Influence of moxibustion at “Shènshù” (肾俞 BL 23) and “Zúsānlǐ ” (足三里 ST 36) on Ras-MAPK signal pathways in synovial tissues of rats with experimental rheumatoid arthritis

Objective To observe influence of moxibustion at ＂Shenshu＂ （肾俞BL 23） and ＂Zusanli＂ （足三里 ST 36） on proteins expression of Ras, ERKI/2, and Raf in synovial tissues in rats with rheumatoid arthritis （RA） to elucidate molecular mechanisms of moxibustion on treating RA. Methods Thirty Wistar rats were randomly divided into a normal control group （Group Cont）, a model group （Group Mod） and a moxibustion group （Group Mox） with 10 rats in each group. The model was established by using both environmental factors such as wind, cold and damp and a biological factor （Freund＇s complete adjuvant）. Suspended moxibustion was applied at bilateral BL 23 and ST 36 for 20 min, applied once daily for 15 days, starting from the 3rd day after modeling. Volumes of metaleg digiti pedis on the right side were measured before, after and 15 days after modeling. Protein expressions of Ras, ERK 1/2, p-ERKI/2 and Raf in synovium tissues were detected by western blot. Results After modeling, volumes of metaleg digiti pedis on the right side were significantly enlarged, compared with those of rats in Group Cont （P〈0.01）. After treatment by moxibustion for 15 days, the metatarsale girth of metaleg digiti pedis on the right side in Group Mox was significantly reduced, compared with that in Group Mod （P〈0.01）. Protein expressions of Ras, Raf, ERK1/2 and p-ERK1/2 in Group Mod were significantly increased, compared with those in Group Cont （P〈0.01） and Group Mox （P〈0.01）. Protein expressions of Ras, Raf, ERK1/2 and p-ERK1/2 in Group Mox were significantly lowered, compared with those in Group Mod （all P〈0.01）. Conclusions Moxibustion can suppress excessive protein expressions of Ras, Raf and ERK1/2 in synovium tissues of rats with experimental RA to inhibit abnormal activation of Ras-MAPK signal Pathway, which may be one of the molecular mechanisms of moxibustion in alleviating synovitis.

Professor Yan Jun-bai's experience in treating rheumatic arthritis with suppurative moxibustion

To summarize the clinical experience of Prof. Yan Jun-bai in treating rheumatic arthritis （RA） with suppurative moxibustion and aim to guide acupuncture treatment for RA. Prof. Yan believes that contributing factors of RA include external contraction of pathogenic factors, obstructed flow of qi and blood, internal phlegm-turbidity （due to deficiency of healthy qi or improper diet）, and obstruction or malnourishment of meridians. As a result, the treatment strategies are to warm yang, remove pathogenic factors, and tonify the liver, spleen and kidney. Suppurative moxibustion is a reliable therapy for RA.

Experimental study on the effect of different moxibustion durations on rats with rheumatoid arthritis

