Rheumatoid arthritis is a chronic inflammatory systemic recurrent disease, the cause of which is still unknown, not only joint lesions but also systemic multi-system damage, large differences in the manifestations of the disease and individual patients, alternating episodes and remissions, high disability rate, modern medicine believes that the disease is an inflammatory disease caused by disorders of the immune system regulation, is a connective tissue disease. The process, scope and type of inflammatory response are controlled by multiple factors such as genes and environment.
Therefore, it is not possible to rule the disease with a single drug or treatment protocol in either Western or Chinese medicine. The long-term efficacy of some of the available combination therapy regimens is being investigated. The use of more Western drugs and some single prescriptions have the disadvantage that some patients cannot adhere to the medication due to the side effects. Therefore, more and more people are seeking treatment from Chinese medicine, and the advantages of Chinese medicine in treating rheumatoid arthritis are to be brought into play. In our clinical practice, we have learned that the following aspects are not negligible in improving the efficacy of TCM in treating rheumatoid arthritis.
Early and correct diagnosis is an important prerequisite
The correct diagnosis is a prerequisite for clinical treatment. For rheumatoid arthritis, although it belongs to the category of Chinese medicine maladies, but is different from the general paralysis, which is caused by the wind, cold and dampness of the evil within the liver and kidneys, deep tendons and bones, coupled with the fact that the identification and typing of this disease in Chinese medicine has not yet been unified, so the prescription of treatment, the course of treatment, the method of medication have some special requirements. Clinical practice has proved that early and correct diagnosis and early formal treatment and multiple care, the treatment effect, prognosis and regression are better.
Usually, it is not difficult to make a correct diagnosis of rheumatoid arthritis with typical attacks by referring to the classification criteria of RA proposed by the American Rheumatism Association (ARA) in 1987. However, some early and mild cases, especially atypical cases, are a test of the basic skills of differential diagnosis for clinicians, so doctors should maintain their characteristic vigilance, integrate symptoms, signs, laboratory test indicators with imaging examinations, carefully and meticulously analyze the clinical data objectively, and refer to the results of auxiliary examinations to make the correct diagnosis. The diagnosis is most likely to be misdiagnosed because of the absence of a clear indication on the joint X-ray. CT or MRI can be performed when necessary, and synovial biopsy, synovial fluid analysis and serum immunological testing can be performed to avoid misdiagnosis. Early and correct diagnosis, timely treatment and delaying the development of the disease is very meaningful.
Precise identification is the key to ensure the effectiveness of treatment
The essence of TCM theory is the holistic concept and evidence-based treatment. The core of TCM treatment of RA is still to firmly grasp the accuracy of identification, grasp this key, the clinical evidence of prescriptions and drugs can be targeted to ensure the effectiveness of the treatment. At present, the research use of some experimental formula, single formula or preparations, such as Leigongteng, white peony total glucoside, etc., also appear limitations, some people effective, some people effect country is not obvious, some patients a period of time effective, and a period of time invalid, showing repeated. All these reflect that RA is a difficult-to-treat systemic disease with recurrent attacks and complex clinical manifestations, which vary from person to person. Therefore, it seems impossible to rule RA with one medicine or one party. For many medical doctors, based on their own experience in medical texts and their rich experience accumulated in long-term clinical practice, they have developed unique insights and effective prescriptions for the treatment of RA, and we believe that they have not lost the purpose of discriminatory treatment. We believe that they still maintain the principle of diagnosis and treatment, because when they are applied in clinical practice, they also have to add or subtract according to the characteristics of the region and population and the specific situation of each person’s clinical manifestations.
We strongly agree with many experts who advocate the use of evidence-based treatment as a guide, combined with the results of modern pharmacology, pharmacy and biotechnology research, both evidence-based and targeted selection of certain pharmacological research of Chinese medicine, the composition of the treatment of RA, can achieve better clinical efficacy. For example, most of the Chinese herbal medicines commonly used to dispel wind and remove dampness and pass paralysis have the same anti-inflammatory and analgesic effects as western non-steroidal anti-inflammatory and analgesic drugs, although the strength is slightly inferior to western drugs, but the side effects are few and easy for patients to accept. If it is cold, you can use Gui Zhi, Ephedra, Aconite, Radix et Rhizoma, Chuanxiong, Qiang Wu, Dou Shuo, Hsiang Xin, Bai Zhi, Mu Gua, Hai Feng Vine, Bai Hua Snake, etc.; if it is hot, you can use Han Fang Ji, Lonicera, Qing Feng Vine, Hai Tong Pi, Gentiana, Niu Knee, Huang Bai, Red Peony, Dan Pi, Stiffy, etc.; if it is stasis, you can use Tao Ren, Safflower, Boswellia, Su Mu, Panax notoginseng, Pu Huang, and Blood Dried; if it is deficiency, you can use Ginseng, Astragalus, Angelica, Shu Di, Chicken For deficiency, we can use ginseng, astragalus, angelica, rehmannia, hen’s blood, epimedium, bacopa monniera, chasteberry, dulcimer, boneset, cistanches, white peony, etc.
