Sheng Peng ,Si-Qing Zhang ,Yu-Ling Wang
1Graduate School,Tianjin University of Traditional Chinese Medicine,Tianjin 301617,China.2Tianjin Hospital Of Itcwm Nankai Hospital,Tianjin 300100,China.
Abstract Moxibustion is one of the characteristics of Traditional Chinese medicine therapy .It has the effects of activating blood circulation and removing stasis,warming the meridians and strengthening and exorcising evil spirits.It shows unique advantages in improving postoperative symptoms of breast cancer patients.In this paper,the overview of moxibustion method,moxibustion method in improving postoperative upper limb dysfunction,cancer-related fatigue,nausea and vomiting,anxiety and depression of breast cancer patients were reviewed,and the existing deficiencies were summarized and analyzed,in order to provide reference for the clinical application of moxibustion method in improving postoperative discomfort symptoms of breast cancer patients and related research.
Key words:moxibustion;breast cancer;symptoms of discomfort.
Introduction
Global Cancer Statistics report 2020 shows that female breast cancer has surpassed lung cancer as the most common cancer,with an estimated 2.3 million new cases,accounting for 11.7% of all cancer cases[1].In China,breast cancer,as one of the five most common cancers in women,accounts for 15% of the total number of cancer cases in women[2].At present,the treatment of breast cancer is mainly surgical treatment,commonly used is modified radical mastectomy or simple mastectomy,in order to prevent or reduce the recurrence of breast cancer[3].With the continuous improvement of early screening,surgical resection and emerging anti-cancer methods,the 5-year survival rate of breast cancer survivors after surgery has been improved as a whole[4].However,patients generally face a lot of physical and psychological discomfort in the process of postoperative treatment,such as upper limb dysfunction,cancer-related fatigue,nausea and vomiting,anxiety and depression,etc.,which seriously affect the quality of life of patients.Therefore,it is very important to explore economic and efficient intervention measures to alleviate postoperative discomfort of patients[5].Moxibustion,as one of the characteristic and appropriate techniques of traditional Chinese medicine in China,has a high clinical application value in the treatment of breast cancer patients due to its advantages of simplicity,convenience,efficiency and cheapness,which can effectively prevent and treat diseases,regulate emotions and relieve discomfort[6].This article reviews the overview of moxibustion and its application in improving postoperative uncomfortable symptoms of breast cancer patients.
Overview of moxibustion method
Moxibustion means that moxa leaves are used as the main material to uniformly burn moxa leaves,and the firepower and heat generated by moxa leaves are applied to the skin on the body surface or specific acupoints,so as to achieve the functions of warming channels and dispersing cold,dispersing wind and relieving the surface,activating Qi and promoting blood circulation,and balancing Yin and Yang[7].The combination of moxibustion and acupuncture is called acupuncture and moxibustion."Lingshu·Guan Neng" stated that"Acupuncture is not suitable for acupuncture",indicating that moxibustion can be used as a supplement and extension of acupuncture therapy in a wider range of applications."God moxibustion classics theory"said:"Take the moxa incense as a column,can pass the twelve classics,walk three Yin,regulate Qi and blood,cure all diseases,such as anti palm effect".The efficacy of moxibustion for disease prevention and treatment is mainly reflected in warm heat stimulation,drug effect,moxa smoke burning and light radiation effect[8,9],among which warm heat stimulation is the most important mechanism of action,and the peak wave treatment and spectral range of light radiation effect are still lacking clear conclusions.Early moxibustion mainly refers to moxibustion therapy,mainly direct moxibustion,with the continuous exploration of all dynasties of physicians followed by moxibustion,moxibustion,warm moxibustion and four flower moxibustion.With the rapid development of modern medicine and scientific and technological innovation,moxibustion materials and moxibustion tools of moxibustion are diverse,including heat sensitive moxibustion,long snake moxibustion,thunder fire moxibustion,controllable temperature moxibustion,etc.,which is the leading clinical moxibustion therapy.Moxibustion has been widely used in the prevention and treatment of diseases of respiratory system,cardiovascular system,digestive system and urinary system since ancient times[10].Breast cancer belongs to the category of "Milk Rock" in traditional Chinese medicine,and it is recorded in Authentic Surgery that moxibustion ironing therapy or moxibustion on the top of the nucleus can be used for external treatment[11].Modern studies have shown[12]that Artemisia argyi belongs to pure Yang and can effectively improve blood circulation,relieve fatigue,warm Yang to complement deficiency,regulate emotions and activate viscera,playing a favorable advantage in postoperative rehabilitation of breast cancer patients.
