appreciated as such) to keep a focus on the

imbalanced Official (Zang or Fu) and the

Causative Factor (CF), a concept Worsley
borrowed from English homeopathy with its
associated concept of law of cure. In doing
this, there was frequent mention of treating
the bodymindspirit, a New Age concept
that had entered acupuncture circles, and
especially with a focus on the Spirit which
was privileged as a level of intervention.

Reflection Four: Yin Tends

Toward Deficiency/Treating the
Source (The Easy Part); Yang
Tends Toward Excess/On Thorns,
Knots, Stains and Obstructions
(The Work)

In the TCM approach, on the other hand,

the focus was still on the primary ZangFu
pattern, but from a decidedly physical
perspective that gathered data about stools,
urine, breathing, sleep, pain, weakness,
etcetera, much more like an internal medical
practitioner of western medicine with a
similar focus in treating the patient on the
physical level of organ dysfunction and
disease.

THE PROBLEM:
Ordinary skills of acupuncture maintain the
physical body [] Some people say chronic
disease cannot be cured. This is speaking
incorrectly.
(LS, Scroll One)

During the course of this on-line project, I

have come to realize as I shared in the
Preface that the ordinary skills of
acupuncture include the Ben (root) and
Biao (symptomatic) aspect of routine
acupuncture treatment, and that there has
been much time spent discussing Root versus
Symptomatic treatment, as if the former were
more important than the latter, and required
higher skills, when they are both in fact part
and parcel of good solid acupuncture.

Lines were drawn, and those entering the

study of AOM to help people deal with
complaints started to lean much more heavily
in the direction of 8 Principle acupuncture,
later referred to as TCM.
While TCM played lip service to the classical
notion that Internal ZangFu problems were
caused by disorders of the 7 emotions, it was
Worlseys approach that took this concept
the furthest in those days. Each approach was
certain it had the correct way of treating the
Root, and each style, from my perspective,
missed the main point of acupuncture, that
in fact has to do with knowing how to
navigate the channels to deal with those
thorny, knotted, messy obstacles which
present themselves as symptoms, which bind
our patients in chronic holding patterns and
which, once they become chronic, make
escape quite difficult without some hands-on
help. And it is especially there, in each of
these two main styles lack of education or
training in palpation and touch, that
treatment of the meridians (jingluo) got so
seriously shoved into the background.

5 Element and 8 Principle Treatment

In both the 5 element and the 8 principle
discussions of 25 years ago, each of these
approaches argued that it was treating the
Root. In Worsleys Five Element
approach, practitioners were strongly
dissuaded from using needles to treat
symptoms (which would make one a Local
doctor using local meridian points for
symptoms), as it encouraged its students from
the very beginning, after removing whatever
basic blocks (which were, interestingly, often
meridian blockages but not taught or

Where Worsley himself was a gifted physical

medicine practitioner before learning
acupuncture, who resorted at every turn to
physiotherapeutic and osteopathic
manipulations to clear away these thorny
obstacles and open the way for a Root
acupuncture treatment, the North American
teachings that derived from his work would
have to wait for Fritz Smiths brilliant zerobalancing method, developed to fill the gap
in this 5 element training tradition, to learn
how to lay on hands to promote free-flow
through the channels and collaterals.

Maciocia stresses that treatment principles

can be discussed in four distinct yet
interrelated ways:
As Root (Ben) and Manifestations
(Biao): Upright Qi is the Root
relative to Pathogenic Factors which
are the Manifestation; Root is
etiologically the root of a disease
while the clinical manifestations are
the Manifestation; Root is the initial
condition while Manifestation is the
later developments of the condition;
Chronic disease is the Root relative
to Acute disease which is the
Manifestation. They are not two
separate entities, but two aspects of a
contradiction, like Yin and Yang (p.
312). Maciocia makes the oft-quoted
statement that [g]enerally speaking,
treating the Root only is sufficient to
clear all clinical manifestations in
most cases when the clinical
manifestations are not too severe(p.
313. The Root and the
Manifestation would be treated
together, an approach he admits is
widely used in chronic conditions,
when the clinical manifestations are
severe and distressing for the
patient or when the clinical
manifestations themselves are such
that they would perpetuate the
original problemp. 314). When the
manifestations/symptoms are severe,
usually in acute conditions, he goes
on, it is often necessary to treat the
manifestations first. You are referred
to Maciocias chapter for the more
detailed discussion regarding
situations where there are more than
one Root, in which case each Root
must be treated; one Root giving rise
to several different manifestations,
where the treatment is still directed
primarily at the Root; and situations
where the Root and Manifestation
coincide which he states can only
happen when the clinical

While I grew to be quite impressed by the

sincerity of the education in Worsleys Five
Element style, I became dizzy with the
gyrations such practitioners would go
through to avoid inserting a needle in places
that were knotted, obstructed, and screaming
for relief, and confused and dismayed by the
associated lack of interest in navigation and
treatment of the meridians of acupuncture in
their classical sense.
It felt to me as if the Worsley tradition, in
short, was intentionally not embodied, seeing
itself instead operating on some rarified
spirit level.

