[Governor vessel moxibustion combined with warming acupuncture for knee osteoarthritis with yang deficiency and cold congelation based on the supporting-yang theory].

OBJECTIVE: To compare the clinical efficacy between governor vessel moxibustion combined with warming acupuncture based on the supporting-yang theory and simple warming acupuncture for knee osteoarthritis (KOA) with yang deficiency and cold congelation. METHODS: A total of 64 patients with KOA of yang deficiency and cold congelation were randomized into a combination group (32 cases, 2 cases dropped off) and a warming acupuncture group (32 cases, 1 case dropped off). In the warming acupuncture group, warming acupuncture was applied at Zusanli (ST 36), Guanyuan (CV 4) and Dubi (ST 35), Neixiyan (EX-LE 4), etc. on the affected side, once a day. On the basis of the treatment in the warming acupuncture group, governor vessel moxibustion was applied in the combination group, once a week. The 14-day treatment was taken as one course, and totally 2 courses with 2-day interval were required in the two groups. The clinical symptom score, the visual analogue scale (VAS) score and the Western Ontario and McMaster Universities arthritis index (WOMAC) score were observed before treatment, after treatment and in the follow-up of 12 weeks after treatment; the volume of suprapatellar bursa effusion was detected before and after treatment; the clinical efficacy was evaluated after treatment and in the follow-up in the two groups. RESULTS: After treatment and in the follow-up, the scores of clinical symptom, VAS and WOMAC were decreased compared before treatment in both groups (P<0.05), and those in the combination group were lower than the warming acupuncture group (P<0.05). After treatment, the volume of suprapatellar bursa effusion was decreased compared before treatment in both groups (P<0.05). After treatment and in the follow-up, the total effective rates were 93.3% (28/30) and 86.7% (26/30) in the combination group, which were superior to 87.1% (27/31) and 74.2% (23/31) in the warming acupuncture group respectively (P<0.05). CONCLUSION: Governor vessel moxibustion combined with warming acupuncture can improve the clinical symptoms i.e. pain and dysfunction and reduce the volume of suprapatellar bursa effusion in KOA patients with yang deficiency and cold congelation, its short-term effect and long-term effect are both superior to simple warming acupuncture.

[Panlong acupuncture combined with Xingnao Kaiqiao acupuncture for post-stroke fatigue: a randomized controlled trial].

OBJECTIVE: To observe the clinical effect of Panlong (dragon-like) acupuncture combined with Xingnao Kaiqiao (regaining consciousness and opening orifice) acupuncture on post-stroke fatigue. METHODS: Sixty patients with post-stroke fatigue were randomly divided into an observation group (30 cases, 1 case dropped off) and a control group (30 cases, 2 cases dropped off). The patients in the control group were treated with Xingnao Kaiqiao acupuncture at Neiguan (PC 6), Shuigou (GV 26), etc. for 30 min; based on the treatment of the control group, the patients in the observation group were treated with Panlong acupuncture at Jiaji (EX-B 2) of T1 to L5 for 15 min. The two groups were treated once a day, 6 times a week, for a total of 4 weeks. The scores of fatigue assessment instrument (FAI), energy of stroke-specific quality of life (SS-QOL), and modified Barthel index (MBI) in the two groups were compared before and after treatment, and the clinical efficacy was evaluated. RESULTS: Compared before treatment, the total score and each item score of FAI in the observation group were reduced after treatment (P<0.05), while the total score and FAI-1 and FAI-4 scores in the control group were reduced after treatment (P<0.05). The total score of FAI and FAI-1, FAI-2 and FAI-4 scores in the observation group were lower than those in the control group (P<0.05). After treatment, the SS-QOL energy scores and MBI scores of the two groups were increased compared before treatment (P<0.05), and the SS-QOL energy score in the observation group was higher than that in the control group (P<0.01). The total effective rate was 72.4% (21/29) in the observation group, which was better than 46.4% (13/28) in the control group (P<0.05). CONCLUSION: The Panlong acupuncture combined with Xingnao Kaiqiao acupuncture could effectively alleviate the fatigue symptoms and improve quality of life in patients with post-stroke fatigue.

[Acupuncture adjuvant treatment for dysphagia in patients with Parkinson's disease: a randomized controlled trial].

