维医沙疗的临床与基础研究及其生物传热机制探讨
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摘要
沙疗是埋沙疗法的简称,是维吾尔医学治疗方法中的一种特殊疗法,它是利用新疆的自然资源磁性沙丘,通过热沙的传热、日光浴、磁性作用、矿物质的渗透及沙粒的按摩作用,组成的综合性物理治疗方法,这种方法在吐鲁番已有百余年的历史。1984年正式成立的吐鲁番沙疗疗养院,至今接受近6万名患者(除疆内外患者外,甚至一部分来自国外),疗效十分显著。沙疗在治疗风湿类疾病、腰腿痛等方面有着独特的疗效,但目前我区的沙疗疗法仍然较为粗放,其作用机制尚不十分明确,有待系统和深入的研究,以便形成规范化、标准化、科学化的沙疗方案。同时由于沙疗受地域、时间、季节、气候等等自然条件的限制,不但降低了疗效,而且影响了其更广泛的应用于临床。众所周知,沙疗作为维吾尔医学实践应用的重要部分,具有祛除机体异常粘液质,活血、消炎的作用,但其内在的作用机理至今无人揭示。而目前国内外对沙疗的研究主要集中于沙疗对人体医学参数的影响及沙疗治病机理的研究。沙疗是热、磁、力等多方面因素综合作用的结果,影响因素复杂,而热作用为其最不能忽视的影响因素之一。因此,沙疗过程中人体与沙体及人体内传热的规律是我们必需解决的问题,这需要应用生物传热学的理论。本研究为多学科交叉研究,应用临床医学和维吾尔医体液理论,通过临床与实验的研究方法,制定规范化、标准化、科学化的沙疗治疗方案,规范沙疗的适应人群,以提高疗效;应用生物传热理论建立室内沙疗生物传热系统,对沙疗的生物传热机制进行探讨,建立兔膝骨关节炎动物模型,分别从病理学、血液动力学、血液流变学的改变,炎症介质、兔膝骨关节炎软骨超微结构及沙疗对细胞凋亡蛋白表达的影响等方面,进一步揭示沙疗的作用机制,为维医沙疗理论体系的建立提供科学依据。
材料和方法
(1)采用美国Keitlev公司2700型多功能数据采集仪,配合微机、热电偶、参考冰点(保温瓶)建立了实地监测沙温工作平台,在新疆吐鲁番沙疗实地,分别对气温、不同深度沙温、沙体表面温湿度、光照度、硬度等随时间的动态变化进行实地测试。
(2)将112例来自新疆吐鲁番地区维吾尔医沙疗所2007年住院患者(依据患者的临床症状、体征及检验资料均符合骨性关节炎疾病),进行埋沙治疗,疗程15天。观察沙疗前后患者晨僵、关节疼痛、肿胀及活动受限症状并检测血沉(ESR)、C反应蛋白(CRP)的改变。采用多组资料的秩和检验、单因素方差分析及两样本的秩和检验。所有数据采用SPSS13.0统计软件处理。
(3)沙体的有效热导率是模拟维医沙疗时沙体中传热规律的重要参数,采用圆球导热法对吐鲁番沙体的有效热导率进行了测量,并设计了室内局部沙疗实验系统,实验测量局部沙疗过程中人体皮肤表面温度及沙体温度随时间的变化规律,并与数值模拟的结果进行了对比。
(4)选用8～14月龄2.0～2.5kg成年新西兰免28只,雄性。28只兔按照兔膝关节制动引起关节软骨退行性改变的实验研究方法,将新西兰兔右后肢伸直位管型石膏固定6周。成功建立兔膝骨性关节炎动物模型后,28只模型兔中随机取2只作为模型动物。其余26只随机分为2组。A组13只为自由活动组,解除石膏固定后,让其自由活动,于自由活动10天后取3只兔膝关节软骨作电镜观察;B组13只为沙疗组,解除石膏固定后让其自由活动,同时进行沙疗,于沙疗10天后取3只兔膝关节软骨作电镜观察。沙疗每天一次,持续20天。于造模前及造模后拍兔双膝正、侧位片。治疗干预前后观察两侧膝关节的宏观结构,HE染色观察软骨的层次、软骨细胞及软骨下骨的形态学变化。透射电镜检查关节软骨的超微结构。并观察兔血液流变学及血液动力学指标的变化;检测关节液及血液中炎性介质白介素1β(IL-β)、肿瘤坏死因子(TNF-α)、一氧化氮(NO)的改变。采用免疫组化S-P法检测caspase-3、bcl-2、bax在兔膝关节软骨细胞及滑膜中的表达,TUNEL法检测骨性关节炎软骨细胞凋亡情况。所有数据用SPSS13.0软件处理,计量资料用均数和标准差进行描述,配对资料采用配对均数的比较及两组均数的比较,多组均数的比较采用单因素方差分析或多组资料的秩和检验。
结果
(1)每年6月中旬至8月中旬,下午15～18时沙疗所气温(40±2.3)℃,离沙丘表面10～20cm深处沙温可保持在(38±4.6)℃。沙疗过程中生物组织(人体皮肤表层)在43℃热沙作用下,皮肤表面温度迅速升高(达39℃以上),由于汗液蒸发散热(释热)等,从皮肤表面到皮肤浅层组织的温度是下降的,皮肤浅层(X=2.08mm处)温度是(36.0±0.32)℃,即在短时间内沙体的温度对人体皮肤表面的温升影响较大,而对中层组织及皮下组织温升的影响微乎其微。2～3h后,皮表温度降至(36.0±0.6)℃,并保持基本不变。由此可得出:43℃热沙对皮肤组织不会产生损伤,人体感觉舒适,这与沙疗的临床效果相吻合。
