(Continuing)
　　 Jiao, Shude
　　 (Sino-Japanese Friendship Hospital, 100029)
　　IV. The differentiation and treatment of Wang-Bi-syndrome
　　1). The commonly-encountered syndromes
　　In my personal opinion, there are five commonly-encountered syndromes of this disease.
　　(1). Deficiency of kidney and the excess of cold.
　　The clinical manifestations include: soreness or aching pain in the lower back and knees, weakness of both legs, susceptible to tiredness, preference for warmth and aversion to cold; painful swelling of joints in knees, ankles, toes, elbows, fingers; stiffness and contracture of limbs; rigidity of all the joints (or the most painful joints) when getting up in the morning; contracture of tendons, heaviness of bones, difficult flexion and extension, or even deformity of joints and limbs, in most cases white tongue coating, weak, small, deep and thready “Chi"?pulse, and deep-wiry, deep-rolling, or deep-thready-wiry in other parts. This is a most commonly-seen syndrome featured by the deficiency for primary and excess for secondary.
　　(2). The mild syndrome of kidney deficiency and heat as secondary
　　In this cases, the patients with pain of joints at night would feel a bit relief if the affected joints are not covered, but the pain is getting aggravated when the affected region is uncovered for too long; there could be a heat sensation of hands and feet, or slight heat in the joints with remarkable pain, but no redness of skin; general weakness, dryness in mouth and dry stool; reddish tongue with yellowish coating, and deep, thready and slightly rapid pulse. This syndrome is due to the long-standing stagnation of the pathogenic cold, or the heat-natured medication invigorating excessively Yang, hence the pathogens converting to heat.
　　(3). The severe syndrome of kidney deficiency and heat as secondary.
　　In this case, there are hot and painful swelling and the deformity of joints, redness of skin with palpable heat sensation, preference for not covering the affected parts in spite of the aggravation of pain, dryness in mouth and throat, feverish sensation in palms and soles, dark-yellow urine and dry stool; red tongue with yellow thick and sticky coating, and rolling rapid, or wiry rolling rapid pulse, but deep and small in “Chi"?pulse. This is a common syndrome in south of China.
　　(4). Deficiency of kidney and cold in Du-meridian.
　　There are manifestations of stiff spine and pain of back, it is discussed in another paper of mine.
　　(5). Damp-heat impairing kidney
　　This is also a syndrome commonly-encountered in south of China because of the humid climate. It is characterized by long-standing course of disease, with manifestations of painful swelling and palpable heat of joints, persistent tidal fever in after noon, soreness and weakness in knees and legs; steaming or burning pain in joints, feeling of the pain from bones, deformity of joints in various degree; yellow sticky tongue coating, and rolling rapid or deep thready rapid pulse, but smaller in “Chi"?pulse.
　　2). Treating principles and formulas for Wang-Bi-syndrome
　　(1). Treating principle: The general principle is to chiefly reinforce kidney and dissipate the cold, and secondarily dissolve the dampness, disperse the wind, strengthen the tendons and bones, and remove the stagnation so as to reopen the meridians and collaterals. In case of transformation of heat, heat should be cleared away on the basis of reinforcing kidney.
　　In addition, functions of spleen and stomach should be always cared and regulated to build up the acquired foundation.
　　(2). Empirical Formulas
　　A.“Decoction of Tonifying Kidney, Dissipating Cold, and Treating Wang-Bi-syndrome"? includes: Xudan (dipsacus root) 12 to 20g, Buguzhi (psoralea fruit) 9 to 12g, Shudihuang (prepared rhemannia root) 12 to 24g, Yinyanghuo (epimedium) 9 to 12g, Zhifuzi(prepared aconite root) 6 to 12g, Gusuibu (drynaria rhizome) 10 to 20g, Guizhi (cinnamon twig) 9 to 15g, Chishao (red peony root) 9 to 12g, Baishao (white peony root) 9 to 12g, Zhimu (anemarrhena root) 9 to 15g, Du huo (pubescent angelica root) 10 to 12g, Fangfeng (ledebouriella root) 10g, Mahuang(ephedra) 3 to 6g, Cangzhu (atractylodes rhizome) 6 to 10g, Weilingxian (clematis root) 12 to 15g, Shenjincao (club-moss)30g, Niuxi(achyranthes root) 9 to 15g, chuanshanjia (pangolin scale) 6 to 9g, and Dibiechong (ground beetle) 6 to 10g, are all decocted in water, one dose a day, taken in twice. Tougucao (herb of tuberculate speranskia) 20g, Xungufeng (herb of wooly dutchmanspipe) 15g, and Zirantong (pyrite) 6 to 9g. are used instead the bones of some endangered animals e.g. tiger, leopard, bear, etc. Qianghuo (notopterygium root) 10g is added for more severe pain in upper limbs. This formula is commonly used for treating the first syndrome mentioned above.
　　B.The Modified “Decoction for Tonifying Kidney and Treating Wang-Bi-syndrome"?
