One of the most common clinical issues I see during the winter season is joint / muscle pain. These issues often appear due to the activities of winter sports or may appear due to seasonal influences on old chronic injuries.
The influence of the seasons on the presentation of symptoms and the pattern presentations of TCM must always be considered by clinicians when encountering patient's complaints in the winter season. Classical texts such as the "Shang Han Lun," and "Wen Bing Xue" clearly reveal the influence of seasons upon the presentation and evolution of pattern expressions. Consequently, clinicians should always keep seasonal influences on their minds while examining the complaints of patients during the winter months.
Seasonal Influences
While I administer patent medicines / formulas / medicinals based strictly upon TCM pattern differentiation, I also take into account the seasonal influences on the patient's mind-body / constitution and the potential for the season to push or sway patterns in particular directions. Keeping this in mind, I often have specific formulas which I may use more during specific months: warming formulas in the winter, coursing / spreading formulas in the spring, cooling formulas in the summer, etc. One such formula which I always tend to use more during the winter months is: Du Huo Ji Sheng Wan.
Du Huo Ji Sheng Wan
The formula targets the issues of Wind-Damp Bi pain, strengthens the Liver and Kidneys, supplements the Qi and Blood, and stops pain. Some of the most common indications for this formula include: chronic joint and muscle pain, stiffness, cramps, spasms, or numbness associated with osteo-arthritis with signs of Wind Damp, Kidney vacuity, and Qi / Blood vacuity; key areas which this formula targets are the lower back / lower body, hips, knees, ankles and feet.
When to Use This Formula
I find this formula extremely effective for chronic osteoarthritis pains which worsen during the colder months and feel better with movement and application of warmth. One key diagnostic factor to keep in mind: the tongue presentation with this formula is typically listed as pale as is the complexion as well. However, in cases of chronic osteoarthritis, the patient often has moved beyond the basic presentations and can present with a red tongue body or a blueish tongue body, especially with swollen engorged sublingual veins.
If a patient feels better with warmth and movement and is experiencing pains, spasms, or numbness during the winter months, I will often use this formula even if the tongue or pulse does not "fit" the generic identifying features. In such cases, the determining factor will be: does the patient experience improvement within one to two weeks of administration of medicines? If so, then I will continue to use this formula and balance as needed with other pattern presentations.
I find this formula to be of importance when treating patients who are elderly, have suffered long-term pain / discomfort, or with athletes who train at a higher competitive level. In all these cases, it is common for the individuals to suffer from long-standing Qi and Blood vacuity which then branches out to a broad range of complex patterns of disharmony.
Underlying Qi & Blood Vacuity
In such cases, formulas or patents which only "clear heat" or "move blood" can often offer minimal help and in some cases may worsen the underlying Qi and Blood vacuity resulting in a decline in future health. The clinician must keep in mind the trajectory or narrative of the history of the patient's presenting complaints as well as the seasonal influence on such pattern presentations / evolution.
In cases of severe pain and / or chronic pain aggravated by winter months, the dose of Du Huo Ji Sheng Wan can be increased as needed until the pain begins to subside. Once pain, stiffness or numbness begins to lessen, the dose can be lowered to a standard prescription. For cases of severe back pain, I will increase the dose of Du Huo and Ji Xue Teng; for cases of severe knee pain I will increase dose of Sang Ji Sheng and Chuan Niu Xi; and for severe muscle spasms I will increase the dose of Bai Shao and Dang Gui.
One of the main purposes of discussing the use of the formula / patent Du Huo Ji Sheng Wan is that I increasingly see TCM practitioners not using TCM formulas for joint / muscle pain! It is extremely common to see patients referred to my clinic as "complex cases" or have patients visit my clinic with a long track record of using acupuncture for chronic pains with only temporary relief.
The Usual Suspects
In almost all cases, the patient will have a grocery bag full of supplements administered for joint pain. I often refer to these as the usual suspects: fish oil, glucosamine, and turmeric. I am always shocked to see licensed acupuncturists and practitioners of Chinese medicine turn to naturopathic supplements before using professionally prescribed TCM formulas.
Can these usual suspects provide relief? Yes, in some cases they can be of great help. But as practitioners of traditional Chinese medicine, we should not ignore the large amount of resources on hand for not only treating but resolving cases of chronic pain, injuries and osteoarthritis. TCM formulas and patent medicines can be adjusted to the unique constitution / pattern presentation of the patient as well as the unique season in which the symptoms / conditions worsen.
I hope this short discussion of the important formula / patent Du Huo Ji Sheng Wan inspires TCM clinicians to reexamine the influence of the seasons on conditions / patterns as well as dig deeper into the history and narrative of the patient's pattern of disharmony and how this may be influenced by shifting seasons.
Chronic pain afflicts over 20% of the adult population. Sadly, most MDs have essentially no education in treating pain, beyond offering a few toxic medications. Then they tend to steer people with pain away from those health practitioners who are trained. This puts the acupuncture community on the front lines for addressing this epidemic.
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