Pain in all four limbs






Prescription



Main formula



Juan bi tang


Remove Painful Obstruction Decoction. This formula, which dispels the Wind, eliminates the Cold, resolves the Damp, promotes the Qi and Blood circulation and relieves the pain, is indicated in limb pain due to invasion of Wind, Cold and Damp with stagnation of Qi and Blood. Chuan Xiong Radix Ligustici Chuanxiong 10g, Hai Feng Teng Caulis Piperis Futokadsurae 10g, Du Huo Radix Angelicae Pubescentis 10g, Huai Niu Xi Radix Achyranthis Bidentatae 10g, and Sang Zhi Fructus Gardeniae 10g should be added to relieve the pain.


Alternative formulas



Qiang huo sheng shi tang


Notopterygium Dispelling Dampness Decoction. This formula could be used to treat limb body pain, especially the upper limb pain, due invasion of Wind, Cold and Damp. Typically this formula was originally designed for headache, but its effect on limb pain is also obvious. Xi Xin Herba Asari 5g, Hai Feng Teng Caulis Piperis Futokadsurae 10g and Sang Zhi Fructus Gardeniae 10g should be added to relieve the pain.


Du huo ji sheng tang


Angelica Pubescens and Sangjisheng Decoction. This formula is indicated in chronic limb pain, especially the lower limb pain, due to invasion of Wind, Cold and Damp with deficiency of Liver and Kidney. Chuan Xiong Radix Ligustici Chuanxiong 10g, Hai Feng Teng Caulis Piperis Futokadsurae 10g and Sang Zhi Fructus Gardeniae 10g should be added to relieve the pain.


Yi yi ren tang


Coicis Decoction. This formula has a strong function for dispelling the Wind, eliminating the Cold, resolving the Damp and relieving the pain, especially indicated in the leg pain due to invasion of Wind, Cold and Damp.


Ma xing yi gan tang


Ephedra Apricot Kernel, Coicis and Licorice Decoction. This formula could be used to treat limb pain in the beginning stage due to invasion of Wind, Cold and Damp.

Huai Niu Xi Radix Achyranthis Bidentatae 10g, Qin Jiao Radix Gentianae Macrophyllae 10g, Rou Gui Cortex Cinnamomi 6g, Cang Zhu Rhizoma Atractylodis 12g, Qiang Huo Rhizoma et Radix Notopterygii 12g and Du Huo Radix Angelicae Pubescentis 10g could be added to the prescription to eliminate the External pathogenic factors and relieve the pain.


Jia wei xuan bi tang


Disband Painful Obstruction Decoction. This formula clears the Heat, eliminates the Damp and relieves the pain, indicated in leg pain due to invasion of Wind, Damp and Heat. Jiang Huang Rhizoma Curcumae Longae 15g, Hai Tong Pi Cortex Erythrinae 15g and Sang Zhi Ramulus Mori 15g, etc., should be added to the prescription.


Modifications





1. If there is a severe aversion to cold, add Gan Jiang Rhizoma Zingiberis 5g and Rou Gui Cortex Cinnamomi 5g to warm the channels and dispel the Cold


2. If the joints are swollen, add Fang Ji Radix Stephaniae Tetrandrae 10g and Tu Fu Ling Rhizoma Smilacis Glabrae 15g to eliminate the Damp and subside the swelling


3. If there are severe sore muscles, add Mu Gua Fructus Chaenomelis 10g to eliminate the Damp and regulate the circulation of Qi


4. If there is a feeling of heaviness in the limbs, add Can Sha Excrementum Bombycis Mori 10g and Ze Xie Rhizoma Alismatis 15g to promote the urination and eliminate the Damp


5. If there is severe muscle pain with a contracting feeling, add Bai Shao Radix Paeoniae Alba 10g to relax the muscles and relieve the pain


6. If the appetite is poor, add Ban Xia Rhizoma Pinelliae 10g and Sha Ren Fructus Amomi 6g to dry the Damp and improve the appetite.


Patent remedy


Feng Shi Pian Wind-Damp Tablet.









Main points


LU-7 Lieque, LI-4 Hegu, SP-6 Sanyinjiao, GB-34 Yanglingquan, BL-40 Weizhong, BL-58 Feiyang and BL-60 Kunlun, as well as some local Ah Shi points on the limbs. Reducing method is used on these points. Moxibustion is used on GB-34, BL40, BL-58 and LI-4.


