Symptomatic rheumatoid review

【云百草组方】

Cordyceps powder + Jizhicao capsule + Zhongzheng Gu Li capsule

[方解]

[ Cordyceps powder raw materials ]

Paecilomyces bat, bat moth, locust, etc.

[吉之草胶囊 Raw materials]

Cordyceps, orange, medlar, coix seed, yam, hazelnut, perilla, puerarin, huangjing, etc.

[ Zhongzheng Gu Li Capsules Raw Materials ]

Cordyceps, Rhodiola, heavy building, gold iron lock, blood, moringa, hazelnut, yacon, leek root, Sanqi, etc.

[Documentation] (to June 2019, HowNet)

[Chongcao rheumatoid] 1

(See Scientific literature review, Scientific literature for immune system diseases)

[ 茯苓 rheumatoid] 14 [[ 薏苡 类 rheumatoid] 98 [ yam rheumatoid] 5 [Purple rheumatoid] 2 [ genus rheumatoid] 10 [yellow rheumatoid] 2 [ Rhodiola rheumatoid] 5 articles [heavy building rheumatism] 1 [golden iron lock rheumatoid] 6 [blood exhaust rheumatism] 4 [three seven rheumatoid] 52

......................................................

[Chinese Pharmacopoeia 2015]

※ Cordyceps sinensis, sweet, warm. Return to the lungs, kidney. "Pharmaceutical test": "Secret and good fortune, specializes in killing the door."

※茯苓, Gan, light, flat. Heart, spleen, lung, kidney. Lee water seeps, strengthens the spleen and stomach, and calms the nerves. "Medicine Heart Method": "Sweet Ganping Bu Yang, Yi Shou and Water." "Materia Medica": "Opening the chest, adjusting the dirty gas, cutting the kidneys and evils, Mo Feili water dehumidification, heat dissipation ""

※薏苡仁, Gan, light, slightly cold. Return to the spleen, stomach, lungs. Lishui and spleen, Shujin remove phlegm, clearing heat and draining pus. Indications of edema, athlete's foot, urinary leaching, wet temperature sickness, diarrhea, taking down, rheumatism and pain, tendons, lungs, intestinal fistula, flat warts. "The Scriptures": "The main ribs are unstoppable and unrestrained, and the rheumatism is suffocating and suffocating. The long-term service is light and good." "Do not record": "In addition to the bones and evil spirits, the stomach is indispensable, the edema is edema, and it is edible." Pharmacological theory: "Can cure hot air, the veins are in a hurry, can make people eat. The main lungs are lung and qi, spit and blood, coughing and suffocating, breaking Wuxi toxic."

※Yam, Gan, Ping. Return to the spleen, lung, kidney. Replenish the spleen, raise the lungs, solidify the kidney, and benefit the essence. "Japanese Huazi": "Help the five internal organs, strong bones and muscles, long-term peace and tranquility, and the main venting is forgetful."

※枸杞子,甘,平. Liver, kidney, lung. "The Herbal Description": "Therapeutic liver and blood deficiency, eye redness and fainting." Treatment of stroke dizziness, labor, see blood syndrome, cough blood, phlegm, phlegm, phlegm, dryness, nocturnal emission, red turbidity, athlete's foot , crane knee wind. "Materia Medica": "Hurricane eyesight, strong muscles and strong bones, replenishing impotence." ”

※ Perilla, Xin, warm. Return to the spleen, stomach, lungs. The qi is wide, the fetus, and the blood. Indications of spleen and stomach qi stagnation, sputum abdomen full, fetal gas is not, edema athlete's foot, hemoptysis. "The Sketch Book": "It is advisable to ventilate the poison." "Baoqing Materia Medica Eclectic": "Stop the cholera, turn the stagnation, break the sputum, and cure the limbs." "Introduction to Medicine": "Cure the cold and dampness, and the bones and muscles pain."

