Acupotomy ameliorates knee osteoarthritis-related collagen deposition and fibrosis in rabbit skeletal muscle through the TGF-β/Smad pathway

Objective:To investigate the effects of acupotomy on skeletal muscle fibrosis and collagen deposition in a rabbit knee osteoarthritis(KOA)model.Methods: Rabbits(n=18)were randomly divided into control,KOA,and KOA+acupotomy(Apo)groups(n=6).The rabbits in the KOA and Apo groups were modeled using the modified Videman's method for 6 weeks.After modeling,the Apo group was subjected to acupotomy once a week for 3 weeks on the vastus medialis,vastus lateralis,rectus femoris,biceps femoris,and anserine bursa tendons around the knee.The behavior of all animals was recorded,rectus femoris tissue was obtained,and histomorphological changes were observed using Masson staining and transmission electron microscopy.The expression of transforming growth factor-β1(TGF-β1),Smad 3,Smad 7,fibrillar collagen types I(Col-I)and III(Col-III)was detected using Western blot and real-time polymerase chain reaction(RT-PCR).Results: Histological analysis revealed that acupotomy improved the microstructure and reduced the collagen volume fraction of rectus femoris,compared with the KOA group(P=.034).Acupotomy inhibited abnormal collagen deposition by modulating the expression of fibrosis-related proteins and mRNA,thus preventing skeletal muscle fibrosis.Western blot and RT-PCR analysis revealed that in the Apo group,Col-I,and Col-III protein levels were significantly lower than those in the KOA group(both P<.01),same as Col-I and Col-III mRNA levels(P=.0031;P=.0046).Compared with the KOA group,the protein levels of TGF-β1 and Smad 3 were significantly reduced(both P<.01),as were the mRNA levels of TGF-β1 and Smad 3(P=.0007;P=.0011).Conversely,the levels of protein and mRNA of Smad 7 were significantly higher than that in the KOA group(P<.01;P=.0271).Conclusion: Acupotomy could alleviate skeletal muscle fibrosis and delay KOA progress by inhibiting collagen deposition through the TGF-β/Smad pathway in the skeletal muscle of KOA rabbits.

Effects of acupotomy on the activity of osteoclasts and osteoblasts in the subchondral bone of rabbits with early and mid-stage knee osteoarthritis models

Objective:To investigate whether acupotomy could inhibit subchondral bone remodeling in knee osteoarthritis(KOA)rabbits by regulating the activity of osteoblasts and osteoclasts.Methods:KOA rabbits were prepared by immobilization for 6 and 9 weeks by Videman method.Nine groups of rabbits(control,6 weeks and 9 weeks model,6 weeks and 9 weeks acupotomy,6 weeks and 9 weeks electroacupuncture,and 6 weeks and 9 weeks drug groups)received acupotomy,electroacupuncture and risedronate sodium intervention,respectively,for 3 weeks.Results:Acupotomy can inhibit the activity of osteoclasts and osteoblasts in subchondral bone by reducing the proteins expression of cathepsin K(CK)and tartrate-resistant acid phosphatase(TRAP)and decreasing the proteins expression of osteocalcin(OCN)and alkaline phosphatase(ALP),to intercept the abnormal bone resorption and bone formation of subchondral bone in 6-week and 9-week immobilization-induced KOA rabbits.Conclusion:These findings indicated that acupotomy may be more advantageous than risedronate sodium intervention in modulating subchondral bone remodeling in KOA rabbits,especially in 9-week immobilization-induced KOA rabbits.

Clinical Study on the Acupotomy for Iliotibial Band Release in the Treatment of Valgus Knee Osteoarthritis

[Objectives]To observe the clinical effect of acupotomy for iliotibial band release in the treatment of valgus knee osteoarthritis.[Methods]Sixty patients with mild valgus knee osteoarthritis who met the inclusion criteria were randomly divided into control group(n=30)and treatment group(n=30).The control group was treated with celecoxib capsule,and the treatment group was treated with acupotomy.The visual analogue score(VAS),modified American knee society score(KSS)and anatomic valgus angulation(AVA)were observed and compared between the two groups before and after treatment to evaluate the curative effect.[Results]Compared with those before treatment,there were significant differences in VAS and KSS between the two groups after treatment(P<0.05).There was no significant difference in AVA between the two groups before and after treatment.There were significant differences in the above-mentioned indexes between the two groups(P<0.05).The comprehensive curative effect of the treatment group was better than that of the control group(P<0.05),and there was significant difference between the two groups one month after treatment(P<0.05).[Conclusions]The acupotomy for iliotibial band release was effective in the treatment of valgus knee osteoarthritis,and it was found to delay the progression of knee valgus deformity through long-term observation.

