Volume 8, Number 2 | Summer 2013

Clinical Report 1 (Acupuncture)
A Case of Quick Relief from Persistent, Blood Stagnation
Related Stiffness of the Interscapular Region

were accompanied by chills. The attacks

Toyoji Sakamoto

years earlier her first child was born throughDepartment of Health Sciences ofthe Moriyama University of Medical Sciences

cesarean section and the second child three

Case: 65 years, female; occupation: housewife andpart-time employee; first visit: Sep. 7, 2013
Chief complaint: #1 stiffness of the interscapularregion, pain (R>L), #2 paroxysmal sweating; #3
tinnitus#1 She has been working with leather products for
30 years, working Mondays to Saturdays from9:00 AM to 5:00 PM, but experiences stiffness in
the interscapular region during work, which
may occasionally progress to pain. Previously
she used to feel fine on her days off, but recently
she is even on holidays often under distress. She
herself thinks, that the poor posture she
assumes when sitting almost the entire day forher work is responsible. Relieving factors
include taking a walk in the park, sleeping,bathing (she sits in the bath tub for only about
5 minutes, but feels fine after the bath) andmassaging. However, the effect does not last
very long and the affected region soon becomes
the source for distress again. Three days ago thestiffness became so severe, it was almost painful.
(NRS10)#2 The sweating phenomenon started around theage of 48. There was no dizziness, but eventhough hands and feet were even in the summer
cold, she suffered from paroxysmal sweating.
has

minutes, lasting for 3 to 5 minutes. Forty-one

years later was also delivered through cesarean
section. She regular menses, but menopause
occurred at the age of 48. (NRS10)#3 Tinnitus started 20 years ago as a cicada
chirping sound heard daily on the right ear. It
gets worse when she is tired. Otolaryngologic
examination revealed low frequency range

Present illness:Sheoccurred with a frequency of once every 40

beentreatedwithhormonepreparations for 10 years, which led to somerelief, but the symptoms recurred during thelast few years, so that she was sweating without
any triggering factors from spring, when theweather starts to get warmer, until the cold of
the winter mainly on the back of her hands, thehearing impairment, but a clear cause could not
be identified, so that the physician explained thesymptom as an aging related phenomenon.
(NRS10) Vertigo, autophonia, no feeling of ear
obstruction.
General condition
Appetite: She does not want to eat, butnevertheless has three meals per day. After
meals she often experiences gastric upset.
Brushing teeth easily causes gum bleeding.
Bowel movements: slightly soft but regular andalmost daily. Micturition: cold causes increased
urinary frequency. She does not really feelthirsty, but ingests small amounts of warm
water because of a bitter taste in the mouth.
Sleep: She goes to be before midnight, but has
difficulties falling asleep. Dreams a lot. Often
has scary dreams in which she is being pursued.
No night sweats. At 4:30 she wakes up and at
5:30 she gets up and wants to have breakfast.
Approximately twice a month she experiences
after a night of poor sleep headaches that feellike compression of the temples. Fatigue isparticularly strong in the morning. However,from the evening into the night she feels
weariness from the waist down into the legs.
This weariness is particularly marked in thecalves. She easily develops eye strains (has been
diagnosed

with

dry

eye).

She

does

not

forearms and her face. Sometimes these attacks
The Journal of Kampo, Acupuncture and Integrative Medicine (KAIM)

9Volume 8, Number 2 | Summer 2013

experience palpitation or shortness of breathof TH3-6 (R>L), where pressure on theduring walking, climbing or descending stairs.

tendernessisassociatedwithpleasure.

Observation shows a mild degree of a stoop anda mild degree of winging of the right scapula.

Past history
her

Deep reflexes: active in all four extremities.

twentieth) that is currently well controlled.

Hoffmann reflex, Trömner's reflex were both

Periodontal

Familiar

hypercholesterolemia(since(sinceher

twentieth),absent. No thickening of the Achilles tendon.

climacteric disorders (17

years

ago),

NeitherdiseaselowIobserveany

palpebralfrequency range hearing impairment (before thexanthomatas. Weber test lateralized towards

age of 20), reflux esophagitis (5-6 years ago).

the healthy side. Rinne test was negative, on theright affected side the time was slightly

Family history

shortened as compared to the left healthy side.

