What is Arthritis?

Arthritis (from Greek arthro-, joint + -itis, inflammation; plural: arthritides) is a group of conditions where there is damage caused to the joints of the body. Arthritis is the leading cause of disability in people over the age of 50.

There are many different forms of arthritis, each of which has a different cause. Rheumatoid arthritis and psoriatic arthritis are autoimmune diseases in which the body is attacking itself. Septic arthritis is caused by joint infection. Gouty arthritis is caused by deposition of uric acid crystals in the joint that results in subsequent inflammation. The most common form of arthritis, osteoarthritis is also known as degenerative joint disease and the result of aging. There is emerging evidence that abnormal anatomy may contribute to early development of osteoarthritis.

All arthritides feature pain. Patterns of pain differ among the arthritides and the location. Osteoarthritis is classically worse at night or following rest. Rheumatoid arthritis is generally worse in the morning; in the early stages, patients often do not have symptoms following their morning shower. In elderly people and children, pain may not be the main feature, and the patient simply moves less (elderly) or refuses to use the affected limb (children).

Elements of the history of the pain (onset, number of joints and which involved, duration, aggravating and relieving factors) all guide diagnosis. Physical examination typically confirms diagnosis. Radiographs are often used to follow progression or assess severity in a more quantitative manner. Screening blood tests may be indicated if certain arthritides are suspected. This may include: rheumatoid factor, antinuclear factor (ANF), extractable nuclear antigen and specific antibodies.

Perceived Causes

1). Osteoarthritis / Osteoarthrosis (OA, also known as degenerative arthritis, degenerative joint disease, arthrosis or in more colloquial terms "wear and tear"), is a condition in which low-grade inflammation results in pain in the joints, caused by wearing of the cartilage that covers and acts as a cushion inside joints. As the bone surfaces become less well protected by cartilage, the patient experiences pain upon weight bearing, including walking and standing. Due to decreased movement because of the pain, regional muscles may atrophy, and ligaments may become more lax. OA is the most common form of arthritis. The word is derived from the Greek word "osteo", meaning "of the bone", "arthro", meaning "joint", and "itis", meaning inflammation, although many sufferers have little or no inflammation. OA affects nearly 21 million people in the United States, accounting for 25% of visits to primary care physicians, and half of all NSAID (Non-Steroidal Anti-Inflammatory Drugs) prescriptions.

The main symptom is chronic pain, causing loss of mobility and often stiffness. "Pain" is generally described as a sharp ache, or a burning sensation in the associated muscles and tendons. OA can cause a crackling noise (called "crepitus") when the affected joint is moved or touched, and patients may experience muscle spasm and contractions in the tendons. Occasionally, the joints may also be filled with fluid. Humid weather increases the pain in many patients.

OA commonly affects the hands, feet, spine, and the large weight-bearing joints, such as the hips and knees, although in theory, any joint in the body can be affected. As OA progresses, the affected joints appear larger, are stiff and painful, and usually feel worse, the more they are used throughout the day, thus distinguishing it from rheumatoid arthritis.

In smaller joints, such as at the fingers, hard bony enlargements, called Heberden's nodes (on the distal interphalangeal joints) and/or Bouchard's nodes (on the proximal interphalangeal joints), may form, and though they are not necessarily painful, they do limit the movement of the fingers significantly. OA at the toes leads to the formation of bunions, rendering them red or swollen.

OA is more common in women than in men.

Do not believe it when you are told that OA cannot be treated.

2) Rheumatoid arthritis (RA) and Gouty arthritis are traditionally considered chronic, inflammatory autoimmune disorder that causes the immune system to attack the joints. It is a disabling and painful inflammatory condition, which can lead to substantial loss of mobility due to pain and joint destruction. RA and GA are systemic diseases, often affecting extra-articular tissues throughout the body including the skin, blood vessels, heart, lungs, and muscles. About 60% of RA and GA patients are unable to work 10 years after the onset of their disease. The name is derived from the Greek Rheumatos means "flowing.

Rheumatoid and gouty arthritis are chronic, inflammatory, multisystem autoimmune disorder. It is commonly polyarticular; that is, it affects many joints. Inflammation, soft tissue swelling, and the involvement of multiple joints are common signs and symptoms that distinguish rheumatoid and other inflammatory arthritis from non-inflammatory arthritis such as osteoarthritis. The joints are usually affected initially asymmetrically and then in a symmetrical fashion as the disease progresses. The pain generally improves with use of the affected joints, and there is usually stiffness of all joints in the morning that lasts over one hour. Thus, the pain of rheumatoid arthritis is usually worse in the morning compared to the classic pain of osteoarthritis where the pain worsens over the day as the joints are used.

