Acupuncture combined with herbal medicine outperforms an immunomodulatory drug for the treatment of Sjögren syndrome. Sjögren syndrome is an autoimmune disorder wherein the immune system attacks the lacrimal and salivary glands, causing impaired production of tears and saliva. Researchers (Li et al.) compared the therapeutic effects of acupuncture plus herbs with hydroxychloroquine.

A Traditional Chinese Medicine (TCM) group received acupuncture and the herbal formula Jie Du Tong Luo Sheng Jin Tang (toxin resolving channel freeing liquid engendering decoction). A drug group received hydroxychloroquine (an immunomodulatory and antimalarial drug) in tablet form. The acupuncture plus herbs group achieved an 83.33% total treatment effective rate. The drug group achieved a 60.00% total effective rate (p<0.05). [1]

Multiple subjective and objective instruments were used to measure patient outcomes. First, the score of the Eular Sjögren Syndrome Patient Reported Index (ESSPRI) and the Eular Sjögren Syndrome Disease Activity Index (ESSDAI) were measured. Second, tear and saliva flow rates were recorded. Third, the level of erythrocyte sedimentation rate (ESR), C-reactive protein (CRP), immunoglobulin G (IgG), and complement components 3 (C3) and 4 (C4) in blood serum were detected. Fourth, TCM syndrome scores were measured. Fifth, routine blood tests, urine tests, liver and kidney function tests were conducted once a month to monitor patient safety; adverse effect events were also recorded.

ESSPRI, ESSDAI, and TCM syndrome scores were used to measure disease activity. Tear and saliva flow rates assessed the severity of eye or mouth dryness. ESR, CRP, IgG, C3, and C4 levels tested immune system function.

The TCM treatment group produced significant improvements across the following parameters (p<0.05): ESSPRI, ESSDAI, TCM syndrome scores, saliva and tear flow rates, and serum ESR, CRP, IgG, C3, and C4 levels. The TCM group produced superior patient outcomes compared with the control group in the following areas (p<0.05): ESSPRI and TCM syndrome scores, saliva flow rates, and serum ESR levels. The researchers conclude that “Combining acupuncture with TCM herbs shows greater therapeutic effects in improving disease activity scores and objective indicators of pSS [primary Sjögren syndrome]. It is safe and effective for the treatment of pSS [primary Sjögren syndrome].”

 

Design
A total of 60 patients were treated and evaluated in this study. The patients received Sjögren syndrome treatment at Yueyang Integrated Traditional Chinese and Western Medicine Hospital (affiliated hospital of Shanghai University of Traditional Chinese Medicine). They were randomly divided into a TCM treatment group and a control group, with 30 patients in each group.

The statistical breakdown for each randomized group was as follows. The treatment group was comprised of 0 males and 30 females. The average age in the treatment group was 51.55 years. The average course of disease in the treatment group was 5.62 years. The control group was comprised of 1 male and 29 females. The average age in the control group was 51.65 years. The average course of disease in the control group was 5.95 years. There were no significant statistical differences in gender, age, and course of disease relevant to patient outcome measures for patients initially admitted to the study.

 

Acupuncture, Herbs, Medication
For the TCM treatment group, a specific acupuncture point prescription and herbal medicine formula were prescribed. The primary acupoints selected were the following:

  • LI4 (Hegu)
  • BL20 (Pishu)
  • BL23 (Shenshu)
  • ST36 (Zusanli)
  • SP6 (Sanyinjiao)
  • KI3 (Taixi)

Additional acupoints were administered based on symptom presentation. For severe eye dryness, the following acupuncture points were added:

  • BL1 (Jingming)
  • BL2 (Cuanzhu)
  • EX-HN4 (Yuyao)
  • TB23 (Sizhukong)
  • GB14 (Yangbai)
  • ST2 (Sibai)

For severe mouth dryness, the following acupoints were added:

  • CV23 (Lianquan)
  • EX-HN12 (Jinjin)
  • EX-HN13 (Yuye)
  • ST6 (Jiache)

For severe nose dryness, the following acupoint was added:

