| OBJECTIVE::Based on the literature and clinical research of moxibustion deqi,this study aims to develop a moxibustion deqi scale and explore the quantitative relationship between moxibustion deqi and clinical efficacy,the best excitation parameters for moxibustion deqi,and the neural synaptic plasticity mechanism of the phenomenon.It provides a scientific basis for the quantification and objectivity of clinical evaluation on moxibustion,optimization and precision of clinical treatment programs,and lays a scientific foundation for further revealing the central mechanism of moxibustion deqi.METHODS:1.Development of Moxibustion Deqi ScaleFirstly,Delphi method was used to screen the items of moxibustion deqi,which were then screened by experts,patient questionnaires,and core group discussions,forming a preliminary scale.After testing the structural validity of the scale by exploratory factor analysis,the moxibustion deqi scale was finally formed.2.The quantitative relationship between moxibustion deqi and clinical efficacyPatients with primary dysmenorrhea and knee osteoarthritis were respectively divided into experimental group(moxibustion until desensitization),control group a(15min of moxibustion),and control group b(continued moxibustion for 20 minutes after desensitization)to compare the relationship between the duration of deqi and curative effect of moxibustion;The case were divided into strong group,medium group and weak group according to the different intensity of moxibustion deqi to compare the relationship between the intensity of deqi and curative effect of moxibustion.3.The better excitation parameters for moxibustion deqiPatients with cervical spondylosis of nerve root type,lumbar disc herniation,and knee osteoarthritis as research objects were naturally divided into the deqi group and non-deqi group according to whether the phenomenon of moxibustion deqi occurred in acupoints to compare the difference in thermal sensation threshold,thermal pain threshold and threshold of thermal pain tolerance by temperature-sensing analysis technology.On the basis of the above research,the GB21(Jianjing),BL 26(Guanyuanyushu)and EX-LE 4(Neixiyan)of deqi group were given moxibusiton respectively at 40℃ and 42℃ to excite deqi.It aimed to explore the better excitation parameters.RESULTS:1."Moxibustion Deqi Scale V 1.0" was formed after the screening of moxibustion deqi items and pre-survey,which was divided into three parts.Part A included three items which were heat penetrating,heat transmitting and non-heat sensation,and each score was obtained by the product of the spatial position and the intensity of deqi.The spatial position and intensity were divided into 4 levels,which were scored with(0),(1),(2),and(3)respectively.Part B was heat expanding.The score was also obtained by the product of the spatial position and the intensity of deqi.The spatial position and the intensity were divided into 4 levels,scored with(0),(1),(2),and(3)respectively.Part C included a preferring to warm,whole body warm,facial flushing(or sweating on the forehead),acro-heat,gastrointestinal motility and diffusible flushing on the skin.The intensity of deqi is divided into 4 levels,scored with(0),(1),(2),and(3).The Moxibustion Deqi Scale was scored in the order of A,B,and C.If the item of heat transmitting in A scored 0,it would start to score in B.If the term did not score 0,it would go directly to C.The sum of scores in A,B and C was the total score of the Moxibustion Deqi Scale.2.Quantitative relationship between moxibustion deqi and clinical efficacy2.1 Quantitative relationship between moxibustion time and clinical efficacy2.1.1 Comparison in symptom scores of primary dysmenorrheal patients with different amount of moxibustionThere was no significant difference in the symptom scores among the experimental group,control group a and control group b before treatment and the scores were comparable(P>0.05).At the end of the first course of treatment,the scores in three groups had significant differences compared with those before treatment(P<0.01);The experimental group had a significant difference compared with control group a(P<0.05),and has no statistical difference compared with control group b(P>0.05);There was a significant difference between the control group a and control group b(P<0.05).At the end of the second course of treatment,the scores in three groups had significant differences compared with those before treatment(P<0.01);The experimental group had a significant difference