Clinical Research Progress of Acupuncture-moxibustion for Chronic Urticaria

Ji Jun, Zhang Cui-hong, Zhang Fu-qing

Shanghai Research Institute of Acupuncture and Meridian, Shanghai 200030, China

Clinical Research Progress of Acupuncture-moxibustion for Chronic Urticaria

Ji Jun, Zhang Cui-hong, Zhang Fu-qing

Shanghai Research Institute of Acupuncture and Meridian, Shanghai 200030, China

To learn the current research status of acupuncture-moxibustion in treating chronic urticaria, the relevant clinical reports indexed by CNKI and VIP databases during 2000 and 2012 were retrieved, and then summarized and analyzed from the aspects of treatment method, acupoint selection, medicine, treatment frequency, and criteria of therapeutic efficacy, for guiding the treatment of chronic urticaria with acupuncture-moxibustion. The results show that acupuncture-moxibustion therapy has stable therapeutic efficacy in treating chronic urticaria with low adverse reaction rate, but the current evaluation criteria are too subjective to quantify.

Acupuncture Therapy; Moxibustion Therapy; Acupuncture-moxibustion Therapy; Urticaria; Review

Urticaria, also known as wheals, is a topical edema reaction caused by vasodilatation or increased permeability in skin or mucosa[1]. It’s manifested by hives in various sizes and itching. During the acute stage, it can be healed through systematic treatment, but in some patients may transform to the chronic type, i.e. chronic urticaria. Modern medicine believes that the pathogenesis can be classified into two types, allergic and non-allergic reactions. The treatment principle should be anti-allergic and symptomatic treatments, and the antihistamines should be the first choice. However, the clinical efficacy of antihistamines is limited by individual differences, drug dependence, compliance, and adverse reactions. The treatment of urticaria with acupuncture-moxibustion is recorded as early as in theZhen Jiu Jia Yi Jing(A-B Classic of Acupuncture and Moxibustion), and also in literatures in the later generations. The clinical practice indicates that acupuncture- moxibustion therapy has stable therapeutic efficacy in treating chronic urticaria, with low adverse reaction rates.

To learn the current research status of acupuncture-moxibustion therapy in treating chronic urticaria, we have retrieved the relevant clinical reports indexed by CNKI and VIP databases during 2000 and 2012, and then summarized and analyzed the literatures from the following aspects: treatment method, acupoint selection, medicine, treatment frequency, and criteria of therapeutic efficacy.

1 Acupuncture-moxibustion Methods

1.1 Summary of treatment selection

The acupuncture-moxibustion methods involved in the literatures were acupuncture, moxibustion, cupping, acupoint injection, acupoint threadembedding, blood-letting, auricular point sticking, scalp acupuncture, abdominal acupuncture, wrist-ankle acupuncture, and needle-knife. About 1/3of the literatures reported single acupuncturemoxibustion method, and the rest were comprehensive methods by combining 2-3 different treatment methods, including comprehensive acupuncture-moxibustion methods, and acupuncture-moxibustion methods combined with Chinese or Western medication.

It follows that the majority of researchers prefer to use the comprehensive treatment methods, as it can enhance the therapeutic efficacy compared to the single one.

The involved treatment methods are summarized and the representative ones are listed as follows.

1.2 Acupuncture

In treatment of chronic urticaria with acupuncture, the commonly selected acupoints are Fengchi (GB 20), Quchi (LI 11), Hegu (LI 4), Fengshi (GB 31), Xuehai (SP 10), Zusanli (ST 36), Sanyinjiao (SP 6), Taichong (LR 3), Dazhui (GV 14), Feishu (BL 13), Xinshu (BL 15), and Pishu (BL 20). Modification according to syndrome differentiation: Tianshu (ST 25) is added for accumulated heat in stomach and intestine; Neiguan (PC 6) is added for nausea and vomiting; Shenmen (HT 7) and Yintang (GV 29) are added for restlessness and insomnia; Qihai (CV 6), Guanyuan (CV 4), and Zhongji (CV 3) are added for qi-blood deficiency. Modification according to the affected sites: Quchi (LI 11), Waiguan (TE 5), and Hegu (LI 4) are added for upper limbs; Xuehai (SP 10), Zusanli (ST 36), and Sanyinjiao (SP 6) are added for lower limbs.

