bubble_chart Concept

Pain in the shoulder joint and the surrounding muscles, tendons, and bones is referred to as shoulder pain. Pain in the posterior shoulder that extends to the scapular region is called shoulder-back pain; shoulder pain that affects the upper arm and even the elbow and hand is referred to as shoulder-arm pain. Since all these conditions primarily manifest as shoulder pain, with pain in other areas being secondary to the shoulder pain, they can be collectively termed shoulder pain.

Shoulder pain often leads to varying degrees of functional impairment in the upper limb, and forced movement exacerbates the pain. In ancient Chinese medical texts, conditions primarily characterized by shoulder pain with minimal impact on functional activity are referred to as "shoulder pain" (Zhenjiu Jiayi Jing), "shoulder-back pain" (Neijing, Zhenjiu Jiayi Jing), "shoulder-arm pain" (Zhenjiu Jiayi Jing), and "anterior shoulder pain" (Neijing). If the main clinical manifestation is functional impairment with the inability to lift the arm, it is termed "shoulder immobility," as described in the entry on shoulder immobility. The symptom of shoulder pain has been classified under the category of Bi disease since the Neijing. The Zhenjiu Jiayi Jing refers to it as "shoulder-back Bi pain" or "shoulder-back general Bi-syndrome," while the Zhenjiu Zisheng Jing describes it as "shoulder pain general Bi-syndrome," "scapulohumeral periarthritis pain," or simply "scapulohumeral periarthritis."

bubble_chart Modern Research

Taiyang meridian shoulder and back pain is roughly equivalent to scapulohumeral periarthritis, cervicobrachial syndrome, supraspinatus tendinitis, and some cervical spondylosis in Western medicine. The integration of Chinese and Western medicine has shown significant efficacy in treatment, which may include oral anti-inflammatory and analgesic medications, as well as Chinese medicinal herbs that invigorate the blood and unblock collaterals, combined with local tuina and other manual therapies. Patients should also actively cooperate by engaging in upper limb exercises to accelerate the recovery of functional activity.

