1. Acupuncture Treatment of Diseases Traumatology 3: Periarthritis of shoulder 漏肩风

2. Definition: 1.Manifest as prolong fixed pain in the shoulder area with restricted movements of the shoulder joint. 2.Often seen in age around 50, thus also called “Shoulders of fifties”. 3.The affected area often has aversion to cold. 4.In the later stage when the adhesion of the tissues of the shoulder joint occurs, the shoulder is plagued with obvious movement restrictions, which is called “frozen shoulder”.

3. Causes and Pathogenesis : Mainly caused by: 1.Weak body constitution, chronic strain and invasion of external wind and cold that disturb the flow of qi in the channels leading to the obstruction of the flow of qi and blood of the shoulder. 2.Over strain injuries of the muscle and tendon resulting in qi and blood stagnation. 3.Aging process has a qi and blood deficiency that fails to nourish the muscles and tendon and bones. 4.The above 2 nd and 3 rd point can affect the flow of qi and blood in the channels of the shoulder leading to pain.

4. Clinical Manifestations: Chief symptoms: i.Pain, soreness and heavy sensation around the shoulder joint that worsens during the night. ii.Often induced or aggravated by the change of weather and overworking. iii.Tender points are distributed over the anterior, posterior and lateral aspect of the shoulder area. iv.Both active and passive movements of the shoulder joint such as abduction, backward extension and rotation and raising the arm are obviously restricted. v.In the later stage, muscular atrophy will occur.

5. Clinical Manifestations: 1.Invasion of cold type Stated manifestations with: i.Pain is worsen by catching wind and cold and is alleviated by warmth. ii.Aversion to wind and cold.

6. Clinical Manifestations: 2.Qi and Blood stagnation type Stated manifestations with: i.Pain is aggravated by pressure. ii.Dark red tongue with purple spots. iii.Pulse is rough. iv.History of trauma or overworking.

7. Clinical Manifestations: 3.Qi and Blood deficiency type Stated manifestations with: i.Aches in the shoulder aggravated by over working. ii.Vertigo and dizziness. iii.Fatigue of the 4 limbs. iv.Pale tongue. v.Thin white coating. vi.Thin, weak pulse.

8. Treatment : General principle Dredge qi and blood in the channel of the shoulder area, activating blood and dispelling wind to relieve pain. Principle Channels: 1.Large Intestine channel. 2.Small Intestine channel. 3.Triple Energizer channel. 4.Ashi points.

9. Principle acupoints : 1.LI 15 Jianyu 肩髃 2.TE 14 Jianliao 肩髎 3.SI 9 Jianzhen 肩贞 4.Ashi acupoint 阿是穴.

10. Prescription explanation (Principle acupoint): 1.LI 15 Jianyu 肩髃， TE 14 Jianliao 肩髎， SI 9 Jianzhen 肩贞 are points of the hand Yangming, Taiyang and Shaoyang channel respectively. Together with the Ashi acupoints, all are local approached points which have the effect of dredging the flow of qi and blood in the channels of the shoulder area as well as activating blood and dispelling wind to stop pain.

11. Principle of treatment 1. Invasion of cold type Dredge qi and blood in the channel of the shoulder area, activating blood and dispelling wind to relieve pain. Disperse cold Principle acupoints: as stated Supplementary acupoints: LI 4 Hegu 合谷. GB 20 Fengchi 风驰.

12. Principle of treatment 2. Qi and Blood stagnation type Dredge qi and blood in the channel of the shoulder area, activating blood and dispelling wind to relieve pain. Principle acupoints: as stated Supplementary acupoints: SP 10 Xuehai 血海. BL 17 Geshu 膈腧..

13. Principle of treatment 3. Qi and Blood deficiency type Dredge qi and blood in the channel of the shoulder area, activating blood and dispelling wind to relieve pain. Tonify qi and blood Principle acupoints: as stated Supplementary acupoints: ST 36 Zusanli 足三里. CV 6 Qihai 气海.

14. TCM medical advises: 1.Avoid cold and raw food. 2.Avoid invasion by pathogenic wind, cold and damp. 3.Combine with physiotherapy