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J Acupunct Res > Volume 33(2); 2016 > Article
Bang, Sohn, Lee, Ok, and Choi: A case report on a patient with Dupuytren’s contracture improved by acupuncture, moxibustion and bee venom pharmacopuncture

Abstract

Objectives:

To treat the progression of fibroproliferative disease that affects the flexion contracture of the fingers for patients with Dupuytren’s contracture, the purpose of this study is to report a case of a patient with Dupuytren’s contracture after complex Korean medical treatment.

Methods:

A patient was treated with acupuncture, moxibustion and bee venom pharmacopuncture on their left palmar aponeurosis. Six rounds of acupuncture and moxibustion were administered from November 30, 2015 through to January 2, 2016. Three rounds of bee venom pharmacopuncture was administered from December 14, 2015 through to January 2, 2016. The degree of flexion contracture and the Tubiana’s stage were measured to evaluate the clinical improvement.

Results:

After 30 treatment sessions the flexion contracture degrees of the 4th finger’s metacarpophalangeal joint and proximal interphalangeal joint improved as much as 25°, 15°, respectively. And the flexion contracture degrees of the 5th finger’s metacarpophalangeal joint, proximal interphalangeal joint and distal interphalangeal joint improved as much as 15°, 10°, 5°, respectively. The Tubiana’s stage of each finger decreased from 4 to 3.

Conclusion:

This study suggests that acupuncture, moxibustion and bee venom pharmacopuncture could be effective for patients with Dupuytren’s contracture.

Fig. 1
Treatment points of acupuncture, moxibustion and bee venom pharmacopuncture
acup-33-2-173f1.gif
Fig. 2
The angle change of flexion contracture of 4th finger
MCPJ: Metacarpophalangeal joint.
PIPJ: Proximal interphalangeal joint.
DIPJ: Distal interphalangeal joint.
Degree: Angle of flexion contractured joint.
Date: Month and day, accordingly.
acup-33-2-173f2.gif
Fig. 3
The angle change of flexion contracture of 5th finger
MCPJ: Metacarpophalangeal joint.
PIPJ: Proximal interphalangeal joint.
DIPJ: Distal interphalangeal joint.
Degree: Angle of flexion contractured joint.
Date: Month and day, accordingly.
acup-33-2-173f3.gif
Table 1
Check List for STRICTA
1. Acupuncture rationale

Style of acupuncture Traditional korean medicine
Rationale for treatment Anatomy
Literature sources to justify rationale Rayan GM. Dupuytren disease: Anatomy, pathology, presentation and treatment. J Bone Joint Surg Am. 2007; 89(1): 189–98.
Han TR, Bang MS, Chung SG et al. Rehabilitaion Medicine. 5th ed. Seoul: Koonja. 2014: 11–3, 184–5, 331.

2. Needling details

Points used Unilateral Sobu (HT8) and three nodule on left palmar aponeurosis
Numbers of needle inserted 4
Depths of insertion 5 ~ 7 mm
Responses elicited None
Needle stimulation None
Needle retention time 20 minutes
Needle type 0.25 × 30 mm, Dong-bang Stainless steel disposable

3. Treatment regimen

Number of treatment sessions 30 times
Frequency of treatment Six times a week in a total of 5 weeks

4. Co-interventions

Other interventions Bee venom pharmacopuncture Indirect moxibustion

5. Practitioner background

Duration of relevant training Korean medicine doctor, who has more than 3 years of clinical experience under acupuncture and moxibustion medicine training education process
Length of clinical experience
Expertise in specific condition

