| Objective:The purpose of this study is to observe the distribution characteristics of TCM Syndrome Types in acute and intermittent gouty arthritis,and to provide theoretical basis and clinical thinking for TCM syndrome differentiation and treatment of gout.At the same time,the patients with acute gouty arthritis with damp heat accumulation syndrome were treated with the method of "clearing heat and detoxification,removing dampness and resolving turbidity",and its effectiveness and safety were observed.Methods:(1)according to the content of the research,we developed the related questionnaire,collected gout patients who met the inclusion criteria as the research object,and filled in the relevant content of the table.All the patients in the group completed 418 times of TCM syndrome determination table survey,including one on the day of acute phase and one in intermittent phase.According to the TCM syndrome classification standard,the acute stage is divided into two syndrome types: dampness heat accumulation,phlegm stasis obstruction.The intermittent stage is divided into three syndrome types: dampness turbid accumulation,liver kidney yin deficiency,spleen kidney yang deficiency.The distribution characteristics of each syndrome type were observed and compared.(2)Combined with the diagnostic criteria of gout of American College of Rheumatology/ European League Against Rheumatism(ACR / EULAR)and TCM syndrome criteria of damp heat accumulation type in 2015,144 patients were selected into the group.The treatment adopts the method of "clearing away heat and detoxification,promoting dampness and resolving turbidness".The selected traditional Chinese medicine mainly includes:Atractylodes macrocephala,phellodendron,Coptis,Achyranthes bidentata,coix seed,Ligusticum chuanxiong,plantain seed,Fangfeng,liquorice,with the increase and decrease of syndrome.The treatment period was 4 weeks.On the day of acute stage,one week of treatment,two weeks of treatment,four weeks of treatment and 12 weeks of drug withdrawal,visits were arranged to record the age,gender,course of disease,family history and vital signs such as breath,heart rate and blood pressure of the patients.The attack times of 12 weeks before treatment and 12 weeks of drug withdrawal were recorded to score the symptoms suchas joint pain,swelling,skin temperature rise,flexion and extension disadvantage,fever and fidgety.The treatment was also recorded The changes of laboratory indexes such as uric acid,liver and kidney function before treatment,4 weeks after treatment and 12 weeks after drug withdrawal were compared.After the observation,statistical methods were used to compare the differences before and after treatment.Results:1.(1)Distribution of gout syndrome types: in acute stage,damp heat accumulation syndrome is the main syndrome,followed by phlegm stasis obstruction syndrome;in intermittent stage,damp turbid accumulation syndrome is the main syndrome,liver and kidney yin deficiency syndrome is the second,spleen and kidney yang deficiency syndrome is the least.(2)There was no correlation between sex,BMI and syndrome type distribution(P>0.05).(3)There is a certain rule between the age of gouty arthritis patients and the distribution of TCM syndrome types.The younger the patients are,the more they are in the acute phase,the more they are in the intermittent phase(P<0.01);the older the patients are,the opposite is,the more they are in the acute phase,the more they are in the intermittent phase,the more they are in the liver kidney yin deficiency or spleen kidney yang deficiency(P<0.01).(4)There is a certain rule between the course of gouty arthritis and the distribution of TCM syndrome types.The shorter the course of disease,the more the syndrome of damp heat accumulation in the acute period,and the more the syndrome of damp turbid accumulation in the intermittent period(P<0.05);while the longer the course of disease,the more the syndrome of phlegm stasis obstruction in the acute period,and the more the syndrome of liver and kidney yin deficiency in the intermittent period(P<0.05).(5)There is a certain rule between some combined diseases of gouty arthritis patients and the distribution of TCM syndrome types.The acute stage syndrome of gouty arthritis patients with hypertension is more likely to be phlegm stasis syndrome than that of gouty patients without hypertension(P<0.01),and most of the intermittent stage is liver kidney yin deficiency syndrome(P<0.01).The acute stage of gout patients with coronary heart disease was mainly phlegm stasis syndrome(P< 0.05),the intermittent stage was mainly liver andkidney yin deficiency syndrome,and the syndrome of dampness and turbidity was the least(P<0.01).Most of the gout patients with diabetes mellitus in the intermittent period were liver kidney yin deficiency(P<0.01).There was no correlation between other combined diseases and the distribution of TCM syndromes(P>0.05).