Postpartum rheumatism, also called “postpartum body pain” and “postpartum arthropathy”, is a common condition that occurs within 100 days after childbirth (including miscarriage and miscarriage) with discomfort, pain, soreness, heaviness, numbness, or mild functional limitation of limbs, muscles, and joints. From June 2008 to December 2009, we formulated our own postpartum rheumatism drink to treat 30 cases with good results.
1. Clinical data
There were 30 cases in the treatment group, aged 20-37 years old, average 27.5 years old; the shortest duration of illness was 12 days, the longest was 2 years, average 5.9 months. In the control group, there were 15 cases, aged 23 to 32 years, with an average of 27.3 years; the shortest duration of disease was 20 days, the longest was 2.5 years, and the average was 5.5 months. There was no significant difference between the two groups in terms of age, disease duration, clinical symptoms and laboratory tests (P>0.05), which were comparable.
Diagnostic criteria There are no corresponding diagnostic criteria at home and abroad, so we refer to the Chinese Rheumatology for self-designed Chinese and Western medical diagnostic criteria. TCM diagnostic criteria.
Main symptoms.
① discomfort of limbs, muscles and joints occurring within 100 days after delivery (including miscarriage and miscarriage);
② pain;
③ soreness and pain;
④ heaviness;
⑤ numbness;
⑥Mild functional limitation.
Secondary symptoms.
①weakness and sweating;
② fear of wind and cold;
③ irritability and insomnia. The tongue is light or tender, or purple and dull with petechial dots; the tongue is thinly coated with white, or thinly coated with yellow, or with little moss, or with white and thick moss; the pulse is thin and moist, or sunken and counted, or sunken and astringent.
Where the main symptoms are.
① plus any 1 or more main symptoms and/or concurrently with 1 or more secondary evidence, can be recognized as this disease.
Western medicine diagnostic criteria.
① Onset during the puerperium or within 100 days after delivery, including miscarriage, abortion and premature delivery;
②Main symptoms: pain, soreness, heaviness, numbness and unfavorable flexion and extension of limb muscles and joints;
(3) Mild functional limitation of the affected joints, with symptoms reduced after activity, and in most cases the joints are painful but not swollen.
④Laboratory examination: blood sedimentation, C-reactive protein, rheumatoid factor, anti-hemolytic streptococcal O and blood routine are normal;
⑤X-ray examination without bone abnormalities;
(6) The condition can be completely relieved by treatment, and the affected limbs and joints will not remain deformed and the function can be restored to normal;
⑦Exclude other rheumatic diseases such as rheumatoid arthritis, rheumatoid arthritis, osteoarthritis and lupus erythematosus.
2.Methods
2.1 Treatment method
The treatment group took postpartum rheumatism drink (30g of raw astragalus, 10g of cinnamon stick, 30g of white peony, 12g of angelica, 30g of yellow essence, 30g of green wind vine, 30g of chicken blood vine, 12g of windbreak, 12g of raw licorice, 6 slices of ginger, 6 jujubes, 15-30ml of rice wine) orally with water decoction, one dose per day. Requirement: Decoct twice with a gentle fire to obtain about 400ml of juice, 200ml in the morning and 200ml in the evening after meals, with 15-30ml of rice wine as a primer, and warming for an hour or so after taking the medicine, with a slight appearance of sweating all over the body. The control group took Zhengqing Wind Pain Ning Delayed Release Tablets (Hunan Zhengqing Pharmaceutical Group Co., Ltd.) orally, 120mg twice daily after meals. Both groups took 4 weeks as a course of treatment.
2.2 Observation indexes and methods
The improvement of the TCM syndrome score before and after treatment was the main observation item, which was reflected in the difference of the TCM syndrome score before and after treatment between the two groups.
2.3 Clinical efficacy criteria
Referring to the relevant contents of the “Guidelines for Clinical Research on New Chinese Medicines”, the formula [(pre-treatment score – post-treatment score) ÷ pre-treatment score] × 100% was calculated and expressed as a percentage.
① clinical cure: Chinese medicine clinical symptoms, signs and symptoms disappeared or basically disappeared, the evidence points reduced by ≥ 95%;
②effective: Chinese medicine clinical symptoms, signs and symptoms significantly improved, the evidence points reduced by ≥ 70%;
③Effective: Chinese medicine clinical symptoms and signs have improved, and the symptom score has been reduced by ≥ 30%;
④Invalid: no significant improvement in clinical symptoms and signs, and less than 30% reduction in symptom score.
