Although there is no specific treatment for ankylosing spondylitis, early treatment can relieve pain and reduce spinal ankylosis, inhibit the development of symptoms, prevent deformities, late treatment lies in the correction of deformities and treatment of complications, if the early patients, should be instructed not to always rest in bed, but to sit as straight as possible with their backs against the chair, if necessary, according to the situation can stand straight back, to sleep on a hard bed, not pillows, so as not to deform the spine and cervical spine The disease, as with other inflammatory diseases, should be appropriate rest, rest period to carry out appropriate activities, walking, never to bed all day, sleep at night, available sedatives to promote sleep.
1, the principle of treatment of ankylosing spondylitis treatment is to alleviate pain and stiffness, a study showed that after 20 years of ankylosing spondylitis patients, more than 85% of patients still have pain and stiffness every day, more than 60% of patients need to take medication, patient education is essential for successful treatment, patients must understand that although pain and stiffness, through appropriate non-steroidal anti-inflammatory drug treatment will Patients must walk upright, do regular back stretches, sleep on a hard bed with pillows and lie flat, preferably on their backs or in a prone position with their backs extended, avoiding curled sides, advise patients to quit smoking, and do regular deep breathing exercises to maintain normal chest expansion. While regular physical exercise and an NSAID drug regimen successfully treat most patients with ankylosing spondylitis, some patients still require antirheumatic drugs for remission.
Cardiac complications may require action valve replacement or pacemaker implantation, and pulmonary apical fibrosis, although not easily managed, rarely requires surgical resection. Cervical spine involvement may result in significant limitation of various neck movements, but the atlanto-occipital and atlanto-axial joints will not be completely ankylosed and may also allow some degree of head rotation and head nodding movements, and special wide-field mirrors are useful for such patients. Similarly, special polygons may increase the number of patients with ankylosing spondylitis due to severe hunchback Total hip replacement can produce good results, partially or completely correcting the patient’s disability due to severe hip pathology, and vertebral wedge osteotomy can be used in patients with severe hunchback, but at a relatively high risk of hemiplegia. fractures, even with relatively minor trauma, including trauma that the patient does not recall. Fracture lines are often transverse, and the cervical spine is the most vulnerable site for fractures, often at the level of cervical 5 to cervical 6 or cervical 6 to cervical 7, and is not easily detected by x-ray. Magnetic resonance imaging is helpful in detecting fractures in any patient with advanced ankylosing spondylitis, once his or her complaints of neck pain or chest pain after a minor injury are Ruling out fractures, fractures may cause spinal discitis (destruction of the disc vertebrae) and pseudarthrosis formation, the incidence of spinal discitis in patients with ankylosing spondylitis is reported to be 5% to 6%, the most common site is thoracic 1 to lumbar 1, but spinal discitis can form spontaneously without trauma, half of the patients are asymptomatic, and some patients need bed rest and local braking rather than exercise to assist in the formation of fibrosis and fusion, which may be one of the few examples requiring fixation with a brace.
2, drug therapy (1) non-steroidal anti-inflammatory drugs (NSAID): the main drug for the treatment of ankylosing spondylitis is still NSAID, both acute onset and in the chronic course, NSAID to improve the symptoms of spinal or peripheral joint disease, all NSAID can alleviate pain (back pain, sacroiliac joint pain, peripheral arthritis-induced pain and intermittent The main problems with NSAIDs remain gastrointestinal side effects and kidney damage, and new drugs with fewer side effects need to be developed. took placebo (n=76), celecoxib (n=80) 100 mg twice/d or ketoprofen (ketobuprofen) (n=90) 100 mg twice/d. Improvement in pain and functional status after 6 weeks was significantly better in both the celecoxib and ketoprofen groups than in the placebo group, and in the celecoxib group, slightly better than in the ketoprofen group.
(2) Glucocorticoids: Oral corticosteroids are worthless in the long-term treatment of ankylosing spondylitis because of their side effects and inability to stop the course of ankylosing spondylitis, persistent tendon telangiectasia and persistent synovitis may respond well to local corticosteroid treatment, and uveitis, which can be better controlled by pupil dilation and eye spotting with hormones, may require systemic hormones or immunosuppressive therapy for refractory iritis. Similarly, CT-guided intra-sacroiliac joint steroid hormone injections are technically feasible for those patients with intractable sacroiliac joint pain. In a 6-month open double-blind-placebo-controlled study in which 10 patients with definite sacroiliac joint inflammation (3 of whom had bilateral pain) participated, ankylosing spondylitis patients were divided into two groups, one with 1.5 ml of long-acting hormone (equivalent to 62.5 mg of prednisone) injected into the sacroiliac joint and the control group with the same volume of saline as a control, with a double-blind evaluation by physicians and patients, respectively (using the V ankylosing spondylitis 10-cm score), which showed that the time to drug onset was 1 to 15 days, with 8/13 patients having an effect within the first 3 days of After the first month of injection, 85% of patients in the drug group achieved good efficacy, and at the sixth month, 58% of patients still maintained remission of sacroiliac joint symptoms, and the pain index decreased by 33% (P<0.05), and the unipedal hopping was the most significant long-term improvement in clinical characteristics in this trial.This study showed that local steroid hormone injections in the sacroiliac joint were well tolerated and efficacious, and compared with the control group, the treatment group The observed indexes of the treatment group were significantly improved, similar to the heel pain-like tendon telangiectasia can also be treated by local injection of steroid hormone, and in recent years there have been some similar reports in China, which have good efficacy in patients with ankylosing spondylitis. < p="">
(3) Palliative drugs: Usually, palliative drugs are rarely used to treat ankylosing spondylitis. They are only considered when NSAID therapy does not satisfactorily control the disease, when the patient is poorly tolerant of NSAID, or when the patient has serious conditions such as extra-articular symptoms.
