• If arthritis is due to Vata, your joints will crack and pop. They become dry and are not swollen as they may be if excess Vata is not the cause. The joints may also feel cold to the touch. They are painful mostly upon movement, and there is usually one particular tender spot. jogging, jumping, trampolining, or any strenuous exercise tends to aggravate the pain.
• Application of a cooling substance, such as Sandalwood powder paste (Chandana Lepa), is soothing. Make the paste by taking 1 teaspoon of Sandalwood powder and adding sufficient water to make a paste. Rub it gently onto the joint.
• Helpful Yoga postures (asanas) include the Boat Pose, Bow Pose, Camel Pose, Cow Pose, and Locust Pose, as well as the series of postures known as the Moon Salutation. (See appendix 4 for illustrations of Yoga postures (asanas).)
• You can also perform Shitali pranayama, as follows: Make a tube of your tongue. breathe deeply through your mouth down into your belly. Hold the breath for a few seconds, then exhale through your nose. Do about 12 repetitions. (See illustration in chapter 6.)
• When there is an effusion (when the joint fills with fluid), you can make an effective paste (lepa) of equal amounts of Punarnava powder and Ginger powder. Mix 1 teaspoon of each with enough warm water to form a paste, and apply.
• Yoga postures (asanas) that are helpful for Kapha Arthritis include the Tree Pose, Triangle Pose, Forward Bend Pose, and Spinal Twist. (illustrations of Yoga postures (asanas) appear in appendix 4.)
In addition to the Vata-Pitta-Kapha method of classifying arthritis, this condition can also be classified as either rheumatoid arthritis or osteoarthritis. If you are sure which condition you have, the following guidelines will add more specificity to your treatment.
• You can also drink 1 cup of Ginger tea with 2 teaspoons of Castor oil added. Castor oil contains natural precursors of steroids, which help to heal the inflammatory condition of rheumatoid arthritis. Take this tea before going to bed. Expect some laxative effect from the Castor oil.
For osteoarthritis: Take 1 tablet of Yogaraj Guggulu twice a day. At night, take one half teaspoon Gandharva Haritaki (Haritaki sauteed in Castor oil) with warm water. If you don't have Gandharva Haritaki, use Ginger tea with Castor oil, as described above.
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There is perhaps no disease that is as close to the human condition as arthritis, or joint pain. It is among the earliest diseases described in the ancient medical literature, and is clearly found throughout the anthropological record, such as in bone and fossil remains. Researchers from many fields tell us that it is a disease we share with a great many animals, including our fellow mammals, as well as birds, reptiles and fish. For all of us, the sad commonality is that it is apparently inevitable: a simple process of wear and tear to joints over a lifetime of use. Interestingly enough, some mammals that hang upside down such as bats and sloths don’t seem to experience this kind of joint damage, although mammals supported by water such as whales do (Berkow 1992). In yogic tradition this might be seen as evidence that inverse postures (asanas) such as headstands promote the proper flow of energy that overcomes stagnant energy… in the philosophical tradition of ancient India this is represented by Bodhi, or Enlightenment tree, which as it grows sends its branches back down into the earth…
Broken down, busted up and good ol’ fashioned deee-generating joint problems got a high falootin’ name in western medicine: osteoarthritis (OA). It nonetheless has a precise definition, to differentiate it from the other forms of arthritis such as the rheumatoid, gouty, or bacterial arthritides (plural of arthritis). OA is characterized as a mild inflammatory joint disease with a gradual loss of articular cartilage and the subsequent hypertrophy of bone producing osteophytes. Its prevalence increases with age, as does its severity, with a usual onset of it more symptomatic forms in the fourth to fifth decades of life (or usually earlier with sports injuries). Men typically have an earlier onset than women, but women get it at an increasing frequency with age. (Berkow 1992; Rubin and Farber 1990, 723)
OA is classified as either primary (idiopathic) or secondary to some identifiable cause. Primary OA involves the distal and proximal interphalangeal joints, the first carpometacarpal joint, the intervertebral disks and zygapophyseal joints in the cervical and lumbar vertebrae, the first metatarsophalangeal joint, the hip, and knee. Secondary OA may present as above, but has a known underlying cause, including congenital joint abnormalities, genetic defects, crystal deposits, infection, metabolic diseases, endocrinopathies, inflammatory disease (e.g. RA, gout), and trauma from fracture or simple “wear and tear.” (Berkow 1992; Rubin and Farber 1990, 723)
Joints are an amazing feature of anatomical mechanics. Cartilage is a spongy, dense tissue covering the articular surfaces of bones, comprised mostly of extracellular matrix managed by a small number of very long-lived chondrocytes. This spongy surface is bathed in an extremely slippery synovial fluid filled with nutrients to feed the chrondrocytes and support cartilage health. Surrounding the synovium is a series of tough fibrous tissues and muscles to unite the joint, and maintain stability. As the cartilage is compressed with movement, fluid is pumped out of it and into the joint space. In essence, this action squeezes the wastes from out of the spongy cartilage, to be absorbed by the capillaries and then venules of the muscosa. As the cartilage is released the cartilage expands, swelling back up with nutrient-rich, slippery synovial fluid. As a result, normal joint movement is essential to joint health, and because joints have a very coefficient of friction, they should maintain themselves almost indefinitely with normal activity. The primary pitfall with cartilage is that it is an avascular tissue, as well as both aneural and alymphatic: or in other words, a part of the body that we have an inherent capacity to take for granted (aneural), but can take a very long time heal (avascular, alymphatic). (Berkow 1992; Rubin and Farber 1990, 723)
The earliest changes of osteoarthritis are the loss of proteoglycans and type II collagen, which is the principal structural elements of cartilage, from the surface of the articular cartilage, followed by the death of the chondrocytes. This process may take several years. Overtime, the articular surface develops microfractures, and the synovial fluid works its way down into these fissures, extending the cracks deeper. Neovascularization from the epiphysis and subchondral bone extends into the areas of the fissures, inducing subchondral osteoclastic bone resorption. Adjacent osteoblastic activity occurs simultaneously, resulting in a thickening of the subchondral bone plate in the area of the crack. Fibrocartilage plugs then form as a substitute for the articular cartilage, and the subchondral bone becomes exposed as it grinds against the opposite joint surface, which is usually undergoing a similar process. These thick, shiny smooth areas or subchondral bone are described as eburnated, or “ivory-like.” This eburnated bone then cracks, allowing synovial fluid to extend into the subchondral bone marrow, leading to a subchondral bone cyst. An osteophyte or bone spur then develops, consisting of bone and a mixture of connective tissues with a coating of fibrocartilage and sometimes islands of hyaline cartilage within the osteophyte. The degree of formation of these spurs varies among the joints, in proportion to the underlying cause. Finally, bony cysts (pseudocysts) form in the marrow below the subchondral bone, resulting from extrusion of joint fluid through the hyaline cartilage into the marrow, with a fibroblastic and osteoblastic cellular reaction. The gross pathology includes a roughening, pitting, and irregularity of the hyaline cartilage surface, proceeding to gross ulceration with focal and then diffuse areas of complete loss of cartilage, leaving only eburnated bony surfaces. By the time symptoms appear, synovial proliferation and some mild synovitis are virtually always present. (Berkow 1992; Rubin and Farber 1990, 723)
The signs and symptoms of OA are insidious and gradual, usually involving one or only a few joints. Pain with movement and morning stiffness are among the earliest symptoms of OA. As the condition progresses joint movement is impaired, with crepitus, tenderness, grating sensations or muscle spasm. Overtime the joint can become edematous and swollen, with the proliferation of the various joint tissues. With improper treatment and repeated injury the chances for recovery become progressively less and less. (Berkow 1992; Rubin and Farber 1990, 723) Medical treatment
The primary focus in the medical treatment of osteoarthritis is upon eliminating risk factors and treating symptoms such as pain and immobility. Thus patient education, physical and occupational therapy, weight reduction, exercise, and corrective devices such as orthotics may be recommended. Initial medications include OTC analgesics such as ASA, acetaminophen and NSAIDs. Prescription NSAIDs may be recommended when OTC medications are ineffective, including the newer generation COX-2 inhibitors that include valdecoxib, celecoxib and rofecoxib. COX-2 inhibitors are believed to exert their anti-inflammatory effects by inhibiting the enzyme cyclooxygenase-2 (COX-2) and thus the synthesis of proinflammatory prostaglandins from arachidonic acid. The stated benefits of COX-2 inhibitors over other non-selective NSAIDs that inhibit both COX-1 and COX-2 is that they do not inhibit COX-1, which plays an important role in prostaglandin-dependent mucosal protective mechanisms. Clinical studies have shown that patients taking selective COX-2 inhibitors have a lower incidence of gastrointestinal irritation and inflammation than patients taking non-selective NSAIDs. Despite being heavily marketed as a safe and important alternative to manage pain in osteoarthritis however, recent research indicates that COX-2 inhibitors also inhibit angiogenesis through direct effects on endothelial cells, and interfere with normal healing (Jones et al 1999). Furthermore, a series of studies published in the New England Journal of Medicine (Mar 17, 2005) have shown an increased risk of cardiovascular complications in patients taking various COX-2 inhibitors, including celecoxib, parecoxib, valdecoxib and rofecoxib. These studies and others initially caused the US FDA to ban these drugs, although in what was seen as a politically motivated move they have been placed back on the market, albeit for more limited indications, and not for sustained periods of time.
Surgical procedures in OA include arthroplasty (joint surfaces are replaced with artificial materials, usually metal or plastic), chondroplasty (surgical repair of the damaged cartilage) and arthrodesis (surgical fusion of the articular surfaces, which prevents movement-induced pain). In some cases joint replacement is recommended, in which the diseased or damaged joints are replaced with an artificial joint composed of a combination of metal and plastic. Knee and hip replacement are among the most common joint replacement procedures, but some joints such those of the spine cannot be replaced with the present technology. Holistic treatment
It is fairly well-established that osteoarthritis is better prevented than treated, as effective treatment is hampered by the relatively poor circulatory supply to cartilage. Thus proper attention to preventing joint injury is key to preventing the later development of OA. Nutritional status however is key in the pathogenesis of OA, and care should be taken to supply the body with an optimal volume of key vitamins, minerals, and accessory nutrients involved in joint repair. To control pain and inflammation medicinal plants are used along with essential fatty acids that can help to down-regulate the production of pro-inflammatory eicosanoids.
Both Ayurvedic and Chinese medicine view osteoarthritis as an evolution of chronically poor circulation, and thus treatments are undertaken to restablish the proper flow of blood to the affected area. In Ayurvedic medicine osteoarthritis is called Sandhigata vata, of which Vata and ama are the primary the pathogenic factors taken into account.
1. Ensure proper nutrition. See the Paleolithic diet listed under The Fire Within: Digestive function and Botanical medicine. Care should be taken to remove foods that are associated with inflammatory symptoms, including red meat (i.e. feed-lot beef, pork), grains, dairy, sugar, fried foods, transfatty acids and solanaceous foods (e.g. potatoes, tomatoes, eggplant etc.). The diet should be optimized to provide the body with all the nutrients needed for proper bone and joint health, including generous amounts of cartilage and bone soups that contain chondroitin and glucosamine sulfate. In particular, chondroitin and glucosamine promote an increase in the synthesis of collagen and proteoglycans that form joints, as well as exert antiinflammatory effect.
Calcium citrate or malate, 800-1200 mg daily Magnesium citrate or malate, 400-600 mg daily Manganese, 15-30 mg daily Boron, 3 mg daily Zinc, 15-20 mg daily Copper, 1.5-3 mg daily Folic acid, 400-800 mcg daily Vitamin A, 20,000 IU daily Niacin, 250 mg up to six times daily (taken with a B complex formula, 100 mg daily) Vitamin C, to bowel tolerance Vitamin D3, 1000-1200 IU daily, taken all year in temperate climates Vitamin E, 800 IU daily Vitamin K, 200 mcg daily Chondroitin, 0.5-3 g bid-tid Glucosamine sulfate, 0.5-3 g bid-tid
2. Decrease pain and inflammation. The focus should be on restoring joint function and limiting the production of proinflammatory eicosanoids.
antiinflammatory botanicals, e.g. Black Cohosh (Actaea racemosa), Wild Yam(Dioscorea villosa), Ash (Fraxinus excelsior), Licorice (Glycyrrhiza glabra), Lignum Vitae (Guaiacum officinale), Devil’s Claw (Harpagophytum procumbens), Buckbean (Menyanthes trifoliata), Trembling Aspen (Populus tremuloides), Salix, Yucca spp., Smilax spp., Tanacetum,, Huang Qin (Scutellaria baicalensis), Ashwagandha (Withania somnifera), Guggulu (Commiphora mukul), Amalaki (Emblica officinalis), Huang Bai (Phellodendron amurense), Mandukaparni (Centella asiatica), Fang Feng (Ledebouriella divaricata), Kushta (Saussurea lappa) analgesic botanicals, e.g. Arnica, Hypericum, Populus, Salix, Lactuca, Gelsemium, Piscidia, Ashwagandha (Withania somnifera), Guggulu (Commiphora mukul), Han Fang Ji (Stephania tetrandra), Yan Hu Suo (Corydalis yanhusuo), Jatiphala (Myristica fragrans) EPA/DHA, 1000 mg each daily MSM, 2-3 g bid-tid; also MSM cream applied topically antioxidants, e.g. vitamins A, C, E; minerals such as zinc and selenium
3. Ensure proper digestion.
Digestive enzymes, full spectrum, 2-3 capsules with each meal Bitters (e.g. Berberis, Gentian,etc.) to enhance gastric and hepatic secretions Dipanapachana dravyas, to enkindle agni, e.g. Yavani (Trachyspermum spp.), Shunthi (Zingiber officinalis), Pippali (piper longum), Hingu (Ferula foetida) Botanicals to relieve Food Stagnation and strengthen the Spleen Qi, e.g. Chen Pi (Citrus reticulata), Shan Zha (Crataegus pinnatifida), Huang Qi (Astragalus membranaceus), Dang Shen (Codonopsis pilosula) Probiotics and synbiotics to restore the ecology of the gut
4. Promote alterative changes and enhance elimination. Conduct a proper review of eliminative function, with particular attention paid to kidney, liver and bowel function.
alteratives, e.g. Smilax, Apium, Rumex, Guaiacum, Galium, Chimaphila, Berberis, Trifolium, Haritaki (Terminalia chebula), Amritbhallataka (Semecarpus anacardium milk extract), Guduchi (Tinospora cordifolia), Haridra (Curcuma longa), Guggulu (Commiphora mukul), Manjishta (Rubia cordifolia) alkalizing diuretics, e.g. Celery seed or juice (Apium graveolens), Nettle (Urtica dioica), Cleaver (Galium aparine), Pipsissewa (Chimaphila umbellata) Triphala churna, 2-3 g bid-tid, with equal parts laxative herb, e.g. Trivrit (Operculina), Turkey Rhubarb (Rheum) in chronic constipation
5. Enhance systemic and local circulation.
steam baths, sauna circulatory stimulants, e.g. Prickly Ash (Zanthoxylum), Ginger (Zingiber), Cayenne (Capsicum), Tvak (Cinnamomum cassia) rubefacients, applied topically, used as a poultice, medicated oil, or volatile oil in joint edema with pain, but little indication of active inflammation, e.g. Ginger (Zingiber), Cayenne (Capsicum), Mustard seed (Brassica spp.), Peppermint (Mentha piperita), Jimsonweed (Datura), Nirgundi (Vitex negundo), Yavani (Trachyspermum spp.), Pippali (Piper longum) low impact weight bearing exercise niacin, 250 mg up to six times daily massage therapy, e.g. with rubefacient medicated oils (see above), or Ayurvedic tailam such as Narayana taila, Balashvagandhalakshadi taila, Pinda taila, Balaguduchyadi taila moxibustion acupuncture
6. Joint trophorestoratives, to rebuild the integrity of the joint. Many of these botanicals are rasayanas in Ayurvedic medicine, and in Chinese medicine, function to support Kidney and Jing.
Western botanicals, e.g. Milky Oats (Avena sativa), Horsetail (Equisetum arvense), Nettle (Urtica), Bladderwrack (Fucus spp), Hawthorn (Crataegus), Bilberry (Vaccinium), Comfrey (Symphytum), Irish Moss (Chondrus), Alfalfa (Medicago) Ayurvedic botanicals, e.g. Ashwagandha (Withania somnifera), Gokshura (Tribulus terrestris), Amalaki (Emblica officinalis), Brahmi (Bacopa monniera), Mandukaparni (Centella asiatica), Guggulu (Commiphora mukul), Bala (Sida spp.), Shilajitu, Shuktibhasma (purified oyster shell ash), Shringaputa (deer horn ash) Chinese botanicals, e.g. Ren Shen (Panax spp.), Shan Yao (Dioscorea opposita), Huang Jing (Polygonatum sibiricum), Shu Di Huang (Rehmannia glutinosa), He Shou Wu (Polygonum multiflorum), Gou Qi Zi (Lycium chinense), Sang Shen (Morus alba), Lu Rong (Deer or Elk velvet), Dong Chong Xia Cao (Cordyceps sinensis), Yin Yang Huo (Epimedium grandiflorum), Bai Ji Tian (Morinda officinalis), Bu Gu Zhi (Psoralea coryfolia), Du Zhong (Eucommia ulmoides) Bone and seaweed soups
7. Specific formulations.
Yogaraja guggulu, 2-3 g bid-tid Kaishora guggulu, 2-3 g bid-tid Feng Shih Xiao Tong Wan, 10 pills bid-tid Guan Jie Yan Wan, 8 pills bid-tid Feng Shi Pian, 2 pills bid Te Xiao Yao Tong Ling (Specific Lumbaglin), 2 caps bid-tidFair Use Source: http://www.toddcaldecott.com/index.php/healing/conditions/225-osteoarthritis-
Definition Osteoarthritis, or degenerative joint disease, is one of the oldest and most common types of arthritis. It is characterized by a breakdown of the joint's cartilage. Cartilage is the part of the joint that cushions the ends of bones. Cartilage breakdown causes bones to rub against each other, causing pain and loss of movement. Osteoarthritis can range from very mild to very severe, and most commonly affects middle-aged and older people. It affects hands and weight-bearing joints such as knees, hips, feet and the back.