Ultrasound guided acupotomy in treating rhomboid muscle and serratus posterior superior muscle injury:a case report

Objective:The study intended to show us the effect and safety associated with ultrasound-guidance during acupotomy treatment by a case report.Methods:The research presented a case study using ultrasound-guided acupotomy in back pain.The study took place in the Department of Acupuncture and Moxibustion,China-Japan Friendship Hospital.A 56-year-old woman with paroxysmal right upper back pain for more than 10 years,who was diagnosed as the rhomboid muscle and serratus posterior superior muscle injury.Results:After two acupotomy treatments,the Visual Analogue Score(VAS)of the patient declined from7 to 2.One month later,the pain disappeared and the patient was satisfied with it.Conclusion:Ultrasound guidance can be used to observe the anatomical structures clearly to improve the safety of acupotomy treatment.

Clinical Study of Acupotomy Trinity Lysis on Cervical Spondylotic Myelopathy with Liver and Kidney Deficiency Syndrome

Objective:To compare the therapeutic effects of acupotomy trinity lysis and traditional acupotomy on cervical spondylotic myelopathy.Methods:A total of 205 patients with cervical spondylotic myelopathy of liver and kidney deficiency syndrome were randomly divided into the experimental group(105 cases)and the control group(100 cases).The experimental group was relaxed with acupotomy in three positions:Heaven(tian),Human(ren)and Earth(di).Traditional acupotomy was used to relax Ashi acupoints of the affected vertebra in the control group.One treatment was conducted in one week,and the duration of one course of treatment was three weeks.The VAS,JOA score and NDI index were observed after treatment.Results:Before and after treatment,the total treatment efficiency of the treatment group was 95.23%,and that of the control group was 80.00%,there was significant difference between the two groups,P<0.05;Before operation,there was no significant difference in JOA score,NDI index score,and VAS score between the treatment group and the control group(P>0.05);there was no significant difference after 1 week(P>0.05),but there were significant differences between the two groups 2 weeks and 3 weeks after operation(P<0.05).Conclusion:Acupotomy trinity lysis is a safe,effective and economical treatment for cervical spondylotic myelopathy.

Clinical Study of Acupotomy Trinity Lysis Combined with Rehabilitation Training for Spastic Paralysis after Stroke

Objective:To study the clinical efficacy of acupotomy trinity lysis combined with rehabilitation training in the treatment of spastic paralysis after stroke,and to provide guidance for clinical diagnosis and treatment.Methods:From July 2019 to November 2020,119 patients with post-stroke spastic paralysis who were admitted to our hospital's encephalopathy department were selected as the research objects,and 61 patients were divided into acupuncture combined with rehabilitation training group as the observation group by random number table method.58 patients were divided into the rehabilitation training group as the control group.After 21 days of treatment,they passed the modified Ashworth Spasm Scale(MAS)grading scale score,Clinical Spasm Index(clinical spasm index,CSI)assessment,Fugl,Meyer exercise function scale(FMA)Score,Modified Barthel Index Score,and compare the clinical efficacy after treatment.Results:After treatment,the total effective rate of the observation group(95.08%)was higher than that of the control group(86.21%),and the difference was statistically significant(P<0.05);Before treatment,the contrast difference of MAS,FMA,CSI scores and modified Barthel index scores of the two groups of patients is not statistically significant;After treatment,the MAS scores and CSI scores of the elbow and knee joints of the observation group[(1.52±0.81)(1.46±0.83)(5.87±2.12)]were significantly lower than those of the control group[(2.17±0.68)(2.03±0.79)(8.36±2.41)];FMA upper limb and lower limb scores and modified Barthel index[(51.87±4.41)(30.21±5.05)(72.41±5.81)]of the observation group were significantly higher than those of the control group[(44.26±4.78)(28.45±4.23)(68.65±6.09)],the difference was statistically significant(P<0.05).Conclusion:Acupotomy trinity lysis combined with rehabilitation training is effective in treating patients with post-stroke spastic paralysis.It provides a safe,reliable and clinically effective new program,which is worthy of popularization and application.

