Wrist pain may occur in one or both wrists, and sometimes the area of pain extends to the palms and arms. According to TCM theory, wrist pain may be caused by invasion of External Wind-Cold, stagnation of Phlegm-Damp in the channels, stagnation of Qi and Blood, or deficiency of Blood.
Wrist pain may be attributed to any of the following disorders in Western medicine: rheumatic pain, rheumatoid arthritis, nerve pain, tenosynovitis, ganglion, sprain of the local muscles or tendons, and tendon injury of the wrist joint.
Aetiology and pathology
Invasion of Wind-Cold
Overexposure to cold, living and working for too long in a cold environment and wearing insufficient clothing can all increase the chance of Wind-Cold invasion. Wind has the characteristic of upward movement; Cold has the characteristic of contraction and stagnation. So if Wind-Cold invades the body it causes the muscles and tendons of the wrist to contract, leading to stagnation of Qi and Blood, and this causes the wrist pain.
Accumulation of Phlegm-Damp in the channels
Living or working for a long time in a damp place, overexertion, and excessive physical labour that places a strain on the wrist may all cause the Qi to stagnate and Phlegm-Damp to accumulate in the channels around the wrist. Also, the circulation of Body Fluids is influenced by the circulation of Qi, so if the Qi stagnates in the locality, then the Body Fluids stagnate as well. If the Body Fluids stagnate this in turn may cause Phlegm-Damp to form. Once Phlegm-Damp blocks the channels, it further disturbs the circulation of Qi and Blood and causes wrist pain and swelling.
Stagnation of Qi and Blood
Qi and Blood should circulate freely in the channels of the wrist. Overstrain, physical trauma, inappropriate movements and inappropriate operations on the wrist may all block the circulation of Qi and Blood in the channels, leading to the stagnation of Qi and Blood, so wrist pain follows.
Deficiency of Blood
Excessive blood loss during the menstrual period, or during an operation, or prolonged chronic disease may lead to consumption of the Qi and Blood, which results in deficiency of Blood. The tendons and joints need to be nourished by Blood if they are to perform their function smoothly. So if there is insufficient Blood circulation in the channels, the wrist is undernourished, and this leads to wrist pain.
Treatment based on differentiation
Differentiation
Differentiation of External or Internal origin
— Acute onset of wrist pain of short duration, accompanied by External symptoms, is usually caused by invasion of External pathogenic factors.
— Chronic onset of wrist 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
— Acute wrist pain, swelling with a cold sensation, aggravation of the pain in cold weather, or alleviation of the pain by movement, is usually caused by invasion of Wind-Cold.
— Swelling and pain of the wrist, with limitation of wrist movement, a heavy sensation of wrist and fingers, or formation of soft nodules around the wrist, is usually caused by accumulation of Phlegm-Damp in the channels.
— Chronic wrist pain, or history of traumatic injury at the wrist, or history of operation, or wrist pain with numbness, with worsening of the pain at night, or alleviation of pain by movement, is often due to stagnation of Qi and Blood.
— Slight wrist pain with numbness, weakness of the wrists and hands, a pale complexion and lips, dizziness or palpitations, is often caused by deficiency of Blood.
Treatment
INVASION OF WIND-COLD
Symptoms and signs
Acute wrist pain, swelling and pain of the wrist with a cold sensation, difficulty in relaxing or extending the wrist, worsening of the pain in cold weather, and alleviation with movement, spasm in the fingers or arms, an aversion to cold, a preference for warmth, a purplish tongue with a white coating and a wiry or tight pulse.
Principle of treatment
Dispel Cold, 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
Gui Zhi Ramulus Cinnamomi 10 g
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
Jiang Huang Rhizoma Curcumae Longae 10 g
Gan Cao Radix Glycyrrhizae 5 g
Explanations
• Gan Jiang and Gui Zhi dispel Cold, warm the channels and relieve the pain.
• Dang Gui and Bai Shao nourish the tendons, regulate the circulation of Qi and Blood in the channels and relieve the pain.
• Xi Xin is good at dispelling Wind-Cold and relieving the pain.
• Qing Feng Teng and Jiang Huang dispel Wind-Cold, promote the circulation in the channels and relieve the pain.
• Gan Cao harmonises the herbs in the formula.
Modifications
1. If there is an aversion to wind, add Fang Feng Radix Ledebouriellae 10 g to dispel Wind and relieve External symptoms.
2. If the wrist is swollen, add Han Fang Ji Radix Stephaniae Tetrandrae 10 g and Wu Jia Pi Cortex Acanthopanacis Radieis 10 g to eliminate Damp and reduce the swelling.
3. If there is a severe aversion to cold and muscular spasm, add Fu Zi Radix Aconiti Lateralis Praeparata 10 g and Rou Gui Cortex Cinnamomi 5 g to warm the channels and collateral and relieve the spasm.
4. If the wrist is rigid, add Di Long Lumbricus IOg and Jiang Can Bombyx Batryticatus 10 g to relax the tendons and resolve Phlegm-Damp in the channel.
5. If there is generalised body pain, add Qiang Huo Rhizoma seu Radix Notopterygii 10 g and Du Huo Radix Angelicae Pubescentis 10 g to dispel Wind-Cold and relieve the pain.
Patent remedy
Feng Shi Pian Wind-Damp Tablet
ACUPUNCTURE TREATMENT
LI-3 Sanjian, LI-4 Hegu, Lu-7 Lieque, SI-4 Wangu, TE-5 Waiguan, Extra Baxie and Ah Shi points.
Reducing method is used on all these points.
