Herbal Medicine: Osteo-Arthritis

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David Hoffmann L. BSc (Hons), MNIMH ©

Primarily a disorder of hyaline cartilage and subchondral bone, though all tissues in and around involved joints are hypertrophic.

Osteo-Arthritis (Degenerative Joint Disease) is the most common form of arthritis, affecting about one out of every six Americans, including 80 percent of persons over the age of 70. Most have few, if any associated symptoms, and the disease is diagnosed only because X rays of the vertebrae show characteristic spurs or because the fingers are knobbed by bony proliferations (Heberden's nodes) at the distal interphalangeal joints. In some the spurs encroach on nerves as they emerge from the spinal canal and produce nerve-root syndromes. In others, the malpositioned joints are a source of ligamentous strain and abnormal muscular tension. The result is pain that becomes worse as the day goes on.

These degenerative processes are in part caused by wear and tear. They affect primarily weight-bearing joints and joints subject to trauma or to malpositioned anatomy. Joints damaged by other forms of arthritis are prone to later degenerative joint disease. Heberden's nodes are more prominent in the right hand of right-handed individuals and in the fingers of typists. Traumas produce microfractures in the cartilage that lines the articulating surfaces exposing raw underlying bone. The bone cells then release enzymes that destroy the protein and polysaccharide components of bone. Frayed pieces of cartilage may be taken up by white blood cells and thus add an element of inflammation.

A number of predisposing factors can hasten this degenerative process, even in young people. If these are in play then the preventive work suggested below is vital. They include:

• obesity (more stress on weight- bearing joints),
• bone deformities (abnormal mechanical forces across the joint),
• previous cartilage injury,
• joint infection,
• certain types of inflammatory arthritis (rheumatoid, gout),
• diabetes mellitus,
• acromegaly (excess growth hormone),
• repetitive occupational or exercise-related joint movements.

Osteo-Arthritis is usually experienced as aching joints and stiffness. The pain is aggravated by movement and weight-bearing on the involved joint. Although swelling may occur, warmth and redness usually imply an inflammatory-type of arthritis. The hips, knees, ankles, neck, low back and hands are the most common joints affected. Hip pain can be especially severe, making walking difficult. The fingers often develop a knobby and gnarled appearance (Heberden's nodes). Osteo-arthritis of the spine is a common cause of chronic pain and decreased neck and back mobility. In some cases, large bone spurs may compress the spinal cord or pinch its nerves.

Physical examination reveals joint enlargement, tenderness and sometimes swelling. X-rays may show narrowing of the joint space and new bone formation adjacent to the joint. Many individuals with abnormal X-rays experience few, if any, symptoms, and other types of arthritis may produce similar X-ray findings.

Actions indicated for the processes behind this disease:
Anti-Rheumatics will usually help but their selection must be based upon a sound therapeutic rationale.
Anti-Inflammatories are fundamental as their use will not only ease the symptom picture but help to stop the degenerative changes to bony tissue. In O.A., the salicylate based herbs are especially helpful.
Alteratives are the key to any attempt at transforming the systemic problem (if present). If the O.A. has its roots in physical wear and tear they will not be quite so fundamental.
Anti-Spasmodic will lessen the impact of physical friction through relaxing the muscular envelop around the arthroses.
Circulatory Stimulants will benefit the healing process through increase the flow through of blood, thus facilitating all the work this amazing tissue fulfills.
Rubefacients can be especially useful for local stimulation of circulation and inflammation reduction.
Analgesic will possibly ease the patients discomfort, but must not replace appropriate treatment.
Diuretics help the kidney do its cleansing work.
Nervines will usually be relevant because of the many ways they in which a stressed patient can benefit from such support. The relaxants also act as anti-spasmodics, the tonics will help the person deal with the constant stress of the pain and discomfort. Hypnotics will help them sleep in the face of pain.
Other Actions bitters, hepatics, expectorants, emmenagogues etc.. The whole digestive process must be working well and not damaged by side effect reactions to non-steroidal anti-inflammatories.

