Diabetic Peripheral Neuropathy And Osteoarthritis Induced Lower Extremity Pain Syndrome Research

Lower limb pain can be seen in many diseases. Such as joint diseases and muscle disease, peripheral vascular diseases and peripheral neuropathy, and diabetic peripheral neuropathy. All these diseases belong to "Bizheng" in Traditional Chinese Medicine. According to a large amount of clinical data, the syndromes of intermingled deficiency and excess are more coming apparent in these diseases. The research selected patients with diabetic peripheral neuropathy (DPN) and knee joint osteoarthritis (KOA). It included two parts:review and the clinical obersvation of DPN and KOA focus on symptomatic characters. First, it reviewed the progress of clinical and experimental researches, both Western Medicine and Traditional Chinese Medicine on treating DPN and KOA, including pathogenesis, diagnosis, and therapies.Objective:To analyse characteristics of syndromes of DPN and KOA, and summarize the types of differentiation.Methord: According to the clinical diagnose standard,55 cases of DPN and 52 cases of osteoarthritis were enrolled. We observed gender, age, body mass index and symptoms, according to four diagnostic methods of TCM. Basic syndrome, syndrome frequency and main syndromes were analysed. Besides, the basic syndrome of higher frequency were sorted out and grouped in syndrome differentiation by means of TCM syndrome diagnostic standard reference. Adopting retrospective hospitalized material investigation and statistical methods, we counted 107 patients symptoms frequency, compared various symptoms condition and analysed the characteristic and the pathological changes peripheral nerve lesions. Meanwhile we surveyed small regional samples, and discussed the symptoms of DPN and KOA, and summarized the distribution characteristic of DPN and KOA. With statistics SPSS13.0 statistical software, general data used frequency method, while counting material used non-parameter test. It had statistical significance as P< 0.05.Results: It is observed that the frequency of deficiency syndrome was significantly higher than the repletion syndrome.②In cases of DPN, the ratio of men and women is about 1.9/1, and that in KOA is about 1/2.7.③In age distribution, the group aged more than 60 years and the other group have no statistical discrepancy (P> 0.05) in DPN, on the contrary, it is statistically significant in KOA (P< 0.05).④Both of them showed no difference in BMI.⑤The main symptoms of DPN are weary, thirsty, positioning pain and aggravating at night, numbness, with dark red tongue. The main symptoms of KOA are the baek and weakness in knee, hair loss and forgetful, weary, tinnitus and deafness, positioning pain and aggravating at night, with dark red tongue.⑥Through observation of TCM syndrome, the main deficiency symdromes of DPN are Qi, Yin and Yang deficiency, while, repletion is mainly blood stasis. The main deficiency symdrome of KOA is the liver and kidney deficiency, while, repletion is mainly blood stasis or Qi stagnation. There are many complex symptoms combinations. Two patterns of syndrome appear simultaneously in the same combinations, in which Qi deficiency plus blood stasis (70.9%) in DPN. Three patterns of syndrome appear simultaneously in the same combinations, in which Qi deficiency, Yin deficiency and blood stasis (50.9%) in DPN. While two patterns of syndrome appear simultaneously in the same combinations, in which deficiency of liver and kidney (51.9%) is the most in osteoarthritis. Three patterns of syndrome appear simultaneously in the same combinations, in which deficiency of liver, kidney and Yin(17.3%) is the most osteoarthritis.⑦Among the DPN patiens, Qi, Yin and Yang deficiency and blood stasis syndrome are common basic syndrome. The differentiation points of them are:syndrome of Qi and Yin deficiency and blood stasis that is weary, throat thirsty, spontaneous sweating and night sweating, dysphoria with feverish sensation in chest, palms and soles, positioning pain, numbness, purplish tongue, thready or deep pulse. Syndrome of Yin deficiency and blood stasis shows weary, spontaneous sweating, dizzinessand palpitation, positioning pain, numbness, purplish tongue, thready pulse or deep pulse. Syndrome of Yin and Yang deficiency and blood stasis are weary, nee fearing the cold, throat thirsty, positioning pain, numbness, squamous and dry skin, dry stool, red tongue and thin coating, enlarged or in dented tongue. Among the KOA patients, deficinency of the liver and kidney syndrome, syndrome of blood stasis, syndrome of qi stagnation, cold-dampness syndrome are common basic syndrome. The differentiation points are common symptoms in the clinical. Syndrome of deficinency of the liver and kidney:the weekness in back and knee joints, weary, dry bitter taste in mouth, tinnitus and deafness, hair falling, insomnia and dreaminess, hypochondriac pain, eye dry, dizziness, red or pink tongue, thin coating, stringy and thready pulse or thin and weak pulse. Syndrome of deficinency of the kidney-yang:the back and knee joints weak, forgetful and hair falling, body or knee fearing the cold, weary, cold pain, white fur or whit greasy fur, deep, thin and weak pulse. Syndrome of qi stagnation and blood stasis: positioning pain, running negative, knee swelling or deformity, the back and knee joints weak, mouth purple bruises, dark purple, stringy pulse.Conclusion:①Symptomatic, treatment based on disease and syndrome differentiation in the course of clinical treatment is according to the symptoms, diagnosis of the disease, combined with treatment based on disease and syndrome differentiation, learn deficiency and excess syndrome, cause of disease, chronic and acute, manifestation and root cause, establish the method of treatment in clinc, it had more significance to combine disease differentiation with syndrome differentiation.②Qi deficiency syndrome, Yin deficiency syndrome, Yang deficiency syndrome, blood stasis syndrome, phlegm-dampness syndrome and dampness-heat syndrom are common basic syndrome in DPN. Deficiency of liver and kidney syndrome, blood stasis syndrome, Qi stagnant syndrome, Yin and Yang deficiency syndrome, cold-dampness syndrome are common basic syndrome in KOA.③Because the research is of small number cases, and limited in the affliated hospital to Changchun University of Chinese Medicine. Besides, the Chinese medicine syndrome diagnosis is not enouthg for symdrome differentiation for future research.