关节炎 GUANJIE YAN - ARTHRITIS

      BI ZHENG – BI PATTERNS

Bi means obstruction or blockage. Bi pattern describes a set of patterns in which the invasion of external evils such as wind, cold, dampness and heat obstruct the flow of Qi and Blood through the channels and connections. This affects the muscles, bones, tendons and joints, presenting symptoms of aching, pain, heaviness, numbness, difficulty of movement or redness and swelling. Bi patterns include several disorders known in Western medicine as osteoarthritis, rheumatoid arthritis, rheumatic fever, fibrosis, gout and sciatica.^[1]

Etiology and Pathogenesis

The etiology of bi patterns usually combines an internal or preexisting deficiency of correct Qi with external evils entering the body: wind, cold, damp or heat. Simultaneous invasion by wind, cold and damp is the most common. Bi patterns are considered in four classes based on the specific external evil and the differing clinical manifestations. Bi patterns involve LV, SP and KD. LV controls tendon, SP controls muscles, and KD controls bones.

1.Wind bi or Feng Bi, also known as wandering bi Xing Bi, is characterized by wind evil with pain roving through various locations. Major pain in joints.

2.Cold bi Han Bi, also known as painful bi Tong bi, is characterized by the accumulation of cold with severe pain in the channels.

3.Damp bi Ji Bi, also known as fixed bi Zhao bi, is characterized by the accumulation of dampness with muscular and joint numbness, aching, heaviness, swelling and pain of fixed location.

4.Heat bi Re Bi, is characterized by fever and red, swollen, and painful joints. Its causes include invasion by heat evil; untreated and chronic Wind-Cold-Dampness-bi that has transformed into heat; or constitutions of either profuse Yang or deficient Yin, that  have transformed external evils to heat. All bi patterns involve obstruction of the channels and connections inhibiting the flow of Qi and Blood. Chronic cases of bi, regardless of a particular evil’s dominance, present three major categories of pathological change.

The first includes manifestations of blood-stasis and phlegm-turbidity such as stasis macules on the tongue, nodes in the area of affected joints and swelling, and difficulty moving the joints.

The second involves symptoms of deficient Qi and Blood. The severity will vary according to the injury and depletion of Qi and Blood during the illness.

The third includes pathological changes from the progress of evils from the channels and connections into the viscera and bowels. Most commonly observed is heart beat with palpitations, cyanosis, asthma, and edema.

TCM Patterns

Wind-Dominant Bi

Cold-Dominant Bi

Dampness-Dominant Bi

Heat-Dominant Bi

Bi with Blood Stasis and Phlegm-Turbidity

Bi with Depletion of Qi and Blood, KD and LV Deficiency

Bi with HT Deficiency

1. Wind-Dominant Bi

Symptoms
Roaming pain in the joints and limbs, pain of indeterminate locations, difficulty in flexion and extension of joints, aversion to cold and in some cases, fever.

Tongue: Thin white coating.
Pulse: Wiry, floating.

Treatment Strategy
Dispel wind, clear the connections, dissipate cold, and drain dampness. For wind problems treat blood first with UB17 and SP10, then needle the rest.

2. Cold-Dominant Bi

Symptoms
Severe pain of the joints and limbs, pain of fixed location accompanied by sensation of cold, decrease in pain with application of heat, increase in pain upon exposure to cold, without redness or feverishness of joints, with difficulty moving the affected parts.

Tongue: Thin white coating.
Pulse: Tight, wiry.

Treatment Strategy:
Dissipate cold, warm the connections, dispel wind, and drain dampness.

3. Dampness-Dominant Bi

Symptoms
Heaviness and aching of the joints and limbs, distention and swelling in some cases, pain of fixed location, local numbness or loss of sensation, with symptoms often increasing during overcast or rainy weather. Swollen joints and dull pain equals Dampness.

Tongue: White slimy coating.
Pulse: Soft, tardy.

Treatment Strategy:
Drain dampness, clear the connections, dispel wind, and dissipate cold.

4. Heat-Dominant Bi

Symptoms
Severe pain, local heat, redness and swelling; difficulty of movement affecting one or more joints accompanied with fever, sore throat, thirst, irritability and dark, scanty urine.

Tongue: Yellow coating.
Pulse: Rapid, slippery.

Treatment Strategy
Drain heat, clear the connections, dispel wind, drain dampness.

5. Bi with Blood Stasis and Phlegm-Turbidity

Symptoms
In each of the above bi patterns, chronic illnesses that have not been properly treated lead to blood stasis and phlegm-turbidity. This blocks the channels, connections and joints. Symptoms include swelling, stiffness and deformity of the joints, incessant pain and complete immobility.

Tongue: Dark or purple, with white slimy coating.
Pulse: Deep-rough, or deep-slippery.

Treatment Strategy
Dispel stasis, transform phlegm, free the connections, relieve pain.

