Rheumatic arthritis is an acute or chronic general
allergic diseases due to infection of hemolytic streptococcus. It is marked by
polyarticular, symmetric and wandering red-swelling and hot-pain of the joints
and temporary dyskinesia. It usually attacks the large joints of the limbs. it
is common in winter and spring. Its subjects are usually youth and children. Its
predisposing cause is often dampness and coldness. Its cure is not followed by
arthrokleisis and deformity of the joints. And it is included, in TCM, in the
category of "arthralgia-syndrome."
Etiology and Pathogenesis
This
disease is due to invasion of exopathogens and deficiency of vital qi. Invasion
of exopathogens is the exopathic cause; while deficiency of vital qi, the endopathic
one. The exopathogen mainly involves wind, cold and dampness; while the deficiency
of vital qi, general deficiency of yang qi and insufficiency of yin essence.
Invasion
of wind-cold-dampness pathogens into the muscles and joints leads to stagnation
of qi and blood in the channels and collaterals and , in turn, malnutrition of
the joints, or heat due to long retention of wind-cold-dampness pathogens results
in accumulation of phlegm-dampness in the channels, network-channels, joints and
tendons. By so doing, this disease results.
Type and Treatment
1. Type of
Wind-Arthalgia
Symptoms: Migratory Pain in the Joints, difficult flections
and extension of the joints, or exterior syndrome manifested as aversion to wind,
fever, etc. white tongue coating, usually floating or taut pulse.
Therapeutic
Method: removing wind, cold and dampness to clear the channels and arrest pain.
Prescription:
Fangfeng Tang (Decoction of Ledebouriellar Root).
Ingredients:
Fangfeng
Radix Saposhinkoviae
Duhuo Radix Angelicae Pubescent
Qinjiao Radix Gentianae
Macrophyllae
Danggui Radix Angelicae Sinensis
Gagen Radix Puerariae
Guizhi
Ramulus Cinnamomi
Baishao Radix Paeoniae Alba
Mahuang Herba Ephedrae
Shengjiang
Rhizoma Zingiberis Recens
Dazao Fructus Jujubae
Gancao Radix glycyrrhizae
Fuling
Poria
Administration: decocted in water for oral use, 1 dose daily.
Modification:
In case of pain mainly in the joints of the upper limb such as wrist joint, elbow
joint and shoulder joint the herbs added are Qianghuo Rhizoma seu Radix Notopterygii,
Jianghuang Rhizoma Curcumae Longae, Weilingxian Radix Clematidis, Sangzhi Ramulus
Mori.
In case of pain mainly in hip joint, knee joint and ankle joint, the
drugs added Niuxi Radix Achyranthis Bidentatae, Fangji Radix Stephaniae Tetrandrae,
Jixueteng Caulis Spatholobi, Mugua Fructus Chaenomelis and Bixie Rhizoma Dioscoreae
Hypoglaucae.
In case of pain mainly in the waist and back, the drugs added
are Duzhong Cortex Eucommiae, Buguzhi Fructus psoraleae, Sangjisheng Herba Taxilli,
Yinyanghuo Herba Epimedii, Laoguancao herba Erodii seu Geranii, Gouji Rhizoma
Cibotii and Chuanduan Radix Dipsaci.
2. Type of Cold-Arthralgia
Symptoms;
Severe localized pain in the joints which is relieved b heat and aggravated by
cold, fixed joints around which the skin is not red and does not feel hot, thin
and white tongue coating, and taut tense pulse.
Therapeutic Method: Dispelling
wind and cold, warming up the channels to relieve pain.
Prescription: Modified
Wutou Tang (Decoction of Sichuan Aconite Root).
Ingredients:
Huangqi Radix
Astragali
Mahuang Herba Ephedrae
Hangshao Radix Paeoniae Alba
Chuanwu
Radix Acoiti
Guizhi Ramulus Cinnamomi
Shengjiang Rhizoma Zingiberis Recens
Fengmi
Mel
Gancao Radix Glycyrrhizae
Administration: Decocted in water for oral
use, 1 dose daily.
Modification: Referring to the modification in wind-arthralgia.
3.
Type of Damp-Arthralgia
Symptoms: Localized soreness in the joints whose movement
is limited, or numbness of the muscles and skin, white greasy tongue coating,
and soft slow pulse.
