Chinese medicine and osteoarthritis
by Nathan Wei, MD, FACP, FACR
Nathan Wei is a nationally known board-certified rheumatologist and author of the Second Opinion Arthritis Treatment Kit. It's available exclusively at this website... not available in stores.
Click here: Second Opinion Arthritis Treatment Kit
Osteoarthritis (OA), or degenerative joint disease, is the most common form of arthritis.
It most often affects middle-aged and older people, involving the neck, lower back, knees, hips and fingers. Newer evidence suggest OA may begin earlier... perhaps as early as the teen years.
Nearly 70 percent of people over the age of 70 have x-ray evidence of the disease, but only half of these people ever develop symptoms. Other risk factors include joint trauma or damage from prior infection or inflammatory arthritis.
OA results from degeneration of the joint cartilage. Cartilage breakdown is due to both mechanical ("wear and tear") effects and biochemical effects.
Health Impact (data from the CDC)
• OA affects more than 21 million Americans.
• OA is the most common type of arthritis and a leading cause of disability in the U.S.
• Virtually everyone over the age of 75 is affected in at least one joint.
• Women are generally affected at a younger age than men.
The diagnosis of OA may be confirmed by a physical examination, x-rays and by ruling out other types of arthritis. Since it is so common, it may be present concurrently with other types of arthritis.
Therapy for OA includes both medication and other treatments that help to relieve pain and improve joint function. Drug therapy includes simple pain relievers (acetaminophen) and non-steroidal anti-inflammatory drugs and/or intermittent corticosteroid injections. Viscosupplements, thick lubricants injected into the joints to help relieve pain and improve function have been approved for use in the treatment of OA of the knee. In addition, there is some evidence suggesting that some dietary constituents may have a beneficial effect.
Newer research into regenerative therapies including the use of autologous (a patient's own) stem cells to restore cartilage, looks promising.
Other therapies include patient education, occupational and physical therapy to restore joint movement and increase strength and aerobic capacity, weight reduction, and heat and cold. Joint surgery to repair or replace seriously damaged joints may be required to end pain and restore functional mobility.
Several non-conventional medical approaches exist for OA. Among them are Chinese medicine techniques.
The following is an excellent resource:
Expert Advice-Treatment of Arthritis in Traditional Chinese Medicine(TCM):Wei Liu, TCMD, MPH, LAC and Changzhen Gong,PhD, MSThe American Academy of Acupuncture and Oriental Medicine (AAAOM)
and the following material is their work.
The joint pain of osteoarthritis is primarily due to the gradual loss of protective cartilage. Physical injury, mechanical stress or metabolic abnormality can break down the cartilage which cushions the ends of the bones from rubbing against each other. As a result, bones begin to grate against each other, producing pain and further degeneration.
In traditional Chinese medicine, the condition that is congruent with arthritis is called "Bi syndrome." Bi syndrome manifests as pain, soreness, or numbness of muscles, tendons and joints, and is the result of the body being "invaded" by the external climatological factors of Wind, Cold, Heat, and/or Dampness. The symptoms manifested by the individual depend on which external pathogenic factor is strongest. The four main patterns of Bi syndrome are differentiated below, and the leading herbs that are used to treat each pattern are listed.
Exposure to wind, especially when one is unprotected and exposed to the wind for a long time, is an important cause of the Wind pattern of arthritis. Any Wind pattern is characterized by movement of symptoms from place to place. In the case of Wind Bi, there is joint soreness and pain which moves from joint to joint. Movement of joints is limited, and there is often fever, as well as an aversion to wind, or windy weather. A thin white tongue coating and a floating pulse are signs that help Chinese medicine practitioners diagnose Wind Bi. Leading herbs for this pattern include ledebouriella (Fang Feng), and ephedra (Ma Huang).
The Cold pattern of arthritis (Cold Bi) is characterized by severe pain in a joint or muscle. This pain has a fixed location, rather than moving about (as in Wind Bi). The pain is relieved by applying warmth to the affected area, but increases with exposure to cold. Movement of joints is limited. A thin white tongue coating, combined with a wiry and tight pulse are signs of Cold Bi. Leading herbs for this pattern include aconite (Wu Tou), and ephedra (Ma Huang).
