Unilateral pain is pain at one side of the body, including that in the joints, tendons and muscles; it may be accompanied by restlessness, insomnia, sweating, fatigue or even hemiplegia. According to TCM, unilateral pain can be caused by disorder of the internal organs or by disturbance of the channels. Many factors may lead to pain at one side of the body, including invasion of the channels by External Wind, blockage of Wind and Phlegm, stagnation of Liver Qi, deficiency of Qi and stagnation of Blood, and deficiency of Yin of the Liver and Kidney.
Unilateral pain may be attributed to any of the the following disorders in Western medicine: the common cold, influenza, poliomyelitis, polymyalgia, rheumatism, depression, chronic fatigue syndrome, cerebral infarction and cerebral haemorrhage.
Aetiology and pathology
Invasion of the channels by External Wind
External Wind is one of the most common causative factors in unilateral pain. Wind exists as a pathogenic factor that may quickly invade the body in any season. When it invades the body, it induces disharmony between the Defensive and Nutritive Qi systems. The result of this is that the Defensive Qi cannot distribute the Body Fluids evenly, so the Body Fluids are unable to remain completely within the channels. Therefore the Qi and Blood cannot circulate freely to nourish the body and unilateral pain follows. Moreover, an invasion of External Wind may cause stagnation of Qi in the channels, muscles and tendons, which could at a later stage cause stagnation of Blood, resulting in unilateral pain.
Blockage of Wind and Phlegm
Eating too much sweet or greasy food may damage the Spleen and Stomach, easily leading to the formation of internal Damp-Phlegm. Phlegm is a substantial Yin pathogenic factor, which may circulate together with Qi, thus reaching everywhere in the body. Phlegm can also block Qi circulation and cause stagnation of Qi in the channels, tendons and muscles.
Wind is a Yang pathogenic factor that easily attacks the superficial levels of the human body. When Wind attacks in combination with Phlegm, the circulation of Qi and Blood will often be blocked, resulting in stagnation of Qi and Blood, and so unilateral pain occurs.
Stagnation of Liver-Qi
The Liver regulates the Qi circulation and stores the Blood. The emotions are closely related with the function of the Liver, and negative emotions, such as anger, stress and frustration, may cause stagnation of the Liver-Qi, which may in turn cause dysfunction of the circulation of Blood. When the tendons and muscles are not nourished properly, unilateral pain occurs.
Deficiency of Qi and stagnation of Blood
Multiple birth, chronic diseases and physical overexertion consume the Qi and may cause Qi deficiency. Qi is the power that promotes the free flow of Blood in the body, and if it is insufficient, the Blood circulation will slow, and later on eventually stagnate, and so unilateral pain occurs.
Deficiency of Yin of Liver and Kidney
Weak constitution, old age and sexual overactivity may cause consumption of the Kidney-Yin. As the Liver and Kidney share the same source, deficiency of Kidney-Yin may cause deficiency of Liver-Yin. As a result, there is insufficient Yin and Blood in the channels to nourish the tendons and muscles, and so pain occurs. Many chronic cases with unilateral pain are due to deficiency of the Yin of the Liver and Kidney.
Treatment based on differentiation
Before a differentiation is made, it is important to make a general examination of the patient. Special attention should be paid to the following characteristics of the unilateral pain: the quality, the accompanying symptoms and the factors that cause the pain to start, to increase or to decrease.
Differentiation
Differentiation of the quality of the pain
— Acute pain with an aversion to cold is usually due to an invasion of External Wind.
— Stagnation of Liver-Qi usually causes chronic pain with distension and migration.
— Stabbing pain with fixed locations and palpable nodulation or masses is usually due to stagnation of Blood.
— Pain with numbness and a heavy sensation is usually caused by Wind-Phlegm.
— A mild pain with a burning sensation is usually due to deficiency of Yin.
Differentiation of occurrence, aggravation and relief of unilateral pain
— A pain that starts or is aggravated when the patient feels cold or after sweating is usually due to an invasion of External Wind.
— A pain that occurs during the menstruation period is usually caused by stagnation or deficiency of Blood.
— If a pain starts or is aggravated when the patient feels warm or is in a hot environment, deficiency of Yin is usually the cause.
— If the pain starts or gets worse under stressful or other emotional conditions, it is usually due to stagnation of Liver-Qi.
— Stagnation of Qi and Blood. A pain that starts after trauma, operations, strokes or other diseases is usually caused by stagnation of Qi and Blood.
— If the pain occurs or gets worse at night, it is usually due to stagnation of Blood or to deficiency of Yin.
Differentiation of accompanying symptoms
— A pain accompanied by fever, an aversion to cold and pain in the limbs is usually due to an invasion of External Wind.
