Treat Knee Osteoarthritis with Acupuncture and the Mediterranean Diet
Written by Nina Jatuparisuthiseen, L.Ac., LMT, C.SMA
The Evidence-Based Integrative Treatment Approach to Knee Osteoarthritis;
The Effect of Acupuncture and the Mediterranean Diet
In Traditional Chinese Medicine, the Bi syndrome is a complex condition characterized by pain, soreness, or numbness in muscles, tendons, and joints. It is often associated with dampness, wind, and cold invading the body, but one will predominate over the others, leading to intricate blockages in the flow of qi and blood. Treatment for Bi syndrome in TCM typically involves addressing the underlying pattern of disharmony through acupuncture, electro-acupuncture, moxibustion, herbal medicine, and other TCM modalities, highlighting the depth of the condition and the need for comprehensive treatment.
Etiology and Pathology
External factors include pathogenic wind, cold, and dampness invading the muscles, joints, and meridians. For example, people have been wearing shorts on cold rainy days for many years, wearing wet clothes for a long period of time, and working outdoors in a cold, wet environment where the knees are exposed.
In Chapter 43 the Bi Syndrome of Su Wen (Plain Questions), a part of The Yellow Emperor’s Canon of Internal Medicine (BC475-221), said that ‘if pathogenic wind, cold and dampness invade the body together, it will lead to obstruction in the meridians and Bi syndrome may take place’. Clinically, we can also see that Bi syndrome is more common in the areas where the weather is cold, wet and windy.
Internal factors include the body's overall weakened state and the defensive qi. This issue could result in the weakening of defense qi and skin and pore function, as well as diminished resistance to external factors. Pathogenic wind, cold, and dampness entering the body can thus easily cause Bi syndrome; this was described in the book -Prescriptions for Succouring the Sickness / Ji Sheng Fang, by Dr YAN Hong-he, in 1253, which stated that ‘it is because of weakness of the body with poor function of defensive qi that invasion of pathogenic wind, cold and dampness can result in Bi syndrome.
Clinically, Bi syndrome is classified into six different types: Wind Bi, Cold Bi, Dampness Bi, Heat Bi, Blood Stasis Bi, and Heart Bi syndrome.
However, Individual differences exist in body composition; for instance, among individuals living with a similar illness, some get Bi syndrome symptoms, while others are unaffected. After developing wind-cold-dampness type Bi syndrome, patients may progress to heat type Bi syndrome if they have accumulated heat and naturally surplus yang. Furthermore, the basic pathophysiology of Bi syndrome blood stasis type may change if pathogenic wind, cold, and dampness remain in the meridians and create an obstruction for an extended period. This explains why blood stasis type is a common clinical manifestation of Bi syndrome in some long-term patients.
Bi Syndrome in Western Medicine
In Western medicine, many diseases may manifest as Bi Syndrome, but mostly seen in a variety of disorders, such as:
Osteoarthritis is usually one-sided and caused by degenerative joint disease, in which the joint tissue breaks down over time.
Rheumatoid arthritis is a chronic autoimmune disorder that causes bilateral pain. It occurs when the immune system attacks its tissues.
Knee osteoarthritis: It is more common in men before age 45 and more common in women after age 55. A chronic joint disease that causes synovial inflammation, subchondral bone disease, articular cartilage degeneration, and reduced mobility in the affected knee joint.
Fibrositis, gout, neuralgia, lupus and others
I have chosen knee osteoarthritis as the pain condition to discuss. Research on the effectiveness of acupuncture for knee osteoarthritis has shown promising results. Several studies have demonstrated that acupuncture can relieve pain, improve joint function, and reduce inflammation in individuals with knee arthritis.
TCM Treatments
According to Shi, G. X., Tu, J. F., Wang, T. Q., Yang, J. W., Wang, L. Q., Lin, L. L., Wang, Y., Li, Y. T., & Liu, C. Z. (2020). Effect of Electro-Acupuncture (EA) and Manual Acupuncture (MA) on Markers of Inflammation in Knee Osteoarthritis. Journal of pain research, after eight weeks, both EA and MA significantly reduced pro-inflammatory cytokines, and cartilage degradation biomarkers increased the anti-inflammatory cytokine compared with pre-treatment (p<0.05).
