Treatment of Rheumatoid Arthritis with Acupuncture and Chinese Herbs – A Case Study

Yan Lu, L.Ac.
Case Study 2
Treatment of Rheumatoid Arthritis with Acupuncture and Chinese
Herbs – A Case Study
ABSTRACT
Background Treatment of rheumatoid arthritis with western drugs can have some
serious side effects.
Object To examine the approach and efficiency of acupuncture and Chinese herbs
in the treatment of rheumatoid arthritis in early stage.
Result After 5 treatments the patient had no joints pain.
Conclusion Acupuncture and Chinese herbs appears to be effective in treating
rheumatoid arthritis, and they have little side effect in long term use.
INTRODUCTION
“Rheumatoid arthritis is chronic systemic inflammatory disease of unknown cause,
mainly affecting synovial membranes of multiple joints. This disease is now considered
to be a disease with such strong tendency to shorten life and cause severe disability that
early and aggressive treatment –often with drugs in combination- is referred.” (1)
However, these drugs often have some serious side effect such as damage to the liver,
lung, GI and kidney, etc. such as lung fibrosis, kidney disease, hepatic dysfunction. (2)
This case history describes the treatment of rheumatoid arthritis with acupuncture and
Chinese herbs and illustrates how acupuncture and Chinese herbs can help patients with
rheumatoid arthritis, and the treatment has little side effect comparing with western
drugs.
BACKGROUND
Biomedicine
Rheumatoid arthritis is “ a chronic syndrome characterized by non-specific, usually
symmetric inflammation of the peripheral joints, potentially resulting in progressive
destruction articular and periarticular structures, with or without generalized
manifestations. The cause is unknown. A genetic predisposition has been identified and,
in white populations, localized to a pentapeptide in the HLA-DRB1 locuslocus of Class II
histocompatibility genes. Environmental factors may also play a role. Immunologic
changes may be initiated by multiple factors. About 1 % of all populations are affected,
women two to three times more often than men. Onset may be at any ages, most often
between 25 and 50 years.” The pathogenic findings in the joint include chronic synovitis
with pannus formation. The pannus erodes cartilage, bone, ligaments, and tendons. The
microscope findings are the subcutaneous nodules. Synovial thickening is the most
physical findings and eventually occurs in most involved joints. Patients may have
1.
stiffness in the morning or after prolonged physical work. They may also have fatigue
and malaise. Deformity may develop rapidly. (3)
The common treatment in biomedicine includes nonpharmacologic management,
nonsteroidal anti-inflammatory drugs and disease-modifying antirheumatic drugs.
Nonpharmacologic management includes physical and occupational therapies, rest, heat
and cold, assistive devices, splints and weight loss. The primary objectives in treating
rheumatoid arthritis are to reduce inflammation and pain, preserve function, and prevent
deformity. The NASAIDs have analgesic and anti-inflammatory effects, but they are not
able to prevent erosions or alter progression of the disease. NASAIDs includes aspirin,
ibuprofen, diclofenac, oxaprozin, nabumetone, etodolac, ketoprofen, celecoxib, and
rofecoxib. Disease-modifying antirheumatic drugs should be used as soon as the
diagnosis of rheumatoid disease is made. These drugs include methotrexate, tumor
necrosis factor inhibitors, antimalarials, cortocosteroids, sulfasalazine, leflunomide,
azathioprine, minocycline, gold salts and penicillamine. However, there are potential
serious adverse events such as serious damage to the liver, lung, GI and kidney, such as
lung fibrosis, proteinuria, hepatic dysfunction, stomach pain, etc. (4)
Traditional Chinese medicine perspective
Rheumatoid arthritis can be considered as Bi syndrome. It can be caused by wind-dampheat,
wind-damp-cold, stagnation of qi, blood and phlegm. Long-term illness can cause
deficiency of qi and blood, and deficiency of liver and kidney. The treatment for different
types bi syndrome include acupuncture and Chinese herbal medicine:
Differentiation Acupuncture Treatment Herbal Treatment
Damp-heat bi ST36, SP5, GV14, LI11
plus local points.
Xuan bi tang plus er miao
san
Damp-cold bi ST36, SP5, BL23, CV4 plus
local points
Wu tou tang plus yi yi ren
tang.
Heat-toxin bi Bleeding GV14. simiao yong an tang.
Deficiency of liver and
kidney
BL18, BL23 plus local
points
you gui wan.
For general body pain, add SI3, BL62, BL17, SP21, LI15, LI11, LI4, TB4, GB30, GB34,
GB39, ST41.
