Meridian Sinew-Based Standardized Therapy for Elderly Chronic Pain

Abstract

Chronic musculoskeletal pain in the elderly population presents a significant clinical challenge, yet existing traditional Chinese medicine external therapies, acupuncture, tuina, and moxibustion often suffer from inconsistent operational protocols and insufficient integration with syndrome differentiation frameworks. Drawing upon meridian sinew system theory and its associated "tendon excess-deficiency and qi-blood stasis" pathological model, this study constructs a standardized combined external therapy protocol tailored to elderly CMP. The protocol operationalizes a four-step "examination-differentiation-prescription-treatment" clinical pathway, classifying patients into three distinct sinew-deficiency subtypes, cold coagulation, damp-heat accumulation, and blood stasis, with correspondingly customized treatment parameters. A three-arm assessor-blinded randomized controlled trial design is proposed to compare the standardized protocol against conventional acupoint-based therapy and a waitlist control group, with pain intensity measured by visual analog scale and pressure pain threshold as primary outcomes. The study also incorporates exploratory biomarker assessments to investigate potential anti-inflammatory mechanisms underlying the integrated intervention. Preliminary feasibility analysis suggests that protocol standardization is achievable within community settings, though several challenges are anticipated, including practitioner training consistency and between-subject variability in treatment response. This research contributes to ongoing efforts in TCM external therapy standardization and offers a replicable framework for integrating classical theoretical constructs with contemporary clinical trial methodologies. Nevertheless, given the exploratory nature of this protocol, further large-scale multicenter studies are required to validate generalizability and long-term efficacy.