Where it hurts, tap there · abdomen for visceral referral
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Visceral Referred Pain Station
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Bi-Syndrome Framework
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Multiple Entry Points
Pattern Index
Reverse lookup by pattern — all patterns grouped by the six Qi-dynamic axes; which pain conditions one Qi disorder runs through, different diseases same treatment.
Mechanism Outline
The two main lines of blockage-pain (excess) and malnourishment-pain (deficiency), each leading pathogen/deficiency families — trace patterns and diseases down from the mechanism.
Bi-Syndrome + Warning Signs
The four-Bi framework (migratory-painful-fixed-heat) running through every joint, and the module-wide safety exit (six warning-sign categories).
Three Layers
Ashi-point needling → FSN → classical acupuncture + herbs: which layer this condition needs, and why. (Expanded within each pattern)
Clue Navigator
Night pain, morning stiffness, radiating numbness, cold aggravation, sore-weak preferring pressure — cross-cut all pain conditions from one prominent symptom, each clue with differentiation points.
All patterns grouped by the six Qi-dynamic axes of ascent-descent-exit-entry — which pain conditions one Qi disorder runs through; different diseases, same treatment. Tap any pattern to reach its chapter.
Excessive Ascent1
Clear-Yang ascends excessively, Qi-fire surges up — pain above, distending, fluctuating with emotion
Turbid-Yin fails to descend, Qi counterflows up — distension, counterflow, unrelieved by pressure
Low Back PainDamp-Heat Accumulation Low Back Pain→
Visceral Referral StationLiver Qi Invading the Stomach (Functional Epigastric Pain · to Internal Medicine)→
Impaired Exit–Entry54
The exit-entry of Qi and Blood is stifled — the core of blockage-pain; wind-cold-damp-heat and phlegm-stasis all belong here, painful site refusing pressure, eased when freed
The generative source of Qi-Blood-Liver-Kidney is deficient — malnourishment-pain, sore and weak preferring pressure, worse with exertion, chronic bodily deficiency
Trace down from the mechanism framework — the two main lines of blockage-pain (excess) and malnourishment-pain (deficiency), each leading several pathogen/deficiency families, back to patterns and diseases.
Blockage Causes Pain (Excess)
Qi and Blood obstructed by pathogens, congested and not flowing; painful site refuses pressure, eased when freed. Acute new disease mostly belongs here.
Wind-Cold-Damp Obstruction20
Elbow PainWind-Cold-Damp Obstruction Elbow Pain→
Knee PainLiver-Kidney Deficiency · Wind-Cold-Damp Bi Knee Pain (Knee Osteoarthritis)→
Knee PainWind-Cold-Damp Bi Knee Pain (Sinew-Channel · Iliotibial Band · Pes Anserinus)→
Qi-Blood and Liver-Kidney deficient, sinew-bone malnourished; painful site prefers pressure, sore and weak, worse with exertion. Chronic long illness mostly belongs here.
Not by site, not by disease name, but by the feature of the pain — cross-disease clues like night pain, morning stiffness, radiating numbness, cold aggravation, each with its mechanism direction leading to the relevant patterns. Tap any pattern to reach its chapter.
Quality of Pain
Stabbing, fixed pain21
Mostly Blood stasis obstruction (stasis of blockage-pain)
First trace the source level: radicular (dermatomal, Spurling/SLR positive) is spinal, entrapment (single-nerve, local Tinel positive) is peripheral, myofascial referral (non-dermatomal, no neuro signs) is the trigger point
TMJ PainTemporalis Trigger Point TMJ Pain→
Elbow PainCervicogenic Referred Elbow Pain (C6/C7 Radicular · Pseudo-tennis-elbow)→
The lumbar region is the pivot of the whole body. The Bladder channel of Foot-Taiyang descends alongside the spine, passing through the low back and connecting with the Kidney; the Du Mai runs within the spine, governing all Yang; the Dai Mai encircles the waist, binding every longitudinal channel. Where these three meet, the low back becomes the obligatory passage for the ascent and descent of Yang Qi — and the mechanical fulcrum for every act of exertion.
Structurally, lumbar load-bearing rests on three muscular layers: the deep multifidus stabilizing each segment against the vertebrae, the middle erector spinae running the length of the spine to drive extension, and the lateral quadratus lumborum linking rib cage to iliac crest for side-bending and accessory respiration. Further down, the gluteus medius and gluteus minimus belong to the buttock, yet their trigger-point referral zones blanket the lumbosacral region — the anatomical basis of pain felt in the back but sourced in the hip.
The Kidney resides in the lumbar region: the low back is the mansion of the Kidney. Kidney essence and Qi are the generative source that nourishes lumbar sinew and bone: when essence is abundant the bones are firm and the marrow full; when Qi is abundant, warming power holds its office. Hence in low back pain, acute cases mostly answer to obstruction of channel Qi and Blood, while chronic cases usually carry an added insufficiency of the Kidney's generative source — one excess, one deficiency, matching exactly the two roots: pain from blockage, and pain from lack of nourishment.
The normal state of lumbar Qi dynamics: clear Yang ascends and spreads along the Bladder channel and Du Mai, Kidney Qi warms from within, and Qi and Blood enter and exit freely among the sinews with every movement. Bending, lifting, and prolonged sitting all test this perfusion system; cold, damp, and twisting injuries are its most common saboteurs.
Clinical pursuit of low back pain locates first and characterizes second: step one asks onset and trigger; step two screens warning signs; step three uses radiation patterns and physical examination to fix the tissue layer and channel; step four palpates to confirm the true source; and only then do cold–heat and pressure preferences settle the nature of the Qi disturbance. The navigator below is laid out along exactly this road.
The pain is in the back — the source may not be. Trace it in order of probability:
Acute Lumbar Sprain (Qi Stagnation and Blood Stasis)
Principle: Move Qi, quicken Blood, free the collaterals to stop pain; distal mobilization first, local deactivation second
Target muscle / point: Erector spinae (longissimus, iliocostalis lumbar segments) and quadratus lumborum; locate taut bands and the point of maximal tenderness by palpation
Technique: Within 48 hours, if local swelling is marked, work distal before local: needle EX-UE7 (Yaotongdian) or SI3 (Houxi) first and have the patient slowly move the back; once pain eases, treat the local trigger points prone. Insert obliquely along the fiber direction into the taut band; stop once a local twitch response is elicited — no wide lift-thrust.
Safety: Deep needling of quadratus lumborum demands strict depth and direction: keep the needle tip aimed at the transverse process plane, never probing ventrally, to protect the abdominal cavity and kidney region.
Entry: Insert subcutaneously 6–8 cm below or lateral to the pain zone, needle tip toward it
Sweep & reperfusion: Subcutaneous sweeping paired with reperfusion activity: the patient performs slow flexion-extension and side-bending, about two minutes of movement per sweeping set, reassessing range each round. Acute sprain is among the fastest-responding FSN indications.
Adjunct points: GV26 (Shuigou) for severe pain preventing any turning; local Ashi points; BL25 (Dachangshu)
Point rationale: SI3 (Houxi) opens the Du Mai and is the key distal mobilization point for acute spinal pain; BL40 (Weizhong) — seek the low back at Weizhong — drains the congestion in the channel; GV26 (Shuigou) opens the Du Mai in emergencies and, with motion needling, can set an acutely wrenched back upright on the spot.
External therapy & care: No forceful manipulation or heat packs within the first 24–48 hours; afterwards local warm compresses and moving cupping assist the movement of Qi.
Classical formula: Shaoyao Gancao Tang (★Classical Original★) with additions
Bai Shao 4 liang, Zhi Gan Cao 4 liang (original 1:1 ratio; start at 30 g each today); add Yan Hu Suo, Chuan Xiong, Xiang Fu to move Qi and quicken Blood
In the Shang Han Lun, Shaoyao Gancao Tang governs leg cramping spasm: sour and sweet transform Yin, relaxing sinew spasm to stop cramping pain — precisely the mechanism of acute sprain with sinew spasm. The additions lead the congestion out.
Textbook reference: Shen Tong Zhu Yu Tang
Qin Jiao, Chuan Xiong, Tao Ren, Hong Hua, Gan Cao, Qiang Huo, Mo Yao, Dang Gui, Wu Ling Zhi, Xiang Fu, Niu Xi, Di Long
Wang Qingren's formula for generalized painful obstruction with Blood stasis: quickening Blood, moving Qi, and freeing the collaterals in one — especially apt when stasis dominates an acute sprain.
Formula analysis: One formula relaxes, one attacks: Shaoyao Gancao Tang resolves the acute presenting spasm, Shen Tong Zhu Yu Tang expels the pathological product of stasis. Mild injury with spasm dominant — the former; obvious swelling and stasis — the latter; or use the former as base combined with the latter's Blood-quickening group.
Modifications:
Marked swelling — add Ze Lan, Tu Bie Chong
Pain pulling into the lower abdomen — add Xiao Hui Xiang, Wu Yao to course Dai Mai Qi
Concurrent cold exposure — add Gui Zhi, Du Huo to warm and unblock
Key point: Distal mobilization before local treatment is the operating rule of this pattern; 48 hours marks both the swelling window and the re-assessment point.
Cold-Damp Obstruction Low Back Pain
Principle: Scatter cold, dispel damp, warm the channels and free the collaterals
Target muscle / point: Erector spinae, quadratus lumborum, multifidus — cold-damp taut bands tend to form diffuse bands of tension rather than single points
Technique: Warm the area first with palm friction until mildly heated, then needle the tension band segment by segment; after eliciting the twitch response, retain needles with added warmth (moxa box or heat lamp), pairing warming with deactivation.
Safety: Standard deep-lumbar rule: needle toward the transverse process plane, never probing ventrally.
Entry: Insert subcutaneously at the outer margin of the tension band, tip toward its center
Sweep & reperfusion: Sweeping with reperfusion: pelvic tilts and cat-stretch. Cold-damp tissue feels board-like; when sweeping resistance is marked, slow the rhythm and work only until release.
