By Andrew Gaeddert
When treating pain, practitioners must be flexible and prepared to evaluate and re-evaluate the treatment and diagnosis. In some cases, experimentation may be required in order to find the appropriate therapeutic regimen.
In Chinese medicine pain is considered to arise from the invasion of any or a combination of the following pathogenic factors: Wind, Cold, Heat, and Dampness. These factors are able to invade in the first place because of an internal weakness. An African proverb that aptly describes this is, “If there is no enemy within, the enemy outside can do us no harm.” After penetrating the body, often through the pores, the accumulated pathogen(s) block(s) the circulation of Qi and Blood in the channels, causing pain. The final stage is when the Organs are invaded. If unresolved, chronic pain, soreness, and swelling, numbness, deformity of the joints, and limited movement are the result.
Depending on the pathogen(s) that invade(s), different syndrome patterns emerge. But the two factors that are common to all these patterns are pain and limited movement. In Chinese, the collective term given to these patterns is bi, meaning blockage of the channels and collaterals. Biomedically, bi syndromes can correspond to diseases such as rheumatoid and osteoarthritis, bursitis, neuralgia, systemic lupus erythematosus, gout, sequelae of traumatic injuries, among others. The various bi patterns and their respective symptoms are as follows.
Hot bi. Heat can be generated by infection or by emotional factors such as stress, repression, or perfectionism which over time can cause Liver Qi stagnation and transformation into Heat. Heat in the body can also be the result of invasion of Wind Damp-Heat. The chief symptoms of Hot bi are fever which may or may not be accompanied by chills, thirst and dry mouth, irritability, and painful, red, and swollen joints that are hot to the touch. The tongue is red with a yellow coating, and the pulse is rapid and slippery, reflecting Dampness.
Cold bi. Cold causes congealing and contraction. When the body is affected by Cold, the circulation of Qi and Blood slow, and if unresolved, this leads to obstruction of the channels and collaterals. Cold bi is characterized by such symptoms as stiffness, or stabbing or shooting pain, that is fixed in one site.
The pain improves with movement and warmth. Other symptoms may include lack of perspiration and copious and clear urine. The tongue may be pale with a thin white coating, and the pulse can be slow, or wiry if the pain is intense.
Damp bi. Pain caused by Dampness is fixed, deep, and dull. Swelling at the site of pain is often present and deformity, particularly of the joints, often results in protracted conditions. Frequently there is a generalized presence of Phlegm. The symptoms can be aggravated by humid, rainy, or foggy weather, or by living in damp buildings. The tongue is often wet and the coating white, sticky, and thick. The pulse is soggy or slippery.
Wind bi. Wind is characterized by movement and change. Thus, pain due to Wind tends to arise suddenly and move from one area of the body to another; the sensation of pain can also change. During the early stage, the signs are often those of an exterior syndrome pattern with aversion to wind, fever, a thin white tongue coating, and a floating and moderate pulse.
TREATMENT
Health Concerns has several formulas that can be used in the treatment of muscle and joint pain. To show how these formulas are applied, various conditions and case histories are presented as follows.
INJURY
Resinall K is based on the classic Qi Li San formula, which is used for bruising and swelling. It is a commonly used pain formula that contains strong Blood moving ingredients. In Chinese medicine, it is said that “all pain must have stasis.” A chief advantage of this formula is that it can be used both internally and externally. If taken internally, the usual dosage is half a dropperful, three or four times daily. If applied externally, it can be massaged into the painful joint; when applied to a larger area, it can be combined with rubbing alcohol or oil and massaged into the muscles. Resinall K is a good formula for practitioners and patients to keep on hand, since it can be used to relieve pain due to simple injuries such as bruises and strains, or even due to more serious causes such as sprains and bone fractures. Chronic pain also responds to this formula because of the residual presence of Blood stasis, and possibly scar tissue due to previous traumatic injury. In fact, one woman who used Resinall K topically for three weeks following breast reconstruction surgery experienced almost complete resolution of scar tissue.
Another formula frequently used in the treatment of pain is AC-Q, which is based on the classic remedy known as Da Huo Luo Dan. This formula has a number of aromatic herbs that move the Blood, as well as herbs that promote the flow of Qi, and finally, it contains tonifying herbs. Thus, it can be used for a wide range of biomedical complaints including acute injury affecting sites below the waist, post-stroke weakness, fibromyalgia, and other joint and muscle pain. For acute, lower body injuries, I often suggest AC-Q combined with Resinall K. For example, many individuals over age 30 suffer chronic pain due to athletic injuries. For them, Resinall K can be taken internally and applied externally just before the sporting activity. AC-Q can be taken on an ongoing basis to reduce pain and inflammation. For injuries affecting the upper body, a combination of Resinall K and SPZM (three capsules, three times daily; or five capsules, twice daily) is recommended.
FIBROMYALGIA
Fibromyalgia is a group of rheumatic disorders characterized by pain, tenderness, and stiffness of muscles, areas of tendon insertions, and adjacent soft-tissue structures. Biomedically, the conditions may be induced or intensified by physical or mental stress, poor sleep, trauma, exposure to dampness or cold, and occasionally by a systemic rheumatic disorder. A viral infection or occasionally toxemia from a remote bacterial infection may precipitate the syndrome in a predisposed host. Primary fibromyalgia is particularly likely to occur in healthy young women who tend to be tense, depressed, anxious, and striving. Men are more inclined to develop localized fibromyalgia in association with a specific occupational or recreational strain. A minority of cases may be associated with significant psychogenic or physiologic manifestations. Thus, this is a difficult condition to address, because the symptoms can be exacerbated by environmental or emotional stress. One such patient was successfully treated with a combination of AC-Q and Adrenosen (two capsules of each formula, four times daily), along with Schisandra Dreams (five capsules, one hour before bedtime). She was also advised to go on a mild exercise program that consisted of walking on a daily basis.
