Arm Support ™
TCM DIAGNOSIS: Qi and blood stagnation
* Shoulder: periarthritis of the shoulder, frozen shoulder, capsulitis, rotator cuff tear, rotator cuff tendonitis, bursitis, inflammation and pain of the shoulder, subluxation or dislocation, AC (acromioclavicular) separation
* Elbow: lateral epicondylitis (tennis elbow), medial epicondylitis (golfer’s elbow), olecranon bursitis, tendonitis
* Wrist: carpal tunnel syndrome, tendonitis, sprain and strain
* General pain and discomfort of the arm: tendonitis, bursitis, arthritis, numbness, decreased range of motion, and atrophy
WESTERN THERAPEUTIC ACTIONS
* Analgesic effect to alleviate pain
* Anti-inflammatory function to reduce swelling and inflammation
* Muscle-relaxant property to relieve spasms and cramps
* Protects and facilitates the recovery of cartilages from repetitive damages
CHINESE THERAPEUTIC ACTIONS
* Dispels cold and damp
* Activates qi and blood circulation
* Opens peripheral channels and collaterals
* Relieves pain
Take 3 to 4 capsules, three times daily as needed to relieve pain. The dosage may be increased up to 6 to 8 capsules every four to six hours if necessary, especially in the early stages of injury when there is severe and excruciating pain. When the pain subsides, the dosage should be reduced to 3 or 4 capsules, three times daily. For maximum effectiveness, take the herbs on an empty stomach with two tall glasses of warm water. In chronic cases or for consolidation of treatment efficacy, the dosage can be reduced to 2 capsules twice daily on an empty stomach.
Bai Shao (Radix Paeoniae Alba)
Dan Shen (Radix et Rhizoma Salviae Miltiorrhizae)
E Zhu (Rhizoma Curcumae)
Ge Gen (Radix Puerariae Lobatae)
Gui Zhi (Ramulus Cinnamomi)
Ji Xue Teng (Caulis Spatholobi)
Jiang Huang (Rhizoma Curcumae Longae)
Luo Shi Teng (Caulis Trachelospermi)
Sang Shen (Fructus Mori)
Sang Zhi (Ramulus Mori)
Shan Zha (Fructus Crataegi)
Wu Jia Pi (Cortex Acanthopanacis)
Xi Xian Cao (Herba Siegesbeckiae)
Yan Hu Suo (Rhizoma Corydalis)
Musculoskeletal and connective tissue disorders are major causes of pain and physical disability. Causes of these bone, muscle, and joint disorders vary greatly, depending on the exact disease. Simple causes include trauma and external injuries, such as pulled muscles, strained ligaments, dislocated joints, and bone fractures. Complicated causes include infection, autoimmune disorders, crystal-induced inflammation, and non-inflammatory tissue degeneration. Optimal treatment must address the symptoms (pain and inflammation) and the underlying causes. After the disorder is stabilized, physical therapy and exercise are important to maintain flexibility and strengthen surrounding muscles.
Arm Support is designed specifically to treat disorders of the arms, including shoulders, elbows, and wrists. Disorders of the arms are usually characterized by swelling, inflammation, pain, decreased range of motion with movement difficulty, and in severe cases, atrophy of the muscles and soft tissues. To successfully treat this condition, herbs are used to activate qi and blood circulation, dispel qi and blood stagnation, open channels and collaterals, and relieve pain.
In this formula, Dan Shen (Radix et Rhizoma Salviae Miltiorrhizae), E Zhu (Rhizoma Curcumae), and Yan Hu Suo (Rhizoma Corydalis) activate qi and blood circulation, dispel qi and blood stagnation, and relieve pain. Shan Zha (Fructus Crataegi) enters the xue (blood) level, moves blood, and reduces inflammation and swelling. Sang Shen (Fructus Mori), Ji Xue Teng (Caulis Spatholobi) and Wu Jia Pi (Cortex Acanthopanacis) tonify yin and blood, and strengthen soft tissues (muscles, tendons, and ligaments). Gui Zhi (Ramulus Cinnamomi), Sang Zhi (Ramulus Mori), Xi Xian Cao (Herba Siegesbeckiae), Jiang Huang (Rhizoma Curcumae Longae) and Luo Shi Teng (Caulis Trachelospermi) open the channels and collaterals and relieve pain. Bai Shao (Radix Paeoniae Alba) relaxes muscles and Ge Gen (Radix Puerariae Lobatae) relieves pain in the upper jiao. Lastly, Gui Zhi (Ramulus Cinnamomi) and Sang Zhi (Ramulus Mori) act as channel-guiding herbs, leading the effect of the formula to the upper body and the extremities to directly treat the affected area.
