Articles

Arthritis, Rheumatoid

Related Health Condition

Not available

Arthritis, Rheumatoid

Introduction

Rheumatoid arthritis (RA) is an autoimmune disease characterized by joint synovitis. (1) In traditional Chinese medicine (TCM), it falls into the category "bi (arthralgia) syndrome," similar to "lijie disease" or "baihu lijie" (severe and migratory arthralgia) and "obstinate bi".

Etiology/Pathogenesis

By the time a disease has become a chronic condition, one of the theories of TCM holds, the pathologic factors often would have invaded the collaterals of the meridian system. In accordance with this theory, Gao, et al. argues that the basic pathological changes of RA are "stagnation" or "accumulation" [of qi, blood or phlegm, etc.], and its basic pathogenesis is "blockage." The disease can be either a cold or heat syndrome, either a deficiency or excess syndrome. (2)

Wang, meanwhile, argues that this disease is closely related to factors such as family history, cold-damp, trauma, the common cold, infection, overstrain, etc. To the extent that the disease is the result of a weak constitution being attacked by wind-cold and pathogenic-dampness, it is attributable to a congenital defect in physique. (3)

Primary Treatments with Chinese Medicinal Herbs

Wang Bi Granules

Ingredients Xu Duan (Dipsacus), Cang Zhu (Atractylodes), Bu Gu Zhi (Psoralea), Fu Pian (Zhi) (processed Aconite), Shu Di Huang (processed Rehmannia), Yin Yang Huo (Epimedium), Gu Shui Bu (Drynaria), Gui Zhi (Cinnamon Twigs), Du Huo (Pubescent Angelica Root), Niu Xi (Achyranthes), Chi Bai Shao (Red and White Peony), Wei Ling Xian (Clematis), Fang Feng (Siler), Zhi Mu (Anemarrhena), Shen Jing Cao (Buck Grass), Ma Huang (Ma-Huang), Song Jie (Nodular Branch of Pine), Chuan Shan Jia (Zhi) (Anteater Scales)

Clinical Application:
The formula is used to treat rheumatoid arthritis, rheumatic arthritis, tetanic arthritis, osseous arthritis, and osteoporosis.

Shu treated 105 cases of gouty arthritis with this formula, and reported satisfactory therapeutic effect. (4) In addition, data collected on 332 cases of arthritis treated with this formula shows a total effective rate of 70.8%. Clinical observation in 37 medical units in China showed the total effective rate of 70.8%. And, according to a pamphlet put out by the manufacturer of this formula, it is also suitable for treating osteoarthrosis deformans endemica, tuberculous arthritis, and bone fluorosis. (5)

Other Treatments with Chinese Medicinal Herbs

In General

In treating rheumatoid arthritis, traditional Chinese medicine stresses holism and differentiation of syndromes. Following this approach, TCM has been relatively successful in relieving joint pain, promoting recovery of joint functions, and ameliorating various clinical indicators.

Fengshi Ning and Wangbi

Zhao, et al. compared the effect of treating rheumatoid arthritis with two herbal formulas. Out of a total of 120 patients treated with Fengshi Ning, 10 patients fully recovered, 53 significantly improved, 46 improved, and 11 showed no response, giving a total effective rate of 90.8%. In comparison, out of a total of 30 patients treated with Wangbi decoction, 2 fully recovered, 5 significantly improved, 20 improved, and 8 with no response, tallying up a total effective rate of 77.1%. The difference between the two treatments was considered significant (P

Zheng Qing Feng Tong Ning

Hu, et al. compared the effects of treating RA with a Chinese herbal formula and with a Western medication. One unit of treatment was one month for both regimes, and all patients received two units of treatment. Out of a total of 428 cases treated with Zheng Qing Feng Tong Ning (enteric tablets taken after meals, 40mg/day, 3 times a day), 86 patients considered their condition to be under control, 179 patients significantly improved, 141 patients improved, and 22 patients with no response. Out of a total of 145 patients treated with ibuprofen, the corresponding numbers were 12, 179, 73, and 12. The difference between the two treatments was significant (P

