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Beth Conroy Compendium - Upper Extremity Pain - Traditional Chinese Medicine

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UPPER EXTREMITY PAIN TCM

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UPPEREXTREMITY

SUBMITTEDBY:TheDaoNow

Studieshaveshownthatarmandshoulderpainisfrequent.Painandinjuryfromdailyoveruse isafrequentcauseofupperextremitypain.Overuse,however,isdifferentforeachperson.An activitythatcausespainforonepersonmaynotforsomeoneelse.Ingeneralthough,themore frequentlyanactivityisperformed,andthemoreliftingorstrainingtheactivityrequires,the greatertheopportunityforinjuryandpain.Thesametransfers,dayinanddayoutcancausea lotofstrainonyourshouldersandwrists.Overuseinjuriescanaffectnearlyanyjointinthe upperextremities,butmostoftenaffecttheshouldersandwrists.Frequentinjurieswouldbe: RotatorCuffTears,BicepsTendinitis,CarpalTunnelSydnrome ForFrozenShoulder (CLICKINGONTHISLINKWILLNOTBRINGYOUTOANEW WINDOW.USEBROWSERBACKSPACETOGETBACKTOTHISPAGE.

SOURCES
CreditPhoto:webbooks.com http://acupuncture.com/conditions/shoulder.htm (CLICKINGONTHISLINKWILLNOT BRINGYOUTOANEWWINDOW.USEBROWSERBACKSPACETOGETBACKTOTHIS PAGE. SharonZhao:LecturesandNotesTSCA2008/2009 Maciocia,Giovanni.TheFoundationsofChineseMedicine:AComprehensiveTextfor AcupuncturistsandHerbalists:2ndEdition.ChurchillLivingston.2005. Tyme.StudentManualontheFundamentalsofTraditionalOrientalMedicine.LivingEarth

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Beth Conroy Compendium - Upper Extremity Pain - Traditional Chinese Medicine

Tyme.StudentManualontheFundamentalsofTraditionalOrientalMedicine.LivingEarth Enterprises.2001. PeiLin,SunandVangermeesch,Luc.BiSyndromesorRheumaticDisordersTreatedby TraditionalChineseMedicine.1994. AcupunctureToday ,April,2007,Vol.08,Issue04,PreventingDelayedOnsetMuscle Soreness:IntegratingTreatments,RondaWimmer,PhD,MS,LAc,ATC,CSCS,CSMS,SPS ExamplesofClinicalApplicationofMultipleNeedlinginNeijinginTreatingBiSyndrome, JournalofAcupunctureandTuinaScience,Aug2005.Vol.3,No4

CLINICALMANIFESTATION
Duetoinvasionofexogenouspathogenicfactors,trauma(sprainsorcontusions) improperdiet,mentaldepression,qideficiency (obstructingqiandbloodcirculation) Pain(boring,stabbing,distended) TONGUE:darkanddistendedsublingualveins/darktonguebody PULSE:choppy,wiry,thready,tight

TREATMENTPRINCIPLE
Qi&BloodStagnation Alleviatepainbymovingqiandblood

TREATMENTPLAN
LOCALPOINTS
FORSHOULDER:LI15,LI14,SJ14,GB21,LI11,LI10,LI4,LU5,SJ5,SI9,LI16, FORELBOW:LU5,LI4,LI10,LI11,LI12,PC5,SJ5,SJ10,HT3 FORWRIST:LU9,LI1LI6,SJ4,SJ5,SI4,SI5,PC7 GENERALPOINTS(QIANDBLOODSTAGNATION) SP10(Xuehai/SeaofBlood)andUB17(Geshu/DiaphragmShu)andSP6(Sanyinjiao/Three YinIntersection) LI4(Hegu/JoiningValley)andLR3(Taichong/GreatRushing) ST36(Zusanli/ThreeMilesontheLeg) CV4(Guanyuan/GateofOrigin) PC6(Neiguan/InnerPass) CV6(Qihai/SeaofQi) (evenorreducingmethodandlocalpointsforpaininupperextremities)

