A Literature Review on Pattern-identification of Shoulder Pain

Article information

Acupunct. 2015;32(2):147-167
Department of Acupuncture & Moxibustion Medicine, College of Oriental Medicine, Sangji University
*Corresponding author: Department of Acupuncture & Moxibustion Medicine, College of Oriental Medicine, Sangji University, 80, Sangjidae-gil, Wonju-si, Gangwon-do, 220-717, Republic of Korea, Tel: +82-33-741-9258, E-mail: redphilips@hanmail.net
Received 2015 May 11; Revised 2015 May 21; Accepted 2015 June 01.

Abstract

Objectives:

The aim of this study is to summarise pattern-identification of shoulder pain based on the classics of oriental medicine, current literature and domestic papers

Methods:

The materials selected were sourced from the classics of oriental medicine, current literature and domestic papers which contained data related to pattern-identification of shoulder pain The pattern-identifications were compared to determine the similarities, and these were classified.

Results:

Thirty-five studies were reviewed, and thirty-seven pattern-identifications were collated. These were classified into the following groups: wind-cold-dampness group(n = 8), blood stasis group(n = 3), phlegm group(n = 7), dual deficiency of Qi and blood group(n = 4), deficiency cold group(n = 2), liver-kidney deficiency group(n = 1) and meridian-collateral group(n = 12).

Conclusions:

On the basis of the classification of pattern-identifications, two groups of pattern-identifications for shoulder pain were suggested The first group included the pattern-identification associated with a disease-cause, which included the wind-cold-dampness pattern(風寒濕型), blood stasis pattern(瘀血型), phlegm pattern(痰飮型), Qi-blood deficiency pattern(氣血氣型氣), deficiency cold pattern(寒型寒), and liver-kidney deficiency pattern(肝腎虧損型). The second included the pattern-identification associated with the meridian-collateral, which included the hand greater Yin meridian pattern(手太陰經型), hand Yang brightness meridian pattern(手陽明經型), hand lesser Yin meridian pattern(手少陰經型), hand greater Yang meridian pattern(手太陽經型), hand reverting Yin meridian pattern(手厥陰經型), hand lesser Yang meridian pattern(手少陽經型), and foot greater Yang meridian pattern(足太陽經型).

Fig. 1

Summary of pattern-identification

Because symptoms from ‘lack of Qi and blood*’ in The Acupuncture and Moxibustion Medicine7) are similar to that of deficiency cold pattern, we made ‘lack of Qi and blood’ belong to deficiency cold pattern.