Effects of Acupotomy on Immobilization-Induced Gastrocnemius Contracture and Fibrosis in Rats via Wnt/β-Catenin Signaling

Objective To determine whether acupotomy ameliorates immobilization-induced muscle contracture and fibrosis via Wnt/β-catenin signaling pathway.Methods Thirty Wistar rats were randomly divided into 5 groups(n=6)by a random number table,including control,immobilization,passive stretching,acupotomy,and acupotomy 3 weeks(3-w)groups.The rat model of gastrocnemius contracture was established by immobilizing the right hind limb in plantar flexion for 4 weeks.Rats in the passive stretching group received passive stretching at gastrocnemius,a daily series of 10 repetitions for 30 s each at 30-s intervals for 10 consecutive days.Rats in the acupotomy and acupotomy 3-w groups received acupotomy once and combined with passive stretching at gastrocnemius a daily series of 10 repetitions for 30 s each at 30-s intervals for 10 consecutive days.Additionally,rats in the acupotomy 3-w group were allowed to walk freely for 3 weeks after 10-day therapy.After treatment,range of motion(ROM),gait analysis[i.e.,paw area,stance/swing and maximum ratio of paw area to paw area duration(Max dA/dT)],gastrocnemius wet weight and the ratio of muscle wet weight to body weight(MWW/BW)were tested.Gastrocnemius morphometric and muscle fiber cross-sectional area(CSA)were assessed by hematoxylin-eosin staining.Fibrosis-related mRNA expressions(i.e.,Wnt 1,β-catenin,axin-2,α-smooth muscle actin,fibronectin,and types I and III collagen)were measured using real-time quantitative polymerase chain reactions.Wnt 1,β-catenin and fibronectin concentrations were measured by enzyme-linked immunosorbent assay.Types I and III collagen in the perimysium and endomysium were analyzed using immunofluorescence.Results Compared with the control group,ROM,gait function,muscle weight,MWW/BW and CSA were significantly decreased in the immobilization group(all P<0.01),while protein levels of types I and III collagen,Wnt 1,β-catenin,fibronectin and mRNA levels of fibrosis-related genes were obviously increased(all P<0.01).Treatment with passive stretching or acupotomy restored ROM and gait function and increased muscle wet weight,MWW/BW and CSA(all P<0.05),while protein expression levels of Wnt 1,β-catenin,fibronectin,types I and III collagen and mRNA levels of fibrosis-related genes were remarkably declined compared with the immobilization group(all P<0.05).Compared with passive stretching group,ROM,gait function,MWW was remarkably restored(all P<0.05),and mRNA levels of fibrosis-related genes as well as protein expression levels of Wnt 1,β-catenin,fibronectin,types I and III collagen in the acupotomy group were obviously decreased(all P<0.05).Compared with the acupotomy group,ROM,paw area,Max dA/dT,and MWW were restored(all P<0.05),and mRNA levels of fibrosis-related genes along with protein levels of Wnt 1,β-catenin,fibronectin,types I and III collagen in the acupotomy 3-w group were decreased(P<0.05).Conclusion Improvements in motor function,muscle contractures,and muscle fibrosis induced by acupotomy correlates with the inhibition of Wnt/β-catenin signaling pathway.

Delphi study for developing a checklist of adverse events associated with acupotomy

Background Acupotomy,a more invasive procedure than acupuncture,involves the use of a thicker needle with an integrated knife at the tip,necessitating safety research.We aimed to define relevant adverse events(AEs)and create a standardized form of the ACUPOtomy-related AEs CHECKlist(ACUPOCHECK).Methods Before conducting the Delphi process,a systematic review and pilot prospective study were conducted to gather information on previously reported AEs.Using these data,pilot versions of the ACUPOCHECK and Delphi questionnaires were developed.The Delphi questionnaire involved selecting types of AE for inclusion,establishing separate criteria for acupotomy-related AEs,and achieving a consensus on AE assessment.Thirteen Korean doctors with experience in acupotomy or AE research were recruited to participate in each Delphi round.Consensus was considered to have been reached if the critical value for the content validity ratio met or exceeded 0.538.Results The final ACUPOCHECK was developed using four rounds of the Delphi method and one face-to-face consensus meeting.It included 12 local AEs(pain,hemorrhage,bruise,hematoma,edema,pruritus,rash,infection,nerve damage,dysesthesia,movement impairment,and pneumothorax)and 14 systemic AEs(disease aggravation,needle fatigue,sleepiness,procedural nausea,procedural vomiting,procedural headache,procedural dizziness,sweating,procedural shock,syncope,dyspnea,procedural pain,sleep disorder,and postprocedural infection).Separate criteria were established for pain,hemorrhage and bruising:pain was defined as pain that occurrs during daily activities and persists for longer than 72 h,hemorrhage as bleeding that continues for≥3 min despite pressure application,and bruising as having a bruise with a diameter of≥3 cm.Open-ended descriptions were allowed for AEs not covered by the checklist,and severity and causality were assessed using the Common Terminology Criteria for Adverse Events and modified World Health Organization-Uppsala Monitoring Center criteria.Conclusion ACUPOCHECK provides a standardization framework that can help research on traditional practices as well as new tools and techniques that are more invasive and may cause more severe AEs.Subsequent studies will use ACUPOCHECK to develop rational safety guidelines for acupotomy techniques.

