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The Journal of Chinese Medicine and Acupuncture Volume 26 Issue 1 April 2019 ISSN: 1745-6843 Volume 26 Issue 1 英 第 26 卷 第 1 期 ISSN: 1745-6843 Volume 26 Issue 1 国英 第 26 卷 第 1 期 The Journal of Chinese Medicine The Journal of Chinese Medicine 中国 And Acupuncture The JournalAnd of AcupunctureChinese Medicine AndAn Acupuncture Official Academic Journal of 中 The Association ofAn Traditional Official Academic Chinese MedicineJournal of and Acupuncture UK 医 The Association of Traditional Chinese Medicine and Acupuncture UK An Official Academic Journal of th 医 The Association of Traditional Chinese3030th April MedicineApril 2019 201and Acupuncture9 UK 针 30th April 2019 针 灸灸 杂杂 志志 英国中医药学会会刊 英国中医药学会会刊 Pioneering the development of Chinese medicine 凤凰集团，致力于中医药健康发展 100% non-sulphur treated herbal product range 100% 无硫磺处理，药效更显著 Zero use of herbicides and pesticides 未使用农药、杀虫剂，服用更安全 Customisable dispensary options for your patients 处方服务，省时、省事为患者提供优质服务 Wholesale phoenixmd.co.uk CPD courses phoenixtcm.org.uk Dispensary chineseherbaldispensary.co.uk Sales: +44 (0) 1245 350822 Email: [email protected] 中药饮片 中药浓缩颗粒 中成药解决方案 营养保健品 全系列无痛润滑针灸针 Dried Herbs | Concentrated Granules | Patent Solutions | Nutrition | Acupuncture Needles 目录 Contents 临床综述与报告 Clinical Reports & Systematic Review Gout and Acupuncture Treatment Gulshinder Johel 1 Syndrome Differentiation and Acupuncture Treatment for Juliet Simpson 6 Hypothyroidism 针药助 IVF-ET 技术的研究现状和存在问题以及提高爱尔兰 IVF- 伍琼娣, 王佩娟 11 ET 成功率的挑战和对策 穴位割治多向埋线术法治疗胃、十二指肠球部溃疡 119 例的疗效 柴振江 15 观察 中医综合疗法对凝肩患者治疗研究 宋志香 18 多科室协作开展体质干预初探 侯献兵, 等 21 Special Column on Multiple Sclerosis 多发性硬化症专栏 New Development in Western Medicine on the Diagnosis and Jodi Hawkes 23 Treatment of Multiple Sclerosis Multiple Sclerosis: TCM Syndrome Differentiation and Malik Khan, Huijun Shen 28 Treatment A Critical Analysis of Clinical Trials on Acupuncture for the Jodi Hawkes, Malik Khan, 31 Treatment of Multiple Sclerosis Huijun Shen 理论与文献研究 Research on Theory and Literature 简述腠理三焦是人体生命空间 徐广文 35 经典中医之气化逻辑脉法浅释 韩永刚 39 Syndrome Differentiation of Heart Patterns Huijun Shen 41 医案医话汇集 Collection of Case Studies Two Case Studies on an FSN Treatment for Acute Depression Alexander. B. Mearns 45 and Anxiety 车祸引起的毁容、嗅觉味觉丧失兼头痛身痛浮针治疗报道 郭久春 48 基于浮针疗法治疗功能性便秘伴腹痛 刘梦， 等 51 消风散加减治疗慢性荨麻疹经验分享病案 1 例 陈伟雄 54 Call for Papers Editorial Committee of 55 JCMA 征稿启事 杂志编辑委员会 15 英国中医药学会 The Association of Traditional Chinese Medicine and Acupuncture UK 地址 Address: ATCM, Suite 10 Brentano House, Unit 5 The Exchange, Brent Cross Gardens, London NW4 3RJ 电话/传真 Tel/Fax: 0044 (0)20 8457 2560 微信 WeChat：ATCM-OFFICE 电子邮件 Email: [email protected] 网站 Website: www.atcm.co.uk The Journal of Chinese Medicine and Acupuncture Volume 26 Issue 1 April 2019 Gout and Acupuncture Treatment Gulshinder Johel BSc (Hons) Acupuncture, Lincoln College Abstract: This paper reviews the diagnosis and treatment of gout in both Western Medicine and Traditional Medicine. It concludes that accurate diagnosis, personalisation and continual review are at the heart of effective treatment in both Western and Eastern treatment. Key Words: gout, arthritis, Bi syndrome, Tong-Feng overconsumption of alcohol and dehydration can also Gout is the most common form of inflammatory arthritis trigger an attack. in the UK, affecting 2.5% of the population (Arthritis Research (AR), 2016). The condition develops in those Treatment with Western-Medicine with hyperuricaemia (Arthritis Foundation, 2018) and Western diagnosis comprises physical examination and occurs in men more than women (Tausche et al., 2009). medical-history evaluation to guide differentiation Gout is a hereditary condition and strongly associated (Badlissi, 2018). The British Society of Rheumatology with numerous metabolic-diseases (Tausche et al., 2009). (BSR) guidelines for Management of Gout state the This paper will review treatment of gout in both Western diagnostic gold standard is arthrocentesis of joint Medicine and in Traditional Chinese Medicine. synovial-fluid revealing urate crystals in the tissue (Hui In Western Medicine primary gout is the reduced ability et al., 2017). However, joint-fluid microscopy is rarely to excrete urate or increased urate production. Secondary performed in primary care due to cost, despite being the gout occurs with conditions such as diuretic treatment or most specific, diagnostic test available (Hui et al., 2017). kidney-failure (Waugh and Grant, 2014). Chronic Differential diagnosis is the epitome of effective gout tophaceous-gout, where tophi form years earlier, is found management. Septic, Osteo, Rheumatoid and Reactive in areas previously affected by acute-gout (Suresh, arthritis (Suresh, 2005) need exclusion before diagnosis. 