abstracted & translated by

Bob Flaws, Lic. Ac., FNAAOM (USA), FRCHM (UK)

Keywords: Chinese medicine, acupuncture-moxibustion, rheumatology, inflammatory arthritis, ankylosing spondylitis (AS), warm needle moxibustion

Ankylosing spondylitis, also called Marie-Strümpell disease, is one of the inflammatory arthrites. It is an autoimmune disorder characterized by inflammation and pain in the sacral and lumbar vertebrae. The pain typically is worse with rest and improves with activity. Arthritis in other joints in also present in 50% of patients. The disease typically progresses up the spine to involve the chest vertebrae, thus causing decreased range of motion of the chest with respiration. Eye inflammation and heart involvement with conduction disorders occur in 25% of cases. Ankylosing spondylitis is characterized by mild or moderate flares of activie spondylitis alternating with periods of almost or totally inactive inflammation. Erythrocyte sedimentation rate, C-reactive protein, and serum immunoglobulin (Ig) levels are mildly elevated in most patients, but serum rheumatoid factor (RF) and antinuclear antibodies (ANA) are negative. Diagnosis is confirmed by x-ray. This condition is three times more common in males than in females. Typical age at onset is between 20 and 40 years. It is 10-20 times more common in first-degree relatives of AS patients than in the general population. Its Western medical treatment primarily involves the use of NSAIDS (including COX-2 drugs) to suppress articular inflammation, pain, an muscle spasm. Radiotherapy to the spine, although effective, is used as a last resort because it increases the risk of acute myelogenous leukemia tenfold.

On pages 52-53 of issue #3, 2004 of Zhong Yi Yan Jiu (Chinese Medical Research), Hou Chun-ying and Liu Qiang published an article titled, "The Treatment of 33 Cases of Ankylosing Spondylitis with Warn Needle Moxibustion." A summary of that article is presented below.

Cohort description:

Altogether there were 54 patients enrolled in this two-wing, comparative clinical trial. In the so-called treatment group of 33, there were 30 males and three females with a median age of 28.4 " 8.9 years and a median disease duration of 7.8 " 5.6 years. Seven cases had been diagnosed with AS for 2-5 years, 16 cases had been diagnosed for 6-10 years, and 10 cases had been diagnosed for more than 10 years. In the comparison group of 21, there were 20 males and one female with a median age of 31.2 " 10.3 years and median disease duration of 7.4 " 5.1 years. Six of these patient had been diagnosed with AS for 2-5 years, eight for 6-10 years, and seven for more than 10 years. Besides the clinical symptoms of aching and pain of the lumbosacral region which was worse on rainy days or after fatigue and inhibited range of motion, diagnosis was confirmed by x-ray in all cases. Exclusion criteria included rheumatoid arthritis, external injury, tuberculosis, and cancer.

Treatment method:

Members of the treatment group were needled bilaterally at the Hua Tuo jia ji (or paravertebral) points at the level of T10. In addition, from T1 down to T9, needles were placed in either right or left paravertebral points, alternating vertebrae by vertebra, beginning with T1 on the left side. These needles were stimulated with twisting and turning supplementation hand technique. Every other treatment, the needles were switched sides from T1 to T9. In addition, Ba Liao (Bl  31-34), Huan Tiao (Bl 30), Cheng Fu (Bl 36), Zhi Bian (Bl 54), Zu San Li (St 36), Yin Ling Quan (Sp 9), and Yang Ling Quan (GB 34) were also needled with twisting and turning supplementing technique. Then, a one inch section of moxa roll was attached to the handles of the needles and lit. This was done once every other day, with the needles being retained for 30 minutes each time. Fifteen treatments equaled one course, and three successive courses were administered. The members of the comparison group only received acupuncture at the same points but without warm needle moxibustion. They were needled at the same frequency and for the same length of time.

Study outcomes:

Treatment outcomes were based on a point system rating the amount of lumbosacral pain and range of motion in the spine. Using this system, three points equaled a cure, two points equaled improvement, and one point equaled no effect. Based on these criteria, in the treatment group of 33, there were four cures, 32 improvements, and six no effect, for a total effectiveness rate of 82%. In the comparison group of 21, there were no cures, 11 improvements, and 10 no effect, for a total effectiveness rate of 52.5%. Therefore, warm needle moxibustion appeared to be significantly more effective for reducing the symptoms of AS than simple needling alone.

In addition, measurements of stiffness in the spine were markedly more decreased in the treatment group than in the comparison group from before to after treatment, while expansion of the chest was more, and flexibility of the lumbar region was markedly more. Mean ESR was more than cut in half in the treatment group but only reduced by 30% in the comparison group. Similarly, mean C-reactive protein was almost a quarter of what it had been in the treatment group but was only 75% of what it had been in the comparison group. And finally, positive HLA-B₂₇, a marker for AS, went from 27 cases to 16 cases in the treatment group but only from 17 cases to 14 cases in the comparison group.

Discussion:

According to Drs. Hou and Liu, AS is categorized as painful impediment and bone impediment in Chinese medicine. It is believed to be due to the attack and entry into the spine of cold qi in turn due to the yang qi failing to open and seal correctly. Therefore, they believe that the treatment principles should be to warm the channels and free the flow of the network vessels, scatter, cold, dispel dampness, and disinhibit the joints. Based on their long clinical experience with this condition, they believe that warm needle moxibustion at the Hua Tuo jia ji and other points gets a good effect on it. In particular, the Hua Tuo jia jia, Ba Liao, Huan Tiao, and other bladder channel points down to Wei Zhong (Bl 40) free the flow of the channels and network vessels and stop pain. These are then assisted by Yin Ling Quan and Zu San Li which dispel dampness and disinhibit the joints. Warm needle moxibustion increases and strengthens the warm flow-freeing effect. Having used this technique over a period of five years, Drs. Hou and Liu believe it achieves satisfactory clinical effects in improving AS patients’ conditions.

Copyright © Blue Poppy Press, 2005. All rights reserved.