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Unbinding the Chest: Soothing Emotionally Induced Shoulder Pain with Acupuncture

Unbinding the Chest: Soothing Emotionally Induced Shoulder Pain with Acupuncture

Muscular-skeletal issues are some of the most common ailments treated by acupuncture. However issues involving the muscles, tendons, bones, ligaments and joints can be much more complex and deeply rooted than they seem.

Recently I was presented with an interesting case. The chief complaint of the patient was extreme pain, tension and restriction of the shoulder, neck and scapular area of the upper back. However there was no clear cause to the problem. The patient hadn’t had an injury or trauma to the area. The pain appeared one day as if out of nowhere.

Acupuncture diagnostics rely heavily on pulse diagnosis. Upon the radial artery of the wrist, the “energetic” workings of the major internal organs and their functional “systems” can be assessed. No matter what symptom I am presented with clinically, I always assess the patient’s pulse. I’ve learned through experience as an acupuncturist that symptoms can come from many aspects of the body and mind. Many times they come from places one would not initially suspect.

The patient is a man in his mid-40s who is in good health. He hardly ever has muscular issues, nor severe pain in his body. He was surprised about his current state of being. His most common symptoms when “out of balance” tend to be insomnia, a tendency towards obsessive-compulsive behavior and anxiety. He sometimes also experiences minor abdominal aches and acid reflex.

According to the pulse of the patient, his “Heart” system was creating a significant amount of inflammatory “fire.” His Kidney pulse, which is the physiological mechanism within the body to “check,” cool and balance the “fire” of the Heart was weak and not adequately communicating with the chest.

Let me translate a bit, since Chinese medicine and the way it sees the physiology of the body differs some from Western medical thinking. Chinese medicine is a system which views the body as a collection of “systems” much like Western medicine. However, each system within Chinese medical thinking is “ruled” or governed by one of six major internal organs: Heart, Lung, Liver, Spleen/Pancreas and Kidney. It is a simplified system, yet in some ways more profoundly aware of interconnectedness within the body.

Similar to Western medicine, the “Heart” system includes the blood vessels, but it also includes the aspect of the mind and spirit related to cognition, animation, love, relationship and the sense of spiritual connectedness.

The Kidney system has a strong relationship with fluid metabolism (as is also acknowledged in Western medicine), but also with endocrinology, the hormones, the bones, joints, brain and the willpower.

When I begin working with a patient suffering from any type of condition, we undergo a process of exploration and examination. Together we are trying to unravel what the symptom is really about. If it is due to an injury, then that is our answer: that is where the problem originated. Our goal becomes the repair and healing of that injury. Depending on the individual this process may include just physical reparation. For others it may also require emotional and mental rebalancing. Trauma can have widespread effects on the mind, body and spirit.

However some symptoms appear mysterious in their origin. They have no clear cause, appearing from out of nowhere. This is where pulse diagnosis becomes vital to uncovering the root of the problem. The body has a marvelous ability to store and hide stress, toxicity and the effects of trauma in “latent” hidden states, often in the blood vessels, joints and bones. These prove to be relatively “safe” areas to maintain unresolved issues, where symptoms can be kept to a minimum without damaging the physiological workings of the internal organ systems. However there will come a time when these holding areas “saturate” and “overflow,” creating symptoms which often appear mysterious and confusing in their origin.

This is why many symptoms and conditions require investigation, time and patience to uncover and resolve.

Within each organ “system” in the body, there are as many as 5 acupuncture channels that serve and maintain circulation, function and strength. The Heart is unique in that it has twice as many acupuncture channels as any of the other organ systems.

The Heart is acknowledged as the most important of all organ systems in the body. It is called the “sovereign ruler” of the organs, likened to an imperial emperor which all other organs serve. The importance of the Heart is related not only to its function of circulating blood, but also to its role as the “house” of the “spirit” and the seat of consciousness.

Chinese medicine acknowledges the Brain as another seat of consciousness, however one which is not as important as the Heart. It too is in service to the “emperor.” One could say the Brain is what stores consciousness; the Heart is what generates it.

I started treating the patient’s shoulder and neck pain with a set of acupuncture channels that relate specifically to the muscular “zones” of the body. By releasing the topmost layer of the body, deeper issues often present themselves more clearly.

