[The treatment of Behcet Disease (BD) is a chronic multi-system autoimmune disease with vasculitis as the pathological basis, and the supervisor, Prof. Ding-Ya Fang, has proposed that “immune abnormality” is the basic pathological mechanism and “vasculitis” is the main pathological change. “In the treatment of “vasculitis”, we treat the disease by detoxifying and activating blood, removing dampness, and improving microcirculation by using prescriptions and medicines with the effects of immune regulation, anti-inflammatory mediators, and improving microcirculation. In this paper, we discuss Professor Fang Dingya’s experience in the identification and treatment of BD and his understanding of the prescriptions and medicines. [关键词] 白塞氏病；络病；调节免疫；改善微循环 [Abstract] Behcet Disease is a systemic autoimmune disease characterized by vasculitis. As Doctor Fang Dingya points out, dysimmunity is the basic pathogenesis of Behcet Disease, and vasculitis is the main pathological change. So the therapy should be aimed directly at vasculitis which is called collateral disease in Traditional Chinese Medicine. We should elect herb medicine which can regulate immunity, resist mediators of inflammation and improve minicirculation to clear away the heat-evil, expel superficial evils, and promote blood circulation. This text is about Doctor Fang Dingya`s clinical experience on Behcet Disease. [key words] Behcet Disease, collateral disease, regulating immunity, improving minicirculation 白塞氏病（Behcet Disease, BD）是一种以血管炎为病理基础的慢性多系统自身免疫性疾病，主要表现为“口腔溃疡.生殖器溃疡.眼色素层炎”，据此临床症状, 多数医家都将其 According to this clinical symptom, most doctors regard it as “fox confusion” disease, and the mechanism of the disease is “damp-heat evil poison within”, which is mostly treated from the perspective of “clearing heat and detoxification”. Professor Fang Dingya, a famous expert in rheumatism, is the academic leader of the Department of Rheumatology and Immunology of Xiyuan Hospital of the Chinese Academy of Traditional Chinese Medicine, and emphasizes the use of medicine based on specific prescriptions for specific diseases. I had the honor to study under Prof. Fang Dingya, and became one of the “first batch of famous Chinese medicine experts’ academic experience inheritance post-doctoral students”, and served under him for more than 2 years. From his long-term clinical practice, Mr. Fang expounded the ancient meaning and integrated new knowledge, and proposed that “immune abnormality” is its basic pathogenesis, and “vasculitis” is its main pathological changes, so the treatment can be directed at “immune abnormal vasculitis Therefore, the treatment can be directed at “immune abnormal vasculitis” from the perspective of “regulating immunity and anti-inflammation”, and the treatment is based on the theory of luo disease, detoxifying and invigorating blood, removing dampness and clearing luo, which is always effective in clinical cases. The following is a study and understanding of the pathogenesis and treatment prescriptions. 1. Theoretical understanding of BD pathogenesis There is no corresponding name for this disease in Chinese medicine. The medical sage Zhang Zhongjing in “The Essentials of the Golden Horoscope” clouded: “The disease of fox confusion is like typhoid fever, with silent desire to sleep, eyes cannot be closed, restlessness in lying down, eclipsed in the throat as confusion, eclipsed in the yin as fox, not wanting to eat and drink, evil smell food odor, its face and eyes at first red, at first black, at first white. Erosion in the upper part of the body is the sound of drinking, Gan Cao Di Xin Tang is the mainstay”, “Erosion in the lower part of the body is the dryness of the throat, bitter ginseng soup is used to wash”, “Erosion in the anus is smoked with Xiong Huang”. The pathogenesis of the disease is “dampness and heat, which is embedded in the evil toxins”, so the treatment is to take internal licorice diarrhea of the heart soup to clear heat and remove dampness; externally, bitter ginseng soup and Xiong Huang are used to clear heat and remove dampness, detoxify and kill worms. Later generations of physicians have also adopted Zhongjing’s method of clearing heat, removing dampness and detoxifying toxins. However, the clinical symptoms of foxglove disease as recorded in “The Essentials of the Golden Horoscope” are characterized by redness of the eyes, throat and erosion of the