Nursing Experience in Treating One Case of Cold-Dampness Obstruction Type Rheumatoid Arthritis with Medicine-Separated Moxibustion Combined with Chinese Medicine Bamboo Cupping

Yang Lin, Wen Ting, Pi Guifang
(Department of Rheumatology and Immunology, The First Hospital of Hunan University of Chinese Medicine, Changsha, 410007, China)
Corresponding Author: Pi Guifang, Email: 364924745@qq.com

Abstract

This paper presents a case report of a patient with cold-dampness obstruction type rheumatoid arthritis who was treated with medicine-separated moxibustion combined with Chinese medicine bamboo cupping. In conjunction with these traditional Chinese medicine interventions, the patient received comprehensive nursing care including dietary guidance, emotional support, daily living assistance, health education, and functional exercise training. This integrated approach effectively alleviated the patient's clinical symptoms, including pain, anxiety, and insomnia.

Keywords: Rheumatoid arthritis; Medicine-separated moxibustion; Chinese medicine bamboo cupping; Traditional Chinese medicine nursing

Rheumatoid arthritis (RA), known as "Wangbi" in traditional Chinese medicine (TCM), is a common chronic autoimmune disease with high disability potential [1]. The primary pathological feature involves chronic inflammation of the synovial membrane, which can ultimately lead to cartilage and bone damage, resulting in joint deformities and severe complications [2]. Epidemiological data indicate that RA affects approximately 0.5% to 1% of the population [3], with a higher incidence in women than in men [4]. The etiology of this disease is closely associated with multiple factors, including genetic predisposition, immune system dysregulation, infections, and environmental stimuli [5]. Furthermore, the disease is characterized by recurrent flare-ups that significantly impair patients' quality of life and psychological well-being, imposing substantial economic and social burdens [6].

Current standard pharmacological treatments for RA include biologic agents, targeted small-molecule drugs, non-steroidal anti-inflammatory drugs, and glucocorticoids [7]. While these medications can delay disease progression and improve joint symptoms, long-term use may lead to adverse effects such as gastrointestinal ulcers, osteoporosis, and compromised immunity, resulting in poor patient compliance [8].

Research has demonstrated that medicine-separated moxibustion can deliver therapeutic heat and medicinal effects directly to lesion sites, thereby alleviating inflammatory responses in RA patients, facilitating soft tissue repair, enhancing joint mobility, and improving quality of life [9]. Chinese medicine bamboo cupping therapy, which combines medicinal steam with thermal stimulation, can effectively promote metabolism, enhance phagocytic cell function, and strengthen the body's disease resistance and immune capacity [10]. The combination of these two modalities produces synergistic effects that improve joint swelling and pain while achieving therapeutic goals of warming the meridians, dispelling cold, and unblocking collaterals to relieve pain.

This article summarizes the nursing experience from one case of cold-dampness obstruction type rheumatoid arthritis, reported as follows.

1.1 General Patient Information

The patient was a 50-year-old female who presented to our Department of Rheumatology and Immunology on February 10, 2025, with a chief complaint of "recurrent polyarthralgia for over 10 years, exacerbated for over 6 months." At admission, the patient reported right knee joint pain with limited mobility, symptoms that worsened with fatigue or exposure to cold. She also experienced poor appetite and sleep, though bowel and urinary functions were normal. Tongue presentation was pale red with a thin white coating, and the pulse was wiry and thready. Past medical history included fatty liver disease.

1.2 Physical Examination

Specialized examination revealed swelling and pain in the right knee joint, no edema in both lower extremities, difficulty with squatting and standing, and a positive patellar floating test on the right side. TCM four diagnostic methods showed: Inspection—normal mental status and facial expression, rosy complexion, normal development and body type, active positioning with independent mobility, pale red tongue with white coating; Auscultation and Olfaction—normal voice and speech, mild shortness of breath without wheezing, occasional mild cough, no abnormal sounds or odors detected; Inquiry—right knee pain with limited mobility, symptom exacerbation with fatigue or cold exposure, poor appetite and sleep, normal bowel and urinary function; Palpation—wiry and thready pulse.

1.3 Auxiliary Investigations

Laboratory findings: Rheumatoid factor 83.10 IU/ml (↑); C-reactive protein 50.97 mg/L (↑); Erythrocyte sedimentation rate 51.00 mm/h (↑); Anti-cyclic citrullinated peptide antibody 184.6 Ru/ml (↑); Antinuclear antibody (1:80) weakly positive (speckled pattern) (↑); Autoimmune antibody panel otherwise unremarkable. Right knee ultrasound demonstrated: (1) right knee suprapatellar bursitis with effusion; (2) right knee synovitis; (3) right knee degenerative changes; (4) posterior knee mass, likely Baker's cyst.