Extra-articular manifestations also distinguish rheumatoid arthritis from osteoarthritis (hence it is a multisystemic disease). For example, most RA patients also suffer with anemia, either as a consequence of the disease itself (anaemia of chronic disease) or as a consequence of gastrointestinal bleeding as a side effect of drugs used in treatment, especially NSAIDs used for analgesia. Hepatosplenomegaly may occur (simultaneous enlargement of spleen and liver caused by drugs).

Do not believe it when you are told that RA and GA cannot be treated.

Root Causes

For TCM the root cause of osteoarthritis is due to the estrogen factor. As women advances in age their lower estrogen level affects the body’s capacity to repair the damages causes by wear and tear of everyday life to the bones, cartilages, tendons, ligaments, cartilages and sinews. The weaken joints cannot efficiently support the body’s normal weight and thus create stress on the joints. The extra stress to these joints causes them to be painful and at rare times inflamed (arthritis means inflamed joints). Gradually these degeneration causes loss of mobility and stiffness. (for treatment see Rener-Liv and NerboneCare)

Rheumatoid (RA) and gouty arthritis (GA) on the other hand are caused by the body’s inability to efficiently remove toxic excess like uric acid. Uric acid is a natural element which results from the normal breakdown of meat and the building of body tissues. From TCM’s view point RA and GA are “bi-syndrome” problems. According to TCM classic Suwen (The Book of Plain Question) states that “bi-syndrome is due to a combined attack of wing, cold and dampness”. Attacks on these meridians by such elements lead to the stagnation of vital energy (qi) and blood circulation in the superficial areas of the body such as the feet and hands. As a result the body suffers from such obstructive joint disorder.

TCM holds that there is a distribution network for the important body substances like vital energy, blood and body fluid throughout our body. This network is classified as the Meridian System. It connects organs, limbs, joints, bones, tendons, tissues, sinews and skin and allowing exchanges to take place. Bi-syndrome refers to those diseases that result from the blocking of the extremities, meridians or organs by pathogens (biological agents that cause diseases). The syndrome manifests as joint pain, numbness and impaired movements of the limbs.

For TCM the treatment involves improving the functions of the kidneys, liver and blood circulation, replenishes the body's estrogen level using phytoestrogen of plants, stop the inflammation (reduce the pain) as well as removing the blood toxicity (high uric acid) to stop the uric acid to attack the joints and repair the weaken joints.

Herbs: Herbs rich in flavonoid compound have been found to help lower uric acid levels in the body. Flavonoids are effective in decreasing inflammation and preventing and repairing the destruction of joint tissue. Herbs have been proven to be able to reduce uric acid levels and to relieve joint pain. High uric acid level in the blood represents a serious strain on the kidneys. Herbs can be used to support kidney functions.

Using herbal formulation is the best alternative to treating uric acid and gout problems as they are designed to be holistic in nature: pain caused by gout has to be treated, uric acid has to be removed, blood circulation, gall bladder, kidneys and liver functions have to be improved. Chinese medicinal herbs have more advantages in treating uric acid problems as they provide holistic treatment and restoration and have no toxic side effects. Using Chinese medicinal herbs for the treatment of uric acid disorder has been done for centuries.  

Herbs like Poria Cocos Wolf, Radix Gentiana, Radix Ledebouriella, Herba Lysimachia Christinae, Herba Artemisa Scoparia, Uncaria Rhynchophylla, Folium Taraxacum Mongolicum, Salvia Miltiorrhiza and Panax Notoginseng have been traditionally used for uric acid and gout problems, improve the function of the liver and protect the kidneys from uric acid damage.

Poria Cocos Wolf:

1) Clinical research by western scientists from Japan has shown that Poria cocos has anti-inflammatory functions. 20314

2) Research by western scientists from Spain has shown that Poria cocos is effective in treating  chronic and acute inflammation. 25140

3) Clinical research by western scientists has shown that Poria Cocos Wolf has   immune-enhancing activity. 65424

4) Clinical research by western scientists has shown that Poria cocos has strong anti-tumor effect (antioxidant). 84472

5) Clinical research by western scientists have shown that Poria Cocos have anti-inflammatory functions, high scavenging activity and protects liver and red blood cells from lipid peroxidation. 60151

6) Clinical research by western scientists has shown that Poria cocos has anti-inflammatory functions and protects red blood cells from AAPH-induced hemolysis (affected by microorganisms). 160 - 162

7) Clinical research by western scientists has shown that Poria cocos improves kidney functions. This would protect the kidneys from being damage by uric acid. 07662

Lysimachia Christinae: Clinical research by western scientists has shown that aqueous extract of Lysimachia christinae possesses potent hypouricemic (meaning removing uric acid) effects on models of hyperuricemia in mice pretreated with oxonate. 41944 

Artemisia Scoparia:

1) Clinical research by western scientists has shown that Artemisiae species were proven to have immunosuppressive principles, some of them were now used clinically for the treatment of rheumatoid arthritis. 41992

