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C h i n J i n te g r M e d 2 0 0 6 S e p ; 1 2 ( 3 ) : 2 1 2 - 2 1 4

CLINICAL EXPERIENCES

Comparative Study cn Treatment cf Acute Gcuty Arthritis by

Electrcacupuncture with Different Frequency

ZOU Ran

» ) ,

ZHANG Hong-xing J . ) , and ZHANG Tang-fa

ABSTRACT Ob jective: To study the therapeutic effect of treatment of acute gouty arthr itis (AG A) re -

spectively by electroacupuncture (EA) with different frequency and oral intake of Western medicine. Meth-

ods:

Seventy-two patients of AGA were randomly assigned into three groups, 24 in each group. Group A was

treated with EA 100 Hz; Group B with EA 2 Hz; and Group C with W estern m edicine. The analgesic effect,

initiating time and sustaining time of analgesia were observed and the level of serum uric acid was measured

before and after treatm ent. Results: The initiating time of analgesia was shorter while the sustaining time of

analgesia was longer in Group A and B than those in Group C (a ll P < 0 . 01 ). The efficacy of analgesia was

higher in Group B than that in Group A , and a better effect was shown in Group B in reducing serum uric acid

level than that in Group A ( P < 0 . 0 1 ) , which was near that in Group C ( P > 0 . 0 5 ) . Conclusion: EA is an ef-

fective treatment for AGA, and low frequency (2 Hz) EA showed a better efficacy.

KEY WORDS electroacupuncture, acute gouty arth ritis, uric acid

Acute gouty arthritis (A G A ) is the primary

symptom of gout, that often occurs in the lower limb

and is characterized by acute initiation, appearance

of redness, swelling and burning pain at the affected

joint and its surrounding tissues, could develop into

gouty tophus after repeated attacks, or even cause

joint deformity dyskinesia in serious cases. Current

treatment for AGA is still insufficient in etiological

curing and radical approach es. By using electro acu-

puncture (E A ) of different frequency, the authors

had 48 patients of AGA effectively treated in the last

two years, and also had them compared with those

treated with Western medicine.

iVIETHODS

Standard for Diagnosis inciusion and Exciu-

sion

The diagnosis of AGA was made according to

the standard in the Stand ard for Diagnosis and

Effi-

cacy Evaluation of Diseases and Syndromes by Tra-

ditional Chinese Medic ine issued by the State Ad -

ministration of TCM' . (1) There abruptly appears

reddening and swelling on a single jo int, with gradu-

ally aggravating pain which is less severe at day

time but more severe at night, and the attack re-

peats,

and may be accompanied by fever, head-

ache, etc. ; ( 2) The symptoms mostly occur in m id-

dle-aged or aged men due to history of the disease

in the family, or often induced by fatigue, ehgorge-

ment, intake of diet with high amount of purine,

wine drinking or external infection with wind-cold;

(3) There is involved single joint at the beginning,

very often the first metatarsophalangeal joint, which

is then followed by reddening and swelling pain on

other small joints like that of heel, ankle or finger,

then when it gets more serious, articular exudative

fluid may appear, and after repeated attacks tophus

may occur in the peri-articular region, auricle, helix

and inter-phalangeal space ; ( 4 ) The level of uric

acid in serum and urine gets elevated and leukocyto-

sis may occur in the acute pe riod ; ( 5 ) Auxiliary

tests of B-ultrasonograp hy, routine urine exam ina-

tion and renal function may be conducted when nec-

essary to find out the condition of gouty nephropa-

thy, and X-ray film could display the uneven chis-

eled round defect in bone substance or at the margin

or cartilage.

Patients whose symptoms conformed to the

foremost 4 items of diagnostic standard were includ-

ed , regardless of their age or sex.

Excluded were patients with hemorrhagic dis-

eases, critical patients with metal conducts at the

treated position, patients with simple hyperuricemia

but without clinical symptom, patients complicated

with diabetes mellitus, rheumatic or rheumatoid ar-

thri t is,

and patients with diseases of heart, liver ,

kidney and hemopoietic system.

Generai Materiais

All the patients were inpatients or outpatients of

Department of Acupuncture, Wuhan Municipal Hospitai of Inte-

grat ive Medicine, Wuhan (430022)

Correspondence to: Dr. ZOU Ran, Te i; 02 7-8 53 32 00 1 Ext.

5 4 7 ; E-maii ; z r r520xyxy@ya hoo.com.cn



Chin J integr Med 2006 Sep;12 (3) : 21 2- 21 4

213

the acupuncture departmen t of Wuhan M unicipal

Hosp i ta l o f In tegra t ive Med ic ine , who were random-

ly a l loc ated by the random izing table in to three

grou ps, 24 in each group. Pat ients in Group A were

18 males and 6 females, 32 70 years o ld, with the

course of d isease 4— 1 2 da ys ; those in Group B

w e re 2 1 ma les an d 3 f e ma le s , 3 1 - 7 2 ye a rs o ld ,

with the course of d isease 5 - 1 3 days and those in

Grou p C w e re 20 ma les an d 4 f e ma le s , 3 5 - 7 1

years o ld , w i th the course o f d isease 3—10 days.