In summary, Arm Support is an excellent formula to treat all types of musculoskeletal disorders affecting the arms, including shoulders, elbows, and wrists.
CAUTIONS & CONTRAINDICATIONS
* This formula has strong qi and blood activating herbs and is contraindicated during pregnancy and nursing.
* Dan Shen (Radix et Rhizoma Salviae Miltiorrhizae) may enhance the overall effectiveness of Coumadin (warfarin), an anticoagulant drug. Patients who take anticoagulant or antiplatelet medications should nottake this herbal formula without supervision by a licensed healthcare practitioner.
* Shoulder pain that originates from a heart condition is known as referred pain. The left shoulder is mostly affected and there will be other accompanying symptoms of chest pain, palpitation, or shortness of breath. Referred pain due to liver or gallbladder problems may also reflect in the shoulder, but especially the right shoulder. These potential differential diagnoses should be investigated and ruled out during initial evaluations. This formula is not designed for referred pain caused by acute internal organ problems.
* This formula is most effective when used as an adjunct formula to acupuncture treatment. Optimal results will show when acupuncture, electro-stimulation, and herbs are included in the treatment regimen.
* Avoid repetitive movements that may contribute to further injuries, such as in cases of inflammation of the joint, tennis elbow, or carpal tunnel syndrome.
* Cold packs may be used for acute injuries to reduce swelling and inflammation. In general, only during the first 24 to 48 hours of the injury where there is prominent inflammation should ice be used. On the other hand, hot packs should be used for chronic injuries to promote blood circulation and enhance healing in the affected area.
* Tui-na and acupuncture can add tremendous relief for the patient immediately. Herbs can then be administered to consolidate the effect.
Pulse Diagnosis by Dr. Jimmy Wei-Yen Chang:
* Frozen shoulder: scattered pulse, a pulse with no border, soft and weak, on the right chi position
* Soft tissue damage of the shoulder: turtle pulse, a convex-shaped pulse, on the right chi position
* Cervical disk problem or spur with radiating pain down the arm: thin, straight, tight pulse extending proximally to the right chi position
* For headache, combine with Corydalin (AC).
* With acute pain or numbness of neck and shoulders, combine with Neck & Shoulder (AC).
* With radiating or tingling pain of the arm caused by cervical spondylosis, combine with Neck & Shoulder (AC).
* With chronic pain of neck and shoulders, combine with Neck & Shoulder (CR).
* For acute disorders of the arm with severe pain, combine with Herbal ANG.
* For chronic disorders of the arm with atrophy and tearing of soft tissues (muscles, ligaments, tendons), combine with Flex (MLT).
* For arthritis or bi zheng (painful obstruction syndrome) due to heat, add Flex (Heat).
* For arthritis or bi zheng (painful obstruction syndrome) due to cold, add Flex (CD).
* For tightness and spasms of the muscles, tendons and ligaments, add Flex (SC).
* For bone spurs and calcific tendonitis, add Flex (SPR).
* For nerve pain, add Flex (NP).
* For bone fractures or bruises, add Flex (TMX).
* For osteoarthritis, add Osteo 8.
* With severe inflammation, add Astringent Complex.
* Shoulder pain: Jianyu (LI 15), Jianliao (TH 14), Jianzhen (SI 9) and any other ah shi points
* Elbow pain: Quchi (LI 11), Xiaohai (SI 8), Tianjing (TH 10), Shousanli (LI 10), Hegu (LI 4) and any other ah shi points
* Wrist pain: Yangchi (TH 4), Yangxi (LI 5), Yanggu (SI 5) and any other ah shi points
Classic Master Tung’s Points:
* Needle contralateral to the pain. If the pain is present on both sides, needle bilaterally or the side with the more ah shi points.
