Observation On The Clinical Efficacy Of Combined Acupuncture And Medicine In The Treatment Of Ulcerative Colitis And Research On Inflammatory Factors

There are four parts in this dissertation:literature review,meta-analysis,clinical researches and animal studies mainly describe the situations of modern medicine and traditional Chinese medicine on ulcerative colitis(UC)in clinical research and animal studies.The goal of the disseration is to evaluate the efficacy of moxibustion or acupuncture with herbs to treat with UC patients and observe "warm yang and improve fire" moxibustion and acupuncture combined with Qingchang Wenzhong Formula in the treatment of UC patients,evaluate the relationship between the severity levels of UC and HCY,pANCN,AIF-1 as well,and explore the influence on UC rats about inflammatory factors from "warm yang and improve fire"moxibustion and acupuncture combined with Qingchang Wenzhong Formula.1.literature reviewThe etiology,diagnosis and treatment of ulcerative colitis were summed up based on the recent ten years from Pubmed and cnki.In addition,clinical researches and animal experimental studies of traditional Chinese medicine,acupuncture or moxibustion therapy and traditional Chinese medicine combined with acupuncture or moxibustion therapy for UC in recent five years were collected and analyzed from cnki and wanfang resource database.2.Meta analysisObjective:To analyze the clinical effect of acupuncture combined with medicine in the treatment of ulcerative colitis systematically.Methods:Search the databases of CNKI,Wanfang,VIP and PubMed by computer,and select the RCT literature of acupuncture and medicine combined therapy for ulcerative colitis.Results:A total of 19 articles conforming to the standards were included,inciuding 1918 patients.The results showed that the total effective rate of combined acupuncture and medicine therapy for UC compared with other methods was:RR=1.24,95%ci[1.20,1.29],P<0.00001,and funnel plot and sensitivity analysis showed low heterogeneity and publication bias.Conclusion:The combination of acupuncture and medicine in the treatment of UC is more effective than western medicine or one of the methods alone.However,given the uneven quality of the literature,further research is needed.3.Clinical researchObjective To observe the clinical effect of "warm yang and improve fire" moxibustion and acupuncture combined with Qingchang Wenzhong Formula in the treatment of mild-moderate ulcerative colitis(UC)patients with cold-heat jumble and stagnation of damp-heat syndrome.Methods 60 patients with mild-moderate UC were divided into moxibustion and acupuncture combined with medicine group(30 cases)and Traditional Chinese medicine group(30 cases)according to the randomized controlled method.The acupuncture group was given warm moxibustion and acupuncture+ Qingchang Wenzhong formula granule,while the traditional Chinese medicine group was given Qingchang Wenzhong formula granule,and both of them were treated for 2 weeks.The changes of single symptom score,TCM syndrome score,IBDQ scale,HCY,pANCA,AIF-1 before and after treatment were observed.Results 52 cases were enrolled by eliminating unqualified cases,22 cases in acupuncture group,30 cases in Traditional Chinese medicine.After treatment,two groups of individual symptoms integral,TCM syndrome integral,IBDQ scale scores were improved from the previous,the difference was statistically significant(P<0.05).According to the score and curative effect comparison of the two groups after treatment,there was no statistically significant difference(P>0.05).The symptoms of chills,poor appetite,nausea and vomiting were significantly improved in the acupuncture group.But there were no difderences between the before and after treatment of the two groups on HCY,pANA,AIF-1.Conclusion "warm yang and improve fire" moxibustion and acupuncture combined with Qingchang Wenzhong Formula can significantly improve the clinical symptoms,reduce the disease activity and improve the quality of life of UC patients and the combination of acupuncture and medicine has a more obvious effect on the improvement of patients’ systemic symptoms than the single treatment with traditional Chinese medicine.But HCY,pANCA,AIF-1 cant’t be used to judge the severity levels.4.Animal experimentsObjective To investigate the changes of serum inflammatory cytokines I1-6,Il-8,I1-10,I1-17 and TNF-α in rats with UC by "warm yang and improve fire" moxibustion and acupuncture combined with Qingchang Wenzhong Formula.Methods 60 SD rats were randomly divided into 5 groups:normal group,model group,medicine group,formula group,moxibustion and acupuncture group,moxibustion and acupuncture combined with medicine group.And normal group of normal diet and water,well,the rest of the four groups drank water for 10 days with 4.5%DSS solutions freely to make mould for UC.In each treatment group,corresponding treatmentat was given at the same time for 10 days.In medicine group,Qingchang Wenzhong formula granule was given according to the "equivalent dose ratio of human and animal body surface area",and the same grasping and fixation technique was used to grasp and fix them as in the moxibustion and acupuncture group.In the moxibustion and acupuncture group,the rats were placed in the rat sheath for fixation.The acupuncture points were selected as Zhongwan,Shuifen,Tianshu(both sides),Daheng(both sides),Qihai and Guanyuan for acupuncture.The needles were retained for 15min and moxibustion was suspended.In the moxibustion and acupuncture combined with medicine group,the same treatments were given as the moxibustion and acupuncture group,moxibustion and acupuncture combined with medicine group.During this period,the general state of the rats was observed every day,as well as the weight,stool characteristics and occultation blood of the rats were recorded to evaluate DAI.Treatment after 10 days,make abdominal aortic blood,centrifugal,-80℃,serum Elisa method to detect the serum IL-6,IL-8,IL 10,IL-17,TNF-α level,at the same time take colon tissue injury 1 x 1 cm,with 4%paraformaldehyde fixed,embedding,sectioning,HE staining to observe its pathological condition,colon histopathological grading(HS).Results:UC model group rats serum IL-6,IL 8,IL-17,TNF-α levels were obviously higher than that of normal group,IL-10 levels significantly lower than normal group(P<0.01),while after the treatment,the level of IL-6,IL-8,IL-17,TNF-α ofthreegroups were lower than in the model group(P<0.05).The level of IL-6,TNF-α in three treatment groups had no statistical significance(P>0.05),and compared with the combined group,the level of I1-8 and I1-17 in the moxibustion and acupuncture group decreased more significantly,while the levels of I1-10 increased more significantly(P<0.05).In terms of symptom and pathological score,there were no significant differences in DAI and HS scores among the three treatment groups(P>0.05).Conclusion:Both Qingchang Wenzhong Formula and warm moxibustion and acupuncture can improve the symptoms of UC and intestinal mucosal injury in rats,possibly by reducing the levels of serum inflammatory cytokines I1-6,I1-8,I1-17 and TNF-α,increasing the level of I1-10,and maintaining the balance between proinflammatory factors and anti-inflammatory factors in UC,so as to achieve the therapeutic effect on the disease.However,it is necessary to explore further whether the combination of Qingchang Wenzhong Formula and warm moxibustion and acupuncture have superposition effects on the treatment of this disease.