Neck & Shoulder (CR) ™
* Chronic neck and shoulder pain, including numbness and discomfort
* Limited movement of the neck and shoulders due to pain and stiffness
* Long-term neck and shoulder injuries with a slow recovery or continuing deterioration
* Injuries of the neck and shoulder muscles commonly caused by over-exertion
* Repetitive stress syndrome of the neck and shoulders (i.e., prolonged upright sitting position, or working in front of a computer)
* Arthritis of the neck
WESTERN THERAPEUTIC ACTIONS
* Chondroprotective function to protect joint destruction and cartilage erosion
* Osteogenic function to promote generation of new bones
* Anti-inflammatory effect to reduce inflammation and swelling
* Analgesic action to alleviate muscle pain
* Muscle-relaxant effect to relieve muscle cramps and spasms
CHINESE THERAPEUTIC ACTIONS
* Disperses painful obstruction, strengthens sinews and tendons
* Disperses residual qi and blood stagnation in the channels and collaterals
* Relieves pain and muscle spasms due to chronic bi zheng (painful obstruction syndrome) of the neck and shoulders
Take 3 to 4 capsules three times daily. Depending on the nature and severity of the illness, the dosage may be increased up to 8 capsules three times daily for three or four days to relieve pain. For maximum effectiveness, take the herbs on an empty stomach with warm water. This formula should not be taken during the acute phases of injuries, where there is still bleeding, inflammation, and bruising.
Bai Shao (Radix Paeoniae Alba)
Chuan Niu Xi (Radix Cyathulae)
Chuan Xiong (Rhizoma Chuanxiong)
Dang Gui Wei (Extremitas Radix Angelicae Sinensis)
Di Gu Pi (Cortex Lycii)
Di Huang (Radix Rehmanniae)
Gan Cao (Radix et Rhizoma Glycyrrhizae)
Ge Gen (Radix Puerariae Lobatae)
Hong Hua (Flos Carthami)
Mo Yao (Myrrha)
Mu Gua (Fructus Chaenomelis)
Qiang Huo (Rhizoma et Radix Notopterygii)
Qin Jiao (Radix Gentianae Macrophyllae)
Ru Xiang (Gummi Olibanum)
Sang Ji Sheng (Herba Taxilli)
Tao Ren (Semen Persicae)
Wu Jia Pi (Cortex Acanthopanacis)
Xu Duan (Radix Dipsaci)
Yan Hu Suo (Rhizoma Corydalis)
Musculoskeletal and connective tissue injuries lead to over 10 million clinic visits per year in the United States. Causes of these injuries may be external (sports injuries, car accidents, trauma), internal (chronic wear and tear of muscles, ligaments and tendons; bones weakened by osteoporosis), or both. Acute injuries are characterized by severe pain, swelling and inflammation, and in some cases, internal bleeding. Treatment of acute injuries should focus on relieving pain, reducing swelling and inflammation, and stopping bleeding. Chronic injuries are characterized by dull pain, stiffness and numbness, and decreased muscle mass and strength. Treatment of chronic injuries includes relief of pain and restoration of physical and physiological functions.
Neck & Shoulder (CR) is designed to treat chronic neck and shoulder problems characterized by pain, numbness, stiffness, discomfort, limited mobility, slow recovery or continuing deterioration. Effective treatment must focus on activating qi and blood circulation, opening the channels and collaterals, and nourishing the muscles and tendons.
Qiang Huo (Rhizoma et Radix Notopterygii) treats soreness, pain and numbness in the neck, upper back, and shoulders due to wind-damp obstruction. Sang Ji Sheng (Herba Taxilli), Chuan Niu Xi (Radix Cyathulae), Di Huang (Radix Rehmanniae) and Xu Duan (Radix Dipsaci) tonify the Kidney and the Liver, strengthen the tendons, and alleviate pain, stiffness and soreness of the muscles. Mu Gua (Fructus Chaenomelis) and Qin Jiao (Radix Gentianae Macrophyllae) dispel painful obstruction and cramping, relax the sinews and unblock the channels. Wu Jia Pi (Cortex Acanthopanacis) treats painful obstruction due to Liver and Kidney yin deficiencies. Yan Hu Suo (Rhizoma Corydalis) invigorates blood, activates qi and alleviates pain. Tao Ren (Semen Persicae), Hong Hua (Flos Carthami), Ru Xiang (Gummi Olibanum), Mo Yao (Myrrha), Chuan Xiong (Rhizoma Chuanxiong), and Dang Gui Wei (Extremitas Radix Angelicae Sinensis) invigorate blood and remove residual stasis in the channels and collaterals. Ge Gen (Radix Puerariae Lobatae) and Bai Shao (Radix Paeoniae Alba) have strong antispasmodic effects to alleviate muscle spasm, cramps and pain. Aside from its anti-inflammatory effects, Gan Cao (Radix et Rhizoma Glycyrrhizae) harmonizes the formula and alleviates muscle pain and spasms. Di Huang (Radix Rehmanniae) and Di Gu Pi (Cortex Lycii) tonify yin, clear deficiency heat, and keep the temperature of this formula cool.