Excessive consumption of dry, cold or stale food
Not sleeping regularly
Suppressing natural urges
Exposure to severe cold and dry weather
Mental trauma can also be a causative factor
Pain in the joints
Stiffness and pain when moving or working
Ayurvedic View According to Ayurveda, Osteoarthritis occurs due to aggravation of Vata Dosha and is known as Sandhivata (Sandhi means the joint and Vata stands for Vata Dosha). Vata is an Ayurvedic humor that symbolizes air or wind and governs all movements in the body as well as mind. The condition of Sandhivata is caused when the activities of Vata increase inside the Sandhis or joints. Because Vata is dry in nature, it absorbs the fluidity from any part of the body. It is also destructive or catabolic in nature, which is why it causes destruction of the cartilages and reduction in the Synovial Fluid inside the joint capsule.
Ayurvedic treatment of Osteoarthritis not only prevents further deterioration in the joints but also rejuvenates damaged cartilages. Vata-alleviating treatments through specific herbs are also suggested for lubrication and strengthening of joints.
Diet & Lifestyle Advice
Avoid carbonated drinks, preserved and packaged foods, and dry or cold food items
Choose foods that are easy to digest and warming
Excessive use of joints and underuse are both problematic, so get some exercise each day, but do not overdo it
Try exercises that are easy on the joints such as walking, swimming and yoga
Keep your weight at an optimum level, neither too overweight nor too underweight
Do not withhold natural urges (such as burping, urinating, releasing gas, etc.)
Some Home Remedies
Use warm sesame oil to massage stiff and painful joints in the morning. Massage improves blood circulation and reduces inflammation and stiffness.
Put one teaspoon of fenugreek in a cup of water and set aside overnight. The next morning, mix well and drink.
Prepare ginger tea by boiling 10 to 12 slices of fresh ginger root in two quarts of water for 5 minutes, and then let steep for 10 or 15 more minutes. Drink this tea at a warm temperature throughout the day.
TREATING ADVANCED ARTHRITIS WITH CHINESE HERBS
by Subhuti Dharmananda, Ph.D., Director, Institute for Traditional Medicine, Portland, Oregon BACKGROUND
During the past year, serious concerns have been raised about one of the most important pharmaceutical therapies for persistent arthritis, the selective COX-2 inhibitor drugs. These non-steroidal anti-inflammatory drugs (NSAIDS) are potent analgesics that were developed specifically to avoid the gastrointestinal and renal side effects common to previously used drugs by focusing on a particular pathway: reducing the prostaglandins produced by the action of COX-2 enzyme (cylooxygenase-2) without inhibiting the COX-1 enzyme. The COX-2 metabolites have functions other than contributing to pain, such as the beneficial effects of limiting thrombosis and promoting vasodilation. As a result, when COX-2 is strongly inhibited by high doses of the drugs used over an extended period of time in the absence of simultaneous COX-1 inhibition, they can increase the risk of vascular events such as heart attack and stroke (1). Some of these drugs were pulled off the market abruptly, though a return to market with significant warnings is likely because of the symptomatic relief the drugs have provided to people with advanced arthritis.
A number of arthritis sufferers who have been on these drugs are likely to seek alternative remedies, looking to natural therapies that might have less risk. Although great progress has been made in recent years towards making the herbal therapies safer, ancient remedies are not themselves inherently safe. So, when examining traditional medicine approaches to treating advanced arthritis, some herbs listed in potentially useful formulas have to be avoided. For example, an herb that had been widely used in Chinese arthritis remedies, stephania, had to be removed from the market a few years ago because its most common source material, a species of Aristolochia, contains aristolochic acid, a substance that could, in rare cases, cause renal damage and renal failure (2). In an attempt to avoid herbs that might sometimes have Aristolochia as a source, other Chinese herbs frequently used for arthritis, such as clematis and sinomenium (which are rarely substituted by Aristolochia), and herbs in the Aristolochiaceae family that may contain aristolochic acid (e.g., asarum), have been removed from most products and are only available from a few suppliers who are willing to go through the steps necessary to assure absence of aristolochic acid.
Other Chinese materials included in arthritis formulas might be safe to use in their traditional form, but are classified as toxic and should not be used; examples are scorpion and scolopendra (which are toxic as live animal stings, but far less toxic when ingested orally) and strychnos (the processed seeds used in Chinese formulas contain 1/10 the strychnine of the toxic raw seeds). Adverse cardiac effects have been associated with ephedrine from ma-huang, an herb that is traditionally used in some arthritis treatments; the reactions have not been associated with complex Chinese herb formulas. Some Chinese prescriptions specify use of raw aconite, which is toxic; processed aconite is safe to use and is the only aconite referred to in this article.
With these herbs left out, the formulas are safe for most users. Nonetheless, prolonged reliance on high dosage of herbs for arthritis should be accompanied by adequate monitoring, as is often done with drug therapies. Thus, for example, one should be alert to warning signs of rare adverse reactions.
A potential advantage of using herbs is that, in addition to alleviating arthritis pain, they may provide some positive effects that are not attained from drugs aimed solely at reducing pain due to inflammation. For example, there is an established herbal benefit of improved circulation, just the condition that could be impaired by the COX-2 inhibitor drugs. In fact, improving circulation to the limbs may be one of the important therapeutic approaches for alleviating arthritis pain. Persons with advanced arthritis often have limited capability for physical exercise, which contributes to worsening circulation in the limbs, which might be partly countered by herbs. The authors of an investigation into blood flow in arthritis patients noted (3):
The results revealed that the disorder of limb blood circulation clearly exists in patients with rheumatoid arthritis. This disorder was closely related to endovasculitis and increased blood viscosity, which interact and facilitate thrombosis of the microvenous system to bring about a series of clinical manifestations. Rheumatoid arthritis belongs to the category of stubborn rheumatism in traditional Chinese medicine….The authors lay stress on the application of blood activating and stasis removing drugs in treating rheumatoid arthritis.
In a previous article by the current author, numerous traditional and modern formulas for arthritis were analyzed to reveal the most commonly used ingredients (4). Generally, those formulas were especially suitable for treating newly diagnosed cases of arthritis or cases of mild to moderate severity in which “external pathological factors” affecting a person with deficiency syndrome is the dominant etiology. A tablet formulation called Chiang-huo 13 was produced to follow the common approach, and has been in use for many years with no adverse effects reported. A feature of this type of formulation is reliance on herbs that are categorized as dispelling wind-chill or wind-damp, such as chiang-huo, siler, cinnamon twig, chin-chiu, and tu-huo.
Persistent severe arthritis is more difficult to treat and usually involves a focus on different therapeutic principles and herbs, particularly those that fit the Chinese therapeutic categories of vitalizing blood and resolving “hidden phlegm” or “phlegm turbidity” that obstructs the channels. It was pointed out in another article by the current author that the “hidden phlegm” syndromes often correlate with what we think of as blood stasis syndromes (5). FOUR TRADITIONAL-STYLE FORMULAS
This article briefly reviews the work with four sample formulations based on a new approach to treatment: Wangbi Chongji; Shuguan Wenjing Chongji and Shuguan Qingluo Chongji; and Fengshi Xiandan. The term “chongji” in the first three formula names refers to the form of preparation: these are instant tea granules, produced by making the extract of the herbs and then combining it with sugar and forming into large granules that will dissolve when hot water is applied; the fourth formula is made into pills (dan). Wangbi Chongji
This formula was developed by the famous physician Jiao Shude, who is widely known for his work in the treatment of arthritis. Western practitioners may know of him through the popular work Ten Lectures on the Use of Medicinals from the Personal Experience of Jiao Shude (6). Jiao was born in Hebei Province in northeastern China in 1922. He began studying medicine as a child with his grandfather. In 1941, at the age of 19, Dr. Jiao opened a medical practice in his hometown and simultaneously entered the Tianjin Medical College. In 1946 he passed his medical examinations and was officially licensed. In 1950 he began to work in Beijing as a doctor of internal medicine and in 1958, Jiao joined the Beijing Chinese Medical College faculty where he taught and practiced for the next 27 years. In 1984 he began working at the newly established China-Japan Friendship Hospital in Beijing, where he continues to practice. He is also a visiting lecturer and practitioner at other facilities in Beijing.
Jiao further developed traditional ideas in the diagnosis and treatment of rheumatic joint disease (bi syndrome; literally: obstruction syndrome) in the light of modern knowledge. Working from the traditional categories of gubi (bone bi or, as commonly used, bony bi; see etiology diagram) and wanbi (stubborn bi), both of which often involve joint deformity and is understood to involve phlegm obstruction of the meridians, he described a new type, which he calls wangbi (the character used for wang is similar to one used to denote crooked, bent or distorted). The disorder is characterized by changes in the joint's physical form, along with deterioration of the bone and difficulty extending the limbs. Its basis is blood stasis that is worsened by kidney yang deficiency (which also contributes to weakness of the bones) along with the usual factors that induce bi syndrome, such as cold, damp, and wind. The etiology is similar to that clearly presented for wanbi (which can include deforming rheumatoid arthritis, gout, and ankylosing spondilitis) in the text Rheumatology in Chinese Medicine (7):
When painful obstruction is chronic, the channels' blood and qi are slowed down and obstructed by the presence of external pathogenic influences. This causes stasis of blood and [accumulation of] turbid phlegm, which settle deeply in the joints. At this point they are very difficult to eradicate. Phlegm and blood stasis meld together, further aggravating the blockage…the pain becomes stabbing and excruciating.
Jiao emphasized the blood stasis aspect, and considered that by warming the kidney yang, the flow of qi and blood would be restored. In 1983, the China National Chinese Internal Medicine Association chose wangbi, along with Dr. Jiao's methodology for treating it, to be investigated nationwide at numerous provincial hospital sites. The patent formula used to treat this pattern, Wangbi Chongji, has received national awards. Following five years of study, in 1986, a second generation of formulas was created on the basis of Jiao's model, called Wangbi Health Restoring Formula 1 and 2. These formulas also received national awards for excellence (8). Dr. Jiao has published articles about his concepts of arthralgia, such as Personal Experience in the Diagnosis and Treatment of Rheumatoid Arthritis and Pattern Identification and Treatment Differentiation as Applied to Wangbi.
The precise formulation for Wangbi Chongji has not been published, and this is a common procedure when the manufacturer wishes to protect their special formulations from being copied. Also, at least three formulations are mentioned above: the original and two modifications. The following ingredients have been listed for the formula; they are presented here divided into therapeutic categories for ease of interpretation (not all ingredients are in a single formulation):
Kidney tonic and warming herbs: rehmannia, drynaria, dipsacus, psoralea, epimedium, aconite Blood vitalizing herbs: carthamus, peony, red peony, achyranthes, pangolin scales Wind-chill and wind-damp dispelling herbs: tu-huo, clematis, siler, red atractylodes, ma-huang, cinnamon twig, pine node, lycopodium Other: anemarrhena, gleditsia, scolopendra
The dominant therapeutic approaches here are tonifying the kidney, warming the body, and vitalizing blood; some of the standard herbs for dispelling wind-chill and wind-damp, used in the anti-arthralgia formulas designed for early and intermediate stage arthritis, are also included. Of the items listed, ingredients that are usually avoided in Western practice are ma-huang, clematis, and scolopendra; pangolin scales are sometimes not available due to endangered species concerns (in China there is a plentiful supply because the animals are raised on farms). The formula is produced by the Benxi Third Pharmaceutical Factory. It comes in packets of 10 grams, and is taken 1-2 packets each time, three times a day.
In clinical work, the formula is mainly used for arthritis and gout. For arthritis, data for 332 patients collected from the medical units in China suggest its effectiveness (some degree of improvement in symptoms) for about 70.8% of those who use it (9). A report on use of a similar formulation for treating wangbi involved an extract of epimedium, curculigo, morinda, cibotium, dipsacus, rehmannia, pine node, carthamus, and sparganium (10). These herbs were extracted and dried, and put into capsules; patients took 4 capsules, three times daily for 60 days. It was claimed that all but 4 of 43 patients so treated had improvement in their clinical condition, especially for pain, swelling, and morning stiffness.
The potential role of phlegm obstruction in advanced rheumatoid arthritis is still important to consider. Wei Song wrote an article on treating wanbi, emphasizing this aspect (11). He noted that:
Invisible stubborn phlegm plays an important role in the pathogenesis of wanbi. If stubborn phlegm isn't eliminated, wanbi won't be healed. Based on the principle of warming transformation (wenhua), the author treated the disease with sinapis, typhonium, silkworm, arisaema, etc. This approach can markedly improve the curative effect of treatment and restrain the condition of wanbi.
This method of therapy, based on resolving phlegm with these herbs, is briefly described by Yang Yifan in her book comparing the effects of various Chinese medicinals (12):
The herbs that transform wind-phlegm are arisaema, typhonium, sinapis, silkworm, gastrodia, pinellia, bamboo sap, and bamboo silica. These herbs are used in clinical practice to treat cramp, numbness, tingling, heaviness and pain in the limbs, facial paralysis, facial spasm, epilepsy, hemiplegia, migraine, neuralgia, and arthritis. They are often used together with herbs that regulate the qi and blood, expel wind-dampness, and extinguish internal wind.
In the above list, the last four herbs are primarily given for the problems of facial paralysis and spasm, epilepsy, and hemiplegia. The Wangbi Chongji formula includes one herb specifically for resolving phlegm, gleditsia (see photos). In the book on his lectures, Jiao mentions use of gleditsia for arthritis:
When I am treating enduring and severe illnesses such as arthritis, wind strike with hemiplegia, or rheumatoid arthritis, I often add gleditsia to the formula prescribed for the pattern, whether it be in pill, powder, or other forms. Adding an appropriate amount of gleditsia spine not only increases the formula's ability to quicken the blood and channels, it also guides the medicinals “directly to the site of disease,” which definitely increases the effectiveness of the formula.
Of all the yang tonifying herbs that are used for this condition, Jiao emphasizes the use of epimedium, pointing out that “it is warm in nature and acrid in flavor, dispels wind-cold, supplements the liver and kidney, and strengthens the sinew and bone.” By eliminating the external pathogenic factors and supplementing the weakened organs and bone, epimedium is ideal for the treatment of wangbi (and the conditions of gubi and wanbi) when combined with herbs that resolve phlegm (e.g., gleditsia) and vitalize blood (e.g., red peony, carthamus, and achyranthes). Shuguan Wenjing Chongji and Shuguan Qingluo Chongji
The Shuguan formulas (shuguan means to clear away the obstacles) were mentioned in articles by a research group about a single study published both in the Journal of Traditional Chinese Medicine (13) and the Chinese Journal of Integrated Traditional and Western Medicine (14). The formulas were given to advanced arthritis patients; the matched control group received the already well-established Wangbi granules. The ingredients mentioned in the articles for these two formulations were:
Shuguan Wenjing: epimedium, dipsacus, aconite, rehmannia, clematis, sinapis, eupolyphaga, scolopendra, and millettia
Shuguan Qingluo: rehmannia, ho-shou-wu, photinia, chin-chiu, campsis, euonymus, arisaema, wasp nest, earthworm
The first formula was given to patients diagnosed primarily as having yang deficiency, while the second was given to those with yin deficiency. Since the patients were specifically selected for having advanced arthritis, the level of response to treatment was less than that reported above, but was in the range of 36-44%, with the Wangbi formula having the higher total effective rate, though on some categories of symptom evaluation, the Shuguan formulas performed somewhat better than Wangbi granules.
While Shuguan Qingluo includes several ingredients not commonly found in the other formulas for arthritis, Shuguan Wenjing has characteristics similar to the Wangbi formula, in tonifying kidney, warming the body, and vitalizing blood (for information on unique ingredients, see table). The use of sinapis and arisaema illustrates the approach of resolving hidden phlegm to treat advanced arthritis.
The Shuguan formulas were manufactured for the clinic conducting the study and are not commercial products. It was reported that 16.5 grams of crude herbs were extracted for each packet of the granules, and the dosage used was one packet each time, three times a day; this corresponds to the decoction of about 50 grams of herbs per day. A course of treatment was three months, which was the observation period. Outside China, the ingredients scolopendra and wasp nest are usually avoided due to concerns for toxicity. Fengshi Xiandan
Formulation principles along the lines outlined above continue to be advocated, even for earlier stages of arthritis. In a 2003 article in the Journal of Traditional Chinese Medicine (15), a formula called Fengshi Xiandan was evaluated for rheumatoid arthritis (fengshi means wind-damp and is the ancient designation of arthritis; xiandan is the ancient term for special pills of the immortals, indicating a highly-valued remedy). The formula ingredient list given was:
epimedium, curculigo, morinda, cibotium, rehmannia, scrophularia, peony, anemarrhena, carthamus, sappan, viola, taraxacum, scorpion, scolopendra, arisaema, and sinapis.
Here, both arisaema and sinapis are included, along with yang tonics and blood vitalizing herbs; the formula is warming in nature. Its unique feature is adding two “antitoxin” herbs, viola and taraxacum, which are mainly used in cases of early stage arthritis (13 of the 53 patients treated had cases of recent onset, and only 4 had late stage arthritis). Anemarrhena and scrophularia are examples of herbs that help nourish the yin and prevent the strong warming and dispersing herbs from further weakening the kidney yin; the formula reportedly produced no side effects.
Fengshi Xiandan was produced by grinding the herbs to powder and forming them into pills. The pills were administered orally, 10 grams each time, three times per day, with three months as a course of therapy; the patients were treated for two courses. A control group was given indomethacin, and the result of treatment outcome was claimed to show that the herb treatment provided significantly better results than the drug, with fewer adverse reactions (all the adverse reactions reported for the herbs involved gastro-intestinal responses, and these occurred only about only about 1/4 as frequently as with the drug, which also produced other types of side effects). The herb formula's benefits were especially noted in reducing the duration of morning rigidity (from an average of 49 minutes to about 19 minutes), greatly reducing the tenderness of the joints, and improving both walking speed and grip strength of the hands. NOTES ON SOME KEY INGREDIENTS
Sinapis is commonly used in the formulas for advanced arthritis. In an extensive article on treatment of bi syndrome (16), the functions of this herb were described:
Sinapis is spicy and warm; it disperses cold, dissolves wetness, opens the meridians, and reaches the luo vessels; it reduces swellings and relieves pain; it is the essential herb for reducing swelling and for analgesia in the treatment of rheumatoid arthritis.
Of the numerous yang tonics employed along with the key herb epimedium, the frequently used ingredients are dipsacus, morinda, curculigo, and cibotium. Yang Yifang compares these ingredients and notes that
Morinda is an excellent herb for tonifying the kidney yang because its warm-sweet nature will not bring about harsh, drying, or cloying side effects. Comparing morinda to curculigo and epimedium, it is the best one for tonifying the kidney yang and treating weakness of the legs and knees, chronic bi syndrome, and sexual disorders….Cibotium's function is similar to that of dipsacus, but it is stronger in expelling wind, dampness, and cold, and regulating the qi and blood. It is used for pain and stiffness of the joints and muscles in chronic bi syndrome.
