Abstract：Objective：To observe the effect of acupotomy combined with heat- sensitive moxibustion for knee osteoarthritis with yang deficiency and congealing cold syndrome in early and middle stage guided by meridian sinew theory. Methods： A total of 78 cases of patients with knee osteoarthritis with yang deficiency and congealing cold syndrome were selected and divided into the observation group and the control group according to the random number table method，with 39 cases in each group. The observation group was treated with acupotomy combined with heat-sensitive moxibustion guided by meridian sinew theory ， and the control group was treated with acupotomy at routine fixed points combined with heat- sensitive moxibustion. Both groups were treated for 3 weeks. Before and after treatment ， the scores of symptoms，Visual Analogue Scale (VAS) in knee pain，and Western Ontario and Mcmaster Universities Osteoarthritis Index (WOMAC) were evaluated ， and the levels of inflammatory factors in synovial fluid including interleukin (IL)-1β，IL-18 and tumour necrosis factor-α (TNF-α)，bone metabolism factors including bone Gla protein (BGP) ， tartrate- resistant acid phosphatase 5b (TRACP- 5b) and bone alkaline phosphatase (BALP) ， and metabolic factors of cartilage extracellular matrix including matrix metalloproteinase- 3 (MMP- 3)， tissue inhibitor of metalloproteinases- 1 (TIMP- 1)，and cartilage oligomeric matrix protein (COMP) were detected. The clinical effects in the two groups were compared， and the safety evaluation and follow-up observation were carried out. Results：After treatment，the total clinical effective rate was 94.87% in the observation group， higher than that of 79.49% in the control group， the difference being significant (P＜0.05). The scores of Chinese medicine symptoms and VAS in knee pain in the two groups were decreased when compared with those before treatment (P＜0.05)，and the scores of Chinese medicine symptoms and VAS in knee pain in the observation group were lower than those in the control group (P＜0.05). The scores of pain， stiffness， and joint function in WOMAC were decreased when compared with those before treatment (P＜0.05)，and the three scores in the observation group were lower than those in the control group (P＜0.05). The levels of IL- 1β， IL- 18， TNF- α， TRACP-5b，MMP-3，and COMP in synovial fluid in the two groups were decreased when compared with those before treatment，and the levels of BALP，BGP，and TIMP-1 were increased when compared with those before treatment， differences being significant (P＜0.05). The levels of IL- 1β， IL- 18， TNF- α， TRACP- 5b， MMP- 3， and COMP in the observation group were lower than those in the control group， and the levels of BALP，BGP，and TIMP-1 were higher than those in the control group，differences being significant (P＜0.05). There was no adverse reaction such as fainting，broken needles，nerve injury，and wound infection during treatment in the two groups. In the six-month follow-up，the recurrence rate in the observation group was lower than that in the control group (P＜0.05). Conclusion： The treatment of acupotomy combined with heat- sensitive moxibustion guided by meridian sinew theory has a significant effect in treating knee osteoarthritis in early and middle stage with high safety，which may be related to the regulation of levels of inflammatory factors， bone metabolism factors， and metabolic factors of cartilage extracellular matrix.