基于数据挖掘的《普济方》治疗膝骨关节痛用药规律分析

目的 搜集、分析《普济方》中治疗膝骨关节痛的临床用药规律,为中药新方研发提供参考。方法 选取《普济方》中治疗膝骨关节痛的处方,运用SPSS 21.0与IBM SPSS Modeler 18.0对用药频次、药物属性(药性、药味、归经)进行统计和聚类分析。结果 筛选后共纳入136首方剂,包含种210味中药,高频药物为当归、附子、牛膝等;关联性药对以附子-牛膝、当归-牛膝出现最高,性味以温、辛居多,归经多归肝、肾、脾经,功效以活血化瘀、祛风除湿为主,常用药物可聚为7类。结论 本研究展示出《普济方》中治疗膝骨关节痛的用药规律,分析治疗膝关节疼痛的病机,为临床实践中药治疗膝骨关节痛提供参考,并为临床研发新方药奠定基础。

膝骨性关节病内侧痛常见原因与治疗的探讨

目的:讨论膝骨性关节病(Osteoarthritis,OA)内侧痛的常见原因与治疗方法。方法:从1997年5月至2001年5月间,收治346例(346膝)膝OA内侧痛的病人,经临床及影像学检查,综合分析确诊后,应用泼尼松龙及利多卡因进行封闭治疗,随访3个月～1年,平均5.7个月,共随访167例。结果:膝OA内侧痛的常见原因是膝内侧副韧带及内侧关节囊韧带劳损引起;经随访与疗效评定,封闭治疗获得89.2％的优良率。结论:膝内侧副韧带劳损性无菌炎症是膝OA内侧痛的常见原因,封闭治疗简便、有效。

The effect of hot intermittent cupping on pain,stiffness and disability of patients with knee osteoarthritis

Objective:The aim of this study was to investigate the effect of hot intermittent cupping on pain,stiffness and inability of patients with knee osteoarthritis(KO).Methods:The present study was a clinical trial,which was performed on 38 patients with KO referring to Gonabad Rheumatology Specialty Clinic.Based on permutation block method,the research units were divided into cupping therapy and control groups.For the cupping therapy group,four sessions of cupping therapy were performed every four days.To collect data,the form of demographic information,Visual Analogue Scale(VAS)and the Western Ontario and McMaster(WOMAC)osteoarthritis scale were used,and the data were analyzed by SPSS software v.16 using descriptive statistics and independent t-test,paired t-test,Chi-square test and Fishers exact test with a significance level of P<0.05.Results:Findings showed that there was no significant difference between the cupping therapy and control groups in terms of demographic characteristics and they were homogeneous.Findings indicated that,based on VAS,the mean pain intensity in the left(P<0.001)and the right knees(P<0.001),as well as based on WOMAC,stiffness(P=0.006),pain intensity(P<0.001)and disability(P<0.001)in the cupping therapy group significantly decreased compared to the control group.Conclusion:Findings showed that hot intermittent cupping therapy reduced the pain intensity,stiffness and disability in patients with KO.

Regenerative Engineering for Knee Osteoarthritis Treatment： Biomaterials and Cell-Based Technologies

Knee osteoarthritis （OA） is the most common form of arthritis worldwide. The incidence of this disease is rising and its treatment poses an economic burden. Two early targets of knee OA treatment include the predominant symptom of pain, and cartilage damage in the knee joint. Current treatments have been beneficial in treating the disease but none is as effective as total knee arthroplasty （TKA）. However, while TKA is an end-stage solution of the disease, it is an invasive and expensive procedure, Therefore, innovative regenerative engineering strategies should be established as these could defer or annul the need for a TKA. Several biomaterial and cell-based therapies are currently in development and have shown early promise in both preclinical and clinical studies. The use of advanced biomaterials and stem cells independently or in conjunction to treat knee OA could potentially reduce pain and regenerate fo- cal articular cartilage damage. In this review, we discuss the pathogenesis of pain and cartilage damage in knee OA and explore novel treatment options currently being studied, along with some of their limitations.

