RHEUMATOID ARTHRITIS

Clinical Manifestations
  • Beginning Stage:
    Disabling inflammatory disease
    Chronic Synovitis
    Joint Lesions
    Pannus-Corneal vascularization (localized malignant inflammatory proliferation)
    Immunological origin- auto immune
    Self sustained
    Rheumatoid nodules
    Lung symptoms
    Vessel Problems
    Pericardium problems
    Above three conditions alternate with joint problems
    Fever
  • Chronic Stage:
    Beginning stage may last several months or years and may not progress beyond this point
    More often moves on, intermittently with
    Worsening of joints
    New invasion of healthy joints
    May affect organs
    Qi and Blood circulation slowed
    Blood and turbid Phlegm stagnate joints (stubborn Bi)
    Joints show chronic inflammation
    Pain occurs spontaneously or from pressure or with movement
    Pain and stiffness worse at night and on awakening
    Disappears late in the morning or afternoon and require a long period of warming up
    Sensitive to weather
    Locations of joint pain depend on patient (antalgic attitudes)
Treatment Principle
Herb Formulas
Points
Clinical Manifestations
  • Slight fever
  • Strong chills
  • Anhidrosis
  • Headache
  • Cold extremities
  • Fatigue with a constant desire to lie down
  • Drowsiness
  • Pale face
  • Lassitude
  • Low voice
  • Weak voice
  • T: Pale
  • C: White
  • P: Floating, big and forceless or Deep and forceless
Treatment Principle
  • Tonify Yang
  • Augment Qi
  • Release the Exterior
  • Induce sweating
Herb Formulas
Points
  • General points
Clinical Manifestations
  • Alternating chills and fever (chills predominate) or
  • Chills without fever
  • Sensation of irritability in the chest
  • Sweating from the head
  • Fatigue
  • Gastrointestinal weakness
  • Heavy head
  • Neuralgia
  • Epigastric distension
  • Lower abdominal pain
  • Tension around pubic bone
  • Periumbilical pain
  • Urinary difficulty
  • T: Moist
  • C: White and slippery
  • P: Superficial and wiry
Treatment Principle
  • Disperse Clumping
  • Harmonize the Shao Yang
  • Warm the Interior
  • Dispel Cold
Herb Formulas
Points
Clinical Manifestations
  • Long standing cold hands and feet that are cold to the touch and feel cold to the patient
  • Maybe lumbago and leg pain
  • Abdominal pain and distention
  • Midline pain
  • Uterine pain
  • Chills
  • Diarrhea
  • Menstrual abdominal pain
  • Maybe chest pain
  • Increased sweating, particularly of the feet
  • Increased salivation
  • Spasm and pain of the limbs
  • Scanty urination
  • Pain at the waist, hips, legs and feet
  • Sciatica
  • Joint pain
  • Irregular menstruation
  • Abdominal Cold
  • Migraine headache
  • Vaginal discharge
  • T: Pale
  • C: White
  • P: Deep and thready (may be almost imperceptible).
