abstracted & translated by

Bob Flaws, Lic. Ac., Dipl. Ac. & C.H., FNAAOM (USA), FRCHM (UK)

Keywords: Chinese medicine, Chinese herbal medicine, periarthritis of the shoulder, rotator cuff tendinitis, bursitis, musculoskeletal pain, treatment based on pattern discrimination

Periarthritis of the shoulder, or what is more commonly referred to as rotator cuff tendinitis and bursitis, is primarily encountered in middle-aged and elderly persons. Western medicine has little to offer in the treatment of this condition other than palliative analgesics and rest. However, Chinese medicine is generally very effective for the treatment of this condition. An example of this is an article written by Qiu Sui-ming titled, "The Treatment of 132 Cases of Periarthritis of the Shoulder By Chinese Medical Pattern Discrimination & Type Differentiation." This article appeared in issue #9, 2003 of Xin Zhong Yi (New Chinese Medicine) on pages 53-54. A summary of this article is given below.

Cohort description

There were 47 males and 85 females enrolled in this study aged 36-78 years, with an average age of 56. These patients had been suffering from rotator cuff tendinitis for from one week to three years. Diagnostic criteria were based on those found in Zhong Yi Bing Zheng Zhen Duan Liao Xiao Biao Sun (Criteria for Chinese Medical Disease & Pattern Diagnosis, Treatment & Outcomes) for periarthritis of the shoulder. In 105 cases, shoulder pain was unilateral, while it was bilateral in 27 cases. There was no bodily taxation and stirring in 77 cases, but there was in 55 cases. Seventy-three cases presented a pattern of wind, cold, and dampness, 21 cases presented a pattern of stasis and stagnation, and 38 cases presented a pattern of qi and blood vacuity.

Treatment method

In those patients presenting a wind, cold dampness pattern (which could appear at any stage in this condition), symptoms included pulling pain in the shoulder area which was made worse by exposure to wind and cold but became better on exposure to warmth, fear of wind and aversion to cold, possible feelings of heaviness in the affected region, mainly aching and pain initially, but stiffness in the latter period with restricted movement, a pale tongue with thin white, possibly slimy fur, and a bowstring, slippery or bowstring, tight pulse. In this case, treatment was in order to dispel wind and scatter cold, eliminate dampness and free the flow of the network vessels. The formula used for these purposes was Du Huo Ji Sheng Tang (Angelica Pubescens & Loranthus Decoction). If pain was severe, six grams each of processed Radix Aconiti Carmichaeli ( Chuan Wu ) and processed Radix Aconiti Kusnezoffii ( Cao Wu ) were added.

The stasis and stagnation pattern was mostly seen during the early stage of this condition. Symptoms of this pattern included swelling and distention of the shoulder, pain which refused pressure and which was worse at night, restricted movement of the affected joint, a dark tongue or possible static macules plus white fur, and a bowstring pulse. The treatment principles in this case were to transform stasis and free the flow of the network vessels. The formula used was Tao Hong Si Wu Tang (Persica & Carthamus Four Materials Decoction). If pain was severe, Yun Nan Bai Yao (Yunnan White Medicine) or Radix Pseudoginseng ( San Qi ) were added. If flexing and extending were inhibited, 15 grams of Herba Lycopodii ( Shen Jin Cao ) and 18 grams of Bombyx Batryticatus ( Jiang Can ) were added.

The qi and blood vacuity pattern was mostly seen during the latter stages of this condition. The symptoms of this pattern were soreness and pain of the shoulder which was made worse by taxation fatigue, a long disease course, restricted movement of the shoulder, and atrophy of the shoulder muscles. If qi vacuity was more, there was shortness of breath, a weak, faint voice and/or disinclination to speak, and lack of strength in the four limbs. If blood vacuity was predominant, there was dizziness, blurred vision, heart palpitations, and tinnitus. The tongue was pale and the pulse was fine and weak or deep. The treatment principles for dealing with this pattern were to regulate and supplement the qi and blood, soothe the sinews and quicken the network vessels. The formula used consisted of Si Jun Zi Tang (Four Gentlemen Decoction) plus Si Wu Tang (Four Materials Decoction). If there was more blood vacuity, 20 grams each of Caulis Milletiae Seu Spatholobi ( Ji Xue Teng ) and Caulis Tinosporae Sinensis Seu Cissi Pterocladae ( Kuan Jin Teng ) were added.

In all patterns, one packet of the above medicinals were decocted in water and administered per day. Ten packets equaled one course of treatment. All other medicines were stopped three days before the commencement of this protocol, and outcomes were analyzed after three courses.

Treatment outcomes

Cure was defined as disappearance of shoulder pain and normalization or basic normalization of the function of the affected joint. Improvement was defined as decrease in shoulder pain and improvement in joint function. No effect meant that there was no improvement in any symptoms associated with this condition. Based on these criteria, of the 73 patients presenting a wind, cold, dampness pattern, 65 were cured, six improved, and two got no effect, for a total effectiveness rate of 97.3%. Of the 21 cases who presented a stasis and stagnation pattern, 13 were cured, five improved, and three got no effect, for a total effectiveness rate of 85.7%. And, of the 38 patients who presented a qi and blood vacuity pattern, 29 were cured, six improved, and three got no effect, for a total effectiveness rate of 92.1%.

Discussion

According to Dr. Qiu, from the Chinese medical department at the Guang Shan Municipal First People's Hospital in Guangdong, This disease is mostly categorized as shoulder congealed wind in Chinese medicine and is mainly due to bodily vacuity or taxation fatigue with recurrent contraction of wind cold external evils. If wind, cold, and/or damp evils lodge in the blood vessels, sinews, and flesh, the blood within the vessels may become congealed and not flow. If cold, damp evils are excessive and spill-over into the sinews and flesh, these will not be able to flex and extend, and there may be wilting and loss of function. If this endures for a long time, adhesions will form. Of the three main patterns of this condition, Dr. Qiu says that the wind, cold, and dampness pattern is the most commonly seen. In fact, 73 out of 132 patients in this study presented that pattern. Dr. Qiu also notes that the best results are seen in those with the shortest disease duration. If the disease course is long with stiffness of the joint and atrophy of the surrounding muscles, treatment is not so effective and requires a correspondingly long period of time. Further, the younger, more robust, and generally the healthier the patient, the more effective is treatment, while the older and weaker the patient and the more yin, yang, qi, and blood vacuity, the more difficult they are to treat.

Copyright © Blue Poppy Press, 2004. All rights reserved.

For more information on the Chinese medical treatment of this condition, see Bob Flaws & Philippe Sionneau's The Treatment of Modern Western Medical Diseases with Chinese Medicine available from Blue Poppy Press.