SCAPULOHUMERAL PERIARTHRITIS, SHOULDER PAIN, (PERIARTHRITIS OF THE SHOULDER)

Clinical Manifestations
  • Soft tissue and joint disease around the shoulder joint due to degeneration, or damage and Wind-Cold Invasion
    Commonly seen in people over fifty years old
  • Seen in women more than men
  • Light pain around the shoulder joint
  • Pain gradually increases
  • Worse at night
  • Pain may radiate to the forearm, neck and back
  • Joint movement is limited
  • Acute stage: Lasts about 2-3 months with pain and limited joint movement
  • Adhesion stage: Lasts about 2-3 months with improvement in both pain and movement.
  • Recovery stage: The symptoms gradually disappear.
  • Sharp pain:
    1. Obstruction of the entry of Yang into the trunk:
        Sharp pain aggravated by pressure, Warmth and the lateral     recumbent position
        Ameliorated by Cold
      2. Obstruction of the exit of Yin from the trunk:
          Sharp pain ameliorated by pressure, Cold and aggravated       by Warmth
  • Dull pain:
    1. Obstruction of exit the exit of Yang from the trunk:
          Dull pain ameliorated by pressure and Warmth
          Aggravated by Cold and movement
    2. Obstruction of the entry of Yin into the trunk:
          Dull pain aggravated by pressure, Cold and the lateral       recumbent position
          Ameliorated by Warmth
    3. Obstruction of the exit of trunk Yang into the head:
          Dull pain in the posterior aspect of the shoulder which radiates       toward the upper limb along the Large Intestine Channel
          The pain is ameliorated by pressure and warmth
          Aggravated by Cold
          Maybe sharp, burning or stinging pain underneath the scapula
  • Local Qi Stagnation:
    The pain worsens with rest and improves with movement
    1. Yang Qi Stagnation:
        Sharp pain
        Manifests in the morning when waking or when resting
        The pain rapidly improves with activity
        Aggravated by Cold
        Alleviated by Warmth|
    2. Yin Qi Stagnation:
        Relatively dull pain
        Hard to get started in the morning
        Aggravated by Warmth and pressure
  • Obstruction of the collaterals:
    The shoulder and elbow cannot be be bent or stretched
  • Extraordinary Vessels:
    1. Yang Qiao Channel:
        Pain in the shoulder with contracture and the necessity of     warm-up in the morning
        Pain with stiffness in the lower limbs and back
        Insomnia
        Eye pain
    2. Yang Wei Channel:
        Pain is severe
        Sensitive to weather changes, especially snow and storms
        Fever and chills
        Headaches which progress from the back to the front
        May follow a Stomach Channel or Spleen Channel condition
Treatment Principle
Herb Formulas
Points
  • St-38 through to UB-57
  • Cup DU-14, SI-11, UB-13
  • Ahshi, GB-20, LI-11, LI-15, SI-13, SI-14, UB-11
  • Jianneiling, LI-4, LI-11, LI-15, LI-16, LU-5, LU-9, SI-11, SJ-4, SJ-9, SJ-14
  • Jianneiling, LI-15, SJ-14
  • LI-15. SI-9 through to HT-1, SI-6, through to PC-6
  • GB-20, GB-21, LI-15
  • LI-11, LI-14, Naoshang
  • HT-1, SI-14
  • Severe: SI-6, UB-10
  • Cannot raise the shoulder: LI-11, SJ-15
  • For redness, swelling and pain: SJ-3, SJ-14, UB-11, UB-12
  • For supraspinatus tendinitis: LI-15, LI-16, St-38 through to UB-57
  • For bursitis: LI-4, LI-11, LI-15
  • For tenosynovitis of the biceps brachii: Jianneiling, LU-5, LU-9, SJ-4, SJ-9, SJ-14
  • For pain and swelling: GB-41, SJ-5
  • For Yang Deficiency: SI-11
  • For Yin Deficiency: LU-2
  • For Yang Excess: LI-15
  • For Yin Excess: LI-4, PC-2, SJ-5
  • For severe banding: LI-15
  • Severe upper difficulty: SJ-14
  • Obstruction of Yang into the trunk: LI-15
  • Obstruction of the exit of Yin from the trunk: LU-2
  • Obstruction of Yang from the trunk: SI-11
  • Obstruction of the entry of Yin into the trunk: PC-2
  • Obstruction of the exit of trunk Yang into the head: SI-14 or SJ-15 or ST-3, depending on the location of the pain
  • Yang Qi Stagnation: SJ-14
  • Yin Qi Stagnation: HT-1
  • Obstruction of the collaterals: SI-7
  • Yang Qiao Channel: SI-3, UB-59, UB-62 + one of the following: LI-15, LI-16, SI-10
  • Yang Wei Channel: GB-21, GB-35, GB-41, SI-10, SJ-5, SJ-15
  • Impairment of shoulder and gestural expressions: LI-14, ST-38
  • Bilateral pain moving downward, scarf-like from the neck to the shoulders and spasms of the trapezius: DU-16, UB-12
  • Recurrent or chronic bilateral pain moving downward, scarf-like from the neck to the shoulders and spasms of the trapezius: DU-14
  • Ear: Shoulder, Subcortex, Shenmen, Adrenal
  • Trigger Points:
    1. Trapezius Muscle, Upper Tract: below SJ-15
    2. Trapezius Muscle, Middle Tract:
      a. Referred pain: superficial burning pain between the medial       border of the scapula and the cervicothoracic hinge: area       around UB-42
      b. Referred pain: pain at the acromion and superior aspect of the       shoulder: area around LI-16
      c. Referred pain: Sensations of Cold, piloerection on the lateral      aspect of the arm: area around SI-14
    3. Trapezius Muscle, Lower Tract:
      a. Referred pain: Pain from behind the mastoid process radiating       to the acromion and a place between the scapular spine and       the spine. The pain feels like numbness and makes the patient       want to scratch: below UB-45
      b. Referred pain: Burning pain at the medial border of the       scapula: At the subscapular fossa between SI-11, UB-43 and       UB-44
    4. Semispinalis Capitis and Multifidus Muscles:
      a. Referred pain: Suboccipital pain radiating toward the superior       border of the shoulder and the medial border of the scapula:       area around Xiaxinshi (1.5 cun lateral to the lower end of the       spinous process of the fourth cervical vertebra)
