A randomized controlled trial of acupuncture at Jiaji points for treatment of lumbar disc herniation under ultrasonic guidance / 中国组织工程研究

BACKGROUND:In the research on acupuncture treatment for lumbar disc herniation,most acupuncture treatments are performed under CT guidance or without guidance.The precise control of the target site and the effective acupuncture location are not clear. OBJECTIVE:To observe the clinical effects of acupuncture at Jiaji points under ultrasonic guidance in treating lumbar disc herniation. METHODS:A total of 70 cases of lumbar disc herniation,36 males and 34 females aged 18-65 years old,were selected from Chinese PLA General Hospital and Third Affiliated Hospital of Beijing University of Chinese Medicine.They were divided into trial group and control group by random number table method,with 35 cases in each group.The control group received acupuncture at Jiaji points.The trial group received acupuncture at Jiaji points under ultrasonic guidance.The patients were treated once on the day of treatment and 4,7 days after treatment.Visual analog scale score,Oswestry disability index,Japanese Orthopaedic Association score,and MOS 36-Item Short-Form Health Survey(SF-36)were evaluated before and after treatment. RESULTS AND CONCLUSION:(1)Compared with before treatment,the visual analog scale scores of both groups were decreased after treatment(P<0.01).Compared with the control group,the visual analog scale scores of the trial group were decreased on days 2,3,6,7 of treatment and 1,2 weeks after the end of treatment(P<0.05,P<0.01).(2)Compared with before treatment,Oswestry disability index after treatment was decreased in both groups(P<0.01).Compared with the control group,Oswestry disability index of the trial group was decreased from days 1 to 7 of treatment and 1,2 weeks after treatment(P<0.01).(3)Compared with before treatment,the Japanese Orthopaedic Association scores of both groups were increased after treatment(P<0.01).Compared with the control group,the Japanese Orthopaedic Association scores of the trial group were increased on days 3,7 of treatment and 1,2 weeks after treatment(P<0.05,P<0.01).(4)Compared with before treatment,SF-36 scores in both groups were increased after treatment(P<0.01).There was no significant difference in SF-36 scores between the two groups after treatment(P>0.05).(5)These results show that acupuncture at Jiaji points has curative effect on lumbar disc herniation,and ultrasonic guidance could improve the clinical curative effect of acupuncture at Jiaji points for lumbar disc herniation.

Cognitive differences between Taoism and medical science in the location of "Jiaji" / 中国针灸

The differences in the cognition on the location of "Jiaji" between Taoism and medical science are summarized through literature searching. In the medical field, "Jiaji" is generally described as "Jiaji Xue (point)", which is considered as EX-B 2, while, in Taoism, it is expressed as "Jiaji Guan (pass)", focusing on the crucial parts of the body. Medical scholars lay their attention to the distance of "Jiaji" lateral to the spine, in which "Jia" (place on both sides) is mostly considered. In comparison, the Taoists emphasize the central axis on the back of human body expressed as "Jiaji Gu (bone)" and "Jiaji Sanguan (three crucial parts)", in which, "Ji (spine)" is the key. Due to the therapeutic purposes of acupuncture, medical scholars focus on the communication of "Jiaji" with the body surface ultimately. Based on the inner perspective of Taoism, "Jiaji" is connoted to be the three-dimensional structural space located deeply inside of the body. The cognitive differences in the location of "Jiaji" between Taoism and medical science reflect the discrepancy in the cognitive dimensions and approaches to the human body between them, which provide the references for the textual research of "Jiaji" in traditional Chinese medicine.

