Effect of mild moxibustion in improving the quality of life of patients with diabetic peripheral neuropathy

Dou-Dou LI, Yu-Hua ZHU, Ting-Li YOU,Yun-Xia GE, Xiao-Rong LIU, Xiao SUN

Departments of 1Endocrinology, 2Traditional Chinese Medicine,3Obstetrics, 4Nursing and 5Urinary Surgery, Affiliated Hospital of Integrated Traditional Chinese and Western Medicine,Nanjing University of Chinese Medicine, Jiangsu Province Academy of Traditional Chinese Medicine, Nanjing, China

ABSTRACT

Objective: The objective of this study is to investigate the effect of mild moxibustion on quality of life of patients with type 2 diabetic peripheral neuropathy (DPN).

Materials and Methods: Fifty-five patients with type 2 DPN from October 2018 to July 2019 were recruited in the present study and randomly divided into two groups: 27 cases in the control group and 28 cases in the intervention group. The control group received routine treatment of hypoglycemic, hypotensive, mecobalamin nutritional nerve, while the intervention group received mild moxibustion on the basis of the control group. The course of treatment for both groups was 10 weeks. The quality of life of the two groups was assessed using short form-36 health survey and compared with t-test at 0.05 significance level.

Results: The total score of the short form-36 in the intervention group was higher than the control group (P < 0.05); the scores of bodily pain, physical functioning (PF), general health (GH), and mental health dimensions in the intervention group increased significantly compared with the control group (P < 0.05); the scores of role physical, social functioning (SF), vitality, and role-emotional (RE) dimensions showed no between-group difference (P > 0.05).

Conclusion: Mild moxibustion can effectively improve the quality of life of patients with type 2 DPN, relieve patient pain symptoms, and improve PF and GH.

Keywords: Diabetic peripheral neuropathy, mild moxibustion, quality of life

INTRODUCTION

Diabetic peripheral neuropathy (DPN) is a common complication of diabetes clinically manifested as limb numbness, formication, coldness, local burning pain, easy to cause local ulcers, infections, and even osteomyelitis.Severe patients suffer from nerve ulcers and amputation.[1-3]In addition, it also leads to huge disease burden and poor working ability, thus seriously affecting the quality of life of patients.[4,5]According to the Chinese medicine theory, if consumptive thirst (referring to diabetes) lasts for a long time,it will consume and damage the essence and Yin, resulting in the deficiency of Qi and blood.[6]The reasons lie in that Qi is the commander of the blood, the blood is the mother of Qi, and the two are interdependent. Therefore, Qi deficiency leads to poor blood circulation, and blood deficiency in turn aggravates Qi deficiency, thus causing Qi deficiency and blood stasis. Due to homogeny of essence and blood, deficiency of blood will inevitably leads to loss of essence, resulting in Yin deficiency.

Therefore, the main mechanisms of DPN are deficiency of both Qi and Yin together with blockage of blood stasis.Although the disease is located in the vessels, the blood stasis in the vessels is a superfacial cause while Qi and blood deficiency is the root cause. Mild moxibustion is a kind of suspension moxibustion. It is a method to keep the burning end of the moxa stick at a distance of about an inch from the skin of the moxibustion site so that the patient has warm feeling but no burning pain.[7]In this study, we focused on the observation of the effect of mild moxibustion on the quality of life of patients and achieved promising clinical results.

MATERIALS AND METHODS

Patients

Totally, 55 patients with type 2 DPN in the outpatient department of our hospital were recruited. The inclusion criteria were as follows: (1) patients met the diagnostic criteria for type 2 DPN according to the 2017 Chinese guidelines on prevention and treatment of diabetes;[3](2)patients aged between 18 and 75 years old; and (3) patient voluntarily participate in the study and signed the informed consent. The exclusion criteria were: (1) patients with severe acute and chronic complications; (2) patients with mental and intellectual abnormalities and inability to cooperate; and (3)patients with skin ulceration at the site of moxibustion. The envelope random grouping method was used to group the patients into the control group (27 cases) and intervention group (28 cases). The general data of two groups are presented in Table 1.

