Q What is the sequence of treatment when a patient visits a Korean medicine clinic for the first time for ankylosing spondylitis?
A During the first visit, we assess the patient's medical history, imaging results, and current medications, followed by a differential diagnosis. Subsequently, we begin acupuncture and moxibustion treatments to alleviate acute pain and stiffness. After 2 to 3 weeks, we evaluate the response to determine whether to add treatments such as fire acupuncture, thread embedding, or pharmacopuncture. The herbal medicine prescription is finalized based on symptom patterns observed during the initial 2 to 4 weeks, and exercise and dietary guidelines are also provided.
Detailed Answer
Evaluation items during the first visit for ankylosing spondylitis: ① BASDAI/VAS pain scores, ② Spinal movement test (BASMI), ③ Imaging findings (sacroiliac joint classification, presence of new bone formation), ④ Blood tests (CRP, ESR, HLA-B27), ⑤ List of medications. Based on this, we establish treatment priorities and goals, and create a personalized treatment plan. At this stage, we also summarize the points of synergy with Western medical treatments.
Korean Medicine Clinic Perspective
At Dongjedang, during the initial consultation, we assess the patient's overall Qi and blood status through four diagnostic methods: observing, listening, asking, and taking the pulse. For patients with ankylosing spondylitis, we specifically check the pulse to determine the depth of kidney energy deficiency and imbalances in cold and hot energies, while examining the condition of the tongue to assess the degree of accumulated waste. The diagnostic results regarding these symptoms serve as the starting point for selecting external acupuncture sites and prescribing internal treatments. We explain the process as a step-by-step flow where the first four weeks prioritize the alleviation of inflammatory pain and the circulation of Qi and blood in the spine, after which the goals shift to constitutional improvement and prevention of recurrence.
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