이 작업은 Shanghai Critical Clinical Specialties Construction Project(보조금 번호: Shslczdzk04001)의 지원을 받았습니다. 상하이 과학 기술위원회의 항해 프로그램 (보조금 번호 : 22YF1444300); Shanghai University of Traditional Chinese Medicine(허가 번호: 2021LK091)의 예산 범위 내 프로젝트.

쥐의 무릎 골관절염에 대한 표준화된 Tuina 조작

<ol>
	<li>Joint Surgery Group of Chinese Orthopaedic Association, Chinese Association of Orthopaedic Surgeons, National Clinical Research Center for Geriatric Diseases, Chinese Journal of Orthopaedics. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=Chinese+Osteoarthritis+Treatment+Guidelines+(2021+Edition).">Chinese Osteoarthritis Treatment Guidelines (2021 Edition).</a> Chinese Journal of Orthopaedics. 41 (18), 24 (2021).</li><li>David, S., et al. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=Epidemiology+of+knee+osteoarthritis+in+general+practice:+a+registry-based+study.">Epidemiology of knee osteoarthritis in general practice: a registry-based study.</a> BMJ Open. 10 (1), 031734 (2020).</li><li>Callahan, L. F., Cleveland, R. J., Allen, K. D., Golightly, Y. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=Racial/Ethnic,+Socioeconomic,+and+Geographic+Disparities+in+the+Epidemiology+of+Knee+and+Hip+Osteoarthritis.">Racial/Ethnic, Socioeconomic, and Geographic Disparities in the Epidemiology of Knee and Hip Osteoarthritis.</a> Rheumatic Disease Clinics of North America. 47 (1), 1-20 (2021).</li><li>Wang, K., Dong, X., Lin, J. H. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=Investigation+of+Medical+Costs+of+Disease+In+Patients+With+Osteoarthritis+of+the+Knee+Joint.">Investigation of Medical Costs of Disease In Patients With Osteoarthritis of the Knee Joint.</a> National Medical Journal of China. 97 (1), 4 (2017).</li><li>Perlman, A., et al. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=Efficacy+and+Safety+of+Massage+for+Osteoarthritis+of+the+Knee:+a+Randomized+Clinical+Trial.">Efficacy and Safety of Massage for Osteoarthritis of the Knee: a Randomized Clinical Trial.</a> Journal of General Internal Medicine. 34 (3), 379-386 (2019).</li><li>Xing, H., et al. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=Therapeutic+massage+for+knee+osteoarthritis:+a+systematic+review+and+meta-analysis+of+randomized+controlled+trials.">Therapeutic massage for knee osteoarthritis: a systematic review and meta-analysis of randomized controlled trials.</a> Journal of Acupuncture and Tuina Science. 19 (5), 354-363 (2021).</li><li>Seo, B. R., et al. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=Skeletal+muscle+regeneration+with+robotic+actuation-mediated+clearance+of+neutrophils.">Skeletal muscle regeneration with robotic actuation-mediated clearance of neutrophils.</a> Science translational medicine. 13 (614), (2021).</li><li>Wu, J. H., Zhang, C., Dong, S. J., Yin, H. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=Effects+of+Massage+with+#34;Relaxing+Tendons&amp;#34;+Technique+on+the+Interleukin-1B+and+5-hydroxytryptamine+Levels+in+the+Joint+Fluid+of+a+Rabbit+Knee+Osteoarthritis+Model.">Effects of Massage with #34;Relaxing Tendons&amp;#34; Technique on the Interleukin-1B and 5-hydroxytryptamine Levels in the Joint Fluid of a Rabbit Knee Osteoarthritis Model.</a> Chinese General Practice. 21 (6), 688-693 (2018).</li><li>Luo, R. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=The+effects+of+IL-1B,IL-6,IL-13,IL-26,TNF-a+by+patellar+manipulations+on+rabbit+knee+osteoarthritis+model.">The effects of IL-1B,IL-6,IL-13,IL-26,TNF-a by patellar manipulations on rabbit knee osteoarthritis model.</a> Guangxi University of Traditional Chinese Medicine. , (2017).</li><li>Qiu, F., Li, C., Wu, X., Liu, Y., Zhang, X. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=Effect+of+Massage+on+the+Function+of+Foot-Yangming+Meridian-Muscle+in+Patients+with+Knee+Osteoarthritis.">Effect of Massage on the Function of Foot-Yangming Meridian-Muscle in Patients with Knee Osteoarthritis.</a> Acta Chinese Medicine. 36 (3), 649-655 (2021).</li><li>Yang, B., Li, S. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=Research+Progress+of+Massage+in+Improving+Biomechanical+Indexes+of+Knee+Osteoarthritis.">Research Progress of Massage in Improving Biomechanical Indexes of Knee Osteoarthritis.</a> Acta Chinese Medicine. 37 (12), 2571-2576 (2022).</li><li>Li, C., Qiu, F., Ding, J., Hu, G., Zhang, X. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=Curative+Observation+of+Retaining+of+Heated+Needle+at+Trigger+Points+Combined+with+Manipulation+for+Muscles+along+Meridians+in+Treating+Knee+Osteoarthritis.">Curative Observation of Retaining of Heated Needle at Trigger Points Combined with Manipulation for Muscles along Meridians in Treating Knee Osteoarthritis.</a> Journal of Guangzhou University of Traditional Chinese Medicine. 37 (11), 2157-2162 (2020).</li><li>Ding, X., Zhang, X., Hou, Y., Zhao, Z., Ye, X. