Chapter 2 Wang's neck and shoulder protocol

This topic is divided into several sections, the neck and the trapezium problems as one, the shoulder joints  and other related issues as the other. The former is very common, with young and old population. The later happens to mostly people in their upper 40’sand older. Younger people only get it through traumatic incidents, such as a bad fall. It will be discussed later the frozen shoulder sections.

Frequently, patients may come in for various complaints such as migraine, dizziness, but not neck and shoulder or simply mild neck issues. These patients would however show various degree of stiff neck. This happens especially with lots of elderly. Some of them may have a significant reduction of range of neck but may not be aware that they have the problem. It kind of creeping up gradually on them, little by little until most range of movement is lost eventually. After treatment, they would notice that they do not need to turn the shoulder to look for the incoming car while driving anymore. They just turn their neck, naturally!!

For younger people, it can be a postural issue or traumatic injury. These days, everybody seems to be perpetually sitting in front of computer terminals. Stiff and sore neck issues are common. It makes people uncomfortable, for most people, some rest and everything is O.K. Without resolving the issue, often it leads to other more serious problems such as numbness of arm and fingers.  Sometimes even turn to problems like carpel tunnel syndrome, which is horrible to live with.

  Graph from :  http://nursing411.org/Courses/MD0556_Basic_Patient_Care_Procedures/2-06_Basic_Pat_Care_Proc.html

 

2.1      N-S protocol: protocol for neck and shoulder problems

         Basic:  (done bilateraly)

                    Luo Zhen 

                   SJ 10  

                 

 Exam: Ask the patient to do neck rotation. 90 degree without tension is healthy. Otherwise, there is some issue with the neck and shoulder. Treat with N-S protocol


                                      

The basic acupuncture treatment for neck and shoulder problems is two sets of acupuncture points: Luo Zhen (which does not belong to any of the twelve meridians) is located on the dorsal of the hand, between the second and third knuckles. Luo Zhen means “fell off pillow” in Chinese. It treats locked neck from bad head posture in sleeping. The other SJ 10, which is at the upper edge of the elbow bone. SJ 10 is a pivotal point in San Jiao (SJ) meridian that travels up the arm, shoulder neck, and surround the ears.

For lots of cases, these points work like magic. You can literally see the neck starting to move like been lubricated right after needle insertion. I have taught all of my students of such application. The feedback has been very good.  Sometimes, the effect is not very apparent. Frequently, it is caused by improper needling technique. Not enough of Qi was moved.

When the case is more complicated as in auto related injury, such protocol might not be sufficient to resolve the whole problem. It is important to seek out what the complicating issues are.

2.2       In an auto accident, people most commonly suffer the whip lash. Their heads are thrashed forward and suddenly pulled backward like the tip of a whip during whipping. In many accidents, more than whip lash injury can happen. Strained torso, impacted chest, twisted low back do happen. Sometimes, the head inside the skull can be injured physically as well.

Head trauma is very serious. Peculiar thing happens after some accident.  Often the victims may have been shaken up violently during the accident, but are not aware of much pain. They would be rushed to the hospital, underwent a battery of exam including x-ray, MRI  They are pronounced as healthy and quickly released from the hospital with clean bill of health. This is totally inappropriate diagnosis but happen all the time.

The diagnosis is based on the status of victims in shock.  There is a disconnection between the mind and the body under such situation. After a while, the sign of injury starts to show up, pain also starts to increase and gets more and more severe with time.

In any case, some victims probably would go through a month or two of physical therapy and then will be taken off the insurance company’s list. Some do recover nicely, many do not. Many people would feel certain improvement but not completely pain free.  Furthermore, lingering pain continued, frequently intensified much later. It becomes  difficult  to relate to the accident. This is not a good thing from legal perspective.

For this reason, I routinely inquire about the history of auto accident when a new patient comes in.  I would also ask history of any other traumatic events. Not surprisingly, very frequently, way too many patients would have been involved in auto accidents. Some even have multiple auto accidents. The accidents could be just a few weeks earlier.  For many, incidents actually happened long time ago, like years.  

Auto accident is sad consequence of our modern society. For some people, lives are changed forever with perpetual health issues. For some of these people, they are not aware of their health issues were related to earlier auto accidents.

For a simple rear ended collision, the neck could be shaken quickly, violently. The cervical spine suffered front and back jerking. So, the treatment is to resolve the injury sustained from that. Frequently, the N-S acupuncture protocols works quite well and would be quite sufficient. For a more severe situation, several additional acupuncture points may be needed as well.

Note: Ask the patient to flex the neck. there should be no tension at all.     Otherwise needle Cheng Jiang, Ren 24. This is using Ren Meridian to treat Du meridain.          

