Rheumatoid Arthritis, A Ten Year Study Of Chinese Medicine Prescriptions

Objective:Using the Chinese Medicine Prescription Intelligent Analysis System (C.M.P.I.A.S.) provided by Beijing Information Research Institute of Chinese Medicine,I analyzed rheumatoid arthritis(RA) cases over a ten year period.The patients studied were from the first affiliated hospital of Guangzhou University of Chinese Medicine. Their prescriptions were analyzed and the most commonly used herbs were listed in the order of their use in order to help practitioners choose the most efficient prescriptions for treatment.Methods:Rheumatoid arthritis and arthralgia syndrome cases were examined in a retrospective study,1999 to 2008,of patients in the first affiliated hospital of Guangzhou University of Chinese Medicine.Rheumatoid arthritis or arthralgia was the first diagnosis in all 643 cases studied.Information was collected concerning signs,symptoms and medication.Then herbal prescriptions were analyzed utilizing the C.M.P.I.A.S.in order to compare the clinical rules for prescriptions for RA,the actual cause of the disease and the herb usage of the experts at the hospital.Results:(1) Of 643 cases,157 were males at 24%and 486 females at 76%.Therefore,the cases of females were three times that of males.Among all cases,minimum age was 11 years while maximum age was 87 years.Therefore,average age was 53.624±14.5 years old.The shortest course of treatment was one month while longest was 480 months(40 years.) Therefore,average course of treatment was 85.888±87.844 months.(2) Of 178 cases of tongue examination,red tongue was most commonly noted at 27.8%.In furs,yellow greasy furs and white greasy furs were most common and were noted in 169 cases.In pulse taking,the string-like pulse was most common and was found in 330 cases.(3) In percentage distribution,the wet-hot evil syndrome are 346 cases which took 53.8%in all cases,the wet-cold evil syndrome are 86 cases which took 13.4%, liver-kidney inadequate yin syndrome are 79 cases which took 12.3%,the blood stasis syndrome are 72 cases which took 11.2%.(4) Most frequently used herbal prescriptions were:dispelling water evil were used 438 times,treating tendon spasms and collateral stasis were used 371 times,alleviating fire evil were used 285 times,relieving pain were used 209 times,promoting blood circulation and removing stasis were used 179 times,relieving wind evil were used 171 times,and enhancing liver and kidney function were used 134 times.(5) In the water-fire evil syndrome,206 herbs were used;83 of these herbs were used more than 9 times.The first ten herbs were:RADIX ET RHIZOMA GLYCYRRHIZAE(Zhigancao),SEMEN COICIS(Yiyiren),RAMULUS CINNAMOMI (Guizhi),RADIX CYATHULAE(Chaungniuxi),RADIX PAEONIAE ALBA(Baishao), CORTEX PHELLODENDRI CHINENSIS(Huangbo),RHIZOMA ATRACTYLODIS MACROCEPHALAE(Baizhu),RHIZOMA ANEMARRHENAE(Zhimu),PORIA(Fuling) and RHIZOMA ATRACTYLODIS(Chuangzhu).In the water-cold evil syndrome,124 herbs were used;29 of these herbs were used more than 10 times.The first ten herbs were: RADIX ET RHIZOMA GLYCYRRHIZAE(Zhigancao),RAMULUS CINNAMOMI (Guizhi),RHIZOMA ATRACTYLODIS MACROCEPHALAE(Baizhu),RADIX PAEONIAE ALBA(Baishao),RADIX SAPOSHNIKOVIAE(Fangfeng),PORIA (Fuling),RHIZOMA ANEMARRHENAE(Zhimu),HERBA EPHEDRAE(Mahuang), SEMEN COICIS(Yiyiren) and RHIZOMA ALISMATIS(Zhexie).In the liver-kidney yin-inadequate syndrome,128 herbs were used;30 of these herbs were used more than 10 