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=Effect+of+massage+manipulation+on+joint+stiffness+of+knee+osteoarthritis+patients+based+on+&amp;#34;spine-pelvis-knee&amp;#34;+holistic+diagnosis+and+treatment+pattern.">Effect of massage manipulation on joint stiffness of knee osteoarthritis patients based on &amp;#34;spine-pelvis-knee&amp;#34; holistic diagnosis and treatment pattern.</a> Shanghai Journal of Traditional Chinese Medicine. 55 (08), 54-57 (2021).</li><li>Fu, Y., Gong, L., Li, Y. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=The+clinical+studies+of+Rolling+combined+with+Pulling+Manipulation+on+Early+and+Middle-term.">The clinical studies of Rolling combined with Pulling Manipulation on Early and Middle-term.</a> Jilin Journal of Chinese Medicine. 40 (07), 958-962 (2020).</li><li>Jiang, J., Hu, X., Tang, R., Qiu, F., Huang, L. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=Change+of+lower+limb+force+line+in+treating+knee+osteoarthritis+with+manipulation.">Change of lower limb force line in treating knee osteoarthritis with manipulation.</a> Journal of Changchun University of Chinese Medicine. 34 (01), 129-132 (2018).</li><li>Liang, Y., et al. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=Some+issues+on+animal+experiments+standardization+of+acupuncture+and+moxibustion.">Some issues on animal experiments standardization of acupuncture and moxibustion.</a> Lishizhen Medicine and Materia Medica Research. 25 (09), 2299-2300 (2014).</li><li>Guo, Y., Liu, Y., Liu, Q., Chen, Z., Zhao, X. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=Basic+System+of+Chinese+Acupuncture+Standard.">Basic System of Chinese Acupuncture Standard.</a> Chinese Acupuncture &amp; Moxibustion. 31 (6), 549-550 (2011).</li><li>YAN, X., Yan, J. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=Study+on+the+Standardization+of+Classification+of+Tuina+Manipulation.">Study on the Standardization of Classification of Tuina Manipulation.</a> Acta Chinese Medicine. 32 (5), 875-878 (2017).</li><li>Aikebaier, G., Lu, X., Liu, J., Liu, l., Wang, S. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=Analysis+on+Manipulation+and+Acupoint+Selection+Laws+of+Massage+for+Treatment+of+Knee+Osteoarthritis+Based+on+Data+Mining+Technology.">Analysis on Manipulation and Acupoint Selection Laws of Massage for Treatment of Knee Osteoarthritis Based on Data Mining Technology.</a> Chinese Journal of Information on Traditional Chinese Medicine. 29 (5), 23-29 (2022).</li><li>Gong, L., Wuquan, S., Zhang, H., Chen, Z. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=Research+of+Yan+Juntao's+Academic+Experiences+of+Differential+Treatment+and+Manipulation+for+Treating+of+Knee+Osteoarthritis.">Research of Yan Juntao's Academic Experiences of Differential Treatment and Manipulation for Treating of Knee Osteoarthritis.</a> Chinese Journal of Traditional Medical Traumatology &amp; Orthopedics. 24 (7), 16-19 (2016).</li><li>Qian, J., Xing, X., Liang, J. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=Two+Methods+to+Establish+Rat+Model+of+Osteoarthritis+of+the+Knee.">Two Methods to Establish Rat Model of Osteoarthritis of the Knee.</a> Research and Exploration in Laboratory. 33 (11), 23-27 (2014).</li><li>Liu, J., et al. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=Experimental+study+of+a+modified+Videman+method+for+replicating+knee+osteoarthritis+on+rabbit.">Experimental study of a modified Videman method for replicating knee osteoarthritis on rabbit.</a> Rehabilitation Medicine. 30 (03), 212-219 (2020).</li><li>Moskowitz, R. W. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=Osteoarthritis+cartilage+histopathology:+grading+and+staging.">Osteoarthritis cartilage histopathology: grading and staging.</a> Osteoarthritis and Cartilage. 14 (1), 1-2 (2005).</li><li>Shen, M., Li, Z., Shen, J. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=Preliminary+Exploration+of+Experiment+Teaching+on+Experiment+Acupuncture+Science.">Preliminary Exploration of Experiment Teaching on Experiment Acupuncture Science.</a> Chinese Medicine Modern Distance Education of China. 7 (02), 130-131 (2009).</li><li>Jeong, J., et al. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=Anti-osteoarthritic+effects+of+ChondroT+in+a+rat+model+of+collagenase-induced+osteoarthritis.">Anti-osteoarthritic effects of ChondroT in a rat model of collagenase-induced osteoarthritis.</a> BMC complementary and alternative medicine. 18 (1), 131 (2018).</li><li>Hulth, A., Lindberg, L., Telhag, H. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=Experimental+osteoarthritis+in+rabbits.+Preliminary+report.">Experimental osteoarthritis in rabbits. Preliminary report.</a> Acta orthopaedica Scandinavica. 41 (5), 522-530 (1970).</li><li>Tawonsawatruk, T., Sriwatananukulkit, O., Himakhun, W., Hemstapat, W. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=Comparison+of+pain+behaviour+and+osteoarthritis+progression+between+anterior+cruciate+ligament+transection+and+osteochondral+injury+in+rat+models.">Comparison of pain behaviour and osteoarthritis progression between anterior cruciate ligament transection and osteochondral injury in rat models.</a> Bone &amp; Joint Research. 7 (3), 244-251 (2018).</li><li>Zhou, Q., et al. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=Cartilage+matrix+changes+in+contralateral+mobile+knees+in+a+rabbit+model+of+osteoarthritis+induced+by+immobilization.">Cartilage matrix changes in contralateral mobile knees in a rabbit model of osteoarthritis induced by immobilization.</a> BMC musculoskeletal disorders. 16, 224 (2015).</li><li>Zeng, J., et al. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=Establishment+and+identification+of+experimental+rabbit+model+of+knee+osteoarthritis.">Establishment and identification of experimental rabbit model of knee osteoarthritis.</a> Chinese Journal of Clinical Research. 29 (5), 679-682 (2016).</li><li>Shang, P., et al. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=Comparison+with+two+kind+osteoarthritis+animal+models+reduced+by+plaster+immobilization+in+extend+excessive+position+and+bend+excessive+position+respectively.">Comparison with two kind osteoarthritis animal models reduced by plaster immobilization in extend excessive position and bend excessive position respectively.</a> Orthopaedic Biomechanics Materials and Clinical Study. (1), 11-14 (2006).</li><li>He, Y., et al. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=Evaluation+of+the+effect+of+improved+cast+immobilization+method+on+rabbit+knee+osteoarthritis+model.">Evaluation of the effect of improved cast immobilization method on rabbit knee osteoarthritis model.</a> Chinese Imaging Journal of Integrated Traditional and Western Medicine. 18 (2), 198-219 (2020).</li><li>Pengfei, S., et al. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=Possible+mechanism+underlying+analgesic+effect+of+Tuina+in+rats+may+involve+piezo+mechanosensitive+channels+within+dorsal+root+ganglia+axon.">Possible mechanism underlying analgesic effect of Tuina in rats may involve piezo mechanosensitive channels within dorsal root ganglia axon.</a> Journal of Traditional Chinese Medicine. 38 (6), 834-841 (2018).</li><li>Wang, Y. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=Mechanisms+of+Massage+Mediating+Chondrocyte+Apoptosis+in+Knee+Osteoarthritis+Through+Piezo+1/JAK2+Signaling+Pathway.">Mechanisms of Massage Mediating Chondrocyte Apoptosis in Knee Osteoarthritis Through Piezo 1/JAK2 Signaling Pathway.</a> Shandong University of Traditional Chinese Medicine. , (2019).</li><li>Liu, J. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=Effect+of+Massage+on+TLR4/MyD88+Signal+Transduction+Pathway+in+Rat+Knee+Osteoarthritis+Model.">Effect of Massage on TLR4/MyD88 Signal Transduction Pathway in Rat Knee Osteoarthritis Model.</a> Guangzhou University of Traditional Chinese Medicine. , (2019).</li><li>Yu, S., Zhou, J., Pang, X. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=Advances+in+induced+animal+models+of+knee+osteoarthritis.">Advances in induced animal models of knee osteoarthritis.</a> Journal of Guangxi University of Chinese Medicine. 25 (5), 50-55 (2022).</li><li>Tan, Q., et al. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=Acupuncture+combined+with+moxibustion+regulates+the+expression+of+circadian+clock+protein+in+the+synovium+of+rats+with+osteoarthritis.">Acupuncture combined with moxibustion regulates the expression of circadian clock protein in the synovium of rats with osteoarthritis.</a> Chinese Journal of Tissue Engineering Research. 26 (11), 1714-1719 (2022).</li><li>Zhang, Z., et al. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=A+Review+of+Massage+Therapy+for+Knee+Osteoarthritis.">A Review of Massage Therapy for Knee Osteoarthritis.</a> Henan Traditional Chinese Medicine. 39 (1), 146-149 (2019).</li><li>Gong, L., Sun, W., Zhang, H., Chen, Z. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=Research+of+Yan+Juntao's+Academic+Experiences+of+Differential+Treatment+and+Manipulation+for+Treating+of+Knee+Osteoarthritis.">Research of Yan Juntao's Academic Experiences of Differential Treatment and Manipulation for Treating of Knee Osteoarthritis.</a> Chinese Journal of Traditional Medical Traumatology &amp; Orthopedics. 24 (7), 16-19 (2016).</li><li>Chen, C., Zhang, H. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=Research+on+the+rules+of+acupoint+selection+for+the+treatment+of+knee+osteoarthritis+with+massage+based+on+data+mining.">Research on the rules of acupoint selection for the treatment of knee osteoarthritis with massage based on data mining.</a> Hainan Medical Journal. 29 (18), 2617-2619 (2018).</li></ol>