Together, Neck & Shoulder (CR) strengthens sinews and tendons to treat chronic neck and shoulder pain.
CAUTIONS & CONTRAINDICATIONS
* Chronic neck and shoulder pain may be accompanied by spinal or anatomical injuries. The patient should be checked for structural and anatomical abnormalities, especially if the overall condition does not improve after two to three weeks of herbal treatment.
* This herbal formula contains herbs that invigorate blood circulation, such as Dang Gui Wei (Extremitas Radix Angelicae Sinensis). Therefore, patients who are on anticoagulant or antiplatelet therapies, such as Coumadin (warfarin), should use this formula with caution, or not at all, as there may be a higher risk of bleeding and bruising.,,
* Dr. Alex Chen, a master of traditional Chinese medicine with over 30 years of clinical experience, formulated Neck & Shoulder (CR)specifically to relieve pain, reduce inflammation and stop muscle cramps. Herbs in this formula are routinely used in the trauma department of hospitals in China.
Pulse Diagnosis by Dr. Jimmy Wei-Yen Chang:
* Thick and forceful pulse proximal to the right chi indicates pain on the upper jiao. This pulse feels like a toothpick underneath the skin. If there is soft tissue damage, the pulse on or proximal to the right chi will feel like a “turtle shell.”
* With bone spurs or calcification, add Flex (SPR).
* For joint pain or arthritis that worsens during cold and rainy weather, combine with Flex (CD).
* For joint inflammation with redness, swelling, and burning pain, combine with Flex (Heat).
* With severe spasms, combine with Flex (SC).
* To strengthen the soft tissues (muscles, tendons, ligaments), add Flex (MLT).
* For bone fractures, whiplash, or acute injuries, combine with Flex (TMX).
* To improve blood circulation, add Flex (NP).
* With acute headache, add Corydalin (AC).
* With chronic headache, add Corydalin (CR).
* For osteoporosis, add Osteo 8.
* To enhance the effect to relieve pain, add Herbal ANG.
* For herniated disk, add Back Support (HD).
* For old injury or stubborn pain due to chronic blood stagnation, add Circulation (SJ).
* For shooting pain radiating down the arms, add Arm Support.
* For stress-related neck pain with insomnia, add Calm ZZZ.
* Ah shi points
* Shousanli (LI 10), Geshu (BL 17), Hegu (LI 4), Xuehai (SP 10), Jianliao (TH 14)
Classic Master Tung’s Points:
* Needle contralateral to the pain. If the pain is in the center, needle bilaterally or the side with the more ah shi points. If the pain is bilateral, needle bilaterally.
* Neck pain (bone spur): Wanshunyi (T 22.08), Wanshuner (T 22.09), Huochuan (T 33.04), Tianhuang (T 88.13), Sizhi (T 77.20), Minghuang (T 88.12), Qihuang (T 88.14), Guciyi (T 44.21)*, Gucier (T 44.22)*, Gucisan (T 44.23)*, Huofu (T 88.41)*, Huoliang (T 88.42)*, Huochang (T 88.43)*, Sojingdian (T 22.19)*
* Neck stiffness: Zhengjin (T 77.01), Zhengzong (T 77.02), Renhuang (T 77.21), Sojingdian (T 22.19)*
* Fallen pillow syndrome: Waisanguan (T 77.27), Tianhuang (T 88.13), Qihu (T 77.26), Wanshunyi (T 22.08), Wanshuner (T 22.09), Yanglao (SI 6), Sojingdian (T 22.19)*
* Shoulder pain: Tianhuang (T 88.13), Waisanguan (T 77.27), Fanhoujue (T 22.12)*, Renzong (T 44.08), Dizong (T 44.09), Tianzong (T 44.10)
* 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.
