Shoulder pain






Prescription



Main formulas



Ma huang tang


Ephedra Decoction.


Gui zhi tang


Cinnamon Twig Decoction. Although both of the above formulas could be used to treat shoulder pain due to invasion of Wind-Cold, the first formula is indicated in severe invasion of Wind-Cold, usually accompanied by no sweating, while the second one is indicated in slight invasion of Wind-Cold.

Some other herbs, such as Ge Gen Radix Puerariae 10g, Qiang Huo Rhizoma seu Radix Notopterygii 10g, Du Huo Radix Angelicae Pubescentis 10g, Chuan Xiong Radix Ligustici Wallichii 10g and Xi Xin Herba Asari 5g could be added to increase the promotion of sweating and to relieve the pain.


Alternative formula



Ma huang fu zi xi xin tang


Ephedra, Prepared Aconite, and Asarum Decoction. This formula is indicated in entire body pain due to invasion of Wind-Cold resulting from deficiency of Yang. Qiang Huo Rhizoma seu Radix Notopterygii 10g, Du Huo Radix Angelicae Pubescentis 10g and Chuan Xiong Radix Ligustici Wallichii 10g should be added to increase the effect of promoting sweating and relieve the pain.


Modifications





1. If there is severe pain at night, add Yan Hu Suo Rhizoma Corydalis 15g to relieve the pain


2. If there is a cough with white sputum, add Jie Geng Radix Platycodi 10g to regulate the Lung-Qi and eliminate the Phlegm


3. If there is a fever, add Jing Jie Herba seu Flos Schizonepetae Tenuifoliae 10g, Fang Feng Radix Ledebouriellae Divaricatae 10g to dispel Wind-Cold and reduce the fever


4. If there is a runny nose, add Qian Hu Radix Peucedani 10g to promote the circulation of Qi and eliminate the Phlegm.


Patent remedy


Feng Shi Pian Wind-Damp Tablet.



Acupuncture Treatment




Main points


LI-4 Hegu, LI-15 Jianyu, LU-7 Lieque, TE-5 Waiguan, GB-20 Fengchi, SI-9 Jianzhen and SI-11 Tianzong. Reducing method is used on these points. Moxibustion should also be used.


Explanations





▪ LI-4, the Source point of the Large Intestine channel, dispels Wind-Cold, promotes the circulation of Qi and relieves the pain. This point is a main point to treat the shoulder pain.


▪ LU-7, the Connecting point of the Lung channel, dispels Wind-Cold, harmonises the collateral and relieves the pain. This point is main point to treat the shoulder pain along the Lung channel.


▪ TE-5, the Connecting point of the Triple Burner channel, dispels Wind-Cold, regulates the circulation of Qi and relieves the pain. This point is main point to treat the shoulder pain along the Triple Burner channel.


▪ GB-20 dispels the Wind and relieves the pain.


▪ LI-15, SI-9 and SI-11 are the local points for promoting the circulation of Qi and relieving the shoulder pain.


▪ Moxibustion warms the channels, dispels Cold and relieve the shoulder pain.


Alternative points


LI-16 Jugu, SI-13 Quyuan, SI-14 Jianwaishu, SI-15 Jianzhongshu and TE-15 Tianliao, etc.


Modifications





1. If the shoulder pain occurs at the place where the Lung channel passes through, add LU-3, LU-4 and LU-5 to promote the circulation of Qi in the channel and sedate the pain


2. If the shoulder pain occurs at the place where the Large Intestine channel passes through, add LI-6, LI-7 and LI-14 to regulate the channel and sedate the pain


3. If the shoulder pain occurs at the place where the Triple Burner channel passes through, add TE-7, TE-14 and TE-15 to harmonise the collateral and sedate the pain


4. If the shoulder pain occurs at the place where the Small Intestine channel passes through, add SI-4, SI-6, SI-10 and SI-12 to harmonise the collateral and sedate the pain


5. If there is stiffness and pain in the neck, add GB-21 and SI-15 to promote the circulation of Qi and Blood and relieve the neck stiffness and pain


6. If there is a headache and feeling of heaviness in the head, add BL-10 and GV-17 to dispel Wind-Cold-Damp, promote the circulation of Qi and relieve the pain


7. If there is a fever, add LI-11 to clear the Heat and reduce the fever


8. If there is generalised body pain, add ST-40 and BL-63 to harmonise the collateral and sedate the pain


9. If there is throat pain, add LU-10 and CV-23 to dispel the External factors and relieve the throat pain.





Invasion of Cold-Damp



Symptoms and signs


Symptoms and signs for this condition are acute shoulder pain with a cold and heavy sensation, which is aggravated by exposure to cold and wind or in rainy weather, and improves with warmth, with occasionally a swollen shoulder with difficult movement, running nose with white discharge, cough with expectoration of white phlegm, aversion to cold, cold hands, upper back pain, neck pain and stiffness, headache, etc, thin and white tongue coating, a slight white and greasy coating and a wiry and tight pulse.