2.4 Statistical methods
All data were counted using the statistical package PEMS 3.1 for Windows of the Chinese Medical Encyclopedia and Medical Statistics. The data were expressed as “mean±standard deviation” by t-test; the data were compared by χ2 test; and the rank data were analyzed by Ridit.
3. Results
3.1 Comparison of clinical efficacy between two groups
In the treatment group, there were 14 cases of clinical cure, 10 cases of significant effect, 5 cases of effective effect and 1 case of invalid effect, with an overall effective rate of 96.67%. In the control group, there were 2 cases of clinical cure, 4 cases of significant effect, 7 cases of effective, and 2 cases of invalid, with a total effective rate of 86.67%. The difference between the two groups was not statistically significant (P>0.05).
3.2 Comparison of symptom scores before and after treatment between the two groups
Table 1 shows that the mean points of each symptom before and after treatment were compared, and the points values of all symptoms in the treatment group decreased after treatment, and the comparison before and after treatment was statistically significant (P<< em="">0.05); the points values of each symptom in the control group decreased before and after treatment, and the comparison before and after treatment was statistically significant (P<< em="">0.05). The comparison between groups after treatment was statistically significant (P<< em="">0.05). This indicates that both groups were effective in improving clinical symptoms, and the treatment group had better efficacy than the control group.
Table 1 Comparison of symptom scores before and after treatment (±S)
Symptoms
Treatment group (N=30)
Control group (N=15)
Before treatment
After treatment
Before treatment
After treatment
Limb pain Soreness
4.00±1.38
1.06±0.33*▲
3.86±0.83
1.92±0.41*
Numbness and heaviness of limbs
3.88±0.50
0.38±0.50*▲
3.62±0.57
1.91±0.38*
Limb function limitation
3.73±1.55
0.86±0.63*▲
3.38±0.17
1.27±0.13*
Fear of wind and cold
3.59±1.34
1.07±0.69*▲
3.18±0.51
1.97±0.41*
Weakness and sweating
3.22±1.01
0.32±0.11*▲
3.19±0.25
1.81±0.23*
Insomnia and irritability
3.31±1.62
0.49±0.54*▲
3.91±0.54
2.02±0.45*
Aggravated by cold, tired and rainy days
3.43±1.06
1.20±0.43*▲
3.08±0.61
2.15±0.37*
Note: Compared with this group before treatment, *P< 0.05; compared with the control group after treatment ▲P< 0.05.
4. Discussion
This disease is mostly caused by postpartum deficiency, compounded by external wind, cold and dampness, and stagnation of blood stasis. The disease is located in the skin, tendons and blood vessels. The pathogenesis is “deficiency”, “evil invasion” and “blood stasis”, and they are interrelated. The pathogenesis is based on deficiency, with wind, cold, dampness and stasis blocking the skin and tendons. The treatment is based on the pathogenesis of “deficiency as the main cause, repeated exposure to external evil, and stagnation of blood and stasis”, and establishes the treatment of sweet-warmness to nourish deficiency and benefit Qi to dispel evil.
The formula emphasizes the use of Huang Qi with Angelica sinensis, taking the meaning of Angelica Sinensis Blood Tonic Soup. Postpartum deficiency, blood deficiency and qi weakness, coupled with fatigue and depletion of qi, more deficiency of its yin and blood. White peony with licorice is Zhongjing peony and licorice soup, sour harvesting and sweet moistening, souring and sweetening yin, for nourishing blood and benefiting yin, relieving pain. Radix et Rhizoma Polygonati with Rhizoma Polygonati Gan tonifies the spleen and stomach of the middle jiao, achieving sweet-warm and beneficial effects on Qi, tonifying Qi and generating blood. Qing Feng Vine with Gui Zhi is used to promote wind-dampness and clear channels, dispersing cold and stasis to remove paralysis and pain. Under the action of the meridian-attracting herb Huang Jiu, Qing Feng Vine and Gui Zhi wind remove dampness and publish to relieve muscle action is more enhanced.
Fangfeng with ginger can elevate the rising Qi of the middle Jiao to harmonize the Ying and Wei, dispersing wind-cold-dampness. Glycyrrhiza glabra and jujube, sweet, warm and beneficial to Qi, replenish Qi and regulate the middle, harmonize the medicinal properties, and rice wine leads all the medicines to reach the disease, together as the enabling medicine. Studies have shown that this formula has good effect on this disease.