　　Shengdi (dried rhemannia root) 15 to 20g, Xuduan (dipsacus root) 15 to 18g, Gusuibu (drynaria rhizome) 15g, Sangjisheng (loranthus mulberry mistletoe) 30g, Buguzhi (psoralea fruit) 6g, Guizhi (cinnamon twig) 6 to 9g, Baishao (white peony root) 15g, Zhimu (anemarrhena) 15g, Huangbai (phellodendron bark) 12g, Weilingxian (clematis root) 12 to 15g, Chuanshanjia (pangolin scale) 6 to 9g, Qianghuo (notopterygium root) 9g, Duhuo (pubescent angelica root) 9g, Fuzi (prepared aconite root) 3 to 5g, Rendongteng (honeysuckle stem) 30g, Luoshiteng (Chinese starjasmine stem) 30g, Dibiechong(ground beetle), Shenjincao(club-moss) ,and Yiyiren (coix seed) 30g.
　　The formula is indicated to the second syndrome.
　　C.“Decoction for Tonifying Kidney, Clearing-away Heat, and Treating Wang-Bi-syndrome"?
　　Shengdi (dried rhemannia root) 15 to 20g, Xuduan (dipsacus root) 15g, Digupi (mulberry bark) 10g, Gusuibu (drynaria rhizome) 15g, Sangzhi(mulberry twig) 30g, Chishao (red peony root) 12g, Qinjiao (large-leaf gentian root) 20 to 30, Zhimu (anemarrhena) 15g, Huangbai (phellodendron bark) 12g, Weilingxian (clematis root) 15g, Qianghuo (notopterygium root) 6 to 9g, Duhuo (pubescent angelica root) 6 to 9g, Ruxiang (frankincense) 6g, Moyao (myrrh) 6g, Dibiechong (ground beetle) 9g, Jiangcan (batryticated silkworm)9g, Cansha (silkworm excrement) 10g, Honghua(safflower) 10g, Rendongteng (honeysuckle stem) 30g, Tougucao (herb of tuberculate speranskia) 20g, Luoshiteng (Chinese starjasmine stem) 30g, and Sangjisheng (loranthus mulberry mistletoe) 30g.
　　This formula is for the treatment of the third syndrome.
　　D.This formula is good at treating the fourth syndrome, but is not discussed here.
　　E.“Decoction for Tonifying Kidney, Eliminating Damp-heat, and Treating Wang-Bi-syndrome"? Gusuibu(drynaria rhizome) 15 to 20, Xuduan (dipsacus root) 10 to
　　20g, Niuxi (achyranthes root) 9 to 12g, Huangbai (phellodendron bark) 9 to 12g, Cangzhu (atractylodes rhizome) 12g, Dilong (earth worm) 9g, Qinjiao (large-leaf gentian root) 12 to 18g, Xiqiancao (siegesbeckia herb) 30g, Luoshiteng (Chinese starjasmine stem)30g, Qingfengteng (orientavine) 12 to 25g, Fangji (tetrandra root) 10g, Weilingxian (clematis root ) 10 to 15g, Yinchaihu (stellaria root) 10g, Fuling (poria) 10 to 30g, Qianghuo (notopterygium root) 9g, Duhuo (pubescent angelica root) 9g, Chuanshanjia (pangolin scale) 6 to 9g, Yiyiren (coix seed) 30g, Rendongteng (honeysuckle stem) 30g, and Zexie (oriental water plantain rhizome) 10 to 15 .
　　This formula is used to treat the fifth syndrome.
　　V. Clinical research of 840 cases of Wang-Bi-syndrome (rheumatoid arthritis)(the abstract)
　　During the 7th 5-year plan, the first formula was made into infusing granule which was named as “Wang Bi Fu Kang (Recovering Wang-Bi-syndrome)"?and is used to treat the first syndrome. And the second and third formulas were mixed as one and also made into the infusing granule named as “Wang Bi Qing Ning (Clearing and Curing Wang-Bi-syndrome)"? which is used to treat the second and third syndrome. The medicaments are taken 3 times daily, one bag each time, successively for 3 months. 840 cases were observed by means of unified national criterion of diagnosis and curative effect.
　　1)."Wang Bi Fu Kang"?group (401 cases)
　　(1). Curative effect l: 31 cases of clinical cure (7.73%), 132 cases of marked effect (32.92%),
　　and 184 of improvement (45.89%), so the total effective rate was 86.53%.
　　(2). Laboratory tests:
　　A.ESR: the normal-converting rate was 50%;
　　B.RF: the normal-converting rate was 72.5%;
　　C.CRP: the normal-converting rate was 28.57%;
　　D.ASO: the normal-converting rate was 51.41%;
　　E.ANA: the normal-converting rate was 51.85%.
　　F.Toxicity test: the formula and its products have no toxicity.
　　G.Pharmacological verification:
　　The product has the antiphlogistic, repercussive, and analgesic effect to the adjuvant arthritis of the experimental animals.
　　H.Immunological test:
　　The formula: (a). has markedly enhancing effect for the immunological functions of mice; and (b). could elevate the content of serum lysozyme, which still needs the test of mass sample, while the product “Wang Bi Qing Ning"?could also reinforce the immunological functions of the experimental animals.
　　2).“Wang Bi Qing Ning"?group (339 cases)
　　(1).Curative effect: 22 cases of clinical cure (8.49%), 92 of marked effect (27.14%), 179 of
　　improvement (52.80%), and the total effective rate was 86.43%.
　　(2). Laboratory test:
　　All the results of test in this group are similar to those in “Wang Bi Fu Kang"?group except ESR (65.09%).