The Effect of Hypothalamus-Pituitary-Adrenal Axis Treatment by

10.6 µm Laser Moxibustion in Kidney Yang Deficiency Syndrome

Model

I Dewa Ayu Agra Darmawati

, Pan Wen

, Zhao Ling

, Ida Ayu Putri Wulandari

and I Ni Kadek Neza Dwiyanti

Applied Bachelor of Acupuncture and Herbal Medicine, Faculty of Health, Institute of Technology and Health Bali,

Indonesia

School of Acupuncture-Moxibustion and Tuina, Shanghai University of Traditional Chinese Medicine, China

Bachelor of Nursing Program, Faculty of Health, Institute of Technology and Health Bali, Indonesia

Bachelor of Midwifery Program, Faculty of Health, Institute of Technology and Health Bali, Indonesia

Keywords: Kidney Yang Deficiency Syndrome (KYDS), Hydrocortisone, HPA Axis, Laser Moxibustion.

Abstract: The damage and functional disorders of different degrees of the hypothalamic-pituitary-target gland axes

(adrenal, thyroid, and gonad) are the mechanisms of kidney yang deficiency syndrome. This study aims to

assess the effects of 10.6 µm laser moxibustion on rats with kidney-yang deficiency syndrome. The 40 SD

rats were randomly divided into a normal group, model group, Sham laser moxibustion (SLM) group, and

Laser moxibustion (LM) group. All rats in model KYDS were induced with a high dose of hydrocortisone

(25mg/kg.BW) for 15 days to mimic the model. The LM group obtained infrared laser moxibustion irradiation

on points GV 4 (Mingmen) and CV4 (Guanyuan) for 10 minutes at each point. The rats in the model showed

a reduction of 17-OHCS, CRH, ACTH, and CORT concentration compared with the normal group (P< 0.01).

These Indicated models have been successfully developed. After the intervention, the biochemistry of the

HPA axis indicators in the LM group had shown to enhance ACTH (22.59 vs 18.69), CRH (21.83 vs 18.01),

CORT (5.04 vs 4.23), and 17-OHCS (6.81 vs 4.14) all with P<0.01 compared with the model group. The 10.6

µm infrared laser moxibustion is effective for the treatment of KYDS by increasing the HPA Axis.

1 INTRODUCTION

According to Traditional Chinese Medicine, kidney

yang deficiency is a type of deficient cold pattern

which causes kidney yang deficiency to lead to an

abnormality in warming and transformation qi Jia-Xu

(2011). Studies have shown the damages and

functional disorders of different degrees of the

hypothalamic-pituitary-target gland axes (adrenal,

thyroid, and gonad) are the mechanism for forming

“kidney yang deficiency syndrome” (Chen, Wang,

Zhan, Zhang, & Wang, 2019; Nan et al., 2016;

Reheman et al., 2019; Tan et al., 2014; C. M. Wang et

al., 2012; L. Zhao et al., 2013; Zhou et al., 2016).

https://orcid.org/0000-0002-1940-270X

https://orcid.org/0000-0002-2411-0314

https://orcid.org/0000-0002-4017-8167

https://orcid.org/0000-0002-1599-8884

https://orcid.org/0000-0002-0715-2811

Based on a certain previous study, the classic

method to mimic the syndrome of kidney yang

deficiency by injecting a high dose of exogenous

glucocorticoid (e.g. Hydrocortisone)(C. M. Wang et

al., 2012). Hydrocortisone is a naturally occurring

corticosteroid that is produced by the adrenal cortex

The mechanism of moxibustion on the stimulating

point is to provide thermal stimulation by burning the

herb on the point itself (Jinfeng, Xinjun, Xiaojing, &

Zhi, 2016).The research on the effects of moxibustion

in KYDS has been limited to English-language

articles. Because of the high risk of bias and low

reporting quality of these studies, it has been difficult

Darmawati, I., Wen, P., Ling, Z., Wulandari, I. and Dwiyanti, I.

