Ankylosing spondylitis is a relatively benign disease, and many patients have a good prognosis with early diagnosis, early treatment, and aggressive control of inflammation. However, a large percentage of patients will have discomfort of one kind or another even after the inflammation is well controlled. There are also many patients who go into spinal ankylosis and joint deformation. What should we do to treat it? Early pathological changes in sacroiliac arthritis include subchondral granulation tissue formation, histologically visible synovial hyperplasia and aggregation of lymphocytes and plasma cells, lymphoid follicle formation, and plasma cells containing IgG, IgA, and IgM. Bone erosion and cartilage destruction follow, followed by progressive replacement by degenerating fibrocartilage and eventually bony ankylosis. In layman’s terms, the early pathology is inflammatory changes, the middle pathology is fibrocartilage formation, and the later is bony ankylosis. The inflammatory changes are reversible, whereas once bony ankylosis occurs, it is irreversible. The early stage is the basis for the pathological changes that occur in the middle and late stages, so it is important to actively control the inflammation in the early stages of ankylosing spondylitis so that the later stages do not occur. How is staging done? When ankylosing spondylitis first begins to appear as low back pain, the pain is worse at night, worse after rest, worse in the morning, and less after activity. This pain is medically called resting pain and is the main manifestation of inflammatory low back pain. This symptom is the external manifestation of the pathological changes of inflammation, and at this time, the blood sedimentation and CRP are elevated, and inflammatory exudative foci appear at the site of inflammation when MRI is checked. This stage must be actively treated. Western medicine can be used to control inflammation and improve symptoms quickly with antipyretic and analgesic drugs (e.g. Ciloxib, meloxicam, diclofenac sodium, etc.), and then to improve the condition with salazosulfadiazine, reaction stop, methotrexate, etc. Biologics are a more effective way to control inflammation, but they are expensive and carry the risk of infection. It is recommended that they be considered after about 2 months of treatment with these drugs if they are not effective. Because ankylosing spondylitis is, after all, a benign lesion, it does not actually develop very quickly, and in 2 months’ time, there will not be very serious bone destruction. If these conventional methods are not effective, the use of biological agents is also necessary. The inflammatory period can be treated with Chinese medicine. The direction of treatment in Chinese medicine requires evidence-based treatment, which can use methods such as dispelling wind and dampness, dispersing cold and dampness or clearing heat and dampness, and the main method is to expel evil. According to the clinical symptoms of the patient, the nature of the external evil is wind, cold, damp, heat and add and subtract according to the evidence, if the evidence is accurate, the treatment effect is still good. In the middle stage, the pathology is fibrocartilage formation, generally speaking, the patient shows pain in the low back, generally speaking, it is mostly vague pain, and the pain is aggravated after a long time of activity, and the pain is reduced after rest. Generally there is no evening and morning pain, mostly manifested as low back pain after exertion, hip pain, and sacroiliac joint pain, low back tend to be sore, low back pain when the day changes, sacroiliac joint pain, etc., these more in ankylosing spondylitis six months later began to gradually appear, many patients will have these symptoms even if the inflammation is well controlled. This is because when the inflammation appeared, it was not controlled in time so that the fibrocartilage formed and these changes appeared. Western medical treatment at this stage is based on functional exercise, you can do a variety of spinal exercises, such as swimming, cycling, tai chi and other ways. Chinese medicine treatment should then be mostly about activating blood stasis, tonifying the liver and kidneys as well as opening up the meridians, removing phlegm and eliminating stasis, etc. Based on the dialectical evidence, observe which type the patient mainly belongs to, prescribe the corresponding treatment plan, and actively cooperate with functional exercises to improve the prognosis and reduce the occurrence of deformities. The osseous ankylosis stage is irreversible. There are usually no inflammation at this stage, and there will be many symptoms. These symptoms are mainly low back pain, inability to move the waist, back and neck, restricted turning and head twisting, and also lesions such as sciatica and neck and shoulder syndrome like lumbar spondylosis and cervical spondylosis, with clinical symptoms such as low back pain even and lower limb pain, shoulder joint pain and numbness in hands and feet. The treatment at this time requires active functional exercise and lying on a hard bed to improve the clinical symptoms. In Chinese medicine, the classification is mostly divided into liver and kidney deficiency, phlegm and stagnation paralysis type, and it is generally recommended to treat the liver and kidney with phlegm and stagnation drugs to improve clinical symptoms. Combined Chinese and Western medicine treatment for the coexistence of inflammation and localized mid- to late-stage lesions In general, patients with a slightly longer course of disease may have the phenomenon of both inflammation and the simultaneous presence of localized fibrocartilage formation and bony ankylosis. This is the most common manifestation, and it is important to actively control the inflammation as well as pay attention to functional exercises. Antipyretic and analgesic drugs can be used to quickly control the inflammation and improve the symptoms, followed by salazosulfadiazine, reactive stop, and methotrexate to improve the condition. Biological agents are used when necessary. According to the clinical manifestations of the patients, they can be divided into liver and kidney deficiency, cold and damp paralysis; liver and kidney deficiency, damp and heat obstruction; spleen and kidney deficiency, cold and damp paralysis; spleen and kidney deficiency, damp and heat obstruction; liver and kidney deficiency, phlegm and stagnation paralysis; according to the classification, the method of tonifying liver and kidney, dispersing cold and dispelling dampness; tonifying liver and kidney, clearing heat and promoting dampness; strengthening spleen and kidney, dispersing cold and dispersing dampness; strengthening spleen and kidney, dispersing cold and dispersing dampness; strengthening spleen and kidney, dispersing cold and dispersing dampness. Treatment at this stage is quite critical, and good control of inflammation can minimize future joint destruction. Functional exercise is is also an important aspect of treatment. Most patients with a slightly longer course of disease are in this stage, and it is difficult to repair joints that have already been damaged, but active control of inflammation can stop the destruction of other joints and greatly improve the quality of life in the future, and standardized functional exercise can also help to alleviate the disease, so it can be said that functional exercise and medication have equal importance in the treatment of ankylosing spondylitis. In conclusion, ankylosing spondylitis is a relatively benign lesion whose inflammation can be controlled, and controlling inflammation is the key to a future without joint deformation. A combination of Chinese and Western medical treatment can help control inflammation. Functional exercise is equally important in the treatment of ankylosing spondylitis. Active treatment, continuous exercise, and optimistic living make ankylosing spondylitis no longer bother us.