Objective To observe the therapeutic effect of moxa fume in the treatment of chronic rhinosinusitis(CRS) and the effect of acupuncture plus smokeless moxibustion or smoky moxibustion on the expression of thymic stromal lymphopoietin(TSLP) and pituitary adenylate cyclase activating polypeptide(PACAP) proteins in the sinus mucosal tissue in CRS mice.Me-thods Sixty male C57 BL/6 J mice were randomly divided into 6 groups

namely normal control

sham operation

CRS model

medication

acupuncture plus smokeless moxibustion(Acu+smokeless Moxi) and acupuncture plus smoky moxibustion(Acu+smoky Moxi) groups

with 20 mice in each group. The CRS model was established by inserting a piece of polyporous sponge filled with streptococcus pneumoniae into the maxillary sinus after operation. The mice in the sham operation group received skin incision after opening the maxillary sinus. Mice of the medication group received gavage of clarithromycin 0.103 g·kg

(-1)

·d(-1)·d

(-1)

for 21 days. For mice of the Acu+smokeless Moxi and Acu +smoky Moxi groups

manual acupuncture stimulation was applied to bilateral “Zusanli”(ST36)

“Shenshu”(BL23) and “Hegu”(LI4) with the needles retained for 30 min

once every other day

and on the following day

moxibustion was applied to “Guanyuan”(CV4) and “Shenque”(BL23) for 20 min

once every other day. The treatment was given for 21 days. Mice of the normal

sham operation and model groups received gavage of normal saline(200 μL/d) for 21 days. Histopathological changes of the nasal mucosa were observed after H.E. staining

the TSLP and PACAP contents and expression were determined by enzyme-linked immunosorbent assay(ELISA) and immunohistochemistry

separately.Results At the end of the treatment

mice of the model group still had symptoms of nasal obstruction and runny nose

but those of the 3 treatment groups were obviously relieved in the nasal symptoms. H.E. staining showed an obvious chronic inflammatory reaction in the sinus mucosa

uneven distribution of the mucosal epithelium and necrotic and exfoliated epithelial cells

hyperplasia of fibrous tissue in the submucosa

etc. in the model group

which were relatively milder in the medication

Acu+smokeless Moxi and Acu+smoky Moxi groups

while no obvious inflammation was found in the normal group and sham operation group. In comparison with the normal group

no significant changes were found in the expression levels of PACAP and TSLP in the sham operation group(P

>

0.05). The expression level of PACAP was significantly lower(P

<

0.05) and that of TSLP significantly higher in the model group than in the normal and sham operatin groups(P

<

0.05). Compared with the model group

no significant changes were found in the expression of PACAP in the medication

Acu+smokeless Moxi and Acu+smoky Moxi groups(P

>

0.05)

and the expression of TSLP was further obviously increased in the Acu+smokeless Moxi group(P

<

0.01)

but obviously decreased in the Acu+smoky Moxi group(P

<

0.01).Conclusion Acupuncture combined with smoky moxibustion can down-regulate the expression of TSLP protein in the nasal sinus mucosa in CRS mice

which maybe contribute to its effect in reducing the inflammatory reaction and nasal symptoms.