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Basic TCM Knowledge regarding Osteoarthritis of the Knee In Traditional Chinese Medicine

Osteoarthritis (Degenerative Joint Disease) is mostly related to Fixed Bi and Painful Bi.

Fixed Bi Syndrome: The chief manifestations include pain and heavy sensation in the relatively fixed areas of body limbs or joints, numbness of the muscles, aggravation of the condition in rainy days, white greasy tongue coating, and soft slow pulse.

Painful Bi Syndrome: The chief manifestations include severe pain in the limbs and joints as if being stabbed or pricked. In the worst cases, there is fixed pain that is alleviated by warmth but aggravated by cold, better in the daytime but worse at night, limited movements of the joints, no local redness nor feverish sensation, cold sensation in the affected parts, thin white tongue coating, wiry tense pulse.

Pathogenesis

Wind, cold and dampness invasion causes the blockage of the Qi and blood in the meridian. In modern medicine, it is related to aging, endocrine disorder as well as trauma and improper posture.

Clinical manifestations
 
The onset of osteoarthritis of the knee is insidious. Initially, there is articular stiffness, seldom lasting more than 15 minutes; this develops later into pain on motion of the affected joint(s) and is made worse by activity or weight bearing and relieved by rest. Deformity may be absent or minimal; however, varus deformity of the knee is not unusual.

Imaging

Radiographs may reveal narrowing of the joint space, sharpened articular margin, osteophyte formation and lipping of the marginal bone, and thickened, dense subchondral bone. Bone cysts may also be present.

Major pattern differentiation

Fixed Bi:
Pain fixed in the knee joint accompanied by heaviness, stiffness and numbness, sometimes slight swelling.

Painful Bi:
Severe pain in the knee joint, aggravated by cold and alleviated by heat.

Treatment Principle:
Expel wind, Cold and dampness, improve the meridian circulation and regulate Qi and blood.

Major Acupuncture points and needle techniques

Acupuncture points for knee:
Xiyan (Ex.), Dubi (ST35), Zusanli (ST 36), Yanglingquan (GB 34)

Alternative Therapies:

Auricular therapy
Corresponding area (Knee), Sympathetic, Shenmen


Subcutaneous needling therapy
Select local point or tender points
Seven-star needle tapping and cupping

Read paper on Osteoarthritis of the Knee for Rachel Peterman's Clinical Acupuncture Practice II class at New York College of Traditional Chinese Medicine in Mineola, NY.

She gives an overview of Osteoarthritis of the knee, and Western and TCM treatment approaches.

Rachel H. Peterman, M.S., DHEd(c), J.D.

Osteoarthritis of the Knee.pdf

Acupuncturist Anna Stephens applies needles to patient Linda Aron in efforts to help facilitate Aron's digestion at Postels Community Health Center, part of the Grinnell Regional Medical Center in Grinnell, Iowa. Photo by Doug Wells for USA TODAY

The American Hospital Association says ...that 37% of hospitals around the USA make complementary and alternative treatments available -- including acupuncture, touch therapy, and music and art therapy. A similar survey by the hospital group in 2005 found that one in four hospitals offered such services...

The majority of hospitals say that patient satisfaction is the No. 1 way they determine if an alternative treatment is beneficial, closely followed by clinical data on a treatment. Cleveland Clinic just completed a complementary and alternative therapy pilot program for patients undergoing heart surgery. Half of the patients -- more than 1,700 -- opted for spiritual care, counseling, art, music, touch therapy or guided imagery, and 93% of patients surveyed said the services were helpful.

Guidance from doctor groups for patients with chronic pain has helped bolster doctors' acceptance of complementary treatments, says Richard Nahin, senior adviser for scientific coordination and outreach at the National Center for Complementary and Alternative Medicine.

He cites new guidelines for treating lower back pain issued jointly last year by the American College of Physicians and the American Pain Society, which suggest many alternative therapies as potential treatments. "As doctors become more aware, hospitals will also follow," Nahin says.

USA Today Health News 9-15-2008 for full article

Pentagon researches alternative treatments

The Pentagon is seeking new ways to treat troops suffering from combat stress or brain damage by researching such alternative methods as acupuncture, meditation, yoga and the use of animals as therapy, military officials said. "This new theme is a big departure for our cautious culture," Dr. S. Ward Casscells, the Pentagon's assistant secretary for health affairs, told USA TODAY. Casscells said he pushed hard for the new research, because "we are struggling with" post-traumatic stress disorder (PTSD) "as we are with suicide and we are increasingly willing to take a hard look at even soft therapies." About 300,000 Iraq and Afghanistan war veterans suffer from PTSD or major depression, and about 320,000 may have experienced at least a mild concussion or brain injury in combat, according to a RAND Corp. study released this year.

The Army reported a record 115 suicides last year, and suicides this year are at a rate that may exceed that, said Col. Eddie Stephens, the Army's deputy director for human resources policy. The Department of Veterans Affairs reported last month that suicides among Iraq- and Afghanistan-era veterans from all services reached a record high of 113 in 2006, the latest year for which there were figures.

Some military hospitals and installations already use alternative therapies, such as acupuncture as stress relievers for patients. The research will see whether the alternatives work so the Pentagon can use them more, said Army Brig. Gen. Loree Sutton, head of the Defense Centers of Excellence for Psychological Health and Traumatic Brain Injury.

Many of the treatments have been used for centuries, Sutton said, "so it just makes sense to bring all potential therapies to bear." Some soldiers who suffer from PTSD are reluctant to share their experiences in traditional psychiatric therapy, said Col. Charles Engel, an Army psychiatric epidemiologist. He said those soldiers may be more willing to use acupuncture and other alternatives if they are effective.

Initial research this summer with combat veterans showed that acupuncture relieved PTSD symptoms and eased pain and depression, Engel said. "Improvements were relatively rapid and clinically significant," he said.

http://www.usatoday.com/news/health/2008-10-07-holistic_N.htm  for full article

CHICAGO (Reuters) - "Acupuncture helped alleviate lingering pain and decreased shoulder mobility in people who had surgery for head and neck cancer, U.S. researchers said on Saturday.

The ancient Chinese therapy also resulted in significant improvements in extreme dry mouth or xerostomia, which often occurs in people who have had radiation treatment for head and neck cancer, they said at a meeting of the American Society of Clinical Oncology in Chicago.

Researchers at Memorial Sloan-Kettering Cancer Center in New York " (Further studies are cited at the link) "studied 70 patients who were at least three months past their surgery and radiation treatments. About half got standard treatments, which include physical therapy and treatment with anti-inflammatory drugs. The other half got standard treatment plus a weekly acupuncture session. After four weeks, 39 percent of those who got acupuncture reported improvements in pain and mobility, compared with only 7 percent in people who got typical care.

"Although further study is needed, these data support the potential role of acupuncture in addressing post neck-dissection pain and dysfunction, as well as xerostomia," Memorial Sloan-Kettering's Dr. David Pfister said at the meeting."This article comes from Reuters

Several of my relatives had head and neck surgery for cancer and suffered from these symptoms. My uncle did use acupuncture for pain and discomfort after he left the hospital. My mother was open to it but never tried it; it was too far away from her established ideas, plus her insurance did not cover it. My aunt had serious back pain and immobility while vacationing in China, was taken to an acupuncture clinic as an emergency patient and got immediate relief. She talked about it for years later, but did not continue with acupuncture. She ended up wearing a narcotic patch on her back for pain and got very disturbed and ill-tempered when the time neared to replace the patch with a new one because the dosage in the patch was declining.