For shoulder joint pain, add LI15, TB14, SI9 and SI10.
For scapular pain, add SI11, SI12, SI14 and BL43.
For elbow pain, add LI11, LU5, TB10, TB5 and LI4.
For wrist pain, add TB4, LI5, SI5 and TB5.
For finger spasm, add SI5, LI4 and SI3.
For numbness and pain in the fingers, add SI3, LI3 and Baxie.
For hip joints pain, add GB30, GB29 and GB39.
For gluteal pain, add BL54, BL36 and GB34.
For knee joint pain, add Heding, ST35, Neixiyan, GB34 and SP9.
2.
For lower leg numbness and pain, add BL57 and BL58.
For ankle pain, add ST41, SP5, GB40, BL60 and KID3.
For numbness in the toes, add SP4, BL65 and Bafeng. (5) (6)
Research
Several research papers describe the treatment of rheumatoid arthritis with acupuncture
and Chinese herbs.
Zhou reported treating 44 and 43 mid-late stage patients of RA respectively with
Shuguan Wenjing granule and Shuguan Qingluo granule based on the principle of
reinforcing Kidney to treat arthritis, removing phlegm to relieve the stasis. The clinic
results were compared with those of Wangbi granule on 41 mid-late stage patients.
Shuguan wenjing granule were composed of Epimedium brevicornum, Aconitum
carmichaeli praeparatum, Dipsacus asper, Clematis chinensis, Sinapis alba, Eupolyphaga
sinesis, Rehmannia glutinosa praeparata, Scolopendra, Spatholobus suberectus (16.5 g
crude herb per package) 1 package each time in warm water for oral adminiatration, 3
times a day. Shuguan Qingluo granule were composed of Rehmannia glutinosa,
Polygonum multiflorum, Berchemia hypocrysa, Gentiana macrophylla, Euonymus alatus,
Arisaema heterophylla, Nidus vespae, Pheretima aspergillum (12.5 raw herbs per
package) 1 package each time with warm water for oral administration, 3 times a day.
The treatment course was 3 month. The effective rate in Shuguan Wenjing group was
88.64%, the effective rate in Shuguan Qingluo group was 93.02%. (7)
Wang described treating 650 cases of rheumatoid arthritis with acupuncture and obtained
satisfactory result. The points they used for the upper extremity were TB5, LI11, LI4, the
points for lower extremity were SP9, GB39, ST41; the points for dorso-lumbar region
were GV14, GV12, UB11, GV9, GV3, GV4, or Huatuo jiaji. Points may be added or
omit according to syndrome differentiation. The needles were retained for 15 minutes. A
course of treatment consists of 20 acupuncture sessions. After 3 courses the patients rests
for 2-4 weeks, when treatment may be resumed. Among the 650 cases, 76 cases (11.69%)
were cured clinically; 204 cases (31.38%) got excellent results; 349 cases (53.69%) were
improved; 21cases (3.23%) failed. (8)
CASE HISTORY
Patient Identification and Chief Complaint
The patient is 20 year-old female with joints pain all over her body.
History of Chief Complaint
The patient had joints pain all over the body for about one month. It was aching, pain
level was 5-6 out of 10. She had rheumatoid arthritis with rheumatic myocarditis last
year. With treatment of Penicillamine and Prednisone for several months, she had no
symptoms until one month ago. Because of the rainy cold weather, she felt joints pain all
over her body with coldness in her knee joint. She felt heaviness in her shoulder, and the
3.
knee pain became worse with walking, she also felt tired and had poor appetite, her
menses was normal, her sleep was disturbed by the pain, she also had frequent urination.
She had no headache, no abnormal sweating, no palpation or short of breath, bowel
movement is firm, once a day, her emotion is even.
Exam
Palpation examination reveals tenderness in her joints, worse in her knee. There was
slight swelling in her knee.
She had white and greasy tongue coat and red tongue, her pulse was deep, wiry and thin.
Diagnosis
Possible relapse of rheumatoid arthritis in western biomedicine because of the history of
rheumatoid arthritis, pain in her joint bilaterally for one month and slight swelling in her
knees and fatigue.
Wind-damp-cold bi syndrome with kidney deficiency in TCM. Because damp-cold
weather worsened her pain. Heaviness, white and greasy coat also suggested wind-colddamp
invasion. Frequent urination with thin pulse suggested kidney deficiency.
Treatment
Treatment principle is to dispel wind-damp-cold and tonify kidney.
