Pestle Needle (Chu Zhen) Treatment for Neck Pain

Abstract

Background:

Neck pain—called Jing Bi or Neck Bi-syndrome in Traditional Chinese Medicine (TCM)—is frequently treated with various TCM modalities. Pestle needle (Chu Zhen) is a unique noninvasive treatment method that originated from the Sichuan province in China. This therapy is a combination of acupuncture and massage. There is little research on the clinical use of pestle needle, and detailed case reports are few in number.

Cases:

This report describes 3 patients' neck pain-treatments via pestle needle; the patients were from Denmark, Indonesia, and China.

Results:

Each author treated 1 of the patients; 1 patient had a significant reduction of his neck pain and 2 patients had successful resolution of their neck pain.

Conclusions:

The clinical experiences of the 3 authors showed that pestle needle therapy could be an effective and simple noninvasive technique to relieve neck pain.

INTRODUCTION

Neck pain occurs between the superior nuchal line and the spinous process of the first thoracic vertebra. Sometimes the pain can be referred to the head, trunk, and upper limbs. Neck pain is becoming increasingly common throughout the world and has a considerable impact on individuals and their families, as well as on communities, health care systems, and businesses.¹ The prevalence of neck pain is estimated as 8% in the general population, the 1-month prevalence is 23%, the 1-year prevalence is 37%, and, finally, the lifetime prevalence can be as high as 48%.² Neck pain is positively related to neck flexion, arm force, arm posture, duration of sitting, twisting or bending of the trunk, hand–arm vibration, and workplace design.³

Neck pain is called Jing Bi (颈痹) or Neck Blockage in Traditional Chinese Medicine (TCM). Various TCM modalities, including acupuncture, tu'ina, acupressure, cupping, etc., could be efficacious for treating neck pain. ⁴ Acupuncture added to routine care in patients with chronic neck pain has produced better effects with reductions in neck pain and disability, compared to treatment with routine care alone.⁵ Tui'na treatment was effective, safe, and relatively cost-effective for patients with chronic neck pain.⁶

Pestle needle (Chu Zhen) therapy is a noninvasive acupoint-stimulating method characterized by a unique set of points, specialized tools, and specific methods of manipulation.⁷ Pestle needle therapy—originating from Taoist medicine and Dao Ying (Qi Guiding) practices—was first written about in a book by Professor Li Zhongyu from the Chengdu University of Traditional Chinese Medicine in the 1970s.⁸ Li's ancestors learned the pestle-needle therapy technique from the Taoist Master Ru Huan from the Wudang Mountain. From then on, pestle needle passed through 16 generations.⁸

Pestle needle is not a local acupuncture style in the Sichuan province—the technique has spread internationally. Pestle needle therapy is a form of acupoint- and meridian-stimulation that was developed from the “nine needles” of the Yellow Emperor's Internal Classic (Huang di Neijing) and is rooted in the theory of meridians and collaterals.⁹ This unique method is a combination of needling and massage. Pestle needle has been used to treat posthemorrhoidectomy pain, lumbodynia after lumbar disc-herniation surgery, lower-back pain, insomnia, ankylosing spondylitis, etc.^9–12 Four specially designed noninvasive needles are used in pestle needle therapy: (1) the Seven Pronged Pestle (Qiyaohunyuanchu); (3) the Three and Five Pronged Pestle (Wuxingsantaichu); (3) the Vajry Pestle (Jingangchu); and (4) the Pencil Pestle (Kuixingbi), as shown in Figure 1.

FIG. 1.

The 4 pestle needles (Chu Zhen): (A) Qiyaohunyuanchu. (B) Wuxingsantaichu. (C) Jingangchu. (D) Kuixingbi.

There are 2 types of acupoints (i.e., Bazhen and Hechelu). A Bazhen points array consists of a center and 24 points as shown on the 3 circles in Figure 2. For instance, in GV 14–Bazhen (Fig. 2), the 8 points on the internal circle are located 1 cun (∼ 1”) from the center point (GV 14) on the 8 directions, based on the array of 8 trigrams. The 8 points on the middle and external circle are located 2 cun and 3 cun from the center point, respectively. Hechelu refers to the 7 lines running on the back and front aspect of the body (Fig. 3). : 1 middle line (the Du or Ren channel); 2 lines 0.5 cun bilaterally; 2 lines 1.5 cun bilaterally, and 2 lines 3 cun bilaterally. Commonly used manipulations include rotating massage (Yunzhuan), stroking up-and-down (Shengjiang), tapping (Diankou), pressing and releasing (Kaihe), and separating (Fenli).

