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Acupuncture and Moxibustion—A Clinical Desk Reference

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Acupuncture and Moxibustion ~A Clinical Desk Reference~

Cheng, Xiaoming Licensed Acupuncturist

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Acupuncture and Moxibustion—A Clinical Desk Reference

No part of this publication may be reproduced, stored in a retrieval system, or transmitted in any form or by any means, electronic, mechanical, photocopying, recording, or otherwise, without prior permission of the author. ISBN: 1-4243-2647-8

Notice All information contained herein is for educational purposes only and is no substitute for diagnosis and treatment from a qualified and licensed acupuncturist and Chinese medical practitioner. Neither the author nor the editor assume any liability for any injury and/or damage to persons or property arising from this publication.

Copyright 2005 Dr. Cheng Xiaoming Chinese Acupuncture and Herb Services

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Acknowledgements Thanks to my friends Mary Moses and Benjamin D. Feeley, for their excellent English editing and design. I truly appreciate all they did for this book.

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Acupuncture and Moxibustion—A Clinical Desk Reference

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Author’s Preface Long ago, when I first began practicing acupuncture and moxibustion, I searched for a clinical acupuncture guidebook to supplement the advice of my clinic supervisor. Unfortunately, 30 years passed and the helpful guidebook I was looking for still hadn’t appeared. As I continued to try to find more clinical information from one book to another, from contemporary texts to books written 2000 years ago, I thought, “Why not make one for myself and other acupuncturists as well?” And thus, I began to compile all the acupuncture clinical information I had been collecting since 1992—effective prescriptions, practical experience, and treatment techniques for such a book. In this book, I give detailed explanations of traditional knowledge according to Traditional Chinese Medical theory, clinical demands, and my own experience. Because most ancient texts only name points and their locations without detailed explanation, it is extremely difficult for modern acupuncturists to learn from the experiences of historical practitioners and apply their knowledge. Therefore, I have also explained critical diagnostic skills needed for the various diseases, needle techniques that should be applied, and sections discussing other acupuncture related therapies—all important aspects of practicing acupuncture that are frequently not examined in detail. The practice of acupuncture and moxibustion is a clinical art in the field of non-conventional medicine. Most of the time the techniques have no set patterns and only follow the practitioner’s ideas. I once came across a research report investigating this kind of randomness in acupuncture clinics. The researcher sent a back pain patient to seven different acupuncture clinics in California, and got seven totally different diagnoses—Qi and Blood Stagnation, Kidney Deficiency, Body fluid retention, Dai-mai Stagnation, and Liver Qi Stagnation were some of them. Unfortunately, these inconsistencies will not make much progress for the profession as a whole in today’s more scientific approach to acupuncture. Because any given disease could have various understandings in acupuncture theory, etiology analysis, diagnosis, point prescription, and treatment techniques, I try to explain the disease from the view of mainstream acupuncture theory. What I mean by mainstream acupuncture theory is according to the standard TCM University texts used in the People’s Republic of China and the mainstream thoughts in ancient acupuncture books. I do this in order to help the readers who have no traditional acupuncture educational background in their practice and use of acupuncture. My hope is that the practice of acupuncture and moxibustion techniques will create its own path toward significant progress in scientific acupuncture research to help people heal from disease and increase their quality of life. In chapter one of this desk reference, I spend a little time mentioning common TCM and acupuncture theories, and summarize the theory to make it a bit easier to understand. The meridian diagnosis and point prescription sections are critical parts in this chapter, and give an unprecedented introduction on to how to make point prescriptions easy, effective, and logical. Chapter two is the main chapter in of the book. In order to help people in their clinical practices, I introduce disease from 5 perspectives: General TCM and acupuncture theory of disease Mainstream acupuncture diagnosis and treatment Adjunctive therapies within the field of acupuncture and Traditional Chinese Medicine Traditional prescriptions that have been effective as well as my own clinical experiences Case analysis and evaluation of acupuncture in the treatment of the discussed disease. With this chapter, I have tried to make each disease have the most appropriate TCM and acupuncture diagnoses and familiarize the reader with more than 10 treatment techniques for each. Chapter three then introduces all the techniques that were mentioned in chapter two. This chapter is intended to help readers who were not exposed to these techniques during their acupuncture education, or their self-study. I have also spent time introducing traditional acupuncture needle techniques and moxibustion techniques as well as other therapies.

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Acupuncture and Moxibustion—A Clinical Desk Reference

My hope is this book will become a great public resource and encourage acupuncturists to donate their own clinical experiences to this initial body of knowledge. My goal is to make this an invaluable resource, rich with information that can be shared by the entire acupuncture community. I look forward to becoming friends and communicating with other acupuncture practitioners and hope this book will help others in their practice and scientific acupuncture research. I am going to open a new web page for this book and sincerely welcome all friends and colleagues to send me your clinically effective acupuncture experience so that we can share acupuncture knowledge and promote acupuncture in North America, as well as abroad and in China. In the coming years we will revise this book to include new information received. Feel free to contact me at [email protected].

Spring 2006 Cheng Xiaoming

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Editor’s Preface As a student of Dr. Cheng in acupuncture school, I was extremely impressed by his knowledge of acupuncture and Traditional Chinese Medicine, as well as his vast knowledge of Western medicine. His lectures were exciting and informative due to his un-exhausting clinical experience, consisting of observations regarding the medicine that just cannot be found in books. So when he told us he had just finished a book in English, I was very eager to read it. The first draft of this book that he made available to us then was full of clinical information and techniques from TCM theories, meridian diagnosis, needle techniques, adjunctive techniques etc. Unfortunately, there were many English misspellings and mistakes, and the layout made it very difficult to read due to the fact it was written in his non-native language. Given this, the knowledge contained in the book was often overlooked and not referenced by us in our clinical internship. In wading through the difficulties however, I discovered many gems that helped me in treating my patients and felt that the book had no chance without a proper revision and edit. So I volunteered to revise the English with him in order to prep the book for a proper publishing. In doing so we were able to keep all the content originally contained in the book, as well as Dr. Cheng’s style of explanation of TCM concepts, techniques, etc. Well into this work, Dr. Cheng expressed the desire to self-publish the material. The reason for this was two-fold: firstly, Dr. Cheng wanted to retain all rights and be able to revise and re-publish the book when he felt necessary, and secondly, to keep the cost of the book low for acupuncture students and practitioners. Therefore, in order to curb any excess costs that would be passed on to those interested in purchasing the book, we have done all the editing and layout of the book ourselves. That being said, I must declare that I am not a professional editor and this book continues to be a work in progress. I do have some experience with languages, completing my undergraduate degree in Japanese language and literature, and teaching English as a foreign language for several years abroad, though I am not a professional editor by any means nor have I tried to be one. I am an acupuncturist. And it is with the mind of an acupuncturist that I have done my best to make Dr. Cheng’s work intelligible, useful, and accessible for the English speaking acupuncture community. Like Dr. Cheng, I share in the hope that this book will become a great public resource, an invaluable one, and rich with information to be shared by the entire acupuncture community. Now over three years have passed since I volunteered to help Dr. Cheng with this book. It is my sincerest wish that the material herein would provide the reader with further insight into acupuncture and Traditional Chinese Medicine. If while reading one finds a mistake or some part of the book that is not clear, please contact us at [email protected] and we will do our best to rectify any content for future editions. Benjamin D. Feeley Summer 2006

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Acupuncture and Moxibustion—A Clinical Desk Reference

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Contents SECTION I A GENERAL INTRODUCTION TO CHINESE ACUPUNCTURE AND MOXIBUSTION

CHAPTER I: BASIC KNOWLEDGE OF ACUPUNCTURE & MOXIBUSTION ......................................................... 4 TREATMENT EFFECTS OF ACUPUNCTURE AND MOXIBUSTION........................................................................... 4 Regulation of Yin and Yang.............................................................................................................................................. 4 Reinforcing Vital Qi and Eliminating Pathogens............................................................................................................. 4 Dredging the Meridians (Ensuring Qi and Blood flow through the Meridians) .............................................................. 5 TREATMENT PRINCIPLES OF ACUPUNCTURE AND MOXIBUSTION..................................................................... 6 “Reinforce Deficiency and Reduce Excess.” ................................................................................................................... 6 “Clear Heat and Warm the Cold.” .................................................................................................................................. 6 “Treat the Branch and the Root.”.................................................................................................................................... 6 “Same disease—different therapeutic method. Different disease—same therapy.” ........................................................ 7 “Local and Whole Body Therapy”................................................................................................................................... 7

CHAPTER II: PRINCIPLES OF DIAGNOSIS................................................................................................................... 8 BA GANG BIAN ZHENG: DIFFERENTIAL DIAGNOSIS—THE 8 PRINCIPAL SYNDROMES. .................................................... 8 Differential Diagnosis of Interior or Exterior Syndrome................................................................................................. 8 Differential Diagnosis of Cold and Heat Syndromes ....................................................................................................... 9 Differential Diagnosis of Deficiency and Excess Syndrome .......................................................................................... 10 Differential Diagnosis of Yin and Yang ......................................................................................................................... 12 ZANG FU AND MERIDIAN DIAGNOSIS TECHNIQUES ............................................................................................. 14 LUNG AND LARGE INTESTINE .................................................................................................................................. 14 SPLEEN AND STOMACH ............................................................................................................................................. 17 HEART AND SMALL INTESTINE................................................................................................................................. 20 KIDNEY AND URINARY BLADDER............................................................................................................................. 24 LIVER AND GALL BLADDER ...................................................................................................................................... 27 PERICARDIUM AND TRIPLE WARMER..................................................................................................................... 30

CHAPTER III: PRESCRIPTION METHODOLOGY ..................................................................................................... 32 PRINCIPLE INDICATIONS OF THE FOURTEEN MAJOR MERIDIANS .................................................................... 32 Three Hand Yin Meridian Indications ........................................................................................................................... 32 Three Hand Yang Meridian Indications......................................................................................................................... 32 Three Foot Yang Meridian Indications .......................................................................................................................... 32 Three Foot Yin Meridian Indications............................................................................................................................. 32 Conception and Governing Meridian Indications.......................................................................................................... 33

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Acupuncture and Moxibustion—A Clinical Desk Reference

THE DISTINGUSHING FEATURES OF THE FOURTEEN MAJOR MERIDIAN INDICATIONS .............................. 34 Hand Tai Yin Meridian of the Lung ............................................................................................................................... 34 Hand Yang Ming Meridian of the Large Intestine ......................................................................................................... 34 Foot Yang Ming Meridian of the Stomach ..................................................................................................................... 36 Foot Tai Yin Meridian of the Spleen .............................................................................................................................. 37 Hand Shao Yin Meridian of the Heart............................................................................................................................ 39 Hand Tai Yang Meridian of the Small Intestine............................................................................................................. 40 Foot Tai Yang Meridian of the Urinary Bladder ........................................................................................................... 41 Foot Shao Yin Meridian of the Kidney........................................................................................................................... 42 Hand Jue Yin Meridian of the Pericardium ................................................................................................................... 43 Hand Shao Yang Meridian of the Triple Warmer .......................................................................................................... 44 Foot Shao Yang Meridian of the Gall Bladder .............................................................................................................. 45 Foot Jue Yin Meridian of the Liver ................................................................................................................................ 46 Governing Vessel ........................................................................................................................................................... 47 Conception Vessel .......................................................................................................................................................... 47 BASIC CONCEPT OF ACUPUNCTURE POINTS........................................................................................................... 48 The Classification of Points ........................................................................................................................................... 48 Treatment Effects of Acupuncture Points....................................................................................................................... 48 POINT SELECTION.......................................................................................................................................................... 48 Selection of Local and Adjacent Points.......................................................................................................................... 49 Selection of Distal Points ............................................................................................................................................... 49 APPLICATIONS OF SPECIAL ACUPUNCTURE POINTS ............................................................................................ 49 Application of the Five-Shu Points................................................................................................................................. 50 Application of the Yuan-Source Points .......................................................................................................................... 51 Application of the Luo-Connecting Points ..................................................................................................................... 53 Application of Back-Shu and Front-Mu Points .............................................................................................................. 53 Application of Lower He-Sea Points—Xia He Xue ........................................................................................................ 55 Application of the Sixteen Xi-Cleft Points ...................................................................................................................... 55 Application of the Eight Influential Points..................................................................................................................... 56 Application of the Eight Confluence Points ................................................................................................................... 57 Application of Crossing-Meeting Points ........................................................................................................................ 58 COMMONLY USED ACUPUNCTURE POINTS FOR SPECIFIC INDICATIONS........................................................ 61 Qi.................................................................................................................................................................................... 61 Blood .............................................................................................................................................................................. 62 Body Fluids .................................................................................................................................................................... 62 Shen-Spirit, Sleep, and Dreams...................................................................................................................................... 63 Voice and Speech ........................................................................................................................................................... 64 External Genitalia and Urination .................................................................................................................................. 64 Anus and Bowel Movement ............................................................................................................................................ 65 Headache and Dizziness ................................................................................................................................................ 66 THE METHODOLOGY OF ACUPUNCTURE POINT PRESCRIPTIONS ..................................................................... 67 Selecting Point Prescriptions Acccording to Meridian Theory...................................................................................... 67 Selecting Point Prescriptions According to the Theory of the Zang-Fu ........................................................................ 67 Selecting Point Prescriptions According to the Theory of Modern Medicine................................................................ 68 Selecting Point Prescriptions According to Other Acupuncture Modalites ................................................................... 68 Selecting Point Prescriptions According to Clinical Experience................................................................................... 69

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SECTION TWO ACUPUNCTURE POINT PRESCRIPTIONS

CHAPTER I: INTERNAL MEDICINE DISORDERS ..................................................................................................... 72 ABDOMINAL PAIN.......................................................................................................................................................... 72 ASTHMA ........................................................................................................................................................................... 78 BELL’S PALSY— PERIPHERAL FACIAL PARALYSIS .............................................................................................. 88 BERIBERI SYNDROME................................................................................................................................................... 94 BI SYNDROME............................................................................................................................................................... 100 CHRONIC FATIGUE SYNDROME—XU LAO ............................................................................................................ 110 COMMON COLD ............................................................................................................................................................ 118 CONSTIPATION ............................................................................................................................................................. 126 COUGH............................................................................................................................................................................ 134 DIABETES....................................................................................................................................................................... 142 DIARRHEA ..................................................................................................................................................................... 150 DIZZINESS AND VERTIGO .......................................................................................................................................... 158 DYSENTERY .................................................................................................................................................................. 164 EDEMA............................................................................................................................................................................ 170 EPIGASTRIC PAIN......................................................................................................................................................... 176 EPILEPSY........................................................................................................................................................................ 182 HEADACHE .................................................................................................................................................................... 190 HEART PALPITATIONS................................................................................................................................................ 203 HEMORRHOIDS............................................................................................................................................................. 208 HERPES ZOSTER ........................................................................................................................................................... 214 HICCUP ........................................................................................................................................................................... 220 HIV................................................................................................................................................................................... 226 HYPOCHONDRIAC PAIN ............................................................................................................................................. 234 IMPOTENCE ................................................................................................................................................................... 242 INSOMNIA ...................................................................................................................................................................... 248 LIN SYNDROME—STRANGURIA............................................................................................................................... 254 LOW BACK PAIN ........................................................................................................................................................... 262 PULMONARY TUBERCULOSIS .................................................................................................................................. 270 MADNESS AND INSANITY .......................................................................................................................................... 276 MALARIA ....................................................................................................................................................................... 284 MULTIPLE SCLEROSIS ................................................................................................................................................ 290 NECK PAIN ..................................................................................................................................................................... 298 OBESITY ......................................................................................................................................................................... 304 PROCTOPTOSIA—ANAL PROLAPSE......................................................................................................................... 312 SHOULDER PAIN........................................................................................................................................................... 318 STOP SMOKING............................................................................................................................................................. 324 SUMMER HEAT STROKE ............................................................................................................................................. 330 TRIGEMINAL NEURALGIA ......................................................................................................................................... 336 URINE RETENTION....................................................................................................................................................... 342 URTICARIA .................................................................................................................................................................... 350 VOMITING...................................................................................................................................................................... 356 WEI SYNDROME—FLACCIDITY PARALYSIS SYNDROME.................................................................................. 364 WIND STROKE............................................................................................................................................................... 370 YU SYNDROME—EMOTIONAL DISORDER............................................................................................................. 378

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Acupuncture and Moxibustion—A Clinical Desk Reference

CHAPTER II: E.E.N.T DISORDERS .............................................................................................................................. 384 ACNE ............................................................................................................................................................................... 384 ACUTE CONJUNCTIVITIS............................................................................................................................................ 390 APHONIA ........................................................................................................................................................................ 394 DEAFNESS...................................................................................................................................................................... 400 SINUSITIS ....................................................................................................................................................................... 406 SORE THROAT............................................................................................................................................................... 412 STY—HORDEOLUM ......................................................................................................................................................... 418 TINNITUS........................................................................................................................................................................ 422

CHAPTER III: O.B.G.Y.N DISORDERS ........................................................................................................................ 428 AMENORRHEA.............................................................................................................................................................. 428 DYSMENORRHEA......................................................................................................................................................... 434 ECLAMPSIA ................................................................................................................................................................... 440 HYPOGALACTIA........................................................................................................................................................... 444 INFERTILITY.................................................................................................................................................................. 448 LEUKORRHEA ............................................................................................................................................................... 454 MENOPAUSE.................................................................................................................................................................. 460 MENOXENIA—MENSTRUAL IRREGULARITIES .................................................................................................... 466 MORNING SICKNESS ................................................................................................................................................... 472 PREMENSTRUAL TENSION SYNDROME ................................................................................................................. 478

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SECTION THREE TECHNIQUE REFERENCE

CHAPTER I: TRADITIONAL NEEDLE TECHNIQUE ............................................................................................... 488 NEEDLE CONTROL: ACCIDENTS IN THE CLINIC .................................................................................................. 490 Fainting........................................................................................................................................................................ 490 Stuck Needle................................................................................................................................................................. 491 Broken Needle .............................................................................................................................................................. 491 Hematoma .................................................................................................................................................................... 492 Discomfort after treatment ........................................................................................................................................... 492 Injured Lung: Traumatic pneumothorax...................................................................................................................... 492 Injury of other organs .................................................................................................................................................. 493 Injured brain and spinal cord ...................................................................................................................................... 494 Injured Nerves.............................................................................................................................................................. 494 NEEDLE MANIPULATION TECHNIQUES ................................................................................................................. 496 Fundamental Needling Technique: Basic Manipulations ............................................................................................ 496 Fundamental Needling Technique: Supplemental Manipulation Methods .................................................................. 496 Reinforcing and Dispersion Technique........................................................................................................................ 499 Reinforcing and Dispersion Technique: Single style ................................................................................................... 500 Reinforcing and Dispersing Techniques: Combining methods .................................................................................... 501 Techniques for Opening the Flow of Channel Qi......................................................................................................... 504 ANCIENT NEEDLE TECHNIQUES AND APPLICATIONS ........................................................................................ 506 Jiu Ci—The Nine Needle Techniques........................................................................................................................... 506 Shi Er Ci—The Twelve Needle Techniques.................................................................................................................. 511 Wu Ci—The 5 Needle Techniques................................................................................................................................ 516

