- The Clinical Practice of Chinese Medicine

by Deng Zhao-zhi

Rheumatology is an important topic in Chinese medicine, and is covered extensively in medical literature throughout the last several millennia, especially in the last decade. There are also records of accumulated experience in the treatment of such disorders. The combination of Chinese and Western medical treatment has been proven to be effective for the management of obstinate illnesses such as rheumatoid arthritis and ankylosing spondylitis.

Rheumatoid arthritis is a chronic systemic disease and a non-infectious inflammatory disorder whose cause is un certain. The disease has a long course and often leads to joint and surrounding tissue damage, varied clinical manifestations, cartilage and bone destruction, joint deformity, and functional impairment. The disease can also lead to damage of the internal organs. So far, the therapeutic effects of the treatment of RA are unsatisfactory. Most treatments only relieve the symptoms or slow down the progression of the disease, but they do not result in a complete cure. Furthermore, most of the drugs used to treat RA produce adverse effects.

Gout is a chronic disorder of purine metabolism, whose clinical features include hyperuricemia, recurrent acute gouty arthritis, fibrous nephritis, the formation of gouty tophi, functional impairment and deformity of the joints, and in most cases, uric acid imbalance. With the continuous rise of living standards, the incidence of this disease is also increasing. However, due to the lack of treatment that targets the cause of the disease, there is no radical cure for this disease. So far, Western medical treatment can only control acute episodes, provide long-term management of hyperuricemia, and reduce relapses.

The general symptoms in both conditions are associated with what is referred to in Chinese medicine as bi syndrome. Combined treatments utilizing Chinese medicinals, acupuncture, massage, and physical therapy show excellent results in reducing both pain and uric acid levels, while also improving joint function and lowering rates of recurrence.

The compilers of this book are themselves veteran clinicians of Chinese medicine who have rich clinical experience in the field of rheumatology, who also collect and extract clinical experience of Chinese renowned physicians and specialists, refer to literature and data of both domestic and international sources, and integrate the analyses and approaches of foreign and domestic research. This book is primarily for readers from abroad, which include teachers and students of Chinese medicine and acupuncture colleges, medical practitioners who are directly or indirectly involved in the practice of Chinese medicine, medical doctors who are interested in Chinese medicine, and lay persons. It will help readers understand the advancement of Chinese medical treatment of rheumatoid arthritis, and promote the integration of Chinese and Western medicine. However, it should be aware that the use of this book cannot replace the treatment advice or suggestions of a professional healthcare practitioner. if you or anyone you know have signs and symptoms similar to those described in this book, please consult a practitioner of Chinese medicine.

Gout

by Deng Zhao-zhi, He Yi-ting, Chen Wei, Zhu Li-qun

Overview
  Diagnostic Criteria: Typical Gout; Gouty Nephropathy; Uric Acid Kidney Stones; Acute Uric Nephropathy
  Differential Diagnosis: Rheumatoid Arthritis; Erysipelas and Phlegmonous Cellulitis; Traumatic Arthritis and Suppurative Arthritis; Psoriatic Arthritis; Bone Tumor; Pseudogout Arthritis; Other Types of Arthritis
  Treatment: General Treatment; Optional Measures; Treatment in the Interval and Chronic Stages; Acute Renal Failure
Chinese Medical Etiology and Pathomechanism
Chinese Medical Treatment
  Pattern Differentiation and Treatment:
    Wind-damp-heat Bi, 白虎桂枝汤Bai Hu Gui Zhi Tang, 犀角散Xi Jao San; 四妙丸Si Miao Wan, 龙胆泻肝丸Long Dan Xie Gan Tang;
    Wind-cold-damp Bi, 薏苡仁汤Yi Yi Ren Tang, 乌头汤Wu Tou Tang
    Phlegm-stasis Obstruction, 桃红饮Tao Hong Yin, 二陈汤Er Chen Tang; 血府逐瘀汤Xue Fu Zhu Yu Tang
    Liver and Kidney Insufficiency, 独活寄生汤Du Huo Ji Sheng Tang, 左归饮Zuo Gui Yin, 右归饮You Gui Yin, 肾气丸Shen Qi Wan;

  Additional Treatment Modalities

1. Chinese Patent Medicine: 豨莶丸Xi Xian Wan; 豨桐丸Xi Tong Wan; 寒湿痹冲剂Han Shi Bi Chong Ji, 舒筋活血片Shu Jin Huo Xue Pian; 丁甲片Ding Jia Pian
2. Acupuncture and Moxibustion
3. Electro-acupuncture Therapy
4. Tui-na Therapy
5. External Applications
6. Simple Prescriptions and Empirical Formulas

