OBJECTIVE: To investigate the clinical effect of Chinese medicine discriminative internal treatment of knee osteoarthritis.
METHODS: Eighty-six patients with osteoarthritis of the knee who visited our hospital from March 2011 to November 2014 were randomly divided into 43 patients in the control group and 43 patients in the treatment group, and patients in the control group were given diclofenac sodium extended-release capsule 100 mg/d, 1 time/d; patients in the treatment group were treated with Chinese herbal soup discriminative internal administration, 1 dose/d, 1 week as a course of treatment, and 4 consecutive courses of treatment. The change of joint pain before and after treatment was assessed by visual pain analogue score VAS, the improvement of knee function was assessed by Lyshom knee score scale; the degree of joint stiffness was assessed by knee osteoarthritis self-assessment scale (WOMAC), the effective rate was calculated, and the occurrence of adverse effects was observed.
Results: The effective rate of patients in the treatment group was 90.7% significantly higher than that of patients in the control group, 69.8%, with statistically significant differences (P < 0.05); the degree of pain relief and decrease in VAS scores of patients in the treatment group were particularly improved compared with those in the control group, with statistically significant differences (P < 0.05); patients' knee function improved to different degrees after treatment, and joint stiffness was relieved. Patients in the treatment group had different degrees of improvement in knee function, joint stiffness was relieved, Lyshom score increased compared with that before treatment, and WOMAC stiffness score decreased compared with that before treatment, and the improvement was especially prominent in the treatment group, and the difference was statistically significant (P < 0.05); patients in the control group had 1 case of nausea, 1 case of acid reflux, 2 cases of stomach discomfort, 1 case of dizziness, 2 cases of drowsiness, and the incidence of adverse reactions was 16.3%, while patients in the treatment group had There were no significant adverse reactions in the treatment group, and the difference was statistically significant (P < 0.05).
Conclusion: The efficacy of Chinese medicine in the treatment of osteoarthritis of the knee is precise, and it can effectively improve the joint pain, improve the function of the knee joint and relieve the joint stiffness of patients.
Knee osteoarthritis is a common chronic, degenerative osteoarthropathy in clinical orthopedics, with joint pain, swelling, and functional limitation as common symptoms. In recent years, the treatment of knee osteoarthritis with Chinese medicine has formed a comprehensive treatment system based on drug therapy, combined with manipulation, acupuncture, functional exercise and other methods, which has the unique advantages of diverse methods, reliable efficacy, low price and few adverse reactions, and has achieved good efficacy in reducing symptoms, adjusting physical fitness, delaying and eliminating the cause of the disease. In this study, the author combined the physical characteristics of osteoarthritis of the knee, starting from the perspective of identification, and treating it by type, with satisfactory results, which are reported below.
1. Data and methods
1.1 General information
Eighty-six patients with knee osteoarthritis who visited our hospital from March 2011 to November 2014 were selected as study subjects, and the patients were randomly divided into the control group and the treatment group. There were 43 patients in the control group, including 20 males and 23 females; age 42-71 years, mean age (52.6±3.8) years; duration of disease 4 months-7 years, mean (2.5±0.8) years; site of onset: 14 cases on the left side, 22 cases on the right side, and 7 cases bilaterally; 43 patients in the treatment group, including 21 males and 22 females; age 40-73 years, mean age ( 53.2±3.5) years old; disease duration 3 months-9 years, mean (2.8±1.2) years; onset site: 15 cases on the left side, 20 cases on the right side, and 8 cases bilaterally; general data of the two groups were processed by statistical SPSS 20.0, and the difference was not significant (P>0.05), indicating that the two groups could be compared.
1.2 Inclusion criteria
The diagnosis was confirmed according to the patients’ symptoms, signs, X-ray manifestations and laboratory examinations with reference to the Guidelines for the Diagnosis and Treatment of Osteoarthritis. (1) Patients were seen to have recurrent knee pain symptoms within the last 1 month; (2) X-ray showed cystic lesions, narrowing of joint space, etc.; (3) Visible joint fluid was viscous and clear with WBC ≤ 2000/ml at least 2 times; (4) Middle-aged and elderly patients ≥ 40 years old; (5) Morning stiffness ≤ 3 minutes; (6) Femoral friction sound during activity. The diagnosis can be confirmed by meeting 1+2 or 1+3+5+6 or 1+4+5+6 of the above. The diagnosis of TCM typing was confirmed by referring to the Guidelines for Clinical Research on New Chinese Medicines.