Shu Guan Wen Jing and Shu Guan Qing Luo

Two TCM principles in treating rheumatoid arthritis are: invigorating the kidney to promote blood circulation, and removing phlegm to rid blood stasis. Observing these principles, Zhou, et al. formulated two formulas of their own for treating rheumatoid arthritis. One of the formulas, Shu Guan Wen Jing decoction, was designed to have a meridian-warming effect. The other, Shu Guan Qing Luo decoction, was intended to have a collateral-dredging function. The two formulas were tried out on 44 and 43, respectively, mid to late-term rheumatoid arthritis patients, with a comparison group treated with Wangbi decoction. The results: Shu Guan Wen Jing decoction was effective in 88.6% of the cases treated, Shu Guan Qing Luo decoction was effective in 93.0% of the cases, as compared to that Wangbi decoction was effective in 73.2% of the cases. Furthermore, experiments on rats found that both Shu Guan Wen Jing decoction and Shu Guan Qing Luo decoction were effective in raising the serum SOD level, lowering the content of interleukin-I, plasma prostaglandin E2, and thromboxane B2 (P

Other Treatments

Zhu, et al. experimented on treating RA with a combination of herbs and physical exercise. A total of 100 patients were randomly divided into three groups to receive three different regimes of treatment. Group A, with 32 patients, received treatment with Leigongteng (Tripterygium wilfordii) multi-glycoside (20mg each time, three times a day). Group B, with 33 patients, was administered every day one dose of San Bi Tang, a herb formula made from Dang Shen (Codonopsis), Huang Qi (Astragalus Root), Fu Ling (Hoelen), Xu Duan (Dipsacus), Du Zhong (Eucommia), Niu Xi (Achyranthes), Fang Feng (Siler), Du Huo (Pubescent Angelica Root), Dang Gui (Dang Gui), Bai Shao (White Peoney), Qin Jiao (Gentian Root), Sheng Di (Rehmannia Root), Gui Zhi (Cinnamon Twig), Chuan Xiong (Cnidium), Gan Cao (Licorice), and Xi Xin (Wild Ginger). Group C, with 35 patients, received the same treatment as Group B plus a physical exercise regimen consisting of one hour of exercise in the morning (e.g., walking, running, or practicing Taichi) and 15 minutes of massage performed on the affected joints in the evening; after the affected joints had warmed up with the massage, the warm residue from the herb formula was applied to them for 15 minutes. One unit of treatment was two months for all three treatment regimes. The results: the total effective rates for Group A, B, and C were 84.4%, 78.8%, and 94.3%, respectively. (6)

Wang, et al. treated 68 cases of RA with Tuina in combination with an external application of Chinese herbs. The Chinese herbs used were Ma Qian Zi (Poison Nut), Sheng Jiang (Ginger), Rou Gui (Cinnamon Bark), Da Huang (Rhubarb), Zhi Zi (Gargenia), Xi Xin (Wild Ginger), Sheng Cao Wu (Wild Aconite Root), and Chuan Wu (Sichuan Aconite Root). These herbs were wrapped in gauze and decocted in water. Patients with affected finger joints were instructed to immerse their hands in the decoction for 10 minutes after it had cooled down to 50-60 degrees Celsius (122-140 degrees Fahrenheit). Patients with other affected areas applied the wrapped herbs to the local areas by the hot compress method. After the local areas had warmed up enough to turn reddish, various Tuina manipulations, including palm-rubbing, rotatory kneading, push-rubbing, foulaging, and holding-and-twisting were performed on them for 10-15 minutes. These treatment sessions were conducted once every other day, and ten sessions constituted one unit of treatment. The results: out of a total of 68 cases treated, 3 cases recovered, 26 cases significantly improved, 34 cases improved, and 5 cases with no response; the total effective rate was 92.2%. (7)

Patients of rheumatoid arthritis in general, and those of late-stage rheumatoid arthritis in particular, often have had osteoporosis and bone deformity. Therefore, the key to treating rheumatoid arthritis is to regulate the body's immune function, and to put the internal organs' intrinsic compensatory mechanism to work. TCM's advantages in treating RA lie in its efficacy, safety and ability to adjust bodily functions in both directions. Through treatment with Chinese herb medicine, it is possible to postpone and even stop the deterioration of rheumatoid arthritis, thus improving the quality of life of RA patients.