Prognosis
  Transformation from heat to Cold and from Acute to Chronic
  Progression from the Exterior to Interior, and from Excess to Deficiency
Preventive Healthcare
  Lifestyle Modification
  Dietary Recommendation
  Regulation of Emotional and Mental Health
Clinical Experience of Renowned Physicians
  Empirical Formulas

1. Zhang Rui-yi Uses 痛风方Tong Feng Fang to Treat Damp-heat Phlegm Obstruction
2. Zhu Liang-chun Treats All Types of Gout with 泻浊化瘀汤Xie Zhuo Hua Yu Tang
3. Ye Wei-hong Treats Wind-damp-heat Bi with 消痛饮Xiao Tong Yin
4. An Yi-xian Treats Gout with both Internal and External Methods
5. Liu Zai-peng Treats Acute Episodes of Gout with 痛风定痛汤Tong Feng Ding Tong Tang

  Selected Case Studies

1. Yin Hui-he's Case Study: Damp-heat Pouring Downward
2. Jiang Shi-ying's Case Study: Join-running Disease 厉节病Li Jie Bing
3. Zhao Fen's Case Study: Yin Depletion and Dampness Pouring Downward
4. Huang Zhen-ming's Case Study: Obstruction of Damp-heat and Blood Stasis

Discussions

1. Zhu Liang-chun on Discharging Turbidity and Transforming Stasis to Treat Gout
2. Wang Lu-qiu Use 五积散Wu Ji San to Treat Gout
3. Lu Cheng-quan on Three Methods of Treating Gout
4. Huang Chun-lin on Pattern Differentiation and Differential Diagnosis in the Treatment of Gout
   Damp-heat Bi, 三妙汤San Miao Tang; Blood Stasis Bi, 身痛逐瘀汤Shen Tong Zhu Yu Tang; Kidney Deficiency with Damp-heat, 知柏八味汤Zhi Bai Ba Wei Tang; Kidney Deficiency Stone Strangury, 六味地黄汤Liu Wei Di Huang Tang and 石苇散Shi Wei San; Kidney Yin and Yang Deficiency, 肾气丸Shen Qi Wan
   Treat the primary disease and eliminate the factors that cause or aggravate the disease; Treatment of hyperuricemia; Treatment of acute attacks of gout and gouty nephropathy
5. Peng Jie-shou on Gaout as Patterns of "Leg Qi"

Perspective of Integrative Medicine
  Challenges and Solutions

1. Preventing Onset and Reducing Recurrence: Family History; Dietary Guidelines; Treatment of Hyperuricemia; Avoiding Drugs that Inhibit Uric Acid Excretion
2. Preventing Kidney Damage

  Insight from Empirical Wisdom

1. Strengthen Recognition of the Disease to Avoid Misdiagnosis
2. Gout is a Type of Bi Syndrome with Unique Features
3. Chronic Stage Tonification without Neglecting to Disperse: Dispelling Stasis and Clearing Phlegm; Freeing Strangury and Dissolving Stones
4. Understanding the Use of Medicinals

Selected Quotes from Classical Texts
Modern Research
  Clinical Research
  Experimental Studies

Rheumatoid Arthritis

Overview
Chinese Medical Etiology and Pathomechanism
  Chinese Medical Perspective of RA Etiology: Constitutional Insufficiency and Liver and Kidney Depletion; The Six External Evils Exploit and Invade the Deficient Body; Imbalance of the Seven Emotions; Imbalance between Work and Rest, and Sexual Intemperance
  Chinese Medical Perspective of RA Pathomechanism: Early Stage Evil Excess and Right Qi Deficiency; Middle Stage a Prolonged Disease Course of Deficiency-Excess Complex; Late Stage Liver and Kidney Insufficiency, Qi and Blood Depletion, and Phlegm-Stasis Bind
Chinese medical Treatment
  Pattern Differentiation and Treatment

1. Wind-cold-damp Bi, 蠲痹汤Juan Bi Tang
2. Wind-damp-heat Bi, 宣痹汤Xuan Bi Tang plus 三妙散San Miao San
3. Kidney Deficiency and Congealing Cold, 桂枝芍药知母汤Gui Zhi Shao Yao Zhi Mu Tang and 虎骨散Hu Gu San
4. Liver and Kidney Deficiency with Phlegm-stasis Bind, 独活寄生汤Du Huo Ji Sheng Tang plus 身痛逐瘀汤Shen Tong Zhu Yu Tang