※Gegen, Gan, Xin, Ping. Return to the spleen, stomach. "The Scriptures": "The main thirst, the body is hot, vomiting, Zhu Yu, from the yin, to solve the poison." "Outline": "Dang Yuhuo."

※Huang Jing, Gan, Ping. Return to the spleen, lung, kidney. Nourishing Yin and moistening the lungs, replenishing the spleen and replenishing qi "Do not record": "The main supplement in the benefit of Qi, in addition to rheumatism, An five dirty. Long service and light body and not hunger." "Japanese Huazi": "Buy five labor and seven injuries, help bones, benefit the spleen and stomach, run the heart and lungs." "Drug chart test": "Mainly manage blood, strengthen bones, moisturize the skin, go face black, eye pain, erosion." "Modern Practical Chinese Medicine": "To nourish strong drugs, effective for post-illness weakness. Heat agent for intermittent heat, gout, periostitis, etc."

※ Rhodiola, Gan, 涩, cold. Return to the lungs, heart. Yiqihuoxue, Tongmai Pingchuan, used for qi deficiency and blood stasis, chest pain, heart stroke, hemiplegia, fatigue and asthma. Rheumatoid arthritis, bruises, neurological paralysis, altitude sickness.

※ Heavy building, bitter, slightly cold, small poison. Go to the liver. Detoxification, swelling and pain relief, cold liver and shock. For acne swelling, sore throat, snake bites, falling and hurting, convulsions.

※ Gold iron lock, bitter, Xin, warm, small poison. Go to the liver. Hurricane dehumidification, dilated and relieved pain, detoxification and swelling, used for rheumatism and pain, stomach cramps and cold pain, bruises, traumatic bleeding, external hemorrhoids, snake bites. "Yunnan Chinese Herbal Medicine": "Hemostasis and pain relief, blood circulation, and rheumatism."

※ blood, sweet, salty, flat, small poison. Heart, liver. "Outline": "Blood, hand, foot and yin medicine"

※Sanqi, Gan, bitter, warm. Return to the liver, stomach, heart, large intestine. Stop bleeding and dilated blood, reduce swelling and pain. "Yu Yu Yao Jie": "And the camp to stop bleeding, Tongmai line."

......................................................

[Western medicine treatment and adverse reactions]

At present, drugs applied at home and abroad, including botanicals, cannot completely control joint destruction, but only relieve pain, reduce or delay the development of inflammation. Commonly used drugs for the treatment of rheumatoid arthritis are divided into four categories, namely non-steroidal anti-inflammatory drugs (NSAIDs), anti-rheumatic drugs (DMARDs) that improve the condition, glucocorticoids and botanicals.

(1) NSAIDs have anti-inflammatory, analgesic, antipyretic and anti-tumor effects by inhibiting cyclooxygenase activity and reducing prostaglandin synthesis. As NSAIDs reduce the synthesis of prostaglandins, adverse reactions such as gastrointestinal reactions: nausea, vomiting, abdominal pain, diarrhea, bloating, poor appetite, severe digestive ulcers, bleeding, perforation, etc.; Reaction: renal perfusion decreased, sodium and water retention, hyperkalemia, hematuria, proteinuria, interstitial nephritis, and renal dysfunction caused by renal necrosis in severe cases. NSAIDs can also cause peripheral blood cell reduction, coagulopathy, aplastic anemia, liver function damage, etc., a small number of patients with allergic reactions (rash, asthma), as well as tinnitus, hearing loss, aseptic meningitis.

