When the Back Stiffens: Managing Ankylosing Spondylitis with Korean Medicine

If the morning back stiffness and pain described earlier persist for more than three months, and particularly if they improve with movement but worsen with rest, inflammatory low back pain such as ankylosing spondylitis may be suspected. Ankylosing spondylitis is a chronic inflammatory autoimmune disease that affects the spine and sacroiliac joints, which connect the pelvis and the spine. It predominantly occurs in young men, but it can also develop in women. This disease occurs when the immune system mistakenly attacks its own joints and ligaments, creating inflammation. Inflammation particularly tends to develop at the enthesis, the site where ligaments around the spine attach to bone. As this inflammation recurs, surrounding bone is damaged, and the body begins to generate new bone to heal the injured area. If this process continues, the spinal segments gradually fuse together, leading to the bamboo spine phenomenon where they join into a single structure like a bamboo stalk. Ultimately, the flexibility of the spine is lost and movement is restricted, which can greatly reduce quality of life. Modern medicine considers the genetic factor HLA-B27 gene to be deeply involved in the onset of ankylosing spondylitis, and uses nonsteroidal anti-inflammatory drugs or biologic agents to control inflammation and slow disease progression. The concept in Donguibogam that wind, cold, and dampness block the circulation of qi and blood to cause stiffness can be interpreted in modern medicine as microcirculatory disorders, tissue edema, and the accumulation of algogens caused by inflammation. Furthermore, replenishing the energy of the kidney corresponds to strengthening immunity and overall physical function, thereby enhancing the body's resilience against inflammatory reactions. It is important to take an integrative approach that focuses on whole-body balance and regulation of the immune system, rather than merely suppressing pain.