[Effect of needle-knife as adjunctive therapy on dry eye syndrome].

OBJECTIVE: To observe the clinical effect of needle-knife at cervical spine area as adjunctive therapy on dry eye syndrome. METHODS: A total of 84 patients with dry eye syndrome were randomized into 3 groups, named group A, group B and group C, 28 cases in each one (1 case dropped off in the group A, 2 cases dropped off in both group B and C). In the group A, needle-knife was applied at the margo inferior of external occipital protuberance, the range of 4 cm bilateral to external occipital protuberance, the spinous process of C2, the range of 3 cm bilateral to 2 cm above C2 spinous process, the range of 2 cm bilateral to C2, C4, C6 spinous process for once a week; acupuncture was applied at Jingming (BL 1), Cuanzhu (BL 2), Zusanli (ST 36), Sanyinjiao (SP 6), Taixi (KI 3), Yanglao (SI 6), Ganshu (BL 18), Shenshu (BL 23), etc. for once a day, 6 times a week; sodium hyaluronate eye drop was given one drop once, 5-6 times a day. Treatment of acupuncture and sodium hyaluronate eye drop was given in the group B, sodium hyaluronate eye drop was given in the group C, the acupoints selection and the manipulation of acupuncture, the dosage of sodium hyaluronate eye drop were the same as the group A. One week was as one course and 3 courses were required in the 3 groups. SchirmerⅠtest (SⅠT), break-up time (BUT), scores of corneal fluorescein staining (CFS) and eye symptom before and after treatment were observed, the clinical effect was evaluated in the 3 groups. RESULTS: SⅠT was increased, BUT was prolonged, scores of CFS and eye symptom were reduced after treatment in the group A and group B (P<0.01); scores of CFS and eye symptom were reduced after treatment in the group C (P<0.01). The variations of SⅠT, BUT and the scores of CFS and eye symptom in the group A were greater than those in the group B and the group C (P<0.01); the variations of above indexes in the group B were greater than those in the group C (P<0.05, P<0.01). The total effective rate was 94.4% (51/54) in the group A, which was superior to 78.8% (41/52) in the group B and 48.1% (25/52) in the group C (P<0.01), and the total effective rate in the group B was superior to the group C (P<0.01). CONCLUSION: Needle-knife at cervical spine area as adjunctive therapy can relieve the clinical symptoms and improve the function of lacrimal gland in patients with dry eye syndrome.

[Phosphorylated Focal Adhesion Kinase, Phosphinositides 3 Kinase and Aggrecan Genes and Proteins in Cartilage Cells Are Probably Involved in Needle Knife Intervention Induced Improvement of Knee Osteoarthritis in Rabbits].