Master Tung’s Points by Dr. Chuan-Min Wang:
* Acute neck, shoulder pain: Bleed trigger points of levator scapula muscle or upper trapezius muscle. Needle bilaterally Shangbai (T 22.03).
* Chronic neck, shoulder pain: Needle bilaterally Shangbai (T 22.03).
Balance Method by Dr. Richard Tan:
* Needle the following points on the side opposite the pain: Lingdao (HT 4), Tongli (HT 5), Shenmen (HT 7), Xuanzhong (GB 39), Shugu (BL 65)
* Needle the following points on the same side as the pain: Houxi (SI 3), Zhongzhu (TH 3), Sanyinjiao (SP 6) or ah shi points nearby.
* After the needles are inserted, the patient should move his or her neck to loosen up the joint and the muscles.
* Neck pain: Cervical Vertebrae, Neck, Shoulder, Shoulder Blades, Kidney. Embed ear seeds and instruct the patient to massage the points three to four times daily for two minutes each time. Switch ears every five days. Five treatments equal one course.
* Frozen shoulder: Shoulder, Shoulder Joint, Adrenal Gland, Clavicle, Liver, Spleen, Subcortex
Auricular Medicine by Dr. Li-Chun Huang:
* Torticollis (strained neck): Triangle Area of Cervical Vertebrae, Occiput, Lesser Occiput Nerve, Large Auricular Nerve
* Periarthritis of shoulder: Shoulder, Shoulder Joint, Clavicle, Large Auricular Nerve. Bleed Ear Apex or Helix 3-4.
§ For pain of the shoulder upon abduction, use Clavicle, Shoulder (front and back of ear), Arm Pit
§ For anterior shoulder pain, use Shoulder Joint (front of ear), Coronary Vascular Subcortex, Large Auricular Nerve.
§ For posterior shoulder pain, use Shoulder Joint (back of ear), Clavicle, Large Auricular Nerve.
* Cervical vertebral degeneration: Triangle Area of Cervical, corresponding points (to the area of injury). Bleed Helix 4.
* Eat plenty of whole grains, 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.
* 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 temperatures or drafts. Adequate clothing such as turtlenecks should be worn to cover the neck and shoulder areas.
* Patients with frozen shoulder should be encouraged to exercise the shoulders as much as possible. Increase the range of motion for the shoulder will help to prevent adhesions of the tendons and ligaments.
* Patients should also be advised to check their pillow height to make sure it is not too high or too low. Mattresses should also be assessed for firmness.
* Hot baths with Epsom salts help to relax tense muscles and withdraw toxins from the tissues. Rest and relax in the bath for about 30 minutes.
* A 46-year-old female presented with left sided pain which originated at the C2 to C7 cervical region followed by a tingling sensation on the lateral side of the left forearm and hand. The practitioner had treated the patient for several years for the same condition. Initially, the pain was only isolated around the neck region with slight radiation towards the middle and lower trapezius. The patient was subsequently diagnosed with hypothyroidism accompanied by intermittent pain, which appeared usually after a couple of days. Administration of the Neck & Shoulder (CR) formula had provided the patient with great relief as well as making the recurrence less severe and not as abrupt. Consequently, she was able to discontinue taking Motrin (ibuprofen). The practitioner concluded that Neck & Shoulder (CR) was an excellent formula for degenerative disc disease. Submitted by C.H., San Jose, California.
* A 44-year-old female, who works as an accountant’s assistant, presented with tightness to her neck and shoulders. She also complained of stress, depression and had a history of multiple surgeries. Her Western diagnosis was spinal stenosis. Her TCM practitioner diagnosed her condition as bi zheng (painful obstruction syndrome) of the neck and shoulders. Prior to taking Neck & Shoulder (CR), the practitioner prescribed Ge Gen (Radix Puerariae Lobatae) with little result. Neck & Shoulder (CR) was the only herbal formula to which the patient responded to favorably. Submitted by D.M., Raton, New Mexico.
