Ang pagpapalakas ng spleen ay kritikal sa paggamot ng "rheumatoid arthritis"

Rheumatoid arthritis ay isang karaniwang chronic inflammatory joint disease. Ayon sa preliminary survey, ang prevalence rate sa China ay 0.3%, at maaaring mangyari sa anumang edad, lalo na sa 20–40 years old. Clinical manifestations include polyarthritis, primarily affecting small joints of hands and feet, with recurrent and persistent course. The main pathological changes involve chronic inflammation of synovial membrane, formation of pannus, destruction of cartilage and subchondral bone, ultimately leading to joint deformity, stiffness, and loss of function. Besides the prominent multi-joint lesions, joint extrinsic organ involvement is also common, among which gastrointestinal lesions are the most frequent, manifesting as nausea, vomiting, poor appetite, acid reflux, abdominal pain, loose stools, etc. These conditions are related both to the disease mechanism and inappropriate treatment. Severe gastrointestinal lesions not only affect drug application but also seriously impact the patient’s overall condition and quality of life.In TCM, the pathogenesis of "rheumatoid arthritis" (RA) is believed to be closely linked to spleen deficiency. ① Spleen deficiency leads to impaired transformation and transportation, causing fluid retention and dampness accumulation, which eventually forms phlegm. ② Spleen deficiency results in insufficient production of qi and blood. ③ Spleen deficiency causes weakened defensive qi, making the body vulnerable to external pathogens, especially dampness, further damaging the spleen. ④ Dampness is sticky and persistent; when accumulated, it transforms into blood stasis, obstructing meridians and impeding blood flow, leading to phlegm-stasis intermingling, aggravating joint pain and swelling, resulting in recurring and stubborn symptoms, or even nodules and ecchymoses around joints. ⑤ Dampness often combines with cold or heat; cold causes stagnation, invading meridians and slowing blood flow, possibly leading to blockage; heat enters blood, boiling it and causing stasis; qi deficiency reduces blood propulsion, leading to stagnation over time. Phlegm and stasis accumulate and combine, forming phlegm-stasis intermingling. Therefore, strengthening the spleen and stomach is crucial in treating RA.Gastrointestinal lesions in RA: Temporomandibular joint lesions cause difficulty in eating and swallowing. About 30% of RA patients show abnormal esophageal motility on pressure measurement, with weakened peristalsis in the lower two-thirds of the esophagus and impaired function of the lower esophageal sphincter, leading to frequent heartburn and acid reflux.Chronic superficial gastritis, atrophic gastritis, and peptic ulcers are commonly associated with anti-inflammatory analgesic drugs and gastric acid imbalance. Peptic ulcers are more common in elderly patients above 60, mostly gastric ulcers, usually located at the lesser curvature near the gastric angle. Unlike typical peptic ulcers (which are mostly duodenal), RA-related ulcers lack regular upper abdominal pain, and many patients have no pain at all, increasing risk of bleeding or perforation.Ischemic colitis or intestinal obstruction: More severe cases of RA can trigger vasculitis, leading to small intestine motility disorders. When the small intestine is involved, symptoms include abdominal pain, bloating, diarrhea, or constipation. RA can also affect the colon and rectum, causing changes in stool consistency.Pancreatitis and cholecystitis: Rarely seen in some RA patients, with possible mild to moderate liver function abnormalities, including mild fatty infiltration and fibrosis in the liver.Strengthening the spleen to treat RAStrengthening the spleen and removing dampness: The relationship between spleen and dampness is very close. Dampness has internal and external origins. External dampness is caused by climate and environment, or due to consuming cold foods. Both internal and external factors stem from spleen deficiency, allowing dampness to invade. For external dampness (including arthralgia), spleen deficiency is the internal factor. Internal dampness arises directly from spleen deficiency itself. Due to poor spleen function, the transformation of food and fluids into nutrients and their distribution fails, causing fluid retention and internal dampness generation.RA patients show obvious signs of dampness, so strengthening the spleen to remove dampness is significant. Patients often experience fatigue, heaviness in the body, numbness, chest tightness, poor appetite, nausea, abdominal distension—these are all signs of dampness. Even if these symptoms are not prominent, just swelling in limbs or joints indicates dampness, requiring spleen strengthening to resolve dampness.Strengthening the spleen and boosting qi: The spleen is closely linked to immune function. "Spleen governs transformation and transportation," "spleen is the acquired foundation," "strong spleen resists pathogens"—meaning the spleen continuously transports nutrients throughout the body, maintaining normal physiological activities, delivering true qi, defensive qi, and yuan qi. Spleen deficiency often presents with immune dysfunction. Animal model studies confirm that herbs like astragalus, dangshen, lingzhi, and atractylodes can enhance immunity.RA patients have immune system defects. While modern immunomodulatory drugs offer some benefit, they are limited in options, expensive, and carry significant side effects. TCM holds great potential here. Herbs like astragalus have been proven to promote interferon production; dangshen, astragalus, atractylodes, and poria can promote lymphocyte transformation and activate the reticuloendothelial system. Some believe that spleen-strengthening herbs may belong to the category of immune-stimulating herbs.