By Andrew Gaeddert
This is the final part of an article on the traditional Chinese herbal approach to treating pain of various types.
REPETITIVE USE PAIN
Pain such as carpal tunnel syndrome, tennis elbow, golfer’s knee should be treated according to whether the condition is acute or chronic. For an acute attack, Resinall K liquid extract (one half dropperful, TID) or Resinall E (3-5 capsules, TID) should be administered as soon as possible. The two formulas each contain herbs such as Dragon’s Blood (xue jie) and Corydalis (yan hu suo) which are used traditionally to invigorate the Blood. Resinall K has the advantage of being used topically as well as internally for quick absorption while Resinall E has proteolytic enzymes that are useful in reducing inflammatory swelling and pain. For acute symptoms that affect the upper body, the formula SPZM (3 capsules, TID) can be administered, and for the lower body AC-Q (2-3 capsules, TID) is particularly effective. As in standard injury treatment, when Heat signs are also present, Coptis Purge Fire (3 capsules, TID) can be used to relieve the Heat and swelling, or Clear Heat (3 capsules TID) for Blood level pain.
Chronic pain that worsens during cold, damp weather can be treated with Mobility 3 (3 capsules, TID). For chronic inflammatory pain, Mobility 2 (3 capsules, TID) along with Clear Heat is the best treatment approach.
LUMBAGO AND SCIATICA
In Chinese medicine, chronic low back pain that does not have a mechanical cause is often due to Kidney deficiency. The formula Backbone (3 capsules, TID) can be used for patterns of lumbago that present symptoms of Kidney Yang deficiency, while Nine Flavor Tea (3 capsules, TID) treats patterns of Kidney Yin deficiency.
For low back pain that does have a mechanical source, i.e., a prolapsed disk (also known as a herniated or slipped disk), surgery may be avoided by administering papain, an enzyme that has been found through research to shrink the protruding disk. Although much of the research has been done on injectable papain, it may be useful to try Resinall E as this formula contains papain as well as synergistics such as bromelain, trypsin, and chemotrypsin. This combination has been used for decades by naturopathic doctors to treat similar conditions.
In Chinese medicine, nerve pain is addressed with Blood-moving formulas such as Mobility 2. Again, when (accumulated) Heat signs due to blockage of the channels are present, the formula Clear Heat can be used with Mobility 2.
BURSITIS
Bursitis is inflammation of the bursa, the small, fluid filled sac that acts as a cushion at a pressure point in the body, often near joints. Bursitis is usually the result of pressure, friction, or slight injury to the membrane surrounding the joint. As bursitis involves pain and swelling, Resinall E can be quite effective for this condition. Standard dosage is up to five capsules three to six times daily; the dosage can be reduced as the swelling dissipates.
Herbs and nutrients that repair and regenerate collagen such as the formulas Osteoherbal (3 capsules, TID), as well as Flavonex which contains herbal bioflavonoids that increase circulation, can also promote healing.
MUSCLE CRAMPS
Cramps are painful spasms in a muscle. They often occur during or immediately after exercise because of a buildup of lactic acid and other chemicals in the muscles. Cramps can also take place during any repetitive movement such as writing, or because of sitting or lying in an awkward position. Cramps at night may be due to poor circulation of blood into the legs. Nerve compression in the spine can also cause leg cramps, thus it is important to obtain a medical examination and diagnosis when the cramps are occurring frequently. In many cases, massage, topical formulas, a hot bath and/or pad can help reduce the incidence of cramps. Cramps caused by poor blood circulation can be treated with the formula Flavonex (3 capsules, TID). For athletes, SPZM can be used to reduce acute spasms.
GENERAL PAIN FORMULA: CHANNEL FLOW
Misha Cohen, OMD, LAc, and I developed a broad-spectrum pain formula based on the herb Corydalis (yan hu suo). This formula – Channel Flow – is used as an adjunct with other pain relieving formulas to treat chronic and acute pain. Chinese research has found that Corydalis has both analgesic and relaxant effects. The formula contains additional pain relieving herbs such as Angelica (bai zhi), Peony (bai shao), Cinnamon twig (gui zhi), Tang-kuei (dang gui), Salvia (dan shen), Myrrh (mo yao), Frankincense (ru xiang), and Licorice (gan cao). Corydalis is processed via water and alcohol, and decocted into a concentrated extract. Dosage of Channel Flow is two to three capsules several times per day. Interestingly, clinical results were better when a lower rather than higher proportion of Corydalis was used in this formula, which correlates with the traditional method of maintaining balance and harmony when constructing an herbal formula. Channel Flow has been found to be helpful in cases of trauma, fibromyalgia, tendonitis, and gynecological pain that were untreatable with other pain relieving formulas including decoctions.
