1. Rheumatoid arthritis A female, 56 years old, accountant, with polyarticular swelling and pain for 6 years, aggravated for more than 1 month. The patient developed pain and swelling in the proximal interphalangeal joints and metacarpophalangeal joints of both hands in May 1989 with no obvious cause, without treatment. Three months after the onset of the disease, the condition gradually worsened, and the pain extended to both knee joints and both elbow joints, with restricted movement and morning stiffness for about half an hour. After the onset of the disease, he was not treated systematically, but took medication on his own, and the joint symptoms were sometimes mild and severe. In the past month, the pain was aggravated by cold, and he could not move around, so he went to our hospital for Chinese medicine treatment. The patient had pain and swelling in the proximal phalangeal joints and metacarpophalangeal joints of both hands, the skin of the painful joints was dark, the local skin temperature was not high, the ends of the fingers of both hands were cold, accompanied by pain in both knee joints and elbow joints, limited movement, morning stiffness for 1.5 hours, there was no pain in other joints of the body, the face was yellowish, tiredness and weakness, aversion to cold and warmth, no fever, dry mouth, oral ulcers, erythema, photosensitivity, hair loss, sleep was fine, urination and defecation were normal. The tongue is light red with thin white coating, and the pulse is sunken and thin. He had a blood sedimentation of 50 mm/h, rheumatoid factor of 40 ku/l, C-reactive protein of 180 ug/l, serum anti-nuclear antibody (C), X-ray of both hands: osteoporosis, narrowing of joint space, bone erosion, consistent with rheumatoid arthritis changes. Diagnosis: rheumatoid arthritis. TCM evidence: deficiency of both spleen and kidney, blood stasis and dampness obstruction. Treatment includes tonifying the kidneys and strengthening the spleen, activating blood circulation and resolving blood stasis, and adjuvantly dispelling wind and dampness to promote circulation and relieve pain. Prescription: Astragalus membranaceus 60g, Radix Codonopsis pilosulae 15g, Rhizoma Atractylodes Macrocephalae 10g, Semen Coicis 30g, Radix Spleen 15g, Radix Bacopa Monnieri 10g, Fructus Lycii 10g, Semen Cuscutae 10g, Radix Achyranthes Macrocephalae 10g, Radix Papaya 10g, Rhizoma Atractylodes Macrocephalae 15g, Radix Erythrinae 15g, Radix et Rhizoma Gynostemma 15g, Radix Curcuma longa 10g, Radix Angelicae Sinensis 10g, Radix Angelicae Sinensis 15g, Radix et Rhizoma Xu 15g, Radix Zedoariae 15g, Radix Glycyrrhiza Uralensis 7g Take 7 doses of this medicine with water. After taking the medicine, the pain and swelling were obviously relieved, and he was able to move around, and the dampness was gradually removed, but the deficiency was real. Each time the above formula 10 payments, add Fu Ling 200g, 200 g of pine knots, 150g each of mulberry and Gui Zhi, 20g each of deer antler and deer tendon (finely grinded into the paste), water decoction 3 times, blend the boiling juice filtered through the dregs, boiled with rock sugar into a paste to collect the paste for use. Take 9g each time, 3 times a day for 6 months. The symptoms gradually disappeared, the swelling disappeared, and the activity was free. The rheumatoid arthritis belongs to the category of palsy, rheumatism, and nagging paralysis in Chinese medicine, and is a difficult disease to treat. In this case, the patient was characterized by swelling and pain at the fingertips, morning stiffness, and local skin darkening of the joints, and black kidney deficiency, so the case should be based on deficiency of the spleen and kidney, and internal obstruction of rheumatism as the symptoms. Rheumatoid arthritis is a disease of persistent paralysis, and we believe that kidney deficiency is the root of the disease. As the “Suwen” said: “kidney water, and born in the bone, the kidney does not produce the marrow can not be full, so the cold even to the bone …… disease is called bone paralysis, is the person when the contracture also.” Because the kidney collects the essence, the main bone marrow, for making strong official, liver and kidney of the same origin, the common nourishment tendons and bones, kidney deficiency, the marrow can not be full, the true qi failure, the three gas of evil to penetrate, the inner shed in the kidney. And the kidney is the path of cold water, cold and dampness of the evil deep attack into the kidney, long depression and heat, dampness and heat of the evil paralysis blocked meridians, stay injected joints, tendons and bones lose nourishment, gradually to tendon contracture bone loose, joint deformation can not flex and extend. Therefore, the key to the treatment of this disease is to seize the method of kidney, the kidney is full of vitality, full of kidney essence, since the evil can be dispelled out, tendons and bones key, inevitably smooth joints, the cold will not flow to go, wet and stagnant blood from the birth, why suffer from stubborn paralysis is difficult to heal? 2, degenerative osteoarthropathy A male, 67 years old, a retired cadre, was seen on October 8, 2005. He had painful swelling in both knees for more than 7 years. 