One of the most common conditions treated in the typical Western TCM clinic is chronic joint pain. Whether the diagnosis is rheumatoid arthritis or osteoarthritis, patients seek TCM as an alternative to allopathic medications with side effects or harsh invasive procedures that often result in minimal pain relief.
Most of the common allopathic and herbal therapies for joint pain focus exclusively on anti-inflammatory action. While inflammation is indeed an important factor in joint pain, new research has shown that several other factors play a contributing role in degenerative joint disease.
The new research supporting the vascular theory of osteoarthritis causation has shown that in many cases, joint degeneration is due to impaired blood flow to the joint tissues, not solely chronic inflammation. Some of the major areas of interest in the new vascular theory of joint pain reveal that patients with osteoarthritis often have blood clots and fat droplets in the small veins near osteoarthritic joints, raised blood lipid levels, an insufficiency of enzymes necessary to dissolve blood clots, and small areas of avascular necrotic joint tissue.
When we look at these unique symptoms through the lens of TCM, some interesting treatment protocols emerge. While we know that TCM medicinals to supplement the liver and kidneys play a vital role in joint health, this new research points to the importance of targeting blood stasis and phlegm when treating chronic joint pain. We can easily turn to some basic TCM statements of fact to support this approach.
According to TCM, one of the most important physiological functions of blood is to "moisten the four limbs and hundreds of bones." TCM also states, "Phlegm and stasis are mutually involved," "Qi depression engenders phlegm," and "Blood vacuity leads to network vessel pain." These statements of fact in TCM all support the new research of the vascular theory of osteoarthritis and provide insights into how herbal protocols can be formulated to more effectively treat chronic joint pain.
In TCM, chronic joint pain is typically categorized as "recalcitrant bi," and several of the above TCM statements of fact play key etiological roles. Recalcitrant bi symptoms include joint pain that is aching, intense and in a fixed location; joints that are stiff, numb and deformed; a tongue that is purple with static spots; and a pulse that is fine and choppy. None of these symptoms typically responds to long-term treatment. Therefore, the treatment principles are to quicken the blood and transform stasis, transform/resolve phlegm, warm the yang and open the bi in order to stop pain.
With this information in mind, it's easy to see that TCM can provide significant help to the typical Western patient who has taken glucosamine sulfate and/or Cox-2 medications without appreciable results. It also suggests that treating any chronic joint issue without addressing blood stasis, qi stagnation and phlegm will provide only limited relief.
There are many medicinals in TCM to regulate the qi, invigorate the blood, transform phlegm and stop pain. To regulate the qi and stop pain, the medicinals xiang fu, chuan lian zi, ru xiang and yan hu suo can be used. To invigorate the blood, the medicinals dang gui, chuan xiong, chi shao, tao ren, hong hua, ji xue teng, san leng, e zhu, san qi, mo yao, chuan niu xi, yu jin and jiang huang can be used. To resolve/transform phlegm, the medicinals hai zao, kun bu, tian hua fen, tian nan xing, bai jie zi, bei mu and xuan fu hua can be used.
These medicinals can be added to appropriate formulas that address the patient's particular pattern, but if chronic join pain or recalcitrant bi is present, the above-mentioned herbs must be utilized to effect a substantial change.
Another TCM statement of fact that is important to keep in mind when treating chronic joint pain is, "New diseases are in the channels, enduring diseases enter the network vessels." With this in mind, TCM has the treatment principle of opening the network vessels and transforming stasis method. Besides using medicinals to quicken the blood and transform stasis, three very important TCM medicinals can be used to open the network vessels: di long, quan xie and ye jiao teng.
Di long is a very effective medicinal for unblocking the channels and collaterals, clearing heat and helping to target arthritis with heat signs such as red, swollen joints with burning pain and difficult movement. Quan xie also removes obstructions in the channels and collaterals, dissipates hard masses and nodules, and stops pain. Both di long and quan xie extinguish wind. Since they are insect and worm medicinals, they are said to have the function of "searching and picking out stasis." Ye jiao teng is an excellent medicinal for chronic joint pain. Not only does it unblock the channels and collaterals, and invigorates blood, but it also nourishes heart blood and calms the spirit. These last two actions can be of great assistance in cases of long-standing pain causing poor sleep or depression. These three medicinals can be added as needed to appropriate formulas to address recalcitrant bi syndromes.
Two other medicinals that can be effective for pain relief in chronic joint pain are yi yi ren and bai shao.Yi yi ren can be added in high doses to blood-stasis/phlegm-transforming formulas to relieve pain more effectively. Bai shao can be used with gan cao to form shao yao gan cao tang and is highly effective for pain relief and qi stagnation. Therefore, it may also be a wise addition to a blood-stasis/phlegm-transforming formula.
In light of the research indicating many patients with chronic osteoarthritis also have elevated blood lipid levels, the use of high doses of dan shen, which both invigorates blood and has been shown to lower blood lipid levels, can be a key addition. Dan shen also calms the shen and clears heat from the heart. When combined with the aforementioned ye jiao teng, it can assist in targeting sleep disorders caused by chronic joint pain.
In my next article, I will discuss the use of the TCM medicinals lu rong and lu jiao jiao (deer antler) in treating chronic joint pain. I will also discuss ways to integrate ayurvedic medicinals into TCM blood-stasis formulas to improve clinical outcomes. I hope this short article has elucidated some ways to treat patients with chronic joint pain above and beyond the standard anti-inflammatory approach and expanded the practitioner's clinical repertoire to improve patient outcomes.
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