-shaping apparatus which can rapidly and conveniently make uniform medical cake, with simple technique, ingenious structure and normal material.

[Theory study: warming-dredging and warming-reinforcing of moxibustion]

Through analysis of the basic mechanism and principle of moxibustion, it is found that the most basic characteristic of moxibustion on acupoints of human body rests with its warm stimulation. The multi-effect of the warm stimulation of moxibustion can be generalized into the following 2 aspects: 1) warming-dredging: to dredge meridians with warming through regulation of qi and blood circulation, and removing stagnation in meridians and collaterals. 2) warming-reinforcing: to reinforce with warming through strengthening of yang qi as well as tonifying yin through reinforcing of yang. The two effects are inter-depending and inter-acting on each other. The mechanism of warming-dredging and warming-reinforcing is different from that of the materia medica, and it has its own specific connotation.

[Effect of mild-warm moxibustion on microcirculation in the raw surface tissue of chronic refractory wound in skin ulcer rats]

OBJECTIVE

To observe the effects of mild-warm moxibustion on dynamic blood flow, microvessel count (MVC)and vascular endothelial growth factor (VEGF) expression in the wound tissue of the chronic skin ulcer in rats, so as to reveal its underlying mechanism in promoting wound recovery.

METHODS

A total of 104 male SD rats with skin injury were randomly divided into control group (n=8), model group (n=32), TDP (far-infrared heating device) group (n=32) and moxibustion group (n=32). Chronic refractory raw surface wound model was established by muscular injection of Hydrocortisone Sodium Succinate. For rats of the TDP and moxibustion groups, TDP irridiation and mild-warm moxibustion were applied to the raw surface, bilateral "Shenshu" (BL 23) and "Zusanli" (ST 36) for 15 min, once daily for 3, 7 and 14 days respectively. The healing rate and the healing time of raw surface of the wound were observed. The blood flow of the raw surface of the wound tissue was measured by laser Doppler flowmeter and the MVC in granulation tissue of chronic skin ulcer was counted under light microscope. VEGF expression was detected by immunohistochemistry.

RESULTS

In comparison with the control group, the healing rate of the wound raw surface was significantly lower and the healing time was prolonged in the model group (P < 0.01). Compared with the model group, the healing rates on day 3, 7, 10 and 14 were significantly higher and the healing time was strikingly faster in both TDP and moxibustion groups (P < 0.01, P < 0.05), and the effects of the moxibustion group in increasing the healing rate and shortening the healing time were significantly better than those of TDP group (P < 0.01). In comparison with the model group, the blood flow volume, MVC and VEGF expression levels on day 3 and 7 were upregulated significantly in both TDP and moxibustion groups (P < 0.01, P < 0.05); while the blood flow volume, MVC and VEGF expression level in the moxibustion group and the blood flow volume and VEGF expression level in the TDP group downregulated considerably on day 14 (P < 0.01). No significant difference was found between the TDP and moxibustion groups in the MVC on day 14 after the treatment (P > 0.05).

CONCLUSION

Mild-warm moxibustion can promote wound healing, which is closely with its effects in increasing blood flow and MVC, and upregulating VEGF expression in the wound granulation tissue of the chronic skin ulcer.

[Zhu Lian's characteristics and experiences in clinical practice of acupuncture and moxibustion]

This paper aims at discussing the clinical characteristics and experiences of ZHU Lian, the renowned contemporary acupuncture master from the following three aspects: "characteristics of clinical manipulations and techniques", "thoughts on diagnosis and treatment" and "examples of clinical cases". The study has shown that ZHU Lian invented the slow insertion technique by rotating needle and the embedding needle technique, improved moxibustion technique with moxa roll and proposed the three keys on the treatment with acupuncture and moxibustion, as well as discovered new acupoints for treatment. The pioneering and distinguished achievements she con tributed play the great demonstrating and driving role in the development of clinical study and practice of acupuncture and moxibustion.

[Discussion on some issues of medicated thread moxibustion of Zhuang ethnic group]

The exploring,standardizing and summarizing of the medicated thread moxibustion of Zhuangethnic group are introduced. It is found that there are something deficiency needed to be improved about its system. Thus,we propose a few suggestions and supplements including the definition,the preparation and grasp of the threads,firing and moxibustion manipulation,its intensity of operation,the specification of the threads and moxibustion frequency. We hope that it will provide reference to the improvement of its system.

