Elbow pain may occur in one or both elbows, but is mostly on one side. According to TCM theory, it can be caused either by invasion of External factors or by stagnation of Blood. Elbow pain may be attributed to any of the following disorders in Western medicine: tennis elbow, subluxation of the capitulum radii, rheumatism, rheumatoid arthritis, muscle strain or traumatic injury to the middle of the arm, and deformation or injury to the elbow joint.
Aetiology and pathology
Invasion of External factors
Overexposure to Wind, Cold, Heat or Damp may allow these pathogenic factors to invade the elbow.
Wind has an uprising nature. It usually attacks the body in combination with other pathogenic factors, for instance, Wind-Cold, Wind-Damp or Wind-Cold-Damp. Cold has the characteristics of contraction and stagnation. If Wind-Cold invades, it causes contraction of muscles and tendons around the elbow, leading to stagnation of the Qi and Blood in the channels, which causes elbow pain.
Damp has the characteristics of stagnation and viscosity. When it attacks the body, it tends to obstruct the free flow of Qi and Blood, again leading to stagnation of Qi and Blood, and elbow pain.
Heat has the characteristics of uprising and burning, and a tendency to move upwards. Furthermore, it may consume the Blood and Yin, causing concentration of the Blood and Body Fluids, which again leads to stagnation of Qi and Blood. If Wind-Heat invades the elbow, it manifests as elbow pain with swelling and redness, an aversion to heat, and a preference for cold.
Stagnation of Blood
The Blood should circulate freely in the channels. Overwork, playing too much sport, or overuse of the elbow may impair the tendons and collateral, leading to stagnation of the Blood, and causing elbow pain. Physical trauma, a wound, adhesions after an operation and inappropriate operation may all directly damage the channels and muscles, which leads to stagnation of Blood and causes elbow pain.
Treatment based on differentiation
Differentiation
Differentiation of External invasion or Blood stagnation should be made in order to set up an accurate diagnosis.
— Acute onset of elbow pain with a short duration, accompanied by External symptoms, is usually caused by invasion of External pathogenic factors.
— Acute onset of elbow pain with an obvious history of trauma or operation is usually caused by stagnation of Blood.
— Chronic onset of elbow pain without a history of trauma, but of long duration, and accompanied by symptoms such as stabbing pain, aggravation of the pain at night, or inability to lie on the affected side, is also usually caused by stagnation of Blood
Treatment
INVASION OF EXTERNAL FACTORS
Symptoms and signs
Acute elbow pain, with an aversion to cold or wind, and varying with weather changes, accompanied by limitation of movement, a thin and white tongue coating and a superficial and tight pulse.
Principle of treatment
Dispel Wind and eliminate External factors.
HERBAL TREATMENT
Prescription
FANG FENG TANG
Ledebourielia Decoction
Fang Feng Radix Ledebouriellae 10 g
Chuan Xiong Rhizoma Ligustici Chuanxiong IOg
Gan Cao Radix Glycyrrhizae 6 g
Fu Ling Poria 15 g
Ma Huang Herba Ephedrae 6 g
Dang Gui Radix Angelicae Sinensis IOg
Sang Zhi Ramulus Mori 12 g
Qin Jiao Radix Genlianae Macrophyllae IOg
Explanations
• Fang Feng, Sang Zhi and Qin Jiao dispel Wind and relieve the pain.
• Ma Huang eliminates Cold, regulates Qi, harmonises the collateral and relieves the pain.
• Dang Gui and Chuan Xiong promote the circulation of Qi and Blood, eliminate Blood stasis and relieve the pain.
• Fu Ling eliminates Damp-Phlegm.
• Can Cao harmonises the function of the other herbs in the prescription.
Modifications
1. If there is severe pain at night, add Xi Xin Herba Asari 3 g and Yan Hu Suo Rhizoma Corydalis 15 g to promote the circulation of Blood and relieve the pain.
2. If the elbow has an aversion to cold, add Gan Jiang Rhizoma Zingiberis 5 g and Gui Zhi Ramulus Cinnamomi 10 g to warm the channels and dispel Cold.
