DISEASE CATEGORIZATION: Rheumatoid arthritis is mainly

categorized as bi zheng, impediment condition, in Chinese medicine. If there is fatigue, this is

categorized as pi juan, fatigue,

while low-grade fever is a species of fa re, emission of heat.

DISEASE CAUSES: Habitual bodily righteous vacuity with

external invasion of evils; long living in a damp environment

and contraction of wind, cold, damp, and/or heat evils

DISEASE MECHANISMS: Due to habitual righteous qi

vacuity, the interstices may be coursed and slack and the constructive and defensive may be
disharmonious. In that case

external evils may take advantage of this vacuity and assail

and enter where they impede and obstruct the qi and blood.

Hence the movement of the joints is inhibited. It is also possible that prolonged living in a damp
environment or exposure to rain and cold, damp, chilly weather may lead to contraction of wind, cold,
and damp evils. If evil qi lodges in the

sinews, bones, and joints, it may congeal there and produce

impediment. And finally, habitual bodily yang exuberance

may transform these evils into heat which may course and

pour into the joints where it obstructs and stagnates the qi and blood, thus producing this disease. If
enduring heat
damages and consumes yin fluids, this may give rise to liver-

kidney yin vacuity. If either spleen qi vacuity reaches the kidneys or yin vacuity affects yang, there may
be concomitant

kidney yang vacuity. If impediment endures and is not treated, it may engender blood stasis which enters
the network

vessels. Because blood and fluids flow together, blood stasis

may further become complicated phlegm obstruction and

nodulation.

TREATMENT BASED ON PATTERN

DISCRIMINATION:

1. WIND COLD DAMP IMPEDIMENT PATTERN

MAIN SYMPTOMS: This pattern typically presents at the initial stage or when this disease’s course has
not gone on too

long. Either one or many joints are swollen and painful.

However, the affected area is not hot or red and may, in fact,

feel cool or cold. There is early morning stiffness, heaviness,

numbness, and/or restricted movement. When the pain

obtains cold, it gets worse; when it obtains heat, it gets bet-

ter. Therefore, the pain typically follows changes in weather.

Other symptoms include possible aversion to cold, loose

stools, and clear, long urination. In the initial stage, fever,

chills, and absence of sweating are possibly accompanied by

severe pain in the joints. The tongue is pale with thin, white

fur, and the pulse is deep and bowstring or deep and tight.

NOTE: This pattern is not commonly seen in its pure form

in Western patients who tend to have spleen vacuity and liver

depression in addition to wind cold damp impediment. In

fact, it is a defensive qi vacuity due, in turn, to spleen qi

vacuity which allows wind, cold, and/or damp evils to

invade, resulting in impediment.

TREATMENT PRINCIPLES: Expel wind and dispel dampness, warm the channels and scatter cold

ACUPUNCTURE & MOXIBUSTION: Feng Chi (GB 20), Ge

Shu (Bl 17), Shen Shu (Bl 23), Guan Yuan (CV 4), appropri-

ate local points

ANALYSIS OF FORMULA: Draining Feng Chi resolves the

exterior and courses wind, while draining Ge Shu quickens

the blood. This combination is based on the statement, “To

treat wind, first treat the blood.” Supplementing Shen Shu

and Guan Yuan with moxibustion warms and supplements

source yang so it can scatter cold and warm the channels.

Draining the local points frees the flow of the network ves-

sels in the affectedvessels

ADDITIONS & SUBTRACTIONS: For jaw impediment, add Xia

Guan (St 7), Yin Feng (TB 17), and He Gu (LI 4). For cervical

impediment, add Feng Chi (GB 20), Wan Gu (GB 12), and

Tian Zhu (Bl 10). For thoracic vertebral impediment, add Jia Ji

(M-BW-35) at the level of involvement. For sacrococcygeal

impediment, add Da Chang Shu (Bl 25), Ming Men (GV 4), Ba

Liao (Bl 31-34), and Wei Zhong (Bl 40). For shoulder impedi-
ment, add Jian Yu (LI 15), Tian Zong (SI 11), and Ji Quan (Ht

1). For elbow impediment, add Qu Chi (LI 11), Xiao Hai (SI

8), Zhou Liao (LI 12), and Shou San Li (LI 10). For wrist

impediment, add Wai Guan (TB 5), Yang Chi (TB 4), and Wan

Gu (SI 4). For upper extremity phalageal and metacarpal

impediment, add Bai Xie (M-UE-22), He Gu (LI 4), and Hou

Xi (SI 3). For sacroiliac impediment, add Guan Yuan Shu (Bl

26), Xiao Chang Shu (Bl 27), Bai Huan Shu (Bl 30), Huan Tiao

(GB 30), Zhi Bian (Bl 54), and Ju Liao (GB 29). For hip

impediment, add Huan Tiao (GB 30) and Yang Ling Quan

(GB 34). For knee impediment, add Du Bi (St 35), Xi Yan (M-

LE-16a), Qu Quan (Liv 8), and Wei Zhong (Bl 40). For ankle

impediment, choose between Jie Xi (St 41), Shang Qiu (Sp 5),
Qiu Xu (GB 40), Kun Lun (Bl 60), Tai Xi (Ki 3), Shen Mai (Bl

