Volume 4, Number 1 | Spring 2009

Clinical Report 1 (Japan)
Cervico-branchial Pain Remote-controlled by PAR

1. Points involved in the greater yang meridian
Shenmai (P) - Jinggu (N)Shouichi Sawatsugawa
Director, Educational Corporation of Handa College
Vice Principal, Nippon Acupuncture & Moxibustion,
and Physical Therapy Vocational College
Director, Incorporated Foundation of Oriental Medicine

Houxi (P) - Wangu (N)2. Points involved in the lesser yang meridian
Huizong (P) - Sanyangluo (N)Yanglingquan (P) - Yangjiao (N)3. Points involved in the large intestine meridian

Introduction

Hegu (P) – Wenliu (N)Remote control based on the application ofelectrical pulses to acupuncture needles is called
PAR in this report. This is an acupuncture

Shousanli (P) – Quchi (N) Note: (P) electrode = the side where stimulation
is felt weak (+)

treatment system that uses remote control to add
stimulation in the treatment of the root of a

(N) electrode=the side where stimulation
is felt intense (-)

disease.
In this report, cases will be taken up in which
PAR was performed for cervico-branchial pain.
For diseases causing cervico-branchial pain,
specialized books should be referred to. In thecases of this report, PAR was applied from theviewpoints of disease patterns, meridians, andacupuncture points of Oriental medicine. Before
the treatment method was decided, it was ensured
where symptoms appeared and where meridianroutes were located. As an important reminder of

The frequency of PAR is 2Hz and duration oftreatment is 15 to 20 minutes.
Clinical case 1: Cervico-branchial pain
Patient: 62-year old, male, teacher, BMI 23
Chief complaints: Pain in the superior border
extending to the deep part of the lateral border ofthe left scapula and numbness in the lateralregion of the left upper arm.
Present medical history: From seven to eightthe treatment method, if a heat sensation, hyper

years ago, pain began to appear once or twice a

pain, spontaneous pain, and jitteriness areyear in the right interscapular region (in the deep

present, stimulation is added by PAR, as a method

part of Dazhu to Fengmen), but it spontaneouslyof reflex induction, to acupuncture points in distal

resolved within 2-4 weeks.

locations of related meridians. If the patient’s
condition is chronic, the patient feels comfortable

This time, however, the patient became aware

when the affected area is pressed, and she or heof sudden pain in the left scapular region andfeels good when the affected area is warmed, allnumbness in the lateral part of the left upper arm

these are conditions of deficiency symptoms andand these symptoms became worse gradually.

needles are inserted directly into the affected area

Although he was aware of mostly no symptoms

that responds. This case, the insertion has to beduring morning hours, they began to aggravate

made little by little, giving it time, to the depth offrom the afternoon to the evening. And pain

40mm where needles are manipulated manuallyand then stimulation is added by PAR toacupuncture points of related meridians.
Selection of acupuncture points by PAR system8

correlated to numbness, so with an increase in thepain intensity, numbness increased. When thesymptoms were intense, they relatively became
eased by keeping the upper limb region slightly

The Journal of Kampo, Acupuncture and Integrative Medicine (KAIM)

Volume 4, Number 1 | Spring 2009

elevated with the elbows on the desk. Although heIntestine Meridian, where needles were left

was able to control the symptoms for about 10

inserted. One month passed after the developmentdays from the start of the symptoms, he could noof symptoms of this time and there were not much

longer tolerate the worsening symptoms andfever and excess type of symptoms. And thebegan to take one tablet of antiphlogistic

symptoms were progressing to the chronic phase.

analgetics (Loxonin) kept at home for prehospital

There had been seven to eight year since the initialuse every afternoon. Once the medicine was used,

onset, so organic changes might possibly havesymptoms became alleviated and the relief lasted

some influence on symptoms. Considering all

for 7 to 8 hours. On the following day, similarly

these factors, the author decided to administer

symptoms became worse in the afternoon and the

local treatment in parallel. For direct local

tablet was used again. This cycle was being

needling, the sparrow pecking technique wasrepeated.

slightly applied to the Bladder Meridian and theOne month after the symptoms had appeared,

Small Intestine Meridian as auxiliary points. The

the conditions further aggravated. Thus, he madeaffected regions were innervated by C5-6 (7)a visit to our clinic.

included in the superior lateral cutaneous nerve ofPatient profile: Alcohol drinking – Japanese sake2-3 go’s (180mL/go) a day. No smoking. Bloodpressure 130/88mm Hg. Unmedicated except
Loxonin.

The

patient

mentioned

thatnoabnormalities had been found in the annual
medical examinations.

the upper arm which continues from the axillarynerve (C5-7), and in the inferior lateral cutaneous
nerve of the upper arm which is a branch of theradial nerve (C5-8). For needling into periphery
nerves of the related nerves, the author decided touse the technique of needle manipulation for theoutward section of the spinous process.

