Periarthritis, referred to as periarthritis, periarthritis, is a wide range of inflammatory reactions caused by degenerative changes in the muscles around the shoulder, tendons, bursa and soft tissues such as the joint capsule. The disease is a chronic disorder characterized by shoulder pain and limited activity, and is more common in middle-aged and older people over 40 years of age. It is more common in women than in men, more common in the left side than in the right side, and less common in those with bilateral onset at the same time. Early manifestations, only pain, or only a slight pain or shoulder discomfort and binding sensation; then the pain gradually aggravated, especially at night, often affecting sleep, shoulder joint activities are also gradually completely limited; and finally the formation of the "frozen state". In Chinese medicine, this disease belongs to the scope of "paralysis", also known as the fifty shoulders, the leaky shoulder wind, shoulder condensation, frozen shoulder and so on.
What are the clinical manifestations of frozen shoulder?
(1) shoulder pain: at the beginning of the shoulder was paroxysmal pain, most of the chronic episodes, and then the pain gradually intensified or pain, or cutting pain, and was persistent, climate change or after exertion, often make the pain aggravated, the pain can be to the neck and the upper limbs (especially the elbow) spread, when the shoulder accidentally by the collision or pulling, can often cause a tear-like pain, shoulder pain, light day and night for the disease a major feature, most patients often complained of after the disease, and then the shoulder pain, the shoulder pain is very serious. Characteristics, most patients often complain of pain in the second half of the night wake up, can not sleep, especially not to the affected side of the side to lie down, such a situation due to blood deficiency is more obvious; if the pain is caused by cold, it is particularly sensitive to climate change.
(2)Restriction of shoulder joint activities: Shoulder joint activities in all directions can be restricted, abduction, supination, internal and external rotation is more obvious, with the progress of the disease, due to the long-term abolition of the joint capsule and the soft tissues around the shoulder caused by adhesion, the muscle strength gradually decreased, coupled with the rostro-humeral ligament is fixed in the shortened position of the internal rotation and other factors, so that the shoulder joint of the various directions of the active and passive activities are limited when the shoulder joint abduction occurs! When the shoulder joint is abducted, there is a typical phenomenon of "carrying the shoulder", especially when combing hair, dressing, washing the face, and crossing the waist, etc. It is difficult to complete the movements, and in serious cases, the function of the elbow joint can be affected, so that the hand can not touch the shoulder on the same side when flexing the elbow, and the flexion of the elbow can not be accomplished, especially when the arm is extended backward.
(3) Fear of cold: the affected shoulder is afraid of cold, many patients use cotton pads to wrap the shoulder all year round, even in the summer days, the shoulder does not dare to blow the wind.
(4)Pressure pain: most patients can touch the obvious pressure points around the shoulder joint, and the pressure points are mostly in the long head of the biceps tendon groove. The biceps subacromial bursa, rostral prominence, supraspinatus attachment point and other places, especially the biceps tendon long head tendon groove, a small number of peri-shoulder soft tissue extensive pressure pain, no pressure point is rare.
(5) Muscle spasm and atrophy: early spasm of the deltoid, supraspinatus and other peri-shoulder muscles can occur, and in the late stage of myasthenia gravis, there is a protrusion of the acromion, lifting inconvenience, and unfavorable bending and other typical symptoms, and the pain symptoms are reduced at this time.
(6) X-ray and laboratory examination: conventional radiographs, mostly normal, some patients can be seen in the late osteoporosis, but no bone destruction, can be seen under the acromion calcification shadow. Laboratory tests are mostly normal.
What western drugs are commonly used in the treatment of frozen shoulder?
(1)Non-steroidal anti-inflammatory drugs (NSAIDs): they can be used as adjunctive therapy on the basis of traditional Chinese medicine, and can be applied in small amounts to relieve pain in cases of severe joint pain, and then discontinued after relief.
