Introduction: Chinese medicine (CM) external therapy is commonly used to treat rheumatoid arthritis (RA) in combination with conventional drug. This study aims to provide a comprehensive synthesis on the efficacy of CM external therapy combined with conventional drug treatment in RA. Methods: Randomised controlled trials (RCTs) experimenting the efficacy of CM external therapy (acupuncture, moxibustion and CM fumigation) combined with conventional drug in comparison with conventional drug only in RA patients were collected from PubMed, Medline, Cochrane Central of Controlled Trials (CENTRAL), ClinicalTrials.gov, China National Knowledge Infrastructure (CNKI), and Wanfang databases. Quality was assessed using the Cochrane Risk of Bias Tool. The outcome measures which include Disease Activity Score-28 (DAS28), Visual Analogue Scale (VAS), Swollen Joint Count (SJC), Tumour Necrosis Factor (TNF-α), serum levels of C-reactive Protein (CRP) and Erythrocyte Sedimentation Rate (ESR) were analysed using Review Manager 5.4.1 and GRADEpro GDT online software. Results: Fifty RCTs fulfilling the criteria were included. Although some level of efficacy was statistically noted on the use of CM external therapies, their certainty levels are mixed, ranging only in between moderate and low. Conclusions Mixed levels of certainty has hindered the drawing of conclusion. The addition of CM external therapies to conventional drug treatment may provide some benefits in RA. Further clinical trials with considerations in minimising the risk of bias are recommended to provide more high-quality evidence in the effect of CM external therapies as a complementary treatment in RA.
Medicine, Chinese Traditional ; Fumigation ; Meta-Analysis [Publication Type] ; Moxibustion ; Arthritis, Rheumatoid ; Systematic Review [Publication Type]

Traditional Chinese medicine(TCM) has a long history and abundant experience in external therapy, which marks human wisdom. In the early history of human, people found that fumigation, coating, and sticking of some tree branches and herb stems can help alleviate scabies and remove parasites in productive labor, which indicates the emergence of external therapy. Pathogen usually enters the body through the surface, so external therapy can be used to treat the disease. External therapy is among the major characteristic of surgery of TCM. As one of the external therapies in TCM, external application to acupoints smooths the zang-fu organs through meridians and collaterals, thereby harmonizing yin and yang. This therapy emerged in the early society, formed the Spring and Autumn Period and the Warring States Period, improved in the Song and Ming dynasties, and matured in the Qing dynasty. With the efforts of experts in history, it has had a mature theory. According to modern research, it can avoid the first-pass effect of liver and the gastrointestinal irritation and improve the bioavailability of Chinese medicine. Based on the effect of Chinese medicine and the theory of meridian and collateral, it can stimulate the acupoints, exert regulatory effect on acupoints, and give full play to the efficacy of TCM and the interaction of the two. Thereby, it can regulate qi and blood and balance yin and yang, thus being widely used in the treatment of diseases. In this paper, the use of external application to acupoints, the effect on skin immunity, the regulation of neuro-inflammatory mechanism, the relationship between acupoint application and human circulation network, and the development of its dosage form were summarized through literature review. On this basis, this study is expected to lay a foundation for further research.
Humans ; Acupuncture Points ; Biological Availability ; Fumigation ; Medicine, Chinese Traditional ; Meridians

Lilii Bulbus is a commonly used Chinese herbal medicine with both medicinal and edible values, while the market products usually has the problem of sulfur fumigation. Therefore, the quality and safety of Lilii Bulbus products deserve attention. In this study, ultra-high performance liquid chromatography-time of flight-tandem mass spectrometry(UPLC-Q-TOF-MS/MS) was combined with principal component analysis(PCA) and orthogonal partial least squares discriminant analysis(OPLS-DA) to analyze the differential components of Lilii Bulbus before and after sulfur fumigation. We identified ten markers generated after sulfur fumigation, summarized their mass fragmentation and transformation patterns, and verified the structures of phenylacrylic acid markers of sulfur fumigation. At the same time, the cytotoxicity of the aqueous extracts of Lilii Bulbus before and after sulfur fumigation was evaluated. The results showed that in the concentration range of 0-800 mg·L~(-1), the aqueous extract of Lilii Bulbus after sulfur fumigation had no significant effect on the viability of human liver LO2 cells, human renal proximal tubular HK-2 cells, and rat adrenal pheochromocytoma PC-12 cells. Moreover, the viability of the cells exposed to the aqueous extract of Lilii Bulbus before and after sulfur fumigation showed no significant difference. This study identified phenylacrylic acid and furostanol saponins as markers of sulfur-fumigated Lilii Bulbus for the first time, and made clear that proper sulfur fumigation of Lilii Bulbus would not produce cytotoxicity, providing a theoretical basis for the rapid identification and quality and safety control of sulfur-fumigated Lilii Bulbus.
Humans ; Animals ; Rats ; Fumigation ; Tandem Mass Spectrometry ; Chromatography, High Pressure Liquid ; Epithelial Cells ; Sulfur

