Ankylosing Spondylistis AS is a systemic disease of unknown origin, mainly characterized by chronic inflammation of the medial joints, with a prevalence of about 0.3% according to domestic literature. The main pathological changes are calcification of the joints and peri-articular tissues, ligaments and intervertebral discs, and eventually bony ankylosis (in fact, spinal ankylosis is only seen in advanced and severe cases, but not in mild cases). Since the discovery of the disease in the late 19th century, the understanding of the disease in Western medicine has been rather vague, and the nomenclature is therefore confusing. In the past, the disease was often referred to as deformational spondylitis, articular stiffness spondylitis, ossifying pelvic spondylitis, adolescent spondylitis, rheumatoid arthritis, or as rheumatoid arthritis central type. The etiology and pathogenesis of AS have not yet been clarified, but with the development of immunology and its sub-disciplines in recent years, the etiology and pathology of AS has been studied in depth, and it is now believed that the pathogenesis of AS is mainly related to HLA-B27 and chronic infections. In the late 1940s, Kellgren and West discovered a tendency for the disease to cluster in families. In the past half century, with the in-depth study of HLA, HLA-B27 and its subtypes were found to be closely related to the development of AS. Chinese scholars, Liu Fenghua and Hu Xiaochen, by exploring the gene structure characteristics of Han Chinese subtypes of AS patients, concluded that B-2704 and B-2705 of HLA-B27 are the main pathogenic genes of AS. And for the first time, Houshan Lu et al. at the People’s Hospital of Beijing Medical University in China successfully established a mouse model of HLA-B2704 transgenic-related disease, which laid the foundation for further research on the pathogenesis and experimental treatment of human spondyloarthropathies. Infection has been considered as a possible causative or predisposing factor for AS. Currently, two types of infections are mainly considered to be associated with AS: chronic genitourinary infections and intestinal infections. Ebringer et al. found that the detection rate of KP bacteria in AS patients was 79%. In China, Huang Feng et al. found a strong correlation between KP bacteria and the development of AS. Based on the above understanding of AS, western medicine lacks specificity in treatment due to unknown etiology, and currently emphasizes early detection, timely administration of NSAID drugs to control symptoms, and application of immune agents such as MTX, SASP, and Radix et al. for more than 3 to 4 years to control the disease. There is no name for AS in Chinese medicine, but according to its clinical manifestations, it belongs to the category of “paralysis” in Chinese medicine. In terms of the etiology of the disease, medical practitioners have believed that there are no internal or external causes. In the case of the external evil causing the disease, “Su Wen? The theory of paralysis” points out: “wind, cold, moisture three gas mixed to, combined for paralysis.” It is also believed that “diet and residence are the basis of the disease.” It is suggested that diet and environmental factors have a certain relationship with the occurrence of this disease. The deficiency of vital energy as an internal cause is an important factor in the development of the disease. As the waist is the house of the kidney, and the kidney is the master of bone and marrow, a kidney deficiency results in clinical pain in the waist, swelling and pain in the hips and knees, and unfavorable joints. Bone paralysis has been blamed on the kidney for generations of medical practitioners. In the Su Wen? The “pulse to the essence of the theory”: “waist of the kidney of the house, turn shaking can not, the kidney will be exhausted.” The “Theory of Palsy” says: “Bone paralysis has not been, and again feel in the evil, within the shed in the kidney, kidney paralysis, good swelling, the tail to replace the heel, the spine to replace the head” description of the wonderful, test the clinical is very appropriate. The ancestral medical text is as vast as a sea of smoke, and most of the discussion on this disease is from this. Contemporary famous rheumatologist Mr. Jiao Shu De explores the source and stream, collects all the theories, quotes the scriptures, and proposes to name AS Chinese medicine as “big hunchback”, taking “Nei Jing? The “Theory of the Breath”: “Yang Qi …… can not open and close, cold Qi from the meaning, it is a big hunchback”, this proposal has been generally recognized by the Chinese medical profession. According to the ancient and modern understanding of AS, combined with our many years of