| BackgroundAs a chronic inflammatory disease,ankylosing spondylitis belongs to seronegative spondyloarthropathy.The incidence rate of the disease is0.3%.The incidence ratio of male and female is2-3:1.The disease is more common in young adults, and the peak age of incidence is15-30years old. The central axis joints,peripheral joints and the tissues outside joints are mainly involved in patients of AS.The lower back pain or stiffness,activity limitation of the spine and hip are the main symptoms.In severe cases,the spine deformity may occur.Western medicine includes NSAIDS and DMARDS.However,the patient compliance is poor because of long treatment courses and side effects.Traditional Chinese medicine can keep long-term remission in patients with AS and improve the life quality of patients.Due to security and low cost,TCM treatment of AS have good social and economic benefits.ObjectiveTo discuss and summarize TCM name of AS,etiology,pathogenesis,TCM syndrome essential factor,therapeutic principle and drug rules,collection and quantitative analysis of literatures concerning the famous TCM doctors’clinical experiences of treating AS were carried out.To collect and mine the tutor’s treatment features and medication experiences,principle of man machine integration was used,which was beneficial to extend the tutor’s academic thoughts.To evaluate the efficacy and safety of the jiejingshudu decoction,clinical cases of AS were observed.MethodPublished literatures concerning AS diagnosis and treatment experience were collected.Denominations were formed into fixed fields of pathogenesis,syndrome differentiation,treatment method and the main drug that involved in these literatures.A database and frequency statistics were established by aid of SPSS16.0.A variety of data mining methods were used under the principle of man machine integration and people-orientation.The tutor’s guidance with personal appreciation was combined,the tutor’s clinical experiences was fully summarized.A randomized controlled clinical trial was conducted.90patients with AS were randomly divided into three groups:TCM group,integration of traditional Chinese and western medicine group,western medicine group.The patients of TCM group were treated with jiejingshudu decoction.The patients of integration of traditional Chinese and western medicine group were treated with jiejingshudu decoction and sulfasalazine.The patients of western medicine group were treated with sulfasalazine and diclofenac sodium.There were three months continuous medication for all AS patients.The changes in the five main and the five secondary efficacy indicators were recorded after two weeks,one month and three months of treatment.The five main efficacy indicators included BASDAI,BASFI,total pain score,overall evaluation score of patients with the disease and TCM symptom score.The five secondary efficacy indicators included thoracic mobility,finger-floor distance, occipital head-wall distance,ESR,CRP.Result1Literature researchThere were29involved TCM names of the disease in the collected literatures. Bone impediment,kidney impediment and impediment syndrome were more common. Pathogen invaded the body in case of healthy qi deficiency,which resulted in the occurrence of AS.Etiology included both internal and external factors.The internal factors refered to healthy qi deficiency,congenital deficiency,acquired dystrophy, emotional trauma,improper diet,and overwork.The external factors refered to six excessive pathogens or wound.The pathogenesis was deficiency-excess complex,that was,deficiency at root and excess at branch.Physicians understund differently the root deficiency.There were52physicians who realised that the root deficiency refered to kidney deficiency(77.6%).There were35physicians who realised that the root deficiency refered to kidney and governor vessel deficiency(52.4%).There were18physicians who realised that the root deficiency refered to liver and kidney deficiency(26.9%).56syndrome types were involved in the literatures.The syndrome names with frequency greater than10times refered to static blood obstruction syndrome,kidney and governor vessel deficiency syndrome,syndrome of dampness-heat impediment,syndrome of cold-dampness impediment,syndrome of phlegm and blood stasis accumulation,syndrome of liver-kidney yin deficiency, syndrome of wind-cold-dampness impediment.According to the quantity of pathological factors or key elements the syndromes were divided into12single-factor syndromes,33two-factor syndromes,8Multi-factor syndromes,3inconvenient category syndromes.8key elements were included in the syndromes.A limited number of key elements were assembled into various types of syndrome of AS.The methods of treatment described in the literatures were decomposed into a single-factor method of treatment.Frequency of 17methods of treatment were greater than10times.These17methods of treatment were composed of tonifying the kidney,eliminating dampness,activating blood and resolving stasis,freeing the collateral vessels,clearing away heat,invigorating or unblocking du,dissipating cold,tonifying the liver and kidney,dispelling wind,relieving pain,resolving phlegm,nourishing blood or harmonizing the nutrient,detoxify,tonifying qi,invigorating bone or nourishing sinew,fortifying the spleen and invigorating the blood,moving qi or tonifying defense qi.The herbs which were applied by10or more physicians belonged