①Aspirin: 3-6g/day, 3-4 times orally; or sodium salicylate, 6-8g/day, 3-4 times orally. Salicylates have analgesic, antipyretic, anti-inflammatory and anti-allergic effects, and are preferred for those without carditis. This drug can have gastrointestinal irritation or gastric bleeding after taking it, and should be observed.
②Antiinflammatory pain: anti-inflammatory, antipyretic, sedative effect, oral 25mg each time, 2 to 3 times a day, after meals, to reduce the symptoms of gastrointestinal tract irritation. Ulcer disease patients are prohibited or used with caution.
3 inflammation pain Xikang: anti-inflammatory, sedative effect, oral 20mg each time, once a day, after meals. This drug dosage is small, with less times, adverse reactions than aspirin, anti-inflammatory pain for the light, so for the commonly used drugs. However, it can still cause bleeding from ulcer disease, so patients with ulcer disease, nursing women, children are prohibited.
(2) adrenocorticotropic hormone: these drugs can inhibit the metabolic reaction, control the development of inflammation, reduce inflammation and exudation, but generally try not to use. Drugs such as prednisone, 10-20mg per day, divided into 2-3 times; or dexamethasone 1.5mg per day, divided into 2 times.
The Chinese medicine clinic generally divided frozen shoulder into the following four types:
(1) wind-cold attack
Main evidence: shoulder pain is mild, the course of the disease is short, the pain is confined to the shoulder, mostly dull pain or vague pain, or numbness, does not affect the upper limb activities, the local cold, warm or caressing the pain is reduced, the tongue coating is white, the pulse is floating or tight, most of the early frozen shoulder.
Subjective analysis: the body of the person, the skin Wei Yang is not solid, but also because of the sweat when the wind, wind and cold to take advantage of the weakness in the skin meridians, paralysis blocked in the shoulder, so that the shoulder qi and blood run unfavorable, not through the pain, so the shoulder pain, localized cold, because of a short period of time, the wind and cold only attacked the muscle surface, so the pain is lighter. The white moss and floating or tight pulse are all signs of cold in the muscle surface.
Treatment: dispel wind and cold, and clear the channels to relieve pain.
Remedy: add subtraction of remission of paralysis soup.
Qiang Wu 10g, Duhuo 10g, Gui Zhi 10g, Gentiana Macrophylla 10g, Hai Feng Teng 15g, Mulberry Branches 10g, Angelica sinensis 10g, Ligusticum Chuanxiong 10g, Mullein 10g, Boswellia serrata 10g, Glycyrrhiza glabra 6g.
Formulae: Qiang Wu, Duhuo, Gui Zhi, Gentiana Macrophylla, Hai Feng Teng and Mullein, etc. in the formula dispel wind and dispel cold, dissolve dampness, clearing the collaterals; with Angelica sinensis, Ligusticum Chuanxiong, Mullein and Boswellia serrata, it activates blood and regulates qi and relieves pain. The combination of Angelica, Rhizoma Ligustici Chuanxiong, Muxiang, Boswellia serrata invigorates blood circulation and relieves pain. All medicines **** play the function of dispelling wind and cold, clearing the channels and relieving pain. If the cold wins, add Chuanwu and Xin; if the wind wins, reuse Qiangwu and then add Fangfeng.
(2) Cold-dampness stagnation
Substantiation: severe pain in the shoulder and the surrounding tendons or radiating to the distal end, light day and night, the course of the disease is longer, due to pain and can not lift the shoulder, the shoulder feel cold, numbness, heavy, fear of cold warmth is slightly reduced. The tongue is pale and fat, the moss is white and greasy, and the pulse is stringy and slippery.
Subjective analysis: old age, liver and kidney deficiency, lack of positive qi, or because of wading in the rain, improper sleep, the outside world of cold and dampness of the evil invasion, stagnation of the local, cold and dampness in the long term, resulting in the local meridian obstruction, so see the local pain, numbness; cold condensation of the evil real, so the pain is severe, fear of cold; dampness, so there is a sense of heaviness, warmth, then the pain is reduced a little. The tongue is pale and fat, the moss is white and greasy, and the pulse is stringy and slippery, all of which are signs of cold and dampness.