Objective： To observe the effect of different moxibustion durations on rats with rheumatoid arthritis（RA） and to evaluate the relationship between moxibustion amount and moxibustion efficacy. Methods： Eight rats were randomly selected as a normal group from the 40 male Sprague-Dawley（SD） rats, and the other 32 rats were used to establish type Ⅱ collagen-induced RA models. After successful modeling, the 32 rats were randomly divided into a model group, a moxibustion for 20 min group, a moxibustion for 40 min group and a moxibustion for 60 min group, with 8 rats in each group. Rats in the normal group did not receive modeling and moxibustion intervention; rats in the model group did not receive moxibustion after modeling; rats in the moxibustion for 20 min group, the moxibustion for 40 min group and the moxibustion for 60 min group were treated with moxibustion at Shenshu（BL 23） and Zusanli（ST 36） for 20 min, 40 min and 60 min, respectively. Six days were a course of treatment, with a total of 3-course treatments and a 1-day rest between the courses of treatment. After treatment, the serum levels of interleukin（IL）-1β and tumor necrosis factor（TNF）-α, arthritis index（AI） scores, toe volumes and pathological score of synovitis were evaluated in the rats. Results： Compared with the normal group, the serum IL-1β and TNF-α levels, and the toe volumes in the model group were increased, and the differences were statistically significant（P〈0.01）, before the treatment. Compared with the model group, the serum IL-1β and TNF-α levels, toe volumes and arthritis index（AI） scores were significantly decreased in the moxibustion for 20 min group, the moxibustion for 40 min group and the moxibustion for 60 min group（P〈0.05 or P〈0.01）. Compared with the moxibustion for 20 min group and the moxibustion for 60 min group, serum IL-1β and TNF-α levels, toe volumes and AI scores were decreased more significantly in moxibustion for 40 min group, and the differences were statistically significant（P〈0.05 or P〈0.01）. There were no significant differences in serum IL-1β and TNF-α levels, AI scores and toe volumes between the moxibustion for 20 min group and the moxibustion for 60 min group（all P〈0.05）. The synovial histopathological improvement was the most obvious in the moxibustion for 40 min group, when the synovial histopathological changes were compared among the moxibustion for 20 min group, moxibustion for 40 min group and moxibustion for 60 min group. Conclusion： The therapeutic efficacy of moxibustion for 40 min in RA rats was more significant than that of moxibustion for 20 min and moxibustion for 60 min, indicating that the duration of moxibustion is the main factor affecting its therapeutic efficacy.

Therapeutic Effect Evaluation of Acupuncture and Chinese Patent Medicine on Rheumatoid Arthritis

Objective： To evaluate the therapeutic effect of combining use of acupuncture and drugs on rheumatoid arthritis（RA） in the early and the active stages of by the imaging of bone and joint with ^99m TC-methlene diphosphate（MDP）. Methods： 102 cases of RA in the early and the active stages were randomly allocated into the compound Fengshining group （Group A）, acupuncture group（Group B）, and compound Fengshining plus acupuncture group（Group C）. They were treated for 30 days. All patients were examined before treatment and after treatment by ^99m TC-MDP imaging of the whole body, hands and feet, and analyzing method of random interested region was used to count the ratio of radioactivity in the affected area of RA to radioactivity in adjacent normal bone（T/TN）. Meanwhile, joint swelling index, joint tenderness index, morning stiffness, gripping force, and erythrocyte sedimentation rate （ESR） were also observed. Results： T/TN of the Group A after treatments had no significant difference comparing with that before treatment（t = 1.35, P〉0.05）, while the Group B and C had significant differences（t = 5.31, t=8.97, P〈0.01）. The changes of clinical and experimental examination in the Group C had more significant differences than those in the Group A and B（P〈0.05）. Conclusion： Acupuncture therapy could promote RA recovery, and combining use of acupuncture and compound Fengshining had better effect.

Clinical observation of warm needling moxibustion for rheumatoid arthritis

Objective： To observe the clinical efficacy of warm needling moxibustion at points on the back in treating rheumatoid arthritis （RA）. Methods： Sixty RA patients were randomized into two groups by the random number table, 30 in each group. The observation group was intervened by warm needling moxibustion at the points from the Governor Vessel on the back and Jiaji （EX-B 2） points, while the control group was by regular acupuncture. Results： After intervention, the morning stiffness, joint pain index, joint swelling index and erythrocyte sedimentation rate （ESR） were significantly improved in both groups （P〈0.01）; the inter-group difference was also statistically significant （P〈0.05）. The total effective rate was 93.3% in the observation group versus 76.6% in the control group, and the difference was statistically significant （P〈0.01）. Conclusion： Warm needling moxibustion at points from the Governor Vessel on the back and Jiaji （EX-B 2） points can produce a higher efficacy than regular acupuncture in treating RA.