    5. Levator Scapulae Muscle:
      a. Referred pain: Posterolateral cervical pain radiating toward the       posterior aspect of the shoulder along the medial border of the       scapula:  Area around SI-15
    6. Scalene Muscles (Anterior, Middle, Posterior):
      a. Referred pain: Pain on the anterior portion of the pectoralis       muscle going down toward the nipple, on the posterior aspect       of the shoulder and arm, the radial aspect of the arm and       forearm following the Large and Small Intestine Channels and       the posterior aspect of the first two fingers: Area around SI-17
    7. Supraspinatus Muscle:
      a. Referred pain: Pain in the suprascapular fossa, deltoid muscle,       and the lateral border of the arm and forearm which may       simulate "tennis elbow: Area around SI-12 and SI-13
      b. Referred pain: Pain in the deltoid muscle area: Area around
         SJ-14
    8. Infraspinatus Muscle:
      a. Referred pain: Deep pain in the anterior aspect of the       shoulder, the anterolateral aspect of the arm, the lateral       border of the forearm and sometimes the fingers: Area around       SI-11
      b. Referred pain: Pain at the medial border of the scapula:       Lateral to UB-44
    9. Teres Minor Muscle:
      a. Referred pain: Deep pain ion the posterior aspect of the deltoid       muscle: Area around SI-9
    10. Latissimus Dorsi Muscle:
      a. Referred pain: Pain at the tip of the scapula, the posterior and       medial aspect of the upper limb and the last two fingers: Area       around GB-22
      b. Referred pain: Pain in the anterior aspect of the shoulder and       in the waist: Area around GB-25
    11. Teres Major Muscle:
      a. Referred pain: Pain in the posterior aspect of the shoulder and      the upper limb Following the San Jiao Channel: Lateral to UB-46
      b. Referred pain: Pain in the stump of the shoulder: Area around       the posterior aspect of the axillary fossa
    12. Subscapularis Muscle:
      a. Referred pain: Pain in the posterior aspect of the shoulder,       scapula, arm and wrist: Area of the body of the subscapularis       muscle in the axilla
    13. Major and Minor Rhomboid Muscles:
      a. Referred pain: Pain along the medial border of the scapula and       in the suprascapular fossa: Areas around UB-42, UB-44 and       UB-45
    14. Deltoid Muscle:
      a. Referred pain: Pain in the anterior and medial aspect of the       deltoid muscle and arm: Area around Taijian
      b. Referred pain: Pain in the posterior aspect of the deltoid       muscle and arm: Area around SJ-14
    15. Coracobrachialis Muscle:
      a. Referred pain: Pain in the stump of the shoulder and on the       poster aspect of the upper limb following the San Jiao Channel:       Lateral to and below LU-2
    16. Biceps Brachii Muscle:
      a. Referred pain: Pain in the anterior aspect of the shoulder and       arm and in the suprascapular fossa: Below LU-4 and lateral to       HT-2
    16. Brachialis Muscle:
      a. Referred pain: Pain in the anterior aspect of the shoulder and       deltoid muscle, in the elbow crease and in the dorsal and       palmar aspect of the thumb: Area around LU-4 and Xiaxiabai (3       cun below LU-4)
    17. Triceps Brachii Muscle, Long Head:
      a. Referred pain: Pain in the posterior aspect of the shoulder and       upper limb: Area around SJ-13
    18. Pectoralis Major Muscle, Clavicular Head:
      a. Referred pain: Pain in the anterior aspect of the deltoid and       subscapular muscles: Area around LU-1 and Jubi
    19. Pectoralis Major Muscle, Sternal Head:
      a. Referred pain: Pain in the pectoralis muscle at the antero-
          medial border of the upper limb, the palm of the hand and the
          palmar aspect of the third, fourth and fifth fingers following the       Pericardium Channel: Area around ST-15 and ST-16
    20. Pectoralis Major Muscle, Costoabdominal Head:
      a. Referred pain: Pain in the mammary region with hyper-
          sensitivity of the nipple radiating to the axilla: Area around
           HT-1
    21. Subclavius Muscle:
      a. Referred pain: Pain in the subclavicular area, the anterior       aspect of the arm, the anterolateral border of the forearm       and the first three fingers, following the Lung Channel: Area       around KI-27
    22. Pectoralis Minor Muscle:
      a. Referred pain: Pain in the anterior aspect of the deltoid muscle,       the subclavicular fossa, the pectoral region, the anteromedial       border of the upper limb and the palmar aspect of the last       three fingers: Area around LU-1
    23. Sternalis Muscle:
      a. Referred pain: Pain in the manubrium radiating toward the       anterior aspect of the shoulder and the anteromedial border of       the arm: Area around KI-24
    24. Serratus Posterior Superior Muscle:
      a. Referred pain: Pain in the subscapular fossa, the posterior       aspect of the shoulder and the anteromedial border of the       arm: Just below the scapular spine, inferior to SI-12
    25. Serratus Anterior Superior Muscle:
      a. Referred pain: Pain in the subaxillary flank, radiating toward       the medial border of the upper limb and palmar aspect of the       fourth and fifth fingers and underneath the tip of the scapula:       Area around SP-21 or GB-22
    26. Iliocostalis Thoracis Muscle:
      a. Referred pain: Pain at the tip of the scapula, along the medial       border of the scapula and in the thorax: Area around UB-45
  • Extra Points: Zhongping (1 cun below ST-36), Jianling (8-9 fen below SP-9), Yanlingquanxia (2 centimeters below GB-34), Huatuojiaji level with the 5th cervical vertebra.