The Effect of Hypothalamus-Pituitary-Adrenal Axis Treatment by 10.6 µM Laser Moxibustion in Kidney Yang Deﬁciency Syndrome Model.

DOI: 10.5220/0012016700003576

In Proceedings of the 2nd Bali Biennial International Conference on Health Sciences (Bali BICHS 2022), pages 101-108

ISBN: 978-989-758-625-5

 2023 by SCITEPRESS – Science and Technology Publications, Lda. Under CC license (CC BY-NC-ND 4.0)

101

to determine whether moxibustion is an effective and

safe treatment for patients with KYDS.

The human body is a biological heater that

delivers infrared rays. Infrared rays were transformed

into internal by absorbed the objects and penetrate

deep into the tissues (Shen et al., 2006). The

mechanism of moxibustion on stimulating point is

provided thermal stimulation by burning the herb on

the points itself. Moxibustion is a therapy in which

thermal stimulation is applied to the surface of human

skin to activate the thermosensitive TRPV channels.

That plays a crucial role in the initial part of the

primary afferent nerves, and may also be the effectors

of moxibustion (Jinfeng et al., 2016)

Infrared laser moxibustion represents a novel non-

invasive and painless technology. Recent research has

indicated that moxibustion’s specific wavelengths of

infrared radiation are as potent as generated thermal

radiation. The 10.6 µm infrared laser applied in our

research mimics the effects and avoids the

shortcomings of traditional moxibustion treatment,

such as smoke, unpleasant smell, and difficulty in

controlling the dosage (Mao et al., 2016). The study

aims to assess the effects of 10.6 µm laser moxibustion

on rats with kidney-yang deficiency syndrome.

2 MATERIAL AND METHOD

2.1 Animals Preparation and Groups

A total of 40 males Sprague-Dawley rats (220 ± 20g)

were supplied by the Laboratory Animal Center of

Shanghai University of Traditional Chinese

Medicine. The rats used in this research were housed

in a cage and provided with certified standard rat

chow and tap water freely available. The room

temperature and humidity were regulated at 20 ± 2º C

and 60% ± 10% respectively. A 12/12 hour light-dark

cycle was set, with the lights on at 8 a.m. After one

week of acclimatization in the new environment to

prior the experimentation.

Rats were randomly divided into five groups:

Normal, model, SLM, and LM. 10 rats in each group

by random sampling method. The research protocol

was approved by the Laboratory Animal Welfare and

Ethics Committee of Shanghai University of

Traditional Chinese Medicine with the ethical number

is PZSHUTCM190322001.

2.2 Reagents and Instruments

Hydrocortisone injection was purchased from Tianjin

Jinyao Pharmaceutical Co., Ltd with National

Medicine Standard H12020886, batch number:

1811101 (China). GFDH pill was purchased from

Zhongjing Henan Wanxi Pharmaceutical Co., Ltd,

approval number: Z41021898. The Enzyme-Linked

Immunosorbent Assay kits for ACTH (ZC-36479),

CORT (ZC-37082), CRH (ZC-36478), and 17-OHCS

(ZC-35937) were provided by Shanghai ZCIBIO

Technology Co., Ltd (Shanghai, China).

The treatment was conducted using SX10-C1

laser moxibustion devices (Shanghai Wonderful

Opto-Electrics Tech Co Ltd, Shanghai, China) with

the following parameters: wavelength 10.6 µm;

power output 85 mV; 10 min/ each point; the diameter

of spot size is 2 mm. The irradiation was conducted

at 2 cm away from the skin surface.

2.3 Modeling Procedure and Treatment

The normal group has been obtained the

administration of NaCl (25 mg/kg of BW) by

intramuscular injection. However, the rats of model,

SLM, LM, and GFDH group induced by injecting

intramuscular hydrocortisone at a dose of 25 mg/kg

of body weight into a hind limb once daily (08.00-

10.00 a.m.) in turn another side respectively for 15

days.

