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IBIS Therapeutics Sample: Rheumatoid Arthritis

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The material contained herein has been compiled by Healthcare Professionals for use by Healthcare ProfessionalS for educational purposes only and SHOULD NOT BE INTERPRETED AS A SUBSTITUTE FOR PHYSICIAN EVALUATION OR TREATMENT BY A Healthcare Professional. Users are advised to use their professional training and clinical judgement in applying any material found in IBIS and/or through this WWW site. This information is not intended to provide or confirm a diagnosis nor is any claim made as to therapeutic efficacy. The information and ideas contained herein do not necessarily reflect those of Integrative Medical Arts Group, Inc. or any of the contributors to IBIS.

Diagnoses

definition and etiologydefinition: A chronic polyarthritis usually involving symmetrical presentation in the peripheral joints that can lead to destruction of the bone and cartilage resulting in characteristic deformities; systemic manifestations can also occur. The disease can appear in many forms: from a mild short-lasting oligoarthritic illness that causes little damage to a severe progressive polyarthropathy that leads to marked joint destruction. Most patients present with an intermediate course of the disease. etiology: The etiology is idiopathic. Rheumatoid athritis (RA) occurs in about 1% of the population, with women presenting three times as often as men. RA usually comes on between the ages of 35-50. It has a genetic association (monozygous twins have a 30% concordance of disease, while dizygous twins have only a 5% concordance). It is correlated with a class II major histocompatibility gene complex antigen HLA-DRA, especially in Caucasians and Japanese with the classic or definite expression of RA. Juvenile onset RA (aka Still's disease), the most common cause of chronic synovitis in kids, is similar to the adult disease. There are three subtypes: * polyarticular: Mostly seen in girls, it accounts for 40-50% of all JRA. There is no eye involvement. Usually the patient presents with multiple symmetrical joint involvement.- 10% have a (+) RF and a (+) ANA, have the disease onset late in childhood and are usually affected quite severe- 30% have (-) RF, (-) ANA, and experience a milder formIn either presentation, there is commonly a mild anemia and a slight leukocytosis. * Pauciarticular: This is responsible for another 30-40% of JRA patients: it affects only a few asymmetrical joints. This group also presents in two ways:- early onset before the age of 5; 30% of cases; patients often develop iritis, (-) RF and (+) ANA- late onset mainly seen in boys, with frequent hip and sacroiliac problems but no iritis, and (-) RF and (-) ANA. In the latter sub-type, there is a high association with HLA-B27. * systemic-onset: This is responsible for 20% of JRA, is found at any age, and affects boys slightly more than girls. It entails fevers; chills; a macular rash; splenomegaly; pleuritis and/or pericarditis; abdominal pain; severe anemia; and marked leukocytosis, followed by the appearance of a polyarthritis. RF and ANA tests are (-). The prognosis for JRA is more favorable than that of adult RA, as about 75% of patients enjoy complete remissions. It has been suggested that RA in females may be related to low estrogens, or in both sexes liver " filtering " dysfunction.

signs and symptomsOnset may be sudden:* Abrupt inflammation of many joints.* Fever.* Lymphadenopathy and splenomegaly. In 75-80% of patients, RA usually occurs insidiously; initial systemic complaints include:* Anorexia.* Fatigue, generalized weakness.* Vague musculoskeletal symptoms.These initial symptoms may exist for months, resisting clear diagnosis. When specific symptoms begin, the joints usually involved are the proximal interphalangeal and metacarpophalangeal joints, feet, wrists, elbows, and ankles: however, any joint may be inflamed. Most commonly the joints are symmetrically affected. Diagnostic criteria for RA as defined by JAMA (Vol. 224, p.799, April 30, 1973) and The Arthritis Foundation are as follows:* Classic RA: Diagnosis needs 7 of the following criteria, with the symptoms of the first five lasting over 6 weeks.- Morning stiffness > 1 hour.- Pain on motion in at least 1 joint.- Swelling (soft tissue: not just bony growth) in at least one joint.- Swelling of at least one other joint.- Symmetrical joint swelling not including terminal phalangeal joint involvement.- Subcutaneous nodules usually distal to the elbow.- X-ray changes typical of RA.- Positive agglutination test: (+) RF.- Poor mucin precipitate from synovial fluid or inflammatory synovial effusion with over 2000 WBC/mm3 and no crystals.- At least 3 characteristic histologic changes in synovial membrane.- Characteristic changes in nodules. * Definite RA: Diagnosis requires 5 of the above criteria: in the first five the joint signs/symptoms must be continuous for at least 6 weeks. * Probable RA: Diagnosis requires 3 of the above criteria: of the first five criteria, only 1 must be continuous for 6 weeks. * Possible RA: Diagnosis requires 2 of the following criteria and the duration of the joint symptoms must be at least 3 weeks:- Morning stiffness.- Pain or tenderness on motion for at least 3 weeks.- History or present joint swelling.- Subcutaneous nodules.- Elevated ESR or C-reactive protein.- Iritis: Only useful for diagnosis of JRA. other lab values seen in RA:* mild or moderate anemia with hemoglobin rarely 10gm/dl, usually hypochromic* leukocytosis seen in only 25% of patients and then rarely >15,000/mm3* in active RA: elevated ESR and C-reactive protein values are usually seen; this test is not specific for RA* (+) ANA test* increased ANA, (+) Coomb's test* increased creatinine* increased ASO titer* increased copper in serum* increased ceruloplasmin causes false (+) test for Bence- protein* increased platelets As the disease progresses, characteristic joint deformities may occur: ulnar deviation of the finger at the metacarpophalangeal joint; swan-neck deformity (hyperextension of the proximal interphalangeal joint, with distal interphalangeal joint in flexion); boutonniere deformity (opposite of swan-neck changes). Extra-articular complaints arising from RA may include rheumatoid nodules, rheumatoid vasculitis, pleuropulmonary problems, neurologic symptoms, and Felty's syndrome (consisting of RA, neutropenia, osteoporosis, splenomegaly, and occasionally anemia and thrombocytopenia).

course and prognosisThe course and prognosis varies from patient to patient and is hard to specify. Conventional treatment can improve as many as 75% during the first year of their disease; however, despite full treatment, 5-10% of patients eventually become disabled. Five years after the onset of the disease, only a third of patients may have evidence of RA, though most patients experience persistent but cyclical illness activity. Remissions usually occur in the first year: sustained RA activity greater than one year indicates a serious problem. The greatest joint damage takes place during the first 6 years of the disease, and then progresses at a substantially slower rate. The median life span of the RA patient is lowered by 3-7 years. An increased mortality rate can be seen in patients with severe disease and is usually due to infections, gastrointestinal bleeding, and drug therapy.

differential diagnosis* Other collagen-vascular disorders: SLE, polyarteritis, progressive systemic sclerosis, dermato(poly)myositis.* Other diseases: Sarcoidosis, amyloidosis, Whipple's disease, acute rheumatic fever, gonococcal arthritis, Reiter's syndrome, psoriatic arthritis, ankylosing spondylitis, gout, Kellegren's syndrome/erosive osteoarthritis.

Somatic Therapies

exercise* acute: ROM exercises within limits of pain* stretching, ROM and gentle resistive exercises* water exercises: - see water exercises for affected areas* strength training* swimming, bicycling, i.e. low load aerobic exercises* qi gong: joint exercises

hydrotherapy* hot epsom salt bath: l lb. per tub, 2x/wk.* hot towels with wool over* charcoal poultice: affected joints* paraffin bath* contrast baths: 50-65Á , then 99-110Á* advanced arthritis: hammock baths* castor oil pack to affected joints* constitutional hydrotherapy, for chronic* Russian bath* heating compress* alternating bath* peanut oil rubbed on affected joints followed by salt glow to joints

manipulation* spine: check and align T10, T11, T12. If hand involved check and align T4 (adjustment contraindicated with active inflammation)* massage: affected joints, esp. after heat to joint* nasal turbinate adjustment: esp. for chronic inflammation

