Prescription
Main formula
Ma huang tang
Alternative formulas
Gui zhi tang
Ma huang fu zi xi xin tang
Modifications
Patent remedy
Main points
Explanations
Alterative points
Modifications
Diagnosis
Principle of treatment
Acupuncture treatment
Explanations
Invasion of Wind-Heat
Symptoms and signs
Principle of treatment
Prescription
Main formula
Chai ge jie ji tang
Alternative formulas
Yin qiao san
Sang ju yin
Modifications
Patent remedies
Main points
Explanations
Alternative points
Modifications
Diagnosis
Principle of treatment
Herbal treatment
Explanations
Invasion of Cold-Damp
Symptoms and signs
Principle of treatment
Prescription
Main formula
Qiang huo sheng shi tang
Alternative formula
Yue bi jia zhu tang
Modifications
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Upper back pain
Ephedra Decoction. This formula can be specifically used to treat upper back pain due to severe invasion of Wind-Cold. There is usually no sweating or very little sweating. Since this formula could cause severe sweating this formula is contraindicated if the patient is weak.
Since this formula can only dispel the External pathogenic factors, its effect on upper pain is limited; therefore, some other herbs should be combined with it, 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 to increase the effect of promoting sweating and relieve the pain.
Besides these herbs, some others can be alternatively used, such as Ji Xue Teng Caulis Milletiae Reticulatae, Wu Jia Pi Cortex Acanthopanacis Gracilistyli Radicis, Hu Zhang Rhizoma Polygoni cuspidate and San Qi Hua Flos Pseudoginseng etc.
Cinnamon Twig Decoction. This formula can be used to treat upper back pain due to mild invasion of Wind-Cold. There is usually slight sweating. 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 to increase the effect of promoting sweating and relieve the pain.
This formula is indicated in entire back pain due to invasion of Wind-Cold resulting from deficiency of Yang. Add Qiang Huo Rhizoma seu Radix Notopterygii 10g, Du Huo Radix Angelicae Pubescentis 10g and CHUAN XIONG Radix Ligustici Wallichii 10g to increase the effect of promoting sweating and relieve the pain.
1. If there is much headache, add Chuan Xiong Radix Ligustici Chuanxiong 10g and Bai Zhi Radix Angelicae Dahuricae 10g to eliminate Wind-Cold and relieve the headache
2. If there is much aversion to cold or wind on the back, add Jing Jie Herba Schizonepetae 10g and Fang Feng Radix Ledebouriellae 10g to dispel the Wind and eliminate the Cold
3. If there is a stiff neck, add Bai Shao Yao Radix Paeoniae Alba 12g to relax the Tendons and regulate the circulation of Qi so as to relieve the neck stiffness
4. If there is severe pain with a cold sensation, add Gan Jiang Rhizoma Zingiberis 6g and Yan Hu Suo Rhizoma Corydalis 12g to warm the channels and relieve the pain
5. If there is a feeling of heaviness in the back, add Cang Zhu Rhizoma Atractylodis 10g to eliminate Damp and relieve the feeling of heaviness
6. If the back pain worsens at night and there is waking at night owing to severe back pain, add Dan Shen Radix Salviae Miltiorrhizae 10g to promote the circulation of Blood, calm the Shen and relieve the pain
7. If there is a cough, add Jie Geng Radix Platycodi 10g and Ju Hong Exocarpium Citri Grandis 5g to disperse the Lung-Qi, eliminate Phlegm and relieve the cough.
San She Dan Zhui Feng Wan Three Snake Gallbladder Dispel Wind Pill.
GB-20 Fengchi, BL-12 Fengmen, BL-Feishu, LU-7 Lieque, BL-58 Feiyang, BL-60 Kunlun, LI-4 Hegu, SI-14 Jiangwaishu and some local Ah Shi points. Reducing method is used on these points. Moxibustion is applied on LU-7, LI-4, BL-12 and BL58.
▪ 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 levels of the body. Needling at GB-20 eliminates Wind so as to stop the pain.
▪ BL-12, the Meeting point of the Governing Vessel and the Bladder channel, and BL-13, the Back Transporting point of the Lung, are the gateways through which pathogenic Wind invades the body. Application of acupuncture and cupping to these two points disperses Wind-Cold and promotes the Lung’s function of dispersing the Lung-Qi.