저자는 경쟁 이익이 없다고 선언합니다.

이 연구는 KOA 쥐에 대한 Tuina 조작에 대한 프로토콜을 제공합니다. 통증 행동 테스트와 조직형태학적 소견을 통해 KOA 쥐에 적용된 이러한 일련의 Tuina 조작이 활막 염증과 연골 세포 사멸을 감소시킬 수 있음을 시사했으며, 이는 KOA 동물 모델에 대한 Tuina 조작의 참고 자료가 될 수 있습니다.
프로토콜 중에는 몇 가지 중요한 절차가 있습니다. 첫째, KOA 모델을 유도하기 위한 적?...

무릎 골관절염(KOA)은 주로 관절통에서 나타나는 퇴행성 질환입니다. 섬유화, 갈라짐, 궤양, 관절 연골 손실이 이 질환의 주요 원인이다1. KOA는 유병률이 높으며 환자의 일상 생활에 지대한 영향을 미쳐 심한 경우 장애를 유발할 수 있습니다. 45-84 세의 사람들 중 KOA의 유병률은 나이가 들면서 증가하고 85 세 이상 인구의 유병률은 15 %이며 여성이 우세합니다 2,3. 또한 KOA는 개인과 사회 모두에 심각한 경제적 부담을 줄 수 있습니다. 설문 조사에 따르면 1인당 KOA의 직접 의료 비용은 연간 $5,120 ± $8,858에 달했습니다4. 사회의 고령화와 함께 KOA는 전 세계적인 건강 문제이자 주요 사회 문제이자 과학 연구의 주제가 되었습니다.
증거 기반 연구에 따르면 KOA5 치료에 Tuina 조작의 효과가 있음이 밝혀졌습니다. Tuina 조작은 KOA 환자의 통증을 완화하고 기능 장애를 개선 할 수 있으며, 그 메커니즘은 항 염증 효과와 관련이 있습니다 6,7. 학자들은 Tuina 조작이 염증 인자인 인터루킨(IL)-β 및 5-하이드록시트립타민의 발현을 효과적으로 억제하고 토끼 KOA 모델8에서 관절 연골의 퇴행을 늦춘다는 것을 발견했습니다. Tuina는 병변 부위의 혈액 순환과 신진 대사를 촉진하여 IL-1, IL-6 및 종양 괴사 인자 (TNF) -α와 같은 염증 인자를 제거하여 KOA9의 임상 증상을 완화 할 수 있음을 시사했습니다. 또한, Tuina 조작을 통한 관절의 수동적 움직임은 관절 연골로의 활액의 침투 및 확산을 촉진하고 조직 영양소 대사를 향상시킬 수 있습니다10. 다른 연구에서는 Tuina 조작이 KOA 환자의 생체역학적 지표를 효과적으로 개선할 수 있다고 제안했다11. 연조직에 적용된 조작은 팔다리의 스트레스 분포를 개선하고 균형 기능을 향상시킬 수 있습니다12,13. 동시에, 일부 관절 조정 조작을 통해 비정상적인 보행을 교정하기 위해 하지의 정렬을 조정할 수도 있습니다(14,15).
KOA 치료에서 Tuina 조작의 작용 메커니즘은 아직 연구되지 않았으므로 실험적 연구가 필요합니다. 실험동물에 투이나를 적용하는 핵심은 모델링, 동물 고정, 개입 방법의 표준화이다16. 모델링 방법은 실험 동물이 질병의 특성을 나타낼 수 있는지 여부를 결정합니다. 한편, 적절한 고정 방법은 Tuina 조작의 개입을 용이하게하고 Tuina의 효과를보다 잘 반영 할 수 있습니다. 개입 방법의 표준화는 Tuina 조작에서 가장 어려운 부분입니다. 2010년 중국 침술 기준의 기본 체계는 실험동물에 대한 경혈 기준을 언급하여 동물실험에서 침술 및 투이나(Tuina) 수술의 가능성을 제공했다17. 그러나 Tuina 조작을 표준화하는 데는 여전히 어려움이 있습니다. Tuina 조작에는 여러 유형이 있습니다18. 특정 조작의 선택은 주로 치료할 질병과 수행자가 선호하는 치료 이론에 달려 있습니다. KOA에 대한 Tuina의 연구에서는 포인트 프레싱 조작(엄지손가락이나 팔꿈치로 특정 경혈을 누르는 것), Yizhichan 푸시 조작(엄지손가락을 흔들어 누르는 조작), 프레스 및 주무르기 조작(손가락이나 손바닥으로 신체 표면의 특정 부위를 누르고 주무르는 것을 말함)에 더 많은 주의를 기울였습니다.19. 프레스 및 반죽 조작은 피하 조직을 이동시키기 위해 압착 및 반죽을 결합하는 가장 널리 사용되는 Tuina 조작 중 하나이다(20). 경혈에 적용되는 프레스 및 반죽 조작은 혈액 순환을 촉진하고 통증을 완화시킬 수 있으며 KOA19에 대한 Tuina의 치료 효과를 나타냅니다.
이 프로토콜에서는 향후 연구를 위한 참고 자료를 제공하기 위해 선택된 경혈, 조작의 강도 및 빈도, 쥐의 신체 위치를 포함하여 KOA 쥐에 대한 프레스 및 반죽 조작 작업을 자세히 설명합니다.

