Uarthritis is a common inflammatory arthritis, which has been well known as the White Tiger arthritis in traditional Chinese medicine. This article discussed the pathogenesis of blood stasis and the related studies in hyperuricemia, acute and chronic phase of Uarthritis. It suggested that blood stasis is a crucial pathogeny of uarthritis. Thus, the chinese herb medicine of blood circulation drugs should beapplied in all the phases of Uarthritis.

Objective To develope effective TCM antirheumatic drug and provide theoratical basis of establishing TCM effect evaluation system of RA,the effect of modified Guizhishaoyaozhimu Decoction on RA was evaluated by SF-36 questionnaire. Methods Evaluation of 59 cases in a RCT (random control test) study was based on SF-36 questionnaire. Treatment group was given modified Guizhishaoyaozhimu decoction bid,while control group was given MTX 10 mg,one time a week with celecoxib 200 mg,qd. Observation last on 24 weeks and comparing patients’ quality of life was done at the beginning and end point. Results There was significant difference between two groups on improving physical functioning,role-physical,body pain,social function,and role-emotional (P 0.05). Conclusions Modified Guizhishaoyaozhimu decoction has better effect on improve RA patients’ quality of life than MTX.

OBJECTIVE:To offer the literature basis for clinical safe drug use by literature research about ADR induced by Yishen juanbi pill. METHODS:Using“Yishen juanbi pill”as searching word,related literatures about ADR induced by Yishen juanbi pill were collected from CNKI,and then the occurrence of ADR was summarized and analyzed. RESULTS:A total of 15 literatures were included,involving 58 patients. Primary disease were mainly rheumatoid arthritis (28 cases,48.28%);organs/systems involved in ADR were digestive system (77 cases, 76.24%). Main clinical manifestations were epigastric discomfort, pernicious vomiting,diarrhea,etc. No obvious ADR was found. ADR-inducing dose was mainly 8 g,tid(47 cases,92.16%);ADR-inducing drug combination were two-drug combination (33 cases,56.90%). Fifty-eighe cases of ADR were recovered after treatment,and main treatment was drug withdrawal or symptomatic treatment. CONCLUSIONS:Although Yishen juanbi pill may induce ADR,those ADR can disappear spontaneously after drug withdrawal or the symptoms are recovered after symptomatic treatment. Yishen juanbi pill is a relatively safe Chinese patent medicine of anti-inflammatory,but ADR monitoring should be strengthened during application.

Objective To evaluate the efficacy and safety of Shuangyi Qushi Tongluo Capsules (SQTC) for the treatment of knee osteoarthritis (KOA).Methods A multi-center,randomized,parallel-controlled trial was carried out in 240 cases of KOA patients.The patients were divided into trial group (N =120) and control group (N =120),which was given SQTC,Xianlinggubao capsules respectively for 8 weeks.Before treatment,and 2,4 and 8 weeks after treatment,we recorded the scores of clinical symptoms and traditional Chinese medical syndromes,Western Ontario and McMaster Universities Arthritis Index (WOMAC) scores and knee function scores.After treatment,the clinical efficacy and adverse reaction were observed.Results (1) After treatment for 8 weeks,the clinical efficacy of the trial group was superior to that of the control group (P ＜ 0.05).(2) The trial group had better effect on improving the visual analogue scale (VAS) scores of knee pain,VAS scores of limitation of motion and time for morning stiffness than the control group after treatment for 8 weeks(P ＜ 0.05 or P ＜ 0.01).(3) After treatment for 4 and 8 weeks,the trial group had better effect on improving scores of traditional Chinese medical syndromes,WOMAC scores and Japanese Orthopedic Association(JOA) scores than the control group (P ＜ 0.05 or P ＜ 0.01).(4) Before and after treatment,the results of blood,urine and stool routine examination,liver and kidney function,and electrocardiography showed no significant changes.Conclusion SQTC are effective and safe in treating KOA,and can start an effect shortly.