(2)从维医体液分型与症状关系来看,112例骨关节病患者中异常粘液质型所占的比例最大,达到53.57%,而异常血液质、异常胆液质、异常黑胆质型患者所占的比例较分别为15.18%、10.5%、20.54%。沙疗对异常粘液质型OA病患者的晨僵、关节疼痛、关节肿胀症状均改善明显,差异具有统计学意义(P＜0.008)。实验室结果表明,沙疗前后异常粘液质型OA患者的ESR结果与异常黑胆质型、异常血液质型患者相比,数值明显下降,差异具有统计学意义(P＜0.008);沙疗前后异常粘液质型患者的CRP结果与异常胆液质型、异常血液质型患者相比,数值下降明显,差异具有统计学意义(P＜0.008)。
(3)本研究设计建造了室内沙疗模拟实验系统,测量了局部沙疗过程中人体皮肤表面及沙体各层温度随时间的变化规律,并与数值模拟的结果进行了对比,模拟结果能够较好的反映沙疗时皮肤表面温度的变化趋势。根据传统的沙疗原理,建立室内沙疗试验平台,通过加热器加热来代替日光的照射,试验测试结果表明,室内试验平台和自然环境中的沙体表面和不同深度沙温基本吻合。
(4)用右后肢关节制动(石膏固定)的方法可以造成兔膝骨关节炎模型。沙疗对于兔膝骨关节炎模型动物关节液中的炎症因子白介素1β(IL-1β)、肿瘤坏死因子(TNF-α)、一氧化氮(NO)均有降低作用(P＜0.01)。光镜及透射电镜观察维医沙疗可改善关节软骨的非特异性炎症,减轻关节软骨的退变。与自由活动组比较,沙疗组在干预后全血黏度低切、中切、高切,红细胞电泳指数,红细胞压积均具有统计学意义(P＜0.05);血浆黏度,全血还原黏度低切也具有统计学意义(P＜0.01);而沙疗组前后比较,全血粘度低切、中切、高切,血浆黏度,全血还原黏度低切均明显下降(P＜0.01);全血还原黏度高切,红细胞压积也有下降(P＜0.05)。沙疗组沙疗前后,右下肢股动脉的收缩期血流峰值(PS)、舒张期血流峰值(ED)数值增加并具有统计学意义(P＜0.01)、阻力指数(RI)的数值降低具有统计学意义(P＜0.05);而沙疗组与对照组干预后比较,沙疗组右下肢的PS、ED的数值均升高,差异均具有统计学意义(P＜0.01)。同时对兔膝骨关节炎模型动物关节软骨细胞中Caspse-3、Bax、Tunel等蛋白的表达具有下调作用。
结论
(1)归纳出维医埋沙疗法包括季节、地点、时间段、埋沙温度、埋沙深度在内的沙疗治疗规范。使维医沙疗更加规范化、科学化、标准化。维医沙疗最佳条件为:每年6月中旬至8月中旬、下午15.00～18.00时、气温(40.0±2.3)℃、离沙丘表面10～20cm处、沙温保持在(38.0±4.6)℃、每次沙疗0.5～1 h。
(2)我们认为维医沙疗的适应人群是:异常粘液质型患者。根据以上沙疗方案治疗骨关节病疗效显著。主要表现为:患者晨僵、关节疼痛、关节肿胀等症状明显改善,血沉(ESR)、C反应蛋白(CRP)指标趋于正常。
(3)建立了室内维医沙疗传热系统,并与自然环境下沙疗相比较,室内沙疗系统基本与吐鲁番沙疗场一致。而且室内沙疗系统不受时间、地点、地域、气候等自然条件的限制,温度可控。
(4)建立了兔膝骨关节炎动物模型,维吾尔医沙疗能够降低模型动物兔膝关节液中IL-1β、TNF-a、NO的水平;改善血液流变学中全血黏度低切、中切、高切,红细胞电泳指数,红细胞压积等指标;升高兔下肢动脉血液动力学中右下肢股动脉的收缩期血流峰值(PS)、舒张期血流峰值(ED),降低阻力指数(RI);促进软骨细胞增生和活跃,加快骨关节炎软骨的组织修复并对关节软骨细胞中Caspse-3、Bax、Tunel蛋白的表达具有下调作用。这可能是维医沙疗的部分抗炎作用机制。
(5)将生物传热机制应用于维吾尔医沙疗的研究,为维医沙疗的研究提供了一个新的手段和方法,为进一步揭示沙疗的作用机理并将其更广泛的应用于临床奠定了理论基础。
Sand treatment is the specific therapy of Uyghur medicine which could eliminate abnormal balgham,promote blood flow and have an effect of anti-inflammatory.It is the comprehensive physical therapy consist of the heat transfer by hot sand,sun bathing,effect of magnetism,permeating of mineral matter and massaging of sand.which has more than one hundred years in Tulufan.The sanatorium of sand treatment has accepted six ten thousand patients(which come from abroad except for internal) been established in 1984 in Tulufan,Although