Ankylosing Spondylitis & Chinese Herbal Medicine

abstracted & translated by Bob Flaws, Lic. Ac., FNAAOM (USA), FRCHM (UK) Keywords: Chinese medicine, Chinese herbal medicine, rheumatology, ankylosing spondylitis (AS) Om page 36 of issue #3, 2004 of Zhong Yi Yan Jiu (Chinese Medical Research), Li Xian-lin published an article titled, "The Treatment of 243 Cases of Ankylosing Spondylitis with Shen Jin Tong Bi Wan (Extend the Sinews & Free the Flow of Impediment Pills)." A summary of that article is given below. Cohort description: Among the 243 patients enrolled in this clinical trial, there were 218 males and 25 females aged 15-60 years. One hundred thirty-one were 15-25 years of age, 89 were 26-35; 14 were 36-45; six were 46-55; and three were 56 years old or older. These patients course of disease ranged from three months to 42 years. All met the 1987 Rheumatology Symposium diagnostic criteria for AS. Treatment method: Shen Jin Tong Bi Wan consisted of: Ma Huang (Herba Ephedrae), 10g Gui Zhi (Ramulus Cinnamomi Cassiae), 10g Du Huo (Radix Angelicae Pubescentis), 10g Qing Feng Teng (Rhizoma Sinomenii Acuti), 12g Mu Gua (Fructus Chaenomelis Lagenariae), 12g Shen Jin Cao (Herba Lycopodii), 15g Wu Jia Pi (Cortex Radicis Acanthopanacis Gracilistylis), 12g Wu Shao She (Zaocys Dhumnades), 15g Dang Gui (Radix Angelicae Sinensis), 15g Chi Shao (Radix Rubrus Paeoniae Lactiflorae), 15g Du Zhong (Cortex Eucommiae Ulmoidis), 15g Gan Cao (Radix Glycyrrhizae Uralensis), 10g These medicinals were ground into a fine powder and then made into pills with water. Five grams of these pills were administered TID with warm water. Three months of continuous administration equaled one course of treatment. Study outcomes: Cure was defined as disappearance of low back and thoracic spinal pain, disappearance of the sensation of stiffness, and normal range of motion of the spinal joints. Marked effect was defined as basic disappearance of pain and stiffness but movement of the spinal joints still less than normal. Improvement meant that the lower and upper back

pain had decreased, joint function had improved, and the disease condition was stable. No effect meant that there was no obvious improvement in symptoms from before the after treatment or that the disease condition actually got worse. Based on these criteria, there were 76 cures, 90 cases of marked effect, 56 improvements, and 21 no effect, for a total effectiveness rate of 91.37%.
Cure 76 Marked effect 90 Improvement 56 No effect 21 Total effect. 91.37%

Discussion: According to Dr. Li, AS is due to wind, cold, damp evils taking advantage of vacuity to enter the body. There, they obstruct the channels and network vessels, resulting in this disease. Therefore, Dr. Li believes that the treatment principles for this condition should be to scatter cold and eliminate dampness, soothe the sinews and free the flow of the network vessels, quicken the blood and stop pain. Within the above formula, Ma Huang, Gui Zhi, Du Huo, and Qing Feng Teng scatter cold, eliminate dampness, and dispel wind. Mu Gua. Shen Jin Cao, Wu Jia Pi, and Wu Shao She can soothe the sinews and free the flow of the network vessels, relax and resolve cramping of the sinew vessels. Du Zhong supplements the liver and kidneys, strengthens the low back and knees. It also warms and shines the governing vessel and can guide the other medicinals to the site of the disease. These are assisted by Dang Gui and Chi Shao which quicken the blood, transform stasis, and stop pain. Gan Cao regulates and harmonizes all the other medicinals in the formula. When all these medicinals are used together, they promote the elimination of cold and dampness, the soothing of the joints, and the freeing the flow of the governing vessel. Thus the impediment pain automatically stops. Because this diseases course is long, this formula should be made into pills for long-term use. Readers should note that the cohort in this study was comparatively large: 243 cases. This study was conducted over a period of 15 or 16 years, from 1992 to the present. Copyright Blue Poppy Press, 2005. All rights reserved.

