Finger pain may occur in one or more fingers, and in one or both hands. According to TCM theory, it can often be caused by the accumulation of Cold-Damp, or of Damp-Heat, stagnation of Qi and Blood, deficiency of Blood, or deficiency of the Liver- and Kidney-Essence. Finger pain may be attributed to any of the following disorders in Western medicine: rheumatoid arthritis, rheumatic fever, chilblains, nerve pain, paralysis or injury of the nerves, sprain of the local muscles or tendons, carpal tunnel syndrome and Raynaud’s syndrome.
Aetiology and pathology
Accumulation of Cold-Damp in the Channels
Exposure to cold over a long period or living in a cold and damp environment may allow Cold-Damp to invade the body. Overeating of cold food or drinking too many cold beverages may damage the Spleen and Stomach, impeding the Spleen’s function of transporting water and damp so that internal Damp forms. Cold has the characteristics of contraction and stagnation; Damp is characteristically heavy, viscous and lingering. Therefore, when Cold-Damp invades or accumulates in the channels, it causes the muscles and tendons of the fingers to contract, leading to stagnation of the Qi and Blood, which triggers the finger pain.
Living or working in a humid and warm place for a long time, or eating of too much fatty, sweet or pungent food, impairs the Spleen and Stomach in their functions of transporting and transforming in the Middle Burner, causing Damp-Heat to form. Once Damp-Heat blocks the channels, it will cause stagnation of the Qi and Blood, so finger pain follows.
Stagnation of Qi and Blood
Qi and Blood should circulate freely in the channels. If there is Qi and Blood stagnation from various causes, such as emotional disturbance, stress, frustration, overstrain, physical trauma, or inappropriate movement of the fingers, the circulation of Qi and Blood slows, leading to blockage in the channels, so finger pain occurs.
Deficiency of Blood
Prolonged chronic disease, excessive bleeding during the menstrual period or during an operation and haemorrhoids may all cause the Qi and Blood to be consumed, resulting in deficiency of Blood. When there is insufficient Blood circulating in the channels, the fingers are not properly nourished and finger pain follows.
Deficiency of Liver and Kidney-Essence
The Kidney dominates the Bones and produces the Marrow; the Liver stores the Blood and dominates the tendons. Overstrain, prolonged sickness or senility and a constitutional weakness may all cause the Kidney-Essence to be consumed, resulting in deficiency of Kidney- and Liver-Essence. In this condition the muscles, tendons and bones are undernourished, causing finger pain to occur.
Treatment based on differentiation
Differentiation
Differentiation of Excess and Deficiency
— Constant finger pain, severe finger pain, aggravation of the finger pain by rest, and alleviation of finger pain by some movement, with swelling on the fingers, is usually caused by Excessive pathogenic factors.
— Intermittent finger pain, slight finger pain, with aggravation of the pain by exertion and movement, or tiredness, is often caused by Deficiency.
Differentiation of the character of the pain
— Finger pain with a cold sensation, swelling, heaviness and numbness, or aggravation of the pain in damp and cold weather, is usually caused by accumulation of Cold-Damp in the channels.
— Swelling, redness and pain of the finger joints, heaviness and numbness of the fingers with a warm or even burning sensation, is usually caused by accumulation of Damp-Heat in the channels.
— Finger pain with a history of trauma or operation, stabbing pain and numbness of the fingers, aggravation of the pain at night, or deformity of the finger joints, is usually caused by stagnation of Qi and Blood.
— Chronic finger pain, numbness of the fingers with stiffness, weakness of the hands, a pale complexion and lips, is often caused by deficiency of Blood.
— Slight finger pain with spasm, shaking, gradual deformity of the fingers, weakness of the fingers, wrists, arms and legs, or lower back pain, is usually caused by deficiency of Essence of Kidney and Liver.
Treatment
ACCUMULATION OF COLD-DAMP IN THE CHANNELS
Symptoms and signs
Swelling and pain in the fingers, heaviness and numbness of the fingers with a cold sensation, which worsens in damp and cold weather, with limitation of joint movement, spasms of the fingers and difficulty in grasping things. Accompanying symptoms include heaviness of the body generally, an aversion to cold, a poor appetite, loose stools, a pale tongue with a white and greasy coating and a deep, slow and slippery pulse or a tight pulse.
Principle of treatment
Dispel Cold, remove Damp, regulate Qi circulation and relieve the pain.
HERBAL TREATMENT
Prescription
DANG GUI SI NI TANG
Angelica Four Rebellious Decoction Gan Jiang Rhizoma Zingiberis 6 g
Fu Ling Poria 15 g
Bai Zhu Rhizoma Atractylodis Macrocephalac 12 g
Gui Zhi Ramulus Cinnamomi IOg
Dang Gui Radix Angelicae Sinensis 10 g
Bai Shao Radix Paeoniae Alba 20 g
Xi Xin Herba Asari 3 g
Qing Feng Teng Caulis Sinomenii 20 g
Gan Cao Radix Glycyrrhizae 5 g
Explanations
• Gan Jiang and Gan Cao dispel Cold in the channels and body and warm the Middle Burner.
