The Summarize Of The Thought Of Fire Needle Treating Bi Syndrome And Clinical Experience Of Prof. Wu Zhongchao And Clinical Research On Knee Osteoarthritis Treated By Fire Needle With Yangci(Quintuple Puncture) Method

The first part The summarize of the thought of fire needle treating Bi Syndrome and clinical experience of Prof. Wu ZhongchaoDr. Wu Zhongchao has been engaged in clinical work, scientific research and teaching of acupuncture and moxibustion for 30 years. He has profound theory basis, clinical experiences, and academic achievements. He has passed on the essence of traditional Chinese medicine and traditional features of acupuncture and moxibustion, and developed them creatively, moreover, he explored the innovation of scientific research. His research directions includes pain, health care and rehabilitation, senile diseases and disease prevention etc. with excellent therapeutic effects.Dr.Wu emphasized the therapeutic clinic effect with diversity of clinical methods, and especially combination of acupuncture with Chinese herbal medicine to treat common diseases. This study included the treatise read. cases analysis, theory study. clinical teaching. technique demonstration. deep interview, so that it organized his academic inheritance system for one hand, and for the other hand. it analyzed his experiences mainly on pain and osteoarthrosis. by extracting his needling method. point formulas. and summarizing fire needle applications on Bi syndrome. And on this basis, it explored and concluded his academic thoughts and experiences on treating pain, then probed his regulation of treatment.The academic feature of Dr. Wu for treating pain laid on:searching for the pathogen and the root, syndrome differentiation for individuals with flexible methods. The general pathogenesis of pain summarized by Dr. Wu as "the upper pain was mainly due to wind, while the middle part due to qi disorder and fire, and the lower part due to dampness". Dr. Wu generalized six methods for treating pain:warming, dredging, circulating, regulating, eliminating and nourishing. Combined by different methods, the therapeutic effect was significant.For treating Bi syndrome, Dr. Wu varied his diagnosis and treatments according to different individual, diseases as well as syndromes. Primary treating features were: warming so as to circulate, dispersing so as to resolve stagnation, regulating meridians so as to treat the whole; the change was the principle and the differentiation brought the effect. From the point to line, from the line to surface, from three-dimensional meridian structure to regulate the whole body. The syndrome differentiation was mainly based on meridian differentiation and Zang fu differentiation came the second. Bi syndrome treating by fire needle was concluded by "five following methods": following the disease, nodules (tendon nodule or nodes), points(reaction points), meridians, syndrome differentiation. It was applied as single use or combination. In points selection of his experiences, Dr. Wu put forward the back shu functional belt(occiput and neck functional belt). the broad application of two belts worked for neck, shoulder, waist, leg pain, rheumatism and rheumatoid arthritis, ankylosing spondylosis etc. osteoarthrosis. Moreover, point groups for treating Bi syndrome included:strengthening the body resistance, eliminating wind, dredging meridians, point groups for shoulder and knee pain. and tranquilization. They were selected flexibly to diseases and parts. In manipulation of fire needle, Dr. Wu focused the details, which included:needle selection, needle warming, manipulation with "red, steady, accurate, light, quick and flexible" at the core; he also focused on flexible usage of needling method, based on record in Lingshu·Guanzhen. various needling methods applied for treatment of five bi syndrome. for example:Mao ci(skin puncture). Ban ci(shallow puncture. Zhizhen ci(perpendicular puncture) applied for skin bi syndrome:Hegu ci(Multi-direction needling). Fen ci(intermuscular needling), Fu ci(superficial needling) treated muscular bi syndrome; Hui ci(lateral puncture), Guan ci(joint puncture), Ju ci(opposing puncture) cured tendon bi syndrome; Shu ci(deep puncture with needles straight in and out) and Duan ci(deep puncture with lifting and thrusting method) treated bone bi syndrome; Baowen ci(Leopard-spot needling), Luo ci(collateral-pricking needling), Zan ci(repeated shallow needling) cured vessel bi syndrome. Dr. Wu also made innovation for fire needling, five ci ’’surround needling, retention needling, moxibustion needling, electric needling. injection needling". Among them, retention needling was different with other methods, the manipulation of which was retention for 5～10 minutes after fire needle