to10categories of Chinese medicinal.10categories of Chinese medicinal were composed of kidney-tonifying medicinal,blood-activating medicinal, wind-dampness-dispelling medicinal,heat-clearing and dampness-drying medicinal, dampness-draining diuretic medicinal,dampness-resolving fragrant medicinal,wormy wind-dispelling or collateral vessels-freeing medicinal,phlegm-resolving medicinal, qi-tonifying medicinal and blood-tonifying medicinal.2The tutor’s clinic experiences and data miningA total of105people cases were collected in the study.The common symptoms included lumbago,pain of hip joints,thoracodorsal stiff and pain,lower extremity and lower back activity limitation,stiff and pain of neck,back pain,lumbosacral pain,mild lumbago,knee pain,heel pain,activity limitation of neck,lack of strength and profuse sweating.The main pattern types included pattern of qi deficiency with blood stasis, pattern of heat toxin impediment,pattern of dampness-heat impediment,pattern of kidney deficiency and blood stasis,pattern of wind-cold-dampness impediment and pattern of liver-kidney deficiency.The main treatment methods included emolliating the liver to relax sinews,arresting convulsions to relieve pain,dispelling wind to free the collateral vessels, resolving phlegm to soften hardness,clearing the heat to detoxify,tonifying qi,tonify the kidney and activating blood.There were128herbs commonly used by the tutor.Herbs of frequency more than80%among them involved Gegen,Baishao,Weilingxian,Shancigu,Wugong.The five herbs were sovereign and minister medicinals of jiejingshudu decoction.3A clinic trial on jiejingshudu decoction treating ASObservation of84cases was completed.There were60males(71.43%) and24females(28.57%).The ratio of male to female was2.5:1.Among the three test groups,there were30cases in TCM group,30cases in integration of traditional Chinese and western medicine group,24cases in the western medicine group.The ages of84patients were from14to58years old.The average age was31.63±6.12in TCM group.The average age was33.13±10.81in integration of traditional Chinese and western medicine group.The average age was33.50±11.45in the western medicine group.The total efficacy of TCM group,integration of traditional Chinese and western medicine group,western medicine group was80.00%,83.33%,79.17%.The result was no significant difference in the statistical analysis.The total efficacy of integration of traditional Chinese and western medicine group didn’t increase.In the period of clinical observation patients of TCM group did not show abnormal blood and urine test,whose main adverse reaction were mild gastrointestinal discomfort such as nausea, distention,diarrhea.The incidence of adverse reactions in TCM group was less than that in the other two groups.The five main efficacy indicators included BASDAI,BASFI,total pain score, overall evaluation score of patients with the disease and TCM symptom score. BASDAI began to decrease to different extent in the three groups after two weeks of treatment.It decreased statistically significantly in the other two groups in comparison to the Western medicine group after two weeks or one month of treatment(TCM group P<0.05, integration of traditional Chinese and western medicine group P<0.01). BASDAI decreased statistically and significantly in the integration of traditional Chinese and western medicine group in comparison to the western medicine group after three month of treatment(P<0.05).BASFI began to decrease to varying degrees in the three groups after two weeks of treatment.It decreased statistically significantly in the other two groups in comparison to the western medicine group after two weeks of treatment.(TCM group P<0.05,integration of traditional Chinese and Western medicine group P<0.01).It decreased statistically and significantly in the other two groups in comparison to the western medicine group after one month of treatment(P<0.05).The difference of BASFI among the three groups was not statistically significant after three months of treatment.Contrasted before and after treatment, total pain scores of the three groups decreased.Total pain score and overall evaluation score of patients with the disease improved statistically and significantly in the integration of traditional Chinese and western medicine group in comparison to the western medicine group after two weeks of treatment(P<0.05).Contrasted before and after two weeks of treatment,TCM symptom scores of TCM group and the integration of traditional Chinese and western medicine group improved statistically and significantly(P<0.001).It improved statistically and significantly in the other two groups in comparison to the western medicine group after two weeks of treatment(TCM group P<0.05, integration of traditional Chinese and western medicine group P<0.01).TCM symptom score of the integration of traditional Chinese and western medicine group in comparison to the western medicine group improved statistically and significantly after two weeks of treatment(P<0.05).It improved in the western medicine group after one or three months of treatment,however,it improved statistically and significantly in the other two groups in comparison to the western medicine group(P<0.01).The five secondary efficacy indicators included thoracic mobility,finger-floor distance,occipital head-wall distance,ESR,CRP.By contemporary comparison, thoracic mobilities of the three