62), and Zhao Hai (Ki 6) depending upon what channels are

involved with the site of pain. For metatarsal and lower extrem-

ity phalangeal impediment, add Jie Xi (St 41), Gong Sun (Sp 4),

Tai Chong (Liv 3), Zu Lin Qi (GB 41), and Ba Feng (M-LE-8).

2. WIND DAMP HEAT IMPEDIMENT PATTERN

MAIN SYMPTOMS: This pattern is seen in those with the

acute, active stage of rheumatoid arthritis. There is joint

swelling, pain, heaviness, and restricted movement. The

affected areas are burning hot to the touch and red to inspec-

tion. Coolness makes the pain less. Other accompanying

symptoms include fever, sweating, aversion to wind, oral

thirst but sometimes no desire to drink, possible vomiting,

short, reddish urination, a red tongue with thin, yellow fur,

and a slippery, rapid or soggy, rapid pulse.

NOTE: This pattern is not commonly seen in Western clin-

ical practice in its pure form. Commonly, wind, damp, and

heat evils complicate spleen vacuity and liver depression pat-

terns where the damp evils are internally engendered as

opposed to externally invading and the heat is due to depres-

sion transforming heat.

TREATMENT PRINCIPLES: Clear heat and disinhibit damp-

ness, dispel wind and free the flow of the network vessels

ACUPUNCTURE & MOXIBUSTION: Da Zhui (GV 14), Qu Chi

(LI 11), He Gu (LI 4), Wai Guan (TB 5), appropriate local
points

ANALYSIS OF FORMULA: Bleeding Da Zhui clears heat and

dispels wind. Draining Qu Chi and He Gu clears heat from

the entire body because, “The yang ming channel has lots of

qi and lots of blood.” Draining Wai Guan courses wind and

clears heat. Draining the local points frees the flow of the

network vessels in the affectedvessels

DDITIONS & SUBTRACTIONS: Please see pattern #1 above.

3. ENDURING IMPEDIMENT TRANSFORMS HEAT

& DAMAGES YIN PATTERN

MAIN SYMPTOMS: Joint redness, swelling, heat, and pain,

stiffness and inflexibility. Initially, when the pain obtains

coolness, it gradually soothes. However, after it has endured

for some time, the sensation does not improve and when it

obtains warmth it is soothed. There is a dry mouth with a

bitter taste, a parched throat, insomnia, vexation and agita-

tion, a red tongue with yellow or yellow, slimy fur, and a

bowstring, fine, rapid pulse.

NOTE: This pattern is sometimes also called mixed cold and

heat pattern.

TREATMENT PRINCIPLES: Scatter cold and eliminate

dampness, clear heat and free the flow of the network vessels

ACUPUNCTURE & MOXIBUSTION: Qu Chi (LI 11), He Gu

(LI 4), Guan Yuan (CV 4), appropriate local points

ANALYSIS OF FORMULA: Needling Qu Chi and He Gu with

lifting and thrusting draining technique clears heat from the

entire body because, “The yang ming channel has lots of qi

and lots of blood.” Needling Guan Yuan with even supple-

menting-even draining technique leads yang back down to

its lower source so that it can scatter cold, and warm the

channels. Draining the local points frees the flow of the net-

work vessels in the affected area.

ADDITIONS & SUBTRACTIONS: Please see pattern #1 above.

4. QI & BLOOD DUAL VACUITY, PHLEGM &

STASIS MUTUALLY BINDING PATTERN

MAIN SYMPTOMS: This pattern is mostly seen in the later

stages of RA where there is joint rigidity and deformation.

The joints aching and painful, swollen, distended, and

deformed, and their movement is inhibited. In addition,

there is an accompanying somber white facial complexion,

heart palpitations, shortness of breath, bodily fatigue,

encumbrance, and lassitude, a pale tongue with white fur,

and a deep, fine, bowstring, and/or tight pulse.

TREATMENT PRINCIPLES: Boost the qi and nourish the

blood, transform phlegm and dispel stasis, free the flow of

the channels and quicken the network vessels

ACUPUNCTURE & MOXIBUSTION: Zu San Li (St 36), San

Yin Jiao (Sp 6), appropriate local points

ANALYSIS OF FORMULA: Supplementing Zu San Li with

supplementing lifting and thrusting technique boosts the qi,

while supplementing San Yin Jiao in the same way nourish-

es the blood. The local points free the flow of the network
vessels in the affected area.

