TCM Case Studies: Pain Management by Youping Hu & Al Stone & Junmei Wu

Author:Youping Hu & Al Stone & Junmei Wu [Hu, Youping]
Language: eng
Format: azw3
Publisher: PMPH-USA
Published: 2017-01-02T05:00:00+00:00

CASE STUDY I

Mr. Li, age 56. Initial Visit: October, 2009

Chief Complaint: Pain in the left shoulder for one month, with limited range of motion for two weeks.

History: The patient was exposed to cold at night a month before, and the next morning he felt soreness, heaviness and pain in the left shoulder. He treated himself with some pain-killers and an analgesic plaster for traumatic injury and rheumatism, but the symptoms were not relieved. The pain had gotten worse over the past week. Mr. Li noted that the pain was aggravated by cold and relieved by warmth. The night before the patient arrived, he was awakened by the pain which also caused difficulty in reaching backwards.

Signs and Symptoms: Pain in the left shoulder, limited movement when reaching backwards (shoulder extension), normal appetite, sleep, urine and stools. His tongue was pale with a thick white coating; the pulse was wiry.

Past History: The patient had suffered from type II diabetes for two years, and took Metformin tablets 500 mg once daily. No history of hypertension, infectious disease such as hepatitis, tuberculosis, etc., no past history of allergies to drugs or foods.

Menstrual, Marital and Childbearing History: Married with two children, spouse and children were healthy.

Physical Examination: The patient was well-developed and moderately nourished, his skin and sclera showed no indication of jaundice, no palpable superficial lymph nodes, no jugular vein distention, hepatojugular reflux (-). Bilateral respiratory movements were symmetrical, with resonant percussion sounds. Heart rate was 70 bpm and regular, no pathological murmur at any valve area. Flat abdomen, liver and spleen were non-palpable, no deformity of the spine or four limbs, no edema in the lower limbs.

Orthopedic Examination: Extensive tenderness in the left shoulder, worst in the adhesion area of the long head tendon of the biceps and below the coracoids. Limitation of movement: flexion 70°, abduction 60°, extension 15°. The tongue was pale with a thick white coating, and the pulse was wiry.

Auxiliary Examination: Blood routine test showed no abnormity. X-ray of the shoulder showed no fracture or spurs.

Pattern Differentiation

The patient suffered from shoulder pain caused by a wind-cold invasion. The wind-cold invaded the shoulder and blocked the channel and collaterals which then resulted in pain. As such, the pain was aggravated by cold and relieved by warmth. Tenderness indicated blockage of the local channel and collateral. The pale tongue with a thick white coating and the wiry pulse suggested an obstruction of cold-dampness.

Diagnosis

TCM pattern: Cold-dampness obstructing the collaterals

Clinical Treatment

Principles: Dissipate cold and dispel dampness, warm the channel to relieve pain

Formula: Modified Má Guì Wēn Jīng Tāng (Ephedra and Cinnamon Twig Channel-Warming Decoction)

[麻桂温经汤加减]

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