Progress of improvement of pain and joint function of knee osteoarthritis treated with thunder-fire moxibustion in the last five years

DENG Kai-feng, MAO Wen-qian, ZHU Ying, CHEN Ri-lan✉

1.Guangxi University of Traditional Chinese Medicine, Nanning 530001, China

2.Ruikang Hospital Affiliated to Guangxi University of Traditional Chinese Medicine, Nanning 530011, China

Keywords:

ABSTRACT Objective: To summarize the clinical research of improvement of pain and joint function of knee osteoarthritis treated with thunder-fire moxibustion in the last five years, in order to provide more objective and scientific theoretical basis for the clinical use of thunderfire moxibustion in the treatment of knee osteoarthritis.Methods: By using "thunder-fire moxibustion" and "knee osteoarthritis" as keywords, the clinical literature on the treatment of knee osteoarthritis mainly by thunder-fire moxibustion in the past 5 years in PubMed,CNKI, WF and VIP were analyzed.Results: Thunderfire moxibustion and its compound therapy, including internal use of traditional Chinese medicine, external use of traditional Chinese medicine, drug injection, physical therapy, acupuncture, heat sensitive moxibustion,pricking collaterals, acupoint application and ozone, could relieve pain, improve joint function,improve joint activity, improve patients daily life ability and have less adverse reactions.Conclusion: Thunder-fire moxibustion was a safe, non-invasive and effective treatment for knee osteoarthritis.However, further research is necessary due to the non-rigidity of the current clinical trial design.

1.Introduction

In recent years, a large number of effective studies on the treatment of knee osteoarthritis (KOA) by thunder fire moxibustion have emerged.By searching CNKI, WF, VIP and PubMed databases, the relevant literature on the intervention of thunder fire moxibustion in KOA was searched.Based on the retrieved data, the current treatment status of thunder fire moxibustion intervention in KOA was reviewed, and the shortcomings of current studies were summarized.

2.Overview

KOA was a chronic painful osteoarthritis with knee pain, stiffness,local swelling, and dysfunction [1-3].According to the current epidemiological survey, the prevalence rate of men and women was 42.8% and 21.5%, respectively[4].Most scholars believed that KOA local factors and systematic factors of the complex interaction[5].The major risk factors for KOA included age, sex, obesity, overuse,joint injury, genetic susceptibility, and mechanical factor [6].Modern medical standard drug therapy routine oral or local use of nonsteroidal anti-inflammatory drugs, hyaluronic acid injection or intraarticular corticosteroids.But these drugs inevitably had adverse reactions, such as hepatorenal toxicity, gastrointestinal reactions,and adverse events that occur cardiovascular disease [7,8].Surgical treatment as KOA advanced treatment, but there were reports of postoperative infection, prosthesis loosening and other adverse reactions [9].Therefore, the necessity of developing other safer and more effective treatments to delay the development of end-stage arthritis of knee joint is self-evident.

According to the characteristics of this disease, thunder fire moxibustion had significant advantages.Modern medical research showed that thunder fire moxibustion could produce strong thermal radiation and infrared radiation during combustion[10].Heat radiation could reach the subcutaneous and muscular layer,while infrared radiation could reach the deep tissue of human body,which could reduce nerve excitement, analgesia, improve tissue edema, eliminate inflammatory reaction, and achieve the effect of warming the meridian and regulating microcirculation[11].Thunder fire moxibustion was non-invasive, easy to operate and less painful to treat and accepted by patients[12,13].A large number of effective research on the treatment KOA thunder fire moxibustion had emerged in recent years.Therefore, by searching the CNKI, WF, VIP and PubMed database, the author looked up the relevant literature about the intervention KOA of thunder fire moxibustion.Based on the data obtained from the retrieval, this paper summarized the current treatment status of KOA with thunder fire moxibustion and the current shortcomings.

3.Current status of clinical research

3.1 Therapy of single thunder-fire moxibustion

Huang[14] found that the VAS score and WOMAC score of the KOA patients were significantly decreased trearing with thunder fire moxibustion, which suggested that thunder fire moxibustion could obviously improve the joint symptoms of the patients and play a positive effect on the affected joints, and the effect was better than celecoxib.Yang[15] compared with ordinary moxibustion treatment KOA, the total effective rate of thunder fire moxibustion group was 90.5% higher than that of ordinary moxibustion group 69%.Through the evaluation of VAS score and SF-36 score, it was found that thunder fire moxibustion relieve pain and improve quality of life.Shen[16] compared the clinical effect of thunder fire moxibustion and ordinary moxibustion intervention KOA, the results showed that the clinical effect of thunder fire moxibustion was higher and the improvement of joint symptoms was more obvious.Zheng[17] treated mild to moderate KOA patients through thunder fire moxibustion,found that thunder fire moxibustion could relieve pain, simple and easy to operate, and could reduce the gastrointestinal reaction caused by long-term oral drugs.

