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Rheumatoid Arthritis

Rheumatoid Arthritis is a chronic degenerative form of Arthritis which particularly affects the small joints of the hands, wrists, feet and ankles. It is the classic 'Wind-Damp' (Feng Shi) joint disease of TCM. Ayurveda calls its Ama-Vata (Ama is the toxic residue of undigested food; Vata is Wind), thus showing a close etiology with TCM. This also highlights the 'Damp' of TCM being a by-product of improper digestion.

This shows the functions required in the Treatment which will include several of the following:
  • Regulate Qi, opens Obstructions (Cyperus rotundus, Costus etc.)
  • Strengthen Digestion (Ginger, Pepper etc,)
  • Clear Damp (Agaric, Colchicum, Poria Fu Ling etc,)
  • Promote Circulation, open the capillaries (Asarum, Saffron, Cinnamon twig etc)
  • strengthen Bones and Joints (Comfrey, Eucommia Du Zhong etc.)
  • clear Heat, Inflammation and Pain (Centuary, Turmeric etc.)

In all Traditions, some of the strongest medicines used was in the treatment of Rheumatoid Arthritis.

In the Western Tradition, purging was indicated, and of the purging medicines, formulas based on Colchicum were most used for Joint disease including Rheumatism. Aloes and Rhubarb also feature prominently in traditional Joint Formulas of the West. In the eastern systems, Aconite and Nux Vomica are often used.

Acute cases or acute exasperation are associated with exposure to Wind, Cold and Damp. In these cases diaphoretics can be used such as Feverfew, Asarum, Cinnamon twig (Gui Zi) Siler and Saposhnikovia Fang Feng.

Acute active forms with Heat, inflammation and pain are treated with medicine to clear Heat and Swelling. Rhubarb, Madder, Swertia, Andrographis, Coptis, Centaury, Gentian and Gentiana Qin Jiao are some of the drugs useful in such situations.

Medicines that strengthen the Kidneys, Bones and Joints include Comfrey, Mistletoe, Eucommia Du Zhong, Dipsacus Xu Duan, Achyranthes Niu Xi and Shilajit. Other tonic medicines are added according to need, but Spleen tonics like Elecampane, Atractylodes Bai Zhu and Withania are useful to increase Qi and strengthen digestion to inhibit formation of Damp.

Warming, aromatic medicines are very important due to their general nature of clearing Damp and regulating or moving Qi. All the spices are beneficial and appear in various formulas for Joint disease. Cinnamon twig (Gui Zhi), Asarum and Saffron are particularly useful medicines with aromatic, opening qualities directed towards the fine capillaries.


Some simple Folk Remedies:
1. Celery.
a. Take Garden Celery and cut into pieces, and boil in water until soft. This water may be taken throughout the day.
b. The following recipe may also be prepared: ‘Put new milk, with a little flour and nutmeg, into a saucepan with the boiled Celery, serve it warm with a piece of toast, and the painful ailment will soon yield’. This was said to have cured many serious cases of rheumatism. (
Vitalogy)
c. Celery seed tea, taken daily over months has been effective in some cases
2.
Asparagus
Stalks of fresh Asparagus boiled in 1.5 cups of water in a covered pan until it falls apart; mash into a paste; add another 0.5 cup of water to thin; boil 3 minutes. Drink twice a day; once upon rising; once at bedtime’. (Green Medicine, Mrs. C. F. Leyel, 1890)

3. Nettle tea consumed regularly has likewise helped some cases.
4. Conserve of Rosehips, taken in spoonful doses every morning has relieved some cases.

