Combination of Chinese and Western medicine for rheumatoid arthritis Abstract: Rheumatoid arthritis (RA) is a common chronic systemic autoimmune disease characterized by chronic inflammatory lesions of the synovial membrane, with characteristic symptoms of symmetrical, peripheral chronic inflammatory lesions of multiple joints.(t) Clinical manifestations include pain, swelling, and decreased function of the affected joints, and the lesions are The disease has a continuous recurrent course and also affects the heart, lungs, blood vessels and other organs. Modern medicine believes that RA is mainly due to autoimmune reactive inflammation caused by multiple factors, in which cellular and humoral immunity are jointly involved. Keywords: rheumatoid arthritis, combined traditional Chinese and Western medicine treatment, efficacy, rheumatoid arthritis is considered to belong to the category of “paralysis” in Chinese medicine, which is similar to the ancient texts of “rheumatism”, “rheumatism” and “crane knee wind”. “It is believed that wind, cold, dampness and heat are the external conditions for the development of rheumatoid arthritis, while the internal causes for the development of rheumatoid arthritis are the deficiency of memory and vital energy. Although there are differences between cold, heat, deficiency and reality, the common feature is that the tendons, bones, joints and veins are blocked by Qi and blood or by fluid. 1 Western medicine treatment 1.1 First-line drugs non-steroidal drugs. The use of individual selection of drugs according to the condition; choose different doses for different purposes of treatment; should not be combined with the application of more than 2 kinds of drugs at the same time; use 3 to 4 weeks before the evaluation of the effectiveness of drugs; pay attention to stomach protection. Commonly used drugs are: ① ibuprofen tablets or fenpropathrin capsules. ②Diclofenac enteric tablets. ③Celecoxib capsules. ④Diclofenac suppositories for external anal use; or indomethacin suppositories. 1.2 Second-line drugs slow-acting anti-rheumatic drugs, which can improve the condition. Once diagnosed, early application is advocated; long-term application, the course of treatment for at least six months, or even longer; the use of the process of attention to the review of liver and kidney function, blood routine, etc.. Commonly used drugs are: ① Methotrexate tablets Methotrexate injection by intravenous push or intravenous drip. ②Lyuze sulfadiazine pyridine tablets. Leflunomide, Etanercept, Infliximab, Minocycline as second-line anti-rheumatoid drugs are also officially added to the guidelines. Leflunomide is a novel immunomodulator that inhibits T-cell activation and proliferation, reduces inflammatory response, and may have some anti-EBV and CMV viral effects. The guidelines recommend a maintenance dose of 10-20 mg/d, while it has been documented that weekly dosing is equally effective, with an onset of effect at 4-6 weeks and significant efficacy at 12 weeks, with the main side effects being gastrointestinal reactions and elevated liver enzymes. Tetracycline antibiotics such as minocycline are another emerging class of second-line anti-RA agents that have been reported in the literature to inhibit disease progression in HLA-DR4+ rheumatoid patients. More effective combination regimens have yet to be studied further. 1.3 Third-line glucocorticoids. Advocate the use of small doses for 1 to 3 months depending on the condition; pay attention to gastric protection and its serious complications. Immunosorbent therapy was formally included in the treatment protocol of RA in the 2002 ACR treatment guidelines, and is recommended once a week for 12 weeks for adult RA patients who have failed DMARD therapy or cannot tolerate DMARD therapy. 1.4 Biological therapy. With the development of life sciences, biological agents have made rapid progress in the treatment of RA, and the effectiveness of anti-TNF agents Infliximab and Etanercept in the treatment of rheumatoid has been confirmed in a large number of publications. A number of randomized double-blind clinical trials in Europe and North America have demonstrated that fully humanized anti-TNFαmAB (Adalimumab) combined with or without MTX can significantly improve the symptoms and signs of RA patients, and the efficiency of ACR20, ACR50 and ACR70 is significantly higher than that of the control group, and has the advantage of low immunogenicity, which may be a more promising new biologic agent. 