Research the construction and mechanism of various joints within the body including knees, shoulders, hands and feet. Look at structures, degeneration and auto-immune conditions. What herbs and protocols are useful for these conditions?
The knee contains synovial, hinge and gliding joints. The lower (distal) end of the femur meets the upper (proximal) ends of the tibia and fibula. There is also a kneecap or patella. Synovial joints have a space between the articulating surfaces and these articulating surfaces are characteristically covered by smooth cartilage. Synovial joints are surrounded by the sleeve like Articular Capsule, which allows a certain amount of movement. The lining of the capsule is called the Synovial Membrane and this secretes synovial fluid which lubricates the joint and provides nourishment to the cartilage. Ligaments surround the joint giving stability.
The shoulder joint is formed by the head of the humerus fitting into the glenoid cavity of the scapula and it is a ball and socket joint, the head of the humerus being the ball. There is an Articular Capsule around the joint which is surrounded by many ligaments; the shoulder has a wide range of movement.
The bones in the hands consist of carpals which are nearest to the wrist, metacarpals which extend towards the fingers and then the phalanges of the fingers. The joints between the carpals are gliding synovial joints which have flat articulating surfaces. The joints between the phalanges are hinge joints and bend as a hinge would. At the base of the thumb between the carpal and metacarpal is a saddle joint. One bone is saddle shaped and the other is shaped like a rider sitting on it.
The feet have tarsal bones nearest to the ankle and the long bones leading towards the toes are metatarsals. The toe bones are phalanges like the fingers. The intertarsal joints are synovial gliding joints and the toes have hinge joints.
Rheumatism – refers to any painful state of the supporting structures of the body such as bones, ligaments, tendons and muscles.
Arthritis – is a form of rheumatism in which the joints have become inflamed, there are three main types:
Rheumatoid Arthritis (RA) is an autoimmune disease where the body attacks the cartilage and joint linings leading to swollen joints, reduced function and pain. Treatment is aimed at reducing pain and inflammation and can include anti-inflammatory drugs, steroids, exercise, physiotherapy, heat and if the joint is badly damaged, surgery.
Todd Caldecott says treatment of RA in the Western herbal tradition focuses on measures to restore digestion, promote elimination and restore integrity to the joints. Bitters like Gentian are used for digestion and can be used with carminatives such as Caraway or Fennel to improve digestion. Diuretics such as Birch leaf are used to enhance elimination from the kidneys. Alteratives and cholagogues are used including Burdock and Dandelion. Circulatory stimulants like Ginger increase circulation in the joints and reduce stagnation. For joint restoration look to herbs with high mineral content, Seaweed, Nettle and horsetail.
This form of arthritis is more common and less damaging than RA and occurs with aging, joint irritation and wear and tear. Cartilage in the joints is worn away to leave bone surfaces, spurs grow on the bone into the joint space which causes pain and reduces movement. There is not the inflammation seen in RA and it strikes the big joints first unlike RA which attacks small joints first.
David Hoffman says anti-rheumatics will usually help but their selection must be based upon a sound therapeutic rationale, a traditional European remedy is the Nettle both internally and externally by stinging the affected joints. Other specifics are Bogbean or Buckbean and Devils Claw. He sees anti-inflammatory herbs as fundamental as their use will not only ease symptoms but helps to stop degenerative changes to bony tissue. In O.A., the salicylate based herbs are especially helpful such as Willow bark and Meadowsweet. Other anti-inflammatories include Angelica and Devils Claw. Circulatory stimulants and rubifacients will help improve healing by increasing the blood supply to the area. Analgesic herbs may ease the pain but the problem will still be there. For the stress of living with constant pain and discomfort nervines such as celery seed might help which is also anti-spasmodic and diuretic. Hypnotics could help if sleep is disturbed by pain. Hoffman suggests using diuretics such as Celery seed and Yarrow to help the kidneys and for the bowels, bitters or hepatics such as Yarrow and Devils Claw to help support the other body systems.
Uric acid, a waste product of the body, builds up in the blood and forms crystals in the cartilage of the joints causing acute pain, swelling and inflammation. If not treated the ends of bones fuse together and the joint is immovable. This is most common in middle-aged and older men and has been linked to genetics, a rich diet, stress, climate and environmental factors. A chemical called colchicine, derived from the saffron or Autumn Crocus, has been used since the sixth century to reduce pain, swelling and tissue destruction. Other drugs used are for the purpose of reducing the production of uric acid. Rest and anti-inflammatory medication can bring relief.
David Hoffman says that diuretic herbs are important as they can flush the urates from the body. Sometimes the build-up of uric acid is due to poor kidney function. The only anti-rheumatic herbs that could help are those with diuretic properties such as Celery seed. Anti-inflammatories may help in small amounts but Hoffman says the inflammation is an appropriate body response which once again, in conventional medicine we would try to reduce. He says that legal herbal analgesics do not have much effect in gout. Generally, elimination needs to be good or support given to the liver and kidneys.
Todd Caldecott does advocate anti-inflammatories in a bid to restore joint function; he mentions Black Cohosh (Actaea racemosa), Wild Yam (Dioscorea villosa), Ash (Fraxinus excelsior), Liquorice (Glycyrrhiza glabra), Lignum Vitae (Guaiacum officinale), Devil’s Claw (Harpagophytum procumbens), Buckbean (Menyanthes trifoliata), Trembling Aspen (Populus tremuloides), Tanacetum and Ashwagandha (Withania somnifera). As topical rubefacients applied topically as a poultice, medicated oil, or volatile oil in joint oedema with little indication of active inflammation, he includes Ginger (Zingiber), Cayenne (Capsicum), Mustard seed (Brassica spp.), Peppermint (Mentha piperita) and Jimsonweed (Datura).