front and back of the two yin, and there is no obvious “stasis of the ligaments and veins” to see the symptoms, while clinically, as a chronic and persistent chronic disease, the disease is not cured for a long time, and “the disease enters the ligaments for a long time “In clinical practice, leukoaraiosis, as a chronic and persistent chronic disease, is not cured for a long time, and “the disease enters the luo”. BD is not only characterized by clinical symptoms of “stagnation of blood vessels”, but also by pathological changes in Western medicine. On the one hand, modern medicine confirms that the basic pathological change of leukoaraiosis is “vasculitis”, with increased vascular permeability, damage to vascular endothelial cells, and accumulation of inflammatory cells, releasing excessive constricting substances and various inflammatory mediators, such as endothelin and prostaglandin E2 (PGE2). The thrombosis and stagnation of blood flow in microcirculation, which is called “blood stasis and blockage” in Chinese medicine. On the other hand, BD, as a systemic vasculitis, not only involves the mouth, eyes and genitalia, but also involves the skin, mucous membranes, joints, cardiovascular tract, gastrointestinal tract, nervous system, lungs, kidneys and other systems and organs along the vascular pathway, and this clinical distribution is quite consistent with the distribution of ligaments in TCM. Qing? Yu Jiayan, “The Law of the Medical School? The theory of luo-vessels: “Twelve meridians give birth to twelve luo, twelve luo give birth to one hundred and eighty system luo, the system luo branches into one hundred and eighty winding luo, winding luo branches are connected to thirty-four thousand sun luo, and there are winding trips between sun luo.” This understanding of Chinese medicine is basically similar to the understanding of Western medicine on the branching of blood vessels, such as the medium and small blood vessels from large blood vessels, which are subdivided into micro-vessels and micro-circulatory arteries and veins, maintaining the normal blood circulation of the body. The basic pathological change of BD is systemic vasculitis, and the characteristics of local microcirculation obstruction, slow blood flow and thromboembolism are similar to the characteristics of “stagnation of blood vessels” in Chinese medicine, so BD can be understood as a part of luo disease. Therefore, the treatment should not be confined to the traditional Chinese medicine idea of “clearing heat, removing dampness and detoxifying toxins”, but should grasp the basic contradiction of “systemic vasculitis – stagnation of ligaments and veins” and treat the ligaments. How does the vascular lesion of BD develop? Modern medicine believes that the vasculitis of BD is caused by autoimmune abnormalities, with local inflammatory cell infiltration and the release of various inflammatory mediators and chemokines, such as tumor necrosis factor-α (TNF-α), interleukin-8 (IL-8), interleukin-6 (IL-6), interleukin-10 (IL-10), interleukin-12 (IL-12), and soluble interleukin 2 receptor (IL-12). The immune complexes and various autoantibodies (e.g. anti-endothelial cell antibodies, anti-oral mucosal cell antibodies, anti-keratin antibodies, anti-neutrophil cytoplasmic antibodies, anti-cardiolipin antibodies, etc.) are also seen. From the perspective of Chinese medicine, the above pathological products can be understood as “toxic evil”. “Toxins” are substances that have adverse effects on the physiological functions of the body, including external and endogenous toxins, such as bacteria, viruses, various kinds of pollution, etc. Endogenous toxins refer to the waste products produced by the body during metabolism and various pathological products in the process of disease development, including various inflammatory mediators, cytokines, autoantibodies, immune system, etc. produced in the inflammation process. Cytokines, autoantibodies, immune complexes, etc. “Toxic” evil infiltrates the human body, affecting the flow of qi and blood, stagnation of blood vessels, and all kinds of diseases, as the saying goes, “no evil is toxic, heat from poison, change from poison, stasis from poison”. The stagnation and blockage of blood circulation in the ligaments and veins, the overflow of water and fluid, and the accumulation of dampness, are consistent with the changes in the local vascularity of BD lesions, edema and exudation. Therefore, its pathogenesis is summarized as follows: autoimmune abnormality → toxicity → stasis → dampness. 