Rheumatoid arthritis (RA) is a chronic disease, mainly characterized by the inflammation of the lining, or synovium, of the joints. It can lead to long-term joint damage, resulting in chronic pain, loss of function and disability.

RA progresses in three stages. The first stage is the swelling of the synovial lining, causing pain, warmth, stiffness, redness and joint swelling. The second stage is the rapid division and growth of cells, which causes the synovium to thicken. In the third stage, the inflamed cells release enzymes that may digest bone and cartilage, often causing the involved joint to lose its shape and alignment, eliciting more pain and loss of movement. Because of its chronic nature, RA continues indefinitely and may not go away. Frequent flares can occur.

RA affects people differently. For some people, it lasts only a few months or a year or two and then goes away without causing any noticeable damage. Other people may have mild or moderate forms of the disease, with periods of worsening symptoms, called flares, and periods when they feel better, called remissions. Still, others may have a severe form of the disease that is active most of the time, lasting for many years or even a lifetime. This form can lead to serious joint damage and disability.

The cause of RA is unknown. According to Traditional Chinese Medicine, this condition is called Bi Zheng, which is typically divided into four types: Wind-Cold Bi, Cold-Bi, Dampness-Bi and Heat-Bi. Through a thorough examination and consultation, including an assessment of the pulse and tongue, a diagnosis is made. Specific acupuncture points and herbs are prescribed and an appropriate diet is designed for the patient to follow. For Wind-Bi, adding green onions and ginger to your diet will help expel the Wind. For Cold-Bi, choose black pepper and dry ginger. Soy bean sprouts and pearl barley are beneficial for Dampness-Bi. For Heat -Bi, you should consume mung bean sprouts and winter melon.

Generally, your daily diet should include enough fresh vegetables, and foods rich in omega 3 and 6, such as flax seeds, sunflower seeds and walnuts. Supplement 100% of your calcium. During flares, eat more bitter melon and dandelion greens to reduce heat. Add some pearl barley, tofu, celery and Chinese yam to alleviate swollen joints. During remissions, eat more mushrooms such as black wood ear to strengthen your immune system. People suffering from RA should avoid oily and greasy food, dairy, shellfish, seaweed, egg, sugar, alcohol and excessive salt. Depending on your specific condition, consult with a TCM practitioner for an appropriate diet.

Dr. Xiaomei Cai graduated from Chengdu University of Traditional Chinese Medicine in China. She was chief doctor in Chengdu University of TCM Hospital. She practiced Chinese Medicine as a senior doctor and gynecological surgeon for over ten years in the Gynecology Department. She owns a Doctorate degree of Oriental Medicine. She also done extensive research and published numerous academic papers in the field of gynecology and reproductive medicine in China. She is a licensed acupuncturist in the state of California and has been practicing since 1986. Along with her general practice she has special interest in reproductive and gynecological conditions. She is a member of Pacific Coast Fertility Society and World Alternative Medicine Organization.

Rheumatoid arthritis (RA) is traditionally considered a chronic, inflammatory autoimmune disorder that causes the immune system to attack the joints. It is a disabling and painful inflammatory condition, which can lead to substantial loss of mobility due to pain and joint destruction. RA is a systemic disease, often affecting extra-articular tissues throughout the body including the skin, blood vessels, heart, lungs, and muscles.

The name is derived from the Greek rheumatos meaning “flowing”, the suffix -oid meaning “in the shape of”, arthr meaning “joint” and the suffix -itis, a “condition involving inflammation”.

Articular (joints)

Rheumatoid arthritis is a chronic, inflammatory, multisystem, autoimmune disorder. It commonly affects the joints in a polyarticular manner. The symptoms that distinguish rheumatoid arthritis from other forms of arthritis are inflammation and soft-tissue swelling of many joints at the same time (polyarthritis). The joints are usually affected initially asymmetrically and then in a symmetrical fashion as the disease progresses. The pain generally improves with use of the affected joints, and there is usually stiffness of all joints in the morning that lasts over 1 hour. Thus, the pain of rheumatoid arthritis is usually worse in the morning compared to the classic pain of osteoarthritis where the pain worsens over the day as the joints are used.

