Therapy Of Scleroderma

China TCM Specialized Diagnosis and Therapy of scleroderma 

General Introduction
Hebei Yiling Hospital, affiliated to Hebei Medical University and located in Shijiazhuang, the capital city of Hebei Province, China, is a modern and comprehensive specialized hospital. It has more than 100 talents holding oversea or domestic degree of postdoctoral, M.D., M.M. or technical title of associate chief physician and tens of internal educated M.D. or M.M by the hospital. With 500 ward beds and 32 clinical specialized departments presently, the hospital is among ones appointed by the provincial and municipal authorities to provide medical services under medical insurance coverage, a national key specialized TCM organization supported by the government, and a postdoctoral research station approved by the Ministry of Personnel. 

Several clinical specialized departments are established based on scientific research in the hospital. Each of them is assigned scientific research projects that may bring about breakthrough in clinical treatment and lay foundation for development of new drugs. The hospital has made so many outstanding achievements in scientific research and clinical treatment of scleroderma, myositis, amyotrophia, cardiac and cerebrovascular diseases as well as kidney diseases that it has been awarded one National Second Prize of Progress of Sciences and Technology and more than ten other prizes by the Ministry of Health or the provincial government; meanwhile, it has developed 9 new drugs that are officially approved, which wins the hospital a positive reputation.  

The diagnosis and treatment specialized department of scleroderma is one of key departments in Yiling Hospital with the scleroderma laboratory of Hebei Medical University attached to it. Well known in the medical field and patients of scleroderma and among the leading treatment clinics of scleroderma in China, it has established a database containing more than 8,000 scleroderma sufferers's medical information so far.  
Established in 1992, the diagnosis and treatment specialized department of scleroderma keeps researching for new therapies of scleroderma continuously by combining Chinese traditional medical with western medical theories for over a decade, and puts forward many new theories such as "Treating Scleroderma of Three Phases with Traditional Chinese Medicines", "Dermal Ecology" and "Treatment of Scleroderma as a Collateral-channel Related Disease". Based on these new theories, "Yingpiling" series of Chinese patent medicines and compound ointment are developed and a multifunctional TCM treatment room is set up, where many proven therapies are put into clinical applications such as medicated bath/steam treatment/ultrasonic & ionic introduction of Chinese drugs/thoracic duct drainage combined with Chinese medicine for systemic scleroderma, Chinese medicine combined with transplantation of stem cells for localized scleroderm (scleroderma circumscriptum), TCM three-in-one therapy based on differentiation of syndromes for pulmonary fibrosis, compound Chinese medicines for digestive-tract affection caused by scleroderma and so on. Meanwhile, the medical workers in the department conducts in-depth scientific study on the pathogenesis of scleroderma concerning skin lesion, esophagus affection, pulmonary fibrosis, Raynauds phenomenon and ulcer of limbs caused by scleroderma, and published over 30 technical papers about scleroderma. For the present, the department are undertaking four scientific research projects, of which the "Experimental and Clinical Research on Shenzhe Zhuyun Mixture in Treatment of Esophagus Disorder Caused by Systemic Scleroderma" undertaken by department chief Mr.Guo Gang has been appraised by expert as internationally advanced and won the first prize of science and technology issued by Hebei Association of Chinese Medicine while the Clinical and Experimental Study on Zhouluotong Capsule in Treatment of Raynauds Phenomenon Caused by Systemic Scleroderma passed the expert appraisal toward the end of 2005 and concluded as domestically leading position. Meanwhile, some other provincial research projects like the "Clinical and Experimental Study on Yingpiling in Treatment of Scleroderma" and the "Clinical and Experimental Study on Tongluo Runfu Soothing Cream in Treatment of Skin Lesion Caused by Systemic Scleroderma" are in the process of collecting clinical results recently, which are expected to complete the technical evaluation in the near future. 
Since its establishment, the department has been always persisting in the guideline of converging Chinese and western medical therapies on the basis of traditional Chinese medicine(TCM) predominated and emphasis of both clinical application and scientific research. The researchers in the department reproduce successfully rat model of scleroderma in the Medicine Academy of Hebei Medical University, and conduct in-depth study on the mechanism of action and effective therapies with Chinese herbal medicine in treatment of scleroderma, which achieve positive effect by guiding clinical prescription. 
Along with rehabilitation of patients one by one, the department is in rapid progress as well. So far, we have provided medical services to ten of thousands sufferers of scleroderma, who are from almost all provinces, cities or autonomous regions of China and tens of countries and regions. It is our best pleasure to see cured patients walking out of the hospital and build a Great Wall together to defend illness. Sincerely, we hope our hard work can bring you health and happy lives! 

