CLINICAL APPLICATIONS

* Pain: acute or chronic

* Pain: dull, sharp, stabbing, numbing, burning, and fixed, moving or radiating

* Pain of skeletal and smooth muscles

 

WESTERN THERAPEUTIC ACTIONS

* Potent analgesic effect to relieve pain

* Strong anti-inflammatory effect to reduce swelling and inflammation

 

CHINESE THERAPEUTIC ACTIONS

* Invigorates blood circulation

* Relieves pain

 

DOSAGE

When taken alone, the recommended dosage is 3 to 4 capsules three times daily as needed to relieve pain. For severe pain, dosage can be increased to 7 to 8 capsules every four to six hours as needed to relieve pain. As an adjunct with other formulas to relieve pain, the recommended dose is 2 to 3 capsules in addition to the regular dose of the base formula. Take the herbs on an empty stomach with two tall glasses of warm water. This formula should be discontinued when the desired effects are achieved.

 

INGREDIENTS

Dang Gui (Radix Angelicae Sinensis)

Mo Yao (Myrrha)

Ru Xiang (Gummi Olibanum)

Sheng Ma (Rhizoma Cimicifugae)

Yan Hu Suo (Rhizoma Corydalis)

 

BACKGROUND

Pain is the most common reason for physician consultation in the United States.[1] Pain is the unpleasant feeling often caused by intense or damaging stimuli, such as burning a finger or stepping on a sharp object. Acute pain is a beneficial and necessary warning signal for survival ¡V it alerts the individual to withdraw from harmful situations, to protect a damaged body part while it heals, and to avoid similar experiences in the future. Chronic pain, however, may persist after the stimulus has been removed or after the body has been healed. In these cases, chronic pain can significantly interfere with a person's quality of life and general functioning, causing complications such as anxiety, stress, depression, anger, fatigue, sleep disturbance, immune suppression, and many others. Because chronic pain affects the body and the mind, effective treatment requires treatment of psychological and physical aspects of the condition.

 

FORMULA EXPLANATION

 ¡§Where there is pain, there is stagnation. When stagnation is cleared, so will the pain.¡¨ For practitioners of traditional Chinese medicine, this is one of the most important fundamental principles for treatment of pain. Herbal ANG is designed as an adjunct formula to relieve severe pain. It can be used alone, or with other formulas for pain in the body.

        Yan Hu Suo (Rhizoma Corydalis) is the strongest and the most effective herb in the entire Chinese herbal pharmacopoeia to relieve pain. It enters both xue (blood) and qi (energy) levels to effectively invigorate blood circulation, regulate qi and relieve pain in the chest, abdomen, and limbs. It is effective to relieve pain of the visceral organs and the musculoskeletal system. To enhance the analgesic effect of Yan Hu Suo (Rhizoma Corydalis), Ru Xiang (Gummi Olibanum) and Mo Yao (Myrrha) are added to Herbal ANG. This pair of herbs is often used together synergistically to relieve a wide range of pain that may be caused by qi or blood stagnation, trauma or arthritic syndrome. Dang Gui (Radix Angelicae Sinensis) tonifies and moves blood. Finally, Sheng Ma (Rhizoma Cimicifugae) is used as a channel-guiding herb. It moves upwards and outwards and has a dispersing nature, which helps break up stagnation and relieve pain.

        In short, Herbal ANG is an extremely effective formula to relieve pain. It can be used individually, or in combination with another formula for pain at a specific location.

 

CAUTIONS & CONTRAINDICATIONS

* This formula should be discontinued one week prior to surgery.

* This formula is contraindicated during pregnancy and nursing.

* This formula is designed for short-term symptomatic treatment of pain. It is not recommended for long-term use.

* For patients with chronic pain, it is essential to identify the cause of pain and treat it accordingly.

* This herbal formula contains herbs that invigorate blood circulation, such as Dang Gui (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.[2]^,[3],[4]

 

CLINICAL NOTES

* Herbal ANG is an excellent formula to treat both internal and external injuries leading to pain of the body and the extremities. The diagnosis for such conditions is often qi and blood stagnation. Therefore, Herbal ANG can be used safely and effectively to relieve pain.