Acupuncture points
At 6-7 local locations, needles were inserted, which included ST34 (Liangqiu), ST35 (Dubi), ST36 (Zusanli), Heding, Neixiyan, GB33 (Xiyangguan), GB34 (Yanglingquan), SP9 (Yinlingquan), SP10 (Xuehai), LR7 (Xiguan), LR8 (Ququan) and ah shi points, and at 2–3 distal points, which included GB31 (Fengshi), GB36 (Waiqiu), GB39 (Xuanzhong), GB41 (Zulinqi), ST40 (Fenglong), ST41 (Jiexi), LR3 (Taichong), BL60 (Kunlun), SP6 (Sanyinjiao) and KI3 (Taixi). In the EA group, an electrical apparatus (HANS-200A acupoint nerve stimulator, Nanjing Jisheng Medical Co, Ltd.) producing a density wave with a frequency of 2/100Hz was connected to the needles with alligator clips to stimulate pairs of needles inserted at ST36- GB34 and ST34-SP10. The fixed current intensity was uniformly 0.2 mA. In the MA group, needles were inserted at the same points, but no current was passed. The middle wire was cut, although the unit's appearance was identical. EA and MA therapies are eight weeks long, with 24 sessions lasting thirty minutes each (typically three sessions each week).
Mediterranean Diet
Diet Advice for Knee Osteoarthritis
According to Wei, N., & Dai, Z. (2022). The Role of Nutrition in Osteoarthritis: A Literature Review. Clinics in geriatric medicine, More than 250 million people worldwide currently suffer from hip and/or knee OA, with the prevalence of OA rising due in large part to the world's aging population and high rate of obesity.
Obesity can have a significant impact on your knee joints. The excess weight puts added stress on the knees, leading to increased wear and tear on the joint tissues. This can contribute to the development and progression of knee osteoarthritis. The added pressure on the knees from excess body weight can also exacerbate pain and reduce mobility, making it harder for individuals to engage in physical activity, which is crucial for maintaining joint health. Maintaining a healthy weight is important for reducing the risk of knee joint damage and managing conditions.
Studies on animals have suggested that high levels of iron and copper may be harmful to the synovial membrane and cartilage, while evidence on polyunsaturated fatty acids, vitamin D, vitamin K, and antioxidants (vitamins C, E, and selenium) may have some positive effects on cartilage, pain symptoms, and structural parameters related to osteoarthritis (OA).
A well-balanced diet that emphasizes foods high in dietary fiber or the Mediterranean diet, which is high in polyunsaturated fats, fruits, and vegetables, may help prevent and manage OA in addition to improving metabolic health, as suggested by the significant causal relationship found between weight loss and OA.
Conclusion
In summary, I have seen many patients with this condition, and I recommend they apply the Mediterranean diets. The multifaceted approach of Traditional Chinese Medicine, particularly acupuncture, has shown considerable promise in the management of knee osteoarthritis. By addressing the underlying mechanisms of inflammation and cartilage degradation, acupuncture offers a valuable therapeutic modality for individuals suffering from this condition. Furthermore, the integration of acupuncture with weight loss and an anti-inflammation diet can form a comprehensive treatment plan for knee osteoarthritis, providing patients with a holistic approach to managing their symptoms and improving their overall quality of life.
References
Bonakdar, R. A., & Sukiennik, A. W. (2016). Integrative pain management. Oxford University Press.
Sangdee, C., Teekachunhatean, S., Sananpanich, K., Sugandhavesa, N., Chiewchantanakit, S., Pojchamarnwiputh, S., & Jayasvasti, S. (2002). Electroacupuncture versus diclofenac in symptomatic treatment of osteoarthritis of the knee: a randomized controlled trial. BMC complementary and alternative medicine, 2, 3. https://doi-org.pacificcollege.idm.oclc.org/10.1186/1472-6882-2-3
Shi, G. X., Tu, J. F., Wang, T. Q., Yang, J. W., Wang, L. Q., Lin, L. L., Wang, Y., Li, Y. T., & Liu, C. Z. (2020). Effect of Electro-Acupuncture (EA) and Manual Acupuncture (MA) on Markers of Inflammation in Knee Osteoarthritis. Journal of pain research, 13, 2171–2179. https://doi-org.pacificcollege.idm.oclc.org/10.2147/JPR.S256950
Wei, N., & Dai, Z. (2022). The Role of Nutrition in Osteoarthritis: A Literature Review. Clinics in geriatric medicine, 38(2), 303–322. https://doi-org.pacificcollege.idm.oclc.org/10.1016/j.cger.2021.11.006
Zhang, En-qin. (2010). Bi Syndrome (Arthralgia Syndrome). Journal of traditional Chinese medicine = Chung i tsa chih ying wen pan / sponsored by All-China Association of Traditional Chinese Medicine, Academy of Traditional Chinese Medicine. 30. 145-52. 10.1016/S0254-6272(10)60032-5.