CHAPTER II: MOXIBUSTION ....................................................................................................................................... 519 INDICATIONS ................................................................................................................................................................ 519 Reinforcing Yang Deficiency........................................................................................................................................ 519 Warming the Meridians in the Treatment of Bi Syndrome........................................................................................... 519 Yang Qi Collapse ......................................................................................................................................................... 519 Resolving Stagnation.................................................................................................................................................... 519 Protecting Health ......................................................................................................................................................... 519 APPLICATIONS OF MOXIBUSTION ........................................................................................................................... 520 Moxibustion with a Moxa Cone ................................................................................................................................... 520 Moxibustion with a Moxa Pole..................................................................................................................................... 521 Warming Needle Technique ......................................................................................................................................... 521 Prohibition of Moxibustion .......................................................................................................................................... 521 COMMON USES OF DIRECT NON-SCARRING MOXIBUSTION FOR SPECIFIC DISEASES ............................. 522 COMMON USE OF INDIRECT MOXIBUSTION FOR SPECIFIC DISEASES .......................................................... 526

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Acupuncture and Moxibustion—A Clinical Desk Reference

CHAPTER III: DISTRIBUTION OF AURICULAR POINTS & INDICATIONS...................................................... 529 SCAPHOID FOSSA......................................................................................................................................................... 529 Finger........................................................................................................................................................................... 529 Wrist............................................................................................................................................................................. 529 Elbow ........................................................................................................................................................................... 529 Shoulder ....................................................................................................................................................................... 529 Shoulder Joint .............................................................................................................................................................. 529 Clavicle ........................................................................................................................................................................ 529 UPPER CRUS OF ANTIHELIX ...................................................................................................................................... 529 Toe................................................................................................................................................................................ 529 Ankle ............................................................................................................................................................................ 529 Knee ............................................................................................................................................................................. 529 Buttock ......................................................................................................................................................................... 530 Ischium......................................................................................................................................................................... 530 Sympathetic .................................................................................................................................................................. 530 TRIANGULAR FOSSA................................................................................................................................................... 530 Shen Men...................................................................................................................................................................... 530 Uterus........................................................................................................................................................................... 530 ANTIHELIX .................................................................................................................................................................... 530 Abdomen ...................................................................................................................................................................... 530 Chest ............................................................................................................................................................................ 530 Neck.............................................................................................................................................................................. 530 Thoracic ....................................................................................................................................................................... 530 Lumbar Sacrum............................................................................................................................................................ 531 Thoracic Vertebra ........................................................................................................................................................ 531 Cervical Vertebra......................................................................................................................................................... 531 TRAGUS .......................................................................................................................................................................... 531 Nose.............................................................................................................................................................................. 531 Throat........................................................................................................................................................................... 531 Inner-nose .................................................................................................................................................................... 531 Upper Tip of Tragus..................................................................................................................................................... 531 Lower Tip of Tragus..................................................................................................................................................... 531 ANTITRAGUS ................................................................................................................................................................ 531 Calm the Asthma .......................................................................................................................................................... 531 Brain ............................................................................................................................................................................ 531 Brain Stem.................................................................................................................................................................... 531 Testicle ......................................................................................................................................................................... 532 Forehead ...................................................................................................................................................................... 532 Occiput......................................................................................................................................................................... 532 Temple.......................................................................................................................................................................... 532 Central Rim .................................................................................................................................................................. 532 AROUND THE CRUS OF HELIX................................................................................................................................... 532 Esophagus .................................................................................................................................................................... 532 Stomach........................................................................................................................................................................ 532 Duodenal...................................................................................................................................................................... 532 Small Intestine.............................................................................................................................................................. 532 Large Intestine ............................................................................................................................................................. 532 Appendix ...................................................................................................................................................................... 532

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CYMBA CONCHA.......................................................................................................................................................... 533 Urinary Bladder........................................................................................................................................................... 533 Kidney .......................................................................................................................................................................... 533 Liver ............................................................................................................................................................................. 533 Spleen........................................................................................................................................................................... 533 Gallbladder (Pancreas) ............................................................................................................................................... 533 CAVUM CONCHA ......................................................................................................................................................... 533 Mouth ........................................................................................................................................................................... 533 Heart ............................................................................................................................................................................ 533 Lungs............................................................................................................................................................................ 533 Trachea ........................................................................................................................................................................ 533 Adrenal Gland.............................................................................................................................................................. 534 Sub Cortex.................................................................................................................................................................... 534 Endocrine..................................................................................................................................................................... 534 San Jiao........................................................................................................................................................................ 534 EAR LOBE....................................................................................................................................................................... 534 Eye 1............................................................................................................................................................................. 534 Eye 2............................................................................................................................................................................. 534 Eye................................................................................................................................................................................ 534 Toothache (1)(2) .......................................................................................................................................................... 534 Inner Ear...................................................................................................................................................................... 534 Tonsil............................................................................................................................................................................ 535 Upper Jaw, Lower Jaw, and Face Area....................................................................................................................... 535 BACK OF EAR ................................................................................................................................................................ 535 Reducing Blood Pressure ............................................................................................................................................. 535 Er Mi Geng................................................................................................................................................................... 535 Upper Ear Root............................................................................................................................................................ 535

CHAPTER IV: INTERNATIONAL STANDARD SCALP ACUPUNCTURE ............................................................ 537 TREATMENT ZONE DISTRIBUTION AND INDICATIONS........................................................................................................ 537 MS1. Middle line of the forehead ................................................................................................................................ 537 MS2. Lateral line 1 of the forehead.............................................................................................................................. 537 MS3. Lateral line 2 of the forehead.............................................................................................................................. 537 MS4. Lateral line 3 of the forehead.............................................................................................................................. 537 MS5. Middle line of the vertex ..................................................................................................................................... 537 MS6. Lateral line 1 of the vertex .................................................................................................................................. 538 MS7. Lateral line 2 of the vertex .................................................................................................................................. 538 MS8. Anterior oblique line from vertex to temple ........................................................................................................ 538 MS9. Posterior oblique line from vertex to temple....................................................................................................... 538 MS10. Oblique anterior line of the temple ................................................................................................................... 538 MS11. Oblique posterior line of the temple ................................................................................................................. 538 MS12. Upper-middle line of the occiput ...................................................................................................................... 539 MS13. Upper lateral line of the occiput ....................................................................................................................... 539 MS14. Lower lateral line of the occiput ....................................................................................................................... 539

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Acupuncture and Moxibustion—A Clinical Desk Reference

APPENDIX 1....................................................................................................................................................................... 541 MERIDIAN ILLUSTRATIONS ............................................................................................................................................... 541 Lung ............................................................................................................................................................................. 541 Large Intestine ............................................................................................................................................................. 542 Stomach........................................................................................................................................................................ 543 Spleen........................................................................................................................................................................... 544 Heart ............................................................................................................................................................................ 545 Small Intestine.............................................................................................................................................................. 546 Bladder......................................................................................................................................................................... 547 Kidney .......................................................................................................................................................................... 548 Pericardium ................................................................................................................................................................. 549 Triple Warmer.............................................................................................................................................................. 550 Gall Bladder................................................................................................................................................................. 551 Liver ............................................................................................................................................................................. 552 Governing Vessel ......................................................................................................................................................... 553 Conception Vessel ........................................................................................................................................................ 554

APPENDIX 2....................................................................................................................................................................... 555 ILLUSTRATIONS FOR THE ADJUNCTIVE THERAPIES ........................................................................................................... 555 Scalp Acupuncture ....................................................................................................................................................... 555 Ear................................................................................................................................................................................ 556 Wrist and Ankle............................................................................................................................................................ 559 Hand............................................................................................................................................................................. 562 Foot .............................................................................................................................................................................. 563 Nose.............................................................................................................................................................................. 564

BIBLIOGRAPHY............................................................................................................................................................... 565

INDEX ................................................................................................................................................................................. 569

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Acupuncture and Moxibustion—A Clinical Desk Reference

SECTION I A General Introduction to Chinese Acupuncture and Moxibustion

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Treatment Effects of Acupuncture and Moxibustion

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Acupuncture and Moxibustion—A Clinical Desk Reference

CHAPTER I: BASIC KNOWLEDGE OF ACUPUNCTURE & MOXIBUSTION This section is a review of the basic knowledge of acupuncture—how acupuncture treatment works and why the needles can cure disease. These are the interests of acupuncture scientists. Traditional Chinese Medicine believes the effects of acupuncture are the result of balance, meaning that acupuncture treatment brings the imbalanced body (a diseased body) back into balance. On the other hand, one may also say that acupuncture is a self-adjusting process in which stimulating effective acupuncture points and arousing the function of meridians brings the body back to health. This balanced function will be the main topic briefly outlined and reviewed in this section.

TREATMENT EFFECTS OF ACUPUNCTURE AND MOXIBUSTION Regulation of Yin and Yang Regulation of Yin and Yang is one of the effects of acupuncture treatment. The reason for this is that Traditional Chinese Medicine views disease as a disharmony between Yin and Yang, Qi and Blood, Ying and Wei, Zang and Fu, related meridians, the upper and the lower sides of the body, etc. This disharmony could be caused from any Exterior or Interior reason and can be restored after creating a new balance, thereby increasing the body’s life force. Therefore, regulating the relative strengths of Yin and Yang, remedying defects, rectifying abuses, and restoring the relative equilibrium of Yin and Yang are the principles underlying the clinical therapy of acupuncture. Combining points and needle techniques in acupuncture is one of the fundamental concepts to regulate Yin and Yang. For example, techniques to reinforce the Kidney Yin and subdue the Liver Yang are used to treat headache caused by the Liver Yang rising with insufficient Kidney Yin. This treatment focuses on building up a new equilibrium between the Kidney Yin and the Liver Yang. That is why points will be selected from the Kidney meridian, with a reinforcing needle technique to reinforce the Yin, and from the Liver meridian, with a reducing needle technique to subdue the Yang. Balancing Yin and Yang can help keep the body in a state of health, where Excessive Yang and Deficiency of Yin causes an unbalance that may cause such symptoms as insomnia. On the other hand, an Excess of Yin and Deficiency of Yang could lead to such symptoms as drowsiness. Selecting two points, KI-6 of the Yin Qiao meridian and BL-62 of the Yang Qiao meridian, can treat both disharmonies. In the case of insomnia, reinforce the Yin and reduce the Yang, and in the case of drowsiness, reduce the Yin and reinforce the Yang. Reinforcing Vital Qi and Eliminating Pathogens Reinforcing the Vital Qi and eliminating pathogenic influences is another fundamental effect of acupuncture treatment. When disease occurs, practitioners most frequently consider the cause, and find a technique to cure the disease. Unfortunately, most of the time the cause and cure of the illness cannot be easily defined or determined. In such cases Traditional Chinese Medical theory advises consideration of two strategies to cure an illness. One strategy is to remove the reason causing the disease, for example, the pathogens. The other is to try to build up the body’s True Qi. This is based on the theory in the Nei Jing which states: “When your body’s True Qi is normal, you will not be sick; when you are sick your True Qi must first be weak.” Reinforcing needle techniques and the application of moxibustion are effective in supporting Vital Qi. Reducing needle techniques and bloodletting are usually used to eliminate pathogens. Many acupuncture points have similar effects. For example, BL-43, CV-4, CV-6 and GV-4 support the Vital Qi, and Shi Xuan, GV-26, and LI-4 usually eliminate pathogens. To support the Vital Qi is to strengthen the body’s resistance. Since a victory or defeat in the struggle between the Vital Qi and the pathogens determines the development or termination of a disease, one of the most important principles underlying clinical therapy is to change the relative strengths of the Vital Qi and the pathogens. In most cases, supporting the Vital Qi is indicated in Deficiency syndromes in order to restore its strength. In this case, the Deficiency of the Vital Qi is the primary unbalance because the pathogens are no longer dominant or have been declining. For example, in the case of a Deficiency of Qi, it is essential to restore the Qi; in the case of a 4

Treatment Effects of Acupuncture and Moxibustion

Deficiency of Yang, it is necessary to build up the Yang. In the case of a Deficiency of Yin, it is advisable to nourish the Yin; in the case of a Deficiency of Blood, it is important to replenish the Blood. Ridding the body of pathogenic factors is called eliminating pathogens. This can be achieved by the use of reducing techniques for Excess syndromes. This is applicable to Excess syndromes in which the invasion by pathogens is the primary factor of illness, and the Vital Qi has not yet begun to decline. However, the actual therapeutic method employed for this purpose varies greatly, according to the different pathogens and the different sites of their invasion. For example, in the case of an invasion of the upper part of the chest by pathogens accompanied by an accumulation of abundant sputum and saliva, prolonged retention of food in the gastrointestinal tract, or food poisoning, it is advisable to apply a reducing pathogen therapy. In the case of an invasion of the lower part of the gastrointestinal tract by pathogenic Heat combined with waste products in the intestines, purging is practiced; in the case of an Excess Heat syndrome and an Excess Fire syndrome, a clear the Heat and Fire technique is applied. In the case of a Cold syndrome, it is advisable to eliminate the Cold pathogenic invasion by warming the Middle-Warmer; in the case of a Damp syndrome, it is better to dispel Damp stagnation by promoting diuresis. In addition, Phlegm must be resolved whenever it is found to exist and Blood Stasis removed whenever it is detected. All these are typical examples of eliminating pathogens. Dredging the Meridians (Ensuring Qi and Blood flow through the Meridians) The functional activities of the meridians are overseen by “Meridian Qi,” which contains physiological functions that may be summarized in the following way. The Meridian, a pathway of the Qi and Blood, circulates around the body and connects all the Zang Fu. Each meridian has its own connected organ(s) relationship, which increases the relationship between different organs, the organs, and the outside of the body. Connecting the exterior parts includes the skin, muscle, bone and other tissues of the body, including the four extremities and the face. In pathological conditions, any stagnation in this circulation will lead to disease, and this relationship will be broken down. Sometimes, the disease could transfer from one part of the body or organ to another by the meridian system. The Nei Jing states: “ Moving throughout causes no pain. Pain is due to the stagnation of the Meridian. The Meridian circulates Qi and Blood to nourish the whole body, lays the inductive and conductive roles in pathological and therapeutic courses, and regulates the functional activities of the Zang Fu.” Acupuncture and moxibustion treatment is a therapy of needling certain points on the body and burning moxa wool to move the Meridian Qi in order to restore and regulate the functions of the Zang Fu and circulate the Qi and Blood of the body. On the basis of differentiation of syndromes, selection of points along the course of meridians is a fundamental principle in moving stagnation in the meridians, along with the additional selection of local points. Selection of points along the course of the meridians refers to the selection of points distal to the affected meridian, or from the meridian pertaining the affected Zang or Fu. For instance, selection of SP-6 on the Spleen meridian in the case of digestion disorder or selection of TW-5 and GB-34 in the case of ringing ear demonstrates this principle.

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Acupuncture and Moxibustion—A Clinical Desk Reference

TREATMENT PRINCIPLES OF ACUPUNCTURE AND MOXIBUSTION The treatment principle is constructed after a correct diagnosis. In the “Jiu Zhen Shi Er Yuan” chapter of the Nei Jing, it mentions the following basic principles of Acupuncture and Moxibustion treatment, which helps in making the decision of how to treat any kind of disease. “Reinforce Deficiency and Reduce Excess.” (Deficiency refers to the body’s Vital Qi and Excess refers to the pathogenic influences.) This principle focuses on the quality of the disease. The patient having Deficient conditions should be built back to normal, not to Excess. For the patient with Excess conditions, reduction to normal must occur. The normal is the rule for Reducing and Reinforcing. The definition of reinforcing Deficiency is: when the patient’s body is insufficient or hypo-active, help return it to normal by using a reinforcing needle technique, Moxibustion, or a selection of reinforcing points. For example, for a patient with watery diarrhea caused by Kidney and Spleen Yang deficiency, select BL-23, GV-4, BL20 and CV-4 with a reinforcing needle technique and Moxibustion. This is called Reinforcing Deficiency. The definition of reducing Excess is: when the patient’s body is Excessive or hyperactive, help return it to normal by using a reducing needle technique along with a selection of reducing points. For example, for the patient with a sty or painful sensation in the eye with difficulty in opening it, select the tip of ear and LI-1 and use a bloodletting technique. This reduces the Excess Heat pathogenic infection and is called Reducing Excess. “Clear Heat and Warm the Cold.” This principle focuses on the nature of the disease. In the clinic, whenever a patient complains of cold or heat inside or outside the body, use a clearing or warming technique for them. This refers to a therapy of the Clearing technique for a Heat syndrome, and a Warming technique for a Cold syndrome. Clinically, an excessive superficial or local Heat syndrome, such as some skin infections or Heat stagnation in the eyes, nose or throat, is due to Excess Heat retention. If it is accompanied by constipation, reddish urine or fever, it is called Interior Heat. They all can use the clear and reduce technique, which means applying a bloodletting technique, or reducing needle technique for all those symptoms. But clinically, when we treat Interior Deficiency Heat caused by a Yin or Blood Deficiency, a clearing technique is performed only as a supplemental technique and should be combined with a reinforcing Yin and Blood technique. For Cold symptoms as well as Heat, there is Exterior Cold, Interior Cold, and Deficient Cold. We can use warming techniques to treat all kinds of Cold syndromes. Usually for Exterior superficial Cold, moxibustion is recommended. For Interior Excess Cold, deep insertion and the prolonged retaining of the needle is used, along with application of moxibustion to restore the Qi and dispel the Cold. “Treat the Branch and the Root.” These techniques focus on both the manifestations and the cause of the disease. During the process of the treatment, the acupuncturist should focus on the disease and the reason that caused the disease as well. The concept of the primary and the secondary symptoms are relative to each other with the involvement of different diseases. For instance, the True Qi is the primary and the pathogenic factor is the secondary; the etiology is the primary, and the manifestation in the clinic is the secondary; the original disease is the primary, while the consequent disease is the secondary. This concept represents the two opposite aspects of one entity during the course of a disease. The incidental is generally the phenomenon and the secondary aspect; the fundamental cause is generally the nature and the primary aspect of a disease. Under general circumstances, the principle is to treat the symptoms that the patient originally is concerned with when it is acute or emergent, and then to treat the fundamental later when the course becomes stabilized. But if the secondary and the primary are both emergent, they must be treated at the same time.