compared with control group a(P<0.01),and had no statistical difference compared with control group b(P>0.05);There was a significant difference between control group a and control group b(P<0.01).The results indicated that the treatment in which moxibustion was administered until desensitization was superior to traditional moxibustion in improving symptom scores of primary dysmenorrhea,the effect of exceeded moxibustion for 20 minutes after desensitization was not significantly different from the amount of desensitization.2.1.2 Comparison in McGill dysmenorrhea questionnaire scores of primary dysmenorrheal patients with different amount of moxibustionThe scores of McGill dysmenorrhea questionnaire in the three groups before treatment were not significantly different and were comparable(P>0.05).At the end of the first course of treatment,the scores in three groups had quite significant differences compared with those before treatment(P<0.01);The experimental group had a significant difference compared with control group a(P<0.05),and no statistical difference compared with control group b(P>0.05);There was a significant difference between control groupa and control b group(P<0.05).At the end of the second course of treatment,the scores in three groups had quite significant differences compared with those before treatment(P<0.01);The experimental group had a significant difference compared with control group a(p<0.05),and no statistical difference compared with control groupb(P>0.05);there was a significant difference between control group a and control group b(P<0.05).The results indicated that the treatment in which moxibustion was administered until desensitization was superior to traditional moxibustion in improving the score of McGill dysmenorrhea questionnaire.Exceeded moxibustion after desensitization did not contribute much to the curative effect.2.1.3 Comparison in pain frequency and degree of primary dysmenorrheal patients with different amount of moxibustionThere was no significant difference in pain frequency and degree among three groups,and they were comparable(P>0.05).During the first course of treatment,three groups were quite significantly different from those before treatment(P<0.01)with a good shortterm outcome;The experimental group had a quite significant difference from control group a(P<0.01),and no statistical difference from control group b(P>0.05)There was a significant difference between the control group a and control groupb(P<0.01).At the end of the second course of treatment,three groups were quite significantly different from those before treatment(P<0.01)with a good shortterm outcome;The experimental group had a significant difference from control group a(P<0.01),and no statistical difference from control group b(P>0.05);There was a significant difference between the control group a and control group b(P<0.01).It shows the treatment in which moxibustion was administered until desensitization was superior to traditional moxibustion in efficacy and long-term efficacy.Exceeded moxibustion after desensitization did not contribute much to the curative effect.2.1.4 Comparison in GPCRND-KOA scores of KOA patients with different amount of moxibustionThe score was 11.12±3.10 in experimental group,10.20±3.01 in control group a and 10.93 ± 3.07 in control group b before treatment.And they were 5.51±1.91,8.42±2.10 and 5.24±2.60 respectively after treatment.The experimental group had a significant difference from control group a(P<0.01)and no statistical difference from control group b(P>0.05);There was a significant difference between control group a and control b group(P<0.01).The score was 3.63±1.39 in the experimental group,5.36±1.42 in control group a,and 3.42±1.73 in control group b in the follow-up after 6 months.The experimental group had a significant difference from control group a(P<0.01),and no statistical difference from control group b(P>0.05);There was a significant difference between control group a and control groupb(P<0.01).The results suggested that an individualized amount of moxibustion administered until desensitization is better than the fixed amount in traditional moxibustion in treating knee osteoarthritis(swelling type).Exceeded moxibustion after desensitization did not contribute much to the curative effect.2.1.5 Comparison in knee joint circumferences of KOA patients with different amount of moxibustionThe knee joint circumferences was 39.02 ± 3.51 cm in experimental group,39.32 ± 2.53 cm incontrol group