OBJECTIVE: To observe the effect of acupuncture on swallowing function and nutritional status of patients with Parkinson's disease (PD) dysphagia. METHODS: A total of 56 patients with PD dysphagia were randomly divided into an observation group and a control group, 28 cases in each one. Both groups were given conventional treatment and swallowing function rehabilitation training.On the basis, the observation group was treated with acupuncture (filiform needling and tongue picking acupuncture). The acupoints of filiform needling were Lianquan (CV 23), Shanglianquan (Extra), Yifeng (TE 17), etc.; and the tongue picking acupuncture was applied at Jinjin (EX-HN 12), Yuye (EX-HN 13) and posterior pharyngeal wall. Rehabilitation training and acupuncture were performed once a day for 5 consecutive days a week, 2 weeks as a course of treatment, 3 courses in total. The swallowing function [oral transit time (OTT), swallowing response time (SRT), pharyngeal transit time (PTT), laryngeal closure duration (LCD)] and nutritional indexes [body mass index (BMI), serum albumin (ALB), serum prealbumin (PA), hemoglobin (Hb)] in the two groups were evaluated before and after treatment, and the clinical effects were compared. RESULTS: After treatment, the paste and liquid OTT, SRT, PTT, LCD in the two groups were shorter than those before treatment (P<0.05), and the observation group was shorter than the control group (P<0.05). After treatment, the nutritional indexes (BMI, ALB, PA, Hb) in the two groups were higher than those before treatment (P<0.05), and the observation group was higher than the control group (P<0.05). The total effective rate of the observation group was 92.9% (26/28), which was better than 67.9% (19/28) of the control group (P<0.05). CONCLUSION: Acupuncture-assisted rehabilitation training can improve the swallowing function and nutritional status in patients with Parkinson's disease swallowing disorders.

[Effect of electroacupuncture at Wnt/ß-catenin signaling pathway on inhibiting cartilage degeneration in rats with knee osteoarthritis].

OBJECTIVE: To explore the action mechanism of electroacupuncture (EA) for knee osteoarthritis (KOA) based on Wnt/beta-catenin (Wnt/ß-catenin) signaling pathway. METHODS: Ten rats were randomly selected into a sham-operation group among 50 male 2-month-old SD rats, and the KOA model was established in the remaining 40 rats by modified Hulth method. Four weeks after the model establishment, the rats were randomly divided into a model group, an experimental A group, an experimental B group and an experimental C group, 10 rats in each group. The rats in the sham-operation group and model group did not receive any intervention. The rats in the experimental A group were treated with EA at "Neixiyan" (EX-LE 4) and "Dubi"(ST 35) for 15 min. The rats in the experimental B group were treated with EA at "Neixiyan" (EX-LE 4) and "Dubi"(ST 35) for 30 min. The rats in the experimental C group were treated with EA at non-acupoint for 15 min. EA intervention was given once a day, five times a week, and totally 12-week treatment was given. After 12 weeks, the knee cartilage tissues were stained and the morphological changes were observed under light microscopy; the severity of cartilage degeneration was evaluated by modified Mankin's score; the content of interleukin-1ß (IL-1ß) in synovium tissues was detected by ELISA method; the content of Wnt-4, ß-catenin and matrix metalloprotein-13 (MMP-13) in cartilage tissues was detected by Western blot method. RESULTS: Compared with the sham-operation group, in the model group the morphology and structure of cartilage were disordered, the number of cells was significantly reduced, the matrix was decontaminated and tidal line was incomplete; the Mankin's score was significantly increased (P<0.01), the content of IL-1ß in synovium tissues were significantly increased (P<0.01), and the expressions of Wnt-4, ß-catenin and MMP-13 at protein level were significantly increased (P<0.01). Compared with the model group, in the experimental A group and experimental B group the morphology and structure of cartilage were more orderly, the number of cells was increased, the matrix staining was deepened and the tidal line was more complete; Mankin's scores were decreased significantly (P<0.01); the contents of IL-1ß in synovium tissues were decreased significantly (P<0.01), and the expressions of Wnt-4, ß-catenin and MMP-13 at protein level were decreased significantly (P<0.01). Compared with the model group, no improvement was observed in the experimental C group. Compared with the experimental A group, in the experimental C group the morphology and structure of cartilage were disordered, the number of cells was significantly reduced, the matrix was decontaminated and the tidal line was incomplete; Mankin's score was significantly increased (P<0.01), the content of IL-1ß in synovium tissues was significantly increased (P<0.01), and the expressions of Wnt-4, ß-catenin and MMP-13 at protein level were significantly increased (P<0.01). The morphological structure of cartilage in the experimental B group was similar to that in the experimental A group, and there was no significant difference in Mankin's score, IL-1ß content in synovium tissues and the expressions of Wnt-4, ß- catenin and MMP-13 at protein level between the two groups (P>0.05). CONCLUSION: EA at "Neixiyan" (EX-LE 4) and "Dubi"(ST 35) may reduce the expression of MMP-13 and the production of inflammatory factor IL-1ß through Wnt/ß-catenin signaling pathway, thus inhibit the degradation of cartilage matrix and the apoptosis of chondrocyte, and improve the morphology and structure of cartilage.