Effects of different moxibustion times on TRPV3 ion channel protein and synovial cell apoptosis in rats with rheumatoid arthritis

Objective： To observe the effects of different moxibustion times on proteins of transient receptor potential vanilloid 3 （TRPV3） ion channel protein and synovial cell apoptosis in rats with rheumatoid arthritis （RA）, to provide a new basis for the anti-inflammatory mechanism of moxibustion. Methods： A total of 50 Sprague-Dawley （SD） rats were divided into a normal group, a model group, moxibustion group Ⅰ, moxibustion group Ⅱ and moxibustion group III by complete randomization, with 10 rats in each group. Rats in the normal group were bred routinely, and rats in the model group were also bred routinely after successful modeling. After successful modeling, rats in moxibustion group I, Ⅱ and Ⅲ accepted consecutive moxibustion at Zusanli （ST 36） and Shenshu （BL 23） for 15 d, once a day, respectively 5 min, 20 min and 30 min for each session. The degree of paw edema was observed and recorded. Immunohistochemical assay was used to detect the protein expression of TRPV3 ion channel in dorsal root ganglia and spinal cord dorsal horn. Terminal-deoxynucleoitidyl transferase-mediated nick end labeling （TUNEL） was used to detect apoptotic synovial cell number. Results： At the end of treatment, paw circumference of rats in moxibustion groupⅡ and Ill were significantly reduced as compared with that in the model group （P〈0.05）. TRPV3 ion channel protein expression of dorsal root ganglia and spinal cord dorsal horn was higher in the model group than that in the normal group （P〈0.05）; the TRPV3 ion channel protein expressions of dorsal root ganglia and spinal cord dorsal horn in moxibustion group [[ and []I were higher than that in moxibustion group Ⅰ （P〈0.05）; apoptotic synovial cell number in the model group was larger than that in the normal group （P〈0.05）, and apoptotic synovial cell numbers in moxibustion group Ⅱ and Ⅲ were significantly higher than that in the model group （P〈0.05）. Conclusion： Moxibustion of appropriate time could induce TRPV3 expression, and promote svnovial cell apoptosis.

Progress of Mechanism Study on Rheumatoid Arthritis Treated by Moxibustion

Objective： There is a better therapeutic effect in the treatment of rheumatoid arthritis by moxibustion, doing a literature review to explore the mechanism in the treatment of rheumatoid arthritis by moxibusfion. Methods： The literature on the treatment of rheumatoid arthritis in the recent ten years were categorized and analyzed. Results and Conclusion： Mainly by its anti-inflammatory and immune effects, moxibustion therapy can be supposed to improve immune functions, inhibit the secretion of the synovial cells factors in the joints, control the proliferation of the synovial cells, and induce apoptosis of the synovial cells in the synovitis, and promote the apoptosis of the fibroblast, so as to play a therapeutic role in the treatment of rheumatoid arthritis. The therapeutic effect is obtained by the comprehensive effect created from integration between the physical factors and herbal factors in burning moxa wool and the special functions of the acupoints and meridians.

Effect of Moxibustion on IL-1β and IL-2 in Rat Models of Rheumatoid Arthritis

Objective： To observe the influence on IL-1β and IL-2 in rat models with rheumatoid arthritis after moxibustion on Shenshu （BL 23） and Zusanli （ST 36） points, and to discuss the mechanism of moxibustion. Methods： Fifty male Wistar rats were divided randomly into 5 groups, control group, model group, drug group, moxibustion group, and laser group, 10 for each. Four groups except the normal group were built on the model of rheumatoid arthritis. The changes of body weight and plantar circumference were measured and the level of IL-1β, IL-2 in sera were examined by ELISA. Results： Compared with the model group, the weight and plantar circumference of rats in the moxibustion group were improved significantly after treatment （P〈0.01）, and the improvement of plantar circumference also had significant differences compared with the drug group and the laser group （P〈0.05）. The level of IL-1β, IL-2 in sera were down regulated in the moxibustion group and the laser group, which had statistical differences compared with the model group （P〈0.05）, but no statistical differences were found when comparing with the drug group. Conclusion： Moxibustion obviously improves the toe tumefaction of the rats with rheumatoid arthritis, which is better than CO2 laser of 10.6μm. On the aspect of decreasing the amount of IL-1β, IL-2, CO2 laser of 10.6μm is similar with moxibustion.

