Balancing Act: TCM Approaches to Easing Rheumatoid Arthritis Discomfort

Rheumatoid Arthritis (RA)  is a chronic inflammatory disorder that causes joint inflammation and pain. RA commonly affects the hands, knees, ankles and usually the same joint on both sides of the body. In some people, RA can affect other parts of the body as well such as skin, eyes, lungs, heart and circulatory system. 

Unlike the wear-and-tear damage (degeneration) of osteoarthritis, RA is an autoimmune disease. The immune system mistakenly attacks the synovium, the lining of the membranes that surround the joints. The immune system considers the body’s own cells, particularly those in the synovium, as foreign invaders, leading to chronic inflammation. Synovium is the tissue lining around a joint that produces fluid to help the joint move smoothly. The chronic inflammation results in  red, warm, tender and painful swollen joints that can eventually cause bone erosion and joint deformity. In addition to the joints, RA can affect other organs in the body. 

Rheumatoid factor (RF) is an antibody that is often present in the blood of individuals with rheumatoid arthritis. Its presence is one of the diagnostic markers for RA, but not everyone with RA has detectable levels of RF, and some people without RA may have elevated RF levels.

The exact cause of RA remains unclear, but researchers believe that a combination of genetic and environmental factors plays a role in its development. It is thought that individuals with specific genetic predispositions may be more susceptible to RA, and certain environmental triggers can activate these genes. These triggers may include viral or bacterial infections, physical or emotional stress, or other external factors (for e.g. being constantly in a cold or humid environment).

The reasons behind a higher prevalence of RA in women compared to men remain unclear, and the condition typically manifests during middle age (25-50 years old). The likelihood of developing RA is higher for individuals with a family history of the condition.

 

Early stage of RA

• • Often affect smaller joints (wrist pain , certain joints (particularly the 2nd and 4th finger) in the hand and feet ) first 

• • Muscle aches or joint pain worsens during humid or rainy days

Disease progression

• • Affect other bigger joints like wrist, elbows, shoulders, hips, ankle and knee

• • Joint pain and deformity affecting daily activities 

• • Anemic 

• • About 40% of people also experience symptoms that do not involve the joints. 

The inflammation associated with RA can damage other parts of the body as well such as: 

Eyes: Dry eyes, redness or sensitivity to light 

Mouth: Dryness and chronic gum inflammation 

Skin: Rheumatoid nodules near joints (formed due to the accumulation of inflammatory cells and fibrous tissue)

Lungs: Chronic inflammation and scarring can lead to progressive shortness of breath

 

How TCM views Rheumatoid arthritis 

RA belongs to the category of “ 痹症，Bi Zheng” in Traditional Chinese medicine (TCM).

《素问·痹论》说：“风寒湿三气杂至，合而为痹也。”

TCM believes that the pathogenesis of RA is related to external causes and internal causes.

External cause: Wind, cold, heat and dampness pathogen

Internal cause: Deficiency of qi, blood, spleen, liver and kidney

RA etiology in TCM perspective 

其人平素体虚或劳倦内伤过甚，腠理空疏，元气不足，导致风寒湿邪（或郁而化热，或风湿热邪）流注于关节。

Experiencing chronic over-exhaustion or having a weaker body constitution may make one more susceptible to the invasion of wind, cold, or dampness pathogens targeting the joints. Extended inflammation leads to the buildup of heat and dampness within the joints.

若反复发炎则诸邪内损，可损及肝脾肾，亦能深伏于骨关节，筋脉，而血停为瘀，湿凝成痰，然后痰热互结，最总导致关节中肿胀，僵硬变形，而关节周围发生结节，皮肤色素沉着。

In the TCM  framework, chronic inflammation has the potential to harm the liver, spleen, and kidneys over time. This persistent inflammatory state can lead to either blood stasis or heat dampness, eventually giving rise to symptoms like swollen and deformed joints, the formation of rheumatoid nodules, or discoloration of skin.

 

TCM approach to treating RA

As rheumatoid arthritis can involve chronic joint discomfort and reduced mobility, TCM pain relief may be incorporated as complementary support depending on the individual’s condition. RA are generally categorized into three stages based on factors such as the duration of the condition, the type of pathogen involved, and the individual’s body constitution. Herbal medication, acupuncture and dietary restrictions are common methods to treat and manage RA. 

For a broader explanation of the proposed mechanisms, read about how acupuncture may support pain relief.

