MusculoSkeletal Conditions

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© Fernandes Acupuncture and Chinese Herbal Medicine 2012
Traditional Chinese Medicine has a long history of being an effective treatment for many pain conditions.

World Health Organization
The World Health Organization has approved acupuncture in the treatment of pain conditions.

Pain and musculoskeletal conditions treated with Acupuncture
  - Hip Pain
  - Shoulder pain
  - Knee pain
  - Back pain/low back pain
  - Sports injuries                              
  - Carpal tunnel syndrome
  - Fibromyalgia
  - Arthritis  
  - Elbow pain (Medial/lateral epicondylitis)
  - Tendonitis
  - Rehabilitation
  - Acute injury
Acupuncture meridians/channels with their corresponding acu-points and muscular system
Pain management with Traditional Chinese Medicine

Pattern of disharmony determines appropriate pain treatment
Patterns of disharmony
    
Qi/Blood stagnation: main reason for pain
    
Qi: dull pain
             • Blood: sharp, fixed pain
             • Often along channel: sciatica, tennis elbow, shoulder pain
             • Use channels/meridians for treatment
             • Treatment:
                 • Ashi points: painful points
                 • LV 3 or SP 10: Qi/Blood Movers
                 • Heat (Moxibustion or heat lamps):
                   heatís moving properties for stagnation, softens tight muscles
                 • Herbal plasters: herbal stickers on painful areas,
                   contain lots of Qi and Blood moving herbs
   • Bi Syndrome
             • Pain that is worse with weather: cold, rain, humidity, heat
             • Can use above treatment protocol: ashi and Qi/Blood movers
             • also rid pathogen:
                  • SP 9 or 3: dampness/humidity
                  • LI 11: hot bi
                  • Heat lamp for or Moxibustion: cold or damp
                  • Chinese Herbal Medicine: bitter herbs to dry dampness
    • Kidney deficiency: low back or knee pain
             • Dull pain
             • Worse with fatigue or at the end of the day
             • Treatment
                  • BL 23: Back shu point, strengthen Kidney
                  • Other strengthening Kidney points: KD 3, 6 or 7
Hip Pain

Biomedical diagnosis examples: Osteoarthritis, bursitis

Traditional Chinese Medicine patterns of disharmony:

Stagnation or blockage in the Gall Bladder channel
Environmental pathogens such as wind, cold, heat or damp lodged in the hip

Traditional Chinese Medicine treatment plan:

Acupuncture to increase circulation or unblock stagnation in the hip area/Gall Bladder channel and expel
any pathogenic factors lodged in the hip

Moxibustion/heat therapy to increase circulation or unblock stagnation in the hip area/Gall Bladder
channel and expel any pathogenic factors lodged in the hip

Electro-acupuncture to increase circulation or unblock stagnation in the hip area/Gall Bladder channel to
eliminate pain

Tui na (Chinese massage) applied after acupuncture to increase circulation or unblock stagnation in the
hip area/Gall Bladder channel and soften muscle knots/tension

Important acupuncture points in the treatment of hip pain
GB 30
GB 34
GB 40
Tunzhong
 
Fernandes Acupuncture and Chinese Herbal Medicine case study

79 year old female with right hip pain:  She had difficulty standing for long periods of time and doing
things such as washing the dishes.  Sometimes she would wake up at night with pain in her hip or
cramping in her legs.  10 acupuncture treatments have been administered and she reports much less pain
in her hip, no waking at night and no cramping in her legs.
Shoulder Pain

Biomedical diagnosis examples: Rotator cuff injury, tendonitis, bursitis

Traditional Chinese Medical patterns of disharmony:

Stagnation or blockage in the Large Intestine, Triple Warmer or Small Intestine channels
Environmental pathogens such as wind, cold, heat or damp lodged in shoulder

Traditional Chinese Medicine treatment plan:

Acupuncture to increase circulation or unblock stagnation in the shoulder/Large Intestine, Triple Warmer or Small Intestine channels and expel any pathogenic factors lodged in the shoulder
Moxibustion/heat therapy to increase circulation or unblock stagnation in the shoulder/Large Intestine, Triple Warmer or Small Intestine channels and expel wind, cold and damp pathogenic factors lodged in the shoulder
Electro-acupuncture to increase circulation or unblock stagnation in the shoulder area/ Large Intestine, Triple Warmer or Small Intestine channels to eliminate pain
Tui na/Chinese massage applied after acupuncture to increase circulation or unblock stagnation in the shoulder/ Large Intestine, Triple Warmer or Small Intestine channels and soften muscle knots/tension

Important acupuncture points in the treatment of shoulder pain

LI 15: local point for pain
TW 14: local point for pain
SI 9: local point for pain
Jian Qian: local point for pain
LI 4 or 10: distal point for LI stagnation
TW5: distal point for TW stagnation
ST35 or GB knee joint: mirror treatment in Dr. Tan style
ST 38: empirical point for shoulder pain
GB 34: meeting of tendons if due to tendonitis

Fernandes Acupuncture and Chinese Herbal Medicine case studies

62 year old female with rotator cuff injury:  She had left shoulder pain that radiated down her left arm to her hand.  She was unable to lift her arm to pull a gallon of milk from the refrigerator or turn over in bed without pain.  Her doctors insisted that she needed surgery.  She received 16 acupuncture visits in 8 months where moxibustion, a herbal heat therapy, was applied.  The condition resolved completely and she returned 2 years later to address the same condition in the opposite shoulder.     

