Henry told me up front that he was highly skeptical about alternative treatments for his arthritis symptoms. His doctor had sent him in for acupuncture because she’d heard positive reports from several of her patients, but she doubted that herbs had any benefit. At his first visit to the clinic, Henry asked me, “Which herbs actually work? Which ones have clinical studies proving their effectiveness?”
As any clinician who counsels arthritis patients knows, this is not an easy disease to treat. Symptoms are at times long-lasting, or they can come and go, sometimes completely clearing, at other times becoming very painful. One treatment doesn’t work for all patients, and many treatments require extended periods of faithful use to have a significant effect. It’s good to consult with a physician to gain more insight into the disease process to determine whether osteoarthritis (non-inflammatory type of joint disease involving the bones), rheumatoid arthritis (inflammatory type), or other associated diseases such as lupus are present. This knowledge can help guide the treatment program.
Henry was diagnosed with rheumatoid arthritis, which meant he had significant “pathogenic heat” or inflammation, especially in his hands. This was a major problem for him because he was both a writer and a musician. The arthritis was limiting his income, which was one reason he was willing to take a chance on complementary treatments.
In my experience, the chances of reducing painful symptoms are increased ten-fold by paying attention to an ancient understanding about the nature of arthritis from Traditional Chinese Medicine (TCM), which says that arthritis is actually several different diseases in one, often with completely different origins, courses, and treatments.
Upon examination, I noted that Henry’s tongue was bright red with a yellow coating. This meant he had significant “true” heat in his body that was not associated with adrenal fatigue or long-term depletion of his hormonal or nervous system. In fact, Henry did seem quite robust—even brawny. I remember thinking that I wanted to insert the acupuncture needles very carefully.
The go-to Western treatments for arthritis include nonsteroidal anti-inflammatory drugs such as aspirin and acetaminophen, and especially for osteoarthritis, the newer cox-2 inhibitors such as Vioxx. Most of these medications are stressful to the liver, and Vioxx costs about $225 for fifty tablets (compared with less than $15 for most herbal extracts).
Henry had used aspirin for years but had trouble with stomach bleeding, even developing an ulcer at one point. Occasionally he had severe flare-ups with so much swelling and pain that he couldn’t completely open or close his hand. During these times, his doctor prescribed Prednisone, which is usually only given for short-term use to treat acute symptoms. Side effects are often a problem and include immune suppression. While sometimes very effective for relieving pain and inflammation of an acute attack, the effectiveness of corticosteroids often diminishes over time, and symptoms often worsen, sometimes dramatically, after stopping.
Each time I’ve worked with arthritis patients and developed a custom herbal and dietary program based on their type of arthritis according to the principles of TCM, I’ve observed that patients often feel significantly better, and faster, than when I simply treat their symptoms.
Arthritis is associated with bi (pronounced “bee”) syndrome in TCM. Bi syndromes are the obstruction of vital energy and blood in the meridians and other channels by invasion of pathogenic wind, cold, and damp. Depending on the constitution (or genetic predisposition) of the patient, the body will respond to this blockage in several major ways, which I list here along with examples of effective herbs for each.
Hot type, with sudden onset of inflammation. Herbs: use cooling herbs that remove the heat and open the channels to reduce pain, including Oregon grape root (Mahonia aquifolium), meadowsweet (Filipendula ulmaria), feverfew (Tanacetum parthenium) and yucca (Yucca spp.).
Wandering type, where pains wander from place to place; associated with wind. Herbs: boldo leaf (Peumus boldus), fringe tree bark (Chionanthus virginicus), and cat’s claw (Uncaria tomentosa).
Painful type, associated with severe pain, usually due to pathogenic cold. Herbs: ginger (Zingiber officinale), prickly ash bark (Zanthoxylum spp.), and cayenne (Capsicum annuum).
Fixed type, with numbness, soreness, and a heavy feeling; associated with dampness. Herbs: dandelion leaf (Taraxacum officinale), uva ursi (Arctostaphylos uva-ursi), and digestive bitters with cinnamon (Cinnamomum verum) or cardamom (Elettaria cardamomum).
Patients often experience a combination of two types, such as heat and damp, with symptoms such as swelling, heat, and soreness.
Henry had a significant amount of heat based on his red tongue with a yellow coating, both signs of heat, and the frequent sudden flare-ups he reported. I suspected he had some dampness as well because he told me the affected areas, his hands, never changed. Based on these observations, I gave him devil’s claw (Harpagophytum procumbens) and standardized willow bark (Salix spp.), herbs to help quickly reduce symptoms (always a popular idea) that also have some positive clinical studies to attest to their effectiveness.
I asked Henry to take 400 mg once a day of the devil’s claw containing 5 percent harpagosides, and 1 tablet of willow bark extract standardized to contain 40 mg of salicin twice daily with meals. To get to the root of the problem, I asked Henry to reduce his intake of foods and drinks that would stimulate the production of internal heat, especially foods with added refined sugar, stimulants with caffeine, red meat, and fried foods.
His herbal formula consisted of herbs to clear dampness and heat: Oregon grape root, dandelion root, and burdock root (Arctium lappa). I added black cohosh (Cimicifuga racemosa), another cool “acrid” herb to move energy through the channels and relieve pain. For this formula I blended equal parts of the extracts and had him take 3 capsules twice daily with meals.
Arthritis is a chronic disease, but I’ve found that significant symptomatic relief can be seen within a few weeks when patients consistently take the recommended dose of both symptomatic herbs and deeper constitutional herbs.
In Henry’s case, he did make a few changes in his diet, although he still struggled with sugar and coffee. He cut his red meat consumption to once a week, his sugar and coffee consumption in half, and felt quite proud of himself for that. He was very good about taking the herbs, though—after I showed him some positive studies on devil’s claw—and as I hoped, his symptoms began to lessen within two weeks. After four weeks he was able to cut his anti-inflammatory medication by about 80 percent, taking a big stress from his liver and immune system in general.
A year later, Henry had become a promoter of natural remedies for arthritis. Recently I heard him play the piano at a party. He told me he was having no trouble playing molto vivace, which is Latin for “very lively.”
Christopher Hobbs’s case studies are gleaned from his thirty years of studying and practicing herbalism. Hobbs, a fourth-generation botanist, herbalist and licensed acupuncturist. He is the coauthor of Vitamins for Dummies (IDG, 1999) and many other books.
“Case studies” is not intended to replace the advice of your health-care provider.
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