| ObjectiveThis study was divided into two parts, the 1st part of a clinical analysis on 90 cases of rheumatoid arthritis patients by using the method of randomized clinical observation on effect of acupuncture, clinical efficacy, quality of life of patients with rheumatoid arthritis. The 2nd part choose the scientific and rigorous behavior as the premise of study, the effects of acupuncture on pain threshold model of rheumatoid arthritis in rats. Using the microdialysis technique, Elisa and HPLC is a new, hermaphroditic, online, dynamic monitoring lesion related transmitters and inflammatory mediators, explore the mechanism and timeliness of fire needle. From the foundation of "disease in the ribs, adjustment of the tendon;disease in bone, adjustment of the bone’ and holism of Chinese medicine, exploring mechanism and the connections between neuroimmunoendocrine network by fire needle.establish a treatment relieve pain effectively, delay the timeline of the disease development, prevent the bone and joint deformities, the methods of improving the quality of life of the patients.MethodsA total of 90 patients with rheumatoid arthritis randomly divided into three groups,30 cases in each group. Take the points with joint pain and Ashi acupoints. Fire needle group:after routine disinfection, smear a little Dieda Wanhua oil, Light the alcohol lamp, using fire needle burn to white light then prick the fire needle into points rapidly, needle punching depth is about 0.1~0.5 inches by 3 times, Each time alternately select 8 points selection. The acupuncture group were treated by 0.30mm ×25mm,0.30mm×40mm stainless steel needle, needle punching depth is about 1.5 inch, for twirling reinforcing reducing, needle after the needle 30min. Catgut implantation at acupoint group will be put catgut into points, Each time alternately select 8 points selection. fire needle group, acupuncture group once every other day, acupoint catgut embedding group once in 2 weeks, one treatment course is one month. After treatment, the time of morning stiffness, the number of swollen joint and tender joint number,visual analogue scale, average grip strength of hands, walking time of 20 meters and objective indexes (ESR, CRP, RF), quality of life and WHOQOL-BREF score were observed.A total of 100 Sprague Dawley rats were randomly into a normal group (n=10), a model group (n=10),a fire needling group (n=10),an acupuncture group (n=10)and a catgut implantating group (n=10), Complete Freund’s adjuvant was injected into the plantar surface of the right hindpaw of the SD rats to make the model of rheumatoid arthritis. In each group, "Zusanli" (ST 36) and "Kunlun" (BL 60) were selected as the major points to receive fire needling, acupunture and catgut implantation. The thermal withdrawal lateney(TWL),mechanical withdrawal threshold(MWT)were measured before injection, after injection and at days1、7、14d after treatment, and serum IL-1 and TNF-α contents were determined by double antibody sandwich ELISA. In addition, the extraction of rats in each group before treatment, after treatment of 30,60,90,120min,4h,8h lesions of muscle tissue by using microdialysis technique, then to detect the content of 5-HT,5-HIAA, HA, PGE2, adenosine, ADP, ATP in muscle tissue during different time by the HPLC-UV technique. All the data were collected into a database and were analyzed by SPSS18.0 statistical software.Resultsthe clinical results show, three groups after 2 courses of treatment, VAS lower than before treatment (P<0.05). joint swelling, tenderness relatively reduce (P<0.01, P<0.05), both hands grip relatively before increase (P< 0.01), comparison between groups when the fire needle group, VAS score, difference, joint swelling/number of tenderness were lower than that of acupuncture and acupoint catgut embedding therapy group (P< 0.01, P< 0.05), that fire needle in the relief of pain, increase the pain threshold, enhance the effect of average grip strength of hands is better than that of other two groups (P< 0.01, P< 0.05). Acupoint catgut embedding therapy in first patients with RA can shorten the course of treatment is 20 meters walking time and the time of morning stiffness (P< 0.01), inter group comparison, fire needle in improving stiffness is better than acupuncture and acupoint catgut embedding therapy group (P< 0.01, P< 0.05). Comparison of three groups before treatment, ESR, CRP, RF, no significant difference (P>0.05), the three groups after treatment than before treatment, ESR decreased (P<0.01); fire needle group ESR compared with the other two groups (P<0.05) slow; the second course of treatment group comparison, between the three groups were not significant the difference (P>0.05). Compared with the treatment of first, three and 2 courses of CRP group before treatment, the difference was statistically significant (P<0.05, P<0.01). There was statistical significance between the three groups data of first course of treatment the difference of CRP between the groups (P<0.05), among them, fire needle group is superior to the other two groups (P<0.05). Comparison of second treatment between the three groups group CRP, no significant difference (P>0.05). Acupuncture, acupoint catgut embedding group first,2 course of treatment compared with those before treatment, no significant difference (P>0.05), indicating that RF levels were reduced after acupuncture, acupoint catgut embedding therapy. Compared with fire needle therapy group first before treatment, no significant difference (P>0.05), suggesting that fire needle in the treatment after 1 courses of treatment, the RA level of RF in patients with no significant improvement in comparison with fire needle therapy; treatment group second, the difference was statistically significant (P<0.05), in