2) Clinical research by western scientists has shown that this herb is effective for treating liver diseases. Research showed that scoparone from Artemisa Scoparia decreases the production of the inflammatory mediators such as NO and PGE2 in macrophages by inhibiting iNOS and COX-2 expression. 203-8 

3) Another group of scientists wrote "these data indicate that the plant artemisia scoparia is hepatoprotective and validate the folkloric use of this plant for treating liver problems". Research showed the protective action of the plant extract against CCl4-induced liver damage. 41001

4) Clinical studies by western scientists have shown that Artemisia Scoparia has strong anti-inflammatory function. Research demonstrate that the inhibition of scoparone on LPS-induced TF expression in HUVECs may mediate by the mechanisms suppressing superoxide anion formation and TF transcription.  72379

5) Clinical studies by western scientists have shown that Artemisia Scoparia  has strong hepatoprotective function against alcohol-induced hepatotoxicity (protects the liver). 75739

6) Clinical studies by western scientists have shown that the flavonoid rutin from Artemisia Scoparia  has strong hepatoprotective function against drug-induced (paracetamol) hepatotoxicity (protects the liver). 90212

7) Clinical studies by western scientists have shown that Artemisia Scoparia  has strong hepatoprotective function against drug-induced (Acetaminophen) hepatotoxicity (protects the liver). 12519

8) Clinical studies by western scientists have shown that Artemisia Scoparia  has strong hepatoprotective function against chemical-induced (carbon tetrachloride) hepatotoxicity. Research showed that Artemisia Scoparia inhibited fibrosis and lipid peroxidation induced by carbon tetrachloride (protects the liver). 33139

9) Clinical studies by western scientists have shown that Artemisia Scoparia  has strong antioxidative and cytoprotective actions. Clinical studies showed that the strong antioxidative functions of Artemisia Scoparia effectively protected liver tissues against the dimethylnitrosamine-induced hepatic fibrosis (protects the liver).  06248

Uncaria Rhynchophylla: Clinical research by western scientists have shown that Uncaria rhynchophylla can be used to lower blood pressure and to protect and relieve various neurological symptoms. Research showed that U. rhynchophylla extract inhibited TNF-alpha and nitric oxide production in BV-2 mouse microglial cells in vitro. These anti-inflammatory actions of U. rhynchophylla extract may contribute to its neuroprotective effects. 28929

Folium Taraxacum Mongolicum: Herbs like Folium Taraxacum Mongolicum is rich in vitamins and minerals. The leaves have a very high content of vitamin A as well as moderate amounts of vitamin D, vitamin C, various B vitamins, iron, silicon, magnesium, zinc, and manganese.

The leaves are a rich source of potassium, which is interesting since they are used for their diuretic action. This may make Folium Taraxacum Mongolicum the only naturally occurring potassium-sparing diuretic, although its diuretic action is likely different from that of pharmaceuticals. At very high doses, the leaves have been shown to possess diuretic effects comparable to the prescription diuretic frusemide (Lasix).

Folium Taraxacum Mongolicum leaves and roots have been used for hundreds of years (since the 3rd century) to treat problems of the joints, liver, gallbladder, and kidneys. In some countries, Folium Taraxacum Mongolicum is considered a blood purifier and is used for ailments such as eczema and cancer. Folium Taraxacum Mongolicum has also been used historically to treat poor digestion and diseases of the liver. Folium Taraxacum Mongolicum has two particularly important uses: to promote the formation of bile and to remove excess water from the body. The root affects all forms of secretion and excretion from the body. It acts as a tonic and stimulant by removing toxins and poisons from the body and increases the flow of urine in patients with liver problems.

The principal constituents responsible for Folium Taraxacum Mongolicum’s effects are its bitter principles. Previously referred to as taraxacin, these constituents are:

Sesquiterpene lactones — eudesmanolide, and germacranolide types.
Triterpenes — taraxol, taraxerol, beta-amyrin
Phytosterols — taraxasterol, , stigmasterol, beta-sitosterol
Phenolic acids — caffeic and hydroxyphenylacetic acids
Fatty acids — myristic acid
Carbohydrates — glucans, mannans, inulin,
Sugars — fructose, glucose, sucrose
Carotenoids — lutein, violaxanthin
Flavonoids — apigenin, luteolin
Miscellaneous — choline, mucilage, pectin

Research scientists says: "Folium Taraxacum Mongolicum helps the liver and kidneys to do their work and keeps the bowels in a healthy condition. Aside from its efficacy in the treatment of kidney and liver disorders, it may also be used to treat inflammation and congestion of the liver and gall bladder by stimulating them. Because of its ability to reduce high uric acid levels, it is an effective treatment for gout. Because Folium Taraxacum Mongolicum is one of the best natural sources of potassium, it is a perfectly balanced and safe diuretic. Taraxacum root contains bitter elements that may stimulate digestion through the stimulation of gastric and salivary juices. Considered one of the best liver tonics, it stimulates the liver to create bile and stimulates the gall bladder to release the stored bile. This increased flow of bile, combined with the action of the triterpenes that may increase the solubility of the bile, makes Taraxacum a good herb for cleansing and removing of toxins. "

1) Susnik F. The present state of knowledge about the medicinal plant Taraxacum officinale Weber [in Slovak; English abstract]. Med Razgl. 1982;21:323–328.