OBJECTIVE: We have demonstrated that needle knife (acupotomy) treatment can improve knee osteoarthritis (KOA) in rabbits. The present study was designed to examine its effect on expression of phosphorylated focal adhesion kinase (p-FAK), phosphinositides 3 kinase (p-PI 3 K) and Aggrecan genes and proteins in the knee-joint cartilage tissues of KOA rabbits, so as to explore its partial molecular mechanism underlying improvement of KOA. METHODS: Forty-nine New Zealand male rabbits were randomly divided into normal control, model, model +inhibitor, needle knife, needle knife+ inhibitor, electroacupuncture (EA), EA +inhibitor groups (n=7 in each). The KOA model was established by modified Videman method (left hindlimb extension immobilization and ankle dorsal flexion 60°). Acupotomy relaxing manipulation was applied to the lateral collateral ligament and patellar ligament of the left knee-joint, two times a week for 4 weeks, and EA (2 Hz/100 Hz, 3 mA) was applied to the left "Liangmen" (ST 21), "Xuehai" (SP 10), "Neixiyan " (EX-LE 4) and "Dubi" (ST 35) for 20 min, three times a week, for 4 weeks. About 2 h before every needle-knife or EA treatment or at the corresponding time-point, intra-articular cavity injection of PF-562271(a specific antagonist of FAK, 200 µmol/L, 0.5 mL)was performed in the three inhibitor groups. The expression levels of p-FAK, p-PI 3 K, Aggrecan genes and proteins in the cartilage tissues were measured with quantitative Real-time PCR and Western blot, separately. RESULTS: After modeling, the expression levels of p-FAK and p-PI 3 K genes and proteins were significantly up-regulated (P<0.05, P<0.01), while those of Aggrecan protein and mRNA considerably down-regulated in the model group in comparison with the normal group (P<0.01). Following 4 weeks' needle-knife or EA treatment, the expression levels of p-FAK and p-PI 3 K and Aggrecan proteins in both EA and needle-knife groups, and Aggrecan mRNA in the needle knife group were significantly up-regulated (P<0.05, P<0.01). After administration of p-FAK antagonist, modeling-induced upregulation of expression of p-FAK mRNA and protein and p-PI 3 K protein, as well as modeling-induced down-regulation of Aggrecan mRNA and protein were significantly suppressed in the model+inhibitor group (P<0.05, P<0.01), and needle knife-induced and EA-induced up-regulation of expression of p-FAK, p-PI 3 K and Aggrecan mRNAs and proteins was notably suppressed respectively in comparison with the needle knife and EA groups (P<0.05, P<0.01). The effect of needle knife was significantly superior to that of EA in up-regulating p-PI 3 K and Aggrecan mRNAs as well as p-FAK, p-PI 3 K and Aggrecan proteins (P<0.05, P<0.01). CONCLUSION: Needle knife intervention can up-regulate the expression levels of p-FAK, p-PI 3 K and Aggrecan proteins and mRNAs in the cartilage tissue of the knee-joint in KOA rabbits, suggesting an involvement of FAK-PI 3 K signaling in the needle knife-induced improvement of KOA.

[Effect of Small Knife Needle on ß-enorpin and Enkehalin Contents of Tansverse Process Syndrome of the Third Vertebra].

OBJECTIVE: To explore the analgesic mechanism of small knife needle for treating transverse process syndrome of the third vertebra (TPSTV) by observing peripheral and central changesof ß-endorphin (ß-EP) and enkephalin (ENK) contents. METHODS: Totally 30 Japanese white big-ear rabbits of clean grade were divided into 5 groups according to random digit table, i.e., the normal control group, the model group, the small knife needle group, the electroacupunture (EA) group, and the small knife needle plus EA group, 6 in each group. The TPSTV model was established by inserting a piece of gelatin sponge into the left transverse process of 3rd lumbar vertebrae. Rabbits in the small knife needlegroup were intervened by small knife needle. Those in the EA group were intervened by EA at bilateralWeizhong (BL40). Those in the small knife needle plus EA group were intervened by small knife needleand EA at bilateral Weizhong (BL40). Contents of ß-EP and ENK in plasma, muscle, spinal cord, and hypothalamus were determined after sample collection at day 28 after modeling. RESULTS: Compared with the normal control group, contents of ß-EP and ENK in plasma and muscle increased significantly, and contents of ß-EP and ENK in spinal cord and hypothalamus decreased significantly in the model group (P < 0.05, P < 0.01). Contents of ß-EP and ENK approximated normal levels in the three treatment groups after respective treatment. Compared with the model group, the content of ß-EP in muscle decreased, and contents of ß-EP and ENK in hypothalamus increased in the three treatment groups after respective treatment (P < 0.05). There were no significant difference among the three treatment groups (P > 0.05). CONCLUSIONS: Small knife needle treatment and EA had benign regulation on peripheral and central ß-EP and ENK in TPSTV rabbits. Small knife needle treatment showed better effect than that of EA.

Effects of acupuncture knife on inflammatory factors and pain in third lumbar vertebrae transverse process syndrome model rats.

