| Osteoarthritis (OA) is a type of chronic disease which causes the degeneration and wearing off of the soft cartilages at the joints between the bones. New pieces of bones (bone spurs) may also grow around the joints that would aggravate the pain already experienced by the sufferers. The symptoms usually appear in middle age and OA has inevitably threatened the health of the aging population around the world. The most obvious clinical observations for OA are marked by pains and stiffness or immobility of the joints affected, though the ultimate causes and pathological pathways of the disease remain unknown.This investigation is divided into two parts, firstly to study the common traits of Singapore's tropical climate, its geographical environment and the habitual life style of typical local residents. The study was enhanced with Professor Zhu Jian Gui (from Beijing Guang An Men Hospital) sharing his unique philosophical viewpoints and rich clinical experience in his many years of treating joint diseases. The aim of this project is to source for specific diagnostic methods to standardise the treatments to be used for the different types of patients' physiques in Singapore. This does not imply to replace the treatments used by the modern western doctors, but rather to complement one other in aiming for a speedy recovery process for the patients.The following factors were explored:1. Causes of OA - According to TCM, OA could be caused by 4 triggering factors, mainly (1) cold with dampness pathogens, (2) heat with dampness pathogens, (3) poor water and blood circulation and (4) severe dysfunctioning of the liver and kidneys. This might be due to the constant hot and humid climate in Singapore all year round, and its geographical location near the Equator and being surrounded by the sea. 2. Pathological pathway of OA - Malfunctioning of the liver and kidneys leading to poor water and blood circulation in the body, which might eventually give rise to symptoms relating to dampness and heat swamped within the meridians.3. Characteristics in TCM Diagnosis - Distinguished and grouped symptoms according to deficiency and excessive characteristics and this would be used as a basic guide for further classifications, e.g. the cold or hot symptoms.4. Characteristics of different combinations of TCM treatments -Firstly was to combine acupuncture with Chinese herbal remedies. Secondly was to combine the use of pungent herbs with warm and cooling properties. Lastly was to improve water and blood circulation in the body to prevent stagnation.5. Characteristics in the acupuncture treatments - Precautions were taken in varying the depth of needle insertion, with respect to the changes in the climate. The climate in Singapore was summer-like all year round, thus the attacking position of the pathogens would be shallow or as deep as the skin layers, and thus insertion of needles should not be deep. Hence, 1.0-1.5 inches acupuncture needles are usually used are such insertions.6. Characteristics of herbal remedies - Aimed to nourish the liver and kidney deficiencies, using Liu Wei Di Huang Pills (六味地黄丸) as the basic template for further variations in the prescriptions. To ward off cold and hot spells, Juan Bi Decoction (蠲痹汤) and Shu Jing Huo Xue Decoction (疏经活血汤) were used respectively.90 OA case studies collected over 24-month duration from January 2005 to December 2006. These cases were then classified into 3 groups, according to the types of treatments used, mainly Acupuncture (AG), Chinese Herbal (CHG), and both Acupuncture and Chinese Herbal (ACHG). There were 30 cases in each group type. The OA cases involved comprised of disorders with the neck, spine, lower back, knee area and other related areas of the body. Each case study for each group was observed from the date of first consultation to the date of full recovery. The results obtained for the 3 groups were statistically tested for treatment efficacies, degrees (or severity) of pain experienced and lastly, the functional changes at the joints. The overall outcome for treatment efficacies for ACHG group and CHG had both scored high percentages of 93.33%, whereas AG fetched a lower 86.66%. With further statistical tests, it was found that the efficacies of the 3 groups ranged from the most effective to the least effective in the manner of ACHG > CHG > AG. The results on the changes in the degree of pain experienced before and after treatment were significant, where the ACHG and CHG were more effective than AG. The statistical test results for functional changes at the joints were significant where the ACHG had improved the mobility of the joints much more than AG and CHG, in the order of ACHG > CHG > AG.This project aims to help standardised the TCM diagnostic methods for joint problems, as well as introduce the treatment alternatives in a much systematic and simplified way. In this way, promote the quality of life amongst the aging generations. This formed a proactive front for TCM in the prevention and treatment of Osteoarthritis. |
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