World Journal of Acupuncture – Moxibustion 31 (2021) 100–104

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World Journal of Acupuncture – Moxibustion

journal homepage: www.elsevier.com/locate/wjam

Clinical Research

Clinical study on acupuncture combined with western medication for

diabetic peripheral neuropathy ✩

Gui-yun LI ()∗, Ya-qiong ZHANG (), Pan-yun LIU (), Hong-wei MA (
), Ji-liang HUANG ()
Department of Endocrinology, 251st Hospital of Chinese People’s Liberation Army, Zhangjiakou 075000, Hebei, China (251, 
 075000, )

a r t i c l e i n f o a b s t r a c t

Article history: Objective: To compare the clinical effect differences between western medication, acupuncture, and
Available online 7 March 2021 acupuncture combine with western medication in the treatment of diabetic peripheral neuropathy.
Keywords: Methods: Ninety-three patients were randomized into western medication group, acupuncture group,
Acupuncture and combination group, with 31 cases in each. The patients in western medication group were treated
Lipoic acid injection with lipoic acid injection and mecobalamin injection/ tablets. The patients in acupuncture group were
Mecobalamin injection/tablet treated with acupuncture, and the acupoints were selected according to the symptoms. The needles were
Diabetic peripheral neuropathy (DPN)
retained for 30 min, once a day. The patients in combination group were treated with both western med-
ication and acupuncture, specific methods as the above. The treatments were for 18 days in succession in
all of three group. The motor nerve conduction velocity (MNCV) and sensory nerve conduction velocity
(SNCV) of median nerve and common peroneal nerve, as well as the changes of symptoms and signs of
patients were observed before and after treatment. The clinical effect was evaluated.
Results: After treatment, the median nerve MNCV in the three groups, the median nerve SNCV and com-
mon peroneal nerve MNCV in acupuncture group and combination groups, and the common peroneal
nerve SNCV in acupuncture group were all higher than those of before treatment, with significantly sta-
tistical differences (all P<0.05). After treatment, the MNCV and SNCV of median nerve and common per-
oneal nerve in combination group were higher than those in western medication group and acupuncture
group, with significantly statistical differences (all P<0.05). After treatment, the number of patients in the
three groups with the symptoms and signs was lower than that of before treatment. The effective rate in
combination group was 96.8% (30/31), higher than those of western medication group, 74.2% (23/31), and
acupuncture group, 83.8% (26/31), with significantly statistical differences (both P<0.05).
Conclusion: Acupuncture combined with western medication in the treatment of diabetic peripheral neu-
ropathy can improve the nerve conduction velocity and improve the symptoms and signs of diabetic pa-
tients, with a better effect than those of western medication and simple acupuncture.
© 2021 World Journal of Acupuncture Moxibustion House. Published by Elsevier B.V. All rights reserved.

Diabetic peripheral neuropathy (DPN) is mainly caused by long-
term poor blood glucose control, leading to numbness and pain
in the limbs of patients, mostly manifested as needling pain or
burning sensation, muscle spasm, numbness and weakness, and
even muscle atrophy in severe cases. DPN is one of the chronic
complications of diabetes mellitus. There is currently no specific
✩
Supported by Zhangjiakou Science and Technology Research Plan: 1321111D.
∗
Corresponding author.
E-mail address: 1285245981@qq.com (G.-y. LI).
treatment for it. At present, the clinical treatment is mostly to
use the neurotrophins, antioxidants, and those drugs for improv-
ing the blood circulation [1], such as mecobalamin and lipoic acid
injection, etc. These drugs have a certain effect, but give patients
a heavy economic burden, because they are slow in relieving the
symptoms, thus causing longer courses of treatment. In order to
find a better way to treat DPN, we did an observation in our clin-
ical practice to compare the therapeutic effect difference among
acupuncture, first-line western medication, and acupuncture com-
bined with western medication groups. Here is the report.

