Arthritis, joint and back pain is so prevalent throughout the world that there really is no point to describe how many sufferers there are. It is safe to say that if you are around the age of 55 or older you probably have some form of arthritis somewhere in your body.

From a Western medical perspective there are two broad forms of arthritis, osteoarthritis and rheumatoid arthritis.

Osteoarthritis is joint pain primarily caused by a gradual loss of protective cartilage. This can be caused by physical injury, mechanical stress or metabolic abnormality that can gradually break down the cartilage that cushions the ends of the bones from rubbing against each other. This is the most common type of arthritis.

Rheumatoid arthritis is the most severe type of inflammatory joint disease. It is an auto-immune condition where the body’s immune system attacks its own tissues, which in turn damages the joints and surrounding soft tissue. This is a chronic form of arthritis that leads to stiff, deformed joints of the hands, arms, legs and feet. It is the slowest and most difficult to treat.

Western medical treatment involves the use of non-steroidal anti-inflammatory drugs (NSAIDS) such as aspirin, ibuprofen and steroid-based drugs such as corticosteroids and immune-suppressive drugs. All of these have long-term adverse side effects and some have short-term adverse effects such as stomach irritation, gastritis and ulcers.

Arthritis and Traditional Chinese Medicine (TCM)

TCM classifies both types of arthritis as “Bi syndrome” disease. Bi means for “blockage.” Thus in TCM all such pains are considered to be caused by some sort of blockage. What is blocked or what causes blockage in arthritis, and for that matter back pain, which is considered in the same category, gets us into some strange concepts and terms (from a Western physiological point of view).

The most common type of arthritic pain is caused and aggravated by coldness and dampness. No wonder that individuals with this type of arthritis complain that their symptoms are worse in cold, damp weather, but also by wind. Heat, a fourth TCM cause, occurs as resistance from the continued effects of Cold-Damp-Wind causing blockage.

Western rheumatology hypothesizes that one of the major reasons why cold and damp weather aggravates most people’s arthritic pains is because of changes in air pressure. Specifically, it is the change of barometric pressure which is the weight of the atmosphere that surrounds us. This pressure occurs when barometric pressure drops before bad weather sets in and cause the joints and cartilage of our joints to expand. This theory is given by Dr. David Borenstein, MD, FACP, FACR, a rheumatologist and clinical professor of medicine at George Washington University Medical Center and past president of the American College of Rheumatology. Still, many people claim that weather does not affect their arthritic pains.

The virtue of the Chinese description of “Bi Syndrome caused by Cold-Damp-Wind” is that it leads the herbalist to select the most appropriate herbs which are classified in TCM as treating Coldness, Dampness, Wind or Heat.  

Cold pattern arthritis (Cold Bi) is characterized by severe joint or muscle pain in a fixed location. It is relieved by the application of warmth.

Damp pattern arthritis (Damp Bi) exhibits symptoms of pain, soreness, swelling of the muscles and joints, and a feeling of heaviness and numbness in the limbs.

Unlike Cold Bi, Wind pattern arthritis (Wind Bi) is characterized by pains that move from place to place, or joint to joint. It is described as being aggravated and caused by exposure to wind.

Heat pattern arthritis (Hot Bi) is characterized by severe pain and joints that feel hot, and look red and swollen. This type of arthritis is relieved by applying cold to the affected areas.

Underlying physiological imbalances that predispose an individual to develop arthritic and lower back pains are described in TCM as coming from deficiencies of the Kidneys and Liver.

In TCM, the Kidneys include the adrenals so that any type of stress or fatigue, be it climatic, physical or emotional will cause the Kidney-adrenals to hyperfunction and react to regain homeostasis. The Liver’s job is to moderate the adrenal hormones caused by stress by breaking them down as necessary. The Liver also neutralizes toxins which cause internal stress.

