Rheumatoid arthritis (RA) is a multisystemic inflammatory autoimmune disease involving mainly peripheral joints. The characteristic symptoms are symmetrical, peripheral chronic inflammatory lesions of multiple joints with chronic synovitis and vasculitis, easily invading cartilage and bone and causing joint destruction. Clinical manifestations include pain, swelling, and decreased function of the affected joints.
The most distinctive clinical feature of this disease is that it is difficult to control the disease and is prone to recurrence after remission, resulting in a continuous and recurrent course of the disease. In this paper, we intend to discuss the recurrence mechanism of RA from the perspective of the theory of paralysis caused by volatile evil in Chinese medicine, with a view to providing theoretical guidance for clinical evidence and treatment.
I. Discussion on the mechanism of RA in Chinese medicine
RA belongs to the identification categories of “disease of the calendar”, “wind of the calendar” and “paralysis” in Chinese medicine. The occurrence of this disease is closely related to physical factors, climatic conditions, living environment and diet. The internal basis of the disease is the deficiency of the body and the external condition of the disease is the feeling of external evil. The pathogenesis of the disease is based on the paralysis of the channels and veins, which mostly involves the tendons, bones, muscles and joints of the limbs, and even affects the internal organs.
In detail, wind, cold, dampness, heat, phlegm and stagnation of evil qi in the tendons, joints and muscles of the limbs, resulting in the blockage of the meridians, and pain if not passed is the basic pathogenesis of the disease. Mostly because the patient’s body is weak, Yang Qi is not enough, the guard is not solid, the couples are empty, easy for the wind, cold, damp and heat of the evil to take advantage of the invasion, paralyzing the tendons, muscles, bones and joints, resulting in Ying Wei line astringent, the meridians do not pass, pain, swelling, soreness, numbness, or limb movement is not working. The external evil attacking the body can be transformed into hot and cold depending on the endowment quality of the person. Those who have a strong yang energy and internal heat accumulation will feel wind, cold and dampness, which will easily turn into heat from yang, and become rheumatic heat paralysis. If the yang energy is weak, the cold will come from within, and if the wind, cold and dampness are felt again, they will become cold from the yin, and become wind, cold and damp paralysis.
Second, phlegm, blood stasis and water-dampness also play an important role in the development of disease. The evil paralyzes the meridians and veins, blocking the channels and delaying the treatment, affecting the flow of Qi, blood and fluid. Blood stagnation becomes blood stasis, and fluid stagnation becomes phlegm, resulting in phlegm and stagnant blood. When phlegm and blood stasis block the meridians, skin petechiae, nodules around the joints, and unfavorable flexion and extension will occur; when phlegm and blood stasis combine with external evil, they block the meridians and penetrate deep into the bones and joints, resulting in joint swelling, stiffness, and deformation. If the paralysis lasts for a long time, it affects the function of the internal organs, loses the transmission of fluid, and water-dampness accumulates locally, resulting in swelling of the joints and limbs. In addition, phlegm, stagnant water and dampness can also affect each other and transform, for example, dampness is phlegm, blood stagnation is stasis, phlegm can hinder blood, stasis can transform water, phlegm, stagnant water and dampness are intertwined, the old disease and the new evil stick together, resulting in a lingering disease and stubborn.
Second, the Chinese medicine mechanism of RA relapse
The main contradiction of RA lies in relapse. Regarding the main root cause of relapse, the author believes that the failure to receive correct and timely treatment during the active period of the disease causes dampness, heat, phlegm and stasis to remain in the body for a long time, resulting in the formation of volatile toxin (or volatile evil, volatile qi). Later, when the voodoo is triggered by the external evil of the six sexes, or touched by factors such as excessive emotions, dietary disorders, and disorders of labor and rest, the disease develops again, or is further aggravated, or causes other diseases.