①Sulfapyridine (SSZ or SASP): SSZ has been widely used worldwide for the treatment of ankylosing spondylitis since 1984, based on the rationale that patients with ankylosing spondylitis have ileal inflammation and a correlation between ankylosing spondylitis and inflammatory bowel disease (Crohn’s disease and ulcerative colitis). The results showed that SSZ (1.0 g, 2 times/d) improved the duration, degree of morning stiffness and low back pain as well as serum IgG levels in patients with ankylosing spondylitis better than placebo, and that people allergic to sulfonamides should not necessarily not take this drug.So far, only SSZ has been proven to be effective in the treatment of ankylosing spondylitis, and the drug is mainly effective in patients with peripheral joints, but not effective in spinal and tendon telangiectasia or Other therapeutic agents (penicillamine, antimalarials, and gold agents) have not been shown to benefit patients with ankylosing spondylitis.
② Methotrexate: a folic acid antagonist widely used in the treatment of RA. Two recent open studies evaluated the efficacy of methotrexate in patients with intractable ankylosing spondylitis. A 3-year study found that 17 patients with ankylosing spondylitis responded well to methotrexate treatment, with only peripheral arthritis and iridocyclitis remaining unchanged, and importantly, imaging did not reveal In another study, which lasted 1 year, the efficacy of methotrexate was observed in 34 patients with ankylosing spondylitis with spinal lesions. 53% of these patients showed improvement in clinical symptoms and a reduction in NSAID dose, with a decrease in ESR, especially in peripheral arthritis symptoms, but no change in spinal symptoms. a placebo-one control trial is needed to determine the efficacy of methotrexate in ankylosing spondylitis.
Pamidronate: Pamidronate is a diphosphonate that inhibits bone resorption and is commonly used in the treatment of metabolic bone diseases (e.g., Paget’s disease, metastatic bone disease, and hypercalcemia) and multiple myeloma. A recent open study evaluated the efficacy of this drug in recalcitrant ankylosing spondylitis. 16 patients were divided into two dose groups. 8 patients in the first group were given 30 mg of pamidronate intravenously once a month for 3 months, followed by 60 mg intravenously once a month for 3 months; 8 patients in the second group were given were given only 60 mg intravenous treatment once a month for 3 months, and the final assessment of the drug on the clinical indicators BASDAI, BASFI and laboratory inflammatory indexes (ESR), such as disease activity and patient function, showed significant improvement in group 1, and in group 2, only BASMI for quantitative assessment of hip and spine mobility showed some improvement, and group 1 hematocrit progressively decreased, with the most significant decrease by the end of the assessment point at month 6. Thus, this study suggests that pamidronate has an anti-inflammatory effect and may improve spinal symptoms in active ankylosing spondylitis, but this was an uncontrolled study, and the above-mentioned investigators then used a double-blind controlled trial to compare another 38 patients with ankylosing spondylitis given 60 mg of pamidronate per month with 10 mg (which is equivalent to placebo ). The study was conducted for 6 months and showed a substantial improvement in clinical and functional indices in the 60 mg dose group without significant changes in their inflammatory indices (ESR, CRP), and the results of this study confirm the previous findings that pamidronate can benefit patients with active ankylosing spondylitis.
④Anti-tumor necrosis factor-α monoclonal antibody: Tumor necrosis factor-α mediates inflammatory and immunomodulatory effects in the immune response. Its effects include activation of lymphocytes, release of other cytokines (e.g. IL-1, IL-6), prostaglandins and metalloproteinases; it also promotes angiogenesis and regulates the role of adhesion molecules. In sacroiliac joint biopsies from patients with ankylosing spondylitis, large amounts of Tumor necrosis factor-α mRNA expression indicates that tumor necrosis factor-α is involved in the pathogenesis of ankylosing spondylitis, and serum levels of tumor necrosis factor-α are higher in patients with ankylosing spondylitis than in patients with non-inflammatory lower back pain. In addition, patients with ankylosing spondylitis and spondyloarthropathy have subclinical intestinal inflammatory lesions similar to those of Crohn’s disease, and anti-tumor necrosis factor-α therapy is effective in Crohn’s disease, therefore The results suggest that anti-tumor necrosis factor-alpha therapy is equally effective in ankylosing spondylitis.
Anti-TNF-α drugs that have been used to treat ankylosing spondylitis include monoclonal antibodies (infliximab), which are chimeric neutralizing monoclonal antibodies on the human/mouse IgG1κ isotype chain. The results showed significant improvements in disease activity, functional and pain scores (BASDAI, BASFI, BASMI) and quality of life, as well as significant reductions in serum inflammatory markers (ESR, CRP and IL-6 levels) in patients treated with Infliximab at weeks 0, 2 and 6. study also used magnetic resonance (MRl) to understand spinal inflammation, and three of the five patients had spinal inflammatory activity at patient enrollment, and dynamic MRI of the spine revealed reduced or no change in inflammation within 6 weeks after three injections.Twenty-one patients with spondylolisthesis participated in another trial, including 10 with ankylosing spondylitis, 9 with psoriatic arthritis, and 2 with unclassified spondylolisthesis In the end, all patients showed improvement in spinal and peripheral joint symptoms and a significant decrease in serum inflammatory markers. Both trials clearly support the effectiveness of anti-TNF-α in the treatment of ankylosing spondylitis, but both trials only evaluated the short-term efficacy (3 months) of anti-TNF-α treatment without a control group and without randomization, and a large, double-blind controlled trial with long-term follow-up is still needed.