* If the pain is located in the trunk of the body, such as in the chest or abdominal regions, additional examination is necessary to diagnose the underlying cause of the pain. While Herbal ANG is still effective to relieve pain, it will not address the underlying illness and may delay the treatment. For example, patients with kidney stones may have tremendous pain in the lower back. Though it is important to relieve pain, it is even more important to address kidney stones. In other words, while it is important to treat pain in acute cases, it is equally important to identify the underlying cause so the overall treatment will not be delayed.

* Herbal ANG is an extra-strength formula to be used in conjunction with other formulas to relieve severe pain. It will begin to show effectiveness within 30 minutes. It can be used in conjunction with acupuncture treatment for a synergistic analgesic effect.

* Pain from cancer is often severe and excruciating, which may not be relieved effectively by herbs. Under these circumstances, opioid drugs should be used for pain management if necessary. CA Support and C/R Support may be used as adjunct treatments.

 

SUPPLEMENTARY FORMULAS

* For headache, add Corydalin (AC) or Corydalin (CR).

* For pain in the neck and shoulder area, add Neck & Shoulder (AC) or Neck & Shoulder (CR).

* For pain in the arm (shoulder, elbow and wrist), add Arm Support.

* For pain in the lower back, add Back Support (AC) or Back Support (CR).

* For pain from herniated disk, add Back Support (HD).

* For pain in the knees, add Knee & Ankle (AC) or Knee & Ankle (CR).

* For gout, add Flex (GT).

* For pain with chronic musculoskeletal disorder with damaged soft tissues (muscles, tendons, ligaments and cartilage), add Flex (MLT).

* For arthritic syndrome or fibromyalgia due to coldness, add Flex (CD).

* For arthritic syndrome or fibromyalgia due to heat, add Flex (Heat).

* For spasms and cramps, add Flex (SC).

* For neuropathy, add Flex (NP).

* For bone spurs, add Flex (SPR).

* For dysmenorrhea, add Mense-Ease.

* For pain due to gallstones, use with Dissolve (GS).

* For pain due to kidney stones, use with Dissolve (KS).

* For external or trauma injuries, use with Flex (TMX).

* For post-surgical care, Flex (TMX) can be added to invigorate blood circulation or relieve pain, and Herbal ABX can be added to prevent infection.

* For pain in the gastric region, add GI Care.

* For pain or bloating due to irritable bowel syndrome, add GI Harmony.

* For abdominal pain due to food poisoning or traveler¡¦s diarrhea, add GI Care II.

* For pain due to ulcerative colitis, add GI Care (UC).

* For hemorrhoids, add GI Care (HMR).

* For pain due to endometriosis, uterine fibroids, ovarian cysts or mass, add Resolve (Lower).

* For fibrocystic breast disorder, add Resolve (Upper).

* For unknown pain with blood stagnation, add Circulation (SJ).

* For pain due to Bell¡¦s Palsy or TMJ (temporo-mandibular joint) pain, add Symmetry.

 

ACUPUNCTURE TREATMENT

Traditional Points:

* Ah shi points; Taibai (SP 3), Neiguan (PC 6), Waiguan (TH 5), Hegu (LI 4)

* Hegu (LI 4), Neiguan (PC 6), Ximen (PC 4), Sanyangluo (TH 8), Guangming (GB 37) and local points:

¡± Head: add Quanliao (SI 18), Yifeng (TH 17), Guangming (GB 37), Hegu (LI 4), Lieque (LU 7), Jinmen (BL 63)

¡± Neck: add Hegu (LI 4), Neiguan (PC 6), Futu (ST 32)

¡± Chest and thoracic: add Hegu (LI 4), Neiguan (PC 6), Ximen (PC 4)

¡± Abdomen: add Zusanli (ST 36), Shangjuxu (ST 37), Hegu (LI 4), Neiguan (PC 6), Taichong (LR 3), Yinlingquan (SP 9)

