Severe disease originally refers to juvenile chronic arthritis of systemic origin, but if the similar disease occurs in adults, it is called adult Severe disease, and Severe disease used to be called “allergic subsepsis” for a long time in China, but after 1987, the name “Severe disease” was used uniformly in China. Since 1987, the name “Still’s disease” has been used in China. The clinical characteristics of adult Steele’s disease are: long-term persistent or intermittent fever; recurrent transient rash; wandering arthralgia and lymph node enlargement, hepatosplenomegaly; significantly higher peripheral blood leukocytes, faster sedimentation, significantly higher serum ferritin, ineffective antibiotic treatment, glucocorticoids can make the symptoms relieve, but the symptoms can often recur when reducing or stopping the hormone. Modern medicine for this disease mainly uses commonly used drugs are non-steroidal anti-inflammatory drugs (NSAIDS), glucocorticoids, improve the condition of anti-rheumatic drugs (DMARDS) for the treatment of this disease, but the efficacy of some patients is poor, the need for Chinese medicine or Chinese and Western medicine combined treatment. The author believes that adult Sclerosis belongs to the category of paralysis in Chinese medicine, and the clinical treatment of this disease advocates the combination of evidence-based and disease-based treatment, and the staging system.
I. Discriminatory treatment and phased treatment.
Generally, according to the characteristics of the clinical manifestations of the disease, it is divided into two phases: the fever phase is characterized by damp-heat paralysis, qi-yang two-burnt evidence and cold-heat mixed evidence, while the recovery phase is characterized by yin deficiency and blood stasis evidence.
1. Dampness and heat are contained in the evidence.
Main symptoms: fever, asr fever, bitter mouth, tasteless diet, dullness or nausea, generalized desire to vomit, joint swelling and pain mainly in the lower extremities, generalized drowsiness and weakness, heavy and sore lower extremities, swelling or joint effusion, yellow and greasy tongue coating, slippery pulse. Most often seen in the fever phase of the disease.
Treatment: Clearing away heat and dampness, dispelling wind, activating blood circulation; formula: Si Miao Wan plus flavor; Atractylodes Macrocephala 12g, Cyperus Macrocephala 12g, Coix Seed 30g, Radix Achyranthes Bidentata 20g Gentiana Macrophylla 15g, Zeligia 20g, Che Qian Zi 20g, Artemisia 15g, Pierced Mountain Dragon 20g, Dioscorea Z 15g, Papaya 20g, Comfrey 10g, Gardenia 10g, Raw Licorice 6g, decoction with water plus reduction: if dampness is heavier than heat, the formula should be reused with Atractylodes Macrocephala, Coix Seed, Zeligia, Radix et Rhizoma. If dampness is heavier than heat, Cang Zhu, Coix Seed, Ze Xie and Dioscorea Z should be used to remove dampness; if heat is heavier than dampness, Huang Bai, Gentiana, Artemisia, Comfrey and Gardenia should be used to clear heat and cool the blood to detoxify the toxin; in addition, Panax notoginseng and Chuan Niu Kne should be used to invigorate the blood and promote blood circulation. If you see obvious redness, swelling, heat and pain in the joints, or even strong heat all over the body, you should add heat-clearing and detoxifying drugs such as honeysuckle, dandelion, panax notoginseng, bitter ginseng, etc.
2.Burnt Qi and Ying evidence.
Main symptoms: persistent high fever, dry mouth and thirst, sore throat and difficulty in swallowing, sweating, restlessness, joint pain, red rash, yellow urine, dry stool, red or reddish tongue, yellow, dry and less fluid coating, and flooded pulse. Most often seen in the fever phase of the disease.
Treatment: Clearing the blood and detoxifying the blood; formula: Bai Hu Tang with Qing Ying Tang, plus or minus 40g of raw gypsum (decoction first), 15g of Zhi Mu, 15g of Sheng Di, 15g of Xuan Shen, 20g of Panax notoginseng, 10g of Dang Pi, 10g of Red Peony, 10g of Dang Shen, 0.6g of Antelope’s horn powder (punch), 30g of Yin Hua, 15g of Forsythia, 10g of Bamboo Leaf, 10g of Gentiana Macrophylla, 6g of Radix et Rhizoma Glycyrrhizae, plus or minus: if thirst is very severe, add Add asparagus powder, maitong, dendrobium. If the sore throat is obvious, add Burdock, Xin Yi and Scutellaria. For hard stools, add Rhubarb and Dandelion. Add Xu Changqing if the joint pain is severe. For irritability, add gardenia and tempeh.
3, cold and heat mixed evidence.
Main symptoms: fever, burning pain in the joints, or redness and swelling, cold form, cold limbs, fear of wind and cold, pain is aggravated on cloudy and rainy days, warmth is relieved, red tongue, white fur, string-like thin or number of pulse. Most often seen in the fever phase of the disease.
Treatment: dispel wind and cold, clear heat and dampness; formula: Gui Zhi Shao Yao Zhi Mu Tang plus or minus; Ephedra 6g, Gui Zhi 12g, Red and White Peony 15g, Zhi Mu 10g Dampi 20g, Bacopa Monnieri 10g, Atractylodes Macrocephalae 12g, Fang Feng 10g, Licorice 6g, Pierced Mountain Dragon 20g, Old X Cao 20g, Gentiana Macrophyllae 10g decoction with water; add Lonicera japonica and Dandelion as appropriate to clear heat and detoxify; if fear of wind and cold is obvious, add Lonicera japonica and Dandelion as appropriate to clear heat and detoxify. If you are afraid of wind and cold, add Astragalus membranaceus and Qiangwu as appropriate to benefit the qi and solidify the surface and disperse the cold.