2.Expert introduction

Mr. Guo Gang, Associate Chief Physician, Medical Postgraduate, Director of No.2 Department of Rheumatism and Immunity, Director of Scleroderma Research Department, Member of Committee of Collateral Channel Diseases of China Association of Chinese Medicine (CACM), Member of Paralysis Specialty Committee of Hebei Association of Chinese Medicine. His expertise is in treatment of scleroderma, pulmonary interstitial fibrosis, polymyositis and peripheral angionosis. With more than 20 papers in provincial or national journals and 3 academic books (over 700 thousand characters) published already, he is currently responsible for three provincial scientific research projects, of which the experimental and clinical research on Shenzhe Zhuyun Mixture in treatment of esophagophathy caused by systemic scleroderma, as a project sponsored by Hebei Commission of Science and Technology, won the first prize of scientific and technological progress issued by Hebei Department of Health. 

Mr. Li Zhenguo,  Physician-in-Chief, Assistant Director Member of North China Subcommittee of China TCM and Western Medicine  Association for Peripheral Angionosis, and Exclusive Member of Hebei Branch of China TCM Specialty Committee for Vessel Diseases. His expertise is in angiitis, scleroderma and vasculitis. 

3.Knowledge of Diseases
4.Special Therapies
Shenzhe Zhuyun Mixture to Treat Digestive Diseases Caused by Systemic Scleroderma
Esophageal affection is a most common splanchnic lesion when systemic scleroderma starts to affect the digestive system. Most patients suffer from symptoms like dysphagia, heartburn, acid regurgitation, foods backflowing from stomach and esophagus, turgor or pain with the upper abdomen. In the late stage or no proper treatment for long, the patient may appear serious dystrophy or prostration, which has a strong impact on the living quality and prognosis. So far, there is no medicine of good efficacy and specificity for such a disease, but adjust posture and diets or give expectant treatment concerning clinical symptoms like applying protective agent of gastric mucosa, antihistamine or gastrointestinal digestion medicines. 

To provide the patients of such disease an ideal Chinese medicine, a team led by Mr.Guo Gang, the Associate Chief Physician of Rheumatism and Immunity Department of Hebei Yiling Hospital obtained approval from Hebei Science and Technology Department and conducted an in-depth experiment and clinical research for TCM therapies of such disease on the basis of Hebei Yiling Medicine Group technical and hardware advantages. An analytical study of the clinical manifestations and pathogenesis shows that the esophageal affection caused by systemic scleroderma can be classified as the category of dysphagia per TCM theories, and the major pathogenesis is insufficiency of both the spleen and the kidney functions as the principal aspect and retardation caused by stagnation of Qi and stagnant blood as the secondary aspect. Based on this conclusion, Mr.Guo Gang and et al determined the treatment principles of warming yang, supplementing Qi, improving digestion，softening and resolving hard masses, regulating the flow of qi and regulating the meridians. Accordingly and referring to proven TCM prescriptions, they have successfully developed Shenzhe Zhuyun Mixture for treatment of esophageal affection caused by systemic scleroderma with strict preparation technology and quality standards. 

An experimental study indicates that three dosage of Shenzhe Zhuyun Mixture will be able to promote mouse's gastricemptying and small intestine's peristalsis as well as reduce inhibition to small intestine peristalsis by L-Ephedrine evidently， of which the effect is equivalent to Motilium(Domperidone), able to improve the pH value at the mucous membrane of the lower end of esophagus. 

Clinical researches indicate that Shenzhe Zhuyun Mixture's functions are evident in relieving the symptoms of esophageal affection, reducing the transit time of barium agent through esophagus in standing or lying position, improving the emptying index of barium agent in lying position and enhancing the peristalsis function of esophagus; meanwhile, it can improve patients' survival quality. In treatment of esophageal affection caused by systemic scleroderma, the overall effective rate is 96.88% with basic cure rate of 3.13%, apparent rate of 50% and effective rate of 43.75% without any toxicity or side effect found. It can be concluded that Shenzhe Zhuyun Mixture is an effective and relatively ideal Chinese medicine product in treatment of esophageal affection caused by systemic scleroderma. 

Furthermore, in the study Mr.Guo Gang and et al created a sophisticated and distinct procedure of X-ray barium meal examination initiatively in China based on patients' clinical symptoms, dynamic changes and 100 normal people's emptying time of barium agent, which can provide objective indicators for clinical applications. Meanwhile, they determined the standard value of barium agent's emptying time of normal person who is in lying position. 