▪ LU-7, the Connecting point of the Lung channel, and LI-4, the Source point of the Large Intestine channel, are a pair of points from externally and internally related channels. Use of these two points in combination eliminates Wind and stops the pain. LU-7 is used for pain in the head and neck; LI-4 is important for sedating body pain due to External invasion.
▪ BL-58, the Connecting point of the Bladder channel, and SI-14 harmonise the collateral and sedate the upper back pain.
▪ BL-60 dispels Wind-Cold in the upper back and relieves the pain.
▪ Local Ah Shi points promote the circulation of Qi and Blood, eliminate stagnation in the channels and stop the pain.
▪ Moxibustion on acupuncture points could warm the channels and dispel the External Wind-Cold and relieve the pain.
Some of the following points from below could be selected as the alterative points, such as LI-16 Jugu, SI-12 Bingfeng, SI-13 Quyuan, SI-15 Jianzhongshu, TE-15 Tianliao, BL-10 Tianzhu, BL-40 and BL-63 Jinmen, etc.
1. If there is pain of the general body, add TE-5, the Connecting point of the Triple Burner channel, to dispel the Wind-Cold, harmonise the collateral and relieve the pain
2. If the back is stiff, add a few Extra Huatuojiaji points and cupping on the local area to promote the circulation of Qi and Blood and relieve the stiffness
3. If there is a sharp pain at night, add Ah Shi points and SP-6 to promote the circulation of Blood, eliminate Blood stasis and relieve the pain
4. If there is a feeling of heaviness in the back, add SP-9 to eliminate the Damp and relieve the feeling of heaviness
5. If there is a limitation of movement in the back, add BL-62 with strong stimulation, to promote the circulation of Qi in the Bladder channel and Yang Heel Vessel so as to improve the movement
6. If there is an absence of sweating, add to SI-3 and BL-10 to open the skin pores, promote the sweating and relieve the External symptoms
7. If there is a headache, add Extra Yintang to promote the circulation of Qi in the head and relieve the headache
8. If there is much cough, add LU-5 to disperse the Lung-Qi, eliminate the Phlegm and relieve the cough.
A 19-year-old boy had been suffering from upper back pain for 1 day. He also had sneezing, a cough with thin and clear sputum and a runny nose with a white discharge. When he arrived at the clinic, all these symptoms were still present, together with generalised body pain, a lack of thirst, a thin and white tongue coating and a superficial pulse.
Invasion of Wind-Cold.
The key symptoms are acute-onset upper back pain with an aversion to cold, a thin and white discharge from the nose, the tongue conditions and the pulse.
Dispel Wind, eliminate Cold, circulate the collateral and sedate the pain.
GB-20, BL-13, LU-7, BL-58, BL-60 and LI-4 together with some local Ah Shi points. Reducing method was used on all these points once a day.
▪ GB-20 is the meeting point of the Gallbladder channel and the Yang Linking Vessel. Needling at GB-20 can eliminate Wind and stop the upper back pain.
▪ BL-12, the Meeting point of the Governing Vessel and the Bladder channel, and BL-13, the Back Transporting point of the Lung, are the gateways for dispersing Wind-Cold and promoting the Lung’s function in dispersing the Lung-Qi.
▪ LU-7, the Connecting of the Lung channel, and LI-4, the Source point of the Large Intestine channel, are a pair of points from externally and internally related channels. They eliminate Wind and stop the pain.
▪ BL-58, the Connecting point, harmonises the collateral and sedates the pain.
▪ BL-60 dispels Wind-Cold in the upper back and relieves the pain.
▪ Local Ah Shi points promote the circulation of Qi and Blood, eliminate stagnation in the channels and stop the pain.
Due to the short duration of the problem, the upper back pain was under control in 2 days. One year later he was followed up and he said that he had experienced no further pain after the acupuncture treatment.
Sudden upper back pain with a burning or pricking sensation, or a sharp pain, or constant pain, which worsens on aggravation of pain by exposure to warmth and alleviated by cold, accompanied by fever, aversion to cold, sweating, thirst, a cough with expectoration of yellow phlegm, dark and scanty urine, accompanied by sweating, a thin and yellow tongue coating and a superficial and rapid pulse are symptoms and signs of invasion of Wind-Heat.
Dispel the Wind, clear the Heat and arrest the pain.