By stat ist ica l manag em ent, the three groups we re

com parab le in se x, age and course of d isease.

Treatment iVIethods

All the patients in Group A and B were treated

by EA in the same way but different parameters of

stimulation were applied. The operative method

was as follows: Patients lay in dorsal position with

the affected position sterilized in routine, needles of

0.25 mm x 40 mm were inserted quickly into acu-

points Zusanii (ST36) and Sanyinjiao (SP6), rein-

forcing maneuver was applied by twisting to transfer

the needling sensation to form a loop between the

two acupoints, then electric stimulation was given

with Han's EA apparatus with the parameters of fre-

quency of 100 Hz and 2 Hz, wave width of 0. 6 ms

and 0.2 ms for Group A and Group B respectively,

strength of current of 0. 5 mA at the beginning,

which was increased to 1 mA after 10 min and to 2

mA after another 10 min. So the stimulation was ap-

plied for 30 min in

total.

In the mean tim e, local

stimulation was applied by needling with purging

maneuver in dominance. The treatment was carried

out once every day with 6 days as one therapeutic

course.

Patients in Group C we re treated with 25 mg in-

dometacin and 100 mg of allopurinol three times a

day through oral intake with 6 days as one therapeu-

tic course.

items and iVietiiods of Observation

The systemic and local symptoms and signs

were recorded.

Degrees of pain were scored adopting the visu-

al analogical scoring (VAS) method'^'by asking the

patient to denote his degree of pain in a iine 10 cm

in length, with the line's head and end demarcated

as no pain and severe pain respectively.

The initiating time of analgesic effect and the

sustaining time of analgesic effect after first time of

EA were recorded.

Serum level of uric acid was measured with

phosphotungstic acid method before treatment and

after finishing one course of therapy.

Standard for Efficacy Assessment

The standard in refer enc e' was adopted.

Cured:

symptoms disappeared with normalized la-

boratory indexes; Improved: swelling and pain of

joint got alleviated with laboratory indexes im-

proved;

Unchanged: symptoms and laboratory inde-

xes were unchanged.

Statisticai Anaiysis

The therapeutic effects were assessed with

i it

test, and comparisons between pain scores,

initiating time and sustaining time of analgesic effect

as well as between blood content of uric acid were

analyzed by intra- and inter-group f- tes t. Data we re

expressed by mean ±standard deviation.

RESULTS

Ciinicai Efficacy

Of the pat ien ts in Group A, 3 pa t ien ts (1 2 .5 % )

w e r e c u r e d , 19 ( 7 9 . 2 % ) i m p ro v e d a nd 2 ( 8 . 3 % )

unc han ged; of those in Group B, 11 patien ts

( 4 5 . 8 % ) w e r e c u r e d , a nd 13 ( 5 4 . 2 % ) i m p r o v e d ;

of those in Group C, 5 pat ients ( 2 0 . 8% ) we re

c u r e d , 16 ( 6 6 . 7 % ) i m p ro v e d a nd 3 ( 1 2 . 5 % ) u n -

changed. The tota l e f fect ive rate in Group B was

better than that in Group A and C, showing signif i -

ca nt d i ff e re n ce (P < 0 . 0 1 ) , w h i le t he d i ff e re n ce b e -

tw e e n Grou p A a n d C w a s in s ig n if ica n t ( P > 0 . 0 5 ) ,

suggest ing that EA t reatment with f requency of 2 Hz

could obta in the best ef f icacy.

Effects on Pain Scores and Serum Levei of U

ric Acid

As shown in Table 1, comparison between the

three groups in pain scores after treatment showed

significant difference ( P < 0 . 0 1 ) , with the score in

Group B superior to that in the other two groups,

showing significant difference ( P < 0 . 0 1 ) , and that

in Group A better than that in Group C, also showing

significant difference ( P < 0 . 0 1 ) . All these sugges-

ted that EA of frequency of 2 Hz had the best effica-

cy in stopping pain, EA of frequency of 100 Hz sec-

ondary, but still better than Western medicine.

Serum level of uric acid was reduced signifi-

cantly after treatment in all the three groups ( P <

0 .0 1) . Comparison between them showed the result

in Group B and C was significantly better than that in

Group A ( P < 0 . 0 1 ) , but the d ifference between



214

C h i n J I n te g r M e d 2 0 0 6 S e p ; 1 2 ( 3 ) : 2 1 2 - 2 1 4

gesting that low frequency EA was superior to high

frequency EA in lowering b lood ur ic acid level, and

equivalent to that of Western nnedicine. See Table 1.