Song NY[2]treated chronic urticaria by puncturing Quchi (LI 11) with intensive stimulation as the major method. Fengchi (GB 20), Hegu (LI 4), and Xuehai (SP 10) were added for general eruption; Zhongwan (CV 12) and Zusanli (ST 36) were reduced for accumulated heat in stomach and intestine; Tianshu (ST 25) was added for abdominal pain. Thirty subjects were enrolled and were recovered finally. Gao H, et al[3]observed the clinical efficacy of puncturing Shendao (GV 11) with thick needle and point-toward-point method versus Levocetirizine Hydrochloride tablets in treating chronic urticaria and the effects on IgE. After 12-week treatment, the inter-group difference in therapeutic efficacy was statistically significant (P＜0.05). The serum IgE level changed significantly after 2-week, 6-week, and 12-week treatment in the treatment group (P＜0.01). The IgE level changed significantly after 2-week and 6-week treatment (P＜0.01), but insignificantly after12-week treatment (P＞0.05) in the Western-medication group. It indicates that puncturing Shendao (GV 11) with thick needle and point-towardpoint method can effectively down-regulate the serum IgE level of chronic urticaria patients, with comparatively shorter treatment course and steady middle- and long-term clinical efficacy. Chen XW[4]punctured Quchi (LI 11), Xuehai (SP 10), Zusanli (ST 36), and Sanyinjiao (SP 6) for urticaria. Meanwhile, Dazhui (GV 14) was reduced for wind heat affecting the exterior; Feishu (BL 13) was reduced for wind heat affecting the exterior; Hegu (LI 4) was reduced for excess heat in stomach and intestine; Feishu (BL 13) and Pishu (BL 20) were added with both reducing and tonifying method for wind dryness due to blood deficiency. The treatment was given twice a week, and the effects were evaluated after 4 weeks. The total effective rate was 96.7% in the treatment group, better than that in the control group. After determining the distributions of patches, He JR, et al[5]selected several points along the edges (generally 0.5-1 cun away from the patches). After standard sterilization, filiform needles were used to puncture the points by 15°-30° and with the tips towards the center. According to the size of lesions, 4-8 needles were used with a 2-cm interval. Twisting needling method was used to induce the needling sensation, once every 10 min, and the needles were retained for 30 min. Body acupuncture was also used simultaneously. The treatment was given once a day, five times as a treatment course, with a 2-day interval before the next course. After 4 treatment courses, it showed that its therapeutic efficacy was better than that of the Western medication group.

1.3 Moxibustion

There were limited reports on moxibustion for chronic urticaria, involving suspended moxibustion, heat-sensitive moxibustion, thunder-fire moxibustion, garlic-separated moxibustion and box moxibustion.

Liao FR, et al[6]applied suspended moxibustion to the Belt Vessel, from the back to the front, making the whole abdomen full of hot sensation. The bilateral Daimai (GB 26) were given specially more time (about 2-3 min). The treatment was given once a day, for totally 4 weeks. The therapeutic efficacy was evaluated respectively after 2-week and 4-week treatment, and the subjects were followed up 4 weeks after treatment via phone. During the observation, the patients were asked to avoid sea food and spicy food. It showed that the recovery rate and total effective rate after 4-week treatment and during the follow-up study were significantly different (P＜0.05) compared to the results after 2-week treatment. It indicates that the symptoms were obviously improved after 4-week moxibustion treatment, and the total effective rate was 95.18%. The follow-up study showed that there was no significant relapse and the therapeutic efficacy was similar to that after 4-week treatment. It suggests that moxibustion to the Belt Vessel can not only produce a good short-term therapeutic efficacy but also a content long-term efficacy and can resist the relapse of symptoms.

Li JE, et al[7]adopted heat-sensitive moxibustion to treat 30 cases of chronic urticaria. Mild moxibustion was first applied to Fengmen (BL 12), Feishu (BL 13), Geshu (BL 17), Shenque (CV 8), Guanyuan (CV 4), Xuehai (SP 10), and Zusanli (ST 36), etc. for searchingthe heat-sensitive points; mild moxibustion was used to the heat-sensitive points until the heat sensation disappeared. The treatment was given once a day, 10 d as a treatment course. After 2 treatment courses, the total effective rate was 76.7%, which was better than that of the control group intervened by Chinese medicine (50.0%). Wang YJ, et al[8]observed the clinical efficacy of thunder-fire moxibustion at Shenque (CV 8) with a randomized controlled method, to prove its effectiveness and safety. Put the ignited moxa stick into the hole of moxibustion box, 2-3 cm away from the bottom of the box, then fix the stick with a pin; place the box on to the umbilicus of patient with the ignited stick pointing at Shenque (CV 8). The moxibustion was given for 15 min, till the skin turned red and heat was produced in the deep layer of body tissue, once every day. Meanwhile, the control group was intervened by Mizolastine tablets. After 2-week treatment, the changes of symptoms such as itching and skin rash were observed, and the clinical efficacy was evaluated. Intra-group and inter-group comparisons of before and after treatment were conducted to compare the improvements of symptoms and the differences between the two treatment methods. It showed that the symptom score changed significantly in both groups after treatment (P＜0.05); the inter-group difference was statistically significant after treatment (P＜0.05); the total effective rate was 77.5% in the treatment group versus 65.0% in the control group, and the difference was statistically insignificant (P＞0.05); theRiditanalysis showed that the inter-group difference in therapeutic efficacy degree was statistically significant (P＜0.05). There wasn’t any severe adverse reaction in the treatment group. Therefore, thunder-fire moxibustion is effective in treating chronic urticaria, as it can significantly improve the clinical symptoms and signs, with better improvement and general therapeutic efficacy compared to Mizolastine tablets. It’s a safe and effective external treatment method in treating chronic urticaria in traditional Chinese medicine.