1.The concept of voodoo
Fuchsia, also known as fuchsia. Before the Ming Dynasty, it was called “Fu Qi” based on the words of “Treatise on Typhoid”. It was not until the end of the Ming Dynasty, when Wu Yucheng wrote “On Plague”, that the term was creatively changed to “Fu Qi”. “Fu” means hidden, latent; “evil” refers to the disease-causing factors arising from climate variation. Fuyi means that the body does not feel the external evil at the time that the disease, evil ambush in the body over time and disease. The so-called voodoo, in the Qing Dynasty, Liu Jiren’s “voodoo new book” has a clear concept: “feel the six perversions and not immediately ill, not regularly after the onset of the party, always said that the voodoo; has been issued and can not be treated, the disease is hidden, also said that the voodoo.”
According to the previous discussion, where the six external disease evil, invading the body after the ambush in the internal, not immediately onset, after a period of time before the symptoms appear, or has been onset but not cured resulting in the internal ambush of evil, are all voodoo (or called voodoo, voodoo). By extension, the paralysis caused by the voodoo is called voodoo paralysis, or voodoo paralysis, or voodoo paralysis.
2.The origin of the doctrine of volatile evil
The theory of fugitive evil is traced back to the Nei Jing. The “Spiritual Pivot – Thief Wind” said: “Fu Zi said thief wind evil gas injury also, people are sick, now there is not away from the shield, not out of the room point, suddenly sick, not must be away from the thief wind evil gas, the reason why also? Qibo said: this have been injured in the dampness, hidden in the blood, between the flesh, long stay and do not go; if there is a fall, bad blood within and do not go. Suddenly joy and anger, diet, cold and temperature from time to time, the couples closed and not pass.
Its open and meet the wind and cold, the blood condensation, and the old evil attack, it is cold paralysis.” Here the old evil (that is, the original “hidden in the blood, between the flesh” of the “dampness”) can be seen as the source of the doctrine of volatile evil. It is agreed that this is the first time that the theory of palsy caused by volatile evil was proposed in the Nei Jing.
The earliest person who clearly put forward the concept of “volatile qi” disease was Zhang Zhongjing in the Han Dynasty. In the “Treatise on Typhoid Fever”, it is said: “The disease of volatile qi is waited for with the intention that within this month there will be volatile qi. If there is an old vapour, the pulse must be taken.”
In the Jin Dynasty, Wang Shuhe further developed Zhongjing’s theory and applied it to clinical practice. He said in the “Typhoid Preface”: “winter severe cold, …… in and that is sick, called typhoid; not that sick, cold poison hidden in the skin, to spring into summer disease, …… all from the winter touch cold, not the time line of gas also. ” [5] Wang Shuhe combined the Nei Jing and the Treatise on Typhoid, using the doctrine of volatile qi to explain the causes of warm diseases without violating the intent of the Treatise on Typhoid, laying the foundation for the formation of the theory of volatile qi causing disease.
The development of the theory of the pathogenesis of fugue was made possible by Wu Youke in the Ming dynasty, who in his treatise on warming and epidemics developed what had not been developed before, breaking through the previous theories and promoting the theory of the pathogenesis of fugue, which was used in the elaboration of the theory of the pathogenesis of warming. “Where the evil is visited, …… the evil of the so-called pestilence is first ambushed and then acted upon, as the evil of pestilence is ambushed in the membrane plain, like a bird in its nest, like a beast hiding its den.”
Later medical practitioners, under the influence of Wu and can the theory of volatile temperature disease, more volatile gas cause disease for temperature disease. However, the author believes that the pathogenesis of paralysis is the same as that of paralysis, so paralysis can also be caused by voodoo.
In the Qing dynasty, Liu Jiren wrote a new book on the concept of voodoo in a more expanded interpretation: “The six diseases are not immediate, and those who develop after an irregular period of time are always called voodoo; those who develop and cannot be treated are also called voodoo.” The theory that all the six lewdnesses can be considered as voodoo is clearly put forward. In the Qing Dynasty, Ye Ziyu also pointed out in the book “Fu Qi Solution”: “Fu Qi is a disease, all six can be, not just one end.” He also listed many specific names of voodoo diseases such as thirst, malaria, impotence, paralysis, and diarrhea. And “the so-called paralysis, each with its time heavy feeling in the wind, cold and damp also.” This shows that all the six phobias can be volatile evil, and the evil that causes paralysis is also no different from its genus.
