The cause and mechanism of ankylosing spondylitis is mainly deficiency of liver and kidney, Qi and blood, loss of nourishment of the Governor’s Vessel, wind, cold, dampness, heat, phlegm and stagnation of stagnation as a problem. The treatment is divided into five types: dampness and heat stagnation of the Governor’s Vessel, cold and dampness staying in the Governor’s Vessel, liver and kidney yin deficiency and evil staying in the Governor’s Vessel, spleen and kidney yang deficiency and cold staying in the Governor’s Vessel, and liver and kidney essence deficiency and loss of nourishment in the Governor’s Vessel. Ankylosing spondylitis (AS) is a chronic progressive immune disease that occurs between the ages of 10 and 40 and mainly affects the central joints, and can involve peripheral joints, internal organs and other tissues to varying degrees. The disease has a high incidence, with a prevalence rate of 0.3% in domestic surveys. It has an insidious onset and a long course, with advanced spinal ankylosis and joint deformity, resulting in varying degrees of disability and affecting the quality of life of patients. Western medicine treatment is still lack of satisfactory drugs. 1. The etiology and pathogenesis of AS belongs to the category of paralysis, bone paralysis and tendon paralysis in Chinese medicine. The clinical features of the disease are different from those of general paralysis, and may be named “spinal paralysis”. This is very close to the modern medical theory that the onset of AS is related to genetic, physical, environmental, and infectious factors. With the development of the lesion and the evolution of deficiency, it can be manifested as deficiency of liver, kidney, qi and blood, loss of nourishment of the veins, wind, cold, dampness, heat, phlegm and stasis, and damage of tendons and bones, resulting in a complex syndrome of mixed deficiency, cold and heat. The original formula of Gui Zhi and Shao Yao Zhi Mu Tang from the Jin Kui Yao is used as the basis, and the formula is formulated as Tong Pao Ling to facilitate the patient’s insistence on taking it. At the same time, the treatment with Tong Piao Ling is combined with the diagnosis and treatment in order to eliminate new pathological factors. According to the many manifestations of ankylosing spondylitis, there are mainly the following clinical types: (1) Damp-heat congestion of the Governor’s vein Most often seen in the early and middle acute activity of ankylosing spondylitis, where Yang is active and evil is real, and the struggle between evil and positive is fierce, with congestion of Qi and blood. The symptoms include severe pain in the lumbar region, refusal to press, stiffness, unfavorable flexion and extension, especially at night, reduced after activity, or even inability to move, or with swollen and burning joints of the lower limbs, heavy body fever, dry mouth and bitterness, dull stomach, yellow and red urine, dry stools, red or dark red tongue, yellow greasy or yellow dry moss, and string, slippery or moist pulse. Treatment is to clear heat and detoxify the toxin, resolve dampness and promote circulation, activate blood circulation and relieve pain. This formula is based on Si Miao Wan plus flavor. Prescription: 15g each of Phellodendron, Atractylodes, Ginger, 30g each of Coix Seed, Rhizoma Dioscorea, Rhizoma Dioscorea, 18g each of Hyssop, 12g of Zelenia, 10g of Glycyrrhiza glabra, plus and minus: 15g each of Yin Chen, Wei Ling Xian, 12g each of Zelenia and Wild Papaya to remove dampness and eliminate swelling; 30g each of Lonicera japonica, Rhizoma Alba, 15g each of Paeonia lactiflora, 12g each of Radix et Rhizoma Scutellariae. In cases of wind and blood stasis, with multiple joint swelling and pain, wandering pain, and bad wind, add 15g of Fanfeng, 12g of Qiangwu and Chuanxiong, and 30g of Jiaohevong to invigorate blood and dispel wind; in cases of severe pain and obvious stasis, add 10g each of Panax ginseng (decoction first) and Beechwood, and 20g of Salviae to invigorate blood and promote circulation to relieve pain. (2) Cold and dampness stay in the Governor’s Vessel Most often seen in the early and middle stages of ankylosing spondylitis, the disease is chronic and active, the body is deficient in Yang, wind, cold and dampness invade the Governor’s