Comparative study on curative effect and recurrence rate of chronic scapulohumeral periarthritis treated with different acupuncture techniques. / ä¸åŒé’ˆæ³•æ²»ç–—æ ¢æ€§è‚©å ³èŠ‚å‘¨å›´ç‚Žçš„ç–—æ•ˆåŠå¤å‘çŽ‡çš„å¯¹æ¯”ç ”ç©¶.

OBJECTIVES: To observe the effects of the local stimulation with 3 acupuncture techniques, i.e. Canggui Tanxue (needle insertion method like dark tortoise detecting point) technique, electroacupuncture (EA) and warm needling (WN) with filiform needles on shoulder pain, shoulder joint function, quality of life, inflammatory indicators and recurrence rate in the patients with chronic scapulohumeral periarthritis (CSP), so as to explore the optimal needling method of acupuncture for the predominant symptoms of CSP during the attack stage in the patients. METHODS: A total of 108 patients with CSP were randomly divided into a manual acupuncture (MA) group (36 cases, one case dropped off), a WN group (36 cases, 3 cases dropped off) and an EA group (36 cases, 1 case dropped off). In the three groups, Jianqian (EX-UE12), Jianyu (LI15), Jianzhen (SI9), Ashi (Extra) and Yanglingquan (GB34) on the affected side were selected. Canggui Tanxue needling technique, WN technique and EA were delivered in the MA group, the WN group and the EA group, respectively, 30 min each time, 3 times weekly for 4 weeks. The Neer test scores were compared；the visual analogue scale (VAS) was used to assess the degree of shoulder joint pain；the daily life activity abilities was evaluated using the activities of daily living (ADL) scale；the serum prostaglandin E2 (PGE2) content was measured using ELISA before and after treatment. The effectiveness rate and recurrence rate were calculated, and the occurrences of adverse reactions were recorded. RESULTS: Compared with the scores before treatment, the scores of pain, joint function, and range of motion as well as the total score of Neer test were all increased after treatment in the three groups (P<0.05)；the VAS score, ADL score and the content of serum PGE2 were decreased (P<0.05). After treatment, the pain score of Neer test in the EA group and the WN group were higher than those of the MA group (P<0.05), the joint function score of Neer test in the MA group and the WN group were higher than that of the EA group (P<0.05), and the range of motion score of Neer test in the MA group was higher when compared with the EA and WN groups (P<0.05). There was no statistical difference in the total score of Neer score among the three groups. VAS score in the EA group was lower than that of either the WN group or the MA group (P<0.05). ADL score in the MA group was lower compared with that of the WN group (P<0.05). PGE2 levels in both the WN group and the MA group were lower than that of the EA group (P<0.05). The total effective rate was 85.71% (30/35) in the MA group, 91.43% (32/35) in the EA group and 90.91% (30/33) in the WN group, there was no statistical differences among the three groups. At the end of the 6-month follow-up visit after treatment, there was no significant difference in the recurrence rate among three groups. No serious adverse reaction was found. CONCLUSIONS: In the treatment of CSP, the short-term effect is equivalent among EA, WN and MA. But, the analgesic effect is the best in the EA group, the treatment for anti-inflammation is the most effective in the MA and WN groups, and the needling technique of Canggui Tanxue in the MA group obtains the most favorable effect of releasing adhesion and recovering the range of motion in the shoulder joint.

[An anti-scald device for warm needling].

Warm needling, i.e. acupuncture with the needle warmed by burning moxa stick or cone, is frequently employed in the treatment of cold and dampness type disorders. During treatment, accidental skin scald may occur if the burning moxa drops on the skin due to slight changes in patient's body position. Thus, we designed and developed an anti-scald device for warm needling which is suitable for any part of the body. This device is made up of two parts, a stainless steel-grid moxa cartridge (including half cylinder, hinge shaft, lug, limit bar, clamping arm, connecting arm, torsion spring, heat insulation pad, through holes) and a clamp holder which is in an integrated structure. The grid moxa cartridge can be used to wrap the burning mugwort cone in all directions to prevent the ignited moxa-cone from falling and skin scalding, and effectively collect the burned moxa ash. At the same time, the clamp holder can be used to help fix the moxa-cone to increase the stability of warm needling operation. The device is convenient to operate and novel in design, can effectively reduce the occurrence of scald accidents in clinical treatment, save time and manpower, and has both economic and ecological benefits, being helpful to the promotion and use of warm needling.

[Clinical observation of acupotomy combined with warm needling for cervical spondylotic radiculopathy of qi and blood stagnation syndrome].