To work with the muscular-skeletal “sinew” acupuncture channels, diagnosis differs from that of other acupuncture channels. Instead of using the pulse as the chief diagnostic tool, the condition is assessed according to movement.

There are specific physical body movements that relate to each of the 12 acupuncture muscle channels. I treated the patient with this set of acupuncture channels for 3 sessions. Upon the first session, extension of the arm and retraction were the most painful. These are movements associated with the Small Intestine and Lung muscle channels.

As I treated the muscle channels on this patient, it became clear the problem was being generated from a deeper place within the body. After each session the pain would disappear, only to resurface later.

As we examined the nature of the pain it became clear that the problem was beginning to localize along the Small Intestine and Heart channels of the arm. Further treatment and investigation showed that the problem was rooted in a deeper acupuncture channel associated with the Heart. The problem seemed to be coming out of the Heart organ itself.

The body is made up of many energetic layers. The topmost layer of the body is where the muscle or “sinew” acupuncture channels flow. Below this is the level of the blood. Below this layer are the “Primary” acupuncture channels where the internal organs express their functional energy. Deeper than this are channels called the “Divergent Channels.” These are mysterious channels where sublimated material is trapped.

The Divergent Channels can be some of the strongest, most immediately effective acupuncture channels in the body. They are the expressions of latent, sublimated issues that create strong sudden symptoms without clear understandable cause. I’ve witnessed many situations where the Divergent Channels are the only method to release and clear symptoms that no other method seems to touch.

The reason the Divergent Channels can be so strong and effective is due to the deep far reaching energetic field they encompass. The Divergent Channels possess the widest range of all the acupuncture channels. They reach up into the most superficial layers of the body: the skin and muscles, and also into the deepest: the bones and joints. They are thought to be protective devices for the health of the internal organs. They have energetic pathways that trap, gather and divert issues that find their way into the internal organs. These issues can be diverted into the deep aspects of the body: the joints and bones, or into the more superficial aspects: the muscles, skin and blood vessels. The power of the Divergent Channels is the ability to treat the root of the problem (the internal organs) at the same time as its manifestation (the joints, skin, muscles and blood vessels). 

After several treatments, the location of the patient’s pain appeared to be fixating along the trajectory of the Heart and Small Intestine Divergent Channels.

Each of the 6 visceral organ systems of the body (Heart, Liver, Kidney, Spleen/Pancreas and Lung) share energetic resonance with the bowel organs (Small Intestine, Gallbladder, Bladder, Stomach and Large Intestine, respectively). They assist one another.

The major assistant to the Heart is the Small Intestine. The idea around these organ system pairs is that the lower, hollow bowel organ helps the solid visceral organ in its detoxification process. The Visceral organs store the precious substances of the body, while the bowels move and transport material throughout the body. They also provide outlets for removal of waste.

The Divergent Channels create an extremely close relationship between the viscera and bowels, such that the two channels such as the Heart and Small Intestine Divergent Channels share a pathway.

In the case of the patient we are discussing, the mental-emotional aspect of the Heart and Small Intestine seemed most important. The Heart had some unresolved conflict involving relationship which the Small Intestine was finding a difficult time processing and detoxing.

The Heart as the seat of consciousness, as well as the epicenter of relationship, love and animation is served by the Small Intestine which is seen as a organ that empowers “sorting” and “separation.” The Small Intestine physically helps metabolize food and drink on a deeper more fine level than the Stomach. Mentally, it does something similar. The medical classics call the Small Intestine the official in charge of “separation of the pure from the impure.” When it is in distress, confusion can result. The physical sensation most commonly associated with the Small Intestine is “binding” or “twisting,” which can create pain or mental confusion, absentmindedness or hyper-sensitivity.

The Divergent Channels are functionally responsible for maintaining the health of the visceral organs whose importance is primary to health and wellbeing. The visceral organs are said to store the “Spiritual” attributes of the body of which Chinese medical philosophy says there are five: the spirit (Shen), the non-corporeal soul (Hun), the corporeal soul (Po), the willpower (Zhi) and mind (Yi). Each of these spiritual attributes have relationship with a particular visceral organ, however the Heart as the seat of all consciousness in the body has relationship with all five.

