| [Background]Patellar tumefaction is a common disease in traditional Chinese medicine. The equivalent of modern medicine is knee arthritis.Knee arthritis is a common disease of the Division of Rheumatology, which is difficult to treat. As the most frequently used joint with the largest synovial area in the body, it thus becomes the most commonly involved j oint of osteoarthritis, rheumatoid arthritis and other rheumatic diseases, characterizing with high incidence, longer duration, severe illness and difficult treatments. Currently, non-steroidal anti-inflammatory drugs and drugs to improve the condition are the main medical treatment methods, though featured with poor efficacy, great side effects, and poor patient compliance. Biological agents are gradually promoted and applied at home and abroad, but the cost is high that the general population is unbearable. In addition, since the surgical treatment has more complications and higher risks, therefore, the exertion of traditional Chinese medicine (TCM) expertise, researches on relevant literature, mining for clinical experience of TCM doctors, excavation for effective medicines are very promising research directions. There is no systematic research. for patellar tumefaction as an independent disease by now. It is necessary to research for patellar tumefaction about pathogenesis, disease and syndrome characteristics, and treatment.[Objective]Through the sorting, collection and collation of ancient "Patellar tumefaction" records as well as the analysis of the latest traditional Chinese and western medicine literature about knee arthritis, the name, pathogenesis, syndrome factors, treatment and therapies, etc. of Patellar tumefaction are reviewed, and the forefront treating inflammation of knee arthritis is summarized. The academic thinking, diagnosis and treatment characteristics and medication experiences of the mentor for knee arthritis is collated and explored, and the clinical efficacy and safety of mentor’s medication of Sishen decoction modification to treat rheumatoid knee arthritis is verified, which provides new ideas and methods for clinical research and treatment of knee arthritis.[Method]By reading18ancient medical records about "Patellar tumefaction", including Differential Diagnosis and Treatment and Experience Gained in Treating External Diseases, its name, pathogenesis, differential diagnosis, syndrome factors, and therapies, etc. were summarized and combed through the literature research, and the forefront progress of knee arthritis in cause, diagnosis, prognosis, treatment and other aspects were summarized currently through the systematic reference to traditional Chinese and western medicine literature on knee arthritis in recent years.Research medical records use cross-sectional epidemiological research methods, The research was based on the "man-machine combination, and people-oriented" principle, and "Research Case Acquisition System Ⅵ.0of China Academy of Chinese Medical Science Xiyuan Hospital","Academic Thought Mining Platform Ⅵ.0from Old Famous TCM Doctors", association rules and other data mining methods were applied. We analyze and summarize the Laws, of differentiation and treatment about patellar tumefactionA randomized case-control test method was adopted in the clinical research, and90cases of patients with Patellar tumefaction were randomly divided into TCM group, integrated group of Chinese and western medicine and western medicine group. The randomized controlled clinical trials were adopted, so that the TCM group was treated by Sishen decoction modification, the integrated group of Chinese and western medicine was treated by Sishen decoction modification combined with ibuprofen and the western medicine group was treated by ibuprofen, all for one successive month. The prior treatment and the post treatment were selected as the evaluation time point to observe the efficacy indicator of WOMAC score, VAS pain score, girth of the knee, syndrome scale, erythrocyte sedimentation rate (ERS) and C-reactive protein, so as to evaluate the clinical efficacy of Sishen decoction modification in the treatment of. patellar tumefaction. [Results]1. Literature researchAncient books combing about patellar tumefaction:the patellar tumefaction was typically expressed by the clinical swelling and pain of knee arthritis. Many ancient doctors had different understanding towards the etiology and pathogenesis of crane-knee arthritis, which were shown in the theoretical differences of exogenous pathogen or Yin or Yang deficiency. However, the etiology and pathogenesis were thought as the "congenital failure of kidney" and "three yin meridian of foot" by most physicians, and the differentiation of syndrome is distinct in the acute, slow, cold, hot, deficiency and reality. patellar tumefaction, patellar abscess, knee urticaria and arthritis of knee were diagnosed differentially were diagnosed differentially. Various sufferings are seen in different cases, but always common with deficiency syndrome and cold syndrome, so the Wen Tong, invigoration and other methods are applied to analyze multiple medical cases with different characteristics. There is analogous pathology in knee osteoarthritis. The pathomechanism of knee osteoarthritis is local inflammatory response mediated by cytokines. A large number of cytokines and antibodies bring about strong immune injuries. Recent research focusing on the use of biological agents.2Cross-sectional study of medical recordsA total of143cases of cases were collected,19males and124females, and the male to female ratio was1:6.5. The involved diseases were:110cases of rheumatoid knee arthritis, accounting for76.92%,33cases of osteoarthritis, accounting for23.08%, The common symptoms were joint swelling, high skin temperature, spasm of limbs, feeling heavy and turbid, sore lumbus and knees, fatigue and weakness, mild at night and serious in daytime, more serious in cold, released in warm, causalgia, and flexion weakness. The main syndromes were44.06%of hot toxic accumulation,26.58%of phlegm and stasis,25.18%of liver and kidney deficiency and4.2%of inadequate Yang and condensated Yin. The main treatment methods were clearing away heat and toxic materials, promoting blood circulation to remove blood stasis, clearing away dampness and reducing phlegm, tonifying qi and yin and so forth.92flavors of TCM were commonly used, of which Sishen decoction (Astragalus, Polygala, Dendrobium, honeysuckle, and Cyathula) was necessary.3Clinical studies of Sishen decoction in the treatment of rheumatoid knee arthritis88patients were observed in the study with16males (18.18%) and72female (81.82%), and the male to female ratio was4.5:1. Among them,30caseswere in TCM group,30cases were in integrated group of Chinese and western medicine and28patients were in western medicine group. There was no statistical significance in gender, age and duration among three groups, thus comparable.The total