The Study Of The Curative Effect Of Kidney-tonifying And Blood-activating Medicinal For The Early Stage Knee Osteoarthritis And The Meaning Of "Kidney" In Traditional Chinese Medicine

Objective1.Literature reviewTo review the opinion of the TCM Ancient Books and Contemporary TCM Doctors on etiology and pathogenesis and curative effect of "Kidney-tonifying and Blood-activating Medicinal" for the early KOA,and explore the meaning of the thery of "Kidney" and "Kidney Governing Bones".2.Clinical StudyTo evaluate the clinical efficacy of "Kidney-tonifying and Blood-activating Medicinal" for the early KOA.3.Animal Experimental StudyAccording to the pathological change of KOA Rats treated by "LuRong",to evaluate the therapeutic effect of "Kidney-tonifying Medicinal";to explore the effective target of "LuRong" and the meaning of the thery of"Kidney" and "Kidney Governing Bones".Methods1.Literature reviewSearching the KOA relative disease by the keywords,"Bi Zheng"?" Gu Bi"?" Tong Bi"?" Han Bi"?" He Xi Feng"?" Xi Yan Feng"?" Xi Tong"in the TCM Ancient Books,to summarize the etiology?pathogenesis and the treatment experience on KOA.2.Clinical Study60 patients who met the inclusion criteria were randomly divided into experimental group(Kidney-tonifying and Blood-activating Medicinal and Celecoxib)and control group(Celecoxib only)by the method of using simple random.The observation for the two groups was 4weeks.The WOMAC Scale and Lequesne index measurement scale of two group were compared before and after treatment.3.Animal Experimental StudyKnee osteoarthritis rat models were established.After the mold establish," LuRong" in the dose of 0.42g · kg-1 was given to the model rats for six consecutive weeks.Results1.Literature review"Asthenia in Origin and Sthenia in Superficiality" was considered the basic pathogenesis of KOA in the opinion of both TCM Ancient Books and Contemporary TCM Doctors,of which "Kidney Deficiency" was the root of the disease and "Stagnation of Phlegm and Blood Stasis" was the superficial characteristic.So strengthening the body resistance was the major treatment and eliminating pathogens was the minor treatment.The method of"Kidney-tonifying and Blood-activating" was a relatively universally acknowledged effective treatment for the early KOA.2.Clinical StudyThe clinical efficacy was evaluted with WOMAC Scale and Lequesne Index.There was no significant difference in WOMAC Scale before treatment(P=0.081,P>0.05),and there was significant difference between the two groups after treatment(P=0.000,P<0.05),and the D-value between before-and post-treament revealed significant difference between the two groups(P=0.000,P<0.05).Total effective rate of experimental group was 93%and the control group was 67%,Ridit analysis revealed the significant difference between the two groups(P=0.000,P<0.05),so the result of experimental group was better than the control group-There was no significant difference in Lequesne Index score(P=0.165,P>0.05)?pain(P=0.616,P>0.05)and function(P=0.075,P>0.05)before treatment,and there was significant difference between the two groups in Lequesne Index score(P=0.000,P>0.05)?pain(P=0.001,P>0.05)and function(P=0.001,P>0.05)after treatment,and the D-value between before-and post-treament revealed significant difference between the two groups(P=0.014,P<0.05).Total effective rate of experimental group was 97%and the control group was 63%,Ridit analysis revealed the significant difference between the two groups(P=0.000,P<0.05),and the result of experimental group was better than the control group.3.Animal Experimental StudyAfter the model established,the tissue sections showed early osteoarthritis,and which improved after 6 weeks of treatment.There were significant difference on cartilage cAMP(F=35.111,P=0.000(P<0.05))and cGMP(F=11.398,P=0.009(P<0.05))among experimental group?control group and blank group;there were significant difference on liver?kidney?brain and ovary cAMP/cGMP(P<0.05),but there were no significant difference on heart?spleen?lung?intestine and stomach cAMP/cGMP(P>0.05).Conclusion1.Literature reviewDeficiency of kidney and blood stasis was the basic pathogenesis of early stage osteoarthritis,of which "Kidney Deficiency" was the root of the disease and "Stagnation of Phlegm and Blood Stasis" was the superficial characteristic.The method of "Kidney-tonifying and Blood-activating" was a relatively universally acknowledged effective treatment for the Early Stage KOA.2.Clinical StudyBoth "Kidney-tonifying and Blood-activating Medicinal" and Celecoxib could effectively improve the symptoms and function of patients,besides "Kidney-tonifying and Blood-activating" had a synergistic effect for celecoxib.The curative effect of "Kidney-tonifying and Blood-activating Medicinal" Combined with celecoxib was better than celecoxib used only,and it Could also reduce the gastrointestinal adverse reaction of celecoxib to a certain extent.3.Animal Experimental Study"LuRong" could directly act on the articular cartilage of the knee to improve the patients symptoms and function of early stage KOA.Moreover according to the result above,liver?kidney?brain and ovary were also the effective target,the mechanism might be related to the hypothalamic-pituitary-adrenal axis(HPA or HTPA axis).From another opinion,we initially confirmed that the traditional Chinese medicine "kidney"contained some functions of the anatomical "kidney"?"liver"?"brain"and "ovary".Therefore,the viscera in TCM was in the sense of function,but not in anatomy.