<table border="1" fo:keep-together.within-page="1" fo:keep-with-next.within-page="always">
	<tbody>
		<tr>
			<td>absolute ethanol</td>
			<td>Supelco</td>
			<td>PHR1070</td>
			<td>For making specimen</td>
		</tr>
		<tr>
			<td>ALMEMO admeasuring apparatus</td>
			<td>ahlborn</td>
			<td>2450-1</td>
			<td>For Mechanical Withdrawal Threshold test</td>
		</tr>
		<tr>
			<td>Anti-Digoxin antibody</td>
			<td>Sigma-Aldrich</td>
			<td>SAB4200669</td>
			<td>For HE stain IHC or TUNEL</td>
		</tr>
		<tr>
			<td>Anti-IL-1 beta</td>
			<td>abcam</td>
			<td>ab283818</td>
			<td>For HE stain IHC or TUNEL</td>
		</tr>
		<tr>
			<td>DAB Substrate kit</td>
			<td>Solarbio</td>
			<td>DA1010</td>
			<td>For HE stain IHC or TUNEL</td>
		</tr>
		<tr>
			<td>Denture base materials</td>
			<td>Shanghai New Century</td>
			<td>20000356</td>
			<td>For model making</td>
		</tr>
		<tr>
			<td>eosin</td>
			<td>bioswamp&#160;</td>
			<td>PAB180016&#160;</td>
			<td>For HE stain IHC or TUNEL</td>
		</tr>
		<tr>
			<td>Finger pressure recordings</td>
			<td>Suzhou Changxian Optoelectronic Technology</td>
			<td>CX1003w</td>
			<td>For Tuina manipulation</td>
		</tr>
		<tr>
			<td>formic acid solution</td>
			<td>Sigma-Aldrich</td>
			<td>695076</td>
			<td>For decalcification</td>
		</tr>
		<tr>
			<td>H2O2</td>
			<td>Sigma-Aldrich</td>
			<td>386790-M</td>
			<td>For HE stain IHC or TUNEL</td>
		</tr>
		<tr>
			<td>hematoxylin</td>
			<td>bioswamp&#160;</td>
			<td>PAB180015</td>
			<td>For HE stain IHC or TUNEL</td>
		</tr>
		<tr>
			<td>Isoflurane</td>
			<td>Shanghai Yuyan Scientific Instrument Company</td>
			<td>S10010533</td>
			<td>For gas anesthesia</td>
		</tr>
		<tr>
			<td>neutral resins</td>
			<td>bioswamp&#160;</td>
			<td>PAB180017</td>
			<td>For HE stain IHC or TUNEL</td>
		</tr>
		<tr>
			<td>Paraformaldehyde Fix Solution</td>
			<td>Sigma-Aldrich</td>
			<td>100496</td>
			<td>For histology</td>
		</tr>
		<tr>
			<td>PBS</td>
			<td>Sigma-Aldrich</td>
			<td>P3813</td>
			<td>For HE stain IHC or TUNEL</td>
		</tr>
		<tr>
			<td>Plantar Test Apparatus</td>
			<td>IITC Life Science</td>
			<td>/</td>
			<td>For Paw Withdrawal Latency test</td>
		</tr>
		<tr>
			<td>plaster of Paris bandage</td>
			<td>WANDE</td>
			<td>20150023</td>
			<td>For model making</td>
		</tr>
		<tr>
			<td>Proteinase K</td>
			<td>Sigma-Aldrich</td>
			<td>124568</td>
			<td>For HE stain IHC or TUNEL</td>
		</tr>
		<tr>
			<td>TNF Alpha Monoclonal antibody</td>
			<td>Proteintech</td>
			<td>60291-1-Ig</td>
			<td>For HE stain IHC or TUNEL</td>
		</tr>
		<tr>
			<td>TUNEL&#160;</td>
			<td>Servicebio</td>
			<td>GDP1042</td>
			<td>For HE stain IHC or TUNEL</td>
		</tr>
		<tr>
			<td>Wax</td>
			<td>Sigma-Aldrich</td>
			<td>327204</td>
			<td>For making specimen</td>
		</tr>
		<tr>
			<td>xylene</td>
			<td>Shanghai Sinopharm Group</td>
			<td>100092</td>
			<td>For making specimen</td>
		</tr>
	</tbody>
</table>

