ARTHRITIS

MARYAM TAMHIDI
Patient Name: Malihe Nikjoufard
Female
82 yrs old
Stroke patient, Twice
and now suffering arthritis

Left side of the body was paralyzed, after 1 week using

leech, she started to move her left hand . And her leg by
the help of physical therapy eventually was able to walk
using the cane.
But since her second stroke happened she can’t walk
anymore, her legs got swollen and that’s when the doctor
diagnosed the pain on her left knee as arthritis.
WESTERN MEDICINE - ARTHRITIS

TC M – PA I N F U L
OBSTRUCTION SYNDROME
(BI SYNDROME)
ARTHRITIS IN WESTERN MEDICINE

Arthritis –
Inflammatory conditions that affects the musculoskeletal
system, specifically the joints* and surrounding tissues that
causes “pain, stiffness and sometimes swelling in the
joints.” Greek “ arthron” means "joint" and Latin “itis” "
inflammation".

Western Medicine describes more than one hundred forms

of arthritis, but the most common forms are osteoarthritis,
rheumatoid arthritis and Gout arthritis.
JOINTS - IS THE POINT WHERE TWO OR MORE BONES MEET, SUCH AS THE KNEES, WRISTS, FINGERS, TOES, AND HIPS.
 THREE MOST COMMON TYPES OF ARTHRITIS-WESTERN MEDICINE

1. OSTEOARTHRITIS (OA) – painful,

degenerative joint disease caused by the wear
and tear or the deterioration of the normal
surfaces of joint cartilage (synovial joints)
that caps the bones in the joints. It usually
begins in a single joint. It often involves the
hips, knees, neck, lower back, or small joints
of the hands.
Symptoms of Osteoarthritis :

 Develop gradually and primarily affects the joints.

 Soreness or stiffness of joints –particularly the hip,
knees and lower back
 Stiffness & Joint pain is worse after activity .
 Bone enlargements and limited range of motion .

What Causes Osteoarthrits

 Mostly Aging.
 Joint injury,
 Repetitive use or stress of joints,
 Obesity or overweight
 family history/genetics.
OSTEOARTHRITIS - CAUSED BY MECHANICAL WEAR AND TEAR ( DETERIORATION
OF THE NORMAL SURFACES OF JOINT CARTILAGE (SYNOVIAL JOINTS).
BONE SPURS (BONY GROWTH FORMED ON NORMAL BONE)
2, RHEUMATOID ARTHRITIS (RA) –

Chronic and most severe type of arthritis and

autoimmune inflammatory disease that usually
involves various joints in the fingers, thumbs,
wrists, elbows, shoulders, knees, feet, and
ankles. The body’s immune system attacks the
tissue (Synovium) linings of joints , causing pain
& inflammation and eventually become deformed.
Multiple joints are usually involved w/ RA. In most
people, the inflammation usually becomes
systemic, affecting organs such as the skin, heart
and lungs.
Symptoms of Rheumatoid Arthritis

 Joint pain and swelling

 Joint stiffness, w/ redness and/or hotness near
the joint
 Restricted range of motion
 Morning stiffness lasting more than an hour
 Extreme fatigue,
 Rheumatoid nodules (lumps),
 Symmetrical joint involvement (both knees, not
just one)
 There also can be lung, kidney, or cardiac
involvement.
WHAT CAUSES RHEUMATOID ARTHRITIS

AN AUTOIMMUNE INFLAMMATORY DISEASE IN WHICH

THE BODY'S OWN IMMUNE SYSTEM ATTACKS THE TISSUE
LINING OF JOINTS. THE SYNOVIUM BECOMES INFLAMED
& PRODUCES EXCESS FLUID THAT LATER THE
CARTILAGE BECOMES ROUGH & PITTED (SMALL HOLES)
 TREATMENT OF OSTEOARTHRITIS & RHEUMATOID ARTHRITIS-
WESTERN MED.

 There is No cure for both OA and RA , but there are

medications to help relieve pain,

 Analgesics and topical creams (painkiller),

 Nonsteroidal anti-inflammatory drugs (NSAIDs), Celebrex,

Naproxen; to relieve pain and reduce inflammation of joints
and prevent or slow joint damage.

