The Scientific Experiences By Shuchun Sun In Soft-tissue Injury And Studies Of Pathogenesis Of CCHD In Rabbits

The studies were divided two part.PartⅠ: the Scientific Experiences by Shuchun Sun in Soft-tissue InjuryShuchun Sun, the chief researcher, is the celebrated orthopedics and traumatology expertise in China. As an instructor of TCM academic experience, a leading scholar in the study of orthopedics and traumatology, a leading figure in academic science of orthopedics and traumatology, Mr. Sun has being engaged in the clinic, scientific research and also the teaching of the orthopedics and traumatology in recent forty years. He is good at using the combined traditional and Western Medicine to diagnose and heal the soft-tissue injury. He advocated the treatment based on the technique of the Traditional Chinese Medicine, carrying forward the characteristic of our homeland traditional medicine. Now, the following is a brief about Mr. Sun's scientific ideas to the soft-tissue injury.1. Sun's theory in Soft-tissue InjurySun's treatment of soft-tissue injury originated from ShangSiYuan of Qing Dynasty's Palace. It is refined from his own skills, widely absorbing achievements from Western Medicine. Sun's unique soft-tissue injury treatment theories include: theory equals to clinical practice; the differentiation of both disease and syndrome; internal treatment supplied with external treatment; dynamics combined with statics, mainly on dynamics; soft-tissue injury differentiation, qi-blood as main points; initiate standardization and develop the superiority.Mr. Sun always teaches students that attention to patients is not enough. Treating them by our hands is more important. The more we get in touch with patients, the better our hands feel the illness. Only in this way, can we really put theories into clinic treatment.Mr. Sun also stresses that patients are our best teachers. Good communications with patients help us to improve our technique, which is not taught in books. In his opinion, theory and clinic treatment are of equal importance and should be put together. He makes himself a good example for us.Mr. Sun believes that symptoms always come along with illness, and we can never separate one from the other. In clinic treatment, what kind of formula and proper technique to choose should be based on an overall analysis of both the illness and signs?The combination of the disease differentiation in Western Medicine and the syndrome differentiation in TCM is just a model in the clinic therapy. So we should base ourselves upon TCM's theory of treatment according to syndromes, in the meanwhile, utilize the theory and means of examination of the modern medicine reasonably to broaden our vision of treatment, and also to observe and analyze the inherent cause of disease, pathogenesis and evolvement regulation.Mr. Sun emphasized that both parts and whole must be taken into account when treatment is administered because where there is a sign, there is a cause. Considering the fact that partial damage is the main part in the soft-tissue injury, during the treatment, not only the part but the whole must be focused on. Then, choose corresponding acupoints and proper manipulation under the guidance of either part or whole in order to release hypertonic and stop pain.What's more, Mr. Sun pointed out that dynamics and statics are opposite but balancing. They support each other and prove a dialectical relationship. The dynamic function is to make the injured limbs get resorted, for the impairment of injured tissues, and for the recovery of the limbs' function.Mr. Sun also believed the treatment differentiation should be mainly on the qi-blood syndrome differentiation. He thought that qi-blood circulated in the whole body, existing everywhere. Any internal injury, from up and down, skin and flesh, sinew and bone, five Zang-organs and six Fu-organs, wherever it is, qi-blood always comes to be the first affected.The manipulation in Traditional Chinese Medicine should be based on a mature and standard set of operational rules, in which Mr. Sun is going to call on his peers to make efforts. Although there will be a lot of difficulties in the way, the rules represent the developing direction of this technology, even the cause of Traditional Chinese Medicine.2. Sun's Dialectics System in Soft-tissue InjuryBased on the diagnosis of inspection, auscultation and olfaction, interrogation and pulse-taking, Mr. Sun takes advantage of his own abundant clinical experiences to refine a set of special diagnosis system which is suitable for the soft-tissue injury.Interrogation is indispensable in the diagnosis