FIG. 2.

GV 14—Bazhen points.

FIG. 3.

Seven lines of Hechlu at the back or front of the body.

THREE CASES: TREATMENTS, AND RESULTS

The three cases below illustrate the authors' clinical experiences in treating neck pain using pestle needle therapy. The pestle needle treatment was explained to the patients and, then, informed consents were acquired from the patients.

Case 1

Mr. C (Danish), a 38-year-old programmer, was suffering with right neck pain for 8 months. His pain was scored on a visual analogue (VAS) at level 7. On his first visit, he presented with stiffness, pain on the right side of the neck and trapezius muscle, and slight numbness of his fingers. Various tender points were found along the Large Intestine and Sanjiao meridians. His pulse was wiry. His tongue coating was thin and white, and the tongue body was slightly dark. In addition, his sublingual vein was purple and slightly enlarged. He reported that his pain became worse if he worked on his computer for more than 2 hours. This pain also disturbed his sleep at night. He had no history of any traumatic injuries. He was diagnosed as having Jing Bi (Neck Bi-syndrome) with Blood Stasis in the Large Intestine and Sanjiao meridians.

GV 14 Bazhen was treated with rotating massage with the bottom of the Jinganchu for 2 minutes and tapping with the tip of the Jinganchu on all 25 points by a reducing manipulation (i.e., tapping heavily and slowly with 60–80 taps/minute). Hechelu (GV 17 to GV 14) was reduced with stroking up-and-down with the Qiyaohunyuanchu for 2 minutes. Ashi points on the left arm, LI 4, and TE 3 were reduced with a pressing and releasing manipulation that was performed with the Kuixingbi.

This patient was treated twice per week. After 4 treatments, he felt apparent relief of the pain with a VAS of 2. Then, 3 more treatments were carried out, once per week. At his 1-month follow-up, he reported being almost pain-free. No adverse effects were observed.

Case 2

Mr. Y (Indonesian), a 62-year-old university lecturer, was obese (a body mass index of 34.8), had been suffering from neck pain and stiffness for nearly 6 months. He scored his VAS at level 8. He spent hours with his head in an antero-flexed position looking at a computer monitor or doing lecturing. Physiotherapy at a hospital near the university several times did not produce significant relief. He had no other complaints, except for primary hypertension, which was controlled with medications. A physical examination of his neck revealed Ashi points at the transverse processes of the right second, third, and fourth cervical vertebrae. A TCM examination led to the diagnosis of Neck Bi-syndrome.

Hechelu (GV 17 to GV 14) was treated mildly with stroking up-and-down, using the rounded end of the Jingangchu. Each side manipulation took ∼2–3 minutes. GV 14 Bazhen and GV 16 Bazhen were treated with rotation, using the rounded end of the Jingangchu for ∼2 minutes, and then with pressing and releasing 7–10 times at each point. Hechelu (GV 17 to GV 14) were treated again with stroking up-and-down, using the rounded tip of the Jingangchu. GV 14 Bazhen and GV 16 Bazhen were treated with rotation, using the rounded end of the Jingangchu. Finally, bilateral GB 21 was treated with a pressing and releasing manipulation. All manipulations were performed with moderate intensity. One treatment took 20 minutes. To facilitate manipulation, soothing massage oil was used as an adjuvant lubricant.

After the first session, the patient felt significant relief; his VAS was 4. He was instructed to rub the back of his neck with both hands several times every day for ∼1–2 minutes with his head upright or somewhat retro-flexed, and to reduce his antero-flexion of his head by adjusting the position of his monitor and working surface. Then, after the second session, 1 week later, his neck syndrome had practically vanished. This patient's condition remained fine at his 6-months' follow-up. No adverse effects were reported.

Case 3

Mrs. L (Chinese), 59, a retired teacher, suffered neck pain and stiffness for 10 months, which was worse after she became fatigued and cold and was better after she engaged in movement. This pain did not disturb her sleep. No radiation to the fingers was observed at that time. Four weeks prior to her current presentation, her impalpable pain became worse after she went on a tour and was cold; her neck movement was restrained. After hospitalization due to this neck pain, she was diagnosed with cervical spondylosis with of a cervical-nerve type. She was treated with acupuncture and medicine, and her symptoms disappeared. However, 5 days after discharge from that hospital, this patient's neck pain reappeared and she developed numbness in her fingers.