a,and 39.15 ± 2.71 cm in control group b before treatment.After the treatment,they were respectively 35.21±3.43,38.02±2.79 and 36.02±3.63 cm.The experimental group had a significant difference from control group a(p<0.05)and no significant difference from control b group(p>0.05);There was a significant difference between control group a and control group b(p<0.05).the circumference was 34.81±3.67 cm,37.92±2.71 and 35.98±2.15 cm respectively in the follow-up after 6 months.The experimental group had a significant difference from control groupa(P<0.05),and no significant difference from control b group(p>0.05);there was a significant difference between control group a and control group b(P<0.05).The results suggested that an individualized amount of moxibustion administered until desensitization is better than the fixed amount in traditional moxibustion in improving the osteoarthritis swelling of the knee joint,and exceeded moxibustion after desensitization did not contribute much to the curative effect.2.2 The quantitative relationship between the intensity of moxibustion deqi and clinical curative effect2.2.1 Comparison in symptom scores of patients with primary dysmenorrhea with different intensity of moxibustion deqiThere was no significant difference in symptom scores in strong deqi group(A),medium deqi group(B)and weak deqi group(C)before treatment(P>0.05);The symptom scores in three groups after treatment were significantly different from those before treatment(P<0.01);Group A was quite significantly different from Group B and Group C(P<0.01)There were significant differences between Group B and Group C(P<0.01).It showed that Moxibustion had a good effect in relieving the symptoms of dysmenorrheal as long as the deqi exists.The stronger deqi was,the better the treatment effect was achieved.2.2.2 Comparison in McGill dysmenorrhea questionnaire scores of primary dysmenorrheal patients with different intensity of moxibustion deqiThe scores of McGill dysmenorrhea questionnaire in strong deqi group(A),medium deqi group(B),and weak deqi group(C)had no significant difference and were comparable(P>0.05)before the treatment.After treatment,the symptom scores of the three groups were significantly different from those before treatment(P<0.01);Group A was quite significantly different from Group B and Group C(P<0.01);There was a quite significant difference between Group B and Group C(P<0.01).It suggested that moxibustion had good curative effect on dysmenorrhea symptoms as long as deqi exists,and the stronger deqi was,the better the treatment effect was achieved.2.2.3 Comparison in GPCRND-KOA scores of KOA patients with different intensity of moxibustion deqiThe scores of GPCRND-KOA in strong group(A),medium group(B)and weak group(C)had no significant difference and were comparable(P>0.05)before the treatment.After 10 days of treatment,the scores in Group A and Group B were significantly different from those before the treatment(P<0.01).Group C had no significant difference as before(P>0.05).There was no significant difference between group A and B(P>0.05).And there were significant differences between group A and C(P<0.01),and between group B and C(P<0.05).The results showed that the stronger deqi was,the better the moxibustion effect was achieved.2.2.4 Comparison in knee joint circumferences of KOA patients with different intensity of moxibustion deqiThere was no significant difference in knee circumference among strong group(A),medium group(B)and weak group(C)before treatment(P>0.05).After 10 days of treatment,the circumferences in three groups were significantly different from those before treatment(P<0.01);There were very significant differences between group A and C(P<0.01),and no significant difference between group A and B(P>0.05).Group B had no significant difference compared with group A and C respectively(P>0.05).The results showed that the stronger deqi was,the better the osteoarthritis swelling of the knee joint was improved.3.Excitation temperature parameters of moxibustion deqi3.1 Distribution of Deqi group and non-Deqi group at different acupoints180 cases were included in this study,which were cervical spondylosis of nerve root type patients,lumbar disc herniation patients,and knee osteoarthritis patients.There were a total of 540 acpoints,with 304(56%)in the deqi group and 236(44%)in the non-deqi group.3.2 Comparison in thermal sensation threshold between the two groupsThe thermal sensation thresholds in deqi group were 37.86±1.10 on DU 14(Dazhui),37.44 1.15 on GB21(Jianjing),38.19 1.16 on LI 15(Jianyu),37.77 0.75 on DU 3(Yaoyangguan),37.54 0.83 on DU 3(Yaoshu),36.91 1.14 on BL 26(Guanyuanshu),38.13.