| This paper is a part of "Research on theoretical framework of diagnosis and treatment of clinical departments of traditional Chinese medicine"(2013cb532004)of "973" project of national key basic research and development plan,and "Research on clinical standardization of rehabilitation treatment scheme of knee osteoarthralgia of traditional Chinese medicine"(gzy-kjs-2017-08)of project of State Administration of traditional Chinese medicine.Knee pain is a common orthopedic disease.It is common in knee osteoarthritis and rheumatoid arthritis.Rheumatoid arthritis can also affect the knee.The patients with mild symptoms can only see knee joint pain,the patients with severe symptoms can be accompanied by knee joint movement disorder,and even lead to deformity and disability of knee joint.Traditional Chinese medicine has a good effect on the disease,can effectively improve the symptoms,improve the quality of life.Based on their own diagnosis and treatment experience,modern doctors put forward their own diagnosis and treatment experience,but at present,there is still a lack of unified understanding.There are abundant literatures about the diagnosis and treatment of knee pain in ancient Chinese medicine,but the contents about knee pain are scattered in many chapters.There has been a lack of systematic discussion on knee pain in ancient books.Throughout the ancient books of all ages,only "Zhang's Yitong" and "Yifa Yuantong" list knee pain in a single chapter to discuss its syndrome differentiation and treatment,but also can not fully reflect the ancient books' full understanding of knee pain.In modern times,there is no comprehensive and systematic study on the literature of knee pain ancient books.Therefore,comprehensively summarizing the knowledge of knee pain in the literature of the past dynasties,and constructing a theoretical framework for the diagnosis and treatment of knee painit has practical value for guiding the theoretical research and clinical diagnosis and treatment of knee pain.The full text is divided into four parts:The first part is the introduction,which clarifies the selection principle andcollection scope of literature.A total of 126 books on traditional Chinese medicine have been selected from “Inner Canon of the Yellow Emperor” till Tang,song,yuan,Ming and Qing Dynasties.Books with complete theoretical content,clear hierarchical framework,or official revision are selected as important bibliographies.And complete the collection of knee pain bibliography.The selected literatures include "knee pain","knee cold pain",as well as the discussion of pathogenesis,which are related to the pain caused by evil Qi flowing into the feet and knees,limb joint pain and joint pain.The collection scope of the literature includes the discussion of the etiology and pathogenesis of knee pain,prescriptions,acupuncture treatment,etc.And find out the current textbooks,major monographs,the dictionary of traditional Chinese medicine,national standards,various kinds of guides,supplement the missing content.The second part is the formation and development of TCM knee pain diagnosis and treatment theory system.Taking the time line as the axis,this paper studies the literature of knee pain in the medical records of the past dynasties,so as to fully and clearly show the understanding of the theory of diagnosis and treatment of knee pain in each medical record.The third part is the research of ancient literature on the theory of diagnosis and treatment.In order to show the theory of diagnosis and treatment of knee pain in different times,we should divide the time into different periods and study the theory of knee pain in different times.The fourth part is the ancient literature of knee pain etiology,pathogenesis and treatment framework.By combing and summarizing the theory of diagnosis and treatment of knee pain in ancient literature,the theoretical framework of diagnosis and treatment of knee pain in traditional Chinese medicine was established.The specific research results are as follows:1.The chapter and disease of knee painBy combing the chapters of knee pain,it is found that there are many chapters of knee pain in the previous literature.Knee pain is commonly seen in the chapters of deficiency syndrome,chapters of Bi Zheng,chapters of pain,and chapters of restore deficiency and eliminating evil Qi.Chapters of deficiency syndrome include kidneydeficiency,spleen and stomach qi deficiency,asthenic disease,etc.The chapter of Bi Zheng includes wind-damp impediment,wind-cold impediment,foot impediment,wind-cold impediment of kidney,Jiao Qi,arthroncus of knee,etc.Pain chapters include knee pain,leg pain,lumbago,foot pain,etc.According to preliminary statistics,knee pain is mainly found in Bi Zheng,Xu Lao,beriberi,lumbago and knee pain,lumbago,gout,disease of wind evil,wind evil of kidney,arthroncus of knee and other diseases.2.The evolution of etiology,pathogenesis and treatment of knee painBy combing the literature of knee pain in the past dynasties,it is found that the understanding of the pathogenesis of knee pain originated before the Song Dynasty,basically formed in the song,Jin and Yuan Dynasties,and enriched in the Ming and Qing Dynasties.