Observation On The Curative Effect Of Medicine-separated Moxibustion Combined With Conventional Western Medicine In The Treatment Of Persistent Moderate To Severe Allergic Rhinitis Of Kidney-yang Deficiency

BackgroundAllergic rhinitis(AR)causes a grave impact on patients’ quality of life,sleeping,emotions and work performance with a prevalence rate as high as 30%worldwide.Current western medicine treatment is focused on quick symptoms relief,while with a high recurrence rate and a lack of individualized treatment scheme.Herbs partitioned-moxibustion can achieve the goal of individualization through pattern differentiation and the following selection of appropriate acupoints and herbs,it can improve patients’ constitution and reach the goal of a stable long term effect.The combination of partitioned-moxibustion and conventional western medicine may achieve the goal of quick symptoms relief on the one hand,and a stable long term effect on the other handPurposeTo evaluate the clinical effect of herbs partitioned-moxibustion combining rhinocort nasal spray for the treatment of persistent,moderate-severe AR in the aspect of the severity of nasal symptoms,quality of life,anxiety and depression state,sleeping,medication use,kidney-yang deficiency Traditional Chinese medicine pattern and infrared thermal imaging,and to investigate the value of infrared thermal imaging in the diagnosis and treatment,and related TCM theory of AR.Methods1 Treatment methods1.1 Grouping70 eligible AR patients conforming to the inclusion criteria were randomized into a herbs partitioned-moxibustion group(treatment group)and a control group with 35 patients in each group,the randomization method was centralized randomization system.During the study,there were 3 drop out cases in the control group,and finally,a total of 67 patients were included in the statistical calculation1.2 TreatmentHerbs partitioned-moxibustion treatment:(1)Acupoints:BL 23,BL 13 on bilateral sides and GV 9,GV 14.(2)herb cakes and moxa cone:Mix the powders of Fuzi(附子,Radix Aconiti Lateralis Preparata),R6ugui(肉桂,Cortex Cinnamomi),and Ganjiang(干姜,Rhizoma Zingiberis)in 1:1:1 ratio and add moderate amount of ginger juice to produce a herb cake of 2-3 cm in diameter and 0.8 cm in height.Penetrate 10-14 holes through the herb cake for a better thermal transmission.Moxa cone will be made manually in the standard of 2.5 cm in diameter,2 cm in height and 2.5 g in weight.(3)Manipulation:After locating the correct acupoint,the herb cakes will be placed on the acupoints,and then the moxa cone will be placed on the cakes.During moxibustion,the length between the moxa cone and the mediator will be adjusted according to each patient’s feeling of heat,generating a feeling of diffuse heat on local points.Three zhuang will be burned on each point for 30 min every time.(4)The treatment will be administered every other day,3 times/week for a total 4 weeksMedicine treatment:patients in both groups received rhinocort nasal spray(AstraZeneca Pharmaceutical Co.Ltd.)treatment,the spray was administrated once at one nostril(64μg)on both sides,twice a day with a total amount of 256μg every day,for a succession of 4 weeks,then the amount of rhinocort will be reduced or sustained according to the condition of different patients.The observation period is 12 weeks1.3 Follow-up visitAfter finishing the 4-week treatment period,patients in both groups received a 12-week follow-up visit,during which the amount of rhinocort was then adjusted and administrated 2 Observation items2.1 Primary outcomeVAS score including Uni-VAS and Multi-VAS were used to evaluate the severity of the overall AR symptoms and congestion,itching,rhinorrhea and sneezing separatelyVAS was observed at baseline and after 2,4 weeks of treatment,and at 4,8 and 12 weeks during follow-up visit period2.2 Secondary outcomesRQLQ,kidney-yang deficiency questionnaire were evaluated at baseline and after 2,4 weeks of treatment,and at 4,8 and 12 weeks during follow-up visit period.SF-36,HAD and PSQI were evaluated at baseline and after 2,4 weeks of treatmentMedicine usage status was evaluated at 4,8 and 12 weeks during follow-up visit periodInfrared thermal imaging was evaluated baseline and after 4 weeks of treatment.Result67 patients were included in the final statistics calculation,there were no between-group difference when comparing gender,age,family history,BMI,course,educational and career level of the patients in two groups.1 Treatment period1.1 Treatment groupAfter 4 weeks of treatment,the VAS,RQLQ,SF-36,HAD,PSQI and kidney-yang deficiency score in the treatment group all improved significantly,intra-group comparison showed statistical significance(P<0.05).Infrared thermal imagining result showed the nose temperature,nose general difference value,lung range value,large intestine range value and kidney range value all improved significantly,intra-group comparison showed statistical significance(P<0.05),other intra-group comparison of temperature showed no statistical significance(P>0.05).The overall effective rate is 82.9%1.2Control groupAfter 4 weeks of treatment,the VAS,RQLQ,SF-36,HAD and kidney-yang deficiency score in the control group all improved significantly,intra-group comparison showed statistical significance(P<0.05),the intra-group comparison of PSQI showed no statistical significance(P>0.05).Infrared thermal imagining result showed the nose temperature,nose range value improved significantly,intra-group comparison showed statistical significance(P<0.05),other intra-group comparison of temperature showed no statistical significance(P>0.05).The overall effective rate is 87.5%1.3Between-group comparisonAfter 