| ObjectiveFirstly,the related articles on the understanding of symptoms including Sour,Dump,Heavy,Distension and Pain caused by Cervical spondylosis(CS),thus Neck Bi,written and recorded by doctors in related dynasties,were comprehensively analyzed.The occurrence frequency of articles about cause,mechanism,and outcome of CS related symptoms mentioned above,were calculated,according to different symptoms.This part aimed at investigating the deep pathologic mechanism on CS and Cervical spondylosis radiculopathy(CSR)occurrence in the perspective of Traditional Chinese medicine(TCM).Based on this and the studies from domestic and abroad,related study data were arranged.The Meta analysis was applied to research the effect of treatment period on the efficacy of Acupuncture treating CSR.The Cluster Analysis was used to group the meridians and points used in Acupuncture treating CSR to select the best meridians and points for Acupuncture treating CSR.Then,identified Acupuncture points were taken as the intervention methods and the clinical RCT test including different treatment periods of Acupuncture treating CSR was carried out,aiming at exploring the efficacy difference and efficacy lasting-time differences of different treatment periods and treatment frequency used by Acupuncture treating CSR.This study aimed at investigating the deep pathologic mechanism of CSR occurrence,summarizing the best meridians,points,and periods for Acupuncture treating CSR,providing the reference for Acupuncture treating CSR in clinic,and reducing the pain and increasing the efficacy for CSR patients.Methods(1)Ancient books and literatures research on the correlations between Cervical spondylosis and "acid","hemp","heavy","swelling","pain":Taking TCM Dictionary and Chinese Medical Dictionary as the main database.Used Bi symptoms,Neck stiff,Neck muscle spasm,and Neck tendon spasm as the searching key terms,which were searched in the two groups.Then related articles were copied and recorded in the EXCEL tables,frequencies of which were analyzed and calculated in the perspectives of disease reason,disease mechanism.For the unclear parts,we turn to library to complete the research by hand.(2)Systematic evaluation and Meta-analysis for treatment duration affecting the efficacy of acupuncture on CSR:We used corresponding search terms to search clinical literature about acupuncture treating CSR in domestic and overseas data(CNKI,WanFang,VIP;Pubmed,Web of Science,Clinical Trials)from inception to December,1 2020.Efficient information was selected and recorded according to the inclusion and exclusion criteria.Through primary management of data in the included studies,VAS and other efficacy markers differences were calculated by corresponding data statistic software from the values before and after treatment.The meta-analysis using R language software 4.0.0 was used to compare the efficacy differences between different treatment time in studies,which were matched strictly in accordance with corresponding standards.The difference in VAS pain scores in CSR patients was analyzed under different acupuncture time periods(10 days,14 days,20 days,etc.).(3)Acupoint clustering analysis of acupuncture treatment for CSR:Corresponding search terms were applied to search clinical literature about acupuncture treating CSR in domestic and overseas data(CNKI,WanFang,VIP;Pubmed,Web of Science,Clinical Trials)from inception to December,1 2020.Efficient information was selected and recorded,which was analyzed by cluster analysis in SPSS 19.0.The results were showed using dendrogram and Agglomeration schedule constructed by Agglomeration schedule.(4)Clinical research for the efficacy-lasting time of Acupuncture treating CSR:180 cases diagnosed as CSR and complying with the inclusion criteria in Jianqun clinic were selected as research subjects,randomly divided into high-frequency treatment group and lowfrequency treatment group with 90 cases in each group.Then they were treated with identified points using acupuncture.According to the follow-up time,the 90 cases in each were divided randomly into long-time treatment group(4 weeks)and short-time treatment group(2 weeks).Then the total 6 weeks follow-up time was applied to analyze the VAS and NDI scores difference between the four groups and changes trends during the 6 weeks follow-up time.Results(1)Ancient books and literatures research on the correlations between Cervical spondylosis and "acid","hemp","heavy","swelling","pain":The location of Bi symptom and Sour article was knee joint,with disease reason being Wind Cold and Moisture and disease metabolism being three reasons attacking body causing Yingwei disorder and tendon and meridian spasmed.The location of Neck stiff and Sour article was neck part(64/74),waist(44/74)waist and back(6/74),with disease reasons being wind attacking upper part,moisture attacking lower part(29/74),wind