Dr Zijing Hu (M.B. M.

Med)
The Therapeutics of Lecturer: Department of
Complementary Medicine

Acupuncture and Moxibustion (Acupuncture)

Faculty of Health Sciences
University of Johannesburg
Myofascial pain syndrome (MFPS)
• Definition
• MFPS is a chronic muscular pain disorder in which
pressure on sensitive points in the muscles causes pain
in seemingly unrelated body parts and is described as
the sensory, motor, and autonomic symptoms caused by
trigger points (TrPs). The syndrome often happens after
repeated injury or muscle overuse.

• TrP is a hyperirritable spot in skeletal muscle or fascia

that is associated with a hypersensitive palpable nodule
in a taut band. A trigger point in a muscle can cause
strain and pain throughout the muscle.
• Epidemiology/prevalence
• Aetiology
• Aetiology for the development of trigger points is unclear.
• The experience of TrPs and their pain pattern and efficacy
of treatment is mostly clinical.
• Taut bands are the precursors of trigger points. They occur
commonly in many asymptomatic individuals, sometimes
tender and sometimes not.
• Injury to the muscles because of trauma or repetitive strain
from sustained muscle contractions are some of the most
common initiating factors.
• The spot is painful on compression and can give rise to
characteristic referred pain, referred tenderness, motor
dysfunction, and autonomic phenomena.

• Several potential mechanisms may play a role, such as

eccentric overload, submaximal sustained, and (sub)-
maximal concentric contractions. A key factor is thought to
be local ischemia, which leads to an acidic pH and
subsequent release of several inflammatory mediators in
muscle tissue.
• These taut bands can become active due to
psychological and biomechanical stress.

• Diverse factors can either exacerbate or alleviate

the pain, such as stress, repetitive strain, poor
posture, relaxation, medications, temperature
change, massage, local anaesthetic injections,
and electrical stimulation.

• There is usually a history of spontaneous pain

associated with acute overload or chronic
overuse of the muscle.
• Typical symptoms of MFPS
• Diagnosis and differentiation diagnosis
• Palpation of the skeletal muscle for the objective physical findings associated with MTrPs
is the gold standard for diagnosis of myofascial pain.
• Management
• The elimination of chronic overuse or stress injury of affected muscles.
• Treatment
• Treatment for MFPS typically includes medications, trigger point injections or physical
therapy.
• Medications: Pain relievers, antidepressants, sedatives, etc.
• Therapy
• Physiotherapy: stretching, posture training, massage, heat, ultrasound, etc.
• Acupuncture (Refer to the Bi pain syndrome, lower back pain, etc.)
Reference:
• Mayo clinic. (2020). Myofascial pain syndrome. Available from:
https://www.mayoclinic.org/diseases-conditions/myofascial-pain-syndrome/symptoms-
causes/syc-20375444
• Sharan, D. (2014). Myofascial pain syndrome: Diagnosis and management, Indian Journal of
Rheumatology, http://dx.doi.org/10.1016/j.injr.2014.09.013
• Desai, M. J., Saini, V., & Saini, S. (2013). Myofascial pain syndrome: a treatment review. Pain
and therapy, 2(1), 21–36. https://doi.org/10.1007/s40122-013-0006-y
• Fernández-de-las-Peñas, C., Dommerholt, J. (2018). International Consensus on Diagnostic
Criteria and Clinical Considerations of Myofascial Trigger Points: A Delphi Study. Pain Medicine,
19(1): 142–150, https://doi.org/10.1093/pm/pnx207
Bi pain syndrome
• Definition
• Bi pain syndrome refers to the syndromes characterised by obstruction of qi and blood in
the meridians and collaterals due to the invasion of pathogenic wind, coldness, dampness
and heat, and manifests as soreness, pain, numbness and heavy sensation of the limbs,
joints and muscles; which may or may not be accompanied with a limitation of movement.
• References
• Huang Di Nei Jing: The combination of pathogenic wind, coldness and dampness may
result in a Bi (pain) syndrome. The wandering bi will present if the pathogenic wind
prevails and the painful bi may occur if the pathogenic coldness prevails and the fixed bi
is the result of prevalence of pathogenic dampness.
• Shang Han Za Bing Lun: damp bi, blood bi, “disease of every joints”, etc.
• Yi Zong Bi Du: One should treat the blood first if they want to treat the pathogenic wind as
the pathogenic wind will disappear if the blood circulation has improved.
• Common medical conditions: rheumatoid arthritis, reactive arthritis, myofascial pain
syndrome, Ankylosing spondylitis, gout, etc
 • Aetiology
• Exogenous pathogenic wind, coldness, dampness and heat
• Anti-pathogenic qi deficiency