Treatment Principle
  • Warm the channels
  • Disperse Cold
  • Nourish the Blood
  • Unblock the Blood vessels
Herb Formulas
Points
Clinical Manifestations
  • Fever and chills, fever more pronounced or
  • Tidal fever
  • Abdominal distention
  • Thirst
  • Sweat
  • Stifling sensation in the chest
  • Restlessness
  • Gastric disturbances:
    Heaviness
    Nausea
    Severe diarrhea
  • Scanty urine
  • T: Red tip and edges
  • C: Greasy white or yellow
  • P: Rapid and soft
Treatment Principle
  • Disperse Wind
  • Clear Heat
  • Resolve Damp
Herb Formulas
Points
Clinical Manifestations
  • Joint redness, swelling, Heat and pain
  • Stiffness and inflexibility
  • Initially the pain eases when exposed to coolness
  • Later, coolness does not help. but warmth does
  • Dry mouth
  • Bitter taste in the mouth
  • Parched throat
  • Insomnia
  • Agitation
  • Irritability
  • T: Red
  • C: Yellow or Slimy and yellow
  • P: Wiry and rapid
Treatment Principle
  • Scatter Cold
  • Eliminate Dampness
  • Clear Heat
  • Unblock the channels
Herb Formulas
Points
Clinical Manifestations
  • Migrating pain in the joints especially the :
    Shoulders
    Elbows
    Wrists
    Fingers
    Upper back and neck
  • Pain quality changes
  • May move from soreness to numbness to aching
  • Sensitivity varies
  • Pain often appears abruptly, acutely or paroxysmal and then disappears
  • Limited range of motion
  • Chills and fever
  • Aversion to Wind
  • Sore throat
  • General body aches
  • Maybe perspiration
  • T: Pink
  • C: Thin and white
  • P: Superficial and moderate
Treatment Principle
  • Relieve Wind
  • Dredge the channels
  • Relieve Cold
  • Resolve Dampness
Herb Formulas
Points
Clinical Manifestations
  • Early stage: Early morning stiffness, heaviness, numbness and/or restricted movement
  • Joint pain, especially in the wrist, ankle, knee and elbow
  • Excruciating sharp, stabbing joint pain
  • The affected joints may feel Cold
  • Muscle pain
  • There may be numbness and heaviness in the limbs
  • The pain is worse with Cold and better with warmth
  • The pain is aggravated by Wind
  • The pain aggravated by Dampness
  • Pain with fixed location
  • The joints cannot be flexed or extended
  • No local redness or Heat
  • Painful area often feels cold to the touch
  • Pain worse at night and better during the day
  • Pain mostly affects low back and lower extremities
  • Muscle weakness
  • Numbness of the muscles and skin
  • Hemiplegia, especially of the upper limbs
  • Slight muscle edema
  • Heaviness of the joints
  • Aversion to Cold
  • The pain worse at night
  • Local inflammation
  • Deviation of the eyes and mouth
  • Spasm of the limbs
  • Ankylosis (stiffness) of joint
  • Aversion to Cold
  • Maybe chills with a slight fever
  • Anhidrosis
  • Frequent nocturnal urination
  • T:Pink or Pale or Slightly purple or purple spots
  • C: Thick and white or Thin and white (thicker than for Wind-Bi)
  • P: Slippery or Slightly superficial or slightly rough or Slow and Soft or Wiry and tight or Floating and wiry or Superficial and tight
Treatment Principle
  • Relieve Wind
  • Dredge the channels
  • Relieve Cold
  • Resolve Dampness
Herb Formulas
Points
Clinical Manifestations
  • Aversion to Wind, Cold and Dampness
  • Numbness and heaviness of the extremities
  • Stiff and painful muscles and joints
  • Soreness and fixed pain of joints
  • Limited movement
  • Pain aggravated by Wind
  • Sensitive to climatic changes
  • Pain aggravated by Cold
  • Numbness of muscles
  • Pain worse on cloudy or rainy days
  • Pain aggravated by Dampness
  • Cold joints
  • Pain worse at night
  • Low back pain or soreness
  • Lumbago
  • Fatigue
  • Heaviness of the body
  • Heaviness of the muscles
  • Preference for warmth
  • Weak joints
  • Palpitations
  • Pale face
  • Joint deformity
  • Shortness of breath
  • Preference for dry weather
  • Maybe peripheral or systemic edema
  • Pain is alleviated by pressure and warmth
  • Pain lingers and is recalcitrant to treatment
  • Limited movement
  • Maybe stifling sensation in chest
  • Maybe anorexia or indigestion
  • Maybe abdominal distention