Root and Symptomatic Treatment

During this period of development of North
American acupuncture, the issue of Root
versus Symptomatic treatment lead
practitioners to galvanize under one or the
other pole, with 5 Element practitioners
claiming the higher, Root ground and stating
that 8 principle/TCM acupuncture was
purely local doctor treatment of symptoms.
For a detailed, although decidedly TCM,
internal medical (and therefore herbalized)
perspective on Root and Manifestation in
TCM, see Maciocias The Foundations of
Chinese Medicine, pp. 312-323, which I will
briefy summarize here.

manifestations are caused by external

physical trauma, such as in an
accident(p. 315). Here the
stagnation of Qi and Blood in the
channels leads to pain because the
pain is the stagnation of Qi and
Blood.
When to support Upright Qi, when
to eliminate pathogenic factors:
Maciocia defines upright Qi as the
bodys resistance to disease []
used only in relation and in
contrast to pathogenic factors
(regardless of whether they are
external such as wind, cold, damp,
heat, or internal such as interior
wind, blood stasis and stagnation of
Qi, phlegm and fire). An Excess in
this circumstance refers to the
presence of an exterior or interior
pathogenic factor, where the upright
Qi is still intact enough to fight the
pathogenic factors, he clarifies. A
Deficiency, on the other hand, refers
to a weakness of upright Qi and an
absence of a pathogenic factor.
Finally, a mixed Deficient/Excess
condition, which he adds is far more
frequent clinically than a purely
excess condition, refers to a
condition where upright Qi is weak,
but pathogenic factors are also
present. Treatment must therefore
be directed at tonifying or dispersing
(expelling) or both.
When to tonify, when to disperse:
Tonifying upright Qi is only
applicable, Maciocia underscores, in
interior conditions. This can be
accomplished with acupuncture,
exercise, diet, Qi Gong, meditation,
rest or herbs, he clarifies. He quotes
the saying support upright Qi, to
eliminate the pathogenic factors(p.
316). In exterior conditions it is
almost always sufficient to expel the
pathogenic factors and the upright
Qi will be strengthened, whence the
saying eliminate the pathogenic

factors to strengthen upright Qi(p.

317) This can be done by using
dispersing acupuncture techniques,
cupping or bleeding. Maciocia
concludes that a strategy commonly
used for exterior and interior
conditions, when the bodys upright
Qi, its resistance, is low, is to expel
the pathogenic factors first, then
tonify the upright Qi (only when
there are no more signs of
pathogenic factors being fought off
does one tonify upright Qi he states).
While this is a required approach in
acute or urgent cases, it is also
commonly used in chronic cases
where the symptoms do not have a
character of urgency, but are
nevertheless, very distressing and
painful(p. 319). This is the case in
chronic visceral and pain disorders,
and the APM/CCA integrated
approach usually adopts this
approach, of focusing on expelling
the pathogenic factors, but also
simultaneously supports the upright
Qi for balance. I agree with Maciocia
that one must be very careful when
dispersing excess to suggest to
patients not to overdue it with
exercise or activities which may
aggravate the dispersal and lead to
undue soreness and fatigue. They
would do well to rest, and/or
meditate to calm the body and mind
and gather resources. If there are
signs of the body fighting something
off, a fever, even if low grade, chills,
a feeling that one is coming down
with something or just getting over
it, I do not treat their original
chronic condition, say chronic
Taiyang Zone pain in the low back
and buttocks, as this would invite the
current EPF to enter more deeply.
This is also why physicians counsel
patients not to work out during a
cold or flu, but rather to stay home
and rest.

 Treating the constitution. This

refers, Maciocia stresses, to the
Three Treasures (San Bao)Essence
(Jing, prenatal, hereditary Qi and
inherited constitution gauged by
general vitality, symptoms, pulse and
eyes- leading to strong bones and
good mental faculties and memory);
Qi (acquired or postnatal Qi, which
can be gauged by symptomatology,
tongue, pulse); and Shen (the state of
mind is primarily a result of the
interaction of Jing and Qi and is also
reflected in the eyes). The heart
pulse will also be strong but not
overflowing. Constitution can also
refer to treating according to the Five
Elemental types. Maciocia raises the
issue of whether one should treat the
constitution in the absence of
clinical manifestations, which he
believes only an experienced
practitioner can ascertain. He
concludes that it is generally better to
treat the constitution toward the end
of the course of treatment to
consolidate the results. On the
other hand, one must pay attention
not to exceed in treating the
constitution and stir up problems
unnecessarily(p. 323).

