A Case Report of Refractory Pain Treated with Traditional Chinese Medicine
The patient, surnamed Wang, is a 51-year-old woman residing in Lanzhou, Gansu Province. Over the past two years, she underwent various examinations in hospitals because of intractable headache and joint swelling and pain, yet no cause could be identified for these symptoms. In July 2026, she was hospitalized at the Third People's Hospital of Gansu Province and was discharged on July 14.
Her discharge diagnoses from that hospital were as follows: (1) duodenal ulcer; (2) non-atrophic gastritis; (3) Helicobacter pylori infection; (4) lumbar disc herniation; (5) arthritis (?); (6) common carotid artery plaque; (7) thyroid nodule; (8) hepatic hemangioma; (9) renal hamartoma; (10) gallbladder polyp; (11) vitamin D deficiency.
At discharge, the attending physician prescribed vitamin D2 soft capsules, rosuvastatin calcium tablets, omeprazole, amoxicillin, colloidal bismuth pectin capsules, furazolidone tablets, and other medications. The treatment strategy was to eradicate H. pylori, lower blood lipids, and supplement vitamin D, among other measures.
After taking these medications, the patient's headache and joint swelling and pain did not improve. Because her husband's family is well acquainted with the author, the patient asked the author for suggestions on Chinese herbal medicine.
For a case like this, it is difficult to find a formula that precisely matches the condition. The author could only consider assembling a prescription from various small formulas and individual herbs for symptomatic treatment, as a trial.
The initial prescription suggested was as follows:
Chuānxiōng (Ligusticum chuanxiong) 10 g
Tiānmá (Gastrodia elata) 10 g
Mànjīngzǐ (Vitex trifolia) 10 g
Báizhǐ (Angelica dahurica) 10 g
Fángfēng (Saposhnikovia divaricata) 10 g
Jīngjiè (Schizonepeta tenuifolia) 10 g
Mùguā (Chaenomeles speciosa) 30 g
Wēilíngxiān (Clematis chinensis) 15 g
Xúchángqīng (Cynanchum paniculatum) 15 g
Qiānghuó (Notopterygium incisum) 10 g
Dúhuó (Angelica pubescens) 10 g
Mòhànlián (Eclipta prostrata) 10 g
Nǚzhēnzǐ (Ligustrum lucidum) 10 g
Shāyuànzǐ (Astragalus complanatus) 10 g
Tùsīzǐ (Cuscuta chinensis) 10 g
Gégēn (Pueraria lobata) 15 g
Suānzǎorén (Ziziphus jujuba var. spinosa) 10 g
Bǎihé (Lilium lancifolium) 10 g
Cāngzhú (Atractylodes lancea) 10 g
Luòshíténg (Trachelospermum jasminoides) 10 g
Shēnjīncǎo (Lycopodium japonicum) 10 g
Qínjiāo (Gentiana macrophylla) 10 g
Sāngjìshēng (Taxillus chinensis) 15 g
Báijí (Bletilla striata) 15 g
Wūzéigǔ (cuttlebone, Endoconcha Sepiae) 15 g
Báisháo (Paeonia lactiflora) 30 g
Zhìgāncǎo (honey-fried Glycyrrhiza uralensis) 10 g
The author advised the patient's family to have a local TCM practitioner review the prescription and decide whether it was appropriate to use. If deemed usable, each dose was to be taken over two days, twice daily. After three doses, if improvement occurred, the decoction was to be converted into pills for gradual treatment over a period of time.
In the above formula, the combination of Chuānxiōng and Tiānmá is a commonly used herb pair in TCM for vascular headache; Mànjīngzǐ, Báizhǐ, Fángfēng, Jīngjiè, Qiānghuó, Dúhuó, and Gégēn also have effects in treating vascular headache. Cāngzhú, Mùguā, Wēilíngxiān, Xúchángqīng, Luòshíténg, Shēnjīncǎo, Qínjiāo, and Sāngjìshēng are all herbs commonly used in TCM for rheumatic bone and joint pain. The combination of Báijí and Wūzéigǔ constitutes Wūjí Sǎn (Cuttlebone and Bletilla Powder), a commonly used formula in TCM for peptic ulcer.
The combination of Báisháo and Gāncǎo is Zhāng Zhòngjǐng's Sháoyào Gāncǎo Tāng (Peony and Licorice Decoction), which is also a pain-relieving formula. Mòhànlián, Nǚzhēnzǐ, Shāyuànzǐ, and Tùsīzǐ serve to strengthen the vital qi and consolidate the root, and they also moderately counterbalance the warming-drying herbs in the formula, helping to prevent side effects such as constipation. Suānzǎorén and Bǎihé have calming and sleep-promoting effects, which can improve the patient's sleep quality.
This approach to formula construction is consistent with the author's characteristic therapy of "large compound formulas with multiple targets." In the eyes of many TCM practitioners, however, it is difficult to escape criticism of piling up herbs. After all, a formula composed of 27 herbs is a fairly large prescription, although in the author's own prescribing experience it would actually count as a small one.
After taking the medication, the patient's headache and joint pain were significantly alleviated, and she gained confidence in the treatment. She then had a local pharmacy prepare small water pills according to the above formula, and is currently taking the pills for gradual conditioning.
This patient's discharge diagnosis sheet fully illustrates that many patients have complex etiologies and pathologies that are difficult to treat according to the approach taught in medical textbooks. Medical school education simplifies the complex disease problems of real life. The author is currently studying clinical medicine at a medical school, where instructors in various departments habitually introduce cases before formal lectures, and the cases they introduce almost all have a single cause. In reality, however, patients who fall ill exactly as the textbook cases describe are very rare. Most patients have diagnoses ranging from as few as three to five items to as many as ten to twenty items, and even then the diagnoses are not necessarily comprehensive or accurate.
Such patients are very difficult to treat, and they are equally challenging to treat with TCM. These patients are relatively common in primary-level healthcare institutions. Modern medicine has no good solutions for them, and TCM has no ready-made approach either. The author's experience is to adopt symptomatic and supportive treatment as much as possible, relieve the patient's most prominent suffering, and allow the body to complete its self-regulation.