Chinese Medicine and Culture

CASE REPORT
Year
: 2019  |  Volume : 2  |  Issue : 4  |  Page : 196--202

Immediate, fast, and overcome response of the organism in response to energy osteopathy on the model of primary gonarthrosis (polyparametric and statistical studies)


Yu O Novikov1, OG Kantor2, JeanPierre Guiliani3,  
1 Federal State Budget Funded Educational Institution of Higher Education “Bashkortostan State Medical University,” Ministry of Healthcare of the Russian Federation, La Tour-d'Aigues, France
2 Ufa State Petroleum Technological University, Ufa, Republic of Bashkortostan, Russian Federation, La Tour-d'Aigues, France
3 SFERE College of Traditional Chinese Energetics, La Tour-d'Aigues, France

Correspondence Address:
Prof. Yu O Novikov
Federal State Budget Funded Educational Institution of Higher Education “Bashkortostan State Medical University,” Ministry of Healthcare of the Russian Federation, Ufa, Republic of Bashkortostan
France

Abstract

In 26 patients with confirmed primary verified gonarthrosis (PGA), a clinical and instrumental examination was conducted to evaluate the response energy osteopathy followed by statistical processing of the data. Three types of the body's response to treatment were identified: immediate, fast, and delayed, which, despite the different informative value of the data of the polyparametric study, allowed judging the effectiveness of the method used.



How to cite this article:
Novikov YO, Kantor O G, Guiliani J. Immediate, fast, and overcome response of the organism in response to energy osteopathy on the model of primary gonarthrosis (polyparametric and statistical studies).Chin Med Cult 2019;2:196-202


How to cite this URL:
Novikov YO, Kantor O G, Guiliani J. Immediate, fast, and overcome response of the organism in response to energy osteopathy on the model of primary gonarthrosis (polyparametric and statistical studies). Chin Med Cult [serial online] 2019 [cited 2020 Aug 4 ];2:196-202
Available from: http://www.cmaconweb.org/text.asp?2019/2/4/196/273895


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 Introduction



Despite the century-old history of of traditional Chinese medicine (TCM), the attitude to its therapeutic effect is ambiguous. In various scientific publications, the attitude toward TCM is polar – from articles proving the high effectiveness of the method before its rejection, when therapeutic phenomena are declared placebo. The method is the object of a critical attitude toward it as evidence-basedmedicine. The basis of TCM is the concept of “qi” (energy), which is not recognized by official science. Therefore, convincingly to prove the mechanisms of the therapeutic effect of acupuncture on the body is very difficult.[1],[2],[3]

However, TCM specialists who have been practicing for more than a decade have shown amazing results of treatment. Hence, in France, the direction of energy osteopathy has been successfully used for 40 years already. The founder of this trend is J.P. Guiliani who, in the last 10 years, has been cooperating with specialists from the Institute of Osteopathy of St. Petersburg State University and SZGMU which was named after I.I. Mechnikov. The result of the cooperation is the method's authentication, the search for new methods of verification of energy osteopathy. Moreover, the main task of researchers is to select the optimal methods for determining, before clinical and laboratory manifestations, nonspecific changes in organs, tissues, and, possibly, the systemic response of the organism under external influence; in this case, the effect on acupuncture points was carried out by the method of dispersion and tonification by the method of J.-P. Guilliani.

Doctors use TCM in almost all areas of clinical medicine, but the greatest number of publications is devoted to the functional and early stages of organic lesions of the musculoskeletal system.[4],[5],[6] The most accessible for research is the knee joint, due to its anatomical features; relatively simple orthopedic methods of research, allowing us to give the fullest possible characterization of the joint changes in its violation as well as well as imaging methods – sonographic, radiographic, and thermographic. As the studied nosological form, gonarthrosis was selected, which is isolated as an independent disease.[7]

The purpose was to study early clinical and instrumental changes involving an immediate, rapid, and delayed response in patients with gonarthrosis, which developed during energy osteopathy according to the method of J.-P. Guilliani.

 Patients and Methods



Participants of the study

The treatment with TGM by Guilliani method was applied to 26 patients (7 men and 19 women) with primary verified gonarthrosis (PGA) of Stages I–II, with a mean age of 57.6 ± 1.8 years and a mean duration of disease of 6.1 ± 2.6 years. The diagnosis of PGA was established in accordance with the criteria of the American College of Rheumatology in the presence of pain in the knee joint, increasing with exercise, crepitus, and morning stiffness.