The Damp pattern of arthritis (Damp Bi) is characterized by pain, soreness and swelling in muscles and joints, with a feeling of heaviness and numbness in the limbs. The pain has a fixed location and is aggravated by damp weather. A white, sticky tongue coating and a soggy, slow pulse are signs of Damp Bi. Leading herbs for this pattern include coix (Yi Yi Ren), and lancea atractylodes (Cang Zhu).
The Heat pattern of arthritis (Hot Bi) can develop from any of the above three patterns. It is characterized by severe pain and hot-red-swollen joints. The pain is generally relieved by applying cold to the joints. Other symptoms include fever, thirst, anxiety, and an aversion to wind. A yellow, dry tongue coating and slippery, rapid pulse are seen with Hot Bi. Leading herbs for this pattern include anemarrhena (Zhi Mu), gypsum (Shi Gao), and cinnamon (Gui Zhi).
A time-tested herbal formula for joint pain is Joint Strength (Du Huo Ji Sheng Wan). This herbal combination was written down about twelve hundred years ago, during the Tang Dynasty. It contains herbs that relieve pain, as well as herbs that nourish and strengthen the joints. It has been used by millions of people over the last millennium. You can take it over a long period of time without worrying about side-effects.
Joint pain, back pain, and headaches constitute a large percentage of all the visits paid to doctors’ offices and acupuncture clinics in any country at all times. In traditional Chinese medical theory, it is believed that the pathogenic factors that cause Bi syndrome (Wind, Cold, Damp, Heat) lodge in the body’s meridians (energy pathways) and obstruct the free flow of Chi and Blood in those meridians. When blood and energy are not able to flow naturally, they stagnate, causing pain, heat, and other symptoms of illness. Acupuncture and herbal therapy help to open the blockage, balance the energy, and harmonize Chi and Blood.
Scientifically proving the validity of these ancient concepts is challenging, but promising. More and more scientifically-designed clinical studies support the use of acupuncture for arthritis. One study examined the effects of acupuncture on 32 osteoarthritis patients waiting for knee replacement surgery. After nine weeks, patients receiving acupuncture treatments reported a decrease in pain, while pain increased in untreated patients. The patients with acupuncture treatments were able to walk farther and faster, compared with the untreated group. Another study at the University of Maryland School of Medicine found that 12 patients with osteoarthritis of the knee improved significantly after acupuncture treatments. These results encouraged the researchers to do a larger study which is currently under way.
Modern scientific research has also revealed the mechanisms which provide relief for arthritis patients. Studies show that acupuncture can stimulate the production of endorphins (natural pain-killing hormones in the brain), and the anti-inflammatory hormone adrenalcorticotropin. Somehow, the acupuncture needles trigger the body to heal itself by producing hormones that reduce pain and inflammation. Acupuncture can then be used on an ongoing basis to prevent re-occurrence of arthritis once it has been successfully cured.
One prime target for osteoarthritis is the low back.
When an individual is diagnosed with a “back problem” in Western medicine be it spondylosis, spinal osteoarthritis, prolapsed lumbar disc or muscular/ligamentous lumbar strain the focus is primarily on the lower back region and within the Western medical model the options become therapies like spinal surgery, physical therapy, pharmaceutical intervention and cortisone or epidural type injections. These are perfectly acceptable modalities but what if they don’t alleviate the pain? And, what about the underlying cause for the back weakness in the first place? Can that underlying weakness be strengthened? Let us consider this possibility via Chinese medicine.
Though the system of TCM is logical and scientific in its own way, it is a separate system from modern Western medicine and can’t always be explained via Western medical logic. To include the successful system of TCM within our minds, we need to expand the way we think and consider both systems as valid while learning how to accept the similarities and differences within the two systems.