that fire needle therapy after 2 courses of treatment can be reduced by the level of RF.In the physiological field, within group comparison, each for first, there was significant 2 course of treatment and treatment before the physiological domain score difference (P<0.01). Comparison of first treatment groups, acupuncture group and acupuncture group had no difference (P>0.05); score fire needle group physiological field was significantly higher than that of acupoint catgut embedding group (P< 0.01). Comparison of second treatment groups, the score of fire needle group physiological field was significantly higher than that of acupuncture group (P< 0.01); higher than the acupoint catgut embedding therapy group (P< 0.05). In the psychological field, within group comparison, each treatment first,2 period of treatment is the treatment of psychological field scores increased significantly (P< 0.01). Comparison of first treatment groups, acupuncture group was higher than that in the acupuncture group (P<0.05)was significantly higher than that of acupoint catgut embedding therapy group (P<0.01); comparison of second treatment groups, acupuncture group was higher than the other two groups (P< 0.05). In the area of social relationships, group itself, course of treatment and treatment of fire needle group of first former comparison score increased (P < 0.05); compared with fire needle therapy group second before treatment, scores were significantly increased (P< 0.01); acupuncture group first,2 period of treatment compared with before treatment had no statistical difference (P> 0.05); group group of first and the treatment of acupoint catgut embedding therapy before were statistically significant (P> 0.05); Acupoint catgut embedding group second courses of social relations in the field scores than before treatment increased, there is difference in Statistics (P< 0.05). Between groups when compared to the field data, three groups of social relationship value no statistical difference (P> 0.05). In the field of environment, the field of first course of treatment three groups of social relationship value increased compared with those before treatment (P< 0.01), fire needle group is obviously better than that of acupoint catgut embedding therapy group (P< 0.01); no statistically significant difference between the acupuncture group (P> 0.05); field second course of three set of social relations value had no statistical difference (P> 0.05).Animal experimental results show, compared with before modeling, model group, acupuncture group, acupoint catgut embedding group and acupuncture group rats pain threshold was decreased, IL-1, TNF-alpha increased (P< 0.01), the emergence of hyperalgesia, fire needle group, acupuncture group, acupoint catgut embedding group pain threshold were increased after treatment, treatment first,7,14 days, fire needle group MWT, TWL value is higher than the acupuncture and acupoint catgut embedding group, the difference was statistically significant (P< 0.05, P< 0.01). Fourteenth days of treatment, three treatment groups TWL, MWT values were significantly higher than those in the model group (P<0.01), in which the fire needle group TWL value is still close to the normal control group (P> 0.05). Treatment can be three group reduced lesion tissue of rats with IL-1 and TNF- were lower than those of the other two groups, acupuncture treatment group (P<0.05), showed that acupuncture, fire needle, thread embedding can decrease IL-1, TNF- alpha content, the curative effect is better than other two needle.Rat muscle tissue after modeling,5-HT content was significantly increased (P< 0.01). After treatment, the content of 5-HT lesion muscle group in needle decreased obviously, close to the normal group (P> 0.05), there was significant difference compared with the model group (P< 0.01), maintaining the state at a low level in the subsequent 8h, there was statistical significance compared with ordinary acupuncture (P< 0.01, P< 0.05), compared with acupoint catgut embedding therapy, in the treatment of the first 4 periods, fire needle group is better than the acupoint catgut embedding therapy group (P< 0.01, P< 0.05), after treatment in the 2 time periods, fire needle group and acupoint catgut embedding group showed no significant difference (P> 0.05). Ordinary acupuncture treatment for 1h, rats with lesions in the muscle tissue 5-HT content compared with the model group, there was significant difference (P< 0.01),90min,5-HT content was gradually restored to the original level, close to the model group (P> 0.05). Acupoint catgut embedding group in the 3 time period no significant difference with the model group (P> 0.05). After 120min treatment, muscle tissue embedding group rats in 5-HT model group and acupuncture points difference (P< 0.05), from 120min to 480min are maintained treatment in lower level.Rat muscle tissue after modeling, PGE2 content was significantly increased (P< 0.01). The content of PGE2 lesion muscle group fire needle group, common acupuncture in decreased significantly (P< 0.01), in which the fire needle group within 2H was close to the normal value ((P> 0.05), in the state of low level sustain 8h, there was statistical significance compared with the model group (P< 0.01), lower than the ordinary acupuncture group after treatment of 60min to 240Min (P< 0.01, P< 0.05), the treatment of 30min to 120min is lower than that of acupoint catgut embedding therapy group (P< 0.01), and after treatment in 2 time periods, fire needle group and acupoint catgut embedding group showed no significant difference (P> 0.05).Rat muscle tissue after modeling, HA content was significantly increased (P< 0.01). After treatment, the content of HA lesion rats in muscle tissue needle decreased