THEBISYNDROMESNEEDLETECHNIQUES
TRIPLENEEDLING LingShusays"Theessentialsofacupuncturelieintheneedlingtechniques"Onesuchisto puncturethecenteroftheaffectedpartwithoneneedleandbothsideswithtwoneedles respectivelyforthetreatmentofaffectionofasmallanddeepareaofcold.Itiscalledtriple needling.EspeciallygoodforTENNISELBOW,injuryofmedialligamentofkneejointandinjury ofthepiriformis.
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Beth Conroy Compendium - Upper Extremity Pain - Traditional Chinese Medicine

Whenthepainfulpointisfoundexactly,oneneedleisinsertedperpendicularlyapproachingor reachingthebone.Afterthearrivalofqi,theneedleismaintained.Thentwoneedlesare puncturedfrombothsidesoftheaffectedpartrespectivelywiththeneedletiptowardsthefirst andwitharelativelyshallowdepth.Afterthearrivalofqi,theneedlesarekeptinfor30 minutes. SUCCESSIVE/TRIGGERNEEDLING (BAOCI)TREATNONLOCALIZEDTRAVELINGPAIN:PROPOGATEDEQI ONENEEDLEISINSERTEDINTOTHEEFFECTEDAREA(ASHIPOINT)ALONGOR OUTSIDETHEMERIDIANWITHEVENORTHEREDUCINGMETHOD.THISNEEDLEIS RETAINEDFORAFEWMINUTES.ANOTHERNEEDLEISINSERTEDINTOTHEOTHER EFFECTEDAREA(ASHIPT)WITHTHESAMEMETHOD RESTORATIVE/REHABILITATINGNEEDLING (HUICI)TREATTENDONANDMUSCLEBI.ITISGOODFORRELAXINGMUSCLESAND TENDONS. ONENEEDLEISINSERTEDINTOTHEEFFECTEDAREA(ASHIPT),ITISFIRSTLY MANIPULATEDUPANDDOWNPERPENDICULARLY.THEN,PULLTHENEEDLETOTHE SKINLEVELTHENREINSERTITOBLIQUELYATTHESAMEEFFECTEDAREAAND CHANGETHENEEDLETOOTHERDIRECTIONSWITHSAMEMETHOD. NEEDLEFOURDIRECTIONS:LEFTRIGHTFORWARDBEHIND AT5OCLOCK,20OCLOCK,35,OCLOCK,50OCLOCK UNIFORM/RANKEDNEEDLING (QICI)TREATCOLDBITHATISFIXEDONASMALLANDRELATIVELYDEEPSPOT FIRSTONENEEDLEISINSERTEDINTHECENTEROFEFFECTEDAREA(ASHIPT)AND TWOOTHERNEEDLESAREPLACEDCLOSELYTOEACHSIDEOFTHEFIRSTONE. SUPERFICIAL/SURROUNDEDNEEDLING (YANGCI) reducemethodTREATCOLDBITHATISRELATIVELYSUPERFICIALONALARGEAREA OFSKINANDMUSCLE FIVENEEDLESAREUSEDTOGETHER.THEFIRSTISINSERTEDINTHECENTEROF THEEFFECTEDAREAPERPENDICULARLY.FOUROTHERNEELESAREINSERTED OBLIQUELYTOWARDTOTHECENTEROFTHEEFFECTEDAREA/SURROUNDTHE DRAGONWITHOUTTHECENTERNEEDLE SHORTTHRUSTNEEDLING (DUANQI)TREATBONEBI ONENEEDLEISINSERTEDATTHENEARESTACUPUNCTUREPOINTORINTHE CENTEROFTHEEFFECTEDAREA.AFTERQIARRIVAL(DEQI),ITISTHRUSTTOTHE DEPTH,UNTILTHETIPOFTHENEEDLEGENTLYTOUCHESTHEBONEUNDERNEATH. THEN,ITISTWISTEDALITTLEANDMANIPULATEDSLIGHTLYUPANDDOWN, CONTACTINGTHEBONEWITHEACHTHRUST SHALLOWNEEDLING (FUCI)TREATTENDONBI,MUSCLEBI,ANDCOLDBIWITHSYMPTOM 2NEEDLES:THEFIRSTNEEDLEISINSERTEDOBLIQUELYMUSCULARNUMBNESSAND MYATHROPHY.ANDSLIGHTLYLATERALTOTHEAFFECTEDMUSCLE, THESECONDNEEDLEISTHENPLACEDSIMILARLYATTHEOTHERSIDEOFTHE MUSCLETOWARDEACHOTHER/ MUSCLENEEDLING (HEGUCI)TREATMUSCLEBI/COLDDAMPBI/MUSCLESPASM/CRAMPING
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3NEEDLES:(LIKEACHICKENSFOOT/TENTED)THREENEEDLESAREUSED.THE FIRSTONEISINSERTEDINTHEMIDDLEOFTHEAFFECTEDMUSCLE,ONTHEMOST PAINFULSPOT,ANDISLIFTEDANDTHRUSTPERPENDICULARLYANDOBLIQUELY. TWOOTHERNEEDLESARETHENADDEDPARALLELTOTHETENDONS,ATEACHSIDE OFTHEATTACHMENTOFTHEMUSCLETOTHEBONE,ANDGENTLYMANIPULATED. PRINCIPLEOFPTSELECTIONS: 1.LOCAL:SHOULDER:NEEDLETHELI/LU/SI/SJFOLLOWTHEMERIDIAN 2.ADJACENTPOINTS:NEARBY:SHOULDERATLI/LUNGAREA:INTERIORASPECTOF SHOULDERADJACENTWOULDBELI11,IFLI18ISWHEREPAINIS,ORLI1O: 3.DISTAL:LI1,LI3OR4ORPOINTSATLOWERLIMB:SHOULDERPAIN:MIRROR INGUINAL:POSTERIORSHOULDER:HIPAREA/ORTOANKLEANDFEET