electrical/oscillating* subacute or chronic: U/S or diathermy

Nutrition

dietary guidelineseating principles:* low sugar* low fat diet of unsaturated fats* calorie percentages: 70% complex carbohydrates, protein 12-15%, fat 15-18%* short fasts (5-7 days) are recommended with 2 week intervals between them* vegetarian cleansing diet* hypoallergenic/rotation diet therapeutic foods:* increase omega-3 and omega-6 fatty acids: vegetable, nut, seed oils, salmon, herring, mackerel, sardines, walnuts, flaxseed oil, evening primrose oil, black currant oil* sesame seeds, kale, artichokes, green beans, millet, celery, barley, okra, almonds, collards, turnip greens, raw goat's milk, goat whey and black mission figs, gelatin (make a gelatin mold with cherry concentrate - no sugar), burdock root, cherries, pineapple, quince, watercress, blackberries, black currants, mustard greens, limes, lettuce, olive oil (Jensen) fresh juices: * celery and parsley (Jensen, p. 49) or tea (decoct 7-8 minutes) (Shefi)* cucumber, endive, and goat's whey (Jensen)* celery and apple (Shefi)* grapefruit ()* celery ()* carrot and celery ()* goat milk or whey and black mission figs (Jensen, p. 43)specific remedies:* soak 500 g of red cherries in 1 liter rice wine for ten days. Drink 30-60 ml of wine b.i.d. (Yin-fang and Cheng-jun, p. 91) avoid: * animal products, cow's milk and other dairy products due to promotion of PGE2 pro-inflammatory mediators* spinach, asparagus, rhubarb, vegetables from the nightshade family: tomatoes, green peppers, potatoes, pimentoes, eggplant, tobacco, coffee, caffeine, sugar, refined foods, fried foods* nonsteroidal anti-inflammatories* food intolerances therapeutic foodsCold-type arthritis: * garlic, green onions, pepper, black beans, sesame seeds, chicken, lamb, mustard greens, ginger, spicy foods, grapes, grape vine tea, parsnip (Ni, p. 103) avoid:* cold foods, raw foods therapeutic foodsWind type Arthritis:* scallions, grapes, grapevine tea, black beans, most grains, leafy vegetables (Ni, p. 103) avoid:* meats, shellfish, sugar, alcohol, smoking and stimulants therapeutic foodsDamp-type Arthritis: * barley, mung beans, mustard greens, red beans, millet, sweet rice wine with meals, cornsilk tea, diuretic foods and herbs (Ni, p. 104) avoid:* cold foods, raw foods, dairy products therapeutic foodsHeat-type Arthritis: * fresh fruits and vegetables, dandelion, cabbage, mung beans, winter melon, soybean sprouts (Ni, pp. 104-105) avoid:* spicy foods, alcohol, smoking, stress, green onions

supplements* Vitamin B5 500 mg q.i.d. (Practitioner, 1980, p. 208ff)* Vitamin C (,1984, p. 88)* Vitamin K 5-10mg t.i.d. (to stabilize synovial linings)* Copper (Hangarter, 1977, p. 217)* Manganese* Selenium 200 mcg q.d.* Zinc 20-50 mg t.i.d. (Svenson, 1985, p. 189ff)* bromelain 2250 mg b.i.d. between meals (Cohen, 1964, p. 27)* catechin* L-histidine* omega-3 fatty acids (Sperling, 1986)* omega-6 fatty acids (e.g EPO-1 g q.i.d.)* D, L phenylalanine* tryptophan* Vitamin E 1000 I.U. q.d.* glycosaminoglycans

Botanicals

primary herbs* Apium graveolens: with mental depression (British Herbal Pharmacopoeia, p. 29)* Arctium lappa* Bryonia alba (toxic): acute, muscular pain (with Cimicifuga racemosa), worse with movement, joints of fingers and hands (Ellingwood, p. 91)* Capsicum frutescens* Caulophyllum thalictroides (toxic): rheumatoid pain (Felter, p. 282)* Cimicifuga racemosa: rheumatoid pain, with Menyanthes trifoliata (Felter, p. 466, British Herbal Pharmacopoeia, p. 66)* Equisetum arvense: diuretic, antidyscratic, antihumoral (Weiss, pp. 238-239)* Glycyrrhiza glabra: anti-inflammatory* Guaiacum officinale: anti-inflammatory; combine with Zingiber officinale, Menyanthes trifoliata, Apium graveolens according to indications (British Herbal Pharmacopoeia, p. 108)* Harpagophylum procumbens: pain, decreased mobility (Weiss, p. 265)* Iris versicolor (toxic): chronic rheumatic conditions (Priest and Priest, p. 75)* Menyanthes trifoliata: with Apium graveolens or Cimicifuga racemosa (British Herbal Pharmacopoeia p. 144)* Phytolacca decandra (toxic): chronic rheumatic conditions (Priest and Priest, p. 75)* Salix spp.: externally: pain, inflammation (NCNM Botanicals)* Solanum dulcamara (toxic): antidyscratic (Weiss, p. 264)* Taraxacum officinale: chronic rheumatic conditions (Weiss, p. 260)* Urtica spp. (Weiss, p. 261)* Xanthoxylum americanum (bark): peripheral circulatory insufficiency (British Herbal Pharmacopoeia, p. 237)

complementary herbs* use an antidyscratic + laxative + carminative (Weiss, p. 258)* for bone pain add: Phytolacca decandra (toxic) or Zingiber officinale or Echinacea spp. (Sherman)* Populus trichocarpa + Salix spp. + Arctium lappa or Chimaphila umbellata; equal parts of each (NCNM Botanicals)* other formulas and external applications, see Weiss, pp. 257-270* formula: rheumatism:Caulophyllum thalictroides (toxic), 1 tbsp.Xanthoxylum americanum, 1 tbsp.Achillea millefolium, 1 tbsp.Sassafras officinale, 1 tbsp.Viburnum opulus, 1 tbsp.To use powder: boil designated amounts in 1 quart water for 30 minutes. Strain.sig: powder concoction: 2 tbsp. a.c.; tincture: 10 minims q.i.d. (Sherman 1979)

Chinese formulae

formulas* Licorice and Aconite C.; Cinnamon, Aconite and Ginger C.: acute severe pain, redness and swelling, heat in the joints, tenderness to touch, decreased range of motion: use Cinnamon, Aconite plus Ginger if less severe(Licorice and Aconite: Hsu, 1980, p. 298; Dharmananda, 1986, p. 110; Cinnamon: Hsu, 1980, p. 305)* Ma Huang and Coix C.: Hot Bi Syndrome: after the acute stage, joint swelling; also generalized aching and arthralgia in the initial mild stage (Hsu, 1980, p. 66)* Ma Huang and Atractylodes C. (Ma Huang Jia Zhu Tang): Cold Bi Syndrome: generalized aching and arthralgia in the initial mild stage, edema, spontaneous sweating(Hsu, 1980, p. 70; Dharmananda, 1986, p. 125; Bensky, p. 34)* Coix C. (Yi Yi Ren Tang): Xue (Blood) Stagnation: more severe: many joints swollen with painful movement, especially upper body; edema(Hsu, 1980, p. 489; Dharmananda, 1986, p. 126; Bensky, p. 206)* Lithospermum 15 (patent) plus Clematis 19 (patent): Xue (Blood) Stagnation with Fire Toxin: autoimmune disorders, joint inflammation (Dharmananda, 1990; Lithospermum, p. 85: Clematis, p. 42)* Du Huo Ji Sheng Wan (patent): Xue Xu (Blood Deficiency) (Zhu, p. 111)* Clematis 19 (patent) plus Alisma 16 (patent): Damp Bi Syndrome: for joint swelling, especially of knees (Dharmananda, 1990; Clematis, p. 42: Alisma, p. 34)* Guan Jie Yan Wan (patent): Wind-Damp (Fratkin, p. 111)* Clerodendron 6 (patent): Bi Syndrome: opens channels and vessels (Dharmananda, 1990, p. 81)* Yunnan Rheumatilin (patent): Wind-Cold Damp; do not use during flare-ups. (Zhu, p. 106)* Feng Shi Ling Pian (patent): Wind-Damp (Should not be used in acute stage or during flare-ups) (Zhu, p. 106)* Clematis and Carthamus F.: Acute and chronic RA: arthritic pain in arms and legs(Hsu, 1980, p. 454)* Shen Rong Hu Gu Wan (patent): Chronic stage, with deformity and dull or no pain(Zhu, p. 302)* Cinnamon and Anemarrhena C. (Gui Zhi Shao Yao Zhi Mu Tang): Chronic articular rheumatism with swollen and emaciated fingers, weak constitiution, NO sensation of heat in the joints (Hsu, 1980, p. 450; Yeung, p. 114; Bensky, p. 205)* Stephania and Astragalus C. (Fang Ji Huang Qi Tang): Deformed knee joints in overweight women(Hsu, 1980, p. 477; Yeung, p. 94; Dharmananda, 1986, p. 343; Bensky, p. 179)* Major Siler C. (Da Fang Feng Tang): Qi and Xue Xu (Blood Deficiency) with joint pain and swelling, especially difficult cases (Hsu, 1980, p. 457; Dharmananda, 1986, p. 343; Bensky, p. 209)* Yun Xiang Jing (patent lotion); Bao Zhen Gao (patent plaster): External application(Yun Xiang Jing: Zhu, p. 119; Bao Zhen Gao: Zhu, p. 11

