湖南中医药大学学报2025，Vol.45Issue(5)：883-890,8.DOI:10.3969/j.issn.1674-070X.2025.05.014
基于"肝主筋,肾主骨"理论辨证取穴温针灸联合膝痹方治疗膝骨关节炎的临床研究及模型化评价
摘要
Abstract
Objective To investigate the clinical efficacy of warm needle moxibustion at selected acupoints from pattern identification based on the theory of"liver governs sinews and kidney governs bones"combined with the Xibi Formula in the treatment of knee osteoarthritis(KOA),as well as its impact on serum inflammatory factors,and to construct a pharmacodynamic model-based evaluation.Methods A total of 97 patients with knee osteoarthritis(KOA)admitted to Shanghai Changning Tianshan Traditional Chinese Medicine Hospital from September 2022 to September 2024 were enrolled in this study.The patients were randomly divided into control group(treated with warm needle moxibustion alone,n=49)and study group(treated with a combination of warm needle moxibustion and the Xibi Formula,n=48),with balanced baseline characteristics between the two groups.The Western Ontario and McMaster Universities Osteoarthritis Index(WOMAC)scores,Lequesne Functional Algorithm Index scores,TCM pattern scores,as well as serum levels of tumor necrosis factor-α(TNF-α)and interleukins(IL),were compared between the two groups before and after treatment.A nonlinear mixed-effects model was utilized to establish a time-effect model for the combined treatment of warm needle moxibustion and Xibi Formula in KOA.The model's goodness-of-fit and parameter stability were evaluated,and its predictive performance was assessed through visualization and analysis.Based on the final model,typical time-effect curves for TCM pattern scores under various baseline conditions were simulated.Results After treatment,the study group exhibited significantly higher cure rates based on the WOMAC scores,marked effectiveness rates,and overall effectiveness rates based on the Lequesne scores compared to the control group(P＜0.05).After treatment,compared with the pre-treatment status,there was no statistically significant difference in fatigue and lassitude score in the control group(P＞0.05),while the scores of the study group decreased(P＜0.05).Both groups showed significant decreases in TCM pattern scores,as well as scores for knee joint pain,restricted mobility,soreness and weakness of the waist and knees,red tongue with scanty coating,and thready and rapid pulse,along with reduced serum levels of TNF-α,IL-1 β,and IL-6(P＜0.05).Moreover,the study group had significantly lower scores for TCM patterns,knee joint pain,restricted mobility,soreness and weakness of the waist and knees,fatigue and lassitude,red tongue with scanty coating,thready and rapid pulse,as well as lower serum levels of TNF-α,IL-1β,and IL-6 compared to the control group(P＜0.05).The TCM pattern scores decreased over time and eventually reached a plateau,consistent with the classic Emax model.After stepwise covariate screening,the final pharmacodynamic model was established as.The model demonstrated good goodness-of-fit and robust parameter estimation.A higher baseline value of the TCM pattern scores indicated a greater magnitude of reduction,and after 42 d of treatment,the scores all decreased to below 8 points.Conclusion The treatment of warm needle moxibustion at selected acupoints from pattern identification based on the theory of"liver governs sinews and kidney governs bones"combined with Xibi Formula,can effectively reduce serum inflammatory factor levels in KOA patients and significantly alleviate their clinical symptoms,including knee joint pain,restricted mobility,soreness and weakness of the waist and knees,fatigue and lassitude,red tongue with scanty coating,and thready and rapid pulse.关键词
膝骨关节炎/肝主筋/肾主骨/温针灸/膝痹方/炎症反应/药效模型Key words
knee osteoarthritis/liver governs sinews/kidney governs bones/warm needle moxibustion/Xibi Formula/in-flammation response/pharmacodynamic model分类
中医学引用本文复制引用
刘顺超,石昆,陈绍华..基于"肝主筋,肾主骨"理论辨证取穴温针灸联合膝痹方治疗膝骨关节炎的临床研究及模型化评价[J].湖南中医药大学学报,2025,45(5):883-890,8.基金项目
上海市长宁区卫生健康委员会课题项目(20234z009). （20234z009）
