On May 24, 2025, Dr. Ji Wei explored the pathogenesis and treatment of rheumatoid arthritis (RA) from the perspective of TCM. In addition to reviewing how TCM can complement biomedical care, Dr. Ji emphasized the importance of individualized treatment approaches for each patient. Below are key highlights from her lecture.

In accordance with TCM theory, pathogenic factors contributing to RA include both internal and external causes.

Pathogenic Factors 

• The deficiency of Vital Qi arising from improper diet, overstrain, postpartum or post-surgical states, and overall constitutional weakness.

• Exogenous pathogens such as invasion by Wind, Cold, Damp, Heat, Summer-Heat, or Dryness (the Six Exogenous Pathogens).

Mechanism of Pathogenesis:

• The disharmony of Ying-Wei Qi and Blood disrupting defensive (Wei Qi) and nutritive (Ying Qi) circulation.

• Internal Zang-Fu Organ Imbalance manifesting as yin-yang and visceral dysfunction.

• Endogenous Damp-Heat and Phlegm-Stasis pathological products arising from internal injury.

Furthermore, Dr. Ji emphasized that syndrome differentiation is at the heart of TCM practice and must focus on the patient’s subjective complaints alongside the diagnostic process:

• Collect symptoms

• Analyze patterns

• Identify the relationships between the Eight Principles and the visceral systems, channels, qi-blood-fluid

• Conduct etiological analyses

Because of this patient-centered model, treatment strategies must be individualized: “Same disease, different treatments” based on syndrome differentiation.

Treatment should also consider the Three Principal Adaptations:

• Temporal: Patient’s age and the season in which they’re treated

• Geographical: Their living and/or working environment

• Personal: Physical condition and overall constitution

Dr. Ji shared a breakdown of commonly used herbs categorized by syndrome differentiation and therapeutic focus (Note: many herbs derived from wild animals such as Wu Shao She have substitutes available - learn more at https://tawap.org/wildlife-ingredients)

Exogenous Pathogen Focus: Elimination with Differentiation

• Wind-Cold Dispersion: Fang Feng, Qi She, Gui Zhi, Zhi Fu Zi

• Heat-Damp Clearing: Yin Hua, Lian Qiao, Huang Bai, Zhi Mu, Yi Yi Ren, Bi Xie, Tu Fu Ling

• Phlegm-Softening: Xia Ku Cao, Bai Jie Zi, Ban Xia (Fa), Fu Ling, Chen Pi, Di Long

Internal Deficiency Correction: Tonification as Foundation

• Qi-Blood Regulation: Tai Zi Shen, Huang Qi, Bai Zhu, Bai Shao, Hong Zao/Da Zao

• Liver-Kidney Nourishment: Sheng Di, Nu Zhen Zi, Han Lian Cao, Wu Wei Zi, Lu Jiao Jiao, Xian Ling Pi

• Tendon-Bone Strengthening: Gou Ji, Xu Duan, Gu Sui Bu, Gui Ban, Du Zhong, Qian Nian Jian

Emphasis on Blood Circulation Promotion, Damp-Phlegm Resolution, and Channel-Unblocking Strategies

• Warm Channels, Activate Blood, and Dredge Collaterals: Gui Zhi, Xi Xin, Chuan Fu Pian, Dang Gui, Ji Xue Teng, Sang Zhi

• Qi-Tonifying, Blood-Activating, and Stasis-Resolving: Tai Zi Shen, Huang Qi, Chi Shao, Dan Shen, Hong Hua

• Wind-Damp Dispelling: Bi Xie, Yi Yi Ren, Fang Ji, Fang Feng, Qiang Huo, Du Huo, Gui Zhi

• Phlegm-Resolving and Channel-Clearing: Bai Jie Zi, Dan Nan Xing, Ban Xia, Jiang Can, Fu Ling, Chen Pi, Di Long, Zhi Shi

• Phlegm-Softening and Mass-Resolving: Mu Li, Jiang Can, Xue Jie, Chuan Bei, Kun Bu, Hai Zao

• Expel Water and Resolve Phlegm: Shang Hu, Bai Jie Zi, Fang Ji, Fu Ling, Jiao Mu, Ting Li Zi

• Wind-Searching and Channel-Unblocking: Di Bie Chong, Quan Xie, Wu Gong, Wu Shao She, Bai Hua She, Jiang Can, Di Long, Lu Feng Fang, Ma Yi

Then, Dr. Ji outlined combined strategies depending on the clinical stage and presentation of RA.

Integrative Strategies

• Damp-Heat Obstruction (Acute Exacerbation)
  Clear heat, resolve dampness, and reduce swelling:
  Cang Zhu, Sheng Yi Ren, Huang Qin, Jin Yin Hua, Zhi Mu, Gui Zhi, Fang Feng, Chi Shao, Ze Xie, Wei Ling Xian, Tu Fu Ling, Hu Zhang

• Cold-Damp Blockage (Acute Exacerbation or Chronic Activity)
  Dispel cold, eliminate dampness, and unblock channels:
  Ma Huang, Gui Zhi, Xi Xin, Zhi Fu Zi, Chuan Wu Cao, Hai Tong Pi

• Cold-Heat Complexity (Acute Exacerbation or Chronic Activity)
  Combine cold and heat treatment: clear heat, eliminate dampness, warm meridians, and transform dampness:
  Gui Zhi, Bai Shao, Zhi Mu, Lian Qiao, Yi Yi Ren, Sang Zhi, Yan Hu Suo, Ji Xue Teng

• Deficiency-Pathogen Persistence
  Tonify qi and blood, nourish liver-kidney, and activate collaterals:
  Huang Qi, Dang Gui, Sang Ji Sheng, Sheng Di, Chi Shao, Fang Feng, Yi Yi Ren, Gui Zhi, Sang Zhi, Gu Sui Bu, Mu Gua

Regarding treatment goals, Dr. Ji offered the following objectives to guide clinical practice.

Treatment Objectives

• Halt disease progression

• Maximize joint functional recovery

• Optimize pain and inflammation control

• Improve health-related quality of life

• Minimize medication toxicity and side effects

• Ensure treatment convenience, affordability, and adherence

• Prioritize patient-reported outcomes

Dr. Ji Wei’s lecture offered a clear and detailed look into how TCM practitioners can approach rheumatoid arthritis using time-tested diagnostic frameworks and highly individualized treatment strategies. While each case requires a tailored plan, these core concepts provide a strong foundation for integrating TCM into modern care for RA patients.

 

 

Don’t Miss the Final Class in the Series!

This lecture was part of the World Chinese Medicine Forum’s Top Experts from China: Rheumatoid Arthritis Series. The next class will be held on June 14, 2025 with Dr. Su Li, offering 2 PDA/CEUs. Don’t miss this opportunity to deepen your understanding of integrative strategies for RA. REGISTER NOW to secure your spot.