The normal and model group raised as normal

without any treatment. The SLM and LM group

obtained treatment with 10.6 µm laser moxibustion.

The procedures were identical in the SLM, except that

the laser output was switched off. The laser probes

aligned on GV 4 and CV 4 acupoints and irradiated

each acupoint for 10 minutes. Each rat received the

treatment every other day, with a total of 10 sessions

of treatments.

Moreover, food and water intakes still reported

every day. In the last treatment session, all rats have

to collect 24 h urine 17-OCHS and ANY-Maze open

field. The procedure carried out the same as after

mimicked the model. All rats were sacrificed to take

blood and organs.

Samples of 24 h period urine were collected on

day 15 of hydrocortisone injection and day 20 after

treatment. The urine was centrifuged at 4º, 2500rpm

for 10 min to remove residues. Afterward, the

supernatants were collected. The blood was collected

from abdominal aorta into heparinized tubes and

immediately centrifuged at 3000rpm for 15 min. The

plasma was transferred into a clean tube. All samples

were stored at −80ºC until biochemical analysis. The

specimen should be slowly equilibrated to room

temperature before use, and should not be heated to

dissolve. The hemolysis of the specimen will affect

the final test results, thus this test should not be

Bali BICHS 2022 - The Bali Biennial International Conference on Health Sciences

102

performed on hemolyzed specimens. The level of

ACTH, CRH, and CORT was measured using ELISA

kits.

2.4 Behavioral Observation

The ANY-Maze open field was used to observation

spontaneous rat locomotor activity by using protocols

that have been published. The open field is a simple

analysis of the general locomotor's ability and

anxiety-related emotional behaviours of the rats

(Seibenhener & Wooten, 2015). It can plot the

animal's track with a simple line or as a heat map.

Heat maps would indicate how much time the animal

spent in different parts of the apparatus (ANY-maze,

2020). The rats were placed on the box within 100cm

x 100cm x 40cm open field apparatus and allowed to

move freely. Adjust the indoor light to minimize the

shadow in the apparatus. The test duration of rats is 5

min each rat. The infrared camera directly above the

open field apparatus to recorded the movement of the

rat using the ANY-MAZE software. The apparatus

was cleaned by 70% alcohol in between tests

3 STATISTICS

Statistical analyses were performed using SPSS

Statistics for Windows (Version 23, IBM corp.).

Normally distributed data were expressed as mean

value ± standard deviation (SD) and the significant

changes of variation between groups after model

determined using the independent sample t-test.

Meanwhile, the evaluation of treatment was analysed

by one-way analysis of variance (ANOVA), the least

significant difference (LSD) tests were performed for

post hoc multiple group comparisons. The one-way

non-parametric ANOVA Kruskal-Wallis test was used

to analyze the nonnormally distribution of data with

the Mann-Whitney test to assess the comparisons

between multiple groups. A p-value of less than 0.05

was considered significant and the zero 𝑃 value was

used in from less than 0.01.

4 RESULTS

4.1 Any-Maze Behavioral Observation

The general behavior or activity changes of rats

during the model and treatment have been recorded.

The ANY-Maze open field was used to observation

spontaneous rat locomotor activity by using protocols

that have been published. The open field is a simple

analysis of the general locomotor's ability and

anxiety-related emotional behaviors of the rats.

In Any-Maze open field, rats in the model

presented less movement thus preferred to stay in one

zone moreover showed frightened, exhaustion, and

increased defecation. It might a presentation of stress

because the hydrocortisone induced the adrenal to

produce the steroid hormone. Inability to adapt to the

new environment when they are separated from the

others compared with the normal. While the rats in

LM were presented with a desire to identify the new

environment with surrounds the area of the Any-

Maze field and can recognize the tracks. However, the

SLM group's inability to recognize the track plots and

less movement (Figure 1).

Figure 1: The general locomotor ability of rats by Any-

Maze open field analysis.