Richard Mabey inThe New Age Herbalist suggests a recipe for gout; 1 part each of Burdock root, purple cone-flower, Birch leaves, Centaury and Devils Claw and ½ part of Celery seed.
|Purple Cone-Flower or Echinacea|
General Arthritis Information
Richard Mabey says that in all forms of arthritis treat the person not the condition. Nutrition is important to make sure all the nutrients are there for repair. He says anti-inflammatories such as Bogbean are important for all types of arthritis. A decoction of Devils Claw three times a day for six weeks could reduce inflammation.
Mabey also says arthritis may be triggered by chronic anxiety and tension; herbs to nurture the nervous system include Cramp bark, Wild Oats, Skullcap and Vervain. Local remedies include Capsicum plasters or Cabbage and Comfrey poultices which stimulate circulation and encourage healing.
Paul Bergner points out that herbal treatment will take weeks to start to have an effect. The main herbs he uses in the treatment of arthritis are Alteratives, Mild Diuretics, Laxatives, and Nutritive herbs. Alteratives are tonic herbs to restore a normal balance to the system. Alteratives also act at cellular level to restore balance. Three alteratives suggested for long term use in arthritis are Dandelion, Nettle, and Burdock; they need to be taken for at least 6 weeks. Dandelion and Nettle have diuretic properties. Juniper is also good for use in arthritis as it also a bitter principles to help the digestive system; it should not be used with kidney disease or during pregnancy. Bergner says the theme of natural treatment for arthritis should be to “nourish, build and tonify”. Nettle has nutritive, alterative, and diuretic qualities. Another nutritive herb with mild diuretic properties is Alfalfa.
Chanchal Cabrera says correct nutrition and detoxifying the body are important. Alterative herbs suggested are; Yellow dock, Barberry, Pokeroot, Burdock, Nettle, Kelp and Cleavers. Cabrera only uses diuretics which encourage uric acid removal; Celery, Parsley and Birch. Cabrera says that herbal anti-inflammatories do not supress natural processes and there is a variety of sources; salicylic anti-inflammatories include Willow, Meadowsweet, Poplar and Black Haw; saponin containing herbs promote production of anti-inflammatory cortisol from the adrenal glands, these include Liquorice, Wild Yam and Black Cohosh; volatile oil containing herbs for example bisabolol and chamaezulene in Chamomile are present in chamomile; fatty acids lead to reduced inflammation and are in Evening Primrose, Blackcurrant and Borage; plant resins can have an anti-inflammatory effect on joints and are present in Devil’s Claw, Bogbean and Arbor Vitae. I found this really useful in understanding how herbs that are anti-inflammatory work and realised there are many different ways in which they work.
Sprains and Strains
Sprains occur when the joint is wrenched or twisted beyond its usual capacity causing damage to blood vessels, muscles, tendons, ligaments or nerves. A strain is the over stretching of a muscle. Symptoms include pain, inflammation and reduced movement, severe sprains can be so painful that the joint cannot be moved.
Kiva Rose has her Choice Injury Herbs; Comfrey is excellent for ligament damage on intact skin; she favours Goldenrod over Arnica for pulled or strained muscles; Plantain is healing and pain relieving for sprains and Snakeweed is advocated for arthritis and sprains but I don’t know of it in Britain.
A common knee injury occurs in footballers after a knock to the side of the knee which can rupture ligaments and tear cartilage.
Todd Caldecott explains how nutrients from food rather than supplements are beneficial for sporting injuries and minerals obtained from seaweed, horsetail and seaweed can help prevent and treat them. Having worked in trauma and orthopaedics for 16 years I am very aware of the routine treatment for joint injuries of ice, compression and anti-inflammatories but Caldecott says this can lead to chronic problems, to get the area to heal we need to encourage blood flow to the area. In Traditional Chinese Medicine (TCM) rubefacient liniments are used on intact skin. Ayurvedic medicine uses specialised massage, medicated oils and yoga for injuries. In my aromatherapy practice I massage rubefacient essential oils into specific areas. In Western herbalism Caldecott states arnica is used to promote circulation and reduce inflammation; Chickweed, Selfheal, Comfrey, St John’s Wort and Calendula for bruising; St John’s Wort and Cow Parsnip root for pain; Hawthorn, Rosehips and Bilberries for tissue healing. Caldecott lists John Christopher’s Bone, Flesh and Cartilage formula to be used internally or externally in appropriate preparations with equal parts of the following:
•Oak bark (Quercus alba)
•Marshmallow root (Althaea officinalis)
•Mullein herb (Verbascum thapsus)
•Wormwood herb (Artemisia vulgaris)
•Lobelia herb (Lobelia inflata)
•Skullcap herb (Scutellaria lateriflora)
•Comfrey (Symphytum officinalis)
•Black Walnut leaf (Juglans nigra)
•Gravel root (Eupatorium purpurea)
Housemaid’s Knee or Carpet Layer’s Knee otherwise known as Bursitis can occur after spending a great amount of time kneeling. The bursa is made of smooth connective tissue which helps the joint to glide. It can also occur in other joints such as the elbow (Tennis elbow) and shoulder. Symptoms include pain, swelling and reduced movement. Bursitis can also be caused by trauma, infection or rheumatoid arthritis.
Again, David Hoffman has good information; the main herbs for pain relief will be anti-inflammatories and anti-spasmodics. Salicylate anti-inflammatories include Meadowsweet and Willow bark and a general anti-inflammatory and anti-spasmodic is Celery seed. Again local blood circulation can be increased by using rubefacients.