the sand treatment has the distinctive curative effect in rheumatism and backleg pain,the method is fairly extensive in Xinjiang.The mechanism of action in sand treatment has not been understand.which waiting for us to reaserch and find the scientific and standardize schema on sand treatment.Meanwhile,because the sand treatment was confined by region,time,season,climate which cuts down the curative effect and affects application in clinic intensively.The study is a intersect research which makes use of the theory conduct heat and humor in Uyghur medicine to institutes the scientific and standardize schema of sand treatment,finds the adapted patients about sand treatment,sets up the platform of heat conduct of sand treatment indoor,Then reveals the mechanism of action and provide the scientific evidence for establishing theory system of sand treatment.
Materials And Methods
(1) we have set up the platform of monitoring sand temperature appling 2700 model multifunction data acquisition equipment which made in USA Keitley corporation, microcomputer,thermocouple and referencing freezing point.we have tested and measured the development changes with the times on the temperature,sand temperature in different depths,humidity of sand on the surface、illuminance and hardness.
(2) 112 cases have adopted the therapy buried in sand who coming from sand treatment station to be in hospital in Xinjing Tulufan from 2007(according with diagnose of the osteoarthritis),continued fifth days.We have detected blood sedimentation, Creactive protein.meanwhile,early morning stiffness,swell,limitation of activity have been observed.All of the datas have been dealed with SPSS 13.0 software.
(3) Available heat conductivity of sand is an important parameter with which simulates the heat transfer regularity from sand to body.The study has measured the Available heat conductivity of sand in Tulufan applying ball heat conduction,and has measured the changing regularity time-variation about the surface temperature of body and sand temperature.then has compared the results with the numerical value.
