Publisher(s):China Academic Journals (CD Edition) Electronic Publishing House Co., Ltd.
First Published: 2021.12.16
Discipline(s): Medical Science
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This book introduces the mechanism of electroacupuncture in treating arthritis, gastrointestinal diseases, Alzheimer's disease, constipation, polycystic ovary syndrome and stroke, which provides scientific basis for the application and popularization of electroacupuncture.
1. Clinical efficacy of different waves of electroacupuncture on knee osteoarthritis and its effect on TGF-β1 in joint fluid
Chinese Acupuncture & Moxibustion,Part 1: Arthritis,Vol 40,No. 01
Objective To observe the therapeutic effects of electroacupuncture (EA) different waves on knee osteoarthritis (KOA), and to explore their mechanisms in promoting cartilage repair. Methods Ninety-seven patients with KOA were randomly divided into a dilatational wave group (32 cases, 2 cases dropped out), a continuous wave group (32 cases, 2 cases dropped out) and a discontinuous wave group (33 cases, 3 cases dropped out). Xuehai (SP10), Liangqiu (ST34), Dubi (ST35) and Neixiyan (EX-LE4) were selected for the three groups. The dilatational wave (frequency of 2 Hz/10 Hz) was used in the dilatational wave group; the continuous wave (frequency of 10 Hz) was used in the continuous wave group; the discontinuous wave (frequency of 10 Hz) was used in the discontinuous wave group. All the needles were retained for 30 min. All the treatment was given 3 times a week (on Monday, Wednesday and Friday) for 4 weeks. Lysholm knees scoring scale (LKSS) was used to evaluate the knee joint function before and after treatment, and the content of transforming growth factor-β1 (TGF-β1) in the joint fluid before and after treatment was determined by enzyme-linked immunosorbent assay (ELISA). Results Compared with those before treatment, the total score and each score of LKSS were increased after treatment in the three groups (all P < 0.05). The improvements in total score, pain score, giving way sensation from the knee, swelling score of LKSS in the continuous wave group and the dilatational wave group were superior to those in the discontinuous wave group (all P < 0.05). The content of TGF-β1 in the joint fluid in each group was increased after treatment ( P < 0.05), and the improvement in dilatational wave group was superior to those in the continuous wave group and the discontinuous wave group (both P < 0.05). Conclusion EA at three different waves all could alleviate the clinical symptoms of KOA patients, and it might promote cartilage repair by increasing TGF-β1 content. The dilatational wave exhibited the best effect, making it considered as the optimal option for clinical treatment.
Chinese Acupuncture & Moxibustion,Part 1: Arthritis,Vol 37,No. 02
Objective To observe the kinetic change that reflects joint loading in different planes during stair climbing in knee osteoarthritis (KOA) after electroacupuncture (EA) by three-dimensional motion analysis, so as to provide reference for its biomechanical mechanism treated with acupuncture. Methods Forty KOA patients, in accordance with the random number table, were assigned into an observation group and a control group, with 20 cases in each one, and finally 18 cases completed the trail. Acupoints in the observation group were Neixiyan (EX-LE 4), Dubi (ST 35), Yanglingquan (GB 34), Yinlingquan (SP 9), Xuehai (SP 10), Liangqiu (ST34) and Zusanli (ST 36). Points in the control groups were located about 2 cm next to the above acupoints for shallow acupuncture. EA was connected at Neixiyan (EX-LE 4) and Yinlingquan (SP 9), as well as at Liangqiu (ST 34) and Yanglingquan (GB 34). The frequency was 2 Hz with continuous wave in the observation group and there was no current in the control group for the corresponding points. All the treatment was given for three weeks, totally 11 times. Climbing stair gait was measured before and after treatment. Velocities and kinetic parameters during ascending and descending stairs were analyzed, including flexion and extension peak torques of hip, knee, ankle on the vertical plane, external knee adduction moment on the coronal plane. Results After treatment in the observation group, velocities during ascending and descending stairs were significantly increased ( P < 0.05, P < 0.01). The maximal ankle plantar flexor moments during ascending and descending stairs and the second peak external knee adduction moment (PEKAM2) during ascending stairs were significantly increased ( P < 0.05, P < 0.01). After treatment in the control group, the first peak external knee adduction moment (PEKAM1) and PEKAM2 during descending stairs were less than those before treatment ( P < 0.05, P < 0.01). In the observation group, the difference value (DV) of velocity before and after treatment was positively correlated to DV in the torque of ankle plantar flexors during ascending stairs in the observation group ( r = 0.598, P < 0.01). The impact of velocity was excluded, and the DV of the maximal torque of ankle plantar flexors during ascending stairs did not show difference in the observation group ( P > 0.05). Conclusion EA can increase the velocities of ascending and descending stairs of KOA patients. It improves the loading capacity of knee joint on both sagittal and coronary planes. But its effect during ascending may be correlated with the increase of velocity. The mechanism of different effects between EA and minimal acupuncture on joint moments is still unclear and warrants further study.
