Liu Deyu Chief Physician Treating Knee Osteoarthritis Bi Disease (knee) Academic Thoughts And Clinical Experience

As a rigorous and virtuous scholar, Professor Liu Deyu has had a thorough understanding of the advantages and disadvantages of traditional Chinese medicine (TCM) and western medicine in his years of medical practice. This makes him have a firm belief to treat bone diseases with integration of traditional Chinese and western medicine. He emphasized that the treatment of bone disease should be based on the differentiation of locations which is a supplement to treatment based on syndromes differentiation by inheriting traditional theories of orthopedics and traumatology, summarizing the academic thoughts of experts of several generations in this field, and combining his own clinical experience The concept of wholism runs through the whole procedure of treatment. He established the principles of treating orthopedics and traumatology diseases as giving consideration to both the part and whole, taking account of disease differentiation, syndrome differentiation and locations\differentiation, attaching equal importance to manipulation and pharmacotherapy, and closely integrating traditional medical theories and modern medical technology. Prof. Liu Deyu has achieved satisfactory effects in the treatment of knee osteoarthritis (KOA) with TCM over decades. The methods and approaches he employs are unique.This paper organizes and summarizes his clinical experience and academic thoughts in the treatment of KOA comprehensively and systematically from the perspectives of etiology, pathogenesis, diagnosis, treatment and prevention for the purpose of further inheritance and innovation. The clinical effects of the therapeutic schedule designed based on his clinical experience were observed, and the probable mechanisms were investigated.This paper presented Prof. Liu’s experience in the treatment of KOA from the following nine aspects:1. Prof. Liu’s study on the geographic environment and climate and the features of people’s constitutions in the Weihe River BasinWeihe River Basin is located at the frontier of northwest China. Its northern part is mountainous area, middle part plain and loess tableland, and southern part the Qinling Mountains. It is like a pointed open groove with Weihe River as its axis. It is in the warm temperate zone of middle latitude, and belongs to continental monsoon climate type of subhumid climate zone. The four seasons are distinct here with cold winter and hot summer. Great difference in temperature is one of the climate features in this area. It is the route that the dry and cold air current in winter from Mongolia and Siberian will pass. The people in this area live in the houses with earth walls and tile roofs, and sleep on kang to keep warm. Such kind of houses is cold in winter and hot in summer. Since the qi of human body is connected with nature, the people living in such environment often get cold diseases. The constitutions of the residents in this area are usually cold, and their yang-qi is often inadequate.2. Prof. Liu’s study on the relevant causes of KOAKOA has a close relationship with natural endowment, age, diet and living habits, labor and rest, trauma, phlegm and blood stasis, climate and geographical environment. The internal cause of the disease is the weakness of healthy qi, and the external causes are the invasion of wind, coldness and dampness, trauma, and the obliquity of the line of force caused by them. In recently years, some scholars also think that the gain of weight and overuse are also important factors of KOA.3. Prof. Liu’s study on the pathogenesis of KOAThe location of KOA is on the knee, including the skin, meridians and collaterals, blood vessels, muscles and bones. Its pathogenesis is disharmonious between nutrient and defence systems, disharmony between qi and blood, phlegm accumulating with blood stasis, and disharmony between yin and yang of zang-fu organs. The initial syndromes of the disease are usually excess with pain and dysfunction as its main clinical manifestation. And the location is shallow, and the disease is less severe and is mainly coldness, dampness, stasis, phlegm, numbness and obstruction. With the passing of time, deficiency may become the main syndrome mixed with excess. The primary clinical manifestations are pain, swelling, and joint dysfunction. The advanced stage of the disease sees the simultaneous occurrence of deficiency and excess. And the principal manifestations are pain, deformed joints, deformity and dysfunction. The lungs, spleen, liver and kidneys may be involved in the development of the disease. The typical pathological mechanisms are obstruction and lack of nourishment. Besides, the obliquity of line of force and overuse as important factors in the development of KOA is gradually been acknowledged.4. Prof. Liu’s study on the common symptoms of KOAThe four main symptoms of KOA are pain, spasm, swelling and deformity. Pain and spasm occur first and last the overall process of the disease. Swelling appears next, and deformity will not occur until the advanced stage of the disease.5. Prof. Liu’s principles on the treatment of KOA The development of KOA is from early stage to middle and advanced stage or from the exterior to interior. Based on the theories of TCM Orthopedics and traumatology and the principles of treatment based on syndromes differentiation, as well as the characteristics of bone diseases, the principles of treating KOA including prevention first, strengthening the body resistance to eliminate pathogenic factors and simultaneous treatment of the symptoms and root cause guided by the concept of wholism. Under the guidance of overall dialectical conception, local dialectical treatment (the differentiation of diseases and locations) is emphasized. The external use of medicine, manipulation, needling, surgery and minimally invasive surgery are used according to the location of the disease.6. Prof. Liu’s fundamental approaches for the treatment of KOASince KOA is a chronic cumulative injury, it is difficult to cure once it occurs. Therefore, preventing its occurrence and slowing down its development are of great importance. It is proposed that prevention should come first, and once the disease occurs, we should prevent its exacerbating and try to effectively intervene and control the pathogenic factors at the early stage. In this way, we could prevent the occurrence of disease, postpone its development, and achieve the aim of prevention and cure. The main approaches of treatment including warming, reinforcing, dredging and regulating therapies.7. Prof. Liu’s administration of drugs for the treatment of KOAProf. Liu’s administration of drugs for the treatment of KOA is characterized by preciseness and appropriateness with fewer kinds and focused potence. Drugs with the effects of warming and reinforcing are the main choices no matter they are for external or internal use, and cold and cool drugs are used with caution. Invigorating spleen and stomach, warming and recuperating the liver and kidney, expelling dampness and removing phlegm and activating collaterals are emphasized. Radix Astragali, Rhizoma Atractlodis, Radix Codonopsis, and Radix Pseudostellariae stregthen the body resistance and regulating the spleen; Radix Aconiti Laterails Preparata, Cortex Cinnamomi, Ramulus Cinnamomi, Rhizma Zingiberis, and Herba Asari warm yang and dispelling coldness; Semen Coicis, Herba Lycopi, Rhizoma Alismatis, Rhizoma Atractylodis, Herba Eupatorii, Herba Pogostemonis expel dampness and remove swelling; and animal drugs promote blood circulation to remove stasis; Rhizoma Pinelliae, Bombyx Batryticatus, and Semen Sinapis eliminate phlegm and activate collaterals; Fructus Chaenomelis, Radix Paeoniae, Radix Glycyrrhizae relieve pain and spasm; Cornu Cervi Gelatinum, Carapax et Plastrum Testudinis, Carapax Trionycis reinforce liver and kidney. The treatment with drugs are combined with psychotherapy. 8. Prof. Liu’s experience in the external treatment of KOASince bone diseases are usually characterized by simultaneous existence of local and systemic lesions, and local lesion is often the main subject of the disease, treatment based on the locations of the disease, massage, minimally invasive surgery with small needles and scalpels, or external use of drugs are applied.9. Prof. Liu’s experience in the prevention, recuperation and nursing of KOAPrevention should be first. Education on the relevant knowledge of KOA should be strengthened. Early discovery and early intervention are of great importance. As to those high risk groups, correcting bad habits, doing appropriate sports, having proper diet, and controlling weight are necessary. The patients should be educated to learn right recuperating and protecting methods like massaging themselves and keeping warm. The people already had the disease should be diagnosed and treated early to delay its development and improve the effects.