| BackgroundPruritus is a common symptom of many skin diseases and systemic diseases,a feeling which can cause scratching as well as a multi-dimensional response of the body to harmful stimuli.High morbidity of pruritus can significantly impact patients 'quality of life.More seriously,it can even lead to suicidal tendencies.As an unbearable symptom,pruritus trouble people's lives for long.Traditional Chinese medicine believes that pruritus is the "itch" category.Pathogenic wind,dampness,heat,insect and virus invade human body surface,coupled with inborn intolerance,cause disharmony between qi and blood,which induce itching.Currently treatment for pruritus focus on sedation and antipruritic treatment,also combine systemic and local treatment.Characterized by syndrome differentiation,treating the same disease with different methods and treating different diseases with the same method,traditional Chinese medicine provides new ideas for the treatment of pruritus.Due to the complex cause of pruritus,the illness relapses easily and it's difficult to achieve the ideally therapeutic effect.New treatments continue to be a hot spot in the future research.As one of the treasures of traditional Chinese medicine,acupuncture and moxibustion has a broad prospect and great practical significance.As a non-medicine therapy,fire-needle therapy combined with dialectical acupuncture has an excellent curative effect of chronic pruritus skin diseases.Fire-needle has a function of dispelling cold and removing dampness,promoting the circulation of qi and eliminating toxin,warming channel and activating blood circulation.We found that fire-needle can be used for the treatment of skin diseases through clinical practice.The thermal effect of fire-needle can improve microcirculation of the skin lesion area and speed up absorption of inflammation and metabolic products.While fire-needle concentrate on local features,syndrome differentiation acupuncture attach importance to the overall status of the disease,seeking cause according to the different syndromes respectively,dispelling wind and cold,clearing heat and cooling blood,nourishing yin and moistening dryness,removing dampness and eliminating toxin,nourishing blood and disperse the depressed liver.Combination of both fire-needle and syndrome differentiation acupuncture can treat both principal and secondary aspects of pruritus disease.Fire-needle therapy combined with syndrome differentiation acupuncture can be used for the treatment of chronic pruritus skin diseases,with certain basic theory and clinical practice evidence.However,the effect and the time point of fire-needle therapy with acupuncture intervention for chronic pruritus skin diseases need further verification of evidence-based medicine methods.This research adopted a prospective case series and took fire-needle therapy combined with syndrome differentiation acupuncture as intervention measures,to verify the effectiveness of the treatment on improving the symptoms and physical signs,life quality,and anxiety and the depression state of chronic pruritus skin disease patient,explore the best effective intervention course,evaluate the security of the treatment,and to provide an evidence and new thought for the clinical practice of the disease.ObjectiveTrough observing the symptom and physical sign effect on chronic pruritus skin disease patient by the intervention of fire-needle therapy combined with syndrome differentiation acupuncture therapy and comparing the curative effect on different kind of pruritus patients,as well as the infrared thermal imaging,laser speckle imaging,physical and chemical index effect,the effect on life quality,and anxiety and the depression state by the intervention,the study meaned to provide trial reference for clinical application and generalization as well as clinical evidence for further mechanism research of fire-needle therapy combined with syndrome differentiation acupuncture therapy.MethodThis study selected all 81 patients from Acupuncture and MoxibustionHospital,CACMS,from March 2015 to March 2017,based on inclusive and exclusivecriteria.Fire needling therapy and body acupuncture were adopted in combination.The acupoint prescription was composed of the main points and the supplementary points.The main points were from the local skin lesions and stimulated with fire needling of shallow puncture.For the supplementary points it was based on syndrome differentiation.The treatment was given twice a week and totally 16 treatments(8 weeks).Integral grading method,Visual Analogue Scale,infrared thermal imaging,laser speckle imaging,physical and chemical index(including EOS and IgE),Hamilton Anxiety Scale,Hamilton Depression Scale,Dermatology Life Quality Index were taken as therapeutic effect index.We recorded the score before treatment,after treatment,after treatment in 1 month follow-up respectively and analyzed the score,evaluating the efficacy.Result(1)Compared with 0 week(before treatment),after 4th week(8 treatments)and 8th week(16 treatments),pruritus level of patients was markedly reduced,and efficacy after 8-week treatment was obviously better than those after 4-week treatment,and effect after 12th week(follow-up visit)remained unchanged.The total score trend of eczema,neurodermatitis,atopic dermatitis and urticaria patients after treatment were roughly the same.(2)Fire-needle therapy combined with syndrome differentiation acupuncture had prominent curative effect on four different types of pruritus skin diseases,but the time points varied.Eczema patients were not sensitive to the treatments,the alleviation was a little after every treatment.But there existed a delay effect,pruritus level of patients had a obviously reduce compared to last treatment.Neurodermatitis patients felt highly sensitive to the treatments and the alleviation was obvious.But compared to last treatment,it showed a slow declined trend.For atopic dermatitis patients,they showed an obvious alleviation after treatment at the beginning,but turned to relapse state from 5th treatment on.They displayed a high or low sensitivity,but showed a downward trend generally.For urticaria patients,they had high sensitivity to the treatments and long-lasting effect.The pruritus level of patients were relieved obviously in the first 3 treatments.After that,the pruritus level was not high,but still declined after treatment.