THEBISYNDROMESTREATMENTS
ObstructionofQiandBloodinthemeridiansandcollateralsduetotheinvasionofpathogenic wind,coldanddamp(1),constitutionalweaknessofthebodyandyangqideficiency(2),pores notopeningandclosingproperlyanddeficiencyofdefensiveyang/weiqi(3). Clinicalmanifestationsinclude:soreness,numbness,pain,swelling,limitedrangeofmotion, andheavysensationinthelimbsandjoints.Theseconditionscanbeaggravatedbycold,wind, and/ordampweatherconditions. TreatmentPrinciple:RemoveObstructionfromthemeridiansandcollateralsandRegulateYing &WeiQiforeliminationofwind/cold/dampGeneralPointSelection: LocalAshipoints DistalpointstoMoveQiandBlood JingWellpointsofaffectedmeridians Elbow:LU5,LI4,LI10,LI11,LI12,PC5,SJ5,SJ10,HT3 Forearm:LU6,PC6,Bizhong,Luozhen Wrist:LU9,LI1LI6,SJ4,SJ5,SI4,SI5,PC7 Fingers:LI3,LI4,SI3,SI5,SJ3,Baxie,Shixuan Warm&CreateCirculationinChannels:addmoxaLI4,SJ4,SJ5 WINDCOLDDAMPBI 1.WINDBI(WANDERINGBI) S/S SORENESSANDPAINMOVINGFROMJOINTTOJOINT LIMITEDRANGEOFMOTIONOFJOINTS AFFECTSQI,BLOODANDBODYFLUID:MIXTURE:EXCESS/DEFICIENCY AVERSIONTOWINDFEVER THINWHITETONGUECOAT FLOATINGPULSE TREATMENT:EXPELTHEWIND,UNBLOCKOBSTRUCTIONFROMTHECHANNELSAND COLLATERALS,SCATTERTHECOLDANDELIMINATEDAMPNESS Treatbloodpriortoexpellingwind.Asbloodcirculationisrestored,windisarrested Selectionofpoints:#1BL17SP10 GB20,DU14(3YANGMERIDIANS), BL12 NEEDLINGMETHOD:REDUCING NEEDLINGTECHNIQUE:SUCCESSIVE/TRIGGERNEEDLING(BAOCI) OTHERTHERAPEUTICMETHODS:FLUSHINGCUPPING,HERBALBATHEXTERNAL OINTMENT,ORTUINA

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Beth Conroy Compendium - Upper Extremity Pain - Traditional Chinese Medicine