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Treatment Principles of Acupuncture and Moxibustion

A disease should be assessed according to such different situations as the primary, the secondary, the root cause, the symptoms, the acute and the chronic, so as to determine the principle of treatment. For example, when a patient has constipation that is caused by Liver Qi stagnation, points helping defecation refer to branch treatment and the point selection for resolving the stagnation of the Liver Qi is called the root therapy. For edema due to insufficiency of True Qi or body energy weakness with a pathogenic factor still prevailing, select both points to reinforce the body energy and to promote the circulation of blood in order to induce diuresis to alleviate the edema. This is most commonly used in the clinic. “Same disease—different therapeutic method. Different disease—same therapy.” Diseases sometimes look like they are in the same stages, or may be manifesting themselves by the same syndromes, but can be caused by different roots. Therefore, they may be treated with different therapeutic methods. For instance, for Stomach pain, which is caused by the Liver Qi attacking, the treatment should be to soothe the Liver and harmonize the Stomach, move the Qi and relieve the pain. Points will be selected from the Jue yin and Yang Ming meridians with a reducing needle technique. When the Stomach pain is caused by a Deficiency of both the Stomach and the Spleen, the treatment should be to reinforce the Spleen and Stomach, warm the Middle Jiao and expel the Cold. The points will be selected from the foot Tai yin and foot Yang Ming meridians with a reinforcing needle technique and moxibustion. The same therapy can be employed to treat different diseases manifesting themselves similarly. For example, both a prolapsed rectum due to a protracted illness and a uterine prolapse can be treated by elevating the Spleen Qi, if the two ailments manifest themselves by a sinking of the Qi of the Middle Jiao. “Local and Whole Body Therapy” This principle of treatment focus is about treating even simple diseases. This refers to a general view of the human body proper as an integrated whole and the looks at the interrelationship between man and nature. The human body is composed of a variety of tissues and organs, each performing a particular function, which is itself a component part of the life activities of the whole body. The human body is an integrated whole in that its constituent parts are inseparable in structure, connected with and conditioned by one another in physiology and interacting with one another in pathology. Holistic therapy means treating the diseases for the original reasons. For instance, for dizziness characterized by hyperactivity of the Liver Yang due to Kidney Yin deficiency, with a failure of Water to nourish Wood, the treatment should be to nourish the Kidney and harmonize the Liver, and not only to treat the head. Local therapy refers to some acupuncture points used for local problems; this local treatment will help the whole body. For example, ST-1 is used for eye problem and SI-18 is used for facial pain. They will help the whole body as well.

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Acupuncture and Moxibustion—A Clinical Desk Reference

CHAPTER II: PRINCIPLES OF DIAGNOSIS

BA GANG BIAN ZHENG: Differential Diagnosis—The 8 Principal Syndromes. The Eight Principle diagnostic features are Exterior-Interior, Cold-Heat, Deficient-Excess, and Yin-Yang. These methods of differential diagnosis are used to determine the nature and location of pathological changes. The conflict between the body, the Vital Essence, and the pathogens are evaluated in terms of these Eight Principles. This determination is based on a comprehensive analysis of the clinical evidence obtained by inspection, auscultation, olfaction, interrogation, quality of pulse and palpation. Differential Diagnosis of Interior or Exterior Syndrome This method of differential diagnosis is used to determine the location of the pathogen and the probability for the development of a disease (i.e. the potential for transformation). The main syndromes are listed below. Exterior Syndrome This refers to a syndrome caused by an attack of the superficial or Exterior of the body by the Six Pathogenic Influences through the skin, hair, mouth or nose. It is sudden in onset, superficial (limited to the Exterior), mild in nature, and short in duration without affecting the function of Zang Fu in most cases. Interior Syndrome In contrast to the Exterior syndrome, the Interior syndrome is characterized by pathological changes of the internal organs. The Interior syndrome may be caused by pathogenic influences, which either enter from outside of the body or transfer into the interior, or by their direct invasion of the Zang Fu. The Interior syndrome may also be caused by some “internal influences”, such as emotional upset, improper diet or psychological stress, which directly affect the function of the Zang Fu. Invasion from the Exterior to the Interior This refers to the invasion of pathogens from superficial aspects of the body to the deep, or the replacement of an Exterior syndrome by an Interior one. A patient with an Exterior syndrome may have such symptoms as fever and aversion to cold, and the tongue may be normal with a white thin coating and a floating pulse. If the sensation of aversion to cold is replaced by aversion to heat, then new symptoms may appear. These symptoms include thirst, scanty dark urine, redness of the tongue with yellowish coating and rapid pulse, indicating that the disease has manifested itself by an Interior Heat syndrome due to an invasion of pathogenic agents from the superficial part of the body to the deep. Invasion from the Interior to the Exterior of the body This refers to the conditions in which the pathogenic factors are brought out from the Interior to the body’s Exterior. For example, in the case of an Interior syndrome due to Interior Heat, at first there is the appearance of restlessness, shortness of breath, cough and chest stuffiness. Then there is progression to fever and sweating, the restlessness subsides or a rash develops. These symptoms indicate that the pathogenic agent has been brought out to the surface and the Interior syndrome has subsided. This usually results from proper and prompt treatment and appropriate nursing, which helps to build up the body’s resistance. The transmission of pathogens from the Interior to the Exterior is indicative of the convalescence of a disease in which the pathogens have been expelled, and the condition of the illness has abated.

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Differential Diagnosis

Mixed Syndrome of Exterior and Interior This refers to the simultaneous appearance of features from both the Exterior syndrome and the Interior syndrome in a patient. Evidence of both Exterior and Interior syndromes appears in the initial stage of an illness. For example, when in late summer or in early autumn, there may appear symptoms characteristic of Exterior syndrome, such as fever, aversion to cold, headache, and general aching sensation on the body. In addition, symptoms characteristic of Interior syndrome, such as epigastric stuffiness, anorexia, diarrhea, thick whitish coating of the tongue, etc. may also be present. This is due to an invasion by External pathogenic Cold and Internal pathogenic Dampness. Differential Diagnosis of Cold and Heat Syndromes This refers to the method of differentiating the nature of a disease. It is identical with the differentiation of Excess and Deficiency of Yin and Yang, because Cold and Heat are the manifestations of Excess and Deficiency of Yin and Yang in the body. The main syndromes are: Cold Syndrome This syndrome can be caused by an invasion of a Cold Pathogenic Influence, also known as Excessive Cold. Another form of Cold syndrome is Interior Deficiency Cold, in which the client always feels cold internally. This is due to insufficiency of Yang and excess of Yin. Clinical manifestations of a Cold syndrome are: aversion to cold, seeking or desire for warmth, no thirst, pale complexion, huddling up when cold, copious clear urine, loose stools, pale tongue with whitish coating, and a tense or slow pulse. Heat Syndrome This is a syndrome caused by invasion of pathogenic Heat or hyperactivity of the body due to a Deficiency of Yin and Excess of Yang. Clinical manifestations are fever, aversion to heat and preference for cold, thirst with a preference for cold drinks, flushed face, congested eyes, fidgeting, scanty dark urine, constipation, reddened tongue with dry brownish coating and a rapid pulse. Simultaneous Occurrence of Cold and Heat Syndromes This means that a Cold syndrome is intertwined with a Heat syndrome in the same patient. This may appear as an Organ disorder, characterized by a Heat syndrome in the upper part with a Cold syndrome in the lower part of the body, or it may appear in the organs themselves. In the case of simultaneous occurrence of an Exterior and Interior syndrome, it is marked by a Heat syndrome in the Exterior with Cold syndrome in the Interior, or vice versa. Transformation of a Cold Syndrome and a Heat Syndrome This refers to a change in the nature of a disease. There is a transfer from a Cold syndrome to a Heat syndrome. For example, when a Cold Pathogenic Influence invades the body, we can see such symptoms as fever, aversion to cold, no sweat, headache, general aching, thin white coating of the tongue, tight floating pulse, etc. Later, owing to further development of the pathological changes, the aversion to cold disappears but the fever does not abate, and an aversion to heat rather than cold occurs. Moreover, other symptoms progressively appear such as irritability, thirst and yellowish coating of the tongue, indicating that the Exterior Cold syndrome has transformed into an Interior Heat syndrome. On the other hand, a disease can initially manifest as a Heat syndrome followed later by a Cold syndrome. This transformation of a Heat syndrome into a Cold syndrome is seen in the case of a patient with high fever due to delayed treatment or misdiagnosis. The patient may be overcome by the pathogenic factor, which damages the Vital Qi and suddenly develops such symptoms as cold limbs, profuse cold sweat, restlessness, and a faint indistinct pulse. This is also called collapse of Yang.

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Acupuncture and Moxibustion—A Clinical Desk Reference

Heat Syndrome with Pseudo-Cold Symptoms In this syndrome, the disease has a Heat syndrome nature but also presents with some Cold symptoms, such as cold limbs, deep pulse, etc. It is different from a Cold syndrome in that the patient’s body is warm in spite of cold limbs, and has an aversion to heat instead of cold, and his pulse is deep, but also rapid and forceful. The patient may also have the following symptoms: excessive thirst, preference for cold drinks, dry throat, foul breath, delirium, scanty dark urine, dry stool or dysentery of the Heat type with rectal tenesmus, and a dark reddish tongue with a dry yellowish coating. In this case, the cold limbs and deep pulse are considered “false appearances,” because the Interior Heat is the essence of the disease. This condition is attributable to Excessive Heat inside the body, which keeps Yin superficial. This is what is known as " Yin kept Externally by Excessive Yang in the Interior". Cold Syndrome with Pseudo-Heat Symptoms In this case, the disease is Cold in nature, but exhibits some Heat symptoms, such as fever, flushed face, thirst, and a large pulse. It differs from a Heat syndrome in that the patient runs a fever, but has a desire for being covered up, feels thirsty, but prefers hot drinks, and the pulse is large but weak. There can be symptoms of a Cold nature observed, such as cold limbs, clear urine, loose stool, and pink tongue with a whitish coating. This syndrome’s cause is an Excessive Yin Cold inside the body, which keeps the Yang External. This is what is called "Yang kept Externally by Excessive Yin in the Interior". Differential Diagnosis of Deficiency and Excess Syndrome factors.

This is a method used to determine the strength of the Vital Qi of the body and the virulence of pathogenic

Deficiency Syndrome This syndrome manifests by a Deficiency of Vital Qi. An individual may be born with a Deficiency of Vital Qi. More commonly a Deficiency of Vital Qi is due to a lack of proper living, excess, or imbalance in one’s life. For example, improper diet may lead to weakness of the body’s constitution; emotional upset may impair the Qi and Blood of the Zang Fu; sexual indulgence may consume the Kidney Qi; and prolonged illness may impair the Vital Qi. All these factors may result in various Deficiency syndromes, which include insufficiency and impairment of Yin, Yang, Qi, Blood, Essence of life, body fluid, and the Zang Fu. Clinical manifestations are: pale or yellowish complexion, restlessness, emaciation, fatigue and weakness, disinclination to talk, palpitation, shortness of breath, lassitude in loins and knees, spontaneous perspiration, night sweat, incontinence of stool and urine, pain relieved by pressing, pink tongue with little or not coating, and feeble or weak pulse. Excess Syndrome This syndrome is manifested by exuberant pathogens. It may result from an excess of pathogens with the Vital Qi not in decline; this condition leads to an intense struggle within the body between these two forces. The main manifestations of Excess syndrome are: strong physical constitution, high fever, agitation, loud voice, abdominal distension, pain and tenderness, constipation, hot burning sensation in urine, rough pale tongue with thick and greasy coating, replete and forceful pulse. Deficiency Syndrome complicated with Excess Syndrome This refers to the simultaneous occurrence of a Deficiency syndrome and an Excess syndrome in the same patient at the same time. For example, if a Deficiency syndrome is dominant, and is complicated with Excess symptoms, a patient may exhibit Blood-Deficient insomnia, with a headache in the back of the head, which is caused by a stiff neck. In the case where an Excess syndrome is predominant, but accompanied by Deficiency symptoms, a patient may suffer from a Cold Pathogenic Influence, with headache, body aches and cough, meanwhile also displaying symptoms of Spleen Deficiency, such as feeling tired, loose stools and bloated abdomen. 10

Differential Diagnosis

Transformation of Excess Syndrome to Deficiency Syndrome An Excess syndrome characterizes the disease in its initial stage. However, due to delayed treatment or misdiagnosis, it evolves into a Deficiency syndrome as a result of a decline of the pathogen and the impairment of Vital Qi due to the protracted course of disease. For example, a patient develops acute diarrhea and is not properly treated or is misdiagnosed. After a few months, it transfers to a Deficiency syndrome, i.e. chronic diarrhea. This is what is known as the transformation of Excess syndrome to Deficiency syndrome. Transformation of Deficiency Syndrome to Excess Syndrome In this syndrome a Deficiency syndrome characterizes the disease in its early stage. Due to insufficiency of Vital Qi, substantial pathogens gradually accumulate inside the body and give rise to some Excess symptoms. For example, Qi Deficiency in the elderly may cause exhaustion of body fluid and dryness of the intestine. This may then lead to an Excess syndrome manifested by constipation. This is known as Excess syndrome due to Deficiency syndrome. Excess Syndrome with Pseudo-deficiency Symptoms This is a syndrome of Excess type characterized by the accumulation of pathogens, but accompanied by symptoms similar to a Deficiency syndrome. It is also known as "appearance of Deficiency in extreme Excess". For example, the accumulation of Heat or retention of Phlegm and food in the Stomach and Intestines may lead to blockage of movement of Stomach and Intestinal Qi. This is accompanied with symptoms such as lassitude, chilliness and cold limbs, and slow deep hidden pulse. Upon careful examination, other symptoms may be found such as loud voice, rough breathing, deep and slow or hidden but strong pulse, indicating that accumulation of pathogens in the interior as the real essence of disease, while symptoms resembling a Deficiency syndrome are merely false phenomena. Deficiency Syndrome with Pseudo-excess Symptoms This is a syndrome of Deficiency, but accompanied by symptoms similar to an Excess syndrome. It is also called “False Excess symptoms in extreme Deficiency". For example, dysfunction of Zang Fu in digesting and transporting nutrients due to insufficiency of Qi and Blood may produce symptoms similar to an Excess syndrome, such as abdominal fullness, distension and pain, wiry pulse, etc. However, upon careful examination it may be found that the abdominal distension is slight, not severe. Moreover it is not persistent and can be relieved by pressure, and that the patient's pulse is wiry and weak indicating that an insufficiency of Qi and Blood of Zang Fu is the real essence of disease. Once again the symptoms similar to an Excess syndrome are but false phenomena. Complicated Syndromes Exterior Syndrome of Excess type: This syndrome results in a tight sensation of the skin and muscles due to invasion of the superficies by a Pathogenic Influence. This manifests as dry skin, no sweat, fever, aversion to cold, headache, body aching, stuffy nose, and a tense floating pulse. Exterior Syndrome of Deficiency type: This syndrome is also called “Disharmony of Ying and Wei Qi.” Its clinical manifestations are spontaneous sweating, fever, aversion to wind, sweating, and a slow floating pulse. Cold Syndrome of Deficiency type: This syndrome is caused by a Yang Qi deficiency. It is manifested by lassitude, pale complexion, aversion to cold and cold limbs, abdominal pain, which is relieved by warmth and pressure, loose stool, frequent clear urine, shortness of breath and weakness, pale tongue, feeble or deep, slow and weak pulse, etc. Cold Syndrome of Excess type: This syndrome is due to Excessive Yin-Cold inside the body, and stagnation of Yang Qi. This syndrome results from excessive intake of cold or raw food, or direct invasion of the Interior by a Cold Pathogenic Influence. It manifests as aversion to cold and cold limbs, epigastric chilliness and pain, abdominal pain and tenderness, vomiting of watery fluid, borborygmus, chronic diarrhea, cough with profuse thin and whitish sputum, asthma, whitish slippery coating of the tongue, and slow or tense pulse. 11

Acupuncture and Moxibustion—A Clinical Desk Reference

Differential Diagnosis of Yin and Yang Differential Diagnosis of Yin and Yang is a general guiding principle underlying all Differential Diagnosis by the Eight Principles. The principles of Yin and Yang govern the other six principles. At times when there is no clear pattern for diagnosis, one can simplify their approach to the patient by applying the differential diagnosis of Yin and Yang.

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Zang Fu and Meridian Diagnosis Techniques

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Acupuncture and Moxibustion—A Clinical Desk Reference

ZANG FU AND MERIDIAN DIAGNOSIS TECHNIQUES LUNG AND LARGE INTESTINE

LUNG The Lung meridian originates in the Middle Warmer and travels downwards, connecting with the Large Intestine. It corresponds to metal, according to the Five-Element theory and its specific emotion is sadness. It nourishes the skin, opens into the nose and manifests outwardly on the skin. The Lung and Large Intestine are Exteriorly-Interiorly related meridians. The main pathological dysfunction of the Lung involves failing in its ascending and descending function. This manifests as a full sensation in the lungs, shortness of breath, and rebellion of the Qi accompanied by cough or asthma. Qi stagnation and Deficiency are main syndromes of the Lung and are associated with Lung organ conditions such as cough, asthma, phlegm, and dysfunction of water metabolism, nasal congestion and dry skin.

LUNG SYNDROMES AND TREATMENT Cough, asthma, chest pain, loss of voice, nose, and skin problems are the main symptoms of the Lung. DEFICIENCY SYNDROMES Insufficient Lung Yin Main symptoms: Dry cough with little or no phlegm, Yin Deficiency and Interior Heat. Clinical manifestations: Deficiency symptoms of the Lung Yin, such as a dry cough with no sputum, flushed cheeks, night sweats, dysphoria with a feverish sensation in the chest, palms and soles, bloodstained sputum (resulting from damage of pulmonary vessels by Deficient Fire), a red tongue with little or no coating and a thin or thread-like pulse. This syndrome is usually due to chronic Lung disease with impairment of the Lung Yin, resulting in insufficiency of the body fluid, or impairment of the Yin fluids in the late stage of a febrile disease. Palpation points: LU-5 and LU-10. Prescription: LU-10, LU-9, KI-3, and BL-13 with a reinforcing needle technique or even movement technique. Moxibustion is contraindicated. Insufficient Lung Qi Main symptoms: Weak cough, hypo-function of the lungs, and shortness of breath. Clinical manifestations: Cough with dyspnea, shortness of breath aggravated by slight exertion, clear thin sputum, low and weak voice, pale complexion, lassitude, spontaneous perspiration, aversion to wind, susceptibility to cold due to exogenous pathogens, a pale tongue with a whitish coating, and a weak pulse. Hypo-function of the lungs is usually due to a chronic illness and weak cough or insufficiency of Qi. Palpation points: LU-1, LU-2, LU-4, and LU-8. Prescription: LU-9, LU-10, BL-13, BL-20, and CV-17. The points are mainly selected from the Hand Tai Yin meridian and the Foot Tai Yang meridian, including the Back-Shu, using a reinforcing needle technique and moxibustion.

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Zang Fu and Meridian Diagnosis Techniques

EXCESS SYNDROMES Wind Cold attacking the Lung Clinically it manifests by a series of symptoms of the Lung’s failure in ascending and descending, such as fever, aversion to cold, headache and body ache, runny nose with no sweating and cough with thin phlegm. The pulse is tight and floating and the tongue is pale with a thin white coating. Palpation points: LU-5 and LU-6. Prescription: LU-7, LU-9, LU-5, LI-4, LI-11, and BL-13 with a reducing needle technique or moxibustion. Heat stagnated in the Lung and the Lung fails in ascending and descending Clinical manifestations are dyspnea, cough with thick yellowish sputum, high fever, thirst, irritability, flaring of the nostrils, chest pain, blood-streaked and pus-stained sputum with a strong smell, constipation, scanty dark urine, reddish tongue with yellowish coating, and slippery fast pulse. Palpation points: LU-10 and LU-6. Prescription: LU-11, LU-5, LI-4, ST-40, and BL-13 with a reducing needle technique. A Blood letting technique is used on LU-5 and LU-11. Damp and Phlegm stagnated in the Lung Clinical manifestations are a cough with copious thin and white sputum, which is easily expectorated, a feeling of oppression in the chest, dyspnea, laryngeal rale, pale tongue with a white greasy coating and a taut and slippery or weak and floating pulse. Palpation point: LU-5 and SP-6. Prescription: LU-11, LU-5, LU-6, SP-4, ST-40, and BL-13 with an even-movement needle technique and moxibustion.

