Acupuncture treatment
Li-4, LI-15, SI-9, SI-11, GB-21 and ST-39. Reducing method is used on all these points. Treatment was given every other day.
Explanations
• LI-4, the Source point of the Large Intestine channel, promotes the circulation of Qi and relieves the pain.
• GB-21 regulates the circulation of Qi and relieves spasm of the muscles and tendons in the shoulder.
• 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 Wind-Cold and dispels Damp.
• SI-4, the Source point, is used to promote the circulation of Qi and dispel Wind-Cold and Damp.
• SI-9 and SI-Il are local points for regulating Qi and relieving the pain.
• ST-40, the Connecting point of the Stomach channel, promotes the circulation of Qi, eliminates Damp and relieves the pain.
The patient was required to move her shoulder joint when needled at ST-40. She also received guidance in shoulder exercises every morning.
After 20 days of treatment and exercise, her shoulder pain had disappeared completely. A year later, she was followed up by letter and she stated she had felt no pain after the acupuncture treatment.
STAGNATION OF QI IN THE CHANNELS
Symptoms and signs
Shoulder pain with a distending or numb sensation, no palpable pain spots, which starts or is aggravated by poor mood, accompanied by irritability, insomnia, a migraine headache, irregular menstruation, a poor appetite, hypochondriac pain, lower abdominal pain, a red tongue with a white coating and a wiry pulse.
Principle of treatment
Smooth Liver, regulate the Liver-Qi and relieve the pain.
HERBAL TREATMENT
Prescription
XIAO YAO SAN
Free and Relaxed Powder Chai Hu Radix Bupleuri 10 g Dang Gui Radix Angelicae Smensis 10 g Bai Shao Radix Paeoniae Alba 20 g Gan Cao Radix Clycyrrhizae 5 g Bo He Hcrba Mentirne 5 g Sang Zhi Ramulus Mori 20 g Xiang Fu Rhizoma Cyperi 6 g
Explanations
• Bai Shao and Dang Gui smooth the Liver, nourish the Blood and strengthen the Liver.
• Chai Hu, Xiang Fu and Bo He regulate and promote the circulation of Liver-Qi so as to remove Qi stagnation in the Liver. These herbs may also serve to relieve pain.
• Sang Zhi regulates the circulation of Qi, harmonises the collateral and relieves shoulder pain.
• Gan Cao harmonises the actions of the other herbs in the prescription.
Modifications
I. If there is a sharp shoulder pain, add Yan Hu Suo Rhizoma Corydalis 10 g and Yu Jin Radix Curcumae 10 g to promote the circulation of Qi and relieve the pain.
2. If there is a migraine, add Chuan Xiong Rhizoma Ligustici Chuanxiong 10 g to regulate the Liver-Qi and sedate the headache.
3. If there is low abdominal pain, add Wu Yao Radix Linderae 10 g and Ju He Semen Citri Reticulatae 10 g to regulate the circulation of Qi and to relieve the pain.
4. If there is irregular menstruation, add Huai Niu Xi Radix Achyranthis Bidentatae 10 g and Yi Mu Cao Herba Leonuri 10 g to promote the circulation of Qi and regulate the circulation of Blood.
Patent remedy
Xiao Yao Wan Free and Relaxed Pill
ACUPUNCTURE TREATMENT
LI-4 Hegu, TE-5 Waiguan, PC-6 Neiguan, SP-6
Sanyinjiao, LR-3 Taichong and GB-20 Fengchi. Even method is used on these points.
Explanations
• LI-4, the Source point of the Large Intestine channel, promotes the circulation of Qi and relieves the shoulder pain.
• PC-6, the Connecting point of the Pericardium channel, and LR-3, the Source and Stream point of the Liver channel, regulate the circulation of Qi, smooth the Liver and remove the stagnation of Qi.
• TE-5, the Connecting point of the Triple Burner channel, harmonises the collateral and relieves the shoulder pain.