Explanations
• LI-3, the Stream point, and LI-4, the Source point, dispel Wind-Cold, promote circulation in the channels and relieve the pain.
• LU-7, the Connecting point of the Lung channels, dispels Wind-Cold and relieves the pain.
• SI-4, the Source point of the Small Intestine channel, and TE-5, the Connecting point of the Triple Burner channel, promote the circulation of Qi and Blood in the wrist and relieve pain.
• 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 a severe aversion to cold and muscular spasm, add moxibustion on LI-4, LU-7 and the Ah Shi points to warm the tendons and muscles and relieve the spasm.
2. If the wrist is swollen, add TE-6 to regulate the circulation of Qi, promote the discharge of excessive water and reduce the swelling.
3. If there is generalised body pain, add ST-40 and SP-21 to regulate the circulation of Qi and Blood and relieve the pain.
Case history
A 45-year-old woman had been suffering from wrist and finger pain on both sides for a year. She had a tense pain and in the morning there was rigidity in both wrists. She also had an aversion to cold, fatigue, a pale tongue with a white coating and a wiry pulse. At the hospital her complaint had been diagnosed as rheumatoid arthritis.
Diagnosis
Invasion of Wind-Cold with deficiency of Qi.
Principle of treatment
Dispel Wind-Cold, regulate Qi circulation, tonify Qi and relieve the pain.
Herbal treatment
DANG GUI SI NI TANG
Angelica Four Rebellious Décoction
Gui Zhi Ramulus Cinnamomi 10 g
Dang Gui Radix Angelicac Sinensis 10 g
Bai Zhu Rhizoma Atractylodis Macrocephalae 10 g
Dang Shen Radix Salviae MUtiorrhizae IOg
Qing Feng Teng Caulis Sinomenii 30 g
Jiang Huang Rhizoma Curcumae Longae 10 g
Xi Xin Herba Asari 3 g
Chi Shao Radix Paeoniae Rubra 10 g
Huang Qi Radix Astragali scu Hedysari 15 g
Fu Zi Radix Aconiti Praeparata 10 g
Zhi Gan Cao Radix Glycyrrhizac Praeparata 5 g
Explanations
• Gui Zhi, Xi Xin and Fu Zi warm the channels and relieve the pain.
• Dang Gui and Chi Shao promote the circulation of Blood and relieve the wrist pain.
• Dang Shen, Huang Qi and Bai Zhu activate the Spleen and Stomach and tonify the Qi.
• Qing Feng Teng and Jiang Huang are good at dispelling Wind-Cold and relieving the joint pain.
• Zhi Gan Cao tonifies the Qi and harmonises the actions of the other herbs in the formula.
The patient was given daily treatment with this herbal decoction. She was also advised to warm her wrists with the moxa stick three times a day, for 5 to 10 minutes each time. After I month of treatment, her wrist and finger pain had disappeared. She was followed up 2 years later, and she stated that she had experienced no more pain since the herbal treatment.
ACCUMULATION OF PHLEGM-DAMP IN THE CHANNELS
Symptoms and signs
Swelling and pain of the wrist, limitation of wrist movement, and a heavy sensation in the wrist and fingers, accompanied by the formation of soft nodules around the wrist, a poor appetite, loose stools, a pale tongue with a white and greasy coating and a deep and slippery pulse.
Principle of treatment
Promote Qi circulation, eliminate Phlegm and relieve the pain.
HERBAL TREATMENT
Prescription
QIANG HUO SHENG SHI TANG
Notopterygium Dispelling Dampness Decoction Qiang Huo Rhizoma sen Radix Notopterygii 10 g Fu Ling Poria 15 g
Chuan Xiong Rhizoma Ligustici Chuanxiong 10 g Gan Cao Radix Glycyrrhizac 6 g
Fang Feng Radix Ledebouriellae 6 g
Zhi Ban Xia Rhizoma Pinelliae Praeparata 10 g
Bai Jie Zi Semen Sinapis Albae 10 g
Explanations
• Qiang Huo dispels Wind-Cold-Damp from the upper body and sedates pain.
• Fang Feng dispels Wind-Cold and relieves External symptoms.
• Chuang Xiong promotes the circulation of Blood and expels Wind so as to arrest the pain.
• Zhi Ban Xia and Fu Ling dry Damp and eliminate Phlegm.
• Bai Jie Zi eliminates Phlegm and resolves Damp in the channels.
• Gan Cao coordinates the effects of the other herbs in the prescription.
Modifications
1. If there is swelling and heaviness in the wrist and fingers, add Cang Zhu Rhizoma Atractylodis IOg and Yi Yi Ren Semen Coicis 10 g to dry Damp, reduce the swelling and relieve the pain.
2. If there is numbness in the wrist, add Di Long Lumbricus 10 g and Si Gua Luo Retinervous Luffae Fructus 10 g to resolve Phlegm-Damp in the channels and harmonise the collateral.
3. If there is a stabbing pain, or worsening of the pain at night, add Dan Shen Radix Salviae Miltiorrhizae IOg and Pu Huang Pollen Typhae 10 g to promote the circulation of Blood and eliminate Blood stasis.
4. If the appetite is poor, add Ji Nei Jin Endothelium Corneum Gigeriae Galli 10 g and Mai Ya Fructus Hordei Germinatus 10 g to activate the Spleen and improve the appetite.
5. If there is nausea or vomiting, add Huo Xiang Herba Agastaehis 10 g and Xuan Fu Hua Flos lnulae 10 g to harmonise the Stomach and help the Stomach-Qi to descend.
Patent remedy
Ren Shen Zai Zao Wan Ginseng Restorative Pill