meridian therapy claims that treatment of

localized areas is unnecessary. Sometimes
local, symptomatic treatment may even have
a beneficial effect on the balance of Qi in the
body as a whole (Japanese Classical
Acupuncture: Introduction to Meridian Therapy,
translated by Stephen Brown, Eastland Press,
Seattle, 1990, p. 152).
Shudo sensei then goes on to summarize the
two opposite views, with some meridian
therapists claiming that root treatment
effectively deals with 70-80% of symptoms,
while others state that symptomatic
treatment is necessary because practitioners
of meridian therapy lack confidence in the
effectiveness of root treatment (ibid), even
questioning the line drawn between root and
symptomatic treatment on the basis that
some practitioners of meridian therapy
actually spend more time on symptomatic
treatment (ibid).
Shudo sensei concludes that there is a major
misconception among some conventional
acupuncture practitioners in Japan that
practitioners of meridian therapy believe
that root treatment is all that is necessary, but
the truth is that symptomatic treatment is by
no means neglected in meridian therapy
(ibid).
Shudo sensei then concludes: The only real
difference between meridian therapy and the
conventional approaches to acupuncture in
Japan is that root treatment is performed to
balance the body energetically before the
specific symptoms are treated ibid).

Japanese and Acupuncture Physical

Medicine Perspectives
This issue of Root versus Symptomatic
treatment has also been a major source of
debate, at times heated, in the Japanese
Acupuncture field over the last half decade,
where conventional acupuncture
practitioners and meridian therapists argue
their views on the subject. In his seminal text,
master practitioner Shudo Denmei
summarizes the issues and debates, by first
stating clearly: It should be emphasized that
both root and symptomatic treatment are
necessary and important. No authority on

With that clarified, Shudo senseis own

simplified approach to root treatment is
presented, and consists in the treatment
primarily of tonfication points, as well as
master points on the mother meridian, to
treat the primary yin meridian/organ
deficiency as phase one of treatment, based
on Nan Jing five phase treatment strategies.

Shudo senseis approach is consistent with

the tonification at the ying level of the most
deficient yin meridian/organ, and/or
balance of the jing level extraordinary
meridians before moving on to treat the
local, symptomatic complaints of the patient,
in APM, which incorporates Shudo senseis
hypothesis that yin tends toward deficiency,
yang tends toward excess as a central focus
for chronic complex disorders specifically, as
well as for internal visceral complaints in
general.

effective fashion: with meridian therapy

reassessing the pulse during the treatment to
check for positive change; KM style
rechecking the hara and other reflexes for
this evidence of change during the treatment;
APM looking for expected reactions to the
needling of the first phase of points (sinking
deeply into the point for tonification,
spreading out and/or propagating away from
the point for dispersal); and TCM rechecking
pulse and tongue the next visit.
But all of these styles and practitioners are in
fact also assessing the effectiveness of the
treatment as it is being administered,
whether consciously or tacitly, by looking for
more general signs of positive change already
enunciated in the first chapter of the Ling
Shu: Look at the patients color. Observe the
eyes. Know how the qi disperses and returns.
Each has its own form. Listen to the patients
movement or stillness. Know his imbalance
and his balance (Ling Shu or The Miraculous
Pivot translated by Wu Jing-Nuan, University
of Hawaii Press, 1993, p. 4).

KM style acupuncture, likewise, begins phase

one of treatment by regulating the Yin,
ventral aspect of the body by needling distal
points often selected based on Nan Jing five
phase theory, to regulate constitutional and
Organ imbalances before moving on to
treatment of the patient complaint and the
yang, dorsal aspect of the body.
Finally, TCM, which has borne the brunt of
five phase criticisms that it only treats
symptoms, also often begins with treatment
of distal essential points to address the
underlying pattern of disharmony, and then
adds local specific points to address the
patient complaint.

Vital Signs of Change

I believe too little is made of these
observations of change, some of which I
learned from practitioners at the Traditional
Acupuncture Institute in Maryland almost
three decades ago. And I believe there is a
tendency to privilege assessment by the radial
pulse, which is prone to very subjective
interpretation by the acupuncturist, rather
than learning to read the signs of energetic
change in the circulation of Blood and Qi by
observing these changes directly: looking for
improved facial color, for the shen to return
a sparkle to the eyes, and listening for more
relaxed breathing and more relaxed speech,
looking for a more relaxed demeanor, and
listening, watching for and questioning how
the qi and blood are moving, changing
temperature, releasing constrictions (creases
across the abdomen, xs in the back of the

In selecting distal points for this first,

YinYang regulatory phase of treatment, the
term the college prefers to Root treatment,
meridian therapy, as well as KM, APM and
TCM styles of acupuncture as taught at the
college, all teach to select from the 5 shutransporting/5 phase elemental points, the
yuan-source points, the luo-connecting points
and the xi-cleft points. Where meridian
therapy and KM style tend to select these
distal command or essential points based
on Nan Jing five phase theory, APM and
TCM tend to select these points for their
functions as jing-well, ying-springhe-sea
points more consistent with earlier Ling Shu
theory.
These four styles also have different ways of
assessing if the treatment is proceeding in an

neck, compressed wrinkles in areas of spinal

stenosis, release of muscular holding
patterns). These things can all be seen, and
those observing will concur on the changes
noted far more consistently, I would submit,
than those checking the pulse.

