Vertebral Artery Stenting for Acute Multiple Cerebral Infarctions Caused by Vertebral Artery Dissection After Massage: A Case Report.

Vertebral artery dissection is a rare pathology that causes ischemic stroke in young people. Cervical massage, especially improper pulling manipulation, is a cause of vertebral artery dissection. We present a case of 32-year-old woman who developed acute multiple posterior circulation ischemic cerebral infarctions as a result of left vertebral artery V4 segment dissection after receiving neck massage. She underwent emergency vertebral artery stent implantation at the site of the dissection. Symptoms were relieved the day after treatment. The patient recovered without adverse complications or endovascular restenosis in the following year.

[Regularity of meridian-acupoint reactions of foot three yin meridians in primary dysmenorrhea and secondary dysmenorrhea patients].

OBJECTIVE: To observe the meridian-acupoint reactions of foot three yin meridians in primary dysmenorrhea(PD) and secondary dysmenorrhea(SD) patients, so as to summarize the rules of meridian-acupoint reaction and acupoints selection. METHODS: Thirty-five patients with PD (PD group), 34 patients with SD (SD group) and 35 healthy subjects (healthy group) were recruited. The compression method was used to examine the lower leg segment of the foot three yin meridians. Positive reactions(palpable skin changes, including cords, nodules, depressions) and tenderness of meridians and acupoints were recorded. The visual analogue scale (VAS) was used to evaluate the tenderness severity of acupoints. RESULTS: Compared with the healthy group, the probability of positive reactions and tenderness in foot three yin meridians were higher in PD and SD groups (P<0.01,P<0.05). Compared with the PD group, the probability of positive reactions in Spleen and Liver Meridians were higher in the SD group, with higher probability of tenderness in Liver Meridian(P<0.05). The probability of positive reactions and tenderness in the Spleen Meridian of PD and SD groups was significantly higher than that in the Kidney Meridian (P<0.01), while the probability of tenderness in the Spleen Meridian of the PD group was significantly higher than that in the Liver Meridian (P<0.05). Positive reactions and tenderness were concentrated at Yinlingquan (SP9), Diji (SP8) and Sanyinjiao (SP6) of Spleen Meridian and Xiguan (LR7) and Ligou (LR5) in Liver Meridian of PD and SD groups. In comparison with the PD group, the probability of positive reactions, tenderness and VAS score of SP8 and LR5 of the SD group were higher (P<0.05, P<0.01). CONCLUSION: The positive reaction occurs most frequently in the Spleen Meridian, followed by the Liver Meridian, and least frequently in the Kidney Meridian. The acupoints with positive reaction are different between PD and SD, which suggests that the Spleen Meridian acupoints should be the main acupoints when treating the two kinds of dysmenorrhea, and acupoints should also be selected according to the meridian and acupoint examination results.

[Constructing of clinical thinking of acupuncture and moxibustion, improving the medical record writing ability of standardized training physicians: teaching experience of the standardized training textbook Acupuncture and Moxibustion for national TCM resident physicians].

To explore the methods of cultivating the clinical thinking ability of acupuncture and moxibustion in the standardized training of resident physicians, so as to improve the medical record writing ability of the regular training physicians. The clinical diagnosis and treatment of acupuncture and moxibustion has its own characteristics and can't copy the syndrome differentiation and treatment mode of TCM internal medicine. In the treatment section, Acupuncture and Moxibustion, a standardized training textbook for national TCM resident physicians, takes clinical cases as the breakthrough point and uses the problem as the guide, guides the training physicians to cultivate acupuncture and moxibustion clinical diagnosis and treatment from three aspects: disease diagnosis, syndrome diagnosis, and treatment ideas, forms a complete understanding of the disease, and improves the standardization, logicality and systematicness of medical record writing through repeated practical training.

[Point-pricking method with fire needle for knee osteoarthritis: a randomized controlled trial].