2. The characteristics of the medication used in the condemned formula —- regulate immunity, detoxify and pass the luo Because of the homogeneity of “veins and luo” and small and medium-sized blood vessels, including microvessels, especially microcirculation, and the consistency of luo-vascular lesions and microcirculation disorders, the treatment of “improving microcirculation disorders in leukoaraiosis” and “pass the luo” is consistent with the treatment of BD. This provides a theoretical basis for the treatment of “improving microcirculatory disorders” and “enlightenment”. Prof. Fang Dingya started from the pathological changes such as “immune vasculitis, inflammatory cell infiltration, inflammatory factor release, local edema and exudation”, combined with “oral ulcers, genital ulcers, uveitis, nodular erythema, skin ulcers (especially scrotum), sepsis (acupuncture reaction: pustules after pricking the skin with acupuncture needles), and joints. The clinical characteristics of the disease include: swollen and painful joints, thrombophlebitis or thrombosis, hemorrhage, etc. It is believed that the main channel and hub of BD vasculitis is the “diseased luo”, and the location of the disease is in the “luo-vessel”. “The cause of ligament damage lies in the “deep stagnation of toxins and stasis in the ligaments due to immune abnormalities”. Therefore, the focus of treatment is also on the “diseased luo”, and the legislation is to “detoxify and invigorate blood, remove dampness and open the luo”. In view of the fact that dampness, heat, toxicity, stasis and other pathological products in the luo are caused by immune abnormalities, it is necessary to clear heat, detoxify and open the luo from the perspective of regulating immunity. The “diseased luo” includes poison, heat, stasis, dampness, and luo damage; among them, “heat and poison into the luo” is the root cause of the luo disease that is difficult to be cured for a long time. Early normalization of abnormal immune response and complete removal of dampness, heat, stasis and toxicity is a crucial step to prevent inflammatory changes in the blood vessels of the whole body. In addition, “removing the toxins” and “opening the ligaments” are mutually beneficial, as removing the toxins helps the normal operation of blood circulation, while “improving microcirculation, invigorating blood and opening the ligaments” helps local edema and exudation dissipate, and helps a variety of inflammatory diseases dissipate. The “improving microcirculation and invigorating blood circulation” can help local edema and exudation dissipate, and help the absorption of various inflammatory factors. 3. case example Lin, female, 60 years old, visited the clinic on 2009-3-30 mainly because of “recurrent mouth ulcers for 25 years”, with the following symptoms: monthly episodes of mouth ulcers, now there are ulcers in the mouth and lips, sharp pain, vulva ulcers and itching, eye swelling and pain, self-conscious blurred vision, but no eye ulcers, headache and dizziness, frequent stomach pain, dry stool, red tongue with yellow fur, and a red tongue. He has a dry stool, a red tongue with yellow coating, and a thin pulse. He had been diagnosed as having leukoaraiosis syndrome for 25 years and was treated with hormones, cyclophosphamide, and reactive stop, but his symptoms were relieved for a time. Because of the clear diagnosis, Master Fang immediately used the special formula “Licorice Detoxification Tang” plus reduction: 8g raw licorice, 8g roasted licorice, 30g silver flower, 20g Radix et Rhizoma Ginseng, 20g Radix Angelicae Sinensis, 30g Radix Scutellariae Sinensis, 10g Radix Scutellariae Sinensis, 9g dried ginger, 6g Radix Panax quinquefolium, 10g Radix et Rhizoma Pleurotus, 20g Plantago ovata, 20g Antifungus, 12g Pedicel, 3g After 7 doses of the medicine, the oral ulcer was The pain disappeared, vulvar ulcer and scratching sensation was reduced, eye distension and headache and dizziness were relieved, vision was improved, acupuncture response, stool was not dry, tongue was light, petechiae, moss was yellow, pulse was thin. The above formula was changed to 6g each of raw roasted licorice, remove dried ginger, add 12g of bitter ginseng and 30g of raw gypsum, and take 14 more