Acupuncture

points and patternsafter assessing the person and palpating, consider these patterns:Damp-Cold; Damp-Heat; Wind-Cold Damp; Wind-Damp; Stagnant Wind; Hot Bi Syndrome; Cold Bi Syndrome; Damp Bi Syndrome; Xue (Blood) Stagnation; Qi and Xue (Blood) Deficiency; Kidney Xu (Deficiency); dysfunction of the Yang Wei Mai (Yang Linking Vessel); Xu (Deficiency) of the Yang Qiao Mai (Yang Motility Vessel) and/or Shi (Excess) of the Yin Qiao Mai (Yin Motility Vessel) - therapeutic note: usually emphasize needles and cupping (often with bleeding) for acute condition; moxa for chronic condition when Cold tends to dominate - palpate and consider:* GB-20 (-): disperses Wind-Cold; reduces and relieves Heat; harmonizes Qi and Xue (Blood); frees the channels and invigorates the collateral vessels* GB-30 (- and/or moxa): dispels Wind and Cold; invigorates the Kidney; strengthens the lower back; regulates the hip joint; benefits the knee; dissipates Wind-Damp in the channels and connecting vessels; frees the channels and removes Obstructions; relaxes the muscles and tendons; relieves Bi of the lower extremities, esp. knee pain* hua tuo jia ji (+): benefit the back and joints; restore Qi and Xue (Blood) flow; strengthen and relax the sinews and tendons* Bl-11(- or +): dispels Wind, Wind-Cold and Cold; connects the Du Mai (Governing Vessel) to the Shu Associated points; distributes Bladder Qi and Jing-Ye (Yin) to all the dorsal Shu points, thus cooling them (Finkelstein, p. 38); removes Obstruction of Qi circulation of the Tai Yang channels (Bladder and Small Intestine) and Du Mai (Governing Vessel) of the upper back; strengthens all bones and joints; facilitates Xue (Blood) flow; relaxes the muscles, sinews and tendons; invigorates the collateral vessels; Hui Reunion point of the Bones; Sea of Xue (Blood) upper entry point* Bl-17 (+ and/or moxa): tonifies the Qi; nourishes and invigorates the Xue (Blood) (esp. invigorates with moxa); transforms Xue (Blood) Stagnation and disperses Obstruction; nourishes Dry Xue (Blood); strengthens Xu (Deficient) conditions and increases stamina; strengthens the upper back (- then +) (Finkelstein, p. 40); Hui Reunion and Master point of the Xue (Blood)* Bl-18 (- then +): benefits, clears and drains the Liver and Gall Bladder; benefits the eyes and improves vision; cools Damp-Heat; moves Stagnant Qi; strengthens Xu (Deficiency) conditions; nourishes and regulates the Xue (Blood); nourishes Liver Yin; relieves mid-back tension; Liver Shu Associated point* Bl-19 (-): regulates the Qi; drains Heat from the Liver and Gall Bladder; nourishes Xue (Blood); transforms Damp-Heat; Gall Bladder Shu Associated point* Bl-20 (- or + and/or moxa): regulates Spleen Qi; tonifies the Spleen and Stomach to facilitate digestive transportation and transformation; enhances Spleen Yang to mobilize Stagnant Qi; tonifies and harmonizes the Xue (Blood); warms the Middle Warmer (moxa); drains Heat Shi (Excess) from the Middle Warmer; relieves splenomegaly; resolves Dampness; dispels Cold and relieves pain; provides strength to the extremities; Spleen Shu Associated point* Bl-23 (+ and/or moxa): tonifies and adjusts the Kidney; nourishes Yin, Xue (Blood) and Kidney Jing (Essence); strengthens Yang and Qi Hai; influences adrenals; counterbalances Liver Fire; resolves Dampness; strengthens the spine, esp. the lower back; benefits the knees; controls the bones; Kidney Shu Associated point* Bl-25 (+ and/or moxa): regulates the Qi of the Fu (Yang organs); regulates the Intestines and Stomach; " initiates bowel movement for extruding the impurities " (Finkelstein, p. 45); resolves Damp-Heat; warms Cold and dries Damp-Cold; benefits the lower back and knees; esp. for arthritis of the sacroiliac, use a transverse insertion, connecting with Bl-27; Large Intestine Shu Associated point* Bl-27 (-): opens and moves the Small Intestine; eliminates Dampness and cools Heat; transforms Stagnation and Accumulation; promotes separation of the Clear and the Turbid; strengthens the lower back; for arthritis of sacroiliac, use a slanted insertion, 0.5 - 2.0 cun; Small Intestine Shu Associated point* Bl-54 (- and/or bleed): clears Heat from the Xue (Blood) to cool fever and relieve inflammation (bleed); transforms Damp-Heat; strengthens the waist; relaxes the sinews and muscles; benefits the lower back, hips, legs and knees; esp. for arthritis of the knee; Bladder He Sea Uniting and Earth point; Command point of the back* Bl-58 (+): dispels Wind and Wind-Damp; dispels Tai Yang channel pathogens; promotes flow of Qi; strengthens Kidney function; increases stamina; eases low back pain; frees the channels and invigorates the collateral vessels; specifically indicated for " Moving Wind in the joints when the fingers and toes cannot be flexed or extended, accompanied by vertigo and belching " (Shanghai, p. 607); Bladder Luo Connecting point* GV-15 (- and/or +): dispels Wind-Cold; facilitates the joints; frees the channels; removes Obstruction from the collateral vessels; stops pain; esp. with arthritis affecting the spine; Sea of Bone Marrow Exit point* GV-14 (- and/or +): dissipates Wind and Cold; disperses Heat; reduces fever; spreads Yang Qi through the Du Mai (Governing Vessel) and whole body; regulates the Xue (Blood); relaxes the sinews and muscles; esp. with arthritis affecting the spine; Jiao Hui Intersecting point of the Yang channels on the Du Mai (Governing Vessel)* GV-12 (- and/or +): dissipates Heat and Wind; dispels pathogens and relieves fever; readjusts Qi of all Yang channels; relieves stiffness in the spine, esp. lumbar; " Body's Pillar " * GV-4 (+ and moxa): strengthens the Kidney to support the healing of bones; benefits and replenishes the Kidney Yang; nourishes the Yuan (Original) Qi; strengthens the back, esp. benefits the lumbar vertebrae; esp. with lumbosacral pain and stiffness; frees the channels and invigorates the collateral vessels* GV-3 (+ and moxa): reinforces the Kidney and regulates the Kidney Qi; dispels Cold-Damp, esp. in the Lower Warmer; benefits the lumbar spine and knees; regulates the Ren Mai (Conception Vessel) and Chong Mai (Penetrating Vessel); esp. with lumbosacral pain and stiffness* yao yan: strengthens the lower back; esp. for lower back pain, stiffness or arthritis* shi qi zhui xia: removes Obstructions from the channel; benefits the lower back and regulates the Lower Warmer; relieves lumbosacral pain and stiffness* Bl-1 (=): disperses and eliminates Wind; cools and eliminates Heat in the eyes; clears the vision and brightens the eyes; relieves iritis of juvenile rheumatoid arthritis; enriches Yin (esp. in relation to the eyes); controls the pituitary gland and its secretions via the hypothalamus and the autonomic nervous system; triggers alarm reaction which releases reserve Jing Qi from the Kidney (esp. with asthma, hives and rheumatoid arthritis); regulates the Yin and Yang Qiao Mai (Motility Vessels); opens the channels and invigorates circulation; Bladder Entry point; Polarization point of the Yin and Yang Qiao Mai (Motility Vessels); Master point for the eyes (Mann, p. 30)* GB-2 (-): eliminates Wind and Cold; clears blockage and restores circulation of Qi in the Gall Bladder and channel near the ear; invigorates the Liver and Gall Bladder; relaxes the sinews and muscles; relieves arthritis of the mandibular joint* TW-17 (-): clears Heat and disperses Wind; frees the channels; relaxes the sinews and tendons, especially facial; relieves temporomandibular arthritis; benefits vision* TW-21 (-): disperses Heat; dispels Wind and Cold; frees the channels and invigorates the collateral vessels; treats temporomandibular arthritis* St-7 (-): dissipates Wind; dispels Heat; sedates pain; removes Obstructions from the Stomach channel; relaxes the jaw; use slanted insertion to treat temporomandibular arthritis* GB-21 (- and/or moxa): clears Heat; dispels Wind-Cold; spreads Liver Qi; disperses Stagnation and stops pain; benefits tendons and muscles; benefits the shoulder; clears and invigorates the channels* jian nei ling (- and/or ind. moxa): expels Dampness and Cold; dispels Wind; benefits the shoulders; relaxes the sinews and muscles; removes Obstructions from the channel* LI-15 (- and/or moxa): expels Wind; harmonizes the flow of Qi and Xue (Blood); frees the channels and invigorates the collateral vessels; stops pain; facilitates the joints, esp. in the shoulder; can also apply three cones of direct moxa, red bean size, to LI-15 if severe (So, 1987, p. 287); Jiao Hui Intersecting point of the Yang Qiao Mai (Yang Motility Vessel) and Hand Tai Yang (Small Intestine) channel on the Hand Yang MIng (Large Intestine) channel; independent associated point of the shoulder (Mann, p. 9)* LI-11(-): clears Heat and eliminates Wind; regulates and harmonizes Qi and Ying; cools and harmonizes the Xue (Blood); improves immune function (Finkelstein, p. 9); tonifies Metal to cool inflammatory processes; eliminates Dampness through the Intestines; benefits sinews, tendons and joints; frees the channels; esp. relieves arthritis in the upper limbs; Large Intestine Upper He Sea Uniting, Earth and Tonification point; Master point of Heat in the body (Finkelstein, p. 9)* LI-10 (-): promotes the circulation of Qi and Xue (Blood); tonifies Qi and Xue (Blood) (Maciocia, p. 378); benefits Qi of the arms and shoulders; removes Obstruction from and invigorates the channels; enhances action of the immune bodies (Finkelstein, p. 8); tonifies Yang Ming (Stomach and Large Intestine) and the internal duct of the Triple Warmer (Finkelstein, p. 8); esp. for for arthritis of the wrist, metacarpals and fingers* LI-5 (-): expels Wind and Heat; dissipates Heat from the Yang Ming (Large Intestine and Stomach); benefits the throat; stops pain; esp. for for arthritis of the wrist, metacarpals and fingers; Large Intestine Fire point* LI-4 (-): dispels Wind-Cold; reduces fever; regulates Qi and Xue (Blood); activates Wei (Protective) Qi and stimulates the immune system; tonifies Metal to cool inflammatory processes; regulates Qi and disperses Heat of the Intestines; moves the bowels; elevates Clear Qi and descends Turbid Qi; clears Toxins; relaxes sinews and tendons; eliminates Damp-Heat; sedates pain; frees the channels and invigorates the collateral vessels; Large Intestine Yuan Source and Entry point* Lu-5 (-): expels Wind; cools fever (bleed); sedates Upper Warmer Shi (Excess); regulates the digestive system and the Water Pathways; benefits the Bladder and Kidney; relaxes the sinews and muscles; treats rigidity of vertebral column (Mann, p. 4); Lung He Sea Uniting, Water and Dispersion point* Lu-7 (-): circulates the Wei (Protective) Qi to expel Wind, dispel Cold, and disperse the Exterior; treats Shi (Excess) patterns, esp. acute; opens and regulates the Ren Mai (Conception Vessel); regulates the Yin Qiao Mai (Yin Motility Vessel); stimulates the Lung function of dominating Water Pathways to eliminate Dampness; communicates with the Large Intestine; promotes diuresis by descending the Turbid; invigorates the collateral vessels; Lung Luo Connecting and Exit point of the Hand Tai Yin (Lung) channel; Master point of the Ren Mai (Conception Vessel); Couple point of the Yin Qiao Mai (Yin Motility Vessel)* Lu-8 (-): disperses Wind and resolves the Exterior; sedates Yang; reactivates circulation of Lung and Stomach Qi; relieves rheumatism of neck; Lung Metal and Horary point* Ht-4 (= and/or +): sends Wei (Protective) Qi to the joints and bones; relaxes the muscles and tendons; invigorates and removes Obstructions from the Heart channel; relieves wrist and elbow arthritis; Heart Metal point* SI-6 (-): relaxes the sinews and tendons; benefits the joints; frees the channels and invigorates the collateral vessels; assists in treatment of arthritis of the arm; Small Intestine Xi Cleft Accumulation point* SI-4 (- and/or moxa): dispels Wind and clears Heat; invigorates Tai Yang (Small Intestine and Bladder); disperses Damp-Heat from the Small Intestine; relaxes the sinews and muscles; reduces swelling; removes Obstruction from the channel; relieves arthritis of the elbow, wrist and fingers; Small Intestine