HOTAL TRADITIONAL ORIENTAL MEDICINE LETTERS, VOLUME 6, NUMBER 1

2019

Acupuncture and Moxibustion Treatment for Hands Numbness
Nobuyuki Otsuka†, ††† Hotal Ancient Medicine Research Institute (HARI), †† Otsuka Clinic

3-8-14 Hotarugaike-nakamachi, Toyonaka, Osaka, 560-0033 Japan
E-mail: hari@otsuka.holding.jp
Keywords: numbness, hand, first joint, VAS, paresthesia, pedestal moxa, stress,
acupuncture and moxibustion

Numbness or a feeling of numbness
often refers to a specific sensation caused
by a combination of sensory escape andsensory abnormality in the extremities
due to compression of sensory nerves [1].
Numbness is one of the abnormal sensations such as zinging or tingling. The actual complaints include a wide variety ofabnormal sensations. On the sensory side,
hypoesthesia, hyperesthesia, and sensory
abnormality are recognized as numbness.
On the motor side, patients complain of
hypertonia, muscle weakness, muscle atrophy, and motor paralysis, as the numbness [2]. Numbness is an everyday term,
not an original medical term. In everyday
use, numbness is often used to refer tosensory abnormality. In the physiologicalrealm, it is described as the feeling of
numbness, but in clinical realm, it is described as numbness. In this paper, numbness and numbness sensation aren’t distinguished, but described them all as
numbness.
Numbness is classified into two types:
dysesthesia that is perceived in the absence of external stimuli, and paresthesia
in which external stimuli such as touch or
pain produce a different sensation [3]. Intense numbness is known to be accompa-

nied by pain [4]. Numbness is defined as
any sensory abnormality accompanied byhypoesthesia. Numbness, like pain, is apersonal experience of discomfort. Numbness is difficult for others to understand.
Patients rarely seek medical care for
numbness alone, even if it is painful, unless it is accompanied by paralysis or severe pain. Most people with chronic
numbness do not seek medical attention[5,6,7]. In the elderly over 65 years of age,the incidence of peripheral neuropathy
with numbness is 7% [8] Among those
aged 65-84 years, 15 of 106 (14%) werereported to have numbness in their fingers [9].
Reported causes of numbness include
carpal tunnel syndrome [10], cervicalspondylosis [11], cervical yellow ligamentcalcification [12], and acromegaly [13].
Sensory nerve action potentials [14] andneurodynamic tests [15] are used to identify any nerve strangulation sites and syndromes. Western medical treatment of
numbness includes soft tissue mobilization [15]. Oriental medical treatment of
numbness has been reported to include
stellate ganglion acupuncture [16].
The following is a case of acupuncture
treatment applied to a 71-year-old

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woman with a chief complaint of painful
numbness from the wrists to the fingertips in both hands. The first acupuncture
treatment was on October 14, X year. She
was 153 cm tall, weighed 61 kg. She
bruised her right lateral region of abdomen in August, X year, and sprained herright leg in September, X year. In early October, X year, when the pain from thebruises and sprains subsided, she noticed
painful numbness in the palms in both
hands from wrists to fingertips. She consulted an orthopedic surgeon, but thedoctor could not find the cause. Magnetic
Resonance Imaging (MRI) was performed
to diagnose the head, but there was noabnormality in the brain. She has not visited the orthopedic surgeon since then.
When she grips or opens her hand, it isnumbness and difficult to use force. She
enjoys going to the theater, but the pain
and numbness makes it difficult her tocontinue clapping her hands. Her medical
history includes a fall down the stairs 30
years ago that resulted in broken ribs. She
has a history of gallstones, cataracts,
hematuria, and hay fever. She takes antihypertensive medication for high bloodpressure. Her social history is currently
unemployed. Her family history is that she
moved to the big city from the rural area
one year ago and lives with her daughter's family.
Examination findings are follows.
Looking diagnosis is chubby and obese.
The color of the medial aspect of the forearm is red. In listening and smelling diagnosis, she speaks well with a slightly low
voice. Five sound is E. Five voice is shouting. Five fragrance is unknown. The results of the asking diagnosis are as follows. Eats three meals a day, with a good