* General arm pain: Zuwujin (T 77.25), Shangjiuli (T 88.26), Zhongjiuli (T 88.25), Xiajiuli (T 88.27), Shangqu (T 44.16)
* Lateral upper arm pain: Tongtian (T 88.03), Tongshan (T 88.02), Tongguan (T 88.01), Simashang (T 88.18), Simazhong (T 88.17), Simaxia (T 88.19), Sihuashang (T 77.08), Sihuaxia (T 77.11), Sihuazhong (T 77.09)
* Medial upper arm pain: Shangquan (T 88.22), Zhongquan (T 88.21), Xiaquan (T 88.20), Simashang (T 88.18), Simazhong (T 88.17), Simaxia (T 88.19), Yizhong (T 77.05), Erzhong (T 77.06), Sanzhong (T 77.07)
* Lateral forearm pain: Waisanguan (T 77.27), Zuqianjin (T 77.24), Zuwujin (T 77.25), Sihuazhong (T 77.09)
* Medial forearm pain: Huoshan (T 33.06), Tianhuang (T 77.17), Dihuang (T 77.19), Renhuang (T 77.21), Waisanguan (T 77.27)
* Frozen shoulder: Linggu (T 22.05), Dabai (T 22.04), Fanhoujue (T 22.12)*, Tianhuangfu [Shenguan] (T 77.18), Minghuang (T 88.12), Tianhuang (T 88.13), Qihuang (T 88.14), Quchi (LI 11), Xiyan, Huantiao (GB 30), Renhuang (T 77.21), Sihuashang (T 77.08), Waisanguan (T 77.27), Sizhi (T 77.20), ah shi points around the second metacarpal phalangeal joint, Baguansan (T 11.30)*, Baguansi (T 11.31)*. Bleed the affected area with cupping. Bleed before needling for best result.
* Tennis elbow: Shuanglongyi (T 77.29)*, Shuanglonger (T 77.30)*, Shangchun (T 77.15), Xiachun (T 77.16), Sizhi (T 77.20), Waisanguan (T 77.27)
* Golfer’s elbow: Shuanglongyi (T 77.29)*, Shuanglonger (T 77.30)*, Waisanguan (T 77.27), Tianhuang (T 88.13), Shangchun (T 77.15), Xiachun (T 77.16), Yinlingquan (SP 9), Quling (T 33.16)
* Wrist pain: Sizhi (T 77.20), Waisanguan (T 77.27), three points around the ah shi points on the front of the ankle
* Finger numbness: Minghuang (T 88.12), Tianhuang (T 88.13), Qihuang (T 88.14), Sifeng, Xinling (T 33.17)*, Zhongjiuli (T 88.25)
* Index finger pain: Sihuazhong (T 77.09)
* Middle finger pain: Dan (T 11.13), Tongguan (T 88.01), Tongshan (T 88.02)
Master Tung’s Points by Dr. Chuan-Min Wang:
* Shoulder pain: Needle contralaterally Jianzhong (T 44.06), Zhongjiuli (T 88.25), Qili (T 88.51)*, Tianhuangfu [shenguan] (T 77.18), Sizhi (T 77.20).
* Elbow pain: Needle contralaterally Quling (T 33.16), Cesanli (T 77.22), Cexiasanli (T 77.23).
* Wrist pain: Needle contralaterally Cesanli (T 77.22), Cexiasanli (T 77.23), Tung’s Wantong (T 66.16)*.
Balance Method by Dr. Richard Tan:
* Shoulder pain:
· Needle ah shi points on the opposite wrist: Yangxi (LI 5), Yangchi (TH 4), Wangu (SI 4) to Yanggu (SI 5), Jingqu (LU 8) to Taiyuan(LU 9), Shenmen (HT 7), Daling (PC 7)
· Needle all ah shi points on the opposite ankle: Zhongfeng (LR 4), Shangqiu (SP 5), Taixi (KI 3), Kunlun(BL 60), Qiuxu (GB 40), Jiexi (ST 41)
* Elbow pain:
· Needle ah shi points on the opposite knee: Yinlingquan (SP 9) to Xuehai (SP 10), Ququan (LR 8), Yingu (KI 10), Weiyang (BL 39) to Weizhong (BL 40), Xiyangguan (GB 33) to Yanglingquan (GB 34), Dubi (ST 35) to Zusanli (ST 36)
* Wrist pain:
· Needle on the opposite side of the pain: Shangqiu (SP 5), Zhongfeng (LR 4), Rangu (KI 2), Taixi (KI 3), Yangxi (LI 5), Yanggu (SI 5), Yangchi (TH 4)
· Needle on the same side of the pain: Kunlun(BL 60), Qiuxu (GB 40), Jiexi (ST 41)
Auricular Medicine by Dr. Li-Chun Huang:
* Tennis elbow (external humeral epicondylitis): Tennis Elbow Point, Elbow. Bleed Helix 2.