Adjunct points: CV4 (Guanyuan) with moxa, BL60 (Kunlun), local Ashi points
Point rationale: GV3 (Yaoyangguan) is the gate where Du Mai Yang enters and leaves the lumbar mansion — moxa it to scatter the Yin congealment; BL23 (Shenshu) reinforces Yang to transform damp at the root; BL40 (Weizhong) drains Bladder-channel congestion. Moxibustion outweighs needling in this pattern.
External therapy & care: Ginger-insulated moxa at Yaoyangguan and Shenshu, five to seven cones per session; a dry dwelling and a warm waist are half the cure.
Gan Cao 2 liang, Bai Zhu 2 liang, Gan Jiang 4 liang, Fu Ling 4 liang
Jin Gui Yao Lue: In Shenzhuo disease the body feels heavy and the waist cold, as if sitting in water... cold and pain below the waist, the abdomen heavy as if girdled with five thousand coins — Gancao Ganjiang Fuling Baizhu Tang governs it. The exact classical match for cold-damp lodged at the waist: warming the center and percolating damp together, it settles the Kidney region without treating the Kidney itself.
Textbook reference: Du Huo Ji Sheng Tang
Du Huo, Sang Ji Sheng, Du Zhong, Niu Xi, Xi Xin, Qin Jiao, Fu Ling, Rou Gui, Fang Feng, Chuan Xiong, Ren Shen, Gan Cao, Dang Gui, Shao Yao, Gan Di Huang
The textbook first choice when painful obstruction has lasted long enough to involve Liver-Kidney insufficiency and dual Qi-Blood deficiency: expelling the pathogen and supporting the upright together.
Formula analysis: Shenzhuo Decoction treats purely cold-damp lodged and unmoving — shallow disease, focused formula; Du Huo Ji Sheng Tang treats long-standing obstruction that has sunk deep with Liver-Kidney already depleted — deep disease, complex formula. New illness in a strong patient: the former. Old illness in a weak patient: the latter. The two hand over across the timeline of the disease.
Modifications:
Severe cold with intense pain — add Fu Zi to Shenzhuo Decoction (approaching the intent of Fuzi Tang)
Damp-dominant heaviness — add Cang Zhu, Yi Yi Ren
Concurrent Blood stasis — add Chuan Xiong, Niu Xi
Key point: Waist cold as if sitting in water is the pathognomonic line of this pattern; moxibustion and damp-proofing of daily life weigh no less than the formula.
Damp-Heat Accumulation Low Back Pain
Principle: Clear heat, drain damp, relax the sinews and free the collaterals
Target muscle / point: Erector spinae and quadratus lumborum tension bands; damp-heat tissue often feels warm to the touch and tough under the fingers
Technique: Standard trigger-point deactivation without moxa or added heat; cupping after needling helps draw the pathogen outward.
Safety: Marked local redness, heat, and swelling with fever: rule out infection first — do not needle.
Entry: Insert subcutaneously at the outer margin of the tension band
Sweep & reperfusion: Sweeping with reperfusion activity; no thermal modalities for this type.
Adjunct points: SP6 (Sanyinjiao), LI11 (Quchi), local Ashi points
Point rationale: BL40 (Weizhong) is the Blood cleft point — pricking and cupping there drains Bladder-channel damp-heat best; SP9 (Yinlingquan), the master point for draining damp, gives the damp an exit; GB34 (Yanglingquan), the sinew meeting point, relaxes the sinews. Clearing and draining lead; moxibustion is contraindicated.
External therapy & care: Collateral pricking with cupping at Weizhong; forbid spicy food and alcohol — most damp-heat enters through the mouth.
Classical formula: Ma Xing Yi Gan Tang (★Classical Original★) modified
Ma Huang 0.5 liang, Xing Ren 10 pieces, Yi Yi Ren 0.5 liang, Zhi Gan Cao 1 liang; Yi Yi Ren in heavy dose, plus Huang Bai and Cang Zhu as needed
Jin Gui Yao Lue: The patient aches all over, feverish, worse toward late afternoon — this is named wind-damp. Light sweating transforms the damp while coix clears and drains; pain from constrained damp turning to heat can ride its gentle diffusing power, and combined with Er Miao it forms a strategy of separating and dispersing exterior and interior.
Textbook reference: Si Miao Wan
Cang Zhu, Huang Bai, Niu Xi, Yi Yi Ren
Clears heat and dries damp, striking straight at lower-burner damp-heat, with Niu Xi guiding the formula down to the waist and knees — the standard textbook formula for damp-heat back and leg pain.
Formula analysis: Si Miao Wan clears and descends, working the interior; Ma Xing Yi Gan Tang lightly diffuses, working the exterior. Damp-heat constrained in the flesh with generalized soreness worse in late afternoon — add the diffusing arm; damp-heat purely in the lower burner — clearing and descending alone.
Modifications:
Dark rough urination — add Bi Xie, Che Qian Zi
Heat exceeding damp — add Zhi Zi, Ren Dong Teng
Lingering long enough to injure Yin — reduce Cang Zhu, add Sheng Di, Bai Shao
Key point: Moxa and heat packs are contraindicated; collateral pricking at Weizhong is the finishing stroke of the acupuncture layer.
Blood Stasis Obstructing the Collaterals (Chronic)
Principle: Quicken Blood, transform stasis, free the collaterals to stop pain; in long-standing stasis, attend to the underlying deficiency
Target muscle / point: Deep multifidus trigger points and old erector spinae cords; stasis-type bands tend to harden into fixed nodules
Technique: For deep multifidus, enter one finger-breadth lateral to the spinous process and advance slowly layer by layer into the taut band, eliciting the twitch response; old nodules may be needled through in several directions.
Safety: Needling toward the lamina is the safe direction; limit targets per session to avoid heavy post-needling reactions.
Entry: Insert subcutaneously 6 cm from the nodule margin, tip toward the nodule
Sweep & reperfusion: Sweeping with reperfusion: slow lunge-and-turn, prone hip-extension press-ups; old adhesion zones may be approached from several directions across sessions.
Primary points: BL17 (Geshu), BL23 (Shenshu), local Ashi points with pricking-cupping, BL40 (Weizhong)
Adjunct points: SP10 (Xuehai), EX-B2 (Jiaji) at the affected segment, KI3 (Taixi)
Point rationale: BL17 (Geshu), the meeting point of Blood, paired with SP10 (Xuehai) moves stagnation in the Blood aspect; local pricking-cupping removes stasis from the collaterals directly; KI3 (Taixi) guards the root in long-standing stasis.
External therapy & care: Pricking-cupping no more than once a week; pair with deep lumbar stabilization training against recurrence.
Classical formula: Guizhi Fuling Wan (★Classical Original★) with additions
Gui Zhi, Fu Ling, Mu Dan Pi, Tao Ren, Shao Yao in equal parts; add Niu Xi and Di Long to guide into the channel and free the collaterals
The ancestral Jin Gui formula for gradually dissolving concretions: stasis that has taken form and cannot be removed overnight is worn away with a pill — warming, unblocking, and dispersing stasis in one motion, matching exactly the momentum of chronic consolidated stasis.
Textbook reference: Shen Tong Zhu Yu Tang
Qin Jiao, Chuan Xiong, Tao Ren, Hong Hua, Gan Cao, Qiang Huo, Mo Yao, Dang Gui, Wu Ling Zhi, Xiang Fu, Niu Xi, Di Long
The general formula for Blood-stasis pain of the limbs and body: moving Qi, quickening Blood, and freeing the collaterals all present.
Formula analysis: Shen Tong Zhu Yu Tang moves and scatters, attacking stasis suspended between the Qi and Blood aspects; Guizhi Fuling Wan slowly dissolves tangible knots, attacking stasis fixed in form. Stabbing pain that still shifts somewhat — the former; a hard point that never moves — the latter, in slow persistence.
Modifications:
Stubborn old stasis — borrow the intent of Da Huang Zhe Chong Wan: add Tu Bie Chong and a small dose of Shui Zhi
Concurrent Kidney deficiency — combine Du Zhong, Xu Duan, Sang Ji Sheng
Severe night pain — add Yan Hu Suo, Ru Xiang
Key point: Fixed stabbing pain, night aggravation, dark tongue — three signs together seal the diagnosis; long stasis always rides on deficiency, and when pure attack stalls, adding supplementation turns the case.
Kidney Yang Deficiency Low Back Pain (Loss of Warming)
Principle: Warm and supplement Kidney Yang to provision the lumbar mansion; supplementation is the unblocking
Target muscle / point: Trigger points are usually atypical in this pattern; if diffuse muscle tension exists, treat erector spinae with light stimulation only
Technique: Gentle technique, few targets; prefer warm needling over bare deactivation — a deficient body cannot afford wide needling expenditure.
Safety: Needle-faint risk is high in deficient patients: treat lying down, keep needle count minimal.
Entry: If FSN is used at all, sweep lightly subcutaneous to the lumbosacral tension zone
Sweep & reperfusion: Gentle slow sweeping; reperfusion activity kept short of fatigue. FSN is the adjunct here — warming supplementation is the principal.
Point rationale: GV4 (Mingmen) and CV4 (Guanyuan) answer each other front and back; moxa them to rekindle the Life-Gate fire and restore the office of warming. BL23 (Shenshu) and BL52 (Zhishi) provision the Kidney mansion; ST36 (Zusanli) supplements the acquired to nourish the innate. Moxibustion is the lead actor in this pattern.
External therapy & care: Aconite-cake-insulated moxa at Mingmen and Guanyuan is best; moderate exertion and desire; a winter paste formula may consolidate slowly.