Effects of electroacupuncture at "Jiaji" (EX-B 2) combined with neurodynamic mobilization on gastrocnemius muscle atrophy and expression of NF-κB and MuRF1 in rabbits after sciatic nerve injury / 中国针灸

OBJECTIVES@#To observe the effects of electroacupuncture (EA) at "Jiaji" (EX-B 2) combined with neurodynamic mobilization (NM) on the cross-sectional area of the gastrocnemius muscle fibers after sciatic nerve injury in rabbits, and the expression of nuclear factor κB (NF-κB) and muscle-specific ring-finger protein 1 (MuRF1).@*METHODS@#A total of 180 common-grade New Zealand rabbits (half male and half female) were randomly divided into five groups, i.e. a normal control group, a model control group, a NM group, an EA group and a combined intervention group, 36 rabbits in each group. Except in the normal control group, clipping method was used to prepare the model of sciatic nerve injury in the rest groups. On the 3rd day of successful modeling, NM was delivered in the NM group. In the EA group, EA was exerted at bilateral "Jiaji" (EX-B 2) of L4 to L6, stimulated with disperse-dense wave and the frequency of 2 Hz/100 Hz. In the combined intervention group, after EA delivered at bilateral "Jiaji" (EX-B 2) of L4 to L6 , NM was operated. The intervention in each group was delivered once daily, for 6 days a week, and lasted 1, 2 or 4 weeks according to the collection time of sample tissue. After 1, 2 and 4 weeks of intervention, in each group, the toe tension reflex score and the modified Tarlov test score were observed; the morphology of the gastrocnemius muscle was observed by HE staining and the cross-sectional area of muscular fiber was measured; using Western blot method, the expression of NF-κB and MuRF1 of the gastrocnemius muscle was detected.@*RESULTS@#After 1, 2 and 4 weeks of intervention, the toe tension reflex scores and the modified Tarlov scores in the model control group were lower than those of the normal control group (P<0.05), and these two scores in the NM group, the EA group and the combined intervention group were all higher than those of the model control group (P<0.05); the scores in the combined intervention group were higher than those in the EA group and the NM group (P<0.05). The gastrocnemius fibers were well arranged and the myocyte morphology was normal in the normal control group. In the model control group, the gastrocnemius fibers were disarranged, the myocytes were irregular in morphology and the inflammatory cells were infiltrated in the local. In the NM group, the EA group and the combined intervention group, the muscle fibers were regularly arranged when compared with the model control group. After 1, 2 and 4 weeks of intervention, the cross-sectional areas of the gastrocnemius muscle fibers in the model control group were smaller than those of the normal control group (P<0.05). The cross-sectional areas in the NM group, the EA group and the combined intervention group were larger than those of the model control group (P<0.05), and the cross-sectional areas in the combined intervention group were larger than those in the NM group and the EA group (P<0.05). After intervention for 1, 2 and 4 weeks, the protein expressions of NF-κB and MuRF1 in the gastrocnemius muscle were higher in the model control group in comparison of those in the normal control group (P<0.05). In the NM group, the EA group and the combined intervention group, the expressions of NF-κB after intervention for 1, 2 and 4 weeks and the expressions of MuRF1 after 2 and 4 weeks of intervention were lower when compared with those in the model control group (P<0.05). In the combined intervention group, the protein expressions of NF-κB after intervention for 1, 2 and 4 weeks and the expressions of MuRF1 after 2 and 4 weeks of intervention were decreased when compared with those in the NM group and the EA group (P<0.05).@*CONCLUSIONS@#Electroacupuncture at "Jiaji" (EX-B 2) combined with NM may increase the muscle strength and sciatic function and alleviate gastrocnemius muscle atrophy in the rabbits with sciatic nerve injury. The underlying mechanism is related to the inhibition of NF-κB and MuRF1 expression.

Effect of acupuncture at neck-Jiaji (EX-B 2) and tuina on the cognitive function in the patients with subjective cognitive decline / 中国针灸