Traditional Chinese medicine fumigation device is the carrier of traditional Chinese medicine fumigation treatment. In recent years, with the rapid development of new technology and new materials, the development of fumigation device changes with each passing day, and a variety of new products continue to emerge. However, at present, the lack of corresponding evaluation norms, resulting in some difficulties in the registration, marketing, quality control, evaluation scale and other aspects of the product. Some products have many disadvantages in clinical use. From the perspective of technical review, this paper elaborates and analyzes the main concerns in technical review, such as product structure, main risks, performance requirements, clinical evaluation, etc., in order to provide a basis for the design, development, production, registration, use and post-marketing supervision of the devices.
Fumigation ; Medicine, Chinese Traditional ; Marketing ; Quality Control

A moxibustion device with the functions of auricular fumigation moxibustion and heat-sensitive moxibustion is designed. The smoke of the ignited moxa stick is used for the fumigation moxibustion at the external auditory canal, while the heat generated works on Dazhui (GV 14) for heat-sensitive moxibustion. The device consists of five parts, i.e. combustion chamber, smoke pipe, smoke processing chamber, power module and connector. It solves the limitations such as unpleasant experience in treatment, unfavorable temperature control, easy scalding and excessive manual dependence induced by usual fumigation moxibustion and during heat-sensitive moxibustion. This moxibustion device may improve the safety and convenience when delivering the treatment with fumigation moxibustion and heat-sensitive moxibustion, as well as the work efficiency of medical staff.
Humans ; Moxibustion ; Hot Temperature ; Fumigation ; Smoke ; Temperature

The continuous cropping obstacle of Panax notoginseng is serious, and effective control measures are lacking. Soil disinfection with chloropicrin(CP) has been proven to be effective in reducing the obstacles to continuous cropping of other crops. In order to ascertain the effect of CP in the continuous cropping of P. notoginseng, this paper explored the influences of CP at different treatment concentrations(0,30,40,50 kg/Mu, 1 Mu≈667 m~2) on soil macro-element nutrients, soil enzyme activity, growth and development of P. notoginseng, and the accumulation of medicinal components. The results showed that CP fumigation significantly increased the content of total nitrogen, alkali-hydrolyzable nitrogen, ammonium nitrogen, nitrate nitrogen, and available phosphorus in the soil, but it had no significant effect on potassium content. The soil protease activity showed a trend of first increasing and then decreasing with the prolonging of the treatment time. Both the soil urease and acid phosphatase activities showed a trend of first decreasing and then increasing with the prolonging of the treatment time. The higher the CP treatment concentration was, the lower the urease and acid phosphatase activities would be in the soil. The protease activity was relatively high after CP40 treatment, which was better than CP30 and CP50 treatments in promoting the nitrogen-phosphorus-potassium accumulation in P. notoginseng. The seedling survival rates after CP0, CP30, CP40, and CP50 tratments in October were 0, 65.56%, 89.44%, and 83.33%, respectively. Compared with the CP30 and CP50 treatments, CP40 treatment significantly facilitated the growth and development of P. notoginseng, the increase in fresh and dry weights, and the accumulation of root saponins. In summary, CP40 treatment accelerates the increase in soil nitrogen and phosphorus nutrients and their accumulation in P. notoginseng, elevates the seedling survival rate of P. notoginseng, enhances the growth and development of P. notoginseng, and promotes the accumulation of medicinal components. CP40 treatment is therefore recommended in production.
Fumigation ; Growth and Development ; Hydrocarbons, Chlorinated ; Panax notoginseng ; Soil

This study aims to investigate the influence of the different dosages of sulfur on the quality and the browning enzyme activity of Chrysanthemum morifolium cv. Boju. In this experiment,UV-spectrophotometry was used to determine the activities of browning enzymes,including polyphenol oxidase( PPO) and peroxidase( POD),in 7 different dosages of 0,4,8,16,50,150,200 g·kg~(-1)( weight ratio of sulfur/fresh chrysanthemum). A comprehensively comparison of the 7 chemical constituents of C. morifolium cv. Boju fumigated with 7 different dosage of sulfur was conducted by HPLC analysis. In this paper,the results showed that the activities of PPO and POD enzymes decreased significantly in chrysanthemum processed by sulfur fumigation. The activities of PPO and POD enzymes decreased gradually with the increase of sulfur dosage. When the sulfur dosage was higher than 4 g·kg~(-1),the PPO enzyme was significantly reduced. When the sulfur dosage was higher than 8 g·kg~(-1),the PPO enzyme was completely inactivated. The effect of different sulfur dosage s on the chemical composition was investigated. In comparison,it was found that when the sulfur dosage was 8 g·kg~(-1),the content of chlorogenic acid was higher than the 4 g·kg~(-1) and that of the sample without sulfur fumigation. Thereafter,with the increase of the sulfur dosage,the content of chlorogenic acid was unchanged. It was speculated that when harvesting,the tissue of fresh flower was destroyed,which caused the activation of browning enzymes. Afterwards,the sulfur fumigation could significantly reduce the activity of browning enzymes,which prevented the conversion of phenols in the reaction substrates( chlorogenic acid and 3,5-dicaffeoylquninic acid) into terpenoids,and better retained quinic acid components. However,when the sulfur dosage reached 8 g·kg~(-1) or16 g·kg~(-1),the content of quinic acid components were no longer changed,which indicated that the sulfur dosage had reached the saturated dosage. Similarly,when the sulfur dosage was increased,the contents of flavonoid aglycones showed a downward trend except for luteolin-7-O-glucoside. It was speculated that the sulfur fumigation inhibited the activity of hydrolase,which reduced the hydrolysis of flavonoid glycosides to aglycones. However,the reaction mechanism needed further verification. In conclusion,although sulfur fumigation could significantly inhibit browning,different dosages of sulfur had a significant effect on the chemical composition of C. morifolium cv. Boju,which could affect the consistency of quality and the stability of the therapeutic effect. Excessive use of sulfur was likely to cause a large amount of SO2 residues in C. morifolium cv. Boju,Therefore,different Sulphur dosages had a significant effect on the quality of chrysanthemum,which therefore was not recommended in production. A small dose of sulfur could be used to prevent enzymatic browning. When the dosage of sulfur increased to a certain extent or reached a saturation state,a small dose of sulfur is recommended in necessary. In this paper,the correlation between the sulfur dosage,the enzyme activity,and the main chemical constituents of chrysanthemum was clarified. The experimental research provided the guidance for regulating the harvesting processing of chrysanthemum and the harvesting processing,and improving the quality of chrysanthemum.
Chromatography, High Pressure Liquid ; Chrysanthemum ; Fumigation ; Quinic Acid ; Sulfur