process, and it takes a very important place. Every generation of the medicine expertise pays great attention to interrogation from ancient time to our modem society. We can get the information that the patients felt by themselves, when and where they got injured, the process of their treatments, their health situations, and even the disease history of their families.Inspection contains the observation of the vitality, color and figure, particularly percept the part of the soft-tissue injury.Auscultation and olfaction include listening to the patient's words, breath, dyspnea and cough. In addition, listening to the sound from the injured areas is the key point in Sun's theory of soft-tissue injury.Palpating plays an important role in Sun's soft-tissue treatment. It's different from pulse-taking and is a method to touch and palpate the part or the whole body by the doctor's hands. It can provide the important diagnosis evidence. Palpation provides a thorough understanding of the injured part and has great significance when X-ray is unavailable.3. Sun's Scientific Characteristic in Soft-tissue InjuryMr. Sun's manipulation is primarily originated from Shoushan Liu, an old famous TCM doctor. He succeeds to inherit Mr. Liu's manipulation for treating soft-tissue injury. At the mean time, Mr. Sun applied modem anatomical physiology and pathological physiology to organize them into order. On the basis of keeping the curative effect, he also simplified and refined the manipulation, made it easier to master and use. Gradually, with special features, Sun's treatment for soft-tissue injury formed. Summarizing forty years clinic experiences and learning widely from others, Mr. Sun managed to form his special treatment, including the treatment for soft-tissue injury (especially for the cervical vertebra), special treatment for certain disease and function exercise. Mr. Sun maintained that the curative effect of the manipulation is all by itself, as mentioned in the Medical Principles, Highlights of the Core Techniques of Ortho-correction. Hand indeed has flesh and blood. The fine use of it is felt by stretching. The proper positioning, speed and strength of hand can sense the stagnation of qi-blood, break and contraction of bones and muscles, gall of flesh, and emotional sufferings. Manipulation must live up to the point that "once face symptoms, bodily conditions and the injured parts are clear in mind." Mr. Sun pointed out that the soft tissue sustains weak strengths and is unbearable to strong ones. Thus manipulation can be called "hand skill" only when the patient cannot feel the pain when a method is being applied.And he also pointed out that application of the manipulation emphasizes on the proper strength that can heal or alleviate the patient's symptoms without pain during the therapy. What is original in Sun's manipulation is being slight, skillful, gentle and soft. PartⅡ: Experimental studies of pathogenesis of Cervical Coronary Heart DiseaseObjective:Along with the quick rhythm of modem society, the change of work manner, increasing opportunity of cervical vertebra bent, incidence of cervical spondylosis (CS)and diseases due to cervical vertebra degeneration rise continuously, now, have become a kind of modem disease accompaning with modem society. At present, domestic and international medical field have noticed that causes of cervical disease can stimulate or oppression nerve root, spinal cord, vertebral artery or sympathetic nerve to produce clinical various syndrome including visceral symptom. Now, the research to causes of cervical diseases has become a new task of world medical field.In numerous clinical syndrome induced by causes of cervical diseases, cervical coronary heart disease (CCHD)is relatively common. Epidemic investigation show that incidence of CCHD in that of CS take 13%. The cause of CCHD now is considered that cervical degeneration and instability resulting from cervical injary or strain stimulated sympathetic never of predominating cardiovascular function. Now, causes of CCHD still have many aspects to be resolved, how to be in trouble for sympathetic never in causes of CCHD?, is nerve factor involved in only or complex nerve-body fluid mechanism participated in simultaneously? In three cervical ganglion(CG), which is in trouble is more easy to arouse symptom of coronary heart disease(CHD) and appearance of corresponding electrocardiogram expression? If vegetative never functional disturbance due to sympathetic nerve stimulated by cervical degeneration or instability can influence cardiac contractility. These problems have not been had systematic research. Whether