efficacy of TCM group,integration of traditional chinese and western medicine group, western medicine group was86.67%,83.33%,82.14%.The result was no significant difference in the statistical analysis. The total efficacy of integration of traditional Chinese and western medicine group didn’t increase. In the period of clinical observation patients of TCM group did not show abnormal blood and urine test, whose main adverse reaction were mild gastrointestinal discomfort such as diarrhea. The incidence of adverse reactions in TCM group was less than that in the other two groups.The main efficacy indicators included VAS, girth of the knee and TCM symptom score. VAS began to decrease to different extent in the three groups after two weeks of treatment. Contrasted before and after two weeks of treatment, VAS of TCM group and the integration of traditional Chinese improved statistically and significantly(P<0.05). It decreased statistically significantly in the integration of traditional Chinese groups in comparison to the other two group after two weeks treatment(P<0.05). Contrasted before and after four weeks of treatment, VAS of the three groups improved statistically and significantly(P<0.05). No significant difference was shown between the three group (P>0.05).Contrasted before and after two weeks of treatment, girth of the knee of TCM group and the integration of traditional Chinese improved statistically and significantly(P<0.05). It decreased statistically significantly in the integration of traditional Chinese group and TCM group in comparison to western medicine group after two weeks treatment(P<0.05). Contrasted before and after four weeks of treatment, girth of the knee of the three groups improved statistically and significantly(P<0.05). No significant difference was shown between the three group (P>0.05).Contrasted before and after two weeks of treatment, TCM symptom score. of TCM group and the integration of traditional Chinese group improved statistically and significantly(P<0.01). It decreased statistically significantly in the integration of traditional Chinese group and TCM group in comparison to western medicine group after two weeks treatment (P<0.05). Contrasted before and after four weeks of treatment, TCM symptom score. of the three groups improved statistically and significantly(TCM group and the integration of traditional Chinese group P<0.01, western medicine group P<0.05). It decreased statistically significantly in the integration of traditional Chinese group and TCM group in comparison to western medicine group after two weeks treatment(P<0.01).The secondary efficacy indicators included ESR, CRP and WOMAC. Contrasted before and after two weeks of treatment, CRP of the three groups improved statistically and significantly(the integration of traditional Chinese group P<0.01, TCM group and western medicine group P<0.05). No significant difference was shown between the three group (P>0.05).After four weeks of treatment, CRP of the three groups improved statistically and significantly(the integration of traditional Chinese group and TCM group P<0.01, western medicine group P<0.05). No significant difference was shown between the three group (P>0.05).After two weeks of treatment, No significant difference was shown in self-control about ESR in the three groups (P>0.05). No significant difference was shown between the three group (P>0.05). after four weeks of treatment, No significant difference was shown in self-control about ESR in the three groups (P>0.05). No significant difference was shown between the three group (P>0.05). After two weeks of treatment, No significant difference was shown in self-control about WOMAC in the three groups (P>0.05). No significant difference was shown between the three group (P>0.05). After four weeks of treatment, No significant difference was shown in self-control about WOMAC in the three groups (P>0.05). No significant difference was shown between the three group (P>0.05).Improvement of TCM symptom score in TCM group or the integration of traditional Chinese and western medicine group was better than that in the western medicine group. Improvement of girth of the knee in the other two groups was better than that in the western medicine group afer two weeks of treatment. Improvement of VAS in the integration of traditional Chinese and western medicine group was better than that in the western medicine group afer two weeks of treatment.With prolonged treatment period, the difference of efficacy indicators in the other groups compared with the western medicine group became not significant-Compared with the western medicine group.The secondary efficacy indicators, including ESR> WOMAC and CRP, had no significant differences.[Conclusion]1. Literature studyThere are complex clinical manifestations of patellar tumefaction. Since the long duration of the course, It is difficult to Identify of the characteristics of the various syndromes. Ancient records were not excessive about treatment of The heat of the actual situation mixed. A large of research focus on Western biologies, but the cost is high, not suitable for China’s national conditions. Further research about patellar tumefaction. is needed.2Cross-sectional study of medical recordsThrough the studies about patellar tumefaction on syndromes, differentiation, governing law, prescription and medication. We found that patellar tumefaction often appear. in advanced disease. by older women.The main syndromes were hot toxic accumulation, phlegm and stasis, liver and kidney deficiency and inadequate Yang and condensated Yin. The common syndromes. is hot toxic accumulation. Patellar tumefaction pathogenesis is characterized by:basic pathogenesis is toxic heat accumulation, Underlying causes is Yin deficiency important characteristics is phlegm. The main treatment methods were clearing away heat and toxic materials, promoting blood circulation to remove blood stasis, clearing away dampness and reducing phlegm, tonifying qi and yin and so forth. Sishen decoction was necessary.3. Clinical studies of Sishen decoction modification in the treatment of patellar tumefaction.Sishen decoction modification is an effective agent with strong target and reliable effect. Joint tenderness, swelling and other local symptoms and signs were proven be improved significantly in clinical, and the inflammatory markers can be reduced, It can improve body condition.The security and compliance is better than Ibuprofen.By the explore law of differentiation and treatment about patellar tumefaction, Under the guidance of endotoxin theory,we catch the key syndromes:reds swollen、 hot、pain of knee,find that common syndromes of patellar tumefaction is toxic heat accumulation type. By the clinical case-control study, treatment about detoxification method obtain satisfaction efficacy. Endotoxin theory have guide significance. to clinical treatment. |
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