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Understanding and Managing Chest Pain and Intercostal Neuralgia with Acupuncture

Chest pain arising from somatic causes, such as intercostal neuralgia, chest wall splinting, and costochondritis, as opposed to internal organ disorders like angina or stomach pain, is a common clinical occurrence. Intercostal neuralgia involves persistent pain in one or several intercostal nerve areas, often exacerbated episodically and sometimes triggered by respiratory movements. Secondary intercostal neuralgia, commonly caused by adjacent organ or tissue pathologies such as spinal joint arthritis, thoracic spine deformities or scarring from chest surgery, and herpes zoster, is more frequent in clinical practice. Chest wall splinting, often acutely triggered by improper movements, resembles intercostal neuralgia in pain. Costochondritis-related chest pain typically localizes at the rib heads or their junctions with the sternum, presenting with noticeable swelling and tenderness.

Acupuncture is effective for various somatic chest pains, including intercostal neuralgia, chest wall splinting, or costochondritis, with similar treatment methods employed.


Intercostal neuralgia and chest wall splinting often occur on the body's lateral aspect. Therefore, distal acupoints or reflex points are frequently found in the body's lateral reflex zones. Acupoints on the Shaoyang meridian of the hands and feet, such as San Yang Luo, Zhigou, Waiguan, Yanglingquan, and Qiu Xu, are located in this area and have been clinically proven to be significantly effective for these conditions.


Costochondritis typically occurs at the front chest, accompanied by costal cartilage swelling and tenderness. Local acupoint stimulation, such as directly targeting the affected area and its vicinity for tender points, proves more effective. In cases of deeper tenderness, methods like "surrounding needling" or "multiple needles in one area" are used. When the skin surface is also sensitive, the seven-star needle can be tapped around the area. Various heat therapies, including infrared radiation during needle retention, are effective in reducing inflammation.


For broader anterior chest wall pain, distal reflex areas such as Neiguan and Ximen on the upper limbs can be stimulated.


However, caution must be exercised due to the shallow nature of chest and back acupoints and the presence of vital organs like the heart and lungs underneath. The needle depth must be appropriate to avoid serious complications such as pneumothorax. Acupuncturists must achieve effective stimulation and obtain a certain needle sensation, balancing the need to avoid excessive depth while ensuring not too shallow insertion. Techniques involving more twirling and less lifting-thrusting, and the use of scraping needle methods, help maintain needle sensation after Qi arrival. Needle retention, especially in the upper back where it's close to the sympathetic nerve chain, is crucial. A needle retention time of about 20 minutes often results in a halo of redness around the needle, indicative of effective treatment not only for visceral diseases but also for somatic pain relief.

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