doses, the ulcer surface was basically healed, only slightly red locally, no pain, and no discomfort. No recurrence at 1 year follow-up. The “Su Wen Yin Yang Ying Xiang Da Lun” says: “The treatment of disease must be sought at the root”, and “Su Wen Ben Ben Disease Transmission” says: “Those who know the root cause of everything, do not know the root cause, is delusional”. Mr. Fang believes that the cause of Leuko’s disease is multifaceted and complex, involving multiple systems and organs, but to explore the root of the disease, from the perspective of Western medicine, it is in the “immune vasculitis”, and to analyze the theory of Chinese medicine, it is “poisonous heat injury to the complex”, which becomes ulcers or nodules in different parts. Therefore, from the perspective of “regulating immunity and improving microcirculation”, combined with modern Chinese medicine pharmacological research results, tested in the clinic, after continuous practice and summary, refined a series of Chinese medicine with clear “regulating immunity and improving microcirculation” efficacy, and created a special formula “Glycyrrhiza Detoxification Soup” to “detoxify and invigorate the blood, remove dampness and open the ligaments”. The formula consists of raw licorice, roasted licorice, silver flower, xuan ginseng, angelica, adzuki bean, child’s tea, white flowered snake’s tongue herb, tiger’s stick, raw astragalus, etc. Fang Lao’s Glycyrrhiza Detoxification Soup is based on the formula “Si Miao Yong An Tang combined with Radix Angelicae Sinensis”, which is a traditional Chinese medicine remedy for vasculitis such as gangrene, and Fang Lao uses “Si Miao Yong An Tang combined with Radix Angelicae Sinensis” to disperse the poisonous heat in the Blood Mansion and treat vasculitis. Research shows that: Si Miao Yong An Tang has the effect of improving peripheral circulation, reducing capillary permeability, anti-inflammatory and regulating immunity; it can significantly reduce the content of PGE2 in inflammatory tissues. The extract of honeysuckle can significantly inhibit T cell activation and proliferation, and significantly reduce the expression of TNF-α and NF-κB p65 [3]. The cyclic enol ether terpenoids contained in Radix et Rhizoma Ginseng [4] promote humoral immunity and macrophage function, which contribute to its anti-infection properties and may be one of the pharmacological bases for its “detoxification and anti-canker sores”; its chemical constituents, phenylpropanoid glycosides, have strong anti-inflammatory effects. Red bean can activate the blood and detoxify the toxin, and adzuki bean and angelica can be used to treat “eye redness like a turtledove’s eye”, and adzuki bean porridge can be taken regularly to prevent the onset of leukoaraiosis; red eyes are mostly conjunctivitis, iritis, uveitis lesions, and their pathology is mostly allergic vasculitis, and since adzuki bean has a preventive effect on it, in the same way, Fang Lao often uses adzuki bean to treat Vasculitis is effective. Angelica reduces vascular permeability, promotes the clearance of antigens and immune complexes, and has a significant inhibitory effect on acute and chronic inflammation caused by various inflammatory agents. According to Mr. Fang, the use of licorice can detoxify; secondly, licorice itself contains steroid hormone, which has good effect on regulating immunity and inhibiting inflammation; thirdly, it can improve microcirculation, and in clinical practice, Mr. Fang also often used a large amount of raw licorice pounded with oil for external use to treat diabetic gangrene. Modern research has shown that licorice extract Lx50 has adrenocorticotropic hormone-like effects, inhibits antibody production and has anti-inflammatory effects; licorice sweetener inhibits the production of inflammatory mediators IL-6 and TNF-α by peripheral blood mononuclear cells. It is now believed that certain pathogenic microbial antigens and heat shock proteins, among other factors, trigger the body’s immunity in people with human leucocyte antigen-B51 (HLA-B51) gene and other specific genetic qualities. This triggers immune dysfunction and neutrophil hyperfunction in people with HLA-B51 gene and other specific genetic qualities, which leads to vascular endothelial cell damage and vasculitis, resulting in extensive and complex clinical manifestations of BD. B. alba promotes the function of