Treatment policy: The symptoms were pain in thescapular region and numbness in the lateralregion of the upper arm and there were no othersymptoms. The conditions were typical symptoms
of cervico-branchial pain. To make sure to get it
confirmed, MRI diagnosis was requested. Since thepain appeared in the Triple Energizer Meridian(TE) and the Small Intestine Meridian (SI), andnumbness extended along the travelling route ofthe Large Intestine Meridian(LI), the author
decided to perform PAR treatment (guided byremote control) for major acupuncture points ofmajor meridians of the Greater Yang SmallIntestine Meridian/Bladder Meridian and Minor
Yang Triple Energizer Meridian, and then usedauxiliary meridians of the Yangming Large

The

affectedregions

weremostly

corresponding to the regions innervated by C5-7.
The axillary nerve (C5-7) travels through theoutward axillary fissure to the dorsal side toinnervate the scapular region – the superior
region of the upper arm (C5-8), while the radialnerve (C5-8) goes out to the dorsal side andinnervates the inferior and posterior parts of theupper arm.
The frequency of treatment was twice a week inconsideration of the sustainability of treatment
effects, and the interval between treatments wasfour days or less.
[Treatment](Face-down position)

The Journal of Kampo, Acupuncture and Integrative Medicine (KAIM)

9Volume 4, Number 1 | Spring 2009

PAR 10 minutes: Kunlun (P) / Jinggu (N)Needling depth 5mm
Needles were left in place for 10 minutes:
6 points needling into 2cm sections lateral tospinous processes of C5, C6, and C7.
Needle manipulation technique:
The Sen-Nen technique was used for the section of
the 4cm depth lateral to spinous processes of C5,
C6, and C7 and then the needles were removed
after a feeling of stimulation was delivered by slow
needling to the 4cm sections.
(Strong response) Light sparrow pecking wasperformed to the left Gaohuans, Tianzong, andJianzhen.
(Face-up position)
PAR for 15 minutes: Wangu (P), Waiguan (N)Needling depth 5 mm
Needles were left in place for 15 minutes:
Needling depth was 5mm into Quchi and Hegu.
Needles used were all made of stainless steel
50mm and the gauge 18.
The frequency of PAR for all courses oftreatment was constantly 2Hz.
[Course]The author considered that pain intensity(measured using the visual analog scale with a 010 numerical scale [hereinafter PS]) should
correlate with dosing frequency and the number oftablets used and made observations with thesefactors as a barometer. The patient received PS
when he visited us to make its records.
1st tratment (January 10)
PS’s for about 10 days were 8-6. The tablet wastaken every day and there were almost no changes
in symptoms and the number of drugs taken.
3rd treatment (January 16)
MRI diagnosis was “cervical spondylosis.”
Osteophyte formation from C4 to C6 vertebral
body and cavity preparation at the levels of C4, 5
and C6 were found.
6th treatment (January 26)
PS was 2. The number of the drug taken were 210tablets during 4 days or 2 tablets during 3 days
with decreases in pain and the number of thetablets taken, indicating the correlation between
pain intensity and the number of the medicine
taken.
9th treatment (February 5)
When the patient visited us, PS increased. He
claimed that pain and the number of tablets
increased after the work of cutting up a whole
frozen salmon taking an hour in the morning ofFebruary 3. With no hospital visit for two days,
there were no records of PS. But the patientmentioned the PSs for the days were about 7-6.
12th treatment (February 16) and 13th treatment(February 20)
The number of the tablets increased. The
patient said: “It may probably because yesterday
and the day before yesterday, I drank to excess, soI almost had a hangover. When I feel good, I takeit too far. After this, the condition becomes worse
as I worked on the frozen salmon. So I will see
myself not to, from now on.”
14th treatment (February 23)
The patient quickly recovered and did not need
the medicine any longer. As he claimed thatnumbness remained slightly, the treatment
frequency was changed to once a week from the15th treatment for preventing a recurrence as wellas numbness. As he desired, a MRI photo shooting
was requested again.
“No changes were found from previous MRI
images of 1/13.”[Consideration]
Cervical vertebral syndrome was suspectedfrom pain in the periphery of the left scapula andnumbness in the lateral part of the left upper arm.
The diagnosis was made as “cervical spondylosis”
based on the MRI findings. The MRI images
showed cervical deformities (such as osteophyte
formation, vertebral disc displacement). Generally,
the symptoms develop in association with thenerve root being compressed. However, in theThe Journal of Kampo, Acupuncture and Integrative Medicine (KAIM)

