Periarthritis of shoulder, referred to as scapulohumeral periarthritis for short, is a widespread inflammatory reaction caused by degenerative changes of soft tissues such as muscles, tendons, synovial bursa and joint capsule around the shoulder. The disease is a chronic disease characterized by shoulder pain and limited activity, which is common in middle-aged and elderly people over 40 years old. Women are more than men, the left side is more than the right side, and it is rare for both sides to get sick at the same time. Early manifestations, mainly pain, or only slight dull pain or shoulder discomfort and restraint; Then the pain gradually increases, especially at night, which often affects sleep, and the shoulder joint activity is gradually completely limited; Finally, a "frozen state" is formed. This disease belongs to the category of "arthralgia syndrome" in traditional Chinese medicine, also known as fifty shoulders, shoulder leakage, shoulder coagulation and scapulohumeral periarthritis.
What are the clinical manifestations of periarthritis of shoulder?
(1) Shoulder pain: At first, shoulder pain was paroxysmal, mostly chronic. Later, the pain gradually increased or suddenly, or it was a knife pain, and it was persistent. After climate change or fatigue, it will often aggravate the pain, which can spread to the neck and upper limbs (especially the elbows). When the shoulder is accidentally hit or pulled, it often produces tearing pain. Shoulder pain is the main feature of this disease. Those who have colds are particularly sensitive to climate change.
(2) Limited motion of shoulder joint: The motion of shoulder joint in all directions can be limited, especially abduction, lifting and internal and external rotation. With the progress of the disease, due to the adhesion of the joint capsule and soft tissue around the shoulder caused by long-term disuse, the muscle strength gradually decreased, and the coracoid-brachial ligament was fixed in a shortened internal rotation position, which restricted the active and passive activities of the shoulder joint in all directions. There is a typical "shoulder" phenomenon in shoulder abduction, especially combing the hair and shoulders.
(3) Fear of cold: The affected shoulders are afraid of cold, and many patients wrap their shoulders with cotton pads all the year round. Even in summer, they dare not blow their shoulders.
(4) Tenderness: Most patients can feel obvious tenderness around the shoulder joint, and the tenderness point is mostly in the tendon groove of the long head of the biceps brachii. Acromion descending capsule, coracoid process, supraspinatus muscle attachment point, etc. Especially in the tendon groove of the long head of biceps brachii, a few cases show extensive tenderness of soft tissue around the shoulder, and those without tenderness point are rare.
(5) Muscle spasm and atrophy: The muscles around the shoulder, such as deltoid muscle and supraspinatus muscle, may have spasms in the early stage and disuse muscular atrophy in the late stage. Typical symptoms include acromion protrusion, inconvenient lifting and unfavorable dorsiflexion. At this time, the pain symptoms are relieved.
(6)X-ray and laboratory examination: Most routine photography is normal. In the later stage, some patients can see osteoporosis, but there is no bone destruction, and calcification shadow can be seen under the acromion. How normal laboratory tests are.
What western medicine is commonly used to treat scapulohumeral periarthritis?
(1) Non-steroidal anti-inflammatory drugs: It can be used as adjuvant therapy on the basis of traditional Chinese medicine treatment. In the case of severe joint pain, a small amount can be used to relieve the pain, and then the drug will be stopped.
① Aspirin: 3 ~ 6g/ day, taken orally for 3 ~ 4 times; Or sodium salicylate, 6-8g/ day, taken orally for 3-4 times. Salicylate has analgesic, antipyretic, anti-inflammatory and antiallergic effects, and it is the first choice for people without carditis. After taking this medicine, there may be gastrointestinal irritation or gastric bleeding, so pay attention to observation.
(2) Indomethacin: It has anti-inflammatory, antipyretic and sedative effects. Take 25mg orally every time, 2-3 times a day, after meals, in order to alleviate the irritation symptoms to the digestive tract. Patients with peptic ulcer should not be used with caution.
③ Tongyan Xikang: It has anti-inflammatory and sedative effects. Take 20mg orally each time, daily 1 time, after meals. The dosage of this medicine is small, and the adverse reactions are lighter than aspirin and indomethacin, so it is a commonly used medicine. But it can still cause ulcer bleeding, so it is forbidden for ulcer patients, lactating women and children.