(1)Pre Qin and Han Dynasties"Suwen" first put forward the view that wind cold and dampness combined is Bi,which is the source of the pathogenesis of knee pain caused by Bi.“Synopsis of the golden chamber” proposes that retention of the drink can cause pain of the limbs.In the “Central Treasury Canon”,it is proposed that the kidney deficiency and evil Qi are inferior to the waist and knees,resulting in knee pain.In terms of treatment,“Miraculous Pivot” first proposed acupuncture for knee pain.“Sheng Nong's herbal classic” records that 5 kinds of herb can treat knee pain,including the root of bidentate achyranthes,gorgon fruit,rhizoma cibotii,soybean and manjiao.(2)Wei,Jin,Sui and Tang DynastiesAt this time,the understanding of knee pain has been further deepened.There are records of knee pain caused by invasion of wind-cold dampness by kidney deficiency,loss of essence,five labors and seven injuries,and invasion of wind evil."Beiji Qianjin Yaofang"(hereinafter referred to as "Qianjin Yaofang")first recorded Duhuojisheng prescription.It is the most commonly used prescription for the treatment of knee pain in the future.The rudiment of the diagnosis and treatment framework of knee pain has been seen in the Essential Secrets from Outside the Metropolis.It includes three types:knee pain of deficiency,knee pain of excess andknee pain of deficiency with excess.The treatment includes strengthening the body,nourishing the liver and kidney,removing pathogenic factors and promoting blood circulation.It also includes Daoyin,ointment and moxibustion.(3)Song,Jin and Yuan DynastiesIn song,Jin and Yuan Dynasties,on the basis of the previous generation's understanding of the etiology and pathogenesis of knee pain,a wider understanding of kidney deficiency,kidney yang deficiency,liver and kidney deficiency,spleen deficiency,viscera deficiency,deficiency of Qi and blood,exogenous wind pathogen of liver and kidney deficiency,exogenous wind pathogen of spleen and kidney deficiency,wind-cold dampness pathogen of liver and spleen deficiency,wind-cold dampness invasion of Qi and blood deficiency,wind-cold invasion,wind-dampness invasion with stagnation of blood vessels and phlegm can cause limb joint pain was added.The diagnosis and treatment framework of knee pain in song,Jin and Yuan Dynasties has been basically formed,which can be divided into three types: knee pain of deficiency,knee pain of excess and knee pain of deficiency with excess.Deficiency knee pain mainly includes deficiency of kidney,deficiency of liver and kidney,deficiency of spleen and deficiency of viscera.Deficiency and excess combined with knee pain include kidney deficiency with wind-cold evil,liver kidney deficiency with wind evil,spleen kidney deficiency with wind evil,liver spleen and kidney deficiency with wind-cold and heat-dampness evil.Excessive knee pain includes wind evil invasion,wind-cold invasion and wind-dampness invasion.At this time,there are 111 prescriptions for knee pain recorded in the pre scription book,which can be divided into three categories:tonic prescription,toni c and dispersing windcold dampness evil prescription,dispersing wind-cold damp ness evil prescription.Among them,there are 32 tonic prescription(28.8%),the m ost commonly used herbs are desert cistanche,the root of bidentate achyranthes,morinda officinalis,cassia twig,radix aconiti carmichaeli,the seed of Chinese dod der,etc.Most of them are herbs for tonifying the kidney and filling the essence.There are 62 tonic and dispersing wind-cold dampness evil prescription(55.9%).Among them,the most commonly used herbs are the root of bidentate achyranthe,cassia twig,the root of fangfeng,radix aconiti carmichaeli,Chinese angelica,lico rice,notopterygium root,etc.There are 9 dispersing wind-cold dampness evil pre scription(8.1%).Eight prescriptions for promoting blood circulation and dispersin g pathogenic factors(7.2%).It can be seen that tonic and dispersing wind-col d dampness evil is the main treatment method at this time.In addition,the acupuncture points of knee pain were also increased in thi s period,including Sanyinjiao,Liangqiu,Zusanli,Tiaokou,Ququan,Xuanzhong,Yanglingquan,Yingu,Jinggu,Fuyang,and Xiyan.It is also the first time that a cupoint compatibility is used to treat knee pain in "Bian que Shen Ying acupu ncture Yulong Jing".