| ObjectiveFocused on the study of the distribution rules of the symptoms and syndromes of 299 patients with gouty arthritis,an analysis was made to analyze the ages,sex,occupations,course of disease,year of occurrence,season of occurrence,residences,personal history,occurrence joint,inducement of onset,systemic symptoms and TCM syndromes of the patients.The use of meta-analysis of statistical methods evaluated the clinical efficacy of traditional Chinese medicine in the treatment of gouty arthritis,which proposed a reference for the clinical practice of dialectical treatment.MethodAccording to the diagnostic criteria and inclusion criteria,cases were collected about 299 patients with gouty arthritis who sought medical treatment in the First Affiliated Hospital of Guangzhou University of Chinese Medicine during January 1st,2013 to October 10 th,2016.According to the diagnostic criteria of the gouty arthritis,the patients were classified by the different syndromes and the various types of the clinical symptoms were collected.The original data of Excel was established.The database was organized by using the statistical software of stata15.1 and spss19.0 to conduct the descriptive analysis and factor analysis of the clinical symptoms and syndromes.The related essays about the gouty arthritis medication had been retrieved in Wanfang Periodical Database,VIP Chinese Journal Service Platform,and CNKI as well as domestic academic journals with the relevant published literature and unpublished academic materials such as dissertations,academic reports and so on.The gouty arthritis patients had been taken as the research objects to determine the topical words and keywords.The clinical trials of literature,which about the traditional Chinese medicine treatment of gouty arthritis,had been full searched,screening by the inclusion criteria and exclusion criteria,and the comparison was took about the randomized controlled trials or semi-randomized trials of the traditional Chinese medicine and western medicine treatment effect.The improved Jadad scale was employed to score the selected documents and the statistical software stata15.1 was used for meta-analysis.ResultIn this study,there were 272 males(90.97%)and 27 females(9.03%)with gouty arthritis.4 cases(1.34%)were under 20 years old,14 cases(4.68%)between 21 and 30 years old and 264 cases(88.29%)between 31 and 80 years old.There were 256 cases(85.62%)in Guangdong,8 cases(2.68%)in Jiangxi and 7 cases(2.34%)in Hunan.There were each 3 cases(1.01%)in Shandong,Guizhou,Guangxi and Hubei,there were each 2 cases(0.67%)in Hong Kong,Zhejiang and Sichuan Jilin,Heilongjiang and each 1 case(0.33%)in Fujian,Jiangsu,Henan,Anhui and Chongqing.The analysis of the patient's personal history data was as follows: 86 cases of smoking history,60 cases of drinking history,178 cases had the history of radioactive exposure.88 cases(29.4%)had a disease course of 1-2 years,86 cases(28.8%)had a disease course of 6-10 years,and 27 cases(9.03%)had a disease course of 11-30 years.The occupations in which the number of patients is from high to low in turn are retirees,peasants,unemployed workers,workers,staff,self-employed workers,national civil servants,professional and technical personnel,freelancers,business managers,students,businessmen,teachers,waiters,reporters and police.The analysis on the patients' occurrence data about the seasons and solar terms were as follows: in seasons,the number of patients in spring,summer and autumn was close to 92(30.77%),70(23.41%)and 86(28.76%)in turn.The smallest number of occurrence was in winter,there were 51 cases(17.06%).In terms of solar terms,the largest number of the occurrence was at Beginning of Autumn,there were 30 cases,accounting for 10.03% of the total number.The rest in order from more to less were End of Heat(18 cases,6.02%),Great Heat(17 cases,5.69%),Rain Water(17 cases,5.69%),Waking of Insect(17 cases,5.69%)Clear Brightness(17 cases,5.69%)Grain Rain(16 cases,5.35%),Cold Dew(15cases,5.02%),Grain in Beard(14 cases,4.68%),Winter Solstice(14 cases,4.68%),Beginning of Spring(13 cases,4.35%),Spring Equinox(12 cases,4.01%),Beginning of Summer(12 cases,4.01%),Frost's Descent(12 cases,4.01%),Slight Cold(12 cases,4.01%),Slight Heat(11 cases,3.68%),Summer Solstice(9 cases,3.01%),Beginning of Winter(9 cases,3.01%),Grain Full(7 cases,2.34%),Great Snow(7 cases,2.34%),White Dew(6 cases,2.01%),Great Cold(6 cases,2.01%),Autumn Equinox(5 cases,1.67%),Slight Snow(3 cases,1%).TCM syndromes of patients with gouty arthritis were as follows: there are 223 cases of dampness-heat accumulation syndrome,accounting for 97.38%;24 cases of phlegm-accumulation stasis syndrome,accounting for 10.48%;21 cases of phlegm and blood stasis syndrome,accounting for 9.17%;9 cases of deficiency syndrome of liver and kidney yin,accounting for 3.93%;9 cases of spleen deficiency and dampness-heat syndrome,accounting for 3.93%;6 cases of spleen and kidney deficiency,accounting for 2.62%.After analyzing the case data,there were 