The general criteria for inclusion in the study were the diagnosis of PGA in the acute or subacute stage, established at least 3 months before inclusion in the study, and the level of pain in the knee joint at the time of inclusion of 4 or more points on a 10-point Visual Analog Scale (VAS). In addition, the criterion for inclusion was the Yang axis of pain in the knee joints. Noninclusion criteria were newly diagnosed PGA and other, severe, and/or unstable diseases: malignant neoplasms, uncontrolled arterial hypertension, unstable angina, stroke, epilepsy, and psychiatric diseases.

Despite the low evidentiary weight, it was decided to dwell on the description of a series of cases without a control group because the therapeutic effect was identical for all patients consecutively included in the study.

Methods of research

Psychological testing

A common method of subjective pain assessment is the VAS. In the study, a patient on a 10-cm-long straight line marked pain intensity, with the beginning of the segment corresponding to the absence of pain. Testing was done twice before and after application of TCM, after 15–20 min. The unconditional advantages of this scale include its simplicity and convenience, but on this scale, the patient only notes the intensity of pain, without taking into account the emotional component of the pain syndrome, which introduces errors in the VAS data.

Tenzoealometry (Algometry)

With the help of strain gauges, a subjective report of pain was quantitatively measured with presentation of increasing pain stimuli. To increase the reliability of the method, the measurement of soreness was carried out in the following four para-articular zones:

In the region of the lateral side of the patellar baseIn the region of the head of the fibulaIn the medial condyle of the tibiaIn the area of the medial condyle of the thigh.

The measurement was carried out twice, the first 2–3 h before the infrared thermography, in order to exclude the possible distortion of the thermograms, and the second one 1–2 h after the treatment.

Uglometry (Goniometry)

With the angularity of the knee joint, a single initial position was used in the supine position, and the patient's leg was brought to the abdomen by flexing the hip joint, after which an anatomical position representing 0° motion of the joints bent the knee joint to a sensation of soreness in it. The amplitude of motion, that is, the path traversed by the segment of the body along the arc of motion, was marked positively in angular degrees. To measure the amplitude of joint movements, a universal protractor is used, which is a protractor with a scale of up to 180°, to which two arms are attached. One of them is fixedly connected with the protractor, and the other – movable – is attached to its center. The protractor should be placed correctly – the corresponding orientation of its shoulders with the help of distinctive bone points. Indications of angular measurements were measured in degrees before treatment and after 10–15 min after the treatment.

Infrared thermography

The thermography makes it possible to accurately estimate the intensity of infrared radiation from the surface of the human body in real time and to detect changes in heat production and heat transfer in various areas of the body, thereby revealing disturbances in blood flow and innervation and the symptoms of developing inflammatory, oncological, and other diseases. In connection with the highly developed vasculature in the skin and subcutaneous tissue, surface blood flow indicators are an important indicator of the pathological process. Thus, the main factor determining the temperature of the skin is the intensity of the blood circulation. The second mechanism of heat formation is the intensity of metabolic processes, the accelerate of which increases the heat production.

And, finally, the third factor that determines the heat balance in the surface tissues is their thermal conductivity, which depends on the thickness, structure, and location of these tissues. Heat output of the human body is determined by the state of the skin and subcutaneous fatty tissue: their thickness, development of the basic structural elements, and hydrophilicity.

The survey was carried out with a thermal imager “testo 870” (PERGAMED, Moscow, Russia). Patients before the infrared thermography were weaned off drugs that affect their blood circulation and metabolic processes. The study was conducted in a 25 m2 office, where a constant temperature (18°C–20°C) and humidity (50%–60%) were maintained. The patient exposed his lower limbs, and then adapted to the temperature of the room for 20–25 min. Both joints were simultaneously examined in the frontal plane, in the standing position. Previously, the test area was degreased with 96% ethanol. The maximum measurement error of the instrument used, according to its technical characteristics, did not exceed 2%. The information during the thermal imaging examination both before and after the treatment came in real time.

