Between Stiffness, Fragility and Pain: A Comprehensive Look at Arthritis and Osteoporosis

May 15, 2024

When morning stiffness is not just a sign of age but a daily companion, and concerns about brittle bones are more than a distant possibility, good advice may be costly. Arthritis and osteoporosis are diseases that affect the bones and joints, but they are different. This short blog will dive into the patterns and treatment of those common conditions.  

What is Arthritis? 

Arthritis is the name given to inflammation of the joints. There are different types of arthritis, but the most common include: 

  • Arthrosis: 

This form of arthritis occurs when the protective cartilage at the ends of bones wears away over time. Typically, older adults are affected. Pain, stiffness and swelling in the joints are the main symptoms. 

  • Rheumatoid arthritis (RA): 

RA is an autoimmune disease. The immune system mistakenly attacks its joint lining, leading to inflammation and joint damage. Rheumatoid arthritis can affect people of all ages and often causes pain, swelling and deformity in the joints. 

  • Psoriatic arthritis: 

This type of arthritis occurs in some people with psoriasis, a skin condition. It can cause joint pain, stiffness, swelling, and skin symptoms. It is a complex clinical picture that requires strategic treatment methods. I always find a common denominator in complicated cases and treat it with relatively “small” formulas. For example, treat blood stasis or blood deficiency with or without heat. With complex patterns, many different symptoms can appear that are contradictory and conflicting. In the presence of divergence (some hot and some cold symptoms), it is crucial to identify if the patient lacks heat/cold or has excessive heat/cold. Once a strategy has been chosen, it’s critical to correct it, particularly if the treatment outcomes are not aligned.  

  • Ankylosing spondylitis: 

This type of arthritis primarily affects the spine and causes inflammation and stiffness of the vertebrae. It can also affect other joints and organs. 

What is Osteoporosis? 

Osteoporosis is a disease characterised by weak, brittle bones more prone to fractures. It occurs when the body loses too much bone material, creates too little bone, or both. Osteoporosis is often referred to as a “silent disease” because it occurs without symptoms until a fracture occurs. Risk factors for osteoporosis include age, gender (women are more likely to develop the disease), family history, certain medications, low body weight and lifestyle factors such as smoking and excessive alcohol consumption. 

Although arthritis and osteoporosis cause pain and impair mobility, they have different underlying causes and require different treatment and management approaches. Arthritis is often associated with joint inflammation, while osteoporosis is related to the weakening and destabilising of the bones. 

The connection between arthritis and osteoporosis:

It may come as a surprise, but arthritis and osteoporosis are often linked. Chronic inflammation in rheumatic diseases can lead to accelerated bone loss, increasing the risk of osteoporosis. Additionally, steroids used to treat arthritis can also affect bone density. Consequently, our patients can present with both diseases at the same time. 

Arthritis and arthrosis from the perspective of TCM 

In TCM, “BI syndrome” is associated with pain, stiffness and obstruction in the joints and muscles. It is often translated as “pain obstruction syndrome” or “bi syndrome.” This concept is based on the idea that pathogenic factors such as wind, cold, dampness and heat can enter the body and obstruct the flow of Qi and blood in the channels and collaterals. This obstruction of Qi and blood will then lead to pain and stiffness. 

The BI syndrome manifests according to the pathogenic factors involved, and we can divide these into the following general subtypes: 

  1. Wind-cold BI syndrome: Characterised by pain and stiffness amplified by cold weather and relieved by heat. The affected joints and muscles may feel cold to the touch, and the pain tends to be fixed and localised. 

A selection of formulas is: 

  1. Wind-Heat BI Syndrome: In this BI syndrome type, pain and stiffness are accompanied by heat symptoms such as redness, swelling and inflammation in the affected areas. The pain may be sharp and intense, and the joints and muscles may feel hot and swollen to the touch. 

A selection of formulas is: 

  1. Dampness BI Syndrome: Dampness is a build-up of moisture or fluids in the body that can cause heaviness, swelling, and a “sticky feeling”. Damp BI syndrome is characterised by heaviness and stiffness in the joints and muscles, swelling, and limited range of motion.
  2. Cold-damp BI syndrome combines cold and damp pathogenic factors. The pain and stiffness are usually worse in cold and damp conditions, and the affected areas may feel cold, heavy, and painful. 

