Articles

Carpal Tunnel Syndrome

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Carpal Tunnel Syndrome

Introduction

Carpal tunnel syndrome is characterized by finger numbness, stabbing pain, weak wrist holding power, etc. The disease is caused by thickening and enlargement of the wrist transversal ligament, the narrowing of the carpal canal after trauma, or finger flexor tendon tissue edema, which is due to the oppression of the median nerve. In traditional Chinese medicine, it belongs to the category of Bi-syndrome.

Etiology/Pathogenesis

This disease occurs when the muscles and tendons are attacked by pathogenic cold, dampness, and wind or trauma, and qi and blood circulation are then hindered, inducing blood stasis and blockage of the meridians, leading to carpal tunnel syndrome.

Other Treatments

Herbal treatment with external application
18 cases of carpal tunnel syndrome were treated to disinfect and then wash the area with herbs. The herbs used included Dang Gui (Chinese Angelica Root), Hong Hua (Carthamus), Wei Ling Xian (Clematis), Shou Wu (Fleece-Flower Root), Sang Zhi (Mulberry Twig), Shen Jin Cao (Buck Grass), Fang Feng (Siler), Dan Shen (Salvia), and Gui Zhi (Cinnamon Twig). The herbs were decocted in water and then soaked in the affected joint region, which was done twice a day. At the same time, the patients were asked to conduct appropriate wrist joint movement. The results indicated that 10 cases were resolved and the other 8 cases had improved. The total of effectiveness rate was 100%. (1)

In another report, 27 cases of carpal tunnel syndrome were treated externally with modified Wu Tou San. The formula was made up of dried Chuan Wu (Sichuan Aconite Root), dried Cao Wu (Wild Aconite Root), Jiang Huang (Curcuma), Wei Ling Xian (Clematis), Tian Hua Fen (Trichosanthes Root), Ma Huang (Ephedra), Gui Zhi (Cinnamon Twig), Chi Shao (Peony Red), and Gan Cao (Licorice). These herbs were grounded into a powder and then mixed with honey or maltose to be processed into paste for external application in the local area. The herbal paste was changed twice every 2 days. The results showed that 24 cases were resolved and 3 cases had no apparent effect. (2)

Treatment with other therapies
In the treatment of 36 cases of carpal tunnel syndrome with blood letting and external application of medicinal herbs, Ba Xie (EX-UE 9) on the affected side was pricked with a three-edged needle to let about 0.1ml of blood out daily. The herbs used were Ma Qian Zi (Nut-vomitive Poisonnut Seed), Da Huang (Rhubarb), Bai Zhi (Angelica), Nan Xing (Arisaema), and Gan Cao (Licorice). They were first grounded into powder, and then mixed with an approximate amount of wine to be applied to the affected area. The results indicated that all 36 cases were resolved. (3)

48 cases of carpal tunnel syndrome were treated by hydro-acupuncture and massage. The results showed that 21 cases were resolved, 15 had remarkable improvement, 9 cases improved, and 3 had no improvement. The total effectiveness rate was 96%. (4)

32 cases of carpal tunnel syndrome were treated. The main acupoints used were Da Ling (PC 7) and Nei Guan (PC 6) to Wai Guan (TE 5), supplemented with Yu Ji (LU 10) and Yang Xi (LI 5). After achieving needling sensation, ignited moxa segments were attached to the needles in the main acupoints to warm the acupoint mildly, with two segments for each acupoint. The auxiliary acupoints were not moxibustioned, only punctured with acupuncture needles. The needles were retained for 30 minutes and manipulated once again every 10 minutes. The treatment was performed once a day. 7 sessions constituted one therapeutic course of treatment. The results showed that 27 cases were resolved, 4 cases had improved, and 1 case had no change. The total effectiveness rate was 96.9%. (5)

10 cases of carpal tunnel syndrome were treated with ginger-separated moxibustion. A slice of fresh ginger, which was about 0.3cm thick and had multiple tiny holes penetrated at its center, was placed at the acupoint and then placed with an ignited moxa cone. The acupoints Da Ling (PC 7) and Nei Guan (PC 6) on the affected side were moxibustioned until the skin looked flushed. 6 cones were used for each acupoint in each session. The treatment was given once every day. 5 sessions constituted one therapeutic course of treatment. The results showed that after treatment, 21 cases are resolved, 8 had apparent improvement, and 3 cases showed some improvement. (6)

20 cases of carpal tunnel syndrome were treated with massage, herbal fumigation, and washing. The rotatory kneading-pressing, plucking-pinching, finger-flicking, and shaking methods were performed once a day, about 10 minutes each time. 7-10 times constituted one therapeutic course of treatment. The interval between two courses was one week. The herbs used were Gui Zhi (Cinnamon Twig), Fang Feng (Siler), Qin Jiu (Gentian Root), Dang Gui (Chinese Angelica Root), Tou Gu Cao (Impatiens), Dan Shen (Salvia), Shen Jin Cao (Buck Grass), Ai Ye (Artemisa Carbon), and Hong Hua (Carthamus). The herbs were decocted in water to wash the affected region, twice a day. One dose was used for 2 days. The results indicated that 15 cases were resolved, 4 cases showed significant improvement, and one had no apparent changes. The total effectiveness rate was 95%. (7)

