TCM Approaches for Shoulder and Neck Pain Caused by Severe Cold
The biggest cold wave of this century is upon us; this morning I saw news that the monkeys at Beijing Zoo are huddling together for warmth. This winter is indeed very cold; in my family of three, two of us developed shoulder and neck pain from this cold wave, so I imagine such problems are common. Here I share the methods I recently used to treat my own and my son's shoulder and neck pain, for patients with similar problems to reference.
First, let me introduce the several formulas I use for shoulder and neck pain:
Mahuang Tang (Ephedra Decoction):
Sheng Mahuang (raw Ephedra) 15g (decoct first to remove foam), Guizhi (Cinnamon Twig) 10g, Xingren (Apricot Kernel) 6-10g, Zhi Gancao (honey-fried Licorice) 6g
Mahuang Jia Zhu Tang (Ephedra Plus Atractylodes Decoction):
Sheng Mahuang 15g (decoct first to remove foam), Guizhi 10g, Xingren 6-10g, Zhi Gancao 6g, Chao Baizhu (stir-fried Atractylodes) 15g
Guizhi Tang (Cinnamon Twig Decoction):
Guizhi 15g, Baishao (White Peony) 15g, Zhi Gancao 10g, Shengjiang (Fresh Ginger) 7 slices, Dazao (Jujube) 7 pieces (broken apart)
Gegen Tang (Pueraria Decoction):
Gegen (Pueraria) 20g, Mahuang 15g (decoct first to remove foam), Guizhi 10g, Baishao 10g, Zhi Gancao 6g, Shengjiang 7 slices, Dazao 7 pieces (broken apart)
Guizhi Jia Gegen Tang (Cinnamon Twig Plus Pueraria Decoction):
Gegen 20g, Guizhi 10g, Baishao 10g, Zhi Gancao 6g, Shengjiang 7 slices, Dazao 7 pieces
Chaihu Guizhi Tang (Bupleurum Cinnamon Twig Decoction):
Guizhi 10g, Baishao 10g, Huangqin (Scutellaria) 10g, Dangshen (Codonopsis) 10g, Zhi Gancao 5g, Fabanxia (processed Pinellia) 8g, Chaihu (Bupleurum) 18g, Shengjiang 7 slices, Dazao 7 pieces (broken apart)
Chaige Jieji Tang (Bupleurum Pueraria Muscle-Resolving Decoction):
Chaihu 6g, Huangqin 6g, Baishao 6g, Gegen 9g, Zhi Gancao 3g, Qianghuo (Notopterygium) 3g, Baizhi (Angelica Dahurica) 3g, Jiegeng (Platycodon) 3g, Shengjiang 3 slices, Dazao 2 pieces.
For all the above formulas containing Mahuang, the Mahuang must be decocted first: bring to a boil, skim off the topmost foam, then add the other herbs. Bring to a rolling boil over high flame, then simmer over low flame for three to five minutes. For formulas containing Chaihu, after the herbs are decocted, pour out the liquid and separately decoct the liquid for another three to five minutes. Each dose is decocted once or twice, yielding 300-400 ml total, divided into two equal portions and drunk in two sittings. After taking the medicine, the patient may drink an appropriate amount of warm congee or hot water to assist sweating. Take the medicine once every two hours; at most, six doses may be taken over a day and night — i.e., at most three packets.
These are the formulas I commonly use for shoulder and neck pain in cold-wind weather; here I discuss symptoms rather than disease names. Shoulder and neck pain may be a cervical spine flare-up or a wind-cold cold; in Western medicine these are different diseases, but in TCM they can be treated with the same method. I keep granules made from various TCM formulas at home year-round, so I don't need to decoct on the spot; I just dissolve one packet when needed. These granule preparations were bought from Japan and Taiwan before the pandemic; because regulations on TCM granules are not as strict in those places as in mainland China, many pharmaceutical companies there produce ready-made granule preparations based on classical TCM formulas.
Before New Year's Day, I had stiff, painful shoulders and neck, and dizziness when lowering my head; looking up or lying flat caused no dizziness. I had no fever, no cough, and no sneezing. Because I do so much desk work, I judged it to be cervical spondylosis. Beijing had already entered extreme cold before New Year's Day, and wind-cold attacking the body should be the main cause of this shoulder/neck stiffness and pain, so I first used Mahuang Tang. After taking it twice, lowering my head no longer caused dizziness, but I still had shoulder and neck stiffness and pain. I then switched to Gegen Tang for one day, and the shoulder and neck stiffness and pain eased by seventy to eighty percent. I then switched to Guizhi Jia Gegen Tang for two days as follow-up, after which there was no more shoulder and neck stiffness and pain. Note that after every dose, I used a hairdryer on my Dazhui acupoint (GV 14) and spine until I sweated. Since after New Year's Day, I run indoors for 30-60 minutes every day, working up a sweat each time; after each run I feel refreshed, and the cervical spondylosis has not recurred since.