Electroacupuncture Delays Cartilage Degeneration by Modulating Nuclear Factor-κB Signaling Pathway.

OBJECTIVE: To illustrate the molecular mechanisms underlying the therapeutic effects of electroacupuncture (EA) on knee osteoarthritis (OA). METHODS: Twenty-seven six-month-old New Zealand white rabbits were allocated into three groups in accordance with a random number table: normal group (no surgery-induced OA; without treatment), model group (surgery-induced OA; without treatment) and EA group [surgery-induced OA; received treatment with EA at acupoints Dubi (ST 35) and Neixiyan (EX-LE 5), 30 min twice a day]. After eight consecutive weeks of treatment, the histopathological alterations in cartilage were observed using optical microscopy and transmission electron microscopy, cartilage degeneration was evaluated by modified Mankin's score principles, the synovial fluid concentration of interleukin-1ß (IL-1ß), interleukin-6 (IL-6), tumor necrosis factor-α (TNF-α) and matrix metalloproteinase-3 (MMP-3) were evaluated by enzyme-linked immunosorbent assay, and the protein expression levels of IL-1ß, IL-6, TNF-α, MMP-3, IκB kinase-ß (IKK-ß), nuclear factor of α light polypeptide gene enhancer in B-cells inhibitor α (IκB-α) and nuclear factor-κB (NF-κB) p65 were quantified by Western blot analysis. RESULTS: EA treatment significantly improved cartilage structure arrangement and reduced cellular degeneration. The IL-1ß, IL-6, TNF-α and MMP-3 of synovial fluid in the EA-treated group were significantly decreased compared with the model group (all P<0.01). Compared with the model group, the IL-1ß, IL-6, TNF-α, MMP-3, IKK-ß and NF-κB p65 protein expressions in cartilage of EA-treated group were significantly decreased (all P<0.01), whereas IκB-α expression was significantly up-regulated (P<0.01). CONCLUSION: EA treatment may delay cartilage degeneration by down-regulating inflammatory factors through NF-κB signaling pathway, which may, in part, explain its clinical efficacy in the treatment of knee OA.

[Efficacy of acupuncture combined with hydro-acupuncture for transverse processes syndrome of the third lumbar vertebra].

OBJECTIVE: To observe the clinical efficacy differences between acupuncture combined with hydro-acupuncture and acupuncture alone for transverse processes syndrome of the third lumbar vertebra. METHODS: One hundred patients were randomly divided into an observation group and a control group, 50 cases in each one. The patients in the control group were treated with regular acupuncture at Weizhong (BL 40), ashi points, Jiaji (L2～L4) and Shenshu (BL 23); the acupuncture was given once a day, six treatments per week for consecutive 2 weeks. Based on the acupuncture treatment in the control group, in the observation group the No.5 injection needle was applied to relieve the tenderness points on the transverse process and articular process of the third lumbar vertebra, followed by hydro-acupuncture with Danshen injection (1 mL per point, 7 days per injection for 2 weeks). The visual analogue scale (VAS), Japanese Orthopaedic Association (JOA) scale and Oswestry disability index (ODI) were observed before treatment, after treatment and during six-month follow-up visit in the two groups. In addition, the clinical efficacy was compared between the two groups. RESULTS: Forty-eight patients completed treatment and 2 patients dropped off in the observation group, while 47 patients completed treatment and 3 patients dropped off in the control group. The total effective rate was 91.7% (44/48) in the observation group, which was significantly superior to 76.6% (36/47) in the control group (P<0.05). Compared before treatment, the VAS and ODI in the two groups were reduced after treatment and during six-month follow-up visit, while the JOA was increased (all P<0.05); the VAS and ODI in the observation group was lower than that in the control group, while JOA in the observation group was higher than that in the control group (all P<0.05). CONCLUSION: Acupuncture combined with hydro-acupuncture are effective for transverse processes syndrome of the third lumbar vertebra, and could significantly improve lumbar function and relieve the pain symptoms, which is superior to regular acupuncture.

