Abstract:Rheumatoid arthritis (rheumatoid arthritis,RA) is an autoimmune disease defined by the World Health Organization. As a simple and easy method to treat RA, traditional Chinese medicine application therapy has a long history and definite curative effect. This article reviews the experimental mechanism and clinical application of traditional Chinese medicine (TCM) application in the treatment of RA.
KEY:Traditional Chinese medicine; application; rheumatoid arthritis
Traditional Chinese medicine boil ointment or grind the end to apply to the specific part to treat the disease is the traditional Chinese medicine application therapy. Based on the theory of meridian of traditional Chinese medicine, meridian, acupoints and drugs are integrated, which is a common external treatment method in traditional Chinese medicine, and plays an important role in the prevention and treatment of diseases. The study shows that acupoint application therapy can regulate the immune and endocrine functions of the body, and enhance the phagocytosis of reticuloendothelial system, thus promoting the dissipation and absorption of inflammation. . RA belongs to the category of "arthralgia syndrome" in traditional Chinese medicine. There is the theory that "wind, cold, dampness, three qi mixed to, and the combination of arthralgia." Modern scholars have summed up the characteristics of RA as "wind, cold, dampness, blood stasis, deficiency". The key of its etiology and pathogenesis lies in the invasion of body by wind, cold and dampness evil, blocking of meridian and collaterals. At present, it is generally believed that RA is a chronic systemic autoimmune disease characterized by synovitis, and the traditional medicine used in western medicine to treat RA often has serious side effects. Traditional Chinese medicine application is one of the effective ways to reduce the side effects of drugs. Scholars have done a lot of research on the experimental mechanism and clinical application.
The experimental mechanism of traditional Chinese medicine application in treating rheumatoid arthritis
1.1 external application alone. Wenjun et al.  to observe the therapeutic effect of traditional Chinese medicine compound rhubarb powder on RA rats. The results showed that the matrix metalloproteinase-10 (MMP-10), The expression of mRNA in interleukin-33 (IL-33) was significantly decreased (P < 0. 05), RA). IL is involved in many physiological and pathological reactions and plays an important role in immune regulation. MMP can degrade most of the extracellular matrix of chondrocytes resulting in swelling of articular cartilage and eventually damage the structure of joints. This experiment suggests that the mechanism of compound rhubarb powder in treating RA may be related to the inhibition of cytokines such as MMP-10,IL-33. Shixiaofen et al.  Bing Wu ointment made of traditional Chinese medicine such as Chuanwu, Asarum and White mustard were directly applied to the affected joints of AA rats. After treatment, the swelling of foot and metatarsus was alleviated, and the pathological damage was improved in varying degrees. The expression of platelet-derived growth factor (PDGF) was positive in inflammatory cell infiltration and proliferative zone, and its expression intensity was positively correlated with the severity of pathological damage. Bingwu ointment could inhibit the expression of PDGF and improve the pathological damage.
1.2External application combined with drug therapy. Wang Jianhui  to explore the immunomodulatory effect on adjuvant arthritis (AA) rats by internal administration and external application of Jiegu ointment. After treatment, the arthritis index of AA rats decreased, the serum IL-8 decreased, and IL-10 increased gradually, which was significantly different from that in model group and before treatment. The results showed that Jiegu ointment could inhibit the growth of inflammatory cytokines and control arthritis. In the experiment of Wenjun , the effect of compound rhubarb powder combined with methotrexate in the treatment of RA was also very good. Fu Weiyan and others studied the curative effect of Angelica Niantong Jiawei plaster which originated from Jin Zhang element in Medicine Qiyuan on AA rats. While applying Danggui Niantong Jiawei Ointment externally, methotrexate was given to the stomach at the same time. Compared with the model group, the pathological section of synovial tissue showed that the inflammatory infiltration was improved, and the apoptosis rate of synovial cells and hypoxia inducible factor-1 α (HIF-1 α) were significantly different (P < 0. 05).
After treatment, HIF-1 α inhibited the activity of HIF-1 α, accelerated the apoptosis of synovial cells, and alleviated the proliferation of synoviocytes and alleviated arthritis.