  • Maybe loose or semi-liquid stools
  • T: Pale or Purplish
  • C: Thin, white and greasy
  • P: Thready and slippery or Floating and rolling or Slow, moderate and soft
Treatment Principle
  • Relieve Wind
  • Dredge the channels
  • Relieve Cold
  • Resolve Dampness
Herb Formulas
Points
Clinical Manifestations
  • High fever accompanied by severe chills and shivering
  • Aversion to Cold
  • Pain worse at night
  • Difficult movement
  • Local inflammation
  • Migratory pain
  • Soreness and pain of the extremities
  • Nasal congestion with sonorous breathing
  • Anhidrosis
  • Pain and stiffness of the head and neck
  • Focal distention and fullness of the chest and diaphragm
  • A productive cough
  • May have numbness and heaviness in the limbs
  • Body aches
  • Lumbago
  • Nasal obstruction
  • Cough with sputum
  • Stuffy nose
  • Joint pain
  • Pain worse with Cold and better with warmth
  • Pain aggravated by Wind
  • Pain aggravated by Dampness
  • Pain is stabbing
  • Muscle weakness
  • Pain alleviated by movement
  • Slight muscle edema
  • Heaviness of the joints
  • Cold joints
  • Headache
  • Dizziness
  • T: Pale or Slightly purple or Purple spots
  • C: White or thin, white, greasy
  • P: Slippery or Slightly superficial or Superficial and soft or Slightly rough or Slow and Soft or Wiry and tight or Superficial and rapid that is forceless under pressure
Treatment Principle
  • Release the Exterior
  • Augment Qi
  • Remove Wind-Cold-Damp
  • Eliminate Painful Obstruction
  • Circulate Qi and Blood
  • Stop pain
Herb Formulas
Points
  • General points
Clinical Manifestations
  • Chronic pain, weakness and numbness (especially in the lower extremities) due to Windstroke
  • Muscle spasms
  • Cramps
  • Heaviness and pain in the lower back and legs
  • Fixed or migrating pain in the bones in the bones and joints with reduced range of motion
  • Long-term numbness or paralysis in the hands and feet
  • T: Normal
  • C: White and moist
Treatment Principle
  • Dispel Wind
  • Eliminate Dampness
  • Transform Phlegm
  • Invigorate the Blood
  • Unblock the collaterals
  • Alleviate pain
  • Warm the channels and collaterals
Herb Formulas
Points
Clinical Manifestations
  • Chills and fever (more chills than fever)
  • Anhidrosis
  • Headache
  • Stiff neck
  • Generalized ache and pains
  • Slight thirst
  • A bitter taste in the mouth
  • T: Normal
  • C: White
  • P: Floating
Treatment Principle
  • Induce sweating
  • Expel Wind-Cold
  • Dispel Dampness
  • Drain Interior Heat
Herb Formulas
Points
  • General points
Clinical Manifestations
  • Generalized body aches and pains
  • Joint swelling, pain and heaviness
  • Restricted movement
  • Irritability
  • Heavy sensation in the shoulder and back
  • Discomfort or a constricted sensation in the area of the chest and diaphragm
  • Redness of the affected joints
  • Affected joints are burning hot to the touch
  • symptoms are better with cold
  • Multiple sores, carbuncles furuncles or abscesses
  • Itching
  • Persistent swelling
  • Chest pain
  • Maybe vomiting
  • Fever
  • Sweating
  • Aversion to Wind
  • Thirst, may not have a desire to drink
  • Aching and painful extremities
  • Unbearable swelling and pain of the lower extremities
  • Shoulder stiffness
  • Short, reddish urination
  • T: Normal or Red
  • C: Greasy and slightly yellow
  • P: Wiry and rapid or Soft and moderate or Soft, superficial and slow or Slippery and rapid or Deep and tight
Treatment Principle
  • Resolve Dampness
  • Clear Heat
  • Disperse Wind
  • Stop pain
  • Activate the Blood
  • Tonify Qi and Blood
Herb Formulas
Points
Clinical Manifestations
  • Fullness in the chest and hypochondrium
  • Palpitations
  • Shortness of breath
  • Coughing up clear, watery sputum
  • Dizziness
  • Vertigo (when standing)
  • Dyspnea
  • Anxiety
  • Tinnitus
  • Difficult urination
  • Mild edema
  • Cold feet
  • Headache
  • Migraine
  • Weak abdomen
  • T: Pale and swollen
  • C: White and slippery or greasy
  • P: Slippery and wiry or soggy or Soft or Deep and tight
Treatment Principle
  • Warm and transform Phlegm and congested Fluids
  • Strengthen the Spleen