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appetite. She prefers salty taste. She
sleeps from 10:00 pm to 5:00 am, andsleeps soundly. Bowel movements areonce a day and are normal in hardness.
Her concerns are tiredness in her eyes,
palpitations, lethargy in the lower body,dizziness, thirst, and swelling in the lower
extremities. She lives with her daughter'sfamily and has no place to stay comfortably. The dog that the daughter keeps inhouse does not get along with her andshe is stressed out the dog. She has no experience with acupuncture and moxibustion, and does not want it to be painful.
The following are the results of touching
diagnosis. Blood color of both hands isgood. There is no coldness. The sprained
right leg has tenderness on the front inner surface. The results of abdominal diagnosis are shiny and plump. The liverarea from GB26 to GB29 is soft and mostdeficient. The kidney area from CV7 toCV2 lacks resilience and the second deficient, which is followed by the liver. Thelung area extending slightly obliquely tothe right of the navel from right GB24 andSP16 is taut and excess. The spleen areafrom CV7 to CV12 to centered on the
navel is taut and excess. The heart areafrom CV12 to CV15 is normal. In the pulse
quality diagnosis, pulse is sinking, rapid,
and deficient. When the pulse is submerged deeply, its contour can be recognized, but it has no elasticity. The comparative pulse diagnosis is as follows. The
liver pulse at the second position of theleft hand is collapsed when pressed, andis the most deficient. The kidney pulse at
the third position of the left hand is weak
and the secondly deficient, which is followed to the liver. The lung pulse at thefirst position of the right hand and thespleen pulse at the second position of theHotal Traditional Oriental Medicine Letters, Vol.6, No.1, pp.1-6, 2019(C) 2019 HARI2HOTAL TRADITIONAL ORIENTAL MEDICINE LETTERS, VOLUME 6, NUMBER 1
right hand are excess. The heart pulse at
the first position of the left hand and yang
meridian pulses are normal.
In the pattern identification of thesymptoms by meridian aspects, E of thefive sound, shouting of the five voices,
redness of the skin, tiredness of the eyes,dizziness, stress from cohabitation anddogs, tenderness in the front inner surface of the right leg are classified the fluctuation of the liver-wood meridian. Preference for salty taste, lethargy in thelower body, and swelling in the lower extremities are classified the fluctuations of
the kidney-water meridian. High bloodpressure, palpitations, and numbness inthe palms of both hands are classified thefluctuation of the heart-fire meridian. The
pattern was identified as liver deficient.
Since the patient wanted to be treated
twice a week, it is thought that her symptoms would improve if the flow of qi andblood was adjusted by the acupuncture
and moxibustion treatment, so the treatment was implemented because the prognosis would be good.
The treatment method is as follows.
Silver needles of 0.16 mm in diameter and
40 mm long (Asahi), stainless steel needles of 0.16 mm in diameter and 15 mm
and 40 mm long (Seirin). Moxa (Nihonichi-ougonsan, Yamasho) and warm tube
moxibustion (Chouan NEO DX regular, Yamasho) are used for moxibustion. At
home, pedestal moxa (Sennen-kyu off
regular ibuki, Senefa) is used. The evaluation of the degree of numbness was performed on a Visual Analogue Scale (VAS)
with the maximum imaginable numbness
intensity being 10. All VASs describedhereafter refer to the VAS of numbness.

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Treatment Results are as follows.
Twenty-three treatments were administered from October 14, X year to February
5, X+1 year. On the first treatment, supplementation was performed on right LR4
and right KI7 with the silver needle. Draining was performed on right ST40 and left
GB37 with the stainless steel needle. Extra meridian treatment was applied onright BL62 with a gold grain and left SI3
with a silver grain. The VAS of the palmar
region was not changed as 8 before thetreatment and 8 after the treatment. In all
following treatments, the patient was
treated mainly for liver deficiency or kidney deficiency the same as in the firsttreatment. The acupuncture points at the
deficient meridians were treated with
supplementation, and the points at theexcess meridians were treated with draining.
On the second treatment (October 17, Xyear), the hand became easier to grip after the treatment and there was no more
numbness in the palmar region if the patient was not aware for it. The VAS of thepalmar region decreased from 8 before
treatment to 1 after treatment.
On the 7th treatment (October 29, Xyear), the numbness in the palmar region
disappeared when the hand was lifted up
and the VAS of the palmar region decreased from 8 before the treatment to 1
after the treatment. When the hand was
not lifted, the VAS of the palmar region
remained at 8.
On the 8th treatment (November 9, Xyear), the VAS in the palmar region decreased from 8 before treatment to 6 after treatment, even when the hand was
not lifted up.
On the 11th treatment (November 21, Xyear), in addition to the usual treatment,

