Summary of case history,　Patient Su XXXX, female, 58 years old. In 2007, she developed bilateral elbow and knee pain and stiffness without any obvious inducement. The symptoms gradually spread to the ankles and toe joints, accompanied by morning stiffness. She bought some unknown herbs and pills for internal use to relieve the symptoms, which presented in intervals but were not diagnosed or treated in a standardized way. In March 2011, she developed scattered red patches on both lower limbs, with burning sensation, pain, and itching. The patches gradually merged into each other and caused local soft tissue swelling. A blood test in a local hospital showed: WBC 7.0×10,9,/L, HGB 105g/L, PLT 368×10,9,/L; RF: 29.90 IU/ml; ESR: 80mm/h; CRP: 43.04 mg/L; ANA(-); X-ray suggested rheumatoid arthritis; left foot MRI suggested synovitis lesions. She was diagnosed with rheumatoid arthritis. She was prescribed Chinese medicine for internal use, together with Meloxicam for anti-inflammation and relieve pain, prednisone tablets 5mg/day, sulfasalazine tablets 1g/day, hydroxychloroquine tablets 0.4g/day for immuno-suppression, which helped alleviate the joint pain and redness. In July 2011, the red patches developed into skin ulcerations at the affected sites, accompanied by unbearable local pain and burning sensation in the bilateral calves and ankles. She was readmitted to the local hospital for treatment of wound dressing changes and continued use of the aforementioned western medicine, but the condition still relapsed. In November 2011, methotrexate tablets 10 mg/week were added to her treatment. However, in January 2012, her symptoms still did not improve. She still suffered from joint swelling and pain, especially in her knees. Her bilateral calves and feet presented with ulcerations, edema, and burning sensation at night. She could not walk due to severe pain.In January 29th, 2012, she came to our department for inpatient treatment. Physical examination revealed bilateral knee and ankle joint swelling and pain with limited activity due to stiffness. Her bilateral calves and foot back had multiple ulcerations with significant yellow exudation. Laboratory examination showed: ANCA negative; ENA negative; ANA 1:320; lower limb artery Doppler ultrasound showed no significant abnormality in both lower limb arteries and deep veins.,TCM diagnosis,　Wang-Bi (deficiency of qi and blood with damp-heat accumulation).,Western medicine diagnosis,　1. Rheumatoid arthritis, rheumatoid arthritis secondary vasculitis; 2. bilateral knee osteoarthritis; 3. severe osteoporosis; 4. mild anemia.,Therapeutic methods,　Stop using hormones and immunosuppressants, give Chinese medicine for internal and external use, combined with Zhuang medicine bamboo cupping therapy and Zhuang medicine bloodletting therapy and other treatments.,Clinical outcomes,　After treatment for 1 month, all symptoms were relieved; after taking the medicine for 3 months, the swelling and pain were relieved, ulcer surface healing scab; ulcer scab fell off and skin color was basically normal after 2 years. Follow-up until September 2023 without recurrence.