The heat and infrared radiation of thunder-fire moxibustion continue to act on local lesions and acupoints, which had the function of meridian transmission and regulating microcirculation.The high concentration drug area formed in the moxibustion area could penetrate into the deep tissue quickly under the action of heat.It had the effect of relieving pain.

3.2 Thunder fire Moxibustion combined with oral Chinese medicine

Zhao[18] treated cold and dampness type KOA with aconitum decoction combined with thunder fire moxibustion.The total effective rate and cure rate of aconitum decoction were higher than that of Fengshi Gutong capsule alone.The effect of activating blood circulation and clearing collaterals is better.

Oral Chinese medicine had obvious advantages in adjusting the function of viscera, and it was more applied in the treatment of KOA.At present, the clinical treatment of KOA drugs, mainly with tonifying liver and kidney, dispelling wind and collaterals, combined with thunder fire moxibustion, the curative effect was better.

3.3 Thunder fire Moxibustion combined with acupoint injection

Wang[19] exploried the effect of thunder fire moxibustion combined with bone peptide injection point injection in the treatment of KOA,the X line score of knee joint in the observation group was lower than that in the control group, and the score of knee joint function(hospital for special surgery, HSS) was higher (P＜0.05).points out that the KOA effect of thunder fire moxibustion combined with bone peptide injection acupoint injection was remarkable, which could effectively improve the knee joint function and is worth popularizing.Cui[20] found that the HSS score of thunder fire moxibustion group was lower and no adverse events occurred.Thunder fire moxibustion combined with joint cavity injection of sodium hyaluronate could effectively reduce KOA recurrence and was worthy of clinical application.

Acupoint injection was a method of selecting drugs to inject corresponding acupoints to treat diseases.Through the dual stimulation of acupuncture and drugs, we could give full play to the comprehensive curative effect, adjust the functional state of the body, and cooperate with thunder fire moxibustion to accelerate the absorption of local drugs.To achieve the purpose of KOA treatment.

3.4 Thunder fire Moxibustion combined with external applicaion of Chinese medicine

Hu[21] found that thunder fire moxibustion combined with external applicaion of Shuangbai powder are superior to simple thunderfire moxibustion in improving the symptoms and delaying the development of the disease for mild and moderate knee osteoarthritis.Xie[22] used the routine western medicine on the basis of thunder fire moxibustion and cold arthralgia prescription external application intervention wind-cold arthralgia type KOA, the study found that it could reduce the VAS score more than the single western medicine,the clinical efficiency was higher, more effective improvement joint local blood circulation, dredging meridian and activating collaterals,relieving pain.

The external application of Chinese medicine was based on the principle of skin penetration, through the direct absorption of drugs by the skin to play a role in the local lesions, could give full play to the efficacy of drugs, combined with the thermal effect of fire moxibustion, drug penetration faster, symptoms improved more obvious.

3.5 Thunder fire Moxibustion combined with physical therapy

Dong[23] observed the effect of ultrashort wave combined with thunder fire moxibustion, and compared with the simple ultrashort wave.The difference of pain, stiffness, joint function score and effective rate was significant (P＜0.05).The combination of thunder fire moxibustion combined with ultrashort wave produces physical heat radiation effect, chemical anti-inflammatory analgesia and acupoint dredging meridian, and the curative effect was further consolidated.

The principle of ultrashort wave was to use high frequency electric field to treat diseases.It had the functions of anti-inflammatory and analgesic, speeding up blood circulation, promoting local tissue growth and absorbing exudate, thus delaying cartilage degradation.Combined with the local stimulation of lightning moxibustion, it could further promote blood circulation, accelerate the absorption of local inflammation and relieve adhesion.

3.6 Thunder fire Moxibustion Combined with acupuncture

Xin[24], Zhu[25], Zhan[26], He[27] observed the treatment of KOA with acupuncture combined with thunder fire moxibustion KOA.It was found that the curative effect was better than that of the control group, and it was more significant in reducing arthritis inflammation index, relieving pain and improving knee joint function than that of the control group.

Acupuncture could speed up blood circulation.Combined with thunder fire moxibustion, it could strengthen the function of meridian sensing.

3.7 Thunder fire Moxibustion combined with heat-sensitive moxibustion

Zhang[28] found effect of heat-sensitive moxibustion and simple thunder fire moxibustion on KOA is different.The VAS score,WOMAC score and clinical effective rate of heat-sensitive moxibustion group after treatment were significantly different with simple thunder fire moxibustion(P＜0.05).

Heat-sensitive moxibustion follows the theory of "effective qi to",paid attention to individualize treatment, dynamically stimulate the meridian sense of acupoints, and achieve the therapeutic purpose of"small stimulation and large reaction" of acupoints.