groups had no statistically significant difference (P>0.05).After two weeks of treatment thoracic mobilities of TCM group and the integration of traditional Chinese and western medicine group improved statistically and significantly(integration of traditional Chinese and western medicine group P<0.001,TCM group P<0.05).Contrasted before and after one or three months of treatment, thoracic mobilities of the three groups improved statistically and significantly. By contemporary comparison,finger-floor distances of the three groups had no statistically significant difference(P>0.05).Contrasted before treatment with after two weeks,one or three months of treatment, finger-floor distances of the three groups improved statistically and significantly.By contemporary comparison, occipital head-wall distances of the three groups had no statistically significant difference (P>0.05).By contemporary comparison,ESR and CRP of the three groups had no statistically significant difference(P>0.05).Compared with this group before treatment, the two indicators of the three groups improved statistically and significantly afer one or three months of treatment(P<0.05,P<0.001).Improvement of TCM symptom score in TCM group or the integration of traditional Chinese and western medicine group was better than that in the western medicine group.Improvement of BASDAI and BASFI in the other two groups was better than that in the western medicine group afer two weeks and one month of treatment.Improvement of BASDAI in the integration of traditional Chinese and western medicine group was better than that in the western medicine group afer three months of treatment.Improvement of total pain score and overall evaluation score in the integration of traditional Chinese and western medicine group was better than that in the western medicine group afer two weeks of treatment.With prolonged treatment period,the difference of the two scores in the other groups compared with the western medicine group became not significant.Compared with the western medicine group,the other secondary efficacy indicators,including thoracic mobility,finger-floor distance, occipital head-wall distance,ESR and CRP,had no significant differences.Conclusion1Literature researchThe contemporary famious TCM doctors did not agree with TCM names of the disease.Most of them regard the disease as bone impediment,kidney impediment and impediment syndrome.Only Professor Fang thinks that AS should be attributated to sinew impediment.Etiology includes both internal and external factors.The main pathogenesis is deficiency-excess complex,that is,deficiency at root and excess at branch.Professor Fang thinks that pathogenesis of AS is sinews dystrophy and qi-blood blockage due to liver qi stagnation or liver blood deficiency.The key syndrome elements refer to deficiency,dampness,cold,wind,stasis,heat,phlegm and toxin.The common methods of treatment include tonifying the kidney,eliminating dampness,activating blood and resolving stasis,freeing the collateral vessels.The herbal drugs of tonifying kidney are selected by heat or cold nature of the syndrome type.Wind-dampness dispelling and cold dispersing medicinal often emerge in many physicians’ prescriptions.The majority of doctors agree with usage of blood-activating and stasis-resolving medicine throughout the therapeutic process.Wormy wind-dispelling or collateral vessels-freeing medicine and animal blood-activating or stasis-resolving medicine are more applied to AS patients in active phase or late stage.Professor Fang realized that emolliating the liver to relax sinews and relieving spasm to alleviate pain are the total principles of treating AS.Jiejingshudu decoction is a self-made recipe for AS by Professor Fang.2The tutor’s clinic experiences and data miningTutor Professor Fang thinks that AS should be attributated to sinew impediment. Sinew impediment is a group of symptoms including sinew contracture or spasm, pulling pain,joint flexion,lumbar back bending and rigidity,trudge,etc.Either wind-cold-dampness-heat pathogen invades the sinews in the statement of body healthy qi deficiency,or the sinews are injured,or phlegm-dampness binds the sinews, which results in the occurrence of sinew impediment.The disease of sinew impediment is located in sinews and joints.The liver viscus is mainly involved.Basic pathogenesis is characterized by sinews dystrophy and qi-blood blockage due to liver qi stagnaton or liver blood deficiency.Typical symptoms consist of pain,spasm and ankylosis. Jiejingshudu decoction is a basic formula treating AS,which is composed of Gegen,Baishao,Weilingxian,Shancigu,Wugong,Shenghuangqi,Luxiancao,Wushaoshe,S henggancao,Yiyiren.Tutor Professor Fang advocates combination disease identification with syndrome differentiation.According to the stage of disease and accompanying syndrome,the herbal drugs are added or cut down on the basis of Jiejingshudu decoction, with reference to modern physiological,pathological and pharmacological knowledge.3A clinic trial on jiejingshudu decoction treating ASJiejingshudu decoction is a effective formula for treating AS.Efficacy of jiejingshudu decoction does not improve in the case of combination of sulfasalazine. Security and patient compliance of jiejingshudu decoction are superior to sulfasalazine in combination or sulfasalazine plus diclofenac sodium... |
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