Promotion and Mechanism of Acupotomy on Chondrocyte Autophagy in Knee Osteoarthritis Rabbits

Objective:To explore the effect of acupotomy intervention on autophagy of chondrocytes in rabbits with knee osteoarthritis(KOA),and to determine the possible mechanisms of acupotomy to alleviate cartilage degeneration.Methods:The modified Videman method was used to construct a KOA rabbit model.After modeling,40 rabbits were randomly divided into 4 groups by a random number table:control;KOA(model);KOA+acupotomy(acupotomy),and KOA+sham acupotomy(sham),10 in each group.After a 3-week treatment course,the knee joint activity was determined by the modified Lequesne MG index.Hematoxylin-eosin staining staining was used to examine the morphological changes of chondrocytes.Autophagy of chondrocytes was observed by transmission electron microscopy.The surface morphology of cartilage tissue was observed by scanning electron microscope.The mRNA and protein levels of AMP kinase/mammalian target of rapamycin/Unc-51(AMPK/mTOR/ULK1)signal pathway key proteins,autophagy-related factor Beclin-1 and microtubule-associated protein 1A/1B light chain 3(LC3)in rabbit knee cartilage were assessed by real-time fluorescence quantitative polymerase chain reaction and Western blot,respectively.Results:The modified Lequesne MG score of acupotomy group was significantly lower than that of model group(P<0.05).Pathological results showed that chondrocyte autophagy decreased and cartilage surface was rough in the model group,which recovered after acupotomy treatment.The mRNA expressions of AMPK,ULK1,Beclin-1 and the protein levels of p-AMPK,p-ULK1,Beclin-1,and LC3Ⅱ/LC3Ⅰwere decreased in the model group,while the mRNA and protein expressions of mTOR were increased(P<0.01).However,acupotomy treatment reversed these abnormal changes(P<0.05).Conclusions:Acupotomy could effectively up-regulate the expressions of AMPK,ULK1 and Beclin1,reduce the expression of mTOR,promote autophagy,and alleviate joint degeneration.Acupotomy is a promising complementary and alternative therapy for KOA.

Effect of ultrasound-guided acupotomy vs electro-acupuncture on knee osteoarthritis:a randomized controlled study

OBJECTIVE:To investigate the effect of acupotomy on knee osteoarthritis(KOA),compared to electro-acupuncture(EA).METHODS:Sixty KOA patients were randomly divided into 2 groups:ultrasound-guided acupotomy group and EA group;each had 3 weeks' therapy.After the treatment,by contrast before and after therapy,by comparing curative effects among groups,we looked into disease improvement degree through activities of daily living score(ADL),hospital for special surgery index(HSS),visual analogue scales score(VAS) and knee joint's infrared thermal imaging detection.RESULTS:Graded by ADL,the excellent rate in acupotomy group was much higher than EA group;both acupotomy group and EA group had obviouschanges in HSS index before and after the therapy(P < 0.01).And there was remarkable difference in HSS index variation between the groups(P < 0.01).Acupotomy group and EA group showed big difference in pain index before and after treatment(P <0.01).Apparent difference also existed in the comparison among groups(P < 0.01).Both acupotomy group and EA group had apparent changes in infrared thermal imaging detection before and after the treatment(P < 0.01).CONCLUSION:Acupotomy and EA both have significant effects in KOA treatment;the former is better than the latter in relieving pain and improving knee functions.

Effect of acupotomy on nitric oxide synthase and beta-endorphin in third lumbar vertebrae transverse process syndrome model rats

OBJECTIVE： To explore the long-term effects and pain relief mechanism of acupotomy by observing changes in nitric oxide synthase （NOS） and beta-en- dorphin （~3-EP） in the hypothalamus, spinal cord, and peripheral blood of rats with third lumbar ver- tebrae （L3） transverse process syndrome. METHODS： Twenty-eight SD rats were randomly as- signed to normal, model, electroacupuncture （EA）, and acupotomy group. The last three groups were put through an operation to emulate L3 transverse process syndrome. Fourteen days after the simulation operation, EA and acupotomy treatments were applied to the respective groups. Fifty-six days afterthe simulation operation, biochemistry tests and enzyme-linked immunosorbent assay were used to measure NOS and 13-EP in the hypothalamus, spinal cord, and peripheral blood. RESULTS： Rats with the simulation operation showed significantly higher levels of NOS and II3-EP in the hypothalamus, spinal cord, and peripheral blood than those in the normal group. The EA and acupotomy groups had significantly lower levels of NOS and β-EP than those in the model group. There was no statistical difference between the EA and acupotomy groups. CONCLUSION： EA and acupotomy treatments significantly lowered NOS and β-EP levels in the hypothalamus, spinal cord, and peripheral blood and alleviated L3 transverse process syndrome.

