Researchers confirm that acupuncture is more effective than two drugs (ibuprofen and diclofenac) for long-term relief of knee osteoarthritis pain, inflammation, and motor impairment. In one investigation, acupuncture plus herbal medicine outperformed acupuncture plus ibuprofen for pain relief. In another independent investigation, acupuncture outperformed diclofenac for relief of pain, inflammation, and motor impairment due to knee osteoarthritis. Let’s take a look at both investigations.
Acupuncture plus herbs outperforms ibuprofen for the alleviation of knee pain, inflammation, and dysfunction. Guangxi Lingshan County Hospital of Traditional Chinese Medicine researchers investigated the benefits of drugs, electroacupuncture, and herbal medicine for the treatment of knee osteoarthritis. The results of the randomized-controlled clinical trial finds acupuncture plus herbs more effective than the ibuprofen (a nonsteroidal anti-inflammatory drug) plus acupuncture protocol.
All patients in the study suffered from pain and dysfunction due to knee osteoarthritis. Patients receiving a special herbal formula for knee dysfunction plus an acupuncture point prescription administered with electroacupuncture stimulation had an 86.7% total effective rate. Another group of patients received ibuprofen drug therapy plus electroacupuncture, but without any herbal medicine. That group had a 63.3% total effective rate. Both groups had effective relief, but the group receiving electroacupuncture plus herbs outperformed the group receiving electroacupuncture plus ibuprofen by 23.4%.
The researchers protocolized their acupuncture and herbal medicine investigation directly from Traditional Chinese Medicine (TCM) classic prescriptions for knee osteoarthritis. The herbal formula chosen for the study, Du Huo Ji Sheng Tang, has been in use since the Tang Dynasty according to multiple acupuncture continuing education sources. Its uses and composition were first published by Sun Si-Miao in the Bei Ji Qian Jin Yao Fang (Thousands of Golden Prescriptions for Emergencies). The formula has since been an important part of Traditional Chinese Medicine for the treatment of chronic pain. Now, modern research confirms that Du Huo Ji Sheng Tang combined with acupuncture is highly effective for the treatment of knee osteoarthritis.
The acupuncture point prescription was straightforward TCM. Local acupoints combined with body style acupuncture and Ashi acupoints comprised the point formula. The combination of Dubi (ST35) and Neixiyan (MNLE16) were applied. Together, this acupoint combination is termed Xiyan (Eyes of the Knee). The point combination is given its name based on its location in the hollows below the patella on the medial and lateral sides of the patellar ligament. Although the TCM classic work Song of the Jade Dragonindicates that acupoint LV7 (Xiguan) combines well with Xiyan for the treatment of pain and inflammation of the knees with the inability to walk properly, a different set of TCM classic acupoints were chosen for this investigation to supplement administration of Xiyan:
A total of 60 patients were treated and evaluated in the study. They were randomly divided into the acupuncture plus herbs treatment group and the acupuncture plus ibuprofen control group, with 30 patients in each group. Both groups received identical electroacupuncture therapy; the treatment group was treated with Du Huo Ji Sheng Tang, while the control group was treated with ibuprofen sustained release capsules.
