Case Study
[Case study] A 45-year-old man with severe pain due to rheumatoid arthritis
31
Oct
Oct
The patient, male, European, 45 years old, of medium build, complained of severe pain caused by rheumatoid arthritis. The patient experienced pain starting from swelling and pain in the joints of the feet in the three months before the visit, and rapidly developed to large areas of joint pain and swelling in the wrists, fingers, knee joints and other areas of the whole body. The pain is severe, and the pain index still reaches the level of 7-8/10 when taking the western medicine Celecoxib for pain relief. Before the first visit to me, he was injected with steroids by a Western medicine specialist, so the pain level was significantly reduced. According to the specialist, the steroid is effective for six weeks, which means injections are possibly needed every six weeks to control pain. The patient’s grandmother used to take an increasingly large number of medicines for life term because of gout, so he strongly hopes to solve the pain through traditional Chinese medicine. The patient usually has severe pain in the morning, relieves a bit after exercise, then turns to peak pain in the afternoon, and wakes up in the middle of the night. Local joints are painful, swelling, with a hot sensation, and stiffness with movement. The body, especially the back, is heavy and cold feeling. The patient is in low emotion and easily gets grumpy. The stools are normal, and the mouth is slightly dry. There is a long and deep crack in the middle of the tongue, the tip of the tongue is reddish, the tongue colour is medium and slightly pale, the root of the tongue has a greasy coating, and the tongue surface is uneven. The pulses of both hands are deep, late, tight and a bit strong.
According to Chinese medicine, it is diagnosed as Bi syndrome. The migratory pain indicates wind, and the tongue and pulse indicate cold and dampness. Therefore, its pathogenesis is in line with the characteristics of Bi syndrome’s wind-cold-damp in traditional Chinese medicine, and at the same time, it is accompanied by mild heat and blood stasis and qi stagnation. Although the diagnosis was clear, the treatment of this patient was quite complicated. On the one hand, he is currently using steroids to control pain, so his strong pulse does not reflect his real pulse; second, according to previous treatment experience, after steroid treatment, the difficulty of treatment by natural herbs will be significantly increased; Third, in the early stage of treatment, the patient have not been able to fully adjust his living habits. For example, improper exercise in the cold and humid winter will make the external cause of wind, cold and dampness unavoidable. Fourth, from the perspective of the tongue, the patient’s spleen and stomach are seriously hurt, which is the root cause of the disease and will have a significant impact on the long-term efficacy.
Therefore, although the patient’s pain was reduced (4-5/10) in the early stage of treatment, the progress was relatively slow. After the six-week validity period of the first steroid injection, the patient’s pain index suddenly rose, and then another injection was given. The result of stressing symptoms with steroids is that they are likely to be constantly backlashed. But since then, I have asked the patient to strictly adjust his lifestyle, avoid external stimulation, and insist on taking herbal medicines. After that, the pain index decreased gradually, and the pain area was limited to the bilateral wrists and fingers. After continuous treatment for the first four months and intermittent treatment for the next two months, the pain completely disappeared, and in the meantime, the patient also did not inject or take any other medication.
The following summarizes the treatment from several aspects.
First, “persistence” is the key to the success of treatment. First of all, the patient’s own persistence and trust is the key to the sequential development of treatment. The treatment of some difficult and complex diseases often has a stagnation period, which sometimes occurs in the early stage of treatment, and sometimes occurs in the middle or late stage. This stagnation period is a critical period for the patient’s body to repair and adjust itself and fight against evils. Once patients get through this period, the therapeutic effect will improve by leaps and bounds.
On the other hand, the success of this treatment also depends on the persistence of the TCM doctor. This persistence is reflected in the persistence in grasping the core pathogenesis. If we, as doctors, are not determined and see that the patient’s treatment is progressing slowly, we then change the prescriptions frequently. In the end, we will not be able to stick to the most correct direction to see the curative effect.
Second, the complexity of the pathogenesis is also an important factor in the difficulty of treatment. When the patient was young, he did not pay attention to the maintenance of the spleen and stomach, and once had serious spleen and stomach problems. Although the symptoms disappeared after treatment, the damage to the spleen and stomach was an important internal cause of the accumulation of dampness and cold. At the same time, the patient’s mood-related problems of liver-qi stagnation and blood stasis will comprehensively affect his treatment. Although all the patient cares about is the pain issue, the factors behind are quite complex. From the level of treatment, in addition to the cause of wind-cold-dampness-induced Bi, it is also necessary to look at deeper qi and blood problems before the goal of medium- and long-term cure can be achieved.
Third, I want to emphasize the integrity and relevance of treatment. Chinese medicine has always emphasized that we need to adjust the overall balance of yin, yang, qi and blood in the body. Therefore, the treatment can not only focus on a certain disease in Western medicine, but all the signals that appear in the patient’s body. In addition to the treatment of Bi syndrome, the patient’s emotional problems caused by liver-qi stagnation must be included in the treatment at the same time. It is reflected in the patient’s pulse and becomes one of the pathogenesis. If it is not adjusted, the circulation of the patient’s qi will be blocked. In the late stage of treatment, the patient’s pulse appeared with a cold syndrome, which was reflected in Hayfever. This problem arises and must be intervened at the same time, not as an unrelated symptom. why? Because the exterior cold is kind of cold, it is also an important part of the patient’s overall pathogenesis. When the cold has the opportunity to rise to the surface from the inside, it also opens the channel of the patient’s body surface to expel the cold. At the same time, it is also a sign that the disease position improves from the deep inside to the exterior level. Therefore, I advised him that we should use traditional Chinese medicine to relieve the cold, and not take anti-allergic drugs to inhibit the body’s natural energy, so as to maintain the smooth flow of the body’s overall disease elimination channel. The patient was in complete remission from hay fever after taking just one day dose.
Overall, although the goal of our treatment is to significantly improve the patient’s pain, and this goal has been achieved, our core treatment goal is to restore the energy level of the patient’s body to a state of yin and yang balance. Therefore, the treatment of traditional Chinese medicine can not only focus on a certain disease, but on the height of improving a patient’s overall health and wellbeing. Therefore, we often see that after treatment, not only the patients’ main complaints are improved, but their other problems will also improve. For this patient, his cold back, low back pain, weak digestive system, hay fever, and emotional problems have been effectively relieved. This reflects the core concept of traditional Chinese medicine that we treat people as a whole, not diseases, and we regulate diseases by treating people.
Case NO.084
Note: TCM doesn’t ‘treat’ any certain WM disease name. TCM has its own system and method to rebalance the human body, release the symptoms and help the body truly recover on its own. TCM treatment methods and effects are different according to individual differences, and the sharing of the case study does NOT constitute treatment recommendations.