Lives with her husband in a 2-person household,where the husband is treated over the past 7-8<Oriental medical findings>

years because of liver cirrhosis induced poor

1)

Facial color: black, yellow. Tongue: dark red, redtip, thin white fur, little fluid, slightly dry.

physical condition.

Venous

Personal history
30 years as a non-regular employee. Two births,

engorgementisobserved

ontheunderside of the tongue.

Housewife who married 43 years ago. Works for2)

Pulse diagnosis: deep, empty, slightly choppy,
right guan pulse is wiry and full. Spleen

two daughters (married).

deficiency pulse, liver repletion.

Medication: Rosuvastatin Calcium 2.5 mg tablets(familiar hypercholesterolemia).

Alendronate

3)

Abdominal diagnosis: operational scar from

Sodium Hydrate, 3.5 mg tablets, for the

below the naval down to the pubic bone. The

prevention of osteoporosis. Myslee, 5 mg tablets,

lower abdomen is cool. Left lateral abdomen isfor sleep disturbances. Omeprazole, 10 mgvery tense. There is mild resistance extending

tablets, for reflux esophagitis.

from the epigastric region to CV12.

<Findings during first examination>

4)

Source point diagnosis: chilling of the feet is

Height: 150 cm; weight: 45 kg. Blood pressure

objectively not very, but subjectively apparently

154/86 mmHg, after deep breathing load 140/80

marked. Left and right SP3 soft and weak.

mmHg. Tends to rise when tense. Pulse: 60 bpm,

Depression at the left and right KI3 associatedregular. Neck ROM is almost normal, but shewith coolness. Left LR3 is deficient. Right LR3feels a certain tension in the region of the rightis replete. At the left GB41 there is tenderness

mastoid process upon rotation to the left. Heartand a replete reaction. The left and right TE4

sounds: second heart sound left parasternaland SI4 there is sweating and chilling.

slightly enhanced but no audible murmurs.

right LU9 there is also sweating.

Percussion of lung-liver border is normal. The

10

did

5)

At theOn the spine, along the governing vessel

region from the epigastric region to the left

tenderness was observed at GV20, GV11, GV10,

hypochondriac region is tympanic.

GV9, GV7. In the shoulder and neck region

The range of motion of the shoulder joint isthere was mainly around the trapezius muscle

normal, but with 170° of abduction on the left

superficial tension (R>L). At the right TE17,

and 165° on the right slightly different. Palpable

BL10, GB20, GB21 and SI14 slight reactions

difference in rhomboideus muscle tension R>L.

with a tendency towards excess (R>L) could be

Palpable deep indurations 1 to 2 fingers lateralpalpated. In the interscapular region on the

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

Volume 8, Number 2 | Summer 2013

right side from BL13 to BL16 the superficial

blood stagnation as a basis for her condition,

layer was soft and weak, while in the deep layer

where the continuous burden from her work anda continuous band of induration could be

the stress load probably led to the development

palpated. Pressure there elicited uncomfortableof the blood stagnation type stiffness (almost

pain. On the left side a similar finding was

painfulobserved only at BL15. On the lower back aninterscapularexcess reaction was observed at right BL17,

combination of a lack of appetite induced by theright BL18, left BL18, left BL19 and both BL20.

ingestion of several medications, decreased foodA deficient reaction was observed on both atintake and a lack of exercise and various similar

BL23.

factors probably enhanced the symptoms.

continuous

stiffness)region.

intheAdditionally,the#2 Regarding the paroxysmal sweating: Similar[Assessment of the condition at the first visit]#1 The stiffness and pain (R>L) the patient

symptoms did develop since her menopause, thecomplains about in her interscapular region

properties of the sweat, the sweating condition

could

etc. suggesting a climacteric disturbance of thebereferred

pain

from

lesionsofcardiovascular, respiratory organs or also upper

autonomic nervous system.