(2) Adrenal cortical hormone: These drugs can inhibit allergic reactions, control the development of inflammation and reduce inflammatory exudation, but they are generally not used as much as possible. Prednisone and other drugs, 10 ~ 20 mg, 2 ~ 3 times a day; Or dexamethasone 65438+ 0.5mg per day, taken twice.
Chinese medicine generally divides scapulohumeral periarthritis into the following four types:
(1) cold attack
Main symptoms: shoulder pain is mild, the course of disease is short, the pain is confined to the shoulder, mostly dull or dull pain, or numbness, which does not affect the activity of upper limbs. Local cold, warmth or touch will relieve the pain, white tongue coating, floating or tight pulse, mostly in the early stage of scapulohumeral periarthritis.
Principal-syndrome analysis: for people with physical weakness, the skin is weak in defending yang, and the secondary reason is that sweat is the wind, while deficiency is the wind-cold attacking the skin meridians, which hinders the circulation of qi and blood in the shoulders. If it fails to pass, it hurts, so the shoulders ache and the local chills. Because the course of the disease is short, the cold only attacks the muscle surface, so the pain is mild. Floating or tight fur and white pulse are all signs of cold evil on the muscle surface.
Treatment principle: dispel wind and cold, dredge collaterals and relieve pain.
Prescription: Juanbi Decoction.
Notopterygii Rhizoma10g, Radix Angelicae Pubescentis10g, Ramulus Cinnamomi10g, Radix Gentianae Macrophyllae10g, Caulis Piperis Kadsurae10g, Ramulus Mori10g, and Radix Angelicae Sinensis/kloc.
Fang Jie: Notopterygium Rhizoma, Radix Angelicae Pubescentis, Ramulus Cinnamomi, Radix Gentianae Macrophyllae, Caulis Piperis, and Ramulus Mori from Zhong Fang have the functions of dispelling wind and cold, removing dampness and dredging collaterals; Compatible with Radix Angelicae Sinensis, Rhizoma Chuanxiong, Radix Aucklandiae and Olibanum, promoting blood circulation, regulating qi and relieving pain. Glycyrrhiza uralensis Fisch blends various drugs. All drugs have the functions of expelling wind and cold, dredging collaterals and relieving pain. Radix Aconiti and Asari are added for patients with cold; The winner of the wind, reuse notopterygium, add wind.
(2) stagnation of cold and dampness
The main symptoms: the muscles around the shoulder are painful or radiate to the far end, the day is light and the night is heavy, the course of disease is long, the shoulder can't be lifted because of the pain, the shoulder feels cold, numb, heavy and cold, and the warmth is slightly reduced. The tongue is light and fat, with white and greasy fur and slippery pulse.
Analysis of main symptoms and signs: the elderly are deficient in liver and kidney, lack of vital qi, or suffer from local pain and numbness due to rain and wading, improper sleep, invasion of exogenous cold and dampness, and long-term accumulation of cold and dampness; Cold congeals evil, so the pain is intense and the cold is feared; The humidity is high, so there is a heavy feeling, and the pain is slightly relieved when it is warm. The tongue is pale and fat, the coating is white and greasy, and the pulse is slippery.
Treatment principle: dispelling cold and removing dampness, removing blood stasis and dredging collaterals.
Prescription: Aconitum soup.
Ephedra10g, Radix Aconiti Preparata12g (stir-fried first), Radix Paeoniae Alba15g, Radix Astragali 30g, Scorpio12g, Notopterygii Rhizoma12g, Asari 6g and licorice 6g.
Prescription: Radix Aconiti Preparata, Notopterygii Rhizoma, Asari, and Scorpio warm channels to dispel cold, remove dampness, dredge collaterals and relieve pain; Mahuang powder is cold and wet; Paeonia lactiflora and licorice. Astragalus membranaceus can replenish qi and consolidate exterior, thus alleviating the medicinal properties of ephedra and aconite and preventing the damage of vital qi. The compatibility of all kinds of drugs can make the pathogenic factors of cold and dampness slightly sweat to relieve exterior symptoms, and eliminate pathogenic factors without hurting vital qi, thus achieving the functions of warming meridians, dispelling cold, eliminating dampness and relieving pain.
