Herb Usage Patterns In Traditional Chinese Medicine Treatment Of Rheumatoid Arthritis Based On Modern Literature

ObjectivesThe use of Traditional Chinese Medicine(TCM)has been reported to possess significant advantages in treatment of Rheumatoid Arthritis(RA).In recent years,there has been significant progress in TCM clinical research on RA treatment.Compared to the perspectives ancient TCM practitioners held on these impediment diseases,the rich variety of modern researches today are based on accurate diagnosis,precise laboratory test result indicators and standardized therapeutic effect evaluation systems.These researches have important significance in guiding our TCM clinical treatments of RA today.In this study,we have analyzed TCM RA treatment prescriptions from literature published in the past 20 years.The most frequently used herbs and their mixing patterns were deduced.Subsequently,we combined TCM theories with the herb usage patterns,and explored the logic behind these results.We hope that through our research,we can provide further guidance and reference for future TCM clinical treatments in RA.MethodologyLiterature sourceA total of 302 literature publications related to effective prescriptions in RA treatment from the past 20 years were collected from Chinese Journal Full-text Database(CNKI1995.1-2014.12),China Science Journal Full-text Database(VIP 1995.1-2014.12),and Wanfang Data Knowledge Service Platform(1995.1-2014.12).MethodsMicrosoft Excel 2010 was used to create a "Rheumatoid Arthritis(RA)Prescription Database".Herbs that appeared under each publication were anointed with "1".The frequency of each herb was calculated.Another database,"Rheumatoid Arthritis(RA)Herb Usage Patterns",was created using computer VB language.Herb frequency was then recorded according to the respective prescriptions they were derived from into the database.A total of 201 herbs were recorded.ResultsHerb usage patterns in RA treatment were:1)tonifying herbs displayed the highest frequency,followed by Anti wind dampness herbs and blood-activating and stasis-resolving herbs.2)Individual herb frequencies:Danggui(English name:Chinese Angelica,Latin name:Radix Angelicae Sinensis)was the most frequently used herb.The five most frequently used herbs were Danggui,Gancao(English name:Liquorice root,Latin name:Radix Glycyrrhizae),Baishao(English name:Debark Peony root,Latin name:Radix Paeoniae Alba),Huangqi(English name:Milkvetch root,Latin name:Radix Astragali seu Hedysari),Guizhi(English name:Cassia Twig,Latin name:Ramulus Cinnamomi).Duhuo(English name:Doubleteeth Pubescent Angelica root,Latin name:Radix Angelicae Pubescentis)was the most highly used anti wind dampness herb,followed by Sangjisheng(English name:Chinese Taxillus herb,Latin name:Herba Taxilli)and an animal medicinal,Wushaoshe(English name:Black-tail snake,Latin name:Zaocys).Animal medicinals also represented a certain proportion amongst the herbs and medicinals used.The most frequent animal medicinals were Wushaoshe(64 times),Quanxie(English name:Scorpion,Latin name:Scorpio)(60 times),Wugong(English name:Centipede,Latin name:Scolopendra)(48 times),Dilong(English name:Earthworm,Latin name:Lumbricus)(46 times).3)Liver meridian(2199times),spleen meridian herbs(1416times)and kidney meridian herbs(1137times)showed the highest frequencies in meridian tropism.4)The most frequent two-herb pair were gancao and huangqi.The five most frequent three-herb pairs were baishao,gancao and guizhi.ConclusionAccording to our statistical analysis results,herb classes used in RA treatment were highly distributed.Tonifying herbs Anti wind dampness herbs,blood-activating and stasis-resolving herbs,were the three most frequently used herb classes.Pairing or mixing of these herbs were frequently observed.Hence,we concluded that the most commonly seen disease mechanism for RA is cold-dampness impediment obstruction,combined phlegm-dampness,and dampness-heat obstructing collateral vessel.Root deficiency and superficiality excess usually appear concurrently,and the most frequently used tonifying herbs possess liver and kidney tonifying effects and sinew-bone strengthening effects.Although Fuzi(English name:Prepared Common Monkshood Daughter root,Latin name:Radix Aconiti Lateralis Preparata),Chuanwu(English name:Common Monkshood Daughter root,Latin name:Radix Aconiti),Quanxie and Wugong belong to the category of poisonous herbs and medicinals,they were amongst the 20 most frequently used.This reflects the importance of using these vigorous herbs and medicinals in treatment of difficult chronic diseases,such as impediment diseases.However,the main guiding principle in TCM treatment of RA is still treatment based on syndrome differentiation.In addition to syndrome differentiation based treatment,focusing on the relationship between Qi and blood,as well as adding or removing herbs and medicinals based on the symptoms are the main reasons for TCM therapeutic effects.