MEDICAL ACUPUNCTURE
Volume 28, Number 3, 2016
Mary Ann Liebert, Inc.
DOI: 10.1089/acu.2016.29023.cpl
CLINICAL PEARLS
How Do You Deactivate Painful Scars in Your Practice?
trittmater1 describes many instances wherein a
scar that is affecting a patient adversely can be treated by
needling or cold lasering the corresponding point on the ear.
Successful auricular therapy depends on an assessment that
leads to the proper selection of points to be treated. Strittmatter also describes the use of Nogier’s vascular autonomic
signal (VAS) as a means of assessing a scar and its effect on
a particular patient’s clinical condition.1
We describe an alternative assessment method that, in our
opinion, is easier to learn and requires less time to perform
than the VAS. This method combines auricular acupuncture
and an applied kinesiology (AK) technique known as autonomic response testing (ART).2–5 Instead of using the VAS to
choose auricular acupuncture points, the ART technique
utilizes the deltoid muscle strength of a surrogate as the indicator to help determine: (1) if a scar is abnormal; (2) if it
affects a particular area of the body; (3) if treating the scar
could improve the patient’s condition with respect to the
presenting complaint; and (4) where the effective treatment
point on the ear is for treating the presenting complaint.
This approach can frequently lead to an immediate
change in a patient’s clinical condition (i.e. decreasing pain,
increasing range of motion, and increasing strength). ART is
especially useful for addressing musculoskeletal pain and
sports injuries. We have had multiple successes using this
technique with National Football League (NFL) players and
other athletes. We have also had multiple successes treating
low-back pain related to Cesarean section scars.
ART2–5 is a form of AK developed by Dietrich Klinghardt,
MD, PhD, and Louisa Williams, ND, DC; it was developed
from the AK methods of George Goodheart, DC, Yoshiaki
Omura, MD,6–9 and others. AK is a form of manual muscle
testing wherein an interpretation is made regarding the response (weakness, no change, or strengthening) of a muscle
S
to manual muscle testing. The interpretation of the muscle
testing can help predict whether the patient will respond
with a positive, negative or neutral response to therapies.
Many chiropractors and holistic/integrative medicine
practitioners utilize some form of AK. In our experience,
and in other practitioners’ experience, use of a surrogate
whose muscle is tested while the surrogate is touching the
patient appears to produce more consistent results and is
more efficient than testing the patient’s muscle strength
directly.8 Different forms of AK can produce conflicting
results.2 In our experience, ART produces useful and
consistent information most of the time.
ART enables the practitioner to determine which area of
the body is abnormal and allows the practitioner to determine causal links between different areas of the body. We
use an assistant as a surrogate for the muscle testing. The
assistant makes physical contact with the patient. The assistant’s left or right hand touches an unaffected part of the
patient’s body while holding the other arm extended laterally abducted 90°. The practitioner then tests the patient by
pressing down on the outstretched arm of the assistant who
acts as a surrogate for the patient. The baseline strength of
the assistant is noted.
The practitioner then touches various areas of the patient’s
body while simultaneously testing the surrogate’s deltoid
muscle strength and comparing it to the baseline strength that
was initially established. The surrogate’s muscle strength can
change when the practitioner touches an abnormal area on the
body, such as an acupuncture point, strained tendon, Ah Shi
point, abnormal scar, etc. Prior to the muscle-testing technique
described above, a number of other steps are performed in the
ART protocol, using specialized low-technology equipment
that differentiates ART from other forms of AK. A detailed
description and explanation of the entire protocol is beyond the
Medical Acupuncture is pleased to continue this regular feature, Clinical Pearls, which we have found to be very useful for, and
practical to, the readership, and very popular. All of us are confronted with clinical challenges, especially when dealing with
therapeutic strategies. We hope this ongoing collection of Clinical Pearls will be easily accessible and ready to put into action for the
benefit of our patients, and even ourselves. How often do we ask our colleagues: ‘‘How do you treat. ?’’ This time, we posed the
question: ‘‘How do you deactivate painful scars in your practice?’’ Herein lie your contributions. We trust that our readership will
continue to participate in this section by either asking the questions or supplying the ‘‘Pearls.’’ If you have a ‘‘question’’ you would like
to see answered, please send it to our managing editor, Yael Ben-Porat, at: yaelbenporat@me.com We encourage and welcome your
input and participation. Please address your answers to ‘‘Pearls’’ to our managing editor, Yael Ben-Porat, at: yaelbenporat@me.com
# Myung Kyu Chung and Patrick J. LaRiccia, 2016; Published by Mary Ann Liebert, Inc. This Open Access article is distributed under
the terms of the Creative Commons Attribution Noncommercial License (http://creativecommons.org/licenses/by-nc/4.0/) which permits
any noncommercial use, distribution, and reproduction in any medium, provided the original author(s) and the source are credited.
