| Objective:Numerous studies have shown that needle warming moxibustion in the treatment of knee osteoarthritis of kidney yang deficiency syndrome has a unique curative effect.The main purpose of this study is to explore the etiology and pathogenesis of knee osteoarthritis of kidney-yang deficiency syndrome in traditional Chinese medicine(TCM)and observe the clinical effect of acupuncture and moxibustion on knee osteoarthritis with kidney-yang deficiency syndrome.The molecular biological basis of gene expression profile in KOA patients with kidney-yang deficiency syndrome and the variation before and after warming acupuncture treatment were preliminarily analyzed.Method:1.Literature study: To analyze the study of KOA in modern medicine and explore the etiology and pathogenesis of KOA in kidney-yang deficiency syndrome and its main therapeutic principles and treatment methods.2.Clinical study: Develop WOMAC pain scale and Kidney Yang deficiency scale,30 KOA patients with Kidney Yang deficiency Syndrome were selected from those who met the diagnostic criteria of western medicine and syndrome differentiation of traditional Chinese Medicine.According to the etiology and pathogenesis of KOA with kidney yang deficiency syndrome,regulating yin and yang of Zang Fu organs,warming up kidney yang and dredging meridians were taken as the main therapeutic principles,and the theory of Zang Fu organs,yin and yang and five elements of TCM were used to guide the selection of acupoints.Take GuanYuan,Qi Hai,Zusanli,Shenshu as main points,knee Eye,Yang Lingquan,local Ashi as auxiliary points,with needle warming moxibustion treatment of two courses,a total of ten days.The clinical effect of needle warming moxibustionon kidney-yang deficiency syndrome of KOA and traditional Chinese medicine syndromes of kidney-yang deficiency syndrome were analyzed.3.Gene expression profile study: using gene chip technology,select 10 cases of typical kidney yang deficiency syndrome of KOA,collect whole blood specimens before and after needle warming moxibustion treatment,and select 3 cases of normal healthy human whole blood specimens and 3 untreated blood samples of kidney yin deficiency type of KOA,respectively study the data analysis of microarray of gene expression profile of kidney-yang deficiency type of KOA before and after treatment,kidney yin type of KOA,and normal healthy people,screening differentially expressed genes.Result:1.At present,modern medicine lacks an effective mean for the thorough treatment of KOA.Kidney yang deficiency syndrome is more common in the pathogenesis of KOA,the TCM etiology and pathogenesis of it are mainly due to deficiency of kidney yang,invasion of external pathogens,and deficiency of vital Qi of Zang Fu organs.Needle warming moxibustion is a combination of moxibustion and acupuncture,it has the effect of treating both the symptoms and the pathogenesis,and is one of the effective methods for the treatment of KOA of kidney-yang deficiency syndrome.2.After treating 30 patients of KOA with kidney yang deficiency syndrome by needle warming moxibustion by teacher LingxiangHu,who works in the Affiliated Hospital of our school,the total effective rates of clinical effect of needle warming moxibustion in treating KOA of kidney-yang deficiency syndrome and curative effect rates of TCM syndrome of kidney-yang deficiency syndrome were 93.33% and 96.67% respectively.The analysis of WOMAC scale and Kidney-Yang deficiency scale showed that after treatment,the scores of KOA patients with kidney-yang deficiency syndrome were significantly decreased(P<0.01),and the curative effect was significant.Throughout the course of treatment,the patient’s acceptance was high and there was no adverse reaction.3.Gene expression profile:.A total of 98 differentially expressed genes were screened by contrast analysis of gene expression profile data between KOA of kidney-yang deficiency syndrome before treatment and healthy control group.1349 differentially expressed genes were screened by contrast analysis of gene expression profile data between KOA kidney yin deficiency syndrome and healthy control group.Before and after needlewarming treatment for KOA of kidney yang deficiency syndrome,differentially expressed genes were screened by go enrichment analysis,52 down-regulated genes were screened,but no up-regulated genes were screened.Down-regulated genes are mainly involved in cellular processes,metabolic processes,in vitro binding and transport activities,etc.The analysis of KEGG signal transduction pathway of differentially expressed gene mainly involves 13 signal pathways related to senescence and metabolism,including p53 signaling pathway,nitrogen metabolism signal pathway,etc.Conclusion:The possible mechanisms of needle warming moxibustion in treating KOA of kidney-yang deficiency Syndrome: Firstly,kidney-yang deficiency may affect material transport,substance metabolism,energy metabolism,and so on,resulting in the impediment of material transport,the obstruction of substance metabolism,and the lack of cellular energy.The associated gene expression are in a state of abnormal increase through negative feedback regulation.The associated gene expression is in a state of abnormal increase through negative feedback regulation.After needle warming moxibustion treatment,the expression of related genes was down-regulated while the syndrome of deficiency of kidney yang was alleviated at the same time.Secondly,before treatment,due to deficiency of yang qi,invasion of exogenous pathogenic factors,rising of vital qi to resist evil and being in a state of fighting between good and evil,some genes expressed,such as those related to immunity.After needle warming moxibustion treatment,the vital Qi recovered,exogenously dispelled,and the gene expression returned to normal;Thirdly,some studies have shown that there is excessive aging and apoptosis of bone tissue in knee joints.Needle warming moxibustion therapy may inhibit p53 induced excessive apoptosis of fine cells by down-regulating the expression of SIAH,thus achieving the therapeutic effect. |
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