Therapy of scleroderma
Chinese Traditional Medicated Bath for Treatment of Systemic Scleroderma 
Medicated bath, as one of Chinese traditional external therapies, is known as soaking some parts of body in a tub full of warm water mixed with herbs for stimulation of skin, acupuncture points, channels and collaterals with water temperature as well as absorption of herbs through skins so as to achieve treatment of diseases and health preservation. Different from regular bath or hot spring bath, it is required to add different herbs into tubs based on different diseases under traditional Chinese medical principles of treatment determination on the basis of differentiating symptoms and signs. It is known as a "green therapy" in the medical field and welcomed by patients increasingly, for the effective elements of herbs are taken directly into the blood system through skin instead of going through and being digested by the stomach and intestine. It has such advantages as quick efficacy, comfortable, no toxicity or side effect and no additional burden to the liver. 
 Chinese medicated-bath therapies, with an over two-thousand-year history, were widely recorded by many famous Chinese ancient therapeutists. The medicated bathing therapy is further subdivided into partial medicated bath and whole-body medicated bath. The partial medicated bath is often used to foot and lower leg, for foot per traditional Chinese medical theory is an important part for qi and blood circulating, viscera interconnecting as well as channels and collaterals linking inside and outside, up and down where the three yin channels and three yang channels of the foot are interconnected. With reflecting regions in respect of internal organs and other parts, foot is composed of 52 pieces of bone and more than 60 muscles, known as "the second heart of human". As for lower leg, the horny layer is relatively thin, good for skin absorption of herbs. The whole-body medicated bath is to soak and steam all body but head and neck, suitable for patients suffering from extensive and general disease for larger active area and higher availability of medicine. 
”As the largest organ of body, skin has many functions as secretion, absorption, permeation, eccrisis and sensation besides resistance to exopathogens. The medicated bathing therapy is to treat diseases by making use of these physiological functions through local effect and entire action. The local action is taken by applying medicine directly on the body surface, muscle and joints so as to improve their metabolism, regain their functions and exert therapeutic effect concerning locations and causes. The entire treatment is to regulate the yin, yang, qi and blood as well as internal organs' functions by absorbing medicine into the blood system through skin. 

Scleroderma, whether localized scleroderm or systemic scleroderma, appears in forms of skin symptoms mainly. The typical skin symptoms can help for definite diagnosis. The medicated bathing therapy allows medicines to act directly on skin and joints, obviously effective in relieving skin swelling, sclerosis, atrophia, pigmentation, depigmentation, arthralgia, contracture and Reynauds syndrome as well as regularizing internal organs functions, which offers an evident efficacy in treatment of splanchnopathy caused by systemic scleroderma. 
Conclusively, the medicated bathing therapy can bring about the following effects by means of drug action, water temperature and magnetic treatment such as regulation of qi and blood, balancing yin and yang, dredging the channels, reaching the juncture between the muscle and the skin, expelling evil factors, normalizing function of the stomach and spleen, dispersing cold by warming the meridians, expelling wind evil and removing wetness evil, removing toxic heat, relieve the swelling, dispersing accumulation of pathogen, regulating the meridians and relieving pain, nourishing skin and promoting tissue regeneration as well as providing aesthetic health care. It is effective not only in treatment of stubborn rheumatism like scleroderma, polymyositis and rheumatic arthritis, but also in treating asomnia, constipation and fracture. Brought along a breakthrough in efficacy and good news to the sufferers, it is popular among patients. 

Chinese Herbal Steaming Therapy for Treatment of Scleroderma
As the largest organ of body, skin has many functions as secretion, absorption, permeation, eccrisis and sensation besides resistance to exopathogens. Chinese herbal steaming therapy is designed to exert drug effect by making use of these physiological functions, that is, to have medicine absorbed through the superficial layer of skin, permeated through the horny layer and transferred through the corium layer into the blood circulation system. The absorption and permeation of skin is dependant on the humidity of air, which can be enhanced by the medical steaming. To be specific, hot herbal steam may raise the skin temperature, induce skin capillaries to expand, promote blood and lymph circulation as well as metabolism and improve the nourishment of peripheral tissues. Meanwhile, the hot herbal steam may also have the pores open and sweat all over, forcing the pathogenic factors inside to be excreted to the outside of the body, which are helpful both in enhancing the body resistance and dissipating fatigue, bringing comfortable sense. On the other hand, the herbal steam may permeate acupuncture points and dredge the channels and collaterals while the steam are moving upwards, therefore, it can supplement qi, nourish the blood, regulate the balance of yin and yang and rectify immunity disorder. Natural herb is safe and environment-friendly in line with the trend that the development of drugs worldwide is turning direction from chemical compound medicine to natural officinal plants. 
Chinese herbal steaming therapy has a very extensive application scope. For treatment of rheumatism and immune diseases, it can regulate the condition of immunity disorder so as to remove the cause of diseases. For treatment of scleroderma and rheumatic arthritis, the herbal steam may act directly on the region affected, softening skin, improving skin metabolism, relieving arthrodynia, inhibiting contracture of joints and preventing disease from expansion to the internal organs. It is therefore known as "skin dealysis". For treatment of muscular atrophy caused by polymyositis or dermatomyositis, it can activate blood circulation, supplement qi, nourish the blood, tonify the kidney and bone, nourish skin, and promote tissue regeneration and growth of muscular cells. 