Therapeutic Method: removing dampness from the channels,
dispelling wind and dispersing cold.
prescription: Yiyiren Tang (Decoction
of Coix Seed).
Ingredients:
Shengyiyiren Semen Coicis
Qianghuo Rhizoma
seu Radix Notopterygii
Duhuo Radix Angelicae Pubescentis
Mahuang Herba Ephedrae
Guizhi
Ramulus cinnamomi
Cangzhu Rhizoma Atractylodis
Danggui Radix Angelicae Sinensis
Chuanxiong
Rhizoma chuanxiong
Gancao Radix glycyrrhizae
Shengjiang Rhizoma Zingiberis
Recens
Administration: Decocted in water for oral use, 1 dose daily.
Modification:
In case of numbness of the muscles, skin, hands and feet, the drugs added are
Haitongpi Cortex Erythrinae, Xixiancao Herba Siegesbeckiae, Huangqi Radix Astragali,
Sangzhi Ramulus Mori.
In case of swelling and distension is the joints the
drugs added are Bixie Rhizoma Dioscoreae Hypoglaucae, Guanmutong Caulis Aristolochiae
Manshuriensis, Jianghuang Rhizoma Curcumae Longae, Fangji Radix Stephaniae Tetrandrae.
If
arthralgia due to wind, cold and dampness is not too severe, the prescription
Juanbi Tang ( Decoction for Treating Rheumatic or Rheumatoid Arthritis) may be
used instead whose ingredients are:
Qianghuo Rhizoma seu Radix Notopterygii
Duhuo
Radix Angelicae Pubescentis
Haifengteng Caulis Piperis Kadsurae
Qinjiao
Radix Gentianae Macrophyllae
Guizhi Ramulus Cinnamomi
Danggui Radix Angelicae
Sinensis
Chuanxiong Rhizoma Chuanxiong
Ruxiang Olibanum
Muxiang Radix
Aucklandiae
Sangzhi Ramulus Mori
Gancao Radix Glycyrrhizae
The ingredients
are decocted in water for oral use, 1 dose daily.
In case of stagnation of
qi and blood due to prolonged arthralgia marked y severe stabbing pain or pain
and numbness in the joints whose movements is limited, petechiae on the tongue,
and thready uneven pulse, the herbs added are
Moyao Myrrha
Niuxi Radix Achyranthis
Bidentatae
Taoren Semen Persicae
Honghua Flos Carthami
Quanxie Scorpio
Baihuashe
Agkistrodon Acutus
Wugong Scolopendra
Simple Prescription 1:
Weilingxian
Radix Clematidis adequate amount
Indications: Arthralgia due to wind, cold
and dampness.
Administration: Ground into coarse powder of the powder is mixed
with vinegar and then taken each time.
Simple Prescription2:
Jiezi Semen
Sinapis adequate amount
Indications: Rheumatic arthritis ad numbness in the
joints.
Administration: Ground into powder and mixed with long-stored vinegar
into a paste. The paste is spread o a piece of cloth and applied on the affected
part, several times daily.
Simple Prescription 3:
Aiye Folium Artemisiae
Argyi
Indications: Arthralgia due to wind, cold and dampness.
Contraindication:
Wind
Administration: Decocted in water for the decoction. The affected part
is washed again and again with the decoction which is kept hot.
Notes: All
the three Chinese patent medicines mentioned are used to treat arthralgia due
to wind, cold and dampness.
4. Type of Wind-Damp-Heat Arthralgia
Symptoms:
Red-swelling and hot-pain in the joints which are relieved by cold and aggravated
by moving, fever, sweating, thirst, circle red spots or subcutaneous nodule, constipation
or loose stools, reddened tongue with greasy coating, and rapid pulse.
Therapeutic
Method: Removing dampness, clearing away heat, eliminating obstruction from the
channels and arresting pain.
Prescription: Xuanbi Tang (Decoction for Removing
Obstruction).
Ingredients:
Fangji Radix Stephaniae Tetrandrae
Lianqiao
Fructus Forsythiae
Yiyiren Semen Coicis
Banxia Rhizoma Pinelliae
Xingren
Semen Armeniacae Amarum
Wancansha Excrementa Bombycum
Huashi Talcum
Chixiaodou
Semen Phaseoli
Administration: Decocted in water for oral use, 1 dose daily.
