Case Report

Constitution-Tailored Acupuncture Added to Meridian-Based
Treatment for Lateral Epicondylitis: A Six-Case Series

Myeng-Gyun Kim¹,*

Abstract

Background/Objectives: Lateral epicondylitis (tennis elbow) is a common musculoskeletal disorder with a prolonged clinical course and no standardized treatment protocol. In Korean medicine, acupuncture is frequently used, yet optimal point selection strategies remain unclear. This case series aimed to explore the clinical outcomes of a combined acupuncture approach integrating conventional meridian-based treatment with constitution-tailored source-point acupuncture.

Methods: Six patients diagnosed with lateral epicondylitis were treated at a primary Korean medicine clinic. All patients received standard acupuncture and electroacupuncture targeting the Large Intestine meridian (LI10, LI11) and related musculature. Based on Sasang constitutional assessment, an additional constitution-specific source point was applied (SI4 for Soyangin, TE4 for Taeumin, and LR3 for Soeumin). Pain severity was assessed using the Numerical Rating Scale (NRS) at baseline and during follow-up. Clinical course, treatment frequency, and safety were descriptively analyzed.Results: From a bio-medical perspective, steroid-induced sarcopenia is characterized by glucocorticoid receptor (GR)–mediated suppression of in-sulin-like growth factor 1/protein kinase B/mammalian target of rapamycin (IGF-1/Akt/mTOR) signaling, Forkhead box O (FOXO)–dependent activation of atrogenes, increased myostatin expression, enhanced autophagy and mitochondrial dysfunc-tion, as well as systemic insulin resistance.

Results: All six patients showed marked reduction in pain severity during the treatment period. Acute or subacute cases demon-strated rapid improvement within 2–4 treatment sessions, while a chronic case required a longer treatment course but showed gradual and sustained improvement. No serious adverse events were reported.

Conclusions: This case series suggests that adding constitution-tailored source-point acupuncture to conventional meridian-based treatment may enhance clinical outcomes in patients with lateral epicondylitis. This simple and feasible combination strategy warrants further investigation through controlled studies to establish standardized and integrative acupuncture protocols.

Keywords

Lateral epicondylitis; Tennis elbow; Acupuncture; Sasang constitutional medicine; Electro-acupuncture; Case serie

Introduction

Lateral epicondylitis, commonly referred to as tennis elbow, is a prevalent musculoskeletal disorder characterized by pain and tenderness over the lateral epicondyle of the humerus. It is estimated to affect approximately 1–3% of the adult population and frequently occurs in individuals engaged in repetitive wrist extension or forearm overuse, including athletes and manual workers. Although the condition is not life-threatening, it is often asso-ciated with prolonged symptoms lasting several months to years, resulting in functional impairment and reduced quality of life.

In conventional medicine, management of lateral epicondylitis typically includes nonsteroidal anti-inflammatory drugs, physical therapy, corticosteroid injections, and, in refractory cases, surgical intervention. While cortico-steroid injections may provide short-term pain relief, their long-term effectiveness remains controversial, and repeated injections carry risks such as tendon degeneration, rupture, and local tissue atrophy. Consequently, many patients seek complementary or alternative treatments when symptoms persist despite conventional care.

Acupuncture is widely used in Korean medicine for the treatment of lateral epicondylitis and has been reported to alleviate pain and improve function. Most acupuncture-based approaches focus on needling local points and meridians related to the affected region, particularly the Large Intestine meridian, which anatomically corre-sponds to the lateral elbow and forearm. However, despite its frequent clinical use, there is no standardized acupuncture protocol for lateral epicondylitis, and treatment strategies vary considerably among practitioners. Previous studies have reported the use of pharmacoacupuncture, burning acupuncture, and acupotomy, yet these approaches often require additional procedures, equipment, or costs, and comparative evidence remains limited.

Sasang constitutional medicine classifies individuals into distinct constitutional types based on physiological and pathological characteristics, and therapeutic strategies are tailored accordingly. While Sasang-based herbal treatments have been extensively studied, constitution-specific acupuncture approaches remain less established, particularly in musculoskeletal disorders. The use of constitu-tion-tailored source points represents a simplified strategy that can be integrated into conventional acupuncture without increasing treatment complexity or cost. This approach is based on the hypothesis that constitutional imbalance may in-fluence pain perception, recovery speed, and treatment responsiveness.

The present case series was conducted to explore the clinical feasibility and out-comes of combining conventional meridian-based acupuncture and electroacu-puncture with constitution-tailored source-point acupuncture in patients with lateral epicondylitis. By analyzing symptom trajectories in six patients treated in a primary Korean medicine clinical setting, this study aims to provide preliminary clinical observations that may inform future comparative studies and contribute to the de-velopment of practical and integrative acupuncture treatment strategies for lateral epicondylitis.

Materials & Methods

This study was designed as a retrospective case series describing the clinical course of patients with lateral epicondylitis treated with a combined acupuncture approach in a primary Korean medicine clinic. Medical records of patients who visited the clinic between November 2023 and October 2024 were reviewed.

