Classical Combination of Points

ClassicalPointCombinationsand
ClustersofPointsin
AcupunctureTherapy
ShmuelHaleviPh.D
Thisworkwillpresentthethesisthat,bothclinicallyandtheoretically,
pointcombinationsinacupuncturetherapyandespeciallyclassicalpoint
combinations,constitutethemostreliableformoftreatmentinChinese
acupuncture.
Weshalltrytodemonstrateasmanysuchcombinationsaspossible,dealing
withtheirlogic,i.e.theoreticalfoundationswithintheframeworkofChinese
medicalphilosophyandotheraspectssuchas:
Analysisofeachpointinregardtoitsplaceintheprescription.
Comparisonofcertainpointcombinationstoherbalformulaeusedtotreat
thesamepatternsofdisharmony.
Whenpossible,comparisonofeachpointintheformulawithaspecific
herbusedforthesameenergeticaction.
Relevantandrealcasehistoriesdemonstratingtheefficacyofaspecific
pointcombination.
TechnicaldataofimportanceinutilizingPOINTCOMBINATIONslike:
1.Needlemanipulationofvariouspointsinthecombination
(i.e.strengthening,reducing,dispersing,heating,etc.).
2.Sequenceofneedlingprocedure.
3.Othertechniquesofstimulationlike:moxibustion,pressure,
cupping,lectroacupunctureandmore.
Inaddition,weshallexamineafewmajormethodsofformulacomposition
existentinChinesemedicineforages.Thesemethodsareveryimportantto
ourthesisastheyformthetheoreticalbasisfromwhichmanyofthepoint
combinationshaveevolved.
Anotherimportantfacetofthissubjectisthetendencyofstudentsand
practitionersalike,toregardpointcombinationsasformulaefortreatment.
Inthiswork,weshallshowthatpointcombinationsarenotformulaeand
thattheyserveonlyassolid"brickconstructions"sotospeakforagood
formula.Acomprehensiveformulahastobeformulatedentirelyon
diagnosis.

CONSTRUCTION
Thisworkconsistsofthefollowingchapters:
A.Pointcombinationsgeneralrules.
B.Thevariouslawsforcombiningpoints.
C.FormulabuildinginacupuncturetherapyutilizingPOINT
COMBINATIONs.
D.Surveyofpopularandeffectivepointcombinations.
DETAILING

CHAPTERAThischapterdiscussesthenatureofpointcombinationsin
generaltermsandwilldemonstratethegeneralprinciplesoftheirexistence.
CHAPTERBChapterBdiscussesindetailthevariouslawsandprinciples
fromwhichtheartofcombiningpointshasevolved.
CHAPTERCInthischapter,wediscussthedifferencebetweentreatment
formulaeandpointcombinations.Thereareafewexamplesofthewayin
whichatreatmentformulaisconstructed,utilizingoneormorepoint
combinations.
CHAPTELDThis is the last and the lengthiest chapter in which we have surveyed
18 effective point combinations, each of which includes the parameters that we have
mentioned above.
REMARKS
Theassumptionofthisworkisthatthereaderiscompletelyfamiliarwith
theconcepts,philosophyandterminologyofTraditionalChineseMedicine
(T.C.M.).
Therefore,basicconceptssuchas:Qi,Blood,Yin,Wind,Heatandthelike,
havenotbeendiscussedorexplained.
Someoftheideaspresentedinthiswork,particularlythosedealingwiththe
practicalaspectsofT.C.M.,havenorootsotherthantheclinicalexperience
accumulatedbymeduringmyyearsofpracticeandmypersonal
observation.Nevertheless,inmostcases,thereisanumberedreference
throughoutthepaper,pointingtoabibliographyattheendofthework.
CHAPTERA
POINTCOMBINATIONGENERALRULES
ApointcombinationinChinesemedicineisatermusedtodescribeawell
knowncollectionofacupuncturepointsfromtwoupto,usually,nomore
thanfiveorsixpoints.Generally,thiscollectionofpointshasalonghistory
ofclinicalusebasedbothontheoreticalfoundationsandexperience.
SincemostofT.C.M.(TraditionalChineseMedicinefromnowonward)
clinicalmeans,herbsandacupuncturealike,haveevolvedfromsolid
theoreticalground,itisnotsurprisingthatalmostallclassicalpoint
combinationsaretheresultoflogicalreasoningofthesamevalidprinciples.
Moreover,thefactthatsomanyclassicalcombinationshavesurvived
throughouttheages(andwearespeakingofsomethousandsofyears)(1),
andhaveproventhemselvesclinicallysuccessful,onlyemphasizesand
reaffirmsthestabilityandtruthfulnessofthesetheoreticalprinciples.
Basicallyapointcombination,orpointcluster(whichisadifferentthing)
(2),issupposedtohaveaveryspecificenergeticimpactonthebody,thus
enhancingtheeffectivenessofthewholetreatmentofwhichitisapart.
Inordertoillustratethisideamoreclearly,hereareafewexamples:
A.Anasalcongestionand/orsinusinfectionissupposedtoclogtheYang
Mingmeridiansystemintheregionofthenasalcavitiesandforehead.There
isanageoldpointcombinationdealingwiththisphenomenon,basedonthe
points:Hequ(LI4),Ouchi(LI11)andYIngx1ang(LI20).Thesethree
pointstogether,whichbelongtotheShouYangMingsystem,ifpunctured
intheabovementionedsequence,haveapushing,obstructionclearing
actiononthemeridianthus,resolvingthestagnationintheaffectedregion.
B.Anotherexample,whichisbasedontheprincipleShuMucombinations,
willshowaneffectdirectedtowardaspecificinternalorganinthebody.For
instancethepoints:Feishu(B13)andZhongfu(L1),whichserveasthe
BackShu(associated)pointoftheLungorganandtheFrontMu(alarm)
pointoftheLungorgan,dealsuccessfullywithproblemssuchasasthma,
painfulbreathing,pulmonarybleedingetc.Theseproblemsneedasoothing,
calmingandharmonizingactionwhichthiscombinationcanprovide.
Yet,othercombinationsarecapableofevenmorefantasticeffects.There
arecombinationsbasedonmorecomplexprinciples,whicharecapableof
multisystemoveralleffects.SuchacombinationisLiehchueh(L7)and
Zhaohai(K6).
ThesetwoformtheMasterandCoupledpointsofanextrameridiantheJen
Mai.Assuch,theyhaveavastinfluenceovertheorgansandfunctionsin
thedomainofthisvessel.Thismayincludethebreathing,digestiveand
sexualurinarysystems;itmayalsoincludefluidmetabolismingeneral,as
wellashormonalimbalancesaffectingtheuterus(3).
Besides"opening"theJenMaibyactivatingitsMasterandCoupledpoints,
thesetwopointsbindthemutualassistancefunctionoftheLungandKidney
systems(4).
Liehchuehactivatesthedownwardflowofthelungenergy,thussettingin
motionthelung'sactivitiessuchasbreathingproperly,dispersingextrafluid
fromthebody(perspiration,urine,etc.),sendingextrafluidtothekidney
andeliminatingphlegm(5).Zhaohai,inresponse,causesanupward
movementbyactivatingkidneyfunctionsassociatedwithYin(water,
phlegmmetabolism)(6),thusharmonizingtheactivitiesintheKidney's
domain,suchassexualurinaryfunctions.Inaddition,asmentionedabove,
thesetwopointsformthelinkbetweentheLungandthekidney,byaiding
thekidneyto"grasp"lungQi(whichdescends),andpreventingitfrom
"rebelling"upward(i.e.dyspnoea,asthma)(7).
Inthesethreeexampleswecanseethatpointcombinationsmayhavealocal
effectonameridian,onaninternalorgan,onaspecificdiseasefocusinthe
bodyaswellasongeneralfunctionsoractivitiesofvarioussystemsinthe
body.
Itis,therefore,ofprimaryimportancetomakeaproperdiagnosiswhichwill
enablethepractitionertochoosetheproperpointcombinationinorderto
assistthetreatmentformulainthedesiredway.Still,itwillbedifficultto
choosetheproperpointcombinationjustbymemorizingthemall.A
profoundcomprehensionofthelogicwhichliesbehindeachcombinationis
needed.
Thisbringsusbacktothe"laws"ofacupunctureandtoitsverycorethe
theoriesofYinYang,Fiveelements,TsangFuetc.
Onlybyathoroughunderstandingoftheseprinciplescanoneunderstandor
evenmemorizethemanifoldpointcombinationsandthenapplythem
correctly.

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CHAPTERB
THEVARIOUSLAWSOFPOINTCOMBINATION
1.TheShuMuLaw(8)
Thistechniqueofpointcombinationisbasedontwospecificpoint
groupings,oneonthefrontofthebodyandoneontheback,i.e.,the
AssociatedandAlarmpoints.Theconceptisthatbothsetshaveadirect
influenceontheorganwithwhichtheyareassociated,likeFeishu(B13)
andZhongfu(L1)onthelung,orPishsu(B20)andZhangmen(LIV13)on
thespleenetc.Furthermore,ifeachpointalonehasastronginfluenceonits
organ,combiningitwithitsvisavispoint,willboostitseffectandenhance
thetherapy.
Clinicalexperiencehasshownthatthiscombinationprincipleusuallyhasa
bettereffectinShiconditionswhenasedatingandsoothingactionis
needed.ItisusedlessinXuconditionswhereothertechniquesareapplied.
BothShuandMupointsarechosenwhenaninternalorganisafflictedthus,
combiningthesetwopointstogetherhasastrongeffectontheorgan,most
frequently,asedatingone.
TheprincipleofShuMuisbasedonanevenmorebasiclaw,thelawof
"opposites".
2.TheLawoftheOpposites
Theuseofthe"lawofopposites"suggeststhatadiseaselocatedinonepart
ofthebodyshouldbetreatedontheoppositepart.ForInstance,adisease
locatedintherightpartofthebodyshouldbetreatedontheleftside.A
diseaselocatedinthebackshouldbetreatedinthefrontandviceversa.A
diseaselocatedintheupperpartshouldbetreatedinthelowerpartofthe
bodyandsoon.
PracticalexamplesofthislawistreatingWeizhong(B54)forbackpain
(lowerupper),ortreatingHegu(LI4)leftforatoothacheintheright
mandible,etc.
Anextensionofthislawgavebirthtomanysetsofpointcombination,using
twoeffectivepointsfromeachoftheopposites.Thus,inthecaseoflower
backpain,theuseofthepointbelowWeizhong(B54),ishappily"married"
withthemosteffectivepointintheupperpart,i.e.Shenshu(B23).These
twopointstogetherformtheverybasisforanylumbagotreatment,taking
advantageofthelawofopposites.
3.CombiningYinChannelPointswithYangChannelPoints
ThislawisanotherexampleofhowChinesethinkingmakesuseofthe
philosophyofdualityorrather,contrastingandcomplementaryphenomena
suchasYinYangetc.
TheComprehensiveTextofShanghaiCollegestates:
"Asweknow,theprimaryYangchannelsareconnectedtotheprimaryYin
channelsinaYin/Yangrelationship.BycombiningapointonaYang
channelwithanotheronitspairedYinchannel,thecumulativeeffectis
greaterthanneedlingeitherpointseparately.Examples:combiningS36
(Zusanli)onthestomachchannel(Yang)withSP4(Gongsun)onthespleen
channel(Yin)forstomachdisease.Or,combiningL9(Taiyuan)onthelung
channel(Yin)withLI4(Hequ)onthelargeintestinechannel(Yang)for
coughing.Themostwellknowncombinationsofthiskindarebetweenthe
Sourcepointsonthechannelprimarilyaffectedbyadisease,andthe
Connectingpointonthechannelpairedwiththefirst,intheYinYang
relationship.InthiscombinationtheSourcepointiscalledthe"host"andthe
Connectingpointthe"guest"."(p.58).
Thisprincipleofcombiningpointshascreatedrenownedcombinationssuch
asHegu(LI4)withLiehchueh(L7)forupperrespiratorytractailments.
Taichong(LIV3)withGuangming(G37)foreyedisorders,Taiyuan(L9)
withPianli(LI6)forcoughfromphlegmaetiology,etc.
Theideabehindthisformofcombinationistodivertexcessenergyfromthe
diseasedorgantoitsparallelYin/Yangrelatedchannel.Thus,bypuncturing
the"host"pointwhichisaSourcepoint,onedirectlydrainsanoveractive
organ(Sourcepointsareincloserelationwiththeirorgan(9)).The
stimulationoftheLuopointoftheparallelmeridianensuresthattheexcess
Qiwouldthusleavebytheclosestpossiblegate.(Luopointsformapassage
betweentwoYin/Yangmeridians).(10)
4.MasterandCoupledPointsofExtraMeridians
Themasterandcoupledpointsoftheeightextrameridiansformeightpairs
ofpointseachattributedtooneextrameridian.Eachpairissaidto"open"
itsextrameridian,thusenablingittoabsorbextraenergylikea"sea"or
"reservoir"ofenergy.(11)
Twotechniquesexistbywhichthesecombinationsareused.oneway
stimulatesthetwomasterpointsandthenthetwocoupledpoints.The
secondadvocatespuncturingrightmasterpointandleftcoupledpointin
womenandviceversainmen.(12)
Manyoftheeightpairshavebeenfoundsosuccessfulinclinicalpractice
thattheyareoftenusedwithnoregardtotheiroriginalassignmentasmaster
andcoupledpointsofanextrameridian.Agoodexamplewouldbethepair
Neiguan(P6)andGongsun(SP4).ThiscouplewiththeadditionofZusanli
(ST36)formthebestpointcombinationtotreatmorningsicknessorany
nausea,ofdifferentetiologies.
Anothercouple:Liehchueh(L7)andShaohai(K6)whichisalsousedquite
frequently,hasalreadybeendiscussedinthepreviouschapter.
Moreofthesecoupleswillbediscussedlaterinourlastchapter.
5.CombiningLocalwithDistantPoints
Thisisagenerallawforcombiningpointsinacupuncture.Thelawtakes
advantageoftheexperiencegainedfromtheuseofvariouspointsandbinds
togethereffectivepointsinthevicinityofthedisease,withothereffective
pointsfromdistantpartsofthebody.
Ithasbeenfound,forinstance,thatLigou(LIV5)isaneffectivepointin
treatingmaladiesoftheexternalsexorgans(byvirtueofitstaskasaLuo
pointofthemeridianthatencirclestheseorgans).Zhongi(CV3)isalsoan
effectivepointfortreatingsuchproblems(13).Thus,bindingthetwo
together,oneclosetothediseasefocus,andonefromafar,makesagood
combinationinanyformulaforthispurpose.
Thislawalsohasadeeprootintheconceptof"RootandBranch"and
"OriginandEnd".
Thisconceptisanancientobservationthatallprimarymeridianshave
reciprocalrelationshipsbetweenpointssituatedontheupperandlower
reachesofthebody,respectively.
Thus,thebladdermeridianhasitsrootareainthevicinityofFuyang(B59)
andbranchareaaroundJingming(B1).
Or,thespleenchannelmakesitsrootaroundSanyiniiao(SP6)andits
branchinPishu(B20)aswellasLianchuan(CV23).(AcupunctureA
ComprehensiveText,p.61).
6.OnePointAbove.TwoPointsBelow
Anextensionofthepreviouslawthisextraordinarylawachieveswondersin
acuteprocesses,ifappliedcorrectly.
Thislawmakesuseofthepreviouslaw:"combininglocalwithdistant
points",withtwoadditions.Oneisthatallthepointsshouldbeonthesame
meridiansegment(i.e.Shaoyang,Yangming,Taiyinetc.).Thesecond,
emphasizesthatonlyoneneedleshouldbeplantednearthedisease,while
farfromittwoneedles.Thismay,atfirst,soundbizarre,butthelogicis
clear.
Taking,oncemore,theexampleofsinusitis,thepointcombinationwhichis
theoutcomeofthislawwouldbe:Hegu(LI4),Yingxiang(LI20),Zusanly
(ST36),Nelting(ST44).
Hegu,asthestrongestpointinthehandYangming,willsetthewholeYang
Mingenergyinmotion.Yingxiangservesasthelocalpointtocausea
dispersioneffectintheareaandZusanli,togetherwithNeiting,are"thetwo
pointsbelow".Thesetwopointsbelowprovideastrongstimulationtothe
otherendofthemeridianacceleratingitsenergyandflowwhileeliminating
thestagnationinitsupperpart.
Thissamelawformulatesanotherveryimportantpointcombination,usedto
effectDampnesseliminationfromtheintestines(purgationofthe
intestines).
Thecombinationis:Tianshu(ST25),Zusanli(ST36),Shangjuxu(ST
37)andXiajuxu(ST39).
Tianshuisthelocalstrongpointfortheintestines(theMupointofthe
colon),theotherthreepointsbeingsituatedonthesamestomachmeridian
andcreatingtheweighttocauseastrongdownwardflowofthestomach
meridianenergy(15).
7.EmpiricalPointcombinations
Therearedozensofpointcombinationsinacupuncturewhichhaveemerged
throughsheerclinical
experience.Everypractitioner,whohasspentaconsiderablelengthoftime
inclinicalwork,hasprobablynoticedthatsomepointsyieldbetterresults
whencombinedwithcertainotherpoints.
Itisonlylogicalthataftersomanygenerationsofaccumulatedexperience
inthefieldofacupuncture,suchempiricalcombinationshavebecomethe
inheritanceofthemajorityofpractitioners.
Incomparisonwiththeotherformsofpointcombinationsthathavesofar
beendetailed,thisformlackstheirtheoreticalbackgroundinmostcases.
Nevertheless,clinicalsuccessisafteralltheultimatejudgeandthus,these
combinationshaveearnedtheirpositioninclinicalwork.
Hereareafewexamplesofpointcombinationswhosesourceisentirely
empirical:
TheadditionofSibai(ST2)tothecombinationofDannangxue(extra),
Tianshsu(ST25)andGuanyuan(CV4),haveagreatsoothingeffecton
biliaryascariasis.ManipulatingSibaiinasedativefashion,usually
eliminatestheverysharppainwhichthisillnesscauses(16).Thereisno
theoreticalexplanationforthisphenomenon.
Hegu(LI4)ontheoppositeside,combinedwithLiangqiu(ST34)onthe
affectedside,isaquickreliefforstrainedmusclesortendonsoftheknee
joint(usuallyduetoasportinjury).Inordertoobtainthefulleffectofthis
combination,oneshouldfirstpunctureHegu,atanobliqueangletowards
themetacarpalbones,twoCundeep,andthenmanipulateLiangqiutocause
numbnessordistensionaroundtheknee(17).
Shaoze(SI1)hasanundeniableinfluenceonthebreasts.Hence,allbreast
diseases,includingagalactia(lackofmilk),aretreatedwiththeaidofthis
point.WhencombiningTaiyang(extra)toShaoze(SI1),wemakean
effectivepointcombinationforswollenbreasts.Thisformula'ssourceisalso
classical(SongoftheJadeDragonCa.1500)(18).
Itisworthwhilementioning,inthisconnection,thatmanyempirical
combinationsincludeextrapoints,andthereareafewthatarecomposed
entirelyofextrapoints.
Thereasonforthisisclear.Sinceextrapointsthemselveshaveoriginated
fromclinicalexperience,andinmanycasesasAhshipoints,theylackthe
theoreticalbasisthatmostofthemeridians'pointshave.
Itisnowonderthen,thatmanyempiricalcombinationsincludeextrapoints,
fortheytoohaveoriginatedfromclinicalobservation.
ExampleNo.3(above)mayillustratethisphenomenon,orthisverypopular
combination:
Yintang(extra),Shenmen(H7),Sanyinjiao(SP6).
Thisformulaisoftenusedtocalmthemind,especiallyincasesofinsomnia
(19),ormentalanxiety.
ShenmenandSanyinJiaoharmonizeFireandWaterelements,orheartand
kidneyfunctions,whileYintangplacesanemphasisoncalmingthemind.
Thus,anextrapoint(Yintang)contributestotheprincipaleffectofthetwo
meridianpoints,withitsempiricallyfoundsoothingproperties.

8.PointClusters
Apointclusterisagroupingofafewpointsinthesameareaofthebody,
whosemutualeffectonthisareaisbeneficial.
Inmanycases,theseclustersareformedfromextrapointslikeSishencong
onthevertexorfromAhshipoints(tenderpoints)inthevicinityofthe
diseasefocus.
Anexampleofapointclusterwouldbe"Threeneedlesattheankle".I.e.
Kunlun(B60),Jiexi(ST41),Taixi(K3).Thisclusterservesasalocal
treatmenttodisperseanybloodstagnationcausedbytraumaintheankle
joint,orparaplegia(20).
Another"Threeneedlesattheankle"servesthesamepurpose,andisa
combinationofthreedifferentpoints:Qiuxu(G40),Jiexi(ST41),and
Shangqiu(SP5).Thisisindeedaveryeffectivetrioforasprainedankle,
etc.
Themajorityofthepointclusters,thoughnotallofthem,areconcerned
withlocalizedinfluence.MakinguseoftheT.C.M.principlethatanypain,
swellingetc.iscausedbystagnantenergyorblood,orboth,(21)theuseof
powerfullocalpointsinconjunction,issupposedtoresolvethisstagnation,
anddislodgethebarrier.
Needlesstomention,theutilizationofsuchacombinationwouldneeda
specialdispersingtechnique,onethatwouldenhancetheflowofenergyin
theregion,anddispersebloodorfluidfromthejoint.
Otherpointclustersservethesamepurposeasregularpointcombinations,
i.e.tocauseanyprecalculatedtherapeuticeffect,withthedifference,aswe
mentionedabove,thattheyarelocatedinclosevicinity.
Thearticulationsofthebody,suchas:shoulderjoint,ankle,kneeorelbow
joint,areconsideredthemostvulnerablepartsofthebody,inrelationtothe
smoothflowofQi(22).Rheumaticpainwhichiscausedbyweather
Influences,accordingtoT.C.M.thinking,isusuallylodgedinthejoints,
thushinderingthesmoothflowofQi.
Itisnotsurprising,therefore,thatmanyclustersofpointshaveoriginatedin
thevicinityofthejointsforthepurposeofremovingthestagnantpernicious
influencethathaslodgedthere.
Suchclustersarethe"threeanklepoints"thatwehavealreadymentionedor
"thethreeshoulderpoints"andthe"threekneepoints",someofwhichwill
bediscussedlater.
9.BalancingandMutualAssistance
ThisverytraditionalprincipleofChinesemedicineisresponsiblefordozens
ofpointcombinations,whichhavebeenformulatedoverthemillennia.
Theideaofbalancingis,afterall,thecoreofChinesethought,originating
fromthebasicconceptionofYinandYang(23).
AllphenomenainourbodycanactuallybeattributedtoYinandYang,and
itsbalancedorimbalancedstate.
Withoutponderingtoodeeplyuponthissubject'sphilosophy,whichis
beyondthescopeofthiswork,itissufficienttosaythatthebalancingof
YinandYang,HotandCold,ShiandXu,istheultimategoalofChinese
medicine(24).
Therefore,besidesthevariousrulesofpointcombinationsthatwehave
summarizedabove,thereistheprincipleofbalancingYinandYang
activities,whichdictateswhatpointstouseineachcaseofimbalance.
Oneofthemostfrequentlyencounteredimbalancesinclinicalpracticeis
thatoftheelementsofFireandWater.Mostoftensymptomssuchasheart
palpitations,insomnia,dreamdisturbedsleep,anxietyetc.,aretheoutcome
ofthisimbalance.AccordingtothepoeticandimaginativeChinese
physiology,kidneyWaterisinsufficientandunabletocontrolheartFire,
whichblazesupward.
Thismaycausepalpitationsandarestlessheart,aswellasadisturbedShen
(spirit),sinceShenresidesintheheartorgan.
Torectifythis,theChinesehaveoriginatedmanycombinations,formulated
frompointshavingtheabilitytorestrainordredgetheheartactivityonthe
onehand,andtostrengthenorsupplementkidneyWater,ontheother.
Suchcombinationsare:
1.Shenmen(H7)andSanyinjiao(SP6)
2.Tongli(H5)andDazhong(K4)
3.Tongli(H5)andZhaohai(K6).(26)
Anotherfrequentlyencounteredbalancingmethodistoharmonizeactivities,
eitheroforgansoroffunctions.Thisisalsobasedontheconceptof
deficiencyorexcessofspecificactivities.Agoodillustrationforthiswould
bethecombinationofHequ(LI4)andFuliu(K7).
Thiscombinationisusedprimarilytotreatcasesofeitherexcessiveorlack
ofperspiration.
Incaseofexcessiveperspiration,WeiQiisdeficient,soHeguhastobe
tonifiedinordertofortifytheprotectiveabilitiesofWeiQi.(Pleasenote
thatWeiQiisresponsibleforthetonusofthesweatpores,thuscontrolling
perspiration).AtthesametimeFuliuhastobereduced,sinceitsactivities
arecloselylinkedto"water"movementsinthebody.
Inthecaseoftheabsenceofperspiration,oneshouldusetheseverypoints,
onlywithreversedmanipulation.Forexample:Hegusedated,inorderto
releasetightnessofthesweatporeswhicharecontrolledbyWeiQi.Fuliu
tonified,inordertoincrease"Water"movementInthebody(27).
Anotherprincipleofpointcombination,whichwasincludedunderthis
heading,istheprincipleofmutualassistance.
Inthesamewaythatherbsarefrequentlychosentoassistandstrengthen
eachothersaction,soarepoints,bythisprincipleofcombination.
Thismethodisoftenrelevantincaseswheretheeliminationofapathogenic
factorisneeded,muchlikeherbaltreatment.
Forinstance,wheretheeliminationofaWindHeatfactorintheheadregion
isneeded(i.e.tonsillitis),Hegu(LI4)isofmajorimportance.Tostrengthen
itsactionweshallmostprobablychooseQuchi(LI11),apointquite
powerfulbyitself,foreliminatingWindHeat.Clinicalobservatonhas
verified,thatthiscoupleofpointshasamuchbetterimpactonthehead
regionthaneachofthemalone(28).
Bythesamelogic,Sanyinjiao(SP6)andYinlingquan(SP9)areoften
combinedtogether,forthepurposeofeliminatingDampHeatpathogen
fromtheLowerBurner.
SanyinJIaoisindicated,amongmanyotherqualities,toresolveDampand
DampHeatfromtheLowerBurner,mostlybyfacilitatingurination(29).
YinlingquanisalsoindicatedtoresolveDampandDampHeatfromthe
LowerJiao,andittreats:edema,ascites,retentionofurine,urinarytract
infection,diarrhea,etc.(30).
Again,clinicalexperiencehasshownthatputtingtogetherthesetwopoints,
enhancesthetherapeuticeffectofeachofthem,andthiscombinationhas
becomeavaluableassetofTraditionalChinesemedicine(31).
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CHAPTERC
FORMULABUILDINGINACUPUNCTURETHERAPY,
UTILIZING
POINTCOMBINATIONS
1.Diagnosis
DiagnosisisofprimeimportanceinT.C.M.Actually,itisimpossibleto
constructatreatmentformula,unlessonehasreachedasounddiagnosis.
Knowingthat,inancienttimestheChinesedevelopedauniquediagnostic
skill,basedonproceduresthatmatchedtheirmedicaldoctrine.
Remainingfaithfultotheirbasicconceptthatviathemeridians'system,the
insideofthebodycanbeperceivedbytheoutsideofthebody,most
diagnosticprocedurewasbasedontechniquesofhowtobestdecipherthese
outsidesigns.
Thus,thefamousfourmethodsofdiagnosisemerged.Thesefourmethods
are:
I.Looking
II.Listeningandsmelling(whichisthesamewordinChinese)
III.Asking
IV.Touching(32)
Withoutgivingafullydetaileddescriptionofeachofthesestepsof
diagnosis,sufficeittosaythattheyconsistof:
Lookingespeciallyatthetongueshape,colorsandfur.
Listeningtothepitchofvoice,orcough(moaningorgroaningandother
sounds)whetherloudorlow,laboredbreathingsuchaswheezingetc.
Askingwhichisaninterrogationofspecifitiesofthepatient'scomplaints,
andespeciallysomepointedquestions,uniquetoT.C.M.