⑤ Thalidomide (thalidomide): Thalidomide has specific immunomodulatory effects. It inhibits monocyte production of tumor necrosis factor-α and also synergistically stimulates human T lymphocytes, aids T cell response, and inhibits angiogenesis and adhesion molecule activity. In vitro tests inhibit IL-12 production by monocytes stimulated by lipopolysaccharide, so its immunomodulatory effects can make it Tumor necrosis factor-alpha plays an important role in the pathogenesis of infectious and autoimmune diseases, and therefore the mechanism of treatment of these diseases is mainly related to its inhibition of tumor necrosis factor-alpha production.
The efficacy of thalidomide (Response Stop) in ankylosing spondylitis was demonstrated in 2 patients with severe intractable ankylosing spondylitis who had both spinal and peripheral joint disease, with a significant improvement in clinical symptoms, a decrease in inflammatory parameters (ESR and CRP levels) parallel to symptoms, and a reduction in thalidomide dose from 300 mg/d to 200 mg/d due to the development of leukopenia The main side effects included sleepiness, bitterness of mouth, increased dandruff and dry mouth, no peripheral neuropathy and leukopenia were found. Thalidomide is of concern because of its teratogenicity, and women of childbearing potential need to use strict contraceptive measures.
(6) Amitriptyline: Amitriptyline is a tricyclic antidepressant with 5-hydroxytryptamine and anticholinesterase activity, mainly sedative, analgesic and hypnotic effects. Some studies have demonstrated that small doses of amitriptyline can be used to treat fibromyalgia, fatigue, the drug itself has no anti-inflammatory effect, but is the best adjunct to small doses of NSAID therapy. Studies have found that fatigue is a major symptom in most patients with ankylosing spondylitis, and that severe fatigue leads to reduced mobility, a sense of morning stiffness and increased pain and significant sleep disturbances in patients with ankylosing spondylitis. The number of patients with improved sleep was much higher in the amitriptyline group than in the placebo group (66% and 20%, respectively; P<0.001). The greatest advantage of amitriptyline, for the treatment of ankylosing spondylitis, is therefore that it promotes sleep integrity and consequently reduces fatigue. < p="">
3, radiation therapy: radiation therapy because of the side effects, easy to cause white blood cell decline and radiation sickness, so it is less used, but the application of small doses of multiple irradiation, to relieve symptoms and delay the onset of deformity does have some effect.
4.Surgical treatment: If the joint deformity has occurred and reached more than half a year, surgical treatment can be performed according to specific conditions.
Tendon release surgery: for patients whose joints can still move and the deformity is caused by contracture of soft tissues around the joints, tendon severing and tendon lengthening are commonly used, and if necessary, joint capsule resection and other soft tissue release surgery can be added.
Bone and joint surgery: for patients whose joint ankylosis is caused by deformity, the following surgeries can be performed.
A, osteotomy orthopedic surgery: osteotomy in the near joint, and then the limb in a functional position, the most used for hip deformity, correction of hunchback deformity, available vertebral osteotomy, in the lumbar 3 and lumbar 4 parts, the operation first cut the spine of the excision site, the vertebral plate and joint synapse, and then the spine will be pressed straight, postoperative bone plate internal fixation of the spine, or ask the patient to rest in a plaster bed for 6 to 8 weeks, with hip Spinal osteotomy is not recommended for those with hip deformity.
B. Joint fusion can be considered if the joint is not strong enough and painful when moving, or if the deformity of the joint cannot be corrected by the above methods.
C. Arthroplasty: When bilateral hip ankylosis occurs, bilateral or unilateral arthroplasty should be performed, and the more satisfactory effect is stainless steel cap shaping.
5.Treatment of complications.
①Ocular treatment: To prevent iritis from developing into glaucoma and blindness, topical or systemic atropine and glucocorticoid therapy can be applied.
② Treatment of heart disease: Treatment of aortic valve closure insufficiency, congestive heart failure, heart enlargement, and heart block is the same as the treatment of other causes of the above heart abnormalities, and surgery can be considered when surgery is indicated.
③Treatment of pulmonary complications: when complicated by bacterial or mycobacterial infections, effective antibiotics or anti-mycobacterial preparations can be applied.
④Other: When the cervical spine deformity compresses the nerve, the bone plate can be surgically removed to relieve the compression symptoms.
Chinese medicine treatment of ankylosing spine (1) Identification and treatment.
(1) Kidney deficiency governor cold.
The main symptoms] lumbosacral, spinal pain, pain even neck, back cold and cold, wandering pain in the limbs, soreness and heavy, or morning lumbosacral, neck and back stiffness, or stiffness and bending, unfavorable movement, the pain is reduced when warm, tongue coating thin or white, pulse sunken string or fine late.
Treatment】Tonic for the kidneys and strengthening the Governor, warming the menstruation and dispersing cold, activating blood circulation and resolving blood stasis.
[Formula]: Tonify the kidney and strengthen the Governor, treat Xuxu Tang with addition and subtraction.