Study of the antioxidant activity of synovial fluid

To study the molecular mechanisms of inflammation, a large role in the development is assigned to free radical oxidation (chloroperoxidase [CPO])–generation of active forms of oxygen (reactive oxygen species [ROS]) and lipid peroxidation, as well as the state of antioxidant status. Free radicals, unlike ordinary molecules, have an electron with an unpaired spin on an external energy orbit and have high chemical activity and a relatively short lifetime, which makes it difficult to detect them. During the interaction of the radicals, energy is released in the form of a quantum of light of a certain intensity (chemiluminescence – CL300), measurement of which allows judging the state of the free radical oxidation (FRO) in the material under investigation. The antioxidant activity of the synovial fluid has been studied with the help of the device HL-003. As a choice, we used the method of CL, based on the phenomenon of energy release in the form of a quantum of light of a certain intensity, measurement of which allows judging the state of free radical oxidation (CPO). The study was conducted twice, before and after treatment, and was only possible in patients with synovitis. The synovial fluid was withdrawn by a puncture of the upper curvature of the knee (recessus suprapatellaris) at the lateral edge of the patellar base. The needle moved forward perpendicular to the axis of the thigh under the tendon stretching of the quadriceps muscle to a depth of 3–4 cm. The whole process of CL registration and processing of the results was carried out in an automatic mode, which made it possible to improve the accuracy and objectivity of the information obtained. As the most informative indicators, the maximum luminosity and the light sum of CL were taken. The duration of the measurement was 5 min. Initially, the CL of the model system in which the formation of the ROS was induced was measured. Then, 0.5 ml of intra-articular fluid was added to the model system. antioxidant activity (AOA) was judged by the degree of suppression of the CL of the model system in the presence of synovial fluid.

Procedure

Among the patients included in the survey were persons with PHA of the Yang direction, whose joint pain was acute, was intermittent, was dagger, wore point character, and intensified during movement. Patients suffered increasing pain during the day and their pain decreased at night, at rest. To reduce pain in the joint, you need cold. When the palpation of the joint revealed intense swelling, without a trace of pressure, the skin in the joint area is dry, hot to touch, there was increased pain from touching, the patient jerks his hand after indicating the localization of the area of maximum pain. The effect on the points of miraculous vessels was used. Points near the knee joint were not used to avoid distortions during thermal imaging. Therapeutic effect on acupuncture points by the method of J.P. Guilliani was carried out by the method of dispersion and tonification. When toning, the impact on the point was short and fast, accompanied by a slight pain sensation, clockwise. Dispersion is characterized by a gradually increasing intensity of stimulation and a longer exposure time, where there are numbness, raspiranie, and aches. The effect is directed counterclockwise. For example, when the left knee is injured, we perform toning of 62 V (shen-mai) on the right and a dispersion of 62 V on the left, then we perform a dispersion of 3 IG (hou-si) to the left and a toning of 6 R (zhao-hai) to the left. With right-hand PGA, they affect similar points on the opposite side.

Statistical processing of data

The processing of patient observation data and the analysis of the results obtained were carried out using the Excel Analysis Package and using the STATISTICA system (StatSoft Russia, Moscow, Russia), designed for performing complex statistical calculations.

 Results



All the 26 PGA patients before and after the procedure underwent a multivariate study, which was carried out in three stages.

At the first stage, immediately after the Guiliani TCM procedure, we expected to get an immediate response from the tissue or organ to the effect used. This criterion corresponded to the temperature changes, which we fixed using a thermal imager. In all patients, we recorded changes in the temperature relief and identified hyperthermia zones in the painful points of the knee joints.

The most pronounced changes in the temperature profile were noted in the extremities with PGA, and the thermal imaging method made it possible to quickly visualize the results of treatment. Hence, when examining all the 26 patients with PGA on the thermograms of the “diseased” knee joint, an increase in the hyperthermia zone was visualized, with the temperature increment dT = 0.65 ± 0.46, whereas in the “healthy” joint, no such changes were detected, and the temperature increase was only dT = 0.15 ± 0.08, which is apparently associated with a vegetative response to the procedure [Table 1].{Table 1}

Assessment of the pain was attributed to the second stage of the study – a rapid response, because to realize the maximum response to medical treatment, a certain time, usually from 15 to 30 min, is necessary. At this stage, the pain was assessed using both test methods (VAS) and with the help of strain gauges.

It should be noted that the changes in VAS in absolute terms during treatment differed significantly from 25.09% before the start of treatment to 87.12% after the treatment [Table 1]. Apparently, this is due to the high subjectivity of assessments of the patients themselves and the emotional component of the pain syndrome, which indicates the advisability of using VAS as an additional informative factor.

Tensoalgimetry (algometry) data, measured in conventional units, were obtained from the analysis of soreness in different anatomical areas of the knee joint before and after treatment. Uglometry, performed in a single starting position, made it possible to evaluate the change in the amplitude of motion, the increase which also indicated a decrease in the pain syndrome during treatment.

