Acupuncture and herbs speed recovery for acute ankle injuries. Guilin Central Hospital researchers conclude that a comprehensive Traditional Chinese Medicine (TCM) approach to patient care increases positive patient outcome rates. The researchers conclude that a combination of electroacupuncture, warm needle acupuncture, and topical herbal applications reduce inflammation and promotes faster healing in patients with acute ankle injuries.

Guilin Central Hospital researchers administered a study comparing electroacupuncture monotherapy with a combined TCM protocol (electroacupuncture, warm needle acupuncture, topical herbs). The patients in the combined therapy group showed significantly greater improvements in clinical symptoms including pain, swelling, and range of motion.

A total of 138 patients were recruited for the study and were assigned to receive either combined TCM therapy or electroacupuncture monotherapy. The combined therapy group was comprised of 43 male and 26 female patients, ages 19–39 years (mean age 28.43). The electroacupuncture group was comprised of 41 male and 28 female patients, ages 20–38 years (mean age 28.41). There were no statistically significant differences between the two groups at the outset.

Inclusion criteria included a clinical diagnosis of acute ankle injury (less than one week in duration), pain, swelling, and difficulty walking on the affected side. Exclusion criteria included psychological disorders, inability to give informed consent or comply with treatment, and incomplete data.

 

Acupuncture
Both groups received electroacupuncture treatment at the following acupoints:

  • Ashi points
  • Sanyinjiao (SP6)
  • Yanglingquan (GB34)
  • Taichong (LV3)
  • Taixi (KD3)
  • Kunlun (BL60)

Needles were inserted at the selected points and were manually stimulated by slowly rotating the needle, then lifting slightly to elicit a sensation, which spread in all directions. An electrical stimulator device was then attached and the needles were stimulated using a continuous wave frequency.

In addition to electroacupuncture, patients in the combined therapy group received treatment with moxibustion and topical herbs. Each patient assumed a supine position with their muscles relaxed, and standard disinfection was performed. The affected ankle was palpated to identify the two most tender spots, and needles were inserted to a maximum depth of approximately 25.5mm. Following insertion, the needles were manipulated by rapid rotation, then withdrawn slightly to the superficial layer of the skin and were then angled and thrust into a different position to elicit a strong distending sensation or numbness. A 10mm piece of moxa was then secured to the handle of the needle, ignited, and was allowed to self-extinguish. According to the patients’ diagnosis, appropriate acupoints were selected including:

  • Kunlun (BL60)
  • Qiuxu (GB40)
  • Shenmai (BL62)

For Kunlun, needles were inserted at a 30 degree angle toward the malleolus, penetrating around 25mm towards Qiuxu and stimulated using a twisting, lifting, and thrusting technique. For Shenmai, needles were inserted perpendicularly. All acupuncture treatments were administered every two days for a total of one month.

 

Topical Herbs
In addition to electroacupuncture and warm acupuncture, patients in the combined therapy group were treated with a topical application containing the following herbs:

  • Rou Cong Rong 20g
  • Shu Di Huang 20g
  • Qiang Huo 12g
  • Ji Xue Teng 12g
  • Hong Hua 12g
  • Ba Ji Tian 12g
  • Zhi Cao Wu 12g
  • Wei Ling Xian 10g
  • Gu Sui Bu 10g
  • Shen Jin Cao 10g
  • Zhi Chuan Wu 10g
  • Ma Qian Zi 5g
  • Xi Xin 5g
  • Shu Fu Zi 5g

The herbs were crushed, mixed, and left to steep in 50% ethanol for 15 days. The resulting formula was applied to the affected ankle following warm needle acupuncture treatment. The area was warmed with a heat lamp for 30 minutes. This treatment was repeated every two days for a total of one month.

 

Outcomes
Clinical outcomes were assessed following one month of treatment, and the patients were categorized as either cured, effective, or ineffective. Those classified as cured showed a complete resolution of clinical symptoms and a fully restored range of motion. In the effective group, patients show some improvements in clinical symptoms and range of motion. In the ineffective group, patients showed no improvement in symptoms or range of motion.

In the electroacupuncture group, 26 patients were classified as cured, 31 cases were classified as effective, and 12 cases were classified as ineffective. The scores from the cured and effective groups were added together to give a total effective rate of 82.61%. In the combined therapy group, 41 patients were cured, 25 cases were classified as effective, and three cases were classified as ineffective, yielding a total effective rate of 95.65%. Outcomes in the combined therapy group were significantly better than those in the electroacupuncture group.