Herbal formula in her first visit included guizhi 18g, zhi fu zi 18g, dan shen 30g, wei ling
xian 18g, qiang huo 18g, qian nian jian 30 g, hai tong pi 18g, bai zhu 10g, fang feng 18g,
yi yi ren 30g, pei lan 18g, du zhong 18g. 3 bags, 1 bag for 2 days. The formula was to
dispel wind-cold-damp and tonify kidney.
Acupuncture points included BL18, BL20, BL23, ST36 (tonifying method), SI3, BL62,
SP21, Ashi in local area, LI15, xiyan, SP5 (reducing method). The needles were retained
for half an hour.
The second treatment occurred 7 days after the first treatment. The patient reported the
pain level was reduced to 4-5 out of 10. I continued using the same herbal formula and
acupuncture points for 3 weeks, with acupuncture treatment once a week. During her 6th
visit, the patient reported the joints pain was almost gone. Her other symptoms were
coldness and frequent urination. I suggested the patient take patent herbal formula du huo
ji sheng wan plus jin gui shen qi wan, 4 pills of each, 3 times a day for 3 months. Jin gui
shen qi wan includes shu di 29.6%, shan Yao 14.8%, shan zhu yu 14.8%, mu dan pi
11.1%, ze xie 11.1%, fu ling 11.1%, fu zi 3.7% and rou gui 3.7%. Du huo ji sheng wan
includes tai zi shen 10.2%, shu di 7.3%, du huo 7.3%, sang ji sheng 7.3%, fang feng
7.3%, xi xin 7.3%, du zhong 7.3%, niu xi 7.3%, rou gui 7.3%, chuan xiong 7.3% and
gang gui 4.9%.
I saw the patient 3 months after, she had no pain but still felt slight cold. I suggested the
patient continue taking jin gui shen qi wan 8 pills tid for 3 months or until her coldness
was gone. Also suggested the patient take du huo ji sheng tang 8 pills tid for one month
when weather became cold and raining. I suggested the patient get acupuncture and
herbal treatment once in a while for tune-up in the future.
4.
Result
After the first treatment, the patient noticed pain reduced to 4-5 of 10, after the 5th
treatment, the patient felt the pain was gone with only slight coldness and frequent
urination. 3 months later, the patient had no pain but still slight coldness. Her prognosis is
good if she continues TCM treatment as tune-up.
DISCUSSION
Western biomedicine can be effective to treat rheumatoid arthritis, however some drugs
have serious adverse effect such as serious damage to the lung, liver, GI, CNS and kidney
causing lung fibrosis, proteinuria, hepatic dysfunction. Acupuncture and Chinese herbal
medicine appears to be of benefit as a complementary modality in treating rheumatoid
arthritis. They have little side effect by literature review. It is, however, difficult to
determine how much of the therapeutic result is contributable to acupuncture treatment
versus Chinese herbal medicine, since both methods were used at the same time during
the treatment. The reality of clinical practice dictates the use of whatever may help the
patient to bring about the most rapid and most complete treatment.
CONCLUSION
Several case series and the case presented in this paper demonstrated the effectiveness of
acupuncture and Chinese herbal medicine in treating rheumatoid arthritis. While these
results are encouraging, further high quality clinical trials such as with control group and
with larger numbers of subjects and adequate follow- up periods are needed.
REFERENCE
(1) Lawrence M. Tierney, jr. Current Medical Diagnosis and Treatment 2003, Lange
Medical Books; 803.
(2) Hand –out by Dr. Andre Barkhuizen from OHSU for OCOM doctoral class 2005.
(3) Mark H. Beers M.D. the Merk Manual, 7th edition, Merk Research Laboratories,
1999; 416-417.
(4) Lawrence M. Tierney, jr. Current Medical Diagnosis and Treatment 2003, Lange
Medical Books; 805-808.
(5) Xinnong Chen. Chinese Acupuncture and Moxabustion 2000, People’s Health
Press; 555-558.
(6) Guiting Chen. Practical Diagnosis and Therapeutics of Integrated Traditional
Chinese and Western Medicine 1995, Chinese Medicine/ Science and Technology
Press; 637-640
(7) Zhou, Xueping. Clinical and experimental study on treatment of mid-late stage of
rheumatoid arthritis with shuguan granules. Chinese Journal of Integrated
Traditional and Western Medicine v5 n3 p165-170, 1999.
(8) Wang, Futian. Acupuncture treatment of rheumatoid arthritis: a report of 650
cases. International Journal of Clinical Acupuncture v4 n2 p123-126, 1993.

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