A selection of formulas is: 

3. Heat toxin BI syndrome: Heat toxin refers to a pathogenic factor that is both hot and toxic and is characterised by severe pain, redness, swelling and inflammation in the affected joints and muscles. It may be     associated with acute infections or inflammatory diseases. 

 A selection of formulas is: 


 Depending on the patient’s constitution, different patterns may be present simultaneously in complicated cases. In my experience, I always combine TCM formulas and often treat the constitution and BI syndrome at the same time. The constitution leading to pain obstruction has much to do with it. 

 I treat BI syndrome in TCM with acupuncture, herbal medicine, dietary advice and, when appropriate, lifestyle changes. Treatment aims to eliminate the pathogenic factors, promote the circulation of Qi and blood, and relieve pain, stiffness, and inflammation in the affected areas. The results of TCM treatments of BI syndrome are often very positive. My best results are when I treat the patient’s pattern and not the condition’s interpretation into a TCM pattern. Unfortunately, some of the effective herbs for treating BI syndrome are not available in Australia (Fu Zi (Aconite), Ma Huang (Ephedra) and Xi Xin (Asarum), for example). These herbs either require a substitute or a change of strategy in cases where there are too many unscheduled substances in the formula.  

 In the case of osteoporosis, TCM is considered a disease related to a deficiency of vital substances in the body, particularly a deficiency of kidney essence and Qi.  

  1. Kidney deficiency: In TCM, the kidneys control bone health. Kidney deficiency is often considered a root cause of osteoporosis. This deficiency may be due to aging, chronic illness, or taxing lifestyle factors.
  2. Qi and blood deficiency: Any illness or imbalance can be traced back to Qi and blood. A deficiency of Qi and blood can lead to bone weakening and loss of bone density. If blood is deficient, then Yin is weak. In the case of osteoporosis and blood deficiency, I would always tonify the blood and only consider the role or state of Yin later.
  3. Stagnation of blood and Qi: Stagnation of blood and Qi circulation can hinder the nutrition of bones and lead to weakness and fragility. The maintenance of Qi and the flow of blood is the predominant treatment method here. If there are clear signs of blood stagnation, the blood needs to be mobilised (and/or nourished), and the Qi will follow. Blood is the mother of Qi. 
  4. Accumulation of moisture and mucus: In some cases, osteoporosis is due to the accumulation of moisture and mucus in the body, which obstructs the flow of Qi and blood to the bones and weakens them over time. In this case, the moisture and mucus must be transformed and eliminated. The underlying pattern often emerges afterwards, which can be addressed in the subsequent step. 

 Nutritional recommendations and dietary advice are essential in all cases of arthritis and osteoporosis. In addition, exercises such as Tai Chi and Qi Gong can be supportive in promoting balance, flexibility, and circulation. 

Brigitte Linder
Brigitte Linder was born in Zurich and has lived near Melbourne on the south coast of Australia since 2008. She operated Safflower – Chinese Herbs Expertly Dispensed until mid-2023. Safflower is an herbal dispensary business operating under the banner of the Therapeutic Goods Administration (TGA). It was issued a GMP licence. Acuneeds acquired the company in January 2024 and intended to offer all services to practitioners in Australia and New Zealand.Brigitte completed a master's degree in 2023 with NICM Health Research (Western Sydney University). Her thesis involved creating a case report guideline for Chinese herbal medicine. In 2019, she published her first book and has since mentored TCM graduates to better transition to full-fledged practitioners. She has been consulting patients for 20 years and enjoys working with children and patients with complex conditions. She is a diplomat of the Institute of Classics in East Asian Medicine (ICEAM) and prescribes Eastern Han-era herbal formulas, namely Shang Han Lun and Jin Gui Yao Lue. Brigitte has always been interested in uniting a strong, cohesive TCM community. She continues to invest time and effort to ensure practitioners and the profession receive support and recognition.


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