— Pain with irritability or bad mood is usually due to stagnation of Liver-Qi.
— Pain accompanied by numbness and a heavy feeling is usually caused by Wind-Phlegm.
— When the pain is combined with fatigue, palpitation and pale lips, it is usually due to deficiency of Qi.
— Deficiency of Yin usually causes pain with a hot sensation and dizziness. Pain with a sharp or stabbing sensation is usually due to stagnation of Blood.
Treatment
INVASION OF CHANNELS BY EXTERNAL WIND
Symptoms and signs
Fever, an aversion to cold, sweating or lack of sweating, a unilateral pain in the trunk, headache, a stiff neck, a unilateral joint pain in the extremities, back pain, a lack of thirst, clear urine, a pale tongue with a white coating and a floating and wiry pulse.
Principle of treatment
Dispel External Wind, regulate Defensive and Nutritive Qi and relieve the pain.
HERBAL TREATMENT
Prescription
GUI ZHI TANG
Cinnamon Twig Décoction
Gui Zhi Ramulus Cintiamomi 10 g
Bai Shao Radix Paeoniae Alba 10 g
Zhi Gan Cao Radix Glycyrrhizae Praeparata 6 g
Sheng Jiang Rhizoma Zingiberis 10 g
Da Zao Fructus Ziziphi Jujubae 6 g
Qiang Huo Rhizoma seu Radix Notopterygii 10 g
Explanations
• Gui Zui warms the channels, dispels Wind and strengthens the Defensive Qi. Bai Shao nourishes the Blood, dries the Body Fluids and tonifies the Yin in the Nutritive system. These two herbs in combination harmonise the Defensive and the Nutritive Qi.
• Qiang Huo helps Gui Zhi to promote sweating and dispel Wind-Cold.
• Sheng Jiang aids Gui Zhi to dispel the External Wind and strengthen the function of the Stomach.
• Da Zao aids Gui Zhi to nourish the Yin and Blood. It may also strengthen the Spleen and promote the Spleen-Qi.
• Zhi Gan Cao harmonises the functions of the other herbs used in the prescription.
Modifications
1. If there is headache, add Chuan Xiong Radix Ligustici Chuanxiong 6 g to eliminate the Wind in the head.
2. If there is a stiff neck, add Ge Gen Radix Puerariae 15 g to nourish the tendons and regulate the circulation of Qi.
3. If there is a severe pain with a cold sensation, add Gan Jiang Rhizoma Zingiberis Offlcinalis IOg and Yan Hu Suo Rhizoma Corydalis 10 g to warm the channels and relieve the pain.
4. If there is joint pain, add Du Huo Radix Angelicae Pubescentis 10 g and Chuan Shan Long Rhizoma Dioscoreae Nipponicae 20 g to eliminate the External Wind and relieve the pain.
Patent remedy
Jing Fang Bai Du Pian Schizonepeta and Ledehmriella
Tablet to Overcome Pathogenic Influences
ACUPUNCTURE TREATMENT
LI-4 Hegu, TE-5 Waiguan, GB-34 Yanglingquan, ST-36
Zusanli, BL-58 Feiyang, BL-60 Kunlun and BL-63
Jinmen. Reducing method is used on these points.
Explanations
• LI-4, the Source point of the Large Intestine channel, regulates the Qi and promotes sweating. TE-5, the Connecting point of the Triple Burner channel, regulates the Qi circulation and relieves the pain. These two points in combination relieve pain in the arm.
• GB-34, the Sea point of the Gall Bladder channel, relieves pain along the channel. It is also the Gathering point of the tendons, regulating the circulation of Qi in the tendons.
• ST-36, the Sea point of the Stomach channel, regulates the circulation of Qi and relieves the pain. BL-60, the River point, regulates the circulation of Qi in the Bladder channel, dispels the external Wind and relieves the pain.
• BL-58, the Connecting point of the Bladder channel, and BL-63, the Accumulation point, promote the circulation of Qi in the channel and relieve the pain.
Modifications
1. If there is fever, add GV-14 and LI-Il to promote sweating and lower the fever.
2. If there is a stiff neck, add GB-20 and BL-10 to promote the circulation of Qi and relieve the pain.
3. If the joints are painful and swollen, add GB-34 and SP-9 to eliminate the Damp and relieve the swelling.
4. If there is headache, add GV-20 and LU-7 to promote the Qi circulation and relieve the headache.
5. If there is back pain, add GB-21 and BL-23 to regulate the Qi circulation and relieve the pain.
BLOCKAGE OF WIND AND PHLEGM
Symptoms and signs
Unilateral pain with a heavy sensation, awkward or even paralysed limbs on the same side of the body, soreness or numbness of the muscles, dizziness with a heavy feeling, nausea, painful and swollen joints, a poor appetite, fullness of the stomach, loose and sticky faeces, a tongue with a white and greasy coating and a wiry and slippery pulse.
