Neck pain






Prescription



Main formula



Ge gen tang


Pueraria Decoction. This formula has two functions: to dispel Wind-Cold and to harmonise the collaterals to relieve the neck pain. It is actually more effective at dispelling Wind-Cold than relieving neck pain. The main herb in this formula which relieves neck pain is Ge Gen Radix Puerariae. Therefore it is very obvious that there are not enough herbs in this formula to relieve the neck pain. Qiang Huo Rhizoma seu Radix Notopterygii 10g, Du Huo Radix Angelicae Pubescentis 10g, Chuan Xiong Radix Ligustici Wallichii 10g and Xi Xian Cao Herba Siegesbeckiae10g could be added to the formula to increase the effect of dispelling Wind-Cold, harmonising the collaterals and relieving neck pain.


Alternative formulas



Gui zhi tang


Cinnamon Twig Decoction. This formula is specially indicated in slight invasion of Wind-Cold, causing disharmony between the Nutrient Qi and Defensive Qi.

Although Gui Zhi Ramulus Cinnamomi could harmonise the Collaterals and promote the Blood circulation in the channels, it is still not enough to use this formula along to treat neck pain, some other herbs should be applied simultaneously, such as Ge Gen Radix Puerariae 10g, Qiang Huo Rhizoma seu Radix Notopterygii 10g, Si Gua Luo Fasciculus Vascularis Luffae 10g, Chuan Xiong Radix Ligustici Wallichii 10g, Xi Xian Cao Herba Siegesbeckiae 10g and Xi Xin Herba Asari 5g to increase the effect of promoting sweating, harmonising the collaterals and relieve the neck pain.


Chuan xiong cha tiao san


Ligusticum–Green Tea Regulating Powder. When there is neck pain together with some headache caused by invasion of Wind-Cold, this formula could be applied. However, some other herbs could be added into the prescription to harmonise the collaterals and promote the circulation in the channels, such as Gui Zhi Ramulus Cinnamomi 6g, Ge Gen Radix Puerariae 10g, Xi Xian Cao Herba Siegesbeckiae 10g, Qiang Huo Rhizoma seu Radix Notopterygii 10g and Si Gua Luo Fasciculus Vascularis Luffae 10g, etc.


Jing fang bai du san


This formula could be used to dispel the External Wind and eliminate the Cold so as to relieve the External symptoms in general; however, it is not sufficient to treat the neck pain so Gui Zhi Ramulus Cinnamomi Cassiae 10g, Bai Zhi Radix Angelicae Dahuricae 10g and Ge Gen Radix Puerariae 10g, etc, could be added to relieve the neck pain.


Modifications





1. If there is a headache, add Man Jing Zi Fructus Viticis 10g to dispel the Wind-Cold and relieve the headache


2. If there is a fever, add Chai Hu Radix Bupleuri 10g to dispel Wind and reduce the fever


3. If there is cough with a clear nasal discharge, add Jie Geng Radix Platycodi 10g to dispel the Wind, disperse the Lung-Qi and open the nasal orifice


4. If there is a severe aversion to cold, add Xi Xin Herba Asari 3g to warm the channels and dispel the Cold.


Patent remedy


Jing Fang Bai Du Pian Schizonepeta and Ledebouriella Tablet to Overcome Pathogenic Toxin.



Acupuncture Treatment




Main points


TE-5 Waiguan, LI-4 Hegu, BL-12 Fengmen, GB-20 Fengchi, GB-21 Jianjing, LU-7 Lieque and some local Ah shi points. Reducing method is used on these points at neck. Moxibustion should be used on the first three points.


Explanations





▪ LI-4 and LU-7 are used to open the skin pores and promote sweating so as to dispel Wind-Cold. LU-7 is also a good point for treating neck pain due to invasion of External factors. Conventionally, it is often used to treat neck pain where there is difficulty in turning the neck to the left and right.


▪ TE-5, BL-12 and GB-20 are applied to dispel Wind and eliminate Cold so as to relieve External symptoms. Moreover, GB-20 and TE-5 can arrest pain at the sides of the neck.


▪ GB-21 and the local Ah shi points could dispel Wind-Cold, harmonise the collaterals and relieve the neck pain.


▪ Moxibustion dispels Wind-Cold, warms the channels and collaterals and relieves the neck pain.


Alternative points


BL-9 Yuzhen, BL-10 Tianzhu, BL-11 Dazhu, BL-60 Kunlun, BL64 Jinggu, BL-65 Shugu and BL-66 Zutonggu, etc.


