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Acupuncture Today
August, 2011, Vol. 12, Issue 08
 
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Herbal Alternatives To Pain Killers

By John Chen, PhD, PharmD, OMD, LAc

Pain is a sensation of discomfort, distress, or even agony that results from the stimulation (by heat, cold or pressure) of specialized nerve endings. Even though pain serves as a protective mechanism for the body, it may cause a tremendous amount of suffering.

In such cases, pain must be managed so the sufferers may resume a normal lifestyle. The goals of pain management are to decrease the intensity of the pain, and to increase the patient's physical activity. I would like to explore some of the advantages and disadvantages of drug and herbal therapies, and to identify the most beneficial treatment you can provide your patients.

Western Medicine

The ideal treatment for pain is to identify and eliminate the cause. However, symptomatic relief of pain is often critical and necessary, such as in cases of traumatic injuries, acute migraine, burns, pain related to cancer, and surgical procedures. Analgesic medications are the first line of treatment in Western medicine, and it is essential that health care practitioners be familiar with the indications, functions, side effects and toxicity of these medications. Below are descriptions of the following key pain drugs used by most physicians today.

Anti-inflammatory drugs:

  • Corticosteroids: prednisone, deltasone, etc.
  • NSAIDS: Motrin / Advil (ibuprofen), Naprosyn (naproxen), Voltaren (dicolfenac)
  • Cox-II Inhibitors: Celebrex (celecoxib)

Analgesics:

  • Opioid: Morphine, Darvocet (propoxyphene w/ acetaminophen), Tylenol (acetaminophen w/ codeine), Vicodin (hydrocodone w/ acetaminophen)

Atypical Analgesics:

  • Antidepressants: Tofranil (imipramine), Elavil (amitriptyline), Cymbalta (duloxetine)
  • Antiseizures: Tegretol (carbamazepine), Dilantin (phenytoin), Neurontin (gabapentin), Lyrica (pregabalin)

Muscle Relaxants:

  • Soma (carisprodol), Flexeril (cyclobenzaprine)

The goal of pain management treatment is to identify and remove the cause(s) of pain so that the patients are able to resume a normal lifestyle. Unfortunately, pharmaceutical analgesic medications prescribed for pain management often lead to unwanted side effects and complications. Some merely address symptoms or mask or dull pain rather than addressing and resolving causes of pain. According to the Journal of the American Medical Association (JAMA), adverse drug reactions and fatal drug reactions are now the 4th and 6th leading causes of death. As a result, patients are actively seeking other modalities of pain treatment, including, but not limited to acupuncture, chiropractic and herbal medicine. The following will explore herbal counterparts to typically-prescribed medications, and detail how these formulas can be used in case management.

Traditional Chinese Medicine

According to Traditional Chinese Medicine (TCM), the fundamental etiology of pain is qi stagnation, blood stagnation, or both. It is often said that where there is pain, there is stagnation; where there is stagnation, there is pain. Therefore, effective pain relief most often requires the use of herbs that activate qi and blood, removing stagnation and thus resolving the cause of the pain. As is true in all treatment involving Chinese medicinal herbs, herbs are most commonly prescribed in carefully-combined formulas that directly address the causes and/or symptoms of the imbalance and treat without creating unwanted side effects or complications.

In addition to treating qi and blood stagnation, successful treatment of pain also requires careful differential diagnosis of pain. The three main diagnostic keys are the location of the discomfort, the type of pain, and the cause of pain. Location refers to the exact part of the body that is affected, such as upper body, lower body, external musculoskeletal muscle, internal smooth muscle, and so on. The type of pain refers to the characteristics of the patient's pain, such as a sharp, stabbing or dull aching pain at a fixed location as opposed to migratory pain, pain helped by cold or by heat, and other such distinguishing characteristics.

Lastly, identifying the cause of the individual's pain helps the practitioner to differentiate soft tissue injuries versus structural damage. For example, leg spasms and cramps often involve only soft tissue, while an acute sprained ankle is often accompanied by structural damage. Accurate evaluation of these three criteria is crucial for greatly-enhanced diagnostic accuracy and successful relief for the patient. Below are a listing of Chinese herbs that are effective for pain management.

