Q. I am a 54-year-old woman. I was diagnosed with rheumatoid arthritis a few months ago. Currently, I am being treated by a rheumatologist.
I am wondering if I can take Western and Eastern medicine together. I tried acupuncture and massage. They relieved the stiffness at the back of my knees only temporarily.
I am still limping. Please advise.
A: In traditional Chinese medicine (TCM), rheumatoid arthritis is probably caused by poor function of the kidneys, liver and spleen.
Good circulation of qi (energy) and blood is required for good health.
Having a weak constitution and chronic diseases as well as ageing can lead to insufficient qi and blood.
This will trigger intermittent joint pain, stiffness, soreness, numbness of the limbs, fatigue, dizziness, shortness of breath and insomnia.
It can also result in malfunction of the kidneys and liver, which will weaken the bones, tendons (bands of fibrous tissue that connect muscles to bones) and ligaments (tissue that connect bones to other bones).
In TCM, the kidneys govern the bones, and the liver governs the tendons and ligaments.
Malfunction of the kidneys and liver can also be caused by ageing, general weakness, chronic diseases, mood swings and anxiety.
This will trigger rheumatoid arthritis, resulting in pain, leg cramps, soreness and weakness in the lower back, dizziness, breathlessness and palpitations.
The spleen governs the muscles around the joints and converts nutrients from food into qi and blood.
When the spleen is weak, it will convert the nutrients into phlegm and "dampness".
Phlegm accumulated in the body for a prolonged period will create blood stasis and trigger rheumatoid arthritis, causing muscle pain, numbness of the limbs and swelling of the joints, eyes and lips.
External injury can also cause the blockage of qi and blood and create blood stasis resulting in intermittent joint pain, swelling and stiffness.
When qi and blood are insufficient, external pathogenic (disease-causing) factors, such as "wind", "cold" and "dampness", can easily invade the body and trigger rheumatoid arthritis characterised by fever and excruciating joint pain that is alleviated by warmth.
When "dampness" and "heat" invade the body, it will trigger rheumatoid arthritis characterised by fever, joint pain and redness of the skin around the joints.
Chinese herbal medicine, acupuncture, moxibustion and cupping therapy can improve your condition by strengthening your organs and dispelling the pathogenic factors.
Moxibustion involves burning a small herb above acupuncture points to help healing. Cupping involves using fire and cups to create a vacuum on the skin to enhance blood and qi circulation.
Chinese herbs, such as Chinese taxillus herb, Himalayan teasel root, medicinal cyathula root, eucommia bark and cassia bark, strengthen the liver and kidneys.
Indian bread, milkvetch root, codonopsis root, processed rehmannia root, white peony root, largehead atractylodes rhizome, Sichuan lovage rhizome and Chinese angelica strengthen the spleen and increase the amount of qi and blood.
Peach seed, safflower, suberect spatholobus stem, red sage root and common burreed tuber enhance blood circulation and reduce blood stasis.
Incised notopterygium rhizome, doubleteeth pubescent angelica root, divaricate saposhnikovia root, common monkshood mother root and Manchurian wildginger dispel "wind", "cold" and "dampness".
Weeping forsythia capsule, rice bean, cape jasmine fruit, atractylodes rhizome and largeleaf gentian root dispel "heat" and "dampness".
Clinical research in hospitals in China has shown that using both Western and Chinese medicine for rheumatoid arthritis can speed up recovery and prevent or reduce joint destruction and the side effects of Western medicine. If you choose to take both types of medicine, I suggest you take one type of medicine two hours after taking the other.
You should have a high-protein, high-fibre, easily digestible, well-balanced and nutritious diet.
Regular stretching exercises or light massage of your joints will help enhance qi and blood circulation.
You should keep your joints warm, especially in the night. Do not expose yourself to the wind immediately after you perspire. When the weather is hot, do not sit or sleep on cement or marble floor.
Avoid emotional stress and anxiety.
Ms Lim Lay Beng,
Traditional Chinese medicine practitioner at YS Healthcare TCM Clinic
Doctor says acupuncture may relieve arthritis symptoms temporarily
A: Rheumatoid arthritis is an autoimmune condition where the immune system fails to recognise the body's own tissue and attacks it.
This results in symptoms of pain, swelling and stiffness of the joints.
Everyone has a different immune system and the condition can be triggered by an infection in those who are prone to developing the condition.
The treatment of the condition is in two areas.
One is to use medicine to control the symptoms.
However, painkillers such as non-steroidal anti-inflammatory drugs (NSAIDs) can cause side effects when taken for months and years.
These include stomach ulcers, worsening kidney function in the elderly, fluid retention and high blood pressure.
So the other - and more important - aspect of treatment is to use medicine that controls the underlying problem, which is the malfunctioning immune system.
There are many such types of medicine available today. They are collectively called disease-modifying anti-rheumatic drugs (DMARDs).
They calm the immune system down so that it stops attacking the patient.
If the dosage of such drugs is adjusted properly, after taking the medicine for a while, there will no longer be any need to take painkillers.
Patients whose conditions are mild may need to take DMARDs for between two and five years.
Those whose conditions are severe may need to be on such medicine almost all their lives.
The side effects of these drugs can include nausea, diarrhoea and rashes. Sometimes, the number of blood cells may fall and the liver may become inflamed.
These side effects are not common, are predictable and can be monitored using blood tests.
On the whole, autoimmune disease becomes milder as the patient gets older and may burn itself out.
However, it is important to treat the disease when it is active to prevent damage to the joints and body.
The results of studies on the efficacy of acupuncture and massage in treating rheumatoid arthritis are conflicting.
Acupuncture may relieve pain and massage may relieve stiffness from muscle spasm, so they may contribute to relieving symptoms and may be helpful in the short term for some patients.
However, they do not control the underlying problem and will not improve the long-term outcome. The problem is with the immune system and these types of treatment have no effect on that.
If you wish to take Chinese medicine in the form of pills and herbs, then you should check with your own doctor in case there are adverse drug interactions.
Dr Leong Keng Hong
Rheumatologist at Leong Keng Hong Arthritis and Medical Clinic at Gleneagles Medical Centre, and adjunct associate professor at Yong Loo Lin School of Medicine at National University of Singapore
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