Discussion on the clinical significance of moxibustion in improving cancer pain

Xian-man Wei,Dong-xin Tang,Feng-xi Long,Qian Deng,Han Shao,Zhu Yang

1.The First Affiliated Hospital of Guiyang College of Traditional Chinese Medicine,Guiyang,China.

2.Tumor Inheritance and Scientific and Technological Innovation Talents Base of Traditional Chinese Medicine in Guizhou Province (Guizhou people lead hair [2018] No.3) Guiyang,China.

Abstract

Key words:Moxibustion,Cancer pain,Three-step therapy

Backgroung

In recent decades,the techniques and methods of cancer treatment have been changing with each passing day,and considerable results have been achieved in clinical trials.However,as the most common and fearful accompanying symptom of cancer in patients with middlelate cancer,the innovative treatment of cancer pain has progressed slowly,according to the WHO valid data statistics,the growth of the cancer patients each year worldwide about nearly 7 million,among them 36% ～ 45% of patients pain cannot be effectively control [1],at present,the field is still dominated by threestep analgesic therapy.Cancerous pain is a symptom caused by cancer itself or in the course of disease and treatment.Excessive pain not only brings pathological effects such as elevated blood pressure and decreased immunity,but also more causes anxiety,depression and restlessness of patients,which affects normal life and brings psychological distress to patients.Disturbance and physiological effects lead to a substantial decline in the quality of life.Moxibustion is one of the traditional external therapies of traditional Chinese medicine.Its role in relieving pain has been increasingly found and recognized.Therefore,this article will briefly summarize the clinical significance of Moxibustion in improving cancer pain.

Problems existing in the treatment of cancer pain by western medicine

The WHO three-step therapy is effective but patients have a lot of concerns about opioids:currently recognized as the most basic clinical treatment plan is the "three-step analgesic therapy" formulated by WHO.This therapy has good clinical efficacy in the initial stage of treatment,but with the progress of the disease and long time use,also can bring some hidden trouble,as the most common clinical opioids cause digestive tract gastrointestinal side effects,such as OIC,there are some patients exist opioid use for a long time "addiction" concerns,but many studies have shown that both at home and abroad,medication under the guidance of the scheme in the specification,with safe and reliable curative effect [2].

Minimally invasive interventional therapy has many contraindications and complications and is expensive [3]:the analgesic effect can be achieved by destroying pituitary gland,statin nerve,T2,T3 sympathetic nerve,visceral nerve plexus and other nerves or by using radiofrequency thermocoagulation to destroy percutaneous dorsal root ganglion,sympathetic nerve (mostly waist and chest),trigeminal ganglion and so on.Neurological regulation relieves pain,mostly by inserting morphine pump into subarachnoid space,or spinal cord electrical stimulation therapy (SCS) by giving drugs or electrical stimulation.But at present,interventional therapy has many contraindications and complications,and its economic price is relatively expensive.It is difficult for ordinary families to afford it.

Radiotherapy is mainly aimed at bone cancer pain with obvious side effects [4]:at present,the use of radioanalgesia mainly focuses on patients with bone metastasis in the middle and late stages of cancer,followed by bone cancer pain,including distal,brachytherapy,systemic radionuclide,indirect therapy,etc.Radiation therapy analgesia has the advantages of high remission rate,high efficacy rate,high persistence and low economic burden.It has become the primary method for the treatment of bone cancer pain [5],but radiotherapy also has side effects such as bone marrow suppression and decreased immunity.

Clinical significance of moxibustion in improving cancer pain

In the traditional Chinese medicine internal treatment of cancer pain,there are also some hidden dangers of insecurity.Most of the cancer patients in the middle and late stages are characterized by deficiency of Qi and blood,pattern of healthy qi deficiency and pathogen excessiveness,while most of the traditional Chinese medicine prescriptions such as anticancer and analgesic prescriptions are fierce antipyretic and detoxicating drugs and insect drugs which may damage the body because of their strong medicinal properties.They can cause dizziness,limb weakness,poor diet and sleep.Therefore,the advantages of external treatment of traditional Chinese medicine are obvious,and moxibustion,as the most basic and simple method of traditional external treatment,is more meaningful to promote and try out.In this regard,the clinical significance of Moxibustion in the treatment of cancer pain is analyzed as follows:

Moxibustion has a long history

Moxibustion is a traditional Chinese medicine external treatment method to prevent and treat diseases by burning moxa grass,moxa leaves or moxa wool and other materials to produce moxa heat,and by using moxa heat to directly or indirectly stimulate body surface acupoints,channels and collaterals,skin,etc.In the Stone Age,human beings mastered the skill of using fire skillfully,as recorded in The First Deduction History of Great Ancient Times:"Primitive humans use wood to get fire,...make people eat cooked food",this skill also laid a foreshadowing for the birth of moxibustion.In the mid-Warring States Period,moxa began to appear as a material for moxibustion,and the main position of moxa as a material for moxibustion was not established until the late Warring States Period and between Qin and Han Dynasties (about 300 BC).