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scope of this contribution, however, Dr. Klinghardt2 presents a
video overview on his website.
Phenomena of ‘‘Two Pointing’’
If an area (‘‘A’’) of a patient is found to be abnormal on
muscle testing, and another area (‘‘B’’) is found to be abnormal, and both A and B are touched simultaneously and
the muscle testing reverts back to normal, it is concluded that
there is a causal relation between areas A and B. (This reversal phenomena occurs whether the practitioner, the patient, or the surrogate assistant palpates one of the two areas).
An NFL player presented with knee problems and leg
weakness. Upon examination, it was noted that this patient’s
right hip flexors were weak, his right psoas muscle was
markedly tender on palpation, and trigger points were
present along the right quadriceps muscle. The patient had
three small arthroscopic ‘‘well-healed’’ surgical scars from
an arthroscopy of the right knee performed several years
before. He denied having knee pain. An ART examination
revealed abnormality of the right psoas muscle, right
quadriceps muscle, and right knee arthroscopic scars.
The arthroscopic scars ‘‘two pointed’’ to the psoas muscle.
That is to say, when the scar and the psoas muscle were palpated simultaneously, the ART testing result was normalized.
It was concluded that the arthroscopic scar was a causal
factor of the inability of the psoas muscle to fire fully.
163
2. Klinghardt D. Autonomic Response Testing Versus Classical Kinesiology [video]. Online document at: www.klinghardtacademy
.com/Videos/Autonomic-Response-Testing-vs-Classic-Kinesiology
.html Accessed January 9, 2016.
3. Klinghardt Academy. Dietrich Klinghardt, MD, PhD. Online
document at: http://www.klinghardtacademy.com/ Accessed
January 9, 2016.
4. Brobyn TL, Chung MK. The use of autonomic response testing
and the 5 Phases paradigm to identify unresolved feelings in
patients with mood disorders. In: Clinical Roundup. Altern
Complement Ther. 2015;21(4):183–184.
5. Brobyn TL, Chung MK, LaRiccia PJ. Neural therapy: An
overlooked game changer for patients suffering chronic pain?
[review]. J Pain Relief. 2015;4:184.
6. Klinghardt D, Williams L. A.R.T., Autonomic Response Testing. Self-published; 1996. Updated ART manuals and videos at
www.klinghardtacademy.com
7. Walther DS. Applied Kinesiology: Synopsis, 2nd ed. Pueblo,
CO: Systems DC; 2000.
8. Shinnick P. An introduction to the basic technique and theory
of Omura’s bi-digital O-ring test. Am J Acupunct. 1996;24(2–
3):195–204.
9. Shinnick P, Borgna A. Whole Person Healing: The O-Ring
Imaging Technique. Influences to Oriental and Occidental
Medicine. Bloomington, IN: Author House; 2009.
Myung Kyu Chung, MD1
Patrick J. LaRiccia, MD, MSCE2*
1
Department of Family Medicine
Cooper Medical School of Rowan University
Camden, NJ
2
51 North Market Street
Penn-Presbyterian Medical Center
Philadelphia, PA 19104
Phenomena of ‘‘Three Pointing’’
We then ‘‘three pointed’’ the knee region of this patient’s
right ear by touching the Nogier Phase 1 auricular knee point of
the right ear with a metal probe while the assistant simultaneously touched the psoas muscle. When the two areas were
touched simultaneously, ART testing results normalized.