Sweating in a windy
environment Pathogenic qi invades the
meridians and stays in the joints
Sitting or sleeping in a Obstruction of qi and blood
humid environment
Working in the rain or in the
water
Result in pain due to obstruction
Pathogenic heat
• Syndrome differentiation
• Main manifestations: pain in joints and muscles and/or limitation of movement.

• Wandering bi (wind bi): wandering pain in the joints, especially the wrists, elbows, knees
and ankles; limitation of movements, chills and fever, a thin and white tongue coating,
floating or floating slow pulse.

• Painful bi (tong bi, cold bi): severe pain in joints, fixed location, aggravated in cold
environment/weather, alleviate in warm environment, limitation of movement, cold
sensation in the affected areas, a pale tongue with a thin white coating, floating tight
pulse.
• Fixed bi (zhuo bi, damp bi): numbness and heavy sensation of the limbs, swelling of
joints, fixed location, aggravated on cloudy and rainy days, a white, greasy tongue coating
and slow or soggy (Ru) pulse.

• Heat bi (re bi): one or multiple joints, local redness, swelling and excruciating pain with
limitation of movement, alleviated with coldness, accompanied by fever and thirst, a
yellow or yellow, greasy tongue coating, slippery, rapid or floating, rapid pulse.
• Treatment principles: relieving pain and unblocking qi and blood stagnation
• Mainly focus on the local acupoints and additional acupoints according to the meridian
differentiation approach may be used.

• Main treatment approaches

• Main acupoints: A-shi points and local acupoints
• Wandering bi: add BL17 (Geshu), SP10 (Xuehai)
• Painful bi: add BL23 (Shenshu), RN4 (Guanyuan)
• Fixed bi: add SP9 (Yinlingquan), ST36 (Zusanli)
• Heat bi: add Du14 (Dazhui), LI11 (Quchi)
• Local acupoints:
• Shoulder: LI15 (Jianyu), SJ14 (jianliao), SI10 (naoshu)
• Elbow: LI11 (Quchi), SI13 (tianjing), LU5 (chize), shaohai (HT3), SI8 (Xiaohai)
• Wrist: SJ4 (Yangchi), SJ5 (waiguan), LI5 (yangxi), SI4 (wangu)
• Back: DU14 (Dazhui), DU12 (shenzhu), DU3 (yaoyangguan), EX-B2 (Huatuojiaji)
• Hip: GB30 (Huantiao), GB29 (juliao), BL54 (zhibian)
• Thigh: LI18 (Futu), BL37 (yinmen), BL36 (chengfu), Gb31 (fengshi), GB34
(yanglingquan)
• Knee: ST35 (Xiyan), ST34 (liangqiu), GB34 (yanglingquan), GB33 (xiyangguan)
• Ankle: BL62 (Shenmai), LD6 (zhaohai), BL60 (Kunlun), GB40 (qiuxu)
• Needling techniques:
• Filiform needles with reducing or even manipulation techniques.
• Cold bi and damp bi: add moxibustion; Heat bi: DU14 (Dazhui) and LI11 (Quchi), prick to
bleed; Cupping may be applied in the affected areas
• Other treatment approaches:
• Skin needling technique followed by cupping: along the back transport points and affected
area.
• Electro-acupuncture technique: electrical stimulation on the above acupoints after De Qi,
firstly Con. wave 5 minutes followed by D-D wave 10-20 minutes
• According to the meridian differentiation: choose the acupoints in the lower region for the
disease in the upper region and choose the acupoints in the right (left) side for the
disease in the left (right) side of the same name meridian