3. Clinical efficacy comparison between electroacupuncture and meloxicam in the treatment of knee osteoarthritis at the early and middle stage: a randomized controlled trial
Chinese Acupuncture & Moxibustion,Part 1: Arthritis,Vol 36,No. 03
Objective To compare the clinical efficacy on knee osteoarthritis (KOA) at the early and middle stage between electroacupuncture (EA) and meloxicam. Methods Ninety patients of KOA at the early and middle stage were randomized into an EA group and a meloxicam group, 45 cases in each one. In the EA group, EA was applied to Dubi (ST 35), Neixiyan (EX-LE 4), Liangqiu (ST 34), Heding (EX-LE 2), Xuehai (SP 10), Yanglingquan (GB 34) and Zusanli (ST 36); the needles were retained for 20 min and EA was applied once every two days. In the meloxicam group, the meloxicam tablets were prescribed for oral administration, 7.5 mg, once a day. The treatment lasted for 6 weeks in the two groups. The Western Ontario and McMaster University Osteoarthritis Index (WOMAC) score, rectus femoris muscle tension, the 8-foot walking test and 5-time sit-to-stand test were adopted to observe and compare the effects in the two groups. Results After treatment, every item score in WOMAC was reduced after treatment (all P < 0.05), but the difference was not significant between the two groups (all P > 0.05). In the EA group, the rectus femoris tension after treatment was reduced as compared with that before treatment ( P < 0.05) and the reducing result was much more apparent as compared with that in the meloxicam group ( P < 0.05). For the 8-foot walking test and 5-time sit-to-stand test, the time was shortened after treatment in the two groups (all P < 0.05) and the result in the EA group was much more obvious than that in the meloxicam group (both P < 0.05). Conclusion Both EA and meloxicam are effective in the treatment of KOA at the early and middle stage. EA improves rectus femoris tension and recovers the internal mechanics balance and the efficacy is better than that of meloxicam.
