章氏加減活血舒筋湯治療氣虛濕阻型膝骨關(guān)節(jié)炎性滑膜炎的臨床療效觀察

章氏加減活血舒筋湯治療氣虛濕阻型膝骨關(guān)節(jié)炎性滑膜炎的臨床療效觀察摘要：目的探討章氏加減活血舒筋湯治療氣虛濕阻型膝骨關(guān)節(jié)炎性滑膜炎的臨床療效及其作用機(jī)制，為臨床提供參考。

方法選取2019年1月至2020年12月我院收治的60例氣虛濕阻型膝骨關(guān)節(jié)炎性滑膜炎患者，按照入組順序隨機(jī)分為治療組和對(duì)照組，每組各30例。治療組采用章氏加減活血舒筋湯治療，對(duì)照組采用常規(guī)治療，均連續(xù)治療12周。比較兩組患者臨床療效、生活質(zhì)量及血液生化指標(biāo)。

結(jié)果治療組總有效率為90%，對(duì)照組為60%，兩組比較具有統(tǒng)計(jì)學(xué)意義（P<0.05）。治療組患者VAS評(píng)分、WOMAC指數(shù)、KSS評(píng)分較對(duì)照組明顯改善，在生活質(zhì)量評(píng)分中，治療組比對(duì)照組高，差異有統(tǒng)計(jì)學(xué)意義（P<0.05）。治療前后兩組血紅蛋白（Hb）、紅細(xì)胞壓積（Hct）、白細(xì)胞（WBC）、超敏C反應(yīng)蛋白（hs-CRP）均有不同程度的變化，但治療組上述指標(biāo)變化達(dá)到了顯著水平（P<0.05）。

結(jié)論章氏加減活血舒筋湯具有顯著的治療氣虛濕阻型膝骨關(guān)節(jié)炎性滑膜炎作用，且具有較好的安全性和耐受性，能顯著改善患者的癥狀和生活質(zhì)量，并且通過改善炎癥反應(yīng)和氧化應(yīng)激狀態(tài)發(fā)揮治療作用。

關(guān)鍵詞：章氏加減活血舒筋湯；氣虛濕阻型；膝骨關(guān)節(jié)炎性滑膜炎；臨床療效；作用機(jī)制。

Abstract:ObjectiveToexploretheclinicalefficacyandmechanismofZhāng’sAdd-SubtractHuóXuShūjīnTanginthetreatmentofgasdeficiencyanddampobstructiontypekneeosteoarthritissynovitis,andprovideclinicalreference.

MethodsAtotalof60patientswithgasdeficiencyanddampobstructiontypekneeosteoarthritissynovitisadmittedtoourhospitalfromJanuary2019toDecember2020wererandomlydividedintotreatmentgroup(30cases)andcontrolgroup(30cases)accordingtotheadmissionorder.ThetreatmentgroupwastreatedwithZhāng’sAdd-SubtractHuóXuShūjīnTang,whilethecontrolgroupwastreatedwithconventionaltherapy,bothfor12weeks.Theclinicalefficacy,qualityoflife,andbloodbiochemicalindexesofpatientsinthetwogroupswerecompared.

ResultsThetotaleffectiverateofthetreatmentgroupwas90%,whilethatofthecontrolgroupwas60%,andthedifferencebetweenthetwogroupswasstatisticallysignificant(P<0.05).TheVASscore,WOMACindex,andKSSscoreofthetreatmentgroupimprovedsignificantlycomparedtothecontrolgroup.Thequalityoflifescoreofthetreatmentgroupwashigherthanthatofthecontrolgroup,andthedifferencewasstatisticallysignificant(P<0.05).TherewerevaryingdegreesofchangesinHb,Hct,WBC,andhs-CRPbeforeandaftertreatmentinthetwogroups,butthechangesinthetreatmentgroupreachedasignificantlevel(P<0.05).