(4) A model of genu OA had been established successfully by fixing right hind limbs with gypsum in New Zealand rabbits.26 of 28 animals were divided randomly into free movement group A and free movement added sand treatment group B.another 2 animals were used as models.these animals were treated by buried with sand once a day last twenty days.We has shoted the X-ray photograph in orthophoria and lateral position, observe the macrostructure of articular genu changes of cartilagineus cells and morphology after HE dyeing,the ultrastructures of Cartilage in their articular genua were observed under electron microscope,effectively.And detected the numerical value of hemodynamics and hemorheology,the serum and the synovial fluid of the diseased joints were obtained for the testing of IL-1β、TNF-a、NO;Positive expression rate of Caspase-3、Bcl-2、Bax were measured by immunohistochemistry and Terminal deoxynucleotidy transferase mediated dUTP nick end labeling(TUNEL).All of data have been dealed with SPSS 13.0 software.
Result
(1) Every year,during June to August between the dates of the 10~(th) through the 20~(th), at the time 15:00 to 18:00 each afternoon it was determined that the air temperature of the sand treatment station reaching 40±2.3℃,and the sand used as a medicinal poultice could be maintained at the temperature of 38.±4.6℃at the depth of 20 cm from the sand surface.During the process of sand therapy,the skin surface temperature rises rapidly,up to 39℃,but the skin surface temperature falls subsequently as the heat stimulates perspiration and the cooling effect of evaporation takes place.When the skin surface temperature is 36±0.32℃it will fall to 36±0.6℃and maintain a stable temperature for two to three hours.When the sand temperature reached 43℃,it could not hurt the skin and tissue,because the body temperature could balance with sand temperature at an ideal temperature for the skin.
(2) On the basis of the differentiation of symptoms and signs of Uyghur medicine,the propotion abnormal Balgham in osteoarthritis disease accounts to 53.57%,which is the most largest,the propotions of abnormal Khan,abnormal Spra and abnormal Savada account to 15.18%,10.5%,20.54%respectively.Sand treatment chould improve the symptom of the patient on early morning stiffness,joint pain and arthrocele(P＜0.008), Meanwhile sand treatment chould cut down the index of the laboratory on detected blood sedimentation,Creactive protein(P＜0.008).
(3) The study has designed and measured the system of model experiment of sand treatment in door.And has measured the changing regularity time-variation about the surface temperature of body and sand temperature.then has compared the result with the numerical value.The results of the model experiment chould better reflect the tendency of temperature in surface.The results indicated that the temperature coincides comparing experimental platform indoor with outdoor According the traditional principle of the sand treatment.
(4) A model of genu OA had been established successfully by fixing right hind limbs with gypsum.Sand treatment chould declined level of IL- 1β、TNF-a、NO in synovial fluid(P＜0.01).The cartilage tissue and cell cataplasia and ultrastructure changes were observed-in these animals right articular genu,It were observed that sand treatment chould improve inflammation,lessen the cataplasia of arthrodial cartilage.Sand treatment could improve Blood viscosity,depress peripheral vascular resistance(PVR) of the the rabbit experimental knee osteoarthritis(P＜0.01),meanwhile it could accelerate blood flow rate and lessen vascular resistance in arteria cruralis of the lower limbs in rabbit(P＜0.01). Sand treatment chould down regulation the express of the Caspse-3、Bax、Tunel in articular cartilage in KOA(P＜0.01).
conculsion
(1) We have Induced the standard of sand treatment including season、spot、time、temperature、depth.It makes sandtreatment more normalization、science and normalization.The ideal time for sand therapy is between June and August between the 10~(th) to 20~(th) days of the month,between 15:00-18:00 every day.When the air temperature reaches 40±2.3℃,the sand temperature will be maintained 38.±4.6℃under the 10-20. centimeter.Basised on this conditions the human body is buried under the sand at the depth of 20 cm for a period of one half of an hour to achieve therapeutic effects.
(2) Abnormal Balgham is the major factor to cause the rheumatism.Furthermore, curative effect of the Abnormal is better than others.We consider that the most accommodative crowd is the patient of the abnormal Balgham.basised on the program,the curative effect of patients with disease of osteoarthritis has a significantly improved which includes the early morning stiffness,joint pain and arthrocele,Meanwhile sand treatment chould cut down the index of blood sedimentation,Creactive protein.
