Overview
Rheumatoid arthritis is a chronic systemic autoimmune disease which is characterized by non-pyogenic inflammation of most joints, especially the small joints. The chief clinical symptoms are pain and dysfunction of the joints on the early stage, deformity and stiffness of the joints resulting in loss of function on the advanced stage. In TCM, it is included in “acute arthritis”、"rheumatism involving the bone" and so on. It is caused by stagnation of the meridian and collateral, blood and qi due to the defensive qi fails to consolidate the skin with invasion of pathogenic wind, cold or damp, or caused by retention of sticking dampness and phlegm in the bones and joints due to qi stagnation and blood stasis with long duration, dampness gathers into phlegm. The principle of acupuncture therapy is expelling pathogenic cold by warming the meridian, activating the blood circulation and dredging the meridians, eliminating phlegm and removing the stagnation.

Treatment
1. Ashi Point
Bee-acupuncture therapy is applicable on the Ashi point of the affected site. ① Sting therapy. After routine sterilization on local skin, pinch the bee's chest with a pair of tweezers. The tail part is placed closely to the point; the sting should be inserted naturally. Remove the bee away. The needle is retained for 15 minutes before withdrawing. 1-2 bees are used for treatment on the first day. One more bee is added each day; define the quantity of bees according to conditions and reactions. Usually 10-20 bees could be used in one day. The treatment is applied once every day or every other day, 15 times for one course, and continuous courses are applicable. ② Bee toxin injection therapy. Before point injection, intramuscular injection 0.5 mg is used. Observe systemic and local reactions. Without pathological reaction, point injection is applicable. Injection 0.5 mg is used each day, and the dose should be increased gradually according to the patients’ conditions and constitution. 3 months for one course, continuous courses are applicable. The dose of bee toxin should be kept below 3 mg each day. 5 mg could be used as the maximum dose.

2. Zusanli (ST36)
Guiding qi by concentrating attention and producing heat by qi gathering therapy is applicable. After routine sterilization, a needle is inserted in 1 cun. Manipulation is done until getting arrival of qi. Defend meridian-qi cautiously with concentrating on the needle tip. The needle is inserted slowly and withdrawn quickly by lifting and thrusting 3-5 times with small amplitude. It is ended by thrusting the needle without distinction of heaven, human body, and earth part. Rotate the needle slightly toward the heart direction about 1800 with the thumb. Hold the needle handle tightly while keeping the needle body perpendicularly without vibration. Concentrate on the needle tip, the meridian-qi is guided to conduct to the affected site. So heat is produced by qi gathering. This therapy is used on the early and middle stage of rheumatoid arthritis. The treatment is applied once every day, 20 times for one course.

3. Jiaji Point (EX-B2)
Point injection therapy is applicable. 3-4 Jiaji points of Huatuo or Ashi points are selected. After routine sterilization on local skin, draw Zhengqingfengtongning lotion with a 5 ml injector which is inserted into the points quickly until getting arrival of qi. The lotion is injected in without feedback of blood. The treatment is applied once every day. The dose should be kept below 4 ml each time, about 1 ml for each point. 10 times for one course, 3 courses might be needed.

Note
Rheumatoid arthritis is an intractable disease which is better to be diagnosed and treated on the early stage. Acupuncture therapy has good effect with application of special method or manipulation.