She notes that curculigo is slightly toxic and should not be used for a prolonged treatment (however, a literature review of curculigo fails to reveal toxic components, so this issue is worthy of further investigation). Cibotium is currently restricted for importation due to endangered species concerns for the ferns, of which this is one. Dipsacus, which is stronger at vitalizing blood circulation might be used as an alternative to cibotium for the late stage of arthritis. For persons who suffer from evident coldness, addition of aconite and/or psoralea will increase the warming effect of the treatment. SUMMARY
Rheumatoid arthritis is often described in the traditional Chinese system as stubborn bi (wanbi) or bone bi (gubi) and the advanced cases are characterized by deformity of the joints with deterioration of the bone structure, which Jiao Shude has dubbed wangbi. Though wangbi-and the herb therapy used to treat it- overlaps with osteoarthritis, it is a description aimed at patients with rheumatoid arthritis. Treatment of these rheumatic conditions is addressed through nourishing the kidney (and liver) to strengthen the bones and tendons and to relax the stiffness, warming the meridians and dispersing hidden phlegm and stagnant blood to reduce swelling and alleviate pain, and by dispersing wind-damp and wind-chill which represent the external influence that aggravates the disease. Key herbs in the treatment include epimedium (with a variety of other yang tonics, such as dipsacus), rehmannia, peony, carthamus, and sinapis. In China, it is common to incorporate animal materials (which are thought to penetrate more readily the obstructed meridians) with reliance on scolopendra, scorpion, pangolin scales, earthworm, and eupolyphaga; the last two are still commonly used outside of China, being non-toxic and plentiful in supply. The effect of the therapies may be to reduce the inflammatory processes while also invigorating the circulation, and this may be a potential solution to those who try Chinese herbs as an alternative to the COX-2 or other anti-inflammatory drugs. REFERENCES
Segev G and Katz RJ, Selective COX-2 inhibitors and risk of cardiovascular events, Hospital Physician 2004; 40(2): 39-46. Dharmananda S, Are Aristolochia plants dangerous? START Manuscripts 2001. Li Shangzhu, et al., Changes in blood flow in the extremities in patients with rheumatoid arthritis and treatment with integrated traditional and western medicine, Chinese Journal of Integrated Traditional and Western Medicine 1996; 2(2): 115-116. Dharmananda S, An analysis of Chinese herb prescriptions for rheumatoid arthritis; START Manuscripts 2000. Dharmananda S, What is phlegm-mist affecting the heart?, START Manuscripts 2004. Mitchell C, et al. (translators), Ten Lectures on the Use of Medicinals from the Personal Experience of Jiao Shude, 2003 Paradigm Publications, Brookline, MA. Guillaume G and Chieu M, Rheumatology in Chinese Medicine, 1996 Eastland Press, Seattle, WA. Anonymous, About Professor Jiao and his texts, http://www.paradigm-pubs.com/html/JiaoBio.html NHIondemand, Rheumatoid Arthritis, http://content.nhiondemand.com Ji Haiwang, et al., TCM Treatment of rheumatoid arthritis by supplementing the kidney and invigorating the blood circulation, Journal of Traditional Chinese Medicine 2001; 21(4): 252-255. Wei Song, Wanbi treated by eliminating phlegm, Journal of Anhui Traditional Chinese Medical College, 2000; 19(3): 4-7. Yang Yifang, Chinese Herbal Medicines Comparisons and Characteristics, 2002 Churchill Livingstone, London. Zhou Xueping, et al., Intermediate and late rheumatoid arthritis treated by tonifying the kidney, resolving phlegm and removing blood stasis, Journal of Traditional Chinese Medicine 2000; 20(2): 87-92. Zhou Xueping, et al., Clinical and experimental study on treatment of mid-late stage rheumatoid arthritis with Shuguan Granules, Chinese Journal of Integrated Traditional and Western Medicine 1999; 5(3): 165-170. Shen Yujie, Qu Quanwei, and Wang Dajun, Clinical observation on treatment of rheumatoid arthritis with Fengshi Xiandan in 53 cases, Journal of Traditional Chinese Medicine 2003; 23(1): 21-26. Lin Jiehou, Bi-entity (arthritis): Clinical experience of master physician Wang Weilan, Journal of the American College of Traditional Chinese Medicine 1983; 3: 3-28. Vangermeersch L and Sun Peilin, Bi-Syndromes, 1994 SATAS, Brussels, Belgium.Etiology and Pathology of Bone Bi Etiology and Pathology of Bone Bi (16)
Herbs mentioned in formulas that are infrequently used (see reference 4 for commonly used ingredients) Herb Main Actions Comments Campsis lingxiaohua vitalizes blood, breaks up stagnation, cools blood, dispels wind Campsis is used for blood stasis syndromes combined with invasion of wind; it is not commonly used for treating arthritis. Euonymus weimao regulates blood, removes stagnation, alleviates pain Euonymus is used for pain associated with blood stasis, and is applied in cases of postpartum abdominal pain and arthritis. Lycopodium shenjincao eliminates wind and dampness; relaxes tendons and unblocks luo vessels Lycopodium is used in cases of arthralgia in which there is tightness of the fingers or limbs associated with contraction of the tendons. It is also used for trauma that causes or worsens the disorder. Gleditsia is in the same plant Family. Photinia shinanye eliminates wind, nourishes kidney Photinia is used in arthritis associated with kidney deficiency, typically used for low back and leg pain, and when there is weakness of the tendons and bones. Often Piper puberulum, or other Piper species are used in place of photinia. Pine node songjie dispels wind and dries dampness, analgesic Pine node is given for severe pain, usually associated with cold blockage and advanced arthritis. It is also used for pain due to trauma. Gleditsia sinensis Gleditsia spine Gleditsia sinensis Gleditsia spine, zaojiaci, is used by Jiao Shude for resolving phlegm obstruction in treatment of advanced arthritis. Other physicians may rely instead on arisaema or sinapis for that purpose.
Osteoarthritis Sunday, May 1, 2005 at 09:11AM posted by Dr. Tillotson in Disease encyclopedia Osteoarthritis is a degenerative disease of the joints associated with aging. The disease mostly affects the spine and large weight-bearing joints, and is often characterized more by degeneration of the articular cartilage than by inflammation. The absolute first thing to do is to make sure the digestive system is working properly, especially in the elderly. Look for signs like poor digestion, low appetite etc.
I have found the herb devil's claw root (Harpagophytum procumbens) helpful in many cases of arthritis with inflammation and pain, taken either by itself or as part of a combination formula, about 2 grams twice a day as a crude powder, or 60 drops of tincture 3 times per day. Boswellia gum is also very effective. Both of these are free of the side effects caused by many NSAIDS because they do not cause bleeding.
Herbs from the blood-nourishing group are also essential to slow, and hopefully reverse, joint degeneration. They act on the structural components of ligament and bone. TCM doctors frequently use raw rehmannia root, dang gui root, shou wu root, millettia stem, eucommia bark (du zhong or E. ulmoides), drynaria rhizome (gu sui bu or D. fortunei), psoralea seed (bu gu zhi or P. corylifolia) and deer antler.
Glucosamine sulfate is extraordinarily effective in most cases so I always use it to treat this disease. This substance is an amino-sugar extract derived from the exoskeletons of shrimp, lobsters and crabs. As people age, they lose the ability to manufacture their own supply of glucosamine sulfate. More than 300 scientific investigations and 20 double-blind studies have shown that patients treated with this nutrient experience an improvement rate between 72% and 95% in various forms of osteoarthritis (reported in Murray 1996). The recommended dosage is 750 mg twice per day. It takes up to six weeks to see results, at which point patients often experience pain relief that exceeds the results from aspirin treatment. Japanese research shows that it works better when combined with MSM.
Glucosamine sulfate is not a painkiller—it literally repairs the joint tissue. This translates into dramatic and long-lasting results. However, in spite of the treatment’s effectiveness, we must remember that it does not reverse or cure the underlying degenerative process that causes the disease.
Traditional Ayurvedic medicine (TAM) doctors consider osteoarthritis (sandhigatavata) to be a degenerative process caused by any food, behavior or condition which results in poor blood circulation, dryness (Vata) or low nutrient supply to the joint. Their treatments emphasize use of the following strategies:
• Gentle and slow oil massage (do not disturb the joint), using the standard tonic oil narayana taila, which contains wild asparagus root as a main component. • The oil massage is followed by application of a warm compress soaked in a warm decoction made from bala, using gentle range-of-motion manipulation. • The well-known tonic yogarajaguggulu, which contains guggul gum, is a standard Ayurvedic medicine for osteoarthritis, used for several months. • A second general tonic should also be prescribed to supply nutrition, such as the ones mentioned in the immune/longevity group. • Use the diet to reduce wind, along with carminative (gas-expelling) spices, especially celery seeds. Other carminatives include cloves, caraway, and fennel (Bajracharya, 1979).
To control arthritic inflammation (as opposed to degeneration), it is often important to use herbs from the heat-reducing group. TCM doctors use phellodendron bark and scute root to control inflammation, in combination with other herbs like myrrh gum, fang feng root (Ledebouriella species), and qin jiao root (Gentiana macrophylla). They also use a relative to boswellia gum called ru xiang gum (B. carterii). Except for short term use, beware of NSAIDs—aspirins and aspirin-like compounds including acetaminophen. Unlike many natural anti-inflammatory herbs, these pharmaceutical products cause damage to mucosa, kidney and heart, and worsen progression of damage to cartilage and joints. One would therefore expect that herbs containing salycilate compounds would cause the same problems. Interestingly, I have used the European prescription herbal tincture Phytodolor–which contains three such herbs, common ash bark (Fraxinus excelsior), aspen leaf/bark (Popuolus tremula), and goldenrod aerial portions (Solidago virgaurea), and it does not seem to cause stomach upset or bleeding, as correctly stated in the promotional literature. This may be because of the slow onset of action (several days) creates less concentrated action on the stomach mucosa. Another trick is to use DGL licorice to protect the mucosa.
Most herbal anti-inflammatories do not cause stomach problems. Turmeric root, for example, has not been reported to cause bleeding, nor has boswellia gum, even in high doses. Such medicines seem not to damage the mucosa because they work in a different biochemical way. A good base herbal anti-inflammatory formula might start with boswellia gum, myrrh gum, scute root and turmeric root. Add other herbs as discussed, and adjust as follows:
• If the patient tends toward coldness, try adding ginger root or prickly ash bark. • If heat and inflammation are severe, add phellodendron bark.
Thus our typical osteoarthritis treatment program consists of:
1. Glucosamine sulfate/MSM supplements: 750 mg, twice per day. 2. An herbal formula for inflammation. 3. Additional nourishing tonic herbs and basic vitamins to slow degeneration. 4. A healthy diet, bodywork, oil/herb massage, exercise and vitamin supplements.
The relative proportion of the formula that tonifies and the formula that reduces inflammation depends on signs and symptoms. In elderly patients, for example, tonification and digestion are usually emphasized.
The following therapies can also be useful additions to your treatment protocol.
• Some patients, especially those over the age of 60, require digestive aids to ensure proper absorption of nutrients. Digestive herbs like bromelain, white atractylodes, and ginseng root can be added to the formula in these cases. • Essential fatty acids (EFA's) are essential to control deficiency-based inflammation, so I use fish oils along with borage oil or evening primrose oil. • Acupuncture can help alleviate pain and stimulate natural healing powers. • Women must remain aware hormonal changes that can affect arthritis and bone loss. In cases of hormone involvement, collateral treatment may be necessary
You can also treat bursitis and Sjogren's syndrome with these same methods.
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AN ANALYSIS OF CHINESE HERB PRESCRIPTIONS FOR RHEUMATOID ARTHRITIS
by Subhuti Dharmananda, Ph.D., Director, Institute for Traditional Medicine, Portland, Oregon INTRODUCTION
Arthritis is a general term for joint (Greek: arthron) inflammation (Greek: itis). The main symptoms are pain, swelling, and stiffness. The cause of the disorder is an immune-based disturbance primarily affecting the joint fluids. There are several types of arthritis, but there are two basic forms mentioned in modern literature that occur frequently: rheumatoid arthritis and osteoarthritis. Rheumatoid arthritis is characterized by autoimmune attacks that usually come and go, and it may be influenced by numerous factors that alter the immune functions, including infections, dietary components, and stress. Osteoarthritis also involves some autoimmune responses, but is characterized by a gradually worsening degradation of the joint spaces, leading to sharp, fixed pain that persists. Although both disorders can begin at any of the joints, rheumatoid arthritis most often affects the upper body first (fingers are frequently the first site), while osteoarthritis most often affects the lower body first (hips and knees are commonly affected). Rheumatoid arthritis tends to be felt for the first time at a somewhat earlier age than osteoarthritis, with rheumatoid arthritis usually starting before age 50 and osteoarthritis usually starting after age 50. Women are more likely than men to suffer from arthritis of both types.
Arthritis has been a recognized medical condition since ancient times, and the Chinese had developed numerous formulas for its treatment. Chinese herbal formulas were not specifically designed for either of the two major types of arthritis defined today. The basis for Chinese doctors differentiating arthritis into subgroups was not the microscopic details of the pathology. Instead, arthritis was divided into traditional medicine categories: hot and cold types, upper and lower body involvement, deficiency or excess syndrome, pain characteristics (such as variability and severity), and whether the site of the arthritis was fixed or “moving.” Both rheumatoid arthritis and osteoarthritis fall under the heading of bi syndrome, a disorder of qi and blood circulation that leads to symptoms of pain, numbness, swelling, and stiffness. Rheumatoid arthritis fits most closely those syndromes characterized by the Chinese as wind-damp invasion affecting the joints. Osteoarthritis more closely fits the syndrome of liver/kidney deficiency syndrome causing weakness and stiffness in the legs with painful joints.
In China, syndromes similar to rheumatoid arthritis were an area of special concern, generating considerable literature on the subject, since the condition could arise suddenly and could rapidly become severely debilitating. Osteoarthritis, on the other hand, tended to be lumped together with other disorders of aging, in which stiffness and pain, especially of the legs, was considered just one part of the gradual deterioration of body functions that occurs with old age. As such, it is usually not the subject of much discussion separate from antiaging therapies. The formulas described in this article mainly fit the category of rheumatoid arthritis treatments.
There are three key pathological factors addressed by the formulas: wind, damp, cold:
Wind (feng) refers to the sudden onset of the disease, mobility of the affected site (mobile bi syndrome), variability of the manifestation of symptoms, and sensitivity to changes in the environment (see: Drawing a concept: feng). Wind-dominant arthralgia most often affects the upper body and corresponds to the early stage of rheumatoid arthritis. Deficiency of qi and blood allows wind to more easily penetrate the body and cause pain. Damp (shi) refers to the worsening of the symptoms in damp weather, the initiation of the disease or worsening of symptoms after spending time working in a wet environment (such as wading in water or sleeping on damp ground), and the accumulation of fluid in the joints and/or nearby areas of the limbs (see: The six qi and six yin). Dampness-dominated arthralgia most often affects the lower part of the body and is characterized by swelling and stiffness of the joints, and accompanying sensations of numbness; it may correspond to a middle stage of rheumatoid arthritis (that is, after the disease has become chronic, with less variability of affected joints). Disorders of fluid metabolism, especially a weakness of spleen function, will aggravate dampness and the resulting joint dysfunction. Cold (han) refers to the worsening of symptoms with exposure to cold, improvement by applying heat (including liniments that cause increased local circulation), and impaired circulation associated with declining kidney yang that most often occurs with aging (see: Exploring yin/yang #6: cold and heat). Cold-dominated arthritis especially affects the extremities (hands and feet) where circulation is poorest, as well as the lower back-the site of the kidneys. The kidney yang, if deficient, is unable to dispel chilliness. Exposure to cold may initiate arthritis; however, the more common association is with advanced arthritis in which the internal metabolism (qi and yang aspects) are debilitated by chronic disease and aging, yielding a cold syndrome. More rarely, there can be a hot type arthralgia, initiated perhaps by excess exposure to the hot sun during the summer, and manifesting with redness of the joints.
The closest traditional Chinese medicine term to rheumatoid arthritis is fengshi bing which literally means wind-damp disease. The wind and damp factors can complex with either cold or heat factors to yield arthralgia. Almost all of the traditional approaches apply to the complex involving cold factors rather than heat. Gout, which has some characteristics in common with arthritis, usually fits the cold-dominated category or the cold-damp category of bi syndromes.
Cold, wind, and dampness cause stagnation of circulation within the channels (meridians; blood vessels). According to the Chinese medical concept, when these pathological factors are dispelled, the circulation returns to normal and the disease goes into remission. If the disease has been experienced for a long period of time, the blood becomes static (a more severe condition than poor circulation). Eventually, the initiating factor (wind) becomes less prominent and the stagnation dominates, with blood stasis an increasing concern. Therefore, in the treatment of the chronic and advanced disease, there is more emphasis on overcoming static blood than when treating an earlier and more variable phase of the disease. BASIS OF THE ANALYSIS
One can use the traditional Chinese description of arthritis to suggest herbs and formulas to use for each patient. However, rather than devising unique formulations for each patient, it is common practice throughout the Orient to make use of a relatively small group of arthritis formulas that are believed be very successful. In this article, 31 such formulas that are in the current literature and based on the traditional approach are analyzed to reveal their commonly used ingredients and the patterns of formulation that have been relied upon. The sources of the prescriptions were as follows:
Two publications of the Oriental Healing Arts Institute (OHAI): the compendium Commonly Used Chinese Herb Formulas with Illustrations (1) and the journal articles in OHAI Bulletin devoted to rheumatism and gout and their Chinese herb treatment (2). The English-language rheumatology books Bi Syndromes (3) and Rheumatology in Chinese Medicine (4) based on traditional Chinese herb prescriptions. The formula reference books Thousand Formulas and Thousand Herbs of Traditional Chinese Medicine (5) and Chinese Herbal Medicine Formulas and Strategies (6). The books on patent remedies available in English, Chinese Herbal Patent Formulas (7), Handbook of Prepared Chinese Herbal Formulas (8), and Chinese Patent Medicines (9). In addition, one Japanese patent remedy based on a popular Chinese patent and approved by the Japanese Ministry of Health, was also included in the listing (10).
Formula selection was based on two main factors:
The indications for the prescription suggest that it could be used in the treatment of arthritis associated with any combination of wind, damp, and cold factors. Formulas specifically designed for unusual cases of arthralgia, such as heat-dominated arthritis, were not included. The presence of common Materia Medica items in the prescriptions, with non-toxic ingredients being the dominant components of the formulas.
The selection of formulas will have some influence on the outcome of the analysis, so an effort was made to include formulas that were described in several different texts, indicating their importance to the study of traditional Chinese medicine.