The clinical significance of treating cancer pain from the perspective of moxibustion

From the point of view of Western medicine,moxibustion can stimulate local skin by temperature to achieve skin pore and capillary dilatation.It can also promote the rapid absorption of drugs,accelerate the blood circulation and lymphatic circulation of the body,shorten the body's metabolic cycle,reduce and alleviate the spasm of smooth muscle,promote the dissipation absorption of pathological products such as inflammation,adhesions,exudates,and congestion.The most important thing is that it can spread the inhibitory substances in the cerebral cortex and reduce the excitability of the sympathetic nervous system,thereby exerting sedative and analgesic effects.Therefore,in the field of treating cancer pain,moxibustion has great research value.From the point of view of traditional Chinese medicine,Yiluo Wu,a famous doctor in Qing Dynasty,has a saying in "Renewal of Materia Medica":"moxa has a bitter and pungent taste,...it can save the people who have yang-qi deficiency,...adjusting Qi,Blood,Yin and Yang,...adjusting emotion,regulating menstruation and preventing abortion...using its moxa fire...curing all diseases.The classic conclusion of this sentence is that moxa itself as a moxibustion material,through its aromatic odor and burning temperature,achieves the effects of warming yang,dispelling cold,dehumidifying,analgesia and hemostasis.Its most powerful effect is to pass through various meridians and save the dying patients with yang deficiency.And the aromatic aroma of moxa itself,can be made into pillows,ornaments,sachets,etc.,as well as sleeping,calming,alleviating restlessness and other effects.Moxibustion not only acts through individual fragrance and temperature,but also acts on different meridians and acupoints to relieve pain and improve systemic diseases.The meridians and collaterals of TCM are not only one line or two lines,but also a multi-level and multi-functional circulatory system connecting internal and external viscera.Through this system,all viscera cooperate with each other to make the body work normally.Meridians and acupoints have the function of storing and disseminating medicines.They release the medicines to the whole body through meridians and acupoints,and then regulate the function of viscera and cure diseases.

Discuss the clinical significance of moxibustion therapy from the perspective of etiology and pathogenesis of cancer pain.

In the field of traditional Chinese medicine,it is believed that the causes of cancer pain mainly include six exogenous pathogenic factors,seven emotions and internal injuries,diet,fatigue,deficiency of Qi and blood,qi stagnation and blood stasis,etc.In terms of pathogenesis,the two main pathogenesis of cancer pain are meridian obstruction and visceral dystrophy.Most of obstruction is "Qi stagnation and blood stasis".Dystrophy is mostly "Qi deficiency,blood deficiency and less body fluid".Most of the patients with middle and late stages of cancer are older,with long-term illness,deficiency of body,gradual deficiency of viscera,impaired spleen and stomach function,incapability of promoting Qi and Blood generation and body fluid qperation,and the patients are mostly insufficient,inadequate intake.Tumors belong to consumptive diseases,lack of nutrition,inadequate supply and nourishment of the body,causing Qi deficiency and Qi stagnation,blood deficiency and less body fluid and other pathological results,and Qi stagnation can make blood flow impeded,blood stasis,so the late stage of tumors are mostly asthenia in origin and asthenia in superficiality.For example,in patients with digestive tract tumors,there are many false symptoms such as dry stool,short urine and so on in the later stage.In fact,the deficiency of spleen and stomach qi can not promote gastrointestinal peristalsis,lubricate intestinal tract and transport water,and finally these "false symptoms" appear.In this regard,starting from the etiology and pathogenesis of cancer pain,combined with the role of moxibustion,the treatment of cancer pain with moxibustion just belongs to random differentiation and treatment.