digestive organs, but based on the general#3 Tinnitus: The accurate cause is unknown. Since

condition of the patient and the physicalan otorhinologist pointed out a low frequency

findings a strong correlation seemed rather

range hearing impairment, I assumed theunlikely. The most likely cause is probably thecondition to be a tinnitus associated with a low

working posturefrequency hearing impairment.

thepatient herself also

recognizes as such, so that the continued
maintenance of this working posture was

Based on the above described modern medical

assumed to be the main reason for an imbalance

assessment of the condition the possibility of anof the muscles in the shoulder girdle1,2,3).

unfavorable prognosis was considered low andFindings obtained during the first examinationaccording to past experiences6) I assumed it to be an

include a mild degree of winging of the rightindication

scapula, that was considered to support thetreatment. Moreover, oriental medical findings

above mentioned assumption4). Moreover, theindicated an inherited weakness of the spleen andillness of her husband, financial problems etc.

stomach,represent other mental and social stresspredisposing her for suffering from decreased

factors5) and observation of her entries in the

movement and transformation function. This kind of

medical record showed very meticulous entries

spleenrelating to name, address, prescriptions etc.,

responsible for the necessity for delivery throughthus suggesting her having a fastidious,

cesarean sections and the two operations then led tomentally very tense, with "liver dominated"the formation of stagnant blood. Also, prolonged

character. These personality traits also add towork requiring intense concentration can lead tothe stress, conceivably facilitating a tendency

injury of the kidney qi, so that at a time when the

towards an easy development of stiffness.

kidney qi is naturally declining, a kidney deficiency

Constitutionally there is a genetic disposition

associatedwithregarding the familiar hypercholesterolemia

personality

traitsand the necessity for birth through cesareandevelopment of liver disease, with the sevensections etc., contributing to the development ofemotions causing internal damage, deteriorating theforacupuncture

givingthedeficiency

andpatient

constitution

tinnitus

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

isamoxibustionawasdeveloped.
factordisposition

probablyAnd

herfavoringthe11Volume 8, Number 2 | Summer 2013

free flow of liver qi and thereby building theinterscapular regions and found that the deep

foundationinduration above and below the right BL15 could

of

blood

stagnation,

which

then

aggravated the shoulder stiffness. Regarding thenow be palpated in a superficial position.

sweating there was no paroxysmal sweating during
daytime activities, no feeling of warmth or strong

2) Treatment in prone position

upsurging, and since it was associated with chills, it

Retaining 30-mm long, 0.14 mm thick needles at

represents a yang deficiency sweating caused by theright BL15, right BL18, left BL20, both BL23 for 7

spleen deficiency. Combining the above describedminutes. Box moxibustion at BL23 (the box

symptoms with the findings of abdominal and pulse

moxibustion of the lumbar region was continued

diagnosis I identified a spleen deficiency liver

after that). For the tension in the superficial layers

repletionof neck and on the top of the shoulders I inserted 30-

pattern7)

andstartedtherapeutic

mm long, 0.14 mm thick needles and performedintervention.

scattered short pricking. At the end I attached a[Treatment and course]

Seirin made PYONEX 2-mm press needle at TE17 to1) Treatment in supine position:finish the first treatment.

According to the root treatment principle the left

Second session (9/12) The patient returned 5 daysside was chosen as the indication side and 40-mm #1

later. She could now sleep better than at the time ofsilver needles used at left SP3, left LR3 to performthe first visit. (NRS8) However, on the day following

contact non-penetrating needling for tonification.

the treatment she felt somewhat tired. #1 Regarding

The right guan pulse became balanced, but although

the stiffness and pain in the interscapular region

the wiry, full left guan pulse loosened, it was still(R>L), she had no pain for 3 days, although thisstrong, so that I used a 40-mm #3 stainless steel

returned later to a level of NRS2. The other day theneedle at GB37 to perform reducing non-penetratinglevel rose to NSR4, but there was no pain, only aneedling. This decreased the fullness of the left guanfeeling of heaviness. (NSR4) Palpation of thepulse still further. However, the tension at the leftinterscapular region showed that the induration at

