J. Acupunct. Tuina. Sci. 2013, 11 (5): 265-268 DOI: 10.1007/s11726-013-0705-2

© Shanghai Research Institute of Acupuncture and Meridian and Springer-Verlag Berlin Heidelberg 2013︱● 265 ●

SPECIAL TOPIC STUDY

Clinical Observation on Treatment of Chronic Eczema with Acupuncture plus Acupoint Injection Therapy

Li Min1, Pu Xiao-lan2 1 Jiulongpo No.1 People’s Hospital,

Chongqing 400050, China 2 Huaxi No.4 Hospital Affiliated to

Sichuan University, Chengdu 610041, China

Author: Li Min, M.M., attending physician. E-mail: zjtnyx@126.com

CLC Number: R246.7 Document Code: A

Abstract Objective: To observe the clinical effects of acupuncture combined with

acupoint injection therapy in treating chronic eczema. Methods: Seventy patients were randomly divided into two groups.

Thirty-six cases in the treatment group were treated with acupuncture, acupoint injection therapy and tapping with plum-blossom needle, while 34 cases in the control group were treated with oral administration of Loratadine plus topical application of Halometasone Cream.

Results: After a three-week treatment, the curative and remarkable effective rate and the total effective rate were respectively 80.6% and 97.2% in the treatment group, versus 47.1% and 79.4% in the control group. The differences in the curative and remarkable effective rate and total effective rate between the two groups were statistically significant (all P<0.05). No obvious adverse reaction appeared in the two groups during the treatment.

Conclusion: Acupuncture plus acupoint injection therapy is effective for chronic eczema with high in safety.

Key Words Acupuncture-moxibustion Therapy; Hydro-acupuncture; Plum-blossom

Needle Therapy; Acupuncture Medication Combined; Eczema

Chronic eczema is a commonly encountered and intractable dermal disease,

mainly manifested by serious itching, severely influencing the patients’ quality of life. We treated 36 cases with acupuncture plus acupoint injection therapy, while we treated other 34 cases with medicine for comparison. The report is given as follows.

1 Clinical Materials

1.1 Diagnostic criteria In reference to the diagnostic criteria of chronic eczema in the

Dermatology[1], the diagnostic criteria were set up based on presence of dark red or brown red rashes or maculopapular rashes, frequently fused and thickened with lichenoid change, such as scales, scratching marks bloody scabs on the surface, surrounded by a few pimples, and maculopapular rashes; present at any locations, but mostly on the exposed areas and flexed aspect; often in symmetrical distribution; severe subjective itching; irregular duration, repeated seizures, and lingering and intractable condition.

1.2 Inclusion criteria Those in conformity with the above diagnostic criteria; with the duration

above two months; both male and female; agreed to participate in this clinical

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trial, and not to use other therapies for this disease during the treatment.

1.3 Exclusion criteria Women in pregnancy or lactation; allergic to

medications; applied with corticosteroids, non-steroidal anti-inflammatory agents or immune inhibitor within 30 d before treatment, and/or applied with anti- histamines, topical corticosteroids and non-steroidal anti-inflammatory agents; those complicated with severe primary diseases in the cardiovascular, cerebrovascular, hepatic, renal or hematopoietic system, or those with mental disorders, diabetes; and those with interference factors impacting absorption, metabolism and excretion of medications.

1.4 General data A total of 70 cases were recruited and divided

randomly into two groups by their visiting orders. Of 36 cases in the treatment group, there were 16 males and 20 females, with the age ranging from 17-69 years old and the duration ranging from 3 months to 9 years. Of 34 cases in the control group, there were 18 males and 16 females, with the age ranging from 19-70 years old and the duration ranging from 2 months to 8 years. By the statistical management of gender, age and duration in the two groups, the differences were not statistical significant (P>0.05), indicating that the two groups were comparable.

2 Therapeutic Methods

2.1 Treatment group 2.1.1 Acupoint injection therapy

Acupoints: Xuehai (SP 10), Zusanli (ST 36), Quchi (LI 11).

Medication: Bacille Calmette Guerin-Polysaccharide Nuceic Acid (BCG-PSN) injection (0.5 mg/ampule).