Within minutes of needling the ear point for the scar, the patient’s hip flexors became markedly stronger, and the tenderness
to palpation essentially disappeared. The patient was flabbergasted that his long-standing problem was relieved dramatically
with a tiny needle placed in his ear for his knee scar.
Generally for centrally located organs, such as the Uterus,
the ear on the dominant-handed side is tested and needled.
For areas that are clearly on one side, such as the right psoas
muscle, the ipsilateral ear is tested and treated.
The ART three-point technique appears to enhance auricular acupuncture treatment of scars and identification of
body scars causing or contributing to a patient’s medical
problems. We are open to collaborations with other colleagues to develop a research agenda to confirm or disconfirm our conclusion.
REFERENCES
1. Strittmater B. Identifying and Treating Blockages to Healing:
New Approaches to Therapy-Resistant Patients. New York.
Thieme Publishing; 2003.
*Address correspondence to:
Patrick J. LaRiccia, MD, MSCE
E-mail: lariccip@mail.med.upenn.edu
T
his contribution deals with external scars (skin
and musculoskeletal); deeper scars, such as intraabdominal surgical scars, are excluded.
Scars are areas of fibrosis that replace normal tissue after
injury. Some are contractile scars that form after the contractile healing process in a scar that has already been epithelialized and healed.1 Hypertrophic scars are fibrous
tissue outgrowths that form from a derailment of a normal
healing process. When a hypertrophic scar extends beyond
the wound margin, it is a keloid.2
Globally, *75 million people develop postsurgery scars
each year.3 Scar tissue becomes painful when there is
damage to a small nerve or when a nerve is entrapped within
the scar.4 Sometimes there is a neuroma formation at the
end of a damaged nerve. Squeezing a certain part of the
scar may be painful. Modern medicine treatment involves
cognitive–behavioral therapy, antidepressants, rehabilitation,
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neuropathic pain medication (pregabalin), capsaicin cream,
transcutaneous electrical nerve stimulation, local injection
of steroids with local anesthetics, nerve blocks, and nerveroot blocks.
In Chinese Medicine (CM), a painful scar is an example
of Bi syndrome or Chronic Painful Obstruction syndrome,
meaning that there is an obstruction to the free flow of Qi
and Blood in the channels. This is a channel syndrome and
the treatment has to be channel-based.
Muscle meridians are branches of the principal meridians
(PMs), and through the muscle meridians, the PMs exert their
influence on the periphery of the body. The muscle meridians
have almost identical trajectories as PMs. All PMs begin or
end at the base of a nail with the exception of the Kidney
meridian, which begins at the sole of the foot. These are the
Ting Well points. All PMs have a Tonification point either
below the knee or below the elbow (see Table 1). The muscle
meridians differ from the PMs in that they have no connection
with the internal organs and the flow of Qi in them is always in
a centripetal direction from the periphery to the center, irrespective of the direction of flow in the PMs to which they
belong.5 When one stimulates the Ting Well point, there is a
surge of Qi at that point, and, when one stimulates the Tonification point, the flow of Qi is accelerated.
In some meridians, Ting Well and Tonification points are
the same. In that case, use a Source point instead of a Tonification point. To facilitate the flow further, the meeting
points of the corresponding meridians are stimulated (see
Table 1). All these points are stimulated using the reinforcement method. The painful area is where the Qi is
blocked, and that area is stimulated using the reduction
method. This is more effective when one uses electroacupuncture (EA; 10 mA/4 Hz) for up to 20 minutes at the
tender points around the area of the scar. All these points are
stimulated bilaterally except the Tonification point, which is
stimulated only on the side where the pain occurs. This
approach is taken to create an asymmetrical situation, which
makes the stimulation more dynamic.
The Penetrating Vessel is the Sea of Blood; stimulation of
this vessel relieves Blood Stagnation anywhere in the body.