6 types of syndromes involved in this study.There were 223 patients with dampness-heat accumulation syndrome,the main clinical manifestations were syndromes of stagnant and jamming dampness-heat,such as the incidence of joints were redness and swelling and pain,fever,urine yellow and so on.The tongue was mostly red,the tongue fur was yellow and greasy,the pulse was rapid and slippery.There were 24 cases of Phlegm-accumulation stasis syndrome,the main clinical manifestations were the wind cold dampness blocking the channel and collateral,such as the incidence of joint was swelling and pain,swelling was around the joints,fatigued spirit and lack of strength,chest distress,puffy face and so on.The tongue was mostly dark red and plump,the tongue fur was white and greasy,the pulse was slippery and string.There were 21 cases of phlegm and blood stasis syndrome,the main clinical manifestations were phlegm and stasis blocking the meridian,such as the incidence of joint was red,swelling and sharp pain,joint was swelling and deformation,dull color and so on.The tongue was mostly dark red with the ecchymosis,the tongue fur was thin and yellow,the pulse was mostly astringent.There were 16 cases of deficiency syndrome of liver and kidney yin,the main clinical manifestations were the liver and kidney deficiency and the internal stasis of dampness and heat,such as the incidence of joint was swelling and pain and heat,slightly in the day and heavy in the night,joint was local deformity and hectic cheek,dry and bitter mouth,fatigued spirit and lack of strength and so on.The tongue was mostly dark red,the tongue fur was thin and yellow or with little coating,the pulse was fine and rapid.There were 9 cases of spleen deficiency and dampness-heat syndrome,the main clinical manifestations were spleen deficiency and dampness-heat,such as the incidence of joint was swelling and pain,slightly in the day and heavy in the night,the pain joint activity was limited and joint was paroxysmal pain,was edema and obesity.The tongue was mostly light pink with the tooth mark,the tongue fur was white and greasy,the pulse was more slippery.The patients with the spleen and kidney deficiency were less,the main clinical manifestations were both spleen and kidney deficiency,such as the incidence of joint was swelling and heat and pain,night urinary was frequency,fatigue,eat little,soreness and weakness of waist and knees and so on.The tongue was mostly pale,the tongue fur was lack or white and greasy,the pulse was more subtle fine or string fine.Through the factor analysis,the main elements of the syndrome of this disease involved wet,hot,phlegm,deficiency of yin and qi.The main elements of the syndrome was the dampness-heat.The disease was mainly appeared in the spleen,involving the liver,kidney,heart and lungs.Four syndromes were got through the further analysis,namely dampness-heat accumulation syndrome,phlegm-accumulation stasis syndrome,internal heat due to yin deficiency and dampness and blood stasis syndrome.By searching the database of Wanfung periodicals,VIP Chinese Journal Service Platform,CNKI and the articles published in the domestic academic journals,etc.,there were 5 literature which conformed to the standards,involving 352 patients.Meta-analysis showed that the odds ratio(OR)was 4.569,95% confidence interval(CI)was [1.765,11.831],P <0.01,the difference has the statistically significant.Conclusion:The results of this study showed that patients with gouty arthritis were mostly male patients,especially in middle-aged and elderly patients,but there was also a trend of occurrence on the young people.The most patients were Cantonese,mostly occurred in the summer and autumn.The main symptoms were joint swelling and heat and pain as well as the limited activity of the joint.On the clinical syndromes,mainly involved the dampness-heat accumulation,phlegm-accumulation stasis,phlegm and blood stasis,yin deficiency in liver and kidney,spleen deficiency and dampness-heat,deficiency of spleen and kidney and so on.The main symptoms included the incidence of joint swelling and pain,fever,yellow urine,vexation,dry and bitter mouth,fatigued spirit and lack strength,chest distress,limited activity of the pain joint,the joint swelling and deformation and so on.The main elements of the syndrome was damp heat,the main disease appeared in the spleen,kidney and liver.The clinical summary of the six syndromes,provided the reference of the diagnosis and treatment of Chinese medicine and prevention and nursing to this disease.Through the collection and arrangement of the literature about the efficacy of the treatment of gout arthritis,the traditional Chinese medicine treatment of gouty arthritis has more obvious advantages than Western medicine,but due to the poor quality and the small size of the included sample,it is still necessary to increase the amount of the sample and use the high quality clinical studies to confirm the conclusion. |
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