Treatment: dispersing cold and removing dampness, removing blood stasis and clearing the channels.
Prescription: Wu Tou Tang plus reduction.
Ma huang 10g, systematic Sichuan wu 12g (first decoction), white peony 15g, astragalus 30g, whole worm 12g, qiangwu 12g, fine Xin 6g, licorice 6g.
Formula: the systematic Sichuan wu, qiangwu, fine Xin, whole worm in the formula to warm menstruation dispersal of cold, remove dampness through the collaterals to relieve pain; use of ma huang dispersal of cold and surface dampness, peony, licorice to slow down the urgency of tendons; astragalus to benefit the qi to consolidate the surface and thus to moderate the nature of the ma huang, The combination of these herbs makes the cold and dampness disappear. The combination of all the drugs, so that the cold and dampness of the evil sweat and solution, the evil to go and do not hurt the positive, in order to achieve the warm menstruation dispersal of cold, dampness and pain relief work.
(3) Blood stasis and obstruction
Substantiation: post-traumatic injury or chronic shoulder pain, pain has a fixed place, localized pain is intense, pinprick-like, refuses to be pressed, shoulder activity is limited. Or localized swelling, purplish skin color, purplish tongue, stringy pulse.
Subjective analysis: trauma and internal frustration, local meridians and collaterals damage, qi and blood inversion; or long-term pain into the collaterals, blood stasis, so see the local pain is intense, pinprick-like and a fixed place, refuses to be pressed, or swollen. The color of the skin is purplish, the tongue is purplish, and the pulse is astringent, all of which are signs of blood stasis.
Treatment: activate blood circulation and eliminate blood stasis, clear the channels and relieve pain.
Prescription and medication: combining and subtracting the combination of Activating the Blood Lines Effective Lingdan and Tao Hong Si Wu Tang.
Danggui 15g, danshen 15g, raw frankincense and myrrh 15g, peach kernel 10g, safflower 10g, ripe earth 10g, chuanxiong 10g, cinnamon branch 10g, white peony 10g, chicken blood vine 15g, mulberry twig 20g.
Formulas: formula: formula with danggui, danshen, peach kernel, safflower, chuanxiong to activate blood circulation to eliminate blood stasis and relieve pain, ripened earth with danggui to nourish the blood; white peony to ease the pain, frankincense and myrrh to activate blood circulation to move qi and relieve pain, White peony eases the pain, frankincense, myrrh activates Blood and moves Qi to relieve pain; Gui Zhi, Mulberry Branches, Chicken Blood Vine are used to dispel wind and open the channels. All medicines **** play blood circulation and eliminate blood stasis, the effect of pain relief.
(4) deficiency of qi and blood
Substantiation: shoulder pain and numbness, limb weakness, skin is not glossy, fatigue, or localized muscle contracture, shoulder peaks protruding, the tongue is pale, the pulse is weak and feeble.
Subjective analysis: long-term illness, weakness, qi and blood deficiency, external evils take advantage of the weakness of the invasion, blocking the meridians, shoulder tendons and veins are lost in the glorification of the shoulder, so shoulder pain and numbness, limb softness and weakness, the skin is not glossy, muscle atrophy, mental fatigue. The tongue is pale, the pulse is weak and feeble for the signs of qi and blood deficiency.
Treatment: benefit qi and blood, eliminate wind and clear the channels.
Prescription: Qin Gui Si Wu Tang, or use this formula plus flavor treatment.
Gentiana Macrophylla 12g, Gui Zhi 12g, Angelica Sinensis 12g, Rhizoma Ligustici Chuanxiong 10g, Radix Paeoniae Alba 12g, Radix et Rhizoma Dioscoreae 12g, Astragalus Membranaceus 15g. Add Qiangwu, Duhu, and Radix Pseudostellariae in case of cold, Coix Seed Pear, and Hai Tong Pi in case of wetness, Papaya, Chicken Blood Vine, Lonicera japonica in case of unfavorable contraction of the tendons, and Whole Insect in case of pain.