  • Resolve Dampness
  • Improve metabolic function
Herb Formulas
Points
Clinical Manifestations
  • Abdominal pain aggravated by Cold
  • Urinary difficulty
  • Deep, aching heaviness in the extremities
  • Generalized edema
  • Loose stools
  • Dizziness
  • Heavy sensation in the head
  • Palpitations
  • Cough
  • Epigastric palpitations
  • Aversion to Cold
  • Watery diarrhea
  • No thirst
  • Leukorrhea
  • Hiccup
  • Profuse perspiration
  • Cold limbs
  • Headaches
  • A husky voice
  • Hair loss
  • Asthma
  • Generalized twitching
  • Tidal flushing of the genitals by Dampness
  • Water buildup leading to hernia
  • Impotence
  • Prone to infections
  • Prone to allergies
  • Prone to Wind erysipelas
  • Diarrhea
  • Constipation
  • Chest pain
  • Mental and emotional disorders
  • Light-headedness
  • Nasal obstruction with clear mucus
  • Impaired visual acuity
  • Prone to dormant papules
  • A sensation of something being stuck in the throat
  • Incessant sneezing
  • Swelling and pain of the teeth or gums
  • Feeling of unsteadiness as if one were about to fall
  • Distended or heavy sensation of the head
  • Palpitations
  • Gradual weight gain
  • Dyspnea
  • Abdominal distention and fullness
  • Pitting edema
  • Scanty urination
  • Chills
  • Weak knees
  • Seminal emissions
  • Flaccid abdomen
  • Muscular aching
  • Chronic lower back pain
  • Nausea
  • Cyclic vomiting
  • Fever, perspiration does not reduce fever
  • Vertigo
  • Impaired memory
  • Shivering and trembling
  • Catches cold easily
  • Severe fatigue
  • Aches and pains in the body or extremities
  • Flank pain
  • Wheezing
  • T: Pale or Dark purple and swollen with teeth marks
  • C: White and slippery
  • P: Deep, thready and forceless or Deep and thready
Treatment Principle
  • Warm Yang
  • Promote urination
Herb Formulas
Points
Clinical Manifestations
  • Joint and muscular atrophy
  • Joint stiffness
  • Inflexibility
  • Deformation
  • Unceasing aching and pain which is worse on exposure to Cold and during the winter and better with warmth and during the summer
  • Dizziness
  • Tinnitus
  • Frequent long, clear urination
  • Nocturia
  • Low back and knee pain and coldness
  • T: Pale
  • C: White
  • P: Deep, weak and slow
Treatment Principle
  • Tonify the Kidneys
  • Warm Yang
  • Nourish the Liver
  • Soothe the sinews
  • Scatter nodulations
  • Unblock the channels
Herb Formulas
Points
Clinical Manifestations
  • Lumbago: low back feels cold, weak and aching
  • Feeling chilled
  • Aversion to Cold
  • Cold limbs
  • General debility
  • Pale face
  • Urinary frequency with abundant, clear urine or
  • Oliguria with edema
  • Maybe nocturia
  • Lassitude
  • Withdrawn, subdued behavior
  • Knees feel cold and aching
  • Dizziness
  • Tinnitus
  • Impotence
  • Spermatorrhea
  • Premature ejaculation
  • Low libido
  • Female infertility ("uterus cold and infertile")
  • Maybe anorexia
  • Maybe loose stools
  • Maybe chronic diarrhea or "cock crow" diarrhea
  • T: Pale and swollen
  • C: Thin and white
  • P: Deep and thready - maybe slow
Treatment Principle
  • Warm and Reinforce Kidney Yang
Herb Formulas
Points
Clinical Manifestations
  • Edema of whole body particularly at and below the waist
  • Pitting edema
  • Low back pain, aching and heaviness
  • Abdominal distention with full sensations
  • Oliguria
  • Cold limbs
  • Face gray and congested or pale
  • Feeling nervous and cold with mental weariness
  • In severe cases:
    Ascites
    Edema of scrotum
  • T: Pale and swollen
  • C: Thin, white or Thick, white and sticky
  • P: Deep and thready
Treatment Principle
  • Warm the Kidneys
  • Promote diuresis
Herb Formulas
Points
Clinical Manifestations
  • Dizziness
  • Tinnitus or deafness
  • Poor memory
  • Aching, soreness or weakness of the low back
  • Spermatorrhea or
  • Premature ejaculation
  • Aching in the bones
  • Aching in the leg and heel
  • Dry mouth
  • Thirst
  • Night sweats
  • Five Sole Heat
  • Malar flush
  • Low grade fever in the afternoon
  • Dry throat, maybe recurrent sore throat
  • Dry stools and/or
  • Constipation
  • Urine short and red
  • Heightened libido