Explanations





▪ LU-7, the Connecting point of the Lung channel, and LI-4, the Source point of the Large Intestine channel, regulate the skin pores, dispel Wind-Cold-Damp, promote the circulation of Qi and relieve the pain


▪ SP-6, the crossing point of the Spleen, Kidney and Liver channels, eliminates the Damp, promotes the urination and relieve the limb pain


▪ GB-34, the Sea point of the Gallbladder channel and the Gathering point for the Tendons, regulates the circulation of Qi and relieves the pain in the Tendons


▪ BL-40, BL-58 and BL-60, the Sea point, the Connecting point and the River point of the Bladder channel respectively, promote the circulation of Qi, eliminate Wind-Damp and relieve the pain


▪ Ah Shi points promote the Qi and Blood circulation and relieve the limb pain


▪ Moxibustion, a warming method, warms the channels, eliminates Wind-Damp-Cold and relieves the pain.


Alternative points


LI-3 Sanjian, TE-5 Waiguan, SP-3 Taibai, SP-9 Yinlingquan, LR-3 Taichong and GB-41 Zulinqi, etc.


Modifications


When there is pain along certain channels, then some corresponding points on these affected channels should be applied, including the Stream point, Source point, Connecting point and Accumulation point, so as to improve the effect on the pain.


1. If there is muscular numbness, add SP-9, the Sea point of the Spleen channel, and ST-40, the Connecting point of the Stomach channel, to promote the circulation of Qi, resolve the Damp, eliminate the Phlegm and relieve the numbness


2. If there is a low fever, add GV-14 to promote the sweat, eliminate Wind-Damp and reduce the fever


3. If there is a headache, add GB-20 to promote the sweating and relieve the headache


4. If the appetite is poor, add CV-12, the Front Collecting point of the Stomach, and ST-36, the Sea point of the Stomach channel, to promote the circulation of Qi and improve the appetite.






A 20-year-old woman had been suffering from a wandering pain in all her limbs with a cold sensation for 3 months. The pain was mainly located along the Large Intestine channel. At the hospital she was diagnosed as having rheumatic arthritis. As well as painful limbs, she also had a low fever, an aversion to cold, aggravation of the pain by exposure to cold and in humid weather, a poor appetite, loose stools, a pale tongue with a white coating and a superficial and rapid pulse.


Diagnosis


Invasion of Wind-Cold.


Principle of treatment


Dispel Wind-Cold, promote the Qi circulation and sedate the pain.


Herbal treatment




Fang feng tang





Ledebouriella Decoction


Fang Feng Radix Ledebouriellae 10g


Chuan Xiong Rhizoma Ligustici Chuanxiong 10g


Gan Cao Radix Glycyrrhizae 6g


Fu Ling Poria 15g


Chai Hu Radix Bupleuri 15g


Dang Gui Radix Angelicae Sinensis 10g


Qin Jiao Radix Gentianae Macrophyllae 10g


Qing Feng Teng Caulis Sinonenii 30g


Gui Zhi Ramulus Cinnamomi 10g.


Explanations





▪ Fang Feng, Qin Jiao and Qing Feng Teng dispel Wind and relieve the pain


▪ Gui Zhi eliminates Cold, regulates the circulation of Qi and Blood and relieves the pain


▪ Dang Gui and Chuan Xiong promote the circulation of Qi and Blood and relieve the pain


▪ Fu Ling eliminates Wind-Damp and strengthens the Spleen


▪ Chai Hu dispels Wind, promotes the circulation of Qi and reduces fever


▪ Gan Cao harmonises the functions of other herbs in the prescription.


Acupuncture treatment


LI-3, LI-4, LI-6, LI-14, LI-15, TE-5, BL-58 and BL-60. Reducing method is used on these points. Moxibustion is used where there is severe pain.


Explanations





▪ LI-3, the Stream point, and LI-4, the Source point, regulate the skin pores, dispel Wind-Cold-Damp, promote the circulation of Qi and relieve the pain


▪ LI-6, the Connecting point, and LI-7, the Accumulation point, harmonise the collateral, promote the circulation of Qi in the channels and sedate the pain


▪ LI-14 and LI-15, the local points, regulate the circulation of Qi and relieve the pain


▪ TE-5, the Connecting point from the Triple Burner channel, BL-58, the Connecting point of the Bladder channel, and BL-60, the River point, dispel external pathogenic factors, promote the circulation of Qi, harmonise the collateral and relieve the pain.

The patient was treated with a daily herbal decoction, and acupuncture was given once every other day. The pain in her limbs was under control after a month. She was followed up a year later and she stated she had experienced no more pain after the herbal treatment.




Downward flow of Damp-Heat



Symptoms and signs


Gradual occurrence of pain in the four limbs, especially at the lower limbs, with a hot and heavy sensation, which is aggravated by warmth and alleviated by cold, with swollen joints, lower back pain, scanty and yellow urine, constipation, or loose stools, fever, a red tongue with a thick and yellow coating and a slippery and rapid pulse are all symptoms and signs of this condition.

Jun 19, 2016 | Posted by in PAIN MEDICINE | Comments Off on Pain in all four limbs

Full access? Get Clinical Tree

Get Clinical Tree app for offline access