LUNG MERIDIAN SYNDROMES AND TREATMENT Wind-Cold-Damp stagnated in the meridian The Wind, Cold and Damp combine together and invade the Lung meridian, which cause Qi and Blood stagnation. Clinically, the patient feels pain on the anterior shoulder and index finger, which is hard to move as well. Palpation point: LU-8. Prescription: LU-10, LU-1, LU-3 and LI-5. Select the points mainly from the Lung meridian and local Ah Shi points using a reducing needle technique and moxibustion. Heat stagnated in the meridian The main clinical manifestations are a swollen and sore throat with a heat sensation in the palms. Palpation point: LU-9 and LU-10. Prescription: LU-11, LI-1, LI-4, LU-5 and tip of ear. Apply a bloodletting technique on LU-11, LI-1 and the tip of the ear, and use a reducing needle technique for LI-4 and LU-5.

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Acupuncture and Moxibustion—A Clinical Desk Reference

LARGE INTESTINE Exteriorly-Interiorly related with the Lung due to the interconnection between their channels, bowel movement and body liquid problems are the main symptoms of the Large Intestine. Manifestations include constipation, diarrhea, fever, dry skin, and borborygmus, abdominal pain, or appendicitis.

LARGE INTESTINE SYNDROMES AND TREATMENT Cold Syndrome Usually due to an excess consumption of cold food, drink, or Cold Pathogenic Influence infecting directly, causing abnormal transportation of fluids. The main symptoms are abdominal pain, watery diarrhea with borborygmus, associated with a fever and aversion to cold, or an achy and tender sensation in the body. The tongue is pale with a white greasy coating and the pulse is deep and slow. Palpation points: LI-4 and LI-6. Prescription: ST-25, ST-37, LI-11, BL-25 and CV-4 with a reinforcing needle technique and moxibustion. Heat Syndrome Due to a Heat Pathogenic Influence, the main symptoms are a burning and painful sensation in the anus, severe diarrhea with blood and pus, urgent abdominal pain, and scanty or reddish urine. In some severe cases, the patient may have some symptoms similar to appendicitis. The tongue is red with a yellow, greasy coating and the pulse is wiry and slippery. Palpation points: LI-10 and LI-20. Prescription: ST-25, Lan Wei Xue, ST-37, CV-4, PC-6, LI-11 and LI-4 with a reducing needle technique. Deficiency Syndrome Usually caused by other Deficiency problems, such as Spleen Qi Deficiency, Kidney Deficiency, weakness of the Ming Men Fire, or other long-term or chronic diseases. The main symptoms are loose stool or watery diarrhea, anal prolapse, poor appetite, diarrhea in the morning, cold sensation in the whole body and sallow complexion. The tongue is pale with a white, wet coating and the pulse is thin and deep. Palpation points: LI-4 and LI-3. Prescription: GV-20, GV-1, LI-11, BL-23, CV-4, CV-12 and ST-36 with a reinforcing needle technique and moxibustion on GV-20 and CV-4 Excess Syndrome A syndrome of stagnated or undigested food in the Large Intestine. The main symptoms are fullness and bloating in the whole abdominal region, pain made worse with pressure, constipation, tenesmus and acid regurgitation. The tongue is red with a thick greasy coating, and the pulse is fast and slippery, or strong and slippery. Palpation points: BL-24 and ST-37. Prescription: LI-2, ST-37, BL-25 and ST-25 with a reducing needle technique.

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Zang Fu and Meridian Diagnosis Techniques

LARGE INTESTINE MERIDIAN SYNDROMES AND TREATMENT Wind-Cold-Damp Pathogenic Influence stagnated in the meridian A painful sensation on the anterior shoulder is the main symptom, accompanied by pain and dysfunction of the index finger. Palpation point: LI-3 and LI-8. Prescription: LI-4, LU-7, LI-5 and LI-11 with a reducing needle technique. Or, use direct non-scarring moxibustion on LI-5 and LI-11. Heat invading the meridian The main symptoms are toothache, swollen neck, halitosis, nasal hemorrhage, and stuffy nose with discharge, sore throat and dry mouth. The tongue is red with a yellow coating and the pulse is fast and slippery. Palpation point: LI-11 and LI-14. Prescription: LI-3, LU-10 and ST-44 with a reducing needle technique or bloodletting technique.

SPLEEN AND STOMACH

SPLEEN The Spleen controls and dominates transportation and transformation, sends nutrients up and produces and sends the Blood flowing in the vessels. An important organ in the digestive system, it opens into the mouth and manifests on the lips. The Spleen corresponds to Earth according to the Five Elements, and its specific emotion is anxiety. It is also associated with saliva secretion, and nourishes the muscles and limbs. In addition, the Spleen and Stomach are Exteriorly-Interiorly related meridians. When the Spleen fails in transportation and transformation, the main symptoms are bloating with a full sensation in the abdomen, stagnation of food, loose stool with borborygmus, a heavy sensation in the whole body and head, edema, Phlegm in the Sinew meridian, transferring to the Lungs. When the Spleen fails in nourishing the muscles and limbs, the main symptom is myoatrophy of the body and limbs. When the Spleen fails in controlling Blood circulation within the vessels, the main symptom is bleeding during bowel movements or metrorrhagia.

SPLEEN SYNDROMES & TREATMENT Spleen Deficiency Commonly due to both Spleen Qi and Yang deficiency, with the Spleen failing in transportation and transformation. Clinical manifestations are a sallow complexion, shortness of breath, weak voice, poor appetite, weak sensation in the limbs, bloated abdomen with loose stool and possible coldness in the four extremities or edema in the feet. The tongue is pale with a white coating, and the pulse is deep and weak, or floating and weak. Palpation points: SP-6, SP-8, SP-21 and SP-18. Prescription: SP-2, BL-20, LV-13, SP-3 and ST-36 with a reinforcing needle technique and moxibustion.

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Acupuncture and Moxibustion—A Clinical Desk Reference

Spleen Excess This is usually caused by stagnation due to Dampness. The main symptoms are bloating in the abdomen that is worse with pressure, a sallow complexion, yellow reddish urine, constipation, sighing, belching and a poor appetite. The tongue is swollen with a thick greasy coating and the pulse is deep and tight. Palpation points: SP-9 and SP-4. Prescription: SP-4, BL-20, LV-13 and CV-12 with a reducing needle technique. Spleen Cold This syndrome is usually due to Spleen Yang and/or Kidney Yang Deficiency. Water retention is the main symptom with associated signs of bloating, borborygmus, poor appetite, loose stool, a cold sensation in the whole body and four extremities and copious clear frequent urine. The tongue is pale with a white coating and the pulse is deep and slow. Palpation points: SP-3, KI-3, and ST-29. Prescription: SP-2, BL-20, ST-36, CV-12 and CV-6 with a reinforcing needle technique and moxibustion. Spleen Heat When Heat and Damp Pathogenic Influences invade the Spleen, a Spleen Heat syndrome can occur. The main symptoms are discomfort in the abdomen, heaviness and pain in the head and body, a poor appetite, constipation, a dry mouth with a refusal to drink and a sweet taste in the mouth. The tongue is red with a yellow, thick, greasy coating and the pulse is weak, floating and fast. Palpation points: SP-8, SP-10, and LI-10. Prescription: SP-4, BL-20, BL-21, SP-4 and LV-13 with a reducing needle technique.

SPLEEN MERIDIAN SYNDROMES AND TREATMENT Wind-Cold-Damp Pathogenic Influence stagnated in the meridian The main symptoms are painful and swollen sensations on the inside of the leg and thigh and painful feet with a big toe that is sore and hard to move. Prescription: SP-9, SP-3, SP-1 and KI-1 with a reducing needle technique and moxibustion to expel the pathogen. Heat Pathogenic Influence stagnated in the Spleen meridian and rising up The main symptoms are stiffness of the tongue, sore throat, epigastric pain, and a heavy sensation in the body, belching, loose stool or jaundice. Prescription: HT-6, SP-4, ST-44, CV-12 and SP-6 with a reducing and even movement needle technique.

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Zang Fu and Meridian Diagnosis Techniques

STOMACH The Stomach likes wetness and hates dryness. It is Exteriorly-Interiorly related to the Spleen due to an interconnection between their meridians. In terms of pathological condition, the main symptoms are related to an upward rebellion of the Qi instead of its normal descent.

STOMACH SYNDROMES & TREATMENT Stomach-Cold This syndrome occurs when Cold Pathogenic Influences invade the Stomach, due to exposure of the abdomen to Cold, excessive intake of raw or cold food, or an improper mode of living. Clinical manifestations are cold pains in the epigastrium and abdomen, which are relieved by warmth and aggravated by cold, tastelessness in the mouth, and absence of thirst accompanied by borborygmus. The tongue is pale with a greasy coating and the pulse is slow and wiry. In the case of repeated and protracted attacks of the disorder with resultant damage of the Yang Qi, such symptoms as lassitude, restlessness and cold limbs, with desire for warmth, are likely to ensue. Palpation points: ST-36, CV-12, and ST-43. Prescription: ST-36, ST-41, CV-12, BL-21 and PC-6 with a lifting and thrusting reinforcing needle technique followed by adding moxa wool on the handle of the needles for 5-7 cones. Stomach-Heat This syndrome is usually due to a Heat Pathogenic Influence invading the Stomach, an excessive intake of hot, spicy, fatty and sweet food, stagnation of the Qi, or emotional depression. Clinical manifestations are burning pain in the epigastrium, gastric discomfort with acid regurgitation, thirst with desire for cold drinks, halitosis, vomiting immediately after meals, inflamed, ulcerated or bleeding gums, constipation and scanty dark urine. The tongue is red with a yellow coating and the pulse is slippery and rapid. Palpation points: CV-14, ST-36, and SP-7. Prescription: ST-36, ST-45, CV-12, LI-4 and LI-11 with a reducing needle technique. Stomach Yin Deficiency Damage of the Stomach Yin usually occurs due to prolonged febrile disease, or impairment of Stomach Yin by excessive intake of pungent food. Clinical manifestations are dull pain of the epigastrium, hunger with a disinclination to eat, belching, hiccups, dry mouth and throat, and constipation. The tongue is red without a coating and the pulse is thread-like and rapid. Palpation points: KI-3, ST-43, ST-40, and CV-12. Prescription: ST-36, BL-21, CV-12 and BL-23 with a reinforcing needle technique. Retention of Undigested Food in the Stomach This is usually due to indigestion or allergic food and drink intake. Its clinical manifestations include epigastric distention and stuffiness or pain, belching with a foul taste and smell, vomiting acidic and rotten food with distention, and pain relieved after vomiting, flatulence and loose stool with acidic, rotten and foul smells. The tongue is red with a thick, greasy coating and the pulse is slippery. Palpation points: LI-11, LI-4, and ST-34. Prescription: ST-36, ST-45, ST-40 and SP-3 with a twisting reducing needle technique.

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Acupuncture and Moxibustion—A Clinical Desk Reference

STOMACH MERIDIAN SYNDROMES AND TREATMENT Wind-Cold-Damp Pathogenic Influence invading the meridian Clinical manifestations are pain and swelling in the knee, pain and distention in the breast, thigh, leg and dorsum of the feet, middle toe pain with difficult usage, a cold sensation in the whole body that is aggravated by cold, windy or damp weather. The pulse is deep and slow and the tongue is pale with a white coating. Palpation points: ST-42, ST-40, and ST-25. Prescription: ST-36, ST-44, ST-42 and LI-11 with a reducing needle technique and moxibustion. Heat Pathogenic Influence stagnated in the meridian and rising up along the meridian Clinical manifestations are hot sensations throughout the whole body, sweating, thirst, dry mouth, swollen and sore throat and neck, toothache and swollen gums. The tongue is red with a yellow coating and the pulse is big and flooding. Palpation points: ST-34, ST-28, ST-41, and ST-8. Prescription: HT-6, SP-5, LI-4, LI-11, and ST-44 with a reducing needle technique. Fire Pathogenic Influence stagnated in the Yang Ming meridian, bothering the Shen House. The main symptoms are mental disorders of a hot and excess nature. Palpation points: ST-5, ST-7, ST-38, and HT-5. Prescription: GV-14, PC-8, PC-5, GV-16, LI-4, and ST-44 with a lifting and thrusting reducing needle technique.

HEART AND SMALL INTESTINE

HEART The Heart governs the vessels, blood circulation, controls mental activities, and houses the mind. It is equivalent to "Fire" in the Five Elements and is thought to typify a Yang organ amongst the five Zang organs by performing the function of coordinating the life activities of the whole body. It has its body opening in the tongue and outwardly manifests on the face. Its particular emotion is joy, and its associated secretion is sweat. The Heart and the Small Intestine are Exteriorly-Interiorly related because of interconnection of the Heart Meridian of Hand Shao Yin and the Small Intestine Meridian of Hand Tai Yang.

HEART SYNDROMES & TREATMENT DEFICIENCY SYNDROMES Insufficient Heart Qi Clinical manifestations are heart palpitations, shortness of breath that is aggravated by activity, spontaneous sweating, a pale complexion and lassitude. The tongue is pale with a white thin coating and the pulse is weak or drop beat. Palpation point: CV-14, BL-14, and HT-2. Prescription: HT-7, PC-6, LU-9, CV-6, ST-36, BL-15 and BL-14 with moxibustion 20

Zang Fu and Meridian Diagnosis Techniques

Insufficient Heart Yang Clinical manifestations are heart palpitations, shortness of breath that is aggravated by activity, spontaneous sweating, a cold sensation inside the body and four extremities, a stuffy and painful sensation in the chest and a dark or gray complexion. The tongue is swollen and pale purple and the pulse is weak and deep or drop beat. Palpation points: HT-3, HT-7, and BL-15. Prescription: HT-7, BL-15, CV-15, CV-4, LU-9 and HT-9 with moxibustion Insufficient Heart Blood Clinical manifestations are heart palpitations and angina, restlessness, insomnia, poor memory, being easily frightened, a sallow or pale complexion, blurry vision and pale lips and nails. The tongue is pale with a thin white coat, and the pulse is thin and fast. Palpation points: CV-14, HT-3, and HT-7. Prescription: PC-6, HT-7, SP-4, ST-36, BL-15, BL-17 and BL-20 with moxibustion Insufficient Heart Yin Clinical manifestations are heart palpitations, restlessness, insomnia, a poor memory accompanied by nightmares and more dreams, a low-grade fever, night sweats, five-heart heat and a dry mouth and throat. The tongue is red without a coating and the pulse is thin and fast. Palpation points: BL-15, CV-14, and HT-6. Prescription: PC-6, HT-9, LU-10, KI-3, BL-15 and GV-4 with a reinforcing needle technique.

EXCESS SYNDROMES Heart Fire flaming up Due to stagnation of interior emotions, which flare upward to bother the Heart "Shen" and burn the tongue, or goes downward and transfers to the Small Intestine, causing red, scanty urine associated with a dry mouth, restlessness and poor sleep. The tongue is red with a yellow coating, and the pulse is fast. Palpation points: HT-7, HT-3, and CV-19. Prescription: HT-5, HT-7, LU-10, BL-15 and SI-4 with a reducing needle technique. Mental confusion due to Phlegm This refers to an impairment of consciousness caused by invasion of the Heart by phlegm, usually resulting from the production of phlegm due to emotional upset, stagnation of Qi or coagulation of pathogenic Dampness in the Heart. It manifests as mental depression, apathy, improper behavior, sudden falling down with loss of consciousness or laryngeal rale. The tongue is red with a yellow greasy coating, and the pulse is slippery and fast. Palpitation points: CV-13, CV-15, HT-5, and HT-2. Prescription: 12 Jing (well) points, HT-7, HT-6, BL-17, GV-14, LI-4 and ST-36 with bloodletting and a reducing needle techniques.

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Acupuncture and Moxibustion—A Clinical Desk Reference

Heart Blood Stagnation This syndrome is a morbid condition due to an obstruction of the collateral meridian of the Heart, resulting from insufficiency of the Heart-Qi, Heart-Yang, or coagulation of phlegm obstructing the collateral meridian. It manifests as palpitations, an intermittent choking sensation or stabbing pain in the chest, dragging pain over the shoulder, back and arm, a dark purplish tongue possibly with petechiae and ecchymoses and a small, hesitant pulse or slow, weak pulse with irregular intervals. In severe cases, there may occur a sudden attack of intolerable pain, cyanosis of the mouth, lips and nails, cold limbs, coma and a faint, indistinct pulse. Palpation points: SP-10, BL-15, BL-43, and HT-3. Prescription: BL-15, PC-5, PC-7, CV-15, BL-17, HT-7 and PC-6 with a reducing needle techniques.

HEART MERIDIAN SYMDROMES AND TREATMENT Wind-Cold-Damp Pathogenic Influence stagnated in the meridian This is a Heart meridian problem due to the stagnation of Wind, Cold and Damp Pathogenic Influence, manifesting as shoulder and upper back pain, which is related to the inside of the arm along the pathway of the Heart meridian. Palpation points: Little finger, HT-1, and HT-3. Prescription: BL-15, HT-7, LU-9, PC-6, and PC-7 with a reducing needle technique and moxibustion. Heat Pathogenic Influence stagnated in the meridian This is an infection due to Heat Pathogenic Influence in the Heart meridian manifesting as a dry mouth, dry throat, yellowish eyes and ulcers in the mouth and on the tongue. Palpation points: HT-6, SI-7, and SI-13. Prescription: HT-3, HT-7, PC-7, SI-4 and SI-8 with a reducing needle technique and bloodletting.

SMALL INTESTINE

SMALL INTESTINE SYNDROMES AND TREATMENT Small Intestine Cold A syndrome of stagnation due to a Cold Pathogenic Influence in the Small Intestine, manifesting as a painful and bloated sensation in the abdominal region, borborygmus, diarrhea, reduced by pressure and warmth and associated with scanty urination. The tongue is pale with a thin white coating, and the pulse is deep and slow. Palpation points: SI-8, SI-10, and SI-4. Prescription: SI-3, ST-37, CV-4, BL-28 and ST-36 with a reinforcing needle technique and moxibustion.

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Zang Fu and Meridian Diagnosis Techniques

Small Intestine Heat The clinical manifestations are a painful, hot and burning sensation during urination, bloody urine in some severe cases, restlessness, a dry mouth, and ulcers on the tongue and in the mouth. The tongue tip is red with a thin yellow coating, and the pulse is fast. Palpation points: SI-5, SI-7, and SP-8. Prescription: CV-3, BL-40, SI-8, ST-39, HT-7 and SI-7 with a reducing needle techniques. Pain due to Qi Stagnation Clinical manifestations are acute, sharp lower abdominal pain that refers to the back, and a dropped testicle (hernia). The tongue is pale with a thin white coating, and the pulse is wiry and tight. Palpation points: CV-6, ST-25, and ST-7. Prescription: BL-28, CV-4, CV-6, LV-3 and LV-1 with reducing needle techniques.

