Monday, February 4, 2013

Periarthritis of the Shoulder: Acupuncture vs. Tuina?

abstracted & translated by Honora Lee Wolfe, Lic. Ac., FNAAOM (USA)

Introduction: This two-wing comparison study is interesting in that it studies patients whose condition is relatively acute and those whose condition was older or chronic. In the more acute cases, contra-lateral acupuncture on Zu San Li (St 36) was quite effective and tuina was less so. However on the more chronic cases, tuina was more effective than acupuncture. Since many of the patients that arrive in our clinics have been to numerous practitioners and have chronic pain conditions that have not been successfully treated, this information is good to know. In my personal experience, I would add moxibustion and liniments to the treatments, along with the tuina for more complete resolution of this type of pain. Check it out.
On pages 604-605 of issue #10, 2004 of the Shan Dong Zhong Yi Za Zhi (Shandong Journal of Chinese Medicine), Bao Tie-zhou published an article titled, “The Treatment of 80 Cases of Periarthritis of the Shoulder by Acupuncturing Zu San Li (St 36).” A summary of this study is presented below.

Cohort description: Altogether, there were 130 patients in this two-wing comparison study. These 130 patients were randomly divided into two groups, an acupuncture group and a tuina group. There were 80 patients in the acupuncture group, 41 males and 39 females 20-65 years of age, with an average age of 43 years. These patients had been suffering from this condition for 1-12 months. There were 50 patients in the tuina group, 26 males and 24 females 22-68 years of age, with an average age of 46 years. These patients had had periarthritis of the shoulder for 2-12 months. Therefore, in terms of sex, age, and disease duration, it was judged that these two groups were statistically comparable. In addition, these patients’ disease was divided into three stages, early, middle, and late. In the early stage, there was mainly aching and pain of the shoulder region, but movement and use were not affected, even though use may have made the pain worse. In the middle stage, the aching and pain of the early stage had remitted. However, there was pressure point point and function was affected by adhesions. This was also called the joint stiffness stage. In the late stage, also called the frozen and bound stage, there was drooping of the shoulder and both motion and use or function were definitely affected to the point of causing disability in lifestyle and work.
Treatment method: Members of the acupuncture group were needled at the contralateral Zu San Li (St 36) with a 28 gauge, 2-5 inch needle and large amplitude twisting and turning technique. At the same time, the patient was asked to mobilize the affected joint. The needle was retained for 20 minutes, during which the patient continued mobilizing the shoulder joint. Strong patients received one such treatment per day, but aged and weak patients were treated only once every other day. Seven treatments equaled one course of therapy in any case. Members of the tuina group received standard tuina therapy for shoulder pain once per day.
Study outcomes: Outcomes were divided into four grades: excellent, good, ok, and poor. Excellent meant that the shoulder pain disappeared and function returned to normal. Good meant that the shoulder pain disappeared but that function was still a little less than normal. In other words, range of motion was 10% less than normal. Ok meant that the pain was less but range of motion was more than 10% less than normal. Poor meant that there was basically no change in the symptoms or range of motion. The following tables show the outcomes based on these criteria. The first chart shows the outcomes only in those with early stage disease. The second table shows the outcomes in those with middle and late stage disease.

Group
No.
Excellent
Good
OK
Poor
Total effect.
Excel. & good
%
Acupuncture
24
20
2
2
0
100%
91%
Tuina
15
2
3
7
3
80%
33%

Group
No.
Excellent
Good
OK
Poor
Total effect.
Excel. & good
%
Acupuncture
66
8
21
28
9
86%
43%
Tuina
35
8
20
5
2
94
80%
These outcomes suggest that this acupuncture protocol is more effective than tuina for those with early stage disease, but tuina is more effective than this acupuncture protocol for middle and late stage disease.
Discussion: Dr. Bao says that, when the yang ming becomes depleted and vacuous, it is not able to nourish the sinews and bones and disinhibit the joints. Zu San Li is a point on the foot yang ming stomach channel, and needling it is able to promote the strengthening and securing of the body’s latter heaven root. Thus the righteous qi is able to obtain banking and nourishment. This then results in the disinhibition of the joints and the outward expulsion of evils. According to the Nei Jing (Inner Classic), “If the righteous qi exists internally, evils cannot strike.”  As to why the acupuncture is effective in the early stage and less effective in the middle and late stages, Dr. Bao says that, although acupuncture can disperse inflammation, its effect is poor when adhesions have caused freezing and binding of the joints. In such cases, tuina is able to break up those adhesions as well as disperse inflammation.  Therefore, acupuncture should mainly be used in early stage cases, and tuina should mainly be used in late and middle stage cases.
For more musculo-skeletal treatment ideas, see The Treatment of External Diseases with Acupuncture and Moxibustion. by Yan Cui-lan & Zhu Yun-long

1 comment:

  1. Thanks for the wonderful blog.Peter Soh, is a certified Oriental Medicine & Acupuncture Practitioner by PITAHC (Department of Health), Philippines.
    Mandaluyong Acupuncture Clinic

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