Treatment of Neck Pain with

Collateral Meridian Acupressure

Therapy: A Randomised,
Sham-Intervention Controlled Trial
Kaikit Wong* BSc
Brendan Yap
Bill King-Piu Fung BMed, MHPEd, GDipAcup, MMedStat, AdvDipTCM

Sydney Institute of Traditional Chinese Medicine, Australia

ABSTRACT
Background: Collateral Meridian Acupressure Therapy (CMAT) is a relatively new technique
that has been developed to relieve intractable pain. Little research has been, however, conducted
to examine its effect on neck pain. The purpose of this study was to investigate the short-term
effect of CMAT on neck pain. Method: In this randomised, sham-intervention control, patient-
therapist blind trial, 60 patients who suffered from neck pain and had restricted neck movement
were recruited. Participants were randomly allocated into the treatment group (n = 30) and control
group (n = 30). CMAT was performed on the treatment group, while the control group received
sham treatment. Severities of pain before and after the treatment were measured on a scale of
0 (no pain) to 5 (most severe pain). Chi-square and t-tests were used to analyse categorical and
continuous data, respectively. Results: All participants completed the study. Prior to the treatment,
there was no group difference in demographic or pain data. After the treatment, the severity of
neck pain in the CMAT group (0.7±0.6) was significantly less than that in the control group
(2.8±0.9). Conclusion: CMAT may induce an immediate analgesic effect on neck pain. Its long-
term effect requires further research.

KEYWORDS Acupressure, neck pain, collateral meridian acupressure therapy, RCT

Introduction quantitative meta-analysis has found that acupuncture is

effective in the short-term treatment of neck pain.3 Other
Neck pain is a common symptom encountered by a high researched modalities are moxibustion, cupping4, point-injection5
proportion of the population. With an increase in internet and electro-acupuncture6,7. Local acupuncture points such as
and computer usage, this affliction is becoming more and GB 20 Fengchi (风池) and GB 12 Wangu (完骨)8, and distal
more predominant among office workers and students who acupuncture points such as SI 3 Houxi (后溪)9 and Luozhen
use the computer daily for long hours.1 Neck pain is usually (落枕) have been studied.11,12 Abdominal points (that correspond
a result of repetitive stress, degeneration and deformity of the to the tortoise plastron)13 and scalp acupuncture have also been
cervical vertebrae as well as a loss of the natural curvature of extensively used in the treatment of neck pain.14–16 Some of
the cervical spine.2 Different methods of Chinese medicine those modalities involve strong manipulation either with
may be used effectively to control and treat neck pain. A electricity stimulation or vigorous manual lift and thrust methods.8,11

* Correspondent author; e-mail: kaikitw@gmail.com Aust J Acupunct Chin Med 2012;7(1):10–15.

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Treatment of Neck Pain K Wong, B Yap
with Acupressure and B K-P Fung

Although a large percentage of patients may benefit The current study was carried out to investigate the short-term
from appropriate administration of acupuncture and/or effect of CMAT in relieving neck pain. The hypothesis was
moxibustion, many patients still hesitate to choose these that CMAT would reduce neck pain significantly better than
treatments due to needle phobia, fear of pain, fear of strong sham intervention did.
physical manipulation, inconvenience of lengthy courses of
treatment, and/or the high treatment cost. These reasons may Participants and Methods
often lead to delayed treatment, resulting in worsened and
chronic pain. This study was approved by the Education and Ethics
Committee of Sydney Institute of Traditional Chinese
In a paper published in the TCM Shanghai Journal of Medicine, which also serves as a research ethics panel.
Acupuncture and Moxibustion, Dr Shan-Chi Ko proposed
an effective treatment of cervical spondylopathy by pressing Participants were recruited amongst patients who attended
distant acupoints.17 It was discovered that by first identifying a clinic of Chinese medicine. Patients with chief complaint
the affected meridian where the worst pain was located, and of neck pain were included. Patients under 12 years of
then pressing corresponding points on the distal parts of the age, or who had surgical procedure in their neck region
body, the pain relief could be almost immediate. Contralateral were excluded. Cervical radiculopathy was not part of the
acupressure may yield better therapeutic results than exclusion criteria. A total of 60 participants were recruited for
acupressure on the affected side.18 This discovery was later the trial. Each one had pain and difficulty with either side-to-
developed into the Collateral Meridian Acupressure Therapy side neck rotation, or neck flexion and extension, or both. All
(CMAT). It is found that manipulating two acupoints on a participants had given written consent. The participants were
collateral meridian is more effective than local needling or randomly allocated into the CMAT group (n = 30) and the
treating the affected meridian alone.18 The two acupoints are control group (n = 30). The randomisation was done by an
(1) the control point for connecting the affected meridian, and interviewer by flipped a coin without knowing if heads/tails
(2) the function point for influencing the affected location. was to be the treatment or control group. The participants
CMAT has been found to achieve dramatic results in reducing were also blind to their group allocation.
intractable pain in Complex Regional Pain Syndrome
(CPRS)18,19 primary dysmenorrhea20, and backache due to
post-regional anesthesia procedure21.