Summary of Pattern-identification Associated with a Disease Cause

Summary of Pattern-identification Associated with the Meridian-collateral

References

1. Sin HJ, Yoon IJ, Oh MS. Consideration of literatures on the treatment of pain in shoulder and arm based on oriental medicine. The J of Daejeon Oriental Medicine 2007;16(1):139–46.
2. Kim KS. Clinical study of acupuncture and moxibustion treatment on shoulder pain. The J of Korean Medicine 1984;5(1):58–61.
3. Kim DC, Kim GS, Ahn CB. Clinical study on pain of shoulder and arm. The J of Korean Medicine 1987;8(2):56–61.
4. National Health Insurance Service. Health insurance statistics 2012 [Internet] Seoul: [cited 2014 April 20 ]. available from: http://kosis.kr/statHtml/statHtml.do?orgId=350&tblId=DT_35001_A8021&vw_cd=&list_id=&scrId=&seqNo=&lang_mode=ko&obj_var_id=&itm_id=&conn_path=K1&path=.
5. Oriental Medicine Dictionary Compilation Committee. Oriental medicine dictionary Seoul: Jeongdam; 2010. p. 580–1.
6. Lee BG, Park YB, Kim TH. Korean medicine diagnosis Gyeonggi: Seongbosa; 2009. p. 11–17.
7. The Acupuncture and Moxibustion Medicine Society. The acupuncture and moxibustion medicine Gyeonggi: Jipmoondang; 2012. p. 325–38. p. 342–7. p. 458–75.
8. Cheong SH, Lee JS, Kim SS, Shin HD. Current tendency for herb-medication of the frozen shoulder. The J of Korean Medicine 1989;10(2):90–2.
9. Shin WW, Kim SH, Song HJ. Clinical study of 3700 patients with cervical and shoulder pain: static blood pigmentation by cupping therapy. The J of Daejeon Oriental Medicine 1998;6(2):303–11.
10. Song IG, Kim GS, Lee SD. A study of similarities between VDT syndrome and Kyunbitong(Jianbeitong, 肩臂痛) on the ground of medical records. The Acupuncture 2001;18(2):37–50.
11. Lee TH, Chang SY, Kim HJ, et al. The comparison of effectiveness between Shunjing-quxue needling and Jiejing-quxue needling on shoulder pain patient. The Acupuncture 2005;22(6):93–100.
12. Hur B, Yim YK. Study on clinical effects of indirect moxibustion at Geogol(LI16) on the shoulder pain. The J of Daejeon Oriental Medicine 2007;16(2):211–6.
13. Hwang JS, Kim KH. The study on the books of oriental medicine which deal with variation in diagnosis on the neck and nuchal pain. The Acupuncture 2007;24(2):169–85.
14. Kim GU. Historiography of Chinese medicine Seoul: Daesung Publishing Company; 2006. p. 63–341.
15. Korea Institute of Oriental Medicine. Standardization and unification of the terms and conditions used for diagnosis in oriental medicine III. Editions of the Korea Institute of Oriental Medicine 1997;3(1):383–94.
16. Sun SH. Literature review on syndrome differentiation of tremor, focusing on Chinese journals. The J of Internal Korean Medicine 2010;31(1):40–53.
17. Oh HS, Han IS, Lee DS, et al. Literature review on syndrome differentiation and herbal medicine of Sjogrens syndrome: focusing on chinese traditional medicine’s journals. Korean J of Oriental Physiology and Pathology 2013;27(5):578–86.
18. Kim GS. The study of oriental and occidental medicine on the type categorization of shoulder and arm pain and acupuncture therapy. The Acupuncture 1985;2(1):81–8.
19. Chae WS, Lee IK, Lee BY. Clinical study on 44 patients with pain of shoulder and arm. The Journal of Korean Medicine 1987;8(2):49–55.
20. Park KH, Lee BR. Philological study on etiology and pathogenesis of neuralgia in the shoulder and the arm, and its acupuncture points for treatment. The J of Daejeon Oriental Medicine 1999;8(1):549–58.