OBJECTIVE: To observe the clinical effect of acupotomy combined with warm needling on cervical spondylotic radiculopathy (CSR) of qi and blood stagnation syndrome. METHODS: A total of 90 CSR patients were randomly divided into an acupotomy group, a warm needling group and a combined treatment group, with 30 cases in each group. The patients in the acupotomy group were treated with acupotomy, once every 7 days, consecutively for 3 times. The patients in the warm needling group received warm needling, once daily, at the interval of 2 days after consecutive treatments for 5 days, 7 days as one session of treatment and 3 consecutive sessions were required. The patients in the combined treatment group were treated with acupotomy and warm needling, and the methods and the treatment session were same as the the previous two groups. Before and after the treatment, the pain rating index (PRI) of McGill pain questionnaire (MPQ) and the 20-point scale of CSR developed by Yasuhisa Tanaka (CSR20) were adopted in the assessment. The changes of clinical symptoms and functions of patients were observed and the clinical efficacy was assessed in each group. RESULTS: After the treatment, the PRI score was decreased (P<0.05) and the CSR20 score was increased (P<0.05) in the 3 treatment groups when compared with those before the treatment. After the treatment, compared with the acupotomy group and the warm needling group, the PRI score was decreased (P<0.05) and the CSR20 score was increased (P<0.05) in the combined treatment group. The total effective rate was 83.3% (25/30) in the acupotomy group, 76.7% (23/30) in the warm needling group and 93.3% (28/30) in the combined treatment group. The total effective rate in the combined treatment group was higher than those in the acupotomy group and the warm needling group (P<0.05). CONCLUSION: The combined treatment with acupotomy and warm needling may obviously improve the clinical symptoms and physical signs, e.g. pain and numbness in the patients with CSR of qi and blood stagnation syndrome. Its efficacy is remarkably higher than that of the simple application of acupotomy or warm needling.

[Effect of balance acupotomy combined with warm needling in treatment of cervical spondylosis of vertebral artery type].

OBJECTIVE: To observe the clinical efficacy of balance acupotomy combined with warm needling in treatment of cervical spondylopathy of vertebral artery type (CSA). METHODS: Ninety patients were randomly divided into a warm needling group, a balance acupotomy group and a combined treatment group, 30 cases in each one. In the warm needling group, warm needling was given, once daily, for 5 days consecutively, with the interval of 2 days every week, and the treatment was conducted for 3 weeks. In the combined treatment group, on the base of the treatment as the warm needling group, the balance acupotomy was exerted, for consecutive 3 weeks. In the balance acupotomy group, the balance acupotomy was adopted, once a week, for 3 weeks consecutively. Clinical efficacy, the mean blood flow velocity of left vertebral artery (LVA), right vertebral artery (RVA) and basilar artery (BA), the pulse index (PI) and the resistance index (RI) were observed in 3 groups separately. The score of vertigo symptom and function was compared before and after treatment in 3 groups. RESULTS: In comparison with before treatment, the score of evaluation scale for cervical vertigo (ESCV) and the mean blood flow velocity of LVA, RVA and BA were all increased (P<0.05). while PI and RI reduced (P<0.05) in each group after treatment. In comparison with those in the warm needling group and the balance acupotomy group, ESCV score and the mean blood flow velocity of LVA, RVA and BA were increased (P<0.05), while PI and RI decreased (P<0.05) in the combined treatment group after treatment. Compared with the balance acupotomy group, the mean blood flow velocity of LVA, RVA and BA was increased (P<0.05), and PI and RI reduced (P<0.05) in the warm needling group after treatment. The total effective rate was 73.3% (22/30) in the warm needling group, 70.0% (21/30) in the balance acupotomy group and 93.3% (28/30) in the combined treatment group respectively. The total effective rate in the combined treatment group was higher than that either in the warm needling group or in the balance acupotomy group (P<0.05). CONCLUSION: Balance acupotomy combined with warm needling may restore the mechanical equilibrium state of the neck, and effectively improve the change of vertebral-basilar artery blood flow and relieve vertigo symptoms in patient with of cervical spondylosis of vertebral artery type.

A systematic review and meta-analysis of the comparative curative effects of warm acupuncture and other traditional Chinese medicines in the treatment of knee osteoarthritis.

BACKGROUND: Knee osteoarthritis (KOA) is more common in middle-aged and elderly people, and seriously affects the quality of life of those affected. Traditional Chinese medicine (TCM) treatment of KOA has been widely recognized. In recent years, warm needling acupuncture (WNA) has been used to treat KOA and has achieved good results. However, there is a lack of comparison of the efficacy of WNA and other TCM treatments for KOA. METHODS: We conducted a search for reports of WNA and/or TCM treatment of KOA in English- and Chinese-language databases. The data was retrieved from inception of the database until October 2021. The Cochrane risk of bias tool was used to evaluate the quality of the included studies, and the network meta-analysis was performed using the software RevMan 5.20. RESULTS: A total of 8 articles met the inclusion criteria, including 399 patients treated with WNA (WNA group), and 396 patients treated with other TCM (TCM group). The results of meta-analysis showed that compared with patients in the TCM group, the effective rate [relative risk (RR)] was 1.18, 95% confidence interval (CI): 1.06 to 1.33, the last follow-up osteoarthritis index [mean difference (MD)] was -6.93, 95% CI: -12.14 to -1.72, and the last follow-up knee pain visual analogue scale (VAS) MD was -1.06, 95% CI: -1.61 to -0.51, which were all statistically significant. However, the difference in daily activities (MD: -4.31, 95% CI: -10.90 to 2.28) was not statistically significant. DISCUSSION: Compared with other TCM treatments for KOA, WNA has better overall patient efficacy. However, further randomized controlled studies are needed to compare WNA and other TCM treatments individually to confirm the efficacy of WNA.

