| Background:The famous elder TCM(Traditional Chinese Medicine,TCM)doctors are the outstanding representatives of TCM practitioners,whose clinical experience is our precious wealth which needs us to inherit,collect,excavate and develop.My tutor Wang Suzhi is a famous specialist in rheumatology,who is Chief Physician in Hospital of integrated Traditional Chinese and Western medicine in Shaanxi province,and the first batch of prominent TCM doctors.She is also the tutor of inheritance of academic experience of TCM experts in the second provincial batch and fifth national batch,as well as one of the experts in the national studio of the famous elder TCM doctors project in 2014.As an academic successor,I have collected,organized,excavated and studied her experience in diagnosis and treatment of rheumatism.Objectives:To trace the academic origin of chief physician Wang Suzhi's academic thought,sum up and summarize the academic experience in treating osteoarthritis.Mainly to excavate and extract the clinical experience in treating OA.To evaluate the effectiveness and safety of "Bushen Tongluo Recipe" in the treatment of knee osteoarthritis by clinical research,which could provide the reliable proof of the treatment,as well as explore,inherit and excavate the academic thought and method of clinical experience of the famous TCM doctors.Methods:In the part of clinical experience and academic thoughts:this study has mainly studied from the related articles,learning follow teacher,teacher-student mutual questions and answers and the clinical cases,to trace the academic origin of chief physician Wang Suzhi's academic thought,sum up and summarize the academic experience in treating OA,in order to achieve the goals of learning and inheriting the the academic thought of chief physician Wang Suzhi.In the part of studying the prescription regularity:this study has collected and collated the tutor's prescriptions of treating OA,which were input to the Traditional Chinese Medicine Inheritance Support System(V2.5)after screening,through which to analyze the frequency of the Chinese herbs and regularity of the prescriptions and discuss the application experience in treating OA.In the part of clinical research:this study contains 72 patients of KOA(Knee Osteoarthritis KOA),who were randomly divided into treatment group and control group.Basic treatment was to give patients education,reduce joint load,and protect the joint function.The control group was treated with Diacerein Capsules.The treatment group was treated with "Bushen Tongluo Recipe" combined with the therapy of control group,which mainly contains the Chinese herbs as Rehmannia Glutinosa 20g,Epimedium Herb 15g,East Asian Tree Fern Rhizome 10g,Himalayan Teasel Root 15g,Davallia mariesii 15g,Achyranthes bidentata 15g,Eucommia ulmoides 15g,Caulis Spatholobi 20g,white mustard seed 10g,lumbricus 10g,Hirudo 10g,Radix Clematidis 15g,Radix Angelicae Pubescentis 10g.After 12 weeks of treatment and observation the study came to the data statistics.The observation index contained safety indicators including blood,urine,liver function,renal function,and electrocardiogram,and the syndrome index of TCM,patients's pain degree,joint movement dysfunction,Michel Lequesen KOA-index,WOMAC OA-index,ESR,CRP,and so on.After statistical analysis,the study evaluated the clinical effectiveness and safety of "Bushen Tongluo Recipe" in treating OA of deficiency of kidney and blood stasis syndrome.Results:Findings of academic experience:1.Wang Suzhi's academic thoughts of syndrome differentiation and treatment of rheumatism comes from Neijing.Wang's academic thoughts was influenced deeply by many famous physicians,such as Zhang Zhongjing,Sun Simiao,Li Zhongzi,Wu Jutong,Ye Tianshi,Wang Qingren,and so on.Wang's academic thoughts formed gradually by taking advantages of doctors above,with the combination of clinical practice.2.Wang Suzhi's academic thoughts in the differentiation and treatment of rheumatism mainly included as follows:Attaching great importance to the prevention,people-oriented,and abidance by triple pathogens.In a Compromise and Western,treats the symptoms or root,concentrate on crucial points,the method of supporting the healthy energy is invigorating liver-kidney,the key pathogenesis is blood stasis and phlegm turbidity,focus on the 'unobstructed' in view of the pathogenesis.Etiology and pathogenesis included liver and kidney deficiency,wind,cold and dampness evil invasion,syndrome of interior dampness-heat and phlegm and blood stasis resistance.Therapeutic methods included reinforcing liver and kidney,eliminating pathogen,promoting circulation and removing stasis,eliminating phlegm and freeing channels.Dialectical syndrome was divided into cold dampness syndrome,syndrome of dampness-heat blocking,and kidney