OINTMENT,ORTUINA

2.COLDBI(PAINFULBI)SEVEREPAIN S/S SEVEREPAINOFTHEJOINTSANDLIMBS FIXEDPAINPAINCANBERELIEVEDBYAPPLICATIONOFWARMTHANDAGGRAVATED BYCOLD,PAINWORSEATNIGHT STIFFNESSOFJOINTSWITHDIFFICULTYINMOVEMENT NOREDNESSANDSWOLLENOFTHEJOINTS THINWHITESLIPPERYTONGUECOAT TIGHTANDWIRYPULSE TREATMENT:WARMTHECHANNELSANDCOLLATERALS,DISPELTHECOLD,EXPEL WINDANDELIMINATEDAMPNESS Warmthcanunblockthecongealingcold Selectionofpoints BL23,CV4,CV14,BL12 NEEDLINGMETHOD:EVEN NEEDLINGTECHNIQUE:RESTORATIVE/REHABILITATINGNEEDLING(HUICI) UNIFORM/RANKEDNEEDLING(QICI) SUPERFICIAL/SURROUNDEDNEEDLING(YANGQI) SHALLOW/SUPERFICIALNEEDLING(FUCI) MUSCLENEEDLING(HEGUCI) OTHERTHERAPEUTICMETHODS:CUPPINGMOXAHERBALBATHEXTERNAL OINTMENTORTUINA

3.DAMPBI(FIXEDBI)HEAVYSENSATION/PAINANDFIXED S/S HEAVINESS,NUMBNESS,ANDSORENESSSENSATIONOFTHELIMBSANDJOINTS SWOLLENJOINTS PAINISFIXEDINLOCATION,DIFFICULTYINMOVEMENT WHITEANDGREASYTONGUECOATING SOFTANDMODERATEPULSE MAYACCOMPANYWITHHEAVYHEADANDBODY,DISTENTIONOFCHESTOR ABDOMEN,REDUCEAPPETITE,DIFFICULTYURINATION,LOOSESTOOLS TREATMENT:ELIMINATEDAMPNESS,UNBLOCKTHECHANNELSANDCOLLATERALS, EXPELTHEWINDANDDISPELTHECOLD, Supporttheearthtodefeatwater Selectionofpoints SP9,SP5,ST36,BL20 NEEDLINGMETHOD:EVEN NEEDLINGTECHNIQUE:RESORATIVE/REHABILITATINGNEEDLING(HUICI) SHALLOWSUPERFICIALNEELDING(FUCI) MUSCLENEEDLING(HEGUCI) OTHERTHERAPEUTICMETHODS:MOXA,CUPPING,HERBALBATH,OINTMENT,
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Beth Conroy Compendium - Upper Extremity Pain - Traditional Chinese Medicine

OTHERTHERAPEUTICMETHODS:MOXA,CUPPING,HERBALBATH,OINTMENT, PLASTER,ORTUINA

4.WINDDAMPHEATBI(SWOLLENANDRED) S/S SUDDENONSET PAINFULJOINTSWITHREDNESSANDSWOLLEN PAINCANBERELIEVEDBYCOLDAPPLICATIONANDAGGRAVATEDPRESSURE REDTONGUEWITHYELLOWCOATING SLIPPERYANDRAPIDPULSE MAYACCOMPANYWITHAVERSIONTOWIND,FEVER,THIRST,SWEATING, IRRITABILITY,SCANTYDARKURINE TREATMENT:CLEARHEAT,DRAINDAMPNESS,EXPELWINDANDACTIVATEBLOOD CIRCULATION Selectionofpoints MAJORPTS GV14,LI11,LI4,ST43 NEEDLINGMETHOD:REDUCING OTHERTHERAPEUTICMETHODS:THREEEDGEDNEEDLE/BLEEDINGONJINGWELL POINTSORGV14WITHCUPPING,HERBALBATHORPLASTER

