How to Treat Osteoarthritis with Chinese Medicine

 Tiejun Tang

Osteoarthritis (OA) is the most prevalent form of arthritis globally, affecting approximately 7.6% of the population—equivalent to around 595 million people as of 2020. The knee is the most commonly affected joint, followed by the hip and hand.^[1] In the United Kingdom, OA is a significant health concern, with an estimated 10 million people living with the condition. Among these, 5.4 million are affected by knee OA and 3.2 million by hip OA. Notably, approximately 18% of individuals over 45 in England have been diagnosed with knee OA.^[2]

Western medicine primarily focuses on managing OA symptoms rather than curing the disease. Common treatments include:

1.    Pharmacological Interventions: Nonsteroidal anti-inflammatory drugs (NSAIDs), acetaminophen, and corticosteroids are commonly prescribed to reduce pain and inflammation. However, long-term use of NSAIDs can lead to gastrointestinal, cardiovascular, and renal complications.

2.    Physical Therapy: Exercise and physical therapy are recommended to improve joint function and strengthen surrounding muscles. While effective, these methods require consistent effort and may not be suitable for all patients.

3.    Surgical Interventions: In severe cases, joint replacement surgery may be necessary. Although surgery can provide significant relief, it is invasive, costly, and carries risks such as infection and prolonged recovery.

4.    Lifestyle Modifications: Weight management and activity adjustments are often advised to reduce stress on joints. However, these measures are not always sufficient to control symptoms.

          Despite these options, many patients continue to experience pain and disability, highlighting the need for alternative or complementary therapies.

Traditional Chinese Medicine Approach to Osteoarthritis

Traditional Chinese Medicine (TCM) views OA as a manifestation of imbalances in the body, particularly involving the deficiency of liver, kidneys, and spleen. According to TCM theory, OA is often associated with "Bi syndrome" (obstruction syndrome), which arises when wind, cold, and dampness invade the body, blocking the flow of Qi (vital energy) and blood in the meridians. This blockage leads to pain, stiffness, and reduced mobility.

TCM treatments for OA aim to restore balance and promote the free flow of Qi and blood. Common approaches include:

1. Chinese Herbal Medicine

Duhuo Jisheng Decoction (DHJSD): This ancient prescription, attributed to Sun Simiao (581–682 AD) of the Tang Dynasty, is widely used in China to treat early-stage knee OA. Recent studies have shown that DHJSD: Increases the synthesis of chondrocyte autophagosomes and the expression of autophagic proteins (LC3 and Beclin-1).Reduces the phosphorylation levels of Akt and mTOR, as well as the levels of zinc, MMP-13, Bax, and Bcl-2.Inhibits the Akt/mTOR signaling pathway, promotes chondrocyte autophagy, and has a protective effect on cartilage.^[3]

Additionally, DHJSD has been found to antagonize the production of proinflammatory cytokines in human nucleus pulposus cells (hNPCs) induced by SDF-1. This suggests that DHJSD may inhibit inflammation by targeting multiple molecules in the SDF-1/CXCR4/NF-κB pathway.^[4]

The latest research in 2025 confirmed that DHJSD can repair cartilage damage in rabbits and reverse the level of inflammatory factors in joint fluid. Its therapeutic mechanism is related to the activation of TGF-β/Smad signaling pathway. This provides a reliable basis for the application of DHJSD in the treatment of cartilage damage after knee osteoarthritis.^[5]

2. Acupuncture

Acupuncture is a well-studied TCM modality for OA. A clinical study involving 442 patients with knee OA compared electroacupuncture (EA), manual acupuncture (MA), and sham acupuncture (SA). The results showed that the remission rates in the EA and MA groups were significantly higher than in the SA group.^[6]

3. Moxibustion

Moxibustion, a therapy that involves burning mugwort near the skin, has also shown promise for OA. A meta-analysis of 57 randomized controlled trials (RCTs) involving 5,149 subjects found that moxibustion and combined moxibustion therapies improved the overall effectiveness of knee OA treatment.^[7]

4. Tuina (Therapeutic Massage)

Tuina, a traditional Chinese therapeutic massage, has been reported to: Reduce knee OA cartilage tissue damage.Decrease inflammatory response and chondrocyte apoptosis.Activate the PI3K/AKT/mTOR signaling pathway, which may contribute to its therapeutic effects.^[8]

Conclusion

Osteoarthritis is a widespread and debilitating condition that poses significant challenges to patients and healthcare systems worldwide. While Western medicine provides valuable tools for managing OA, it has limitations and potential side effects. TCM offers a promising complementary approach, with mechanisms of efficacy increasingly supported by scientific research. By combining the strengths of Western and Traditional Chinese Medicine, we can provide more comprehensive and effective treatment options for osteoarthritis patients globally.

References

1.  GBD 2021 Osteoarthritis Collaborators. Global, regional, and national burden of osteoarthritis, 1990–2020 and projections to 2050: a systematic analysis for the Global Burden of Disease Study 2021. Lancet Rheumatol. 2023 Aug 21;5(9):e508-e522 .

2.  Versus Arthritis. Data and Statistics. Available at: https://versusarthritis.org/about-arthritis/data-and-statistics.

3.  Ye-Hui Wang. Duhuo Jisheng Decoction regulates intracellular zinc homeostasis by enhancing autophagy via PTEN/Akt/mTOR pathway to improve knee cartilage degeneration. PLoS One. 2024 Jan 2;19(1):e0290925 .

4.  Zong-Chao Liu. Duhuo Jisheng Decoction inhibits SDF-1-induced inflammation and matrix degradation in human degenerative nucleus pulposus cells in vitro through the CXCR4/NF-κB pathway. Acta Pharmacol Sin. 2018 Jun;39(6):912-922.

5.  Zhao Ye. Duhuo Jisheng Decoction in reduction of inflammatory response via Transforming growth factor-β/Smad signaling pathway for repairing rabbit articular cartilage Injury: A Randomized Controlled Trial. International Immunopharmacology. Volume 144, 10 January 2025, 113646

6.  Jian-Feng Tu. Efficacy of Intensive Acupuncture Versus Sham Acupuncture in Knee Osteoarthritis: A Randomized Controlled Trial. Arthritis Rheumatol. 2021 Mar;73(3):448-458.

7.  Shao Yin. An Overview of Systematic Reviews of Moxibustion for Knee Osteoarthritis. Front Physiol. 2022 Feb 3:13:822953.

8.  Zhen Wang. Traditional Chinese Manual Therapy (Tuina) Improves Knee Osteoarthritis by Regulating Chondrocyte Autophagy and Apoptosis via the PI3K/AKT/mTOR Pathway: An in vivo Rat Experiment and Machine Learning Study. J Inflamm Res. 2024 Sep 17:17:6501-6519.