deficiency and blood stasis syndrome.Results of prescription regularity was analyzed by the Traditional Chinese Medicine Inheritance Support System which indicated that the common Chinese herbs Wang usually used in OA included Rehmannia glutinosa,caulis spatholobi,radix achyranthis bidentatae,cortex eucommiae,epimedium,rhizoma drynariae,poria cocos,dog ridge,live alone,radix dipsaci,yam,earthworm,dogwood,alisma,leeches,white mustard seed,radix clematidis,c.Deserticola.These herbs mostly had the effect of reinforcing liver and kidney,strengthening the bones and muscles,promoting menstruation and promoting circulation and removing stasis.The most common combination included ?Rehmannia Glutinosa and Caulis Spatholobi,? Rehmannia Glutinosa and Radix achyranthis bidentatae,?Rehmannia Glutinosa and Eucommia ulmoides,and so on.After clustering algorithm analysis,the common herb pairs included Wolfiporia extensa and lumbricus,Wolfiporia extensa and Halloysitum Rubrum,Wolfiporia extensa and Rhizoma Drynariae,and so on.New prescriptions based on entropy hierarchical clustering included:? Radix Glycyrrhizae prepaeata,Ligusticum wallichii,Codonopsis pilosula,Angelica sinensis,Colla Cornus Cervi,? Pinellia ternata,semen coicis,Forsythia suspensa,cortex mori radicis,?Rhizoma Dioscoreae,Rhizoma Alismatis,Radix Angelicae Pubescentis,Cornus officinalis,Schisandra chinensis,? Radix achyranthis bidentatae,Radix Bupleuri,Radix Rehmanniae Preparata,Eucommia ulmoides.Clinical study:compared with the control group,the treatment group was significantly better than the control group in The efficacy of TCM syndromes(P<0.05).The severity of WOMAC osteoarthritis index and Michel Lequesen knee injury were significantly decreased(P<0.01),and the improvement was better in the treatment group than that in the control group(P<0.01).The curative effect of the treatment group was better than that of the control group(P<0.05).Evaluation of patients with arthralgia after treatment(VAS),the doctor 's overall assessment of the condition(VAS),ESR and CRP were significantly improved(P<0.05 or P<0.01),but there was no significant difference between the two groups(P>0.05).There was no significant difference in the usage and consumption of loxoprofen sodium capsules(P>0.05).There was no significant difference in the incidence of adverse reactions between the two groups(P>0.05).There were no significant differences in safety indexes between blood group and urine group,liver and kidney function and electrocardiogram(P>0.05).Conclusions:Chief Physician Wang Suzhi's academic thoughts of syndrome differentiation and treatment of rheumatism origins from Huangdi Neijing,influenced deeply by taking advantages of previous dynasties physicians,which has formed gradually combined with clinical practice.Wang Suzhi thought that OA belongs to rheumatism of TCM,such as Bi disease,Lijie Disease,Arthroncus of knee,and so on.OA belonged to body resistance weakened while pathogenic factors prevailing.The Vital-Qi deficiency included deficiency of kidney and liver,and deficiency of qi and blood.Pathogenic factors included wind,cold,dampness,hot,stasis and phlegm.The key to expel pathogen was 'unobstructed',while the key to strengthen the body resistance was 'nourishing'.The study on exploring the prescription regularity was based on the Traditional Chinese Medicine Inheritance Support System,which got the unique clinical experience from the clinical cases and provided a new method to excavate and inherit academic thoughts.The clinical research indicated that "Bushen Tongluo Recipe" was safe and effective to treat OA of kidney deficiency and blood stasis syndrome."Bushen Tongluo Recipe" combined with diacerein treatment of KOA could improve the efficacy,alleviate the clinical symptoms of patients effectively,improve joint function,and control the disease,which was of high security and worthy of promotion.Chinese medicine,Chinese and Western medicine treatment of OA is more effective than western medicine alone,which was of promising clinical application.Innovations:1.This sutdy has summarized the chief physician Wang Suzhi's academic thoughts in treating rheumatism diseases systematically.2.This study has summarized the the chief physician Wang Suzhi's clinical experience in treating OA by the Traditional Chinese Medicine Inheritance Support System.3.This study has extracted essence of treating OA which was tonifying kidney and dredging collaterals by combing,summing up and refining the academic experience of Wang Suzhi and has created the "Bushen Tongluo Recipe" in treating OA of the kidney deficiency and blood stasis syndrome.This recipe was proofed to be safe and effective by conducting a clinical research and provided a new method to OA. |
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