CONCLUSION
Many of the products mentioned in this article possess Wind-dispelling and Blood-moving properties. Thus, for best results, these formulas should be used in conjunction with tonic formulas, particularly when the condition is chronic, or when the patient is deficient and/or over 40 years of age. In using tonifying herbs/formulas, one must select those that are appropriate for the patient’s constitution. For example, while Marrow Plus (3 capsules TID) is a good overall tonic containing both Blood-moving and Blood-circulating herbs, additional effects can be achieved by administering this formula with Backbone (3 capsules TID) if Kidney Yang deficiency is present, or with Astra Essence (3 capsules TID) if Yin, Yang, and Qi deficiency are present. Finally, in order to treat pain effectively, it is necessary to differentiate the presenting symptoms according to the traditional pattern in order to choose the most suitable formula.
CASE HISTORIES
NEUROPATHY
Morgan is a male in his 70s who suffers neuropathy of unknown origin. His primary complaint was numbness and ice-cold pain in the feet and lower legs. Other symptoms included low backache, fatigue, and occasional dizziness. His pulse was sinking, and tongue purple.
I recommended a combination of Mobility 3 (3 capsules, TID) and Marrow Plus (3 capsules, TID). I also advised him to apply Red Tiger Balm twice daily on his legs and feet, followed by covering with a hot cloth. Within two weeks Morgan noticed substantial relief in pain and increased sensation in his legs and feet. To further promote circulation, he began a daily walking program. In time, I will evaluate whether he should take tonic formulas such as Backbone or Virility Caps, although he could remain on Mobility 3 for a longer period.
Discussion: In this case, the formula Mobility 3 was administered because it treats pain due to Cold. Within the formula, herbs such as Cinnamon twig (gui zhi), du-huo, among others, disperse Cold. The other constituents eliminate pain, invigorate the Blood, and tonify the body. Marrow Plus was administered in order to tonify and invigorate the Blood. Red Tiger Balm is known for its penetrating and warming effects.
TENNIS ELBOW
Joel is a 55-year-old weekend tennis player. His joints, particularly the elbow of the arm that he plays with, feel stiff all week, although he does not experience pain while playing. He also remarked that his joints feel stiffer in cold and damp weather.
This past year he was in an auto accident which gave rise to Blood stasis. I recommended that Joel apply Resinall K topically to his joints after playing tennis, as well as taking the formula internally (half a dropperful three times daily). In addition, he was given Mobility 3 (4 capsules, three times daily, with ginger tea), and advised to apply hot compresses with Po Sum On oil as needed. Within two weeks, Joel reported significantly less pain and stiffness.
HERPES ZOSTER PAIN
A 40-year-old female complained of outbreak of shingles every month about 1-3 days before menstruation. She also suffered severe PMS, frequent abdominal pain, and alternating diarrhea and constipation. Her pulse was thin and wiry, and her tongue was red. I concluded that she had a pattern of Blood deficiency causing false Heat; excess Heat and Qi and Blood deficiency were also present.
I recommended that she take Astra Isatis (2 capsules, TID) and Woman’ s Balance (2 capsules, TID). For the acute shingles flare-ups, she took Resinall K orally (one half dropperful, TID) and applied it topically (twice daily) to the well-cleaned affected site. In addition, she took Clear Heat (4 capsules TID) during the flare-ups. After several months of the above regimen, the PMS abated, and although the shingles still appeared, the Clear Heat and Resinall K helped alleviate the pain. At this time, I switched her to a more tonifying regimen of Woman’s Balance (same dosage as above) premenstrually, and Eight Treasures (3 capsules TID) postmenstrually; Astra Isatis (same dosage as above) was taken during the entire month. Six months later, she reported a reduction in the shingles outbreaks. As the PMS had completely disappeared, she was taken off Woman’s Balance, and instead, took Eight Treasures and Astra Isatis (each at the respective dosage as above) all month. In a one-year follow-up, she indicated that the shingles occurred only rarely, and if so, it was following her period. She also reported marked improvement in overall health.
DISCUSSION
Pain due to herpes zoster, or shingles, can be severe and persist for months. Often the outbreaks arise from emotional stress or a compromised immune system. Such is the situation with this patient.
As noted in the history above, the herpes outbreak had occurred prior to her period before she began traditional treatment. A year later, the occasional flare-ups happened following her periods. My analysis is that initially the outbreaks occurred during a time of excess Heat caused by Blood and Qi stagnation, which were prominent prior to menstruation. Once the stagnation and thus excess Heat were resolved through treatment, the flare-ups were the result of deficiency Heat and occurred after menstruation.