 Physical Therapy (appropriate exercises) to protect joints.

 If the Joint are severely damaged by rheumatoid arthritis,
surgery may be necessary , splinting or joint replacement
surgery (Arthroplasty) for seriously damaged larger joints,
(knee or hip).
 GOUT
Gout is caused by deposition of uric acid crystals in
the joint, causing inflammation. There is also an
uncommon form of gouty arthritis caused by the
formation of rhomboid crystals of calcium
pyrophosphate known as pseudogout. In the early
stages, the gouty arthritis usually occurs in one
joint but with time, it can occur in many joints and
be quite crippling. The joints in gout can often
become swollen and lose function.
PAINFUL OBSTRUCTION SYNDROME-TCM

Painful obstruction syndrome also

known as “bi syndrome” or “bone Bi” in TCM
is a blockage/obstruction of channels by
pathogenic factors (Wind, Cold, Damp, Heat &
Phlegm) which impair the smooth flow of Qi
and Blood circulation that affects the bones,
muscles and joints ( such as the knees,
wrists, fingers, toes, and hips). Long-term Bi
syndrome can lead to deformities of the
bones and joints.
“Bi Syndrome” means “obstruction”

In Traditional Chinese Medicine

typically does not make a diagnostic
distinction between osteoarthritis and
rheumatoid arthritis. Instead, it makes a
diagnostic distinction based on the
predominance of Wind, Cold, Damp, or
Heat symptoms.
 CAUSES OF PAINFUL OBSTRUCTION
SYNDROME ( BI SYNDROME)
Due to exposure/invasion of the external pathogenic
factors – wind, cold, damp or heat invade the body.
Exposure to other conditions such as sitting on damp
surfaces, wading in water, living in a damp
environment.
Excessive sport (aerobic or jogging) or excessive work
activities (constant repetition of movement in one’s
work )
Trauma/accident injury of the channels and vessels
(causes either stagnation of Qi (if Light) or Blood (If
Serious) in an area.
Deficiency of Blood or Yin w/c leads to
malnourishment of the channels (prone to
invasion of external pathogenic factors)
Emotional problems are also contributing
factors :
Anger/Resentment=cause stagnation
of Qi =affects channels
Sadness/grief/shock =Depletion of Qi
& Blood =leads to malnourishment of the
channels
 FIVE (5) CLASSIFICATION OF BI SYNDROME ACCORDING TO
PREDOMINANT PATHOGENIC FACTORS/PATTERNS

1. Wind Painful Obstruction Syndrome

(wandering Bi syndrome)- Wind
predominates when pain moves and
changes rapidly.

Pain w/ moving from joint to joint

(wandering pain)
Windy weather make symptoms worse
Tongue: Thin white coating
Pulse: Floating & slightly Rapid
2.Cold Painful Obstruction Syndrome ( Painful Bi
syndrome)- Cold predominates when pain is
severe.

 Severe (stabbing) pain in one joint (unilateral)

 pain is alleviated by warmth.

 Tongue: Thin white coating

 Pulse: Wiry & Tight pulse
3. Damp Painful Obstruction Syndrome ( Fixed Bi Syndrome)-
Damp predominates when the pain is characterized by
heaviness & soreness and the area of pain is fixed .

 Fixed pain w/ soreness, heaviness, numbness of the

muscles

 Aggravate by rainy/damp weather

 Tongue: White sticky/greasy coating

 Pulse: Slow & slightly slippery
4.Heat Painful Obstruction Syndrome
(Febrile Bi Syndrome)- It develops from
any of the previous 3 types of patterns
(wind,Cold & Damp) transforming into
Heat in the Interior.

