Raynaud’s Disease or Raynaud’s Phenomenon
Raynaud’s Disease by Jennifer Machacek
Raynaud’s Disease or Raynaud’s
Phenomenon, is still a disease that is very mysterious in its origins. It is
known to be a disruption in how the nervous system controls blood vessels,
resulting in decreased blood flow, mainly to extremities such as fingers and
toes, but it can also affect other areas of the body. [1] Raynaud’s is a result
of spasming of blood vessels (vasospasms) in response to cold, stress, or
emotional upset. [1,2,3]
Raynaud’s can occur on its own,
known as primary Raynaud’s, or it can be accompanied by other diseases, which
is then classified as secondary Raynaud’s. Primary Raynaud’s is the most common
type, often beginning between the ages of 15-25 years of age and is less severe
than the secondary form. Secondary Raynaud’s develops later in life between
ages 35-40 and if the disease progresses to its most severe and rare form,
gangrene can occur causing infection or even amputation to the area. [1,2]
Raynaud’s is very painful and
can be debilitating at the onset of an attack. During an attack, areas of skin
first turn white, then blue, purple or even black. Degrees of pain, and return
time of blood flow back into the affected area are different for each person.
Blood flow improves anywhere from 15-45 minutes unless extreme exposure to cold
persists and the body remains inactive. [1,6]
In my own personal
experiences, when a Raynaud’s attack occurs in the lower extremities such as
the feet it is difficult to walk or even remain standing. In upper extremities
such as the fingers, contact with objects is extremely painful and can be
nearly impossible. Due to the pain, fingers become dysfunctional trying to
perform simple tasks such as zipping a coat, picking up a glass, or holding a
fork. Anyone with Raynaud’s Disease knows that reaching into a refrigerator or
freezer could set off an episode so gloving up is recommended. When the vessels
finally relax, the affected parts usually become red, throbbing, painful,
stabbing, and tingly as a result of circulation trying to return to the area.
WESTERN
POINT OF VIEW
Experts still do not fully
understand Raynaud’s phenomenon and healthcare providers have been unable to
pinpoint an exact cause. [1] From a Western point of view, it is believed that
some type of blood disorders may cause Raynaud’s by increasing blood thickness.
This may happen from extra platelets or red blood cells. Or special receptors
in the blood vessels may be more sensitive. [3]
Risk factors for Raynaud’s
include: A connective tissue or autoimmune disease, chemical exposure,
cigarette smoking, injury or trauma, repetitive actions such as typing, a
person’s sex, (the condition is found to be more common in women than men),
climate, (the illness is more prevalent in people who live in colder climates),
family history, (the disease appears to link family members), and side effects
from certain medications such as beta blockers for high blood pressure, some
migraine medicines, ADHD meds, certain cancer meds and some cold medicines.
[1,2,3]
Western medicine documentation
and case studies prove that prevention is key and some recommendations are as
follows: Avoid smoking, which tightens the
blood vessels and causes skin temperature to drop. Exercise regularly to
increase blood flow and manage stress better which can decrease triggering
Raynaud’s symptoms. Avoid rapidly changing temperatures if possible. Bundle up,
wear layers and warm up a vehicle in damp or cold weather before getting in to
avoid exposure. Some medications may help to manage the condition. [1,2,3]
Western medications used to
treat Raynaud’s are: Calcium channel blockers to relax and open small blood
vessels in the hands and feet such as: Nifedipine (Procardia), amlodipine
(Norvasc), felodipine and isradipine. Vasodilators to relax blood vessels: the
high blood pressure drug losartan (Cozaar), the erectile dysfunction medicine
sildenafil (Viagra, revatio), the antidepressant fluoxetine (Prozac) and a
class of medicines called prostaglandins. In severe cases, nerve surgery can be
performed or chemical injections used as numbing medicines can be administered.
OnabotulinumtoxinA or (Botox) can block nerves in affected hands or feet. [1] Raynaud’s
syndrome is indicated for massage. Massaging the area can help dilate blood
vessels and bring blood back into the fingers and toes. [4]
EASTERN
POINT OF VIEW
Treatment of Raynaud’s Disease
is not frequently mentioned in medical literature. This may be due to the
already existing broad theoretical framework for treating numerous diseases
heavy on the concept of circulation. Qi and blood are the subject of medical
philosophy and the practical aspect of therapy. As a result, the saying in
Chinese tradition, “The Qi moves the blood and the blood carries the Qi,” has
established itself. [5]
In the case of Raynaud’s, the
Chinese point of view is that the disorder occurs because the normal
circulation of Qi and blood has been disrupted. [5,7,8] The suddenness of the
symptom onset and its temporary but repetitive nature indicates an underlying
imbalance which is in complete agreement with the modern medical views.
