Advances in TCM Treatment of Skeletal Fluorosis

Liu-Bo Zhang, Jun Zhou, Ji-Peng Song, Wen-Hao Li, Ming-Sheng Tan, Pi Yi, Feng Yang, Xiang-Sheng Tang

1. Graduate School, Beijing University of Chinese Medicine, Beijing 100029, China

2. Department of Spine Surgery, China-Japan Friendship Hospital, Beijing 100029, China

3. Graduate School of Peking Union Medical College, Beijing, 100029, China

Keywords:Skeletal Fluorosis Palsy Tonifying Kidney and Dispelling Evil TCM treatment Review

ABSTRACT By consulting and collating the relevant literatures on the treatment of fluorosis in Traditional Chinese medicine, the research progress of TCM in the treatment of fluorosis was summarized. This paper summarizes the treatment of fluorosis in traditional Chinese medicine from the aspects of the traceability of TCM theory, etiology and pathogenesis, syndrome differentiation and cure, special disease specialty and foreign medicine, so as to guide clinical practice. TCM treatment of fluorosis more use of tonifying kidney and bone, activating blood circulation stasis, cold moisturizing, Tongluo pain relief and other methods, based on dispelling evil and tonifying kidney, combined with a variety of treatment methods, in relieving clinical symptoms and improving the quality of life of patients have an irreplaceable role, has been widely recognized, but most of the research reports are their own work experience summary, Lack of uniform diagnosis and treatment standards, and small sample size, data repeatability is weak, future research needs to further enhance the scientific and objective of the experiment, for TCM treatment of fluorosis to provide a scientific and reasonable diagnosis and treatment program, give full play to the advantages of TCM therapy.

1. Introduction

Skeletal fluorosis is a kind of chronic invasive osteopathy, which is caused by fluoride poisoning and bone joint damage. At present, there are about 2.76 million patients with skeletal fluorosis in China, especially in the western region. Skeletal fluorosis can be divided into industrial skeletal fluorosis and local skeletal fluorosis, which can be divided into drinking water type, tea type and coal type [2]. Industrial pollution is serious in China, and the incidence of industrial skeletal fluorosis is increasing rapidly. [3] At present, the diagnosis based on clinical symptoms, physical signs and X-ray signs of bone and joint is the two main methods for the diagnosis of skeletal fluorosis. There is no statistical difference between them, but the diagnosis still depends on X-ray films of bone and joint [4].

The main symptoms of skeletal fluorosis are pain in the waist and joints of limbs, numbness of limbs, convulsion of hands and feet, etc. there are no obvious signs in the light patient. With the development of the disease, the movement of joints may be limited or stiff, the skeleton may be deformed, and in the serious patients, the clinical manifestations such as stooping, hunchback, genu varus or valgus, walking difficulty or even paralysis may occur [5]. Some scholars from Western Medicine [6], surgery [7], recipes [8, 9] and other aspects [10, 11] to prevent skeletal fluorosis, but its effect has certain limitations. Traditional medicine has done a lot of clinical research in this area, and has made important contributions in alleviating symptoms and improving quality of life. According to its clinical manifestations, it is mostly classified as "arthralgia", "kidney arthralgia" and "bone arthralgia". For serious paralysis in bed, muscle atrophy performance, also similar to the "impotence syndrome" of traditional Chinese medicine. The author summarized the origin, etiology, pathogenesis and internal and external treatment of skeletal fluorosis as follows:

2.Materials

Ancient doctors realized that the occurrence of the disease was closely related to the regional soil and water. According to Lu's spring and Autumn Annals, jichunji (12), "chongshui Institute has many doctors and nurses; Kushui Institute has many doctors and nurses; Kushui Institute has many doctors and nurses." The water quality in the high fluorine water area is mostly bitter, salty and astringent, which is very similar to the "heavy water" and "bitter water" in Lu's spring and Autumn Annals. There is no disease name of skeletal fluorosis in ancient literature, but there are very similar disease records with skeletal fluorosis. "On Bi" in Suwen [13]: "wind, cold and dampness are three kinds of Qi, and they are Bi. The winner of wind is Xingbi, the winner of cold is Tongbi, and the winner of moisture is Zhubi. " "Bi Lun" of Suwen: "those with kidney Bi are good at swelling, and the rump is used to replace the heel, and the spine is used to replace the head." The main clinical manifestations of arthralgia are limbs, joints, pain, pain, numbness, weight and movement disorders [14] are similar to those of skeletal fluorosis in pain, numbness, tightness, hardness, disability, etc. many Chinese medicine scholars have achieved certain curative effect according to the treatment of arthralgia. Kidney arthralgia is caused by the fact that bone arthralgia can't recover from external evils for a long time. It can be seen that the back of the waist and the back of the waist can't be extended, and the lower limbs are contracted, which is very similar to the stoop and hunchback of fluorosis and the difficulty of walking.

2.1. Etiology and pathogenesis

Traditional Chinese medicine scholars generally attribute "skeletal fluorosis" to "arthralgia" for syndrome differentiation and treatment, but they have different views on its pathogenesis, which are summarized as follows: first, the kidney stores essence, the main bone generates marrow, and the pathogenesis of the disease is based on deficiency of kidney qi, exogenous wind, cold and dampness, blood stasis blocking collaterals [15]. Wind, cold and dampness are three kinds of Qi, and the combination of them is Bi, the disease is deep, and the combination of the two is bi. Kidney stores essence, bone generates marrow, liver stores blood and sinew, fluoride damages liver and kidney, causes deficiency of liver and kidney, energy and vessels lose nourishment. After a long illness, the meridians and collaterals are blocked, and the symptoms such as waist and leg pain are fixed. Secondly, [16] exogenous wind, cold, humidity and other evil Qi invade, and the evil Qi invades by the weakness of viscera and meridians, blocking Qi and blood, and closing the channels and collaterals. When it is closed to the skin, it will cause skin arthralgia, when it is closed to the muscles, it will cause muscle arthralgia, when it is closed to the veins, it will cause muscle arthralgia, when it is closed to the bones, it will cause bone arthralgia; thirdly, [17] when it is attacked by the evil of water and poison, because of the lack of internal Qi, it cannot expel evil spirits, and it will cause water and poison to stay, damage the viscera, and damage the muscles and collaterals. Fluorosis does not heal for a long time, causing water poison to gather for a long time, damaging kidney qi, causing kidney yang to weaken, unable to warm limbs and gasify water.

2.2.Internal governance

2.2.1syndrome differentiation and treatment

Syndrome differentiation and treatment is the basic principle for TCM to recognize and treat diseases. Different from modern medicine, modern medicine determines the treatment plan on the basis of diagnosis of "disease", while traditional medicine makes the treatment plan on the basis of "syndrome differentiation". Ge Zhenghua [18] divides skeletal fluorosis into six syndrome types: ① cold dampness type of osteoarthralgia, the prescription uses the selfmade Decoction of Aconitum cassia twig to prevent oneself; ② Yin deficiency type of osteoarthralgia, the prescription uses danxihuqian pill to add and subtract; ③ Yang deficiency type of osteoarthralgia, the prescription uses the self-made Decoction of Aconitum and eucommia; ④ Yin and yang deficiency type of osteoarthralgia, the deficiency of Qi and blood uses Bazhen decoction or Shiquan Dabu decoction, the deficiency of Qi and yin or the deficiency of yin and Yang uses the decoction of Aconitum and eucommia hehuqian pill to add Reduce; ⑤ the type of muscle arthralgia, the prescription uses the decoction of imitating Uncaria and peony; ⑥ the type of bone arthralgia and flaccid syndrome, partial Yang deficiency uses Shiquan Dabu decoction, partial Yin deficiency Huqian pill.

