Research On Ramulus Cinnamomi, Paeoniae And Anemarrhenae Decoction's Treatment Of Rheumatoid Arthritis And Its Effect On Life Quality

Rheumatoid Arthritis(RA) is a chronic systematic autoimmune disease with the feature of arthrosynovitis which may occur repeatedly,cause articular cartilage and bone destruction and finally cause joint abnormality and dysfunction.Chinese Medicine holds that the pathogen is deficiency of healthy qi and invasion of external evils like wind cold,dampness and heat,etc,which cause the meridian and collateral obstruction.The joints and muscles may feel pain,numb,swollen and inflexible,and even take dysarthosis.As the course is long and it' s hard to cure,Chinese Medicine calls it obstinate arthralgia, severe and migratory arthralgia,etc.As a systematic autoimmune disease with the characteristics of multi-joint chronic inflammation,it is often accompanied by joint injury and deformity. It is 200 years since the discovery of RA,medicine and therapies for its treatment are numerous,starting from the therapy limited to pain and inflammation relief originally,to medicine which may change the illness condition and now to the related immunological medicine.The clinical efficacy is improved.Many patients have relieved symptoms and their life quality is also improved for the amelioration of joint function.The purpose of treatment is to control pain and disease development,prevent the irreversible bone change,protect the joint and muscle function and improve the patients' life quality.But considering the current medical level,RA can' t be cured and can just be slowed.It' s urgent to make research on safe and efficient medicine for RA.RA is classified as arthromyodynia of Chinese Medicine and doctors of generations have discussions on its pathogenesis.In Su Wen,it says that wind, cold and dampness cause the arthromyodynia.Confucian' s Duties to Their Parents says the origin of arthromyodynia is dampness,heat and cold combined together.Golden Chamber says the Cunkou pulse is heavy and weak,so the healthy qi is not sufficient and arthromyodynia is caused.Classified Treatment and Syndrome Differentiation says all arthromyodynia is caused because the yingqi and weiqi are deficient,the interspaces of skin and muscles are loose,the wind,coldness and dampness attack,the healthy qi is obstructed,the sweat can' t be excluded and it stagnates,the qi and blood stagnate and all the factors mentioned cause arthromyodynia.Thread Ink of Medical Circle says generally the arthromyodynia is caused by deficient qi and blood and the nourishing qi is not smooth,therefore the three qi enter the interspaces of skin and muscles.Modern doctors have their own opinions about RA' s pathogenesis and etiology from the angle of Chinese Medicine:however most doctors agree that the pathogenesis of RA is the healthy qi asthenia and external invasion.The healthy qi asthenia refers to the fact that healthy qi is deficient,the interspace between skin and muscles and can' t defend the external evils.The external invasion refers to the coldness,wind, dampness and heat.This disease is of deficient origin and sthenia syndromes. Damp stagnation and sputum is both the pathological outcome and the pathogenesis factors.In Chinese Medicine,there is a variety of medicine for RA and the most commonly seen is syndrome differentiation which is usually the modification of classical prescriptions.The most frequently used is Ramulus Cinnamomi, Paeoniae and Anemarrhenae Decoction originally from Golden Chamber consisting of ramulus cinnamomi,white peony root,sweet root,joint fir,rhizome, atractylodes marcrocephala,anemarrhenae,saposhnikoviae and aconite root. It can diminish the wind and dampness,warm the meridians and disperse coldness, nourish yin and get rid of heat.Its indication is RA.The original text says that if all joints feel pain,the body is weak,the feet are swollen,and the person feels dizzy and short of breath and wants to vomit,it' s suitable to use Ramulus Cinnamomi,Paeoniae and Anemarrhenae Decoction.Ramulus cinnamomi, joint fir and saposhnikoviae can disperse coldness and dampness.Paeonia and anemarrhenae can smooth the arthralgia spasm.Atractylodes macrocephala and aconite root can help nourish yang and diminish dampness.Rhizoma and sweet root can ameliorate stomach and the internal organs.Joint fir and ramulus cinnamomi can diminish the dampness of the internal and external part with atractylodes macrocephala and can warm meridians and recover yang with aconite root.Rhizoma can help joint fir to disperse coldness and help atractylodes macrocephala and sweet root to ameliorate the internal organs.These elements used together can take care of both the internal and external parts,diminish wind and dampness,warm but not hurt yin and nourish yin not hurt yang.There are both experimental and clinical studies on RA treatment with Ramulus Cinnamomi,Paeoniae and Anemarrhenae Decoction.However the clinical study mainly adopts simple observation indexes,some just observing clinical syndromes,some considering the lab indexes.About the Chinese Medicine treatment of RA,few researches adopt internationally