Volume 4, Number 1 | Spring 2009

patient, the symptoms were resolved every
morning and became worse every afternoon,
which may have been attributed to related-nerve
tension caused, with time, by the upper extremityload. Aggravated conditions during the course
mayhavebeentriggeredbythemotion/labor/action which became a burden on theneck because secondary muscle tension andcirculatory disturbance having occurred from theunderlying deformities still remained. Painpersisting for several years meant the deformities
had been chronic. The pain of this time may haveresulted from nerves being compressed bytensions, inflammation, and circulatory disorderoccurred secondarily in the surrounding tissues
and muscles, in addition to the direct compression
by the deformities. No changes were shown in thefindings of MRI photos taken after relief ofsymptoms. Since there were no correlation
between the relief of symptoms and the MRI
findings, it is hard to believe that organic changes(which could be confirmed from the images) werelinked to the relief of symptoms.
It was suggested in this case that acupuncture
treatment had the possibility of being applied tothe clinical condition having cervical deformities
on MRI images.
Case 2PAR for cervical sprain “whiplash syndrome
27 years old, female, company employee
Chief complaints: Due to a head-on collision, dull
pain in the cervical region, headache, and upper
limb pain.
No symptoms were felt in the initial period
after the accident. After a week from the accident,
pain and a sense of stiffness began to develop in
the cervical region. Since the examination at anorthopedics, he had been receiving physiotherapy
and medication with antiphlogistic analgesics andexternal preparations. However, headaches began
to appear and gradually became worse withincreasing dull pain and stiffness in the cervicalregion. Furthermore, numbness and dull pain in
the area from the shoulders to the upper arms
developed. She had painful days but never tookeven a day off work. She had continued to receive
orthopedics treatment for a month without
improvements, so she was referred to our hospitaland visited us.
In the initial visit, her clinical condition,prognosis, and the content of treatment wereexplained to her before the start of treatment. Asa heat ‘sho’ and an excess ‘sho” were slightly
localized in the cervical region, remote-controlled
PAR for legs and arms was performed. The patient
was in the face-up position with a low height
pillow. Selected acupuncture points were Houxi(P) - Wangu (N), Shenmai (P) – Jinggu (N) on theright and left sides. The author decided to needle
to the depth of about 7mm using 40mm 0.18
disposable stainless steel needles with 2Hz to add
moderate stimulation for 20 minutes. After thefirst PAR treatment, headache and cervical dull
pain were considerably reduced. The patient
claimed she was feeling very well. The secondtreatment was performed after a week due to her
work schedule. She said that after the treatment
on the day of initial visit, she could stop using
headache medicines d and the cervical condition
improved markedly. The second PAR treatment
was performed similarly as in the first one. In thethird treatment of further a week later, symptoms
mostly disappeared and she expressed her thanks
for the enigmatic effects. As a precautionary
measure, PAR in the same procedure as in thefirst treatment was performed. The author told
her to have treatment again if symptoms recurred.
However, she has not made a visit to us since then.

The Journal of Kampo, Acupuncture and Integrative Medicine (KAIM)

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Volume 4, Number 1 | Spring 2009

Guide to treatment rooms of acupuncture andgraduation. Student patients are allowed tomoxibustion

receive treatment at lower rates, so that they can

The Acupuncture and Moxibustion Clinic

have treatment experiences. During the student

affiliated with Nippon Acupuncture, Moxibustion

patient is being treated, other students observeand Physical Therapy Vocational College locatedthe treatment while getting instructions at theat 28-9 Sakuragaoka-cho, Shibuya-ku, Tokyo hassame time.

been established on the 3rd floor of Hanada College

In the acupuncture and moxibustion treatment

Medical Building. The treatment room of thisroom, there are three practitioners of acupuncturecollege is situated right behind Cerulean Tower

and moxibustion on a steady basis and full-time

Tokyu in Shibuya, and the access is three minutes

teachers take turns to provide clinical care orwalk from Shibuya Station on JR Yamanote-Line.

guidance.
For post-graduation clinical training, the Clinic

In the Hanada College Medical Building, there

accommodates

is a clinic (internal medicine and orthopedics)

graduation.

internsaffiliated with the Institute of Oriental Medicine.
There are MRI and X-ray Rooms in the basement.
On the first floor, there are the reception desk,
pharmacy, treatment rooms for internal medicine
and authopedics; the second floor is used asrehabilitation facilities; the third floor is used as
the room for acupuncture and moxibustion
treatment; the fourth floor is an orthopedic clinic;
and the fifth floor is the space for meeting rooms.
The acupuncture and moxibustion treatment
room on the third floor is equipped with eightadjustable

beds,

low

frequency

electricalgenerators used in combination with acupuncture
and moxibustion treatment, electronic warmmoxibustion equipment, far-infrared radiationequipment and these are applied to treatment.
Acupuncture treatment is mainly performed withthe method of remote-control in the combined useof pulses.
The Acupuncture and Moxibustion Clinic
affiliated with Nippon Acupuncrure, Moxibustion
and Physical Therapy Vocational College is theplace to provide treatment to patients in generaland also the place for students to have clinicaltrainings. This clinic also provides clinicaleducation of pre-graduation and that of post-12

The Journal of Kampo, Acupuncture and Integrative Medicine (KAIM)

foroneyear

after