A randomized controlled trail on the treatment of knee osteoarthritis with acupotomy therapy based on the meridian sinew theory

Objective: To compare the clinical efficacy differences of acupotomy therapy guided by the meridian sinew theory and acupotomy therapy guided by the anatomy theory of western medicine in the treatment of knee osteoarthritis.Methods: Sixty-three patients were randomly divided into the acupotomy group of the meridian sinew theory(Group A, n = 32) and the acupotomy group of the anatomy theory(Group B. n = 31). For Group A, with positive reaction points such as the tenderness points of three yang meridians and three yin meridians of the foot, and funicular nodules as the points of needle insertion, the needle-knife, after disinfection and anesthesia, gives priority to longitudinal dissection after insertion, and then carries out subcutaneous sweeping maniplation. For Group B, with 8 points for needle insertion, including the origins and terminations of the medial and lateral collateral ligaments, the origins and terminations of the patellar ligament, the terminations of the quadriceps femoris tendon, and pes anserinus bursa point, the treatment was performed in strict accordance with the four-step procedures of acupotomy(positioning,orientating, pressurizing to separate, and puncturing) after disinfection and anesthesia. The treatment was conducted once a week and three times in total. Statistical analysis was conducted with the Western Ontario and McMaster Universities(WOMAC) Osteoarthritis Index and Visual Analogue Scale(VAS)for overall pain before treatment and at week 2 and 4 during treatment, and the adverse reactions of patients were observed and recorded to evaluate the curative effect.Results: During the treatment period, the overall response rates(ORRs, that is markedly effective + effective) were compared between the two groups. The ORR of Group A was 90.63% and that of Group B was 87.09%. There was no statistical significant difference between the two groups(P>0.05).After treatment, the WOMAC function score of Group A was significantly lower than that before treatment(17.28 ±10.22 vs 32.75 ± 14.88, P <0.001), and that of Group B was lower than that before treatment(24.87 ±16.48 vs 30.90 ±16.64, P< 0.05). there was a statistical significant difference between the two groups(P<0.05). As for the comparison of VAS pain scores, in Group A, there was statistical significant difference(4.48 ± 1.60 vs 5.05 ± 1.60. P< 0.05) between at Week 2 and before treatment, and statistically significant difference(1.88 ± 1.03 vs 5.05 ± 1.60, P<0.001) between at Week 4 and before treatment.In Group B, there was no significant difference(P>0.05) between at Week 2 and before treatment, and there was statistically significant difference(3.31 ± 1.56 vs 4.77 ± 1.68, P<0.001) between at Week 4 and before treatment. The VAS pain score of Group A was significantly lower than that of Group B(P< 0.001),and 2 cases of mild adverse reactions occurred in Group A and 3 in Group B.Conclusion: Both acupotomy therapies guided by the meridian sinew theory and by the anatomy theory of Western medicine have good curative effect on knee osteoarthritis, but acupotomy guided by the meridian sinew theory has more superiorities in operability, safety and effectiveness, which is easy to be generalized in grass-roots and community hospitals.

Influence of acupotomy loosing on IL-6, IL-10 and TNF-α in synovial fluid of rheumatoid arthritis patients with elbow joint stiffness