One could say that Chinese medicine was born out of the theory of Yin and Yang. As well as describing that which exists in nature, Yin and Yang perfectly describes all the parts and functions of the body. Yin and Yang are in a constant state of dynamic balance, when this balance is threatened disease is possible. An example in nature of this dynamic balance is the rhythm of the sun (yang) and moon (yin). In a 24-hour period each is unique, change over to the other and require each other for overall balance (from the perspective of earth that is). Yin and Yang each have an individual expression in the body and yet requires the other to exist, for example Yin represents stillness, form and blood whereas, Yang represents activity, function and Qi. Qi needs blood to nourish it and blood needs Qi to move it.
Qi can be described as energy, material force, electromagnetic current, matter, ether, vital force, or life force. Qi travels throughout our entire body in channels or meridians reaching every aspect of our body. These channels are understood to be separate from the pathways of the nervous, vascular and lymph systems in Western medicine. Loosely, when we are born we begin with a gas tank of Qi and when the tank of Qi is empty our life force is gone or in other words, we die. This tank of gas is rooted in the organ system of the Kidneys according to Chinese medicine theory and is distributed throughout our organs, glands and channels in a very systematic way. Because of this intricate channel system within our body when we refer to an organ such as the Kidneys, that includes much more than the organ alone according to anatomy. Each organ system has representations of Yin and Yang, hormone balance as well as specific Qi and blood functions which plays a vital role in connecting, via the channels, with other organ systems and the entire body to render the body a holistic system. In other words, it isn’t possible, within the structure of TCM, to deem an organ or body part as an isolated problem without considering the whole body system.
The low back is the “mansion of the Kidneys” meaning that the low back is most closely related, but not limited to, the health of the Kidney system. It is without question, in low back pain, that the Kidney system be treated in Chinese medicine.
Back on the subject of Qi, it is said in Chinese Medicine:
If there is free flow, there is no pain;
If there is no free flow, there is pain.
Basically, what this means is if the Qi and/or blood stagnate in the channel(s), specifically through the region of the low back, there will be pain. Imagine a river flowing unimpeded and suddenly a tree falls across the river, we see in our imagination the water no longer flowing freely, but getting blocked by the log, pushing into the banks of the river. The basic concept of acupuncture is to re-open the river, create a circulation so that the log lifts and normal flow is restored.
How does the free flow of Qi and blood in the body become impeded, so as to cause pain?
1. An external invasion of wind, cold, dampness, or heat may invade the lower back region causing pain. If our defensive Qi or immune system is weak we become more susceptible to external invasions through the pores of our skin.
2. The Qi and blood can stagnate due to trauma (i.e. lifting, repetitive strain over time, an accident or similar sprain).
3. There may be an insufficiency of Qi or blood creating a sluggishness or stagnation of flow throughout the channel(s). This is an internal cause or weakness with a number of possible etiologies such as:
•Poor diet, insufficient rest coupled with too much activity or overwork (i.e. busy lives, excessive sex*), overuse of drugs, chronic illness, heredity weakness, an excess of the emotions fear and anxiety, and general aging as our Qi is naturally declining.
•The Chinese believe that a healthy, moderate amount of sex supports a good flow of Qi and too much sex (specifically ejaculation for men and childbirth for women), depletes the Qi, blood and essence of the Kidneys.
Caring for the low back with Chinese Medicine
1. Acupuncture: The use of thin, pre-sterilized, disposable needles to re-establish the proper flow of Qi and blood through the channel(s) of the back. This flow increases circulation allowing for oxygen, blood and lymph to support the bodies healing process. If the channels have been blocked for a long period of time, or if there is pronounced deficiency of Qi and blood, it is necessary to have acupuncture for a longer period of time to assist the body in regaining it’s normal function. Research has shown acupuncture to cause the release of neuro-chemicals such as: endorphins, enkephalins, serotonin and corticosteroids all of which contribute to the reduction of pain and inflammation.
2. Moxabustion: Concentrated herbs that are sprayed or burned above the skin to open and warm the channels.
3. Herbal medicine: The use of herbs from the Chinese herbal pharmacopia also dates back several thousand years. Typically, individual herbs are put together synergistically to create a formula with a specific function (i.e. open the channels or strengthen the Kidneys). Herbs go to specific channels and have specific properties (i.e. sweet, bitter, cold, warm etc.).