* Carpal tunnel syndrome: Wrist (front and back of ear). Bleed Helix 1.
* Trigger finger: Wrist (front and back), Finger (front & back). Bleed Ear Apex.
* Eat plenty of whole grains, seafood, dark green vegetables, and nuts. These foods are rich in vitamin B complex and magnesium, which are essential for nerve health and relaxation of tense muscles, respectively.
* Adequate intake of minerals, such as calcium and potassium, are essential for pain management. Deficiency of these minerals will lead to spasms, cramps, and tense muscles.
* Patients should avoid exposing affected areas to cold or drafts. Wear adequate clothing to cover the arms, shoulders, and neck to avoid exposure to cold.
* Patients with disorders of the elbows or wrists should be encouraged to gently exercise the affected area as much as possible.
* Frozen shoulder is one condition in which the patient should be advised to exercise the joint frequently. Because the shoulder has the greatest range of motion of any joint in the body, stretching and strengthening exercises are essential in keeping the shoulders healthy. Prolonged immobilization causes adhesions, which makes treatment very difficult and painful. Patients should be advised to move their shoulder(s) in all directions (external and internal rotation, abduction and extension) to improve pain free range of motion. Heat packs are often helpful in this condition.
* Hot baths with Ai Ye (Folium Artemisiae Argyi) or Epsom salt help to relax tense muscles, invigorate blood flow, and draw toxins from tissues. Rest and relax in the bath for about 30 minutes. About 2 to 3 tablespoons of Ai Ye (Folium Artemisiae Argyi) powdered extract can be mixed in the hot water each time.
* Patients should note their sleeping position, as poor sleeping position may lead to shoulder and neck pain in the morning.
* R.T., a 48-year-old male patient, presented with pain in his right elbow, which began four months prior. Over a short period of time it got progressively worse to the point where he couldn’t use his hand and arm at all. Objective findings were tenderness to the touch around the lateral epicondyle and Chize (LU 5) area, and weakness of the hand. The Western diagnosis was lateral epicondylitis; the TCM diagnosis was qi and blood stagnation. The patient was prescribed Arm Support. After two bottles, the patient reported that almost all of the arm function had returned and only felt minor pain when working out. Consideration was then made to switch to Flex (MLT) for future maintenance. Submitted by E.C., Lake Forest, California.
* B.L., a 25-year-old male patient, presented with pain in the left shoulder which had begun one month prior. On a scale from 1 to 10 (with 10 being the most painful), the patient rated his pain as a 7. He was involved in boxing and packaging activity and noted that he was unable to perform with his left arm at work. Objective findings were limited range of motion reduced to about 30% mobility, and positive signs for supraspinatus injury. The Western diagnosis was rotator cuff injury; the TCM diagnosis was local qi and blood stagnation. Arm Support was prescribed at three capsules three times daily. After nine days of taking the herbs, the patient reported he was experiencing no pain in his left shoulder and his range of motion had increased to 100% mobility. Submitted by E.C., Lake Forest, California.
* D.S., a 65-year-old female, presented with discomfort fluctuating between the areas of the neck, shoulder, and lower back. It was noted that this condition had been affected by sitting at her desk job throughout the day. Objective findings included limited range of motion, and a positive reaction when palpating her rotator muscles. The practitioner diagnosed this condition as damp-cold bi zheng (painful obstruction syndrome); her Western diagnosis was fibromyalgia. For treatment, Herbal ANG and Arm Support were prescribed. After taking the herbs, the patient has reduced the amount of her anti-inflammatory drugs and other prescription drugs by 70%. When lower back pain was also present, the patient was given Back Support (CR). Overall the patient reported her pain has decreased by 50% and continues taking the herbs for more relief. Submitted by J.L., San Diego, California.