3, the scope and classification of voodoo
Historically, voodoo is divided into a narrow sense of voodoo and a broad sense of voodoo. In the narrow sense of the term voodoo refers to the voodoo temperature disease, that is, the external evil invasion of the human body, the positive energy is bound, can not support the evil out, so that the evil can be voodoo, or voodoo in the membrane, or voodoo in the muscle coup, or voodoo in the muscle nucleus, or voodoo in the lipid membrane, over time and hair. In a broader sense, voodoo refers to all the voodoo that does not immediately develop, referring to both the seven emotions, diet, phlegm, blood stasis, internal toxins and other intrinsic pathogenic factors, and also includes voodoo temperature.
As Wang Yanchang’s “Wang’s Medical Cun” of the Qing Dynasty said, “All the diseases in the vastness are caused by six kinds of perversions, all kinds of depression, diet, blood stasis, phlegm, accumulated gas, water storage, and all kinds of worms.” Because the evil has not yet exceeded the body’s own regulation of the righteousness, it does not develop immediately, but is hidden inside, or triggered by the feeling of the six evil spirits, or touched by the seven emotions, dietary disorders, labor and relaxation, etc., and then attack again, or further aggravate, or cause other diseases.
The viciousness is not only due to external sensation, but also due to internal injuries: for example, after treatment of internal injuries, the disease is controlled, but the evil is not removed and the disease lurks, which can lead to other diseases. Or some internal injuries have been treated and clinically cured, but the cause of the disease has not been completely eliminated, resulting in residual evil lurking and recurring attacks when triggered.
As Liu Jiren’s “New Book of Evil” of the Qing Dynasty says: “Those who feel six kinds of lust and have an immediate illness are called injured in the lighter cases, and in the heavier ones. Those who feel six perversions and are not ill, and those who develop after an irregular period of time, are always called voodoo. Those who have already developed but cannot be treated, the disease is hidden, also called voodoo. There is the first sense of treatment can not be law, the righteousness of internal injury, the evil within the trapped, temporary false healing, and later still author, is also called voodoo. There has been cured, but failed to get rid of the root of the disease, the legacy of the evil within the ambush, and then recurrence, is also said to be voodoo.”
There may still be some patients who have inherited the evil poison from their parents, which is hidden in the body and induced by time. In addition, due to different innate endowments and dysfunctions of the five organs, self-generated toxins are gradually accumulated and develop when they are encountered. The result is the onset of the disease.
4.Mechanism of paralysis caused by volatile evil
The “Su Wen – Theory of Paralysis” said: “Rong Wei Qi, also causes paralysis? Qibo said, the glory of the valley of the essence of the gas also …… Wei, the valley of the humble gas also, against its gas is sick, from its gas is healed. Not with the wind, cold and moisture together, so not for paralysis.” “The so-called paralysis, each with its time heavy feeling in the wind, cold and damp gas also.” This means that when the body’s Ying and Wei function normally, the body’s immune function is normal and cannot develop paralysis. The “real qi cannot be circumscribed” when the paralysis cannot be avoided. Here, “its time”, can be both the meaning of the season, but also for the body in a certain functional state, that is, when the body immune function is not normal, its “heavy feeling” and “so the evil attack” and It is a paralysis. This article also says: “Food and drink are the basis of the disease.” This means that diet and environmental factors can cause evil to lie in the body, waiting for an opportunity to develop.
The “Spiritual Pivot: Thief Wind” says: “Fu Zi said that the evil of the thief wind is also hurt, people are sick, now there is not away from the shield, not out of the room point, suddenly sick, not necessarily away from the evil of the thief wind, what is the reason? Qibo said: this have been injured in the dampness, hidden in the blood, between the flesh, long stay and do not go; if there is a fall, bad blood within and do not go. Suddenly joy and anger, diet, cold and temperature from time to time, the couples closed and not pass. Its open and meet the wind and cold, the blood condensation, and the old evil attack, it is cold paralysis.” It can be seen that “Nei Jing” has a profound discussion on the causes of volatile evil and how it causes paralysis, which is the theoretical source for later medical doctors to discuss and treat paralysis.
