Exploration on Etiopathogenesis and Therapeutic Principles of Ankylosing Spondylitis Guided by Ye Tianshi’s Theory of Dredging Collaterals

Abstract

Ankylosing spondylitis (AS) is an immune-mediated chronic inflammatory disease that mainly involves the axial joints and sacroiliac joints. Its pathological characteristics include bone destruction and new bone formation induced by immune inflammatory responses. The collaterals disease theory can be traced back to Huangdi Neijing (Huangdi’s Internal Classic). Collaterals function to defend against exogenous pathogens, connect the exterior and interior of the body, and nourish the skin and interstices. Harmonious qi and blood circulation in collaterals maintains normal bodily functions. Abnormal circulation of qi and blood in collaterals impairs its functions such as pathogen resistance and internal-exterior communication, triggering immune inflammatory responses in AS, followed by bone destruction and neo-osteogenesis, resulting in joint swelling and pain, partial spinal fusion and even deformity. Ye Tianshi’s collaterals disease theory carries important guiding significance for the treatment of this disease. By sorting out Ye Tianshi’s academic thought of “chronic diseases entering collaterals”, this paper systematically elaborates three core pathogeneses of AS: the early stage of AS is characterized by “channel heat leading to bi syndrome”; the middle stage manifests as “dampness invasion and intermingling of phlegm and blood stasis”; the late stage is dominated by “deficiency of extraordinary meridians and malnourishment of collaterals”. At the therapeutic level, a three-dimensional collateral-unblocking system is proposed: at the defensive aspect, pungent-cool dispersion to expel pathogens outward; at the qi aspect, dispersing sanjiao to resolve phlegm and remove blood stasis; at the nutrient aspect, tonifying liver and kidney and insect medicinals for collateral dredging. It provides new ideas and therapeutic options for the treatment of AS.