SMALL INTESTINE MERIDIAN SYMDROMES AND TREATMENT Wind-Cold-Damp Pathogenic Influence stagnated in the meridian Clinical manifestations are painful sensations on the neck, shoulder, cheek, elbow and backside of the arm. Palpation points: SI-12, SI-6, SI-14, and SI-11. Prescription: SI-4, SI-8, SI-10 and HT-5 with reducing needle techniques and moxibustion. Heat Pathogenic Influence stagnated in the meridian and traveling up The main clinical manifestations are a dry sore throat, deafness, and yellowish eyes. Palpation points: SI-8, SI-3, and HT-5. Prescription: SI-19, SI-4, SI-3, HT-7 and HT-9 with reducing needle techniques and bloodletting.

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Acupuncture and Moxibustion—A Clinical Desk Reference

KIDNEY AND URINARY BLADDER

KIDNEY The Kidney stores the life essence, which is considered the origin of Yin and Yang of the Zang Fu and the source of life of the human body. Hence, they are called "The Origin of the Congenital Constitution." It dominates growth, development and reproduction, governs water metabolism, receives the Qi and produces marrow, which nourishes the bones. They outwardly manifest in the head hair, and their specific body opening is into the ears and the two Yin-orifices. The emotions associated are fear and fright, and their associated secretion is spittle. The Kidney and the Urinary Bladder are Exteriorly-Interiorly related due to interconnections of the Kidney meridian and Urinary Bladder meridian.

KIDNEY SYNDROMES & TREATMENT Kidney Yang Deficiency This is usually due to insufficiency of the Kidney Yang Qi. It results mainly from Kidney Deficiency in the aged, injury of the Kidney due to chronic diseases and intemperance in one’s sexual life. Its clinical manifestations are a pale complexion, an aversion to the cold, cold limbs, listlessness, weakness or a cold pain in the low back and knees, impotence, sterility in females due to a cold womb, persistent diarrhea containing undigested food or diarrhea before dawn, and edema more in the lower limbs. The tongue is swollen and pale with a white coating, and the pulse is deep, thread-like and weak. Palpation points: KI-3, KI-7, and KI-10. Prescription: KI-3, CV-3, BL-23, CV-4, GV-4 and KI-7 with reinforcing needle techniques and moxibustion. Kidney Qi Deficiency Usually due to insufficiency of the Kidney Qi with a decrease in renal functioning, it generally results from Kidney Deficiency in the aged, insufficient Kidney Qi in infants, chronic or long-term diseases or intemperance in sexual life. Clinical manifestations are lassitude, listlessness, weakness in the lower back and knees, frequent urination, incontinence, enuresis, urinary incontinence, nocturia, spermatorrhea or premature ejaculation in men, clear leukorrhea or spontaneous abortion in women. The tongue is pale with a white coating, and the pulse is deep and weak. Palpation points: KI-6, KI-10, and CV-4. Prescription: CV-6, KI-10, KI-3, ST-36, BL-23 and BL-24 with reinforcing needle techniques and moxibustion. Insufficiency of the Kidney Essence (Jing) Generally caused by congenital defects, improper care after birth, intemperance in sexual life and damage to the Kidney due to chronic and long-term disease, the clinical manifestations are retarded development in infants, marked by bradypragia (slow movement), low intelligence, tardy closure of the fontanel, and dysostosis; in adults it expresses itself through sterility due to spermacrasia in males and due to amenorrhea in females, premature senility, baldness and odontoseisis (headache with loose teeth), tinnitus, deafness, amnesia, flaccidity of the feet, hypopnea and bradypragia. Palpation points: KI-3, KI-24, KI-25, and LV-8. Prescription: CV-4, GV-4, GV-14, KI-3, GV-20 and LI-11 with reinforcing needle techniques and moxibustion.

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Zang Fu and Meridian Diagnosis Techniques

Kidney Yin Deficiency Insufficiency of Yin fluids in the Kidney and whole body leading to clinical manifestations consisting of a weak sensation in the low back and knees, dizziness, tinnitus, insomnia, dreaminess, frequent erection of the penis or emissions in men, scanty menstruation or amenorrhea in women, emaciation, tidal fever, night sweats, dysphoria with a feverish sensation in the chest, palms and soles, flushed cheeks, dry throat and constipation. The tongue is red without a coating, and the pulse is thin and fast. Palpation points: KI-3, KI-5, BL-52, BL-23, and GV-4. Prescription: KI-6, BL-23, KI-3, BL-52, CV-2 and GV-4 with reinforcing needle techniques. Kidney fails to receive the Qi This is a Qi deficiency syndrome usually due to Lung Qi Deficiency and asthma. Its clinical manifestations are shortness of breath with prolonged exhalation and shortened inhalation that is aggravated by activity, difficulty breathing that worsens upon exertion, dyspnea, spontaneous sweating, lassitude, leptophonia, and weakness of the loins and knees. The tongue is pale with a white coating, and the pulse is floating and big, with no root. Palpation points: KI-7, KI-3, KI-10, and KI-26. Prescription: KI-3, CV-6, KI-7, CV-17, BL-23 and LU-9 with reinforcing needle techniques and moxibustion.

KIDNEY MERIDIAN SYNDROMES AND TREATMENT Wind-Cold-Damp Pathogenic Influence stagnated in the meridian Clinical manifestations are pain, soreness and weakness in the spinal column region and lower back and blurry vision. Palpation points: KI-1, KI-8, and KI-14. Prescription: KI-10, BL-23, KI-3 and BL-58 with reducing needle techniques and moxibustion. Heat stagnated in the Kidney meridian The main symptoms are a dry tongue, a dry and sore throat, a hot sensation in the mouth, chest pain and a burning sensation on the soles. Palpation points: KI-2 and KI-5. Prescription: KI-1, KI-7, BL-64 and KI-4 with reducing needle techniques.

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Acupuncture and Moxibustion—A Clinical Desk Reference

URINARY BLADDER The Urinary Bladder's main function is to store and excrete urine. In pathological conditions, when the Urinary Bladder fails to store urine, there may be frequent micturition and urinary incontinence. The Dampness and Heat accumulating in the Urinary Bladder often cause frequent or urgent urination that can be painful. TCM believes that the fulfillment of the Urinary Bladder's function of storing and excreting urine depends upon the Kidney’s help in transforming the Qi, which means dividing the clear fluids from the turbid. The Urinary Bladder and the Kidney are Exteriorly-Interiorly related due to interconnections of the Urinary Bladder meridian and the Kidney meridian.

URINARY BLADDER SYMDROMES AND TREATMENT Deficiency Cold in the Urinary Bladder This syndrome is due to both Kidney and Urinary Bladder Yang Deficiency. Clinical manifestations include a pale complexion, lassitude, cold and weak sensations on the lower abdomen that are improved by pressure and warmth, frequent urination and/or possible bed-wetting. The tongue is pale with a white coating, and the pulse is weak and deep. Palpation points: KI-3, BL-10, BL-59, BL-40, and BL-23. Prescription: CV-3, GV-4, BL-28, BL-40, BL-23, BL-65 and LI-2 with reinforcing needle techniques and moxibustion. Damp Heat in the Urinary Bladder This is usually due to retention of pathogenic Dampness and Heat in the Urinary Bladder. Clinical manifestations are frequent and urgent micturition, scanty urination and dysuria, brownish-red urine or hematuria, urinary calculus, often accompanied by fever and lumbago, a red tongue with a yellowish and greasy coating, and a slippery and rapid pulse. Palpation points: CV-3, ST-29, SP-9, and BL-40. Prescription: BL-63, BL-65, BL-40, BL-28, CV-3 and ST-28 with reducing needle techniques.

URINARY BLADDER MERIDIAN SYNDROMES AND TREATMENT Wind-Cold-Damp Pathogenic Influence invading the meridian The main symptoms of the Wind, Cold and Damp Pathogenic Influence in the Urinary Bladder meridian are a painful sensation on the nape of the neck, back, leg, foot, and back of the head. Palpation points: BL-10, BL-7, BL-60, and BL-58. Prescription: BL-67, BL-65, BL-40, KI-7 and GB-34 with reducing needle techniques and moxibustion. Heat stagnated in the Urinary Bladder meridian and traveling upwards Clinical manifestations include a headache, a yellowish color in the eyes, eye tearing, epistaxis and hemorrhoids. Palpation points: BL-39, BL-55, BL-62 Prescription: KI-1, BL-67, BL-63 and KI-4 with reducing needle techniques.

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Zang Fu and Meridian Diagnosis Techniques

LIVER AND GALL BLADDER

LIVER The Liver controls the free-flow of Qi, houses the Blood and dominates the tendons. It has its outward manifestations on the nails and its specific body opening in the eyes. Its expressive emotion is anger, and its associated secretions are tears. The Liver and Gallbladder are Exteriorly-Interiorly related due to interconnections of the Liver meridian of Foot Jue-Yin and the Gallbladder meridian of Foot Shao-Yang.

LIVER SYNDROMES & TREATMENTS Liver Qi Stagnation This is a syndrome characterized by an inability of the Liver to aid in the free flowing of Qi. Emotional depression, abrupt mental irritation and invasion by pathogenic infectors can induce Liver Qi stagnation. Clinical manifestations are emotional depression, irritability, and stuffiness in the chest, frequent sighing and wandering pain with distention in the chest, hypochondriac region and lower abdomen. Further symptoms include the sensation of a foreign body in the throat, which can be neither swallowed nor coughed up, goiter, abdominal masses, and painful distension in the breasts in women, dysmenorrhea, and irregular menstruation. The tongue has a white coating, and the pulse is wiry. Palpation points: LV-13, LV-3, LV-8, and TW-6. Prescription: TW-6, LV-2, BL-18, LV-14, ST-36 and GV-34 with reducing or even movement needle techniques. Liver Fire flaring up This is an excess syndrome of the Liver, which is usually caused by stagnation of the Liver Qi and accumulations of the Heart that turn to fire. Clinical manifestations include dizziness, distended headache, a flushed face, a bitter taste, a dry mouth, restlessness and irritability, insomnia, nightmares, burning pain in the hypochondriac region, constipation, dark urine, tinnitus, otopyorrhea, hematemesis and epistaxis. The tongue is red with a yellow coating, and the pulse is fast and wiry. Palpation points: GV-20, LV-3, LV-5, and LV-14. Prescription: LV-4, GB-38, LV-3, BL-18 and GB-37 with reducing needle techniques. Hyperactive Liver Yang This syndrome is due to a Liver and Kidney Yin Deficiency. (The Kidney water fails to nourish the Liver wood.) It results mostly from Liver Fire due to anger and anxiety, stagnation of Liver Qi, consumption of Yin fluid, and failure of the Yin to counterbalance the Yang. Clinical manifestations are dizziness, tinnitus, distended pain in the head and eyes, a flushed face, conjunctiva congestion, irritability, palpitations, amnesia, insomnia, dreaminess, weakness of the loins and knees and vertigo. The tongue is red with a yellow coating, and the pulse is wiry and thread-like. Palpation points: KI-3, LV-8, BL-23, and BL-18. Prescription: GB-40, LV-5, LV-8, GB-34, BL-18, LV-3 and BL-23

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Acupuncture and Moxibustion—A Clinical Desk Reference

Liver Blood Deficiency This syndrome occurs when the Liver fails in housing the Blood, usually caused by deficiency of both the Spleen and Kidney, massive loss of blood or consumption of Liver Blood due to chronic disorders. Its clinical manifestations are a pale complexion, dizziness, tinnitus, dryness and discomfort of the eyes, poor sight, night blindness, numbness of the limbs, contracture of the tendons and muscles, muscular twitches, colorless nails and scanty light menstruation or even amenorrhea. The tongue is pale, and the pulse is thin and weak. Palpation points: LV-8, LV-3, SP-6, and SP-10. Prescription: BL-17, BL-18, BL-20, BL-23, LV-8, KI-3 and SP-4 with reinforcing needle techniques and moxibustion.

Syndromes of Up-Stirring of Liver Wind Interior Wind caused by an over-flowing of Liver Yang This is a mental disorder that clinically manifests as having a tendency to fall due to dizziness, head shaking due to distended pain, a stiff neck, tremor, aphasia, numbness of the limbs, an abnormal gait or sudden syncope, unconsciousness, facial distortion or even hemiplegia. The tongue is red with a yellow coating, and the pulse is wiry and rapid. Palpation points: LV-3, LI-4, LV-14, and CV-14. Prescription: GB-34, Shi Xuan, LV-2, BL-18, GV-14, GV-20 and LI-4 with reducing needle techniques and bloodletting. Interior Wind resulting from an overabundance of Heat This is usually due to extreme hyperactivity of pathogenic Heat. Clinical manifestations are a high fever, a coma, restlessness, and convulsions of the limbs, a stiff neck, and eyeballs turning upward, lockjaw or even opisthognathous. The tongue is red with a yellow coating, and the pulse is wiry and fast. Palpation points: SP-6, LV-8, and LI-10. Prescription: ST-36, SP-6, GB-34, GV-14, GV-20, LI-4, LV-3, PC-6 and LI-11 with reducing needle techniques. Interior Wind caused by Deficiency of Blood Usually caused by lack of nourishment to the tendons and muscles owing to a Deficiency of Blood stored in the Liver, for clinical manifestations, refer to the section on the syndrome of Deficiency of the Liver Blood. Palpation points: LV-5, LV-8, and LV-12. Prescriptions: SP-6, SP-10, BL-17, BL-19 and LV-3 with reinforcing needle techniques.

LIVER MERIDIAN SYNDROMES AND TREATMENT Wind and Cold Pathogenic Influence stagnated in the Liver meridian This is a syndrome due to retention of Wind-Cold Pathogenic Influence in the Liver meridian. Clinical manifestations are a cold pain in the lower abdomen, with a bearing-down or distended pain in the testes or a dragging-pain in the scrotum upon contraction. Conditions are aggravated by cold and relieved by heat. The tongue is pale with a white greasy coating, and the pulse is deep and wiry. Palpation points: LV-11, LV-12, LV-5, and LV-2. Prescription: CV-4, SP-6, LV-1 and LV-3 with moxibustion and an even-movement needle technique.

28

Zang Fu and Meridian Diagnosis Techniques

GALL BLADDER The function of the gall bladder is to store and excrete bile that is produced, excreted, controlled and regulated by the liver. This is related to the Liver’s function of controlling the normal flow of Qi. Consequently, if the liver functions properly, the gallbladder will excrete bile regularly and freely, and the Spleen and Stomach will also conduct the transportation and transformation functional activities normally. In pathological circumstance, when depression of the Liver Qi leads to an obstruction of excretion of bile, there may appear distending pain in the hypochondriac and abdominal regions, a poor appetite and loose stool. If the bile flows upward, there may appear a bitter taste in the mouth and vomiting of a yellow-green bitter fluid. In the case of an overflow of the bile, jaundice may result. Excess Syndrome Frequently referred to as Gall Bladder fire rising up, its clinical manifestations are distention and pain in the hypochondriac region, a bitter taste in the mouth, ringing ear or even loss of hearing ability, restlessness, angering easily, a headache with red eyes and vomiting of bitter fluids. The tongue is red with a yellow coating, and the pulse is fast and wiry. Palpation points: GB-41, GV-5, and GB-22. Prescription: GB-40, TW-5, LV-3, GV-20, GB-2 and LV-14 with reducing needle techniques. Deficiency Syndrome Due to an insufficiency of the Qi and Blood, clinical manifestations are a tendency to fright, heart palpitations, insomnia and nightmares. The tongue is pale with a thin white coating, and the pulse is thin and weak. Palpation points: GB-25, GB-26, and GB-39. Prescription: BL-19, BL-23, BL-15, HT-7, KI-3, LV-13 and GB-40 with reinforcing needle techniques and moxibustion.

GALLBLADDER MERIDIAN SYNDROMES & TREATMENT Wind-Cold-Damp Pathogenic Influence invading the meridian Clinical manifestations are painful sensations traveling from the hip down to the lateral malleolus along the Gall Bladder meridian with a numb sensation on the fourth toe. Palpation points: GB-20, GB-21, and GB-34. Prescription: GB-30, GB-29, GB-34 and GB-42 with reducing needle techniques and moxibustion. Gall Bladder Heat transfers to the meridian and stagnates the flow of Qi This is a syndrome due to the Heat, which is transferred from the Gall Bladder organ to the meridian. The main clinical manifestations are sighing, belching, a bitter taste in the mouth, hypochondriac pain and deafness. Palpation points: GB-34, GB-41, and BL-19. Prescription: GB-2, GB-43, LV-2, LV-13 and Tai Yang with reducing needle techniques and bloodletting.

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Acupuncture and Moxibustion—A Clinical Desk Reference

PERICARDIUM AND TRIPLE WARMER

PERICARDIUM TCM envisions the Pericardium as the peripheral tissue of the Heart, which enables the Heart to avoid invasion of Pathogenic Influences. For example, in TCM, a high fever, coma or loss of consciousness with a red tongue, occurring during the course of a febrile disease is often described as "an attack on the Pericardium by pathogenic Heat." In fact, the signs and symptoms occurring after the Pericardium has been invaded by external pathogenic factors, are the same as those appearing after the Heart has been attacked. The Pericardium and Triple Warmer (San Jiao) are Exteriorly-Interiorly related due to interconnections of the Pericardium meridian of hand Jue Yin and the Triple Warmer meridian of hand of Shao Yang. PERICARDIUM MERIDIAN SYNDROME AND TREATMENT Acupuncture points in this meridian are used for heart, chest, and peptic diseases as well as mental illness, and for symptoms manifesting along the meridian’s pathway. Qi Stagnation in Pericardium Meridian Symptoms usually are caused by physical injury and mental trauma. Clinical manifestations are cardiac pain, mental restlessness, chest discomfort, palpitations and an oppressed feeling in the chest, and stomach pain. Since the Heart stores the “Shen,” the symptoms related are insomnia, depression, mental illness, epilepsy, anxiousness and panic attack. Palpation points: PC-2, PC-3, and PC-6. Prescription: PC-6, ST-36, and CV-14 with moving the Qi needle techniques. Heat Syndromes retaining in the Pericardium Meridian This syndrome occurs when the Pathogenic Influences invade, or it maybe due to other metabolism problems. Clinical manifestations are swelling of the axilla and spasms of the elbow and arm, wrist injuries, and heat sensations in the palm. Palpation points: PC-7, PC-1, and PC-4. Prescription: PC-8, PC-4, LI-10, and TW-10 with reducing needle technique.

TRIPLE WARMER The Triple Warmer, a general term for the Upper, Middle, and Lower Warmers, is regarded as one of the six Fu bowels. It is generally accepted that the main functions of the Triple Warmer are to pass various kinds of Qi and to circulate body fluids. It is Exteriorly- Interiorly related to the Pericardium by their meridians. The Triple Warmer performs the function of dredging water passages, thereby serving as the pathway for lifting and lowering, entering and exiting of body fluids. Water metabolism is accomplished through the coordination of many organs such as the Lungs, Spleen, Stomach, Intestines, Kidneys and Urinary Bladder, with the Triple Warmer as its passageway so that body fluids can ascend-descend and enter-exit normally. If the water passages of the Triple Warmer are blocked, the distributive and regulative functions of the Lungs, Spleen, Kidneys and others are hard to fulfill.