myocardial ischemia (MI) induced by CS can lead to organic myocardial damage, and whether CS is one of the causes of CHD still have not unambiguous viewpoint. In basic research, for lack of CCHD animal model, thorough research of its detailed pathogenesis is especially affected.CS can arise symptom of similar CHD. That CS and CHD come on at the same time is also not rare. According to Dates ,18.4%～53.6% in CS patients have heart disease at the same time. Not knowing the connecton between two diseases is necessary or accidental yet.. Therefore, it is significant to study pathogenesis of CCHD and relation between CS and cardiac function.Professor Sun Shu-chun thinks that cervical vertebra is related closely with the qi and blood, meridian and zang fu of the whole body, the pathological changes of cervical vertebra can involve in correlative organs. Following degeneration of cervical intervertebral discs(CIVD) and cervical vertebra instability, CS can be occurred. Cervical local hyperosteogeny and aseptic inflammation can stimulate cervical sympathetic nerve fiber or vertebral artery, so pathological changes passing through central or peripheral reflection and nerve-body fluid-blood circulation factor can influence heart and its blood vessel, which result in CCHD. Professor Sun speculated that sympathetic nerve factor maybe took important role in pathogenesis. Professor Sun also thought that CCHD should belong to" tendon off groove and bone in staggering" in pathogenesis of traditional Chinese medicine (TCM) and by using massage, making "bone reset and tendon go back to groove" could alleviate the stimulation of sympathetic nerve and increase blood supply of vertebra artery. thus, corresponding symptom get been treated better. His experience riched single sympathetic effect theory in pathogenesis of CCHD, and put forward that nerve-body fluid- blood circulation factor took important role in appearance of CCHD.According to "tendon off groove and bone in staggering" theory of TCM, "three columns" theory of modem medicine about spine and theory of internal and external balance of vertebral steady, the experiment made animal cervical vertebra be in staggering and instability with operation, thus induceing MI imitating CHD in electrocardiogram(ECG). The X-rays changes of cervical vertebra and ECG changes were observed regularly to demonstrate if animal model of CCHD was established successfully, the experiment measured changes of neuropeptide substance such as Neuropeptide Y(NPY), Endothelin (ET), Calcitonin gene-related peptide(CGRP), Atrial natriuretic peptide (ANP) in plasma. In order to study that changes of nerve-body fluid-blood circulation induced by cervical instability, vertebra degeneration and sympathetic nerve stimulated is important cause of MI, weaken myocardial contractility and myocardial damage. Author discussed pathogenesis of CCHD, which supplyed academic foundation of prevention and cureing of this disease, at the same time, also riched connotation of diseases related with cervical vertebra. It had been proved by studies on pathogenesis of lumbar disc protrusion that the compression of spinal nerve roots was not the single factor leading to radicular pain and dysfunction and inflammation may be more important to cause impairment on the structure and function of nerve roots. What are the roles of inflammation, inflammatory cytokines and growth factors in the episode of cervical spondyosis? Therefore the cervical intervertebral discs of 3 groups had undergone histological observation for inflammation and detection for the expression of basic fibroblast growth factor (bFGF) and transforming growth factor-β1(TGF-β1) in contrast to the functional status of spinal cord to discuss the role of inflammation, inflammatory cytokines and growth factors in the degeneration of cervical intervertebral discs and impairment of spinal cord. So the pathogenesis of cervical degenerative diseases can be illuminated more completely and it can expand new ideas in the clinical prevention and cure.Methods:1.Study of establishment of animal model of myocardial ischemia induced by cervical instability and pathogenesis of CCHD.30 rabbits were divided into 3 groups randomly, each group of 10, A: normal group; B: model group; C: pseuoperation group. Making CCHD animal model with cutting off supraspinal ligament of C5～6, C6～7, C7～T1, peeling off paravertebral muscle, spining and staggering C6～7 vertebral bodies. After 4, 8 and 12 weeks, taking postero-anterior and lateral radiograph of cervical vertebra to observe changes of cervical intervertebral space, cervical vertebra curvature, intervertebral