tuina manipulation to reduce inflammation and cartilage loss in knee osteoarthritis rats

임상 시험에 따르면 Tuina 조작은 무릎 골관절염 (KOA) 치료에 효과적이며 그 메커니즘을 발견하기 위해서는 추가 연구가 필요합니다. 따라서, 무릎 골관절염의 동물 모델의 조작은 매우 중요하다. 이 프로토콜은 KOA 쥐에 대한 Tuina 조작을 위한 표준 프로세스와 KOA에 대한 Tuina의 메커니즘에 대한 예비 탐색을 제공합니다. 프레스 및 반죽 조작 방법 (신체 표면의 특정 부위를 누르고 반죽하는 것을 의미하는 Tuina 조작의 일종)은 쥐의 무릎 관절 주위의 5 개의 경혈에 적용됩니다. 조작의 힘과 빈도는 손가락 압력 기록에 의해 표준화되었으며 조작 중 쥐의 위치는 프로토콜에 자세히 설명되어 있습니다. 조작의 효과는 통증 행동 테스트와 활액막과 연골의 현미경 소견으로 측정할 수 있습니다. KOA 쥐는 통증 행동에서 상당한 개선을 보였다. 활막 조직 염증 침윤은 Tuina 그룹에서 감소했으며 종양 괴사 인자 (TNF) -α의 발현은 현저히 낮았다. 대조군에 비해, 연골세포 아폽토시스는 Tuina 그룹에서 더 적었다. 이 연구는 KOA 쥐에 대한 Tuina 조작에 대한 표준화된 프로토콜과 Tuina의 치료 효과가 활막 염증 감소 및 지연된 연골 세포 사멸과 관련이 있을 수 있다는 예비 증거를 제공합니다.

Knee osteoarthritis (KOA) is a degenerative disease mainly manifested in joint pain. Fibrosis, cracking, ulceration, and loss of articular cartilage are the main causes of this disease1. KOA has a high prevalence and may result in a profound impact on the daily life of patients, causing disability in severe cases. Among people aged 45-84 years, the prevalence of KOA increases with age, and the prevalence among people aged 85 years and above is 15%, with a predominance in women2,3. In addition, KOA might bring a serious economic burden on both the individual and the society. A survey showed that direct health care costs on KOA per capita reached up to $8,858 &#177; $5,120 per year4. With the aging of society, KOA has become a worldwide health problem and a major social issue, as well as a topical issue for scientific research.
Evidence-based studies have shown the effectiveness of Tuina manipulation in treating KOA5. Tuina manipulation could relieve pain and improve dysfunction in KOA patients, the mechanism of which is related to anti-inflammatory effects6,7. Scholars found that Tuina manipulation effectively inhibited the expression of inflammatory factors interleukin (IL)-&#946; and 5-hydroxytryptamine and slowed down the degeneration of articular cartilage in a rabbit KOA model8. It suggested that Tuina could promote blood circulation and metabolism at the lesion site, which helped clear inflammatory factors such as IL-1, IL-6 and tumor necrosis factor (TNF)-&#945;, thereby alleviating the clinical symptoms of KOA9. In addition, the passive movement of the joint through Tuina manipulation can promote the penetration and diffusion of synovial fluid into the articular cartilage and improves tissue nutrient metabolism10. Other studies suggested that Tuina manipulation can effectively improve the biomechanical indexes in KOA patients11. Manipulations applied on soft tissues can improve stress distribution over limbs and enhance balance function12,13. At the same time, with some joint adjustment manipulations, the alignment of the lower limbs can also be adjusted to correct abnormal gaits14,15.
The mechanism of action of Tuina manipulation in treating KOA remains to be explored, and therefore, an experimental study is necessary. The key to the application of Tuina in experimental animals is the standardization of modeling, animal fixation and intervention methods16. The modeling method determines whether the experimental animal can exhibit the characteristics of the disease. Meanwhile, appropriate fixation methods can facilitate the intervention of the Tuina manipulation and better reflect the effect of Tuina. The standardization of intervention methods is the most difficult part of Tuina manipulation. In 2010, the basic system of Chinese acupuncture standards mentioned the acupuncture point standards for experimental animals, providing the possibility for acupuncture and Tuina operations in animal experiments17. However, there are still difficulties in standardizing Tuina manipulation. There are multiple types of Tuina manipulation18. The choice of the specific manipulation mainly depends on the disease to be treated and the therapeutic theories the performer prefers. In the study of Tuina for KOA, more attention has been paid to the point-pressing manipulation (pressing the specific acupoints with the thumb or elbow), Yizhichan pushing manipulation (a pushing manipulation by wiggling the thumb), and press and kneading manipulation (which refers to pressing and kneading the specific area of the body surface by finger or palm)19. Press and kneading manipulation is one of the most widely used Tuina manipulations, which combines pressing and kneading to move the subcutaneous tissue20. Press and kneading manipulation applied on acupoints can promote blood circulation and relieve pain and represents the therapeutic effect of Tuina on KOA19.
In this protocol, the operation of press and kneading manipulation on KOA rats will be described in detail, including selected acupoints, intensity and frequency of the manipulation and the body position of the rat, so as to provide a reference for future research.