Finally, if one makes positive change in the

pulse the sole arbiter of therapeutic change,
the classical rules of assessment have been
ignored, which call for assessing in as many
fashions as possible, to glean as much
information as one can, until this
information is able to be assessed tacitly,
which I believe is the case with all senior
practitioners. And no practitioner taking the
pulse during the treatment is failing to also
take in changes in complexion, tone of voice,
breathing patterns etcetera, all of which will
influence how they interpret the pulse.

Treating Excess: Surface Manifestations

and the Patient-Complaint

It might be interesting to devise a research

study to see if assessing therapeutic change
without taking the pulse by some
practitioners coincides with therapeutic pulse
changes assessed in that way by others.

In excess disorders the jingluo, the soma,

and especially the cutaneous regions (zones)
and tendinomuscular meridians need to be
dispersed as the primary strategy. In APM,
YinYang regulatory treatment at the ying
level in such cases simply consists in
supporting the yin paired meridians primary
Zang (supporting the Kidneys for Taiyang
Zone, Liver for Shaoyang Zone and Spleen
for Yangming Zone) and completing the
circuit for zone excesses, or needling the 4
gates or distal jing-well and other tender
points for tendinomuscular excess to clear
the jingluo and promote smooth flow of
Blood and Qi.

That being the case, Shudo Denmei makes a

point that is a truism in APM, KM and TCM
style practices as well: When it comes to
symptomatic treatment, there is practically
no limit to the variety of approaches and
techniques that can be employed.
Symptomatic treatment is an area in which
every practitioner can display his own talent
and unique skills. Each of us must spend a
lifetime developing our own treatment style
(Shudo, ibid, p. 153).

In deficiency conditions the ZangFu are the

main target of treatment, but the French
acupuncture strategies that lie at the
foundation of APM treat these visceral
disorders and diseases through the
extraordinary vessels as well, which are
activated when the organism is confronted
with the strain of chronic disease or
dysfunction. Here a jing level treatment of
the extraordinary vessels is done first, and
then a ying level treatment of paired yin

This would certainly be true in the three

main styles taught at the Tri-State College of
Acupuncture, where local treatment of the
patient complaint are varied indeed:

APM use of classical Chinese bisyndrome and modern trigger point

dry needling techniques, preacupuncture palpation, pacing and
leading ones therapeutic comments
and silences to prod change (based
on Ericksonian hypnotherapy and
NLP techniques), and prodding of
the bodily felt-sense (Gendlin), as
well as education of the patient
about their holding patterns and
armoring (Reich, Keleman);
TCM use of stationary and moving
cupping, guasha, indirect
moxibustion, tui na, Qi Gong and
Daoyin exercises.

KM style use of various needling

techniques and depths, moxibustion,
patchi-patchi, ion chains and diode
rings, sotai, etcetera;

meridians to any yang zones affected is

executed, to regulate yinyang circuits at the
same time as removing chronic muscle
channel obstructions by addressing ashi and
trigger points.

As for that which is termed tri (level)

insertion for promotion of grain qi (ie; the
correct qi), one first inserts the needle
shallowly, barely penetrating the skin to drive
out yang evil. Next one needles to drive out
yin evil [inserting the needle] slightly deeper
to penetrate the skin and flesh but not
penetrating the parting of the flesh. Finally,
one needles still deeper, penetrating the
parting of the flesh to promote the
emergence of the grain qi (p. 279).

It is in this sense that APM focuses on the

need to disperse excess in the three Yang
Zones (the cutaneous regions) or the
tendinomuscular (muscle) channels, thereby
fortifying the bodys defenses/upright Qi.
This is also why APM focuses on addressing
up-regulation/hyper-reactivity in the
extraordinary vessels, especially, chong, du,
dai and ren, which are called into play,
according to certain French acupuncture
understandings, when the body is perpetually
attacked, to protect the ZangFu against this
steady onslaught.

The so-called arrival of the grain qi implies

that supplementation has replenished (the
channel) and drainage has evacuated (the
channel). Thus one may know that the grain
qi has been attained (p. 305).
Once the evil qi has been removed, despite
a failure to regulate yin and yang, the disease
will display signs of improvement. This is
why it is said that supplementation is sure to
replenish, while drainage is sure to evacuate,
and that although the disease may not appear
to have diminished following acupuncture, it
will have indeed been mollified (p. 306).

