Rheumatoid arthritis is a chronic, consumptive and recurrent autoimmune disease, mainly involving the joints. Its cause of disease remains unknown up to now. The author of the present paper treated this disease with combined therapies of acupuncture, moxibustion and acupoint injection, and obtained a better result. The data are summarized as follows.   

CLINICAL DATA

A total of sixty-four cases of out-patients and in-patients including 16 males and 48 females were subjected into this study. Their ages were between 16 and 70 years. The shortest duration of disease was 2 months and the longest 23 years.   

CRITERIA OF DIAGNOSIS

The rheumatoid arthritis was diagnosed according to the Standards of Diagnosis and Effectiveness of Syndromes of Traditional Chinese Medicine.   

1) At the beginning of the onset, rheumatoid arthritis often involves the small joints (of fingers, toes, and dorsal spinal column), marked as symmetric pain and swelling, rigidity in the morning and restriction in movement. 

2) This disease is induced often due to invasion of the body by wind-cold pathogens, and manifested as slow onset, repeated attack and a protracted and lingering course. The patient often becomes emaciated gradually.   

3) The affected joints are marked as shuttle-like swelling, tenderness and aversion to pressing and pain worsening during movement and after standing for long.  At the late stage, the joints manifest as deformity and rigidity, glossy surface, and atrophy of the circumferential muscles. In fewer cases, some nodes may be found beneath the skin. 

4) Examination of the blood samples shows that rheumatoid factor test is positive during onset and the blood sedimentation is accelerated. Roentgenogram suggests osteoporosis, or lesion and fusion of the articular surface showing dislocation or semidislocation, bony ankylosis etc.    

METHODS OF TREATMENT

1) Acupuncture   

Acupoints were selected according to the focus and the meridians involved in the traveling course. Quchi (LI 11), Chize (LU 5), Xiaohai (SI 8) and Waiguan (TE 5), etc. were selected for elbow joint pain; Waiguan (TE 5), Yangxi (LI 5), Wangu (S I 4), Yangchi (TE 4) and Daling (PC 7), etc. selected for wrist joint pain; Baxie (Extra), Hegu (LI 4), Houxi (SI 3) and Ashi point (tender-point), etc. selected for metacarpophalangeal articular pain; Heding (EX-LE 2), Xiyan (EX-LE 5), Yinlingquan (SP 9), Yanglingquan (GB 34), Liangqiu (ST 34), etc. selected for knee joint pain; Jiexi (ST 41), Qiuxu (GB 40), Taixi(KI 3), Kunlun(UB 60), etc. selected for ankle joint pain; Taichong(LR 3), Bafeng(Extra), Ashi-point, etc. selected for toe joint pain; and acupoints of Dumai or Jiaji (EX-B 2) corresponding to the pain site o f the spine also selected. After insertion and gaining needling sensations, the needles were manipulated with uniform reinforcing-reducing method, and then retained about 30 minutes. In treatment of patients with redness, swelling, hotness and pain around the joint, the local acupoints were stimulated with Electroacupuncture using dense or sparse waves; and in treatment of patients with cold feeling and pain in the joint, the local acupoints were punctured combined with moxibustion for 2-3 moxa cones.   

2) Moxibustion 

Ginger separated moxibustion was applied to Guanyuan (CV 4) or Qihai (CV 6), 3   

Moxa-cones per point, once a day. These two points were used alternately.   

3) Point injection 

Zusanli (ST 36) was used for point injection in combination with Quchi (LI 11) for arthritis of the upper limbs. At the acute stage, Zheng Qing Feng Tong Ning (Paederoside) injection was employed for point injection, 1-2 ml each point, 1 -2 points being used every time and once a day.  After the symptoms and signs were alleviated, Danshen (Radix Salviae Miltiorrhizae) injection was used instead, 2 ml each point, 2 points each time, and once every other day. One therapeutic course was composed of 10 times.   

CRITERIA OF THE THERAPEUTIC EFFECT

In the present paper, the therapeutic effect was analyzed according to The Standards of Diagnosis and Effectiveness of Syndromes of TCM.  

Clinical cure: Articular pain and swelling are eliminated, the functional activities return to normal and the laboratory examination shows normal in the related indexes.   

Improvement: Articular pain and swelling are alleviated, the functional activities are improved and the laboratory examination shows improvement in some related indexes.  

Ineffectiveness: After treatment, articular pain and swelling and the related indexes of laboratory examination have no any changes.   

RESULTS   

Of the 64 cases, 16 (25%) were cured clinically, 42(65.6%) improved and 6(9.4 %) ineffective. The total effective rate was 90.6%.   