Bupleurum and Kudzu Decoction to Release the Muscle Layer. This formula has a strong effect which dispels Wind-Heat and relieves the muscle pain and back pain. Chuan Xiong Radix Ligustici Wallichii 10g, HU ZHANG Rhizoma Polygoni cuspidati, REN DONG TENG Ramus Lonicerae Japonicae 10g and XI XIAN CAO Herba Siegesbecki 10g could be added to relieve the back pain.
Honeysuckle and Forsythia Powder. This formula could be used to dispel the Wind, clear the Heat and relieve the External symptoms. Chuan Xiong Radix Ligustici Wallichii 10g and Huang Qin Radix Scutellariae 10g could be added to relieve the pain.
Besides, some other herbs could also be used instead of those above combined with the formula, such as
Bai Ju Hua Flos Chrysanthemi Morifolii 10g, Huang Lian Rhizoma Coptidis 3g, Hu Zhang Rhizoma Polygoni cuspidati 10g, Ren Dong Teng Ramus Lonicerae Japonicae 10g and Xi Xian Cao Herba Siegesbeckiae 10g, etc.
Mulberry Leaf and Chrysanthemum Decoction. This formula could be prescribed to treat upper back pain due to invasion of Wind-Heat to the Lung system, manifested mainly as cough and throat pain, etc. Chuan Xiong Radix Ligustici Wallichii 10g, and Huang Qin Radix Scutellariae 10g, etc., should be added to strongly relieve the pain.
1. If there is upper back pain with burning sensation, add Zhi Mu Rhizoma Anemarrhenae 10g and Xi Qian Cao Herba Siegesbeckiae 10g to clear the Heat in the channel and relieve the pain
2. If there is a high fever, add Chai Hu Radix Bupleuri 10g and Shi Gao Gypsum Fibrosum 30g to clear the Heat and reduce the fever
3. If there is a feeling of heaviness in the back, add Cang Zhu Rhizoma Atractylodis 10g to activate the Spleen, eliminate the Damp and relieve the feeling of heaviness
4. If the back pain is worse at night and there is waking at night owing to severe pain, add Dan Shen Radix Salviae Miltiorrhizae 10g to promote the circulation of Blood, calm the Shen and relieve the pain
5. If there is constipation, add Da Huang Radix et Rhizoma Rhei 10g and Mang Xiao Natrii Sulfas 10g to eliminate the Heat, promote defecation and relieve constipation
6. If there is severe thirst, add Mai Men Dong Radix Ophiopogonis 12g and Sha Shen Radix Glehniae 12g to nourish the Yin, promote the secretion of Body Fluids and relieve the thirst
7. If there is a sore or swollen throat, add Xuan Shen Radix Scrophulariae 12g to clear the Heat, reduce the swelling and relieve the sore throat
8. If there is a severe cough and expectoration of much sputum, add Bei Mu Bulbus Fritillariae 10g and Wei Jing Rhizoma Phragmitis 20g to clear the Heat, eliminate the Phlegm and stop the cough
9. If there is chest pain and expectoration of yellow sputum, add Huang Qin Radix Scutellariae 15g and Dong Gua Ren Semen Benincasae 30g to clear the Heat in the Lung and relieve the chest pain.
Yin Qiao Pian Honeysuckle and Forsythia Tablet.
Huang Lian Shang Qing Wan Coptis Pill to Clear Heat of Upper Burner.
GV-14 Dazhui, GB-20 Fengchi, LI-4 Hegu, TE-5 Waiguan, SI-11 Tianzong, SI-14 Jiangwaishu, BL-58 Feiyang, BL-60 Kunlun and some local Ah Shi points. Reducing method is used on these points.
▪ GV-14, the meeting point of all the Yang channels, invigorates the Yang-Qi and clears Heat. It also can be needled with a three-edged needle to cause bleeding, which gives a better result in clearing Heat.
▪ 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 can eliminate Wind so as to stop pain.
▪ LI-4, the Source point of the Large Intestine channel, dispels Wind-Heat. It is also an important point for promoting the circulation of Qi in the superficial layers of the body so as to relieve the upper back pain.
▪ TE-5, the Connecting point of the Triple Burner channel and also the Confluence point communicating with the Yang Linking Vessel, disperses pathogenic factors on the body surface.
▪ SI-11 and SI-14 dispel Wind-Heat in the upper back and stop the pain.
▪ BL-58, the Connecting point of the Bladder channel, harmonises the collateral and sedates the pain.
▪ BL-60 dispels Wind-Heat in the upper back and relieves the pain.
