Progress in Traditional Chinese and Western Medicine Treatments and Nursing Care of Knee Osteoarthritis☆

Xiao-Hua Shen，Yi Cui

Shuguang Hospital，Shanghai University of Traditional Chinese Medicine，Shanghai 201203，China

Review article

Progress in Traditional Chinese and Western Medicine Treatments and Nursing Care of Knee Osteoarthritis☆

Xiao-Hua Shen，Yi Cui*

Shuguang Hospital，Shanghai University of Traditional Chinese Medicine，Shanghai 201203，China

A R T I C L E I N F O

Article history:

18 May 2015

Accepted 22 June 2015

Published 20 September 2015

Knee osteoarthritis

Traditional Chinese medicine

Western medicine

Treatment

Nursing care

Progress

This paper reviews the causes of knee osteoarthritis，traditional Chinese and Western medicine therapies and nursing research progress and indicates that traditional Chinese and Western medicine have gradually recognized the cause of knee osteoarthritis.Knee osteoarthritis has been treated with various treatments and nursing care planning，and the combination of traditional Chinese and Western medicine has constantly been improved.Nurses should instruct the discharged patient to correctly treat their disease，adopt the health education，and，via the establishment of a healthy lifestyle，insist on a functional exercise to relieve the pain，delay disease progression，and improve quality of life.

?2015Shanxi Medical Periodical Press.Production and hosting by Elsevier B.V.This is an open access article under the CC BY-NC-ND license（http://creativecommons.org/licenses/by-nc-nd/4.0/）.

Knee osteoarthritis is the most common multiple bone and joint disease of the elderly，accounting for approximately 40% of all types of arthritis.Previousstudies have shown1that the incidence rate of people over 65 years is nearly 100 percent.The pathological features of knee osteoarthritis are joint cartilage deformation and destruction and osteophyte formation.The main clinical manifestations include knee swelling，pain and stiffness，and dysfunction.2With an improvement in the patient’s standard of living and the growing trend of population ageing，the incidence of knee osteoarthritis continues to increase.It results in motor dysfunction andchronic disabling major diseases that severely damage the patient’s quality of life.3Currently，relieving pain，slowing the pace of progression，promoting recovery from disease and improving quality of life have become the main tasks of medical staff.The aetiology，treatment and nursing care of knee osteoarthritis in Western medicine and Chinese traditional medicine are summarized as follows.

1.Progress in the understanding and treatment of knee osteoarthritis and its aetiology in Western medicine

1.1.Western medical understanding of the etiology of knee osteoarthritis

1.1.1.Genetic factors

Epidemiological studies have shown4 that the articular manifestations of this disease are an inherited metabolic disorder caused by systemic change.

1.1.2.Age and sex

Knee osteoarthritis is more common in people over the age of 65 years and postmenopausal females.The incidence of patients who develop knee osteoarthritis is higher in females compared to males.4

1.1.3.Obesity

ome researchers proposed5that obesity increases pressure on the knee joint.Thus it causes damages to knee joint cartilage，and other surrounding tissue.

1.1.4.Joint trauma

Shen et al.5showed that knee joint injury and sports injury damage the articular cartilage and lead to the development of knee osteoarthritis.

1.1.5.Autoimmunity

Xiao et al.4demonstrated decreasing levels of IgA，IgM，IgG in the synovial fluid of patients with knee osteoarthritis，which increases the possibility of joint infection and refractory periostitis.

1.1.6.High-pressure inside bone

Previous studies have found 4 that high pressure changes bone haemodynamics，which results in an insufficient oxygen supply and the accumulation of acidic metabolites.High pressure also reduces synovial blood flow，resulting in the secretion of acid in synovial fluid and subsequent degenerative changes in articular cartilage.

1.2.Progress in Western medicine treatment of knee osteoarthritis

1.2.1.Non-drug non-surgical treatment

Non-drug non-surgical treatments include physical therapy and exercise therapy.6Ji et al.7have shown that physical therapy can improve local blood circulation，reduce inflammation and promote the absorption of synovitis，relieve muscle spasms，and reduce intraosseous hypertension.It can also promote the growth of articular cartilage.These treatments include magnetic physical therapy，electrotherapy，thermotherapy，cold therapy，traction，laser，ultrasound，and transcutaneous electrical nerve stimulation.Zhang et al.6showed that proper exercise，aerobics and other sports therapy can reduce weight，thereby reduce pressure on the knee.

1.2.2.Drug treatment

Previous studies have shown7that oral non-steroidal anti-inflammatory drugs，such as aspirin and indomethacin，can relieve pain and diminish inflammation.Wang et al.8showed that oral diclofenac and sulindac could promote cartilage synthesis.Yuan et al.9showed that oral glucosamine sulphate and diacerein could protect thearticular cartilage.Huang et al.10found that the intra-articular injection of sodium hyaluronate can lubricate joints，protect articular cartilage and prevent infection，thereby relieve pain.Chai et al.11showed that the intraarticular injection of bone peptide can promote cartilage regeneration and the intra-articular injection of triamcinolone acetonide can inhibit inflammatory substances，prevent tissue adhesion，reduce local swelling and pain. Jiang et al.12showed that an intra-articular injection of ozone can not only promote vasodilation and absorption of inflammation but can also direct nerve endings to exert an analgesic effect.