This TCM Kidney-Liver organic function may be deficient due to congenital conditions or may gradually weaken with lifestyle abuse and age. Thus to achieve any enduring benefit from treatments, one would wisely add herbs to supplement and strengthen this vital internal TCM function.   

Traditional diagnostic methods based on symptomology, tongue, and pulse are employed to determine the most effective treatment approach. However, in the case of arthritis and lower back pain, there is one formula which is in a unique small class out of the possible thousands of TCM formulas that I consider to be the “best bet” or “use first, refine later” group of formulas. It is Du Huo Ji Sheng Tang (Du Huo Angelica and Loranthes Mistletoe (Taxillus) Decoction).  

How effective is it for these conditions? I would estimate that it will relieve joint pains at least 80% of the time.

It consists of the following:

1. Angelica pubescentis (du huo) – 4.5 g. Traditionally this herb is used to disperse Wind-Cold-Dampness especially from the Lower Warmer (from the lower back down through the legs and knees). I would venture that these properties would also be found in Western Angelica archangelica root.

2. Herba Asarum (wild ginger, xi xin) 1-3 g. This herb releases Exterior Wind-Cold, warms the Lungs, transforms Phlegm, and scours Wind-Dampness from the sinews and bones to stop pain. Chinese wild ginger, as well as North American Wild ginger in my opinion specifically, can be used to treat colds and induce diaphoresis. However, its unique property is that it also promotes internal circulation and dispels Wind, Cold and Damp to relieve pain. It is used because of its special effect to open both externally via sweating, but more important internally between the tissues and organs of the body. It is currently removed from commercial formulations because it contains Aristolochic acid which is thought to cause kidney damage. (http://www.niehs.nih.gov/health/materials/ar i stolochic_acids_508.pdf). To my mind, I think we should be aware of this potential danger but based on the lower dosage, and widespread use over millennia, I would use it for a short time especially in patients with severe arthritic pains that may not be relieved if this herb is left out of the formula. An acceptable, though not as powerful, substitute for this herb would simply be fresh ginger root.

3. Saposhnikovia root (fang feng) 3-10 g. This is another root from the Apiaceae family, which includes Angelica archangelica, osha, and lovage.  It also expels Wind-Cold and Dampness and alleviates pain. It is especially effective for dispelling Wind.

4. Radix Gentianae Macrophyllae (qin jiao) 9-10 g. This herb is a species of Chinese gentian root. Gentian root is bitter and in Western herbal practice is almost completely relegated to use as a bitter digestive herb. However, it seems to be neglected as an herb that is detoxifying and anti-inflammatory.  It is used in this formula because it expels Wind-Dampness and relaxes the ligaments. It may be that the Western gentians could be used similarly.

5. Herba Taxilli (sang ji sheng, Chinese mulberry mistletoe) 4.5 to 30 g. This is a particularly useful herb for arthritic pain symptoms. It also expels Wind-Dampness, strengthens the ligaments and bones, tonifies the Liver and Kidney Yin, and nourishes the Blood. European mistletoe is commonly used today as a nervine, hypotensive, and as an anticancer herb. It was important to the Druids for many conditions including arthritis.

6. Radix Dipsacus (xu duan, teasel root) 4.5 to 30 g. This specifically tonifies the Liver and Kidneys, and strengthens the lower back and bones. It is used for the weakness of the legs and knees and to mend bones. It also helps to prevent miscarriage. Western teasel root (D. fullonum or “Fuller’s teasel) found growing both in Europe as well as North America is widely promoted because of its ability to relieve joint pains associated with Lyme disease for which it is indeed effective. However, In Scottish herbal medicine, it is also used to treat arthritis.  (http://www.herbalmedicine.org.uk/index.php?page=tim-entwistle)

7. Eucommia bark (du zhong) 3-10 g. This is the bark of a species related to the rubber tree. It tonifies the Kidneys and Liver and strengthens the ligaments and bones. It also downregulates high blood pressure.