Geng P, et al[9]adopted acupuncture and garlicpartitioned moxibustion to treat chronic urticaria. In the observation group, Quchi (LI 11), Sanyinjiao (SP 6) and Xuehai (SP 10) were selected, and the adjunct points were Weizhong (BL 40), Chize (LU 5), Hegu (LI 4), Zusanli (ST 36), Dazhui (GV 14), and Fengshi (GB 31). According to the disease condition, 3-5 points were selected each time. Zusanli (ST 36), Xuehai (SP 10), Quchi (LI 11), Dazhui (GV 14), Geshu (BL 17), Waiguan (TE 5), and Taixi (KI 3) were treated with garlic-partitioned moxibustion. Operation: Fresh garlic was sliced and placed on the points, 7-9 cones of moxa for each point. Acupuncture and garlicpartitioned moxibustion were operated alternately, 10 times as a treatment course. The control group was intervened by acupuncture alone. The results showed that in the observation group, of the 46 subjects, 34 were recovered, 6 had remarkable effect, 2 were improved, 4 failed, and the total effective rate was 91.3%; of the 30 subjects in the control group, 12 were recovered, 7 had remarkable effect, 3 were improved, 8 failed, and the total effective rate was 73.3%. There was a statistically significant difference in comparing the total effective rate between the two groups (P＜0.05).

Lu Y[10]used acupuncture plus box-moxibustion to treat chronic urticaria by selecting Qihai (CV 6), Neiguan (PC 6), Xuehai (SP 10), Zusanli (ST 36), and Sanyinjiao (SP 6) as the major points. Fengchi (GB 20) was added for wind excess; Quchi (LI 11) and Hegu (LI 4) were added for excessive heat; Dazhui (GV 14) for excessive cold; Yinlingquan (SP 9) for dampness. The box-moxibustion was applied to Qihai (CV 6) after reinforcing-reducing manipulations. The treatment was given once a day, 10 times as a treatment course. The results showed that of the 16 subjects, 9 were recovered, 4 showed remarkable effect, 2 were improved, 1 failed, and the total effective rate was 93.8%.

1.4 Cupping

Cupping is a common assistant method in treating chronic urticaria, and is often used in combination with other treatments. It majorly covers cupping and flash cupping at Shenque (CV 8); moving cupping along the Bladder Meridian on the back and the Governor Vessel and cup retaining; pricking cupping at Back-Shu acupoints.

Operation: Flash cupping is applied to Shenque (CV 8) for 4-5 times with a middle or big cup, and then the cup is retained for 5-10 min; moving cupping is applied to the Bladder Meridian at the back and the Governor Vessel till the skin turned red, and the cups are retained for 5-10 min.

Gao XL, et al[11]treated chronic urticaria with acupuncture plus cupping. In the treatment group, bilateral Quchi (LI 11), Hegu (LI 4), Xuehai (SP 10), Zusanli (ST 36), and Sanyinjiao (SP 6) were treated with even reinforcing-reducing manipulations; moving cupping was then applied to the Bladder Meridian at back and the Governor Vessel till the skin became red. Of the 40 subjects, 12 were recovered, 24 were improved, 4 failed, and the total effective rate was 90%. Zhao JQ, et al[12]treated 80 cases of chronic urticaria with flash cupping at Shenque (CV 8) plus threadembedding at the Back-Shu acupoints, and 69 showed remarkable effect, 7 showed effect, 4 failed, and the total effective rate was 95.0%.

1.5 Acupoint injection

In treating chronic urticaria, acupoint injection has similar point selection to the acupuncture treatment, but it selects comparatively less points. 1-3 points are usually selected each time, mostly from the four limbs. Quchi (LI 11), Zusanli (ST 36), Xuehai (SP 10),Sanyinjiao (SP 6), and Fengshi (GB 31) are often selected. Besides, auricular points are also selected to receive acupoint injection, i.e. Endocrine (CO18) and Fengxi (SF1,2i), 0.1 mL Chlorpheniramine Maleate injection for each point, three times a month[13].