and cold attacking Taiyang meridian(13/74)and so on.The location of Bi symptom and Sour article was neck(12/17),waist and back(3/17),and knee joint(1/17),with disease reason being wind cold moisture(8/17),wind(3/17)and so on and disease mechanism being wind cold moisture blocking meridian,Qi and Blood operation disorder,wind attacking skin causing dump,wind cold moisture blocking skin and muscle and soon.The location of Neck stiff and dump article was neck(10/14),with diseases being wind cold moisture(5/14),wind cold(3/14)and so on and disease mechanism being wind cold moisture blocking skin and muscle causing dump and less felling,wind attacking Taiyang directly,deficiency of Qi and Blood.The location of Bi symptom and Heavy article was waist and back(2/7)and four limb(2/7),with disease reasons being wind cold moisture(2/7),liver depression(2/7)and disease mechanism being wind cold moisture blocking four limb meridian,moisture attacking spleen and stomach,liver air depression,Qi not running Blood and so on.The location of Neck stiff and Heavy article were neck(43/108),head(16/108),head and back(9/108)and four limb(2/108),with disease reasons being wind cold moisture(20/108),wind phlegm moisture(9/108),wind cold shu moisture(5/108),phlegm moisture(5/108),liver depression,moisture heat and so on and disease mechanisms being wind cold moisture attacking Taiyang,Qi and Blood blocking,moisture pressing spleen and stomach,wind blocking,phlegm blocking meridian causing headache,nasal congestion,sound heavy,liver pain,wind moisture blocking Taiyang meridian and so on.The locations of Bi symptom and Distension article included stomach and abdomen,waist and knee,lung and four limb,lung and thoracoabdominal part(1/7 respectively),with disease reasons being wind cold moisture,gastric deficiency with food destroying,kidney yang deficiency,phlegm moisture,floating moisture and disease mechanisms being spleen and stomach deficiency,internal food destroying,wind moisture blocking meridian,Qi congestion and Blood stasis,kidney not receiving Qi,Lung air stasis and so on.The locations of Neck stiff and Distension article included neck(26/32),thoracal and flank part(9/32),lung(6/32),with disease reasons being kidney Yang deficiency(6/32),lung Qi deficiency(5/32),wind cold Shu moisture(5/32),spleen lung deficiency and phlegm moisture blocking(4/32),wing moisture heat(3/32),heat toxin and so on and disease mechanisms being deficiency of lung causing lung Wei,Qi deficiency causing lower protection ability,cold moisture blocking,deficiency of spleen and lung,digestion disorder,water and moisture blocking and laying in muscle and joints,wind moisture heat blocking Yang Qi causing Qi congestion and Blood stasis,kidney not receiving Qi causing lung Qi stasis,external wind attacking skin with Yang deficiency causing disorder of Qi and Blood,limb swelling thoracal distension and asthma,heat toxin staying in lung causing distension of lung Qi and so on.The locations of Bi symptom and Pain article included whole body(25/60),four limb joint(5/60),and waist knee(4/60),with disease reasons being wind cold moisture(7/60),wind cold(12/60),wind moisture heat(3/60),and so on and disease mechanisms including walking Bi caused by priority of wind,fixed Bi caused by priority of moisture,pain Bi caused by priority of cold,wind cold blocking Yang Qi and disconnection of Ying and Wei causing pain Bi,cold moisture blocking meridian causing waist knee heavy,limb body cold pain causing wind Bi and moisture Bi.The locations of Neck stiff and Pain article included neck part()17/30 mainly,with disease reasons being wind cold moisture(9/30),wind Shu moisture(4/30),wind cold(2/30),wind attacking upper part and moisture attacking lower part and so on and disease mechanisms being wind cold blocking Yang Qi with disconnection of Ying Wei,leading Pain Bi,external wind Shu heat blocking Taiyang meridian Three Jiao blocking with disconnection of external and internal,wind cold attacking Taiyang and Shaoyang and so on.(2)Systematic evaluation and Meta-analysis for treatment duration affecting the efficacy of acupuncture on CSR:257 efficient studies were selected.By relative data statistics,we found the VAS difference between 30 days group and 10 days group was significant,P=0.002.Compared with the 10 days group,the VAS decreasing value of 30 days group was 1.18,with 95%confidence interval being 0.56 and 1.79.The VAS difference between 30 days group and 14 days group was significant,P=0.0415.Compared with the 14 days group,the VAS decreasing value of 30 days group was 3.47,with 95%confidence interval being 0.13 and 6.80.The rest groups had no difference.The rest efficacy markers could not be calculated because of less literatures.