Modern Famous Chinese Medicine Expert's Unique Techniques for Treating Rheumatoid Arthritis

Author: Wu Dazhen, Wang Fengqi, Wang Lei / Country: Mainland China
Publisher:
Publishing Date: 2005-07-01
Features: Professor Jin Shi's experience in treating rheumatic diseases (Nanjing University of Traditional Chinese Medicine, Zip Code: 210029), a doctoral supervisor at Nanjing University of Traditional Chinese Medicine, has been engaged in rheumatic disease research for over 30 years. With extensive experience and profound medical knowledge, he particularly emphasizes syndrome differentiation and treatment formulation, often innovating beyond conventional methods. Clinical practice has consistently yielded effective results.
1. Sj?gren's Syndrome (SS)
Sj?gren's Syndrome (SS) falls under the category of "dryness syndrome" and "dry arthralgia" in Traditional Chinese Medicine (TCM). Its occurrence and progression is a complex process.
Etiology and Pathogenesis: The lung belongs to the upper (jiao), and lung qi functions through dissemination and smoothness. Through the lung's dissemination, body fluids are distributed to the five senses, orifices, and the entire body. Since the mouth and nose are channels for lung qi, if the upper orifices such as the mouth, eyes, nose, and lips are properly nourished with body fluids, health is maintained. However, if yin fluids are insufficient, or if the lung fails to distribute fluids, qi stagnation occurs, or collaterals become obstructed, impairing fluid distribution. Alternatively, lung qi stagnation may lead to "qi stagnation causing blood stagnation, blood stagnation impairing circulation, resulting in internal dryness." Therefore, the key pathogenesis of Sj?gren's Syndrome (SS) involves yin fluid depletion, lung qi failure to disseminate, qi stagnation and blood stasis, and obstructed collaterals responsible for fluid circulation. While this syndrome manifests as yin deficiency, its essence lies in lung qi failure to disseminate and descend, qi stagnation, and obstructed collaterals, leading to a relative state of yin fluid insufficiency in the five zang-fu organs and the entire body.
Symptoms: Dryness in the mouth, nose, eyes, and skin.
Treatment Principle: Based on Liu Wan Su's principle of "opening pathways, nourishing yin, reducing yang, and cooling herbs for regulation," the methods of nourishing fluids to moisten dryness, dispersing lung qi to distribute fluids, and unblocking collaterals to resolve stagnation are established. This not only nourishes depleted fluids but also focuses on their circulation and distribution.
Medication: Self-prescribed Increased Fluids and Distributed Fluids Decoction (Ophiopogon japonicus, Asparagus cochinchinensis, dried plum fruit, thimbleweed, gypsum, licorice).
Explanation of the Decoction: The combination of Ophiopogon japonicus, Asparagus cochinchinensis, and dried plum fruit replenishes without greasiness, resolves without dryness, and moisturizes without stagnation. Thimbleweed, with its pungent and warm nature, directly enters the lung channel, excelling in moistening and dispersing the lungs. It ensures "open pathways without stagnation, fluids generated without depletion, and blood flow without obstruction," while also dispersing water qi, allowing fluids to distribute and moisten dryness. Gypsum, with its pungent and sweet, cold nature, not only alleviates muscle aches and heat but also conserves fluids and quenches thirst. Its dispersing properties guide the herbs to the affected area. Licorice harmonizes all herbs. This formula primarily treats heat-clearing, moisturizing dryness, and nourishing yin fluids, while the pungent flavor disperses the lungs, promotes qi flow, opens pores, resolves stagnation, and ensures fluids reach the affected area.
2. Systemic Lupus Erythematosus (SLE)
Systemic Lupus Erythematosus (SLE) falls under the category of "yin (poison)," "blood wind sores," and "sunshine sores" in TCM.
Etiology and Pathogenesis: The kidney is the root of congenital essence, the residence of water and fire, and the foundation of the body's yin and yang. Congenital deficiency, postnatal imbalance, kidney qi exhaustion due to overexertion, sexual debauchery, chronic illness affecting the kidneys, or medicinal damage to the body may all lead to kidney qi deficiency and yin fluid insufficiency, resulting in yin-yang imbalance and impaired qi and blood harmony. This is the foundation of the disease. Clinically, various toxic and stasis manifestations are common, with "toxins" arising from external six pathogenic factors, internal five evils, phlegm-dampness, and blood stasis. These may include wind-cold transformation into toxins, rampant fire-toxin, dampness accumulation into internal toxins, or phlegm obstruction leading to blood stasis and toxins. The root of this disease lies in kidney deficiency, while wind, fire, cold, and dampness pathogens invade when the body is weak, causing toxic stasis to obstruct collaterals, qi stagnation and blood stasis, gradually damaging the skin and joints, affecting the five zang-fu organs, and leading to prolonged and recurrent courses. Kidney deficiency and toxic stasis persist throughout the disease process.
Clinical challenges often arise from the use of hormones and immunosuppressants, whose adverse effects and complications hinder effective treatment. Antibiotics may also trigger lupus, making the condition prone to recurrence and persistence.
Symptoms: If cold coagulates qi, symptoms include purple spots, tongue ecchymosis, rough skin, and Raynaud's phenomenon. If fire-toxin burns, symptoms include high fever and extreme thirst. If heat forces blood flow, symptoms include skin rashes, severe as vomiting, hemoptysis, and bleeding gums.
Treatment Principle: Nourishing yin and tonifying the kidneys, detoxifying and resolving stasis. Detoxification methods vary, including dispelling wind, resolving dampness, warming cold-toxins, clearing fire-toxins, and resolving stasis. On the basis of tonifying the kidneys and detoxifying, treatment is adjusted according to symptoms, combined with clearing the lungs, strengthening the spleen, softening the liver, nourishing the heart, and resolving phlegm. This approach balances nourishing and draining, avoiding bias.