Modification:
In case f more evident dampness marked by severe localized pain in the joints
around which there exists flatting swelling that does not look reddish, the herbs
added are Fuling Poria, Wujiapi cortex Acanthopanacis.
In case of more evident
heat marked by fever, dry mouth and thirst, red-swelling and hot-pain in the joints,
and the pain which becomes aggravated by palpation, the drugs omitted are Banxia
Rhizoma Pinelliae, Chixiaodou Semen Phaseoli, the drugs added are Shengdi Radix
Rehmanniae, Maidong Radix Ophiopogonis, qinjiao Radix Gentianae Macrophyllae,
Sangzhi Ramulus Mori, Rendongteng Caulis Lonicerae, Shengshigao Gypsum fibrosum,
Zhimu Rhizoma Anemarrhenae, Guizhi Ramulus Cinnamomi.
If there appear circle
red spots, the herbs added are Chishao Radix Paeoniae Rubra, Honghua Flos Carthami,
Danpi Cortex Moutan, Sigualuo Retinervus Luffae Fructus, Shengdi Redix Rehmanniae,
Danggui Radix Angelicae Sinensis.
For subcutaneous nodule, the herbs added
are Haizao Sargassum, Juhong Exocarpium Citri Rubrum, Chishao Radix Paeoniae Rubra,
Zaoci Spina Gleditsiae.
Proven Prescription
Ingredients:
Laoguancao Herba
Erodi seu Geranii
Xixiancao Herba Siegesbeckiae
Administration: Decocted
in water for oral use, 1 dose daily.
Chinese Patent Medicine: Fengshi Guanjieyan
Pain (Tablet for Treating Rheumatic Arthritis).
Administration: Taken with
warm boiled water, 3-4 tablets each time, twice daily. One course of treatment
involves 10 days and there is an interval of 2-3 days between two courses.
5.
Type of Arthralgia due to Deficiency of Qi and Blood
Symptoms; Joint pain sometimes
mild and sometimes severe, limited movement, soreness, numbness, no red-swelling
or swelling which does not look red, all of which are relieved by heat and aggravated
y cold, listlessness, acratia, palpitation, shortness of breath, poor appetite,
loose stools, pale complexion, pale tongue with white coating, and weak or thready
rapid pulse.
Therapeutic Method: Invigorating Qi and blood, nourishing the
kidney and liver, and expelling wind and dampness.
Prescription: Sanbi Tang
(Decoction for Treating Three Types of Arthralgia).
Ingredients:
Huangqi
Radix Astragali
Dangshen Radix Codonopsis
Chuanniuxi Radix Cyathulae
Fuling
Poria
Gancao Radix Glycyrrhizae
Rougui Cortex Cinnamomi
Shudi Radix Rehmanniae
Preparata
Danggui Radix Angelicae Sinensis
Baishao Radix Paeoniae Alba
Chuanxiong
Rhizoma Chuanxiong
Duzhong Cortex Eucommiae
Chuanduhuo Radix Angelicae Pubescentis
Qinjiao
Radix Gentianae Macrophyllae
Fangfeng Radix Saposhinkoviae
Xixin Herba Asari
Administration:
Decocted in water for oral use, 1 dose daily.
Notes: In the treatment of arthralgia,
drugs such as Fuzi Radix Aconiti Lateralis Preparata Chuanwu Radix Aconiti are
often used for the purpose of removing wind-dampness and warming the channels
to arrest pain. Principles to be followed when such drugs are used are as follows:
1.
Their dosage should be small in the beginning and added step by step.
2. They
should be decocted first in order to be decocted longer.
3. Same amount of
Gancao (Radix Glycyrrhizae) or Proper amount of Shengjiang (Rhizoma Zingiberis
Recens) and Fengmi (Mel) may be used to reduce their toxicity.
Prevention
Take
an active part in physical training, prevent infection of the upper respiratory
tract, pay attention to proper exposure to cold and warmth, avoid long living
in a wet place, and strike a proper balance between work and rest.
Dr. Ming's
TCM Medical Center,
Hua Xi Xiao Yuan, Hutian Developing Area,
Huaihua city,
Hunan province
China