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An acupuncture-based triple therapy significantly controls refractory ankylosing spondylitis

Ankylosing spondylitis is a subtype of axial spondyloarthritis with radiographic structural damage. Within conventional Western medicine, no specific treatment is currently available. Non-steriodal anti-inflammatory drugs (NSAIDs) and tumor necrosis factor-α (TNF-α) antagonists are the two main categories of conventional pharmaceutical administered. NSAIDs have only about a 12%-15% clinic remission rate in patients with longstanding disease. and the cardiovascular, gastrointestinal, and renal risks of long term treatment is always a concern. TNF-α antagonists look promising, but discontinuation generally resulted in a relapse in 75%-90% of cases.

Non-pharmaceutical therapy is usually safe and has minimal side effects. One example of non-pharmaceutical therapy, acupuncture, has been used in the treatment of ankylosing spondylitis. It has been reported that acupuncture-based therapy can improve up to 95.6% of patients. but in most of these reports, the clinical outcome was mainly symptom improvement, not good clinical control of disease progression.

A single-center, retrospective case series study was conducted in a clinic in Munich, Germany. Patients with ankylosing spondylitis admitted to the clinic between February 1999 and December 2022 were collected and analyzed. Each patient was diagnosed in local conventional Western hospitals/clinics. All cases were refractory to conventional treatment. Most of the patients also received TNF-α antagonists treatment.

All patients received Zhang’s cupping triple therapy: 2 sessions of cupping on the back, acupuncture in the jiaji points from the level of GV 14 (Dazhui) point to the level of GV3 (Yaoyangguan) point. An infrared lamp was applied during the entire process of cupping and acupuncture.

All patients received "Zhang's Cupping Triple Therapy" which is detailed as:

1.1 Electric cupping. The electric cupping machine is recombined from a sputum suction machine and a plastic vacuum cupping machine. The pressure was between minus 0.5 and minus 0.8 atmospheres. The size of cup varies, depending on the need of shape and area in the skin, usually with an internal diameter of 3.5cm -5.5cm.

Cups were placed on the back, waist and sacrum area. After setting the cups for 10 minutes, a second session of cupping was placed at the other location that the first session did not cover and set for another 10 minutes.

1.2 Acupuncture. One inch acupuncture needles were inserted in the Jiaji points, from the level of GV 14 (Dazhui) point to GV3 (Yaoyangguan) point. For patients with pain in the sacroiliac joint region, needles were added locally. The duration of acupuncture was 20 minutes.

1.3 Infrared light. Infrared therapy was applied in the whole process of cupping and acupuncture. The total voltage is 750 volts, covering the whole back area. The total duration of therapy was about 50 minutes.

The median follow-up was five years 4.5 months, with the maximum of 22 years 10 months.

Primary outcome

On average, after 1 (IQR 1.0-1.0) visit or 2.5 days (IQR 1.0-10.8) of treatment, patients started to feel pain improvement, and 4 (IQR 2.3-6.5) visits or 52.5 days (IQR 20.5-181.3) of treatments to feel pain free. 59.1% of patients were completely pain free (13/22) and 36.4% of patients reported improvement (8/22) at their last visit, with only one case of no change (4.5%). The visual analog scale (VAS) score was reduced from 7.3±0.3 at the initial visit to 1.4±0.5 at the last visit.

Secondary outcome

A significant functional improvement after the cupping triple therapy was also observed. The BASFI score was reduced from 7.0±0.4 to 2.3±0.6 and the BASDAI was reduced from 6.6±0.4 to 1.3±0.5.

Figure 1: Change of pain severity after treatment. A: Pain status; B: visual analog scale (VAS). p value is shown in the figure.

Figure 2: Change from baseline in Bath ankylosing spondylitis functional index (BASFI) and Bath ankylosing spondylitis disease activity index (BASDAI). p value is shown in the figure.

The result is markedly better than the report of TNF- α antagonist. For example, a randomized, placebo controlled, multicenter phase 3 trial of a TNF-α antagonist, certolizumab pegol (CZP), showed a 63.6% response rate, and 25.2% of patients’ ankylosing spondylitis disease activity scores (ASDAS) showed inactive disease (clinical remission).

My comments:

This therapy is worth a large clinical trial to confirm its effectiveness. Our clinic provides this therapy.


Zuobiao Yuan, Yikai Li, Liang Zhang. Ankylosing Spondylitis Treated with Zhang’s Cupping Triple Therapy: A Restrospective Case Series Study. Clinical research and clinical trials. 2023. DOI:

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