ACUPUNCTURE WITH LOCAL POINTS
The points chosen to treat frozen shoulder are often selected from those on the small intestine meridian, especially from SI-9 through SI-12, which run across the shoulder area. A key point is bingfeng (SI-12) at the attachment zone for the shoulder capsule. Bingfeng (grasping the wind; which became the title of a book about the names of acupuncture points; 8), is located by raising the arm, which produces an indentation at this spot. It is used to relieve disorders where there is shoulder pain accompanied by difficulty raising the arm, as occurs with frozen shoulder. In a report published in 1998 (9), results from treating 60 patients with “shoulder-arm” syndrome were relayed. Although this report did not address frozen shoulder, it claimed to produce marked effects through use of this single point (a second point would be treated for manifestations of the disorder in the forearm or hand).
Local treatment was the primary focus of a recent report by Jin Dongxi and Li Zhingtai, who described treatment of 50 patients with frozen shoulder using acupuncture and massage (10). They stimulated several points on the shoulder, including bingfeng, as well as others on the hand and arm of the same side as the affected shoulder. The points selected for treatment were:
extra point taijian (the name means “lift shoulder;” it is located 1.5 below the anterior part of the acromion);
extra point jubi (the name means “raise arm;” located 3.5 cun below the anteroinferior part of the acromion);
tianzhong (SI-11); bingfeng (SI-12); and houxi (SI-3)
naohui (TB-13) and jianliao (TB-14)
quchi (LI-11) and hegu (LI-4)
During each acupuncture session, 4-8 points were selected for treatment, with stimulation maintained by electro-acupuncture, relying on the highest stimulus tolerated by the patient (with a loose-dense alternating waveform). Manipulation of the arm so as to relax the tendons around the affects shoulder were also performed, as well as other arm movements and kneading of the muscles. It was reported that the condition resolved in 48 cases and that all other cases had some degree of improvement.
The elbow point quchi (LI-11) included in the above protocol is traditionally utilized for treating pain in the shoulder and arm, and it considered especially useful when the pain prevents the arm from being lifted. In 1999, an article by B.H. Ma (11) described use of three acupuncture points for frozen shoulder, recommending two points along side of quchi (LI-11; one cun anterior and one cun posterior to the point) plus jianyu (LI-15) located at the shoulder. This area (shoulder and upper arm) is to be treated by cupping about 15 minutes after the needling is done, followed by a massage therapy with rapid motion of the palm against the arm and then shaking of the arm by holding at the wrist and lifting the arm to 90 degrees, then shaking with a downward pressure.
A treatment method relying primarily on local points is presented in the Encyclopedia of Practical Traditional Chinese Medicine volume on acupuncture (12). The recommended points are mainly from three yang channels of the hand-arm-shoulder area: jianyu (LI-15), binao (LI-14), quchi (LI-11), and hegu (LI-4) of the large intestine meridian; jianzhen (SI-9) and houxi (SI-3) of the small intestine meridian, and waiguan (TB-5) of the triple burner meridian. In cases where the pain radiates to the neck and back, additional small intestine meridian points would be added, such as bingfeng (SI-12) and quyuan (SI-13). Combining acupuncture and moxibustion was also suggested, with moxibustion especially at jianyu (LI-15) for 20 minutes.
Treatments featuring both the local points (shoulder/arm) and distal points (leg) have also been described in the context of clinical reports. Emad Tukmachi, in England, wrote an article on treatment in the journal Acupuncture in Medicine describing his approach (13). This report was not about a controlled trial, but about treatment of a series of 31 patients. He asserted that treatment effect will usually be noted within about 6 sessions and that successful treatment may require from 4-19 sessions. In a summary of this report, he noted that:
Ashi or trigger points around the shoulder should be carefully sought and needled superficially; tiaokou (ST-38) with strong manipulation is useful. Deqi should be sought in the robust patient, with less stimulus in the weak patients. Electroacupuncture at quchi (LI-11), jianyu (LI-15), jianjing (GB-21), and jianzhen (SI-9) at 5 Hz helps; yanglingquan (GB-34) bilaterally for 2 minutes alone often controls pain and releases stiffness. Auricular therapy at shenmen, shoulder, shoulder joint, clavicle, and adrenal points is helpful. The patient should exercise faithfully with a slow warm-up.
Dr. Li Lingling offered data from her work with frozen shoulder, which is presented on a website (14), and involves the local and distal points, with points on the large intestine dominating the shoulder/arm selections. According to the report, 61 patients were treated using electro-acupuncture and massage. The main acupoints treated were jianyu (LI-15), jianzhen (SI-9), quchi (LI-11), binao (LI-14), and tiaokou (ST-38), and the primary supplemental points were jianliao (TB-13), shousanli (LI-10), houxi (SI-3), taiyuan (LU-9), and yinlingquan (GB-34). Treatment was set up with two groups of points for each patient, one group of five points treated one time, and another group of five points treated the next time. Massage therapy included massaging various muscles and certain acupuncture points in the shoulder area. After about five treatments it was reported that 25 of the patients had the problem resolved and that all but three others showed some degree of improvement.
Finally, the use of scalp acupuncture should be mentioned. This treatment is frequently used for chronic pain syndromes and was the subject of an evaluation involving 210 cases (15). A point was treated along the vertex-temporal line, which runs from the head vertex baihui (GV-21) to the temple at xuanji (GB-6), about 40% of the way from the vertex to GB-6, which is in the zone corresponding to upper extremity disorders. The needle was threaded about 30 mm (about an inch) towards the temple (a second needle, inserted close to the same point but angled 45 degrees to the first and crossing its path, was often used to get more intense stimulus). If only one shoulder was affected, the contralateral side would be treated; with both shoulders affected, both sides would be treated. The patient was advised to relax, focus on the affected shoulder, and carry out shoulder movements during the treatment, while the practitioners manipulated the needles (with repetitive rapid withdrawal about 3 mm, then slower return) at least every 5 minutes and sometimes also massaged the shoulder. The needles would then be retained for 1-2 hours, or up to 1-2 days for severe cases. Typically, treatment was carried out every 1-2 days with seven sessions as a course of treatment. It was claimed that on the basis of this therapy, 72% of the cases were resolved after one course of treatment, and that all but 3 of the patients showed some degree of improvement; the first 3-5 sessions of scalp acupuncture were said to often bring significant relief.
