| Objective1 To study the effects of treating Vascular Cognitive Impairment of None dementia (VCIND) by moxibustion of Zhuang medicated thread combined with electro-acupuncture in the congnitive function, for the further promotion providing the scientific clinical and practice basis.2 Using a rat model with chronic cerebral ischemia, through the testing of histopathology, molecular biology and other modern experimental techniques, we studied the impact of moxibustion by Zhuang medicated thread on this animal model, and investigated the effects of neuronal cells in the hippocampal CA1 region of rats, for providing the scientific theory basis.Methods1 Clinical ResearchAccording to their own wishes, there are 75 patients who matched the inclusion criteria were divided into three groups with every 25 cases to the clinical observations:moxibustion-electro-acupuncture group were treated by moxibustion of Zhuang medicated thread combined with electro acupuncture. Electro-acupunture group were treated by electro-acupuncture and control group were used foundation treatment only. The chosen points were Baihui, Sishencong, Shenting, Fengchi, Neiguan, Zusanli and Sanyinjiao, Xuanzhong for kidney deficiency syndrome, Taichong for heart and liver yin-deficiency, Yinlingquan for heart and spleen deficiency, Fenglong for phlegm obstructing orifices, Xuehai for the type of qi stagnation and blood stasisvery, every other day, three times a week, one day of rest, a total of 8 weeks. After treatments, using the Montreal congnitive function assessment scale (MoCA), Minimum mental state examination (MMSE) to evaluate the effects of moxibustion of Zhuang medicated thread combined with electro-acupuncture on the neuropsychology cognition function.2 ExperimentsResearch40 male Wistar rats were randomly divided into groups:normal group 7, sham group 7, and the remaining 26 rats were surgically to chronic cerebral ischemia model. After surgery one week, the remaining 14 model rats were randomly divided into model group, moxibustion group. After 2 weeks of surgery, moxibustion group were treated by moxibustion by Zhuang medicated thread, during the observation period of 4 weeks, once a day for 6 consecutive days and rest one day, for 4weeks a total of 24 times. We evaluated the therapy of moxibustion by Zhuang medicated thread against chronic cerebral ischemia. HE staining was used to observe the pathomorphism of the brain. Immunohistochemistry was used to observe the changes of apoptosis in hippocampal CAlregion related indicaters Bax, Bcl-2 and C-fos by moxibustion of Zhuang medicated thread in rats model. Semi-quantitative analysis was done by image analysis techniques.Results1 Clinical resultThe trial included 75 patients,64 cases of final completion of the experiment. The results found that:(1) After 8 weeks of treatment, compared with the control group, the moxibustion of Zhuang medicated thread combined with electro acupuncture (EA) group and EA group were significantly increased on MoCA scores and the difference was statistically significant (P<0.01). Also, compared with the EA group, moxibustion of Zhuang medicated thread combined with EA group’s MoCA scores increased, and the difference was significant (P<0.01). Both of moxibustion of Zhuang medicated thread combined with EA and EA therapy could improve VCIND patients’ cognitive ability and the former was superior to EA therapy. The moxibustion of Zhuang medicated thread combined with EA group’s scores in memory and attention were higher than EA group’s (P<0.05). In improving visuospatial and executive function, and abstract thinking ability, the moxibustion of Zhuang medicated thread combined with EA group and EA group were no significant difference (P>0.05).(2) the score of MMSE scale changed or improved, or declined, but by statistical analysis, these differences did not result in defference between groups statistically significant (P>0.05). But two comparative analysis between the two groups when it was found that the difference between before and after treatment MMSE score, moxibustion of Zhuang medicated thread combined with EA group was different from control group (P<0.05), and this difference was statistically significant (P<0.05). Compared with control group, the therapy of moxibustion of Zhuang medicated thread could improve MMSE score of VCIND patients and cognitive function.(3) 8 weeks after the treatment,2 cases of moxibustion of Zhuang medicated thread group treatment, effective 4, symptoms improved 11, invalid improvement of 3 people,85% efficiency; 0 cases of EA group treatment, effective 0, symptoms improved 14, invalid improvement of 7 people,66.67% efficiency; 0 cases of control group treatment, effective 0, symptoms improved 6, invalid improvement of 17 people,26% efficiency. Three groups of the total efficiency compared to a very significant statistical difference (P<0.01). By worst-case scenario analysis, the total efficiency showed that the total efficiency among the three groups significant differences between groups was statistically significant (P<0.05).2 Experimental Result6 weeks after model, neurons in the hippocampus necrosis were more obvious than the moxibustion of Zhuang medicated thread groups’. This indicated that under the internal environment for chronic cerebral ischemia, hippocampal neurons was damaged, but the therapy of moxibustion of Zhuang medicated thread could reduced the damaging effects so as to protect neurons. In the hippocampus of rats with chronic cerebral ischemia model, a clear expression of C-fos and Bax were found, but the expression in moxibustion of Zhuang medicated thread group was less than the model group (P<0.01). This clarified that the treatment of moxibustion of Zhuang medicated thread could reduce C-fos, Bax factor’s expression, inhibit the release of pro-apoptotic factor and protect neurons. Bcl-2 expression was a large number in hippocampus region of model group, while the model group’s level were lower than normal (P<0.05). After treatment, the expression of Bcl-2 in hippocampus of moxibustion of Zhuang medicated thread group increased significantly, more than the model group (P<0.05), with the sham group’s considerably (P>0.05). That showed the treatment of moxibustion of Zhuang medicated thread could increase the level of Bcl-2, inhibit apoptosis and protect neurons.Conclusion1 The treatment of moxibustion of Zhuang medicated thread combined with EA and EA could improve VCIND patients’ overall cognitive ability. The treatment of moxibustion of Zhuang medicated thread combined with EA was good at improve memory and attention than EA treatment. In improving visuospatial, executive and abstract thinking ability, both of the treatment of moxibustion of Zhuang medicated thread combined with EA and EA treatment were similar. The treatment of moxibustion of Zhuang medicated thread combined with EA and EA treatment were safe and effective to VCIND. It was worthy of promoting.2 Using 2-VO method to prepare the rat model of chronic cerebral ischemia, we found that 6 weeks the neurons in hippocampal CA1 mortified. The treatment of moxibustion of Zhuang medicated thread could inhibit neurons apoptosis in hippocampal CA1 for neuroprotection by the way of down-regulating Bax and C-fos, regulating Bcl-2, and keeping balance of Bax/Bcl-2. To inhibit apoptosis may be one of the mechanisms of its action.
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