(3) The system of conduct heat has been set up indoor which based on experiment method compared with the physiocracy in Tulufan.the temperature coincides to Tulufan outdoor.Furthermore,the system of conduct heat indoor of sand treatment will be not inhibited by the time,place,climate,and temperature will be controlled,
(4) We have established the animal model of the osteoarthritis.Sand treatment chould declined level of IL-1β、TNF-a,NO in synovial fluid,The cartilage tissue and cell cataplasia and ultrastructure changes were observed in these animals right articular genu. Sand treatment could improve Blood viscosity,depress peripheral vascular resistance (PVR) of the the rabbit experimental knee osteoarthritis,meanwhile it could accelerate blood flow rate and lessen vascular resistance in arteria cruralis of the lower limbs in rabbit.Forthmore,sand treatment chould suppress the Apoptosis of articular cartilage, improve the inflammation.Meanwhile it made the proteinic express down regulation on Caspse-3,Bax,Tunel.So,we consider that This is one of the cause which it gives a play for anti-inflammatory action.
(5) The study makes use of the biology conduct heat to research the sand treatment which provides a new method and means for research the sand treatment,and establishs theory basis for the reveal the mechanism action of sand treatment.
材料和方法
(1)采用美国Keitlev公司2700型多功能数据采集仪,配合微机、热电偶、参考冰点(保温瓶)建立了实地监测沙温工作平台,在新疆吐鲁番沙疗实地,分别对气温、不同深度沙温、沙体表面温湿度、光照度、硬度等随时间的动态变化进行实地测试。
(2)将112例来自新疆吐鲁番地区维吾尔医沙疗所2007年住院患者(依据患者的临床症状、体征及检验资料均符合骨性关节炎疾病),进行埋沙治疗,疗程15天。观察沙疗前后患者晨僵、关节疼痛、肿胀及活动受限症状并检测血沉(ESR)、C反应蛋白(CRP)的改变。采用多组资料的秩和检验、单因素方差分析及两样本的秩和检验。所有数据采用SPSS13.0统计软件处理。
(3)沙体的有效热导率是模拟维医沙疗时沙体中传热规律的重要参数,采用圆球导热法对吐鲁番沙体的有效热导率进行了测量,并设计了室内局部沙疗实验系统,实验测量局部沙疗过程中人体皮肤表面温度及沙体温度随时间的变化规律,并与数值模拟的结果进行了对比。
(4)选用8～14月龄2.0～2.5kg成年新西兰免28只,雄性。28只兔按照兔膝关节制动引起关节软骨退行性改变的实验研究方法,将新西兰兔右后肢伸直位管型石膏固定6周。成功建立兔膝骨性关节炎动物模型后,28只模型兔中随机取2只作为模型动物。其余26只随机分为2组。A组13只为自由活动组,解除石膏固定后,让其自由活动,于自由活动10天后取3只兔膝关节软骨作电镜观察;B组13只为沙疗组,解除石膏固定后让其自由活动,同时进行沙疗,于沙疗10天后取3只兔膝关节软骨作电镜观察。沙疗每天一次,持续20天。于造模前及造模后拍兔双膝正、侧位片。治疗干预前后观察两侧膝关节的宏观结构,HE染色观察软骨的层次、软骨细胞及软骨下骨的形态学变化。透射电镜检查关节软骨的超微结构。并观察兔血液流变学及血液动力学指标的变化;检测关节液及血液中炎性介质白介素1β(IL-β)、肿瘤坏死因子(TNF-α)、一氧化氮(NO)的改变。采用免疫组化S-P法检测caspase-3、bcl-2、bax在兔膝关节软骨细胞及滑膜中的表达,TUNEL法检测骨性关节炎软骨细胞凋亡情况。所有数据用SPSS13.0软件处理,计量资料用均数和标准差进行描述,配对资料采用配对均数的比较及两组均数的比较,多组均数的比较采用单因素方差分析或多组资料的秩和检验。
结果
(1)每年6月中旬至8月中旬,下午15～18时沙疗所气温(40±2.3)℃,离沙丘表面10～20cm深处沙温可保持在(38±4.6)℃。沙疗过程中生物组织(人体皮肤表层)在43℃热沙作用下,皮肤表面温度迅速升高(达39℃以上),由于汗液蒸发散热(释热)等,从皮肤表面到皮肤浅层组织的温度是下降的,皮肤浅层(X=2.08mm处)温度是(36.0±0.32)℃,即在短时间内沙体的温度对人体皮肤表面的温升影响较大,而对中层组织及皮下组织温升的影响微乎其微。2～3h后,皮表温度降至(36.0±0.6)℃,并保持基本不变。由此可得出:43℃热沙对皮肤组织不会产生损伤,人体感觉舒适,这与沙疗的临床效果相吻合。
(2)从维医体液分型与症状关系来看,112例骨关节病患者中异常粘液质型所占的比例最大,达到53.57%,而异常血液质、异常胆液质、异常黑胆质型患者所占的比例较分别为15.18%、10.5%、20.54%。沙疗对异常粘液质型OA病患者的晨僵、关节疼痛、关节肿胀症状均改善明显,差异具有统计学意义(P＜0.008)。实验室结果表明,沙疗前后异常粘液质型OA患者的ESR结果与异常黑胆质型、异常血液质型患者相比,数值明显下降,差异具有统计学意义(P＜0.008);沙疗前后异常粘液质型患者的CRP结果与异常胆液质型、异常血液质型患者相比,数值下降明显,差异具有统计学意义(P＜0.008)。