1.2.3.Surgical treatment

Surgical treatments include arthroscopic debridement，knee arthroplasty and arthrodesis.Arthroscopic debridement can relieve pain.Knee arthroplasty and arthrodesis can promote the recovery of knee function.6

2.Progress in the understanding and treatment of knee osteoarthritis using traditional Chinese medicine

2.1.Chinese medical understanding of the etiology of knee osteoarthritis

2.1.1.Deficiency of the“l(fā)iver”and“kidney”（the meanings of these words are different from the liver and kidney n Western medicine）

Knee arthritis，known as“knee arthralgia disease”in Chinese traditional medicine is based on a deficiency of the liver and kidney，which gradually results in muscle weakness.

2.1.2.Meridians impassability and blood deficiency

In classical traditional Chinese medicine，Zheng Yin Mai Zhi states that Meridian impassability and blood deficiency attack joints，resulting in pain，numbness and reduced joint mobility.13

A weak spleen and stomach limit the absorption of cereal essence of the source and thus result in the loss of kidney essence.The deficiency of kidney essence causes muscles atrophy and joint acute spasm.14

2.2.Progress in traditional Chinese medicine treatment of knee osteoarthritis

Traditional Chinese medicine considers that liver and kidney deficiencies，meridian impassability，blood deficiency，weak spleen and stomach are the main causes of knee osteoarthritis.In addition，the treatment should emolliate the liver，tonify the kidney，regulate blood running and cure the spleen and stomach disease.By following the overall concept，treatment of the disease is performed according to different syndromes.15

2.2.1.Herbal medicine

The Rougan Recipe，Bushen Recipe and Spleen-Fortifying Stomach-Nourishing Recipe are the most commonly used recipes.The Rougan Recipe can nourish the liver and blood，the Bushen Recipe can invigorate the kidney and strengthen the bones，and the Spleen-Fortifying Stomach-Nourishing Recipe can invigorate the kidney and strengthen muscles.15

2.2.2.External treatment with traditional Chinese medicine

External treatment of traditional Chinese medicine consists of fumigating with traditional Chinese medicine，16externally applying traditional Chinese medicine，16fumigating and washing with decoction of Chinese herbs，17sticking and spreading a Chinese crude drug，17traditional Chinese medicine plasma import，18and Traditional Chinese medicine ironing.19Some researchers proposed that external treatment methods using heat and traditional Chinese medicine and applying heatcan stimulate the local meridian points.Thus，the drug goes into the meridians and blood comes from the body surface.Hair orifices penetrate the meridian blood to warm the meridians，and qi and blood circulation eliminate cold and stop pain.Spleen-Fortifying and Stomach-Nourishing recipes invigorate the kidney and strengthen muscles，while the drug also induces local vasodilation，and reduces bone stress and pain.

2017年7月7 —11日，內(nèi)蒙古自治區(qū)興安盟出現(xiàn)強降水天氣過程，期間伴有短時強降水、冰雹、雷雨大風等強對流天氣。7日08：00至11日08：00，3個站累積降雨量超過50.0 mm，分別為中旗吐列毛都鎮(zhèn)罕查干55.9 mm、阿爾山五岔溝鎮(zhèn)南溝55.8 mm、中旗吐列毛都54.0 mm。累積降雨量為25.0～50.0 mm的站點有55個，主要分布在中西部地區(qū)。主要降水時段在7日白天至8日白天。7日11：00左右，降水從南部地區(qū)開始，隨著時間推移雨帶逐漸向北推進。7日白天降水集中在中南部地區(qū)，夜間降水集中在中北部地區(qū)，8日白天之后則以分散性的雷陣雨天氣為主，9日以后降水強度和范圍明顯減弱。

2.2.3.Acupuncture

Acupuncture methods include acupuncture，electroacupuncture，warm needle，fire needles，skin needles，moxibustion，acupuncture point injection，and other techniques.20Ran et al.20found that when acupoints around the knee，such as Xuehai and Heding，were selected，acupuncture could promote blood circulation and relieve pain.Acupoints in the foot Yangming Meridian，such as Xiyan，Liangqiu and Zusanli can replenish qi and the blood and nourish joint muscles.Acupoints Leong and Yinlingquan can disperse cold in the body and regulate blood flow.

2.2.4.Acupotomy

Previous studies have shown11that acupotomy can loosen and decompress the knee joint as can soft tissue therapy.Acupotomy combined with local drug injection can reduce bone high-pressure，improve microcirculation，inhibit cartilage and synovial inflammation，and promote cartilage cells to produce and regulate immune function.

2.2.5.Massage Therapy

Liu et al.21showed that massage practices can dredge the meridians，warm channels and disperse cold，improve local blood circulation and make significant improvements in knee function.

