A Study Of Chinese Medicine Syndrome Differentiation And Treatment Principle For Fibromyalgia Syndrome

Objective:Fibromyalgia Syndrome(FS)is a clinical problem characterised by general widespread pain which last for more than 3 months.The cause of this disease is not clear,so there is no cure for it in western medicine.General analgesics is not effective on this disease,nor does steroids.In recent years,western medicine practitioners use a combination of antidepressant drugs such as amitriptyline and opioids such as tramadol to treat the disease.Such combination can control the patient’s symptoms but they easily to relapse.Patients also suffers from side effect due to the long-term use of painkillers.In recent years,research about this disease has increased globally.Many western medicine articles can be seen published,and since ancient times many Chinese Medicine(CM)literature have also documented the disease’s symptoms and its corresponding treatment methods.However,the specific treatment methods and principles of CM are still unclear.Therefore,it is still worth to further study on FS,to explore effective Chinese Medicine treatment.Research objective:1.Clarify CM research status and identify major CM treatment methods used through in-depth systematic analysis of related CM literature on fibromyalgia syndrome.2.Study effective clinical CM treatment,patterns of herbs used and basic principle in Chinese herbal formulation through data mining and analysis of published cases of treated using CM in the past 30 years.This will provide clues towards understanding CM and its FS treatment in and objective evidence-based manner.3.Explore clinical efficacy of the combined modified GuiZhi Tang prescription with external treatment for fibromyalgia syndrome in comparison to manipulation,acupuncture and herbal medicine through retrospective and prospective clinical study.Research methods:1.Theoretical research:This paper first looked at the literature which related fibromyalgia syndrome from China and global databases in the past 30 years,and then summarised the literature.2.Data mining:Inclusion and exclusion criteria were applied when collecting information related to FS.The information was then processed to determine the high occurrence of diagnosed syndromes,prescribed medicine and acupuncture points.Relevance between medicine and syndrome,as well as medicinal combination were determined using correlation analysis method.3.Clinical research:A.Retrospective study:Outpatient FS records dated from May 1,2014 to April 30,2017 at Han Neuro Acupuncture&Herbal Specialists Chinese Medicine Centre were collected.These records were then classified into A,B and C groups according to received treatment methods.Group A patients received manipulation treatment only;Group B received manipulation and acupuncture treatment;Group C patient received manipulation,acupuncture and herbal medicine treatment.Only cases treated with GuiZhi Tang and its modifications were included in Group C.All patient in Group A,B and C were observed for their pain,sleeping condition,living function and overall condition after receiving treatment.This research also looked into relapse condition 1 month after treatment,as well as overall clinical efficacy 3 months after treatment.Finally,efficacy among groups was compared.B.Prospective study:Using the diagnostic criteria approved by the American College of Rheumatology in 1990,patient were recruited from Han Neuro Acupuncture and Herbal Specialists Chinese Medicine Centre at Malaysia between 1 May 2017 and 31 December 2017.All FS patients were treated by doctor Tham Hui Saan using manipulation,acupuncture and Chinese herbal medicine treatment.Visual Analogue Scales(VAS)were adopted to assess patients before and after received treatment by trained residents and nurses.The Revised Fibromyalgia Impact Questionnaire(FIQR)was also used during the follow up visit one month after treatment.Finally,statistical methods were used to compare the outcome of the treatment.The Chinese herbal medicine and its dosage were analysed to