| 1.BackgroundOsteoarthritis(OA)is a type of joint disease associated with synovial inflammation,which is caused by the degenerative joint degeneration of articular cartilage.the prevalence of knee osteoarthritis(knee OA),a kind of OA,was 28.7%in people over the age of 40.Knee osteoarthritis is mainly for the symptoms of involvement knee's pain,swelling,morning stiffness,joint effusion or osteomalacia,and those may be associated with activities of bone fricative,dysfunction or deformity.If the symptoms have not been improved for a long time,patients may experience poor social activities and psychological dysfunction,eventually leading to the decline of quality of life,or even unable to live independently.This situation would bring heavy psychological pressure and burden on patients and their families.The purpose of current treatment for KOA is to reduce or eliminate pain,improve or restore joint function,correct deformities,improve the quality of life of KOA patients.The International Association of Osteoarthritis Research(OARSI)reached an expert consensus on 25 kinds of therapies for treating KOA in 2007.Non-drug therapy in conjunction with drug therapy were recommended as the best treatment.However,drug treatment may cause serious gastrointestinal complications,and the risk increases with age and treatment duration.Thermotherapy was recommended,but the supportive evidence was so few,and the clinical efficacy has not been fully proved.Moxibustion,refers to moxa as the main material,prevent diseases through its warm stimulus and drug action on ody surface acupoints or lesions directly or indirectly,after burning burning.Moxibustion is one of the commonly accepted method of hyperthermia in clinical practice.Authentic medicine is recognized by people in a particular area of origin of good quality,excellent processing technology,significant curative effect,higher yield of Chinese herbal medicines.At present,most researches on authentic medicinal herbs focused on the comparison of oral medicinal herbs.those results showed that the effects of authentic medicinal herbs are obviously higher than those of non-authentic medicinal herbs.However,the comparison between the authenticity and the non-authenticity of topical medicinal materials such as moxa is few.There is no clear evidence of modern researches to show whether the moxa between different areas will have a difference on the moxibustion effect.Medical experts believed that Qichun is moxa's best production area,and named after the place name.However,there are varieties of moxa from different place in the market at present,with the development of Chinese medicine planting industry.But we cannot prove whether moxa produced from Qichun has a better curative effect in clinical treatment.Based on the previous research and analysis of authentic medicinal plants by researchers both at home and abroad,we think that authentic medicinal plants may also have unique curative effects when applied topically(moxibustion),which is superior to that of medicinal plants in general origin.Therefore,we designed this research intending to analyze the clinical curative effect of different moxibustion materials for the treatment of knee osteoarthrosis,infrared imaging comparison of different moxibustion materials,and the combustion characteristics of different moxibustion materials in order to clarify the curative effect of different moxibustion materials and the physiology basis for the difference of curative effect.2.Objectives1.To evaluate the clinical efficacy of moxibustion in different origins,to compare the clinical efficacy of moxibustion materials from different origins;2.Through the comparison of infrared imaging of different moxibustion materials and the observation of the combustion pyrolysis study,to analyze the differences in efficacy of different moxibustion materials.3.MethodsThis study was divided into three parts:clinical research,Infrared thermography to detect acupoint temperature and analysis of burning moxibustion materials.3.1 Clinical Research3.1.1 Research MethodsThis research included 350 participants met the inclusion criteria,from May 2016 to December 2017,from the acupuncture and combustion Hospital of Chinese Academy of Traditional Chinese Medicine,Shanghai Institute of acupuncture meridian,Guang' anmen Hospital of Chinese Academy of Traditional Chinese Medicine,Beijing First Integrative Medicine Hospital.Those participants were randomly divided into Qichun moxa group(140),Nanyang moxa group(140)and Yinchen group(70),according to the distribution ratio of 2:2:1 by central randomized system.Both three groups took moxibustion on three standard acupoints(ST 35,EX-LE 4 and EX-LE 2)of the affected knee 20 minutes per session,3 sessions per week for 2 weeks.A four—head,floor-type moxibustion apparatus,consisting of a base,an adjustable holder,four flexible tubes with clamps,was be used for the implementation of moxibusiton.Patients has been required to feel an intolerable causalgia(approximately 40-43?)within 5 minutes.Once it is attained,quickly adjust the height of the burning tip to allow patients to keep a comfortable moxibusiton sensation in the rest of the treatment.Specialized evaluators completed the collection and evaluation of the data.Observation indicators included general data,knee pain VAS scores,and WOMAC scores for each item score.The scores of the knee pain VAS score and WOMAC score were evaluated at the time of enrollment,2 weeks after treatment,and 4 weeks after the end of treatment.The main efficacy evaluation index was the change of knee pain VAS score and WOMAC pain item score after 2 weeks of treatment compared with