ConclusionZhāng’sAdd-SubtractHuóXuShūjīnTanghassignificanttherapeuticeffectongasdeficiencyanddampobstructiontypekneeosteoarthritissynovitiswithgoodsafetyandtolerance.Itcansignificantlyimprovethesymptomsandqualityoflifeofpatientsandexerttherapeuticeffectsbyimprovinginflammatoryreactionandoxidativestress.

Keywords:Zhāng’sAdd-SubtractHuóXuShūjīnTang;gasdeficiencyanddampobstructiontype;kneeosteoarthritissynovitis;clinicalefficacy;mechanismKneeosteoarthritis(KOA)isacommondegenerativejointdiseasethataffectsmillionsofpeopleworldwide.AmongthedifferenttypesofKOA,gasdeficiencyanddampobstructiontypeKOAischaracterizedbysymptomssuchasjointpain,swelling,stiffness,andlimitedmobility,whicharecausedbytheaccumulationofdampnessandphlegminthejoint.TraditionalChinesemedicine(TCM)hasbeenusedtotreatKOAforcenturies,andHuóXuShūjīnTangisawell-knownTCMformulathathasbeenusedforthetreatmentofgasdeficiencyanddampobstructiontypeKOA.

Zhāng’sAdd-SubtractHuóXuShūjīnTangisamodifiedformulathatincludesadditionalherbstoenhancethetherapeuticeffectsoftheoriginalformula.ClinicalstudieshaveshownthatZhāng’sAdd-SubtractHuóXuShūjīnTangcansignificantlyimprovethesymptomsofgasdeficiencyanddampobstructiontypeKOAsynovitis,suchasjointpain,stiffness,andswelling,andalsoincreasetherangeofmotionoftheaffectedjoint.Theformulahasveryfewsideeffectsandiswelltoleratedbypatients.

ThemechanismofthetherapeuticeffectsofZhāng’sAdd-SubtractHuóXuShūjīnTangisbelievedtoberelatedtoitsabilitytoimprovetheinflammatoryreactionandoxidativestressinthejoint.Theherbsintheformulacontainactivecompoundsthathavebeenshowntohaveanti-inflammatoryandantioxidanteffects.Thesecompoundscanreducethelevelofinflammatorycytokinesinthejointandinhibittheproductionofreactiveoxygenspecies,whichcandamagethejointtissues.

TheclinicalefficacyandsafetyofZhāng’sAdd-SubtractHuóXuShūjīnTangmakeitapromisingtreatmentoptionforgasdeficiencyanddampobstructiontypeKOAsynovitis.However,furtherstudiesareneededtoconfirmitsefficacyandtoelucidateitsmechanismofaction.Inaddition,itisimportanttonotethatTCMshouldbeusedundertheguidanceofaqualifiedpractitionerandinconjunctionwithconventionalmedicaltreatmentInadditiontoTCM,variousconventionalmedicaltreatmentsareavailableforKOAincludingnonsteroidalanti-inflammatorydrugs(NSDs),corticosteroids,hyaluronicacidinjections,andsurgery.However,thesetreatmentsmayhaveundesirablesideeffectsandmaynotbesuitableforallpatients.Therefore,thereisaneedforalternativetreatmentsthatareeffectiveandsafe.

Exercisetherapyisonesuchalternativetreatmentthathasbeenshowntobeeffectiveinreducingpain,improvingfunction,anddelayingtheprogressionofKOA.Exercisecanhelpstrengthenthemusclesaroundthejoint,improvejointmobility,andreduceinflammation.Moreover,exercisetherapycanalsohelpreducetheriskofcomorbiditiessuchascardiovasculardisease,diabetes,andobesity.

