I was asked recently about treating shoulder problems and the very next day when I was working in a busy drug clinic eight out of the nine clients had shoulder complaints, giving me ample opportunity to play around with different treatment protocols.
Shoulder problems are commonly encountered in the clinic and, as the shoulders cover a relatively large area, treatments can vary with Ahshi points being found around the shoulder point, i.e. St 24 (Huaroumen), or in the vicinity of Kid 17 (Shangqu). Shoulder pain can often cause referred pain down the arm or into both the neck and head. If this is the case, then a more comprehensive treatment will be required until the pain becomes more localised. When the condition is new or acute and more localised, fewer needles will give good results unless there are complications.
FROZEN SHOULDER is a particularly painful condition and it can result in limited mobility, stiffness and referred pain. Often there will be a distinct temperature decrease felt on the abdomen around the shoulder point, i.e. St 24 (Huaroumen) on the affected side.
A Comprehensive Treatment for Frozen / Painful Shoulder
If the pain is chronic, and the client is Deficient, then it is worthwhile using the ‘Bringing Qi Home / to the Source’ prescription. If there is a temperature difference (i.e. Cold) around the shoulder area of the abdomen (St 24 Huaroumen), then there will be an element of external Cold invasion or Deficiency of Yang leading to internal Cold. In either case, heat should be applied to the relevant shoulder.
Prescription for Chronic Shoulder Pain:
- ‘Bringing Qi Home / to the Source’ i.e. Ren 12 (Zhongwan), Ren 10 (Xiawan), Ren 6 (Qihai) and Ren 4 (Guanyuan);
- Kid 17 (Shangqu) on the affected side;
- St 24 (Huaroumen) on the affected side. When the pain is covering a large area of the anterior and posterior of the shoulder a number of needles at various depths may be necessary in the area of St 24 (Huaroumen) to achieve a good result. See the case study below ‘A Case of Frozen Shoulder’.
CASE STUDY: A CASE OF FROZEN SHOULDER
Fred came for acupuncture as a result of his shoulder, which was progressively becoming more painful and less mobile by the day. He had gradually developed this problem and was having difficulty lifting his arm to the front or back. His main pain was on the Large Intestine (Hand Yangming) and Sanjiao (Hand Shao Yang) meridians. Heat packs gave some relief to this 34-year-old. He had a warm abdomen, in general, but the area around his right shoulder (St 24 Huaroumen) was palpably colder.
There was also an obvious nodule the size of a small pea. As Fred was otherwise very healthy a very minimal treatment was used - namely, Ren 12 (Zhongwan) and Ren 4 (Guanyuan) to connect the north and south. St 24 (Huaroumen) on the right was needled through the nodule to a depth of 0.4 cun and after it had dissipated the needle was withdrawn a little and left at a superficial depth of 0.2 cun.
On questioning Fred and getting him to rotate his arm he acknowledged that the pain at the front was almost totally gone. However, there was still some pain at the back of his shoulder. Another needle was inserted approximately 2 fen (0.2 cun) superior and lateral to St 24 (Huaroumen). This needle was left slightly deeper (due to the fact the pain was at the back of the shoulder) to give the best effect at approximately 0.3-0.4 cun (see Fig 1). When rotating his arm on this occasion, Fred reported minimal discomfort and he was left for 25 minutes with the needles in situ. A heat lamp was placed above the abdomen to warm the shoulder area and the point Ren 8 (Shenque), thus invigorating his body’s Yang energy.
This treatment was repeated three more times and the shoulder problem was resolved completely.
Moxa can be used on the needles but as they were so superficial it was not practical. You could use a moxa stick (or other methods) around the abdominal area!
It was not necessary to use moxa on Ren 8 (Shenque) as the Yang Deficiency was only affecting the local area of the shoulder.
Fig 1. AA Prescription for ‘A Case of Frozen Shoulder’
Prescription for Acute Shoulder Pain or Sports Injury:
Ren 12 (Zhongwan);
Ren 9 (Shuifen) at the acute stage, to relieve swelling and inflammation;
Kid 17 (Shangqu) on the affected side;
St 24 (Huaroumen) on the affected side;
Locate the Ahshi points on the abdomen and adjust the depths or add needles in a format that best addresses the area of pain, e.g. a triangular format (see Fig 2).
Fig 2. AA Prescription for treating acute shoulder pain
A More Minimal Prescription for Acute Shoulder Pain or Sports Injury:
- St 24 (Huaroumen) on the affected side;
- Locate the Ahshi points on the abdomen and adjust the depths or add needles in a format that best addresses the area of pain, e.g. a triangular format.
