A 57-year-old male patient walked into the clinic with acute pain in the left index finger. The pain was caused by an injury from a hammer and was rated 8/10; range of motion was very limited due to the pain. After a 20-minute acupuncture treatment, the pain went down to 0/10 and full range of motion was recovered.
"Jerry" (not his real name) was working on a project in his backyard. While hammering nails into a wooden frame, he missed one of the nails and the hammer directly hit his left index finger. He was taken to the hospital by his family; an X-ray confirmed no broken bone.
Three hours after the injury, Jerry came in for his weekly acupuncture appointment. He showed me his finger and wondered if we could help him with it, but he wasn't expecting too much since it was not his chief complaint, nor did he think needles would help with situations like this.
The finger was red, swollen, warm, and painful to touch, with a very limited range of motion due to the pain.
Treatment
Acupuncture points: GB 34 (Yanglingquan) [Bi], GB 39 (Juegu) [Bi], LI 3 (Sanjian) [R], LI 7 (Wenliu) [R], LI 2 (Erjian) [R][Reduce], and LU 7 (Lieque) [R].
First, I inserted all the needles, then started gently stimulating GB 34 and LI 7 with even rotations. Then I reduced LI 2 by rotating the needle counterclockwise six times per set for two sets; the pain instantly dropped to 4/10 and Jerry was able to slightly move the finger.
I reduced LI 2 for another four sets and then asked the patient to rest. Twenty minutes later, the patient reported that his pain had gone down to 0/10; range of motion was fully recovered; the redness was gone; and the finger was no longer swollen.
At his next visit, the patient reported that the pain did not come back after the needles were removed on the previous visit.
Discussion
Diagnosis: Due to the injury being very fresh, the skin red and warm, and the finger swollen, I personally preferred to diagnose this case as heat in the LI channel. While treating pain, especially pain caused by injuries, channel pattern differentiation comes in very handy.
Point selection: I'm an old-school practitioner; from the tradition I follow, I generally choose points by their categories. My protocols are also mostly point categories-based instead of point indications-based. Here are the reasons why I chose certain points:
LI 3 is a shu stream point. Shu stream points treat "heaviness sensation in the body and painful joints" according to the Nan Jing. With my knowledge and experience in the ancient Chinese language, I've learned it's not uncommon that ancient scholars alternate the orders of words in one sentence in a specific way to make the sentence look balanced, so I think it should be understood as "Heaviness and pain of the body and joints." The "body" refers to the "muscles," so my interpretation of this is "muscles and joints pain and heaviness/swollen along the channel pathway."
LI 2, a ying-spring point. Ying-spring points treat "heat in the body" and "disease manifesting in color changes" (also from the Nan Jing), which matched this patient's case. Also, LI 2 is the water point of a metal channel; thus, it's a child point. When it's in excess, reduce the child.
LI 7 is the xi-cleft point. I use xi-cleft points to treat inflammation or any condition manifesting in redness, swollen, heat and pain at a certain level.
GB 34: Meeting point of the sinews, pairing with shu stream points of respective channels, it will coordinate the treatments to the affected sinews. Used bilaterally to enhance the effectiveness.
GB 39: Meeting point of the marrow. Due to the relationship between bones and marrow, I commonly use this point to replace BL 11 when the patient is facing up on a treatment table. In this case, despite there being no confirmed bone damage, I think GB 39 was still necessary to help manage the pain. Used bilaterally to enhance the effectiveness.
LU 7: Luo connecting point of the LU channel. One branch of the LU channel separates from LU 7 and is connected to the index finger.
I chose most of the points from the opposite side. In my experience and the traditions I follow, if the points are on the limbs and at the top of the head, to me, the opposite-side points provide stronger effectiveness in the way I prefer to practice (in most cases). On top of that, due to the fact that the injury was still acute and fresh, I think this also avoided further pain caused by needling the injured tissues directly.
Challenges and Cautions
In the tradition I follow, I always find all the points in the indentations, so in order for this simple treatment to work, every needle needs to be inserted into the center of the indentation of each point.
Due to possible internal bleeding at the injury, in my opinion, local bleeding technique / moxa and other techniques that might promote better blood circulation should be avoided during this stage.
Chronic pain afflicts over 20% of the adult population. Sadly, most MDs have essentially no education in treating pain, beyond offering a few toxic medications. Then they tend to steer people with pain away from those health practitioners who are trained. This puts the acupuncture community on the front lines for addressing this epidemic.
When the body is going through a stressful event, the sympathetic system is activated. This activation will help the body with a life-threatening situation. If this state is activated for prolonged periods of time, it starts to consume energy. These traumatic events that generate stressors in the autonomic nervous system (ANS) will eventually become internalized.
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One of the things that makes acupuncture so difficult to measure is that the medicine actually does contain some esoteric aspects. There have been numerous studies that demonstrate the neurochemical reasoning behind why acupuncture points stimulate the autonomic nervous system to enact change However, not all the benefits of TCM can easily be measured by randomized, controlled trials. But does that make them fundamentally and definitively untrue?
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