[1,2,3,6]
From the traditional Chinese
perspective, susceptibility to coldness implies that the person is already
internally cold. The external cold combines with the pre-existing cold to
produce a condition sufficiently extreme that the Raynaud’s phenomenon occurs.[5]
It is well established by modern
investigators, that a natural and normal response to coldness is for the
circulation in the extremities to lessen; this response is the body’s means of
protecting the heat of essential interior organs or thermoregulating.[6]
Physical reactions to
emotional distress such as substantial vasoconstriction suggest the body is
already sensitized to emotions, and a pattern of response has been established.
From the Chinese viewpoint, the internal organ system referred to as “gan”
translated as liver, is the one that is involved in these reactions. It is
understood in the Chinese system that when the liver is distressed, it can
react rapidly, often with contraction of muscles as a response. One solution is
to resolve the liver imbalance. [5] These however are not entirely exclusive
patterns because the body can also react rapidly and severely to cold not just
emotional distress. [1,3]
Chinese researchers have used
observation of nailfold capillary circulation as a determinate of blood stasis
syndrome which differs from poor circulation of Qi and blood and usually
involves a physical distortion or blockage of some sort that disrupts circulation.
The syndrome also involves thickening of the blood, easy blood coagulation or
clotting of the blood either within or outside of the vessels. Researchers
found the red blood cell sedimentation rate was not raised, therefore from the
traditional Chinese medicine perspective there is a disruption of Qi and blood
but not a blood stasis syndrome. [5]
Chinese medicine treats
Raynaud’s as a stagnation of Qi and blood. From the Chinese perspective,
invasion of dampness whether internal or external generates internal fire which
aggravates stagnation. Treatments for Raynaud’s Disease in Chinese medicine
include: Use of herbs such as: (ginger, hawthorne, cayenne, magnesium, horse
chestnut, dong quan and prickly ash), biofeedback, (using the mind to control
body temperature), meditation, deep breathing, exercise, massage, and acupuncture.
[5,7]
Acupuncture is commonly used
to improve symptoms of increased blood flow and circulation to affected areas.
[7,8] Clinical trials have shown the effectiveness of acupuncture treatments in
people with Raynaud’s. Chinese acupuncture has shown to reduce the duration of
attacks due to regulating energy and blood flow as well as reducing stress and
tension. [7,8] Points commonly recommended are: LI 11 and ST 36, the
Homeostatic points; and LU 9, the Grand Point for blood vessels. These points
are used in all cases. In addition, for upper extremities, HT 3, TB 5, PC 6 and
the Jiaji points from C-6 to T-3 as well as the Baxie Extra Points. Lower
extremities; GB 34, SP 9, GB 39, ST 32, SP 6, and the Jaiji Points from LI to LI
II, and the Bafeng Extra Points. [7]
In conclusion, Raynaud’s is indicated
for massage. However, modifications may need to me made to ensure a warm,
comfortable, and relaxing environment for the client. Blankets and a space
heater are good investments. Checking the temperature of the massage room is
essential and may require air conditioning to be turned off. Prevention is key
in avoiding onset of an attack. Raynaud’s is situational, so establishing good
rapport with the client and having awareness of nonverbal cues through body
language is important. Some clients may be fine with ROM in the extremities to
help with circulation and to bring blood flow back to the affected area. In the
case of a very painful attack though, Raynaud’s should be treated as a local
contraindication.[4]
1. Mayo
Clinic; Raynaud’s Disease-Symptoms and causes. (Nov 2022)
https://www.mayoclinic.org
2. National
Institute of Arthritis and Musculoskeletal and Skin Diseases. (July 2024)
https://www.niams.nih.gov
3. Cleveland
Clinic; Raynaud’s Syndrome, Symptoms and Causes. (2024)
https://www.my.clevelandclinic.org>98
4. MBLEX
Comprehensive Guide; David Merlino, LMT, BCTMB (2024-25 addition)
5. Attilio
D’Alberto; Acupuncture for Raynaud’s Disease. (1999-2024)
https://www.atilliodalberto.com
6. National
Library of Medicine; Raynaud Disease; Rina Musa; Ahmad Quire (August 2023) https://www
ncbi.nim.nih.gov
7. Research
Gate; Raynaud’s Treatment in Chinese Medicine; Medical Acupuncture; Mary Ann
Liebert, Inc. Volume31 (Nov 2019)
https://www researchgate.net
8. Internet
Journal of the Institute for Traditional Medicine & Preventative
Healthcare; Raynaud’s Disease: Chinese Medical Perspective; Subhuti
Dharmananda, Ph.D., Director, Institute for TM. (July 2002) https://www.itmonline.org/journal
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