A. Neck pain
¨ç Causes and differential diagnosis
Herniation of cervical disc, spinal stenosis, traumatic cervical spondylosis, RSD(reflex sympathetic dystrophy), MPS(myofascial pain syndrome), tumor in the cervical region, OPLL(ossification of posterior longitudinal ligament), torticolis, TOS(thoracic outlet syndrome), and cervical instability are widely known causes of neck pain. If the patient complains of numb hands, symptoms may be from problems in the shoulder or carpal tunnel, but not the neck although symptoms may appear similar.
CT(computer tomography) and MRI(magnetic resonance imaging) are commonly used for diagnosis and the results are speculated through DITI(digital infrared thermal imaging system).
Acute cases are treated by acupuncture and moxibustion to attenuate the stiffness of the neck and compression of the nerve muscles. Based on theory SI3, BL62, TE3, GB34, PC7, and CV24 are commonly used acupoints. LU7, and LI4 may be added if the neck shows stiffness. TE3, and BL40 may be added for those who have a stiff spine.
B. Shoulder Pain
Shoulder pain includes the pain around the shoulder joints as well as in circumferential muscles and upper limbs from the shoulders to the wrists. The number of patients complaining for shoulder pain is increasing these days from increase in office lifestyles and uses of computers.
¨ç Causing factors
Major causes are adhesive capsulitis, TOS(thoracic outlet syndrome), tendinitis of supraspinatus, subacromial bursitis, biceps tendinitis, and levator scapulae bursitis.
¨è Differentiations of symptoms Patients with acute cases within a period of 2 weeks have a history of damage such as dislocation, fracture or rupture of the rotator cuff. In these cases, the common symptoms are deformity or swelling.
Patients with chronic cases of more than 2 weeks should especially be examined with their ages and symptoms taken into consideration.
Pain coming from the rotator cuff induces pain at night, which prevents the patients from sleeping on the painful side. If the pain is limited only to the top of the shoulder, dislocation of joint is suspected. Pain from bursitis or rupture of the rotator should radiate from the deltoid part to the outer portion of the brachium. Sometimes, patients with rotator cuff complain for numbness on forearms and hands, for which the symptoms may be misdiagnosed as carpal tunnel syndrome. Pains coming from rotator cuff are more severe when the patient stretches his or her arms up to the sky, and also when the patient is trying to throw something. However, shoulder pain from stimulation on the cervical nerve root is lessened when the forearms and hands are placed on the head.
In Oriental medicine, shoulder pains are closely related to the Heart, Lung, Spleen and Stomach. It is said to be caused by the deficiency of Qi and Blood, which enables Wind, Cold, and Dampness to penetrate into the body easily. phlegm-Dampness(ÓÃã¥) comes from Yang-deficiency of the Spleen and Kidney(Þ¡ãìåÕúÈ), which causes the watery phlegm(ÓÃëæ) to be stagnated and cause the transportation of Qi and Blood to slow down. Stagnated Blood is caused by contusions.
Moxibustion is more widely used for those who have suffered for a long period of time with symptoms of numbness, heaviness and soreness whereas acupuncture is preferred for acute cases with severe pain. If the ill portion is swollen without fever, moxibustion is recommended, but if the ill portion with both swelling, fever, and pain, acupuncture is more effective. Commonly used acupoints for treatments include LI15, LI4, LI16, TE5, TE3, TE10, and TE14.
Prescriptions may differ according to the causing factors and below are lists of frequently prescribed herbal medicine.
C. Low Back Pain
CT (computed tomography) and MRI (magnetic resonance imaging) are commonly used, and the clinical results from these are examined through DITI (digital infrared thermal imaging system).
Acupuncture and moxibustion are applied to the ill portion of the low back and acupoints related to the low back to make smooth the cycle of Qi and Blood. classical acupuncture is usually given, and Sa-am acupuncture therapy, and Constitution acupuncture therapy are also in use.
For treatments with aqua-acupuncture, acupoints are chosen according to the nervous level of the sciatica, and acupoints of BL23, BL24, BL25, BL26 are treated on both sides.
Of eight acupoints on the sacrum(bilateral B31, B32, B33, and B34), GB30, BL40, BL57, BL60 are acupunctured on the affected side. If it appears as BL Meridian Type, BL36, BL37, B56 or tonification of the Urinary Bladder Meridian are also acupunctured on the ill side. If it is GB Meridian Type, GB31, GB34, GB39, or tonification of the Gall Bladder Meridian are acupunctured. In Central Type, BL36, BL37, GB31, GB34 are acupunctured on the affected side while Mixed Type is used on the affected side on BL36, BL56, GB31, GB34, and GB39.
Electro-acupuncture and bee-venom acupuncture are also used, and negative therapy and Chuna therapy are used with physically treating machines of Western Medicine. Medications are dependent upon the causing factors, symptoms and the Constitutions of each patients, and may vary based on Pattern Identification.
¨é Clinical practice for low back pain
- Wind-Dampness Type
The back is heavy and in pain and it may also characteristically be a cramp all the way through the legs. If it is rainy or cloudy, the pain becomes more severe and may be attenuated by warming it or doing some activities. The patients' tongue coating is thin and white and the pulse is weak which is felt as gentle. Treatments should be based on elimination of Wind with dispersion of Cold and Smoothing Dampness with penetrating the numbness. Commonly used prescriptions are Ohjucksan(çéîÝß¤: HK159), Dokhualkisaengtangkagam(Ô¼üÀÐôßæ÷·Ê¥Êõ: HM381), and Ohyaksoonkisankagam(è¡å·â÷Ñ¨ß¤Ê¥Êõ: HK157).