1.4 Diagnosis

1. TCM Diagnosis: Wangbi; Pattern differentiation: Cold-dampness obstruction syndrome.
2. Western Medicine Diagnosis: Rheumatoid arthritis.

1.5 Treatment

Western medical treatment included methotrexate combined with iguratimod for disease modification, celecoxib for anti-inflammatory analgesia, and technetium [99Tc] methylene diphosphonate injection for bone repair. TCM treatment involved oral administration of Chinese herbal medicine (Danggui Sini Decoction with modifications) to tonify qi, nourish blood, dispel cold, and eliminate dampness. Nursing interventions comprised medicine-separated moxibustion combined with Chinese medicine bamboo cupping to unblock meridians, relax spasms, and relieve pain. Treatment was administered for seven days per course, with two courses completed before discharge. The patient's right knee pain and swelling symptoms were significantly reduced.

2.1.1 Pain Assessment

The Visual Analogue Scale (VAS) for joint pain [11] was used to evaluate pain severity. On this scale, 0 indicates no pain, 1-3 represents mild pain, 4-6 indicates moderate pain, and 7-10 denotes severe pain.

2.1.2 Anxiety Assessment

The Self-Rating Anxiety Scale (SAS) [12] was employed to assess anxiety levels. SAS total scores below 50 are considered normal; 50-59 indicates mild anxiety; 60-69 suggests moderate anxiety; and scores above 70 represent severe anxiety. Due to pain-induced tension and anxiety, the patient was introduced to the SAS assessment tool, yielding a score of 70, indicating moderate anxiety.

2.1.3 Quality of Life Assessment

The Health Assessment Questionnaire (HAQ) [13] was administered, with higher scores indicating lower quality of life and greater disability.

2.1.4 Disease Activity Assessment

The 28-joint Disease Activity Score (DAS28) [14] was utilized to evaluate disease activity. This scoring system facilitates accurate clinical assessment and treatment of rheumatoid arthritis patients. DAS28 scores above 5.1 indicate high disease activity; 3.2 to 5.1 suggests moderate activity; 2.6 to 3.2 represents low activity; and scores of 2.6 or below indicate clinical remission.

2.2 Nursing Diagnoses

Based on the patient's pattern differentiation and primary symptomatology, nursing diagnoses included: (1) Chronic pain, related to external pathogenic obstruction of meridians causing impaired qi and blood circulation; (2) Impaired physical mobility, related to external pathogenic obstruction of meridians causing impaired qi and blood circulation; (3) Anxiety, related to recurrent pain and protracted disease course; (4) Disturbed sleep pattern with restless nights, related to persistent joint pain; (5) Risk for falls, related to joint pain limiting flexion and extension.

2.3 Nursing Plan

To address the identified factors, the following nursing plan was developed: (1) Leverage the advantages of TCM characteristic techniques including medicine-separated moxibustion and Chinese medicine bamboo cupping to alleviate pain; (2) Provide comprehensive daily living care and a comfortable ward environment to improve insomnia symptoms; (3) Enhance emotional nursing care through increased communication frequency to reduce anxiety.

2.4.1 Medicine-Separated Moxibustion

Following medical orders, the patient received medicine-separated moxibustion treatment applied to acupoints including Pishu (BL20), Yanglingquan (GB34), Yaoyangguan (GV3), and Mingmen (GV4) to harness the synergistic effects of moxibustion, meridians, and acupoints. The medicinal formula comprised Jianghuang (Curcumae Longae Rhizoma), Sanleng (Sparganii Rhizoma), Qingfengteng (Sinomenii Caulis), Xixin (Asari Radix et Rhizoma), and ginger juice to dispel cold and dampness, warm kidney yang, warm meridians and unblock collaterals, promote qi flow and break blood stasis, draw out toxins and reduce swelling, and unblock the governor vessel to relieve pain.

The specific procedure involved: preparing equal proportions of Jianghuang, Sanleng, Qingfengteng, and Xixin, grinding them into fine powder and mixing thoroughly, then blending with ginger juice to form a paste. An appropriate amount was evenly applied to sterile adhesive patches. Before application, each acupoint was massaged for 5-10 minutes, after which the patches were securely affixed. An ignited moxa stick was placed in a single-hole moxibustion box, and after full combustion, positioned over the acupoints with a towel barrier to prevent burns. Each moxibustion session lasted approximately 30 minutes, ideally producing a mild skin erythema response. Treatment was administered once daily for seven days per course, with two complete courses delivered [9].