Table 1: General data of two groups

Interventions

Patients in the control group received with hypoglycemic,hypotensive, and oral mecobalamin drugs; hypoglycemic drugs included insulin and/or glucose-lowering drugs,Oral medication to improve peripheral neuropathy is mecobalamine, mecobalamine capsules (Qishin, national drug approval number: H20052315, 0.5 mg × 50 tablets/box)0.5 mg/time, 3 times/day, and diet, exercise, blood glucose monitoring, and self-management guidance every 2 weeks,and treatment for 10 weeks.

Patients in the intervention group were supplemented with mild moxibustion in addition to conventional nursing.Acupoints were selected in accordance with the positioning criteria in the National Standard of the People’s Republic of China--Location of Acupoint[8]issued by the State Bureau of Technical Supervision. The acupoints such as feishu,pishu, and shenshu on the bladder meridian of foot Taiyang were selected for moxibustion. Patients with upper limb symptoms were treated with additional quchi and waiguan acupoints, while those with lower limb symptoms were treated with additional sanyinjiao, yanglingquan, and zusanli points. The moxibustion materials are moxa sticks made of 3-year Chinese mugwort, 18 mm in diameter,200 mm in length, and 278 g in weight. A moxa stick was divided into seven sections on average, and one of them was taken in a single-hole moxibustion box for preparation.The patient is positioned, the whole body is relaxed,and the moxibustion parts are fully exposed. Then, the operator used the single-hole moxibustion box for mild moxibustion, 10 min per acupoint. If the patient felt burning sensation, immediately stop operation and change other acupoint. After the treatment, the patient was asked to drink 150 mL warm water. In total, there were two courses of moxibustion, 15 times for each course, one treatment every other day, 3 times a week.

Observation indicators

The quality of life was evaluated by two trained professionals using the short form-36 health survey before treatment and after two courses of treatment.[9]The short form-36 health survey includes eight dimensions: physical functioning (PF)with 10 items, role physical (RP) with 4 items, bodily pain (BP)with 2 items, social functioning (SF) with 2 items, vitality (VT)with 4 items, role-emotional (RE) with 3 items, general health (GH) with 5 items, and mental health (MH) with 5 items.[10]The Cronbach's α of each dimension was PF = 0.87,RP = 0.88, BP = 0.66, GH = 0.76, VT = 0.80, SF, = 0.70, RE= 0.92, MH = 0.80, respectively. The higher the score of each dimension is, the better the health status is. This scale is mainly fulfilled by patients themselves, and patients who could not complete it independently completed with the assistance of professionals.

Statistical analysis

The data were analyzed via Statistical Package for the Social Sciences (SPSS, version 23.0, Chicago, IL) software. was used for statistical analysis. If the measurement data are normally distributed, the comparison within the group was performed using the pairedt-test, while the comparison between the groups was performed using the independent samplet-test. For the measurement data that do not meet the normal distribution,the rank-sum test is used. The enumeration data were expressed as frequency and percentage and the measurement data were presented as mean ± standard deviation. AP< 0.05 was considered to be statistically significant.

RESULTS

There was no statistical difference between the control group and the intervention group, regarding the general data such as age, gender, course of diabetes, fasting blood glucose, high-density lipoprotein, low-density lipoprotein,total cholesterol, and triglyceride (Pall > 0.05), which was comparable [Table 1].

No statistical difference was found between the two groups before treatment regarding the scores of each dimension and the total score (P> 0.05). However, the scores of BP, PF,RP, GH, SF, RE, and MH dimensions and the total score in the intervention group increased significantly after treatment compared with treatment before (P< 0.05), and the scores of those indicators in the intervention group were higher than those in the control group (P< 0.05) [Table 2].

