MEDICAL ACUPUNCTURE

Volume 28, Number 2, 2016

CASE REPORT
# Mary Ann Liebert, Inc.
DOI: 10.1089/acu.2015.1156

Use of Dr. Tan’s Chinese Balance Acupuncture

For Treatment of Chronic Neck–Shoulder Pain

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Arkady Kotlyar, PhD, DiplAc, Rina Brener, MD, and Michael Lis, MD

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ABSTRACT

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Introduction: Neck–shoulder pain is a common musculoskeletal problem that is often chronic or recurrent.

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The mechanism of the neck–shoulder pain musculoskeletal disorder is complicated, multifactorial, and
sometimes unclear.

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Cases: Seven patients presented at an outpatient pain clinic, each with a chief complaint of chronic neck–
shoulder pain that these patients had had for various time periods.
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Intervention: The patients were treated with 45-minute sessions of Chinese Balance Acupuncture per the
protocol of Richard Teh-Fu Tan, OMD, LAc.
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Main Outcome Measures: Pain intensity, pain duration, and quality of life (QoL) were measured during the
treatment period, and the QoL was measured during the 3-month follow-up after three acupuncture sessions.
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Results: After the third session (1.5 weeks after the beginning of treatment), the patients reported complete
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dissipation of pain or significant reductions in pain intensity. There was also substantial improvement in QoL
during the treatment period and during the 3-month follow-up.
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Conclusions: To date, this is the first case report on the effectiveness of Dr. Tan’s Chinese Balance Acu-
puncture for treatment of chronic neck–shoulder pain. Studies to confirm the results of the present report are
warranted.
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Key Words: Pain, Complementary and Alternative Medicine (CAM), Dr. Tan’s Chinese Balance Acupuncture
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INTRODUCTION heart rate variability (HRV), especially during sleep.3 In

addition, the neck–shoulder pain group in this study had a
lower activity level.3 Changes in HRV reflected an auto-
N eck–shoulder pain is a common musculoskeletal
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problem that is frequently chronic or recurrent.1 Mus- nomic imbalance associated with chronic musculoskeletal
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culoskeletal pain often co-occurs with sleep disturbances.2 pain.3

The mechanism of the neck–shoulder pain musculoskel- Moon et al. reported that patients with congenital
etal disorder is complicated, multifactorial, and sometimes monosegment synostosis between spinal levels C-2 and C-6
unclear.3 However, it is known that changes in physical complained of neck–shoulder discomfort or pain.4 It was
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activity and autonomic nervous system regulation may be concluded that spondylosis at the mobile segments in a
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involved in the pathogenesis of chronic neck–shoulder synostotic spine is a fusion-related pathology rather than
pain.3 In an investigation conducted by Hallman et al. pa- solely age-related disc degeneration.4
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tients with neck–shoulder pain were rated to have higher Although neck and shoulder pain are common, the presenting
levels of stress and fatigue, and reduced sleep quality.3 symptoms of shoulder and neck pathologies overlap signifi-
These patients also had elevated heart rates and reduced cantly.5 Medical history, physical examination, and imaging

Outpatient Pain Clinic, Kaplan Medical Center, Rehovot, Israel.

1
2 KOTLYAR ET AL.

studies are often nonspecific.5 On radiographs and magnetic

resonance imaging (MRI), the absence of abnormalities in the
area of the expected pain source can lead to the conclusion that
symptoms have nonorganic etiology.5 Yet, abnormal findings
on shoulder and spine images do not necessarily correspond to
the manifestation of pain.5 Approximately 1 in 25 patients seen
for a presumed shoulder or neck problem may have neck–
shoulder crossover, in which a pathology in one area may be
mistaken for or coexist with the other area.5

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The present case report describes the results obtained
using the Chinese Balance Acupuncture protocol of Richard

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Teh-Fu Tan, OMD, LAc, to treat chronic neck–shoulder

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pain. One of the unique features of this acupuncture method
is that it is fully based on the Meridian Theory—the diag-
FIG. 2. The X-ray depicting neck facet degenerative changes of
nostic tool historically used in an ancient system for acu-