Western Tradition

Simples
Colchicum
Rhubarb
Chebula
Bdellium
Cyperus rotundus
Celery seed
Agaric
Nettle
Burdock seed
Guaiacum
Withania
Viper
Shilajit


Turbith
Senna
Rose hip
Frankincense
Madder
Nigella
Mistletoe
Willow bark
Rosehip
Sarsaparilla / China root
Tinospora
Earthworm
Sulphur

1. Decocto dry Ginger and drink everyday to cure Ama-Vata.
2. Plumbago, Ginger, Long Pepper
3. Ginger, Celery seed, Tribulus seed


Formulas
General

Honey Water (Hydromel)
Oxymel of Squill
Compound Syrup of Vinegar
Infusion for Rheumatoid Arthritis
Decoction for Arthritis (Mynsichts)
Decoction of Guaiacum Compound
Tinospora 5 Decoction (Sle tres lnga thang) (Tibetan)
Wine for Arthritis
Antidote of Seven Things (Paulus Aegineta)
Electuary of Clove and Costus (Caryocostinum)
Compound Guaiacum Confection (Chelsea Pensioner)
Powder Against Joint Pain
Powder for Gout of the Duke of Portland
Troches of Viper (Trochisci Viperini)
Pills for Arthritis (Nicholas)
Pills for Arthritis (Wirtzung)
Pills for Joint Disease
Pills of Agaric (Avicenna)
Pills of Colchicum (Mesue) (Habb E Suranjun)
Pills of Colchicum Greater (Habb E Suranjun Kalan)
Foetid Pills (Mesue)
Golden Pills (Nicholas)

Guggulu Thiktam Kashayam
Punarnavadi Kashayam
Balaguluchiadi Kashayam



Wind-Damp

Troches of Viper (Trochisci Viperini)
Pills for Joint Disease
Pills of Colchicum (Mesue) (Habb E Suranjun)
Pills of Colchicum Greater (Habb E Suranjun Kalan)
Golden Pills (Nicholas)
Pills of Agaric (Avicenna)
Pill of Three Tastes (Mongolian Medicine)
Tinospora 5 Decoction (Sle tres lnga thang)
Frankincense 10 (Spos dkar 10)



With Marked Deficiency

Confected Chebulic Myrobalan
Conserve of Rosehip
Honey Water (Hydromel)
Decoction of Guaiacum Compound
Troches of Viper (Trochisci Viperini)
Diathamaron Magna (Nicholas)
Tinospora 5 Decoction (Sle tres lnga thang)

Electuarium Alcharif (Mesue)

To Strengthen between Purging or after Treatment
Aromaticum Rosatum
Cooling Pearl Powder (Diamargariton) (Mesue)

Compound Galangal Powder (Diagalanga) (Mesue)
Electuary of Ginger (Dia Zingiber) (Nicholas)
Electuary of Life (Arnold de Villa Nova)
Compound Cinnamon Powder (Diacinnamonum)

Restorative Electuary (Antidotus Analeptica)
Restorative of Nicholas (Pleres Arconticon)

Triphera of the Saracens (Triphera Saracenica Magna)

To Purge

Pills for Joint Disease
Pills of Colchicum (Mesue) (Habb E Suranjun)
Pills of Colchicum Greater (Habb E Suranjun Kalan)
Golden Pills (Nicholas)

Greater Polycrest Pills


Chinese Classification

Simples
Aconitum Fu Zi
Achyranthes Niu Xi
Acanthopanax Wu Jia Pi
Saposhnikovia Fang Feng
Gentiana Qin Jiao
Clematis Wei Ling Xian
Viper Bai Hua She

Nux Vomica Ma Qian Zi
Eucommia Du Zhong
Mistletoe Sang Ji Sheng
Cinnamon twig Gui Zhi
Angelica Du Huo
Sigesbeckia Xi Xian Cao
Earthworm Di Long

Formulas
General


Du Huo Ji Sheng Tang


Wind-Damp

Fu Zi Tang
Zhen Wu Tang
Gui Zhi Shao Yao Zhi Mu Tang
Du Huo Ji Sheng Tang
Xiao Huo Luo Wan
Feng Shi Ma Qian Pian


Yang Deficiency

Fu Zi Tang
Zhen Wu Tang


Yin Deficiency

Liu Wei Di Huang Wan
Zuo Gui Wan

Other Herbs
1. 200mg doses of an extract of Rhus verniciflua bark has been used in Korea as a stand-alone herb with promising results. (See here)

