Acupuncture ..An Alternative Treatment for Hip Osteoarthritis in the Elderly

Osteoarthritis of the Hip: Acupuncture and TCM Insight (English Translation)
Osteoarthritis of the hip is caused by degeneration of the articular cartilage covering the joint surface, leading to pain and restricted movement. Many people tend to overlook the early stages and delay seeking treatment, which can severely impact daily activities such as walking, dressing, tying shoelaces, climbing stairs, and even sleeping. It often results in chronic pain and disability among the elderly globally.


Risk Factors for Hip Osteoarthritis
Genetics: A family history of osteoarthritis or congenital hip deformities (e.g., misaligned or malformed hips) can increase risk.
Advanced Age: Cartilage and hip joint structures deteriorate naturally over age 50.
Overuse: Occupations or daily routines involving heavy physical activity can accelerate joint wear.
Injury: Hip injuries (e.g., dislocation or fractures) can damage cartilage or disrupt blood supply, leading to osteoarthritis.
Obesity: Excess body weight places additional stress on the hip joints.
Chronic Conditions: Diseases like rheumatoid arthritis and other inflammatory joint disorders can lead to osteoarthritis.

Key Clinical Features
Pain: Dull, tight, or needle-like hip pain radiating to the thigh, lower back, or perineum; often aggravated by activity or cold exposure.
Limited Mobility: Difficulties in bending, straightening, or rotating the hip, affecting walking, dressing, and stair use.
Stiffness: Joint stiffness especially after prolonged sitting or upon waking.
Advanced Signs: Chronic cases may include joint deformity, muscle atrophy, impaired gait, and difficulty with daily tasks.

TCM Perspective on Hip Osteoarthritis
In Traditional Chinese Medicine, hip osteoarthritis falls under categories such as Bi syndrome (痹证), Bone Bi (骨痹), Lumbar‑hip pain (腰髋痛), or Bone Wei (骨痿)—a chronic degenerative hip condition common among the elderly. Symptoms include hip or joint pain, restricted movement, and difficulty walking.

Pathogenesis:
1. External Pathogenic Factors
Wind–Cold–Damp Invasion: Obstructs meridians, impedes Qi and blood flow, leading to pain intensifying with cold.
Accumulated Heat and Dampness: Creates swelling, heat, and pain in the joints.

2. Internal Factors
Liver and Kidney Deficiency: Aging reduces jing (essence) and blood, weakening nourishment of tendons and bones.
Spleen Qi Decline: Impairs nutrient transport and leads to fluid stagnation, which worsens blockages.
Disease Progression:

Initial Stage (Excess pattern, “Shi”): Characterized by invasion of wind, cold, and dampness or heat–damp accumulation and blood stasis.
Chronic Stage (Mixed deficiency and excess, “Xu‑Shi”): Qi and blood stagnation coexisting with Liver/Kidney deficiency and inadequate nourishment of tendons and bones.

TCM Pattern Differentiation & Acupuncture Treatment
Wind‑Cold‑Damp Obstruction (风寒湿痹型)
Symptoms: Hip pain worse in cold/rain, heaviness, stiffness improving with movement, pale swollen tongue with white greasy coating, wiry or deep-slow pulse.
Treatment Principle: Disperse wind, expel cold and dampness, relieve pain.
Main Points: GB 30 (Huantiao), Zhibian, Ashi points.
Additional: Yanglingquan (GB 34), Zusanli (ST 36), Sanyinjiao (SP 6).
Adjunct: Fengchi (GB 20), Fengfu (GV 16) for cold; Yinlingquan (SP 9) for dampness.
Method: Dispersing technique, warm needling or moxibustion.

Damp‑Heat Obstruction (湿热痹阻型)
Symptoms: Red, swollen, hot, burning hip joint, aggravated by heat, irritability, thirst, yellow scanty urine, red tongue with yellow greasy coating, slippery-fast or wiry-fast pulse.
Treatment: Clear heat, expel dampness, unblocking meridians to relieve pain.
Core Points: GB 30, Zhibian, Ashi points, SP 9, Quchi (LI 11), Hegu (LI 4).
Adjunct: Dazhui (GV 14), Xing Pond; Zusanli (ST 36), Fenglong (ST 40) for damp.
Method: Clearing technique, cupping or herbal compress post-needling.

Blood‑Stasis Obstruction (瘀血阻络型)
Symptoms: Sharp localized hip pain, pain worsens at night, possible joint deformity, purplish tongue or ecchymosis, choppy or wiry-choppy pulse.
Treatment: Invigorate blood, eliminate stasis, unblock channels, relieve pain.
Points: GB 30, Zhibian, Ashi points, Xuehai (SP 10), Geshu (BL 17), Yanglingquan (GB 34).
Adjunct: Sanyinjiao (SP 6), Weizhong (BL 40) for stasis.
Method: Stimulating techniques, cupping or fire needle adjunct.

Liver and Kidney Deficiency (肝肾亏虚型)
Symptoms: Dull hip ache aggravated by exertion or prolonged walking, better with rest; dizziness, tinnitus, weak waist and knees, emaciation, red or pale tongue, thin/coatingless, fine or deep-fine pulse.
Treatment: Tonify Liver and Kidney, strengthen tendons and bones.
Points: GB 30, Zhibian, Ashi points, Shenshu (BL 23), Taixi (KI 3), Guanyuan (CV 4), Zusanli (ST 36).
Adjunct: Mingmen (GV 4), Yaoyangguan (GV 3) for weak back/knees.
Method: Tonifying techniques, moxibustion.

Spleen and Kidney Deficiency (脾肾两虚型)
Symptoms: Chronic recurrent dull hip pain, muscle atrophy, fatigue, poor appetite, loose stools, weak waist and knees, pale tongue with thin white coating, deep weak pulse.
Treatment: Strengthen Spleen and Kidney, dispel dampness, relieve pain.
Points: GB 30, Zhibian, Ashi points, Zusanli (ST 36), Sanyinjiao (SP 6), Pishu (BL 20), Shenshu (BL 23).
Adjunct: Zhongwan (CV 12), Tianshu (ST 25) for fatigue/loose stools.
Method: Tonifying methods, warm needling or moxibustion.

Commonly Used Acupoints (Based on Clinical Experience)
GB 30 (Huantiao)
Zhibian
Ashi Points (tender spots)
Yanglingquan (GB 34)
Zusanli (ST 36)
Sanyinjiao (SP 6) – to harmonize Qi and blood
Shenshu (BL 23)
Mingmen (GV 4) – for lumbar and sacral strengthening

Conclusion & Recommendations
Acupuncture in TCM can effectively reduce hip joint pain and inflammation, stimulate the movement of Qi and blood around the joint, relax muscles, ease stiffness, and improve mobility—enhancing the ability to walk, sit, and stand more smoothly. It is a safe, non‑surgical treatment that can complement conventional Western therapies effectively.