https://doi.org/10.1016/j.wjam.2021.03.004
1003-5257/© 2021 World Journal of Acupuncture Moxibustion House. Published by Elsevier B.V. All rights reserved.
G.-y. LI, Y.-q. ZHANG, P.-y. LIU et al.
Table 1
Comparison of general data of DPN patients in the three groups.
Groups Cases Gender (cases) Male Female
Western medication 31 17 14
Acupuncture 31 18 13
Combination 31 18 13
Clinical data
General information
All 93 patients with DPN were from the outpatient and inpa-
tient of the Endocrinology Department of the 81st Group Army
Hospital of the PLA from January 2015 to October 2019, includ-
ing 53 males and 40 females, aged between 37 years old and 76
years old, with a disease course from one year to 16 years. Of the
93 patients, 86 cases were type 2 and 7 cases were type 1 dia-
betes mellitus. The patients were randomized into western medi-
cation group, acupuncture group and combination group by using
the random number table method, with 31 cases in each group.
There were no statistically significant differences in age, gender, di-
abetes and diabetic peripheral neuropathy course among the three
groups (all P>0.05), as shown in Table 1.
Diagnostic criteria
According to Zhongguo Erxíng Tangniaobing Fangbing Zhinan
(2China Guideline for Prevention and Treat-
ment of Type 2 Diabetes) [1], the diagnostic criteria were as follows.
(1) Continuous pain, numbness and/or sensory impairment in the
four limbs or lower limbs, and any one of the 5 examinations
(ankle reflex, tingling pain, vibration sense, pressure sense, and
temperature sense) was abnormal.
(2) The vibration sense of one thumb or both thumbs decreased.
(3) Bilateral or one side ankle reflex decreased to disappeared.
(4) The conduction velocity of common peroneal nerve was one
standard deviation lower than the normal value in the same
age group. Electromyogram showed the electrophysiological ab-
normalities, including delayed nerve conduction velocity, pro-
longed latency, and decreased amplitude, etc. in both lower
limbs.
Inclusion criteria
Those who met the diagnostic criteria of DPN, aged between 37
and 76 years old, signed the informed consent were admitted into
the study.
Exclusion criteria
(1) Patients with pregnancy, breastfeeding, severe cardiac, hepatic,
and renal failure.
(2) Patients with severe diabetic complications (such as the blind-
ness due to severe retinopathy, loss of pulse of the foot dorsal
artery), or with other serious disease (such as stroke, myocar-
dial infarction, malignant tumor, chronic alcohol poisoning, se-
vere mental illness, etc.).
(3) Patients with diabetic coma and severe infection in recent time.
(4) Patients with peripheral neuropathy due to other causes (such
as infection, chemical damage, nutritional disorders, metal poi-
soning, lumbar disease, Guillain-Barré syndrome, etc.).
(5) Severe arteriovenous diseases (venous embolism, lymphangitis,
etc.).
(6) Damage of the nerves especially caused by neurotoxic effect of
chemotherapeutics and metabolic poison due to renal failure.
World Journal of Acupuncture – Moxibustion 31 (2021) 100–104
Age (Mean±SD, years) Diabetes course (Mean±SD, years) DPN course (Mean±SD, years)
57.0 ± 8.0 8.0 ± 5.0 3.3 ± 2.0
59.0 ± 8.0 8.0 ± 7.0 3.4 ± 2.1
56.0 ± 9.0 9.0 ± 6.0 3.5 ± 2.1
Withdrawn criteria
Patients failed to complete all treatment and follow-up, and
those who requested to withdraw from the study for any reason.
Termination criteria
(1) Patients who were not able to adhere to the whole course
of treatment, those who were fainting during acupuncture or
afraid of needling.
(2) Patients had other infections or accidental injuries during treat-
ment.
(3) Patients had worsened pathological conditions during treat-
ment.
Treatment methods
Basic treatment
All of patients in the three groups received the same basic
treatment, adhered to scientific and reasonable diet and exercise,
and were guided by WeChat for using oral hypoglycemic drugs or
hypodermic insulin to control blood glucose. The intervention was
started when the average fasting blood glucose of each group was
less than or equal to 8.0 mmol/L.
Western medication group
Patients should go through hospitalization procedures and re-
ceive lipoic acid injection and mecobalamin injection/tablets af-
ter admission. Lipoic Acid Injection 0.6 g was added into 0.9%
sodium chloride injection 250 mL for intravenous drip, once a day.
Mecobalamin injection (1 mL: 0.5 mg), once a day, intramuscular
injection, or mecobalamin tablet 0.5 mg, oral taking, three times a
day. The treatment lasted for 18 days.
Acupuncture group
Patients did not need to go through hospitalization procedures.
Acupuncture and moxibustion were performed in the outpatient
department. The patients were in the sitting position for treat-
ment. All acupoints were disinfected with 75% medical alcohol,
and treated with 0.30 × 40 mm, 0.30 × 50 mm, 0.30 × 75 mm
Hwato brand stainless-steel needles. The needles of different spec-
ifications were selected according to the muscle richness of acu-
point location. Acupoints: Shènshū (BL23), Pı̌shū (BL20),
Gānshū (BL18), Guānyuán (CV4), Qìhǎi (CV6), Xuèhǎi
( SP10), Sányı̄njiāo (  SP6). If the upper limb symptoms
were obvious, Qǖchí (LI 11), Shǒusānlı̌ (LI 10), Nèiguān
( PC 6), Wàiguān ( TE 5), Hégǔ ( LI 4), and Bāxié (
Extra) were added. If the lower limb symptoms were obvious,
Yı̄nlíngquán (SP9), Yánglíngquán (GB34), Zúsānlı̌ (
ST36), Fēnglóng (ST40), Xuánzhōng (GB39), Zhàohǎi (
KI6), Tàixı̄ (KI3), and Tàichōng (LR3) were added. For the
numbness and pain of upper limbs, LI11, LI10, PC6, and TE5 were
added. For the numbness and pain of fingers, LI 4 and Bāxié (Ex-
tra) were added. If the burning sensation was obvious, SP 9 and
KI 3 were added. If there was cold feeling and pain in the lower
101
G.-y. LI, Y.-q. ZHANG, P.-y. LIU et al.
extremities, GB34, ST36, ST40, GB39, and KI6 were added. If there
was cold feeling and being afraid of cold or muscular spasm of
hands and feet, moxibustion was applied for 15 to 20 min at SP10,
LI10, ST36, PC6, TE5, SP9, GB34, and SP6.
Manipulation: at BL20, needle was inserted obliquely with an
angle of 30 ° in a direction towards the spine, to a depth about 15
