1 Western medical aetiology and pathology

Raynaud’s phenomenon is often a complex and serious disorder, caused by an underlying disease or condition. Connective tissue diseases are the most common cause of Raynaud’s phenomenon, which is seen in patients with such diseases as scleroderma, mixed connective tissue disease and lupus. Some of these diseases reduce blood flow to the digits by causing blood vessel walls to thicken and the vessels to constrict too easily.

There are various abnormalities that can induce symptoms of Raynaud’s phenomenon. Generally, they affect the blood vessel wall (particularly the endothelium), the neural control of vascular tone, and the many circulating factors that can impair blood flow and/or cause endothelial injury. Vascular abnormalities include those of both structure and function. Neural abnormalities include deficiency of the vasodilator calcitonin, gene-related peptide (released from sensory afferents), α₂-adrenoreceptor activation, and a central nervous system component, such as stress or emotional disorder. Intravascular abnormalities include platelet activation, impaired fibrinolysis, increased viscosity and probably oxidative stress. As our understanding of the pathophysiology of Raynaud’s phenomenon increases, so do the possibilities for identifying effective treatments.¹

2 Diagnosis by Western medicine

The criteria used to diagnose Raynaud’s disease include:

• Periodic vasospastic attacks of pallor or cyanosis. Note: an additional criterion is the presence of these attacks for at least 2 years

• Normal nailfold capillary pattern

• Negative antinuclear antibody (ANA) test

• Normal erythrocyte sedimentation rate (ESR)

• Absence of pitting scars or ulcers of the skin, or gangrene in the fingers or toes.

The criteria used to diagnose Raynaud’s phenomenon include:

• Periodic vasospastic attacks of pallor and cyanosis

• Abnormal nailfold capillary pattern

• Positive ANA test

• Abnormal ESR

• Presence of pitting scars or ulcers of the skin, or gangrene in the fingers or toes.

3 Chinese medical aetiology and pathology

Chinese medical theory does not specifically speak of Raynaud’s phenomenon. However, according to its symptoms, the illness can be characterized by Yu Zheng (Qi Yu)² , or melancholia,³ and Jue Zheng , cold extremities (symptoms are very cold hands and feet).

Chinese medicine theorizes that the movement of Qi follows the flow of Blood in the body. Qi has the function to warm the Blood and push it smoothly through the vessels. Qi also dominates the flow of Blood in the body and prevents it from leaving the vessels. Therefore, when Qi stagnation occurs for any reason, the Qi can neither move well, nor warm the Blood and promote Blood circulation; then Blood stasis occurs. This is an internal cause. The patient will have symptoms of Heat and a burning sensation in the body, but the fingers of both hands and the toes of both feet will be cold, because blood circulation is blocked by Blood stasis. Thus, the Qi cannot perform its function of warming the body, particularly the fingers and toes. Another cause of Blood stasis is that pathogenic Heat in the Blood singes the Blood, which becomes Blood stasis. The Blood stasis then blocks the channel Qi, and Blood and Qi cannot pass through the channel, causing Yu Zheng and Jue Zheng.

An external reason, specifically exposure to Cold, can also affect circulation in the fingers and toes. For instance, if the weather becomes very cold it will physically cause extreme artery constriction, thereby blocking circulation and leading to Yu Zheng and Jue Zheng.

4 General treatment principle

According to the symptoms of Raynaud’s, the treatment principle should be to remove Blood stasis and activate the Qi.

Differentiation and treatment

Raynaud’s phenomenon is associated with symptoms of multiple autoimmune diseases. Therefore, its treatment is usually combined with the treatment of other autoimmune diseases. If both the Raynaud’s phenomenon and another autoimmune disease are active, the autoimmune disease can be treated first, or both conditions treated simultaneously. Or, when the autoimmune disease goes into remission, the Raynaud’s phenomenon can then be treated. Which treatment plan is chosen depends on the main condition of the disease. If the condition of the disease is serious, the treatment plan should be to treat the main symptoms to save the patient’s life; if the patient’s condition is less serious and there is a cold sensation in both hands and feet, the treatment plan chosen should remove the Blood stasis and activate channel Qi and Yang. This means that treatment of Raynaud’s phenomenon is secondary unless the primary condition is in remission or is not severe.

3 Blood stasis with Yin deficiency

Clinical manifestations

Heat or burning sensation in the body (but normal temperature), thirst, dry mouth, night sweats, palpitations, and cold and purple fingers and toes. The tongue is red with less coating. The pulse is thready and uneven.

Treatment principle

Remove Blood stasis and nourish Yin.

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Musculoskeletal Key

Fastest Musculoskeletal Insight Engine

Raynaud’s phenomenon

1 Western medical aetiology and pathology

2 Diagnosis by Western medicine

3 Chinese medical aetiology and pathology

4 General treatment principle

Differentiation and treatment

1 Blood stasis

Clinical manifestations

Treatment principle

Herbal treatment

Acupuncture

2 Blood stasis due to Qi stagnation

Clinical manifestations

Treatment principle

Herbal treatment

Acupuncture

3 Blood stasis with Yin deficiency

Clinical manifestations

Treatment principle

Herbal treatment

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Raynaud’s phenomenon

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