Table 1: Arthritis Formulas. This table displays the names of the formulas, the list of ingredients, and some comments about each of the formulas. In the first column, the pinyin transliteration of the Chinese formula name is given first, followed by the common name (OHAI system) if available, and then the references to the source texts (which have been listed above). In the ingredients column, the herbs have been listed in order from the most frequently used to the least frequently used (see Tables 2 and 3), followed by a short list of some rarely used items (after “plus”). The final column gives the Chinese traditional source text (STNA denotes source text not available) and some comments about the use and application of the formulas. Formula Name: Pinyin, Common Name, References Ingredients: Most Frequently Used Herbs/Additional Herbs Source Text (with Author, Date), and Comments Sanbi Tang Chin-chiu and Tu-huo Comb. (1-6) tang-kuei, siler, licorice, cinnamon, cnidium, peony, achyranthes, chin-chiu, tu-huo, hoelen, rehmannia, eucommia, ginseng, astragalus, asarum; plus dipsacus Furen Liangfang (Chen Ziming 1237 A.D.). This formula nourishes qi and blood and addresses the three bi factors: wind, damp, and cold. Shujing Houxue Tang Clematis and Stephania Comb. (1, 2) tang-kuei, siler, licorice, chiang-huo, atractylodes, cnidium, peony, achyranthes, chin-chiu, hoelen, ginger, rehmannia, angelica, clematis, stephania, persica; plus citrus Wanbing Huichun (Gong Tingxian 1587 A.D.). This formula is widely used in Japan and Taiwan for lower limb arthralgia, and for lumbago and sciatica; it clears the meridians and vitalizes blood. Duhuo Jisheng Tang Tu-huo and Loranthus Comb. (1-6) tang-kuei, siler, licorice, cinnamon, cnidium, peony, achyranthes, chin-chiu, tu-huo, hoelen, rehmannia, ginseng, eucommia, asarum; plus loranthus Qianjin Yaofang (Sun Simiao 652 A.D.). This is perhaps the best known and most widely used formula for arthralgia; also sold as a patent remedy; it tonifies liver/kidney. Da Qinjiao Tang Major Chin-chiu Combination (1-6) tang-kuei, siler, licorice, chiang-huo, atractylodes, cnidium, peony, chin-chiu, tu-huo, hoelen, rehmannia, angelica, asarum, scute; plus gypsum Suwen Bingji Yiqi Baomingji (Zhang Yuansu 1186 A.D.). This formula is usually considered when there is muscle contraction and stiffness accompanying joint pain. Da Fangfeng Tang Major Siler Combination (1-6) tang-kuei, siler, licorice, chiang-huo, atractylodes, cnidium, peony, achyranthes, ginger, rehmannia, aconite, eucommia, ginseng, astragalus; plus jujube Hejiju Fang (Imperial Medical Dept. 1085 A.D.). This formula was designed for pain and weakness in the legs due to downward flow of cold fluid; knee swelling may occur in such cases. Shujing Lian San Clematis and Carthamus Formula (1, 2) siler, licorice, chiang-huo, atractylodes, cnidium, achyranthes, chin-chiu, tu-huo, hoelen, rehmannia, aconite, angelica, stephania, clematis, citrus, carthamus, persica, scute, phellodendron, others Wangbing Huichun (Gong Tingxian 1587 A.D.). This formula is mostly used in Japan, where it is given to patients with recalcitrant arthritis producing severe pain. Jianbu Huqian Wan (3, 4, 6) tang-kuei, siler, chiang-huo, atractylodes, peony, achyranthes, tu-huo, hoelen, rehmannia, aconite, ginseng, eucommia, astragalus, chaenomeles, coix, phellodendron; plus lycium, others Shoushi Baoyuan (Gong Tingxian 1615 A.D.). This formula is designed for cases of kidney/liver deficiency resulting in weakness, stiffness, and pain in the lower body. The formula has been made into a patent medicine as well. Shufeng Houxue Tang Stephania and Carthamus Comb. (1-4, 6) tang-kuei, cinnamon, chiang-huo, atractylodes, cnidium, hoelen, ginger, angelica, clematis, stephania, carthamus, phellodendron; plus arisaema Shenshi Zunsheng Shu (Shen Jinao 1773 A.D.). This formula is used in cases of excess syndrome, with red, swollen joints. Shangzhong Xiatong Yongtong Feng Cinnamon and Angelica Formula (1-6) cinnamon, chiang-huo, atractylodes, cnidium, chin-chiu, angelica, clematis, stephania, persica, carthamus, phellodendron; plus arisaema, shen-chu Xifang Jijie (Wang An 1682 A.D.). This formula is used to treat arthralgia that is due to an excess syndrome; therefore, it lacks most of the tonic herbs used in other formulas. Fangfeng Tang Siler Combination (2,3,5) tang-kuei, siler, licorice, cinnamon, chiang-huo, chin-chiu, hoelen, ginger, ma-huang, scute; plus pueraria, apricot seed, jujube Xuanming Lunfang (Liu Wansu 1172 A.D.). This formula is given to patients with wind-type arthritis, where the symptoms may vary considerably in intensity and site. Shiweicuo San Astragalus and Aconite Formula (1, 2) tang-kuei, siler, cinnamon, atractylodes, cnidium, peony, hoelen, rehmannia, aconite, astragalus Yijianfang (Wang Shuo, Song Dynasty). This formula is designed to treat weakness and stiffness; it has a warming quality to treat cold-sensitive arthralgia. Guizhi Shaoyao Zhimu Tang Cinnamon and Anemarrhena Comb. (1-6) siler, licorice, cinnamon, atractylodes, peony, ginger; aconite, ma-huang; plus anemarrhena Jingui Yaolue (Zhang Zhongjing 220 A.D.). This formula is used for treating those with swollen, stiff joints, especially if warm to the touch. Yiyiren San Coix Formula (1) tang-kuei, siler, licorice, cinnamon, chiang-huo, atractylodes, cnidium, tu-huo, ginger; ma-huang, aconite (wutou), coix Mingyi Zhizhang (Huang Fuzhong 1502 A.D.). This formula is aimed at treating cold-dominated arthralgia. Yiyiren Tang Coix Combination (1-6) tang-kuei, licorice, cinnamon, atractylodes, peony, ginger, ma-huang, coix Mingyi Zhizhang (Huang Fuzhong 1502 A.D.). This formula is used for patients with moisture dominant rheumatic disorder; it is widely used in Japan. Shufeng Liushi Yin Clematis and Chin-chiu Comb. (1) siler, peony, achyranthes, chin-chiu, hoelen, angelica, clematis, stephania; plus capillaris, moutan STNA. This formula is mostly used in Japan, where it is given to patients with moisture accumulation as the dominant disorder; the syndrome may cause numbness. Danggui Niantong Tang Tang-kuei and Anemarrhena Comb. (1-6) tang-kuei, siler, licorice, chiang-huo, atractylodes, ginseng, scute; plus cimicifuga, polyporus, alisma, capillaris, pueraria, sophora, anemarrhena Lanshi Micang (Li Gao 1276 A.D.). This formula was designed to treat dampness accumulation in the lower body, causing swelling and pain. Shentong Zhuyu Tang Cnidium and Chiang-huo Comb (1-6) tang-kuei, licorice, chiang-huo, cnidium, achyranthes, chin-chiu. persica, carthamus; plus myrrh, pteropus, earthworm, cyperus Yilin Gaicuo (Wang Qingren 1830 A.D.). This formula is designed to treat a blood stasis syndrome, which is generally associated with fixed location of stabbing pain. Quhanbi Tang (3) tang-kuei, licorice, cinnamon, peony; ma-huang, atractylodes, asarum, carthamus, chaenomeles; plus typhonium, strychnos, frankincense, myrrh STNA. This formula is used for cold type arthralgia, marked by worsening with exposure to cold. Hanshibi Tang (3) cinnamon, chiang-huo, atractylodes, achyranthes, chin-chiu, aconite, clematis, chaenomeles; plus piper, pangolin, drynaria, sinomenium STNA. This formula is used for cold-damp arthralgia with symptoms of joint swelling and stiffness. Qufeng Tang (3) tang-kuei, siler, cinnamon, peony, ma-huang, aconite, angelica; plus zaocys, typhonium, schizonepeta STNA. This formula is used for wind-dominant arthralgia, with the location of pain changing. Juanbi Tang Chiang-huo and Turmeric Comb. (1-6) tang-kuei, siler, licorice, chiang-huo, peony, ginger, astragalus; plus turmeric Yixue Xinwu (Cheng Guopeng 1732 A.D.). This formula is often selected for pain in the neck, shoulder, and upper back. Qianghuo Shengshi Tang Chiang-huo and Tu-huo Comb. (1-6) siler, licorice, chiang-huo, cnidium, tu-huo; plus kao-pen, vitex Nei Wai Shangbian Huolun (Li Gao 1247 A.D.). This formula is especially used when the patient reports a sensation of heaviness. Fangji Huangqi Tang Stephania and Astragalus Comb. (1-6) licorice, atractylodes, ginger, stephania, astragalus; plus jujube Jingui Yaolue (Zhang Zhongjing 220 A.D.). This formula treats dampness accumulation in patients with a weak constitution; used especially for knee arthralgia. Siwu Qinjiu Tang Chin-chiu Four Combination (2) tang-kuei, cinnamon, cnidium, peony, chin-chiu, rehmannia, carthamus; plus morus twig STNA. This formula is used for vitalizing blood circulation, a therapy applied in cases of fixed location stabbing pain. Qing Huang San Schizonepeta and Ma-huang Formula (2) tang-kuei, siler, licorice, cinnamon, chiang-huo, atractylodes, cnidium, peony, tu-hou, ma-huang; plus schizonepeta, pueraria, cimicifuga STNA. This formula is given in cases of moisture accumulation and for pain in the upper body and arms. Mugua Wan Chaenomeles Pill (9) tang-kuei, cnidium, achyranthes, angelica, aconite, ginseng, clematis, chaenomeles; plus cibotium, millettia This is a patent medicine that is indicated primarily for numbness and pain in the lower body. Baixianbi Jianbu Wan (10) tang-kuei, siler, chiang-huo, atractylodes, peony, achyranthes, rehmannia, eucommia, ginseng, astragalus, phellodendron; plus lycium, sinomenium, cuscuta, dioscorea, psoralea, others This formula is used in Japan, where it is known as Kenpo-gan, for general rheumatoid arthritis treatment. Guanjieyan Wan (7) cinnamon, atractylodes, achyranthes, chin-chiu, tu-huo, ginger, ma-huang, stephania, coix; plus erythrina This is a patent medicine aimed at treating dampness-dominant arthralgia, which usually affects the legs. Fengshi Pian (8) siler, cinnamon, licorice, achyranthes, tu-huo, ma-huang, eucommia; plus scorpion, strychnos This is a patent medicine indicated for arthralgia associated with stiffness and numbness of the limbs. Duzhong Fengshi Wan (7) tang-kuei, siler, cinnamon, cnidium, achyranthes, chin-chiu, tu-huo, hoelen, eucommia, ginseng (codonopsis), asarum; plus loranthus This is a patent medicine mainly used for pain in the lower body. Zhuifeng Huoxue Pian (8) siler, cinnamon, licorice, chiang-huo, achyranthes, tu-huo, ma-huang, eucommia; plus frankincense, myrrh, homalonema, chaenomeles, illicium, pyritum This patent medicine is indicated for weakness, coldness, and pain in the legs and lower back. It is a blood vitalizing formula, used in treating sharp pain. MAIN HERBS IN THE SELECTED FORMULAS
Table 2 lists 8 herbs as “standard herbs” for arthralgia syndromes. They are broadly used in constructing arthralgia formulas and were included in at least half of the formulas listed in Table 1. There were another 21 herbs, listed in Table 3, that serve as adjunctive therapies; they each were present in at least 4 of the formulas. Each of these 29 herbs are described in some detail below, with the herbs presented from most frequently mentioned (21 times for tang-kuei and siler) to least frequently mentioned (4 times for coix, persica, scute, and phellodendron). In both Tables, the common name and pinyin name for the herb is given in the first column, followed by the botanical name and the plant family (in parentheses) in the second column. Traditional actions are from Oriental Materia Medica (11) and only include those that are related in some way to treatment of arthralgia.
Table 2: Standard Herbs. The following herbs are routinely used in arthritis treatments and are not specific for a location or type of arthritis. In some cases, more than one variety of an herb can be used. For example, with cinnamon, the twig is most often utilized, but cinnamon bark, considered more warming, is included in some formulas; white atractylodes, which serves as a qi tonic, is more often used than red atractylodes (for clearing dampness), but sometimes both are included in the formulation; white peony, the blood-tonifying herb, is more often used than red peony, which may be substituted when a stronger blood-vitalizing action is desired. Herb Name: Common/Pinyin Botanical Source/Family Traditional Actions/Uses Comments Tang-kuei danggui Angelica sinensis (Umbelliferae) supplements and moves blood By nourishing blood and moving blood, tang-kuei prevents external factors of wind, cold, and damp from entering the vessels and causing disease. Siler fangfeng Ledeborella divaricata = Siler divaricata (Umbelliferae) dispels wind, resolves surface, removes dampness Siler is important because it not only dispels wind and damp, but it also tonifies the spleen to aid in circulation of dampness. Licorice gancao/zhigancao Glycyrrhiza uralensis (Leguminaceae) supplements spleen, replenishes qi, harmonizes all drugs Licorice is included in the formulas mainly to support the tonic action of other herbs and to harmonize the various herbal components; additionally, it has powerful antiinflammatory actions that have been demonstrated in laboratory experiments. Cinnamon guizhi/rougui Cinnamonum cassia (Lauraceae) resolves surface, warms and promotes the flow of channels, removes obstruction of qi Cinnamon twig is traditionally used in formulas to resolve the surface and normalize circulation; cinnamon bark may be used in cold-dominant arthralgia syndromes. Chiang-huo qianghuo Notopterygium forbesii or Angelica pubescens (Umbelliferae) dispels wind, resolves surface, expels wind-damp, controls pain Chiang-huo is highly aromatic and is thought to quickly break through blockages in the surface. Atractylodes baizhu/cangzhu Atractylodes macrocephala [baizhu] and Atractylodes lancea [cangzhu] (Asteraceae) baizhu: supplements spleen, tonifies qi, directs dampness; cangzhu: dries dampness, strengthens spleen, removes wind-dampness Atractylodes is mainly used to tonify the stomach/spleen system in order to properly distribute moisture and generate healthy qi; red atractylodes is sometimes selected for dampness-dominated arthralgia when the fluid retention is obvious. Cnidium chuangxiong Ligusticum walichii or Cnidium officinale (Umbelliferae) invigorates blood circulation, promotes the flow of qi, dispels wind, controls pain Cnidium has a sedative action in laboratory experiments. Peony baishao/chishao Paeonia lactiflora (Ranunculaceae) baishao: supplements blood, controls pain; chishao: invigorates blood circulation, disperses stagnancy Peony is used along with tang-kuei to nourish blood and along with cinnamon to regulate the surface; red peony is selected for blood-stasis type arthralgia, usually in the advanced stages.
Table 3: Adjunctive Herbs. The herbs in this section are used for particular types of arthralgia or particular constitutional conditions of the patient. The herbs may be selected to address the dominance of one of the three factors contributing to bi syndromes: wind (e.g., use ma-huang or angelica); damp (e.g., use tu-huo, hoelen, clematis, stephania, or coix); or cold (use aconite or asarum). Further, the herbs may be selected for deficiency syndromes: for weakness add astragalus; for kidney/liver deficiency add rehmannia, eucommia, and achyranthes; for blood-stasis syndrome add persica and carthamus; for stiffness add chin-chiu and chaenomeles; for underlying heat syndrome, add scute and phellodendron. Herb Name: Common/Pinyin Botanical Source/Family Traditional Actions/Uses Comments Achyranthes niuxi/chuanniuxi Achyranthes bidentia [niuxi] and Cyathula capitata [chuanniuxi] (Amarantheae) niuxi: removes stagnant blood, disperses swelling, supplements kidneys and liver; chuanniuxi: removes wind, promotes water metabolism, invigorates blood Achyranthes is mainly utilized as a blood tonic for cases of liver/kidney deficiency; for this purpose it is usually combined with rehmannia and/or eucommia. Cyathula is used in cases of blood-stasis type arthralgia. Chin-chiu qinjiao/longdancao Gentiana macrophylla [qinjiao]; Gentiana scabra [longdancao] (Gentianaceae) qinjiao: removes wind and dampness; longdancao: expels dampness-heat Chin-chiu is usually selected in cases of deficiency-type arthralgia, added to formulas comprised of many tonic herbs. It is especially selected when there is stiffness; gentiana is used instead when there is an excess-type arthralgia, with stagnation being the dominant condition. Tu-huo duhuo Angelica pubescens or A. laxiflora (Umbelliferae) removes wind-dampness, promotes circulation of meridians, expels dampness This herb is closely related to chiang-huo and sometimes interchangeable. Tu-huo is preferred for dampness-dominated arthralgia, while chiang-huo is preferred for wind-dominated arthralgia; they are often combined together in formulas. Hoelen fuling Poria cocos = Pachyma hoelen (Polyporacea) promotes diuresis, eliminates dampness, strengthens spleen Hoelen is preferred for dampness dominated arthralgia, where it is often combined with either atractylodes or stephania or both. Ginger shengjiang/ganjiang Zingiber officinale (Zingiberaceae) shengjiang: resolves surface, warms stomach and spleen; ganjiang: warms middle warmer, reinvigorates yang Fresh ginger (shengjiang) is usually used in arthralgia formulas to resolve the surface and benefit the spleen; dry ginger may be substituted in cold-dominated arthralgia. Laboratory studies reveal an antiinflammatory action. Ma-huang mahuang Ephedra sinensis (Ephedrae) resolves surface, regulates water metabolism Ma-huang is especially used for the early stage of arthralgia where there are intense but short-duration inflammatory reactions and where the site of inflammation varies. Rehmannia dihuang Rehmannia glutinosa (Scrophulriaceae) shoudi: nourishes blood, supplements liver and kidneys Cooked rehmannia (shoudi) is usually used in arthritis formulas, as a tonic, almost always with tang-kuei, to nourish the liver. Aconite fuzi/caowu Aconitum charmichaeli (Ranunculaceae) restores yang, warms spleen and kidneys, dispels cold, controls pain Aconite is used in cold-dominated arthralgia; it has marked analgesic action when used in higher doses (or if unprocessed roots are used), but toxicity concerns lead to limiting the dosage and using it to restore yang. Angelica baizhi Angelica dahurica (Umbelliferae) removes wind, dissolves surface, controls pain, dries dampness Angelica is primarily used in formulas for early stage arthritis, where the site of inflammation varies, and in arthralgia affecting the upper body. Eucommia duzhong Eucommia ulmoides (Eucommiaceae) supplements liver and kidneys Eucommia is mostly used for arthralgia affecting the lower body. Ginseng renshen Panax ginseng (Araliaceae) replenishes and supplements qi, expels evil qi Ginseng is used to tonify the spleen and improve the qi and blood conditions. In patent medicines, it is substituted by Codonopsis pilosula (Campanulaceae) Clematis weilingxian Clematis chinensis (Ranunculaceae) removes wind-dampness, promotes meridian flow, controls pain Clematis is mainly used in cases of dampness-dominated arthralgia, which usually affects the legs, especially the knees. Stephania fangji Stephania tetrandra [hanfangji] (Menispermaceae) or Aristolochia fangji [guangfangji] (Aristolochiaceae) promotes diuresis, disperses swelling, expels wind, relieves pain Stephania is mainly used in cases of dampness-dominated arthralgia, usually in combination with hoelen. Recently, Aristolochia plants have been removed from the herb trade due to rare but serious kidney toxicity problems. Astragalus haungqi Astragalus membranaceous (Leguminosae) supplements qi, increases yang, delivers water Astragalus is mainly included in formulas for weakened patients. It is used along with ginseng, atractylodes, and other tonic herbs. Asarum xixin Asarum heterotropoides; Asarum sieboldii (Aristolochiaceae) dispels cold and wind Asarum is mainly used in formulas for cold-dominated arthralgia; it is often combined with aconite for that purpose. Chaenomeles mugua Chaenomeles lagenaria (Rosaceae) relaxes muscles and meridians, harmonizes the stomach, removes dampness Chaenomeles is usually used in dampness-dominated arthralgia and especially when there is stiffness of the limbs. Coix yiyiren Coix lacryma-jobi (Gramineae) relieves water retention, dispels dampness, strengthens the spleen, soothes numbness Coix is usually used for dampness-dominated arthralgia and for accompanying numbness. Persica taoren Prunus persica (Rosaceae) stagnated blood accumulated in the meridians Persica is used for blood-stasis syndrome, which contributes to fixed stabbing pain; it is often combined with carthamus for this purpose. Scute huangqin Scutellaria baicalensis (Labiatae) dries moisture Scute is used in cases where there is some internal heat or localized heat; the herb is selected because it also dries dampness. Phellodendron huangbai Phellodendron amurense (Rutaceae) dries dampness Phellodendron is used in cases where there is some internal heat, especially in cases of kidney deficiency syndrome. For this purpose, it is combined with rehmannia.
