Hui-Li Shui, Zhu Yang, Feng-Xi Long, Wen-Qi Huang, Bing Yang, Zhen Zhang, Dong-Xin Tang,

1Guiyang College of Traditional Chinese Medicine, Guiyang 550002, China.2 Key Laboratory of Chronic Pain Treatment by Miao Medicine, State Administration of Traditional Chinese Medicine,Guiyang 550002, China.

Abstract

Keywords: Miao doctor, Sputum acupuncture therapy, Cancer pain, Technical specification

Introduction

The International Association for Pain Research defines pain as:“Pain is a painful experience of sensory,cognitive, emotional, and social dimensions associated with tissue damage or potential tissue damage” [1].According to the latest statistics of the National Cancer Center, there are about 3.084 million new cases of cancer in China each year, and an average of more than 10,000 people are diagnosed with cancer every day [2].In the patient's self-feeling, the rate of pain is highest compared with other bad feelings.Among them, the incidence of newly diagnosed cancer pain is close to 25%, and the incidence of pain caused by advanced cancer is about 60% to 80% [3].Currently, the“three-step drug analgesic therapy” recommended by WHO is the main way to intervene in cancer pain, but it has not been able to control the pain of all cancer patients ideally.Also, its adverse reactions have brought great pain to patients, and it is also a reason why people talk about the "cancer" discoloration.A large number of studies have shown that pain control is closely related to the quality of life of cancer patients, and pain management has become an important part of cancer treatment [4].Therefore, to improve the quality of life of patients with advanced cancer, it is especially important to explore a new method for the safe and effective intervention of cancer pain from traditional medicine and to rescue cancer patients from pain.

Cancer pain is a category of "pain syndrome" in traditional Chinese medicine, and is closely related to the pain caused by "Jiju", "Guzhang" and "Zangdu".In terms of etiology, cancer pain is closely related to factors such as “Xiantian Bingfu”, “Zhengqi Xukui”,“Yinshi Shitiao”,“Qiqing Neishang” and “Liuyin Xiedu”.In terms of pathogenesis, it is mainly caused by the "Burong" and the "Butong".In the treatment,Chinese medicine is mainly based on "Bu” and “Xie".At the time of clinical application, adjustments are made according to the actual conditions of the patient,such as the degree of pain, tumor stage, and the like [5].Cancer pain is a category of "Meng disease" in Miao medicine [6], which is closely related to the pain caused by "Gonggui disease" [5].It is caused by various pain-causing factors to damage the body structure and stimulate the pain nerve stimulation.The painful nerves transmit information to the painful response of the brain.Miao doctor believes that "no poison, no disease, no chaos, no disease", whether it is an external pathogenic factor or a pathological product of human volume can be turned into a “toxin”.When the “toxin” invades the body, the disease begins to develop.The pain caused by the “Gonggui disease” is caused by the "four major toxins".The Qi is deficient, the body cannot effectively operate the poison, regulate the poison, discharge the poison, and so the poison accumulates in the body and organs.As a result, long-term or excessive accumulation of toxins causes pain [7].Therefore, the method used by Miao medicine to treat cancer pain is mainly to remove “toxins” [8].Among them, sputum acupuncture is one of the most representative strategies for the treatment of cancer pain in Miao medicine.

The sputum acupuncture therapy is called “bat bit nggab ghaob jub ghunb kob” in Miao language [9].The therapy originated from the ancient Miao people who hunted large animals and applied a special amount of specially formulated poison on the bow.Later, it was found that small doses of peony have a function of pain relief.After repeated improvement and practice by Miao people, they have been used to treat some chronic intractable diseases.In order to reduce toxicity, Miao doctors in some areas add honey to the preparation of peony, also known as "sugar needle" [10].The sputum acupuncture therapy is a kind of "toxic attack" treatment under the guidance of the "poison" theory of Miao medicine.It is the advantage of using toxic drugs with heavy bias, strong drug effect, and quick effect, and the body is treated by "from outside treatment".Poisonous evil carries out a strong attack, and introduces the active ingredients of the drug into the body and muscles to remove the toxins and stimulate the tendons, and promote the body's vitality and escort, thereby smoothing the body's meridians and clearing the blood vessels.The traditional peony needle is made according to the original hunting slash.It is folded with bamboo chopsticks or wooden sticks to limit the length of 15cm.One end is opened 2～3cm from the middle, and several sewing needles are inserted to reveal the tip of the needle about 2～3mm, and then the thread is used.Because of its simple production and operation, it has been used for a long time.However, there are also deficiencies, such as the limited production of folk materials, the needles are rough and mad, the number is small, it is not easy to control the depth and frequency during treatment, and it is not easy to disinfect and preserve.However, with the development of modern medicine, according to the same treatment principle,Miao doctors have used electric needles, skin needles,plum needles, and other needles instead.

