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.