Prescription for Treating Shoulder with Referred Pain:
Shoulder pain often leads to referred upper limb problems, in this situation complete the upper limb points with Ab1 (elbow) & Ab 2 (wrist) and chase the pain by focusing on the relevant painful area.
If the problem is of a chronic nature use ‘Bringing Qi Home / to the Source’, i.e. Ren 12 (Zhongwan), Ren 10 (Xiawan), Ren 6 (Qihai) and Ren 4 (Guanyuan);
- Kid 17 (Shangqu) on the affected side;
- When there is referred pain moving down the arm, it is essential to open the gate to move Qi from the Kidneys to the relevant shoulder and down the entire arm. This is achieved by needling the opposite or contra lateral Kid 17 (Shangqu) point;
- Then needle shoulder point, St 24 (Huaroumen) on the affected side;
- Ab 1 (elbow) and Ab 2 (wrist) points should be treated on the affected side when the whole arm is affected;
- If the pain only radiates as far as the intersection of the muscle deltoideus at the level of LI 14 (Binao), then only needle distally as far as Ab 1 elbow point;
- If the referred pain radiates past the elbow or changes and starts moving down the whole arm continue with needling wrist point Ab 2;
- When the pain is covering a large area of the anterior and posterior of the shoulder a number of needles at various depths may be necessary in the area of St 24 (Huaroumen) to achieve a good result. It may also be appropriate to use any ahshi points around Kid 17 (Shangqu), on the affected side to completely remove the pain;
- Be mindful of the area you are treating. Locate the Ahshi points on the abdomen and adjust the depths or add needles to work at multiple pain sites.(see case history above, ‘A Case of Frozen Shoulder‘)
- Locate the Ahshi points in each of the relevant areas. Start with the shoulder and move distally towards the wrist or fingers. In this example, where pain is focused at the intersection of the muscle deltoideus at the level of LI 14 (Binao), locate the Ahshi approximately midway between shoulder point St 24 (Huaroumen) and Ab 1 elbow point;
- Treating the thumb will necessitate using the thumb point (Ab 3) while finger points will be found lateral to and between the level of the wrist (Ab 2) and the elbow point (Ab 1). These Ahshi points should only require very superficial needling to achieve the desired goal (see Fig 3).
- When the pain moves up into the neck and head, isolate the ahshi points in the vicinity of Kidney meridian and Ren 12 (Zhongwan) and Ren 10 (Xiawan) area.
- If the pain moves up into the neck and head, isolate the ahshi points in the vicinity of Kidney meridian and Ren 12 (Zhongwan) and Ren 10 (Xiawan) area.
It is possible to just needle the affected area of the body, such as the elbow point (Ab1) for elbow pain and get rid of the pain. From my experience, I find that it is best to move Qi through the whole area. This is more important for first treatments and particularly when you are familiarising yourself with abdominal acupuncture.
If the problem is due to Wind/Damp, then use rheumatism points (Feng Shi Dian). If there is a Bi Syndrome affecting only the upper part of the body (above the waist), just use Ab 1 and Ab 2 anti-arthritic points bilaterally (see fig 8.9) and include Ab 3 if the pain goes into the fingers. If there is a lot of damp, due to Spleen Deficiency use Sp 15 (Daheng).
Tip: When there are a number of Ahshi points detected and the pain is moving it is imperative that you maintain communication with your client. By checking with them how the pain has changed with each needle inserted and/or adjusted, you will get a comprehensive picture as to which needles are exerting the best results and where. You might have to come back to these needles later if the pain changes. If this happens, it will be very useful to know exactly what the effect is of each of the Ahshi needles.
Fig 3. AA Prescription to treat shoulder and referred limb pain
It is vital that you remain focused and use a systematic approach especially in complicated cases where there are lots of areas that need to be worked on, start with your main points (Ren, St and Kid) first, then the Ab and ahshi points, fix the pain in each area (to some degree) before moving to address the next area of pain. Avoid just adding needles blindly, if you have 3-5 ahshi needles in one area, fix the depths of each ahshi point, check the effect of any minor depth adjustments at each stage of the refining process and note which needles are giving the best results, before adding more. If the client is older or deficient it might be a case that the results will take 24-48 hours to really take hold, in this situation, if you are happy with the patterns, locations and depths of the needles, be confident that you will get a result. If you are a novice with abdominal acupuncture and you are going to see your client again in a few days, avoid combining the treatment with other systems for the initial treatments. It is important that you develop your skills and if there is any doubt as to which system of acupuncture produced the best result then you are less likely to refine your abdominal skills and trust it as a stand - alone method.
I encourage you to use whatever combination of treatment protocols you deem necessary to give your client the best possible result, but I suggest that you do so after you have tested the efficacy of abdominal first!