Chuan Xuan Guan, Golden Dog’s Backbone, Epimedium, Fried Eucommia, Deer horn cream (or gum), Piece of Pine, Cinnamomum, Boneset, Radix Rehmanniae, Red and White Peony, Raw Coix Seeds, Radix Rehmanniae, White Sclerotium, Ground turtle worm, Zhi Mu, Ephedra, Ginger, Qiang, Dou Wu, Cao Wu, Fang Feng, Niubizi.
Clinical experience: Lou Duofeng believes that this evidence of the patient’s body kidney deficiency involved in the Governor’s Vessel, the Governor’s Vessel and the foot Sun meridian in the Fengmen rendezvous, auxiliary Sun meridian to play the role of the external guard, the Governor’s Vessel is open, the guard Yang Zhen, the couples are dense, evil can not offend, when the kidney is insufficient, wind, cold and damp evil take advantage of the deficiency and enter, depressed and not transformed, affecting the Governor’s Vessel resulting in Qi and blood stagnation, meridian paralysis, so the development of low back pain, clinical symptoms in addition to the Sun meridian, there is a contracture of the back, for cold In addition to the clinical symptoms of the Sun, there are also contracture of the back, cold, pain and other characteristics of the involvement of the Governor’s Vessel, as described in the “Internal Canon” “Governor’s Vessel for the disease spine strong anti-folding”, this is the early stage of ankylosing spondylitis, kidney deficiency as the basis, cold is the standard, is a deficiency of the symptoms of the evidence, cold into the kidneys, the internal residence in the Governor, so the treatment to strengthen the kidneys and Governor, dispel the cold, dampness and the method of circulation.
② liver and kidney deficiency, tendons and bones lose glory: [Symptoms
Main symptoms] pain in the back, lumbosacral and collar and back straightening deformity, activity dysfunction, thoracic outline does not open, low fever form win, waist and knee soreness, dizziness, dizziness, deafness, cold limbs, impotence, pale face, slightly red tongue, less moss or thin white, sunken and thin pulse, weak ulnar pulse.
Treatment】Nourish the liver and kidney, strengthen the bones and glory the tendons.
[Formula] Jian Bu Hu Qian Wan combined with tonifying the kidneys and strengthening the governor to cure Xu Tang plus or minus.
Bonesetter, Bonesetter, Qiang, Dushu, Sheng, Shu Di, Red, White Paeonia, Tribulus terrestris, Cornu Cervi Pantotrichum, Oncidium, Centipede, Roasted Mountain A, Wei Ling Xian, Gui Zhi, Luo Shi Vine, Chicken Blood Vine, Seeking Bone Wind, Pine Joints, Chuan Break, Pieces of Pine, Stretching Tendon, Ground Turtle Worm, Fried Yellow Cypress, Red Flower.
(3) Congestion in the Governor’s Vessel and prolonged depression and heat.
The main symptom is dull pain in the back, waist, femur, hip acidity and heavy stagnation, or even painful and cracking, spinal column ankylosis, deformity, serious obstruction of movement, physical wasting, five heartburn, or low fever, dry mouth, muscle heat sensation to touch, limbs like to be put outside, and soon afraid of cold, dry stool, yellow urine, red tongue, yellow thick and greasy tongue coating, smooth pulse or string slippery number.
Treatment】Benefiting the kidneys and strengthening the Governor, clearing heat and activating the ligaments.
[Formula]: Tonifying the kidney and clearing heat to treat Xuxu Tang plus reduction.
(2) Comprehensive treatment.
①Chinese medicine: kidney deficiency and cold in the governor can be chosen from Xuxu paralysis punch, cold paralysis stop tablets, Jin Guan tablets, liver and kidney deficiency can be chosen from Strong Waist and Kidney Pills, Yi Kidney Tongdu tablets, long depression and heat can be chosen from Zhengqing Wind Pain Ning, Ermiao Pills, Wujia Pi Wine.
②External treatment with drugs.
A, medicine bag hot compress: qiangwu, doklam, Chuanxiong, dahurica, Xu Changqing, Qing Mu Xiang, Su Mu, Gui Zhi, angelica, made frankincense, made myrrh, fine pine each equal part, a little ice chips, the above drugs together research fine powder, and poured clean fine sand 2 parts mixed, put into a cloth bag, left 0.5 ~ 1 hour, 1 time / d, 10 days for a course of treatment, with the effect of warming the meridians to disperse cold, remove blood stasis and relieve pain.
B. Wu Gui San (Experienced formula): the medicine is used to make Chuan Wu, make Cao Wu, Gui Zhi, Hosin, Cornu Cervi Pantotrichum, Ginger, Gong Ding Xiang, Huo Xiang, Bai Zhi, Musk, the above medicines are coarsely ground, mixed with vinegar and wet, applied to the umbilicus, 6-10g each time, replaced once in 2-3 days according to the situation, for those with stiff back, severe pain and difficulty in moving, with the efficacy of dispersing wind and cold and relieving pain.
C, warming and clearing the back of the ointment (“Chinese medicine injury science lecture”): medicine with frankincense, myrrh, ephedra, strychnine 250g each, the above drugs together as a fine powder, syrup adjustment back pain, for cold and damp injury tendons, thoracic vertebrae soreness and pain, tendons and veins unfavorable.
③Specialized prescription treatment.
Wang Weilan treated 57 cases with Yi kidney Tongdu tablets (dog’s spine, cuscuta, bone crushed tonic, wolfberry, raw rehmannia, pig spinal cord, cow’s spine, deer horn gum, leech, fried white mustard seed), with apparent effect in 17 cases, effective in 3l cases and ineffective in 9 cases, with a total effective rate of 84.2%.