TYPICAL CASE   

Miss Ma, 25 years old, a cadre, and the registered number of the case being 43318. She was admitted to our hospital on November 17, 1997 due to having got redness, swelling, hotness and pain of both knee joint for 7 months. Since April of 19 97, the swelling and pain of her both knee joints have been aggravating gradually, with the right one being more severe, manifested as redness, swelling and hotness. She was treated in the local hospital; her symptoms and signs had some relief. Three months later, she felt her both knee joints sore again, with the right knee being more severe in swelling and distension. After treatment with medication and hydrarthrosis withdraw (right knee), her symptoms and signs still attacked repeatedly, so she came to our hospital and asked for acupuncture and moxibustion treatment further.   

Clinical manifestation: redness, swelling and pain of both knee, particularly the right one, with limited flexion and extension activities, difficulty in walking, rigidity particularly in the morning, distending pain in both wrists and both ankle joints, deep red tongue with yellow and slightly greasy fur, taut and slippery pulse. Laboratory examination: total number of leukocytes being 8.4×109 /L, neutrophils 73.8%, lymphocytes 17.00%, rheumatoid factor(+), blood sedimentation 40 mm/h, antistreptolysin “O" <200 u/ml, IgG 17.61 g/L, IgM 2.41 g/L. It was diagnosed as rheumatoid arthritis. She was treated with the above-mentioned methods for 20 times, then the pain, swelling and distension sensation of knee joints were alleviated markedly, the flexion and extension activities were better as compared with pre-acupuncture. After the treatment was conducted continually for 20 more days, the  leukocyte count was 4.5×109/L, neutrocytes 56.9%, lymphocytes 36%, rheumatoid factor(-), blood sedimentation 16 mm/h, IgG 13.68 g/L, IgM 1.99 g/L. The swelling and pain of joints disappeared, her articular activities turned normal. She was cured clinically and discharged from the hospital.   

DISCUSSION   

1). This disease is attributed to “Bi-syndrome"(arthralgia) in TCM. It is induced mostly by blockage of meridians, qi stagnation and blood stasis due to weakness of the body resistance and attack of the body by pathogenic wind, cold, damp ness, heat, etc. At the late stage, the pathogens invade the muscles and bones to induce insufficient supply of blood and nutrition, resulting in muscular spasm and articular rigidity. This type of illness is more severe in the severity and complicated than the common ones. Thus, under the circumstances, the therapeutic principles of strengthening the body resistance to eliminate pathogenic factors, treating its symptoms and the root cause at the same time, and laying stress on combination of the local treatment and general treatment should be adopted.   

2) Needling the local points may dredge the channels and collaterals to relieve pain, meaning “elimination of the obstruction leads to pain-relief". Applying moxibustion to Guanyuan (CV 4) and Qihai (CV 6) may strengthen body resistance, warm yang; replenish qi and help eliminating pathogenic factors.  Zheng Qing Feng Tong Ning (Paederoside) injection is extracted from Paederia scanden Nerr, possesses a better analgesia, anti-inflammation and anti-rheumatism. Danshen (Radix Salviae Mitiorrhizae) possesses the function of promoting blood circulation to remove obstruction in the channels. At the acute pain stage, the Paederoside injection is better in relieving pain, while at the late stage, the obstruction of channels and collaterals appears, or the symptoms and signs subside, application of Radix Salviae Miltiorrhizae is better. Zusanli (ST 36) injection of medicines can not only effectively play a role in relieving pain, resisting inflammation and promoting blood circulation via the drug's effective component, but also strengthen the ability of the body in resisting disease by the specific role of Zusanli.   

3) Modern medicine holds that rheumatoid arthritis is a kind of systemic autoimmune disease, the cause of the disease is unknown up to now, but it relates to factors of immunity, infection, dysfunction of endocrine, abnormality of metabolism and inheritance, etc. It is often treated with the drugs for anti-inflammation, analgesics, immuno-suppressants, or combined with hormones, but side effects often occur. Whereas acupuncture and moxibustion belong to physiotherapy and work fairly well in treating rheumatoid arthritis, especially at the early stage, and have no any obvious side effects. Moreover, experimental and clinical studies demonstrate that the tissue injury caused by rheumatoid arthritis usually relates to the cell mediated immunity and humoral immunity, while acupuncture and moxibustion are capable of regulating the immune functions of the organism and promoting the cell mediated and humoral immunity. Therefore, acupuncture and moxibustion are effective. Some studies also reveal that in patients with rheumatoid arthritis, the viscosity of the blood is higher, while acupuncture and moxibustion can relieve or ameliorate the high viscosity state to reach the aims of eliminating inflammation and stopping pain. It is coincident with the principles of promoting blood circulation to remove blood stasis, removing obstruction in the channels to stop pain in TCM.   

4) According to our clinical experience, acupuncture and moxibustion are fairly effective in treatment of early stage rheumatoid arthritis, while at the late stage, the patients' symptoms and signs are often very serious and the rheumatoid factor test is positive persistently, under the circumstances, acupuncture and moxibustion with Chinese and Western drugs are used together to control the symptoms as quickly as possible. To sum up, acupuncture and moxibustion do work well for relieving symptoms of rheumatoid arthritis.

By Lin Yiping