Table 1. Comparison in Pain Scores and Serum Levei of

Uric Acid before and after Treatment (x ± s)

Group

A

B

0

n

24

24

24

Time

BT

AT

BT

AT

BT

AT

Pain Scores

9 . 8 2 1 1 . 5 2

4 . 7 4 1 1 . 6 1 ' *

9 . 8 3 1 1 . 6 1

3 , 2 7 1 1 .4 8 ' ^ *

9 . 7 9 + 1 . 4 8

6 , 0 8 1 1 . 5 5 '

Ur ic Acid (mmoi/L)

517 .40 + 72 .29

4 4 0 . 6 4 1 4 2 . 6 8 '

5 2 4 . 8 2 + 1 0 5 . 7 4

4 0 5. 56 + 2 7 . 2 8 ' ^

5 3 2 . 4 5 + 1 1 1 . 2 7

3 9 6. 7 6 + 3 9 . 4 7 ' ^

No tes: ' P < 0 . 01 , compared wi th before t reatment in

the same group; ^ P < 0 . 0 1 , compared with group A af ter

treatment; * P < 0 . 0 1 , compa red with group C after treat-

ment; BT means before treatment, AT means after treatment

Comparison of Initiating and Sustaining Time

of naigesia

The initiating and sustaining time of analgesia in

the groups treated by EA were shorter and longer

than those in the Western medicine treated group,

respectively, showing difference of statistical signif-

icance ( P < 0 . 0 1 ) ; when the effect in Group B was

compared with that in Group A, suggesting that the

analgesic effect of EA treatment was superior to

Western medicine, and low frequency EA was supe-

rior to high frequency EA in analgesia initiation and

duration.

See Table 2.

Table 2. Comparison of Initiating and Sustaining

Time of Analgesia among Three Groups (x ± s)

Group

A

B

0

24

24

24

init iat ing Time

3.

2.

12.

7 6 1 1

2 5 1 1

8 3 1 1

.1 8

. 0 7 '

.1 3

(m in )

*

Sustaining

21 ,

27 ,

13,

3 2 1 1 .

4 6 1 1 .

1 4 1 1 .

Time

8 7 '

27

(h )

NoteS: P < 0 . 0 1 , compared with group C;

compared with group A

DiSCUSSiON

Modern medicine holds that the occurrence of

gout is mainly due to congenital or acquired defect,

physiologic disorder and metabolic disturbance of

purine metabolism related organized enzyme in the

body, which cause the concentration of urate in

plasma to go up over the critical limit, with the

presence of gouty arthritis as the primary symptom.

The disease is treated commonly with anti-inflam-

matory drugs and those for promoting uric acid me-

tabolism in the blood, but it is a pity that these

drugs always have high toxicity and great adverse

effects.

In the view of traditional Chinese medicine, the

disease is considered as a blocking syndrome

caused by damp ness-heat, its pathogenesis is both

i (1^) -Sh en ( ' If ) deficiency in origin with turbid-

dampness and toxic-hea t in sup erfic iality. Acupoint

Zusanii is the converging point of Wei(

W

)-Meridi-

an.

Since Pi-Wei is the root of acquired essence,

the source of qi and blood, stimulation of this point

could supplement qi-blood. Acupoint Sanyinjiao is

the intersecting point of the three meridians of Gan

( f f ) - P i - S h e n ,

and needling it could strengthen Pi

and reinforce Gan-Shen. Ashi point is located where

pain occurs. Thus the use of the three acupoints in

combination could treat both the origin and the su-

perficiality.

By comparative study, the authors found that

the efficacy of EA in treating AGA is closely related

with the frequency use d. It has been displayed in

this study that the initiating time and sustaining time

of analgesia of low frequency EA were superior to

those of high frequency EA. Moreover, low frequen-

cy EA showed a more excellent effect in reducing

blood uric acid than high frequency EA. Although in

this respect Western medicine has an effect equiva-

lent to that of low frequency EA , its great adverse

reaction makes it unacceptable for long-term appli-

cation.

Lots of clinical studies proved that EA has good

effect of analgesia, and its efficacy is directly relat-

ed with the frequency ap p li e d '. It was shown in

this study that 2 Hz frequency EA is the best chosen

parameter for treatment of AGA. However, the act-

ing mechanism for EA in regulating blood uric acid

content remains to be further studied.

In sum, EA has favourable therapeutic effect for

AGA, especially low frequency EA, and this fact

provides a theoretical basis for applying low fre-

quency EA in treating AGA in clinical practice.

R F R N S

1. state Administration of Tradit ionai Chinese Medicine. Standard for

diagnosis and eff icacy evaiuation of diseases and syndromes by tra-

dit ionai Chinese medic ine. Nanjing: Nanjing University Press,

1 9 9 4 : 3 1 - 3 2 .

2 . Miao HS , editor. Rehabiiitat ion medicine theory and parctice.

Shangha i: Shanghai Scientif ic and Technical Pubiishers, 2000 :

1 1 6 7 - 1 1 6 8 .

3. Han JS. Further cert if ication on frequency spe cif ication of acupunc-

ture anaigesia. Acupunt Res 2001 ;26 (3) : 22 4 -2 27 .

4 . Wang YJ> Wang SK. Anaigesic effect of eiectroacupuncture of dif-

ferent intensity and frequency. Acupunt Res 19 93; 18(1 ) : 44 — 4 7 .

(Received June 6, 2006)



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