When a physical, mental or emotional issue challenges one of the internal organs directly, it is the Divergent Channels that gather the problem and shuttle it away into a holding area of the body, generally seen to be the joints.

The shoulder joint is a common area for the Heart-Small Intestine Divergent Channel pair to place unresolved Heart organ issues. The scapular region of the upper back is also part of this holding area, which often creates pain, tension, numbness or spasm in the neck, paravertebral muscles, jaw, ear and eye.

We must remember that according to Chinese medicine each of the organ systems are responsible for not only physical function, but also that of the mind and emotions. Therefore, material that has been shuttled into the shoulder joint by the Heart-Small Intestine Divergent Channel can be rooted in physical, mental or emotional problems. Some say, they can even store away spiritual issues that have not yet been resolved.

When an issue related to a Divergent Channel appears, it usually indicates to me that the body-mind-spirit of the individual has reached a place where they are ready to address and resolve whatever has been stored away. This occurs when the person is in relatively good health, strong enough to clear toxic overload. The other situation I observe the Divergent Channels expressing their pathology is when a person is in poor health, unable to maintain the silent hidden state the Divergent Channels try to create. This is a more serious, difficult situation. But not the case with this particular patient.

The patient was healthy and strong, therefore I assessed that their spirit was ready to address whatever “heart pain” had been sublimated. Therefore treatment had to involve something deeper than just the alleviation of surface level pain. The “sinew” channels were not going to be enough to create significant impact for this patient. We had to work with the “pandora’s box” of the Heart-Small Intestine Divergent Channel.

Something fascinating I notice when working with the Divergent Channels is when these channels are treated, unresolved things from the past start to resurface in the person’s life. This can be old, unresolved physical conditions from the past: infections, injuries, emotions. However, mysteriously they can also call back into a person’s life people, situations and conflicts that were never completely resolved. When I work with the Divergent Channels, I make sure to allow a lot of time and space where myself and the patient can discuss the events of life. We must process together that which begins to re-emerge.

I trust that the Divergent Channels express themselves when the spirit is ready to make a choice: to resolve and/or let go of events, situations and conditions from the past. But while they are being treated we must make sure the patient is strong and well-supported, otherwise the material that is trying to resolve will simply go back into latency, hiding until another time.

The Divergent Channels often express themselves in dramatic ways. They can be stubborn and “loud.” Classically these channels were treated three days in a row, followed by a three day break, and then resumed. Treatment could go on for several weeks, showing the intensity of the condition and the demand of these channels in their insistence for resolution and acknowledgment.

With this patient, we began with three treatments of the the Heart-Small Intestine Divergent Channel, which eased the pain significantly. However the pain continued to resurface. Other things in the person’s life resurfaced as well: an old “heart-pain” in the form of a past relationship: “the one that got away” as he put it. This person was in his words “the love of his life” who he couldn’t manage to create a harmonious relationship with. He was surprised that out of nowhere his past girlfriend contacted him and wanted to meet. Throughout our next few sessions we discussed the thoughts and emotions occurring as he met with his ex-girlfriend several times. The two of them discussed what had happened between them in the past, and also shared with one another ways in which they had grown over the time they’d been separated. The meetings were, in his words: “surprisingly harmonious and calm.”

After several treatments with the Heart-Small Intestine Divergent Channel, targeting the site of his shoulder, neck and scapular pain, his discomfort improved significantly. Until one day he returned and the pain was worse: as bad as it had ever been. He appeared confused, agitated and upset: not knowing what to do to feel better. His meetings with his ex-girlfriend were going very well. They both acknowledged they still loved one another, and enjoyed the company of one another. However he didn’t know what he wanted to do. The fear of the difficulties from the past were haunting him. It seemed as if his heart was trying to open, yet his old shock and disappointment was creating a blockage, which was generating pain.

When the patient asked me to describe what I was feeling in his pulses, I described a sense of “scattered” energy in his heart pulse. And his Kidney energy and its strength of willpower was not supporting the heart in its ability to connect, trust and freely express.

