3. JIANYU (LI-15), JIANEILING (EXTRA), JIANLIAO (T-14)

 

Main effect and clinical purpose

 

The combination above is a points-cluster of the shoulder. It is frequently used to disperse stagnation in the shoulder joint, and to facilitate the flow of Qi there.

 

The cluster is usually effective in Cold stagnation of the shoulder, or Damp Bi (cases of frozen shoulder, perifocal inflammation of the shoulder joint etc.). It may also be of value for traumatic pain from sport, or accident.

 

Points discussion

 

Jianyu - in Chinese - "shoulder bone", is the main point for all shoulder diseases. Its indications are:

1. to eliminate Wind

2. to removeobstruction from the Jingluo, and promote circulation of Qi and blood.

3. to soothe the Joints, relieve pain and scatter Bi.

 

Jianyu is either punctured deeply, with the arm abducted, towards Jiquan (H-1), for inflammation of the Joint bones, or along the deltoid muscle, for Damp or cold Bi, affecting the muscles and tendons.

 

It is often cauterized with moxa, by all the variations: direct (scarring) moxibustion, warm needle technique, and moxa on ginger. These techniques are applied for Cold, or Damp Cold induced problems. For the "frozen shoulder" syndrome, Cold penetrating to the bone level, one may use the "Fire needle" technique. By this technique a long needle is heated by fire, and immediately introduced to the deep level of Jianyu, and then withdrawn. This technique was already mentioned in the "Ling Shu”, and the Ming dynasty physician, Wu Hegao, recommended it for Cold-Bi of the shoulder.

 

In any case, utilization of moxa, or heat at this point, accelerates the flow of Qi, disperses the Cold and Damp stagnations, and returns the joint and muscles to normal functioning. However, it is imperative to stress that any shoulder inflammation exhibiting Heat condition, (i.e. febrile Bi) should not be treated with moxa, which will undoubtedly aggravate the condition.

 

Jianneiling is an extra point situated exactly between Jianyu and the top of the anterior axillary crease. Its indications are the same as Jianyu.

 

Jianliao - "Shoulder Seam" in Chinese, also has exactly the same indications as Jianyu.

Needling these three points together affects the shoulder from three different angles, and causes an acceleration of the Qi that passesthrough this joint. The various methods of stimulation, when properly applied, deal with the cause and nature of the stagnation accordingly.

 

Needling sequence, manipulation and stimulation

 

The needling sequence in this combination is usually related to the site of the pain. If the pain is in the anterior part of the shoulder, Jianneiling is usually needled first, and then the other two. If the whole shoulder is painful, Jianyu is needled first, as the strongest point of the trio.

 

Besides moxa stimulation, of which we have already spoken, "cupping" treatment over these points is also beneficial.

 

Cupping is generally applied on spots where we need to enhance circulation of Qi and Blood, and is widely used in China and in T.C.M. clinics.

 

Also electrical stimulation of these points is often applied, as shoulder problems usually involve pain. Electrical stimulation is usually applied with a dense-disperse wave, for periods of 10-20 minutes. Cupping is usually applied after needling the points, or over the needles, also for 15-20 minutes.

 

When "warm needle" technique is utilized, generally only one needle of the trio is cauterized with moxa. It is usually the needlethat is situated in the most painful site of the shoulder. This is a small variation of a technique called Qiciwhich was already mentioned in the Nei Jing (45).

 

Another technique, which is often used to disperse stagnation of Qi and Blood, and to resolve pain quickly, is called "Huici", and has also been mentioned in the Nei Jing.

By this method a 1.5 inch needle is Inserted and manipulated until "Deqi" is obtained. The needle is then raised and redirected to the left or right, and manipulated again for 3 minutes, after which the needle is raised and redirected toward another direction, and manipulated once again. It is then raised to a superficial level, and left intact.

 

Case history

 

 

Mrs. D.B., a teacher by profession, was born in 1951. On April 18, 1990 she consulted me, complaining of severe pain in her right shoulder, which hindered her sleep, and disabled her right hand of almost any movement.

 

X-ray examination at "Rambam" Hospital in Haifa revealed excessive calcium deposits in the shoulder joint, hence she had been advised to undergo calcium-pumping, as well as steroid Injections.

 

Mrs. D. was reluctant for such "adventures". as she expressed it, and since she had had a previous successful experience in my clinic, for another problem, she made an appointment.

 

Examination of Chinese medicine brought me to a diagnosis of a Cold-Bi condition in the shoulder, and kidney hypofunctioning (Kidney Yang Xu).

 

The main signs were:

1. Fear of cold in general, and especially a need for warmth around both shoulders.

2. Pallid face and lips.

3. Pale, wet tongue, with a thin white fur.

4. Thin, soft and deep pulse, weak on third position.

 

The only sign which did not match the diagnosis entirely, was the pulse, which should have been more tight. Nevertheless, I interpreted the thin pulse as a sign of a Blood-Xu, to some extent due to her Kidney Yang Xu condition, which prevented her proper creation of blood. The relative weakness and depth of the pulse wasdue to her kidney weakness.

 

The prescription for treatment was:

Right side: Tiaokou (ST-38), Jianyu (LI-15), Jianliao (T-14), Jianneiling.

Both: TaIxi (K-3), Shenshu (B-23).

 

Tiaokou is an excellentempirical point for acute shoulder pain. It was inserted toward Chengshan (B-57), and manipulated for 5 minutes (46).

 

On Jianyu I burnt four moxa balls, on top of the needle, in each session.

 

The three cluster points of the shoulder were manipulated by the dispersal "Huici” pattern (see above). This was done prior to the application of moxa, and in order to disperse the stagnant Cold which lodged in the area.

 

Taixi and Shenshu were chosen to stimulate and reinforce Kidney Yang. In order to ensure a full impact on Kidney Yang, three moxa balls were installed over the left Shenshu needle.

 

Since all the Yang go to the left, and all the Yin go to the right, Shenshu left is also considered to belong to Yang, and was given extra stimulation there.

 

Mrs. D. experienced significant relief following the first session, and could sleep the whole night through. After the second and third treatments her condition improved even more, and on the fourth, the treatment was performed without moxa.

 

After the fourth treatment her condition worsened, probably due to a cold change in the weather.

 

Five more treatments were required to establish a full recovery, all of them with moxa.