Yuan Source point* SI-3 (+): opens the Du Mai (Governing Vessel) and regulates the Yang Qiao Mai (Yang Motility Vessel); dispels Dampness and Internal Heat; dispels Wind-Phlegm; tonifies the Small Intestine; strengthens the spine; relaxes the sinews and muscles; benefits the joints; invigorates the channels; Small Intestine Wood and Tonification point; Master point of the Du Mai (Governing Vessel); Couple point of the Yang Qiao Mai (Yang Motility Vessel)* TW-5 (-): dissipates Wind; clears Heat, esp. from Triple Warmer channel; opens and moves the Yang Wei Mai (Yang Linking Vessel) and regulates the Dai Mai (Girdle Vessel); dissolves Toxins; tonifies Wei (Protective) Qi; frees the channels to facilitate the circulation of Qi in the channels; invigorates the collateral vessels; strengthens and relaxes the sinews and tendons; alleviates pain, esp. due to Wind-predominant painful Obstruction; Triple Warmer Luo Connecting point; Master point of the Yang Wei Mai (Yang Linking Vessel); Couple point of the Dai Mai (Girdle Vessel)* TW-4 (-): dispels Wind; clears Fire and Heat; left TW-4 is tonic to Yang of the whole body (Finkelstein, p. 61); relaxes the sinews and muscles; promotes function of Chong Mai (Penetrating Vessel) and Ren Mai (Conception Vessel); frees the channels and collateral vessels; Triple Warmer Yuan Source point* PC-7 (-): clears Heat; nourishes Heart Xue (Blood); dissipates Heat from the Ying (nutrient system) and Xue (Blood); influences adrenals (Worsley, 1975, p. B-20); relieves arthritis in the wrist; Pericardium Yuan Source, Earth and Dispersion point* xiao gu kong: facilitates flow of Qi and Xue (Blood); relaxes and strengthens sinews and tendons; frees the channels and invigorates the collateral vessels; relieves pain in the hand joints, esp. with arthritis in the thumb knuckle* da gu kong: facilitates flow of Qi and Xue (Blood); relaxes and strengthens sinews and tendons; frees the channels and invigorates the collateral vessels; relieves arthritis and pain in the thumb knuckle* shang ba xie (- and/or ind. moxa): alleviate Exterior conditions; dispel Wind; clear Heat; relax the sinews and tendons; free the channels and invigorate the collateral vessels* ba xie (- and/or ind. moxa): alleviate Exterior conditions; dispel Wind; expel Wind-Damp; clear Heat; relaxes the sinews and muscles; invigorate the Xue (Blood)* si feng (- ): expel Wind; resolve Dampness; facilitate Qi and Xue (Blood) flow; relieve finger pain due to arthritis* Lv-14 (-): spreads and moves Liver Qi to regulate circulation of Qi; soothes and promotes function of the Liver; strengthens the Spleen and Stomach; invigorates flow of Xue (Blood) and removes Stagnant Xue (Blood); dispels Heat from the Xue (Blood); Liver Mu Alarm point* Lv-13 (= and/or +): spreads and promotes smooth flow of Liver Qi; clears Obstructions of the Liver channel and its Luo channels; invigorates the Stomach and Spleen; relieves splenomegaly; benefits the Qi; transforms Damp-Heat; disperses Cold-Damp; regulates circulation of Qi and Xue (Blood); quickens the Xue (Blood) and disperses Xue (Blood) Stagnation; Spleen Mu Alarm point; Hui Reunion point of the five Zang (Yin viscera)* GB-24 (-): regulates Liver and Stomach; invigorates the Gall Bladder; spreads Liver Qi; cools and transforms Damp-Heat; Gall Bladder Mu Alarm point* shen xi: dissipates Wind; disperses Damp and Cold; benefits the Kidney; facilitates flow of Qi and Xue (Blood); facilitates the joints, esp. the knees; relaxes the sinews and muscles; frees the channels and invigorates the collateral vessels* ling hou: facilitates flow of Qi and Xue (Blood); dissipates Wind; disperses Damp and Cold; relaxes and strengthens sinews and tendons; facilitates the joints, esp. the knees; frees the channels and invigorates the collateral vessels* lan wei (xue): regulates the Intestines; transforms Damp-Heat; relieves lower extremity arthritis* St-34 (= and moxa): expels Wind; dispels Stagnation and Accumulation of the Yang Ming (Stomach and Large Intestine); facilitates the joints, esp. benefits the knee; frees the channels and invigorates the collateral vessels; Stomach Xi Cleft Accumulation point* St-35 and nei xi yan (= and ind. moxa): dispels Wind; facilitates the joints, esp. benefits the knee; invigorates the channels; relieves swelling; stops pain* St-36 (+ and moxa): dispels Cold and expels Wind; facilitates the Lung and regulates Wei (Protective) Qi; dispels and eliminates Dampness; regulates and strengthens Qi and Xue (Blood); regulates the Stomach and strengthens the Spleen; spreads Liver Qi and benefits the Gall Bladder; nourishes Kidney, Liver and Spleen; tonifies Kidney Yin; regulates ascension of the Clear and descension of the Turbid (-), esp. by the Intestines; frees the channels and invigorates the collateral vessels; Stomach He Sea Lower Uniting, Earth and Horary point; Sea of Nourishment point* St-37 (-): drains Shi (Excess) from the upper region of body; rectifies the Spleen and harmonizes the Stomach; drains and frees the Intestines, esp. the Large Intestine; cools Heat and resolves Dampness to clear Damp-Heat; frees the channels and invigorates the collateral vessels; esp. treats arthritis and swelling of the knee; He Sea Lower Uniting point of the Da Chang (Large Intestine); Exit point of Sea of Xue (Blood)* St-38 (- and/or moxa): dissipates Cold; treats acute shoulder problems; relaxes the muscles and tendons; warms the channels and invigorates the collateral vessels; relieves arthritis of the knee* St-41 (= and/or moxa): dispels Wind; supports Spleen Qi; removes Obstructions from Stomach channel; transforms Damp Stagnation; relieves arthritis of the ankle; Stomach Fire and Tonification point* Sp-9 (-): regulates and tonifies Spleen (especially Yang); transforms Damp Stagnation, dispels Damp-Heat, and promotes diuresis; regulates the Water Pathways; benefits Lower Warmer; Spleen He Sea Uniting and Water point* Sp-6 (+): clears Fire due to Xu (Deficiency); strengthens the Spleen and tonifies the Qi; clears, nourishes and moves the Xue (Blood); dispels Cold from the Xue (Blood); clears Xue (Blood) Heat; transforms Xue (Blood) Stagnation; aids transportation and transformation to improve digestion and nourishment; frees Qi Stagnation and spreads Liver Qi; tonifies the Kidney; transforms Dampness and Heat; Jiao Hui Intersecting point of the three Foot Yin channels* Sp-5 (-): strengthens the Spleen and Stomach; transforms Damp Stagnation and Damp-Heat; relaxes muscles, sinews and tendons; stimulates the channels; Spleen Metal and Dispersion point* GB-31 (- and/or moxa): disperses Wind and Cold; clears Heat and transforms Damp; strengthens the waist, thighs and knees; strengthens bones; relaxes and strengthens sinews and tendons; " Wind Market " * GB-34 (= and/or moxa): opens and drains the Gall Bladder to regulate distribution of functional Qi (Finkelstein, p. 68); clears Dampness and cools Heat; facilitates and harmonizes the Liver; tonifies the Spleen; strengthens and relaxes sinews and tendons; benefits joints, esp. knees and hips; frees the channels and invigorates the collateral vessels; alleviates pain; esp. with arthritis affecting the knee; Gall Bladder He Sea Uniting and Earth point; Hui Reunion point of Jin (sinews and tendons)* GB-35 (-): regulates the Gall Bladder; invigorates the Xue (Blood); soothes the sinews and tendons; relieves pain; Xi Cleft Accumulation point of the Yang Wei Mai (Yang Linking Vessel)* GB-37 (=): dispels Wind and Damp; dissipates Heat, esp. from the Liver; regulates the Liver; clears and brightens vision to relieve iritis of juvenile rheumatoid arthritis; transforms Damp-Heat; relaxes the sinews and muscles; invigorates the channels; Gall Bladder Luo Connecting point* GB-39 (=): transforms Damp-Heat; pacifies the Liver; relaxes the neck; regulates the Gall Bladder; clears Heat and communicates the superficial with the internal of the three Foot Yang channels; relaxes the muscles and sinews; tonifies the Bone Marrow and strengthens the Bones; expels Wind-Damp and otherwise frees the channels and connecting vessels; Hui Reunion point of the Marrow; Jiao Hui Intersecting point of the three primary Yang channels of leg; Group Luo point of the three Lower Yang* GB-40 (=): spreads the Liver Qi; benefits Gall Bladder; transforms Damp-Heat; benefits the joints; frees the channels; esp. with arthritis in the ankle; Gall Bladder Yuan Source point* GB-41 (=): dissipates Wind; removes Fire; harmonizes and regulates the Liver and Gall Bladder; removes Stagnancy of Liver Qi; clears and regulates the Dai Mai (Girdle Vessel); clears Wetness (Damp Spleen) by draining into Dai Mai (Girdle Vessel), thereby increasing Spleen Qi and Xue (Blood) production and warming the extremities; dispels Damp-Heat; esp. with migratory pains; Gall Bladder Wood and Horary point; Master point of the Dai Mai (Girdle Vessel); Couple point of the Yang Wei Mai (Yang Linking Vessel)* Lv-7 (-): dispels Wind; relieves pain; frees the channels and collateral vessels; facilitates the joints; resolves Wind Bi; treats rheumatoid arthritis affecting the knee, esp. with swollen and painful joints and limited range of motion* Kd-10 (=): tonifies Kidney (especially Yin and Qi); dispels Heat (especially Lower Warmer); regulates Fluid balance; expels Dampness from Lower Warmer; strengthens the knee; treats with arthritis of knee, particularly when knees painful and cannot be flexed, especially medial aspect; Kidney He Sea Uniting, Water and Horary point* Kd-8 (=): regulates Qi and Xue (Blood); clears Heat; eliminates Damp; tonifies the Kidney; regulates adrenals and Kidney Qi; removes Obstructions from the channels; regulates fluid balance; Xi Cleft Accumulation point of Yin Qiao Mai (Yin Motility Vessel)* Kd-6 (=): cools and clears Heat; clears Xu (Deficiency) Fire; removes Obstruction from the Yin Qiao Mai (Yin Motility Vessel); opens the Ren Mai (Conception Vessel); tonifies the Kidney (especially Yin); dispels Dampness; promotes bowel movement; strengthens the lower back and loins; frees the channels and invigorates the collateral vessels; sedates pain; palpation: steroid hormone reflex point (Nagano as per Matsumoto); Master point and Entry point of the Yin Qiao Mai (Yin Motility Vessel); Couple point of Ren Mai (Conception Vessel)* Kd-3 (+): tonifies the Kidney, Yuan (Original) Qi, Xue (Blood) and Jing (Essence); warms Cold; cools and descends Heat; pacifies Xu (Deficiency) Fire; tonifies Kidney Yang and Ming Men Fire (moxa); regulates the Chong Mai (Penetrating Vessel) and Ren Mai (Conception Vessel); strengthens the lower back, waist and knees; relieves pain in the bones, esp. the ankles; Kidney Yuan Source and Earth point* Bl-59 (= and/or +): regulates Qi; dispels Wind and clears Heat; promotes flow of Xue (Blood); disperses Damp-Heat; effects the Yang Qiao Mai (Yang Motility Vessel); eliminates mild toxins (Finkelstein, p. 50); relaxes the sinews, tendons and muscles; beenfits and strengthens the lower back; frees the channels and invigorates the collateral vessels; sedates pain; esp. for " rheumatoid arthritis in males " (Finkelstein, p. 50); Xi Cleft Accumulation point of the Yang Qiao Mai (Yang Motility Vessel)* Bl-60 (-): disperses Wind; promotes Qi function and Xue (Blood) circulation; reinforces the Kidney; strengthens the lower back; descends the Turbid; relaxes the sinews, tendons and muscles of the neck, shoulder, waist, back, ankle and foot, esp. the lower back; frees the channels and collateral vessels; relieves pain* Bl-62 (+): dispels Wind and Cold; cools and clears Fire and Heat; opens and moves the Yang Qiao Mai (Yang Motility Vessel); regulates the Du Mai (Governing Vessel) and benefits Du Mai (Governing Vessel) disorders; soothes sinews, tendons and vessels; relaxes the Muscle channels; esp. with arthritis affecting the spine and/or ankle; Master point of the Yang Qiao Mai (Yang Motility Vessel); Couple point of the Du Mai (Governing Vessel)* ba feng (+): dispel Wind; expel Wind-Damp; clear Heat; relax the sinews and tendons; invigorate the Xue (Blood); transform Damp-Heat * ear: sympathetic, shen men, corresponding area(s)