This is achieved by reducing SP 4 (Rt), PC 6 (Lt), in that
order, for women; and SP 4 (Lt) and PC 6 (Rt), in that order,
for men.6
Also one should reduce BL 17 (Back Shu point for Blood)
and SP 10 to reduce Stagnation of Blood further.
If the scar is confined to the skin, one can just use EA
(10 mA/4 Hz) for 20 minutes at points around the scar tissue.
If this is not sufficient, other steps, as described above, may
be taken. In cases of musculotendinous scars, such as
rotator-cuff syndrome, all the abovementioned steps would
be necessary. For example, if the pain were over the anterior
shoulder (LI meridian) on the right side, one would reinforce LI 1 on both sides (Ting Well point), reinforce LI 11 on
the right side only (Tonification point), and reinforce GB 13
bilaterally (meeting point). One should reduce all tender
points (Ah Shi points) electronically over the anterior
shoulder. If the pain is over the posterior shoulder, the involved meridian would be the Small Intestine channel and
the corresponding points of that channel would be used (see
Table 1).
ST 38 is an important additional point for addressing
anterior shoulder pain. If one looks at the circulation of Qi,
the first circulation starts at the Lung meridian. This connects at the index finger to the Large Intestine meridian, and
then connects to the Stomach meridian in the face, flowing
down to the foot through the Stomach meridian, which
connects with the Spleen meridian and then back to the
Lung meridian. There are two axes here: (1) Large Intestine +
Stomach and (2) Lung + Spleen meridians. Use of distal
points are very effective in resolving channel problems and,
in the case of the anterior shoulder (the Large Intestine
channel), the distal point should come from the Stomach
channel (the same axis). That is why ST 38 is such an important point for resolving anterior shoulder pain. If it were
a posterior shoulder lesion, the corresponding point would
be BL 58 (Small Intestine, Urinary Bladder axis). This
Table 1. Ting Well, Tonification, Source, and Meeting Points of Muscle Meridians
Meridian
Lung
Pericardium
Heart
Spleen
Liver
Kidney
Large Intestine
Triple Burner
Small Intestine
Stomach
Gall Bladder
Bladder
Ting Well points
Tonification points
Source points
Meeting points
LU 11
PC 9
HT 9
SP 1
LR 1
KI 1
LI 1
TB 1
SI 1
ST 45
GB 44
BL 67
LU 9
PC 9
HT 9
SP 2
LR 8
KI 7
LI11
TB 3
SI 3
ST 41
GB 43
BL 67
LU 9
PC 7
HT 7
SP 3
LR 3
KI 3
LI 4
TB 4
SI 4
ST 42
GB 40
BL 64
GB 22
GB 22
GB 22
CV 3
CV 3
CV 3
GB 13
GB 13
GB 13
ST 7/SI 18
ST 7/SI 18
ST 7/SI 18
CLINICAL PEARLS
would then be followed by SP 4 + SP 6, BL 17, and SP 10, as
described above.
It is an axiom in CM, to treat Phlegm in any recalcitrant
case and, if a case is resistant to treatment, even if there are
no signs of Phlegm—such as a swollen, thickly coated
tongue and a slippery pulse—one should reduce SP 9 and
ST 40 to resolve the Phlegm. The current author treats such
cases with acupuncture twice per week for 8 weeks and then
at monthly intervals until relief is obtained. Neuropathic
pain usually resolves slowly.
Although the abovementioned method is effective, the
result in many cases may be short-lived. The concomitant
use of Chinese herbal preparations—such as Miraculously
Effective Invigorating the Connecting Channel Pill or Three
Treasures Benefit the Sinews Remedy—usually helps prolong the effects of acupuncture, thus reducing the frequency
and number of treatments, as they reduce Blood Stasis.
Homeopathic Lachesis 30c (resolves Blood Stasis), at a
dose of 5 drops daily for 3 days and then twice a week, can
be used instead of Chinese herbs, often with better results, as
both systems work through the Life Force. In the current
author’s experience this combination has helped in nearly
all cases with varying levels of improvement.
In intractable cases one can apply Battlefield Acupuncture,7 using bilateral stimulation of auricular points—
Cingulate Gyrus, Thalamus Point, Omega 2, Point Zero and
ear Shenmen.