Electroacupuncture plus external application of Chinese medicine for knee osteoarthritis

Objective： To reveal the action mechanism and efficacy of electroacupuncture（EA） plus external application of Wei Ling Xian（Radix Clematidis） extract in treating knee osteoarthritis（KOA）, for providing theoretical evidence and novel plan for the treatment of KOA. Methods： Totally 284 inpatients were divided into an EA group and an observation group by the random number table, 142 cases in each group. The EA group was intervened by EA, ultrashort waves, and oral administration of Glucosamine Hydrochloride capsules; while the observation group was by external application of Wei Ling Xian（Radix Clematidis） extract at topical area in addition to the treatment given to the EA group. The intervention lasted 14 d in both groups. X-ray examination of knee joint was ordered before and after treatment, as well as the detection of positive expression of matrix metalloproteinase-1（MMP-1） in cartilage of knee joint, hyaluronic acid（HA） and interleukin-1β（IL-1β） in the inflammatory effusion; the Western Ontario and McM aster Universities osteoarthritis index（WOMAC） and visual analogue scale（VAS） were adopted to evaluate the clinical efficacy. Results： In the observation group, the X-ray examination result of knee joint was significantly improved, the positive expressions of MMP-1 and IL-1β content were significantly decreased, the level of HA was increased, WOMAC and VAS scores dropped, and the total effective rate was 91.5%, which were significantly different from those in the EA group（P〈0.05）. Conclusion： EA plus external application of Wei Ling Xian（Radix Clematidis） extract can produce a more significant efficacy in treating KOA compared to ordinary EA treatment.

Clinical research on the short-term efficacy of massaging quadriceps for knee osteoarthritis

Objective： To observe the short-term efficacy of massaging quadriceps on knee osteoarthritis （KOA）. Methods： Totally 30 KOA patients were enrolled and treated mainly with massaging quadriceps, 20 min for each session, once a day, 2 weeks as a treatment course, and for 2 courses in total. After treatment, the changes of visual analogue scale （VAS） and Western Ontario and McMaster Universities osteoarthritis index （WOMAC） were observed. Result： The VAS and WOMAC scores dropped after treatment, with a statistically significant difference （P〈0.01）. After a course of treatment, the recovery rate was 33.3% and the total effective rate was 86.7%; after 2 courses, the recovery rate was 60.0% and the total effect rate was 96.7%. Conclusion： Massaging quadriceps can alleviate pain, improve the function of knee joint, and produce a significant short-term efficacy in treating KOA.

Observation on clinical effects of herbal cake-partitioned moxibustion for knee osteoarthritis

Objective： To observe the clinical effects of herbal cake-partitioned moxibustion in the treatment of knee osteoarthritis （KOA）. Methods： A total of 120 cases with KOA were randomly divided into two groups by the random digital table, 60 cases in each group. The herbal cake-partitioned moxibustion （HCPM） group was treated by herbal cake-partitioned moxibustion, once per day and five days per week, with ten sessions as one course. The Western medication （WM） group was treated by the oral administration of Diclofenac Sodium Sustained-release Tablets. The knee functions of the patients were assessed by Western Ontario and McMaster Universities osteoarthritis index （WOMAC） before and after the treatment. The clinical effects were observed in the two groups after four-week continuous treatment. Results： The total effective rate was 86.7% in the HCPM group and 73.3% in the WM group. The difference in the total effective rate between the two groups was statistically significant （P〈0.05）. After treatment, WOMAC scores in the two groups were statistically different than those of the same group before the treatment （both P〈0.05）; the difference between the two groups were statistically significant （P〈0.05）. Conclusion： Herbal cake-partitioned moxibustion and oral administration of Didofenac Sodium Sustained-re;ease Tablets can improve the knee functions of KOA patients, but the therapeutic effect was better by herbal cake-partitioned moxibustion than by oral administration of Diclofenac Sodium Sustained-release Tablets.