3. If there is a fever, add Chai Hu Radix Bupleuri 15 g to dispel Wind and reduce the fever.
4. If there is a feeling of heaviness in the elbow, add Qiang Huo Rhizoma seu Radix Notopterygii 10 g to eliminate Damp, promote the circulation of Qi and relieve the pain.
5. If the elbow is red and swollen, add Ren Dong Teng Caulis Lonicerae 15 g and Xi Xian Cao Herba Siegesbcckiae 10 g to dispel Wind and clear Heat.
6. If there is a fever and a burning sensation at the elbow, add Sheng Di Huang Radix Rehmanniae Recens 10 g and Chi Shao Radix Paeoniae Rubra 10 g to clear Heat, reduce the fever and remove Toxin.
7. If there is neck pain, add Ge Gen Radix Puerariae 10 g to harmonise the collateral and relieve the pain in the neck.
8. If there is a headache, add Chuan Xiong Rhizoma Ligustici Chuanxiong IOg and Man Jing Zi Fructus Viticis 10 g to dispel Wind and sedate the headache.
Patent remedies
Feng Shi Pian Wind-Damp Tablet for invasion of Wind- Cold and Damp
Feng Shi Xiao Tong Pian Wind-Damp Dispel Pain Pill for invasion of Wind, Damp and Heat.
ACUPUNCTURE TREATMENT
LI-4 Hegu, LI-10 Shousanli, TE-5 Waiguan, GB-20
Fengchi and Ah Shi points. Reducing method is used on these points.
Explanations
• LI-4, the Source point of the Large Intestine channel, dispels Wind, relieves External symptoms, promotes the circulation of Qi and relieves the pain.
• LI- IO promotes the circulation of Qi in the channel, dispels Wind and relieves the pain.
• TE-5, the Connecting point of the Triple Burner channel, dispels Wind, harmonises the collateral and relieves the pain.
• GB-20 dispels Wind, relieves external symptoms and sedates the pain.
• The Ah Shi points dispel Wind-Cold, promote the circulation of Qi in the locality and relieve the pain.
Modifications
1. If there is pain along the Large Intestine channel, add LI-3, the Stream point, LI-6, the Connecting point, and LI-7, the Accumulation point, to harmonise the Large Intestine collateral, promote circulation in the channel and relieve the pain.
2. If there is pain along the Triple Burner channel, add TE-3, the Stream point, TE-7, the Accumulation point, and TE-10, the Sea point, to harmonise the collateral, promote circulation in the Triple Burner channel and relieve the pain.
3. If there is pain along the Small Intestine channel, add SI-3, the Stream point, and SI-6, the Accumulation point, to harmonise the collateral, promote circulation in the Small Intestine channel and relieve the pain.
4. If there is pain along the Lung channel, add LU-9, the Stream point and Source point from the Lung channel, LU-7, the Connecting point, LU-6, the Accumulation point, and LU-5, the Sea point, to harmonise the collateral, promote circulation in the Lung channel and relieve the pain.
5. If there is pain along the Heart channel, add HT-7, the Stream point, HT-5, the Connecting point, HT-6, the Accumulation point, and HT-3, the Sea point, to harmonise the collateral, promote circulation in the Heart channel and relieve the pain.
6. If the elbow has an aversion to cold, add moxibustion and BI-12 to warm the channels and dispel Cold.
7. If there is a stabbing pain, or an aggravation of pain at night, add SP-6 to promote the circulation of Blood and relieve the pain.
8. If there is a feeling of heaviness in the elbow, add SP-9, the Sea point, and ST-40, the Connecting point, to eliminate Damp, promote the circulation of Qi and relieve the pain.
9. If the elbow is red and swollen, add LI-2 and TE-2, the Spring points, to dispel Wind, clear Heat and reduce the swelling.
10. If there is a constant pain in the elbow, add LI l and TE-1, the Well points, to open the collateral and remove obstruction in the channels.