The aim of this paper was to explore the long-term effects and pain relief mechanism of acupuncture knife on third lumbar vertebrae (L3) transverse process syndrome. Forty SD rats were randomized into control, model, electroacupuncture (EA), and acupuncture knife (AK) group. Except control rats, other rats were subjected to an operation to emulate L3 transverse process syndrome. Fourteen days after the operation, EA and AK rats were given electroacupuncture and acupuncture knife treatments, respectively. Fifty-six days after the operation, enzyme-linked immunosorbent assay was used to measure substance P (SP), 5-hydroxytryptamine (5-HT), interleukin-1ß (IL-1ß), interleukin-10 (IL-10), tumor necrosis factor-α (TNF-α), and transforming growth factor-ß (TGF-ß) in peripheral blood. The tail flick test was used to observe pain threshold. We found that rats with the simulation operation had significantly higher levels of SP, 5-HT, IL-1, IL-10, TNF-α, and TGF-ß, while the AK rats had lower levels. In addition, the pain threshold of AK rats was similar to that of control rats. AK pretreatment could alleviate pain through modulating inflammatory response.

[Effects of acupotomy lysis on local soft tissue tension in patients with the third lumbar vertebrae transverse process syndrome].

OBJECTIVE: To explore the mechanism of acupotomy lysis in treatment of the third lumbar vertebrae transverse process syndrome. METHODS: One hundred and eighty patients were randomly assigned into an acupotomy group and an electroacupuncture (EA) group, 90 cases in each group. The acupotomy group was treated with acupotomy on the tip of the 3rd lumbar vertebrae transverse process (tender point) combination with massage manipulation of hyperflexion and hyperextension on the waist, once a week for 3 weeks. The EA group was treated with EA at bilateral Shenshu (BL 23), Yaoyangguan (GV 3), Ashi point (local tender point) and ipsilateral Weizhong (BL 40), 3 times a week for 3 weeks. The 500 g pressure displacement and the energy absorption ratio were measured by JZL-II soft tissue tension meter and the clinical effect was evaluated by JOA low back pain scale before treatment, after treatment and 6 months after treatment. RESULTS: After treatment and at follow-up visit, the 500 g pressure displacement in the acupotomy group increased significantly (both P < 0.01), but it was decreased significantly in the EA group (P < 0.05, P < 0.01). The energy absorption ratio in the acupotomy group after treatment and at follow-up visit increased significantly (both P < 0.01), and in the EA group, there was no significant difference after treatment as compared with that before treatment (P > 0.05), but it was increased significantly at follow-up visit (P < 0.01). The total therapeutic level distribution in the acupotomy group was better than that in the EA group after treatment and 6 months after treatment (P < 0.05, P < 0.01). CONCLUSION: Acupotomy therapy can significantly increase the 500 g pressure displacement and the energy absorption ratio of the local soft tissue around the third lumbar vertebrae transverse process, decrease the local soft tissue tension so as to alleviate pain. The clinical effect of the acupotomy is superior to that of electroacupuncture.

[Affection of acupotomy lysis on leu-enkephalin (L-ENK) content in different parts of centrum of rats with knee osteoarthritis].

OBJECTIVE: To study the analgesia mechanism of needle-knife lysis in spinal cord and other parts of central nervous system by comparing the changes of Leu-Enkephalin (L-ENK) content in different parts of centrium of rats undergone needle-knife lysis and electro-acupuncture respectively. METHODS: Sixty healthy SD rats were randomly devided into normal control group, model group, needle-knife lysis (NKL) group and electro-acupuncture (EA) group. 4% papain solution mixed with 0.3 mol/L cysteine solutin in the ratio of 1:1, paused for 0.5 h,injected the mixture, 20 microl each time,into the left knee joint cavities of rats in model, NKL, EA groups at the 1st, 4th, 7th day. After 4 weeks in NKL group and EA group were treated with needle-knife lysis and electro-acupuncture, respectively. Three weeks after treatment, samples of spinal cord of the swollen part of rat waists and rat brains were taken from and the content of L-ENK of medulla oblongata, midbrain, pituitary gland, and hippocampus were measured. RESULTS: L-ENK content of model group increased higher than that of normal control group in spinal cord, hippocampus and midbrain (P < 0.01); there were no significant difference between normal control group and modle group on L-ENK in medulla oblongata and thalamus (P > 0.05). After intervening of NKL or EA, L-ENK content of NKL group increased higher in hippocampus than that of model group and EC group (P < 0.05); but L-ENK content of NKL group in midbrain was lower than that of model group (P < 0.05). CONCLUSION: Needle-knife lysis has characteristic of regulation for the L-ENK content in different parts of central nervous system of rats with knee osteoarthritis, and analgesic effect of needle-knife was possibly related with regulation of center L-ENK.