Clinical study on mild moxibustion for knee osteoarthritis

Objective: To observe the clinical effect of mild moxibustion for knee osteoarthritis (KOA) and to explore the role of mild moxibustion in relieving pain, reducing stiffness and improving joint dysfunction in patients with KOA. Methods: Eighty patients with KOA were randomly allocated into either a moxibustion group or a medication group by the random number table, with 40 cases in each group. The moxibustion group used mild moxibustion at Neixiyan (EX-LE 5), Dubi (ST 35), Xuehai (SP 10) and Liangqiu (ST 34), 30 min each time, 3 times a week;the medication group was given celecoxib capsule (celebrex), 0.2 g each time, once a day. Both groups were treated for 4 weeks. The visual analog scale (VAS) and Western Ontario and McMaster Universities osteoarthritis index (WOMAC) scores were evaluated before and after treatment. The efficacy of the two groups was compared after treatment. Results: After treatme nt, the overall efficacy of the moxibustion group was sign ificantly differ ent from that of the medication group (P<0.05). The VAS and WOMAC scores of the two groups were lower than those before treatment (both P<0.01). The changes in the VAS and WOMAC scores after treatment in the moxibustion group were significantly different from those in the medication group (both P<0.05). After treatment, in single item of WOMAC, the changes in pain and joint dysfunction in the moxibustion group were more statistically significant than those in the medication group (both P<0.05). Conclusion: Mild moxibustion and oral celebrex can reduce the VAS and WOMAC scores of patients with KOA. Mild moxibustion is superior to oral celebrex in relieving pain and improving joint function.

Electronic moxibustion apparatus and traditional moxibustion in treating knee osteoarthritis:a randomized controlled trial

Objective:To observe the clinical efficacy of DZWJY-1 type electronic moxibustion apparatus and traditional moxibustion in treating knee osteoarthritis(KOA).Methods:A total of 76 eligible patients were randomized into an electronic moxibustion apparatus group and a traditional moxibustion group,with 38 cases in each group.The electronic moxibustion apparatus group was intervened by DZWJY-1 type electronic moxibustion apparatus,and the traditional moxibustion group received moxa stick moxibustion for treatment.Neixiyan(EX-LE 4),Dubi(ST 35),Xuehai(SP 10)and Liangqiu(ST 34)were selected for both groups and the treatment was conducted 3 times a week for a total of 12 times.The visual analog scale(VAS)and the Western Ontario and McMaster Universities osteoarthritis index(WOMAC)scores were observed before treatment and after 6 and 12 sessions of treatment,respectively.Results:There were 4 dropout cases in the traditional moxibustion group.Therefore,this trial had 72 valid cases,including 38 cases in the electronic moxibustion apparatus group and 34 cases in the traditional moxibustion group,the differences in the baseline data between the two groups were statistically insignificant(P>0.05).After 6 and 12 sessions of treatment,the VAS scores decreased significantly with the increase of treatment sessions in both groups(all P<0.01),and the betweengroup differences were statistically insignificant at the same time points(both P>0.05).The pain intensity was evaluated using the weighted value of VAS score.The markedly effective rate was 47.4%and the total effective rate was 89.5%in the electronic moxibustion apparatus group,versus 50.0%and 94.1%in the traditional moxibustion group,and the betweengroup differences were statistically insignificant(both P>0.05).After 6 and 12 sessions of treatment,the total score and the component scores including pain,stiffness and difficulty moving in the WOMAC decreased significantly with the increase of treatment sessions in both groups(all P<0.01),and the between-group differences were statistically insignificant(all P>0.05).Conclusion:Electronic moxibustion apparatus and traditional moxibustion both are effective in reducing joint pain and improving joint function in KOA patients,and they are equivalent comparing the clinical efficacy.