Acupunture & Acupressure

Acupuncture and Moxibustion Therapy
Shi compared the effects of treating rheumatoid arthritis with acupuncture alone and with a combination of acupuncture and moxibustion. The acupuncture-only treatment treated 20 patients at Guan Yuan (RN 4) with acupuncture alone, while the combination treatment treated 30 patients at the same acupoint with both acupuncture and moxibustion. The moxibustion treatment was administered twice daily, each session lasting 2 hours. One unit of treatment was five days for both treatments. The results: of the combination treatment group, 10 patients significantly improved, 15 patients improved, 5 patients with no response, with a total effective rate of 83%; of the acupuncture-only group, 5 patients significantly improved, 10 patients improved, and 5 patients with no response, with a total effective rate of 75%. (8)

Wang, et al. compared the effects of treating rheumatoid arthritis with indirect moxibustion and with oral administration of penicillamine. Finding that the two treatments had similar percentages of patients responding in similar fashions (while the indirect moxibustion treatment was effective in 90.48% of the cases treated, and significantly effective in 39.68% of the cases, the corresponding percentages for the penicillamine treatment were 80% and 32%), the authors concluded that the two treatments were similar to each other and both could be regarded as effective treatments. (9)

Xu, et al. used "midnight-noon ebb-flow bee-sting acupoint therapy" to treat 86 cases of rheumatosis and RA. The results: 7 cases (8.14%) fully recovered and 78 cases (90.7%) improved. The total effective rate was 98.84%. The authors believe that this therapy can lower blood sedimentation, render tests of antistreptolysin O and rheumatoid arthritis factors negative, and therefore improve the biochemical environment of the human body. (10)

Liang treated 30 cases of RA patients with acupuncture and moxibustion during the three hottest ten-day periods of the year. All patients received treatment at acupoints Fenchi (GB 20), Taiyang (EX-HN 5), Taixi (KI 3), Fengshi (GB 31), Quchi (LI 11), and Hegu (LI 4). In addition, patients with elbow joint pain also received treatment at Waiguan (SJ 5), Yanggu (SI 5), and Yangchi (SJ 4); patients with knee joint pain were also treated at Xuehai (SP 10), Yanglingquan (SP 9), Lianqiu (ST 34), and Zusanli (ST 36); those with ankle joint pain were treated at Jiexi (ST 41), Qiuxu (GB 40), Kunlun (BL 60), and Shangqiu (SP 5); patients with joint pain in the little fingers were treated with penetration needles from Neiguan (PC 6) to Waiguan (SJ 5), and from Hegu (LI 4) to Houxi (SI 3); and patients with toe joint pain were treated with penetration needles from Sanyinjiao (SP 6) to Xuanzhong (GB 39) or Bafeng (EX-LE 10). After insertion and a needling sensation was achieved, the needle was retained, and a segment of moxa stick was attached to the filiform needle handle and ignited for moxibustion. The results: after receiving the treatment for 1-3 seasons, out of a total of 30 patients, 20 fully recovered, 8 significantly improved, and 2 with no response. The treatment was considered effective in patients without joint deformity. (11)

Li treated 35 cases of RA with thermal needling therapy. RA patients are known to have experienced pathological changes to their blood rheology, and SOD and LPO levels. The author found that the treatment was conducive to remedying those changes. (12)

References

  1. Chen Ji Fan, et al. Journal of New TCM. 1997;29(9):13.
  2. Gao Wen You, et al. Journal of Shaanxi Correspondence School of TCM. 1996;(4):19-20.
  3. Wang Ming Zhong. Journal of New TCM. 1989;21(9):10-11.
  4. Xu Yong San, et al. AnHui Journal of Clinical Application of TCM. 1997;8(6).
  5. Benxi No. 3 Pharmaceutical Co. Liaoning, China. Pamphlet of Wang Bi Granules.
  6. Zhu Jian Hong, et al. Journal of Tiajing College of TCM. 1999;19(10):588.
  7. Wang De Yu, et al. Hunan Journal of TCM. 1999;15(5):33.
  8. Shi Jing. Shanghai Journal of Acupuncture. 1999;18(6):13.
  9. Wang Wei Ming, et al. Shanghai Journal of Acupuncture. 1999;18(6):5-7.
  10. Xu Jie, et al. Shanghai Journal of Acupuncture. 1999;20(6):10-12.
  11. Liang Yong Hua. Yunnan Journal of TCM and Chinese Drug. 1999;19(9):544.
  12. Li Ling. China Journal of Acupuncture. 1999;18(3):31-32.