OBJECTIVE: To observe the effects of point-pricking method with fire needle on the symptoms of knee joint and physio-psychological health in the patients with knee osteoarthritis (KOA). METHODS: Sixty six patients with KOA were randomly divided into a fire needling group (33 cases) and a filiform needling group (33 cases). The patients received the point-pricking method with fire needle in the fire needle group while the conventional acupuncture with filiform needle was provided in the filiform needling group. The basic health management was performed in both groups. The acupoints included bilateral Liangqiu (ST34), Xuehai (SP10), Dubi (ST35), Neixiyan (EX-LE4), Yanglingquan (GB34) and Zusanli (ST36) as well as Ashi points. The treatment was conducted twice a week for 6 weeks consecutively. Before and after treatment, the scores of Western Ontario and McMaster University Osteoarthritis Index (WOMAC), traditional Chinese medicine (TCM) symptoms and visual analogue score (VAS), the numbers of affected areas of knee joint pain and the scores of 12-item short-form health survey (SF-12) were assessed and the incidence of adverse effects was recorded. RESULTS: The score for pain, stiffness and function, as well as the total score of WOMAC were all reduced (P<0.05), the score of TCM symptoms, VAS score and the numbers of the affected areas of knee joint pain were lower (P<0.05) after treatment when compared with those before treatment within group. After treatment, the score of each domain of SF-12 (i.e. general health, physical function, role-physical, vitality, role-emotional, physical component summary and mental component summary) was higher in comparison to those before treatment in both groups (P<0.05), while the scores of bodily pain, mental health and social functioning in SF-12 were increased in the fire needling group (P<0.05). Compared with the filiform needling group, the score of joint function and the total score in WOMAC and VAS score were reduced remarkably (P<0.05), and general health score in SF-12 was more obviously increased (P<0.05) in the fire needling group after treatment. None adverse effects were found in either group. CONCLUSION: The point-pricking method with fire needle is safe and effective when compared with conventional acupuncture with filiform needle. In the aspects of improving knee joint function, relieving joint pain and advancing the quality of life, the point-pricking method with fire needle is superior to the conventional acupuncture with filiform needle.

[Consolidating the foundation, highlighting the practice and strengthening the training of clinical thinking of acupuncture and moxibustion: the thoughts of compiling the China national standardized training textbook Acupuncture and Moxibustion for residents of traditional Chinese medicine].

Based on the clinical needs and examination requirements of standardized training students, the China national standardized training textbook Acupuncture and Moxibustion for residents of traditional Chinese medicine has made innovations in the textbook content and form. In the part of meridians and acupoints, the classic original text is introduced and the main indications and operation methods of 200 commonly-used acupoints are summarized in the form of tables. In the part of acupuncture and moxibustion technique, the operating procedures are standardized and the core technical points of 20 commonly-used acupuncture and moxibustion techniques are summarized in the form of flow chart. In the part of acupuncture and moxibustion treatment, 48 typical diseases are introduced in the form of case discussion, highlighting the problem orientation and demonstrating the diagnosis and treatment procedures.

[Acupoint selection rules and characteristics of insomnia in the elderly treated with acupuncture].

The published literature of insomnia in the elderly treated with acupuncture was retrieved in CNKI, Wanfang and VIP from the date of establishment to December 31, 2019. Association rule analysis and cluster analysis were used to summarize the acupoint selection rules of insomnia in the elderly treated with acupuncture. A total of 37 articles were included, involving 60 acupuncture prescriptions. The most commonly used acupoints were Sanyinjiao (SP 6), Shenmen (HT 7), Anmian (Extra), Baihui (GV 20), Sishencong (EX-HN 1), Neiguan (PC 6), Xinshu (BL 15) and Taixi (KI 3). The most commonly used acupoint combinations were Sanyinjiao (SP 6)-Anmian (Extra)-Baihui (GV 20)-Sishencong (EX-HN 1)-Shenting (GV 24)-Shenmen (HT 7)-Xinshu(BL 15), Xinshu(BL 15)-Pishu (BL 20)-Shenshu (BL 23)-Shenting (GV 24), Zhaohai (KI 6)-Shenmai (BL 62), Taichong (LR 3)-Ganshu (BL 18), Daling (PC 7)-Taixi (KI 3), Neiguan (PC 6)- Zusanli (ST 36) and Guanyuan (CV 4)-Qihai (CV 6)-Zhongwan (CV 12). On the basis of acupoint selection according to disease differentiation, the acupoint selection rules and characteristics of insomnia in the elderly treated with acupuncture are regulating and supplementing the spleen and kidney and treating according to spleen-kidney.

[Thought on diagnosis and treatment with acupuncture and moxibustion for facial spasm based on qijie theory].