punctured into the skin in order to strengthen effect of eliminating the cold. The manipulation of moxibustion needling was that after retention of fire needle, moxibustion was applied onto the needle to expel cold pathogenic factor. The manipulation of electric needling was that after retention of fire needle, electricity was applied onto the needle, which was suitable to patients with severe pain. The manipulation of innovative injection needling was that the 5ml injector was burnt into red, after insertion into certain depth, the medicine was injected into points. The depth was accordance with location of points. The medicine chosen was according to diseases. The pain with qi stagnation and blood stasis suited safflor injection or compound angelica chinensis injection; pain with local muscle atrophy was suitable to Mecobalamin injection or Adenosine cobalt amine injection. In treating the stubborn diseases, Dr. Wu proposed that diseases without certain pathogens, treatment without definite symptoms, formula without assured herbs, acupuncture and moxibustion without fixed methods. The best way was always treating by differentiation according to individual person, disease, syndrome and time.To sum up, Dr. Wu not only inherited the theory from ancient classic books, but also made a connecting link between the preceding and the following. His divergent thinking combined the classics with experiences, focused on scientific research with innovation, more than just clinics, emphasized the research-driven clinical development, and it was just the root for acupuncture development.The second part Clinical research on knee osteoarthritis treated by fire needle with Yangci(quintuple puncture) methodObjectiveTo observe fire needle with Yangci(quintuple puncture) method compared with regular needling method for improvement of knee pain, knee function, as well as life quality. To evaluate the therapeutic effect of fire needle with Yanci(quintuple puncture) method. To consolidate the effect and safety of fire needling on Bi syndrome from experiences of Dr. Wu Zhongchao.1. Research method1.Source of case72 cases of patients enrolled in the research came from clinic of Acupuncture and Moxibustion Hospital, China Academy of Chinese Medical Sciences, and the consultation dated back from March 2014 to September 2015.2. Design methodAfter enrollment of 72 patients in accordance with inclusive criteria, centra randomization method was applied in the trial. And the two groups were Yangci (quintuple puncture) method of fire needle group and filiform needle group respectively.3.Treatment methods(1)Treatment groupPoints selection:Xuehai(SP10),Liangqiu(ST34),xiyan(EX-LE4),Dubi(ST35), Zusanli(ST36),Yanglingquan(GB34),Yinlingquan(SP9) and Ashi point.Needling instruments:Φ0.40×25mm,Φ0.40×40mm fire needle; suction cups; cupping device of Kangzhu brandNeedling method:Yangci(quintuple puncture) method of fire needling based on fire needling method applied by Prof.Wu Zhongchao and essential procedures of Yangci (quintuple puncture) operation. Patients took supine position. After routine disinfection on Ashi point, the pinpoint and body of fire needle were burned to red with white by means of an alchol bar, and then it was quickly thrust into the acupoint with 20～30mm in depth. After that, oblique needling was taken 1～1.5 cun away from Ashi point in four directions with 20-30mm in depth. After retention for 3～ 5min, the needles withdrew and cupping method was then applied on those points. suction cups were quickly applied on local parts where yangci (quintuple puncture) method was operated.3～5min after retention, needle holes were disinfected by iodophor. If Ashi point located around the knee joint where the muscle were really thin, we would like to use lcun fire needle and insertion with 10～20mm in depth.Other method was the same.Two of other points were selected each time, and the operation was the same as Yanci and cupping.When choose the point xiyan(EX-LE4) or Dubi(ST35), only use lcun fire needle to pricking on the points without yangci (quintuple puncture) or retention.Treatment course:3 times every week.,6 times as a course,2 courses in total. (2)Control groupAcupoints selection and location were the same as in treatment group.Needling instruments:0.30×25～40mm disposable acupuncture needle of Huatuo Brand; Cupping device was the same as in treatment group.Needling method:Patients took supine position. After routine disinfection on all acupoints. regular needling method was taken, and after getting qi sensation, needles retained for 30min. Even method was used and after needles withdraw, cupping on local parts was applied with the method the same as in treatment group.Treatment course was the same like Treatment group.Diagnostic criteriaThe