Acupuncture is effective for treating knee osteoarthritis. Dongzhimen Hospital and Puxiang Hospital in Beijing researchers treated joint dysfunction and pain due to knee osteoarthritis successfully with abdominal acupuncture in their multicenter study. [1]

A total of 65 osteoarthritis patients were recruited and randomly assigned to standard body acupuncture (n=30) or abdominal acupuncture (n=35). Six male and 24 female patients were treated in the body acupuncture group. Two patients in this group were 40–49 years old, 8 were 50–59 years old, 15 were 60–69 years old, and 5 were 70–75 years old. Disease duration varied in these patients: 16 had a duration of 0–5 years, 10 had a duration of 6–10 years, 4 had a duration of 11–15 years, and 1 had a duration of >15 years.

Eight male and 27 female patients were treated in the abdominal acupuncture group. Four patients in this group were 40–49 years old, 14 were 50–59 years old, 12 were 60-69 years old, and 6 were 70–75 years old. Disease duration varied in these patients as well; 19 had a duration of 0–5 years, 9 had a duration of 6–10 years, 4 had a duration of 11–15 years, and 3 had a duration of >15 years. There were no statistically significant differences in these baseline characteristics between the two groups (p>0.05).

 

Inclusion Criteria
Biomedical diagnostic criteria for knee osteoarthritis include joint deformity (shown by medical imaging), narrowing of the joint space, and progressive worsening of symptoms with multiple episodes each month.

TCM diagnosis has three categories of criteria. The first is kidney deficiency with marrow depletion, characterized by vertigo, tinnitus, deafness, dizziness, dull aching joints, weak and painful knees and lumbar region, reduced spinal flexibility, a fine pulse, and a pale red tongue with a thin, white coating. The second is yang deficiency with cold congealing, characterized by painful and heavy limbs, inhibited knee flexion, worsened symptoms at night aggravated by climatic changes and cold, alleviated symptoms in heat, a sinking, fine, moderate pulse, and a pale tongue with a white coating. The third is blood stasis obstruction, characterized by joint deformity, dark complexion, purple tongue and lips, stabbing and fixed pain, reduced mobility or curvature of the spine, and a sinking or fine and rough pulse.

Patients included in this study were required to meet the above diagnostic criteria. They were also required to be 40–75 years old, able to give informed consent, and able to comply with treatment. Exclusion criteria included patients that did not meet the diagnostic criteria, received related treatments, had pain due to tumors, nodules, rheumatoid arthritis, stroke sequalae, or lumbar dysfunction, or that had serious cardiovascular or cerebrovascular disease.

 

Body Acupuncture Procedure
Participants assigned to the body acupuncture group were treated with the following acupoints:

  • Inner and outer Xiyan (MNLE16)
  • Heding (MLE27)
  • Zusanli (ST36)
  • Liangqiu (ST34)
  • Yanglingquan (GB34)
  • Xiyangguan (GB33)

After the arrival of deqi, needles were retained for 25 minutes while the affected area was warmed with an infrared heat lamp. Treatment was administered 3 times a week for a total of 4 weeks.

 

Acupuncture
Participants assigned to the abdominal acupuncture group were treated with the following acupoints:

  • Zhongwan (CV12)
  • Xiawan (CV10)
  • Qihai (CV6)
  • Guanyuan (CV4)
  • Daheng (SP15)
  • Huaroumen (ST24)
  • Wailing (ST26)
  • Qipang (navel triangle, located 0.5 cun lateral to Qihai)
  • Xiafengshidian (lower rheumatism point, located 2.5 cun lateral to Qihai)

Daheng was needled bilaterally, while Huaroumen, Wailing, Qipang, and Xiafengshidian were needled on the affected side only. For patients with inner knee pain, Xiafengshineidian (located just lateral to Qipang) was added. For patients with a long disease duration, Qixue (KD13) was added. For patients with knee swelling, Shuifen (CV9) was added.

Patients were treated in the supine position. Following disinfection of the abdominal area with 75% ethanol, all points were located and marked in accordance with abdominal acupuncture procedure. For needle size, 0.20 x 40 mm filiform needles were selected. Zhongwan, Xiawan, Qihai, and Guanyuan were needled deeply, while Huaroumen, Wailing, Qipang, and Xiafengshidian were needled shallowly. Daheng was needled to a medium depth. Patients were then instructed to move their affected knee, and needle depth was adjusted until their pain reduced significantly or disappeared altogether. Needles were retained for 30 minutes with an infrared heat lamp directed at Shenque (CV8). Treatment was administered 3 times a week for a total of 4 weeks.

 

Results
Primary outcomes for the study were measured with the FPS-R (Faces Pain Scale), a self-rated score for pain intensity, and the LKSS (Lysholm Knee Scoring Scale), an 8-section questionnaire covering knee pain, swelling, and function. The maximum possible LKSS score is 100, with scores lower indicating more severe knee dysfunction.

At the beginning of the study, mean FPS-R scores were 5.37 in the body acupuncture group and 5.94 in the abdominal acupuncture group. Following the four-week course of treatment, these scores fell to 3.86 and 2.09 respectively. There were significant improvements in both groups (p<0.01), although improvements were significantly greater in the abdominal acupuncture group (p<0.01).

Pretreatment LKSS mean scores were 60.06 in the body acupuncture group and 56.74 in the abdominal acupuncture group. Following treatment, these scores increased to 72.77 and 70.51 respectively. Once again, both groups showed significant improvements (p<0.01). There was no statistically significant difference between the two groups.

Thus, acupuncture is indicated as an effective tool in knee osteoarthritis treatment, with abdominal acupuncture offering greater pain reduction than standard body acupuncture. However, both forms of acupuncture offer similar improvements in knee function as measured by the LKSS.

 

Reference:
1. Liu Na, Cai Cheng-mu, Ding Yan-ting, Wei Liang-yan, Li Duo-duo, Zhao Jin-xin, Du Lin (2018) “Clinical therapeutic effects of abdominal acupuncture on pain and knee joint function in osteoarthritis of knee of deficiency and cold type in TCM” World Journal of Integrated Traditional and Western Medicine Vol. 13 (10) pp.1410-1413.

 

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