My Medical Philosophy: A Case of Treating Refractory Pain with TCM

The patient, a woman surnamed Wang, is a long-term resident of Lanzhou, Gansu, 51 years old. Over the past two years she had various hospital tests for intractable headache and swollen, painful joints, but no cause for the headache or the joint swelling and pain could be found. In July 2026 she was admitted to Gansu Provincial Third People's Hospital and discharged on July 14.

The discharge diagnoses were: 1. Duodenal ulcer; 2. Non-atrophic gastritis; 3. Helicobacter pylori infection; 4. Lumbar intervertebral disc herniation; 5. Arthritis? 6. Common carotid artery plaque; 7. Thyroid nodule; 8. Hepatic hemangioma; 9. Renal angiomyolipoma; 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 drugs. The treatment plan was to eradicate H. pylori, lower blood lipids, and supplement vitamin D.

After taking the medicines, the patient's headache, joint swelling and pain, and other symptoms did not ease. Her husband's family is acquainted with me, so the patient wanted me to give some TCM medication suggestions.

In a case like this, it is hard to find a single specifically matching formula. I could only try to compose a formula from various small symptom-directed medicinals.

Initial prescription suggestion: Chuanxiong 10 g; Tianma 10 g; Manjingzi 10 g; Baizhi 10 g; Fangfeng 10 g; Jingjie 10 g; Mugua 30 g; Weilingxian 15 g; Xuchangqing (Cynanchi Paniculati Radix) 15 g; Qianghuo 10 g; Duhuo 10 g; Mohanlian 10 g; Nüzhenzi 10 g; Shayuanzi 10 g; Tusizi 10 g; Gegen 15 g; Suanzaoren 10 g; Baihe 10 g; Cangzhu (Atractylodis Rhizoma) 10 g; Luoshiteng (Trachelospermi Caulis) 10 g; Shenjincao (Lycopodii Herba) 10 g; Qinjiao 10 g; Sangjisheng 15 g; Baiji (Bletillae Rhizoma) 15 g; Wuzeigu (Sepiae seu Os Sepiella) 15 g; Baishao 30 g; zhigancao 10 g.

I advised the patient's family to have a local TCM physician review it and decide whether it could be used. If usable, each dose should last two days, taken twice daily. After three doses, if there was improvement, switch from decoction to pills and treat slowly for a period.

In this formula, the combination of Chuanxiong and Tianma is a common medicinal pair in TCM for treating vascular headache; Manjingzi, Baizhi, Fangfeng, Jingjie, Qianghuo, Duhuo, and Gegen also all treat vascular headache. Cangzhu, Mugua, Weilingxian, Xuchangqing, Luoshiteng, Shenjincao, Qinjiao, and Sangjisheng are all common TCM medicinals for wind-damp bone pain. Baiji combined with Wuzeigu is Wuji San, a common TCM formula for peptic ulcer. Baishao combined with Gancao is Zhang Zhongjing's Shaoyao Gancao Tang, also a pain reliever. Mohanlian, Nüzhenzi, Shayuanzi, and Tusizi support healthy qi and secure the root, and they also somewhat neutralize the warm, drying medicinals in the formula, preventing side effects such as constipation. Suanzaoren, Baihe, and similar medicinals calm the spirit and aid sleep, improving the patient's sleep quality.

This formula-composition approach fits my large, multi-component, multi-target signature therapy, though to many TCM physicians it would incur the criticism of heaping medicinals together. After all, a formula of 27 ingredients counts as a large formula—although, by my own dosing experience, it is really a small one.

After taking it, the patient's headache, joint pain, and other symptoms eased markedly, and she gained confidence in the treatment. She then had a local pharmacy make the above formula into small water-pills and is now slowly regulating herself with the pills.

This patient's discharge summary fully illustrates that many patients' causes and pathologies are complex and hard to treat according to the reasoning found in medical textbooks. Medical education simplifies the complex disease problems of real life. I am now studying clinical medicine at school; each teacher, before formally lecturing, introduces a case, and the cases they introduce basically all have a single cause.

But in reality, patients who fall ill exactly according to the textbook cases are very rare. Most patients carry anywhere from three or five to ten or twenty diagnoses, and even those diagnoses may not be complete or accurate.

Treating such patients is very difficult, and treating them with TCM is difficult too. Such patients are relatively common in grassroots medical institutions, where modern medicine has no great solution and TCM has no ready-made approach. My experience is to use as much symptom-directed supportive care as possible, relieve the patient's chief suffering, and wait for the body to complete its own regulation.