OBJECTIVES@#To observe the effects on cognitive function, sleep quality and hemodynamics in the patients with subjective cognitive decline (SCD) after treated with acupuncture at neck-Jiaji (EX-B 2) and tuina on the base of healthy lifestyle education and meta-memory training.@*METHODS@#Sixty SCD patients were randomly divided into an observation group (30 cases, 1 case dropped out) and a control group (30 cases, 3 cases dropped out). In the control group, the healthy lifestyle education and meta-memory training was performed, twice daily, 15 min each time; the 5-day intervention was delivered a week, lasting consecutively 4 weeks. On the base of the intervention as the control group, in the observation group, acupuncture at neck-Jiaji (EX-B 2) and tuina was conducted. First, one-finger pushing and plucking method of tuina was exerted on the neck region along the running courses of the bladder meridian of foot-taiyang and the governor vessel, for 10 min to 15 min; afterwards, acupuncture was delivered at bilateral neck-Jiaji (EX-B 2), from C1 to C7; and the needles were retained for 30 min. This intervention was given once daily, 5 times a week, for consecutive 4 weeks. Before and after treatment, the score of the mini-mental state examination (MMSE), the score of full scale memory quotient (FSMQ) were assessed by Wechsler memory scale-fourth edition (WMS-Ⅳ) and the score of the Pittsburgh sleep quality index (PSQI) was compared between the two groups. Using transcranial Doppler ultrasound, the hemodynamic indexes (the mean velocity [Vm] and pulsatility index [PI] of the left vertebral artery [LVA], the right vertebral artery [RVA] and the basilar artery [BA]) were determined in the two groups.@*RESULTS@#After treatment, the scores of MMSE and FSMQ increased compared with those before treatment in the two groups (P<0.05, P<0.001), PSQI score was lower (P<0.05) and Vm of BA was higher (P<0.001) in the observation group when compared with those before treatment. The scores of MMSE and FSMQ, as well as Vm of BA were higher (P<0.05, P<0.001), and PSQI score was decreased (P<0.05) in the observation group when compared with the control group.@*CONCLUSIONS@#The combined therapy of acupuncture at neck-Jiaji (EX-B 2) and tuina is more advantageous to improving cognitive function, relieving chronic emotional stress and ameliorating sleeping quality in the patients with subjective cognitive decline, which may be achieved by improving the blood supply of the basilar artery.

Effect of panlong needling at Jiaji (EX-B 2) on motor dysfunction in patients with Parkinson's disease of liver and kidney deficiency: a randomized controlled trial / 中国针灸

OBJECTIVE@#To compare the curative effect of panlong needling at Jiaji (EX-B 2) combined with western medication and western medication alone on motor dysfunction in patients with Parkinson's disease (PD) of liver and kidney deficiency.@*METHODS@#A total of 98 patients with PD were randomly divided into an acupuncture and medication group (49 cases, 1 case dropped off) and a western medication group (49 cases,1 case was removed). The patients in the western medication group were given oral of levodopa and benserazide hydrochloride tablets, 125 mg each time, three times a day in the 1st week, and the dose was increased according to the needs of the patients' condition from the 2nd week until 250 mg each time, three times a day, for 16 consecutive weeks. On the basis of the same western medication treatment as the western medication group, panlong needling was applied at Jiaji (EX-B 2) from C2 to L5 in the acupuncture and medication group, once a day, 20 times as a course of treatment, for 4 consecutive courses. The scores of unified Parkinson's disease rating scale (UPDRS-Ⅲ, UPDRS-Ⅳ), TCM symptoms score, and 39-item Parkinson's disease questionnaire (PDQ-39) score were evaluated before treatment, after treatment and during follow-up of 1 month after treatment, respectively. The safety of the two groups was compared.@*RESULTS@#After treatment and during follow-up, except the PDQ-39 score of the western medication group, the scores of UPDRS-Ⅲ, UPDRS-Ⅳ, TCM syndrome and PDQ-39 were lower than those before treatment in the two groups (P<0.05), and the scores of above indexes in the acupuncture and medication group were lower than those of the western medication group (P<0.05). The total incidence of adverse reactions in the acupuncture and medication group was 10.4% (5/48), which was lower than 29.2% (14/48) in the western medication group (P<0.05).@*CONCLUSION@#Panlong needling at Jiaji (EX-B 2) combined with western medication could significantly improve the motor dysfunction and clinical symptoms, improve the quality of life and has high safety, and the efficacy is superior to western medication alone.

