Patient: Description of condition (onset time, main symptoms, hospital visited, etc.): Hello, Dr. Wu! My beloved has been ill for more than 10 years. In 1998, her right pinky finger was swollen, and then both hands were deformed, and her condition worsened in 2002 and 2003, and by 2005 and 2006 she was paralyzed in bed and relied on a wheelchair to go out. In August 2007, he underwent a double knee replacement procedure at Shanghai Guanghua Hospital. At present, both knees are fine, but other joints are still painful. Now I have stopped taking hormones, but I still take painkillers (Intazing) every day. Now I am having pain in my hips, shoulders, elbows, ankles, hands and feet, etc. I need Dr. Wu’s help. Ditto Please ask Dr. Wu if he can control or even cure the disease, reduce her pain and improve her quality of life?
Dr. Wu Zhongzhao, Chief Physician, Acupuncture Hospital, Chinese Academy of Traditional Chinese Medicine.
This is a younger patient with rheumatic or combined rheumatoid disease. Of course, no matter which diagnosis is made, it is not the main thing, but the treatment and the effect is the most crucial and the fundamental purpose.
In terms of age, this patient is not very old, only 42 years old. However, the clinical symptoms involved almost all joints of the body. From the medical history, the development of the disease is rapid, and the treatment is basically ineffective in all related specialties, especially the double knee replacement, and the disease seems to be developing, and it is difficult to predict how serious the subsequent symptoms will be.
This raises the following questions.
1. What is the diagnosis and cause of this disease?
The information mentioned in the patient’s message is limited. However, it is not difficult to see that certainly numerous departments are treated according to rheumatoid or rheumatic diseases. From the available symptom feedback or retrospective diagnosis, this diagnosis should not be wrong. However, when carefully analyzed, the occurrence of this disease may be rheumatoid symptoms at the beginning, but by the later development, it is rheumatism-based symptoms. Therefore, the main problem of this disease is that rheumatism is the main disease, rheumatoid disease is only a stage in the course of the disease, or a relatively less dangerous disease. Or, the total diagnosis of this disease is more likely to be a combination of rheumatism and rheumatoid disease. From the present data, we do not know the specific clinical tests to support the above judgment. However, from decades of clinical experience, I have gradually developed a mode of thinking in which the diagnosis is inferred from clinical manifestations and clinical efficacy, while various clinical examinations and imaging indicators are in a reference or secondary position. There have been more patients, in clinical symptoms, early rheumatic or rheumatoid manifestations, but just can not be supported by clinical tests. Maybe I still treat them according to rheumatism or rheumatoid, and the clinical results are very good. In some cases, it took several years, or even up to ten years, before the clinical test was confirmed.
Patients live in the Lixia River area for a long time. This region is densely networked with rivers and ditches, with a high rainfall and heavy humidity. According to the etiological basis of disease meteorology and environment, it has the basic external conditions for the development of rheumatism and rheumatoid rheumatism. Of course, the occurrence of this disease, but also with the micro-meteorological conditions (their own home), work environment, etc. also have a relationship, this should be understood.
From the perspective of rheumatism and rheumatoid pathogenesis, the occurrence of this disease is also related to family genetics.
The aforementioned situation, the clinical symptoms of the disease, the living environment, etc. still support the diagnosis of rheumatism or rheumatoid disease.
2, why long-term treatment is ineffective, and even developing?
From the available information, the patient still attaches great importance to clinical diagnosis and treatment, at least some specialties or medical strength, higher technical level of medical institutions have been to, but basically failed to work, and even rapid development of the disease. Why is this? From the medical history and treatment history, at least a few points can be analyzed.
(1) The diagnosis and treatment is mainly based on Western medicine. The development of the disease, Western medicine anti-rheumatic or rheumatoid in, in the acute or symptomatic period, for the relief of clinical symptoms, control of inflammatory exudation, reduce pain, etc., but in the slow progress of the period, to prevent rheumatic infiltration has not been a good way, especially the drug has strong side effects, which is inevitable.