After school this Friday, my son suddenly felt severe pain in both shoulders, as if dislocated, with discomfort around the shoulder joints as well; no fever, cough, runny nose, or sneezing. That evening it was very cold in Beijing; my son was wearing too few clothes and rode his bicycle home without gloves. Analyzing the overall picture, I judged it to be cold-wind pain. I first gave him one packet of Gegen Tang, then had him wrap himself in bedclothes while I used the hairdryer on his Dazhui acupoint and spine. After half an hour of this, no sweat appeared, so I added one packet of Guizhi Tang; after drinking it, I had him drink a large cup of hot water, then again used the hairdryer on his Dazhui and spine. This time the right shoulder sweated; after sweating, all symptoms in the right shoulder disappeared. But the left shoulder did not sweat and remained severely painful, easing only when the hairdryer was on it. An hour later, I decided to give him one packet of Mahuang Tang, followed by a large cup of water. About ten minutes later, my son's left shoulder began to sweat, and sweat spread across his chest and back; once sweating began, the illness vanished as if lifted. The entire treatment took less than three hours, and my son recovered. On Saturday he went normally to his advanced-study class; after returning home he said his shoulders felt more comfortable than ever. As of this morning (Sunday), there has been no recurrence.
Here I should explain my medication reasoning. I deliberately do not mention pulse conditions in this article because, when treating myself and my child, I did not take the pulse at all; I decided how to medicate based only on the weather and our symptoms. Often, when choosing Chinese herbal medicine to treat disease, taking the pulse is not necessarily required; if the analysis of the cause and condition is thorough, one can treat disease well without pulse diagnosis.
Mahuang Tang is suitable for body pain caused by wind-cold binding the exterior, with headache and no sweating. Therefore, in such cold-wind weather in northern China, the probability of using Mahuang is particularly high. For body pain, shoulder and neck pain caused by great wind and great cold, the first choice should be Mahuang Tang or Mahuang Jia Zhu Tang. But Mahuang Tang should not be taken for too long; after taking Mahuang Tang and the body sweats, if the various wind-cold symptoms have not eased, one may switch to Guizhi Tang or Guizhi Jia Gegen Tang, because Guizhi Tang and Guizhi Jia Gegen Tang can treat patients with wind-cold shoulder and neck pain or whole-body pain accompanied by sweating. After Mahuang Tang induces sweating, even if sweat has appeared, switching to Guizhi Tang or Guizhi Jia Gegen Tang is safer.
Gegen Tang and Guizhi Jia Gegen Tang are representative formulas for treating "stiffness and tightness of the neck and back" (shoulder and neck discomfort). Gegen Tang contains Mahuang, so its sweat-inducing force is slightly stronger; it is suitable for wind-cold shoulder and neck discomfort without sweating. Guizhi Jia Gegen Tang is Guizhi Tang plus Gegen; Gegen is a specific herb for treating shoulder and neck discomfort, so this formula is the representative prescription for wind-cold shoulder and neck discomfort with sweating.
In TCM treatment, as the patient's condition changes, the prescription should be changed accordingly; so when treating myself and my son, I switched formulas at any time as our symptoms changed after taking the medicine.
The above formulas can basically resolve shoulder and neck pain caused by cold-wind weather. But both my son and I are health-conscious people; although we do a lot of desk work, we normally know how to protect our shoulders and necks, so my cervical spondylosis and his shoulder pain were easy to treat. Many people normally take even less care of their bodies than we do, so that shoulder and neck problems have become long-term chronic conditions that are not so easy to treat; medication can only temporarily relieve symptoms, after which the patient must change their lifestyle and work habits, treat their body kindly, and slowly wait for the body to recover on its own.
Shoulder and neck pain also has some accompanying symptoms that our treatment method cannot resolve. One is shoulder and neck pain in chronic periarthritis of the shoulder or arthritis patients, which worsens with cold and wind; this is a kind of vexing pain — the patient is both pained and restless — and in this case Chaihu Guizhi Tang is appropriate. Another, more complex situation is when the patient not only has shoulder and neck pain but also dry throat and mouth and irritability; in this case, Chaige Jieji Tang works better. If the patient has body pain accompanied by signs of heavy dampness, Mahuang Jia Zhu Tang should be used.
These are all approaches I have applied in practice with confirmed efficacy. There may be other solutions to these problems, but my methods are offered for everyone's reference.