obtain the frequency and the total quantity of each medicine used in the study.Research results:1.Theoretical research results:Fibromyalgia syndrome is a disorder of unknown cause characterised by chronic widespread aching,stiffness,insomnia and depression.Although there is no FS term recorded in the ancient Chinese medical literature,however most physicians treat it in accordance with"Bi-syndrome" or "Zhou Bi".The major pathogeneses include liver depression,spleen deficiency,qi stagnation,blood stasis,Yang deficiency,cold coagulation,meridians blockage.In clinical practice,the commonly used CM treatment methods include soothing the liver,strengthening the spleen,activating the Qi,moving the blood,warming the Yang,disperse cold,soothing the tendons and unblocking the meridians.In addition to internal medication,Chinese Medicine practitioners frequently combined many other external treatments,including acupuncture,moxibustion,thermal,cupping(normal and moving cupping),acupotomy,silver needling and tuina to treat this disease,whereas western medicine practitioners is mainly focuses on symptomatic treatment.They also encourage patients to exercise to relieve the symptoms.There are many hypotheses and controversies still surrounding in the pathogenesis of FS,and its main cause is still unknown.2.Data analysis research results:a.Commonly used acupoints:the acupoints which have been used by various CM practitioners for more than 10 times,from high to low are:Ashi point,Zusanli(ST36),Guanyuan(CV4),Shenshu(BL23),Sanyinjiao(SP6),Pishu(BL20),Ganshu(BL18),Taixi(KI3),Hegu(LI4),Taichong(LV3),Quchi(LI11),Baihui(GV20),Yanglingquan(GB34)and Waiguan(TB5).b.Commonly used herbal medicine:the herbs which have been used by various CM practitioners for more than 20 times from high to low are:Baishao(59),Chaihu(47),Danggui(45),Chuanxiong(31),FuLing(31),Guizhi(26),Xiangfu(25),Gancao(24),Huangqi(24),Baizhu(22),Zhiqiao(21),Dazao(21).c.Types of medicine after classification,the types of medicine used by various CM practitioner for more than 10 times,from high to low are:nourishing medicine(35%),exterior releasing medicine(21%),Qi activating medicine(12%),blood moving medicine(9%),mind calming medicine(8%),heat clearing medicine(6%),dampness draining medicine(5%),anti-rheumatic medicine(2%)and phlegm resolving medicine(2%).d.Common clinical syndromes:The syndromes which have been diagnosed by various CM practitioners for more than 5 times,from high to low are:liver depression(18.22%),blood stasis(15.25%),Qi stagnation(12.29%),spleen deficiency(9.32%),meridians blockage(8.05%),Qi deficiency(5.08%),blood deficiency(4.66%),Yang deficiency(3.39%),phlegm and dampness(3.39%),cold coagulation(2.54%)and wind-damp impediment(2.12%).e.Relationships between common syndrome and prescribed medicine:Liver depression is treated with Baishao,Chaihu,Fuling,Baizhu,Xiangfu,Chuanxiong,Suanzaoren,Huangqi,Zhike and Zhigancao;Qi stagnation is treated with Zhike,Taoren,Honghua,Yujin;blood stasis is treated with Yujin,Taoren and Honghua.f.Common herbal combination:Based on the correlation percentage,the common herbal combination used by various CM practitioners from high to low are:Baishao-Danggui,Baishao-Chaihu,Baishao-Chuanxiong,Baishao-Baizhu,Chaihu-Fuling,Baishao-Xiangfu,Chaihu-Gancao,Danggui-Baizhu,Chaihu-Xiangfu,.Baishao-Guizhi,Baishao-Gancao,Fuling-Baizhu,Chaihu-Baishu,Danggui-Huangqi,Baishao-Suanzaoren,Baishao-Zhigancao,Baishao-Huangqi,Baishao-Dazao,Chaihu-Zhike,Baishao-Zhike,Baishao-Shengjiang,Chaihu-Yujin,Baishao-Fangfeng,Baishao-Zhizi.3.Clinical results:a.Retrospective study:A total of 107 cases that met the inclusion criteria were collected and classified according to treatment methods,43 cases in group A,32 in group B and 32 in group C.Indicators in pain level,sleep quality,living function and overall condition,before and after treatment,for each groups were statistically significant(p<0.01),and all indicators after treatment were significantly lower after treatment.When comparing among the 3 groups,the difference in the four indicators before and after