Classical formula: Ba Wei Shen Qi Wan (★Classical Original★)
Gan Di Huang 8 liang, Shan Yao 4 liang, Shan Zhu Yu 4 liang, Ze Xie 3 liang, Fu Ling 3 liang, Mu Dan Pi 3 liang, Gui Zhi 1 liang, Fu Zi 1 piece (blast-fried)
Jin Gui Yao Lue: For deficiency-taxation low back pain, tension of the lower abdomen, and inhibited urination, Ba Wei Shen Qi Wan governs it. Seeking Yang within Yin, kindling a small fire to steam Kidney Qi — the canonical formula whose original text names low back pain as the chief symptom.
Textbook reference: You Gui Wan
Shu Di Huang, Shan Yao, Shan Zhu Yu, Gou Qi, Lu Jiao Jiao, Tu Si Zi, Du Zhong, Dang Gui, Rou Gui, Zhi Fu Zi
Zhang Jingyue's design of pure supplementation without draining — fitting when Life-Gate fire is markedly declined and no water-damp lingers.
Formula analysis: Shen Qi Wan supplements with draining built in (three draining herbs keep the tonics from clogging), suiting deficiency with unresolved water-Qi; You Gui Wan is pure heavy replenishment for unmixed deficiency. Inhibited urination or marked nocturia showing water signs — the former; cold aversion and cold essence in pure deficiency — the latter.
Modifications:
Frequent nocturia — add Yi Zhi Ren, Sang Piao Xiao
Waist cold as ice — add Lu Jiao Shuang, Bu Gu Zhi
Concurrent leg edema — increase Fu Ling and Ze Xie, approaching Ji Sheng Shen Qi Wan
Key point: In this pattern supplementation is the unblocking: few needles, more moxa, slow-acting herbs — tell the patient the course runs in months, or impatience will break it off.
Kidney Yin Deficiency Low Back Pain (Loss of Moistening)
Principle: Enrich Kidney Yin, moisten the sinews, and clear deficient heat alongside
Target muscle / point: As with the Yang-deficient type, trigger points are usually atypical; treat diffuse tension with light stimulation
Technique: Light technique, few targets, no moxa or minimal warmth only; advise water and rest after needling.
Safety: Yin-deficient bodies feel needling keenly: start at half the usual stimulus.
Entry: If a local tension band exists, sweep lightly subcutaneous at its margin as an adjunct
Adjunct points: HT6 (Yinxi), KI2 (Rangu) to clear deficient heat, light needling at local Ashi points
Point rationale: KI3 (Taixi), the Kidney source point, paired with KI6 (Zhaohai) enriches Kidney water while easing the throat and calming sleep; SP6 (Sanyinjiao) regulates all three Yin to broaden the generative source; KI2 (Rangu), the Kidney channel spring-fire point, clears deficient heat without harming the upright. Supplementing technique, light or no moxa.
External therapy & care: Heavy moxibustion is unsuitable; for movement, gentle stretching and the Baduanjin section of reaching for the feet to strengthen kidney and waist.
Classical formula: Ba Wei Shen Qi Wan minus Gui and Fu (the Liu Wei method)
Gan Di Huang 8 liang, Shan Yao 4 liang, Shan Zhu Yu 4 liang, Ze Xie 3 liang, Fu Ling 3 liang, Mu Dan Pi 3 liang
Qian Yi carved Liu Wei Di Huang Wan out of Shen Qi Wan by removing Gui Zhi and Fu Zi — the Jin Gui original less two herbs is the standard treatment for Yin deficiency: three supplements, three drains, enriching without cloying.
Textbook reference: Zuo Gui Wan
Shu Di Huang, Shan Yao, Shan Zhu Yu, Gou Qi, Chuan Niu Xi, Tu Si Zi, Lu Jiao Jiao, Gui Ban Jiao
Zhang Jingyue's purely sweet water-strengthening design, more forceful at filling essence and boosting marrow — for heavier depletion of true Yin.
Formula analysis: The Liu Wei method is balanced and general, supplementing and draining together; Zuo Gui Wan is pure heavy replenishment holding without draining. Mild-to-moderate Yin deficiency with deficient heat — the former plus Zhi Mu and Huang Bai; marked essence depletion with weak soft knees — the latter.
Modifications:
Marked deficient heat, vexing heat in palms and soles — add Zhi Mu, Huang Bai (the Zhi Bai Di Huang intent)
Restless dreamy sleep — add Suan Zao Ren, Ye Jiao Teng
Dry eyes and dim vision — add Gou Qi, Ju Hua (the Qi Ju Di Huang intent)
Key point: Soreness plus five-center heat plus red tongue with scant coat settles the case; Yin-enriching formulas must be held steady for a hundred days — the effect lies in slow accumulation.
Radicular Low Back and Leg Pain (Sinew-Channel Entrapment)
Principle: Release the entrapment and free the channel Qi; treat the branch in crisis, the root in remission
Target muscle / point: Quadratus lumborum, gluteus medius, gluteus minimus, piriformis — the myofascial overlay of radicular pain is routinely missed, and deactivating it often shrinks the radiation markedly; deep multifidus at the affected segment
Technique: Treat the three gluteal muscles and piriformis first (their referral lines stack onto the radicular radiation), then the multifidus beside the affected segment; each session assess whether the radiation is retreating centripetally (centralization is the favorable sign).
Safety: Deep piriformis needling must respect the sciatic nerve course: any electric shooting sensation — withdraw at once and redirect.
Entry: Insert subcutaneously proximal on the radiation line, tip toward the lumbosacral region; add a needle at the posterolateral thigh when leg symptoms dominate
Sweep & reperfusion: Sweeping paired with straight-leg-raise reperfusion: while sweeping, the patient slowly raises the straight leg and pumps the ankle, comparing raise angle in real time. FSN gives some of the fastest immediate gains of the three layers in radicular pain.
Primary points: EX-B2 (Jiaji) at the affected segment, BL25 (Dachangshu), GB30 (Huantiao), BL40 (Weizhong), GB34 (Yanglingquan)
Point rationale: EX-B2 (Jiaji) takes the entrapped segment directly — deep insertion with Qi propagating down the leg is ideal; GB30 (Huantiao) is the pivot of leg channel Qi, able to open the channels of leg and foot; distal points deploy along the Taiyang or Shaoyang line according to the radiation path.
External therapy & care: In the acute phase avoid prolonged sitting and loaded flexion; in recovery, McKenzie extension and core stabilization run in parallel.
Classical formula: Shaoyao Gancao Tang combined with Guizhi Fuling Wan (★Classical Combination★)
Bai Shao and Zhi Gan Cao from 30 g each, combined with Gui Zhi, Fu Ling, Mu Dan Pi, Tao Ren; add Fu Zi for cold-dominant cases
Shaoyao Gancao Tang relaxes sinew spasm and resolves the radiating cramping pain; Guizhi Fuling Wan dissolves the paravertebral knot of stasis and water — one eases the acute, one removes the knot: the classical pairing for the double mechanism of sinew spasm plus stasis obstruction in radicular pain.
Textbook reference: Du Huo Ji Sheng Tang or Shen Tong Zhu Yu Tang by presentation
Long illness with Liver-Kidney depletion: Du Huo Ji Sheng Tang. Marked stasis: Shen Tong Zhu Yu Tang plus Di Long and Quan Xie
Radicular pain has no dedicated textbook formula; borrow the standard formula matching the predominant cold-damp, stasis, or Liver-Kidney deficiency.
Formula analysis: Here herbal choice follows the accompanying disease nature, while the location diagnosis (entrapment) directs the needling layers — nowhere does the division of labor between the two axes show more clearly than in this pattern.
Modifications:
Marked numbness — add Huang Qi, Ji Xue Teng (Qi too weak to move brings numbness)
Severe night pain — add Yan Hu Suo, Di Long
Chronic with leg muscle wasting — add Du Zhong, Xu Duan, Yin Yang Huo
Key point: Record radiation extent and straight-leg-raise angle at every visit — centralization is the iron proof of recovery; progressive weakness means immediate referral, never a lone battle.
Gluteal Referred Low Back Pain (Pain in the Back · Source in the Hip)
Principle: Trace the source and extinguish the point — treat the hip to cure the back
Target muscle / point: Trigger points of the anterior, middle, and posterior fibers of gluteus medius, and of gluteus minimus (whose referral can reach the lateral calf); L1 is the absolute mainstay of this pattern
Technique: Side-lying with hip flexed for localization: sweep the fan of gluteus medius one finger-breadth below the iliac crest, gluteus minimus one layer deeper. When needling elicits the twitch and reproduces the patient's familiar back pain, the target is hit — referral replication is the moment where diagnosis and treatment become one act.
Safety: Aim deep insertion toward the iliac surface; bone contact means the safe layer. Sensations spreading down the leg here are referral phenomena — distinguish them from electric nerve pain.
Entry: Insert subcutaneously at the upper lateral thigh, tip toward the gluteal lesion
Sweep & reperfusion: Sweeping with reperfusion: side-lying resisted abduction, alternating single-leg stance; re-test the lumbosacral pain immediately after the gluteal fascia releases.
Primary points: GB30 (Huantiao), GB29 (Juliao), BL54 (Zhibian), local Ashi points
Adjunct points: GB34 (Yanglingquan), BL23 (Shenshu) to secure the root, GB31 (Fengshi)
Point rationale: In this pattern the points are the muscles: GB29 (Juliao) sits on the anterior fibers of gluteus medius, GB30 (Huantiao) covers the deep gluteal layer, BL54 (Zhibian) answers the deep surface of gluteus maximus — the Foot-Shaoyang gluteal segment and the three muscles' trigger points coincide, and channel point and target become one.
External therapy & care: Daily self-maintenance with a tennis ball on the gluteal tender points; correct prolonged sitting and leg-crossing — habitual single-side loading is the seed of relapse.
Classical formula: Choose by accompanying pattern; no dedicated principal formula
With cold-damp: Shenzhuo Decoction. With stasis: Guizhi Fuling Wan. Deficient constitution: Ba Wei Shen Qi Wan
This pattern is a victory of location diagnosis — find the true source, needle where the illness sits, and herbs need only mind the constitutional undertone.