165
4. University Pain Centre Maastricht (UPCM). Scar Tissue Pain
[in Dutch]. Online document at: www.pijn.com Accessed
March 27, 2016.
5. Sudhakaran P. Use of Ting Well points for chronic musculoskeletal pain (chronic painful obstruction syndromes or
‘‘Bi’’ Syndromes). Med Acupunct. 2012;24(2):82–88.
6. Sudhakaran P. Acupuncture for irritable bowel syndrome.
Med Acupunct. 2013;25(1):78–87.
7. Niemtzow RC. Battlefield Acupuncture. Med Acupunct. 2007;
19(4):225–228.
8. Dimitrova A, Murchison C, Oken B. Effect of acupuncture on
neuropathic pain: A systematic review and meta analysis
(P3.306). Neurology. 2015;84(14):Supp P3.306. Online document at: http://www.neurology.org/content/84/14_Supplement/
P3.306 Accessed January 28, 2016.
9. Fang S. The successful treatment of pain associated with scar
tissue using acupuncture. J Acupunct Meridian Stud. 2014;
7(5):262–264.
10. Song H, Mu JP, Wang J. Clinical study on treatment of hypertrophic scar by acupuncture. J Acupunct Tuina Sci. 2011;
9(3):159–161.
Poovadan Sudhakaran, MBBS, PhD,
MastACU, MastTCM
26 Tuckers Road
Templestowe, 3106
Australia
E-mail: dr.p.sudhakaran@gmail.com
Evidence for Acupuncture
Scar pain is an example of neuropathic pain.4 Studies
show beneficial effects of acupuncture on neuropathic pain.8
Fang reported on a case of severe scar pain treated with
acupuncture, with reduction of pain from 7 to 1 on a Likert
scale of 0°–10.9 Kitade et al. reported beneficial effects of
acupuncture on scar-pain syndrome as cited by Fang.9 Song
et al. reported a 93.9% effective rate in relieving pain in
hypertrophic scars with acupuncture in 40 cases, compared
to placebo.10
All treatments should be undertaken by a suitably qualified medical practitioner.
REFERENCES
1. Rudolph R, Vande Berg L, Elrich HP. Wound contraction and
scar contracture. In: Cohen IK, Diegelmann RF, Lindblod
WS, eds. Wound Healing: Biochemical and Clinical Aspects,
1st ed. Philadelphia: W.B. Saunders; 1992:96–114.
2. Peacock EE Jr, Madden JW, Trier WC. Biologic basis for the
treatment of keloids and hypertrophic scars. South Med J.
1970;63(7):755–760.
3. Al-Attar A, Mess S, Thomassen JM, Kauffman CL, Davison
SP. Keloid pathogenesis and treatment. Plast Reconstr Surg.
2006;117(1):286–300.
T
here are honorable exceptions, of course, but
surgeons in general regard an operation as successful if
they can discharge a patient to go home, irrespective of
postsurgical pain. In 1971, Ranger and colleagues reported
on patients with continuing appendix-like pain despite appendicectomy. These clinicians suggested that this was
caused by nerve entrapment, and reported that they relieved
the patients’ pain by local anesthetic injection into the scars.1
Since then, others have injected saline, sterile water, homeopathic remedies, and caffeine, all similarly relieving
pain in various surgical scars. The important element seems
not to be the agent used, but the needling—acupuncture is
equally as effective.
Scar pain occurring immediately after surgery is usually
caused by nerve or tissue damage from the operation, but
pain may not develop until some months later as the scar
tightens and nerve entrapment occurs. Pain in the scar itself
(superficial or deep) is common, but pain related to the scar
may also be referred locally to adjacent muscles and other
tissue, or distantly within the nerve-root distribution so
that, for instance, abdominal scars can sometimes relate to
back pain.
The history, particularly that of past surgery, should give
pointers to the possible implication of scars, but a careful
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CLINICAL PEARLS
examination is needed to confirm this. Start by using one
finger to palpate gently along the full length of the scar
noting points of tenderness, then press again more deeply.