In the guidance of qijie (qi street, path of qi ) theory, the thought on diagnosis and treatment with acupuncture and moxibustion for facial spasm is analyzed. Qijie theory is a summary of the horizontal distribution rule of human body and the conclusion of the characteristics of function and indication in a certain area. In terms of spatial location and functional characteristics, facial spasm is related to "head qijie". In treatment with acupuncture and moxibustion, the local acupoints are predominated. Additionally, the distal acupoints are selected based on the characteristics of qijie in pathological condition, "qijie is unblocked even though the obstruction occurs in minor collateral"; and the acupoints for calming the mind are combined based on the relationship between head qijie and the brain function, aiming to regulating the body, qi and spirit. Regarding the techniques of acupuncture and moxibustion, align with the spatial location and hierarchical location of disease, the depth of filiform needle insertion and needling stimulation are specified and the palpation on the local meridians and acupoints are emphasized before acupuncture specially.

[Instructive significance of "treatment in accordance with time factor" for the idea of clinical diagnosis and treatment with acupuncture and moxibustion].

"Treatment in accordance with time factor" is one of the key principles of acupuncture and moxibustion treatment. In clinical practice of acupuncture and moxibustion, the connotation of "timing/time factor" should be fully understood and the temporal rule on physiology and pathology affected by the changes of four seasons and day and night be grasped. Based on the change law of qi, blood, yin and yang and the rise and fall rules of pathogens and antipathogenic qi, the intervention is exerted timely. The dynamic law of acupoints should be associated with the changes in pathogenesis and illness location, thus, the acupoint selection, needle manipulation and needle withdrawal can be operated precisely. The idea of time factor should be considered in the whole process of clinical diagnosis and treatment with acupuncture and moxibustion so as to provide some guidance for clinical analysis and practice.

[Acupuncture for secondary dysmenorrhea of adenomyosis: a prospective case-series study].

OBJECTIVE: To observe the clinical effect of acupuncture by stages on secondary dysmenorrhea of adenomyosis through prospective case-series study. METHODS: A total of 36 cases of adenomyosis patients with moderate-to-severe dysmenorrhea were treated with acupuncture by stages. The acupoints of Diji (SP 8), Sanyinjiao (SP 6), Ciliao (BL 32) and Shiqizhui (EX-B 8) were selected and acupuncture was given once a day during menstrual period; the acupoints of Guanyuan (CV 4), Zigong (EX-CA1), Sanyinjiao (SP 6) and Zusanli (ST 36) ect. were selected and acupuncture was given twice per week during non-menstrual period. All the treatment was given for three menstrual cycles. The visual analogue scale (VAS), Cox menstrual symptom scale (CMSS), Endometriosis Health Profile-5 (EHP-5) scores and the menstrual blood volume of pictorial blood loss assessment chart (PBAC) were observed before treatment and at the 1st, 2nd and 3rd menstrual cycle into treatment. Before treatment and at the 3rd menstrual cycle into treatment, the volume of uterus was measured by transvaginal ultrasound and the correlation among the quality of life, the severity of pain and symptoms was analyzed. RESULTS: The VAS, CMSS and EHP-5 scores at the 1st, 2nd and 3rd menstrual cycle into treatment were lower than those before treatment (P<0.01, P<0.05), and the PBAC scores were reduced but without statistical different (P>0.05). Compared before treatment, at the 1st, 2nd and 3rd menstrual cycle into treatment, the PBAC scores were reduced in patients with PBAC>100 points (P<0.01). Compared between 2nd and 1st menstrual cycle into treatment, between 3rd and 2nd menstrual cycle into treatment, the VAS, CMSS scores were all decreased (P<0.01, P<0.05). There was a significant positive correlation between the severity score of CMSS and EHP-5 at the corresponding time points of the 1st, 2nd and 3rd menstrual cycle into treatment (P<0.01). CONCLUSION: The acupuncture by stages has significant analgesic effect in patients with secondary dysmenorrhea of adenomyosis, and has the advantages of relieving the menstruation-related symptoms, regulating menstrual blood volume and improving the quality of life.

[Discussion on the classification of acupoints].

This paper discusses the existing classification of acupoints and puts forward a new classification method of acupoints. Through the definition of 3 kinds of acupoints and the analysis of the original meaning of ashi points, it is pointed out that the existing classification of acupoints has overlapping among different categories. The acupoints are reclassified based on the characteristics of acupoints in reflecting and treating disease as well as the application of acupoints in clinic. Acupoints can be divided into traditional acupoints and modern holographic acupoints, among which traditional acupoints can be divided into meridian system points and extra points. According to their structure and function features, meridian system points can be divided into meridian points, collateral points, meridian-muscles points and cutaneous region points. The new classification method of acupoints highlights the importance of channel-collateral theory in acupuncture clinic and the feature of acupuncture in the diagnosis and treatment of disease.

