“Tianxian Drink” for Phlegm-Flow Arm Pain (Shoulder-Arm Pain)

Chinese medicine has a condition called “phlegm-flow arm pain” (tan zhu bi tong), whose typical symptoms are persistent aching and heaviness of the arm, limited shoulder movement, possibly with swelling, numbness, or abnormal local temperature. The arm pain is usually aching or dull, fixed in location, worse at night or on damp days, and may ease temporarily with movement. On palpation, the affected area feels abnormally warm or cool, with tense muscles or pitting on pressure. TCM holds that phlegm-dampness obstructs the meridians, impeding the flow of qi and blood.

This resembles modern-medicine disorders caused by damage to the shoulder muscle group (deltoid, supraspinatus, infraspinatus, teres minor, subscapularis, etc.); some patients also develop these symptoms after a cold or flu. In addition, patients with lung cancer or other tumors with pulmonary metastases may present the same symptoms; such patients often also have Horner syndrome (with miosis, ptosis, enophthalmos, and reduced or absent sweating on the same side of the face). In lung cancer, shoulder pain is caused by tumor compression of the nerves.

Renzhai Zhizhi Shu, by the Southern Song physician Yang Shiying, includes a formula called “Tianxian Drink,” which addresses phlegm-flow arm pain. Its composition is: turmeric slices (Pian Jianghuang) 6 qian (18 g); Dutchman’s pipe vine (Tianxianteng), notopterygium (Qianghuo), Atractylodes (Baizhu), and angelica dahurica tip (Baizhi Shao), each 3 qian (9 g); processed Pinellia (Zhi Banxia) 5 qian (15 g). Crush the herbs; take 3 qian (9 g) each time and decoct with five slices of ginger for oral use.

According to traditional TCM theory, this formula expels wind and resolves phlegm, and unblocks the collaterals to stop pain. In the formula, turmeric slices invigorate blood and stop pain; Dutchman’s pipe vine expels wind and stops pain; notopterygium and angelica dahurica disperse cold and stop pain; Atractylodes dispels dampness; processed Pinellia resolves phlegm. Used together, they address shoulder pain both at the root and the branch in a fairly comprehensive way; adding ginger to the decoction helps disperse the medicinal force. Patients with shoulder-arm pain may try this formula. When lung cancer causes shoulder pain, it may also be added to a compound formula to relieve pain.