NECK PAIN, STIFFNESS AND TENSION

GENERAL

Clinical Manifestations	Neck pain and stiffness Obstruction of the Qi's downward movement from the head to the trunk: Obstruction at UB-10: Severe pain in the shoulders and neck Stiff neck Spasms Torticollis Obstruction at GB-21: Spasms of the trapezius muscle Obstruction at ST-11: Sore throat Difficulty tolerating anything tight around the neck Obstruction of the Qi's upward movement from the trunk to the head: Obstruction at SI-14: Stiff neck Torticollis A Cold sensation at the nape Obstruction at SJ-15: Pain in the hand Pain in the Taiyang channels at the nape, back and shoulders Numbness or coolness around the ear Diffuse Yang Deficiency at the nape of the neck: Cervical weakness requiring a cervical collar Pain under strain or exhaustion Pain is better with pressure and warmth Torticollis: Wry neck, or torticollis, is a painfully twisted and tilted neck. The top of the head generally tilts to one side while the chin tilts to the other side. This condition can be congenital (present at birth) or acquired. Spasmodic torticollis: A constant contracture of the neck muscles causing a rotation or inclination of the head
Treatment Principle
Herb Formulas
Points	DU-16, REN-24 For pain at the nape of the neck: 1. DU-16, GB-20, LU-7, SI-3, UB-11, UB-66 2. SI-3, UB-62 For general or lateral pain: GB-41, SJ-5 To free-up rotation: 1. SI-3 2. SI-3, SJ-16 For a stiff neck: GB-20, GB-39, Luozhen, SI-3, UB-60 For diffuse Yang Deficiency at the nape of the neck: moxa or moxa needle DU-14 Torticollis: 1. GB-39, Luozhen, SI-3 2. HT-3, SI-1, SI-2, SI-3, SI-4, SI-5, UB-2, UB-60 3. GB-21, SI-3, SJ-10, SJ-16, UB-10, UB-11, UB-42, UB-64 4. DU-16, REN-24, SI-3 Spasmodic torticollis: SI-10

TAI YANG ZHONG FENG

Clinical Manifestations	Neck pain and stiffness Inhibited side to side turning Aversion to Wind Mild, or severe chills Fever which may be persistent Uneasiness from fever Spontaneous perspiration Headache Nausea Nasal irritation Nasal obstruction Tendency to snore Itchy throat T: Normal C: Thin and white P: Superficial and slow or Moderate and maybe weak
Treatment Principle	Create sweat to relieve the Exterior and expel Wind Harmonize Ying and Wei to protect digestion and nourish Wei Qi
Herb Formulas	Gui Zhi Jia Ge Gen Tang Gua Lou Gui Zhi Tang modified Gui Zhi Jia Hou Po Xing Ren Tang Gui Zhi Tang With muscle pain: Gui Zhi Qu Shao Yao Jia Fu Zi Tang
Points	Bitong, DU-16, GB-20, GB-21, KI-7, LI-4, LI-20, LU-7, SJ-5, UB-12, UB-13, Yintang SI-3, UB-62

TAI YANG SHANG HAN

Clinical Manifestations	Neck and shoulder pain and stiffness Inhibited side to side turning Severe chills Mild or no fever Headache Generalized discomfort Stiff neck and shoulders Body aches Joint ache Nausea Vomiting Hiccups Anhidrosis Gasping Stabbing joint pain Itchy throat Cough Asthma Aversion to Wind and Cold Maybe low back pain Maybe frozen shoulder Maybe dyspnea Maybe epistaxis (severe) T: Normal C: Thin and white P: Floating and tight
Treatment Principle	Relieve the Exterior Expel Cold Disperse the Lungs Stop asthma
Herb Formulas	Ge Gen Tang modified Ma Huang Tang modified Hua Gai San Jia Wei Ge Gen Tang Du Huo San Jin Fei Cao San With Internal Cold: Wu Ji San With Fluid Accumulation in the Middle Jiao: Gui Zhi Qu Gui Fu Ling Bai Zhu Tang With Phlegm: Jin Fei Cao San #2
Points	DU-16, GB-20, GB-21, LI-4, LU-7, SI-3, SJ-5, Taiyang, UB-12, UB-13, UB-62 DU-16, GB-20, GB-21, SI-3, UB-42 With a severe headache: + DU-14, LI-20. Taiyang GB-20, LU-7, moxa or moxa needle LI-4, SJ-5, UB-12 For neck pain with stiffness and difficulty turning the neck: + SI-3 For upper back pain with with a feeling of Cold: + UB-58, UB-62 For neck pain at the side of the neck: + GB-1, SJ-23 For neck pain referring to the back of the shoulder: + SI-4, SI-7, SI-12 For a headache: + DU-16, Taiyang For a cough with with nasal discharge: + LU-1, UB-13 Ahshi, GB-39, Luozhen, SI-3 DU-14, DU-16, GB-20, GB-21, Huatuojiaji from C-1 to C-4, SI-3, SI-14, SJ-12, UB-11, UB-12, UB-64 GB-21, SJ-10, SJ-16, UB-10, UB-11, UB-42, UB-64 DU-16, REN-24, SI-3 SI-3, UB-62 For an immobile, severely painful neck: GB-12, HT-3, SI-1, SI-2, SI-3, SI-5, UB-2, UB-60 Ear: Cervical Vertebrae, Neck

WIND-COLD WITH RETENTION OF PHLEGM-DAMP

Clinical Manifestations	Fever and chills (chills predominant) Anhidrosis A rattling cough Wheezing (asthma) Copious, white, stringy, difficult to expectorate sputum Stifling sensation in the chest Lacrimation General heaviness (especially upper body) General body aches Stiff neck No thirst Floating edema (severe) Considerable difficulty breathing while lying down (severe) Intolerance of Cold Periorbital edema Dyspnea or orthopnea Vomiting of frothy saliva during pregnancy Chest distention Dry heaves Decreased urine Subcardiac edema Stridor Occasional chills on the back Hiccups Retching Dysphagia Diarrhea Dysuria Decreased urination Flushed face Dizziness Headache Inflammation of the tear ducts T: Pink C: Moist or White and greasy P: Superficial and tight
Treatment Principle	Release the Exterior Transform congested Fluids (Thin Mucus) Transform Phlegm Warm the Lungs Descend Qi Relieve wheezing and coughing Stop pain and stiffness
Herb Formulas	Xiao Qing Long Tang
Points	SJ-5, SP-3, ST-40, UB-12, UB-13