¡± Lower limbs: add Huantiao (GB 30), Chengshan (BL 57), Sanyinjiao (SP 6)

 

Master Tung¡¦s Points by Dr. Chuan-Min Wang:

* Generalized pain

¡± Wind: Shouwujin (T 33.08), Shouqianjin (T 33.09)

¡± Damp: Shuiqu (T 66.09), Minghuang (T 88.12), Tianhuang (T 88.13), Qihuang (T 88.14)

¡± Cold: Huofuhai (T 33.07), Jianzhong (T 44.06)

 

Balance Method by Dr. Richard Tan:

* Left side: Fengchi (GB 20), Zhongchong (PC 9), Shaochong (HT 9), Shaoshang (LU 11), Zusanli (ST 36), Weizhong (BL 40), Yanglingquan (GB 34), ear Shenmen

* Right side: Fengchi (GB 20), Hegu (LI 4), Houxi (SI 3), Zhongzhu (TH 3), Taixi (KI 3), Zhongfeng (LR 4), Sanyinjiao (SP 6), Yintang (Extra 1), ear Shenmen

 

Auricular Medicine by Dr. Li-Chun Huang:

* Corresponding point of the pain, Sympathetic, Shenmen, Occiput. Bleed Ear Apex.

* Phantom limb pain: Sympathetic, Shenmen, Occiput, Lesser Occipital Nerve, Large Auricular Nerve, Nervous Subcortex. Bleed Ear Apex.

 

NUTRITION

* If pain is characterized by cold, avoid cold or raw foods (vegetables and salads), fruits (watermelon and pear), drinks and exposure to cold weather or surface. Avoid taking cold showers or swimming in cold water. Foods that are warm or hot in nature such as lamb, pepper, onions and scallions are recommended.

* If pain is characterized by heat, avoid eating spicy food. Increase the intake of vegetables or fruits that are cold in nature such as watermelon and cucumber.

* If pain is due to dampness, avoid eating greasy, fatty or fried food. Dairy products are not recommended.

* Increase the intake of minerals such as calcium and magnesium, which calm the nerves and reduce sensitivity to pain.

 

LIFESTYLE INSTRUCTIONS

* Proper diet and exercise are extremely important in preventing recurrent pain syndrome. Chronic pain is often the result of occupations that require repetitive use of the same joints or repeated injuries to the same area. Strong efforts should be made to eliminate or improve such working conditions.

* Exercise is always helpful in keeping qi and blood circulating properly in the body.

* Other therapies that are effective for pain management include massage, relaxation techniques, deep breathing, and heat/cold therapy.

 

CASE STUDIES

* R.B., a 25-year-old female, presented with severe head and neck pain. The patient had also been experiencing tension headaches in the frontal and occipital area. Objective findings included a pain level of 7/10, decreased mobility, and increased heart rate. Diagnostic tests had been received, which ruled out infection and meningitis. She had also joined a yoga group and was receiving psychotherapy and massage. The practitioner diagnosed the condition as chronic neck and back pain; her Western diagnosis was occipital neuralgia. For treatment, the patient was instructed to make certain dietary changes, received acupuncture twice a week and was prescribed Herbal ANG and Neck & Shoulder (AC). The patient reported that with taking the herbs she experienced a slow, steady improvement to a healthier lifestyle. She felt her tendons and ligaments were getting stronger due to enhanced blood flow. She was very happy with the results of taking the herbs. Submitted by E.S., Castro Valley, California.

* Y.J., a 63-year-old female, presented with arthritis and gout pain located throughout her feet, fingers, wrists, and arms. Objective findings included inflammation on the joints, redness, and an inability to extend the joints. The pain was described as a sharp burning sensation. Blood pressure was 132/61 mmHg and heart rate of 73 beats per minute. The practitioner diagnosed this condition as qi and blood stagnation. Flex (GT) and Herbal ANG were prescribed. After taking the herbs and receiving acupuncture just a few times, the patient reported that her pain alleviated from a 9 to a 5 level. It was also noted that her range of motion had improved and was not as stiff as she was during the initial treatment. Submitted by J.C., Rosemead, California.