* A 42-year-old female nurse presented with chronic pain throughout her body, especially located in the neck and shoulder areas. The TCM diagnosis was Liver qi and blood stagnation along with Spleen and Heart deficiency. For treatment, Herbal ANG and Neck & Shoulder (CR) were prescribed. After taking the herbs and receiving acupuncture treatment twice a week for a month, the patient found that her condition had improved more than it had by physiotherapy and anti-inflammatories she had tried previously. Other findings in result of taking the herbs were increase of range of motion by 50% and softening of the muscles. Submitted by J.L., San Diego, California.
* A 53-year-old female presented with neck and shoulder pain which had been occurring for the previous 12 years. Current x-rays had shown a bone spur located in the C6-7 area. No curvature of the spine was seen. The practitioner had diagnosed the condition as yin and qi deficiencies with local qi and blood stagnation. Neck & Shoulder (CR) and Flex (SPR) were both prescribed. After taking the herbs, the patient had reported that her pain had decreased from a 7-8/10 to a 3-4/10 pain level. Submitted by H.C., Sydney, New York.
* A 22-year-old female presented with pain, tightness and tension in her neck, shoulders and upper back regions. The patient had been living with the condition for about the last six years. Initially her problems were due to stress; however, a severe car accident about 2½ years ago made the pain worse and constant. Symptoms exacerbated if under stress or when sick (sinus and head congestion). The pain on the right side of her back and neck was worse than her left. In particular, a point in her upper back where energy had been blocked since the car accident appeared quite weak. She had sought treatments from various physicians, chiropractors, physical therapists and massage therapists, which included shiatsu. Some of the treatments provided temporary relief but none had long-lasting effects. The patient was also taking birth control pills, zinc, echinacea, vitamin C, and Claritin (loratadine). Additionally, she was given antibiotics for her sinus infection, Prevacid (lansoprazole) for acid reflux, and a nasal spray prescription for her allergies. Her history and clinical picture directed the practitioner to diagnose the condition as qi and blood stagnation with bi zheng (painful obstruction syndrome) due to damp-cold. She was treated with acupuncture and began taking Neck & Shoulder (CR). The patient’s neck muscles gradually became unconstrained over a period of 3½ months. Submitted by J.M., Baltimore, Maryland.
* A 40-year-old female presented with neck tension and pain. There was decreased range of motion in her cervical spine but all reflexes and DTR’s were within normal limits bilaterally. Upon taking Neck & Shoulder (CR),the patient immediately noticed a diminished stiffness in her trapezius region. Submitted by G.P., Lawndale, California.
* A 47-year-old female presented with localized pinpoint pain situated 3 cun lateral to Shendao (GV 11) within the region of Shentang (BL 44). The patient also complained of insomnia, poor night vision, dry, itchy and flaky skin patches, ridged nails and clumps of falling hair. Her menstruation was regular at 28-days with no clots. Her tongue had teeth marks, a crack in the middle jiao and a white tongue coat. Her pulse was thin, wiry and rapid but slippery in the Spleen position. The Western diagnosis of her condition was reflex sympathetic dystrophy syndrome. The TCM diagnosis was qi and blood stagnation, Liver blood deficiency, and Kidney/Liver yin deficiency. After taking Neck & Shoulder (CR),her qi and blood stagnation subsided and her pain intensity decreased, as evident upon deep palpation. Her tongue cracks in the Spleen area also dwindled in size. Additionally, the patient reported improvement in sleep patterns because of pain relief. Submitted by M.D.P., Estes Park, Colorado.
* A male presented with pain and decreased range of motion in the right shoulder. There was pain upon palpation of the Large Intestine and Small Intestine channels. The practitioner diagnosed the condition as bi zheng (painful obstruction syndrome) due to stagnation of qi and blood. The patient was instructed to take Neck & Shoulder (AC). Acupuncture treatments using Dr. Tan’s Balance Method and tui-na massage using Dr. Alex Chen’s techniques were also applied. After six acupuncture and herbal treatments, he regained full shoulder range of motion and had no pain. After the pain was completely resolved, the practitioner switched the prescription to Neck & Shoulder (CR) at 3 capsules per day intended for maintenance care. Upon recurrence of pain, the patient was instructed to increase the dosage, which in turn resolved the pain sensation. Submitted by K.S., Encinitas, California.