  • Famous points for shoulder pain:
    For pain along the San Jiao channel or if the patient suffers from Liver Qi Stagnation or Depressive Heat: GB-34
    For pain along the Large Intestine channel: ST-38 (needle through to UB-57) (LI-2 and LI-3 may also be used)
    Two points in the neck: LI-18, SI-16 (avoid deep needling)
Clinical Manifestations
  • Shoulder pain and numbness
  • The pain is dull and wandering in nature
  • The pain mainly involves the posterior part of the shoulder
  • The pain may involve the upper back
  • If the pain involves the anterior shoulder, it may also involve the upper arm
  • The disease course is normally short
  • A Cold sensation in the shoulder which is relieved by warmth and massage
  • The pain is aggravated by Cold
  • Aversion to Cold
  • Stuffy nose
  • Neck and back spasms
  • Joint pain
  • Headache
  • Anhidrosis
  • Muscular pain
  • Joint swelling and pain
  • Slight fever
  • Slight expectoration of white Phlegm
  • Heaviness of the body and joints
  • Cold feeling in the joints
  • Cough
  • Heaviness of the head
  • Preference of the joints for warmth
  • Limited movement of the joints
  • T: Normal
  • C: Thin and white or Thin, white and greasy
  • P: Superficial and tight
Treatment Principle
  • Dispel Wind-Cold
  • Relieve muscular spasm
  • Relieve Bi syndrome
  • Release Exterior symptoms
  • Sedate pain
  • Relieve neck pain
Herb Formulas
Points
  • LI-11, LI-15, SJ-5, SJ-14
    For pain along the posterior aspect of the shoulder, along the SI Channel: + SI-3, SI-8
    For pain along the posterior aspect of the shoulder, along the LI Channel: + LI-14
    For pain along the posterior aspect of the shoulder, along the SJ Channel: + SJ-3, SJ-10
    For pain along the anterior aspect of the shoulder: + LI-4, LU-7
    For pain that radiates to the upper back and neck: + SI-10, SI-11, SI-14, SI-15
    For Qi and Yang Deficiency: + DU-14, LI-4
    For pain and numbness in the ring, middle and little fingers: + SJ-3
  • GB-20, LI-4, LI-15, LU-7, SI-9, SI-11, SJ-15
    For pain that occurs at the place where the Lung channel passes through: + LU-3, LU-4, LU-5
    For pain that occurs at the place where the Large Intestine channel passes through: + LI-6, LI-7, LI-14
    For pain that occurs at the place where the San Jiao channel passes through: + SJ-7, SJ-14
    For pain that occurs at the place where the Small Intestine channel passes through: + SI-4, SI-6
    For stiffness and pain in the neck: + GB-21, SI-14
    For a headache and heaviness of the head: + DU-17, UB-10
    For a fever: + LI-11
    For generalized body pain: + ST-40, UB-63
    For throat pain: + LU-10, REN-23
  • LI-11, LI-15, SI-9, SJ-5, SJ-14
    For pain in the lateral part of the shoulder: + SI-3, SI-8
    For pain in the anterior part of the shoulder: + LI-4, LU-7
    For pain radiating to the upper back and neck: + SI-10, SI-11, SI-14, SI-15
    For pain with numbness in the middle and ring fingers: + SJ-3
    For pain with Qi and Yang Deficiency: + DU-14
Clinical Manifestations
  • Itching or tickling in the throat
  • Wheezing
  • Sneezing
  • Gasping
  • Cough with expectoration of thin, watery or frothy white sputum
  • General body aches
  • No thirst
  • Dyspnea
  • Headache
  • Body aches
  • A sensation of heaviness
  • Chills with low grade fever
  • Maybe asthma
  • Intolerance of Cold
  • Anhidrosis
  • Blocked and/or runny nose with watery nasal discharge
  • Chest discomfort
  • Neck stiffness
  • Irritability
  • T: Pink
  • C: Thin, white and moist
  • P: Superficial and tight
Treatment Principle
  • Disperse Wind-Cold
  • Induce diaphoresis
  • Dispel Dampness
Herb Formulas
Points
Clinical Manifestations
  • Chills and fever
  • Anhidrosis
  • Stiff and rigid neck, shoulders and upper back
  • Intolerance of Wind
  • Dislike of Cold
  • Inflammation
  • Vomiting
  • Muscle spasms
  • Mucosal swelling
  • Nasal congestion
  • Sensitivity to dust
  • Headache
  • Wind-Cold Bi (few joints affected, intense but short lived, changes over days or weeks)
  • Inflammation
  • T: Normal
  • C: Thin and white
  • P: Floating and tight
Treatment Principle
  • Releases Wind-Cold in the Exterior and muscle layer
  • Generates Fluids
  • Relieves muscle-ache of the neck
Herb Formulas
Points
Clinical Manifestations
  • Long standing cold hands and feet that are cold to the touch and feel cold to the patient