From another point of view, on the basis of evidence-based treatment, herbs with immunosuppressive effects, such as smallpox powder, antibiotics, Andrographis paniculata, sanguinaria, bitter ginseng, safflower, zedoary, angelica, saxifrage, yucca, bupleurum, scutellaria, summer bitter herbs, serpentine, silkworm, andrographis, cicadelle, leech, and leigongtang, can be applied to eliminate inflammation and control the development of the disease.
The pathogenesis of RA is not well understood, but it is definitely related to autoimmune dysfunction. In addition to the use of immunosuppressive herbs, some immune-enhancing herbs, such as ginseng, Radix et Rhizoma Polygonati, Astragali, Rhizoma Polygonati, Atractylodes Macrocephala, Ganoderma Lucidum, Poria, Poria, Schisandra, Fructus Lycii, Fructus Lycii, Fructus Chasteberry, Epimedium, Deer antler, Radix et Rhizoma Polygonati, Semen Cuscutae, Semen Coicis, etc., can also be used clinically. The combination of immune-enhancing herbs and immune-suppressing herbs is often used in the same formula to bring into play their two-way regulation of the body’s immune function, which is beneficial to the control and improvement of RA. The main effect is to take the two-way regulation of immune function to control and improve joint inflammation and bone destruction, so as to achieve better clinical effect.
A large proportion of RA patients have been treated with glucocorticoids. It is true that glucocorticosteroids are very effective in controlling inflammatory activities, and indeed the strong anti-inflammatory and immunosuppressive effects of glucocorticosteroids have not yet been compared with those of other drugs. However, for RA, the side effects of prolonged application make it intolerable to patients and force them to discontinue the drug. According to modern research, many traditional Chinese medicines have glucocorticoid-like effects, and although their efficacy is not as strong as that of western medicines, their side effects are much less than those of glucocorticoids. The side effects are much less than those of glucocorticosteroids, and can be used for a longer period of time, often with remarkable results. Some drugs can be combined with immunomodulatory functions and can prevent the “rebound” caused by the discontinuation of hormones. For example, Chinese medicine traditionally uses worm medicine, especially snake medicine, such as white flower snake, wuzhang snake, herb snake, leech, dragon, scorpion, centipede, ground turtle worm, piercing beetle, nine incense worms, ants, etc. They are believed to have the function of searching the wind and picking up the ligaments, penetrating into the meridians and tunnels, and expelling evil. Modern research shows that they can promote the synthesis and release of adrenocorticotropic hormones, thus achieving anti-inflammatory, anti-swelling and pain-relieving effects, but without the side effects of adrenocorticotropic hormones.
Chinese medicine believes that vines are light and good at walking the meridians, easy to pass through the joints and reach the extremities, and are often used in the treatment of RA as a meridian-led medicine, leading the force of the medicine directly to the disease to improve the effectiveness of treatment. Commonly used are Qing Feng Vine, Hai Feng Vine, Lonicera Vine, Chicken Blood Vine, Tian Xian Vine, and Loxodendron Vine.
For those with severe pain, Chinese herbal medicines such as Aconite, Radix et Rhizoma, Strychnine, Cyperus, Radix et Rhizoma, Radix et Rhizoma and Paeonia are often used.
Combination of evidence and disease identification, Chinese and Western medicine to control the development of the disease
Due to the specificity and intractability of RA, the combination of diagnosis and diagnosis, Chinese and Western medicine should be used according to the patient’s condition and individual differences, so as to give full play to the strengths of Chinese and Western medicine and complement each other to flexibly control the development of the disease and better relieve or alleviate the patient’s pain as much as possible.
If the disease starts rapidly, develops rapidly, and the joints are severely swollen and painful, we should not hesitate to use western medicine and add glucocorticoids or NSAIDs to control the disease and relieve the patient’s pain as soon as possible. Those with acute illness and serious extra-articular manifestations, such as pericardial effusion, cerebrovascular disease causing central N lesions, serious eye disease, anemia, etc., and significantly increased blood sedimentation, should promptly apply glucocorticoids to control the development of the disease after NSAIDs treatment is ineffective, and then carry out Chinese medicine treatment after the condition is relatively relieved.