  • If Heart Fire also Flares:
    Insomnia
    Frequent dreams
    Palpitations
  • If Liver Yang also Rises:
    Dizziness
    Blurred vision
  • T: Red
  • C: Little or None
  • P: Thready and rapid
Treatment Principle
  • Nourish Yin
  • Subdue Fire
Herb Formulas
Points
Clinical Manifestations
  • Late stage
  • Joint rigidity and deformities
  • Aching and painful joints
  • Swollen, distended and deformed joints
  • Inhibited joint movement
  • A somber, white facial complexion
  • Palpitations
  • Shortness of breath
  • Fatigue
  • Lassitude
  • T: Pale
  • C: White
  • P: Deep, thready wiry and/or tight
Treatment Principle
  • Tonify Q!i
  • Nourish the blood
  • Transform Phlegm
  • Dispel Stasis
  • unblock and activate the channels
Herb Formulas
Points
Clinical Manifestations
  • The lower back feels hot either to the patient or practitioner
  • Pain in low back and knees
  • The pain is aggravated by Heat , humid or rainy weather and is not improved by rest
  • Aches and pains in the bones and sinews
  • Weakness or atrophy of lower extremities
  • Scanty yellow urine
  • Red, hot, swollen and painful feet or knees
  • Edema in lower legs
  • Leukorrhea (thick, yellow, foul-smelling)
  • Sores on lower extremities due to Damp
  • Redness, swelling and pain of the knees with burning sensations
  • Oliguria
  • Eczema
  • Irritability
  • Feverishness
  • Thirst
  • T: Normal
  • C: Yellow and greasy
  • P: Soft and and rapid
Treatment Principle
  • Clear Damp-Heat from the Lower Jiao
  • Ease the tendons
  • Stop pain
Herb Formulas
  • Er Miao San modified
  • Chinese Patent Medicines:
    Qian Jin Zhi Dai Wan
    Yu Dai Wan
    Shi Lin Tong Pian
Points
Etiology
  • Latent Heat which is reactivated by a new external attack or
  • Wind-Cold-Damp stagnates and creates Heat
Clinical Manifestations
  • Inflammatory condition
  • Arthralgia involving one or several joints of the extremities
  • Localized pain, redness, Heat and swelling
  • Can be accompanied by fever during crisis (high fever with aversion to Wind which is not abated by sweating)
  • Pain is hot, burning or shooting
  • Swelling with excruciating pain
  • Pain intensity is high (worse late at night)
  • Pain persists in the morning with stiffness
  • Severe limitation of movement
  • Fever
  • Maybe slight chills
  • Thirst
  • Dryness of the mouth
  • Irritability
  • Nervousness
  • Restlessness
  • Aversion to Heat
  • Desire for Cold drinks
  • T: Normal or Red
  • C: Thin and yellow
  • P: Wiry and rapid or Rolling and rapid maybe slippery
Treatment Principle
  • Clear Heat
  • Relieve toxicity
  • Activate the Blood
  • Clear the channels
  • For Wind-Damp-Heat Bi:
    Eliminate Dampness
Herb Formulas
Points
Clinical Manifestations
  • Vomiting
  • Diarrhea
  • Spasms
  • Cramps
  • Thirst
  • Irritability
  • Oliguria with reddish urine
  • Restlessness
  • Arthralgia with a burning sensation, redness and swelling
  • Abdominal pain
  • T: Pink
  • C: Thick, dry and yellow or Yellow and greasy
  • P: Soggy and rapid or Floating and rapid or Floating, soft and rapid
Treatment Principle
  • Clear Heat
  • Resolve Dampness
  • Separate the clear from the turbid
  • Alleviate pain
Herb Formulas
Points
  • General points
Clinical Manifestations
  • Chronic Bi with many recurrences
  • Joints are stiff and deformed
  • Joints deep red
  • Areas surrounding the joints are slightly purple
  • Dark red or purple cheeks
  • Palpitations
  • Joint pain
  • Pain is excruciating
  • Fixed location
  • Maybe painful numbness
  • Joint may be red, swollen and painful or
  • Icy cold and worse in cold weather and better with warmth
  • Maybe fever
  • Chest oppression and pain
  • Fearful throbbing
  • T: Dark purplish or Purple spots
  • C: White
  • P: Choppy or Thin and choppy
Treatment Principle
  • Break up Blood Stasis
  • Resolve Phlegm
  • Break up harnesses
  • Clear Damp-Heat or
  • Expel Wind-Cold and Damp
Herb Formulas
Points
Etiology
  • Poor diet - too much food drink, and smoking causing Internal Heat which consumes Qi and Yin. Combined with External attack causes Blood Stagnation in the vessels. Worse in Summer.