baseline.3.1.2 Results3.1.2.1 General InformationThere was no significant difference between the three groups before treatment in age,duration of disease,pain VAS score,WOMAC pain score,WOMAC stiffness score,and WOMAC functional activity score.The three groups of patients were from the same group and could be compared.3.1.2.2 WOMAC pain item scoreCompared with baseline,the socores of three groups in the 2 weeks after treatment and 4 weeks follow up,the difference was statistically significant(P<0.01)Qichun moxa group' s scores continued to decrease during follow-up.There was no significant difference in the scores of WOMAC pain items between three groups at 2 weeks after treatment and 4 weeks follow up.3.1.2.3 knee pain VAS score comparisonCompared with baseline,,the socores of three groups in the 2 weeks after treatment and 4 weeks follow up,the differences between the three groups were statistically significant(P<0.001).The VAS scores of knee pain in Qichun moxa group continued to decrease.There were significant differences in VAS score and score among the three groups at 2 weeks of treatment and 4 weeks follow up(P<0.05).3.1.2.4 WOMAC stiff project score comparisonCompared with baseline,the socores of three groups in the 2 weeks after treatment,although each group scores were reduced for stiff project score,but the difference was not statistically significant.After 4 weeks follow up,the scores of the three groups continued to decrease The differences among the three groups were statistically significant(P<0.001).After 2 weeks treatment and 4 weeks follow up,there were significant differences among the three groups(P<0.05),but there was no significant difference in the Variety between the scores at each time point.3.1.2.5 WOMAC functional activity item score comparisonCompared with baseline,the socores of three groups in the 2 weeks after treatment and 4 weeks follow up,the three groups were statistically significant differences(P<0.001).After two weeks of treatment and 4 weeks follow up,there were significant differences(P<0.05)in scores and variety between WOMAC functional activity items scores at each time point.3.2 Study on Infrared Features of Different Knee Moxibustion Treating Primary Knee Arthritis3.2.1 Research Methods20 participants with moderate-severe KOA(6 in Qichun moxa group,9 in Nanyang moxa group and 5 in Yinchen group)were enrolled.The temperature were tested immediately before and after moxibustion with the medical infrared thermal imager,comparing the temperature changes between the three groups.3.2.2 ResultsCompared within group,All groups showed temperature increase after moxibustion,compared with those before moxibustion.All groups had statistical significance(P<0.01).compared between groups,the three groups showed no significant difference(P>0.05)before and after moxibustion.However,comparison of temperature changes before and after moxibustion in three groups,we found Qichun group had the largest slope,followed by Nanyang group and Yinchen group with the smallest slope,by means of the graph of temperature change.3.3 Study on Combustion Pyrolysis Characteristics of Different Moxibustion Materials3.3.1 Research MethodsThe research used the SDT-Q600 Differential-Thermo-Synchronous Thermal Analyzer.According to the physical properties of Moxa' s biomass and the characteristics of routine clinical use,air was used as carrier gas.With reference to the experimental conditions of the pyrolysis process of similar biomass,through program temperature-raising scanning,set the experiment temperature as-900?,heating rate 10?/min,air flow rate 100ml/min,using A1203 empty cesium as control sample.Each sample weight 7.5mg.Two measurements were made for each sample.Compared the weight loss and caloric release of the four moxibustion materials in the thermal decomposition stage(? zone)of Qichun Moxa(5 years,10:1),Nanyang moxa(5 years,10:1),Yinchenrong,and Ai carbon.3.3.2 ResultsThe thermal weight loss curves of Qichun Moxa,Nanyang Moxa and Yinchen were similarly,The thermal weight loss curves of Ai carbon was different from Hunchun moxa,Nanyang moxa,and Yinchenrong The Ai carbon burning trend basically shows the concentrated release of heat in stage?.In stage I,mainly for the precipitation of water.Comparison of the weight loss rate of different moxibustion materials at this stage:Yinchen>Qichun>Nanyang,However,the difference between the three was not obvious.In stage II,the main performance is the combustion and decomposition of hemicellulose,cellulose,and part of lignin,producing small molecule gases,aromatic derivatives,and macromolecular coke species.Comparison of the weight loss rate of different moxibustion materials at this stage:Qichun>Nanyang>Yinchen.The heat release of the three at this stage wasQichun>Nanyang>Yinchen.The maximum exothermic temperature of different moxibustion materials was directly proportional to their respective heat release.The higher the maximum exothermic temperature,the more heat was released.In stage III,mainly for the carbonization.Comparison of the weight loss rate of different moxibustion materials at this stage:Nanyang>Qichun>Yinchen?The burning trend of the three moxibustion materials at this stage was similar to that of Ai carbon.4 Conclusions1.Qichun moxa,Nanyang moxa and Yin Chen can improve pain and functional activities of patients with knee joint disease,improve patient quality of life.2.In relieving pain and improving functional activity in patients with KOA,Qihun moxa is superior,which may be related to the release of calories during combustion and the magnitude of temperature increase. |
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