[Comparative observation of efficacy on lumbar disc herniation treated with acupotomology and operation].

OBJECTIVE: To compare the efficacy difference between acupotomology and operation in the treatment of lumbar disc herniation (LDH). METHODS: One hundred and eighty-four cases were randomized into an acupotomology group (109 cases) and an operation group (75 cases). In acupotomology group, acupotomology was applied to relevant local soft tissues in LDH and the reactive points in the distribution of superior gluteal nerves, at the outlet of sciatic nerve and in the nerve innervate area of the lower extremities separately. In operation group, the small-windowed discectomy through small incision was adopted. The clinical efficacies were assessed between two groups. RESULTS: In acupotomology group, the clinical cured rate was 82.6% (90/109) and the effective rate was 96.3% (105/109). In operation group, they were 86.7% (65/75) and 97.3% (73/75) respectively. There were no significant differences in statistics between two groups (both P > 0.05). CONCLUSION: Acupotomology is definitely effective in the treatment of lumbar disc herniation and its efficacy is similar to that of operation.

[Characteristics of acupuncture in Shanghan Lun (Treatise on Febrile Diseases)].

Through summarization and analysis on etiology, pathology and acupoint selection in chapters about acupuncture in Shanghan Lun (Treatise on Febrile Diseases), written by ZHANG Zhong-jing, famous physician of the Eastern Han Dynasty, five features of acupuncture in the book are concluded: to cut off the pathway of pathogenic factors to prevent progress of diseases; to adopt both acupuncture and herbal medicine to give full play to their respective advantages in treatment; to distinguish pathogenesis carefully and select the proper acupoints; to observe the progressing tendency of diseases to give treatment accordingly; and to understand that yang channels are appropriate for acupuncture, while yin channels can also be selected in treatment. In this way, the law of acupuncture of ZHANG Zhong-jing is expected to be better understood.

[Effect of acupotomy lysis on hypothalamic POMC mRNA and PPE mRNA expression in rats with 3rd lumbar vertebrae transverse process syndrome].

OBJECTIVE: To observe the effect of acupotomy lysis (AL) on hypothalamic proopiomelanocortin (POMO) mRNA and preproenkephalin (PPE) mRNA expression in rats with the third lumbar vertebrae transverse process syndrome (TLVTPS) so as to study its underlying mechanism in relieving symptoms of lumbar muscle strain. METHODS: Twenty-four SD rats were randomly divided into normal control group, model group, AL group and electroacupunture (EA) group. The TLVTPS model was established by inserting a piece of gelatin sponge into the posterior of the left 3rd lumbar vertebrae transverse process. AL and EA were applied to the left "Shenshu"(BL 23) and "Yaoyangguan" (GV 3) respectively. The POMC mRNA and PPE mRNA expression levels in the hypothalamus were detected by in situ hybridization. RESULTS: In comparison with the normal group, the integrated optical density (IOD) values of hypothalamic POMC mRNA and PPE mRNA positive cells in the model group were increased significantly (P < 0.01); while compared with the model group, those of POMC mRNA and PPE mRNA positive cells in both left and right hypothalamus were increased further considerably in both AL and EA groups (P < 0.01). No significant differences were found between AL and EA groups in POMC mRNA and PPE mRNA expression levels (P > 0.05). CONCLUSION: AL and EA therapies can increase the expression of POMC mRNA and PPE mRNA in hypothalamus in rats with TLVTPS, which may contribute to its effect in relieving pain in the treatment of lumbar muscle strain.