Pain in the left shoulder Acupoints: SP9 (Yinlingquan) through to Gb34

(Hand taiyin meridian)
Pain in the left shoulder
(Hand yangming meridian)
Pain in the left shoulder
(Hand taiyang meridian)
(Yanglingquan) (right)
Acupoints: ST38 (Tiaokou) through to BL57
(Chengshan) (right)
Acupoints: BL58 (Feiyang) through to SP7 (Lougu) (right)
• Note:
• Bone cancer or bone TB need to be differentiated.
• Recommend that the patients keeps warm and avoids exposure to pathogenic wind,
coldness and dampness (Such as windy, cold or humid weather).
Appendix: Meralgia paresthetica
• Definition
• Meralgia paresthetica is a medical condition resulting from
compression (pressure on or squeezing) of the lateral femoral
cutaneous nerve (LFCN) and resulting in sensations of aching,
burning, numbness, or stabbing in the thigh area.

• Symptoms
• Tingling and numbness in the outer (lateral) part of your thigh
• Burning pain on the surface of the outer part of your thigh
• These symptoms commonly occur on one side of your body and
might intensify after walking or standing.
• Mostly one side
• Aetiology
• Meralgia paresthetica occurs when the lateral femoral cutaneous nerve — which supplies
sensation to the surface of your outer thigh — becomes compressed, or pinched.
• Common causes
• Tight clothing, such as belts, corsets and tight pants
• Obesity or weight gain
• Wearing a heavy tool belt
• Pregnancy
• Scar tissue near the inguinal ligament due to injury or past surgery
• Nerve injury, which can be due to diabetes or seat belt injury after a motor vehicle
accident, for example, also can cause meralgia paresthetica.
• The following might increase the risk of meralgia paresthetica:
• Extra weight. Being overweight or obese can increase the pressure on your lateral
femoral cutaneous nerve.
• Pregnancy. A growing belly puts added pressure on your groin, through which the lateral
femoral cutaneous nerve passes.
• Diabetes. Diabetes-related nerve injury can lead to meralgia paresthetica.
• Age. People between the ages of 30 and 60 are at a higher risk.

References
• Mayo clinic. (2020). Meralgia paresthetica. Available from: https://www.mayoclinic.org/diseases-conditions/meralgia-
paresthetica/symptoms-causes/syc-20355635
• Cleveland clinic. (2020). Meralgia Paresthetica. Available from: https://my.clevelandclinic.org/health/diseases/17959-
meralgia-paresthetica
• Treatment principles: activating qi and blood circulation, unblocking meridians.
• Main treatment approaches
• Main acupoints: local points and points on the foot shaoyang meridian. Such as GB31
(Fengshi), GB30 (huantiao), ST32 (futu), SP10 (xuehai), A-shi points
• Acupoints at the lower back also may be added if due to the compression from lumbar
region, such as Yaojiaji (Huatoujiaji points of the lumbar region), BL25 (dachangshu)

• Needling techniques: Mostly filiform needling technique with reducing or even

manipulation approaches. Moxibustion may be added if due to coldness and dampness.
• Other approaches:
• Moxibustion, cupping and skin needling technique may be applied.
• Electro-acupuncture may be applied with the above acupoints, D-D wave, 20 minutes
• Three-edge needling technique + cupping, may be applied in a chronic condition where
the main symptom is numbness.
Lower back pain
• Definition
• Lower back pain refers to pain in the lumbar
region that is closely associated with chronic
lumbar muscle strain which results from injuries
that cause damage to muscles, ligaments, bones
and joints.