  • Maybe lumbago and leg pain
  • Abdominal pain and distention
  • Midline pain
  • Uterine pain
  • Chills
  • Diarrhea
  • Menstrual abdominal pain
  • Maybe chest pain
  • Increased sweating, particularly of the feet
  • Increased salivation
  • Spasm and pain of the limbs
  • Scanty urination
  • Pain at the waist, hips, legs and feet
  • Sciatica
  • Joint pain
  • Irregular menstruation
  • Abdominal Cold
  • Migraine headache
  • Vaginal discharge
  • T: Pale
  • C: White
  • P: Deep and thready (may be almost imperceptible).
Treatment Principle
  • Warm the channels
  • Disperse Cold
  • Nourish the Blood
  • Unblock the Blood vessels
Herb Formulas
Points
Clinical Manifestations
  • Fever and chills
  • Headache
  • Thirst
  • Sore throat
  • Abdominal pain due to disharmony between the Liver and Stomach
  • Epigastric, hypochondriac or flank pain
  • Muscle spasms, pain and numbness
  • Chronic dysenteric disorders
  • Rectal prolapse
  • Uterine prolapse
  • Vertigo
  • Dizziness
  • Thoracic and costal pain,
  • Menstrual irregularity
  • Five Sole Heat
  • T: Red
  • C: Little or None
  • P: Thready, wiry and rapid and maybe floating
Treatment Principle
  • Release the Exterior
  • Vent measles
  • Clear Heat
  • Relieve toxicity
Herb Formulas
Points
Clinical Manifestations
  • Long disease course
  • Severe shoulder pain
  • Cold sensations and aversion to Cold in th shoulder
  • Cold and pain are relieved by warmth
  • Relief does not last long
  • Severe pain can cause sweating and disturb work, eating and sleeping
  • Maybe restricted movement
  • Heavy, painful head
  • Generalized sensation of heaviness
  • Back pain
  • Generalized pain or muscle ache
  • Difficulty bending or rotating trunk
  • Mild fever
  • Slight aversion to Wind and Cold
  • Dizziness
  • Anorexia
  • Anhidrosis
  • Stiffness of the neck
  • Sciatica
  • Chest oppression
  • Chills
  • No perspiration
  • Aversion to Cold
  • Lassitude
  • Scanty urination
  • T: Pale
  • C: White
  • P: Wiry or Thready and wiry
Treatment Principle
  • Dispel wind
  • Eliminate Dampness
  • Unblock the channels
Herb Formulas
Points
  • Moxa needle LI-11, LI-15, SI-9, SJ-5, SJ-14
    For pain in the lateral part of the shoulder: + SI-3, SI-8
    For pain in the anterior part of the shoulder: + LI-4, LU-7
    For pain radiating to the upper back and neck: + SI-10, SI-11, SI-14, SI-15
    For pain with numbness in the middle and ring fingers: + SJ-3
    For pain with Qi and Yang Deficiency: + DU-14
    For pain that is pricking or piercing due to Blood Stasis: + LI-4, UB-17
    For pain with Qi Deficiency: + LI-4, Moxa needle REN-6
Clinical Manifestations
  • Chronic pain, weakness and numbness (especially in the lower extremities) due to Windstroke
  • Muscle spasms
  • Cramps
  • Heaviness and pain in the lower back and legs
  • Fixed or migrating pain in the bones in the bones and joints with reduced range of motion
  • Long-term numbness or paralysis in the hands and feet
  • T: Normal
  • C: White and moist
Treatment Principle
  • Dispel Wind
  • Eliminate Dampness
  • Transform Phlegm
  • Invigorate the Blood
  • Unblock the collaterals
  • Alleviate pain
  • Warm the channel and collaterals
Herb Formulas
Points
Clinical Manifestations
  • Acute shoulder pain with a cold, heavy sensation
  • Pain is worse on exposure to Cold, Wind and rainy weather
  • Pain improves with warmth
  • The pain is fixed and worse at night
  • Occasionally a swollen shoulder with restricted movement
  • Purplish or slightly blue facial complexion
  • Heaviness
  • Stiffness
  • Numbness of the fingers
  • T: Pale or slightly purplish
  • C: White and greasy
  • P: Wiry and tight or Slippery and wiry or Rough
Treatment Principle
  • Dispel Cold
  • Eliminate Damp
  • Circulate Qi
  • Sedate pain
Herb Formulas
Points
  • GB-20, LI-15, SI-9, SI-11, SJ-5, ST-36, ST-40
    For pain that occurs at the place where the Lung channel passes through: + LU-3, LU-4, LU-5
    For pain that occurs at the place where the Large Intestine channel passes through: + LI-6, LI-7, LI-14
    For pain that occurs at the place where the San Jiao channel passes through: + SJ-7, SJ-14
    For pain that occurs at the place where the Small Intestine channel passes through: + SI-4, SI-6
    For pain in the scapular region: + SI-10, SI-11
    For stiffness and pain in the neck: + GB-21, SI-14