Thoracic Duct Drainage Surgery for Therapy of scleroderma 
In treatment of systemic scleroderma, thoracic duct drainage surgery is defined as to insert silicone tube into the cervical part of thoracic duct and have the far end of silicone tube led to a drainage bottle through subsurface of skin. 
Systemic scleroderma as a general desmosis, is widely believed this disease is an autoimmune disease caused by long-term chronic infection on a hereditary basis. A great variety of autoantibodies in the patients' sero are found. For the untreated patients of systemic scleroderma, the peripheral lymph counting is found normal or slightly decreased; however, a study of the subgroup found that the proportion of helper T lymphocytes (CD4) and B-cells increased while T suppressor cells (CD8) decreased, and the humoral immunity enhanced obviously. Especially, there are plenty of autoantibodies and immune complexes existing, and IgG is higher than the normal limit. 95% of the patients' thoracic duct lymph liquid is found T lymphocyte. In addition, there are plenty of autoantibodies, cell factors, inflammatory factors and immune complex found inside the patients' thoracic duct. After a thoracic duct surgery, the counting of autoantibodies and sensitized lymphocyte, especially memory cells, will decrease while the ratio of T4 to T8 will become lower. Along with the lose of B cell, many immature B cells will get into the circulation system to cause the counting of IgG, circulating immune complexes and receptors of interleukin-2 decreased significantly, which can inhibit the sthenic condition of humoral immunity and thus affect the immunity cause to systemic scleroderma. 
On the basis of thoracic duct drainage surgery, a thoracic duct drainage surgery combined with TCM three-phase softening therapy is developed. Traditional Chinese medicine has such functions as removing toxic heat, warming yang, dispelling pathogenic cold, promoting blood circulation, regulating the meridians, dissolving the stagnant and promoting the subsidence of swelling, which is helpful in inhibiting proliferation of fibrous tissue and damage to the organs by inflammatory cells, regulating the function of microcirculation, metabolism of muscle cells, protein and enzyme as well as physical and chemical properties of blood so as to improve patients' internal environment and retard the progress of disease towards internal organs from skin. Therefore, this combined therapy may soften the affected skin evidently, relieve pigmentation, Reynauds phenomenon, dysphagia, joint symptoms and limb ulcer, recover the affected internal organs gradually and improve the laboratory examination result so as to cure the disease eventually. 
The thoracic duct drainage surgery combined with TCM therapy is appraised by experts as the best solution currently in treatment of systemic scleroderma internationally, which established a new approach to curing systemic scleroderma. 

TCM Introduction Therapy for Treatment of Scleroderma
Two introduction therapies are often used, ionic introduction and ultrasonic introduction. 
The ionic introduction therapy is designed to extract the effective essential substances from herbs with advanced technology and prepare them into herbal liquid concentrate for ionic introduction, and then force the drug ions of the herbal liquid concentrate to make oriented movement into the depth of body surface with electrical pulses, so as to form a higher concentration locally; meanwhile, this therapy may also give electrical acupuncture to local non-fixed points for reducing swelling and easing pain. In addition, the heating function of this therapy plus herbal cushion may improve the local blood circulation. The clinical observation indicates that the ionic introduction therapy has little adverse reaction and quick efficacy in treatment of localized scleroderm, acidophily fascitis and scleredema. 
The ultrasonic introduction is a therapeutic method to force drugs into the body through skin or mucous membrane ultrasonically by adding drugs into couplant. It is known as ultrasonic drug penetration therapy, or ultrasonic penetration therapy for short. 
Ultrasonic waves may improve the permeability of cell membrane and expand local capillary, which is good for drug penetrated into patient's body; meanwhile, micro sound stream will be generated inside cells that can alter the cellular structure and improve cells' sensitiveness to drugs. The mechanical and thermal effect of ultrasonic wave may break the chemical bonds of macromolecules and help herbal macromolecules gather and enter the body. The ultrasonic introduction therapy is effective in relieving pain and itching, activating blood circulation, rebuilding the ecological balance of skin and resuming the micro physiological environment of skin. On the other hand, the percutaneous absorption of drugs is another way of systemic administration, which can regulate the immune system of skin and achieve the general therapeutic effect. 

Transplantation of Stem Cells for Treatment of Localized Scleroderm
The transplantation therapy of stem cells is to take a given amount of bone marrow from a patient in vivo, and then separate the stem cells in a laboratory to prepare them into autologous bone-marrow stem cells injection, and eventually inject back into the affected region of the patient. 
The transplantation therapy of autologous bone-marrow stem cells is able to treat localized scleroderm effectively due to the following reasons. Firstly, the bone marrow stem cells have function of differentiation, which means they can be differentiated into histiocytes needed by organism at the transplanted region so as to repair the damaged tissues. Secondly, the bone marrow stem cells may differentiate and proliferate at the transplanted region to generate active substances like enzymes and special peptides that can stimulate organismic tissues to grow so as to quicken tissue regeneration. Thirdly, the bone marrow stem cells are able to induce and enhance the tolerance of local immunity so as to inhibit further progress of localized scleroderm and skin lesion. Finally, the bone marrow stem cells may urge proliferation of local capillary, correct the undernutrition of the tissues around the region affected, which is favorable in restoring the pathogenic skin and subcutaneous tissues of scleroderma sufferers, thus to regain the normal function of skin. 
The transplantation therapy of autologous stem cells is suitable for the skin diseases dominated by atrophia because of stem cells' differentiation and proliferation, especially for atrophia limited in a small region. In addition, this therapy is worthwhile for treatment of macular atrophy, progressive idiopathic atrophoderma, facial hemiatrophy and atrophia of subcutaneous fat caused by local injection when other therapies show not good effects. Generally speaking, a course of treatment with this therapy is required to inject at the local region affected three or four times at interval of two or three weeks. The transplantation therapy of autologous stem cells is still a means of expectant treatment though it has certain efficacy, which however cannot terminate the recurrence and progress of disease by the root. A normal treatment combining TCM treatment with other supplementary treatments is still needed. 