Operation: Acupoints on the same side were selected each time, and injected in the left or right side in alternation. Each time, a 5 mL disposable syringe was used to draw 1 mg of drug (2 ampules), and after the acupoint area was disinfected routinely, the syringe was inserted. After the aching, numb, distending or painful needling sensation appeared and no blood was withdraw, 0.33 mg drug was injected into each acupoint. After the needle was taken out, a cotton swab was used to press the injecting spot for a while.

2.1.2 Plum-blossom therapy and moxibustion method

The local skin lesion was tapped with plum-blossom needle till slight blood oozing. Then, suspended moxibustion by moxa roll was applied to the skin lesion till the skin became slightly red. The treatment was given once every three days.

2.2 Control group Patients in the control group were given oral

administration of Loratadine 10 mg (10 mg/tablet), plus topical application of 0.05% Halometasone Cream for skin lesion. The treatment was given twice every day.

The cases in both groups took three-week treatments for a course. The return visit was requested once every week. The symptoms and signs were scored before the treatment and after three weeks of the treatment in both groups.

3 Observation of Therapeutic Effects

3.1 Observed items The symptoms and signs were scored based upon

four grades[2], and the therapeutic effects were assessed in accordance with the scores of the symptoms and signs.

3.1.1 Scoring criteria of symptom (itching)

0 point: No itching. 1 point: Slight itching, tolerable, not influencing the

daily life and sleep. 2 points: Moderate itching, intolerable sometimes,

intermittent and sometimes influencing the daily life or sleep, but not severe.

3 points: Severe itching, difficult to tolerate, often influencing the daily life and sleep.

4 points: Very severe itching, persisting day and night, almost impossible to tolerate, and to sleep and rest.

3.1.2 Scoring criteria of sign (skin lesion)

0 point: No skin lesion or only left with pigmentation.

1 point: Slight skin lesion, with pimples, scratching marks and scabs, and tendency of lichenification.

2 points: Moderate skin lesion, in moss tendency, accompanied by scaly keratosis.

3 points: Severe skin lesion, in obvious lichenification, accompanied by scaly keratosis and pigmentation.

4 points: Extremely severe skin lesion, with severe lichenification, thickening hypertrophy in the skin lesion, obvious scaly keratosis and pigmentation.

3.2 Criteria of therapeutic effects The total scores were obtained by summing up the

scores of the symptoms and signs. The efficacy indexes were calculated by total scores, and the effects were assessed by the efficacy indexes.

Efficacy index = (Total scores before treatment – Total scores after treatment) ÷ Total scores before treatment × 100%.

Cured: Efficacy index >90%. Remarkable effect: Efficacy index >60%, ≤90%. Improvement: Efficacy index >30%, ≤60%. Failure: Efficacy index ≤30%.

3.3 Statistical methods The SPSS 17.0 statistical software was applied to

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process data, and the grading data were processed with the rank sum test.

3.4 Therapeutic results After three-week treatment, the curative and

remarkable effective rate and total effective rate were

obviously higher in the treatment group than those in the control group (all P<0.05), indicating that the therapeutic effect was better in the treatment group than that in the control group (table 1).

Table 1. Comparison of therapeutic effects between the two groups (case)

Groups n Cured Remarkable effect Improvement Failure Curative and remarkable effective rate (%) Total effective rate (%)

Treatment 36 12 17 6 1 80.61) 97.21)

Control 34 4 12 11 7 47.1 79.4

Note: Compared with the control group, 1) P<0.05

3.5 Adverse reaction No severe adverse reaction was seen in the two

groups. In 3 cases of the treatment group, slight swelling appeared in the injected area, but disappeared after management without influence on the continuous treatment. In the control group, transient somnolence and drownsiness appeared in 4 cases, and dry mouth and headache appeared in 3 cases, and skin atrophy appeared in 2 cases. But all were tolerable, and the medications were used till the end of the treatment.