Effect of Moxibustion Therapy on the Serumal Intercellular Cell Adhesion Molecule and the Histopathology of Experimental Arthritis in Rats

Objective： To observe the effects of moxibustion therapy at Shenshu （BL 23） and Zusanli （ST 36） of rats with induced rheumatoid arthritis （RA） on the serumal intercellular cell adhesion molecule-1 （ICMA-1） and the pathological tissue, to discuss the mechanism of the warming and activating effect of moxibustion. Methods： After establishing the RA rats model, the induced rats were treated with moxibustion therapy on the acupoint Shenshu （BL 23） and Zusanli （ST 36）, followed by analyzing the pathological section of the ankle of the hind limb and testing the ICAM-1 content with ELISA. Results： The plantar circumferences of the induced rat increased significantly compared with the rats in the control group （P〈0.01）, accompanying with the increase of the synovial layer, the erosion of phlogocytes to chondrocytes and the specific increase of ICAM- 1 content. After the moxibustion therapy, the plantar circumferences decreased significantly （P〈0.01） while the synovial layer tended to reduce. In addition, there was no pathological damage of the articular cartilage and the ICAM content decreased with significant deviation （P〈0.01）, compared to the model group. Conclusion： It was concluded that moxibustion therapy could inhibit the arthrosynovitis and hyperplasia, ameliorate the erosion of phlogocyte to cartilage, prevent articular periosteal lesions and delay the pathological course. The warming and activating effect of moxibustion therapy may involve the inhibition of the formation of ICAM- 1 and pannus.

Effect of moxibustion on tumor necrosis factor-α and nuclear transcription factor kappa B in ankle joints of rats with rheumatoid arthritis

Objective： To observe the effect of moxibustion on the expressions of tumor necrosis factor-α（TNF-α） and nuclear transcription factor kappa B（NF-κB） proteins in ankle joints of rats with rheumatoid arthritis（RA）, and to explore the anti-inflammatory mechanism of moxibustion in the treatment of RA. Methods： Adjuvant arthritis（AA） rat models were induced and used as rat models of RA. Rats were randomly divided into a normal group, a model group, a moxibustion group and a saline group. Rats in the normal and model groups were not treated; rats in the moxibustion group accepted treatment by moxibustion at Zusanli（ST 36） and Shenshu（BL 23） after modeling; rats in the saline group were injected with 0.15 mL saline to the bottom of the left hind paw and had no other treatments. Hematoxylin-eosin（HE） staining was used to observe the histopathological changes of rats＇ ankle joints under light microscope. Immunohistochemistry was used to observe the expressions of TNF-α and NF-κB in ankle joints of rats. Results： Compared with the normal group, the rats＇ ankle joints in the model group showed disorganization, joint surface defect, and significantly increased mean optical density（MOD） of TNF-α and NF-κB（all P〈0.05）. After moxibustion treatment, rats in the moxibustion group showed repaired ankle tissues, smooth joint surface without defects, decreased MOD of TNF-α and NF-κB than those in the model group（all P〈0.05）. Rats in the saline group had no damage to ankle joints, while TNF-α and NF-κB were significantly different from those in the model group（P〈0.05）. Conclusion： Moxibustion could down-regulate the expressions of NF-κB and TNF-α protein in ankle joints of RA rats, and produce an anti-inflammatory effect to promote tissue repair.