Objective To observe the therapeutic effect of adjunctive treatment with Qiangzhu Recipe for ankylosing spondylitis(AS). Methods Forty-eight AS patients were evenly randomized into observation group and control group according to the admission order. The observation group was given Qiangzhu Recipe together with sulfasalazine and celecoxib orally, and the control group received oral use of sulfasalazine and celecoxib. Four weeks constituted one treatment course, and the treatment covered 3 courses. The main clinical outcomes of the patients included Bath AS functional index ( BASFI) , Bath AS disease activity index ( BASDAI) , pain visual analog scale ( VAS) scores, global VAS scores, spinal mobility indexes ( finger-to-floor distance, occiput -wall distance, thoracic mobility, Schober test, scoliolosis test) , and laboratory inflammatory indicators of erythrocyte sedimentation rate (ESR) and C-reactive protein. Moreover, the incidence of adverse reaction was also recorded. Results (1) After treatment for 4, 8, and 12 weeks, the percentage of the patients arriving at the degree of ASAS20 was 16.67%, 33.34%, and 70.83% respectively in the observation group, and was 8.33%, 29.17%, and 58.33% in the control group; the percentage of the patients arriving at the degree of ASAS40 was 4.17%, 20.83%, and 37.50% respectively in the observation group, and was 0.00%, 12.50%and 25.00% in the control group. The differences of the percentage of the patients arriving at the degree of ASAS20 and ASAS40 were insignificant between the two groups (P>0.05). (2) After treatment, symptoms were much relieved, spinal mobility was improved, and inflammatory indicators of ESR and CRP were alleviated in the two groups ( P<0.05 or P<0.01 compared with those before treatment) . The observation group had better effect on BASDAI than the control group ( P<0.01) , but only showed a trend on improving the other clinical outcomes ( P>0.05 compared with the control group). Conclusion Adjunctive treatment with Qiangzhu Recipe exerts certain synergistic action on sulfasalazine and celecoxib in treating ankylosing spondylitis.

Objective To observe the effect of Duanteng Yimu decoction (DYD) on bone turnover markers of C-terminal telopeptide of type Ⅰ collagen (CTX-Ⅰ) and N-terminal propeptide of type Ⅰ procollagen ( PⅠNP) of adjuvant-induced arthritis (AA) rats. Methods Seventy-two SD rats were divided into 9 groups, and complete Freund's adjuvant was injected into the rats to establish adjuvant-induced arthritis rat model. After medication for 36 days, the pedal swelling, the serum levels of CTX-Ⅰand PⅠNP, and ankle X-ray photographic scores were observed. Results The pedal swelling degrees and ankle X-ray scores in medication groups were lower than those in the model group ( P<0.05). The PⅠNP level had no statistically significance in various groups ( P>0.05). The CTX-Ⅰlevel in low-dose DYD group was decreased (P<0.05). Conclusion Caulis Celastri has two-way effects on CTX-Ⅰlevel of female AA rats, and its side effects can be reduced by Radix Dipsaci and Herba Leonuri, but their antagonism effect will disappear with the increase of the dose of Caulis Celastri.

Objective To evaluate the effectiveness and safety of Shuangyi Qushi Tongluo Capsules ( SQTC) in treating ankylosing spondylitis (AS), and to explore the synergistic action of SQTC combined with sulfasalazine. Methods A randomized and parallel-controlled trial was carried out in 80 AS patients. The enrolled subjects were evenly randomized into testing group and control group. Both groups were given oral use of sulfasalazine enteric-coated tablets, and the testing group was additionally given oral use of SQTC, which is mainly composed of silky ant (Formica Fusca), black-winged Termitidae, Scorpio, Radix Ginseng, Radix Astragali, Rhizoma Atractylodis Macrocephalae, Radix Angelicae Sinensis, Flos Carthami, Radix Salviae Miltiorrhizae, Radix Achyranthis Bidentatae, Caulis Spatholobi, Herba Epimedii, and Radix Morindae Officinalis. The treatment for the two groups covered 24 weeks. On treatment week 4, 12, 24, we recorded the Bath Ankylosing Spondylitis Disease Activity Index (BASDAI), visual analog scale (VAS) scores of rachialgia, patients’ general assessment (PGA), VAS scores of night pain, spondylitis scores, Bath Ankylosing Spondylitis Functional Index ( BASFI) , Bath Ankylosing Spondylitis Metrology Index ( BASMI) , scores of the quality of life ( QOL) , erythrocyte sedimentation rate ( ESR) , C-reactive protein ( CRP). Moreover, the adverse reaction of the two groups was also monitored. Results ( 1) Compared with the control group, testing group had high ASAS 20 percentage on treatment week 4, 12 and 24 (P<0.05 or P<0.01). (2) After treatment for 12, 24 weeks, the observation indexes were much improved in the testing group ( P<0.05 or P<0.01 compared with the control group). ( 3) In the control group, one case ( 2.86%) had slight abnormal hepatic function, and one case (2.63%) in the testing group had slight gastrointestinal discomfort, the difference being insignificant (P>0.05). Conclusion SQTC are effective and safe in treating AS, starting an effect shortly and having synergistic effect on salfasalazine for the treatment of AS.

Objective To investigate the effects of alcohol extract of Kunmu decoction on proliferation and apoptosis of rheumatoid arthritis fibroblast-like synoviocytes (RA-FLS). Methods Synovial tissues were obtained from patients with active RA received joint replacement or arthroscopy. The surface antigen and the amount of apoptotic cells were determined by flow cytometry. The inhibitive effect was detected by MTT assay. Results The CD90+surface antigen of synoviocytes was (94.78 ± 0.98)%. The inhibitive effect on the proliferation in all treatment groups were in a time-and dose-dependent manner. The apoptosis rate was increased in a dose-dependent manner among all dosage alcohol extract groups. Conclusion Kunmu decoction might inhibit proliferation and induce apoptosis of RA-FLS.