My strategy for giving the patient a jolt of strength and invigoration was to use a stronger,  energetically “deeper” Divergent Channel to consolidate his energy and focus so he could make a choice as to what he wanted to do in relation to his heart pain.

I used another supportive channel for the Heart: that of the Pericardium-Triple Heater (San Jiao) Divergent Channel. This pair of channels act like the outer borders of the Heart: the communicative capacity of the Heart in its circulatory function. The Heart is more than the organ itself, it is also comprised of the blood vessels and arteries: the complete system of blood and spirit animation.

The problem was seeming to be not necessarily the function of the Heart system itself, but the circulatory process around the expression of the Heart. There was a resultant neurosis from the trauma of the breakup the patient experienced with “the one that got away.” He was obviously still attached to her, yet the problem involved his ability to reach out, which is more a function of the Pericardium and Triple Heater.

The idea of the Triple Heater (San Jiao) is that it is an outer extensive field of energy that emanates from the Heart, but also empowered by the Kidneys. It is like an attractive and reactive field that reaches out and pulls in people and experiences that resonate with our essential selves. The Triple Heater is like the destiny in motion. However when it is blocked, we can become unsure about what to allow into our lives and what to reject. When we reject that which our spirit is attracting, this can create a miscommunication between the Heart and Kidneys which manifests itself through the Pericardium and Triple Heater systems. A Triple Heater with too much energy flowing to the external can attach too quickly and strongly; a Pericardium with too much energy trapped internally will fail to connect. Ideally energy should flow from the external and internal seamlessly, allowing the workings of the Heart to proceed without our sensing it, making the world and its manifestations appear and disappear magically.

Consolidating the patient’s Pericardium-Triple Heater Divergent Channel made the pain even worse, but more solid and specific. The spams in his pectoral muscles and deltoid intensified. I followed this treatment in his next session with the Bladder-Kidney Divergent Channel which strongly utilized the consolidated energy to flush his system of the stagnation manifesting in his shoulder and upper back. This finally removed the painful symptoms from his body, leaving him with abundant energy and calm. He was finally beginning to reach the state where he could let go. 

After his initial breakthrough, we continued to energetically support his movement towards making a choice. We alternated between using the Bladder-Kidney Divergent Channel to clear out his system, as well as the Small Intestine-Heart Divergent Channel to continue connecting to the heart pain which is the root of his condition. There were several releases followed by significant relief. There were also several recurrences of pain and discomfort. The deep pain coming from his heart wasn’t an easy fix; it was a process that required patience, inquiry and attention.

The strategy for resolving this condition was two-fold. It became clear there were times during the process where the patient needed to be soothed and relaxed. This was satisfied through working with the Small Intestine-Heart Divergent channel which possesses points which soothe pain, stop spasm and calm the mind and spirit. The personality of this channel is one that gathers blood and energy, providing more of a hug than a push. This state alternated with times when the patient was strong enough to begin releasing the problem, which called for a more confrontational channel, which was satisfied by use of the Bladder-Kidney Divergent Channel which has many points that strongly flush the system.

Focusing too intensely on release and detox would have been agony for the patient, and therefore counterproductive. His heart and spirit needed fortification before he could begin to let go of what he was harboring. We alternated between these two strategies for sometime.

Most interesting within this process were the moments of understanding and action that followed our sessions. His relief from pain would often coincide with an active decision or clarifying choice regarding putting his emotional and relationship life in order. He’d report that people from his past would contact him and without thinking he’d agree to meet with them. Or he felt moved to spontaneously book a trip to Europe to visit someone from his past he had unfinished business with. His stubborn, knotted inner process was beginning to be more expressive, active and engaged with rectifying the past.

Nicholas Sieben, MS, L.Ac.

Nicholas is a healer who uses acupuncture and reiki to help awaken and heal. His mission is to promote greater freedom of body, mind and spirit through compassionate self-awareness. Through the use of ancient medical practices and the spiritual philosophies of Taoism and Buddhism, Nicholas helps illuminate the path to healing. He is a student of the renown Taoist priest and Chinese Medical Master Jeffrey Yuen. He completed his acupuncture studies under Mr. Yuen at the Swedish Institute College of Health Sciences, and received a B.A. from Brandeis University in Sociology and Philosophy. He has a practice in New York City.

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