CHARACTERISTICS OF THE COMMONLY USED HERBS
There are at least three important characteristics of the herbs listed in Tables 2 and 3 in relation to treatment of arthritis: the common nature and taste of most of the herbs; the fact that several of the listed herbs are components of widely used traditional tonic formulas; and the reliance on herbs from a particular plant family with a similar group of active constituents.
As to the nature and taste of the herbs, nearly all are warming, or at least neutral (exceptions: peony, stephania, coix, scute, and phellodendron are cold-natured), and most are spicy (exceptions: licorice, peony, achyranthes, hoelen, rehmannia, eucommia, stephania, astragalus, chaenomeles, coix, persica, scute, and phellodendron). Even among the herbs that stand as exceptions to this rule, only very few of these are used frequently in the formulas that were analyzed, namely: licorice, peony, and achyranthes, all of which serve the role as tonics. The warm quality dispels cold, and the spicy quality dispels wind; the warm-spicy action disperses dampness accumulation and resolves stagnation at the surface (i.e., limbs, skin, flesh; not internal organs).
As to the correspondence of several key herbs to traditional base formulas, the following two formulas contribute several of the herbs that are used with high frequency:
Tang-kuei Four Combination (Si Wu Tang), which contains tang-kuei, peony, cnidium, and rehmannia; Tang-kuei Four Combination nourishes and vitalizes blood circulation; and Four Major Herbs Combination (Si Junzi Tang), which contains ginseng, atractylodes, licorice, and hoelen. Four Major Herb Combination invigorates the stomach/spleen functions, tonifies qi, and promotes moisture circulation.
Deficiency of qi and blood flowing through the meridians makes the body susceptible to external pathological factors, such as wind, cold, and dampness. Qi deficiency further makes the body susceptible to developing internal chilliness or moisture accumulation that will merge with external cold and damp factors to worsen arthralgia. Blood deficiency will allow the development of internal wind secondary to liver dryness, which will merge with external wind to worsen arthralgia. The herbs in these two formulas are not specific for arthralgia, but, instead, are aimed at treating internal deficiencies that contribute to susceptibility to this and other diseases and that allow further progression of the diseases rather than spontaneous remission.
The plant family that dominates this group of herbs is the Umbelliferae, sometimes known as the “celery family” because it includes this well-known plant. The herbs in this family mentioned in Tables 2 and 3 are: tang-kuei (see Figure 1), siler (see Figure 2), chiang-huo, cnidium, tu-huo, and angelica. In all cases, the root material is used. The roots are fragrant, and there is a certain similarity in their odor that is attributable to the common active constituents. By contrast, the three Ranunculaceae herbs (peony, aconite, and clematis), the two Rosaceae herbs (chaenomeles and persica), and the two Leguminoseae herbs have only remotely related substances within each family group that contribute to their actions in the arthritis formulas (i.e., it is a coincidence that they fall into the same plant family).
The common active constituents of interest belong to the chemical category of benzopyrone derivatives, mainly the coumarins (e.g., osthenol) and the furanocoumarins (e.g., bergapten). These compounds have been claimed to reduce protein-rich edematous swellings (see: Chinese herbs for lymphedema) and they have some antiinflammatory actions that have been revealed in laboratory animal experiments. Of the formulas listed in Table 1, all but one formula contains at least one of the Umbelliferae herbs (Da Qinjiao Tang contains all six of them); the exception is Stephania and Astragalus Combination, an ancient formula for leg edema that has been adopted to treat arthralgia of the knee. REPRESENTATIVE FORMULAS
There are five formulas presented in Table 1 (the first five listed) that are comprised almost entirely of the commonly used herbs for treatment of arthralgia and might be considered representative formulas:
Sanbi Tang (Chin-chiu and Tu-huo Combination) Shujing Huoxue Tang (Clematis and Stephania Combination) Duhuo Jisheng Tang (Tu-huo and Loranthus Combination) Da Qinjiao Tang (Major Chin-chiu Combination) Da Fangfeng Tang (Major Siler Combination)
Each of these formulas contains at least 14 ingredients from Tables 2 and 3, but few additional ingredients not listed in the Tables. All of these formulas contain Tang-kuei Four Combination (Siwu Tang: tang-kuei, peony, cnidium, and rehmannia) plus siler and licorice. Of these, Sanbi Tang and Duhuo Jisheng Tang are the most commonly referenced formulas in the modern literature devoted to traditional herb formulas for treatment of arthritis. RESEARCH EFFORTS
The most recent Chinese medical literature on rheumatoid arthritis treatments, including English language publications as found in the Journal of Traditional Chinese Medicine and the Journal of Integrated Western and Traditional Medicine, reveal that there is much experimentation still going on with herbal recipes for rheumatoid arthritis. The new formulas may treat heat syndrome, blood stasis, phlegm accumulation, or other disorders that were not the principal targets (wind, cold, damp) of the more traditional approaches. In addition, they may utilize ingredients that are toxic and cannot be used in Western practice, such as the immune-inhibitor tripterygium or the powerful muscle stimulant strychnos. Such ingredients may have a more profound effect than the commonly used and gentle components of the formulas described above. Since Western patients are usually seeking treatments to substitute for the modern drugs that cause unacceptable side effects, the herbal prescriptions used must be essentially non-toxic.
Due to concerns about the quality of design, conduct, and reporting of clinical trials for Chinese herbs, rather than reviewing the broad range of reports that can be found by searching the literature, an example will be provided here to illustrate the claimed results and the duration of therapy that was indicated as sufficient to yield those results. The study was selected for its large number of patients enrolled.
The tableted formula Fengshi Hantong Pian (Rheumatism Cold Pain Tablets) was given to 310 patients suffering joint pain (12). The prescription included tang-kuei, chiang-huo, cinnamon, red peony, aconite, astragalus, clematis, coix, scute, sinemonium, deer antler, lycium, and corydalis. According to the report, after a course of treatment lasting ten days, marked pain relief was experienced by about 70% of the patients, with pain being the main arthritic symptom of concern. A 30 day course of this therapy produced normalization of ESR (erythrocyte sedimentation rate) and RF (rheumatoid factor) values in about half of the patients that were followed up (31 of 61 had normal ESR; 24 of 38 had RF turn from positive to negative).
This report, and information garnered from other Chinese studies, suggest that alleviation of pain may be expected during the first week of treatment, blood chemistry changes may be expected as early as the first month of treatment, and remission may occur from one month to several months after treatment begins in some patients. Since rheumatoid arthritis can have periods of spontaneous remission, the possibility that the herbs bring on an earlier or more complete remission can only be determined by very careful testing with large treatment and control groups.
Unlike steroid drugs that powerfully inhibit the immunological component of the disease and can produce results within 24 hours, the herbal compounds may need to first reach a certain blood concentration that requires two or three days of regularly consuming the herbs, and then there may be another few days in which the changes in metabolism and immune function eventually result in a reduction of the inflammatory process. Still, if given in adequate dosage and if the formula ingredients are suited to the individual, some improvements (most alleviation of severe pain) could be reasonably expected in the first 3-7 days. Patients should not need to pursue the therapy for several weeks to determine if it has any influence on their condition. Other effects may take longer. For example, with benzopyrones in the treatment of protein-rich edemas, it has been indicated that a treatment time of several months is required to markedly reduce the swelling. Typically, Chinese herbal therapies for chronic diseases, such as rheumatoid arthritis, are given for several weeks or several months to attain substantial improvements. This duration of time is consistent with traditional Chinese theories of treatment of deficiency syndromes that underlie the disorder: it simply takes time to overcome the visceral weaknesses so that pathologic factors can be expelled. MECHANISM OF ACTION
Chinese researchers have attempted to elucidate how the herbs used in traditional arthritis formulas alleviate the symptoms-from the modern viewpoint-by carrying out numerous studies of the blood constituents of patients. According to studies that have been carried out recently (13, 14, 15), the mechanism of action that may be dominant in the situations with good therapeutic results is a reduction in the levels of pro-inflammatory cytokines, such as interleukin-1 (IL-1). The effect is then to alter the levels of T-cells and the production of activated antibodies and other components. In addition, or as a result, the properties of the blood and its circulation also change, with lowered sedimentation rate and improved circulation to the extremities. The herbs may also act on the prostaglandin synthesis and degradation pathways, yielding a lower level of pro-inflammatory prostaglandins. REFERENCES
Hsu HY and Hsu CS, Commonly Used Chinese Herb Formulas with Illustrations, 1980 rev. ed., Oriental Healing Arts Institute, Long Beach, CA. Hsu HY, Neuralgia, rheumatism, and gout and their Chinese herb treatment, Bulletin of the Oriental Healing Arts Institute, 1979; 4(4): 16-27. Vangermeersch C, and Sun Pei-lin, Bi-Syndromes, 1994 SATAS, Belgium. Guillaume G and Chieu M, Rheumatology in Chinese Medicine, 1996 Eastland Press, Seattle, WA. Huang Bingshan and Wang Yuxia, Thousand Formulas and Thousand Herbs of Traditional Chinese Medicine, vol. 1, 1993 Heilongjiang Education Press, Harbin. Bensky D and Barolet R, Chinese Herbal Medicine: Formulas and Strategies, 1990 rev. ed., Eastland Press, Seattle, WA. Fratkin J, Chinese Herbal Patent Formulas: A Practical Guide, 1986 Shya Publications, Santa Fe, NM. Chun-Han Zhu, Clinical Handbook of Chinese Prepared Medicines, 1989 Paradigm Publications, Brookline, MA. Chen Keji (editor), Chinese Patent Medicines, 1997 Hunan Science and Technology Press, Hunan, China. Tsung PK and Hsu HY, Arthritis and Chinese Herbal Medicine, 1987 Oriental Healing Arts Institute, Long Beach, CA. Hong-Yen Hsu, et al., Oriental Materia Medica: A Concise Guide, 1986 Oriental Healing Arts Institute, Long Beach, CA. Wang Zhaoming, et al., A report on 310 cases of articular rheumatism treated with Fengshi Hantong Pian, Chinese Journal of Integrated Traditional and Western Medicine 1985; 5(5): 284-285. Zhou Xueping, et al., Clinical and experimental study on treatment of mid-late stage rheumatoid arthritis with Shuguan Granules, Chinese Journal of Integrated Traditional and Western Medicine 1999; 5(3): 165-170. Xu Desheng, et al., Clinical and experimental study on RA Mixture in treatment of rheumatoid arthritis, Chinese Journal of Integrated Traditional and Western Medicine 1996; 2(3): 178-183. Li Shangzhu, et al., Changes in blood flow in the extremities in patients with rheumatoid arthritis and treatment with integrated traditional and western medicine, Chinese Journal of Integrated Traditional and Western Medicine 1996; 2(2): 115-116.
August 2000 Angelica sinensis; tang-kuei Figure 1. Angelica sinensis; tang-kuei. Ledeborella divaricata; siler Figure 2. Ledeborella divaricata; siler.
Causes of Arthritis from Chinese Medical Perspective By Yang, Jwing-Ming The author of this article, Mr. Jwing-Ming Yang, has done a wonderful job of translating traditional Oriental concepts into words and ideas that are better understood by us in the Western world. For more information on how arthritis is described in the terms that practitioners of traditional Chinese medicine use, please see the article on “Bi” Syndromes among the Clinical Point Selections. “Bi” means pain, and many of the “Bi” syndromes overlap with the Western differentiation of arthritis. Although we understand how some forms of arthritis start, we are still in the dark about other forms. In this section we would like to summarize the known possible causes, and also contribute some ideas from Chinese medicine and Qigong. 1. Weakness of the Internal Organs: We already know that the condition of the internal organs is closely related to our health. According to Chinese medicine, there are five Yin organs which are considered the most important for our health and longevity. These organs are the heart, liver, lungs, kidneys, and spleen. Whenever any of these five organs is not functioning properly, sickness or even death can occur. Furthermore, all of these five organs are mutually interrelated. Whenever there is a problem with one, the others are always involved too. For example, gouty arthritis is caused by the improper functioning of the liver and kidneys. 2. Defective Genes: Only recently it was reported that some forms of arthritis are caused by defective genes, which are inherited from one's parents. According to Chinese medicine, the genes are considered the essence of your being. This essence is responsible for the production of hormones, from which Qi is generated. When this Qi is led to the brain, the spirit is raised. When all of these conversion processes are functioning normally, the immune system is strong and sickness is less likely. One of the main goals of Qigong is learning how to convert the essence into Qi efficiently and lead it to the brain. 3. Weak Joints: Weak joints can come from heredity or from lack of exercise. The body is a living machine, so the more you use it, the better condition it will be in. Chinese medicine believes that even if you have inherited a weak joint it is still possible to strengthen it through Qigong. When you exercise, Qi is brought to the joint by the movement of the muscles and tendons. This will nourish the joint and rebuild it. 4. Injury: According to today's medicine, some forms of arthritis are caused by injury to the joints. Although the injury may not be serious, it may have significant results. The injury can affect the muscles, tendons, ligaments, or even the cartilage and bone. Whenever any joint injury, even a minor one, is not treated, the normal smooth Qi circulation in the joint area will be affected. If the situation persists, the Qi imbalance can cause problems such as arthritis. 5. Aging: Aging has always been the cause of many sicknesses, including arthritis. When you are old, the Qi level in your body is low. Since your system is being deprived of the required amount of Qi, it starts to degenerate. One of the main goals of Qigong practice is learning how to slow down the aging process by building up the Qi in the body. 6. Qi Deficiency: Qi deficiency is responsible for many problems. It can be caused by emotional depression and sadness, which can lead the Qi inward and make the body Yin. This deprives the outer body of Qi. When this happens, you will generally feel cold. If the problem persists for a long time, the muscles and tendons will be affected by the the lack of Qi, and the joints will be weakened. Qi deficiency can have other causes, such as the weather. For example, your body's Qi is more deficient in the winter, and there fore, arthritis can be more serious then. Qi deficiency can also be caused by working for prolonged periods in a damp area, or by exposing your joints to the cold. 7. Tension: Tension includes both mental tension and physical tension, which are related and cannot be separated. Constant mental and physical tension can increase the pressure on the joints. For example, some people are very tense and grind their teeth in their sleep, which can cause arthritis in the jaw. A lot of body tension is caused by the emotional disturbance which is related to your mental reaction to stressful events. For this reason, learning how to regulate your mind is an important part of the treatment of arthritis. 2-5. Other Possible Means of Preventing or Curing Arthritis In addition to the ones already discussed, there are a number of other methods of preventing or curing arthritis. Although many of them are still awaiting scientific confirmation, they may be worth your consideration. However, you must understand that everybody has his or her own unique characteristics, and his or her own unique inheritance. In addition to the habits and lifestyle that each person has developed, everyone's mental and physical structure is different. For example, some people are affected by allergies while others are not. What this means is that you cannot necessarily use the same method to treat different people, even when they have the same disease. Even modern Western medicine has found that the same treatment will not work equally well on all patients. Therefore, do not automatically brush off some of the treatment methods we will discuss. After all, Western medicine is only in its infancy, and it may come to understand and accept these alternative remedies. 1. Diet: People who are experienced in Qigong have always considered food to be a significant influence on the condition of the Qi in the body. For this reason, diet is one of the main concerns of Chinese medicine. There is a saying: “You are what you eat.” It is well known that improper diet is one of the main causes of gouty arthritis. The Chinese have found many different herbs that can ease the pain and reduce the swelling of arthritis. It has recently been discovered that protein, calories, and fats can reduce the inflammation of arthritis. Certain fish oils may interfere with the process of inflammation and therefore reduce the symptoms of rheumatoid arthritis.(*5, *6). 2. Change of Residence: Since the Qi in your environment can affect the Qi in your body, arthritis sufferers should give serious consideration to this method. If the climate where you live is too damp or too cold, it may be affect ing your arthritis. It has recently been discovered that the Qi in our bodies can be significantly affected by the electromagnetic fields generated by modern technology, and therefore cause some forms of cancer. For example, people who live near high tension power lines tend to get cancer more often than those who do not. Perhaps similar environmental effects on arthritis will be found. 3. Change of Lifestyle: Your lifestyle affects how the Qi circulates in your body. If you frequently feel ill, especially mentally, you might need to change your lifestyle. How you think and how you coordinate the Qi pattern in your body with the natural Qi is very important for your health. Whenever your Qi circulation is against the “Dao” (nature), you will be sick. You may find that walking for an hour or doing Qigong exercises every morning improves your Qi circulation. 4. Clothing: What you wear also affects the Qi in your body. In the winter you must stay warm, and especially protect your joints. Joints that are left unprotected can loose Qi very quickly. It has been discovered that many man-made fibers can adversely affect the Qi distribution and circulation in the body. For example, polyester is known to cause Qi stagnation, and to prevent the body's Qi from exchanging with the environmental Qi. You may have noticed that clothing made of polyester can accumulate a considerable charge of static electricity in the winter. This builds up an electromagnetic field and affects the Qi circulation in your body. There are many other ways of improving the condition of your arthritis. For example, it is reported that sexual activity can stimulate the adrenal glands to produce more corticosteroid, a hormone that reduces joint inflammation and pain. It is believed that sexual activity may also trigger the release of endorphins, a naturally occurring painkilling substance.(*7) You can see from our brief discussion that, if we want to under stand arthritis completely, we must remain humble and continue our study and research. Only then will we be able to reach the goal of a complete cure. References 1. “Medicine for the Layman - Arthritis,” Clinical Center Office of Clinical Reports & Inquiries, Building 10B, Room 1C255, Bethesda, Maryland, 20892. 2. “The Complete Medical Guide,” Benjamin F. Miller, M.D., Simon and Schuster, New York, 1978. 3. “Arthritis, Rheumatic Diseases, and Related Disorders,” U.S. Department of Health and Human Services, Public Health Service, National Institutes of Health. 4. “An Overview of Arthritis and Related Disorders,” Caring, January 1989. 5. “Arthritis and Diet,” Arthritis Foundation, 1314 Spring Street, N.W., Atlanta, GA 30309. 6. “Can Diet Relieve Arthritis,” University of California, Berkeley, Wellness Letter, Volume 6, Issue 8. 7. “Arthritis and Your Love Life,” 8, Men's Health, 1989. From the book entitled “Arthritis - The Chinese Way of Healing & Prevention”, YMAA Publication Center, Jamaica Plain.