4. Effects of Electroacupuncture on Joint Function in Rheumatoid Arthritis Patients of Liver- and Kidney-Yin Deficiency Type
Acupuncture Research,Part 1: Arthritis,Vol 41,No. 04
Objective To compare the effects between electroacupuncture (EA) plus western medicine and simple western medicine in improving clinical symptoms and local joint function of rheumatoid arthritis (RA) patients with yin deficiency of Liver and Kidney. Methods A total of 68 RA patients of yin deficiency of Liver and Kidney were equally randomized into EA+ medication group and medication group (n = 34 in each group). Both groups were given once-a-week methotrexate (7.5 mg/time) and once-a-day leflunomide (10 mg/time), while EA + medication group was additionally treated by EA at bilateral Ganshu (BL 18), Shenshu (BL 23), Xuanzhong (GB39), Zusanli (ST 36), Taichong (LR 3), Hegu (LI 4) 3 times/week. The treatment lasted for 12 weeks. The visual analogue scale (VAS, for assessing rest pain), swollen joint count (SJC), tender joint count (TJC), patient’s global assessment (PGA), physician’s global assessment (PhGA), traditional Chinese medicine (TCM) symptom scoring, 28 joints activity index (disease activity score, DAS 28), American College of Rheumatology 20 (ACR 20, i.t. 20% of clinical improving rate), and health assessment questionnaire (HAQ) were assessed and erythrocyte sedimentation rate (ESR), serum C-reactive protein (CRP) levels were examined for comparison. Results Statistical differences were observed in before-after-treatment comparisons in both groups in reducing rest pain, SJC, TJC, serum CRP content, PGA and PhGA, HAQ scoring and DAS 28 ( P < 0.05, P < 0.01). The ESR in the medication group and TCM symptom scoring of the EA + medication group were also significantly decreased after the treatment ( P < 0.05). The effects of the EA + medication group were superior to those of the medication group in reducing rest pain, SJC, TJC, TCM symptom and HAQ score, and the total effective rate ( P < 0.05, 90.9% vs 66.67%). Adverse reactions as pharyngeal obstruction sensation, anorexia, abdominal distension, etc. can be reduced by EA therapy coordinated with western medicine. Conclusion EA is effective in relieving symptom and joint function in RA patients with yin deficiency of Liver and Kidney.
5. Effects of Short Thrust Needing plus Electroacupuncture Intervention on Cartilage Tissue in Rabbits with Knee Osteoarthritis
Acupuncture Research,Part 1: Arthritis,Vol 41,No. 05
Objectives: to observe the effectiveness of short thrust needling (STN, close-to-bone needing) plus electroacupuncture (EA) in healing knee cartilage tissue and in regulating expressions of cartilage vitamin K dependent gamma-glutamyl carboxylase (GGCX), matrix metalloproteinase-13 (MMP 13) and serum uncarboxylated matrix gla protein (ucMGP) in rabbits with knee osteoarthritis (KOA), so as to reveal its mechanism underlying improvement of KOA. Methods: Forty New Zealand rabbits were randomly divided into Normal, Model, EA and STN+EA groups ( n = 10 in each group). The KOA model was created by cutting the medial lateral ligament and medial parapatellar arthrotomy of rabbits as described by Hulth and colleagues. For rabbits in the STN+EA group, “Neixiyan” (EX-LE 4) and “Waixiyan” (ST 35) were punctured with filiform needles by controlling the needle-tip obliquely to advance till the bone surface of the knee joint cavity, and “Yinlingquan” (SP 9) and “Zusanli” (ST 36) punctured by holding the filiform needles vertically along the tibia, and “Liangqiu” (ST 34) was punctured by controlling the filiform needle to advance till the thigh-bone, followed by EA stimulation. EA (2Hz/100 Hz, 1–3 mA) was applied to unilateral EX-LE 4 and ST 35, and ST 36 and SP 9, separately for 20 minutes, once daily for 20 days except weekends. The pathological changes of the knee cartilage cells were observed by using H.E. staining, Toluidine blue staining and electron transmission microscope, respectively. The immunoactivity of GGCX of the knee cartilage was determined by immunohistochemistry and the expression levels of GGCX and MMP 13 proteins in the cartilage were detected by Western blot, and the content of serum ucMGP was assayed by ELISA. Results: H.E. staining, Toluidine blue staining and electron transmission microscope results showed that pathological changes of knee cartilage cells in structure after modeling were improved in both the STN + EA and EA groups, particularly the former group. In comparison with the Normal group, the expression levels of GGCX proteins in the cartilage tissue showed by both Western blot and immunohistochemistry were notably down-regulated ( P < 0.01), and the cartilage MMP 13 protein expression and serum ucMGP content were considerably up-regulated in the Model group ( P < 0.01, P < 0.05). After STN + EA and simple EA, the decreased GGCX and the increased MMP 13 expression and serum ucMGP content were reversed ( P < 0.01, P < 0.05). The effects of STN + EA were significantly superior to those of simple EA in down-regulating MMP13 and ucGLA levels, and up-regulating GGCX expression. Conclusion: Both STN + EA and simple EA can effectively improve pathological changes of cartilage cells in KOA rabbits, which may be associated with their actions in up-regulating the expression of cartilage GGCX proteins and lowering the levels of serum ucMGP content and cartilage MMP 13 protein expression, and the effects of STN + EA are better.
