Acupuncture-moxibustion therapy of "banking up original qi and consolidating the foundation" for prevention and treatment of seasonal allergic rhinitis: a randomized controlled trial
MA Yao (马尧) BU He (布赫)* LI Xiu-ye (李秀叶) LÜ Hong-yan (吕红艳) ZHANG Xue (张雪)
Acupuncture-moxibustion Department, The Second Affiliated Hospital of Baotou Medical College, Baotou 014030, Inner Mongolia Province, China (内蒙古包头医学院第二附属医院针灸科，内蒙古包头 014030，中国)
First author: MA Yao, attending physician.
Research field: acupuncture-moxibustion for nerve system diseases.
*Corresponding author: BU He, chief physician, professor.
Research field: acupuncture-moxibustion for cerebrovascular diseases.
* Baotou medical science and technology project: Wsjj2015060
Objective To observe the clinical efficacy of acupuncture-moxibustion therapy of "banking up original qi and consolidating the foundation" for prevention and treatment of seasonal allergic rhinitis. Methods Sixty included patients were divided into two groups according to the random number table method with 30 patients in each group. In acupuncture group, warming-needle moxibustion was carried out at Zúsānlĭ (足三里ST 36), and cone moxibustion on Fùzĭ （附子Radix Aconiti Lateralis Praeparata）cake was conducted at Guānyuán (关元CV 4), Qìhăi (气海CV 6) and Dàzhuī (大椎GV 14). The treatment was conducted in May or June (2 months before the onset of rhinitis in this area). The treatment was carried out for once every other day and three times per week. Treatment for 24 times was considered as 1 course of treatment. No intervention treatment was conducted in control group. The score of rhinitis symptom, the visual analogue scale (VAS) score changes of total nasal symptom score (TNSS) and total non nasal symptom score (TNNSS) of patients in 2015 and in 2016 were observed, and the clinical efficacy of the two groups was compared. Results (1) The score of rhinitis symptom, the VAS score changes of TNSS and TNNSS in acupuncture group in 2016 declined when compared with the results in 2015, which were 4.57±0.82 vs 9.40±1.89, 13.37±4.01 vs 30.80±4.77 and 15.93±6.30 vs 46.13±9.79 (P＜0.001)，the results in acupuncture group after treatment were lower than that in control group at same time, which were 4.57±0.82 vs 7.53±2.06,13.37±4.01 vs 27.17±6.84,15.93±6.30 vs 35.53±11.69(all P＜0.001). According to comparison, there was no obvious difference in the results in control group at the two time points, which were 8.60±2.39 vs 7.53±2.06, 29.63±6.30 vs 27.17±6.84 and 40.90±12.31 vs 35.53±11.69 (all P＞0.05). (2) the total effective rate was 96.7% (29/30) in acupuncture group and 10% (3/30) in control group, and the difference was statistically significant (P＜0.001). Conclusion Acupuncture-moxibustion therapy of "banking up original qi and consolidating the foundation" was effective on prevention and treatment of seasonal allergic rhinitis.
KEY WORDS Acupuncture-moxibustion; seasonal allergic rhinitis; prevent disease before it arises; bank up original qi and consolidate the foundation
Allergic Rhinitis (AR) is a kind of non-infectious inflammatory disease of nasal mucosa mediated by IgE after the body contacting the allergen, with the typical symptoms of paroxysmal sneezing, watery nasal discharge, rhinocnesmus and nasal congestion, and concomitantly with ocular symptoms, including eye itching, lacrimation, red eyes and burning sensation. AR, as a kind of common clinical disease in otolaryngology head and neck surgery, can be classified into two categories in accordance with the types of allergens, including seasonal AR and perennial AR. The morbidity of seasonal AR in our country is 1-5% which is increasing yearly. In this study, unconventional therapy ideas were adopted in order to give prophylactic treatment before the disease attacked, and the study results are reported as follows.
The 60 included seasonal allergic rhinitis patients were who visited the doctor from January, 2016 to December, 2016. All the included patients conformed to the diagnostic criteria. They were divided into acupuncture group (30 cases) and control group (30 cases) according to the visiting sequence by adopting the random number table. There was no drop-out case. There was no significant difference between the two groups according to the comparisons of gender, age, rhinitis symptom score, visual analogue scale (VAS) scores of total nasal symptom score (TNSS) and total non nasal symptom score (TNNSS), type and degree of allergic rhinitis (all P＞0.05), and the results were comparable. The details are shown in Table 1. This study was approved by the ethic committee of the Second Affiliated Hospital of Baotou Medical College with the No. of 2015 K.L.S. No. 009.