recognized efficacy observation indexes,and few focus on the life quality of RA with Chinese Medicine treatment.Considering the deficiency mentioned above,we selected 50 cases consistent with the diagnosis criteria of RA,give treatment for 3 months with Ramulus Cinnamomi,Paeoniae and Anemarrhenae Decoction Granules,adopt DAS-28 to judge the efficacy and adopt HAO to evaluate the effect of treatment on patients' life quality.We hold the hope that our research may provide proof for Chinese Medicine treatment of RA.1.MethodsSelect 50 patients consistent with the diagnostic,inclusion and exclusion criteria and group them into two Chinese Medicine clinics.Give treatment for 3 months with Ramulus Cinnamomi,Paeoniae and Anemarrhenae Decoction Granules and score the DAS-28 before treatment,one and two months after treatment and at the end of the treatment respectively.Score the HAQ of RA patients' life quality before treatment,one and two months after treatment and at the end of the treatment respectively.2.ResultClinical syndrome improvement shows that after one month' s treatment,the patients' joint pain ameliorates,but there is no statistical significance (P＞0.05) compared with that before treatment;two months later,the joint haphalgesia continuously lessens and there' s statistical significance (P＜0.01) compared with that before treatment;at the end of the treatment, the joint haphalgesia obviously ameliorates and there' s statistical significance(P＜0.01).About arthrocele,the result shows that after one month' s treatment,the patients' arthrocele ameliorates,but there is statistical significance(P＜0.05) compared with that before treatment;two months later,the arthrocele continuously lessens and there' s statistical significance(P＜0.01) compared with that before treatment;at the end of the treatment,the arthrocele obviously ameliorates and there' s statistical significance(P＜0.01).The result shows that after one month' s treatment,the patients' blood sedimentation drops,and there is statistical significance(P＜0.05) compared with that before treatment;two months later,the blood sedimentation continuously drops and there' s statistical significance (P＜0.01) compared with that before treatment;at the end of the treatment, the blood sedimentation obviously drops and there' s statistical significance(P＜0.01).The result shows that after one month' s treatment,the patients' general health ameliorates,and there is statistical significance(P＜0.05) compared with that before treatment;two months later,the general health continuously ameliorates and there' s statistical significance(P＜0.01) compared with that before treatment;at the end of the treatment,the general health obviously ameliorates and there' s statistical significance(P＜0.01). After one month' s treatment,the patients' DAS-28 score improves,but there is no statistical significance(P＞0.05) compared with that before treatment;two months later,the DAS-28 score improves continuously and there' s statistical significance(P＜0.01 ) compared with that before treatment;at the end of the treatment,the DAS-28 score improves obviously and there' s statistical significance(P＜0.01).The result shows that after one month' s treatment,the patients' deformity and discomfort index drops,and the HAQ score improves,but there is no statistical significance(P＞0.05) compared with that before treatment;two months later,the deformity index obviously drops and there' s statistical significance(P＜0.01) compared with that before treatment;the discomfort index has no difference,the HAO score continuously drops and has statistical significance(P＜0.05);at the end of the treatment,the deformity index,the discomfort index and HAQ score obviously drop and there' s statistical significance(P＜0.01).3.ConclusionRamulus Cinnamomi,Paeoniae and Anemarrhenae Decoction Granules Effectively Ameliorate Patients' Joint Swelling and PainRamulus Cinnamomi,Paeoniae and Anemarrhenae Decoction is a classical famous prescription for RA.Arthrocele is the most objective sign of RA and causes the greatest pain of patients.Lab research also shows that Ramulus Cinnamomi,Paeoniae and Anemarrhenae Decoction can obviously inhibit the mice' s writhing response caused by acetic acid and rats' cotton ball granuloma hyperblastosis,lower the mice' s abdomen cavity capillary permeability,and inhibit adjuvanticity arthritis,rats' primary forced foot and secondary arthritis.Mechanism research shows that Ramulus Cinnamomi, Paeoniae and Anemarrhenae Decoction can obviously lower the prostaglandin content of rats' adjuvanticity inflammatory textures,and inhibit the leukoplania of inflammatory reaction.In the prescription,ramulus cinnamomi and aconite root can warm meridians,disperse coldness and stop pain;joint fir and rhizome can disperse wind and coldness,activate yang and smoothing spasm,and disperse cold wind and dampness from the surface;atractylodes macrocephala and saposhnikoviae root can diminish wind and dampness; anemarrhenae and paeonia can nourish yin and diminish heat;sweet root and paeonia alba can stop pain and ameliorate the drug property.All elements combined can effectively diminish pain