Editorial:

The author, being a pain specialist, is used to receiving complex cases that do not usually improve with usual treatments.

At the end of 2020, the author received in her clinic two patients who had a diagnosis of frozen shoulder, who were not getting better with the use of non-hormonal anti-inflammatory drugs and local injection of corticosteroids.

The author will explain through this editorial article, the reason for this evolution, and she will use the argument of older medicines, such as through traditional Chinese medicine, because we will not have this explanation using only Western medicine thoughts. [1]

According to traditional Chinese medicine, all symptoms presented by patients are reflections of internal imbalances of Yin, Yang, Qi and Blood energies, which are in the root level of the tree, that is the metaphor the author usually uses to explain in all her articles, the different perspectives between Western and traditional Chinese medicine’s point of view. [1]

In addition to the Yin and Yang theory, at the root of the tree, there is the theory of the five elements of traditional Chinese medicine. This theory shows that the five massive organs, that are Liver, Heart, Spleen, Lung and Kidney, represents the five elements, that are the Wood, Fire, Earth, Metal and Water and each massive organ has a hollow organ attached to it. They are Gallbladder, Small intestine, Stomach, Large intestine and Bladder, respectively. [2]

For each massive organ, there is an emotion that commands it and if this emotion in chronic and was not treated accordingly, this organ can become imbalanced. The emotion that imbalance the five elements and the five massive organs (Liver, Heart, Earth, Metal and Water) are anger, excessive joy, worry, sadness or grief and fear, respectively. [3]

Each internal massive organ has an external sensory organ that it commands. For example, the Liver (Wood element) commands the eye and is responsible for vision. The Heart (Fire element) commands speech and communication and sleeping process and is responsible for the tongue. The Spleen (Earth Element) is responsible for the absorption of nutrients and the formation of Blood. The Lung (Metal element) controls the distribution of energy and is responsible for the skin, hair and smell. The kidney (Water element) has the external sensory organ the ear and it is responsible for hearing. In addition, it also controls the teeth, bones, sexuality, reproduction and the process of memory, concentration and maintains the patient's youthfulness. [3]

Regarding the patients described by the author in this article, they present a frozen shoulder that was not improving even using anti-inflammatory medications and injections of corticosteroids in the shoulder. This articulation is a structure where many tendons and muscles are inserted. [1]

Tendons are organs commanded by the energy of the Gallbladder and muscles is commanded by the energy of Spleen-pancreas and Stomach energy meridian. [1]

When the patient ingests anti-inflammatory drugs or any highly concentrated medication, the drugs are metabolized in the Liver and end up generating an imbalance in the Liver's energy. [1]

Since the organ that is attached to the Liver is the Gallbladder, which commands the tendons, the medications used to treat the shoulder pain, are maintaining the energy imbalance that is inflaming the tendons. [1]

Analyzing the emotional aspects involved in the shoulder pain process, patients who have shoulder pain, often feel like want to be hitting someone (in the present or in the past). [4]

As it is not correct to hit someone, this desire is repressed in the person's subconscious and many times, the upper limb wants to do the hitting process, but many times it cannot. [4]

It creates a feeling of always wanting to hit but not being able to do, until the tendon in the shoulder is ruptured. [4]

Therefore, people who have a torn tendon in the shoulder have an emotional event in its depth, which if not treated and are only treated surgically, by mending the torn tendons, tend to tear the tendon again, because the emotional process that triggered this tear was not treated, which induced tearing of the shoulder tendon. [4]

Another situation, in addition to the inflammation generated by the use of the drug and the emotionally induced process, is that often when the shoulder is frozen, the patient cannot make the movement of raising the arm to the side, upwards, forwards and backwards, as the shoulder is often out of place. Often, due to spinal deviations, which may be in the lumbar hip region, it can change the dynamics of the shoulder, even altering the articulation, which the shoulder does with the various structures of the spine, for example. In the article wrote by Murphy et al. (2012) entitled Chiropractic management of frozen shoulder syndrome using a novel technique: a retrospective case series of 50 patients, they showed in the article that that patients with frozen shoulder that receives chiropractic approach have a better outcome and the majority of them can improve their condition when associating this kind of therapy. [5]

In the article wrote by Greenberg (2014) entitled Evaluation and treatment of shoulder pain, the author is saying that most problems in the shoulder pain is a problem in the sub acromial bursa and rotator cuff. [6]

The author, always aiming to balance the internal energies of her patients, in all kinds of treatment, she usually uses as first step, changes in the eating habits, in order to maintain the balance of the internal energy of the five massive organs. [1, 2]

To balance the Liver and Gallbladder energy meridian, she usually advises the patients to avoid fried foods, eggs, chocolate, honey, coconut, alcoholic beverages, and melted cheese. [2]

The second step in the treatment was to rebalance the Yin, Yang, Qi and Blood energies, which are important for the maintenance of the patient's health and using this kind of reasoning, everything would become better, also improving the process of tendonitis in the shoulder, which is only a manifestation of the imbalance of the Liver and Gallbladder meridian. According to the author's clinical practice, whenever patients took local injection of corticosteroids, they always reported worsening of the pain of shoulder symptoms instead of improvement, because these drugs would be attacking even more on this imbalance of the Liver and Gallbladder, further inflaming more the tendons. [1]

In addition to systemic acupuncture, the author always uses auricular acupuncture and apex ear bloodletting and in the helix of the ear, corresponding to the shoulder part. This last procedure is a very important to reduce inflammation and take out the pain condition. [1]

The ear, being considered a microsystem, has all the structures that represent the human body and therefore, the pain process at the site of shoulder is only a manifestation of a systemic energy imbalance process. [7]

In addition, these patients had all chakras’ energy centers all without energy and the use of highly concentrated medication to treat local pain was causing more systemic energy deficiencies, explained by the Arndt Shultz Law. According to this law, the use of highly concentrated medications will reduce even more the vital energy of these patients that is already low and for this reason, the author used highly diluted medications such as homeopathies, according to the theory Constitutional Homeopathy of the Five Elements based on Traditional Chinese Medicine and crystal-based medications to replenish the chakras’ energy centers. The chakra that corresponds to the Liver is the first one. But as the Liver receives energy from the Kidney, this organ receives energy from the Lung. The Lung receives energy from the Spleen that receives energy from the Heart. And this last organ receives energy from the Liver. This sequence of flowing of energy is called generation cycle of the five elements theory. For this reason, to treat the Liver, we need to treat the entire organ, that are all without energy. [8]

Using this theory, treating symptoms at the leaf level using medications to treat the root level, has been the subject of discussion in all the ancient scientific article by the author, as it integrates the teachings of traditional Chinese medicine with Western medicine thoughts. [8]

Therefore, to understand in depth why frozen shoulder patients do not improve with anti-inflammatory drugs, we must associate older medicines as recommended by Hippocrates ( 460 b.c.- 377 b.c) , father of medicine, who says that we should consider older medicines before current medical practice. [9]

As Albert Einstein recommends, we cannot solve our problems with the same thinking we create them. [10]