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.