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Managing repetitive strain injuries with channel-based acumoxa therapy

Townsend Letter for Doctors and Patients, Feb-March, 2005 by Honora Lee Wolfe

Repetitive strain injuries such as carpal tunnel syndrome and hand, wrist, forearm tendinitis represent 56% of all workers compensation claims in the US at this time. (1) In many acupuncture clinics, hand, wrist, and forearm pain and numbness is a common pain pattern that is seen on a regular basis. It is most often related to the type of work that a patient does and is twice as common in women as in men. Hairdressers, musicians, aestheticians, massage therapists, manicurists, and anyone who works for extended hours on a computer seem to be particularly prone to this type of overuse injury. And since it threatens their livelihood, such people often find these injuries as frightening as they are physically painful. Unfortunately, it may be true that a patient with a severe case of hand/wrist tendinitis or full-blown carpal tunnel syndrome may have to stop the work that aggravates the condition at least for a while. Less severe cases can be treated quite successfully with acumoxa therapy for a very reasonable cost and kept from becoming debilitating and, therefore, threatening to someone's livelihood.

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Western medical etiological factors

In Western medicine, the continuum leading to full blown carpal tunnel syndrome starts with any repetitive, complex set of motions placing very specialized demands on this specific region of the upper extremities. Further, because of the tremendous variability of their movement, the great number of articulations and intrinsic and extrinsic muscles, and their use as a major sensory as well as a motor organ, the hand and wrist are particularly vulnerable to injury and difficult to treat successfully. According to Western medical theory, tendinitis in the hand and wrist is a process, which begins with tendinomuscular fatigue leading to micro-tears which becomes chronic inflammation as they are aggravated over and over again without adequate rest. Without rest, muscles do not receive enough oxygen and other nutrients from the blood and are unable to flush lactic acid and other metabolic wastes. When the nervous system becomes involved, the muscle tendon bundles remain hypertonic and pain reflexes in the area are activated. This becomes a chronic inflammatory/pain cycle and is the same for any part of the body.

Chinese medical etiological factors

The causes of muscle and sinew pain have been well described in many Chinese medical texts, as early as the "The Treatise on Bi" in the Nei Jing Su Wen. In Huang-fu Mi's Systematic Classic of Acupuncture & Moxibustion, there are several chapters devoted specifically to these types of problems. (2) In more modern books such as Bi Syndromes by Vangermeersch and Sun, theories about muscle/sinew pain have been synthesized into a format that is quite accessible for Western students and practitioners.

1. Bi

Classically, many types of muscle or sinew pain may be classified as bi or blockage pattern. According to Drs. Vangermeersch and Sun, "In TCM, the term bi is specifically used to indicate obstruction of qi and blood in the channels and collaterals due to several kinds of pathogenic factors, such as wind, coldness, dampness, etc ... and leading mainly to pain, numbness, and impairment of movement." (3) In the same book, the authors state that in order for external pathogenic qi to invade the tissue, correct or righteous qi must be weak, as is often the case in elderly or weakened patients. (4)

While blockage patterns are definitely a co-factor to be considered when confronted with a patient presenting pain in the forearm, wrist, and hand, (or anywhere else in the musculoskeletal system), it is my experience that there are usually other factors of equal importance involved. These may include vacuity of qi and blood, weakness or one or another organ, and possibly blood stasis.

2. Qi and blood vacuity due to spleen qi vacuity

Chinese medicine says that the spleen rules the muscles and flesh and the four limbs. If a patient with wrist, hand, and/or arm pain has other signs and symptoms indicating spleen qi vacuity as well, this will definitely have an impact on their dysfunction. If the patient has numbness as well as pain, spleen vacuity may be participating in this problem as well. We know this because Chinese medicine says that the spleen is the organ of transformation of qi and blood. (5) A weak spleen may not be able to transform enough qi and blood to circulate the extremities adequately.

Further, qi is required to transform dampness. If the spleen is unable to generate enough qi to transform and transport fluids, they congeal in the tissues and hinder the normal flow of qi. The patient will describe this as pain that feels heavy or worsens in damp weather. Also, since dampness is one of the three factors in bi patterns, this is another example of how qi vacuity can contribute to a bi or blockage pattern.

As a person gets older, the spleen function weakens and less qi and blood is created to circulate to the extremities. This inadequate flow of qi and blood makes older people more prone to pain, weakness, and/or numbness. Also, as stated by Vangermeersch and Sun above, an elderly person whose qi and blood are weak is also made more vulnerable to invasion of external evils. (6)

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Managing repetitive strain injuries with channel-based acumoxa therapy

Townsend Letter for Doctors and Patients, Feb-March, 2005 by Honora Lee Wolfe

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