Textbook reference: Sinew-relaxing Blood-quickening formulas by presentation
Shu Jin Huo Xue Tang or a light Shen Tong Zhu Yu Tang
To consolidate the needling result — not the main weapon.
Formula analysis: The formula analysis of this pattern lies in needles, not herbs: the sequence of hunting and extinguishing the three muscles' trigger points is its sovereign–minister–assistant–courier.
Modifications:
Sedentary occupation — weight the prescription toward gluteal activation training
Repeated recurrence — screen pelvic tilt and leg-length discrepancy
Key point: Treating the hip for back pain is the most vivid demonstration of this module's source-tracing idea; when treating the back fails, examine the hip first — three or four in ten live there.
Sacroiliac Joint Origin Low Back Pain
Principle: Reset the pivot and release the knotted tissue around it
Target muscle / point: Around the sacroiliac joint: gluteus maximus origin, sacral multifidus, tension points in the sacrotuberous ligament zone
Technique: Prone, sweep the inner and outer margins of the sacroiliac groove for tenderness and tension points and deactivate one by one; pairing with pelvic manipulative reduction (flexed hip-knee technique for posterior rotation) adds effect on effect.
Safety: Needle only shallowly over the posterior sacral foramina — deep to them lies the sacral canal outlet.
Entry: Insert subcutaneously 6 cm inferolateral to the sacroiliac groove, tip toward the joint
Sweep & reperfusion: Sweeping with reperfusion: alternating single-leg stance, pelvic clock; reduce both manipulation and sweeping dose in postpartum patients.
Adjunct points: BL40 (Weizhong), local Ashi points, BL62 (Shenmai)
Point rationale: BL32 (Ciliao) sits exactly on the posterior sacral foramen — the anchor point for sacroiliac pain; BL27 (Xiaochangshu) and BL28 (Pangguangshu) flank the upper joint margin; BL62 (Shenmai) opens the Yang Qiao to tune the leg's force line.
External therapy & care: A sacroiliac belt assists fixation (especially postpartum); avoid leg-crossing and long sitting on soft sofas.
Classical formula: Choose by accompanying pattern
Postpartum Blood deficiency: Danggui Shaoyao San (★Classical Original★: Dang Gui, Shao Yao, Chuan Xiong, Fu Ling, Bai Zhu, Ze Xie). With stasis: Guizhi Fuling Wan
Danggui Shaoyao San nourishes Blood and drains water in one motion — the right fit for postpartum sacroiliac pain with Blood deficiency and water retention; structural pain is led by reduction and needling, herbs tune the inner terrain.
Textbook reference: Du Huo Ji Sheng Tang
See under the cold-damp pattern
The general base formula for chronic joint painful obstruction with Liver-Kidney insufficiency.
Formula analysis: Resetting the pivot is the first meaning of this pattern; needles and herbs are consolidation after reduction — reverse the order and the effect discounts itself.
Modifications:
Postpartum — add Du Zhong, Xu Duan, Sang Ji Sheng to secure Kidney and strengthen the waist
Morning stiffness over an hour in a young man — check HLA-B27 and sacroiliac MRI before treating further
Key point: Pain on rolling over and rising, unilateral point location, positive provocation tests — three signs fix the location; keep the inflammatory-spondyloarthropathy red line taut at all times.
Lumbar Facet Joint Origin Low Back Pain
Principle: Unlock the hinge, mobilize the joint, stabilize the deep layer
Target muscle / point: Multifidus at the affected segment (the facet's direct stabilizer) and the same-segment erector spinae
Technique: Enter one finger-breadth lateral to the spinous process, advancing layer by layer to the multifidus taut band for deactivation; in acute entrapment, unlock first by manipulation (side-lying oblique thrust), then needle to consolidate.
Safety: Needle toward the lamina; the oblique thrust demands precise localization and a short crisp impulse — never brute force.
Entry: Insert subcutaneously 8 cm lateral to the affected segment, tip toward the facet
Sweep & reperfusion: Sweeping with reperfusion: slow extension and rotation to the edge of pain and back; in the acute phase keep amplitude within tolerance.
Primary points: EX-B2 (Jiaji) at the affected segment, BL25 (Dachangshu), BL40 (Weizhong), SI3 (Houxi)
Adjunct points: GB34 (Yanglingquan), local Ashi points
Point rationale: EX-B2 (Jiaji) lies against the facet capsule — the anatomically matched point for targeted treatment; SI3 (Houxi) opens the Du Mai to ease the hinge's opening and closing; GB34 (Yanglingquan), the sinew meeting, governs impaired bending and stretching of joints.
External therapy & care: Within 48 hours of acute entrapment, manual reduction comes first; in recovery, isometric multifidus training (prone alternate arm-leg raises) against recurrence.
Classical formula: Shaoyao Gancao Tang (★Classical Original★) as base
Bai Shao and Zhi Gan Cao from 30 g each; for acute entrapment pain add Yan Hu Suo, Wei Ling Xian
Relaxing spasm and easing urgency, it meets the guarding spasm of joint entrapment head-on — a simple formula, quick to act, escorting the manual reduction.
Textbook reference: Shen Tong Zhu Yu Tang or Du Huo Ji Sheng Tang by presentation
Acute stasis: the former. Long-standing degeneration with Liver-Kidney depletion: the latter
Long-term management of facet degeneration borrows the standard formulas along the deficiency–excess axis.
Formula analysis: In crisis: manipulation plus Shaoyao Gancao Tang to unlock and stop pain. In remission: training plus Liver-Kidney supplementation to stabilize the segment — this pattern's plan is a timeline, not a single prescription.
Modifications:
Repeated locking — weight the prescription toward deep-muscle training
Elderly degeneration — combine You Gui Wan or Shen Qi Wan in slow persistence
Key point: Extension-rotation pain, flexion relief, brief stiffness — the facet's mechanical fingerprint, opposite in direction to discogenic pain; two intake questions make the first cut.
Principle: No pattern identification, no needling; recognize, refer, follow up — three steps
Target muscle / point: Not applicable
Technique: Once a warning sign stands, suspend all needling, complete referral documentation, and grade the urgency.
Safety: Saddle numbness plus sphincter dysfunction = cauda equina syndrome, a surgical emergency — same-day emergency department; delay is measured in hours.
Entry: Not applicable
Sweep & reperfusion: Not applicable.
Primary points: Not applicable
Adjunct points: Not applicable
Point rationale: Before warning signs are cleared, any needling may blur the observation window on disease progression.
External therapy & care: Graded disposition: cauda equina signs — emergency department; fever plus percussion tenderness — same-day blood work, inflammatory markers, imaging; progressive night pain plus weight loss — tumor-direction screening within two weeks; trauma or osteoporosis — X-ray or MRI.
Classical formula: Not applicable
None
With the diagnosis unsettled, a prescription is itself a risk.
Textbook reference: Not applicable
None
As above.
Formula analysis: This page exists so that the user walks this step before writing any treatment plan at all.
Key point: Once warning signs are cleared and the diagnosis set, the patient returns to the standard pathway; referral is not losing a patient — it is earning trust.
The neck is the throat-pass through which the whole body's Yang Qi ascends and descends. Every hand and foot Yang channel climbs through it: the Du Mai runs the posterior midline governing all Yang, Foot-Taiyang flanks the spine ruling the exterior, Foot-Shaoyang runs the lateral neck governing the pivot, and the three hand-Yang channels rise from the arm over the shoulder to the head. Small as it is, the neck is the obligatory gate where six Yang channels converge and clear Yang rises to the head — block it, and both what rises and what descends are dragged along.
Structurally, neck movement depends on three cooperating muscle layers: the deep suboccipital four fine-tune skull position, the middle splenius and semispinalis drive extension and rotation, and the superficial upper trapezius and levator scapulae link neck to shoulder and suspend the head. In front, the sternocleidomastoid drives rotation and flexion, the scalenes pull laterally and assist respiration. The trigger points of these muscles are exactly where channel blockage becomes palpable in the flesh.
Pain location directly indicates the blocked channel: posterior midline pain with spinous stiffness is Du Mai; posterior paravertebral pain along the erector spinae is Foot-Taiyang; lateral pain radiating to temple and shoulder-arm is Shaoyang and the hand-Yang channels; dermatomal numbness radiating to the fingers means the disease has sunk to the level of nerve-root compression. Fixing the channel by pain location and the depth by radiation pattern is the first measuring rod of neck-pain localization.
In its ordinary course, acute neck pain is mostly external pathogen or trauma: Wind-Cold enters through the neck in the gap when defensive Qi withdraws inward during sleep, or whiplash directly injures the channel Qi and Blood. Chronic pain usually carries an underlying deficiency: prolonged forward-head posture chronically overloads the posterior cervical fascia, Phlegm-stasis gradually accumulates in the channel, and in the elderly this compounds with Kidney depletion and marrow-sea emptiness. Acute is mainly blockage; chronic is blockage riding on malnourishment — one excess, one deficiency, still the two roots of pain.
Clinical pursuit of neck pain locates first, characterizes second, and must screen warning signs before all: step one asks the onset trigger to separate acute from chronic; step two screens warning signs to exclude cord compression and vertebral artery involvement; step three fixes channel and layer by radiation and examination; step four palpates to lock the true responsible muscle and segment; and finally cold–heat preference settles the nature of the Qi disturbance. The navigator below is laid out along this road.
The pain is in the neck — the source may not be. Trace it in order of probability:
Wind-Cold Obstruction Neck Pain (Stiff Neck)
Principle: Dispel Wind and scatter Cold, free the collaterals and release spasm; open the channel distally first, release the contracted muscle locally second
Target muscle / point: The contracted sternocleidomastoid, levator scapulae, or upper trapezius; palpate to fix the taut band and point of maximal tenderness
Technique: First needle distal SI3 (Houxi) and GB39 (Xuanzhong, contralateral to the worst side), asking the patient to slowly turn the neck while needling; once the spasm eases, treat the local trigger points prone. Insert obliquely along the fiber into the taut band, stop at the local twitch response, no wide lift-thrust.