[Effect of acupotomy lysis on SP and CCK-8 contents in hypothalamus and spinal cord in rats with transverse process syndrome of the third lumbar vertebra].

OBJECTIVE: To observe changes of SP and CCK-8 contents in the hypothalamus and spinal cord after performing acupotomy lysis so as to study its central analgesic effect in rats with transverse-process syndrome of the third lumbar vertebra. METHODS: Twenty-eight SD rats were randomly divided into normal control group, model group, acupotomy lysis group and electroacupuncture (EA) group, with 7 cases in each one. The model of the third lumbar vertebra transverse process syndrome was established by inserting a piece of gelatin sponge into the deep subfascial part of the 3rd lumbar transverse process. Acupotomy lysis was conducted 1 time/week for 2 weeks. EA (2/100 Hz, 1-2 mA) was applied to the left "Shenshu" (BL 23)-"Yaoyangguan"(GV 3) for 20 min/time, 3 times/week and for 2 weeks. SP and CCK-8 contents in the hypothalamus and spinal cord were detected with enzyme linked immunosorbent assay (ELISA). RESULTS: In model group, SP and CCK-8 contents in the hypothalamus and spinal cord were increased significantly in comparison with normal control group (P < 0.01). Compared with model group, both SP and CCK-8 contents in hypothalamus and SP content in spinal cord in acupotomy lysis and EA groups were apparently lower (P < 0.01, 0.05). CCK-8 content in spinal cord in cupotomy lysis group was lower markedly than that of model group (P < 0.01), while no significant difference was found between model group and EA group in CCK-8 level in spinal cord (P > 0.05). CONCLUSION: Acupotomy lysis can downregulate SP and CCK-8 contents in hypothalamus and spinal cord, which may contribute to its effect in relieving pain from transverse process syndrome of the third lumbar vertebra.

[Effect of lysis of acupotomology on plasma vasoactive substance levels in rats with third lumbar vertebra transverse process syndrome].

OBJECTIVE: To observe the effect of small needle-knife lysis on plasma calcitonin gene-related peptide (CGRP), endothelin (ET), 6-keto-prostaglandin F1alpha (6-keto-PGF1alpha), thromboxane A2 (TXA2) contents in rats with experimental third lumbar vertebra transverse process syndrome (TLVTPS) so as to explore its underlying mechanism in clinical treatment. METHODS: Forty SD rats were randomly divided into normal control, model, lysis and EA groups. TLVTPS model was established by embedding a piece of gelatin sponge (0.5 cm x 0.5 cm) to the transverse process of the 3rd lumbar vertebra under anesthesia. EA (2/100 Hz, 1-2 mA) was applied to left "Shenshu" (BL23) -"Yaoyangguan" (GV3) for 20 min, once every other day, 6 times altogether. For animals of lysis group, the lysis was performed by using a small needle-knife in the induration spot or cord-like region near the incision, once a week and twice altogether. Four weeks later after modeling, plasma CGRP, ET, 6-keto-PGF1alpha and TXA2 contents were detected by using radioimmunoassay and enzyme linked immunosorbent assay (ELISA). RESULTS: Compared with normal control group, plasma CGRP, ET, TXA2 and 6-keto-PGF1alpha increased significantly in model group (P<0.01); in comparison with model group, plasma CGRP, TXA2 and 6-keto-PGF1alpha in both EA and lysis groups decreased considerably (P<0.05, 0.01). No significant differences were found between EA and lysis groups in plasma CGRP, ET and 6-keto-PGF1alpha levels (P>0.05). CONCLUSION: Both EA and lysis of acupotomology have an adjusting effect on vasoactive substances (CGRP, TXA2 and 6-keto-PGF1alpha) levels in TLVTPS rats, which may contribute to their effects in improving local blood circulation and relieving soft tissue injury in the treatment of third lumbar vertebra transverse process syndrome.