[NSAIDs table commonly used in rheumatoid arthritis]

Classification, English, half-life (hours), daily total dose (mg), each dose (mg), times/day

※Protein derivative

Ibuprofen 2,1,200~3,200,400~600,3

Naproxen naproxen 14 , 500~1,000 , 250~500, 2

Loxoprofen, 1.2,180,60, 3

※benzoic acid derivatives

Diclofenac diclofenac, 2,75~150,25~50, 3

※decanoic acid

Indomethin, 3~11, 75, 25, 3

Sulindac sulindac, 18, 400, 200, 2

Acemexin acemetacin, 3, 90~180, 30~60, 3

※pyranocarboxylic acid

Etodolac etodolac, 8.3, 400~1,000, 400~1,000, 1

※Non-acidic

Nabumetone nabumetone, 24, 1,000~2,000, 1,000, 1~2

※Xi Kang

Inflammatory fluoxicam, 30~86, 20, 20, 1

※Enol acids

Meloxicam meloxicam, 20, 15, 7.5~15, 1

※ Sulfonanilides

Nimesulide nimesulide, 2~5,400, 100~200,2

※Xibu class

Celecoxib, celecoxib, 11 , 200~400 , 100~200 , 1~2

Rofecoxib, 17 , 12.5~25 , 12.5~25 ,1

Recent studies have found that cyclooxygenase has two isomeric isomers, cyclooxygenase-1 (COX-1) and cyclooxygenase-2 (COX-2). Selective COX-2 inhibitors (such as oxime) can significantly reduce severe gastrointestinal adverse effects compared to non-selective traditional NSAIDs. It must be noted that no matter which NSAIDs are selected, the dose should be individualized; only one NSAIDs will be changed to another after 1-2 weeks of incomplete use; avoid taking two or more NSAIDs simultaneously, because The efficacy is not superimposed, and the adverse reactions are increased; the elderly should choose NSAIDs with short half-life. For elderly people with a history of ulcers, selective COX-2 inhibitors should be taken to reduce adverse reactions in the gastrointestinal tract. Although NSAIDs can alleviate the symptoms of rheumatoid arthritis, but can not change the course of disease and prevent joint damage, it must be combined with DMARDs.

(2) DMARDs These drugs play a slower role than NSAIDs, and the obvious improvement of clinical symptoms takes about 1 to 6 months, so it is also called slow-acting drugs. Although it does not have immediate analgesic and anti-inflammatory effects, it has the effect of improving and delaying the progression of the disease. It is unclear which DMARDs are preferred for the treatment of rheumatoid arthritis. In terms of efficacy and cost, methotrexate is generally preferred and is the basic drug for combination therapy. See commonly used in DMARDs for rheumatoid arthritis (Table)

[Forms of DMARDs commonly used in rheumatoid arthritis]

Drug, onset time (months), usual dose (mg), route of administration, toxicity

※ methotrexate, 1~2, 7.5~15 weekly, oral intramuscular injection, gastrointestinal symptoms, stomatitis, rash, hair loss, occasional myelosuppression, liver toxicity, pulmonary interstitial (rare but serious) May be life threatening)

※ sulfasalazine, 1~2, 1000, 2-3 times/day, oral, rash, occasional myelosuppression, gastrointestinal intolerance. Those who are allergic to sulfonamide should not take it

※ Leflunomide, 1~2, 10~20, 1 time/day, oral, diarrhea, itching, reversible transaminase elevation, hair loss, rash

※chloroquine, 2~4,250, 1 time/day, oral, dizziness, headache, rash, retinal toxicity, occasional myocardial damage, banned from sinus node dysfunction, conduction block

※ Hydroxychloroquine, 2~4, 200, 1~2 times/day, oral, occasional rash, diarrhea, rare retinal toxicity, banned from sinus node dysfunction, conduction block

※ Jinnuofen, 4~6, 3, 1~2 times/day, oral, may have stomatitis, rash, bone marrow suppression, thrombocytopenia, proteinuria, but the incidence is low, diarrhea is common.

※Azathioprine, 2~3, 50~150, 1 time/day, oral, myelosuppression, occasional hepatotoxicity, early flu-like symptoms (such as fever, gastrointestinal symptoms, abnormal liver function)

※ Penicillamine, 3~6, ​​250~750, 1 time/day, oral, rash, stomatitis, taste disorder, proteinuria, myelosuppression, occasional severe autoimmune disease

1 Methotrexate (MTX) is effective for oral, intramuscular or intravenous injection. Oral administration of 60%, daily administration can lead to significant myelosuppression and toxic effects, so it is often administered once a week. The usual dose is 7.5~25mg/week, and individual severe patients can increase the dose as appropriate. Common adverse reactions are nausea, stomatitis, diarrhea, hair loss, rash, a small number of myelosuppression, hearing impairment and pulmonary interstitial changes. It can also cause miscarriage, teratogenicity and fertility. Blood routines and liver function should be checked regularly during medication.