Redness hot swelling burning joints

Very severe pain joints
Pain is relieved by applying cold to the joints
Tongue : red w/ yellow coating
Pulse: Rapid & Slippery
5. Bone Painful Obstruction Syndrome –
occurs in chronic cases & develops from any of
the previous 4 types.
Persistent obstruction of the joints by
pathogenic factors leads to retention of body
fluids w/c turn into Phlegm w/c further obstruct
the joints & channels. This lead to muscular
atrophy and swelling & deformity of bones.
This becomes an interior syndrome affecting
not only muscles ,joints & channels but also the
internal organs.
 Painful joints w/ swelling & bone deformity
 Tongue: Purplish dark tongue Pulse: Thready pulse
GENERAL- PRINCIPLES IN TREATMENT OF PAINFUL OBSTRUCTION SYNDROME-

1. Expel all three pathogenic factors from the

channels
 Expel the Wind
 Scatter the Cold
 Resolve dampness
 Eliminate the local stagnation Of Qi & Blood in the
channels
2. Treat the internal organs
 Treating Liver-Blood (nourishes the sinews &
tendons) in case of Wind
 Tonifying Fire (Kidney Yang-nourishes bones) in
case of Cold
 Strengthening the Spleen in case of Dampness
 Provide symptomatic relief by stopping pain.
 Herbal Treatment
 Qi Gong massage therapy, which can further
increase the flow of Qi and help reduce pain.
ACU. POINTS ACCORDING TO PREDOMINANT PATHOGENIC
FACTORS/PATTERNS
1. Wind (Bi) Painful Obstruction
Syndrome:
LI-4 Hap Gok - main point to expel Wind
Spleen 10 (hyul hae)- Tonifies Blood
GV-14 -Dae Choo-expels the
Wind/releases Exterior
BL-17 – Gyeok Soo -Tonifies Qi & Blood
Bl-18 – Gan Soo - Eliminate Winds
In Acute Cases- use reducing method
Chronic Cases- use even method
2. Cold (Bi) Painful Obstruction Syndrome:
ST36 –Jok Sam Ri -Tonify Qi & Blood, Dispel
Cold
CV-6- Gi Hai -Tonify Qi & Yang
CV4- Gwan Won - Strengthen Yang
GV-14 –Dae Choo –Releases exterior & Tonifies
Yang
BL-10 – CheonJoo -Removes obstruction from
channel
BL-23 – Sin Soo -Benefits Bones & Marrow
BL-40 – Wi Joong -Benefits lumbar areas &
knees
LI-11- Quchi –decreases swelling & soothes pain
Reinforcing method and moxa
3. Damp (Bi) Painful Obstruction
Syndrome:
 SP-6 –Sam Eum Gyo -to resolve dampness
 ST36-Jok Sam Ri-Expels Wind & Dampness
 BL-20 Bi Soo -Resolves Dampness
 Bl-17 Gyeok Soo-Descends rebellious Qi
 Moxa
4. Heat (Bi) Painful Obstruction Syndrome:
 LI-4-Hap Gok -Clears Heat & alleviate pain
 LI-11 Quchi- Clears Heat & Cools the Blood
 GV-14 Dae Choo-clears heat & tonify Yang
5. Chronic/Bone Bi Painful Obstruction Syndrome:
a.) Qi-Blood Deficiency
 ST-36 JokSamRi(Zusanli)-Tonify Qi & Blood, Strengthen immune system
 SP-6 SamEumGyo(Sanyinjiao)-promotes function of Liver & smooth
flow of Liver Qi
 CV4 GwanWon(Guanyuan)-Nourishes Blood & Yin & benefits original Qi
 BL-20 BiSoo(Pishu)- nourishes Blood
 Bl-23 SinSoo(Shen shu)-Nourishes Blood & strengthen kidney function
of reception of QI

b.) Phlegm in Joints

 SP-6 SamEumGyo(Sanyinjiao) –Strengthen Spleen & resolve
dampness (even or reduced)
 CV12 JoongWan(Zhongwan) –Tonify Spleen & Stomach & Resolves
dampness reinforced
 CV-9 SooBoon(Shuifen) –promotes transformation of fluids even or
reduced
 BL-20 BiSoo(Pishu)- Resolves Damp & tonify Spleen & stomach –
reinforced
c.) Stasis of Blood
 SP-10 Hyul Hae – removes stasis & stagnation of blood & Tonify Blood
 SP-6 SamEum Gyo- Promotes function of Liver & smooth flow of Liver Qi
 BL-17 Gyeok Soo-Tonify Qi & Blood & Important point to treat any blood related
conditions
d) Deficiency of Liver & Kidneys
 SP-6 SamEum Gyo – Tonifies Kidney & nourishes Blood & Yin, Promotes
functions of Liver
 ST-36 JokSamRi- Tonify Qi & Blood & Strengthen immune system,regulates Nutritive &
defensive Qi
 BL-18 Gansoo- Moves stagnant Liver Qi & benefits Liver & GB
 BL-23 Sin soo- Tonify & strengthen the Kidneys function, Nourishes Kidney
Essence
 CV-4 GwanWon-Tonifies Kidneys, Nourishes Blood & Yin,Benefits Original Qi
PAINFUL OBSTRUCTION SYNDROME (BI SYNDROME)
ACCORDING TO SPECIFIC PARTS OF THE BODY