(3) Blood stasis blocking collaterals
Main symptoms: shoulder pain, local pain, severe local pain, acupuncture-like, refusal to press, and limited shoulder movement after trauma or long illness. Or local swelling, dark purple skin, dark purple tongue and unsmooth pulse.
Main syndrome analysis: trauma, internal injury, local meridian injury, qi and blood imbalance; Or long-term pain enters the collaterals, blood stasis, so the local pain is intense, showing acupuncture-like, positioning, refusing to press, or swelling. Dark purple skin, dark purple tongue and unsmooth pulse are all manifestations of blood stasis.
Treatment: promoting blood circulation, removing blood stasis, dredging collaterals and relieving pain.
Prescriptions: Huoluo Xiaolingdan and Taohong Siwu Decoction.
Angelica sinensis 15g, salvia miltiorrhiza 15g, milkweed 15g, peach kernel 10g, safflower 10g, Radix Rehmanniae Preparata 10g, Chuanxiong 10g, Ramulus Cinnamomi/.
Solution: Radix Angelicae Sinensis, Radix Salviae Miltiorrhizae, Semen Persicae, Flos Carthami and Rhizoma Chuanxiong were used to promote blood circulation, remove blood stasis and relieve pain, and Radix Rehmanniae Preparata was combined with Radix Angelicae Sinensis to nourish blood. Paeonia lactiflora can relieve pain urgently, while frankincense and myrrh can promote blood circulation and qi circulation to relieve pain; Ramulus Cinnamomi, Ramulus Mori and Caulis Spatholobi are used for expelling wind and dredging collaterals. All drugs have the effects of promoting blood circulation, removing blood stasis, dredging collaterals and relieving pain.
(4) Deficiency of both qi and blood
Main symptoms: shoulder pain and numbness, weakness of limbs, dull skin, mental fatigue, or local muscle contracture, acromion hypertrophy, pale tongue and weak pulse.
Analysis of main symptoms: chronic illness, weakness of qi and blood, invasion of exogenous pathogens, obstruction of meridians, and lack of shoulder muscles and meridians in nursing for the elderly, so we can see shoulder pain and numbness, weakness of limbs, dull skin, muscle atrophy and mental fatigue. Weak tongue and weak pulse are all symptoms of qi and blood deficiency.
Treatment principle: Yiqi Yangxue, Qufeng Tongluo.
Prescription: Qin Gui Si Wu Decoction, or treat it with this prescription.
Gentiana macrophylla 12g, Ramulus Cinnamomi 12g, Radix Angelicae Sinensis 12g, Rhizoma Chuanxiong 10g, Radix Paeoniae Alba 12g, Radix Rehmanniae 12g, Radix Astragali 15g. Cold plus Notopterygium, Radix Angelicae Pubescentis and Radix Aconiti Lateralis; Moisten with Coicis Semen and Pittosporum bark; Adding Fructus Chaenomelis, Caulis Spatholobi and Caulis Lonicerae to contract muscles; Pain increases the whole worm.
Prescription: This prescription uses Angelica sinensis, Ligusticum Chuanxiong, Radix Paeoniae Alba and Radix Rehmanniae to nourish blood and soften tendons, uses Gentiana macrophylla to dispel wind and cold, uses Guizhi and Astragalus to warm meridians and dispel cold, and uses * * * to invigorate qi and nourish blood, disperse meridians and dispel cold.
What Chinese patent medicines are there to treat scapulohumeral periarthritis?
(1) Kunming Haitang tablets
Pharmaceutical ingredients: Tripterygium hypoglaucum.
Efficacy: dredge meridians, reduce swelling and relieve pain.
Indications: Pain in bones and muscles, rheumatism and cold arthralgia, numbness and early scapulohumeral periarthritis.
Usage: Take 2-3 tablets orally, 3 times a day.
(2) Shi Feng Hantong Tablet
Composition of drugs: See the chapter on rheumatoid arthritis.
Efficacy: expelling wind and cold, promoting diuresis and dredging collaterals, strengthening the body resistance and consolidating the foundation.
Indications: scapulohumeral periarthritis in various stages.
Usage: Take 6 tablets orally, 2-3 times a day.
