Acupuncture Continuing Education

Acupuncture Beats Drugs For Rheumatoid Arthritis Study

Researchers conclude that acupuncture combined with a special herbal formula produces positive patient outcomes for rheumatoid arthritis sufferers. In a surprise finding, the acupuncture combined with herbal medicine group outperformed the drug control group. Members of the drug group received a combination of NSAIDs (non-steroidal anti-inflammatory medications) combined with a powerful anti-rheumatic drug, methotrexate. The acupuncture combined with herbal medicine group had an overall effective rate of 95.08% and the drug group had an effective rate of 68.85%. Acupuncture applied to the back reduces pain according to a new study. In addition, the adverse side effects associated with the drug group was significant at 18.0% whereas the acupuncture combined with herbal medicine group had a 3.2% adverse effect rate. The researchers concluded that acupuncture with herbs is safer and more effective than NSAIDs combined with methotrexate.

What Is Rheumatoid Arthritis?
Rheumatoid arthritis is a chronic inflammatory disorder that usually affects the small joints of the hands and feet. Other areas such as the skin, eyes, blood vessels and internal organs may be affected. It is an autoimmune disorder wherein the body attacks its own tissues. Rheumatoid arthritis (RA) affects the lining of the joints and often leads to bone erosion, severe pain and swelling, range of motion impingement and joint deformity.

Traditional Chinese Medicine
Traditional Chinese Medicine (TCM) classifies rheumatoid arthritis according to its clinical presentation: numbness, wind, cold, dampness and heat. To understand these concepts from a TCM perspective, think of how symptoms appear in a clinical presentation. Wind poetically describes the character of the pain in that it may come and go suddenly from one area to another. Heat syndrome specifies the redness, soreness and heat felt at the affected regions whereas cold syndrome specifies joints that turn pale and ache, especially in cold weather. Dampness expresses the general concept of swelling and fluid retention in the affected regions. 

Differential diagnostics with the TCM system specify internal organ hypo and hyperfunction as causative factors for this often debilitating and painful autoimmune disorder. This can be categorized into the organs affected such as the liver and kidney but may also be categorized into disorders affecting the blood and overall energy level, qi. Rheumatoid arthritis may also be seen as a disharmony of the ying and wei. Translated into biomedical terms, this is akin to the body’s immunological defense system as it relates to nutritional support within the body, the ability to excrete toxins through perspiration and more. Classic treatment principles include dredging the channels, removing blockages and to strengthen the body and eliminate pathogenic factors. 

Gan Cao

The acupuncture with herbal medicine group received a protocolized acupuncture and herbal prescription that was modified for individual patient clinical needs. The drug group received the NSAID diclofenac sodium in sustained release tablet form. The dosage was 75 mg, once per day. In addition, the drug group took methotrexate tablets. The dosage of this anti-rheumatic drug was 10 mg, once per week.

The study consisted of 122 patients with rheumatoid arthritis that were randomly divided into the acupuncture with herbs group and the drug group. The acupuncture with herbs group received modifications of the herbal formula Gui Zhi Shao Yao Zhi Mu Tang (Cinnamon Twig, Peony and Anemarrhena Decoction). Results were tabulated after a two month treatment period and significantly superior clinical results were achieved in the acupuncture with herbs group with the additional benefit of a significantly lower adverse effect rate.

The base herbal formula contained:
Gui Zhi 15g
Chi Shao Yao 12g
Zhi Mu 12g
Fu Zi 10g
Ma Huang 9g
Fang Feng 15g
Bai Zhu 12g
Gan Cao 6g

In cases of acute symptoms, the following herbs were added to this formula:
Qin Jiao 12g
Shen Jin Cao 12g
Qiang Huo 12g

For chronic symptoms, the following herbs were added:
Huang Qi 45g
Du Zhong 15g
Niu Xi 12g

In cases of severe pain, the following herbs were added:
Yan Hu Suo 12g
Lu Feng Fang 12g
Wu Tou 9g

According to TCM principles, the function of Gui Zhi Shao Yao Zhi Mu Tang is to unblock Yang Qi, promote the movement of Qi, dispel wind, eliminate dampness, clear the heat, unblock the channels and collaterals and to stop pain.

The primary acupuncture point prescription for all patients was:
Jinsuo (DU8)
Sanyinjiao (SP6)
Zusanli (ST36)
Ganshu (UB18)
Shenshu (UB23)
Pishu (UB20)

For cases of arm pain, the following acupuncture points were added:
Tianjing (SJ10)
Waiguan (SJ5)
Yangchi (SJ4)
Hegu (LI4)

For cases of leg pain, the following acupuncture points were added:
Weizhong (UB40)
Dubi (ST35)
Kunlun (UB 60)
Jiexi (ST41)
Yanglingquan (GB34)

Hua Tou Jia Ji acupuncture points were added for cases of back pain. Primary acupuncture points received the application of manual reinforcing techniques whereas secondary acupuncture points for specific types of pain received manual reducing manipulation techniques. Needling manipulation was applied once for 15 minutes and retention of needling was 30 minutes. Moxibustion was also applied to acupuncture points. Both acupuncture and moxibustion were applied once every 2 days for a course of 30 days. The total treatment consisted of 2 courses.

After 2 months of treatment, 27 patients in the acupuncture group showed marked improvements, 27 showed moderate improvements and 3 showed no improvements. The overall effective rate for the acupuncture with herbs group was 95.08%. This drug group had an overall effective rate of 68.85%. As for adverse side effects, two patients (3.2%) in the acupuncture group experienced adverse effects, much lower than the 18.0% for the drug group. The differences in both curative effects and adverse effects were statistically significant. Based on these results, the researchers conclude that Gui Zhi Shao Yao Zhi Mu Tang combined with acupuncture is a superior approach to rheumatoid arthritis treatment compared with routine biochemical treatment using NSAIDs with methotrexate.

Wang, Zizhen. “Clinical observation on treating rheumatoid arthritis with the Guizhi Shaoyao Zhimu decoction plus acupuncture.” Clinical Journal of Chinese Medicine 6.4 (2014): 89-90.

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