TRADITIONAL MEDICINE’S CONCEPT

OF

OSTEOPOROSIS

TRADITIONAL MEDICINE’S CONCEPT

OF

OSTEOPOROSIS

NGUYEN THI BAYNGUYEN THI BAYFaculty of Traditional medicineFaculty of Traditional medicine

University of Medicine and Pharmacy, HCMCUniversity of Medicine and Pharmacy, HCMC

IntroductionIntroduction

Physiology and Pathology of Physiology and Pathology of Traditional MedicineTraditional Medicine

Yin – YangYin – Yang theory theory

Five Elements Five Elements theorytheory

5 organs of the body5 organs of the body Materials help the body to workMaterials help the body to work

Fire HeartFire Heart

Wood Wood LiverLiver

Earth Earth SpleenSpleen

Water Water KidneyKidney

Metal Metal LungLung

SemenSemen

EnergyEnergy

BloodBlood

SpiritSpirit

Body fluidBody fluid

IntroductionIntroduction

Wood LiverWood Liver Water KidneyWater Kidney

Unbalance of Energy – Blood Unbalance of Energy – Blood & Yin – Yang& Yin – Yang

Osteolysis > OsteogenesisOsteolysis > Osteogenesis

Vague spinal painVague spinal pain

Pain along the length of bone, tired musclePain along the length of bone, tired muscle

Pain increases when sitting or standing too Pain increases when sitting or standing too long, when changing position…long, when changing position…

Decreased bone massDecreased bone mass

Combined with:Combined with:

Functions of the Wood LiverFunctions of the Wood Liver

Controls TENDONControls TENDON

Controls CATALYSTSControls CATALYSTS

Store BLOODStore BLOOD

MobilityMobility

BirthBirthGrowthGrowth

Maintains the Maintains the

quick and strong quick and strong

mobility of the mobility of the

skeletal systemskeletal system

Nurture and assist skeletal Nurture and assist skeletal

movements and the movements and the

vegetal nervous systemvegetal nervous system

Belongs to Movement Belongs to Movement

and Developmentand Development

Functions of the Water KidneyFunctions of the Water Kidney

Store Store Vital Genital Vital Genital

SubstancesSubstances

Controls Controls Bone and Bone and

Bone MarrowBone Marrow

Controls Controls Genital Genital

OrgansOrgans

Control and maintain Control and maintain

the bone’s strengththe bone’s strength

Related to the causes Related to the causes

of Osteoporosisof Osteoporosis

Etiology – Mechanism – TreatmentEtiology – Mechanism – Treatment

Congenital InsufficiencyCongenital Insufficiency

Internal causesInternal causes

Age accumulationAge accumulation

Energy – Blood Energy – Blood

Wood Liver – Water Kidney Wood Liver – Water Kidney

Re-establishment of Re-establishment of YIN – YANGYIN – YANG balance balance

Re-establishment of Re-establishment of Energy – Blood Energy – Blood balancebalance

Tonify Tonify Wood Liver – Water KidneyWood Liver – Water Kidney

Ancient medical formulaeAncient medical formulae

has the general effects of:has the general effects of:

• Tonify the Tonify the Liver – KidneyLiver – Kidney

• Establishment the balance of Establishment the balance of Energy – BloodEnergy – Blood

Rehmannia Rehmannia glutinosaglutinosa

Rhizoma Rhizoma HomalomenaeHomalomenae

Anglelica Sinensis Anglelica Sinensis DielsDiels

Eucommia Eucommia ulmoides Oliv.ulmoides Oliv.

Achyranthes Achyranthes bidentata Blumebidentata Blume

Objective of StudyObjective of Study

Evaluate the effectiveness of these formulae:Evaluate the effectiveness of these formulae:

Formula 1: “Luc vi” 6 Formula 1: “Luc vi” 6 medicinal plantsmedicinal plants

Formula 2: “Doc hoat” Formula 2: “Doc hoat” 12 medicinal plants12 medicinal plants

on osteoporosis patientson osteoporosis patients

Study of Formula 1 – Tonify the LiverStudy of Formula 1 – Tonify the Liver

Study design:Study design: single-blind clinical trial single-blind clinical trial

Patients:Patients: Women aged > 50, menopausal, diagnosed Women aged > 50, menopausal, diagnosed

with Osteoporosiswith Osteoporosis

Venue: Venue: Hospital 175 Ho Chi Minh CityHospital 175 Ho Chi Minh City

Medication:Medication:

Trial group: Trial group: 6 herbs 6 herbs capsule 500mg capsule 500mg

Control group: Control group: Placebo: Malt – capsule 500mgPlacebo: Malt – capsule 500mg

Duration: Duration: Continuous observation in and after 12 Continuous observation in and after 12

monthsmonths

Observation and EvaluationObservation and Evaluation

Pain evaluation by QDSA (Saint – Antoine):Pain evaluation by QDSA (Saint – Antoine):

Patients’ complaintsPatients’ complaints

Spontaneous movement decreasedSpontaneous movement decreased

Pain-killers demandedPain-killers demanded

Bone mineral density (BMD) by DXA Bone mineral density (BMD) by DXA method (T-score < -1.6)method (T-score < -1.6)

Meunier index by Spinal X-ray (>10)Meunier index by Spinal X-ray (>10)

ResultResult

N = 68 patientsN = 68 patients

Calcaneus BMD by DEXA methodCalcaneus BMD by DEXA method

Trial groupTrial groupControl groupControl group

BeforeBefore 6 6 monthsmonths

12 12 monthsmonths Dr. Phan Thi Hoa et al.Dr. Phan Thi Hoa et al.