30

Zang Fu and Meridian Diagnosis Techniques

Deficiency Syndrome of Triple Warmer A syndrome caused by insufficiency of the Kidney Qi, clinical manifestations are a puffy face and a heavy sensation in the whole body, bloating and distention in the epigastric and abdominal regions, rebellion of the Qi with a cold sensation in the abdomen, bed-wetting or urinary incontinence and a swollen and distended sensation in the four extremities. The tongue is swollen and pale with a white greasy coating, and the pulse is thin and deep or deep and weak. Palpation points: TW-4, TW-8, and SP-6. Prescription: TW-3, BL-39, BL-22, CV-5, ST-28, CV-4 and SP-9 with reinforcing needle techniques and moxibustion. Excess Syndrome of Triple Warmer Usually due to the Dampness and Heat stagnated in the Triple Warmer, obstructing the flow of water. Main clinical manifestations are a swollen body with a low-grade fever, bloating and distention in the epigastric and abdominal regions and scanty or turbid urine. The tongue is red with a yellow greasy coating, and the pulse is floating and weak. Palpation points: TW-5, TW-19, and TW-13. Prescription: TW-10, BL-39, BL-22, CV-5 and GV-4 with reducing needle techniques.

TRIPLE WARMER MERIDIAN SYNDROME AND TREATMENT Wind-Cold-Damp Pathogenic Influence stagnated in the meridian Clinical manifestations are painful sensations on the shoulder, arm, elbow and ring finger. Palpation points: TW-3 and TW-13. Prescription: TW-2, TW-5, TW-13 and TW-14 with reducing needle techniques and moxibustion. Heat Stagnation in the meridian This is a symptom due to the Heat Pathogenic Influence, Interior Heat or Heat due to stagnation of the Qi and the seven emotional changes. The main clinical manifestations are a sudden loss of hearing, tinnitus, and a painful and swollen sensation on the outside of canthus, chin, ear and neck, sore throat and hypochondriac pain. The tongue is red with a yellow coating and the pulse is fast. Palpation points: TW-3, TW-6, and TW-10. Prescription: TW-3, TW-5, TW-7, GB-34 and GB-43 with reducing needle techniques and bloodletting.

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Acupuncture and Moxibustion—A Clinical Desk Reference

CHAPTER III: PRESCRIPTION METHODOLOGY

PRINCIPLE INDICATIONS OF THE FOURTEEN MAJOR MERIDIANS Three Hand Yin Meridian Indications Meridian

Indications

Hand Tai Yin

Lung Disorders

Hand Jue Yin

Heart and Stomach Diseases

Hand Shao Yin

Heart Diseases

Indications of Two Meridians

Indications of All Three Meridians Diseases in the chest region

Mental Disorders

Three Hand Yang Meridian Indications Meridian

Indications

Hand Yang Ming

Forehead, nose, mouth, and teeth problems

Hand Shao Yang

Side of the head and problems in the hypochondriac region

Hand Tai Yang

Back of the head, scapular, and mental disorders

Indications of Two Meridians

Indications of All Three Meridians Eye problems Sore throat

Ear problems

Febrile diseases

Three Foot Yang Meridian Indications Meridian Foot Yang Ming

Indications

Indications of Two Meridians

Mental diseases

Forehead, mouth, teeth, throat, Stomach and Intestine problems

Foot Shao Yang

Side of the head, ear, and hypochondriac pain

Foot Tai Yang

Back of the head, back, and organ diseases

Indications of All Three Meridians Febrile diseases

Eye problems

Three Foot Yin Meridian Indications Meridian

Indications

Indications of All Three Meridians

Foot Tai Yin

Stomach and Spleen Diseases

Diseases of the genital region

Foot Jue Yin

Liver problems

OBGYN Diseases

Foot Shao Yin

Kidney, Lung, and throat problems

32

Principle Indications of the Fourteen Major Meridians

Conception and Governing Meridian Indications Meridian Conception Vessel

Indications Reinforcing and building up Yang Qi

Governing Vessel Wind Stroke, coma, febrile diseases, and problems of the head and face

Indications of Two Meridians Organ Disorders Mental Disorders GYN Disorders

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Acupuncture and Moxibustion—A Clinical Desk Reference

THE DISTINGUSHING FEATURES OF THE FOURTEEN MAJOR MERIDIAN INDICATIONS Hand Tai Yin Meridian of the Lung All the points that are located in the Lung meridian can treat the disorders of the Lungs, chest, Stomach and diseases of the regions along the course of this meridian. Lung Disorders Cough: •

LU-1 used for cough by Heat stagnated in the Lung

•

LU-9 used for cough with large amounts of phlegm

•

LU-10 treat dry cough with hemoptysis

•

LU-7 used for cough with sore throat and difficulty speaking.

Hemoptysis: •

LU-5 and LU-10 are effective to treat hemoptysis

•

LU-6 is used for acute hemoptysis

•

LU-10 treats phlegm with bleeding during the cough, and asthma.

Sore throat: •

LU-11 used for swollen and sore throat

•

LU-10 treats sore throat with Heat

•

LU-7 is used for dryness and soreness in the throat.

Stomach and Intestine Problems •

LU-5 treats vomiting

•

LU-9 is used for dry vomiting without anything being expelled

•

LU-10 is used for vomiting and diarrhea during dysentery

•

LU-11 treats vomiting due to Summer Heat stroke.

Hand Yang Ming Meridian of the Large Intestine All of the points that are located in Large Intestine meridian can treat disorders of the head and face, Stomach and Intestine diseases, mental disorders, dermatological disorders, fever, and diseases of the regions along the course of the meridian. Head and Face Problems •

LI-4 is used for any type of disease on the head and face

•

LI-1 is used for mumps and lower toothache

•

LI-2 can treat mumps and eye pain

•

LI-14 is used for any kind of eye problems

•

LI-7 is used for epistaxis

•

LI-20 treats nose diseases and facial paralysis.

34

Distingushing Features of the Fourteen Major Meridian Indications

Lung and Throat Problems •

LI-4 is used for any type of Lung disease

•

LI-1 is effective for cough and asthma, and a sore, swollen throat

•

LI-3 is used for sore throat with a stagnation sensation

•

LI-11 treats sore throat with severe infection

•

LI-18 and LI-19 can treat sudden loss of voice.

Stomach and Intestine Problems •

LI-4 and LI-11 is the main combination point prescription used for Stomach and Intestine problems

•

LI-11 is effective to treat abdominal pain, vomiting, diarrhea, and dysentery

•

LI-8 is the main supplemental point to treat Large Intestine problems

•

LI-9 is the main supplemental point to treat Small Intestine problems.

Mental Disorders •

LI-3 is used for over sleeping

•

LI-5 used for mental disorders, and epilepsy

•

LI-11 is effective for mental disorders and ease to be frightened.

Dermatological Problems •

LI-11 is effective to any kind of skin problems

•

LI-4 is used for Urticaria

•

LI-14 used for eczema.

Fever •

LI-11 is the main point to reduce the fever

•

LI-4 is effective for fever and aversion to cold

•

LI-1 used for high fever with mental symptoms.

Muscular and Tendon Problems •

LI-11 treats muscle contraction in the elbow area

•

LI-15 is used for frozen shoulder

•

LI-4 is effective for numb sensation or dysfunction of the fingers.

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Acupuncture and Moxibustion—A Clinical Desk Reference

Foot Yang Ming Meridian of the Stomach All the points located in Stomach meridian are mainly used for various kinds of diseases such as: Stomach and intestine disorders, mental disorders, blood problems, febrile diseases, cough and asthma, head and face problems and the diseases of the regions along the course of this meridian. Stomach and Intestine Diseases •

ST-36 is the main point for any Stomach and intestine problem.

•

ST-37 and ST-25 are very effective to remedy Large Intestine problems such as: diarrhea or constipation.

•

ST-39 is used for Small Intestine diseases such as: loose stool and dysuria

•

ST-43 used for bloating sensation on the Stomach and the whole abdomen

•

ST-44 can treat bowel movements with blood and pus

•

ST-45 is used for diabetes with symptoms related to hunger.

Mental Problems •

ST-36 is used for dyspnea, manic-depressive disorders, epilepsy, and for those easily frightened or scared.

•

ST-40 is used for mental disorders with crazy laughing and more phlegm.

•

ST-41 is effective to treat mental disorders with crying and sadness.

•

ST-42 is used for mental disorders without hunger and irritability.

•

ST-45 is used for mental disorders with bad nightmares

•

ST-23 and ST-24 treat mental disorders in patients with affinity to move or play with their tongue.

Blood Problems •

ST-14 is used for cough with blood or pus

•

ST-19 and ST-20 treat vomiting of blood

•

ST-25 is used for women with abdominal masses due to Blood stagnation and irregular menstruation.

•

ST-36 is used for Blood stagnation in the chest region and fainting after labor.

•

ST-45 can also treat epistaxis.

Febrile Diseases •

ST-36 is used for hot sensations in the abdominal region and restlessness of the whole body, febrile disease with a heavy sensation in the head, and forehead pain.

•

ST-41 is effective for Stomach Heat with trembling speech

•

ST-37 is used for Heat in the Large Intestine with borborygmus and abdominal pain

•

ST-39 can treat Heat in the shoulder and in front of the ear.

•

ST-41, ST-44, and ST-45 are used for febrile disease without sweat.

Cough and Asthma •

ST-13 is used for cough with rebellious of Qi

•

ST-14 can treat cough with bleeding and pus

•

ST-1 is used for asthma and shortness or breath.

•

ST-36 is effective for chronic asthma in deficiency types.

36

Distingushing Features of the Fourteen Major Meridian Indications

•

ST-40 is used for asthma and cough with large amounts phlegm.

Head and Face Symptoms •

ST-2 treats eye problems, including facial paralysis.

•

ST-3 is effective for twitching of eyelids, deviation of the mouth and eye, and pain in the face.

•

ST-4 is used for facial paralysis, wry mouth, and salivation

•

ST-6 treats deviation of the mouth and eye, toothache, swelling of the cheek, and trismus.

•

ST-8 is used for pain in the eyes and side headache

•

ST-36 and ST-40 are used for dysphasia with more phlegm and inability to speak.

•

ST-41 treats pain on the eyebrow

•

ST-44 treats sore throat and toothache.

Muscular and Tendon Problems •

ST-31 is used for lower back and thigh pain and muscle contraction on the leg

•

ST-34 and ST-35 can treat swelling and pain in the knee with difficulty of movement.

•

ST-41 is used for leg pain and muscle contraction.

Foot Tai Yin Meridian of the Spleen The points of the Spleen meridian usually can be used to treat the all of the five organs’ diseases and Blood problems, including the diseases of regions along the course of this meridian. Spleen and Stomach Diseases •

SP-1 is used for abdominal bloating and acute sudden diarrhea or vomiting

•

SP-2 is used for vomiting with a full sensation in the abdomen and swelling in the four extremities.

•

SP-3 is effective for abdominal bloating with borborygmus, or vomiting, diarrhea, poor appetite, heavy sensation in the whole body and four extremities, paralysis, etc.

•

SP-4 treats the pain in the intestine and face, or head swelling

•

SP-6 is used for epigastria and abdominal area bloating and cramping, poor appetite, heavy sensation in the body with low energy, and paralysis of the legs.

•

SP-9 treats bloating in the abdomen, retention of the urine, and swollen limbs.

•

SP-15 is used for constipation or diarrhea.

Heart Disease •

SP-1 is used for restlessness, heart pain and nightmares

•

SP-2 treats insomnia and heart pain

•

SP-3 is used for heart pain with slow pulse

•

SP-4 is effective for Heart Fire with mental disorders like laughing.

•

SP-5 treats mental disorders, epilepsy and nightmares

•

SP-6 is used for restlessness, insomnia and night emission. 37

Acupuncture and Moxibustion—A Clinical Desk Reference

•

38

SP-15 used for sadness with crying.

Distingushing Features of the Fourteen Major Meridian Indications

Lung Disorders •

SP-1 is used for shortness of breath, asthma and stuffy chest sensations

•

SP-4 treats asthma with cough

•

SP-9 is effective for asthma and shortness of breath with phlegm

•

SP-20 used for cough with large amounts of yellowish or green phlegm.

Liver Problems •

SP-1 is used for infantile convulsion or those in coma

•

SP-3 is used for distention and distending sensation on the chest and hypochondriac region.

•

SP-4 is used for chronic infantile convulsion and hernias pain

•

SP-6 treats genital area pain and hernia pain.

Kidney Problems •

SP-5 is used for infertility, nocturnal emission, and irregular urination.

•

SP-9 treats nocturnal emission, bed-wetting, and retention of urine.

•

SP-6 is effective for enuresis, irregular menstruation, and any kind of urine problems.

Bleeding •

SP-1 treats any kind of acute or chronic bleeding, particularly abnormal menstruation bleeding and pathological bleeding during febrile disease.

•

SP-4 treats bowel movement with bleeding.

•

SP-6 is used for menorrhagia.

•

SP-10 is effective for Blood Heat, urticaria, eczema, irregular menstruation, and Blood stagnation in any part of the body.

Hand Shao Yin Meridian of the Heart The points of the Heart meridian usually treat diseases in the Heart and chest, mental diseases, blood problems, and diseases of the regions along the course of the meridian. Mental Disorders •

HT-3 is used for depressive psychosis, mania, and epilepsy.

•

HT-4 treats sadness and fear, or mental disorders with laughing.

•

HT-7 is used for epilepsy, mental disorders, poor memory, insomnia, and heart palpitation due to fright.

•

HT-9 treats mental disorder or epilepsy in coma.

Heart Diseases •

HT-1 is used for cardiac pain and a stuffy sensation in the chest.

•

HT-6 is used for cardiac pain with night sweating.

•

HT-7 treats cardiac pain with heart palpitations. 39

Acupuncture and Moxibustion—A Clinical Desk Reference

•

HT-8 is used for cardiac pain with restlessness.

•

HT-9 treats chest pain with heat sensations in the mouth.

Blood Problems •

HT-5 is used for profuse menstruation or menorrhagia

•

HT-6 is used for hemoptysis and epistaxis.

Skin Problems •

HT-3 is used for scrofula

•

HT-8 treats itching in the genital area.

Hand Tai Yang Meridian of the Small Intestine The principal indications of the Small Intestine meridian in the clinic are commonly used for diseases of the head, nape, ear, skin, eyes, throat, febrile and mental diseases, and the diseases of the regions along the course of the meridian. Mental Disorders •

SI-2 and SI-3 are used for mental disorders and epilepsy with tense type.

•

SI-4 is used for infantile convulsion.

•

SI-7 treats depressive psychosis, fright, sadness, over thinking and poor memory.

•

SI-8 is effective to treat epilepsy

•

SI-1 is good to treat febrile disease in a coma.

Body Liquid Problems •

SI-1 is used for lack of milk after labor and dry mouth

•

SI-2 treats no milk after labor with tearing and eye pain.

•

SI-3 is used for night sweating

•

SI-4 and SI-5 can treat diabetes.

•

SI-7 is used for diabetes with over drinking

•

SI-17 is used for vomiting with water.

Dermatological Problems •

SI-1 is used for mastitis, sore and swollen throat.

•

SI-3 treats skin disorders with severe itching, swollen, red and itching eyes.

•

SI-5 is effective for scrofula, hemorrhoids, lumps, and eczema.

•

SI-7 treats itching skin and urticaria.

•

SI-8 is used for lumps in the arm with hot and painful sensations.

•

SI-9 and 10 are used for scrofula

•

SI-16 and SI-17 are used for swollen lumps on the neck.

40

Distingushing Features of the Fourteen Major Meridian Indications

•

SI-18 treats lip infection with red, pain and swollen sensations.

Head Problems •

SI-1 and SI-19 are used for tinnitus and deafness with Heat sensations.

•

SI-2 is used for tinnitus and stuffy nose

•

SI-3 and SI-4 are used for blurry vision, eye pain and poor vision.

•

SI-5 treats blurry vision with a dry sensation in the eyes.

•

SI-16 is used for ringing ear and deafness.

•

SI-18 is used for facial pain and paralysis.

Foot Tai Yang Meridian of the Urinary Bladder The points located in this meridian are usually used for all the organ diseases and the diseases of the head, mental aspect, hemorrhoids, tendons, and muscles, including diseases of the regions along the course of this meridian. Zang-Fu Problems •

T-1 to T-6 (including first and second line) can be used for heart and Lung diseases.

•

T-7 to T-12 can be used for Middle Warmer and any digestion system problem.

•

L-1 to S-5 can treat all of the diseases in Lower Warmer including the urinary system and reproductive system diseases and some of digestion system diseases.

•

BL-67 is used for mal-position of the fetus.

Mental Disorders •

BL-8 is used for mental disorders and epilepsy, convulsion and double vision.

•

BL-15 is used for mental disorders, epilepsy, poor memory, and insomnia.

•

BL-16 treats mental disorders with non-stop speaking.

•

BL-11 is used for mental disorders and epilepsy with spasm and convulsion.

•

BL-10 treats epilepsy with a heavy sensation in the head, dizziness and vertigo.

•

BL-60 treats epilepsy with trismus.

Head and Facial Problems •

BL-1 is used for any kind of eye problems.

•

BL-2 treats the pain on the eyebrow and eye problems.

•

BL-6 is used for glaucoma and blurry vision.

•

BL-4 is used for nose problems.

•

BL-7 is effective for dizziness and a heavy sensation in the head.

•

BL-12 is used for sinusitis, stuffy nose, and large amounts of nasal discharge.

Hemorrhoid Problems •

BL-54, BL-57 and BL-58 treat hemorrhoids with swelling and pain.

•

BL-36 and BL-56 are used for hemorrhoids with sticky bowel movement. 41

Acupuncture and Moxibustion—A Clinical Desk Reference

Muscular and Tendon Problems •

BL-2, BL-5, BL-8 and BL-11 are used for muscle tightness and spasm on the head with poor vision.

•

BL-18 is used for tendon and muscle spasm with convulsion.

•

BL-56 treats the leg muscle spasms

•

BL-57 is used for leg spasm related to lower abdominal pain.

•

BL-60 is used for tendon contraction and spasm and BL-62 treats stiffness and hard to move legs and feet.

Foot Shao Yin Meridian of the Kidney Kidney meridian points are usually used for the five Zang organ diseases, particularly for Kidney, urinary system, reproductive system diseases, and diseases of the region along the course of the meridian. Kidney and Urinary Bladder Problems •

KI-1 is used for a cold sensation on the lower extremities, lower back soreness and pain, irregular bowel movement and urination, asthma (indicated by failure in holding the root of the Qi), and dark colored complexion.

•

KI-2 treats urine leakage, cloudy urination, and diabetes

•

KI-3 is effective for irregular stool and urine, shortness of breath, and asthma.

•

KI-4 is used for spinal column pain and lower back pain, and retention of urine

•

KI-5 treats leakage of urine.

•

KI-7 is used for leg edema, pain and burning sensation during urination.

•

KI-8 treats distention in the lower abdomen and bloating.

•

KI-10 is used for difficulty in emptying the bladder and frequent urination with a painful sensation in the genital region.