Zhang Zheng et al. [17] classified skeletal fluorosis into kidney deficiency cold coagulation type and kidney deficiency blood stasis type. Kidney deficiency cold coagulation type was treated with Bushen Yangzhen pill and Shujin Zhitong powder; kidney deficiency blood stasis type was treated with Bushen Zhuanggu pill and Huoxue Shujin pill, and then it was treated flexibly according to pain, numbness and other symptoms. Hu Xiaoming et al. [19] divided the patients into syndrome differentiation group, kidney tonifying group and Cistanche group. The syndrome differentiation group was divided into five types: kidney deficiency and blood stasis, kidney deficiency and cold dampness, arthralgia and blood stasis, arthralgia and cold dampness, and kidney deficiency and arthralgia. The kidney tonifying group was divided into three types: kidney deficiency and cold dampness, kidney deficiency and blood stasis, and kidney deficiency and arthralgia. Cistanche group was not divided into three types. In the morning and evening, they took Cistanche pill 1 respectively, and took fluorine disease No. 1 (arthralgia type), fluorine disease No. 2 (blood disease) for different syndrome types Blood stasis type, fluorosis 3 (kidney deficiency type) and fluorosis 4 (cold dampness type). The results showed that the syndrome differentiation group and kidney tonifying group were better than Cistanche deserticola group.

The effective treatment of traditional medicine is based on the "holistic concept" and "syndrome differentiation and treatment". TCM syndrome differentiation and treatment runs through all aspects of the treatment of skeletal fluorosis, and the treatment of skeletal fluorosis cannot be separated from the guidance of syndrome differentiation and treatment. Although different doctors have different syndrome differentiation, but generally speaking, it is nothing more than invigorating the kidney and strengthening the bones, combining with promoting blood circulation and removing blood stasis, dispersing cold and removing dampness, dredging collaterals and relieving pain and so on.

2.2.2special treatment

Bai Xingwei [20] randomly divided 300 patients with skeletal fluorosis into the observation group and the control group. The observation group was treated with Cistanche tablet (prepared land, Cistanche deserticola, Herba caryophyllae, Caulis Spatholobi, cortex Pittosporum, Drynaria, ginger and Ligusticum chuanxiong). The control group was treated with ibuprofen sustained-release capsule. One month later, the total effective rate of the observation group was 99.33%, and the total effective rate of the control group was 86.67%, the difference was statistically significant (P ＜ 0.05). Zhang Zhaoxian et al. [21] treated 30 cases of fluorosis with Guo's Maqian decoction. The results showed that the activity of cervical and lumbar vertebrae, elbow and knee joints, hip joints and lower limb functions were significantly improved, and the total effective rate was 100%. Guo shengqiong et al. [22] used compound Chinese medicine (Eucommia, wolfberry, dangshen, Fuling, and Jinqiancao) to treat rats with chronic skeletal fluorosis. The results showed that compound Chinese medicine can promote the elimination of urinary fluoride and reduce the accumulation of skeletal fluoride. Song Tao [23] used gulingtongbi pill to treat 102 patients with skeletal fluorosis (caused by water source). According to whether to use water to improve the water content in the treatment process, the results showed that: the total effective rate of improving water combined with gulingtongbi pill was 94.12%, while that of uncontrolled water combined with gulingtongbi pill was 80.39%. Liu Juan et al. [24] treated 500 cases of skeletal fluorosis with the anti hyperosteogeny pill, the total effective rate was 95.8%, and the cure rate was 6%. In addition to the above, many Chinese medicine scholars also use Gubi powder, Funing tablet, gulingxian, qufjiangu pill, Fukangning capsule, and futongkang tablet to treat skeletal fluorosis, which has a certain therapeutic effect.

2.2.3treatment of integrated traditional Chinese and Western Medicine

Ren Jianping [25] randomly divided 112 patients with skeletal fluorosis into the observation group and the control group, 56 cases in each group. The control group was given oral treatment of calq-d for 90 days, and the observer was given basic treatment of calq-d, combined with Ma Qian Tang (0.4-1.2g of Strychnos nux, 30g of Astragalus, 9g of safflower, 12g of angelica, 15g of Dipsacus, 9g of earthworm, 9g of Bombyx mori, 0.4g of initial amount of Strychnos nux, 0.1g of increase every 1D, maximum dose of 1.2g) for 60 days The results showed that the improvement rate of limb joint function was 92.68% in the observation group and 42.86% in the control group.

3.External treatment

In addition to the internal treatment of traditional Chinese medicine, it is often combined with acupuncture, Chinese herbal fumigation, acupoint application and other external treatment, with significant effect.