Clinical application of Moxibustion in the treatment of cancer pain

At present,moxibustion has achieved good clinical effect in relieving cancer pain.Mi [7] studied the relief of cancer pain by Moxibustion in patients with advanced gastric cancer.96 patients were randomly divided into experimental group and control group,48 cases in each group.The control group only used three-step therapy,while the experimental group added moxibustion therapy on the basis of the control group to observe the degree of pain relief.The final experimental results showed that the control group and the experiment The total effective rates of group A were 77.08% and 91.67%,respectively,P ＜ 0.05,which had statistical significance,and could effectively improve the quality of life and psychological state of patients.Fei et al [8].36 patients with primary hepatocellular carcinoma pain were treated by Moxibustion therapy.The experimental results showed that 12 patients had moderate pain relief (33.33%),13 patients had improved (36.11%) and 11 patients had no effect (30.56%).The effective rate was 69.44%.In addition,there are also studies on the combination of acupuncture and moxibustion to alleviate cancer pain [9],electronic moxibustion apparatus to treat cancer pain [10],herbalseparated moxibustion to alleviate pain [11].

External treatment of moxibustion therapy in ethnic medicine

There are many ethnic medicine systems in China,and the Miao medicine and Tujia medicine systems are the main areas in the region.In both national medicine systems,there are external treatment methods and odd treatment methods that have the same principle as moxibustion therapy.Because the Miao people lived in mountainous areas for a long time,the inconvenient transportation and selfsufficient life mode also enabled the Miao people to master the use of fire and to be good at discovering the healing effects of fire on diseases,thus producing the most primitive and primary physiotherapy methods which is similar to the principle of moxibustion.For example,in the secretive therapy of Miao nationality,there is a burning method and a baking method [12].The principle of burning the fire method is to ignite the drug particles at the selected acupoints,through the intense heat stimulation of the acupoints and the dual effects of the drug components.Stimulates the skin,penetrates the skin throughout the body,reaches the smoothed meridian,removes poisonous evils,and relieves pain.The principle of baking method comes from the ancient society,which is to make the human body be stimulated by heat,and receive a certain amount of radiation from the infrared rays (including ultraviolet rays) of the flame,so as to dredge the meridians and phlegm,relief pain and so on.Similar treatments exist in the Tujia medicine system.In the treatment of osteoarthritis and sciatica,the Tujia people use the moxibustion therapy in the fire attack therapy [13],which is also through the thermal stimulation of temperature and drugs to give full play to curative effect.

Cases of moxibustion to improve cancer pain

Zhang XX,male,52 years old,admitted to the hospital on January 27,2019,found lung occupying position 7 months ago,postoperative pathological biopsy confirmed lung cancer,patients complained of pain in the chest after surgery,accompanied by cold limbs,fatigue,still good spirit,pale face color,poor sleeping,diet,well urination and defecation,light tongue and its fur,weak pulse.The clinical diagnosis is the yang deficiency syndrome of lung accumulation.The patient's surgical wound has healed,the skin has no ulceration,no fever and other discomfort.The NRS score is 4 points,which is moderate pain.After the cancer pain knowledge mission,the patient still refuses to take opioid painkillers.We combine the patient's condition and actual situation.Moxibustion was used for treatment,and Ashi points of local pain were selected as the site of operation.Specific operation methods:1.Iodine disinfection of the local skin of Ashi points;2.Select a cylindrical clear strip,about 20-21cm long,1.9-2.1mm in diameter,2-3cm away from the skin,against Ashi and its Smoke moxibustion around,each of the moxibustion time is about 15min,to the degree of flushing of the skin,pay attention to avoid burns.2 times a day,7 days for a course of treatment.After using moxibustion,the daily dynamic NRS score fluctuated between 2-4 points in the first 4 days.From the 5th day,the NRS score was always ＜ 3 points,and the patient's limbs had no previous cold feeling.Both have improved,the face is slightly rosy,but still weak,patients and their families are quite satisfied with the treatment effect.

Conclusion

As one of the external treatment methods of traditional Chinese medicine,moxibustion has a theoretical fit and practical operability for relieving and improving cancer pain.It reduces the onset time of oral drugs through direct stimulation of skin,mucous membrane,acupoints and meridians.It has the advantages of fast onset time,better curative effect,smaller side effects and simple operation,and has aromatherapy,which can effectively relieve pain and patients' anxiety and depression with cancer pain,being widely used in clinical practice and can be easily accepted.It can effectively alleviate the patient's economic pressure and psychological burden,thereby greatly improving the confidence and compliance of patients' treatment and improving their quality of life.