mononuclear phagocytes and resists viral or bacterial infections, which provides the immunopharmacological basis for its “clearing heat and detoxifying” and anti-immune inflammatory damage. The effective component of Astragalus membranaceus, resveratrol glycoside, significantly inhibits the early respiratory burst of human neutrophilic leukocytes, inhibits the release of lysozyme and hydrogen peroxide from neutrophils, inhibits the chemotaxis and aggregation of neutrophils, thus reducing inflammatory damage. Astragalus has a two-way regulatory effect on the body’s immunity, whether it promotes or inhibits depends on the dose of the drug used and the immune status of the body. According to Mr. Fang, raw Astragalus regulates immunity and is effective for autoimmune diseases that are weak and have a long duration of illness, and the combination of “raw Astragalus, Astragalus alba, and tiger scepter” can supplement qi to regulate immunity. In clinical practice, many BD patients show “heat accumulation in the gastrointestinal tract”, which is characterized by sticky or dry stools, distention and fullness, red tongue with yellow coating, and slippery pulse, and those with heat in the gastrointestinal tract are prone to mouth sores. Therefore, it can also be used to clear the accumulated heat in the intestines and stomach, as in the case of licorice diarrhea. For those with dry and cracked lips and mouth ulcers, it is common to add Plantago ovata, Fanfeng, gypsum, Scutellaria baicalensis and Huanglian to clear stomach fire. Neutrophil hyperfunction is the most significant feature of BD inflammation, so for those with heavy ulcers of leukoaraiosis, long-standing oral ulcers or vulvar ulcers, or even intestinal ulcers with localized lumps and obvious abdominal pain, Fan Lao often used Shanci mushroom to clear heat and detoxify and regulate immunity, or Shanci mushroom and Danshen in combination. According to Fang, the mushroom contains a large amount of colchicine, which can inhibit the chemotaxis of neutrophils. Tanshinone can inhibit leukocyte chemotaxis and has anti-inflammatory and anti-allergic effects. The combination of Salvia miltiorrhiza injection and colchicine can make most BD patients’ blood anti-lymphocyte antibodies turn negative and the number and morphology of lymphocytes return to normal, thus correcting the immune dysfunction of BD patients. “The heart is open to the tongue. Therefore, for heavy mouth ulcers, bamboo leaves are often added to clear the heart fire. If genital ulcers are obvious, add Zedoary and Bitter Ginseng; if eye symptoms are obvious, add Wild Chrysanthemum and Gou Jing Cao. In summary, although licorice detoxification soup does not have many flavors, but it is in line with both Chinese medicine and Western medicine pharmacology, from the perspective of Chinese medicine, it can “clear heat and detoxify, activate blood circulation”, from the perspective of Western medicine, it can “regulate immunity, inhibit inflammation and improve microcirculation”, so every use is effective. Although few people are cured, most of them are effective. He believes that the development of any discipline is to keep pace with the times, and to develop Chinese medicine, it should not be always in the traditional cycle of “yin and yang, five elements, internal organs and meridians, cold, heat, deficiency, fluids and blood”, but should make full use of modern technology, combined with Western medicine on the etiology of disease, pathological changes and modern Chinese medicine pharmacological research results, comprehensive understanding of disease, accurate treatment of disease. We should make full use of modern science and technology, and combine western medicine’s research on disease causes and mechanisms, pathological changes and modern pharmacological research results of Chinese medicine to understand diseases and treat them accurately. The true combination of Chinese and Western medicine is not a simple superposition of two therapies, but the use of modern research results on disease causes, pathogenesis, pathology and pharmacology in clinical practice, combined with the traditional Chinese medical understanding of disease and Chinese medicine, in continuous practice to improve, refine and summarize, which not only helps to improve the treatment of difficult diseases, but also helps to enrich and improve the theory of Chinese medicine.