Nape myofascitis refers to a series of clinical manifestations of edema, exudation and fibrosis of both fascia and muscle tissues in the back and neck caused by the cold, dampness and the chronic overstrain. The most common inducing factors is the damp and cold climate, which contributes to the vascular contraction of the muscles, ischemia, and edema. They cause local fiber exudation and ultimately lead to fibrous inflammation. Chronic overstrain is another important pathogenic factor. After fascia impairment, fibrosis fascia and slight soft tissue avulsion injury appear. With the increase and contraction of fibrous tissues and the local capillaries sqeezing, the peripheral nerve pain occurs. In clinical practice, Jin’s three-needle therapy for myofascitis in the neck and back has shown remarkable curative effects.

Methods 

Point combination
Three neck points: BL 10 (Tianzhu), EX-HN 15 (Bailao), and BL 11 (Dazhu)
Three back points: BL 11 (Dazhu), BL 12 (Fengmen), BL 13 (Feishu)

Operation
After the routine disinfection of the local skin, perpendicularly insert 2-Cun (#30) filiform needles into BL 10 (Tianzhu), EX-HN 15 (Bailao), and BL 11 (Dazhu) to a depth of 1-1.5 Cun, and obliquely insert the 2-Cun (#30) filiform needles into BL 12 (Fengmen), BL 13 (Feishu) to a depth of 1-1.5 Cun too. Twirl and rotate the nees with small ranges to obtain the local soreness, numbness, distending sensation (obtaining qi, De Qi), and retain needles for 20 minutes. Manipulate the needles once every 10 minutes. This treatment needs to be performed five times.
Jin’s three-needle therapy has significant effects on myofascitis in the neck and back, with a total effective rate of 90% or so; but this therapy is not suitable for patients who suffer from organic and other functional disorders and who also have serious heart, liver or kidney diseases.
To avoid fatigue, the patients need to pay attention to keep the neck warm and do relaxing activities. 

Discussion
Myofascitis in the neck and back is a chronic disease of stiffness, hardness and soreness of the neck, back and shoulder caused by chronic overstrain, improper treatment for trauma, externally-contracted wind-cold, and dampness. It is mainly manifested as pain in the neck, shoulder muscles and soft tissues. It often occurs in the population who bend over the desk and work with the bent head. The treatment effects of Western medicine are dissatisfactory, while that of Chinese medicine such as acupuncture and Chinese massage (Tuina) have shown good effects. 

In Chinese medicine, myofascitis in the neck and back is in category of “Neck Impediment (Bi)”. Pathogenic factors lodging in the meridians have negative impact on the flow of the qi in Taiyang meridians; consequently, the defensive qi is insecure and disharmony between the nutritive qi and defensive qi occurs. The governor vessel may also be influenced. These impacts may cause spasm and worsened pain in the neck and back, limited movement of head and neck.

The three neck points and three back points for myofascitis in the neck and back involve BL 10 (Tianzhu), EX-HN 15 (Bailao), BL 11 (Dazhu), BL 12 (Fengmen), and BL 13 (Feishu), and have specific therapeutic effects for conditions in the cervical spine and the back. BL 10 (Tianzhu) is located in the upper cervical spine. As mentioned in A-B Classic of Acupuncture and Moxibustion (Zhen Jiu Jia Yi Jing), it is used to treat symptoms that “the neck seems to be lifted”, “the neck is too stiff to turn to other directions”, and “the neck is as painful as being broken”, which show the common symptoms of myofascitis in the neck and back. EX-HN 15 (Bailao), an extra point, is effective for deficiency and overstrain by various causes. Located in the root of the spine, it can be combined with BL 10 (Tianzhu) to supplement qi and blood, strengthen bones and tendons. BL 11 (Dazhu), the bone-meeting point, one of the eight meeting points, is the crossing point of the Taiyang meridians (the bladder meridian and the small intestine meridian). It can be treated to unblock qi and blood in the Taiyang meridians. BL 12 (Fengmen), the crossing point of the bladder meridian and governor vessel, is the gate where the wind pathogen invades the body, which makes it the main point for treating diseases caused by wind. BL 13 (Feishu), where the essence and qi in the lung and qi of the lung meridian flow to the back, has actions of boosting and dispersing lung qi, opening orifice(s), eliminating wind, and relieving the exterior. The combination of these five points can exert immediate curative effects of regulating the governor meridian, expelling wind and cold, boosting lung and kidney qi.

Notes
In recent years, with the accelerated pace of life, increasing use of air conditioning, and bending over the desk to work, the occurrence of myofascitis in the neck and back has been rising. For such a commonly seen condition, Jin’s three-needle therapy has shown significant effects. Professor Jin advocated to use three neck points and three back points in the treatment of myofascitis in the neck and back, and suggested that one could use “three major points” and select some “extra points” which are identified by applying tender-point theory in acupuncture and modern medical anatomy. The selected points, located in the upper, middle, and lower neck and the upper back, covering a wide range of diseased area, can exert actions of unblocking meridians and collaterals, activating blood and moving qi.