* 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-inflammatory drugs 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.

* L.S., a 27-year-old male electrician, complained of bad back spasms, which then lead to being unable to stand up straight for two days. This occurred after a recent job he had been bending over for while working and was in extreme pain. This condition was diagnosed as Liver yin deficiency. The patient was treated with Back Support (AC) and Herbal ANG four pills three times a day. It took one week for complete recovery, while the intensity of the pain decreased during the one week of treatment. Submitted by A.I., Hilo, Hawaii.

* N.T, a 41-year-old female patient, presented with neck pain, spasms, not being able to turn her head to the left, and waking up with pain in the morning. She was in severe pain and discomfort. This condition was diagnosed as Liver blood deficiency. Upon diagnosis, the patient was prescribed Neck & Shoulder (AC) and Herbal ANG. After taking the herbs for two days the neck pain decreased and the range of motion greatly improved. Submitted by A.I., Hilo, Hawaii.

* D.S., a 65-year-old female, presented with discomfort fluctuating between the areas of 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. The patient continued to take the herbs as needed; however, she has reduced the amount of her anti-inflammatories and other prescription drugs by 70% after taking the herbs. An additional prescription was Back Support (CR) when her lower back pain was present. Overall, the patient reported her pain had decreased by 50% and she still wanted to continue taking the herbs for more relief. Submitted by J.L., San Diego, California.

* A 44-year-old female presented with chronic migraines, described as a tight sharp pain. It was mentioned that she had been having headaches for the past 30 years and she was also experiencing neck and arm pain. Objective findings included tight muscles upon palpation of the sternocleidomastoid, trapezius, biceps, and deltoid muscles. The TCM diagnosis was Liver qi stagnation along with qi and blood stagnation; Western diagnosis was repetitive muscle syndrome. Corydalin (CR) for headaches and Herbal ANG for muscle discomfort were prescribed and directed to take as needed. The patient had been treated on and off by these herbs for the past six months and had finally gotten off all her medications. She has sworn by them because they gave her better results than her anti-inflammatories. Submitted by J.L., San Diego, California.

* L.K., a 58-year-old female, presented with pain located on her left knee. Objective findings included limited range of motion, pain with movement, and limping. It was noted that her pain level was 7 out of 10 and the pain was only slightly alleviated with elevation or rest. The practitioner diagnosed this condition as qi and blood stagnation along with Liver and Kidney yin deficiencies. Knee & Ankle (CR) and Herbal ANG were prescribed upon diagnosis. After taking the herbs and receiving acupuncture, the patient¡¦s ROM was greater and her pain level had reduced. Submitted by J.C., Rosemead, California.

* J.B., an 83-year-old female, presented with upper right shoulder and low back pain. Her TCM diagnosis was qi and blood stagnation in the Urinary Bladder and Small Intestine channels. For treatment, Back Support (CR) and Herbal ANG were prescribed. The patient had reported a decrease in pain and an improvement in her quality of life. However, due to a removal of a shoulder muscle years back, she doesn¡¦t feel the pain may ever fully resolve. Submitted by B.S., Niceville, Florida.

* At a seminar in Providence, Rhode Island, a question was raised as whether Yan Hu Suo (Rhizoma Corydalis) would cause a person treated with this herb to test positive in a drug screen (as do a number of analgesic substances). A very small study was conducted in a laboratory at the Rhode Island Clinical Research Center: two people taking 6 capsules of Corydalin (AC) were screened for drugs three hours later. Both were completely negative in the seven drug panels. A solution of 5% Yan Hu Suo (Rhizoma Corydalis) powdered extract (freed from excessive carbohydrate) was also tested in the drug-screening test, again with negative results. It was concluded by the researchers that a person being treated for pain with the usual dosage of Corydalin (AC) would not risk testing positive for opiates, benzodiazepines, barbiturates, etc. [Note: Yan Hu Suo (Rhizoma Corydalis) is the main ingredient that is present in both Corydalin (AC) and Herbal ANG.] Submitted by D.W., Hadley, Massachusetts.

