Comparison Study for Rheumatoid Arthritis using Different Chinese Medicinal Formula

Rheumatoid Arthritis or RA is a chronic systemic disease that affects the joints, connective tissues, muscle, tendons, and fibrous tissue. Thus, it tends to strike during the most productive years of adulthood, between the ages of 20 and 40, and is a chronic disabling condition often causing pain and deformity. The prevalence varies between 0.3% and 1% of the world population and is more common in women and in developed countries.

Furthermore, different researches and clinical studies are being conducted all over the world to find the best treatment for RA. Another, one of these studies is explained on an article by Dr. Li Shu-fang which is entitled as “A Clinical Study on the Treatment of Rheumatoid Arthritis with Self-composed Tong Bi Tang (Free the Flow of Impediment Decoction)”.

Thus, this study gives details of two different Chinese Medicinal formulas. In fact, the study enrolled a total of 60 patients which were divided into 40 patients under Treatment group and 20 patients under Comparison group.

Chinese Medicinal Formula

Basic Chinese medicinal formula was given to the members of the Treatment group as follow:

Quiang Hao (Radix Et Rhizoma Notopterygii), 10g
Du Huo (Radix Angelicae Pubescentis), 10g
Ma Huang (Herba Ephedrae), 9g
Gui Zhi (Ramulus Cinnamomi Cassiae), 12g
Fu Zi (Radix Lateralis Praeparatus Aconiti Carmichaeli), 10-20g
Wu Gong (Scolopendra Subspinipes), 6g
Quan Xie (Buthus Martensis), 6g
Dang Gui (Radix Angelicae Sinensis), 15g
Huang Qi (Radix Astragali Membranacei), 20g
Chi Shao (Radix Rubrus Paeoniae Lactiflorae), 12g
Du Zhong (Cortex Eucommiae Ulmoidis), 15g
Wu Jia Pi (Cortex Radicis Acanthopanacis Gracilistylis), 12g

Dosage: One packet of these medicinal was decocted in water and administer warm in three divided doses per day. Then, after decoction, the dregs were boiled again in 1,500ml of water for 15 minutes. In addition, this resulted to a warm liquid which were used to wash and bathe the hands and feet three times a day. Also, other medicinal were suspended during administration of these medicinal.

Hence, additional Formulas were added to treat side-effects; some were categorized with different patterns based on the side effects.

1. Honey, 50g

– for any Gastrointestinal side-effects

2. Extreme wind, cold, and dampness pattern

– Replaced Fu Zi with Chuan Wu (Radix Aconiti Carmichaeli),15g and raised dosed of Ma Huang to 15g

If there was joint swelling and distention, aching and pain, fixed-in-location pain, stiffness and impairment of flexing and bending, pain worsened through exposure to cold, white fur on the tongue, and a floating pulse that was tight or deep and tight. Thus, this pattern was categorized as Extreme wind, cold, and dampness.

3. Wind, damp, and heat pattern

– Shi Gao (Gypsum Fibrosum), 40g + Zhi Mu (Rhizoma Anemarrhenae Aspheloidis), 12g + Jin Yin Teng (Caulis Lonicerae Japonicae), 20g

Note: Shi Gao and Fu Zi were boiled for one hour before adding the other ingredients.

Thus, for patient who experienced joint redness, swelling, and pain, stiffness, and poor mobility accompanied by nausea, fever unresolved by sweating, a red tongue with yellow fur, and a slippery, rapid pulse.

4. Phlegm stasis congelation and gathering

– 10g each of Ban Xia (Rhizoma Pinelliae Teratae), Bai Jie Zi (Semen Sinapis Albae), and Tao Ren (Semen Pruni Persicae) were added.

If there was joint swelling, distention, pain, and stiffness with impaired flexing and bending, a dark tongue with/without possible static macules and glossy tongue fur, and a soggy, slippery pulse.

5. Kidney vacuity with cold congelation

– 15g each of Shan Zhu Yu (Frustus Corni Officinalis), Gou Qi Zi (Fractus Lycii Chinensis), and Xu Duan (Radix Dipasaci)

If joint swelling, distention, aching, pain, stiffness, impaired movement with fear of cold and dread of chill, and low back and knee soreness and pain were present.

6. Qi and Blood debility and vacuity

– 15g each of Dang Shen (Radix Codonopsitis Pilosulae) and Suan Zao Ren (Semen Zizyphi Spinosae) were added.

If there was joint swelling, distention, aching, pain stiffness, numbness, insensitivity with a pale, white facial complexion, heart palpitations, spontaneous perspiration, lassitude of the spirit, lack of strength, a pale tongue with thin, white fur, and a fine, weak pulse.

Ready-made Medicines

Whereas, for the members of the Comparison group, three pills of ready-made medicines were given to them, to be taken two times a day. Furthermore, it is known as Feng Shi Gu Tong Jiao Nang (Rheumatic Bone Pain Gelatin Capsules) which is manufactured by Anhui Extract, Formulas, and Medicinals Trading & Manufacturing Co. Hence, these consisted of the following formula (amounts or proportion are not specified):

Chuan Wu (Radix Aconiti Carmichaeli)
Cao Wu (Radix Aconiti Kusnezoffii)
Mu Gua ( Fructus Chaenomelis Lagenariae)
Hong Hua (Flos CarthamiTinctorii)
Gan Cao (Radix Glycyrrhizae Uralensis)
Wu Mei (Fructus Pruni Mume)
Ma Huang (Herba Ephedrae)

Criteria were based on the “Criteria for the Chinese Medical Diagnosis of Diseases & Patterns and Treatment Outcomes” and “A Guide to the Principles of the Clinical Research of Chinese Medicinals & New Medicinals”.

Outcome

The outcomes of the study shows that the bulk-dispensed decoction modified for presenting patterns was more effective on all accounts than the single ready-made medicine. Hence, the significance of this clinical study depends in the appearance of a clinically proven, effective formula for RA.

On the other hand, this study also shows some important information for Western practitioners of Chinese medicine who commonly recommends ready-made Chinese medicines. Thus, practitioner should consider the following factors in the study outcomes.

First, dosage, compared to the bulked-dispensed, water-based decoctions used in this study, the ready-made medicine which is given to the comparison group almost assuredly provided a considerably smaller daily dose of Chinese medicinal.
Second, the ready-made medicine did not have as many wind-treating medicinal as the decocted formula. Nor, did the ready-made medicine supply any qi or liver-kidney supplementing medicinal. As a result, the ready-made medicine’s ingredients did not correspond directly to the causes of RA. As well as, the mechanisms that work in RA.
Lastly, the ready-made formula was a fixed formula, whereas, the bulk-dispensed decoctions were modified base formula for specific patients. Consequently, each patient had a big chance of receiving the Chinese medicinal suitable for each of them.

As cited by Dr. Li, “When used for the treatment of wind, cold, damp impediment with additions and subtractions based on the individual patient’s presenting patterns, the first formula achieves fully satisfactory therapeutic effects”.

Conclusion

Therefore, considering all of the above mentioned factors, we should not anticipate excellent results with ready-made medicines, especially when trying to treat a composite disease like RA.

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