Objective： To compare differences of acupotomy loosing combined with medication treatment, electroacupuncture combined with medication treatment and simple medication treatment in effects on rheumatoid arthritis patients with elbow joint stiffness and investigate the anti-inflammatory mechanism of the acupotomy loosing.Methods： A total of 60 cases of rheumatoid arthritis（RA） patients with elbow joint stiffness were randomly assigned into the group receiving acupotomy loosing（group A）, group with electroacupuncture（group B） and the one undergoing medication treatment（group C） with 20 cases for each group. Based on the medication treatment, all patients underwent continuous oral administration with Methotrexate（MTX）, Leflunomide（LEF） and Bitongding capsules for 3 weeks. And no other treatments were given to group C. In addition to medications treatment, the electroacupuncture was performed in group B. The acupoints of Tianzhu（天柱 BL 10）,DAzhui（大椎 GV 14）; Fengchi（风池 GB 20）,Quchi（曲池 LI 11）,Quze（曲泽 PC 3）,Chize（尺泽 LU 5）, Shousanli（手三里 LI 10）, Xiaohai（小海 SI 8）, Shaohai（少海 HT 3）, Tianjing（天井 TE 10）,Qinglengyuan（清冷渊 TE 11） and Hegu（合谷 LI 4） in the affected side were selected. A pair of electrodes were connected to LI 11 and LI 10, and another pair of electrodes were connected to PC 3 and LU 5, and the continuous wave with frequency of 2 Hz was designed, the needle retention for 30 min was performed, and the acupuncture was performed for 6 times per week with 3 weeks for one course,and there was one course totally. Besides the medication treatment, group A underwent the acupotomy loosing therapy. The tender point in lateral elbow joint, etc. were taken as the treatment point, and 6-8 treatment points being taken for each time, and longitudinal dredging and transverse exfoliation were conducted for 2-3 times with the acupotomy. The treatment was given for one time per week with three weeks for one course, and there was one course totally. The changes of maximum angle of active extension position, maximum angle of active flexion position and range of motion were observed, and levels of IL-6, IL-10 and TNF-a in affected synovial fluid of elbow joint were tested before the treatment and 2 weeks after the treatment in the groups.Results： ① Compared with those before treatment, the maximum angle of active extension position were smaller, the maximum angle of active flexion position were larger and the range of motion were wider of the affected elbow joints of the patients in the 3 groups on the 2 weeks after the treatment.There were statistical significances for the differences（All P 0.05）. Two weeks after the treatment,as compared with those in group C, the affected elbow joint for patients in the group B and group A was smaller in maximum angle of active extension position, larger in maximum angle of active flexion position and wider in range of motion and there were statistical significances for the differences（All P 0.05）. Comparing with those in the group B, the affected elbow joint for patients in the group A was smaller in maximum angle of active extension position, larger in maximum angle of active flexion position and wider in range of motion and there were the statistical significances for the differences（All P 0.05）. ② Compared with those before treatment, the levels of TNF-a and IL-6 were lower and the level of IL-10 was higher of the 3 groups on the 2 weeks after the treatment. There were the statistical significances for the differences（All P 0.05）. For 2 weeks after the treatment, compared with those in the group C, group B and group A were lower in levels of TNF-α and IL-6 and higher in level of IL-10 and there were the statistical significances for the differences（All P 0.05）. As compared with those in the group B, group A was lower in levels of TNF-a and IL-6 and higher in level of IL-10 and there were the statistical significances for the differences（All P 0.05）.Conclusions： The combination of acupotomy loosing can improve the maximum angle of active extension position, maximum angle of active flexion position and range of motion in affected elbow joint for RA patients with elbow joint stiffness, whose efficacy was superior to single basic treatment and electroacupuncture combined with basic treatment. Meanwhile, the levels of proinflammatory cytokines,such as TNF-α and IL-6 can be decreased, and the level of anti-inflammatory cytokines, such as IL-10 can be increased, playing a role in regulating the imbalance between proinflammatory cytokines and anti-inflammatory cytokines in RA patients, which may be one of mechanisms regarding treating RA and improving the range of motion for stiff joints.

Current Usage of Terminologies Related to Acupotomy: A Literature Research and Standardization Suggestion

Objective: To investigate the current usage of terminologies related to acupotomy through systematic search and analyze the pros and cons of each for proposing a standard terminology. Methods: Seven medical journal databases were searched including PubMed, EMBASE, Cochrane Central Register of Controlled Trials, China National Knowledge Infrastructure, Oriental Medicine Advanced Searching Integrated System, KoreaMed, and Korean studies Information Service System using 10 candidate terminologies as searching terms. All studies published from their inception to July 26, 2017 were collected. Articles were included if the title stated one of the 10 candidate terminologies consistent with the definition of acupotomy. Priorly established frequency and consistency of each candidate terminology from medical databases were calculated and evaluated. Moreover, the pros and cons of each were analyzed to propose a standard terminology. Results: A total of 112 studies in English databases, 1,129 studies in Chinese database, and 44 studies in Korean databases were included. The most frequently used terminologies were needle knife(35.71%), acupotomy(48.54%) and acupotomy(90.90%) in English, Chinese and Korean database, respectively. Overall, acupotomy and needle knife were the most frequently used. Others like acupotomology, needle scalpel, miniscalpel acupuncture and miniscalpel needle were used within 10% of the total searched literature. Acupotome, stiletto needle, sword like needle, and Xiaozhendao were rarely used. Acupotomy had the advantages of high frequency and consistency but lacked representativeness. Needle knife also showed a high frequency, but the consistency was poor. Though miniscalpel acupuncture and miniscule needle were used less frequently, they had advantages of inclusiveness and clarity. Conclusions: A debate for standardization of the terminology is necessary. This preliminary research can provide a basic outline for the standardization consensus process, and we believe it is noteworthy to discuss miniscalpel needle and miniscalpel acupuncture along with acupotomy and needle knife on the subject.