study used diagnostic criteria of American College of Rheumatology (ARA) 1995. recommended by diagnostic and treatment guideline for osteoarthritis (Draft) drawn up by Chinese Rheumatology Association of Chinese Medical Association. Disease grades was assessed according to Kellgren-Lawrence (K-L) and disease severity was evaluated according to Lequesne instituted ISOA. TCM diagnosis and syndrome differentiation referred to diagnosis and classification criterion of ’Gu bi’ in Criteria of diagnosis and therapeutic effect of diseases and syndromes in traditional Chinese medicine released by State Administration of Traditional Chinese Medicine that released TCM industry standard in 2012. Therapeutic effect criteria adopted the Western Ontario and McMaster Universities (WOMAC) Osteoarthritis Index.Data processing and statistical analysisEpidata 3.1 was adopted to setup database. Special-assigned person checked and input data. CHISS software was used to do statistical analysis. Based on related statistical theory and characteristics of clinical data, comparability of baseline in the same block, and therapeutic effect were analyzed.In data analysis, ranked data used rank-sum test, measurement data firstly adopted normality test, and if it was conformed to the normal distribution, analysis of variance was used. Equal variance used T test, and if not, T’ test was adopted. For measurement data not conformed with normal distribution, normal transformation was in need; after transformation, data conformed with normal distribution used parametric test; data without normal distribution adopted rank-sum test.Results1.Comparisons of therapeutic effects at different time points within each groupIn aspect of VAS. WOMAC total score, degree of joint pain, degree of joint stiffness, disorder of joint function, degree of affected social function, degree of affected emotion scores, scores of each group after treatment at different time points improved compared with those before treatment with statistical differences(P<0.01).Negative rate of floating patella test in treatment group 1 month after treatment during follow-up period improved significantly than that of before treatment (P< 0.05), but at other time points, there were no significant differences (P>0.05); the negative rate in control group had no significant differences before treatment compared with those at different time points after treatment (P>0.05) 2.Comparisons of therapeutic effects between two groupsThere were significant statistical differences in VAS, integral of pain degree in WOMAC total score after treatment between two groups (P<0.05). It proved that at all time points after treatment, VAS, integral of pain degree in treatment groups improved significantly than those in control group.After treatment for 4 weeks and follow-up for 1 month, disorder of joint function, and WOMAC total score both improved significantly in treatment group than those in control group (P<0.05), it proved that at the two time points, the treatment group improved the joint function and general condition more than those in control group.There were no significant differences on degree of joint stiffness, degree of affected social function, degree of affected emotion scores between two groups (P> 0.05)3. Comparisons of comprehensive therapeutic effects between two groupsAfter treatment, the cure rate and obvious effect rate of treatment group was 63.89%, and control group 41.67%, with a significant statistical difference (P< 0.05)4. After treatment for 4 weeks in disorder of joint function, and after treatment for 2&4 weeks, in WOMAC total score both improved significantly in treatment group for the type of cold stagnated due to yang deficiency and type of blood stagnation than those in kidney deficiency type. (P<0.05)5. In aspect of safety evaluation. both groups had no abnormal changes in physical indexes and without adverse effect of needling.Conclusions1. Both yangci (quintuple puncture) of fire needle and filiform needle methods take satisfactory therapeutic effects; especially advantaging on analgesia.2. Yangci (quintuple puncture) of fire needle has better therapeutic effects on improvement of joint pain, joint function disturbance, total function of knee joint as well as prognosis compared with filiform needle method.3. Yangci (quintuple puncture) of fire needle has relatively higher cure rate and obvious effect rate compared with filiform needle method, with quicker effect, shorter course of treatment, and relatively lower sequelae ratio in short time.4. Yangci (quintuple puncture) of fire needle are effective for the type of cold stagnated due to yang deficiency and type of blood stagnation.5. Both of methods are safe and effective, and can be promoted into clinical application.