* S.C., a 62-year-old female, presented with pain in the right wrist due to practicing yoga, along with high stress and insomnia. The patient had not yet seen a Western doctor for this condition, but her TCM diagnosis was qi and blood stagnation in the Lung, Pericardium, and Heart channels. For treatment, Arm Support and Calm ZZZ were prescribed at 3 to 4 capsules three times a day for each formula. After taking the herbs for one week, the wrist pain had completely resolved and did not return. The additional symptoms of stress and sleep had improved during the course of the following two weeks. The patient has stopped taking the Arm Support and continues taking only the Calm ZZZ. Submitted by B.S., Niceville, Florida.
* A.M., a 40-year-old female, presented with pain in the wrist due to giving massages, in which any rest was helpful in pain relief. The TCM diagnosis was qi and blood stagnation in the Lung, Pericardium, and Heart channels along the wrist. For treatment, Arm Support was prescribed at 3 to 4 capsules three times per day. Pain had decreased with taking the herbs; however, the pain returned when she resumed massaging and discontinued taking the herbs. In response, the patient continued to take the herbs for pain management while massaging due to not being able to refrain from massaging. Submitted by B.S., Niceville, Florida.
* C.C., a 47-year-old female, who is overweight, presented with arthritis pain in her thumb. The practitioner diagnosed this condition as qi stagnation along the wrist and along the Lung, Pericardium, and Small Intestine channels, and also phlegm fluid retention. For treatment, Herbalite and Arm Support were prescribed. After taking the Arm Support, the pain in her wrist had stopped and her thumb’s range of motion had increased when combined with acupuncture treatment. Submitted by B.S., Niceville, Florida.
PHARMACOLOGICAL AND CLINICAL RESEARCH
Arm Support is designed specifically to treat disorders of the arms, including shoulders, elbows, and wrists. Clinical manifestations of such disorders include swelling, inflammation, and pain; decreased range of motion with movement difficulties, and in severe cases, atrophy of the muscles and soft tissues. Clinical applications of this formula include periarthritis of the shoulders, frozen shoulder, tennis elbow, carpal tunnel syndrome, and general conditions such as tendonitis, bursitis, and arthritis.
Yan Hu Suo (Rhizoma Corydalis) is one of the strongest and most potent herbs for treatment of pain. Its effects are well documented in both historical references and modern research studies. According to classical texts, Yan Hu Suo (Rhizoma Corydalis) has been used to treat chest and hypochondriac pain, epigastric and abdominal pain, hernial pain, menstrual pain, amenorrhea and pain of the extremities. According to laboratory studies, the extract of Yan Hu Suo (Rhizoma Corydalis) has been found to effectively treat both acute and chronic phases of inflammation. The mechanism of its anti-inflammatory effect is attributed to its inhibitory action on the release of histamine and pro-inflammatory mediators., Furthermore, it has a strong analgesic effect. With adjustment in dosage, the potency of Yan Hu Suo (Rhizoma Corydalis) has been compared to that of morphine. In fact, the analgesic effect of Yan Hu Suo (Rhizoma Corydalis) is so strong and reliable that it has been used with satisfactory anesthetic effect in 98 out of 105 patients (93.4%) who underwent surgery. The analgesic effect can be potentiated further with concurrent acupuncture therapy. In one research study, it is demonstrated that the analgesic effect is increased significantly with concurrent treatments using Yan Hu Suo (Rhizoma Corydalis) and electro-acupuncture, when compared to a control group, which received electro-acupuncture only. Overall, it is well understood that Yan Hu Suo (Rhizoma Corydalis) has a marked effect to treat pain. Though the maximum analgesic effect of Yan Hu Suo (Rhizoma Corydalis) is not as strong as morphine, it has been determined that the herb is much safer, with significantly less side effects, less risk of tolerance, and no evidence of physical dependence even with long-term use.