Clinical observation of warm needling moxibustion plus lumbar traction for lumbar disc herniation / 针灸推拿医学（英文版）

Objective: To observe the clinical efficacy of warm needling moxibustion plus lumbar traction for lumbar disc herniation (LDH) and its effect on Oswestry disability index (ODI) score, present pain intensity (PPI) score, and the degree of straight leg raising.Methods: A total of 146 patients with LDH were randomized into a combination group and a control group by the random number table method, with 73 cases in each group. The control group was treated with lumbar traction, and the combination group was treated with lumbar traction plus warm needling moxibustion. The curative efficacy of the two groups was compared. Also, the lumbar function, pain, straight leg raising degree, and inflammatory factor levels before and after treatment were compared. Results: The total effective rate of the combination group was 93.2％, which was higher than 78.1％ of the control group (P<0.05). After treatment, the lumbar ODI score, the PPI scores of lumbar pain and lower-limb pain, tumor necrosis factor (TNF)-α and interleukin (IL)-6 levels, and straight leg raising test score in both groups were significantly decreased (P<0.05). The Japanese Orthopaedic Association (JOA) score significantly increased (P<0.05). The improvements of the above items in the combination group were all superior to those in the control group (P<0.05). Conclusion: Warm needling moxibustion plus lumbar traction in the treatment of LDH can improve lumbar function, relieve pain, and reduce inflammatory response of the body.

Effect of electroacupuncture at "Jiaji" (EX-B 2) points on the proliferation and differentiation of oligodendrocyte precursor cells in rats with acute spinal cord injury / 中国针灸

OBJECTIVE@#To observe the effect of electroacupuncture (EA) at "Jiaji" (EX-B 2) points on the proliferation and differentiation of oligodendrocyte precursor cells in rats with acute incomplete spinal cord injury, and to explore the mechanism of EA on improving motor function of spinal cord injury.@*METHODS@#A total of 72 male SPF SD rats were randomly divided into a sham operation group, a model group, an EA group and a medication group, 18 rats in each group. Each group was further divided into 1-day subgroup, 7-day subgroup and 14-day subgroup, 6 rats in each subgroup. The T acute incomplete spinal cord injury model was established by modified Allen's method in the model group, EA group and medication group. The rats in each group received intraperitoneal injection of 5-bromodeoxyuridine (BrdU, 50 mg/kg), once a day, and each subgroup received continuous injection for 1, 7, 14 times for cell proliferation labeling. The rats in the EA group were treated with EA at "Jiaji" (EX-B 2) points 3-4 mm next the spinous process of the upper and lower segments of the injured spinal cord (T, T) with a frequency of 2 Hz/100 Hz and intensity of 1-2 mA. The muscle twitch at the treatment site was taken as the degree. The treatment was given 20 min each time, once a day. In the medication group, monosialogangliosides (GM1) was injected intraperitoneally (10 mg/kg), once a day. The subgroups of EA group and medication group were treated for 1, 7, 14 times. The score of Basso Beattie Bresnahan (BBB) was used to evaluate the motor function of hind limbs. The co-expression of BrdU/NG2 positive cells was detected by immunofluorescence, and the expression of Olig2 and Sox10 was detected by Western blot.@*RESULTS@#Compared with the sham operation group, the BBB score was decreased 1 day, 7 days and 14 days after operation in the model group (<0.05), the expression of Olig2 and Sox10 was increased (<0.05), and the co-expression of BrdU/NG2 positive cells was increased 7 days and 14 days after operation (<0.05). Seven days and 14 days after operation, the BBB score in the EA group and medication group was higher than that in the model group (<0.05), and the co-expression of BrdU/NG2 in the medication group was higher than that in the model group (<0.05). Fourteen days after operation, the co-expression of BrdU/NG2 in the EA group was higher than that in the model group (<0.05); 1 day, 7 days and 14 days after operation, the expression of Olig2 and Sox10 in the EA group and medication group was higher than that in the model group (<0.05). Compared with the medication group, the co-expression of BrdU/NG2 positive cells in the EA group 14 days after operation was decreased (<0.05); 1 day, 7 days and 14 days after operation, the expression of Olig2 and Sox10 in the EA group was decreased (<0.05).@*CONCLUSION@#EA at "Jiaji" (EX-B 2) points could promote the expression of Olig2 and Sox10 after spinal cord injury, which has similar effects with GM1. It could promote the proliferation and differentiation of oligodendrocyte precursor cells into oligodendrocytes, so as to promote the recovery of motor function of rats.