(3)本研究设计建造了室内沙疗模拟实验系统,测量了局部沙疗过程中人体皮肤表面及沙体各层温度随时间的变化规律,并与数值模拟的结果进行了对比,模拟结果能够较好的反映沙疗时皮肤表面温度的变化趋势。根据传统的沙疗原理,建立室内沙疗试验平台,通过加热器加热来代替日光的照射,试验测试结果表明,室内试验平台和自然环境中的沙体表面和不同深度沙温基本吻合。
(4)用右后肢关节制动(石膏固定)的方法可以造成兔膝骨关节炎模型。沙疗对于兔膝骨关节炎模型动物关节液中的炎症因子白介素1β(IL-1β)、肿瘤坏死因子(TNF-α)、一氧化氮(NO)均有降低作用(P＜0.01)。光镜及透射电镜观察维医沙疗可改善关节软骨的非特异性炎症,减轻关节软骨的退变。与自由活动组比较,沙疗组在干预后全血黏度低切、中切、高切,红细胞电泳指数,红细胞压积均具有统计学意义(P＜0.05);血浆黏度,全血还原黏度低切也具有统计学意义(P＜0.01);而沙疗组前后比较,全血粘度低切、中切、高切,血浆黏度,全血还原黏度低切均明显下降(P＜0.01);全血还原黏度高切,红细胞压积也有下降(P＜0.05)。沙疗组沙疗前后,右下肢股动脉的收缩期血流峰值(PS)、舒张期血流峰值(ED)数值增加并具有统计学意义(P＜0.01)、阻力指数(RI)的数值降低具有统计学意义(P＜0.05);而沙疗组与对照组干预后比较,沙疗组右下肢的PS、ED的数值均升高,差异均具有统计学意义(P＜0.01)。同时对兔膝骨关节炎模型动物关节软骨细胞中Caspse-3、Bax、Tunel等蛋白的表达具有下调作用。
结论
(1)归纳出维医埋沙疗法包括季节、地点、时间段、埋沙温度、埋沙深度在内的沙疗治疗规范。使维医沙疗更加规范化、科学化、标准化。维医沙疗最佳条件为:每年6月中旬至8月中旬、下午15.00～18.00时、气温(40.0±2.3)℃、离沙丘表面10～20cm处、沙温保持在(38.0±4.6)℃、每次沙疗0.5～1 h。
(2)我们认为维医沙疗的适应人群是:异常粘液质型患者。根据以上沙疗方案治疗骨关节病疗效显著。主要表现为:患者晨僵、关节疼痛、关节肿胀等症状明显改善,血沉(ESR)、C反应蛋白(CRP)指标趋于正常。
(3)建立了室内维医沙疗传热系统,并与自然环境下沙疗相比较,室内沙疗系统基本与吐鲁番沙疗场一致。而且室内沙疗系统不受时间、地点、地域、气候等自然条件的限制,温度可控。
(4)建立了兔膝骨关节炎动物模型,维吾尔医沙疗能够降低模型动物兔膝关节液中IL-1β、TNF-a、NO的水平;改善血液流变学中全血黏度低切、中切、高切,红细胞电泳指数,红细胞压积等指标;升高兔下肢动脉血液动力学中右下肢股动脉的收缩期血流峰值(PS)、舒张期血流峰值(ED),降低阻力指数(RI);促进软骨细胞增生和活跃,加快骨关节炎软骨的组织修复并对关节软骨细胞中Caspse-3、Bax、Tunel蛋白的表达具有下调作用。这可能是维医沙疗的部分抗炎作用机制。
(5)将生物传热机制应用于维吾尔医沙疗的研究,为维医沙疗的研究提供了一个新的手段和方法,为进一步揭示沙疗的作用机理并将其更广泛的应用于临床奠定了理论基础。
Sand treatment is the specific therapy of Uyghur medicine which could eliminate abnormal balgham,promote blood flow and have an effect of anti-inflammatory.It is the comprehensive physical therapy consist of the heat transfer by hot sand,sun bathing,effect of magnetism,permeating of mineral matter and massaging of sand.which has more than one hundred years in Tulufan.The sanatorium of sand treatment has accepted six ten thousand patients(which come from abroad except for internal) been established in 1984 in Tulufan,Although the sand treatment has the distinctive curative effect in rheumatism and backleg pain,the method is fairly extensive in Xinjiang.The mechanism of action in sand treatment has not been understand.which waiting for us to reaserch and find the scientific and standardize schema on sand treatment.Meanwhile,because the sand treatment was confined by region,time,season,climate which cuts down the curative effect and affects application in clinic intensively.The study is a intersect research which makes use of the theory conduct heat and humor in Uyghur medicine to institutes the scientific and standardize schema of sand treatment,finds the adapted patients about sand treatment,sets up the platform of heat conduct of sand treatment indoor,Then reveals the mechanism of action and provide the scientific evidence for establishing theory system of sand treatment.
Materials And Methods