Medication: Kidney-Tonifying and Detoxifying Lupus Calming Formula (rehmannia glutinosa, prepared rehmannia glutinosa, leech plant, white-flowered snake tongue grass, etc.).
Explanation of the Formula: Rehmannia glutinosa, with its sweet, bitter, and slightly cold nature, is light in qi but heavy in flavor, sinking and descending, belonging to the heart, liver, and kidney channels. It "clears heat from the blood and greatly nourishes yin and blood" (from Pharmacological Explanations). Prepared rehmannia glutinosa, with its sweet and warm nature, nourishes blood and yin, replenishes essence and fills marrow, and its descending nature calms restless, ascending (deficiency fire). Leech plant promotes blood circulation and resolves stasis, regulates menstruation, and reduces edema. White-flowered snake tongue grass clears heat and detoxifies. The combination of these herbs balances nourishing and draining, treating both root and manifestation, achieving the effects of nourishing yin and tonifying the kidneys, and detoxifying and resolving stasis.
3. Rheumatoid Arthritis (RA)
Rheumatoid Arthritis (RA) falls under the category of "arthralgia" and "wind-damp arthralgia" in TCM. The main manifestation is joint swelling and pain, caused by wind, cold, dampness, heat, phlegm, and stasis, with prominent pathogenic factors. Treatment should focus on expelling pathogens, with methods such as dispelling wind, dispersing cold, resolving dampness, clearing heat, resolving phlegm, and resolving stasis. Generally, treatment should prioritize external then internal, clearing then warming, attacking then tonifying, and emphasize resolving blood stasis and promoting blood circulation.
(1) Early RA or acute active phase.
Etiology and Pathogenesis: External pathogens (wind, cold, dampness) accumulate in the muscles and sinews.
Symptoms: Joint pain, accompanied by chills, fever, and poor sweating.
Treatment Principle: Since the condition is superficial, it should be guided to expel pathogens outward, thus requiring opening pores and inducing sweating. Sweating reduces pain.
Medication: For mild cases, herbs like Notopterygium incisum, Saposhnikoviae divaricata, and Cimicifuga foetida are used to slightly induce sweating. For severe cases, stronger sweating herbs like Ephedra sinica, Cinnamomum cassia, and Asarum heterotropum are used, which can be taken for 30–60 days. If the prescription is well-balanced, excessive sweating is avoided. Otherwise, without sweating, effective results are difficult to achieve. After sweating and pain relief, the amount of exterior-dispersing herbs can be reduced, and methods such as dispelling cold, resolving dampness, resolving phlegm, and promoting blood circulation should be applied.
(2) Early RA or acute active phase, with worsened joint swelling and pain and significantly elevated erythrocyte sedimentation rate.
"Without cold, there is heat," so it can be temporarily treated as a heat syndrome. First, clear heat and resolve arthralgia to unblock collaterals, using herbs like gypsum, anemarrhena asphodeloides, rhinoceros horn, rehmannia glutinosa, moutan bark, peony root, and Akebia cordata to alleviate symptoms. If joint redness, swelling, and pain are accompanied by symptoms like joint coldness and warmth preference, this indicates a mixed cold-heat pattern. Treatment should combine cold and heat-clearing methods, adding warming herbs like Cinnamomum cassia and Aconitum carmichaelii to gypsum, anemarrhena asphodeloides, rhinoceros horn, and rehmannia glutinosa.
(3) RA in remission.
Most patients experience cold joint pain. Treatment shifts from clearing to warming, using herbs like Cinnamomum cassia, Aconitum carmichaelii, and Aconitum kusnezoffii to warm meridians and dispel cold.
(4) Chronic RA.
Long-term illness may lead to emaciation, poor complexion, fatigue in limbs, soreness and weakness in knees and lower back, and a deep, weak pulse, indicating lingering pathogens, leading to kidney and liver deficiency and qi and blood insufficiency. Treatment should focus on tonifying the kidneys and liver and nourishing qi and blood, using herbs like Dipsacus asper, Euonymus alatus, Angelica sinensis, Astragalus membranaceus, Epimedium brevis, and Psoralea corylifolia.
(5) Chronic RA.
External six pathogenic factors and internal wind-cold-dampness pathogens invade the joints and collaterals, obstructing qi and blood and impairing fluid distribution, leading to phlegm accumulation, blood stasis, and their mutual causation. Phlegm and stasis are difficult to resolve, causing persistent and difficult-to-relieve swelling and pain. Joint swelling and pain are often due to phlegm and stasis, while localized joint or subcutaneous nodules indicate phlegm, while fixed pain and joint stiffness suggest stasis. Joint swelling and pain are the primary issues for RA patients.
Clinical treatment uses herbs like Polygonus multiflorus, Gastrodia elata, and Sinapis alba to resolve phlegm and clear turbidity. Promoting blood circulation and resolving stasis uses Persicae Semen, Polygonum hydropiper, prepared Trichopus tricuspidatus, and Mantis religiosa. For deep-seated pain affecting collaterals, herbs like Scutellariae Radix, Centipede, Polygonum multiflorum, Vespertilio foetidus, Mantis religiosa, Lumbricus, and Trichopus tricuspidatus are used to penetrate and expel pathogens, resolving wind, dampness, phlegm, and stasis in collaterals, achieving clear turbidity, resolved stasis, harmonized qi and blood, unobstructed meridians and collaterals, and eliminating deeply lodged pathogens.