Clinical observation on electroacupuncture plus long-snake moxibustion for rheumatoid arthritis due to kidney deficiency and cold coagulation

Objective:To observe the clinical efficacy of electroacupuncture(EA)plus long-snake moxibustion for rheumatoid arthritis(RA)due to kidney deficiency and cold coagulation.Methods:A total of 60 patients in active stage of RA were randomly divided into an observation group and a control group,with 30 cases in each group.Patients in the control group took methotrexate tablets and nimesulide dispersible tablets orally for treatment,while those in the observation group received additional treatment of EA plus long-snake moxibustion.Both groups were treated for 12 weeks.The post-treatment changes in symptomatic grading and quantifying score,disease activity score with 28 joint counts(DAS28),and inflammatory indicators erythrocyte sedimentation rate(ESR)and C-reactive protein(CRP)were observed,and the efficacy was evaluated.Results:The total effective rate in the observation group was 89.9%,versus 76.6%in the control group,and there was a significant difference in the total effective rate between the two groups(P<0.05).After treatment,the symptomatic grading and quantifying score and DAS28 in both groups were significantly improved(all P<0.05),and the improvements in the observation group were more significant than those in the control group(both P<0.05).Besides,there were 11 cases with low disease activity index(DAI)and in remission in the observation group versus 5 cases in the control group,showing a statistically significant between-group difference(P<0.05).The ESR and CRP scores in both groups were significantly reduced after treatment(all P<0.05),also showing statistically significant between-group differences(both P<0.05).Conclusion:The efficacy of additional EA plus long-snake moxibustion based on oral medications for RA due to kidney deficiency and cold coagulation is better than that of the oral medications alone.

Micro-invasive Thread-embedding Therapy in Treating Rheumatoid Arthritis

Rheumatoid arthritis(RA) is a chronic systemic autoimmune disease characterized by arthrosynovitis.The recurrent attacks of synovitis may lead to destruction of articular cartilages and bones,and dysfunction of joints.The symptoms are often symmetrical,affecting the small joints such as the interphalangeal joints,wrists,and the metatarsophalangeal joints.The large joints including elbow,shoulder,ankle,and knee may also be involved in severe cases.

Study on the Effect of Moxibustion in Treating Rhreumatoid Arthritis Rats and Its Mechanism

Objective： To investigate the therapeutic efficacy of moxibustion in treating rheumatoid arthritis （RA） and its mechanism. Methods： A hundred male Wistar rats were randomized into 5 groups, 20 in each group. RA models were developed in all groups except for the normal group. When the models were successfully prepared, the rats in the normal group and the model group didn’t receive any treatment. Those in the moxibustion group received suspended moxibustion by moxa stick, those in the cigarette group received fumigation by cigarette; while those in the moxa oil group were treated by applying moxa essential oil to acupoints. After consecutive 15-day treatment, body weight, paw circumference, thymus and spleen indexes were compared among the five groups, and the expression of Fas/FasL protein in synovium of rat’s joint was detected by using immunohistochemical （IHC） method. Results： After treatment, the moxibustion group had body weight increased, joint swelling relieved, thymus index enhanced, spleen index dropped, and the expression of Fas/FasL protein raised. Regarding the above indexes, the moxibustion group and the cigarette group showed more significant improvements than the moxa oil group; the moxibustion group had more significant effect on the expression of Fas/FasL than the cigarette group. Conclusion： Moxibustion obviously improves the symptoms of RA rats, regulates the expression of Fas/FasL protein in synovium of rat’s joint, and induces apoptosis of synovial cells, which maybe one of the mechanisms of moxibustion in achieving the warming and unblocking effect.

