Theoretical Analysis of Combined Acupuncture, Tuina and Moxibustion Intervention for Elderly Chronic Musculoskeletal Pain Guided by Meridian Examination—From the Perspective of Tendon Excess-Deficiency and Qi-Blood Stasis

Elderly chronic musculoskeletal pain is a highly prevalent and disabling chronic degenerative disease characterized by protracted course and high recurrence rate, which severely impairs the quality of life among the elderly. Long-term analgesic medication in Western medicine carries prominent toxic and side effects accompanied by high recurrence risks, limiting its clinical application. Combined external therapy of acupuncture, tuina and moxibustion serves as a safe and effective intervention regimen for elderly pain. Nevertheless, current clinical practice mostly relies on empirical treatment without objective and standardized meridian differentiation criteria, leading to arbitrary acupoint selection, non-standard operation, highly heterogeneous therapeutic effects and insufficient evidence-based grades. Based on traditional tendon and qi-blood theories as well as the degenerative physiological characteristics of the elderly, this paper elaborates the specific pathogenesis of elderly musculoskeletal pain: tendon insufficiency as the root cause, cold-heat stasis as the secondary manifestation, and intermingled excess and deficiency as the core feature. Relying on the five diagnostic methods of observation, palpation, tracing, temperature palpation and pressing, an elderly-adapted standardized meridian examination procedure and quantitative scoring system for tendon qi-blood are constructed. The multi-dimensional synergistic analgesic mechanism of the triple combined therapy of acupuncture, tuina and moxibustion is systematically analyzed, and an integrated precise diagnosis and treatment model of Examination–Differentiation–Acupoint Matching–Treatment together with standardized operation specifications are established. This research fills the theoretical gap in precise TCM diagnosis and treatment for elderly musculoskeletal pain, conforms to the international non-opioid pain management concept, and provides theoretical support for standardized and international evidence-based application of TCM external therapy.