Ankylosing Spondylitis (AS) & Warm Needle MoxibustionKeywords; Chinese medicine, acupuncturemoxibus
abstracted & translated by Bob Flaws, Lic. Ac., FNAAOM (USA), FRCHM (UK) Keywords: Chinese medicine, acupuncture-moxibustion, rheumatology, inflammatory arthritis, ankylosing spondylitis (AS), warm needle moxibustion Ankylosing spondylitis, also called Marie-Strmpell disease, is one of the inflammatory arthrites. It is an autoimmune disorder characterized by inflammation and pain in the sacral and lumbar vertebrae. The pain typically is worse with rest and improves with activity. Arthritis in other joints in also present in 50% of patients. The disease typically progresses up the spine to involve the chest vertebrae, thus causing decreased range of motion of the chest with respiration. Eye inflammation and heart involvement with conduction disorders occur in 25% of cases. Ankylosing spondylitis is characterized by mild or moderate flares of activie spondylitis alternating with periods of almost or totally inactive inflammation. Erythrocyte sedimentation rate, C-reactive protein, and serum immunoglobulin (Ig) levels are mildly elevated in most patients, but serum rheumatoid factor (RF) and antinuclear antibodies (ANA) are negative. Diagnosis is confirmed by x-ray. This condition is three times more common in males than in females. Typical age at onset is between 20 and 40 years. It is 10-20 times more common in first-degree relatives of AS patients than in the general population. Its Western medical treatment primarily involves the use of NSAIDS (including COX-2 drugs) to suppress articular inflammation, pain, an muscle spasm. Radiotherapy to the spine, although effective, is used as a last resort because it increases the risk of acute myelogenous leukemia tenfold. On pages 52-53 of issue #3, 2004 of Zhong Yi Yan Jiu (Chinese Medical Research), Hou Chun-ying and Liu Qiang published an article titled, "The Treatment of 33 Cases of Ankylosing Spondylitis with Warn Needle Moxibustion." A summary of that article is presented below. Cohort description: Altogether there were 54 patients enrolled in this two-wing, comparative clinical trial. In the so-called treatment group of 33, there were 30 males and three females with a median age of 28.4 " 8.9 years and a median disease duration of 7.8 " 5.6 years. Seven cases had been diagnosed with AS for 2-5 years, 16 cases had been diagnosed for 6-10 years, and 10 cases had been diagnosed for more than 10 years. In the comparison group of 21, there were 20 males and one female with a median age of 31.2 " 10.3 years and median disease duration of 7.4 " 5.1 years. Six of these patient had been diagnosed with AS for 2-5 years, eight for 6-10 years, and seven for more than 10 years. Besides the clinical symptoms of aching and pain of the lumbosacral region which was worse on rainy days or after fatigue and inhibited range of motion, diagnosis was confirmed by x-ray in all cases. Exclusion criteria included rheumatoid arthritis, external injury, tuberculosis, and cancer. Treatment method:

Members of the treatment group were needled bilaterally at the Hua Tuo jia ji (or paravertebral) points at the level of T10. In addition, from T1 down to T9, needles were placed in either right or left paravertebral points, alternating vertebrae by vertebra, beginning with T1 on the left side. These needles were stimulated with twisting and turning supplementation hand technique. Every other treatment, the needles were switched sides from T1 to T9. In addition, Ba Liao (Bl 31-34), Huan Tiao (Bl 30), Cheng Fu (Bl 36), Zhi Bian (Bl 54), Zu San Li (St 36), Yin Ling Quan (Sp 9), and Yang Ling Quan (GB 34) were also needled with twisting and turning supplementing technique. Then, a one inch section of moxa roll was attached to the handles of the needles and lit. This was done once every other day, with the needles being retained for 30 minutes each time. Fifteen treatments equaled one course, and three successive courses were administered. The members of the comparison group only received acupuncture at the same points but without warm needle moxibustion. They were needled at the same frequency and for the same length of time. Study outcomes: Treatment outcomes were based on a point system rating the amount of lumbosacral pain and range of motion in the spine. Using this system, three points equaled a cure, two points equaled improvement, and one point equaled no effect. Based on these criteria, in the treatment group of 33, there were four cures, 32 improvements, and six no effect, for a total effectiveness rate of 82%. In the comparison group of 21, there were no cures, 11 improvements, and 10 no effect, for a total effectiveness rate of 52.5%. Therefore, warm needle moxibustion appeared to be significantly more effective for reducing the symptoms of AS than simple needling alone.
Group Treatment Comparison Number 33 21 Cure 4 0 Improvement 23 11 No effect 6 10 Total effect. 82% 52.5%

In addition, measurements of stiffness in the spine were markedly more decreased in the treatment group than in the comparison group from before to after treatment, while expansion of the chest was more, and flexibility of the lumbar region was markedly more. Mean ESR was more than cut in half in the treatment group but only reduced by 30% in the comparison group. Similarly, mean C-reactive protein was almost a quarter of what it had been in the treatment group but was only 75% of what it had been in the comparison group. And finally, positive HLA-B27, a marker for AS, went from 27 cases to 16 cases in the treatment group but only from 17 cases to 14 cases in the comparison group. Discussion: According to Drs. Hou and Liu, AS is categorized as painful impediment and bone impediment in Chinese medicine. It is believed to be due to the attack and entry into the spine of cold qi in turn due to the yang qi failing to open and seal correctly. Therefore, they believe that the treatment principles should be to warm the channels and free the flow of the network vessels, scatter, cold, dispel dampness, and disinhibit the joints. Based on their long clinical experience with this condition, they believe that warm needle moxibustion at the Hua Tuo jia ji and other points gets a good effect on it. In particular, the Hua Tuo jia jia, Ba Liao, Huan Tiao, and other bladder channel points down to Wei Zhong (Bl 40) free the flow of the channels and network vessels and stop pain. These are then assisted by Yin Ling Quan and Zu San Li which dispel dampness and disinhibit the joints. Warm needle moxibustion increases and strengthens the warm flow-freeing effect. Having used this technique over a period of five years, Drs. Hou and Liu believe it achieves satisfactory clinical effects in improving AS patients conditions. Copyright Blue Poppy Press, 2005. All rights reserved.