Impact of acupuncture for allergic rhinitis on the activity of the hypothalamus-pituitary-adrenal axis: study protocol for a randomized controlled trial.

BACKGROUND: Patients with moderate and severe persistent allergic rhinitis (AR) have long-term physical and mental stress, leading to dysfunction of the hypothalamus-pituitary-adrenal (HPA) axis, which results in recurrence of AR. Previous research has proved acupuncture can regulate the function of the neuron-endocrine-immune system and contribute to improving the quality of life of patients with AR. This research aims to investigate the mechanism of acupuncture on the HPA axis in patients with moderate or severe persistent AR. METHODS/DESIGN: This randomized controlled trial aims to study the impact of acupuncture on the HPA axis of patients with moderate and severe AR. This research also aims to compare the curative effects of different treatments in three groups of patients: those receiving western medicine, western medicine and conventional acupuncture, or western medicine and mind-regulating acupuncture. We will study the therapeutic effect of acupuncture and the correlation between the changes of therapeutic indexes and experimental indexes after the treatments. Therapeutic indexes include the Visual Analog Scale (VAS) of nasal symptoms and the Rhinoconjunctivitis Quality of Life Questionnaire (RQLQ) for AR patients; experimental indexes include corticotropin releasing hormone (CRH), adreno-corticotropic hormone (ACTH), cortisol (CORT), interleukin 4 (IL-4), and interferon-γ (IFN-γ). DISCUSSION: The results of this trial will provide evidence for the influence of chronic, long-term, repeated stimulation in patients with moderate and severe persistent AR and the impact of acupuncture on the HPA axis of these patients. TRIAL REGISTRATION: Acupuncture-Moxibustion Clinical Trial Registry, AMCTR-IOR-16000009 . Registered on 22 August 2016.

[Randomized controlled clinical trial of acupuncture treatment for knee osteoarthritis in the early stage].

OBJECTIVE: To observe the therapeutic effect of acupuncture in the treatment of patients with knee osteoarthritis (KOA) in the early stage. METHODS: A total of 60 KOA patients were randomized into medication group and acupuncture combined with medication (acupuncture) group (n＝ 30 in each group). Patients of the medication group were treated by external application of Diclofenac Diethylamine Emulgel around the affected joint, 3 times a day for 2 successive weeks and reasonable exercising training. Patients of the acupuncture group received routine medication and reasonable exercising training and acupuncture of Ashi-points, Zusanli (ST36), Yanglingquan (GB34), Yinlingquan (SP9), Neixiyan (EX-LE4) and Dubi (ST35) at affected side with filiform needles which were manipulated with uniform reinforcing-reducing method for a while, followed by retaining the needles for 30 min. The treatment was conducted once every other day for 2 weeks. The pain degree was assessed by using visual analog scale (VAS) and the Western Ontario McMaster Universities Osteoarthritis Index (WOMAC) scale (0－240 points) was used to evaluate the severity of KOA, and the "Diagnosis of Syndromes of Traditional Chinese Medicine" was used to assess the therapeutic effect after the treatment. RESULTS: After the treatment, the VAS and WOMAC scores of both medication and acupuncture groups were significantly and respectively decreased in comparison with their own pre-treatment (P<0.05), and the scores of the two indexes of the acupuncture group were evidently lower than those of the medication group (P<0.05). Of the two 30 cases in the medication and acupuncture groups, 5 (16.67%) and 6 (20.00%) were cured, 17 (56.67%) and 19 (63.33%) experienced marked improvement, 6 (20.00%) and 4 (13.33%) were effective, 2 (6.67%) and 1 (3.33%) were ineffective, with the effective rate of cure plus marked effectiveness being 73.33% and 83.33%, respectively. No significant difference was found between the two groups in the therapeutic effect (P>0.05). CONCLUSION: Acupuncture combined with medication has a better therapeutic effect in the treatment of KOA in the early stage than that of the simple medication.

[A Randomized Controlled Clinical Trial of Treatment of Moderate and Severe Persistent Allergic Rhinitis of Spleen Deficiency Pattern by Herbal Cake-partitioned Moxibustion Combined with Rhinocort Nasal Spray].