7 years ago, he found pain in both knees for unknown reasons and had difficulty walking, which gradually improved with symptomatic treatment. The pain was gradually improved with symptomatic treatment. After that, the pain was severe in the cold season of autumn and winter, and slightly relieved in the hot season of spring and summer, and aggravated after exertion and relieved after rest. Current symptoms: The patient had painful swelling in both knees and a slight limp when walking, the right knee was more swollen, the left knee was slightly less swollen, the medial joint space and tibial condyle of the right knee had obvious pressure pain, floating patella test (+), jerk patella test (+), knee movement was 5° anterior extension and 90° posterior flexion, the left knee movement was slightly limited. The left knee patella has slight hyperplasia on the upper and lower margins and intercondylar ridge, and the whole bone shows laxity. The tongue is pale, the fur is thin and white, and the pulse is sunken and thin. The diagnosis of osteoarthrosis of both knees is due to deficiency of qi and blood, deficiency of liver and kidney, loss of nourishment of tendons and bones, and paralysis of blood vessels. The treatment is to benefit the Qi and invigorate the Blood, promote the circulation of the meridians, warm the Yang and remove the paralysis. This formula is based on Astragalus membranaceus and Cinnamomum vitae Tang with addition. Prescription: Astragalus membranaceus 40g, Radix Astragali 15g, Cornu Cervi Pantotrichum 15g, Radix Angelicae Sinensis 15g, Radix Paeoniae Alba 20g, Cortex Eucommiae 10g, Rhizoma Dioscorea 20g, Radix Panax Notoginseng 10g, Radix Achyranthes Bidentatae 15g, Radix Sinensis 6g, Rhizoma Ligustici Chuanxiong 10g, Rhizoma Allium 6g, Radix Ginger 10g, Radix Zizao 6g. After taking the medicine, the pain was significantly reduced, the swelling gradually subsided, and the activity was improved compared with before. In order to consolidate the efficacy, the patient was advised to take the medicine for a long time, and to reduce the tediousness of daily decoction, the patient was given a cream formula for treatment. Prescription: Astragalus membranaceus 300g, Radix Astragali 150g, Cornu Cervi Pantotrichum 150g, Radix Angelicae Sinensis 150g, Radix Paeoniae Alba 200g, Cortex Eucommiae 100g, Rhizoma Dioscorea 200g, Radix Panax Notoginseng 100g, Radix Achyranthes Bidentatae 150g, Rhizoma Ligustici 60g, Rhizoma Ligustici Chuanxiong 100g, Rhizoma Alliaceae 60g, Rhizoma Ulmoides 100g, Rhizoma Dioscorea 150g, Radix Papaya 150g, Radix Angelicae Sinensis 150g, Radix Ginger 100g, Radix Ziziphi Jujube 60g. Decocted 3 times with water, mixed and concentrated, added 150g of honey, 100g of deer horn gum, 150g of turtle shell gum and 100g of Panax ginseng powder to collect the paste. 15g of the medicine was taken every morning and evening for 3 months, the pain disappeared and the walking activity was as normal. The pain disappeared and the walking activity was as normal. There was no recurrence at the follow-up. Note: Huangqi Gui Zhi Wu Wu Wu Tang is from “Jin Kui Yao”, and is used to treat blood paralysis, which is characterized by numbness of the skin and astringent and tight pulse. Degenerative osteoarthrosis, which belongs to the category of paralysis in traditional Chinese medicine, is caused by a variety of factors that lead to the destruction of articular cartilage, including the disruption of load transmission in the knee joint, the action of articular cartilage enzymes, free radicals, cytokines on the joint, and autoimmune reactions, resulting in the inhibition of the synthesis of proteoglycans in articular cartilage and the destruction of collagen fibers. As a result, the cartilage loses its elasticity, the hydraulic permeability increases and the pressure on the cartilage cells increases, the catabolic enzymes increase, the lubrication decreases and the articular cartilage surface is destroyed. According to Chinese medicine, the main mechanism of this disease is the deficiency of liver and kidney, loss of harmony of qi and blood, or feel wind, cold and dampness, or due to fall and injury, resulting in local qi and blood is not smooth, the veins and collaterals are paralyzed and blocked, so the tendons and bones lose moistening, joint cartilage destruction and make the joint movement unfavorable. Huang Qi and Gui Zhi Wu Wu Wu Tang has the effect of benefiting the temperature and meridians, and the effect of harmonizing the Ying and Tong Tong paralysis, which is exactly the pathological mechanism of this disease, so it is used to treat this disease with the addition of flavor, and it really has the effect of harnessing a hundred. The formula is based on Astragalus, Cornu Cervi Pantotrichum, and Weilingxian to benefit the qi and replenish the yuan, expel cold and dampness; Angelica and Peony to nourish the blood, nourish the blood and also harmonize the camp and expel paralysis; Gui Zhi and Shanjia to warm the meridians and help the yang to open the channels, Gui Zhi is good at reaching the limbs, meridians and joints, Shanjia is good at running, the limbs, meridians, muscles, tendons and bones are nowhere to be found, and then with Ox Knee, Dog Knee and Papaya to lead the meridians to the disease, so that the qi can move the blood, the tendons and bones can be nourished, the blood vessels can be opened, then the The pain disappears, and the joints are smooth, easy and flexible, and the patient can walk as usual. It is important to insist on the use of medicine for this disease, and if the evidence is accurate and the prescription fits the disease mechanism, we will definitely get good results. It is worthwhile to promote the use of this medicine because it is not only beneficial to the long-term use of medicine, but also reduces the trouble of long-term decoction and saves the resources of Chinese medicine.