(3)Acupoint clustering analysis of acupuncture treatment for CSR:A total 556 literatures were selected according to the inclusion and exclusion criteria.Points used more than 10 times were 66,with total 9580 times.Total 13 meridians were applied.More than 10%of appliance frequency belonged to the extraordinary points(18.9%),Shou yangming large intestine meridian(15.28%),Shou taiyang small intestine meridian(12.31%),Zu taiyang bladder meridian(12.13%).More than 10%of appliance frequency belonged to Du meridian(7.32%),Shou shaoyang sanjiao meridian(7.16%).The rest were Zu yangming gastric meridian,Shou taiyin lung meridian,Zu shaoyin kidney meridian,Zu taiyin spleen meridian,Zu jueyin liver meridian,Shou shaoyin heart meridian,which were used less.The cluster analysis about points used in acupuncture treating CSR showed five categories of points used in acupuncture treating CSR.The forst category were Ashi point,Neck Jiaji.The second category Hegu,Fengchi,Dazhui,Quchi,Houxi.The third category were Tianzhu,Fengmen,Lieque,Waiguan,Jianjing;The forth categor common were Fengfu,Wailaogong,Tianzong,Jianliao,Jiaoyu.The fifth category were Jianqian,Bizhongshu,Jingbailao,Binao,Jianzhongshu,Jianzhen,Taixi,and so on;The fifth most common were Yangchi,Naohui,Renying,Gongsun,Biguan,Yanglao,Futu,Tongli,Guangming,Zhizheng,Pianli,Dazhu,Futu and so on.The extra acupoints were applied more frequently,which were successively Jingjiaji,Wailaogong,Jianqian Point,Bizhong Point,Jingbailao,Jiansanzhen and so on.(4)Clinical research for the efficacy-lasting time of Acupuncture treating CSR:Before treatment,the VAS and NDI scores between the four groups had no difference.After treatment,compared with the low-frequency and short-time treatment group(41.87%),the effective percentages of high-frequency and short-time treatment group(68.30%)and lowfrequency and long-time treatment group(63.42%)were higher,P<0.05.After treatment,the VAS scores of high-frequency and long-time treatment group and low-frequency and longtime treatment group were better,lasting for approximately 4 weeks.At the same time,the pain alleviation efficacy and lasting time of low-frequency and long-time treatment group was better than those of high-frequency and long-time treatment group.From the perspective of VAS changes,1 week after the treatment the VAS score of long-time treatment group and low-frequency and long-time treatment groups decreased to some extent than that before treatment and kept a relatively stable during the first and forth weeks of follow-up time.The VAS score of low-frequency and long-time treatment group was always lower than that of high-frequency and long-time treatment group.From the perspective of NDI changes,1 week after the treatment,the NDI level of low-frequency and long-time treatment group increased more or less.From the first week to the second week after the treatment,the NDI scores of the rest three groups kept a lower level,but always higher than that of high-frequency and short-time treatment group.During the follow-up time,the NDI levels of high-frequency long-time treatment and short-time treatment groups were higher than those of low-frequency long-time treatment and short-time treatment groups,with the higher NDI level of highfrequency short-time treatment group compared to high-frequency long-time treatment group during the follow-up time.Conclusions(1)Ancient books and literatures research on the correlations between Cervical spondylosis and "acid","hemp","heavy","swelling","pain":The understanding of Sour,Dump,Heavy,Distension,and Pain and Cervical Spondylopathy had differences,with mainly disease reason and disease mechanism including wind cold moisture,wind moisture heat,moisture heat,Qi congestion and Blood stasis,Qi and Blood blocking,meridian blockage and relative understandings with each’s characteristics.(2)Systematic evaluation and Meta-analysis for treatment duration affecting the efficacy of acupuncture on CSR:Compared with once acupuncture a day consecutively for 10 days,14 days,and 20 days,once acupuncture a day lasting for 30 days might have better analgesic efficacy for CSR patients from the VAS perspective.(3)Acupoint clustering analysis of acupuncture treatment for CSR:The common meridians used in acupuncture treating CSR were extraordinary points,Shousanyang meridians,and Du meridian.The points applied in acupuncture treating CSR in clinic mainly included local points ameliorating neck and shoulder back pain,and disability,which had particular efficacies for CSR.At the same time,the points used in motivating blood and removing meridian obstruction,nourishing liver and kidney,and expelling wind and removing cold were also applied in a lower frequency.(4)Clinical research for the efficacy-lasting time of Acupuncture treating CSR:From the perspectives of saving medical resource and relieving the acupuncture of patients,the high frequency(6 times/week)plus short-time(2weeks)of acupuncture might be the proper management for CSR. |
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