(2) not pay attention to the role of their own positive energy in the disease. The reason why this disease occurs, the vast majority of long-term often have poor physical fitness, chronic fatigue, or a certain lack of physical genetic aspects. That is, the deficiency of positive qi, as Chinese medicine calls it, means that the resistance is weak. In the treatment of a single emphasis on anti-rheumatic or rheumatoid treatment, these methods and drugs, are in a relatively low function of the body to be a new grammer, so that the body’s resistance is more and more low. For example, anti-rheumatic drugs have a great impact on the human gastrointestinal tract, and can even cause ulcers, affecting the intake, digestion and absorption of diet. And this is what Chinese medicine calls injury to the spleen and stomach function. The spleen and the stomach are the source of the postnatal essence, the source of biochemical energy and blood, that is, the root of the body’s positive energy (resistance). Therefore, when the righteousness is insufficient, it is easy to get sick, and when the righteousness is injured, the sickness advances. Therefore, it is inevitable that wind and dampness are rampant in this disease.
(3) The characteristics of the disease are not considered. The treatment of this disease, the use of Western medicine alone anti-rheumatism, etc., is far from enough. The clinical manifestations of this disease often vary from person to person, and even each person is different. Without individualized treatment plans, it is difficult to achieve results. In addition, the patient lives in a humid place, more should be treated with evidence, such as Chinese medicine.
This treatment is not the best treatment plan if you only look at the disease but not the person.
3.How do you know about double knee replacement? Is it necessary?
When the joints are deformed, especially the knees, replacement is the easiest and simplest from the Western medical point of view. Is replacement necessary? What are the results after replacement? What is the psychological response of the patient that is better than the clinical outcome is no longer a matter for many doctors to consider.
We have looked at similar knee replacement patients in Europe and many other countries around the world and found that very few, if any, had satisfactory results without symptoms. Many of them were able to move around and take care of themselves before the replacement, at least on one side, but after the replacement, not only did the affected side not heal, but the healthy side also lost its ability to walk and take care of itself because of the loss of balance and biomechanical changes on both sides. What is more damaging to the patient is that after the replacement of the knee joint, the patient has basically lost the courage to take care of his own life, and the psychological imbalance is greater than the pathological imbalance, and he even loses his strength. Such a situation is detrimental to both the treatment of the disease and the related rehabilitation and functional exercises, i.e., it can affect the implementation of functional exercises, etc.
More importantly, is it necessary to perform surgery such as knee joint replacement? In many rheumatic patients, during the progressive, inflammatory, or infiltrative phase, the joints become larger, deformed, swollen, red, and “fused”, etc. This is mostly a temporary phenomenon, and as the inflammation improves, the body’s adaptability and inherent ability to repair itself to a certain extent increases, the symptoms will improve, even greatly. The so-called joint deformation, “fusion”, etc., sometimes contains a false component, there are reversible benign changes, that is, through anti-inflammatory, local treatment, functional exercises, etc., to a large extent, there can be functional improvement of the knee joint, such as restoring the ability to take care of themselves, should not be rashly for the so-called joint replacement. What’s more, the joint replacement is not a permanent solution, but a new replacement within a short period of five years or ten years, which involves more costs, a new adaptation process and physical and mental pain.
4. What are the main mechanisms of subsequent disease progression?
So far, the disease is still not effectively controlled, or rather, it is still progressing, both in terms of functional loss, pain presence, joint deformation, and psychological damage. What are the main pathological changes of its subsequent disease?
There are four main aspects.
One is that the functional impairment worsens with time.
Two, the compound arthropathy remains and, indeed, the condition of the whole body will decline.
Third, the associated pain mechanisms and pain symptoms will survive, but will not necessarily be as intense as before, or will be somewhat milder.
Fourth, the psychological changes will fluctuate. Because once the disease is not controlled into multi-system, multi-joint, multi-site and multi-level lesions, it will be more difficult to treat, and the sequelae pathological manifestations will be multiple, complex and stubborn. From physical lesions to physical and mental effects.
5.What is the understanding of this disease in Chinese medicine?