Intranasal Pretreatment with Z-Ligustilide, the Main Volatile Component of Rhizoma Chuanxiong, Confers Prophylaxis against Cerebral Ischemia via Nrf2 and HSP70 Signaling Pathways.

Z-Ligustilide (Z-LIG) is a major component in Rhizoma Chuanxiong, which has been traditionally used as a health food supplement for the prevention of cerebrovascular disease in China. This study investigates the ability of intranasal Z-LIG pretreatment to enhance protection against neuronal damage in rats with middle cerebral artery occlusion (MCAO) and the role of cellular stress response mechanisms Nrf2 and HSP70. Z-LIG significantly mitigated infarct volume, neurological dysfunction, blood-brain barrier disruption, and brain edema (p < 0.01). Moreover, Z-LIG prevented the loss of collagen IV, occludin, and ZO-1 (p < 0.05) and decreased MMP-2 and -9 levels (p < 0.01). Meanwhile, Z-LIG up-regulated NQO1 and HSP70. Notably, blockage of Nrf2-driven transcription or down-regulation of HSP70 remarkably attenuated the preventive effect of Z-LIG (p < 0.05). Together, intranasal delivery of Z-LIG enhanced protection against ischemic injury via Nrf2 and HSP70 signaling pathways and has prophylactic potential in the population at high risk of stroke.

Potential synergistic and multitarget effect of herbal pair Chuanxiong Rhizome-Paeonia Albifora Pall on osteoarthritis disease: a computational pharmacology approach.

OBJECTIVE: To study the polypharmacological mechanism of herbal pair Chuanxiong Rhizome-Paeonia Albifora Pall (HP CXR-PAP) on the treatment for osteoarthritis (OA). METHODS: Chemical space was used to discuss the similarities and differences between the molecule sets of HP CXR-PAP and drugs. Docking protocol was used to study the interaction between HP CXR-PAP and OA target enzymes. The similarities and differences of HP CXR-PAP and drugs in target spaces were elucidated by network features. RESULTS: The plots between the molecule sets of HP CXR-PAP and drugs in chemical space had the majority in the same region, and compounds from HP CXR-PAP covered a much larger additional region of space than drug molecules, which denoted the diverse structural properties in the molecule set of HP CXR-PAP. The molecules in HP CXR-PAP had the properties of promiscuous drugs and combination drug, and both HP CXR-PAP ligand-target interaction network and drug ligand-target interaction network were similar in the interaction profiles and network features, which revealed the effects of multicomponent and multitarget. CONCLUSION: The clue of potential synergism was obtained in curing OA disease by Chinese medicine, which revealed the advantages of Chinese medicine for targeting osteoarthritis disease.

[Clinical experiences of professor WU Bing-Huang on emergency treatment with acupressure].

The key points of acupoint selection and manipulations of Professor WU Bing-huang's experiences on emergency treatment with acupressure are introduced. It includes emergency treatment on coma (collapse, faint, faint at the sight of blood, faint during acupuncture, faint during moxibustion, shock, etc.), and pain, cough as well as asthma relieving with acupressure (include abdominal pain, vomiting, diarrhea, headache, toothache, dysmenorrhea, lumbago, neck stiffness after sleep, cough, asthma, etc.). At the same time, typical cases are given as examples.

Experimental study on the suppression of sodium nitroprussiate-induced chondrocyte apoptosis by Tougu Xiaotong Capsule (透骨消痛胶囊)-containing serum.

