The Law Of TCM Treatment Of Rheumatoid Arthritis Based On The Real World Study

Rheumatoid arthritis(RA)is a kind of autoimmune disease with inflammatory proliferation of synovial cells and formation of pannus,which can invade the cartilage and bone in the lower layer and cause joint damage.There are obvious problems in the treatment of RA with western medicine.Although there is no name of RA in traditional Chinese medicine,there are many discussions related to the name of RA,such as "Wan Bi","Gu Bi" and "Li Jie".In the treatment of RA,it also has a positive clinical effect,especially in the control of recurrence.Real world study(RWS)is a kind of research that takes a variety of data under the real clinical conditions to evaluate the real impact of a certain medical means on patients’ health and efficacy.It is the latest research progress and thinking of epidemiological development.ObjectiveThis project undertakes the theoretical and preclinical research stage of "research and development of new drugs of Guizhi Shaoyao Zhimu Decoction based on consistency evaluation",a national science and technology major special project.This research combines ancient literature to find the definition,treatment,syndrome differentiation and treatment of "Bi" and "Li Jie" related to RA,and comprehensively analyzes the research of modern literature in the treatment of RA for a comprehensive exploration This paper discusses the understanding of traditional Chinese medicine on RA,discusses the characteristics of RA syndrome type,treatment based on syndrome differentiation,the law of drug use and the curative effect through the real world outpatient case study,and sorts out Professor Gao Yong Xiang’s experience in treating RA,so as to provide part of evidence-based medical evidence for the treatment of RA based on syndrome differentiation of traditional Chinese medicine.Methods: 1.In this study,we have consulted ancient Chinese medicine books,modern Chinese medicine and traditional Vietnamese medicine research,preliminarily sorted out and summarized the related disease name,etiology and pathogenesis,treatment method and treatment of RA,consulted CNKI,Wanfang,web of science,etc.,classified the literature,and comprehensively analyzed the research status of ancient RA related treatise and modern literature.At the same time,we summarize the characteristics of RWS,discuss the research methods of traditional Chinese medicine in the real world,take RA as the research object,carry out clinical investigation,and discuss the law of TCM treatment of RA.2.Based on the real world research,with the clinical outpatients as the core,according to the basic data of patients,the relevant factors were analyzed.Based on the case data of Professor Gao Yong Xiang’s clinic from 2017 to 2019,302 cases of RA were included in the study.From then on,the relevant factors were analyzed to explore the TCM Treatment Law and effect of RA.3.From the synthesis and analysis of the above part,the clinical experience,medication director and academic thought of Professor Gao Yong Xiang in the treatment of RA syndrome differentiation were sorted out.Results:1.From the literature preliminary summary,analysis:(1)The pathogenesis and mechanism of RA have not been completely clear,and there are obvious problems in modern medical treatment of RA,such as not fundamentally alleviate the development of the disease,more and more adverse reactions.(2)From the understanding of RA in ancient books,we can see that the clinical pathogenesis of RA is complex and diverse,and it has developed into a mature system in the Qing Dynasty.After thousands of years of academic thoughts of medical scholars,modern Chinese medicine doctors mostly treat viscera,deficiency and excess,meridians,phlegm,blood stasis and toxin,so as to play the role of traditional Chinese medicine.(3)Vietnam’s traditional medicine has a history of thousands of years and is deeply influenced by Chinese traditional medicine.In the process of development,Vietnam traditional medicine has its own characteristics in understanding RA,and has achieved good results in treatment,which provides the achievements of traditional medicine in treating the disease between China and Vietnam.(4)The thought and mode of RWS are consistent with the characteristics of TCM diagnosis and treatment mode.Using RWS can improve the research efficiency of traditional Chinese medicine,discover and provide new laws and features of traditional Chinese medicine,so as to promote the innovation of basic theory of traditional Chinese medicine,clinical diagnosis and treatment theory and clinical evaluation method of traditional Chinese medicine,and ultimately promote the inheritance and development of traditional Chinese medicine.2.Real world clinical outpatient case study results show that:(1)The incidence of female was higher than that of male,the ratio of male to female was 7.38:1.In terms of age,the most patients are 40-59 years old,and the course of RA is more than 5-10 years.The main complications of RA were osteoporosis,diabetes and Sjogren’s syndrome.At the time of treatment,235 cases were treated with the combination of traditional Chinese and Western medicine.(2)In this study,82 cases(34.89%)were identified as deficiency of liver and kidney syndrome.There is a gap between TCM syndrome type and laboratory index,reflecting the correlation between RA TCM syndrome type and laboratory index,which can be used as the basis for RA TCM syndrome type classification to some extent.(3)In 235 cases,144 kinds of drugs were used for 1103 times,with the total frequency of 16814 times,among which the drugs for removing wind and dampness accounted for the largest proportion(15.31%),followed by the drugs for resolving external symptoms(14.80%),tonifying the liver and kidney(13.92%),the drugs for removing dampness and phlegm,and the drugs for promoting blood circulation.Combined with the compatibility of common traditional Chinese medicine,it always shows that the law of medication is to dispel wind and dampness,to invigorate liver and kidney,to disperse and solve the table,to dispel dampness and promote blood circulation.(4)Combined with modern medicine and pharmacology research,it is found that the effect of traditional Chinese medicine in the treatment of RA is very consistent with that of modern medicine in the treatment of RA.It mainly has the anti-inflammatory and analgesic effects,the regulation of immunity,and the prevention of bone and joint damage.(5)Further analysis showed that the data of 165 cases were complete,and the combination of traditional Chinese and Western medicine was used for 3 months,in which 16 cases of Western medicine reduction and 149 cases of maintenance dose were used in the treatment process,and there was no case that needed to be added.Before and after the treatment,ESR,rheumatoid factor,C-reactive protein and anti cyclic citrulline polypeptide antibody were significantly decreased,and the symptoms were significantly relieved,which showed that the combination of traditional Chinese and Western medicine had a good effect on RA.3.Professor Gao Yong Xiang ’s experience in the treatment of RA:(1)Etiology and pathogenesis: kidney deficiency is the basic pathogenesis;external pathogenic invasion is an important factor in the pathogenesis of RA;and phlegm and blood stasis are the pathological basis of RA.(2)Dialectical Essentials: emphasize to distinguish the cold and heat,and distinguish the false and the real.(3)Principle and method of treatment: focus on the treatment of the disease,and give consideration to both the specimen and the root.It puts forward the treatment methods of invigorating the kidney,combining with kaixuanfu,dredging meridians and collaterals,removing phlegm and removing blood stasis,soothing the liver and relieving depression,harmonizing emotions,nourishing yin and strengthening water,clearing heat and moistening dryness.(4)Classification of syndrome and treatment: 6 syndrome types.Among them,the cold dampness arthralgia syndrome is treated with Juanbi decoction,Jiuwei Qiang Huo Decoction and Qiang Huo Shengshi Decoction;the damp heat arthralgia syndrome is treated with Dang Gui Niantong decoction,Sanren Decoction and Simiao powder;the cold heat syndrome is treated with Guizhi Shaoyao Zhimu Decoction;the phlegm dampness syndrome is treated with Xuefu Zhuyu Decoction,Shentong Zhuyu Decoction and Erchen decoction;the deficiency of liver and kidney syndrome is treated with Duhuo Jisheng Decoction;the deficiency of yin and dryness heat syndrome is treated with Lianmei Decoction.