Modifications





1. If there is neck pain with stiffness and difficulty in turning the neck, add SI-3, the Confluence point of the Governing Vessel, to open the Vessel, harmonise the collateral and relieve the neck stiffness


2. If there is upper back pain with a cold feeling due to invasion of Wind-Cold to the Bladder channel, add BL-58, the Connecting point of the Bladder channel, and BL-62, the Confluence point of Yang Heel Vessel, to dispel the Wind-Cold and relieve the pain


3. If there is neck pain at the side of the neck due to disharmony of the Lesser Yang channels resulting from invasion of Wind-Cold, add GB-1 and TE-23 to remove the blockage in the channel and harmonise the collateral so as to arrest the pain


4. If there is neck pain referring to the back of the shoulder, add SI-4 and SI-7, the Source point and the Connecting point of the small Intestine channel, and SI-12 to dispel the Cold, harmonise the collateral and relieve the pain


5. If there is a severe headache, add Extra Yintang and GV-16 to dispel the Wind-Cold and stop the headache


6. If there is a severe cough with a white nasal discharge due to failure of the Lung to disperse the Qi, add BL-13, the Back Transporting point of the Lung, and LU-1, the Front Collecting point of the Lung, to disperse the Lung-Qi and relieve the cough.


Case History



A 41-year-old woman had complained of neck pain for 6 days. She had developed an acute neck pain when she woke up one morning in an air-conditioned room in the summer. The pain was mainly located on the right side. A doctor gave her some painkillers and asked her to stay at home. After taking painkillers for 1 day, there had been some relief of pain but it was not completely gone, so she asked for TCM treatment.

On her arrival at the acupuncture clinic, she had neck pain with a rigid sensation, limitation of movement, an aversion to cold and a slight upper back pain. Her tongue was white and wet, and her pulse was superficial and wiry.


Diagnosis


Neck pain due to invasion of External Cold with blockage of the channels.


Principle of treatment


Warm the channels, eliminate External Cold and relieve the neck pain.


Herbal treatment




Ge gen tang





Pueraria Decoction


Ge Gen Radix Puerariae 15g


Ma Huang Herba Ephedrae 6g


Gui Zhi Ramulus Cinnamomi 6g


Bai Shao Radix Paeoniae Alba 15g


Da Zao Fructus Ziziphi Jujubae 6g


Sheng Jiang Rhizoma Zingiberis Recens 10g


Qiang Huo Rhizoma seu Radix Notopterygii 10g


Chuan Xiong Rhizoma Ligustici Chuanxiong 10g


Bai Zhi Radix Angelicae Dahuricae 10g


Gan Cao Radix Glycyrrhizae 6g


Explanations





▪ Ma Huang and Gui Zhi promote sweating and dispel Wind-Cold


▪ Ge Gen regulates the Qi circulation, nourishes the Body Fluids and relieves the neck pain


▪ Qiang Huo and Bai Zhi dispel Wind, promote the circulation of Qi and relieve the headache


▪ Chuan Xiong promotes the Qi and Blood circulation and relieves the neck pain


▪ Sheng Jiang and Da Zao dispel Wind-Cold and harmonise the Nutritive and Defensive Qi so as to relieve External symptoms


▪ Bai Shao and Gan Cao relieve tension in the tendons to relieve the neck pain.


Acupuncture treatment


TE-5 Waiguan, LI-4 Hegu, BL-12 Fengmen, BL-58 Feiyang, GV-16 Fengfu, GB-20 Fengchi and LU-7 Lieque. Reducing method was used on these points. Moxibustion should be used on the first three points. Treatment was given once every 2 days.


Explanations





▪ LI-4 and LU-7 open the skin pores and promote sweating so as to dispel the Wind-Cold. LU-7 is also a good point for treating neck pain due to invasion of External factors. Conventionally, it is often used to treat neck pain where there is difficulty in turning the neck.


▪ TE-5, BL-12 and GB-20 dispel Wind and eliminate Cold so as to relieve External symptoms. Moreover, GB-20 and TE-5 have the function of arresting neck pain at the sides of the neck.


▪ GV-16 dispels Wind-Cold in the upper back and relieves the neck pain.


▪ BL-58, the Connecting point, harmonises the collateral, dispels Wind-Cold and relieves the neck pain.

Her neck pain disappeared after 1 week of treatment. She was followed up 6 months later and she stated she had experienced no neck pain since the treatment.





Invasion of Wind-Heat



Symptoms and signs


Acute neck pain with stiffness and a burning feeling, aggravation of the pain on exposure to warmth and alleviation on exposure to cold, a slight aversion to cold and wind, fever, a runny nose with a yellow discharge, headache, sweating, thirst, restlessness, generalised body pain, a thin and yellow tongue coating and a superficial and rapid pulse are symptoms and signs of Wind-Heat.


Principle of treatment


Dispel the Wind, clear the Heat, harmonise the collateral and relieve the pain.

Herbal Treatment




Prescription



Main formula



Chai ge jie ji tang


Bupleurum and Kudzu Decoction to Release the Muscle Layer. This formula is very strong in dispelling the Wind, clearing the Heat and relieving the neck pain and muscle pain caused by invasion of Wind-Heat. There are not so many herbal formulas which could dispel Wind-Heat and relieve the muscle pain, and this formula is certainly one which could be used to deal with neck pain due to this pathogenic factor. Shi Gao Gypsum Fibrosum is very cold in nature, so if there is no high fever, this herb could be left out. If there is little or no cough, then Jie Geng Radix Platycodi could be left out.

