Name: Pan.
Sex: Female.
Age: 62 years.
0ccupation: A peasant.
Chief Complaint: Aching-pain of left shoulder-joint for 6 years, aggravation for half a month.
History of Present Illness: Six years ago, the patient slowly got an aching-pain in the left shoulder-joint. At the beginning, it's only induced by over working or catching a cold. Finally it became a continuous aching-pain in the left shoulder. It' s a dull pain as usual, but it's easy to be aggravated by over-working or cloudy weather. Furthermore, the range of lifting, abduction and rotation of the left shoulder-joint became smaller and smaller, at last the shoulder-joint lost the ability of rotation. The range of lifting and abduction was greatly reduced. So that she couldn't comb her hair and put on her clothes. Half a month ago, the shoulder-pain was aggravated by cloudy weather, it caused she couldn't sleep throughout night, furthermore, the shoulder couldn't move about at all. Then she came to our hospital for treatment on September 7, 1997 through somebody. After the illness came on, she separately went to the local hospitals for treatment. But there was no obvious curative effect on her. In addition, she had gotten the treatment of oral taking Chinese herbs, but she gave up it because of her many years' gastric ulcer. There was not other complaint.
Physical Examination: The patient was conscious with a weak general condition. The pulse was thready and uneven, the tongue was red with a thin layer of white fur. The range of the left shoulder-joint's lifting was less than 30°. The range of left deltoid muscle and the lateral region of left greater pectoral muscle became rigid and lacked in elasticity, accompanied with tenderness. There was not other abnormal sign.
Diagnosis: Scapulohumeral Periarthritis.
Differentiation: This disease, in TCM, belongs to the category of "Bi-syndrome. "It's caused by attack of exogenous pathogenic wind and cold, which lurked into the affected meridian. As a result of a long period of it, there were stagnation of meridian qi and blood stasis in the affected region, and then the affected joint could not be nourished well as normal and the muscles around the joints became withered and rigid.
Therapeutic Principle: Activating blood to resolve stasis; expelling wind and clearing away pathogenic cold; dredging the obstructed channel and promoting the joint's movement. In addition, because this illness only involved partial meridian, where the efficacy of acupuncture can easily reach while the efficacy of oral taking decoction can not easily reach; furthermore the patient got many years' gastric ulcer. So that it's necessary to use external treatment and acupuncture.
Recipe:
Hegu(L14)
Lieque(LUT)
Chize(LW5 )
All points were left side. I manipulated the needles in the chosen points with balancing skill. In addition, I chose the most painful part of the affected region as "Yes" point, punctured the "Yes" point with 5 needles, manipulated the needles with a special skill named as "five tigers bring a sheep down. "(This method means 1 needle is punctured into the centre point of the affected region vertically, the other 4 needles were separately punctured into the edge of the affected region obliquely towards the centre point. )After acupuncture, I applied the external drugs onto the affected region. The recipe of the external drugs was as follow.
DingXiang, Cloves
XiaoHuiXiang,Common Fennel Fruit
HongHua, Safflower
ChuanXiong,Chuanxiong Rhizome
CaoWu,Wild Aconite Root
All the above drugs were to be ground into powder, she was to1d to mix the powder together, put some mixed powder into a small cloth bag, whose size was almost as same as the affected region. She should wet the cloth bag with some 75% alcohol and put the wet bag onto the affected region, irradicate the wet bag with the TDP lamp in order to increase the permeability of the external drugs, or cover the wet bag with a hot-water bottle in order to have a fomentation. During the treatment, the patient was told to keep stretching her left arm upward against a wall so as to extend the range of the movement of the shoulder joint.
Effect Observation: After 15 days' treatment, the aching pain in the left shoulder disappeared completely. The range of the left shoulder's lifting got more than 120°. She could comb her hair and put on her clothes by herself. Then she was told to go on the external treatment by herself. After 3 months' follow-up, the illness didn't recur. Then it's ending.