TAI YANG - YANG MING

Clinical Manifestations	Chills and fever Anhidrosis Stiff and rigid neck, shoulders and upper back Intolerance of Wind Dislike of Cold Inflammation Vomiting Muscle spasms Mucosal swelling Nasal congestion Sensitivity to dust Headache Wind-Cold Bi (few joints affected, intense but short lived, changes over days or weeks) Inflammation T: Normal C: Thin and white P: Floating and tight
Treatment Principle	Releases Wind-Cold in the Exterior and muscle layer Generates Fluids Relieves muscle-ache of the neck
Herb Formulas	Ge Gen Jia Ban Xia Tang Gen Gen Huang Qin Huang Lian Tang Ge Gen Jia Ban Xia Tang
Points

SHAO YANG JING

Clinical Manifestations	Alternating chills and fever Restlessness Irritability Anorexia Sometimes fatigue Nausea Occasional vomiting Headaches (side of head) Hypochondriac pain Rib pain Achiness Ear infection Hearing difficulty Red eyes Stiff shoulders Throat pain Hip pain T: Normal with bumps or dots on side C: Thin white P: Wiry
Treatment Principle	Harmonize the Liver and Gall Bladder
Herb Formulas	Xiao Chai Hu Tang
Points	GB-41, SJ-5 To harmonize the Liver and Gall Bladder: GB-34, LIV-3, LIV-14, SJ-5 To stop nausea and vomiting: PC-6, SP-4, ST-36 To treat headache: GB-1, GB-8, GB-14, Taiyang To treat constipation: SJ-6, ST-25 To treat fever: DU-13, DU-14 To support the San Jiao and Regulate Yin: PC-5, PC-6 To support Yin: KI-7 To support the Ying: SP-10 Head: GB-8, SJ-20, Yintang Eyes: GB-14, GB-20, ST-1, UB-1, UB-2 Ear: GB-2, SJ-5, SJ-17, SJ-21 Hypochondriac area: GB-34, GB-40 Ear: Shenmen, Gall Bladder, Point 0

WIND-HEAT

Clinical Manifestations	Acute, burning neck pain with stiffness Aggravation of the pain on exposure to warmth Alleviation of the pain on exposure to Cold Aversion to Wind Slight chills Cough with thick, sticky, yellow sputum Sore, red, swollen throat Thirst with a desire to drink cold liquids Runny or blocked nose with thick, yellow discharge Fever with perspiration Headache Maybe dyspnea with flared nostrils Maybe chest pain T: Red tip C: Thin and yellow P: Superficial and rapid
Treatment Principle	Expel Wind Clear Heat Harmonize the collaterals Alleviate pain
Herb Formulas	Chai Ge Jie Ji Tang Huo Yu Tang Chinese Patent Medicine: Huang Lian Shang Qing Wan
Points	DU-14, GB-20, LI-4, LI-11, LU-7, UB-12 For neck pain with stiffness and difficulty turning the neck: + SI-3 For upper back pain with a burning sensation: + UB-58, UB-62, UB-66 For pain at the sides of the neck: + GB-1, GB-21, SJ-23 For neck pain radiating to the back of the shoulder: + SI-4, SI-7, SI-12 For neck pain with a headache: + DU-16, Taiyang For neck pain with a cough and yellow nasal discharge: + LU-5, UB-13 For neck pain with redness, pain and swelling of the throat: + LI-2, LU-10 DU-14, DU-16, GB-20, LI-4 + LU-7 or LI-4 + SJ-5, LU-5, LU-10, LU-11, UB-12, UB-13

WIND-HEAT MIXED WITH PHLEGM

Clinical Manifestations	Neck pain Fever Aversion to Cold Sore throat Thirst White-colored, hard, swollen lymph nodes on both sides of the neck Red, swollen maybe ulcerated nodes in severe cases T: Red C: Yellow P: Wiry and rapid
Treatment Principle	Clear Heat Dispel Wind Transform Phlegm Unblock the channels
Herb Formulas	Niu Bang Jie Ji Tang modified
Points	GB-20, LI-4, SJ-5, SJ-16, ST-40, ST-44 For a fever: + LI-11 For inhibited defecation: + SJ-6 lymph node enlargement: + moxa Bailiao, Zhoujian

XUE STAGE: BLOOD HEAT GENERATES WIND

Clinical Manifestations	High fever Confusion of mind Delirium Mania Dark yellow urine Excessive skin rashes all over body Hemorrhage: Hematemesis Hemoptysis Epistaxis Hemafecia Hematuria Stiffness Convulsions: Clenched jaws Clenched fists Shaking Opisthotonis Stiff neck Semi-consciousness T: Deep red and dry C: Yellow P: Wiry and rapid
Treatment Principle	Subdue Wind Clear Heat Nourish Yin Stop convulsions
Herb Formulas	Ling Jiao Gou Teng Tang
Points	To clear Heat and Toxins: Bleed the Jing Well points, DU-14, LI-11, ST-44 To promote Blood circulation: SP-10, UB-17 To treat hemafecia: SP-1, ST-25, ST-37 To restore consciousness: DU-26, K-1 To nourish Yin: KI-3, SP-6 To calm the Shen: HT-7