Ancient Chinese Remedies For Arthritis
face="Arial" size="2"By Maoshing Ni, L.Ac., Ph.D.As the population of America ages, the most common health concern of physically active baby-boomers is the condition of their joints. It is estimated that 70 million Americans have some form of arthritis. Furthermore, countless Americans undergo surgical procedures for joint injuries every year. Besides obvious traumas, common causes of arthritis include heredity, infections, aging and environment. If left untreated, arthritis and joint problems can be crippling and vastly affect one’s quality of life. Chances are you or someone you know has arthritis. Arthritis is one of the most common diseases in the U.S. and is the leading cause of disability. According to the Centers for Disease Control and Prevention, one out of every three Americans is affected by one of the more than 100 types of arthritis. These include conditions such as osteoarthritis, rheumatoid arthritis, gout, carpal tunnel syndrome, lupus, Lyme disease, ankylosing spondylitis, bursitis, tendonitis and fibromyalgia to name a few. The cause of most types of arthritis is unknown. Scientists are currently studying aging, genes, environment and lifestyle factors that contribute to the development of arthritis. The most common symptoms involve pain, stiffness and swelling around the joints or soft tissue. This can contribute to difficulty in daily activities that require movement. Other symptoms may include fatigue, fevers, depression and weight gain. The one common characteristic of any arthritic condition is inflammation. The inflammation is an immune system response to a foreign invasion (virus), injury or dysfunction (auto-immune response). Conventional treatments include anti-inflammatory agents, steroids and other immuno-suppressant drugs complemented by physiotherapy. The side effects of conventional treatments can be immense and often trouble arthritic patients for the rest of their lives. There is another way to obtain relief from arthritis without the side effects of taking drugs—the Chinese medicine way. This alternative to western medicine is several thousands of years old with a strong track record of good results. In Chinese medicine, arthritis is called a “Bi” or “stagnation and stasis” condition. We categorize “Bi” conditions according to their symptomatic characteristics such as location, intensity of pain, amount of heat or inflammation and amount of swelling and disability. For example, arthritic pain that moves from joint to joint is called “Xin Bi” or moving arthritis. Both external and internal factors can cause arthritis. External causes include invasion by pathogenic factors such as wind, cold or dampness that obstruct the normal flow of Qi and blood, thereby resulting in swelling, stiffness, numbness and pain of the joints and soft tissues. Internal causes include emotional stress weakening the defensive ability of one’s immune system and depletion of the Kidney/vitality system resulting in degeneration of one’s bones, tendons and cartilage. Treating arthritis in Chinese medicine focuses on ridding the body of the invading pathogens, restoring normal circulation and flow of blood and Qi, promoting emotional harmony and fortifying the Kidney/Vitality system. Effective treatments include acupuncture, moxibustion, herbal and dietary therapy, exercise therapy, cupping and massage. Acupuncture Acupuncture has been found to be clinically effective in reducing arthritic pain and improving mobility and circulation. Often, localized acupuncture therapy directly on the joint or tissue itself, with or without electrical stimulation or moxa (heat therapy with the herb mugwort) can be extremely helpful in managing arthritis. This obviously requires obtaining treatments from a licensed acupuncturist. Herbal Therapy Herbal therapy is useful in reducing inflammation, nourishing joints and soft tissues and improving one’s energy. It may also be a useful replacement for anti-inflammatory drugs that some people find upsetting to their stomach. Besides relieving arthritic symptoms, it is as important to nourish and prevent the onset of arthritis. There is good news for arthritis sufferer unable to access acupuncture treatments. Traditions of Tao, a company dedicated to the research of herbal products for modern needs formulated Healthy Joint and Arthritis Elixir to help people nourish and promote the proper function of their joints. It also offers relief of symptoms of arthritis. The Healthy Joint and Arthritis Elixir is specially formulated based on long years of Ni Family clinical success in helping their patients with joint conditions. This proprietary formula contains licorice root and peony root, which soothe pain and spasms; notopterygium root and Korean ash bark dispel dampness from the joints and restores flexibility; eucommia bark and mulberry stem nourish the joints; dang gui root, sheng di root and Szechwan lovage root promote proper lubrication of the joints; astraglus root modulates and balances the immune system; Chinese lovage root, peach kernel and safflower support proper circulation; and finally poria root helps proper stomach and digestive function. Dietary Therapy Dietary Therapy advocates avoiding foods that produce dampness or mucous that may further obstruct the flow of qi and blood in the channels, therefore exacerbating the arthritis. Foods to avoid: cow milk products (milk, cheese, yogurt, butter, ice cream, etc.) night shade vegetables (tomato, eggplant, peppers, potato) deep fried and fatty foods processed and refined foods cold and raw foods (salads, fruits) wheat red meat alcohol coffee sugar Exercise Therapy Exercise Therapy focuses on joint mobility, increasing circulation and strengthening tendons, ligaments and muscles. The best types of exercise include water exercise, taiji, qigong, gentle yoga, stationary bike, walking and light weight-training. Cupping and Massage Cupping and Massage are treatment modalities designed to vastly increase circulation to affected areas, ridding toxins and waste products that aggravate inflammation and introducing the joints and tissues to fresh nutrients and oxygen. These techniques are effective for reducing swelling, stiffness and pain. There is no reason why you cannot live a full and active life, even if you suffer from arthritis. The therapies listed above, either alone or in combination can vastly improve your quality of life if you practice them diligently. Dr. Maoshing Ni, a Licensed Acupuncturist and a Diplomat of Chinese Herbology, is currently in general practice at the Tao of Wellness Clinic in Santa Monica, California. The Tao of Wellness Clinic is one of the oldest in Los Angeles, established in 1976. (310) 917-2200
Dietary Guidelines for Rheumatoid Arthritis By Xiaomei Cai, L.Ac., Ph.D., O.M.D. (China)
Rheumatoid arthritis (RA) is a chronic disease, mainly characterized by the inflammation of the lining, or synovium, of the joints. It can lead to long-term joint damage, resulting in chronic pain, loss of function and disability.
RA progresses in three stages. The first stage is the swelling of the synovial lining, causing pain, warmth, stiffness, redness and joint swelling. The second stage is the rapid division and growth of cells, which causes the synovium to thicken. In the third stage, the inflamed cells release enzymes that may digest bone and cartilage, often causing the involved joint to lose its shape and alignment, eliciting more pain and loss of movement. Because of its chronic nature, RA continues indefinitely and may not go away. Frequent flares can occur.
RA affects people differently. For some people, it lasts only a few months or a year or two and then goes away without causing any noticeable damage. Other people may have mild or moderate forms of the disease, with periods of worsening symptoms, called flares, and periods when they feel better, called remissions. Still, others may have a severe form of the disease that is active most of the time, lasting for many years or even a lifetime. This form can lead to serious joint damage and disability.
The cause of RA is unknown. According to Traditional Chinese Medicine, this condition is called Bi Zheng, which is typically divided into four types: Wind-Cold Bi, Cold-Bi, Dampness-Bi and Heat-Bi. Through a thorough examination and consultation, including an assessment of the pulse and tongue, a diagnosis is made. Specific acupuncture points and herbs are prescribed and an appropriate diet is designed for the patient to follow. For Wind-Bi, adding green onions and ginger to your diet will help expel the Wind. For Cold-Bi, choose black pepper and dry ginger. Soy bean sprouts and pearl barley are beneficial for Dampness-Bi. For Heat -Bi, you should consume mung bean sprouts and winter melon.
Generally, your daily diet should include enough fresh vegetables, and foods rich in omega 3 and 6, such as flax seeds, sunflower seeds and walnuts. Supplement 100% of your calcium. During flares, eat more bitter melon and dandelion greens to reduce heat. Add some pearl barley, tofu, celery and Chinese yam to alleviate swollen joints. During remissions, eat more mushrooms such as black wood ear to strengthen your immune system. People suffering from RA should avoid oily and greasy food, dairy, shellfish, seaweed, egg, sugar, alcohol and excessive salt. Depending on your specific condition, consult with a TCM practitioner for an appropriate diet.
Rheumatoid Arthritis, Lupus and Scleroderma Sunday, May 1, 2005 at 11:03AM posted by Dr. Tillotson in Disease encyclopedia
The connective tissues are fabric-like substances that form a matrix that wraps and fills all the spaces in the body, even extending into the innermost parts of cells. All the major bodily systems–the circulatory system, the nervous system, the digestive tract, the musculoskeletal system, and each individual organ–are surrounded and supported by the connective tissue. With the exception of cartilage, all the connective tissues are highly vascular. Collagen is a fibrous, insoluble protein in connective tissue. It represents about 30% of the total body protein. The diseases that affect this tissue are collectively known as connective tissue disease (CTD), or sometimes collagen vascular diseases. These include systemic lupus erythematosus (SLE), scleroderma, rheumatoid arthritis, and combinations of these three diseases, called mixed connective tissue diseases or MCTD's. They share many characteristics, so the herbal treatments discussed here can be used for all these problems.
Rheumatoid arthritis is characterized by fatigue, weakness, and gradually intensifying joint pain. The pain usually begins in the small joints, eventually affecting all the joints in the body. It is an extremely painful and disfiguring condition.
Lupus (SLE) is an inflammatory CTD that occurs predominantly in young women–90% of all cases are diagnosed in this portion of the population. Although it can develop slowly over time, lupus often starts with a fever or acute infection. Most patients complain of arthritis-like pain, swelling, and skin inflammation, and there is often a characteristic butterfly-shaped reddening on the cheeks. Lupus can spread to the brain, kidneys, lymph glands, lungs and other tissues. There is a strong suspicion that part of the cause involves hormonal abnormality. For example, there is a higher incidence of the disease in women taking synthetic estrogen supplements (Sanchez-Guerrero et al 1995). Patients should avoid prolonged sun exposure as it often exacerbates the disease.
Scleroderma is a CTD disease characterized by progressive thickening and stiffening of the skin, followed by atrophy and changes in pigmentation. It can progress to the internal organs, eventually leading to death.
Treatment of CTD's
The high level of inflammation and tissue destruction that occurs with CTD's points clearly to a weakness in the body’s detoxification systems and resultant accumulations in the tissues that precipate immune attack. Alteration in blood chemistry parameters indicates a need for immune and general tonification, as well as additional support of the digestive system. The seriousness of these diseases often necessitates concomitant use of strong Western anti-inflammatories such as prednisone when a patient is in crisis. The swelling and pain dictate a need to remove dampness and blockage.
To understand the connective tissue you must realize that it is elastic. Moreover, it is not found just in our fibrous well-known “gristle.” Connective tissue proteins are also found within cells in the contractile filaments, stiff tubes and connecting trabeculae, and some even surrounds the genetic material (Oschman 1986). Just as the discovery of the virus erased the supposed dividing line between “life” and “non-life,” scientists are now moving away from the traditional rigid view of the body as a collection of separate cell units with distinctly different functions. As they delve deeper into the physical tissue, it is possible to find the same or similar patterns, tissue types and functions repeating themselves at all levels.
It is essential to seek professional help in serious or advanced cases. Nutritional experts emphasize the need to check for food allergies. Many patients benefit from dietary elimination of cow's milk products, wheat, oats, barley, rye, and grains containing the proteins gluten and gliadin. As in most inflammatory diseases, fish and flaxseed oils are often used to treat CTDs. Long-term use of borage oil has also been shown to benefit rheumatoid arthritis patients (Zurrier, 1996). The combination of boths oils together has been reported effective by numerous practitioners (reported in Bland, 2000).
According to Jonathan Wright, MD, author of the Nutrition & Healing Newsletter, digestive weakness is very common. He says, “I can't remember the last time I saw someone with lupus who had a normal stomach test; usually there is no stomach acid and pepsin at all, or very little. Replacement hydrochloric acid and pepsin capsules are almost always necessary” (Wright 1999).
Hollywood news media reports in 1999 claimed that actor James Coburn recovered from a severe case of RA using a nutritional supplement called MSM. MSM is an easily assimilated food source of nutritional sulfur that helps strengthen connective tissue. MSM has captured interest among the nutritional science community because of its ability to strengthen and maintain joints and collagen structures. It is also a scavenger for free radicals and foreign proteins. Patients usually use 1,500 mg of MSM twice a day. Initial onset of action is typically three to six weeks, with maximum benefits seen at three months. I have used it with moderate success. It sometimes works very well, and sometimes does not work at all.
TCM expert Bob Flaws wrote a very interesting piece on a Mainland China TCM treatment for SLE. He reported that most of his patients had wind, damp, and heat blockages, liver energy blockage, kidney Yin and/or digestive energy (Spleen Qi) weakness, and sometimes blood stasis (Flaws 1999). He used complex formulas that would require formulation by a professional TCM practitioner according to signs and symptoms. I would agree, and my clinical experience confirms that these problems require complex and long-term guidance under a professional. Any suggestions I make here (and elsewhere, for that matter) should not be seen as panaceas.
TAM doctors suggest using anti-inflammatory herbs, along with laxative, diuretic and digestive herbs, for six months or longer. Effective anti-inflammatory herbs include triphala, guggul gum, and guduchi stem. Interestingly, they also use plasters that contain sulphur— MSM cream would perhaps be the modern equivalent. One unique medicine that may be of benefit is narayana taila, a complex medicated oil also used to treat osteoarthritis.
Antibiotic treatment with minocycline has been shown effective in rheumatoid arthritis, lending credence to the idea that there may be an unknown infectious component to CTD's (Kawanaka N et al. 1998). In fact allopathic doctors are increasingly using two antibiotics, sulfasalazine and minocycline, that have been shown effective in treating rheumatoid arthritis. I have seen Dr. David Jezyk, a holistic MD, put rheumatoid arthritis patients into temporary remission using these medicines. This method seems to only work in a percentage of patients, perhaps about 1/3. This treatment can serve as a good beginning for a holistic program. Along similar lines, and as a result of my own experiences in developing protocols for MS (another autoimmune disease), I have concluded that immune system tonification is an important component of treatment. I often use herbs like ginseng root and astragalus root.
Dietary counseling is essential. I often find that the diet for heat and dampness is the best choice. The exercises of T'ai Chi and Yoga, combined with “breathwork” such as Qi gong and Pranayama, work to restore energy and elasticity directly to this tissue and are therefore fundamental to the treatment of CTD's.
I treat CTD patients by first helping them to understand the importance of strict dietary control as outlined above. I think it is important for patients to accept the fact that CTD's do not respond to “quick fix” methods. I then formulate at least two long-term herbal combinations, choosing herbs primarily from the following lists, emphasizing different herbs depending on the patient's signs and symptoms. My choices are highly individualized.
Herbs for treating CTDs
• To strengthen the body's own anti-oxidant status and liver removal of toxins, choose from amla fruit, dandelion root, milk thistle seed, wheat sprouts, and white peony root.
• I often use two or three grams of concentrated wheat sprouts for a minimum of six weeks early in the therapy.
• To directly remove inflammation and swelling, make a combination of herbs that reduce heat or heat and dampness such as ashwaghanda root, boswellia gum, honeysuckle flower, licorice root, raw rehmannia root, rhubarb root, willow bark, guduchi stem, and turmeric root (concentrated to be high in curcumin)
• Essential fatty acids are critical to use
• To modulate the immune system and reduce autoimmune attack, use either (a) low-dose prednisone (b) moducare or © isocort. This part of the protocol is critical, not as an end in itself, but to buy time for the cleansing and dietary therapies to work.
• For digestive support and to help the body eliminate protein or sticky deposits, use high doses of digestive enzymes These should be used along with guduchi stem or kaishore guggul.
• To remove dampness and swelling, choose from black atractylodes, coix, dandelion leaf, and phellodendron bark.
• To strengthen the connective tissue itself, choose from herbs and nutrients like glucosamine sulfate, gotu kola leaf, bamboo sap (Bambusa species), flavonoid-rich fruits, multi-mineral combinations, hawthorn, stoneroot and MSM. In scleroderma cases, MSM is also useful topically, as a cream.
Combinations of these herbs must be used in moderate to high doses for a long period of time, and chosen and adjusted according to patient response. Although we have not succeeded in completely reversing CTD's, many of our patients have experienced slowed progress and a noticeable reduction in symptoms. We have put some patients into remission, but it is too early to know if these will last. Not enough time has passed. You can add breathing and stretching exercises to the regimen once the patient has progressed enough to do them comfortably. This usually occurs a few months into treatment. Moderation is the key.