3.1.Acupuncture therapy

Zhou Jincao et al [26] used fire needle to treat 38 patients with drinking water type skeletal fluorosis, and put forward that fire needle can significantly improve the pain symptoms of patients, the timely effect on the patients' joint activity is better, and the long-term effect is not obvious. Wang Tong et al. [27] randomly divided 95 patients with skeletal fluorosis into fire acupuncture group, electroacupuncture group and calcium carbonate D3 group. The fire acupuncture group and electroacupuncture group took Ashi point, Dazhui point, Geshu point, Quchi point, Hegu Point and Xuehai point, respectively, and applied fire acupuncture and electroacupuncture. The calcium carbonate group took three tablets of calcium carbonate D3, 600 mg each time, twice a day. After the treatment, the urine fluoride content in the fire acupuncture group and the electroacupuncture group increased significantly, but there was no statistical difference in the calcium carbonate group before and after the treatment, suggesting that the fire acupuncture and electroacupuncture can promote the excretion of urine fluoride. In addition, the use of time medicine [28], fire acupuncture combined with bamboo pot [29], acupuncture and moxibustion combined treatment of skeletal fluorosis, have achieved satisfactory results.

3.2.fumigation

According to the prescription structure of "gubitongtian pill", Fu Shijie et al. [30] adopted the treatment principle of reconciling Shaoyang, combined with the external fumigation and washing of Shujin Tongluo traditional Chinese medicine to treat 28 cases of skeletal fluorosis, the total effective rate was 89.29%.

3.3.Acupoint Application

Zhang Bing et al. [31] randomly divided 112 patients with skeletal fluorosis into the treatment group of Cigu plaster, the control group of Cistanche tablet and the control group of xiaoyanzhitong plaster. In the treatment group, more than 20 traditional Chinese medicines, such as Drynaria, semen Strychni, and pangolin, were used to make Cigu plaster on acupoints to treat 65 patients with skeletal fluorosis. Results: the effective rate of Cigu plaster group was 95.38%, Cistanche tablet group was 81.25%, xiaoyanzhitong plaster group was 53.33% The model of Cigu plaster is simple and easy to be popularized. Sun Jinsheng [32] et al. Took invigorating the kidney and strengthening the bones, promoting blood circulation and unblocking collaterals as the treatment principle, and used the anti fluorine plaster acupoint application (selecting acupoints at the dysfunctional joints) to treat 20 patients with skeletal fluorosis, the effective rate was 100%, and the basic cure rate was 82.6%, suggesting that acupoint application could directly act on the pain site, with concentrated effect and great effect.

4.Discussion

In conclusion, osteofluorosis is a chronic and persistent osteopathy that is difficult to treat. Traditional medicine has accumulated rich clinical experience and made great progress in diagnosis and treatment. Most Chinese medicine scholars follow the principle of "expelling pathogenic factors and tonifying the kidney" in the treatment of skeletal fluorosis, which can effectively relieve joint pain, improve the quality of life of patients, and reduce the family burden of patients. However, most of the research reports are the summary of their own work experience, lack of unified diagnosis and treatment standards, and the sample size is small, the data repeatability is weak, the future research needs to further enhance the scientific and objective of the experiment, provide scientific and reasonable diagnosis and treatment scheme for the treatment of skeletal fluorosis by traditional Chinese medicine, and give full play to the advantages of traditional Chinese medicine treatment. As the pathogenesis of skeletal fluorosis is not completely clear, clinical cure rate is generally low, lack of specific drugs and radical treatment measures, the essence of traditional Chinese and Western medicine in treating skeletal fluorosis is to reduce the absorption of fluoride and promote the discharge of fluoride, but how to use them together still needs more in-depth clinical research. The prevention and treatment of skeletal fluorosis should be based on prevention. The key to prevent fluorosis is is to change water to reduce fluorine, change stove to change stove, and control tea fluorine content. Residents are encouraged to eat more vegetables and fruits rich in vitamin C and E, and exercise actively [1]. More supervision and education should be carried out to make the residents realize the harm of skeletal fluorosis, improve their awareness of disease prevention, and make the next generation no longer suffer from "pityriasis" and "rhubarb tooth".