(3) Feng Tongan Capsule
The medicine comprises Radix Stephaniae Tetrandrae, Fructus Chaenomelis, Ramulus Cinnamomi, Gypsum Fibrosum, Curcuma Rhizome, Cortex Erythrinae, Caulis Lonicerae, Fructus Forsythiae, medulla Tetrapanacis, and Cortex Phellodendri.
Efficacy: clearing away heat and promoting diuresis, promoting blood circulation and dredging collaterals.
Indications: Patients with scapulohumeral periarthritis have fever symptoms in the early and middle stages.
Usage: Take 4-5 capsules orally, 3 times a day.
(4) Bikunaiting tablets
Pharmaceutical ingredients: Radix Aconiti Preparata, Radix Aconiti Kusnezoffii Preparata, Olibanum Preparata, Myrrha Preparata, Semen Strychni Preparata, Radix Rehmanniae, Coicis Semen, etc.
Efficacy: dispel wind and cold, promote blood circulation and remove blood stasis, relax tendons and dredge collaterals.
Indications: scapulohumeral periarthritis in various stages.
Administration method: Take 5 ~ 7 tablets orally, 4 times a day, and take it continuously for 3 months 1 course of treatment.
(5) Bilongqing 'an Tablets
Composition of the drug: holmium? , Radix Rehmanniae, Semen Strychni, Olibanum, Myrrha, Coicis Semen, etc.
Efficacy: eliminating dampness and swelling, promoting blood circulation and removing blood stasis, relaxing tendons and activating collaterals.
Indications: Patients with scapulohumeral periarthritis at various stages have fever symptoms.
Usage: Take 5 ~ 7 tablets orally, 4 times a day, and take it continuously for 3 months 1 course of treatment.
What external plasters are there for treating scapulohumeral periarthritis?
(1) First Tieling
The composition and preparation method of the medicine are realgar, camphor, impatiens balsamina, clove, Pinellia ternata, Zaocys, centipede and vaseline. Grinding the medicine into fine powder, and mixing with vaseline to make ointment.
Efficacy: Warming meridians and dredging collaterals, dispelling cold and relieving pain.
Indications: scapulohumeral periarthritis due to wind-cold invasion and blood stasis.
Usage: Apply proper amount of ointment to the dressing and stick it on the affected area.
(2) shoulder pad cream
A pharmaceutical composition and its preparation method: Fructus Arctii1500g, Impatiens balsamina120g, Rhizoma Chuanxiong120g, Ramulus Cinnamomi 60g, Radix et Rhizoma Rhei 60g, Radix Angelicae Sinensis 60g, Radix Ampelopsis 60g, Cortex Cinnamomi 60g, Radix Aconiti Kusnezoffii 60g, Lumbricus 60g, and Radix et Rhizoma Rhei 60g. Adding the above medicinal materials into fried cake, filtering the residue, adding beeswax and stirring into paste. Beeswax should be added in summer and reduced in winter, and it will be used in a week.
Efficacy: Warming meridians and dredging collaterals, expelling wind and cold, removing blood stasis and relieving pain.
Indications: Various types of scapulohumeral periarthritis.
Usage: Apply proper amount of ointment to cotton pad, evenly apply it to the affected area, and change it every 3 ~ 5 days 1 time.
(3) removing ointment
Composition and preparation method of the medicine: 2500g of fresh Euphorbia helioscopia before Qingming, 7500g of raw vegetable oil, 0/80g of raw ephedra, 0/80g of raw Pinellia ternata, 0/80g of raw Rhizoma Arisaematis and 0/80g of kansui, 240g of white mustard seed, 240g of Stellera chamaejasme and 240g of Bombyx Batryticatus, 90g of rattan, 30g of nitric acid and fried lead powder/kloc. Firstly, boiling Euphorbia helioscopia in oil to remove residues, adding Herba Ephedrae, Rhizoma Arisaematis, Radix Kansui, Semen Sinapis Albae, Radix Euphorbiae, and Bombyx Batryticatus, boiling to remove residues, adding Radix Pseudostellariae when dripping into beads, filtering the boiled oil with sodium sulfate, adding Huang Dan, and spreading the ointment on kraft paper.
Efficacy: Warming channels and dispelling cold, resolving phlegm and relieving pain.
Indications: Scapulohumeral periarthritis due to phlegm blocking collaterals.