Figure 2: The distance of ANY-Maze open field apparatus

in each group. Bars represent means ± SD of 10 rats per

group, ## P<0.01, # P<0.05 versus the normal group; **

P<0.01,* P<0.05 versus the model group;▲▲ P<0.01,

▲P<0.05 versus the SLM group.

4.2 The Comparison of the Biochemical

Indicator of HPA Axis in Each

Group of Rats

The 17-OHCS of the rats in the model group were

decreased on day 15 (4.87 vs 7.72 µmol/L; P < 0.01)

(Table 1). Moreover, the model group has been

established successfully from the decreased blood

plasma concentration of CRH, ACTH, and CORT

with P < 0.01 (Table 2). All these results indicated

that the KYDS model was successfully established.

Group

Distance (m)

ANY-Maze

Normal

Model

SLM

The Effect of Hypothalamus-Pituitary-Adrenal Axis Treatment by 10.6 µM Laser Moxibustion in Kidney Yang Deﬁciency Syndrome Model

103

Table 1: The 24 h urine 17-OHCS on the 15 days after

hydrocortisone withdrawal (𝒙

𝒔).

Group n 17-OHCS (µmol/L)

Normal 10 7.72 ± 1.39

Model 30 4.87 ± 1.81

Note: Compared with the Normal group

P<0.01.

The CRH, ACTH, CORT, and 17-OHCS of rats in

LM were showed an increase when compared with

the model group (P <0.01) (Table 2). On the contrary,

in the SLM group was showed a decrease of the

ACTH concentration compared with the normal

group (20.28 vs 23.40 pg/mL; P<0.01), the 17-OHCS

(5.06 vs 7.02) µmol/L, CRH (18.52 vs 21.95) pg/mL,

and CORT (4.72 vs 5.50) ng/mL (P< 0.05) when

compared with the normal group but had not a

significant difference compared with the model group

(Table 2).

Table 2: Hormones variation investigation result after the

treatment in each group (𝒙

𝒔).

Grou

n 17-OHCS

(

mol/L

)

CRH

(pg

/mL

)

CTH

/mL

)

CORT

(

/mL

)

N 10 7.02 ±

0.96

21.95 ±

4.44

23.40 ±

2.26

5.50 ±

0.46

M 10 4.14 ±

1.1

18.01 ±

1.91

18.69 ±

1.89

4.23 ±

0.58

SLM 10 5.06 ±

2.45

18.52 ±

2.51

20.28 ±

1.74

4.72 ±

0.56

LM 10 6.81 ±

1.82**

21.83 ±

3.04**

22.59 ±

2.56*

5.04 ±

0.25**

Note: Normal (N); Model (M); Sham Laser Acupuncture (SLM);

Laser Moxibustion (LM). Compared with the normal group (##

P<0.01, #P<0.05), compared with model group (**P<0.01, *

P<0.05).

Figure 3: The changes in biochemical parameters related to

the HPA axis of kidney-yang deficiency syndrome (KYDS)

rats. Bars represent means ± SD of 10 rats per group,

##P<0.01, # P<0.05 versus the normal group, **P<0.01,

*P<0.05 versus the model group.

5 DISCUSSION

A large number of exogenous hormones and repeated

injections could disturb the stability of energy

metabolism and the self-adjusting ability in vivo (Lu,

Wang, Zhu, Lin, & Wo, 2012). Subsequently, causing

the damage of cellular or function degeneration in the

HPA axis. It was found and showed in clinical

manifestations of KYDS in humans (Liu et al., 2016).

The HPA axis is the main neuroendocrine system that

regulates responses to stress. It is well known that the

production of high levels of ROS into the glands that

comprise the HPA axis is associated with the

activation of a stress response system. The

hyperactivity of the HPA axis induced by redox

imbalance occurs by a reduction in negative feedback

through a decrease in GR translocation to the cellular

nucleus in corticotroph cells of the pituitary. The

hyperactivity of the HPA axis induced by redox

imbalance may occur by a reduction in negative

feedback through a decrease in GR translocation to

the cellular nucleus in corticotroph cells of the

pituitary.