Systematic Review and Meta-Analysis of Efficacy and Safety of Fire Needling and Warm Needling on Acute Gout.

Objectives: This study aimed to evaluate the efficacy and safety of heat stimuli (e.g., fire needling, warm needling) in acupuncture for acute gout. Methods: Four international online databases (PubMed, Cochrane, Embase, and Chinese National Knowledge Infrastructure) were searched to identify randomized, controlled trials (RCTs) that used fire needling and warm needling for acute gout. The methodological quality of the RCTs was evaluated using the Cochrane risk-of-bias (RoB) tool. Thirteen RCTs (840 patients) were included and analyzed. Three evaluation tools (total effective rate, uric acid level, and pain score) were mainly used. Comparisons were made between Western medicine (WM) and i) fire needling or warm needling treatment alone, ii) fire needling and bloodletting combination treatment, iii) combination of fire needling, bloodletting, and herbal medicine, iv) warm needling (concurrently). Heat stimuli in acupuncture alone or in combination treatment were more effective in terms of the total efficacy rates, uric acid levels, and pain scores than WM alone. Results: In all the evaluation tools, the treatment effects in the fire needling alone or warm needling alone treatment group and the fire needling and bloodletting combination intervention group were significantly better than those in the WM control group. The warm needling and WM combination intervention groups also experienced significantly better treatment effects in terms of total efficacy rates and uric acid levels. Only the pain scores in the fire needling, bloodletting, and herbal medicine combination groups demonstrated significant improvement. Only four studies mentioned adverse reactions one reported loss of appetite; three studies reported none. According to the Cochrane RoB tool, most studies showed either high or uncertain RoB. Conclusion: Heat stimuli during acupuncture could be effective for acute gout. However, as the included studies were regionally biased, more high-quality studies are needed to confirm the level of evidence.

Therapeutic efficacy observation of warm needling moxibustion plus Tuina for knee osteoarthritis / 针灸推拿医学（英文版）

Objective: To observe the clinical efficacy of warm needling moxibustion plus Tuina (Chinese therapeutic massage) for knee osteoarthritis (KOA).Methods: A total of 60 patients with KOA were randomized into an observation group and a control group by the random number table, with 30 cases in each group. The control group was treated with warm needling moxibustion, and the observation group was treated with additional Tuina treatment. The treatments were performed once every other day, for a total of 10 times. The visual analog scale (VAS) and Western Ontario and McMaster Universities osteoarthritis index (WOMAC) were scored before and after treatment, and the surface electromyography (sEMG) signals of quadriceps femoris were collected. Results: The total effective rate of the control group was 76.7％, and that of the observation group was 90.0％. The difference between the two groups was statistically significant (P<0.05). The WOMAC and VAS scores in both groups after treatment were improved, and the integrated electromyography (iEMG) and median frequency (MF) of quadriceps femoris were increased. The intra-group differences were statistically significant (P<0.05). After treatment, the WOMAC and VAS scores in the observation group were lower than those in the control group, and the differences between the two groups were statistically significant (P<0.05). The improvement of quadriceps femoris function in the observation group was more notable than that in the control group, and the iEMG value and MF were significantly higher than those in the control group (P<0.05). Conclusion: Warming needling moxibustion plus Tuina can effectively relieve the pain in patients with KOA, improve their daily activity function, and increase the sEMG signals of the quadriceps femoris.

Clinical observation of warm needling moxibustion plus lumbar traction for lumbar disc herniation / 针灸推拿医学（英文版）

Objective: To observe the clinical efficacy of warm needling moxibustion plus lumbar traction for lumbar disc herniation (LDH) and its effect on Oswestry disability index (ODI) score, present pain intensity (PPI) score, and the degree of straight leg raising.Methods: A total of 146 patients with LDH were randomized into a combination group and a control group by the random number table method, with 73 cases in each group. The control group was treated with lumbar traction, and the combination group was treated with lumbar traction plus warm needling moxibustion. The curative efficacy of the two groups was compared. Also, the lumbar function, pain, straight leg raising degree, and inflammatory factor levels before and after treatment were compared. Results: The total effective rate of the combination group was 93.2％, which was higher than 78.1％ of the control group (P<0.05). After treatment, the lumbar ODI score, the PPI scores of lumbar pain and lower-limb pain, tumor necrosis factor (TNF)-α and interleukin (IL)-6 levels, and straight leg raising test score in both groups were significantly decreased (P<0.05). The Japanese Orthopaedic Association (JOA) score significantly increased (P<0.05). The improvements of the above items in the combination group were all superior to those in the control group (P<0.05). Conclusion: Warm needling moxibustion plus lumbar traction in the treatment of LDH can improve lumbar function, relieve pain, and reduce inflammatory response of the body.

