In my last two articles, I briefly explored the ideas of the TCM pathology of blood stasis in light of modern research concerning chronic degenerative joint disease. In this final installment, I will focus on the contributing factor of phlegm in chronic degenerative joint disease, explore the important complication of blood stasis combined with phlegm, and discuss ways to integrate Western supplements into TCM protocols to improve therapeutic outcomes for patients suffering with chronic, degenerative joint issues.
The subject of phlegm or tan has preoccupied TCM practitioners for hundreds of years. Phlegm syndromes often present with a complex symptomology that can be difficult to diagnose and differentiate, and most often occurs against a background of qi stagnation and blood stasis. Some of the most important indications suggesting phlegm are as follows: aching, heavy sensation of muscles/limbs/joints, hypersensitivity to odors, excessive sleep, incomplete or sluggish bowel movements, insomnia, symptoms that are aggravated by seasonal/weather changes and chronic low-grade fevers.
The statement that phlegm typically occurs against a background of qi stagnation and blood stasis is based on the TCM statements: “Qi depression engenders phlegm,” and “Qi is the commander of blood.” These ideas are germane to the condition of chronic, degenerative joint disease, as we know that there will be pain if there is no free flow of qi. Chronic joint pain indicates qi stagnation and most often concomitant blood stasis as a result. Another interesting TCM statement to keep in mind is: “Qi depression transforms into fire. Fire engenders phlegm.” This TCM idea is quite interesting in relation to chronic joint pain, particularly if we view “fire” as inflammation. If we keep in mind the new research regarding chronic, degenerative joint disease I discussed in Part I of this series, both modern research and TCM classical ideas support the use of qi-regulating, blood-invigorating and phlegm-dissolving medicinals to effectively treat chronic joint pain.
Most practitioners of TCM are familiar with effective ways to use medicinals to course the qi, invigorate the blood and target phlegm. Zhu Ceng-Bo, a modern TCM authority who has written extensively on TCM phlegm theory, recommends some particular herbs to focus on the clinical etiology and pathology of phlegm: bai zhu, zhi shi, chai hu, qiang huo, fang fen and bai jie zi. These medicinals are excellent additions to TCM formulas which target qi stagnation, blood stasis and phlegm. Bai zhu boosts the spleen qi and dries damp, in order to eradicate the root of phlegm; zhi shi courses the qi and resolves phlegm; chai hu courses and lifts the qi mechanism, which can be dragged down as a result of damp and phlegm encumbrance; qiang huo and fang feng target wind damp and stop pain; and bai jie zi promotes the flow of qi and unblocks the channels and collaterals to alleviate pain.
With these indications in mind, the clinician can clearly see how to integrate each of these medicinals into the appropriate formulas to improve therapeutic outcomes. Another herb which has a particular affinity for chronic joint pain complicated by phlegm is the Western herb devil’s claw (Harpagophytum procumbens). This herb has historically been used for chronic joint pain and modern research has confirmed its anti-inflammatory, analgesic and anti-edematous properties. Devil’s claw also acts as a bitter digestive tonic, stimulating the production of HCL (hydrochloric acid) to ameliorate a weak appetite. It also stimulates the gallbladder to release bile, thereby reducing flatulence and bloating due to an atonic digestive system. This is particularly important in chronic joint issues with phlegm involvement, as weak digestion or weak spleen qi can allow dampness to accumulate and transform into phlegm. As a mild bitter tonic, devil’s claw will not damage the spleen qi but should be used with caution in the case of patients inclined to ulcers.
With these indications in mind, devil’s claw can be intelligently integrated into TCM formulas to help buffer the chronic pain of degenerative joint disease and prevent a weak digestive system from allowing metabolic by-products to build up and become deposited into joint tissues. This build up of metabolic waste products is one the reasons patients suffering from phlegm can present with chronic low-grade fevers. The body will heat up to “cook” the phlegm in an attempt to transform the phlegm. This idea is also found in Ayurvedic medicine and is one of the indications of the herb guduchi, which I discussed in Part 2 of this series. Ayurveda always strives to improve digestion in chronic joint disease to prevent further toxic buildup from depositing into joint tissues and to help the body digest or “cook” the phlegm, referred to as ama in Ayurvedic diagnostic parlance.
This also gives indications as to how to therapeutically use TCM medicinals as well. Besides purging/scouring phlegm and draining dampness, clinicians must always evaluate the patient’s digestive capacity or spleen qi in chronic, degenerative joint disease. Anti-inflammatory herbs or anodynes will not adequately resolve difficult, recalcitrant joint-pain presentations.
I hope this short three-part series on chronic joint pain and TCM theory in light of modern research has provided some novel ways of viewing treatment options and applications. Chronic pain not only damages a patient’s joints, ligaments tendons or bones; it also wears down a patient’s spirit. As clinicians, we must always remember this. Each moment we insert a needle or dispense an herb is an opportunity and a responsibility never to be taken lightly or administered blindly.
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