5.STUBBORNBI(HUANBI) 1)CHRONICBIDUETOQI&BLOODDEFICIENCY S/S INTERMITTENTJOINTPAINWITHDIFFICULTYINMOVEMENT SORENESSANDNUMBNESSOFTHELIMBS SORENESSANDWEAKNESSOFTHELOWERBACKANDKNEES FATIGUE,LASSITUDE,ANDSHORTNESSOFBREATH DIZZINESS,PALECOMPLEXION,ANDINSOMNIA PALETONGUEWITHTHINWHITECOAT THREADYANDWEAKPULSE TREATMENT:TONIFYQIANDNOURISHBLOOD,ACTIVATETHECHANNELSAND COLLATERALS,UNBLOCKTHEOBSTRUCTIONANDALLEVIATEPAIN Selectionofpoints: MAJORPTS ST36,SP6,BL17,BL18,BL20,BL23,GB39 NEEDLINGMETHOD:REINFORCING OTHERTHERAPEUTICMETHODS:MOXA,CUPPING,ORTUINA 2)CHRONICBIDUETOPHLEGMACCUMULATIONANDBLOODSTASIS S/S INTERMITTENTJOINTPAINWITHSWOLLENJOINTS JOINTDEFORMATION STIFFNESSANDDIFFICULTYINMOVEMENT SUBCUTANEOUSNODULES PURPLISHTONGUEWITHWHITEGREASYTONGUECOATING
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Beth Conroy Compendium - Upper Extremity Pain - Traditional Chinese Medicine

THEADYANDCHOPPYPULSE TREATMENT:TRANSFORMPHLEGM,DISSOLVEBLOODSTASIS,ACTIVATETHE CHANNELSANDCOLLATERALS,UNBLOCKTHEOBSTRUCTIONANDALLEVIATEPAIN. Selectionofpoints: MAJORPTS ST40,CV12,ST36,UB17,SP10,PC6 NEEDLINGMETHOD:REDUCINGOTHERTHERAPEUTICMETHODS:CUPPINGORTUINA

PATIENTEDUCATION/RECOMMENDATIONS
Herbalandacupuncturemedicinecanbeveryhelpfulinthetreatmentofarticularandsoft tissuerheumatologicaldisorders.Thefollowingarebasicpatternsseenclinically.Thetreatment ofpaininTCMispredicatedbasicallyonthesaying"ifthereisfreeflowthereisnopain." Therefore,formulasthatrestoreflowareused.Ingeneral,therapiesthatcanunblockflowand thustreatpainincorporateoneormoreofthefollowingherbalcategories(deficiencyofQiand Bloodmayalsoleadtoobstruction). Bloodmoving. Qiregulating. SpicyExteriorreleasing. Windextinguishing. Warming. Dampresolving WhichincludeherbsthatclearHeatandDryDampness,spicyExteriorreleasing,purgatives, Dampnessdraining,WindDampdispelling,aromaticallytransformingDampness,Phlegm transformingaswellasQimoving. AcupunctureToday ,April,2007,Vol.08,Issue04,PreventingDelayedOnsetMuscle Soreness:IntegratingTreatments,RondaWimmer,PhD,MS,LAc,ATC,CSCS,CSMS,SPS states: Theuseofacupuncturepoints,tuina,linaments,cupping,moxabustion,auriculartherapyand herbalformulasareveryeffective,amongotherTCMmodalities.Thereareanumberofherbal formulasusedtotreatbloodandqistagnation,aswellasindividualpreexistingconditions.In somecases,herbalformulasusedinbisyndromealsomaybeeffectiveusuallyifpreexisting deficiencyispresent.

PROGNOSIS
AccordingtoAcupunctureandElectroacupuncture:EvidenceBasedTreatmentGuidelines, CAOMA2004:GRADEA/LEVELII THEUSEOFACUPUNCTUREANDELECTROACUPUNCTUREISAPPROPRIATEFOR, BUTNOTLIMITEDTO,THEFOLLOWINGTYPESOFSHOULDERCONDITIONS: INJURIESTOTHESHOULDERGENERAL ACROMIOCLAVICULARJOINTSEPARATION/COMPRESSION BICEPSTENDONINJURY ROTATORCUFFTEAR ADHESIVECASULITIS(FROZENSHOULDER SHOULDERTENDINITIS/BURSITIS MUSCLESPASM THORACICOUTLETSYNDROME
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Beth Conroy Compendium - Upper Extremity Pain - Traditional Chinese Medicine

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