Principle of treatment
Dispel Wind, eliminate Phlegm and relieve the pain.
HERBAL TREATMENT
Prescription
BAN XIA BAIZHU TIAN MA TANG
Pinellia-Atractylodes-Gastrodia Decoction
Tian Ma Rhizoma Gastrodiae 10 g
Bai Zhu Rhizoma Atractylodis Macrocephalae 10 g
Ban Xia Rhizoma Pinelliae 10 g
Qiang Huo Rhizoma seu Radix Notopterygii IOg
Chen Pi Periearpium Citri Reticulatae 10 g
Fu Ling Poria 20 g
Gan Cao Radix Glycyrrhizae 5 g
Sheng Jiang Rhizoma Zingiberis Recens 6 g
Da Zao Fructus Ziziphi Jujubae 6 g
Explanations
• Tian Ma pacifies the Liver and eliminates the Wind-Phlegm.
• Ban Xia, Bai Zhu and Fu Ling strengthen the Spleen, dry the Damp and resolve the Phlegm.
• Qiang Huo eliminates the Damp-Phlegm in the muscles and resolves soreness and numbness of the muscles.
• Chen Pi regulates the Qi and resolves the Phlegm.
• Sheng Jiang, Gan Cao and Da Zao reinforce the Spleen and Stomach.
Modifications
1. If there is dizziness, add Man Jing Zi Fructus Viticis IOg and Chuan Xiong Rhizoma Ligustici Chuanxiong 10 g to pacify the Liver-Wind and relieve the dizziness.
2. If there is swelling of the limbs, add Tong Cao Medulla Tetrapanaeis 10 g and Gui Zhi Ramulus Cinnamomi 6 g to warm the channels and eliminate the Phlegm.
3. If there is soreness and numbness of the limbs, add Chang Pu Rhizoma Acori Graminei 10 g and Yuan Zhi Radix Polygalae 10 g to eliminate the Wind-Phlegm and regulate the circulation of Qi in the channels.
4. If there is nausea or even vomiting, add Guang Mu Xiang Radix Saussureae Lappae 10 g and Dan Nan Xing Arisaema cum Bile 10 g to resolve the Phlegm and cause the Stomach-Qi to descend.
5. If there is paralysis of the limbs, add Dang Gui Radix Angelieae Sinensis 10 g, Tao Ren Semen Persicae 10 g and Shui Zhi Hirudo 6 g to remove the Blood stagnation.
Patent remedy
Tian Ma Qu Feng Bu Pian Gastrodia Dispel Wind
Formula Tablet
ACUPUNCTURE TREATMENT
Ll-4 Hegu, PC-6 Neiguan, GB-20 Fengchi, SP-6
Sanyinjiao, LR-3 Taichong, ST-36 Zusanli and GB-34
Yanglingquan. Reducing method is used on these points.
Explanations
• LI-4, the Source point of the Large Intestine channel, regulates the Qi and eliminates the Phlegm to relieve the pain.
• PC-6, the Connecting point of the Pericardium channel, promotes the circulation of Qi.
• GB-20, the crossing point of the Gall Bladder and the Yang Linking Vessel, is very effective for dispelling Wind in the Upper Burner.
• SP-6, the crossing point of the Spleen, Kidney and Liver channels, regulates the circulation of Qi and Blood and eliminates the Phlegm.
• LR-3, the Stream and Source point of the Liver channel, promotes the circulation of Qi and eliminates the Phlegm in order to stop the pain.
• ST-36, the Lower Sea point of the Stomach channel, tonifies the Stomach-Qi and eliminates the Phlegm.
• GB-34, the Gathering point of the tendons, regulates the circulation of Qi and relieves the pain.
Modifications
1. If there is dizziness, add GV-20 and ST-8 to promote the circulation of Qi and eliminate the Wind.
2. If there is swelling of the limbs, add TE-6, SP-9 and ST-39 to promote the Qi circulation, to eliminate the Damp and relieve the swelling.
3. If there is a feeling of dullness or fullness of the Stomach, add CV-12, the Front Collecting point of the Stomach channel, and SP-4, the Connecting point of the Spleen channel, to promote the circulation of Qi and to improve the appetite.
4. If there is soreness and numbness of the limbs, add SP-I and SP-21 to promote the circulation of Qi and to eliminate the Wind-Phlegm.
5. If there is a poor appetite, add SP-3 and BL-20 to activate the Spleen and to improve the appetite.
6. If there is nausea or vomiting, add BL-21 and ST-40 to regulate the Qi circulation in the Stomach channel and stop vomiting.