The reactive oxygen species are ions or

small molecules containing oxygen and an unpaired

electron, and this free electron confers high reactivity

to oxygen. The HPA axis is the main neuroendocrine

system that regulates responses to stress. The

production of high levels of ROS into the glands that

comprise the HPA axis. It was known that associated

with the activation of a stress response system

(Prevatto et al., 2017)

The deficiency of kidney yang is the result of the

hypofunction or dysfunction of many hormones

control by the hypothalamus-pituitary-target gland

axes. The hypothalamic–pituitary–adrenal axis is a

neuroendocrine axis that utilizes three primary

structures, allowing it to respond appropriately to

stressful life-events. Thus involved in the

paraventricular nucleus of the hypothalamus (PVN),

the anterior pituitary gland, and the adrenal gland.

The PVN is the houses of the key neurons controlling

the level of activation of the HPA axis, regulation of

metabolism, growth, and immune functions, as well

as pre-autonomic control of gastrointestinal,

cardiovascular, and renal functions. The rat

neuroendocrine neurons of the PVN can be divided

into Magno- and parvocellular divisions based on

each neuron’s size and projections. When once the

releasing factor to reach the anterior pituitary, the

PVN would trigger the release of hormones into the

general circulation. The CRH, thyrotropin-releasing

hormone (TRH), oxytocin, dopamine, somatostatin,

and vasopressin (AVP) expressing neurons are among

those that project to the median eminence.

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104

Additionally, OT and AVP magnocellular neurons

project to the posterior pituitary and secrete directly

into the general circulation (Burford, Webster, &

Cruz-Topete, 2017).

The pituitary gland is the organ that has a function

to the secretion of protein hormones, plays a critical

role in the maintenance of homeostasis during and

after stress, as well as during other physiological

processes (growth and metabolism). The pituitary is

divided into the anterior lobe (or adenohypophysis)

and the posterior lobe (or neurohypophysis). The

posterior pituitary receives axonal inputs from

magnocellular OT and AVP neurons residing in the

supraoptic nucleus and PVN, where they release their

secretory product into the general circulation. The

corticotrophs are the key anterior pituitary cell type

involved in HPA axis regulation and the production of

ACTH. These cells contain receptors that bind CRH

to activate the synthesis of ACTH in response to

humoral signals from the hypothalamus. The adrenal

cortex is composed of three distinct concentric zones:

the zona glomerulosa, zona fasciculata, and zona

reticularis from outside to inside. In addition to the

cortical zones, the adrenal medulla is also involved in

the regulation of homeostasis. Following the

autonomic nervous system activation which secretes

epinephrine and norepinephrine. However, the main

adrenal region responsible for glucocorticoid

secretion is the zona fasciculata. Cells in the zona

fasciculata express the melanocortin receptor-2

(MC2R). The regulation basal and reactive hormone

is from the allowed of access to the vascular system

of the adrenal glands (Oyola & Handa, 2017) .

The CRH is a 41-amino acid peptide and arginine

vasopressin (AVP) released from the

hypophysiotrophic neurons in the paraventricular

nucleus (PVN) of the hypothalamus. Thus stimulate

the pituitary to the secretion of ACTH into the

bloodstream through the activation of the CRH

receptor type 1 (CRH-R1). The binds ACTH and the

melanocortin type 2 receptors (MC2-R) in the zona

fasciculate of the adrenal cortex, made a trigger the

adrenal cortex to synthesize and release of the

primary stress hormones. By the exogenous

glucocorticoids (Hydrocortisone) directly suppressed

ACTH production, the cortex of adrenal glands

produces glucocorticoids (cortisol in humans and

corticosterone in rodents) (Kokras, Hodes, Bangasser,

& Dalla, 2019). The ACTH stimulated CORT

production. In the end, it led to a decrease in the

content of CORT(Coursin & Wood, 2002).