Formula: This formula uses Angelica sinensis, Rhizoma Ligustici Chuanxiong, Radix Paeoniae Alba, Radix et Rhizoma Dioscoreae to nourish blood and soften tendons, Radix Gentiana Macrophyllae to expel wind and disperse cold, Cortex Gui Zhi and Radix Astragali to benefit Qi and warm the meridians and clear away the cold.
What are the proprietary Chinese medicines for the treatment of frozen shoulder?
(1) Kunming Begonia tablets
Drug composition: Kunming Begonia.
Effects: Promotes circulation, reduces swelling and relieves pain.
Treatment: tendon and bone pain, wind-dampness and cold paralysis, numbness and insensitivity, the early stage of frozen shoulder.
Dosage: Orally take 2 to 3 tablets each time, 3 times a day.
(2) rheumatism cold pain tablets
Drug composition: see rheumatoid arthritis chapter.
Effects: Dispelling wind and dispersing cold, inducing dampness and clearing the channels, supporting the upright and strengthening the root.
Treatment: all stages of frozen shoulder.
Dosage: Take 6 tablets orally each time, 2 to 3 times a day.
(3) Wind Pain Capsule
Drug composition: Fangji, papaya, cinnamon sticks, gypsum, turmeric, sea tongpi, Lonicera japonica, forsythia, Tongcao, cypress.
Effects: Clearing heat and inducing dampness, promoting blood circulation.
Treatment: early and middle stage of frozen shoulder with signs of heat.
Dosage: Oral 4 to 5 capsules each time, 3 times a day.
(4)Paralysis Bitter Naijian Tablets
Drug composition: Prepared Chuanwu, Prepared Caowu, Prepared Frankincense, Prepared Myrrh, Prepared Strychnine, Prepared Radix et Rhizoma Dioscoreae, Semen Coicis, and so on.
Effects: Expelling wind and dispersing cold, activating blood circulation and removing blood stasis, and relaxing tendons and collaterals.
Treatment: all stages of frozen shoulder.
Dosage: Oral 5-7 tablets each time, 4 times a day, for 3 months as a course of treatment.
(5)Paralysis Long Qing An Tablet
Drug composition: castor seed, dioscorea villosa, tetrapod, strychnine, and other ingredients. The ingredients are: Dioscorea villosa, Dioscorea villosa, Strychnine, Boswellia serrata, Myrrh, Semen Coicis, etc.
Effects: Removing dampness and swelling, activating blood circulation and removing blood stasis, relaxing tendons and activating collaterals.
Treatment: all stages of frozen shoulder with heat symptoms.
Use: Oral 5-7 tablets each time, 4 times a day, for 3 months as a course of treatment.
What are the topical creams for the treatment of frozen shoulder?
(1) shoulder paste spirit
Drug composition and method: andrographis, camphor, acute, male clove, raw half-summer, snake, centipede, petroleum jelly. The above medicines are finely ground and mixed with petroleum jelly to form an ointment.
Effects: Warming the meridians, dispersing cold and relieving pain.
Treatment: Frozen shoulder with wind-cold attack and stasis.
Use: Take appropriate amount of ointment and spread it on the dressing, stick it on the affected area.
Effects: Warming the meridians, dispelling wind and cold, resolving blood stasis and relieving pain.
Treatment: all types of frozen shoulder.
Use: Spread the appropriate amount of ointment on a piece of cotton cloth, apply it evenly and stick it to the affected area, and replace it once every 3 to 5 days.