▪ Local Ah Shi points promote the circulation of Qi and Blood, eliminate stagnation in the channels and stop the pain.
Some of the following points from below could be selected as the alterative points, such as LI-2 Erjian, LI-3 Sanjian, SI-12 Bingfeng, SI-13 Quyuan, SI-15 Jianzhongshu, TE-15 Tianliao, BL-40 and BL-66 Zutonggu, etc.
1. If there is a fever, add LI-11, the Sea point of the Large Intestine channel, to clear the Heat and reduce the fever
2. If there is a cough, add LU-5, the Sea point of the Lung channel, and BL-13, the Back Transporting point of the Lung, to stop the cough and clear the Heat
3. If there is chest pain, add LU-6, the Accumulation point of the Lung channel, to harmonise the collateral and sedate the pain
4. If there is a burning feeling in the upper back, add BL-66, the Spring point of the Bladder channel, to clear the Heat and relieve the burning feeling.
A 32-year-old man had been suffering from upper back pain with an aversion to wind for 1 day. To begin with, he had sneezing, a cough with sticky sputum and a runny nose with little discharge. When he arrived at the clinic, all these symptoms were still present, together with generalised body pain, a sore throat, a slight thirst, sweating, a thin and yellow tongue coating and a superficial and rapid pulse.
Invasion of Wind-Heat.
Dispel Wind, clear Heat, circulate the collateral and sedate the pain.
Yin Qiao San
Honeysuckle and Forsythia Powder
Jin Yin Hua Flos Lonicerae 10g
Lian Qiao Fructus Forsythiae 10g
Niu Bang Zi Fructus Arctii 10g
Bo He Herba Menthae 6g, decocted later
Jing Jie Spica Schizonepetae 6g
Jie Geng Radix Platycodi 10g
Gan Cao Radix Glycyrrhizae 6g
Yan Hu Suo Rhizoma Corydalis 15g
Chuan Lian Zi Fructus Meliae Toosendan 10g
▪ Jin Yin Hua and Lian Qiao, pungent in flavour and cool in nature, relieve the Exterior symptoms and clear pathogenic Heat and Toxin
▪ Bo He and Jing Jie expel Exogenous Heat and induce sweating
▪ Niu Bang Zi, Jie Geng and Gan Cao dispel Wind-Heat in the Upper Burner, open the nasal orifice and relieve cough
▪ Yan Hu Suo and Chuan Lian Zi regulate the circulation of Qi and relieve the pain.
The patient was treated with a herbal decoction daily. The upper back pain had disappeared after 10 days. Three months later he was followed up and he reported that he had experienced no further pain.
Symptoms and signs of invasion of Wind-Cold are acute occurrence of upper back pain with a heavy sensation and a fixed location, and an aversion to wind, together with a heavy sensation in the body or limbs, a poor appetite, a feeling of dullness in the stomach, a thin and greasy tongue coating and a superficial and slippery pulse.
Dispel the Wind, dry the Damp and sedate the pain.
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Notopterygium Dispelling Dampness Decoction. This formula dispels the Wind, eliminates the Cold, resolves the Damp and relieves the pain. Ge Gen Radix Puerariae 10g, Gui Zhi Ramulus Cinnamomi 6g and Xi Xian Cao Herba Siegesbeckiae 10g could be added into the prescription to harmonise the collaterals and relieve the back pain.
Maidservant from Yue Decoction plus Atractylodes. This formula could be used to dispel Wind-Cold and eliminate Damp in the body, but its effect on the pain is limited. It is especially used to treat acute invasion of Wind, Cold and Damp. If there has been accumulation of Cold-Damp in the body for a long time, then this formula is not suitable. JUAN BI TANG could then be prescribed instead.
1. If there is a feeling of severe heaviness in the back, add Cang Zhu Rhizoma Atractylodis 10g to dispel the Wind, eliminate the Damp and relieve the feeling of heaviness
2. If there is back pain with an obvious cold sensation, add Gan Jiang Rhizoma Zingiberis 10g to warm the channels, dispel Cold and relieve the cold sensation
3. If the back pain worsens at night and there is waking at night owing to severe pain, add Dan Shen Radix Salviae Miltiorrhizae 10g to promote the circulation of Blood, calm the Shen and relieve the pain
4. If there is an absence of sweating, add Ma Huang Herba Ephedrae 10g to open the skin pores, promote the sweating and relieve the Eternal symptoms