GB26 still remained. Therefore, based on belt vessel

the left BL15 had disappeared and while indurations

pattern according to the 'Miyawaki Extraordinary

could be palpated at the right BL14 and BL15, but

Vessel Abdominal Diagnosis'8) I attached the southpressure did not elicit discomfort any longer. The

pole of the tester magnet to GB41 and its north polewinging of the right scapula was less obvious than

to the right TE5. The tension around GB26 in the left

the last time. #2 No changes in paroxysmal sweating

lateral abdominal region abated and the abdominal(NSR10); #3 the sound intensity of the tinnitus had

pattern changed, to that I applied three half-riceslightly decreased. (NSR8)

grain sized cones of moxa and let them burn 90%

Changes in other symptoms: The subjective feelingdown at the left GB41, similarly 2 cones to the rightof coldness of the toes had not changed, but theTE5 and repeated this moxa treatment three times.

objective finding of coldness remitted. (NSR10) The

During the extraordinary vessel moxibustion I

subjective feeling of tiredness of the gastrocnemial

retained a 0.14 mm 15 mm long needle at EX-3.

muscle region had been slightly alleviated. Meals are

Through the extraordinary vessel moxibustion thestill not perceived as tasty and the patient has noleft lateral abdominal tension decreased further andappetite, but the bitter taste in her mouth has

softened to the degree, that it equaled the right

improved. (NSR10)

abdominal region. At this point I observed changes

Since abdominal diagnosis did not show tension inof the stiffness in the neck, upper shoulder andthe left lateral abdominal region, I did not add the12

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

Volume 8, Number 2 | Summer 2013previous extraordinary vessel treatment. Pulse

The subjective chilling of the toes decreased. (NSR9)

diagnosis did not show the left guan wiry pulse any

Sleep tended to improve. (NSR8)

longer and because the left deep chi pulse wasTreatment: The mild resistance extending from thedifficult to palpate, I restricted myself to kidney

epigastric region to CV12 found during themeridian tonifying root treatment.

abdominal diagnosis made at the first visit had

Treatment in supine position: I chose the left side as

decreased, but nevertheless still persisted. Because

the indication side and used 40-mm 0.16 mm silver

the three bilateral radial pulses showed bothneedles at the left KI7 to perform tonification

weakened spleen and kidneys, I identified thethrough non-penetrating needling. Next I applied 5

pattern as spleen/kidney five phase restraining andhalf-rice grain sized moxa cones each at both KI3

performed the relevant systemic and generaland ST36 that were burnt down 90% and added

treatment. After the systemic and general treatment

application of moxa roll on the abdominal CV4.

I also repeated the extraordinary vessel treatment.

Treatment in prone position: On the back I added

Systemic and general treatment (use of silver

skin piercing needle retention at the right BL14 toneedles for non-penetrating needling): For thethe last treatment. Otherwise the treatment was thetreatment of the root I tonified the left GB34 and left

same. After the treatment the legs grew warmer andKI10. The force of both the right guan pulse and thetheregionleft chi pulse had increased and was more easily

disappeared, so that I recommended the patient

palpable, but in the superficial position of both guan

applies moxibustion herself at home at both KI3 andpulse I could still feel evil properties. I added someST36. Also similar to the last treatment I attached agentle reducing at ST40 and GB37. Extraordinary

Seirin made PYONEX 2-mm press needle at TE17. I

vessel treatment: I checked with a tester based on

also instructed her how to do stretch exercises tothe Miyawaki style extraordinary vessel abdominal

improve the balance of the muscles of the shoulder

diagnosis8) and thus identified a yin linking vessel

girdle and muscle strengthening exercises mainly forpattern. As moxibustion treatment I applied a set ofthe rhomboideus muscle to be done both at work andeach 3 half-rice grain sized cones of moxa at the left

at home.

PC6 and 2 cones at the right SP4, burnt down to 90%,

Third session (9/21) Good physical condition sincerepeating the set three times.

last treatment.