(3) dispersal cream
Drug composition and method of preparation: 2500g of fresh Zeqi grass before the Qingming Festival, 7500g of raw vegetable oil, raw ephedra, raw half-sia, raw star, Gan Sui each 180g, white mustard, halibut, stiff silkworms 240g, Huangteng 90g, 30g of fire nitrate, fried yellow lead powder 1500g. first Zeqi grass into the oil to simmer withered and dregs, and then into the ephedra, star, Gan Sui, White mustard, halberd, stiff silkworm, and then boiled withered slag, was dripping into a bead when adding Huangteng, fire nitrate boiled withered oil filtering, into the yellow lead powder to collect the paste, the paste will be spread on kraft paper.
Effects: Warming the menstruation and dispersing cold, exempting phlegm and relieving pain.
Treatment: Frozen shoulder, phlegm obstruction type.
Use: Wash the affected area, dissolve the paste, stick it on the affected area and change it once in 5 days.
(4) five branches cream
Drug composition and method: mulberry branches, acacia branches, elm branches, peach branches, willow branches 36cm (diameter 12mm, late fall, early winter picking is appropriate). The branches cut into each section 3cm long, into the 500g of sesame oil frying (yellow) out, frankincense, myrrh 15g research fine, add oil, while adding the side of the stir (stirring in one direction), mixing and then add Zhangdan 250g, continue to stir, the paste was warmed and then spread on 25-30 sheets of kraft paper standby.
Effects: Promote circulation of menstruation and activate collaterals, dissolve blood stasis and relieve pain.
Treatment: Periarthritis of shoulder joint.
Use: Wash the affected area, take the paste and paste the affected area, change once in 5 days. At the same time, the patient is instructed to strengthen the shoulder joint functional exercise.
What are the medicinal baths for the treatment of frozen shoulder?
(1) lotion Ⅰ
Drug composition: Fenghui 30g, Weilingxian 30g, Wugapi 30g, Qiangwu 30g, Dugong 30g, Chuanxiong 30g, red peony 30g, safflower 3 0g, papaya 30g, chickweed 30g, millennium Jian 30g, Haifengteng 30g, Qingfengteng 30g, Sangzhi 30g, Strychnine 30g, extensor herb 30g. 30g of Turbinaria.
Effects: Warming the meridians and activating collaterals, dispelling wind and dispersing cold.
Treatment: Frozen shoulder.
Use: soak the medicine in cold water in an iron porcelain basin, 2 hours later, the fire decoction for 20 minutes, do not go to the slag, to be placed at a suitable temperature, with a towel dipped in liquid hot compresses on the affected area, or directly with the liquid bath the affected area, and then again with the warmth of the temperature can be added to the warmth of the water can be renewed before. 1 to 2 times a day, 30 minutes each time, each dose of medicine available for 1 week.
(2) Lotion No. II
Drug composition: 15g each of Elixir of Cordyceps, Weiling Xian, Renunciation, Ephedra, Gui Zhi, 12g each of Angelica sinensis, Safflower, Chuanwu, Caowu, Wooden turtle seed, Frankincense, Myrrh, Chuanxiong Ligustici.
Effects: Relieving tendons and activating blood circulation, warming menstruation and dispersing cold.
Treatment: all stages of frozen shoulder.
Use: same as lotion Ⅰ.
(3) Leaky shoulder wind fumigation formula
Composition: 15g of ghost arrow feather, cinnamon sticks, safflower, papaya 9g each, 15g of late serpentine sand, 250g of wine.
Effects: dispelling wind and dispersing cold, invigorating blood circulation and removing blood stasis, and opening the meridians and collaterals.
Attention: Periarthritis of the shoulder joint belonging to the type of wind-dampness paralytic obstruction.
How to use: Add water and soak for 15 minutes, then add half a basin of water, add yellow wine and decoction boiling, fumigate the affected area while it is still hot, and then fumigate again when it is cold, and then fumigate again, and then fumigate again, and then fumigate for 15-30 minutes each time. 2 times a day, each dose for 3 days.
What are the medicinal treatments for frozen shoulder?