WIND-DAMPNESS

Clinical Manifestations	Neck stiffness Inhibited ability to look left and right Heavy, painful head Heavy, painful joints Generalized sensation of heaviness Back pain Generalized pain or muscle ache Difficulty bending or rotating trunk Mild fever Slight aversion to Wind and Cold Foggy-headedness Dizziness Anorexia Anhidrosis Sciatica Chest oppression Chills No perspiration Aversion to Cold Lassitude Scanty urination T: Pink C:White or Greasy and white P: Superficial or Superficial and slow or Superficial and soft or Superficial and tight
Treatment Principle	Dispel Wind Overcome Dampness
Herb Formulas	Qiang Huo Sheng Shi Tang modified Juan Bi Tang #1 Jia Wei Ge Gen Tang For superficial Wind-Dampness with Qi Deficiency: Wang Qiang Huo Sheng Shi Tang
Points	DU-16, GB-38, REN-24 With a persistent stiff neck: + LU-7 With Dampness predominant: + SP-9 or SJ-6 With diarrhea: + ST-25, ST-36

WIND-COLD-DAMP BI

Clinical Manifestations	Neck pain A feeling of heaviness in the neck and body Worse in rainy, windy, cold weather Aversion to Cold Cold rheumatic pain A preference for warmth Pain relieved by massage Headache Stiffness Muscle tightness Better with Heat Maybe worse at night May feel Cold to the touch Stiffness and pain which is temporarily worse after immobility or on awakening Stiffness eases with movement T: Normal C: Greasy and white P: Floating and slippery
Treatment Principle	Expel Wind-Cold-Damp Move Qi Invigorate the Blood Warm the channels Alleviate pain
Herb Formulas	Juan Bi Tang Qiang Huo Sheng Shi Tang modified Di Long Tang Jia Jian Jing Fang Bai Du San Chinese Patent Medicine: Feng Shi Pian
Points	DU-16, GB-20, SI-3, SJ-5, SP-9, UB-11, UB-12, UB-58, UB-62 With wandering pain at the neck: + LU-7 For fixed pain with a heavy feeling: + SJ-6, SP-3 For severe pain with a Cold feeling: + moxa or moxa needle SJ-5, UB-11, UB-12, UB-58, UB-62 For pain at the sides of the neck: + GB-1, GB-21, SJ-23 For neck pain radiating to the back of the shoulder: + SI-4, SI-7, SI-12 With a headache: + GB-8, Yintang LI-11, ST-36 Local Points: Ahshi, DU-14, DU-15, DU-16, GB-12, GB-20, Huatuojiaji, UB-10 Adjacent Points: GB-21, SJ-15 Distal Points: GB--39, SI-3, SJ-5 or SJ-6, UB-60 Use moxa or moxa needle where appropriate

WIND-COLD-DAMP BI: COLD PREDOMINANT

Clinical Manifestations	Early stage: Early morning stiffness, heaviness, numbness and/or restricted movement Joint pain, especially in the wrist, ankle, knee and elbow Excruciating sharp, stabbing joint pain The affected joints may feel Cold Muscle pain There may be numbness and heaviness in the limbs The pain is worse with Cold and better with warmth The pain is aggravated by Wind The pain aggravated by Dampness Pain with fixed location The joints cannot be flexed or extended No local redness or Heat Painful area often feels cold to the touch Pain worse at night and better during the day Pain mostly affects low back and lower extremities Muscle weakness Numbness of the muscles and skin Hemiplegia, especially of the upper limbs Slight muscle edema Heaviness of the joints Aversion to Cold The pain worse at night Local inflammation Deviation of the eyes and mouth Spasm of the limbs Ankylosis (stiffness) of joint Aversion to Cold Maybe chills with a slight fever Anhidrosis Frequent nocturnal urination T:Pink or Pale or Slightly purple or purple spots C: Thick and white or Thin and white (thicker than for Wind-Bi) P: Slippery or Slightly superficial or slightly rough or Slow and Soft or Wiry and tight or Floating and wiry or Superficial and tight
Treatment Principle	Relieve Wind Dredge the channels Relieve Cold Resolve Dampness
Herb Formulas	Wu Tou Tang modified Qu Han Bi Tang Fu Ling Tang Jia Jian Er Hao
Points	DU-14, DU-16, GB-20, SI-3, SJ-5, UB-12 With nasal congestion: + LI-20 With nausea: + PC-6, REN-12 For neck pain along the Bladder Channel: + UB-10, UB-60 For neck pain along the Large Intestine Channel: + LI-10 For neck pain along the Small Intestine Channel: + SI-11, SI-13 For neck pain along the San Jiao Channel: + SJ-15 For neck pain that prevent backward bending of the head: + REN-24 For neck pain that prevent forward bending of the head: + DU-26 For neck pain that involves the upper back and shoulders: + LI-15, SJ-15

WIND-DAMP BI: WIND PREDOMINANT

Clinical Manifestations	Pain and stiffness in the neck which is worse on windy days Rigidity of the neck Aversion to Wind Fever which is not relieved by sweating Feels worse in Dry weather Pain can move up and down or from side to side Headache Heavy headedness Body aches T: Normal C: White P: Floating
Treatment Principle	Expel Wind Move Qi Invigorate the Blood
Herb Formulas	Qiang Huo Sheng Shi Tang Fang Feng Tang modified Qu Feng Tang With numbness: Juan Bi Tang Er Hao
Points	DU-16, GB-20, GB--39, SJ-6 DU-14, DU-16, GB-20, SI-3, SJ-5, UB-12 With nasal congestion: + LI-20 With nausea: + PC-6, REN-12 For neck pain along the Bladder Channel: + UB-10, UB-60 For neck pain along the Large Intestine Channel: + LI-10 For neck pain along the Small Intestine Channel: + SI-11, SI-13 For neck pain along the San Jiao Channel: + SJ-15 For neck pain that prevent backward bending of the head: + REN-24 For neck pain that prevent forward bending of the head: + DU-26 For neck pain that involves the upper back and shoulders: + LI-15, SJ-15 Local Points: Ahshi, DU-14, DU-15, GB-12, Huatuojiaji, UB-10 Adjacent Points: GB-21, SJ-15 Distal Points: SI-3, SJ-5, UB-60 Use moxa or moxa needle where appropriate