21. Lee HY, Lee BB. Literatual study on acupuncture treatment of shoulder pain. The Acupuncture 1999;16(3):139–54.
22. Lee HY, Kim SH, Heo JE, et al. Clinical study about acupuncture and moxibustion treatment according to the different type of the meridian pathways of the patients who have shoulder pain. Korean Journal of Acupuncture 2006;23(4):67–84.
23. Park KH, Lee H. Consideration of literatures on the treatment of pain in shoulder and arm based on oriental medicine and western medicine. The J of Daejeon Oriental Medicine 2006;15(1):59–69.
24. Heo SW, Kwon MJ, Kim HG, et al. Clinical study on effect of ginger herbal acupuncture therapy on shoulder pain of paralytic patients. The Acupuncture 2006;23(5):145–54.
25. Kim YI. Comparison study acupuncture treatment with acupuncture & moxibustion combined treatment for frozen shoulder patients. The J of Daejeon Oriental Medicine 2006;15(2):1–7.
26. Shin WY, Hyun JO, Choi EY, et al. 3 case reports of Cheongungkyeoji-tang for post-stroke patients with shoulder pain. The J of Korean Medicine 2006;27(4):936–44.
27. Lee JS, Song KH, Lee SN, et al. Clinical study of different effect between trigger point needling and remote acupuncture point needling on shoulder pain patient. The Acupuncture 2007;24(5):89–96.
28. Lee HY, Youn HM, Kim WI. Clinical study about shoulder pain by oriental medical treatment and oriental-western medical treatment. The J of Korean Institute of Pharmacopuncture 2008;11(2):97–110.
29. Kim SH, Ko KM, Lee YK, et al. A case report of the patient with calcified tendinitis treated by oriental medicine. The J of the Association of Spine & Joint Korean Medicine 2008;5(1):11–7.
30. Ahn MS, Park JS, Jung JH, et al. A case report of frozen shoulder with muscular acupuncture and muscle energy technique. The J of Korea Chuna Manual Medicine for Spine & Nerves 2009;4(2):137–48.
31. Park SH, Ro HR. The case report of prescribing Kamiseokyong-tang (nam) for the two patients with superior labral anterior posterior lesion. The J of Korea Chuna Manual Medicine for Spine & Nerves 2011;6(1):129–39.
32. Kwon SA, Lee JW, Kim MJ, et al. A study of blood stasis pattern for frozen shoulder using blood stasis pattern questionnaires(BSPQ) and the relationship of pain, shoulder range of motion and BSPQ score. The Acupuncture 2011;28(4):49–55.
33. Jeong JY, Kim JH, Song CH, et al. 1 case of shoulder pain treated with oriental treatment including pharmacopuncture in rotator cuff surgery. The Acupuncture 2012;29(6):119–25.
34. The Korean Orthopaedic Association. Orthopaedics 1 Seoul: Choisin Medical Books; 2013. p. 615–24.
35. Chang IK. Bibliographical studies on the upper extremity pain. The J of Korean Medicine 1985;2(1):43–52.
36. The Society of Internal Korean Medicine of Circulatory System. Internal Korean medicine of circulatory system Seoul: Koonja; 2006. p. 174–84.
37. Korean Pharmacopuncture Institute. Pharmaco-puncturology Seoul: Elsevier Korea; 2011. p. 175–81.
38. Jeong DH, Ahn HJ, Hwang KS, et al. Clinical study on effect of carthmi-flos herbal acupuncture therapy on shoulder pain. The Acupuncture 2002;19(6):184–92.
39. Heo J. Donguibogam Gyeongsangnam-do: Donguibogam Publishing Company; 2006. p. 198–211. p. 773.
40. Won SH, Kwon GR. The literatual study about frozen shoulder. The J of Korean Institute of Pharmacopuncture 1999;2(1):27–38.
41. Meridian & Acupoints Compilation Committee Of Korean Orienal Medical Colleges. Principles of meridians & acupoints: a guidebook for college students Wonju: Yibang Medical Book Center; 2009. p. 20–30. p. 70–72. p. 75–199.