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Patient 1.
puncture treatment.6

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had had these symptoms for *4 months. Based on his

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computed tomography (CT) scan, he was diagnosed with
CASES

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C-2–C-7 disc prolapse and cervical thecal sac compression.
An ultrasound showed tendinitis of the right shoulder and

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Patient 1

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A 70-year-old Caucasian male presented at an outpatient
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pain clinic with the chief complaint of chronic right shoulder–
neck pain that he had had for *1 year (Fig. 1). Based on his
X-ray, the patient was diagnosed with pain in the right
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right C-6 root lesion, and an electromyogram examination
revealed mild sensory axonal polyneuropathy. The patient
was prescribed 1 60-mg capsule of Duloxetine Delayed-
Release Capsules (Cymbalta) per day, 1 dose of acet-
aminophen (Rokacet Plus) 3 times per day, and a cervical

cervical facet irradiating to the shoulder, caused by degen- epidural steroid injection. The patient refused to receive the
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erative changes in the cervical facet (Fig. 2). About 3 epidural steroid injection and was prescribed acupuncture
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months before, he had already visited the outpatient pain treatment.

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clinic. He was prescribed Traumeel ointment three times

per day, a medial branches block C-3–C-6, and a right
Patient 3
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cervical facet block C-5–C-7. None of these procedures

affected the pain. The patient was prescribed acupuncture A 71-year-old Caucasian male was referred to the pain
treatment. clinic with the chief complaints of headache and chronic left
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and right neck–shoulder pain that he had had for *1.5

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Patient 2 years. Based on his CT examination, he was diagnosed with

diffuse idiopathic skeletal hyperostosis, stenosis in the
A 65-year-old Caucasian male presented at an outpatient
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cervical region, and pain in the cervical facet. Prior to the

pain clinic with the chief complaints of mostly right
referral to treatment at the pain clinic, he was treated with
shoulder–neck pain and weakness in both hands. The patient
600 mg per day of oral etodolac, a nonsteroidal anti-
inflammatory drug (NSAID). During the treatment period of
20 days, the NSAID treatment decreased the intensity of his
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pain to a certain extent. He was prescribed acupuncture

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treatment.

Patient 4
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A 41-year-old Caucasian male was referred to an outpa-

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tient pain clinic with the chief complaint of chronic left

shoulder–neck pain that he had had for *15 years.
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About 15 years before, this patient underwent surgery to

FIG. 1. The neck–shoulder area of pain shown by the patient (in
gray).
immobilize recurrent shoulder dislocation by screw fixation.
Postsurgery, pain in the left shoulder appeared and later
became exacerbated to neck–shoulder pain. About 6 years
later, the patient was operated on again twice to excise the
immobilizing screw. Based on a CT examination,
CHINESE BALANCE ACUPUNCTURE FOR NECK–SHOULDER PAIN 3

Patient 7
A 55-year-old Caucasian female was referred to the pain
clinic with the chief complaint of chronic left and right
shoulder pain that she had had for *7 months. Based on her
CT examination, she was diagnosed with rotator-cuff syn-
drome of the right shoulder and allied disorders, and adhe-
sive capsulitis of the left shoulder. The patient was
prescribed 600 mg of daily oral etodolac. During the treat-

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ment period of 20 days, the NSAID treatment did not affect
her pain. Thereafter, the patient was prescribed acupuncture

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treatment.

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METHODS

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Outcome Measures

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The outcome measures included pain intensity, pain du-

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ration, and quality of life (QoL). Pain intensity was rated

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using a numeric scale from 0 to 10, in which 0 was defined
FIG. 3. The computed tomography scan depicting severe de- as ‘‘no pain at all,’’ 1–3 as ‘‘mild pain,’’ 4–6 as ‘‘moderate