times.The first ten herbs were:RADIX ET RHIZOMA GLYCYRRHIZAE(Zhigancao), RADIX CYATHULAE(Chaungniuxi),RADIX PAEONIAE ALBA(Baishao),RADIX SAPOSHNIKOVIAE(Fangfeng),RAMULUS CINNAMOMI(Guizhi),PORIA (Fuling),CORTEN EUCOMMIAE(Duzhong),HERBA TAXILLI(Sangjisheng),RADIX ANGELICAE PUBESCENTIS(Duhuo) and RHIZOMA ANEMARRHENAE(Zhimu). In the blood stasis syndrome,130 herbs were used;38 herbs were used more than 7 times. The first ten herbs were:RADIX ET RHIZOMA GLYCYRRHIZAE(Zhigancao), RADIX PAEONIAE ALBA(Baishao),RADIX CYATHULAE(Chaungniuxi),SEMEN COICIS(Yiyiren),RAMULUS CINNAMOMI(Guizhi),RADIX ANGELICAE SINENSIS(Danggui),RHIZOMA ATRACTYLODIS MACROCEPHALAE(Baizhu), PORIA(Fuling),RADIX ASTRAGALI(Huangqi) and RHIZOMA ANEMARRHENAE (Zhimu).(6) The most frequently used herbal prescriptions were:dispelling water evil were used 507 times,expelling wind evil were used 359 times,alleviating fire evil were used 244 times,promoting blood circulation and removing stasis were used 227 times,treating tendon spasms and collateral stasis were used 224 times,dispelling edema were used 207 times,enhance spleen function were used 137 times,and relieving pain were used 104 times.(7) The clinical treatments and the results of the C.M.P.I.A.S.match and both obeyed the normal distribution of P=0.000<0.001,which is statistically significant.Conclusion:(1) Disease incidence is three times higher in females than in males.(2) Red tongue and greasy fur are symptomatic of water-heat evil syndrome and yin inadequacy syndrome.(3) The string-like pulse indicates the patient has pain and mucus and also indicates the disease is located in the liver.(4) Water-fire evil and water-cold evil cause pain and stasis,which is consistent with traditional conclusions.(5) Dispelling water-evil is the most important rule of treatment;this benefits Qi essence,as well as assisting the spleen and stomach organs.(6) With water-fire evil syndrome of RA,the herbs that worked best to dispel water evil syndrome were SEMEN COICIS(Yiyiren),PORIA(Fuling) and assisted with RHIZOMA ATRACTYLODIS(Changzhu);the herbs most frequently used to alleviate fire evil syndrome were CORTEX PHELLODENDRI CHINENSIS(Huangbo) and RHIZOMA ANEMARRHENAE(Zhimu);the herbs most frequently used for expelling wind evil syndrome were RAMULUS CINNAMOMI(Guizhi) and RADIX SAPOSHNIKOVIAE(Fangfeng).With water-cold evil syndrome of RA,the herbs most frequently used to dispel water-cold evil syndrome were SEMEN COICIS(Yiyiren) and PORIA(Fuling);the herbs most frequently used to expel wind and cold evil syndrome were RAMULUS CINNAMOMI(Guizhi) and RADIX SAPOSHNIKOVIAE'(Fangfeng), the herb most frequently used for decreasing blood stasis was RADIX CYATHULAE(Chaungniuxi).With liver-kidney inadequacy syndrome of RA,the herb most frequently used was RADIX CYATHULAE(Chaungniuxi),assisted by HERBA EPHEDRAE(Sangjisheng),RADIX ANGELICAE PUBESCENTIS(Duhuo) and CORTEN EUCOMMIAE(Duzhong);With the blood stasis syndrome of RA,the herbs most frequently used in dispelling water evil were SEMEN COICIS(Yiyiren), PORIA(Fuling) and assisted with RHIZOMA ATRACTYLODIS(Changzhu);the herbs most frequently used in promoting blood circulation and removing stasis was RADIX CYATHULAE(Chaungniuxi),assisted with RHIZOMA CHUANXIONG (Chuangxiong),RADIX ET RHIZOMA SALVIAE MILTIORRHIZAE(Danshen) and RADIX ET RHIZOMA NOTOGINSENG(Sanqi).(7) There is consistency between the clinical treatment for RA and the results according the C.P.I.A.S.