2005). Polyarticular gout can be confused with rheumatoid arthritis with tophi being mistaken for rheumatoid Uric-acid is the waste product created when the body nodules and both having symmetrical joint-involvement breaks down purines, a protein found within our cells and (Wazir et al., 2005). within foodstuffs (UK Gout Society (UGS), 2018). Build-up occurs when the kidneys are not able to remove Sustained hyperuricaemia is the single most important it efficiently, a genetic abnormality is present or there is factor in the development and diagnostics of gout (Hui et increased purine intake. Persistent hyperuricaemia leads al., 2017) and is defined as ‘Serum uric acid levels of to needle-like crystals, in the form of sodium-urate, above 408umol/L’ (Drug and Therapeutics Bulletin, collecting in cartilage (UGS, 2018). These are usually 2018). However, varied thresholds for maximum uric acid engulfed by leucocytes from the American College of Rheumatology (ACR) and the BSR cause some ambiguity (Khanna et al., 2012). The condition leads to severe, sudden pain in the joints, Furthermore, whilst gout sufferers usually have particularly the big toe, knees, wrists and fingers with hyperuricaemia, not all those with hyperuricaemia will erythema, swelling and heat (NHS, 2017). Collection of have gout (Stanaszek, 1999). Blood-urate levels, although urate crystals outside the joint result in small white lumps not diagnostic of gout, are a strong indicator (Suresh, called tophi. Tophi can appear on the tissues surrounding 2015). Interestingly, uric acid is usually raised but there joints, the ear lobes and may deposit in the delicate kidney are exceptions so gout-diagnosis is excluded if the serum tissue (Stephenson, 2017,399). uric acid level is in the lower half of what is considered Humans, unlike other mammals, lack the enzyme the normal-range (Ballinger and Patchett, 2008, 275). Uricase which speeds the oxidation of uric acid to Local physical examination revealing redness, swelling allantoin (Shannon and Cole, 2012) so acute attacks and heat (Suresh, 2005) helps confirm the condition in develop quickly, often overnight, and peak within 12-24 conjunction with other tests. Radiographs are generally hours of the first inflammatory attack. They usually deemed unhelpful with diagnosis of gout as they only subside within 1-2 weeks (AR, 2016). show swelling or evidence of osseous destruction which Ageing, male-gender and the menopause increase the risk are indicators of recurrent attacks (Suresh, 2015). of gout (Hui et al., 2017). Other aetiological factors However, they can be helpful in differentiating include genetic inability to remove uric acid, central conditions such as rheumatoid arthritis. Newer diagnostic obesity, hyperlipidaemia, Type-2-Diabetes and kidney tools such as Magnetic Resonance Imaging, Dual-energy disease (AR, 2016). Injury to the area, illness, computed tomography and Ultrasound, although ATCM, Suite 10 Brentano House, Unit 5, The Exchange, Brent Cross Gardens, London NW4 3RJ Tel/Fax: 020 8457 2560, Email: [email protected] Website: www.atcm.co.uk 1 The Journal of Chinese Medicine and Acupuncture Volume 26 Issue 1 April 2019 expensive, are now offering a non-invasive way of wind and is caused by unregulated eating and drinking, monitoring tophi-dissolution and disease-progression chronic disease and external-evils (Flaws and Sionneau, (Dubchak and Falasca, 2010). 2005, 255). Early literature specifically attributes rich, greasy food to gout formation. Bi-syndrome Iatrogenic causes of gout include low-dose Aspirin, pathogenesis is Damp, Wind and Heat invasion causing Thiazide-Diuretics (Dubchak and Falasca, 2010) and the Qi and Blood-stagnation in the channels and collaterals increasing use of Cyclosporin for organ-transplantation (Jia, 1998). Qi-blockage and fluid movement then cause (The Drug and Therapeutics Bulletin, 2018). Damp-Heat and consequently Phlegm-Stasis. The result Hypertension-related diuretic use can increase urate is hot, swollen, painful joints (Jun et al., 2000). The levels (Choi et al., 2005) highlighting the need for disease is defined as ‘Hot-Bi’ (Jia, 1998). Severe and regular review. fixed pain without the heat would be ‘Painful-Bi’. Genetics and individual levels of inflammation are now In the literature ‘Ge-Zhi-Yu-Lun’ gout is categorised as offering part-explanation for gout (Terkeltaub, 2017). ‘Phlegm, Wind-Heat, Wind-Wet and Blood-Deficiency’ Cysteinyl-Aspartate-Specific-Protease-1 (CASP1) (Dang (Dang et al., 2015). Other categories include et al., 2015) and the PYCARD-gene (Dang et al., 2018) obstruction-of-dampness-and-heat, may be responsible for the inflammatory response. intermingled-phlegm-stasis-blood, Western treatment of gout is hinged on pharmacotherapy Pi-deficiency-induced-dampness, and with lifestyle advice. The ACR and Qi-blood-deficiency syndromes (Dang et al., 2015). European-League-Against-Rheumatism (EULAR) Gout
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