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generative changes in the left shoulder joint of Patient 4.
pain,’’ 7–9 as ‘‘severe pain,’’ and 10 as ‘‘the worst imag-
inable pain.’’7 At baseline, the patients rated their pain in-
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tensity as 10.
performed after the third surgery, he was diagnosed with
The outcome measures were documented from the be-
adhesive capsulitis, also known as ‘‘frozen shoulder,’’
ginning of acupuncture treatment throughout the treatment
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caused by severe degenerative changes in the shoulder joint
period. Prior to each session, all the details related to the
(Fig. 3). This patient was prescribed acupuncture treatment.
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effect of the previous session were recorded carefully in the

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patients’ files. After the pain had completely dissipated or its

Patient 5
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intensity had significantly decreased, the patients were fol-

A 69-year-old Caucasian male was referred to an outpa- lowed up for 3 months.
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tient pain clinic with the chief complaint of chronic pain in

both shoulders that he had had for *30 years. Based on his Diagnostics and Treatment
ultrasound examination, he was diagnosed with rotator-cuff
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As the first step, Dr. Tan’s Balance Acupuncture 1–2–3

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syndrome of the right shoulder and allied disorders, tendi-

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diagnostics was used to determine the affected meridians.6

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nitis and bursitis of the right shoulder, and a bilateral su-

The pain was determined as being a local problem involving
praspinatus tear. In his medical history, it was noted that he
an imbalance of the Shao Yang (Gall Bladder [GB] and
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had pharmacologically balanced diabetes mellitus and hy-

Triple Energizer [TE; San Jao) and hand Yang Ming (Large
pertension, aspirin-treated coagulation defects, ischemic
Intestine [LI]) meridians (Table 1). Chinese pulse diag-
heart disease, congestive heart failure, and a pacemaker
nostics was used to confirm the involvement of the
defibrillator implanted *4 years before. The patient was
diagnosed meridians. An oral informed consent for the
prescribed acupuncture treatment.
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publication of the present case report was obtained from

each patient.
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Patient 6
After the ‘‘sick’’ meridians were diagnosed, the second
A 49-year-old Caucasian male was referred to an outpa- step was to select two out of the five most popular and
tient pain clinic, with the chief complaint of chronic left effective Dr. Tan’s systems of meridian interrelations as the
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shoulder–neck pain that he had had for *6 months. About most appropriate treatment. Namely, System 2, the Bie-Jing
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1.5 years before, the patient underwent surgery to immo- (Branching meridian) was chosen to balance the LI and TE;
bilize recurrent shoulder dislocation. Postsurgery, left neck– and System 3, the Biao-Li (Interior–Exterior pairs) was
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shoulder pain appeared and increased, especially during
shoulder movements. Based on his MRI, he was diagnosed
with rotator-cuff syndrome of the left shoulder and allied
disorders. An ultrasound examination revealed a partial left
supraspinatus tear. The patient was prescribed acupuncture
treatment.
selected to balance the GB (Table 1).
In System 2, the interrelation of the meridians is based on
their Chinese names. System 2 demonstrates the mutual at-
traction and balance of the Yin–Yang meridians. Foot me-
ridians balance hand meridians and vice versa. Specifically,
foot Jue Yin (Liver meridian [LR]) balances hand Yang Ming
4 KOTLYAR ET AL.

Table 1. 1–2–3 Balance Acupuncture Summary

Steps Meridian(s) and points

1 Diagnosing the ‘‘Sick’’ meridian(s) GB, SJ, LI

2 Determination of ‘‘Treating’’ meridians System 2: Biao-Li (Interior–Exterior pairs) LR, KI
based on the 5 Systems System 3: Bie-Jing (Branching meridian)
3 Point selection Ashi points along LR and KI meridians,
above the medial malleolus of the
contralateral leg, * up to SP 6

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GB, Gallbladder meridian; SJ, San Jao meridian; LI, Large Intestine meridian; LR, Liver meridian; KI, Kidney meridian; SP, Spleen meridian.

