Clinical Study Of Jiawei Yangxue Rougan Decoction In Treating De Quervain's Disease

According to the Swiss surgeon Fritz de Quervain,the first definition of De Quervain's Disease was made in 1895.This disease is due to the first extensor of the dorsal carpal A condition in which the extensor pollicis longus muscle(EPB)and the abductor hallucis muscle(APL)tendon sheath are inflammatory.The main clinical symptoms are swelling,pain,tenderness,weakened limb grip,ipsilateral thumb and wrist dysfunction,and positive fist scapular test.If the condition is serious,it will affect the patient's work.Ability,even quality of life.The etiology of De Quervain' s Disease is still unknown,and its pathological changes may be related to inflammatory factors,estrogen levels,fibrous connective tissue thickening and/or mucoid degeneration.It is generally believed that the occurrence of this disease is mainly due to repeated repetitive movements such as thumb adduction and wrist ulnar deviation,which make the tube of the bun fiber duct of the abductor hallucis muscle and the extensor muscle of the bucklingbone extensor and the styloid process of the humerus.The wall is stimulated by long-term mechanical friction and strain.followed by inflammation(chronic and sterilized).The secretion of inflammation leads to congestion and edema of the tendon sheath,and it can cause pathological changes such as hyperplasia,hypertrophy and adhesion in the fibrous connective tissue,thus producing a series of clinical symptoms of De Quervain ' s Disease of the sacral styloid process.The disease occurs in women in late pregnancy and postpartum lactation,some scholars have pointed out that this may be due to the increase in estrogen levels during the second trimester and the prolactin levels during postpartum lactation,causing systemic retention edema.As the tendon,tendon sheath and connective tissue both swell,the content of the bony fibrous tube of the styloid process of the humerus increases,the space of the sheath becomes narrower,and the friction between the tendon and the sheath wall is increased,causing aseptic inflammation and causing disease.Western medicine for conservative treatment of De Quervain's Disease includes;external fixation of the brace,oral administration of external medicine,ultrasound,shock wave,partial closed injection therapy,and the like.If the situation has not improved after conservative treatment,surgical treatment can be said to be the ultimate treatment of Western medicine treatment of this disease,it is also considered to be the best and most effective.However,the recovery of local tissue after surgery is slow,and most of the scars are left after surgery,which may lead to the re-stenosis of the sheath,and also,may damage the function of the trochle,leading to dislocation of the tendon and irritability of the superficial branch of the sacral nerve.The theory of traditional Chinese medicine is based on the principle of holistic view.The treatment of the disease must be based on local symptoms and other systemic symptoms in patients with De Quervain ' s Disease.According to the syndrome differentiation and treatment,the corresponding rule of treatment is determined according to the etiology and pathogenesis.Based on the disease,it belongs to the so-called "fascia"of Chinese medicine.It is believed that the disease is in the liver,the pathogenesis of the disease is liver and blood deficiency,the tendon is dystrophic,and the fascia is vulnerable to wind,cold,wet and other external evil invasion.The stagnation of the veins makes the blood and blood block,but it does not pass.Syndrome is the lack of liver blood,Weiqi is not solid,evil sputum and tendons,treatment is to "reinforcing the blood and soft liver" as the main treatment.Because the liver and kidney are homologous,the kidney is the liver,and the liver blood is full.Therefore,the use of Bugan liver and kidney,nourishing blood and softening the liver,strengthening the spleen and replenishing qi,and treating the blood with phlegm as a method to form a clinical treatment of De Quervain's Disease The characteristic experience side-Jiawei Yangxue Rougan Soup.This study used a randomized controlled trial to evaluate the clinical efficacy and safety of Jiawei Yangxue Rougan Decoction in the treatment of De Quervain ' s Disease.Objective:1)To explore the academic thought of Jiawei Yangxue Rougan Decoction in the treatment of De Quervain' s Disease.2)To evaluate the clinical efficacy and safety of Jiawei Yangxue Rougan Decoction in the treatment of De Quervain' s Disease,and provide a powerful clinical basis for the treatment of De Quervain' s Disease.Methods:In this study,a randomized controlled trial was conducted.From November 2017 to November 2018,a total of 60 patients with De Quervain ' s Disease who met the diagnostic criteria of the included cases were randomly divided into Chinese medicine treatment group and diluted drug.The control group was 30 cases in each group.The Chinese medicine treatment group was treated with Jiawei Yangxue Rougan Decoction,and the diluted drug control group was given a diluted placebo.The two groups of patients were also treated with external application of wet yellow water and external fixation as the basic treatment.Treatment for 3 