Effect of electroacupuncture at "Jiaji" (EX-B 2) points combined with nerve mobilization on motor function and mRNA and protein expression of RhoA in rabbits with sciatic nerve injury / 中国针灸

OBJECTIVE@#To observe the effects of electroacupuncture (EA) at "Jiaji" (EX-B 2) points combined with nerve mobilization on protein and mRNA expression of RhoA in rabbits with sciatic nerve injury, and to provide theoretical basis for the treatment of peripheral nerve injury by EA at "Jiaji" (EX-B 2) points combined with nerve mobilization.@*METHODS@#A total of 180 New Zealand rabbits were randomly divided into a normal control group, a model control group, a nerve mobilization group, an EA group, an EA plus nerve mobilization group, 36 rabbits in each group. Each group was further divided into a 1-week subgroup, 2-week subgroup and 4-week subgroup, 12 rabbits in each subgroup. The sciatic nerve injury model was made by clamping method. The rabbits in the normal control group did not receive any intervention. The rabbits in the model control group was normally fed after operation. The rabbits in the nerve mobilization group were treated with nerve mobilization; the manipulation lasted for 1 s and relaxed for 5 s, 10 times per day, 6 days per week. The rabbits in the EA group were treated with EA at "Jiaji" (EX-B 2) points (L-L), once a day, 30 min each time, 6 times per week. The rabbits in the EA plus nerve mobilization group were treated with EA at "Jiaji" (EX-B 2) points, followed by nerve mobilization. The function of sciatic nerve on the injured side was evaluated by toe tension reflex and modified Tarlov score; the tissues of corresponding segments of spinal cord L-L and sciatic nerve were taken; the expression of RhoA gene was detected by real-time PCR and the expression of RhoA protein was detected by Western Blot.@*RESULTS@#① Toe tension reflex and modified Tarlov score: at 1, 2 and 4 weeks, the scores in the model control group were lower than those in the normal control group (all 0.05); at 2 weeks, the expression in the nerve mobilization group was higher than that in the EA group (all <0.01); at 4 weeks, the expression in the nerve mobilization group was lower than that in the EA group (all <0.01).@*CONCLUSION@#The nerve mobilization and EA at "Jiaji" (EX-B 2) points could both promote the repair of injured sciatic nerve, which may be related to the down-regulation of RhoA expression, and the combination of the two methods has better effects.

Clinical observation on the inflammatory indexes in septic gastrointestinal dysfunction treated with acupuncture at Jiaji (EX-B 2) / 中国针灸