    For a headache: + Taiyang, Yintang
    For nausea and vomiting: + PC-6, REN-12
Clinical Manifestations
  • Shoulder pain
  • Inability to raise the arm
  • Pain may radiate to the back or arm
  • Weakness of the affected arm
  • Swelling of the fingers
  • Cold limbs
  • Alternating chills and fever
  • T: Pink
  • C: White
  • P:Taut and tense
Treatment Principle
  • Invigorate the Blood
  • Eliminate stasis
  • Unblock the channels
  • Disperse Cold
Herb Formulas
  • Wu Tou Tang  modified
  • Chinese Patent Medicines:
    1. Xiao Huo Luo Dan + Yuan Hu Zhi Tong Pian
    2. Yi Li Zhi Tong Dan
Points
Clinical Manifestations
  • Aversion to Wind, Cold and Dampness
  • Stiff and painful muscles and joints
  • Limited movement
  • Pain aggravated by Wind
  • Sensitive to climatic changes
  • Pain aggravated by Cold
  • Numbness of muscles
  • Pain aggravated by Dampness
  • Cold joints
  • Pain worse at night
  • Low back pain or soreness
  • Lumbago
  • Fatigue
  • Heaviness of the body
  • Heaviness of the muscles
  • Preference for warmth
  • Weak joints
  • Palpitations
  • Pale face
  • Joint deformity
  • Shortness of breath
  • Preference for dry weather
  • T: Pale or Purplish
  • C: Thin, white and greasy
  • P: Thready and weak or Thready and slippery
Treatment Principle
  • Dispel Wind-Cold-Damp
  • Nourish and Activate the Blood
  • Break up Blood Stasis
  • Eliminate Damp
  • Stop pain
Herb Formulas
Points
Clinical Manifestations
  • Chronic pain, weakness and numbness (especially in the lower extremities) due to Windstroke
  • Muscle spasms
  • Cramps
  • Heaviness and pain in the lower back and legs
  • Fixed or migrating pain in the bones in the bones and joints with reduced range of motion
  • Long-term numbness or paralysis in the hands and feet
  • T: Normal
  • C: White and moist
Treatment Principle
  • Dispel Wind
  • Eliminate Dampness
  • Transform Phlegm
  • Invigorate the Blood
  • Unblock the collaterals
  • Alleviate pain
  • Warm the channels and collaterals
Herb Formulas
Points
Clinical Manifestations
  • Marked limitation of range of motion of the shoulder
  • Pain not too severe
  • Dizziness
  • Vertigo
  • Tinnitus
  • Low back and knee soreness and weakness
  • Lack of strength when lifting and/or walking
  • Loss of teeth in extreme cases
  • Disinclination to speak
  • T: Red
  • C: Thin
  • P: Thready and weak
Treatment Principle
  • Tonify the Liver and Kidneys
  • Tonify Qi
  • Expel Wind and Dampness
Herb Formulas
Points
  • GB-39, KI-3, LI-11, LI-15, SJ-5, SJ-14, UB-11
    For pain along the posterior aspect of the shoulder, along the SI Channel: + SI-3, SI-8
    For pain along the posterior aspect of the shoulder, along the LI Channel: + LI-14
    For pain along the posterior aspect of the shoulder, along the SJ Channel: + SJ-3, SJ-10
    For pain along the anterior aspect of the shoulder: + LI-4, LU-7
    For pain that radiates to the upper back and neck: + SI-10, SI-11, SI-14, SI-15
    For Qi and Yang Deficiency: + DU-14, LI-4
    For pain and numbness in the ring, middle and little fingers: + SJ-3
Clinical Manifestations
  • The disease course is usually long
  • Chronic, severe pain, weakness and numbness (especially in the lower extremities) due to Windstroke
  • Cold sensations and aversion to Cold in the shoulder
  • Muscle spasms
  • Cramps
  • Heaviness and pain in the lower back and legs
  • Fixed or migrating pain in the bones in the bones and joints with reduced range of motion
  • There may be sweating
  • Long-term numbness or paralysis in the hands and feet
  • Working, sleeping and eating may be interrupted
  • T: Normal or Pale
  • C: White and moist
  • P: Wiry or Thready and wiry
Treatment Principle
  • Dispels Wind-Dampness
  • Unblocks the channels
  • Alleviates pain
  • Disperses Cold
Herb Formulas
Points
Clinical Manifestations
  • Aversion to Wind and Cold
  • Facial edema moving to generalized edema
  • Slight fever or fever and chills
  • Thirst
  • Slight but continuous perspiration
  • Sore, heavy limbs
  • Decreased urination
  • Headache
  • Edematous orbits
  • A red, swollen sore throat
  • Weak abdomen
  • Belching
  • Cough
  • Asthma
  • Dyspnea
  • Bulging eyes
  • Severe cough
  • Weak, aching feet
  • Skin problems
  • T: Normal
  • C: White or Thin white
  • P: Floating or Floating and big
Treatment Principle
  • Promote perspiration