(4)Ming and Qing DynastiesIn Ming and Qing Dynasties,the understanding of etiology and pathogenesis of knee pain was further enriched.Compared with song,Jin and Yuan Dynasties,the pathogenesis of knee pain deficiency was further understood,and the pathogenesis of kidney yin deficiency and kidney yang deficiency appeared.The pathogenesis of knee pain with deficiency and excess includes wind-cold dampness evil of kidney deficiency,wind-cold dampness evil of liver and kidney deficiency,heat-dampness injection of spleen deficiency,cold-dampness evil of spleen and kidney,wind-cold dampness evil of liver deficiency.Most of them are wind-cold dampness evil of kidney deficiency and wind-cold dampness evil of liver kidney deficiency.On the basis of song,Jin and Yuan Dynasties,it was also mentioned that dampness-heat evil,dampness evil and phlegm and blood stasis of excessive knee pain.In terms of treatment,the principles of medicine put forward the treatment methods of "tonifying the kidney and removing wind-dampness evil" and "dispel dampness evil,dredge stagnation".In the book of “Leizheng Zhicai”,the author puts forward the treatment method of "remove evil in Luo meridians and nourish blood essence".In the book of “Yifa Yuantong”,the author puts forward the treatment method of “promote sweating and pissing”,”Warming spleen and kidney””nourishing Yin and clearing away Yang,regulating qi and dehumidification”.In Ming and Qing Dynasties,there were 166 prescriptions for the treatment of knee pain,which can alsobe divided into three categories:tonic prescriptions,tonic and dispersing wind-cold dampness evil prescriptions and dispelling wind-cold dampness evil prescriptions.Among them,there are 54 tonic prescription(32.5%),The most commonly used herbs are the root of bidentate achyranthes,the seed of Chinese dodder,desert cistanche,cultivated land,the bark of eucommia,etc.It is mainly used for tonifying liver and kidney and filling essence.There are 83 tonic and dispersing wind-cold dampness evil prescription(50.0%).The most commonly used herbs are the root of bidentate achyranthes,the root of Fangfeng,Chinese angelica,adix aconiti carmichaeli,tuckahoe,liquorice,notopterygium root,Bixie,Ligusticum wallichii,cassia twig,etc.There are 29 dispersing wind-cold dampness evil prescription(17.5%).The most commonly used traditional Chinese medicines are notopterygium,Fangfeng,Atractylodes,ephedra,Ramulus Cinnamomi,Angelica dahurica,etc.There are 26 prescriptions for promoting blood circulation.The commonly used traditional Chinese medicines are frankincense,myrrh,angelica,wulingzhi,etc.It is the innovative feature of Ming and Qing Dynasties.During the Ming and Qing Dynasties,external treatment methods such as external application,external ironing,fumigation and washing,as well as medicine liquor,food therapy,and Daoyin for knee pain were also increasing.In terms of acupuncture point selection,before the Ming and Qing Dynasties,only a single point was recorded.In the Ming and Qing Dynasties literature,the records of acupoint compatibility in the treatment of knee pain gradually increased.3.Study on the framework of etiology,pathogenesis and treatment of knee painThe etiology of knee pain includes external and internal injury.Exogenous etiology is the invasion of knee joint by exogenous wind,cold,damp and heat evil.The internal injury of body deficiency refers to knee joint loss of body deficiency due to postnatal loss of nourishment,exhaustion due to sexual indulgence,after serious illness,age and other factors.The pathogenesis of knee pain includes deficiency,evil and stasis.Deficiency means deficiency of vital energy,including deficiency of liver,spleen and kidney and deficiency of essence,Qi and blood,which makes knee joint lose nourishment and pain.Evil is the invasion of wind,cold,damp and heat evil bydeficiency,but also the invasion of wind,cold,damp and heat evil without deficiency.The stagnation of evil Qi causes knee pain.Stasis refers to phlegm and blood stasis.Phlegm is formed by the stagnation of body fluid and Qi.If phlegm and retained fluid blocks the knee joint up and down,blocks the Qi pulse,it can cause knee pain.Blood stasis is caused by cold,damp,heat evil.The syndromes of knee pain can be divided into three types:deficiency syndrome,deficiency and excess syndrome and excess syndrome.