4 weeks of treatment,RQLQ and sleeping sub-scale,PSQI and kidney-yang deficiency score in the treatment group were lower than those in the control group,between-group comparison showed statistical significance(P<0.05).Infrared thermal imagining result showed the D-value of nose temperature,nose general difference value,nose range value,lung temperature in the treatment group were higher than those in the control group,between-group comparison showed statistical significance(P<0.05).The comparison of overall effective rate in two groups showed no statistical significance(P>0.05)2 Follow-up visit period2.1 Treatment groupAfter 4-week of follow-up visit period,the Uni-VAS,itching sub-score,RQLQ and kidney-yang deficiency score in the treatment group all rose substantially when compared with the end of the treatment,intra-group comparison showed statistical significance(P<0.05)The intra-group comparison of all items between 8-week to 4-week and 12-week to 8-week all showed no statistical significance(P>0.05).During follow-up visit period,all index were lower than those before treatment,intra-group comparison showed statistical significance(P<0.05).The overall effective rate was 84.4%in the treatment group after 12-week of follow-up visit.2.2Control groupAfter 4-week of follow-up visit period,the intra-group comparison of the Uni-VAS,itching sub-score,RQLQ with those at the end of the treatment in the control group showed no statistical significance(P>0.05),while the kidney-yang deficiency score rose substantially,showing statistical significance(P<0.05).The intra-group comparison of Uni-VAS and itching sub-scale between 8-week to 4-week showed statistical significance(P<0.05),two items rose substantially,intra-group comparison of the other two items showed no statistical significance(P>0.05).The intra-group comparison of all items between 12-week to 8-week all showed no statistical significance(P>0.05).During follow-up visit period,except for kid-yang deficiency score which showed no statistical significance(P>0.05)when compared with that before treatment,all index were lower than those before treatment,intra-group comparison showed statistical significance(P<0.05).The overall effective rate was 66.7%in the treatment group after 12-week of follow-up visit.2.3Between-group comparisonAt 4-week of the follow-up visit period,the between-group comparison of Uni-VAS,Multi-VAS,RQLQ and kidney-yang deficiency score showed no statistical significance(P>0.05).At 8-week of the follow-up visit period,the congestion and itching score in the treatment group were lower than those in the control group,between-group comparison showed statistical significance(P<0.05),the between-group comparison of other items showed no statistical significance(P>0.05).At 12-week of the follow-up visit period,the congestion and itching score,RQLQ and kidney-yang deficiency score in the treatment groupwere lower than those in the control group,between-group comparison showed statistical significance(P<0.05),the between-group comparison of other items showed no statistical significance(P>0.05).During all follow-up visit period,the medication use in the treatment group was lower than that in the control group,between-group comparison showed statistical significance(P>0.05).At 12-week of follow-up visit period,the overall effective rate in the treatment group was higher than that in the control group,between-group comparison showed statistical significance(P<0.05).3 Correlation analysisVAS is correlated with RQLQ,showing statistics significance(P<0.05);RQLQ is correlated with the kidney-yang deficiency score,showing statistics significance(P<0.05);SF-36 is correlated with HAD,showing statistics significance(P<0.05);HAD is correlated with the kidney-yang deficiency score,showing statistics significance(P<0.05).In the infrared thermal imaging result,nose temperature,lung general difference value,large intestine general difference value were correlated with Uni-VAS,showing statistics significance(P<0.05);Lung temperature,kidney temperature were correlated with SF-36,showing statistics significance(P<0.05);Lung temperature,kidney temperature were correlated with HAD,showing statistics significance(P<0.05);Nose general difference value,large intestine range value and kidney range value were correlated with PSQI,showing statistics significance(P<0.05);Kidney range value was correlated with kidney-yang deficiency score,showing statistics significance(P<0.05).C onclusion1 Herbs partitioned-moxibustion combining conventional western medicine treatment can alleviate nasal symptoms,improve quality of life,sleeping quality and promote emotion and kidney-yang constitution in patients with persistent moderate-severe AR of kidney-yang deficiency pattern.2 During the treatment period,herbs partitioned-moxibustion can further improve patients’sleeping quality and kidney-yang deficiency constitution on the basis of rhinocort.Compared with single western medicine treatment,union treatment scheme has a better effect for improving nose and lung temperature,it can also change the temperature distribution characters in lung,large intestine and kidney region.3 On the perspective of skin temperature tested by infrared thermal imaging,herbs partitioned-moxibustion combining rhinocort spary can regulate nose and lung,large intestine and kidney pathological states in AR patients,which might be used as a therapeutic evaluation item.The nasal symptoms of AR patients are substantially correlated with their quality of life Nose temperature is substantially correlated with the severity of nasal symptoms,and could become a standard for determining symptoms severity.