Patients were included if they were diagnosed with lateral epicondylitis based on clinical presentation, including localized pain and tenderness over the lateral epicondyle, pain pro-voked by resisted wrist extension, and a positive Cozen test. Patients with a history of elbow fracture, inflammatory arthritis, cervical radiculopathy, or previous elbow surgery were excluded. A total of six patients met the inclusion criteria and were included in the analysis.

All patients received a standardized acupuncture protocol targeting the meridians and mus-culature commonly associated with lateral epicondylitis. Sterile disposable acupuncture needles were inserted at points corresponding to the Large Intestine meridian, primarily LI10 (Shousanli) and LI11 (Quchi), as well as tender points along the affected extensor muscle group when indicated. Electroacupuncture was applied to LI10 and LI11 using a commercial electroacupuncture device, delivering low-frequency stimulation (2–8 Hz) in a repetitive stimulation mode for approximately 15 minutes per session.

All treatments were conducted in a primary Korean medicine clinic setting. The diagnosis and treatment were performed by a licensed Korean medicine doctor with clinical experience in musculoskeletal disorders. Patient demographic data, symptom duration, and clinical course were extracted from electronic medical records.

All patients received a standardized acupuncture protocol targeting the meridians and musculature commonly associated with lateral epicondylitis. Sterile disposable acupuncture needles were inserted at points corresponding to the Large Intestine meridian, primarily LI10 (Shousanli) and LI11 (Quchi), as well as tender points along the affected extensor muscle group when indicated. Electroacupuncture was applied to LI10 and LI11 using a commercial electroacupuncture device, delivering low-frequency stimulation (2–8 Hz) in a repetitive stimulation mode for approximately 15 minutes per session.

In addition to standard meridian-based acupuncture, constitution-tailored source-point ac-upuncture was applied based on Sasang constitutional assessment. Constitutional type was determined through clinical evaluation by the practitioner, incorporating patient physical characteristics, symptom patterns, and overall constitutional tendencies. Based on this as-sessment, one additional source point was selected for each patient: SI4 (Wangu) for Soyangin, TE4 (Yangchi) for Taeumin, and LR3 (Taichong) for Soeumin. This source-point acupuncture was applied concurrently with the standard protocol at each treatment session.

Pain intensity was assessed using the Numerical Rating Scale (NRS), with scores ranging from 0 (no pain) to 10 (worst imaginable pain). NRS scores were recorded at baseline prior to treatment and at each subsequent visit until symptom resolution or treatment completion. Treatment frequency and total number of sessions were determined according to clinical response and patient condition.

Safety was assessed through review of medical records for any reported adverse events during the treatment period. Adverse events were defined as any unexpected or undesirable symp-toms occurring during or after treatment, including increased pain, neurological symptoms, or local reactions at the needle insertion sites.

This study was conducted in accordance with the principles of the Declaration of Helsinki. As this was a retrospective review of clinical records, formal institutional review board approval was not required. All patients provided informed consent for treatment and agreed to the use of their anonymized clinical information for academic publication. Personal identifying information was removed to ensure patient confidentiality

Results

Patient Characteristics and Treatment Exposure

Six patients diagnosed with lateral epicondylitis were included in this case series. The cohort consisted of four females and two males, with a mean age of 39.5 years (range, 30–49 years). Symptom duration ranged from 2 weeks to 18 months at the initial visit. Four patients presented with acute or subacute onset related to recent overuse, while two patients had chronic symptoms persisting for more than three months. All patients completed treatment and follow-up without dropout. The number of treatment sessions varied according to symptom duration and clinical response, ranging from 2 to 31 sessions. Constitution-tailored source-point acu-puncture was applied in all cases in addition to standard meridian-based acupuncture and electroacupuncture.

Overall Clinical Outcomes

All six patients demonstrated a clinically meaningful reduction in pain severity during the treatment period. Baseline NRS scores ranged from 7 to 10, indicating moderate to severe pain. At the final follow-up, NRS scores decreased to 0–3 in all cases. Patients with acute or subacute onset generally showed rapid improvement within 2–4 treatment sessions, whereas the patient with long-standing chronic symptoms required a longer treatment course but showed gradual and sustained improvement.No serious adverse events were reported, and no patients experienced symptom aggravation requiring treatment discontinuation

Individual Case Summaries

Case 1 (Female, 33 years; Soyangin)

The patient presented with right elbow pain radiating to the wrist following frequent tennis activity. Baseline pain severity was rated as NRS 10. After four treatment sessions, pain decreased to NRS 2–3, with near-complete resolution of wrist pain. Treatment was terminated after four sessions due to substantial improvement.

Case 2 (Female, 49 years; Taeumin)

The patient reported right elbow pain extending toward the wrist with concomitant shoulder discomfort. Baseline pain was mild to moderate. After two treatment ses-sions, pain almost completely resolved, and no further treatment was required.