Assessed for eligibility (n = 62)

Excluded (n = 2)
Did not meet inclusion criteria:
Age<12 (n = 1)
Neck surgery (n = 1)
Randomised (n = 60)

CMAT group (n = 30) Control group (n = 30)

Completed group (n = 30) Completed study (n = 30)

None dropout None dropout

FIGURE 1 Flow chart of selection process

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 Treatment of Neck Pain K Wong, B Yap
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FIGURE 2 Control Points (C) and Function FIGURE 3 Plastic rods with round tip used in
Points (F) treatment

All participants were interviewed before their treatment.

Data about their age, gender, duration of pain, location of
Results
pain, and severity of pain were recorded. The duration of A total of 60 participants with neck pain were recruited to
pain was recorded as categorical data – acute and chronic, this study. All participants completed the study and no side
where acute was less than or equal to 12 weeks and chronic effects were reported. Table 1 summarises the demographic
was more than 12 weeks. Pain scores were measured on a scale information of the two groups. There were no statistically
of 0 (no pain) to 5 (most severe pain). After the treatment, significant differences between the two groups in terms of
participants were asked to rate their neck pain again. The age, gender, duration and location of pain. The majority of
interviewer who collected the data and the practitioner participants in the two groups experienced pain along both the
who performed the treatment were not the same. The bladder and gall bladder channels.
practitioner was an accredited qualified acupuncturist who
had no knowledge about the pain scores of the participants The pain scores before and after treatment for both groups are
at any point in time. presented in Tables 2 and 3 respectively.

One session of treatment was given to all participants. For the Mean and standard deviation of the pain scores before and after
CMAT group, a standard treatment protocol was used. Points treatment in two groups are presented in Table 4.
F1, F2 and F3 were pressed one by one as function points in
this sequence, while holding C1 as the control point (Figure 2). Results of the independent two-sample t-tests showed that
Next, points F4, F5 and F6 were pressed as function points in prior to the treatment, there was no group difference in pain
this sequence, while holding C2 as the control point (Figure 2). severity; and after the treatment, the CMAT group reported
The same six points were repeated on the other arm in the same significantly lesser pain than the control group did ( p < 0.0001)
sequence. Pressure was maintained at each point for a minute
using a plastic rod with slightly pointed round tip (Figure 3). Discussion
Sufficient pressure was applied to each point till the patient felt
some tenderness or pain on the point. For the control group, This study aimed to evaluate if CMAT was effective in relieving
the same protocol was conducted with the exception that the neck pain. CMAT is based on the theory of Zang Fu Bie Tong (脏
points were touched gently without any pressure. 腑别通), also known as Zang Fu Tong Zhi (脏腑通治)22. Zang Fu
Bie Tong and Zang Fu Tong Zhi are translated as the Extraordinary
The data were entered into statistical software (JMP-IN 3.2.1, Connection of Zang Fu by Dr Wei Jie Yang（杨维杰).23
SAS Institute Inc.). The chi-square tests and t-tests were used This system of the channels pairing is less familiar for most
to analyse the categorical and continuous data, respectively. practitioners of Chinese medicine, compared with the more
The level of significance was set at alpha = 0.05. commonly known pairs such as the internal-external pairs
(表里经), and the same name pairs (同名经). The pairing
system is illustrated in Table 5.

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Treatment of Neck Pain K Wong, B Yap
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TABLE 1 Demographic profile

CMAT Group Control Group

(n = 30) (n = 30)
Age (yr)
32.2+2.2 29.7+2.0
(mean±SD)
Gender Male 16 (53) 15 (50)
N (%) Female 14 (47) 15 (50)
Duration of pain Acute 12 (40) 15 (50)
N (%) Chronic 18 (60) 15 (50)
Location of pain Along bladder channel 7 (23) 4 (13)
N (%) Along gall bladder channel 10 (33) 9 (30)
Along both bladder and gall bladder channels 13 (44) 17 (57)

(Data are mean±SD for continuous variables, and number (%) for categorical variables, p > 0.05 for all comparisons.)