  Additional Treatment Modalities

1. Chinese Patent Medicine: 尫痹冲剂Wang Bi Chong Ji; 寒湿痹冲剂Han Shi Bi Chong Ji; 湿热痹冲剂Shi Re Bi Chong Ji; 瘀血痹冲剂Yu Xue Bi Chong Ji; 益肾蠲痹丸Yi Shen Juan Bi Wan; 风湿马钱片Feng Shi Ma Qian Pian; 木瓜丸Mu Gua Wan; 独活寄生丸Du Huo Ji Sheng Wan; 昆明山海棠片Kun Ming Shan Hai Tang Pian; 正清风宁Zheng Qing Feng Tong Ning; 火把花根片Huo Ba Hua Gen Pian
2. Acupuncture and Moxibustion
3. Cupping
4. Medicinal Steams and Washes
5. External Application
6. Simple Prescriptions and Empirical Formulas: 复方马钱子散Fu Fang Ma Qian Zi San; 五藤汤Wu Teng Tang; 外用麝香九龙膏Wai Yong She Xiang Jiu Long Gao; 清热蠲痹汤Qing Re Juan Bi Tang; 蚂蚁丸Ma Yi Wan; 活络洗方Huo Luo Xi Fang; 银耳鸡蛋汤Yin Er Ji Dan Tang; 川乌粥Chuan Wu Zhou

Prognosis
Preventive Healthcare
  Lifestyle Modification
  Dietary Recommendation
  Regulation of Emotional and Mental Health
Clinical Experience of Renowned Physicians
  Empirical Formulas

1. Jiao Shu-de uses 补肾祛寒治尫汤Bu Shen Qu Han Zhi Wang Tang to Treat Lame Bi due to Kidney Deficiency with Exuberant Cold
2. Jiao Shu-de Uses 加减补肾治尫汤Jia Jian Bu Shen Zhi Wang Tang to Treat Lame Bi due to Kidney Deficiency with Branch heat (Mild Pattern)
3. Jiao Shu-de Uses 补肾清热治尫汤Bu Shen Qing Re Zhi Wang Tang to Treat Lame Bi due to Kidney Deficiency with Branch Heat (Severe Pattern)
4. Zheng Hui-bo Uses 郑氏虎挣散Zheng Shi Hu Zheng San to Treat Yang Deficiency with Obstruction of the Collaterals by Cold-damp Bi
5. Ren Ji-xue Uses an Empirical Formula to Treat Chronic Bi Syndromes with Qi Stagnation and Blood Stasis
6. Xie Hai-zhou Uses 痹痛宁Bi Tong Ning to Treat Bi Syndromes due to Kidney Deficiency with Cold Exuberance and Obstruction in the Channels and Collaterals
7. Zhu Chen-yu Uses 四藤一仙汤Si Teng Yi Xian Tang to Treat Bi Syndromes due to Wind Cold Damp Obstruction with Qi and Blood Stagnation

Selected Case Studies

1. Jiao Shu-de's Case Studies: the Treatment of Lame Bi by Tonifying the Kidney and Dispersing Cold
2. Lou Duo-feng's Case Study: Blood Stasis and Evil Coagulation
3. Ding Gan-ren's Case Studies: Wind, Damp and Phlegm Entering the Collaterals and Blocking Nutritive and Defensive Qi; Dampness Entering the Collaterals with Concurrent Blood Stasis
4. Zhu Liang-chun's Case Study: Yang Qi Depletion with Cold-damp Invasion and Binding Obstruction of Phlegm and Stasis
5. Zhao Shao-qin's Case Study: Dampness Transforming into Heat and Phlegm-stasis Obstructing the Collaterals
6. Gao Hui-yuan's Case Study: Disharmony of the Nutritive and Defense and of Qi and Blood, with Obstruction of the Collaterals by Wind-cold-damp
7. Zhang Bo-yu's Case Study: Long-term Obstruction of the Vessels and Collaterals by Wind-cold-damp Complicated by Stasis Binding
8. Hu Zhen-ya's Case Study: Cold Evil Obstructing the Collaterals and Liver and Kidney Depletion
9. Guo Qian-heng's Case Study: Blood Deficiency and Wind Invasion Obstructing the Channels and Collaterals

Discussions

1. Jiao Shu-de Discusses the Etiology and Pathomechanism of Lame Bi and Creates an Empirical Formula for its Treatment
2. Lou Duo-feng Uses Effective Medicinals and Formulas in Accordance with Differential Diagnosis and Disease Location
3. Wang Wei-lan Divides RA into Acute Episodes and Chronic Remission
4. Lu Zhi-zheng Emphasizes the Five Attention Points of Treatment
5. Xie Hai-zhou Discusses the 3 Essentials and 4 Rules in the Treatment of Bi Syndromes
6. Hu Qiao-wu Divides Bi Syndrome into Three Stages
   In the early stages, the disease is in the channels; treat the qi; Chronic illness enters the collaterals, treat the blood; In the late stage, there is bone destruction; treat the bone
7. Zhang Pei-qiu Divides Bi Syndrome into Heat and Cold Patterns and uses Insect Medicinals to Treat Chronic Bi
8. Zhang Ming-he Emphasizes the Expulsion of Evils in the Treatment of RA
9. Wu Sheng-nong Advocates the Four Methods of Expelling Evils to Treat RA
10. Chen Xiang-jun Treats RA by Tonifying Qi and Warming Yang
11. Wang Shi-fu on the Use of Large Dosages in the Treatment of the Early, Middle, and Late Stages of Bi Syndromes