11. If the arm is painful, add LI-15 and TE-14 to promote the circulation of Qi and Blood and relieve the pain.
12. If there is neck pain, add GB-21 and BL-Il to harmonise the collateral, strengthen the bones and relieve the pain.
13. If there is a headache, add Extra Yintang to dispel Wind and sedate the headache.
14. If there is a fever and aversion to cold, add BL-13 to dispel Wind-Cold and relieve External symptoms.
15. If there is generalised body pain, add BL-58, the Connecting point, and BL-63, the Accumulation point, to dispel External factors and relieve the pain.
STAGNATION OF BLOOD
Symptoms and signs
Traumatic history or history of elbow strain, elbow pain of long duration, stabbing pain in the elbow, which is aggravated at night or by immobility, accompanied by a limitation of elbow movement, a dislike of pressure and massage, a purplish tongue and a wiry pulse.
Principle of treatment
Promote the circulation of Blood, eliminate Blood stasis and relieve the pain.
HERBAL TREATMENT
Prescription
SHEN TONG ZHU YU TANG
Meridian Passage
Qin Jiao Radix Gentianac Macrophyliae 10 g
Chuan Xiong Rhizoma Ligustici Clmanxiong 10 g
Tao Ren Semen Persicae 10 g
Hong Hua Flos Carthami 6 g
Qiang Huo Rhizoma seu Radix Notopterygii IOg
Xiang Fu Rhizoma Cyperi 10 g
Wu Ling Zhi Facces Trogopterorum 6 g
Jiang Huang Rhizoma Curcumae Longae 10 g
Di Long Lumbricus 10 g
Dang Gui Radix Angelieae Sinensis 12 g
Gan Cao Radix Glycyrrhizae 6 g
Explanations
• Dang Gui, Chuan Xiong, Tao Ren and Hong Hua promote the circulation of Blood and eliminate Blood stasis.
• Wu Ling Zhi eliminates Blood stasis and sedates the pain.
• Since the circulation of Qi leads to the circulation of Blood, Xiang Fu is used to promote the circulation of Qi so as to reinforce the effect of promoting Blood circulation.
• Jiang Huang promotes the circulation of Qi and Blood in the channels and relieves the elbow pain.
• Di Long promotes circulation in the collateral and removes obstruction in the channels.
• Qiang Huo and Qin Jiao harmonise the collateral and relieve the elbow pain.
• Gan Cao harmonises the function of the other herbs in the prescription.
Modifications
1. If there is severe pain at night, add Yan Hu Suo Rhizoma Coiydalis 12 g and Mo Yao Resina Myrrhae 5 g to remove Blood stasis and relieve the pain.
2. If there is numbness in the elbow, add Mu Xiang Radix Aucklandiae 12 g and Gui Zhi Ramulus Cinnamomi 6 g to promote the circulation of Qi and Blood.
3. If there is an aversion to cold, add Gan Jiang Rhizoma Zingiberis 10 g and Rou Gui Cortex Cinnamomi 3 g to warm the channels and dispel Cold.
Patent remedy
Xiao Huo Luo Dan Minor Invigorate the Collaterals
Special Pill
ACUPUNCTURE TREATMENT
LI-3 Sanjian, LI-4 Hegu, LI-6 Pianli, LI-IO Shousanli,
TE-5 Waiguan, TE-IO Tianjing, LR-3 Taichong and SP-6
Sanyinjiao. Reducing method is used on these points.
Explanations
• LI-3, the Stream point, and LI-6, the Connecting point, harmonise the collateral, promote circulation in the channels and relieve the pain.
• LI-4, the Source point of the Large Intestine channel, promotes circulation in the channel and relieves the pain.
• TE-5, the Connecting point, harmonises the collateral and sedates the pain.
• LI-IO and TE-10, two local points, promote the circulation of Qi and Blood in the locality and sedate the pain.
• LR-3, the Source point and the Stream point from the Liver channel, promotes the circulation of Qi and relieves the pain.
• SP-6, the crossing point of three Yin channels, promotes the circulation of Blood and eliminates Blood stasis so as to sedate the pain.
Modifications
1. If there is pain along the Large Intestine channel, add LI-7, the Accumulation point, and LI-8 to harmonise the Large Intestine collateral, promote circulation in the channel and relieve the pain.
