Study and Discussion on Acupuncture Treatment of Urticaria

Cai Lingling(蔡玲玲), Li Yuanwen(李元文), Zhang Yueyue (张月月), Li Hua(李华),Yin Xia (殷霞), Dong Ying(董颖), Zhao Fengzhu(赵凤珠), Fang Yun(方芸), Sun Jie(孙杰),Shi Jingwen(石静纹), and Xu Kaituo(许开拓)

Study and Discussion on Acupuncture Treatment of Urticaria

Cai Lingling(蔡玲玲), Li Yuanwen(李元文), Zhang Yueyue (张月月), Li Hua(李华),Yin Xia (殷霞), Dong Ying(董颖), Zhao Fengzhu(赵凤珠), Fang Yun(方芸), Sun Jie(孙杰),Shi Jingwen(石静纹), and Xu Kaituo(许开拓)＊

OBJECTIVE:To explore the etiology and pathogenesis of urticaria and its characteristics, advantages of acupuncture and moxibustion treatment of it and the commonly used acupoints,with a prospect of providing clinical guidance for other doctors.

METHODS:Methods and views of urticaria treatment with acupuncture and moxibustion were summarized and the representative acupoints were found out by retrieving related literatures in recent years.

RESULTS:Traditional Chinese medicine holds that urticaria is caused by weakness and leads to the wind stroke knot on the skin, which fights against qi and blood and generates wheal..Acupuncture therapy has its unique advantages in treating, which is worth clinical reference and promotion,however, there are still some problems in its clinical study.

CONCLUSION:Acupuncture therapy should be combined with reinforcing qi and nourishing blood,detoxification dehumidification,dispelling wind and arresting itching as the principle, as according to the the principle that different symptoms match with the corresponding points after selecting the main point. Physiciansshould treat patients by choosing acupuncture point according to the law of syndrome differentiation in selecting, tired to choose acupuncture point,local pick acupuncture point and choosing particular points.As urticaria may attack in any season, in any place and on any person. Therefore, the prevention and treatment of urticaria is a protracted war,and needs to strengthen the nursing in the treatmentto achieve the desired effect.

Acupuncture and moxibustion; Urticaria;Channels and collaterals;Treatment

SUMMARY

Urticaria is a clinical common kind of allergic,recurrent, intractable skin diseases,it belongs to the traditional Chinese medicine "addiction rash"and "wheal", "wind", "wind bumps" category.Various reasons lead to skin and mucous membrane permeability, small blood vessels and increase and leads toa localized edema reaction. The disease characterized by sudden attack of red or white skin rash, , swinging hair, itching, all of which fade after leaving no traces.Severe cases can drag in the digestive tract, respiratory tract, which cause nausea, vomiting, diarrhea, difficulty breathing, and even serious symptom of suffocation. The incidence of this disease is about 23.27%1, can attack at any age, season and area. Course for acute urticaria iswithin 6 weeks, and chronic urticaria is more than six weeks and attacks at least twice a week. The disease has the characteristics of longer duration, repeated attacks, deferment painless,and it is a kind of refractory dermatological department common and frequentlyoccurring disease. Acute and chronic phase is not set in stone. Acute urticaria can transform into chronic urticaria due to misdiagnosis or not being treated in time, chronic urticaria may also be flashy. Severe itching may seriously influence patient's study, work and life. The abnormal skin state of patients may also affect patients' external image, cause patients' tension state. Severe cases can even cause sleep disturbances and depression.