One typical program for osteoarthritis is:
• Upper limb pain: cinnamon twig
• Lower limb pain: angelica pubescentis root
• Lower back pain: eucommia cortex
• Mild pain worse with cold: jujube dates, ginger root, cinnamon twig
• Pain from blood and qi deficiency: dang gui, astragalus, poria, rehmannia
• With fatigue and diarrhea: cinaamon twig, astragalus, white peony root, licorice root
• One general herb formula for OA is called juan bi tang (Alleviate Impediment Decoction)
The above herbs may help for mild and simple joint pains- but for stronger cures, see a Chinese herbalist.
4. Tui Na or Chinese massage: Working on the meridians with the hands, using techniques specific to Tui Na. Care must be taken not to exacerbate inflammation if it is present.
5. Proper Diet: If we put cider in our finely tuned automobile it won’t run, it needs good clean gas. Our bodies’ “gas tank” needs good clean nutrients. This means a balance of quality protein, good/essential fats, and carbohydrates (5-9 servings of vegetables and fruit with a moderate of whole grains). This means no overeating as our body has a hard time managing the overload, eat meals at regular times, do not eat late at night, minimize or eliminate sugar, processed foods/drinks, alcohol and don’t eat any one thing in excess (i.e. dairy products or bread). Drink plenty of water. Our body can only be as healthy as the fuel we give it.
6. Qi Gong Breathing: Qi Gong is the art of therapeutic breathing. Breath is Qi, Qi is life. The two substances that fill our Qi tank up are air and nutrients (breathing and healthy foods). To take in a full breath of air into our abdomen is health promoting, yet poor breathing habits have left most of us breathing on the shallow side. To begin with make an effort to remember to breathe deeper, post little notes if necessary that say, “breathe deep”. Be aware of inhaling fresh air/Qi in through your nostrils all the way down into your abdomen and exhaling through your mouth. Your abdomen should visibly push outward on the exhale and contract back in on the inhale. As well, there are specific breathing exercises to open the spine, which in turn, supports the flow of cerebral spinal fluid. You may want to get a book or video on breathing exercises to support your health. Deep breathing has far reaching affects in our body by balancing our nervous system, increasing oxygen delivery and keeping the Qi moving. Do not underestimate the value of this simple, yet powerful practice; we have to breathe anyway, why not do it right?
7. Proper Exercise: Exercise promotes the normal flow of Qi and blood. Our bodies were designed to move. Back pain is on the rise in proportion to an increasingly sedentary lifestyle. Regular aerobic activity, regular stretching, keeping the abdominal muscles strong and proper body mechanics when bending and lifting are some of the necessities in back maintenance.
8. Stress Management: It has been proven that prolonged stress creates disharmony on many levels: physically, emotionally and spiritually. Explore avenues to keep stress at a minimum in your life. Learning to meditate is another recommended way of managing stress as well as pain.
9. Proper Rest: Our bodies need regular sleep and rest balanced with the activity we perform. Rest is Yin, activity is Yang, and attention to both is required to maintain balance. When we push ourselves too hard for too long and ignore the need for rest our Yang consumes our Yin and imbalance ensues. A healthy body can recover from a temporary period of hard work or emotional strain; the imbalance only begins when it goes beyond temporary.
Acupuncture is strictly regulated via individual state medical licensing boards as well as the National committee. Practitioners are typically qualified and trained to provide you with a successful experience. Acupuncture doesn’t “hurt” but you may feel sensations that are “different” (like tingling, dull, achy), these sensations are Qi. The thin needles are inserted according to your individual diagnosis and are left in for approximately 20-40 minutes. During this time, most people experience a deep sense of relaxation, in part because of the endorphins that are released during acupuncture. Depending on whether your pain is acute or chronic guides the number of treatments you may need. Your pain may be resolved in a few treatments or it may take several courses, in some cases acupuncture serves primarily as pain management. In any case, your whole body benefits from the affects of acupuncture.
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