In addition to Yan Hu Suo (Rhizoma Corydalis), Arm Support contains many other herbs with analgesic and anti-inflammatory effects. Bai Shao (Radix Paeoniae Alba) has an excellent anti-inflammatory effect to treat arthritis by modulating the production of pro-inflammatory mediators from macrophage-like synoviocytes. Ge Gen (Radix Puerariae Lobatae) contains many isoflavonoid compounds which have significant analgesic and muscle relaxant activities. Xi Xian Cao (Herba Siegesbeckiae) has both analgesic and anti-inflammatory effects. It reduces swelling and inflammation through significant inhibition of the productions of nitric oxide, prostaglandin E(2), tumor necrosis factor-alpha (TNF-α), inducible nitric oxide synthase and cyclo-oxygenase-2 proteins., In comparison with drugs, the topical application of Xi Xian Cao (Herba Siegesbeckiae) shows comparable analgesic effect to piroxicam gel and methyl salicylate ointment.
Beyond alleviating the pain and reducing inflammation, Arm Support utilizes herbs to facilitate the recovery from repetitive damages to the cartilages. Xi Xian Cao (Herba Siegesbeckiae) has a marked effect to protect the cartilages in collagenase-induced osteoarthritis. This herb contributes to a significant increase in proteoglycan, aggrecan, and type II collagen expression. In comparison with Celebrex (celecoxib), the drug showed anti-inflammatory effect but had no effect on cartilage protection.
In terms of clinical applications, the herbs in Arm Support have shown marked effects to treat a wide variety of disorders. According to one clinical study, herbs such as Sang Zhi (Ramulus Mori), Ji Xue Teng (Caulis Spatholobi), Gui Zhi (Ramulus Cinnamomi) and others demonstrate marked success to treat 15 patients with tendonitis of the elbow. According to another study, herbs such as Gui Zhi (Ramulus Cinnamomi) have been used with good success in a study of 30 patients with arthritis. Lastly, one study reported that use of Xi Xian Cao (Herba Siegesbeckiae) and others resulted in a positive effect to treat generalized bi zheng (painful obstruction syndrome) characterized by wind-damp.
Overall, Arm Support is considered as one of the best formulas to treat various musculoskeletal disorders of the arms. Clinical applications of this formula include, but are not limited to, periarthritis of the shoulder, frozen shoulder, tennis elbow, carpal tunnel syndrome, and general conditions such as tendonitis, bursitis, and arthritis.
Pain is a basic bodily sensation induced by a noxious stimulus that causes physical discomfort (as pricking, throbbing, or aching). Pain may be of acute or chronic state, and may be of nociceptive, neuropathic, or psychogenic origin. NSAIDs are generally prescribed for musculoskeletal disorders of the arm, including shoulders, elbows, and wrists. NSAIDs [such as Motrin (ibuprofen) and Voltaren (diclofenac)] treat pain of mild to moderate intensity, and are most effective to reduce inflammation and swelling. Though effective, these drugs cause serious side effects such as gastric ulcer, duodenal ulcer, gastrointestinal bleeding, tinnitus, blurred vision, dizziness, and headache. Furthermore, the newer NSAIDs, also known as COX-2 inhibitors [such as Celebrex (celecoxib)], are associated with significantly higher risk of cardiovascular events, including heart attack and stroke. Therefore, practitioners and patients must evaluate the potential benefit versus risk before prescribing and taking these drugs. In short, it is important to remember that while drugs offer reliable and potent symptomatic pain relief, they should only be used if and when needed. Frequent use and abuse leads to unnecessary side effects and complications.
Treatment of pain is a sophisticated balance of art and science. Proper treatment of pain requires a careful evaluation of the type of disharmony (excess or deficiency, cold or heat, exterior or interior), characteristics (qi and/or blood stagnations), and location (upper body, lower body, extremities, or internal organs). Furthermore, optimal treatment requires integrative use of herbs, acupuncture, and tui-na therapies. All these therapies work together to tonify underlying deficiencies, strengthen the body, and facilitate recovery from chronic pain. TCM pain management targets both the symptom and the cause of pain, and as such, often achieves immediate and long-term success. Furthermore, TCM pain management is often associated with few or no side effects.
In conclusion, for treatment of mild to severe pain due to various causes, TCM pain management offers similar treatment effects as Western medicine with significantly fewer side effects.
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