The point is, that excess conditions must be

dispersed. I believe it is a mistake to treat the
constitution alone in the presence of excess
in the zones and/or muscle channels and luo
vessels, as this excess will block Qi and Blood
and the ensuing stagnation and constraint
will create a vicious cycle of pathogenic
activity that will generate more excess. Here is
where lifestyle counseling, especially
regarding getting proper rest, sleep and stress
reducing activities like Yoga, meditation, Tai
Qi and Qi Gong can be so critical. Tui-Na
and massage, moving cupping and GuaSha
are also a vital part of treatment of excess, to
keep the body supple and functioning
optimally. If Excess in the jingluo is left
unaddressed, this will lead to stagnation of
Blood, constrained Qi, Phlegm and Fire, the
internal pathogenic factors. These, too, must
be dispersed.

It takes a tough kind of compassion, and

focus, to disperse Excess and evacuate evils in
patients with chronic conditions, where the
excess is laden with pain, suffering, and even
at times abuse. The going can get rough at
times. But the result, freeing patients from
some of this excess, from holding patterns
that have been constricting or suffocating
them, is worth the effort for practitioner and
patient alike.
To focus on the constitution alone, then, to
attempt to gently tonify patients with Excess
conditions with acupuncture is, and here I
agree totally with TCM and Maciocia, an
error. This could be done if the patients were
addressing the excesses in another somatic,
physical practice, like Rolfing for example.
But somewhere the Excess has to be
dispersed, or these Exesses will build up and
lead, potentially, to what yoga refers to as a

This focus on dispersing Excess as a primary

strategy is clear from the LingShu and later
texts that develop this notion in the classic
discussion of tri-level needling. Here is
Huang-fu Mis version in the Jia Yi Jing or
Systematic Classic of Acupuncture &
Moxibustion (Blue Poppy, 1993):

Kundalini experience where the Excess

remains trapped in the patients nervous
system. This can lead in extreme cases to
never-ending nervous system agitation.

symptomology as part of the internal branch

of the 12 regular meridians, I found
Chamfrault and Van Nghis earlier
categorization in Lenergetique humaine
more useful than Van Nghis later FrenchVietnamese one based on the Vietnamese
Trung Y Hoc, in his Pathogenie et pathologie
energetique en medecine traditionnnelle
chinoise.

Beyond Root and Symptomatic

Treatment
After much reflection on how North
Americans tend to ascribe more significance
to Root, than to Symptomatic treatment, I
discussed this issue with Kiiko Matsumoto,
who was rather surprised at how one might
think a tree might have only roots or
branches and still be a tree! This lead to a
decision at the college to refer instead to:
YinYang regulation, using the essential
points (distal command and local Mu and
Shu) to treat primary Organ or
Constitutional patterns; and Treatment of
the Patient-Complaint, using reactive points,
which focuses on the complaint, and its signs
and symptoms as manifested by the patient.
This reformulation underscores the fact that
one must address the patients complaint if
one wishes to practice patient-centered care,
as this part of the treatment focuses on the
patients experience and story of illness and
distress, not ours. This reformulation also
hopefully puts to rest the fantasy,
pronounced by those who profess to have the
deep secrets, that one can treat chronic
complex disorders by root treatment alone,
a fantasy that has lead far too many
practitioners to clinical failure after failure.

In the earlier text, Chamfrault and Van Nghi

organized the teaching of the jingluo filter by
category of meridian, and therefore category
of point strategy, to be utilized in formulating
a comprehensive treatment plan based on
jingluo pattern identification. This
categorization was broken down into Ying,
Jing and Wei as follows.

Ying & Ying Level Treatment

The Ying level is comprised of the 12 regular
meridians, and internal branches (parallel to
the 12 divergent meridians) which function
as a circuit as presented in the previous
Reflection. Here, one identifies the regular
meridian that is most affected, and its circuit,
and utilizes the source, or ying and shu, or
tonfication or other essential command
point on the Yin meridians, and the luo,
dispersal, xi-cleft, or other essential command
point on the paired yang meridian. The yang
meridians are primarily used to address the
symptomatic presentation, while the yin
meridians address the underlying regular
meridian dysfunction. If one has already
made a TCM ZangFu pattern diagnosis, say
in preparation for an herbal
recommendation, one can just select the
corresponding regular meridian and its
associated circuit to develop a jingluo
treatment plan.

Treating the Patient-Complaint and

Holding Patterns
As I reorganized the curriculum of the
Quebec Institute of Acupuncture into a more
workable model that integrated in TCM
ZangFu pattern identification (the ZangFu
diagnostic filter) in the second year, and
after a thorough grounding in jingluo pattern
identification in Year I, that viewed visceral

When the internal associated organ and

bowel are affected, resulting in internal
visceral symptomology, one can add the local

front-Mu and/or back-Shu points to address

the ZangFu directly.