Article information Continued

Fig. 1

Summary of pattern-identification

Because symptoms from ‘lack of Qi and blood*’ in The Acupuncture and Moxibustion Medicine7) are similar to that of deficiency cold pattern, we made ‘lack of Qi and blood’ belong to deficiency cold pattern.

Table 1

The Characteristics of Data

No Reference Disease cause Meridian-collateral / meridian sinew Others
1 Huangdi’s internal classic Western wind Hand greater Yin meridian, hand Yang brightness meridian, hand lesser Yin meridian, hand greater Yang meridian, hand reverting Yin meridian, hand lesser Yang meridian, foot greater Yang meridian Viscera and bowels disease(lung disease, heart disease, spleen cough, Yin impediment)
Classified classic
A-b classic of acupuncture and moxibustion
2 Introduction to medicine 1. Wind, cold, dampness, heat(wind, wind-dampness, dampness-heat)
2. Phlegm(liquor-phlegm, Qi-phlegm, wind-phlegm, dampness-phlegm)
3. Qi and blood stagnation
1. Viscera and bowels disease(spleen overexertion, spleen cough)
2. Food accumulation
3 Complete compendium of acupuncture and moxibustion 1. Wind, cold, dampness(wind, cold, cold-dampness, wind-dampness)
2. Phlegm(phlegm-retained fluid, phlegm-fire, dampness-phlegm)
3. Qi and blood stagnation
Hand greater Yin meridian, hand Yang brightness meridian, hand lesser Yin meridian, hand greater Yang meridian, hand reverting Yin meridian, hand lesser Yang meridian, foot greater Yang meridian Viscera and bowels disease(spleen cough)
4 Complete works of jingyue 1. Wind, cold, dampness, heat(wind, western wind, wind-cold-dampness, dampness-heat)
2. Phlegm(phlegm, phlegm-heat)
Hand greater Yin meridian, hand lesser Yin meridian, foot greater Yang meridian 1. Viscera and bowels disease(lung disease, spleen cough, Yin impediment, Qi stagnation in upper energizer)
2. Smallpox
3. Erysipelas facialis
5 The golden mirror of medicine Wind-dampness
6 Treatise on blood patterns/syndromes Static blood(static blood in upper energizer)
7 Correction of Errors in Medical Classics Static blood(blood coagulation because of wind, cold, dampness, heat)
8 Recovery from All Ailments 1. Wind, cold, dampness, heat(wind-cold-dampness, dampness-heat, wind-dampness)
2. Phlegm(phlegm, dampness-phlegm, phlegm-fire)
Hand greater Yin meridian, hand Yang brightness meridian, hand lesser Yin meridian, hand greater Yang meridian, hand reverting Yin meridian, hand lesser Yang meridian
9 Treasured Mirror of Eastern Medicine 1. Wind-cold-dampness
2. Phlegm-retained fluid
Greater Yin meridian, lesser Yin meridian, reverting Yin meridian, Yang brightness meridian, greater Yang meridian, lesser Yang meridian Viscera and bowels disease(pathogen in heart-lung)
10 The Acupuncture and Moxibustion Medicine7) 1. Wind-cold-dampness
2. Phlegm-retained fluid
3. Lack of Qi and blood
1. Greater Yin meridian, Yang brightness-lesser Yang meridian, greater Yang meridian
2. Greater Yin meridian, lesser Yin meridian, reverting Yin meridian, Yang brightness meridian, greater Yang meridian, lesser Yang meridian
11 Standardization and unification of the terms and conditions used for diagnosis in oriental medicine(III)15) 1. Wind, cold, dampness(wind, cold, wind-cold, wind-cold-dampness)
2. Phlegm(phlegm-dampness, phlegm-retained fluid)
3. Static blood(external damage-static blood, blood stasis due to Qi stagnation)
4. Qi deficiency, blood deficiency, dual deficiency of Qi and blood
5. Deficiency cold
12 Kim2) 1. Wind-cold-dampness
2. Phlegm-retained fluid
Lung meridian pattern, heart meridian pattern, pericardium meridian pattern, large intestine meridian pattern, small intestine meridian pattern, triple energizer meridian pattern 1. Viscera and bowels disease (heart-lung disease)
2. Cervical joint disease
13 Kim18) Lung • large intestine meridian pattern, pericardium • triple energizer meridian pattern, heart • small intestine meridian pattern, bladder meridian pattern
14 Chae et al19) 1. Qi and blood stagnation
2. External damage • static blood
Cervical shoulder pain
15 Cheong et al8) 1. Wind-cold-dampness impediment pattern
2. Dual deficiency of Qi and blood pattern
3. Liver-kidney deficiency pattern
4. External damage-static blood pattern
16 Shin et al9) Static blood
17 Park et al20) 1. Wind-cold assailing the exterior
2. Meridian sinew dystrophy
18 Lee et al21) Greater Yin meridian, lesser Yin meridian, reverting Yin meridian, Yang brightness meridian, greater Yang meridian, lesser Yang meridian
19 Song et al10) Hand greater Yin meridian, hand Yang brightness meridian, hand lesser Yin meridian, hand greater Yang meridian, hand reverting Yin meridian, hand lesser Yang meridian, foot greater Yang meridian
20 Lee et al11) Hand greater Yin meridian, hand Yang brightness meridian, hand lesser Yin meridian, hand greater Yang meridian, hand reverting Yin meridian, hand lesser Yang meridian, foot greater Yang meridian
21 Lee et al22) Yang brightness meridian pattern, greater Yang meridian pattern, lesser Yang meridian pattern
22 Park et al23) Following the pattern-identifications of Cheong et al8) Hand greater Yin meridian, hand Yang brightness meridian, hand lesser Yin meridian, hand greater Yang meridian, hand reverting Yin meridian, hand lesser Yang meridian, foot greater Yang meridian
23 Heo et al24) Wind-cold-dampness
24 Kim26) Hand Yang brightness meridian, hand greater Yang meridian, hand lesser Yang meridian
25 Shin et al26) Wind-cold-dampness
26 Hur et al12) Large intestine meridian, large intestine • lung meridian, large intestine • triple energizer meridian, three Yang meridians of the hand, three Yang meridians of the hand • lung meridian
27 Lee et al27) Greater Yin meridian, lesser Yin meridian, reverting Yin meridian, Yang brightness meridian, greater Yang meridian, lesser Yang meridian
28 Lee et al28) Yang brightness meridian pattern, greater Yang meridian pattern, lesser Yang meridian pattern
29 Kim et al29) Blood stasis syndrome
30 Ahn et al30) Hand and foot greater Yang meridian sinews, hand lesser Yang meridian sinews, hand Yang brightness meridian sinews
31 Park et al31) Phlegm-retained fluid • static blood
32 Kwon et al32) Static blood
33 Jeong et al33) Static blood