Another fibromyalgia case is a woman in her early forties who suffered severe shoulder and neck pain along with insomnia. A combination of SPZM and Ease Two (three capsules of each, three times daily) was recommended, in addition to Schisandra Dreams which was taken before bedtime. SPZM is based on the classic formula Shao Yao Gan Cao Tang, and contains herbs that promote the circulation of Blood and Qi; it also has calcium and magnesium, dietary elements that are essential for maintaining the normal functioning of nerves and muscles. Thus, this formula addresses spasms and pain that affect, in particular, the upper body. Since this patient also experienced fatigue and loose stools, she was given Ease Two, which is based on the classic formula Chai Hu Gui Zhi Tang, to help strengthen the Spleen as well as to address her shoulder and neck tension. After two months on a regimen of herbal medicine and acupuncture, this patient’s condition improved substantially.
JOINT PROBLEMS
Arthritis is another difficult to treat condition. A good overall herbal protocol that I have developed for osteoarthritis in particular is the combination of Mobility Two, which is based on the classic formula Shu Jing Huo Xue Tang, and AC-Q (two capsules each, four times daily). Dr. Fung, recommended a specific species of sea cucumber (that has since been used in studies on arthritis in Australian patients) to patients who suffered joint conditions. Unfortunately, sea cucumber is difficult to obtain because it is only available at Asian grocers and some Chinese restaurants.
The symptoms of rheumatoid arthritis and systemic lupus erythematosus (SLE) are often baffling because the syndrome pattern can alternate from week to week and even day to day. This phenomenon can be compounded by the environmental and/or climate changes that the patient is in. For instance, in the San Francisco Bay Area, the day often begins cold and damp, and turns warm and dry in the afternoon. One particular SLE patient is a prime example of this: she was not experiencing any relief from the herbal remedies that had been originally recommended. I then suggested that she come for a consultation in the morning rather than in the afternoon. It was like seeing two different patients. In the morning she showed a Cold Damp pattern accompanied by fatigue, whereas in the afternoons she usually came in with signs of Yin deficiency and joint pain. Based on her morning presentations, her protocol was modified, such that in the mornings she now took Six Gentlemen and Mobility Two (three capsules of each) in addition to ginger tea, and in the afternoons and early evenings she continued on Nine Flavor Tea, which is based on the classic formula Liu Wei Di Huang Wan, and Mobility Two (three capsules of each). After one week, she reported that her digestion was improved and that the joint pain and fatigue were diminishing.
Another case that I encountered was a woman who was diagnosed with reflex sympathetic dystrophy (a disturbance of the sympathetic nervous system marked by pallor, rubor, pain, sweating, edema, or skin atrophy following sprain, fracture, or injury to nerves or blood vessels). She suffered generalized aching, with joint pain that was alternatingly icy cold and then burning hot. She was given a combination of Resinall K (half a dropper, four times daily) and Gastrodia Relieve Wind (five pills, four times daily). Resinall K was recommended because there was rebellious Qi as evidenced by the alternating Cold and Hot signs, and the severe pain. Gastrodia Relieve Wind was used to dispel Wind as manifested by tremors and dizziness that the patient experienced. After two weeks of this combination of formulas, her pain was significantly reduced. She continued with these two formulas for another two months. Then Resinall K was replaced by Marrow Plus in order to tonify the Blood; Gastrodia Relieve Wind was continued. In Chinese medicine it is said, “If the Blood is rich, then Wind will not invade; if Wind does invade, the Blood will chase it away.”
INFLAMMATION
Pain accompanied by Heat signs, such as seen in flare-ups of rheumatoid arthritis or immediately following injury, can be addressed with a combination of Mobility Two and Heat-clearing formulas such as Coptis Purge Fire and Clear Heat. Mobility Two (three capsules, four times daily) is useful for inflammatory conditions, and Coptis Purge Fire, which is based on the classic formula Long Dan Xie Gan Tang (three capsules, four times or more daily), helps alleviate early inflammation during which the joints are hot to the touch and swollen. Ice applied over the site can be helpful during the initial hours of swelling and inflammation, followed by alternating application of ice and hot packs. Liniments such as Dr. Shir’s Liniment or Zheng Gu Shui can also be used by gently massaging the liquid into the inflamed area for twenty minutes or so.
Soaking or washing the affected area with an herbal remedy is also helpful. For example, capsules of Coptis Purge Fire can be crushed and then decocted (one or two capsules per eight ounces of water) for five minutes followed by suitable cooling before soaking or washing the site. A topical remedy can also be made by combining powdered capsules of Coptis Purge Fire with just enough hot water to form a paste, which is then spread over the affected area. Rubbing alcohol, spirits, or rice wine may be added to enhance penetration into the joints and tissues. The advantage of topical application of herbs is that the active ingredients reach the affected area more quickly and directly. Of course, patients and practitioners should be vigilant of any side effects such as contact dermatitis, rash, or even worsening of symptoms that appear to be caused by the application of the remedy. When such symptoms occur, the remedy should be discontinued immediately.
CONCLUSIONS
In all of the above cases, two or more formulas were used. By combining formulas, swifter results can be achieved because the treatment protocol can be more individualized, focusing on the type and location of pain. It should also be remembered that with chronic conditions, tonification is an important part of the treatment strategy.
The second portion of this article will discuss other types of pain, including neuropathy and headache.
Andrew Gaeddert is the author of Chinese Herbs in the Western Clinic: A Guide to Prepared Herbal Formulas.
For part 2 of this series, click here.