6. Bi with Depletion of Qi and Blood, KD and LV Deficiency

Symptoms
Prolonged cases of bi pattern often present symptoms of depletion of Qi and Blood as well as deficiency of the LV and KD. These include aching pain in the lower back and knees, difficulty in the flexion and extension of joints, numbness or loss of sensation in affected areas, palpitations and shortness of breath, in some cases aversion to cold and symptoms relieved by warmth.

Tongue: Pale with white coating.
Pulse: Weak, thready.

Treatment Strategy
Supplement Qi and Blood, benefit LV and KD, dispel wind, cold and dampness.

7. Bi with HT Deficiency

Symptoms
Palpitations, oppression in the chest, shortness of breath, edema, aggravation of symptoms with physical activity, lusterless complexion and, in some cases, cyanosis.

Cyanosis: Blueness or lividness of the skin, as from imperfectly oxygenated blood. Livid: 1) Having a discolored, bluish appearance caused by a bruise, congestion of blood vessels or strangulation, in the face, flesh, hands, or nails, 2) dull blue, dark, grayish-blue, 3) enraged; furiously angry, 4) reddish or flushed, 5) deathly pale, pallid.

Tongue: Pale.
Pulse: Rapid, forceless or intermittent.

Treatment Strategy
Boost Qi, nourish the HT, warm Yang, restore the pulse.

ARTHRITIS AND NATURAL SOURCES OF HYALURONIC ACID   

Since the beginning of time, people have been searching for an effective way to reverse aging. Hyaluronic acid is seen by many to be the ‘Fountain of Youth,’ and there are plenty of natural sources available to make it part of a healthy diet. Hyaluronic acid is found in the connective tissues of humans and animals. It plays a key role in cushioning and lubricating the body and is abundant in the eyes, joints and heart valves. A powerful antioxidant, hyaluronic acid is perhaps best known for its ability to bond water to tissue.

The body’s hyaluronic acid levels decrease with age. In theory, sustaining optimal hyaluronic acid levels could retard the aging process, prolong a youthful appearance, and sustain life. A prominent component in synovial fluid, hyaluronic acid helps lubricate the joints and fight arthritis. It can be taken in capsule form or injected directly into the joints to relieve pain, and eat a diet full of hyaluronic acid to help even old joints feel young. Hyaluronic acid, with its remarkable ability to keep tissue moist, is particularly effective in treating wrinkles and dry skin. It maintains skin elasticity and even speeds-up the healing process for wounds and scars. Hyaluronic acid promotes healthy eyes and heart valve function.

Since hyaluronic acid is found in the connective tissue of humans and animals, consuming certain animal products could be the best natural source available. Most hyaluronic acid supplements are made from rooster combs. Soup of chicken heads with combs, turmeric powder, oregano leaves, onions, garlic, and celery, and a quarter avocado on the side sprinkled with first cold press olive oil and salt to taste, can make for a very delicious and healthy lunch.

To synthesize hyaluronic acid the body needs magnesium. Foods rich in magnesium are avocados, broccoli, sweet potatoes, and spinach. Zinc deficiency appears to coincide with low hyaluronic acid. Therefore, consuming brown rice, pumpkin seeds and other zinc-rich foods could aid the staying power of hyaluronic acid. Moreover, starchy root vegetables like Okinawa sweet potatoes, yucca, soy, edamame, tempeh, soy sauce, lotus root, jicama, oranges, grape fruits, cabbage, carrots, olives and a diverse other fruits have naturally high levels of hyaluronic acid.

Chicken soup made from boiling the bones and skin of chickens can be a surprisingly rich source for hyaluronic acid. Pig’s feet soup with the same ingredients of the chicken heads with combs soup, but cooked in a pressure cooker for 30 minutes is very nutritious and almost fat free. Same as beef tendon soup that tastes like fat, but has none at all. They’re both very delicious and can be accompanied by boiled yucca or Okinawa sweet potatoes.

The option for vegetarians as mentioned above include foods rich in magnesium to keep  the congenital hyaluronic acid levels of the body from dropping too low, together with soy products, sweet potatoes, bananas, mangoes, papayas, and vegetables that are excellent sources of hyaluronic acid.

Estrogen and hyaluronic acid have somewhat of a symbiotic relationship. When the level of one rises, so does the level of the other. Soy products like tofu, have been shown to increase estrogen levels, making them an indirect source for hyaluronic acid. Thus, men beware of soy products. 

Zinc deficiencies seem to coincide with low hyaluronic acid. Consuming brown rice, pumpkin seeds and other zinc-rich foods could alleviate the problem. Hyaluronic acid, with its remarkable ability to keep tissue moist, is particularly effective in treating wrinkles and dry skin. It maintains the skin’s elasticity and even speeds-up the healing process. As mentioned, it promotes healthy eyes and heart valve function, because the liver is the mother of the sinews.