* A 50-year-old retired male presented with severe neck and shoulder pain and stiffness, which is worse at night and disturbs sleep. The Western diagnosis included degenerative disk disease at C5 to C7. The diagnosis was blood stagnation, bi zheng (painful obstruction syndrome), and deficiencies of Spleen yang and Kidney jing (essence). The patient was instructed to take Neck & Shoulder (CR) (6 capsules three times daily) and Osteo 8 (2 capsules three times daily). Upon return, the patient commented that Neck & Shoulder (CR) was effective for relieving pain. In fact, it was the only treatment that clearly helped. The patient remained under the care of an acupuncturist and a chiropractor, and continued to take the herbs. Submitted by J.B., Camarillo, California.
* A 41-year-old female housewife presented with neck and shoulder pain and occipital headaches. Severe muscle spasms bilateral to C4 to C7 were found as well as neck and shoulder tightness. The patient also reported anxiety and insomnia due to pain and depression. Her pulse was wiry and her tongue was purple. Past histories include eight surgeries to correct her condition. The practitioner diagnosed the presentation as blood and qi stagnation. After taking Neck & Shoulder (CR), a reduction in the severity of her neck and shoulder pain was noted. The patient also came to the realization that she was now less affected by damp and cold weather conditions. The practitioner also observed an improvement in the patient’s neck range of motion. Submitted Anonymously.
PHARMACOLOGICAL AND CLINICAL RESEARCH
Neck & Shoulder (CR) is an excellent formula for rehabilitation from chronic neck and shoulder injuries, such as repetitive injuries or long-term wear and tear of the muscles and joints. As a result, the chronic nature of this condition may eventually contribute to atrophy and degeneration of the soft tissues, accompanied by decreased mobility of the joints, and generalized weakness and pain of the muscles. Neck & Shoulder (CR) contains herbs with chondroprotective and osteoprotective effects to facilitate recovery, anti-inflammatory effects to reduce swelling and inflammation, analgesic effects to relieve pain, and muscle-relaxant effects to relieve spasms and cramps.
Chronic pain is often associated with injuries to the muscles, tendons, ligaments, and bones, Neck & Shoulder (CR) contains many herbs to strengthen and rebuild the underlying structural damages. Chuan Niu Xi (Radix Cyathulae) is an excellent herb to protect the cartilage from repetitive and stress-induced injuries. According to one study, the extract of Chuan Niu Xi (Radix Cyathulae) has a potent effect to inhibit the induction of MMP-13, an important enzyme for the degradation of the cartilage collagen matrix, especially under arthritic conditions. By down-regulating the MMP-13 activity, Chuan Niu Xi (Radix Cyathulae) exerts great chondroprotection against cartilage degrading disorders. Dang Gui (Radix Angelicae Sinensis) is an effective herb to promote the generation of bones. According to one study, the water extract of Dang Gui (Radix Angelicae Sinensis) has been found to contribute to the formation of bones and treatment of bone injuries. It directly stimulates the proliferation, alkaline phosphatase activity, protein secretion and particularly type I collagen synthesis of human osteoprecursor cells in a dose-dependent manner. Lastly, Sang Ji Sheng (Herba Taxilli) and Xu Duan (Radix Dipsaci) have significant osteogenic and antiosteoporotic effects that promote the generation of new bones and prevent osteoporosis. According to a bone cells culture experiment, administration of Sang Ji Sheng (Herba Taxilli) shows a potential effect to increase the proliferation and differentiation of the osteoblasts without affecting osteoclast activity. The researchers conclude that these herbs can effectively increase the rate of tissue regeneration of damaged bones.
