“Tennis elbow” is popular term that was first described in 1883 as “Lawn tennis elbow” to describe a variety of painful maladies that occur in and about the elbow. Lateral epicondylitis of the elbow is currently thought to be caused by tendon overuse and failed tendon healing. Most tennis-elbow patients do not play tennis, and the condition is found almost equally in men and women. Tennis-elbow patients have pain in the lateral epicondyle of the elbow and weakness when extending the wrist and fingers. Superficial radial nerve entrapment, elbow joint lesion, osteochondritis dissecans, radiohumeral arthritis, instability of inversion, and radiating pain of the arm due to radiculopathy of the cervical spine have symptoms similar to those of lateral epicondylitis, so distinguishing lateral epicondylitis (“tennis elbow”) from other diseases is important .
Lateral epicondylitis of the elbow is one of the common diseases in patients with elbow pain, and it can be treated in several ways: rest, physical therapy, joint fixation, orthosis, iontophoresis, injection, etc. If elbow pain continues after treatment, surgery may be performed, depending on the patient . Sufficient rest is needed in the early stage. In particular, patients have to avoid clenching their fist and strongly grabbing objects. If isometric motion is possible without pain, then isometric exercises and stretching of the extensor muscles can be done. Furthermore, if pain decreases, dumbbell exercises or other isotonic exercises may be helpful .
In Korean medicine, elbow pain is relevant to Bijeung, and the oldest text of Bijeung is in Huang-Di-Nei-Jing (Yellow Emperor’s Inner Canon). Bijeung is also called Yeokjeolpoong, Tongpoong after Huang-Di-Nei-Jing. In symptoms filled with bad energy (Siljeung), Huang-Di-Nei-Jing (Yellow Emperor’s Inner Canon) classified Bijeung as windy numbness and pain (Haengbi), cold numbness and pain (Tongbi), and dampy numbness and pain (Chakbi). In symptoms lacking vitality (Heojeung), the text classified Bijeung as lack of Qi and blood (Kihyulheobi), lack of Yang (Yangheobi), and lack of Yin (Eumheobi). The treatment of Bijeung is to make the dampness flow out, circulate Qi and meridians, and emit wind, cold, and dampness from human body [16, 17].
Hwachim is a treatment method that that was used in ancient times from the Huang-Di-Nei-Jing period to cure diseases by using heating acupuncture and needling in certain lesions . In Huang-Di-Nei-Jing, there is a phrase that Hwachim can be used to treat muscle and bone diseases. The therapeutic range of Hwachim became wider, and it is now used to treat skin diseases, internal diseases, gynecological diseases, and ENT diseases. Now, it is also used in many different fields: It can make the ligament stronger by causing an inflammatory reaction in the ligament, boost Yangqi in the human body, circulate meridians and meridian points, and expel bad energy . Traditionally, in Hwachim, the acupuncturist heated the needle before applying acupuncture, but nowadays the acupuncturist heats the needle after applying acupuncture to lesion. The latter is more effective in avoiding injury to dense connective tissues. Hwachim can stimulate heat that is deeper than moxibustion, and hotter than a warm needle (Onchim). Also, the acupuncturist can control the temperature of the needle by using the power of the heating system .
All of the patients in this study had pain and tenderness in the lateral epicondyle of the elbow, and all had a positive reaction on Cozen’s test. Most of them also experienced weakness when grasping an object or pain when grabbing and lifting an object. Thus, we applied Hwachim and S-BV pharmacopuncture to the origin of the ECRB several times. The overall VAS score decreased from 10.00 ± 0.00 before treatment to 4.00 ± 2.47 (Table 2) after treatment.
In a study, Park et al  applied scolopendrid aqua acupuncture in 2 patients, and the overall VAS score decreased from 10 to 1 after 3 to 5 treatments. Kim et al  and An et al  compared bee-venom acupuncture therapy to normal acupuncture and observed a significant effect in the bee-venom-treated group. Choi et al  used pharmacopuncture of an anti-inflammatory herbal compound (AiC, Soyeom) in 2 lateral epicondylitis patients, and the overall VAS score decreased from 9 to 1.5. Kim et al  applied deep thermo-conductive acupuncture therapy in 13 patients, and the VAS score decreased significantly from 6.08 ± 1.54 to 3.31 ± 1.92 (P = 0.005). Park et al  used burning acupuncture therapy in 6 patients, and the overall NRS score decreased from 10 to 1.83.
In this case study, we applied Hwachim in 20 patients, so the results of this study should be meaningful for treating lateral epicondylitis with burning acupuncture therapy. Finally, although we can conclude that the use of Hwachim and S-BV pharmacopuncture is effective in treating lateral epicondylitis, this study has several limitations: The number of cases was insufficient, and other treatments like TENS were also done simultaneously. Moreover, we plan to study the dependence of the reduction of pain on the duration of the treatment more. The mechanism of Hwachim has not been clearly proven to be effective until now, so more cases and continuous study are needed before Hwachim can become a general treatment method.