| Primary Knee Osteoarthritis(KOA) is a chronic joint disease which occurs most frequently among middle-aged and old people,its main symptoms including knee joint pain,dysfunction and aggravation after tire or catching cold.Its pathological features are degenerative pathological changes of knee joint cartilages and osteophyte which is the result of recovery and regeneration. With the aging of population,the incidence of KOA is rising.Many patients lose movement ability for joint dysfunction.It seriously affects middle-aged and old people' s normal life and work,bringing heavy burden to individuals, families and society.This problem will be more prominent with the aging progress.In 1999,Osteoarthritis(OA),together with cardiovascular diseases and cancer,is listed as three killers of human health by WHO and 2000-2010 are designated as "ten years of bones and joints".KOA affects not only the joint cartilage but also bone substances at joint brims and even the whole joint.However,the basic change takes joint surface cartilage as the center and gradually affects the whole joint,including subchondral bone substance,joint capsule,ligament,bursa and the peri-joint musculature.With aging,subchondral nutrient vessels drop in number, cartilage has abnormal physiological and biochemical changes,cartilage polysaccharide protein organisms compose and decompose abnormally,cartilage cells can' t compose normal and long-chain-structured Hyaloplasm Acid(HA) and Glucosaminoglycan(GAG) and the short-chain-structured Protein-polysaccharide polymers transgress from the collagenous reticular structure.Therefore the joint cartilages intenerate locally,lose flexibility,fret and the structure ruins.The secondary effects include the activation of superoxide free radical,collagen enzyme and phospholipase and injury of cartilages and OA effect of bones near joints.Besides,after the degeneration or injury of cartilages,collagen fiber framework severs first, the supporting ability of degenerated or injured cartilage drops,subchondral bone endures excessive stress and has micro-fracture.The rehabilitated osseous tissue loses the normal flexibility and causes further injury in joint cartilages and subchondral hyperosteogeny.Cartilages may easily exfoliate and joints may develop into abnormality and wreckage,finally resulting in knee joint anatomical abnormality and dysfunction.At present,there are many ways to treat this disease,but no radical cure. Commonly used treatment includes diminishing inflammation and pain with non-steroid anti-inflammatory drugs and promoting blood circulation, removing blood stasis and activating channels and meridians with Chinese Materia Medica.Long-term administration of non-steroid anti-inflammatory drugs frequently causes side effects and the curative effect is not desirable. For the diagnosis and treatment of this disease,Chinese Medicine and Chinese Materia Medica have advantages.From angle of Chinese Medicine,ROA is mainly caused by liver and kidney deficiency,loss of nutrition in tendons and meridians,coldness and dampness invasion,meridian and channel blockage and stagnation and the loss of nutrition in joints.The Primary ROA takes deficiency of liver,kidney, tendons and bones as the root and meridian and channel blockage by coldness and dampness as signs.The treatment principle is to disperse coldness and dampness,activate the channels and reinforce kidney.Angelicae Pubescentis and Loranthi Decoction is from Valuable Prescriptions for Emergencies which originally treats kidney-qi deficiency,cold and pain in back and legs for wind invasion and staying in cold and damp places,to treat the hemiplegia, arthralgia spasm with chill,weakness and pain or to treat the back pain,foot sprain and severe arthralgia spasm.Nowadays,it' s used to treat the long-term arthralgia spasm and asthenia healthy qi and sthenia pathogenic factor syndrome,like chronic arthritis and chronic back and leg pain.Angelicae Pubescentis and Loranthi Decoction is from Valuable Prescriptions for Emergencies.As the major element of the prescription, Angelicae Pubescentis cures the potential wind evil and is good at demolishing the wind cold and dampness evil between Lower Energizer and bones and muscles. Asiasarum can disperse wind cold and diminish rheumatism in bones and muscles so as to relieve pain.Saposhnikoviae can prevent wind evil and dampness. Largeleaf gentian root can relieve rheumatism and stretch the tendons. Loranthi,eucommia bark and achyranthis can reinforce liver and kidney. Angelica,ligustici rhizome,rehmannia,paeoniae alba can nourish and promote blood circulation.Ginseng and hoelen can reinforce qi and spleen.Cortex cinnamon can warm the biood vessels.Licorice root ameliorates all elements. The whole prescription can diminish the evil factors,support the healthy qi, take care of both root and signs of diseases,invigorate blood and qi and diminish rheumatism,reinforce liver and kidney and cure arthralgia spasm and pain.The combination