The tender spots often seem to occur at soft areas of the scar,
where the deeper tissue seems deficient. Continue with
palpation around the scar on both sides and extending for a
few centimeters at each end. Finally, examine areas of reported local or distant pain together with related muscles,
including stretching or movements that reproduce the pain,
checking associated trigger points.
In general, needling of scars should be superficial, particularly if there is a prosthesis or mesh from the surgery,
as there is then an increased risk of infection. If there are
few tender spots, I needle directly into each, although often
a tough scar necessitates inserting the needle obliquely
from the side. If there a many tender points, I use a pair of
longer needles horizontally, just under the skin from either
end, one on each side of the scar. Sometimes, I stimulate
manually, but more often I use electroacupuncture (EA) at
Han frequencies (2/100 Hz). In addition, I needle any
trigger points found in associated muscles or related to
distant referred pain within the nerve-root distribution.
There is usually some response following a single treatment (10 minutes of manual acupuncture or 20 minutes of
EA) but I find that three or four sessions often produces
permanent success.
REFERENCE
1. Ranger I, Mehta M, Pennington M. Abdominal wall pain due to
nerve entrapment. Practitioner. 1971;206(236):791–792.
Simon Hayhoe, MSc, MBBS
Pain Management Department
University Hospital
Turner Road
Colchester CO4 5JL
United Kingdom
Upon inspection, it was noted that the patient’s tenderness was localized along the sternal incision and hypertrophy was evident. Trigger points were identified in the
trapezius and pectoral muscles according to Simon and
Gerwin’s diagnostic criteria.2
Methods
Stainless steel acupuncture needles (SEIRIN,Ò 0.25 mm)
were inserted at the following acupuncture points: LI 4, 11;
ST 36; PC 6; and LR 3.
In addition, an intralesional injection of lidocaine 1%
(0.1 mL) in the localized trigger points and along the sternal
hypertrophied incision (using sterile 22 gauge syringes) was
performed. This combined therapy was given twice weekly,
for 4 consecutive weeks (comprising 8 sessions).
RESULTS
The patient reported remarkable improvement, with decreased pain sensation along the scar and the adjoining
upper chest wall (VAS = 2–3).
CONCLUSIONS
CPSP is a challenging chronic pain condition that can
affect scars following cardiac surgery. Acupuncture sessions and intralesional injection of local anesthetics have
helped relieve pain associated with this condition. Further
research on the possible etiology and proposed management
is required.
REFERENCES
E-mail: simonhayhoe@doctors.org.uk
P
ainful scars secondary to sternal wounds after
cardiac surgery are common. Chronic poststernotomy
pain (CPSP) is a prevalent complication after cardiac surgery operations, accounting for 30% of postoperative cases.1
I report here about a 40-year-old female patient, who was
referred to the Outpatient Pain Clinic of National Research
Centre in Cairo, Egypt, 3 months after mitral-valve replacement at the Cardiac Surgery Academy of Ain Shams
University. She complained of pain and discomfort over the
sternotomy incision, extending to her upper limb and the
anterior chest wall. Her visual analogue scale (VAS) pretreatment score was 8.
1. Van Leersum NJ, van Leersum RL, Verwey HF, Klautz RJ.
Pain symptoms accompanying chronic poststernotomy pain:
A pilot study. Pain Med. 2010;11(11):1628–1634.
2. Gerwin RD. Myofascial pain syndrome. In: Mense S, Gerwin
RD, eds. Muscle Pain: Diagnosis and Treatment, Berlin &
Heidelberg Springer-Verlag; 2010:15–18.
Hemat Allam, MD
Medical Division
National Research Centre
Elbohouth Street
Dokki 12662, Cairo
Egypt
E-mail: allamhemat@gmail.com
CLINICAL PEARLS
S
car tissue usually forms after deep traumas, such as
piercings, burns, and surgery, to the dermis. Globally,
*75 million patients develop scars after surgery each year.
