Palmar pain may occur on one or both palms. It may appear as an independent disorder, or exist as one of the symptoms seen in the Bi syndromes (arthritis). It is usually accompanied by a sensation of cold or heat in the palm, painful finger joints, numbness or swelling of the palm, a pale or red skin colour on the palm, and even ulcers. According to TCM theory, palmar pain may be caused by invasion of External Cold-Damp, or of External Damp-Heat, stagnation of Liver-Qi and deficiency of Yang, invasion of Toxic Fire or stagnation of Blood. Palmar pain may be attributed to any of the following disorders in Western medicine: rheumatoid arthritis, rheumatic arthritis, gout, cervical radiculitis, thoracic radiculitis, carpal arthritis, carpal tunnel syndrome, palm infection, fracture of the palm or injury to the soft tissue of the palm.
Aetiology and pathology
Invasion of External Cold-Damp
Damp is a substantial pathogenic factor of the Yin type; it has the characteristics of heaviness and viscosity. Cold is characterised by stagnation and contraction. Therefore, when Cold-Damp invades the palms, it obstructs their physiological function by causing the channels and tendons in the area to contract, which disturbs the circulation of Qi and Blood in the palm. Stagnation of Qi and Blood follows, and pain follows. In addition to causing pain in the palm, Cold-Damp may also invade the finger joints, causing finger pain (see Ch. 39).
Invasion of External Damp-Heat
During a hot and humid summer, External Damp-Heat may easily invade the palm directly. In addition, if Exterior Cold-Damp persists in the body for a long time it may turn into Damp-Heat. Overeating of fatty and sweet food, or drinking too much alcohol, may cause a dysfunction in the Spleen and Stomach, leading to the formation of internal Damp-Heat in the body. When Damp-Heat accumulates it slows down the circulation of Qi and Blood, leading to stagnation of the Qi and Blood in the channels and tendons of the palm, and causing palmar pain.
Stagnation of Liver-Qi with deficiency of Yang
The emotions are closely related to the function of the Liver. Unstable emotional states, or excessive stress or frustration, may cause the circulation of Liver-Qi to slow down, so that it eventually stagnates. In some people with a constitutional Yang deficiency, stagnation of Liver-Qi may lead to stagnation of Cold in the Liver channel; this condition is often seen in women who are exposed to cold environments during their menstrual periods. This occurs because there is a temporary weakness of Blood in the Liver and Vang deficiency during the menstrual period, which attracts the invasion of External Cold. As a result, the circulation of Qi and Blood in the palm becomes blocked and pain occurs.
Invasion of Toxic Fire
A traumatic wound to the palm may leave the person vulnerable to direct invasion of toxic Fire to the muscles and tendons in the area, or even invasion of Toxic Heat into the Blood. When the pathogenic factors spread in the channels of the palm, they may cause stagnation of Qi and Blood in the palm, or even decomposition of the muscle in the locality, leading to palmar pain. Incomplete elimination of Exterior Cold and Damp from the body over a long period of time may also lead to stagnation of Qi and Blood and generate Internal Fire.
Toxic Fire may also form as a result of bad diet and emotional states as well as a poor constitution. For instance, overeating of pungent food or drinking too much alcohol may cause Damp-Heat to form in the body. When this Damp-Heat accumulates in the body over a long period, it may generate Toxic Fire; diabetic patients who suffer with palm pain are usually found to have this condition.
Stagnation of Blood
All the pathological changes mentioned above may eventually influence the circulation of Qi and Blood in the palm. Moreover, physical trauma or inappropriate movement of the hands may directly damage the muscles, tendons and even bones, leading to Qi and Blood stagnation. Inappropriate surgical operations on the palm may also directly cause stagnation of Blood directly. Once the channels of the palm are blocked, pain appears there.
Treatment based on differentiation
Differentiation
Differentiation of External or Internal origin
— Acute onset of palm pain of short duration, accompanied by External symptoms, is usually caused by invasion of External pathogenic factors.
— Chronic onset of palm pain of long duration, accompanied by symptoms resulting from Internal disorder, is usually caused by disorder of Internal organs.
Differentiation of character of the pain
— Palmar pain with a cold and heavy sensation, pale skin on the hands, aggravation of the pain by exposure to cold, or alleviation of pain by warmth, is usually caused by invasion of Cold-Damp.