175 Hospital175 Hospital

p < 0.05

Trial groupTrial group Control groupControl group

Percentage of patients with changed Calcaneus BMD by DEXA Percentage of patients with changed Calcaneus BMD by DEXA

methodmethod

6 months 12 months6 months 12 months 6 months 12 months6 months 12 months

IncreasedIncreased

ConstantConstant

DecreasedDecreased

Dr. Phan Thi Hoa et al.Dr. Phan Thi Hoa et al.

175 Hospital175 Hospital

Evaluate patients’ complaints of spinal pain (QDSA)Evaluate patients’ complaints of spinal pain (QDSA)

Before 6 months 12 months

Trial groupTrial groupControl groupControl group

Dr. Phan Thi Hoa et al.Dr. Phan Thi Hoa et al.

175 Hospital175 Hospital

Evaluate the decrease of spontaneous movements in patients Evaluate the decrease of spontaneous movements in patients with spinal back pain (QDSA)with spinal back pain (QDSA)

Trial groupTrial groupControl groupControl group

Before 6 months 12 months

Dr. Phan Thi Hoa et al.Dr. Phan Thi Hoa et al.

175 Hospital175 Hospital

Evaluate the demand of pain-killers by patients with spinal pain (QDSA)Evaluate the demand of pain-killers by patients with spinal pain (QDSA)

Trial groupTrial groupControl groupControl group

Before 6 months 12 months

Dr. Phan Thi Hoa et al.Dr. Phan Thi Hoa et al.

175 Hospital175 Hospital

Study of Formula 2Study of Formula 2

Study design:Study design: patients diagnosed with osteoporosis, patients diagnosed with osteoporosis,

no gender biasno gender bias

Venue:Venue:

33rdrd branch, University Medical Center, Ho Chi Minh City branch, University Medical Center, Ho Chi Minh City

Traditional Medicine Hospital, Ho Chi Minh CityTraditional Medicine Hospital, Ho Chi Minh City

Traditional Medicine Institute, Ho Chi Minh CityTraditional Medicine Institute, Ho Chi Minh City

Medication:Medication:

Trial group: Trial group: 12 herbs – capsule 500mg12 herbs – capsule 500mg

Control group: Control group: Placebo: malt – capsule 500mgPlacebo: malt – capsule 500mg

Duration: Duration: 12 months12 months

ResultResult

n = 180 patientsn = 180 patients

Age 45 – 70, men and womenAge 45 – 70, men and women

29% of patients have increased BMD29% of patients have increased BMD

76% of patients have lessened pain after 4 weeks76% of patients have lessened pain after 4 weeks

88% of patients have improved mobility after 4 weeks88% of patients have improved mobility after 4 weeks

Dr. Do Tan Khoa et al.Dr. Do Tan Khoa et al.

Traditional Medicine HospitalTraditional Medicine Hospital

Conclusion 1Conclusion 1

OsteoporosisOsteoporosis

Energy – Blood Energy – Blood

Wood Wood Liver Liver

Water Water Kidney Kidney

Terminology – Name of diseaseTerminology – Name of disease

MechanismMechanism

Same consequence: OsteoporosisSame consequence: Osteoporosis

Conclusion 2Conclusion 2

Result of Formula 1 (Tonify Kidney):Result of Formula 1 (Tonify Kidney):

BMD increases after 12 months of medicationBMD increases after 12 months of medication

Result of Formula 2 (Tonify Liver – Kidney):Result of Formula 2 (Tonify Liver – Kidney):

BMD increases after 6 and 12 months of medicationBMD increases after 6 and 12 months of medication

Evidence:Evidence: In Traditional Medicine theory, the In Traditional Medicine theory, the

functions of Liver – Kidney are related to the functions of Liver – Kidney are related to the

activities of the skeletal systemactivities of the skeletal system

Conclusion 3Conclusion 3

Traditional Medicine has a vital role in the Traditional Medicine has a vital role in the

TREATMENT and PREVENTION of OsteoporosisTREATMENT and PREVENTION of Osteoporosis

Result of Formula 1 (Tonify Kidney):Result of Formula 1 (Tonify Kidney):

BMD increases after 12 months of medicationBMD increases after 12 months of medication

Result of Formula 2 (Tonify Liver – Kidney):Result of Formula 2 (Tonify Liver – Kidney):

BMD increases after 6 and 12 months of medicationBMD increases after 6 and 12 months of medication