ETIOLOGY AND PATHOGENESIS

Urticaria, as a kind of intractable, common and recurrent disease in the Dermatology, its etiology is not clear. Addiction rash is recorded in the literature of traditional Chinese medicine first in 4 q, inverse theory “in the element, Paper records: “Yin, less disease skin bi implicit rash”. The YiZong Jin Jian surgical method, key, of the Qing dynasty said:“by the sweat out of wind, or dew lies the cool, the wind said more empty. Beginning of skin itching, secondary flat knot,like douban, heap tired slices”. At the same time it puts forward the treatment agent, “day what itch, radix gentianae macrophyllae burdock soup; night to itch the person that weigh, take the appropriate angelica YinZi. External use shochu radix stemonae, with the blue cloth dips in alcohol to wipe, have cool wind from effect”2. In recent years, with the development of this disease, the doctors put forward varieties of ideas on the etiology and pathogenesis. Yihua Deng3believes that the cause of this disease is related to the wind, which is regarded as the external cause, it has longer duration,repeated attacks, blood deficiency and weathering drying, which are interacts and affects blood, thereby increases treatment difficulty. Qi and blood weakness is the internal cause of this disease, should be treated by promoting blood circulation and tonifying blood,eliminating the pathogenic heat. Wenjing Liu4holds that urticaria disease caused by both internal and external causes and the internal cause is debilitating,the external cause is induced by a variety of pathogenic factors. TCM pathogenesis of urticaria includes cold outside, the hot wind evil, or the imbalanced diet,intestinal parasites, intestines and stomach being hot and humid, weak or flat ferrite, insufficiency of qi and blood, blood loss or illness due to long injury, the wind invasion, or the modern internal injuries, blunt disorders, liver and kidney deficiency, along with the dry skin and depression in the skin. Liang Ma believes that the disease is mainly caused by qi and blood,which is not solid, the evil wind gets into the body.He holds spring and winter are two season when the weather is dry, during which cou is not fixed, fl uid loss and the wind evil is easy to invade, which manifests as clinical dry skin, wind area being small and not fixed, but frequently in upper limbs and face, painful itching, thirst, red tongue with thin white moss. During the long and wet summer, the origin traps spleen and causes fluid metabolism disorders, combined with the exogenous pathogenic wind, the diseases attacks, the clinical performance for wind area is larger, itching spot is fixed, which is most in the waist and lower limbs, tongue has thick red moss. Wei Wang6gives his dialectical thought on chronic urticaria: the “blood stasis” causes “secondary”, “poison”, which is divided into the following different syndrome types: cold bundle of phenotype, hot wind makes phenotype, damp and hot accumulate in skin, which causes gastrointestinal syndrome, blood deficiency type dry wind, lung spleen-deficiency type, liver depression XieReXing,collaterals blood stasis type resistance, the spleen and stomach discord, qi deficiency, Yang deficiency wind medium and toxin factor mixed type, which should be respectively treated with different clinical treatment.To sum up, this disease belongs to weak category, who is not solid, or because of cold and hot wind evil;or because of gastrointestinal depression of damp and hot at the skin; or because of lack of qi and blood,deficiency endogenous wind; or because of modern internal injuries and disharmony of thoroughfare and conception channels, liver and kidney deficiency, and the wind stroke knot on the skin, with qi and blood occur to wheal.