clinical experience in the diagnosis and treatment of AS, the evidence and treatment of AS from the kidney is discussed as follows: I. Etiology AS is mostly seen in adolescents, the age of onset is mostly between 10 and 40 years old, the onset is rare after 40 years old. At this time, when the kidney is full of energy and the essence is full of marrow, the back pain, weakness, and even hunchback is strong and straight, which means that the innate endowment is insufficient, and the deficiency of kidney energy is the primary factor of the disease; and the Governor’s Vessel supervises the Yang of the whole body, so the deficiency of kidney Yang causes the void of the Governor’s Vessel, which cannot fill the bone marrow and moisten the meridians, and the tendons and bones are not nourished. AS has an insidious onset and has the clinical characteristics of temporary remission, recurrent attacks, constant aggravation, gradual dysfunction, and deformity and disability. This is closely related to the deficiency of the kidney in the patient’s body and the inability of the innate kidney energy to control the yang of the body and protect the body against evil, and the damage to other internal organs over time. The liver and kidney are of the same origin and nourish each other. A deficiency of kidney energy will damage the liver in the long term. Liver is the master of tendons, bones and joints, kidney deficiency of water does not contain wood, can lead to deficiency of liver yin, tendons and veins lose nourishment, can not bundle the joints, tendons and veins m flexion, joint contracture; liver also opens the orifice in the eyes, liver yin deficiency of eyes loss of moistening, can appear eyes astringent, red, pain and other symptoms. The spleen is the master of the central state, the master of the limbs and muscles, and the spleen yang is warmed by the kidney yang. Insufficient kidney yang, spleen yang is also deficient, the water and grain essence is not transported and transformed, insufficient qi and blood, which can lead to a thin body, muscle atrophy, poor energy and other symptoms. Kidney deficiency is a long-standing disease of the son and mother, and kidney deficiency is not able to take in qi, the lung loses suction and lowering, then qi reverses on the top, resulting in shortness of breath and chest tightness, shortness of breath when moving, or coughing, coughing and sputum. The heart is a fire organ. Insufficient kidney water cannot nourish the heart yin, and loss of nourishment for the heart and mind or exuberant heart fire can lead to palpitations and palpitations, irritability and insomnia. To sum up, the etiology of this disease is mainly due to kidney deficiency and the feeling of external evil as the symptoms, because the kidney is the root of the innate nature, the main bone and marrow, kidney energy is sufficient to fill the bone and marrow, tendons and bones are strong; the supervisory vein is the main supervisor of all the yang in the waist, the kidney is deficient and the supervisor is not able to inspire the yang energy to protect the body against evil. If the wind, cold, dampness of the evil invade the body, then paralysis of the meridians, Qi and blood is not smooth, tendons and bones without nourishment and disease. This is similar to the doctrine of human genetic constitution or variation and the triggering of infection and environmental factors proposed by modern medicine. Clinical characteristics and typology AS takes the sacroiliac joint as the initial site of invasion, and about 40% of them first show the involvement of sacroiliac joint, and gradually develop in an upward direction, invading the lumbar, thoracic and cervical vertebrae in turn. The early manifestations are lumbar, hip and groin distension and discomfort, which are characterized by insidious occurrence, often hidden pain that is difficult to locate, and pain that is heavier in the morning and relieved after activity. Some patients have pain at night, which affects sleep and requires them to get out of bed before they can go back to sleep. If the lumbar spine is involved, there is lumbar pain, stiffness, and limitation of forward and backward, left and right activities. If the thoracic spine is involved, back pain, anterior and lateral chest pain, restricted mobility of the chest, and shortness of breath when moving are manifested. Involvement of the cervical spine may result in strong cervical pain, inability to turn the head, and inability to hold the head up and look down. In addition to the above-mentioned central joint symptoms, more than 50% of patients with AS may develop peripheral joint symptoms, and about 20% of patients have peripheral joint symptoms for the first time, especially the large joints of the lower limbs are most frequently involved. The younger the age of onset, the higher the rate of hip joint involvement, and hip joint involvement and destruction often leads to disability. In addition, AS can also cause extra-articular manifestations such as eye, heart and kidney, and systemic symptoms such as low fever, weakness, anorexia and emaciation. According to the above clinical characteristics, combined with the understanding of the etiology and pathogenesis of AS in Chinese medicine, in clinical practice, we propose to divide it into three types of evidence and treatment. 