of all elements can reinforce liver and kidney,diminish wind evil and dampness,stretch tendons and promote blood circulation and collaterals to stop pain.Modern pharmacology research shows largeleaf gentian root and angelicae pubescentis have anti-inflammatory and analgesic function.Ramulus cinnamoni and saposhnikoviae can relieve fever and pain. Angelica and ligustici rhizoma can improve the microcirculation besides relieving pain.The researches on KOA treatment with Angelicae Pubescentis and Loranthi Decoction are mainly experimental.The clinical researches are mainly simple observations.Some don't take strict diagnosis and inclusion standard and some take comparatively simple curative efficacy judgment criteria with low reliability.Therefore these are low-level researches and can't fully prove the accurate curative efficacy of Angelicae Pubescentis and Loranthi Decoction.Considering the problems and defects,based on strict clinical research results,this research intends to fully prove the clinical efficacy of Angelicae Pubescentis and Loranthi Decoction in KOA treatment so as to provide clinical reference for Chinese Medicine and Chinese Materia Medica treatment of KOA.1.MethodsThis research takes strict inclusion standard and selects 53 KOA patients consistent with diagnostic,incIusion and preclusion standards.They take Angelicae Pubescentis and Loranthi Decoction granules orally for 3 months. The author adopts KOA curative efficacy evaluation index used in large-scale clinical researches in the country and at the end of the first,second and third month records patients' and doctors' general evaluation(grading) of arthritis,knee joint pain degree(VAS Visual Analogue Scale) and WOMAC arthritis index.Compare the index changes before and after the treatment and give objective and systematic evaluation. 2.Result2.1 The research shows that patients' general grading of arthritis is high and it drops after one month' s treatment,but there' s no significant difference.The grading drops further at the end of the second month and there' s significant difference.After three months,the grading obviously drops and the difference is quite prominent and significant.Patients' general grading of arthritis improves at 41.2%compared with that before treatment.2.2 Research shows doctors' general grading of arthritis is high and it drops after one month' s treatment,but there' s no significant difference.The grading drops further at the end of the second month and there' s significant difference.After three months,the grading obviously drops and the difference is quite prominent and significant.Patients' general grading of arthritis improves at 35.3%compared with that before treatment.2.3 The research shows that patients' general grading of knee pain is high and it drops after one month' s treatment,but there' s no significant difference.The grading drops further at the end of the second month and there's significant difference.After three months,the grading obviously drops and the difference is quite prominent and significant.Patients' general grading of knee joint pain improves at 62.5%compared with that before treatment.2.4 The result shows the average WOMAC joint index grading is high before treatment and it drops after one month's treatment,but there's no significant difference.The grading drops further at the end of the second month and there's significant difference.After three months,the grading obviously drops and the difference is quite prominent and significant.The WOMAC index grading improves at 57.8%compared with that before treatment.2.5 The result shows 2 patients' condition reaches the improvement standard, 50 patients' condition doesn't have obvious change,1 patient' s condition worsens after 1 month' s treatment;28 patients' condition improves,25 patients' condition doesn't have obvious change,and no patient's condition worsens after 2 months' treatment;41 patients' condition improves,12 patients' condition doesn't have change and no patient' s condition worsens after 3 months' treatment.At the end of the treatment, the general improvement rate is 77%. 3.Conclusion3.1 Angelicae Pubescentis and Loranthi Decoction Granules Obviously Improves Patients' General Grading of KOABecause of long-term strain,the liver and kidney deficiency,which needs a long period of time for treatment,causes KOA.Statistical significance in curative efficacy occurs only after two months' treatment.With the extending of treatment,liver and kidney are reinforced,so the patients' pain and swelling and limited function improve.At the end of the treatment,the difference is significant compared with that before treatment.Osteoarthritis is a lifelong disease.As the bone substance is damaged,so theoretically the joint abnormality is not reversible.The treatment purpose is to relieve symptoms,slow the KOA development,and improve the patients' function so as to improve lift quality.Therefore the treatment takes a long period of time.3-month treatment