Research progress of traditional Chinese medicine in the treatment of complications related to spinal cord injury

ZHONG Yuan-ming, YE Wei-quan, QIU-Wei, ZHAO Qing-rui, HUANG Yong, FU Xiaopeng, WAN Tong, HE Bing-kun

1.The First Affiliated Hospital of Guangxi University of Traditional Chinese Medicine, Nanning 530023, China

2.Graduate School of Guangxi University of Traditional Chinese Medicine, Nanning 530001, China

Keywords:

ABSTRACT Spinal cord injury is one of the common neurological diseases in clinical practice.It has the characteristics of high incidence rate, high disability rate and high cost.It brings great pain and mental stress to patients.Spinal cord injury patients with neurological impairment, slow recovery, in the process of disease treatment is easy to produce a series of complications,such as respiratory complications, neurogenic bladder, spasm, deep vein thrombosis, pressure sores and so on.At present, western medicine and auxiliary equipment are mainly used in the treatment of related complications, but traditional Chinese medicine also plays a very important role.Traditional Chinese medicine is not only economical, cheap and has little side effects, but also can promote the functional rehabilitation of patients with spinal cord injury and reduce the incidence of complications.In this paper, through searching the literature reports on the treatment of spinal cord injury related complications with traditional Chinese medicine at home and abroad, we review the treatment of neurogenic bladder, spasm, venous embolism,neuropathic pain, neurogenic intestinal dysfunction, pressure sores, respiratory complications with traditional Chinese medicine, in order to provide reference for the clinical treatment of spinal cord injury related complications.

1.Introduction

Spinal cord injury (SCI) is a central nervous system disease that causes structural and functional damage to the spinal cord due to various reasons, leading to sensory, motor and autonomic nervous dysfunction below the injury level.It is mainly seen in traffic accidents, sports injuries, myelitis, myeloma, etc.[1,3].The incidence rate of this disease is 236～009/million people[4], and the disability rate is as high as 70%[5], which will not only generate huge medical costs, Increasing the financial burden on patients and causing them physical and mental pain.In the acute phase of spinal cord injury patients, in addition to minimizing secondary spinal cord injury and conducting necessary surgical treatment, treatment such as correcting electrolyte disorders, supplementing calories, and providing nutritional support should also be taken according to the patient’s actual situation.At the same time, patients with spinal cord injury are prone to a series of complications, which seriously affect their physical recovery and even endanger their lives, such as neurogenic bladder,pressure ulcers, spasms, neuropathic pain, osteoporosis, deep vein thrombosis, respiratory complications, etc.[6].Therefore, how to reduce and manage the complications of spinal cord injury patients is a key concern for clinical physicians.This not only affects the overall treatment plan of spinal cord injury patients, but also affects their functional recovery and prognosis.In recent years, traditional Chinese medicine has been widely used in clinical practice, and its role in treating spinal cord injury related complications has become increasingly prominent.This article reviews the treatment methods of spinal cord injury related complications with traditional Chinese medicine, in order to provide reference and reference for the treatment of spinal cord injury patients in clinical practice.

2.Neurogenic bladder

Neurogenic bladder is one of the serious complications of spinal cord injury.Its incidence rate is more than 60%[7], which is mostly seen in cone injury or cauda equina nerve injury.Due to the dysfunction of detrusor and urethral sphincter, such patients often have urinary retention, incontinence, urinary tract infection and other conditions, which can lead to renal failure and even death in serious cases[8,9].For patients with neurogenic bladder after spinal cord injury, in addition to indwelling a catheter and nerve electrical stimulation, traditional Chinese medicine treatment can also be used to improve bladder function and improve patient quality.Zhou[10]divided 60 patients with neurogenic bladder after complete spinal cord injury into a control group and a treatment group.Compared to the control group, the treatment group used routine treatment and nursing.On the basis of the control group, the urinary tract infection rate of the treatment group was significantly lower than that of the control group (P<0.05), which was treated with “Chuanzi Moxibustion” combined with Wenyang Lishui Liniment; And the treatment group had better urinary function and other aspects than the control group (P<0.05).Prove that “Chuanzi Moxibustion Method” can significantly improve neurogenic bladder function after spinal cord injury, reduce residual urine volume, increase spontaneous urination volume, and significantly reduce urinary tract infection rate.He[11] compared the therapeutic effect of acupuncture and moxibustion combined with Buyang Huanwu Decoction(research group) on neurogenic bladder on the basis of conventional rehabilitation treatment (control group) and conventional rehabilitation treatment, and found that the total effective rate and bladder function of the research group were higher than those of the control group (P<0.05).It is proved that acupuncture and moxibustion combined with Buyang Huanwu Decoction can significantly improve the urination, urodynamic indexes and quality of life of patients with neurogenic bladder after spinal cord injury.Shen Yingfei et al.[12] divided 60 patients with incomplete spinal cord injury and urinary retention into two groups.The results showed that the total effective rate (73.33%) of the control group with basic treatment and bladder function training was significantly lower than that of the treatment group with aconite cake separated moxibustion on the basis of the control group (86.67%), and the improvement of urinary tract infection was significantly better than that of the control group (P<0.05).Prove that the combination of moxibustion with aconite cake and bladder function training can enhance bladder control ability, maintain bladder compliance, promote the recovery of bladder autonomous urination function, and have a significant therapeutic effect.