저자 스포트라이트: 쥐에서 Tuina 조작 메커니즘 이해 

무릎 골관절염 쥐의 염증과 연골 손실을 줄이기 위한 Tuina 조작

We studied the mechanism of Tuina manipulation in treating knee osteoarthritis. We found that Tuina is effective for pain relieving and improving motor functions. However, there is still standard protocols for Tuina of KOA, and the conclusions are not reliable enough, so we are trying to build a standard protocol.Recently, many teams have begun to develop Tuina on massage robots, which can output special mechanical wave forms for manipulation to achieve standardization of techniques. In addition, there are some cell mechanic loading devices, which can now put the manual force for the cell for cellular research. We believe that the difficulty of Tuina in animals is how to maintain the standardization of manipulation and how to accurately locate acupuncture points.We preliminarily verified the effect of Tuina on inhibiting synovial inflammation and the cartilage of proptosis through preliminary experiments, which will point out the direction for future research on the mechanism of Tuina for KOA. In the future, we'll focus on the mechanism of Tuina for KOA, mainly related to the mechanical signal transduction pathway, and how to inhibit synovial inflammation and cartilage apoptosis.

통증 행동 테스트 MWT 결과는 모델링 후 오른쪽 뒷다리의 MWT가 이전보다 현저히 낮은 것으로 나타났습니다(p<0.05). 대조군과 비교하여, 래트의 MWT는 Tuina (p<0.05; 그림 5 및 표 2).
<img alt="Figure 5" class="xfigimg" src="/files/ftp_upload/65451/65451fig05.jpg"> 그림 5. 기계적 인출 역치 ?...

Watch this Scientific Journal Video about Understanding the Mechanism of Tuina Manipulation in Rats at JoVE.com

우리는 석고로 고정된 무릎 골관절염 쥐에 대해 수행되는 Tuina 조작에 대한 프로토콜을 제시합니다. 예비 결과에 기초하여, 상기 방법의 효능은 염증 및 연골 손실의 감소에 의존한다는 것을 시사하였다.

Clinical trials suggest that Tuina manipulation is effective in treating knee osteoarthritis (KOA), while further studies are required to discover its ...

우리는 무릎 골관절염 치료에서 Tuina 조작의 메커니즘을 연구했습니다. 우리는 Tuina가 통증 완화 및 운동 기능 개선에 효과적이라는 것을 발견했습니다. 그러나 KOA의 Tuina에 대한 표준 프로토콜은 여전히 존재하며 결론은 충분히 신뢰할 수 없으므로 표준 프로토콜을 구축하려고 노력하고 있습니다.최근 많은 팀들이 기술의 표준화를 달성하기 위해 조작을 위한 특수 기계적 파형을 출력할 수 있는 마사지 로봇에 Tuina를 개발하기 시작했습니다. 또한 세포 연구를 위해 세포에 수동 힘을 가할 수 있는 일부 세포 역학 로딩 장치가 있습니다. 우리는 동물에서 Tuina의 어려움이 조작의 표준화를 유지하는 방법과 경혈을 정확하게 찾는 방법이라고 믿습니다.Tuina가 활막염 억제 및 안구돌출증 연골에 미치는 영향을 예비실험을 통해 예비적으로 검증하였으며, 이는 향후 KOA에 대한 Tuina의 기전 연구 방향을 제시하고자 합니다. 앞으로 우리는 주로 기계적 신호 전달 경로와 관련된 KOA에 대한 Tuina의 메커니즘과 활막 염증 및 연골 세포 사멸을 억제하는 방법에 초점을 맞출 것입니다.

tuina-manipulation-to-reduce-inflammation-cartilage-loss-knee

Research

JoVE Journal

Medicine

Tuina Manipulation to Reduce Inflammation and Cartilage Loss in Knee Osteoarthritis Rats