Zhu Liangchun applied Yi Kidney Paralysis Pill (the main medicine is Dihuang, Angelica, Xian Ling Spleen, Scorpion, Centipede, Beehive, Deerbit, Ground turtle worm) to treat the disease with satisfactory results.
Lou Yu Ins, et al. believed that the key to this disease is the deficiency of kidney governor, and formulated Kidney Paralysis Tang (dog’s spine, mulberry, cow’s knee, papaya, shouwu, fried shanjia) to treat 67 cases of this disease, with an efficiency of 92%.
Wu Qifu treated 160 cases with Right Return Pill plus reduction, with an effective rate of 86%.
Li Ruilin treated 80 cases with Leigongteng with an effective rate of 89%.
Tian Changyan etc. treated 54 cases with Yang Jinhua preparation, also achieved certain efficacy, 28 cases with significant effect, 20 cases with effective effect, 6 cases with ineffective effect, no toxic effect on liver and kidney, and better effect of injection.
Wu Zhicheng used ants to treat this disease also achieved certain efficacy.
In addition, some clinical experience has been accumulated in treating this disease with Body Pain and Stasis Removal Soup, and related research has been conducted on the basis and treatment of this disease with Jin Guan Tablet, Strong Waist and Kidney Pill, Zheng Qing Feng Pain Ning, Er Miao Pill and Wu Jia Pi Wine.
A. Kidney paralysis soup: composed of red peony, white peony, Wang Bu Liuxing, Chuan Jian, safflower, Pueraria lobata, Astragalus membranaceus, Dou Gong Ying, Dou Wu, Jin Yin Hua, Tu Fu Ling, Sheng Di Huang 20-90 g. Yang Aiguo et al. reported that 30 cases of strong spondylitis were treated with this formula plus reduction and the efficiency was 93%.
B, strong spine soup: from the cinnamon branch, turmeric, Chuanxiong, millennium Jian, the whole scorpion, the dragon, Ge Gen, white peony, angelica, dog’s spine, Chuan break, bone flesh, the only living, mulberry, luo shi vine, old stork grass, party ginseng, Wei Ling Xian, astragalus, licorice composition, water decoction, 1 dose per day, 30 doses for a course, Gao Fei et al. reported that the treatment of 30 cases, the efficiency of 98%.
C. Shudu Tongzhi Tang: composed of Ephedra, Gui Zhi, Dou Shu, Licorice, Angelica, Red Peony, Papaya, Radix Rehmanniae, Qing Feng Vine, Wu Zhi Snake, Duzhong, Wu Jia Pi, with cold symptoms plus Chuan Cao Wu; heat symptoms plus Lian Qiao, Gardenia, 3 months as a course of treatment, Li Xianlin et al. reported treating 47 cases with an efficiency of 91.3%.
D. Dulvus and Sansheng Tang Plus: It is composed of Dulvus, Sambucus, Angelica, Radix Paeoniae, Chuanxiong, Rhizoma, Rhizoma, Fructus, Radix et Rhizoma, Eucommia, Radix et Rhizoma, Radix et Rhizoma, Gentiana, Radix et Rhizoma, Gui Xin, with the addition and subtraction of symptoms. Qian Xian reported that among 22 cases treated, 6 cases were significantly effective, 14 cases were effective, and 2 cases were ineffective, with an overall efficiency of 90.9%.
E, Leigongteng with tonifying kidney Tongzhi Tang: Leigongteng decoction 12-15g/d, given at a dose of 1g at the age of 1 year under 14 years, tonifying kidney Tongzhi Tang formula consists of Doklamia, Fructus Herba, Eucommia, Huai Niu Knee, Fructus Lycii, Fructus Psoralea, Radix Astragali, Cortex Gastrodiae, Radix Rehmanniae, Salviae Miltiorrhizae, Salviae Miltiorrhizae, one dose per day, Zhang Silin reported 25 cases, with a total effective rate of 92.7%.
F. Kidney Tongdu formula: It consists of deer horn gum, turtle plate gum, wolf dog bone gum (melted), Epimedium, Bacopa monniera, bone marrow, cuscuta, fried Eucommia, Fructus Lycii, dogwood, chasteberry, angelica, white peony, fried white mustard seed, leech, rehmannia, centipede (powdered and taken), descending incense, Chuan Wu each, fine spice, Wang Weilan reported 151 cases of clinical treatment of ankylosing spondylitis, with a total efficiency of 94.7%. Wang Weilan reported that the clinical treatment of ankylosing spondylitis 151 cases, with a total effective rate of 94.7%, experimental study is better than diclofenac (diclofenac pain) and the group of Dahuluo Dan.
G. Bone paralysis soup: It is composed of 15g of dog’s spine, dulcimer, Chinese hyssop, bonesetter, dulcimer, Chenpi, 15-30g of epimedium, wei lingxian, raw groundnut, wolfberry, 12g of silkworm, ripe groundnut, angelica, 9-15g of cinnamon branch, and 2 centipedes, and is taken with water decoction, 1 dose daily for 30 days. Liu Hongli reported that after 1 to 3 courses of treatment, there were 21 cases with significant improvement, 24 cases with improvement, and 2 cases with invalidation, with an overall efficiency of 95.7%.