AcknowledgementAcknowledgement

Thank you,Thank you,

Dr. Phan Thi HoaDr. Phan Thi Hoa

Dr. Do Tan KhoaDr. Do Tan Khoa

The Director Boards of Hospital 175, The Director Boards of Hospital 175,

Traditional Medicine Hospital, Traditional Traditional Medicine Hospital, Traditional

Medicine Institute, and the 3Medicine Institute, and the 3rdrd branch of branch of

University Medical CenterUniversity Medical Center

ReferencesReferences1. Nguyeãn Thò Bay – Beänh hoïc keát hôïp taäp III – Boä moân YHCT 19971. Nguyeãn Thò Bay – Beänh hoïc keát hôïp taäp III – Boä moân YHCT 19972. Nguyeãn Thò Bay, Phan Thò Hoøa – Nghieân cöùu taùc duïng cuûa baøi 2. Nguyeãn Thò Bay, Phan Thò Hoøa – Nghieân cöùu taùc duïng cuûa baøi thuoác luïc vò gia giaûm treân bieåu hieän loõang xöông ôû phuï nöõ maõn thuoác luïc vò gia giaûm treân bieåu hieän loõang xöông ôû phuï nöõ maõn kinhkinh3. Hoaøng Baûo Chaâu – Noäi khoa hoïc coå truyeàn – NXB Y Hoïc 19973. Hoaøng Baûo Chaâu – Noäi khoa hoïc coå truyeàn – NXB Y Hoïc 19974. Buøi Chí Hieáu – Döôïc lyù trò lieäu thuoác Nam – NXB Ñoàng Thaùp 19944. Buøi Chí Hieáu – Döôïc lyù trò lieäu thuoác Nam – NXB Ñoàng Thaùp 19945. Boä moân YHCT Tröôøng Ñaïi Hoïc Y Haø Noäi – Y Hoïc Coå Truyeàn – NXB 5. Boä moân YHCT Tröôøng Ñaïi Hoïc Y Haø Noäi – Y Hoïc Coå Truyeàn – NXB YH Haø Noäi 1994.YH Haø Noäi 1994.6. Harrison’s – Principles of Internal Medicine 17 th Edition6. Harrison’s – Principles of Internal Medicine 17 th Edition7. H.Ralph Schumacher, Jr.,MD.Primer on the Rheumatic Diseases.9th edition7. H.Ralph Schumacher, Jr.,MD.Primer on the Rheumatic Diseases.9th edition8. Haûi Thöôïng Laõn OÂng Leâ Höõu Traùc – Haûi Thöôïng Y toân taâm lónh 8. Haûi Thöôïng Laõn OÂng Leâ Höõu Traùc – Haûi Thöôïng Y toân taâm lónh – NXB Y hoïc Haø Noäi 1997– NXB Y hoïc Haø Noäi 19979. Traàn Vaên Kyø – Döôïc hoïc coå truyeàn – NXB TPHCM 19979. Traàn Vaên Kyø – Döôïc hoïc coå truyeàn – NXB TPHCM 199710. Ñoã Taát Lôïi – Nhöõng vò thuoác – caây thuoác Vieät Nam – NXB KHKT 10. Ñoã Taát Lôïi – Nhöõng vò thuoác – caây thuoác Vieät Nam – NXB KHKT 2000200011. Vieän Y Hoïc Trung Y Baéc Kinh, Löôïc dòch: Döông Höõu Nam, Döông 11. Vieän Y Hoïc Trung Y Baéc Kinh, Löôïc dòch: Döông Höõu Nam, Döông Troïng Hieáu – Phöông teã hoïc dieãn nghóa – NXB Y Hoïc Haø Noäi 1994Troïng Hieáu – Phöông teã hoïc dieãn nghóa – NXB Y Hoïc Haø Noäi 199412. Vibeke strand, David I. Scott, Lee S. Simon – Novel therapeutic Agents for 12. Vibeke strand, David I. Scott, Lee S. Simon – Novel therapeutic Agents for the treatment of Autoimmunethe treatment of Autoimmune13. Nguyeãn Töû Sieâu – Hoaøng ñeá noäi kinh toá vaán – NXB TP.HCM 13. Nguyeãn Töû Sieâu – Hoaøng ñeá noäi kinh toá vaán – NXB TP.HCM 1992.1992.14. Hoäi thaáp khôùp hoïc TP.HCM – Moät soá beänh lyù cô xöông khôùp 14. Hoäi thaáp khôùp hoïc TP.HCM – Moät soá beänh lyù cô xöông khôùp thöôøng gaëp / Beänh loaõng xöông – NXB Y Hoïc Haø Noäi 2006thöôøng gaëp / Beänh loaõng xöông – NXB Y Hoïc Haø Noäi 200615. Osteoporosis prevention, diagnosis, and therapy, NIH conses statement 15. Osteoporosis prevention, diagnosis, and therapy, NIH conses statement (2000) March 27-29; 17(1): 1-36(2000) March 27-29; 17(1): 1-36

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