Effects of moxibustion on serum IL-6, IL-8 and TNF-α in rats with experimental rheumatoid arthritis

Objective:To observe the effects of moxibustion on serum levels of interleukin(IL)-6,IL-8 and tumor necrosis factor-α(TNF-α),and to explore the effects of moxibustion on inflammatory damaging factors in experimental rheumatoid arthritis(RA)model rats;the relationship between the therapeutic effect of moxibustion on RA and the change in the Toll-like receptor(TLR)signaling pathway was analyzed using Toll-like receptor 4(TLR4)antagonists and agonists.Methods:Fifty Sprague-Dawley(SD)rats were divided into a normal group,a model group,a moxibustion group,a moxibustion plus TLR4 agonist group(agonist group)and a moxibustion plus TLR4 antagonist group(antagonist group)according to the random number table,with 10 rats in each group.Except the normal group,rats in the other four groups were subjected to model preparation with the wind,cold and wet environmental factors plus Freund's complete adjuvant(FCA).Rats in the normal and model groups were not treated;rats in the moxibustion,agonist and antagonist groups started to be treated with the moxibustion(cigarette-type moxa)at bilateral Shenshu(BL 23)and Zusanli(ST 36)from the 4th day after the successful modeling,for 20 min each time with a total of 10 d.Rats in the agonist and the antagonist groups were injected with TLR4 agonist or antagonist[0.1 mg/(kg*bw)]via the tail vein 30 min before moxibustion.The concentrations of serum IL-6,IL-8 and TNF-αin each group were determined by enzyme-linked immunosorbent assay(ELISA).Results:Compared with the normal group,in the model group,the rat's right hind paw swelling was significantly obvious(P<0.01);there was a lot of inflammatory infiltration in the synovial tissues,the surface of the synovial membrane was unsmooth,the synovial membrane was hyperplasia and thicker,and the serum IL-6,IL-8 and TNF-αconcentrations increased significantly(P<0.05).Compared with the model group,the paw swelling degrees of the rats in the moxibustion,the agonist and the antagonist groups reduced significantly(all P<0.01);the swelling degree in the antagonist group was milder than that in the agonist group,but the between-group difference was not statistically significant(P>0.05);inflammatory infiltration and synovial membrane hyperplasia in the synovial tissues of the moxibustion group and the antagonist group were all relieved differently;the decrease of synovial layer number in the moxibustion group was more obvious,and there were no obvious improvements in inflammatory infiltration and synovial thickness in the agonist group;the concentrations of IL-6,IL-8 and TNF-αin the moxibustion group were decreased,and the differences in the IL-6 and TNF-αconcentrations were statistically significant(all P<0.01);there was no significant between-group difference in the IL-8 concentration(P>0.05);the concentrations of serum IL-8 and TNF-αin the agonist group increased significantly(both P<0.01),while the IL-6 concentration decreased without significant difference(P>0.05);the concentrations of IL-6 and IL-8 in the antagonist group decreased but the between-group differences were statistically insignificant(both P>0.05);and the TNF-αconcentration significantly increased(P<0.05).Compared with the moxibustion group,IL-6,IL-8 and TNF-αconcentrations increased in the agonist group,and the differences in the IL-8 and TNF-αconcentrations were statistically significant(both P<0.01);the concentrations of IL-6,IL-8 and TNF-αincreased in the antagonist group,and the differences in the IL-6 and TNF-αconcentrations were statistically significant(both P<0.01);there was no significant difference in the IL-8 concentration between the groups(P>0.05).The serum levels of IL-6,IL-8 and TNF-αin the antagonist group were lower than those in the agonist group(all P<0.05).Conclusion:Moxibustion at Shenshu(BL 23)and Zusanli(ST 36)can reduce the joint swelling degree and inflammation in synovial tissue of RA model rats,decrease the serum levels of IL-6,IL-8 and TNF-αin RA model rats;the decreases of IL-6 and TNF-αare more significant than the decrease of IL8;TLR4 agonist and antagonist can significantly attenuate the effect of moxibustion in inhibiting releases of IL-6,IL-8 and TNF-α,so that the change in TLR signaling pathway affects the effect of moxibustion in inhibiting the releases of IL-6,IL-8 and TNF-α.