3.Venous Embolism

Patients with spinal cord injury have limited mobility and require long-term bed rest treatment, which increases the risk of venous thromboembolism events due to blood hypercoagulability, stasis,and endometrial damage[13].The main reasons include two aspects:firstly, the interruption and paralysis of nerve impulses can lead to metabolic changes in blood vessels and changes in venous function,such as decreased dilation and increased flow resistance.Secondly,prolonged bed rest and immobilization can lead to slow blood flow and the formation of venous thrombosis.The early mortality rates of deep vein thrombosis and pulmonary embolism are 3.8% and 38.9%, respectively[14], which seriously endanger patient life and are a key issue that clinical workers need to pay attention to.In clinical practice, in addition to using anticoagulation, antiplatelet therapy, and using elastic socks or lower limb pressure for early prevention, traditional Chinese medicine treatment has significant effects in improving coagulation status and blood flow velocity, and reducing the incidence of deep vein thrombosis.Research[15] has shown that traditional Chinese medicine foot bath combined with acupoint massage can effectively reduce the incidence of deep vein thrombosis in the lower limbs.

4.Spasms

More than 70% of patients with spinal cord injury will experience spastic states, mainly manifested as decreased muscle strength,limited mobility, and even developing joint contractures.Current research suggests that the occurrence of spasms is related to the inhibition of neural pathways and the excitation of motor neurons in the spinal cord, which often leads to abnormal posture and pain[18,19].This disease belongs to the scope of “flaccidity”in traditional Chinese medicine.Traditional Chinese medicine treatment can reduce the muscle tension of patients with spinal cord injury, improve the range of motion of contracted joints, and improve their daily activities.Wu[20] explored the therapeutic effect of rotation training on spasms in patients with spinal cord injury.They compared the control group using routine limb rehabilitation training with the treatment group using limb rehabilitation training combined with rotation training.The results showed that rotation training combined with rehabilitation training can alleviate spasms in patients and improve joint mobility.Chen[21] demonstrated that modified Taohong Siwu Tang combined with comprehensive rehabilitation can effectively improve muscle spasms after traumatic spinal cord injury and promote functional recovery in patients with spinal cord injury.Huang[22] demonstrated that Shaoyao Gancao Tang may alleviate spasms by increasing the content of GABA, Gly,and 5-HT in the spinal cord of spastic paralyzed rats, reducing the muscle tension of the affected limbs after SCI.

5.Neurogenic intestinal dysfunction

Neurogenic Bowel Dysfunction (NBD) refers to a series of intestinal problems such as abdominal distension, stubborn constipation, and fecal incontinence caused by the loss of central nervous system control in the intestine after spinal cord injury,resulting in a decrease in the function of the intestinal and anal sphincters.About 80% of spinal cord injury patients are accompanied by NBD.Traditional Chinese medicine has accumulated rich clinical experience in treating NBD, playing a therapeutic role from multiple mechanisms, links, and targets, which can significantly improve patients’ intestinal function and improve their quality of life.Liu[24]divided 60 paraplegic patients with thoracolumbar spinal cord injury into an observation group (n=30) and a control group (n=30).Compared to the control group, the observation group treated with Wu Zhuyu acupoint application on top of the control group received basic treatment, and the total effective rate, first exhaust time, and abdominal distension score of the observation group were better than the control group (P<0.05).Prove that Wu acupoint application therapy can effectively improve the abdominal distension symptoms of paraplegic patients with thoracolumbar spinal cord injury and improve their quality of life.Scholars[25] have demonstrated that the combination of “Tongdu Tiaoshen” moxibustion and rehabilitation training can promote the recovery of intestinal function in SCI patients, and its therapeutic effect is significantly better than that of simple rehabilitation training.Chi[26] confirmed that bamboo circle generated rhubarb moxibustion can significantly improve intestinal dysfunction after solid heat type spinal cord injury, and the therapeutic effect is significant.

6.Neuropathic pain

Neuropathic pain (NP) is a spontaneous pain that occurs after spinal cord injury, mainly manifested as abnormal pain such as numbness,pricking pain, electric burning pain, and hyperalgesia[34].Its symptoms are severe, lasting for a long time, and seriously affecting the quality of life of patients.Research has shown that 50% to 60%of SCI patients produce NP[35], which is based on the biological basis of glial cell activation and neuronal overactivity caused by spinal cord injury[36].This disease belongs to the category of “Bi disease”in traditional Chinese medicine.Through dialectical treatment and the use of traditional Chinese medicine, it can play a role in relaxing tendons, unblocking collaterals, promoting blood circulation,resolving blood stasis, and relieving pain.Zheng[37] demonstrated that scalp acupuncture combined with Jiaji electroacupuncture can significantly improve the NP of patients with spinal cord injury and promote the recovery of neurological function.Zhao[38] divided 80 patients with neuralgia after spinal cord injury into an observation group and a control group.The control group was treated with Western medicine, while the observation group was treated with acupuncture at Neiguan point combined with puncture and cupping on the basis of the control group.The results showed that the observation group was significantly better than the control group in alleviating pain (P<0.05).Prove that acupuncture at Neiguan point combined with puncture and cupping can significantly alleviate NP caused by spinal cord injury.Zhu[39] found that electroacupuncture can improve NP in spinal cord injury rats, and its mechanism may be related to serum IL-1, IL-6, and TNFαThe decrease in level is related.