2.Clinical Application of traditional Chinese Medicine in treating Rheumatoid Arthritis
2.1, external application alone. Wang Xiujing treated 110 patients with RA with external application of traditional Chinese medicine after syndrome differentiation. The effect of tonifying liver and kidney, dispelling evil and activating collaterals analgesia can obviously reduce inflammatory swelling reaction, ameliorate the phenomenon of morning stiffness of joints and relieve pain. Quick recovery of joint function.  using drugs such as Radix Atractylodes, Cinnamomum Cinnamomi and Atractylodes, etc., the results showed that there were significant differences in the scores of clinical indexes between the two groups before and after the treatment (P < 0. 05), and the results showed that the application of cold dampness Qubi powder to the joints of the patients had a significant difference. Symptoms are effectively improved. Cao Wei and others used compound Tripterygium wilfordii external application to treat patients with active RA. After treatment, the symptoms of joint damage were alleviated by direct contact with lesion sites or effective acupoints. Some scholars adopted the characteristic therapy of traditional Chinese medicine, "treatment of winter disease and summer", to treat RA patients with acupoint application, which obviously alleviated the symptoms of joint pain, swelling, morning stiffness and so on.
2.2, external application combined with drug therapy. Qiu Mingshan  and other indexes such as joint pain, morning stiffness, arthritis index (AI) and self-assessment of pain degree (VAS) were observed and compared with traditional western medicine and application of Angelica dahurica (Radix angelicae dahurica). It was found that the AI and VAS of RA patients decreased significantly after application of Angelica dahurica. On the basis of routine western medicine treatment, Fan Lifeng and others used self-made ointment to treat RA, to remove heat and detoxification, dehumidification and detumescence. The results showed that the levels of IL-1 and TNF- α in peripheral serum of patients were obviously decreased. Forty out of 45 active RA patients met the ACR50 standard established by the American Rheumatology Society, and the effective rate was significantly higher than that of the control group (P < 0. 05). Some scholars treated RA patients with internal and external application of traditional Chinese medicine, although the drugs are different, but they all have the effect of detumescence and pain, promoting blood circulation and removing blood stasis, so they all get satisfactory curative effect, and no serious adverse reactions. The results of Peng Xiufeng et al showed that the external application of Fengshi Tongbi ointment made of Radix Notopterygii, Radix Notopterygii and Chuanwu etc. on the basis of routine western medicine treatment could obviously improve the erythrocyte sedimentation rate (ESR),) of rheumatoid factor (RF),. C-reactive protein (CRP) was used to reduce the symptom score of RA.
2.3, others. Some scholars treated RA, with acupuncture on the basis of external application of traditional Chinese medicine. The results showed that this treatment method could obviously alleviate the clinical symptoms of RA, and the laboratory indexes such as RF,ESR,CRP were better than those of western medicine alone (P < 0. 05). Jiang Xiawei and others were treated with moxibustion on the basis of acupoint application combined with western medicine. After treatment the clinical symptoms were relieved and the serum IgG,IgA,IgM,C3 level was significantly lower than that before treatment (P < 0. 05). Zhou Xiumei was treated with bee acupuncture combined with external application of traditional Chinese medicine for RA,. The results showed that, on the basis of routine western medicine treatment, the treatment with bee acupuncture combined with traditional Chinese medicine had a better curative effect, and the CRP, erythrocyte sedimentation rate of patients was better. The level of RF was lower than that of western medicine alone (P < 0. 05). Other scholars in the external application of traditional Chinese medicine at the same time infrared physiotherapy, but also achieved satisfactory results. Previous studies have shown that the treatment of RA with Chinese medicine can reduce the recurrence rate, improve the curative effect, restore the function of joint, relieve pain, and then improve the quality of life. Compared with traditional Chinese medicine, western medicine has some toxic side effects. Acupoint application therapy has a clear effect, convenient operation, less side effects, and has a good development prospects. The application of traditional Chinese medicine at specific points can not only make the Chinese herbal medicine permeate through the skin, but also stimulate the corresponding acupoints, and play a dual role from the acupoint meridian and the application of medicine to increase the curative effect. Acupoint application therapy is a precious legacy of traditional Chinese medicine. Its curative effect on rheumatoid arthritis is positive and worth popularizing. However, from the current research, there are still some shortcomings: there are many kinds of Chinese medicine to treat RA, lack of a detailed database of pharmacological effects and side effects of Chinese medicine compatibility; In addition, researchers often study a certain type of RA, Chinese medicine application has achieved good results, but there are a variety of clinical types of RA, there is a lack of a treatment standard to guide the clinical application of acupoint application of different types of RA. These problems need to be studied and explored in the future.