"Tongluo Runfu Soothing Cream"--a TCM Compound Medical Ointment for Treatment of Scleroderma
Tongluo Runfu Soothing Cream is made up with pure herbs as per a prescription worked out on the basis of differentiation of symptoms and signs under the TCM principle that the therapy for internal disease can also be used in external treatment. It is produced with advanced pharmaceutical technology into compound medical ointment, which can be directly acted on skin and joints to rectify skin swelling, sclerosis, atrophia, pigmentation, depigmentation, arthrodynia, contracture and Reynauds syndrome. In clinical practice, this herbal compound medical ointment is proven easy for application and definite effect. 

Jiweiling Injection is one of the tenth five-year key projects planned by China government to be tackled. With efficiency of enhancing the body resistance, treating atrophy, nourishing skin, promoting tissue regeneration, supplementing qi and activating the channels, Jiweiling Injection is applicable for patients suffering from atrophoderma, muscular atrophy caused by scleroderma, hypofunction of internal organs in late stage and weakness. Based on the clinical efficacy obtained from more than 3,000 clinical cases, Jiweiling Injection is proven able to rectify the symptoms of muscular atrophy, regain skin elasticity, improve immunity and prevent the disease from affecting the internal organs. Jiweiling Injection is proven by animal experiments that it is able to promote regeneration of skin cells, improve the vitality of normal muscle and motor neuron cells, promote the proliferation of skin and muscular stem cells as well as hasten the differentiation of stem cells into skin and neurons；

6 Prevention and Recuperation
Advices from Doctors for Scleroderma Sufferers
I. Confidence and Determination is the Key.
The patients of scleroderma should be aware that this disease is NOT an incurable disease, no necessary to be pessimistic. Never give up the treatment though the illness is still progressive through certain treatment with some traditional Chinese medicines or western medicines. However, it should be recognized that scleroderma is one chronic and stubborn disease, which is not easy to cure. Therefore, every patient of scleroderma should have firm faith and strong determination to mobilize his or her potential resistance against the disease, and make every effort to be the winner in the battle.  
II. Long-term and Proper Treatment should be Persisted in.
Scleroderma is still a chronic and stubborn disease currently in the medical world, and so far there is no medicine or therapy able to cure it easily in a short term. It is the only way for best efficacy or even recovery to persist in long-term treatment and proper administration under the instructions of professional doctors who have abundant clinical experience and high sense of accountability. Keep the saying-- "Fool's haste is no speed" in mind. In comparison of such diseases with systemic lupus erythematosus and dermatomyositis, TCM therapy has more outstanding advantages in treatment of scleroderma; therefore, a comprehensive therapy dominated by TCM on the basis of combining Chinese medicine with western medicine together is the best solution to scleroderma at present. 
As the Chinese saying goes, "thirty percent medical care plus seventy percent daily nursing is the way to curing a chronic disease". It is quite evident that daily nursing is very important. A patient suffering from scleroderma should hold optimistic altitude and avoid mental stress or emotional fluctuation. Remember the rule--do what the strength allows in career pursuit and housework. Be sensitive in preventing overstrain, protecting oneself against cold and keeping warm. Stay away from catching cold, infection or any other diseases. Particular attention should be paid to protection of limbs and the protrudent parts of joint. Light diet is recommended, neither too hot nor too cold. Have many meals but little food at each. Chew long for one mouthful and swallow little each time. Smoking and drinking alcohol should be abandoned. Appropriate functional training with or without help is encouraged. Some supplementary treatment like massage, physical therapy or medicated bath is good if it is available. The medicines that are unfavorable for the treatment or the affected internal organ should be avoided. The supports from family and colleagues are all very important too. 