is just a small part and further treatment is needed.3.2 Angelicae Pubescentis and Loranthi Decoction Granules Obviously Improves Doctors' General Grading of KOADoctors' evaluation of KOA tends to be more objective and complete which fully reflects the curative efficacy.In this research,the doctors' and patients' general grading of arthritis are consistent.After one-month treatment,part of the patients have obvious curative efficacy.Those with lighter disease condition recover more quickly in joint pain and function improvement and completion of walking,squatting and sitting,etc.These greatly enhance the patients' confidence and life quality.Those patients with severe condition improve slowly.Part of the patients don' t have obvious changes after one month' s medicine administration.After two months' treatment,because of improvement of pain relieving and function,patients cooperate with treatment more actively and make more progress,so the doctors' evaluation has statistical significance.At the end of the treatment, most patients' pain relieves and function improves.With the lengthening of treatment,liver and kidney deficiency will gradually lessen and patients' and doctors' general grading of arthritis will have more improvement.3.3 Angelicae Pubescentis and Loranthi Decoction Granules Effectively Relieve Knee Joint PainKidney is in charge of bones and liver of tendons.Reaching middle age, people have deficient liver and kidney.The tendons and bones lose nutrition and so pain occurs.If wind and dampness evil attacks and stays at joints or tumbling and spraining occur,artery and vessel stagnation will be caused. Stagnation of qi and blood may bring about pain.At the end of the first month' s treatment,the knee joint rest pain improves obviously,but the activity pain improvement is not obvious.So the VAS grading of knee joint pain has no obvious improvement.This reminds us that the pain relieving effect of Angelicae Pubescentis and Loranthi Decoction is not achieved by directly inhibiting the inflammation factors like non-steroid anti-inflammatory drugs. It lessens the production of inflammatory factors with upstream controlling. By reinforcing the kidney and liver,it strengthens tendons and bones.By diminishing rheumatism,it smoothes the joints and tendons blocked by arthralgia spasm.Strong tendons and bones and smooth muscles and vessels don' t bring about pain.With reinforcing kidney and diminishing rheumatism, knee joint pain will gradually relieve and finally the improvement rate will reach 62.5%.3.4 Angelicae Pubescentis and Loranthi Deeoction Granules Obviously Improves WOMAC Joint Index GradingAfter one month' s treatment,WOMAC grading lowers but doesn't have statistical significance.Only after two months does it improve obviously. At the end of the third month,the curative efficacy is the best.WOMAC changes shows KOA treatment is a long-term process.As mentioned above,the KOA in this group is caused by liver and kidney deficiency and rheumatic arthralgia blockage.These are internal wind and dampness and related to liver and kidney deficiency which is related to aging-caused degeneration and long-term joint strain.So to reverse the liver and kidney deficiency takes long time.If liver and kidney are reinforced,joints are stronger;if qi and blood are reinforced, the joints obtain nutrition.Thus the pain and stiffness of patients are lessened.Because of strong joints and relieved pain,the knee joint function improves obviously.Patients make progress in standing,walking,going up and down the stairs,putting on and taking off shoes and socks,going out for shopping,doing part of or all the housework and improving life quality, therefore WOMAC grading reaches the greatest improvement level.Angelicae Pubescentis and Loranthi Decoction is not to diminish pain and swelling.It's a medicine to reinforce kidney.This tells us syndrome differentiation is essential when using Chinese Medicine to treat osteoarthritis.Treatment must be undertaken according to etiological factors and pathogenesis.Chinese Medicine is to cure the root of diseases,not the signs.3.5 Angelicae Pubescentis and Loranthi Decoction Granule Has Definite Curative Efficacy in KOA TreatmentThe general improvement rate of Angelicae Pubescentis and Loranthi Decoction Granule's treatment of KOA is 77%.Because of the clinical efficacy of non-steroid anti-inflammatory drugs and articular cartilage supplements in many researches,we discover from the whole curative process that half the patients have obvious improvement only after 2 months' treatment and most patients after 3 months.Compared with non-steroids,Angelicae Pubescentis and Loranthi Decoction granules exert function slowlier but no adverse reaction is found in treatment.The patients have good tolerance.Angelicae Pubescentis and Loranthi Decoction can not only stop pain,but also improve the joint function of patients so as to improve the life quality.
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