3.Progress in traditional Chinese and Western medicine nursing care of knee osteoarthritis

3.1.Emotional regulation and psychological rehabilitation

Because of knee swelling，pain，stiffness，and dysfunction，patients tend to experience depression，pessimism，restlessness or irritability.Jiang et al.22found that nurses introduce pathogenesis，prognosis and prevention of knee osteoarthritis to patients；illustrate the relationship of emotion，Qi，blood and disease；and encourage patients to maintain a good mental state，which is conducive to the rehabilitation of knee osteoarthritis.

3.2.Diet Care

He et al.23showed that guiding patients to eat more food that is rich in protein，calcium，and collagen as well as other foods，such as dairy，soy，eggs，fish，pig’s trotters，beef tendons，seaweed，and black fungus with calcium supplement，prevents osteoporosis and also promotes the growth of articular cartilage and calcium metabolism，thereby can reduce the symptoms of arthritis.In addition，it is also better to take more wolfberry，black sesame and lamb to nourish the liver and kidney. In addition，taking astragalus and jujube is better to tonify the Qi and promote blood circulation.Taking barley，melons，hawthorn，and Chinese yam is good to fortify the spleen and nourish the stomach.

3.3.Medical care

To guide patients to take medications according to proper directions，close observation of the effect and adverse reaction of drugs and fully informing the patient of the purposes of the medication and precautions is necessary.Qin et al.24showed that:（1）Oral non-steroidal anti-inflammatory drugs（aspirin，indomethacin）and the promotion of articular cartilage synthetic drugs（diclofenac，sulindac）requires the patient to take the medication half an hour after a meal to avoid stimulating the gastric mucosa；（2）oral medications to protect articular cartilage（glucosamine sulphate，diacerein）requires the pa-tient to have the meal to avoid lowering the effect；and（3）oral medicine should be administered warm and between meals.

3.4.Health Education

Health education consists of information dissemination and behavioural interventions to help individuals or groups to master health knowledge，establish a healthy concept，andrationalizethevoluntaryadoptionof healthy behaviours and lifestyles conducive to healthy activities and processes.25（1）Establish a healthy lifestyle to guide patients to recognize joints and guide the patient to reduce the wear and tear of joints，avoid prolonged standing，squatting，kneeling and going up and down the stairs and other weight-bearing activities to increase joint pressure；advise obese patients to diet，exercise to lose weight；and with regard to their daily diet. Increase the food intake of calcium and vitamins and drink and adequate amount of water to promote the generation of articular cartilage and chondrocytes.（2）Safety Guidelines:Instruct the patient to wear non-slip shoes and knee pads to protect the joints26when moving.（3）Rehabilitation exercises:Liu et al.27found that rehabilitation exercises can help patients to improve knee contracture adhesion and can promote the regeneration of cartilage and ligaments of the knee tendon repair，improve blood circulation，reduce swelling and pain，thereby to improve the degree of knee living skills and quality of life.These include mentioning ankle training（patients hold the wall standing，adding some weightbearing materials，heeling lift and remaining toe in the standing posture）and kicking exercises（lying on the bed performing a pedalling motion，two times a day，30 minutes each time）.（4）Exercise Prescription:Li et al.28showed that patients who participate in calisthenics，broadcast gymnastics，tai chi，Ba Duan Jin，and Wu Qin Xi can not only see improvements in their daily life but also see enhancements in the muscles around their knee as well as increased endurance and flexibility.

4.Summary

Knee osteoarthritis is a knee joint disease that mainly manifests as degenerative changes in the articular cartilage，with comprehensive，multi-level，and varying degrees of chronic inflammation of the periosteum，joints and other structures of the joint.Knee osteoarthritis decreases the patients’self-care ability and affects quality of life.With the advancement of technology，traditional Chinese medicine and Western medicine with regard to the aetiology of osteoarthritis of the knee have gained a gradual understanding of this disease，and various treatment options have consequently improved.In recent years，through continuous efforts of nurses，nursing has developed a complete care plan based on the cause of knee osteoarthritis patients and doctors for the treatment of various patients in the Western and Chinese medicine system using combinatorial care to promote the rehabilitation of patients who have the disease.However，these studies showed29that it is difficult to effectively slow the progression of the disease and improve the self-care ability and quality of life through treatment and care during the hospitalization alone.Thus，it is important to guide patients after discharge by having them properly understand their disease，enhancing their adherence to health education，and relieving pain through the establishment of a healthy lifestyle as well as having them adhere to a functional exercise.Thus，slowing the disease progression and improving quality of life is the direction needed by most nursing staff.

Conflicts of interest

All contributing authors declare no conflicts of interest.

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20 December 2014

in revised form

☆This work was supported by the health and family planning committee of Shanghai（No.2014LP093A）.

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E-mail address:cuiyi0411@163.com（Y.Cui）.

Peer review under responsibility of Shanxi Medical Periodical Press.

http://dx.doi.org/10.1016/j.cnre.2015.09.001

2095-7718/?2015 Shanxi Medical Periodical Press.Production and hosting by Elsevier B.V.This is an open access article under the CC BY-NC-ND license（http://creativecommons.org/licenses/by-nc-nd/4.0/）.