This disease belongs to the category of paralysis in Chinese medicine. It is affected by wind, cold and dampness for a long time, and the meridians are blocked and the qi and blood do not flow smoothly, so it is painful without pain. As stated in the Nei Jing, “Wind, cold, and dampness mixed with the three qi are paralysis”. Of course, the symptoms may vary because of the difference in the severity of wind, cold and dampness. Wind evil is heavy, wind is good at moving, and pain is mostly wandering; cold is heavy, cold is the main attraction, and pain is intense; dampness is heavy, dampness is heavy, and limbs are heavy and hard to relieve. Of course, a certain stage of the disease into heat, or feel the heat, localized fever or redness, etc., this is also damp-heat. The above manifestations can be at different stages of the disease process. However, the current situation of the patient is that the phlegm and stagnation have become a compound of muscle paralysis, tendon paralysis, and bone paralysis.
As for the onset of the disease, as mentioned above, it is mainly due to the deficiency of the body’s positive energy and the feeling of external evil. As the ancients said: “If the righteousness exists within, the evil cannot dry up”, and where the evil comes together, its qi must be deficient”. The main reason why the disease has not been cured for a long time and the disease has become more serious is that it has failed to take into account the support of the positive and the evil.
6.What are the recommendations for follow-up treatment?
Four suggestions.
First, the treatment method should be changed from mainly Western medicine to mainly Chinese medicine or combined Chinese and Western medicine.
The second is to shift from drug therapy to physical therapy, the latter including acupuncture, herbal bath, acupuncture point medication, buried wire therapy, functional exercise, etc.
Third, a shift from local treatment-oriented to overall adjustment-oriented.
Fourthly, there is a shift from treatment of disease and evil to rehabilitation and corrective treatment.
7.What is the prognosis of the disease?
The prognosis of this disease depends on the change of treatment mode and method and its correct application. Most of the joints and most of the symptoms can be improved with proper treatment and adherence to treatment, at least to control the development of the disease and to take care of oneself, and to prevent the disease from invading the internal organs (heart valve lesions, etc.).
8. What are the lessons learned from the treatment of this disease?
Lessons learned from the treatment of this disease include
(1) The development of rheumatic-type diseases is related to the overall disorder, i.e., to the low function of the body (deficiency of positive energy).
(2) The treatment of rheumatic diseases should not only target the local area, but also the whole body, i.e., a holistic concept is needed.
(3) rheumatic diseases should be tailored to local conditions and individuals.
(4) Rheumatic diseases should be treated not only for the disease, but also for the person.
(5) rheumatic-type diseases should be treated for pathology while also paying attention to the support of correction.
(6) Rheumatic diseases should not only be treated by Western medicine, but also by timely application of traditional Chinese medicine methods.
(7) Arthroplasty for rheumatic-type diseases should be done with caution.
(8) Rheumatic diseases should be treated from a single drug to comprehensive treatment and functional exercises.
(9) rheumatic diseases are not cured for a long time, and they mostly develop from physical diseases to physical and mental diseases.
(10) rheumatic diseases in the middle and late stages or dysfunctional period should be both physical and mental conditioning, functional exercise and use.
9.How to care for such patients?
Selecting a good hospital and setting a good method is the greatest angle of care for patients; paying attention to supporting positive energy, physical and mental conditioning, and comprehensive treatment is the most correct treatment care.
10.Other aspects of the treatment of this disease
For those with complications of rheumatic heart disease, muscle pain, joint stiffness, movement disorders and other symptoms, there are many methods available in Chinese medicine, such as long snake moxibustion, acupuncture points and re-moxibustion, acupoint injection, ear point application, cupping, etc., which are all good treatment methods. The idea of TCM miscellaneous to treat is very applicable to the treatment of this disease.
Patient: Thank you, Dr. Wu! After reading your reply, I think my family’s treatment is mainly western medicine, which has been misunderstood and not combined with the root cause of the treatment. Now I am in the idle period and would like to go to receive your treatment, what do I need to bring? How does the route go?
A: Hospital name: China Academy of Traditional Chinese Medicine Acupuncture Hospital; Address: Beixincang Hutong, South Xiaojie, Dongzhimen, Beijing. Directions: Beijing Subway Line 2, Dongzhimen Subway Station, Exit D, a few minutes walk. It can be reached by bus 24, 635, etc. Tel: 01064008265.