±2.13 on SP 10(Xuehai),37.54 1.83 on EX-LE 4(Neixiyan),37.76 1.23 on SP 9(Yinlingquan)respectivelyThey were 36.20±1.43 on DU 14(Dazhui),36.12±1.24 on GB21(Jianjing),37.10±2.05 on LI 15(Jianyu),36.52±0.79 on DU 3(Yaoyangguan),6.15±0.98 on DU 3(Yaoshu),35.89±1.53 on BL 26(Guanyuanshu),36.87±1.54 on SP 10(Xuehai),35.96±1.63 on EX-LE 4(Neixiyan),36.02±2.06 on SP 9(Yinlingquan)respectively in non-deqi group;Different acupoints had different thermal sensation thresholds,and they were higher in the Deqi group than in the non-Deqi group.There were significant differences between the two groups on LI 15(Jianyu)and SP 10(Xuehai)(P<0.05).And there were quite significant differences on the rest acupoints between the two groups(P<0.01).3.3 Comparison in thermal pain thresholds between the two groupsThe thermal pain thresholds in the Deqi group were 44.23±1.08 on DU 14(Dazhui),44.23 1.79 on GB21(Jianjing),44.45 1.51 on LI 15(Jianyu),44.36 1.74 on DU 3(Yaoyangguan),44.39 1.04 on DU 3(Yaoshu),44.56 1.83 on BL 26(Guanyuanshu),44.73±1.66 on SP 10(Xuehai),44.65 1.68 on EX-LE 4(Neixiyan),44.53 1.02 on SP 9(Yinlingquan)repectively;They were 42.56±1.13 on DU 14(Dazhui),42.05±1.54 on GB21(Jianjing),42.38±1.22 on LI 15(Jianyu),42.27±1.31 on DU 3(Yaoyangguan),43.03±1.79 on DU 3(Yaoshu),43.01±1.74 on BL 26(Guanyuanshu),42.87±2.07 on SP 10(Xuehai),42.92±1.90 on EX-LE 4(Neixiyan),42.69±1.39 on SP 9(Yinlingquan)respectively in non-deqi group.Different acupoints have different thermal pain thresholds,and they were higher in the Deqi group than the non-Deqi group.There were quite significant differences between the two groups(P<0.01).3.4 Comparison in thresholds of thermal pain tolerance between the two groupsThe thresholds of thermal pain tolerance in the deqi group were 47.87±1.63 on DU 14(Dazhui),48.36±0.93 GB21(Jianjing,48.34±0.99 on LI 15(Jianyu),48.56±1.62 on DU 3(Yaoyangguan),48.32±0.79 on DU 3(Yaoshu),48.31±0.68 BL 26(Guanyuanshu),48.19±0.74 on SP 10(Xuehai),47.47±0.56 on EX-LE 4(Neixiyan).47.26±0.29 on SP 9(Yinlingquan)respectively;They were 46.96±1.65 on DU 14(Dazhui),46.29±1.52 on GB21(Jianjing),46.05±0.78 on LI 15(Jianyu),46.87±0.89 on DU 3(Yaoyangguan),46.90±0.72 on DU 3(Yaoshu),46.34±0.89 on BL 26(Guanyuanshu),46.58±1.14 on SP 10(Xuehai),45.13±0.79 on EX-LE 4(Neixiyan),45.95±0.61 on SP 9(Yinlingquan)respectively in non-deqi group.Different acupoints have different thresholds of thermal pain tolerance,and they were higher in the Deqi group than the non-Deqi group.There were significant differences between the two groups on DU 14(Dazhui)(P<0.05),and quite significant differences on the rest acupoints(P<0.01).3.5 Comparison in the latent time,effective time,and intensity of deqi between the two groups with temperature controlThere were significant statistical differences in the latent time of moxibustion deqi(P<0.01)and in the effective time of moxibustion deqi(P<0.05)between the 42℃ excitation group and the 40℃ excitation group.The former one had a shorter latency period and the longer effective period.There was a significant difference in the intensity of moxibustion deqi when excited on EX-LE 4(Neixiyan)between the 42℃ group and the 40℃group(P<0.05),and no significant difference when excited on the other two acupoints(P>0.05).Conclusion:1.The Moxibustion Depression Scale includes 9 items which are heat penetrating,heat transmittingor heat expanding,non-heat sensation,a preferring to warm,whole body warm,facial flushing(or sweating on the forehead),acro-heat,gastrointestinal motility,and diffusible flushing on the skin.2.The duration of moxibustion deqi,not the time of moxibustion,is one of the key factors affecting the efficacy of moxibustion.Continued moxibustion does not contribute to clinical efficacy after the moxibustion deqi has subsided.An individualized amount of moxibustion based on the disappearance of deqi which means desensitization is better than the current fixed amount of moxibustion3.The intensity of moxibustion deqi,not the intensity of moxibustion,is one of the key factors affecting the efficacy of moxibustion.When applying moxibustion clinically,the intensity of moxibustion deqi should be used as the standard to select the moxibustion site.4.It is initially revealed that 42℃ is a better excitation temperature for moxibustion deqi than 40℃. |
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