Stomach 38 is recognized in TCM as an empirical point for frozen shoulder (adhesive capsulitis). This point can also be used for other shoulder joint disorders including pain following dislocation, AC joint dysfunction, glenohumeral arthritis, and chronic shoulder pain in general. However, getting the best results when using this point depends on several factors. A key question to ask when using ST 38, and for acupuncture in general, is how do we combine this point with other points to get the most effective results?
Let’s compare two styles of acupuncture, TCM and Master Tung's methods, to see how each system arrives at using Stomach 38 (ST 38) and/or similar points. In TCM shoulder pain is classified as Bi syndrome which may be divided into wind-cold-damp bi, heat bi, and qi and blood stagnation bi. In TCM ST 38 would be combined with other points appropriate to the specific pattern of bi syndrome. For wind-cold-damp patterns ST 38 could be combined with points like LI 4, ST 40, SP 9, GB 20, etc. In a qi and blood stagnation pattern points like LI 4, LV 3, and SP 10 could be combined with ST 38.
In Master Tung style acupuncture, points near stomach 38 are used as a dao ma for shoulder pain. A dao ma is defined as a group of 2 or 3 points in close proximity and with a similar function. In Tung's acupuncture methods, there are two groups of points near ST 38 that are used for treating shoulder pain. The first group, the Four Flowers (77.08 & 77.09) are near ST 36 and ST 37, but are located directly on the border of the tibia rather than one cun lateral. The second group 77.24 and 77.25 are very close to ST 38. The first point 77.24 is one cun above ST 38 and one cun lateral, while 77.25 is one cun below ST 38 and one cun lateral. This places them in very close proximity. In the image below 77.24 (Foot Thousand Metal) and 77.25 (Foot Five Metal) are indicated by the red dots.
The image on the left shows what is known as the Superficial Front Line (SFL). Notice that all of the points we are discussing are located on this myofascial line.
One thing I like about the Tung system is that it offers fast, effective, and easy-to-use point combinations for specific conditions. For instance, we can use either of the two-point units 77.08 & 77.09 or 77.24 & 77.25 to treat frozen shoulder, shoulder impingements, and AC joint pain. However, with all of these points in or around the ST meridian, how do we know which ones to choose? I will return to this question soon.
Notice that in the picture all of these points including ST 38, 77.08, 77.09, 77.24, and 77.25 are located on the SFL. We can also see how the SFL is very similar to the ST meridian. Let’s also note that all of these points are located in the muscle tibialis anterior. In some people, 77.25 may be located in the extensor digitorum longus, but this is also a part of the SFL. Additionally, a group of points known as the Three Weights (77.04, 77.05, 77.06) are also located in extensor digitorum longus, and are also effective for anterolateral shoulder pain. This brings us to a total count of eight points on the SFL that can be used for shoulder pain.
So back to the original question, with all of these points, how do we choose the best ones to use?
This is where the art of touch and palpation comes in to the equation.
We must palpate each client to best determine what points to use. When we palpate we need to look for trigger points and tender points. We need to refine our palpatory skills so that we can best determine where tension is being held in each client’s myofascial system. If we simply plug points in based on textbook point locations, without doing a thorough physical exam, we will often miss our mark.
Palpating the Lines
To palpate the SFL and ST meridian I typically begin just below ST 35, pressing on the edge of the tibia and in the small space between the edge of the bone and the tibialis anterior muscle. This is the region where the Tung points are located, and they are often more sensitive than the stomach meridian points. After palpating this line I will move to the stomach meridian and thus palpate down the belly of the tibialis anterior muscle. It is important to compare these two lines to find where the most sensitive points are located.
When I reach the distal end of the leg I like to compare the reactivity of the Three Weights to the points more proximal like ST 38, 77.24, 77.25, 77.08, and 77.09. If the Three Weights are the most sensitive I will needle them instead of ST 38 or the other points. If I find that ST 38 has a reactive bulge in the muscle that feels tight, I will needle that point along with two more. Those other two points might be one of the Three Weights and 77.09. It might be any combination of two points that we have discussed. I'm not fixed on doing the same two or three point combinations for every patient. I let their body decide where I'm going to place the needles. I find the two or three most sensitive points in the SFL that are holding tension and needle them.
Give this method a try on your next patient with anterior or lateral shoulder pain. Simply palpate the lines and point regions to find the most sensitive areas or those with trigger points. These points should also be needled on the same side as the pain.
In light,
Jim Spears M.S.