She presented at the current hospital with neck stiffness and impalpable pain that was worse at night, and she felt better when a warm compress was applied. She had a slightly dark color around her neck, a reduced cervical skin temperature, restrained neck movement, radiating pain to her right arm and fingers, numbness in her fingers, fatigue, lower-back pain, knee weakness, and watery stools. She averted cold situations. Her urine was clear, and she had no fever or sweating. Her tongue had a white and greasy coating and the body of her tongue was blue–purple. Her pulse was deep and wiry. Her TCM diagnosis was Neck Bi-syndrome with Wind and Cold Blockage, and Kidney Qi Deficiency.

For this patient's first treatment, Hechelu (GV 20–GV 17), Hechelu (GV17–GV14), Hechelu (GV 14–GV 9), Bazhen (GV 4), Bazhen (CV 8), PC 8, TE 5, and ST 36 were selected. The separating manipulation was applied on the Hechelu sections with the Qiyaohunyuanchu until her skin became red or she felt warm. Bazhen points were pressed with the Jinganchu, and even manipulation was applied 64 times for each spot. PC 6 and TE 5 were pressed with the Kuixingbi, with even manipulation, 64 times for each spot. ST 36 was added by the pressing technique, 64 times.

After the patient's first treatment, her neck stiffness and pain, and numbness in her fingers were reduced. The radiating pain disappeared. Her skin temperature became normal. In the second treatment, Hechelu (GV 17–GV 14), Hechelu (GV 14–GV 9), Niwan (GV 20), Shenque (CV 8), and ST 36 were selected. The separating manipulation was applied on the Hechelu sections with the Qiyaohunyuanchu until the patient's skin became red or she felt warm. Bazhen points were pressed with the Jinganchu, with moderate-intensity manipulation, 64 times for each spot. ST 36 was also pressed and released 64 times.

After this treatment, all of this patient's symptoms almost disappeared. For her third treatment, Bazhen (GV 20), Bazhen (GV 14), Bazhen (GV 4), Bazhen (CV 8), ST 36, and SP 6 were selected for manipulation. All Bazhen points were pressed with the Jinganchu, with moderate intensity, 64 times at each spot.

After 3 treatments (once every other day), all of the patient's symptoms disappeared, and she returned to work. In addition Zuo Gui Wan (Left-Restoring Pill) and Liu Wei Di Huang Wan (Six-Ingredient Rehmannia Pill) were given to her to address her Kidney Qi Deficiency. After 6 months, this patient confirmed that her neck pain did not recur.

DISCUSSION

The mechanism of pestle needling for relieving neck pain is relaxing and soothing the tense supportive tissues, including the muscles and ligaments of the neck, to facilitate blood and lymph circulation, absorb local inflammatory substances, and reduce swelling and compression upon nerve roots.¹³ In pestle needle therapy for a cervical syndrome, it is imperative to move Qi and Blood to alleviate the pain of the cervical Bi syndrome. Bazhen (GV 14; Dazhui) points are located at the base of the neck and at the meeting point of all Yang meridians. The manipulations on Bazhen (GV14) stimulate all the cervical segments, tonify Yang, relieve stiffness and pain of the neck and head, and calm the Mind. Manipulations on the Hechelu sections can promote Qi and Blood movement of the Du and Bladder meridians, which are frequently selected to treat neck pain.¹⁴ Distal points (e.g., ST 36, SP 6, and TE 5) can be added based on syndrome differentiation and the meridians connected to the morbid regions.

The cases in this report show that pestle needling can be performed with the special tools in various ways, depending on the therapists' preference. However, the principle is to start from the softer manipulations of relaxing with rotating massage, stroking up-and-down, tapping, and then pressing the Bazhen points with the pointed tip of the Jingangchu or Kuixingbi. Instruction for patients to imitate the simple manipulation of stroking up-and-down along the neck (Hechelu) bare-handed at home will expedite their recovery and smooth flow of energy and blood to relieve the various complaints due to the cervical syndrome swiftly.

CONCLUSIONS

The authors' clinical experiences showed that pestle needle therapy is an effective, safe, and simple noninvasive technique to relieve neck pain swiftly.

AUTHOR DISCLOSURE STATEMENT

No financial conflicts of interest exist.

AUTHORS' CONTRIBUTIONS

Each author wrote and edited the text about 1 case: Dr. Japaries was responsible for Case 2; Dr. Wen was responsible for Case 3; and Dr. Zhang was responsible for Case 1.

FUNDING INFORMATION

No funding was received for this study.