2 Sulfasalazine (SSZ) usually takes 4 to 8 weeks to take effect. Gradually increasing the dose from small doses can help reduce adverse reactions. How to use it: Start with 250~500mg daily, then increase 500mg per week until 2.0g per day. If the effect is not obvious, it can be increased to 3.0g per day, such as 4 months. There is no obvious effect within the treatment, and the treatment plan should be changed. The main adverse reactions were nausea, vomiting, anorexia, dyspepsia, abdominal pain, diarrhea, rash, asymptomatic transaminase increase and reversible sperm reduction, occasional white blood cells, thrombocytopenia, and sulfonamide allergy. Blood routine and liver function should be checked regularly during medication.

3 leflunomide (LEF): dose of 10 ~ 20mg / day treatment. The main adverse reactions are diarrhea, itching, high blood pressure, increased liver enzymes, rash, hair loss and transient white blood cell decline. Liver function and white blood cells should be checked regularly during the initial dose. Because of teratogenic effects, pregnant women are forbidden. Since leflunomide and MTX both inhibit cell proliferation through different links, the synergistic effect of the two is synergistic. Blood routine and liver function should be checked regularly during medication.

4 Antimalarials: There are two kinds of chloroquine (250mg/tablet) and hydroxychloroquine (100mg/tablet). The drug has a slow onset of action, and the effect reaches a peak 3 to 4 months after taking it. It can only be declared invalid after 6 months of service, and can be reduced after it is effective. Usage: chloroquine 250mg / day, hydroxychloroquine 200 ~ 400mg / day. The drug has an accumulating effect and is easy to precipitate in the pigment epithelial cells of the retina, causing retinal degeneration and blindness. The fundus should be checked after taking the drug for about half a year. In addition, in order to prevent myocardial damage, ECG should be checked before and after medication, sinus node dysfunction, heart rate slow, conduction block and other heart disease patients should be banned. Other adverse reactions include dizziness, headache, rash, itching and tinnitus.

5 Penicillamine (D-penicillamine): 250 ~ 500mg / day, oral, can be gradually reduced to a maintenance dose of 250mg / day after effective. Penicillamine has many adverse reactions, and long-term high-dose application can cause renal damage (including proteinuria, hematuria, nephrotic syndrome) and myelosuppression. If the drug is stopped in time, most of it can be recovered. Other adverse reactions include nausea, vomiting, anorexia, rash, mouth ulcers, loss of smell, swollen lymph nodes, joint pain, and occasional autoimmune diseases such as myasthenia gravis, polymyositis, systemic lupus erythematosus and pemphigus Wait. Blood, urine, and liver and kidney function should be checked regularly during treatment.

6 auranofin: for oral gold preparations, the initial dose is 3mg / day, after 2 weeks increased to 6mg / day maintenance treatment. Common adverse reactions are diarrhea, itching, dermatitis, glossitis and stomatitis. Others have liver and kidney damage, leukopenia, eosinophilia, thrombocytopenia or whole blood cell reduction, and aplastic anemia. Peripheral neuritis and encephalopathy can also occur. In order to avoid adverse reactions, routine hematuria and liver and kidney function should be checked regularly. Pregnant women and lactating women should not be used.

7 Azathioprine (AZA): 50% absorption after oral administration. The usual dose is 1~2 mg/kg/day, generally 100mg/day, and the maintenance amount is 50mg/day. Adverse reactions include hair loss, rash, bone marrow suppression (including thrombocytopenia, anemia), gastrointestinal reaction