Rheumatoid Arthritis
Rheumatoid Arthritis is a chronic degenerative form of Arthritis which particularly affects the small joints of the hands, wrists, feet and ankles. It is the classic ‘Wind-Damp’ (Feng Shi) joint disease of TCM. Ayurveda calls its Ama-Vata (Ama is the toxic residue of undigested food; Vata is Wind), thus showing a close etiology with TCM. This also highlights the ‘Damp’ of TCM being a by-product of improper digestion.Differential Diagnosis
Acute cases or acute exasperation are associated with exposure to Wind, Cold and Damp. In these cases diaphoretics can be used such as Feverfew, Asarum, Cinnamon twig (Gui Zi) Siler and Saposhnikovia Fang Feng. Wind is also predominant in moving types of Rheumatoid Arthritis, where pain moves around the body affecting different areas at diffreent times,
Acute active forms with Heat, inflammation and pain are treated with medicine to clear Heat and Swelling. Rhubarb, Madder, Swertia, Andrographis, Coptis, Centaury, Gentian and Gentiana Qin Jiao are some of the drugs useful in such situations.
Chronic forms are used associated with Wind-Cold-Damp. There will be chronic pain, swollen joints, aggravation in cold or damp weather. Chronic forms are also typically associated with Kidney (and Liver) deficiency. There will be lower back pain, nocturnal urination. If the Yin is deficienct, there is dry mouth and throat, dry skin and joints. If the Yang is deficienct, there is copious clear urine, feeling of cold, deep and slow pulse.
Medicines used in the treatment of RA
Various functions are required in the Treatment which will include several of the following:
- Regulate Qi, opens Obstructions (Cyperus rotundus, Costus etc.)
- Strengthen Digestion (Ginger, Pepper etc,)
- Clear Damp (Agaric, Colchicum, Poria Fu Ling etc,)
- Promote Circulation, open the capillaries (Asarum, Saffron, Cinnamon twig etc)
- strengthen Bones and Joints (Comfrey, Eucommia Du Zhong etc.)
- clear Heat, Inflammation and Pain (Centuary, Turmeric etc.)
In all Traditions, some of the strongest medicines used was in the treatment of Rheumatoid Arthritis.
In the Western Tradition, purging was indicated, and of the purging medicines, formulas based on Colchicum were most used for Joint disease including Rheumatism. Aloes and Rhubarb also feature prominently in traditional Joint Formulas of the West. In the eastern systems, Aconite and Nux Vomica are often used.
Medicines that strengthen the Kidneys, Bones and Joints include Comfrey, Mistletoe, Eucommia Du Zhong, Dipsacus Xu Duan, Achyranthes Niu Xi and Shilajit. Other tonic medicines are added according to need, but Spleen tonics like Elecampane, Atractylodes Bai Zhu and Withania are useful to increase Qi and strengthen digestion to inhibit formation of Damp.
Warming, aromatic medicines are very important due to their general nature of clearing Damp and regulating or moving Qi. All the spices are beneficial and appear in various formulas for Joint disease. Cinnamon twig (Gui Zhi), Asarum and Saffron are particularly useful medicines with aromatic, opening qualities directed towards the fine capillaries.
Some simple Folk Remedies:
1. Celery.
a. Take Garden Celery and cut into pieces, and boil in water until soft. This water may be taken throughout the day.
b. The following recipe may also be prepared: ‘Put new milk, with a little flour and nutmeg, into a saucepan with the boiled Celery, serve it warm with a piece of toast, and the painful ailment will soon yield’. This was said to have cured many serious cases of rheumatism. (Vitalogy)
c. Celery seed tea, taken daily over months has been effective in some cases
2. Asparagus
Stalks of fresh Asparagus boiled in 1.5 cups of water in a covered pan until it falls apart; mash into a paste; add another 0.5 cup of water to thin; boil 3 minutes. Drink twice a day; once upon rising; once at bedtime’. (Green Medicine, Mrs. C. F. Leyel, 1890)