Case 3 (Male, 44 years; Taeumin)

This patient had a chronic course of lateral epicondylitis lasting approximately 18 months and had previously received corticosteroid injections and extracorporeal shock wave therapy without improvement. Pain severity gradually decreased over repeated treatments, reaching minimal levels after more than 30 sessions. At the final follow-up, pain was reported only at extreme elbow extension.

Case 4 (Female, 49 years; Soyangin)

The patient presented with a two-week history of elbow pain. Pain severity decreased from moderate to mild after the first session and further improved to minimal levels after four sessions, at which point treatment was discontinued.

Case 5 (Female, 30 years; Soeumin)

The patient experienced severe elbow pain following tennis activity. Baseline NRS score was high despite short symptom duration. After three treatment sessions, pain decreased to NRS 3, with symptoms present only during strenuous activity.

Case 6 (Female, 32 years; Soyangin)

The patient had a three-month history of elbow pain associated with tennis. Pain severity improved markedly after the first session and continued to decrease with subsequent treatments. Near-complete symptom resolution was achieved after four sessions.

Summary of Clinical Outcomes

The clinical characteristics, treatment exposure, and outcomes of all six cases are summarized in Table 1.

Table 1. Clinical Characteristics and Outcomes of Patients with Lateral Epicondylitis

Safety Outcomes

No serious adverse events were observed during the treatment period. Mild transient discomfort at needle insertion sites was occasionally reported but resolved spon-taneously without intervention.

Discussions

This case series describes the clinical outcomes of six patients with lateral epicon-dylitis treated using a combined acupuncture strategy integrating conventional me-ridian-based acupuncture with constitution-tailored source-point acupuncture. All patients demonstrated clinically meaningful pain reduction during the treatment period, suggesting that this integrative approach may be beneficial in the manage-ment of lateral epicondylitis in primary Korean medicine practice.

A notable clinical observation was the relatively rapid symptom improvement in patients with acute or subacute onset, most of whom showed substantial pain relief within two to four treatment sessions. Although lateral epicondylitis is known to improve spontaneously over time, the speed of symptom reduction observed in several cases suggests a potential additive benefit of combining constitution-specific source points with standard meridian-based treatment. In contrast, the patient with long-standing chronic symptoms required a prolonged treatment course, yet still demonstrated gradual and sustained improvement, indicating that this approach may also be applicable to chronic cases, albeit with longer treatment duration.

The therapeutic rationale for this combined approach can be interpreted from both biomedical and traditional Korean medicine perspectives. From a conventional viewpoint, needling points along the Large Intestine meridian, including LI10 and LI11, may modulate local pain through neuromuscular stimulation, improved mi-crocirculation, and endogenous analgesic mechanisms. Electroacupuncture may further enhance these effects by providing consistent and reproducible stimulation. The addition of constitution-tailored source points may influence systemic pain modulation and recovery patterns by addressing individual physiological differ-ences, although the exact mechanisms remain speculative.

From the perspective of Sasang constitutional medicine, individuals differ in their physiological balance and susceptibility to musculoskeletal disorders. Tailoring acupuncture point selection according to constitutional type may therefore con-tribute to improved treatment responsiveness. The present case series supports the clinical feasibility of this approach, as the addition of a single constitution-specific source point required minimal procedural change while potentially enhancing therapeutic outcomes.

Compared with previously reported Korean medicine treatments for lateral epicondylitis, such as pharmacoacupuncture, burning acupuncture, or acupotomy, the present approach has practical advantages. It does not require specialized equipment, additional invasive procedures, or increased treatment cost, making it easily applicable in routine clinical settings. This simplicity may be particularly relevant in primary care, where efficient and accessible treatment strategies are needed.

Several limitations of this study should be acknowledged. The retrospective design and small sample size limit generalizability, and the absence of a control group prevents definitive conclusions regarding treatment efficacy beyond natural recovery. Pain was assessed primarily using the Numerical Rating Scale, and functional outcomes were not systematically measured. Additionally, treatment effects may have been influenced by practitioner skill and patient expectations.

Despite these limitations, this case series provides preliminary clinical observations supporting the feasibility and potential usefulness of combining constitution-tailored source-point acupuncture with conventional meridian-based treatment for lateral epicondylitis. Future prospective studies with controlled designs, standardized outcome measures, and larger sample sizes are warranted to further evaluate this integrative approach and to establish evidence-based acupuncture protocols for musculoskeletal disorders.

Conclusions

This case series suggests that a combined acupuncture approach integrating con-ventional meridian-based acupuncture with constitution-tailored source-point treatment may provide clinically meaningful pain relief in patients with lateral ep-icondylitis. Rapid symptom improvement was observed in acute and subacute cases, while gradual and sustained improvement was noted in chronic cases. This treatment strategy is simple, cost-effective, and feasible in routine clinical practice without additional procedural burden. However, given the small sample size and retrospec-tive design, further prospective controlled studies are required to confirm efficacy and clarify underlying mechanisms.