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International Journal of Clinical Case Reports 2014, Vol. 4, No. 3, 1-4
http://ijccr.biopublisher.ca
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kidney and damp syndrome due to spleen deficiency.
Prescription: Fried Codonopsis pilosula and
Astragalus 30G;
Sinomenium acutum 20G;
Rehmannia Root,
Cooked Rehmannia Root,
Asparagus Tuber, Ophiopogon Tuber, Golden Eye
Grass Rhizome, Large Gentian Root, Cyathula Root,
Achyranthis Bidentatae, Cornus Fruit, Radix Dipsaci,
and Morinda Root 10G; Honey-fried Frankincense
and Honey-fried Myrrh 4G (14 prescription); zhou che
da zao wan Chinese herb.
The patient's condition continued to show slight
improvements with some episodic recurrence of
symptoms with significant pain on his left wrist. The
result of Magnetic resonance imaging (MRI) on
December 4, 2010 revealed synovial arthritis between
ulnar and carpal joint capsule of the left wrist. Then
the patient was diagnosis with early RA according to
the ACR/EULAR 2010 rheumatoid arthritis
classification criteria. Western medicines were given
and it had an exact effect. RA showed no further
progress until the follow-up in May 2013 and the
blood biochemical, and immune analysis still showed
no abnormalities in March 2005 onward.
Discussion
RA is a highly disabling disease of which untreated
patients show about 50% disability in two years, and
three years of morbidity is 70% (ACR, 1996). One
cause of the high morbidity of RA is the long latency
from the onset of symptoms to the definitive diagnosis
of RA and the initiation of appropriate treatment.
Several composite and increasingly sophisticated
measures of disease activity have been objectively
evaluated over the last two decades (Kathryn and
Marc, 2012). But it was still difficult to make
diagnoses of early RA since the early manifestations
were atypical and the lack of specific diagnostic
methods. Therefore, the important role of preventive
thought -"preventive treatment of diseases"- in
traditional Chinese medicine (TCM) in the early
diagnosis and treatment of RA needs to be emphasized.
The theory involves two aspects: preventive treatment
before the occurrence of diseases and preventing
deterioration after the occurrence of diseases. It refers
to taking various measures to prevent diseases from
occurring, which must start with both strengthening
the resistance inside the body and preventing
pathogens from invading the human body. Research
shows that, the fastest progression of RA occurs In the
onset of the first stage in the first year, there is a short
therapeutic window in this period, during which the
RA inflammatory changes are reversible (Emery,
1994), one year incidence of patients' articular bone
destruction is about 70%-90%. Hence, early diagnosis
and beginning of actively using disease modifying
anti-rheumatic drugs (DMARDs) before X-ray bone
erosion destruction arises can succeed in improving
the prognosis of patients with RA and quality of their
lives. However, early RA patients without any
symptoms can be measured by medical appliances but
can't be diagnostics according to the current diagnostic
system; however, traditional medicine can make
initiate treatment based on early clinical symptoms
and thus delays the progression of RA. In other words,
it requires at least more than five years from the onset
of symptoms to diagnosis to meet the minimum
requirements of Western medicine diagnose system
for these RA patients similar to this case. Without
appropriate treatment of TCM on early stage, the
progress of RA in this patient should be a lot faster.
The effectiveness of TCM treatment of early patients
with RA is also reflected in the treatment process in
this case. The philosophy of modern medicine is a
confrontation strategy to fight against diseases on the
basis of understanding of the pathogen and symptoms.
However, most cases in real life are caused by
multi-factors via different ways and they are
interacting with the niche in the body resulting in
multiple effects. In Chinese medicine, RA belongs to
"Be Syndrom", the outcome of the struggle between
body resistance and pathogenic factors. Therefore, in
the treatment of RA certain factors and conditions
should be considered, which are time (seasonal,
climatic conditions), place (geographical location,
environment), and personal characteristics (living
customs, age, sex, body constitution). And also, the
same disease, but with different sexes, different
physiological characteristics, and different body
constitutions should be treated accordingly. The
incidence of RA is due to the cold damp outside and
the blood deficiency, as well as liver and kidney