local points for consideration:(all regional treatments: So, 1987, p. 287-289; Mc, et al, Lesson 31, p. 186-188; Lee and Cheung, p. 275-277; and/or Shanghai, p. 606-608) - temporo-mandibular joint:* St-7, SI-19, TW-17, LI-4 for temporomandibular arthritis (Lee and Cheung, p. 275)* St-7 and LI-4 for temporomandibular arthritis (Shanghai, p. 155)* TW-17 and St-7 for temporomandibular arthritis (Shanghai, p. 161) - vertebrae:* GV-15 and GV-14 for rheumatoid arthritis affecting the spine (Shanghai, p. 607)* hua tuo jia ji, yao yan, Bl-51, Bl-54 and GV-26 for rheumatoid arthritis affecting the spine* Bl-60 and Bl-62 removes Qi Obstructions of the Tai Yang channel to treat stiffness of the neck and back (Finkelstein, p. 50)* GV-14, Bl-20, Bl-23, Bl-27 and appropriate hua tuo jia ji points for rheumatoid arthritis of vertebrae (Shanghai, p. 214) - shoulder:* LI-15, TW-14, jian nei ling, GB-21, LI-16, LI-4 (+ and moxa); can also apply three cones of direct moxa, red bean size, to LI-15 if severe (So, 1987, p. 287)* jian nei ling, LI-15, TW-14 and local tender point(s) for perifocal inflammation of the shoulder joint or pain in the shoulder (Shanghai, p. 223)* SI-6 and Bl-10 for " shoulder pain [so severe that the patient} wants to break it off " (Shanghai, p. 607) - upper limbs:* LI-15, LI-11 LI-4 and jing bi to treat rheumatic arthritis in the upper limbs (Flaws, 1989, p. 100)* GB-21, LI-11 LI-10 and LI-8, then LI-13, LI-9 and Lu-8, for arm pain caused by Cold-Wind (Shanghai, p. 607)* LI-11and GB-21 to relieve pain in the upper arm (Ellis, et al, 1988, p. 100); - elbow:* Lu-5, TW-10 (+), PC-3 (+ and moxa) and LI-11(+ and moxa) for rheumatoid arthritis of the elbow* LI-11 TW-10 and LI-4 for rheumatoid arthritis of the elbow* LI-11 St-42 and TW-15 for painful elbow (Shanghai, p. 659) - wrist, metacarpals and phalangeals:* TW-5, TW-4, LI-10, LI-5, SI-4, PC-7, shang ba xie and si feng for arthritis of the wrist, metacarpals and fingers (Shanghai, p. 606)* TW-4, PC-7, si feng and shang ba xie for arthritis of the wrist, hand, fingers and bones of hand (Shanghai, p. 237)* ba xie, shang ba xie, si feng, LI-10, PC-7, SI-4, Lu-9, LI-5, TW-4, TW-5 (-); ind. moxa and/or and five to seven cones of direct moxa, red bean size, to tender point(s) (So, 1987, p. 288)* da gu kong and xiao gu kong: esp. for arthritis in the thumb knuckle - lumbosacral and sacroiliac:* GV-3, Bl-26, Bl-27, Bl-28, Bl-30, Bl-54, Bl-60, shi qi zhui xia, tender pts (-)* shi qi zhui xia, Bl-49 and Bl-26 for lumbosacral pain (Shanghai, p. 213) - hip:* Bl-54, GB-29, GB-30, GB-31, GB-34, GB-39, ashi (tender) points (-); ind. moxa to GB-30 and ashi (tender) points for arthritis of the hip - lower limbs:* St-33, GB-31 and GB-34 for arthritis of the knee or paralysis of lower limb (Shanghai, p. 266)* GB-30 before GB-34 for Cold-Damp-Wind Bi; augments and adjust function of lower limb; dispels Wind and Damp; removes Obstructions of channels; regulates Qi and Xue (Blood) circulation (Ellis, et al, 1988, p. 317; Finkelstein, p. 68) - knee:* Lv-8, St-34, St-35, St-36, GB-34, Sp-9, Bl-54, he ding, shi yan, xi xia (+ and moxa);Bl-54 with deep insertion, to bone, and sensation to patella, for arthritis of the knee (So, 1987, p. 288)* St-34, St-35 and GB-34 for arthritis of the knee (Shanghai, p. 271)* he ding, xi xia, St-34, St-35, St-36, Sp-9 and GB-34 for arthritis of the knee (Shanghai, p. 606)* Bl-11 Bl-17, Bl-23, GV-4, CV-6, Sp-10, he ding, St-35, nei xi yan, St-34, GB-34 and Sp-9 for rheumatoid arthritis due to Kidney Yang Xu (Deficiency) with Damp-Cold in the knees (Jirui and Wang, p. 156) - ankle and metatarsophalangeal:* GB-35, Kd-8, Kd-6, St-41, Bl-60, Kd-3, Bl-62, shang ba feng (-); add Sp-5, GB-40, Lv-4 if pain on anterior aspect; ashi (tender) points: + and moxa* St-41, GB-40, GB-35, Kd-3, Kd-8, Bl-60 and Sp-5 for arthritis in the ankle (Shanghai, p. 606)