After disinfection of the acupoint sites, a needle was inserted into each acupoint to a standard depth. For the primary acupoints, the Ping Bu Ping Xie (mild attenuating and tonifying) manipulation technique was applied. The rest of the acupoints were applied with either the Bu (tonifying) or Xie (attenuating) manipulation technique based on symptom presentation. A 30-minute needle retention time was observed. Acupuncture treatment was conducted once per day, three times per week. A TCM herbal formula named Jie Du Tong Luo Shen Jin Tang was prescribed, which contained the following herbs:

  • Bai Hua She She Cao 15 g
  • E Zhu 15 g
  • Sheng Huang Qi 30 g
  • Dang Gui 9 g
  • Bai Shao 12 g
  • Sheng Gan Cao 6 g

Patients consumed the above herbs twice per day in a decoction. The control group patients received 0.1 g of hydroxychloroquine tablets, twice per day. For both groups, treatment was conducted for 30 days to complete one entire treatment course. A total of 2 courses were administered.

 

Treatment Principles
Li et al. selected Hegu clear heat, reduce inflammation, and reinforce immune function. Pishu and Shenshu were selected to regulate relevant Zang-fu organs (i.e., spleen and the kidney). Zusanli is the He-confluence point of the foot yangming stomach meridian. Needling this point regulates the spleen and stomach, invigorates blood, and frees the meridians and collaterals. Research confirms that Zusanli regulates the immune system. [2]

Sanyinjiao combined with Taixi were selected to nourish yin, downbear fire, and tonify the kidneys and liver. Lianquan is a primary point of the conception vessel (Ren Mai). According to the Ling Shu (Magic Pivot), needling this point “promotes saliva secretion.” Jinjin and Yuye were selected to nourish yin, engender liquid, and downbear fire. Jiache was selected to drain stomach fire. Jingming and Sibai are traditionally indicated for the treatment of eye disorders. Needling these points frees the meridians and collaterals near the eyes. Yuyao and Cuanzhu were selected to relieve eye dryness. Yinxiang was selected to address nose dryness.

Jie Du Tong Luo Sheng Jing Tang was chosen for its ability to nourish yin, engender liquid, resolve toxins, and free the meridians and collaterals. Li et al. cited independent research noting that total glucosides of peony (TGP), extracted from Bai Shao, improves mouth and eye dryness by decreasing serum IgG levels and ESR. [3] Another study found that Bai Hua She She Cao increases the amount of AQP5 (a water channel protein), accelerates transport of water into cells, promotes secretory activity in glandular cells, and improves mouth dryness. [4] The rest of the herbs were used to nourish yin and invigorate blood.

 

Results
The total effective rate of the TCM treatment group was 83.33% with the following breakdown of improvement tiers: 30.00% significant improvements, 53.33% moderate improvements, 16.67% no improvements. The total effective rate of the control group was 60.00% with the following breakdown of improvement tiers: 20.00% significant improvements, 40.00% moderate improvements, 40.00% no improvements. The results demonstrate that acupuncture and herbal medicine treatments yield significant positive patient outcomes for patients with Sjögren syndrome.

 

References
[1] Li B, Xue L, Piao XM, Zhu J. Clinical observation on the effects of disease index linked to Sjögren syndrome by acupuncture combined with traditional Chinese medicine[J]. Tianjin Journal of Traditional Chinese Medicine, 2017,34(01):26-31.
[2] Bian XD, Wang SC, Luo KT. Acupuncture combined with herbs for the treatment of Sjögren syndrome: a study of 60 cases[J]. Shandong Journal of Traditional Chinese Medicine, 2011,30(3):178-179.
[3] Zhao H, Zhao FT. Clinical study of total glucosides of paeony combined with hydroxychloroquine for the treatment of Sjögren syndrome[J]. Henan Traditional Chinese Medicine, 2013,33(4):530-531.
[4] Ma WK, Wang Y, Tang F et al. Regulatory effect of Jie Du Hua Yu Formula on water channel protein AQP5 in submandibular gland of mice with Sjögren syndrome [J]. Chinese Journal of Gerontology, 2012,32(1):95.

 

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