Clinical study on warm needling moxibustion plus isokinetic muscle strength training in treating knee osteoarthritis / 针灸推拿医学（英文版）

Objective: To observe the clinical efficacy of warm needling moxibustion plus isokinetic muscle strength training for knee osteoarthritis (KOA).Methods: A total of 135 patients with KOA due to Yang deficiency and coagulated cold were randomized into a warm needling moxibustion group, an isokinetic muscle strength training group, and a combined group by the random number table method, with 45 cases in each group. The warm needling moxibustion group was treated with warm needling moxibustion. The isokinetic muscle strength training group was treated with isokinetic muscle strength training. The combined group was treated with warm needling moxibustion plus isokinetic muscle strength training. The Western Ontario and McMaster Universities osteoarthritis index (WOMAC) and visual analog scale (VAS) were scored before and after treatment, and isokinetic indicators of peak torque (PT), total work (TW) and average power (AP) were evaluated. Results: The total effective rate of the combined group was 92.5％, which was significantly higher than 83.3％ in the warm needling moxibustion group (P<0.05) and 72.5％ in the isokinetic muscle strength training group (P<0.05). After treatment, the scores of WOMAC (total, pain, stiffness, and function) and VAS, and isokinetic indicators (PT, TW, and AP) were all improved compared with those before treatment (P<0.05) in all three groups. The differences among the three groups were statistically significant (P<0.05). The WOMAC total score and score of stiffness in the combined group were lower than those in the warm needling moxibustion group and the isokinetic muscle strength training group (P<0.05), and the scores in the warm needling moxibustion group were lower than those in the isokinetic muscle strength training group (P<0.05). The WOMAC score of pain and VAS score in the warm needling moxibustion group and the combined group were lower than those in the isokinetic muscle strength training group (P<0.05). The differences between the warm needling moxibustion group and the combined group were not statistically significant (P>0.05). The WOMAC function score in the combined group was lower than that in the warm needling moxibustion group and the isokinetic muscle strength training group (P<0.05), while there was no statistical difference between the warm needling moxibustion group and the isokinetic muscle strength training group (P>0.05). PT, TW, and AP in the combined group were higher than those in the warm needling moxibustion group and the isokinetic muscle strength training group (P<0.05), and they were higher in the isokinetic muscle strength training group than in the warm needling moxibustion group (P<0.05). Conclusion: Warm needling moxibustion plus isokinetic muscle strength training has a better effect in the treatment of KOA due to Yang deficiency and coagulated cold than either warm needling moxibustion or isokinetic muscle strength training alone.

Clinical study of warm needling moxibustion plus intra-articular injection of sodium hyaluronate for hip involvement in ankylosing spondylitis / 针灸推拿医学（英文版）

Objective: To observe the efficacy of warm needling moxibustion plus intra-articular injection of sodium hyaluronate for hip involvement in ankylosing spondylitis (AS). Methods: A total of 60 patients with hip involvement in AS were randomly divided into a control group and an observation group, with 30 cases in each group. The patients in the control group were given an intra-articular injection of sodium hyaluronate, once a week. The patients in the observation group were given additional warm needling moxibustion, once a day, with a 2-day interval after five consecutive days of treatment. After 5 weeks, changes in such indicators as visual analog scale (VAS) score, Harris score, Bath ankylosing spondylitis disease activity index (BASDAI), Bath ankylosing spondylitis functional index (BASFI), serum cartilage oligomeric matrix protein (COMP), interleukin (IL)-17 were observed, and the efficacy was evaluated. Six months after treatment, Bath ankylosing spondylitis radiology index-hip (BASRI-hip) was evaluated. Results: After treatment, the total effective rate in the observation group was higher than that in the control group (P<0.05). After treatment, the VAS scores in both groups were lower than those before treatment (P<0.05), and the score of the observation group was lower than that of the control group (P<0.05). After treatment, the Harris scores of both groups were higher than those before treatment (P<0.05), and the score of the observation group was higher than that of the control group (P<0.05). Six months after treatment, the BASRI-hip score of the control group was higher than that before treatment (P<0.05), while the score of the observation group was not significantly different from that before treatment (P>0.05) and was lower than that of the control group (P<0.05). After treatment, the scores of BASDAI and BASFI of both groups were lower than those before treatment (P<0.05), and the scores of the observation group were lower than those of the control group (P<0.05). After treatment, the levels of serum COMP and IL-17 of both groups were lower than those before treatment (P<0.05), and the levels of the observation group were lower than those of the control group (P<0.05). Conclusion: The efficacy of warm needling moxibustion plus intra-articular injection of sodium hyaluronate for hip involvement in AS is better than the intra-articular injection of sodium hyaluronate alone. This combined approach can alleviate hip pain, improve hip functions, delay the destruction of the hip, prevent AS development, and reduce the levels of serum COMP and IL-17.