[Ancient clinical application of herb-participated moxibustion on umbilicus]

In order to further improve the curative effect of the herb-participated moxibustion on umbilicus, we collected a wide range of literature on herb-participated moxibustion on umbilicus and then systematically arranged them to analyze and summarize the technology and operating methods of herb-participated moxibustion on umbilicus. We also briefly discussed issues on application of medicine, locust tree skin and ginger, the method of kneading dough for medical uses, and the appropriate size of moxa cone and its using frequency in order to form clear concepts and standardized operations to provide theories and operational basis for the clinical application of modern herb-participated moxibustion on umbilicus.

[The design for curing circuit used in Chinese acupuncture & moxibustion instrument]

In this paper, we introduce a multiple electro-stimulative pulse generator based on IC555, which can produce continuous, discontinuous, frequency modulated and amplitude modulated modes, and thus multiple-output, independent adjustment & control are realized. The principle block diagram and a reference circuit are presented too. This design adds acusetor curing function to BME-500 series Chinese Acupuncture & Moxibustion Instrument, making it a multifunctional therapy device of electro-acupuncture, massage and drug permeation Moxibustion Instrument.

[Clinical application on innovated burning rush moxibustion]

On the basis of traditional burning rush moxibustion, Dr. DIAO Ben-shu innovated moxibustion device and technique. Many different herbal medicines are selected to prepare moxa stick, a matchstick in size. After ignited, this stick burns swiftly and directly at acupoint in human body so that the meridian qi circulation is invigorated and the disease is prevented and treated. Diao's moxa stick technique is characterized as scientific preparation, safe and simple operation and quick efficacy. A better efficacy is achieved in clinical practice. The operation and clinical application of Diao's moxa stick technique as well as the theory of moxibustion are discussed and analyzed in this paper.

[Anti-inflammatory: effect mechanism of warming-dredging in moxibustion]

The universality of anti-inflammation in moxibustion is analyzed in this article from its adaptation disease and ancient documentary records. The specificity of anti-inflammation in moxibustion is pointed out from its disease series research and scientific fact that moxibustion could be used for heat syndrome. The integrity of anti-inflammation in moxibustion is explained by series research result that four basic circulations of moxibustion for chronic inflammation are all effective. The two-way characteristic of moxibustion anti-inflammation is explained from the fact that moxibustion has regulation function both for excess and insufficiency of inflammation to demonstrate the effect mechanism of warming-dredging in moxibustion lies in its anti-inflammation. At last, the relevant possible mechanism between moxibustion anti-inflammation and transient receptor potential vanilloid (TRPV) is proposed. The effect mechanism of warming-dredging in moxibustion lies in anti-inflammation, which could provide theoretic basis for prevention and treatment of moxibustion for serious diseases.

[Design and application of a new type minor smoke warming moxibustion cup]

OBJECTIVE

To design a new type minor smoke warming moxibustion cup for convenient use of both the physicians and the patients.

METHODS

The double-deck minor smoke warming moxibustion cup is fixed on the part receiving moxibustion by vacuum adsorption; the filtration device on the upper can filtrate and adsorb the harmful substance in the moxa-smoke, and the device with a double-temperature control on the lower can sensitively regulate the moxibustion temperature.

RESULTS

This new type minor smoke warming moxibustion cup has the advantages of minor smoke discharge, convenient fixation, sensitive regulation of temperature, saving moxibustion material, lasting action, safety, besides the advantages of traditional moxibustion.

CONCLUSION

The new type minor smoke warming moxibustion cup can use for treatment and prevention of diseases, suitable to clinical treatment and family health care.

[Effects of moxa-stick ignition locations on temperature of needle body and surrounding environment during warm needling]

OBJECTIVE

To observe the effects of different ignition locations of moxa stick on temperature of needle body and surrounding environment during warm needling, so as to provide experimental references for clinical manipulation.

METHODS

A high-accuracy infrared temperature measuring instrument was applied during warm needling to measure the temperature of needle body and surrounding environment at different ignition locations. The ignition method was divided into 2 ignition types with 4 measuring locations. The first method was to ignite moxa stick from upper-end to measure the temperature of needle body and surrounding environment 2 cm and 3 cm away from bottom-end of moxa stick; the second one was to ignite moxa stick from bottom-end to measure the temperature of needle body and surrounding environment 2 cm and 3 cm away bottom-end of moxa stick. Each ignition method was repeatedly measured for 5 times. The averaging values of measurement results which were processed with superposition method at identical time point were used to draw a temperature curve.