  • Disseminate Lung Qi
  • Clear Heat
  • Move water
Herb Formulas
Points
Clinical Manifestations
  • Burning hot shoulder pain
  • Redness
  • Swelling
  • Inability to lift the arm
  • Pain alleviated with exposure to Cold
  • Aversion to touch
  • Pain radiates to the back, arm and hand
  • Fever
  • Aversion to Wind
  • Dysphoria
  • Lesions in the genital area
  • Generalized body aches and pains
  • Irritability
  • Heavy sensation in the shoulder and back
  • Discomfort or a constricted sensation in the area of the chest and diaphragm
  • Multiple sores, carbuncles furuncles or abscesses
  • Redness
  • Itching
  • Persistent swelling
  • Chest pain
  • Fever
  • Thirst
  • Aching and painful extremities
  • Aching and painful joints
  • Unbearable swelling and pain of the lower extremities
  • Shoulder stiffness
  • T: Red
  • C: Yellow and slimy
  • P: Wiry and rapid or Soft and moderate or Soft, superficial and slow or Slippery and rapid or Deep and tight
Treatment Principle
  • Resolve Dampness
  • Clear Heat
  • Disperse Wind
  • Stop pain
  • Activate the Blood
  • Tonify Qi and Blood
Herb Formulas
Points
Clinical Manifestations
  • Sallow complexion
  • Anorexia (maybe with vomiting)
  • Four limbs feel tired and heavy
  • Abdominal and epigastric distention after eating
  • Maybe acid regurgitation or vomiting
  • Loose stools or watery stools containing undigested food
  • Shortness of breath
  • Pain in the epigastrium with cold sensations (pain is relieved by warmth)
  • Cold limbs
  • Feeling chilled
  • Frequent, clear urination
  • Mental fatigue
  • Maybe scanty urine with edema
  • Maybe clear, watery vaginal discharge
  • T: Pale
  • C: Thin and white
  • P: Deep and weak
Treatment Principle
  • Warm the Center
  • Dispel Cold
Herb Formulas
Points
Clinical Manifestations
  • Shoulder pain
  • Palpitations
  • Stabbing pain in the anterior region over the Heart
  • Suffocating sensation in the chest
  • Maybe drawing pain down the internal aspect of arm (especially the left arm)
  • Pain (in chest and/or arm) tends to be severe and intermittent
  • Severe cases:
    Cold limbs
    Cyanosis of lips and nails
  • T: Dark red with purple spots or Purple body
  • C: Little
  • P: Minute (scarcely perceptible) and thready or Knotted
Treatment Principle
  • Clear Yang
  • Invigorate the Blood
  • Transform Stagnation
Herb Formulas
Points
Clinical Manifestations
  • Palpitations
  • Shortness of breath
  • Excessive perspiration (daytime)
  • Above symptoms worse after exertion or when tired
  • Cold limbs
  • Fatigue
  • Weakness
  • Maybe chills
  • Cyanosis
  • Suffocating sensation in chest
  • Depression
  • Facial pallor
  • T: Pale and swollen
  • C: White
  • P: Thready and weak or Knotted or Intermittent
Treatment Principle
  • Warm and Clear Heart Yang
Herb Formulas
Points
Clinical Manifestations
  • Palpitations
  • Dysuria
  • Shortness of breath
  • Dyspnea
  • Dizziness
  • Muscular twitching
  • Whole body edema
  • Cold body
  • Icy limbs
  • Cold abdomen with watery stools
  • Edema of limbs
  • Cough
  • Pale complexion
  • Lips and nails cyanosed
  • Soreness and aching of the shoulders and back
  • Abdominal pain
  • Diarrhea
  • T: Pale or Purple (Lavender)
  • C: White and greasy
  • P: Deep or Deep and minute
Treatment Principle
  • Support Yang
  • Expel Cold
  • Promote diuresis
Herb Formulas
Points
Clinical Manifestations
  • Vague lower abdominal pain
  • Feelings of cold and heaviness
  • Fond of warmth and pressure
  • Abdominal fullness intermittently
  • Borborygmus
  • Unformed, loose stools or
  • Chronic, incessant diarrhea
  • Urinary frequency
  • T: Pale
  • C: Thin and white
  • P: Deep and even
Treatment Principle
  • Warm and Clear the Small Intestine
Herb Formulas
Points
Clinical Manifestations
  • Lower abdominal pain and Cold
  • Abdomen feels chilled
  • Aching bones and joints
  • Muscle ache
  • Whole body pain
  • Aversion to Cold, especially at the back
  • Cold limbs
  • No Thirst
  • Lower abdominal pain and Cold
  • Abdomen feels chilled
  • Maybe fever
  • No thirst
  • T: Normal
  • C: White and slippery
  • P: Deep and faint or Forceless or Choppy and slow or Wiry
Treatment Principle
  • Dispel Cold
  • Warm the channels
  • Assist Yang
  • Dispel Dampness
  • Relieve pain
Herb Formulas
Points
Clinical Manifestations
  • Shoulder pain with a distending or numb sensation