Usage: Wash the affected area, melt the ointment and stick it on the affected area, and change it every 5 days 1 time.
(4) Wuzhi ointment
Composition and preparation method of the medicine: mulberry branch, Sophora japonica branch, elm branch, peach branch and willow branch are 36cm each (diameter 12mm, suitable for harvesting in late autumn and early winter). Cut each branch into 3cm long, fry it in 500g of sesame oil (yellow), take it out, grind15g of frankincense and myrrh respectively, add it into the oil, stir while adding (one-way stirring), add 250g of Zhang Dan, continue stirring, and spread it on 25-30 pieces of kraft paper after the paste is warm.
Efficacy: dredge meridians, remove blood stasis and relieve pain.
Indications: Periarthritis of shoulder joint.
Usage: Wash the affected area, apply the ointment to the affected area, and change it every 5 days 1 time. At the same time, guide patients to strengthen shoulder function exercise.
What medicine bath methods are there to treat scapulohumeral periarthritis?
(1) lotion Ⅰ
Pharmaceutical composition: 30g of Radix Stephaniae Tetrandrae, 30g of Radix Clematidis, 30g of Cortex Acanthopanacis, 30g of Notopterygii Rhizoma, 30g of Radix Angelicae Pubescentis, 30g of Rhizoma Ligustici Chuanxiong, 30g of Radix Paeoniae Rubra, 30g of Carthami Flos, 30g of Fructus Chaenomelis, 30g of Caulis Spatholobi, 30g of Caulis Ginseng, 30g of Caulis Piperis Kadsurae, 30g of Caulis Sinomenii, 30g of Ramulus Mori, 30g of Semen Strychni, and 30g of spreading.
Efficacy: Warming channels and activating collaterals, expelling wind and dispelling cold.
Indications: scapulohumeral periarthritis.
Usage: Put the medicinal materials into an iron porcelain basin, soak them in cold water for 2 hours, and then simmer for 20 minutes without removing residue. When the temperature is appropriate, dip the towel in the liquid medicine and apply hot compress to the affected area, or directly bathe the affected area with the liquid medicine and then heat it. Water can be added before heating. 1 ~ 30 minutes twice a day, each dose can be used 1 week.
(2) lotion II
The medicine composition: Lycopodium, Radix Clematidis, Radix Dipsaci, Herba Ephedrae and Ramulus Cinnamomi each 65438±05g, Radix Angelicae Sinensis, Carthami Flos, Radix Aconiti, Radix Aconiti Kusnezoffii, Semen Momordicae, Olibanum, Myrrha and Rhizoma Chuanxiong each 65438±02g.
Efficacy: relax muscles and promote blood circulation, warm channels and dispel cold.
Indications: scapulohumeral periarthritis in various stages.
Usage: same as emulsion I.
(3) shoulder air leakage fumigation and washing prescription
Medicine composition: Euonymus japonicus15g, Cinnamomum cassia twig, Carthamus tinctorius and Chaenomeles each 9g, Bombyx batryticatus15g and yellow wine 250g.
Efficacy: dispel wind and cold, promote blood circulation and remove blood stasis, and dredge meridians.
Indications: Periarthritis of shoulder joint belongs to rheumatic joint pain type.
Usage: soak the medicine in clear water for 15 minutes, then add water to half a basin, add yellow wine to boil, smoke and wash the affected area while it is hot, and smoke and wash it after it is cold, each time for 15 ~ 30 minutes. Twice a day, each dose lasts for 3 days.
What medicine is used to treat scapulohumeral periarthritis?
(1) Shouzhou powder
Pharmaceutical composition: Pinellia ternata, Rhizoma Arisaematis, Radix Aconiti, Radix Angelicae Dahuricae, Radix Aconiti Kusnezoffii, Asari, Carthami Flos, Myrrha, Olibanum, Onion, Ginger and Chinese Liquor.
Efficacy: Warming channels and dispelling cold, promoting blood circulation and removing blood stasis.
Indications: scapulohumeral periarthritis in various stages.
Usage: Apply the medicine * * * into fine powder, then add ginger and raw onion, mash it, mix it with appropriate amount of Chinese liquor, stir-fry it in a pot, apply it to the affected shoulder, fix it by outsourcing, and change the medicine every other day 1 time. If the skin is allergic to drugs, gauze can be dipped in clear oil to separate it from the skin and then applied.