As the pathology progresses the inflammatory activity leads to erosion and destruction of the joint surface, which impairs their range of movement and leads to deformity. The fingers are typically deviated towards the little finger (ulnar deviation) and can assume unnatural shapes. Classical deformities in rheumatoid arthritis are the Boutonniere deformity (Hyperflexion at the proximal interphalangeal joint with hyperextension at the distal interphalangeal joint), swan neck deformity (Hyperextension at the proximal interphalangeal joint, hyperflexion at the distal interphalangeal joint). The thumb may develop a “Z-Thumb” deformity with fixed flexion and subluxation at the metacarpophalangeal joint, leading to a “squared” appearance in the hand.

Extra-articular (elsewhere)
Extra-articular manifestations also distinguish this disease from osteoarthritis (hence it is a multisystemic disease). For example, most patients also suffer of anemia, either as a consequence of the disease itself (anaemia of chronic disease) or as a consequence of gastrointestinal bleeding as a side effect of drugs used in treatment, especially NSAIDs (non-steroidal anti-inflammatory drugs) used for analgesia. Splenomegaly may occur with concurrent leukopaenia (Felty’s syndrome), and lymphocytic infiltration may affect the salivary and lacrimal glands (Sjögren’s syndrome).

Dermatological
Subcutaneous nodules on extensor surfaces, such as the elbows, are often present.

Pulmonary
The lungs may become involved as a part of the primary disease process or as a consequence of therapy. Fibrosis may occur spontaneously or as a consequence of therapy (for example methotrexate). Caplan’s nodules are found as are pulmonary effusions.

Autoimmune
Vasculitic disorders, resulting in nail fold infarcts, neuropathies and nephropathies.

Renal
Amyloidosis, which can also result in muscular pseudohypertrophy.

Cardiovascular
Pericarditis, endoscarditis, left ventricular failure, valvulitis and fibrosis.

Ocular
Keratoconjunctivitis sicca (dry eyes), episcleritis and scleromalacia.

Neurological
There can be signs of mononeuritis multiplex and atlanto-axial subluxation. The latter is due to erosion of the odontoid process and or/transverse ligaments in the cervical spine’s connection to the skull. Such an erosion (>3mm) can give rise to vertebrae slipping over one another and compressing the spinal cord. At first the patient experiences clumsiness but without due care this can progress to quadraplegia.

Epidemiology
Rheumatoid arthritis occurs most frequently in the 40-60 age group, although can start at any age. It is strongly associated with the HLA marker DR4 (W4, W14 & W15 are associated with the disease and W10 & W13 are protective) - hence family history is an important risk factor. The disease is 3 times more common in women than men and up to 4 times more common in smokers than non-smokers.

Diagnosis
Diagnostic criteria
The American College of Rheumatology has defined (1987) the following criteria for the diagnosis of rheumatoid arthritis:[1]

Ancient Chinese Remedies For Arthritis

By Maoshing Ni, L.Ac., Ph.D.

As the population of America ages, the most common health concern of physically active baby-boomers is the condition of their joints. It is estimated that 70 million Americans have some form of arthritis. Furthermore, countless Americans undergo surgical procedures for joint injuries every year. Besides obvious traumas, common causes of arthritis include heredity, infections, aging and environment. If left untreated, arthritis and joint problems can be crippling and vastly affect ones quality of life.

Chances are you or someone you know has arthritis. Arthritis is one of the most common diseases in the U.S. and is the leading cause of disability. According to the Centers for Disease Control and Prevention, one out of every three Americans is affected by one of the more than 100 types of arthritis. These include conditions such as osteoarthritis, rheumatoid arthritis, gout, carpal tunnel syndrome, lupus, Lyme disease, ankylosing spondylitis, bursitis, tendonitis and fibromyalgia to name a few.