Touchingespeciallytheartoftakingthepulse,butalsothepalpationof
theabdomenorofsomespecialacupuncturepoints.
Aftertheseprocedureshavebeenperformed,thepractitionerhastoforma
diagnosis,basedontheeightprinciplesofT.C.M.Theseprinciplesare:
YinorYang(1+2)
HotorCold(3+4)
ShiorXu(5+6)
InternalorExternal(7+8)
Inaddition,theinformationgatheredsofarmustincludethesiteofdisease
(whetherthespleen,colon,oranyofthemeridians)and,ofnoless
importance,thecauseofthedisease.
Allthesedetailsandknowledgehaveastrongimpactontheplanned
treatment,aswellasontheprognosis.
Whenallofthisinformationhasbeencollectedandprocessedintoalogical
andworkablediagnosis,thenwemustdetermineourtreatmentapproach.
Thisapproachisbasedentirelyondiagnosis.Thusifwehavediagnoseda
simplecaseofaWindHeatcondition,theapproachwouldbe:the
eliminationofWindHeatandrestoringnormalbalance.Or,inamore
complicatedcase,whereourdiagnosisleadsustoaconclusionof
disharmonyofstomachandspleenandakidneyYindeficiency,our
approachshouldbetotonifyspleenQiandsedatestomachFire,while
placinganemphasisonstrengtheningkidneyYin.
Atthisstage,thepractitionermustassesswhetherStomachFireismore
severethanthedeficiencyconditionofthekidneys,andthisconclusion
mustleadhimeithertoputanemphasisonsedatingthestomach,oron
tonifyingKidneyYinandSpleenQi.
Itisnolessimportanttoeducatethepatientastohowtobehaveinthe
future,enablinghimtokeephisreharmonizedstateofhealthintact.This
educationcannotbeofvalueunlesstherealcauseofdiseasehasbeen
graspedbythepractitioner.
Whenaspecificapproachhasbeendetermined,aswehaveillustrated
above,ournextstepistochooseaspecifictechniqueforthetreatment.
Aspecifictechniquemayactuallybecomprisedofseveraltechniques,with
onegoal:toinduceageneraleffectonthepatient,inordertoachievethe
aimsoftheapproach.
Atechniquemaybeatonifyingtechnique,basedonchoosingpointsthat
usuallytonify.Itmayusemoxa,inordertoenhancethetonifyingeffect,and
itshouldapplycertainneedlemanipulationsthatcauseaneffective
tonification.
Atechniquemayneedtodispersestagnantbloodthatcausespain,swelling
andimmobility.Thereforedispersiontechniquesshouldbeadoptedsuchas:
drawingbloodwithacup,or,again,certainneedlemanipulationslike:
"needlingonepointinfourdifferentdirections"(33),etc.
Whilediscussingthetechnique,wemustalsobearinmindthatatthisstage,
wehavetosetthecourseofthewholetreatment.Wehavetodecidewhether
wetreattheBenfirst,ortheBiao(i.e.thesymptoms,orthecause),orwe
havetodecidewhetherwetreatanexternallyinflicteddisease,beforewe
treataninternalimbalanceor,sometimes,viceversa.Inthesamemanner,
weshallhavetodecidewhethertotreattheShiconditionortheXu
conditionfirstandmakemanyotherdifficultdecisions.
Asarule,allthesedecisions,andothers,willbetheoutcomeofacareful
assessmentofourpatient'scondition,whichwilldictatethetreatment
technique,itsimpetus,itsrhythm,andaboveallthetreatmentformula.
Buildingthetreatmentformulaisreallytheclimaxofthepractitioner's
intellectualability.Bycomposingtheformula,thepractitioner'sdiagnostic
skills,aswellashisthoroughmemorizationofpoints,combinationsand
actions,willcometofullrealization.
Therearemanymethodsandapproachesastohowtoconstructaformula.
Someoftheseapproachesevencontradicteachother.Someapproaches
statethatanyformulashouldhaveclosepoints,mediumpointsanddistant
points(34),inordertohaveafulleffect.
SomeapproachesadvocatetheuseoftheFiveElementsschool,asthebasis
foranytreatment.Otherapproachesrecommendprescriptionsbythenew
ChinaT.C.M.approach.
Thereareevenpractitionerswhoaretrainedtobuildatreatmentformula
thatwillmatchtheirpatient'sastrologicalmap,andsomethatusethe
famousIChingtrigramshexagramsandtoconstructaformula.
Themethodsarenumerous,anddifferentirely.However,theChinaT.C.M.
streamisthemain,andthisisthemethodthatyieldsthebestresults,
accordingtoChineseresearchers(35).
TheT.C.M.methodofformulabuildingreliesmostofallonempiricism.It
reliesalsoonstrongfoundationsofsoundtraditionalmedicaltheories.Its
maintheoreticalsourceissyndromedifferentiationaccordingtotheTzang
Fusystem,but,nevertheless,itadoptsanytreatmentprocedurethathas
provenitselfvaluablethroughouttheages.
Itisnowonderthatamethodthatreliesmostofallonclinicalexperience,
willuseasmanypointcombinationsasdoesthismethod.
Wehavealreadyshownthatpointcombinationshaveboththeoreticaland
empiricalbackgroundastheirbackbone.
Thus,wecanrarelyfindatreatmentformulathatdoesnotinclude,atleast,
onepracticalpointscombination.Inordertoillustratethisassumption,the
followingisacasuallychosenlistoftreatmentformulae,forvarious
complaintsinwhichIhavemarkedthepointcombinations:
I.Ganshu(B18),Qimen(LIV14),Danshu(G24),Changman(LIV13).
Thisisaformulaforinfectioushepatitis,combinedbytwopairsofpoint
combinationsaccordingtotheShuMuprinciple.
II.Foracuteenteritis:Tianshsu(ST25)withShangjuxu(ST37).This
combinationisonepointaboveandonepointbelow,onthesamemeridian.
III.Forbronchitis:Chitze(L5),Hegu(LI4)andLiehchueh(L7).Inthis
formula,HeguandLiehchuehformthe"HostGuest"relationship
combination.
IV.Ermen(T21),Tinggong(SI19),Tinghui(GB2),Yifeng(T17),
Waiguan(T5)andChungzhu(T3),isarecommendedformulatotreat
deafness.Ermen,Tinggong,TinghuiandYifeng,makeaclusterofpoints
forearproblems.
V.ForrectalprolapsewemaychoosePaihui(GV20),Changqiang(GV1),
Zusauli(ST36),Sanyinjiao(SP6),Qihai(CV6)andShenchueh(CV8)the
lasttwopoints,andprobablyPaihultoo,withmoxa.Paihu,Qihaiand
Shenchuehtogethermakeaverystrongpointcombinationthatpowerfully
raisesYangQitherebyelevatingprolapsedorgans,liketherectum.This
combinationisbasedonthemutualassistanceprinciple(seeprevious
chapter,paragraphNo.9).
ChangqiangandPaihuiisanothercombinationinthisformula,builtonthe
principleof"onepointabove,onepointbelow,"onthesamemeridian.
Whilepuncturingbothendsofthemeridian,webalanceitsactivities,andif
itisonanextrameridian,liketheDuMomeridian,bydoingsowedrainits
excessenergy(36,37).
VI.Forthetreatmentofpalpitationscausedbyventricularseptaldefectwith
symptomssuchas:generalweaknessandshortnessofbreath,thefollowing
formulamaybeutilized(38):
Neiguan(P6),Shenmen(H7),Tanzhong(CV17),Zusanli(ST36),Qihai
(CV6),Sanyinjiao(SP6),Shaohal(K6),Jueyinshu(B14),Xinshu(B15),
Keshu(B17).
Inthisformula,severalclassicalpointcombinationswereused,inorderto
bringaboutthedesiredeffect.Thisisobviouslyacasethatneedsadirect
effectonthemainsymptom,palpitations,whilenotneglectingtherestof
theproblemwhichisQiandblooddeficiency.
ThepointsNeiguan,ShenmenandTanzhongserveasawellknown
combinationtorelaxtheheart,calmtheShenand"openthechest".("Open
thechest"isaChinesemetaphorusedtodescribefunctionssuchas:to
improvebloodcirculationbetweenheartandlungs,ortorelaxsymptoms
suchassensationsoffullnessorcongestionandtightnessinthechest).
Jueyinshuandagain,Tanzhong,isanothercombinationwhichusesthe
principleofShuMu.Inthiscase,addingmutualassistancetotheprevious
combinationtoenhanceheartcirculation.
Zusanli,SanyinJiaoandQihaiconstituteanevenmorefrequentlyused
combinationwhosegoalistotonifytheQiandeliminatelassitude.Inthis
case,italsohasanothertaskofhelpingincreationofblood,since"Qiisthe
motherofblood"(39.TonifyingtheQiwillhelpproducenewblood.
But,thisexcellentformulacreatorhasmadeanotherimportantlinkand
addedShaohaiandSanyinjiaototheformula.Thispairhaveamutual
assistanceeffectonthegeneralYinQi.SincebloodisYin,itisimportantto
tonifybothQiandYin,inordertosupplementblood.
ThelastcombinationinthisformulaisSanyinjiao,XinshuandKeshu.This
isalsoabloodstrengtheningcombination(basedonKeshuwhichisthe
associatedpointofblood),onlyitputsanimpetusontheheart'sblood.We
havetobearinmindthataccordingtoChinesephysiology,bloodisalso
formedintheTanzhongareawiththeaidoftheheart.
Fromthefewexamplesabove,wecanseethattreatmentformulaemayvary
considerablyfromoneanother.Aformulamaycontain,orevenbe
composedofonepointcombinationanditmayhaveasmanyasfouror
evenmorepointcombinations.
Inanycase,thepurposeofincludingthesecombinationssodeliberatelyin
theformula,istoensurethatcertaininfluencesshallbeexertedasdecisively
andpromptlyaspossible.Sincemanyofthepointcombinationshave
provedthemselvesmostvaluableinclinicalwork,itisobviousthatone
shouldusethesecombinationswhilecomposingatreatmentscheme.
Thus,besidestakingadvantageoftheuseofalreadyclinicallyproven
combinationsandgivingourformulaasolidbasis,thereisalsoabenefitin
utilizingpremadesegmentsfortheformula,liberatingusfromthenecessity
tobuildthembyourselves.
backtotopofpage
CHAPTERD
SURVEYOFPOPULARANDEFFECTIVEPOINT
COMBINATIONS
Forewordtothischapter
Mostofthecombinationsinthischapterhavebeentakenfromthebook:
ACUPUNCTUREACOMPREHENSIVETEXT,bytheSHANGHAI
COLLEGEOFTRADITIONALCHINESEMEDICINE.
Themajorityofthecombinationsformthebackboneoftheclinical
knowledgeofeverypracticingacupuncturistandassuch,theyshould
certainlynotbeexpectedtobeinnovationsorrareinformation.Moreover,
theeighteenpointcombinationsanalyzedhere,areonlyadropintheocean
whencomparedwiththemyriadcombinationswhichhaveevolved
throughoutthehistoryofT.C.M.
However,theaimofthisanalysisistounderstandtheprinciplesbywhicha
pointcombinationhasbeenformed,aswellasitsclinicalvalueand
application.
Thefunctionsofthevariouspointsinthefollowingcombinationsaswellas
theirclassicalindicationsandqualities,weretakenfromtwomainsources:
1.ThesameCOMPREHENSIVETEXT(seeabove).
2.THEACTIONSOFACUPUNCTUREPOINTSbyPeterDeadman
whichwaspublishedinseveral
partsintheJOURNALOFCHINESEMEDICINE.
Therestofthematerial,includingtheanalysisofeachpoint,thetheoretical
backgroundofthecombination,thepracticalapplicationandthecomparison
withaherbalprescription,werealltakenfrommyownclinicalexperience
andpersonalobservation,unlessotherwisestated.
Needlesstosay,allthecasehistoriesinthischapterareofpersonstreated
bymeinmypractice.
Thesourceforallinformationpresentedhereregardingherbs,including
herbalprescriptions,isthebook:CHINESEHERBALMEDICINE
MATERIAMEDICAofEastlandPress,byDanBenskyetal.However,
comparisonofthepointcombinationswiththeherbalprescriptionsinthis
chapter,isminealone.
backto
topofpage
1.SANYINJIAO(SP6),GUANYUAN(CV4),QIHAI(CV6).
Maineffectandclinicalpurpose
ThispointcombinationiscommonlyusedasageneraltonicforQiand
Blood.Itisthereforefrequentlyusedincasesofseverelassitude,anemia,
impotence,spermatorrheaandthelike.
Becauseofthispointcombination'smaineffect,itisusedwithatonifying
manipulationand/ormoxa.
Pointdiscussion
Sanyinjiao(SP6)isthepointofintersectionoftheliver,spleenandkidney
meridiansandfunctionstoregulateandtonifytheOiinthesechannels.It
alsohasastrongeffectonthereproductive,aswellasontheurinary
systemsandisthereforeusedtoregulateYinQieithertotonify,ordrain.
Sanyinjiaobelongstothespleenmeridianandhasagreatinfluenceonall
thefunctionsofthespleenorgan.Thatincludes:regulatingthedigestive
system,improvingappetite,creationofbloodandeliminationofDampness
(40).
Guanyuan(CV4)ThemeaningofGuanyuanis"thepassagefortheSource
Qi".ThisisthepointofintersectionofthethreeYinchannelsofthelegon
theConceptionVessel(41).
NeedlingthispointtonifiestheYuanQiwhichistheprenatalQi.It
thereforestrengthensthekidneysandactuallythewholebody.Duetoits
location,itisprimarilyusedtotonifyYinQibutitcanbeusedtotonify
YangQiaswell.Itishardlyeverusedtosedate.Qihai(CV6)isalso
locatedontheConceptionVessel,RenMai.Itsnameimpliesthatitcontrols
theseaofQiwhichliesexactlyonthisspot,knownasthe"LowerDan
tien".QihaiisthereforeusedtoregulateQi,especiallypostnatalQi(42)and
strengthenkidneyQi,YinandYangingeneral.
CombiningGuanyuanandQihaihasastrongstrengtheningeffectontheQi
ofthewholebody.ThesepointstogetherstimulatepreandpostnatalQiand
thekidneys.AddingSanyinjiaotothesetwo,givesafurtherimpetusto
creationofYinandblood,improvedliverandspleenfunctioning,thus
makingthebesttonifyingpointcombination.
ThereisanothersimilarpointcombinationthatusesZusanli(ST36)instead
ofSanyinjiao(SP6).Thedifferencebetweenthesetwoisthatthelatteris
usedmainlyforgeneralstrengtheningpurposes,withanemphasison
digestiveirregularities,bloodandgeneralstamina.Theprevious
combinationhasamoreurogenitalbias.
Needlingsequence,manipulationandstimulation
ForpurposesofgeneralstrengtheningofQi,onegenerallypuncturesinthis
order:Guanyuan,QihaiandthenSanyinjiao.But,ifouraimistostrengthen
YinQi,ortreattheurogenitalsystem,Sanyinjiaoprecedestheothertwo
points.
Aswehavestatedbefore,thegoalofthiscombinationisprimarilytotonify.
Inordertodoso,wemustuseatonifyingmanipulation,i.e.penetratethe
pointgentlyinthreestages.Whilemanipulating,weneedtopushintothe
pointmorestronglythanwhenwithdrawingtheneedle.
Oftenwemayutilizethe"BurningtheMountain"technique.Inthis
techniquetheneedleisfirstinsertedtoasuperficiallevelandisthen
advancedtoamiddleandfinallytoadeeplevel.Ateachleveltheneedleis
forcefullythrust,andgentlyraised,ninetimes.Then,theneedleisleftinthe
superficiallevel.Thismanipulationisrepeateduntilthepatientexperiences
awarmorburningsensation.
Itisalsoverycommontousemoxaonthesepoints,eitherdirectmoxa,or
"warmneedling".Moxaisusedmainlyincold/deficientdiseases.
Herbaleguivalent
ItisadequatetocomparetheuseofGuanyuanandQihaitoradixPanax
Ginseng.ThisherbismainlyusedinsevereQideficienciesoreven
collapse.ItisalsoknowntotonifytheYuanQiandbothYinandYangQi.
WecanalsofindsimilaritiesbetweenAngelicaSinensis,DanGuiandthe
actionsofSanyinjiao.Thisherb,too,isusedtotonifythebloodandtreat
urogenitaldisorders.Alongwiththis,DangGuiisalsousedforabdominal
pain,constipation,DampBietc.,forallofwhichSanyinjiaoisalsouseful.
Casehistory
Mr.A.M.ofAraborigin,age27,occupation:buildingworker,marriedfor
twoyears.
Complaintinfertility,spermatorrheaespeciallyatnightandpremature
ejaculation.
Diagnosticfeatures
1.Redface,coldfeet.
2.Feelsgenerallyfine,exceptsometimesdribblingurine.
3.Pulseslippery,big.
4.Tonguepale,soft
5.Abdominaltendernessunderumbilicusandrighthypochondriacregion.
Diagnosis
1.Weaknessandloosenessofthe"gateofsperm"("MingMen"),dueto
excessivesexualintercourseandhardphysicallabor.
2.ExcitementofHeartFire.
Treatment
1.Sanyinjiao(SP6),Gyanyuan(CV4),Qihai(CV6)andTaling(P7).
2.Refrainfromsexualintercourseuntilspermatorrheasubsides.
Explanation
Sanyinjiao,GuanyuanandQihaitogethertonifytheYuanQithusenlivening
thespermandstrengtheningtheMingMen.TalingisusedtodecreaseHeart
Fireandtherebyhelpsthepatientcontrolhissexualenthusiasm.Talingwas
puncturedagainsttheflowofQi,i.e.needlepointedproximally,inorderto
causesedation.
Results
Aftertwosessionsthespermatorrheaceased.Afterthreemonthsthe
patientswifebecamepregnant.
2.HEGU(LI4),YINGXIANG(LI20),ZUSANLI(ST36),NEITING
(ST44),XIANGU(ST43)[43].
Thisisapointcombinationbasedonthelaw"onepointabovetwopoints
below"(seepreviouschapter).Itspurposeistoclearobstructionfromthe
YangMingsystem,mainlysinusitis.
Ithasaclearsedatingeffectandisthereforeusedforexcesspatterns
characterizedbyHeatandDampness.
Pointdiscussion
Heguisoneofthemostfrequentlyusedacupuncturepoints.Itisthe
strongestpointonthehandYangmingchannelandisoftenusedforall
complaintsofthehead.
ItisusedtoeliminateWindheatorWindcold.Heguisananalgesicpoint
anditrelievespain.Itisantiphlogistic,antipyreticandusedforall
inflammatoryprocessesintheheadregion.
YingxiangisthelastpointofthehandYangmingchannel.Itsindicationsare
foralldiseasesofthenoseandtodispelWindheatfromthenasalcavities.It
isalsoanintersectionpointbetweenthelargeintestineandstomach
meridians.
Zusanliisalsooneofthemostfrequentlyusedpointsinacupuncture.Itis
themostpowerfulpointonthestomachmeridianandisusedforall
digestivecomplaints.InthiscontextitisusedtoeliminateDampnessand
HeatfromtheYangmingchannel.Zusanlimaybeeithertonifiedorsedated,
dependingonthenatureofthedisharmony.
Thus,amongitsmanifoldactivities,itmaybeusedtoeliminateWindand
Dampness,toregulatecirculationofQiandblood,totonifyweaknessand
promoteantipathogenicQi.
Neitingisapointofchoiceinthetreatmentofexcesspatternsinthe
stomachorstomachmeridian.ItismainlyusedtoreduceHeatinthe
channelorinorgansundercontrolofthischannel.Thisincludesthenasal
cavities,theupperteethandgums,thestomachandintestines.Its
indicationsarealsotoregulateQiandrelievepain.
Xianguisindicatedmainlyforfacialedema,forpainandeliminationof
Wind.SinusitisischaracterizedasaWindHeatdiseaseanditcauses
accumulationoffluid(Dampness)inthefaceduetoaHeatstagnation.
Aswehaveexplainedinthepreviouschapter,thistypeofcombination
placesanemphasisonregulatingtheQiinthechannel,makingitflowmore
vigorouslyintheproperdirection,byutilizingmorepointssituatedonthe
desireddirection.
Therefore,pointsZusanli,NeitingandXianguprovideaheavierweightthan
HeguandYingxiang,inordertopromotetheflowofQiintheirdirection.
ThisinvigorationofQiissaidtocleartheobstruction(sinusitis)wherethe
handYangmingandlegYangmingmeet(thenasalarea).
ItisworthwhilementioningthatallofthesepointshaveaclearDampness
andHeatclearingfunctioningamongtheirotherqualities.
Needlingsequence.manipulationandstimulation
Theneedlingsequenceisofmajorimportanceinthiscombination.Sincethe
wholeideaistopropeltheenergyalongthemeridianinthedesired
direction,wehavetostimulatethepointsintheappropriateorder.By
needlingthesepointsinsuccession,wepropagateboththeneedlesensation
andtheeffecttowardstheorienteddirection.
ThefactthatNeitingisneedledbeforeXianguisbecauseNeitingisa
strongerpointthanXianguandthereforeplaysamoreimportantroleinthe
"seesaw"balanceofthecombination.
Thepointsarenaturallymanipulatedinareducing,orsedatingtechnique.
Thismaybeeithertheanticlockwiserotationoftheneedles,orpullthrust
maneuvering.
Whenanexcessivehotconditionisobserved,itispossibletoperformthe
"CoolingtheSky"technique.Bythistechniquetheneedleisinsertedrapidly
tothedesireddepthandthenforcefullyraisedupafraction,thengently
insertedagain.Thismanipulationisrepeatedsixtimes.Theprocedureis
repeatedatthreedifferentlevels,fromthedeepesttothemostsuperficial
position,untilthepatientsensescoolness.Thisisexactlytheopposite
procedureto"burningthemountain"whichwasdescribedunderthe
previouscombination(44).
Asarule,forsedationpurposestheneedlemanipulationrequiresstronger
movementsbythepractitioner,withlargeramplitudeandanglesthanthe
tonifyingmanipulations.Onshallowsurfacesitisoftensufficienttopoint
theneedletipalongoragainsttheenergystream,inordertotonifyor
sedate,respectively.
Casehistory
Mrs.S.A.,age40,hassufferedfromchronicsinusitisfor12years.Shehad
some45acuteincidentseachyear,forwhichvariousantibioticshadbeen
prescribed.Twiceshehadundergonenasaloperationsandsinuspumping
withoutlongtermsatisfactoryresults.
Shecametoseemethreeyearsago,sufferinganacuteattackwhichdidnot
respondtoantibioticremedies.Shehadalowfever,feltveryweakandsick
andhadunbearablepainaroundthesupraorbitalarea,especiallyofherleft
eye.Mrs.S.A.hadapurulentyellow,foulsmellingnasaldischarge,dry
mouthandconstipation.
BothherpulseandtongueindicatedanexcessiveDampHeatcondition.Her
pulsewasalsoweakandindicatedhergeneralweakness.
Mrs.S.receivedsixtreatments.Theprescriptionwasbuiltfromtheabove
combination,withtheadditionofZanshu(B2).Zanshuwasmanipulatedby
adispersiontechnique,i.e.waspuncturedinthreedirectionsoneafterthe
other,andthenwasleftintact.
Zanshuwaschosenduetoitslocaleffect,inordertodispersethepurulent
liquidaroundtheeyes'orbit.
AftertwotreatmentsMrs.S.experiencedsignificantreliefandafterthefifth
appointmentsheproclaimedthatshewasfreeofallsymptoms.Hence,she
wasgivenanothertreatmenttoconsolidatetheeffectandthetreatmentwas
terminated.
DuringthelastthreeyearsMrs.S.sufferedonemoreattackwhich
respondedtotreatmentinthesamefashion.
3.JIANYU(LI15),JIANEILING(EXTRA),JIANLIAO(T14)
Thecombinationaboveisapointclusteroftheshoulder.Itisfrequently
usedtodispersestagnationintheshoulderjointandtofacilitatetheflowof
Qithere.
TheclusterisusuallyeffectiveincoldstagnationoftheshoulderorDamp
Bi(casesoffrozenshoulder,perifocalinflammationoftheshoulderjoint
etc.).Itmayalsobeofvaluefortraumaticpainfromsportsoraccidents.
Pointdiscussion
JianyuinChinese"shoulderbone",isthemainpointforallshoulder
diseases.Itsindicationsare:
toeliminateWind
toremoveobstructionfromtheJingluo,andpromote
circulationofQiandblood.
tosoothetheJoints,relievepainandscatterBi.
Jianyuiseitherpunctureddeeply,withthearmabducted,towardsJiquan(H
1),forinflammationofthejointbones,oralongthedeltoidmuscle,for
DamporcoldBi,affectingthemusclesandtendons.
Itisoftencauterizedwithmoxa,byallthevariations:direct(scarring)
moxibustion,thewarmneedletechniqueandmoxaonginger.These
techniquesareappliedforCold,orDampColdinducedproblems.Forthe
"frozenshoulder"syndrome,Coldpenetratingtothebonelevel,onemay
usethe"Fireneedle"technique.Bythistechniquealongneedleisheatedby
fire,andimmediatelyintroducedintothedeeplevelofJianyu,then
withdrawn.Thistechniquewasalreadymentionedinthe"LingShuand
theMingdynastyphysician,WuHegao,recommendeditforColdBiofthe
shoulder.
Inanycase,utilizationofmoxaorheatatthispoint,acceleratestheflowof
Qi,dispersesthecoldanddampstagnationsandreturnsthejointand
musclestonormalfunctioning.However,itisimperativetostressthatany
shoulderinflammationexhibitingheatcondition,(i.e.febrileBi)shouldnot
betreatedwithmoxawhichcanundoubtedlyaggravatethecondition.
JianneilingisanextrapointsituatedexactlybetweenJianyuandthetopof
theanterioraxillarycrease.
ItsindicationsarethesameasJianyus.
Jianliao"ShoulderSeam"inChinese,alsohasexactlythesameindications
asJianyu.Itismoreoftenusedforpainlocatedontheposterioraspectof
theshoulder,ontherouteoftheSanjiaochannel.
Needlingthesethreepointstogetheraffectstheshoulderfromthreedifferent
anglesandcausesanaccelerationoftheQithatpassesthroughthisjoint.
Thevariousmethodsofstimulation,whenproperlyapplied,dealwiththe
causeandnatureofthestagnationaccordingly.
Theneedlingsequenceinthiscombinationisusuallyrelatedtothesiteof
thepain.Ifthepainisintheanteriorpartoftheshoulder,Jianneilingis
usuallyneedledfirst,andthentheothertwo.Ifthewholeshoulderis
painful,Jianyuisneedledfirst,asthestrongestpointofthetrio.
Besidesmoxastimulation,ofwhichwehavealreadyspoken,the"cupping"
treatmentoverthesepointsisalsofrequentlyused.
Cuppingisgenerallyappliedonspotswhereweneedtoenhancecirculation
ofQiandBloodandiswidelyusedinChinaandinT.C.M.clinics.
Alsoelectricalstimulationofthesepointsisoftenapplied,asshoulder
problemsusuallyinvolvepain.Electricalstimulationisusuallyappliedwith
adensedispersewave,forperiodsof1020minutes.Cuppingisusually
appliedafterneedlingthepoints,orovertheneedles,alsofor1520minutes.
Whenthe"warmneedle"techniqueisutilized,onlyoneneedleofthetriois
generallycauterizedwithmoxa.Itisusuallytheneedlethatissituatedinthe
mostpainfulsiteoftheshoulder.Thisisasmallvariationofatechnique
calledQiciwhichwasalreadymentionedintheNeiJing(45).
AnothertechniquewhichisoftenusedtodispersestagnationofQiand
Bloodandtoresolvepainquickly,iscalled"Huici",andhasalsobeen
mentionedintheNeiJing.
Bythismethoda1.5inchneedleisinsertedandmanipulateduntil"Deqi"is
obtained.Theneedleisthenraisedandredirectedtotheleftorright,and
manipulatedagainfor3minutes.Theneedleisthenraisedandredirected
towardanotherdirectionandmanipulatedonceagain.Itisthenraisedtoa
superficiallevelandleftintact.
