Researchers find acupuncture combined with moxibustion effective for the treatment of chemoradiotherapy induced leukopenia. Shanghai Tongji Hospital researchers determined that acupuncture combined with moxibustion successfully increases white blood cell levels and stabilizes the overall health of patients suffering from leukopenia (a disorder characterized by reduced white blood cell levels). The results were verified by blood assays and additional clinical evidence in a controlled trial comparing the effects of medications with acupuncture and moxibustion. Acupuncture combined with moxibustion produced a positive patient outcome rate of 90.0%. The medications batilol and leucogen produced a 53.3% positive patient outcome rate for the treatment of chemoradiotherapy induced leukopenia.

Acupuncture and moxibustion produced faster positive patient outcomes than for patients receiving medications (batilol and leucogen tablets). Data points measured immediate and short-term benefits of both therapies. Acupuncture produced increased white blood cell levels by the day 3 and day 7 data points. Batilol and leucogen produced the same effect by the day 14 data point. In addition, batilol and leucogen further increased white blood cell levels at the day 21 data point that had already been achieved by the acupuncture and moxibustion group by day 14 data point.

For subjective improvements, patients in the acupuncture plus moxibustion treatment group had less symptoms by the day 14 data point. Patients in the medication control group had less symptoms by the day 28 data point. The researchers conclude that acupuncture combined with moxibustion is safe and effective for the treatment of leukopenia. Let’s take a closer look at the results.

Tongji Hospital researchers (Shen et al.) used the following study design. A total of 120 patients were randomly distributed into a control group and a treatment group, each consisting of 60 patients. The control group received drug therapy. The Traditional Chinese Medicine (TCM) treatment group received acupuncture plus moxibustion. All patients were diagnosed with chemoradiotherapy induced leukopenia between January 2006 and December 2015.

The statistical breakdown for each randomized group was as follows. The treatment group was comprised of 32 males and 28 females. The average age in the TCM treatment group was 52 (±4) years. The average Karnofsky Performance Scale Index in the TCM treatment group was 59 (±4.1). The drug control group was comprised of 33 males and 27 females. The average age in the drug control group was 55 (±5) years. The average Karnofsky Performance Scale Index was 60 (±4.5). There were no significant statistical differences in terms of age, gender, and Karnofsky performance status relevant to patient outcome measures prior to the investigation.

The acupuncture group received a combination of acupuncture and moxibustion therapy and the medication group received batilol tablets and leucogen tablets. The acupoints selected for all TCM treatment group patients were the following:

GV14 (Dazhui)
ST36 (Zusanli)
SP6 (Sanyinjiao)

Treatment commenced with patients in a seated position. After disinfection of the acupoint sites, a 0.30 mm x 40 mm disposable filiform needle was inserted into each acupoint with a high needle entry speed. Mild reinforcing and attenuating (Ping Bu Ping Xie) techniques were applied. Once a deqi sensation was obtained, the needles were retained for 30 minutes and moxibustion was applied to the following acupoints:

GV14 (Dazhui)
ST36 (Zusanli)

Moxa cigar cuttings were attached to each needle handle and ignited. Moxa was left in place until the local skin showed initial signs of redness, this is approximately at the 15 minute marker. One acupuncture and moxibustion session was conducted daily for 28 consecutive days. For the control group, patients received 50 mg of batilol tablets and 20 mg of leucogen tablets. Tablets were orally administered three times per day, for a total of 28 consecutive days. Following completion of treatments, the efficacy for each patient was categorized into one of three tiers:

Recovery: White blood cell levels increased to over 5×109/L, or increased from less than 2×109/L to over 4×109/L.

Effective: White blood cell levels increased by 100 percent.

Not effective: No improvement in white blood cell levels.

Acupuncture and moxibustion produced faster results. This was verified by blood assays. In addition, acupuncture and moxibustion outperformed drug therapy by 37%. Acupuncture plus moxibustion produced a 90% positive patient outcome rate and the medications produced a 53.3% positive patient outcome rate.

In Traditional Chinese Medicine, leukopenia falls under the Xulao (translated as weakness and detriment) class of disorders. According to TCM principles, the kidney governs the bones and marrow, and stores the essence, whilst the spleen generates qi and blood. TCM differential diagnostic pattern identification classifies leukopenia as a disorder due to spleen and kidney deficiency.

The researchers also provide some insight into the TCM principles relative to the treatment of leukopenia. Needling Zusanli, Dazhui, and Sanyinjiao fortifies the spleen and stomach and supplements qi and blood. Zusanli is a He-Sea point on the foot yangming stomach meridian and is traditionally indicated for the treatment of chronic deficiency and chronic illnesses. Needling Zusanli frees the meridians, and strengthens the spleen and stomach to generate qi and blood. Dazhui is a Hui-meeting point of six yang meridians and the Du meridian. Needling Dazhui frees all yang meridians and promotes their qi and blood circulation. Its traditional uses include the treatment of febrile disease, exogenous and endogenous pernicious influences, and chronic deficiency. Sanyinjiao, as a crossing point of the three Yin meridians, supplements essence-blood and regulates the middle burner.

Leukopenia is a significant adverse effect associated with chemoradiotherapy. The research demonstrates that acupuncture and moxibustion present important treatment options for patients suffering from chemoradiation induced leukopenia. The challenges are significant. Access to licensed acupuncturists and integration of licensed acupuncturists into usual care protocols has not been established as a routine in the majority of hospitals and outpatient clinics. Given the positive patient outcomes documented in this study, integration of acupuncture and moxibustion is both safe and effective for patients with chemoradiation induced leukopenia and additional studies are warranted. Investigation of cost-effectiveness and models of integrated protocols will help bring relief to patients in need of care and support.

Reference
Shen Q et al. Clinical Observation of Acupuncture plus Moxibustion for Chemoradiotherapy-induced Leukopenia [J]. Shanghai Journal of Acupuncture and Moxibustion, 2017, 36(4).