Chapter 2.2: Neck & Shoulder – Auto accident, work-related injury, and  cervical disc herniation

 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.


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Chapter 2: Wang’s neck and shoulder protocol (part 1)

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.

Chapter 1: Calm the mind and settle the body

“Pain is a submodality of somatic sensation. The word “pain” is used to describe a wide range of unpleasant sensory and emotional experiences associated with actual or potential tissue damage. ”      

from     http://neuroscience.uth.tmc.edu/s2/chapter06.html

       It is an ironic situation that we lead ourselves into. We created a living structure to provide us comfortable, rich, convenient life. Yet in order to maintain such life, we have to find a good paying job, cope with less than desirable working environment, stressed about the tasks that need be accomplished, deadline to meet, daily chores that can’t be neglected. Everything we depends on , the house,  the cars, the vacation, the stereo, TV , health insurance, student loans, that is “needed for this comfort in life” get us over extended, stressed, unable to relax. Such environment, if not handled properly, can’t be good for our health. It leads to all kind of disorder in our health.

Invariably, stress itself complicates the nature of sickness. The complication comes from mind and body interaction- stressed in the mind and tension in the body. Then. people would spend long hours on the internet searching from the e-universe for the answer. All they got is confusion about his or her physical problems. Or maybe they got so alarmed and discouraged for the projected outcome for their conditions. All of these adds more weight on their already problematic mind and body.

It is easy for our mind to be distorted in a stressful condition. When a person is lost in desert or ocean, as the physical bodies were stressed  to extreme, they start to see things that are not real. One such example is shown in a NPR documentary on body and mind. It is quite fascinating. Fighter jets pilots under high G force saw themselves flying the jet plan along with them. ( For this topic, do refer to Professor Ramachandran’s work  or  http://psychology.ucsd.edu/people/profiles/vramachandran.html).

To the extent possible, mental issues must be addressed at the very beginning of any therapy visit. It is vital to the healing process.  In addition to address the emotional stress with concilling, there are several acupuncture points that are very helpful for the stress of mind and body. Among the most common points are He Gu, LI 4, one on each hand and Tai Chung, Lv 3, one on each foot.  

Many acupuncturists would needle all these four points simultaneously. I prefer to just use two, one each across from each other.  In acupuncture, it is not just which point to use, it is also important to know how to handle the needles. 

He Gu is such an amazing point; it addresses almost all of the physical disorder that has certain link to mental issues-concern, angry, worry or stress. 

A new variation that gets popular recently is the combination of two points around He Gu. This combo is being promoted by late Master Tung’s disciples. They are Ling Gu” magical bone” and Da Bai or  “great white”. The function is much the same as He Gu but the intensity of treatment is greater. This can be very beneficial but can be overpowering at times. Many well known acupuncturists in U.S. were his students.

Point He Gu is so valuable that it deserves close attention. Most people associated it with relieving headache. It is true. But it does lots more. A lady in her late 40’s has strange problem that her eyes become blurry as soon as she steps into a closed room. One needle on the He Gu and the problem was resolved.

A patient called me from the hospital because her daughter was about to undergo colonoscopy but could not get the medicine down to cleanse the intestine. She kept throwing up. I went to the hospital and gave her acupuncture using just this one point, He Gu. In a few minutes, the vomit stopped and she had no problem of medication. It is very powerful in many patients with acute upset stomach as well. Problem goes away in a few seconds after needle insertion. That is how fast acupuncture can work.

One caution, this point should never be used for women in early pregnancy. In TCM, He Gu acts to regulate the Qi. By regulation, it implies that it will subdue the overactive Qi when needed . It will boost Qi at the area of body that has a lack of Qi. It rectify the Qi in places where Qi is not doing it is right thing. For example, when the patient is throwing up, the Qi that allows the Food item to descend is not functioning. By using the He Gu, the descending function resumes and the problem gets resolved. In early pregnancy, presumably the body still regard the fetus as some foreign invader and will facilitate it departing.

One pregnant woman was overdue for two weeks became concerned because no sign of labor. I use He Gu plus Sp 6, San Yin Jiao on her and let her go home. She got labor that evening and had a healthy delivery afterward. Such practice were recorded over thousands of years ago.

Alternatively, to reduce the stress, some patent Chinese herbal formula can be used; they can be taken on daily basis for a while. One such formula is called Xiao Yao Wan. Sometimes it is referred as relax pill. This formula has nothing in common as the muscle relaxer in Western medicine, which is actually a moderate neurotoxin. It does not contain anything to sedate the brain either. But it works wonderfully well for lots of stressful people.

The other situation where mind issue must be addressed is with patients who went through horrifying events such as unfolding of an auto accident. The horror can scar the mind and need be resolved along with the bodily injury. This can be achieved by needling PC 6, Nei Guan, meaning “inner gate”. Other mind calming points can also be used as well. The link between the body and the mind is so intimate that often it is not easy to know which one is the culprit. It is interesting to note that using Nei Guan for vomiting is widely known, including numerous gynecologists. Together with ginger soup, stimulating plus fresh ginger roots are becoming standard choice for nausea and vomiting problem during early pregnancy . Important to note that the He Gu, good as it is for stomach upset, should never be used at this stage of pregnancy. If this point is to be used, I recommend it be done with moxibustion not needling.

In our society, substance addiction together with stress is very common concern. In the eighties, a group of acupuncturists developed a protocol for treating addiction issues through inserting of needles on the ears. It is now called NADA protocol. This protocol utilizes a set of five acupoints on the ear lobes. Such protocol is also very helpful in providing relaxation for people under stress. Acupuncture volunteer often travel to areas of nature disasters and help victims and other volunteers with such treatments. It has good track record of success

He Gu, LI 4

Yao Tong Xue( extra point) consists two points. I use just one

Lv 3,  Tai Chung, a powerful Qi regulating point

Nei Guan, PC 6

 Note: Nei Guan is located at the forearm under the thumb in the above figure. Figure comes from Source:      http://www.pyroenergen.com/articles07/motion-sickness.htm