This palpation of the target or symptomatic

area has been a hallmark of the meridian
approach I have practiced for three decades,
and was most elegantly and simply stated by
Dr. Ni in her clinical text, when she stressed
that any local point on a meridian may be
used to treat local symptoms in the area of
that point. For those who palpate distally and
locally, to assess the state of excess and
deficiency of the beginning and ends of the
meridians, a rich array of circuit palpation
and treatment is readily available that is
always patient-centered, because it starts by
assessing that area of the body-person (shenti)
that brings the patient to our office and
affords us the privileged opportunity to
witness and support their efforts at change.

A] Ying-Level Local Treatment of PatientComplaint

The main difference in this jingluo approach,
from TCM acupuncture treatment, is that
points are selected based on their dynamic
effect on the circulation of Qi (what the early
French authors referred to as the energetics
of the points) rather than based on supposed
indications, and that local points are selected
from the meridians in the area of the
complaint, by palpating for obstruction and
excess. Thus one might palpate and find
tightness and constriction over the lungs in a
patient suffering from chronic obstructive
pulmonary disease (COPD) in the following
configurations, with the local obstruction
guiding the distal YinYang regulatory
treatment as well:

I have started with this discussion of local

treatment of the patients complaint in
visceral disorders of the ZangFu to stress that
in such cases, the local symptomatic
treatment addresses the ying level of the
regular meridians based on the classical
notion of assessing and treating the
beginnings and ends of the meridians, not
trigger points in the muscle channels.

Tight Tender Points (TTPS, not to

be confused with Trigger Points or
TrPs) in the area of the Taiyin
union, Lu 1-2 and Sp 20 (beginning
of hand taiyin lung and end of foot
taiyin spleen), indicating a Taiyin
dysfunction;
The above TTPs, with exquisite
tenderness at ST 14-16 and LI 17,
indicating a taiyin/yangming
dysfunction;
TTPs at Lu 1 and Liv 14, indicating a
blockage in the circulation of Qi
from foot jueyin liver to hand taiyin
lung OR in Metal and Wood (Metal
controls Wood);
TTPs at Lu 1-2 and Kidney 23-27,
indicating a hand taiyin lung and
foot shaoyin kidney dysfunction
(disorder of Metal and Water/
Mother and Child);
TTPs at CV 18-17 and CV 23 with
plumpit Qi, indicating a dysfunction
of Wood and Water/ Liver and
Kidney/ Mother and Child.

In such ying level visceral disorders, one may

add treatment of the 8 extraordinary vessels
with their distal opening points, a
characteristic of Van Nghi style French
meridian acupuncture, but also of Manaka
style Japanese style treatment, where ionpumping cords are attached to the distal
opening points instead of needles.
I list common local ying and jing level points
of union for addressing the patient-complaint
in my earlier Acupuncture Imaging, p. 26, and
especially in chapter 7, on bodymindenergetic palpation, pp. 66-78, as well as in
the drawings of the greater meridian units in
my earlier BodyMind Energetics, chapter 2.
Main union points that I routinely observe,
assess and release are:

TH 22-23 and GB 1-3 as well as the

extra point taiyang for Shaoyang
lateral head pain, dizziness, vertigo,
headache, migraines;
TH 15 and GB 21 for Shaoyang
upper back, trapezius, supraspinatus
pain and dysfunction;
TH 16 and GB 20, as well as the
extra point anmian for
Shaoyang/Jueyin tinnitus,
temperature problems including
excess sweating and hot flashes, and
neck pain;
Bl 1 (not needled) and SI 18 for
Taiyang facial pain, trigeminal
neuralgia and sinusitis signs and
symptoms, which has come to
include Bl 2 and ST 2 where tender
in the same area of facial pain and
sinus symptoms;
Bl 11 and SI 9-14 for rotator cuff
disorders and shoulder pain and
dysfunction;
ST 2 and LI 20 for Yangming facial
pain and sinus symptoms;
ST 3-4 and LI 19 for trigeminal
neuralgia;
LU 1-2 and SP 20 for Taiyin chest
pain, respiratory disorders, shoulder
pain and dysfunction;
Kid 27 and HT 1 (HT 1 replaced by
subclavius trigger point near ST 13)
for Shaoyin Thoracic Outlet-like
signs and symptoms of neck pain
and arm repetitive strain signs and
symptoms;
Liv 14 and Per 1-2 for Jueyin chest
pain, panic disorder, shoulder pain
and dysfunction, respiratory
problems.