Table 1 Comparison of general information of the patients with seasonal allergic rhinitis in the two groups
（1） Diagnostic criteria of allergic rhinitis
The diagnostic criteria was defined in accordance with the stipulations in Diagnosis and Treatment Principle and Recommended Regimen for Allergic Rhinitis issued by the Editorial Board of Chinese Journal of Otorhinolaryngology Head and Neck Surgery and Chinese Medical Association Otorhinolaryngology Branch after 2009 Wuyi Mountain Conference. Clinical symptoms: with two or more symptoms such as sneezing, watery nasal discharge, nasal congestion, nasal pain and etc., concomitantly with eye itching, conjunctival congestion and other ocular symptoms. Signs: pale nasal mucosa, edema and watery nasal discharge were commonly seen. Allergic rhinitis should be diagnosed with the consistency between clinical manifestation and skin point bloodletting or serum specific IgE detection results.
(2) Diagnostic criteria of seasonal allergic rhinitis
By reference to the diagnostic criteria of seasonal allergic rhinitis revised by Chinese Medical Association Otorhinolaryngology Branch in 1997 in Haikou, the following criteria was formulated by combining with the characteristics of seasonal rhinitis in Baotou area: (1) seasonal onset, with basically consistent onset seasons in each year (July to September) and the transmission period of sensitizer, and the disease attacks at least in the same season in two years,(2) typical clinical symptoms and signs during the period of onset.
(3) Diagnosis of type and severity of allergic rhinitis
Allergic rhinitis was divided into intermittent AR and persistent AR in accordance with the duration of symptoms, and divided into mild AR and moderate-severe AR according to the severity of the condition.
Type: the disease with a course shorter than 4 weeks or the the duration of the symptoms shorter than 4 days per week was intermittent AR;The disease with a course longer than 4 weeks and the duration of symptom longer than 4 days per week was persistent AR.
Severity: the disease with no effect on the following items was mild AR, and the disease with effect on one or more of the following items was moderate-severe AR:① sleeping, ② daily activities, sports activities and recreational activities, ③ normal work and learning.
① Patients conforming to the diagnostic criteria of allergic rhinitis and seasonal allergic rhinitis,② with an age of 18-65 years old, without disturbance of consciousness; ③ patients voluntarily signed the informed consent form, ④ patients who can express their own wills, provided valid contact information and were willing to cooperate with the follow-up visitors.
① Patients with paroxysmal respiratory diseases such as asthma, ② patients who accepted other treatments during the study period (from 1 month before treatment to the period of onset), ③ patients with incomplete materials about basic information and clinical efficacy evaluation before and after treatment,④ psychiatric patients.
Criteria of removed cases
① Patients who cannot finish the follow-up visit, or with incomplete information, ② patients who experienced great changes of dwelling and working environments during the period of follow-up visit, and the changes affected the effectiveness evaluation, ③ patients suffered from asthma or other diseases which affected the conditions of allergic rhinitis, ④ patients lost to follow-up due to any other reason.
Acupoint selection: Zúsānlĭ (足三里ST 36, bilaterally), Guānyuán (关元CV 4), Qìhăi (气海CV 6) and Dàzhuī (大椎GV 14). Manipulations: First, the patient was asked in supine position. The acupoints were disinfected conventionally. Hwato 0.35×40 mm disposable filiform needles were adopted to perform perpendicular insertion at ST 36 with a depth of 0.8～1cun. After deqi, the moxa sticks, with a diameter of about 1.8 cm and a length of about 1.5 cm, were applied to perform warming-needle moxibustion. Moxibustion on Fùzĭ （附子Radix Aconiti Lateralis Praeparata）cake was carried out at CV 4 and CV 6 , with 5 moxa cones at each acupoint. Then, the patient was asked in prone position,Moxibustion on Fùzĭ （附子Radix Aconiti Lateralis Praeparata）cake was carried out at GV 14 , with 5 moxa cones at the acupoint. Clinical intervention was conducted in May and June, 2 months before the onset period of rhinitis. The treatment was performed for 3 times a week, once every other day, and treatment for 24 times was considered as 1 course of treatment.
No intervention was conducted.
① Scoring criteria table of rhinitis symptoms, ② VAS score of total nasal symptom score (TNSS), ③ VAS score of total non-nasal symptom score (TNNSS).Rhinitis status of patients in the two groups in rhinitis onset period in 2015 and 2016 were evaluated respectively.
（1） Scoring criteria table of rhinitis symptoms
Curative effect evaluation was conducted by adopting the scoring criteria table of rhinitis symptoms in Diagnosis and Treatment Principle and Recommended Regimen for Allergic Rhinitis issued by the Editorial Board of Chinese Journal of Otorhinolaryngology Head and Neck Surgery and Chinese Medical Association Otorhinolaryngology Branch in 2004 after Lanzhou Conference in terms of the four major symptoms: sneezing, runny nose, nasal congestion and rhinocnesmus ( Table 2).
Table 2 Scoring criteria table of rhinitis symptoms
≤ 4 times
Feeling when consciously inhaling
Intermittent or interactive