treatment were also statistically significant(p<0.01).The difference in the four indicators in group C were significantly higher than group A and group B(p<0.01),and the difference in the living function indicator of group C was significantly higher than group B(p<0.05),and group B was significantly higher than group A(p<0.05).In terms of relapse follow up 1 month of treatment,the difference among the three groups was statistically significant(p<0.01).Group C’s relapse was significantly lower than group A and group B(p<0.01).There was no statistical difference between group A and group B(p>0.05).2.Prospective study:A total of 33 patients were recruited.1 patient had to be withdrawn from the study due to lost contact after leaving Malaysia,and 2 other patients were dropped due to poor compliance.The remaining 30 patients successfully completed their course of treatment,followed up and completed their questionnaires.Each of the patients’ VAS and FIQR,before and after treatment,were statistically significant(p<0.01),and all indicators were significantly lower than the first visit.Comparing the efficacy of pain relief and overall symptomatic relief,the pain relief(VAS)was 65.5%markedly effective,27.6%effective and 6.9%ineffective.Total effective rate of VAS was 93.1%.The overall symptomatic relief(FIQR)was 31%markedly effective,58.6%effective and 10.3%ineffective.Total effective rate of FIQR was 89.7%.Pain relief was markedly more effective than overall symptomatic relief and this carried statistical significance(p<0.05).A total of 42 types of Chinese herbal medicine were used in the treatment.The top 25 highest dosage,from high to low,were Guizhi Tang,Shen Ling Baizhu San,Huangqi,Taoren,Rougui,Danggui,Si Jun Zi Tang,Chuanxiong,Si Wu Tang,Sangjisheng,Bu Yang Huan Wu Tang,Duhuo Jisheng Tang,Shengjiang,Wuzhuyu,Fuling,Danggui Si Ni Tang,Honghua,Yiyiren,Suanzaoren,Zhike,Bohe,Xiao Yao San,Gouji,Weilingxian and Fuzi.These 25 herbs accounted for 93%of the total prescribed dosage.In addition,the top 25 frequently used herbs,from high to low,were Guizhi Tang,Taoren,Rougui,Huangqi,Danggui,Chuanxiong,Sangjisheng,Shen Ling Baizhu San,Honghua,Wuzhuyu,Jingjie,Bohe,Yiyiren,Si Jun Zi Tang,Fuzi,Zhike,Si Wu Tang,Suanzaoren,Lulutong,Zhimu,Duhuo Jisheng Tang,Bu Yang Huan Wu Tang,Puhuang,Gouji and Weilingxian.These 25 herbs accounted for 87%of the total prescribed frequency.Among them,the frequency and total dosage of Guizhi Tang was 17.24%and 34.04%.Conclusion:Data analysis of the past 30 years’ Chinese Medicine literature suggested that the pathogeneses of FS mainly include liver depression,Qi stagnation,blood stasis,spleen deficiency,meridians blockage,Qi deficiency,blood deficiency and Yang deficiency.The Chinese herbal medicine treatments mainly include types of herb that are replenishing,exterior-releasing,Qi-activating,blood-activating,mind-calming,heat-clearing and dampness-draining.The herbal medicine involved were mainly Baishao,Chaihu,Danggui,Chuanxiong,Fuling,Guizhi,Gancao,Xiangfu,Huangqi,Baizhu,Dazao,Zhiqiao,Zhigancao,Shengjiang,Suanzaoren and Hehuanpi.The acupoints mainly involved Ashi point,Zusanli(ST36),Guanyuan(CV4),Shenshu(BL23),Sanyinjiao(SP6),Pishu(BL20),Ganshu(BL18),Taixi(KI3),Hegu(LI4),Taichong(LV3),Quchi(LI11),Baihui(GV20),Yanglingquan(GB34)and Waiguan(TB5).The findings conform to the traditional Chinese Medicine syndrome differentiation and treatment principle.The prescription of modified Guizhi Tang on top of using Doctor Tham Hui Saan’s muscle’s manipulation and acupuncture treatment showed remarkable efficacy in the treatment of fibromyalgia syndrome.Its therapeutic significance is shown in relieving pain,improving sleep quality,recovering living function and improving overall condition.More importantly,after adding this herbal medicine,patients’ relapse rate is significantly reduced.This indicates that Chinese herbal medicine that can regulate Ying and Wei,warm the Yang,nourish the Qi and move the blood are important in the treatment of FS.The modification of Guizhi Tang is thus particularly effective in treating FS.