Rheumatoid arthritis falls within the category of "Wang Bi" (chronic arthralgia with joint deformity) in traditional Chinese medicine. Based on long-term clinical experience, Professor Chen divides this disease into three stages—early, middle, and late—for diagnosis and treatment. A brief discussion is as follows:

1 Early Stage: Pathogenic qi initially invades the meridians and collaterals, while the healthy qi is still relatively strong. The urgent task is to expel pathogenic factors, with the principle of "unblocking" as the guiding aim.

1.1 Heat-predominant pattern: Joints are burning hot, red, swollen, and painful; there is a preference for coolness and aversion to heat, thirst with a desire to drink, restlessness, yellow urine, a red tongue with a thin yellow coating and reduced moisture, and a rapid pulse that may also be surging and slippery. The basic formula uses Zhongjiefeng (Sarcandra glabra), Rendongteng (Lonicera japonica caulis), Hanfangji (Stephania tetrandra), Luoshiteng (Trachelospermum jasminoides), Qinjiao (Gentiana macrophylla), Sangzhi (Morus alba ramulus), Mutong (Akebia caulis), Shengdi (Rehmannia glutinosa radix), Danpi (Paeonia suffruticosa cortex), Chishao (Paeonia lactiflora radix rubra), and Zhimu (Anemarrhena asphodeloides rhizoma). In this formula, heat-clearing and obstruction-removing medicinals such as Zhongjiefeng and Rendongteng are combined with blood-cooling and stasis-dispersing medicinals such as Shengdi and Danpi to unblock heat-type impediment.

1.2 Wind-predominant pattern: Joint pain is migratory and erratic, appearing here and subsiding there; the joints are averse to wind, or there is generalized aversion to wind with sweating; the pulse is wiry or may also have a floating quality. The basic formula uses Fangfeng (Saposhnikovia divaricata), Qianghuo (Notopterygium incisum), Duhuo (Angelica pubescens), Haifengteng (Piper kadsura), Xuchangqing (Cynanchum paniculatum), Weilingxian (Clematis chinensis), Danggui (Angelica sinensis), Chuanxiong (Ligusticum chuanxiong), Shengdi (Rehmannia glutinosa radix), and Jixueteng (Spatholobus suberectus). In this formula, wind-dispelling and pain-relieving medicinals such as Fangfeng and Qianghuo are combined with blood-nourishing and blood-activating medicinals such as Danggui and Chuanxiong to unblock wind-type impediment. If there is exterior deficiency with aversion to wind and sweating, Huangqi (Astragalus membranaceus) and Guizhi (Cinnamomum cassia ramulus) are added to secure the exterior.

1.3 Cold-predominant pattern: Joint pain is severe, with spasm and rigidity, difficulty in flexion and extension, cold limbs, and aversion to cold; the tongue is pale and enlarged with a thin white coating, and the pulse is deep, slow, or fine. The basic formula uses Mahuang (Ephedra sinica), Fuzi (Aconitum carmichaelii radix lateralis preparata), Xixin (Asarum sieboldii), Guizhi (Cinnamomum cassia ramulus), Baizhu (Atractylodes macrocephala), Ruxiang (Boswellia carterii), Moyao (Commiphora myrrha), Duhuo (Angelica pubescens), prepared Ruxiang and Moyao, Danggui (Angelica sinensis), Baishao (Paeonia lactiflora radix alba), and Zhigancao (Glycyrrhiza uralensis radix preparata). In this formula, yang-warming and cold-dispersing medicinals such as Mahuang and Fuzi are combined with blood-activating and pain-relieving medicinals such as Ruxiang, Moyao, and Danggui to unblock cold-type impediment.

1.4 Dampness-predominant pattern: The joints feel heavy and numb, aggravated on rainy or overcast days, with generalized heaviness and discomfort throughout the body; the tongue coating is thick and greasy, and the pulse is soft or slippery. The basic formula uses Yiyiren (Coix lacryma-jobi), Cansha (Bombyx mori excrementum), Fuling (Poria cocos), Zexie (Alisma orientale), Mutong (Akebia caulis), Cangzhu (Atractylodes lancea), Mugua (Chaenomeles speciosa), Qianghuo (Notopterygium incisum), Duhuo (Angelica pubescens), Fangji (Stephania tetrandra), and Qinjiao (Gentiana macrophylla). In this formula, dampness-percolating and turbidity-draining medicinals such as Yiyiren and Cansha are combined with wind-dispelling and dampness-eliminating medicinals such as Qianghuo and Fangji to unblock damp-type impediment.

Although the clinical manifestations in this stage are divided into the above four patterns, in actual clinical situations the patterns are often mixed and overlapping. Therefore, Professor Chen emphasizes careful and detailed differentiation and advocates prescribing one formula specific to each individual patient. The common feature of all these treatments is that "unblocking" is the key—whether by draining heat, dispelling wind, scattering cold, or transforming dampness, the ultimate aim is to restore free flow through the meridians and vessels. Attention is also frequently given to the blood aspect: activating and harmonizing the blood assists the free flow of the meridians, so that pathogenic factors have no place to lodge and the disease resolves on its own.