Special Formula

1. Gentian
    Agrimony                   1 oz. each
decoct briefly in 2 pints of water. ‘Remarkable results have been achieved in some advanced cases of Rheumatoid Arthritis’. The dose is a wine-glassful three or four times daily. (Wonders in Weeds, W. Smith)

2. Nettle
    Agrimony
    Birch leaf
    Celery seed
    Rosehip

3. Horsetail
    Elder flower
    Nettle
    Dandelion
root & leaf
    Birch leaf


4. Yarrow
    Meadowsweet
    Sea Holly
    Chickweed                    half oz. ea.
Decoct briefly in 2 pints of boiling water, strain, add 1 teaspoon of Cayenne powder and sit until cool. Strain. (Wonders in Weeds, W. Smith)

5. Willow bark
    Elder flower
    Rosemary
    Golden Rod
    Coltsfoot

6. Smilax glabra (Tu Fu Ling)
    Bolbostemma paniculatum (Tu Bei Mu)
These have been combined in TCM as a stand-alone treatment with good results.

7. 'Artrex':
(doses per capsule)
  Turmeric 36mg
  Ginger 48mg 
  Withania 180mg
  Frankincense 180mg
Despite being a patent medicine it is closely allied with traditional Ayurvedic principles and formula. Research has proven efficacy and safety. (See here)

8. Clove Pills (Ayurveda)
    Triphala
    Clove
    Cubebs
    Cinnamon
    Indian leaf
    Cardamon
    Mesua ferrea
    Tabasheer
    Plumbago
    Prepared Iron
Powder and take with Ghee and Treacle every morning.

9. Bi Qi Capsule:
  Prepared Nux Vomica (Ma Qian Zi)
  Earthworm (Di Long)
  Codonopsis Dang Shen
  Atractylodes Bai Zhu
  Poria Fu ling
  Salvia Dan Shen
  Ligusticum Chuan Xiong
  Panax notoginseng San Qi
  Achyranthes Niu Xi
  Licorice (Gan Cao)
Research demonstrated efficacy similar to methotrexate but with no severe side effects noted. (See here)



Research:
1. General/ Review
–A mechanistic review on medicinal plants used for rheumatoid arthritis in traditional Persian medicine, (Farzaei et al., J. of Pharmacy and Pharmacol., June, 2016).

–Treatment of rheumatoid arthritis with traditional chinese medicine.  (Lee WY et al. Biomed Res Int. (2014)
–Systems Pharmacology Dissection of Multiscale Mechanisms of Action for Herbal Medicines in Treating Rheumatoid Arthritis.

2. Specific Herbs
–
Borage oil reduction of rheumatoid arthritis activity may be mediated by increased cAMP that suppresses tumor necrosis factor-alpha. (Kast, Int Immunopharmacol. Nov, 2001)
–Stems and leaves of Aconitum carmichaelii Debx. as potential herbal resources for treating rheumatoid arthritis: Chemical analysis, toxicity and activity evaluation.
–Total glucosides of paeony for rheumatoid arthritis: A systematic review of randomized controlled trials.
–
Consumption of Hydrolyzable Tannins Rich Pomegranate Extract (POMx) Suppresses Inflammation and Joint Damage In Rheumatoid Arthritis

3. Combinations and Formula
–Therapeutic effects of Smilax glabra and Bolbostemma paniculatum on rheumatoid arthritis using a rat paw edema model.
–Arachidonic acid metabonomics study for understanding therapeutic mechanism of Huo Luo Xiao Ling Dan on rat model of rheumatoid arthritis.
–Wu-Tou Decoction Inhibits Angiogenesis in Experimental Arthritis by Targeting VEGFR2 Signaling Pathway.
–Efficacy and Safety of Gui Zhi-Shao Yao-Zhi Mu Decoction for Treating Rheumatoid Arthritis: A Systematic Review and Meta-Analysis of Randomized Clinical Trials.
–[Medicinal-powder-separated Long-snake Moxibustion over the Governor Vessel with Different Skin Vesiculation Conditions for Treatment of Patients with Rheumatoid Arthritis].

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