bubble_chart Pattern Analysis

1. Wind-cold︰For those with mild shoulder pain, the course of the disease is relatively short, and the pain is dull or aching in nature, not affecting the functional movement of the upper limbs. The pain may be localized to the shoulder, extend to the posterior shoulder and scapular region, or involve the anterior shoulder and upper arm, often accompanied by stiffness in the neck, back, or upper arm. The shoulder may feel cold, and warmth or massage can alleviate the pain. The tongue coating is white, and the pulse is floating or normal. Also known as "shoulder impediment pain" or "shoulder pain with generalized impediment," it is primarily caused by exposure to wind-cold. This occurs when wind strikes the body during sweating or when one is carelessly exposed to wind-cold while sleeping, with the pathogen lingering superficially in the skin. However, in individuals with weak constitution, defensive yang in the skin is insufficient, often leading to spontaneous sweating and susceptibility to wind-cold pathogens, resulting in shoulder pain. Suwen·"Generation of the Five Zang-Organs" states: "When lying down and exposed to wind, blood congeals in the skin, causing impediment." Jingui Yaolue·"Treatment of Blood Impediment, Deficiency, Fatigue, and Abnormal Pulse Syndromes" mentions: "Those of noble and luxurious status have weak bones and abundant skin and flesh. If further burdened by fatigue and sweating, lying still without movement, and exposed to slight wind, they will contract this disease." When wind-cold pathogens invade and linger in the skin and muscles, the qi and blood in the meridians become stagnant and obstructed, leading to impediment pain. The pain is mild and may be accompanied by numbness. For shoulder impediment pain due to weak constitution and unconsolidated defensive yang, Astragalus and Cinnamon Twig Five Ingredients Decoction can be used with additions such as Chinese Angelica, Turmeric, and mulberry twig. For cases where qi and blood deficiency is pronounced and exposure to wind-cold is severe, resulting in more noticeable pain, Juanbi Tang can be employed.
2. Damp Phlegm︰The pain in the shoulder and surrounding muscles is severe, and the course of the disease is prolonged. Although the functional movement of the shoulder joint is normal, the patient dares not move it due to the intense pain, as movement exacerbates the pain. Prolonged unhealed conditions can lead to restricted shoulder joint mobility. The shoulder feels cold and is averse to cold; warmth may temporarily alleviate the pain, but after a while, the pain and cold sensation return. Due to the severe pain, it often affects the patient's sleep, diet, and normal work. Profuse sweating is common because of the intense pain. Because the course of the disease is long, patients often exhibit symptoms of qi deficiency, such as spontaneous sweating, shortness of breath, intolerance to fatigue, and susceptibility to common colds. The tongue texture is pale with a white coating, and the pulse is wiry or wiry and thin. This is a more severe case of shoulder pain, with a broader range of pain than wind-cold shoulder pain. It is primarily caused by exposure to cold-dampness, where the pathogenic cold-dampness lingers in the muscles for a long time, resulting in pronounced pain and a prolonged course of illness. It is often caused by prolonged lying in cold-damp environments or soaking in cold water after profuse sweating. Lingshu· "Zhou Bi" (Generalized Bi Syndrome) states: "Wind-cold-dampness invades the space between the muscles, pressing urgently to form froth. When the froth encounters cold, it accumulates; when it accumulates, it pushes apart the muscles, causing splitting, and splitting leads to pain." Xu Ling-tai annotates: "Neijing does not contain the word 'phlegm'; froth here refers to phlegm." Froth refers to dampness and is called phlegm. Pressing urgently to form froth means pressing urgently to form phlegm. When phlegm-dampness accumulates between the muscles, "pushing apart the muscles and causing splitting," the pain becomes severe, hence it is called phlegm-dampness shoulder pain. Neijing refers to this as "Zhou Bi" (Generalized Bi Syndrome). The "Zhen Jiu Zi Sheng Pian" (Acupuncture and Moxibustion for Life Preservation) calls it "shoulder pain Zhou Bi." When phlegm-dampness lingers between the muscles and does not dissipate, not only is the pain severe, but qi and blood also become deficient. Therefore, the treatment focuses on dispelling cold-dampness and tonifying qi and blood. The prescription includes Aconite Main Root Decoction, supplemented with Atractylodes Rhizome, White Atractylodes Rhizome, Poria, Stephania Tetrandra, etc. The pain is severe, the course of the disease is prolonged, and there is no obvious history of trauma, nor significant local swelling or bruising. For cases that do not heal over time, static blood is often involved, manifesting as stabbing pain, Jingjin (sinew channel) stiffness, muscle atrophy, etc., with no significant changes in the tongue or pulse. In addition to dispelling cold-dampness and tonifying qi and blood, treatment should also include herbs to remove static blood, such as frankincense, myrrh, and Pangolin Scales.
3. Static Blood︰If caused by sprain, there is a clear history of external injury. If there is no sprain or external injury, but the shoulder pain is severe, characterized as stabbing pain, and shows little improvement despite treatments such as warming meridian and dissipating cold or dispelling wind-dampness to relieve pain, and persists for a long time, it is also considered static blood shoulder pain. Sprain-induced static blood shoulder pain may present with grade I swelling or no swelling, with obvious localized tenderness at the sprain site. Chronic static blood shoulder pain, on the other hand, shows no swelling, has a relatively widespread pain area, and no distinct tender points. Both types may cause grade I restriction in shoulder joint movement due to pain. With a clear history of trauma, sudden onset, possible localized swelling and tenderness, and pain often described as stabbing pain, the condition affects upper limb function. The primary treatment focuses on activating blood circulation, dispelling stasis, and relieving pain. The formula Peach Kernel, Carthamus and Four-Ingredient Decoction can be used, supplemented with Turmeric, frankincense, myrrh, and Ground Beetle.

The symptom of shoulder pain has traditionally been classified by medical practitioners within the scope of Bi disease, attributed either to wind-cold, phlegm-dampness, or static blood due to sprain. Clinically, the vast majority of cases present as cold pattern, often initially manifesting as excess pattern. In chronic conditions, it typically involves a deficiency of the body's vital energy with the presence of pathogenic factors, frequently accompanied by manifestations of insufficiency in qi, blood, liver, and kidney.

bubble_chart Documentation

1. Zhenjiu Jiayi Jing．Volume: "Heat in the shoulder, pain in the fingers and arms, the shoulder Yu point governs it."
2. Jingyue Quanshu："For those with dampness-heat disease, internal heat symptoms and a slippery, rapid pulse must be present before treating with cooling methods, suitable withTwo Wonderful Herbs Powder and modified Two Wonderful Herbs Pill,Angelica Pain-Relieving Decoction and the like. For those with severe heat, such as Chouxin Drink, it can also be temporarily used."
3. Linzheng Zhinan Yi'an Xu Ling-tai commented under the section "Pain in the Shoulder, Arm, and Back": "Pain fixed in the shoulder and back, this is a type of fixed arthralgia, external medicinal treatments must be used to attack and lift it, decoctions cannot achieve the effect."