Manual acupuncture was applied prior to the administration of electroacupuncture. After elicitation of a deqi sensation, the acupuncture needles were connected to an electroacupuncture device with a continuous wave. The needles were retained for 30 minutes once electroacupuncture began. One 30 minute electroacupuncture session was conducted daily, for a total of 20 consecutive days. The slightly modified version of Du Huo Ji Sheng decoction for the treatment group was comprised of the following herbs:
Dang Gui (9 g)
Bai Shao (12 g)
Chuan Xiong (6 g)
Shu Di Huang (10 g)
Dang Shen (18 g)
Fu Ling (12 g)
Du Zhong （12 g)
Niu Xi (15 g)
Qin Jiu (10 g)
Fang Feng (10 g)
Du Huo (10 g)
Sang Ji Sheng (30 g)
Xi Xin (3 g)
Gan Cao (6 g)
Gui Zhi (9 g)
Additional herbs were prescribed according to individual symptoms, for arthralgia the following herbs were added:
Yin Yang Huo (10 g)
Yan Hu Suo (12 g)
For knee pain and swelling, the following herbs were added:
Yi Yi Ren (30 g)
Huang Bai (10 g)
For qi deficiency, the following herb was added:
Huang Qi (30 g)
One batch of the above herbs was boiled in water and simmered to yield a 200 ml decoction. Two decoctions were given to the patient daily, one in the morning and one at night, for a total of 20 consecutive days. For the drug control group patients, two 0.3 g ibuprofen sustained release capsules were given to the patient daily, one after breakfast and one after dinner, for a total of 20 consecutive days. Patients were evaluated before and after the treatment course. Joint function and severity of knee osteoarthritis were evaluated based on the Lysholm Knee Score Standard (LKSS). The total treatment effective rate for each patient group (treatment and control) was derived as the percentage of patients who achieved at least an effective treatment tier of improvement. The treatment efficacy for each patient was categorized into 1 of 3 tiers:
Significantly effective: Complete or significant absence of symptoms. ≥70% improvement in LKSS score.
Effective: Symptoms showed improvement. ≥30% but <70% improvement in LKSS score.
Not effective: Symptoms showed no visible improvement. <30% improvement in LKSS score.
The study confirms that herbs and acupuncture outperform drugs and acupuncture. This is a clinically significant finding for important reasons. First, the herbal medicine with acupuncture protocol does not cause the gastrointestinal distress common with ibuprofen intake. Second, this is a proven treatment option for the effective relief of disability and pain due to knee osteoarthritis.
Sun et al. had similar results in their independent investigation published in the Anhui Medical and Pharmaceutical Journal. The researchers determined that acupuncture plus moxibustion is more effective than diclofenac (an NSAID) for relief of knee osteoarthritis pain and motor impairment. The NSAID (nonsteroidal anti-inflammatory drug) had a faster onset of effective action but acupuncture produced significantly greater positive patient outcomes for long-term relief. The primary acupoints used in the study were Xiyan (M-NLE-16) and Heding (M-LE-27), two local acupoints commonly used for the treatment of knee disorders. Additional acupoints were added for specific diagnostic considerations. For stomach yangming channel related knee osteoarthritis issues, the following acupuncture points were added:
For gallbladder shaoyang channel related disorders, the following acupuncture points were added:
For bladder taiyang channel related disorders, the following acupoints were added:
For spleen taiyin related disorders, the following acupoints were added:
For liver jueyin related issues, the following acupuncture points were included:
For wind-cold channel concerns, the following acupuncture points were added:
For blood stasis, the following acupoints were added:
For liver and kidney related conditions, the following acupuncture points were added:
Acupuncture combined with moxibustion produced a positive patient outcome rate of 63.33%. The NSAID produced a 33.33% positive patient outcome rate for the treatment of knee osteoarthritis. Both studies reviewed in this article demonstrate that acupuncture is an effective therapy for relief from knee osteoarthritis inflammation, pain, and motor dysfunction. Given the data, acupuncture and other TCM modalities are recommended as viable treatment options by the researchers.
References: Liang CX. (2013). Clinical Observation on Duhuojisheng Decoction Combined with Acupuncture Treating 30 Cases of Knee Osteoarthritis. Journal of World Chinese Medicine. 8(10).
Li JG & Zhang J. (2009). TCM in treating osteoarthritis. Journal of Henan University of Chinese Medicine. 24(2):105-107.
Sun K, Huang XY & Wei FL. (2015). Clinical study on the treatment of knee osteoarthritis by acupuncture of Wei’s acupoints. Anhui Medical and Pharmaceutical Journal. 19(8).
Chen B, Fang ZC & Xiong FL. (2011). Acupuncture in treating knee osteoarthritis and improving the patients’ quality of life. Journal of Guiyang College. 33(3): 7-9.