(1) we have set up the platform of monitoring sand temperature appling 2700 model multifunction data acquisition equipment which made in USA Keitley corporation, microcomputer,thermocouple and referencing freezing point.we have tested and measured the development changes with the times on the temperature,sand temperature in different depths,humidity of sand on the surface、illuminance and hardness.
(2) 112 cases have adopted the therapy buried in sand who coming from sand treatment station to be in hospital in Xinjing Tulufan from 2007(according with diagnose of the osteoarthritis),continued fifth days.We have detected blood sedimentation, Creactive protein.meanwhile,early morning stiffness,swell,limitation of activity have been observed.All of the datas have been dealed with SPSS 13.0 software.
(3) Available heat conductivity of sand is an important parameter with which simulates the heat transfer regularity from sand to body.The study has measured the Available heat conductivity of sand in Tulufan applying ball heat conduction,and has measured the changing regularity time-variation about the surface temperature of body and sand temperature.then has compared the results with the numerical value.
(4) A model of genu OA had been established successfully by fixing right hind limbs with gypsum in New Zealand rabbits.26 of 28 animals were divided randomly into free movement group A and free movement added sand treatment group B.another 2 animals were used as models.these animals were treated by buried with sand once a day last twenty days.We has shoted the X-ray photograph in orthophoria and lateral position, observe the macrostructure of articular genu changes of cartilagineus cells and morphology after HE dyeing,the ultrastructures of Cartilage in their articular genua were observed under electron microscope,effectively.And detected the numerical value of hemodynamics and hemorheology,the serum and the synovial fluid of the diseased joints were obtained for the testing of IL-1β、TNF-a、NO;Positive expression rate of Caspase-3、Bcl-2、Bax were measured by immunohistochemistry and Terminal deoxynucleotidy transferase mediated dUTP nick end labeling(TUNEL).All of data have been dealed with SPSS 13.0 software.
Result
(1) Every year,during June to August between the dates of the 10~(th) through the 20~(th), at the time 15:00 to 18:00 each afternoon it was determined that the air temperature of the sand treatment station reaching 40±2.3℃,and the sand used as a medicinal poultice could be maintained at the temperature of 38.±4.6℃at the depth of 20 cm from the sand surface.During the process of sand therapy,the skin surface temperature rises rapidly,up to 39℃,but the skin surface temperature falls subsequently as the heat stimulates perspiration and the cooling effect of evaporation takes place.When the skin surface temperature is 36±0.32℃it will fall to 36±0.6℃and maintain a stable temperature for two to three hours.When the sand temperature reached 43℃,it could not hurt the skin and tissue,because the body temperature could balance with sand temperature at an ideal temperature for the skin.