These points include Bai Hui, or Du 20. This point belongs to Du meridian and addresses the spine disorder.  The Ren 24, Cheng Jiang for cervical spine which is on the Ren meridian, used because of Yin and Yang coupling relationship. It released the pain and stiffness at the T-1 of spine. Frequently, SI 3, Hou Xi is needed because they are the Lou point of Du meridian. It addresses the pain along the spine. If the pain is at the occipital, then UB 65(Shu Gu)  has to be needled, on the same side as pain. This point can be used for lots of other problems but is a sensitive spot that I don’t like to use it unless necessary.

Evaluate the progress after needling each point. I like to ask the patient to turn the neck from side to side to see the progress. It was found that the therapeutic result gets a boost if the patients exercise the painful area while needles are in.

The result should be quite impressive, regardless of the duration of the injury. In addition to moving the stagnated Qi, I suspect that is also because of resetting of neurological memory( so called muscle memory).

As mentioned above, the mode of automobile injury can be complex. Therefore, if the above N-S treatment method only brings about some degree of pain relieve. It would suggest that other parts of body are significantly injured as well. Two likely scenarios are the twisted torso during the collision or pulled chest muscle caused by restraining safety belt. Under these circumstances, certain areas on the chest near the shoulder joint, under the clavicles, the flank of the body can be sore to the touch. Needle painful area, or better yet, apply indirect moxibustion over the painful spots generously. The pain in the neck would show relieve immediately.

 A female patient had a complaint of tight shoulder. Sometimes it would be so tight that it became painful and head would hurt. I asked her to turn head from side to side. It was apparent that her right shoulder was very tight. The right upper trapezius muscle was tender to the palpating pressure. Bending the neck caused the achiness at the occipital area.

 I inserted needles at the regular places- Luo Zhen, SJ10. The improvement was moderate.  I then added SI 3,  Ren 24, Cheng Jiang and Tiao Kou, St 38 on the right. The pain was further reduced but still not completely gone.  This implied that it was a more complex case with multiple sources of problems. I palpated her left infra clavicle area. Both distal and proximal ends of sub clavicle exhibited sensitive to palpation. I used indirect moxibustion on these areas until she felt too hot. Immediately, the tightness of the shoulder disappeared. Her comment was that she never aware that the left chest is so sensitive to touch.

A 62 year old female patient who was injured in an auto accident. Front and rear of the car on the driver side were smashed. The car was totaled by the insurance company. The above mentioned treatment was successful. However, in addition to the pain mentioned above, a few weeks after the accidents, her right head started to hurt so was her left eye. She felt constant pressure on the left eye. She was examined and referred to glaucoma specialist. She was told to be a good candidate for laser treatment of glaucoma. This was strange as glaucoma usually takes a while to develop. I used indirect moxibustion over her forehead, her left temporal area and area up to one inch inside the hairline on the left side. After three sessions, the eye pressure disappeared, so was the headache. A couple follow-up treatments and the problem seemed gone.  She continued for treatment for about three months for other injury.

Moxibustion on and over the head /face needed to be conducted with extreme care.  Historically, acupuncturists try to stay away from such practice as much as possible. However, I found it is very powerful and useful. I achieved lots good results that are hard to get with other modality. But, great care has to be exercised to prevent patients from burn injury due to the debris of moxibustion stick. Do protect all the eyes thoroughly. Otherwise, don’t do it.

Cervical disc herniation

Herniated disc syndrome refers to the protruded disc from the spinal column. It can happen in the cervical area between C-5 to C-7, cervical spine or the low back between L3-L5, lumbar spine. These areas have unprotected spine and are subjected to majority of motion. Other places also could have it but much rare.

A 40 year old female was struck accidentally to the neck by an object while at work. She was referred to me by a chiropractor friend and an MD when the pain at the neck had spread to the left cheek.

X-ray has shown that her cervical area suffered from a herniated disc injury, “up to 2 mm broad based posterior disc protrusion at the C5-C6” and “up to 5 mm left posterior-central disc protrusion severely compressing the adjacent sac and moderately compressing the left margin of the spinal cord which is displaced posteriorly at the C6-C7 .” according to the radiology report.   Her neck’s range of motion from side to side is only about 45 degree.

The acupuncture treatment was performed followed N-S protocol, plus a few additional points. The pain immediately reduced. After 12 weekly visits, she had a complete range of motion, no pain at the neck or facial area. Interestingly, x-ray continues to show some disc herniation at the C6-C7. Years later, the patient still showed no problem on the neck.        

What is meant by “Cure” of herniation of discs?

            Such incident brought about a question about concept  of “ cure”. The fact about herniated disc problem is that the presence of herniation does not necessary causes significant health problem. People can have herniated disc yet walking around without any discomfort. Clearly, herniation of disc does create potential physical interference to the nerve. The good posture would therefore be preferred for the optimum health. More important, with good posture, the reversal of herniation is possible.