The pain is experienced deep inside the joint.

Knee Joint Pain ( –
Painful Obstruction syndrome of the knee often occurs from
combination of pathogenic factors:
 Invasion of Exterior Cold & Dampness
 Previous Local stagnation of Qi due to an old accident
 Local stagnation of Qi & Blood from old injury/over-use of the joint.
Manifestation:
 Severe knee pain in one joints usually unilateral (one side)
 Acute (start fairly suddenly)
 Affected by weather (usually worsening w/ rainy or damp weather)
 Knee may be swollen (w/c indicates retention of Dampness)
KNEE JOINT PAIN (PAINFUL BI SYNDROME)
IDENTIFICATION OF PATTERNS ACCORDING TO THE
EIGHT PRINCIPLES/PATTERNS
Knee (Joint) Pain- Bi Syndrome
 Interior/Exterior- Exterior affecting the channels and obstruct the circulation of
Qi causing pain & swelling.
 Hot/Cold- Cold & Damp
 Excess/Deficient- Deficient
 Yin/Yang- Yin
 Acute /Chronic- Acute
PRINCIPLE TREATMENT- KNEE JOINT PAIN (BI SYNDROME )

Expel all the pathogenic factors from the channels

 Scatter the Cold
 Expel Wind- (treat blood (Liver) ;if blood is harmonized, Wind is automatically expelled)
 Warm the Channels
 Dry Dampness
 Tonify Fire (Kidney Yang) –(If Heat moves, Cold goes, proper
circulation removes pain)
 Strengthen and Tonify the Spleen to remove Dampness (if Qi is strong
no numbness-symptoms of Dampness)
 Remove the local stagnation of Qi & Blood in the channels .
 Tonify Qi & Blood
 Provide symptomatic relief by stopping pain.
 Herbal Treatment
 Qi Gong- massage therapy, which can further increase the flow of Qi
and help reduce pain.
ACUPUNCTURE POINTS-KNEE PAIN

7 Basic points (CV-13+CV12+CV9+CV6+CV4+Hwang Soo L&R)

LI-4 Hap Gok & LV-3 Taichong-Tonify and move the Qi & Blood to remove
stagnation
SP-6 SamEumGyo-Strengthen Spleen,Kidney & Stomach
SP-10 HyulHae-Remove stagnation of blood, Expels dampness & tonify Blood
ST-36 JokSamRi- expels Dampness and Tonify Spleen & Stomach
GV14 Dae Choo- Tonify Yang ,releases the Exterior
BL-20- Bi Soo- Tonify Spleen & stomach ,resolves damp,nourishes blood
BL-23 Sin Soo- Resolves dampness & benefits Bones & marrow
BL-17 Gyeok Soo- Tonify Qi & Blood & nourishes blood
BL-40 Weizhong- local point for pain behind the knee, Expels dampness
BL-57 Seung San-relaxes the sinews & alleviate pain Resolves dampness
Xiyan (EX-LE) (Knee eyes) points – two points in the depression medial & lateral
to the patellar ligament. This point functions to reduce wind-dampness,
relaxes the tendons and alleviates pain (knee joint).
Heding (EX-LE ),- In the depression at the midpoint of the superior border of the
patella. Activates the vessels & alleviate knee pain)
AhShi points (areas of tenderness and pain)
Moxibustion (warming) & Cupping
GB 34 YANG LINGQUAN-BELOW THE LATERAL ASPECT OF THE KNEE, IN THE
DEPRESSION APPROX. 1 CUN ANTERIOR & INFERIOR TO THE HEAD OF THE
FIBULA. STRENGTHEN THE SINEWS & BONES & ALLEVIATES PAIN,REMOVES
OBSTRUCTION FROM THE CHANNEL .
HEDING- IN THE DEPRESSION AT THE MIDPOINT OF THE SUPERIOR BORDER OF
THE PATELLA. ACTIVATES THE VESSELS & ALLEVIATE PAIN(KNEE JOINT)
XIYAN- TWO POINTS IN THE DEPRESSION MEDIAL & LATERAL TO THE PATELLAR
LIGAMENT. LATERAL XIYAN OVER LAPS W/ DUBI (ST-35)THIS POINT FUNCTIONS TO
REDUCE WIND-DAMPNESS, RELAXES THE TENDONS AND ALLEVIATES PAIN
(KNEE JOINT).