Clinical study of warm needling moxibustion combined with entecavir in the treatment of compensated cirrhosis due to chronic hepatitis B / 针灸推拿医学（英文版）

Objective: To investigate the efficacy and possible mechanism of action of warm needling moxibustion combined with entecavir in the treatment of compensated cirrhosis due to chronic hepatitis B (CHB).Methods: Ninety patients were randomly divided into a control group and an observation group, with 45 patients in each group. The control group was given oral entecavir, and the observation group was given additional warm needling moxibustion. The serum alanine transaminase (ALT), aspartate transaminase (AST), albumin (ALB) levels, portal vein internal diameter, splenic vein internal diameter, spleen thickness, and liver hardness were compared before and after treatment. The serum hyaluronic acid (HA), laminin (LN), procollagen type Ⅲ (PCⅢ), type Ⅳ collagen (Ⅳ-C), interleukin (IL)-21, and platelet-derived growth factor (PDGF) levels were also measured. Results: After treatment, the serum ALT and AST levels decreased (P<0.05), and the serum ALB levels increased (P<0.05) in both groups. The serum ALT and AST levels were lower in the observation group than in the control group (P<0.05), and the ALB level was higher in the observation group (P<0.05). The portal vein internal diameter, splenic vein internal diameter, spleen thickness, and liver hardness values were reduced in both groups after treatment (P<0.05), and were lower in the observation group than in the control group (P<0.05). The serum HA, LN, PCⅢ, and Ⅳ-C levels were reduced in both groups (P<0.05), and were lower in the observation group than in the control group (P<0.05). In the control group, the serum IL-21 level decreased (P<0.05), but the serum PDGF level did not change significantly (P>0.05); in the observation group, the serum IL-21 and PDGF levels decreased significantly (P<0.05) and were lower than those in the control group (P<0.05). Conclusion: Warm needling moxibustion combined with entecavir treatment can improve liver function, reduce the inner diameters of the portal vein and splenic vein, spleen thickness, and liver hardness, and improve liver fibrosis indicators in patients with CHB cirrhosis, which may be related to the reduction of serum IL-21 and PDGF levels.

Efficacy of electroacupuncture plus warm needling therapy for plantar heel pain: a randomised waitlist-controlled trial.

OBJECTIVE: To investigate the therapeutic effects of electroacupuncture plus warm needling (EAWN) therapy on pain and foot function in adults with plantar heel pain (PHP). METHODS: This prospective, randomised, parallel-group, waitlist-controlled trial was conducted at a Chinese medicine centre in Hong Kong between May 2018 and February 2019. Eighty eligible community-dwelling subjects with PHP (mean age 59.7 years; 85% female) were equally randomised to receive EAWN therapy or remain on a waitlist. The treatment group received six 30-min sessions of standardised EAWN therapy over 4 weeks; the control group received no treatment. The outcome measures were the visual analogue scale (VAS) score for first-step pain, foot function index (FFI) scores and global rating of change (GRC) scale scores. Assessments were made at baseline, week 2 and week 4 (primary endpoint). The treatment group underwent additional assessments at week 8. Outcomes were evaluated by intention-to-treat analysis. RESULTS: Patients who received EAWN therapy exhibited greater improvements in the mean first-step pain VAS and all FFI scores than did those in the control group at weeks 2 and 4, with significant between-group differences (all P < 0.001). Compared with baseline, there were significant decreases in mean first-step pain VAS scores at weeks 2 and 4, and FFI scores at week 4, in the treatment group but not in the control group. The improvements in the treatment group continued until week 8. GRC scores at week 4 indicated improvement in all treated patients and only 22.5% of the control group patients (P < 0.001). There were no study-related adverse events. CONCLUSION: EAWN therapy could be an effective treatment for PHP in middle-aged and older adults. TRIAL REGISTRATION NUMBER: ChiCTR1800014906 (Chinese Clinical Trials Registry).

Therapeutic efficacy observation of warm needling moxibustion plus spine subtle adjusting manipulation for cervical radiculopathy / 针灸推拿医学（英文版）

Objective: To observe the clinical efficacy of warm needling moxibustion plus spine subtle adjusting manipulation for cervical radiculopathy. Methods: A total of 70 patients with cervical radiculopathy were randomized into an observation group and a control group, with 35 cases in each group. The observation group was treated with warm needling moxibustion plus spine subtle adjusting manipulation, while the control group was treated with warm needling moxibustion alone. The treatments were performed three times a week, and for four weeks in total. The visual analog scale (VAS) was scored before and after treatment. And the clinical efficacy of the two groups was compared after treatment. Results: The total effective rate was 97.1％ in the observation group, versus 88.6％ in the control group. The difference between the two groups was statistically significant (P<0.05). After treatment, the VAS scores in both groups significantly decreased (P<0.01), and the score in the observation group was significantly lower than that in the control group (P<0.05). Conclusion: Warm needling moxibustion plus spine subtle adjusting manipulation has a better effect in the treatment of cervical radiculopathy than warm needling moxibustion alone.