foramen and hyperplasia aroud vertebra, and analyseing these changes. Furthermore, recording and analyseing changes of ECG before making animal model and 1, 2, 4, 6, 8, 10, 12 weeks after making animal model to observe whether cervical instability lead to ECG of MI.The changes of ECG mainly observed were waveform of each wave, P-R and Q-T interval, ST segment elevation or depression, time of QRS wave, form and direction of T-wave. When finishing the experiment, NPY, ET, CGRP and ANP were measured with radio-immunity methods,2. Study of the experiment measured changes of neuropeptide substance.the experiment measured changes of neuropeptide substance such as Neuropeptide Y(NPY), Endothelin (ET), Calcitonin gene-related peptide(CGRP), Atrial natriuretic peptide (ANP) in plasma. In order to study that changes of nerve-body fluid-blood circulation induced by cervical instability, vertebra degeneration and sympathetic nerve stimulated is important cause of MI, weaken myocardial contractility and myocardial damage.3. study of the infiltration of inflammatory cells.All discs were divided into underwent fixation, dehydration, paraff'm soak, embedding, paraffin blocks making to detect the expression of LCA and KP-1 by immunohistoChemistry (SABC method) on paraffin sections and hematoxylin-eosin(H-E) staining for histoogical observation to study the infiltration of inflammatory cells. The result was positive when there were yellow or brown granules in the cellular plasm of intervertebral disc cells.4. study of the infiltration of growth factors.All discs were divided into underwent fixation, dehydration, paraffin soak, embedding, paraffin blocks making to detect the expression of bFGF and TGF-β1 by immunohistochemistry(SABC method) on paraffin sections and hematoxylin-eosin(H-E) staining for histoogical observation to study the infiltration of inflammatory cells. The result was positive when there were yellow or brown granules in the cellular plasm of intervertebral disc cells.Results:1.Changes and analysis of X-rays of cervical vertebraIntegral value of X-rays of model group was obviously higher than that of normal group and pseuoperation group at 4 weeks and discrepancy was significant(P＜0.01). Along with time prolonging, the discrepancy is more notable, especially at 12 weeks. Integral value of X-rays of normal group compared with pseuoperation group did not have significant discrepancy(P＞0.05). Showing that cervical vertebra has occurred changes of degeneration obviously after cervical vertebra instability caused by operation, and these changes aggravated gradually with times.2.Changes of ECG and analysisIn experimental period, P-wave time of all animals were measured, but outcome did not have significant discrepancy between every groups(P＞0.05). Showing that cervical vertebra instability did not influence electrical exciting course for intra-atrial conduction. After cervical vertebra instability, P-R interval of model group was prolonged, having significant discrepancy (P＜0.05), which was compared with before instability. P-R interval of model group which compared with that of normal group and pseuoperation group was prolonged (P＜0.05), implying that after cervical vertebra instability, the electrical exciting course of atrioventricular conduction was affected and time from atrium to ventricle was prolonged. Time of QRS-wave of model group which compared with that of normal group and pseuoperation group was prolonged(P＜0.05), assoon as cervical vertebra instability. After that time, this instance came into being continuously. Especially, after 8 weeks, discrepancy was more significant(P＜0.01). Showing that the electrical exciting course of intraventricular conduction was affected. Q-T interval of model group which compared with that of normal group and pseuoperation group was prolonged (P＜0.05), showing that cervical vertebra instability could influence electrical exciting course of intraventricular depolarization and repolarization. ST segment depression, T-wave depression and inversion could been observed in all model animals, after cervical vertebra instability. Along with prolongation of time of cervical vertebra instability, the changes of ST-T existed continuously in model animals, but all animals in normal group and pseuoperation group did not express changes of ST-T all the while. Showing that myocardial ischemia of rabbits could been caused by cervical vertebra instability and staggering. Animal model of CCHD was made successfully.3. Changes of plasma neuropeptide and analysisThe plasma NPY, ET, ANP of model group was higher than that of normal group and pseuoperation