WIND-COLD-DAMP BI: DAMP PREDOMINANT

Clinical Manifestations	Neck pain Damp rheumatic pain Stiffness Heaviness Maybe generalized body aches Symptoms worse on Damp, muggy days Better in dry weather Stiffness and pain which is worse after immobility Stiffness eases with movement
Treatment Principle	Expel Wind and Dampness Move Qi Invigorate the Blood
Herb Formulas	Qiang Huo Sheng Shi Tang modified Han Shi Bi Tang
Points	SP-3, SP-6, SP-9 DU-14, DU-16, GB-20, SI-3, SJ-5, UB-12 With nasal congestion: + LI-20 With nausea: + PC-6, REN-12 For neck pain along the Bladder Channel: + UB-10, UB-60 For neck pain along the Large Intestine Channel: + LI-10 For neck pain along the Small Intestine Channel: + SI-11, SI-13 For neck pain along the San Jiao Channel: + SJ-15 For neck pain that prevent backward bending of the head: + REN-24 For neck pain that prevent forward bending of the head: + DU-26 For neck pain that involves the upper back and shoulders: + LI- 15, SJ-15 Local Points: Ahshi, DU-14, DU-15, DU-16, GB-12, GB-20, Huatuojiaji, UB-10 Adjacent Points: GB-21, SJ-15 Distal Points: GB--39, SI-3, SJ-5 or SJ-6, UB-60 Use moxa or moxa needle where appropriate

WIND-COLD-DAMP BI WITH INTERIOR HEAT

Clinical Manifestations	Chills and fever (more chills than fever) Anhidrosis Headache Stiff neck Generalized aches and pains Slight thirst A bitter taste in the mouth T: Normal C: White P: Floating
Treatment Principle	Induce sweating Expel Wind-Cold Dispel Dampness Drain Interior Heat
Herb Formulas	Jiu Wei Qiang Huo Tang
Points

WIND-COLD-DAMPNESS WITH QI DEFICIENCY

Clinical Manifestations	Pain and stiffness of the head and neck High fever accompanied by severe chills and shivering Aversion to Cold Pain worse at night Difficult movement Local inflammation Migratory pain Soreness and pain of the extremities Nasal congestion with sonorous breathing Anhidrosis Focal distention and fullness of the chest and diaphragm A productive cough May have numbness and heaviness in the limbs Body aches Nasal obstruction Cough with sputum Stuffy nose Joint pain Pain worse with Cold and better with warmth Pain aggravated by Wind Pain aggravated by Dampness Pain is stabbing Muscle weakness Pain alleviated by movement Slight muscle edema Heaviness of the joints Cold joints Headache Dizziness T: Pale or Slightly purple or Purple spots C: White or thin, white, greasy P: Slippery or Slightly superficial or Superficial and soft or Slightly rough or Slow and Soft or Wiry and tight or Superficial and rapid that is forceless under pressure
Treatment Principle	Release the Exterior Augment Qi Remove Wind-Cold-Damp Eliminate Painful Obstruction Circulate Qi and Blood Stop pain
Herb Formulas	Ren Shen Bai Du San
Points

WIND- COLD-DAMP-BI WITH LIVER AND KIDNEY DEFICIENCY OR QI AND BLOOD DEFICIENCY

Clinical Manifestations	Neck pain and stiffness Painful joints Heavy and painful sensations at fixed locations in lower back and extremities with weakness and stiffness or hypertonicity and immobility Aversion to Cold Attraction to warmth Palpitations Pain in the midline and back during pregnancy Pain worse at night General coldness Sallow complexion Wandering pain Pale complexion Shortness of breath May be paresthesia and numbness Cold pain in the low back and knees Limited movement Soreness, weakness and numbness of the joints Tinnitus Muscle spasms Dizziness T: Pale C: Thin and white or White and moist P: Thin, weak and slow or Deep, thready and weak or slippery
Treatment Principle	Disperse Wind-Dampness Scatter Cold Stop Bi pain Tonify the Kidneys and Liver Tonify Qi Nourish the Blood
Herb Formulas	Du Huo Ji Sheng Tang
Points

WIND-DAMP-HEAT BI

Clinical Manifestations	Excruciating hot Bi pain and stiffness in the neck Unbearable pain on light pressure Local redness with Heat sensations Symptoms worse in Heat
Treatment Principle	Expel Wind-Damp and Heat Move Qi Invigorate the Blood
Herb Formulas
Points	DU-14, LI-4, LI-11 Local Points: Ahshi, DU-15, DU-16, GB-12, GB-20, Huatuojiaji, UB-10 Adjacent Points: GB-21, SJ-15 Distal Points: GB--39, SI-3, SJ-5 or SJ-6, UB-60 Use moxa or moxa needle where appropriate

WIND-PHLEGM WITH QI AND YIN DEFICIENCY

Clinical Manifestations	Marked emotional changes and behavior Irritability A feeling of Qi rushing upward Red eyes Headache - lasts all day Tinnitus Palpitations Insomnia Hot flushes Anorexia A feeling of distention and oppression below the Heart Abdominal bloating Muscle spasms in the shoulders, neck and back Dizziness Vertigo T: Red edges C: Greasy P: Soft and wiry and maybe rapid
Treatment Principle	Clear Heat from the Liver channel Descend Liver Yang Extinguish Liver Wind Transform Phlegm Strengthen the Spleen Enrich Fluids
Herb Formulas	Gou Teng San
Points

LUNG AND STOMACH FIRE

Clinical Manifestations	Pain occuring at the front of the neck and referring to the sides Fever Throat pain, redness and swelling Difficulty swallowing Coughing Formation of pus in the throat or tonsils Thirst Constipation T: Red C: Yellow and dry P: Rapid and forceful
Treatment Principle	Clear Heat Remove toxins Reduce swelling Relieve pain
Herb Formulas	Liang Ge San modified Chinese Patent Medicine: Wei Te Ling
Points	LI-4, LU-5, LU-6, LU-10, REN-23, ST-42, ST-44, UB-13 With difficulty swallowing: + REN-22 For coughing with copious yellow Phlegm: + REN-17, ST-40 With a fever and headache: + DU-14, LI-11 With constipation: + ST-25 With severe thirst: + LI-2, LU-8