Safety: Lateral neck needling must avoid the carotid sinus and external jugular vein; grasp and needle the SCM shallowly, no deep probing.
Entry: Insert subcutaneously at the upper thoracic level (T1–T3), needle tip toward the cranial neck region
Sweep & reperfusion: Sweeping with reperfusion: the patient slowly rotates and extends the neck, reassessing range each two-minute sweeping set. The upper-thoracic to upper-cervical fascia is continuous, so working the thoracic end releases the cervical end. Acute stiff neck responds very fast to FSN.
Adjunct points: GB21 (Jianjing, oblique toward the spine), BL10 (Tianzhu), local Ashi points
Point rationale: SI3 (Houxi) opens the Du Mai and is the fastest-acting distal point for acute posterior neck stiffness; needle it while the patient turns the neck, motion and needling together swiftly opening Taiyang and Du Mai. GB39 (Xuanzhong), the marrow meeting point, needled contralaterally quickly releases SCM and trapezius spasm; GV14 (Dazhui), meeting of all Yang, may be moxaed for cold.
External therapy & care: Keep the neck warm and out of drafts; for cold patterns, local warm needling or gentle moxa; usually resolves in 1–3 treatments.
Classical formula: Gegen Tang (★Classical Original★)
Ge Gen 4 liang, Ma Huang 3 liang, Gui Zhi 2 liang, Sheng Jiang 3 liang, Shao Yao 2 liang, Gan Cao 2 liang, Da Zao 12 pieces (Ge Gen 15–30 g today)
Shang Han Lun: for Taiyang disease with stiffness of the nape and back and no sweating with aversion to wind, Gegen Tang governs it. Ge Gen specifically relaxes the posterior neck sinews and generates fluid to nourish cold-dehydrated sinews — the one herb with a unique affinity for the neck; Ma Huang and Gui Zhi open the exterior and scatter cold, ginger-jujube-licorice harmonize the center. It combines with Ashi-point needling and FSN for acute stiff neck, faster together than any single method.
Qiang Huo, Du Huo, Gao Ben, Fang Feng, Chuan Xiong, Man Jing Zi, Zhi Gan Cao; add Ge Gen for neck stiffness
For Wind-Cold-Damp predominant heavy pain of head, nape, shoulder, and back — dispelling wind and overcoming damp to free Taiyang channel Qi; the textbook general formula for nape-and-back wind-damp.
Formula analysis: Gegen Tang treats Taiyang Wind-Cold with nuchal stiffness, acting by opening the exterior and relaxing sinew; Qianghuo Shengshi Tang excels at diffuse wind-damp with generalized heavy pain. Pure acute Wind-Cold takes the former; Wind-Cold with diffuse damp takes the latter, or use Gegen Tang as base with the damp-dispelling herbs added.
Modifications:
Severe spasm, near-impossible turning — add Bai Shao, Mu Gua, Ji Xue Teng to relax and ease sinew
With Blood stasis (trauma plus cold) — add Chuan Xiong, Jiang Huang to move Qi and quicken Blood
Constitutionally deficient and cold — add Dang Gui, Huang Qi to warm, nourish, and support
Key point: Distal before local is the operating rule of this pattern; strong local needling of a fully contracted SCM may worsen the spasm before it improves.
Traumatic Blood Stasis Neck Pain
Principle: Quicken Blood and transform stasis, free the collaterals to stop pain; break the stasis knot first, nourish the sinew to prevent recurrence second
Target muscle / point: Deep splenius and semispinalis trigger points and fixed pain points at the injured segment; stasis-type nodules tend to harden into points
Technique: Prone and relaxed, advance slowly one finger-breadth lateral to the spinous process into the taut band, eliciting the twitch; old nodules may be needled through in several directions. Within 48 hours of marked swelling, treat distal SI3 (Houxi) first and keep local work light.
Safety: Exclude fracture before treating; needling toward the lamina is the safe direction, no deep probing toward the foramen.
Entry: Insert subcutaneously 6–8 cm from the pain zone, needle tip toward it
Sweep & reperfusion: Sweeping with reperfusion: the patient slowly rotates and extends the neck, reassessing each two-minute set. FSN restores fascial circulation and works well on post-traumatic muscle stiffness.
Primary points: BL17 (Geshu), SP10 (Xuehai), local Ashi points with pricking-cupping, SI3 (Houxi)
Point rationale: BL17 (Geshu), meeting of Blood, with SP10 (Xuehai) moves stasis in the Blood aspect; local pricking-cupping removes stasis from the collaterals directly; SI3 (Houxi) opens the Du Mai distally to restore neck movement.
External therapy & care: Pricking-cupping no more than once a week; within the first 48 hours avoid strong manipulation and heat, warm compresses afterward assist movement.
Classical formula: Guizhi Fuling Wan (★Classical Original★) with Blood-quickening herbs
Gui Zhi, Fu Ling, Mu Dan Pi, Tao Ren, Shao Yao in equal parts; add Chuan Xiong, Jiang Huang, Ji Xue Teng to guide into the neck and free the collaterals
The ancestral Jin Gui formula for gradually dissolving concretions: formed stasis cannot be removed overnight, so it is worn away with a pill — warming and dispersing stasis at once, matching post-traumatic stasis knots; neck-guiding herbs lead the stasis out.
Textbook reference: Shen Tong Zhu Yu Tang
Qin Jiao, Chuan Xiong, Tao Ren, Hong Hua, Gan Cao, Qiang Huo, Mo Yao, Dang Gui, Wu Ling Zhi, Xiang Fu, Niu Xi, Di Long
Wang Qingren's formula for generalized Blood-stasis painful obstruction: quickening Blood, moving Qi, and freeing collaterals together, especially for stasis-dominant trauma.
Formula analysis: Shen Tong Zhu Yu Tang moves and scatters, treating stasis suspended between Qi and Blood; Guizhi Fuling Wan slowly dissolves formed knots. Stabbing pain that still shifts takes the former; a hard fixed point takes the latter in slow persistence.
Modifications:
Heavy stasis, severe night pain — add Yan Hu Suo, Ru Xiang
With Wind-Cold — add Ge Gen, Gui Zhi
Old stasis unresolved — add a small dose of Tu Bie Chong
Key point: Exclude fracture before treating stasis; the delayed consolidation of stasis pain must be foretold, not mistaken for relapse.
Phlegm-Stasis Obstruction Neck Pain (Chronic)
Principle: Transform phlegm and dispel stasis, release the sinew and free the collaterals, with postural correction
Technique: Locate active trigger points by pincer or flat palpation, needle obliquely into the band to elicit the twitch; after releasing the upper trapezius trigger point, test neck rotation immediately, usually gaining 20–40°. Postural correction matters as much as this layer.
Safety: At GB21 (Jianjing), do not needle perpendicularly beyond 0.5 cun (pneumothorax risk); angle obliquely toward the spine.
Entry: Insert subcutaneously at the deltoid-trapezius junction or upper thoracic level, needle tip toward neck and occiput
Sweep & reperfusion: Sweeping with reperfusion: for the lateral upper trapezius, the patient actively depresses the ipsilateral shoulder against the upward-spasming trapezius while sweeping — shoulder depression plus fascial sweeping gives dramatic release; at the upper-thoracic end the patient slowly rotates and extends the neck.
Adjunct points: SI3 (Houxi), ST40 (Fenglong) to transform phlegm, local Ashi points
Point rationale: GB20 (Fengchi) is the master point for head-neck wind disorders, needled toward the opposite inner canthus; GB21 (Jianjing) is the classic upper-trapezius point where the Gallbladder channel gathers; ST40 (Fenglong) transforms phlegm to clear the sticky pathogen in the channel; together they release neck-shoulder and open Taiyang and Du Mai.
External therapy & care: Chin-tuck exercises to correct forward head; move the neck and shoulders hourly during prolonged sitting — the source of chronic overload lies in posture.
Classical formula: Gegen Tang combined with Guizhi Fuling Wan (★Classical Combination★)
Gegen Tang opens Taiyang and relaxes the neck sinew, combined with Guizhi Fuling Wan (Tao/Dan/Shao/Ling) to slowly dissolve phlegm-stasis; for long illness add Dang Gui, Ji Xue Teng
For cervical-type spondylosis with Phlegm-stasis obstruction: Ge Gen relaxes the posterior neck sinew and opens Taiyang channel Qi, while Guizhi Fuling Wan slowly dissolves the formed phlegm-stasis in the channel — one opening, one dissolving, matching chronic obstruction.
Qiang Huo, Du Huo, Gui Zhi, Qin Jiao, Hai Feng Teng, Chuan Xiong, Dang Gui, Zhi Gan Cao; add Ge Gen, Wei Ling Xian, Jiang Huang (to guide upward to the neck and shoulder)
The base formula for chronic neck Bi: Ge Gen guides to the neck, Wei Ling Xian dispels wind-damp, Jiang Huang moves Qi and quickens Blood up to the neck and shoulder — the textbook general formula for cervico-scapular Bi pain.
Formula analysis: Juanbi Tang dispels wind-damp and frees the collaterals, excelling at diffuse Bi pain; Gegen Tang with Guizhi Fuling Wan leans toward relaxing the neck sinew and dissolving phlegm-stasis. Diffuse wind-damp of neck and shoulder takes Juanbi Tang; localized formed phlegm-stasis takes the combination.
Modifications:
Heavy phlegm-damp, thick greasy coat — add Ban Xia, Bai Zhu, Fu Ling
With Liver-Qi stagnation (worse after stress) — add Chai Hu, Bai Shao, Xiang Fu
With Liver-Kidney deficiency (older, low back soreness) — combine the nourishing arm of Duhuo Jisheng Tang
Key point: The responsible muscle of chronic neck pain fixes the sweeping target; without correcting forward-head posture, release is only temporary.