illustrative combinations:* TW-10, Lu-5, Ht-3, Bl-54 and GB-38 for Wind Blockage (Shanghai, p. 607);* Lv-13 and Bl-20: drive away the Cold and Damp (Finkelstein, p. 75)* GV-26, GB-20 and LI-20: remove Wind-Damp and sedate pain (Finkelstein, p. 83)* GB-34 and LI-11 spread Qi, reduce Fire, descend the Turbid, facilitate the joints, and remove Obstruction of the tendons and bones (Finkelstein, p. 69)* GB-30, GB-34 and Sp-9: dispel Wind; disperse Cold; dissolve Damp; remove Obstructions of channels (Finkelstein, p. 68)* GB-34 and GB-39: strengthen the tendons and consolidate bone (Finkelstein, p. 69)* Kd-6 and Lu-7: open the Yin Qiao Mai (Yin Motility Vessel) which transports Yin and for which Bi syndromes of the joints are a Shi (Excess) symptom* Bl-62 and SI-3: open the Yang Qiao Mai (Yin Motility Vessel) for which Bi syndromes of the joints are a Xu (Deficiency) symptom* TW-5 and GB-41: open the Yang Wei Mai (Yang Linking Vessel) for which arthritis is a symptom of dysfunction* GB-41 and TW-5: open the Dai Mai (Girdle Vessel) for which arthritis of the hip is a symptom of dysfunction* GB-34, GB-24, Lv-14 and dan nang xue (GB-34A): disperse Stagnation of the Liver, ease the Gall Bladder, disperse Damp-Heat, and regulate the Middle Warmer (Finkelstein, p. 69)* GB-34, Bl-18 and Bl-19: disperse Damp-Heat of the Liver and Gall Bladder (Finkelstein, p. 69)* GB-34 and GB-43: reduce Damp-Heat of Liver and Gall Bladder (Finkelstein, p. 71)

Homeopathy

remedy differential* Arsenicum album: like rhus-t. except wandering pains, after midnight; anxiety, need company* Aurum metallicum: sunset to sunrise; deep wandering pains which wake patient up; cold, uncovering; > motion, warmth; depressed* Bryonia: slow developing, gradually moves one joint to another; after eating, motion, damp; stitching pains > pressure* Calcarea carbonica: follows rhus-t.; excessive worry; overtired* Causticum: very stiff, > raining; lot of joint deformity, rising from a seat* Kali bichromicum: shifting pain, disappears and appears, motion, much > heat; alteration of arthritis with gastrointestinal symptoms (diarrhea) and pulmonary symptoms* Kali carbonicum: right side, very stiff, sensitive to cold; stitching pain 3 am, > moving* Pulsatilla: as day goes on, stiff sore in evening after sitting; wandering pains* Rhododendron: #1 before storm, cold, damp, windy; severe arthritis;> walking* Rhus toxicodendron: main remedy; cold, damp and > heat; stiffness first motion and > continual motion, restlessness

