Fistula disease, also known as frozen shoulder or fifty shoulder, is characterized primarily by pain and heaviness in the shoulder and limited movement. It was first recorded in the Neijing as shoulder pain or inability to lift the shoulder. As mentioned in Lingshu-Jingmai: "The lung meridian of hand taiyin... if the qi is excessive, it causes shoulder and back pain due to wind and cold." Lingshu-Jingjin states: "The sinew of foot taiyang... its disease includes inability to lift the shoulder."

The disease mechanism of this syndrome may be due to aging, decline in essence and blood, inability to nourish the sinews, invasion of wind-cold dampness, stagnation in the meridians and collaterals; or due to overexertion and injury, blood stasis causing stagnation and pain.

Acupuncture and moxibustion treatments for this syndrome are recorded in multiple places in the Jin dynasty's Zhenjiu Jiayi Jing, and later in Beiji Qianjin Yaofang, Zhenjiu Zisheng Jing, and medical texts up to the Ming and Qing dynasties.

In modern Western medicine, conditions such as scapulohumeral periarthritis, supraspinatus tendinitis, and biceps tendon sheathitis can be classified under this syndrome.

bubble_chart Pattern Identification

(1) Emptiness of meridians and collaterals, invasion of external pathogens.

Diffuse pain in the shoulder, worse at night, pain aggravated by lifting the arm and turning it backward, limited movement, local aversion to cold, pain relieved by warmth, normal tongue and pulse.

(2) Malnourishment of meridians, contraction and shortening.

Long-standing shoulder pain, malnourishment of shoulder meridian sinews, muscle atrophy, contraction and shortening of meridian sinews, difficulty in lifting the arm and turning it backward, soreness and weakness, local aversion to cold, worsened by cold, thin pulse, pale red tongue or with ecchymosis, thin white coating.

(1) Emptiness of meridians and collaterals, invasion of external pathogens.

1. Treatment principle: Disperse wind-cold, warm and nourish meridians.

2. Prescription: Jianyu (LI15), Jianjing (GB21), Jianliao (TE14), Quchi (LI11), Hegu (LI4), Tiaokou (ST38).

3. Explanation: The pain is located in the shoulder, mainly along the three yang meridians of the hand, foot shaoyang meridian, and hand taiyang meridian, hence the selection of Jianyu (LI15), Jianjing (GB21), Jianliao (TE14), Quchi (LI11), Hegu (LI4) to warm and unblock meridians and vessels, disperse wind-cold; Tiaokou (ST38) is an effective point for this disease.

4. Treatment method: Use neutral reinforcement and reduction techniques, warm needle or moxibustion after acupuncture on shoulder points.

(2) Malnourishment of meridian sinews, contraction and shortening.

1. Treatment principle: Replenish qi and invigorate blood, strengthen sinews and invigorate bones.

2. Prescription: Jianyu (LI15), Jianliao (TE14), Tianzong (SI11), Binao, Quchi (LI11), Jianzhen (SI9), Waiguan (TE5), Geshu (BL17).

3. Explanation: The above combines local points on the shoulder with distant points to tonify qi, invigorate blood, and soothe sinews, adding the blood meeting point Geshu (BL17) to enhance the effect of invigorating and nourishing blood.

4. Treatment method: Use tonifying method, slightly stronger stimulation. Moxibustion or cupping can be added after acupuncture.

bubble_chart Ancient Prescriptions

Zhenjiu Jiayi Jing‧Volume 10: For shoulder and back pain, inability to lift the arm, cold and heat, Jianjing (GB21) is the main point.

For heat in the shoulder, pain in the arm and fingers, Jianyu (LI15) is the main point.

Beiji Qianjin Yaofang‧Thirty Volumes: Quchi (LI11), Tianpi governs shoulder heaviness and pain with inability to lift.

Tianzong (SI11) governs shoulder heaviness and arm pain.

Jianwaishu (SI14) governs shoulder blade pain and cold extending to the elbow.

Leijing Tuyi‧Volume Eleven: Jianjing (GB21), Jianyu (LI15), Yuanye, Quchi (LI11), Quze (PC3), Houxi (SI3), Taiyuan (LU9).

Shenying Jing: For scapulohumeral periarthritis pain, select Jianyu (LI15), Tianjing (TE10), Quchi (LI11), Yanggu (SI5), Guanchong (TE1).

Zhengzhi Zhunsheng: For shoulder and arm pain with inability to raise the head, select Jianyu (LI15), Wangu (SI4); for shoulder and arm soreness and heaviness, select Zhigou (TE6), Guanchong (TE1), Tianzong (SI11); for shoulder, arm, and neck pain, select Yongquan (KI1); for inability to flex and extend the shoulder and arm, select Jugu (LI16).

Zhenjiu Jicheng‧Volume Two: For prolonged shoulder pain with the shoulder joint stuck like glue and inability to lift, select below the shoulder and above the armpit, and also needle the tendon knot area.