Introduction
Intercostal neuralgia is marked by puncturing or lightning pain in the region with the distribution of intercostal nerves. It may be worsened by laughing, sneezing or deep breath. In severe cases, pain may radiate to the shoulder and back. Intercostal neuralgia is usually secondary, primary case is rare. This syndrome pertains to pain in rib-side in TCM. It is usually caused by stagnation of liver qi, damp-heat in the liver and gallbladder, obstruction of blood stasis and insufficiency of blood in the liver and kidney that lead to obstruction or malnutrition of the liver and gallbladder meridians.

Syndrome Differentiation
1. Liver Depression and Qi Stagnation
 Distending pain in the rib-side and hypochondria, oppression and discomfort in the chest, anorexia, bitter taste in the mouth, aggravation with depression and rage, thin and white or yellow tongue fur, taut pulse.

2. Obstruction of Collaterals by Blood Stasis
Fixed stabbing pain in the rib-side, or caused by sprain, contusion and falling with purplish tongue and unsmooth pulse.

3. Insufficiency of Blood
Vague hypochondriac pain, dry mouth and dysphoria, dizziness, red tongue with scanty fur, thin and rapid pulse.

Treatment
1. Body Acupuncture
Prescription:
Zhigou (TE 6) and Yanglingquan (GB 34).

Modification:
For liver depression and qi stagnation, Qimen (LR 14) and Taichong (LR 3) are added; for obstruction of the collaterals by blood stasis, Geshu (BL 17), Ganshu (BL 18) and Taichong (LR 3) are added; for insufficiency of blood, Ganshu (BL 18), Shenshu (BL 23), Sanyinjiao (SP 6), Zusanli (ST 36) and Xingjian (LR 2) are added.

Performance:
Liver depression and qi stagnation as well as obstruction of the collaterals by blood stasis are sthenia syndromes and should be treated with reducing needling technique; Qimen (LR 14) and Back-Shu acupoints should be needled obliquely with rotating reducing technique or mild reinforcing and reducing techniques; insufficiency of blood pertains to asthenia syndrome and should be treated with reinforcing needling technique; Xingjian (LR 2) and Taichong (LR 3) should be needled with rotating manipulation.

2. Ear Acupuncture
Prescription:
Chest (AH10), Ear Shenmen (TF4), Liver (CO12) and Gallbladder (CO11).

Performance:
Moderate and strong stimulation, retention of needles for 15 - 30 minutes.