2 Chinese medicine treatment was diagnosed according to the diagnostic basis of vicious paralysis in the “Diagnostic and efficacy criteria for Chinese medicine diseases”, and all of them were wind-cold and damp obstruction type. The main symptoms: swollen and painful joints, pain with a fixed location, morning stiffness, flexion and extension disadvantage, sharp pain in case of cold, localized cold and fear of cold, thin white tongue coating, floating tight or sunken tight pulse. The composition of the formula, now domestic experts continue to explore new composition of the formula, in order to achieve better therapeutic effect, for example, how to keep the formula again: Chuan Wu 6g, Ephedra 12g, Bai Shao 60g, Astragalus 30g, raw licorice 12g, and add and subtract with the evidence, the wind evil is heavy, add Fang Feng, Luo Shi Vine, Hai Feng Vine, Qing Feng Vine, etc., the damp evil is heavy, add Fang Ji, Wei Ling Xian, Wood Turtle Seed, Dou Shuo, Qiang Wu, etc.; cold evil is heavy, add If the cold evil is more important, add Hsiang Xin, Qian Jiang, etc. For those with concurrent symptoms, add frankincense, myrrh, safflower, panax ginseng, panax ginseng, soapberry, etc.; for those with phlegm obstruction, add Chenpi and Poria; for wind search, add centipede, scorpion, white flower snake, wuzhang snake, etc.; Fan Renzhong and others applied paralysis removal soup (Gui Zhi, Bai Shao, Radix Aconiti [first decoction], Astragali, Atractylodes, Shu Di Huang, Radix Angelicae Sinensis, Radix et Rhizoma Glycyrrhiza Glabra, Zhi Mu, Qing Feng Vine, Ding Gong Vine, Dou Shuo, Gentiana Macrophylla, Fang Feng) as the basic formula. If the pain is severe, add Hosin and Poppy husk; if the body aches and pains are heavy, add Fangji and Papaya; if the limbs are numb, add Dan Shen and Chicken Blood Vine; if the limbs are cold, add Cinnamon and Deer Horns; if the mouth is dry and urine is yellow, add Lonicera and Tu Fu Ling. 3 Commonly used treatment options 1: 1 first-line drugs + MTX + SASP + Leigongtang thirteen-line drugs + Chinese herbal medicine treatment; option 2: 1 first-line drugs + SASP + Leigongtang + third-line drugs + Chinese herbal medicine treatment; option 3: 1 first-line drugs + MTX + SASP + Leigongtang + Chinese herbal medicine treatment; option 4: 1 first-line drugs + SASP + Leigongtang + Chinese herbal medicine treatment. Although there are many treatment methods for rheumatoid arthritis, but the efficacy is not good, often interrupting the treatment of Chinese medicine because of the adverse effects of long-term treatment of Western drugs. Combine Chinese and Western medicine to avoid shortcomings. For those with obvious symptoms of swelling and pain, Western medicine is optional to stop the development of the disease. In the field of modernization and combination with Chinese medicine: the combination of Chinese and Western medicine can effectively regulate the immune function of the body, reduce liver and kidney damage, improve the efficacy, and significantly reduce the dosage of immunosuppressants, non-steroidal anti-inflammatory drugs and hormones in the treatment of Western medicine alone, indicating that some Chinese medicines have the effect of regulating immunity and adrenal cortical function, with the characteristics of anti-inflammatory and analgesic and slow-acting drugs. In addition, modern pharmacological studies of Chinese medicine have concluded that yin and yang regulating drugs have immunomodulatory effects. Yin-nourishing drugs can reduce the adverse reactions caused by immunosuppressive drugs and also inhibit the hyperactive immune function. 4 Conclusion RA is still a difficult disease that threatens human health, and relying on one drug alone cannot achieve the ideal treatment effect. Chinese medicine and modern medicine should be combined to find a clinically effective method to reduce patients’ pain and improve their quality of life. In conclusion, rheumatoid arthritis is still a difficult disease that threatens the health of human beings, and relying on any one drug alone cannot achieve the ideal therapeutic effect. The advantages of traditional medicine should be brought into play, and Chinese medicine should be organically combined with modern medicine to find a clinically effective method to reduce patients’ pain and improve their quality of life. References [1] State Administration of Traditional Chinese Medicine. Diagnostic and efficacy criteria for Chinese medical conditions [M]. Nanjing: Nanjing University Press, 1994: 47-48 [2] He Shou Zai, Xia Shi Nian. 78 cases of rheumatoid arthritis treated with combined Chinese and Western medicine. Clinical rational drug use 2009 Feb. vol. 2, no. 3: 54-55