Formulas, such as YIN QIAO SAN Honeysuckle and Forsythia Powder and SANG JU YIN Mulberry Leaf and Chrysanthemum Decoction, etc., are not suitable here, because they are often used to dispel Wind-Heat or remove the Toxic Heat; they don’t have sufficient effects to relieve the muscle pain and neck pain.


Alternative formulas



Xiong zhi shi gao tang


Cnidium, Angelica and Gypsum Decoction. This formula can dispel the Wind, clear the Heat and relieve the neck pain and headache due to invasion of Wind-Heat with predominance of Heat. Sang Ye Folium Mori 10g, Jin Ying Hua Flos Lonicerae 10g and Sheng Di Huang Radix Rehmanniae 10g could be added to relieve the neck pain.


Ju hua cha tiao san


Chrysanthemum Powder to be Taken with Green Tea. This formula is based upon CHUAN XION GCHA TIAO SAN by adding Ju Hua Flos Chrysanthemi 10g and Jiang Can Bombys Batryticatus 10g. Sang Ye Folium Mori 10g, etc., could be added to relieve the headache.


Modifications





1. If there is severe headache, add Man Jing Zi Fructus Viticis 10g to dispel the Wind-Heat and relieve the headache


2. If there is high fever, use Chai Hu Radix Bupleuri 10g to clear the Heat and reduce the fever


3. If there is a yellow nasal discharge, add Jin Yin Hua Flos Lonicerae 10g to dispel the Wind and clear the nasal passage


4. If there is much thirst, add Zhi Mu Rhizoma Anemarrhenae 10g and Xuan Shen Radix Scrophulariae 10g to promote the secretion of Body Fluid, clear the Heat and relieve the thirst


5. If there is restlessness, add Huang Lian Rhizoma Coptidis 10g and Zhi Zi Fructus Gardeniae 10g to clear the Fire and calm the Shen.


Patent remedy


Huang Lian Shang Qing Wan Coptis Upper Clearing Tablet.


Acupuncture Treatment




Main points


TE-5 Waiguan, LI-4 Hegu, LI-11 Quchi, BL-12 Fengmen, GB-20 Fengchi, GB-21 Jianjing, LU-7 Lieque, GV-14 Dazhui and some local Ah shi points at neck. Reducing method is used on these points.


Explanations





▪ LI-4, LI-11 and GV-14 dispel the Wind, clear the Heat and reduce the fever.


▪ LU-7 dispels Wind-Heat from the Lung channel and relieves cough. Also, LU-7 is a good point for treating neck pain where there is difficulty in turning the neck.


▪ TE-5, BL-12 and GB-20 dispel the Wind, clear the Heat and relieve External symptoms. Moreover, GB-20 and TE-5 arrest pain at the side of the neck.

GB-21 and the local Ah Shi points could dispel Wind-Cold, harmonise the collaterals and relieve the neck pain.


Alternative points


BL-10 Tianzhu, BL-11 Dazhu, BL-60 Kunlun, BL64 Jinggu, BL-66 Zutonggu, GB-34 Yanglingquan and GB39 Xuanzhong, etc.


Modifications





1. If there is neck pain with stiffness and difficulty in turning the neck, add SI-3, the Confluence point of the Governing Vessel, to open the Vessel and harmonise the collateral


2. If there is upper back pain with a burning feeling due to invasion of Wind-Heat to the Bladder channel, add BL-58, the Connecting point, BL-62, the Confluence point of Yang Heel Vessel, and BL-66, the Spring point, to dispel the Wind, clear the Heat, harmonise the collateral and relieve the pain


3. If there is pain at the sides of the neck due to disharmony of the Lesser Yang channels resulting from invasion of Wind-Heat, add GB-1 and TE-23 to open the channels and harmonise the collateral so as to arrest the pain


4. If there is neck pain referring to the back of the shoulder, add SI-4 and SI-7, the Source point and the Connecting point of the Small Intestine channel, and SI-12 to harmonise the collateral and relieve the pain


5. If there is much headache, add Extra Yintang and GV-16 to dispel the Wind-Heat and stop the headache


6. If there is a cough with a yellow nasal discharge due to failure of the Lung to disperse the Qi, add BL-13, the Back Transporting point of the Lung, and LU-5, the Water point of the Lung channel, to disperse the Lung-Qi and relieve the cough


7. If there is a throat pain with redness and swelling, add LU-10 and LI-2, the Spring point of the Lung channel and the Large Intestine channel respectively, to clear the Heat, reduce the swelling and relieve the pain.


Invasion of Wind, Cold and Damp



Symptoms and signs


The symptoms and signs of this condition are neck pain with soreness, a feeling of heaviness in the neck, aggravation of the pain in rainy, humid, windy and cold weather, an aversion to cold, a cold feeling at the neck, a preference for warmth and alleviation by massage, headache, a heavy feeling to the body, a thin, white and greasy tongue coating and a superficial and slippery pulse.


Principle of treatment


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Jun 19, 2016 | Posted by in PAIN MEDICINE | Comments Off on Neck pain

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