(3)Infrared thermal imaging value and laser speckle imaging value of local skin lesions were significantly higher than that of healthy skin.After treatments,with the gradual recovery of the lesions,the value was decreasing and high value area of the infrared thermal imaging were diminishing.The trend of laser speckle imaging was almost the same as that of infrared thermal imaging.(4)Twenty four cases of chronic pruritus skin disease had a detection of eosinophile granulocyte(EOS)counting and serum total IgE before and after treatment.From the observation on EOS,all tested value of the patients were in normal range(normal value for 0.02-0.5x109/L)before and after treatment.From the observation on IgE,the value of 9 cases(including 4 cases of eczema,1 case of neurodermatitis,2 cases of atopic dermatitis,2 cases of urticaria)were higher than normal(normal for<100IU/ml),while 15 cases were in the normal range.As pruritus symptom relieved after treatment,IgE levels did not have much changes.(5)After treatments,HAMA and HAMD score of pruritus patients were significantly decreased compared to before treatment.Before treatment,there were 28 patients(34.57%)in slight anxiety condition,27 patients(33.33%)in medium anxiety condition,13 patients(16.05%)in severe anxiety condition and 1 patient(1.23%)in extremely severe anxiety condition,only 12 patients(14.82%)in no anxiety condition.After treatments,the anxiety state of all patients were improved.There were 40 patients(49.38%)in no anxiety condition,26 patients(32.2%)in slight anxiety condition,14 patients(17.28%)in medium anxiety condition,only 1 patient(1.2%)in severe anxiety condition and no patient in extremely severe anxiety condition.Before treatment,there were 21 patients(25.93%)in slight depression condition,18 patients(22.22%)in medium depression condition,2 patients(2.47%)in severe depression condition,only 40 patients(49.38%)in no depression condition.After treatments,the depression state of all patients were improved.There were 55 patients(67.9%)in no depression condition,16 patients(19.75%)in slight depression condition,10 patients(12.35%)in medium depression condition,and no parient in severe depression condition.After treatment,the population of anxiety-free was more than that before treatment,and medium,severe and very severe anxiety population declined,which indicated after treatment the relieving pruritus can ease the overall situation of anxiety.The population of depression-free was more than that before treatment,and medium and severe depression population declined,which indicated after treatment the relieving pruritus can ease the overall situation of depression.(6)Before treatment,81 cases of chronic pruritus skin disease patient took a dermatology life quality scale(DLQI)scoring an average of 18.41 ± 3.24 points.The items from high to low points were prutitus or pain,skin care,dressing,working,embarrassing or inferiority,exercise,sexual life,shopping or doing housework,social entertainment,relationships with family and friends in sequence.DLQI score decreased significantly after treatment to 8.94 ± 4.52 points on average.It indicated that fire-needle therapy combined with syndrome differentiation acupuncture may improve pruritus patients'life quality by addressing their pruritus problems.(7)After 8 weeks(16 treatments),in 81 cases of chronic pruritus skin disease patient,42 cases(51.85%)were cured,24 cases(29.63%)were remarkably effective and 15 cases(18.52%)were effective.Overall response rate was 100%.After 12 weeks(follow-up visit),44 cases(54.32%)were cured,21 cases(25.93%)were remarkably effective and 16 cases(17.95%)were effective.Overall response rate was still 100%.(8)In 81 patients treated with fire-needle therapy,42 patients(52%)considered fire-needle therapy very comfortable and were willing to accept it;22 patients(27%)thought fire-needle therapy was neither painful nor itching;15 patients(19%)thought fire-needle therapy was painful but acceptable;only 2 patients(2%)considered fire-needle therapy is hard to accept.There were no acupuncture fainting,broken needles,hematoma or infection situation in all 81 patients in or after treatments,or in the follow-up visit.Except for 1 patient who had long scar fading time due to personal physical constitution,no more adverse reactions or side effects were found in fire-needle therapy combined with syndrome differentiation acupuncture.Conclusion(1)Fire-needle combined with syndrome differentiation acupuncture can effectively improve pruritus level,pruritus area and the pruritus frequency of chronic pruritus skin disease patients.The best effective intervention course of the treatment was 8 weeks.(2)Fire-needle therapy combined with syndrome differentiation acupuncture had prominent curative effect on four different types of pruritus skin diseases,including eczema,neurodermatitis,atopic dermatitis and urticaria,but the time points varied.(3)Fire-needle therapy combined with syndrome differentiation acupuncture can regulate infrared thermal imaging value and laser speckle imaging value of local skin lesions.The intervention can obviously improve the life quality,anxiety and depression situation of chronic pruritus skin disease patients.(4)The physical and chemical index(including EOS and IgE)did not have much changes after treatments.(5)Fire-needle combined with syndrome differentiation acupuncture is a minimally invasive therapy,but as long as being manipulated and cared properly,the treatment is safe. |
PDF Full Text Request