A female patient presents to your office. When you ask about her main complaint, she replies:
"My shoulders are tense; there's a lot of pain and stiffness. I've had it for almost two months.I don't have any history of injury or arthritis. I checked with a doctor, and everything is fine, but two and a half months ago, my job became very stressful. Plus, my son was very sick last month."
This is a common picture seen in acupuncture clinics. Based on zang fu theory, this pattern usually will be diagnosed as liver qi stagnation. However, from the point of view of the jing luo (channels), the diagnosis doesn't seem to make sense. Neither the Liver channel itself, nor its luo-connecting, divergent or sinew channels pass through the shoulder or neck regions. How is it, then, that liver qi stagnation can cause shoulder tension?
Here is a situation with which we are all familiar. Something stressful comes along, and you put your head in your hands to try to "wring out" an answer to your problem. Or, just when you've made it through that stressful situation, you feel your shoulders drop as you exhale deeply with relief and say, "It's done!" These are common phenomena, along with holding your breath (or forgetting to take a breath) while you're worried. Labored breathing, shallow breathing, and holding your breath cause tension in the thorax and shoulders, but this behavior is just a natural response to stress for all of us. Furthermore, how much of the workday is spent with one's shoulders hunched over a desk or keyboard? How much of the day is spent driving? More simply, how much of the modern patient's day is spent in one position, without movement? These everyday occurrences give us an indication that the shoulders are intimately involved in stress behavior. Let's look to traditional Chinese medicine to tell us how and why.
Shoulder Pain Is a Disorder of the Tendons and Sinews
Most of the shoulder pain and stiffness seen in a clinic is the result of disordered tension in the muscles and tendons that cross the shoulder joint. Not many shoulder pain patients truly have problems with the bones in their shoulder joint, or have actual cervical protrusions. Because liver rules the tendons and sinews in TCM, it's easy to relate shoulder pain to the liver in this first step.
The Secret of GV 20
GV 20 is a meeting point of the Liver, Bladder, Gallbladder, San Jiao and Governing channels. Four of these channels (all except the Liver) pass through the neck and shoulder area. Thus, liver qi stagnation can be transmitted to these other channels - and the shoulder region - via their influence at GV 20.
Stress Is a Disorder of the Liver
When people are under stress or are anxious, the liver is the organ most immediately influenced. In zang fu theory, the liver is the "general." As general, the liver likes to accomplish all things quickly and completely, without questions, problems or disagreement. Liver also is the zang that performs fu functions; it uses the yin (i.e., blood) to perform the yang function of spreading the qi. Thus, anything "unhappy" will frustrate the general and his spreading function, leading to liver qi stagnation. Furthermore, once liver qi has encountered emotional resistance and begins to stagnate, the qi will tend to rise toward the head. It is as a result of this process that many people will have headaches, a red face or a "big head." Second, because of the liver's influence via GV 20, stagnated qi often is just as likely to enter any of those channels that pass through the posterior neck and shoulder (UB, GB, SJ, GV).
The Relationship With the Gallbladder
Just as important, we know the liver and gallbladder are coupled together in TCM meridian theory. This contributes to the high likelihood that liver qi stagnation will be passed to the Gallbladder channel and will therefore pass into the shoulder region. That is why GB 21 is such a great point of tension for almost all of our patients.
Now we know why a simple shoulder massage can offer such relaxation; massaging the shoulders releases whole-body stress and whole-body qi stagnation. Just one region influences the whole. Acupuncture works in exactly the same way.
So, what can we tell our patients to do? First, we need to remind them how important it is to breathe deeply, even under duress. Next, we must teach them effective ways in which to move their shoulders and body. Let's teach our patients how to help themselves prevent qi stagnation. And, of course, we must remind them to stay healthy and relaxed with regular massage or acupuncture treatments.