7.Osteoporosis

Osteoporosis is also one of the common complications after spinal cord injury.Although its pathological basis is currently unclear,some scholars believe that it is related to various factors such as mechanical factors, nutritional factors, hormone regulation, and neuroimmune regulation.Patients with spinal cord injury are prone to disuse osteoporosis, with a significantly increased risk of lowenergy fractures[40, 41].8.7% to 50% of spinal cord injury patients will experience fractures[42,44], and the risk of fractures gradually increases with the prolongation of injury time[45, 46].Therefore, for patients with spinal cord injury, it is particularly important to prevent and treat osteoporosis and reduce the incidence of fractures.Wu[47]believe that in the treatment of patients with osteoporosis after spinal cord injury using traditional Chinese medicine, promoting blood circulation and resolving blood stasis is the foundation,tonifying the kidney and filling the essence is the key, the kidney governs bone and generates marrow, tonifying the kidney leads to bone source and foot, and the essence and foot lead to bone strength.Zhou[48] demonstrated that Erxian Tang can improve the hind limb motor function of SCI rats and has a certain therapeutic effect on osteoporosis after spinal cord injury.Meng[49] observed the therapeutic effect of extract of Cornus officinalis on osteoporosis in rats with spinal cord injury, proving that the treatment of Cornus officinalis extract may have an anti osteoporosis effect by stimulating osteoblast induced bone tissue response.Xu[50] studied the effect of electroacupuncture combined with low-frequency pulsed electromagnetic field on bone metabolism in patients with spinal cord injury.They compared the treatment of patients with spinal cord injury using an osteoporosis treatment instrument(control group) and an osteoporosis treatment instrument combined with foot Shaoyang electroacupuncture (observation group).The results showed that the combination of osteoporosis treatment instrument and foot Shaoyang electroacupuncture can significantly improve bone metabolism and reduce the incidence of osteoporosis in patients with spinal cord injury.

8.Pressure ulcers

Pressure ulcers refer to localized damage caused by pressure or friction on the skin or subcutaneous tissue, also known as pressure ulcers.Patients with spinal cord injury may develop pressure ulcers at the bone protrusions due to impaired motor function, prolonged bed rest, limited mobility, and failure to roll over in a timely manner.Research has shown that the formation of pressure ulcers is related to local tissue ischemia, microcirculation disorders, and reperfusion injury[52].Clinically, pressure ulcers can be divided into 6 stages based on their manifestations[53], with stage 1 pressure ulcers being the most common[54].Its occurrence seriously hinders patients’recovery, prolongs their hospitalization time, and increases the economic burden on patients and society.Therefore, in addition to frequently turning over and actively eliminating the factors that trigger pressure ulcers, for patients who have already developed pressure ulcers, traditional Chinese medicine treatment can promote wound healing.Wang[55] treated patients with pressure ulcers after spinal cord injury with traditional Chinese medicine safflower(treatment group) on the basis of routine care (control group) and routine care, and compared the results.The combination of routine care and external use of traditional Chinese medicine safflower was found to have better efficacy than simple routine care in treating stage I pressure ulcers.Fu[56] demonstrated that disinfected talc powder is more effective in treating bedsores than traditional dressing changing methods, with a high cure rate and a short course of disease.Kang[57] divided 90 patients with stage I pressure injury into four groups based on the location of the injury: foot group,sacrococcygeal group, hip group, and other groups.The results showed that the traditional Chinese medicine Lefujia has good therapeutic effect on stage I pressure injury of the feet and other limb parts, with shorter healing time and more obvious therapeutic effect.

9.Conclusion

Spinal cord injury has many complications and great harm, which not only prolongs the hospitalization time of patients, increases their economic burden, but also causes physical and psychological harm to patients, and even threatens their lives.For a long time, scholars at home and abroad have conducted a large number of clinical trials and basic research on spinal cord injury.Although there is increasing evidence that traditional Chinese medicine treatment can promote functional recovery and reduce the incidence of complications in patients with spinal cord injury, there is no unified standard in clinical practice, leading to the use of traditional Chinese medicine therapy is not yet widespread.In the future, we should continuously explore the treatment ideas and evaluation system of traditional Chinese medicine for spinal cord injury.We should focus on the breadth and depth of research, conduct multi center and large sample studies, comprehensively and deeply explore its mechanism of action, and make it better promoted and applied in clinical practice.