Chinese herbs with analgesic effect:

Bai Bu (Radix Stemonae), Bai Shao (Radix Paeoniae Alba), Bai Tou Weng (Radix Pulsatillae), Bai Zhi (Radix Angelicae Dahuricae), Bei Dou Gen (Rhizoma Menispermi), Bei Sha Shen (Radix Glehniae), Bi Cheng Qie (Fructus Litseae), Bing Pian (Borneolum Syntheticum), Chai Hu (Radix Bupleuri), Chan Su (Venenum Bufonis), Chan Tui (Periostracum Cicadae), Chi Shao (Radix Paeoniae Rubra), Chou Wu Tong (Folium Clerodendri Trichotomi), Dang Gui (Radix Angelicae Sinensis), Dang Shen (Radix Codonopsis), Ding Xiang (Flos Caryophylli), Du Huo (Radix Angelicae Pubescentis), Du Zhong (Cortex Eucommiae), Fang Feng (Radix Saposhnikoviae), Fang Feng (Radix Saposhnikoviae), Fang Ji (Radix Stephaniae Tetrandrae), Fu Zi (Radix Aconiti Lateralis Praeparata), Gan Jiang (Rhizoma Zingiberis), Gao Ben (Rhizoma et Radix Ligustici), Gao Liang Jiang (Rhizoma Alpiniae Officinarum), Gui Zhi (Ramulus Cinnamomi), Hai Shen (Strichopus Japonicus), Hong Hua (Flos Carthami), Hua Jiao (Pericarpium Zanthoxyli), Hua Jiao (Pericarpium Zanthoxyli), Jiao Gu Lan (Rhizoma seu Herba Gynostemmatis), Jin Qian Cao (Herba Lysimachiae), Jing Jie (Herba Schizonepetae), Ju Ye San Qi (Herba seu Radix Gynura Segetum), Ling Zhi (Ganoderma), Man Jing Zi (Fructus Viticis), Mu Dan Pi (Cortex Moutan), Mu Zei (Herba Equiseti Hiemalis), Niu Xi (Radix Achyranthis Bidentatae), Qiang Huo (Rhizoma et Radix Notopterygii), Qin Pi (Cortex Fraxini), Qing Feng Teng (Caulis Sinomenii), Quan Xie (Scorpio), Rou Gui (Cortex Cinnamomi), San Qi (Radix et Rhizoma Notoginseng), Sang Bai Pi (Cortex Mori), She Xiang (Moschus), Sheng Jiang (Rhizoma Zingiberis Recens), Sheng Ma (Rhizoma Cimicifugae), Suan Zao Ren (Semen Ziziphi Spinosae), Tian Ma (Rhizoma Gastrodiae), Tian Zhu Huang (Concretio Silicea Bambusae), Wei Ling Xian (Radix et Rhizoma Clematidis), Wu Zhu Yu (Fructus Evodiae), Xi Xin (Radix et Rhizoma Asari), Xiang Fu (Rhizoma Cyperi), Xiao Hui Xiang (Fructus Foeniculi), Xu Chang Qing (Radix et Rhizoma Cynanchi Paniculati), Xun Gu Feng (Herba Aristolochiae Mollissimae), Yan Hu Suo (Rhizoma Corydalis), Ying Su Ke (Pericarpium Papaveris), Zao Xiu (Rhizoma Paridis), Zhi Cao Wu (Radix Aconiti Kusnezoffii Praeparata), Zhi Chuan Wu (Radix Aconiti Praeparata).

Chinese herbs with anti-inflammatory effect:

Ba Ji Tian (Radix Morindae Officinalis), Bai Shao (Radix Paeoniae Alba), Bai Zhi (Radix Angelicae Dahuricae), Bing Pian (Borneolum Syntheticum), Cang Er Zi (Fructus Xanthii), Chai Hu (Radix Bupleuri), Chan Su (Venenum Bufonis), Chi Shao (Radix Paeoniae Rubra), Chou Wu Tong (Folium Clerodendri Trichotomi), Chuan Xin Lian (Herba Andrographis), Da Huang (Radix et Rhizoma Rhei), Da Qing Ye (Folium Isatidis), Dan Shen (Radix et Rhizoma Salviae Miltiorrhizae), Dang Gui (Radix Angelicae Sinensis), Dang Shen (Radix Codonopsis), Di Yu (Radix Sanguisorbae), Du Huo (Radix Angelicae Pubescentis), Du Zhong (Cortex Eucommiae), Fang Feng (Radix Saposhnikoviae), Fang Feng (Radix Saposhnikoviae), Fang Ji (Radix Stephaniae Tetrandrae), Fu Zi (Radix Aconiti Lateralis Praeparata), Gan Jiang (Rhizoma Zingiberis), Gao Ben (Rhizoma et Radix Ligustici), Ge Jie (Gecko), Ge Qiao (Concha Meretricis seu Cyclinae), Gu Sui Bu (Rhizoma Drynariae), Guang Jin Qian Cao (Herba Desmodii Styracifolii), Hei Zhi Ma (Semen Sesami Nigrum), Hong Hua (Flos Carthami), Hu Zhang (Rhizoma et Radix Polygoni Cuspidati), Huai Hua (Flos Sophorae), Huang Lian (Rhizoma Coptidis), Huang Qi (Radix Astragali), Huang Qin (Radix Scutellariae), Jiang Huang (Rhizoma Curcumae Longae), Jie Geng (Radix Platycodonis), Jin Qian Cao (Herba Lysimachiae), Jin Yin Hua (Flos Lonicerae Japonicae), Jing Jie (Herba Schizonepetae), Ju Ye San Qi (Herba seu Radix Gynura Segetum), Ku Shen (Radix Sophorae Flavescentis), Kuan Dong Hua (Flos Farfarae), Lai Fu Zi (Semen Raphani), Lei Gong Teng (Radix Tripterygii Wilfordii), Lei Wan (Omphalia), Lian Qiao (Fructus Forsythiae), Liu Huang (Sulfur), Lu Hui (Aloes), Lu Lu Tong (Fructus Liquidambaris), Ma Bian Cao (Herba Verbenae), Ma Dou Ling (Fructus Aristolochiae), Ma Huang (Herba Ephedrae), Man Jing Zi (Fructus Viticis), Mao Dong Qing (Radix Ilicis Pubescentis), Mu Dan Pi (Cortex Moutan), Niu Huang (Calculus Bovis), Nu Zhen Zi (Fructus Ligustri Lucidi), Pi Pa Ye (Folium Eriobotryae), Qiang Huo (Rhizoma et Radix Notopterygii), Qin Jiao (Radix Gentianae Macrophyllae), Qin Pi (Cortex Fraxini), Qing Feng Teng (Caulis Sinomenii), Ren Dong Teng (Caulis Lonicerae Japonicae), San Qi (Radix et Rhizoma Notoginseng), Sha Yuan Zi (Semen Astragali Complanati), Shan Dou Gen (Radix et Rhizoma Sophorae Tonkinensis), Shang Lu (Radix Phytolaccae), She Gan (Rhizoma Belamcandae), She Tui (Periostracum Serpentis), She Xiang (Moschus), Sheng Jiang (Rhizoma Zingiberis Recens), Sheng Ma (Rhizoma Cimicifugae), Su Mu (Lignum Sappan), Tao Ren (Semen Persicae), Tian Ma (Rhizoma Gastrodiae), Wu Jia Pi (Cortex Acanthopanacis), Xi Xian Cao (Herba Siegesbeckiae), Xi Xin (Radix et Rhizoma Asari), Xia Ku Cao (Spica Prunellae), Xian Mao (Rhizoma Curculiginis), Xiang Fu (Rhizoma Cyperi), Xiao Ji (Herba Cirsii), Xu Chang Qing (Radix et Rhizoma Cynanchi Paniculati), Xue Jie (Sanguis Draconis), Xue Yu Tan (Crinis Carbonisatus), Xun Gu Feng (Herba Aristolochiae Mollissimae), Ye Ju Hua (Flos Chrysanthemi Indici), Yin Yang Huo (Herba Epimedii), Yu Xing Cao (Herba Houttuyniae), Ze Xie (Rhizoma Alismatis), Zhi Cao Wu (Radix Aconiti Kusnezoffii Praeparata), Zhi Chuan Wu (Radix Aconiti Praeparata), Zhi Zi (Fructus Gardeniae), Zi Cao (Radix Arnebiae).

Chinese herbal formulas for pain, based on location:

Neck and Shoulders

  • Ge Gen Tang (Kudzu Decoction)
  • Er Zhu Tang (Two-Atractylodes Decoction)
  • Wu Yao Shun Qi San (Lindera Powder to Smooth the Flow of Qi)

Back

  • Du Huo Ji Sheng Tang (Angelica Pubescens and Taxillus Decoction)
  • Huan Shao Dan (Return to Youth Pill)

Limbs

  • Shu Jing Huo Xue Tang (Relax the Channels and Invigorate the Blood Decoction)
  • Shu Jin Li An San (Relax the Tendons and Instill Peace Powder)