Principle: Supplement Liver and Kidney, strengthen sinew and bone to secure the root, transform long-accumulated phlegm-stasis, treating root and branch together
Target muscle / point: Trigger points are often atypical in this pattern; if diffuse taut bands exist, treat splenius and upper trapezius with light stimulation only
Technique: Gentle technique, few targets — a deficient body cannot afford wide expenditure; prefer warm needling over bare deactivation.
Safety: Deficient patients faint easily: treat lying down, keep needle count low; in the elderly with cervical degeneration, test the vertebral artery before any manipulation.
Entry: If FSN is used, sweep lightly subcutaneous to the neck-shoulder tension zone
Sweep & reperfusion: Gentle slow sweeping, reperfusion short of fatigue. FSN is adjunct; supplementing Liver and Kidney is principal.
Point rationale: BL23 (Shenshu) with KI3 (Taixi) supplements the Kidney root; BL11 (Dazhu, bone meeting) and GB39 (Xuanzhong, marrow meeting) strengthen bone and marrow to provision the degenerated vertebrae; GB20 (Fengchi) and GV14 (Dazhui) open the neck branch. Supplementing technique, moxa for cold.
External therapy & care: Insulated moxa at Mingmen and Shenshu to slowly supplement Kidney Qi; avoid cold, moderate exertion; a winter paste may consolidate slowly.
Classical formula: Ba Wei Shen Qi Wan (★Classical Original★) as base
Gan Di Huang 8 liang, Shan Yao 4 liang, Shan Zhu Yu 4 liang, Ze Xie 3 liang, Fu Ling 3 liang, Mu Dan Pi 3 liang, Gui Zhi 1 liang, Fu Zi 1 piece (blast-fried); add Ge Gen to guide to the neck
The Jin Gui ancestral Kidney-supplementing formula, seeking Yang within Yin and kindling a small fire to steam Kidney Qi, matching the Kidney depletion and bone withering of cervical degeneration; add Ge Gen to guide to the neck. For marked Yin-deficient heat, remove Gui and Fu for the Liu Wei method.
Du Huo, Sang Ji Sheng, Du Zhong, Niu Xi, Xi Xin, Qin Jiao, Fu Ling, Rou Gui, Fang Feng, Chuan Xiong, Ren Shen, Gan Cao, Dang Gui, Shao Yao, Gan Di Huang; add Ge Gen to guide to the neck
The gold standard for chronic Bi pain with Liver-Kidney deficiency: expelling pathogen and nourishing Liver-Kidney-Qi-Blood together, with Du Zhong, Sang Ji Sheng, Niu Xi nourishing Liver and Kidney to restore bone and sinew; add Ge Gen to guide to the neck.
Formula analysis: Shen Qi Wan purely supplements the Kidney root, seeking Yang within Yin; Duhuo Jisheng Tang supports the upright and expels the pathogen together, addressing long-accumulated wind-damp phlegm-stasis. Pure deficiency with little pathogen takes the former; deficiency with Bi takes the latter.
Modifications:
Marked hand numbness, obstructed collaterals — add small doses of Quan Xie, Wu Gong, insect medicinals to penetrate the deep channel blockage
Yin-deficient heat, five-center heat — remove Gui and Fu, add Zhi Mu, Huang Bai
Blood deficiency and malnourishment, pale face and thin pulse — increase Dang Gui, Bai Shao, add Ji Xue Teng
Key point: In this pattern supplementation is the unblocking: few needles, more moxa, slow-acting formulas held for months; if myelopathic signs appear, refer.
Principle: Release the suboccipital and upper-trapezius trigger points and open the neck channel Qi, treating the neck to cure the head
Target muscle / point: Upper trapezius (refers to the temple) and suboccipital four muscles (refer behind the eye) trigger points; this is the main battlefield
Technique: Pincer-palpate the upper trapezius for the active point, needle obliquely to elicit the twitch that reproduces and then resolves the ｢headache｣; palpate the suboccipital muscles below the occipital ridge with the patient supine and head slightly flexed, needle shallowly, no deep probing toward the foramen magnum.
Safety: The deep suboccipital region is near the foramen magnum and vertebral artery: needle shallowly with clear bony contact, no deep upward-inward probing.
Entry: Insert subcutaneously at the upper thoracic level, needle tip toward the cranial neck and occiput
Sweep & reperfusion: Sweeping with reperfusion: the patient slowly rotates and extends the neck; referred headache usually eases at once after releasing the upper trapezius and suboccipital muscles.
Adjunct points: SI3 (Houxi) distal, GB21 (Jianjing), LV3 (Taichong) to course the Liver, local Ashi points
Point rationale: GB20 (Fengchi) sits at the lateral border of the suboccipital muscles, essential for head-neck wind disorders and cervicogenic headache; BL10 (Tianzhu) reaches the occiput via Taiyang; SI3 (Houxi) opens the Du Mai distally; for stress-type add LV3 (Taichong) to course the Liver and lower trapezius tension.
External therapy & care: Chin-tuck and deep neck flexor training; limiting screen time is the root of maintaining the result.
Classical formula: Gegen Tang (★Classical Original★) modified
Gegen Tang as base, add Chuan Xiong, Bai Zhi to ascend to the head; for Liver constraint add Chai Hu, Bai Shao
Ge Gen relaxes the posterior neck sinew and opens Taiyang channel Qi; once the neck sinew loosens the referred headache eases; Chuan Xiong and Bai Zhi carry the formula up to the head, matching the ｢treat the neck to cure the head｣ mechanism of cervicogenic headache.
Textbook reference: Juanbi Tang with Chai Hu and Chuan Xiong
Juanbi Tang base plus Ge Gen, Chai Hu, Chuan Xiong
For cervicogenic headache with Phlegm-stasis obstruction and Liver-Qi stagnation, freeing the collaterals while coursing the Liver and moving Qi upward.
Formula analysis: Internal-origin headache (Liver-Yang rising, Phlegm-turbidity clouding, Qi-Blood deficiency, etc.) has its own treatment — refer to the Internal Medicine headache chapter; the formulas here address only the cervical branch, set by the neck's phlegm/cold stasis or Liver constraint.
Modifications:
Mainly occipital, Taiyang predominant — increase Ge Gen, add Qiang Huo
Deep retro-orbital pain, suboccipital predominant — add Bai Zhi, Man Jing Zi
Key point: Pressing the responsible muscle to precisely reproduce the ｢headache｣ is the diagnostic moment; no aura, no nausea, shifting with neck posture is the divide from migraine.
Radicular Neck Pain (Dermatomal Radiation)
Principle: Release the entrapment and free the channel Qi; treat the branch in crisis, the root in remission
Target muscle / point: Deep splenius and semispinalis at the involved segment, plus levator scapulae and upper trapezius (whose referral overlays the radicular radiation; releasing them often markedly shrinks it)
Technique: Release the overlaid neck-shoulder myofascial component first, then treat the deep layer of the involved segment; each session assess whether the radiation retreats centripetally (centralization is favorable).
Safety: Needling toward the lamina is the safe direction; an electric shooting sensation into the arm means withdraw and redirect, do not repeatedly stimulate the nerve root.
Entry: Insert subcutaneously proximal on the radiation line, tip toward the cervical segment; add a needle on the posterolateral arm when arm symptoms dominate
Sweep & reperfusion: Sweeping with reperfusion: the patient slowly moves the neck and affected arm, comparing radiation extent and range in real time.
Primary points: EX-B2 (Jiaji) at the involved segment, GB20 (Fengchi), GV14 (Dazhui), SI3 (Houxi)
Point rationale: EX-B2 (Jiaji) takes the entrapped segment directly, deep insertion with Qi propagating down the arm ideal; GB20 (Fengchi) and GV14 (Dazhui) open the neck channel Qi; distal points deploy along the involved channel to free the arm Qi.
External therapy & care: In the acute phase avoid prolonged flexion and loading; in recovery, deep neck flexor and scapular stabilization training run in parallel.
Classical formula: Gegen Tang with the Guizhi-plus-Gegen intent (★Classical Original★)
Gegen Tang as base, heavy Ge Gen to relax the neck; for stasis add Tao Ren, Hong Hua; for deficiency combine Duhuo Jisheng Tang
Ge Gen relaxes the posterior neck sinew and opens Taiyang channel Qi to ease the nape-and-arm stiff pain, matching the ｢nuchal Bi extending to the arm｣ mechanism; combine by whichever of cold, stasis, or deficiency predominates.
Textbook reference: Juanbi Tang with insect medicinals
Juanbi Tang base plus Ge Gen, Quan Xie, Wu Gong
For cervical radiculopathy, insect medicinals penetrate the channel blockage around the compressed nerve root, reaching where plant medicinals cannot, to ease the neuropathic pain.
Formula analysis: Here formula choice follows the accompanying cold/stasis/deficiency, while the location diagnosis (entrapment) directs the needling layers — the division of labor between the two axes shows most clearly in this pattern.
Modifications:
Marked numbness — add Huang Qi, Ji Xue Teng (Qi too weak to move brings numbness)
Severe night pain — add Yan Hu Suo, Di Long
Chronic with muscle wasting — add Du Zhong, Xu Duan, Yin Yang Huo, insect medicinals to penetrate
Key point: Record radiation extent and Spurling change each visit — centralization is the iron proof of recovery; progressive weakness means immediate referral, never a lone battle.
Principle: No pattern identification, no needling; recognize, refer, follow up
Target muscle / point: Not applicable
Technique: Once a warning sign stands, suspend all needling, complete referral documentation, and grade the urgency.
Safety: Bilateral hand numbness/weakness + hyperreflexia/clonus + bowel/bladder dysfunction = myelopathy, emergency assessment, delay measured in hours; dizziness on rotation-extension = vertebral artery, no high-velocity cervical manipulation.