(2) Chuanwu powder
The medicine composition: 90g of Radix Aconiti, 90g of Radix Aconiti Kusnezoffii and 90g of camphor.
Efficacy: Warming channels and dispelling cold, activating yang and removing arthralgia.
Indications: scapulohumeral periarthritis.
Usage: Apply the medicine and grind it into powder, take appropriate amount of powder according to the size of the painful part, mix it into paste with vinegar, evenly apply it to the affected part and tender point with a thickness of about 0.5cm, wrap it with gauze, and press it on the local hot compress with hot water bag for about 30 minutes, once a day/kloc-0.
(3) Wuyi salt powder
Medicine composition: Fructus Evodiae, Coicis Semen, Raphani Semen, Semen Cuscutae, Perillae Fructus, and crude salt each 30g.
Efficacy: dispelling wind and cold, warming meridians and dredging collaterals, eliminating dampness and relieving pain.
Indications: Periarthritis of shoulder joint.
Usage: grind the medicine into coarse powder, first fry it in a crude salt pan, then add the Chinese medicinal powder and fry it until it becomes slightly discolored, then pour it into a cloth bag and apply it to the affected shoulder, and move the shoulder joint while ironing until the temperature of the medicine is low. Stir-fry and apply it once in a while, three times a day.
What external rubbing therapies are there to treat scapulohumeral periarthritis?
(1) External rubbing prescription
Pharmaceutical composition: Radix Aconiti Kusnezoffii 12g, Radix Aconiti Kusnezoffii 12g, Rhizoma Zingiberis 12g, Asari 8g, Radix Clematidis 6g and Impatiens balsamina 8g. 6 grams of safflower, 4 grams of Ligusticum Chuanxiong, 7 grams of cassia twig, 8 grams of Radix Angelicae Pubescentis, 6 grams of Andrographis paniculata, 6 grams of camphor 15, 6 grams of pine branches, 8 grams of rhubarb, 6 grams of curculigo, 6 grams of Morinda officinalis, 6 grams of fennel, 6 grams of clove, 6 grams of notoginseng, 6 grams of acanthopanax bark, 4 grams of Achyranthes bidentata, 0/2 grams of frankincense/kloc-0.
Efficacy: Warming channels and dispelling cold, dredging collaterals and relieving pain.
Indications: Various types of scapulohumeral periarthritis.
Usage: pulverize the medicine into coarse powder, soak in 55% Chinese liquor, filter for 5 days in summer 14 days, spring and autumn 2 1 day, and winter 30 days. Before going to bed at night, dip a cotton swab in an appropriate amount of liquid medicine and apply it to the painful part, and cover it with polyethylene ultra-thin film (thin soft food plastic bag). The clothes outside will be covered on it for about 10 minutes, and the temperature will rise (the burning feeling is normal). After 6 hours, remove the cover. Every day 1 time. Precautions: The medicine should contact the skin evenly, and it is forbidden for pregnant women and those with alcohol allergy and skin injury.
(2) Anti-inflammatory and analgesic liquid
Pharmaceutical composition: clove, camellia each10g, radix aucklandiae 9g, rhubarb12g, safflower10g, angelica sinensis12g, radix rehmanniae, radix paeoniae rubra, cortex moutan, radix Angelicae dahuricae and Rhizoma Ligustici Chuanxiong each10g, respectively.
Efficacy: Warming channels and dispelling cold, dredging collaterals and relieving pain.
Indications: scapulohumeral periarthritis. Shoulder pain is unbearable, it is difficult to sleep, and the hand can't lift and turn the latter.
Usage: Except camphor, soak it in 90% alcohol (proper amount) for 24 hours (the ratio of alcohol to medicine is 1∶2), then put water into a pot, distill and collect 200ml of distillate, filter out the residue in the residue, add camphor powder into the distillate, and mix with the filtrate to make 350ml of external liniment for use. When in use, the product is applied to the affected part 10 minute with a specific electromagnetic spectrum therapeutic apparatus, and then applied to the affected part every 5 minutes 1 time. Each irradiation lasts for 30 minutes, twice a day.