1.Initial stage (早期：Wind and cold dampness Type  风寒湿型)

Symptoms: 

• • Shorter duration 病程短

• • Generally weaker body constitution 多体虚

• • Morning stiffness and joint pain , especially during cold, humid or rainy environment or emotional triggers 晨僵，痛处受寒或气候潮湿或情绪波动时加重

• • No redness or warm joints 患处不发热发红

• • Aversion to cold or heat 恶寒发热

• • Floating and tight pulse 脉浮紧或沉弦带紧

Herbal prescription commonly used: 麻黄加白术汤加减 （麻黄， 桂枝，炒白芍，炙甘草，炒白术，姜黄，鸡血藤，忍冬藤等。) 

Common acupuncture points used

• • 五虎穴 

• • 复原穴 

• • 三间穴

• • 阴陵泉穴 

 

2. Middle stage (中期： 久病化热伤阴型）

Symptoms:

• • Pain in the hand and feet joints 四肢关节肿痛，僵硬

• • Morning stiffness worsens with inactivity 晨僵，屈伸不利

• • Other accompanying symptoms: Dry throat, heart palpitations, dizziness 咽干，心悸，眩晕

• • Tight, thin and fast pulse 脉弦细数

Herbal prescription commonly used: 桂枝芍药知母汤加减 （桂枝，白芍，炙甘草，知母，生石膏，白术，防风，生地，炮附子，石斛，姜黄，秦艽等。）

Common acupuncture points used

• • 五虎穴 

• • 复原穴 

• • 三叉三穴

• • 四肢穴

 

3. Late stage (晚期： 肝肾气血亏虚，痰瘀痹阻型)

Symptoms:

• • Chronic pain: persistent and intense joint pain 慢性疼痛，关节刺痛或僵直

• • Limited mobility 关节活动不利

• • Joint deformities: swelling, stiffness and changes in joint structure maybe more pronounced 关节变形

• • Rheumatoid nodules can be seen 可见类风湿结节

• • Decreased quality of life. Daily activities, social interactions, and mental well-being may be compromised. 生活素质变差。

Herbal prescription commonly used: 独活寄生汤合虎潜丸加减 （独活 桑寄生 秦艽 防风 黄芪 当归 生地黄 熟地黄 黄柏 知母 白薇 炒白芍 石斛 姜黄 淫羊藿 桂枝等。）

Common acupuncture points used

• • 五虎穴 

• • 复原穴 

• • 足三里穴

• • 丰隆穴

• • 太溪穴

Acupuncture is a traditional Chinese medicine practice that involves inserting thin needles into specific points on the body to stimulate energy flow and promote healing. Here are some potential ways acupuncture might help individuals with RA:

Pain Relief: Acupuncture may help alleviate pain associated with rheumatoid arthritis. The insertion of needles at specific acupuncture points is thought to stimulate the release of endorphins, the body’s natural painkillers, which may contribute to pain relief.

Inflammation Reduction: Some studies suggest that acupuncture may have anti-inflammatory effects. By modulating the immune system and reducing inflammation, acupuncture might contribute to the management of RA symptoms.

Improved Joint Function: Acupuncture may help improve joint function and mobility in individuals with RA. By promoting better circulation and reducing muscle tension, acupuncture might have positive effects on the range of motion in affected joints.

Dietary restrictions

Reduce consumption of
Sugary Foods, Cold Drinks, and Beer	Excessive sugar consumption is associated with inflammation, and some people may experience allergic reactions or increased joint pain as a result.
Raw and Cold Foods	In TCM, foods that are considered “cold” and “damp” are thought to obstruct the flow of yang energy, potentially leading to discomfort or achy joints.
Peanuts, chocolate, millet, yogurt, glutinous or dairy products	These certain foods possible due to their amino acid content  (tyrosine, phenylalanine or tryptophan), may contribute to production of inflammatory factors such as prostaglandins, leukotrienoic acid or IgE antibodies, potentially worsening joint inflammation or causing pain relapse
Too much sour food such as  sour plum, vinegar or lemon.	Sour foods are generally considered to have a contracting and cooling nature and may worsen joint pain.

One is encouraged to consume more Chinese barley (reduce dampness), black beans, green beans, yellow beans, soy products, chestnut or sesame, Chinese yam, carrot, blueberry or turmeric powders (antioxidant properties).

Early diagnosis and treatment in the earlier stages of RA can help prevent or slow down the progression to late-stage complications. Regular medical monitoring and adjustments to treatment plans are crucial in managing the disease effectively. Individuals with late-stage RA may benefit from working closely with a rheumatologist, TCM physicians and other healthcare professionals to optimize their care and improve their quality of life.

Note: Information provided is not a substitute for a physician or any form of medical care. Individual symptoms differ due to different body constitutions and diagnosis. One should consult a licensed TCM practitioner for accurate diagnosis and treatment.