  • No palpable pain spots
  • Pain which starts or is aggravated by a poor mood
  • Irritability
  • Insomnia
  • Migraine headache
  • Irregular menstruation
  • Poor appetite
  • Hypochondriac pain
  • Lower abdominal pain
  • T: Dark
  • C: White
  • P: Wiry
Treatment Principle
  • Regulate the Liver
  • Regulate Qi
  • Relieve pain
Herb Formulas
Points
Clinical Manifestations
  • Aching and pain around the shoulder
  • Inhibited bending and stretching
  • The pain is worse upon waking or after a prolonged period of inactivity
  • The pain is better after use
  • The pain is worse after taxation
  • Possible muscle withering and weakness of the shoulder area
  • Sinew vessel contractions and spasms
  • Insensitivity of the skin
  • An enduring condition which does not heal
  • A lusterless facial complexion
  • Fatigue
  • Lack of strength
  • Loose stools
  • Poor appetite
  • Dizziness
  • Pale face
  • Weak voice
  • Shortness of breath
  • Reluctance to speak
  • Sweating with little or no exertion
  • Palpitations
  • Insomnia
  • Dry skin
  • Dry hair
  • Poor memory
  • Paleness
  • Scanty periods
  • T: Pale , maybe teethmarks
  • C: Thin and white
  • P:Deep, thready and forceless
Treatment Principle
  • Tonify Qi
  • Nourish the Blood
  • Harmonize Ying
  • Stop pain
Herb Formulas
Points
  • LI-11, LI-15, SJ-5, SJ-14, UB-17, UB-20, UB-21
    For pain along the posterior aspect of the shoulder, along the SI Channel: + SI-3, SI-8
    For pain along the posterior aspect of the shoulder, along the LI Channel: + LI-14
    For pain along the posterior aspect of the shoulder, along the SJ Channel: + SJ-3, SJ-10
    For pain along the anterior aspect of the shoulder: + LI-4, LU-7
    For pain that radiates to the upper back and neck: + SI-10, SI-11, SI-14, SI-15
    For Qi and Yang Deficiency: + DU-14, LI-4
    For pain and numbness in the ring, middle and little fingers: + SJ-3
Clinical Manifestations
  • Long standing shoulder pain with a fixed location
  • Severe, sharp, pricking shoulder pain
  • Pain is worse with pressure
  • Restriction of shoulder movement
  • Since Blood Stasis is localized, there should be no general symptoms
  • A history of trauma to the area
  • Swelling in the joint
  • The pain is worse at night
  • A purplish-black facial complexion
  • T: Normal or Dark or Purplish
  • C: White
  • P: Choppy or Wiry and choppy
Treatment Principle
  • Invigorate the Blood
  • Break up Stagnation
  • Stop pain
Herb Formulas
Points
  • LI-11, LI-15, SJ-5, SJ-14
    For pain along the posterior aspect of the shoulder, along the SI Channel: + SI-3, SI-8
    For pain along the posterior aspect of the shoulder, along the LI Channel: + LI-14
    For pain along the posterior aspect of the shoulder, along the SJ Channel: + SJ-3, SJ-10
    For pain along the anterior aspect of the shoulder: + LI-4, LU-7
    For pain that radiates to the upper back and neck: + SI-10, SI-11, SI-14, SI-15
    For Qi and Yang Deficiency: + DU-14, LI-4
    For pain and numbness in the ring, middle and little fingers: + SJ-3
  • Ahshi Points, LI-4, LIV-3, SP-6, SP-10
    For pain that occurs at the place where the Lung channel passes through: + LU-3, LU-4, LU-5
    For pain that occurs at the place where the Large Intestine channel passes through: + LI-6, LI-7, LI-14
    For pain that occurs at the place where the San Jiao channel passes through: + SJ-7, SJ-14
    For pain that occurs at the place where the Small Intestine channel passes through: + SI-4, SI-6, SI-9, SI-10
    For stiffness and pain in the neck: + GB-21, SI-14
    For pain in the scapular region: + SI-10, SI-11
    For stiffness and pain in the shoulder joint: + GB-34
    For numbness and heaviness in the shoulder: + SP-9, ST-40
    For chest pain: + HT-5, PC-6
Clinical Manifestations
  • Shoulder pain
  • Abdominal pain in women
  • Dizziness
  • Blurred vision
  • Pale, lusterless complexion
  • Pale nails
  • Pale lips
  • Generalized muscle tension
  • Irregular menstruation with little flow
  • Amenorrhea
  • Periumbilical pain
  • Lower abdominal pain
  • Vertigo
  • Tinnitus
  • Blurred vision
  • Insomnia
  • Spotting of pale Blood
  • Postpartum uterine bleeding
  • Maybe five sole Heat
  • Delayed menstruation
  • Palpitations
  • Dizziness
  • Dry skin
  • Maybe leukorrhea
  • Maybe fever
  • Firm, painful abdomen
  • Sporadic fever and chills
