Thermal Field Analysis of Two Kinds of Suspended Moxibustion

Background: Moxibustion has been widely used in Chinese medicine treatment and health care, it is necessary to study the mechanism and characteristics of moxibustion treatment. The warm effect of moxibustion is closely related to the therapeutic effect. Studying the distribution and change of thermal field is an effective way to understand the mechanism of moxibustion. Methods: The finite element analysis software COMSOL was used to establish the heat transfer model to simulate the whole moxibustion process. Two kinds of suspended moxibustion methods, including mild moxibustion and sparrow-pecking moxibustion, were used to perform moxibustion trial at Zusanli acupoint (ST36) of volunteers, with Institutional Review Board (IRB) approval, and the thermal field on the skin surface was detected with an infrared thermometer. Results: Moxibustion method and moxibustion distance are the factors that affect the temperature change. The temperature rising speed of mild moxibustion was slower than that of sparrow-pecking moxibustion. When the moxibustion distance changes, the temperature changes obviously. If the moxibustion distance does not change, the body temperature will continue to rise slowly. If the distance increases, the body temperature will show a downward trend. On the contrary, it goes up. The thermal fields of mild moxibustion and sparrow-pecking moxibustion were distributed in concentric circles around Zusanli. After natural cooling, the temperature of subcutaneous tissue was higher than that of epidermis.Conclusion: The speed of skin temperature change is affected by the method of moxibustion. The temperature field characteristics formed on the skin surface and acupoint are affected by the moxibustion distance and the moxibustion duration. Moxibustion will produce warm heat stimulation to the subcutaneous tissue.

Effects of Moxibustion on Amygdala -HPA Axis in Rats with Kidney-Yang Deficiency Syndrome Induced by Hydrocortisone Injection

Background: The syndrome of kidney-yang deficiency is one of the main syndromes in traditional Chinese medicine. Modern evidences prove that the hypothalamus - pituitary - adrenal axis (HPA axis) function disorder is the main material basis of kidney-yang deficiency syndrome. The upper regulating center, such as hippocampus and amygdala can affected HPA axis. Although moxibustion have a therapeutic effect for kidney-yang deficiency syndromes, the underlying mechanism remains unclear. This study investigated the effect of suspended moxibustion on amygdala and HPA axis and elucidated the possible molecular mechanism of moxibustion in improving kidney-yang deficiency syndrome.Methods: 60 male Sprague-Dawley rats were randomly divided into the normal group ( n=12) and the model-building group (n=48). Rats in the model-building group were given intramuscular injection of hydrocortisone to establish the model of kidney-yang deficiency. The 48 rats successfully modeled were then randomly divided into model group (model, n=12) , carbenoxolone intraperitoneal injection group (CBX, n=12), moxibustion group (moxi, n=12) and moxibustion plus carbenoxolone intraperitoneal injection group (moxi+CBX, n=12). In the moxibustion group, Shenshu (BL23) and Guanyuan (CV4) points were treated with moxibustion for 14 days. After treatment, the level of corticostesone (CORT), adrenocorticotropic hormone (ACTH) and corticotropin-releasing hormone (CRH) in serum, the expressions of mineralocorticoid receptor (MR), glucocorticoid receptor (GR), 11 beta-hydroxysteroid dehydrogenase type 1 (11β-HSD1), corticotropin releasing factor (CRF) and ACTH in rats’ amygdala and (or) hypothalamus, pituitary were detected. Data were analyzed by one-way analysis of variance.Results: Compared with the normal group, the level of CRH, ACTH and CORT in serum, and the mRNA and protein expressions of MR, GR and 11β-HSD1in amygdala, the mRNA and protein expressions of 11β-HSD1 in hypothalamus and CRF mRNA expression in amygdala and hypothalamus, and ACTH mRNA expression in pituitary of rats in the model group were all significantly decreased (P < 0.05 or 0.01). After treatment with moxibustion, except for 11β-HSD1 mRNA expression, the observation index mentioned above were increased to different degrees compared with those in the model group (P < 0.05 or 0.01). Conclusion: Suspended moxibustion can effectively improve the serum levels of ACTH, CRH and CORT, and can up-regulate the mRNA and protein expression of MR, GR , 11β-HSD1, CRF and ACTH in amygdala and hypothalamus of kidney-yang deficiency rats, which may be one of the molecular mechanisms of moxibustion in improving kidney-yang deficiency syndrome.