Muscle regions of meridians warm needling method plus pricking Jing-Well points for blood-letting in the treatment of shoulder-hand syndrome after stroke / 针灸推拿医学（英文版）

Objective: To observe the effect of muscle regions of meridians warm needling method plus pricking Jing-Well points for blood-letting in improving nail fold microcirculation in the patients with shoulder-hand syndrome (SHS) after stroke, and the effects on hemorrheology, calcitonin gene-related peptide (CGRP) and serum substance P (SP). Methods: A total of 72 patients were randomized into an observation group and a control group by the random number table method, with 36 cases in each group. The control group was treated with physical rehabilitation training, and the observation group was treated with additional muscle regions of meridians warm needling method plus pricking Jing-Well points for blood-letting treatment. The treatment course lasted for 4 weeks. After treatment, the clinical efficacy of the two groups was compared. The changes in shoulder-hand syndrome scale (SHSS), simplified Fugl-Meyer assessment-upper extremity (FMA-UE), visual analog scale (VAS), activities of daily living (ADL), traditional Chinese medicine (TCM) syndrome score, nail fold microcirculation hemorheology indictors [whole blood viscosity (high-shear, low-shear), hematocrit, erythrocyte sedimentation rate (ESR)], CGRP and SP levels were observed. Results: The total effective rate in the observation group was 86.1％, higher than 63.9％ in the control group (P<0.05). The overall curative effect in the observation group was better than that in the control group (P<0.05). After treatment, the scores of pain sensation, edema, external turn and rotation of the arm in SHSS, and the total score were significantly decreased in both groups (all P<0.05), and each score in the observation group was lower than that in the control group (all P<0.05). After treatment, the scores of VAS and TCM syndrome in both groups decreased significantly (all P<0.05), and the scores of FMA-UE and ADL increased significantly (all P<0.05). The scores of VAS and TCM syndrome in the observation group were lower than those in the control group (both P<0.05), and the scores of FMA-UE and ADL were higher than those in the control group (both P<0.05). After treatment, the whole blood viscosity (high-shear and low-shear) and hematocrit in both groups decreased obviously (all P<0.05), and ESR increased obviously (both P<0.05), and the whole blood viscosity (high-shear and low-shear) and hematocrit in the observation group were lower than those in the control group (all P<0.05), and ESR was higher than that in the control group (P<0.05). After treatment, the peritubular state, loop shape, blood flow and total score of nail fold microcirculation in both groups decreased significantly (all P<0.05), and each score in the observation group was lower than that in the control group (all P<0.05). After treatment, SP in both groups decreased obviously (both P<0.05), CGRP increased obviously (both P<0.05), and SP in the observation group was lower than that in the control group (P<0.05), CGRP was higher than that in the control group (P<0.05). Conclusion: Compared with conventional physical rehabilitation training, muscle regions of meridians warm needling method plus pricking Jing-Well points for blood-letting treatment can significantly reduce the clinical symptoms of SHS, promote the recovery of physical functions, improve the nail fold microcirculation and hemorrheology indictors, and regulate the serum cytokine levels such as CGRP and SP.

Clinical study of warm needling moxibustion plus intra-articular injection of sodium hyaluronate for chondromalacia patellae / 针灸推拿医学（英文版）

Objective: To observe the therapeutic efficacy of warm needling moxibustion plus intra-articular injection of sodium hyaluronate in treating chondromalacia patellae and its effect on inflammatory factors in knee joint fluid. Methods: Sixty-eight patients with chondromalacia patellae were randomized into a control group and an observation group, with 34 cases in each group. The control group was treated with intra-articular injection of sodium hyaluronate, while the observation group was given additional warm needling moxibustion treatment. Before and after treatment, the two groups were scored using Western Ontario and McMaster Universities osteoarthritis index (WOMAC) and visual analog scale (VAS), examined by magnetic resonance imaging (MRI) and determined for the levels of nuclear factor-κB (NF-κB), tumor necrosis factor (TNF)-α and interleukin (IL)-1β in knee joint fluid. Clinical efficacy was estimated after treatment. Results: The effective rate was higher in the observation group than in the control group (P<0.05). After treatment, the scores of pain, stiffness and daily activities, as well as the general score of WOMAC declined significantly in both groups (all P<0.05), and were lower in the observation group than in the control group (all P<0.05); the time cost for climbing up and down one staircase and VAS score decreased markedly in both groups (all P<0.05), and were shorter or lower in the observation group than in the control group (both P<0.05); the MRI grading showed no significant change in the control group after intervention (P>0.05), while the grading in the observation group showed notable improvement (P<0.05), and was better than that in the control group (P<0.05); the levels of NF-κB and IL-1β in knee joint fluid dropped significantly in the control group after treatment (both P<0.05), while the levels of NF-κB, TNF-α and IL-1β in knee joint fluid all decreased significantly in the observation group (all P<0.05) and were lower than those in the control group (all P<0.05). Conclusion: Warm needling moxibustion plus intra-articular injection of sodium hyaluronate can produce definite efficacy in treating chondromalacia patellae; it can mitigate the clinical symptoms, improve the lesion extent of chondromalacia and down-regulate the levels of NF-κB, TNF-α and IL-1β in knee joint fluid.