(1)deficiency syndromeDeficiency syndrome includes deficiency of kidney,deficiency of liver and kidney,deficiency of spleen and deficiency of viscera.Kidney deficiency syndrome and liver kidney deficiency syndrome are common.kidney-deficiency syndrome:the main syndrome is knee pain,often accompanied by low back pain,tinnitus,weakness,emaciation,decreased vision,frequent urination,reduced diet,night sweat and dark complexion.Its therapeutic method is tonifying kidney essence.The commonly used prescriptions are Cishi pill,Cistanche pill,Anshen pill and Cuscuta pill.In addition,kidney yang deficiency syndrome:the main syndrome is cold pain of knee,Often accompanied by low back pain,tinnitus,emaciation,fatigue,frequent urination,dizziness.Its treatment is warming and tonifying the kidney yang.The commonly used prescriptions are Bawei Dihuang Pill addition and subtraction,fennel seed pill,and Wennaqi pill.Deficiency of liver and kidney syndrome:the main syndrome is knee pain,often accompanied by lumbago,weakness,emaciation,dizziness,deafness.The commonly used prescriptions are Muguajian pill and Lurong Sijin pill.Spleen deficiency syndrome:the main syndrome is knee pain,often accompanied by emaciation,sallow complexion,lumbago,fatigue,disordered stool,dizzy head.The treatment is to nourish the spleen and stomach.Commonly used prescriptions are Astragalus pill,orange peel pill and fennel pill.Deficiency of viscera syndrome:the main syndrome is knee pain,often acco mpanied by low back pain,poor appetite,sallow complexion,emaciation,weakness,palpitation,forgetfulness,dizziness and sweating.The treatment is to nourish the five internal organs.The commonly used prescriptions are Wennaqi pill,Zexie p ill and Shiquan Dabu pill.(2)Deficiency-excess syndromeDeficiency-excess syndrome includes kidney deficiency with wind cold dampness evil syndrome,liver deficiency with wind cold dampness evil syndrome,liver and kidney deficiency and wind cold dampness evil syndrome.Kidney deficiency with wind cold and dampness evil syndrome are common.Kidney deficiency with wind cold dampness evil syndrome:the main syndrome is knee pain,or cold pain,or swelling pain,often accompanied by low back pain,lack of strength and difficulty in walking,tension of the sinews.The treatment is invigorating the kidney and dispersing cold and dampness evil.Commonly used prescriptions are Duhuo Jisheng decoction and Bajitian decoction.Liver deficiency with wind cold dampness evil syndrome:the main syndrome is knee pain,tension of the sinews,often accompanied by low back pain,difficulty in walking,rib-side distention.The therapeutic method is invigorating the liver and dispersing pathogenic factors.The commonly used prescription is Bugan baiziren powder.Liver and kidney deficiency with wind cold dampness evil syndrome:the main syndrome is knee pain,often accompanied by difficulty in walking,low back pain.The therapeutic method is invigorating the liver and kidney,and dispersing cold-dampness evil.The common prescription is Jiawei Sijin pill.(3)Excess syndromeThe excess syndrome includes wind cold dampness evil syndrome,wind evil invasion syndrome,dampness-heat evil syndrome,water-dampness evil syndrome and phlegm and retained fluid syndrome.Wind cold dampness evil syndrome is common.Wind cold dampness evil syndrome:the main syndrome is knee pain or swelling pain,Often accompanied by low back pain,numbness,difficulty in walking,and tension of the sinews.The treatment is to dispel the wind,cold and dampness evil or to promote blood circulation to dispel cold-dampness evil.The common prescriptions areQinhu pill,Huoxue Yingtong pill.Wind evil invasion syndrome:the main syndrome is knee pain,often accompanied by low back pain.The commonly used prescriptions are Zhuifeng pill,A golden pill and Ruxiang Dingtong pill.Dampness-heat evil syndrome:the main syndrome was swelling and pain in the knee and heavy limbs.The treatment is to clear heat and dispel dampness.The commonly used prescriptions are Ermiao powder and Danggui Niantong decoction.Water-dampness evil syndrome:the main syndrome is swelling and pain of the knee,often accompanied by edema of the foot and shin,swelling and pain of the waist,and inhibited urination.Phlegm and retained fluid Syndrome:the main syndrome is knee pain,often accompanied by sense of suppression in the chest,stringy pulse or smooth pulse.The treatment is warming phlegm and retained fluid.The common prescriptions are Jiawei Erchen decoction and Wuji powder.Acupuncture is also an important treatment for knee pain,except for medi cal treatment.Acupuncture points