OBJECTIVE: To evaluate the clinical effect of herbal cake-partitioned moxibustion combined with medication in the treatment of moderate and severe persistent allergic rhinitis (PAR) patients of spleen deficiency pattern. METHODS: Sixty patients with moderate and severe PAR of spleen deficiency pattern were randomized into medication (Rhinocort) group and herbal cake-partitioned moxibustion combined with medication group (combination group, n=30 cases in each). Medicinal cake-partitioned moxibustion was applied to Yintang (GV 29, for about 20 min), Shenque(CV 8, about 50 min), bilateral Zusanli (ST 36, about 40 min)and Hegu(LI 4, about 40 min)once every other day for successive 8 weeks. All the patients received treatment with Rhinocort nasal spray, 2 jets/day for each nostril (64 µg/jet) for 8 weeks. The patients' conditions (symptoms of nasal sufferings, sleeping, sniffle, eye, emotion, etc.) were assessed by visual analogue scale (VAS) and rhino conjunctivitis quality of life questionnaire (RQLQ, 24 items of 7 aspects, 0-6 points/item), respectively. The spleen deficiency syndrome score was determined according to "Guiding Principles for Clinical Research of New Drugs of Chinese Materia Medica" (2002). The therapeutic effect was assessed by referring to "the Diagnostic and Therapeutic Principles and Recommended Schemes for Allergic Rhinitis" (2004). RESULTS: Following the treatment, the scores of VAS, RQLQ, spleen deficiency syndrome were significantly decreased on the 4thand the 8th week of treatment in both groups in comparison with those of their own individual pre-treatment (P<0.05, P<0.01). Four weeks' follow-up survey showed that the VAS score and RQLQ score of the combination group were obviously lower than those of the medication groups (P<0.05), suggesting a better post-effect of moxibustion. Of the two 30 cases in the medication and combination groups, 9 and 9 experienced marked improvement in their symptoms, 16 and 17 were effective, and 5 and 4 ineffective, with the effective rate being 83.3% and 86.7%, respectively. No significant differences were found between the two groups in the VAS and RQLQ scores on the 4th and 8th week during treatment and in the effective rate (P>0.05). CONCLUSION: Herbal cake-partitioned moxibustion combined with hormone (Rhinocort) nasal spray is effective in relieving symptoms of moderate and severe PAR patients of spleen deficiency syndrome, and has a better post-effect.

[Acupuncture Treatment of Primary Dysmenorrhea by Needling Acupoints of the Spleen Meridian with Positive Reactions：A Randomized Controlled Clinical Trial].

OBJECTIVE: To observe whether acupuncture of the tender-points of the Spleen Meridian can achieve a better therapeutic effect for primary dysmenorrhea (PD) patients, so as to verify the importance of examining meridian-acupoint reactions in clinical practice. METHODS: A total of 72 PD patients were randomly assigned to tender-point group (observation group) and regular acupoint group (control group, n＝36 in each). For patients of the observation group, the tender-points around San-yinjiao (SP 6), Diji (SP 8) and Yinlingquan (SP 9) were needled, and for those of the control group, the regular SP 6, SP 8 and SP 9 were needled. After "Deqi", the filiform needles were manipulated with lifting-thrusting reducing technique for about 30 s, repeated once again every 10 min during 30 min's needle retention, and the treatment was conducted once daily for 3 days during every menstrual cycle, continuously for 3 months. The visual analogue scale (VAS) was rated for assessing the pain severity, and the COX menstrual symptom scale (CMSS) consists of 17 items and 5 grades/item (0－4 points) according to the severity of discomfort was rated before and after the treatment. RESULTS: After the treatment, the VAS and CMSS scores on the 1st days of the 1st, 2nd and 3rd menstrual cycles were significantly decreased in both control and observation groups in comparison with their own individual pre-acupuncture (P<0.05), suggesting a marked relief of both pain and discomforts after the treatment, and the therapeutic effect of the tender-point needling was significantly superior to that of the regular acupoint needling in relieving pain in the 2nd and 3rd menstrual cycles. No significant difference was found between the two groups in the discomfort severity (P>0.05). CONCLUSION: Acupuncture stimulation of the tender points around the SP 6, SP 8 and SP 9 has a stronger analgesic effect relevant to needling the regular acupoints in PD patients.