The#1 Regarding the stiffness and pain in theapproximately the same.

interscapular region (R>L): she experienced pain in

Fourth session (10, 5)

the interscapular region 1 or 2 times. But the#1 Regarding the stiffness and pain in the

stiffness had improved to a NRS level of about 3-2.

interscapular region (R>L): there was no pain and#2 Whether the treatment for paroxysmal sweating

the stiffness improved to a level of NSR 3-2. Last

had been effective or the slightly cooler weather was

week there was very little stress, so that she

responsible is unclear, but the symptom had

experienced no stiffness at all. However, from thedecreased. (NSR7) #3 The tinnitus sometimes

other day she again experienced some heaviness.

disappeared on turning the face to the left. (NSR6)(NSR2) Examination showed, that indurations could

Changes in other symptoms: There was a tendency

not be felt, but at the right BL14, BL15 a thin strand

towards improvement of the stomach upset. There isof increased muscle tone could be palpated. Winging

still no appetite, but the bitter taste in the mouthof the right scapula (-). #2 Paroxysmal sweating did

had disappeared at some time unnoticed. (NSR9)

not occur any longer. The symptom disappeared 1

heavinessoftheinterscapulartreatment

in

the

prone

positionwasmonth earlier than in previous years. (NSR0) #3 She

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

13

Volume 8, Number 2 | Summer 2013

was very happy, because she experienced now days,

occasionallystrong,during which the tinnitus did not bother her at all.

alleviated. (NSR3)(NSR4)

Treatment:

Treating

but

generally

the

has

been

fundamental

andStopped using

extraordinary vessel treatment were the same, but I

hypnagogues. It took her about 20 minutes to fall

shallowly inserted a 30-mm 0.16 mm needle at GV20

asleep. Wakes up twice during the night. (NSR4) She

and retained it for 3 minutes.

experiences times when she does not have tinnitus.

* Because of the favorable course I widened the(NSR4) The other day she felt tired from the calvestreatment intervals to once a month.

down into the soles of the feet. Maybe the

Sixth session (11/9) Good physical condition.

moxibustion performed at home had started to take

#1 Stiffness and pain in the interscapular region

effect, but the feeling of an upset stomach remitted(R>L): There is occasionally some stiffness, but it isand she gradually developed an appetite. (NSR4)

not very distressing. (NSR1)

The bitterness in the mouth had disappeared.

#2 Sweating has stopped completely. #3 There is

Chilling of the feet had been relieved. (NSR5)

some tinnitus, but it does not bother the patient.

Abdominal diagnosis: The resistance in the vicinity

Changes in other symptoms: The occasions whereof CV12 had disappeared, but the resistance in theshe falls asleep quickly and does not wake up during

epigastric region still remained. The pulse still

the night have become more frequent. (NSR2)

showed weakness of both the spleen and kidney. The

Although she experiences some chilling of the feet, it

color of the tongue had grown lighter as compared tohas become less marked. (NSR3) Eye strain has

the first visit, but the edges are still dark red and thedecreased to a degree, where she experiences onlyveins on its underside remain engorged. Dryness had

occasionally some mild eye fatigue. The number ofsignificantly improved.

days on which she has appetite and enjoys her food

Changes in other symptoms:andhas increased. Yet, when she thinks, she might haveextraordinary vessel treatment were the same as

eaten a little too much, she later experiences

during the previous session, but I added 5 cones ofstomach upset. (NSR4)

moxa burned 90% at SP6. * Will undergo a

Abdominal diagnosis: The tension of the epigastricgastroscopic examination on October 16.

region decreased but still remains. Pulse diagnosis

Fifth session (10/19) The gastroscopic examination

showed a balanced spleen on the right guan pulse,

revealed a mild inflammation. The test for HP

but the left chi pulse was floating and the kidney stillbacteria was negative.