NSAIDs analgesics and glucocorticoids are still indispensable for the treatment of rheumatoid arthritis to control inflammation in the acute active phase. Proper use is meaningful for RA treatment.
For those with recurrent synovial inflammation causing swelling, pain, stiffness, increased blood sedimentation, and increased C-RP, and who are forced to discontinue the medication due to ineffective treatment with western drugs or because of their serious intolerable side effects, some characteristic medications and empirical medications for paralysis, such as Lei Gong Tang, Ma Qian Zi, Wu Tou, Herb Snake, etc., can be added along with the identification of Chinese medicine. For joint effusion, add Gui Zhi and Ze Xie; for late stage joint deformation, add Tian Nan Xing, Andrographis paniculata, White Mustard Seed, Whole Scorpion, and Lu Hifang and other phlegm-busting drugs to enhance the therapeutic effect. It can also be combined with external treatment method and other multifaceted joint treatment.
The treatment effect is better when the doctor and patient cooperate and keep the prescription for a long time
Because RA is a refractory disease, the disease is weak and the evil is real, and the disease is long-lasting, it is necessary to do a good job in the ideological work of the patients to make them understand the danger of the disease and related general knowledge, and to cooperate closely with the doctor and have confidence so that a good treatment plan can be implemented to achieve better results.
Patients who seek medical help indiscriminately and believe in the wandering doctors and wild medicine often delay the disease and cause lifelong harm. The treatment of RA can not be solved in a short period of time, even if the famous doctors need time to take good medicine, doctors should not be excused from the general principle of “stopping when sick” and miss the opportunity to turn. Both the doctor and the patient should build up confidence and adhere to the prescription treatment (3-6 months), or even take the medicine for life. Even during the remission period, Chinese medicine should be used to regulate the treatment, and with life and emotional conditioning exercise, etc. in order to obtain results.
Patients with RA tend to neglect the treatment and maintenance during the remission period, and stop taking medication when many symptoms are relieved or disappeared and functional activities are restored, or stop taking medication due to economic situation, which often results in recurrence of the disease. We believe that patients should still insist on using traditional Chinese medicine or Chinese patent medicine during the remission period to adjust the body’s yin and yang, qi and blood, clear the remaining evil, stabilize the disease, reduce recurrent attacks, and consolidate the therapeutic effect. Commonly used formulas include Yi Kidney Palsy Pill, Duzhong Zhuangbone Pill, Yangzhen Decoction, Yi Kidney Compound, Astragalus Punch, Jianquan Pill, Zhi Bai Dihuang Pill, Yu Ping Feng San, Dushu Zuosheng Pill, Zuo Gui Pill, and Yu Gui Pill, which can be selected according to the patient’s specific conditions and add or subtract.
Life, mental conditioning and exercise are important components of the overall RA treatment plan.
The onset and development of rheumatoid arthritis are related to environmental factors (exposure to cold, humidity, exertion, trauma, infection, malnutrition, etc.) and the body’s own factors (genetics, autoimmunity and endocrine status). The ancestral medicine has an incisive discussion of the disease, belonging to the category of maladies, that most of the wind, cold and damp evil deficiency invade the human body, or the vegetation contains heat, wind, cold and damp depression for a long time into heat, stagnation of the meridians, occlusion is not made, long time does not heal, liver and kidney loss, tendons and bones lost in moistening, resulting in joint deformity and stiffness. Modern research suggests that the onset of rheumatoid arthritis may be an antigen-driven “stimulation-chain reaction” process. Infection and autoimmune reactions are central to the development and progression of rheumatoid arthritis, while endocrine, genetic, and environmental factors increase susceptibility to the disease.
So rheumatoid arthritis patients and their families should pay attention to creating a good living environment for patients, pay attention to scientific diet and living, do a good job of life conditioning, away from disease-causing factors, to enhance physical fitness, but also to carry out psychological conditioning. The ancients have long recognized the close relationship between human heart activity and disease, and modern research has also shown that mental stress often leads to endocrine disorders in the body, making the immune system dysfunctional. The mental state of a person is directly related to the development of many diseases. Whether RA patients can treat the disease and treatment correctly, establish confidence in overcoming the disease, maintain a positive and optimistic mood, moderate physical exercise and joint function exercise to recover, cooperate well with doctors to establish good compliance with treatment, and develop a healthy mentality and good habits conducive to disease recovery will be a solid foundation for the treatment of RA. The treatment of RA is not a one-time event, so life, mental conditioning and exercise are an important and indispensable part of the overall RA treatment plan.