Outline:
Degenerative arthritis is a chronic articular disease characterized by degeneration of articular cartilage and secondary hyperosteogeny. It occurs when the tendon and bone are deprived of nourishment and warmth or circulation of qi and blood is blocked, with the symptoms of arthralgia and joint dysfunction. It generally results from the insufficiency of the kidney with marrow deficiency, yang deficiency with cold accumulation, and qi stagnation with blood stasis. The disease may be classified into secondary and the primary ones. The secondary cases mostly follow the congenital or acquired deformity of joint, articular injury and arthritis; the primary cases often occur in old people, and commonly in weight-bearing joints such as cervical spine, lumbar spine, hip, knee and ankle joints.

Major points for diagnosis
1. There is a history of articular trauma or disease in the case of secondary degeneration.

2. The onset is slow. At beginning, there is arthralgia, which gradually gets worsened and attacks frequently. In the severe cases, it is a persistent dull pain with limitation of joint movement, or with obvious swelling. When the attack is mild, it is a discomfort of joint or vague pain, which is obvious after movement and relieved after rest. During the intermission stage, there is generally no obvious symptom.

3. There is tenderness around the joint. In some joints there may occur hydrarthrosis. A crepitant rales or crepitation or a rough rub can be heard or felt in examination of the joint. Ankylosis may be found in the long-standing cases.

4. X-ray film can show stenosis of joint space, increase in bone density below the cartilage, labial hyperosteogeny at the margin of joint. At the late stage, epiphysis may become malformed and intra-articular corpus liberum may be found in some cases. CT and MRI examinations can help to establish a definite diagnosis.

Herbal therapy
Internal treatment based on syndrome differentiation
(1) Syndrome of insufficiency of the kidney with marrow deficiency

Main symptoms and signs:
Vague arthralgia, impaired movement, soreness and weakness of the waist and knee, dizziness, vertigo, tinnitus, deafness, pale tongue
with little coating, and thready pulse.

Therapeutic methods:
Nourishing kidney yin, replenishing the essence and marrow.
 
Recipe and herbs:
Modified Liuwei Dihuang Decoction. Specifically, Shudihuang (Radix Rehmanniae Praeparata )  15 g,  Huaishanyao ( Rhizoma Dioscoreae ) 12 g, Shanzhuyu (Fructus Corni) 12 g, Zexie (Rhizorna Alismatis ) 10 g, Fuling ( Poriae ) 10 g, Heshouwu (Radix Polygoni Multiflori ) 10 g, Xuanshen ( Radix Scrophulariae ) 10 g, Huangjing ( Rhizoma Polygonati ) 10 g, Huainiuxi (Radix Achyranthis Bidentatae ) 10 g and Gancao (Radix Glycyrrhizae ) 3 g.

(2) Syndrome of yang deficiency with cold accumulation
Main symptoms and signs:
Pain in the limb joints with heavy feeling worsened in nighttime and cold days and relieved in daytime and warm days, and impaired movement of flexion and extension, soreness and cold in the waist and knee, pale tongue with white coating, deep, thready and forceless pulse.

Therapeutic methods:
Tonifying the kidney and strengthening yang, dredging collaterals and expelling cold.

Recipe and herbs:
Modified Jingui Shenqi Pill. Specifically, Shudihuang (Radix Rehmanniae Praeparata ) 25 g,  Huaishanyao  ( Rhizoma  Dioscoreae )  12 g, Shanzhuyu (Fructus Corni) 12 g, Zexie (Rhizoma A1ismatis) 10g, Fuling (Poriae) 10g, Rougui (Cortex Cinnamorni Cassiae ) 10 g, Zhifuzi ( Radix Lateralis Aconiti Praeparata) 10 g, Xianmao (Rhizoma Curculiginis Orchiodis ) 10 g, Yinyanghuo ( Herba Epimedii ) 10 g, Weilingxian (Radix Clematidis ) 10 g and Gancao (Radtix Glycyrrhizae ) 3 g.

(3) Syndrome of blockage of stagnant blood
Main symptoms and signs: Fixed stabbing pain in the limb joints, deformity of joint with impaired movement, or hunchback, dark complexion, cyanosis of lips and tongue, deep or thready-choppy pulse.
 
Therapeutic methods:
Promoting blood flow to remove the stasis, dredging collaterals to stop pain.
 
Recipe and herbs:
Modified Bushen Huoxue Decoction. Specifically, Shudihuang (Radix Rehmanniae Praeparata) 25 g, Shanzhuyu (Fructus Corni) 12 g, Danggui ( Radix Angelicae Sinensis ) 10 g, Danshen ( Radix Salviae Miltiorrhizae ) 15 g, Moyao ( Myrrha ) 10 g, Duzhong ( Cortex Eucommiaeulmoidis) 10 g, Honghua ( Flos Carthmi )  10 g, Chishaoyao ( Radix Paeniae Rubrae) 10 g, Yanhusuo ( Rhizoma Corgdalis ) 15g, Dilong ( Lumbricus ) 15 g, Oinjiao ( Radix Gentianae Macrophyllae) 10 g and Gancao (Radix Glycyrrhizae ) 3g.

External therapy:
Shangke Xiaoyan Paste is externally applied; or Goupi Plaster or Tianhe Gutong Paste is topically used; or Zhenggu Liquor is externally used; or Haitongpi Decoction is used for fumigation and bathing; or Kanli Sands is used for hot compress.

Acupuncture therapy:
Meridian points and Ashi points around the joint may be selected, with the needle retained for 20 minutes; or moxibustion is added, once a day.