BIOMEDICAL PERSPECTIVE ON ARTHRITIS

Shoulders, hips, and knees are the locations of the body with the most mobile joints. These joints take a lot of wear and tear and become worn-out and weakened through the years. Shoulder and hip arthritis are particularly painful and affect the shoulder and hip joints.

Arthritis does not only damage muscles and tendons but also joints and ligaments, and it causes symptoms of joint pain and limited range of motion. The American Academy of Orthopaedic Surgeons (AAOS) has identified five distinct forms of arthritis. RA Rheumatoid Arthritis, OA Osteoarthritis, PA Post-traumatic Arthritis, AVN Avascular Necrosis, and RCTA Rotator Cuff Tear Arthropathy.

RHEUMATOID ARTHRITIS
One common form of arthritis is an autoimmune condition called rheumatoid arthritis (RA). Pain is experienced in the joints all at once, but the following may also be experienced: tenderness and warmth in the joints; a stiff feeling especially in the morning that improves after daily movements; rheumatoid nodules, which are bumps under the skin in the affected regions; fatigue; weight loss; or fever. RA affects the joint lining and can cause joint swelling. It can cause erosion of the bones in the affected areas, and deformity of the joints over time.

OSTEOARTHRITIS

The classic form of arthritis associated with wear and tear is osteoarthritis (OA). This can affect the shoulders as well as other joints like knees, hands, elbows and hips. The AAOS reports that people over the age of 50 are more likely to develop OA. This challenging form of arthritis which is more common than any other type, according to the Mayo Clinic, is characterized by a combination of joint pain, tenderness, and stiffness.

POST-TRAUMATIC ARTHRITIS
People who have suffered severe bodily injury may develop this type of arthritis.

AVASCULAR NECROSIS
A condition called avascular necrosis (AVN) can result in arthritis by destroying the joint tissues in the hips or shoulders. It is generated when blood cannot reach the humerus or femur bones which can cause cells in these bones to die.

This can happen due to joint dislocations and bone fractures. It can also be a result of taking steroids at high doses and drinking too much alcohol.

AVN is a progressive disease. It can gradually evolve from an asymptomatic disease to mild pain and eventually cause severe pain.

ROTATOR CUFF TEAR ARTHROPATHY
The shoulders and hips contain a rotator cuff, which connects the shoulder blade with the top of your arm through a collection of tendons and muscles. Injuries to the rotator cuff are common and can lead to a form of shoulder arthritis called rotator cuff tear arthropathy.

A rip in the tendons of the rotator cuff is generally what causes this condition. Arthritis develops in your shoulder when bones in the shoulder are damaged. Symptoms include intense pain and muscle weakness that can make lifting difficult.

SURGERY AND OTHER TREATMENTS
Shoulder arthritis is treatable. Talk to your doctor about the best treatment for your specific condition. Depending on your diagnosis, symptoms, and disease progression, your doctor may recommend:

lifestyle changes, such as range-of-motion exercises, physical therapy, or rest medications such as ibuprofen or aspirin to calm inflammation and reduce pain shoulder injections with corticosteroids (like cortisone) surgery, if nonsurgical treatments fail to relieve symptoms. If the doctor recommends surgery for shoulder arthritis, there are several surgical interventions available. Depending on the condition of the patient, these treatments include:

Joint replacement surgery: also called arthroplasty. Joint replacement of the shoulder involves replacing the parts of the shoulder damaged by arthritis with an artificial prosthetic joint.

Arthroscopy: Certain milder forms of arthritis can be treated with an arthroscopic procedure. This involves a surgeon relieving joint pain through small incisions and “cleaning out” your joint. A tiny camera is inserted into the joint and this camera guides the surgeon.

Resection arthroplasty: This procedure involves surgically removing bone from your collarbone. In its place, scar tissue develops, which helps arthritis of specific joints.

OUTLOOK FOR SHOULDER ARTHRITIS
Talk to your doctor if you or a loved one experiences shoulder pain or other symptoms that may be related to arthritis. Since pain and stiffness associated with shoulder arthritis can worsen over time, it’s important that you don’t ignore symptoms. Your doctor may order several tests to diagnose arthritis of the shoulder, such as blood tests and MRI or CT scans.

GOUT

TREATMENTS OFFERED

__________________________________________________________________________________________________________________________________________________________________REFERENCES
-Personal classroom notes. 2005-2011.
-Robin Madell and Valencia Higuera. Types of Arthritis That Affect the Shoulder. Healthline. September 17, 2018. https://www.healthline.com/health/osteoarthritis/shoulder-arthritis-types.
-What is Rheumatoid Arthritis. Foot Care MD.https://www.footcaremd.org/conditions-treatments/midfoot/rheumatoid-arthritis-of-the-foot-and-ankle. Retrieved July, 16th, 2020.

-Above Article Written by Dr. Osorio, Gloria DAOM, L.Ac., MQP. 2020.