Casehistory
Mrs.D.B.,ateacherbyprofession,wasbornin1951.OnApril18,1990she
consultedme,complainingofseverepaininherrightshoulderwhich
hinderedhersleepanddisabledherrighthandpreventingalmostany
movement.
Xrayexaminationat"Rambam"HospitalinHaifarevealedexcessive
calciumdepositsintheshoulderjoint,henceshehadbeenadvisedto
undergothecalciumpumpingoperation,aswellassteroidinjectionstothe
affectedjoint.
Mrs.D.wasreluctantforsuch"adventures"assheexpressedit,andsince
shehadhadaprevioussuccessfulexperienceinmyclinicforanother
problem,shemadeanappointment.
AnexaminationbymeansofChinesemedicinebroughtmetothediagnosis
ofaColdBiconditionintheshoulder,andkidneyhypofunctioning
(KidneyYangXu).
Themainsignswere:
1.Fearofcoldingeneralandespeciallyaneedforwarmtharoundboth
shoulders.
2.Pallidfaceandlips.
3.Pale,wettongue,withathinwhitefur.
4.Thin,softanddeeppulse,weakonthirdposition.
Theonlysignwhichdidnotmatchthediagnosisentirely,wasthepulse,
whichshouldhavebeentighter.Nevertheless,Iinterpretedthethinpulseas
asignofaBloodXutosomeextentduetoherkidneyYangXucondition
whichpreventedherfromapropercreationofblood.Therelativeweakness
anddepthofthepulsewasduetoherkidneyweakness.
Theprescriptionfortreatmentwas:
Rightside:Tiaokou(ST38),Jianyu(LI15),Jianliao(T14),Jianneiling.
Both:Taixi(K3),Shenshu(B23).
Tiaokouisanexcellentempiricalpointforacuteshoulderpain.Itwas
insertedtowardChengshan(B57)andmanipulatedfor5minutes(46).
onJianyuIburntfourmoxaballsontopoftheneedle,ineverytreatment
session.
Thethreeclusterpointsoftheshoulderweremanipulatedbythedispersal
"Huicipattern(seeabove).Thiswasdonepriortotheapplicationofmoxa,
andinordertodispersethestagnantColdwhichlodgedinthearea.
TaixiandShenshuwerechosentostimulateandreinforcekidneyYang.In
ordertoensureafullimpactonkidneyYang,threemoxaballswereburnt
overtheleftShenshuneedle.
SincealltheYanggototheleftandalltheYintotheright,Shenshuleftis
alsoconsideredtobelongtoYang,andwasgivenanextrastimulationthere.
Mrs.D.experiencedsignificantpainrelieffollowingthefirstsessionand
couldsleepthewholenightthrough.Afterthesecondandthirdtreatments
herconditionimprovedevenmoreandonthefourth,thetreatmentwas
performedwithoutmoxa.
Afterthefourthtreatmentherconditionworsened,probablyduetoacold
changeintheweather.
Fivemoretreatmentswererequiredtoestablishafullrecovery,allofthem
withmoxa.
4.FENGCHI(G20),TAIYANG(EXTRA),XINJIAN(LIV2),
YANGLINGCHUAN(G34)
Thispointcombinationworksprimarilyontheliverandgallbladder
channelsandhasastrongYang,orFirereducingaction,aswellasWind
clearing,especiallyliverWindfromthehead.
Asaresultoftheseproperties,thecombinationiswidelyusedtotreat
hypertensionofliverYang,orliverFireorigin.Itmayalsotreatheadaches,
migraine,orpressurebehindtheeye(glaucoma)stemmingfromthesame
etiology.
Pointdiscussion
Fengchiisanimportantpoint,situatedonthegallbladdermeridian,below
theoccipitalbone.Itisinvolvedinalmosteveryformulathattreats
headaches,especiallyofaShinature.Thepointisindicatedtoeliminate
Wind(external,oraninternalliverWind),topacifytheliverandreduce
YangQi,toclearthemind,brightentheeyes,tobenefittheearsandto
reduceheat.
Fengchiisusuallypuncturedtowardtheeyeballoftheoppositesite,with
carenottopointthetipupward,thedirectionofthemedullaoblongata.
SinceitsuseismostoftenindicatedtocalmhyperactiveYangorsedate
Wind,itismanipulatedtosedatebyaleftwardtwirling,orforcefully
withdrawingandgentlythrustingback.
FengchiisoftencombinedwithHegu(LI4)forvariousheadachesandthis
isabasiccombinationforheadaches.Heguhasastrongeffectontheface,
foreheadandtheanteriorhalfofthehead,whereasFengchlhasthesame
effectontheposteriorhalf.Bothpointstherefore,circulatetheQiandBlood
ofthewholeheadanddisperseWindandstagnation.
Taiyangisanextrapointsituatedonbothtemples.Itsindicationsarealsoto
disperseWindandHeatfromtheheadandeyes.Itisoftenusedformigraine
headaches,redandpainfuleyes,feverorhighbloodpressure.
TaiyanghasacloserelationshiptotheGallbladdermeridian,firstlybecause
ofitslocation,aswellasitsfunctioning.
Itispunctureduptoadepthofonecunperpendicularlyanditisoften
prickedwithatriangularneedletoreleaseafewdropsofblood.Thisis
usuallydoneinacuteconditions,involvingpain,heat,severeinflammation,
etc.
Xinjianalsohassimilarproperties.ItiswidelyusedtoreduceliverFire,but
itislocatedontheotherendofthebody,i.e.thefoot.
BesidesdrainingtheexcessiveliverFire,Xinjianisalsosaidtospreadthe
stagnantQioftheliver.Thisisusuallyaheatstagnation,whichisoneof
sevenstagnationsthatexistinclassicalChinesemedicine:stagnationsofQi,
Blood,Dampness,Cold,Heat,PhlegmandFood(47).
Thisstagnationofheatofteninvolvesthebloodtoo,asitcausesthebloodto
coagulate.Sincebloodandheatbothhaveaclosephysiologiclinkwiththe
conceptofliverinT.C.M.,itisnotsurprisingthathypertensioninitsmost
commonetiology,istreatedviatheliverorGallmeridians.Xinjian
therefore,isanimportantpointforthisdisorder,asittreatsbothheatand
stagnation.
Yanglinchuanalsohastheabilitytocoolliverheat,aswellastoclear
dampness.Itregulatesandbenefitstheliverandgallbladderandstrengthens
thetendons,sinewsandbones.
Afteranalyzingeachpointinthecombination,itisclearthatthispoint
combinationisbuiltontheconceptofmutualassistance.Actually,allthe
mentionedabovepointshavethequalityofloweringYang,andsubduing
liverFire.
ThemostfrequentlyencounteredetiologyforhighbloodpressureinT.C.M.
ishyperactiveliverYang.Thispatternusuallyinvolvessymptomssuchas:
headache,glaucoma,redeyesandface,dizziness,tinnitus,etc.,allofwhich
areverycommoninthemodernconceptofhypertension.
AccordingtoChinesemedicalphilosophy,whentheliverlacksYinQi(due
toakidneydeficiency,mostoften),orblood(duetospleendeficiency),or
itsQistagnatesduetoothercauses,itcreatesheat.Heattendstoclimbup,
orfloattotheheadregion,viathegallbladdermeridian,whichistheliver
coupledmeridian,orviatheinternalbranchofthelivermeridianitself.The
heatrushesuptheblood,thuscreatingthehypertensionaswellasthe
accompanyingsymptoms.
Theneedlingsequenceinthiscombinationisfromabovedownward,in
ordertolowerorbringdownliverYang.
Itisthereforenecessarytousetheheadpointsfirst,inordertosedateliver
FireorWindintheheadregion,thenXinjianwhichismoreimportantfor
thispurposeandfinallyYanglingchuan.
ManipulationoftheneedlesiseffectedtosedateliverYangandtherefore,
theamplitudeandstrengthshouldbeashighasthepatientcantolerate.
Nevertheless,caremustbetakenincaseshavingafragileconstitution,ora
patternwhichincludesaXucondition,atthesametime.Inthiscasethe
practitionermustassesswhichispredominant,theShiortheXucondition
andstimulateaccordingly.Itisalsoadvised,inanycase,nottobetoo
vigorouswiththemanipulationatthefirstsession.
Aswehavestatedbefore,incaseswhichinvolveanacuteheadoreyepain,
withinflammationorFiresigns,itispossibletobleedTaiyangandreleasea
fewdropsofbloodwiththeprysmaticneedle.
Herbalequivalent
TheeffectofthispointcombinationmaybecomparedtotheuseofSpica
PrunellaVulgaris(XiaKuCao),togetherwithFlos.ChrysanthemiMorifoli
(JuHua).
Thefirstherbiscoldinnatureandacridandisusedtocleartheliverand
brightentheeyes.VerymuchlikeTaiyangandXinjian.Thelatterherbis
slightlycoldandbitterandisusedtodisperseWindandclearheat.It
thereforeclearsWindHeatintheliverchannelandpacifiestheliverand
relievesheadache,dizziness,redandpainfuleyes,etc.Itsactionresembles
thatofFengchi.
Thetwoherbstogetherarethereforeclassicallyusedforheadache,
dizziness,vertigo,painfulandredeyesandhighbloodpressure.
Casehistory
Mr.G.,age46abusinessman,hassufferedforthepasteightyearsfrom
hypertensionandoccipitalheadaches.Duringthisperiodhehasregularly
takenhypotensivedrugs(50mgConvertin),whichhaveadverselyaffected
hissexualabilities.Withthedrugs,hisbloodpressurewas140/110Hg.
Mr.G.hadashinyredface,redeyesanddarkishlips.Hespokeloudlyand
wasverytalkative.
Examinationofthetonguerevealedredrims,andaslipperyyellowcoating.
Hispulsewasmoderateandfirstandsecondpositionsofhisrighthandwere
Shi.
ItwasapparentthatMr.G.hadanexcessheatcondition.Theproblemwas
whetheritwasofliverYangorigin,orstomachFire.Asneitherofthese
possibilitiesinvolvedothersymptoms,itwasdecidedtocleartheheatfrom
theYangmingsystemthroughacombinationrenownedforthispurpose.
Thecombinationis:Quchi(LI11),Zusauli(ST36)Neiting(ST44).
Actually,theYangmingchannelwaschosentooperateuponbecauseofthe
pulse,whichshowedpredominanceontherightGuanposition.
Afewtreatmentswerecarriedoutbythismethod,butthepatientshowedno
improvement.
Thediagnosiswasthenreconsidered,andchangedtohyperactiveliver
Yang.Thepulseabnormalitywasthenceinterpretedasanoveractivityof
therightliverchannel,ratherthanbothchannels,afactwhichhasshown
itselfontherighthandpulse.
Theformulafortreatmentwasthuschangedtothefollowing:Fengchi(G
20),Taiyang,Xinjian(LIV2),Yanglingchuan(G34),Qimen(LIV14)on
therightsideonly,andFuliu(K7).
Allpoints,exceptQimenandFuliu,weresedatedinabroadangletwirling
andraisethrustmanipulation.Qimenwasmanipulatedinanevenmanner,in
ordertoregulateliverQiandFuliuwastonifiedsoastotonifykidneyYin.
Afterthefirsttreatment,Mr.Gsbloodpressuredecreasedto140/100Hg.
andafterfivemoretreatmentsto140/90Hg.Hewasadvisednottotakeany
morehypotensivedrugs,advicewhichheacceptedreadily,andhisblood
pressureremainsstable.
SinceMr.G.wasnotpronetoanger,hewasonlyadvisedtoregulatehis
diet,toexcludeYangnourishingfoods(coffee,seafood,friedfood,pepper,
alcohol,etc.)andtotendhisbusinessinamorerelaxedmanner.
5.QUCHI(LI11),XUEHAI(SP10),WAIGUAN(T5)
Theabovepointcombinationiswidelyusedtotreatskindisorders,mainly
characterizedbyheatandWindofeitherinternalorexternalorigin.
Thesedisordersincludeallergicskinreactions,varioustypesofeczema,
rash,hives,andotherconditions.
WithaddedpointslikeYinlingchuan(SP9),orSanyinjiao(SP6),itmay
alsotreatskinconditionsinwhichDampnessexists,i.e.weepingeczema,
furunculosis,etc.
Pointdiscussion
Quchiisthemosteffectivepointforskindiseases,especiallythose
characterizedbywindandheat.Itstraditionalfunctionsare:
1.EliminatesWindandexteriorconditions.
2.CoolsheatandalleviatesDampness.
3.RegulatestheBlood.
Quchiissituatedonthelargeintestinemeridian,ameridianmostofwhose
functionsdealwithexteriorconditionsorwiththeouterlayersofthebody,
suchas:skin,muscles,etc.
Asitsmostpronouncedfunctionistoeliminateheatandthereforeitisused
incasesoffever,andsinceitisveryinfluentialattheskinlevel,Quchialso
removesheatfromtheskin.Byremovingheatfromtheskin,itimproves
ChingI(fluid)circulationatthecellularlevel,thusfacilitatingskin
nutrition.
Quchiisalsoanimportantpointtoclearheatfromtheblood.Weknowthat
thelargeintestinemeridiancarriesthelargestamountofbloodin
comparisonwithothermeridians,asitbelongstotheYangmingsystem.As
aresultofthisfact,Quchiisabletoactdirectlyontheblood,regulateitand
drainexcessheattherefrom.
Inthisregard,weshouldbearinmindthatmanyskindiseasesaretheresult
of"heatenteringthebloodlevel",accordingtoT.C.M.theory.Theheatin
thebloodconceptmaybeparalleledtothewesternconceptoftoxinsinthe
blood.Thisphenomenonoftoxinsisofahotenergeticnature,often
manifestingitselfasredskineruptionsofvariouskinds.Initsmostextreme
variationitisdefinedeveninT.C.MasFiretoxin.Thisdefinitionis
oftenattributedtothewesternmedicaldiseasessuchasfurunculosis,
purulentabscessesandthelike.
Xuehai"Seaofblood"inChinese,issituatedonthespleenmeridian.The
Spleengovernsthecirculationofblood(i.e.keepsthebloodintheblood
vessels)andgovernsthevolumeofblood,asitstimulatesitscreation.
Xuehaitherefore,isthepointwhichservestoregulateandinvigorateblood
circulation,onbehalfofthespleen.InitsindicationsXuehaiissaidto
harmonizebloodandYingQi(thenourishingQi)andtocoolheat.In
accordancewiththesequalitiesXuehaiisusedtotonifyblood,improveits
circulationanddrainexcessiveheatfromit.
Waiguanisusedinthisprescriptionforitsqualitytorelieveexteriorandhot
conditions.Itiscalledthe"OuterGate"inChineseandthusservesasagate
keeperagainstexogenousperniciousinfluences.
TraditionalChineseMedicineteachesthatinordertocontrolwind,the
bloodmustbefirstregulated.Windsubsidesbyitselfwhennormalblood
flowisrestored,i.e.,itisexpellednaturallywhenithasnothingtoclingto.
TheuseofXuehaiandWaiguanforinvigoratingthebloodanddispersing
thewind,combinedwithQuchiforclearingtheheat,isanimportant
combinationofpointsfortreatingtheitchingduetostagnationofWindand
Heatintheskin."(48).
Theneedlingsequenceinthiscombinationisfromtheupperlimbtothe
lowerlimb.Thisfollowsthegeneralacupuncturerulesaccordingly:
1.Generallyapplyneedlesfirsttotheupperpartsofthebodyandthentothe
lowerparts.
2.Firstapplytopointssituatedonthebackandthenontheabdomen.
3.Applyneedlesfirsttotheleftsideandthentotherightside.
Manipulationsoftheneedlesare,inmostcases,inordertodispersewind
andheat,whichareShiconditions.Inanycase,Xuehaimaysometimesbe
tonified,whenthebloodisxu,ordry,ormoreoften,bemanipulatedevenly
soastotonifythebloodandatthesametimedrainthepathogenicheat.
Inveryacuteconditionsitispossibletobleedthesepointswiththe
triangularneedle,butitshouldnotbedonetoooften,asitmightdamage
bothQiandBlood.
Herbalequivalent
ThefunctionsofXuehaiareverysimilar,inmanyaspects,tothoseofRadix
RehmainiaGlutinosa(ShengDiHuang).
Thisherbhastheseproperties:
1.Clearsheatandcoolstheblood.
2.Indicatedforcasesofhemorrhage,whereheathaspenetratedtheblood
level(incaseslikeexcessivemenstruationandprematuremenstruation,for
whichXuehaiisalsoindicated).
3.NourishestheYinandtheblood.
Thewholepointcombinationmaybecomparedtoaclassicalherbal
prescriptionthathasaboutthesameproperties.itincludes:
1.PeriostracumCicade(ChanTui)
2.HerbaMentha(BoHe)
3.RadixRehmaniaGlutinose(ShengDiHuang)
ChanTuiandBoHebelongtothecoolingherbsthatrelieveexterior
conditions.Thereforetheirmainactivityistodispersewindandclearheat.
Bothofthemarealsousedtospeedrecoveryinmeasles,astheyaresaidto
encouragerashestorisetothesurface.
ShengDiHuang,asmentionedabove,actsonthebloodlevel.Bytonifying
theblooditassistsindispersingWindconditionsandbycoolingthebloodit
removesthebasisforanyskinhotconditions.
Casehistory
MissO.S.,age9,hassufferedforonemonthfromapruriticrashonher
rightcostalsurface,anteriorlyandposteriorly.
Variousallergicexaminationsdidnotrevealanyspecialsensitivityandlocal
applicationofointmentshadnotimprovedhercondition.
Questioningrevealedthattherashhadappearedsuddenlyandthatitwas
veryitchy.
Observationshowedthattherashconsistedoftinyredpoints,givingthe
impressionofsandontheskin.Italsoshowedaredrimmedtonguewitha
verythinwhitemoss.
ThediagnosiswasanexternallycontractedWindHeat,affectingthe
liver/gallbladdermeridians.(WindRash,inChinese).
Thefactthattherashappearedonlyonthesurfaceoftherightribcage,
alongwiththeredrimmedtongue,pointedtotheinvolvementoftheliver
andgallmeridians.Thesuddenappearanceofthedisease,togetherwithits
redcolor,plusthethinwhitecoatingofthetongue,indicatedanexternally
contractedWindHeat.
Theformulachosenfortreatmentwas:Quchi(LI11),Xuehai(SP10),
Waignau(T5),Talchong(LIV3),Sanyinjiao(SP6).
TaichongandSanyinjiaowereaddedtotheprescriptioninordertoresolve
stagnationoftheliverandhastentherecovery.Thisisanotherwellknown
pointcombination,usedtopromotethefunctionoftheliverandspread
LiverQi.
Aftertwotreatmentswhichwerecarriedoutontwoconsecutivedays,there
wasnoitchinessatallandtherashhadsignificantlydiminished.
Afterthefifthtreatmenttheproblemwasentirelyresolved.
6.NEIGUAN(P6),TALING(P7),LIEHCHUEH(L7)
ThispointclusterhelpsfacilitatetheflowofQiandbloodtothepalmand
fingers.ItisusedincasesofMetacarpalTunnelSyndrome,whereQiand
Bloodareblockedinthematacorpaljointtunnelandthesymptomsexhibit
numbness,painandweaknessofthefingers.
Pointdiscussion
Neiguanisthemostimportantpointonthepericardiumchannel.Itismainly
usedtotreatchestorabdominalproblemsanditsfunctionsspreadfrom
regulatingthestomachactivities,toimprovingbloodcirculationintheheart.
OneofitsmanifoldcharacteristicsistoregulatetheQi.Thefactthatit
belongstothepericardiumliversystem,theChuehYinenergeticsegment,
suggeststhatitisalsocloselylinkedwithbloodcirculationproblems.(In
factsomeauthorscallthepericardiummeridian"CirculationSexmeridian")
(49).
Asatributetoitsanatomicallocationnearthemetacarpaltunnel,it
influencesQiandbloodcirculationinthisarea.Duetoitsmajorrolein
improvingbloodcirculationingeneral,Neiguanhasadoubleeffectonthis
area:onemerelyasalocaleffectandthesecondasaninfluenceonsystemic
circulationinthewholebody.
AnotheruniquecharacteristicofNeiguanisthatcontributingtoits
anatomicallocationabovethemedialnerveofthearm,itisveryeasyto
propagatetheneedlesensationasfarasthefingertips.AsMetacarpal
TunnelSyndromeusuallyexhibitsnumbnessofthemiddlefinger,oreven
oftheotherfingerstoo,wecanmanipulateNeiguantotransmitaclear
sensationtothosefingers,thusfacilitatingtheflowofQiandblooduptothe
desiredforemosttarget.
TalinghasmuchthesamecharacteristicsasNeiguan,withoneadvantage
overthelatter.Itslocationisexactlyabovethemetacarpalbonesandjoint,a
factwhichmakesTalingabarrierpointforthisarea.Itsneedlesensationis
alsomostoftenfeltthroughtothefingertips,andpuncturingthispointhasa
directeffectonthejointtunnelitself.Talinghasamorecoolingeffectthan
Neiguan.ItisapointoftenusedtoclearHeartFireandresolveheatinthe
meridianortheorgan.InmanycasesMetacarpalTunnelSyndromealso
exhibitsheatsymptomsduetothepressureofthestagnationthere.Theuse
ofTalingisverybeneficialforsuchacondition.
LiehchuehistheLuopoint,orconnectingpointofthelungmeridian.The
connectingchannelofthelung,afterleavingthemainlungchannelatpoint
Liehchueh,travelstothelargeintestinemeridianandconnectswithitat
pointPianli(LI6).Anotherbranchfollowsthelungmeridianintothepalm
andspreadstherethroughthethenareminence.
Duetoitscourse,Liehchuehisalsousedforwristjointproblemsor
abnormalitiesofthepalm,suchas:pain,hotpalms,eczematousornumb
palms.
Liehchuehneedstobepuncturedwiththetipoftheneedlepointedtoward
thethumb,formaladiesofthepalm.Theneedlesensationmustfollowthe
routeofthelungmeridianortospreadintothepalm.
Inthispointcombinationwecanseethatbesidesitsqualityasapoint
cluster,thereisacombinationoftwopoints,TalingandNeiguan,whereby
eachenhancestheactionoftheother.Thus,thereistheprincipleofmutual
assistanceaswellasthefacilitationofthenormalflowofQiandbloodthat
anypointclusterwouldachieve.
TheorderofneedlingthesepointsisfromNeiguantoTaling,soastofollow
theordinaryflowofQiinthismeridian.Thesearealsothemoresignificant
pointsofthetrioandthepericardiummeridianismoresignificantthanthe
lungmeridianforthisprescriptionspurpose.Liehchuehispuncturedlast.
Aswashintedabove,afterDeqihasbeenobtained,needlesmustbepointed
towardsthepalmandmanipulatedindispersionsoastocauseneedle
sensationtotraveldownwardstowardthefingers.
InMetacarpalTunnelSyndrome,wherespecificheatsignsareabsent,itis
recommendedtoapplymoxastimulationonthepointsafterneedling.
Inseverecases,directmoxibustionisusuallyappliedandscarsareformed.
Inlesssevereconditionsitispossibletolaythemoxacones,thesizeof
beans,onathinlayeroffreshginger(ShengJiang).Thelayerispunctured
through,inordertoallowtheheattopenetrateeasilyandtheconesare
placedoneaftertheother,untilthewholeareabecomesred.
Anothertechniqueadvocatestheuseofwhitepeppermixedwithflourto
makeapasteandspreadoverthepoint.Thethicknessofthelayershouldbe
0.1inch,andaholeismadeinthecenter.
Amoxaconeissetuponitandignited.Thismethodisindicatedusuallyfor
numbnessandstiffnss,andismostsuitablefortheMetacarpalTunnel
Syndrome(50).
Casehistory
Mrs.O.T.,age35,istheownerofagoatfarmandsheisalsothemotherof
casehistorynumber5(seeabove).
Ayearandahalfpriortoherfirstvisittomyclinic,shebeganexperiencing
numbnessalongtheanteriormedialaspectofherrightarm,extending
towardsherfingers.Itwasmorepronouncedatnight,whilesleeping.Later,
sheexperiencedpainwhennumbnessreacheditsclimax.Inthelastfew
weeksshestartedhavingthesamephenomena,thoughtoamuchmilder
extent,inherlefthandtoo.
RoutinechecksatNahariyaHospitalrevealednosignsonhercervical
vertebrae,wheretheyhadprojectedtheirsuspicion.Thediagnosisgiven
wasofaMetacarpalTunnelSyndromeandshewasadvisedtoundergoan
operation.
Onquestioning,Mrs.O.T.revealedthatsometimeswhensheawakensinthe
morning,shesensesasharpprickinherheartregion,experiencingdifficulty
inbreathingdeeply,forawhile.Thesensationthendisappears.
Questioningalsorevealedthatsheisinthehabitofmilkinghergoatsfor
manyhoursandthatsheridesamotorcycleinthefields.Observation
revealedaredtippedtonguewithredpointsandredrims.Shealsohad
peeledareas.Herrightpalmwasdryandeczematous,shesaidthatshehad
beentoldthatitwasafungalinfection,butitdidnotrespondto
medications.Idiagnosedherconditionasfollows:
1.Apreexistingstateofslightheatstagnationofthepericardiumwhich
gaverisetotheshapeofthetongue,tothestabbingpaininthechest,andto
disturbancesalongthepericardiummeridian.
2.Hardlaborofmilkinghadstrainedthebrachialmuscles,especiallythe
flexorgroup.ThisstrainhadimpededtheflowofQiandbloodtothepalm
andhadlaidanextraburdenonthepericardiumchannel.
3.DuetoimpededflowofQiandbloodtothepalm,thepalmbecamedry,
undernourishedandhaddevelopedtheeczema.
Thereasonforaggravatednumbnessatnight,wasthatresthinderedthe
flowofQiandbloodevenmoreduetolackofmovementoractivity,thus
makingthenumbsensationmorepronounced.
Thetreatmentwasconstructedfromthethreeclusterpoints,plusTanzhong
(CV17).Tanzhongwasutilizedtobuildtheformuladuetoitstaskasthe
Mupointforthepericardium.Ithasastronginfluenceonbloodcirculation
andissaidtopropelQiintheUpperBurner,thusenhancingblood
formationandQiandbloodcirculation(51).
BychoosingTanzhang,Idealtwiththelocalcarpalstagnation,aswellas
assistingfromafarbyviewingthelocalprobleminitsholisticbackground.
AfterneedlingNeiguanIappliedsevenmoxaconesonthepoint,usinga
layerofapastemadefromflourandwhitepepperunderneath.
Afterseventreatmentsoveratwoweeksperiod,Mrs.O.T.improvedby
90%assheproclaimed.
Aboutoneyearlatershecametomeagain,sayingshewasafraidthather
previoussymptomswerereturning.Shewasthengivenfourmore
treatments,afterwhichshefeltbetteragain.
7.JIANYU(LI15),OUCHI(LI11),HEGU(LI4)
Thisfrequentlyusedpointcombinationhasbeendevisedinaccordwiththe
principleofchoosingpointsonthesamemeridian,formutualassistance.
Itisusedinmanydifferentproblemsofthearm,involvingtheshoulder,
arm,handandfingers.
Itsmainuse,however,istoinvigoratetheflowofQiandbloodintheupper
limb,forproblemssuchaspainfulBisyndromeofdifferentetiologies,or
paralysis.
Thefactthatallthesepointsaresituatedonlyonthelargeintestinemeridian
andnotononeormoreoftheotherfivemeridiansofthearm,isbecause
thismeridianisknowntohavetherichestsupplyofQiandblood(together
withitsYangmingcounterpart,thestomachmeridian).
TheNeiJingstates:"Whentreatingflaccidityofthelimbs(Weisyndrome),
usepointsonlyfromYangming"(52).
Pointdiscussion
Asstatedabove,allthethreepointsaresituatedonthelargeintestine
meridianandareconsideredimportantpoints.Thetitleofimportantpoints
isusuallygiventothosepointswhichhaveabroadspectrumofactivityand
thatplayamajorroleinmanyformulae.