All the data obtained met the requirements of completeness, reliability and accuracy, uniformity and comparability, and timeliness, which allowed their statistical processing to use a wide range of mathematical and statistical methods.

Quantitative determination of the intensity of the inflammatory process was carried out in the third stage – a delayed response. The object of the study at this stage was synovial fluid, the degree of inflammatory process, which was assessed by CL.

Observations of patients revealed the presence of all patients have a positive effect of osteopathic treatment [Figure 1].{Figure 1}

Analysis of the numerical characteristics of the rates of change in the analyzed indicators [Table 2] showed that virtually on all indicators (except for VAS), the patient population is homogeneous (the corresponding coefficients of variation do not exceed 36%). The small values of root-mean-square deviations and, as a result, the coefficients of variation in the rates of change of these indicators caused small spreads in the corresponding ranges of the most probable values, which, in turn, provides a fairly good predictability of patients' “responses” to the treatment according to these indicators. A significant variation in the rate of change in the VAS score (73.60%) confirmed the validity of the earlier assumption that it was appropriate to use it as an additional informative factor.{Table 2}

Analysis of the frequencies of changes in the absolute values of the analyzed parameters [Figure 2] (showing histogram of frequencies of changes in absolute values of indicators) confirmed the positive effect of the treatment and allowed us to conclude that the response of the patient's organisms to a treatment that is not described by the known probability distribution laws is accidental.{Figure 2}

Modeling the effect of the treatment using regression analysis was not possible for the VAS and the chemilumenomer [Figure 3] (showing regression relationships describing the effect of treatment). From the presented results, it follows that the predicted values of the expected effects from the treatment are:{Figure 3}

2.1% for the thermal imager3.6% for indicators of angular measurement7.8%, 15.6%, 14.21%, and 9.8% for the tensoalgimetry index for points I–IV, respectively.

In order to increase the validity of the interpretation of observational data and to identify the most significant indicators, one of the tools of factor analysis was used – the method of principal components [Table 3]. At the same time, the VAS data (due to high subjectivity) and CL (due to the lack of data for all the 26 patients) were not used. The results of the calculations made it possible to establish that 88% of the variation of all available data is due to the first four factors, in which there are no clear dominant indicators (in each of these factors, there are at least two indicators whose load exceeds 0.5 in modulus).{Table 3}

According to the Kaiser criterion, factors that have variance less than 1(<1), should not be regarded as significant. Thus the first three factors should be considered the most significant. Factor 1 is characterized by high loads on the parameters of the thermal imager, angular measurements, and two of the four indicators of the strain gage (II and IV points); factor 2 – the indices of the I and III points of the strain gage; and factor 3 – the thermal imager, as well as the I and II points of the strain gage.

Thus, the results of statistical processing of the experimental data confirmed the expediency of dividing the entire aggregate of the analyzed indicators into three groups. The first group includes the parameters of the thermal imager, angle meter, and tensoalgimetry, equally and meaningfully characterizing the results of treatment; the second – the parameters of chemiluminomer, reliably characterizing the effect of treatment, this method of research can be used only in patients with the presence of synovitis; in the third – the VAS indicator, which, due to the high subjectivity of its assessments, should be regarded as poorly informative.

 Conclusion



According to the results of the study, the effectiveness of treatment by the method of J.-P. Guiliani, which can be attributed to the sanogenetic, three types of reaction of the organism were identified: an immediate, rapid and delayed response. The instant response corresponded to the temperature changes, which were fixed with the thermal imager. To the rapid reaction, we included the assessment of the pain syndrome with the help of VAS and tensoalgimetry; we also classified the angular velocity, which allowed us to estimate the change in the amplitude of motion, which correlated with the degree of pain syndrome. A delayed response was determined by the degree of dynamics of the inflammatory activity of the synovial fluid, which was assessed by CL. The indicators characterizing the effectiveness of treatment could be divided into three groups with different informativeness. The most informative were the parameters of thermal imaging, angular, and tensoalgimetry, followed by the study of the inflammatory activity of synovial fluid with the help of chemilumenomer, and the least informative was the assessment of pain syndrome according to the VAS. Despite the heterogeneous data undergoing statistical processing, it can be concluded that the method of energy osteopathy used is effective.

Financial support and sponsorship

Nil.

Conflicts of interest

There are no conflicts of interest.

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