Therapeutic efficacy observation of warm needling moxibustion plus Tuina for knee osteoarthritis

Objective To observe the clinical efficacy of warm needling moxibustion plus Tuina(Chinese therapeutic massage)for knee osteoarthritis(KOA).Methods A total of 60 patients with KOA were randomized into an observation group and a control group by the random number table,with 30 cases in each group.The control group was treated with warm needling moxibustion,and the observation group was treated with additional Tuina treatment.The treatments were performed once every other day,for a total of 10 times.The visual analog scale(VAS)and Western Ontario and McMaster Universities osteoarthritis index(WOMAC)were scored before and after treatment,and the surface electromyography(sEMG)signals of quadriceps femoris were collected.Results The total effective rate of the control group was 76.7%,and that of the observation group was 90.0%.The difference between the two groups was statistically significant(P<0.05).The WOMAC and VAS scores in both groups after treatment were improved,and the integrated electromyography(iEMG)and median frequency(MF)of quadriceps femoris were increased.The intra-group differences were statistically significant(P<0.05).After treatment,the WOMAC and VAS scores in the observation group were lower than those in the control group,and the differences between the two groups were statistically significant(P<0.05).The improvement of quadriceps femoris function in the observation group was more notable than that in the control group,and the iEMG value and MF were significantly higher than those in the control group(P<0.05).Conclusion Warming needling moxibustion plus Tuina can effectively relieve the pain in patients with KOA,improve their daily activity function,and increase the sEMG signals of the quadriceps femoris.

Efficacy and safety of acupuncture for the treatment of knee osteoarthritis:a systematic review and meta-analysis

Objective:To evaluate the efficacy and safety of acupuncture for the treatment of knee osteoarthritis and to provide evidence for its use in clinical practice.Methods:Eight databases were extensively searched up to March 2018.Randomized controlled trials(RCTs)comparing the efficacy of acupuncture with sham acupuncture or no acupuncture for knee osteoarthritis were included.Study selection,data extraction and quality assessment were independently conducted by two reviewers.The Cochrane Collaboration's tool was used for assessing the risk of bias.Results:A total of 18 RCTs were included,involving a total of 3522 participants.The results showed that acupuncture was superior to sham acupuncture in relieving pain(SMD=-0.34,95%CI:-0.57 to-0.11,I^2=85%,P=0.003)and improving physical function(SMD=-0.34,95%CI:-0.57 to-0.11,I^2=85%,P=0.003).In comparison to the no-acupuncture group,the acupuncture group also showed significant advantages in relieving pain(SMD=-0.79,95%CI:-1.15 to-0.43,I^2=87%,P<0.0001)and improving physical function(SMD=-0.75,95%CI:-1.19 to-0.31,I^2=91%,P=0.0008).Sensitivity analyses suggested that the results were robust,and Egger's test found no potential publication bias.Conclusion:In the treatment of knee osteoarthritis,the acupuncture group had significant advantages over sham acupuncture or no-acupuncture groups in relieving pain and improving physical function.

Modified green dragon swaying its tail needling manipulation for treatment of knee osteoarthritis

Objective To compare the difference in the effect of modified green dragon swaying its tail needling manipulation and common needling manipulations on the overall rating of pain of patients with knee osteoarthritis, and to evaluate the advantages of modified green dragon swaying its tail needling manipulation for. Methods Ninety-five patients with knee osteoarthritis were divided into 2 groups according to the random number table method with 48 patients in the modified green dragon swaying its tail group（group special manipulation, SM group for short） and 47 patients in the common acupuncture group（group convention needling, CN group for short）, and different acupuncture manipulations were applied in the two groups. Internationally recognized Simplified Mc Gill Pain Questionnaire（SF-MPQ） scale used for description and measurement of pain was applied to evaluate the pain degree, including pain rating index（PRI）, visnal analogue scale（VAS）and present pain intensity（PPI）. The index of severity for osteoarthritis（ISOA） was adopted for evaluation of clinical efficacy. Results（1） In SM group, the scores of PRI, VAS and PPI were 6.63±4.67, 2.23±1.45 and 0.65±1.32, respectively, after treatment, and in CN group, the scores of PRI, VAS and PPI were 13.32±7.96, 4.34±1.79 and 2.28±1.21, respectively, the scores decreased in the two groups after treatment（all P〈0.05）, and the improvement in SM group was superior to that in CN group（all P〈0.01）.（2） The clinical cure rate in SM group was 52.08%, and the total effective rate was 97.92%, the clinical cure rate in CN group was 25.53%, and the total effective rate was 85.10%. The comparison of clinical cure rate in the two groups showed that P〈0.01. Conclusion The SM group is obviously superior to CN group in the improvement of overall rating of pain of patients. It is indicated that modified green dragon swaying its tail acupuncture therapy can effectively relieve the pain of patients with knee osteoarthritis, which was worthy of popularization and application with definite clinical efficacy