  • Dysmenorrhea
  • Breast distention and pain before and during menses
  • Menorrhagia
  • Hard abdominal masses with recurrent pain
  • Unstable fetus with bleeding
  • Chills and fever
  • T: Pale
  • C: Normal
  • P: Thready and wiry or Thready and choppy
Treatment Principle
  • Nourish the Blood
  • Invigorate the Blood
  • Dispel Stasis
Herb Formulas
Points
Clinical Manifestations
  • Abdominal pain
  • Irritability
  • Slight chills
  • Spasms of the calf muscles
  • Cramps in the hands
  • Weak legs
  • Hypertonicity of the extremities characterized by difficult flexion and extension
  • Wheezing
  • Coughing
  • Hiccup
  • Constipation
  • Vomiting
  • Diarrhea
  • Sciatic pain
  • Severe and painful muscle spasms in the Stomach, bronchi, Gallbladder and uterus. Intestines
  • Shoulder pain
  • Pain in the head, body or limbs due to arterial spasms characterized by a severe pulling pain
  • T: Normal or Reddish
  • C: None or Yellowish
  • P: Wiry and rapid or Thready and rapid
Treatment Principle
  • Soften the Liver
  • Nourish the Blood
  • Nourish Yin
  • Moderate painful spasms
  • Relieve pain
  • Harmonize the Middle Jiao
  • Replenish Body Fluids
Herb Formulas
Points
Clinical Manifestations
  • Abdominal pain
  • Constipation
  • Hypochondriac pain
  • Chills
  • Low-grade fever
  • Cold hands and feet
  • Intolerance of Cold
  • Pain in the armpits
  • Unilateral pain in the abdomen and hypochondrium
  • Stiffness and spasms beside and below the umbilicus
  • Pain in the waist and legs
  • T: Normal
  • C: Greasy and white
  • P: Deep, tight and wiry
Treatment Principle
  • Warm the Interior
  • Disperse Cold
  • Unblock the bowels
  • Alleviate pain
Herb Formulas
Points
Clinical Manifestations
  • Long standing recalcitrant shoulder pain with a heavy sensation
  • Severe pain in the sinews and muscle of the shoulders area
  • Restricted movement ameliorated by movement for a short time and warmth
  • Soreness and numbness of the muscle
  • Swollen joints
  • Exacerbated by Cold and Dampness
  • The condition is long and seems incurable
  • Nausea
  • Vomiting
  • Dizziness
  • Lassitude
  • Anorexia
  • Fatigue
  • Abdominal pain
  • A sensation of fullness in the Stomach
  • Four limbs feel tired and heavy
  • Maybe acid regurgitation or vomiting
  • Loose stools
  • Shortness of breath
  • T: Pale and flabby - may have teethmarks
  • C: White and slimy
  • P: Slippery
Treatment Principle
  • Tonify the Spleen and Stomach
  • Resolve Dampness
  • Expel Wind-Dampness
  • Transform Phlegm
  • Unblock the channels
Herb Formulas
Points
  • Moxa needle LI-15, SI-9, SJ-14, SP-9, ST-36, ST-40
    For pain along the posterior aspect of the shoulder, along the SI Channel: + SI-3, SI-8
    For pain along the posterior aspect of the shoulder, along the LI Channel: + LI-14
    For pain along the posterior aspect of the shoulder, along the SJ Channel: + SJ-3, SJ-10
    For pain along the anterior aspect of the shoulder: + LI-4, LU-7
    For pain that radiates to the upper back and neck: + SI-10, SI-11, SI-14, SI-15
    For Qi and Yang Deficiency: + DU-14, LI-4
    For pain and numbness in the ring, middle and little fingers: + SJ-3
  • Ahshi Points, LI-4, LI-15, SJ-6, SJ-14, SP-6, ST-40
    For pain that occurs at the place where the Lung channel passes through: + LU-3, LU-4, LU-5
    For pain that occurs at the place where the Large Intestine channel passes through: + LI-6, LI-7, LI-14
    For pain that occurs at the place where the San Jiao channel passes through: + SJ-7, SJ-14
    For pain that occurs at the place where the Small Intestine channel passes through: + SI-4, SI-6, SI-9, SI-10
    For pain in the scapular region: + SI-10, SI-11
    For stiffness and pain in the shoulder joint: + GB-34
    For stiffness and pain in the neck: + GB-21, SI-14
    For limited shoulder movement: + GB-34
    For a swollen shoulder joint: + ST-39
    For a feeling of dullness or fullness in the Stomach: + REN-12, SP-4
    For a poor appetite: + SP-3
  • For bilious patients: + One needle technique GB-34 or ST-38
Clinical Manifestations
  • Long standing, recalcitrant condition
  • Shoulder pain, mild at times, severe at others
  • Impeded movement
  • T: Purple
  • C: White
  • P: Thready and choppy
Treatment Principle
  • Resolve Phlegm
  • Invigorate the Blood
  • Resolve Stagnation
  • Expel Wind
Herb Formulas
Points