1. Myofascial Meridian Stimulation Therapy Case Study (The MMST( 經筋動穴針法 ) on shoulder pain) Dr.Seonghyung Cho,M.D. The following case study is a fairly typical type of response seen with the MMST

2. Myofascial Meridian Stimulation Therapy Korean Integrative Medicine Institute The MMST on shoulder pain A 57 years old housewife female presented with left shoulder pain referred to left elbow and chronic knee pain Pain on left shoulder appeared spontaneously Pain on left shoulder was aggravated by shoulder elevation and lying on that side at night The problem started 5 months ago She has had various treatments including medication, physiotherapy, traditional acupuncture and steroid injection which was not effective.

3. Myofascial Meridian Stimulation Therapy Korean Integrative Medicine Institute Physical Examination Limitation of Passive lateral rotation > abduction > medial rotation : Capsular pattern Initial range of active left shoulder abduction: 35 degree

4. Myofascial Meridian Stimulation Therapy Korean Integrative Medicine Institute Initial range of abduction on left shoulder before the MMST: 35degree Abnomal on scapulohumeral rhythm

5. Myofascial Meridian Stimulation Therapy Korean Integrative Medicine Institute 1. Improvement of autonomic nervous dysfunction Sympathetic switch points: - bilateral LI4, LI11, LV3, ST36 -GV14, GV26 -duration of treatment: 20-30 min -acupuncture or subcutaneous taped acupuncture

6. Myofascial Meridian Stimulation Therapy Korean Integrative Medicine Institute 2. Maintenance of myofascial meridian balance

7. Myofascial Meridian Stimulation Therapy Korean Integrative Medicine Institute The MMT Evaluation Cervical : 1.superficial back line:( + / - ) -neck flexion: UB, SI, GV 2.superficial front line:( +/ - ) -neck extension: LI, ST, CV 3.lateral line: Rt( + / - ), Lt( + / - ) -neck side-bending: GB, TE Thoracolumbar : 1.superficial back line:( + / - ) -trunk flexion: UB, GV 2.superficial front line:( +/ - ) -trunk extension: CV 3.lateral line: Rt( + / - ), Lt( + / - ) -trunk side-bending: GB 4.spiral line:Rt( + / - ), Lt( + / - ) -trunk rotation: both GB, UB Upper extremity 1.deep front arm line: Rt( + / - ), Lt( + / - ) -shoulder extension: LI, LU 2.superficial front arm line: Rt( + / - ), Lt( + / - ) -wrist extension: PC 3.deep back arm line: Rt( + / - ), Lt( + / - ) -shoulder elevation: HT, SI 4.superficial back arm line: Rt( + / - ), Lt( + / - ) -wrist flexion: TE Lower extremity 1.superficial back line: Rt( + / - ), Lt( + / - ) -leg elevation: UB 2.superficial front line: Rt( + / - ), Lt( + / - ) -leg extension: ST 3.lateral line: Rt( + / - ), Lt( + / - ) -fabere test: GB, LR,KI, SP Axis Extremities Examine limitation(tightness) or pain on passive movement

8. Myofascial Meridian Stimulation Therapy Korean Integrative Medicine Institute The result of the MMT Cervical 1.superficial back line:( + ) -neck flexion: UB, SI, GV 3.lateral line: Rt( + ), Lt( + ) -neck side-bending: GB, TE Thoracolumbar 1.superficial back line:( + ) -trunk flexion: UB, GV 2.superficial front line:( +) -trunk extension: CV 3.lateral line: Lt( + ) -trunk side-bending: GB 4.spiral line:Rt( + ), Lt( + ) -trunk rotation: both GB,UB Upper extremity 1.deep front arm line: Rt( + ), Lt( + ) -shoulder extension: LI, LU 3.deep back arm line: Lt( + ) -shoulder elevation: HT, SI 4.superficial back arm line: Rt( + ),Lt( + ) -wrist flexion: TE Lower exremity 1.superficial back line: Rt( + ) -leg elevation: UB, 2.superficial front line: Rt( + ), Lt( + ) -leg extension: ST 3.lateral line: Rt( + ), Lt( + ) -fabere test: GB, LR, KI, SP Axis Extremities

9. Myofascial Meridian Stimulation Therapy Korean Integrative Medicine Institute LI 11 LI 4 LU10 TE 5 deep front arm line: Rt( + ) -shoulder extension: LI, LU superficial back arm line: Rt( + ) -wrist flexion: TE