Effect of moxibustion in improving postoperative symptoms of breast cancer patients
Improvement of postoperative upper limb dysfunction
Upper limb Lymphedema：Breast Cancer-Related Lymphedema(BCRL)belongs to the category of "Edema" and "Pulse obstruction" in traditional Chinese medicine,which is caused by deficiency of vital Qi,deficiency of Qi,blood and body fluid,stagnation of meridians and veins,and imbalance of Yin and Yang of viscera caused by surgery or chemotherapy[13]."All diseases" said:"Limbs for the end of the Yang,Yang Qi and warm." In clinical,after breast cancer patients undergo axillary lymph node dissection,not only the axillary lymph nodes are removed,but the lymph vessels are also ligated.Therefore,a large amount of protein-containing lymph fluid cannot pass through the reflux path and stay in the interstitial space and cause the swelling of the tissue in the relevant part.In addition,due to the influence of axillary effusion,infection,and scar contracture after surgery,the lymphatic and venous return of the upper limbs are also affected.Moxibustion and acupuncture have similar effects.Both of them play a role in raising Yang and lifting depression,warming the meridian and clearing the Bi,and activating the collateral and blood circulation[14]by stimulating specific acupoint locations,which is one of the ideal ways to improve BCRL.Chen et al.[15]used the technique of"Smoothing,Tonifying and Reducing" to relieve chronic lymphedema after 30min of acupuncture with moxa stick suspension moxibustion.Studies have shown that warm acupuncture can reduce the degree of lymphedema by recanalizing lymphatic vessels of affected limbs and stimulatingphagocytosisofleukocytestoreduce inflammation.Zushui Powder prescription has the effect of Heying Tongbi.Combined with microwave moxibustion,it can enhance the permeability of blood vessel wall and speed up blood flow,thus warming Yang and promoting blood circulation in all directions,improving water and reducing swelling.Cheng et al.[16]applied this method to treat BCRL with an effective rate of 93.33%.Lou et al.[17]intervened in 130 patients with BCRL.The experimental group was given breast function recovery exercise combined with moxibustion therapy,and moxibustion was applied at Tianzong,Guangming,Danzhong,Renzhongshu,Zusanli and Yinlingquan points on the 5th day after surgery,once a day for 30min each,while the control group only received simple function recovery exercise.The results showed that in the experimental group,the recovery effect of lymphedema was more obvious,the possible reason is that moxibustion warming meridians and collasals can effectively reduce the pain caused by rehabilitation exercise,and patients are more likely to comply and adhere to the intervention process.The study also showed that the longer the intervention time combined with moxibustion and rehabilitation exercise,the better the therapeutic effect may be,which still needs further research and discussion in the future.The study of Wang et al.[18]showed that moxibustion therapy has a definite effect on improving lymphedema by stimulating the meridians with warm heat,compared with the barometric circulation therapy of wearing a pressure suit every day.Comprehensive results at home and abroad show that moxibustion can effectively relieve the swelling caused by blocked Qi and blood meridians by using its"Warm ventilation" effect,and play a great role in improving the local tissue microcirculation disorder and lymphedema degree of breast cancer patients.
Limb and shoulder joint activity obstacle:from the perspective of traditional Chinese medicine shoulder joint activity obstacle"Poliomyelitis" category,the breast cancer patients postoperative local wound pain,decreased muscle strength,lateral arm lymphedema,local scar tissue contracture causes shoulder joint limited range,severe cases can cause shoulder joint stiffness,limb muscle disuse atrophy[19].Moxibustion has the effect of softening scar,warming meridian and dispersing cold,promoting blood circulation and relieving pain,and is conducive to the recovery of nerve and motor function.Some studies have pointed out that[20]moxibustion,when smoked and burned,can produce an efficient and suitable infrared ray for the human body,which has strong penetration and can directly reach the deep tissue of muscle,has anti-inflammatory,spasmolysis,analgesic and immunity improvement,and can effectively promote the recovery of upper limb and shoulder joint function of patients.Zheng[21]in breast cancer postoperative 72h for coracoid midpoint,placed on the shoulders of Moxa salt wrapped warm moxibustion 30 min,the results showed that patients with shoulder joint activity increased obviously.Compared with simple moxibustion therapy,moxibustion with Moxa salt contains moxa salt and traditional Chinese medicine components,which has stronger blood tonic,blood circulation and conduction ability.At present,more and more studies not only focus on the efficacy of moxibustion,but also on the improvement of moxibustion materials,such as controllable temperature moxibustion,that is,moxibustion is applied in a constant temperature,smoke-free and convenient environment,so as to improve patients' shoulder range of motion,reduce the incidence of shoulder dysfunction,and achieve the purpose of rapid rehabilitation[22].Controllable temperature moxibustion therapy is a safe and reliable non-invasive operation with low medical cost,which is worthy of further clinical application.