Allthreehaveintheirindicationsqualitiessuchas:invigoratingQiand
bloodcirculation,removingobstructionfromtheJingLuo,relievingpain,
scatteringBiandthelike.
Bychoosingthesethreepoints,wecombinetheirabilitiestoassisteach
otherandtohaveamutualimpactonthedisease,whichisfarbetterthan
anyoneofthemalone.
Thefactthatallthethreearesituatedonthesamemeridian,enableseach
point'ssensationtotraveltothenextpointandthuspropagatetheneedle
sensationalongthewholelimb.Whenneedlesensationispropagated,sois
Qiandthereafterblood.
ThereisasayinginT.C.M.that"AcupunctureisonlyeffectivewhentheQi
reachestheaffectedarea".Manycontemporaryresearchershaveverified
thisconcept.Theyalsofoundasignificantcorrelationbetweenthedegreeof
inducedpropagatedneedlesensation,andtherapeuticsuccess(53).
Aswehavementionedabove,theNeiJinghasrecommendedtheuseofthe
Yangmingsystemfordiseasescharacterizedbyflaccidity,numbnessand
hypertrophicalfeatures.ThefactthattheYangminghasbeenrecommended
forsuchtasksisduetoitsabundanceofQi,andespeciallyblood.
RecentresearchersinChinahaveverifiedforinstance,thattheuseofthese
pointsinaC.V.A.sequelae,likehemiplegia,hasnosubstitute.Thereasons
arethosementionedabove.Hemiplegia,asanexample,isaparalysisofhalf
ofthebody,causedbybloodstasis(orhemorrhage)inthebrain.This
stagnationhascausedaQiandbloodcirculatoryimpedimentandinfacta
realblockageinhalfofthebody,usuallylongitudinally.
Thus,thesethreepoints(amongotherpoints),aremanipulatedtoinvigorate
theblockedcirculationandreturnthelimbtoitsnormalfunction.
Bythesametoken,thesepointshelpeliminatepaincausedbyaXu
conditionlikeparalysis,oraShiconditionsuchaspainfulobstructionofthe
joints.Theonlydifferenceisinthetechniqueofstimulationandinthe
combinationofotherpointswithintheformula.
Theneedlingsequenceinthiscombinationisusuallyperformedin
accordancewiththenatureofthedisease.InXuconditions,whenparalysis,
numbnessorweaknessofthearmandfingersexists,theneedlingsequence
isappliedfromJianyutoHegu.ThisisdoneinordertodrivetheQi
sensationtowardthefingerswhich,inmostcases,areinaworsecondition.
InpainfulShiconditionsHeguismostoftenpuncturedfirstduetoits
generalizedanalgesiceffect,followedbytherestofthepoints.Itis,
nevertheless,possibletostartwithJianyu,especiallyifthereisamarked
stagnationthere.
Intheconditionsofparalysisoratrophiedmuscles,thestimulationisby
tonification.Themethodoftonificationvaries,butinmostcasesitisa
strongtonificationfortworeasons:
A.TheparalyticstateofthelimbdoesnotallowasatisfactoryDeqi
sensationinmanycases,ifthemanipulationistooweak.
B.Thisisasevereconditionwhichgenerallywillnotrespondsatisfactorily
toamildstimulation.Inthiscontextwemaycomparetheamountof
stimulation,ordegreeofneedlemanipulation,toameasureddosein
medicationoraherbalformula.Insevereconditionsthedosewillgenerally
beincreased.Thedifferencehowever,betweenacupunctureandother
remedies,isthatonlyawellexperiencedpractitionerisabletodevelopthe
"touch"orsensitivityfortherightamountofmanualstimulation.Inorally
takenremediesthedosageismeasurableandrecommendedintheformula.
InmanycasesofXuconditions,especiallythemostsevereorthosein
whichcoldisapartofthecondition,thepreferredtypeoftonificationisthe
"BurningtheMountain"(54)technique,whichwasdiscussedundercase
number1inthischapter.
Xuconditionsoftheupperlimbareveryoftentreatedwithmoxatoo.The
warmneedletechniqueishighlyrecommended,asitwarmsthechannel,
tonifiestheQiandacceleratesitsflow.
Massagetechniques,TuiNawithwarmingandactivatingoilsand
ointments,arealsoverypopularandwidelyused.Themassageiscarried
alongthelimbmeridians,withrubbingandpinching,andscraping
movements,pressingontheacupressurepointsandactivatingQiandBlood.
Forsuchconditionsalsotheplumblossom,sevenstarhammerneedleis
appliedbytappingitalongthemeridians,untilthewholerouteisreddened.
InShiconditions,suchaspainfulBioftheshoulder,elbow,carpaland
phalangealjoints,theneedletechniqueisinsedationanddispersion.The
needleisinsertedagainsttheenergystreamofthechannelormanipulatedin
sedatingprocedures,orintheHuiCitechniquewhichwasdescribedearlier
inthiswork.
Cuppingisalsoapplicable,asitdrainsexcessanddispersesstagnation.Also
electroacupunctureispossible,usuallycombiningtwopointsfromthetrio
inadispersewave.
Casehistory
Mr.G.,age63,abarberbyprofession,lefthanded,had,amonthbeforehe
cametoseeme,amarkeddecreaseinthepowerofhislefthand,fingersand
leg.
Hehadasuddendecreaseofmentalacuity,ofhisusualsenseofhumor,as
wellasphysicalabilitiesofhandandleg.Mr.G.hadtoceaseworkinginhis
barbershop,sincehewaslefthanded.
Aweekbeforecomingtome,hesuddenlyfeltveryunwellandalmostlost
consciousness.Hecouldnotspeakproperly,andsufferedastaggering
headache.HewastakentoNahariyaHospitalwhereheunderwentaC.T.
scanofthehead.Thediagnosiswasacerebrovascularinfarctinhisright
brainlobe.
Uponexaminationitwasobviousthathehadsignificantdifficultyin
movinghisleftfingersfreelyandhisgaitwasalittleclumsy.Histongue
wasbig,redandpeeled.ThepulsewasmoderateandbigattheCunand
Guanpositions.Mr.G.confessedtoalonghistoryofmoderate
hypertension.
MydiagnosiswasabasicShiconditionofliverYang,complicatedbyaXu
condition,afterthebraindamagehadoccurred.
Thetreatmentprinciplewas,therefore,toinvigoratetheflowofQiand
bloodinhislefthandandleg,subdueliverYangandinvigoratetheblood
circulationingeneral.
Thepointschosenforthesepurposeswere:
Jianyu(LI15),Ouchi(LI11),Hegu(LI4),Baxie(extra),Biguan(ST31),
Zusanli(ST36)allintheleftsideonlyand,Taichong(LIV3),Sanyinjiao
(SP6),Xuehai(SP10)bilaterally.
Jianyu,OuchiandHeguweremanipulatedinastrongtonification.Baxie,
areeightpointssituatedbetweentheknucklesofthefingers.Thesewere
stimulatedinordertofacilitatetheflowofQiandbloodinthefingers.
BiguanandZusanliareacombinationoftwopointsonthelegYangming
channel,andtheprincipleoftheirchoiceanduseisexactlythesameasfor
thethreeYangmingpointsofthearm.
TaichongandXuehaiactonthebloodlevel,ingeneral.Taichongreduces
liverYangandimprovesbloodcirculationbyfacilitatingliverQiand
XuehaisroleinblooddisordershasalreadybeendiscussedincaseNumber
5ofthischapter.
Mr.G.feltmentalimprovementafterthefirsttreatment.Followingthis
treatmentheneveragainexperiencedanyepisodeoflosingconsciousnessor
difficultyinspeaking.Afterthethirdtreatment,whichtookplaceduringthe
sameweek,hislegreturnedtonormalandhehadlosthisclumsygait.
Aftertheseventhtreatmenthishandandfingersregainedtheirnormal
flexibilityandstrength.
Mr.G.wasadvisedtocomeonceamonthforacheckupforhisliverYang
andwasconsultedabouthiswayoflifeforthesamepurpose.
8.SHAOZE(SI1),TANZHONG(CV17),RUGEN(ST18)
Thispointcombinationwasmentionedinthe"GreatCompendiumof
AcupunctureandMoxibustian"(ZhenjiuDacheng)writtenin1601inChina
duringtheMingDynastybyYangJizhow(55).
Sincethoseancienttimestherelevanceofthecombinationhasnot
diminishedanditsvalidityservesustodayequallywell.
Thecombinationissuitableforallbreastdiseases,especiallythoseofaShi
nature.Itisusedwithgreatefficacyincasesofbreastabscess,mastitis,
benigntumorsofthebreastandthelike.Thissameformulaisalsoutilized
inmastosisoragalactia(insufficientlactation)whichareprimarilyXu
conditions.
Pointdiscussion
ShaozeistheWellpointofthesamllintestinemeridiananditsmain
indicationsshow:
1.DispersesWindandHeat.
2.Facilitatestheflowofmilkinthebreast.
Itsfirstindication,whichisinaccordwithitsroleasaWellpoint,makesit
usefulinacuteconditionsoffebrilediseases,comaetc.
Itssecondindicationpointstoitssoothingeffectonthebreast.
Thebreastiswheremilkisoriginatesandisproducedinthefemalebody.It
isanatomicallylocatedintheUpperBurner,wherebloodisalsoproduced.
Milk,accordingtoChinesemedicaltheory,ismadeofsevenpartsbloodand
onepartQi(56).Themechanismofmilkproductioninthefemalebody,is
closelyrelatedtothefunctioningoftheChongMai(theextrameridian
whichisalsocalledtheSeaofBlood)andwhichtraversesthebreasts(57).
TheStomachmeridianalsotraversesthebreastsandthismeridiantoo,aswe
know,isveryrichinblood,thusbothmeridiansnourishthebreasts.
Thecloselocationofthebreaststothelungsandlungmeridian,permitsthe
accessofQifromtheairtothebloodofthebreasts.Thustheintermingling
ofQiandbloodintheproperamounts,maketheformationofmilkpossible.
Still,inordernottoaccumulateandbecomestagnant,milkneedsa
harmonizerwhichwillactivateandsuperviseitsflow.Forthispurposeliver
Qiisresponsible,fortworeasons:
ThisisthemaintaskofliverQiinthewholebody,astheliveris
responsibleforthefreeflowofQianywhereinthebody.
Thelivermeridianitselftraversesthebreasts.
Milkflow,therefore,isverydependentonthefreeflowingofliverQi,inthe
samemannerasbloodflow(likemenstrualflow)isalsodependentonliver
Qi.(NeiJing:QiistherulerofBlood").
WhenliverQistagnatesduetoemotionalproblems,thenbloodand/ormilk
tendstostagnatetoo.Innursingmothers,thisstagnationcausesheat(dueto
thepressure)andthenmastitis,breastabscesses,etc.
Shaoze,bothduetoitsmilkflowfacilitatingquality,aswellasitsheat
dispersingquality,isafirstchoicepointforsuchproblems.
Tanzhongwaspartiallydiscussedinthispaperundercasehistorynumber6.
ItisthemasterpointoftheUpperBurner,andtheMupointofthe
pericardium.ItsstimulationsetsinmotiontheUpperBurnerQi,inorderto
eliminatestagnationintheUpperBurner.Itthushelpsfacilitatethefunction
ofthelungs,aidsindispersionofphlegminthechestincasesofasthma,
facilitatestheflowofheartQiandresolvesanginapectoris,circulatestheQi
ofthebreastsandeliminatesstagnationthere.
Inaccordwiththesequalities,Tanzhongwasselectedforthiscombination.
IncasesofagalactiaduetoaXupattern,Tanzhongisstimulatedwithmoxa,
totonifytheactivitiesoftheUpperBurnerformilkproduction.
Rugenissituatedinthefifthintercostalspace,directlybelowthenipple.
Duetoitslocationinthevicinityofthebreastandtoitsbelongingtothe
stomachmeridian,itsfunctionistoregulatethebreast.Rugen,therefore,
assistseitherbytonificationinXuconditionsorbysedationinShi
conditionsofthebreast.
Thecombination,aswecansee,wasbasedontheprincipleofjoiningpoints
whichcanassisteachotherbyinfluencingthesameorgan.Shaozeand
Rugenarespecificpointsfoxbreastproblems,whileTanzhongisthemost
powerfulpointinthevicinityofthebreast.Tanzhonghassomesystemic
influencesinadditionaswehaveseenabove,influencesthathelpregulate
breastfunctioningthroughgeneralphysiologicalfunctioning.
Usually,Shaozeisfirstpuncturedsoastodirecttheinfluenceofthe
treatmenttothebreast.ThenTanzhongisstimulatedduetoitsprime
importanceandthenRugen.
Shaozeispunctured12fendeep,slantingly,inthedirectionofthewrist.
Tanzhongispuncturedeitherpointedupwardordownward,untilDeqiis
obtained.Whenthisisdone,theneedleisliftedtotheskinleveland
redirectedtowardsthediseasedbreast.Manipulationoftheneedleisthen
performedbytwirlingandliftthrustingmovements,allowingthesensation
toprojecttothebreast.Incasesofabscessesormastitis,itisimperativethat
needlesensationshouldprojectinsidethediseasedbreast.
Ifbothbreastsarediseased,thesameprocedureisappliedtotheotherbreast
aswell.
InXuconditionsoftheUpperBurnerleadingtoagalactia,theuseofmoxa
isverybeneficial.Itispossibletoapplydirectmoxibustion,takingproper
carenottocauseascald.Itispossibletowarmthepointwithamoxastick
orbyindirectmoxibustiononathingingerlayer.
ItisforbiddentostimulateTanzhongwithelectricity,orcupping,asitmay
haveanadverseeffectupontheheart.Actuallytherearesometextsthat
forbidthestimulationofthispointevenbyacupuncture,andrecommend
onlytheuseofmoxa(PointsofChineseAcupuncturebyDr.J.Lavier,or
ChineseAcupuncturebyDr.WuWeiPingforinstance).Inanycase,
contemporaryexperienceinChinastronglyadvocatesacupunctureinthis
point,plusmoxibustion.
WithRugen,theprocedureofneedlingisthesameaswithTanzhong.After
obtainingtheQitheneedleisdirectedproximallytowardthebreastandthen
manipulated.
Herbalequivalent
Thispointcombination,especiallywhenperformedinordertosootheShi
patterns,resemblesaherbalprescriptiongenerallyusedtotreatthesame
disorders.
1.PericarpiumCitriReticulata(QingPi)
2.SemenVaccaria(WangBuLiuXing)
3.RadixSalviaMiltihorriza(DanShen)
Thisherbalprescriptionisusedtotreatpainandswellingofthebreasts,
palpablemassesorlumpsinthebreasts,duetocongealedbloodor
constrainedQi.
Itisalsousedtopromotelactation.Muchlikethepointcombination,itisa
basicprescription,onwhichotherherbsareusuallyaddedaccordingtothe
variousnecessitiesofanyspecificcase.
QingPiisamajorherbtoregulatethefreeflowofliverQi.ItreducesQi
accumulationsduetoconstrainedliverQiinthebreastsandtherefore
alleviatespainanddistension.
DanSheninvigoratesbloodflowandbreaksupcongealedblood.Itmaybe
usedalsoforpalpablemassesinthechest,cystsandlumps.DanShenalso
clearsheatandmaybeusedthereforetotreatbreastabscessduetoheat
stagnation.
WangBuLiuXing,withitsqualitiesregardingthebreasts,maybe
adequatelycomparedtopointShaoze.Italsopromoteslactationandtreats
breastabscessesandswellings.Themeridiansitentersarethoseofthe
stomachandliver,exactlythesamemeridiansthatplaysuchalargerolein
breastphysiology.
Thisformula,whentonifyingherbssuchasradixAstragali(HuangQi)are
addedto,maybeusedtotreatagalactiaduetoQiXuconditionswhichhave
ledtoconstrainedQi.
Ontheotherhand,whenherbslikeTaraxacum(PuGongYing)areadded,it
maytreatbreastabscesses,duetofireandpoisonoriginandconstrained
liverQi.
Casehistory
MissK.,age27,astageactressbyprofession,complainedofalargeabscess
onherleftbreast.Amonthpriortothat,shehadanotherabscessonherright
thigh,onthepathofthelivermeridiannearYinlian(LIV11).
Shewastreatedatthattimewithantibioticswhichcausedtheformer
abscesstodisappearandthenewonetoappearonherleftbreast.The
antibiotics,sheproclaimed,hadmadeherveryweak,lethargic,and
depressed.
Onarrivalatmyclinic,shehadafeverandsufferedgreatpaininherleft
breast,apainthatradiatedalongthepericardiumchannelofherleftarm.
Theabscesswaslarge,situatedunderherleftnipple,inflamedand
resembledasecondred,bignipple.
MissK.'spulsewasmoderateandchoppy,deepandweak.TheCunposition
onbothsideswasverychoppy.
Hertonguewasredpurplewithevenredderrims.Theinsideofhereyelids
showedaredshadedlineontheupperpartofthelidsabloodstasis
indication.
Inreplytomyquestionastowhethershehadhadanyproblemswithher
liver,shesaidthatshehadsufferedaseverejaundicefiveyearsearlier.
Thus,inaccordancewithallthesymptomsandsigns,IdiagnosedMissK.
assufferingfromliverheatstagnation,affectingthemeridian.Theabscess
onherleftbreastwasoftheFirePoisoncategoryandalsoinvolvedblood
stagnation.Thisbloodinvolvementhadcausedthefeverandthe
involvementofthepericardiumchannel.Thepericardiumchannelisin
continuumwiththeliverchannel,asapartnerintheChuehYinsegment.
Theformulafortreatmentwasdevisedasfollows:
Leftside:Shaoze(SI1),Tanzhong(CV17),Rugen(ST18),Zulinqi(G41),
Waiguan(T5)
Bothsides:Quchi(LI11),Zusanli(ST36).
Thisformulawasactuallyconstructedfromthreewellknownpoint
combinations.
onthefirstcombinationthereisnoneedtoelaborate,itissufficienttosay
thatinthiscaseallthecriteriaexistedinordertoutilizethiscombination.
ZulinqiandWaiguanaretheMasterandCoupledpointsofDaiMaithe
GirdleVessel.Thisextrameridianharmonizesliverandgallbladder
activitiesanditsareasofinfluencearethewaist,ribsandchestandthehead.
DaiMai,asanextrameridian,absorbsexcessenergyfromtheliverandgall
channelsandadjuststheirfunctioning.Moreover,Zulinqiisindicatedfor
liverQistagnationaffectingthebreastandthatincludesmastitisand
abscess.
Waiguan,inadditiontoitsroleasthecoupledpointoftheDaiMai,isthe
LuopointofthehandTripleBurner(SanJiao)meridian.Itscoupled(Yin
Yang)meridianisthepericardiummeridian.PuncturingWaiguanmaybe
thususedtodivertexcessfromthepericardiumandtoadjustitsfunctioning.
AllthisisduetotheLuopoints'roleasa"tap"thatmaybeusedtobalance
twocoupled(YinYang)meridians.
QuchiandZusanli,bothsituatedontheYangmingsegmentofchannels,
drainexcessheat,relievefeverandinvigorateandregulatetheblood.They
arethereforewidelyusedinhypertensionduetoexcessheatafactwhich
hasalreadybeendiscussedinthispaper.
Thefirstsessionlastedthirtyminutes,inwhichTanzhongandZulinqiwere
manipulatedeverytenminutes.Thepatientexperienceda"sucking"
sensationtravelingfromTanzhongtotheabscess.Followingthetreatment,
sheexperiencedthesame"sucking"sensationpluspainalongherleftarm,
foraboutsixhours.
Aftersixhourstheabscessburstopenandagreatdealofpusandblood
weredischarged.Afterwards,sheexperiencedasuddenrelief.Thepain
subsidedalmostcompletely,asdidthefeverandthedepression.
MissK.cameforsixconsecutivetreatmentsthereafter,followingwhichher
breasthealedcompletely.
MissK.cametomeayearlaterforadifferentproblemandwhileexamining
herInoticedthatherbreastdidnotbeareventheslightestmarkofthe
episodeshehadundergone.
9.HEGU(LI4),TIANTU(CV22),FUTU(LI18)
Thepointcombinationaboveismainlyusedtotreatconditionsinwhich
phlegmhasaccumulatedintheregionofthethroat,givingrisetoproblems
suchas:hoarsevoice,asthmawithasensationofblockedthroat,lumpsin
thethroat,goiteretc.
Pointdiscussion
Heguisapointwhichpossessesmanyqualities,someofwhichhavebeen
discussedinvariouspartsofthisworkandespeciallyundercasesnumbers2
and7.
Heguwaschoseninthispointcombinationduetoitskeyroleinthelarge
intestinemeridianwhichmakesitsroutethroughtheneckandthroat.
WehavealreadydiscussedtheinvigoratingqualityofHegu,which,when
stimulated,setsinmotionandinvigoratestheflowofQiinthischannel,
thusclearinganyblockagesalongitsroute.Incasenumber2,forexample,
thepointwasutilizedtounblockstagnationintheareaofthenasalsinuses.
Here,thepointservestoresolvephlegm,orPhlegmFire,orDampPhlegm
intheregionofthethroat,conditionsthatmaycause,ifuntreated,grave
problemsinthatarea.
DuetoHegusotherqualitiesitmaybeusedjustaswellforexternally
contracteddampnessthathastransformedintophlegm,oraninternally
originatedPhlegm.
WealreadyknowthatHeguisafirstchoicepointforexternallycontracted
situations.Thatmayincludeinfactallthepatterns.Wind,Heat,Cold,
Dampness,plusanycombinationsofthem.Internally,HeguistheYuan
pointofthelargeintestine,thereforeincloserelationwiththeorganitself.
Thelargebowelisresponsibleforeliminatingtoxinsandwastethroughthe
lowerorificeandthereby,Heguplaysanimportantrole.Moreover,Hegu
alsobelongstotheYangMingsystemandthereby,exertsaninfluenceover
thestomachtoo.Sinceweknowthatthestomach/spleenmalfunctioningis
responsibleforphlegmcreation,wecanimaginehowHegumayhavean
influenceontheinternaloriginsofphlegm.
Tiantuisprobablythemostimportantsymptomaticpointinthecaseof
asthma.Itislocatedinthebaseofthethroatandformsthebarrierbetween
thetrunkandtheheadregion.
Inthisarea,peoplesometimesfeelasensationasif"something"isstuckin
theirthroat,asensationmetaphoricallyrelatedtoas"plumseed"inChinese.
Thissensationistypicaloftheformationofphlegmaccumulationsinthe
throat.
Sincephlegmhasadenseenergy,or"dirty"energy,itisstuckinthenarrow
passagesofthethroatandblocksliverQi,orthe"ClearYang"ofstomach
Qifromascendingtonourishthebrain(58).
StimulationofTiantudispersesthephlegminthisareaandfacilitatesboth
theascentofQitotheheadandtheabsorptionofairQiinthelungs.
TiantuisalsoindicatedwhenFireexistsinthethroat.Firemaypresenton
itsown,butinthethroatregionitisusuallycombinedwithphlegm,creating
thephenomenonofPhlegmFire.PhlegmFireexistsincasesofthroat
cancer,abscess,acutegoiter,etc.
Futuisalsoapointonthelargeintestinemeridianandislocatedonboth
sidesoftheneck.ItiscombinedwithHeguwhichisontheotherendofthe
meridian,formingthebondofonepointinthevicinityofthediseasedorgan
andonedistantpoint.
Futustraditionalindicationsare:
Coughingandwheezing,excessivemucous,difficultyinswallowing,hoarse
voice,and"ducklike"soundsinthethroat.
ItisthereforeinmutualassistancewithHeguonthesamemeridianandwith
Tiantuinthevicinityofthefocusofthedisease.
AswithotherconditionswhicharebasicallyShi,needlingisinitiatedwith
distantpointsandcontinuedwithclosepoints(59).
HeguisstimulatedinsedationinordertoinvigoratetheflowofQiInthe
meridianandtodispersephlegminthethroat.Then,Futuispunctured,to
makeacontinuumwithHeguandtakeadvantageofthepropagatedQithat
Heguhastransmittedupward.
Tiantuislastlyutilizedtoproduceitseffectonthewholearea.
InTaiwanIhavewatchedpractitionersusingthe"warmneedle"technique
onHeguinthiscontext,whentherewerenoheatsigns.Theideabehindthis
isthattheNeiJingstatesthatincasesofabundantdampness"warmneedle"
techniqueissuperior(60).
Thelogicisthattheheatedneedleconveyswarmththroughthepointtothe
meridian.Thiswarmthhelpsdissipatethephlegmbydryingit.
Ihaveoccasionallyusedthistechniquemyselfwithverygoodresults.
Futu,incasesofgoiterornecklumps,issometimesstimulatedwithindirect
moxibustionoveralayerofginger.Thisisappliedafterthepointhasbeen
needledandtheneedleiswithdrawnrightafterwards.
IncasesoflumpsinthevicinityofFutu,itisoftenseenthatthelumpitself
ispiercedratherdeeply,tofollowrightafterwardswiththeindirect
moxibustionprocedure.
RegardingTiantutherearetwomainpossibilities.Thefirstistoinsertthe
needleparalleltothesternumposteriorly,untilDeqiisobtainedandthento
withdrawit.Thesecondistodolikewise,butsuspendtheneedleuntilthe
wholetreatmentisterminated.
Herbalequivalent
Aherbalformulaconsistedofthefollowingherbs:
1.ThallusAlgae(KunBu)
2.HerbaSaragassi(HaiZao)
3.RadixCynanchiStautoni(BaiQian)
isverysimilarinactiontotheabovementionedpointcombination.
KunBuandHaiZaoassisteachotherindissipatingphlegmnodulesinthe
neckregionortheyareusedtogethertotreatgoiter.Theirnatureiscoldand
saltyandtheyclearheatandreducephlegm.
BaiQianisverysimilarinactiontopointFutuandprobablyTiantuaswell.
Itisusedtotreatphlegmconditionsinthethroatandtoredirectrebellious
lungQi,whichmeansasthmaticconditions.
ItstraditionalindicationsalsomentionthatBaiQianiseffectiveintreating
"gurglingsoundsinthethroat"whichisasignofaccumulationofDamp
Phlegm,.
Thisindicationinparticularremindsusoftheclassicalindicationofthe
pointFutuwhichwehavementionedabove,thatittreats:"soundsinthroat
likeaduck".
Casehistory
MissS.,age26,alsoastageactressandaclosefriendofMissK.fromcase
historynumber9,wasdiagnosedfiveyearsbeforeashavingabenigntumor
onhervocalcords.
Sheexhibitedsymptomsofhoarsevoice,afactthatwasnotatall
unwelcomeinherprofessionandaconstantsensationofmucousinher
throat.
Shehadanodorlessvaginaldischarge,occasionalstomachacheandnotvery
frequentlyalsonausea.
AllfourmethodsofChinesediagnosisrevealedastateoflungandspleenQi
Xuasabasisforformationofphlegmandtheobstructionofherthroatby
phlegm.
Herpulsewasthin,soggyandweak,especiallyonrightCunandGuan
positions.
Hertonguebodywasslightlyflabbyandcoveredwithathick,white,
transparentandslipperycoating.
Changmen(LIV13)ontheleftsidewastenderbutveryticklish,and
Zhongwan(CV12)wasverytenderaswell.
MissS.wasatenyearsmokerandusedtosmokeatleast20cigarettesa
day.
Theprincipleoftreatmentwastoeliminatephlegminthethroatandto
tonifyspleenandlungQi.
Ithereforechosethefollowingpointsfortreatment:
Hegu(LI4),Futu(LI18),Tiantu(CV22),Panglianquan(extra),Liehchueh
(L7),Fenglong(ST40)
SincetherewerenoheatsignsdespitethefactthatMissS.wasquitea
smoker,Heguwasactedonbythewarmneedletechnique.