Moxibustion is one of complementary alternative

medicine in China with a technique that applies heat

to the acupoints utilizing by burning a compressed,

powdered, combustible mass obtained from the

young leaves of moxa (Artemisia vulgaris) on the

certain locations of the body surfaces to treats and

prevents the diseases. The moxibustion is warm in

property and can smooth the circulation in the twelve

meridians with regulates the qi and blood, as well as

expelling the coldness and dampness, warming the

meridians, strengthen yang from collapsing, reduce

abscesses, dissipate nodules, stopping bleeding

maintain health and well-being. Moxibustion is very

effective in treating yin syndrome, cold syndrome,

and deficiency syndrome(Iravani et al., 2020; Kim,

Chae, Lee, Lee, & Park, 2011). It has significant

advantages to the treatment of chronic diseases and

the prevention of diseases. In modern research,

moxibustion therapy can promote metabolism,

improve immune system functions, and regulate the

physiological function of internal organs. The thermal

effect has produced by the moxibustion is beneficial

to play a role in the therapeutic. The selection of an

appropriate moxibustion material might important for

optimal therapeutic effect. The understanding of the

mechanism of the moxibustion effect from the

following has three aspects was the pharmacological

action, thermal effect, and infrared physical

properties (Ling Zhao & Shen, 2022).

It presented the thermal stimulation produced by

moxibustion significantly increased local blood flux

and affected heart rate variability. That found a two-

phase response in blood flow, a transient decrease

followed by an increase without blood pressure

change when applying moxibustion the thermal

stimulation to the gastrocnemius muscle. The analysis

demonstrated that the increase in blood flow occurred

due to an axon reflex that had a reflex arc below the

spinal cord, and the transient decrease in blood flow

was induced by the excitation of postganglionic

muscle sympathetic fibers. Moreover, several studies

have been shown the effect of stimulation influenced

the modulate autonomic nervous activity,

neurotransmitter levels, endogenous substance levels,

levels of inflammatory factors, and cardiovascular

and renal function, especially the sympathetic

nervous system. The sympathetic nervous system is a

branch of the autonomic nervous system and plays a

crucial role in the control of the cardiovascular

system in humans through the regulation of both

cardiac function and peripheral blood flow. Based on

the fingertip temperature was found the sympathetic

nervous induced changes in microcirculation. It used

various stimuli of noise, deep breath, and hand

cooling to triggering the sympathetic nervous system

to induce the decreases in cutaneous microcirculation

with the lag phase of approximately 21 and 26

The Effect of Hypothalamus-Pituitary-Adrenal Axis Treatment by 10.6 µM Laser Moxibustion in Kidney Yang Deﬁciency Syndrome Model

105

seconds, were record the transient decrease of

fingertip temperature. Moreover, found of the first

minute of manual acupuncture stimulation, the burst

rate of skin sympathetic nerve activity increased

accompanied by the reduction of skin blood flow. It

was suggested the thermal stimulation probably could

trigger the sympathetic nervous system and induce

the reduction of microcirculation included by the

decrease of fingertip temperature. Furthermore,

moxibustion could increase heart rate and mean

femoral arterial pressure. It has a regulatory effect on

cardiac function in brachycranial rats with the

promotion of the degranulation of mast cells. Because

of the degranulation of mast cells that play an

important role in signal transmission between mast

cells and peripheral sensory nerves (Matsumoto-

Miyazaki et al., 2016).

The mechanism of action of infrared radiating

material is transforming heat energy from the body

through (convection and conduction) into radiation

within the infrared wavelength range between 3~20

μm to induce homeostasis and photobiomodulation

via deeper penetration of IR radiation and water

molecule absorption in the skin. It uses to enhance

blood circulation and metabolism of the human

body(Tsai & Hamblin, 2017).

