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Acupuncture Vancouver - Rheumatoid Arthritis

Acupuncture Vancouver - Rheumatoid Arthritis

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Published by ImegHealth
Acupuncture Vancouver - Treatment of Rheumatoid Arthritis - by IMeG Health
Acupuncture Vancouver - Treatment of Rheumatoid Arthritis - by IMeG Health

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Published by: ImegHealth on Apr 09, 2010
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IMeG Health
Clinical Report,
2009, No.5
Traditional Chinese Medicine Clinic
Suite 300
1177 West Broadway, Vancouver, BC V6H 1G3
© Platinum Link Health Management Inc. 2009 All Rights Reserved.
Traditional Chinese Medicine Treatment ofRheumatoid Arthritis (RA)
arthritis, OA, osteoarthritis, RA, rheumatoid arthritis, Traditional Chinese Medicine, TCM,Acupuncture, Herbal medicine, IMeG Health
Clinic, Vancouver, Canada, joint pain, inflammatorypain, CAM, phlegm, blood stasis, herb-drug interactions
There are more than 100 kinds of arthritis, themost common of which are osteoarthritis (OA) andrheumatoid arthritis (RA). Of the two, osteoarthritis isthe most common form, affecting approximately threemillion Canadians, mostly over the age of 45. Whileboth forms involve the typical joint pain associatedwith arthritis, they are in fact completely differentdiseases.Osteoarthritis is commonly caused by hardrepetitive activity, and joint injury. The condition isnormally limited to the joint capsule, and is the resultof the gradual deterioration of the cartilage that linesthe bone surfaces. As it wears away, the synoviallining in the joint capsule becomes inflamed. Whensevere, the bone ends will touch, and begin to wearaway, resulting in joint
On the other hand, in rheumatoid arthritis, theinflammation is the result of an autoimmune illness.Autoimmune conditions result when the bodyrecognizes some of its own cells as being harmful andin turn begins to attack itself.Like OA, RA affects the joints, but in addition it canalso result in inflammation of the tendons, lungs, andblood vessels. Over the years, there has beenspeculation as to its causes, but as yet its causeremains unknown.Conventional treatment for rheumatoid arthritisemploys the use of pain killers, anti-inflammatorymedications (which includes the COX-2 inhibitorssuch as Vioxx and Celebrex), and a category ofmedications known as disease modifying anti-rheumatic drugs, or DMARDS (which includesmedications such as methotrexate). Reports over thelast year have resulted in several of the commonly-used COX-2 inhibitors being pulled off the market.In addition to these conventional treatments,more and more patients are seeking out differenttreatment options, and in many cases seeing multiplepractitioners for the same condition. One of the mosthighly sought treatment options is traditional Chinesemedicine (TCM).
TCM Treatment of RheumatoidArthritis
Traditional Chinese medicine classifies all
arthritis as a syndrome called “Bi”, or “PainfulObstruction Syndrome”. This syndrome is further 
differentiated on the basis of the presenting signs andsymptoms, resulting in names suc
h as “Wind Bi”, PainBi”, Hot Bi”, “Damp Bi”, “Bone Bi”, and others. Many
studies have been conducted over the years as to theefficacy of TCM in the treatment of this disease, manyreporting success rates of over 80%. However, in
Clinical practice at the
IMeG Health
TCMClinic is supported by research at some of the finestuniversities in the world. This platform enables
practitioners to achieve the mission of “patient
focus” health care delivery. IMeG Health™
ClinicalReport is a community service provided by IMeGHealth
. For all enquiries on this report, pleasecontact the editor: Professor Steve C. F. Au-Yeung,email:s.auyeung@imeghealth.com.Other clinical
resource materials are available on the IMeGHealth
s website at www.imeghealth.com. 
IMeG Health
Clinical Report,
2009, No.5
© Platinum Link Health Management Inc. 2009 All Rights Reserved.
many of those studies very little information isprovided regarding outcome measures.
Still, thereare many studies that are noteworthy, and they dopoint to the efficacy of TCM in arthritis.
In their paper “Arthritis and Acupuncture: TheEvidence for Effectiveness”, which was p
ublished bythe British Acupuncture Council in October 1998,authors Saunders, Gould, and MacPherson revieweda total of 18 papers, and regarding rheumatoidarthritis, they reached this conclusion:
“Acupuncture has been shown to give some pain relief 
in rheumatoid arthritis and an anti-inflammatory response may also be present. Treatment early in the disease is preferable but age and duration of the 