Panglianquanaretwopointslocated0.5cunonbothsidesofLianquan(CV
23).Thesearespecialpointsfordiseasesofthevocalcords.Oneshould
inserttheneedletheretransversely,alongtheskin,inanupwardproximal
direction,untilthepatientsfeelasifthey"hadswallowedfishbones"
LiehchuehandFenglongmakeaveryeffectivepointcombinationtotreat
phlegmintheupperrespiratorytract.LiehchuehistheLuopointofthelung
meridianandisveryusefulinresolvingdampconditionsofthelungs,as
wellasredirectingrebelliouslungQi.ItisalsothemasterpointoftheRen
Mai,theextrameridianwhichpassesthroughandnourishesthethroatand
whichisverypronetoDampPhlegmaticdiseases.Liehchuehwasalso
chosenbecauseoftheleucorrheaofthepatient,aproblemwhichisalso
subjecttothefunctioningoftheRenMai.
Fenlongisthepointtotreatanyphlegmconditioninthebody,asitadjusts
thefunctioningofthespleenandstomachmeridians.
ThelastpointcombinationinthisformulaisHeguandLiehchuehwhich
followthe"HostGuest"principleandhavearenownedabilitytoharmonize
thelungs,dissipatephlegmandredirectlungQi.
Thepatientwasinstructedtocutoffhercigaretteconsumption,aswellas
coffeeandmilkproducts.
Shemadeeffortstoeatmoreregularlyandtoavoidjunkfoodandtoomuch
salt.
MissS.receivedseventeentreatments,afterwhichallhersymptomshad
practicallydisappeared.Shewouldnotagreetoundergoanother
examinationofhervocalcordsinordertocheckuponthetumorthere.She
wascompletelysatisfiedwiththewayshefeltandsaidshecouldnotcare
lesswhetherornotthetumorwasstillthere.
10.SHENSHU(B23),WEIZHONG(B54),KUNLUN(B60)
Thisisanotherpointcombinationinexistenceforatleast400years.This
combinationwasfirstmentionedinthe"GreatCompendiumofAcupuncture
andMoxibustion",writtenbyYangJizhowin1601,aswascombination
number8above(61).
Itisstructuredontheprinciple"onepointabovetwopointsbelow,onthe
samemeridian"(seechapterB,number6).
Itisperhapsthemostpopularcombinationtreatinglowbackpainofany
etiology.Itmaydefinitelybeofgreatvalueevenincasesofmiddleand
upperbackpain,withtheadditionofsomeotherlocalpoints.
Pointdiscussion
ShenshuistheBackShupointofthekidneys.Itisaverystrongpoint,and
oneofthemostfrequentlyusedinclinicalpractice.
Shenshu'straditionalfunctionsinclude:
RegulatesKidneyQi.
Strengthensthelumbarvertebraeandknees.
Benefitstheearsandeyes.
Eliminatesdampness.
ItreinforceskidneyQiinallkidneysyndromes:
KidneyQiXuornotfirm,KidneyYinXuandKidneyYangXu.
ItisawellknownfactinT.C.MthatKidneyQiistheactualsourceofallthe
energeticactivitiesofthebody.KidneyQiisthePrenatalQi,aswellasthe
storageofallreservesofpostnatal,acquiredQi.
ItisalsothesourceofYangQi,astheFireofMingMenresidesbetween
thetwokidneys.
Shenshu,astheShupointofthekidneys,isinclosecontactwiththeorgan
itself.Ithasprobablythebestinfluenceoverthekidneyfunctionandis
thereforeutilizedinanydiseaseinvolvingtheorganitself.
But,besidesdiseasessuchas:nephritis,renalcalculi,nephroptosisor
bladderdiseases,thephysiologicspectrumofthekidneyfunctioningisso
broadthatShenshuisalsoappliedinmanyotherpathologies.Thismay
include:skeletalproblems,sexualproblems,hematogenesis,agingdiseases,
gastrointestinal,hormonalandotherproblems.
Inthispointcombinationcontext,Shenshuisappliedduetotwoofits
manifoldqualities:
A.Asalocalstrongpointinthelowerbackwhich,likeanylocalpoint,
helpsregulatelocalfunctioningandresolvelocalQistagnation.Thisis
especiallysowhenitsindicationsincludelowbackpain.
B.ManyetiologiesoflowbackpainstemfromKidneyXu,leadingtoeither
skeletaldeformationsormuscularimpairmentinthelowerback.
Thus,thesequalitiesmakeShenshuthefirstchoicelocalpointforlowback
pain.
Weizhong,accordingtochapterfourofthe"SpiritualAxis"(LingShu),
connectsbehindthekneewithitsbladdermeridian,asits"LowerUniting
Point".ThebladderchannelconnectswiththekidneymeridianviatheYin
Yangcoupledmeridianslaw.
Thecourseofthebladdermeridianpassesthroughthelowerbackand
influencesit.
Moreover,intheclassics,WeizhongisregardedasoneoftheSixMain
Pointsclassification,recordedasfollows:"TakeSanliforthebellyand
abdomen,Weizhongforthewaistandback,Liehchuehfortheheadand
neck,Heguforthefaceandmouth,Neiguanfortheheartandthoraxand
Sanyinjiaoforthelowerabdomen".
Therefore,twoindicationsofthispointshow:
Relaxestendonsandinvigoratescollaterals.
Benefitsthelowerbackandkneesandstrengthensthewaist.
Theothertwoindicationsmaywellbelistedhere,being:
Clearsheatfromtheblood.
DispelsSummerHeatevil(pathogen).
Fromtheabovedatawecanseethateven3000yearsago,Weizhongwas
thefirstchoicedistalpoint,asmuchasShenshuthelocalpoint,fortreating
lowbackpain.
Itisusedthereforetotreatacutebacksprainsorinflammationsoflower
backtendonsandmuscles,or,justasoften,Xuconditionsofchroniclow
backpainorweakness,etc.Weizhongisalsoaveryimportantpointinthe
treatmentofsciatica.Itislocatedabovethetrunkofthesciaticnervebehind
thekneeanditsstimulationmaycauseanelectricshocksensationallalong
thesciaticnervedowntothetoes.Aswehavementionedinthecaseof
Neiguan(P6)(seeundercasenumber6),thiselectriclikesensationhelps
propagatetheQialongthechannelandtoresolvevariousstagnanciesalong
it.TheverydistinctsensationthatWeizhongproduces,isthusconsidered
thecauseforitsgreatefficacyinthetreatmentoflowbackpainandsciatica.
Kunlunisanotherpointonthebladderchannel,whoseindicationsalsosay:
"Torelaxthesinewsandmusclesandbenefitthelowerback".
Itisverymuchusedinthetreatmentoflowbackpainandsciatica,asmuch
asstiffneckandheadproblemsrelatedtowind.
Since"Dispersingthewindandclearingthechannels"isitsotherindication,
KunlunismainlyusedinlowbackpainrelatedtoWindBi.WindBiisa
formofwanderingrheumatismwhichmayaffectvariouspartsofthebody
progressively.Intheposteriorpartofthebody,itismostoftenseenin
peoplesufferingalternatelyfromstiffneckorbackorbuttocks.Insuch
casestheadditionofKunluntotheformulaisveryrewarding.
Thelawof"Onepointabove,twopointsbelow"isverypertinentinthecase
oflowbackpain.Thebladdermeridianenergyflowsinadistaldirection
fromtheback.Shenshuservesasthelocalpointthatactivatesand
invigoratestheflowofQiinthelowerback,whiletheothertwopoints
attractthebladderenergydownward,enhancingandacceleratingitsflow.
Besidethisprinciple,allthethreepointsserveinmutualassistanceto
benefitthelowerbackandrelaxmusclesandtendonsthere,astheir
indicationsimply.
Inaddition,Shenshuhasamorefundamentaltaskwhichistoactdirectlyon
thekidneys,whicharetheorgansresponsibleforthelowerback.
Needlingsequences,manipulationandstimulation
Inveryacutecasesthatinvolvepain,itisadvisabletostartwiththemost
powerfuldistantpoint.Thus,Weizhongisusuallythefirstpoint,then
ShenshuandlastlyKunlun.
Inacutesprainsofthelowerback,Weizhongismaybeutilizedwhilethe
patientisstanding.Itismanipulatedinsedation,asstronglyasthepatient
cantolerate,whileheorsheisaskedtogentlyrotatethewaist.Thistypeof
procedureisoftenperformedinacute,painfulconditionsofvariouspartsof
thebody.Apointisstronglymanipulatedwhilethepatientsareaskedto
rotateandmaneuvertheirpainfuljoint(62).
InacutehotconditionsWeizhongisfrequentlybledwiththepyramid
needle.Thisisdoneespeciallyifcongestedveinsarevisibleinthevicinity
ofWeizhong.
AnotherpopularmethodistoapplycupsonShenshu,withorwithout
needles.AlsorecommendedistheapplicationofcuppingonWeizhongin
thecaseofpainfulknee,relatedtolowbackpain.Thisisusuallydoneafter
theneedleshavebeenwithdrawn(63).
Electricalstimulationofthepointsisalsopossibleandoftenseeninthe
clinic,incasesoflowbackpain.Usuallytherightsideisstimulatedbyone
wireandtheleftsidebytheother.Itisperformedbyadispersionwave.
Herbalequivalent
RadixDuhuo(Angelicapubescens)hasverysimilarqualitiestopoint
Kunlun.ItisinthecategoryofWindDampexpellingherbsandits
indicationsare:
ExpelsWindDampthatcausespainfulobstruction.
Alleviatespaincausedbytheformerindication.
Channelsenteredarekidneyandbladder.
Usedtotreatlowbackpainandlegpain.
AlsotreatsheadacheandtoothachebecauseofWindColdDamp.
WiththeadditionofherbaAssricumradice(XiXin)andRadixGentiana
Macophylla(QinJiao),itconstitutesaclassicformulatotreatsoreness,pain
andnumbnessintheneck,backandlowerextremitiesduetoWindDamp
Bi.
WiththeadditionofradixDispaci(XuDuan)thisformulaimitatesourpoint
combinationveryclosely,asXuDuanplaystheroleofpointShenshu.Xu
DuantonifieskidneyQiandYanganditstrengthensthesinewsandbones.
XuDuanalsopromotesandinvigoratesbloodcirculationandistherefore
usefulevenincasesoflowbackpainduetotraumaandbloodstagnation.In
this,XuDuanimitatesthemutualeffectofbothShenshuandWeizhong.
Casehistory
Mrs.D.,40yearsold,marriedplustwochildren,hassufferedfromchronic
lowbackpainforyears.Everyweatherchange,especiallycooler,ora
damperweather,hadaffectedherbody.Shecouldnottoleratecoldweather
ingeneral,apartfromitseffectonherlowerbackcondition.
DuringthelastsevenyearsMrs.D.hasnotusedanycontraceptivesbecause
shewascertainshecouldnolongerconceive.
Hertonguewaspale,flabbywith"toothmarks",andcoveredwithathin
layerofwhite,dampmoss.
Mrs.D.spulsewassunkenandweak,evenmoresoinbothChipositions.
ItwasapparentthathercasewasakidneyYangdeficiency,withDamp
ColdBiinherlowerback.
Treatmentwasadministeredthreetimesaweek,basedonthepoint
combinationdiscussedabove.Inadditiontothesepoints,Iapplieddirect
moxibustiononherMingmen(GV4),everysecondvisit.
Followingthefirstsessionherlowerbackimprovedradicallyandafterthree
moretreatmentsitdidnotbotherheratall.Thefrequencyoftreatmentswas
thenreducedtoonceaweek,forfourmoretreatments.
Twomonthslater,toMrs.D.sgreatastonishmentanddelight,shebecame
pregnant.
NowMrs.andMr.D.haveathreeyearolddaughterinadditiontotheirtwo
formersonsandsheveryseldomcomplainsaboutherlowerback.
11.DINGCHUAN(EXTRA),TIANTU(CV22),TANZHONG(CV17),
NEIGUAN(P6),FENGLONG(ST40).
Thegoalofthismuchusedpointcombinationistorelievewheezingandto
abatephlegmfromthechestandrespiratorytract.
Itisthereforeusedincasesofasthmawithexcessivephlegmorbronchitis,
oranyotherlungdiseasecharacterizedbymuchphlegmanddifficult
breathing.
Pointdiscussion
Dingchuanisanextrapointlocated0.5cunlateraltothelowerendofthe
spinousprocessofthe7thcervicalvertebra.Itismainlyusedtostop
wheezinganddyspneaandindeed,itseffectis,inmostcases,verydramatic.
DingchuanbelongstotheHuaTuoJiajipoints,namedafterthegreat
Chinesephysicianwhodiscoveredthem.HuaTuolivedintheHanperiod,
duringthereignoftheEmperorsShun(136141AD),andHuangDi(208
AD).
TheJiajipointsarelocated0.5cunfromeachvertebra,bilaterally.TheDing
Chuanpoint,beingsoeffectiveintreatingdifficultbreathing,haswona
uniquenameofitsown.
Dingchuanisalsoeffectiveintreatingurticaria,whichisanallergicskin
disease,oftenrelatedtolungdisorders.
Dingchuanhasaremarkableeffectonbronchodilation,andrelievingspasm
ofthebronchialbranches.Itislesseffectiveinclearingthephlegmfromthe
respiratorytract,andthereforeitmakesafirstchoicepointinthecaseof
acuteasthmaticattack.
Tiantuwasdiscussedbroadlyundercasenumber9.Itsindicationsare:
Todispersethelung.
Toresolveandlowerphlegm.
ToregulateQi.
Toclearandreducefireinthethroat.
Tostopcough.
Tosootheasthma.
Wecanseethatitisaverysuitablepointinallcasesinvolvingcough,
asthma,excessivephlegm,etc.
TiantuisanimportantpointontheJenMai,thevesselofconception.This
vesselisthe"reservoir"ofallYinenergyinthebodyandtherefore,oneof
itschiefconcernsistoregulatebodyfluids.SedationofpointTiantu,may
disperseaccumulationsoffluid,ofwhichphlegmisonephenomenon.In
ordertoperformthisadequatelyviatheJenMai,itisappropriateto"open"
theJenMaibystimulatingLiehchueh(L7)whichservesasitsmasterpoint,
atthesametime.
Tanzhong,anotherpointofJenMai,wasalsodiscussedinthispaper,under
casenumber8.
BesidesplayingaroleinJenMaifunctioning,asdescribedabove,Tanzhong
servesasthemasterpointofallactivitiestakingplaceinthechestandupper
Jiao.
Becauseofthis,itsmajorindicationisto"regulateQiinthechest,,"andto
"relax,expandanddispelfullnessfromthechest".Anotherindication,much
liketheformerpointTiantu,is:"Toclearthelungsandresolvephlegm."
TanzhongisalsoconsideredtheMu(alarm)pointoftheUpperBurner,as
muchasZhongwan(CV12)isoftheMiddleBurnerandYinjiao(CV7)of
theLowerBurner.
Becauseofthisrole,TanzhongisresponsibleforregulatingQiandbloodin
theUpperBurnerandresolvinganyformsofstagnationthere.
TheQicollectedinthechestisZongQi,andistherefinedGuQi("grain"
Qi)whichascendsastheessenceoffood,bytheactivityofthespleen.This
Qiisresponsibleforthefunctioningoftheheartandlung,includingtheQi
controlovertheblood.ThisQialsodominatesthevoiceandenhancesblood
circulationintheextremities.TheplacewhereZongQigathersandactsin
thechestiscalled"SeaofQi",andTanzhongisthepointresponsibleforits
activities(64).
Oneofthecommoneststagnationsinthebodyandespeciallyinthechest,is
phlegm.ByutilizingTanzhongweactivateZongQi,enhanceitsflowina
circularfashioninthechestandthusdispersephlegm.
Neiguanhasalsobeendiscussedinthiswork(Seecasenumber6).Itis
consideredthemostpowerfulpointofthepericardiummeridianandisalso
itsLuopoint.
Neiguan'sfunctioningiscloselyrelatedtothechestanddiaphragm,mainly
becauseoftherouteofthepericardiumchannelwhichtraversesthechest,
alongwithitsLuochannelthatconnectswiththeheart.
ThefunctionofNeiguanwhichrelatestothechestsays:"Itexpandsthe
chest,regulatesQicirculationandstopspain."InthisregardNeiguan's
functionisverysimilartothatofTanzhong,asitimprovesQicirculationin
thechest,anactivitywhichalsodispersesphlegm.
FenglongistheconnectingLuopointofthestomachmeridian.Thepoint
connectswiththespleenmeridianwhichisthestomachcoupledmeridianin
theYinYangrelationship.
Thespleen,whenmalfunctioning,isconsideredthesourceofphlegminthe
body.BystimulatingFenglongonerestoresharmonybetweenthestomach
andspleen,readjuststheirfunctioningand,inthisway,eliminatesphlegm.
Fenglong'squalitiesaretherefore:
Itresolvesphlegm,dampnessandPhlegmHeat.
Itcalmsandclearsthemind.
IteliminatesPhlegmFireinthestomach.
DuetothesequalitiesFenglongisaveryimportantpointinanycasewhere
phlegmisabundantandthat,ofcourse,includesasthmaticconditions.
Thesefivepointsarecombined,aswecansee,inordertohaveastrong
effectonphlegmaccumulationintherespiratorytract.
Thepointswhichwerechosenshareamutualqualityofphlegmabatement
andregulatingtheQioftherespiratoryorgans.
Thepowerandgreatefficacyofthiscombinationisduetothefactthatthe
pointswhichwerecombinedherebelongtodifferentsystemsthus,dealing
withtheproblemfromdifferentangles.
Dingchuan,forexample,exertsitsinfluencethroughthenervoussystem,
directlyonthetracheaandthebronchusandrelievestheirspasm.Tiantu,
achievesitsmaineffectbyeliminatingphlegmfromthetrachea.Tanzhong
affectsthelungsandthebronchiolesbyeliminatingphlegmandadjusting
theirfunction.Neiguanplaysitsroleasadistantpointthatregulatesfrom
afar,thewholechestorgansfunctionandlastbutnotleast,Fenglongdeals
withtheverysourceofphlegmandabatesitsystemically.
Inthispointcombinationtheneedlingproceduregenerallystartswith
Dingchuan,inasittingposition.Thepatientbendsforwardwithhisarms
crossedbeneathhisforeheadandthen,Dingchuanispunctured0.5cun
mediallyslanted,slightlybelowbothsidesoftheprominenceofseventh
cervicalvertebra.
Afterneedling,thepointismanipulatedindispersionfor23minutes.
Usuallythepatientexperiencesanimmediaterelieffromwheezingand
dyspnea.
After515minutes,thepatient'spositionischangedtosupine,andtherest
ofthepointsareneedledinthisorder:Neiguan,Tiantu,Tanzhongand
Fenglong.
Allthepointsareneedledtosedateanddispersephlegm.Whenitisdesired
toaccentuatetheneedlesensation,thetechniqueof"waggingthetail"is
utilized(65).Bythistechnique,afterobtainingQi,theneedlehandleis
"wagged"backandforth,untilthepatientsensesastrongreactionalongthe
meridian.ThisprocedureissaidtomovetheYangQiandbysodoingto
dispersephlegmstagnation.
Inthecaseofchildren,TinatuisusuallyremovedafterDeqi,whereaswith
adultstheneedlemaybeleftinsituduringthewholetreatment.
Theprocedureof"waggingthetail"maybeperformedonNeiguan,ifthe
patientisrobustenoughtoendureit,andonFenglongaswell.However,
attentionmustbepaidtoavoidastrongreactionwhichmightoccurafterthe
treatment.Insomepatients,Fenglonghasastrongimpactonphlegm
movementsinthebody,andthismayaggravatetheirconditionatthe
beginningofthetreatment.Itisadvisableinsuchcases,toinstructthese
patientstokeepusingtheir"Westernmedicine"bronchodilatorsuntiltheir
basicconditionhasbeensignificantlyimproved.
Ithasbeenobservedthatscarringmoxibustionisalsoveryeffectivein
stubbornasthma.Thepointssuitableforthistechnique,fromamongthis
combination'spoints,areNeiguan,TanzhongandFenglong.
Inordertoperformthiscorrectly,atinyconeofwhitemoxaisplacedover
thepoint,preferablyafterneedlingitandburnedtoitsend.Immediately
afterwardstheprocedureisrepeated,withslightlylargercones,onthesame
spot,threetosevenmoretimes.Therearesomespecificointmentswhich
maybeutilizedtohealthewound,afterpusexudates.Oneofthemanda
verygoodonetoo,isthe"RedJadeOintment"(66),inthecaseofaserious
wound,orsimplyeggwhite,forarelativelymildwound.
Herbalequivalent
Thispointcombinationmaybecomparedtothefollowingherbalformula:
SemenPruniArmeniaca(XingRen)
FructusPerillaFrutescentis(SuZi)
BulbusFritillariaThunbergi(ZheBeiMu)
RhizomaPinelliaTeranta(BanXia)
RadixCynanchiStautoni(BaiGian)
Stalactitum(EGuanShi)
Thisherbalprescriptionisacombinationofherbsthathaveaneffecton
coughduetorebelliousLungQi,andaccumulationofphlegm.
Onecomponentthough,isEGuanShiwhichisamineral,andhasageneral
effectonstrengtheningYangandtransformingphlegm.Itmaybecompared
topointFenglong,eventhoughitdoesnotaffectthespleendirectly.
Inordertoachieveamorestraightforwardeffectonstrengtheningthespleen
andtherebyresolvingphlegm,itissuitabletoaddtotheformulaherbssuch
asCodonopsisPilosula(DangShen),orRadixGlycyrrhiza(GanCao),both
ofwhichtonifytheQiviathespleenandalso,havetheeffectofreducing
phlegm.
XingRenmaybecomparedtobothDingchuanandTiantuinitsabilityto
stopwheezingandredirectLungQidownward.
SuZiisusedtostopwheezinganddissolvephlegm.Itismainlyusedwhen
copiousphlegmobstructstheairpassages.
ZheBeiMuisalsosuitableforthesameindications,onlyitismore
appropriatefordealingwithheatinthelungs,aswell.
BanXiaandBaiQianarebothusedtotreatwheezingandcoughdueto
rebelliousQiandphlegm.
Casehistory
Mrs.M.,age36,sufferedsincechildhoodfromseverehayfeverand
urticariaonherupperbackandshins.
Twoyearspriortohervisitinmyclinic,shebegantoexperienceoccasional
asthmaticattacks,untilthisconditionbecamepermanent.
Mrs.M.hada"barking"coughandwheezingandcongestedchest,witha
sensationoflodgedphlegmwhichcouldnotbeexpectorated.
Herpulsewasverysoggyandslippery.Chipositionwasnotpalpableatall,
andthepulseofherlungswassmallandhard.
Hertonguewaspinkpale,wetandscalloped;thecoatingwaswhiteand
damp.
Onevaluatingthedifferentaspectsofthisinformation,Icametothe
conclusionthatMrs.M.wasonthevergeofanexternallyinflicteddisease
turningintoaninternaldisharmony.
Thehistoryofmanyyearsofstubbornhayfever,alongwiththewetand
whitecoatedtongue,pointedtoanexternalDamp,andprobablyColdorigin
oftheproblem.
TheSlipperyandSoggypulse,alongwiththescallopedtongue,suggesteda
weakspleenandaccumulationofdampnessandphlegm.
Thecongestedpulseontherightcunpositionwithcheststuffinessand
wheezing,demonstratedaconcentrationofphlegminherchest,probably
phlegmwhichhadbecometooviscosetoallowitselftobeexpectorated.
Thepointcombinationabovewas,therefore,utilized,inordertoactdirectly
onthephlegm,disperseandeliminateit.PointNeiguanwasintermittently
switchedwiththecoupleHegu(LI4)andLiehchueh(L7).Thiscouplehas
alreadybeendiscussedseveraltimesinthiswork.(SeeChapterB,
paragraphIII,casehistorynumber9.)Hereitwaschosenforitsmarked
effectonredirectingrebelliousLungQiandeliminatingstagnationinthe
upperrespiratorytract.
ItisinterestingtonoteherethatwheneverMrs.M.hadcometothe
treatmentdemonstratingdyspneaandwheezing,pointDingchuan,
manipulatedinthefashiondescribedabove,had,infiveminutes,relieved
hersymptomscompletely.
Afterfivesessionsonly,theurticariaandtheitchyskinhaveboth
disappeared.Herasthmaticconditionimprovedgradually,andafterten
treatmentsMrs.M.reportedthatshehadnofurtherdyspneanorwheezing.
Ithenchangedherprescriptioninordertoplaceanemphasisonthe"BIAO"
therootofherbodilycondition.Theprinciplewastotonifybothlungand
spleenQi,strengthenWeiQi,whilestilloccasionallyusingpointsthat
releaseexteriorconditions,suchas:Fengmen(B12),Fengfu(GV16)etc.
Today,afteroneandahalfyears,Mrs.M.suffersnomorefromeither
asthmaorurticaria.Sheneverthelesshas,eventhoughtoamuchlesser
extent,occasionalhayfeverattacks.
Itisveryimportant,duringthecourseofsuchtreatment,toemphasizetothe
patienttheimportanceofavoidingphlegm,ordampproducingfoods.These
wouldbeespeciallymilkproducts,sweetsandverysweetfood,overly
greasyfood,friedfoodwithmuchoil,andsalt.
Itisnolessimportanttostresstheessentialroleofphysicalexerciseand
breathingtechniques.
12.NEIGUAN(P6),ZUSANLI(ST36),ZHONGWAN(CV12)
Thispointcombinationisthebasicandmostfundamentalprescriptionfor
allstomachcomplaints.ItsactionistoregulateandharmonizeStomachQi,
resolvegastricstagnationofanykindandredirecttherebelliousQiofthe
stomach.
Itisthereforemainlyusedforgastricpainofdifferentetiologies,nauseaand
vomiting,suchasinthemorningsicknesssyndrome.
Pointdiscussion
Neiguanisoneofthemostpopularpointsinclinicalpractice.Itisveryoften
encounteredintreatmentsandithasabroadspectrumofindications.Thisis
thethirdpointcombinationinthisworkinwhichNeiguanispresent.
Underpointcombinationnumber10,wehavealreadymentionedthat
Neiguanisoneofsixpointsconsidered"MainPoints"intheclassics.There,
itsindicationssay:"TakeNeiguanfortheheartandthorax."
Actually,thetwomainorgansthatNeiguanissomucheffectivefor,arethe
heartandthestomach.TheinfluencethatNeiguanexertsuponthestomach
isreflectedinitsindicationslist:
"Topromotethefunctionofthestomach,andregulatetheMiddleJiao."
Neiguanisalsousedasanimportantpointtoregulatetheheartandcalmthe
mind.Itisthereforeusedextensivelyincasesofanxietyandpalpitations,
etc.ThefactthatNeiguanissohelpfulintheseconditions,isprobablydue
toitsroleastheMasterpointoftheextravesselYinWeiMai.
Thisextravesselisusedprimarilytotreatemotionalproblemsrelatedto
deficiencyofYinQiandblood.ItisavesselthatbindsalltheYinmeridians
andcontrolstheheartfunctioning,inrelationtoblood(67).Neiguan,asits
Masterpoint,issituatedontheChuehyinsegment,whichisthehingeofthe
Yin,andthuscontrolstheYin.
Inordertohaveaneffectonbloodproduction,soastotonifytheheart
functioning,NeiguanmustregulateStomachQiinordertopermitthe
stomachandspleentoproduceblood.ItscoupledpointintheYinWeiMai
meridian,Gongsun(SP4),actuallycomplementsNeiguan'sinfluenceupon
thestomachduetoitsroleastheconnectingLuopointbetweenthestomach
andthespleen.Thus,Gongsunhasatonifyingeffectonthespleen,it
pacifiesthestomachanditregulatestheChongMai,ofwhichitisits
Masterpoint.
Insummary,Neiguanhasaregulatingandtonifyingeffectoverthestomach,
duetoitsmanifoldconnectionswithothervesselsinthebody.
ZusanliisthelowerHeSeapointofthestomach.Itisalsocalledthe
FissuralpointanditsactionisdescribedintheLingShuasfollows:"They
(Fissuralpoints)refertothedeepregionswheretheenergyofthemeridians
gatherstogether,andtheyaremoreeffectiveinrelievingacutepaininthe
travelingregionsoftherelatedmeridian,andalsointheinternalorganto
whichthemeridianinquestionbelongs."
