ABSTRACT
Gouty arthritis （GA） is the metabolic rheumatism caused by purine metabolism disorder， which can be acute or chronic. The main manifestations of GA include recurrent redness， swelling， heat pain， and dysfunction of the affected joints. According to the theory of modern medicine， GA is closely associated with the increase in uric acid， the participation of inflammatory cytokines， the weakening of antioxidant response， apoptosis， and the imbalance of intestinal flora and bone metabolism， whereas the specific pathogenesis remains unclear. GA is characterized by easy diagnosis， difficult treatment， and high recurrence rate， which seriously affects the life quality of patients. Colchicine， corticosteroids， non-steroidal anti-inflammatory drugs， and selective cyclooxygenase-2 inhibitors are the commonly used western medicines for this disease， which demonstrate remarkable short-term therapeutic effect. However， long-term use of these medicines will bring serious adverse reactions. Chinese medicines， with high safety and causing few adverse reactions， have a variety of active components which can act on multiple pathways and targets to exert synergistic effects， thus attracting wide attention. This paper systematically reviews the literature reporting the Chinese medicines in improving antioxidant response， reducing chondrocyte apoptosis， and regulating intestinal flora and bone metabolism， aiming to further clarify the pathogenesis of GA and provide a scientific basis for the clinical application of Chinese medicines in the prevention and treatment of GA.
ABSTRACT
Objective::To investigate the clinical efficacy and mechanism of Guige Lingxian decoction combined with moxibustion at neck Jiaji acupoint on cervical spondylotic radiculopathy (CSR) of wind-cold-dampness arthralgia syndrome. Method::Totally 120 cases of cervical spondylotic radiculopathy with wind-cold-dampness syndrome were randomly divided into two groups: traditional Chinese medicine(TCM) group and combination group, with 60 cases in each group. The TCM group was treated with Guige Lingxian Tang 150 mL/time, twice a day. The combination group was treated with moxibustion at neck Jiaji acupoint in addition to the therapy of the TCM group, 30 minutes/time, once a day. Both groups were treated for 8 weeks. CSR 20 subscale score, SF-36 scale score, typical symptoms and signs remission time were recorded. The total effective rate and the cure rate were recorded after treatment. Serum levels of leukotriene B4(LTB4), leukotriene C4(LTC4), leukotriene D4 (LTD4), chitinase protein 40 (YKL-40), interleukin-1β (IL-1β) and tumor necrosis factor-α (TNF-α) were measured by enzyme linked immunosorbent assay(ELISA) before and after treatment. Result::The total effective rate was 98.11%(52/53), and the cure rate was 43.39%(23/53) in the combination group, which were higher than 91.04%(61/67) and 20.89%(14/67) in the TCM group (P<0.05). Compared with the TCM group, the scores of CSR 20 subscale and SF-36 scale in combination group were increased (P<0.05), and the remission time of typical symptoms and signs was shortened. Serum levels of LTB4, LTC4, LTD4, YKL-40, IL-1β and TNF-α were decreased (P<0.05). Conclusion::Moxibustion at neck Jiaji acupoint combined with Guige Lingxian decoction is effective in treating CSR of wind-cold-dampness arthralgia syndrome, which is worthy of clinical promotion. Its mechanism may be related to the inhibition of the expression of LT, and the reduction of the content of IL-1β and TNF-α in serum, thus promoting the repair of cervical cartilage and increasing the pain threshold.
ABSTRACT
Objective: To explore the curative effect and partial mechanism of modified Guipitang combined with Xingnao Kaiqiao acupuncture in the treatment of non-dementia vascular cognitive impairment (VCIND). Method: Totally 122 patients with VCIND admitted to the First Teaching Hospital of Tianjin University of Traditional Chinese Medicine (TCM) from May 2017 to October 2018 were randomly divided into modified decoction group (39 cases), acupuncture group (42 cases) and combination group (41 cases). All of the three groups were orally given routine anticoagulants and lipid-lowering drugs. The decoction group was orally given modified Guipitang 150 mL/times, 2 times/day, in addition to the routine treatment, the acupuncture group was treated with Xingnao Kaiqiao acupuncture method in addition to the routine treatment, involving Shuigou, Neiguan (bilateral), Sanyinjiao (bilateral), Sishencong, Xuanzhong (bilateral) and Taixi (bilateral) acupoints, 2 times/day, for six days a week, the combined group was treated with Xingnao Kaiqiao acupuncture in addition to modified Guipitang. All of the three groups were treated for 8 weeks. The Montreal cognitive assessment scale (MoCA scale, Beijing version) and activity of daily life (ADL) scale, TCM symptoms and clinical efficacy were scored before treatment, 4 weeks after treatment and 8 weeks after treatment in three groups. Serum levels of calcitonin gene-related peptide (CGRP) and cone-like protein-1 (VILIP-1) were measured by enzyme-linked immunosorbent assay at different time points. Result: Compared with decoction group and acupuncture group, MoCA score, ADL score and TCM syndrome score of the combined group were decreased, the total effective rate was increased significantly after 4 and 8 weeks of treatment, the serum CGRP content was increased, and the VILIP-1 content was decreased. Conclusion: Modified Guipitang combined with Xingnao Kaiqiao acupuncture has a definite curative effect on VCIND with heart and spleen insufficiency syndrome. Its mechanism may be related to the expansion of blood vessels, the alleviation of blood supply of brain and the reduction of neuron injury.