Study Of Academic Thought And Experience In Treatment For Rheumatoid Arthritis Of Professor Ji Haiwang

Rheumatoid arthritis (RA) is a symmetrical polyarthritis with the main clinical manifestations of autoimmune disease. The character is chronic inflammation of synovium of joint and progressive failure of joints. The clinical manifestation is changeable and poor prognosis. It appears ankylosis, abnormalities and function failure in advanced stage and it cause the impairment of heart, lung, kidney, other organs and multisystemic which will compromise to the patient’s health and quality of life seriously. In northern of China, RA has the high incidence, therefore, the prevention and treatment of RA has important theoretical and social significance.In Traditional Chinese medicine. RA was always considered as "Bi-syndrome",,’obstinate arthralgia’,’rheumatism involving bone’,’rheumatism’,’crane-like arthropathy’,’drumstick wind’and etc. In modern TCM area. RA has been always diagnosed as’Wang bi’ that established by Professor Jiao Shude.Professor Ji Haiwang (chief physician, doctoral supervisor) is committed to treatment and research of internal medicine disease for30years which focus on organ pattern identification, identify patterns and administer treatment according to bowels and viscera. He suggested several theories, such as improving spleen in treatment of cough, improving liver in treatment of chest-abdom fullness, improving spleen and kidney in treatment of gout, improving spleen and stomach in treatment of recurrent aphthous ulcer, improving liver, spleen and kidney in treatment of alopecia.Professor Ji Haiwang conducted in-depth study and had considerable achievements in the field of rheumatology research. He represented RA which caused by kidney asthenia and exogenous evil. The internal cause is the pathogenic foundation. The external cause is the significance factor which includes environmental factor (cold, wet), bacteria, viruses and etc. kidney asthenia includes not only asthenia of Native endowment but also disorder of immune function. According to his theory, it should oriented focus on Kidney in treatment of RA. Because invigorating the Kidney and essence replenishment could make up congenital asthenia, invigorating the Kidney and improving spleen could improve acpuired asthenia, invigorating the Kidney and could nourish liver could nourishing Yin and muscle, invigorating the Kidney and nourishing blood could enriched Yi and Wei, invigorating the Kidney and warming yang could promote blood circulation to remove meridian obstruction. According to development of RA, it has been divided into acute phase, sub-acute phase and chronic-phase by Professor Ji Haiwang. Base on the principle of therapy is treating tip in acute condition and treating root in chronic condition, we should remove heat to relieve convulsion and reinforce kidney and activating blood in the acute phase. Dispelling wind and eliminating dampness, tonifying kidney and activating blood analgesia in sub-acute phase. Reinforcing kidney and activating blood in chronic-phase. The characteristic feature on drug was the major drug was the wind-damp-dispelling medicinal in acute condition. The ratio of kidney yang-supplementing medicinal and blood-quickening medicinal gradually increased during the state of an illness worsening.This article validates the RA’s determination of treatment rule of Professor Ji Haiwang according to retrospective and prospective clinical research. To utilize the clinical efficiency evaluation of Chinese Herbs Fengshi Ⅱ capsule in treatment with RA, it can certify the efficiency and safety of reinforcing kidney and activating blood in treatment with RA.Record the related clinical symptoms, signs, drug use and statistics analysis according to retrospective analysis of70RA patients. The incidence of kidney asthenia and blood stasis is50.00%, kidney asthenia and cold evil stasis is33.86%, damp-heat damaging kidney is7.14%. other pattern type is10.00%. It indicated the most frequent symptom is kidney asthenia and blood stasis. The major medication is damp-dispel agent&diuret, the minor is kidney-reinforcing drugs, the next is hemorheologic agent and the last medication is diaphoretics. The regular pattern of medication in treatment of RA is kidney asthenia and blood stasis combined with dispelling wind and eliminating dampness.According to observe the prospective studies in60RA patients (the medication of control group is Methotrexate Tablets), we observed the efficiency and safety of Fengshi Ⅱ capsule in treatment of RA. The result:the total effective rate of Fengshi Ⅱ capsule was96.67%, there was statistical significance between two groups (P<0.05). The effective of Fengshi II capsule is better than Methotrexate Tablets. In the further comparison with two groups, there was significant same effect in pain, tenderness of articular, articular edema, early morning stiffness and average hand strength of RA (P<0.01). Otherwise, there was statistical significance between two groups in articular edema. Compared to methotrexate, Fengshi II capsule had the same effect on the symptoms of the patients such as rest pain, articular edema index, articular pain and articular flexion-extension dysfunction, but had better effect on kidney-yang deficiency including morning stiffness duration, aversion to wind and cold, lassitude in loins and weakness and tiredness after8weeks of treatment. Compared to methotrexate group, the level of CRF had no statistical significance in Fengshi Ⅱ capsule. However, the levels of erythrocyte sedimentation rate (ESR) and rheumatoid factor (RF) hadn’t changed in both group. The levels of WBC before and after treatment in the two groups were compared between the two groups, there was statistical significance in methotrexate group (P<0.05), however, there was no obvious difference in Fengshi Ⅱ capsule group. As a result, methotrexate can cause a decrease in the level of WBC, but no this side effect in Fengshi Ⅱ capsule group, in another word, Fengshi Ⅱ capsule was more safely than methotrexate. The method of nourishing kidney and activating blood emphasis the advantages of TCM in treatment of RA, and embody the superiority of abidance by triple pathogens and syndrome differentiation and treatment.According to the clinical experience of Pro.Ji and the research results of etiology, genetic principle and experimental medicine, the author considered that there is not only kidney asthenia and blood-stasis but also toxicity which could result the complication of disease in the pathogenesis of RA. As a result, on the basis of reinforcing kidney and activating blood, the application of dissolving blood stasis and detoxication could be added properly.In a word, the objective of this study is to research systematically the treatment experience of RA by learning and arranging the academic thought of Pro.Ji Hai-wang. In addition, the study is to verify the effect and mechanism of Fengshi Ⅱ capsule on RA and provide the evidence for the treatment from kidney.