Zusanliisalsooneofthe"SixMainPoints"oftheclassicsdescribedbefore
andisindicatedthereforalldiseaseslocatedintheabdomenandbelly.
AsthelowerHeSeapointofthestomach,Zusanliadjuststhefunctionof
thestomachandspleenandisusedasthemajorpointtotonifythespleen.It
isoftenusedinconjunctionwithpointTaiyuan(L9)totonifytheQiofthe
wholebody,asthesourceofpostnatalQiarethelungsandspleen.
ZusanlialsoregulatesthecirculationofQiandbloodandtonifiesanti
pathogenicQiinthebody.
Inallstomachdiseasesitplaysthemostimportantroleandisusedto
strengthenconditionsofdeficiency,asmuchastosedateexcess.
ZhongwanistheAlarmMupointofthestomach.Itisalsousedinall
stomachsyndromes,bothxuandshi.ItregulatesStomachQiandis
thereforeusedinpainfulsyndromesornauseaandvomiting.Itrelievesfood
stagnationandtreatsindigestion,abdominaldistensionandthelike.Itisalso
usedtotonifythestomachandspleenandthereforetreatsanorexia,anemia,
chronicdiarrhea,etc.Zhongwanrelievesabdominalpainandisusedtotreat
gastriculcersandgastrodyniaofvariousetiologies.
ZhongwanisalsoaconfluentpointofalltheFuorgansandexertsits
influenceonalltheiractivities.Itisknown,forinstance,thattheintestinal
rhythm,orperistalsis,affectsthestomachfunctionandviceversa.
Zhonwan,asthemeetingpointofalltheFuorgans,isthususedto
harmonizeandregulatetheperistalsisofthestomachandintestines.
Afteranalyzingthethreepoints'functions,itisobviousnowhowthesethree
pointshavearegulatingeffectoverthestomach.Itisimportanttobearin
mind,however,thatthisisaveryfundamentalcombination,despiteitsgreat
efficacy.Itisnecessary,asarule,toaddotherpointstothistrio,according
tothevariousmanifestationsofthegastricstagnation.
Inordertofurtherelaborateonthis,letustakeafewexamples:
1.Ifwehavediagnosedagastricstagnationduetofoodandheat
accumulation,itwouldbeappropriatetoadd:Neiting(ST44)andWeishsu
(B21).
2.IfthestagnationisduetoliverQiinvadingthespleen,wemayadd:
Taichong(LIV3)andChangmen(LIV13).
3.Or,inthecaseofphlegmaccumulation:Fenglong(ST40)and
Yinlingchuan(SP9)andsoon.
Neiguan,astheMasterpointofYinWeiMaiandadistantupperpoint,
opensthetreatmentbyitsregulatingeffectoverthechestandabdomen.Itis
mostlypropertodosowhennauseaand/orvomitingexist,duetoNeiguan's
calmingeffectanditsabilitytodiminishnausea.
InShisyndromesitismanipulatedwithliftthrustandtwirlingmovements.
Incasenumber6wehavestressedtheverydistinctQisensationofthis
point.Itisimportanttodirectthissensationinproximaldirection(in
contrastwithcasenumber6whichwasadistaldirection).Thismaybedone
bypointingtheneedletipinaproximaldirectionandgentlymassagingthe
routeofthepericardiumchannel,fromtheneedleupward(68).Zhongwanis
thenneedledtoproduceasoreortightsensation,usuallyinwavesencircling
thepoint.ItismanipulatedinthesamewayasNeiguan,withonedifference.
Thisisapointwhich"loves"heatstimulationandreactsextremelywellto
it.Thus,incaseswherecoldisthecauseofdiseaseoroneofits
manifestations,thispointmaybestimulatedbyallformsofmoxa
applications(whichwerediscussedearlierinthiswork).Alsothe
applicationofamoxaboxisrecommended.Thisisaperforatedmetalbox
withahandle,inwhichmoxaislituntilitgetshot.Thenitisplacedoverthe
point,afterapieceofgauzehasbeenplacedbetweenthebodysurfaceand
theinstrument(69).
Incasesofnauseaorheartburn,theneedletipatZhongwanmaybepointed
downward,soastoredirectSomachQi.Incasesofprolapsedstomachdue
toYangdeficiency,theneedletipshouldbepointedupwardandZhongwan
isstimulatedbyheat.
ZusanlyisalsomanipulatedinthesamefashionasNeiguan,onlyitismore
difficulttocauseitssensationtotravelproximally.Itisalsonotnecessary,
asitmaysometimesaggravatethepatient'scondition.Quiteoften,also
Zusanliisstimulatedbymoxa.
Herbalequivalent
Aproperherbalequivalentforthispointcombinationisthefollowing
prescription:
PericarpiumCitriReticulataChenPi
CortexMagnoliaOfficinalisHouPo
RhizomeAtractylodisCangZhu
FructusCitriseuPonciriZhiShi
This,too,isabasicprescriptiontoregulatestomachandspleenQi.Itisused
forepigastricandabdominalfullness,distensionandpainfromstagnantQi
andittreatsnauseaandvomitingduetorebelliousStomachQi.
ChenPimovesstagnantStomachQiandtonifiesSpleenQi.Italsoredirects
rebelliousStomachQiandisusedforanytypeofnauseaandvomiting.In
addition,itisanimportantherbtotreatcoughingduetoexcessivedampand
phlegmoriginatedbythespleen.
HouPoalsomovesthestomachstagnantQi,redirectsrebelliousQiwith
symptomsofnauseaandvomitingandjustlikeChenPi,itdriesdampness
andtransformsphlegm.ItthuscomplementsChenPi,andaccentuatesits
action.
CangZhutoohasmoreorlessthesamequalities,withtheadditionof
tonifyingthespleen.Itisthereforeusedalsoforanorexiaanddiarrhea
causedbyweakspleen.
ZhiShibreaksupstagnantQiandreducesaccumulationsanditdeals
thereforemoreadequatelywiththepainfulsymptomsofstagnantstomach
Qi.
CaseHistoryNo.I
MissK.wastenyearsoldwhenherparentsbroughthertoseemeon
emergencycall.Priortohervisitshehadbeenhospitalizedforonemonthin
thepaediatricInPatientdepartmentofRambamHospital,Haifa,buther
conditiondidnotimprove.
MissK.sufferedacutegastrodyniawithoccasionalnausea.Herepigastric
regionwasverytender,herfaceverypaleandsheappearedveryemaciated
andingreatpain.Herpulsewasfastandhertonguehadredpointsonitstip
andbothsides.
IdiagnosedherconditionasastagnationofStomachQiduetoirregular
eatinghabitsandemotionalproblems.
Thisconclusionwasreachedafteraninterrogation,duringwhichherparents
admittedthefacts.Shedidnothavethefoodstagnationsigns,neither
phlegm,norbloodstagnation.
IappliedthepointcombinationwiththeadditionofLiangqin(ST34).
LiangqinistheXiCleftpointofthestomach.Itisappliedincasesofacute
painintheorgantowhichitisassociated.
Allthepointsweremanipulatedintheregularsedationtechnique.
DuringthefirstfewtreatmentsMissK.experiencedpainreliefwhich
sometimeslastedforafewhoursafterthetreatment.Afterninetreatments,
whichwerecarriedoutoverthecourseofelevendays,herproblemwas
resolvedcompletely.Oneyearaftertheterminationofthetreatmentthere
hasbeennorecurrenceofsymptoms.
CasehistoryNo.2
Mrs.G.,age37,marriedplusfourchildren,wasinherseventhmonthof
pregnancywhenshecametoseeme.Sincethebeginningofher
contemporarypregnancyshehadsufferedseverenauseaandvomiting.
Sinceherfifthmonthshehadbeenexperiencinglassitude,anorexia,
heartburn,vomitingandnausea.
Furthermore,Mrs.G.complainedofdrymouth,especiallyatnightin
additiontoconstantthirstandcravingforfruit.Inadditionshefeltabundant
phlegminherthroat.
Herpulsewasveryslipperyandhertonguewasscalloped.
Inthiscase,aStomachQistagnationwasalsopresent,butthepatternwas
morecomplex.
Inthefirstplaceitwasobviousthatherspleenandstomachwerenotin
harmony.Thereweresymptomssuchaslassitude,anorexiaandphlegm,
alongwithascallopedtongue,suggestiveofSpleenQideficiency.Onthe
otherhand,herStomachQiwasrebellious,shehadheartburn,vomitingand
thirst,allofwhichindicatedaShi/Hotstomach.
Thedeficientconditionofthespleengaverisetoabundantphlegm,aShi
pattern,whichaggravatedthesituationofthepatient.Thus,wecouldsee
thatshewasconstantlythirstyandcravedforfruit(averyYinfood.Atthe
sametimeshewasanorecticandnauseousbecauseofphlegmstagnationin
herstomach.
Itisverycommon,ofcourse,toseenauseaandvomitinginpregnant
women.TheT.C.M.explanationforthisphenomenonistheheavyburden
thatpregnancyexertsuponthespleenandkidney.Bothorgansplayamajor
roleintheproductionofbloodandYin,essentialsubstancesforconception
andmaturationofthefoetus.Thisburdenweakensthespleenandkidney,
givingrisetoabundantphlegmandtheweakeningofStomachQi(70).
TheprescriptionforMrs.G.includedthepointcombinationwiththe
additionofthefollowingpoints:Tiantu(CV22)andFenglong(ST40)to
reducephlegminthethroatandinthewholebody.Themutualfunctioning
ofthesetwopointswasalreadyexplainedinthepreviouscombinationof
points,number11.Inaddition,twootherpointswerealsoadded:Neiting
(ST44),andGongsun(SP4).
NeitinginordertodecreaseStomachHeatandstagnation,andGongsun,as
theLuoconnectingpointofthespleen,toshiftexcessenergyfromthe
stomachtothespleen.
symptomatically,Gongsuniscapableofrelievingnauseaanditthusaidsin
theoverallactionofthepointcombination.
ItisimportanttonoteherethatZusanliwasmanipulatedgentlyin
tonificaiton,whereastheotherpointsweremanipulatedinsedation.AsMrs.
G.wassomewhatfrightenedandsensitivetothetreatment,themanipulation
oftheneedles,eveninsedation,wascarriedoutrathergently.
Mrs.G.feltmuchbetterimmediatelyafterthefirstsession.Afterthethird
session,shehadsignificantlylessphlegm,hernauseaandvomitingsubsided
andshefeltmuchstronger.
ThewholetreatmentlastedthreeweeksafterwhichMrs.G.feltthatshehad
regainedfullstrength.shegavebirthinduetime,withoutanycomplications
andingoodhealth.
13.CHANGQIANG(GV1),CHENGSHAN(B57),PAIHUI(GV20)
Thispointcombinationhasindeedalonghistory.Thefirsttwopoints,
ChangqiangandChengshan,werealreadymentionedasacombination500
yearsago,in1529,bythephysicianGaoWuinhisBaiZhengFu(Odeofa
HundredSyndromes)(71).
Thisisthebasicformulafortreatinghemorrhoidsofanyaetiology.This
combinationtreatshemorrhoidssymptomatically,includingbleedingand
prolapse,butitmayneedadditionalpointsinordertoeffectivelytreatthe
underlyingcauseofthehemorrhoids.
Pointdiscussion
ChangqiangisthefirstpointoftheDuMaichannelandisalsothe
connectingLuopointofDuMaiandJenMai.
onitsroute,theDuMaiencirclestheanusandthenclimbsupthespineto
thebrainandemergesatthevertex,atpointPaihui.Duetoitscourse,this
channelisalsoassociatedwithdiseasesoftheanus,suchashemorrhoids.
Hemorrhoids,inmostcases,isaShiphenomenon,associatedwith
inflammationandbleedingoftherectalarea,causingveinstheretobulge
outandcausesharppain.Inmostcasesthediseaseinvolvesheatsymptoms
suchasredness,acutepain,bleedingandaburningsensation.Insomecases
dampnessalsoexistswhenthereispusinvolved,diarrheaandaheavy
sinkingsensation.
InsomeothercasesthemostsalientetiologyisaspleenQideficiency,an
etiologythatmayalsocausebleeding,prolapseanddiarrhea,butthenthe
symptomswillnotbesoacute,rathermorechronic.Inanycase,evenonthe
basisofaSpleenQiXucondition,aShiconditionmayarise,includingthe
previouslydescribedsymptomsandsigns,aconditionwhichisbothsevere
andacuteatthesametime.
InordertodrainexcessfromtherectalareaandfromtheDuMai,thereare
threemaintechniques:
1.PunctureinsedationthepointChangqiangwhichistheLuopointwith
theRenMai,andthereby,totransferexcessfromDuMaitoRenMaiand
dispersethestagnationintherectalarea.Bydoingso,wealsotake
advantageofthefactthatChangqiangtooisalocalpoint,situatedinthe
rectalareaandaffectingthisareasymptomatically.
2.Anyextrameridian,includingtheDuMai,maybe"opened"anddrained
bysimultaneouslypuncturingtwopoints,oneateachend.Thus,puncturing
ChangqiangandPalhuisimultaneously,woulddraintheexcessand
harmonizetheGoverningVessel.
3.Itisalsopossibletodrainexcessenergyfromanextrameridianby
puncturingitsmasterandcoupledpoints.
Inthispointcombination,bothtechniquesNo.1andNo.2areutilized,
makinguseoftwopossiblemethodstodraintheexcessfromtheDuMai
andtoresolvethehemorrhoidsproblem.Consideringthefactsmentioned
above,itisnowonderthatoneofthemainindicationsofChangqiang,isto
treathemorrhoidsandprolapsedanus.Itstraditionalfunctionsquote:"To
regulateandremoveobstructionfromtheDuMaiandJenMai,topromote
thefunctionsoftheintestines,totreathemorrhoidsandrectalprolapse.
Chengshanisapointlocatedonthebladdermeridianandisthefirstchoice
symptomaticpointtodealwithhemorrhoids.Thebladdermeridiantraverses
theanalregionandthereforeaffectsit.
ChengshanhasaneffectoveralltheYangorgans.Itsindicationsare:
1.ItregulatestheQioftheYangorgans.
2.Itbenefitshemorrhoids.
Sincehemorrhoidsaresituatedonthe"outergate"ofthelargeintestine
whichisaYangorgan,andbecausethebladdermeridianitselfconnects
withthesame"outergate",itisnotsurprisingthatChengshanexertssuchan
influenceovertheanus.
Paihui("hundredmeetings")isthehighestpointonthevertex.Pictoriallyit
constitutestheotherendofthebodyinrelationtoChengqiang.Thispoint
isusedintheformulafortworeasons:
1.ItislocatedattheotherendoftheDoMaichannelandisthususedin
conjunctionwithChengqiangtodrainthischannelfromexcess.This
functionhasalreadybeenexplainedabove.
2.PaihuiisthecrossroadpointonthevertexforalltheYangchannelsandit
hasthefunctionofstrengtheningYang,andelevatingQi.Itisalsoknownto
raisethesinkingQiofthespleenandbythis,arrestbleedingandraise
prolapsedorgans(72).
ItisimportanttorememberherethatthespleenisresponsibleinT.C.M.
thinking,forthefunctionsof"holdingthebloodinthebloodvessels"and
"keepingtheorgansintheirplaces".Therefore,functionalbleedingor
prolapseoforganssuchas:rectum,uterus,stomach,etc.,areattributedto
SpleenQiXu,and/orYangXu.
Itshouldbeobviousbynowhowthesethreepointstogetherhaveacommon
calmingeffectonthehemorrhoids.Nevertheless,aswithalmostanyother
pointcombination,anassessmentoftheetiologyandenergetic
manifestationofthehemorrhoidsmustbemade.Thisdone,a
comprehensiveformulamaybebuilt,utilizingalsootherpointsinorderto
dealeffectivelyandholisticallywiththedisease.
Toillustratethismoreclearly,hereareafewexamples:
1.Inchronichemorrhoidsduetospleenandkidneydeficiency,Taibai(SP
3),Taixi(K3),Sanyinjiao(SP6)maybeutilizedintonification.(Palhuitoo
intonification)
2.Whendampandheatcoexist,itispossibletoadd:Dachangshu(B25),
Chengfu(B50),Quchi(LI11)andErbai(extra).
3.Ifmassivebleedingispredominant,itwouldbeappropriatetouse:Yinbai
(SP1)indirectmoxibustion,Xuehai(SP10)andQihaishu(B24).
Needlingsequence,manipulation,andstimulation
Inacutecasesinvolvingpain,itisusuallyrecommendedtobeginthe
treatmentwithadistantpoint,manipulatedindispersion.Inthiscase
Chengshanistheappropriatepoint.
ItisveryimportanttolocateChengshanaccuratelyandthen,manipulateit
inasmallamplitudebythepullthrustsedationtechnique.Incasesofsevere
heat,itisadvisabletoutilizethe"Coolingthesky"techniqueonChengshan,
untilacoolingornumbsensationisachievednearthepointoraroundthe
hemorrhoids.
NextpointisChengqiang.Thispointissomewhatproblematic,asmany
practitionersarereluctanttouseitbecauseofitsanatomicallocation.Still,
thisisaveryimportantpointandthepatientshouldbetoldtowashthe
regionproperlybeforecomingtotheclinic.Theneedlemaybeinserted
thereperpendicularlyandmanipulatedbytwirlingmovementsafterdeqihas
beenobtained.
Paihuiisneedledlast.Itiseitherneedledinaposteriordirection,orfromthe
lefttotherightifthepatientislyingonhisstomachandhisrightcheekon
thebed.
Inasinkinghemorrhoidalcondition,aftertheheatandinflammationhave
subsided,moxamaybeappliedafterneedling,usuallywiththewarming
stickmethod.ThismoxibustionfurtherenhancestheraisingofspleenYang
Qithus,contractingthehemorrhoidaltissueinside.Thesameprocedure,
though,maybeexecutedwithJenchueh(CV8)whichpossessesthesame
quality.
Herbalequivalent
RadixSanguisorba(DiYu)andFlosSophoraJaponica(HuaiHuaMi)are
usuallyusedtogetherforhotandbleedinghemorrhoids.Bothoftheseherbs
belongtothecategoryofherbsthatarrestbleeding.Bothofthemalsocool
thebloodandarethereforesuitableforulcerations,burns,andsimilarskin
problems.DIYu,inaddition,clearsheatandpromoteshealingandis
suitableforexternalapplicationonsuchskinproblems.
Inaddition,itiscommontofindinaformulaforhemorrhoidsherbsthat
treatDampHeatconditionssuchasScutellariaBaicalensis(HuangQin).
ThisherbalsoentersthelargeintestinemeridianandisusedforIntestinal
Windwhichisbloodinthestoolsandforintestinalabscess.
HerbslikeCorydalis(YanHuSuo)thatinvigoratethebloodandstoppain,
mayalsobefoundinsuchformulae.MineralssuchasSuccinumresin(Hu
Po)whichisgroundAmber,isalsosuitable,duetoitsabilitytoreduce
swellingandpromotehealingofulcerations,carbunclesandswollen
scrotum.
IncomparisonwithpointPaihui,RadixAstragali(HuangQi)mayperfectly
fitin.ThisherbhasthefunctionofraisingtheYangQiofthespleenand
thus,itisusedinprolapsedsyndromes,orbleeding,duetodeficiency.Itisa
warmherb,ittonifiesthespleenandthelung,anditmaybeaddedtoa
herbalformulathattreatsprolapsedanuswithhemorrhoidsorsinking
bleedinghemorrhoids.
Casehistory
Mrs.M.,age42,sufferedforseveralyearsfromrecurrentbleeding
hemorrhoids.Herrecentattack,whichshedefinedastheseverestofthem
all,hadcaughtherabroad,onvacation.Variousmedicinesprescribedfor
herwerenotofmuchhelpandshecametomesufferinggreatpainand
discomfort.
DespitethefactthatMrs.M.wasaphysicalfitnessteacher,shewasslightly
obese.Whenaskedtodescribethepain,shesaidthatithadbeenasharp
prickingpain,withasensationofheavinessandsinking.
HerpulsewasSoggy,butBigintheCunposition.Hertonguewas
scalloped,somewhatpurplishblue,andcoveredwithmanyredpoints
aroundthetip.Italsohadathinyellowishlayer.
Aswasevidencedbyactuallyallthesymptomsandsigns,hercasewasa
DampHeatstagnationintherectalregion,plusapreexistingspleenQiXu
pattern.
Asoggypulseandscallopedtonguearebasicqualitieswhichpointouta
weakspleencondition.Theredpointsonthetongueandtheyellowish
cover,exhibitaDampHeatcondition.TheBigpulse,thathadaSoggy
qualityaswellintheCunposition,alsoshowedadampexcessivecondition
inthedomainofthelargeintestine.
Hersymptomsclearlymatchedthosesignsthus,sheexhibitedacasethat
"goeswiththecurrent".ThisisaChinesesayingthatsuggeststhatwhenever
thesignsmatchthepatient'ssymptoms,thecasemayrespondwelltothe
treatment(73).
Mrs.M.wastreatedtwiceadaybythefollowingformula:Chengshan(B
57),Changqiang(GV1),Quchi(LI11),Huiyang(B35).Quchiwas
introducedintheformulainordertotreatheatanddampinthelarge
intestineingeneral,asdidHuiyang,locally.
OntheseconddaythepaindecreasedmarkedlyandonthethirddayQuchi
wassubstitutedbyPaihui(GV20).
Afterfivemoredailytreatmentswiththerevisedformula,Mrs.M.was
completelycured.
14.SHENMEN(H7),NEIGUAN(P6),YINTAMG(EXTRA),
SANYINJIAO(SP6)
Manypointsandcombinationsexistinacupunctureforthepurposeof
relaxingthenervoussystem.Thiscombination,however,isprobablythe
mostrenownedforthispurpose.
ItisusedtorelaxtheheartandcalmtheShen,relievetensionandanxiety
andtreatinsomnia.
Pointdiscussion
Shenmen,whichistheYuanSourcepointoftheheartchannel,isthemost
effectivepointusedtorelaxthenervoussystem.Here,bothclinical
observationandtheoreticalbackgroundsupporteachotherandprove
validity.
AccordingtotheT.C.M.theory,theShenSpirit,residesintheheart.This
meansthatanyemotionaldisorderthatonemayencounter,willprobably
haveitsimpactupontheheartsystem.Thismayalsomean,thatillnessesof
theheartorganortheheartmeridian,mayinfluencetheSpirit(74).
ClassicalproblemsoftheSpirit,accordingtoT.C.M.are:insomnia,tension,
anxiety,excessivedreaming,forgetfulnessforthelightproblemsand,for
themoreserious:hysteria,insanity,delirium,etc.
Shenmen,astheYuansourcepointoftheheartmeridian,isconnectedvia
theYuanenergy,directlytotheheart.Itisalsoconsideredthemost
importantpointontheheartchannel.Itsindicationsare:
1.TocalmtheSpirit.
2.ToregulateHeartQi.
3.ToremoveobstructionfromtheJingLuo.
Thus,besidesbeingusedtosupplementheartQiortotonifyHeartBloodor
Yin,ShenmenisbroadlyusedinallproblemsassociatedwiththeSpirit.
ItisbelievedinT.C.M.thatwhentheheartlacksblood,thereisrestlessness,
insomniaandpalpitations.ThesesymptomsarisebecauseofshortageofYin
energythatcausestheheartYang,orFire,toflareup.Tosubduethis,
Shenmenisutilizedto"cooltheheart",orsedateitsfire,while,atthesame
time,otherpointsareusedtotonifytheYinandblood.Bydoingso,the
harmonyisrestoredandYinandbloodprovidethesubstantialbasisfor
heartYang.
Neiguanhasbeendiscussedseveraltimesinthispaperandthereisnoneed
toelaboratefurther.Inthiscase,itwaschosenbecauseofitstraditional
functiontotranquilizetheheartandcalmthemind".
Inaddition,clinicalpracticedemonstratesthatNeiguanmakesaverygood
couplewithShenmen,mainlybecauseitisthemostimportantpointonthe
pericardiumchannel,anorgancloselyrelatedtotheheart.
Thus,eachofthesetwoaccentuatestheotherpointsfunctionofcalming
theShenandrelaxingtheheart.
YintangisanextrapointsituatedontherouteoftheDuMaimeridian,
exactlybetweentheeyebrows.Itsindicationsintheclassicsarefirstlyto
eliminateWindHeatandsecondly,tocalmtheSpirit.
Itisthereforeusedforrhinitis,sinusitis,headacheandotherWindHeat
inducedproblems.
Asforitssecondindication,Yintangisoftenusedforinsomniaor
restlessness.Traditionallythepointissituatedwherethemystic"thirdeye"
islocated.This"thirdeye"isthe"windowofthesoul",andmysticism
attributesgreatmentalpowerstothosewhoareabletousetheir"thirdeye".
Modernresearchershavefoundthatthestimulationofthispointhasan
effectonproducingelectricalAlphawavesinthebrain.TheAlphawaves
aretypicalofastateofdeepsleepormeditation.Thereareevenacupuncture
laserstimulatorsthathaveaspecialswitchforAlphawaveform,andthe
practitionerisinstructedtostimulatepointYintangusingthiswavelength
(75)incasesofnervoustension,insomnia,etc.
Sanyinjiaowasdiscussedundercombinationnumber1ofthiswork.Itis
oneofthemostimportantandfrequentlyusedacupuncturepoints.Itisalso
amemberinthepreviouslydiscussed"Sixmainpoints"category.
Inthispointcombinationitwasaddedinordertobalancethetreatment
(pleaserefertoChapterB,paragraphIX).
SanyinjiaoisperhapsthemostfrequentlyusedpointtotonifyYinQi.Itis
themeetingpointofthethreelegYinmeridians:thekidney,liverand
spleenandithastheeffectofstimulatingthemall.
DuetoitseffectontheYiningeneralandonthesethreeorgansin
particular,Sanyinjiaoisamajorpointtotonifythebloodtoo.Takinginto
considerationtherolethatthesethreeorgansplayinregardtotheblood
functioning,wecanunderstandtheimportanceofSanyinjiaoinrelationto
theblood.
Thekidneysareassociatedwithbloodproductionbyrulingthebone
marrow(Jing),wherebloodiscreated.Atthesametime,thekidneys
providetheYuanQiforthespleeninordertoproduceblood.ThisYuanQi
playsamajorrolealsointheareacalled:TheSeaofQiunderTanzhong
(CV17),wherebloodisproducedbythemutualenergeticcooperationof
theheartandlungsintheUpperJiao.
Thespleenrulesthecreationofbloodfromtheessenceoffooddigestedin
thestomach.Thusthevolumeofbloodismostdependentonthespleen.The
liverstoresthebloodandrulesitsmovementanddistribution,duetoitsQi
sprinklingactivities(76).
Thus,pointSanyinjiaoplaysaroleinsupplementingdeficientbloodandin
circulatingandinvigoratingstagnantblood.
Wemustkeepinmindthemostfrequentcausesofinsomniaand
restlessness,mentionedinrelationtopointShenmen(H7),inthis
combination.
The"HeartblazingFire",or"HeartYangShi",isdueto,orincontinuum,
withHeartYinXuorHeartBloodXu.Ineithercase,Sanyinjiaoisutilized
heretosupplementbothYinandbloodandtherebytoreduce,oreliminate,
HeartFire.
Thispointcombinationisconstructedofthreepointsthathaveamutually
assistantactiononcalmingtheShenbyreducingHeartFireandregulating
itsactivity.Thefourthpointgivesthebalancetotheformula,byacting
directlyonthecauseofthedisharmony.
Onthisveryprinciplemanyotherpointcombinationshavebeendeveloped,
especiallypointsthatreduceHeartFireontheonehandandpointsthat
supplementKidneyWaterontheotherhand.
Suchcombinationsare:
Tongli(H5)Dazhong(K4)
Tongli(H5)Zhaohai(K6)
Shenmen(H7)Taixi(K3)(77)
ShenmenandthenNeiguanareneedledfirst.Thesetwopointshavethe
strongestandfastestresponse,andtheyareusedtocalmthepatientas
quicklyaspossible.Bothpointsaregenerallyusedinsedation.Incasesof
tooweakoranxiouspatients,thestimulationshouldbemild,andskilful
needletechniqueisimportantinordertocauseminimalpaintothepatient.
