Disease and Condition Overview
Stiff neck is characterized by acute and intense pare in the neck accompanied by limited movement of the neck. In Chinese medicine, it is often caused by improper sleep posture or inappropriate height of the pillow leading to the disharmony of qi and blood stagnation. Alternatively, it may be caused by sprain m the neck, external injury or wind cold attacking the neck and the back, causing the irregularity of the qi.
Thought it can occur at any age, it is often seen in adult, middle and older aged patients exhibiting symptoms of cervical spondylosis and it often reoccurs. Severe pare and difficulty of movement caused by cervical muscle strain, wind and dampness attacking the neck and shoulder, neck sprain, and cervical degeneration can also employ the same treatment.

Pair-point Treatment Combinations

(1) Fengchi (GB20), Fengfu (DU16) (Fig 29)
Fengchi (GB20) and Fengfu (DU16), both located between the head and the neck, are gateways through which pathogenic wind enters the body. This pair point combination works in synergy to disperse and open qi and blood in the head and neck area. It also soothes tendons, activates luo-connecting channels and stops pain. This treatment is appropriate for stiff neck accompanied by headache and vertigo.

Needling techniques:
1. Fengchi (GB20) towards the direction of the throat, perpendicular insertion to a depth of 1 cun.
2. Fengfu (DU16) perpendicular insertion to a depth of 0.5 cun.

(2) Dazhui (DU14), Shugu (BL65) (Fig 70)
Dazhui (DU14) connects to the Du channel and elevates yang. Shugu (BL65) disperses and opens taiyang. This pair point combination opens and connects the superior and the inferior. It also regulates defensive and nutritive qi and resolves and unobstructs muscle strains. This treatment is appropriate for all types of stiff neck.

Needling techniques:
1. Dazhui (DU14) perpendicular insertion to a depth of 1 cun.
2. Shugu (BL65) perpendicular insertion to a depth of 0.5 cun.

(3) Tianzhu (BL10), Shugu (BL65) (Fig 91)
Tianzhu (BL1O) is located at the border of the head and neck which is the superior collaterals of taiyang. Shugu (BL65) is located at the end point of taiyang. This pair point combination, one superior and one inferior, works in synergy to promote and elevate qi of the foot-taiyang channel to stop pain. This treatment is appropriate for stiff neck accompanied by difficulty in turning the head.

Needling techniques:
1. Tianzhu (BL10) perpendicular insertion to a depth of 1 cun.
2. Shugu (BL65) perpendicular insertion to a depth of 0.5 cun.

(4) Shousanli (LI10), Taixi (KI3) (Fig 63)
Shousanli (LI10) disperses and opens qi of the yangming channel, reduces swelling and stops pain. Taixi (KI3) tonifies kidney and strengthens bone. This pair point combination, one tonifying and one reducing, works in harmony to tonify kidney, strengthen tendons and bones, open channels and invigorate luo-connecting channels, reduce swelling and stop pain. This treatment is appropriate for stiff neck accompanied by pain radiating upwards.

Needling techniques:
1. Shousanli (LI10) perpendicular to a depth of insertion 1 cun.
2. Taixi (KI3) perpendicular insertion to a depth of 1 cun.

(5) Houxi (SI3), Shugu (BL65) (Fig 136)
Houxi (SI3): on the ulnar side of the hand, when the fist is formed, it is located at the end of the transverse crease proximal to the fifth metaearpo-phalangeal joint, on the junction of the red and white skin.
Shugu (BL65): on the lateral side of the foot, posterior to the fifth metatarsophalangeal joint, at the junction of the red and white skin.
Houxi (SI3) is shu-stream point of the hand-taiyang. It unobstructs qi to the Du channel. Shugu (BL65) is shu-stream point of the foot-taiyang channel. These points in this combination, one superior and one inferior, located on the same channel, echo and couple the effects of one another. Together they have augmented effects on the qi of that channel and disperse and open qi of the taiyang and the luo-connecting channels to stop pain. This treatment is appropriate for stiff neck accompanied by pain in the taiyang channel.

Needling techniques:
1. Houxi (SI3) perpendicular insertion to a depth of 1 cun.
2. Shugu (BL65) perpendicular insertion to a depth of 0.5 cun.

(6) Lieque (LU7), Houxi (SI3) (Fig 137)
Lieque (LU7): on the radial aspect of the forearm, above the styloid process of the radius, 1.5 cun proximal to the transverse crease of the wrist, between the tendons of brachioradialis and abductor pollicis longus.
Houxi (SI3): on the ulnar side of the hand, when the fist is formed, it is located at the end of the transverse crease proximal to the fifth metacarpo-phalangeal joint, on the junction of the red and white skin.
Lieque (LU7) is the luo-connecting point of the hand-taivin channel. It disperses and opens qi and blood in the head and neck region. Houxi (SI3) connects to the Du channel, elevates yang and stops pain. This pair point combination unobstructs and regulates both Ren and Du channels, promotes and elevates taiyang, opens the luo-connecting channels and stops pain. This treatment is appropriate for stiff neck accompanied by severe head and neck pain.

Needling techniques:
1. Lieque (LU7) upwards oblique insertion to a depth of 0.5 cun.
2. Houxi (SI3) perpendicular insertion to a depth of 1 cun.

(7) Yanglingquan (GB34), Xuanzhong (GB39) (Fig 138)
Yanglingquan (GB34): on the lateral side of the lower leg, in a depression anterior and inferior to the head of the fibula.
Xuanzhong (GB39): on the lateral side of the lower leg, 3 cun superior to the tip of the lateral malleotus, on the anterior border of the fibula.
Yanglingquan (GB34) is the he-sea point of the foot-shaoyang channel and also the meeting point of the tendon. It soothes tendons, activates luo-connecting channels and stops pain. Xuanzhong (GB39) a point of the foot-shaoyang channel and is also the meeting point of the marrow. It tonifyies marrow and strengthens bone. This pair point Combination connects channels and qi within the channels, disperses and reduces qi in the shaoyang channel, nourishes marrow, strengthens bone, relaxes and unobstructs the sinews. This treatment is appropriate for recurring stiff neck, or kidney deficiency.

Needling techniques:
1. Yanglingquan (GB34) perpendicular insertion to a depth of 2 cun.
2. Xuanzh0ng (GB39) perpendicular insertion to a depth of 1 cun.

Commentaries
Acupuncture treatment of stiff neck is fast and has great results.
The key in treatment is to select local points. In selecting distal points, it is important to use strong stimulation combined with the patient slowly moving the neck. In addition, it is important to maintain better sleep postures, select a better pillow and avoid attacks of external pathogenic qi such as wind cold.