2. If the pain is along the Triple Burner channel, add TE-3, the Stream point, and TE-7, the Accumulation point, to harmonise the collateral, promote circulation in the channel and relieve the pain.
3. If the pain is along the Small Intestine channel, add SI-3, the Stream point, and SI-6, the Accumulation point, to harmonise the collateral, promote circulation in the channel and relieve the pain.
4. If the pain is along the Lung channel, add LU-7, the Connecting point, LU-6, the Accumulation point, and LU-5, the Sea point, to harmonise the collateral, promote circulation in the channel and relieve the pain.
5. If the pain is along the Heart channel, add HT-7, the Stream point, HT-5, the Connecting point, HT-6, the Accumulation point and HT-3, the Sea point, to harmonise the collateral, promote circulation in the channel and relieve the pain.
6. If there is limitation of movement in the elbow joint, add one or two points on the knee from the corresponding channel, to regulate the circulation of Qi and improve the joint function.
7. If there is severe pain at night, add BL-17, the Gathering point for the Blood, and HT-7 to promote the circulation of the Blood, calm the Mind and sedate the pain.
8. If the elbow is red and swollen, add LI-2 to clear Heat and reduce the swelling.
9. If there is a stabbing pain in the bones, add LI-I to promote the circulation of Blood and eliminate Blood stasis in the joint.
Case history
A 27-year-old man had been suffering from right elbow pain at a fixed location for a month. It had started after physical trauma to the elbow. He did not go for treatment immediately. Later on it was diagnosed as tennis elbow. The main manifestations were intermittent stabbing pain in the elbow, with fixed location near to LI-II, which worsened at night, with an inability to lie down on the same side, a slightly purplish tongue with a thin coating and a deep and wiry pulse.
Diagnosis
Elbow pain due to stagnation of Blood.
Principle of treatment
Circulate the Blood, smooth the collateral and sedate the pain.
Herbal treatment
TAO HONG SI WU TANG
Four-Substance Decoction with Safflmver and Peach Pit
Dang Gui Radix Angelicae Sinensis 10 g
Sheng Di Huang Radix Rehmanniae Reccns 12 g
Chi Shao Radix Pneoniae Rubra 10 g
Chuan Xiong Rhizoma Ligustici Chuanxiong 6 g
Jiang Huang Rhizoma Curcunwe 10 g
Gui Zhi Ramulus Cinnamomi 10 g
Tao Ren Semen Persicae IOg
Hong Hua Flos Cnrthami 10 g
Explanations
• Chuan Xiong and Hong Hua promote the circulation of Blood and remove Blood stagnation.
• Dang Gui and Tao Ren regulate the circulation of Blood, remove Blood stagnation and relieve the pain.
• Jiang Huang and Gui Zhi are specific herbs for elbow pain caused by Blood stagnation, and harmonise the collateral and promote circulation in the channels.
• Sheng Di Huang and Chi Shao regulate the circulation of Blood, prevent the formation of Heat in the Blood and relieve the pain.
Acupuncture treatment
LI-4, LI-6, LI-7, LI-11, LR-3 and SP-6. Since the pain was mainly located along the Large Intestine channel, several points from this channel were prescribed. Reducing method was used on these points.
Explanations
• LI-4, the Source point of the Large Intestine channel, and LI-11, the Sea point, promote circulation in the channel and relieve the pain.
• LI-6, the Connecting point, and LI-7, the Accumulation point, harmonise the collateral, promote circulation in the channels and relieve the pain.
• LR-3, the Source point and the Stream point of the Liver channel, promotes the circulation of Qi and relieves the pain.
• SP-6, the crossing point of the three Yin channels of the foot, promotes the circulation of Bkiod and eliminates Blood stasis so as to sedate the pain.
The patient was given daily treatment. He was advised to warm the painful elbow himself with moxa three times a day, each time for about 10 minutes. He had some elbow movement every day. After a month of treatment his elbow pain was cured. He was followed up a year later and he stated he had experienced no further pain since the herbal treatment.