Yintangisthenneedledinthesamemanner,andatlast,Sanyinjiao,in
tonification.
Itisnotnecessaryinthiscombinationtocauseapropagatedneedle
sensation,asthereisnospecificareaofdiscomfortorpain.Itisenoughto
suspendtheneedlesinsituafterDeqihasarrived,withoutfurther
manipulation.
Whenthiscombinationisutilizedforinsomniaticpatients,itis
recommendedtoretaintheneedlesfor3040minutes,andthetreatment
shouldbeconductedasclosetobedtimeaspossible(78).
Herbalequivalent
Therearemanyherbalprescriptionsthatdealwithanunquietheartand
troubledspirit.Thereareeventwocategoriesofherbsthatdealdirectlywith
thesesymptoms.Onecategoryisofherbsthat"nourishtheheartandcalm
thespirit"andtheotheris,"substancesthatsettleandcalmthespirit".
TheprescriptionthatIhavechosentoparallelthispointcombinationis
constructedoffourherbs.Twoherbsthathaveacalmingeffectonthespirit.
Theysimultaneouslynourishtheheartandregulateitsfunction.Thethird
herb,hasadirecteffectoncalmingthespiritandthefourthherbtonifies
bloodandYin.
Theherbsare:
RadixPolygaleTennifoliaYuanZhi
SemenZiziphySpinosaSuanZaoRen
SclerotiumPoriaCocosFuShen
RadixRehmaniaGlutinosaShuDiHuang.
YuanZhiisusedtocalmthespiritandfacilitateheartfunctionandisused
mainlyfornervoustension,anxietyandemotionalproblemshinderingthe
heartfunction.
SuanZaoRenalsocalmsthespirit,but,inaddition,itnourishestheheart
bloodandYin.
FuShenisafungussimilartoFuLing,butitenvelopestherootandis
consideredbetterforcalmingthespirit.
ShuDiHuangisawidelyusedherbtotonifybothYinandbloodingeneral,
anditisusedheretosupplementtheYinsubstancefortheheartfunction.
Thus,themutualactionofYuanZhiandSuanZaoRenisverysimilartothe
actionofpointsShenmenandNeiguan.FuShenmaybecomparedto
Yintang,especiallywhenevenitsnameFuShen(TockahoeSpirit)implies
itsinfluenceuponthespirit(Shen).
ShuDiHuanginthisformulaimitatestheroleofSanyinjiaoanditseffect
uponbloodcreationandYintonification.
Thewholeformulaisthereforeeffectiveinthetreatmentof:insomnia,
dreamdisturbedsleep,anxiety,palpitations,weaknessandanemia,
forgetfulness,disorientationandlightheadednessandthelike.
Casehistory
Mrs.C.,age31,gavebirthtoheronlychildthreeyearsago,aftersixyears
ofsterility.Shehadbeentreatedforhersterilitywithhormonesanddidnot
feelwellduringthecourseofthetreatment.
Ayearaftershegavebirth,shehadsuddenlyexperiencedpalpitations,pain
inherleftchest,leftarmandleftleg,lassitudeandanxiety.
Sincethattimeandforthelasttwoyears,herconditionhadnotimproved,
despitedifferenttranquilizersthatshehadbeenprescribedandsessionsof
conversationswithherpsychiatrist.Lately,shestartedhavingheadachesin
hertemplesandhervertex.
Mrs.C.hadaveryfastpulse(around110),ofchoppyandwiryquality.The
Cunpositionwassoftandthinandweak,onbothwrists.Liverpositionwas
choppyandwiry.Kidneypositionwaschoppyandwiryandweak.
Hertonguewaspurplishred,butunderneathwaspale.Itwasveryflabby
andthelungareashowedsmallcracks.Thetipofthetonguewasredand
hadredpimples.However,itwasmoist,notdry.
Mrs.C.hadapalecomplexionwithredcheeksandingeneral,shehada
thinandfragilefigure.Hervoicewaslowandweak,almostawhisper.
OnherfirstexaminationImeasuredherbloodpressurewhichwas110/75
Hg.
ItwasveryobviousthatMrs.C.hadadepletionofYinandbloodand
deficiencyofQi,ingeneral.Thisconclusionwasreachedowingtoherweak
appearance,palecomplexionandthin,choppypulse.Asaresult,she
obviouslyhadaheartYin/bloodXucondition,withasubsequentblazingof
HeartFire.Thiswasevidencedbythefastpulse,palpitations,anxietyand
redcheeks.ThelongperiodofYindeficiency,ledeventuallytoan
ascendingLiverYang,whichgaverisetotherecentheadaches.
Furthermore,Isuspectedthatbloodstagnationwasdeveloping,relyingon
herchoppypulseandtheredpimplesonhertonguetip.
Thetreatmentplanwastoputanemphasisonresolvingthestagnationinthe
heart,reduceitsfireandsupplementtheYinandblood.Todoso,Iusedthe
abovepointcombination,withtwoadditions:
1.Ximen(P4),onlyontheleftside,inordertoinvigoratetheheart
circulation,breakthestagnationthereandalleviatethepain.
2.Xingjian(LIV2)onbothsides,toreduceLiverYang,dispersetheliver,
andtreattheheadache.
SanyinjiaowastheonlypointthatwasreinforcedinordertotonifytheYin.
Mrs.C.'sconditionimprovedgradually,withsomeregressions,overa
periodofonemonthoftreatments.Whenherheadachessubsided,together
withthechestpain,thepointprescriptionwaschangedasfollows:
Shenmen(H7)andNeiguan(P6)wereleftinordertocontinuethe
treatmentofcalmingtheShenandfurtherfacilitateHeartQi.ToSanyinjiao,
IaddedGuanyuan(CV4)andQihai(CV6),inordertostrengthenher
constitutionandgeneralhealth.Thelastthreepointsalsoformapoint
combination,whichwasdiscussedincombinationnumberoneofthiswork.
Afteronemoremonth,Mrs.C.feltmuchimprovementinallrespectsand
thetreatmentwasthereforeterminated.
Addendum
SixmonthslaterMrs.C.becamepregnant,andinhersecondmonthshehad
recurrenceofheadaches,chestpain,togetherwithmorningsickness.
Shereceivedfivemoretreatmentsinthecourseoftwoweeks,afterwhich
allhersymptomshaddisappearedagain.
Shegavebirthtohersecondchildinduecourse,withoutanycomplications.
15.ZHIGOU(T6),QIMEN(LIV14),YANGLINGQUAN(G34),
TAICHONG(LIV3)
Thispointcombinationisusedtoregulatetheliverandgallbladder
meridians,toremoveobstructionfromtheirpassages,andtoresolve
stagnationofLiverQi.
Therefore,itisoftenusedincasesofflankpain,oppressionanddiscomfort
inthechestanddistensionofthebreasts.
Besidesthisitmayalsotreatsciaticawhichoccursalongtherouteofthe
Gallbladdermeridian,orparalysisofonesideofthebodyassociatedwith
thismeridian.
Pointdiscussion(79)
ZhigouisapointonthehandShaoYangmeridian,whichisincontinuum
withthelegShaoYang,Gallbladdermeridian.
ItsindicationsaremainlyconcernedwiththedomainoftheShaoYang
system.ItspreadsandinvigoratestheQiinthismeridiananddisperses
obstructionswhicharelocatedalongitsroute.
Theaxilla,sideofthechestandtheribcage,areallirrigatedbytheQiofthe
ShaoYangandChuehYinmeridians.Thesemeridiansformthe
internal/externalrelationship,andpointsfromeachofthemalsoaffectthe
other.
ZhigouislocatedatthebeginningoftheShaoYang,whichisliterallythe
smallYang.ThepointsatthebeginningoftheShaoYanghavean
acceleratingeffectonthemovementoftheYangfromtheupperpartsofthe
body,tothelowerparts.Byacceleratingthismovement,wecandisperse
obstructionsalongtheroute,oneofwhichischestorflankpain(80).
Symptomatically,Zhigouisveryrelevantincasesofflankpainanditis
oftenmentionedinancientworksfromChina,thus:"Inpainoftheribsand
flank,needleZhigouwaswrittenintheBIAOYOUFU(Odeofthe
StandardofMystery).Also,intheYULONGGE(SongoftheJade
Dragon),wefind:"Whenthereispainandobstructionoftheflanks,using
Zhigou,willgiveexcellentresults."
Zhigouisalsofrequentlyusedinthetreatmentofconstipation,duetoits
abilitytoremoveobstructionfromtheintestinesaswell.
QimenistheFrontMupointoftheliverchannel.Itislocatedinthecostal
regionandhasalocaleffectonthisarea.Besidesitslocationinthesiteof
thepain,ithasasimilaractiontoZhigou.ItspreadsandinvigoratestheQi.
Furthermore,italsohastheabilitytotransformcongealedbloodandremove
bloodstagnation.Thus,evenincasesoftraumaticinjury,suchasabroken
rib,Qimenisindicated.
Qimen,astheFrontMupointoftheliver,hasadirecteffectonthisorgan.
SincetheliveristheorganmostlyassociatedwithQistagnation,Qimen,as
itsMupoint,hasaneffectoninvigoratingtheQiingeneral.Therefore,even
costalpainthatisduetoemotionalproblems(i.e.depression)orinternal
diseases(i.e.hepatitis),maybetreatedbyQimen.
Withregardtoitseffectontheflanks,wecanfindintheZhenJiuDacheng
(GreatCompendiumofAcupunctureandMoxibustion),writtenbyYang
Jizhouin1601,thefollowingrecommendation:"pain,fullnessand
obstructionoftheflanks,whenQimenisused,greatresultswillbe
achieved".
YanglingchuanconstitutesthecounterpartofZhigouonthesamesegment
ofShaoYang.ItistheHeSeapointoftheGallbladder,andhasastrong
effectonthisorgan.
Asweknow,thegallbladderisanatomicallysituatedunderthecostal
region,andmalfunctioningofthisorganoftengivesrisetoflankpain,
distensionandsorenessofthewholearea.
StimulationofYanglingquanhasacalmingeffectonthegallbladderandit
regulatesitsfunction.Therebyitisbeneficialforflankpain.
Besidesregulatingthefunctionoftheliverandgallbladder,Yanglingquanis
theconfluentpointofthetendonsandligaments.Itsindicationssayinthis
respectthatitsusebenefitstendonsandbones.Thus,incasesoftraumatic
injury,thisisaveryimportantpointtoresolvestagnationinthecostal
region,broughtaboutbyaccident.
Inthe"SongofPointsforMiscellaneousDiseases(ZabingXueweiGe),
writtenin1537,wefind:"Whenthereisflankpain,Yanglingquanmustbe
used".
TaichongconstitutesacontinuuminthispointcombinationwithQimen.
TheyarebothsituatedonthelivermeridianandTaichongistheYuan
Sourcepointoftheliver.
YuanSourcepointsarecloselyconnectedwiththeorgantowhichtheyare
linked.Inthisrespect,Taichonghasthesamequalitiesthatwehave
mentionedunderQimen,onlyitoperatesfromafar.
TaichongisactuallythestrongestpointinthetreatmentofstagnantLiver
Qi.ItismostusefulininternaldiseasescausedbystagnationofQi,butmay
beusedinanyformorcauseofstagnation.
Taichonghaspainrelievingqualities,duetoitsroleasadestagnationpoint.
Itissoremarkablyeffectiveinrelievingpain,thatithasbeenusedfor
generationsintherenownedpointcombinationknownasthe"FourGates".
ThecombinationisHegu(LI4),twopointsabove,andTaichong,twopoints
below.Thiscombinationhasastrongsedativeeffectbyactivatingand
dispersingQiandbloodinthewholebody.
Inthetreatmentofflankpain,Taichongplaysitsrolebyrelievingpain,
dispersingstagnantQi,regulatingtheliverandliverchannelandregulating
theblood.
Inthispointcombination,twoprincipleshavecombinedinordertoformthe
theoreticalbasisforitsexistence.Oneistheprincipleofmutualassistance,
andthesecondIs"onepointabovetwopointsbelow."
Wehavedemonstrated,undereachpointdescription,theinfluencethatit
hasuponthecostalregion.Wehaveseenthateachoneofthepointsis
capabletoaffecttheflanks,chestandtheribs.Together,theyexertamuch
greaterpotencyinresolvinganykindofpaininthisregion,thananyoneof
themalone.
TheShaoYangandChuehYinmeridians,formtheexternal/internal
Yin/Yangrelationship.Theythusinfluenceoneanotherandmayalsobe
treated,onebytheother.
InthiscombinationwehavetwopointsbelongingtotheShaoYang
segment,Zhigouabove,andYanglingquanbelow,andtwopointsbelonging
totheChuehYinsegment,Qimenabove,andTaichongbelow.
Bytheprincipleof"oneabovetwobelow",Zhigou,aswasdescribedabove,
acceleratestheflowofQiinordertounblockthestagnationinthecostal
region.Qimenservesasthelocalupperpoint,thatinvigoratesQiandBlood
inthediseasefocus.TaichongwithYanglingquanconstitutetheweighton
theotherendoftheseesaw,soastoattracttheenergyandfacilitateitsflow.
Itisverysimilartothepreviouslydescribedsinusitispointcombination,
undercombinationnumbertwoofthischapter.Theonlydifferencebeing
thatthelatterisbasedononemeridiansegment,whereastheformer,ontwo
meridiansegments.Theeffect,nevertheless,isthesame.
Theorderofneedlinginthiscombination,isasinothercombinationsbased
onthe"oneabovetwobelow"principle.Zhigouisthestarter,forthe
reasonsmentionedabove.Qimen,YanglingquanandTaichongfollow.The
sequence,thus,goesindescendingorderandfollowstheappropriate
directionofenergy.
Themethodofstimulationisdispersion,withanemphasisonconducting
theQiinthedirectionofthediseasefocus.Itispossibletoadminister
electricalstimulationinthecaseofacutepain,inthesamewayaswehave
discussedinothercases.
Inthecaseoftraumaticinjuryoftheribcage,itispossibletoapplymoxa.
ThisisusuallydonewithamoxastickabovelocalpointssuchasQimenor
Ahshipoints.Itisnotrecommendedtoapplymoxaimmediatelyafterthe
injuryhasoccurred,butafewdayslater.Itisalsonotrecommendedifheat
signsareevident.
Herbalequivalent
Theopeningherb,muchlikeZhigou,waschoseninthisprescriptionmainly
becauseitentersboththeTripleBurnerandthelivermeridians.Thisherbis
RhizomaCyperiRotundl(XiangFu).ItregulatestheflowofQiinthesetwo
meridiansanditresolvesstagnationofLiverQi.
TogetherwithRadixBupleuri(ChaiHu),itisclassicallyusedforpainand
distensioninthechestandflanks.
ChaiHu,togetherwithitsabilitytoreleaseexteriorconditionsassociated
withtheShaoYangpattern,isalsousedtorelaxconstrainedLiverQi.As
such,itsindicationsinclude:chestandflankpain,afeelingofconstrictionin
thechestandothersymptomsnotrelevantinthiscontext.
Anotherherbthatmayassistthefunctionoftheformercouple,is
PericarpiumCitrireticulata(QingPi).Thisherbenterstheliverand
gallbladdermeridians,isusedtoregulatetheirQiandtoalleviatepain.Itis
usedforchest,breast,flankandhypochondriacpainduetoQistagnation,
andalsoforbloodstasistosomeextent.
Thelastherbinthisformulaisusedtoinvigoratethebloodinthedomainof
theShaoYangandChuehYinchannels.Itisamajorherb,andisusedin
manypainsyndromes,includingheadaches.TheherbisRadixLigustici
Wallici(ChuanXiong).
Duetoitsabilitytoinvigoratethebloodandbreakupcongealedblood,it
makesthewholeformulavalideveninthecaseoftraumaticinjuryinthe
chestorflankregions.
Casehistory
Mr.E.age48,wasapsychologistwhohaddecided,amonthpriortohis
visitatmyclinic,tolearnhowtofly.Thus,heenrolledinaskygliding
courseandinhisfirstattempttotakeoff,hebrokethreeribsonhisleftside.
Afteramonthofsufferingseverepainandsleeplessnights,hisXray
examinationdidnotshowanyimprovement.So,whenhecametomefor
treatment,hewasalreadyweakandexhausted,nottomentionhissincere
repentanceforhisheroicaspirations.
Mr.E.wasgivenacourseofsixtreatments,duringtwoweeks,afterwhich
hispainanddistensionhadlefthimcompletely.Aweeklaterheunderwent
anotherXrayexaminationwhichshowed,thistime,completelyhealedribs.
Histreatmentsincludedourpointcombination,withtheadditionofDazhu
(B11),andShenshu(B23).
Thepointcombinationwaschosenbecausethebrokenribswereinthe
domainoftheShaoYangandChuehYinchannels.Thecombination,as
alreadyexplained,hastheabilitytoresolvestagnationandinvigoratetheQi
andbloodintheflanksandcostalregion.
Dazhuwasaddedduetoitstaskastheconfluentpointofthebonesandthe
effectithasonrepairingskeletaldamageandstrengtheningthebone
structure.
Shenshu,astheBackShupointofthekidneys,joinedtheformulainorder
tostrengthenthepatientingeneralandtoreinforcethekidneyswhich,
accordingtoT.C.M.,rulethebones.Thus,byreinforcingthekidneys,the
bonesarealsotonified.
16.ZHIGOU(T6),ZHAOHAI(K6),TIANSHSU(ST25)
Thiscombinationofpointshasaspecialeffectonregulatingthefunctionof
theintestinesandeliminatingconstipation.
Pointdiscussion
Zhigouwasbroadlydescribedandanalyzedinthepreviouscombination,
number15.
There,wealsomentionedthatZhigouisveryeffectiveinthetreatmentof
constipationduetoitsabilitytoremoveobstructionsfromtheintestines.
TheexplanationforthisabilityofZhigouisintwoofZhigou's
characteristics:
1.BeingsituatedonthebeginningofShaoYang,thispointhastheabilityto
invigoratethemovementofYangQithroughoutthebody,inadownward
directionfromabovetotheinferiorpartsofthebody.SincealltheYangQi
travelsdownward,whilealltheYinQistartsfrombelowandtravels
upward,ShaoYangisutilizedtofacilitatetheYangmovement,asmuchas
ShaoYin,bythesameprinciple,themovementofYinQi.
2.AsapointbelongingtotheTripleBurner,thispointhelpsregulatethe
circulationofQiinthethreeJiaos.AlongwithZhigou'sabilitytoremove
obstructions,itmakesapowerfulpointinbothregulatingandcleaningthe
intestines.
ZhaohaiislocatedinthelegShaoYinmeridian.TheShaoYinstartsthe
movementsoftheYinQitowardstheupperpartsofthebody(81)andthis
makesZhaohaioneofthemostimportantpointstotonifytheYin.
Oneofthemostfrequentcausesofconstipationisaccumulationofexcess
heatinthelargeintestine.Itdriesthestools,makingithardanddifficultto
evacuate.
Anotherfrequentcause,isthelackofsufficientfluidinthelargeintestine,
whichcausesdrynessofthebowelandinsufficientlubricationtoallow
smoothpassageofthestools.Thelackoffluid,orYin,maybeeither
becausethereisexcessheatinthelargebowelor,becauseofaXucondition
ofsystemicYinorblooddeficiency.
Zhaohai,asaYintonic,suppliesthelargeintestinewithYinQiandthus
provideslubricationfortheconstipateddryintestines.
Anotherfacetoftheseingeniouslycombinedtwopoints,istheenergetic
outcomeofthesimultaneoususeofbothofthem.
ZhigoustartsanacceleratedmovementofYangQidownward.YangQi
makesperistalsisfasterandbetter,asYangQimanifestsitselfinmovement
andfunction.Zhaohai,foritsrole,startsanacceleratedmovementofYinQi
upward.YinQibringscoolnessandfluid,asthosearethemanifestationsof
Yin.Astheresultofthisbipolarmovement,theintestinesaremovedto
expeltheircontents,andatthesametimeareirrigatedtoallowitsfree
passage.Thus,theuseofthesepointstogethercreatesanenergeticmotion,
harmoniousandcomplementary,thathasaregulatingeffectoverthe
functionofthelargeintestine.
TianshuistheFrontMupointofthelargeintestine.Inthiswayitis
connecteddirectlywiththeorganitselfandisthereforeassociatedwithall
theproblemsofthisorgan.
Initsindicationswecanfindthefollowing:
Tianshuadjuststhefunctionoftheintestines.
TianshuregulatestheQioftheintestines.
ItrelievesstagnationofQi,bloodandfoodintheintestines.
Itregulatesmenstruation.
Becauseofthesequalities,Tianshuisusedinbothchronicandacute
constipation.
AsdomostoftheFrontMupoints,Tianshualsoservesasalocalpoint,
closetothefocusofdisease.Assuch,ithasadirectandimmediateeffect
uponthelargeintestine,aneffectthatmaybetakenadvantageof,evenby
handmanipulationoftheTuiNamassage.UsingTianshuasapressurepoint
movestheintestines,relievesdistensionandhelpsachieveanevacuation,
especially,inacute,painfulconstipation.
ThecombinationofZhigouwithZhaohaiwasmentionedasaneffective
treatmentforconstipation,asfarbackastheyear1537.
ItwasmentionedthenintheYuLongGe(SongoftheJadeDragon),found
intheCollectionofGatheringsFromOutstandingAcupuncturists(Zhenjiu
Juying)(82).
Themethodologybywhichthesetwopointswerecombinedhasalready
beenexplainedpreviously.TheintroductionofTianshutothecouple,
centerstheireffectonthelargeintestineandaddsthestronginfluenceof
Tianshuitselfupontheintestine.
ZhigouandZhaohaiareneedledoneaftertheothertoperformtheir
energeticinfluence,aswasdescribedpreviously.Tianshuisthenneedled
andmanipulated.Zhigouisusuallymanipulatedinadispersionfashion.
ZhaohaihasabettereffectifitsQiismadetotravelupwardalongthe
medialaspectoftheshin,towardsSanyinjiao.Tianshuisalsomanipulated
indispersionusually.
WhenthecauseoftheconstipationisadeficiencyofYinand/orbloodinthe
largeintestine,usuallyduetooldage,ZhaohaiandTianshumaybetonified.
Otherwise,theconditionofaconstipationisShi(obstruction,heat,
congestion,stagnation)ingeneralandthepointsshouldbesedated.
Herbalequivalent
SemenTrichosanthis(GuaLouRen),SemenCannabis(HuoMaRen),
SemenPersica(TaoRen),SemenBiotaorientalls(BaiZiRen)andSemen
SesamiIndici(HeiZhiMa),alltreatconstipation.
GuaLouRentreatsconstipationduetoheatinthelungsthatpenetratesinto
thelargeintestine,usuallyafterfever.HuoMaRentreatsconstipationdue
todeficientQi,especiallyintheelderly.DeficientQicausesstagnationand
drynessintheintestines.TaoRenisanherbusedtoinvigoratethebloodand
treatconstipationduetocongealedbloodandheatstagnation.BaiZiRen
tonifiesbloodandYinintheintestines,asitisanourishingherb,andis
thereforeusedinthetreatmentoftheelderlyanddebilitated.HeiZhiMa,
maybeusedlikepointZhaohai.IttonifiestheYinofthekidneyandliver
andlubricatestheintestines.
Thisformulaactuallyencompassesallthepossiblecausesforconstipation,
andeachherbcontributesitspersonalquality,plusageneralizedeffect
commontoallofthem,namely,tolubricatetheintestinesandsmooththeir
action.
Thisprescriptionmustbemodifiedinanyparticularcase,accordingtothe
diagnosis.Thus,ifBloodXudominatesthepicture,thenherbssuchas
RadixAngelicaSinensis(DangGui)mustbeaddedandsoon.
Casehistory
Mrs.K,age45,sufferedformanyyearsfromconstipation.Sometimesshe
didnothaveabowelmovementforawholeweek.Inadditionshe
complainedofhalitosisandmuchgasintheabdomen.Amonthbeforeour
firstappointment,shestartedexperiencingweaknessandsometimeseven
palpitations.Shewasslightlyobeseandhadpuffybagsbelowhereyes.
Observationalsorevealedabrightredtongue,purplishinthecenter,with
manyredpricklesaroundthetipandsides.Itwaspeeledandslightly
scallopedinthesides.Thepulsewasregularandsoft,withthekidney
positiondeepandweak.
ThesesymptomswereevidentlyaYangwithinYincondition,oraXu
conditiongivingrisetoShisymptoms.
Thebasicpattern,asevidencedbythesoftpulse,puffyeyebags,scalloped
tongueandobesity,pointedoutaspleenQiXu.SpleenQiXuaffectsthe
transformationtransportation(YunHua)functionofthespleen,givingrise
toobesityandlazybowelmovementshenceconstipation.
LongtermconstipationcausesstagnantQiinthelargeintestine,whichin
turndevelopsintoheat.Heatcausesdrynessoftheintestines,hardstools,
andmayalsocausebloodstasis.Mrs.K.showedashinyredtonguewitha
purplishcenterandredprickles.Allthesesignspointedtoaheatstagnation,
probablywithcongealedbloodinsidetoo.
ThetreatmentgiventoMrs.K.includedourpointcombinationtotreatthe
basicstagnationandtolubricatetheintestines.Inaddition,otherpointswere
combined,inordertoformacomprehensiveformula.
Dachangshu(B25)TheBackShupointofthelargeintestine,inorderto
activatethebowelanddispersetheheattherefrom.DachangshuandTianshu
together,makeanotherpointcombination,basedontheShuMuprinciple,
thathasastrongdrainingeffectonthebowel.
Taichong(LIV3)andSanyinjiao(SP6)werealsoaddedasanotherpoint
combination.ThesepointsregulatetheQi,dispersestagnantQiandblood
andtonifyboththeliverandspleen.
Zusanli(ST36)isperhapsthemostimportantpointtotonifyspleenQiand
strengthenitstransportationfunction.Inaddition,ithasastronginfluence
onconstipation,ittonifiesthebloodandstrengthensitscirculationinthe
gastrointestinaltract.
Mrs.K.hasbeentreatedseveraltimesduringthepastthreeyears.She
usuallyreceivedafewtreatmentsbasedontheaboveprescription.Her
constipationimprovedforayearorso,untilthenexttime.
Itisveryimportanttoeducatethepatientregardingtheproperlifehabitsfor
dealingwithconstipation.Fiberrichfoodsareessential,alongwithYin
supplementingfoods,suchas:wholewheat,vegetables,fruit,oils,dried
fruit,almonds,andsoon.Physicalexerciseisessentialforpeoplewithweak
abdominalmusclesand,noless,regulareatinghabits.
17.YINBAI(SP1),QIHAI(CV6),XUEHAI(SP10),SANYINJIAO
(SP6)
Thiscombinationhasastrongeffectontheblood.Mostofthepointshere
havearegulatingeffectontheblood,andasawhole,itisusedforastringent
purposes.Itarrestsbleedingfromanyofthebodynineorifices,but
particularlyuterinebleeding,orbleedingofthedigestivetract.
Pointdiscussion
Yinbaiisfrequentlyusedtotonifythespleen.Oneofthespleen'smain
functionsistocontaintheblood,orkeepthebloodinthebloodvessels.This
functionofthespleencomesincontinuumwithitsroleincreationofblood.
Bycommandingthedigestivefunctionofthestomach,thespleenextracts
thepureessenceofdigestedfoodanddrinkandtransformsitintoQiand
blood(83).
Thereafter,asthemasteroftransportationtoo(i.e.,theYunHuaroleofthe
spleen,translatedastransformationandtransportation),thespleenis
responsibleforkeepingthebloodflowingthroughitsproperroutesthe
bloodvessels.
Becauseofthesefunctions,thespleenmeridian,orpointsthattonifythe
spleensituatedonthismeridian,areusedindiseasesassociatedwithblood
disorders.