3. Nettle tea consumed regularly has likewise helped some cases.
4. Conserve of Rosehips, taken in spoonful doses every morning has relieved some cases.
Special Formula
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1. Gentian Agrimony 1 oz. each decoct briefly in 2 pints of water. ‘Remarkable results have been achieved in some advanced cases of Rheumatoid Arthritis’. The dose is a wine-glassful three or four times daily. (Wonders in Weeds, W. Smith) 2. Nettle Agrimony Birch leaf Celery seed Rosehip 3. Horsetail Elder flower Nettle Dandelion root & leaf Birch leaf 4. Yarrow Meadowsweet Sea Holly Chickweed half oz. ea. Decoct briefly in 2 pints of boiling water, strain, add 1 teaspoon of Cayenne powder and sit until cool. Strain. (Wonders in Weeds, W. Smith) 5. Willow bark Elder flower Rosemary Golden Rod Coltsfoot 6. Smilax glabra (Tu Fu Ling) Bolbostemma paniculatum (Tu Bei Mu) These have been combined in TCM as a stand-alone treatment with good results. |
7. ‘Artrex’: (doses per capsule) Turmeric 36mg Ginger 48mg Withania 180mg Frankincense 180mg Despite being a patent medicine it is closely allied with traditional Ayurvedic principles and formula. Research has proven efficacy and safety. (See here) 8. Clove Pills (Ayurveda) Triphala Clove Cubebs Cinnamon Indian leaf Cardamon Mesua ferrea Tabasheer Plumbago Prepared Iron Powder and take with Ghee and Treacle every morning. 9. Bi Qi Capsule: Prepared Nux Vomica (Ma Qian Zi) Earthworm (Di Long) Codonopsis Dang Shen Atractylodes Bai Zhu Poria Fu ling Salvia Dan Shen Ligusticum Chuan Xiong Panax notoginseng San Qi Achyranthes Niu Xi Licorice (Gan Cao) Research demonstrated efficacy similar to methotrexate but with no severe side effects noted. (See here) |
Research:
1. General/ Review–A mechanistic review on medicinal plants used for rheumatoid arthritis in traditional Persian medicine, (Farzaei et al., J. of Pharmacy and Pharmacol., June, 2016).
–Treatment of rheumatoid arthritis with traditional chinese medicine. (Lee WY et al. Biomed Res Int. (2014)
–Systems Pharmacology Dissection of Multiscale Mechanisms of Action for Herbal Medicines in Treating Rheumatoid Arthritis.
–Traditional Tibetan medicine: therapeutic potential in rheumatoid arthritis
–Impact of humid climate on rheumatoid arthritis faecal microbiome and metabolites
2. Specific Herbs
–Borage oil reduction of rheumatoid arthritis activity may be mediated by increased cAMP that suppresses tumor necrosis factor-alpha. (Kast, Int Immunopharmacol. Nov, 2001)
–Stems and leaves of Aconitum carmichaelii Debx. as potential herbal resources for treating rheumatoid arthritis: Chemical analysis, toxicity and activity evaluation.
–Total glucosides of paeony for rheumatoid arthritis: A systematic review of randomized controlled trials.
–Consumption of Hydrolyzable Tannins Rich Pomegranate Extract (POMx) Suppresses Inflammation and Joint Damage In Rheumatoid Arthritis
–200mg doses of an extract of Rhus verniciflua bark has been used in Korea as a stand-alone herb with promising results. (See here)
3. Combinations and Formula
–Therapeutic effects of Smilax glabra and Bolbostemma paniculatum on rheumatoid arthritis using a rat paw edema model.
–Arachidonic acid metabonomics study for understanding therapeutic mechanism of Huo Luo Xiao Ling Dan on rat model of rheumatoid arthritis.
–Wu-Tou Decoction Inhibits Angiogenesis in Experimental Arthritis by Targeting VEGFR2 Signaling Pathway.
–Efficacy and Safety of Gui Zhi-Shao Yao-Zhi Mu Decoction for Treating Rheumatoid Arthritis: A Systematic Review and Meta-Analysis of Randomized Clinical Trials.
–[Medicinal-powder-separated Long-snake Moxibustion over the Governor Vessel with Different Skin Vesiculation Conditions for Treatment of Patients with Rheumatoid Arthritis].