2.4.2 Chinese Medicine Bamboo Cupping Therapy

Chinese medicine bamboo cupping is a traditional TCM therapy that applies bamboo cups to body surface acupoints, utilizing negative pressure within the cups to promote blood and qi circulation, relax muscles and tendons, and clear heat and toxins [10]. For acupoint selection, treatment was targeted to the right lower extremity Ah Shi points based on the specific location of joint pain. These points facilitate joint patency, dispel wind-dampness, and activate collaterals to relieve pain, thereby effectively alleviating joint swelling, pain, and stiffness.

The specific procedure involved: preparing a topical decoction from Chinese medicinals including Weilingxian (Clematidis Radix et Rhizoma), Jixueteng (Spatholobi Caulis), Fangfeng (Saposhnikoviae Radix), Honghua (Carthami Flos), Taoren (Persicae Semen), Guizhi (Cinnamomi Ramulus), Qianghuo (Notopterygii Rhizoma et Radix), and Aiye (Artemisiae Argyi Folium). The decoction was heated for 10 minutes, followed by heating the bamboo cups for 5 minutes. The appropriately sized cups were then boiled with the medicinal liquid for 10 minutes before application. Cups were retained for 8-10 minutes and could be removed immediately if too tight. Treatment frequency was once daily for seven days per course, with two courses completed [15].

2.4.3 Daily Living Care

Patients were encouraged to maintain regular lifestyles with proper daily rhythms. During remission periods, patients were advised to participate in suitable activities while receiving guidance for targeted systematic training, gradually increasing activity volume to ensure intensity remained within the patient's tolerance.

2.4.4 Health Education

Health education was delivered through distribution of health manuals, establishment of educational bulletin boards, and organization of group discussions. The education emphasized key daily precautions, including medication guidance, daily care techniques, and the importance of psychological adjustment. The education team actively listened to and patiently addressed patient questions to eliminate doubts and enhance disease understanding.

2.4.5 Dietary Nursing

Dietary recommendations for rheumatoid arthritis patients emphasized light meals while avoiding greasy, spicy, and irritating foods such as fried foods, chili peppers, seafood, and raw garlic to prevent exacerbation of joint pain. Patients were also cautioned against high-sugar foods including sugary beverages and candies to prevent aggravation of inflammation. Additionally, patients were advised to follow regular meal schedules with fixed portions, avoid overeating, and abstain from smoking and alcohol consumption.

2.4.6 Emotional Nursing

Establishing positive relationships with patients and their families was considered essential in nursing practice. Through effective communication, nurses gained insight into patients' psychological status to develop targeted interventions. Family members and friends were guided to provide necessary support and encouragement, as familial care contributes to emotional stability and enhances confidence in overcoming disease. Patients were encouraged to maintain positive attitudes, avoid excessive psychological stress, and actively participate in self-care and group activities to improve psychological well-being and overall health.

2.4.7 Functional Exercise

Patients were recommended to engage in appropriate moderate-intensity exercises such as Tai Chi and calisthenics, which demonstrate significant benefits for joint health. Regular, systematic, individualized functional exercise can effectively relieve joint pain, improve joint function, and positively enhance patients' daily quality of life. Through scientific exercise guidance, patients can improve both physical condition and psychological health, thereby better managing their disease and improving overall quality of life.

2.5 Nursing Evaluation

Following integrated Chinese and Western nursing interventions, the patient's clinical symptoms showed marked improvement. After 14 days of treatment, the patient's VAS score decreased from 7 to 2, SAS score from 70 to 47, HAQ score from 38 to 32, and DAS28 from 4.9 to 1.9, demonstrating significant efficacy (Table 1 [TABLE:1]).

[TABLE:1]

3 Results and Follow-Up

After two weeks of treatment, the patient's condition improved and she was discharged. A telephone follow-up conducted six months post-discharge revealed no deterioration in joint swelling or pain severity. The patient was advised to maintain appropriate activity levels and regular dietary habits, demonstrating good compliance with no adverse events occurring.

In TCM, Wangbi belongs to the "Bi syndrome" category. The disease name first appeared in the Huangdi Neijing, which states in the Suwen·Bi Lun Pian: "When wind, cold, and dampness three qi arrive together, they combine to form Bi" [16]. The Gujin Yijian records: "It arises from internal deficiency of original essence, allowing invasion by wind, cold, and dampness three qi, which cannot be expelled in time, flowing into and lodging in the meridians, entering and becoming Bi." The pathogenic mechanism is considered to involve external pathogenic factors such as wind, cold, and dampness invading the muscles, tendons, bones, and joints, causing meridian obstruction and vessel blockage, leading to malnourishment of the limbs and tendon tension, thus producing Bi syndrome [17]. Clinical observations have identified the cold-dampness obstruction pattern as the most common [18]. In this case, the disease location involved tendons, bones, and joints, resulting from kidney deficiency with pathogenic stagnation causing both blockage and malnourishment. The pattern differentiation was qi and blood deficiency with cold-dampness obstruction. Therefore, pattern-based nursing care focused primarily on tonifying qi and nourishing blood while dispelling cold and eliminating dampness.