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(LI), formerly called hand Jue Yang, and foot Shao Yin (KI
meridian) balances hand TE.
System 3 represents the Zang Fu interior and exterior
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other words, an image of the painful neck–shoulder area on
the foot–ankle area was expected to contain Ashi points
along the LR and KI meridians. The Ashi points were found

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counterparts. Namely, foot Jue Yin (LR) treats foot Shao above the medial malleolus, approximately up to SP 6. They

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Yang (GB) and vice versa. The meridians defined by even were punctured using oblique insertion of 0.25 · 50–mm

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systems (2 and 4) are punctured either ipsi- or con- silicone-covered, sterile acupuncture needles (Best Needles,
tralaterally, while those defined by uneven systems (1, 3, HaMillenium Chinese Medicine, Israel; Fig. 5). Acupuncture

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and 5) are punctured contralaterally only. Considering that sessions lasted at least 45 minutes, and three such sessions

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both an even and an uneven system were selected for were performed in the course of 1.5 weeks.
treatment, contralateral acupuncture was applied. The data were analyzed using an analysis of variance:
Finally, the third step was to determine the treating points two-factor without replication analysis. The value of
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along the LR and KI meridians (Table 1). The Reverse p £ 0.05 was considered significant.
Mirroring Format, in which the foot–ankle mirrors the
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neck–shoulder area and vise versa, was used (Fig. 4). In
RESULTS
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The acupuncture treatment did not cause any pain or

discomfort. No adverse events occurred during or after the
acupuncture treatment.
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Pain Intensity
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A gradual dissipation of pain or a significant decrease of

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its intensity in the neck–shoulder area was reported by the

patients following three acupuncture sessions (1.5 weeks
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after the beginning of treatment; Fig. 6). According to the

patients’ reports, the improvement started during the first
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FIG. 4. Illustration of the neck–shoulder pain area projection to FIG. 5. Representation of oblique acupuncture of the Ashi
the contralateral foot–ankle. points covering the LR and KI meridians.
CHINESE BALANCE ACUPUNCTURE FOR NECK–SHOULDER PAIN 5

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FIG. 6. The intensity of pain throughout the 1.5-week acupuncture treatment period, assessed by using a numeric pain-rating scale,

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expressed as mean – standard error. * Indicates statistical significance of the result.

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session. Following the first session, the patients reported a To keep the duration of pain as short as possible for the
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significant decrease in pain intensity from 10 to 5.5 – 0.5 other 6 patients, they continued treatment after the third
(mean – standard error [SE]; p = 0.00002). After the second session.
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session, an additional significant decrease of pain intensity
to 3.07 – 0.3 (mean – SE; p = 3.04E-10) was reported. Post Quality of Life
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the third session, 1 patient reported a complete dissipation of

Throughout the treatment period, starting post 1st session,
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pain, and the rest of the patients reported significant de-

the patients reported a dramatic improvement in their
creases in its intensity to 0.88 – 0.09 (mean – SE;
quality of night sleep as well as gradual, improved ability to
p = 8.5E-15). No statistical difference among the results re-
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move their upper extremities and considerable improvement

ported by the patients post each session was found ( p > 0.1).
in their QoL. During the follow-up period of *3 months
In patient 1, no severe irreversible damage was diag-
after the third session, no pain or a significantly decreased
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nosed. Hence, the effect of the treatment was sustained and

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intensity of pain was reported.

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long-lasting. During the follow-up period of *3 months

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after the third session, patient 1 did not report any pain.
In the other patients, the pain was associated with severe
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DISCUSSION
irreversible damage to anatomical integrity. A cervical root
lesion and sensory axonal polyneuropathy diffuse idiopathic
Chronic pain is a widespread problem that is a significant
skeletal hyperostosis and stenosis in the cervical region, and
burden on society.8 The response of the healthcare system to
severe degenerative changes in the shoulder joint were di-
the issue of chronic pain can be generally divided into
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agnosed in patients 2, 3, and 4, respectively. Rotator-cuff

several approaches. Among these approaches, the following
syndrome of the right shoulder was diagnosed in patients 5,
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can be taken into consideration and discussed.

