🌿 Folk Prescriptions

Ankylosing spondylitis (AS) falls under the category of “bone arthralgia” in TCM. The therapeutic principle is syndrome differentiation and treatment, aiming to expel wind and cold, remove dampness, unblock collaterals, activate blood, resolve stasis, detoxify, reduce swelling, tonify kidneys, strengthen bones, and regulate overall constitution. Early-stage AS is predominantly real syndrome, dominated by wind-cold-dampness and blood stasis; late-stage features mixed deficiency and excess, with deficiency as the root, kidney deficiency being fundamental. Treatment should focus on nourishing liver and kidney, while also addressing clearing heat, activating blood, dispelling cold, and relieving pain.
1. Syndrome Differentiation: Clinical syndromes are commonly categorized into five types:
① Cold-damp obstruction: waist and sacral pain, spinal rigidity, difficulty bending forward or backward, soreness and weakness in waist and knees, aversion to cold, preference for warmth. Formula: Qianghuo, Duhuo, Guizhi, Qinjiao, Hai Fengteng, Chuanxiong, Xixin.
② Damp-heat obstruction: joint swelling and burning pain, spinal rigidity, limited mobility, heavy limbs. Formula: Huangbai, Cangzhu, Yiyiren, Fangji, Niuxi, Fengfang, Huzhang, Baihuashesheng, Sheng Shigao, Zhi Mu.
③ Blood stasis obstruction: stabbing pain in waist and sacrum (worse at night), stiff back, difficulty turning or bending, joint deformities. Formula: Danggui, Danshen, Chuanxiong, Taoren, Honghua, Ruyi, Mo Bie, Diling, Qinjiao, Qianghuo.
④ Liver-kidney yin deficiency: waist and sacral pain, muscle spasms, soreness and weakness in waist and knees, limited flexion and extension, cold sensation, fatigue, possibly accompanied by dizziness, palpitations, irritability, insomnia. Formula: Shudihuang, Shanzhuyu, Shanyao, Guiban, Zhi Mu, Duchong, Niuxi, Danggui, Baishaoyao.
⑤ Kidney deficiency and deficient du meridian: cold, painful aching in waist, sacrum, spine, hips, neck, joint stiffness, limited motion, accompanied by soreness in waist and knees, cold extremities, or loose stools. Formula: Duzhong, Jisheng, Shudihuang, Rourui, Qiannianjian, Buguzhi, Duhuo, Niuxi, Qinjiao, Xixin.
2. Specialized Formulas
① Wutou Guizhi Tang: composed of Chuanwu 4.5g, Chuan Guizhi, Baishao, Shengjiang each 9g, Zhi Gancao 6g, Dazao 7 pieces. One dose daily, decocted and taken orally. Can be modified with Chao Bao, Weilingxian, Fangji, etc., based on symptoms. Dai Chaoshou reported 89 cases treated with 100% total effectiveness, and 76.4% early cure rate.
② Qiangji Tang: composed of Guizhi, Jianghuang, Chuanxiong, Qiannianjian, Quanxie, Diling each 9g, Gegen, Huangqi, Baishao, Danggui, Gouji, Chuanduan, Buguzhi, Duhuo, Sangjisheng, Luoshi Teng, Laoguancao, Dangshen, Weilingxian each 15g, Huangqi 20g, Gancao 6g. Decocted and taken once daily. Gao Fei et al. reported 98% effectiveness in 30 cases.
③ Liu Lihong used Gubi Tang; Yang Aiguo used Shenbi Tang to treat 47 and 30 cases of AS respectively, with total effectiveness rates of 97% and 93%.
④ High-efficacy Rheumatic Spirit Decoction: heavily uses Xixin 60–200g, combined with Zhi Fuzi, Huangqi, Xixiancao, Zhi Chuanwu, Fangfeng, Qianghuo, Yiyiren, Chuanxiong, Gancao, Fangji, Baizhu, Baishaoyao, Yinyanghuo, Baji Tian, etc. Gao Jiajun treated 38 cases with 98.6% total effectiveness. Xixin is toxic; must be taken under doctor’s supervision—do not self-medicate.
3. External Herbal Therapy: External applications and medicated baths are most common. External stimulation helps unblock meridians and harmonize qi and blood. Medicinal absorption through skin can penetrate channels and exert therapeutic effects. Gao Jiajun used “Bai Shuning Magnetic Herbal Patch” and “Gutong Patch” externally, combined with oral herbs, achieving synergistic effects—treating both root and branch. In 57 AS patients observed, pain, swelling, and morning stiffness were significantly alleviated.
4. Integrated Chinese-Western Medicine Comprehensive Treatment: Pure Western medicine provides rapid relief but relapse easily after discontinuation, with unstable long-term outcomes. Pure Chinese medicine shows better long-term results and low recurrence but slower onset. Combined use leverages strengths of both, achieving satisfactory outcomes. The Rheumatology Department of Tianjin First Hospital of Traditional Chinese Medicine uses both Chinese and Western drugs, supplemented with acupuncture, massage, hot baths, herbal baths, hot compresses, fumigation, infrared radiation, magnetic therapy, etc.—yielding excellent results. The Rheumatology Department of Tianjin Medical University Third Hospital combines Tongbi Tang with methotrexate (MTX), or tetrandrine, chloroquine, and tripterygium glycosides, and adds herbal iontophoresis or six-needle injection into acupoints or joints as needed. Thirty-five cases of all AS stages achieved good results. (Author: Associate Professor, Department of Rheumatology, First Hospital of Traditional Chinese Medicine, Tianjin)