Yinbaiisthemostimportantpointonthespleenchannelregardingits
functionofcontainingtheblood.ThisfunctionofYinbalisprobablydueto
itsroleasthe"Well"pointofthespleenmeridian.Wellpointsareused
primarilyinacuteordangerousconditions,astheyconnecttheYinandthe
Yang,exteriorinteriorchannels.Thustheyarecommonlyusedinacute
fever,deliriumandexcessiveheatconditions,orresuscitationfromfainting
andcoma.Lossofbloodisalsoconsideredadangerouscondition.Lossof
bloodisalossofQitoo.Thus,theWellpointofthechannelmostassociated
with"keepingthebloodinthevessels"function,isthemostappropriateto
dealwithsuchproblems.
Asstatedbefore,theotherfunctionofYinbai,istostrengthenthespleen.By
strengtheningthespleeningeneral,allthespleen'sactivitiesare
strengthened,includingdigestion,bloodandQiproduction,containingthe
blood,holdingtheorgansandtissuesintheirproperposition,nourishingthe
muscles,transportingwasteoutsidethebodyandadditionalfunctionsas
well.
Qihaiwasalreadydiscussedundercombinationnumberoneinthischapter.
Astherulerofthe"seaofenergy"inthelowerDantien,thispointhasa
strongimpactupontheamplitudeofQiinthebody.
Sinceabnormalbleedingimplies,firstofall,aweakQiwhichisincapable
of"rulingtheblood"properly,thispointiscalledupontodrawoutextraQi
fromthereserveswhicharelocatedatthe"SeaofQi.
ThespecialrelationshipbetweenQiandbloodisoneofthecornerstonesof
Chinesemedicalthinking.Qiisconsideredthecommanderofblood,and
BloodisregardedasthemotherofQi(84).ThismeansthatQiregulatesthe
blood,movesitandkeepsitinplace,whilethebloodnourishestheorgans
thatproduceQi.
TheSpleen,ofallorgans,ismostlyinvolvedinthisrelationship.Itcreates
blood,aswehavealreadyseen,andifbloodisabundantenoughtofeedthe
spleenitself,thespleeniscapableofproducingQi.
IfQifails,however,itmaybestrengthenedandsuppliedbytonifyingthe
spleenitselfandbydrawingQifromitsreserves,namelyQihai.
Xuehaiwasalsodiscussedpreviouslyinthischapter,undercombinationno.
5.
Wewouldliketostress,however,thatthistooisapointonthespleen
channel,mostlyassociatedwithblood.Xuehaidrainsheatfromtheblood
andcoolsit.Sincemanyoftheabnormalbleedingsyndromesoccurdueto
thisphenomenonofheatintheblood,causingrecklessmovementofblood
andbleeding(85),Xuehaiisperfectlyappropriatefortreatingthiskindof
problem.
Inaddition,XuehairegulatesthemovementofYingQi(nutritiveenergy)
andbloodandisthusacounterpartforYinbaiinthefunctionofkeepingthe
bloodenroute.
SanyinjiaowasAlsothoroughlydiscussedinthischapter,under
combinationsnumber1and15.Inshort,SanyinjiaotonifiesYinandblood
andthethreeorgansthatproduceandcontrolblood,exceptfortheheart.
Bytonifyingthebloodanditsproduction,andbytonifyingthespleen,this
pointisasubstantialadditiontothiscombination,whoseaimistostop
abnormalbleeding.
Thiscombination,aswehaveshown,isconstructedofthreepointsthathave
astrongtonifyingeffectoverthespleenitself.Theyhavebeenchosen,from
alltheotherpointsonthespleenchannel,becauseofeachone'spersonal
characteristicsasabloodregulator.
Thus,theirmutualeffectonthespleensystemstrengthensthisorgan's
functionsof"buildingtheblood",and"holdingtheblood",whilethepoints
themselvesexerttheirsymptomaticinfluenceforthesamepurpose.
Thefourthpoint,Qihai,actsdirectlyontheQi,reinforcingitandenablingit
toperformitsdutyasthe"commanderofblood",meaning:toprevent
recklessmovementandstopbleeding.
Itisimportanttonoteherethatthecombinationiseffectiveprimarilyfor
digestiveoruterinehemorrhage.Itislesseffectiveforepistaxis,coughing
upofblood,bloodintheurine,orbleedinghemorrhoids.
Thereasonisthattheinvolvementofthespleenchannelisprimarilyin
diseasesassociatedwithuterinefunctionanddigestivedisturbances.
Itdoesnotmean,however,thatthiscombinationcannotbeusedinother
hemorrhagicproblems,becauseaswasexplained,thespleendoeshavean
effectonalloccurrencesofabnormalbleeding.Still,thecombinationshould
thenbemodifiedtodealwiththeseproblemsspecifically.
Inthiscombinationwestartfrombelowandproceedinanupwarddirection.
Thereasonforthisistwofold:
1.InordertotonifytheblooditisnecessarytoactontheYin,sincebloodis
mostlyYin.Yinstartsflowingfrombelow(fromearth)andtravelsupward,
whileYangdoestheopposite.Thus,westartwithYinbai,goonto
Sanyinjiao,andadvancetoXuehai.
2.Aswehaveshown,thiscombinationhasalsotheaimoftonifyingthe
spleen.Oneoftherulesoftonificationistoneedlethepointsinthedirection
oftheenergystream.SincethespleenmeridianisYinanditflowsfrom
Yinbalupward,theneedlingorderfollowssuit.
Qihaiisanadditionalpointinthiscombinationaswehavedemonstrated
earlier.Thereforeitisneedledlast,anditcrownsthecombination.The
spleenpointsactdirectlyontheblood,whileQihaibalancestheformulaby
actingontheQi,thecommanderofblood.
ClinicalexperiencehasshownthatstimulationofYinbaiwithtinymoxa
cones,bearsthebestresults.Itisatinypointattheangleofthethumbnail,
so,tinymoxacones,thesizeofricegrains,areplaceddirectlyonitand
ignited.Usually,threeconessufficeforeverytreatment.
TherestofthepointsarepuncturedintonificationincaseofaXucondition
andinevenmanipulation,incasesofheatinthebloodthatcausesthe
bleeding.
Inperforminganevenmanipulation,itisimportanttodistinguishthe
relativeimportanceofXuandShiwithinacomplicatedsyndrome.Inour
case,XumeansdeficientspleenQianddeficientblood,whileShiisusually
thepresenceofheatinthebloodandYingQi.
WhenXusymptomsarepredominantoneshouldreinforcewithdoubled
effortandreducewithasingleeffort.Oneshouldalsoreinforcefirstand
thenreduce.
Traditionally,theprocedureisappliedasfollows:Theneedleisthrustnine
times,emphasizingonthrustingforcefullywhileliftingtheneedlegently.
Afterninetimes,thesamepointisreducedbyliftingtheneedleforcefully
sixtimesandthrustingitgently.
WhenShisymptomsaremorepronounced,theprocedureisreversed(86).
Qihaiisstimulatedonlyintonification.WhenYangQiisindeficiency,itis
recommendedtoapplymoxibustion,eitherbywarmneedlingorindirect
moxibustionuponalayerofgingeroraconite(FuZi).
Moxibustionis,ofcourse,permissiblealsoonSanyinjiaoandXuehai,ifthe
patient'sconditionisaCold/deficiencypattern.Insuchcases,thewarming
needletechniqueissuperior,asitwarmsthechannel,dispersescoldand
supportstheQi.
Herbalequivalent
TerraFlavaUsta(FuLongGan),whichisactuallythecenteroftheashes
fromthebottomofacookingstove,whereRadixLithospermi(ZiCao)has
beenburnt,isusedtotonifythespleenYangandstopbleeding.Whenadded
toCrinisCarbonisatus(XueYuTan),whichisactuallycharredhumanhair,
thiscombinationiseffectiveintreatingabnormaluterinebleeding.
Bothsubstancestreatbleedingduetodeficiency.
HerbaAgrimoniaPilosa(XianHeCao)treatsabnormalbleeding,nomatter
ofwhichetiology.Itmaybeaddedtootherherbsaccordingtoaspecific
etiology.
RadixSanguisorba(DiYu)coolsthebloodandstopsbleeding,both
digestiveanduterine.Itmaybe,tosomeextent,comparedtopointXuehai,
especiallybecause,likeXuehai,italsotreatsskindisorders.
Thelastherb,whichalsohasanastringentinfluenceonbleeding,ischosen,
likepointQihai,totonifytheQi,raisetheYangQiofthespleenandtreat
theproblemfromitscore.ThisherbisRadixAstragali(HuangQi).
Actually,itsqualitiesmaybecomparedtotheactionsofseveralpoints
together.Thesequalitiesare:
1.Ittonifiesthespleeningeneralandtreatssymptomsofanorexia,
weakness,chronicdiarrhea,etc.Thisqualitymaybeparalleledtothe
influencethatpointSanyinjiaohasuponthespleen.
2.ItraisestheYangQiofthespleenandthismaybecomparedtothe
mutualactionofpointsYinbaiandQihai.
3.IttonifiesbothQiandbloodandinthisitissimilartopointsXuehaiand
Qihai.
Casehistory
Mrs.H.,age30,hastriedsinceshewas27yearsoldtobecomepregnant.At
theageof19shehadgonethroughanartificialabortionandaccordingto
herdoctors,thiswasthereasonwhyshecouldnotretainherpregnancies.
Sincetheageof27,shehashadfourmiscarriages.48hoursbeforehervisit
tomyclinicshehadhadanothermiscarriage,followedbyheavybleeding,
painandnausea.
Iobservedatall,slimwoman,verypale,andverymuchinpain.Herlips
werepaleanddullandherfingernailswerewhite.Thepulsewasmoderate,
wiryandweak,whilethetonguewasbrightred.
Mrs.H.alsotoldmethatshehadaveryweakdigestionandthatshefelt
weakmostofthetime.Shesufferedfromheartburn,swollenandpainful
gums,anddrymouth.Herperiodswerealwaysaccompaniedbyexcessive
bleedingandcontainedbloodclots.
ItwasobviousthatMrs.H.sufferedabasicspleenstomachdisharmony,
causedbyspleenQiXu.Thespleendeficiencycauseddeficientbloodand
animpairmentofthespleenfunctionofretainingtheblood,orthefetus.
Thefirstgoalofthetreatmentwastostopthemassivebleedingandthepain
whichfollowedthemiscarriage.Thesecondphasewasplannedto
strengthenthespleen,tonifyYinandbloodandreharmonizestomachand
spleenfunctioning.
Thus,inthefirsttreatmentIusedthepointcombinationwithanadditionof
Hegu(LI4)andTaichong(LIV3).Thiscombinationwassupposedto"open
thefourgates",whichmeanstoregulateQiandbloodinthewholebodyand
tostopthepain.
IntheseconddayMrs.H.hadmuchlesspainandlessbleeding.Thesecond
treatmentwasconstructedofthesamepointcombination,excludingHegu
andTaichong.InsteadZhiyin(B67)andZhongJi(CV3)wereadded.These
pointswereaddedinordertocausetheuterustoexpeltheremainingtissue
ofthedeadfetus.
Thenextdaytherewasalmostnobleedingatall,butshefeltcontractionsin
herlowerabdomen.Thus,thesameformulawasappliedtoheronceagain
andinthenextdaysheexpelledsomeverybigbloodclots.
Twodayslater,whenshecametomeagain,therewasnopainatallandno
bleeding.Herpulsehadchangeddramaticallyandthewiryqualityremained
onlyatthestomachposition.
18.TIANSHU(ST25),SHANGJUXU(ST37),SHANGQIU(SP5),
YINLINGQUAN(SP9)
Thiscombinationisaclassicalpointcombinationtocleardampandheat
fromtheintestines.Itisthereforeusedtotreatproblemssuchaschronic
diarrhea,dysentery,enteritisandcolitis.
Pointdiscussion
Tianshuwasdiscussedincombinationnumber16,dealingwith
constipation.AstheFrontMupointofthelargeintestine,thispointactually
dealswithalltheafflictionsoftheintestines.
Itsindicationsimplythatitregulatesandfacilitatesthefunctioningofthe
intestinesandeliminatesstagnation.Thisindeedcoversallthepossible
diseasesoftheintestines.
Theoretically,theLargeIntestineistheorganbywhichthespleenappliesits
transportationfunction.Thelargeintestinetransportsandevacuatesthe
residuesofthedigestedfoodandfluids(87).
WhenthespleenQiisweak,thetransportationabilityofthelargeintestine
isimpaired,givingrisetoconstipationordiarrhea.Anotherphenomenon
whichoftenexistswhenspleenQiisweak,istheformationofdampness
andphlegm.Whenthisdampness"pours"intotheintestines,thereisadamp
stagnation,givingrisetochronicdiarrhea,colitis,etc.
AsaFuorganwhichisinclosecontactwithexternalinfluence,thelarge
intestinemayoccasionallybeinvolvedwithintoxicationbroughtaboutby
contaminatedfoodordrink.Thisintoxicationhasusuallythecharacteristics
ofdampheatorFirePoisonanditcausesdiseasessuchasseverecolitis,
ulcerativecolitis,dysenteryandthelike.
Tianshu,astheFrontMupointofthelargeintestine,iscapableof
eliminatingstagnationintheorganandthatincludesDampHeat,Damp
Cold,bloodstasis,etc.
ShangjuxuisthelowerHeSeapointofthesameorgan,thelargeintestine.
WehavedescribedalreadyhowtheclassicsrefertoHeSeapoints,in
combinationnumber12,withreferencetopointZusanli,whichisthelower
HeSeapointofthestomach.AlsoShagjuxuisconnecteddirectlywithits
organandaffectsitverysimilarlytoTianshu.ItregulatestheOiofthelarge
intestineandstomachandeliminatespain.Iteliminatesaccumulationsand
stagnation,butmainlyinvolvingdampstagnation,characterizedbyvarious
typesofdiarrhea.Itclearsandcoolsdampnessandheat,treatingDampHeat
conditionssuchascolitis,diarrheawithbloodandpusandthelike.
Itisimportanttonoteinthiscontext,thatShangjuxuisoneofagroupof
threepoints,situatedalongthemuscletibialisanteriorthathavean
influenceoverthewholegastrointestinaltract.Zusanli(ST36),thelower
HeSeapointofthestomach,Shangjuxu(ST37),thelowerHeSeapointof
thelargeintestineandXiajuxu(ST39),thelowerHeSeapointofthesmall
intestine.
Thesepoints,whenusedtogether,haveastrongdrainingeffectonthegastro
intestinaltractandtheyareusuallyusedinthisformwhenastrong
purgationisneeded,inordertocleanandclearthedigestivetractoffood
intoxication.
Shangqiuhasasedativeeffectonexcessiveconditionsofthespleen,
concerningthedigestivesystem.
Itisthemetal(FiveElements)pointofthespleenandassuchitactsasthe
sonofearthelement,thespleen.Sonpointsareusedmainlyforsedation
purposes,whichisinaccordwiththeclassics:"Ifameridianisempty,
tonifyitsmother.Ifitisfull,sedateitschild"(ZhenjiuYixue).
Themostcommonexcessiveconditionofthespleenisabundantdampness.
Thus,Shangqiuisutilizedtosedatethespleenanddispersethedamp
condition.Initsclassicalindications,therefore,wecanfindthatitisusedto
transformdampstagnationandtherebytostrengthenthestomachand
spleen.Inthelistofdiseasesthatthispointiscapableoftreating,wemay
findthefollowing:gastritis,enteritis,indigestion,edema,diarrhea,intestinal
noisesandmore.
Yinlingquaniscloselyassociatedwiththeurinaryanddigestivesystems,in
allafflictionsbroughtaboutbyexcessivedampness.Itsmainindicationisto
transformdampstagnation,verymuchliketheformerpointShangqiu,only
itisequallybeneficialforthedigestiveandurinarysystems.Thus,inthe
digestivesystemitmaytreatdiarrhea,whetheracuteorchronic,distension
oftheabdomenduetoretentionoffluids,ascites,enteritis,dysenteryand
more.Thetheoreticalbackgroundforthispoint'sindications,is,alsohere,
relatedtotheFiveElementsprinciples.
YinlingquanistheWaterpointofthespleenmeridian.Becausedampnessis
anenergeticphenomenonrelatedtotheelementwaterandthespleenisthe
organmostlyassociatedwithdampconditions,thereforethewaterpointof
thespleenissedated.Dispersionofthispointisconsideredtoabate
dampness,improvewatermetabolismandbalancethespleen.
Thispointcombinationisactuallytwopointcombinationscombined
together,inordertohaveamorecomprehensiveeffectonaspecific
problem.
TianshuandShangjuxuhaveadirecteffectoverthelargeintestine,asboth
ofthemarerelateddirectlytothisorgan.Infact,inmanysources,bothof
thepointsappearasacombinationbyitselfforthetreatmentofenteritis(88)
ordysentery.
ShangqiuandYinlingquanrepresent,inthisformula,afunctionwhichis
relatedtothespleen,andthisistoeliminatedampconditions.The
connectionofthesetwopairstogether,havecenteredtheeffectof
eliminatingdampinthelargeintestine.
Ofcourse,asisinthecaseofothereffectivepointcombinations,Shangqiu
andYinlingquanaresymptomaticallyhelpfulinlargeintestineafflictions,as
isevidencedbytheirlistedfunctions,asmuchasbothTianshuand
Shangjuxuareeffectiveinthetreatmentofexcessivedampconditions.This
isalsoevidencedbytheirlistoffunctions.
Becausethiscombinationdealswithproblemsofthelargeintestine,Tianshu
andShangjuxuarefirsttobeneedled.ShangqiuandYinlingquanare
secondaryinimportanceandtheyarethereforeneedledsecondly.
Inmostofthecasesallthefourpointsareneedledinreducingtechniques,in
ordertodispersetheexcessivedampnessandmostoftheheat.Mostoften,
however,theShiconditionoftheenteritisordiarrhea,iscomplicatedwitha
basicXucondition,usuallyofthespleen,andinsuchcasescaremustbe
takennottooversedatethepatient,asitmightaggravatethecondition.
SometimesthebasicconditionisaShicondition,suchaswithfood
intoxication(Shazheng),andifprolongedenoughthetrueQiofthepatient
becomesdamaged,resultinginaXucondition.Insuchcases,the
manipulationofthepointsmustbeperformedwiththeutmostcareand
consideration,usingothertonifyingpointsasmainpointsandthis
combinationbecomessecondary.
Whenthereisacolddysentery,ordiarrheaoftheXutype,andthereareno
heatsigns,moxibustionisrecommendedonTianshuandYinlingquan.This
maybedoneasawarmingneedletechnique,or,inseverecases,alsoby
directmoxibustion.Insuchcases,moxibustiontherapyisimperativeandthe
resultsareastonishinglydecisive.
Inthecaseofbleedingalongwiththediarrhea,asinulcerativecolitis,
dysentery,etc.,otherpointsmustbeintroducedintotheformula.Yinbai(SP
1)(pleaserefertothepreviouscombination,number17),orPaihui(GV20)
(89)andKeshu(B17)arethepointsofchoice.
Herbalequivalent
AveryfamiliarprescriptionforDampHeatdysenterylikedisorders,isthe
following:
1.RadixScutellariaBaicalensis(HuangQin)
2.RhyzomaCoptidis(HuangLian)
3.RadixPeoniaLactiflora(BaiShao)
HuangQindrainsDampHeatandisconsideredamajorherbforDampHeat
inthestomachorintestines.ThisDampHeat,asweknow,maymanifestas
diarrheawithaburningsensationintheanusor,dysenterylikedisorders
withpusandblood.
HuangLianhasverysimilarqualities,especiallyinregardtothedigestive
systemanditisusedforthesameproblems.Itsadvantage,however,over
HuangQin,isthatitiscapableofarrestingbleedingduetoheat.
BaiShaoisusuallyusedtonourishtheblood,butitisalsocapableof
adjustingthefunctionsoftheliverandspleenandtoalleviateabdominal
painassociatedwithdysenterylikedisorders.
ThesethreeherbsimitatethefunctionsofpointsTianshuandShanjuxu,
which,aswehaveseen,regulatetheQiofthelargeintestine,stoppain,
drainDampHeat,coolandstopbleeding.
Nevertheless,inordertoprovideacomprehensiveherbalequivalenttothe
pointcombination,twootherherbsareadded:
RadixSaussariaseuVladimiria(MuXiang)
SclerotiumPoriaCocus(FuLing)
MuXiangisaherbthatregulatestheQi,andisusedinQistagnations
involvingpain.Itisoftenapartnerinaformulathattreatsintestinal
problemssuchaswehavediscussedhere,asmostoftheminvolvepain.Its
indicationssaythatitadjustsandregulatesstagnantQiintheintestinesand
isusedfordiarrheaanddysenterylikedisorders,orforabdominalpainand
tenesmus.Thisherbissaidtoenterthespleenmeridianandtostrengthen
thespleen.Theotherherb,FuLing,alsotonifiesthespleen,andisthemost
importantsubstancefordrainingdampconditions.Muchlikepoint
Yinlingquan,itisusefulbothforexcessiveurinaryanddigestiveconditions.
Casehistory
Pleaserefertothecasehistorydescribedinmyarticle:TheAstringent
QualityofPointPaihuiinmyhomepage:
http://www.acumedico.com/colitis.htm
ThearticlewasoriginallypublishedinSept.1989intheJournalofChinese
MedicineinEngland.
EventhoughpointShangqiuismissingfromthepointcombinationinthis
article,Idecidedtobringthiscasehistoryasitis,forthefollowingreasons:
Thecasehistoryisveryrelevanttotheexamplesofthedisharmonyfor
whichthispointcombinationisused.
PointShangqiuhasbeensubstitutedintheinitiativeformulaofthecase
historybySanyinjiao(SP6)becauseofthebloodandYindeficiencypattern
exhibitedbythepatient.Nevertheless,Sanyinjiaoisalsocapableof
performingthefunctionsShangqiusuchastransformingdampstagnationin
theintestinesandstrengtheningthespleen.Itsadvantage,however,liesin
itspowerfulinfluenceoverthespleen,aninfluencewhichmakesitabetter
associateforYinlingquaninmostcases.
Thiscasehistoryincludessomeothercommonpointcombinationsas
well,alsorelevanttothetreatmentofDampHeatdysenterylikestagnations.
Theyarementionedanddiscussedbrieflythroughoutthearticle.
Thiscasehistoryhasbeenwrittenbymeasanarticleforthemagazine,
anditismorecomprehensiveanddetailedthananyofthecasehistories
introducedsofarinthiswork.Itencompassesmanyfacetsofbothdiagnosis
andtreatmentinT.C.M.,aswellasaninterestingtreatmentprocess.Itwas
thereforeconsideredfittingasthelastaccordinthiswork.
BIBLIOGRAPHYANDNOTES
Abbreviationsandbibliography
J.C.M.TheJournalofChineseMedicine
N.S.T.NanjingSeminarTranscriptofSpring1984,transcribedbyPeter
Deadman.
W.N.W.TheWebThatHasNoWeaver,byDr.TedKaptchuk,publishedby
CongdonandWeed,N.Y.
A.C.T.AcupunctureaComprehensiveTextbyEastlandPress,Seattle.
A.C.H.C.AcupunctureCaseHistoriesfromChinabyEastlandPress,
Seattle.
N.A.C.A.TheNorthAmericanCollegeofAcupuncturebecamelicensedin
1976inSalem,Oregon,bytheStateofOregonDepartmentofEducation
andtheBoardofMedicalExaminers.
T.D.A.TreatmentofDiseasewithAcupuncturebyDr.JamesTinYaoSo,
publishedby:ParadigmPublications,Brookline,Mass.
P.D.PulseDiagnosisbyLiShiZhen,basedontheBinHuMaiXue,
ParadigmPublications.
(1)TheJournalofChineseMedicine(J.C.M.)No.9p.10.
(2)PleaserefertochapterB,forPointsClusters.
(3)NanjingSeminarTranscript(N.S.T.)p.12,J.C.M.No.29,P.67.
(4)J.C.M.,No.29,pp.67,W.N.W.p.65(TheKidneysrulethegraspingof
Qi).
(5)TheWebThatHasNoWeaver(W.N.W.)byDr.Kaptchukp.55
(6)J.C.M.No.29p.67.
(7)W.N.W.chapter3p.65.
(8)AcupunctureaComprehensiveText(A.C.T.)bytheShanghaiCollegeof
T.C.M.,P.558.
(9)AcupunctureCaseHistoriesfromChina(A.C.H.C.)p.67.
(10)AcupunctureCaseHistoriesfromChina(A.C.H.C.)p.67.
(11)J.C.MNo.29p.37
(12)J.C.M.No.29p.37
(13)J.C.M.No.19p.18
(14)LucienM.Deshepperlessonstranscriptfrom1982.
(15)LucienM.Deshepperlessonstranscriptfrom1982
(16)A.C.T.p.152
(17)Dr.WuWeiPing,Taipei1984,personalcommunications.
(18)A.C.T.p.241.
(19)A.C.T.p.144
(20)A.C.T.p.306
(21)W.N.W.p.40,43
(22)LingShu(SpiritualAxis)chapter71.
(23)W.N.W.p.715(YinandYang)
(24)W.N.W.p.178184(The8principles)
(25)J.C.M.No.12p.5
(26)J.C.M.No.27p.1416
(27)A.C.T.p.233,J.C.M.No.32p.24.
(28)NorthAmericanCollegeofAcupuncture,(N.A.C.A.)coursesbyProf.
LeungKokYuen.
(29)J.C.M.No.13p.12TheclinicalapplicationofpointSanyinjiao.
(30)J.C.M.No.19p.14
(31)N.A.C.A.coursesmaterial.
(32)W.N.W.p.142.
(33)J.C.M.No.24p.5.
(35)J.C.M.No.9p.14,W.N.W.p.343357.
(36)Thetreatmentof100commondiseasesbyacupuncture,(Medicineand
HealthPublishingCo.).
(37)Thetreatmentof100commondiseasesbyacupuncture,(Medicineand
HealthPublishingCo.).
(38)A.C.H.C.p.75
(39)HuangTiNeiJing,SuWen,chapter46
(40)A.C.H.C.p.59,25.
(41)A.C.H.C.p.56
(42)A.C.H.C.p.44
(43)LucienM.Deshepperlessonstranscriptof1982.
(44)A.C.H.C.p.12.
(45)J.C.M.No.24p.5.
(46)A.C.H.C.p.181,A.C.T.p.315.
(47)ZhuDanXi12801358.
(48)A.C.H.C.p.234.
(49)Dr.FelixMann,inhisbooksforexample.
(50)A.C.T.p.441.
(51)J.C.M.No.7p.6.
(52)J.C.M.No.29p.9,15.
(53)J.C.M.No.22p.15.
(54)J.C.M.No.29p.16.
(55)A.C.T.p.177.
(57)N.C.T.p.1.
(58)J.C.M.No.23p.2930.
(60)N.A.C.A.coursesmaterial,Dr.WuWeiPing,Taipei1984,personal
communications.
(61)A.C.T.p.280.
(62)A.C.H.C.p.181,A.C.T.p.315.
(63)Dr.WuWeiPingpersonalcommunications.
(64)J.C.M.No.7p.6.
(65)A.C.T.p.526.
(66)TreatmentofDiseasewithAcupuncture(T.D.A.)byDr.JamesTinYao
So.,p.38.
(67)J.C.M.No.2p.2.
(68)J.C.M.No.22p.16.
(69)T.D.A.p.69.
(70)J.C.M.No.2p.8.
(71)A.C.T.p.216.
(72)J.C.M.No.31p.24.
(73)PulseDiagnosis(P.D.)byLiShiZhen(ParadigmPublications)p.32.
(74)W.N.W.p.54.
(75)InfraRedLaserLS12030devisedbyJossnerElectronicsGMBH,
Muenchen.
(76)J.C.M.No.7p.78.
(77)J.C.M.No.27pp.1316.
(78)N.S.T.p.34.
(79)Mostofthematerialandreferencesforthiscombinationwastaken
fromtheJ.C.M.No.30pp.2021.
(80)LucienM.DesheppermovementsofQi.
(81)LucienM.DesheppermovementsofQi.
(82)A.C.Tp.236
(83)W.N.Wp.57
(84)NeiJingSuWenchapter46,section13.123.
(85)W.N.Wp.123
(86)N.S.Tp.7879
(87)W.N.Wp.67
(88)A.C.Tp.183
(89)J.C.M.No.31p.23
(90)TheMerckManual14theditionp.783786.
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