Vessel, and evil stays in the Governor’s Vessel. The symptoms are cold pain in the lumbosacral region or heavy, sore bones, warmth is soothing, heavy body, unfavorable turning, especially in the morning, alleviated after activity, aggravated on rainy days, light mouth without thirst, light red tongue, white fur, moist and slow pulse or tight strings. The treatment is to disperse cold and remove dampness, pass the Governor and relieve pain. This formula is based on combining Ephedra, Radix et Rhizoma, and Zeligang with the addition of flavor. Prescription: 12g each of Ephedra, Cinnamomum, Radix et Rhizoma (first decoction), Zelenia, Zelenia, Doklam, Chuanxiong, Angelicae, 6g of Radix et Rhizoma, 15g each of Rhizoma Atractylodis Macrocephalae and Radix Paeoniae, 30g of Radix et Rhizoma Mulberry, plus or minus 12g of Qiangwu and 15g of Fangfeng to disperse wind and dispel cold; for heavy dampness, greasy moss and stuffiness, 10g of Sharen (later), 15g each of Atractylodis Macrocephalae and Houpao to dry dampness and strengthen spleen. For patients with blood stasis, pain with fixed location and recurrent pain, add 12g each of Panax ginseng (decoction) and Peach kernel (broken), 6g each of Boswellia serrata and Myrrh to remove blood stasis and relieve pain. (3) Liver and kidney yin deficiency, evil retention in the Governor’s vein Most often seen in the middle and late stages of ankylosing spondylitis, which is chronic and active, where the evil has left the yin injury or the residual heat has not been cleared. The symptoms are low back straightness, flexion and extension, low back pain and leg weakness, muscle atrophy, with irritable heat and night sweats, insomnia and irritability, dry eyes, dry throat, dry stools, yellow urine, red tongue, thin or less moss, thin string or string count pulse. Treatment is to nourish the liver and kidney, dispel dampness and relieve pain. This formula is based on Six Flavors Dihuang Tang plus or minus. Add and subtract: if Yin deficiency, internal heat, dry throat and mouth, red tongue, greasy moss, add Zhi Mu 12g, Huang Bai 15g to nourish Yin and clear heat and dry dampness; if sore throat is uncomfortable, add Gang Mei Root 30g, Radix et Rhizoma Pinelliae 12g, Tu Niu Knee 15g to benefit the throat and relieve pain; if Yin deficiency, night sweating, tendons and veins are constricted, add Gang Mei Root 30g, Radix et Rhizoma Pinelliae 12g, Tu Niu Knee 15g to benefit the throat and relieve pain. In cases of Yin deficiency, sweating, tense tendons and veins, add 15g each of Radix et Rhizoma Lonicerae and Rhizoma Polygonati, 30g of Rhizoma Polygonati to nourish the liver and kidney, and nourish the tendons and veins. (4) Spleen and kidney yang deficiency, cold stay in the veins Most often seen in the middle and late stages of ankylosing spondylitis, the disease is long yin loss and yang, or a long time to take bitter cold attack agent damage yang. The symptoms include back straightening, unfavorable flexion and extension, lumbar soreness and leg weakness, muscle atrophy. With cold form and cold limbs, no color, short of breath and fatigue, sweating and lazy speech, thin body, little stomach, loose stools and diarrhea, frequent nocturnal urination, pale or dark tongue, fat body with tooth marks on the side, thin white fur, sunken and thin pulse. The treatment is to warm the spleen and kidney, disperse cold and clear the ducts. This formula is based on Jin Kui Kidney Qi Pill with addition and reduction. Prescription: Radix Rehmanniae Praeparata, Rhizoma Polygonati, Rhizoma Cinnamomum, Radix et Rhizoma Sequoiae, Radix et Rhizoma Dogwood, Cortex Eucommiae, Radix et Rhizoma Hyoscyamus, Rhizoma Cornu Cervi Pantotrichum, Rhizoma Danpi, Rhizoma Zedoariae, Radix et Rhizoma Dulcis, Radix et Rhizoma Dulcis, Radix et Rhizoma Poriae, Radix et Rhizoma Staphylococcus, 20g each, Radix et Rhizoma Glycyrrhiza Uralensis, 6g. To open the stomach and eliminate stagnation; for deficiency of the liver and kidneys, see soreness and weakness of the waist and legs, add 15g each of Radix et Rhizoma Polygonati, Radix et Rhizoma Polygonati, and 30g each of Radix et Rhizoma Polygonati to nourish the liver and kidneys; for frequent nocturnal urination, add 20g of Fructus Edodes and 15g of Epimedium Epimedium to tonify the kidneys and fix