🌿 Folk Prescriptions

Ankylosing spondylitis (AS) belongs to the TCM category of "Gubi" (Bone Bi Syndrome). The TCM treatment principle focuses on syndrome differentiation and treatment, emphasizing dispelling wind-cold-dampness, promoting circulation of channels, activating blood to resolve stasis, detoxifying and reducing swelling, tonifying the kidneys and strengthening bones, and regulating overall constitution. In early stages, AS is predominantly characterized by excess patterns due to mixed wind, dampness, cold, and blood stasis; in late stages, it becomes a mixture of deficiency and excess, with kidney deficiency as the root cause. Treatment should focus on nourishing liver and kidneys while addressing heat-clearing, blood-activating, cold-dispelling, and pain-relieving measures.
1. Syndrome Differentiation in Clinical Practice: Common syndromes are categorized into five types:
① Cold-damp obstruction: waist and sacral pain, spinal stiffness, difficulty bending forward or backward, soreness and weakness in waist and knees, aversion to cold, preference for warmth. Formula: Qiang Huo, Du Huo, Gui Zhi, Qin Jiao, Hai Feng Teng, Chuan Xiong, Xi Xin, etc.
② Damp-heat obstruction: joint swelling and burning pain, spinal rigidity, limited mobility, heavy limbs. Formula: Huang Bai, Cang Zhu, Yi Yi Ren, Fang Ji, Niu Xi, Feng Fang, Hu Zhang, Bai Hua She She Cao, Sheng Shi Gao, Zhi Mu, etc.
③ Blood stasis obstruction: stabbing pain in the waist and sacrum (worse at night), stiff back, difficulty turning or bending, joint deformity. Formula: Dang Gui, Dan Shen, Chuan Xiong, Tao Ren, Hong Hua, Ru Mo, Di Long, Qin Jiao, Qiang Huo, etc.
④ Liver-kidney yin deficiency: waist and sacral pain, muscle spasms, weak waist and knees, poor flexion and extension, cold intolerance, fatigue, possibly accompanied by dizziness, palpitations, irritability, and insomnia. Formula: Shu Di, Shan Zhu Yu, Shan Yao, Gui Ban, Zhi Mu, Du Zhong, Niu Xi, Dang Gui, Bai Shao, etc.
⑤ Kidney deficiency and deficient Governor Vessel: cold pain in the waist, sacrum, spine, hips, and neck, joint stiffness and limited movement, accompanied by weak waist and knees, cold extremities, or loose stools. Formula: Du Zhong, Ji Sheng, Shu Di, Rou Gui, Qian Nian Jian, Bu Gu Zhi, Du Huo, Niu Xi, Qin Jiao, Xi Xin, etc.
2. Specialized Formulas
① Wu Tou Gui Zhi Tang: composed of 4.5g processed Aconite root (Chuan Wu), 9g each of processed Cinnamon twig (Chuan Gui Zhi), White Peony root (Bai Shao), and Fresh Ginger (Sheng Jiang), 6g fried Licorice (Zhi Gan Cao), and 7 jujubes (Da Zao), taken once daily as decoction. Additions may include Chuan Cao Bo (Herba Ephedrae), Wei Ling Xian (Clematis), and Fang Ji as needed. Dai Chao Shou reported treating 89 cases with 100% total effective rate, and early cure rate of 76.4%.
② Qiang Bi Tang: composed of 9g each of Cinnamon twig (Gui Zhi), Turmeric (Jiang Huang), Chuan Xiong, Thousand-Year Health (Qian Nian Jian), Whole Scorpion (Quan Xie), Earthworm (Di Long), 15g each of Gegen (Pueraria), Astragalus (Huang Qi), White Peony root (Bai Shao), Dang Gui, Dog Spine (Gou Ji), Chuan Duan (Drynaria), Bu Gu Zhi (Psoralea), Du Huo, Mulberry Branch (Sang Ji Sheng), Luoshi Teng (Trachelospermum), Old Crane Grass (Lao Guan Cao), Dang Shen (Codonopsis), Wei Ling Xian (Clematis), 20g Astragalus, and 6g Licorice, decocted and taken once daily. Gao Fei et al. reported a 98% effective rate in treating 30 cases.
③ Liu Li Hong used Gu Bi Tang, and Yang Ai Guo used Shen Bi Tang to treat 47 and 30 cases of AS respectively, achieving total effective rates of 97% and 93%.
④ High-Efficacy Rheumatic Spirit Decoction: uses large doses of Xi Xin (60–200g), combined with processed Fu Zi (Aconite root), Huang Qi (Astragalus), Xi Xian Cao (Siegesbeckia), processed Chuan Wu (Aconite root), Fang Feng (Siler), Qiang Huo (Notopterygium), Yi Yi Ren (Coix), Chuan Xiong (Ligusticum), Gan Cao (Licorice), Fang Ji (Stephania), Bai Zhu (Atractylodes), Bai Shao (White Peony), Yin Yang Huo (Epimedium), Ba Ji Tian (Morinda), decocted and taken orally. Gao Jia Jun treated 38 cases with a total effective rate of 98.6%. Note: Xi Xin is a toxic herb and must be used under physician supervision—do not self-administer.
3. External Application of Chinese Medicine: External applications and medicinal baths are most commonly used. External therapies stimulate meridians to regulate qi and blood, and absorbed drugs penetrate through the skin to exert effects along meridians. Gao Jia Jun used "Bai Shu Ning Magnetic Plaster" and "Gu Tongs Plaster" externally, combined with internal herbal intake, achieving synergistic effects of external and internal treatment. Among 57 observed AS patients, relief from pain, swelling, and morning stiffness was satisfactory.
4. Integrated Chinese-Western Medicine Comprehensive Treatment: Monotherapy with Western medicine offers rapid results but relapses easily upon discontinuation, with poor long-term stability. Monotherapy with TCM shows good long-term outcomes and low recurrence rates but acts slowly. Combined treatment leverages the strengths of both systems. The Rheumatology Department at Tianjin First Hospital of Traditional Chinese Medicine uses both Chinese and Western drugs, supplemented with acupuncture, massage, hot baths, medicated baths, warm compresses, fumigation-washing, infrared radiation, and magnetic therapy, yielding excellent results. The Rheumatology Department at Tianjin Medical University Third Hospital combines Tong Bi Tang with methotrexate (MTX), or with tetrandrine, chloroquine, and tripterygium glycosides, and adds Chinese medicine iontophoresis or six-needle injections into acupoints or joints as needed, successfully treating 35 cases across all stages of AS with favorable outcomes.