The injection used in acupoint injection includes single injection and mixed one. According to the literatures, single injection covers the following types. One is autoblood injection, and the dose varies from 0.5 mL, 2 mL, to 5 mL according to the number of points selected[14-16]. Then it’s BCG-PSN injection, 1 mL for each time in total[17-19]. The third is Compound Ammonium Glycyrrhizinate, 1 mL for each point[20]. The fourth is placental tissue fluid, 2 mL for each point[21]. The fifth is compoundDan Shen(Radix Salviae Miltiorrhizae) injection, 2-5 mL for each point[22]. The sixth isHuang Qi(Radix Astragali) injection, 1 mL for each point[23]. The seventh isChuankezhiinjection, 1 mL for each point[24]. The eighth is Glycyrrhizin injection, 2 mL for each point[25]. The ninth is Promethazine Hydrochloride injection, 0.1 mL for each point[26]. The tenth is Diphenhydramine injection, 0.2 mL for each point[27]. Then it’s transfer factor 3 U, injected after solved in injection fluid, 1 mL for each point[28]. The No.12 is Histaglobulin 12 mg, injected into 3 points, once every 3 d[29]. The 13th is Vitamin D2and Calcium Colloid injection, 0.5 mL for each point, once every 3 d[30]. The acupoint injection is usually given once every day or once every other day.

Mixed injections are as follows. One is Chlorpheniramine Maleate injection 10 mg (replaced by Promethazine Hydrochloride injection 25 mg in conditions of glaucoma, prostatic hypertrophy, and hyperthyroidism), Vitamin B12injection 1 000 μg,Dang Gui(Radix Angelicae Sinensis) injection 2 mL, and Vitamin D2and Calcium Colloid injection 2 mL. With a 10 mL disposable syringe and a No.5 syringe needle, the above 4 medicine mixture was injected into 4-6 selected acupoints, 1 mL for each point, once every day or every other day[31]. The second type is Vitamin B12500 μg (1 mL) mixed with Vitamin D2and Calcium Colloid injection 2 mL, 0.5 mL for each point, once per day[32]. The third type is 654-2 injection 10 mg and Dexamethasone injection 5 mg, injected into the bilateral Zusanli (ST 36), once every other day, 5 times as a treatment course, 1-week interval between each two courses. Dexamethasone is reduced by half since the third day of each course[33]. The fourth is Cimetidine injection 4 mL (400 mg) mixed with Lidocaine 2 mL, 1.2-1.6 mL for each point, once per day, 7 d as a treatment course, with a 2-day interval between each two courses. After the first course, the doses of medicines are reduced by half, Cimetidine injection 2 mL (200 mg) mixed with 2% Lidocaine 1 mL, 0.5-0.7 mL for each point[34]. The fifth type is Chlorpheniramine Maleate injection 10 mg, Vitamin B12injection 1 000 μg (or Vitamin C injection 100 mg), injected into a pair of acupoints, once each day, for continuous 2-3 d[35]. The sixth is Diphenhydramine injection 10 mg (20 mg/bottle) and Vitamin C injection 0.5 g (0.5 g/bottle), injected into two acupoints, once each day[36]. The seventh is autoblood 2 mL and Diphenhydramine injection 20 mg, injected into two points, once per day[37]. The eighth is Prednisolone 25 mg and 2% Procaine 2 mL, injected into bilateral Quchi (LI 11), once every 5 d[38]. The Ninth is Vitamin B122 mL and Lidocaine 1 mL, 1 mL for each point, then replaced byDang Gui(Radix Angelicae Sinensis) injection since the third day by 2 mL for each point[39].

1.6 Acupoint thread-embedding

Acupoint thread-embedding selects similar acupoints in treating chronic urticaria, usually with absorbable catgut. It’s reported that the catgut was soaked in Cimetidine[40]or Chinese medicine[41]before embedding. It’s commonly applied once a week, once every 10 d, once every 14 d, or once every 20 d. Compared to acupuncture, thread embedding has its advantage of reducing the treatment frequency and increasing the compliance of patients.

Sun G, et al[42]selected bilateral Geshu (BL 17), Hegu (LI 4), Quchi (LI 11), Zusanli (ST 36), and Sanyinjiao (SP 6), and chose catgut of size 00. The catgut was cut into 1 cm and soaked in 75% alcohol for use. Under sterile condition, insert the catgut into the needle of a No.8 syringe; cut off the head of an acupuncture needle of 0.38 mm in diameter and 50 mm in length, and insert it into the syringe from the end; after standard sterilization, puncture the syringe needle into the acupoint till proper depth; when there is needling sensation, gently push the acupuncture needle and embed the catgut into the acupoint and withdraw the syringe simultaneously. Press the acupoint for a while. After 2 treatment courses, the effective rate was 88%. Huang H, et al[43]selected and marked Feishu (BL 13), Danzhong (CV 17), Quchi (LI 11), Zusanli (ST 36), Xuehai (SP 10), Yinlingquan (SP 9), and Sanyinjiao (SP 6). With a proper position, the patient was treated from the back to the front. After standard sterilization, 2% Lidocaine 2-3 mL was used for topical anesthesia. According to the depth of each acupoint, 1-3 cm catgut of size 1 or 2 was embedded into the expected place with a No.12 syringe. Withdraw the syringe, and fix and protect the acupoints with sterile wipes for 1-2 d. The treatment was given once every 5-20 d, 3 times as a treatment course. After 1-3 courses, the recovery rate was 62.9% and the total effective rate was 90.3%. Zeng HY[40]chose Quchi (LI 11), Xuehai (SP 10), Geshu (BL 17), and Zusanli (ST 36). After soaked in alcohol and Cimetidine, the No.3 catgut was placed into the above acupoints with a No.9 syringe and an acupuncture needle of 0.35 mm in diameter and 50 mm in length with the head cut off. Of the 53subjects with chronic urticaria, after 1-2 treatment courses and half a year follow-up study, 39 were cured, occupying 73.6%; 7 showed remarkable effect, occupying 13.2%; 4 were improved, occupying 7.5%; 3 failed, occupying 5.7%. The total effective rate was 94.3%.