for the treatment of knee pain mostly belong to the liver,gallbladder,spleen,stomach and kidney channels.Acupoints are ma inly distributed around the knee joint and lower limbs.Liver meridian,Taichong,Xiguan,Zhongfeng,Ququan;Gallbladder meridian:Linqi,Guangming,Yangguan,Xuanz hong,Fengshi,Yanglingquan,Yangjiao,Xiaxi,Waiqiu,Yangfu;Spleen meridian,Sanyinji ao;Stomach channel,Dubi,Yinshi,Biguan,Liangqiu,Tiaokou,Zusanli,Fenglong,Lidui;Kidney channel,Yongquan,Yingu,Jiaoxin;Bladder meridian,Heyang,Jinggu,Dazhu,Shangliao,Weizhong,Fuyang;Extra nerve points,Xiyan.Treatment of inside knee pain:Xiguan,Zhongfeng,Taichong,Sanyinjiao,Ya nglingquan,Jiaoxin;Treatment of outside knee pain:Yangguan,Xiaxi,Yanglingqu an,Linqi,Taichong;Treatment of knee contracture and pain,Xiguan,Ququan,Ya ngguan,Fengshi,Xuanzhong,Yanglingquan,Liangqiu,Dubi,Yingu,Jinggu,Daz hu;Treatment of knee weakness,Biguan,Zusanli.Treatment of knee cold pain,Bigu an,Liangqiu,Tiaolou,Yinshi,Ququan,Shangliao,Xiyan;Treatment of knee heat pain,Guangming;Treatment of knee numbness.Dubi.Liangqiu.Yanglingquan.Guangming.Yangguan.Treatment of knee ache,Fengshi,Guangming,Zusanli,Tiaokou,Fenglo ng;Treatment of swelling and pain of knee by cold-dampness evill,Fuyang,Lidu i.Treatment of heat swelling pain of knee,Xiguan,Xiyan.In addition,fumigation is mainly used to treat knee pain caused by kidney deficiency and stagnation of cold dampness evil.Fumigant prescription,use wheat bran,pepper,salt,scallion,wine,vinegar.Frying untill heat.Fumigation under the affected leg.Cover the quilt and wait for the sweat.Fumigation for about 1 hour.Remove the quilt after 1 to 2 hours.To sum up,this paper is the first time to systematically review the understanding of knee pain in ancient books and its historical evolution.the etiology and pathogenesis of knee pain,the development and evolution of treatment methods and prescriptions are clarified.To summarize the literature of knee pain in ancient books into the diagnosis and treatment framework of etiology,pathogenesis and syndrome type treatment of knee pain.It will provide important theoretical guidance for clinical diagnosis and treatment of knee pain.To provide literature support for the construction of TCM diagnosis and treatment standardization of modern related diseases.The conclusion is as follows:The understanding and treatment of knee pain symptoms have existed in“Neijing”.No direct discussion on the pathogenesis of knee pain in the literature before Sui and Tang Dynasties.However,it is mentioned that the pathogenesis of kidney deficiency,wind cold and dampness evil invading waist and feet,which is the source of the development of pathogenesis of knee pain.A large number of prescriptions for knee pain appeared in song,Jin and Yuan Dynasties,and there were a lot of critical discussions on pathogenesis in the provisions of prescriptions.During this period,there were basically three aspects of knowledge about the pathogenesis of knee pain.In the Ming and Qing Dynasties,the understanding framework of the pathogenesis of knee pain was slightly enriched on the basis of the song,Jin and Yuan Dynasties.In this period,for the first time,physicians listed knee pain in a single chapter to discuss its pathogenesis.In Ming and Qing Dynasties,there were also records of knee pain caused by phlegm.In ancient literature,knee pain is common inBizheng,Xulao,hegenufeng and other diseases.The causes include external wind,cold,dampness and heat,invasion of knee joint,or fatigue,post disease,age,etc.Pathogenesis includes deficiency,evil and stasis.The main syndromes of knee pain are kidney deficiency,liver and kidney deficiency,kidney deficiency,wind cold dampness and wind cold dampness.There are few spleen deficiency syndrome,viscera deficiency syndrome,liver deficiency and wind cold dampness syndrome,liver and kidney deficiency and wind cold dampness syndrome,wind evil invasion syndrome,damp heat syndrome,water dampness syndrome and phlegm drink syndrome.In the treatment of knee pain,the drug treatment includes four aspects: strengthening the body,dispersing wind,cold and dampness,promoting blood circulation and removing blood stasis,warming and resolving phlegm.The main prescriptions are Duhuo Jisheng decoction,cishiwan,etc.There are 33 main acupuncture points in acupuncture treatment,most of which belong to liver,gallbladder,spleen,stomach and kidney channels.It is mainly distributed around the knee joint and lower limbs.In addition,fumigation can also treat knee pain caused by stagnation of cold and dampness due to kidney deficiency. |
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