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HOTAL TRADITIONAL ORIENTAL MEDICINE LETTERS, VOLUME 6, NUMBER 1
single stabbing was performed on the tipsof the right hand's thumb and index finger
with the stainless steel needle. Immediately after, the VAS of the mother and index fingers decreased from 8 to 1 evenwhen the hand was not lifted up.
On the 12th treatment (November 27, X),
the VAS of the tips of the fingers of both
hands decreased to 1 if nothing was done.
However, by rubbing the fingers together
and being aware of them, the VAS was increased to 8. From this result, the remaining numbness in the first joint is considered to be paresthesia, in which different
sensations are produced by external stimuli such as touch and pain.
On the 13th treatment (November 30, Xyear), the VAS decreased from 8 to 1 after
applying warm tube moxibustion on PC5,
PC8, and SP6. She was instructed to perform daily pedestal moxa at home on PC5,
PC8, and SP6.
On the 20th treatment (January 15, X+1),
the next morning after performing
pedestal moxa at home, the VAS of thefingertips was 1. After applying one moxibustion of warm tube moxibustion on thefirst joint of all fingers of the palmar side,
and on PC8 and PC6, the VAS of all fingertips decreased to 1 immediately after thetreatment. She was thrilled that she wasreturned to the condition before she
started feeling numbness.
On the 23rd treatment (February 5, X+1
year), VAS became 1 the day after thetreatment and the day after she did moxibustion at home. She was pleased thather VAS was 1 all day. The patient herself
was convinced of the effect of the moxibustion. During the treatment, when thepatient remember a scene decades ago
when patient and her daughter went tovisit a shrine together, the numbness sud-2019

denly disappeared.
In discussion, the course of treatment
is summarized and the cause of thenumbness is identified. The course of reduction of numbness in the upper extremity is as follows. Initially, the patient
had numbness in the palms and throughout the fingers. Firstly, the VAS of the palmar region reduced from 8 to 1. Sequentially, the numbness in the fingers was reduced to a VAS of 1 at the third joint andthen to the VAS of 1 at the second joint.
Finally, the numbness only at the firstjoint, the fingertip, remained the VAS of 8.
At this treatment case study, the VAS became 1 after treatment, and the VAS became 1 all day the day after performing
pedestal moxa at home, although treatment of numbness is relatively difficult. In
consideration of the cause of the numbness, the VAS at the tips of the fingers ofboth hands decreased to 1 if the hands
were kept raised or not rubbing the fingers together. When rubbing the fingers
together and being aware of them, theVAS was returned to 8. From this result, it
is clarified that the numbness remaining
in the first joint is paresthesia, in which
different sensations are produced by external stimuli such as touch or pain. In theclassics, numbness in the hands is often
associated with liver deficiency, lung deficiency, and spleen deficiency, and moxibustion of the fingertips and relaxation oftension in the neck, shoulders, and backare helpful. In this case study, liver andkidney deficiency were the main patterns.
It is thought that treatment of liver deficiency alleviated the nerve strangulation
associated with muscle tension in theneck and shoulders, resulting in a decrease in VAS. It is also thought that treat-

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HOTAL TRADITIONAL ORIENTAL MEDICINE LETTERS, VOLUME 6, NUMBER 1
ment of the kidney deficiency decreased
the VAS as a result of increased nerve
blood flow to the ulnar nerve due to theimproved flow of qi and blood in theheart meridian. Pedestal moxa at home
was highly effective in reducing the VAS of
the first joint. The day after the pedestal
moxa was performed, the VAS decreased
to 1, definitely. For numbness, not only
treatment at the acupuncture clinic but
also moxibustion at home was clarified tobe effective. Currently, she is instructed todo pedestal moxa at home every day. She
is treated once a week so that she canmaintain a VAS of 1 for as long as possible. The area of numbness was reduced
from the entire palm and fingers to only
the first joint of the fingers, but the VAS of
the first joint was remained 8. If the peripheral nerves were repaired, the VAS
values would decrease gradually. Since
the highest VAS values did not change, it
is possible that the cause of the numbness is not only in the peripheral nerves
but also in the sensory areas of the cerebral cortex. It is possible that the stresscaused by a major change in living environment may have disrupted the sensory
areas of the cortex and formed degenerative areas, similar to the pathogenesis ofdepression. The VAS was decreased by remembering pleasant scenes from the past
spending with her daughter. Remembering pleasant scenes may reduce the effectof the degenerative areas in the cortex. As
a result, the numbness was reduced dueto the suppression of excitation in the degenerative areas, and the numbness area
was shrunk. The home moxibustion treatment is also expected to have an aroma
effect of moxa. The aroma effect isthought to have reduced stress and suppressed excitation at the degenerative2019

