Chinese Medicine By Tendon Dialectical Study For Osteoarthritis Of The Knee

Knee Osteoarthritis (KOA) also known as degenerative knee osteoarthritis, hypertrophic knee osteoarthritis, etc, which is a chronic multiple degenerative joint disease in middle and aged people. The basic pathological characteristic of it is articular cartilage degeneration, destruction, subchondral sclerosis, reactive hyperplasia of articular cartilage edge and cartilage sending down fishbone and the formation osteophyte. With the extension of human life, serious problems of the aging population have appeared, the incidence of this KOA is increased markedly, which has brought heavy burden to home and society.2002-2012 has been confirmed as "Bone and Joint Decade" so the research of knee osteoarthritis has been paid high attention.In the clinical observation the most KOA patients have knee hyperosteogeny, so the most cognitions of this disease focus on the bone changes, as well as, the treatments are for the bone changes of cartilage and cartilage sending down fishbone, however, it is difficult to gain satisfactory therapeutic effects in some cases. In our previous studies we found that the clinical manifestation of KOA patients disagrees with the severity of the bone changes, but it had more relationships with the surrounding tissues of lesions joints. So we put our attention to the surrounding tissues of joints-the meridian sinew in traditional Chinese medicine.In traditional Chinese medicine KOA belongs to the category of "arthralgia syndrome of bone", "tendontious pain", "Wei (atrophy) syndrome of bone" or "A Wei (atrophy) syndrome of sinew". Through a mass of ancient and modern archival research, we found that KOA belongs to the category of meridian sinew disease whether in physiological and pathological or in clinical treatment. First of all, the knee is the biggest joint in the body, "the knee is the mansion of tendon", and the function of the soft tissues surrounding knee, known as the meridian sinew system, decides the normal physiological activity of knee. The meridian sinew of three yang meridians and the three yin meridians of the foot both pass by and knit knee, so the diseases of knee have a close relationship with meridian sinew. Secondly, the pathogenesis of KOA also relates to the pathogenesis system.In 1995,a definition was released in the international meeting for OA, which is, OA is a result of disequilibrium of decompose and anabolic metabolism among cartilage cell, ECM and cartilage sending down fishbone, caused by the integration of mechanical and biological factors. Though many factors could lead to KOA, the factor of the mechanical unbalance of the soft tissues surrounding knee is the leading one. Even biological factors make the cartilage degeneration, but the cartilage abrasion and the hyperostosis formation are the consequence of the unbalance of joints tress.So the unbalance of meridian sinew system is still the leading case of KOA. Thirdly, the main clinical manifestations of KOA are joint pain, rigidity, motor dysfunction and intumescences, etc. The cause of these manifestations is the lesions of meridian sinew system. The location of pain is mainly on the point of结筋病. The rigidity and motor dysfunction of joint are caused by the adhesion and contracture of tendon as well.Finally, if the treatment of KOA only points at the knee articular cartilage, it just relieves the symptom temporarily and is poor for long-term. But the treatment for meridian sinew system has achieved a good clinical efficacy either in exercising muscular strength or in lifting Jiejing. Therefore, we could infer that the essence of KOA is a meridian sinew disease.The core of the meridian sinew therapy is dialectical and treatment. In the meridian sinew dialectical, the most commonly used means to gather information is the hand-touch meridian sinew method, which find abnormal reaction points according to examine the soft tissue around joints, then judge the disease nature, the severity index and so on. The hand-touch method is the most widely used in clinical meridian sinew therapy. At the same time, it also has an important guide pole in post-treatment. The modern technologies are increasing widely applied in meridian sinew therapy, such as motion analysis, detection of soft tissue tension, sEMG and human motion image measure. These techniques check and analyze the diseases, which are all based on the knee mechanics imbalance which is an important factor in KOA disease process. But they are still immature and need further refinement.There is a detailed discussion of the treat of the meridian sinew disease from the NeiJing age. Because the key pathological in