Reproductive System Problems •

KI-2 is used for prolapsed uterus, infertility, and irregular bleeding.

•

KI-3 treats impotence, nocturnal emission, and pain sensations in the genital region.

•

KI-6 is used for irregular menstruation and leukorrhea with reddish discharge, and a prolapsed uterus.

•

KI-8 treats uterine bleeding, prolapsed uterus, pain and swelling of testes, or amenorrehea.

•

KI-10 is used for impotence, hernia, irregular menstruation, and uterine bleeding.

•

KI-13 and KI-14 are used for irregular menstruation, and leukorrhea with reddish discharge and strong odor as well as uterine bleeding after the labor, hernia, and nocturnal emission.

Lung Diseases •

KI-1 is used for cough with a heat sensation in the whole body, and can also for hemoptysis.

•

KI-2 treats sore and swollen throat with bleeding.

•

KI-3 is used for asthma and cough with shortness of breath.

•

KI-6 treats dry sore throat due to deficiency.

42

Distingushing Features of the Fourteen Major Meridian Indications

Heart Diseases •

KI-1 is used for cardiac pain, and urticaria.

•

KI-2 treats severe chest pain and night sweating.

•

KI-7 is used for night sweating and dry tongue.

•

KI-9 is used for epilepsy with a tendency to playing with the tongue.

Liver Diseases •

KI-1 is used for a mental disorder with crazy anger and mania, loss of consciousness, hernia, and muscle spasms.

•

KI-2 is used for acute infantile omphalitis, tetanus, and lockjaw.

•

KI-6 is used for epilepsy with evening onset and plum-pit Qi.

Spleen Diseases •

KI-2 is used for jaundice, diarrhea, and swelling of the feet.

•

KI-3 treats abdominal bloating with vomiting, poor appetite, and over sleep.

•

KI-7 is used for abdominal bloating, swelling in four extremities and weakness in the legs.

Hand Jue Yin Meridian of the Pericardium The points that are located in the Pericardium meridian can treat mental disorders, Heart and chest problems, Blood disharmonies, Stomach problems, dermatological diseases, and the diseases of the region along the course of this meridian. Mental Disorders •

PC-6 is used for any kind of mental disorder.

•

PC-3 is effective to heart palpitations and tendency for fright.

•

PC-5 is used for epilepsy.

•

PC-7 is used for mental disorders with abnormal laughing.

•

PC-9 is used for coma

•

PC-8 for phlegm stagnated in the Pericardium, and epilepsy.

Heart and Chest Problems •

PC-6 is used for any kind of heart and chest problems, such as heart pain and stuffiness in the chest.

•

PC-5 is used for heart pain and difficulty to speak.

•

PC-7 is used for stiffness and pain in the chest.

•

PC-8 is used for chest pain caused by Phlegm-Fire.

Dermatological Diseases •

PC-4 is used for skin infections.

•

PC-7 is used for itchiness of the skin.

•

PC-8 is used for ulcers in the mouth or on the tongue, and swelling of the gums. 43

Acupuncture and Moxibustion—A Clinical Desk Reference

Blood Symptoms •

PC-4 is used for spitting of blood, and epistaxis.

•

PC-6 is used for a cracked tongue with bleeding.

•

PC-8 is used for any bleeding related to Heat syndromes.

Stomach Problems •

PC-6 is effective to any kind of Stomach and intestine problems.

•

PC-7 is used for vomiting with clear salivation.

•

PC-5 is used for dry vomiting

•

PC-8 is used for foul, severe vomiting.

Hand Shao Yang Meridian of the Triple Warmer The main point indications of the Triple Warmer meridian are diseases of the ears, eyes, hearing, chest, hypochondriac area and throat, febrile diseases, as well as diseases in the regions along the meridian. Five Sense Diseases •

TW-1, TW-2 and TW-16 are used for sudden loss of hearing.

•

TW-3, TW-4, TW-5, TW-6, and TW-17 are used for deafness or tinnitus.

•

TW-21 is used for high-pitched ringing in the ear and water in the ear.

•

TW-1 and TW-6 are used for red eyes.

•

TW-2 is used for swelling and pain of the eye and with more tearing.

•

TW-3 is used for eye pain.

•

TW-2 is used for toothache.

•

TW-1 and TW-16 are effective for sore throat.

•

TW-6 and TW-8 are used for sudden loss of voice.

•

TW-16 is used for sinusitis.

Head and Face Problems •

TW-1 is used for headache, dizziness and cheek pain.

•

TW-3 is used for temporal headache.

•

TW-11 is used for headache with a cold sensation

•

TW-17 is used for facial paralysis.

Mental Disorders •

TW-2 is used for mental disorders of the hyperactivity type.

•

TW-7 is used for epilepsy

•

TW-19 is used for infantile convulsion.

44

Distingushing Features of the Fourteen Major Meridian Indications

Febrile Diseases •

TW-1 is used for febrile disease in coma.

•

TW-3 and TW-6 is used for febrile disease without sweating.

•

TW-5 is used for febrile diseases with alternative hot and cold sensations.

Foot Shao Yang Meridian of the Gall Bladder The points located in the Gall Bladder meridian are commonly used for head, eye, ear, throat, and mental problems, as well as diseases in the regions along the meridian. Head and Face Problems •

GB-20 is used for any kind of head and face problem.

•

GB-2 used for ear problems and toothache.

•

GB-3 is used for ringing in the ear, and temporal headache.

•

GB-4 and GB-5 are used for migraine headache.

•

GB-12 is used for stiff neck and facial paralysis.

•

GB-16 and GB-37 are used for eye problems.

•

GB-45 is used for deafness and severe headache.

Mental Disorders •

GB-38, GB-12, GB-18 and GB-9 are used for epilepsy.

•

GB-13 is used for epilepsy with coma

•

GB-45 is used for nightmares.

Liver and Gall Bladder Problems •

GB-23 and GB-24 are used for distention and a painful sensation on the hypochondriac region, as well as jaundice.

•

GB-34 is effective for bloating and distending pain in the hypochondriac and abdominal area with nausea, poor appetite, jaundice or even severe pain in the Gall Bladder.

Gynecology Problems •

GB-20 is used for difficult labor and mastitis.

•

GB-26 is used for morbid leukorrhea and irregular menstruation.

•

GB-24 is used for profuse bleeding during the menstruation.

Muscle and Tendon Problems •

GB-20 is used for facial paralysis and stiff neck.

•

GB-21 is used for stiff neck, back and shoulder pain.

•

GB-29 and GB-30 are effective to treat lower back and leg pain as well as Bi syndrome and paralysis.

•

GB-34 is used for tendon problems anywhere in the body and lower extremity pain, paralysis, and numbness. 45

Acupuncture and Moxibustion—A Clinical Desk Reference

•

GB-31 is used for numb and tingling sensations on the lower leg.

•

GB-39 is used for pain and weak sensations on the leg and foot.

Foot Jue Yin Meridian of the Liver The Liver meridian is mainly used for diseases of the Liver and other Zang organs, gynecological diseases, external genitalia problems and diseases in the regions along the meridian. Liver and Gall Bladder Problems •

LV-1 is used for hernia, infantile epilepsy, prolapsed uterus, and pain in the genital area.

•

LV-2 is used for hernia, chest, and hypochondriac pain, ease to anger, headache, dizziness and vertigo, epilepsy, and acute convulsion.

•

LV-3 is used for epilepsy, hernia, eye problems and pain in the genital area.

•

LV-6 is used for metrorrhagia.

•

LV-13 is used for those with a tendency to anger easily, and pain in the chest and coastal region.

•

LV-14 is used for hypochondriac pain and acid regurgitation.

Heart Diseases •

LV-1 is used for coma and heart pain.

•

LV-2 is used for heart pain and blood tinged vomiting.

•

LV-8 is used for insomnia and epilepsy.

Lung Diseases •

LV-2 is used for cough with rebellion of Qi and body fever.

•

LV-3 is used for sore and dry throat.

•

LV-4 is used for dry throat and aversion to cold.

•

LV-13 is used for cough with shortness of breath.

Spleen Problems •

LV-1 is used for over sleep due to Spleen Qi deficiency and also treats metrorrhagia.

•

LV-2 is used for diarrhea or loose stool, and abdominal bloating.

•

LV-3 is used for edema, jaundice, and diarrhea.

•

LV-6 is used for Intestinal deficiency.

•

LV-13 is used for borborygmus and abdominal bloating, poor digestion, lassitude, and jaundice.

Kidney Problems •

LV-1 is used for slow bowel movement.

•

LV-3 is used for bed-wetting or retention of urine, as well as edema of the foot, and low sexual ability in men.

•

LV-8 is used for irregular urine, itchiness in the genital area, and prolapsed uterus.

•

LV-13 is used for cloudy urine and back pain due to deficiency.

46

Distingushing Features of the Fourteen Major Meridian Indications

Governing Vessel The Governing Vessel treats mental diseases, febrile diseases, local diseases of lumbosacral region, back, head and neck, and the corresponding spinal vertebre: •

L-2 to S-5 are used for lower abdomen, urine, and reproductive system problems

•

T-7 to L-2 are used for Middle Warmer problems related to Liver, Gall Bladder, Spleen and Stomach problems

•

T-2 to T-7 are used for Upper Warmer problems related to Heart, Lung, upper extremity and mental diseases.

•

GV-13 and GV-14 are used for Heat diseases caused by Pathogenic Influence.

•

GV-15 to GV-20 are used for Interior and Exterior Wind problems.

•

GV-20 to GV-24 are used for mental problems.

•

GV- 25 and Gv.26 are used for emergency situations.

Conception Vessel The points located in Conception Vessel are used for local diseases of the abdomen, chest, neck, head and face, and diseases of the corresponding internal organs. A few points of this meridian have reinforcing effects and can be used to treat mental diseases. The points located below the navel: •

CV-3 is used for urine problems

•

CV-4 is used for the Zang organ deficiencies and gynecological problems.

•

CV-5 is used for Triple Warmer problems

•

CV-6 is used for any kind of Qi problem such as: Qi deficiency and Qi stagnation.

•

CV-8 is used with moxibustion for abdominal pain and vomiting or diarrhea due to Yang Qi deficiency.

Upper abdomen points: •

CV-9 is used for edema and irregular urine

•

CV-12 is used for Spleen and Stomach problems

•

CV-14 is used for Heart diseases

•

CV-15 is used for epilepsy

Points located in the chest area: •

Treat Heart and Lung diseases such as: stuffy sensation in the chest, heart palpitations, chest pain, shortness of breath, cough, etc.

•

CV-17 regulates the Qi and also can help to increase a mother’s milk production.

Points located on the neck and face: •

CV-22 is used for asthma, cough, and Plum-pit Qi

•

CV-23 is used for sore throat and stiffness of the tongue due to stroke

•

CV-24 is used for facial paralysis with salivation

47

Acupuncture and Moxibustion—A Clinical Desk Reference

BASIC CONCEPT OF ACUPUNCTURE POINTS The Classification of Points Acupuncture points are the sites through which the Qi of the Zang Fu and channels is transported to the body surface. Acupuncture points fall roughly into three categories: the14 main meridian points, the extra-points, and Ah Shi points. These are described as follows: Fourteen Main Meridian Points: These points are distributed along the twelve regular meridians as well as the Governing and Conception meridians and make up the majority of acupuncture points. They have regular locations and regular names pertaining to the meridians. Extra-points: These are points with regular names and regular locations but do not belong to the 14 regular meridians. There have specific indications for the treatment of certain diseases. Ah Shi Points: They have no specific names or definite locations. These tender spots and other sensitive areas are places for needling and moxibustion. Treatment Effects of Acupuncture Points The therapeutic properties of acupuncture points manifest themselves in the following three aspects. Local and adjacent therapeutic properties: All the points in the body share common features in terms of their therapeutic properties. Each point located on a particular site is able to treat disorders of this area and nearby tissues and organs. Distant therapeutic properties: These are the basic therapeutic properties of the points along the 14 meridians. The points of the 14 meridians, especially those of the 12 regular meridians, are located below the elbow and knee joints. They are effective not only for local disorders, but also for disorders of the tissues and Zang Fu, as far as the course of their pertaining meridians can reach. Some even have systemic therapeutic properties. For example, ST-36 (Zu San Li) not only treats problems of the lower extremities, but also regulates the whole digestive system and can even increase the body’s energy and immunity. Special therapeutic properties: Needling certain special points may bring forth biphasic beneficial regulation on a variety of functional abnormalities of the body. For instance, needling ST-25 relieves both diarrhea and constipation. In addition, the therapeutic properties of some points show relative specificity, e.g. GV-14 has an antipyretic effect, and BL-67 helps correct the mal-position of a fetus.

48

Point Selection

POINT SELECTION Selection of Local and Adjacent Points There is a method of selecting acupuncture points locally or adjacent to the diseased area, and it’s usually applied for head or body problems. There are two techniques used in the clinic: Local Ah Shi points: Palpate the local area of the disorder and look for two different reactions to take place: pain from the pressure, or pain reduced by the pressure. Both provide reactions of good local Ah Shi points. Adjacent points: This is a point, which is nearby the organs or tissue area of the disorder. Usually, they are along the 14 regular meridian points. Examples are BL-1, ST-1 and GB-1 for eye problems. CV-12, BL-21, and ST-20 are good adjacent points for Stomach pains. Selection of Distal Points This is the method of treating diseases by using areas quite distant to the diseased area. Distant points are far from the diseased area that are related to the affected area either directly or indirectly through the meridian system. Selecting points following the diseased meridian: ST-36, for example, treats Stomach pain, as it is located on the Stomach meridian as well as being the Stomach meridian’s special Lower He-sea point. Selecting points according to the external and internal relationship: GB-37 treats eye problems as the eyes are seen as the window of the Liver, and the Gall Bladder and Liver have an internal-external relationship. Selecting points according to the Zang-Fu diagnosis: GV-20, for example, treats prolapsed rectum or uterus because it is located in the Governing meridian and can lift up the prolapsed Qi. Selecting points following the same name meridian: Treat the disease of the body’s left side with points from the right and disease of the right side of the body with points from the left along the same meridian. The bilateral meridian is full of the same Qi and blood. Those are described in the Classical Book, the “Nei Jing,” as Ju Ci and Liao Ci. Selecting points according to the special acupuncture technique: Ear or scalp acupuncture, for example, treats organ disorders or other disharmonies in any area of the body because it is one kind of special acupuncture technique belonging to one kind of micro-system. The four extremities and head points treat organ disorders in such a fashion as well.

49

Acupuncture and Moxibustion—A Clinical Desk Reference

APPLICATIONS OF SPECIAL ACUPUNCTURE POINTS Special points refer to those of the 14 regular meridians that have specific therapeutic properties. They have their special names given according to their different indications and functions. Application of the Five-Shu Points These are five points on each of the twelve regular meridians, namely the Jing-Well point, the Ying-Spring point, the Shu-Stream point, the Jing-River point, and the He-Sea point. •

Jing-well points treat symptoms of fullness in the epigastric region, which is caused by Liver Qi stagnation failing in controlling the flow of Qi, or attacking the Stomach and Spleen. Sometimes it’s commonly used for unconsciousness or mental disorders that are due to stagnation in the Heart.

•

Ying-spring points treat body Heat and fever, or Interior Heat due to Heart Fire flaming up.

•

Shu-stream points treat heaviness and joint pain caused by the Spleen’s failure to transport and transform, leading to stagnation of the retained water in the body and muscles.

•

Jing-river points treat Dyspnea, cough and alternating cold and heat caused by the Lung’s failing in ascending and descending and all other meridians problems.

•

He-sea points treat all the organ problems, and the adverse flowing and leaking of the Qi caused by the Kidney’s failure to hold or retain the Qi.

The Five Shu points are located below the knee and elbow joints and are very often used to treat symptoms throughout the whole body, as well as local areas. In the ancient times, most treatments applied the Five Phase Theory, utilizing the Five Shu-transporting points. The main techniques are as follows: Reinforcing the mother and reducing the son on the same meridian: For example, if the Lung meridian is Excess, reduce LU-5 (Water is the son of Metal—the water point on the Metal meridian). If Deficient, reinforce LU-9 (Earth is the mother of Metal—the Earth point on the Metal meridian.) Reinforcing and reducing techniques on the mother and son related meridians: There are two techniques in this relationship. First, for example, if the Lung is Deficient, select the mother meridian (the Spleen) of the Lung and choose the mother point on the mother meridian—SP-3 (Earth point on the earth meridian) and apply a reinforcing needle technique. Otherwise, select the mother point on the Exteriorly and Interiorly related meridian (LI-11, the Earth point on the LI channel) and apply a reinforcing needle technique. The Five Shu Points of the Yin Meridians Meridian

Jing-Well

Ying-Spring

Shu-Stream

Jing-River

He-Sea

Wood

Fire

Earth

Metal

Water

Lung

LU-11

LU-10

LU-9

LU-8

LU-5

Pericardium

PC-9

PC-8

PC-7

PC-5

PC-3

Heart

HT-9

HT-8

HT-7

HT-4

HT-3

Spleen

SP-1

SP-2

SP-3

SP-5

SP-9

Liver

LV-1

LV-2

LV-3

LV-4

LV-8

Kidney

KI-1

KI-2

KI-3

KI-7

KI-10

50

Point Selection

The Five Shu Points of the Yang Meridians Meridian

Jing-Well

Ying-Spring

Shu-Stream

Jing-River

He-Sea

Wood

Fire

Earth

Metal

Water

Large Intestine

LI-1

LI-2

LI-3

LI-5

LI-11

Triple Warmer

TW-1

TW-2

TW-3

TW-6

TW-10

Small Intestine

SI-1

SI-2

SI-3

SI-5

SI-8

Stomach

ST-45

ST-44

ST-43

ST-41

ST-36

Gall Bladder

GB-44

GB-43

GB-41

GB-38

GB-34

Bladder

BL-67

BL-66

BL-65

BL-60

BL-40

Applications of the Five Shu Points with the Seasons Season

Layer of the Body Qi

Selection of Points

Summer

Superficial Layer

Jing-Well

Spring Fall

Ying-Spring Deep Layer

Shu-Stream

Winter

He-Sea

Application of the Yuan-Source Points Yuan points can be found in both Yin and Yang meridians. The twelve Yuan-Source points are used for organ disorders. The Nei Jing says: “when organs are diseased, apply the 12 Yuan points.” The Twelve Yuan-Source Points Yin Meridians

Yuan-Source

Yang Meridians

Points

Yuan-Source Points

Lung

LU-9

Large Intestine

LI-4

Heart

HT-7

Small Intestine

SI-4

Pericardium

PC-7

Triple Warmer

TW-4

Spleen

SP-3

Stomach

ST-42

Kidney

KI-3

Bladder

BL-64

Liver

LV-3

Gall Bladder

GB-40

51

Acupuncture and Moxibustion—A Clinical Desk Reference

Yuan and Luo Point Prescriptions: This treats disease in both Exterior and Interior related meridians. The Yuan point addresses the disease as the main point and the Luo point as supplemental point. For example, the patient has the Lung meridian symptoms such as: cough, asthma, shortness and breath and fullness sensation in the chest. At the same time, he has some Large Intestine meridian symptoms such as: fever, headache, abdominal bloating, borborygmus, and irregular bowel movements. The LU-9 (Lung meridian Yuan point) will be used with the LI-6 (Large Intestine meridian Luo point). This prescription also addresses problems in one meridian only, when the patients with weak body constitutions. For example, use LU-9 (Lung Yuan source point) with reinforcing technique and LU-7 (Lung Luo connecting point) with a reducing technique to treat chronic cough with shortness of breath and stuffy sensation in the chest. Yuan and Back-Shu Point Prescriptions: This is commonly used for the treatment of organ disorders. For instance, LV-3 (Yuan point of Liver meridian) and BL-18 (Back Shu point of Liver) as the group can soothe the Liver and regulate the stagnation of the Qi. It is very effective for Liver stagnation, resulting in: abdominal distention and distending sensation in the chest and hypochondriac region, a bitter taste in the mouth, a tendency for anger, headache, insomnia and nausea. Yuan and He-sea Point or Lower-He-sea Point Prescriptions: There are different techniques in order to apply this in a clinical situation. Selecting points according to the Exterior and Interior relationship of their meridians. For example, choice SP-3 (Yuan point of Spleen meridian) and ST-36 (He-sea point of Stomach meridian) can treat anorexia, nausea, vomiting or diarrhea whish caused by disharmony of Spleen and Stomach. On the other hand, select LU-9 (Yuan point of Lung meridian) and ST-37 (LowersHe-sea point of Large intestine) to treat constipation that in this case is caused by the result of a cold or flue like symptom. Which will increases the body temperature and decreases the body fluids in the intestinal tract causing the drying of bodily waste. This is prescription of Yuan and Lower-He Sea point. There were two sentences to describe He-sea and Source Yuan point combination in the Nei Jing, “The He-sea treats organ diseases, and when the disease is in the organs, use the Source Yuan point.” Which means both of the Yuan and He-sea points can treat organ disorders. For instance LI-4 (Yuan point of Large Intestine meridian) and LI-11 (He-sea point of large intestine) can treat wind heat symptoms, such as high fever, headache, and sore throat. Selecting points according to organ diagnosis. For example, LV-3 (Yuan point of liver meridian) and ST-36 (He-sea point of Stomach meridian) can treat the syndrome of liver Qi attacks Stomach, such as: abdomen bloating, pain sensation on the epigastric region, nausea, vomiting and poor appetite or diarrhea.