6. Control interventions

Control None
Table 2
List of Herbal Medication
Period Prescription Composition
One dose: 25 mg
2015-11-30 ~ 2015-12-13 Bosinji Powder [補腎肢] (tsumura, tokyo, japan) Rehmannia root 4.5 mg, Achyranthes root 2.7 mg, Cornus fruit 2.7 mg, Dioscorea rhizome 2.7 mg, Psyllium husk 2.7 mg, Alisma rhizome 2.7 mg, Hoelen 2.7 mg, Moutan root bark 2.7 mg, Cinnamon bark 0.9 mg, Pulvis aconiti tuberis purificatum 0.9 mg
2015-12-14 ~ 2015-12-16 Ijin Decoction [二陣湯] Pinelliae rhizome 8 g, Zingiberis rhizoma recens 6 g, Hoelen (red) 4 g, Citri pericarpium 4 g, Glycyrrhizae radix (broiled) 2 g
2015-12-17 ~ 2015-12-21 Pyeongwi Decoction [平胃散] Atractylodis rhizome 16 g, Citri pericarpium (dried) 12 g, Magnoliae cortex 8 g, Glyrrhizae radix 5 g, Zingiberis rhizoma recens 4 g, Jujubae fructus 4 g
Pyeongwi Decoction added
2015-12-22 ~ 2015-12-23 Aurantii immaturus fructus (jisil) Row rhei rhizoma (daehwang), [平胃散加枳實, 大黃] Atractylodis rhizome 8 g, Citri pericarpium 6 g, Magnoliae cortex 4 g, Glyrrhizae radix 3 g, Zingiberis rhizome 2 g, Jujubae fructus 2 g, Aurantii immaturus fructus 2 g, Row rhei rhizome 2 g
Yukgunja Decoction added
2015-12-24 ~ 2015-12-30 Fritillariae thunbergii bulbus (jeolpaemo) [六君子湯加浙貝母] Pinelliae rhizoma 6 g, Atractylodis rhizoma alba 6 g, Citri pericarpium (dried) 4 g Hoelen 4 g Ginseng radix 4 g, Glyrrhizae radix (broiled) 2 g, Zingiberis rhizoma recens 2 g, Jujubae fructus 2 g, Fritillariae thunbergii bulbus 2 g
2015-12-31 ~ 2016-01-02 Hyangsapyeongwi Decoction [香砂平胃散] Atractylodis rhizome 8 g, Citri pericarpium (dried) 4 g, Cyperi rhizome (processed) 4 g, Aurantii immaturus fructus 3 g, Agastachis herba 3 g, Magnoliae cortex 3 g, Amomi fructus 3 g, Aucklandiae radix 2 g, Glycyrrhizae radix 2 g
Table 3
Tubiana’s Assessment of deformities in Dupuytren’s Disease
Stage Deformity
0 Aponeurotic lesion (nodule or band) with no contracture
1 Overall contracture between 0 and 45 degrees (°)
2 Overall contracture between 45 and 90 degrees (°)
3 Overall contracture between 90 and 135 degrees (°)
4 Overall contracture greater than 135 degrees (°)
Table 4
The Changes of Tubiana’s stage during Treatment Period
Date Tubiana’s stage of 4th digit Tubiana’s stage of 5th digit
2015-11-30 4 4
2015-12-07 3 3
2015-12-12 3 3
2015-12-19 3 3
2015-12-26 3 3
2016-01-02 3 3

IV. References

1. Korean Acupuncture and Moxibustion Society TextbookCompilationCommittee. Theacupuncture and moxibustion medicine. Gyeonggi: Jipmoondang. 2012:249–54, 412–6, 483637–8.

2. Bayat A, McGrouther DA. Management of dupuytren’s disease-clear advise for an elusive condition. Ann R coll Surg Engl. 2006;88(1):3–8.
crossref pmc
3. The Korean academy of oriental rehabilitation medicine. Oriental rehabilitation medicine. 3rd ed. Seoul: Koonja. 2011:148.

4. Han TR, Bang MS, Chung SG et al. Rehabilitaion Medicine. 5th ed. Seoul: Koonja. 2014:11–3, 184–5, 331.

5. Tubiana R, Michon J, Thomine JM. Scheme for the assessment of deformities in Dupuytren’s disease. Surg Clin North Am. 1968;48(5):979–84.
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6. Worrel M. Dupuytren’s disease. Orthopedics. 2012;35(1):52–60.
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7. Gabbiani G, Majno G. Dupuytren’s contracture: fibroblast contraction? An ultrastructural study. Am J Pathol. 1972;66(1):131–46.
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9. Honner R, Lamb DW, James JI. Dupuytren’s contracture-Long term results after fasciectomy. J Bone Joint Surg Br. 1971;53(2):240–6.
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