Principle of treatment


Dispel the Cold, eliminate the Damp, promote circulation of Qi and sedate the pain.



Herbal Treatment




Prescription




Qiang huo sheng shi tang


Notopterygium Dispelling Dampness Decoction. This formula is relatively good for dispelling the Wind, eliminating the Cold, resolving the Damp and relieving the pain. Xi Xin Herba Asari 5g, Yu Jin Tuber Curcumae 10g, Gui Zhi Ramulus Cinnamomi Cassiae 10g and Ji Xue Teng Caulis Milletiae Reticulatae 10g could be added to strengthen the effect on pain relief.


Ma huang jia zhu tang


Ephedra Decoction plus Atractylodes. This formula, compared with the one above, has a relatively strong effect which promotes sweating and relieves the invasion of Wind and Cold. Its effect on Damp is not as strong, however, as that of the formula above.


Juan bi tang


Remove Painful Obstruction Decoction. Besides dispelling the Wind, eliminating the Cold, resolving the Damp and relieving the pain, this formula also can tonify the Qi and Blood. 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.


Modifications





1. If there is a heavy sensation of the shoulder, add Jiang Huang Rhizoma Curcumae Recens 10g and Qing Feng Teng Caulis Sinomenii 20g to eliminate the Damp and relieve the pain


2. If there is an aversion to cold, add Fu Zi Radix Aconiti Lateralis Praeparata 10g to warm the channels and relieve the pain


3. If the shoulder is swollen, add Tu Fu Ling, Rhizoma Smilacis Glabrae 20g and Ban Xia Rhizoma Pinelliae 10g and eliminate the Damp and reduce the swelling.


Patent remedy


Tian Ma Qu Feng Bu Pian Gastrodia Dispel Wind Formula Tablet.


Acupuncture Treatment




Main points


GB-20 Fengchi, LI-15 Jianyu, TE-5 Waiguan, SI-9 Jianzhen, SI-11 Tianzong, ST-36 Zusanli, ST-40 Fenglong and SP-6 Sanyinjiao. Reducing method is used on all these points. Moxibustion should be applied on the local points around the shoulder.


Explanations





▪ GB-20 is the meeting point of the Gallbladder channel and the Yang Linking Vessel. This vessel connects with all the Yang channels and dominates the superficial level of the body. Needling at GB-20 eliminates Wind-Damp and stop the pain.


▪ LI-15, the meeting point of the Bright Yang channel of the hand and the Yang Heel Vessel, regulates the circulation of Qi in the channels and collateral, eliminates Cold and Damp and relieves the pain.


▪ TE-5, the Connecting point of the Triple Burner channel, promotes the circulation of Qi, dispels Cold and Damp and relieves the pain.


▪ ST-36, the Sea point of the Stomach channel, and ST-40, the Connecting point, together with SP-6 promote the circulation of Qi, eliminate the Damp and relieve the pain. ST-40 can be needled whilst moving the shoulder joints to promote the circulation of Qi and relieve the pain.


▪ SI-9 and SI-11, the local points, relieve the shoulder pain.


▪ Moxibustion warms the channels, dispels Cold and relieve the shoulder pain.


Alternative points


LI-16 Jugu, SI-13 Quyuan, SI-14 Jianwaishu, SI-15 Jianzhongshu, TE-15 Tianliao, ST-38 Tiaokou and SP-9 Yinlingquan, etc.


Modifications


When the shoulder pain involves different channels, corresponding points have to be combined (see invasion of Wind-Cold above):


1. if there is stiffness and pain in the neck, add GB-21 and SI-14 to promote the circulation of Qi and Blood and relieve the neck stiffness and pain


2. if there is a headache, add Extra Taiyang and Extra Yintang to sedate the headache


3. if there is an aversion to cold, add moxibustion to dispel Wind-Damp and relieve Cold


4. if there is nausea and vomiting, add PC-6 and CV-12 to harmonise the Stomach and help the Stomach-Qi to descend.

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

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