site, resulting in a decrease in the VAS.
Stress can be alleviated through acupuncture and moxibustion treatment and cognitive behavioral therapy. Further reduction of the size of degenerative areas in
the cerebral cortex is thought to be realized by alleviating stress.
In summary, numbness often refers toa specific sensation caused by a combination of sensory escape and sensory abnormality in the extremities due to compression of sensory nerves. Numbness is divided into dysesthesia and paresthesia.
Patients rarely seek medical care for
numbness alone. Most people withchronic numbness do not seek medical
attention, but 14% of the elderly over 65
years of age had numbness in their fingers. The acupuncture treatment was applied to a 71-year-old woman with a chiefcomplaint of painful numbness from thewrists to the fingertips in both hands. The
numbness was reduced from 8 to 1 in VAS
of numbness after acupuncture treatment
or the day after performing daily pedestal
moxa at home. The course of the reduction of VAS for numbness in the upper extremity was initially from 8 to 1 in the palmar region. The numbness in the fingers
was reduced to the VAS of 1 at the third
joint, and then at the second joint. Finally,
only at the first joint the numbness wasremained. The VAS of the first joints ofboth hands became 1 if the fingers were
not rubbed together. Since the VAS at thefirst joints of both hands returned to 8
when rubbing the fingers together andbeing aware of them, it was clarified to beparesthesia. Pedestal moxa at home was
effective in reducing the VAS of the firstjoint. Since the highest VAS values of thefirst joint did not change, it is possible

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HOTAL TRADITIONAL ORIENTAL MEDICINE LETTERS, VOLUME 6, NUMBER 1
that the cause of the numbness is in thesensory areas of the cerebral cortex. It is
possible that the stress caused by the major change in living environment may havedisrupted the sensory areas of the cortex
and formed degenerative areas. The
home moxibustion treatment may have
reduced the VAS as a result of stress reduction due to the aromatic effect ofmoxa. Further reduction of the size of degenerative areas in the cerebral cortex isthought to be realized by alleviatingstress.

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[12] Rintaro Sakamoto et al., “Three cases of cervical myelopathy due tocalcification of the ligamenta flava, Iryo vol.43, pp.361-365, 1989.
[13] Masahiro Otomo, et al. “A 34-year-old man with numbness in both
hands”, Journal of Japan Mibyou System Association, vol.11, pp.198200, 2005.
[14] Gen Shiraishi et al., “Clinical validation of sensory conduction in thering finger associated with hand numbness”, Orthopedics &Traumatology, vol. 44, pp.985-987, 1995.
[15] Takanori Takeda, “Intervention effect of soft tissue mobilization on
upper limb pain and numbness associated with stiff neck”, Journal of
the Japanese Physical Therapy Association supplement, vol.37, P1149, 2010.
[16] Kazushige Ide et al., “A case of cervical spondylosis in which pain

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Dr. Nobuyuki Otsuka

neuropathies in the Italian elderly”, Neurology, vol. 68, pp.1460-

He graduated from Tohoku University in 1985 and completed the first

1467, 2007.

half term of doctoral course of Tohoku University graduate school in[9] Kimiko Akamatsu et al., “The relationship between touch-pressure,1987. He was awarded doctor degree in 1997 from Tohoku University.

pinch force, and grip strength and symptoms of numbness in the

He established Hotal Ancient medicine Research Institute (HARI) in

elderly”, Japanese Journal of Nursing Art and Science, vol.13,

1999. He established Otsuka Clinic for acupuncture and moxibustion af-

pp.108-116, 2014.

ter graduated from Meiji school of oriental medicine in 2017. He is en-[10] Shuzi Tokoro, “Numbness of finger”, Journal of Japan of
Acupuncture and Moxibustion Society, vol.21, pp.43-44, 1972.

gaged in research on oriental medicine such as traditional Chinese
medicine, acupuncture and moxibustion, qigong etc.

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