bubble_chart Concept

This disease falls under the category of "Bi disease" in Chinese medicine, where "Bi" signifies obstruction and blockage. Any factor that can cause the stagnation and obstruction of qi, blood, meridians, and collaterals, leading to impaired joint movement, is considered a cause of this disease. Common causes include:

1. constitutional deficiency, loose striae and interstice, disharmony between nutrient and defensive qi, allowing external pathogens to invade, obstructing qi and blood, and impairing joint movement. As stated in Jisheng Fang: "It is all due to physical weakness, empty and loose striae and interstice, and exposure to wind-cold dampness that leads to Bi."
2. Long-term residence in damp environments, exposure to rain or water, or erratic climate changes, cold-dampness pudendal coldness, exposure to wind-cold damp pathogens, pathogenic qi directly attacking muscles, bones, and joints, congealing to form Bi.
3. Constitutional yang exuberance, or pathogens transforming into heat, multiple abscesses in joints, obstructing qi and blood, leading to disease.
4. If the pathogenic influence is predominantly cold, the pain is severe, like needles or knives, and is alleviated by heat and worsened by cold. Cold causes contraction and stagnation, hence severe pain is the main manifestation, also known as agonizing arthralgia.
5. If the pathogenic influence is predominantly dampness, the limbs and joints feel heavy, even numb and immobile, with swelling. Dampness is heavy and sticky, hence it is also called fixed arthralgia.
6. If the pathogenic influence is predominantly heat, or pathogenic qi transforms into heat, the joints become red, swollen, hot, and painful, with burning pain that is unbearable, worsened by heat and slightly relieved by cold, but becomes more painful over time. This type is called heat arthralgia.
7. If the joint pain is migratory and wandering, this type is mainly due to wind pathogens, as wind is characterized by movement and change, hence the joint pain is migratory.
8. Prolonged illness leads to qi and blood deficiency, liver and kidney insufficiency, and spleen dysfunction, resulting in malnutrition of muscles, tendons, and bones, causing joint swelling, deformity, stiffness, and tendon spasms.

In summary, the disease mechanism involves constitutional weakness or direct attack by external pathogens causing wind-cold dampness to multiple abscesses in meridians and joints, obstructing the smooth flow of qi and blood, congealing to form Bi. Wind-cold dampness pathogens are often mixed, and the pattern types are complex, hence treatment should combine pattern identification and disease differentiation, carefully selecting appropriate formulas and medications.

bubble_chart Modern Research

Rheumatoid arthritis is a systemic chronic autoimmune disease of unknown cause. The incidence of this disease is 1% to 3%, more common in women than in men, with a male-to-female ratio of 1:3. It can occur at any age but is most common between 20 and 40 years old. The course of the disease is long, and the condition is stubborn. The pathological cause of this disease is still unclear and is often triggered by infections, surgery, trauma, emotional fluctuations, and postpartum conditions. Scholars represented by Graner believe that this disease is a composite or biphasic disease. The first phase involves infectious agents or metabolic abnormalities in connective tissue, leading to antigenic changes in the joint synovial membrane. The second phase involves the body's persistent immune response to exogenous or endogenous new antigens. Scholars represented by Harry believe that the primary sexually transmitted disease factor persists in the body's tissues, leading to a persistent immune response in the host, or that an endogenous persistent stimulatory amplification mechanism replaces the primary disease, thus allowing the disease to progress.

The clinical manifestations of this disease are varied. The onset is usually slow, often with prodromal symptoms such as lack of strength, weight loss, vascular dysfunction (paresthesia), periarticular pain, and morning stiffness, which is joint stiffness in the morning that disappears after activity. Acute onset is less common.

[Diagnosis]

1. Morning stiffness.
2. Pain and tenderness in one joint.
3. Swelling in one joint for at least 6 weeks.
4. Swelling in another joint.
5. Symmetrical widespread joint involvement.
6. Nodules.
7. X-ray changes in rheumatoid arthritis.
8. Positive rheumatoid factor.
9. Histological changes in the synovial membrane.