OBJECTIVE@#To evaluate the effect on the inflammatory indexes of septic gastrointestinal dysfunction treated with acupuncture at Jiaji (EX-B 2).@*METHODS@#A total of 118 patients of septic gastrointestinal dysfunction were randomized into an observation group and a control group, 59 cases in each one. In the control group, mosapride citrate was prescribed for oral administration, 5 mg each time, 3 times a day, bifidobacterium triple viable capsules, 420 mg each time, twice a day, intravenous drip with omeprazole, 40 mg, twice a day. Additionally, the antibiotics and the symptomatic treatment were selected rationally for maintaining the functions of the important organs, e.g. heart, lung, brain and kidney, and water-electrolyte balance. In the observation group, on the routine management as the control group, acupuncture at Jiaji (EX-B 2, T-T) was added, the needles were retained for 30 min in each treatment, once a day, 10 days as one course and 1 course was required. Separately, on the 1st, 3rd, 6th and 10th days of treatment, the white blood cell (WBC) count, the levels of hypersensitive C-reactive protein (hs-CRP) and procalcitonin (PCT) were observed, the enteral nutrition feeding dose and gastrointestinal dysfunction score before and after treatment as well as the clinical effect were assessed in the two groups.@*RESULTS@#The differences were not significant in the indexes mentioned above on 1st and 3rd days of treatment between the two groups (>0.05). On the 6th and 10th days of treatment, regarding the gastrointestinal dysfunction score and inflammatory indexes count, the results in the observation group were lower than the control group (all <0.05), and feeding dose in the observation group was higher than the control group (<0.05). After treatment, the gastrointestinal dysfunction scores and inflammatory indexes count were all reduced and feeding dose was increased as compared with those before treatment in the patients of the two groups (all <0.05). After treatment, the total effective rate was 91.5% (54/59) in the observation group, higher than 76.3% (45/59) in the control group (<0.05).@*CONCLUSION@#Acupuncture at Jiaji (EX-B 2) points achieves the satisfactory effect on septic gastrointestinal dysfunction and reduces the inflammatory indexes count.

Effects of electroacupuncture combined with nerve mobilization on lower limb motor function and mRNA and protein expression of C3 botoxin substrate 1 after sciatic nerve injury / 中华物理医学与康复杂志

Objective To investigate the effect of combining electroacupuncture with nerve mobilization to improve lower extremity motor function after sciatic nerve injury. And to document any changes in mRNA and protein expression of Ras-related C3 botoxin substrate 1. Methods 180 New Zealand rabbits were randomly divided into a normal control group, a model control group, an electroacupuncture group, a nerve mobilization group, and an elec-troacupuncture combined with nerve mobilization group, each of 36. Sciatic nerve injury was modelled using the clam-ping method in all except the normal control group. The control group had no intervention, while the nerve mobiliza-tion group, the electroacupuncture group and the combined group were treated with nerve mobilization, and/or elec-troacupuncture applied to the rabbit analogue of the jiaji acupoint. After 1, 2, and 4 weeks of treatment, toe reflex scores and modified Tarlov scores were used to assess any functional recovery. After 1, 2, and 4 weeks of treatment, 12 of the rabbits in each group were sacrificed and the sciatic nerve and the L4-L6 segments of the spinal cord were re-sected. The expression of Ras-related C3 botoxin substrate 1 mRNA and protein was detected using the polymerase chain reaction and western blotting. Results Sciatic nerve function and the expression of Ras-related C3 botoxin sub-strate 1 mRNA in the spinal cords and sciatic nerves of the three treatment groups were significantly higher than in the model control group at all three time points, but significantly lower than in the normal control group. The combined group′s results were significantly better than with electroacupuncture or nerve mobilization alone. After 1, 2, and 4 weeks of treatment, the average expression of Ras-related C3 botoxin substrate 1 protein in the spinal cords of the three treatment groups was significantly higher than the model control group′s average, but significantly lower than that of the normal control group at the same time point. After 1 week of treatment the average expression of Ras-related C3 botoxin substrate 1 protein in the spinal cords of the combined group was significantly higher than that in the group receiving electroacupuncture alone. After 2 and 4 weeks it was also significantly higher than the nerve mobilization group′s aver-age. After 1 week of treatment, the average expression of Ras-related C3 botoxin substrate 1 protein in the sciatic nerves of all three treatment groups was significantly lower than that of the control group. However, 1 and 3 weeks later the av-erage protein expression in the sciatic nerves was significantly higher than in the model control group, but significantly lower than in the normal control group at the same time points. The combined group′s average was then significantly higher than those of the groups receiving electroacupuncture or nerve mobilization alone at the same time point. Conclusion Nerve stimulation combined with electroacupuncture applied to the jiaji acupoint can promote the regener-ation of axons after sciatic nerve injury. The mechanism may be related to up-regulation of the Ras-related C3 botoxin substrate 1 gene and protein expression in the injured sciatic nerve and corresponding spinal cord segments.