Traditional Asian Medicine for Back and Neck Pain
Chief Complaint: back and neck pain
Western Diagnosis: myofascial pain syndrome, “herniated and bulging discs”
Medical History: The patient came for treatment in 2001.
The patient is female, 25yrs old.
5′ 6″ 160lbs
2 children ages 3 and 6
Employed in Customer service fora Medical Clinic
Severe pain began following MVA in 1987. Subsequent MVAs in 97, 98, 99, 00, and 01. Surgery on RS knee 3X.
MD DX with allergies of “sinus type, unknown cause”, and HBP.
Reports being diagnosed with psoriasis but has no recent outbreaks, complains of dry skin and hair, and acne but does not currently present with blemishes.
Occasional difficulty in urinating, consistent history of poor digestion with symptoms of abdominal bloating, indigestion, high appetite, abdominal pain and cramping, and chronic constipation.
Medications include: Colace , BCP, Elantin, Nasonex, Celebrex, Robaxin , Oxycontin, and Effexor.
Questioning exam: The patient has difficulty falling and staying asleep because of pain. Is able to sleep with prescribed medication but reports sleep as “unsound” and complains of constant fatigue.
Describes the pain as constant aching with periods of throbbing and numbness, and weakness in the limbs. Has reduced sexual energy.
Reports depression and irritability. Headaches (self-described as “migraines” but not medically diagnosed), and sees floaters on occasion.
Has regular and unremarkable menstruation.
Patient presents as articulate and well spoken. Has some “flatness” in tone, and dullness in the eyes; both of which I assume are attributable to medications. Her muscle tone is somewhat flaccid, and edematous, she is “fleshy” but not obese. Bearing and posture is stiff, especially the upper body, with a tendency to turn her whole upper torso instead of the neck, and she has slightly rounded shoulders. Her back is cold to the touch, and her hands and feet are moist with cold, clammy sweat.
Pulse exam: Pulses are thready, deep, and rapid (80-96 BPM).
Tongue exam: Her tongue body is red, puffy and wet. The tongue coating is thin and white, (sometimes thin and yellow). There are small, dark purple spots throughout.
OM Diagnosis: Diagnosis is Painful Obstruction Syndrome, Blood Stasis from repeated trauma injuries, and obstruction by Cold-Dampness. There is also Liver and Spleen disharmony.
Treatment Principle: The treatment principle was to Open the channels, invigorate Blood and Qi, and resolve Dampness. A smaller portion of the treatment focused harmonizing Liver and Spleen.
Point Prescription: Patient was given a moderate treatment initially, using bodywork only.The trapezius and SCM muscles were on the verge of spasm, so techniques used were primarily sustained pressure and some limited kneading. The most tender areas were the upper back and neck and the SI joint on the right side.
Treatment was emphasized at: GB20 and GB21, SI17, SI15, SI11, SI10, SI9. The Bladder and Gallbladder channels were treated repeatedly with emphasis at ashi points and Bl11-Bl16 and BL27-BL30. Distal points used were BL40, BL60, SI3, BL62, GB31 and GB34. Mild dispersing was used at SP10 and SP9, LR3 and BL18, and even treatment at SP6 and ST36, K7, and LR8 . Light traction was given to both shoulders. No ROM was used for the initial treatment as she was unable to relax and maintained a degree of resistance-tension throughout the treatment. The patient called 2 days after treatment reporting an exasperation of pain.
On questioning, the patient was not sure if the exasperation was due to treatment or her subsequent activity following treatment which included lifting and digging in her garden. Patient was scheduled for acupuncture.
Herbal Formula: Patient then requested herbal medicine to help her sleep. I suggested we try ” Meridian Passage Formulation” a liquid extract preparation made by Kan herbs. I thought we should try and reduce her pain levels rather than just try more narcotics. A moderately high dosage is taken twice daily; instead of three times. She is not to take the formula close to bedtime as it contains warming herbs. This formula is based on Shen Tong Zhu Yu Tang and Mo Yao Xiang Sheng Dan. It contains the following herbs:
Hong Hua ” safflower ” warm and pungent; enters Heart and Liver and moves Blood.
Niu Xi ” achyranthes root ” bitter, sour, and neutral, enters Liver and Kidney; moves Blood, and strengthens the Tendons and Bones.
Qin Jiao ” gentian root ” bitter, pungent and neutral, enters the Liver, Stomach, and Gallbladder; expels Wind-Damp, harmonizes Blood, and relaxes the Tendons.
Qiang Huo – notopterygium root ” bitter, warm, and pungent, enters Bladder and Kidney; removes Wind/Cold/Damp.
Chuan Xiong ” Ligusticum ” Pungent and warm, enters Liver, Gallbladder, and Pericardium; moves Blood, expels Wind and alleviates pain.
Dang Gui ” sweet, pungent, bitter and warm, enters Liver, Heart, and Spleen; moves Blood and nourishes Blood.
Xiang Fu ” cyperus rhizome ” pungent, slightly bitter, and sweet, enters the Liver and Triple Heater; “penetrates” the Qi of all 12 meridians; moves both Qi and Blood.
Gan Cao ” licorice root – sweet and neutral, enters Spleen and Lung; harmonizes all the herbs and with Bai Shao, relieves spasm.
Mo Yao ” myrrh ” Bitter and neutral, enters the Liver; scatters Blood, reduces swelling, and promotes healing.
Zi Ran Tong ” pyrite ” pungent, bitter, and neutral, enters Liver and Kidney; scatters Blood and alleviates pain.
Gu Sui Bu ” drynaria rhizome ” bitter and warm, enters Liver and Kidney; promotes healing of Tendons and Bones.
Bai Shao ” white peony root ” bitter., sour, and cool, enters Liver and Spleen; nourishes Blood, relaxes the tendons to relieve pain.
Ru Xiang ” frankincense ” pungent, bitter, and warm, enters the Heart, Liver. and Spleen; moves Blood, relieves spasm, and promotes healing.
Lifestyle Prescription: Acupuncture treatment was given. There was no change in the general presentation so no change in diagnosis. Needling concentrated on ashi points in the neck and upper back and in the sacrum. General points were: LR3, LI4, SP6, SP10, ST36, SI3 and BL62. Four needles were placed in the neck and upper back and three needles were placed along the SI joint on the RS and given mild manipulation. The patient reported relief from pain, albeit temporary, following treatment.
Subsequently, the patient canceled or no-showed several appointments. Several months passed before she scheduled again. She once showed up for an appointment on the wrong day and then argued with the receptionist for several minutes. She called to cancel recently and requested that I stay late or make special arrangements for her.
The patient is currently out of town seeing her neurologist in Tucson, AZ. She has been treated 5X since April. Her brother is paying for the treatment.
Synopsis: There was no resolution to this case. The patient never returned for treatment and could not be contacted by our clinic for follow up. This was a difficult case, chosen for it’s complexity and the multiplicity of symptoms, medications, physiological and mental-emotional levels. I would welcome any insight and comments other practitioners can offer.