Neck & Shoulder (CR) contains herbs with marked anti-inflammatory effect to reduce swelling and inflammation. Dang Gui (Radix Angelicae Sinensis) exerts both analgesic and anti-inflammatory effects through the inhibition of pro-inflammatory mediators, including nitric oxide and prostaglandin E2 in peritoneal macrophages., In comparison with acetylsalicylic acid, the anti-inflammatory effect of Dang Gui (Radix Angelicae Sinensis) is approximately 1.1 times stronger, and its analgesic effect is approximately 1.7 times stronger.Chuan Xiong (Rhizoma Chuanxiong) exerts its anti-inflammatory effect via an inhibitory activity on tumor necrosis factor-alpha (TNF-α) production and bioactivity, and shows promising effect to treat inflammation and related diseases. Qiang Huo (Rhizoma et Radix Notopterygii) also has an anti-inflammatory effect to reduce swelling and inflammation. The mechanism is attributed to the inhibition of 5-lipoxygenase and cyclo-oxygenase. Lastly, Di Huang (Radix Rehmanniae) and Gan Cao (Radix et Rhizoma Glycyrrhizae) exert their anti-inflammatory effect via the endocrine system. Di Huang (Radix Rehmanniae) reduces swelling and inflammation by influencing the endocrine system to increase the plasma levels of adrenocortical hormones, even in the presence of dexamethasone. Clinically, Di Huang (Radix Rehmanniae) has been used in an herbal formula to successfully treat 12 patients with rheumatoid arthritis. Gan Cao (Radix et Rhizoma Glycyrrhizae) demonstrates marked anti-inflammatory effects by enhancing the effect of glucocorticoids through increased production and secretion as well as decreased metabolism by the liver. In terms of anti-inflammatory actions, the comparison of cortisone to glycyrrhizin and glycyrrhetinic acid, two compounds from Gan Cao (Radix et Rhizoma Glycyrrhizae), is approximately 10:1. Clinical applications of Gan Cao (Radix et Rhizoma Glycyrrhizae) include pain, inflammation, edema, arthritis, spasms, cramps and others.,
Neck & Shoulder (CR) incorporates many herbs with analgesic effects to relieve pain. Yan Hu Suo (Rhizoma Corydalis) is one of the strongest and most potent herbs for treatment of pain. It has a strong analgesic effect that is comparable to 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. Overall, it is well understood that Yan Hu Suo (Rhizoma Corydalis) has a marked effect to treat pain. In addition, Ru Xiang (Gummi Olibanum) and Mo Yao (Myrrha) have an analgesic effect to relieve pain and anti-inflammatory to reduce swelling and inflammation., These two herbs also showed an antiarthritic effect by reducing edema and decreasing arthritic scores in subjects with adjuvant-induced arthritis. The mechanism of action is attributed to the suppression of pro-inflammatory cytokines, such as TNF-α and interleukin-1beta (IL-1β). Clinically, they have been used effectively to treat pain associated with various types of trauma and external injuries. Furthermore, the combination of Bai Shao (Radix Paeoniae Alba) and Gan Cao (Radix et Rhizoma Glycyrrhizae) has a marked analgesic effect to relieve pain. The effectiveness is increased significantly when combined with acupuncture. Clinically, these two herbs have been used successfully to treat conditions such as pain, neuralgia, trigeminal neuralgia,, neck pain,  acute back pain, heel pain, pain in the lower back and legs, sciatica, gastric and abdominal pain, and dysmenorrhea. Lastly, Ge Gen (Radix Puerariae Lobatae) contains many isoflavonoid compounds which have significant analgesic and muscle-relaxant activities. It is also a guiding herb that enhances the effect of all the herbs in the formula.
To relieve spasms and cramps, Bai Shao (Radix Paeoniae Alba) and Gan Cao (Radix et Rhizoma Glycyrrhizae) are used for their excellent muscle-relaxant effect to relax both smooth and skeletal muscles., Clinically, these two herbs have been used successfully to treat conditions such as leg cramps in the calf, muscle cramps in hemodialysis, restless leg syndrome, intestinal spasm, facial spasms and twitching, and menstrual cramps and pain.
In summary, Neck & Shoulder (CR) is an excellent formula that contains herbs with chondroprotective and osteogenic functions to repair cartilage erosion, protect joints from destruction, and promote generation of new bones. Furthermore, it also utilizes herbs with analgesic and anti-inflammatory effects to relieve pain and inflammation associated with back pain.
Pain is a basic bodily sensation induced by a noxious stimulus that causes physical discomfort (such as pricking, throbbing, or aching). Pain may be of acute or chronic state, and may be of nociceptive, neuropathic, or psychogenic origin. For acute pain, use of non-steroidal anti-inflammatory drugs (NSAIDs) and opioid analgesics offer immediate and reliable effects to relieve pain. Though these drugs have serious side effects, short-term use can be justified because the benefits often outweigh the risks. For chronic pain, on the other hand, use of NSAIDs and opioid analgesics are usually not the desired treatment options, as they symptomatically relieve pain, but do not change the underlying course of illness. Unfortunately, the convenience of these drugs contributes to the vicious cycle of pain, followed by continuous and repetitive use of drugs to symptomatically relieve pain. When the effect of the drugs dissipates, patients are often left with nothing but more pain and more complications from side effects. Therefore, it is important to understand that while these drugs may be beneficial for acute pain, they do not adequately address most cases of chronic pain. Additional treatment modalities must be incorporated to ensure effective and complete recovery from chronic pain conditions. [Note: Common side effects of NSAIDs include gastric ulcer, duodenal ulcer, gastrointestinal bleeding, tinnitus, blurred vision, dizziness and headache. Serious side effects of newer NSAIDs, also known as COX-2 inhibitors [such as Celebrex (celecoxib)], include significantly higher risk of cardiovascular events, including heart attack and stroke. Side effects of opioid analgesics [such as Vicodin (APAP/hydrocodone) and morphine] include dizziness, lightheadedness, drowsiness, upset stomach, vomiting, constipation, stomach pain, rash, difficult urination, and respiratory depression resulting in difficult breathing. Furthermore, long-term use of these drugs leads to tolerance and addiction.]