Long-Term Potentiation of Prelimbic Cortex Ascribed to Heat-Sensitization Responses of Moxibustion

Heat-sensitization responses occurred in certain patients while exposed to suspended moxibustion. The response often indicated that the efficacy of moxibustion to those with it tended to triumph over those without. However, its mechanism remains to be explained. Our previous fMRI and EEG studies confirmed the changes of activities in cerebral certain regions accompanied with heat-sensitization responses, especially in prefrontal cortex. Therefore, we hypothesize that neurological system is involved in moxibustion-induced heat-sensitization responses. In the present study, phosphorylation of Cofilin representing long-term potentiation in synapse of prelimbic cortex of medial prefrontal cortex in stroke rats over suspended moxibustion was assessed, and the size of phosphorylated Cofilin positive spine in synapse was also measured. The result showed that heat-sensitization responses were observed to augment cerebral ischemic stroke-induced phosphorylation of Cofilin in prelimbic cortex of rats and increase the numbers of large synapses. This indicated that long-term potentiation of prelimbic cortex was attributed to heat-sensitization responses that were certain neurological responses of medial prefrontal cortex to suspended moxibustion.

Anti-inflammatory Effect of Heat-sensitive Moxibustion via the NF-κB Signaling Pathway on Cerebral Ischemia/Reperfusion Injury in Rats

Ischemic stroke is universally acknowledged as a common cause of long-term disability or even death. Suspended moxibustion, an indirect form of moxibustion, is when moxibustion is placed superfcially over the skin without being in contact with it. Some researchers have used this method to treat stroke patients, but strong evidence of its therapeutic effectiveness is lacking.However, the effect of traditional suspended moxibustion has recently been improved with the development of heat-sensitive suspended moxibustion. Our previous studies showed that moxibustion for 35 min provided a more effective treatment strategy than moxibustion for 15 min, and moxibustion by 35 min with tail temperature increase had a better outcome than that without, however,the mechanism underlying the effect is not clear. In this study, we treated the stroke rats with moxibustion by 35min and divided them into non-heat sensitive moxibustion(NHSM) group and heat sensitive moxibustion (HSM) group according to difference in the tail temperature increase, then we compared the effect and investigated the mechanisms between NHSM and HSM. We found that HSM signifcantly decreased tail-flick latency, increased neurological function score, decreased infarct volume, reduced inflammatory cells,decreased the expression of inflammatory factor ICAM-1 and reduced the expression of NF-κB p65 and p-IKKα/β in rats with focal cerebral ischemia/reperfusion injury. Our experimental fndings revealed that HSM exerted its anti-inflammatory and neuroprotective effects from MCAO-induced injury by decreasing the expression of the NF-κB signaling pathway.

Heat Sensitisation in Suspended Moxibustion: Features and Clinical Relevance

We have observed a ‘heat-sensitisation’ phenomenon in a large proportion of patients receiving suspended moxibustion treatment. Patients become thermally sensitised to moxibustion stimulation at certain locations on the body, indicated by sensations of strong warmth or heat penetrating into the body (heat penetration), warmth spreading around the stimulation site (heat expansion), warmth conducting in certain directions and reaching some body regions or even internal organs remote from stimulation sites (heat transmission), or other non-thermal sensations such as aching, heaviness, pressure etc. These heat-sensitised locations are not fixed, but may, during the progression of disease, dynamically change within a certain range centred on acupuncture points. Each condition seems to have its specific set of such sensitised acupuncture points and such phenomena are not commonly observed in other body regions or in healthy subjects. A number of clinical trials have shown that the appearance of heat sensitisation is correlated with better therapeutic effects in various diseases, indicating the clinical significance of such responses. Further investigation is required to elucidate the epidemiological characteristics and biological mechanisms of the heat sensitisation in suspended moxibustion.

Influence of the Deqi Sensation by Suspended Moxibustion Stimulation in Lumbar Disc Herniation: Study for a Multicenter Prospective Two Arms Cohort Study

Moxibustion stimulates the Deqi (Qi arrival) phenomenon. Many clinical observations have documented that the character of the Deqi was a composite heat-sensitive moxibustion sensation. In this prospective multicentre comparative observational nonrandomized study, 92 patients with moderate to severe LDH were included. This study consisted of two parallel arms (A: heat-sensitive moxibustion sensation group; B: nonheat-sensitive moxibustion sensation group). Moxibustion was applied in the following three acupuncture points simultaneously: Da Changshu (BL25), Wei Zhong (BL40), and A-Shi acupuncture point (tenderness). The adjusted mean total Modified-JOA score showed significant differences between the groups in the first week (10.32 ± 4.27 95% CI [9.23~11.40] versus control group 12.42 ± 5.02 [11.62~13.69],P=0.03). The outcome in the second week also presented significant differences in both groups (7.62 ± 4.80 [6.46~8.77] versus 10.56 ± 4.75 [9.35~11.76],P=0.005). Significant differences were also manifested in the follow-up period (P=0.007). It can be inferred that the existence of the Deqi (heat-sensitive moxibustion sensation) phenomenon in the process of suspended moxibustion is closely related to the curative effect, and arrival of heat-sensitive moxibustion sensation could improve the clinical curative effect of moxibustion.