Joints

  • Dang Gui Nian Tong Tang (Tangkuei Decoction to Lift the Pain)
  • Gui Zhi Shao Yao Zhi Mu Tang (Cinnamon Twig, Peony, and Anemarrhena Decoction)

General

  • Juan Bi Tang (Remove Painful Obstruction Decoction)
  • San Bi Tang (Three-Painful Obstruction Decoction)

Chinese herbal formulas for pain, based on pattern differentiation:

Wind-cold-damp obstruction

  • San Bi Tang (Three-Painful Obstruction Decoction)
  • Juan Bi Tang (Remove Painful Obstruction Decoction)
  • Shang Zhong Xia Tong Yong Tong Feng Wan (Upper, Middle, and Lower General Use Pill for Wind-Pain)

Wind-heat obstruction

  • Bai Hu Jia Gui Zhi Tang (White Tiger plus Cinnamon Twig Decoction)
  • Gui Zhi Shao Yao Zhi Mu Tang (Cinnamon Twig, Peony, and Anemarrhena Decoction)

Heat obstruction

  • Bai Hu Jia Gui Zhi Tang (White Tiger plus Cinnamon Twig Decoction)

Damp-heat

  • Si Miao Wan (Four-Marvel Pill)
  • Xiao Huo Luo Dan (Minor Invigorate the Collaterals Special Pill)

Blood stagnation

  • Shen Tong Zhu Yu Tang (Drive Out Blood Stasis from a Painful Body Decoction)

Liver and Kidney deficiencies

  • Du Huo Ji Sheng Tang (Angelica Pubescens and Taxillus Decoction)
  • Hu Qian Wan (Hidden Tiger Pill)

Yin-deficient heat

  • Zhi Bai Di Huang Wan (Anemarrhena, Phellodendron, and Rehmannia Pill)

Kidney yang deficiency

  • Jin Gui Shen Qi Wan (Kidney qi Pill from the Golden Cabinet)
  • Xing bi (mobile painful obstruction)
  • Gui Zhi Shao Yao Zhi Mu Tang (Cinnamon Twig, Peony, and Anemarrhena Decoction)
  • Zhuo bi (fixed painful obstruction)
  • Yi Yi Ren Tang (Coicis Decoction)
  • Re bi (heat painful obstruction)
  • Bai Hu Jia Gui Zhi Tang (White Tiger plus Cinnamon Twig Decoction)
  • Xue bi (blood painful obstruction)
  • Shen Tong Zhu Yu Tang (Drive Out Blood Stasis from a Painful Body Decoction)
  • Wan bi (stubborn painful obstruction)
  • Da Huo Luo Dan (Major Invigorate the Collaterals Special Pill)
  • Xiao Huo Luo Dan (Minor Invigorate the Collaterals Special Pill)
  • Shen Tong Zhu Yu Tang (Drive Out Blood Stasis from a Painful Body Decoction)
  • Wei bi (atrophic painful obstruction)
  • San Bi Tang (Three-Painful Obstruction Decoction)
  • Huang Qi Gui Zhi Wu Wu Tang (Astragalus and Cinnamon Twig Five-Substance Decoction)
  • Zhou bi (generalized painful obstruction)
  • Juan Bi Tang (Remove Painful Obstruction Decoction)
  • Shang Zhong Xia Tong Yong Tong Feng Wan (Upper, Middle, and Lower General Use Pill for Wind-Pain)

Pain is universally understood as a signal of disease and is the most common symptom that brings a patient to a physician. Western clinical medicine and traditional Oriental medicine share common goals of alleviating pain and eliminating the causes of pain, however, the philosophy and clinical approach to pain management in the two disciplines is very different.

Generally speaking, Western drugs have immediate and reliable analgesic effects. Unfortunately, Western pharmaceuticals often cause serious short- and long-term side effects. In addition, the chronic use of drugs, especially opioid analgesics, is strongly associated with addiction and negative social consequences and connotations. As a result, more and more patients are turning to herbal medicine as their primary, complementary, or alternative treatment for pain. Herbal medicines definitely have outstanding analgesic, anti-inflammatory, and anti-spasmodic functions and benefits. However, even though herbs and pharmaceutical drugs have many overlapping functions, they are not directly interchangeable or analogs of each other. The therapeutic effectiveness of herbal formulas is dependent on accurate diagnosis and careful prescription. When used properly, herbs are powerful alternatives to drugs for pain management.


Click here for more information about John Chen, PhD, PharmD, OMD, LAc.

 

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