A diagnosis of typical rheumatoid arthritis requires 7 positive criteria; 5 positive criteria confirm rheumatoid arthritis; 3 positive criteria suggest possible rheumatoid arthritis.

bubble_chart Pattern Analysis

1. Wind-cold Dampness Obstruction︰The disease is in its initial stage or has not lasted long, with swelling and pain in one or more joints, but without local fever or redness, morning stiffness, pain aggravated by cold and relieved by warmth, often worsening or slightly alleviating with weather changes. The tongue is pale with thin white coating, and the pulse is deep and wiry or deep and tight. Treatment involves dispelling wind and eliminating dampness, warming the meridians, and dissipating cold. Modified Zhu Liang-chun's Wenjing Juanbi Decoction (empirical formula): Chinese Angelica 20g, Cinnamon Twig, Epimedium Herb, and Pinellia 15g each, Pyrola Herb, prepared Aconite Mother Root, prepared Kusnezoff Monkshood Root, Ground Beetle, Black-Tail Snake, and Honeycomb 10g each, Liquorice Root 5g. For wandering pain with prominent migratory arthralgia, add Xun Gu Feng, Zuan Di Feng, Notopterygium, and Pubescent Angelica. For heavy sensation and edema in joints and limbs, with prominent fixed arthralgia, add Atractylodes Rhizome, raw Coix Seed, and fried White Mustard Seed. For preference for warmth and fear of cold, pain relieved by heat and aggravated by cold, with dominant cold arthralgia, add Aconite Lateral Root, Centipede, and Scorpion. For severe arthralgia like needles or stabbing pain, with dominant painful arthralgia, add Tian Sanqi, Myrrh, Corydalis Tuber, Peach Kernel, Carthamus, and Suberect Spatholobus Stem to activate blood and resolve phlegm.
2. Chronic Bi Transforming into Heat Damaging Yin︰The joints are red, swollen, hot, and painful, with stiffness. Initially, they feel relieved by cold but become uncomfortable after prolonged exposure, while warmth provides comfort. Symptoms include dry and bitter mouth, dry throat, insomnia, and dysphoria. The tongue is red with yellow or yellow greasy coating, and the pulse is wiry, thin, and rapid. Treatment involves dissipating cold and eliminating dampness, clearing heat, and unblocking collaterals. Modified Cinnamon Twig, Peony, and Anemarrhena Decoction is used, consisting of: Cinnamon Twig 30g; Red Peony Root and Peony Root 20g each; Anemarrhena, Prepared Aconite Mother Root, Prepared Kusnezoff Monkshood Root, Chinese Angelica, and Black-Tail Snake 15g each; Unprocessed Rehmannia Root, Stiff Silkworm, Earthworm, and Liquorice Root 10g each. For excessive heat, reduce Cinnamon Twig, Aconite Mother Root, and Kusnezoff Monkshood Root, and add Giant Knotweed, Calcitum, Hops, and Phellodendron Bark. For yin deficiency with internal heat and dry stools, increase Unprocessed Rehmannia Root to 30–40g.
3. Liver-kidney Depletion with Spleen Deficiency and ︰Muscle atrophy in the limbs, stiff and deformed joints, persistent pain, and in severe cases, sleeplessness throughout the night, with symptoms worsening at night and easing during the day. Emaciated body, shallow yellow complexion, mental fatigue and lack of strength, soreness and weakness in the lower back and knees, dizziness, tinnitus, anorexia, loose stools, shortness of breath, and reluctance to speak. Pale tongue with white coating, deep, thin, and slightly wiry pulse. Strengthen the foundation and replenish vitality, relieve obstruction and dredge collaterals. Yishen Juanbi Pill (Zhu Liang-chun's empirical formula): Unprocessed Rehmannia Root, Prepared Rehmannia Root, Chinese Angelica, Suberect Spatholobus Stem, Epimedium Herb, Desertliving Cistanche, 20g each; Pyrola Herb, Black-Tail Snake, Paniculate Swallowwort Root, Xungufeng, Stiff Silkworm, Centipede, Roasted Scorpion, Giant Knotweed, Oldenlandia, Dung Beetle, Ground Beetle, 10g each. For pronounced qi deficiency, add Astragalus Root and Tangshen; for pronounced yang deficiency, add Fortune's Drynaria Rhizome and Psoralea; for pronounced blood deficiency, increase the dosage of Chinese Angelica and Suberect Spatholobus Stem, and add Barbary Wolfberry Fruit and Donkey-hide Gelatin; for pronounced yin deficiency, add Dendrobium, Ophiopogon Tuber, Asparagus Root, Tortoise Carapace, and Turtle Carapace; for qi stagnation and blood stasis, add Peach Kernel, Carthamus, and Paniculate Swallowwort Root, among others. This formula is now available as a ready-made medication. After treatment with this medication, ESR, ASO, IgG, IgA, and IgM levels significantly decrease, hemoglobin increases, local inflammatory reactions lessen, joint function markedly improves, and there is no harm to liver or kidney function.