bubble_chart Concept

Arm pain refers to the symptom of pain occurring in the entire upper limb, that is, the area below the shoulder and above the armpit (excluding the palm and fingers).

This symptom was already recorded in the Lingshu. Jingmai chapter, with descriptions such as "pain and coldness in the inner front of the arm", "pain in the front of the shoulder and arm", and "pain in the shoulder, arm, and outer elbow". It has been discussed in various medical texts throughout history, but it always relates to the mechanism described in the Lingshu. Jingmai chapter, where the flow of qi and blood is obstructed along the pathways of the three yin and three yang meridians of the hand Jingmai, leading to stagnation, blockage of the meridians, and pain due to obstruction.

Arm pain can also occur in certain internal organ disorders. For example, the Suwen. Zangqi Fashi Lun states: "Those with heart disease... experience pain in both inner arms," which is referred pain in the shoulder and arm caused by obstruction of the heart meridian. See also the section on inability to lift the shoulder.

bubble_chart Pattern Analysis

1. Wind-cold Dampness Obstruction︰Pain in the muscles, tendons, and joints of the arm, or soreness, swelling, and numbness. If wind predominates, the pain wanders and shifts, sometimes upward and sometimes downward, with a thin white tongue coating and a floating pulse; if cold predominates, the pain is more severe, the local skin is cold, and the tendons are tense, with a white tongue coating and a tight pulse; if dampness predominates, the pain is heavy and fixed, with slight local swelling, a white and greasy tongue coating, and a soggy pulse; if heat predominates, the pain is burning, with local redness and swelling, a yellow tongue coating, and a rapid pulse. Suwen states: "When wind, cold, and dampness evils combine, they form bi syndrome. If wind qi predominates, it is wandering bi; if cold qi predominates, it is painful bi; if dampness qi predominates, it is fixed bi." Due to the varying predominance of these three evils, the clinical manifestations of arm pain also differ. When wind qi predominates, the pain wanders and shifts, sometimes upward and sometimes downward; when cold qi predominates, the pain is more severe, the local skin is cold, and the tendons are tense due to cold constriction and astringency; when dampness qi predominates, the aching pain is heavy and fixed, with local swelling, as dampness is a yin pathogen with a sticky and greasy nature, so soreness is more pronounced than pain. Wind is a yang pathogen and easily transforms into dryness-heat, while extreme cold or dampness obstruction can also transform into heat, or constitutional yang exuberance can lead to heat bi. In heat bi, the arm pain is burning, with local redness and swelling. Clinically, differentiation should be based on the nature, severity, and manifestations of the pain. For wind predominance, treatment aims to expel wind and dredge collaterals, dissipate cold, and eliminate dampness, using Modified Saposhnikovia Root Decoction; for cold predominance, treatment focuses on dissipating cold to relieve pain, dispelling wind, and eliminating dampness, using Modified Aconite Main Root Decoction; for dampness predominance, treatment aims to eliminate dampness and unblock collaterals, dispel wind, and dissipate cold, using Modified Notopterygium Overcoming Dampness Decoction; for heat bi, treatment focuses on clearing heat and unblocking collaterals, dispelling wind, and overcoming dampness, using Modified White Tiger Decoction Plus Cinnamon Twig.
2. Deficiency of Both Qi and Blood︰Arm aching pain and numbness, mainly soreness and numbness, limb weakness, dull skin, accompanied by dizziness, dizzy vision, mental fatigue, lack of strength, poor appetite, pale tongue with thin coating, and thin weak pulse. Mostly due to chronic illness and physical weakness, deficiency of the spleen and stomach, insufficient source of qi and blood generation and transformation, failing to nourish the muscles, tendons, and joints of the arm, hence the arm aching pain and numbness, mainly soreness and numbness, weakness of joints and tendons, dull skin, and mental fatigue lack of strength. Due to insufficient qi and blood, the ability to resist external pathogens weakens, making it prone to invasion by wind-cold dampness, hence arm pain is commonly seen. Pale tongue with thin coating, thin weak pulse. Treatment should focus on tonifying and replenishing qi and blood, regulating the spleen and stomach, using Eight Precious Ingredients Decoction with modifications. It should also be noted that deficiency of qi and blood weakens the ability to resist pathogens, making it susceptible to invasion by wind-cold dampness, often accompanied by external pathogens. As Jisheng Fang states, "All are due to physical weakness, empty and loose interstices, affected by wind-cold dampness, leading to impediment." Clinical treatment should take this into account. If it is a deficiency pattern, there must be systemic deficiency manifestations, with emphasis on tonifying deficiency. Although external pathogens easily invade due to deficiency, the approach should still focus on reinforcing healthy qi and eliminating pathogenic factors.
