董氏奇穴三肩穴治疗肩周炎：理论基础、潜在机制与未来研究方向

Three Shoulder Points of Dong’s Extraordinary Points for Frozen Shoulder: Theoretical Basis, Potential Mechanisms, and Future Research Directions

摘要: 肩周炎在现代医学中通常称为冻结肩或粘连性肩关节囊炎，主要表现为肩部疼痛、僵硬及肩关节主动、被动活动范围受限。其病理过程与关节囊及肩周软组织的炎症、纤维化和挛缩有关，部分患者可伴随肩峰下滑囊炎、保护性肌肉痉挛及肩关节功能下降。董氏奇穴三肩穴位于手背第一掌骨尺侧，临床多采用健侧远端取穴，并可配合肩关节活动训练。其理论基础包括“以筋治筋、以骨治骨”、太极全息定位及“上病下治”“左病右治”等。现代医学视角下，三肩穴针刺可能通过感觉传入、脊髓及中枢疼痛调制、自主神经调节、感觉–运动整合和神经–免疫调节等途径发挥作用。现有研究提示，三肩穴联合治疗可能改善特定证型冻结肩患者的疼痛、肩关节活动度及部分炎症相关指标；但直接证据数量有限，且存在样本量小、联合干预较多、随访不足等问题。尤其目前缺乏三肩穴远端取穴与传统肩部局部取穴的头对头随机对照研究，尚不能认定其在疗效、患者接受度、依从性或安全性方面更具优势。本文旨在梳理三肩穴治疗肩周炎的理论基础、潜在机制与证据局限，并提出未来研究方向。

Abstract: In contemporary medicine, periarthritis of the shoulder is commonly referred to as frozen shoulder or adhesive capsulitis. It is primarily characterized by shoulder pain, stiffness, and restricted active and passive range of motion of the glenohumeral joint. Its pathological process is associated with inflammation, fibrosis, and contracture of the joint capsule and periarticular soft tissues. Some patients may also present with subacromial bursitis, protective muscle spasm, and impaired shoulder function. The Three Shoulder Points of Dong’s Extraordinary Points are located on the ulnar aspect of the first metacarpal bone on the dorsum of the hand. In clinical practice, these points are commonly needled on the contralateral, unaffected side as distal points and may be combined with shoulder range-of-motion exercises. Their theoretical basis includes the principles of “treating tendons through tendons”, “treating bones through bones”, Taiji holographic correspondence, “treating upper-body disorders from below”, and “treating left-sided disorders from the right side”. From a modern biomedical perspective, acupuncture at the Three Shoulder Points may exert therapeutic effects through sensory afferent input, spinal and supraspinal pain modulation, autonomic regulation, sensorimotor integration, and neuroimmune modulation. Available studies suggest that multimodal interventions involving the Three Shoulder Points may improve pain, shoulder range of motion, and selected inflammation-related biomarkers in patients with frozen shoulder of specific traditional Chinese medicine syndrome patterns. However, direct evidence remains limited, with common limitations including small sample sizes, frequent use of combined interventions, and inadequate follow-up. In particular, no head-to-head randomized controlled trials have directly compared distal needling at the Three Shoulder Points with conventional local shoulder acupuncture. Consequently, it cannot currently be concluded that distal needling offers superior efficacy, patient acceptability, treatment adherence, or safety. This article reviews the theoretical basis, potential mechanisms, and evidentiary limitations of the Three Shoulder Points in the management of periarthritis of the shoulder and proposes directions for future research.