To study the effect of different storage time on the chemical compositions and sulfur dioxide residues of sulfur-fumigated Gastrodiae Rhizoma (GR), and provide scientific basis for solving the quality and safety issues of sulfur-fumigated traditional Chinese medicinal materials. GR, sulfur-fumigated GR and its medicinal slices were stored under the same conditions, and then 8 active ingredients and sulfur dioxide residues were measured respectively. The results showed that the content of gastrodins in sulfur-fumigated GR and its medicinal slices was significantly lower than that in the non-fumigated GR. Moreover, the content of sulfur dioxide residue in sulfur-fumigated GR was significantly higher than that in its medicinal slices. That is to say, sulfur fumigation degree had significantly higher effect on GR quality as compared with its medicinal slices. During the whole storage time (8 months), the content of the eight chemical components in GR was not changed greatly in general. However, after the storage for 4 months, the content of 8 components and sulfur dioxide residues in all of GR samples were significantly changed. In particular, the content of sulfur dioxide residue in GR medicinal materials decreased up to 50% or more.
Drug Storage ; Drugs, Chinese Herbal ; chemistry ; Fumigation ; Gastrodia ; chemistry ; Rhizome ; chemistry ; Sulfur ; Sulfur Dioxide ; analysis

As Gastrodiae Rhizoma (GR) is one of the herbs more seriously affected by sulfur fumigation, so its quality has been always of a great concern. In this paper, GR samples collected from eight main producing areas and in three forms were fumigated with sulfur and quantitatively and qualitatively analyzed based on UPLC-Q-TOF-MS/MS. The results showed that the contents of gastrodin, parishin, parishin B and parishin C were decreased, while the content of parishin E was increased after sulfur fumigation treatment. Besides, a new sulfur marker named p-hydroxybenzyl hydrogen sulfite was produced in sulfur-fumigated GR samples. As compared with producing origins, forms had a greater impact on the quality of GR, especially in Hongtianma and Wutianma. Besides, the contents of gastrodins and parishins in Hongtianma from Jilin were lowest as compared with those in other producing areas. This might be correlated with planting patterns and environmental factors. In conclusion, sulfur fumigation has a more obvious impact on the quality of GR than origins and forms, which is attributed to the generation of new sulfur fumigated markers.
Chromatography, High Pressure Liquid ; Drugs, Chinese Herbal ; standards ; Fumigation ; Gastrodia ; chemistry ; Quality Control ; Rhizome ; chemistry ; Sulfur ; Tandem Mass Spectrometry

Studies on the characteristic chemical markers of sulfur fumigation have become an effective auxiliary way for quality control of traditional Chinese medicine. This study established a quantitative analysis method for the determination of -hydroxybenzyl hydrogen sulfite (-HS) in Gastrodiae Rhizoma (GR) based on UPLC-MS/MS. Then, 37 batches of GR were screened, and the results showed that 27 batches of them were sulfur-fumigated. Especially, the GR samples in Yunnan producing areas were sulfur-fumigated more seriously. Based on the stability of -HS after different storage time and heat treatment methods, it was found that the content of -HS was stable and reliable in the storage period of 8 months and under normal heat treatment (50, 60, 70, 80 °C) conditions. In conclusion, this study shows a high sensitivity, good selectivity and good stability of -HS, which can provide reference for the quality control and sulfur fumigation screening of GR.
China ; Chromatography, Liquid ; Drugs, Chinese Herbal ; chemistry ; standards ; Fumigation ; Gastrodia ; chemistry ; Quality Control ; Rhizome ; chemistry ; Sulfites ; analysis ; Sulfur ; Tandem Mass Spectrometry