group, and discrepancy was significant (P＜0.05,P＜0.01). The plasma NPY, ET, ANP between normal group and pseuoperation group did not have significant discrepancy(P＞0.05). The plasma CGRP of model group was lower than that of normal group and pseuoperation group, and discrepancy was significant (P＜0.05,P＜0.01). The plasma CGRP between normal group and pseuoperation group did not have significant discrepancy(P＞0.05). Showing that cervical vertebra instability stimulated nerve fiber, which resulted in sympathetic excitability increased. At the same time, synthesis and release of NPY which coexisted with NA in sympathetic system were increased. NPY could contract blood vessel intensively, which made coronary artery spasm and brought about MI. Catecholamine(CA) which was released because of exciting sympathetic nerve, could directly promote the synthesis of vascular endotheliocyte and secretion of ET. Furthermore, plenty of CA could also make vertebrobasilar artery insufficiency(VBI) and brain ischemia, which could stimulate vascular endotheliocyte of brain and expression of ET-mRNA of cerebral neurogliocyte. thus, secretion of ET may be increased. At the same time, cervical vertebra instability and staggering could oppress vertebral artery, which also made ET increased. ET could made coronary artery spasm and brought about MI, as effected of NPY. When release of plasma NPY was increased, NPY could reinforce the regulation of cardial sensory nerve and decrease composition and release of CGRP. Decreasion of CGRP caused by effect of presynatic regulation of NPY could influence normal chronotrpic and inotropic action of heart and the function of expanding coronary artery, which influenced cardiac function and resulted in MI. CA also could make ischemia and anoxia of lung and myocardium, contraction of lung blood vessel and all capillary, returned blood volume increased, pressure of right atrium increased, which resulted in lots of ANP secreted.The changes of ANP might be protective and compensatory reaction of body.4. Changes of inflammatory cells.In 10 herniatied cervical intervertebral discs, 7(70%) had infiltration of abundant inflammatory cells in margin of the herniated discs. Most of the inflammatory cells were monocytes and macrophages and there was a small quantity of lymphocytes and granulocytes. There were no infiltration in the normal discs. It was showed by ststistical analysis the incidences of inflammatory cells infiltration in model group were more than normal group and there was statistical difference among these 3 groups.5. Changes of inflammatory cells.bFGF and TGF-β1 were negative in most intervertebral discs of normal group and positive in most intervertebra discs of model group. The positive rates of bFGF and TGF-β1 in model gaoup were all significantly more than that in normal group. There was significant difference of the positive, rates of bFGF and TGF-β1 among trauma group, normal group and pseuoperation group. Conclusion:1. Confirmed by X-rays of cervical vertebra and ST-T changes of ECG, methods of damaging three column structure of spine and making internal and external imbalance of cervical vertebra could successfully establish animal model ofCCHD.2.Pathogenesis of CCHD was that cervical sympathetic nerve was simulated, especially ICG and postganglionic fibers. Vegetative never functional disturbance due to stimulating sympathetic nerve could make coronary artery spasm and MI, and also influence electrical exciting course of atrioventricular and intraventricular conduction.3.Furthermore. When VBI caused by stimulating sympathetic nerve occurred, NPY, ET, CGRP and ANP maybe participated in pathogenesis of CCHD.4.It hand been proved that nucleus pulposus had the ability to cause inflammation. More than half of degenerative and injured cervical intervertebral discs had inflammation. Therefore inflammation may play an important role in cervica interverbral disc degeneration, pathogenesis and development of cervical spondylosis. What's more, this study showed that chondrocytes in the degenerative intervertebral discs have inflammatory characteristics which could secret inflammatory cytokines. These inflammatory cytokines not only act on the disc cells and influence the matrix synthesis and degradation of intervertebral discs, but also act on spinal cord and nerve roots to cause inflammation, pain and neurotoxic effect which aggravate the nerve impairment of cervical spondylosis patients. It was showed that the expression level of bFGF and TGF-β1 correspond with different phases maybe the important factor inducing the degeneration of cervical intervertebral discs.