Disease and Condition Overview
Rib pain is characterized by pain in one side or both sides of the intercostal region. In Chinese medicine, the intercostals region is the pathway of foot-jueyin and foot-shaoyang channels. Rib pain is therefore understood to be primarily caused by problems of liver and gallbladder. In addition, it may also be associated with pathological changes of spleen and stomach. Whether it is excess pathogenic factors such as qi and stagnation, blockage of blood, or damp heat, blocking channels in the intercostals regions or the essence and blood deficiency leading to malnourishment of intercostals channels, rib pain can result.
Rib pain may also be present in many types acute chronic disease, such as acute chronic hepatitis, liver cirrhosis, liver cancer, acute chronic cholecystitis, gallbladder stone, roundworm in gallbladder duct, liver and gallbladder lesion and intercostals neuralgia.

Pair-point Treatment Combinations

(1) Qimen (LR14), Wenliu (LI7) (Fig 111)
Qimen (14), the front-mu point of the liver, disperses and reduces liver and gallbladder, regulates and harmonizes the exterior and interior. Wenliu (LI7), the xi-cleft point of the Large Intestine channel, clears heat and harmonizes and regulates intestine to resolve pain and numbness. These points in this combination, one yin and one yang, work in synergy to release the exterior and interior and promote and elevate qi and blood function. This treatment is appropriate for rib pain caused by liver and gallbladder damp heat.

Needling techniques:
1. Qimen (LR14) oblique insertion to a depth of 0.5 cun.
2. Wenliu (LI7) perpendicular insertion to a depth of 1 cun.

(2) Waiguan (SJ5) disperses and opens qi of Sanjiao (upper, middle and lower jiao). Yangfu (GB38) disperses and resolves liver and gallbladder suppression. These points in this combination, located on the same channel, echo and reinforce the effects of one another. Together they have heightened effects on the qi of that channel. The combination disperses and reduces liver and gallbladder, and resolves shaoyang. This treatment is appropriate for intercostal distending pain caused by liver and gallbladder qi suppression.

Needling techniques:
1. Waiguan (SJ5) towards Neiguan (PC6) direction penetration needling to a depth of 1 cun.
2. Yangfu (GB38) perpendicular insertion to a depth of 1 cun.

(3) Danshu (BL19), Riyue (GB24) (Fig 110)
Danshu (BL19) is the back-shu point of gallbladder. Riyue (GB24) is the front-mu point of gallbladder. This pair point combination, one anterior and one posterior, one yin and one yang, work together to regulate functions of gallbladder, disperse and reduce liver and gallbladder, open the luo-connecting channels and stop pain. This treatment is appropriate for rib pain caused by irregularities of qi in liver and gallbladder.

Needling techniques:
1. Danshu (BL19) towards spine oblique insertion to a depth of 1 cun.
2. Riyue (GB24) oblique insertion to a depth of 0.5 cun.

(4) Yanglingquan (GB34), Taichong (LV3) (Fig 31)
Yanglingquan (GB34) is the he-sea point of gallbladder. It disperses and reduces liver and gallbladder, soothes tendons and activates luo-connecting channels. Taichong (LV3) is the yuan-souree point of liver. It soothes the liver, regulates qi, invigorates blood and opens the luo-connecting channels. This pair point combination, one exterior and one interior, one zang organ and one fu organ, regulates and liver and gallbladder, harmonizes and regulates qi and stops pain. This treatment is appropriate for rib pain caused by liver suppression, qi stagnation, and channel and collaterals disharmony.

Needling techniques:
1. Yanglingquan (GB34) perpendicular insertion to a depth of 1 cun.
2. Taichong (LV3) perpendicular insertion to a depth of 1 cun.

(5) Zhigou (SJ6), Yanglingquan (GB34) (Fig 105)
Zhigou (SJ6) clears and harmonizes Sanjiao (upper, middle and lower jiao). Yanglingquan (GB34) disperses and reduces liver and gallbladder. The points in this combination, one superior and one inferior, located on the same channel, reinforce the effects of one another. Together they have greater effects on the qi of that channel, resolve Shaoyang, disperse and remove blockage. This treatment is appropriate for rib pain caused by shaoyang qi suppression.

Needling techniques:
1. In sitting or prone position, perpendicular insertion or upwards oblique insertion Zhigou (SJ6) to a depth of 1 cun.
2. Yanglingquan (GB34) towards Yinlingquan (SP9) direction penetration needling to a depth of 2 cun.
3. Manipulate for 5 minutes.

Commentaries
Rib pain is closely related to the irregulation and suppression of shaoyang qi and liver and gallbladder. Acupuncture treatment of rib pain has definite results, especially in relieving the intense pain caused by gallbladder stone and roundworm in the gallbladder duct. However, it is important to obtain an accurate diagnosis through complete examination and combine with other treatment methods.
Liver and gallbladder damp heat caused by rib pain, select Qimen (LR14), Wenliu (LI7).
Intercostal distending pain caused by liver and gallbladder qi suppression, select Waiguan (SJ5), Yangfu (GB38).
Irregulation of qi in liver and gallbladder, select Danshu (BL19), Riyue (GB24).
Liver suppression, qi stagnation, and channel and collaterals disharmony, select Yanglingquan (GB34), Taichong (LV3).
Suppression and stagnation of qi in shaoyang channel, select Zhigou (SJ6), Yanglingquan (GB34).
Use needling rather than moxa.