• Fu Ling and Bai Zhu strengthen the Spleen and remove Damp.
• Gui Zhi and Dang Gui regulate the circulation of Qi and Blood in the channels and also warm the channels.
• Xi Xin and Qing Feng Teng dispel Wind and Damp so as to relieve the pain.
• Bai Shao nourishes the tendons and relieves the pain.
Modifications
1. If there is a severe aversion to cold and muscular spasm, add Fu Zi Radix Aconiti Lateralis Praeparata 10 g to warm the channels and collaterals and relieve the spasm.
2. If there is swelling or heaviness in the fingers due to the predominance of the invasion of Damp, add Du Huo Radix Angelicae Pubescentis 10 g and Cang Zhu Rhizoma Airactylodis 10 g to remove the Damp and sedate the pain.
3. If the appetite is poor, add Ban Xia Rhizotna Pinelliae IOg and Bai Kou Ren Semen Amomi Rotundus 5 g to dry Damp and improve the appetite.
Patent remedy
Feng Shi Pian Wind-Damp Tablet
ACUPUNCTURE TREATMENT
TE-5 Waiguan, CV-12 Zhongwan, SP-6 Sanyinjiao, SP-9 Yinlingquan, LI-4 Hegu, Extra Baxie and Ah Shi points. Reducing method is used on these points. It is advisable to use moxibustion in all patients who suffer from severe pain.
Explanations
• TE-5, the Connecting point of the Triple Burner channel, promotes the circulation of Qi and relieves the pain.
• CV-12, the Front Collecting point of the Stomach and the Gathering point for all the Fu organs, removes obstructions from the channels, invigorates the circulation of Qi in the collateral and eliminates both Cold and Damp.
• SP-6, the crossing point of the three Yin channels of the foot, promotes urination and eliminates Damp.
• SP-9, the Sea point of the Spleen channel, activates the Spleen and Stomach and eliminates Damp.
• LI-4, the Source point of the Large Intestine channel, promotes the circulation of Qi and Blood in the hands and relieves the finger pain.
• The Extra Baxie and Ah Shi points promote the circulation of Qi in the local channels and collateral and stop the pain.
• Moxibustion warms the needles so as to warm the channels and Middle Burner, dispels Cold and relieves Damp.
Modifications
1. If there is a severe aversion to cold and muscular spasm, add moxibustion on CV-6 to warm the channels and collateral and relieve the spasm.
2. If the fingers are swollen and there is a heavy sensation in the body due to an invasion of Damp, add TE-6 and ST-36 to remove the Damp and reduce the swelling.
3. If the appetite is poor, add LR-13, the Front Collecting point of the Spleen, and SP-3, the Source point, to activate the Spleen and Stomach, regulate the circulation of Qi and improve the appetite.
Case history
A 30-year-old woman had been suffering from finger pain on both sides for 5 months. She had a heavy sensation in both hands, and rigidity of the fingers in the morning, accompanied by a poor appetite, fatigue, abdominal distension, loose stools, a white and watery tongue coating and a soft and slow pulse. At the hospital she was diagnosed as having rheumatoid arthritis.
Diagnosis
Invasion of Cold-Damp in the channels with Spleen and Kidney-Yang deficiency.
Principle of treatment
Dispel Wind, Cold and Damp, tonify the Yang-Qi and sedate the pain.
Herbal treatment
DANG GUI SI NI TANG
Angelica Four Rebellious Decoction
Gui Zhi Rainulus Cinnamomi IOg
Dang Gui Radix Angelicae Sinensis IOg
Qing Feng Teng Caulis Sinoinenii 30 g
Jiang Huang Rhizoma Curcumae Longae 10 g
Xi Xin Herba Asari 3 g
Fu Ling Poria 15 g
Gan Cao Radix Glycyrrhizae 5 g
Explanations
• Gui Zhi and Dang Gui promote the circulation of Blood, tonify the Yang-Qi, warm the channels and relieve the pain.
• Gui Zhi and Xi Xin warm the channels, dispel Cold and relieve the finger pain.
• Fu Ling activates the Spleen and Stomach and eliminates Damp.
• Qing Feng Teng and Jiang Huang are good at dispelling Wind-Damp and relieving the painful joints.
• Gan Cao harmonises the actions of the other herbs in the formula.
The patient had daily treatment with the herbal decoction. She was also advised to wash her painful fingers with the remainder of the hot herbs after decocting them. Every day she kept her fingers warm. After 3 months of treatment, her finger pain had disappeared. She was followed up 2 years later and reported that she had experienced no more finger pain since the herbal treatment.