Acupotomy combined with fire needle for sacral nerve dysfunction syndrome:A randomized,single-blind clinical trial

Objective： To provide the clinical evidence to evaluate the feasibility and refine the protocol for acupotomy combined with fire needle and pudendal nerve block therapy in treatment of sacral nerve dysfunction syndrome（SNDS）. Methods： Seventy-five patients with SNDS were randomized into the treatment group（acupotomy and fire needle and pudendal nerve block therapy） and the control group（pudendal nerve block therapy）. After a course of treatment, Visual Analogue Scales（VAS） of anorectal pain, defecation disorders, anal incontinence, VAS of lumbar pain or soreness, VAS of abdominal distension and pain were compared before and after the treatment. Result： Scores of defecation disorders, including defecation interval time index, defecation time index, fecal property index and defecation difficulty index, of patients with SNDS in the two groups were statistically different before and after the treatment in the same group（all P〈0.05）, but the differences of those indexes between two groups were not statistically significant（all P〈0.05） after the treatment,. Scores of anal incontinence, VAS scores of lumbar pain or soreness, VAS scores of abdominal pain and distension in the two groups were statistically different before and after the treatment（all P〈0.05）. However, after treatment, the differences between two groups were not statistically significant（all P〈0.05）. VAS scores of anorectal pain in the two groups were statistically different before and after the treatment（both P〈0.05）, and that of the treatment group was statistically lower than control group after the treatment（1.61 ± 0.95 vs. 3.04 ± 1.81, P〈0.01）, the total effective rate of the treatment group was higher than that of the control group, and the difference was statistically significant（94.74% vs. 81.08%, P〈0.01）, there was no difference in self-evaluation between the two groups（P〈0.05）. Conclusion： In treating SNDS, acupotomy combined with fire needle and pudendal nerve block therapy can more effectively alleviate anorectal pain and improve the total effective rate.

Acupotomy combined with thunder-fire wonder moxibustion for 165 cases of calcaneodynia

Objective： To observe the clinical efficacy of acupotomy combined with thunder-fire wonder moxibustion for calcaneodynia. Methods： Acupotomy combined with thunder-fire wonder moxibustion was applied in 165 cases of calcaneodynia on single foot. Acupotomy was used to the releasing and stripping at the local tender point of the affected heel. Thunder-fire wonder moxibustion was carried out around the incision after the acupotomy. After treatment for once, the patients were asked to visit to hospital again after 1 week to observe the curative effect. If the symptom disappeared, the treatment can be terminated. If not, the treatment for another time was conducted. Treatment should not be performed for more than 3 times. Results： A total of 25 patients were cured after treatment for once, accounting for 15.2%（25/165） of the whole. A total of 105 patients were cured after treatment for 2 times, accounting for 63.6%（105/165） of the whole. A total of 20 patients were cured after treatment for 3 times, accounting for 12.1%（20/165） of the whole. A total of 15 patients were ineffective after treatment for 3 times, accounting for 9.1%（15/165） of the whole. The total cure rate was 90.9%. Conclusion： Acupotomy combined with thunder-fire wonder moxibustion for calcaneodynia has definite effect, which is worthy of clinical popularization and application.

Safety of acupotomy in a real-world setting:A prospective pilot and feasibility study

Objective:Acupotomy is a modern acupuncture method that includes modern surgical methods.Since acupotomy is relatively more invasive than filiform acupuncture treatment,it is important to establish the safety profile of this practice.To justify further large-scale prospective observational studies,this preliminary study was performed to assess the feasibility of the approach and investigate the safety profile and factors potentially associated with adverse events(AEs).Methods:This was a prospective pilot study that assessed the feasibility of a large-scale forthcoming safety study on acupotomy treatment in a real-world setting.The feasibility(call response rate,dropout rate,response rate for each variable and recruitment per month)and safety profile(incidence,type,severity and causality of AEs,and factors potentially associated with AEs)were measured.Results:A total of 28 participants joined the study from January to May 2018.A follow-up assessment was achieved in 258(1185 treatment points)out of 261 sessions(1214 treatment points).The response rate via telephone on the day after treatment was 87.3%.There were 8 systemic AEs in all the sessions(8/258;3.11%)and 27 local AEs on the total points treated(27/1185;2.28%).Severe AEs did not occur.Total AE and local AE occurrence were associated with blade width and the number of needle stimulations per treatment point.Conclusion:The findings suggest that it could be feasible to analyze the safety of acupotomy in a realworld setting.Moreover,the primary data on some relevant AEs could be determined.We are planning large-scale prospective studies based on these findings.Trial registration:Clinical Research Information Service(CRIS)KCT0002849(https://cris.nih.go.kr/cris/search/detailSearch.do/11487).