6, and 7. To keep the intensity of pain as low as possible,
these 6 patients continued treatment after the third session.
Invasive Treatment
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Intravenous (IV) sedation analgesia is often used in pa-

Pain Duration
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tients with chronic spinal pain undergoing diagnostic spinal

Following the first two sessions, patient 1 (without severe injection procedures.8 The drugs used for IV sedation an-
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irreversible damage) reported a recurrence of pain with a
decreasing intensity, but the pain was not constant. Pain
duration decreased from constant before the beginning of
treatment to 7 – 1 hour (420 – 60 minutes) after the first
session, 30 – 15 minutes after the second session, and no
pain after the third session (Fig. 7).
algesia produce varying degrees of sedation, amnesia, an-
xiolysis, muscle relaxation, and analgesia.9 However, there
is no consensus with regard to the use of sedation analgesic
measures prior to controlled diagnostic blocks and the in-
fluence of these measures on the accuracy and validity of a
diagnosis.9 The immediate pain relief caused by cervical
6 KOTLYAR ET AL.

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FIG. 7. The duration of pain throughout the 1.5-week acupuncture treatment period, expressed in minutes as mean – standard error

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(SE). e, constant. W
and lumbar-facet controlled nerve blocks is not enhanced by limited.8 Furthermore, chronic exposure to opioids can re-
IV sedation with midazolam or fentanyl.9 This is especially sult in opioid misuse, addiction, and risk of overdose.8
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true if stringent outcome criteria are used, such as at least Therefore, nonopioid treatment options are warranted.8
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75% pain relief combined with an increase in range of Novel pharmacologic nonopioid agents may eventually
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motion for pain-limited movements.9 prove to be the most effective method of ameliorating the
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Wu et al. investigated pulse radiofrequency stimulation symptoms and adverse consequences of chronic pain.8 The
applied to the suprascapular nerve for adhesive capsulitis pain-management approach of the future may use multi-
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lesioning.10 The combination of pulse radiofrequency modal interventions that combine cognitive training regi-
stimulation with physical therapy provided better and faster mens with somatic therapies (e.g., physical therapy,
relief from pain, reduced disability, and improved passive massage, and/or acupuncture).8
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range of motion, an effect that persisted for at least 12 In a study by Andersen et al., patients with chronic
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weeks.10
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nonspecific pain in the neck–shoulder region were ran-

Smith et al. investigated the use of cervical radio- domized to 10 weeks of 3 · 20 minutes of scapular function
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frequency neurotomy for symptoms associated with chronic
whiplash disorder.11 The results of this study showed an
attenuation of the psychophysical measures of augmented
central pain processing and improved cervical movement.11
Work by Fernandes et al. suggested that suprascapular
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training.14 According to the results of the study, scapular-
function training is effective in reducing pain in adults with
chronic nonspecific pain in the neck–shoulder region.14
Lidegaard et al. investigated the acute and longitudinal
effects of resistance training on occupational muscle ac-

nerve block is reproducible, reliable, widely used in clinical tivity in office workers with chronic neck–shoulder pain.15
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practice, and an extremely effective treatment method for Acute response to a single session of resistance training
addressing chronic diseases that affect the shoulder.12 appeared to generate an unfavorable muscle activity pat-
Findings of a study performed by He et al. suggested that tern.15 Only the changes following 10 weeks of resistance
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coblation is an effective, safe, minimally invasive, and less- training were beneficial in terms of longer and more fre-
uncomfortable procedure for treating discogenic upper-back quent periods of complete muscular relaxation and reduced
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pain.13 pain.15
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Noninvasive Treatment TCM Acupuncture

Pain-management services focused on opioid pharmaco- Every year, *3 million American adults receive Tradi-
therapy represent one of the noninvasive approaches to tional Chinese Medicine (TCM) acupuncture treatment.16
chronic-pain treatment.8 However, for many patients with Chronic pain is the most common complaint for which TCM
chronic pain, the analgesic efficacy of long-term opioids is acupuncture is known to have analgesic physiologic
CHINESE BALANCE ACUPUNCTURE FOR NECK–SHOULDER PAIN 7