ST-35
GB34
Xiyan
HERBAL TREATMENT
Natural Remedies for Arthritis (Bi Syndrome)
 Kilaw poultice ( English: Tumeric, Round tumeric)
 Chop or crush a rhizome and mix with oil.
Apply on the joint as poultice overnight.
 Mangga bark hot compress ( English: Mango)
 Boil a piece of chopped bark. Use the decoction for hot compress.
 Malabulak leaves and young stalks compress
 Chop leaves and young stalks and put in a cloth bag. Add 1/2 tsp. salt. Warm the b
ag
and apply as compress
 Lumbang bato leaves compress
 Heat the leaves. Apply on the joints directly while still hot for 15 minutes, 2 times a
day.
 Herba Buena leaves ( english: Marsh mint, Pepper mint)
 Boil 4 tablespoons of dried leaves in 2 cups of water for 15 minutes.Dosage: Adults
: 1/2 glass, every 4 hours
Arthrid Herbal Supplement - (Boswellia Serrata) Salai guggul & Piper Longum
General Points (Bi Syndrome) for other Underlying Factors:

 Liver Qi Stagnation – LV3 Taichong

 Kidney & Spleen Deficiency- ST—36 Jok Sam Ri & SP-6 Sam
Eum Gyo
 Blood Stasis- SP-10 Hyul Hae Removes stasis & stagnation of
blood & Tonify blood
 Phlegm – ST 36-Expel Dampness in Bi Syndrome
 FOOD BIG ROLE IN ARTHRITIS

1. Cut down on the amount

of fried and processed foods
2. Cut the salt in your diet.
3. Fill half your plate with
fruits and vegetables.

Osteoarthritis

A small study published in Arthritis in 2015 reported on a 6-week

intervention individuals with osteoarthritis who were placed on
a plant-based diet of fruits, vegetables, legumes (beans, peas,
lentils) and whole grains, experienced significantly reduced pain
and improved physical function.
RHEUMATOID ARTHRITIS

People with RA, researchers have found a diet rich in omega-3 fatty
acids, antioxidants and with powerful anti-inflammatory nutrients.
These foods are fish, olive oil, fruits, vegetables, nuts/seeds and
beans.

GOUT ARTHRITIS

Of all the forms of arthritis, gout has the most obvious dietary link. When
the body breaks down purine, a substance found in many foods, uric
acid forms. When People who they produce too much uric acid cause
inflammation and severe pain in the joints.
Researchers suspect the anthocyanins in cherries have an anti-inflammatory
effect and may help reduce the frequency of gout attacks. Anthocyanins
are found in red and purple fruits, including strawberries, raspberries,
blueberries and blackberries
 NO TO ALCOHOL & TOBACCO

Tobacco and alcohol use can lead to a number of health

problems, including some that may affect your joints.
Smokers are more at risk for developing rheumatoid
arthritis, while those who consume alcohol have a
higher risk for developing gout.
Healthy joints require a balanced diet, physical activity,
and an adequate amount of rest—Cut back on
drinking and smoking and ramp up your eating habits
with healthy choices, regular exercise, and good
quality sleep.
EXERCISE

Exercises that is easy on the joints. Like

simple workout routines, water walking,
easy walking and yoga
SUMMARY TREATMENT FOR MY PATIENT

• Acupuncture.
• Diet.
• Doing light exercises.
• Hot compress.

Thank You