Later generations of physicians have continued to enrich and improve the theory of palsy, based on the idea of voodoo in the Neijing. In the Confucianism, it is said that paralysis is the result of “cold phlegm in the chest and diaphragm” and that “all methods are effective if the cold phlegm is removed first”. In the “Jin Kui Wing”, it is pointed out that “the so-called Yang is met with Yin, the internal organs and meridians first have stored heat, and then encounter wind and cold gas guest of the, heat for the cold depression, gas can not pass, long cold also into heat, then paralysis fir Huanpu disease thin clearly pointed out that the volatile evil has cold and heat, and for the entire course of the key to the transformation of the disease mechanism.
5.Characteristics of paralysis caused by volatile evil
There are three characteristics of paralysis caused by volatile evil, as follows.
(1) The disease develops from within. (1) The disease develops from within. The initial onset of the disease is mostly based on internal evidence, or only internal evidence without superficial evidence. For example, paralysis may cause joint pain in the presence of wind, cold, and rain, but there is no superficial evidence of cold, and even if there is superficial evidence, it is light and short.
(2) The onset of sensation of evil does not always match. When an external evil touches a volatile evil, the external evil is only the causative factor, while the internal volatile evil is the root of the disease. Therefore, although the external wind, cold, and dampness are present, they can show the signs of redness, swelling, and heat pain in the joints.
(3) The evil is hidden, difficult to get rid of, easy to recur. Most patients with paralysis have recurring illnesses that are difficult to cure, with varying lengths of time, and with recurrences after the initial “cure”.
Clinical evidence and treatment of paralysis caused by voodoo
1. Characteristics of the symptoms of paralysis caused by voodoo
The following clinical symptoms are characteristic of paralysis caused by voodoo: most of the slow onset and long duration of the disease, the sudden appearance of one or more joints swollen and painful, unfavorable activities, morning stiffness and heavy; or joint muscle pain and soreness, wandering; or local burning and redness of the joints, pain is not touchable, then Shu, there may be subcutaneous nodules or erythema; or muscle joint tingling, fixed, joint skin purple, swollen, press The skin of the joint is purple, swollen, and hard, and the limbs are numb or heavy; or the joints are stiff and deformed, with unfavorable flexion and extension, with hard nodes and petechiae. The tongue is red or dark red or purple, the tongue coating is greasy or yellowish, and the pulse is smooth, slippery, sunken or sunken.
2.Treatment idea of paralysis caused by volatile evil
The clinical treatment of paralysis caused by volatile evil is mostly staged from the active and remission stages. The basic pathogenesis of RA in the active phase is mostly dampness, heat and toxicity paralyzing the meridians, tendons, veins and bones, so the treatment should be based on the treatment method of “heat is cold” in the Nei Jing, and the total pathogenesis of dampness, heat and toxicity is reversed, and the method of clearing heat and relieving dampness is often effective. If heat is more important than damp, clear heat and detoxify; if damp is more important than heat, clear heat and detoxify damp; if dampness and heat injure yin, clear heat and nourish yin. When the damp-heat poisonous evil decreases its most half, the patient’s condition is relieved, the symptoms are reduced or disappear, entering the remission period. As the damp-heat toxins are not eliminated, they remain in a certain part of the body, ambush and wait for the onset, when there is a trigger can make the remaining toxins rekindle, there is another attack, this is the main reason why RA is good at recurrence, lingering difficult to heal. Therefore, the treatment during the remission period should be based on eliminating toxins and clearing heat, promoting dampness, and supporting the righteousness, so that the residual toxins can be cleared and the evil can be removed, then the patient can no longer suffer from recurrence.
