Patient

Mr. BA, 41y
 
Chief Complaint : Right shoulder and arm pain for one week
Clinical manifestations : Wandering pain of right upper limb with localized swelling , numbness and frozen pain in shoulder joint which is aggravated in cloudy and rainy days and alleviated by warmth , sometimes the pain of shoulder could radiate downwards along the lateral side of anterior aspect of the upper arm , he also has stiff joints in the morning. limited flexibility,aversion to wind and cold , good appetites, normal urination and defecation, there is no fever and sweating.
He has pale tongue body with greasy and white coating , His pulse is superficial and tense.

According to palpation the painful points mainly locate on lateral side of the anterior aspect of the upper arm and apex points of the shoulder

DIAGNOSTIC CONCLUSION
  
TCM disease : Painful Bi syndrome
TCM type/pattern : wind - cold - damp attacking the Jing Luo

Classify patients condition
  (    v    ) Patients condition is classified according to the Fundamental substances
  (          ) Patients condition is classified according to the Zang Fu
  (    v    ) Patients condition is classified according to Jing Luo
  (    v    ) Patients condition is classified according to aetiology

According to the eight-principle syndromes

Aetiology                according to condition                        eight-principle                      
  External                   wind ,clod, damp                          yin, exterior,cold, excess
                                attacking the Jing Luo

  Shanghan               Hand Taiyin Lung syndrome
 

Explanation

• The shoulder pain for one week , aversion to wind and cold  ,short duration onset can be attack by wind, cold, dampness  which is aggravated in cloudy and rainy days and alleviated by warmth , this is belongs  to  Bi syndrome

• Pathogenic Wind :the main symptoms are wandering pain , upper part,  stiff joints in the morning ,numbness and frozen pain(cold - dampness evil) limited flexibility, , blood stasis leads to  localized swelling ,this is indicated Qi & Blood stagnation

• cold damp leads to pale tongue body with greasy and white coating , pulse is superficial and tense
• radiate downwards along the lateral side of anterior aspect of the upper arm, this is indicated the location of the disorder is Hand Taiyin Lung channel

Treatment Principle    

• Expel wind & warm cold , remove dampness

• promote qi and blood circulation to remove stasis, stop pain

Explain the rationale for treatment according to TCM principles

The exterior wind,cold ,damp attack the body, it blockage the qi and blood circulation then result joint pain, apply with dispersing wind,warm cold ,eliminating dampness and regulate qi and blood circulation can relieve patients shoulder pain.


Function and indications of each point relevant to the treatment principle

 Point number & name                                                         Function & Indication

• LI 15   Jianyu                                        Promote circulation to remove stasis and   relieve pain,  arm impairment/ Shoulder Pain 
• SI 14   Jianliao                                Promote circulation to remove stasis and relieve pain, arm impairment/ Shoulder Pain
• LU 7  Lieque(Luo) , LI 4 Hegu(yuan)             Expel wind and reducing pain around arm & shoulder
• SP9   Yinlinquan(He)                                  Eliminate dampness treat heaviness
• BL 17 Geshu(B/shu)                                   Make blood circulation to remove stasis

Treatment formulation

• Painful Bi syndrome  due to wind cold damp obstruction ,apply with mix point of local & distal points can Expel wind & warm cold , remove dampness ,also can Promote circulation of qi and blood to remove stasis and relieve pain. 

• All points forcus to to remove wind-cold -damp and strengthen qi and blood to improve the patients condition.

Explain the  selection of points in terms of

  (a) Treatment technique intended

• Reducing  excess to expel wind,cold , remove dampness
• Cupping + Moxibustion to strengthen the effect to remove cold, dampness

  (b) Function of channels incolved

• in relation with wind,cold ,damp obstruction the Taiyin Lung Channel, Lung channel has the function to strengthen the defensive system to disperse exterior evil.
• Yangming channel is the paired channel with Taiyin , it can assist Hand Taiyin Lung to release exterior evil.
• SP channel, Opens And Regulates The Water Passages, Drains Damp