System Support
In addition to musculo/skeletal attention, the digestive system needs especial care. Beyond that it will depend upon the individuals specific case. Always remember the general principles of good elimination, without resorting to strenuous `purging & puking'.

Specific Remedies
Both Menyanthes trifoliata and Harpagophytum procumbens could be considered as almost specifics here. However, the multi-factorial causation must be remembered, highlighting the unlikelihood of one total specific. Urtica dioica is a traditional remedy throughout Europe, used internally and externally as a rubifacient. This external use, with fresh raw leaf, is not a treatment for the fainthearted!

One possible prescription:

Menyanthes trifoliata 2 parts
(Harpagophytum procumbens)
Filipendula ulmaria 1¹/2 parts
(Salix spp.)
Cimicifuga racemosa 1 part
Zanthoxylum americanum 1 part
Apium graveolens 1 part
Angelica archangelica 1 part
Achillea millefolium 1 part in tincture to 5ml.
three times a day
(Harpagophytum & Salix may be used as equivalent alternatives if necessary)

External treatments as indicated.

If there is any associated stomach irritation due to the harshness of the Menyanthes, then add Althaea. In this combination we are combining anti-rheumatics that provide a range of relevant actions:

• alterative remedies: Menyanthes trifoliata, Cimicifuga racemosa
• salicylate anti-inflammatories: Filipendula ulmaria
• general anti-inflammatories: Angelica archangelica, Menyanthes trifoliata, Cimicifuga racemosa
• nervine anti-spasmodics: Cimicifuga racemosa & Apium graveolens
• peripheral vaso-dilator: Zanthoxylum americanum
• diuretics: Apium graveolens & Achillea millefolium
• `stomachics', in this case carminative and intestinal anti-inflammatory :
  • Angelica archangelica, Apium graveolens
• bitter tonics: Menyanthes trifoliata, Achillea millefolium

Broader Context of Treatment
Nutritional factors are very important in the successful treatment of these problems. As has been pointed out repeatedly, there are many ideas about which foods or supplements to use for any condition, and I do not want to enter such confused debates at this stage. Whilst staying clear of such controversies, it is appropriate to focus on which foods to avoid as they definitely aggravate arthritic problems. A basic exclusion diet would Include:

• Coffee, wether decaf. or regular. * Red meat of any kind in any form.
• Vinegar and anything based upon vinegar such as pickles. Apple cider vinegar may possibly be an exception.
• Vegetables that contain high levels of plant acids. e.g. Tomatoes and Rhubarb.
• Berries rich in fruit acids such as Gooseberries, Red and Black Currants
• Refined white sugar and products that contain it.
• Refined white flour and its multitude of products.
• Artificial additives, flavorings and preservatives.
• Processed foods. * Red wine, port and sherry.
• Carbonated drinks. * Shell fish
• Any food or beverage that causes the patient specific problems.

Such diets will produce the best results in the earlier, more painful stages of this long drawn out disease. In the extreme of long standing O.A., there is a balance that must be found between nutritional dogma that might not be too effective and eating habits that have a positive psychological effect on the patient.

Attention must be given to physical aids & support for the patient who is becoming disabled by this disease. There are a wealth of simple devices available that ease the simple daily tasks of life that have become taxing for the patient. These range from specially designed kitchen devices such as cutlery, can openers and faucet grips, to brushes with extended handles and adaptations to telephones. Using such devices can ease the patients experience of life enormously.

Known as Activities of Daily Living (A.D.L.) devices, they are the field of Occupational Therapists and other physical therapy specialists. More information can be obtained through the publications of the National Arthritis Foundation and local official agencies on aging.

Whilst working in conservation and lecturing in ecology and the eco-crisis for the University of Wales, David Hoffman became convinced that to heal the world, to embrace planetary wholeness and responsibility for it......more

• on Arthritis
• on Osteoarthritis
• Herbal Medicine
• Alternative Medicine Center
• Herbal Medicine Center
• by David Hoffmann