CENTRAL QI SINKING

Clinical Manifestations	Neck pain Prolapse of one or more organs Sallow complexion Anorexia Four limbs feel tired and heavy Abdominal and epigastric distention after eating Maybe acid regurgitation or vomiting Loose stools Shortness of breath Gonorrhea T: Pale and flabby - may have teethmarks C: White P: Even or Soft and thready
Treatment Principle	Strengthen the Spleen Benefit Qi Reinforce the Center Invigorate Yang
Herb Formulas	Bu Zhong Yi Qi Tang
Points

HEART BLOOD STAGNATION

Clinical Manifestations	Neck pain Palpitations Stabbing pain in the anterior region over the Heart Suffocating sensation in the chest Maybe drawing pain down the internal aspect of arm (especially the left arm) Pain (in chest and/or arm) tends to be severe and intermittent Severe cases: Cold limbs Cyanosis of lips and nails T: Dark red with purple spots or Purple body C: Little P: Minute (scarcely perceptible) and thready or Knotted
Treatment Principle	Clear Yang Invigorate the Blood Transform Stagnation
Herb Formulas	Gua Lou Xie Bai Bai Jiu Tang
Points	HT-5, HT-6, HT-7, PC-3, PC-4, PC-5, PC-6, PC-7, REN-14, REN-17, UB-15, UB-17

HEART YANG DEFICIENCY

Clinical Manifestations	Neck pain Palpitations Shortness of breath Excessive perspiration (daytime) Above symptoms worse after exertion or when tired Cold limbs Fatigue Weakness Maybe chills Cyanosis Suffocating sensation in chest Depression Facial pallor T: Pale and swollen C: White P: Thready and weak or Knotted or Intermittent
Treatment Principle	Warm and Clear Heart Yang
Herb Formulas	Gua Lou Xie Bai Bai Jiu Tang
Points	Moxa or moxa needle DU-25, HT-5, HT-7, HT-8, PC-3, PC-4, PC-5, PC-6, PC-7, REN-14, REN-17, SP-6, ST-36, UB-15

LIVER QI STAGNATION

Clinical Manifestations	Spasm, tension and pain at one side or both sides of the neck Neck and shoulder stiffness Pain in the occipital and temporal regions The pain moves up and down The pain is related to the emotional situation Symptoms worse with stress, upset or anger Symptoms better with massage and relaxation Irritability Flushed head or upper body Sometimes worse in the afternoon or evening Red eyes Blurred vision Possible heavy head with fogginess Poor concentration Distention and pain in the sides or flanks Suffocating sensation in the chest Tendency to sigh Melancholy Depression Headache Inappropriate anger A bitter taste in the mouth Insomnia Irregular menses Dysmenorrhea Breast distention and pain before and during menses T: Dark or Purplish C: Thin and white P: Wiry
Treatment Principle	Soothe the Liver Harmonize the Gallbladder Clear Stagnation Stop pain
Herb Formulas	Xiao Yao San Chai Hu Shu Gan Tang With Spleen Dampness: Xiao Chai Hu Tang Chinese Patent Medicines: Xiao Yao Wan Shu Gan Wan
Points	Ahshi, DU-20, GB-20, GB-21, KI-3, KI-6, LI-4, LIV-3, SJ-5, SP-6 GB-20, GB-21, GB-35, GB-36, GB-41, LIV-3, PC-6, SJ-5 For neck pain radiating to the back of the shoulder: + SI-4, SI-7, SI-12 With a headache: +DU-20 With insomnia: + HT-3 With depression: + LIV-14, REN-17 With irritability: + GB-43, LIV-2 With a bitter taste in the mouth, a poor appetite and constipation: + GB-40, SJ-6

LIVER QI STAGNATION INVADES THE SPLEEN

Clinical Manifestations	Neck and upper back stiffness Abdominal distention and pain Gas Borborygmus Diarrhea Distention and pain in the sides or flanks Suffocating sensation in the chest Tendency to sigh Melancholy Depression Irritability Inappropriate anger Women: Irregular menses Dysmenorrhea Breast distention and pain before and during menses T: Pink C: White and greasy P: Slippery and wiry
Treatment Principle	Soothe the Liver Invigorate the Spleen
Herb Formulas	Chai Hu Shu Gan Tang Tong Xie Yao Fang
Points	LIV-3, LIV-13, SP-6, ST-25, ST-36, ST-37

LIVER QI STAGNATION INVADES THE STOMACH

Clinical Manifestations	Neck and shoulder tension Epigastric pain (worse when emotionally upset) Belching with acid regurgitation Nausea Vomiting Anorexia Epigastric distention Distention and pain in the sides or flanks Suffocating sensation in the chest Tendency to sigh Melancholy Depression Irritability Inappropriate anger Irregular menses Dysmenorrhea Breast distention and pain before and during menses T: Pink C: Thin and white P: Wiry
Treatment Principle	Soothe the Liver Harmonize the Stomach
Herb Formulas	Si Ni San
Points	LIV-3, LIV-14, PC-6, REN-12

LIVER FIRE

Clinical Manifestations	Neck pain Stiffness Maybe one-sided Symptoms worse with stress, upset or anger Symptoms better with massage and relaxation Irritability Flushed head or upper body Sometimes worse in the afternoon or evening Red eyes Blurred vision Possible heavy head with fogginess Poor concentration Severe, splitting headaches with dizziness Sudden tinnitus or Sudden deafness Flushed face Red, swollen, painful eyes Irascibility with violent angry outbursts Dry mouth Bitter taste in mouth Thirst Vomiting sour or bitter liquid Insomnia Restlessness Constipation or dry stools Maybe rib pain T: Red tip and edges C: Thick, yellow, dry and rough P: Wiry, Excess and rapid
Treatment Principle	Clear the Liver Purge Fire Stop pain
Herb Formulas	Long Dan Xie Gan tang
Points	Ahshi, DU-20, GB-20, GB-21, KI-3, KI-6, LI-4, LIV-3, SJ-5, SP-6