(1)Frozen shoulder powder
Drug composition: raw half-summer, raw southern star, raw Chuanwu, Angelica dahurica, raw strawberry, fine Xin, safflower, myrrh, frankincense, raw onion, ginger, white wine, each appropriate amount.
Effects: Warming menstruation, dispersing cold, activating blood circulation and removing blood stasis.
Treatment: all stages of frozen shoulder.
Usage: the above medicine *** research fine powder, and then add ginger, raw onion mashed, with the appropriate amount of white wine, together into the pot fried hot, compress on the affected shoulder, outsourcing fixed, every other day for 1 time. If the skin is allergic to the medicine, the gauze can be dipped in oil on the skin, and then apply the medicine.
(2) Chuan Wu San
Composition: Chuan Wu, Cao Wu, camphor 90g.
Effects: Warming menstruation and dispersing cold, through the sun in addition to paralysis.
Treatment: frozen shoulder.
Use: the above medicine powder, according to the size of the pain site, take the medicine powder appropriate amount, with vinegar will be mixed into a paste, uniformly applied to the affected area and the pressure point, about 0.5cm thick, wrapped in gauze, with a hot water bag pressed in the local hot compress for about 30 minutes, 1 time a day.
(3) WU CAU SALT SAN
Composition: WU JU, CAU, Coix Seed, Lai Chi Zi, Cuscuta, Zi Su Zi, raw salt 30g.
Effects: Dispel wind and dispersal of cold, warming the meridians and collaterals, eliminating dampness and relieving pain.
Treatment: Periarthritis of shoulder joint.
How to use: all the medicine research for coarse powder, first raw salt pan fried yellow, and then add the end of the Chinese medicine mixing fried until slightly discolored, and then poured into a cloth bag, external compresses on the affected shoulder, ironing while the activities of the shoulder joints until the temperature of the medicine has been low. Every now and then, the medicine will be re-fried and re-compressed, 3 times a day.
What are the external rubbing therapies for the treatment of frozen shoulder?
(1) external rubbing prescription
Drug composition: raw Chuanwu 12g, raw Caowu 12g, dry ginger 12g, Xinxin 8g, Wei Lingxian 6g, Fenghuang Xianhua 8g. safflower 6g, Chuanxiong 4g, Guizhi 7g, Duhuo 8g, seeking bone wind 6g, camphor 15g, pine branches 6g, rhubarb 8g, cynomolgus 6g, bacopa monniera 6g, fennel 6g, clove 6g, panax ginseng 6g, Wu Jia Pi 6g, oxalic acid 6g.
Treatment: all types of frozen shoulder.
How to use: Crush all the drugs into coarse powder, soak in 55 degrees white wine, 14 days in summer, 21 days in spring and fall, 30 days in winter, filtering and precipitation for 5 days. At night before going to bed with a cotton swab dipped in the appropriate amount of liquid coated in the pain, covered with polyethylene super film (thin soft food plastic bag), covered with external clothing for about 10 minutes, there is a feeling of heat, the temperature rises (burning sensation is normal), 6 hours after the removal of the coverings. 1 time daily. Note: the drug should be uniformly in contact with the skin area, pregnant women and alcohol allergy, broken skin is prohibited.
Treatment: Frozen shoulder. The evidence shows that the pain in the shoulder joint is unbearable, it is difficult to sleep, and the hand cannot be lifted to turn the latter.
Usage: in addition to camphor, add 90% alcohol (appropriate amount) soaked for 24 hours (alcohol and medicine ratio of 1:2), and then placed in a pot of water, distillation method, collect distillate 200ml, residual liquid filtration of the dregs of the liquid, the camphor powder added to the distillate stirred, and the filtrate merged into 350ml of rubbing liquid standby. When used in the lesion area first, with specific electromagnetic spectrum therapeutic device irradiation for 10 minutes, the product will be coated with the affected area, the interval of 5 minutes coated 1 time. Each irradiation 30 minutes, 2 times a day.