meridian sinew disease is the joint mechanics imbalance caused by inflammation, effusion, adhesion, and contracture of the soft tissue around the joint, "Jie Jie" is a general principle of the meridian sinew disease treatment. In clinical, the ways of treating meridian sinew disease are various, such as fire needle therapy, tendon-soothing maneuver, acupuncture and needle-knife therapy. The principle is that the treatment in the Jinjie points could dredge meridians, release adhesion and restore mechanical balance around the joint, so as to ease the pain and lubricate the joint. The theory of meridian sinew has widely used in KOA in clinical, but few researches about its mechanism and theoretical system are reported. In order to improve the system of the meridian sinew theory and guide to the treat in clinical, we have carried out a series of studies in KOA meridian sinew theory.This study is divided into two parts. The first part is animal study, which selected by the typical meridian sinew therapy-the acupotome therapy operating at the animal model of KOA, to observe the effect and analyze the mechanism. In the second part, we summarized the meridian sinew dialectical regular according to clinical investigation.The acupotome therapy has been used to treat KOA for thirty years and achieved a good clinical effect. Its basic principle is to restore the joint mechanics balance according to peeling the adhesion, contracture of the soft tissue around joints. And its treatment core is "Jie Jie", which is one of the therapies of meridian sinew.The hindlimb KOA rabbit that observed in our study was made by extension position on the brake and be treated with acupotome therapy, the results showed that the acupotome therapy can improve the KOA rabbit of pain, gait, range of motion and joint swelling significantly. The mechanism may be that acupotome therapy restore the joint's mechanical equilibrium by acting on the joints around the "bar end" position, so the inflammation around the joint be reduced, the formation of osteoarthritis of the process be interrupted, arrangement and shape of chondrocytes and collagen fiber be repaired, then improved the local collagen fiber structure, and achieve the therapeutic effect eventually.Muscle meridian theory has been widely used in the clinical treatment of KOA, but its dialectical method and characteristics of the system of law has not yet formed. Through the standard clinical investigation of KOA patients, combined with TCM Syndrome survey and JOA joint function score, analyze the characteristics of muscle meridian dialectical of KOA and the relationship betwen different muscle meridian,TCM Syndrome and JOA score, so as to find the law of muscle meridian symptom of KOA. Results showed that the foot-yangming Syndrome and foot-taiyang Syndrome are the most common Syndromes, meanwhile, the TCM syndrome type performances are also not the same in the muscle meridian symptoms, hepatic asthenia, spleen deficiency and Kidney Deficiency are the main Syndromes, such as muscle meridians of foot-yangming, foot-shaoyang and three yin meridians of foot usually show the Kidney Deficiency, muscle meridian of foot-taiyang usually show the hepatic asthenia, muscle meridian of foot-shaoyang also have a higher proportion of stagnation performance, all these have important reference value when we use muscle meridian theories in clinical treatment in future. Combine the JOA score, we also found that with the increase in the number of lesion muscle meridian, knee function score decreased, this shows that the number of lesion muscle meridian determine the tendons severity. The muscle meridian symptoms are also have significant individual differences in pain, mobility, swelling and other indicators, indicators of muscle meridian of foot-taiyang are the most serious and with foot-shaoyang relatively the lightest, the single index of flexion and extension of foot-taiyang are more serious, indicators of muscle meridian symptoms of three-yin of foot behind that of foot-yangming, this also shows that the severity of KOA have significant correlation with muscle meridian symptoms, confirmed the views that KOA is a muscle meridian diseases.In this study, the essence of muscle meridian diseases of KOA are described from the view of theoretical, experimental and clinical point, mechanism of their disease, the dialectical law of muscle meridian and the pathway of acupotome therapy were systematically studied, conducted a preliminary exploration of theoretical system of muscle meridian dialectical of KOA, provide a theoretical basis for the use of muscle meridian therapy in clinical therapy, enrich the contents of muscle meridian theory.