• Long-standing stagnation of Qi may in turn cause stagnation of Blood. SP-6, the crossing point of the three Yin channels of the foot, regulates the Blood and removes Blood stagnation.
• GB-20 calms the Liver, regulates the circulation of Qi and relieves the pain.
• GV-20 calms the Mind and improves the mood.
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 and TE-14 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-9 and SI-10 to harmonise the collateral and sedate the pain.
5. If there is pain in the scapular region, add SI-Il and SI-12 to harmonise the collateral and sedate the pain.
6. If there is stiffness and pain of the neck, add GB-21 and SI-14 to promote the circulation of Qi and Blood and relieve the neck stiffness and pain.
7. If there is a headache, add Extra Taiyang and Extra Yintang to sedate the headache.
8. If there is hypochondriac pain, add LR-14 and GB-41 to regulate the circulation of Qi and relieve the pain.
9. If there is lower abdominal pain, add ST-29 and SP-9 to regulate the circulation of Qi and relieve the pain.
10. If there is irregular menstruation, add LR-12 and KI-3 to regulate the menstruation.
11. If there is insomnia, add HT-7 and BL-15 to calm the Heart and tranquillise the Mind.
12. If there is irritability, add LR-2 and GV-20 to regulate the circulation of Qi and calm the Mind.
Case history
A 47-year-old woman had been suffering from shoulder pain on both sides for nearly a year. She complained of shoulder pain with numb limbs when she was angry or during stressful periods. Sometimes she had a headache before her menstrual period. She had a general check-up and was diagnosed as having a climacteric depression. Besides the shoulder pain, she had a headache, irregular menstruation, a dull feeling in her stomach and a sensation of numbness on her tongue. Her tongue was red with a white coating, and her pulse was wiry.
Diagnosis
Stagnation of Liver-Qi.
Principle of treatment
Regulate Liver-Qi, remove Qi stagnation and relieve the pain.
Herbal treatment
XIAO YAO SAN
Free and Relaxed Powder
Chai Hu Radix Bupleuri 10 g
Dang Gui Radix Angelicae Sinensis 10 g
Bai Shao Radix Paeoniae Alba 20 g
Gan Cao Radix Glycyrrhizae 5 g
Bo He Herba Mentirne 3 g
Yu Jin Radix Curcumac IOg
Jiang Huang Rhizomn Curcumac Longae 10 g Huang Qin Rndix Scutellariae IOg
Explanations
• Chai I Iu promotes the circulation of Qi in the Liver and smoothes the Liver.
• Bai Shao and Dang Gui nourish the Blood and strengthen the physiological function of the Liver.
• Bo He and Huang Qin cool the Liver and promote the circulation of Qi in it.
• Yu Jin helps Chai Hu to regulate the Liver-Qi and relieve the pain.
• Jiang Huang regulates the Qi and relieves shoulder pain.
• Gan Cao harmonises the actions of the other herbs in the prescription.
The patient received daily herbal treatment. Her shoulder pain was relieved after 6 weeks of treatment. A year later, she was followed up by letter and she replied that she had experienced no further shoulder pain since the herbal treatment.
STAGNATION OF BLOOD IN THE CHANNELS
Symptoms and signs
Long-standing shoulder pain with a fixed location, stabbing pain, history of traumatic injury to the shoulder joint, and swelling of the joint, worsening of the pain at night, accompanied by a purplish colour to the face, a purplish tongue with a thin coating and a wiry pulse.
Principle of treatment
Promote circulation of Qi and Blood, remove Blood stasis and sedate the pain.
HERBAL TREATMENT
Prescription
SHEN TONG ZHU YU TANG
Meridian Passage
Qin Jiao Radix Genlianae Macrophyilae 10 g
Chuan Xiong Rhizoma Ligustici Chuanxiong 12 g
Tao Ren Semen Pcrsicae IOg
Hong Hua Flos Carthami 6 g
Qiang Huo Rhizoma seu Radix Notopterygii 10 g
Mo Yao Resina Myrrhae 6 g
Xiang Fu Rhizoma Cyperi IOg
Di Long Lumbricus IOg
Dang Gui Radix Angelicae Sinensis 12 g
Jiang Huang Rhizoma Cureumae Longae IOg
Yan Hu Suo Rhizoma Corydalis 15 g
Gan Cao Radix Glycyrrhizae 6 g
Explanations
• Dang Gui, Chuang Xiong, Tao Ren and Hong Hisa promote the circulation of Blood and eliminate Blood stasis.