Subtle Support

soundpain:* Mendelssohn's Spring Song* Meditation from Thais* Chopin's Preludes* On Wings of Song* Andante, Beethoven's Fifth Symphony* Adagio, Beethoven's Pathetique Symphony(Heline, p. 18) musculoskeletal:* Sousa's marches* The Anvil Chorus* Tell Overture* Brahm's Hungarian Dances* By the Waters of the Minnetonka(Heline, p.18)

flower essences* rock water* gentian* water violet* willow* rock rose* vine* impatiens* gorse* pine* star of Bethlehem(Chancellor, pp. 170, 197, 200, 219) * mustard* larch* vervain* red chestnut* centaury* mimulus(Weeks, p. 130) * dill* garlic* mallow(Gurudas, pp. 213, 211)

electromagnetic* Abrams: 40, 52, 60, 78, 147; localize to specific joint * Digitron: 35-94

coloracute:* green (balances brain when placed on face and back of head; balances the body when used on the front; promotes tissue and muscle restoration; is antimicrobial and acts as a disinfectant and antiseptic) and magenta (a vasodilator) on whole body* blue (promotes relaxation; lowers high temperatures and reduces inflamed tissue) or indigo (is phagocytogenic; acts as a general sedative) on affected areas(Dinshah, 1985, p. 96) * blue or green in water* blue or green for 30 minutes* violet on chest(Amber, 1983) * blue (Gardner, 1988) chronic:* lemon (helps to dissolve blood clots; acts as a chronic alterative; acts in bone formation through a phosphorus effect) and magenta (a vasodilator) on whole body* turquoise (acts as an acute alterative) and/or indigo (an astringent, antipyic, antiemetic, and hemostatic; acts as a general sedative) if effusions or pain* orange on areas of bone atrophy (has a calcium effect and will help build up bone)(Dinshah, 1985, p. 96) * lemon or orange in water* lemon or orange for 30 minutes, violet on chest(Amber, 1983, p. 208) * red, violet and infra-red (Bhattacharya, 1981)

gems and minerals* Topaz (Bhattacharya, p. 46)* Sapphire (Bhattacharya, p. 47)* Onyx (Bhattacharya, p. 47)* Ruby, Sapphire, Cat's Eye combination (Bhattacharya, p. 81)* Pearl (Bhattacharya, p. 83)* Coral (Bhattacharya, p. 45)* Ruby (Bhattacharya, pp. 91, 175, 178)* Cat's Eye (Bhattacharya, p. 80)

