Acupuncture and moxibustion alleviate rheumatoid arthritis. Research published in the Jilin Journal of Traditional Chinese Medicine finds an 83.3% total effective rate for acupuncture combined with moxibustion for the treatment of rheumatoid arthritis. Lower levels of clinical success were achieved by using acupuncture and moxibustion independently as standalone treatment modalities. However, once the researchers combined acupuncture and moxibustion into one treatment protocol, the positive patient outcome rate increased significantly.

Rheumatoid arthritis (RA) is an autoimmune disorder characterized by joint inflammation and pain. X-rays, MRIs, ultrasonography, and blood tests are useful diagnostic tools. Joint deformities due to cartilage and bone destruction demonstrate common patterns that indicate RA. For example, rheumatoid arthritis of the hands typically affects the metacarpophalangeal and proximal interphalangeal joints. The distal interphalangeal joints are often unaffected. The presence of rheumatoid factor, antibodies to cyclic citrullinated peptides, and an elevated erythrocyte sedimentation rate are common in patients with rheumatoid arthritis.

Three separate groups received therapies at a rate of five times per week for four weeks at Shunyi Hospital of Traditional Chinese Medicine (TCM). The standalone acupuncture and moxibustion study groups achieved positive patient outcomes, however, the acupuncture plus moxibustion study group demonstrated optimal clinical outcomes. Acupuncture was applied to the following acupoints:
Mingmen, DU4
Zusanli, ST36
Shenshu, BL23
Pishu, BL20
Ganyu, BL18
Quchi, LI11
Taixi, KD3
Hegu, LI4
Waiguan, SJ5
Yangchi, SJ4
Wangu, GB12
Shenmai, BL62
Kunlun, BL60
Yanglingquan, GB34

Lifting, thrusting, and rotating manual acupuncture techniques were applied to elicit deqi at the acupoints. Moxibustion was applied to the following acupoints: Mingmen, Pishu, Shenshu, Zusanli, and Wangu. Total needle retention time was thirty minutes per acupuncture treatment session. This acupuncture plus moxibustion protocol achieved an 83.3% total effective rate.

The aforementioned research of Wang et al. (2014) is consistent with the findings of Ouyang et al. (2011) whose research concludes that electroacupuncture "could effectively lower the contents of TNF-α and VEGF in peripheral blood and joint synovia to improve the internal environment for genesis and development of RA, so as to enhance the clinical therapeutic effectiveness." Manual acupuncture and electroacupuncture significantly reduced both blood and synovial joint levels of tumor necrosis factor-a (TNF-a) and vascular endothelial growth factor (VEGF) for patients with rheumatoid arthritis. However, electroacupuncture lowered VEGF more significantly than manual acupuncture.

Liu et al. (2015) took a slightly different approach to TCM for the treatment of rheumatoid arthritis and produced significant results. Liu et al. (2015) combined acupuncture with herbal medicine into an integrated treatment regimen. Acupuncture plus Dang Gui Si Ni Tang resulted in a total effective rate of 93.75%. The researchers concluded that acupuncture combined with the herbal formula Dang Gui Si Ni Tang has a "significant curative effect on rheumatoid arthritis…."

Research published in the Clinical Journal of Chinese Medicine (Wang et al., 2014) demonstrated significant positive patient outcomes but with a different herbal formula: Gui Zhi Shao Yao Zhi Mu Tang (Cinnamon Twig, Peony, and Anemarrhena Decoction). The total effective rate for acupuncture plus Gui Zhi Shao Yao Zhi Mu Tang was 95.08%. Notably, the acupuncture plus herbal medicine study group significantly outperformed a drug therapy group.

The study compared patients taking drug therapy with patients receiving acupuncture plus herbal medicine. The drug therapy group consumed a nonsteroidal anti-inflammatory drug (NSAID): diclofenac sodium (75 mg, once per day, sustained release tablet). In addition, the drug group consumed methotrexate tablets (10 mg, once per week). The total effective rate for drug therapy was 68.85% compared with 95.08% for acupuncture plus herbal. The adverse effect rate was 18% for drug therapy and only 3.2% for acupuncture plus herbs.

The study design used a semi-protocolized structure allowing for modifications of the acupuncture point prescription and herb formula. All patients received the following herbal formula ingredients:
Gui Zhi, 15g
Chi Shao Yao, 12g
Zhi Mu, 12g
Fu Zi, 10g
Ma Huang, 9g
Fang Feng, 15g
Bai Zhu, 12g
Gan Cao, 6g

Modifications were allowed for three diagnostic variables. For cases of acute symptoms, the following herbs were added to the base formula:
Qin Jiao, 12g
Shen Jin Cao, 12g
Qiang Huo, 12g

For cases of chronic symptoms, the following herbs were added:
Huang Qi, 45g
Du Zhong, 15g
Niu Xi, 12g

For cases of severe pain, the following herbs were added:
Yan Hu Suo, 12g
Lu Feng Fang, 12g
Wu Tou, 9g

The acupuncture point prescription consisted of a set of primary acupuncture points and additional secondary acupuncture points based on diagnostic variations. The primary acupuncture point prescription applied to all patients was the following:
Jinsuo, DU8
Sanyinjiao, SP6
Zusanli, ST36
Ganshu, BL18
Shenshu, BL23
Pishu, BL20

For patients with arm pain, the following acupoints were added:
Tianjing, SJ10
Waiguan, SJ5
Yangchi, SJ4
Hegu, LI4

For patients with leg pain, the following acupoints were added:
Weizhong, BL40
Dubi, ST35
Kunlun, BL60
Jiexi, ST41
Yanglingquan, GB34

The aforementioned studies indicate that acupuncture, moxibustion, and herbal medicine are helpful therapeutic modalities for patients with rheumatoid arthritis. The evidence strongly indicates that TCM therapy is a responsible and effective approach to pain management protocols for patients with rheumatoid arthritis. Given the potential severity of this condition, additional research is warranted.

References:
Wang SG, Zhao J, Yao J, Yang Y, Mao XW & Hong QY. (2014). Clinical research on acupuncture combined with moxibustion on the treatment of rheumatoid arthritis. Jilin Journal of Traditional Chinese Medicine. 34(10).

Tang ZL, Song XG, Li J, et al. (2001). Moxibustion anti-inflammatory and immunity boosting effects on pineal glands in the regulation of melatonin. China Journal of Acupuncture. 21(7): 429.

Ouyang, Ba-si; Gao, Jie; Che, Jian-li; Zhang, Yin; Li, Jun; Yang, Hai-zhou; Hu, Tian-yan; Yang, Man; Wu, Yuan-jian; Ji, Ling-ling. Effect of electro-acupuncture on tumor necrosis factor-α and vascular endothelial growth factor in peripheral blood and joint synovia of patients with rheumatoid arthritis. Chinese Journal of Integrative Medicine. 2011-07-01. Chinese Association of Traditional and Western Medicine, China Academy of Chinese Medical Sciences. 672-0415, 505- 509 v17 issue 7.

Liu Xiaoli. "Efficacy Observation on Acupuncture Combined with Danggui Sini Decoction for Rheumatoid Arthritis." Chinese Manipulation & Rehabilitation Medicine. 2015 (3), R246, 116300.