AIM: To evaluate the effect of manipulation and pyrola compound traditional Chinese medicine on senile osteoarthritis of knee. METHODS: Eighty-six outpatients with knee osteoarthritis were selected from Department of Massage and Department of Traditional Chinese Medicine, First People's Hospital Affiliated to Shanghai Jiaotong University from March 2002 to June 2004. All patients were willing to join the observation. They were randomly assigned to 4 groups: manipulation plus pyrola group (n = 22), manipulation group (n = 22), pyrola compound traditional Chinese medicine group (n = 22), and self-exercise group (n = 20). (1) The manipulation group: Prone position, rolling manipulation to the affected thigh for 5 minutes, mainly the Weizhong and Weiyang of the fossa poplitea and the posterolateral part of the leg; Supine position, rolling manipulation for 5 minutes to affected side of quadriceps femoris and superior part of the whirbone; Alternately manipulation of pressing-kneading, flicking-poking and digital-pressing to Dubi, xiyan, Yanglingquan, Heding, Xiyangguan and Liangqiu; Rotating of the knee joint cooperated by the passive stretch, flexion, inward and lateral rotation; At last, spreading some ointment of Chinese holly leaf on the affected knee joint and scrubbing until give the patient a warm sensation. The treatment was done three times weekly for 4 weeks. (2) Pyrola group: The patients were treated with Chinese herbs orally (modified Pyrola compound traditional Chinese medicine) twice a day with water for weeks. (3) Manipulation plus pyrola group: Patients were treated by Chinese herb orally besides the manipulation with the same processes as the manipulation group for 4 weeks. (4) Self-exercise group: Patients were told to do exercise themselves such as stretching exercises, active and passive range-of-motion exercises, strengthening exercises and so on for 4 weeks. Western Ontario and McMaster universities osteoarthritis index (WOMAC) score (including pain, stiffness and daily life, 0 to 100 mm visual scale was used, the more the scores, the worse the function, so the greater effect to life) and 20 m walking time test were used for evaluation of the function of knee joint before and 4 weeks after treatment. The standard for evaluation: (1) effective: Arthralgia and swelling disappeared, motor function recovered with normal physiochemical detection. (2) improved: Arthralgia and swelling lessened, and the motor function was improved. RESULTS: All the 86 patients were involved in the result analysis without any loss. (1) The time in the 20 m walking and scores in WOMAC of each group were decreased after 4 weeks of treatment (p < 0.05). The average WOMAC scores of the manipulation plus pyrola group were obviously lower than the self-exercise group (p < 0.05); and the time in 20 m walking of the manipulation group and manipulation plus pyrola group was shorter than the self-exercise group (p < 0.05). (2) After 4 weeks of treatment and exercise, the effective rates of the manipulation plus pyrola group, manipulation group, pyrola group and self-exercise group were 86%, 82%, 82% and 60%, respectively, which had no significant difference (p > 0.05). CONCLUSION: Simple manipulation, pyrola and self-exercise can all markedly improve the knee osteoarthritis, but the therapeutic effect of combined therapy of manipulation and pyrola is better.

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