🌿 Folk Prescriptions

Rheumatoid arthritis is a common chronic inflammatory joint disease. Preliminary surveys indicate that the prevalence of rheumatoid arthritis in China is 0.3%, affecting people of all ages, with the highest incidence among those aged 20–40. Clinically, it presents as polyarthritis primarily involving small joints of hands and feet, with recurrent and persistent progression. The main pathological changes include chronic inflammation of joint synovium, formation of pannus, destruction of cartilage and subchondral bone, ultimately leading to joint deformity, stiffness, and loss of function. Besides prominent multi-joint involvement, extrajoint manifestations in vital organs are also common, among which gastrointestinal lesions are most frequent. Clinical symptoms often include nausea, vomiting, poor appetite, acid reflux, heartburn, abdominal discomfort, and loose stools. These conditions are related not only to the disease's pathogenesis but also to inappropriate treatment. Severe gastrointestinal lesions can impair medication use and significantly affect patients’ overall condition and quality of life.
From a Traditional Chinese Medicine perspective, the etiology of "rheumatoid arthritis" lies in the spleen being the root of postnatal constitution and the source of qi and blood. Spleen deficiency plays a crucial role in the development of rheumatoid arthritis (shortened as "RA"). ① Deficient spleen Qi impairs transformation and transportation, causing water metabolism disorders, stagnation of fluid, accumulation over time into phlegm-dampness, resulting in excessive phlegm-dampness. ② Deficient spleen Qi leads to insufficient production of qi and blood. ③ Deficient spleen Qi weakens defensive Qi, making one prone to external pathogens—especially dampness—which further damages the spleen and stomach. ④ Dampness is sticky and tenacious; when accumulated, it generates stasis over time, obstructing meridians and impeding qi and blood circulation, thus combining phlegm-dampness with blood stasis. Phlegm-stasis intermingling blocks meridians, exacerbating joint blood stasis, causing recurring pain and swelling, or even nodules and ecchymosis around joints. ⑤ Dampness often combines with cold or heat: cold causes stagnation, invades meridians, slows blood flow, or even causes blockage; heat enters blood, thickens it, causing stagnation; qi deficiency weakens propulsion, leading to poor blood flow and eventual stasis. Long-standing phlegm-dampness combined with blood stasis results in phlegm-stasis interlocking. Therefore, strengthening the spleen and harmonizing the stomach is key to treating "RA."
Gastrointestinal manifestations in "RA" include temporomandibular joint dysfunction, difficulty eating and swallowing. About 30% of RA patients show impaired esophageal motility upon esophageal pressure measurement, with weakened peristalsis in the lower two-thirds of the esophagus and dysfunction of the lower esophageal sphincter, commonly presenting as heartburn and acid regurgitation.
Chronic superficial gastritis, atrophic gastritis, and peptic ulcers are generally linked to anti-inflammatory analgesic drug use and gastric acid secretion disorders. Peptic ulcers commonly occur in elderly patients over 60, predominantly gastric ulcers located in the gastric antrum. Unlike typical ulcers (where duodenal ulcers are more common), gastric ulcers frequently develop at the lesser curvature near the gastric angle. In RA patients, ulcer symptoms often lack regularity in upper abdominal pain, and many patients may have no pain at all, increasing risks of bleeding or perforation.
Ischemic colitis or intestinal obstruction may be triggered by vasculitis in severe RA cases, causing intestinal motility disorders. When small intestine is involved, symptoms include abdominal pain, bloating, diarrhea, or constipation. RA may also affect the colon and rectum, altering bowel habits.
Pancreatitis and cholecystitis may occasionally occur in some RA patients, with mild to moderate liver function abnormalities possible, including mild fatty infiltration and fibrous tissue proliferation within the liver.
Treatment of "RA" Using Spleen-Strengthening Methods
Spleen-Strengthening and Dampness-Dispelling The relationship between the spleen and dampness is very close. Dampness has internal and external origins. External dampness, known as "damp pathogen," relates to climate and environment, or injury from consuming raw/cold foods. Both internal and external dampness arise due to spleen deficiency, allowing dampness to invade. For externally caused damp diseases (including arthralgia), spleen deficiency serves as the internal predisposition. Internal dampness originates directly from spleen deficiency itself. Due to impaired spleen function, the transformation of food and fluids into essence and the distribution of body fluids decline, leading to fluid retention and internal generation of dampness.
RA patients exhibit obvious dampness signs, so using spleen-strengthening therapy to eliminate dampness is highly significant. Patients often experience fatigue, heaviness in limbs, numbness, chest tightness, poor appetite, nausea, abdominal distension—symptoms indicative of dampness. Even if these symptoms are mild, mere limb edema or joint swelling still indicates dampness, necessitating spleen-strengthening to resolve dampness.
Spleen-Strengthening and Qi-Tonic The spleen is closely linked to immune function. "Spleen governs transportation and transformation," "Spleen is the foundation of postnatal constitution," and "Strong spleen resists pathogens" imply that the spleen continuously transports nutrients from food and drink throughout the body, maintaining normal organ function and distributing true Qi, defensive Qi, and original Qi. Those with deficient spleen Qi often display immune dysfunction. Animal model studies confirm that herbs like Astragalus membranaceus, Codonopsis pilosula, Ganoderma lucidum, and Atractylodes macrocephala can enhance immunity.
RA patients have immune system deficiencies. While modern immunomodulatory drugs offer some benefit, options are limited, costly, and carry significant side effects. Traditional Chinese medicine holds great potential here. For example, herbs such as Astragalus membranaceus have been proven to promote interferon production; Codonopsis pilosula, Astragalus membranaceus, Atractylodes macrocephala, and Poria cocos can promote lymphocyte transformation and activate reticuloendothelial systems. Some believe spleen-strengthening and qi-tonifying herbs may belong to the category of immune-stimulating Chinese medicines.