2 Middle Stage: If Wang Bi in the early stage is treated promptly and appropriately, it can mostly be cured. If treatment is missed, the disease progresses to the middle stage. Professor Chen holds that the clinical patterns in this stage can be differentiated with reference to the aforementioned four patterns, but the principal contradiction is that between deeply hidden pathogenic qi entrenched in the sinews and bones and the depletion of healthy qi. The specific pathomechanism characteristics are as follows:
(1) Prolonged disease entering the collaterals necessarily leads to blood stasis. When Wang Bi persists for a long time, pathogenic qi moves from the meridians into the collaterals. Wind, cold, and damp pathogens are stagnated and suppressed there; they cannot be dispersed or permeated, and are especially difficult to eliminate. As a result, the impediment pain recurs repeatedly and lingers without end. The collateral vessels are where the blood is irrigated; if the collateral qi cannot extend freely, stasis and turbidity accumulate internally, producing symptoms such as stabbing joint pain, distended and tortuous blood vessels, and squamous, dry skin.
(2) Phlegm and stasis bind together in the sinews and bones. Cold and damp are yin pathogens; carried by wind, they penetrate progressively deeper and lodge internally in the sinews and bones. When pathogenic factors lodge there, healthy qi cannot extend, liver blood and kidney essence fail to nourish the sinews and bones, dampness accumulates and cold condenses into phlegm, blood stagnation produces stasis, and phlegm and stasis become cemented in the sinews and bones. Hence the joints become swollen, enlarged, deformed, and difficult to flex and extend.
(3) Deficiency of healthy qi. In a normal person, nutritive and defensive qi are mutually connected, qi and blood flow freely, and the essence and blood of the liver and kidneys nourish the sinews and bones externally, so impediment disease does not arise by itself. If a person's healthy qi is constitutionally deficient, or if pathogenic qi has persisted long enough to damage healthy qi, then healthy qi lacks the strength to move and unblock, and pathogenic qi is thereby able to linger and penetrate deeply. According to clinical characteristics, deficiency of healthy qi can be divided into three aspects: dual deficiency of nutritive and defensive qi, depletion of qi and blood, and insufficiency of the liver and kidneys. With dual deficiency of nutritive and defensive qi, the interstices become loose and pathogenic qi can take advantage of this to invade. With depletion of qi and blood, the meridians and blood vessels become sluggish and stagnant, and pathogenic qi can linger. With insufficiency of the liver and kidneys, the sinews and bones are not invigorated, and pathogenic qi can penetrate deeply.

Based on the above pathomechanism characteristics, treatment in the middle stage of Wang Bi should still seize the opportunity to attack and expel pathogenic qi. However, attacking pathogens must be supported by abundant healthy qi. Therefore, Professor Chen advocates the basic therapeutic principle of simultaneous reinforcement and elimination at this stage. In terms of specific medication, Professor Chen has the following characteristics:
(1) Preference for vine, snake, and insect medicinals. Vine plants are mostly excellent medicinals for dispelling wind-dampness, and they have the subtle effect of guiding other medicinals into the sinews and vessels. Representative medicinals include Rendongteng (Lonicera japonica caulis), Shenjincao (Lycopodium japonicum), and Haifengteng (Piper kadsura). Insect medicinals are especially good at searching, picking out, and eliminating pathogens, directly assaulting the lairs of pathogenic factors. Representative medicinals include Tubiechong (Eupolyphaga sinensis), Quanxie (Buthus martensii), and Lufengfang (Vespa nidus). Tubiechong is adept at removing stagnant blood from the joints and meridians; Quanxie is good at dispelling wind from the meridians and collaterals and guiding it outward; Lufengfang specifically searches out hidden wind in the joints and collaterals, disperses bound stagnation, and reaches the collateral qi. Snake medicinals excel at penetrating movement. In the human body, sinews and bones are dense in texture and pathogenic factors are not easily expelled; these medicinals are particularly capable of penetrating deeply into the disease location and leading pathogens outward. Representative medicinals include Xiaohuashe (Agkistrodon acutus) and Wushaoshe (Zaocys dhumnades).

(2) Emphasis on phlegm-transforming and mass-dispersing medicinals. Phlegm and stasis obstructing and binding the meridians and collaterals is an important pathomechanism in the progression of the disease in the middle stage of impediment patterns. Therefore, it is often necessary to use medicinals that open phlegm, disperse masses, and break stasis to free the blood vessels and meridians. Commonly used medicinals include Dannanxing (Arisaema cum bile preparata), Baijiezi (Sinapis alba semen), Maqianzi (Strychnos nux-vomica semen), and Banxia (Pinellia ternata rhizoma). These medicinals have a strong opening and penetrating nature and can seize and wrest away the places where pathogens hide. Professor Chen attaches great importance to this category of medicinals and has personally formulated a "Compound Maqianzi Capsule," which, when used in combination with decoctions, is an excellent remedy for treating rheumatoid arthritis.