to 25 mm. BL 23, needle was inserted perpendicularly to a depth
about 20 to 25 mm. The two acupoints were treated with rein-
forcing method by a clockwise twisting at 20–30 r/min to make
the needle gradually deeper, till the patient had a strong sensation
and the doctor had a tight feeling under the needle.
At BL 18, needle was inserted obliquely with an angle of 30 °
in a direction towards the spine, to a depth about 15 to 25 mm,
and treated with even method by a clockwise and counterclock-
wise twisting at 30 r/min, till the patient had a needling sensation
and the doctor had deqi under the needle.
The rest acupoints were needled perpendicularly to a depth of
25 to 30 mm, and treated with even method. The needles were
retained for 30 min, and manipulated once every 10 min. Before
withdrawing the needles, proper lifting, thrusting, and rotating of
the needles would be performed. The treatment was applied daily,
for 18 days in succession.
Combination group
Patients were treated with intervention measures in the west-
ern medication group and the acupuncture group respectively. The
specific methods were the same as described above. They needed
to be hospitalized for a total of 18 days.
Observation of therapeutic effect
Observation indicators
(1) Motor nerve conduction velocity (MNCV) and sensory nerve
conduction velocity (SNCV) of median nerve and common peroneal
nerve
The assessment of MNCV and SNCV is a diagnostic technique of
peripheral nerve function. It can represent the damage degree of
myelin sheath and neuraxon. By using the electromyograph (EMG),
KEYPOINT made by Danish Dandi Company, the damage of neural
function can be detected and diagnosed. In reference of Linchuang
Jidiantuxue (       Clinical Electromyography) [2], the
normal value of MNCV and SNCV of the median nerve is ≥45 and
≥47 m/s, respectively, and that of the common peroneal nerve is
≥42 and ≥40 m/s, respectively. If the MNCV and SNCV are lower
than normal values, it indicates neurological impairment. The in-
dexes were examined once before and after treatment, and the
specific values were recorded.
(2) The changes of symptoms and signs of patients
The patient’s 5 symptoms and signs, including numbness, pain,
muscular weakness, cold hands and feet, and reduced or absent
tendon reflexes, were recorded. The number of patients with these
symptoms and signs was counted before and after treatment.
Clinical effect
The evaluation criteria for clinical effect were formulated as fol-
lows according to Linchuang Jibing Zhenduan Yiju Zhiyu Haozhuan
Biaozhun (    Diagnosis of Diseases
and Criteria of Cure and Improvement) [3].
1 Significantly effective: the clinical symptoms, such as numb-
ness, pain, cold hands and feet, being afraid of cold, etc., were sig-
nificantly improved or basically disappeared. The physical signs,
such as muscle strength, tendon reflexes, etc., were significantly
improved or returned to normal. EMG showed that the motor and
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World Journal of Acupuncture – Moxibustion 31 (2021) 100–104
sensory nerves’ conduction velocity was significantly accelerated,
>5 m/s or returned to normal.  2 Effective: the clinical symptoms
were relieved and the physical signs were improved. EMG showed
that the motor and sensory nerves’ conduction velocity was sig-
nificantly accelerated, but≤5 m/s. 
3 Ineffective: the clinical symp-
toms, signs, and EMG were without changes or worse than before
treatment. Total effective rate = (number of significantly effective
cases + number of effective cases) ÷ total number of cases × 100%.
Statistical process
The SPSS 19.0 statistical software was used for statistical de-
scription. Measurement data were expressed as mean ± standard
deviation (Mean ± SD) and analyzed by paired t-test before and
after treatment and inter-group comparisons; enumeration data
were analyzed by chi-square test. The rank-sum test was adopted
to analyze ranked data. P<0.05 was considered as statistically sig-
nificant difference.
Results
All the selected patients in this study had good compliance, ad-
hered to the whole treatment, and could be discharged early if
they got better, according to Diagnosis of Diseases and Criteria of
Cure and Improvement, and the patients should be classified as sig-
nificantly effective, which would not be affecting the evaluation of
therapeutic effect. During the trial, there were no withdrawn, elim-
inated, or terminated cases in the three groups.
Comparison on changes of MNCV and SNCV of median nerve and
common peroneal nerve before and after treatment in the three
groups of patients with DPN
There were no significant differences in MNCV and SNCV of the
median nerve and common peroneal nerve before treatment
among the three groups (all P>0.05). After treatment, the
MNCV in the three groups, the SNCV of median nerve and
the MNCV of common peroneal nerve in the acupuncture
group and combination group, the SNCV of common per-
oneal nerve in the acupuncture group were all higher than
those of before treatment, and the differences were statis-
tically significant (all P<0.05). After treatment, all the in-
dexes of the combination group were higher than those of
the western medication group and acupuncture group, with
statistically significant differences (all P<0.05). See Table 2
for details.
Comparison of clinical symptoms and signs of DPN patients in the
three groups before and after treatment
The symptoms and signs of patients in the three groups before
and after treatment are shown in Table 3. The numbers of
patients with these 5 symptoms and signs before treatment
were more than those of after treatment.
Comparison of clinical effect of DPN patients in the three groups
The effective rate was 74.2% in the western medication group,
83.8% in the acupuncture group, and 96.8% in the combina-
tion group. The effective rate of combination group was higher
than those of western medication group and acupuncture group,
and the difference was statistically significant (both P<0.05). See
Table 4 for details.
G.-y. LI, Y.-q. ZHANG, P.-y. LIU et al. World Journal of Acupuncture – Moxibustion 31 (2021) 100–104