1.3 Exclusion criteria
Patients with poor compliance or even withdrawal were excluded; patients who were pregnant or lactating were excluded; patients with gastrointestinal bleeding, peptic ulcer and other diseases were excluded; patients with allergic reactions to aspirin, other NSAIDs and other drugs that may cause cross-allergy were excluded; patients with restricted sodium intake were excluded; patients with severe knee deformities were excluded; patients with severe heart, liver, lung, kidney, hematopoietic system and other pathologies were excluded; patients with severe heart, liver, lung, kidney and hematopoietic system pathologies were excluded. Patients with serious cardiac, hepatic, pulmonary, renal, hematopoietic and other pathologies; patients with a history of arthritis such as gout and rheumatoid arthritis; patients who have been treated with hormones and non-steroidal anti-inflammatory drugs in the past 2 weeks are excluded.
1.3 Treatment method
Patients in the control group were given diclofenac sodium extended-release capsule (0.1g*6s) 100mg/time, 1 time/d, 1 week as a course of treatment, 4 courses of treatment. Patients in the treatment group were given internal treatment with Chinese herbal medicine to identify the type of treatment. (1) Wind-cold and damp paralysis evidence: Fangfeng Tang plus reduction. The formula is as follows: Gentiana macrophylla 15g, Fangfeng 8g, Red Poria 30g, Chuanniu Knee 15g, Chuanxiong 10g, Radix Paeoniae Alba 10g, Sangxis 10g, Dog’s Tongue 8g, Qiangwu 10g, Gui Zhi 12g, Xin 3g, Angelica dahurica 10g, Glycyrrhiza glabra 6g. Add or subtract according to the symptoms, add Scutellaria 15g, Coix seed 30g if the cold is very hot, add Yuanhu 20g, Angelica sinensis 15g if the pain is very bad, add If the pain is severe, add Yuan Hu 20g, Angelica Sinensis 15g; if the pain is severe, add Deer Antler Cream 20g; ② Qi stagnation and blood stasis evidence: Shu Tuan Tang plus or minus. Red peony 30g, angelica 10, qiangwu 10g, turmeric 10g, sea wind vine 8g, stretching grass 12g, dolphin 10g, wind 6g, Chuanxianhe 15g, Chuanxianniu 10g, licorice 6g; with the symptoms, add Chaihu 8g, Bai Shao 30g; for severe pain, add neem 10g, for severe heat, add Yujin 15g, Yin Chen 10g; for severe blood stasis, add frankincense 8g, myrrh 4g. Myrrh 4g; (3) Liver and kidney deficiency: Douwuxiaosheng Tang, plus or minus. The formula is as follows: Duluxiang 10g, Sang Sang Sang 15g, Eucommia 10g, Frying Chuanjian 15g, Chuan Niu Knee 15g, Gentiana 8g, White Poria 15g, Cinnamon 10g, Chuanxiong 15g, Fried Radix Codonopsis 15g, Radix Angelicae Sinensis 10g, Paeoniae Alba 30g, Radix Rehmanniae 10g, Fructus Ligusticum 10g, Radix Araliaceae 10g, Pericarpium Citri Reticulatae 8g, Radix Glycyrrhiza Uralensis 6g. Add and subtract according to the symptoms. According to the type of identification of the patient, the treatment is divided into types. 1 dose of the drug is taken daily, and the drug is soaked in water and decocted and taken twice in the morning and evening. 1 week is a course of treatment, and 4 courses of treatment are given.
1.4 Observation indexes, efficacy criteria
(1) The change of joint pain before and after treatment was assessed by visual pain analogue score VAS, and patients were given a score of 0-10 according to the severity of joint pain. 0, no pain, 10, severe pain, and the pain level was evaluated as follows: mild pain, 1-3; moderate pain, 4-6; severe pain, 7-10, with the pain level becoming more severe as the score increased. (2) Improvement in knee function was assessed with the Lyshom knee rating scale [6], and knee function improved with increasing scores. (3) Patients’ joints were assessed for stiffness using the Osteoarthritis of the Knee Index (WOMAC), with a total score of 0-200, the higher the score, the more severe the stiffness of osteoarthritis of the knee. (4) Evaluate the efficacy with reference to the Guiding Principles for Clinical Research on New Chinese Medicines. Clinical control: Patients have normal joint movement, X-rays show normal, and the points are reduced by ≥95%. Effective: the patient’s joint movement is not restricted, X-ray shows significant improvement, and the integral is 70%-95%. Effective: The patient’s joint movement was mildly restricted, and the X-ray showed improvement, with a 30%-70% reduction in points. Ineffective: No significant improvement in joint movement, no change in X-ray, and less than 30% reduction in points. (5) Observe the adverse reactions such as gastrointestinal discomfort and neurological damage.