OBJECTIVE: To study the mechanism of action of Tougu Xiaotong Capsule (透骨消痛胶囊, TGXTC) ex vivo in suppressing chondrocyte (CD) apoptosis induced by sodium nitroprussiate (SNP). METHODS: Thirty New Zealand rabbits, 2 months old, were randomized by lottery into five groups, six in each: the blank group treated with saline, the positive control group treated with Zhuanggu Guanjie Pill (壮骨关节丸, 70 mg/kg), and the three experimental groups, EGA, EGB, and EGC, treated with low dose (35 mg/kg), moderate dose (70 mg/kg), and high dose (140 mg/kg) of TGXTC, respectively. All treatments were administered via gastrogavage twice a day for 3 days. Arterial blood was collected from the abdominal aorta and drug or drug metabolites-containing serum was prepared. CDs obtained from knee joints of 16 four-week-old New Zealand rabbits were cultured to the third passage and confirmed by toluidine blue staining. SNP of various final concentrations (0, 0.5, 1.0, and 2.0 mmol/L) was used to induce CD apoptosis, and the dosage-effect relationship of SNP in inducing CD apoptosis was determined. Serum samples from the blank, control, and three dosages of TGXTC-treated rabbits were tested in the CD culture in the presence of SNP. Cell apoptosis was determined by Hoechst 33342 staining, viability of CDs was quantified by MTT, CD apoptosis rate was determined by annexin V-FITC/PI staining, levels of p53 and Bcl-2 mRNA expression in CDs were determined with RT-PCR, and contents of caspase-3 and caspase-9 proteins were determined by colorimetry. RESULTS: CD apoptosis was induced by SNP at all concentrations tested and in a dose-dependent manner. The SNP concentration of 1 mmol/L and treatment duration of 24 h appeared to be optimal and were selected for the study. Serum samples from the positive control rabbits and from the two higher doses of TGXTC-treated rabbits showed reduction of SNP-induced CD apoptosis, decrease in p53 mRNA expression, inhibition of catalytic activities of caspase-3 and caspase-9, and increase in Bcl-2 mRNA expression when compared with the serum from the blank group (P<0.05). CONCLUSION: TGXTC-containing sera antagonized SNP-induced CD apoptosis and the molecular basis for the action was associated with up-regulation of Bcl-2, down-regulation of p53 expression, and inhibition of caspase-3 and caspase-9 catalytic activities.

Clinical study on the treatment of knee osteoarthritis of Shen-Sui insufficiency syndrome type by electroacupuncture.

OBJECTIVE: To study the clinical effificacy of electroacupuncture (EA) on treating knee osteoarthritis (KOA) of Shen ()-Sui () insuffificiency (SSI) syndrome type. METHODS: A total of 245 patients (279 knees) of KOA-SSI were randomly assigned to two groups by lottery: 141 knees in the treatment group and 138 knees in the control group. The treatment group was managed with EA at the dominant points of Neixiyan (Ex-LE4) and Waixiyan (Ex-LE5) as well as the conjugate points of Xuanzhong (GB39) and Taixi (KI3) for 30 min, once a day, with 15 days as one course; 2 courses were applied with a 5-day interval in between. The control group was treated with intra-articular injection of 2 mL hyaluronic acid into the affected joint every 7 days for 5 times in total. The clinical effects on the patients in different stages were observed, and their symptom scores of knee and contents of cytokines, including interleukin-1 (IL-1), interleukin-6 (IL-6), tumor necrosis factor-alpha (TNF-alpha), prostaglandin E(2alpha) (PGE(2alpha)) and matrix metalloproteinases-3 (MMP-3), in the knee joint fluid were measured before and after treatment. RESULTS: The study was completed in 235 patients (263 knees); four patients (7 knees) in the treatment group and six patients (9 knees) in the control group dropped out. Comparison of therapeutic effects (excellent and effective rates) between the two groups showed insignificant differences (P>0.05). Symptom scores of knee and contents of cytokines in the knee flfluid after treatment were lowered signifificantly in the patients of stage I-III in both groups (P<0.05 or P<0.01). However, the lowering of the total symptom score of knee in the patients of stage III in the treatment group was more signifificant (P<0.05). CONCLUSIONS: EA could effectively alleviate the clinical symptoms in KOA patients of stage III, showing an effect superior to that of hyaluronic acid. EA also shows action in suppressing the secretion of IL-1, IL-6, TNF-alpha, PGE(2alpha) and MMP-3 in the knee flfluid.