• Common medical condition: Soft tissue injuries

in the lumbar region, diseases related to the
vertebra and/or intervertebral disks in the lumbar
region and some other diseases related to
internal organs

• Aetiology
• Exogenous factors, trauma, over work
Attacked by exogenous
wind and coldness
Exogenous factors
Sitting or sleeping in
humid environment
Working involves prolonged
bending or heavy lifting
Trauma
Injuries from external forces
Weak body constitution, senior
Overwork
age, excessive sexual life
Obstruction of qi and
blood in the lower back
Obstruction of meridian qi due to
exogenous wind and dampness
Injuries of the meridians and collaterals,
obstruction of the meridian due to stagnant
blood
Malnourishment in
the lower back,
Kidney deficiency Coldness in the lower
back
• Syndrome differentiation
• Main symptoms: pain in the lumbar region;
pain may be in the du or bladder meridian

• Examination: Lumbar X-ray, CT or MRI;

gynecological examination
• Cold-damp: soreness, pain and stiffness that result in significant loss of range-of-motion
that is aggravated by humid or rainy weather; weakness, pain and swelling in the knees;
heaviness sensation. A pale tongue with a greasy coating; soggy and slow pulse.

• Blood stasis: fixed, stabbing pain in the lumbar region; mild condition may present with
difficulty bending; severe condition may present with difficulty in twisting. A purple tongue
with or without petechiae; choppy pulse.

• Kidney deficiency: dull pain in lumbar region that is relieved by pressing or rubbing,
weakness in knees and lower back, a sensation of bearing down or prolapse in the belly
or lumbar region that is relieved by lying and aggravated by exertion, frequent nocturia or
dribbling, lassitude and fatigue. A pale tongue with deep and weak pulse.
• Treatment principles: warming meridians and dispelling coldness for the damp-cold;
removing stagnant blood and activating blood circulation for the blood stasis.
• Main treatment approaches
• Main acupoints: BL23 (Shenshu), DU6 (Jizhong), DU3 (Yaoyangguan), BL25
(dachangshu), A-shi points
• Cold-damp: add DU2 (yaoshu) (moxibustion)
• Blood stasis: add BL17 (geshu)
• Kidney deficiency: add DU4 (mingmen shu) (moxibustion with Fuzi)

• Needling techniques
• A combination of acupuncture and moxibustion can be applied, with the reducing method.
• Tonifying kidney deficiency for kidney deficiency, a combination of acupuncture and
moxibustion, reinforcing manipulation approach
• Other treatment approaches:
• Skin needling technique + cupping: suitable for lower back pain due to cold-damp and
blood stasis
• Auricular acupuncture technique: lumbo-sacral vertebrae, kidney, ear shenmen region,
with filiform needling technique, and require the patient to move the lower back at the
same time.
• Electro-acupuncture: electrical stimulation on the above acupoints after De Qi, Con. wave
for 20-30 minutes
Acute waist strain
• Definition
• Acute waist strain involves damage to soft and connective tissues, such as joints,
ligaments, muscles, tendons and blood vessels of the waist due to

• Improper movements
• Overexertion
• Falls or sudden muscle strains

• There is neither damage to the skin, nor dislocations or fracture of bones/vertebra.

• Aetiology
• Damage to the soft tissue in the waist region

Sudden jerking, twisting or pulling movements

Obstruction of qi and blood in
during exercise, carrying heavy loads, …
the bladder meridian

Other possible causes:

Severe coughing, continuous sneezing,
yawning, ect.

