Arthritic Diseases –Rheumatoid Arthritis

Rheumatoid Arthritis falls into the category known in Chinese medicine as Painful Obstruction Syndrome or Bi Syndrome. Symptoms of rheumatoid arthritis include soreness, pain, numbness and a heavy sensation of the limbs and joints, with limitation of joint movement. Distinguishing rheumatoid arthritis from osteoarthritis is the presence of heat and inflammation at the joints, as well as a generalized immune system reaction evidenced throughout the body by fever, weight loss, and feelings of weakness and low energy. Chinese medicine sees these symptoms as arising from a combined invasion of four pathogens: wind, cold, damp, and heat, with heat predominating. There are many different types of Bi syndrome, and they are named for their most prominent feature. Two types are particularly important in describing rheumatoid arthritis:

  • heat bi – has the predominant symptom of heat, shown by such things as redness, swelling and warmth at the joints, and more generalized symptoms as fever and weight loss. These illustrate that this is a systemic inflammatory condition, describing such varying conditions as rheumatic fever, rheumatic arthritis, rheumatoid arthritis, fibrositis, neuralgia, and gout.

  • bone bi – has the predominant symptom of joint swelling and deformity. This arises from a chronic type of phlegm obstructing the joints. It may arise over time from any type of bi syndrome, but is particularly severe in rheumatoid arthritis. It shows that an interior condition has developed, that the disease is no longer affecting only the surface of the body.

Wind, cold, and damp are the underlying pathogens found in all forms of Bi syndrome, including Heat Bi. These pathogens combine with heat in differing ways, in part depending on the constitutional tendencies of the person affected, to produce different symptom pictures. Examples are wandering bi (wind), in which the pain moves around like a wind blowing through the body, and fixed bi (damp), in which the pain is sticky and heavy and unmoving. Several other types of bi are described historically by reference to the specific tissue location of the pain. These are skin bi, muscle bi, tendon bi, blood vessel bi, and finally heart bi (a serious condition in which inflammation has affected the heart tissue). Symptoms for patients with rheumatoid arthritis may change over time as the four primary pathogens vary in relative strength and as different tissues are affected; inflammation of skin, muscle, and tendons around the joints is a prominent feature of rheumatoid arthritis.

A third category of arthritis, which should be noted, is infectious arthritis such as that from Lyme disease or gonorrhea. In the case of infectious arthritis, appropriate laboratory testing and physical evaluation are necessary to determine appropriate treatment; antibiotic therapy is strongly recommended. Acupuncture and herbal therapy are seen as a complementary therapy in this case, helpful in remedying damage done by the infection and restoring full function to the body.

Painful obstruction syndrome results from obstruction of qi and blood in the meridians and collaterals. The meridians and collaterals are pathways of energy, fluid, and nourishment that run to every part of the body.

They form a network of channels that cover the skin and distribute blood and energy to all superficial areas, like a net enclosing the body. Good circulation of energy and fluid is vital for health. When the body is invaded by wind, cold and damp the channels can become blocked. Severe blockage or stagnation over time produces heat. It is at important points along the meridians and collaterals that acupuncture needles are inserted to clear pathogens, release blockage and strengthen energy. If the blockage is not cleared, it invades inwardly, affecting the internal organs, producing:

  • stasis of blood – which results in increased pain.

  • deficiency of the liver – which results in aches and stiffness throughout the body. The liver blood is responsible for nourishing the sinews.

  • deficiency of the kidneys – which results in deformity and swelling in arthritic cases. The kidneys are responsible for nourishing the bones, and it is kidney fire that steams the body fluids to produce synovial fluid for the joints.

Severe long-term bi may produce atrophy or wasting syndrome, in which the muscle and tissue of a limb wastes away. In rheumatoid arthritis, this is seen as a result of heat burning off the cool, nourishing yin fluids of the liver and kidney.

The invasion of pathogenic wind, cold, and damp is possible due to a relative deficiency of defensive qi and of blood. It is important to note that this is a relative deficiency. If the pathogenic factors are very strong, they may successfully attack an otherwise healthy person. In addition, one may have a constitutional, or inherited, tendency towards heat and stagnation. Several factors may contribute to the severity of symptoms. These include excessive use of the joints, excess body weight, repetitive motion, and traumatic injury. This last category includes accidents that may have occurred in the past and which the patient may have forgotten. Emotional factors play a role as well. Prolonged and excessive anger and resentment block energy flow and can encourage blockage of the channels; prolonged and excessive sadness and grief deplete the qi and blood, leaving the body more vulnerable to disease. Some practitioners of Chinese medicine believe that the inflammation typical in rheumatoid arthritis is a symptom of internalized and unexpressed anger; a patient may have difficulty facing feelings of aggression, or feel trapped in a close relationship.

Because rheumatoid arthritis may have serious health consequences, long-term treatment to control symptoms and reduce disease progression is strongly recommended. Treatment for rheumatoid arthritis focuses on clearing heat and toxin, and removing wind, cold and damp, while tonifying the organ systems, especially the Kidneys and Liver. Regulation of the immune system, to prevent an excessive response and reduce inflammation, is important as well. Acupuncture and herbs can have a strong effect in regulating and strengthening the immune response. Acupuncture around the affected joints can be extremely effective in relieving pain and increasing mobility. Tapping around the joints with a seven-star needle, which gently pricks the skin, followed by cupping to induce expression of a few drops of blood is often helpful in clearing heat and reducing pain. In addition, points are used to strengthen the blood and energy of all the organs to prevent the disease from progressing inwards. Moxa, which is the gentle application of heat by burning a special herbal product, is not to be used in heat conditions. Herbal treatments include the use of specific herbs that affect the extremities such as ren dong teng, or honeysuckle vine, and herbs that increase circulation such as ru xiang, or frankincense. Medicinal wines used in cases of osteoarthritis for reducing pain and strengthening bones, such as Wu Jia Pi wine, may be too warming for a heat condition like rheumatoid arthritis. Walking, cycling, and swimming are helpful in relieving symptoms, while jogging, weights, and aerobics often prove too stressful upon the joints and may increase symptoms. Patients should avoid dairy and greasy foods that may cause more damp to accumulate. Sour foods may bother the Liver and increase tightness of the sinews; these include yogurt, oranges, and pickles. Irritating or allergy-inducing foods should also be avoided; spinach and shellfish are common examples.