Effect of warm needling therapy on nerve conduction in patients with occupational hand-arm vibration disease / 中国职业医学

OBJECTIVE: To investigate the effect of warm needling therapy on the conduction of hand-arm motor nerve and sensory nerve in patients with occupational hand-arm vibration disease(HAVD). METHODS: Male occupational HAVD patients were divided into control group(39 cases) and experimental group(36 cases) by random number table method. The control group received routine therapy, while the experimental group was treated with routine therapy plus warm needling therapy five times a week for four consecutive weeks. The changes on the conduction of motor nerve and sensory nerve in these two groups before and after treatment were compared. RESULTS: Before treatment, the motor nerve conduction velocity(MCV), distal motor latency(DML), compound muscle action potential amplitude(CMAP), sensory nerve conduction velocity(SCV) and sensory nerve action potential amplitude(SNAP) of the median nerve and ulnar nerve in the two groups were compared, and there was no statistically significant difference(all P>0.05). After treatment, the MCV and SCV of median nerve and ulnar nerve in the experimental group were accelerated(all P<0.05), the DML of median nerve and ulnar nerve were shortened(all P<0.01), and the CMAP of median nerve increased compared with the control group(P<0.01). However, there was no significant difference in the CMAP of ulnar nerve and SNAP of median nerve and ulnar nerve(all P>0.05). CONCLUSION: Warm needling therapy can improve the conduction of motor nerve and sensory nerve. Warm needling therapy might be able to promote the repair of injury in axons and myelin sheaths.

Warm needling moxibustion plus PKP for vertebral compression fracture due to kidney deficiency and blood stasis: a randomized controlled trial / 针灸推拿医学（英文版）

Objective: To explore the efficacy and mechanism of warm needling moxibustion plus percutaneous kyphoplasty (PKP) for osteoporotic vertebral compression fracture (OVCF) due to kidney deficiency and blood stasis. Methods: A total of 70 OVCF patients were randomized into a control group and an observation group, with 35 cases in each group. The control group was given PKP treatment, and the observation group was treated with warm needling moxibustion on the basis of the treatment in the control group. The visual analog scale (VAS) and Oswestry disability index (ODI) were scored and the Cobb angle of fractured vertebrae was measured before and after treatment. The re-fracture rate of the adjacent vertebrae was recorded at 1-year follow-up. The serum levels of transforming growth factor (TGF)-β1 and omentin-1 were measured before and after treatment. Results: After treatment, the VAS and ODI scores in both groups decreased (all P<0.05), and all the scores in the observation group were lower than those in the control group (both P<0.05). After treatment, the Cobb angle of fractured vertebrae in both groups decreased (both P<0.05), and the Cobb angle in the observation group was smaller than that in the control group (P<0.05). At 1-year follow-up, the re-fracture rate of the adjacent vertebrae in the observation group was lower than that in the control group (P<0.05). After treatment, the serum levels of TGF-β1 and omentin-1 in both groups increased significantly (all P<0.05), and the serum levels of TGF-β1 and omentin-1 in the observation group were higher than those in the control group (both P<0.05). Conclusion: The treatment of warm needling moxibustion plus PKP can relieve pain, improve dysfunction, promote healing of the injured vertebrae, and reduce the re-fracture rate of the adjacent vertebrae in patients with OVCF due to kidney deficiency and blood stasis, which may be related to the increase of serum TGF-β 1 and omentin-1 levels.

Different kinds of acupuncture treatments for knee osteoarthritis: a multicentre, randomized controlled trial.

INTRODUCTION: Knee osteoarthritis (KOA) is a chronic disease with symptoms of persistent pain or resting pain, joint stiffness, numbness, limitation of activity and even disability, with significant associated costs and effects on individuals' life quality. The use of acupuncture for the management of chronic pain is receiving increasing recognition from both the public and professionals. The aim of this study is to identify the effects of three commonly used acupuncture treatments for KOA. METHODS/ANALYSIS: In a prospective trial involving six hospitals in Zhejiang Province (China), 360 patients with KOA will be included. Eligible patients will be randomized into six groups: Acupuncture, Electro-acupuncture, Mild moxibustion, Warm-needling, Sham acupuncture and Celebrex treatment. Twelve treatment sessions will be performed over a 4-week period. The primary outcome will be the visual analogue scale and Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC) function scores (the average of the past 3 days) at weeks 2 and 4 and at 3-month and 6-month follow-up. Secondary outcome measures will be as follows: the WOMAC pain score and WOMAC stiffness score (the average of the past 3 days); the Physical Activity Scale of the Elderly (PASE); knee joint swelling measurement; the WHO Quality Of Life-BREF (WHOQOL-BREF) life quality scale; and the incidence of adverse events. TRIAL REGISTRATION: ClinicalTrials.gov, NCT03563690. Registered on 2rd July 2018.

[Analysis on the temperature-time curve in warm needling manipulation with acupuncture needles of different materials].