— Palmar pain with a hot and heavy sensation, redness, swelling and a burning feeling, is often due to invasion of Damp-Heat.
— Formation of ulcers on the palm, and reddish skin of the palm with a hot feeling, aggravation of the pain by pressure, fever, or restlessness, is often due to invasion of Toxin Fire.
— Chronic onset of palmar pain with a cold sensation, and aggravation of the palm pain by emotional upset or exposure to cold, especially during the menstruation, is usually caused by stagnation of Liver-Qi with deficiency of Yang.
— Injury, or history of operation on the palm and fingers, stabbing pain with a fixed location, with aggravation of the pain at night, is usually due to stagnation of Blood.
Treatment
INVASION OF EXTERNAL COLD-DAMP
Symptoms and signs
Palm pain with a cold and heavy sensation, which worsens on exposure to cold and humid weather or by contact with water, and is alleviated by warmth, with swelling of the joints. Other symptoms include pale skin on the hands, a slight fever, an aversion to cold, numb or frigid fingers, cold limbs, a poor appetite, an absence of thirst, clear urine, a pale tongue with a white and moist coating and a floating and tense pulse.
Principle of treatment
Dispel External Cold-Damp and promote Blood circulation.
HERBAL TREATMENT
Prescription
JUAN BI TANG
Remove Painful Obstruction Decoction Qiang Huo Rhizoma seu Radix Notopterygii 10 g
Huang Qi Radix Astragali scu Hcdysari 10 g
Fang Feng Radix Lcdebouriellac 10 g
Dang Gui Radix Angelicae Sinensis 10 g
Jiang Huang Rhizoma Curcumae Longae 15 g
Chi Shao Radix Paeoniae Rubra 10 g
Gan Cao Radix Glycyrrhizae 6 g
Sheng Jiang Rhizoma Zingiberis Recens IOg
Explanations
• Qiang Huo, Fang Feng and Jiang Huang dispel Wind, Cold and Damp and relieve the pain.
• Dang Gui and Chi Shao promote Blood circulation and relieve the pain.
• Huang Qi strengthens the Antipathogenic Qi and consolidates the skin.
• Sheng Jiang and Gan Cao harmonise the stomach and regulate the herbs in the formula.
Modifications
1. If there is severe coldness in the hands and palms, add Fu Zi Radix Aconiti Praeparata 10 g and Rou Gui Cortex Cinnamomi 6 g to warm the channels, eliminate Cold-Damp and relieve the pain.
2. If the limbs are pale and cold, add Tao Ren Semen Persicae IOg and Hong Hua Fios Carthami 10 g to regulate the circulation of Blood and remove Blood stasis.
3. If there is severe pain, add Xi Xin Herba Asari 3 g to warm the channels and relieve the pain.
4. If the joints are swollen, add Han Fang Ji Radix Stephaniae Tetrandrae 10 g and Bi Xie Rhizoma Dioscorcac Scptemlobae 15 g to eliminate Damp and reduce the swelling.
Patent remedy
Feng Shi Pian Wind-Damp Tablet
ACUPUNCTURE TREATMENT
LI-4 Hegu, LI-5 Yangxi, TE-5 Waiguan, LU-7 Lieque, SI-3 Houxi and LR-3 Taichong. Reducing method is used on these points.
Explanations
• LI-4, the Source point of the Large Intestine channel, promotes sweating and dispels Wind-Cold and Damp. It can also promote the circulation of Qi and reduce the swelling.
• LI-5, the River point, regulates the circulation of Qi and dispels Wind and Damp to relieve palmar pain.
• TE-5, the Connecting point, dispels Wind-Cold and Damp, promotes the circulation of Qi, harmonises the collateral in the hands and relieves the pain.
• LU-7, the Connecting point, disperses the Lung-Qi, relieves External symptoms, regulates the Qi and relieves the pain.
• SI-3, the Stream point, promotes the circulation of Qi and relieves the pain.
• LR-3, the Source point of the Liver channel, promotes the circulation of Qi and Blood and relieves the palmar pain.
Modifications
1. If there is a cold sensation in the palm, add TE-6 and ST-36 with moxibustion to warm the channels, dispel Cold and relieve the pain.
