Chinese Medicine Paper III
Treatment of scapulohumeral periarthritis with acupuncture combined with warm moxibustion
Abstract
Scapulohumeral periarthritis is a degenerative, aseptic, chronic inflammation that impacts the humeral joint capsule and surrounding soft tissues. Often prevalent in individuals around the age of 50—commonly referred to as the "fifty shoulders"—this study investigates the treatment efficacy of combining acupuncture at Jianyu (LI 15) through Jiquan (EX-B2) with warm moxibustion and a Western medicine approach using prednisolone blocking. The treatment yielded satisfactory results, which are detailed below.
Clinical Data
The study involved 152 patients, comprising 70 males and 82 females. The age range of participants spanned from 42 to 67 years. The duration of their conditions varied from as short as two months to as long as 10 years.
Clinical Manifestations
Patients commonly experienced shoulder pain that extended to the neck and entire upper limb. Additional symptoms included finger numbness, restricted range of motion in abduction, external and internal rotations, various degrees of shoulder joint dysfunction, and muscle disuse atrophy.
Treatment Methods
1. Combined Acupuncture and Warm Moxibustion Group (94 Cases)
Acupoint Selection
Patients were positioned in a sitting posture with their elbows flexed and arms abducted horizontally. Acupoints were identified in the center of the upper part of the deltoid muscle, at the same height as the shoulder and at the lower margin of the acromion.
Acupuncture Depth
Needles were inserted vertically and deeply, approximately four inches, so that the tip could be felt in the axillary region without protruding through the skin.
Manipulation Technique
Initial insertion involved a twirling, lifting, and thrusting technique, followed by additional twirling and tonifying.
Needle Sensation
Patients reported sensations of swelling and numbness radiating from the shoulder to the elbow, and sometimes to the neck and fingers. A local warm sensation was also diffused around the needle site. Needles were retained for 15–20 minutes.
Moxibustion Therapy
Mild moxibustion was performed using either a suspended moxa stick or a fixed moxa holder for about 20 minutes.
Moxibustion Sensation
Patients typically felt a localized heat sensation that extended to the neck and across the shoulder. After moxibustion, some reported a cool sensation that gradually transitioned into warmth, leading to symptom improvement or complete relief. Acupuncture was generally applied in the morning, and moxibustion in the afternoon. A full course lasted seven days.
2. Prednisolone Local Blocking Group (58 Cases)
Prednisolone (25 mg) was combined with 2% procaine (2–4 mL) and injected into key tender points like the greater tuberosity of the humerus and the gluteus monodon. Patients often experienced a rebound effect with worsened symptoms the following day, which then gradually improved. Treatments were administered once a week, with three to five sessions constituting a complete course.
Efficacy Criteria
- Complete Recovery: Pain completely relieved, full range of motion restored in the affected limb.
- Markedly Effective: Pain largely alleviated and shoulder joint function mostly restored, though some discomfort remains.
- Improved: Notable reduction in pain and enhanced shoulder joint functionality compared to pre-treatment.
- No Effect: No noticeable change in symptoms post-treatment.
Therapeutic Results
-
Acupuncture and Warm Moxibustion Group (94 cases):
- Cured: 48 cases (51%)
- Markedly Improved: 24 cases (25.5%)
- Improved: 19 cases (20.2%)
- Ineffective: 3 cases (3.2%)
- Overall Effectiveness Rate: 96.8%
-
Prednisolone Local Blocking Group (58 cases):
- Cured: 16 cases (27.6%)
- Improved: 24 cases (41.3%)
- Ineffective: 18 cases (31.0%)
- Overall Effectiveness Rate: 69% (P<0.01)
A Typical Case Study
Patient: Wang XX, a 59-year-old woman with a 10-year history of right scapulohumeral periarthritis.
Symptoms: Episodes of severe pain in winter, mild in summer. Limited mobility in the affected limb, with aching pain exacerbated at night.
Previous Treatments: Prednisolone injections, acupuncture, and traditional Chinese medicine provided only mild relief.
Clinical Presentation: The shoulder felt as if bound ("如捆绑状"). Tongue coating was thin and white; pulse was deep and slippery.
Treatment: Deep needling was performed at the "Taiji Spring" located below the Jianyu (LI 15) acupoint. The technique was similar to the standard procedure. Post-needling, the patient felt a warm sensation flowing into her palm, reducing pain by half and improving mobility.
Moxibustion: Applied in the afternoon for 15 minutes, initially causing a cold sensation followed by warmth.
Outcome: Four days post-treatment, the patient experienced no chills and improved muscle flexibility. The right hand could now touch the left shoulder, and backward extension reached the twelfth thoracic vertebrae. After two weeks, all symptoms disappeared, and shoulder function was fully restored.
Follow-up: No recurrence observed in a 4-year follow-up.
Experiences and Insights
Jianyu (LI 15) holds a pivotal role in treating enduring shoulder and arm ailments. Ancient texts often highlighted its efficacy; for instance, it was said that "Zhenquan acupuncture emanates directly from Jianyu (LI 15)," underscoring its therapeutic importance.
Esteemed physicians of the past emphasized the value of focusing on this acupoint when treating shoulder-related conditions. In the "Song of Jade Dragon," penned by Guonao Wang from the Yuan Dynasty, it was noted that the shoulder pain—often aggravated by cold and dampness—could be mitigated by applying both nourishing and reducing techniques at the Jianyu (LI 15) acupoint, further enhanced by moxibustion to maintain overall well-being.
Similarly, Yiding Wu, in the late Qing Dynasty, stressed the effectiveness of this acupoint in his work "On Magic Moxibustion." He observed that people often experienced cold-induced shoulder pain, which could be superficially managed by massaging with warm hands and adding extra blankets at night. However, he advocated for the more targeted approach of using moxibustion at two specific acupoints at Jianyu (BL 15) for effective treatment.
Authors' Personal Experiences
1. Understanding the Nature of the Ailment
Scapulohumeral periarthritis rarely presents as red, swollen, and hot; more commonly, it manifests as cold and damp discomfort. My own practice has demonstrated that acupuncture and moxibustion from Jiquan (CV 4) to Jianyu (LI 15) effectively unblock channels, dispel wind and cold, activate blood flow, and alleviate pain. My mentor, Director Meisheng Zhou, emphasizes that the depth and sensation of the needle insertion are pivotal for an effective outcome. The ideal depth for acupuncture at this point is around 4 cun, and the manipulation should be such that it generates a local warm sensation that radiates to the perineum or extremities. The curative effect often stems from the local warm sensation alone, without necessitating further interventions.
2. The Anatomy Behind Successful Penetration at Jianyu Jiquan
The shoulder joint is unique in its anatomy, offering the largest range of motion among all joints and characterized as a ball-and-socket joint. The glenoid fossa is remarkably shallow, accounting for only 1/3 to 1/4 of the humeral head, and the joint capsule is thin and expansive. Given these anatomical specifics and the unique needling position, penetrating from Jianyu to Jiquan becomes not just feasible but also quite manageable, as long as the practitioner understands the key principles.
3. Comparing with Western Treatment Methods
When contrasted with the control group, which received local blocking treatment using Western medicine, our method stands out for its absence of hormone-induced side effects, symptom rebound, or the discomfort of receiving multiple injections at multiple points. It also outperforms the conventional "strong corrective" therapies in preventing the exacerbation of chronic strain.
This article was originally published in "Naturopathy" Quarterly, Volume 15, Issue 3 (Autumn), 1992 By Li Yangzhen & Li Mingjie
from 針刺肩髃透極泉穴配合温灸治療肩周炎的體會