3. Traumatic Blood Stasis︰Arm pain, localized swelling, thin tongue coating, and wiry pulse. If prolonged pestilent qi deficiency leads to blood stasis and stagnation, symptoms may include localized numbness of the skin, muscle atrophy, thin and greasy tongue coating, or petechiae on the edges, with a fine-wiry or fine-choppy pulse. Often caused by trauma or falls, the arm exhibits pain, swelling, and tenderness, possibly accompanied by muscle, tendon, or joint damage or tearing. Blood fails to circulate properly and spills outward, resulting in static blood accumulation, localized swelling, and bruising—pain arises from obstruction. Treatment should focus on invigorating the blood to unblock collaterals and dispelling stasis to promote regeneration. The recommended formula is Peach Kernel, Carthamus and Four-Ingredient Decoction with modifications. Another type is wind-cold-damp obstruction arm pain, which persists over time, leading to meridian blockage and impaired qi-blood circulation, causing qi stagnation and blood stasis—as the saying goes, "chronic illness inevitably leads to stasis." Symptoms include numbness of the skin, dull complexion, and muscle atrophy, all due to meridian obstruction depriving tissues of nourishment. Treatment should aim to activate blood circulation and dredge collaterals, using Peach Kernel, Carthamus and Four-Ingredient Decoction supplemented with insect-based herbs like Black-Tail Snake, whole scorpion, ground beetle, and earthworm.
4. Damp Phlegm︰Arm pain and heavy limbs, slight anasarca swelling, accompanied by chills and cold limbs, vertigo with nausea, chest tightness, loose stool, absence of thirst, pale and swollen tongue with white greasy coating, deep soggy or soggy-slow pulse. Mostly caused by spleen-kidney yang deficiency and internal retention of phlegm-fluid, obstructing the meridians and impeding the circulation of qi and blood, leading to arm pain. If spleen deficiency predominates, clear yang fails to ascend, resulting in vertigo, chest tightness, nausea, loose stool, white greasy tongue coating, and soggy-slow pulse. Treatment should focus on fortifying the spleen to resolve fluid retention, dispelling phlegm and harmonizing the collaterals. The formula used is Poria, Cinnamon Twig, Bighead Atractylodes and Licorice Decoction combined with modified Poria Pill. If kidney deficiency predominates, the warming function is impaired, leading to chills and cold limbs, slight anasarca swelling, pale and swollen tongue, and deep soggy pulse. Treatment should focus on warming the kidney and assisting yang, eliminating fluid retention and resolving phlegm. The formula used is modified Kidney Qi Pill combined with Two Old Ingredients Decoction.

In the clinical treatment of arm pain, based on the aforementioned pattern differentiation and treatment, it can be combined with horizontal limb movement, invigorating blood and nourishing blood, harmonizing the nutrient to unblock collaterals using herbs such as mulberry twig, Cinnamon Twig, Luffa Vegetable Sponge, Turmeric, and suberect spatholobus stem. If the condition persists for a long time without improvement, it is likely due to lingering stasis in the meridians, and the use of insect-based methods for dredging and removing obstructions is often effective.

bubble_chart Documentation

1. Danxi Xinfa-Gout: "Swelling and pain in the limbs and joints, with a choppy and rapid pulse, this is due to static blood."
2. Zabing Yuanliu Xizhu-Disorders of the Shoulder, Upper Arm, Elbow, Forearm, Wrist, and Hand: "As for the arm, it is where the six meridians are distributed, so when it comes to disease, it must be differentiated according to the affected area.… The reason for the pain, although not due to external wind, cold-dampness, or heat, must be due to the invasion of pathogens because of a deficiency of essential qi, and thus has its origin.… If there is soreness and swelling in the arm extending to the shoulder and back, and weakness and numbness in both hands, it is due to phlegm-fluid retention flowing into the limbs."