Acupunture & Acupressure

40 cases of carpal tunnel syndrome were treated with acupuncture by puncturing Da Ling (PC 7, as the primary acupoint), He Gu (LI 4), Er Bai (EX-UE 2), and Wai Lao Gong (EX-UE 8). 1 - 3 acupoints were used during each session. Da Ling (PC 7) was stimulated with the mild needling method with the acupuncture needle tip being inserted into the carpal tunnel. He Gu (LI 4), Er Bai (EX-UE 2), and Wai Lao Gong (EX-UE 8) were stimulated with the strong needling manipulation until the patient experienced soreness, numbness, and swelling in the local area. The needles were retained for 15 minutes. This acupuncture treatment was given once a day. 10 sessions constituted one therapeutic course of treatment. The results indicated that among the 40 cases treated, 23 were resolved, 14 had improved, and 3 cases had apparent improvement. The total effectiveness rate was 92.5%. (8)

25 cases of carpal tunnel syndrome were treated with electroacupuncture. The main acupoints used were Hand-Yang Ming Meridian and San Jiao Meridian. Gauge-26 filiform needles were inserted straight into Qu Chi (LI 11), He Gu (LI 4), Wai Guan (TE 5), Zhong Du (GB 32), and Da Ling (PC 7). After achieving needling sensations, the acupoints were stimulated with electrical pulses. The Shi Xuan (EX-UE 11) acupoint was used for blood-letting. The treatment was conducted once a day. 10 sessions constituted one therapeutic course of treatment. The results showed that 15 cases were resolved, 5 cases showed significant improvement, 4 cases had improved, and one case had no improvement. The total effectiveness rate was 96.0%. (9)

Combined treatment with acupuncture and herbal medicines
65 cases of carpal tunnel syndrome were treated with electroacupuncture and Wen Jing Huo Xue San. The points Wai Guan (TE 5) and Lao Gong (PC 8) were used as a group, while Da Ling (PC 7) and Zhong Du (GB 32) were used as another group. One group was used in every session of treatment. After insertion and achieving needling sensations, the needle handles were connected with an electroacupuncture therapeutic apparatus to stimulate the acupoints 30 minutes each time. The acupuncture treatment was conducted once every other day. In addition, the following herbs were used: dried Chuan Wu (Sichuan Aconite Root), dried Cao Wu (Wild Aconite Root), Pian Jiang Huang (Curcuma), Zhang Nao (Camphora), Wei Ling Xian (Clematis), Gui Zhi (Cinnamon Twig), and Chi Shao (Peony Red). These herbs were grounded into a powder. Then the powder was mixed with honey to be made into paste and applied to the affected wrist joint. The paste was changed once every other day. 10 sessions constituted one therapeutic course of treatment. The results indicated that among the 65 cases, 16 were resolved, 31 had remarkable improvement, 13 cases had improved, and 3 cases had no apparent improvement. (10)

In another report, 23 carpal tunnel syndrome cases were treated with acupuncture and herbs. Yang Chi (TE 4), Nei Guan (PC 6), and He Gu (LI 4) on the affected side were punctured and stimulated with the uniform reinforcing-reducing method, and the needles were retained for 15 minutes. The acupuncture treatment was given once a day. The herbs used included Gui Zhi (Cinnamon Twig), Bai Shao (White Peony Roots), Tou Gu Cao (Impatiens), Hong Hua (Carthamus), Wei Ling Xian (Clematis), Dang Gui (Chinese Angelica Root), Zhi Chuan Wu (prepared Sichuan Aconite Root), Xi Xin (Wild Ginger), and dried Di Huang (Rehmannia Root). The herbs were immersed in water (2500ml) for 30 minutes, and decocted with soft fire for one hour. The decoction was mixed with wine (100ml) and rice vinegar (100ml) for washing the wrist and forearm, about 30 ~ 40 minutes twice every day. In the control group, 23 cases were treated with local block therapy by injecting prednisolone acetate plus procaine, once a day. 4 sessions constituted one therapeutic course of treatment. The results for the combined acupuncture and herbal treatment group and the control group were, respectively: 16 and 4 cases had marked improvement, 5 and 10 improved, and 2 and 9 had no improvement. The total effectiveness rates were 91.3% and 60.9%, respectively (P

References

  1. Jiao Hong Pu. Treating 18 cases of carpal tunnel syndrome by washing with Chinese herbs. Journal of Applied Integrated Medicine. 1993;6(4):203.
  2. Yang Qi Jing. Treating 27 carpal tunnel syndrome with external application of modified Wu Tou San. Sichuan Journal of TCM. 1994;12(1):51.
  3. Li Jian Mei. Treating carpal tunnel syndrome with blood-letting at acupoints combined with massage. Heilongiang Journal of Traditional Chinese Medicine and Pharmacology. 1999;15(1):37-38.
  4. Li Xia, et al. Treating 48 cases of carpal tunnel syndrome with hydroacupuncture and massage. Journal of Acupuncture Clinical Application. 1999;15(1):37-38.
  5. Xu Wen Liang, et al. Treating carpal tunnel syndrome with warm acupuncture. Anhui Journal of Clinical Application of TCM. 1999;11(3):188.
  6. Yang Yong Hui. Treating 32 cases of carpal tunnel syndrome with ginger-separated moxibustion. Anhui Journal of Clinical Application of TCM. 1999;11(4):258.
  7. Jiang Jiang Ping. Summary for treating 20 cases of carpal tunnel syndrome with massage and external washing. Jiangxi Journal of TCM. 1992;23(1):38.
  8. Ma Qing Lin. Treating 40 cases of carpal tunnel syndrome with acupuncture. Shaanxi Journal of TCM. 1998;9(3):133.
  9. Wang Dong Yan, et al. Treating 25 cases of carpal tunnel syndrome with electroacupuncture. China Journal of Acupuncture. 1996;16(5):37.
  10. Ma Xiang Ri. Treating 65 cases of carpal tunnel syndrome with electroacupuncture combined with external application of Wen Jin Huo Xue San. Journal of Folk Chinese Medical Treatment. 1996;16(5):37.