Jingui Yaolue is a part ofTreatise on Cold-Attack and Miscellaneous Diseases. Because of the archaic words, students lost the interest on it. So it became the questions that how to make students interested in learning theJingui Yaolue and to make traditional Chinese medicine(TCM) classical guide clinical treatment. Thus, a try has been made to teach the TCM classic in the clinical practice apprentice setting rather than the classrooms. Here, some experiences about apprentice teaching in clinical practice of Jingui Yaolue were shared.

Objective:To investigate the expression of programmed death 1 (PD-1)/programmed death ligand 1 (PD-L1) pathway in patients with acute myeloid leukemia (AML) and its relationship with clinical features and prognosis, and to examine its effect on PD-1-positive natural killer (NK) cells against AML cells in vitro.Methods:The bone marrow samples of 65 AML patients and the peripheral blood of 32 AML patients diagnosed in Affiliated Cancer Hospital of Zhengzhou University from July 2019 to December 2020 were prospectively collected, and the peripheral blood of 24 healthy people was taken as healthy control. The expression level of PD-L1 in bone marrow tumor cells and expression level of PD-1 in peripheral blood NK cells were detected by flow cytometry. The correlations of PD-1 expression in bone marrow tumor cells and PD-1 expression in NK cells with the clinicopathological features, curative effect and prognosis of patients were analyzed. Flow cytometry was used to detect the expression level of PD-L1 in AML cell line THP-1 (target cells) and the expression level of PD-L1 in NK cell line NKL (effector cells). THP-1 cells treated with and without 25 μmol/L of PD-L1 inhibitor fraxinellone were used as experimental group and control group, and co-cultured with NKL cells at different effector-to-target ratios. The apoptosis of THP-1 cells and the expression of NKG2D in NKL cells were detected by flow cytometry, the cell proliferation status was detected by CCK-8 and the cell proliferation inhibition rate was calculated; the levels of interferon-γ (IFN-γ) and tumor necrosis factor-α (TNF-α) in the supernatant of co-culture system were detected by enzyme-linked immunosorbent assay (ELISA).Results:The proportion of AML patients with PD-L1-positive expression in bone marrow tumor cells was higher than that in the healthy control group [38.5% (25/65) vs. 8.3% (2/24), P = 0.029]. The proportion of AML patients with PD-1-positive expression in peripheral blood NK cells was higher than that in the healthy control group [40.6% (13/32) vs. 12.5% (3/24), P = 0.035]. There were no statistical differences in sex, age, hemogram, proportion of primordial cells, risk stratification, chromosomal karyotype, gene mutation (except NPM1 gene), fusion gene and French-American-British cooperative group (FAB) typing between patients with PD-L1 positive and negative in bone marrow tumor cells and between patients with PD-1 positive and negative in peripheral blood NK cells (all P > 0.05). In relapsed/refractory patients, the proportion of patients with PD-L1-positive expression in bone marrow tumor cells was higher than that in newly treated patients [58.8% (10/17) vs. 31.2% (15/48), P = 0.045]. There was no significant difference in the proportion of patients with PD-1-positive expression in peripheral blood NK cells between relapsed/refractory patients and newly treated patients [(38.5% (5/13) vs. 42.1% (8/19), P = 0.837]. There was no statistical difference in complete remission (CR) rate between PD-L1 positive and negative patients [69.6% (16/23) vs. 74.3% (26/35), P > 0.05]. There was no statistical difference in CR rate between PD-1 positive and negative patients [66.7% (8/12) vs. 70.6% (12/17), P > 0.05]. There was no statistical difference in recurrence rate after CR between PD-L1 positive and negative patients [12.5% (2/16) vs. 19.2% (5/26), P > 0.05]. There was no statistical difference in recurrence rate after CR between PD-1 positive and negative patients [25.0% (2/8) vs. 16.7% (2/12), P > 0.05]. Flow cytometry showed that the positive rate of PD-1 in NKL cells was (67±6)% and the positive rate of PD-L1 in THP-1 cells was (85±5)%. After co-culture with NKL cells, the apoptotic rate and proliferation inhibition rate of THP-1 cells were higher in the experimental group compared with the control group, the expression of NKG2D on the surface of NKL cells was elevated, and the levels of IFN-γ and TNF-α in the co-culture supernatant were increased. Conclusions:In AML patients, the expression of PD-L1 in bone marrow tumor cells is high, and the expression of PD-1 in peripheral blood NK cells is also high. The expression of PD-L1 in bone marrow tumor cells of relapsed/refractory AML patients is higher than that of newly treated patients. Inhibition of PD-L1 expression in THP-1 cells can enhance the tumor killing activity of NKL cells in vitro. The mechanism may be that inhibition of PD-L1 expression in THP-1 cells up-regulates the expression of NKL cell activated receptor NKG2D and promotes the secretion of IFN- γ and TNF- α.