Rheumatoid arthritis is a chronic syndrome characterized by non-specific, usually symmetric inflammation of the peripheral joints, potentially resulting in progressive destruction of articular and periarticular structures (Berkow 1992, 1305). It is generally considered to be an autoimmune disease in which the immune system attacks the cartilage and joint linings. The synovial membrane becomes inflamed, proliferates and thickens, forming villi that encroach upon space in the joint. The inflammatory membrane then produces an abnormal granulation tissue, called pannus that adheres to the surface of the articular cartilage. At the point of contact between the pannus and the hyaline cartilage, proteolytic enzymes are released and begin to digest the articular cartilage and subchondral bone, leading to joint deformities.
Diagnosis of RA
According to the Merck Manual, any four criteria must be present to diagnose rheumatoid arthritis; criteria 1 through 4 must have been present for at least 6 weeks:
Morning stiffness for at least one 1 hour Arthritis of at least three joints Arthritis of hand joints Symmetric arthritis Rheumatic nodules Serum rheumatoid factor, by a method positive in more than 5% of normal control subjects Radiographic changes (erosions, decalcification) (Berkow 1992, 1307)
Diagnostic factors in laboratory investigations include elevated ESR (Erythrocyte Sedimentation Rate), normocytic anemia, rheumatoid factor (usually IgM subclass, but also IgG and IgA), elevated immunoglobulins, and lowered serum complement. Investigations of the synovial fluid itself should reveal low viscosity, high cell count (mostly neutrophils), low glucose, high protein and positive RF (Rheumatoid Factor) (Berkow 1992, 1307). Medical Treatment of RA
Complete bed rest is occasionally indicated for short periods during the most active painful stage of the severe disease. In less severe cases regular rest periods are recommended.
Nonsteroidal antiinflammatory drugs (NSAIDs) such as acetylsalicylic acid (ASA), ibuprofen and celecoxib are the traditional cornerstones of medical treatment, along with acetaminophen. All of these drugs except acetaminophen inhibit the cyclooxygenase-2 (COX-2) pathway, thereby preventing the synthesis of the PgE2 series of prostaglandins that promotes inflammation. Acetaminophen in contras exerts its analgesic activity through the inhibition of the nitric oxide pathway and neurotransmitter receptors including N-methyl-D-aspartate and substance P. Side effects for these drugs are numerous including nausea, vomiting, gastrointestinal irritation and ulceration, tinnitus, vertigo, leukopenia, thrombocytopenia, anemia, edema, skin eruptions, asthma, and mental confusion. The side effects of acetaminophen specifically include renal tubular necrosis, renal failure and hepatoxicity (Berkow 1992, 1308-9).
Corticosteroids are also employed and will provide dramatic results initially, although they do not prevent destruction of the joint and will eventually become of less benefit with chronic use. Side effects are weight gain, water and sodium retention, high blood pressure, osteoporosis, thinning of the skin, cataracts, acne, muscle weakness, immunosuppression, stomach ulcers and depression (Berkow 1992, 1310-11).
Immunosuppressive drugs such as cyclosporine and azathioprine are used in rheumatoid arthritis unresponsive to NSAIDs, and function mostly by inhibiting and suppressing white blood cells and the immune response. Side effects due to azathioprine include gastrointestinal disturbances, heartburn, immunosuppression, bleeding and bruising, and malignancy. A side effect due to cyclosporine is kidney damage. Methotrexate is also employed to inhibit cell growth and is used as an antineoplastic drug as well. Possible side effects include mucosal ulceration and bone marrow suppression (Berkow 1992, 1311). Immunomodulators (e.g. abatacept), Interleukin Receptor Inhibitors (e.g. anakinra, tocilizumab), and Tumor Necrosis Factor (TNF) Inhibitors (e.g. infliximab) also inhibit the immune response by suppressing the activity of proteins and cytokines such as CD80, TNF-alpha and interleukins 1 and 6 that participate in the immune response (King and Worthington 2010). All these drugs have serious side-effects including immunosuppression and risk of serious infection.
Remittive drugs such as gold and penicillamine are used in patients suffering from serious rheumatoid arthritis. It is not entirely clear how they work but may produce clinical remission and a decrease in tissue destruction. Side effects to gold include pruritis, dermatitis, stomatitis, thrombocytopenic purpura and aplastic anemia as well as diarrhea, hepatitis, pneumonitis and neuropathy. Marrow suppression, proteinuria, nephrosis as well as fatalities due to penicillamine have been reported (Berkow 1992, 1309-10).
Exercise to restore muscle mass and preserve normal range of motion is also encouraged, as well as orthopedic shoes for those so affected. Surgery and joint replacement is indicated in severe degeneration and must be undertaken while the disease is active. Ayurvedic Treatment of RA
The classic text on diagnosis called the Madhava Nidana provides three basic causes of amavata, a condition described in Ayurveda that is very similar to the clinical description of rheumatoid arthritis:
Weakness of digestion: The digestive fire is one of the prime motivators of all human function, ensuring the proper absorption and metabolism of nutrition. When digestion is impaired ama accumulates, the doshas become vitiated, and the vitality (ojas) diminishes. Incompatible foods in the diet: Incompatible foods include foods consumed out of season or without respect to local bioclimactic factors; unfamiliar foods (asatmya, i.e. opposite of the healthy norm [satmya], i.e. non-traditional foods; spoilt and contaminated foods; food additives; refined flour; feed-lot and farmed meat, etc. Lack of physical activity: Physical exercise (vyama) is considered an important aspect to dinacharya, the daily regimen recommended in Ayurveda. A lack of exercise predisposes one to amavata because the circulation of blood to and the removal of wastes (ama) from the periphery is impaired.
The treatment of inflammatory joint disease is threefold:
support and enhance digestion (agni) facilitate the removal of ama from the body repair damaged tissues and restore vitality (ojas)
The initial treatment often begins with enkindling agni, the digestive fire. This can be achieved by a short period of fasting, sudation therapy and the use pungent and bitter herbs. Fasting is particularly appropriate during a time of exacerbation: the food should be light, little and liquid. Weak ginger tea with a little lemon and honey and a simple diet of kichari (mung and rice soup) is best. Dipanapachana herbs to stimulate the appetite (‘dipana’) and ‘eat up’ (‘pachana’) the accumulated ama include Guduchi (Tinospora cordifolia), Guggulu (Commiphora mukul), Lasuna (Allium sativum), Haritaki (Terminalia chebula), Shunthi (Zingiber officinalis) and Yavani (Trachyspermum ammi). One important formula for amavata is Yogaraja guggulu, the Ayurvedic text the Chakradatta stating that it “stimulates the digestive fire, promotes energy and strength, and overcomes vatika (vata) disorders even if located in the joints and marrow” (Sharma 2002, 250). The Ayurvedic Formulary of India suggests a recommended dose of 3 grams, twice daily (1978, 58-59). While Yogaraja guggulu is best used for the chronic pain of RA, another guggulu called Kaisara guggulu is frequently used concurrently to reduce active inflammation.
The elimination of ama in the joints is best facilitated by applying an oil to the affected area, such as castor oil, and followed with dry heat. Medicated oils used in amavata include Kottamchukadi taila and Mahanarayana taila. Once the oil has been applied, heated brick dust, heated sand, or powdered rock salt may be wrapped inside a linen bag and applied to the affected area to enhance blood flow. It is important to note however, that counterirritant therapies should never be used in during active inflammation. Warm water and medicated enemas are used to remove ama in the digestive tract and correct the flow of vata. Gentle laxative called aperients such as Triphala and bulk laxatives like Isabgol (Plantago psyllium) improve the tone of the colon as well as cleanse the dhatus. Hatha yoga and regular exercise also becomes important at this time as it increases circulation to and away from the affected areas, although the person would do well to take care and not engage in any strenuous exercise that may damage the joints further. Western herbal treatment of RA
Treatment of RA in the Western herbal tradition is along the similar line as Ayurvedic therapies, focusing on measures to restore digestion, promote elimination and restore integrity to the joints.
Digestive remedies are frequently given in the form of a bitter tonic, which functions by improving digestion, especially of proteins by increasing HCl acid production, which may protect against undigested proteins that can irritate the gut wall and stimulate immune reactions. An excellent bitter tonic is Devil’s Claw (Harpagophytum procumbens) which contains the iridoid glycoside harpogoside that has significant analgesic effects. Other useful bitter tonics include Gentian (Gentiana lutea) and Barberry (Berberis vulgaris), which may also be combined with carminatives such as Caraway (Carum carvi) and Fennel (Foeniculum vulgare) to enhance digestion.
To cleanse and detoxify the tissues, a number of remedies are used in tandem including diuretics, alteratives and cholagogues. Diuretics such as Birch leaf (Betula alba) and Celery seed (Apium graveolens) are useful as the kidneys are the body's primary way to eliminate acids that may build up in the joints. Alteratives and cholagogues such as Yellowdock (Rumex crispus), Burdock (Arctium lappa), Dandelion root (Taraxacum officinalis), and Barberry (Berberis vulgaris) are all useful for cleansing and facilitating elimination, clearing the body of accumulated toxins. In addition to these remedies, circulatory stimulants such as Prickly Ash berry (Zanthoxylum spp) and Ginger root (Zingiber officinalis) are used increase blood flow to the affected areas, breaking up stagnation in the joints, as well as have diaphoretic actions that promote elimination.
Joint restoratives typically utilize herbs that contain an abundance of minerals that help to restore joint integrity, including seaweeds (e.g. Laminaria, Fucus, Macrocystis spp.), Nettle (Urtica dioica) and Horsetail (Equisetum arvense). White Bryony (Bryonia dioica) is a potentially toxic herb that is considered to be a restorative specific to the serous membranes by nourishing and increasing the secretion of synovial fluid, the 1:3 dry plant tincture dosed at between 5-10 drops thrice daily.
Supplementary measures undertaken to relieve pain may include a variety of anti-inflammatory, analgesic, muscle relaxant and sedating herbs including White Willow bark (Salix alba), Black Cohosh (Actaea racemosa), Kava (Piper methysticum), Wild Yam (Dioscorea villosa) and Jamaican Dogwood (Piscidia erythrina).
Supplementation with antioxidants can help with repair of tissues and prevent further damage to tissues and cells by free-radicals generated in a toxin producing diet and a stressful environment. Vitamin C and E, as well as selenium, zinc, super oxide dismutase, N-acetyl cysteine, manganese and bioflavonoids are all useful antioxidants.
Topical applications in Western herbal medicine include poultices, baths, lotions, plasters and salves. Counterirritants can be used during remissive phases to promote local circulation, including Kelp (Fucus spp.), Cayenne (Capsicum spp), Jimsonweed (Datura stramonium) and Ginger root (Zingiber officinalis). During active inflammation useful topical herbs include St. John’s Wort (Hypericum perforatum) and Lobelia (Lobelia inflata).
For more information on RA and dietary therapies, please refer to the section on autoimmune disease.
Definition Rheumatoid Arthritis (known as Amavata in Ayurveda) is an autoimmune disease that causes chronic inflammation of the joints. It can also cause inflammation of the tissue around the joints, as well as in other organs in the body. Autoimmune diseases are illnesses that occur when the body's tissues are mistakenly attacked by their own immune system. Patients with autoimmune diseases have antibodies in their blood that target their own body tissues, where they can be associated with inflammation. Because it can affect multiple other organs of the body, Rheumatoid Arthritis is referred to as a systemic illness and is sometimes called rheumatoid disease.
Causes Increased intake of indigestible, heavy and incompatible foods; having food at improper times; indigestion; intake of milk and milk products, especially yogurt; intake of meat of aquatic animals; lack of physical activity or doing exercise after having fatty foods are some of the common causes of Rheumatoid Arthritis.
Symptoms There is pain and stiffness in the body along with thirst, lethargy, heaviness in the body, indigestion, swelling, and sometimes lack of appetite. In acute stages, there is pain and stiffness in the joints of the hands, feet, wrists, ankles, and knees.
Ayurvedic View Improper food habits and sedentary lifestyle can lead to impairment of digestive fire, formation of ama (toxin) and vitiation of Vata (air). When a person indulges in Vata-aggravating diet and lifestyle, then this aggravated Vata circulates ama in the channels of the body and deposits it in the joints, causing Amavata.
Ayurvedic treatment of Rheumatoid Arthritis starts with pacification of Vata and elimination of toxins from the body. Herbal medicines are administered to improve the digestive fire and prevent further formation of ama. Panchakarma massage therapies are quite useful in subsiding pain in Arthritic patients.
Diet & Lifestyle Advice
Increase intake of barley flour, horse gram (a type of bean), split green gram, honey, celery seeds, cumin seeds, dried ginger root powder, garlic, bitter gourd and castor oil.
Avoid eating fish and milk together or milk and jaggery together.
Avoid incompatible, heavy, and oily foods.
Avoid an improper diet and lifestyle, such as waking up late in the night, suppressing natural urges of the body, and getting direct exposure to cold winds.
Some Home Remedies
Fasting is the best method to digest ama. It could be absolute fasting, i.e., having nothing until the ama is digested, or having a liquid or semi-solid diet, depending on the patient’s strength. This is to be followed by hot fomentation (application of moist heat) that can be done by having a bath with lukewarm water or a steam bath.
After fasting and fomentation, one should take herbal preparations to increase digestive fire. Mix powdered long pepper, black pepper, and dried ginger root in equal quantities. Take 1 teaspoon of the powder with lukewarm water twice a day.
Dry fomentation (application of dry heat) using sand is very helpful for reducing pain and swelling. Take a four-folded cloth, fill with hot sand, and make a bundle of it. Place the bundle on the painful joints.
Arthritis From Wikipedia, the free encyclopedia
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Arthritis Classification and external resources
Hands affected by rheumatoid arthritis, an autoimmune form of arthritis ICD-10 M00.-M25. ICD-9 710-719 DiseasesDB 15237 MedlinePlus 001243 eMedicine topic list MeSH D001168
Arthritis (from Greek arthro-, joint + -itis, inflammation; plural: arthritides) is a form of joint disorder that involves inflammation of one or more joints.
There are over 100 different forms of arthritis. The most common form, osteoarthritis (degenerative joint disease) is a result of trauma to the joint, infection of the joint, or age. Other arthritis forms are rheumatoid arthritis, psoriatic arthritis, and related autoimmune diseases. Septic arthritis is caused by joint infection.
The major complaint by individuals who have arthritis is joint pain. Pain is often a constant and may be localized to the joint affected. The pain from arthritis occurs due to inflammation that occurs around the joint, damage to the joint from disease, daily wear and tear of joint, muscle strains caused by forceful movements against stiff, painful joints and fatigue. Contents
1 Classification 2 Differential diagnosis 2.1 Osteoarthritis 2.2 Rheumatoid arthritis 2.3 Lupus 2.4 Gout 2.5 Other 3 Signs and symptoms 3.1 Disability 4 Diagnosis 5 Prevention 6 Treatment 6.1 Physical Therapy 6.2 Medications 7 Epidemiology 8 History 9 See also 10 References 11 External links
 Classification Crystal Clear app kedit.svg
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Primary forms of arthritis:
Osteoarthritis Rheumatoid arthritis Septic arthritis Gout and pseudo-gout Juvenile idiopathic arthritis Still's disease Ankylosing spondylitis
Secondary to other diseases:
Ehlers-Danlos Syndrome Sarcoidosis Henoch-Schönlein purpura Psoriatic arthritis Reactive arthritis Haemochromatosis Hepatitis Wegener's granulomatosis (and many other vasculitis syndromes) Lyme disease Familial Mediterranean fever Hyperimmunoglobulinemia D with recurrent fever TNF receptor associated periodic syndrome Inflammatory bowel disease (Including Crohn's Disease and Ulcerative Colitis)
An undifferentiated arthritis is an arthritis that does not fit into well-known clinical disease categories, possibly being an early stage of a definite rheumatic disease.  Differential diagnosis  Osteoarthritis
Osteoarthritis is the most common form of arthritis. It can affect both the larger and the smaller joints of the body, including the hands, feet, back, hip or knee. The disease is essentially one acquired from daily wear and tear of the joint; however, osteoarthritis can also occur as a result of injury. Osteoarthritis begins in the cartilage and eventually leads to the two opposing bones eroding into each other. Initially, the condition starts with minor pain while walking but soon the pain can be continuous and even occur at night. The pain can be debilitating and prevent one from doing some activities. Osteoarthritis typically affects the weight bearing joints such as the back, spine, and pelvis. Unlike rheumatoid arthritis, osteoarthritis is most commonly a disease of the elderly. More than 30 percent of females have some degree of osteoarthritis by age 65. Risk factors for osteoarthritis include: prior joint trauma, obesity, sedentary lifestyle.
Osteoarthritis, like rheumatoid arthritis, cannot be cured but one can prevent the condition from worsening. Weight loss is the key to improving symptoms and preventing progression. Physical therapy to strengthen muscles and joints is very helpful. Pain medications are widely required by individuals with osteoarthritis. When the disease is far advanced and the pain is continuous, surgery may be an option. Unlike rheumatoid arthritis, joint replacement does help many individuals with osteoarthritis.  Rheumatoid arthritis
Rheumatoid arthritis is a disorder in which, for some unknown reason, the body's own immune system starts to attack body tissues. The attack is not only directed at the joint but to many other parts of the body. In rheumatoid arthritis, most damage occurs to the joint lining and cartilage which eventually results in erosion of two opposing bones. Rheumatoid arthritis affects joints in the fingers, wrists, knees and elbows. The disease is symmetrical and can lead to severe deformity in a few years if not treated. Rheumatoid arthritis occurs mostly in people aged 20 and above. In children, the disorder can present with a skin rash, fever, pain, disability, and limitations in daily activities. No one knows why rheumatoid arthritis occurs and all treatments are focused on easing the symptoms. With earlier diagnosis and aggressive treatment, many individuals can lead a decent quality of life. The drugs to treat rheumatoid arthritis range from corticosteroids to monoclonal antibodies given intravenously. The latest drugs like Remicade can significantly improve quality of life in the short term. In rare cases, surgery may be required to replace joints but there is no cure for the illness.  Lupus
This is a common collagen vascular disorder that can be present with severe arthritis. Other features of lupus include a skin rash, extreme photosensitivity, hair loss, kidney problems, lung fibrosis and constant joint pain.  Gout
Gout is caused by deposition of uric acid crystals in the joint, causing inflammation. There is also an uncommon form of gouty arthritis caused by the formation of rhomboid crystals of calcium pyrophosphate known as pseudogout. In the early stages, the gouty arthritis usually occur in one joint, but with time, it can occur in many joints and be quite crippling. The joints in gout can often become swollen and lose function. Comparison of some major forms of arthritis Osteoarthritis Rheumatoid arthritis Gouty arthritis Speed of onset Months Weeks-months Hours for an attack Main locations Weight-bearing joints (such as knees, hips, vertebral column) and hands Hands (proximal interphalangeal and metacarpophalangeal joint) wrists, ankles and knees Great toe, ankles, knees and elbows Inflammation No Yes Yes Radiologic changes
Narrowed joint space Osteophytes Local osteosclerosis Subchondral cysts
Narrowed joint space Bone erosions
"Punched out" bone erosions
Laboratory findings None Anemia and elevated ESR and rheumatoid factor Crystal in joints Other features
No systemic signs Bouchard's and Heberden's nodes
Extra-articular features are common Ulnar deviation, swan neck- and Boutonniere deformity of the hand
Infectious arthritis is another severe form of arthritis. It presents with sudden onset of chills, fever and joint pain. The condition is caused by bacteria elsewhere in the body. Infectious arthritis must be rapidly diagnosed and treated promptly to prevent irreversible and permanent joint damage.