  • Wind, Cold, Damp, Heat and Toxin Invasion into the Blood vessels, leading to Qi and Blood Stagnation.
  • Long-term presence of pathogenic factors leading to Qi and Blood Deficiency.
Clinical Manifestations
  • General manifestations:
    Stabbing fixed pain
    Pain aggravated at night
    Painful muscles and joints
    Uneasiness in the Heart
    Uncomfortable sensations in the chest
    Distress in the chest
    Anxiety
    Depression
    Aversion to Cold
    Fullness in the body (like gas)
    Epigastric fullness
    Sudden shortness of breath
    Dryness of the upper throat
    Frequent belching
    Burning sensations on the skin
    Red or purple spots on or under the skin
    Weakness or disappearance of the pulse
    Numbness, soreness and pain of the affected limbs.
    Low temperature of the affected limb
    Numbness of the limbs
    Aggravation of the above symptoms by Cold
    Pale complexion
    T: Pale
  • Blood Stasis due to Cold:
    Affected limb is cold
    Aversion to Cold
    Numbness of the limbs
    Worse with Cold
    Pale face
    T: Pale
    C: White
    P: Weak or disappeared
Treatment Principle
  • Weakness or disappearance of the pulse
    Warm the channels
    Dispel Cold
    Circulate Blood in the collaterals
  • Blood Stasis due to Cold:
    Warm the meridians
    Dispel Cold and
    Circulate Blood
Herb Formulas
Points
Etiology
  • Long term illness leads to Yang Deficiency which may lead to Wei Qi Deficiency, allowing pathogens to easily penetrate deeply.
Clinical Manifestations
  • Painful, numb bones and joints
  • Deformed bones and joints
  • Localized Cold sensation
  • Muscles and sinews atrophied
  • Pale, lusterless face
  • Cold body and limbs
  • Spine bent forward (hunched)
  • Weak, sore low back
  • Weak, sore knees
  • Profuse urination
  • Watery stools
  • Daybreak diarrhea
  • T: Pale
  • C: White P:
  • Deep and Weak
  • With Spleen Yang Deficiency :
    Anorexia
    Weakness
    Shortness of breath
Treatment Principle
  • Warm the Yang
  • Augment Qi
Herb Formulas
Points
Clinical Manifestations
  • Weakness of the knees
  • Soreness of the lower back
  • Lumbago
  • Atrophy of the leg muscles
  • Lower back weakness
  • Knee pain
  • Difficulty walking
  • Emaciation
  • Impotence
  • Poor memory
  • Dizziness
  • Night sweats
  • Five-sole Heat
  • Aggravation of the pain by Damp weather
  • Pale complexion
  • Profuse urination at night
  • Tinnitus
  • Hair loss
  • Sensation of warmth
  • Thirst
  • Dry skin
  • T: Red or Pale and flabby with teethmarks
  • C: Little or Thin and white
  • P: Thready and weak, especially in the Kidney positions
Treatment Principle
  • Tonify the Liver and Kidneys
  • Strengthen the tendons and bones
  • Eliminate Damp-Heat
  • Tonify Kidney Jing
  • Relieve rheumatic pain
Herb Formulas
Points