obviously, maintaining the state at a low level in the 4h, there is statistical significance compared with the model group (P< 0.01). The content of HA lesion muscle group common acupuncture in the first 3 time lower than that of model group, there were statistically significant (P< 0.01, P< 0.05), after 120min, the content of HA gradually returned to the original level, close to the model group (P> 0.05). Acupoint catgut embedding group in the 3 time period no significant difference with the model group (P> 0.05), after 480min treatment, muscle tissue embedding group rats in HA model group and acupuncture points of statistical difference (P< 0.05).Rat muscle tissue after modeling, ATP content was lower than the control group (P< 0.01). After treatment,30min, ATP content of fire needle group, acupuncture group rats with lesions in the muscle tissue significantly increased, with statistical significance compared with the model group (P< 0.01), close to the normal group (P> 0.05), there was no statistical difference between the two groups (P> 0.05), acupoint catgut embedding group the content of ATP was not significantly increased, the former the two group is obviously better than that of acupoint catgut embedding therapy group (P< 0.01). Acupuncture group treated with 90min, ATP content is reduced to the level before treatment, compared with model group showed no significant difference (P> 0.05); fire needle group ATP content continued to maintain 120min in lower level, close to the normal value (P> 0.05), there is statistical significance compared with the model group (P< 0.01), fire needle therapy in the treatment of 120min, ATP content remained close to normal levels (P> 0.05), until the 4H gradually returned to a high level before treatment, no significant difference with the model group (P>0.05). The increase of ATP content in muscle tissue of rats with lesions of acupoint catgut embedding therapy for 4h, with significant difference compared with the model group (P<0.01)Rat muscle tissue after modeling, ADP content was lower than the control group (P<0.01). After treatment,30min, ADP content of fire needle group, acupuncture group rats with lesions in the muscle tissue significantly increased, with statistical significance compared with the model group (P< 0.01), close to the normal group (P>0.05), there was no statistical difference between the two groups (P>0.05), acupoint catgut embedding group the content of ADP was not significantly increased, the former the two group is obviously better than that of acupoint catgut embedding therapy group (P<0.01). Acupuncture group treated with 90min, ADP content is reduced to the level before treatment, compared with model group showed no significant difference (P> 0.05); fire needle group ADP content continued to maintain 90min in lower level, close to the normal value (P>0.05), there is statistical significance compared with the model group (P<0.01), fire needle therapy for 120min, ADP content began to decline after treatment, gradually returned to a high level before treatment, no significant difference with the model group (P> 0.05).Rat muscle tissue after modeling, ADP content was lower than the control group (P< 0.01). After treatment,30min, ADP content of fire needle group, acupuncture group rats with lesions in the muscle tissue significantly increased, with statistical significance compared with the model group (P< 0.01), close to the normal group (P> 0.05), there was no statistical difference between the two groups (P> 0.05), acupoint catgut embedding group the content of ADP was not significantly increased, the former the two group is obviously better than that of acupoint catgut embedding therapy group (P< 0.01). Acupuncture group treated with 90min, ADP content is reduced to the level before treatment, compared with model group showed no significant difference (P> 0.05); fire needle group ADP content continued to maintain 90min in lower level, close to the normal value (P> 0.05), there is statistical significance compared with the model group (P< 0.01), fire needle therapy for 120min, ADP content began to decline after treatment, gradually returned to a high level before treatment, no significant difference with the model group (P> 0.05).Conclusion:Clinical results show that the fire can not only significantly reduce the number of rheumatoid arthritis, joint swelling, tenderness, and reduce the degree of joint pain, swelling, tenderness, and can shorten the time of morning stiffness, improve joint function, reduce the ESR and C reactive protein and rheumatoid factor levels, improve physical, psychological, social relations, environment. Animal experiment results show that the built model rats after suffering from foot pain threshold is reduced, the lesion within the muscle tissue inflammation medium (IL-1, TNF alpha),5-HT, HA, PGE2 is obvious rise, ADP and ATP and adenosine in low state, giving needle, fire needle, acupuncture point bury line can effectively increase the pain threshold of rats in the agreed upon period of time, reduce the level of pain, reduce 5-HT in diseased tissue, HA, PGE2 levels, activate cell membrane outside Al receptors, improve the level of ADP and ATP, adenosine, acupuncture and fire needle in acupuncture instant namely can appear benign adjustment effect, while acupuncture point bury line need at least 4 h can be improved in effect. In addition, this topic also shows that the analgesic effect of acupuncture treatment by instant and 60 min, ADP, ATP and adenosine levels fell to a low level state, the needle between 90 and 120 min after each index gradually restore to the original level, and can maintain the analgesic effect of fire needle to 2 to 4 hours. |
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