Rheumatoid arthritis treated with the triple strong-stimulation technique of acupuncture and moxibustion at specific acupoints:A randomized controlled trial

Objective: To explore the clinical therapeutic effects and the mechanism on rheumatic arthritis(RA)treated with the combination of the instruments and techniques of acupuncture and moxibusiton.Methods: A total of 60 RA patients were randomized into an observation group and a control group,30 cases in each one. In the control group, diclofenac sodium sustained release tablets were prescribed for oral administration, 0.3 g each time, twice a day, methotrexate tablets(MTX) for oral administration,10 mg each time, once a week and folic acid tablets for oral administration, 5 mg each time, once a week. In the observation group, besides the treatment with western medicines, simultaneously, the specific acupoints were selected and stimulated with the triple strong-stimulation therapy, in which, the strong bloodletting technique, the strong cupping technique and the strong moxibustion technique were combined together, with different instruments of acupuncture and moxibustion adopted. The treatment was given once every 3 days, consecutively for 10 times. In 30 days of treatment, the therapeutic effects were observed in the two groups. Separately, before and after treatment, the rheumatoid factors(RF),hypersensitive-C reactive protein(hs-CRP) and erythrocyte sedimentation rate(ESR), the scores of joint symptoms and physical signs as well as the disease activity score(DAS-28) were observed in the two groups.Results: Regarding RF, there were statistical significant differences before and after treatment in the observation group and the control group(the observation group 248.01 ± 79.81 vs 31.17 ± 29.01,the control group 254.11 ± 72.16 vs 66.42 ± 37.07, both P < 0.05). The result in the observation group was lower significantly than the control group after treatment(P < 0.05). Regarding hs-CRP, there were statistical significant differences before and after treatment in the observation group and the control group(the observation group 26.12 ± 9.22 vs 8.98 ± 7.66, the control group 23.18 ± 7.18 vs 16.01 ± 5.02, both P < 0.05). The result in the observation group was lower significantly than the control group after treatment(P < 0.05). Regarding ESR, there were statistical significant differences before and after treatment in the observation group and the control group(the observation group 30.56 ± 11.38 vs 12.58 ± 5.91,the control group 35.52 ± 9.67 vs 21.47 ± 6.91, both P < 0.05). The result in the observation group was lower significantly than the control group after treatment(P < 0.05). Regarding DAS-28, there were statistical significant differences before and after treatment in the observation group and the control group(the observation group 8.89 ± 2.01 vs 3.01 ± 0.74, the control group 8.14 ± 1.38 vs 4.12 ± 0.96, both P < 0.05). The result in the observation group was lower significantly than the control group after treatment(P < 0.05). Regarding the quantitative grading score of symptom, there were statistical significant differences before and after treatment in the observation group and the control group(the observation group 7.87 士 1.69 vs 3.82 ±1.96, the control group 7.77 ± 1.68 vs 5.01 ± 11.23, both P < 0.05). The result in the observation group was lower significantly than the control group after treatment(P < 0.05).The total effective rate was 96.67%(29/30) in the observation group and was 80.0%(24/30) in the control group, indicating the statistical significant difference between the two groups(P < 0.01).Conclusion: Based on western medications, the triple strong-stimulation therapy of acupuncture and moxibustion at specific acupoints significantly relieves the joint symptoms, reduces the inflammatory reaction indicators and improves the clinical therapeutic effects on RA in the patients.