ACCUMULATION OF DAMP-HEAT IN THE CHANNELS
Symptoms and signs
Swelling, redness and pain in the fingers, which worsens in damp and warm weather, heaviness and numbness in the fingers with a warm or even burning sensation, with difficulty in grasping, limitation of joint movement and spasm of the fingers. Accompanying symptoms include a feeling of heaviness in the body generally, an aversion to cold, a poor appetite, loose stools, a red tongue with a yellow and greasy coating and a deep, slippery and rapid, or tight and rapid, pulse.
Principle of treatment
Dry Damp, clear Heat, regulate the circulation of Qi and relieve the pain.
HERBAL TREATMENT
Prescription
SI MIAO SAN
Four-Marvel Powder Huang Bai Cortex Phellodcndri 10 g Cang Zhu Rhizoma Atractylodis 10 g Yi Yi Ren Satten Coicis 10 g Chuan Niu Xi Radix Cyathulae 10 g Ren Dong Teng Caulis Lonicerae 20 g Dang Gui Radix Angelicae Sinensis 10 g Bai Shao Radix Paeoniae Alba 20 g Qing Feng Teng Caulis Sinomenii 20 g Gan Cao Radix Glycyrrhizae 5 g
Explanations
• Huang Bai clears Heat, dries Damp and sedates pain.
• Cang Zhu activates the Spleen and dries Damp.
• Yi Yi Ren and Chuan Niu Xi promote urination, eliminate Damp and reduce the swelling.
• Dang Gui and Bai Shao harmonise the Blood circulation, relax the tendons and muscles and relieve the spasm so as to sedate the finger pain.
• Ren Dong Ten clears Heat in the collateral.
• Qing Feng Teng dispels Damp, circulates the channels and relieves the finger pain.
• Gan Cao harmonises the function of the other herbs in the prescription.
Modifications
1. If there is a fever, add Shi Gao Gypsum Fibrosum 20 g and Zhi Mu Rhizoma Anemarrhenac 10 g to clear Heat and reduce the fever.
2. If the fingers are swollen and red, add Bi Xie Rhizoma Dioseoreae Septemlobrae 10 g and Tu Fu Ling Rhizoma Smilacis Glabrae 10 g to clear Heat, eliminate Damp and reduce the swelling.
3. If there is severe spasm in the fingers, add Bai Jiang Cao Herba Patriniae 10 g and Bai Hua She Agkistrodon Acutus 10 g to promote the circulation in the channels and relax the tendons.
4. If the fingers are deformed, add Wu Jia Pi Cortex Acanthopanacis Radieis 10 g and Di Long Lumbricus 10 g to strengthen the tendons and bones and relieve obstruction in the channels.
5. If the finger pain worsens at night, add Pu Hung Pollen Typhae IOg and Wu Ling Zhi Faeces Trogopterorum 10 g to promote the circulation of Blood and eliminate its stasis.
6. If the appetite is poor, add Shan Zha Fructus Crataegi 15 g and Bai Kou Ren Semen Amomi Rotundus 5 g to activate the Spleen and Stomach and improve the appetite.
Patent remedy
Feng Shi Xiao Tong Pian Wind-Damp Dispel Pain Pill
ACUPUNCTURE TREATMENT
TE-6 Zhigou, CV-12 Zhongwan, LI-2 Erjian, LI-3 Sanjian, LI-4 Hegu, ST-40 Fenglong, ST-44 Neiting,
SP-9 Yinlingquan, Extra Baxie and Ah Shi points.
Reducing method is used on all these points.
Explanations
• TE-6 eliminates Damp, clears Heat, promotes the circulation of Qi and relieves the pain.
• CV-12, the Front Collecting point of the Stomach and the Gathering point for all the Fu organs, removes Damp from the channels, invigorates the circulation of Qi in the collateral and activates the Stomach.
• LI-3, the Stream point, and LI-4, the Source point, reduce the swelling and promote the circulation of Qi in the channels so as to sedate the finger pain.
• LI-2 and ST-44, the Spring points, dear Heat, reduce the swelling and sedate the finger pain.
• SP-9, the Sea point of the Spleen channel, and ST-40, the Connecting point of the Stomach channel, activate the Spleen and Stomach, eliminate Damp and relieve obstruction in the channels.
• The Extra Baxie and Ah Shi points promote the circulation of Qi in the local channels and collateral and stop the pain.
Modifications
1. If there is severe redness, add TE-2 and SI-2, the Spring points, to clear Heat and reduce the swelling.
2. If there is a fever, add GV-14 and LI-Il to clear Heat and reduce the fever.
3. If there is spasm in the finger, add SI-3 to circulate the channels and collateral and relieve the spasm.
4. If there is swelling of the fingers with a heavy sensation in the body, add ST-36 to remove Damp and reduce the swelling.
5. If the appetite is poor, add LR-13, the Front Collecting point of the Spleen, and SP-3, the Source point, to regulate the circulation of Qi and improve the appetite.