ADDITIONS & SUBTRACTIONS: Please see pattern #1 above.

5. LIVER BLOOD-KIDNEY YIN & YANG

VACUITY WITH PHLEGM & STASIS

MUTUALLY BINDING PATTERN

MAIN SYMPTOMS: In this case, the symptoms of kidney

yang vacuity are even more pronounced. There is joint and

muscular atrophy, joint stiffness, inflexibility, and deforma-

tion, unceasing aching and pain which is worse on exposure

to cold and during the winter and better on obtaint of

warmth and during the summer. Other signs and symptoms

include dizziness and tinnitus, long, clear, frequent urina-

tion, nocturia, low back and knee pain and chill, a pale

tongue with white fur, and a deep, weak, slow pulse, espe-

cially in the cubit position.

TREATMENT PRINCIPLES: Supplement the kidneys and

invigorate yang, nourish the liver and soothe the sinews,

scatter nodulation and quicken the network vessels

ACUPUNCTURE & MOXIBUSTION: Shen Shu (Bl 23), Ming

Men (GV 4), Guan Yuan (CV 4), appropriate local points

ANALYSIS OF FORMULA: Needling Shen Shu, Ming Men, and

Guan Yuan with even supplementing-even draining technique

followed by moxibustion warms and supplements source yang

so it can scatter cold and warm the channels. The local points

free the flow of the network vessels in the affected area.

ADDITIONS & SUBTRACTIONS: Please see pattern #1 above.

REMARKS

1. As in all chronic, enduring diseases, there will be an ele-

ment of liver depression due, if nothing other than to the

frustration of being ill. If there is concomitant liver depres-

sion qi stagnation, one should add appropriate qi-rectifying

medicinals. However, it should also be remembered that

wind-treating medicinals can also be used to rectify the qi.

Therefore, if there are wind-treating medicinals in the for-

mula already, one may not have to add other ingredients to

rectify the qi. This depends on the symptoms of qi stagna-

tion and whether or not those wind-treating medicinals

address those qi stagnation symptoms. For instance, Fang

Feng (Radix Saposhnikoviae) treats wind at the same time as

it alleviates qi stagnation intestinal cramping.

2. As with most autoimmune diseases, proper diet is

extremely important. If a person is invaded by external evils,

it means their righteous qi is vacuous and weak. The defen-

sive qi issues from the middle burner and its source is the

spleen. Therefore, whether in the active or remittent stages,

most patients with RA do also have spleen vacuity. When

there is spleen vacuity, one should eat a spleen-supporting

diet. This means little if any sugars and sweets, little if any

uncooked and chilled foods and drinks, and care when eat-

ing foods which strongly engender fluids. Foods which

engender fluids are typically those which have a lot of wei or

“flavor.” This includes many foods which enrich yin and fill

the essence, such as dairy and animal products. When com-

plicated by blood and/or yin vacuity, some yin-enriching

foods are necessary. However, so many of these should not be

eaten so as to damage the spleen. In general, it is always safer

in terms of diet to foster essence via the spleen’s engender-

ment and transformation of qi and blood than to eat a lot of

slimy, enriching, flavor-laden, yin-supplementing foods.

When damp heat complicates RA, then patients should stick

to a clear, bland, hypoallergenic, yeast-free diet. This means

eating little or nothing made through fermentation or which

molds easily. This includes, in addition to sugars and sweets,

bread and yeasted grain products, cheese, alcohol, and vine-

gar, tomatoes, oranges, peaches, strawberries, raspberries,

cantaloupe, etc. Although acrid, hot foods are contraindicat-

ed in cases of damp heat, if there are gu worms, one should

eat onions and garlic liberally.

3. Like most other autoimmune diseases, this condition’s sever-

ity fluctuates, and there are often periods of relative remission.

In general, Chinese medical treatment should mainly be used

for the long-term prevention of future reoccurrences and the

progression of this disease, while during acute attacks, a com-

bination of Chinese medicine, including acupuncture and

moxibustion, and modern Western medicine may be most

effective. In particular, many patients with rheumatoid arthri-

tis may be prescribed corticosteriods during acute attacks, and

Chinese medicine can be used to treat the side effects of medi-

cines like Prednisone. In that case, treatment should merely be

given based on the patient’s total pattern discrimination.

ENDNOTES

1 Pizzorno, J.E. & Murray, M.T., Encyclopedia of Natural Medicine, Prima

Publishing, Rocklin, CA, 1991

2 The Burton Goldberg Group, Alternative Medicine, The Definitive Guide,

Future Medicine Publishing Inc., Puyallup, WA, 1993, p. 530