Application prospects

Cancer pain is a major problem in the current tumor field.Miao medicine medicinal acupuncture is a special compound external treatment method integrating manipulation, medicine, and acupuncture [11], and it is closely related to transdermal drug absorption.The combination improves the speed of drug onset,maintains a constant pharmacological effect, prolongs the analgesic time, and overcomes the side effects of oral administration of the drug.Pharmacological experiments have shown that the sputum liquid extracted from pure natural medicines has a safe dosage,no corresponding skin allergies, and irritation reactions,and can be used for clinical use [12].Clinical studies have shown that acupuncture combined with medicine have obvious analgesic and anti-inflammatory effects,which provides a scientific basis for the clinical use of peony acupuncture [13].The Department of Oncology,the First Affiliated Hospital of Guiyang College of Traditional Chinese Medicine, used it for the treatment of patients with cancer pain, and initially achieved good results, which can reduce the use of opioids and improve the quality of life of patients.The author believes that the application of its promotion to the treatment of cancer pain should have considerable prospects and is the gospel of patients with cancer pain in the future.

Disease diagnosis standard

Western diagnostic criteria

(1) Clinically and pathologically confirmed, or influentially combined with specific tumor markers diagnosed as malignant tumors, and refer to the diagnostic criteria for various types of cancer in the Manual of Clinical Oncology published by the People's Health Publishing House [14].(2) In line with the"Cancer Pain Diagnosis and Treatment Regulations(2011 Edition)" [15] pain directly caused by tumors(direct tumor invasion, recurrence and metastasis accumulation of other tissues,et al.), tumor treatment(surgery, radiotherapy and chemotherapy,et al.) and tumor Related pain caused by complications or complications.

TCM diagnostic criteria

Refer to the "Guidelines for the Diagnosis and Treatment of Malignant Tumors" [16] for the syndrome characteristics of blood stasis, phlegm, and dampness in the syndrome differentiation of cancer pain.(1)“Yuxue Zuzhi”:often manifested as tingling, the pain has a fixed place, refused to press, or accompanied by skin malocclusion, pain can touch the mass, dull complexion,body weight loss, tongue ecchymosis, pulse and so on.(2) “Tanshi Zhongzu symptom”:often manifested as heavy pain, abdominal distension, dizziness, drowsiness,greasy tongue, pulse Shen and so on.

Miao medicine diagnostic criteria

(1) Refer to the "Miao Medical Foundation" [17],"Guizhou Miao Medicine Research and Development"[18] in the description of the male tortoise disease:growing in the body, shaped like a rounded mass of the turtle, round and angular.(2) Refer to "Chinese Miao Medicine" [6] for the diagnosis of pain syndrome:1, Qi dysfunction, lack of energy; 2, patients with self-pain expression; 3, patients with painful facial expressions,The patient has a painful facial expression, and the patient with severe pain has a bruising or grayish complexion.; 4, patients with painful sputum; 5, patients have painful posture; 6, The patient has tenderness,mild tenderness, exercise pain, snoring and other reactions; 7, meridian determination of Tianying point bioelectrical index increased; 8, previous history of pain;9, In severe cases, symptoms such as cold sweat and shock may occur.More than two of the above symptoms can be diagnosed as pain.

Indication

(1) Meet the diagnostic criteria for disease; (2) age 18-80 years old, and gender is not limited; (3)population range:patients with cancer pain.

Contraindications

(1) Allergies, infectious skin diseases, and allergies to drugs related to expectorant drugs are prohibited.(2)The skin of the operation site is damaged, ulcerated,scarred, and edema is prohibited.(3) Those with severe functional impairment such as cardiovascular,cerebrovascular, liver or kidney are prohibited.(4) Not allowed to use on the head and face.(5) Not allowed to use in the shape of the artery.(6) Not allowed to use in pregnant and lactating women.(7) patients with severe coagulation function are prohibited.

Technical operation specification

Instruments and materials

(1) Preparation of sputum liquid (prescription and medicinal sources:Institute of National Medicine,Guiyang College of Traditional Chinese Medicine)Prescription:Saggentodoxa cuneata Rehd.et Wils.(Jieshang/Daxueteng) 50g,Alangium platanifolium(Gajiongdoudiulao/Bajiaofeng) 15g,Yunnan wintergreen stem and leaf(Douzhenkong/Touguxinag)50g,Periploca forrestii Schltr(Gabacha/Heiguteng)30g,radixaconitikusnezoffill(Baojialiyou/Shengwucao) 20g.

Method:The above drugs are sliced, placed in a ceramic container, 1000 ml of 50% glutinous rice wine is added, immersed for 25 days at room temperature,and then filtered by percolation method, slowly at a rate of 2 ml per minute.For seepage, the leachate is collected in a storage bottle.When three-quarters of all the liquid is collected, the seepage is stopped, and then the dregs are pressed, and the remaining liquid is squeezed out and combined with the former liquid.Sealed, protected from light, and stored at room temperature for 25 degrees.

Traits:clear brown liquid.

Check:The amount of ethanol is 40% to 50%, in line with the relevant provisions of the Chinese Pharmacopoeia 2005 edition of an appendix IM wine.

Efficacy:Qudu Sanjie, Qufeng Zhitong, Shujing Huoxue, Tongluo Kaiqiao, Huayu Xiaozhi.