6. Effect of Electroacupuncture on Serum TNF-α, IL-1β and Intercellular adhesion molecule 1 Levels in Rheumatoid Arthritis Rats
Acupuncture Research,Part 1: Arthritis,Vol 41,No. 06
Objective To investigate the effects of electroacupuncture on the contents of serum tumor necrosis factor-α (TNF-α), interleukin-1β (IL-1β) and intercellular cell adhesion molecule-1 (ICAM-1) of a model of rats with collagen induced arthritis and to discuss the mechanism by which electroacupuncture treats rheumatoid arthritis (RA). Methods A total of 60 Wistar male rats were included in the current study, where 8 rats were randomly selected as a normal group, while others were adopted to establish an RA model using chicken type II collagen and Freund’s adjuvant incomplete. After successful modeling, 24 rats were randomly divided into three groups ( n = 8): a model group, a prednisone group and an electroacupuncture group. Needles were inserted into Zusanli and Kunlun points on both sides of rats of the electroacupunture group, 30 min per time daily for 10 consecutive days. Those in the prednisone group were intragastrically administrated with prednisolone acetate (0.1 mL/10 g). Then, the diameters of the left ankle joint were measured before and after modeling, and after treatment. The contents of serum TNF-α, IL-1β and ICAM-1 were examined by ELISA. Results Compared with the normal group, rats in the model group had larger ankle diameters and higher contents of serum TNF-α, IL-1 b and ICAM-1 ( P < 0.05). Compared with the model group, reduced ankle diameters and decreased contents of serum TNF-α, IL-1 b and ICAM-1 were found in rats after electroacupunture or prednisone treatment ( P < 0.05). No statistical difference was seen between the electroacupunture and prednisone groups ( P > 0.05). Conclusion Electroacupunture is effective to treat rats with RA, which may be associated with its abilities to effectively weaken the secretion of serum TNF-α, IL-1 b and ICAM-1.
7. Repair effects of close-to-bone needing combined with electroacupuncture on extracellular matrix of cartilage in rabbits with knee osteoarthritis
Chinese Acupuncture & Moxibustion,Part 1: Arthritis,Vol 36,No. 07
Objective To observe the effects of close-to-bone needing combined with electroacupuncture (EA) on cartilage collagen type Ⅱ/discoidin domain receptor/matrix metalloproteinase 13 (collagen type Ⅱ/DDR2/MMP 13) signaling pathway in rabbits with knee osteoarthritis (KOA), and to explore the possible action mechanism of this method on repair of extracellular matrix of knee cartilage. Methods Forty New Zealand white rabbits were randomly assigned into a normal group (10 rabbits) and a model establishing group (30 rabbits). The HulthTelhag technique was applied to establish the model of KOA, and X-ray was used for outcome assessment. The rabbits with successful modeling were randomly assigned into a model group, a close-to-bone needing group, a regular acupuncture group, with 10 rabbits in each one. The rabbits in the close-to-bone needing group were treated with close-to-bone needing and EA. The rabbits in the regular acupuncture group were treated with regular acupuncture and EA. “Neixiyan” (EX-LE 4), “Dubi” (ST 35), “Yinlingquan” (SP 9), “Zusanli” (ST 36), and “Liangqiu” (ST 34) were selected in the two groups. The intervention was given for 20 min per time, once a day, five days as a course, with an interval of two days between courses, for a total of four courses. Rabbits in normal and model group were immobilized without any treatment. After the treatment, western blotting method was applied to evaluate the expression of DDR2 and collagen type Ⅱ; The activities of collagen type Ⅱ, DDR2 and MMP 13 were assessed by immunohistochemistry method; The mRNA expression levels of DDR2and