Chief Physician Zhang Tang-fas Clinical Academic Thought On Acupuncture-moxibustion

Part Ⅰ. Chief physician ZHANG Tang-fa’s clinical academic thought on acupuncture-moxibustionAs famous Hubei Chinese medicine practitioner,Chief physician Zhang Tangfa is always rigorous at scholarship, diligent at seeking the old saying, with a wealth of knowledge on Chinese and Western, clinical experience in acupuncture and unique academic thinking. He is good at twisting the needle without pain, emphasizes sparse and simple pinhole, gas to the disease, rule of god, getting and keeping the gas. He advocates clinical syndrome, combined with identification of disease and meridian, combination of acupuncture with moxibustion, combination of acupuncture with pharmacy. He is tends to the road of clinical research,pushing integrative medicine as an important way for the development of acupuncture.Part Ⅱ. Research on the protective effect and its mechanisms of Jiaji-electroacupuncture on lumbar disc degenerationObjective: To observe the curative effects of EA at Jiaji points in treating Lumbar Disc Herniation(LDH).Based on the influence evidence of Jiaji-electroacupuncture(EA)on MRI and extracellular matrix(ECM) expression of degenerated lumbar intervertebral disc in rabbit model firstly, to study the efficacy and mechanism of EA, such as regulation on apoptosis, influence on the expression of ECM regulatory factors in turn, correction of imbalance between matrix degradation and anabolic metabolism, retardation of disc degeneration, promotion the repairment and regeneration of the intervertebral disc.Methods: 29 patients were given electroacupuncture therapy once a day,6 times continuous as a course of treatment,before the next course of treatment has one day interval.The treatment were two courses total.Oswestry disability index questionnaire was selected to evaluate the therapeutic effects before and after treatment.Modified Macnab curative effect evaluation standard was used to evaluate the clinical efficacy of after the treatment.36 New Zealand white rabbits were randomly divided into 4 groups :normal group, sham model group, model group and treatment group, establishing the disc degenerna tion mode induced by the external dynamic compression device attached to the rabbit lumbar spine for 28 days, referring to Kroeber M’s modeling method. The rabbits in model group accept production of LIDD model without any treatment. The rabbits in the sham model group almost accept the same processing but without the intervertebral pressure,also without any treatment. The rabbits in the EA group accept the EA treatment at the first day after the successful modeling. The modeling last 28 days, the treatment last 28 days. Normal group will be fed as usual. For each group, animal was killed at the 1, 28, and 56-day time points and the discs were examined radiographically, histologically and with gene expression. The rabbits of the four groups accept MRI test of the corresponding lumber intervertebral disc at the 1st day, 28 th day and 56 th day.After the MRI test, we selected 3 rabbits randomly from each group and take the intervertebral disc tissue of the corresponding Lumber at the 1st day,28 th day and 56 th day. All of the lumbar intervertebral disc tissue were sent for double-labelling immunofluorescence to detect the expression of ECM(COL-1, COL-2),ECM reglulatory factors(MMP-13, TIMP-1,BMP-2)and Western Blot to detect the protein expression of ECM(biglycan, decorin), ECM reglulatory factors(MMP-13, BMP-2), apoptosis-related genes(Bcl-2,Bax).Results: 1.ODI scores were significantly reduced after two weeks treatment compared with the results before treatment, the differences were statistically significant(P<0.05);The total effective rate was 89.66%. 2.Influence of Jiaji-EA on MRI grading index of degenerative disc Normal disc showed a uniform bright high signal, no significant difference from adjacent segments.Signs of lumbar disc degeneration occurred in rabbits after modeling,its intensity on T2-weighted images showed low signal change, lower than the adjacent disc. The degenerated disc showed narrowing of intervertebral space, thinning, posterior process, instability and deformity for some portion. The MRI assessment showed that the healthy and compressed discs are clearly differentiated on the T2-weighted image, the signal intensity of the nucleus pulposus decreased progressively during the 28 day compression period. With the lowest signal intensity at 56 day post-compressionly. Different images showed that the device was able to induce the IVD model. According to the Pfirrmann’s MRI grade scores, which indicate the degree of disc degeneration, grade IV degenerative changes were first detected at 28 post-compressionly, grade IV or V were detected 56 days after loading. In contrast, the control and sham groups remained relatively constant during the 28 or 56 day period, with grade I on T2-weighted imaging. After EA intervention for 28 days, the degree of degenerated disc were characterized grade III or IV,compared to the model group in 28 days,56 days and EA group in 28 days(P<0.05). 