Intercostal+Neuralgia


 * IBIS:**

Definition:
Pain in the nerve that runs between two ribs (intercostal nerve).

Etiology:
The etiology is frequently unknown. Trauma can initiate nerve irritation, as well as a Vitamin B1 deficiency.

Botanicals
• Hypericum perfoliatum: oil: use locally; tincture internally • Valeriana spp.: as a lotion, apply externally (Jolley)

Chinese Formulae
• Rhubarb and Aconite C. (Da Huang Fu Zi Tang) with Peony and Licorice C. (Shao Yao Gan Cao Tang): Acute and severe pain and spasms (Rhubarb and Aconite: Hsu, 1980, p. 150; Yeung, p. 64; Dharmananda, 1986, p. 152; Bensky and Barolet, p. 126; Peony and Licorice: Hsu, 1980, p. 108; Dharmananda, 1986, p. 109; Bensky and Barolet, p. 252) • Bao Zhen Gao (patent): Wind-Cold Damp Bi Syndrome. (Zhu, p. 116) • Pueraria C. (Ge Gen Tang): Wind-Cold: early stages; for chronic conditions add aconite and atractylodes (Hsu, 1980, p. 51; Yeung, p. 105; Dharmananda, 1986, p. 125; Bensky and Barolet, p. 51) • Bupleurum and Scute C.: Liver Qi Stagnation with chest pain (Hsu, 1980, p. 543; Dharmananda, 1986, p. 133) • Pinellia and Arisaema C. (Qing Shi Hua Tan Tang): Phlegm Bi Syndrome (Hsu, 1980, p. 549; Yeung, p. 173; Dharmananda, 1986, p. 345; Bensky and Barolet, p. 434) • Bupleurum 12 (patent): Qi Stagnation; plus San Qi 17 (patent) for trauma; plus Corydalis 5 (patent) for severe pain; plus San She Dan (patent) for pain along the Gall Bladder meridian (Dharmananda, 1990; Bupleurum, p. 39: San Qi, p. 56: Corydalis, p. 44: San She Dan, p. 91)

Acupuncture
after assessing the person and palpating, consider these patterns: Qi Stagnation, esp. Liver Qi Stagnation; Wind-Cold; Wind-Cold Damp Bi Syndrome; Phlegm Bi Syndrome

» prognosis: high rate of success within 6 months of onset; treatment more difficult and prolonged after 6 months (Serizawa, p.161)

» illustrative combinations: • St-18 and Lv-2, possibly also LI-11, CV-17 and Sp-20 for intercostal neuralgia; use "mild stimulation... deep enough to obtain a numb, sore, distended sensation,... retained for half an hour (Shanghai, p. 618; Lee and Cheung, p. 304) • UB-17, UB-18, Lv-14 and St-36 (D) for intercostal neuralgia (Shanghai, p. 181) • Lu-9, LI-4 and UB-13; UB-17, Lv-13 and CV-17; GB-41, St-36 and SI-5; TW-6, UB-62 and Kd-1 for intercostal neuralgia (Mann, p. 122) • Ht-1, TW-5 and GB-34 for intercostal neuralgia (Shanghai, p. 229) • TW-6 and GB-34 for intercostal neuralgia (Shanghai, p. 236); provide immediate relief of pain in the lower ribs (Ellis, et al, 1988, p. 283); disperse Qi in the intercostal region • TW-6, Lv-5, GB-34 and related jia ji points (also consider Lv-14, GB-40, Lv-2, Lv-3, UB-18, UB-17, Lv-13, St-40, Sp-9 and PC-6) for intercostal neuralgia (Lee and Cheung, p. 304) • UB-11, UB-12, UB-13, UB-15, UB-18, Kd-22, Kd-25, Lu-5 and Lu-9 for intercostal neuralgia (Lee and Cheung, p. 304) • GB-40 and TW-8 for intercostal neuralgia (Shanghai, p. 279) • TW-6, Lv-13 and TW-5 for rib pain (Shanghai, p. 236) • SI-5, SI-4, TW-6, UB-17 and UB-62 for subcostal pain (Lee and Cheung, p. 304) • UB-29, UB-17, GB-11, SI-5 for subcostal pain (Lee and Cheung, p. 304) • GB-24 and/or GB-25 (-): spread Liver Qi and transform Damp-Heat; relieve hypochondriac pain; disperse Qi in the intercostal region • TW-3, TW-5 and/or TW-6 (-): facilitate Qi flow; regulate the Triple Warmer; expand and relax the chest; disperse Qi in the intercostal region • LI-10 and PC-6 (+): supplementary distal points; relieve chest constriction • St-12, Lu-1, Kd-23 and CV-17 (-): relieve muscular tension in chest • UB-13, UB-15, UB-17 and UB-18 (=): relieve local muscular tension; restore normal Qi and nerve flow to associated organs • reactive points below Kd-21 and Kd-16 (-): relieve associated abdominal pain (Serizawa, p. 161)

Homeopathy
• Arnica montana: cause is traumatic, chronic cases later in life; simulating pleurisy; < by cough and breathing; stinging and pricking in affected parts, with restlessness so he has to stir about constantly; < by noise or slightest exertion • Arsenicum album: cause is anemia, influenza, debility, malaria; recurring periodically; burning, tearing pains at night and even during sleep • Asclepias tuberosa: cause is influenza; sharp pains, shooting from left nipple downward; spaces between ribs and close to sternum tender • Chelidonium majus: cause is after injuries where arn. is not well borne; pains gradually increase and gradually decrease • Cimicifuga racemosa: cause is uterine/ovarian disease; sharp lancinating pains

Mind/Body
• Punishment for guilt; anguish over communication. (Hay, 1984, p. 177)

• Liver ~ Gan is the home of the Hun (Ethereal Soul); it relates to decisiveness, control, and the principle of emergence; maintains smooth flow of Qi and Xue (Blood); controls the muscles, ligaments, and tendons; expresses itself in the nervous system; and reflects emotional harmony and movement. » Healthy expressions are kindness, spontaneity, and ease of movement. » Liver Qi Stagnation reflects and accentuates emotional constraint as the Liver's function of facilitating smooth flow in the body is constricted. Stagnation is associated with frustration, irritability, tension, and feeling stuck. With time this pattern tends to produce a gloomy emotional state of constant resentment, repressed anger or depression, along with tightness in the chest, frequent sighing, abdominal tension or distension, and/or a feeling of a lump in the throat with difficulty in swallowing. (Maciocia, p. 216)
 * Chinese psychophysiology:**

• Gall Bladder ~ Dan is the source of courage and initiative, and is responsible for decision-making as the bodily Minister of Justice; and expresses itself through the sinews (ligaments and tendons). » Healthy expressions are kindness, decisiveness, control, and spirit of initiative. » Gall Bladder Xu (Deficiency) signs include insomnia; wandering pains; chest and side pains; swollen breasts (Seem, p. 29); weakness in muscles and tendons of the legs; difficulty standing; asthenia; vertigo; chills; timidity; cowardice; indecisiveness; and excessive sighing.