Table 2: Comparison of short form-36 scores in all dimensions before and after treatment between the intervention group and the control group

DISCUSSION

DPN is one of the most serious chronic complications, and population-based cohort studies have shown that 59% of the patients with type 2 diabetes have DPN.[11]DPN is a nerve conduction disorder mainly caused by the degeneration or necrosis of neurons and nerve fibers. Patients suffer from pain, psychological pressure, and extra financial burden for a long time, which seriously affects the quality of life of patients.[12,13]

In this study, we found that the scores of the quality of life indicators in the intervention group increased significantly after treatment, except for the dimension of VT. However,there was no significant difference before and after treatment in the control group. Compared with the control group, the four dimensions of BP, PF, GH, and MH were significantly improved, and the total score was significantly increased compared with the control group. DPN not only affects the patient’s physical pain and physiology function but also affects the patient’s social function psychology and interpersonal relationship to varying degrees, thereby affecting the patient’s quality of life. Moderate moxibustion has a significant effect on improving the quality of life of patients. It has been shown in the study that the patients’physical pain and physiology function have been restored to a certain extent, which has also played a significant effect on the psychological and MH of patients.

The pathogenesis of DPN lies in both deficiency and excess factors, and mostly, deficiency is the root cause and excess is the superficial cause. In the 2016 guidelines for the prevention and treatment of DPN,[14]DPN was divided into six syndrome types: Qi deficiency and blood stasis, phlegm stasis and collateral obstruction, Yin deficiency and blood stasis, dampness and heat obstruction, Yang deficiency and cold coagulation, and liver and kidney deficiency. The most common type is Qi deficiency and blood stasis, manifested as numbness in hands and feet, occasionally prickling and especially aggravation at night, formication, lassitude in loin and legs, tiredness, diaphoresis, and so on. At present,treatment is mainly based on the principle of “replenishing Qi, promoting blood circulation, removing stasis”.[15]Moxibustion is a therapy of using heat produced by the burning of moxa sticks to treat and prevent diseases.[16]When the moxa stick is burning, the heat effect generated by burning of moxa is transferred through the surface of the skin to the deep layer of the muscles and tendons to stimulate specific parts of the human body, thus achieving the effect of warming meridian and dredging the collaterals,regulating Qi and blood, and promoting smooth circulation of Qi and blood.[17,18]

In the study, we chose the self-developed single-hole moxibustion box for mild moxibustion to avoid scalds of the patients; the patients felt that the temperature was appropriate, so no scalds occurred. In the process of moxibustion, prone position and sitting position were taken to avoid the adverse reactions (scalds) brought by the same posture.

CONCLUSION

Mild moxibustion can effectively and safely treat DPN and improve the quality of life of patients, which can be popularized in clinical practice. The treatment of DPN is not a simple treatment of the disease; how to improve the quality of life of patients is particularly important. With the overall health needs of patients and the continuous progress of medicine, we can use TCM appropriate technology to improve the quality of life of chronic diseases. To improve the application of TCM in patients with health problems, we need to continuously improve the quality standards of appropriate technology of TCM. Further observations and integration of resources are required from multiple centers, and further research is needed to confirm these findings and identify potential mechanisms.

Declaration of patient consent

This study was approved by the Ethics Committee of the Hospital of Integrated Traditional Chinese and Western Medicine Affiliated to Nanjing University of Traditional Chinese Medicine (TCM) (No.: 2018LWKY036). The authors certify that they have obtained all appropriate patient consent forms. In the form, the patients have given their consent for clinical information to be reported in the journal. The patients understand that their names and initials will not be published and due efforts will be made to conceal their identity, but anonymity cannot be guaranteed.

Financial support and sponsorship

This study was support by Jiangsu Administration of Traditional Chinese Medicine: National TCM clinical research base open topic (JD: 201711)

Con flicts of interest

There are no conflicts of interest.