1.7 Other treatments

1.7.1 Scalp acupuncture

Mo XF[44]selected bilateral Lateral Line 1 of Forehead (MS 1), Posterior Oblique Line of Vertextemporal (MS 7), and Middle Line of Forehead (MS 1). Insert the needles with an angle of 30° and apply mild lifting-thrusting reducing manipulations. The results showed that, of the 40 subjects, 29 were recovered, 11 were improved, and the total effective rate was 100%.

1.7.2 Abdominal acupuncture

Regarding the abdominal acupuncture, Chen LY, et al[45]tookYin Qi Gui Yuan[Zhongwan (CV 12), Xiawan (CV 10), Qihai (CV 6), and Guanyuan (CV 4)] as the major points,Fu Si Guan[Huaroumen (ST 24) and Wailing (ST 26)], as well as Daheng (SP 15) (regulating the spleen qi) as the adjunct points. The Bo’s abdominal needles of 0.22 mm in diameter and 40 mm in length were used for acupuncture plus mild moxibustion to Shenque (CV 8). Of the 31 patients, 15 were recovered (48.4%), 10 were improved (32.3%), and the total effective rate was 80.7%.

Lin YQ[46]selected the same abdominal points in treating chronic urticaria, plus moxibustion to Shenque (CV 8) during needle-retaining. The control group was intervened by Cetirizine Hydrochloride tablets. After 4-week treatment, the symptoms and general score were changed significantly (P＜0.05). After treatment, the inter-group differences were all statistically significant (P＜0.05) except for the comparison of the diameter of the biggest patch (P＞0.05). After treatment, the dermatology life quality index (DLQI) scores were changed markedly in both groups (P＜0.001); the two groups were significantly different in comparing DLQI score (P＜0.05). In the treatment group, 8 were cured, (26.67%), 12 showed marked effect (40%), 8 showed effect (26.67%), 2 failed (6.67%), and the total effective rate was 66.67%. In the control group, 4 were cured (13.33%), 7 showed marked effect (23.33%), 13 showed effect (43.33%), 6 failed (20%), and the total effective rate was 36.67%. The difference was statistically significant (P＜0.05), indicating that the treatment group has a better therapeutic efficacy. It suggests that abdominal acupuncture plus moxibustion to Shenque (CV 8) and Cetirizine Hydrochloride tablets can improve the symptoms of chronic urticaria, reduce the number and diameter of hives, the disease duration, edema, and itching, and the occurrence of scratch syndrome, and improve the patients’ quality of life. Except for the biggest diameter of the wheal, abdominal acupuncture plus moxibustion to Shenque (CV 8) is better than Cetirizine Hydrochloride tablets in improving clinical symptoms, signs, and quality of life. It also proved that abdominal acupuncture plus moxibustion to Shenque (CV 8) is a safe method.

1.7.3 He-Ne acupoint radiation

Yang YH[47]adopted Levocetirizine Hydrochloride tablets 10 mg per time and once a day, plus He-Ne laser (power at 25 mV) at Quchi (LI 11), Xuehai (SP 10), and Sanyinjiao (SP 6), 5 min for each point each time and once per day. The total effective rate was 90.7%, better than the Western-medication group (74.1%).

1.7.4 Acupoint application

Zhang YQ[48]used Chinese medicine plus acupoint application in treating 64 cases with chronic idiopathic urticaria. The medicine ointment was made fromSheng DiHuang(Radix Rehmanniae) 20 g,Shu DiHuang(Radix Rehmanniae Praeparata) 20 g,Dang Gui(Radix Angelicae Sinensis) 10 g,Dan Shen(Radix Salviae Miltiorrhizae) 15 g,Di Fu Zi(Fructus Kochiae) 20 g,Chan Tui(Periostracum Cicadae) 15 g, andFu Ping(Herba Spirodelae) 20 g. The medicines were made into pills with Vaseline, 9 g for each pill. When used, one pill was placed at Shenque (CV 8) and radiated by the magnetic wave for 20 min. After 1, 2, and 3 weeks, the total effective rates were respectively 46.9%, 75.0%, and 93.8%. Yuan SZ, et al[49]ground Doxepin 12.5-25 mg and made it into paste with cold water to apply to Shenque (CV 8). It was used during sleep and removed in the next morning. Simultaneously antihistamines were used. The total effective rate was 94.1%.