It was developed the peak of infrared radiation

produced by moxibustion which is vigorous as those

generated by thermal radiation. The peak wavelength

of the infrared radiation spectrum of indirect

moxibustion from conventional partitioned

moxibustion and acupuncture points are

approximately 10 µm. It played an important role

when combined with purely the thermal effect from

infrared radiation of indirect moxibustion. The

wavelength of 10.6 𝜇m laser is similar to the 10 µm

from conventional indirect moxibustion and

acupuncture points to generate a potent thermal effect

(Deng & Shen, 2013; Mao et al., 2016; L. Wang et al.,

2013; L. Zhao et al., 2013). The irradiation on GV4

and CV 4 points provides the therapeutic effect by

generates a protective response against viral and

bacterial infection thus promotes autophagy and the

bactericidal function of macrophage that probably

contributed to the inhibition of Akt phosphorylation

and the activation of eIF2𝛼 phosphorylation, these the

key signal pathways of variety of stresses. Moreover,

by adjusting the 5-HT to release the MC

degranulation would trigger the reaction of the body

to active the nervous-endocrine-immune system, and

regulate the immunity to achieving the target of

disease prevention and treatment (Li et al., 2014;

Qiong et al., 2018; 沈雪勇, 1996)

Infrared laser moxibustion was represented as a

novel noninvasive and painless technology that

provides self-regulation within treatment parameters.

Recent research has indicated that the specific

wavelengths of infrared radiation produced by

moxibustion are as potent as generated thermal

radiation (Mao et al., 2016). In traditional Chinese

medicine, kidney yang deficiency is the condition of

yang abnormality in warming and transformation qi

functions. This also the main type of deficient of the

cold pattern then can be alleviated by warm therapy

(沈雪勇, 1996). The laser moxibustion was irradiated

on GV 4 and CV 4 to stimulate a warm sensation. The

combination of these two points is provided the

therapeutic effect of seeking yang from yin, vice

versa. Reinforcing yang without damaging yin, may

regulate and strengthen both yin and yang also

balancing. Moreover, tonifying kidney essence and

strengthen primordial qi (Yuan, Yang, Han, & Ni,

2018).

The sham laser treatment, not able to change the

condition of the restraining state of the releasing

hormones in the hypothalamus, pituitary, and adrenal

cortex. Because of the absence of the laser irradiation

on the points. The placebo or sham group was used to

avoid bias in the treatment.

6 CONCLUSION

The 10.6 µm infrared laser moxibustion is effective

for treatment KYDS. It might relieve through

increasing the content of ACTH, CRH, CORT

concentration of HPA axis. Further study would focus

on the histopathology examination of the

hypothalamus, pituitary, and adrenal gland organ.

CONFLICTS OF INTEREST

“The authors declare that there is no conflict of

interest regarding the publication of this review.”

STATEMENT OF HUMAN AND

ANIMAL RIGHTS

“The treatment of animals conformed to the ethical

criteria in this experiment.”

Bali BICHS 2022 - The Bali Biennial International Conference on Health Sciences

106

ABBREVIATIONS

TCM: Traditional Chinese Medicine

KYDS: Kidney Yang Deficiency syndrome

HYD: Hydrocortisone

SLM: Sham Laser Moxibustion

LM: Laser Moxibustion

HPA: Hypothalamic-Pituitary-Adrenal

ELISA: Enzyme-Linked Immunosorbent

Assay

ACTH: Adrenocorticotropic Hormone

CRH: Corticotropin-Releasing Hormone

CORT: Cortisol (Human) / corticosterone

(Rodents)

17-OHCS: 17-Hydroxicorticosteroid

AVP: Arginine Vasopressin

ROS: Reactive Oxygen Species

GR: Glucocorticoid Receptor

MR: Mineralocorticoid Receptor

FFAs: Free Fatty Acids

PVN: Paraventricular Nucleus

MC2-R: Melanocortin Type 2 Receptor

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