H. Scorpion-centipede soup: It consists of whole scorpion, centipede, white flowered snake’s tongue herb, salvia, gentiana, wei ling xian, white peony, and licorice, and Fang Jianzhi reported a total efficiency of 79% in treating blood stasis type of paralysis.
I. Kidney tonic and strong governor treatment of Xuxu Tang: It is composed of Shu Di Huang, Phellodendron, Deer horn gum, Chuan Gui, Qiang Wu, Dou Wu, Gui Zhi, Red peony, White peony, Zhi Mu, Earth turtle worm, Fang Feng, Ma Huang, Dry ginger, Huai Niu Knee, Roasted panax quinquefolium, Roasted Cao Wu, and Bone broken tonic, and is added and subtracted according to the symptoms.
J. Wu Tou Gui Zhi Tang: consists of Chuan Wu, Chuan Gui Zhi, Bai Shao, ginger, roasted licorice, 7 large red dates, 1 dose per day, decoction, can be added and subtracted with the symptoms of Chuan Dioscorea Z, Coix Seed, Wei Ling Xian, Tu Fu Ling, Fang Ji, etc., Dai Chao Shou reported that the treatment of 89 cases, the total efficiency of 100%, the cure rate of 76.4%.
K. Dispersing paralysis soup: the basic formula consists of Qingfeng vine, raw ephedra, cinnamon stick, ginger, Radix et Rhizoma, raw gypsum, mucuna pruriens, licorice, for cold, reuse Radix et Rhizoma, add Hesperidin; for heat, remove Radix et Rhizoma, add Zhi Mu, Huang Bai, for wind, add Centipede, Ge Gen; for wet, add Coix seed, Tu Fu Ling; for stasis, add Turtle worms, leech; for pain, add Liu Fan Nu, decoction, 1 dose daily, reported by Pan Qinghai, treating Pan Qinghai reported that 32 cases were treated, with apparent effect in 16 cases, effective in 13 cases and ineffective in 3 cases, with an overall efficiency of 90.6%.
④Single experimental formula treatment.
A. Leigongteng tablets: each tablet contains 3g of raw herbs, take 3-5 tablets each time, 3 times/d, 1 month as a course of treatment.
B. Kunming Shanhaigang tablets: take 100mg each time, 3 times/d, 1 month as a course of treatment.
C. Lumbago Ning Capsules: Composed of strychnine, turtle shell, frankincense, myrrh, scorpion, hyssop, ephedra, atractylodes, for ankylosing spondylitis with blood stasis and cold dampness paralysis, 3~5 capsules each time, 2 times/d, with appropriate amount of yellow wine (10~30ml), mixed with boiled water, 1 month as a course of treatment.
D. Gui Zhi and Shao Yao Zhi Mu Tang (“The Essentials of the Golden Horoscope”): Gui Zhi, Bai Shao, Licorice, Ephedra, Ginger, Atractylodes, Zhi Mu, Fen Fengshui, and Pieces of Pieces of Pith, decocted in water, 1 dose per day.
E. Bone crushing tonic pill (“Taiping Huimin and Pharmaceuticals Bureau Formula”): Jingzhu Sui, made of sliced herbs, cow knee, cistanches 30g each, bone crushing tonic, Wei Lingxian, sand, wide dragon, myrrh, natural copper (wine quenching nine times), grass wool, made of half a summer, a total of fine powder, wine boiled Shen Qu for paste pill, such as wutong seeds large, each time to take 5-7 pills, warm yellow wine send down, women can be used Angelica soup to send, pregnant women should not take.
F, Qingfeng vine: taste hard, warm, has the wind winds win dampness through the pain, Zhan Tie Min to Qingfeng soup 30-50g, gentiana, seek bone wind each 15g, He Shou Wu 30g, treatment of this disease is effective.
G, wolfberry sheep kidney porridge (“drink meal is about to”): wolfberry leaf 500g, sheep kidney 2 pairs, lamb 250g, onion stems a little, Wu Wei Zi, spices appropriate, japonica rice 50g, first cook wolfberry leaf, sheep kidney, lamb, spices, soup into the next rice, boil porridge, morning and evening each eat 1, wolfberry leaf available wolfberry 30g instead of it.
H, sheep backbone soup (“drinking food is about to”): sheep backbone 1, hammered, Cistanches 30g, 3 grass fruit, wicker 6, boiled into juice, into the white onion, do noodle soup to eat, lumbar spine pain is obvious for people.
I. Urticae congee (Materia Medica): 10g of raw Sichuan Urticae as powder, 1 bowl of fragrant white rice porridge, boil slowly, add 1 spoon of ginger juice and 3 tbsp of honey, take on an empty stomach, or add 6g of coix seeds, also suitable for wind-cold dampness paralysis blocking the kidney meridian and kidney Yang deficiency.
J. Shanghai Hospital of Traditional Chinese Medicine, Wind Pain San (Paralysis Treatments): Simmondsia and Ephedra, boil together for 4-6 hours, remove the skin and core of Simmondsia; fry Ephedra until yellow but not scorched, remove the surface blisters, wipe off the surface oil, grind together and put into capsules, take once a day before going to bed, 0.3g each time, 1 tbsp of yellow wine or warm water, increase the amount once every 3 days, increase by 0.3g each time, in order to have slight dizziness and occasional If there are more convulsions, drink more boiled water or use sedative to antagonize them. This formula is suitable for those who have severe paralysis and pain caused by wind-cold and damp paralysis and mutual obstruction of phlegm and stasis.