ACUPUNCTURE AND MOXIBUSTION

Acupuncture and moxibustion treatment can promote and regulate cellular and humoral immunity by enhancing phagocytosis of macrophges compared with drugs, which can prolong the maintenance time of antibody in blood, and regulate the immune balance,and enhance phagocytosis of T and B cells. Also, it playsan important role in inhibiting inflammatory cell infiltration, reducing vascular permeability, reducing swelling, and promoting cell repair.7Acupuncture and moxibustion treatment is a kind of Chinese traditional treatment which is easily accepted, and has the advantages of safety, specially good effect, no toxin side effects, simple, and is of less pain. So far,acupuncture and moxibustion has many ways being in treating the disease, such as body acupuncture, pricking blood with cupping, acupoint injection, auricular point compression, pricking blood, moxibustion,electroacupuncture, acupoint laser irradiation, acupoint catgut embedding, scalp acupuncture, combination therapy and so on according to the related reports. Most researchers advocate using combination therapy8, which means combing two or more of the above methods.Compared with the single therapy, combination therapy can improve clinical efficacy, shorten the course of treatment, decrease the pain. When we use acupuncture to treat the disease, we should choose main points first，and then choose appropriate acupoints according to different symptoms and achieve the purpose of eliminating disease,symptoms and pathogenesis and preventing relapse. The treatment principle is Qi-Reinforcing and Blood-Enriching, detoxification and dehumidification, wind-dispelling and itching-arresting.When we use acupuncture to treat the disease, Large Intestine Meridian and Spleen Meridian are most frequentlyselected by doctors, Quchi（LI 11）and Xuehai (SP 10) are most frequently selected. While in moxibustion and cupping therapy, Shenque (CV 8) is most frequentlyselected. And in bloodletting therapy,Dazhui (GV 14) is mostfrequently selected9. Large Intestine Meridian connects Lung Meridian, lung is related to skin, it passes out the used air and toxins of the lung from the large intestine, and then nourish the skin to prevent the skin disease. Also, Yangming Meridian characterized by excessive qi and blood can enhance righteousness. The spleen, acquired foundation,governs transportation and transformation, and plays an important role in maintaining normal function of digestive tract and transforming into Qi and blood from food. Spleen Meridian can regulate the circulation of the blood and Qi and enhance the immunity. The two meridians combined can play an effect in Qi-Reinforcing and Blood-Enriching, wind-dispelling and dehumidification, harmonization of Ying-qi and Weiqi. Qu-chi (LI 11) is the Sea Point of Large Intestine Meridian, which means qi and blood in the meridians is just like the water in the pool, So Qu-chi (LI 11) has a strong function of regulating qi and blood in our body.Because Qu-chi (LI 11) and He-gu (LI 4) are the points of Yangming Meridian, which is good at diffusing, the acupoints can expel wind and relieve exterior syndrome as well as purges heat of Yangming Meridian. Since Qu-chi (LI 11) is the Sea Point of Large Intestine Meridian and Lung Meridian connects Large Intestine Meridian, Qu-chi (LI 11) can ventilate lung qi, expel pathogenic factors from muscles and skin, harmonize Ying-qi and Wei-qi, purge heat retention of Yangming,and then achieve the effect of wind-dispelling, heatclearing, itching-relieving and pain-relieving. Xuehai(SP 10) can promote blood circulation by removing blood stasis, tonify blood and nourish blood, lead blood to meridians. Blood circulation can affect qi-movement.Qi is the commander of blood, blood is the mother of Qi. The so-called treating blood before treating wind and self-eliminating of wind after blood circulating,the pathogenic factor of the disease is in blood. Geshu(BL 17), blood convergence, Weizhong (BL 40) is also named Xuexi, with Xuehai (SP 10) , it can regulate Ying-blood. Shenque (CV 8) is named Qishe in Compendium of acupuncture and moxibustion, it is the acupoint of Conception Vessel, which means it is closely related to Qi. Because of its special location, it is closely linked to liver, spleen, heart, kidney, Thoroughfare Vessel, Conception Vessel, Governor Vessel and so on.Thoroughfare Vessel, Conception Vessel and Governor Vessel have the same source, the Qi of the three Vessels is interlinked and connects twelve meridians,internal organs and the limbs and bones. When we use acupuncture and cupping on Shenque (CV 8), through the circulation of the vessels around the navel, Shenque(CV 8) as the hub of meridians and the convergence of Qi can regulate the circulation of Qi of the body. Dazhui(GV 14) is the acupoint of Governor Vessel, which is the confluence of Yang-qi from three yang meridians of hand and foot and Governor Vessel. If urticaria is due to heat syndrome, we can prick the point, which will regulate the circulation of Qi and blood and plays a role in wind-dispelling and itching-relieving, heat-clearing and detoxification. According to the majority of the literature on acupuncture treating the disease, doctors would like to treat the disease by following the law of selecting based on syndrome differentiation, selecting acupoints along meridians, selecting local point and selecting specific acupoints—the meridians are fixed while the acupoints are variable, they would rather miss the acupoint than miss the channel.

CONCLUSION

Urticaria, a kind of allergic, recurrent and intractable skin disease, belongs to the category of obscure rash, rubella, wheal, and wind bumps in Traditional Chinese Medicine. Urticaria is a kind of localized edema reaction, which is due to small vascular dilatation and increased permeability of skin and mucous membrane caused by unknown reasons.Chinese medicine believes that the inner endowment intolerance and the external wind fighting with qi and blood in the skin leads to wheal. The combination therapy of acupuncture and moxibustion has significant features and advantages in treating the disease, which is worthy of clinical promotion and reference. And Large Intestine Meridian, Spleen Meridian, Quchi (LI 11), Xuehai (SP 10), Shenque (CV 8), Dazhui (GV 14)are most frequently used in the treatment because of their own characteristics. At the same time, we should pay attention to nursing work. Above all, there are some problems in the clinical study of acupuncture and moxibustion in the treatment of urticaria. In the future research, we should improve and solve the problems, so as to better serve the clinical treatment.

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9 Zeng XX, Sun ZR, Lv XL, et al. Meridian of acupuncture in treating urticaria. Shandong J Tradit Chin Med,2016(5):420-423.

Dongfang Hospital, the Second Affiliated Hospital of Beijing University of Chinese Medicine, Beijing 100078, China

Funding:1. Beijing Administration of Traditional Chinese Medicine Development Plan in 13th Five-Year of Key Specialty of Dermatology. 2. Project from Human Resources Dept of Dongfang Hospital “Dongfang Famous Doctors”

*Corresponding author:Email: 1245724774@qq.com；Mobile phone: +86-17710599346

(Accepted: February 12, 2017)