Treatment of chronic 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 symptoms and causes 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.
For treatment of mild to severe pain due to various causes, TCM pain management offers similar treatment effects with significantly fewer side effects. Though TCM therapies may not be as potent as drugs for acute pain management, they are often superior [better effects with fewer side effects] for chronic pain management.
 Berkow R. et al. The Merck Manual of Medical Information. Merck Research Laboratories. 1999 February.
 Chan K, Lo AC, Yeung JH, Woo KS. Journal of Pharmacy and Pharmacology 1995 May;47(5):402-6.
 Pharmacotherapy 1999 July;19(7):870-876.
 European Journal of Drug Metabolism and Pharmacokinetics 1995; 20(1):55-60.
 Park HY, Lim H, Kim HP, Kwon YS. Downregulation of Matrix Metalloproteinase-13 by the Root Extract of Cyathula officinalis Kuan and its Constituents in IL-1β-treated Chondrocytes. College of Pharmacy, Kangwon National University, Chunchon, Korea. Planta Med. 2011 Feb 23.
 Yang Q, Populo SM, Zhang J, Yang G, Kodama H. Effect of Angelica sinensis on the proliferation of human bone cells. Clin Chim Acta. 2002 Oct;324(1-2):89-97.
 Yao CH, Tsai HM, Chen YS, Liu BS. Fabrication and evaluation of a new composite composed of tricalcium phosphate, gelatin, and Chinese medicine as a bone substitute. Institute of Biomedical Engineering and Material Science, Chungtai Institute of Health Science and Technology, Taichung, Taiwan, Republic of China. J Biomed Mater Res B Appl Biomater. 2005 Nov;75(2):277-88.
 Xin Yi Yao Xue Za Zhi (New Journal of Medicine and Herbology), 1975; (6):34.
 Chao WW, Kuo YH, Li WC, Lin BF. The production of nitric oxide and prostaglandin E2 in peritoneal macrophages is inhibited by Andrographis paniculata, Angelica sinensis and Morus alba ethyl acetate fractions. Department of Biochemical Science and Technology, Institute of Microbiology and Biochemistry, National Taiwan University, Taipei 106, Taiwan, ROC. J Ethnopharmacol. 2009 Feb 25;122(1):68-75.
 Yao Xue Za Zhi (Journal of Medicinals), 1971; (91):1098.
 Liu L, Ning ZQ, Shan S, Zhang K, Deng T, Lu XP, Cheng YY. Phthalide Lactones from Ligusticum chuanxiong inhibit lipopolysaccharide-induced TNF-alpha production and TNF-alpha-mediated NF-kappaB Activation. Planta Med. 2005 Sep;71(9):808-13.
 Zschocke S, Lehner M, Bauer R. 5-Lipoxygenase and cyclooxygenase inhibitory active constituents from Qianghuo (Notopterygium incisum). Planta Med. 1997 Jun;63(3):203-6.
 Zhong Yao Yao Li Yu Ying Yong (Pharmacology and Applications of Chinese Herbs), 1983: 400.
 Zhong Yao Xue (Chinese Herbology), 1998; 156:158.
 Zhong Yao Lin Chuan Xin Yong (New Clinical Applications of Chinese Medicine), 2001; 242-243.
 Zhong Yao Zhi (Chinese Herbology Journal), 1993; 358.
 Zhong Cao Yao (Chinese Herbal Medicine), 1991; 22(10):452.
 Zhe Jiang Zhong Yi Za Zhi (Zhejiang Journal of Chinese Medicine), 1980; 2:60.