60 year old male with one kidney and shoulder pain.  He had difficulty raising his arm above his head and performing manual labor work tasks. He was being treated primarily for the pain in his shoulder, but I chose to address the kidney as well knowing his medical history.  He has 100% improvement in his shoulder and his primary care physician has informed us that his kidney functions has improved greatly with no other changes in medications or diet.
Knee Pain

Biomedical diagnosis examples: osteoarthritis

Traditional Chinese Medical patterns of disharmony:

Stagnation or blockage in the Stomach, Spleen, Liver or Gall Bladder channels
Environmental pathogens such as wind, cold, heat or damp lodged in knee
Kidney deficiency or weakness

Traditional Chinese Medicine treatment plan:

Acupuncture to increase circulation or unblock stagnation in the Stomach, Spleen, Liver or Gall Bladder channels and expel any pathogenic factors lodged in the knee.  Tonify or strengthen the Kidneys if from deficiency.
Moxibustion/heat therapy to increase circulation or unblock stagnation in the Stomach, Spleen, Liver or Gall Bladder channels and expel wind, cold and damp pathogenic factors lodged in the knee
Electro-acupuncture to increase circulation or unblock stagnation in the Stomach, Spleen, Liver or Gall Bladder channels to eliminate pain
Tui na/Chinese massage applied after acupuncture to increase circulation or unblock stagnation in the Stomach, Spleen, Liver or Gall Bladder channels and soften muscle knots/tension

Important acupuncture points in the treatment of knee pain

Knee pain treatment using acu-points Xi Yan with heat therapy Moxibustion to resolve knee pain effectively and quickly.

Research for knee pain
Acupuncture treatment for chronic knee pain: a systematic review.
White A, Foster NE, Cummings M, Barlas P.
.
http://www.ncbi.nlm.nih.gov/pubmed/17215263
 
Back Pain/ Low Back Pain

Biomedical Diagnosis: Sciatica, Herniated or bulging disc, degenerative disc disease

Traditional Chinese Medical patterns of disharmony:

Stagnation or blockage in Bladder or Governing Vessel channel     
Kidney deficiency or weakness
Environmental pathogens, wind, cold, heat or damp lodged in area

Traditional Chinese Medicine treatment plan:

Acupuncture to increase circulation or unblock stagnation in the Bladder or Governing Vessel channels and expel any pathogenic factors lodged in the back.  Tonify or strengthen the Kidneys if from deficiency.
Moxibustion/heat therapy to increase circulation or unblock stagnation in the Bladder or Governing Vessel channels and expel wind, cold and damp pathogenic factors lodged in the back
Electro-acupuncture to increase circulation or unblock stagnation in the Bladder or Governing Vessel channels to eliminate pain
Tui na/Chinese massage applied after acupuncture to increase circulation or unblock stagnation in the Bladder and Governing Vessel channels and soften muscle knots/tension
Cupping applied especially if excessive lactic acid/knots in the muscles. 

Important acupuncture points in the treatment of back pain

Huatuojiaji: along vertebrae especially if there are disc issues
Back shu points: along erectors especially if erectors are tight
BL 23: if from underlying Kidney deficiency/weakness
BL 40: if acute
BL 60: if chronic
BL 10: if at center of low back
Josen: if at center of low back
BL 62: if pain is located at Bladder 26 to illiac crest
SP 9 or SP3: if damp weather is making the pain worse known as Bi syndrome

Chinese Herbal formulas used to treat back pain

Du Huo Ji Sheng Tang: If back pain is due to external pathogenic factors such as cold and damp with underlying KD deficiency.
Die Da Wan (Trauma Pill): If pain is due to trauma

Back Pain Research

Meta-Analysis: acupuncture for low back pain

Manheimer E, White A, Berman B, Forys K, Ernst E.
University of Maryland School of Medicine, Center for Integrative Medicine, Baltimore, Maryland 21207, USA.
Manheimer E, White A, Berman B, et al. Meta-analysis: acupuncture for low back pain. Annals of Internal Medicine. 2005;142(8):651-663.

http://www.ncbi.nlm.nih.gov/sites/entrez?orig_db=PubMed&db=pubmed&cmd=Search&term=142[volume]%20AND%208[issue]%20AND%20651[page]%20AND%202005[pdat]



Back Shu acu-points used to treat back pain