disease should not be seen as barriers to treatment.” 
There are also countless studies regarding theefficacy of Chinese herbal medicines. Some of thesestudies examined the effects of a single herb, whileothers examined the effects of herbal formulas. In onesuch study, a team of researchers from the Universityof Texas and the National Institutes of Healthanalyzed the effect of the herb
Tripterygium wilfordii Hook F,
or lei gong teng as it is known in Chinese.Thirteen patients with long-standing rheumatoidarthritis participated in the trial over a 12-18 monthperiod. Nine of the patients went through the
wholeprogram, all experienced marked improvement andone went into complete remission on a dose of 390mg/day. ESR (erythrocyte sedimentation rate) wentfrom 55 mm/hour to 22 mm/hour on a dose of 480mg/day.
Fuelled by the results of this small trial,researchers are currently conducting a much larger,double- blind, controlled study to confirm the benefitsof
lei gong teng 
Clinical Experience
In my own experience, I have found arthritis to beone of the most commonly-encountered clinicalconditions, and one that responds very favourably totreatment. Based upon my own clinical experienceusing acupuncture, I have devised a treatmentprotocol that divides the treatment into differentphases (Table 1). I recommend treatment initially at 2-3 times per week for several weeks. Depending on a
patient’s reaction to treatment, this will be reduced to
1-2 treatments per week (perhaps for several weeksor more), then 1 per week, then every 2 weeks, then3, and eventually tapering to a maintenance scheduleof one treatment per month (plus or minus).
 Table 1. Acupuncture: General Treatment Protocol for RA
TreatmentPhaseDuration (# ofweeks)Treatment Frequency(times/week)Receptivity toTreatmentTotal TreatmentsI 2 - 4 2 -3 Good 4-12II 4 - 8 1 - 2 Good 4-16III 8 - 20 1 Good 8-20IV 20 - 30 1 per 2 weeks Good 10-15V 30 - 40 1 per 3 weeks Good 10-13Maintenance Continuous 1 per month Good 10-12 per year
Like the above acupuncture protocol, herbaltherapy is also of longer duration, and patients canexpect approximately one month of herbal therapy forevery year they have had the condition. Therefore, if apatient has had RA for 10 years, they can reasonably
IMeG Health
Clinical Report,
2009, No.5
© Platinum Link Health Management Inc. 2009 All Rights Reserved.
expect to be taking herbal medicines for at least 10months. 
Case Example: Rheumatoid Arthritis(62-year-old Female Accountant)
The case history of a 62-year-old femaleaccountant is summarized in Table 2.
Table 2. Case History - Rheumatoid Arthritis of theHands
Chief Complaint
Joint pain of hands
MD Diagnosis
Rheumatoid arthritis
anti-inflammatory medication -Methotrexate (DMARD)
A 62-year-old female sought help for her jointpain due to rheumatoid arthritis. She had beendiagnosed several years earlier, and was prescribedmethotrexate, (a disease modifying anti-rheumaticdrug
“DMARD”). Her pain was considerable and joint
deformity in the metacarpophalangeal (MCP) joints aswell as
the thumbs of both her hands was evident.Her right hand was somewhat more painful, but both
were at times “intolerable”. Her hands were especially
stiff in the morning, and could remain so for severalhours or more. She was an accountant, and the pain
made doing her job “impossible at times”.
The TCM diagnosis confirmed that she was
suffering from “Bi Zheng” due to “Wind
(considered to be the main etiological factors inarthritic conditions). In accordance with thediscussion presented above, the recommendation forthis patient was a comprehensive treatment ofacupuncture and herbal medicine (Table 3). Theacupuncture treatment focussed on invigoratingcirculation and stopping the pain, while the herbalmedicine treatment focussed on resolving the Wind-Cold-Damp condition, clearing the stagnation ofPhlegm and blood, tonifying the Kidneys,strengthening qi, and clearing heat-toxins.
 Table 3. TCM Diagnosis and Recommended Concomitant Treatment ModalitiesDiagnosis:TCM Disease:
Bi Zheng
 TCM Pattern:
Wind-Cold-Damp Bone Bi
Initial treatment frequency of weekly acupuncture, gradually decreased overthe course of one year
Herbal Medicine:
Herbal formula was modified periodically, with focus on
Clearing Wind-Cold-Damp
Clearing stagnation of Phlegm
Invigorating Blood
Strengthening Kidneys
Boosting Qi
Clearing Heat-Toxins
 Other Recommendations:
The patient was also encouraged to participate in stress-reducingactivities such as meditation, and to ensure she was getting adequate rest.

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