Chinese medicine functional diagnosis: An integrative insight to understand rheumatoid arthritis of the hand

Introduction: Chinese medicine (CM), may provide insights into understanding the neuro-immunological mechanisms involved in Rheumatoid Arthritis (RA). The objective of this study was to ascertain if objective assessment strategies could help to determine CM functional diagnosis and if the complicated issues surrounding the symptoms of RA of the hand could be more easily understood by using the Shang Han Lun. Methods: First, 190 RA patients were stratified into two groups: (1) “hand pain worsened by handgrip” or (2) “hand pain worsened by thumb resistance”. Second, a CM diagnosis of patients with “hand pain worsened by handgrip” was performed, obtained through inspection, auscultation, interrogation and palpation. Third, clinical features based on data from tongue-diagnosis were assessed by two CM doctors. Results: (1) 79.5% of the participants showed worsening hand pain by handgrip; (2) all these patients showed concomitant presence of imbalances and intermingled symptoms; (3) clinical findings of the invasion of the pathogen agent algor/“cold” were: cold hands (62.9%), tearing and localized pain with gradual onset (82.9%), worse pain upon cold exposure (82.9%), pain relief by applying warmth to the affected area (62.9%), tongue exhibiting a hyaline (85.7%) and white coating (52.4%). Conclusions: This study provides new options for assessing the CM diagnosis, which may improve RA treatment strategies. Identification of joint non-related symptoms and pathogenic external factors such as algor/“cold” may help understanding activation of specific immunological mechanisms, changes of capillary endothelium and the microcirculation disturbances. Overactivation of the functional defence mechanisms by algor/“cold” seem to be of utmost importance for RA symptoms.