• Di Long, Mo Yao and Yan Hu Suo eliminate Blood stasis, promote circulation in the collateral and sedate the pain.
• Xiang Fu promotes the circulation of Qi to reinforce the effect of promoting the circulation of Blood.
• Jiang Huang promotes the circulation of Qi and relieves the shoulder pain.
• Qin Jiao and Qiang Huo eliminate Damp and Wind to stop the pain.
• Gan Cao harmonises the herbs in the formula.
Modifications
1. If the pain is severe, add Xu Chang Qing Radix Cynanchi Paniculati 10 g and Wei Ling Xian Radix Clematidis 15 g to promote the circulation of Qi and relieve the pain.
2. If there are palpitations, shortness of breath and lassitude, add Dang Shen Radix Codonopsis Pilosulae 10 g to reinforce the Qi and regulate the respiration.
3. If there is irritability and insomnia, add Suan Zao Ren Semen Ziziphi Spinosae 15 g and Ye Jiao Teng Caulis Polygoni Multiflori 15 g to relieve the pain and calm the Mind.
Patent remedy
Xiao Huo Luo Dan Minor invigorate the Collaterals Special Pill
ACUPUNCTURE TREATMENT
SP-6 Sanyinjiao, SP-10 Xuehai, LI-4 Hegu, LR-3
Taichong and Ah Shi points. Reducing method is used on these points.
Explanations
• LI-4, the Source point of the Large Intestine channel, and LR-3, the Stream and Source point of the Liver channel, promote the circulation of Qi and Blood and relieve the pain.
• SP-6, the crossing points of the three Yin channels of the foot, and SP-10 promote the circulation of Blood and remove Blood stasis.
• The Ah Shi points regulate the circulation of Qi and Blood, harmonise the collateral and remove Blood stasis so as to relieve the pain.
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 and TE-14 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-9 and SI-10 to harmonise the collateral and sedate the pain.
5. If there is pain at the scapular region, add SI-Il and SI-12 to harmonise the collateral and sedate the pain.
6. If there is stiffness in the shoulder joint, add GB-34 to promote the circulation of Qi, harmonise the collateral and improve joint movement.
7. If there is neck pain, add GB-21 and SI-14 to promote the circulation of Qi and Blood and relieve the neck pain.
8. If there is numbness and heaviness in the shoulder, add ST-40 and SP-9 to promote the circulation of Qi, harmonise the collateral and eliminate Damp.
9. If there is chest pain, add PC-6 and HT-5, the Connecting points, to regulate the circulation of Qi and Blood in the chest and relieve the chest pain.
ACCUMULATION OF DAMP-PHLEGM IN THE CHANNELS
Symptoms and signs
Long-standing shoulder pain, with a heavy sensation, limitation of shoulder movement, and soreness or numbness of the muscle, accompanied by dizziness, lassitude, nausea, painful and swollen joints, a poor appetite, a feeling of fullness on the stomach, a white and sticky tongue coating and a deep and slippery pulse.
Principle of treatment
Promote Qi circulation, dispel Damp-Phlegm and relieve the pain.
HERBAL TREATMENT
Prescription
BAN XIA BAI ZHU TIAN MA TANG
Pineliia-Atractylodes-Gastrodia Decoction
Ήβη Ma Rhizoma Gastrodiae 10 g
Bai Zhu Rhizoma Atractylodis Macrocephalae IOg
Ban Xia Rhizoma Pinelliae 10 g
Chen Pi Pericarpium Citri Reticulatae 10 g
Fu Ling Poria 20 g
Gan Cao Radix Glycyrrhizae 5 g
Bai Jie Zi Semen Sinapis Albae 10 g
Qing Pi Pericarpium Citri Reticulatae Viride 10 g
Sang Zhi Ramulus Mori 15 g
Qiang Huo Rhizoma seu Radix Notopterygii IOg
Explanations
• Ήβη Ma smoothes the Liver and eliminates Wind-Phlegm.