MMP 13 were determined by reverse transcription-polymerase chain reaction (RT-PCR). Results Compared with the normal group, the activities of collagen type Ⅱ were significantly reduced in the other groups (all P < 0.01), while the activity and mRNA expression levels of DDR2 and MMP 13 were notably increased (all P < 0.01). Compared with the model group, the activities of collagen type Ⅱ in the close-to-bone needing group and regular acupuncture group were increased (both P < 0.01), while the activity and mRNA expression levels of DDR2 and MMP 13 were reduced (all P < 0.01). Compared with the regular acupuncture group, the activity and mRNA expression levels of MMP 13 and DDR2 in the close-to-bone needing group were reduced (all P < 0.01), while the activities of collagen type Ⅱ were increased ( P < 0.01). Conclusion The close-to-bone needing combined with EA and regular EA could both promote the repair of knee cartilage, whereas, closing-to-bone needing combined with EA shows a superior efficacy. The mechanism might be associated with the blocking effect of collagen type Ⅱ/DDR2/MMP13 signaling pathway and the inhibiting effect of degradation in extracellular matrix of cartilage.
8. Anti-inflammatory and synovial-opioid system effects of electroacupuncture intervention on chronic pain in arthritic rats
Chinese Acupuncture & Moxibustion,Part 1: Arthritis,Vol 35,No. 08
Objective To observe the analgesic effect of electroacupuncture (EA) on collagen-induced arthritis (CIA) rats and its regulating effect on inflammation reaction and the endogenous opioid system of synovial tissues. Methods A total of 30 healthy male Wistar rats were randomly divided into control group, model group and EA group, 10 rats in each one. The chronic pain model of CIA rats was made by bovine type-II collagen in the model group and EA group. Rats in the EA group were treated with EA at “Zusanli” (ST 36) and “Kunlun” (BL 60) for 30 min from 16 th day after model establishment, once a day for consecutive 10 days. Rats in control group did not receive any treatment. Rats in model group were treated with fixation as the EA group. Threshold of pain, arthritis index, paw swelling were measured before model establishment and 16 d, 20 d, 23 d and 25 d after model establishment. The levels of beta-endorphin (β-END), met-enkephalin (met-ENK), dynorphin A (Dyn A) were measured by radioimmunoassay; the mRNA expressions of mu opioid receptor (MOR), kappa opioid receptor (KOR) and delta opioid receptor (DOR) in synovial tissues of CIA rats were detected by quantitative polymerase chain reaction (qPCR). Results Compared with the control group, threshold of pain was reduced (all P < 0.01), arthritis index was increased (all P < 0.01) and paw swelling was increased (all P < 0.01) in the model group on the 16 th day, 20 th day, 23 rd day and 25 th day after model establishment. Compared with the model group, the threshold of pain was increased in the EA group (all P < 0.01), arthritis index and paw swelling were reduced (all P < 0.01) on the 23 rd day and 25 th day after model establishment. Compared with the control group, the level of Dyn A in synovial tissues of CIA rats was increased in the model group ( P < 0.01); the mRNA expressions of MOR, KOR and DOR were down-regulated lower than 0.5 fold of normal level. Compared with the model group, the level of β-END in synovial tissues of the knee joint was increased in the EA group ( P < 0.05), and the mRNA expressions of MOR, KOR and DOR in synovial tissues of CIA rats were up-regulated more than 2 folds of normal level. Conclusion The intervention of EA on chronic pain of CIA rats is superior, which is likely to be related with effects of EA on anti-inflammation and up-regulation of synovial tissue β-END and MOR, KOR, DOR.