(Key for symbols used: "+" = Reinforcing; "-" = Reducing; "+/-" = Neutral; "^" = Moxibustion)

Thromboangitis obliterans, also called Buerger’s Disease, refers to chronic and progressive inflammation of the peripheral arteries and veins of the body. It occurs predominantly in men aged 20 to 40 who smoke cigarettes. Only about 5% of cases occur in women. This suggests that cigarette smoking is its primary etiologic factor. It is clinically marked in the initial stage by numbness and coldness of the extremities, fixed pain, and intermittent claudication. In the intermediate and advanced stages, there is persistent severe pain worsening at night, myoatrophy, and black pigmentation or dry or moist necrosis of the affected region. According to TCM, thromboangitis obliterans is classified into Bi Zheng (blockage syndrome), Tuo Ju (gangrene of finger or toe), and it is caused by exogenous cold or dampness, trauma, or mental injury, which leads to stagnation of qi and blood and subsequent insufficient nourishment of the muscles and skin.

I. STANDARD TREATMENT

Usually, thromboangitis obliterans is divided into two types---- cold-damp syndrome and blood stasis syndrome. Points on the Yang Meridians are frequently selected in its treatment.

1. Cold-Dampness

Manifestations: Coldness and numbness of the diseased limb, pale colour of the local skin, weak or even disappearing of the artery pulse beating of the dorsum of the foot or leg, intermittent claudication.

Tongue: Pale body with white sticky coating.

Pulse: Deep, thready and slow.

Treatment Principle: Warm the meridian, dispel cold, activate blood circulation and dredge the collateral.

Point Prescription & Manipulation:

According to the diseased region:

On the lower limb:

ST-36 Zusanli

ST-41 Jiexi

SP-9 Yinlingquan

LR-2 Xingjian

DU-4 Mingmen

KI-3 Taixi

On the upper limb:

LI-11 Quchi

SJ-5 Waiguan

LI-4 Hegu

SJ-3 Zhongzhu

DU-14 Dazhui

PC-7 Daling

Explanation:

Acupuncture is taken as the main the treatment, and moxibustion as the assistant. At first, only 1-2 points are needed to induce obvious good results. After 5-15 treatments, it is needed to increase the number of acupoints gradually and to select the points alternately in order to sustain the result. Additionally, the needling manipulation should increase from mild to heavy, and the retention of the needles from short to long periods of time. During the retention moxibustion can be applied in co-operation.

• ST-36 Zusanli and ST-41 Jiexi dredge the Foot-Yangming Meridian, promote generation of qi and blood, and dispel coldness;

• SP-9 Yinlingquan reinforces the spleen and removes dampness;

• LR-2 Xingjian and ST-41 Jiexi promote flow of the meridian qi in the lower limbs;

• DU-4 Mingmen and KI-3 Taixi warm kidney yang to dispel cold and dampness;

• LI-11 Quchi and LI-4 Hegu dredge the Hand-Yangming Meridian, promote generation of qi and blood, and dispel coldness;

• DU-14 Dazhui warms yang to dispel cold;

• PC-7 Daling, SJ-5 Waiguan and SJ-3 Zhongzhu promote flow of the meridian qi of the upper limbs.

2. Blood Stasis

Manifestations: Constant pain of the diseased limb, which is aggravated in the night, purple-yellow, dark-red or purple colour of the diseased limb with atrophy of the skin.

Tongue: Purple-dark body.

Pulse: Deep, thready and uneven.

Treatment Principle: Activate blood, remove blood stasis, and dredge the collaterals.

Point Prescription & Manipulation:

According to the diseased region:

On the lower limb:

BL-40 Weizhong

BL-60 Kunlun

KI-3 Taixi

ST-41 Jiexi

ST-43 Xiangu

EX-LE-10 Bafeng

On the upper limb:

LI-11 Quchi

SJ-5 Waiguan

LI-4 Hegu

SJ-3 Zhongzhu

EX-UE-9 Baxie

PC-3 Quze

Explanation:

BL-40 Weizhong is pricked to cause bleeding. Manipulation on the other points is the same as above.

