Chinese Medicine Paper III
Treatment of scapulohumeral periarthritis with acupuncture combined with warm moxibustion
Scapulohumeral periarthritis is a degenerative, aseptic, chronic inflammation of the capsula articularis humeri and the soft tissue of periarthritis humeri. It is often seen in patients around the age of 50, so it is also called “fifty shoulders”. We explored the treatment of 152 cases of scapulohumeral periarthritis with acupuncture at Jianyu (LI 15) through Jiquan (EX-B2) combined with warm moxibustion and western medicine prednisolone blocking method. It shows that the acupuncture treatment has satisfactory efficacy. The results are summarized below.
In the 152 cases of general data, there are 70 males and 82 females, with the minimum age of 42 years and the maximum of 67 years. The shortest course of disease was two months and the longest was 10 years.
Pain in the shoulder, involving the neck and the whole upper limb, numbness of the fingers, limited abduction, external rotation and internal rotation, different degrees of obstacle at the shoulder joint, and disuse atrophy of the muscles.
1. Acupuncture combined with warm moxibustion group (94 cases)
Acupoint selection: in sitting position, with elbow flexion, and arm abduction to a horizontal position, at the same height as the shoulder, in the center of the upper part of the deltoid muscle, a bright depression is observed as acupoint on the lower margin of the acromion.
Acupuncture depth: the needling is performed vertically and deeply for about four inches, to the extent that the tip could be touched in the axilla, without passing out of the skin.
Manipulation: the needles are first inserted by twirling, lifting and thrusting, followed by twirling and tonifying.
Needle sensation: the swelling and numbness in the shoulder can be radiated to the elbow, or even to the neck and fingers, and the local warm sensation can be diffused around. Retain the needle in place for 15–20 minutes.
Moxibustion therapy: the mild moxibustion was performed using suspended moxibustion with moxa stick or fixed with a moxa holder, which lasted about 20 minutes.
Moxibustion sensation: the local baking-like heat sensation is transmitted to the neck, transverse to the shoulder, or even to the finger, or after moxibustion the patient feels cold sensation outward, with the cool sensation flowing mixed with warm sensation, and finally replaced by heat sensation, whereupon the symptoms well improved or disappeared. Acupuncture is usually applied in the morning and moxibustion in the afternoon, with seven days as a course of treatment.
2. Local blocking with prednisolone group in contrast (58 cases)
Prednisolone 25MG plus 2% procaine 2-4ML was injected into the greater tuberosity of humerus, gluteus monodon and other common tender points. Generally, there is a rebound reaction with aggravating symptoms on the next day, and the symptoms gradually improved after that. The treatment was conducted once every seven days, and three to five times constituted a course of treatment.
- Recovery: Pain disappeared, affected limb abduction, adduction, anterior flexion and posterior extension activities freely.
- Markedly effective: The pain basically disappeared, and the shoulder joint function was basically restored, but the affected shoulder was sour, swollen and uncomfortable.
- Improved: The pain was obviously milder, and the shoulder joint function was improved as compared with that before treatment.
- No effect: No change in symptoms after treatment.
- Acupuncture combined with warm moxibustion group (94 cases): 48 cases (51%) cured, 24 cases (25.5%) markedly improved, 19 cases (20.2%) improved, 3 cases (3.2%) ineffective, and the effective rate is 96.8%.
- Prednisolone blocking group (58 cases): 116 cases (27.6%) cured, 24 cases (41.3%) improved, 18 cases (31.0%) ineffective, and the effective rate is 69% (P<0.01???).