Effect of moxibustion on N-methyl-D-aspartate receptor subtype 2B expression in hippocampus of rheumatoid arthritis model rats

Objective:To observe the effect of moxibustion on the expression of N-methyl-D-aspartic acid(NMDA)receptor subtype 2B(NR2B)in the hippocampus of rheumatoid arthritis(RA)rats,and to explore the analgesic mechanisms of moxibustion in RA treatment.Methods:Sixty male Sprague-Dawley rats were randomly divided into a normal group,a model group,a moxibustion group,a moxibustion+NMDA receptor antagonist(AP-5)group,and a moxibustion+NMDA receptor agonist(NMDA)group,with 12 rats in each group.Except for the normal group,rats in the other four groups were treated with complete Freund's adjuvant in a windy,cold,and damp environment to replicate RA models.Rats in the moxibustion group received suspended moxibustion with moxa sticks at Shenshu(BL23)and Zusanli(ST36),and the two points were used alternately.After intraperitoneal injection of AP-5 or NMDA,rats in the moxibustion+AP-5 group and the moxibustion+NMDA group received the same moxibustion intervention as in the moxibustion group,once a day for 15 d.The thermal withdrawal latency(TWL)of rats in each group was detected before and after modeling and after the 15-day intervention.After the 15-day intervention,hematoxylin-eosin staining was performed to observe the pathological changes in knee joints.The real-time fluorescence quantitative polymerase chain reaction method was used to detect the mRNA expression of NR2B in the hippocampus;Western blotting assay was used to detect the protein and the phosphorylated protein expression of hippocampal NR2B.Results:The synovial tissue was proliferated,the synovial lining was significantly thickened,the pannus was formed,and the cartilage and bone tissues were significantly damaged in the model group.After intervention,the pathological morphology of the knee joints in the moxibustion group,the moxibustion+AP-5 group,and the moxibustion+NMDA group was significantly improved,and the improvement in the moxibustion+AP-5 group was more notable than that in the moxibustion+NMDA group.Compared with the normal group,the TWL was significantly decreased(P<0.01),and the mRNA,protein,and phosphorylated protein expression levels of hippocampal NR2B were significantly increased in the model group(P<0.01).Compared with the model group,the TWL of each intervention group was significantly increased(P<0.01 or P<0.05),and the mRNA,protein,and phosphorylated protein expression levels of hippocampal NR2B were significantly decreased(P<0.01).Compared with the moxibustion group,the TWL was significantly increased(P<0.01),and the mRNA,protein,and phosphorylated protein expression levels of hippocampal NR2B were significantly decreased in the moxibustion+AP-5 group(P<0.01);the TWL was significantly decreased(P<0.01),and the mRNA,protein,and phosphorylated protein expression levels of hippocampal NR2B were significantly increased in the moxibustion+NMDA group(P<0.01).Conclusion:Moxibustion reduces hyperalgesia in RA inflammatory rats.The analgesic effect may be related to the decrease in the expression and phosphorylation levels of NR2B in the hippocampus.

Study on the mechanism of moxibustion for rheumatoid arthritis based on liquid chromatography-mass spectrometry

Objective To explore the mechanism of moxibustion for rheumatoid arthritis(RA)by observing the metabolite changes in urine using liquid chromatography-mass spectrometry(LC-MS)-based metabolomic analysis.Methods Twenty-four rats were randomly divided into a control group,a model group,and a moxibustion group.Rats in the model and moxibustion groups were established as collagen-induced arthritis(CIA)models.The control and model groups did not receive any intervention;rats in the moxibustion group received moxibustion at Shenshu(BL23)and Zusanli(ST36).After three weeks of intervention,ankle joint,serum,and urine samples were collected for pathological examinations and metabolomic tests.Results After moxibustion treatment,the CIA rats showed increased body mass,reduced swelling of the hind paws and arthritis score,decreased serum cytokine levels,and improved histopathological evaluation of the ankle joint.Twenty-four significantly altered metabolites were found,mainly involved in alanine metabolism,taurine and hypotaurine metabolism,tricarboxylic acid cycle,phenylalanine metabolism,tyrosine metabolism,and primary bile acid biosynthesis.These metabolites may serve as potential biomarkers for RA.Conclusion Moxibustion can effectively resist inflammation in CIA rats.The potential biomarkers and the abnormal metabolic pathways of RA can be identified by LC-MS-based metabolomics.Metabolomics may be an effective way to explain the mechanism of moxibustion in treating RA.