effects.16 However, there is no accepted mechanism by
which it could have persisting effects on chronic pain.16
Although TCM acupuncture is widely used for chronic
pain, considerable controversy regarding TCM’s value for
addressing chronic pain still remains.16 Vickers et al.
conducted a systematic review to identify randomized
trials using TCM acupuncture to treat chronic pain, in-
cluding nonspecific neck and shoulder pain.16 The indi-
vidual patient data meta-analyses in this review were
hand Yang and the foot Yin meridians balance each other and
vice versa. In this system, the acupoints are punctured on
either side of the body. Thus, balance is created by opposite
Yang–Yin polarity and opposite extremities.
3. Biao Li/Interior–Exterior pairs. In the third
system, the meridians are paired according to their Zang Fu
relationship (i.e., the foot Jue Yin (LR) and Shao Yang (GB)
balance each other. This is the only system in which the

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conducted using data from 29 of 31 eligible trials, with a hand Yin and Yang meridians balance each other, and the
total of 17,922 patients analyzed.16 TCM acupuncture was foot Yin and Yang meridians balance each other. In this

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found to be effective for treating chronic pain and, there- system, the acupoints are punctured on the contralateral side
fore, is a reasonable referral option.16 Significant differ-

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of the body. Thus, balance is created by the opposite side
ences between true and sham acupuncture indicated that and opposite Yang–Yin polarity.
acupuncture is more than a placebo.16

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To summarize, TCM acupuncture continues to gain ad- 4. The opposite of the Chinese clock. In the fourth

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ditional data confirming its effectiveness for treating various system, the meridians that are opposite on the Chinese clock

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disorders. (Fig. 8) balance each other (i.e., the foot Tai Yin [SP] bal-
ances the hand Shao Yang [SJ] and vice versa). In this

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system, the acupoints are punctured on either side of the
Dr. Teh-Fu Tan’s Chinese Balance Acupuncture

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body. Thus, balance is created by the opposite Yang–Yin
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polarity.
As opposed to TCM, Chinese Balance Acupuncture is
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fully based on the Meridian Theory, which has been his- 5. The neighbors of the Chinese clock. In the fifth
torically used as a diagnostic tool for effective acupuncture system, the hand meridians that are adjacent on the Chinese
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treatment.6 In TCM acupuncture, the Zang Fu diagnosis of clock (Fig. 8) balance the foot meridians and vice versa (i.e.,
Chinese Herbal Medicine is used.6 This diagnosis includes the hand Tai Yin (LU) and the foot Jue Yin (LR) balance
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such notions as Liver Qi Stagnation, Spleen Qi Deficiency, each other). Several meridian pairs of the fifth system
Blood Vacuity, and more.6
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overlap those of the first system. In the fifth system, the

Certainly, the method of treatment detailed in the present acupoints are punctured on the contralateral side of the
case report is not the first and only instance in which Dr. Tan’s body.
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Chinese Balance Acupuncture has been used successfully.

Actually, it is fully based on the I Ching (Yi Jing or Book of
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Changes) Balance Acupuncture. This ancient method relies

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on the interrelations of the acupuncture meridians, an idea

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first introduced by Dr. Chao Chen, LAc, Taiwan.17 The

interbalancing relations of the acupuncture meridians are
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summarized in the following five most efficient systems 6,17:

1. Chinese meridian name sharing. The first system

is based on the pairings of the acupuncture layers (i.e., the
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hand Tai Yang [SI] and the foot Tai Yang [BL] balance each
other). Consequently, the hand and foot Yang meridians
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balance each other, and the hand and foot Yin meridians
balance each other. In this system, the acupoints are punc-
tured on the contralateral side of the body. Thus, balance is
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created by the opposite side and opposite extremities. An

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exception is the Du (GV) and Ren (CV) meridians, which

also balance each other.
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2. Bie-Jing/Branching meridians. In the second

system, the meridians are paired by their Chinese names (i.e.,
the hand Tai Yin [LU] and the foot Tai Yang [UB] balance
each other). Consequently, the hand Yin and the foot Yang
meridians balance each other and vice versa. In addition, the FIG. 8. The Chinese clock.
8 KOTLYAR ET AL.