1.7.5 Wrist-ankle acupuncture

Zhang ZK[50]adoptedYu Ping Fengpowder plus modifiedGui Zhi(Ramulus Cinnamomi) decoction and wrist-ankle acupuncture to treat chronic urticaria, compared to Mizolastine. It showed that the total effective rate was 80.0% in the treatment group versus 53.3% in the control group, and the difference was statistically significant. The 3-month follow-up study revealed that of the 15 recovered patients in the treatment group, 2 had relapse and the rate was 13.33%; 3 out 6 in the control group had relapse and the rate was 50.0%. The difference in relapse rate was statistically significant. The remission time of the treatment group was (31.50±4.95) d, significantly longer than that in the control group (17.33±3.21) d. The adverse reaction rate was 3.3% in the treatment group versus 26.7% in the control group, and the difference was statistically significant. It indicates that Chinese medicine plus wrist-ankle acupuncture has a better efficacy in treating chronic urticaria, especially in the total effective rate, relapse rate and prolonging the remission time.

1.7.6 Needle-knife therapy

Zhu QB, et al[51]used needle-knife to treat chronic urticaria. The major points were Jiaji (EX-B 2) points (T3-7), and the adjunctive points were Quchi (LI 11), Xuehai (SP 10), Baichongwo (EX-LE 3), and Zusanli (ST 36). Needle-knife of type I and No.4 was used. After sterilization and with a prone position, Jiaji (EX-B 2) points (T3-7) were punctured perpendicularly till depth of 25-37 mm. When the needle-knife was pulled out, the wounds were pressed and then fixed with band-aids. With a supine position, Quchi (LI 11), Xuehai (SP 10), Baichongwo (EX-LE 3), and Zusanli (ST 36) were treated in the same way. The adjunctive points should be adjusted according to conditions. Zusanli (ST 36) was added for qi deficiency; Xuehai (SP 10) for blood deficiency; Quchi (LI 11) for wind excess; Baichongwo (EX-LE 3) for insect stings and bites. During treatment, spicy food should be avoided and no bath in the first 3 d to prevent infection. The points from different sides were used alternately. The treatment was given once every 5 d, 3 times as a treatment course, generally no more than 5 times. Of the 10 subjects, 9 were recovered, and 1 showed marked effect.

2 Effect Evaluation

According to the literatures, there are currently two major types of therapeutic evaluation. One is to evaluate according the improvement of symptoms and signs, such as theCriteria of Diagnosis and Therapeutic Effect of Diseases and Syndromes in Traditional Chinese Medicine, and also the self-made standard based on the changes of symptoms and signs. This type of criteria is usually very subjective and too rough for scientific research and statistics. The second type is to evaluate according to the change rate of symptom score, which can reflect the therapeutic efficacy more objectively. However, the observation items, scoring standard, the scope of therapeutic index, and the evaluation standard haven’t been unified.

3 Conclusion

In a word, simple acupuncture, and acupuncture plus cupping, medicine, or moxibustion are effective in treating chronic urticaria. It can significantly reduce the dose of medicine, adverse reaction, and is thus worth promoting in clinic.

However, there are still some shortcomings in the clinical researches. One is the diversity in the evaluation of therapeutic efficacy and the lack of quantification standard. Second is the lack of control criteria. Although the first treatment choice in Western medicine is antihistamine, different antihistamines have different efficacies and treatment courses, which is not good for the standardization of the research. Never to mention that some reports only focused on the therapeutic efficacy without setting up a control. The third is the lack of the comparison among different acupuncture-moxibustion methods in treating chronic urticaria. These all require complements in the future study.

[1] Zhao B. Clinical Dermatology. Nanjing: Jiangsu Science and Technology Press, 1988: 521.

[2] Song NY. Acupuncture at Quchi (LI 11) for 30 cases of urticaria. Hebei Zhongyi, 2005, 27(9): 706.

[3] Gao H, Li XZ, Ye WW, Zhou BY, Jin YJ, Qiu Y, Wu JJ. Analysis of the clinical effect and the changes of serum IgE of bodkin Shendao point penetration needling in treating chronic urticaria. Zhejiang Zhongyiyao Daxue Xuebao, 2009, 33(1): 111-112.

[4] Chen XW. The clinical observation in treating chronic urticaria with ‘the urticaria four points’ on acupuncture. Master Theses of Guangzhou University of Traditional Chinese Medicine, 2009: 25.

[5] He JR, Deng JF. Surrounding needling for 30 cases of chronic urticaria. Anhui Zhongyi Xueyuan Xuebao, 2009, 28(4): 51-52.