7.Typical Cases
A Typical Case of Esophagus Affection Caused by Scleroderma
Ms.Wang, 40, a patient of Scleroderma. Six years ago, she initiated such symptoms as swelling and stiffness with face, trunk and limbs. The color of both hands deepened and got pale or cyanosis at cold temperature. Then, both hand's skin became tight, stiff, bright and hard to pinch, plica vanished, painful joints with movement restricted or unmovable along with ulcer at fingertips and articular heads while the disease deteriorated. Especially in the recent four years, she developed such symptoms as heartburn, acid regurgitation, epigastric distention, belching and swallowing foods not smoothly, and even became aggravated progressively---from the condition that she had a hard time to eat dry foods initially to the condition later only able to have liquid diet. After meal, she felt foods retained behind her breastbone and backflowed frequently, even a bending posture would make her vomit of sour fluid. In the worst stage, she could only drink mild, and rice meal was a hard time for her. Along with reduced meal volume, her weight dropped gradually from the original 55kg down to less than 40kg. Hard to take care of herself, let alone working capacity. She saw many doctors and visited provincial hospitals and folk herbalists without any improvement before came to our department in September 2004. When diagnosing initially, she appeared obvious thin and suffering from anemia, tight and stiff skin all over, atrophia, restricted to open mouth or stick out of her tongue. The movement of joints at shoulders, elbows, wrists, knees, ankles and fingers were limited noticeably and some joints were stiff and unmovable. The contrast examination of upper digestive tract indicated stiff esophagus wall with obviously slack peristalsis. The transit time of barium meal was 58 seconds in standing position and there were still plenty of barium meals left in the esophagus after 10 minutes in lying position. The lower segment of esophagus was found narrow and some barium meal backflowed at the cardia. The laboratory report of blood routine examination indicated 80g/L of haemoglobin only. After comprehensive treatment for a period of time with Shenzhe Zhuyun Mixture, Yingpiling preparation and herbal medicinal broths as well as intravenous transfusion of Jiweiling Injection, supportive nourishment and Chinese traditional medicated bath, the patient’s condition showed improvement markedly. Specifically, the symptoms like acid regurgitation and heartburn started to relieve, foods swallowing smoother, increased appetite, better mind and strength, and wider range of motion after one week's hospitalization. And the condition improved further after one month's hospitalization--able to eat noodle and cake, obviously easy of acid regurgitation, heartburn and epigastric distention, looked not that pale as originally. Her weight increased to near 40kg, and she could basically to take care of her basic living activities. The laboratory examination indicated haematoglobin of 102g/L, the transit time of barium meal in standing position was 33 seconds and the narrow esophagus was improved too. So, she went out of hospital with prescribed administration of medicines. The telephone visit after three more months found the patient's condition was comparatively stable, no recurrence of original symptoms and her weight went up to 44kg with satisfactory efficacy. 

A Typical Case of Thoracic Duct Drainage Surgery in Treatment of Scleroderma
Ms. Liu, 47, was hospitalized for both hands' cyanosis for one year, stiff of skin all over for four months and dysphagia for one month. She was treated with hormone and immunosuppressor for one month and no improvement. Instead, the disease was deteriorated progressively and appeared such symptoms as dysphagia, palpitated after little movement, short breath, and general weakness, going upstairs and crouching with difficulty. For effective treatment, the patient came to our hospital. The following main symptoms were found at admission of our hospital: stiff skin all over, especially at both upper limbs, chest and belly, lift hands with difficulty, pigmentation, wrinkle on part of sweat glands and face vanished, swelling with both hands and upper limbs, restricted crouching movement, intolerance to cold and cold limbs, cough, spitting frequently out white phlegm, choking sensation in chest, short breath especially after body movement, difficulty in swallowing, acid regurgitation and heartburn occasionally; no sense of chilling or headache or dizziness, sleep alright, and normal in excretion. The physical checkup found T: 36.0℃, P: 100 C.P.M., R: 21 C.P.M., BP: 110/70 mmHg, and no abnormality with heart, lung and abdomen, Ⅲ grade of limbs' muscle strength. Laboratory examination indicated ESR 60 mm/h, CK 509.6U/L, CK-MB 50.5U/L, AST 41 U/L,LDH 240.4U/L. The electromyography reported original abnormality of muscle. She was diagnosed as suffering from systemic scleroderma and polymyositis. Based on the case history and symptoms above, the patient was considered in the swelling stage of the disease. Therefore, a comprehensive treatment combining thoracic duct drainage surgery with Chinese herbal medicine was prescribed. After 15 days' draining operation of liquid and TCM treatment for warming yang, activating the channels, supplementing qi and enriching the blood, the patient's skin condition got close to normal and no more choking sensation in chest, short breath, difficulty in swallowing, cough and expectoration. The muscle strength of limbs resumed to normal too. The laboratory examination showed that: ESR 24 mm/h, CK 180.6U/L, CK-MB 40.5U/L, AST 32 U/L and LDH 124.4U/L. 

Systemic scleroderma, as a general desmosis, is widely believed it is an autoimmune disease caused by long-term chronic infection on a hereditary basis. A great variety of autoantibodies in the patients' sero are found. For the untreated patients of systemic scleroderma, the peripheral lymph counting is found normal or slightly decreased; however, a study of the subgroup found that the proportion of helper T lymphocytes (CD4) and B-cells increased while T suppressor cells (CD8) decreased, and the humoral immunity enhanced obviously. Especially, there are plenty of autoantibodies and immune complexes existing, and IgG is higher than the normal limit. 95% of the patients' thoracic duct lymph liquid is found T lymphocyte. In addition, there are plenty of autoantibodies, cell factors, inflammatory factors and immune complex found inside the patients' thoracic duct. After a thoracic duct surgery, the counting of autoantibodies and sensitized lymphocyte, especially memory cells, will decrease while the ratio of T4 to T8 will become lower. Along with the lose of B cells, many immature B cells will get into the circulation system to cause the counting of IgG, circulating immune complexes and receptors of interleukin-2 decreased significantly, which can inhibit the sthenic condition of humoral immunity and affect the immunity cause to systemic scleroderma. Therefore, the patient's skin became soft obviously, the affected internal organs started to recover and the disease appeared a favorable turn. 
Thoracic duct drainage surgery is nothing but a treatment means. The patients who had the surgery still need a long-term nursing and treatment with Chinese herbal medicines before get rid of the disease thoroughly. 