4 Discussion Eczema is a commonly encountered allergic and

inflammatory dermal disease, characterized by polymorphous rashes, tendency to the moist area, symmetrical distribution, easy reoccurrence and chronic tendency, and serious subjective itching[3]. The pathogenic factors of eczema are complicated and closely related to allergic reaction. The patients often have allergic constitution. BCG-PSN injection is a new immunemodulatory agent, BCG extract, containing over 10 immune active substances of ribose and polysaccharides, and has the effects to inhibit Th2 cells to secrete the cytokines of interleukin-4 (IL-4) and interleukin-5 (IL-5), so as to enable Th1/Th2 equilibrium to migrate to Th1 to realize a new equilibrium[4-5]. At the same time, BCG-PSN can also balance the humoral immunity, activate the functions of monocyte-macrophage cells, stabilize the mast cells, reduce the degranulation cells to release active substances by intensifying the cellular immunity of the body[6], so as to relieve the symptoms of chronic eczema and inhibit its recurrence.

Acupoint injection therapy is a specific therapy created by the combination of the pharmacological effect of the medications and injecting method in the modern medicine, based upon the basic theory of Chinese medicine. On one hand, the effects of acupuncture and medication directly irritate the meridians and acupoints to produce certain therapeutic effect. On another hand, after the acupoint injection,

medications can stay in the acupoints for a long time, so as to intensify and prolong the therapeutic efficacy of the acupoints, and to dredge the meridian qi along the pathways of the meridians to reach the corresponding pathological organs and tissues for fully displaying the joint therapeutic effect of acupoints and medications. The effects of medications to the acupoints can also work on the organism to excite the anti-pathogenic ability of the human body and produce greater efficacy by influence of the nerve system, endocrine system and blood ingredients[7-8]. In this method, Quchi (LI 11), Xuehai (SP 10) and Zusanli (ST 36) are selected. Among them, Quchi (LI 11), an important acupoint to clear away heat, is used to clear away heat, dissipate wind, regulate Ying-Nutrient blood, and correct the reversely-flowing qi and activate the collaterals. Xuehai (SP 10) can be used to nourish and harmonize blood, strengthen the spleen and dissolve dampness. Zusanli (ST 36) can be used to strengthen the spleen and harmonize the stomach for supporting the anti- pathogenic ability and build up Yuan-Primary qi, dredge the meridians and activate the collaterals, and normalize qi dynamics. Three acupoints in combination can be used to support the anti-pathogenic ability, expel the pathogenic factors, strengthen the spleen and dissolve dampness, clear away heat, dissipate wind and stop itching, and can also holistically deal with the pathogenesis of dampness, heat, blood stasis and deficiency in chronic eczema. At the same time, it has been indicated in the relevant studies in the modern times that the stimulation on these three acupoints can excite and regulate the immune functions of the organism, and antagonize the active substances of histamine, so as to enhance the cellular immune functions of the patients, inhibit the allergy, dilate the capillaries, and improve microcirculation, with the effects to regulate the immunity of the organism and diminish inflammation for reducing inflammatory exudation, inhibiting leukocyte migration and the release of lysoome[9-10].

In long term duration of chronic eczema, the pathogens enter the blood collaterals and cause the

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obstruction of qi and blood in the meridians, leading to heavy, turbid and sticky stagnation of pathogenic dampness, and hence resulting in steeped hypertrophic skin lesions and lingering and intractable condition. To tap the local skin lesions by the plum-blossom needle can open the external door of the meridians and promote the circulation of qi and blood for expelling wind, removing dampness, diminishing obstruction and disperse stagnation, so as to expel the internally and externally accumulated pathogens[11]. Then, mild moxibustion on the skin lesions can smoothen the local circulation of qi and blood by the warm and penetrating force and dredge the meridians, so as to dissipate damp-heat and disperse the accumulated fire[12]. Therefore, tapping technique by the plum-blossom needle and mild moxibustion by moxa roll can solve the problem of local skin lesions effectively.

It has been indicated by the study that the clinical effect in the treatment of chronic eczema with acupuncture plus acupoint injection therapy is obviously better than the therapeutic effect with oral administration of antihistamines plus topical application of glucocorticoids. Moreover, this therapy is of less adverse reaction and worthy of clinical application.

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Translator: Huang Guo-qi

Received Date: April 18, 2013