Clinical Study On Skeletal Fluorosis Treated By Acupuncture From The View Of Spleen And Kidney

1. objectiveThis research adopted randomized controlled method based on clear diagnosis, unified curative effect indicators.The research aimed to evaluate the therapeutic effects on treating skeletal fluorosis by acupuncture with reinforcing the kidney and invigorating the spleen.2.Methods72 skeletal fluorosis patients from Qing Xian in HeBei Province(fluoride content in drinking watert is 2.67-7.28mg/L) meeting the inclusion criteria were divided into the treatment group and control group by stratified random method,36 patients each group. The treatment group received acupuncture therapy with treating principle of reinforcing the kidney and invigorating the spleen to promote urinary fluoride excretion and stop pain. The control group was treated by oral administration of calcium carbonate D3 tablets.2.1 Diagnostic criteriaWe set diagnostic criteria according to the national WS192-2008 standard.2.2 Criterion for therapeutic evaluationClincial criterion for therapeutic evaluation include visual analogue scale,urinary fluoride, serum calcium, serum phosphorus, range of motion, Self-Care Ability, TCM syndrome etc.Criterion for safty evaluation include the normal blood pressure, heart rate, respiratory rate.2.3Treatment protocols Treatment group: Filiform needle and electroacupucnture were applied. Acupoints:fixed acupoints and local acupoints. Fixed acupionts:Pishu (BL20), Shenshu (BL23), Guanyuan (RN4), Qihai (RN6),Zusanli (ST36), Shousanli (LI10), Taixi (KB).Local acupoints:Jianyu (LI15), Chize (LU5), Yangchi (SJ4), Tianzhu (BL10), Yaoyangguan (DU3), HuanTiao (GB30) or Juliao (GB29), Dubi (ST35), Jiexi (ST41)) And as the same time, Ashi point in local part was coordinated with others.Acupuncture manipulation:Fixed acupoints use reinforcing method by lifting and thrusting, swirling and rotating acupuncture manipulation.The local acupoints use reducing method by lifting and thrusting, swirling and rotating acupuncture manipulation.Eletroacupuncture was applied on three pairs of acupoints every time.For points without application of eletroacupuncture needle was manipulated one time every 15 min.Acupuncture therapy was employed every other day, with 30 minutes for each time, and 3 times a week.The course of treatment was 2 month.Control group:Oral administration of calcium carbonate D3 tablets (600mg/pill,60 pill/bottle, TianJing Wyeth)The oral intake method:600mg each time, twice each day.The course of treatment was 2 month.2.4 Data process and Statistical analysisEpiData3.1 and SPSS were adpoted for managing and analyzing data.3. Result3.1 Urinary FluorideIntra-group:Urine fluorine of treatment group after treatment was higher than that before treatment, which had a significant statistical difference(P<0.05) between before and after treatment.Inter-group:after treatment Urine fluorine of treatment group is higher than that of control group(P<0.01),this result demonstrated that the urinary Fluoride Excretion of acupuncture group was higher than that of control group.3.2 visual analogue scale Intra-group:VAS was significantly lower than that of before treatment in both group P<0.01. Two groups both had benign function to alleviate pain. The mean value of VAS before treatment in treatment group was 5.93±1.64. The mean value of VAS after treatment was l.93±1.30.The result demonstrated that acupuncture had a remarkable effect to alliviate pain. The mean value of VAS after treatment in control group waslower than that before treatment.which showed that Oral administration of calcium carbonate also had a remarkable effect to soothe pain.Inter-group:Therapeutic index of VAS treatment group was higher than that of control group after treatment.3.3The calcium-phosphorus product in bloodThe calcium-phosphorus product in blood significantly decreased in both treatment group and control group after treatment(P<0.05), but the differences between the two groups is not statistically significant after treatment(p>0.05). The result demonstrated that both acupuncture therapy and Oral administration of calcium carbonate D3 therapy can adjust metabolic disorders between calcium and phosphorus.3.4 range of articular motionIntra-group:Range of articular motion was significantly higher than that of before treatment in both treatment and control group. Two groups both had benign function to improve range of articular motion of patient with endemic fluorosis.Inter-group:Range of articular motion of treatment group was higher than that of control group after treatment(P<0.01). It indicated that the therapeutic effect on improving range of articular motion in acupucnture group was remarkably suprior to that of control group.3.5 Self-Care AbilityIntra-group:The mean value of Self-Care Ability was significantly lower than that of before treatment in both treatment and control group (P<0.01). Two groups both had benign function to improve Self-Care Ability of patient with endemic fluorosis.Inter-group:There was no statistically significant difference between two groups after treatment (P>0.05). It indicated that the therapeutic effect on improving Self-Care Ability in acupucnture group was not suprior to that of control group. 3.6 length of morning stiffnessIntra-group:length of morning stiffness was significantly lower than that of before treatment in both treatment and control group. Two groups both had benign function to reduce length of morning stiffness of patient with endemic fluorosis. The mean value of length of morning stiffness before treatment in treatment group was 1.87±1.93. The mean value of VAS after treatment was0.93±1.14 (P<0.01). which demonstrated that acupuncture therapy had a remarkable effect to reduce length of morning stiffness of patient with endemic fluorosis.Inter-group:There was no statistically significant differencebetween two groups after treatment (P>0.05). 3.7Convulsion, numbness, stiffnessIntra-group:Convulsion, stiffness and numbness could be improved in the treatment group.(P<0.05).Inter-group:There was no statistically significant difference in numbness, stiffness between two groups (P>0.05).3.8 Syndromes of TCMIntra-group:Syndromes of TCM score was significantly lower than that of before treatment in both treatment and control group (P<0.01) That demonstrated the deficiency of spleen and kidney could be improved in both treatment group and control group.Inter-group:Syndromes of TCM score of treatment group was lower than that of control group after treatment(P<0.01).The therapeutic effect in treatment group was suprior to that of control group.4 conclusions(1) The deficiency of spleen and kidney is the basic pathogenesis of endemic fluorosis, Acupuncture guided by reinforcing the kidney and invigorating the spleen.is effective method for endemic fluorosis intervention. (2) Acupuncture guided by reinforcing the kidney and invigorating the spleen can promote urinary fluorine excretion of patient with endemic fluorosis.(3) Acupuncture guided by reinforcing the kidney and invigorating the spleen can alleviate pain and reduce VAS of patient with endemic fluorosis.(4) Acupuncture guided by reinforcing the kidney and invigorating the spleen can improve range of articular motion.(5) Acupuncture guided by reinforcing the kidney and invigorating the spleen can decrease calcium-phosphorus product in blood and adjust metabolic disorders between calcium and phosphorus of patient with endemic fluorosis..(6) Acupuncture guided by reinforcing the kidney and invigorating the spleen can reduce length of morning stiffness of patient with endemic fluorosis.(7) Acupuncture guided by reinforcing the kidney and invigorating the spleen has a obvious therapeutic effect on eliminating convulsion, numbness, stiffness and improve self-care ability.