LIVER WIND STIRRING INTERNALLY: EXTREME HEAT GENERATES WIND

Clinical Manifestations	High fever Contractures Spasms Neck stiffness Convulsions Oculogyric crises Opisthotonos Coma Possibly death T: Red or Deep red P: Wiry and rapid
Treatment Principle	Clear Heat Cool the Liver Subdue Wind
Herb Formulas	Ling (Yang) Jiao Gou Teng Tang Zhi Jing San
Points	Bleed the Jing-Well points of Six Hand Channels, needle DU-14, DU-16, DU-20, DU-26, LI-11, LIV-2, LIV-3

LIVER YIN DEFICIENCY WITH LIVER YANG RISING

Clinical Manifestations	Spasms, pain and rigidity of the neck A burning sensation in the neck Stiffness Maybe one-sided Symptoms worse with stress, upset or anger Symptoms better with massage and relaxation Irritability Flushed head or upper body Sometimes worse in the afternoon or evening Red eyes Blurred vision Possible heavy head with fogginess Poor concentration Dizziness Impaired vision Night blindness Tinnitus Irascibility Throbbing headache with distended feeling Flushed face Red, dry eyes with feeling of grit in eye Dry mouth and throat with bitter taste in mouth Palpitations Headache Nervousness Insomnia with much dreaming Dry throat Thirst Five Sole Heat (palms, soles and center of chest) Night sweats Light or late menses or Amenorrhea T: Red and dry C: Little or None P: Thready and wiry or Wiry and rapid (when Yang is Rising and Excess, pulse is forceful) or Thready and rapid when Yang is not prominent
Treatment Principle	Nourish Yin Pacify the Liver Subdue Yang Stop pain
Herb Formulas	Tian Ma Gou Teng Yin modified With Liver Wind: Yi Gan San Chinese Patent Medicines: Jiang Ya Ping Pian
Points	Ahshi, DU-20, GB-20, GB-21, KI-3, KI-6, LI-4, LIV-3, SJ-5, SP-6 DU-20, GB-20, GB-21, GB-44, LIV-2, LIV-8 With a headache: + DU-21, Taiyang With symptoms of Kidney and Liver Yin Deficiency: + KI-3, KI-7, SP-6 With symptoms of Liver Qi Stagnation: + LIV-4, PC-6 With irritability: + GB-40, HT-3 With insomnia and palpitations: + HT-7, HT-8

KIDNEY YANG DEFICIENCY

Clinical Manifestations	Chronic slight neck pain that is worse on exertion Stiff neck, worse with overwork or fatigue Weakness in the neck Inability to lift the head Lumbago: low back feels cold, weak and aching Weakness in the knees Feeling chilled Aversion to Cold Cold limbs General debility Pale face Urinary frequency with abundant, clear urine or Oliguria with edema Maybe nocturia Lassitude Withdrawn, subdued behavior Knees feel cold and aching Fatigue Dizziness Tinnitus Impotence Spermatorrhea Premature ejaculation Low libido Female infertility ("uterus cold and infertile") Maybe anorexia Maybe loose stools Maybe chronic diarrhea or "cock crow" diarrhea T: Pale and swollen C: Thin and white P: Deep and thready - maybe slow
Treatment Principle	Warm and Reinforce Kidney Yang Benefit the bones
Herb Formulas	You Gui Wan modified Ba Wei Di Huang Wan With Jing Deficiency: You Gui Yin Chinese Patent Medicines: Ge Jie Da Bu Wan
Points	DU-14, GB-39, KI-3, SI-3, SP-6, UB-11, UB-62 With dizziness and a poor memory: + DU-20, GB-20 With low back pain and weak knees: + DU-4, ST-36, UB-23 With general fatigue, cold hands and feet and shortness of breath: + moxa or moxa needle REN-4, REN-6 With symptoms of Kidney Yin Deficiency: + KI-2, KI-6, KI-7 DU-4, GB-39, KI-3, SI-3

KIDNEY AND LIVER YIN DEFICIENCY

Clinical Manifestations	Head, neck, shoulder and upper back aching and pain Maybe distending pain in the head Numbness and lack of strength in the four limbs Low back and knee soreness and weakness Walks haltingly Maybe paralysis Dizziness Blurred vision Tinnitus Deafness Tidal redness Night sweats Hot sensations in the face Dry mouth and throat Bitter taste in the mouth Toothache Insomnia or Dream disturbed sleep Agitated Easily angered With Kidney Yang Deficiency: Frequent, copious urination Dribbling urination Maybe urinary and fecal incontinence T: Red C: Little or none P: Thready and rapid or Thready and wiry or Choppy and wiry
Treatment Principle	Nourish and Reinforce the Liver and Kidneys
Herb Formulas	Jing Zhui Bing Fang With Fire Rising: Zhi Bai Di Huang Wan
Points	KI-3, LIV-3, SP-6, UB-18, UB-23

YIN AND YANG DEFICIENCY

Clinical Manifestations	Head, neck, shoulder and upper back aching and pain Maybe distending pain in the head Numbness and lack of strength in the four limbs Low back and knee soreness and weakness Dizziness Blurred vision Tidal redness Night sweats A dry mouth and throat Cold feet Decreased libido Loose stools T: Red or Pale pink C: Little or none or white P: Thready and rapid or Deep and slow
Treatment Principle	Nourish Yin TonifY Yang Invigorate the Blood Dispel Wind-Dampness Unblock the channels and collaterals Stop pain
Herb Formulas	He Shi Jing Zhui Bing Fang With Blood Deficiency: Shao Yao Gan Cao Tang
Points

QI STAGNATION

Clinical Manifestations	Stiffness and tightness of the neck and upper back Constipation Abdominal discomfort, distention or pain which is relieved by a bowel movement Irritability Depression Moodiness Fullness and tightness in the chest and hypochondrium Poor appetite Frequent belching Frequent sighing Premenstrual syndrome Irregular menstruation Breast tenderness T: Normal or Dark C: White P:Wiry
Treatment Principle	Regulate and move Liver and Large Intestine Qi Eliminate Stagnation Descend Qi
Herb Formulas	Li Mo Tang
Points