1. Central type (bone paralysis type): The main pathogenesis is kidney deficiency and cold in the governor, and evil blocking the ligaments. The onset of the disease is insidious, with pain in the lumbosacral region, stiffness of the back in the morning, difficulty in tilting and turning, aversion to cold and warmth, activity or pain reduction when exposed to warmth, weakness of the extremities, dullness and emaciation, cold scrotum in men and cold and slippery leucorrhoea in women; the tongue is pale with thin white fur or white greasy, and the pulse is sunken and stringent or the ulnar pulse is sunken and stringent and weak. 2. Peripheral type (luo paralysis type): The main pathogenesis is kidney deficiency and pulse blockage, and heat is caused by the depression of evil. The onset of the disease is sudden, with pain in the hip, knee and ankle, unfavorable movement, or even redness, swelling, burning, stiffness or pain in the lumbar spine, accompanied by low fever, bitterness in the mouth and distress in the heart, redness and pain in the eyes, fullness in the chest and epigastrium, yellowish red urine and dry stool; red tongue with yellow or yellowish greasy coating, moist pulse or sunken string. 3.Prolonged type (persistent paralysis type): The main pathogenesis is liver and kidney deficiency, blood stasis and paralysis, and loss of nourishment of tendons and bones. It is common in patients with recurrent or prolonged disease, with pain in the back and neck, ankylosis of the spine or hunchback deformity, chest expansion, palpitation and shortness of breath, pain in the hips and knees, and unfavorable movement; in the later stages, even the bones are withered, the flesh is atrophied and the tendons are shrunken, rickets are disabled, often accompanied by distress and insomnia, fever in the heart, spermatorrhea and night sweating; the tongue is red with little coating or dull, with petechiae and petechiae, and the pulse is sunken and fine or sunken and stringent. AS is mainly due to the deficiency of kidney and the void of the governor, and the feeling of external evil is the symptom, so the treatment of this disease should be based on tonifying the kidney and strengthening the governor, complemented by activating the blood vessels, strengthening the tendons and bones, dispelling wind and removing dampness, opening the tendons and activating the joints. In recent years, many doctors have used Chinese herbal medicines such as Leigongteng, Yang Jinhua, Ma Qianzi and Ant to carry out the treatment of AS with certain clinical efficacy, but there is a lack of control and control of bone destruction observation. In long-term clinical practice, we found that the treatment of this disease should not only relieve the symptoms, but also focus on controlling bone and joint destruction and promoting bone repair. After more than three years of clinical application, we have achieved satisfactory results in protecting bone joints and promoting bone repair for patients in the early and middle stages of AS. ”The formula is based on deer antler, dog’s spine, epimedium and bacopa monniera to strengthen the kidney, mulberry, peony, santonin, papaya and bonesetter to soothe the tendons and strengthen the bones, chicken blood vine, Chuanxiong, scorpion and dragon to invigorate blood circulation, and lianduo vine, qingfeng vine, leigong vine, hosin and wei lingxian to dispel dampness and remove paralysis. For the central type – for kidney deficiency and cold in the governor, add Cao Wu, Pithospermum, Gui Zhi, Deer Cnidium as appropriate; for dampness, add Job’s Tears, Fang Qi, and Stiffle. Peripheral type – Add Atractylodes, Phellodendron, gypsum, Poria. In case of prolonged type – liver and kidney deficiency, blood stasis and paralysis, add Radix Rehmanniae Praeparata, Radix Angelicae Sinensis, Rhizoma Polygonatum, Rhizoma Polygonatum, Rhizoma Polygonatum, Rhizoma Polygonatum, Rhizoma Polygonatum, Rhizoma Centipede, Rhizoma Polygonatum; in case of yin deficiency and fire, add Artemisia, Rhizoma Polygonatum, Rhizoma Dioscorea. In advanced cases of joint destruction and loss of function, surgery should be performed.