(2) On the basis of the differentiation of symptoms and signs of Uyghur medicine,the propotion abnormal Balgham in osteoarthritis disease accounts to 53.57%,which is the most largest,the propotions of abnormal Khan,abnormal Spra and abnormal Savada account to 15.18%,10.5%,20.54%respectively.Sand treatment chould improve the symptom of the patient on early morning stiffness,joint pain and arthrocele(P＜0.008), Meanwhile sand treatment chould cut down the index of the laboratory on detected blood sedimentation,Creactive protein(P＜0.008).
(3) The study has designed and measured the system of model experiment of sand treatment in door.And has measured the changing regularity time-variation about the surface temperature of body and sand temperature.then has compared the result with the numerical value.The results of the model experiment chould better reflect the tendency of temperature in surface.The results indicated that the temperature coincides comparing experimental platform indoor with outdoor According the traditional principle of the sand treatment.
(4) A model of genu OA had been established successfully by fixing right hind limbs with gypsum.Sand treatment chould declined level of IL- 1β、TNF-a、NO in synovial fluid(P＜0.01).The cartilage tissue and cell cataplasia and ultrastructure changes were observed-in these animals right articular genu,It were observed that sand treatment chould improve inflammation,lessen the cataplasia of arthrodial cartilage.Sand treatment could improve Blood viscosity,depress peripheral vascular resistance(PVR) of the the rabbit experimental knee osteoarthritis(P＜0.01),meanwhile it could accelerate blood flow rate and lessen vascular resistance in arteria cruralis of the lower limbs in rabbit(P＜0.01). Sand treatment chould down regulation the express of the Caspse-3、Bax、Tunel in articular cartilage in KOA(P＜0.01).
conculsion
(1) We have Induced the standard of sand treatment including season、spot、time、temperature、depth.It makes sandtreatment more normalization、science and normalization.The ideal time for sand therapy is between June and August between the 10~(th) to 20~(th) days of the month,between 15:00-18:00 every day.When the air temperature reaches 40±2.3℃,the sand temperature will be maintained 38.±4.6℃under the 10-20. centimeter.Basised on this conditions the human body is buried under the sand at the depth of 20 cm for a period of one half of an hour to achieve therapeutic effects.
(2) Abnormal Balgham is the major factor to cause the rheumatism.Furthermore, curative effect of the Abnormal is better than others.We consider that the most accommodative crowd is the patient of the abnormal Balgham.basised on the program,the curative effect of patients with disease of osteoarthritis has a significantly improved which includes the early morning stiffness,joint pain and arthrocele,Meanwhile sand treatment chould cut down the index of blood sedimentation,Creactive protein.
(3) The system of conduct heat has been set up indoor which based on experiment method compared with the physiocracy in Tulufan.the temperature coincides to Tulufan outdoor.Furthermore,the system of conduct heat indoor of sand treatment will be not inhibited by the time,place,climate,and temperature will be controlled,
(4) We have established the animal model of the osteoarthritis.Sand treatment chould declined level of IL-1β、TNF-a,NO in synovial fluid,The cartilage tissue and cell cataplasia and ultrastructure changes were observed in these animals right articular genu. Sand treatment could improve Blood viscosity,depress peripheral vascular resistance (PVR) of the the rabbit experimental knee osteoarthritis,meanwhile it could accelerate blood flow rate and lessen vascular resistance in arteria cruralis of the lower limbs in rabbit.Forthmore,sand treatment chould suppress the Apoptosis of articular cartilage, improve the inflammation.Meanwhile it made the proteinic express down regulation on Caspse-3,Bax,Tunel.So,we consider that This is one of the cause which it gives a play for anti-inflammatory action.
(5) The study makes use of the biology conduct heat to research the sand treatment which provides a new method and means for research the sand treatment,and establishs theory basis for the reveal the mechanism action of sand treatment.
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[2]Todd PA,Clissold SP.Naproxen.A reappraisal of its pharmacology and therapeutic use in rheumatic diseases and pain states.Drugs,1990,40:91-137[medline]
[3]DT Felson.Nonmedicinal therapies for Osteoarthritis[J].Bull Rheum Dis,April 1,1998:47(2):5-7
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