QI AND BLOOD STAGNATION

Clinical Manifestations	Stiff neck Restricted movement of the neck Pricking pain in the neck T: Purple, possible purple or red spots C: White P: Choppy or Wiry and choppy
Treatment Principle	Move Qi Invigorate the Blood Unblock the channels
Herb Formulas	Huo Luo Xiao Ling Dan modified Shen Tong Zhu Yu Tang
Points	GB-20, GB-34, SI-3

QI AND BLOOD DEFICIENCY

Clinical Manifestations	Stiffness, cramps or spasms of the muscles of the neck, limbs and back Fatigue Lethargy Weakness Loose stools Poor appetite Dizziness Light-headedness Pale face Weak voice Shortness of breath Reluctance to speak Sweating with little or no exertion Palpitations Insomnia Dry skin Dry hair Poor memory Paleness Scanty periods T: Pale or Pale, thin and dry C: Thin and white P: Weak or Thin and choppy or Thready and wiry
Treatment Principle	Tonify Qi Nourish the Blood
Herb Formulas	Ba Zhen Tang Huang Qi Gui Zhi Wu Wu Tang
Points	KI-3, LIV-3, LU-9, SP-6, ST-36, UB-11, UB-17

BLOOD STAGNATION

Clinical Manifestations	Stabbing, fixed pain at the neck Occurs mostly along the midline of the back Worse at night Stiffness and spasms of the neck, back and occasionally the extremities Difficulty with movement Dislike of pressure Often occurs after cervical surgery Maybe a history of physical trauma Torticollis Maybe convulsions Sever, localized, progressive headache Double vision Loss of vision Dark, sallow, ashen or purple complexion Dark or purple lips and conjunctiva Spider naevi Emaciation T: Purple with brown or purple stasis spots C: Little or None P: Thready and choppy or Wiry
Treatment Principle	Invigorate the Blood Circulate Qi Expel Stagnant Blood Nourish the tendons Stop spasms Unblock the channels Alleviate pain
Herb Formulas	Tong Qiao Huo Xue Tang modified Da Huo Luo Dan Zhu Yu Tang Chinese Patent Medicines: Da Huo Luo Dan Xiao Huo Luo Dan Yan Hu Suo Pian
Points	DU-13, DU-14, GB-20, GB-35, LI-4, SI-3, SJ-5, SP-6, UB-58, UB-62 With severe neck pain, worse at night: + UB-17 With a stiff neck: + GB-34 With neck swelling due to Blood Stagnation: + GB-21, SI-14 With restlessness due to severe neck pain: + HT-3, UB-15 With pain at the side of the neck: + GB-1, SJ-23

PHLEGM OBSTRUCTION

Clinical Manifestations	Spasms, cramps and stiffness in the limbs, neck and back Convulsions Diffuse headache Heaviness Fogginess or fullness in the head Visual disturbances Double vision Loss of sight Dizziness Vertigo Fullness and discomfort in the chest and epigastrium Nausea Vomiting T: Normal C: Greasy and white P: Soft, slippery and/or wiry
Treatment Principle	Expel Wind Disperse Phlegm Move Qi Stop spasms
Herb Formulas	Qu Feng Dao Tan Tang With Phlegm lurking above and below the diaphragm: Kong Shen Dan
Points	DU-8, DU-14, DU-16, DU-20, GB-20, SI-3, SP-3, ST-40, UB-62

PHLEGM-DAMP OBSTRUCTING THE CHANNELS

Clinical Manifestations	Head, neck, shoulder and upper back aching and pain Dizziness Vertigo Heavy-headedness Heaviness of the body Weakness Nausea Chest and ductal fullness and oppression T: Pale C: White and maybe slimy P: Slippery and wiry
Treatment Principle	Transform Phlegm Dispel Dampness Invigorate the Blood Unblock the Channels
Herb Formulas	Fu Ling Wan Jia Jian
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INTERNAL HEAT DAMAGING THE FLUIDS

Clinical Manifestations	Neck stiffness Hypertonicity of the limbs High fever Irritability Anxiety Clenched jaws Abdominal fullness Constipation Scanty, dark urination Severe cases: Opisthotonis Possible clouded Spirit in severe cases Delirious speech T: Red C: Dry and yellow P: Wiry and rapid
Treatment Principle	Clear Internal Heat Nourish Yin
Herb Formulas	Zeng Ye Cheng Qi Tang modified
Points	DU-14, DU-16, LI-4, SP-6, ST-41, ST-44 For convulsions: + GB-34 For a disturbed Shen: + HT-7, PC-3 For a sore throat: + bleed LU-11 For severe thirst with profuse drinking: + LU-5 For a clouded Spirit and delirious speech: + bleed DU-26, Shixuan

TRAUMA (QI AND BLOOD STAGNATION)

Clinical Manifestations	Neck pain A history of trauma (whiplash, sprain, poor posture in sedentary work, repeated sprain) Sudden onset Acute pain Stiffness Limited movement Rigidity Maybe bruising No improvement with rest Worse with movement
Treatment Principle	Regulate Qi Invigorate the Blood Stop pain
Herb Formulas	Huo Xue Zhi Tong Tang Jia Jian
Points	Posterior aspect of the neck, pain may radiate down the shoulder and arm: Ahshi, DU-14, SI-3, UB-10, UB-11, UB-60 Lateral aspect of the neck: Ahshi, GB-12, GB-20, GB-21, GB-39, GB-41, SJ-5, SJ-15, SJ-16 Acute stiff neck on waking: GB-39, Luozhen (needle while patient rotates the neck), SI-3