weak. However, the dryness has resolved and#1 Regarding the stiffness and pain in theinstead some moistness is beginning to show. Theinterscapular region (R>L): She did not feel any pain

tongue has a thin white coating. The dark red edges

or stiffness in the interscapular region. (NRS0) #2

of the tongue have grown lighter in color and theParoxysmal sweating did not occur any more. #3

venous engorgement on the underside of the tongue

Tinnitus was the same as as during the previous

has decreased.

session. (NRS4)

Treatment:

Changes in other symptoms: She fell quicker asleep.

extraordinary vessel treatment were the same. As

Waking up twice. (NRS2) The other day shetreatment of the incidental I performed the same

experienced heaviness from the calves to the soles oftreatment on the back as before.

her feet. The feeling of stomach upset decreased and

The course after one month is still good. Therefore I

she started to enjoy her food. (NSR2) The bitterness

recommended the patient continues the moxibustion

Treatment:

Treatingthefundamental

Treating

in the mouth had disappeared. Chilling of the feet is

14

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

thefundamentalandVolume 8, Number 2 | Summer 2013

treatment at home and comes once a month for

fatigue may then further increase the sympathetic

health management and she agreed to this proposal.

nerve excitation, again leading to the contraction ofarterioles and increased excitation of muscles, which[Discussion]then results in stagnation within the venous system.

Regarding the stiffness of the interscapular region

If still more algogenic substances are produced, thisinspection during the first visit showed a mild degree

will enhance the sympathetic nerve excitation andof a stooping and a mild degree of winging of thethus establish a viscous cycle."right scapula, thus suggesting that the prolonged

Moreover, it has been said, that "when the activity ofmaintenance of the working posture was the main

the α-motor neurons is increased via excitation of γ-

cause leading to a disruption of the muscle balance

motor neurons outside the sympathetic nervous

in the shoulder girdle 1,2,3,4). For that reason I

system muscle tone also increases, resulting in the

instructed the patient to do stretch exercises todevelopment of the same kind of viscous circle

regain the balance of the shoulder girdle muscle

triggered by circulatory insufficiency, consequently

group in addition to the acupuncture treatment andleading to shoulder stiffness."11) In this case too themuscle strengthening exercises mainly for theacupuncture treatment relieved the sympathetic

rhomboid muscle to be done at home9).

nervous bias and thus conceivably interrupted thisThe earnest adherence to this exercise program byviscousthe patient led to improvements of the imbalance of

sympathetic

the

the

parasympathetic nerves to normal functioning anddisappearance of winging of the right scapula. The

thus probably improves gastrointestinal function.

above described general results contributed to the

The regulation of the autonomic nervous systemalleviation of the almost painful distress caused byprobably also led to an early alleviation of thethe stiffness. Moreover, before a background of theabnormal sweating, but the possibility that thepatient's earnest and fastidious character traits, thecoming of the cold season resulted in a spontaneous

illness of her husband, financial problems etc.

remission cannot be ruled out. Although the tinnitus

represented other mental and social stress factors

didand the mental tension exacerbated sympathetic

acupuncture and moxibustion invention, it improved

activity, resulting in a sympathetic bias (increased

so much, that it did not bother the patient any longer.

myotactic reflexes and extrafusal muscle tone due toThis is presumably due the influence of the

an increased activity of the sympathetic nerves),

therapeutic

causing the muscle tone to increase and thereby

intervention via some sort of mechanism affecting

probably aggravating the shoulder stiffness10).

the inner ear or the pathways of the auditory area.

Ogawa et al.11) too stated, that "regardless ofFrom an oriental medical point of view the patientwhether the mechanism for the shoulder stiffness is

had basically a constitution marked by a weak

idiopathic or symptomatic, an increased activity of

spleen and stomach. In this context the delivery of

the sympathetic nerves always play an important

two children through cesarean section led to bloodrole". In other words, "since the sympathetic nerves

stagnation and the daily stress caused seven

do not only control blood vessels, but also both extra-

emotions induced internal damage, resulting in liverand intrafusal fibers, their excitation results in

qi depression and stagnation

contraction of blood vessels and increase muscle tone.

aggravating the blood stagnation and thus leading to

The accumulation of algogenic substances etc.

the development of the condition "interscapular pain

induced by increased mental tension or muscle

and stiffness". In other words, I assumed theshouldergirdlemuscle

group

and

not

cycle12).