(3) Emphasis on healthy qi-supporting medicinals. According to the pathomechanism characteristic of healthy qi deficiency with hidden pathogenic qi in the middle stage of Wang Bi, healthy qi-supporting medicinals occupy an important position in its treatment. Depending on the patient's specific condition, corresponding qi- and blood-supplementing medicinals are used, such as Huangqi (Astragalus membranaceus), Baizhu (Atractylodes macrocephala), Danggui (Angelica sinensis), and Jixueteng (Spatholobus suberectus); liver- and kidney-nourishing medicinals such as Heshouwu (Polygonum multiflorum), Gouqi (Lycium barbarum), and Shanzhuyu (Cornus officinalis); kidney-supplementing and yang-invigorating medicinals such as Huluba (Trigonella foenum-graecum), Roucongrong (Cistanche deserticola), and Buguzhi (Psoralea corylifolia); and sinew-strengthening and bone-fortifying medicinals such as Duzhong (Eucommia ulmoides), Gouji (Cibotium barometz), Baogu (Panthera pardus bone), and Haima (Hippocampus).

(4) Constant protection of the spleen and stomach. In the treatment of Wang Bi, attacking medicinals are often dry and harsh, while supplementing medicinals are often rich and cloying—both are unfavorable to stomach qi. If the spleen and stomach are injured, the therapeutic power of the medicinals loses its support, and patients also find it difficult to continue treatment. Therefore, formulas for treating impediment disease should constantly take the spleen and stomach into consideration. In addition to appropriately regulating dosages and combinations, spleen-fortifying and stomach-nourishing medicinals should be appropriately added, such as Shanyao (Dioscorea opposita), Dazao (Ziziphus jujuba), Zhigancao (Glycyrrhiza uralensis radix preparata), and Maiya (Hordeum vulgare germinatus).

(5) Giving full play to the advantages of integrated Chinese and Western medicine. In long-term clinical practice, Professor Chen has not only developed a complete and distinctive approach to the Chinese medical treatment of Wang Bi, but for a very small number of refractory impediment diseases, he can also draw on the strengths of Western medicine to improve efficacy and relieve the patient's suffering as quickly as possible. According to the pathological characteristics of rheumatoid arthritis as an autoimmune disease, Professor Chen sometimes plans the coordinated use of small to moderate doses of glucocorticoids, and after achieving therapeutic effect, gradually reduces the dosage. In the early stage of hormone use, yin deficiency with dryness-heat patterns tend to arise, and Chinese medicinals that clear heat, nourish yin, and moisten dryness should be used to supervise and moderate these effects, such as Zhimu (Anemarrhena asphodeloides rhizoma), Shengdi (Rehmannia glutinosa radix), and Gancao (Glycyrrhiza uralensis radix). In the later stage of hormone reduction and withdrawal, kidney-yang deficiency patterns may be seen, and medicinals such as Buguzhi (Psoralea corylifolia), Xianlingpi (Epimedium brevicornu), and Bajitian (Morinda officinalis) may be added as appropriate. With such integrated use of Chinese and Western medicine, Professor Chen reports that no adverse effects have been observed and disease rebound is rarely seen.

Professor Chen believes that the middle stage of Wang Bi is the critical stage of treatment. If the physician treats appropriately and the patient persists in taking medication, most cases can be controlled and approach recovery. Otherwise, if the disease is protracted and repeatedly worsens, it will ultimately progress to the late stage of Wang Bi.

3 Late Stage: In the late stage of Wang Bi, phlegm and stasis are deeply hidden in the sinews and bones, and the essence and qi of the zang-fu organs are greatly depleted, making the contradiction of healthy qi deficiency even more prominent. It manifests as enlarged, deformed, stiff, and fixed joints, withered muscles, and dry skin, to the extent that the patient cannot manage daily life, and treatment is extremely difficult. At this stage, syndrome differentiation and medication can still be carried out with reference to the middle stage, but the treatment course is longer and the prognosis is poorer.

The clinical manifestations of Wang Bi are highly varied. On the basis of referring to the patterns of the above stages, specific problems should be analyzed specifically. Professor Chen emphasizes that treatment based on syndrome differentiation is the living soul of Chinese medicine. Clinically, the principal contradiction is generally identified first, and then a therapeutic approach is formulated through syndrome differentiation, after which medicinals are selected and a formula is composed according to the established approach. Therefore, Professor Chen's selection of medicinals and formulas is not constrained by any single fixed pattern, but changes according to the syndrome, with therapeutic effectiveness as the constant goal from beginning to end.