Acupuncture is an important part of Traditional Chinese
Medicine (TCM), and, in TCM theory, scar tissues are
considered to be Qi and Blood Stagnations in the Ying and
Wei levels (the superficial levels) as a result of trauma. The
Ying Qi and Wei Qi cannot move smoothly through the scar
area to defend and nourish it. Thus, there may be pain,
itching, numbness, or other abnormal feelings.1
Transforming growth factor–beta (TGF-beta) plays a
central role in wound healing and scarring, which subsequently trigger extracellular matrix deposits and collagen
overproduction. TCM can reduce expression of TGF-beta,
resisting fibrosis, to lessen development of scar tissue and
accelerate wound healing.2 Hence, acupuncture is not
only commonly used to treat pain3 but is also used to treat
scars, playing an important role in the correct healing
process.4
The following acupuncture points could be used to treat
painful scars: LI 4 (Hegu) and ST 44 (Neiting) are the best
analgesic points; GV 20 (Baihui) and HT 7 (Shenmen) are
the best sedatives and tranquilizing points5,6; and GB 34
(Yangneungcheon) is known to have an effect on pain and
motor dysfunction,7 and could be used to reduce scar-related
pain and to improve the patient’s well-being.
TCM theory considers scar tissues as Qi and Blood
Stagnations in the Ying and Wei levels (the superficial
levels). A combination of LI 4 and LR 3 (Taichong) has
been reported to have a strong effect in moving Qi and
Blood. Hence, addition of LR 3 could be considered.1
Given that healing plays a vital role in the development
of painful scars, acupuncture points such as LI 11 (Quchi)
and ST 36 (Zusanli) could play a vital role in improving immunity and homeostasis.5,6 Ah Shi points (i.e., the
points that exist in the vicinity of the diseased part) are
the effective stimulation points used to promote the healing process.5
In previous studies on painful scars, acupuncture needles
‘‘Circling the Dragon’’ up to ten small needles were placed
in healthy skin as close to the edge as possible, *1 cm apart
(Ah Shi points), with no stimulation.4 Very thin needles
were placed on an area considered painful or fibrotic.8
167
A case of a painful surgical scar was treated with acupuncture.1 In all three articles, acupuncture was shown to
have promising results.
REFERENCES
1. Fang S. The successful treatment of pain associated with scar
tissue using acupuncture. J Acupunct Meridian Stud. 2014;
7(5):262–264.
2. Wang RG, Zhou W, Zhang YD. Study on the progress of the
mechanism of TGF-beta in the scarring and the effect of TCM
[in Chinese]. Zhongguo Gu Shang. 2008;21(2):161–163.
3. Madsen MV, Gøtzsche PC, Hróbjartsson A. Acupuncture
treatment for pain: Systematic review of randomised clinical
trials with acupuncture, placebo acupuncture, and no acupuncture groups. BMJ. 2009;338:a3115.
4. Hunter J. Acupuncture for keloid scar. Acupunct Med. 2011;
29(1):2.
5. Agrawal AL, Sharma GN. Clinical Practice of Acupuncture,
2nd ed. New Delhi: CBS Publishers and Distributors, 2003.
6. Jayasuriya A. Clinical Acupuncture, Revised Edition 2001.
New Delhi: B Jain; 2013.
7. Park JY, Park JJ, Jeon S, et al. From peripheral to central: The
role of ERK signaling pathway in acupuncture analgesia.
J Pain. 2014;15(5):535–549.
8. Zanier E, Bordoni B. A multidisciplinary approach to scars:
A narrative review. J Multidiscip Healthc. 2015;8:359–363.
L. Nivethitha, BNYS, MD (AM), PhD(cand)1
A. Mooventhan, BNYS, MD2*
and Hemant Bhargav, MBBS, MD, PhD2
1
Department of Acupuncture
2
Department of Research and Development
Swami Vivekananda Yoga Anusandhana Samsthana
S-VYASA University
No. 19, Eknath Bhavan, Gavipuram Circle
Kempe Gowda Nagar, Bengaluru 560019
India
*Address correspondence to:
A. Mooventhan, BNYS, MD
E-mail: dr.mooventhan@gmail.com