organs, are at risk. Treatment here is directed

toward stimulation of key points to address
dysfunction in the chong, dai, ren and du
vessels (Sp 4, GB 41, Lu 7, SI 3), with their
paired vessels key points (Per 6, TH 5, Kid 6
and Bl 62).
Local points from the extraordinary vessels
involved can also be selected to address
visceral or somatic symptomology that
constitute the patients complaint, distress
and suffering. While APM has specific stress
patterns (the Four Patterns of
Fatigue/Visceral Agitation presented in
Reflection II) to address common chronic
adrenal patterns of our day, APM is
predicated upon a solid grounding in jingluo
theory and treatment, and I frequently resort
to treatment of an extraordinary vessel or
vessels on their own, with little or no
treatment at the ying level.
This is common for me in addressing
gynecological and reproductive problems,
where I treat distal opening points for chong,
dai and ren, but also address excess and
deficiency along the local points of these
meridians, so GB 26-28 (dai), Kid 11-15 and
ST 30-26 (chong) and CV 2-4 (ren). I also
often treat a series of local HJJ points in
spine disorders, with the infinity opening
point treatment for ren and du: Lu 7/Kid 6;
SI 3/Bl 62, as a du mai treatment (HJJ and
adjacent BL meridian points, as well as the
muscle channel multifidi, being seen as part
and parcel of du mai).
I felt the need early in my teaching career to
focus heavily on teaching the extraordinary
vessels when English language texts did not
exist and Chamfrault and Van Nghis texts
were the main resources. When these texts
went out of print, there was still Royston
Lows book on the secondary vessels, which
then went out of print as well, and Felix
Manns early text on the meridians of
acupuncture, which recently went out of
print but appears to be circulating in an
unofficial on-line version, has also

B] Jing-Level Local and Distal Treatment

The Jing level is comprised of the 8
extraordinary vessels, which function outside
of the 12 main meridians but kick in when
disorders are complex or chronic and two or
more regular meridians, and their associated

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disappeared. Since Mann recanted all of his

earlier books based on classical theory,
support for training in the secondary vessels
and extraordinary vessels was scanty indeed.

correlate to, and perhaps more manageable

form of such complex emotionally laden
problems.
In its simplest version, one merely palpates
along a muscle channel and performs wei
level oblique shallow needling (a needling
approach known as Bao Ci), to point after
point in the symptomatic area as well as
distally on the channel involved (jing-well
and other tender ashi points), and this is
done in APM most frequently on the Yang
tendinomuscular meridians. One can also
incorporate trigger point dry needling based
on referral patterns, an extremely pragmatic
addition to classical muscle channel
treatment, and these muscle channels can be
treated by region as well, with points from all
three Yang or Yin meridians of the arm or leg
depending on region affected. Distally, one
can treat the jing-well point as the furthest
point from the symptomatic area, the jingriver point if the problem has become
chronic and rheumatic affecting the joints,
the luo-connecting point if its target area is
within the symptomatic region, or excess
reactive points on palpation along the same
channels.

And then Dr. Ni published her brilliant

Navigating the Channels, which we use as the
main authoritative text at the college for
jingluo clinical pattern differentiation and
treatment.
That said, any serious student of a jingluo
approach should study Maciocias book on
the channels carefully and repeatedly, as it is
full of clinically useful and classically
informed information, even if an awkward
text to use in the clinic itself. His study of the
extraordinary vessels alone contains
everything Chamfrault and Van Nghi wrote,
is consistent with Felix Manns early text on
the jingluo, and with Nis text. His treatment
of the extraordinary vessels fills 10 chapters
and over 270 pages, and is a book unto itself
that I highly recommend.
C] Wei Level Muscle Channel Local
Treatment
Finally, APM focuses on W ei level treatment
in all myofascial and many musculoskeletal
Bi syndromes where the treatment is
comprised of the 12 tendinomuscular
meridians (muscle channels) and the 15
primary luo vessels, which are activated
according to classical theory to protect the
regular meridians and the skeletal system
from external attack, injury, repetitive strain
and wear and tear, thus diverting the brunt
of the attack to the larger muscle channels
and superficial cutaneous regions (Zones),
which occupy the broadest area and thus
serve best to offer this protection. In chronic
emotional disorders, affecting the internal
meridian/organ complex, the muscle
channels and cutaneous regions often serve
as a shock absorber to take on the bulk of the
trauma, thus creating physical symptoms and
myofascial holding patterns, which Wilhelm
Reich referred to as Character Armor as a

While release through a special sparrowpecking needling technique is my preferred

way to release active local trigger points,
especially if acute, or if newly inflamed in a
chronic condition, which I lay out in my A
New American Acupuncture: Acupuncture
Osteopathy, I also often simply use rapid
lifting and thrusting to deep muscle ashi
points if sparrow-pecking does not lead to
rapid fasciculation and release, which can be
the case in chronic pain where the fascia has
become fibrotic, in women right before or
during menstruation when their cou li layer
is congested and full of damp Sha, or in
patients with very low Blood Pressure or with
Low Thyroid conditions.
While some practitioners who have trained
with me might make almost exclusive use of
my APM Trigger Point Dry Needling

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technique for local excess ashi points, I

discriminate much more than that, and
reserve such a technique for actual myofascial
trigger points, and rarely when I am treating
ying level regular meridian or jing level
extraordinary vessel local areas of the specific
patient-complaint. I also incorporate trigger
point release into full-scale jingluo
acupuncture treatments for any complex or
chronic disorder, based on my approach to
the three Yang Zones as outlined in chart
form and in clinical protocols in Acupuncture
Physical Medicine.