Improvement of postoperative cancer-induced fatigue
Cancer-Related Fatigue(CRF)is classified as "Fatigue exhaustion" in traditional Chinese medicine.A survey shows that 75% of breast Cancer patients will experience fatigue after surgery,which has a great impact on patients' comfortable life experience[23].It is pointed out in Acupuncture and Moxibustion To "moxibustion for deficiency,so that fire Qi to help the Yuan Qi",indicating that exhaustion is one of the indications of moxibustion[24].According to LingShu,"Deficiency can be repaired,and subsidence can be moxibustion".Therefore,moxibustion can be used for CRF to strengthen Yang,promote jin,strengthen deficiency and improve body immunity[25].Thunder fire moxibustion uses pure traditional Chinese medicine.During burning,various components in Moxa stick penetrate into the body for circulation through skin and meridians,and reduce the activity of inflammatory cells and inhibit tumor necrosis factor through neuroendocrine effect,which can effectively reduce Qi deficiency and fatigue[26].Lu et al.[27]used thunder fire moxibustion to intervene in 60 breast cancer patients with Qi-deficiency cancer induced fatigue due to chemotherapy,and applied warm moxibustion from top to bottom on foot sun bladder meridian and Ren-pulse segment,with a total effective rate of 83.3%.This study indicates that cancer-induced fatigue is a persistent uncomfortable symptom,and various traditional Chinese medicine characteristic therapies,such as emotional therapy and exercise therapy,can be included in future studies to fully demonstrate the advantages of traditional Chinese medicine palliative therapy in CRF of cancer patients.In order to maintain health and strengthen the body,moxibustion Zusanli can supplement deficiency and regulate blood,and improve the symptoms of exhaustion.Xie[28]used ginger moxibustion Zusanli to treat postoperative CRF of breast cancer.After 2 weeks of intervention,it was found that the total score of CFS and the scores of all dimensions were significantly reduced(P＜0.05).The four-flower moxibustion method is named for its moxibustion like four sparks,first recorded in Wang Tao's "Secret To the Outside Taiwan",which has the effect of soothing the liver,regulating qi,tonifying the spleen and benefiting the kidney,significantly improving the body's immunity and tissue repair ability,and alleviating the fatigue of patients[29].In addition,Mao et al.[30]are conducting a randomized double-blind controlled trial on the effect of infrared laser moxibustion on cancer-related fatigue in breast cancer survivors,which will provide more reliable evidence for infrared laser moxibustion in the treatment of CRF in breast cancer patients.
Improve postoperative nausea and vomiting
Postoperative Nausea and Vomiting(POAV)is classified as "Vomiting"in traditional Chinese medicine.POAV is a common postoperative discomfort of breast cancer patients,caused by the disease itself and adverse reactions caused by related treatment.It may lead to patients'rejection of later treatment[31].Studies have shown that a special heat signal can be generated during the burning of artemisiae,which can effectively prevent the stimulation of gastrointestinal by drugs and reduce the metabolic load of liver and kidney,in line with the "green and healthy" treatment concept of cancer patients[32].Liu et al.[33]observed the effect of moxibustion on the treatment of POAV in breast cancer.The observation group used anti-emetic drugs combined with acupoint moxibustion to carry out roundabout moxibustion.Guo et al.[34]treated 48 patients with breast cancer chemotherapy with mild moxibustion and salt-separated moxibustion.The combination of the two special external therapies of traditional chinese medicine can effectively improve gastrointestinal blood circulation of breast cancer patients and alleviate adverse reactions of POAV.It is not clear whether mild moxibustion and salt-separated moxibustion will have a more obvious and lasting effect before chemotherapy.In addition,some researchers also used moxibustion combined with acupoint application[35]and moxibustion combined with acupoint massage[36]to intervene nausea and vomiting caused by postoperative chemotherapy for breast cancer,and the research results showed that the intervention was effective.The combination of two or more suitable techniques of traditional Chinese medicine has advantages and disadvantages.In clinical practice,it is necessary to strengthen communication with patients and formulate reasonable treatment plans while meeting their individual needs.