Table 2

Summary of Pattern-identification Associated with a Disease Cause

No Pattern identification Symptoms References
1 Wind-cold-dampness pattern Sudden occurrence. When lieing on the humid place, sleeping in the cold place, having sex while he drunk. Short-term disease duration. 1, 2, 3, 4, 5, 6, 7, 10, 11, 12, 13, 14, 17, 19, 24, 25, 27
Mild pain, blunt pain, dull pain. The pain gets worse when the weather is cold, where as better when warm weather. Getting better during the day, getting worse during the night.
Cold sensation around the shoulder, refusing to be touched due to red-swelling-pain of the shoulder, feeling sunken and heavy, mild limitation of range of motion(ROM) of the shoulder, unable to rotate head due to should and back pain. Fear of wind, aversion to cold.
Pale red tongue. White or white thin or slimy fur. Floating or string-like slippery or tight pulse.
2 Blood stasis pattern Injury like fracture, luxation, external damage. Frequent occurrence at the initial stage of disease. 4, 5, 8, 9, 13, 16, 17, 18, 24, 31, 33, 34, 35
Shoulder pain, oppressive pain, fixed sore spot, stabbing pain, refusing to be touched due to pain, getting worse at the night. Swelling, induration, limitation of ROM of the shoulder, friction sound.
Partial sensory paralysis, affected side hand flexion-extension disorder due to swelling. If severe, difficult to sleep.
Dark red or purpura tongue. White or yellow thin fur. String-like or fine rough pulse.
3 Phlegm pattern Long-term disease duration. 4, 5, 6, 10, 11, 12, 13, 14, 31
Pain in the arm with swelling, a little edema of the skin, unable to raise arm. The pain gets worse when he move his shoulder, dragging pain, discomfort while either sitting or lieing, moving place to place of the pain.
Sometimes numbness of the shoulder, back, both hand or numbness of the hand and foot. Dizziness, nausea, oppression in the chest, sloppy stool, not thirsty.
Pale tongue. White or slimy fur. Sunken soggy or sunken fine pulse.
4 Qi-blood deficiency pattern Overwork or excessive bleeding. Frequent occurrence at the end stage of disease. Long-term disease duration. 13, 17, 19, 24
Mainly aching pain, aching numbness. Getting worse when fatigue, getting better when rest. Prolonged healing.
Fatigue, powerlessness, muscle and skin dystrophy, dizziness, dizzy vision, anorexia, shortness of breath, being tired of speaking, palpitations, tinnitus, pale complexion.
Pale tongue. White fur. sunken weak or fine weak pulse.
5 Deficiency cold pattern Frequent occurrence at the end stage of disease. 12, 13
Partially aching, distending, cold pain. Getting worse after overwork. Severe pain when the weather is cold.
Feeling hot during the day where as dyring the night, lassitude of spirit, lack of strength.
Pale tongue. White thin fur. Sunken fine pulse lacking of strength.
6 Liver-kidney deficiency pattern Old age, physically weak. Long-term disease duration. Insufficient essence and blood of the liver and kidney because of excessive sexual intercourse 17, 24
Pain aroud the shoulder joint. Dizziness, dizzy vision, tinnitus, lumbar convulsions.
Reddish tongue. Fine weak pulse.

References: these are the number of the order in which they are described in table 1.

The Characteristics of Data

Table 3

Summary of Pattern-identification Associated with the Meridian-collateral

No Pattern identification Symptoms References
1 Hand greater Yin meridian pattern Pain in the anteromedial arm. Shoulder-back pain when Qi excession, shoulder-back cold pain when Qi deficiency. Arm cramp when disease deteriorates. 1, 2, 3, 5, 6, 10, 11, 12, 14, 15, 20, 21, 22, 24, 28, 29
2 Hand reverting Yin meridian pattern Arm spasm, axillary swelling. Unable to expand the arm. Arm cramp when disease deteriorates. 1, 2, 3, 5, 10, 11, 12, 14, 15, 20, 21, 22, 24, 29
3 Hand lesser Yin meridian pattern Pain and reversal cold in the posteromedial arm. Arm cramp with pain when disease deteriorates. 1, 2, 3, 5, 6, 10, 11, 12, 14, 15, 20, 21, 22, 24, 29
4 Hand greater Yang meridian pattern Severe pain in the posterolateral shoulder and arm. Pain in the axilla and posterior axilla. Pain from the scapula to the neck, unable to rotate head. 1, 2, 3, 5, 10, 11, 12, 14, 15, 20, 21, 22, 23, 24, 26, 28, 29, 30, 32
5 Hand lesser Yang meridian pattern Pain in the lateral shoulder and arm, unable to raise hand. Arm cramp when disease deteriorates. 1, 2, 3, 5, 10, 11, 12, 14, 15, 20, 21, 22, 23, 24, 26, 28, 29, 30, 32
6 Hand Yang brightness meridian pattern Pain in the anterior shoulder and arm. Occuring of pain with cramp and unabling to raise shoulder or to rotate head when disease deteriorates. 1, 2, 3, 5, 10, 11, 12, 14, 15, 20, 21, 22, 23, 24, 26, 28, 29, 30, 32
7 Foot greater Yang meridian pattern Headache with neck and shoulder pain, neck and spine stiffness, axillary and supraclavicular pain. 1, 2, 3, 5, 6, 15, 20, 21, 22, 24, 32

References: these are the number of the order in which they are described in table 1.