A Typical Case of Shenzhe Zhuyun Mixture plus Yingpiling Capsule and Jiweiling Injection for Treatment of Scleroderma
Mr.Zhao, 53, from Hebei Province, was hospitalized and numbered as 9548 for sensation of tight, thick and stiff skin for four years along with difficulty in swallowing for two years. 
He was suffering from such symptoms as follows: skin stiff all over, especially with upper limbs, face, chest and belly, rhicnosis and lanugo vanished, skin too stiff to be pinched, pigmentation mixed with lose of pigment, hands paled or purpled at cold temperature or emotional change, dysphagia,  heartburn, vomiting of sour fluid, epigastric distemison and feeling uncomfortable(the above symptoms got worse at night), occasionally mental confusion, short breath, intolerance to cold and cold limbs, anorexia, pale tongue, thin and yellow tongue fur, deep and faint pulse. 　　　　
He was taking delta cortisone at dosage of 40mg/day before being hospitalized and diagnosed as systemic scleroderma along with digestive disease by western medical doctors and arthralgia syndrome plus blockage of the esophagus by TCM doctors. After the principles of treatment was worked out for his case to relieve the cold, disperse dampness, tonify the kidney, invigorate the spleen, nourish skin, activate the channels, regulate the function of the stomach and improve the digestion, he was prescribed to take medicinal broths one dose per day, Yingpiling No.2 and No.7, Shenzhe Zhuyun Mixture 20ml, 3 doses per day, Jiweiling Injection 24ml for intravenous transfusion at night, and decreased the dosage of delta cortisone gradually; meanwhile, he was advised to have many meals but little food at each, ate grease and pungent foods as little as possible, not to lie down right after each meal and keep stable emotion. He went out of hospital four months later with the dosage of delta cortisone decreased down to 5mg/day, general skin softened obviously, the elasticity and hardness of skin returned to normal, relieved pigmentation, recurrence frequency of Reynauds phenomenon with hands (becoming pale or cyanosis at cold temperature) reduced, better appetite noticeably, no more difficulty in swallowing but still heartburn occasionally, normal excretion and no more mental confusion or short breath after body movement. Therefore, he left hospital as clinical recovery and his condition stayed stable in the following two years. 

A Typical Case for Treatment of Adult Scleredema by Oral Adminstration of Chinese Herbal Medicines and Medicated Bath upon Differentiation of Symptoms and Signs

Ms.Ni, 43, Indonesian,  was hospitalized for skin swelling and stiff all over for eight years. 
The disease started with swelling skin at her nape eight years ago without any obvious cause and expanded to her upper limbs, face and chest, but no Raynauds phenomenon or pigmentation or lose of pigment. Without knowledge of diagnosis result and prescribed medicines at local hospitals, she suffered from markedly increased body weight, face swelling and stiff skin all over later. When hospitalized, she had such symptoms like swelling and stiff with the skin of her face, nape, both upper limbs and chest, skin hard to be pinched, no wrinkle on face, sweating, short and awkward fingers, no Raynauds phenomenon or pigmentation or lose of pigment, no choking sensation in chest or short breath, no cough or expectoration and no pharyngostenosis. 
Based on the above symptoms, medical history and physical signs, she was diagnosed as scleredema. After comprehensive treatment with Chinese herbal medicine to promote blood circulation and dispel blood stasis, Chinese herbal steaming therapy and medicated bath, the symptoms like swelling and stiff skin at posterior nape, movement range of upper limbs and swelling facial skin became rectified somewhat. 
Adult scleredema is often originated from diseases like deabetes or hyperthyreosis, with different medical history and varied symptoms, which needs a relatively long time to be cured. Generally speaking however, it is prognosticated better result if the patients are patient and active in cooperation of proper therapeutic medication. 
A Typical Case in Treatment of Acidophily Fascitis with Chinese Herbal Medicine Based on Differentiation of Symptoms and Signs