K. Xuxu Paralysis Punch: 10g per sachet, 1 sachet each time, 2 to 3 times/d.
L.Yi kidney remission pills: water pills: 8g each time, 3 times/d, taken after meals.
M. Golden snake injection: injection, 4ml each time, 2 times/d, intramuscular injection, 1 month as a course of treatment.
N. Rejuvenation Soup (Hundred and One Selected Formulae) O. Tiger Qian Wan (Danxi Xinfa) is indicated for the late stage of this disease with internal heat of yin deficiency, liver and kidney deficiency, and impotence and weakness of limbs.
P, Professor Zhu Liangchun medicine bag hot compress method: medicine bag prescription: Kaempferia, Qiangwu, Dushu, Chuanxiong, Zhi Xu Changqing, Qing Mu Xiang, Su Mu, Gui Zhi, Angelica, made frankincense, made myrrh, Hosin each equal parts, a little ice chips, a total of finely ground, and poured clean fine sand 2 parts mixed, put in a cloth bag, put in a pot and steam for 30min, folded on another unsteamed medicine bag, placed in the pain, left for 0.5 ~ 1h, 1 time/d. It can be applied to the painful area and left for 0.5~1h, 1 time/d, 10 times for 1 course of treatment, with the function of warming the meridians and dispersing cold, dispelling stasis and relieving pain.
⑤ Acupuncture therapy: acupuncture treatment of this disease, mostly from the foot sun meridian and the Governor’s vein selection of acupuncture points, should also pay attention to the selection of acupuncture points of the foot Shaoyin meridian, not only to pay attention to the near part of the acupuncture points, should pay more attention to the overall treatment, acupuncture treatment of this disease, when the kidneys to strengthen the waist, harmonize the qi and blood, relaxing the tendons and activating the channels for the method.
A. Body acupuncture.
a, cold and damp paralysis type: take liver Yu, kidney Yu, diaphragm Yu, Fengchi, Dazhi, waist Yangguan, acupuncture with diarrhea, 1 time / d, 10 days for a course of treatment.
b. Damp-heat blocking type: take Dazhi, Fengchi, Lumbar Yangguan, Liver Yu, Kidney Yu, Huanjiao, Hegu, acupuncture with laxative method, 1 time/d, 10 times for 1 course of treatment.
c. Kidney deficiency type: take Liver Yu, Kidney Yu, Diaphragm Yu, Yanglingquan, Sanyinjiao, Zhizhong, Guan Yuan, acupuncture with tonic method, 1 time/d, 10 days for 1 course of treatment, each time stay for 15-25min.
d, liver and kidney yin deficiency type: take liver Yu, kidney Yu, Sanyinjiao, Guan Yuan, Dazhi, Taichong, acupuncture with flat tonic and flat diarrhea method, 1 time/d, 10 times for 1 course of treatment, each time stay for 15-25min.
e, blood stasis blocking type: take Dazhi, Fengchi, Liver Yu, Kidney Yu, Huanjiao, Yanglingquan, Sanyinjiao, acupuncture with the diarrhea method, 1 time/d, 10 times for a course of treatment.
B. Ear acupuncture.
a, cold and damp paralysis type: take the lumbar vertebrae, sacral vertebrae, kidney, Shenmen, jiaojiao, each time to stay acupuncture 10-15min, every other day, 3-5 times for a course of treatment, to Wang Bu Liuxing paste pressure, 2-3 days once, rotate acupuncture points.
b, damp-heat blocking type: take the lumbar, sacral vertebrae, hip, sympathetic, kidney, adrenal gland, retaining needles for 10-15 min each time, once every other day, 3 to 5 times for a course of treatment.
c. Kidney deficiency type: take the lumbar, sacral vertebrae, cervical vertebrae, thoracic vertebrae, kidney, liver, Shen Men, and keep the needles for 10-15 min each time, once every other day, 3-5 times for a course of treatment.
d, liver and kidney yin deficiency type: take the liver, kidney, lumbar, sacral vertebrae, Shen Men, jiaoshen, each time to stay for 10-15min, every other day, 3 to 5 times for a course of treatment.
e, blood stasis blocking type: take the lumbar, sacral vertebrae, kidney, Pingma, Shenmen, jiao-sense, each time to stay for 10-15min, every other day, 3-5 times for a course of treatment.
C. Moxibustion method.
Acupuncture points: the same as “milli-needle”.
Method: commonly used moxibustion, moxa cone moxibustion, warm needle moxibustion, warm moxibustion device moxibustion, each time to choose 3-5 points, moxibustion 10-20 minutes or 5-7 strong, 1 time / d, 10 days a course of treatment, interval 2-3 days to perform the second course of treatment.
Contraindicated: moxibustion should not be applied to the lumbosacral region of pregnant women.
(6) Tui Na therapy: early stage is based on the principle of harmonizing the campanile and smooth the joints; late stage bony ankylosis is based on the principle of relaxing the tendons and channels, activating blood circulation and relieving pain.
A, the patient lies prone, the upper chest and thighs in front of 2-3 pillows, respectively, so that the forehead and abdomen suspended, the two arms flexed elbows in front of the head, the doctor stands next to the patient’s waist back along the spine and both sides, with the rubbing method up and down treatment, while the other palm in the back along the spine pressure, pressure to match the patient’s breathing, when exhaling downward pressure, relax when inhaling.
B, following the above situation, press the bladder meridian and the hip chichiban, ring jump, and jus points on both sides of the spine with the finger press method.