1.5 Statistical methods: SPSS20.0 was used to analyze the data, and the measurement data were expressed as mean ± standard deviation ( ± s), ANOVA and t-test were performed; X2 test was used for counting data. p<0.05 means the difference is statistically significant
2, Results
2.1 Comparison of the efficacy of the two groups of patients with osteoarthritis of the knee: the effective rate of patients in the treatment group was 90.7% significantly higher than that of patients in the control group, 69.8%, with significant differences (P < 0.05). See Table 1.
Table 1 Comparison of the efficacy of patients with osteoarthritis of the knee in the two groups (cases)
Group n clinical control significant effective ineffective effective rate (%)
Control group 43119101369.8
Treatment group 4323115490.7a
Note: compared with the control group, X2=5.939, aP=0.0284<0.05< p="">
2.2 Comparison of joint pain, knee function and joint stiffness scores between two groups of patients with knee osteoarthritis The degree of pain relief and decrease in VAS scores of patients in the treatment group were especially improved compared with those in the control group, and the difference was statistically significant (P < 0.05); patients had different degrees of improvement in knee function and relief of joint stiffness after treatment, and Lyshom scores increased compared with those before treatment The Lyshom score increased compared with the pre-treatment level, while the WOMAC stiffness score decreased compared with the pre-treatment level, and the improvement in the treatment group was particularly significant (P < 0.05). See Table 2.
Table 2 Comparison of joint pain, knee function, and joint stiffness scores between two groups of patients with knee osteoarthritis (points)
Group Eye time VASLyshomWOMAC stiffness
Control group 43 Before treatment 7.85±0.7622.38±7.4574.65±18.29
Post-treatment 5.42±0.43a51.45±10.53a43.46±12.35a
Treatment group 43 Pre-treatment 7.91±0.7420.42±8.3676.41±20.33
After treatment 2.84±0.36ab82.35±11.47 ab18.57±10.14 ab
Note: Comparison between the two groups of patients and this group before treatment, aP < 0.05; comparison between the two groups after treatment, bP < 0.05
2.3 Adverse reactions
Patients in the treatment group did not show significant adverse reactions, while patients in the control group showed 1 case of nausea, 1 case of acid reflux, 2 cases of gastric discomfort, 1 case of dizziness, and 2 cases of drowsiness, with an incidence rate of 15.9% of adverse reactions, and the difference was statistically significant (P < 0.05).
3. Discussion
Osteoarthritis of the knee belongs to the categories of “bone paralysis”, “knee paralysis” and “atrophy” in Chinese medicine, and is a common clinical orthopedic disease. In recent years, the incidence of osteoarthritis in clinical practice has increased significantly, becoming one of the main causes of pain and disability in patients. Modern medicine believes that its pathogenesis is still unclear, but some studies suggest that the occurrence of the disease is closely related to age, mechanics, obesity, biology, and genetics. Pathological studies have confirmed that its pathology is characterized by degeneration of articular cartilage, degenerating cartilage tissue cells mainly fibroblast-like chondrocytes and hypertrophic cartilage-like cells, and also involves the whole joint, which eventually causes behavioral dysfunction such as joint pain, joint stiffness, and joint disuse. Therefore, joint pain relief, joint function improvement and stiffness relief have become the hot spots of clinical research. The focus of treatment at home and abroad is on delaying cartilage degeneration, relieving pain, improving function, and avoiding deformity, and is treated with corticosteroid and sodium vitreous acid injections in the joint cavity, oral local analgesics, and non-steroidal anti-inflammatory drugs, or in severe cases, surgery. Studies have proven that Chinese medicine is the most effective treatment.