Entry: Not applicable
Sweep & reperfusion: Not applicable.
Primary points: Not applicable
Adjunct points: Not applicable
Point rationale: Before warning signs are cleared, any needling may blur the window on disease progression.
External therapy & care: Graded disposition: myelopathic signs — emergency; fever with neck stiffness — blood count, inflammatory markers, imaging, beware meningitis; positive vertebral artery — no manipulation, imaging; deformity after trauma or cancer history — imaging.
Classical formula: Not applicable
None
With the diagnosis unsettled, a prescription is itself a risk.
Textbook reference: Not applicable
None
As above.
Formula analysis: This page exists so that the user walks this step before writing any treatment plan at all.
Key point: Once warning signs are cleared and the diagnosis set, the patient returns to the standard pathway; referral is not losing a patient but earning trust.
The shoulder is the root of the arm and the pivot where the three hand-Yang channels converge. Hand-Yangming runs the front of the shoulder and lateral upper arm (LI15 Jianyu at its focus), Hand-Shaoyang wraps the posterior shoulder (TE14 Jianliao), Hand-Taiyang runs the posterior scapula and axilla (SI9 Jianzhen, SI10 Naoshu). The three Yang channels rise from the arm over the shoulder to the head — the shoulder is their relay gate; block it, and the arm cannot lift, the Qi cannot rise.
Structurally, the glenohumeral joint has the greatest mobility yet relies most on soft tissue for stability: the superficial deltoid abducts, the deep rotator cuff four (supraspinatus, infraspinatus, teres minor, subscapularis) bind the head like a sleeve, dynamically stabilizing the humeral head. The supraspinatus passes under the acromion in mid-abduction and is most prone to impingement; the infraspinatus and teres minor externally rotate, and their trigger points refer to the front of the shoulder — the reason for ｢front shoulder pain, source in the back｣; the subscapularis hides in front of the scapula and is the main contracted muscle in frozen shoulder.
Pain location indicates the involved channel and tendon: lateral shoulder pain with a painful arc of 60–120° is Hand-Yangming and supraspinatus; front shoulder pain with painful resisted elbow flexion is mostly biceps long head or infraspinatus referral; posterior shoulder pain with limited external rotation is Hand-Taiyang and infraspinatus/teres minor; precise point pain at the shoulder top is the acromioclavicular joint. Fixing the channel by pain location and the muscle by the limited direction is the measuring rod of shoulder-pain localization.
In its ordinary course, excess shoulder pain is mostly Wind-Cold-Damp obstructing the channel-tendon, or Phlegm-stasis filling the joint capsule (frozen shoulder); deficient shoulder pain is mostly Liver-Kidney depletion in the elderly with tendon degeneration causing rotator cuff tears, and the torn tendon further carries Blood stasis — so shoulder pain often mixes deficiency and excess, pain and weakness together. An empty-can weakness signals a true tear, distinct from the ｢painful but strong｣ of simple impingement or frozen shoulder.
Clinical pursuit of shoulder pain locates first, characterizes second, and must screen warning signs and true tears before all: step one asks onset and night pain; step two examines range and special tests to fix impingement / tear / frozen / instability; step three palpates to lock the responsible muscle (especially the posterior infraspinatus); and finally cold-heat and deficiency-excess settle the nature of the Qi disturbance. The navigator below is laid out along this road.
The pain is in the shoulder — the source may not be in the front. Trace it in order of probability:
Wind-Cold-Damp Bi Shoulder Pain (Rotator Cuff Impingement)
Principle: Dispel Wind, scatter Cold, remove Damp, quicken Blood and free the collaterals, widening the subacromial space
Target muscle / point: The supraspinatus tendon region, and the infraspinatus trigger point (which pulls the humeral head upward and worsens impingement, and must be released alongside)
Technique: Needle the supraspinatus region obliquely along the tendon to elicit a local response; the infraspinatus trigger point must be released — prone, arm at side, find the taut band horizontally below the scapular spine, needle to elicit a posterior twitch, then test abduction, usually gaining 20–40° with reduced pain.
Safety: Do not needle too deep under the acromion (labrum); avoid the subclavian vessel direction in the supraspinatus region.
Entry: Insert subcutaneously below LI15 on the lateral upper arm, needle tip toward the shoulder
Sweep & reperfusion: Sweeping with reperfusion: the patient slowly abducts to the edge of the painful arc and back, actively abducting while sweeping; impingement responds well to FSN.
Adjunct points: LI11 (Quchi), SI10 (Naoshu), local Ashi points; moxa for cold-damp
Point rationale: LI15 (Jianyu) is the master point for the lateral shoulder, Hand-Yangming at the supraspinatus level; three-direction needling (anterolateral, lateral, posterolateral) makes it the central impingement point; TE14 (Jianliao) treats the posterior infraspinatus region; GB34 (Yanglingquan, sinew meeting) governs tendon disorders, needled while the patient slowly raises the arm.
External therapy & care: Local gentle moxa for cold-damp of the subacromial region; avoid cold-damp and repeated overhead motion.
Classical formula: Guizhi-plus-Gegen intent with Yi Yi Ren (★Classical Original★ modified)
Gui Zhi, Shao Yao, Sheng Jiang, Da Zao, Gan Cao, Ge Gen, add Yi Yi Ren, Qiang Huo, Jiang Huang to guide to the shoulder
Gui Zhi Tang harmonizes ying and wei, Ge Gen opens the channel and releases the flesh, with Yi Yi Ren removing damp and Jiang Huang guiding the formula up to the shoulder and neck, matching Wind-Cold-Damp obstruction of the shoulder channel; for heavy damp combine the Ma-Xing-Yi-Gan intent.
Qiang Huo, Du Huo, Gui Zhi, Qin Jiao, Hai Feng Teng, Chuan Xiong, Dang Gui, Zhi Gan Cao; add Jiang Huang, Wei Ling Xian to guide to the shoulder
The base formula for shoulder-arm Bi pain: Jiang Huang guides to the shoulder, Wei Ling Xian dispels wind-damp and frees the collaterals — the textbook general formula for shoulder Bi.
Formula analysis: The Guizhi-Gegen modification leans toward harmonizing ying-wei and removing damp, suiting exterior-deficient Wind-Cold-Damp; Juanbi Tang leans toward dispelling wind-damp and freeing collaterals, suiting diffuse Bi pain. Exterior deficiency with sweating takes the former; heavy wind-damp takes the latter.
Modifications:
Heavy damp, thick greasy coat — add Cang Zhu, Fang Ji
Severe pain with stasis — add Ru Xiang, Mo Yao, Jiang Huang
Severe cold — add blast-fried Fu Zi (decocted first)
Key point: The infraspinatus is the hidden driver of impingement — release it first, then widen the subacromial space; painful arc plus empty-can strength is the divide from a tear.
Infraspinatus Referred Shoulder Pain (Front Pain · Source in the Back)
Principle: Trace the source to the back and extinguish the trigger-point knot — treat the back to cure the front
Target muscle / point: Infraspinatus belly (below the scapular spine, medial to SI9 Jianzhen–SI10 Naoshu), teres minor trigger points; this layer is the absolute mainstay
Technique: Prone, arm at side, find the taut band horizontally (perpendicular to the fibers) below the scapular spine, needle 1.5–2.5 cm to elicit a posterior twitch and reproduce the patient's front pain — referral replication is the moment where diagnosis and treatment become one act. Test abduction immediately after, usually gaining 20–40° with reduced pain.
Safety: Aim the needle toward the scapular surface, bone contact as the safe layer; do not needle too medially toward the lung apex on the posterior shoulder.
Entry: Insert subcutaneously at the posterolateral shoulder, needle tip toward the infraspinatus lesion
Sweep & reperfusion: Sweeping with reperfusion: the patient performs pendulum swings or slow external rotation, re-testing the front pain immediately after sweeping.
Primary points: TE14 (Jianliao), SI9 (Jianzhen), SI10 (Naoshu), local Ashi points
Adjunct points: SI11 (Tianzong, in the infraspinatus fossa), GB34 (Yanglingquan), LI15 (Jianyu)
Point rationale: In this pattern the points are the muscles: SI11 (Tianzong) sits in the infraspinatus fossa, the key point for the infraspinatus; SI9 (Jianzhen) and SI10 (Naoshu) cover Hand-Taiyang on the posterior shoulder — channel point and target muscle become one, so needling the point releases the knot.
External therapy & care: Self-maintenance with a tennis ball on the posterior infraspinatus tender points; correct rounded-shoulder forward posture to reduce infraspinatus eccentric overload.
Classical formula: Choose by accompanying pattern; no dedicated principal formula
With cold-damp: Guizhi-plus-Gegen modification; with stasis: Guizhi Fuling Wan; deficient constitution: Ba Wei Shen Qi Wan
This pattern is a victory of location diagnosis — find the true source and needle where the illness sits; herbs need only mind the constitutional undertone.
Textbook reference: Sinew-relaxing Blood-quickening formulas by presentation
Shu Jin Huo Xue Tang or a light Shen Tong Zhu Yu Tang
To consolidate the needling result, not the main weapon.
Formula analysis: The formula analysis of this pattern lies in needles, not herbs: the sequence of hunting and extinguishing the posterior three muscles' trigger points is its sovereign-minister-assistant-courier.
Modifications:
Sedentary rounded shoulders — weight the prescription toward scapular stability and thoracic extension training
Recurrent — screen rounded-shoulder forward posture and thoracic alignment
Key point: Treating the back to cure the front is the most vivid demonstration of source-tracing; always palpate the posterior infraspinatus when assessing front shoulder pain.