In clinical practice, according to the characteristics of active and remitting RA, the following empirical formula is used. Active phase: Lei Gong Tang 9g, Bai Shao 30g, Qing Feng Vine 15g, Dou Wu 15g, Hu Zhi 20g, Artemisia annua 15g, Sheng Gan Cao 12g, Shuang Hua 15g. 6 doses are taken orally weekly. In the remission period, Astragalus membranaceus 30g and Radix Angelicae Sinensis 12g are added to the above, while in the remission period, the emphasis is on clearing heat, relieving dampness and detoxifying the toxins, and in the remission period, the emphasis is on clearing volatile toxins by benefiting Qi and nourishing Blood. The Ten Flavors in combination is applied to the remission period, focusing on the path of dispelling wind, removing dampness, clearing heat and resolving blood stasis, without forgetting the strategy of benefiting Qi, strengthening the middle and nourishing Blood to support the righteousness. The aim is to eliminate the vicious toxins, dispel the evil and relieve pain, and support the correctness. The whole formula is aimed at eliminating the toxins, treating the root cause, balancing the symptoms with the root cause, and supporting the righteousness. The medication is taken orally 2-3 times a week (i.e. one dose every other day or one dose every two days). For those who are afraid of wind and cold, Gui Zhi and Fang Feng can be added; for those with joint pain, Chuanxiong and Xinyin Cao can be added; for those with excessive sweating, Huang Qi is used.
The author believes that the treatment of paralysis caused by volatile evil should focus on the following three aspects.
(1) The treatment should be directed at the site, nature, deficiency, heat and cold, and the cause of the disease. In the case of internal disease, the disease is mainly caused by internal evidence, or only internal evidence without superficial evidence. For example, paralysis can cause joint pain when it encounters wind, cold and rain, but there is no superficial evidence of malignant cold, and even if there is superficial evidence, it is light and short.
(2) In the case of paralysis caused by volatile evil, the treatment should be different from person to person, and should be combined with physical characteristics and disease location to adopt a method of treatment that recognizes the disease.
(3) It is difficult to get rid of the voodoo evil, and it is easy to recur. Therefore, for patients with relatively stable disease, the method of long-term intermittent oral administration of small doses of traditional Chinese medicine can be used to support the correctness of the disease while resolving the voodoo, so as to balance the symptoms and the root cause.
3. A clinical case of paralysis caused by volatile evil
Li, female, 49 years old, had a history of RA for more than 10 years. She has been treated in many hospitals, but the effect is sometimes poor and the disease is not effectively controlled. This time, she saw swelling and pain in the fingers, wrists, elbows, knees and ankles of both hands, swan-neck deformity of the finger joints, stiffness of the elbow joints, unfavorable flexion and extension of both knees, tenacious numbness of the limbs, persistent morning stiffness, slightly yellow and dark face, poor sleep and bowel movement.
The tongue is dark red, with a thin yellowish coating and a slippery pulse. Blood sedimentation: 72mm/h ↑, rheumatoid factor: 135.9Iu/ml ↑, platelets: 371×109/L ↑. Western medicine diagnosis: rheumatoid arthritis, Chinese medicine diagnosis: prosperous Yuな羰榷驹獭V我郧迦冉舛荆纭4Ψ剑豪坠9g.青风藤15g.双花15g.白芍30g.独活15g.虎杖20g.青蒿15g.生甘草12g.猫爪草15g.猫眼草15g.土茯苓30g.蜂房9g.白芥子15g. 1 dose daily, divided into 2 times in the morning and evening orally. After 12 doses, the swelling of the joints was significantly relieved, and the joints were more flexible than before, with morning stiffness for a few minutes, better sleep, and a rosy complexion.
He was advised to take 12 more doses of the original prescription and stop taking diclofenac sodium. At the time of re-examination, the joints were no longer swollen, except for the deformity of the bones, morning stiffness for a few minutes, sleep and sleep were all good, and the tongue was light red with a slightly thin yellow coating and a string pulse. The damp-heat toxin has been mostly removed and has entered the remission period. The original formula removed Cat’s Claw Herb, Cat’s Eye Herb, Tu Fu Ling, Bee’s Nest and White Mustard Seed, reduced Tiger Balm to 12g, added Astragalus Membranaceus 30g, Angelica Sinensis 12g, and Sandy Seed 6g. 12 doses later, the condition continued to remit. He was instructed to continue to take this formula and changed to one dose every other day. Six months later, he called to inform that his condition was stable and asked whether he should continue to take the medicine.