RESULTS

With any identical ignition method, the maintenance time of moxibustion temperature 2 cm away from bottom-end of moxa stick was longer by 3 min compared with that from 3 cm, for bottom-end ignition and upper-end ignition, in the case of 30 degrees C to 35 degrees, more ignition time could be kept from bottom-end ignition; in the case of more than 35 degrees C, the maximum temperature of needle body by upper-end ignition was higher by 5 degrees C than that by bottom-end ignition. The bottom-end ignition could achieve earlier effective initial time of moxibustion temperature. From the curves, bottom-end ignition was characterized by left-shift peak while upper-end ignition was characterized by right-shift peak.

CONCLUSION

The ignition location of warming needling seems to be reasonable if moxa stick is ignited from bottom end which is 2 to 3 cm away from skin.

[Application of intensive moxibustion with ginger paste]

The manipulations, range of application and characteristics of intensive moxibustion with ginger paste are discussed in this article. Adjustment is made on the base of traditional moxibustion with ginger slice. Fresh ginger is smashed, and the ginger paste is applied on acupoints. Two to 3 moxa sticks are ignited together in moxibustion at each point, and long duration of treatment of 30 to 60 min is adopted. The effects of the above mentioned moxibustion on dysfunction of the internal organs, postpartum diseases, hyperplasia, furuncle and diseases of bones, joints and muscles are obviously better than that of the traditional way. Thus, it is concluded that the effect of intensive moxibution with ginger paste is remarkable in promoting qi and blood circulation, warming up yang qi and regulating the functions of zang-fu organs. The potency of ginger can reach a deeper part with the heat produced by moxibustion. The heat is even and easy to be controlled. Moreover, the manipulation is simple, practical, safe and effective.

[The design and application of a moxibustion instrument with less harmful smoke and direction adjustment]

The design of a clip-on moxibustion instrument which could adjust the directions and absorb harmful granules of moxa smoke was introduced in this paper. It was designed to solve the problems in home health care and clinical treatment, such as the inconvenience of adjustment of moxibustion directions and temperature, more dust and granules of moxa smoke and inconvenience of moxibustion placement. The main part of moxibustion instrument was made up of moxibustion box, bracket and base clamp. The moxibustion box could fix moxa stick and absorb smoke granules; the bracket could be twisted to adjust the direction of moxibustion box; the base clamp was aimed to fix moxibustion box on the edge of the object to save space. This moxibustion instrument could be used for various indications of moxibustion, especially in the joints or body parts with less muscles; and it can significantly enhance the pertinence and safety of moxibustion, and reduce the labor intensity. This moxibustion instrument is original and unique, simple and reasonable, easy to operate, with low cost and good effect, which will increase new vitality for the popularization and development of moxibustion.

[Standardizing the manipulation procedure of acupuncture-moxibustion, reinforcing the training of' clinical skill: learning experience of Acupuncture-moxibustion Clinical Skills Training: Chapter of Commonly Used Needling and Moxibustion Techniques]

The book Acupuncture-moxibustion Clinical Skills Training is one of "Twelfth Five-Year Plan" in novative teaching materials, which is published by People's Medical Publishing House. Through learning the first half of the book commonly used needling and moxibustion techniques, it is realized that the selection of book content is reasonable and much attention is paid to needling and moxibustion techniques; the chapter arrangement is well-organized, and the form is novel, which is concise and intuitive; for every technique, great attention is paid to standardize the manipulation procedure and clarify the technique key, simultaneously the safety of acupuncture and moxibustion is also emphasized. The characteristics of the book, including innovativeness, practicability, are highlighted, and it greatly helps to improve students' clinical skills and examination ability.

[Elucidation of the national standard for Standardized Manipulation of Acupuncture and Moxibustion, Part VII: Skin needle]

The importance of standardization, the main content and important cautions in the Standardized Manipulation of Acupuncture and Moxibustion, Part VII: Skin Needle are introduced briefly in this paper. It standardizes the stimulation intensity, the tapped needling location, the course of treatment and the interval between treatments. It elucidates the key points, the difficulty and the important cautions in clinical practices. In order to promote the standardization and its implementation, it also states the experiences of establishing the national standard of acupuncture and moxibustion manipulations.