The cause of most types of arthritis is unknown. Scientists are currently studying aging, genes, environment and lifestyle factors that contribute to the development of arthritis. The most common symptoms involve pain, stiffness and swelling around the joints or soft tissue. This can contribute to difficulty in daily activities that require movement. Other symptoms may include fatigue, fevers, depression and weight gain.

The one common characteristic of any arthritic condition is inflammation. The inflammation is an immune system response to a foreign invasion (virus), injury or dysfunction (auto-immune response). Conventional treatments include anti-inflammatory agents, steroids and other immuno-suppressant drugs complemented by physiotherapy. The side effects of conventional treatments can be immense and often trouble arthritic patients for the rest of their lives.

There is another way to obtain relief from arthritis without the side effects of taking drugs”the Chinese medicine way. This alternative to western medicine is several thousands of years old with a strong track record of good results.

In Chinese medicine, arthritis is called a Bi or stagnation and stasis condition. We categorize Bi conditions according to their symptomatic characteristics such as location, intensity of pain, amount of heat or inflammation and amount of swelling and disability. For example, arthritic pain that moves from joint to joint is called Xin Bi or moving arthritis.

Both external and internal factors can cause arthritis. External causes include invasion by pathogenic factors such as wind, cold or dampness that obstruct the normal flow of Qi and blood, thereby resulting in swelling, stiffness, numbness and pain of the joints and soft tissues. Internal causes include emotional stress weakening the defensive ability of ones immune system and depletion of the Kidney/vitality system resulting in degeneration of ones bones, tendons and cartilage.

Treating arthritis in Chinese medicine focuses on ridding the body of the invading pathogens, restoring normal circulation and flow of blood and Qi, promoting emotional harmony and fortifying the Kidney/Vitality system. Effective treatments include acupuncture, moxibustion, herbal and dietary therapy, exercise therapy, cupping and massage.
Acupuncture

Acupuncture has been found to be clinically effective in reducing arthritic pain and improving mobility and circulation. Often, localized acupuncture therapy directly on the joint or tissue itself, with or without electrical stimulation or moxa (heat therapy with the herb mugwort) can be extremely helpful in managing arthritis. This obviously requires obtaining treatments from a licensed acupuncturist.
Herbal Therapy

Herbal therapy is useful in reducing inflammation, nourishing joints and soft tissues and improving ones energy. It may also be a useful replacement for anti-inflammatory drugs that some people find upsetting to their stomach. Besides relieving arthritic symptoms, it is as important to nourish and prevent the onset of arthritis. There is good news for arthritis sufferer unable to access acupuncture treatments.

Traditions of Tao, a company dedicated to the research of herbal products for modern needs formulated Healthy Joint and Arthritis Elixir to help people nourish and promote the proper function of their joints. It also offers relief of symptoms of arthritis.

The Healthy Joint and Arthritis Elixir is specially formulated based on long years of Ni Family clinical success in helping their patients with joint conditions.

This proprietary formula contains licorice root and peony root, which soothe pain and spasms; notopterygium root and Korean ash bark dispel dampness from the joints and restores flexibility; eucommia bark and mulberry stem nourish the joints; dang gui root, sheng di root and Szechwan lovage root promote proper lubrication of the joints; astraglus root modulates and balances the immune system; Chinese lovage root, peach kernel and safflower support proper circulation; and finally poria root helps proper stomach and digestive function.
Dietary Therapy

Dietary Therapy advocates avoiding foods that produce dampness or mucous that may further obstruct the flow of qi and blood in the channels, therefore exacerbating the arthritis.
Foods to avoid:

* cow milk products (milk, cheese, yogurt, butter, ice cream, etc.)
* night shade vegetables (tomato, eggplant, peppers, potato)
* deep fried and fatty foods
* processed and refined foods
* cold and raw foods (salads, fruits)
* wheat
* red meat
* alcohol
* coffee
* sugar