C, the patient lies on his back, treat the front of the hip joint with the method of hip abduction, external rotation passive activities, and then take the inner thigh muscles and rub the thigh.
D. With the patient sitting, the physician stands behind and applies the method to both sides of the neck and scapula, with left and right neck rotation and tilting activities, and then presses and kneads or pushes both sides of the cervical vertebrae with one finger meditation, going up and down several times, and then takes Fengchi and both sides of the cervical vertebrae to the shoulder well.
E, pick up the potential, ask the patient to bend both elbows, hold in the back of the head occiput, two fingers crossed and clasped, the doctor stands behind, with the knee against the patient’s back, and then hold the patient’s two elbows with both hands, for backward traction and forward to pitch the expansion of the thoracic tilt movement, in this back movement activities, the patient should cooperate with breathing exercises (exhale when the front pitch, inhale when the back pitch), tilt 5 to 8 times.
F. The patient sits, exposing the lower back, the upper body is bent forward, the doctor stands by the side and applies elbow pressure to both sides of the spine, and then rubs the back straight to the Governor’s vein and both sides of the bladder meridian, and rubs the sacral area horizontally, all to the degree of heat penetration, and can be added with hot compresses.
Auxiliary treatment ①Medication: see “treatment” section.
②Posture treatment: active arthritis symptoms are obvious, bed rest, sleep on a hard bed, the neck pillow should be low or not, in order to maintain the cervical and lumbar spinal physiological curvature, often prone position is conducive to the prevention of spinal and hip deformation, 1 to 2 times / d, time increment, lumbar curvature disappears or stiffness can be lying back pad a small pillow to prevent the formation of spinal deformity, sitting, standing position should be kept straight back, practice back against the wall Standing posture to maintain good posture.
③ Exercise therapy: medical gymnastics is the first method chosen for exercise therapy, mainly to prevent deformity, improve joint mobility, increase extensor strength, improve lung function and other effects, commonly used methods are respiratory gymnastics, spinal mobility, back muscle exercise, etc.
A, respiratory gymnastics: deep breathing exercises can maximize the expansion of the thorax, promote diaphragmatic movement, but also abdominal breathing exercises, pranayama therapy can increase lung capacity, relax the muscles, the whole body into the quiet, is a good way to improve lung capacity.
B, back muscle exercises: the use of unarmed or equipment can be back muscle exercises.
C, spinal mobility exercises: in the “limbs on the ground” position for spinal mobility exercises, crawling exercises can also be carried out, traditional Chinese medicine in the wash the marrow scripture-based gong method also has a good effect, cervical spine exercises include slow and gentle flexion and extension, lateral flexion and rotation movements, patients riding on the chair twisting, can increase the thoracic spine rotation activities.
D, hip exercises: can compensate for the function of the lumbar spine, mainly exercises for hip extensors and external rotators.
E. Endurance exercise exercises: if the condition is stable, swimming, mountain climbing, badminton and tennis can be done, which can enhance the whole body muscle strength, promote cardiopulmonary function and prevent spinal deformity.
④Physical therapy: warm therapy can analgesic and relieve stiffness, ultrasound, audio can enhance the extensibility of tendons, after warm therapy and then give exercise therapy, it has a better effect on improving the contracture of ligaments and tendons.
A.Thermal therapy: used to eliminate muscle spasm, improve blood circulation (not used in the acute stage), types: steam bath, sand bath, wax therapy, infrared lamp irradiation, etc.
B, electrotherapy: available high, medium and low frequency electrotherapy, such as TENS, intermittent electrotherapy, interference electrotherapy, etc.
C. Ultrasonic penetration therapy: with some drugs, such as hydrocortisone, Chinese herbal medicine to activate blood circulation and remove blood stasis, dispel wind and relieve pain, soak electronic end cotton pad, etc.
⑤ Tui-na, acupuncture therapy: for muscle spasm around the joint, and joint muscular ankylosis can be used tui-na, massage and other techniques to release muscle spasm, improve joint function, acupuncture, moxibustion points, the effect is very obvious to release inflammatory pain at the muscle end.
(6) Application of splints and orthoses: In the acute stage, splints can be used to fix painful joint parts, but the splints should be removed several times a day and joint activities should be performed; orthoses can be used for non-severe deformities.
(7) Daily living activities training: dressing, squatting, eating, washing, walking and other training.
(8) Psychotherapy: Patients generally have low self-esteem and pessimism, medical staff should sympathize with patients, explain in detail the changes in the condition, comfort, encourage, persuade and enlighten patients to cooperate and adhere to treatment.
⑨Surgical treatment: according to the need of the condition, surgical treatment, including synovectomy, osteotomy, arthroplasty, hip arthroplasty, etc. should be carried out.
(B) Prognosis The evolution of the course of ankylosing spondylitis varies greatly and is characterized by alternating spontaneous remission and exacerbation. The prognosis is generally good and self-limiting, with a few patients experiencing rapid bone loss and severe disability in the early stages, with hip involvement and complete ankylosis of the cervical spine.
The survival of patients with mild forms is not different from that of the general population; however, concomitant spinal fractures, cardiovascular involvement, renal amyloidosis, and other serious complications can shorten survival in some patients, with loss of function occurring within the first 10 years of disease onset in most patients, and is associated with peripheral arthritis, radiographic changes in the spine, and a “bamboo spine “The prognosis is good in about 85% of patients, even if severe deformity or disability occurs, they can still take care of themselves with surgical treatment, while a few patients may die of heart failure, uremia and cervical fractures complicated by paraplegia.