Ohjucksan(çéîÝß¤: HK159) is a prescription widely used for low back pain with Palmihwan(ø¢Ú«ü¯: HK161), Dokhualkisaengtang(Ô¼üÀÐôßæ÷·: HM381), and Boeuntang(ÜÍëä÷·: HM380).
Prescriptions for removin stagnated Blood(ÏÌåÜúìð¥) may be added according to the patients' condition. Powder for five kinds of accumulation in the abdomen is especially added with Yeoshintang(åýãê÷·:úÜû×ßã, éÚã£, ÙÊúÅ: HM378) in cases of sprains. For pain in the lower limbs, powder of semen arecae and folium perillae is added. Sopoongboshimdodamtang(áÂù¦ÜÍãýÓôÓÃ÷·: HM304), which is used in outpatient clinics of Kyunghee University Medical Center, may be applied to patients of Wind-Dampness Type.
Taking the lateral position lightens the burden of the patient when treating with acupuncture and moxibustion. Commonly used acupoints are BL23, BL24, BL26, and BL25 which should be inserted on both sides, and BL32, GB31, GB40, GB57, and G B60 for parts of the lower limbs with sciatica.
- Cold-Dampness Type
Pains include freezing pain in the low back with heaviness and stickiness, which gets severe in rainy or cold/freezing weather. When it happens to be under Heat, the pain lessens and the painful part is relatively fixed with feelings of sinking and heaviness.
The patients' tongue coating is either white or sticky, and the pulse is felt as sunken and slow. Treatments should be based on elimination of Cold with moving of phlegm-Dampness(ÓÃ) warming and opening the passages for Meridians. Widely prescribed medicines are Samseuptang(?ã¥÷·) with additions, and Younggaechoolgamtang(Ö½ÌýõôÊö÷·: HK153). KHU KOREAN MEDICINE Hospital widely uses medications like Sopoongboshimdodamtang(áÃù¦ÜÍãýÓôÓÃ÷·: HM304), and GV4, GB3, and GB34 are acupoints commonly treated in addition to moxibustion therapy.
- Dampness-Heat Type
Pains characteristically accompany fever on the painful part, and feelings of heaviness also come with the pain as if sitting in water. Physical activities may lessen pain, and if exposed to too much dampness, the pain will worsen. Symptoms such as scanty dark urine, thirst, fever with dysphoria and spontaneous sweating may occur. Tongue coating is yellow and greasy, and the pulse is slippery and frequent. Treatments should be based on clearing Heat with transforming Dampness and easing the branches of the Meridians. Chilmichangbaekhwan(öÒÚ«óïÛÛß¤) and Sammyohwan(ß²ÙØü¯) are fundamental prescriptions, and Yongdamsagantang(×£ÓÅÞáÊÜ÷·)may also be prescribed for its' cold nature with an effect of clearing Heat and detoxifying. ST36 and GB34 are commonly treated with acupuncture and moxibustion.
- Blood Stagnation Type
The affected part has stabbing pain which is felt to be fixed in one place and the pain gets worse when pressed. The pain tends to lessen during the day, but worsen during the night. Bodily symptoms include solid and blackish bowels, blackish tongue coating, and a choppy pulse. Treatments are basically ones that promote blood flow to remove blood stasis, and govern Qito stop pain. Common prescriptions include Kamihwalheoltang(Ê¥Ú«üÀúì÷·: HH141), Dangguibinsan(Ó×ÏýâÑß¤) and Yeoshintang(åýãê÷·: HM378). Therapy for removal of stagnated blood can be applied to the ill part of the body. Acupoints like GV26, GV1, and SI3 may also be used in addition.
- Kidney-Deficiency Type
Low back is prone to muscular atrophy and becomes feeble, and the pain in the region may not be strong but steady. It may get worse with overworking and improve by taking bed rest, or getting massages. Bodily symptoms include dizziness, tinnitus, nocturnal emission, and an increase in the amount of leukorrhea. If there is a deficiency of Kidney-Yang, symptoms such as clear urine, loss of thirst, a pale tongue, and a sunken and slow pulse is likely to accompany. In cases where Kidney-Eum is deficient, dryness of the mouth and throat, ¡°flushing sensation over the palms and soles, restlessness, insomnia, a reddened tongue with little coating, and tiny and frequent pulse occurs. For deficiency of Kidney-Yang, Kidney-Yang should be warmed and supplemented and the low back should be supported with strength. Prescriptions should be made for the vital gate such as Palmihwan(ø¢Ú«ü¯: HK161). For deficiency of Kidney-Eum, Eum(vital essence) should be replenished with the clearance of Heat, and the Blood should be nourished. A commonly used prescription is Yookmijihwangtang(ë»Ú«ò¢üÜ÷·: HM306). For acupuncture therapy, GV4, BL52, and KI3 may be additionally treated according to the conditions of the patient. Moxibustion may be applied on BL23 and GV4 for times.