Exercise Therapy

Exercise Therapy focuses on joint mobility, increasing circulation and strengthening tendons, ligaments and muscles. The best types of exercise include water exercise, taiji, qigong, gentle yoga, stationary bike, walking and light weight-training.
Cupping and Massage

Cupping and Massage are treatment modalities designed to vastly increase circulation to affected areas, ridding toxins and waste products that aggravate inflammation and introducing the joints and tissues to fresh nutrients and oxygen. These techniques are effective for reducing swelling, stiffness and pain.

There is no reason why you cannot live a full and active life, even if you suffer from arthritis. The therapies listed above, either alone or in combination can vastly improve your quality of life if you practice them diligently.

Dr. Maoshing Ni, a Licensed Acupuncturist and a Diplomat of Chinese Herbology, is currently in general practice at the Tao of Wellness Clinic in Santa Monica, California. The Tao of Wellness Clinic is one of the oldest in Los Angeles, established in 1976. (310) 917-2200

Causes of Arthritis from Chinese Medical Perspective

By Yang, Jwing-Ming

The author of this article, Mr. Jwing-Ming Yang, has done a wonderful job of translating traditional Oriental concepts into words and ideas that are better understood by us in the Western world. For more information on how arthritis is described in the terms that practitioners of traditional Chinese medicine use, please see the article on “Bi” Syndromes among the Clinical Point Selections.

“Bi” means pain, and many of the “Bi” syndromes overlap with the Western differentiation of arthritis.

Although we understand how some forms of arthritis start, we are still in the dark about other forms. In this section we would like to summarize the known possible causes, and also contribute some ideas from Chinese medicine and Qigong.

1. Weakness of the Internal Organs:

We already know that the condition of the internal organs is closely related to our health. According to Chinese medicine, there are five Yin organs which are considered the most important for our health and longevity. These organs are the heart, liver, lungs, kidneys, and spleen. Whenever any of these five organs is not functioning properly, sickness or even death can occur. Furthermore, all of these five organs are mutually interrelated. Whenever there is a problem with one, the others are always involved too. For example, gouty arthritis is caused by the improper functioning of the liver and kidneys.

2. Defective Genes:

Only recently it was reported that some forms of arthritis are caused by defective genes, which are inherited from one’s parents. According to Chinese medicine, the genes are considered the essence of your being. This essence is responsible for the production of hormones, from which Qi is generated. When this Qi is led to the brain, the spirit is raised. When all of these conversion processes are functioning normally, the immune system is strong and sickness is less likely. One of the main goals of Qigong is learning how to convert the essence into Qi efficiently and lead it to the brain.

3. Weak Joints:

Weak joints can come from heredity or from lack of exercise. The body is a living machine, so the more you use it, the better condition it will be in. Chinese medicine believes that even if you have inherited a weak joint it is still possible to strengthen it through Qigong. When you exercise, Qi is brought to the joint by the movement of the muscles and tendons. This will nourish the joint and rebuild it.

4. Injury:

According to today’s medicine, some forms of arthritis are caused by injury to the joints. Although the injury may not be serious, it may have significant results. The injury can affect the muscles, tendons, ligaments, or even the cartilage and bone. Whenever any joint injury, even a minor one, is not treated, the normal smooth Qi circulation in the joint area will be affected. If the situation persists, the Qi imbalance can cause problems such as arthritis.

5. Aging:

Aging has always been the cause of many sicknesses, including arthritis. When you are old, the Qi level in your body is low. Since your system is being deprived of the required amount of Qi, it starts to degenerate. One of the main goals of Qigong practice is learning how to slow down the aging process by building up the Qi in the body.

6. Qi Deficiency:

Qi deficiency is responsible for many problems. It can be caused by emotional depression and sadness, which can lead the Qi inward and make the body Yin. This deprives the outer body of Qi. When this happens, you will generally feel cold. If the problem persists for a long time, the muscles and tendons will be affected by the the lack of Qi, and the joints will be weakened.