What characterizes APM style above all else is

its focus on careful palpation not only
distally, but locally along extraordinary vessel,
regular meridian, and tendinomuscular
meridian and luo vessel pathways for areas of
excess and deficiency to be needled to relieve
symptoms, remove obstructions, and
promote the flow of Qi and Blood.

Acupuncture PHYSICAL medicine is thus

aptly named, to underscore a style akin to
AOM bodywork, where laying on of hands is
central and critical to clinical success.

The Jingluo Filter at a Glance

Based on this way of categorizing the jingluo
filter, jingluo pattern identification and APM
treatment planning consists of the following
elements:

The 3 circuits (of the 12 regular

meridians): select the circuit based
on the primary Yin regular meridian
involved, and treat its corresponding
paired Yang meridians, thus treating
at least 2 out of 3 meridians in a
circuit;
The 3 levels (ying, jing, wei ): to the
above regular meridian/circuit
treatment, add the corresponding
extraordinary vessel treatment of key
distal and local points, if the disorder
is complex or chronic and involves

two or more regular meridians and

their associated organs; OR just treat
the extraordinary vessel involved as
the main root treatment;
The 3 Zones (Taiyang, Shaoyang,
Yangming): when a chronic
myofascial or musculoskeletal pain
and dysfunction condition is
involved, especially when it is
comprised of symptomatic areas at
multiple sits within a zone and
especially if there are regular
meridian concomitants, treat and
entire zone with its APM protocol,
selecting wei, ying and jing level
strategies to address the complex
disorder from several angles;
One hypothesis: Yang tends toward
excess (so select the yang regular
meridians to address local visceral
symptomology (such as TH 23 and
GB 1 for migraine headache and TH
16 and 17 and GB 20 for tinnitus;
and the yang muscle and/or luo
channels for bi syndrome and
repetitive strain or injury); Yin tends
toward deficiency: tonify the most
deficient yin regular meridian
(derived from Shudo Denmeis
simplified meridian therapy
protocol);
Combine and sequence needle
selection and stimulation based on
the 8 conditions: select points from
the foot and the hand meridians,
and from the right and the left, and
from the front and the back, and
from Yin and Yang meridians, to
regulate Yin and Yang.

8 Conditions of Point Sequencing

The 8 conditions figure into jingluo
treatment planning at the point where one
decides how to combine the selected
treatment strategies in terms of location
where each point is needled. Following the
basic principle of treating on the diagonal to

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regulate Yin and Yang meridians, most

common in the treatment of two paired
extraordinary meridians (SP 4 on one side,
and Per 6 on the opposite side, for example,
thus regulating right and left and upper and
lower with just two needles), I treat the distal
ying meridian points in the same fashion: if
doing the 4 gates, I needle Liver 3 on one
side, and LI 4 on the other (thus regulating
upper and lower, right and left and yin and
yang with just two, or at most four needles).
When multiple distal points are selected (say
ST 36, 37 and 39 as lower he-sea points,
and/or as distal points of chong mai, I just
needle each point where most tender, or
arrange them, perhaps ST 36 and 37 on one
side, and ST 39 on the other, based on the
number and location of the other needles so
as to avoid unnecessary bilateral treatment.

Maciocia presents numerous treatment

strategies for treatment based on the 8
condition method of point sequencing in his
The Channels of Acupuncture, Chapters 8-10,
pp. 107-177, and especially in chapter 11, pp.
177-215.

Summing Up
As I routinely tell students, a way to
remember that one can treat from all three
jingluo levels (jing, ying and wei) is to
imagine each level being done with different
therapies and no acupuncture:

In brief, based on the 8 conditions, I

alternate between distal leg/foot, and distal
arm/hand points on the diagonal, and
complete my distal points to regulate Yin and
Yang meridians, from the extraordinary
vessels and regular meridians, and then add
local mu or shu points if the viscera are
involved, as well as local points on these
meridians to address local symptoms, and
finally distal and local wei level excess yang
points to disperse muscle channel excess and
clear the obstructions.

All three levels can also be treated only with

acupuncture, something Acupuncture
Physical Medicine does routinely.

The jing level, by the patient her or

himself, in daily prescribed Qi Gong
practice;
The ying level, with herbal remedies
taken daily;
The wei level, with tui na in the
office, and self-administered moxa at
home by the patient.

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