weeks.Observation indicators:Before and after treatment,the clinical efficacy was evaluated according to the clinical efficacy standard of De Quervain' s Disease in the TCM "Diagnostic and Efficacy Standards for TCM Diseases",and the degree of deviation of the wrist joint was measured.Visual analog scale(VAS),wrist joint function self-rating scale(PRWE),etc.,score the degree of pain and dysfunction of the wrist joint,and then compare within and between groups.Results:This clinical controlled trial included 80 patients with stenotic tenosynovitis of the sacral styloid process,including 14 males and 66 females.The male to female ratio was approximately 1:5,aged 25-65 years,and the course of disease was 1-40 weeks.Before the treatment,the general data of the cases were compared.There were no significant differences in gender,age,disease duration.VAS pain score,PRWE score and wrist joint deviation activity score between the Chinese medicine treatment group and the diluted drug control group.(P>0.05),comparable.Clinical efficacy:After 3 weeks of treatment,the Chinese medicine treatment group cured 8 cases.27 cases were effective,3 cases were ineffective,the total effective rate was 92.1 1%;the diluted drug control group was treated in 2 cases,effective in 26 cases,ineffective in 10 cases,and the total effective rate was 73.68%.There was a significant difference between the two groups(Mann-Whitney U=512.00,P=0.007<0.05).After the Fisher chi-square test,the total effective rate of the Chinese medicine treatment group was higher than that of the control group,and there was a significant difference(P=0.025<0.05).Visual analogue scale(VAS):The VAS pain score after intervention in the Chinese medicine treatment group was significantly lower than that before the intervention(P=0.000<0.01);compared with the pre-intervention,the VAS pain score of the diluted drug control group after intervention was The significance was significantly lower(P=0.000<0.01).The difference of VAS between the two groups before and after treatment was significantly higher than that of the diluted drug control group(P=0.000<0.01).It indicated that the pain relief of the Chinese medicine treatment group was better than that of the diluted drug control group.Self-rating scale for wrist function(PRWE):The PRWE score after intervention in the Chinese medicine treatment group was significantly lower than that before the intervention(P=0.000<0.01);compared with the pre-intervention,the diluted drug control group was treated with PRWE after intervention.The scores were significantly reduced,and the difference was significant(P=0.000<0.01).The difference of PRWE between the two groups before and after treatment was significantly higher than that of the diluted drug control group(P=0.000<).0.01).It indicated that the improvement of pain relief and dysfunction in the Chinese medicine treatment group was better than that in the diluteddrug control group.The ulnar deviation of the wrist joint:Compared with the pre-intervention,the score of the wrist ulnar deviation activity of the Chinese medicine treatment group was significantly lower after the intervention,the difference was significant(P=0.000<0.01);the wrist of the diluted drug control group after intervention The deviation of the joint ulnar mobility was significantly lower than that before the intervention(P=0.000<0.01).The scores of the ulnar deviation activity scores before and after treatment were compared between the two groups.The value was significantly greater than that of the diluted drug control group,and the difference was significant(P=0.001<0.01).It indicated that the degree of improvement of wrist ulnar deviation in the Chinese medicine treatment group was better than that of the diluted drug control group.Concolusion:1)In patients with De Quervain' s Disease,in addition to local swelling,nodules,pain,tenderness,limited mobility,weak grip and positive fist stagnation test,such as accompanied by facial discoloration or chlorosis,palpitations Some symptoms of systemic symptoms such as sputum,stun,dizziness,bloody sputum,hand and foot numbness,hair dryness,dry skin,pale nails,joint stiffness,unfavorable activity,pale lips,weak pulse,etc.Blood-deficient type of De Quervain's Disease,the pathogenesis of liver and blood is insufficient,the qi is not solid,the evil sputum is veins.The stenosis of tenosynovitis of the tibia is in the ribs.When the nourishing blood and soft liver is the main treatment method,based on the homologous liver and kidney,the kidney is the liver,and the liver blood is also filled with the characteristics of traditional Chinese medicine treatment.It uses the liver and kidney to nourish the liver.Liver,spleen and qi,and bloody phlegm for treatment.2)Jiawei Yangxue Rougan Decoction can reduce the VAS pain score of patients with De Quervain ' s Disease,reduce the value of PRWE wrist joint function score,and increase the wrist joint deviation activity.3)Jiawei Yangxue Rougan Decoction can improve the clinical symptoms of De Quervain's Disease such as local swelling,pain,tenderness,limited wrist movement and functional activity disorder.4)Jiawei Yangxue Rougan Decoction provides a new way of thinking about the syndrome differentiation and treatment of De Quervain' s Disease.