3.8 Thunder fire Moxibustion combined with pricking bloodletting

He[29] and Han[30] evaluated curative effect of KOA by using thunder fire moxibustion combined with pricking bloodletting.After treatment, the outcome indexes were significantly decreased, which was significantly different from the control group (P＜0.05).The curative effect of thunder fire moxibustion combined with pricking bloodletting was more prominent and worthy of clinical promotion.

Pricking bloodletting had an effect of activating blood circulation to relieve pain and removing blood stasis.It could effectively promote local blood circulation and cooperate with thunder fire moxibustion treatment KOA which could accelerate the local metabolism speed of the joint and improve the environmental state of the joint, thus improving the symptoms.

3.9 Thunder fire Moxibustion combined with acupoint application

Ma[31] found thunder fire moxibustion combined with acupoint application could remove blood stasis and relieve pain ointment.After thunder fire moxibustion, the metabolism of local skin and tissue cells was accelerated, and the osmotic absorption effect of acupoint application was enhanced.The combined effect was better than single acupoint application.Liu[32] observed the clinical efficacy of thunder fire moxibustion combined with acupoint application and single acupoint application respectively.The results showed that the KOA of thunder fire moxibustion combined with acupoint application was more effective in treating KOA.

Acupoint application used application drugs to directly act on KOA related meridian acupoints and infiltrate into the body through skin and mucous membrane, which could accelerate local blood circulation.Combined with thunder fire moxibustion, skin and deep tissue cells were expanded to enhance the osmotic absorption of local tissues.

3.10 Thunderfire moxibustion combined with ozone therapy

Li[33] found that ozone therapy combined with thunder fire moxibustion could significantly down-regulate the serum interleukin 1β, interleukin 6 and tumor necrosis factor release level of KOA patients, relieve pain, swelling and stiffness symptoms, and improve the daily life ability of patients.All the indexes were better than that of single ozone group.

Ozone therapy could provide activation energy for pathological cells with long-term energy deficiency, correct energy metabolism disorder in pathological state, improve hypoxia state quickly, inhibit the release of inflammatory mediators, and have a wide range of anti-inflammatory effects.Combined with thunder fire moxibustion to further improve the efficacy and optimize joint function.

4.Summary and Outlook

Synthesizing the relevant literature of thunder fire moxibustion treatment KOA in recent years, most of the research conclusions were generally consistent.The clinical efficacy of thunder fire moxibustion and its compound therapy intervention KOA was higher than that of the control group, and the total effective rate was more than 80%.All a result, the effect of thunder fire moxibustion alone or in combination with other treatment methods was very significant, and thunder fire moxibustion had gradually become common treatment method.At the same time, clinical studies had been replaced by randomized controlled trials from previous one-arm trials, and the quality of methodology was improving.Complementary Therapies in Medicine the inclusion criteria of KOA patients had been basically unified, most of the research literature had adopted the diagnostic criteria KOA by the american society of rheumatism (ACR).the commonly used WOMAC scores,Lequesne index scores, knee Lysholm scores, and HSS scores on the observation indicators were also increasingly standardized.

Recently, some basic studies also found that the inflammatory markers such as interleukin 1β, tumor necrosis factor in serum of KOA model rats were significantly reduced, suggesting that thunder fire moxibustion had a effect on the excessive expression of proinflammatory factors[34].Zhang[35] found that thunder fire moxibustion in KOA model rats could regulate the abnormal expression of MMP-3 and TIMP-1 in joint fluid and have a certain up-regulation function for the TGF-β1.All these results further demonstrated the effect of thunder fire moxibustion on KOA.On the whole, the curative effect KOA thunder fire moxibustion was accurate, but the clinical research of thunder fire moxibustion treatment KOA was still insufficient: (1) Almost clinical research were insufficient sample size.(2) In the group design of patients,most of the research random sequence generation methods were unreasonable, there was little literature on specific random methods.(3) In the experimental study of the treatment KOA of thunder fire moxibustion, there were differences in the description of its operation method, distance and time.There was a lack of unified standard treatment method of thunder fire moxibustion, which could be referred to less.(4) In the aspect of curative effect analysis, most scholars had similar expositions on its mechanism of action, and most of them remain in the category of TCM theory.

Above all, in the future research, the researchers should strengthen the scientific design of the KOA test scheme, standardize the experimental research process, establish the systematic operation standard of acupoints selection and improve the research quality.Based on the basic research, the existing research is limited to the level of downstream inflammatory factor marker expression, few studies from the cell receptor, gene transcription, signal protein expression level, innate immunity level to explore the mechanism of KOA intervention.The author thinks that the future research can start from these aspects, further explore the potential mechanism of lightning moxibustion intervention KOA, and provide more reliable evidence for the wide application of lightning moxibustion in KOA.

Author's Contribution

Deng Kai-feng was responsible for research design and writing papers; Mao Wen-qian was responsible for document retrieval and collation; Zhu Ying and Chen Ri-lan were responsible for revising.

All authors declare no conflict of interest.