Mind/Body

metaphors and correlations* The weight of research suggests a multicausal hypothesis in which genetic, autoimmune, infectious, and psychosocial factors interact in varying degrees to create a predisposition matrix. A triggering factor, perhaps a psychological event, then leads to clinical RA. An approach to the patient is outlined in which he is not viewed as a 'rheumatoid personality,' but as a unique human being facing acute and chronic stress which reverberates through the family, interpersonal, intrapsychic, occupational, and health systems of which he is a part. (Locke, 1983, p. 102)* Dys-stressful emotions increase muscle tension and result in excessive activation of the sympathetic branch of the autonomic nervous system which can exacerbate the condition. (Rossi, 1986, p. 168)* Disruption of meaningful relationships with resulting emotional trauma precedes an attack of arthritis. Goal of treatment should be to restore patient's sense of security. (Locke, 1986, p. 95)* Theory: denial, suppression, and/or repression of right hemispheric experience denied left hemisphere information needed to express problems in words, resulting in a disruption (blockage, short-circuit, misdirection) of the normal accessing and flow of information in the mind-body system. (Rossi, 1986, p. 170)* May be associated with blunted mind-cortical processes; RA patient is often devoid of affect, emotionally flat or colorless, may be manifesting a form of body language that substitutes for the lack of verbal and imagistic-emotional language. (Rossi, 1986, p. 168)* Condition has been dePractiScribed as inability to fantasize. (Rossi, 1986, p. 168)* Fear and martyrdom. Social withdrawal. Fear of being fully mobile because of demands, real or imagined, that full mobility imposes. (on, p. 142)* Personality: The general psychodynamic background is a chronic, inhibited hostile-aggressive state, a reaction to the earliest masochistic dependence on the mother. This is carried over to the father and all human relationships, including sexual relationships. The majority of these personalities discharge hostility through masculine competition, physical activity, and service, and also through domination of the family. When these methods of discharge are interrupted in specific ways, the persistent increased muscle tonus resulting from the inhibited aggression and the defense against it precipitates arthritis in some. (, p. 497)* Perceived rejection by parents. Highly conscientious and self-sacrificing. Associated with conscientiousness, masochism, self-sacrifice, denied hostility, long-standing stressful circumstances. (Gentry, p. 120)* The accepted character traits (compulsive, perfectionist, over-conscientious and helpful, excessively moral, with depressive tendencies) show the soul of arthritics: rigid and stubborn, inflexible and immobile. All the athletic activity and physical restlessness merely serve to overcompensate for this inner immobility and divert attention from their compulsive rigidity and aggressiveness. Since they are unable to admit these characteristics, they produce strong unconscious guilt feelings, which in turn lead them to display great helpfulness and self-sacrifice. (Dethlefsen, p. 211-2)* Seronegative patients (absence of rheumatoid factor) were more suceptible to psychiatric disturbance than seropositive patients. (Locke, 1983, p. 129)* Rheumatoid patient may be more vulnerable to separation, real or threatened. (Locke, 1986, p. 95)* Onset in many instances associated with loss of support. (Locke, 1986, p. 104)* Deep criticism of authority. Feeling very " put out. " (Hay, 1988, p. 60)* Feeling unloved; criticism; resentment. (Hay, 1984, p. 153)* Inflammation: Fear; inflamed thinking; seeing red; anger and frustration about conditions in one's life. (Hay, 1984, p. 170-1)* Survey of 88 children with JRA (juvenile RA) showed that the most striking findings were psychosocial factors: children whose parents were unmarried comprised 29%; in addition, adoption occurred three times more often in the JRA population. 51% of these events (divorce, separation, death, or adoption) occurred near the date of onset. (Locke, 1983, p. 90)* Serum specimens from 46 patients with JRA were tested for measles, rubella, adenovirus and herpes simplex virus antibodies. The mean antibody titer of the 16 JRA patient of the major conflict group were generally higher than those of the 30 patients of the non-conflict group. (Locke, 1983, p. 102) Chinese psychophysiology:* Spleen (Pi) governs digestion and manifests in the muscle tissues; transforms food into Blood and Qi; governs the Blood; resolves Dampness and Phlegm; and relates to the ability to assimilate, stabilize, and feel centered and balanced.- Healthy expressions are fairness, openness, deep thinking, and reminiscence.- Spleen Deficiency signs include slightness (deficient " form " ); abundant elimination; morning fatigue; cold, wet feet (Seem, p. 28); abdomen taut and distended like a drum; craving for sweets; flatulence; nausea; mild edema; memory failure; heavy feeling in legs; pale lips; loose stools; muscular weakness; and, indirectly, obesity. Unresolved Spleen Deficiency predisposes to Spleen Excess, particularly accumulation of Dampness and Phlegm, as the Spleen's functioning declines. The Heat produced by Liver Stagnation may then transform the Dampness into Damp-Heat.- Spleen Excess signs include heaviness (excess " form " ); large abdomen; great sighing; sadness; obsessions and nightmares (Seem, p. 28); abdominal pain; irregular appetite; stickiness in the mouth and on lips; red lips; chest congestion; fatigue; and constipation. Dampness and Phlegm excess usually derive from Spleen Yang and/or Qi Deficiency.- The excessive use of the mind in thinking, studying, concentrating, and memorizing over a long period of time tends to weaken the Spleen and may lead to Blood Stagnation. This also includes excessive pensiveness and constant brooding. (Maciocia, p. 241) Likewise, inadequate physical exercise and excess consumption of sweet and Cold foods will also deplete the Spleen. Environmentally, the Spleen is highly susceptible to attack from external Dampness and Cold. * Kidney (Shen) stores Jing (Essence) and governs birth, growth, reproduction, development, and aging; houses the Will Power; expresses ambition and focus; governs Water to regulate body fluids; provides the " Fire of Life " through its Yang functions; provides the nourishing and stabilizing qualities of Yin and Water that balance the Yang and the Fiery qualities; controls the bones, particularly the lumbar spine and knees; produces the Marrow which generates the spinal cord, " fills up " the brain, and possibly manifests through the immune system; carries the constitutional endowment from the parents; and displays the effects of overwork, aging, chronic debilitation or degenerative processes, and extreme stress.- Healthy expressions are gentleness, groundedness, and endurance.- Kidney Deficiency signs include indecisiveness; confused speech; dreams of trees submerged under water; cold feet and legs; abundant sweating (Seem, p. 28); fearfulness; apathy; chronic fatigue; discouragement; scatteredness; lack of will; negativity; impatience; difficult inhalation; low sex drive; lumbago; sciatica; and musculoskeletal irritation and inflammation, especially when worse from touch. As always, chronic Yin Deficiency predisposes to Empty Heat and/or acute inflammation.- Intense or prolonged fear depletes the Kidney. Often chronic anxiety may induce Deficiency and then Fire within the Kidney. (Maciocia, p. 250) Overwork, parenting, simple aging, and a sedentary or excessively indulgent lifestyle all contribute significantly to Kidney Deficiency. * Liver (Gan) is the home of the Hun (Ethereal Soul); it relates to decisiveness, control, and the principle of emergence; stores and cleanses the Blood; maintains smooth flow of Qi and Blood; controls the muscles, ligaments, and tendons; and reflects emotional harmony and movement.- Healthy expressions are kindness, spontaneity, and ease of movement.- Liver Deficiency signs include impotence; frigidity; pain in thighs, pelvic region, and throat; ready tendency to " the blahs " (Seem, p. 28); timidity; depression; irritability; vertigo; pruritis; dry eyes, skin, and/or tendons; asthma; aching at the waist; hernia; and difficulty raising head up and down. Liver Blood Deficiency predisposes to Blood Stagnation. Liver Yin Deficiency predisposes to the Excess conditions of Liver Wind.- Liver Qi Stagnation reflects and accentuates emotional constraint as the Liver's function of facilitating smooth flow in the body is constricted. Stagnation is associated with frustration, irritability, tension, and feeling stuck. With time this pattern tends to produce a gloomy emotional state of constant resentment, repressed anger or depression, along with tightness in the chest, frequent sighing, abdominal tension or distension, and/or a feeling of a lump in the throat with difficulty in swallowing. (Maciocia, p. 216) Blood Stagnation often begins with Qi Stagnation.- Liver Wind derives from Deficiency of Liver Yin and/or Liver Blood and their subsequent inability to embrace the Yang, and can manifest as joint stiffness, dizziness, tremor, paralysis, convulsions, rashes, itching, and neurological problems. Wind can also be internalized after exposure to inclement, especially windy, weather and any concomitant influences of Damp, Cold, and/or Heat. * Gall Bladder (Dan) is the source of courage and initiative, and is responsible for decision-making as the bodily Minister of Justice; controls circulation of the nourishing and protecting energies (Ying Qi and Wei Qi); expresses itself through the sinews (ligaments and tendons); and opens into the eyes. Its channel purifies Yang energy in the body.- Healthy expressions are kindness, decisiveness, control, and spirit of initiative.- Gall Bladder Excess signs include tiredness; sighing; irritability; bitter taste in the mouth in the morning; pain in all joints; edematous knees and legs (Seem, p. 29); tinnitus; lateral headache; heaviness in head and stomach; muscular spasms; and limbs slightly cold. Chronically suppressed anger can implode and give rise to Fire in the Liver and Gall Bladder.- Gall Bladder Deficiency signs include insomnia; wandering pains; chest and side pains; swollen breasts (Seem, p. 29); weakness in muscles and tendons of the legs; difficulty standing; asthenia; vertigo; chills; timidity; cowardice; indecisiveness; and excessive sighing.- Anger, frustration, and resentment can cause Liver Qi Stagnation which, in turn, can produce Heat which affects the Gall Bladder. * San Jiao (Triple Warmer) regulates the relations among the three regions roughly delimited by the chest, abdomen, and pelvis; influences the supply of Blood, Qi and Fluids; is the source of Wei (Protective) Qi; and relates to the function of heat regulation.- Mental signs of Triple Warmer channel disorders include emotional upsets caused by breaking of friendships or family relations; depression; suspicion; anxiety; and poor elimination of harmful thoughts. (Seem, p. 28) * Spleen (Pi) governs digestion; transforms food into Blood and Qi; governs the Blood; resolves Dampness and Phlegm; and relates to the ability to assimilate, stabilize, and feel centered and balanced.- Healthy expressions are fairness, openness, deep thinking, and reminiscence.- Spleen Deficiency signs include slightness (deficient " form " ); abundant elimination; morning fatigue; cold, wet feet (Seem, p. 28); abdomen taut and distended like a drum; craving for sweets; flatulence; nausea; mild edema; memory failure; heavy feeling in legs; pale lips; loose stools; muscular weakness; and, indirectly, obesity. Unresolved Spleen Deficiency predisposes to Spleen Excess, particularly accumulation of Dampness and Phlegm, as the Spleen's functioning declines. The Heat produced by Liver Stagnation may then transform the Dampness into Damp-Heat.- Spleen Excess signs include heaviness (excess " form " ); large abdomen; great sighing; sadness; obsessions and nightmares (Seem, p. 28); abdominal pain; irregular appetite; stickiness in the mouth and on lips; red lips; chest congestion; fatigue; and constipation. Dampness and Phlegm excess usually derive from Spleen Yang and/or Qi Deficiency.- The excessive use of the mind in thinking, studying, concentrating, and memorizing over a long period of time tends to weaken the Spleen and may lead to Blood Stagnation. This also includes excessive pensiveness and constant brooding. (Maciocia, p. 241) Likewise, inadequate physical exercise and excess consumption of sweet and Cold foods will also deplete the Spleen. Environmentally, the Spleen is highly susceptible to attack from external Dampness and Cold.- Mental signs of Spleen channel disorders include mental sluggishness; vertigo; melancholia; obsessions turned toward the past; fixed and rigid ideas; sleepwalking; agitated sleep; and nightmares. (Seem, p. 27)

therapiesbehavior modification:* Biofeedback, behavior modification, group therapy, hypnosis, imagery, relaxation, and visualizations may all be useful in management of pain. (Locke, 1986, p. 96)* Therapeutic use of play. (Locke, 1986, p. 99) visualization:related materia medica listings: visualizations for immune enhancement* Octopus: Imagine an octopus with flexible tentacles. (Epstein, p. 62) affirmation:* I am my own authority. I love and approve of myself. Life is good.(Hay, 1988, p. 60)* I am love. I now choose to love and approve of myself. I see others with love. (Hay, 1984, p. 153)* (Inflammation) My thinking is peaceful, calm, and centered. I am willing to change all patterns of criticism. I love and approve of myself. (Hay, 1984, p. 170-1) theotherapy: Centaurs, Cronus, Hades, Hephaestus, Hera, Prometheus, Rhea (Lemesurier, p. 88) hypnotherapy:* Hypnotherapy included relaxation, self-hypnosis, and imagery; remission continued in 90% of patients who were followed 3-4 years and who remained on a maintenence program. (Locke, 1986, p. 102)* Definite aid in determining the degree of function possible; aided some to overcome inhibitions and fears which have plagued them. Note there is danger in developing further dependence, to which they are especially vulnerable. (Locke, 1986, p. 106) psychotherapy:* Behavioral treatment which illustrates the interconnection of daily events, mood, and RA symptoms demonstrate how techniques to meet depression may also increase the patient's control over somatic RA symptoms. (Locke, 1986, p. 98)* Those who are prone to inflammations are attempting to avoid conflicts. The following questions may be useful:- What conflict in my life am I failing to see? hear? feel? move?- What conflict am I dodging? What is my relationship to it?- What conflict am I failing to admit to? (Dethlefsen, p. 108) process paradigm:* What is the symptom preventing me from doing? What is the symptom making me do? (see process interview: immune system; musculoskeletal system interview) related materia medica listings:the shadow and physical symptomsconverting a symptom to a signalbehavior modification techniques (see also: biofeedback)relaxation techniquesvisualizations for immune enhancementvisualization: precautionsvisualization: receptive or programmed?visualization: techniquesaffirmations: guidelines and precautionstheotherapyhypnotherapyprocess paradigm

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