 Zhong Hua Nei Ke Za Zhi (Chinese Journal of Internal Medicine), 1960; 4:354.
 He Bei Xin Yi Yao (Hebei New Medicine and Herbology), 1973; 4:34.
 Zhong Yao Xue (Chinese Herbology), 1998; 539:540.
 Yoshikawa M, Morikawa T, Oominami H, Matsuda H. Absolute stereostructures of olibanumols A, B, C, H, I, and J from olibanum, gum-resin of Boswellia carterii, and inhibitors of nitric oxide production in lipopolysaccharide-activated mouse peritoneal macrophages. Kyoto Pharmaceutical University, Japan. Chem Pharm Bull (Tokyo). 2009 Sep;57(9):957-64.
 Fan AY, Lao L, Zhang RX, Zhou AN, Wang LB, Moudgil KD, Lee DY, Ma ZZ, Zhang WY, Berman BM. Effects of an acetone extract of Boswellia carterii Birdw. (Burseraceae) gum resin on adjuvant-induced arthritis in lewis rats. Center for Integrative Medicine, School of Medicine, University of Maryland, 3rd Floor, James Kernan Hospital Man, 2200 Kernan Drive, Baltimore, MD 21201, USA. J Ethnopharmacol. 2005 Oct 3;101(1-3):104-9.
 He Nan Zhong Yi Xue Yuan Xue Bao (Journal of University of Henan School of Medicine), 1980; 3:38.
 Guo Wai Yi Xue (Foreign Medicine) 1984;6(1):58.
 Shang Hai Zhong Yi Yao Za Zhi (Shanghai Journal of Chinese Medicine and Herbology), 1983; 4:14.
 Zhong Yi Ming Fang Lin Chuang Xin Yong (Contemporary Clinical Applications of Classic Chinese Formulas) 2001;313.
 Jiang Xi Yi Yao (Jiangxi Medicine and Herbology) 1965;5(7):909.
 Zhong Yi Za Zhi (Journal of Chinese Medicine), 1983; 11:9.
 Jiang Su Zhong Yi (Jiangsu Chinese Medicine), 1990; (10):29.
 Zhe Jiang Zhong Yi Za Zhi (Zhejiang Journal of Chinese Medicine) 1995;(11):524.
 Si Chuan Zhong Yi (Sichuan Chinese Medicine) 1996;11:38.
 Yun Nan Zhong Yi (Yunnan Journal of Traditional Chinese Medicine), 1990; 4:15.
 Fu Jian Zhong Yi Yao (Fujian Chinese Medicine and Herbology), 1994; (1):7.
 Fu Jian Zhong Yi Yao (Fujian Chinese Medicine and Herbology) 1961;9(4):44.
 Tanaka T.A novel anti-dysmenorrhea therapy with cyclic administration of two Japanese herbal medicines. Clinical & Experimental Obstetrics & Gynecology 2003;30(2-3):95-8.
 Yasuda T, Endo M, Kon-no T, Kato T, Mitsuzuka M, Ohsawa K. Antipyretic, analgesic and muscle relaxant activities of pueraria isoflavonoids and their metabolites from Pueraria lobata Ohwi-a traditional Chinese drug. Biol Pharm Bull. 2005 Jul;28(7):1224-8.
 Guo Wai Yi Xue (Foreign Medicine) 1984;6(1):58.
 He Nan Zhong Yi (Henan Chinese Medicine) 1986;(6):15.
 Zhong Yi Za Zhi (Journal of Chinese Medicine) 1985;6:450.
 Inoshita F, Ogura Y, Suzuki Y, Hara S, Yamada A, Tanaka N, Yamashita A, Marumo F.Effect of orally administered shao-yao-gan-cao-tang (Shakuyaku-kanzo-to) on muscle cramps in maintenance hemodialysis patients: a preliminary study. American Journal of Chinese Medicine 2003;31(3):445-53.
 He Bei Zhong Yi (Hebei Chinese Medicine) 1984;3:29.
 Zhong Yi Za Zhi (Journal of Chinese Medicine), 1985; 6:50.
 Zhong Xi Yi Jie He Za Zhi (Journal of Integrated Chinese and Western Medicine), 1991; (1):43.
 Bei Jing Zhong Yi (Beijing Chinese Medicine) 1983;(1):33.