Also,

nerve

disappear

reduction
excitation

completely

acupuncture

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

and

of

excessive

restoresfollowing

the

the

moxibustion

and thereby

15Volume 8, Number 2 | Summer 2013

condition to be a spleen deficiency liver repletion

Conclusions

pattern where Qi stagnation was added to blood

Because this patient, who presented at the first visit

stagnation. Moreover, relieving factors for thewith a chief complaint of almost painful, persistentshoulder stiffness suggested that the healthy qi wasstiffness of the interscapular region (R>L) associatednot severely weakened, providing sufficient potential

withfor recovery from the condition. Actually, throughparoxysmal sweating and tinnitus, I expected a

the acupuncture and moxibustion intervention andprolonged therapy would be necessary and madeqi regulation the spleen deficiency liver repletion

appropriate plans. However, not only the chief

was corrected, qi stagnation improved and ancomplaint improved more quickly than I expected

improving tendency in the blood stagnation observed.

after only a few treatments, the accessory symptoms

This resulted in the relief of the "interscapular

did so too. Moreover, the gastrointestinal symptoms

shoulder stiffness". Again, spleen and stomach

were also alleviated. This is because I did notfunction inhibited by the liver qi recovered, thereby

concentrate on just one symptom, but rather based

improving appetite and presumably contributed to

my treatment plan on a holistic view and the results

the reduction of drug side effects. Adjustment of theshowed, that this treatment seems to have been

restraining five phases between spleen and kidneylargely correct.

long-standing

accessory

symptomsofled to a recovery of the kidney qi, which is probably
why an improving tendency was observed for thetinnitus.

Course of this case
Chief complaint

16

1st time

2nd time

3rd time

4th time

5th time

6th time

Stiffness of the interscapular retion

10

4

2

2

0

1

Pain of the interscapular region

10

0

2

0

0

0

Sweating

10

10

7

0

0

0

Tinnitus

10

9

6

4

4

1

Stomach upset

10

10

9

4

4

4

Lack of appetite

10

10

10

5

2

2

Sleep disorder

10

8

8

4

2

2

Chilling of feet

10

10

9

5

3

3

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

Volume 8, Number 2 | Summer 2013

<Complaints in this case and overview of the course>
Graph title
15
10
5
0
1st time

2nd time

3rd time

Pain of the interscapular region

Sweating

Tinnitus

Stomach upset

Lack of appetite

Sleep disorder

Chilling of feet

4)5)

Hiromichi

Fukushima:

Adjustment

of

the

restraining five phases, essentials of meridian

originating from the cervical vertebrae; All Japan

therapy; Secretariat of the Toyo Hari Medical

Hospital Publication Society; 2008:19-15.

Association; 1984:274-269

ofshoulderJunichiro Hamada: Cultural background of

8)

KazutoMiyawaki:Easilyunderstandable

shoulder stiffness as well as examination andextraordinary vessel treatment; extraordinary

treatment of primary shoulder stiffness; Practicalvessel abdominal diagnosis; Taniguchi Shoten;

examination of shoulder stiffness and pain; All2005:81-63
9)

Norio Hayashi: The mechanisms of shoulder

Tetsuya Shinozaki, Kenji Takagishi: Pathology

stiffness seen from the point of view ofand symptoms of shoulder stiffness, MBOrtho

physiotherapists;

p19(4) 2006:1-5

shoulder stiffness and pain; All Japan Hospital

Shogo Takama, Kunihiro Kato: Kinesiologic

Publication Society; 2008:41-34.

Practical

examinationofapproach to shoulder stiffness and pain;

10) Sakae Yoneyama: Modern medical explanation

Practical examination of shoulder stiffness andof shoulder stiffness – interpretation based on thepain; All Japan Hospital Publication Society;myofascial (tendinous) system; The Japanese

2008:96-85

JournalShinichi

Kinoshita:

Examinationofpsychological and social stress induced shoulder

6)

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