Mr.Lee, 57, was hospitalized for stiff and thick skin with limbs for two years. He found sclerosis of the skin on the sides of limbs without any obvious cause in 2002 and gave no enough attention. However, his skin in the affected area started to get darker color along with the stiff area enlarged. And then, the condition spread down to his lower limbs and appeared dark-color spots. He was diagnosed as acidophily fascitis in Beijing Xiehe Hospital and treated with Fu Su Pian but the condition aggravated instead of any improvement. He was diagnosed as localized scleroderm and acidophily fascitis by our hospital along with symptoms like stiff and dark colored skin and subcutaneous tissues with limbs, restricted movement of digital articulation joints, wrist joints and elbow joints, local skin becoming orange color when being touched, dark color and stiff skin with the thighs, and intolerance to cold and cold limbs. After six months' comprehensive treatment with Chinese herbal medicines to promote blood circulation and dispel blood stasis, soften and resolve hard masses, warm yang and supplement qi along with Chinese traditional medicated bath and steaming therapy, the patient got the subcutaneous tissues of limbs softened and close to normal condition obviously, malfunction of joints relived completely, skin color returned to normal and no more chilly sensation and cold limbs. 
Acidophily fascitis as an autoimmune disease, had no effective western medical therapy. But we adopt a therapy combining Chinese medicine with western medicine together for it, including partial medicated bath, general steaming treatment and ointment for exterior use, which achieved confirmed general efficacy. Some cases can even be relieved completely depending on different conditions. It must be recognized however that the patients have to be patient and persist in treatment, for this disease requires a longer course of treatment. 

A Typical Case of Treating Localized Scleroderm(sword-cut type) with Transplantation of Bone-marrow Stem Cell plus TCM upon Differentiation of Symptoms and Signs
Miss Ren, 18, was hospitalized for stiff skin and atrophia as well as dark color on her skullcap and around her right front forehead like a band for more than two years. She was diagnosed that her skullcap was pitted due to skin atrophy, about 3×3cm big and 1cm deep; her vertex on the right side appeared stiff and thick skin, pitted, atrophy and dark color, about 10×2.5cm big. The affected region extended down to the eyebrows, suffering from hypotrichosis and partial lose of right eyebrow, but no flush, itching, pain or high skin temperature. After being treated with Chinese herbal medicinal broths and Yingpiling No.2 as well as bone-marrow stem cell transplantation once every other week for three courses, her skin became plumper than before at the right front forehead and the hair of the right eyebrow grew more. 

A Typical Case in Treatment of Pulmonary Interstitial Fibrosis Caused by Systemic Scleroderma with Chinese Herbal Medicine Based on Differentiation of Symptoms and Signs

Ms. Wang, 57, came to our hospital for five years' stiff skin with her both hands and limbs and two years' asthma and dry cough after body movement. Symptoms included when being hospitalized: cyanosis of both hands at cold temperature, stiff skin with face and limbs, asthma after body movement, chest stuffiness, cough, little phlegm but sticky and hard to be expectorated, obvious Velcro rale with both lungs at middle and lower position, uniform heart rhythm at 90 C.P.M. along with systolic murmur at pulmonary artery. The CT examination of chest region indicated pulmonary interstitial fibrosis and color B-ultrosonic sound examination of heard indicated slight backflow at the pulmonary valve. The examination of pulmonary function indicated poor ventilation perfusion ratio and moderate diffusion disturbance. The routine blood test and the function test of liver and kidney indicated normal. Therefore, she was diagnosed as systemic scleroderma along with pulmonary interstitial fibrosis; meanwhile, as per TCM theory, she was diagnosed as arthraligia syndrome caused by deficiency of pulmonary and renal yin. After 40 days' treatment with Chinese herbal medicines to nourish kidney and strengthen lung, oral administration of No.3 Yingpiling, intravenous transfusion of Kalii Dehydrographolidi Succinatis(DAS) Injection Solution, Red Sange Root Injection Solution and Ligustrazine Injection Solution along with aerosol inhalation of TCM extracts, such symptoms as asthma and cough after body movement as well as cyanosis of both hands at cold temperature were eased obviously. CT check of chest region showed no obvious change while pulmonary function, vital capacity and forced expiratory volume per second were enhanced then before. 


A Typical Case of Treating Fingertip Ulcer Caused by Systemic Scleroderma with TCM Compound Medical Ointment
Ms.Jiang, 52, was hospitalized for suffering from stiff skin with limbs for six years and limb ulcer for two years. His symptoms were as follows when came to our hospital: stiff skin all over along with pigmentation, atrophy as well as pale skin and lose of pigments obviously, cyanosis of both hands at cold temperature, ulcer and pain with the finger joints, not smooth movement with hand joints. She was diagnosed as systemic scleroderma and treated with Chinese medicinal broths to warm yang and activate the channels, oral administration of No.9 Yingpiling, intravenous transfusion of Jiweiling Injection and Ligustrazine Injection plus Chinese herbal ointment applied to the ulcerous regions in addition to keeping the limbs warm. After one week's treatment, the sensation of pain in the ulcerous regions was relieved and dried obviously while granulation tissue could be seen growing. Twenty days later, the ulcer healed basically and the joints became smooth when moving than before. 

8.Contact Information
China National Key TCM Specialized Organization to Support, Postdoctoral Scientific Research Working Station, Provincial and Municipal Hospital for Insurance Medical Services, Hospital to Consumers' Satisfaction of Provincial Capital, Diseases Prevention and Health Education Base of Provincial Capital, Hospital Attached to Hebei Medical University, a modern and comprehensive specialized hospital.