2. If the palmar joints are swollen, add PC-6 and ST-40 to promote the circulation of Qi, eliminate Damp and reduce the swelling.
3. If the fingers are painful, add Extra Baxie to promote the circulation of Qi and relieve the pain.
4. If there is numbness in the palm, add PC-7 and HT-7 to regulate the circulation of Qi and relieve the numbness.
5. If there is a fever, add GV-14 and LI-Il to promote sweating and reduce the fever.
Case history
A 35-year-old man had been suffering with palmar pain for 6 months. The pain in the palm and finger joints had started when he was caught in a big storm the previous winter. He was diagnosed as having rheumatoid arthritis, and a doctor had given him some painkillers and some Chinese herbal pills. There was some relief of the joint pain, but he still had pain in the palm.
Therefore he wanted acupuncture treatment as well as the other therapies. When he arrived at the acupuncture clinic, he had finger and palmar pain in both hands. He also had a slightly rigid and cold sensation in his hands, pale and swollen fingers, an aversion to cold, a poor appetite, an absence of thirst, clear urine, a white tongue and a superficial and wiry pulse.
Diagnosis
Invasion of External Cold.
Principle of treatment
Dispel External Cold, warm the channels and relieve the pain.
Acupuncture treatment
LI-4, TE-5, SI-4, LU-5, SP-3 and LR-3 were needled with reducing method. The patient also used moxa sticks to warm the finger joints twice a day. He was treated with acupuncture every other day. Besides this acupuncture and moxibustion treatment, he was given a herbal formula Feng Shi Bi Chong Ji to take every day.
Explanations
• LI-4 is the Source point of the Large Intestine channel. TE-5 is the Connecting point of the Triple Burner channel. SI-4 is the Source point of the Small Intestine channel. These three points in combination promote the circulation of Qi, dispel Cold and relieve the pain.
• LU-5 is the Sea point of the Lung channel. SP-3 is the Source point of the Spleen channel. These two points in combination promote the circulation of Qi and dispel Cold in these channels and resolve Damp.
• LR-3 is the Stream and Source point of the Liver channel. The Liver dominates the tendons, so LR-3 regulates the circulation of Qi and relieves the pain in the tendons.
• The moxa treatment strengthens the warming effect, dispels External Cold and relieves the pain.
After 3 weeks, his palm pain was completely under control. He was followed up by telephone a year later and he said he had experienced no more pain in the palm after this treatment.
INVASION OF EXTERNAL DAMP-HEAT
Symptoms and signs
Palmar pain with a hot and heavy sensation, accompanied by redness, swelling and a burning feeling in the finger joints or all the limb joints, a preference for cold, fever, a thirst, yellow urine, restlessness, a red tongue with a yellow coating and a rapid and slippery pulse.
Principle of treatment
Clear Damp-Heat and promote the Blood circulation.
HERBAL TREATMENT
Prescription
BAI HU JIA GUI ZHI TANG
White Tiger Ramulus Cinnamomi Decoction
Shi Gao Gypsum Fibrosum 30 g
Zhi Mu Rhizoma Anemarrhenae 12 g
Gan Cao Radix Glycyrrhizae 6 g
Jing Mi Semen Oryzae 30 g
Gui Zhi Ramulus Cinnamomi 10 g
Explanations
• Shi Gao and Zhi Mu clear Heat and reduce fever.
• Gan Cao and Jing Mi protect the Stomach-Qi and relieve the pain.
• Gui Zhi eliminates Wind-Damp and promotes the circulation of Blood so as to relieve the palmar pain.
Modifications
1. If there is a fever, add Huang Qin Radix Scutellariae 10 g and Da Qing Ye Folium Isatidis 10 g to clear Heat and reduce the fever.
2. If the palm and the joints are swollen, add Han Fang Ji Radix Stephaniae Tetrandrae 10 g and Jiang Huang Rhizoma Curcumae Longae 10 g to eliminate Damp-Heat and reduce the swelling.
3. If the joints are reddish, add Jin Yin Hua Flos Lonicerae 10 g, Sang Zhi Ramulus Mori 10 g and Luo Shi Teng Caulis Trachelospermi 15 g to clear Damp-Heat and cool the Blood.
Patent remedy
Feng Shi Xiao Tong Pian Wind-Damp Dispel Pain Pill