• BL-40 Weizhong removes blood stasis;

• BL-60 Kunlun, KI-3 Taixi, ST-41 Jiexi, and ST-43 Xiangu promote flow of the meridian qi in the lower limbs;

• EX-LE-10 Bafeng relieves foot pain.

• LI-11 Quchi, SJ-5 Waiguan, LI-4 Hegu and SJ-3 Zhongzhu promote flow of the meridian qi in the upper limbs;

• PC-3 Quze and EX-UE-9 Baxie promote flow of qi and blood and relieve hand pain.

II. EXPERIENTIAL TREATMENT

1. Puncturing EX-LE-16 Tongmai

Indication: Thromboangitis obliterans at the early stage or middle stage.

Point Prescription:

EX-LE-16 Tongmai of the diseased side, located at the supero-bacterior aspect of the buttock, at the crossing point of the line starting from BL-30 Baihuanshu and going down perpendicularly and the line starting from EX-LE-13 Huanzhong and going horizontally.

Manipulation: Ask the patient to lie on the stomach with the lower limbs extended, insert a 4 cun long needle perpendicularly into the point 3 cun deep, and constantly lift, thrust and rotate the needle for about 5 minutes to make the needling sensation radiate to the bottom of the foot. Retain the needle in the point for 20-40 minutes and manipulate it every 10 minutes.

2. Puncturing the Reaction Points

Indication: Thromboangitis obliterans at the early or middle stage.

Point Prescription:

According to the diseased region:

1. On the lower limb---EX-B-12 Maigen, located on the lower back, 0.5 cun below the level of the second spinal process of the sacrum and 3 cun lateral to the spinal column; EX-LE-22 Shangququan, located on the posterior border of the thigh and 3 cun directly above LR-8 Ququan. If the toe is diseased, SP-9 Yinlingquan and SP-8 Diji are added; if the dorsum of the foot and the second and third toes are diseased, Zusanli ST 36 and ST-40 Fenglong added; and if the fourth toe and lateral side of the leg are diseased, GB-34 Yanglingquan is added.

2. On the upper limb---LI-11 Quchi, HT-3 Qingling, EX-UE-20 Shouni, located on the midline of the medial aspect of the arm, at the midpoint of the line connecting the transverse crease of the wrist and elbow. If the diseased site is the thumb, LI-10 Shousanli is added; the ring finger, SJ-5 Waiguan added; and the small finger, HT-5 Tongli is added.

Manipulation: After insertion of the needles, lift, thrust and rotate them with medium stimulation to induce arrival of qi. Then retain the needles for 20-40 minutes

3. Ear Acupuncture

Indication: Thromboangitis obliterans at the early or middle stage.

Ear Point Prescription:

The corresponding region, Heart, Lung, Kidney, Liver, Spleen, Sympathetic, Subcortex, Ear Apex.

Manipulation: See page 255-256.

Comment:

As thromboangitis obliterans is usually aggravated by coldness, emotional depression, and smoking, the patient should be advised to keep warm, avoid bad emotional stimulation and give up smoking. Zhenjiu may be one of the best treatment methods for thromboangitis obliterans. It can act to effectively relieve the patient’s condition and prevent his/her condition from becoming worse. However, this disease is obstinate, and long-term treatment in co-operation with some other therapeutic methods, such as herbs, is generally needed.

About the author, GANGLIN YIN

Dr. Yin received his M.D. from Hunan University of Traditional Chinese Medicine (HUTCM) in Changsha, China in 1982 and received three years of postgraduate training at the same medical school. From 1985 to 1996, he taught and practiced TCM in HUTCM, and he was promoted as Associate Professor of Acupuncture in 1994. From 1997 to 2000, he taught and practiced TCM at the International College of Traditional Chinese Medicine in Victoria, Canada. In June of 2000, Yin practiced and lectured at the Atlantic Institute of Oriental Studies in Florida. Presently, he is the Principal of Oshio College of Oriental Medicine at Victoria, BC. His long and distinguished career in TCM includes teaching students from the Europe, America, Africa, and Asia and treating patients in China, Russia and Canada, as well as publishing several books on acupuncture, moxibustion, Qi-gong and herbology in both Chinese and English.

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