[Medicinal-powder-separated Long-snake Moxibustion over the Governor Vessel with Different Skin Vesiculation Conditions for Treatment of Patients with Rheumatoid Arthritis].

Objective: To observe the curative effect of herbal-medicine -powder-separated "Long-snake moxibustion" over the Governor Vessel at different vesiculation conditions in the treatment of rheumatoid arthritis (RA).
Methods: A total of 120 RA patients received herbal-powder-separated long-snake moxibustion in the present study and randomized into Banmao ( Cantharides , CANT, being able to promote skin vesiculation for enhancing the therapeutic effect)-0 g group, CANT-1.5 g group and CANT-3.0 g group ( n =40 in each group) according to the dosage of CANT used in the herbs-medicinal powder. In addition to Cantharides, the medicinal powder also contained Shexiang ( Moschus , 1 g), Dingxiang ( Flos Caryophylli ,1 g) and Rougui ( Cinnamon bark ,1 g). When treated, the patient was asked to take a prone position, the ginger juice was evenly smeared on the patient's back from Dazhui (GV 14) to Yaoshu (GV 2, about 3 cm wide), then, the above-mentioned medicinal powder was spread on the smeared ginger juice, followed by putting a layer of gauze, ginger powder and ignited moxa-stick, respectively. The treatment was conducted once every 30 days, and twice altogether. The visual analog scale (VAS) was used to assess the pain seve-rity of moxibustion-induced skin vesiculation on the patient's back in 24 h after moxibustion. The severity of vesiculation was assessed according to the status of vesicles appeared at the local skin (0 point:no vesicles;3 points:string-of-beads-like vesicles with the vesicle diameter being less than 2 cm; 6 points:foliated vesicles with the vesicle diameter being larger than 2 cm). The patient's symptoms and dysfunction of hand-knee joints were scored, and serum rheumatoid factor (RF), C-reactive protein (CRP), immune globulin IgM and IgG contents were assayed by ELISA, and the erythrocyte sedimentation rate (ESR) was determined by using Westergren method.
Results: After moxibustion, of the three 40 RA patients in the CANT-0 g, CANT-1.5 g and CANT-3.0 g groups, 0, 10 and 12 cases were under control in their symptoms, 7, 16 and 19 experienced marked improvement, 17, 9 and 6 were improved, 16, 5 and 3 failed in the treatment, with the effective rates being 60.0%(16/40), 87.5%(35/40) and 92.5%(37/40), respectively. The curative effects of CANT-1.5 g and CANT-3.0 g were significantly superior to that of CANT-0 g ( P <0.01). Both the scores for skin vesiculation status and pain severity were significantly higher in the CANT-3.0 g group than in the CANT-0 g (no skin vesiculation) and CANT-1.5 g groups, and markedly higher in the CANT-1.5 g group than in the CANT-0 g group ( P <0.01). Following the treatment, the symptom score and joint dysfunction score, ESR level, and serum RF, CRP, IgM and IgG contents were considerably decreased in the three groups in comparison with pre-treatment in the same one group ( P <0.01); and those of the CANT-1.5 g and CANT-3.0 g groups were markedly lower than those of CANT-0 g group ( P <0.01). In addition, CANT-3.0 g was notably superior to CANT-1.5 g in lowering symptom and joint dysfunction scores, ESR, serum RF and CRP contents ( P <0.05). No significant differences were found between the CANT-1.5 g and CANT-3.0 g groups in serum IgM and IgG levels and in the therapeutic effect ( P >0.05).
Conclusions: Long-snake moxibustion combined with CANT-induced vesiculation has a good curative effect in the treatment of RA, which may be associated with its effects in lo-wering ESR level, and serum RF, CRP, IgM and IgG contents. The curative effect of vesiculation moxibustion is far better than non-vesiculation moxibustion, but mild vesiculation moxibustion is recommended due to severe pain of CANT-3.0 g.