Result in pain due to obstruction

• Symptoms:
• (Acute) swelling, pain and limitation of movement.
• A history of lumbar sprain
• Mild sprain, waist pain usually begins either after a few hours or 1-2 days
• Severe sprain, manifests with sudden, severe pain and limitation of movement (such as
difficulties in sitting, lying or standing, etc.)
• The pain is worse when coughing or sneezing
• Treatment principles: activating qi and blood circulation, relieving
pain. The primary points are Ashi points and points on the foot
taiyang meridian
• Main treatment approaches
• Main acupoints: A-shi points, BL23 (shenshu), EX-UE7
(yaotongxue), BL40 (weizhong)
• Severe pain in middle of the lumbar: add DU26 (shuigou), SI3
(Houxi)
• Needling techniques
• A-shi points, reducing manipulation method or bleed before cupping
• Strong stimulation or Electro-acupuncture may be applied on the
above acupoints
• Three-edge needling technique: BL40 (Weizhong)
• Yaotongxue (EX-UE7): filiform needles, towards the centre of the palm until the qi arrives
to alleviate sharp pain; then ask the patient to move his/her waist
• Note
• Acupuncture is considered to be one of the best treatment for acute waist sprains after
receiving a confirmed diagnosis that excludes fractures and/or dislocations.
• Treatment should incorporate needling distal acupoints while requesting the patient to
move his/her waist in order to promote the circulation of qi and blood.
• Results will be better if treatments are received immediately after injuries, otherwise there
is an increased incidence of chronic lower back pain.
• Exercise should be avoided in the acute stage. However, patients are recommended to
exercise to strengthen the waist after recovery.
Sciatica
• Definition
• Sciatica is a condition involving pain,
weakness, numbness, or tingling along the
path of the sciatic nerve, either partially or
along the whole nerve in the leg.

• The pain characteristically starts at one side

of the lumbar area or hip, radiating a burning
or lancing pain along the posterior thigh and
buttock, knee flexors and lateral side of leg.
• Aetiology
• Factors affecting the foot taiyang and foot shaoyang meridians
Injuries/trauma in the lower back/waist
Living in a humid environment,
prolonged exposure to rainy weather,
dressing in not enough clothes, sweating
a lot in windy weather
Damp-heat or stagnant dampness results in
internal heat
Obstruction of qi and blood in
the bladder meridian
Pathogenic wind, coldness and dampness
attacks the waist and lower extremities
Affecting the foot taiyang and foot
shaoyang meridians
Result in pain due to obstruction
• Symptoms:
• Shocking pain, burning sensation,
tingling
• Radiating pain in the lower back, hip,
thigh, calf or foot.
• Positive in the Straight Leg Raise (or
Lasègues) Test (SLRT)

• Examination: Lumbar X-ray, CT or

MRI

SLRT available from https://www.youtube.com/watch?v=LdAD9GNv8FI

• Nerve root affected: mostly one sided, fixed
pain in the lower back or sacrum region,
symptoms are aggravated by increasing
pressure in the abdomen
• Nerve trunks affected: no obvious pain in the
lower back, symptoms manifest mostly below
the hip
• Treatment principles: activating qi and
blood circulation, relieving pain.
• Main treatment approaches
• Main acupoints: mainly focus on the
foot taiyang and foot shaoyang meridian
• Foot taiyang subtype: GB30 (Huantiao),
GB34 (yanglingquan), BL54 (zhibian),
BL36 (chengfu), BL37 (yinmen), BL40
(weizhong), BL57 (chengshan), BL60
(Kunlun)
• Foot shaoyang subtype: GB30
(Huantiao), GB34 (yanglingquan), GB31
(fengshi), GB33 (xiyangguan), GB38
(yangfu), GB39 (xuanzhong), GB41
(zulinqi)
• Accompanied with pain in lower back region: add BL23 (shenshu), BL25 (dachangshu),
DU3 (yaoyangguan), yaojiaji, A-shi points
• If pain is related to the change in climate: add moxibustion technique on DU14 (dazhui)
and A-shi points
• Qi stagnation and blood stasis: BL17 (Geshu), LI4 (Hegu), LV3 (Taichong)
• Kidney deficiency: KD3 (Taixi)

• Needling techniques
• A combination of acupuncture and moxibustion, reducing manipulation method
• Prick to bleed followed by cupping on the A-shi points
• Electro-acupuncture may be applied on the above acupoints, D-D wave
• Three-edge needling technique: Weizhong (BL40)
• Note
• Find the causes, if any
• Acute stage, rest and lumbar/waist support
• Mind the posture
• Keep warm, especially in the lumbar region
 Dr Zijing Hu (M.B. M.Med)
Lecturer: Department of Complementary Medicine
(Acupuncture)
Room 7106d John Orr Building DFC
Faculty of Health Sciences
University of Johannesburg
Tel: 011 559 6999
E-mail: zhu@uj.ac.za