Medicine-separated moxibustion functions to elevate yang qi, support healthy qi and expel pathogenic factors, and warm and unblock meridians while enhancing immune function [19]. The selected medicinals included Jianghuang, Sanleng, Qingfengteng, Xixin, and ginger juice. Jianghuang disperses wind-cold pathogenic factors and promotes qi and blood circulation, particularly effective for relieving Bi pain; Sanleng activates blood and resolves stasis, promotes qi flow to alleviate pain; Qingfengteng and Xixin dispel wind and eliminate dampness, resolve the exterior and disperse cold, demonstrating excellent effects for relieving Bi and reducing swelling; ginger disperses cold and warms meridians [9]. Additionally, ginger juice preparation promotes blood circulation and resolves stasis, thereby enhancing transdermal drug absorption [9]. Medicine-separated moxibustion combines medicinal efficacy with moxibustion heat to more effectively penetrate therapeutic effects into the body, achieving superior treatment outcomes. The selected acupoints—Pishu, Yanglingquan, Yaoyangguan, and Mingmen—were chosen to enhance moxibustion efficacy, promoting spleen strengthening, dampness elimination, and collateral warming. Pishu and Yanglingquan primarily strengthen the spleen, eliminate dampness, and unblock collaterals, while Yaoyangguan and Mingmen warm and tonify kidney yang. This combined action achieves the goals of strengthening the spleen, eliminating dampness, and unblocking collaterals [9]. In this case of cold-dampness obstruction type, medicine-separated moxibustion demonstrated clear effectiveness in relieving pain and improving physical mobility limitations.

Chinese medicine bamboo cupping is a traditional TCM therapy that applies bamboo cups to meridian acupoints, utilizing negative pressure to promote blood and qi circulation, relax muscles and tendons, and clear heat and toxins [10]. Chinese medicated bamboo cups can rapidly absorb and store medicinal substances, employing combined suction, medicinal vapor, and thermal effects to achieve cold dispelling, dampness elimination, and meridian warming. This therapy offers advantages of thorough blood stasis removal, flexible application sites, strong suction, and minimal pain [15]. Bamboo cupping can enhance blood circulation and immune function while reducing inflammatory responses. Clinical studies have found that bamboo cupping therapy significantly improves symptoms and quality of life while decreasing inflammatory markers such as erythrocyte sedimentation rate and C-reactive protein [20]. In this study, the medicinal liquid for soaking bamboo cups included Weilingxian, Jixueteng, Fangfeng, Honghua, Taoren, Guizhi, Qianghuo, and Aiye. The combination of multiple medicinals collectively exerts effects of dispelling wind, eliminating cold and dampness, warming and unblocking meridians, promoting qi and blood circulation, and relieving pain, significantly reducing knee pain in rheumatoid arthritis patients, improving joint mobility, and enhancing clinical treatment efficacy [10].

The combination of TCM treatment and emotional nursing accelerated patient recovery while leveraging modern scientific technology and methods to promote continuous development of TCM theory and practice. This approach upholds and advances the characteristic advantages of TCM, maintains original TCM thinking, and continuously develops new features and advantages through innovation, enabling effective promotion of TCM nursing techniques. The results of this case indicate that post-intervention VAS, SAS, HAQ, and DAS28 scores were all significantly lower than pre-intervention values. Moreover, no adverse reactions were observed during treatment, demonstrating good safety.

In summary, the combination of medicine-separated moxibustion and Chinese medicine bamboo cupping is technically simple to perform, associated with few adverse effects, and readily accepted by patients. When combined with routine nursing measures including dietary guidance, emotional care, daily living support, health education, and functional exercise, this approach effectively improves clinical symptoms such as pain, anxiety, and insomnia. However, as this case analysis represents a single case report, its conclusions inevitably have certain limitations. Future research should conduct prospective studies with larger sample sizes and long-term patient follow-up.

Patient Informed Consent: Publication of this case report was approved with the patient's informed consent.
Conflict of Interest Statement: The authors declare no conflicts of interest.
Funding: Hunan University of Chinese Medicine Hospital-University Joint Fund Project (2025XYLH040)

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