Dosage:For external use only, apply a proper amount.

(2) Needle:MyM electric micro-needle machine(Shanghai Lanyou Technology Co., Ltd.).

(3) Instruments:storage bottles, bamboo cans, 75%alcohol cotton balls, iodophil cotton balls, 95% alcohol torches, dry cotton swabs, gloves, and other related materials.

Peony needle therapy operation procedure

Location:It is mainly based on Tianying Point (local pain point).According to the needs, it can be combined with the Chinese medicine meridian system for corresponding acupoints.

Method:1 The doctor washes the hands before treatment, and uses 75% alcohol cotton balls to rub and disinfect the hands.2 pairs the selected acupuncture points with a 75% alcohol cotton ball to wipe out from the center point; 3 a 10ml sterile syringe is used to extract 10ml of sputum liquid for local rubbing, and massage with a “Dian”, “An” and “Rou” methods for 5 minutes until the affected area is slightly warm; 4 use a sterile electric microneedle to take the sputum liquid at the selected acupuncture point.Do the "Z" shaped movement around the pain point for 5 minutes, until the skin is slightly flushed; 5 use the bamboo cans to cup in the acupuncture site for 5 minutes, then take the can; 6 after removing the cans, disinfect the acupuncture site with iodophor cotton balls, apply the sputum solution again, and wash it after 24 hours.

Treatment

Treatment once every 2 days, 14 days for a course of treatment, a total of 1 course of treatment.

Key technical links

In this study, the electric microneedle was used to replace the traditional sputum needle, and the vertically visible channel was opened on the stratum cornea of the affected area.According to the skin condition of the patient, the depth and frequency of stimulation can be flexibly adjusted, and the drug can be accurately and quickly administered.The adverse reaction is small, and the curative effect is remarkable.The traditional sputum liquid needle is difficult to control the pain caused by the depth of acupuncture, and the sterile disposable needle solves the traditional medicinal needle and multi-use, avoiding the cross-infection between patients and increasing the patient's therapy.

Precautions

(1) Strict disinfection before and after treatment to prevent infection.

(2) The treatment room is kept clean, and the temperature is appropriate.

(3) Explain clearly to the patient before treatment,eliminate the patient's doubts, and obtain patient cooperation.

(4) Pay attention to the depth and time of acupuncture movement, and treat the acupoints alternately, leaving enough recovery time for the operation site.

(5) Those that are hungry, full, and frail are used with caution.

(6) Strictly observe the operating procedures,accurately grasp the toxicity of the peony to prevent poisoning, and the clinical safety use range recommended by pharmacological experimental research is (0.19-0.93) g/Kg [12].

(7) If there is any discomfort during the treatment,stop the operation immediately, pay close attention to blood pressure and heart rate changes, and actively rescue.

Possible accidents and treatment plans

(1) Fainting:Stop treatment immediately.Make the patient supine, pay attention to keep warm, lighter to drink warm water or sugar, rest for a while to recover;on the basis of the above treatment, the person can acupuncture Baihui, Renzhong, Neiguan, and other points; if still unconscious First-aid measures should be taken if the breathing is fine and the pulse is weak.

(2) Hematoma:If there is a small piece of bruising in the subcutaneous area of the operation site, it can be resolved by itself without special treatment.If the area of the treatment site is large, the topical sputum or cold compress may be used to stop bleeding, and then the hot compress is used to promote the absorption and absorption of blood stasis.

(3)Allergic reaction:Stop treatment immediately.Flushing acupoints can alleviate patients with mild allergic reactions with 0.9% saline.If the symptoms are still not relieved, allergic reactions are aggravated, give anti-allergy treatment.

Adverse reactions

No adverse reactions have been found clinically

Conclusion

Peony medicine acupuncture is one of the special external treatment methods commonly used by Miao medicine.It can play the role of “treatment of ailments and sinking.” Its technique is relatively mature; its curative effect is safe, reliable, easy to operate, low in price, and easy for patients to accept.At the same time,it is easy to learn and easy to promote.Previous experiments and clinical studies have shown that both peony and sputum have obvious effects of analgesia,anti-inflammatory, and inhibition of inflammatory factors [13].The use of peony acupuncture to treat cancer pain can make the medicinal effect of peony directly exert its analgesic effect, avoiding the stimulation of digestive tract by oral administration, and is the first choice for patients who cannot be orally administered cancer pain in the advanced stage.In the combination of the guidance of Miao medicine theory and modern medicine, the therapy has achieved good results in clinical practice.Now, the operation specifications of sputum acupuncture therapy are summarized, which is convenient for the promotion and application of Miao researchers.The application of this technology provides a direction for the systematic study of the combination of Miao medicine theory and clinical research, combined with laboratory indicators for objective research.Establishing the objective diagnosis and treatment criteria and efficacy evaluation criteria of Miao medicine sputum acupuncture treatment for interventional cancer pain, providing an objective basis for the promotion and application of sputum acupuncture therapy, and providing an effective national medical technique for cancer pain.