Therapeutic observation of warm needling moxibustion plus tuina for knee osteoarthritis due to cold-dampness blocking collaterals

Objective： To observe the clinical efficacy of warm needling moxibustion plus tuina in treating knee osteoarthritis （KOA） due to cold-dampness blocking collaterals. Methods： Forty-eight KOA patients were randomized into 2 groups by their visiting sequence, 24 cases in each group. The treatment group was intervened by warm needling moxibustion plus tuina, while the control group was treated with acupuncture plus tuina. The two groups were both treated once a day, 30 min for each session, 10 d as a treatment course, totally for 3 treatment courses. The visual analogue scale （VAS） and Lysholm knee scoring scale （LKSS） were observed before and after the treatment to evaluate the clinical efficacy. Results： After 3 treatment courses, the VAS and LKSS scores were significantly changed in the two groups （P〈0.01）, and the between-group differences were also statistically significant （P〈0.01）. The markedly-effective rate was 83.3% in the treatment group versus 66.7% in the control group, and the difference was statistically significant （P〈0.05）. Conclusion： Warm needling moxibustion plus tuina can produce a more significant efficacy than acupuncture plus tuina in treating KOA due to cold-dampness blocking collaterals.

Therapeutic efficacy observation on moxibustion with moxa of different storage years for moderate-to-severe primary knee osteoarthritis

Objective:By observing the differences in Western Ontario and McMaster Universities osteoarthritis index(WOMAC)and visual analog scale(VAS)scores in moxibustion treatment for moderate-to-severe primary knee osteoarthritis(KOA)with moxa of different storage years(3-year moxa and 1-year moxa from Qichun,Huanggang City,Hubei Province,China)through a randomized clinical trial,to objectively evaluate the differences in therapeutic efficacy of moxibustion with moxa of different storage years.Methods:A total of 63 patients with moderate-to-severe KOA who met the inclusion criteria were randomized into moxibustion group 1 and moxibustion group 2 by central randomization method,with 32 cases in moxibustion group 1 and 31 cases in moxibustion group 2.Moxibustion group 1 was treated with moxa stored for 3 years,and moxibustion group 2 was treated with moxa stored for 1 year.Dubi(ST 35),Neixiyan(EX-LE 4)and Heding(EX-LE 2)were selected in both groups,and the treatment lasted 20 min per time,3 times a week.The immediate efficacy was compared after 6 times of treatment,and long-term efficacy was compared at follow-up 4 weeks after the end of treatment.Results:During the treatment,there were 2 dropouts in moxibustion group 1,and 1 dropout in moxibustion group 2.The total effective rate in the two groups was 83.3%and 60.0%,respectively.Followed up at 4 weeks after the end of treatment,the total effective rate in the two groups was 80.0%and 66.7%,respectively.There were no statistical differences between the two groups(both P>0.05).After treatment and 4 weeks after the end of treatment,the WOMAC and VAS scores in both groups decreased significantly compared with those before treatment(all P<0.01);the scores of stiffness item of WOMAC in moxibustion group 1 were lower than those in moxibustion group 2(both P<0.05);there were no statistical differences in the scores of pain item and dysfunction item of WOMAC,and VAS scores between the two groups(all P>0.05).Conclusion:Moxibustion with moxa of different storage years(stored for 3 years and 1 year)both can improve the pain,stiffness and motor function in patients with moderate-to-severe KOA.While moxa stored for 3 years has a better therapeutic efficacy in improving stiffness of the knee joint than that stored for 1 year.