Principle: Transform phlegm and dispel stasis, release the joint capsule, treating by stage
Target muscle / point: Subscapularis (the main contracted muscle of frozen shoulder), infraspinatus, deltoid trigger points
Technique: In the freezing phase, mainly release the pain points with draining technique; in the frozen phase, releasing the subscapularis trigger point is key — find the subscapularis taut band at the anterior axilla, needle to elicit the twitch, paired with passive external rotation and elevation. Adjust the dose by phase.
Safety: Axillary needling must avoid the axillary artery and brachial plexus, with clear bony and muscular contact.
Entry: Insert subcutaneously below LI15 on the lateral upper arm, needle tip toward the shoulder
Sweep & reperfusion: Sweeping with reperfusion: the patient performs pendulum exercises (arm hanging and swinging), gravity-assisted capsular stretch plus fascial sweeping giving rapid range improvement in frozen shoulder.
Adjunct points: In the freezing phase add BL17 (Geshu), SP10 (Xuehai) to quicken Blood, ST40 (Fenglong) to transform phlegm; contralateral balancing points
Point rationale: The three shoulder points encircle the glenohumeral joint and open the Qi of the three Yang channels wrapping the shoulder; in the freezing phase pair the Blood and phlegm points to drain phlegm-stasis, GB34 (Yanglingquan, sinew meeting) frees the joint, needled while the patient slowly raises the arm.
External therapy & care: Daily active range work — wall climbing, pendulum, hand-behind-back — is the key to thawing; warm compresses assist movement.
Classical formula: Guizhi Fuling Wan (★Classical Original★) with the Danggui Sini intent
Gui Zhi, Fu Ling, Mu Dan Pi, Tao Ren, Shao Yao, combined with Dang Gui, Xi Xin, Tong Cao to warm and unblock the vessels; add Jiang Huang, Song Jie to guide to the shoulder and free the joint
Guizhi Fuling Wan slowly dissolves the formed phlegm-stasis of the capsule, combined with Danggui Sini to warm and unblock the shoulder-arm vessels, Song Jie softening the contracted joint channels — both dispersing stasis (the freezing mechanism) and nourishing sinew (against post-thaw weakness).
Textbook reference: Juanbi Tang with stasis-dispersing sinew-nourishing herbs
Juanbi Tang base plus Dang Gui, Chuan Xiong, Hong Hua, Wei Ling Xian, Xu Duan, Wu Jia Pi, Song Jie
Designed for shoulder-arm sinew stiffness with Blood stasis: Dang Gui, Chuan Xiong, Hong Hua quicken Blood; Wei Ling Xian, Fang Feng dispel wind; Xu Duan, Wu Jia Pi strengthen sinew (Liver-Kidney support); Song Jie softens and opens the contracted joint channels.
Formula analysis: The Guizhi Fuling combination leans toward warming, unblocking, and dispersing stasis, suiting vessel-obstruction pain; the Juanbi modification leans toward dispersing stasis and nourishing sinew together, suiting frozen stiffness with deficiency. Severe night pain takes the former; persistent stiffness with deficiency takes the latter.
Modifications:
Severe night pain — add Yan Hu Suo, Ru Xiang, Mo Yao
Diabetic frozen shoulder — combine Xiaoke management (see the Internal Medicine Xiaoke chapter)
Key point: Treat frozen shoulder by phase: freezing phase drains phlegm-stasis, frozen phase actively releases the subscapularis plus passive mobilization; foretell that the course runs in months.
Principle: Supplement Liver and Kidney and strengthen sinew and tendon to nourish the root, quicken Blood and free the collaterals to transform the tear's stasis at the branch
Technique: Lightly release the overlaid trigger points, prefer warm needling; avoid strong direct stimulation of the torn tendon, emphasizing surrounding myofascia and constitutional supplementation.
Safety: In confirmed larger tears, avoid strong local stimulation; deficient patients treated lying down with few needles to prevent fainting.
Entry: If FSN is used, sweep lightly subcutaneous to the diffuse shoulder tension zone, tip toward the shoulder
Sweep & reperfusion: Gentle slow sweeping with mild reperfusion; FSN is adjunct, nourishing Liver and Kidney is principal.
Point rationale: LI15 (Jianyu) and SI9 (Jianzhen) open the shoulder branch; BL23 (Shenshu) with KI3 (Taixi) supplements the Liver-Kidney root; GB39 (Xuanzhong) and BL11 (Dazhu) boost marrow and strengthen bone and tendon; SP10 (Xuehai) transforms the tear's stasis.
External therapy & care: Progressive isometric rotator cuff training (avoid impact); moderate overhead motion and avoid loads that worsen the tear.
Classical formula: Ba Wei Shen Qi Wan (★Classical Original★) with Blood-quickening
Gan Di Huang 8 liang, Shan Yao 4 liang, Shan Zhu Yu 4 liang, Ze Xie 3 liang, Fu Ling 3 liang, Mu Dan Pi 3 liang, Gui Zhi 1 liang, Fu Zi 1 piece (blast-fried); combine Tao Ren, Hong Hua, Jiang Huang
Shen Qi Wan supplements the Kidney root, seeking Yang within Yin to restore the tendon's generative source, combined with Tao-Hong-Jiang Huang to transform the tear's stasis and guide to the shoulder, matching Liver-Kidney deficiency with stasis. For Yin-deficient heat, remove Gui and Fu for the Liu Wei method.
Du Huo, Sang Ji Sheng, Du Zhong, Niu Xi, Qin Jiao, Fang Feng, Xi Xin, Rou Gui, Chuan Xiong, Dang Gui, Shao Yao, Gan Di Huang, Ren Shen, Fu Ling, Gan Cao; add Jiang Huang to guide to the shoulder
The gold standard for chronic Bi pain with Liver-Kidney deficiency: supporting the upright and expelling the pathogen together, with Du Zhong, Sang Ji Sheng, Niu Xi nourishing Liver-Kidney to restore sinew and bone; add Jiang Huang to guide to the shoulder.
Formula analysis: Shen Qi Wan purely supplements the Kidney root with stasis-transformation, suiting deficiency-dominant with stasis; Duhuo Jisheng Tang supports upright and expels pathogen together, suiting deficiency with Bi. Pure deficiency with stasis takes the former; deficiency with wind-damp Bi takes the latter.
Modifications:
Marked tear stasis, night pain — add Ru Xiang, Mo Yao, Ji Xue Teng
Yin-deficient heat — remove Gui and Fu, add Zhi Mu, Huang Bai
Key point: Empty-can weak = true tear; a partial tear can be treated conservatively with nourishment plus needling, but a full-thickness tear with marked weakness requires surgical referral — do not delay the window.
Acromioclavicular Joint Origin Shoulder Pain
Principle: Release the peri-AC soft tissue and free the local channel Qi
Technique: Precisely localize the pain point at the shoulder top, encircle-needle the Ashi points and release the surrounding taut bands; horizontal-adduction-provoked pain is the localizing basis.
Safety: The AC joint is superficial, shallow needling suffices; acute red-hot swelling must exclude infection before treating.
Entry: Insert subcutaneously below and lateral to the shoulder top, needle tip toward the AC joint
Sweep & reperfusion: Sweeping with reperfusion: the patient slowly horizontally adducts back and forth, sweeping to release the surrounding fascia.
Primary points: LI15 (Jianyu), LI16 (Jugu, adjacent to the AC joint), GB21 (Jianjing), local Ashi points
Point rationale: LI16 (Jugu) sits right beside the AC joint, the local key point; GB21 (Jianjing) releases upper-trapezius traction; together they free the shoulder-top channel Qi and release the surrounding soft tissue.
External therapy & care: Avoid carrying loads and cross-body motions on the affected side; relative rest in the acute phase.
Classical formula: Choose by accompanying pattern
With stasis: Guizhi Fuling Wan; with wind-damp: Guizhi-plus-Gegen modification
The AC joint is mainly treated by local release; herbs follow the accompanying pattern to mind the constitution.
Textbook reference: Shu Jin Huo Xue Tang
Qiang Huo, Fang Feng, Jing Jie, Du Huo, Dang Gui, Xu Duan, Qing Pi, Niu Xi, Wu Jia Pi, Du Zhong, Hong Hua, Zhi Ke
Relaxes sinew, quickens Blood, frees the collaterals, consolidating the local treatment, not the main weapon.
Formula analysis: This pattern is led by local release and Ashi points, with herbs as adjunct; when acute inflammation is marked, immobilization and local care come first.
Modifications:
Acute swelling and pain — immobilize and treat locally first, cautious with strong stimulation
Chronic strain — strengthen scapular stability training
Key point: Pain at the shoulder top rather than the lateral shoulder, plus positive horizontal adduction, is the localizing key; exclude infection first with acute red-hot swelling.
Principle: Mostly no pattern identification, no needling; recognize — exclude/refer — follow up
Target muscle / point: Not applicable
Technique: Once a warning sign stands, suspend needling-related handling and complete exclusion or referral.
Safety: Left shoulder pain with chest tightness and cold sweat = suspect cardiac, screen the heart at once, do not needle; full-thickness tear with marked weakness = seize the surgical window.
Entry: Not applicable
Sweep & reperfusion: Not applicable.
Primary points: Not applicable
Adjunct points: Not applicable
Point rationale: Before warning signs are cleared, needling may delay recognition of the critical condition.
External therapy & care: Graded disposition: suspect cardiac — immediate emergency screening; full-thickness tear with marked weakness — orthopedic surgical assessment; progressive rest/night pain with weight loss — tumor-direction screening; red-hot-swollen with fever — infection, blood count and inflammatory markers; provoked by neck movement — check the cervical spine (see the neck-pain nerve-root branch).
Classical formula: Not applicable
None
With the diagnosis unsettled, a prescription is itself a risk.
Textbook reference: Not applicable
None
As above.
Formula analysis: This page exists so that the user excludes these situations outside first-line acupuncture before writing any shoulder treatment plan.
Key point: Left shoulder pain with chest tightness and cold sweat — think heart first; full-thickness tear with marked weakness — do not delay; once warning signs are cleared, return to the standard pathway.