Summary Acupuncture, which is based on ancient Chinese philosophy

and is thousands of years old, is not yet explored.
As it can be seen from the above systems, Balance
Acupuncture is a very logical and straightforward method
that covers the whole body. Also, by definition, it is bal-
CONCLUSIONS
ancing rather than enforcing or dispersing. Therefore, the
application of this method does not have any contraindica-
To date, this is the first case report on the effectiveness of
tions. However, Balance Acupuncture has some limita-
Dr. Tan’s Chinese Balance Acupuncture for treatment of
tions.6 Rapid and constant aggravation, severely damaged

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chronic neck–shoulder pain. The method appears to be very
anatomical integrity, and restricted treatment frequency
logical, effective, and safe. Although severe and irreversible
limit the efficacy of the method.6

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damage to the anatomical integrity limits the efficacy of this
To strengthen the efficacy of acupuncture treatment, one
method, no effective treatment without limitations or side-
must first identify whether a disorder is local or global.6

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effects is known today. Considering the fact that the method
Disorders located in restricted areas and barely involving a
is balancing rather than dispersing or enforcing, no side-
systemic response or not involving it at all are referred to as

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effects are expected to be related to it. Certainly, studies
being local and are treated by local balance acupuncture.6

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validating the efficacy of Dr. Tan’s Chinese Balance Acu-

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Disorders involving a systemic response are referred to as
puncture treatment for neck–shoulder pain of various eti-

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being global and are treated by global balance acupuncture.6
ologies are necessary. Also, the absence of any side-effects
After this stage, Dr. Tan’s Balance Acupuncture is incred-

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caused by Chinese Balance Acupuncture has to be validated
ibly convenient to apply, and its strategy is deducible. The
and confirmed in additional studies. Further investigation of

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systematization of an implementation of the I Ching Bal-
the effectiveness of Dr. Tan’s Chinese Balance Acupuncture
ance Acupuncture, named by Dr. Tan ‘‘1–2–3 Acu-
for treatment of various disorders and the limitations of the
puncture,’’ is one of the components that form Dr. Tan’s
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method is warranted.
Chinese Balance Acupuncture.6 It is a three-step process
that includes:
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 First step—Determination of the involved or ‘‘sick’’ ACKNOWLEDGMENTS

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meridians.
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 Second step—Determination of the balancing meridi- The first author treated the patient, analyzed the data, and
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ans and the system to be used for treatment prepared the manuscript. The coauthors are mentors who
 Third step—Selection of the acupuncture points to be contributed equally to this work.
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punctured for treatment. The present work was performed at the Outpatient Clinic
of Pain, Kaplan Medical Center, in Rehovot, Israel. The
The meridians that are adjacent to the location of the
authors wish to thank the patients for their willingness to
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disorder (e.g., pain) are considered to be ‘‘sick.’’ The second

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grant consent to the publication of this report. The authors

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step is to reveal the most appropriate meridian(s) and sys-

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also express their gratitude to Dr. Tan, who performed de-

tem(s) to be used for balance acupuncture. The third step
cades of meticulous work to establish a simple, logical, and
relies on whether the disorder is defined as local or global.
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effective acupuncture method and now teaches it; and his

An additional factor to be taken into consideration for the
teaching assistant Delphine Armand, DVM, LAc.
selection of the points to be punctured is anatomical struc-
The present case report is a tribute to Tan, who passed
ture similarity.6
away at the end of December 2015.
In the present report, the second step revealed the most
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balancing meridians and systems. The cases of neck–

shoulder pain were defined as local disorders. Therefore, the
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AUTHOR DISCLOSURE STATEMENT

local balance approach was chosen for acupuncture treat-
ment.6 Anatomical structure similarity and the results of the
The authors have no conflicts of interest to declare.
second step led to finding the Ashi points at the anticipated
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locations. The third step was implemented following the

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detection of the Ashi points.

REFERENCES
The efficacy of the above method is best characterized by
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mediately.6 The results described in the present case report
support the above. The effectiveness of Chinese Balance
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