Table 2
Comparison of MNCV and SNCV of median nerve and common peroneal nerve in patients with DPN before and after treatment in the three groups (Mean±SD, m/s).

MNCV of common peroneal SNCV of common peroneal

Groups Cases MNCV of median nerve SNCV of median nerve nerve nerve

Before After Before After Before After Before After

treatment treatment treatment treatment treatment treatment treatment treatment

Western medication 31 40.7 ± 2.4 43.6 ± 2.8a , b 35.3 ± 2.6 36.7 ± 3.1b 35.7 ± 1.8 35.7 ± 1.8b 30.4 ± 2.3 31.7 ± 1.9 b

Acupuncture 31 40.5 ± 2.3 43.8 ± 3.3a , b 35.5 ± 2.4 37.6 ± 2.5 a , b 35.6 ± 1.9 37.2 ± 2.7 a , b 30.5 ± 2.2 31.9 ± 2.7 b

Combination 31 40.6 ± 2.5 47.2 ± 4.5a 34.7 ± 2.5 39.1 ± 2.7 a 35.7 ± 2.1 42.1 ± 2.6 a 30.3 ± 2.1 34.6 ± 2.7 a

Notes:.
a
Compared with the same group before treatment, P<0.05.
b
Compared with the same index in the combination group after treatment, P<0.05.

Table 3
Comparison of clinical symptoms and signs of DPN patients in the three groups before and after treatment (cases).

Groups Cases Time point Numbness Pain Muscular weakness Cold hands and feet Reduced or absent tendon reflexes

Western medication 31 Before treatment 31 20 11 3 12

After treatment 8 6 3 1 4
Acupuncture 31 Before treatment 31 21 13 4 15
After treatment 5 3 2 1 2
Combination 31 Before treatment 31 22 15 5 18
After treatment 1 1 1 1 1

Table 4
Comparison of therapeutic effect of DPN patients in the three groups (cases).

Groups Cases Significantly effective Effective Ineffective Total effective rate (%)

Western medication 31 12 11 8 74.2a

Acupuncture 31 13 13 5 83.8 a , b
Combination 31 22 8 1 96.8

Notes:.
a
Compared with the combination group, P<0.05.
b
Compared with the western medication group, P<0.05.