8. Achyranthes bidentatae (niu xi)3-10 g. This herb invigorates Blood circulation to relieve pain and strengthen the bones and ligaments. It also benefits the joints and nourishes Liver and Kidney Yin.

9. Cinnamon bark (rou gui or Chinese cinnamon) 1-6 g. This is Cinnamomum cassia distinct from “true cinnamon” known as Cinnamomum verum. It is this latter species that is widely used as a condiment in the West. It may share some of the properties of C. cassia which is a very hot herb used to Warm the Kidneys, strengthen Yang, strengthen Ming Men Fire, disperse deep Cold, warm and unblock the channels and vessels (blood circulation), and to open the lower back and alleviate pain.

10. Angelica sinensis (dang gui) 9-10 g. This is another herb in the Apiaceae family and is used to promote blood circulation, disperse Cold and relieve pain.

11. Chuan xiong ligusticum (Chinese lovage) 4.5 – 9 g. An Apiaceae family plant that is one of a number of herbs in this formula that promotes Blood circulation regulate the flow of energy, expel Wind-Cold and alleviate pain. It is reasonable to assume that Western lovage root and the various ligusticum species including North American osha could be used as a substitute.

12. Unprocessed Rehmannia glutinosa (sheng di huang) 3-10 g. This is the premier TCM herb used to nourish Yin (fluids) and Blood. It tonifies TCM Kidneys and Liver, which are considered to contain the root of deficiency for lower back and arthritic pains. Unprocessed Rehmannia is more strongly antiinflammatory than the processed form which is considered to be more tonic.

13. Rice wine-soaked Rehmannia glutinosa (shu di huang) 3-10 g. This herb has stronger Liver and Kidney tonic properties.

14. Paeonia alba (bai shao, white peony root) 3-10 g. This herb nourishes Blood and relieves spasm and pain. It is one of a group of tonic herbs along with dang gui, Rehmannia, white peony root, ginseng or Codonopsis and honey-fried licorice that serve as tonics to treat underlying deficiencies associated with lower back and arthritic joint pains.

15. Ginseng (Panax ginseng) or Codonopsis (dang shen) 9-30 g. (Use the greater amount for the latter.) These tonify Qi and generates body fluids. They are the supreme Qi or energy tonics used in TCM. The principle of this formula used to treat lower back and joint pains is called ‘root and branch’ therapy which combines herbs that tonify the underlying deficiency (root) so that the herbs that dispel Wind-Cold -Dampness which are Blood-moving and pain-relieving treat the primary (branch) symptoms. This important TCM formulation principle is unfortunately pretty much absent from Western drug treatments for these conditions which use strong antiinflammatory drugs to only relieve inflammation and pain but do nothing to treat underlying causes. (It is also absent from sensational commercial marketing of herbs such as turmeric root only for its anti-inflammatory properties.)

16. Poria mushroom (fu ling) 4.5 – 12 g. This is used to promote urination, relieve dampness, strengthen the Spleen and harmonize the Middle Warmer (digestive organs). Traditional medicines generally agree that disease begins in the GI tract from dietary habits causing weak digestion. Thus, digestion, which might be considered ‘the root of the root’ of most diseases, are treated by herbs including Poria, ginseng or Codonopsis, and honey-fried licorice root.

17. Honey-fried Glycyrrhizae praeparata (zhi gan cao) 3-6 g. This herb contributes to the Qi and digestive tonic properties but also harmonizes and relieves any of the harsh effects of the other herbs in the formula.

Modern Formulations of Du Huo Ji Sheng Tang

Active Herb’s version of this formula is called Jointsjoy.

Another version, Solitary Hermit, is manufactured and sold as part of the Plum Flower herb line.

A Planetary Herbal formulation based on this formula and widely used in my clinical practice is simply called Lower Back support.

Any of these three products can be used with more than relative efficacy to relieve and cure musculoskeletal pains of all kinds.