Perspective of Integrative Medicine

1. The Integration of Internal and External Treatment to Replace or Reduce the Use of NSAIDs
2. Early Application of Slow-acting Drugs (Combined with Chinese Medicinals to Reduce Side Effects)
3. Use Hormones with Caution (Chinese Medicinals can Counteract the Misuse or Abuse of Hormone Therapy)

  Challenges and Solutions

1. How to Diagnose the Disease as Early as Possible
2. How to promptly Control the Symptoms
3. How to Effectively Stop Progression
4. How to Prevent the Side Effects of Western Pharmaceutical Drugs

  Insight from Empirical Wisdom

1. Understanding the Characteristics of the Disease, Accurately Identifying the Pattern, and Sticking to Medicinal Therapy
2. Tonify the Kidney, Disperse Cold, Transform Stasis, and Eliminate phlegm throughout the Entire Course of the Disease
3. Choose Appropriate Vine and Insect Medicinals to Strengthen the Effects of Tracking down Wind and Scraping Evils from the Collaterals
4. Protect the Right Qi at All Times to Reduce the Risk of External Evil Invasion
5. Refer the Patient to Biomedical Care if Necessary 

Selected Quotes from Classical Texts
Modern Research
  Clinical Research
  Experimental Studies

Title: Gout & Rheumatoid Arthritis
Author: Deng Zhao-zhi
Series: The Clinical Practice of Chinese Medicine
Publisher: People's Medical Publishing House, 2007
Language: English

This book is an important component text in the series The Clinical Practice of Chinese Medicine. The focus of this book is to provide effective complementary treatment methods for gout and rheumatoid arthritis, both chronic diseases that affect great numbers of people around the world.

Although current pharmaceutical approaches to treatment achieve a certain therapeutic effect, many side effects usually result. Systematic literature review shows that the application of Chinese medicine also results in a definite therapeutic effect, but with very few side effects. Combined treatments utilizing Chinese medicinals, acupuncture, massage, and physical therapy show excellent results in relieving pain and reducing uric acid levels, while also improving joint function and lowering rates of recurrence.

By providing the time-honored clinical methods of Chinese traditional medicine, this text will undoubtedly benefit the many patients who suffer with these conditions.

Features:

• Pattern differentiation and treatment with Chinese medicinals and acupuncture
• Clinical experience of renowned physicians
• Case studies from famous Chinese doctors
• Relevant contemporary research on pattern differentiation and formulas
• Selected quotes from classical texts

About the Author

Dr Deng Zhao-zhi is a professor and chief physician of Chinese internal medicine at Guangzhou University of Chinese Medicine. As an expert in rheumatology, Professor Deng specializes in the diagnosis and treatment of diseases such as systemic lupus erythematosus, ankylosing spondylitis, gout, osteoarthritis, Sjogren's syndrome, erythemanodosum, scleroderma, dematomyositis, multiple myositis, adult still's disease, and psoriatic arthritis. She has a distinct perspective towards the clinical classification and differentiation of the signs and symptoms of rheumatic disease. In the past few year, the department of rheumatology has become one of the most outstanding departments in the Guangdong Provincial Hospital of TCM. The department handles the most specialized diseases, and most patients come from all over the world. The number of patient visits to this department exceeds 10,000 per year.

书名：中医临床实用系列 - 痛风与类风湿性关节炎 （英文版）
作者： 邓兆智 编　著
出版社： 人民卫生出版社，第1版2008
开本/装帧：16开平装本，378页
ISBN：9787117094856

全面阐述了中医痛风与类风湿性关节炎的方法，并包括名老中医的治疗经验，现代研究，临床研究，中西医结合等等。

邓兆智，女，广东省中医院，主任医师，现任中华中医药学会风湿病分会委员、广东省中医药学会风湿病专业委员会主任委员．从事中西内科临床工作三十余年， 1986年创建具中西医结合特色的风湿病专科，近年来业已成为广东省中医院有特色专科之一。对风湿类疾病如类风湿性关节炎、系统性红斑狼疮、强直性脊柱炎、痛风、骨关节炎、干燥综合征、结节性红斑、硬皮病、皮肌炎、多发性肌炎、成人Still病、银屑病性关节炎等病的诊断与治疗有着深厚的学术造诣，学术上形成了以中西医结合综合方法的特点，学习与吸取了近代及全国名老中医治疗的特色与精髓，师古而不泥古，对风湿类疾病的中医证候的临床规范分类、辨证有独特的临床见解和论述。