Improve postoperative anxiety and depression
Anxiety and depression is classified as "Depression syndrome" in traditional Chinese medicine.Most breast cancer patients are accompanied by stress,anxiety,depression,panic,depression and other negative emotions after surgery,among which anxiety and depression are the most common[37,38].According to The Theory of Natural Questions,Anger and Heaven,"Yang Qi can nourish the spirit and nourish the soul,while soft Yang Qi can nourish the tendons",indicating that the Warm and warm promoting effect of Yang Qi is conducive to the body's Qi,blood and spiritual nourishing wisdom.Moxibustion therapy can nourish Yin and Yang,regulate Yang meridian,thus treating anxiety and depression[39].Mo et al.[40]used Zusanli,Yongquan,Taichong and Hegu as the main points to perform moxibustion with ginger moxa box on 118 patients who planned to undergo radical mastectomy for breast cancer.The study showed that moxibustion with ginger moxa box could regulate patients' Qi and mind through the dual efficacy of moxibustion and ginger,thus relieving anxiety and depression.Liu etc.[41]compared the drug treatment and temperature effect of acupuncture and moxibustion therapy of breast cancer patients postoperative anxiety depression,the results of two groups of patients with Depression Scale Score(SDS),Anxiety Scale Score(SAS)were lower,but compared with western medicine treatment,warm acupuncture as a kind of physical rehabilitation therapy,can directly stimulate the cerebral cortex,relieve the patient's depressed mood,The effect was even more pronounced in the improvement of anxiety and depression.However,at present,the psychological research and treatment research of breast cancer patients at home and abroad is not sufficient.It is hoped that in the future,more staff engaged in psychology and tumor-related researchers will actively invest in the mental health research of breast cancer patients and draw more beneficial clinical research conclusions.
Deficiencies and prospects
Existing studies have confirmed that moxibustion has significant efficacy in improving upper limb dysfunction,cancer-related fatigue,nausea and vomiting,anxiety and depression symptoms of breast cancer patients.Under the guidance of the overall concept of traditional Chinese medicine and the concept of syndrome differentiation,moxibustion can be strengthened in clinical use and implementation,but there are still some deficiencies that need to be further studied and improved.First of all,moxibustion method in improving postoperative symptoms of breast cancer patients in the selection of points,moxibustion techniques,moxibustion sequence,moxibustion quantity,moxibustion treatment frequency and time differences are great,is not conducive to traditional chinese medicine syndrome differentiation and treatment.Second,in the market at present all kinds of moxibustion emerge in endlessly,such as controlled temperature moxibustion box,moxibustion apparatus of microwave and infrared laser moxibustion apparatus,etc.,while overcomes the traditional moxibustion pollute the environment,complicated operation,easy to burn,the risk of unsafe,improve the use of moxibustion convenient degree,but the specific what kind of moxibustion symptoms in patients with breast cancer intervention effect is best.Finally,in the moxibustion improve breast cancer patients postoperative symptoms of clinical study,the overall sample,overall intervention time is shorter,mostly from 2 weeks to 4 weeks,only consider the short-term curative effect of moxibustion,and domestic and foreign research focuses on moxibustion improve breast cancer patients body discomfort,less research on psychological,emotional mechanism.Therefore,future research should constantly improve the operation and implementation specifications of moxibustion,integrate and analyze the application of different moxibustion methods in tumor patients,orderly promote the scientific research and development of moxibustion materials and utensils,and explore more specific moxibustion treatment programs.At the same time,the implementation of multidisciplinary integration development system,increase the research on the mental health of breast cancer patients,and gradually make up for the deficiencies in the research.
Summary
Although the modern medical treatment can bring satisfactory clinical effect,it will bring double trauma to patients both physically and mentally in the long run.Moxibustion,as a unique treatment of traditional Chinese medicine,plays a role in dredging meridians,regulating Yin and Yang,nourishing and dispelling evil,and has unique application advantages and broad application prospects in improving postoperative discomfort symptoms of breast cancer patients.Studies have shown that the warming effect of moxibustion can dilate local capillaries under the skin,improve blood circulation at the moxibustion site,relieve muscle spasm,enhance local metabolism,and regulate the immune system[42,43,44].It is hoped that in the future,more excellent medical workers at home and abroad will actively participate in the rehabilitation study of moxibustion to improve postoperative discomfort symptoms of breast cancer patients,and demonstrate the therapeutic effect of moxibustion on these symptoms with a more objective,rigorous,large-scale and standardized randomized controlled clinical study.The combination of Traditional Chinese medicine therapy and modern precision medicine,while making full use of the advantages of western medicine,increases the characteristic technology and concept of traditional Chinese medicine,and promotes the development trend of moxibustion to adapt to the new situation and new background,aiming to guide clinical practice and benefit more patients.