astringency. (5) Deficiency of liver and kidney essence, loss of nourishment of the veins Most often seen in the middle and late stages of ankylosing spondylitis, wind, cold and dampness are attached to the tendons and bones by the meridians, and the positive energy is depleted, from the qi and blood to the liver and kidney, deficiency of liver and kidney essence and blood, loss of nourishment of the tendons and bones, wind, cold and dampness, phlegm and stasis are difficult to go and tendon contracture and bone loss. The symptoms include back stiffness, flexion and extension, morning stiffness, lumbar soreness and leg weakness, muscle atrophy, mental atrophy, dizziness and forgetfulness, tinnitus and deafness, night dreams, impotence and premature ejaculation in men, low menstrual flow in women, pale tongue with white fur and sunken and weak pulse. Treatment is to tonify the liver and kidney, strengthen the tendons and nourish the governor. This formula is based on Duluxiaosheng Tang with addition and subtraction. Prescription: Dou Wu, Gui Zhi, Angelica Sinensis 12g each, Sang Sang Sang 30g, Fu Ling 20g, Shu Di Huang, Bai Shao, Huai Niu Knee, Eucommiae, Sequoia 15g each, roasted licorice 6g. Adding and subtracting: with blood stasis or pain, add Panax ginseng (first decoction), Ze Lan 12g each, Jiang Huang, Dan Shen 15g each to invigorate blood and relieve pain; for dream emission and spermatorrhea, add Jin Zhen Zi 15g, Sang Gong 20g to tonify the kidney and fix astringency; for women with menstrual disorders Add 30g each of motherwort and henbane, 20g of Semen Cuscutae to tonify the kidney, regulate menstruation and activate blood circulation. 3, the rheumatism should be slow to attack and slow to supplement, and should know the changes and adapt to the changes when following the evidence, in order to improve the efficacy. This is also true for the treatment of AS. The following drugs are calm in nature, and 1-2 flavors can be used to improve the therapeutic effect. If you need to strengthen the power of dispelling wind-dampness, you can choose to add Wei Ling Xian, Qiang Wu, Cang Zhu, Fang Feng, Dou Wu; if you want to strengthen the power of opening the meridians, you can choose to use the products of branches and vines, such as Luo Shi Vine, Kuan Jian Vine, Chicken Blood Vine, Mulberry Branch, Hai Feng Vine, Lei Gong Vine; if you want to strengthen the power of tonifying the liver and kidney and strengthening the muscles and bones, you can choose to add Chuan Zhuan, Niu Knee, Du Zhong, Sang Yu Sheng, Wu Jia Pi; if you have muscle atrophy, you can reuse Huang Qi, Bai Zhu, Sheng Di Huang, Epimedium. If the disease is prolonged or painful, even if there are no obvious signs of stasis, we should add drugs to resolve stasis, and we can use slow products to invigorate blood circulation and resolve stasis, so as to take the intention of slow attack on the persistent evil, such as Chuanxiong, Angelica, Dan Shen, Jiang Huang, Red Peony, Tian Qi, Ze Lan, Tao Ren, and Hong Hua; for those who have low back straightness, stiffness, and unfavorable flexion and extension, we should add insects to search for wind and pick up the luo, such as whole scorpion, centipede, stiff silkworm, Di Long, beehive, wuzhang snake, insects and ants with If you see numbness in the limbs and swelling in the joints that does not go away, you can add biliary nancellus, white mustard seeds, dahurica, mother of pearl, and fenugreek to remove phlegm; if you see redness and swelling in the pharynx and dryness of the throat, you can add xuan shen, maidenhair, mandarin, gomphocarpus root, dried eucommia, and fire charcoal, etc., which are good for the pharynx and detoxification; if you have dry stools, add heliotrope, heshouwu, and cistanches to move the qi and moisten the intestines; if you have abdominal pain and diarrhea, add Huanglian, xylopia, and xylopia. If you have abdominal pain and diarrhea, add Huanglian, Mu Xiang, Dioscorea Z, Che Qian Cao and other products to eliminate the former and the latter; if you take the products of wind circulation for a long time, it is easy to break the qi, consume blood and hurt the yin instead of moistening the tendons and veins, if you see the tendons and veins are constricted, you can add Yu Zhu and Shan Yao to moisten the tendons and veins.