The results of this study indicate that while electroacupuncture alone is an effective treatment for acute ankle injuries, therapy efficacy is significantly increased by the addition of warm needle acupuncture and herbal applications. The topical application of herbs allows direct absorption into the affected area, increasing efficacy.

The researchers note that when combined with acupuncture treatment, topical herbs have the ability to relieve pain, increase local microcirculation, and reduce inflammation to promote faster recoveries. They add that early treatment of acute injuries helps prevent lasting damage and chronic pain.

 

Nanning Hospital of Traditional Chinese Medicine
The results of this investigation are consistent with findings from researchers at the Nanning Hospital of Traditional Chinese Medicine. The hospital researchers determined that electroacupuncture, warm needle acupuncture, and topical herbs significantly improve recovery rates for patients with sports related ankle injuries. Electroacupuncture monotherapy achieved a 76.7% total effective rate; however, the combined therapy approach to patient care (manual acupuncture, warm needle acupuncture, herbs) achieved a 95% total effective rate. [2] The Nanning Hospital researchers used the following acupoints for the combined therapy group:

  • Ah Shi
  • SP6 (Sanyinjiao)
  • SP5 (Shangqiu)
  • KD2 (Rangu)
  • GB34 (Yanglingquan)
  • GB41 (Zulinqi)
  • BL62 (Shenmai)
  • LV3 (Taichong)
  • BL60 (Kunlun) added for lateral ankle injuries
  • GB40 (Qiuxu) added for lateral ankle injuries
  • KD3 (Taixi) added for medial ankle injuries
  • KD6 (Zhaohai) added for medial ankle injuries

Patients assumed a supine position. Acupuncture needles of a 1.5” or 1” length were inserted into acupoints at areas of the greatest pain levels. Lifting, thrusting, and twisting techniques were administered. Needles were repeatedly lifted to the superficial level so that they could be thrust into the four directions, using lifting, thrusting, and twisting techniques to elicit deqi. Warm needle acupuncture employed 1 cm moxa pieces that were attached to the needles. Each session was 30 minutes. One acupuncture treatment was applied each day. For the electroacupuncture group, similar acupoints were applied. The herbal liniment was comprised of the following herbs:

  • Sheng Di Huang 20 g
  • Rou Cong Rong 20 g
  • Bai Ji Tiang 15 g
  • Du Zhong 12 g
  • Liang Mian Zhen 15 g
  • Gu Sui Bu 12 g
  • Shen Jin Cao 15 g
  • Wei Ling Xian 12 g
  • Shi Da Gong Lao Ye 12 g
  • Chuan Xiong 15 g
  • Qiang Huo 10 g
  • Zhi Cao Wu 10 g
  • Xu Duan 15 g
  • Ma Qian Zi 4 g
  • Hong Hua 15 g
  • Zhi Chuan Wu 10 g
  • Fu Zi 6 g
  • Ji Xue Teng 15 g
  • Xi Xin 4 g
  • Xue Jie 10 g

The herbs were combined in raw powder form and were submerged into a 50% alcohol solution for two weeks. During warm needle acupuncture, the herbs were topically applied. Cotton was dipped into the alcohol-herbal medicine solution and was dabbed onto the ankles. During the acupuncture and herbal medicine procedure, a TDP (Teding Diancibo Pu) heat lamp was aimed at the ankles.

The total effective rate was based on reductions in ankle pain and swelling and improvements in walking ability. Electroacupuncture had a 76.7% total effective rate and manual acupuncture plus topical herbs and warm needle therapy achieved a 95% total effective rate.

 

References
[1] Tao Liang (2018) “Analysis of the Effect of External Application of Chinese Herbal Medicine Combined with Warm Acupuncture on Acute Sports Ankle Joint Injury” World Latest Medicine Information Vol. 18 (75) pp. 156, 161.

[2] Yue, J., Mo, Z. Z., Yue, Y. Q. & Chen, J. J. (2015). Clinical Observation of Warm Acupuncture Therapy Combined with External Application of Chinese Medicine in the Treatment of Acute Sports-induced Ankle Injury. Journal of Clinical Acupuncture and Moxibustion. 31(2).

 

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