SPRAIN OR STRAIN

Clinical Manifestations	Neck pain, often with a weight-bearing sensation which radiates to the upper back The pain is worse on movement of the neck The pain is worse on deep breathing, coughing or sneezing in severe cases
Treatment Principle	Soothe the sinews Unblock the channels
Herb Formulas	Huo Xue Zhi Tong Tang Jia Jian
Points	GB-39, SI-3, SI-7, UB-62 With nasal congestion: + LI-20 With nausea: + PC-6, REN-12 For neck pain along the Bladder Channel: + UB-10, UB-60 For neck pain along the Large Intestine Channel: + LI-10 For neck pain along the Small Intestine Channel: + SI-11, SI-13 For neck pain along the San Jiao Channel: + SJ-15 For neck pain that prevent backward bending of the head: + REN-24 For neck pain that prevent forward bending of the head: + DU-26 For neck pain that involves the upper back and shoulders: + LI- 15, SJ-15

CRICK IN THE NECK

Clinical Manifestations	Sudden onset of pain in the neck after sleep Pain on one or both sides of the neck Pain is more severe when the neck moves Pain inhibits neck movement Pain may involve the upper back and shoulders
Treatment Principle	Unblock the channels Alleviate pain
Herb Formulas	Gen Gen Tang modified
Points	DU-16, GB-20, SI-3, SI-14, Luozhen (If Luozhen is used, needle it alone and mobilize or massage the neck while the needle is in place, stimulating the needle every so often.) For aversion to Wind and Cold: + SJ-5 For a fever: + DU-14 With nasal congestion: + LI-20 With nausea: + PC-6, REN-12 For neck pain along the Bladder Channel: + UB-10, UB-60 For neck pain along the Large Intestine Channel: + LI-10 For neck pain along the Small Intestine Channel: + SI-11, SI-13 For neck pain along the San Jiao Channel: + SJ-15 For neck pain that prevent backward bending of the head: + REN-24 For neck pain that prevent forward bending of the head: + DU-26 For neck pain that involves the upper back and shoulders: + LI- 15, SJ-15

WIND-TOXIN FROM AN INCISED WOUND

Clinical Manifestations	Neck stiffness with hypertonicity following an incised would Clenched jaws Aversion to Cold Fever Headache Irritability Agitation Facial grimace like a wry smile Spasms of the limbs Opisthotonis in severe cases P: Wiry and tight
Treatment Principle	Dispel Wind Settle tremors
Herb Formulas	Yu Zhen San modified
Points	DU-26, GB-34, LI-4, LIV-3 For clenched jaws: + ST-6 For hypertonicity in the upper limbs: + LI-10, PC-7 For hypertonicity in the lower limbs: + UB-57 For opisthotonis: + DU-15, DU-16

CHANNEL PATHOLOGY

Clinical Manifestations	Bladder Channel: Severe Cold pain at the nape with a "tearing-apart" sensation Headaches Pain in the spine A "breaking" sensation in the lumbar spine Small Intestine Channel: More lateral pain Restricted movement of the head Pain along the channel in the shoulder and arm Gallbladder Channel: Lateral cervical pain vertigo Headaches Polyarthralgia Flank and intercostal pain Pain along the channel of the leg Difficulty turning around Chills and fever Pain and swelling in the supraclavicular fossa Sinew Channels: 1. Bladder Sinew Channel: Cervical spasms which are difficult to overcome May extend to the supraclavicular fossa and the thoracic spine The cervical column is bent backward Difficult to turn the head left or right Difficult to lift the shoulders 2. Kidney Sinew Channel: Deep cervical pain Difficult flexion and extension of the neck 3. Gallbladder Sinew Channel: Stiffness and contracture of the cervical spine and supraclavicular fossa DU Channel Collateral Excess: Stiffness in the vertebral column, including the cervical spine Extraordinary Channel: 1. DU Channel: Cervical and spinal stiffness With Deficiency: Headaches Vertigo 2. Yin Qiao and Yang Qiao Channels: Contracture of the muscles and tendons Pain with a sudden antalgic posture Sleep disorders Ocular problems Whole body stiffness 3. Yang Wei Channel: Cervical pain is generally sensitive to weather changes Occipitofrontal headaches Feverish sensation 4. Dai Channel: Yang Excess above Yin Excess below with a very heavy lower half of the body with a "riding breeches" look Organs: Kidney: Abdominal distention Difficulty defecating Neck, shoulder and back pain Occasional vertigo or dizziness
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Points	Bladder Channel: UB-67 If relief is not immediate: + UB-63 For unilateral involvement: needle the opposite side Small Intestine Channel: LIV-6, LIV-10, SI-1, SI-3, SI-12 Gallbladder Channel: GB-20, GB-21 Bladder Sinew Channel: Ahshi, UB-67 If External Wind is involved: + SI-18, UB-60 Kidney Sinew Channel: SP-1, SP-5 If Pathogenic Dampness is involved: + REN-2, REN-3, SP-2 Gallbladder Sinew Channel: Ahshi, GB-40, GB-44 If External Wind is involved: + GB-43, SI-18 DU Channel Collateral Excess: DU-1 DU Channel: SI-3 If the entire frame of the body is deficient: + DU-1, UB-11 Yin Qiao Channel: KI-6, KI-8 Yang Qiao Channel: DU-16, GB-20, UB-59, UB-62 Yang Wei Channel: GB-35, SJ-5 + choose one of the following points according to the location of the pain: DU-15, DU-16, GB-18, GB-19, GB-20, GB-21, SI-10, SJ-15 Dai Channel, Yin Excess below with a very heavy lower half of the body with a "riding breeches" look: GB-26, GB-41 Trigger Points: 1. Trapezius Muscle: a. Superior Portion: The areas surrounding GB-21 1) Suboccipital pain radiating to the shoulders: SJ-15 b. Inferior Portion: 1) Suboccipital-retromastoidal pain from the nape to the acromion: The area of UB-45 2. Splenius Capitis Muscle: a. Pain at the nape, particularly at the cervicoscapular angle: At the level of the spinous process of C-7 on the Bladder Channel 3. Multifidus Muscle: a. Suboccipital pain descending to the cervicothoracic junction and the posteriosuperior border of the shoulder: Xiaxinshi (N-BW-48, located 1.5 cun lateral to the lower border of the spinous process of C-4) 4. Levator Scapulae: a. Pain at the cervicoscapular angle radiating along the vertebral border of the shoulder: The areas surrounding SI-15 and UB-41

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