3.Influence of Jiaji-EA on ECM expression of degenerative disc Immunofluorescence labeling was used to detect the immunoreactivity of COL-1 and COL-2.In comparison with the control and the sham compression group,the immunoactivity levels of COL-1 and COL-2 in the compressed disc was found decreased significantly(P<0.05). After EA intervention, the immunoreactions positive cells in the 56 days EA group were found obviously higher than that in the model group and the 28 day in the EA group(P<0.05). Western blot analysis demonstrated that no significant changes were found between control and sham compression groups at any time point. Compared with the two groups, the relative expression levels of biglycan(P<0.01)Anddecorin(P<0.05)protein in disc were apparently decreased in the model group. Following EA intervention, the expression in the EA group were considerably higher than those in the model group and the 28 days in the EA group(P<0.05). A trend to stimulated expression was found in matrix components. 4.Influence of Jiaji-EA on ECM regulatory factors expression of degenerative disc We detected MMP-13 by the immunofluorescence method and found that MMP-13 immunoreactivity in the compressed disc was increased compared with the control group, of which the positive cells were even not detectable(P<0.05).Following EA intervention,the immune-oreactivity level was down-regulated(P<0.05).TIMP-1,inh ibittor of ECM catabolic factors and the growth factor BMP-2 were detecte by the same method. Compared with the control group and the sham group,the immunoreactivity level of TIMP-1 was lower in the compressed disc(P<0.05), which was in contrast to the MMP-13. After EA intervention,immunoreactivity level was upregulated in compareson with the model group(P<0.05). The result of BMP-2 was similar to that observed in TIMP-1. 5.Influence of Jiaji-EA on Apoptosis genes expression of degenerative disc At the 28 th day,compared with the sham model group,the Bcl-2/GAPDH, Bax/GAPDH of The Intervertebral disc tissue of the rabbits in model group and EA group show statistically significant difference(P <0.05).Combined with the result of MRI examination which pointed significant degeneration,it showed that Bcl-2 protein expression decreased and Bax protein expression rised in the degenerative lumbar Intervertebral disc tissue. At the 56 th day, the Bcl-2/GAPDH, Bax / GAPDH of the interver- tebral disc tissue of the rabbits in the model group and EA group show statistically significant difference(P<0.05).The Bcl-2 protein expression rised and the Bax protein expression decreased in the degenerative lumbar Intervertebral disc tissue of the rabbits in EA group.It showed that Jiaji EA could raise the levels of Bcl-2 protein and decrese the levels of Bax protein in the degenerative lumbar disc tissue of model rabbits.Conclusions: 1. The thearpy of EA at Jiaji points could effectively improve the symptoms of patients with LDH and reduce the affect of waist pain to daily life and work. 2.Under axial intervertebral pressure for 28 days, New Zealand white rabbits become an ideal animal model of lumbar disc degeneration, its MRI sigals showed typical signs of lumbar disc degeneration. The modeling program showed strong operability, higher repeatability, higher success rate. Jiaji-EA can improve the MRI grading index of degenerative disc. 3.Jiaji-EA can up-regulate the ECM expression of degenerative disc, such as COL-1, COL-2, biglycan, decorin, etc. 4.Jiaji-EA can regulate the ECM regulatory factors expression of degenerative disc, down-regulate the expression of catabolic enzyme and degenerative marker(MMP-13), up-regulate the express- ion of anabolic enzyme(BMP-2) and anti-catabolic enzyme(TIMP-1), thus improving the imbalance between extracellular matrix synth- esis and degradation. 5.The Bcl-2 and Bax protein involved in the process of LIDD. The expression of Bcl-2 protein decreased and the Bax protein increased in the degenerative lumbar disc tissue of rabbit model.Jiaji-EA could upregulate the levels of Bcl-2 protein and down-regulate the levels of Bax protein in the degenerative lumbar disc tissue of model rabbits, thus decrease the sensitivity of the cell to apoptosis and increase the ability to antagonize apoptotic, which may be the channel that Jiaji-EA regulate LIDD. 6.up-regulating the expression of Bcl-2 protein and downregulating the expression of Bax protein in the degenerative lumbar disc tissue of model rabbits, decreasing the sensitivity of the cell to apoptosis, increasing the ability to antagonize apoptotic, then influence the expression of ECM regulatory factors, improving the imbalance between extracellular matrix synthesis and degradation, promoting increased matrix components,which may be the important mechanism of Jiaji-EA to retard disc degeneration, romote repair and regeneration of intervertebral disc,play a protective role on degenerated disc.