Efficacy And Safety Evaluation Of Acupuncture And Moxibustion Combined With Tongyang Method In The Treatment Of Moderate And Severe Persistent Allergic Rhinitis

Background:Allergic rhinitis is a nasal mucosal allergic disease caused by exposure to allergens.The duration of persistent AR attack is usually more than 4 days a week and the duration of disease is more than 4 weeks a year.It is a chronic non-infectious disease.Moderate and severe allergic rhinitis may also induce diseases such as sinusitis and bronchial asthma,which greatly reduces people’s quality of life.The effectiveness of acupuncture and moxibustion has been reported in the literature of acupuncture and moxibustion in the treatment of this disease.However,due to some deficiencies in research design,the quality of evidence provided by research conclusions is uneven or the reliability of conclusions is reduced.For example:1.The control scheme selected in the study is unreasonable;2.The outcome can not fully reflect the purpose of the study.There are few studies using the difference to report the main efficacy evaluation outcome,and the observation outcome has not designed the internationally recognized efficacy evaluation outcome;3.The sample size has not been calculated or the sample size is too small;4.The observation period and time point do not accord with the law of the disease.With the development of evidence-based medicine in the field of traditional Chinese medicine,systematic evaluation of acupuncture and moxibustion in the treatment of allergic rhinitis gradually appears.The conclusions of these systematic reviews initially provide new evidence for allergic rhinitis with needle therapy and moxibustion,and provide a direction for the research and design of acupuncture and moxibustion in the treatment of allergic rhinitis.However,it is also found that there is a lack of high-quality clinical research.It is necessary to design reasonable high-quality clinical studies to further fully verify the effectiveness and safety of acupuncture and moxibustion in the treatment of allergic rhinitis.With the development of society,the change of climate,diet and other factors,the pathogenesis of this disease is more common,such as excessive heat in the chest and excess of Yang Ming.Therefore,according to the experience of treating this disease for many years,Professor Tian conghuo adopted acupuncture and moxibustion and Tongyang method to treat allergic rhinitis,and achieved good clinical curative effect.Based on this,this study intends to use two parts to demonstrate:1.At present,there is no systematic evaluation conclusion to confirm the effectiveness and safety of acupuncture and moxibustion in the treatment of allergic rhinitis.Therefore,"meta analysis of randomized controlled trials of different moxibustion methods combined with acupuncture in the treatment of adult allergic rhinitis" is carried out to evaluate the effectiveness and safety of acupuncture and moxibustion in the treatment of allergic rhinitis.2.A prospective,randomized controlled research design was adopted to observe the effectiveness and safety of acupuncture and moxibustion combined with Tongyang method in treatmenting moderate and severe persistent allergic rhinitis,so as to provide high-quality research basis for the further clinical application of traditional Chinese medicine,and also provide a safe and effective treatment method for the majority of AR patients.Research I Literature ResearchMeta analysis of randomized controlled trials of different moxibustion combined with acupuncture in the treatment of adult allergic rhinitisObjective:To systematically evaluate the efficacy and safety of different moxibustion combined with acupuncture in the treatment of allergic rhinitis based on Meta-analysis.Methods:The randomized controlled trials(RCTs)of acupuncture combined with Moxibustion in the treatment of allergic rhinitis from the date of establishment to April 1,2021 were searched in seven databases including CNKI,SinoMed,Wanfang,VIP,PubMed,EMBASE and Cochrane Library,After data extraction and quality evaluation,Revman 5.3 software was used for meta-analysis.Result:Eleven RCTs involving 1238 patients were included.The results of meta-analysis showed that:①The comprehensive evaluation of different moxibustion combined with acupuncture in the treatment of allergic rhinitis was better than that of Western medicine group(OR=2.57,95%CI:1.69 to 3.91,P=0.34);The symptom and sign score of warm acupuncture in the treatment of allergic rhinitis was better than that of Western medicine SMD=-0.30,95%CI:-0.53 to-0.06,P=0.88);The serum IgE level of warm acupuncture in the treatment of allergic rhinitis was better than that of Western medicine group(SMD=-1.32,95%CI:-1.55 to-1.10,P=0.43).②The comprehensive evaluation of different moxibustion methods combined with acupuncture and Western medicine in the treatment of allergic rhinitis was better than that of Western medicine alone(OR=3.35,95%CI:1.63 to 6.89,P=0.34);The score of symptoms and signs of warm acupuncture combined with western medicine in the treatment of allergic rhinitis was better than that of Western medicine alone(SMD=-1.49,95%CI:-2.14 to-0.84,P=0.03);The level of serum IgE in the warm acupuncture combined with western medicine group was better than that in the western medicine group alone(SMD=-2.29,95%CI:-2.54 to-2.04,P=0.0001).