Psoriasis is another type of arthritis. With psoriasis, most individuals develop the skin problem first and then the arthritis. The typical features are of continuous joint pains, stiffness and swelling. The disease does recur with periods of remission but there is no cure for the disorder. A small percentage develop a severe painful and destructive form of arthritis which destroys the small joints in the hands and can lead to permanent disability and loss of hand function.  Signs and symptoms Extra-articular features of joint disease Cutaneous nodules Cutaneous vasculitis lesions Lymphadenopathy Oedema Ocular inflammation Urethritis Tenosynovitis (tendon sheath effusions) Bursitis (swollen bursa) Diarrhea Orogenital ulceration
Regardless of the type of arthritis, the common symptoms for all arthritis disorders include varied levels of pain, swelling, joint stiffness and sometimes a constant ache around the joint(s). Arthritic disorders like lupus and rheumatoid can also affect other organs in the body with a variety of symptoms.
Inability to use the hand or walk Malaise and a feeling of tiredness Fever Weight loss Poor sleep Muscle aches and pains Tenderness Difficulty moving the joint
It is common in advanced arthritis for significant secondary changes to occur. For example, in someone who has limited their physical activity:
Muscle weakness Loss of flexibility Decreased aerobic fitness
These changes can also impact on life and social roles, such as community involvement.  Disability
Arthritis is the most common cause of disability in the USA. More than 20 million individuals with arthritis have severe limitations in function on a daily basis. Absenteeism and frequent visits to the physician are common in individuals who have arthritis. Arthritis makes it very difficult for individuals to be physically active and soon become home bound.
It is estimated that the total cost of arthritis cases is close to $100 billion of which nearly 50% accounts from lost earnings. Each year, arthritis results in nearly 1 million hospitalizations and close to 45 million outpatient visits to health care centers.
Arthritis makes it very difficult for the individual to remain physically active. Many individuals who have arthritis also suffer from obesity, high cholesterol or have heart disease. Individuals with arthritis also become depressed and have fear of worsening symptoms.  Diagnosis
Diagnosis is made by clinical examination from an appropriate health professional, and may be supported by other tests such as radiology and blood tests, depending on the type of suspected arthritis. All arthritides potentially feature pain. Pain patterns may differ depending on the arthritides and the location. Rheumatoid arthritis is generally worse in the morning and associated with stiffness; in the early stages, patients often have no symptoms after a morning shower. Osteoarthritis, on the other hand, tends to be worse after exercise. In the aged and children, pain might not be the main presenting feature; the aged patient simply moves less, the infantile patient refuses to use the affected limb.
Elements of the history of the disorder guide diagnosis. Important features are speed and time of onset, pattern of joint involvement, symmetry of symptoms, early morning stiffness, tenderness, gelling or locking with inactivity, aggravating and relieving factors, and other systemic symptoms. Physical examination may confirm the diagnosis, or may indicate systemic disease. Radiographs are often used to follow progression or help assess severity.  Prevention Wiki letter w cropped.svg This section requires expansion.  Treatment
There is no cure for either rheumatoid or osteoarthritis. Treatment options vary depending on the type of arthritis and include physical therapy, lifestyle changes (including exercise and weight control), orthopedic bracing, medications. Joint replacement surgery may be required in eroding forms of arthritis. Medications can help reduce inflammation in the joint which decreases pain. Moreover, by decreasing inflammation, the joint damage may be slowed.  Physical Therapy
In general, studies have shown that physical exercise of the affected joint can have noticeable improvement in terms of long-term pain relief. Furthermore, exercise of the arthritic joint is encouraged to maintain the health of the particular joint and the overall body of the person.
Individuals with arthritis can benefit from both physical and occupational therapy. In arthritis the joints become stiff and the range of movement can be limited. Physical therapy has been shown to significantly improve function, decrease pain, and delay need for surgical intervention in advanced cases. Exercise prescribed by a physical therapist has been shown to be more effective than medications in treating osteoarthritis of the knee. Exercise often focusses on improving muscle strength, endurance and flexibility. In some cases, exercises may be designed to train balance. Occupational therapy can teach you how to reduce stress on your joint from daily living activities. Occupation therapy can also teach you how to modify your home and work environment so that you do reduce movements that may worsen your arthritis. There are also assist devices available that can help you drive, getting a bath, dressing and also in housekeeping labors.
Occupational therapy can help you do everyday activities without worsening pain or causing joint damage. The techniques can help you distribute pressures to minimize stress on any one joint. Ways to accomplish daily living tasks are made easier.  Medications
Treatment typically begins with medications that have the fewest side effects with further medications being added if insufficiently effective. Treatment depends on the type of the arthritis. The first-line treatment for osteoarthritis is acetaminophen while for inflammatory arthritis it involves non-steroidal anti-inflammatory drugs like ibuprofen.  Epidemiology
Arthritis is predominantly a disease of the elderly, but children can also be affected by the disease. More than 70% of individuals in North America affected by arthritis are over the age of 65. Arthritis is more common in women than men at all ages and affects all races, ethnic groups and cultures. In the United States a CDC survey based on data from 2007–2009 showed 22.2% (49.9 million) of adults aged ≥18 years had self-reported doctor-diagnosed arthritis, and 9.4% (21.1 million or 42.4% of those with arthritis) had arthritis-attributable activity limitation (AAAL). With an aging population this number is expected to increase.  History
While evidence of primary ankle (kaki) osteoarthritis has been discovered in dinosaurs, the first known traces of human arthritis date back as far as 4500 BC. In early reports, arthritis was frequently referred to as the most common ailment of prehistoric peoples. It was noted in skeletal remains of Native Americans found in Tennessee and parts of what is now Olathe, Kansas. Evidence of arthritis has been found throughout history, from Ötzi, a mummy (circa 3000 BC) found along the border of modern Italy and Austria, to the Egyptian mummies circa 2590 BC 
In 1715 William Musgrave published the second edition of his most important medical work De arthritide symptomatica which concerned arthritis and its effects.
Blood tests and X-rays of the affected joints often are performed to make the diagnosis. Screening blood tests are indicated if certain arthritides are suspected. These might include: rheumatoid factor, antinuclear factor (ANF), extractable nuclear antigen, and specific antibodies.  See also
Arthritis Care (charity in the UK) Osteoimmunology Arthritis Foundation (US not-for-profit) Knee arthritis
^ thefreedictionary.com > arthritis in turn citing: The American Heritage Dictionary of the English Language, Fourth Edition copyright 2000 Collins English Dictionary – Complete and Unabridged, HarperCollins Publishers 2003 The American Heritage Science Dictionary Copyright 2005 ^ Healthline ^ Web MD ^ Wollenhaupt, J.; Zeidler, H. (1998). "Undifferentiated arthritis and reactive arthritis". Current opinion in rheumatology 10 (4): 306–313. PMID 9725091. edit ^ VanItallie TB (October 2010). "Gout: epitome of painful arthritis". Metab. Clin. Exp. 59 (Suppl 1): S32–6. doi:10.1016/j.metabol.2010.07.009. PMID 20837191. ^ Witter J, Dionne RA (2004). "What can chronic arthritis pain teach about developing new analgesic drugs?". Arthritis Res. Ther. 6 (6): 279–81. doi:10.1186/ar1450. PMC 1064875. PMID 15535840. ^ Chronic Diseases Australian Institute Of Health And Welfare. Retrieved on 2010-01-24 ^ Rheumatoid Arthritis: Differential Diagnoses & Workup~diagnosis at eMedicine ^ Severe Arthritis Disease Facts Retrieved on 2010-02-05 ^ Unless otherwise specified in table box, the reference is: Agabegi, Elizabeth D.; Agabegi, Steven S. (2008). "Table 6–7". Step-Up to Medicine. Step-Up Series. Hagerstwon MD: Lippincott Williams & Wilkins. p. 253. ISBN 0-7817-7153-6. ^ Diagnosis lag time of median 4 weeks, and median diagnosis lag time of 18 weeks, taken from: Chan, K.; Felson, D.; Yood, R.; Walker, A. (1994). "The lag time between onset of symptoms and diagnosis of rheumatoid arthritis". Arthritis and rheumatism 37 (6): 814–820. PMID 8003053. edit ^ Schaider, Jeffrey; Wolfson, Allan B.; Gregory W Hendey; Louis Ling; Carlo L Rosen (2009). Harwood-Nuss' Clinical Practice of Emergency Medicine (Clinical Practice of Emergency Medicine (Harwood-Nuss)). Hagerstwon, MD: Lippincott Williams & Wilkins. pp. 740 (upper right of page). ISBN 0-7817-8943-5. ^ Severe Arthritis Disease Facts Retrieved on 2010-02-05 ^ Psoriatic Arthritis Mayo Clinic. Retrieved on 2010-02-05 ^ Swash, M, Glynn, M.(eds). 2007. Hutchison's Clinical Methods. Edinburgh. Saunders Elsevier. ^ Arthritis: The Nation’s Most Common Cause of Disability Centers for disease prevention and health promotion. Retrieved on 2010-01-24 ^ ^ Arthritis: The Nation’s Most Common Cause of Disability Centers for disease prevention and health promotion. Retrieved on 2010-01-24 ^ Chronic Arthritis treatment, symptoms and relief Retrieved on 2010-01-24 ^ Types of Arthritis The Arthritis Society. Retrieved on 2010-02-05 ^ How to treat arthritis Retrieved on 2010-02-01 ^ Ettinger Wh, Jr; Burns, R; Messier, SP; Applegate, W; Rejeski, WJ; Morgan, T; Shumaker, S; Berry, MJ et al. (1997). "A randomized trial comparing aerobic exercise and resistance exercise with a health education program in older adults with knee osteoarthritis. The Fitness Arthritis and Seniors Trial (FAST)". JAMA : the journal of the American Medical Association 277 (1): 25–31. doi:10.1001/jama.277.1.25. PMID 8980206. edit ^ Fransen M, Crosbie J, Edmonds J (January 2001). "Physical therapy is effective for patients with osteoarthritis of the knee: a randomized controlled clinical trial". J. Rheumatol. 28 (1): 156–64. PMID 11196518. ^ Arthritis Disability Information Centers for disease control and prevention portal. Retrieved on 2010-02-01 ^ "Arthritis Drugs". arthritistoday.org. Retrieved July 5, 2010. ^ Walsh (7 October 2010). "One in Five Adults Has Arthritis". MedPage Today. based on Centers for Disease Control and Prevention (CDC) (October 2010). "Prevalence of doctor-diagnosed arthritis and arthritis-attributable activity limitation – United States, 2007–2009". MMWR Morb. Mortal. Wkly. Rep. 59 (39): 1261–5. PMID 20930703. ^ Bridges PS (1992). "Prehistoric Arthritis in the Americas". Annual Review of Anthropology 21: 67–91. doi:10.1146/annurev.an.21.100192.000435. ^ Arthritis History Medical News ^ Alick Cameron, "Musgrave, William (1655–1721)", Oxford Dictionary of National Biography, Oxford University Press, Sept 2004
 External links
Arthritis at the Open Directory Project American College of Rheumatology – US professional society of rheumatologists Arthritis Foundation – US national not-for-profit organization for arthritis
v · d · eMusculoskeletal disorders: Arthropathies (M00–M19, 711–719) Arthritis (monoarthritis/ polyarthritis) Inflammation (Neutrophilia)
Septic arthritis · Tuberculosis arthritis · Reactive arthritis (indirectly) Noninfectious
Seronegative spondyloarthropathy: Reactive arthritis · Psoriatic arthritis · Ankylosing spondylitis Rheumatoid arthritis: Juvenile idiopathic arthritis · Adult-onset Still's disease · Felty's syndrome Crystal arthropathy: Gout · Chondrocalcinosis Noninflammatory
Osteoarthritis: Heberden's node · Bouchard's nodes Other hemorrhage (Hemarthrosis) · pain (Arthralgia) · Osteophyte · villonodular synovitis (Pigmented villonodular synovitis) · Joint stiffness
anat(h/c, u, t, l)/phys
noco(arth/defr/back/soft)/cong, sysi/epon, injr
proc, drug(M01C, M4) v · d · eInflammation Acute Plasma derived mediators
Bradykinin · complement (C3, C5a, MAC) · coagulation (Factor XII, Plasmin, Thrombin) Cell derived mediators
preformed: Lysosome granules · vasoactive amines (Histamine, Serotonin) synthesized on demand: cytokines (IFN-γ, IL-8, TNF-α, IL-1) · eicosanoids (Leukotriene B4, Prostaglandins) · Nitric oxide · Kinins Chronic Macrophage · Epithelioid cell · Giant cell · Granuloma Processes Traditional: Rubor · Calor · Tumor · Dolor (pain) · Functio laesa Modern: Acute-phase reaction/Fever · Vasodilation · Increased vascular permeability · Exudate · Leukocyte extravasation · Chemotaxis Specific types Nervous
CNS (Encephalitis, Myelitis) · Meningitis (Arachnoiditis) · PNS (Neuritis) · eye (Dacryoadenitis, Scleritis, Keratitis, Choroiditis, Retinitis, Chorioretinitis, Blepharitis, Conjunctivitis, Iritis, Uveitis) · ear (Otitis, Labyrinthitis, Mastoiditis) Cardiovascular
Carditis (Endocarditis, Myocarditis, Pericarditis) · Vasculitis (Arteritis, Phlebitis, Capillaritis) Respiratory
upper (Sinusitis, Rhinitis, Pharyngitis, Laryngitis) · lower (Tracheitis, Bronchitis, Bronchiolitis, Pneumonitis, Pleuritis) · Mediastinitis Digestive
mouth (Stomatitis, Gingivitis, Gingivostomatitis, Glossitis, Tonsillitis, Sialadenitis/Parotitis, Cheilitis, Pulpitis, Gnathitis) · tract (Esophagitis, Gastritis, Gastroenteritis, Enteritis, Colitis, Enterocolitis, Duodenitis, Ileitis, Caecitis, Appendicitis, Proctitis) · accessory (Hepatitis, Cholangitis, Cholecystitis, Pancreatitis) · Peritonitis Integumentary
Dermatitis (Folliculitis) · Cellulitis · Hidradenitis Musculoskeletal
Arthritis · Dermatomyositis · soft tissue (Myositis, Synovitis/Tenosynovitis, Bursitis, Enthesitis, Fasciitis, Capsulitis, Epicondylitis, Tendinitis, Panniculitis) Osteochondritis: Osteitis (Spondylitis, Periostitis) · Chondritis Urinary
Nephritis (Glomerulonephritis, Pyelonephritis) · Ureteritis · Cystitis · Urethritis Reproductive
female: Oophoritis · Salpingitis · Endometritis · Parametritis · Cervicitis · Vaginitis · Vulvitis · Mastitis
male: Orchitis · Epididymitis · Prostatitis · Balanitis · Balanoposthitis pregnancy/newborn: Chorioamnionitis · Omphalitis Endocrine
Insulitis · Hypophysitis · Thyroiditis · Parathyroiditis · Adrenalitis Lymphatic
Lymphangitis · Lymphadenitis Categories: Aging-associated diseases | Arthritis | Inflammations | Rheumatology | Skeletal disorders
Ayurvedic cures can be sought for any ailments, however arthritis is the most common ailment that sufferers take the Ayurvedic methods for.
To the Ayurvedic way of thinking bodily pain is caused of vata dosha and is primarily an air disease When too much ama, which is a toxin produced by a poor digestive system, accumulates within the bodily system it aggravates vata. The ama then circulates around the body until it settles in weak spots, most often the joint areas. Where these ama settle it causes arthritis in the effected joints.
Despite the best efforts of the finest medical scientists there is no known cure for arthritis and so the Ayurvedic methods can only alleviate this very painful condition.
To attain this Ayurvedic prescribes a combination of good diet and healthy eating, herbal remedies, exercise and a more spiritual outlook for the sufferer. Useful Dietary Information for Arthritic Remedy
Ayurvedic advises that you avoid hot and spicy food and other foodstuffs that can aggravate bodily gas like cabbage, cauliflower, broccoli, okra, potatoes etc.
It also advises that stuffs like coffee, tea, sugar, yoghurt amongst others should only be enjoyed in moderation. This is too aid the purification of the digestive system.
The best foodstuffs to consume to achieve purification are: Fruit Juices, homemade soups, fresh fruit, green salads and cooked vegetables like pumpkin and squash.
Herbs and spices to use in the Ayurvedic cure for arthritis Cumin Coriander Ginger Asafetida Garlic Fennel Turmeric
These are readily and cheaply available and can be easily added when cooking most foods.
Other herbal remedies are Guggul and Contra-Indications which can be ingested by adding a small dose to a cup of warm water twice daily.
But note Contra-Indications is dangerous to those suffering from kidney ailments and should be taken if you are.
Fasting is another method used in Ayurvedic arthritis treatment. It goes without saying that if taken too far this can be very dangerous, but if done in moderation it is a wonderful way, even if you choose only to partly fast, to purify the body of all its toxins.
To achieve this safely you should take into account the age of the person and the seasonal local weather conditions and to fast for only about one day out of seven.
Other remedies for arthritis with the Ayurvedic method
Light exercise. But don’t go overboard, know your limits and don’t exercise too much that it causes further aggravation to your arthritic condition.
Regular intake of orange juice or other vitamin C based beverage, as the goodness of the vitamins helps combat skeletal pain.
Regular body massages in mustard, sesame oils or by-products of reduces vata which thus reduces the pain. Rub harder and longer on the most severely affected areas for full benefits.
If you are an arthritis sufferer then the Ayurvedic way is probably the healthiest way to ease your very painful condition. All the above methods should be done in moderation and to suit the individual needs and health. To get the best results it is best to do a little bit of each one.
Adapted from Fair Use Source: http://www.ayurvedic-medicines.com/arthritis.html
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