2) European Scientific Cooperative on Phytotherapy. Taraxaci radix (dandelion). Exeter, UK: ESCOP; 1996–1997:2. Monographs on the Medicinal Uses of Plant Drugs, Fascicule 2.

3) Bohm VK. Studies on the choleretic action of some drugs [in German, English abstract]. Arzneimittelforschung. 1959;9:376–378.

Salvia Miltiorrhiza:

1) Clinical research by western scientists confirmed the validity of the historical use of the drug for improving liver functions.  566-572(7)

2) Clinical research by western scientists confirmed the validity of the historical use of the drug, Salvia Miltiorrhiza for improving liver functions by preventing liver damage and micro-circulation disorders. 41991.

3) Scientists confirmed the validity of the historical use of the drug to improve heart and kidneys functions, promoting coronary blood flow without affecting heart rate, inducing dilation of renal vascular system, an increase in renal blood flow and glomerular filtration rate, decreases blood urea nitrogen, serum creatinine, methylguanidine, guanidinosuccinic acid and inorganic phosphate (in rat studies), is a free radical scavenger, inhibits platelet aggregation and reduces accumulation of methylguanidine and guanidinosuccinic acid levels (methylguanidine and guanidinosuccinic acid have been reported to cause platelet dynfunction, hemolytic activity, glucose metabolism disturbance and inhibition of lymphocyte transformation). 1527-0661  

4) Clinical research by western scientists from Taiwan showed that Salvia Miltiorrhiza exerts antifibrotic effects and confirmed the validity of the historical use of the herb for improving liver functions. Stronger liver would reduce kidney stress. 64749

5) Clinical research by western scientists confirmed Salvia Miltiorrhiza has antioxidative agent by inhibiting the production of nitric oxide (NO), interleukin-1beta (IL-1beta), interleukin-6 (IL-6) and tumor necrosis factor-alpha (TNF-alpha), and suppressed the expression of inducible nitric oxide synthase (iNOS). 35448

6) Research by western scientists confirmed Salvia Miltiorrhiza has antioxidative agent. The active constituents 1,2,15,16-tetrahydrotanshiquinone and Ro-090680 showed inhibitory activity against P388 Leukemia cell in vitro and Ro-090680 was reported to be a potent inhibitor of rabbit platelet aggregation induced by collagen (platelet aggregation can cause vascular obstruction via the formation of a thrombus).  57662

7) Clinical research by western scientists have shown that Tanshinone I from Salvia miltiorrhiza has in vivo anti-inflammatory activity. The methanol extract of Salvia miltiorrhiza was found to inhibit PGD₂ production and Tanshinone I was found to inhibit PGE₂ formation.  616 - 620

8) Clinical research by western scientists has shown that hydroxyl radical seems to be the most important factor in ischemia and reperfusion injury to skeletal muscle and that Salvia Miltiorrhiza have a role in antioxidation as a hydroxyl radical scavenger. 171-175

Panax Notoginseng:

1) Experiments and modern clinical trials have shown that Panax notoginseng has immunologically active. Panax notoginseng stimulates macrophages, promotes antibody formation, activates complement and increases T lymphocyte proliferation.  (T lymphocyte: a small lymphocyte developed in the thymus; it orchestrates the immune system's response to infected or malignant cells) and protected animals from liver intoxications. 41992

2) Clinical research  by western scientists has shown that Panax Notoginseng has anti-inflammatory, analgesic (reduces pain) and immunomodulatory action. 44000

3) Clinical research  by western scientists has shown that Panax Notoginseng reduces thrombogenicity (blood clot) and arrhythmias (improves blood and heart function), increases erythrocyte deformability (causes the ability erythrocytes cells to change shape as they pass through narrow spaces, such as the microvasculature i.e. improves blood flow), is an antioxidant, which can counteract free radical damage associated with atherogenesis and myocardial damage seen with ischemia (reduce blood supply) and reperfusion (damage to tissue caused when blood supply returns to the tissue after a period of ischemia). 66054

4) Clinical research by western scientists has shown that Panax Notoginseng has anti-inflammatory effect. 78152

5) Clinical research by western scientists has shown that ginsenosides Rg1 from Panax Notoginseng has estrogen-like activity and should be classified as a novel class of potent phytoestrogen. 61497