③The adverse reaction rate of different moxibustion methods combined with acupuncture and Western medicine in the treatment of allergic rhinitis was similar to that in the western medicine group alone(OR=0.49,95%CI:0.17 to 1.43).Conclusion:Different moxibustion combined with acupuncture is safe and effective in the treatment of allergic rhinitis,which is superior to western medicine.Maybe it can be used as a supplementary treatment of Western medicine in the treatment of allergic rhinitis,without increasing its adverse reactions.However,more high-quality,large sample,multicenter randomized controlled trials are needed to provide further evidence for the conclusion of this systematic review.Research 2 Clinical StudyEfficacy and safety evaluation of acupuncture and moxibustion combined with Tongyang method in the treatment of moderate and severe persistent allergic rhinitisObjective:To evaluate the efficacy and safety of acupuncture and moxibustion combined with Tongyang method in improving moderate and severe persistent allergic rhinitis.Methods:This study was a prospective,randomized controlled study.52 patients with allergic rhinitis who met the inclusion criteria and voluntarily signed informed consent and were willing to participate in the study were randomly assigned to acupuncture group and sham acupuncture group in the ratio of 1:1,with 26 cases in each group.The two groups of acupoints were Dazhui,Yingxiang,Quchi,Zusanli and Huangshu.The patients were treated for 4 weeks and followed up for 8 weeks.During the treatment period,the difference of total score of nasal symptoms at the end of 4 weeks of treatment was taken as the main outcome.At the same time,the total score of nasal symptoms(TNSS)at other time points,total score of inflammatory concomitant symptoms(TNNSS)and RQLQ score of quality of life questionnaire of nasal conjunctivitis were observed.The efficacy and safety of acupuncture and moxibustion combined with Tongyang method in the treatment of persistent allergic rhinitis were explored by observing the outcome scores and safety evaluation of each evaluation time point of the two groups.SPSS 25.0 statistical software was used for statistical analysis.All tests were performed by two-sided test.The measurement data were expressed by X±S.P<0.05 was considered statistically significant.When the data of the two groups accord with the normal distribution and the homogeneity of variance,paired t-test was used to compare the difference in efficacy within two groups,and independent sample t-test was used to compare the difference in efficacy between two groups;Those that do not meet the normal distribution are described by median and interquartile spacing.The counting data are described by the number of cases and percentage.Result:1.Within 4 weeks of treatment,acupuncture and moxibustion combined with Tongyang method was effective in improving the TNSS score of patients with allergic rhinitis and better than the control group(P<0.05).It was effective for nasal itching and nasal congestion until the end of the treatment course(P<0.05).For sneezing,it had a good short-term effect(P<0.05),but the lasting effect was not certain(P>0.05);At the 8th week of follow-up,due to the insufficient number of follow-up cases,it can only show that this method has a continuous advantage in improving the TNSS score of AR(P<0.05).2.Acupuncture and moxibustion combined with Tongyang method was not better than the control group in improving the TNNSS score of patients with AR(P>0.05).3.Acupuncture and moxibustion combined with Tongyang method is effective in improving the quality of life of allergic rhinitis(P<0.05);It also showed good advantages in daily non nose/eye problems(such as energy,attention,working ability,etc.),eye problems and emotions(P<0.05).4.In the course of treatment,1 case in the experimental group and 1 case in the control group had slight acupuncture local short-term pain,which improved without special treatment.There were no adverse events in both groups.Conclusion:Acupuncture and moxibustion combined with Tongyang method is safe and effective in the treatment of moderate and severe persistent allergic rhinitis,which is better than comfort acupuncture.In particular,it shows obvious therapeutic advantages in improving the main symptoms of persistent allergic rhinitis,improves the quality of life,and has certain post-treatment advantages.Therefore,it is a safe and effective acupuncture method for the treatment of persistent allergic rhinitis.Due to the limitations of epidemic situation,research time and funds,the sample size of cases included in this study is slightly insufficient,especially the follow-up observation data.In the later stage,it is still necessary to continue to collect cases,expand the sample size,further explore the clinical efficacy of acupuncture and moxibustion combined with Tongyang method in the treatment of allergic rhinitis,and more comprehensively and objectively verify the effectiveness of acupuncture and moxibustion combined with Tongyang method in the treatment of allergic rhinitis.