Qi deficiency can have other causes, such as the weather. For example, your body’s Qi is more deficient in the winter, and there fore, arthritis can be more serious then.

Qi deficiency can also be caused by working for prolonged periods in a damp area, or by exposing your joints to the cold.

7. Tension:

Tension includes both mental tension and physical tension, which are related and cannot be separated. Constant mental and physical tension can increase the pressure on the joints. For example, some people are very tense and grind their teeth in their sleep, which can cause arthritis in the jaw.

A lot of body tension is caused by the emotional disturbance which is related to your mental reaction to stressful events. For this reason, learning how to regulate your mind is an important part of the treatment of arthritis.

2-5. Other Possible Means of Preventing or Curing Arthritis

In addition to the ones already discussed, there are a number of other methods of preventing or curing arthritis. Although many of them are still awaiting scientific confirmation, they may be worth your consideration. However, you must understand that everybody has his or her own unique characteristics, and his or her own unique inheritance. In addition to the habits and lifestyle that each person has developed, everyone’s mental and physical structure is different. For example, some people are affected by allergies while others are not. What this means is that you cannot necessarily use the same method to treat different people, even when they have the same disease. Even modern Western medicine has found that the same treatment will not work equally well on all patients. Therefore, do not automatically brush off some of the treatment methods we will discuss. After all, Western medicine is only in its infancy, and it may come to understand and accept these alternative remedies.

1. Diet:

People who are experienced in Qigong have always considered food to be a significant influence on the condition of the Qi in the body. For this reason, diet is one of the main concerns of Chinese medicine. There is a saying: “You are what you eat.” It is well known that improper diet is one of the main causes of gouty arthritis. The Chinese have found many different herbs that can ease the pain and reduce the swelling of arthritis. It has recently been discovered that protein, calories, and fats can reduce the inflammation of arthritis. Certain fish oils may interfere with the process of inflammation and therefore reduce the symptoms of rheumatoid arthritis.(*5, *6).

2. Change of Residence:

Since the Qi in your environment can affect the Qi in your body, arthritis sufferers should give serious consideration to this method. If the climate where you live is too damp or too cold, it may be affect ing your arthritis. It has recently been discovered that the Qi in our bodies can be significantly affected by the electromagnetic fields generated by modern technology, and therefore cause some forms of cancer. For example, people who live near high tension power lines tend to get cancer more often than those who do not. Perhaps similar environmental effects on arthritis will be found.

3. Change of Lifestyle:

Your lifestyle affects how the Qi circulates in your body. If you frequently feel ill, especially mentally, you might need to change your lifestyle. How you think and how you coordinate the Qi pattern in your body with the natural Qi is very important for your health. Whenever your Qi circulation is against the “Dao” (nature), you will be sick. You may find that walking for an hour or doing Qigong exercises every morning improves your Qi circulation.

4. Clothing:

What you wear also affects the Qi in your body. In the winter you must stay warm, and especially protect your joints. Joints that are left unprotected can loose Qi very quickly.

It has been discovered that many man-made fibers can adversely affect the Qi distribution and circulation in the body. For example, polyester is known to cause Qi stagnation, and to prevent the body’s Qi from exchanging with the environmental Qi. You may have noticed that clothing made of polyester can accumulate a considerable charge of static electricity in the winter. This builds up an electromagnetic field and affects the Qi circulation in your body. There are many other ways of improving the condition of your arthritis. For example, it is reported that sexual activity can stimulate the adrenal glands to produce more corticosteroid, a hormone that reduces joint inflammation and pain. It is believed that sexual activity may also trigger the release of endorphins, a naturally occurring painkilling substance.(*7) You can see from our brief discussion that, if we want to under stand arthritis completely, we must remain humble and continue our study and research. Only then will we be able to reach the goal of a complete cure.