• Ban Xia, Bai Zhu and Fu Ling strengthen the Spleen and Stomach, dry Damp and resolve Phlegm.
• Chen Pi and Qing Pi promote the circulation of Qi and resolve Phlegm·
• Bai Jie Zi eliminates Phlegm in the channels and resolves blockage in them.
• Sang Zhi and Qiang Huo regulate the circulation of Qi in the channels, resolve Damp-Phlegm and relieve the shoulder pain.
• Gan Cao harmonises the actions of the other herbs in the prescription.
Modifications
1. If the shoulder is swollen, add Tong Cao Medulla Tetrapanacis 10 g and Gui Zhi Ramulus Cinnamomi 6 g to warm the channels and eliminate Phlegm.
2. If the arm is numb or sore, add Chang Pu Rhizoma Acori Graminci 10 g and Yuan Zhi Radix Polygalae 10 g to eliminate Wind-Phlegm and regulate the circulation of Qi in the channels.
3. If there is fullness of the Stomach, add Guang Mu Xiang Radix Saussureae Lappae 10 g and Dan Nan Xing Rhizoma Arisaematis Praeparatum Cum Felle Bovis 10 g to resolve Phlegm and calm down the Stomach-Qi.
4. If there is pain at night, add Dang Gui Radix Angelicae Sinensis 10 g, Tao Ren Semen Persicae 10 g and Shui Zhi Hirudo 6 g to remove Blood stagnation.
Patent remedy
Ren Shen Zai Zao Wan Ginseng Restorative Pills
ACUPUNCTURE TREATMENT
LI-4 Hegu, LI-15 Jianyu, TE-6 Zhigou, TE-14 Jianliao,
SP-6 Sanyinjiao, SP-9 Yinlingquan, ST-40 Fenglong and
Ah Shi points. Reducing method is used on these points.
Explanations
• LI-4, the Source point, and LI-15, the local point on the Large Intestine channel, regulate the Qi, eliminate Phlegm and relieve the pain.
• TE-5, the Connecting point of the Triple Burner channel, and TE-14, the local point on the same channel, promote the circulation of Qi, harmonise the collateral and sedate the shoulder pain.
• SP-6, the crossing point of the Spleen, Kidney and Liver channels, SP9, the Sea point, and ST-40, the Connecting point, regulate Qi circulation and eliminate Phlegm in the channels.
• The Ah Shi points promote Qi circulation and relieve the pain.
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 and TE-14 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 Sl-4, Sl-6, SI-9 and SI-IO to harmonise the collateral and sedate the pain.
5. If there is pain in the scapular region, add SI- II and SI-12 to harmonise the collateral and sedate the pain.
6. If the shoulder joint is stiff, add GB-34 to promote the circulation of Qi, harmonise the collateral and improve joint movement.
7. If there is neck pain, add GB-21 and SI-14 to promote the circulation of Qi and Blood and relieve the neck pain.
8. If there is limitation of shoulder movement, add GB-34, the Gathering point for the tendons, to promote the circulation of Qi and increase the range of movement.
9. If the shoulder is swollen, add TE-6 and ST-39 to promote the circulation of Qi, eliminate Phlegm and reduce the swelling.
10. If there is a feeling of dullness or fullness in the stomach, add CV-12, the Front Collecting point of the Stomach and the Gathering point for the Pu organs, and SP-4, the Connecting point, to harmonise the Stomach, help the Stomach-Qi descend and relieve nausea.
11. If the appetite is poor, add SP-3, the Source point, to activate the Spleen and improve the appetite.
