Objective To observe the curative effect of herbal-medicine-powder-separated"Long-snake moxibustion"over the Governor Vessel at different vesiculation conditions in the treatment of rheumatoid arthritis(RA).Method A total of120 RA patients received herbal-powder-separated long-snake moxibustion in the present study and randomized into Banmao(Cantharides

CANT

being able to promote skin vesiculation for enhancing the therapeutic effect)-0g group

CANT-1.5g group and CANT-3.0g group(n=40in each group)according to the dosage of CANT used in the herbs-medicinal powder.In addition to Cantharides

the medicinal powder also contained Shexiang(Moschus

1g)

Dingxiang(Flos Caryophylli

1g)and Rougui(Cinnamon bark

1g).When treated

the patient was asked to take a prone position

the ginger juice was evenly smeared on the patient's back from Dazhui(GV 14)to Yaoshu(GV 2

about 3cm wide)

then

the above-mentioned medicinal powder was spread on the smeared ginger juice

followed by putting a layer of gauze

ginger powder and ignited moxa-stick

respectively.The treatment was conducted once every 30 days

and twice altogether.The visual analog scale(VAS)was used to assess the pain severity of moxibustion-induced skin vesiculation on the patient's back in 24 hafter moxibustion.The severity of vesiculation was assessed according to the status of vesicles appeared at the local skin(0point:no vesicles;3points:string-of-beads-like vesicles with the vesicle diameter being less than 2cm;6points:foliated vesicles with the vesicle diameter being larger than 2cm).The patient's symptoms and dysfunction of hand-knee joints were scored

and serum rheumatoid factor(RF)

C-reactive protein(CRP)

immune globulin IgM and IgG contents were assayed by ELISA

and the erythrocyte sedimentation rate(ESR)was determined by using Westergren method.Results After moxibustion

of the three 40 RA patients in the CANT-0g

CANT-1.5g and CANT-3.0g groups

0

10 and 12cases were under control in their symptoms

7

16 and 19experienced marked improvement

17

9and 6were improved

16

5and 3failed in the treatment

with the effective rates being 60.0%(16/40)

87.5%(35/40)and 92.5%(37/40)

respectively.The curative effects of CANT-1.5g and CANT-3.0g were significantly superior to that of CANT-0g(P<0.01).Both the scores for skin vesiculation status and pain severity were significantly higher in the CANT-3.0g group than in the CANT-0g(no skin vesiculation)and CANT-1.5g groups

and markedly higher in the CANT-1.5g group than in the CANT-0g group(P<0.01).Following the treatment

the symptom score and joint dysfunction score

ESR level

and serum RF

CRP

IgM and IgG contents were considerably decreased in the three groups in comparison with pre-treatment in the same one group(P<0.01);and those of the CANT-1.5g and CANT-3.0g groups were markedly lower than those of CANT-0g group(P<0.01).In addition

CANT-3.0g was notably superior to CANT-1.5g in lowering symptom and joint dysfunction scores

ESR

serum RF and CRP contents(P<0.05).No significant differences were found between the CANT-1.5g and CANT-3.0g groups in serum IgM and IgG levels and in the therapeutic effect(P>0.05).Conclusion Long-snake moxibustion combined with CANT-induced vesiculation has a good curative effect in the treatment of RA

which may be associated with its effects in lowering ESR level

and serum RF

CRP

IgM and IgG contents.The curative effect of vesiculation moxibustion is far better than non-vesiculation moxibustion

but mild vesiculation moxibustion is recommended due to severe pain of CANT-3.0g.