OBJECTIVE: To analyze the characteristics of the temperature-time curve in warm needling manipulation with the acupuncture needles made of copper, silver, gold and stainless steel and explore the applicable temperature range and most suitable needle materials of warm needling manipulation in clinical practice. METHODS: A total of 10 healthy subjects were included. Using the digital thermometer, with different moxibustion dose (1.2 g or 1.5 g, moxa), the temperature was measured at the site where the skin contacts with the needle body during the warm needling manipulation with stainless steel needle, copper needle, gold needle and sliver needle separately. The initial heat pain threshold (the temperature when hot feeling started) and the burning pain threshold (feeling very hot but tolerable) were recorded when using the different needles mentioned above. Through the subject questionnaire, the comfort degree, the heat sensation, the adverse reaction and the acceptability to warm needling manipulation with the different needles were investigated. RESULTS: During the warm needling manipulation, the initial heat pain threshold was (42.8±2.7) ℃ and the burning pain threshold was (46.7±2.9) ℃. The strongest warm stimulation was presented in the warm needling manipulation with 1.5 g moxa and silver needle and the highest temperature was (55.5±6.3) ℃, followed by (52.9±4.2) ℃ with 1.2 g moxa and silver needle, (46.6±3.7) ℃ with 1.5 g moxa and gold needle, (46.6±1.9) ℃ with 1.5 g moxa and copper needle, (43.1±1.5) ℃ with 1.2 g moxa and copper needle and (41.7±0.9) ℃ with 1.5 g moxa and stainless steel needle. The sequence of the maintaining time of the initial heat pain threshold over 43℃ was 480 s with silver needle and 1.5 moxa, 325 s with silver needle and 1.2 g moxa, 270 s with gold needle and 1.5 g moxa, 185 s with copper needle and 1.5 g moxa, 42 s with copper needle and 1.2 g moxa and 0 s with stainless steel needle and 1.5 g moxa successively. The heat score graded by the subjects to the warm needling manipulation with different needles, from high to low, was presented in the manipulation with 1.5 g moxa and silver needle, 1.2 g moxa and silver needle, 1.5 g moxa and copper needle, 1.5 g moxa and gold needle, 1.2 g moxa and copper needle and 1.5 g moxa and stainless steel needle. The VAS score was different significantly in comparison among the six needles in warm needling manipulation (P<0.001). The comfort degree of the subjects in the warm needling manipulation with silver needle and 1.5 g moxa was significantly lower than the warm needling manipulation with the other 5 materials (P<0.05). Three subjects complained that the warm needling manipulation with silver needle and 1.5 g moxa was too hot to be tolerable and the most of subjects were willing to accept warm needling manipulation with these 6 materials (acceptability 70.0% to 100.0%). Except blisters presented in 9 subjects after warm needling manipulation with silver needle and 1.5 g moxa, no severe adverse reaction occurred in warm needling manipulation with 6 materials. CONCLUSION: In the warm needling manipulation in the human body, the initial heat pain and the burning pain threshold were 43 ℃ and 47 ℃ respectively, which is the applicable temperature range of moxibustion in clinical practice. The warm needling manipulation with silver needle induces a quite strong heat stimulation and the discomfort may be caused when the temperature is exceeded to some threshold. The warm needling manipulation with copper needle generates the onset temperature, without inducing adverse reactions, e.g. discomfort and burning in the subjects.

Efficacy and safety of electroacupuncture plus warm needling therapy for heel pain: study protocol for a randomized controlled trial.

BACKGROUND: Heel pain is a common foot disorder that causes pain and functional limitations. The prevalence of disabling foot pain will increase as the population ages. Previous studies have reported the positive therapeutic effects of electroacupuncture, warm needling, or the combination of both for heel pain but with limitations in the study methodologies. The current study is a rigorously designed randomized controlled trial that aims to evaluate the clinical efficacy and safety of electroacupuncture plus warm needling therapy in patients with heel pain. METHODS/DESIGN: The study protocol describes a prospective, open-label, parallel-group, randomized controlled trial to be conducted in Hong Kong. Eighty patients aged 50-80 years who have reported heel pain and first-step pain equal to or exceeding 50 mm on the 100-mm visual analog scale (VAS) will be recruited. They will be randomly assigned (1:1 ratio) to the electroacupuncture plus warm needling therapy (i.e., treatment) group or the waitlist (i.e., control) group. The treatment group will undergo six treatment sessions in 4 weeks. The control group will receive no treatment during the study period. The primary outcome measure is a mean change in the first-step pain VAS score from the baseline to week 4. Secondary outcome measures include a mean change in first-step pain VAS score from the baseline to week 2, a mean change in Foot Function Index (FFI) subscale scores and the total score from the baseline to week 2 and week 4, and patients' self-reported level of improvement at week 4. Additional week 8 follow-up assessments with first-step pain VAS and FFI measurements will be arranged for the treatment group. Any adverse events will be recorded throughout the study to evaluate safety. An intention-to-treat approach will be used to analyze the study results. DISCUSSION: This study will provide evidence on the efficacy and safety of electroacupuncture plus warm needling therapy as an alternative treatment method for heel pain. The findings will determine whether the treatment protocol is efficacious in relieving pain and improving foot function among older adults with heel pain. The study will also provide information for subsequent large-scale randomized controlled trials in the future. TRIAL REGISTRATION: Chinese Clinical Trial Registry, ChiCTR1800014906 . Registered on 12 February 2018.