1.2K 조회수.  Yueyang Hospital of Integrated Traditional Chinese and Western Medicine Affiliated to Shanghai University of Traditional Chinese Medicine. 우리는 무릎 골관절염 치료에서 Tuina 조작의 메커니즘을 연구했습니다. 우리는 Tuina가 통증 완화 및 운동 기능 개선에 효과적이라는 것을 발견했습니다. 그러나 KOA의 Tuina에 대한 표준 프로토콜은 여전히 존재하며 결론은 충분히 신뢰할 수 없으므로 표준 프로토콜을 구축하려고 노력하고 있습니다.최근 많은 팀들이 기술의 표준화를 달성하기 위해 조작을 위한 특수 기계...

비디오: 저자 스포트라이트: 쥐에서 Tuina 조작 메커니즘 이해 

Clinical trials suggest that Tuina manipulation is effective in treating knee osteoarthritis (KOA), while further studies are required to discover its mechanism. Therefore, the manipulation of animal models of knee osteoarthritis is critical. This protocol provides a standard process for Tuina manipulation on KOA rats and a preliminary exploration of the mechanism of Tuina for KOA. The press and kneading manipulation method (a kind of Tuina manipulation that refers to pressing and kneading the specific area of the body surface) is applied on 5 acupoints around the knee joint of rats. The force and frequency of the manipulation were standardized by finger pressure recordings, and the position of the rat during manipulation is described in detail in the protocol. The effect of manipulation can be measured by pain behavior tests and microscopic findings in synovial and cartilage. KOA rats showed significant improvement in pain behavior. The synovial tissue inflammatory infiltration was reduced in the Tuina group, and the expression of tumor necrosis factor (TNF)-&#945; was significantly lower. Compared to the control group, chondrocyte apoptosis was less in the Tuina group. This study provides a standardized protocol for Tuina manipulation on KOA rats and preliminary proof that the therapeutic effects of Tuina may be related to reducing synovial inflammation and delayed chondrocyte apoptosis.

We present a protocol for Tuina manipulation performed on plaster-immobilized-induced knee osteoarthritis rats. Based on the preliminary results, it suggested that the efficacy of the method relied on the reduction of inflammation and cartilage loss.

연구

의학

Experimental Modeling of Knee Osteoarthritis in Rats

After anesthetizing the rat, use a shaving machine to remove the hair of the right hind limb. Then, place a medical cotton pad between the right ankle and hip joint. Fix the right knee joint at 180 degree extension using five to six layers of wet plaster bandage evenly.Spiral wrap the plaster bandage starting from the ankle and covering one-third of the previous one. Use a hairdryer to dry and harden the plaster. After the plaster bandage dries and hardens, mix the denture base materials to make it sticky.And externally wrap the plaster with denture based materials to fix and prevent it from gnawing. Once the mixture hardens, turn off the anesthesia machine and supervise the blood circulation in the terminal limb. Then, wait for the rat to wake up naturally.After three weeks of continuous immobilization, using surgical scissors, cut off the denture base material outside and plaster bandage. Rinse the lower limb of the rat with saline and dry it with gauze.

쥐의 무릎 골관절염의 실험적 모델링

Tuina Manipulation, Pain Behavior Tests, and Statistical Analysis

Select five acupoints on the right hind limb of the rat according to the principles of acupoint positioning. Before the Tuina manipulation, gently pull the rat tail to make it burrow into the bag and expose its hind limbs outside the bag. For Tuina manipulation, using one hand, place the rat in the prone position, holding its tail and hind leg, then place the performer's thumb on the selected acupuncture point to perform rhythmic press and kneading, driving the skin and subcutaneous tissue together in a circular motion ensuring consistent intensity and frequency of manipulation.For the next mechanical withdrawal threshold, or MWT, stimulate the rat with electronic Von Frey fiber at the center of the foot and withdraw the fiber when the rat shows obvious movements, like leg grazing and avoidance. The machine automatically records the maximum pressure value in Newtons. After measurement, delete the values with large differences and take the average of the remaining three values as the MWT.Next, for paw withdrawal latency, or PWL, focus the spotlight on the center of the rat's foot and press the start button. Monitor the rat for behaviors such as foot retraction or paw licking, and record the time before pressing the stop button. After measurement, delete the values with large differences and take the average of the remaining three values as the PWL.For statistical analysis, open the analysis software. If the data conforms to a normal distribution, perform a T-test. Alternatively, analyze repeated measurement data by generalized estimating equations.The MWT results showed that the MWT of the right hind limb after modeling was significantly lower than before. Compared with the control group, the MWT of rats was significantly elevated after Tuina. The PWL results showed that the PWL of the right hind limb after modeling was significantly shorter than before.Compared with the control group, the MWT of rats was significantly prolonged after Tuina.