| Background: Rheumatoid arthritis(RA)is an autoimmune disease that attacks joints and surrounding tissues.RA is the name of a modern medical disease,which is now classified as a category of "bi syndrome".The main pathological manifestation of RA is synovitis,and the main symptoms are "swelling" and "pain".When it comes to RA in modern medical disease,subjective understanding of this disease is "pain" as the first main symptom.However,as the main clinical feature,pain is not enough to objectively present the clinical characteristics of RA.Joint "swelling" is important for this disease,whether it is in Traditional Chinese Medicine or in modern medicine.When diagnosing and treating RA,swelling is important for research significance and clinical value,such as the clinical symptoms,diagnostic criteria,evaluation of disease activity and laboratory research of RA.Joint swelling is more representative than pain in actual clinical practice.Therefore,it is very meaningful to focus on the relatively characteristic performance of "swelling" in RA.Objective:1.Theoretical research: Systematically summarizing the knowledge of ancient and modern literature on RA swelling,and clarify the value of RA swelling in basic theory and clinical practice.2.Clinical research: Observing the clinical efficacy and safety of the graduate student tutor's experiential prescription "SHENLING ?" for patients with RA swelling,cold-heat complex syndromes in the active period.Methods:1.Theoretical research: Based on the research of traditional Chinese medicine and modern medicine literature,this manuscript summarized the related disease names,the relationship between swelling and the characteristics of pain in RA joint swelling.2.Clinical research: This study collected into standard,a total of 63 cases,adopt randomized controlled openness experiment design,through the random number table,eventually 33 cases in test group and control group 30 cases,control group treated with methotrexate treatment,on the basis of control group,experimental group patients take a tutorexperience side "SHENLING ?" treatment.Before treatment,treatment of 4 weeks,8 weeks,12 weeks,swelling of the integral,ACR20 records patients / 50/70(number of joint tenderness and joint swelling,pain VAS scores overall status score overall status score,doctors,patients,HAQ scale,etc.),traditional Chinese medicine syndrome,laboratory indexes such as the improvement of the situation,and two groups of patients,adverse reaction and the number of cases occurring separately within the group and between groups before and after treatment in the efficacy and safety evaluation.Results:1.Theoretical research:(1)The related disease names of RA joint swelling in ancient books of traditional Chinese medicine include Li jie,Gout,He xifeng,Krypton,etc.(2)The relationship between swelling and pain: etiology and pathogenesis-Qi injury is pain,shape injury is swollen;clinical features-swelling pain,combined swelling and pain;treatment rules-guide qi to relieve pain,dispel evil and reduce swelling;Outcome and prognosis-pain is easy to eliminate,swelling is difficult to remove.(3)Based on the theoretical basis of "double poisons theory" and combined with RA stages,early,middle,and late RA joint swelling has many similarities and differences in etiology,location,skin temperature,and pain characteristics.2.Clinical research:(1)joint swelling integral aspect,the experimental group in 4 weeks,8 weeks,12 weeks of total effective rate were 39.4%?66.7%?93.9%,control group total effective rate were 30.0%?43.4%?63.3%,treatment group total effectiveness is higher than the control group after treatment,no less efficient than the control group,by chi-square test,p< 0.05,differences were statistically significant.(2)in terms of clinical efficacy,the proportion of patients with remission of ACR20,ACR50 and ACR70 at week 4 and week 8 in the two groups was higher than that in the control group,but the difference was not statistically significant(P>0.05).After 12 weeks of treatment,the proportion of patients with ACR20 and ACR50 remission in the experimental group was higher than that in the control group,but the difference was not statistically significant(P>0.05).The proportion of patients with ACR70 remission in the experimental group was higher than that in the control group(P<0.05).(3)in terms of traditional Chinese medicine symptoms,the total effective rate of the experimental group at week 4,week 8 and week 12 was 27.3%,45.5% and 87.9%,respectively,and the total effective rate of the control group was 16.7%,35.5% and 73.3%,respectively.After treatment,the total clinical effective rate of the experimental group was higher than that of the control group,and the total ineffective rate was lower than that of the control group.There was no statistically significant difference at week 4 and week 8(P >0.05),and the chi-square test at week 12 showed statistically significant difference(P<0.05).(4)in terms of laboratory indicators,both the experimental group and the control group could effectively reduce the serum level of immunological indicators and inflammatory indicators,but the reduction level of immunological indicators was the same as that of the control group,with no statistically significant difference(P>0.05),and the decrease of inflammatory indicators was more significant,with statistically significant difference(P<0.05).(5)in terms of safety evaluation,5 cases of adverse reactions were found in the test group,all of which were mild diarrhea.There were 9 cases of adverse reactions in the control group,including diarrhea,abnormal liver and kidney function,irregular menstruation,etc.At the end of the experiment,only 2 patients in the control group had mild abnormal liver function,and the rest had no obvious abnormal safety indicators during the experiment.The number of cases of adverse reactions in the two groups was statistically significant by chi-square test(P<0.05),and the incidence of adverse reactions in the experimental group was lower than that in the control group.Conclusion:1.Theoretical study:Based on the "Double poisons theory",joint swelling is a more representative pathological feature in RA patients.2.Clinical research:(1)Based on the instructor Professor Ying Senlin 's theory of“Double poisons theory” on the onset of RA,combined the basic theory of traditional Chinese medicine with modern pharmacological research,through the “double solution and swelling method”,the empirical formula “SHENLING ?” was used to treat active RA For swelling patients,the clinical effect of "clearing evil poison,Dispel the poison that lay within,eliminating swelling" is remarkable.(2)Clinical studies have shown that,compared with the control group,the "Double detoxication and swelling reduction method" has a significant effect on reducing joint swelling,and it has more advantages in improving the long-term effect of ACR70 and TCM symptoms.(3)"Double detoxication and swelling reductionmethod" can better reduce the inflammation indicators ESR and CRP.(4)In terms of safety,the "Double detoxication and swelling reduction method" is highly safe and can reduce the side effects of methotrexate to a certain extent,but it is still necessary to pay attention to its gastrointestinal tract and other adverse reactions during clinical application. |
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