[6] Liao FR, Fu CW. Moxibustion to the Belt Vessel for 48 cases of refractory urticaria. Zhongguo Zhenjiu, 2011, 31(11): 991-992

[7] Li JE, Kang MF, Lǘ CH, Wu ZH. Heat-sensitive moxibustion for 30 cases of chronic urticaria due to blood deficiency and wind dryness. Fujian Zhongyiyao, 2009, 40(1): 13-14.

[8] Wang YJ, Chai WH, Wang HR, Wu ZQ. Clinical observation on thunder-fire moxibustion for chronic urticaria. Shanghai Zhenjiu Zazhi, 2012, 31(2): 107-109.

[9] Geng P, Tian YH, Lin ZJ, Wang GF. Therapeutic effect observations on treatment of urticaria with acupuncture plus garlic-partitioned moxibustion. J Acupunct Tuina Sci, 2004, 2(1): 44-45.

[10] Lu Y. Acupuncture plus box-moxibustion for 16 cases of chronic urticaria. Zhongguo Zhongyiyao Keji, 2009, 16(5): 358.

[11] Gao XL, Zhao YB, He L, Zhao YX, Ding M. Therapeutic observation on acupuncture and cupping for 40 cases of chronic urticaria. Xin Zhongyi, 2008, 40(4): 74.

[12] Zhao JQ, Liu X. Cupping at Shenque (CV 8) plus threadembedding at Back-Shu acupoints for 80 cases of chronic urticaria. Zhongguo Zhenjiu, 2012, 32(7): 634-634.

[13] Lin W, Xia XY. Medicine injection at auricular points for chronic urticaria. Zhongyi Waizhi Zazhi, 2001, 10(5): 46.

[14] Shi WY, Zhong HJ, Zhang W, Xi JY, Luo GH. Clinical observation on acupoint injection with autoblood plusSi WuXiao Fengpowder in treating chronic urticaria due dryness for blood deficiency. Zhongyiyao Daobao, 2010, 16(12): 69-71.

[15] Lei XR, Zhou JX, Qiu H. Applied investigate of acupuncture combined with autohemotherapy on chronic urticaria. Zhonguo Dangdai Yiyao, 2009, 16(11): 126-127.

[16] Xu J, Qu HQ. Clinical observation on treatment of 30 cases of chronic urticaria with acupoint injection with autoblood. Jiangsu Zhongyiyao, 2005, 26(7): 34-35.

[17] Chen ZW, Nie XL, Su AX. Therapeutic observation on treatment of chronic urticaria with acupoint injection with BCG-PNA plus Desloratadine. Linchuang Pifu Ke Zazhi, 2005, 34(5): 329.

[18] Na M Li LY, Wang RK. Therapeutic observation on the treatment of chronic urticaria with acupoint injection with PNA. Zhongguo Pifu Xingbing Xue Zazhi, 2002, 16(1): 32-33.

[19] Zhai LX. Acupoint injection with BCG-PNA plus Desloratadine for chronic urticaria. Qinghai Yiyao Zazhi, 2010, 40(8): 22-23.

[20] Liu H, Zhang ZY. Therapeutic observation on acupoint injection with compound Ammonium Glycyrrhetate plus Ceritizine Hydrochloride for chronic urticaria. Zhongguo Zhongxiyi Jiehe Pifu Xingbing Xue Zazhi, 2009, 8(5): 303-304.

[21] Wang XL, Ma DM, Qin LY. Acupoint injection with placenta tissue fluid for 56 cases of chronic urticaria. Zhongguo Zhenjiu, 2006, 26(5): 327.

[22] Zhu YQ, He C. Acupuncture-moxibustion plus acupoint injection for chronic urticaria. Zhongguo Xiangcun Yiyao, 2004, 11(8): 48.

[23] Liu FS. Acupoint injection withHuang Qiinjection for 36 cases of chronic urticaria. Yiyao Chanye Zixun, 2005, 2(18): 71.

[24] Wang JF, Zhang M, Li B, Gu HQ, Xu WB, Wang YF, Wu WJ. Clinical observation on chronic utticaria treated with combination ofChuankezhiinjection and Cetirizine Hydrochloride tablets. Zhongguo Pifu Xingbing Xue Zazhi, 2008, 22(9): 542-544.

[25] Chen Y. Therapeutic observation on acupoint injection with Glycyrrhizin for chronic urticaria. Zhongguo Pifu Xingbing Xue Zazhi, 2004, 18(5): 318.

[26] Yuan FH, Pan XD, Zhang WX, Kong LW, Fan YH. Acupoint injection with united antihistamines for 78 cases of chronic urticaria. Zhongguo Xiandai Yaowu Yingyong, 2010, 4(15): 40-41.

[27] Liu HL, Zhang JC, Chen DY, Liu H. Acupuncture plus acupoint injection for 35 cases of chronic urticaria. Shandong Zhongyi Zazhi, 2004, 23(1): 32.