(6)In the acute stage,the syndrome of damp heat accumulation mostly evolves into the syndrome of damp turbid accumulation in the intermittent stage,and in the acute stage,the syndrome of phlegm stasis obstruction mostly evolves into the syndrome of liver and kidney yin deficiency in the intermittent stage(P<0.01).2.(1)After 1 week of treatment,14 cases were cured,45 cases were effective,71 cases were effective,3 cases were ineffective,the total effective rate was 97.74%;after 2 weeks of treatment,46 cases were cured,74 cases were effective,13 cases were effective,0 cases were ineffective,the total effective rate was 100%;after 4 weeks of treatment,75 cases were cured,57 cases were effective,1 case was effective,0 case was ineffective,the total effective rate was 100%.There were significant differences in the composition of clinical control,significant effect and effective number between 1 week and 2 weeks,1 week and 4 weeks,2weeks and 4 weeks(P< 0.01).(2)The total score of TCM syndrome was significantly lower than that of before treatment(P < 0.01).(3)The pain,swelling,flexion and extension of joints,skin temperature rise,redness,irritability,thirst,yellow urination and sticky stool were significantly improved in 1,2 and 4weeks of treatment compared with those before treatment(P < 0.01).No matter for one week,two weeks or four weeks,it has an effect on improving the above symptoms,and its effect is more significant with the prolongation of the treatment course.(4)Compared with 12 weeks before treatment,the number of attacks decreased significantly(P < 0.01).A kind of(5)In the aspect of blood uric acid,the level of blood uric acid decreased significantly in4 weeks after treatment and 12 weeks after drug withdrawal compared with that before treatment(all P < 0.01).There was no significant difference between 4 weeks and 12 weeks(P > 0.05).(6)There was no significant difference in creatinine,glutamic pyruvic transaminase and glutamic oxaloacetic transaminase between 4 weeks and 12 weeks after treatment and before treatment(P > 0.05),while the level of urea nitrogen decreased significantly(P < 0.01;P <0.05).During the treatment,the vital signs of all the subjects were stable,respiratory rate,heart rate,body temperature and blood pressure were normal,among which 4 patients had diarrhea in the first week of taking medicine,which was relieved after adjusting the medicine.Conclusion:(1)(1)The distribution of gout syndrome in acute stage is mainly damp heat accumulation syndrome,followed by phlegm stasis obstruction syndrome;in intermittent stage is mainly damp turbid accumulation syndrome,followed by liver and kidney yin deficiency syndrome,followed by spleen and kidney yang deficiency syndrome.In the acute stage,the syndrome of dampness and heat accumulation mostly evolves into the syndrome of dampness and turbid accumulation in the intermittent stage,and in the acute stage,the syndrome of phlegm and stasis stagnation mostly evolves into the syndrome of liver and kidney yin deficiency in the intermittent stage.(2)There are some rules between the age,course of disease and TCM syndrome type distribution of gouty arthritis patients.(3)High blood pressure,diabetes mellitus and coronary heart disease may affect the distribution of gout type,while hyperlipidemia,fatty liver and kidney stone may not affect the distribution of gout type.(4)There was no correlation between sex,body mass index and syndrome type distribution.2.(1)The method of "clearing away heat and detoxifying,removing dampness and turbidity" can significantly improve the TCM syndrome score of patients with acute gouty arthritis with damp heat accumulation syndrome,improve the symptoms of joint pain,joint swelling,skin temperature rise,flexion and extension disadvantage,fever,fidgety,thirsty,yellow urine,sticky stool,and reduce the number of attacks.(2)The method of "clearing away heat,detoxifying,removing dampness and turbidity" can significantly reduce the level of blood uric acid in patients with acute gouty arthritis withdamp heat accumulation syndrome,and there is no obvious adverse reaction,so it has better safety. |
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