DietaryinterventionsarealsoemergingasapotentialalternativetreatmentforKOA.SeveralstudieshaveshownthatdietarysupplementssuchasglucosamineandchondroitinsulfatecanimprovesymptomsinpatientswithKOA.Thesesupplementscanhelpreduceinflammation,supportjointstructure,andimprovejointfunction.Moreover,certainfoodssuchasfish,fruits,andvegetableshaveanti-inflammatorypropertiesandmayhelpreducepainandswellinginthejoints.

Inconclusion,KOAisacommonconditionthataffectsmillionsofpeopleworldwide.TCM,exercisetherapy,anddietaryinterventionsarepromisingalternativetreatmentsthatcanhelpreducepainandimprovefunctioninpatientswithKOA.However,furtherstudiesareneededtoconfirmtheirefficacyandelucidatetheirmechanismsofaction.ItisimportanttonotethatthesetreatmentsshouldbeusedundertheguidanceofaqualifiedpractitionerandinconjunctionwithconventionalmedicaltreatmentInadditiontotraditionaltreatmentsforKOA,suchaspainmanagementandjointreplacementsurgery,therehasbeengrowinginterestinalternativetherapiesthatcancomplementorevenreplaceconventionaltreatmentoptions.ThesealternativetherapiesincludetraditionalChinesemedicine(TCM),exercisetherapy,anddietaryinterventions.

TCMisaholisticapproachtohealththathasbeenpracticedforthousandsofyearsinChina.Itisbasedontheconceptofqi,thevitalenergythatflowsthroughthebodyalongmeridians,andthebalanceofyinandyang,theopposingbutcomplementaryforcesthatgovernnaturalphenomena.TCMpractitionersviewKOAasamanifestationofseveralunderlyingimbalancesandseektorestorebalancethroughindividualizedtreatmentplansthatmayincludeacupuncture,herbalmedicine,cupping,andmoxibustion.

SeveralstudieshavefoundTCMtobeeffectiveinreducingpainandimprovingfunctioninpatientswithKOA.Forexample,ameta-analysispublishedintheJournalofTraditionalChineseMedicinein2017analyzed36randomizedcontrolledtrialsthatcomparedTCMtoconventionaltreatmentsorplaceboforKOA.ThestudyconcludedthatTCMwaseffectiveinreducingpainandimprovingjointfunction,withfeweradverseeffectsthanconventionaltreatments.

Exercisetherapy,suchasstrengthtraining,aerobicexercise,andaquaticexercise,hasalsobeenshowntobeeffectiveinreducingpainandimprovingfunctioninpatientswithKOA.Exercisetherapyworksbystrengtheningthemusclesaroundtheaffectedjoint,reducingstressonthejoint,andincreasingflexibilityandmobility.Additionally,exercisetherapymayhelpimproveoverallhealthandreducetheriskofcomorbidconditions,suchasheartdiseaseanddiabetes.

Ameta-analysispublishedintheJournalofClinicalMedicinein2021analyzed23randomizedcontrolledtrialsthatcomparedexercisetherapytousualcareorothertreatmentsforKOA.ThestudyconcludedthatexercisetherapywaseffectiveinreducingpainandimprovingfunctioninpatientswithKOA,withagreatereffectonpainreduction.

Lastly,dietaryinterventions,suchasweightloss,omega-3fattyacidsupplementation,andanti-inflammatorydiets,havebeenstudiedfortheirpotentialtoreducepainandimprovefunctioninpatientswithKOA.Obesityisawell-establishedriskfactorforKOA,andweightlosshasbeenshowntoreducepainandimprovefunctioninpatientswithKOA.Omega-3fattyacidshaveanti-inflammatorypropertiesandmayreducejointinflammationinpatientswithKOA.Anti-inflammatorydiets,whichemphasizewholefoodsandlimitprocessedfoods,havebeenshowntoreduceinflammationinpatientswithotherinflammatoryconditions,suchasrheumatoidarthritis.

WhiledietaryinterventionshaveshownpromiseinreducingpainandimprovingfunctioninpatientswithKOA,moreresearchisneededtoconfirmtheireffica