According to Chinese medicine, osteoarthritis of the knee, as a kind of “paralysis”, is caused by deficient endowment, old age and frailty, long term illness and strain, resulting in deficiency of internal organs, loss of liver and kidney, and loss of nourishment of tendons and bones. In “Introduction to Medicine”, it is said that “paralysis is the blockage of the flow of Qi. ……` is similar to impotence”. The “Ji Sheng Fang” says: “The disease of paralysis, cold is more painful, wind is more line, wet is more stick; in the bone is heavy and does not lift, when the cold is urgent, when the heat is vertical, this are with the evil Qi and the evidence of the evidence”. From this, it can be seen that it is the evidence of deficiency of the liver and kidney as the root and wind, cold, dampness and stasis as the symptoms. Combined with years of clinical experience, the author believes that clinical treatment should be based on the identification of priorities and the differentiation of types on the basis of evidence-based treatment. Clinical statistics show that the drugs commonly used in the treatment of osteoarthritis in Chinese medicine are mainly blood activators (Chuanxiong, Niubizi), wind-damp dispelling drugs (Weilingxian, Dushu), blood tonic drugs (Angelica sinensis, Bai Shao), etc. The main treatment for osteoarthritis of the knee is to activate blood and resolve blood stasis. The author sees three types of symptoms: wind-cold-damp paralysis, qi-stagnation-blood stasis and liver-kidney deficiency. The wind-cold-damp paralysis is caused by the invasion of wind-cold-dampness into the joints and tendons, and the stagnation of Qi and blood, which leads to paralysis. The treatment must be to dispel wind and dampness, disperse cold and relieve pain, so the author mostly uses the soup made by adding flavor to Fangfeng Tang to treat it internally. The formula of Gentiana macrophylla is moist and not dry, and is a good medicine for the treatment of paralysis, regardless of cold and dampness, dampness and heat, paralysis can be applied for a long time; Fangfeng is a general medicine for the treatment of wind, which can dispel wind and win dampness, remove paralysis and relieve pain; red poria, nux vomica, Chuanxiong, red peony main into the blood, can invigorate blood and remove blood stasis, relieve tendons and veins; mulberry, dog’s spine can nourish the liver and kidneys, strengthen tendons and bones; Qiangwu qiqing is Yang, good at moving the qi, can release the evil, has the ability to dispel cold, remove wind and dampness. It has the effect of dispelling wind and dampness, relieving pain; Gui Zhi warms the tendons and veins, disperses cold and removes paralysis; Hsiang Xin can dispel wind and cold, move water and open the orifice; Licorice harmonizes the cold and warm properties of all medicines, and the combination of multiple medicines can dispel wind and cold, move Qi and relieve pain. In the formula, red peony and angelica nourish the blood and invigorate the blood; qiangwu and douhu disperse cold, dispel dampness and relieve pain; turmeric breaks the blood and moves the qi, clears menstruation and relieves pain; hai feng teng works on the meridians, and blood vessels, broadens the middle and rationalizes the qi, and removes dampness and wind; stretching tendon grass focuses on relaxing the tendons and activating the channels, removing dampness and eliminating paralysis; prevention of wind is the specific medicine for treating wind; Chuan sanguinaria and Chuan niu knee nourish the liver and kidney, niu knee The herbs also have the function of invigorating the blood and opening up the meridians; licorice harmonizes all the medicines, and the combination of multiple medicines can help to promote the flow of qi and blood, so that the joints can be relaxed and the paralysis can be healed. In patients with liver and kidney deficiency, the author emphasizes tonification and selects Douwuxiaosheng Tang with addition and subtraction. The formula is based on the characteristics of “long-standing paralysis, deficiency of liver and kidney, and deficiency of qi and blood”. Cinnamon warms the kidney and helps the yang; Chuanxiong, Angelica, and Peony have the effect of nourishing the blood and invigorating it, and licorice harmonizes all the medicines. The combination of all the herbs, mainly tonifying and supplementing with tonics, together nourish the liver and benefit the kidney. In conclusion, TCM treats osteoarthritis of the knee by adhering to the formula of the patient’s group, which has the advantages of balancing the symptoms with the root cause and attacking and tonifying at the same time.
The results of the present study showed that the patients treated in the TCM evidence-based internal medicine group had precise efficacy and high efficiency, and the degree of improvement in joint pain relief, knee function, and joint stiffness was more prominent compared with the control group, and the changes in pain VAS score, Lyshom score, and WOMAC stiffness score were more significant compared with the control group patients, and the difference was statistically significant (P < 0.05). It is noteworthy that patients in the control group showed gastrointestinal and neurological discomfort symptoms such as nausea, acid reflux, gastric discomfort, dizziness, drowsiness, etc., while no adverse reactions were seen in the Chinese medicine group, which reflects that Chinese medicine tonics taken internally have the advantages of precise efficacy and high medication safety compared with oral Western medicine alone, and clinical application of both the symptoms and the root cause can make up for the disadvantages of Western medicine's pure symptomatic treatment, which can effectively improve patients' joint pain, enhance It can effectively improve joint pain, knee function, and joint stiffness, which is the prominent manifestation of Chinese medicine in the treatment of orthopedic diseases by differentiation and typology, and is worthy of wide clinical promotion.