A typical case:
Wang XX, a 59-year-old woman, had a history of right scapulohumeral periarthritis for ten years, with repeated episodes of severe winter and mild summer. In case of relapse due to coldness, local sealing with prednisolone, acupuncture, and Chinese medicine treatment could slightly relieve the pain. 疼痛、發涼、酸痛 and aching pain of shoulder joint were mild in day and severe at night, with limited activity. The affected limb was not easy to extend, and the right arm could not reach the left shoulder, nor could it reach the front of the iliac. The shoulder felt stiff, like in a bundle shape 如捆绑状. The patient accepted Gu Jiu-xiang纳谷久香, and her tongue coating was thin and white, and his pulse was deep and slippery. After deep needling of “Taiji Spring” at the lower part of Jianyu (LI 15) 給予深針肩髃穴下透極泉, the manipulation was performed as presented above, so that the warm sensation in the shoulder was felt to flow into the palm of the hand. After the needle, the pain was relieved by half and the activity was improved. In the afternoon, moxibustion was applied, and after 15 minutes, the patient felt cold air driven outward, followed by warm sensation in the whole shoulder and upper limb. The limbs after moxibustion felt comfortable and their function was improved. Four days after the treatment, no further chill occurred, and the shoulder muscles felt released. The right hand could touch the left shoulder, and backward extension could reach the twelve thoracic vertebrae. After two weeks of this routine treatment, all the symptoms disappeared and the shoulder joints moved freely. The 4-year follow-up showed no recurrence.
Experience and insights
Jianyu (LI 15) is an important acupoint for the treatment of persistent ailment of shoulder and arm. In classical works, there was a quotation that “Zhenquan acupuncture projects immediately from Jianyu (LI 15)”, revealing its great efficacy. Ancient physicians attached great importance to the treatment of this disease with local shoulder measurements at Jianyu (LI 15). In “Song of Jade Dragon” written by Guonao Wang from the Yuan Dynasty, he said, “the swelling and pain at the shoulder were unbearable, and that cold and dampness vied with qi and blood. If one applied nourishment and reduction to the shoulders and curls, one could benefit from moxibustion for peaceful health”. Yiding Wu in the late Qing Dynasty also wrote in his “On Magic Moxibustion“: “mortals’ shoulder arms often feel cold pain once encountering cold weather. Some suggested to massage with hot hands, and add comforters in the night to make do. Moxibustion with two acupoints at Jianyu (BL15) is required to treat this disease. “
The author’s own experiences are as follows.
1, The cases of red swelling and hot pain in scapulohumeral periarthritis are rare, and most of them are cold, wet and cold. It has been proved in practice that acupuncture and moxibustion at Jiquan (CV 4) through Jianyu (LI 15) have the effects of dredging channels and collaterals, dispelling wind and cold, activating blood and relieving pain. My teacher, Director Meisheng Zhou, believes that deep needling and good needling sensation are the key for effective treatment. The depth of acupuncture at this point must be limited to about 4 cun4寸, and the needling manipulation is preferably to such extent that the needle enables the local warm sensation diffusing to the perineum or limb end. The effect is due to moxibustion sensation from local baking-like heat, flowing hot air with outflow of cold air. There are also cases of cure due only to local warm sensation.
2. The key for the successful penetration of Jianyu Jiquan 肩髃透極泉?? Lies in the anatomical factors. The shoulder joint is the joint with the largest overall range of motion, belonging to the ball-and-socket joint屬球窝關節. Its glenoid is only 1/3–1/4 that of the humeral head其關節盂僅及肱骨頭的1/3～1/4. The glenoid fossa is extremely shallow, and the joint capsule is thin, loose and wide. In addition, due to the above special position during needle insertion, the penetration of Jianyu Jiquan is possible, and the humeral head cannot block it. It has been proved clinically that it is easy to succeed as long as the essentials are grasped.
3. Compared with the control group (locally blocked group) using western medicine, this method is not only free from the side effects of hormones and symptoms rebound from local irritation, as well as from the pains of having to accept multiple times of multi-point injections, it is also superior to the strong “correcting” therapy in preventing the aggravation of chronic strain.
By Yangzhen Li & Mingle Li
“Naturopathy” (quarterly), Vol. 15, no.3 (autumn), 1992