and swelling.Clinical research shows that since RA is a long-term chronic repeated disease,so the treatment course is long with no matter Chinese or Western Medicine treatment.One month' s treatment later,the arthrocele lessens and it proves that Ramulus Cinnamomi, Paeoniae and Anemarrhenae Decoction has good function of swelling diminishing. About joint haphalgesia,there' s statistical significance after two months' treatment which indicates that the analgesic effect of Ramulus Cinnamomi, Paeoniae and Anemarrhenae Decoction takes place around two months.Ramulus Cinnamomi,Paeoniae and Anemarrhenae Decoction Can Effectively Lower the Blood Sedimentation and Lessen Inflammatory ReactionBlood sedimentation is an effective lab index to show the RA activity. Though it doesn't have strong specificity,but if the other conditions like infection and tumor are excluded,it can reflect the activity of RA.It' s more persuasive if combined with clinical manifestation.This research shows that after one month' s treatment with Ramulus Cinnamomi,Paeoniae and Anemarrhenae Decoction granules,the blood sedimentation drops and there' s statistical significance compared with that before treatment.It shows that besides effectively ameliorating clinical syndromes,Ramulus Cinnamomi, Paeoniae and Anemarrhenae Decoction can also improve the lab index.Its effective after just one month and it' s more efficient than some Western drugs like Methotrexate and Leflunomide which takes effect after 3 to 6 months. Ramulus Cinnamomi,Paeoniae and Anemarrhenae Decoction Granules Effectively Improve Patients' General HealthResearch shows that after one month' s intake of medicine,patients' pain and swelling improve and life quality improves.With improvement of swelling, the joint function improves and radius of action is enlarged and patients' physiological and psychological condition improves,so their general health improves.With treatment,each index is in the process of improvement.Ramulus Cinnamomi,Paeoniae and Anemarrhenae Decoction Granules Effectively Improve Patients' DAS-28 Score and Lessen Arthritis ActivityDAS-28 is a comprehensive index to judge the RA activity in the international RA field and also an efficacy criterion to evaluate RA drug. This research takes DAS-28 to judge the efficacy of Ramulus Cinnamomi,Paeoniae and Anemarrhenae Decoction Granules in RA treatment.It is found that after 2 months,DAS-28 obviously improves and has statistical difference compared with that before treatment which fully proves that Ramulus Cinnamomi,Paeoniae and Anemarrhenae Decoction is an effective medicine for RA.Ramulus Cinnamomi,Paeoniae and Anemarrhenae Decoction Granules Lower Patients' HAQ Score and Improve Life QualityRamulus Cinnamomi,Paeoniae and Anemarrhenae Decoction can improve both the life quality and clinical syndrome consistently.After one month' s treatment,because of the improvement of joint haphalgesia and arthrocele, the patients' activity radius enlarges and they can finish some task which they couldn't do before.For example,with the improvement of upper extremity function and the shoulder and elbow function,the patients can put on clothes, bathe and wipe dry their bodies by themselves;with the improvement of wrist, finger and articulations interphalangeae patients can tie shoelace and buttons, take a glass of water to the mouth,and can open or close the tap or cork; with the improvement of coax and knee function,patients can get on or off bed by themselves and can walk on the outdoor ground,squat down,pick up the clothes on the floor,get on or off cars,etc.After two months' treatment, with the function improvement,there' s significant difference in deformity index compared with that before treatment.With life ability improvement,patients feel they can relieve their families' burdens and are needed by others,so their mood improves and can gradually like what they are doing.They can lessen anxiety or dysphoria,calm down and lessen adverse moods like sadness or depression.By lessening discomfort of body,their psychological burden also lessens,so the HAQ Score improves with the recovery of physical syndromes.The current research shows that medical treatment can only inhibit the inflammation of RA but can' t repair the deformed joints and can' t reverse the lost function.So compared with clinical syndromes,the discomfort index takes longer time.Since part of the function can' t be repaired,the patients' discomfort is difficult to diminish.Generalizing what we mention above,we find that Ramulus Cinnamomi, Paeoniae and Anemarrhenae Decoction can lessen arthrocele after one month' s treatment,obviously lessen the joint haphalgesia around two months and improve blood sedimentation around one month.It can improve patients' general evaluation of function and the DAS-28 score.Around two months' treatment,except discomfort index,each index is improved obviously around two months compared with those before treatment.After 3 months' treatment, all indexes are obviously improved.It shows that in analgesia,it takes effect slowly.But considering the other indexes,it is quicker in taking effect than Western Medicine.