Observation of clinical therapeutic effect of different techniques of acupotomy on coracoid pain of frozen shoulder

Objective:To explore the manipulation techniques of acupotomy in treatment of coracoid pain of frozen shoulder.Methods:A total of 60 patients with coracoid pain of frozen shoulder were collected.The randomized double-blind controlled method was adopted.Using random number table,the patients were divided into two groups,named a treatment group and a control group,30 cases in each one.In the treatment group,the pricking technique of acupotomy was adopted.In the control group,the traditional dissection technique of acupotomy was used.The duration of treatment was 5 weeks.Acupotomy was given once a week.At the end of treatment,pain index(visual analogy scale,VAS)and the therapeutic effect index were used to evaluate the therapeutic effect.Results:Before treatment,the average VAS score was 8.31±0.84 in the treatment group and it was 8.14±0.24 in the control group.After treatment,the average VAS score was 0.01±0.89 in the treatment group and it was 0.10±1.01 in the control group.The difference was significant before and after treatment in the patients of the two group(both P<0.05).The difference before and after treatment was not significant between the two groups.The effective rate was 100%and the remarkably effective rate was100%in either the treatment group or the control group.Conclusion:The pricking technique of acupotomy achieves the same therapeutic effect on coracoid pain of frozen shoulder as compared with the dissection technique,which suggests that the dissection technique is not the indispensable manipulation in the treatment of the disease.The pricking technique of acupotomy brings a smaller wound,less medical damage in,less suffering in patients and quicker recovery of wound,as well as quicker remission of pain after acupotomy.Such modified method of acupotomy is more significant in practice.However,a further research is suggested for the pathological mechanism of frozen shoulder.

Effect of holistic stratification acupotomy on lower limb function,MMP1 and MMP13 in bursal fluid of patients with knee osteoarthritis:A randomized clinical trail

Objective:To observe the differences in clinical effect on knee osteoarthritis(KOA)between the holistic stratification acupotomy and the joint injection with sodium hyaluronate so as to provide a safe and effective treatment for KOA.Methods:A total of 100 KOA patients were randomly divided into an acupotomy group and a sodium hyaluronate group,50 patients in each one.In the acupotomy group,the holistic stratification acupotomy was adopted.In the sodium hyaluronate group,sodium hyaluronate injection was applied in the joints.The index of Western Ontario and McMaster University(WOMAC)and the expressions of MMP1 and MMP13 in bursal fluid of the patients were compared before and after treatment in the patients between two groups before and after treatment,and the clinical therapeutic effect was observed.Results:After treatment,WOMAC score of each dimension and the concentrations of MMP1 and MMP13 in bursal fluid of the patients of either group were all lower than those before treatment(all P<0.05).After treatment,WOMAC score of each dimension and the concentrations of MMP1 and MMP13 in bursal fluid in the acupotomy group were lower than the sodium hyaluronate group(all P<0.05).The total effective rate in the acupotomy group was higher than that of the sodium hyaluronate group(P<0.05).Conclusion:Both the holistic stratification acupotomy and the joint injection with sodium hyaluronate are effective on KOA in this trial.However,the therapeutic effect of holistic stratification acupotomy is remarkable,which is probably related to the improvements in inflammatory response.

Applied anatomy of intrusive operations of lumbar intervertebral foramen

Objective:To provide anatomical datum for intrusive operations of lumbar intervertebral foramen,especially that using acupuncture-knife as intrusive tool.Methods:To dissect 10 antisepsis cadavers and observe the exposed blood vessels,ligaments,nerves and their adjacent relations in L1/2~L5/S1intervertebral foramen.Results:Lumbar intervertebral foramen exit zones were almost sealed by nerves and blood vessels.There were two zones with relatively no blood vessel and nerve(triangular working zones)located in the midpoint of the distance between two adjacent roots of transverse processus,and clung to lamina of vertebral arch,and they were also found upon the margo superior of the root of transverse processus,but the ascending lumbar vein or(and)the rami anastomoticus between the remi inferior of intervertebral vein and lumbar veins were observed in 12%triangular working zones upon the margo superior of root of transverse processus.Conclusions:"Triangular working zone"was relatively avascular zone.Pay attention to the possibilty of presence of blood vessels on the entrance passage of intrusive operations on lumbar side rear.The needlepoint should be pierced at the midpoint of the distance between two adjacent roots of transverse processus and cling to the outer edge of lamina of vertebral arch when doing the foraminal lumbar puncture.As lumbar intervertebral foramina exit zone was almost sealed by nerves and blood vessels,blind incising and debonding with acupuncture-knife in this area was relatively much more dangerous.