 

PHARMACOLOGICAL AND CLINICAL RESEARCH

Herbal ANG is formulated specifically for relieving pain throughout the body. It contains ingredients that have shown exceptional analgesic and anti-inflammatory effects. Clinical applications include treatment of various aches and pains, swelling, inflammation, and external injuries.

        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, amenorrhea or menstrual pain, and pain of the extremities. According to laboratory studies, the extract of Yan Hu Suo (Rhizoma Corydalis) has been found to be effective in both acute and chronic phases of inflammation. The mechanism of its anti-inflammatory effect is attributed to its activity to inhibit the release of histamine and pro-inflammatory mediators.[5]^,[6] 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 a satisfactory anesthetic effect in 98 out of 105 patients (93.4%) who underwent surgery.[7] 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.[8] 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 fewer side effects, less risk of tolerance, and no evidence of physical dependence even with long-term use.[9]

        In addition to Yan Hu Suo (Rhizoma Corydalis), Ru Xiang (Gummi Olibanum) and Mo Yao (Myrrha) are added to enhance the effect to treat acute trauma and injuries. These two herbs have an analgesic effect to relieve pain and an anti-inflammatory effect to reduce swelling and inflammation.[10],[11] They 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 tumor necrosis factor-alpha (TNF-£\) and interleukin-1beta (IL-1£]).[12] Furthermore, use of Ru Xiang (Gummi Olibanum) and Mo Yao (Myrrha) is also beneficial to facilitate wound healing by stimulating maturation and differentiation of white blood cells.[13] Clinically, they have been used effectively to treat various types of pain, such as trauma and external injuries,[14] chest pain, colicky or sharp pain,[15] and pain due to acute sprain of the lower back and legs.[16]

        Dang Gui (Radix Angelicae Sinensis), another important herb in this formula, exerts both analgesic and anti-inflammatory effects through the inhibition of pro-inflammatory mediators, including nitric oxide and prostaglandin E2 in peritoneal macrophages.[17]^,[18] 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.[19] According to clinical studies, Dang Gui (Radix Angelicae Sinensis) has been used successfully to treat menstrual pain in 112 patients,[20] migraine headache in 35 patients,[21] different types of headache in 36 patients,[22] and general complaint of pain in 105 patients.[23]

        Lastly, Sheng Ma (Rhizoma Cimicifugae) has mild anti-inflammatory and analgesic effects.[24] Sheng Ma (Rhizoma Cimicifugae) also functions as a guiding herb, as it has the effects to reach the far ends of the body, such as the extremities. Its guiding function helps to enhance the overall effect of all the herbs in this formula.

        In summary, Herbal ANG has marked analgesic and anti-inflammatory effects, and can be used individually or as an adjunct to another formula to treat pain of various onset, duration and characteristics.

 

COMPARATIVE ANALYSIS

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. Two classes of drugs commonly used to treat pain include non-steroidal anti-inflammatory agents (NSAID) and opioid analgesics. NSAIDs [such as Motrin (ibuprofen) and Voltaren (diclofenac)] are generally used for mild to moderate pain, and are most effective to reduce inflammation and swelling. Though effective, they may cause such serious side effects 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. Opioid analgesics [such as Vicodin (APAP/hydrocodone) and morphine] are usually used for severe to excruciating pain. While they may be the most potent agents for pain, they also have the most serious risks and side effects, including but not limited to 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. In brief, it is important to remember that while drugs offer reliable and potent symptomatic pain relief, they should be used only if and when needed. Frequent use and abuse leads to unnecessary side effects and complications.

        In TCM, 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 locations (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 the 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. However, as with any therapeutic modality, it is important to recognize the limitations of TCM pain management. In some cases, such as excruciating cancer pain in terminally ill patients, drugs are simply superior to herbs. Under these circumstances, immediate, potent and consistently reliable pain relief is the main objective, and this can be accomplished more effectively with drugs, such as intravenous injection of morphine. Herbs should be used to support the underlying constitution of the body, and to alleviate the side effects of the drugs.