Treating rheumatoid arthritis by TCM

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Rheumatoid arthritis is a chronic systemic autoimmune disease characterized by pathologic changes of the joints. Clinical manifestation is symmetric polyarthritis with the joints of hands, wrists and feet involved. In the early stage, there can be redness, swelling, hot sensation, pain and limited motion in the affected joints. In the severe stage, stiffness and deformity of joints can be seen. The prognosis of rheumatoid arthritis is unfavorable, about 10% of the patients are disabled.
In TCM, rheumatoid arthritis pertains to obstructive syndrome. The external factors are exogenous pathologic wind, cold, dampness and heat; internal factors are insufficient Qi and blood, deficiency of liver and kidney, Ying-Wei disharmony and Yin-Yang disharmony, etc. Pathogenesis is the blockage of meridians and collaterals, Qi stagnation and blood stasis. In the chronic stage, phlegm stagnation and blood stasis will happen, which induce insufficiency and excess complicated.
Dr. Zhicai Chen, professor in Shanghai Tianshan TCM hospital, think that reducing pain and swell in treating rheumatoid arthritis is important.
For the severe pain patients, she put forwards inquiring and checking pain, including pain character, symptoms that the patients’ complains, temperature of the pain location, pulse, tongue fur, skin color, etc. for example,
1. Severe pain, the patients feel heat and averse to press pain location, powerful pulse. Companied by feverish body, scanty yellow urine, red eyes, constipation, excessive thirst, and red tongue with yellow tongue fur. This is heat type, clearing heat and reducing pain are therapeutic methods. Modified by Rendongteng, Huangbai, Zhimu, Shengdi, Lianqiao, etc.
2. Chronic pain, aversion to clod and preference to heat and press, pain location is not heat and color is normal, slow pulse, light color and swollen tongue. Companied by water stool. This is cold type. Eliminating cold, warming meridians and reducing pain. Modified by Fuzi, Wutou, Guizhi, etc.
For the swollen patients, the skin color, temperature, swollen location’s softness or hardness are keys. That is, cold and heat, red and white, soft and hard. For example,
1. Normal skin color or dull, swollen location is cold and not hard. Warming Yang and removing blood stasis to reduce swell. Prescribing Si Wu Tang plus Gui Zhi Tang.
2. Red skin color, swollen location is heat and tense. Clearing heat and reducing swell are therapeutic methods. Modified by Yinhua, Chishao, Danpi, Lianqiao, Zhimu, etc.
3. Prolonged and slight swell, normal skin color, diffuse swelling, if the fingers sink into the skin when the skin is pressed and the depression on the skin fails to rebound when the fingers are lifted. White and greasy tongue fur, removing dampness and reducing pain are therapeutic methods. Modified by Fangji, Fuling, Zexie, Cheqian, Mirengen, etc. for lower limbs’ swelling, add Nuixi, Mugua, etc.
Reducing pain and swell are only treating branch. After the pain and swell disappearing, treating root is necessary by syndrome differentiation. For example, strengthening the spleen and removing dampness, nourishing the kidney and liver, in order to make the diseases’ condition stable and reduce recurrent rate.

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