Discussion bination, and some combined acupuncture on the basis of western

In order to find out a better treatment for DPN, this study com-
pared acupuncture therapy with first-line western medications,
and discovered the therapeutic effect differences among the three
groups, i.e. western medication combined with acupuncture, sim-
ple acupuncture, and western medication. The result of study was
similar to other previous similar studies, the effect of the com-
bination group was the superiority, and the quality of life of pa-
tients has been improved. In acupuncture treatment, acupoints
were stimulated to activate the self-regulating mechanism of hu-
man body, giving full play to its function in increasing the nerve
conduction, promoting blood circulation to remove blood stasis to
stop pain. In case acupuncture combined with western medications
functioning to nourish nerves, they two nourish each other, bring-
ing out the best result of each other in the treatment of DPN. Thus,
the effect of combination group was definitely good.
DPN is one of the chronic complications of diabetes, and its in-
cidence has been increasing year by year, most of which is related
to poor blood glucose control of patients. There may be no obvi-
ous abnormal symptoms in the early stage [4], but when symp-
toms appear, it has led to obvious and even irreversible damage
of peripheral nerves, including numbness, needling-like pain, and a
burning sensation of limbs, even limited movement of limbs; in se-
vere cases there would be depression or anxiety [5], some patients
are profoundly pessimistic. It seriously affects the patient’s physi-
cal and mental health [6–7], lowering the patients’ life quality. Its
pathogenesis is not yet clear, its development is owing to multiple
factors [8]. Referred to previous similar studies [9–16], we found
that more and more doctors tried to apply different therapies to
treat DPN in recent years. Some applied western medication vita-
min B1, vitamin B12, mecobalamin or lipoic acid alone or in com-
medication. The combination of acupuncture with western medi-
cation showed a better clinical effect. Similar result was obtained
in this study. The therapeutic effect was 96.8% in the combination
group, 83.3% in the acupuncture group, and 74.2% in the western
medication group. It can be seen from the above result that the ef-
fect of acupuncture combined with western medication group was
superiority than that of western medication group, and the effect
of acupuncture group in the treatment of DPN was better than that
of western medication group.
Based on the holism theory of traditional Chinese medicine,
acupuncture treats DPN with syndrome differentiation, reinforc-
ing for deficiency syndrome, removing stasis for stagnation syn-
drome, and warming for cold syndrome in order to balance yin
and yang and remove obstruction of meridians and collaterals [17].
Acupoints are selected as primary and secondary ones accordingly.
In this study, the main ones, BL 20 and BL 23, are treated with
reinforcing method to activate yang qi to dispel pathogenic cold,
or with moxibustion to help yang qi to dispel cold, so as to warm
and replenish the spleen and kidney yang. BL18, CV4, CV6, SP6, and
SP10, are treated with even method to soothe the liver qi, replen-
ish yin and activate blood, and remove obstruction of meridians
and collaterals. For the different symptoms of damaged peripheral
nerves, different acupoints on the limbs are selected as secondary
ones, for the purpose to regulate yin yang, to promote qi and blood
circulation, so that the pain is stopped. Thus, this local treatment
plays a role of improving the function of peripheral nerves. The
12th chapter of Suwen (Plain Questions) says: “with the ap-
plication of combination of different methods, the good therapeutic
effect of each of them will be achieved.” The combination of pri-
mary and secondary acupoints plays a role of regulating the whole
body, accelerate the blood flow, thus to improve the blood oxygen

103
G.-y. LI, Y.-q. ZHANG, P.-y. LIU et al.
supply of the peripheral nerves, so that the impaired nerves can be
repaired. This method is simple, but achieves a remarkable thera-
peutic effect and without side effect. It is worth to be popularized.
In addition, attention should be paid to the clinical application
of acupuncture. If the blood glucose control is not satisfactory, it is
easy to cause infection, ulceration, or necrosis of local tissues. Local
disinfection of the skin should be strictly cautious before inserting
the needles, so as to avoid infection and unnecessary trouble.
To sum up, it can be seen from this study that, with the appli-
cation of acupuncture and western medication respectively to treat
DPN, either has certain effect, but if the two ways of treatment are
used in combination, the clinical effect is significantly higher than
any one of them. This study has shown that in case these two ways
are combined with each other for the treatment of DPN, the effect
is definitely better, which is worthy of application in the future.
Declaration of Competing Interest
The authors declare that they have no known competing finan-
cial interests or personal relationships that could have appeared to
influence the work reported in this paper.
State of Human Rights
The intervention conformed to the ethical criteria.
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