4.Yin deficiency and blood stasis evidence.
Main symptoms: Fever slowing down but low fever persisting, five hearts troubled by heat, two cheek flushing, night sweating, body fatigue, rash faintly unclean, hidden pain in the abdomen especially at night, painful and distended joints, dry mouth and urination, tender red tongue or with petechiae, thin white or thin yellow and dry moss, thin and slightly counted pulse. Most often seen in the recovery phase of the disease.
Treatment: Nourishing Yin and reducing heat, activating blood circulation, resolving blood stasis and promoting circulation; formula: Zengliang Tang with Artemisia annua and turtle nail soup with addition and subtraction; Xuan Shen 15g, Sheng Di 15g, Mai Dong 10g, roasted turtle nail 15g (first decoction) Zhi Mu 10g, Dan Pi 10g, Artemisia annua 15g, Di Bark 10g, Gentiana macrophylla 10g, Red peony 15g, raw licorice 6g, Pierced Mountain Dragon 20g decoction with water. If fatigue is obvious, add princeton ginseng and astragalus. For dry mouth and thirst, add powdered smallpox and sage. Add Xu Changqing if the symptoms of joint pain are obvious.
Second, the clinical use of drugs, the originality of the art.
The clinical use of medicine advocates the combination of identification of evidence and disease, and on the basis of the differentiation of evidence and treatment, the addition of botanicals with hormone-like effects, and the formation of unique fixed pairs of medicine, such as Dioscorea and Dioscorea Z, Dioscorea and Zhi Mu, Zhi Mu and Gentiana, Dioscorea and Xu Changqing, etc.
1. Dioscorea and Dioscorea Z: Dioscorea, bitter and slightly cold, enters the liver and lung meridians, with the function of dispelling wind and dampness, activating blood circulation, and clearing lung and phlegm, cooling blood and eliminating carbuncles; Dioscorea Z, bitter and flat, enters the kidney and stomach meridians, with the effect of dispelling dampness and turbidity, dispelling wind and paralysis. It is especially effective in relieving morning stiffness. Modern pharmacological research has confirmed that the main component of Andrographis paniculata is diosgenin and other steroidal saponins, which have steroid hormone-like effects in the body. It also has steroid hormone-like effects in the body. The combination of Dioscorea and Dioscorea Z not only enhances the effect of dispelling wind and dampness, but also has hormone-like effect on immunosuppression, which can play a targeted role in the treatment of rheumatic immune diseases such as adult Sclerosis.
2, ZhiMu and wear the mountain dragon: ZhiMu, bitter, sweet, cold. It belongs to the lung, stomach and kidney meridians. It has the effect of clearing heat and fire, generating fluid and moistening dryness. It is used in combination with Andrographis paniculata to dispel wind and dampness, clear heat and fire, cool the blood and invigorate the blood circulation. The rhizome of Zhi Mu contains many kinds of Zhi Mu saponins (steroidal saponins) and Zhi Mu polysaccharides, etc. In animal experiments, Zhi Mu infusion has the effect of preventing and treating hyperthermia caused by Escherichia coli, and clinical studies have proved that Zhi Mu saponin oral solution can significantly reduce the side effects produced by glucocorticoids when taken orally for the treatment of primary nephrotic syndrome. Also can also because of the antipyretic and hormone-like effect, the fever, arthralgia, rash in adults with Still’s disease can play a good therapeutic role.
3, Baji Tian and Zhi Mu: Baji Tian, pungent, sweet, slightly warm. It belongs to the liver and kidney meridian, has the effect of tonifying the kidney to help Yang, dispel wind and dampness, and Zhi Mu with each other for use, pungent open bitter down, cold and warm and can dispel wind and dispel cold and dampness, and can clear heat and fire, moisten dryness, treatment of external cold and internal heat, cold and heat mixed evidence. Modern pharmacological research shows that: the main components of Baji Tian are sugars, flavonoids, amino acids, etc., its ethanol extract and water decoction has a significant pro-adrenocorticotropic hormone-like effect, Zhi Mu and Baji Tian together, play a hormone-like effect and antipyretic effect, the fever, joint pain, rash of adult Sclerosis can play a good therapeutic effect.
4, Gentiana macrophylla and Zhi Mu: Gentiana macrophylla, bitter, pungent, slightly cold. It belongs to the stomach, liver and gallbladder meridian, with the effect of dispelling wind and dampness, reducing deficiency heat, and is used in combination with Zhi Mu, which is pungent, open and bitter, and works together to dispel wind and dampness, nourish yin and clear heat. Modern pharmacological research shows that the main component of Gentiana macrophylla alkaloid A has antipyretic, sedative, analgesic, anti-inflammatory and anti-allergic effects, and its anti-inflammatory effect is achieved by agitating the pituitary gland through the central nervous system and promoting adrenal cortical hormone. The anti-inflammatory effect is realized through central nervous system agitation of pituitary gland and promotion of adrenal cortical hormone. Gentiana macrophyllae and Zhi Mu combine to play hormone-like effect and antipyretic effect, which can play a good therapeutic effect on fever, joint pain and rash of adult Sclerosis, especially for those who need to withdraw hormone gradually after long-term application of hormone, which can reduce hormone withdrawal reaction and help patients withdraw hormone smoothly.