10. Myofascial Meridian Stimulation Therapy Korean Integrative Medicine Institute SI 3 TE 5 LI 11 deep front arm line: Lt( + ) -shoulder extension: LI, LU deep back arm line: Lt( + ) -shoulder elevation: HT, SI superficial back arm line: Lt( + ) -wrist flexion: TE LI 4 LU 5

11. Myofascial Meridian Stimulation Therapy Korean Integrative Medicine Institute GB 21 LI 15 LU 2 deep front arm line: Lt( + ) -shoulder extension: LI, LU superficial back arm line: Lt( + ) -wrist flexion: TE lateral line: Lt( + ) -trunk side-bending: GB TE 14

12. Myofascial Meridian Stimulation Therapy Korean Integrative Medicine Institute CV 12 CV 4 superficial front line:( +) -trunk extension: CV

13. Myofascial Meridian Stimulation Therapy Korean Integrative Medicine Institute SP 9 ST 36 SP 6 KI 3 LR 3 superficial back line: Rt( + ) -leg elevation: UB superficial front line: Rt( + ) -leg extension: ST lateral line: Rt( + ) -fabere test: GB, LR, KI, SP UB 60 GB34

14. Myofascial Meridian Stimulation Therapy Korean Integrative Medicine Institute ST 32 ST 36 superficial front line: Lt( + ) -leg extension: ST

15. Myofascial Meridian Stimulation Therapy Korean Integrative Medicine Institute GB 26 GV 3 GB26 GV 14 superficial back line:( + ) -trunk flexion: UB, GV lateral line: Lt( + ) -trunk side-bending: GB spiral line:Rt( + ), Lt( + ) -trunk rotation: both GB,UB GV 6

16. Myofascial Meridian Stimulation Therapy Korean Integrative Medicine Institute 3. Restoration of segmental dysfunction Somatovisceral Points(SVP): Stimulate T5/6 interconnected to lateral column of lateral horn comprised in cell bodies of preganglionic fibers toward extremities(C5/6) by magnetic therapy Somatosomatic Points(SSP): combined area points of C5/6 dermatome, myotome and sclerotome: LU2, LI15, TE14 (deep dry needling)

17. Myofascial Meridian Stimulation Therapy Korean Integrative Medicine Institute T5 T6 Magnetic therapy on UB line (paraspinal dermatome area) onT5-6 Somato-Visceral Point C5/6 vasodilation (decrease sympathetic tone ) Secondary segmental relation In the selection of points for treating abnormal somatovisceral reflex on common C5 segment area, we used magnetic therapy on UB meridian line of trunk related to anatomy of autonomic nervous system and secondary segmental relation (C5/6-T5/6) instead of using acupuncture needle. SomatoVisceral Points (SVP) consisted of UB meridian points on surrounding T5-6 dermatome area. In using acupuncture needle on T5-6 segment of UB meridian line, the blood vessel tone was increased on C5-6segment area. But in using magnetic therapy, we found the blood vessel tone was not increased in our clinical observation.

18. Myofascial Meridian Stimulation Therapy Korean Integrative Medicine Institute LU2 LI15 TE14 Somato-Somatic Point Deep dry needling Stimulate meridian points (combined area of dermatome,myotome and sclerotome on C5/6) by deep dry needling Stimulate skin, muscle and periosteum in order Combined area of dermatome,myotome and sclerotome on C5/6 In the selection of points for treating abnormal somatosomaic reflex on left shoulder pain, we applied SSP to common C5 segment area (dermatome,myotome and sclerotome). These points consisted of LU2, LI15 and TE14. Also, we stimulated these points by deep dry needling

19. Myofascial Meridian Stimulation Therapy Korean Integrative Medicine Institute She received the MMST three times a week for 2 weeks After 2 weeks, post treatment range of abduction on left shoulder is 85 degree and there was nearly no pain on left shoulder. And right knee pain is also decreased significantly.

20. Myofascial Meridian Stimulation Therapy Korean Integrative Medicine Institute left shoulder elevation increased to almost normal range without pain.

21. Myofascial Meridian Stimulation Therapy Korean Integrative Medicine Institute “We have to know about effects of neuro-physiology on acupuncture as well as effects of biomechanics on acupuncture.” Dr.Cho

22. Myofascial Meridian Stimulation Therapy Korean Integrative Medicine Institute Thank you ! E-mail: medicmart@freechal.commedicmart@freechal.com medicx@hanmail.net