[28] Liu J, Li XP. Therapeutic observation on acupoint injection with transfer factor for chronic urticaria. Pifubing Yu Xingbing, 2005, 27(2): 17-18.

[29] Dong P, Gu BW, Wang Y. Therapeutic observation on acupoint injection with histaglobulin for 120 cases of chronic urticaria. Shenyang Budui Yiyao, 2007, 20(6): 414.

[30] Chen Y, Song DY. Therapeutic observation on hydroacupuncture plus medication for chronic urticaria. Zhongguo Shequ Yishi: Yixue Zhuangye, 2012, 14(4): 232.

[31] Sun ZH, Wang YZ. Acupoint injection based on syndrome differentiation for chronic urticaria. Liaoning Zhongyiyao Daxue Xuebao, 2007, 9(4): 117.

[32] Liao JF. Therapeutic observation on acupoint injection for 50 cases of chronic urticaria. Hainan Yixue, 2001, 12(5): 67.

[33] Zhang S. Analysis of acupoint injection for 57 cases of chronic urticaria. Gansu Zhongyi, 2001, 14(4): 61.

[34] Wei L, Yuan GB. Clinical observations on curative effects of point injection on chronic urticaria. Zhongguo Zhenjiu, 2001, 21(12): 715-716.

[35] Sun ZH. Acupuncture plus acupoint injection for chronic urticaria. Henan Zhongyi, 2001, 21(4): 55, 116.

[36] Wu RL. Therapeutic observation on combined Chinese and Western medicine plus acupoint injection for 50 cases of chronic urticaria. Zhongguo Yiyao Daobao, 2010, 7(9): 82.

[37] Qin GH. Clinical observation on acupoint injection with Diphenhydramine plus autoblood for 80 cases of chronic urticaria. Zhaoqing Yixue, 2008, (3): 29-31.

[38] Liu XS. Acupoint injection for 23 cases of chronic urticaria. Zhongyi Linchuang Yanjiu, 2010, 2(16): 15.

[39] Xu HJ, Cheng YF. Therapeutic observation on acupoint injection for 53 cases of chronic urticaria. Zhonghua Xiandai Zhongxiyi Zazhi, 2005, 3(2): 149-150.

[40] Zeng HY. Therapeutic observation on acupoint threadembedding for 53 cases of chronic urticaria. Zhenjiu Linchuang Zazhi, 2003, 19(11): 44.

[41] Yue DR, Li YP, Gong YY, Li P. Acupoint embedding with catgut soaked in Chinese medicine for chronic urticaria. Yunnan Zhongyi Zhongyao Zazhi, 2000, 21(5): 42-43.

[42] Sun G, Kong B, An ZL, Zhao LH, Hu YL. Clinical observation on acupoint thread-embedding for chronic urticaria. Baotou Yixueyuan Xuebao, 2010, 26(1): 85-86.

[43] Huang H, Xu LJ, Chen YS. Acupoint thread embedding for 124 cases of chronic urticaria. Linchuang Junyi Zazhi, 2009, 37(6): 1031.

[44] Mo XF. Scalp acupuncture for 40 cases of chronic urticaria. Zhejiang Zhongyiyao Zazhi, 2003, 13(7): 360.

[45] Chen LY, Guo YQ. Observation on short-term therapeutic effect of Bo’s abdominal acupuncture on chronic urticaria. Zhongguo Zhenjiu, 2005, 25(11): 768-770.

[46] Lin YQ. Clinical study on abdominal acupuncture plus moxibustion at Shenque (CV 8) for chronic urticaria. Master Theses of Guangzhou University of Traditional Chinese Medicine, 2012: 23.

[47] Yang YH. Clinical observation on Levocetirizine plus He-Ne acupoint radiation for chronic urticaria. Zhongguo Linchuang Yanjiu, 2010, 23(8): 701.

[48] Zhang YQ. Chinese medicine plus acupoint application for chronic idiopathic urticaria. Guangming Zhongyi, 2008, 23(10): 1551.

[49] Yuan SZ, Sun XK. Therapeutic observation on Doxepin applied to Shenque (CV 8) plus oral administration of medication for chronic urticaria. Zhongguo Wuzhen Xue Zazhi, 2010, 10(9): 2052-2053.

[50] Zhang ZK. Therapeutic observation on Chinese medicine plus wrist-ankle acupuncture for chronic urticaria. Master Theses of Heilongjiang University of Traditional Chinese Medicine, 2010: 1.

[51] Zhu QB, Gou JJ, Gou P, Ye S. Ten cases of chronic urticaria treated with needle-knife. Zhongguo Zhenjiu, 2010, 30(s1): 100.

Translator: Hong Jue

R246.7

A

Date: May 6, 2013

Author: Ji Jun, M.D., associate researcher.

E-mail: jijunmm@126.com