TABLE 2 Pain scores of the two groups before the treatment (number [%])

0 1 2 3 4 5 Total

CMAT 0 (0) 0 (0) 3 (10) 13 (43) 12 (40) 2 (7) 30

Control 0 (0) 0 (0) 6 (20) 14 (46) 8 (27) 2 (7) 30

TABLE 3 Pain scores of the two groups after the treatment (number [%])

0 1 2 3 4 5 Total

CMAT 10 (33) 18 (60) 2 (7) 0 (0) 0 (0) 0 (0) 30

Control 1 (3) 0 (0) 10 (33) 12 (40) 7 (24) 0 (0) 30

TABLE 4 Pain scores of the two groups before and after treatment (Mean±SD)

CMAT Control p

Before treatment 3.4±0.7 3.2±0.8 0.269

After treatment 0.7±0.6 2.8±0.9 <0.0001

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 Treatment of Neck Pain K Wong, B Yap
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TABLE 5 Collateral Channels used in Zang Fu Tong Zhi

Open Pivot Close

Tai Yang Shao Yang Yang Ming

Bladder Small intestine Gall bladder San Jiao Stomach Large intestine

Lung Spleen Heart Kidney Pericardium Liver

Tai Yin Shao Yin Jue Yin

Pain is due to a blockage of qi. Most of the participants The same name channel pair matches a hand channel with a
had neck pain located along the bladder channel and the foot channel. For example, one can use points in the hand tai
gall bladder channel, meaning there was a blockage of qi yin channel to treat an illness in the foot tai yin channel. The
in those channels. According to the Zang Fu Tong Zhi, the emphasis is on distal treatment – using the upper body to treat
bladder channel corresponds with the lung channel and the the lower body and vice versa. The internal-external pair matches
gall bladder channel corresponds with the heart channel. By a yin organ/channel to a yang organ/channel, and its emphasis
pressing points on their collateral channels – lung and heart is on yin-yang balance. In Zang Fu Tong Zhi, there is a hand
channels respectively, it is possible to balance the flow of qi in channel and foot channel, and a yin channel and a yang channel
the affected channels and relieve pain. In the standard protocol in every pair, to reach a balance between hand-foot, upper-lower,
used in this study, C1 and C2 are the control points. C1 connects zang-fu, and yin-yang. This may explain of the therapeutic effect
the lung channel to the bladder channel, and C2 connects the of CMAT from the theory of Chinese medicine.22
heart channel to the gall bladder channel. Function points F1
and F4 have an effect on the occipital area directly. Function The strength of this study is that it is a randomised, sham-
points F2 and F5 affect the cervical region. Function points F3 intervention controlled trial. However, due to time and budget
and F6 affect the upper back. constraints, the sample size selected for this study was only
60. The weakness of this study is that there is no sample size
Zang Fu Tong Zhi was first mentioned by Li Yan（李延）in Yi estimation and evaluation of the success of the blinding. This
Xue Ru Men (医学入门) (Elementary Course for Medicine)24 study only tested for short-term pain relief, hence the long-
during the Ming dynasty. The theory was further elaborated term effect cannot be established. It may be possible that data
by Tang Zong Hai（唐宗海）in Yi Xue Jing Yi (医学精义) collected on a different trial of different setting or population
(A Refined Interpretation of the Medical Classics)25 during may produce different results. Therefore, future study is
Qing dynasty. Dr Wei Jie Yang had applied this system in encouraged to further explore the long-term effect of CMAT.
acupuncture and herbal treatments since 1972 and achieved
remarkable results.22 The CMAT seems to have a satisfactory therapeutic effect for
patients suffering from neck pain. The findings of this study
Zang Fu Tong Zhi is established based on the theory of the may help acupuncturists, and other healthcare professionals to
opening, closing and pivot nature of the three yang and three discover a convenient yet non-invasive method of pain relief.
yin channels. The three yang channels are taiyang (太阳), The application of this method can even be taught to patients
shaoyang (少阳) and yangming (阳明). The three yin channels or their carers and be applied when necessary at home as part of
are taiyin (太阴), shaoyin (少阴) and jueyin (厥阴). It is self-help. This may improve the quality of patient care. CMAT
mentioned in Neijing and Lingshu that ‘Taiyang and Taiyin may be considered as a treatment option, in conjunction with
opens, Shaoyang and Shaoyin pivots, Yangming and Jueyin other conventional methods.
closes’ (太阳为开, 少阳为枢, 阳明为合,太阴为开，少阴
为枢, 厥阴为合). Hence by matching the open-close-pivot
nature of the three yang channels to the three yin channels, a
new pairing system of Zang Fu Tong Zhi is established.22

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Treatment of Neck Pain K Wong, B Yap
with Acupressure and B K-P Fung

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