According to the clinical characteristics of this disease, it is mostly classified under the categories of "warm toxin," "stasis syndrome," and "Bi disease." The disease cause and mechanism of disease involve the invasion of heat toxin into the blood vessels, leading to obstruction of the collaterals and stagnation of qi and blood; or pathogenic heat consuming qi and yin, resulting in deficiency of both qi and yin; or qi stagnation leading to phlegm production, causing obstruction by phlegm and stasis. Over time, the healthy qi is severely damaged, and the five zang-organs are affected, leading to the occurrence of various deteriorated pattern.

bubble_chart Modern Research

Nodular polyarteritis, also known as nodular periarteritis, abbreviated as polyarteritis, panarteritis, polyangiitis, necrotizing arteritis, is an autoimmune disease related to immune complex deposition. It is characterized by necrotizing vasculitis in small and medium-sized muscular arteries, inflammation in all three layers of the artery, and multiple arterial aneurysms, thrombosis, infarction, and fibrinoid necrosis. Clinically, it often presents with fever, leukocytosis, arthritis, muscle pain, abdominal pain, hypertension, neurological lesions, and lesions in the lungs, brain, kidneys, etc., either simultaneously or alone. It is now considered to be a widespread or disseminated necrotizing vasculitis with overlapping syndromes. The disease is more common in young and middle-aged adults, with a male to female ratio of about 3:1.

The cause of the disease is related to allergic reactions caused by serum injections, infections, and drug use. Drugs mainly include sulfonamides and methamphetamine, and infections are commonly upper respiratory tract infections. Half of the patients have hepatitis B antigenemia. The pathogenesis of the disease is mainly an allergic mechanism, where immune complexes deposit in the vascular wall, activate complement to cause inflammation, and activate complement components to attract polymorphonuclear leukocytes, which release lysosomal enzymes to injure the arterial wall while phagocytosing the deposited immune complexes.

[Diagnosis]

The clinical manifestations of this disease are diverse and difficult to diagnose. If fever, chills, weight loss, fatigue, and multi-system damage are present, the disease should be suspected. Peripheral nerve damage and kidney lesions can be used for clinical diagnosis. Skin symptoms and signs, such as subcutaneous nodules distributed in batches or linearly along the blood vessel walls; tenderness and erythema in the acute phase, with nodules commonly found on the limbs, especially the lower legs, etc., can basically confirm the diagnosis. Biopsy of subcutaneous nodules and rashes, as well as tissues such as the testes and kidneys, is the most important diagnostic method. Laboratory tests may show increased erythrocyte sedimentation rate, increased white blood cells and platelets, significantly elevated eosinophils, abnormal renal function, positive immune complexes; abnormal cardiopulmonary function.

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1. Exuberant Heat Toxin︰It is commonly seen in the acute inflammatory stage, presenting with fever and chills or fever without chills, headache, chest pain, panting, cough, thirst, poor appetite, mental fatigue and lack of strength, weight loss, or accompanied by abdominal pain, or even hematemesis, bloody stool, dysuria, or small tender nodules with erythema appearing on the limbs, or muscle and joint pain. The tongue appears purplish-red with a yellow coating, and the pulse is rapid or thin and rapid. The treatment focuses on clearing heat and removing toxins, as well as invigorating blood to unblock collaterals. (1) For cases dominated by excessive heat at the qi aspect, use a modified **White Tiger Decoction with Lonicera and Forsythia**: - Raw Gypsum (30–50g), Anemarrhena Rhizome, and Skullcap Root (10g each), - Lonicera Flower, Forsythia Fruit, Dandelion, and Unprocessed Rehmannia Root (15g each), - Coptis Root (6g). **Modifications**: - If aversion to cold is present initially, add Schizonepeta and Fermented Soybean (10g each). - For alternating chills and fever, add Bupleurum and Sweet Wormwood (10g each). - For chest pain, cough, and panting, add Bitter Apricot Seed and Sichuan Fritillaria (10g each). - For abdominal pain, add Peach Kernel and Carthamus (10g each). - For severe constipation, add raw Rhubarb (15g, to be decocted later). - For muscle and joint pain, add Gentian (10g), Salvia (30g), and processed Myrrh and Frankincense (10g each). - For mental fatigue and lack of strength, add raw Astragalus Root (20g). (2) For cases dominated by excessive heat at the nutrient-blood aspect, use a modified **Plague-Clear Toxin-Vanquishing Decoction**: - Raw Gypsum (30–90g), Buffalo Horn (30g), - Unprocessed Rehmannia Root and Scrophularia Root (15g each), - Coptis Rhizome, Gardenia, Forsythia, Moutan Bark, Red Peony Root, Platycodon Root, Skullcap Root, and Anemarrhena (10g each), - Bamboo Leaf and Liquorice Root (6g each). **Modifications**: - For dark purple skin erythema, add Arnebia and Imperata Rhizome (15g each). - For palpitations, chest tightness, or arrhythmia, add Prepared Liquorice Root and Turmeric (10g each) and Salvia (30g).
2. Deficiency of Both Qi and Yin with Obstruction of ︰Commonly seen in the remission stage of disease, palpitation, severe palpitation, arrhythmia, chest pain, chest tightness, shortness of breath, mental fatigue, lack of strength, dry mouth and throat, numbness and stabbing pain in the affected skin area, dark tongue with scant coating, thin and choppy pulse. Tonifying qi, nourishing yin, promoting blood circulation, and unblocking the vessels. Modified Prepared Liquorice Decoction: Prepared Liquorice Root, Tangshen (or heterophylly falsestarwort root), Ophiopogon Tuber, Unprocessed Rehmannia Root, Donkey-hide Gelatin (melted) 15g each; Cinnamon Twig, Chinese Angelica, Hemp Seed, Chinese Date, Peach Kernel, Carthamus, Turmeric 10g each; Fresh Ginger Rhizome 6g. For persistent fever, add Lonicera and Forsythia 10g each; for subcutaneous nodules or joint pain, add Scrophularia Root, oyster shell, Salvia, prepared frankincense, and myrrh 15g each.
3. Spleen-kidney Yang Deficiency with Water-dampness ︰It is commonly seen in the chronic stage of diseases. The manifestations include a pale complexion, absence of thirst, loose stools, mental fatigue and lack of strength, lumbago, scanty urine, edema, a cold and numb sensation in the affected skin area, a pale tongue with white, greasy, and moist coating, and a deep, slow pulse. Laboratory tests may reveal proteinuria or hematuria, azotemia, anemia, and elevated blood pressure. The treatment involves warming yang to transform qi and draining dampness to promote water metabolism, using Yang-Harmonizing Decoction with modifications: Prepared Rehmannia Root 15g, degelatined deer-horn, Cassia Bark, Aconite Lateral Root, Blast-Fried Ginger, Cinnamon Twig, Tangshen, White Atractylodes Rhizome 10g each, suberect spatholobus stem, Salvia 30g each. For blood deficiency, add Chinese Angelica 10g; for abdominal pain, add Peony Root 15g and Liquorice Root 5g; for qi deficiency, add Astragalus Root 15g; for edema and scanty urine, add Poria and Alisma 15g each. For subcutaneous nodules, add Scrophularia Root and Bulbus Fritillariae Thunbergii 10g each.