52

Point Selection

Application of the Luo-Connecting Points Luo points are usually used for the treatment of both Exterior and Interior related meridians, because of its connection function. For example, ST-40 (Luo-connecting point of Stomach meridian) can treat not only the disease of the Stomach meridian, but also those of the Spleen meridian. On the other hand, TCM thinks long term or chronic diseases often transfer to Luo meridians, where there are a lot small Luo Mai (including Blood Luo) in each organ and tissues that become stagnated after long term disease developed from Blood stagnation inside of the organ or tissues. So the Luo Meridian can treat chronic diseases is an advanced technique in TCM. The Fifteen Luo-Connecting Points Meridian

Luo-Point

Meridian

Luo-Point

Lung

LU-7

Pericardium

PC-6

Large Intestine

LI-5

Triple Warmer

TW-5

Stomach

ST-40

Gall Bladder

GB-37

Spleen

SP-4

Liver

LV-5

Heart

HT-5

Conception Vessel

CV-1

Small Intestine

SI-7

Governing Vessel

GV-1

Bladder

BL-58

Major Spleen

SP-21

Kidney

KI-4

Application of Back-Shu and Front-Mu Points The Back-Shu and Front-Mu points are the sites at which the Qi of the Zang-Fu are concentrated. The Back-Shu points are mainly used to treat the problems of the Five Zang-organs. Nan Jing Chapter 67 says: “Needle the Yang (Back-Shu points) to treat the Yin diseases. Because those points are on the Yang side of the body, Back Shu points are located on the Bladder Meridian of the Foot Tai Yang, bilateral to the spinal column on the back. Most of them are situated close to their respective ZangFu. So the Back Shu points present abnormal reactions, such as tenderness, burning or painful sensations, representing the dysfunction of their corresponding Zang-Fu. They are very significant in the diagnosis and treatment of the disorders corresponding to the Zang-Fu. For instance, BL-18 can treat some symptoms that are caused by dysfunction of the Liver organ, such as: Liver Qi stagnation, Liver Yang rising, or Liver Blood deficiency. The Twelve Back Shu Points Yin

Back-Shu

Yang

Back-Shu

Organs

Points

Bowels

Points

Lung

BL-13

Large Intestine

BL-25

Heart

BL-15

Small Intestine

BL-27

Pericardium

BL-14

Triple Warmer

BL-22

Spleen

BL-20

Stomach

BL-21

Liver

BL-18

Gall Bladder

BL-19

Kidney

BL-23

Bladder

BL-28

53

Acupuncture and Moxibustion—A Clinical Desk Reference

The Twelve Front-Mu Points Yin

Front-Mu

Yang

Front-Mu

Organs

Points

Bowels

Points

Lung

LU-1

Large Intestine

ST-25

Heart

CV-14

Small Intestine

CV-4

Pericardium

CV-17

Triple Warmer

CV-5

Spleen

LV-13

Stomach

CV-12

Liver

LV-14

Gall Bladder

GB-24

Kidney

GB-25

Bladder

CV-3

The Front-Mu points are mainly used to treat problems of the six Fu-bowels. They are located close to their corresponding bowels. There are some abnormal reactions during meridian palpation, such as tenderness and pain often in its corresponding Front-Mu point if the bowel is diseased. Nan Jing Chapter 67 says: “Yang disease, treat the Yin side.” This means to treat the Yang Fu-bowels disease by using the Front-Mu points. For instance, epigastric pain is very commonly treated by CV-12 (Front-Mu point of Stomach). Bowel movement problems and urinary problems are commonly treated using CV-3 and ST-25 (Front-Mu point of the Large Intestine and Urinary Bladder). Besides treating the Six Fu-bowels using the Front Mu points, it is very common to use it in combination with other points such as the Back Shu points and the Six Lower He-sea points (Xia He Xue). Front-Mu and Back Shu Point Prescriptions: This is often called Yin and Yang Combination Prescriptions. There are two techniques applied in the clinic: One is used for a single Zang or Fu problem, for example, for the treatment of Spleen deficiency with abdominal bloating, lassitude, loose stool and pain reflected to the middle of the back. Needle BL-20 first then needle LV-13. This is a typical case of using a Front-Mu and Back-Shu point prescription. Treating related organs after diagnosis is the other method frequently used in the clinic. For example, fore retention of urine caused by Kidney Qi deficiency, needle the Front-Mu CV-3 first to move the Urinary Bladder Qi and then needle BL-23 to warm the Kidney Qi. This technique is usually applied for Exterior and Interior related meridians. Front-Mu and Lower He-sea Point Prescriptions: This combination is used for Six Fu-bowel Excess or Heat diseases. For example, when patients suffer from severe Stomach pain caused by improper food intake, select CV-12 (Front-Mu of the Stomach) combined with ST-36 (Lower He-sea of the Stomach meridian). When patients have bad Gall Bladder pain, use GB-24 and GB-34 with a dispersive needle technique.

54

Point Selection

Application of Lower He-Sea Points—Xia He Xue The application of the Lower He-Sea points is mainly used for the Six Fu-bowel problems. In the Nei Jing it states, “ The He-Sea points can treat the disorders of Six Fu-bowels.” According to this theory, the Lower He-sea points are selected to treat the diseases of their respective Fu-bowels. For example, BL-40 (Lower He-sea point of Urinary Bladder) can be used to treat acute Urinary Tract Infection. The Six Lower He-Sea Points Six Bowels

Stomach

Large Intestine

Small Intestine

Gall Bladder

Bladder

Triple Warmer

Points

ST-36

ST-37

ST-39

GB-34

BL-40

BL-39

Application of the Sixteen Xi-Cleft Points Each of the 12 regular meridians has one Xi (Cleft) point. In addition, within the 8 extra meridians, only the Yin Wei, Yang Wei, Yang Qiao and Yin Qiao meridians have their own Xi (Cleft) point. Totally, there are 16 Xi (Cleft) points. The Xi (Cleft) points are used primarily in the treatment of acute diseases appearing in their corresponding meridians, organs, and bowels. Xi (Cleft) points in the Yin meridians are mainly used for treating Blood syndromes and in the Yang meridians they are used to treat acute pain syndromes. For instance, LU-6 is effective to hemoptysis or vomiting of blood, KI-5 commonly treats irregular menstruation, ST-34 is mainly used for acute Stomach pain, and SI-6 is effective for acute lower back pain. The Xi (Cleft) point can be singly selected or combined with other points. For example, ST-34 (Stomach meridian Xi-cleft point) and CV-12 (Front-Mu point) are effective in the treatment of acute Stomach pain. The Sixteen Xi-Cleft Points Meridians

Points

Meridians

Points

Lung

LU-9

Small Intestine

SI-6

Pericardium

PC-4

Gall Bladder

GB-36

Heart

HT-6

Bladder

BL-63

Kidney

KI-5

Triple Warmer

TW-7

Liver

LV-6

Yin Wei

KI-9

Spleen

SP-8

Yang Wei

GB-35

Stomach

ST-34

Yin Qiao

KI-8

Large Intestine

LI-7

Yang Qiao

BL-59

55

Acupuncture and Moxibustion—A Clinical Desk Reference

Application of the Eight Influential Points The Eight Influential Points refer to eight specific points at which the vital essence of the Zang, Fu, Qi, Blood, Tendons, Pulse/Vessels, Bone and Marrow are concentrated. In clinical application, their respective influential points may treat all the diseases related to these eight aspects. The Eight Influential Points Eight Influences

Points

Specific Points

Zang

LV-13

Front-Mu of Spleen

Fu

CV-12

Front-Mu of Stomach

Qi

CV-17

Front-Mu of Pericardium

Blood

BL-17

Bladder Meridian

Tendon

GB-34

Lower He-Sea of Gall Bladder

Pulse

LU-9

Source Point of the Lung

Bone

BL-11

Bladder Meridian

Marrow

GB-39

Gall Bladder Meridian

Indications of the Eight Influential Points Influential Point of the Zang Organs: LV-13. Used for abdominal bloating, borborygmus, hypochondriac pain, masses in the abdomen, cold and painful sensations in the lower back and spinal region, frequent cloudy white urine, and any kind of organ disease, particularly for treating disorders of the Liver and Spleen. Influential Point of the Fu Bowels: CV-12. Used for abdominal bloating, Stomach pain and poor appetite, vomiting, diarrhea, dysentery, jaundice, particularly for digestion system problems such as Stomach, Large Intestine and Small Intestine diseases. Influential Point of the Qi: CV-17. Used for treating stuffiness in the chest or chest pain, cough, shortness of breath, hiccup, rebellious of the Qi, and other Qi problems. It’s very often used with other points in the clinic. For example, apply CV-17 with CV-12 for vomiting, with PC-6 for angina, with BL-13 for asthma, and with SI-1 for lack of milk after labor. Influential point of Blood: BL-17. Used for any kind of Blood problems such as anemia, dizziness, etc. It is very effective for anemic patients, for bleeding in accordance with BL-20, for GYN problems with BL-23, and for Heart Blood stagnation, or chest pain with BL-14. Influential point of Tendons: GB-34. Used to treat paralysis, contraction, and numb sensations on the lower extremities. It is also effective for some Gall Bladder and Liver problems such as: distension and distending sensation on the chest and hypochondriac region, bitter taste in the mouth, vomiting, and lassitude. Influential Point of Pulse-vessels: LU-9. The Heart dominates the pulse and the Lung controls all of the pulse, this is why LU-9 is mainly used for Heart and Lung organ problems such as: Chest Bi syndrome, Heart disease, choppy pulse, cough and asthma.

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Point Selection

Influential Point of the Bones: BL-11. Used for stiffness and painful sensations on the neck and shoulder area, back pain, and difficult movement, heavy sensation in the head, and problems in the scapular region. It is also effective for Pathogenic Influences such as: fever, headache, and cough. Influential Point of the Marrow: GB-39. Used for Wind stroke, dysfunction of the four extremities, muscle and bone problems. Also use GB-39 with moxibustion technique to be able to prevent Wind stroke because in Traditional Chinese Medicine, it is said that the brain is the Sea of Marrow. Nan Jing chapter 45 says: “ Interior Heat disease, select the Influential points.” For example, to treat constipation caused by Interior Heat and damage of the Large Intestine fluids, use CV-12 with ST-25. And when treating Liver Yang rising in a patient with red complexion and hypochondriac pain, select GB-34 with LV-3.

Application of the Eight Confluence Points The Eight Confluence Points refer to the eight special points where the eight extra meridians communicate with the twelve regular meridians. All of them are distributed on the areas superior and inferior to the wrist joint and ankle joints. They are all regular twelve meridian points and also they all connect to the eight extra meridians. That is why they not only treat twelve regular meridian problems, but also treat the eight extra meridian problems. The Eight Confluence Points Eight Meridians

Points

Indications

Chong-mai

SP-4

Heart, chest, Stomach, Liver, or Spleen diseases

Yin Wei

PC-6

Dai-mai

GB-41

Yang Wei

TW-5

Governing Vessel

SI-3

Yang Qiao

BL-62

Conception Vessel

LU-7

Yin Qiao

KI-6

Outer canthus, ears, neck, nape, side of the body, and alternation of cold and heat Inner canthus, ears, neck, scapula, back, fever, and aversion to cold. Chest, Lung, throat, diaphragm, Liver, Kidney, and Interior Heat due to Yin Deficiency

Single Point Technique: SP-4 communicates with the Chong Mai, in order to treat both Spleen and Chong Mai problems such as irregular menstruation with loose stool, poor appetite, and a weak sensation in four extremities and body. Combination Point Technique: Choose a group of special confluence points, each one from the upper and lower extremities. For example, SP-4 and PC-6 as a group prescription to treat Stomach, Heart and chest problems; TW-5 and GB-41 as a group prescription to treat diseases which are located on outer canthus, face, shoulder, and also for alternating cold and hot sensations.

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Acupuncture and Moxibustion—A Clinical Desk Reference

Application of Crossing-Meeting Points Crossing points refer to a single point where two or more meridians intersect. Most of them are distributed on the head, face and body. They are used to treat disorders related with more than one meridian. Crossing Points Meridians

Points

Crossing Meridians

Hand Taiyin Lung

LU-1

LU & SP

Hand Yangming Large Intestine

LI-14 LI-15 LI-16

LI-SI-BL-Yang Wei LI-TW-SI-Yang Qiao LI-Yang Qiao

LI-20

LI-ST

Foot Yangming Stomach

ST-1 ST-3 ST-4 ST-6 ST-8 ST-9 ST-30

ST-Yang Qiao-CV ST-LI-Yang Qiao ST-LI-Yang Qiao-CV ST-GB ST-GB-Yang Wei ST-GB ST-Cong Mai

Foot Taiyin Spleen

SP-6 SP-12 SP-13 SP-15 SP-16

SP-LV-KI SP-LV-Yin Wei SP-LV-KI-ST-Yin Wei SP-Yin Wei

Hand Taiyang Small Intestine

SI-17 SI-10 SI-12 SI-18 SI-19

SI-TW SI-BL-Yang Wei-Yang Qiao SI-ST-GB-TW SI-TW SI-GB-TW

Foot Taiyang Bladder

BL-1 BL-11 BL-12 BL-41 BL-31 BL-33

BL-SI-GB-TW-ST-Yang Qiao BL-SI-GB-TW-GV BL-GV BL-SI BL-GB BL-GB-LV

BL-34 BL-59 BL-61

BL-Yang Qiao

BL-62 BL-63

BL-Yang Wei

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Point Selection

Foot Shaoyin Kidney

KI-6 KI-8 KI-9 KI-11 KI-12 KI-13 KI-14 KI-15 KI-16 KI-17 KI-18 KI-19 KI-20

KI-Yin Qiao KI-Yin Wei

KI-Cong Mai KI-Cong Mai

Hand Jueyin Pericardium

PC-1

PC-TW-GB

Hand Shaoyang Triple Warmer

TW-13 TW-15 TW-17 TW-20 TW-22 TW-23

TW-LI-Yang Wei TW-GB-Yang Wei TW-GB TW-GB-LI-SI TW-GB-SI TW-GB

Foot Shaoyang Gall Bladder

GB-1 GB-2 GB-3 GB-4 GB-5 GB-6 GB-7 GB-8 GB-9 GB-10 GB-11 GB-12 GB-13 GB-14 GB-15 GB-16 GB-17 GB-18 GB-19 GB-20 GB-21 GB-22 GB-24 GB-26 GB-27 GB-28 GB-29 GB-30 GB-35

GB-TW-SI GB-TW GB-TW-ST GB-TW-LI GB-BL GB-TW-BL GB-BL GB-Yang Wei GB-TW-LI-Yang Wei & Yin Wei GB-BL-Yang Wei GB-Yang Wei GB-TW-Yang Wei GB-TW-ST-Yang Wei GB-BL GB-SP-Yang Wei GB-Dai Mai GB-Yang Wei & Yang Qiao GB-BL-Yang Wei GB-Yang Wei 59

Acupuncture and Moxibustion—A Clinical Desk Reference

60

Foot Jueyin Liver

LV-13 LV-14

LV-GB-Dai Mai LV-SP-Yin Wei

Governing Vessel

GV-1 GV-4 GV-13 GV-14 GV-15 GV-16 GV-17 GV-20 GV-24 GV-26 GV-28

GV-BL-GB-KI GV-Dai Mai GV-BL GV & all Six Yang Meridians GV-Yang Wei GV-BL-Yang Wei GV-BL GV-LV & all Six Yang Meridians GV-BL-ST GV-LI-ST GV-CV-ST

Conception Vessel

CV-1 CV-2 CV-3 CV-4 CV-7 CV-10 CV-12 CV-13 CV-17 CV-22 CV-23 CV-24

CV-GV-Cong Mai CV-LV CV & Three Foot Yin Meridians CV-Cong Mai-ST & Three Foot Yin Meridians CV-Cong Mai-KI CV-SP CV-ST-SI-TW CV-ST-SI CV-SP-KI-SI-TW CV-Yin Wei CV-GV-LI-ST

Commonly Used Acupuncture Points For Specific Indications

COMMONLY USED ACUPUNCTURE POINTS FOR SPECIFIC INDICATIONS These effective acupuncture points are all selected from ancient prescriptions. Most of them are abstracted from the Jing, Yuan, Ming and Qing dynasties, and some of them from the classic books: Nei Jing and Nan Jing. After a few thousand years, they all still play an important role in the acupuncture clinic and are still a service in modern society. Qi Any kind of Qi problem: Needle CV-6 or apply moxibustion, according to different symptoms. Rebellious Qi: LU-5, SP-5, SP-3, and SP-6 with a reducing needle technique. Sighing with rebellious Qi: LU-9, HT-7 with even movement needle technique. Shortness of breath: PC-7, LU-5 with a reducing needle technique for Excess types. GV-12, BL-13, CV-8, BL-18, LU-10 with moxibustion for Deficiency types. Weakness of Qi: Use PC-5, HT-7, PC-7, HT-8, ST-36, LI-9, LV-2, KI-2, BL-67, BL-18, and CV-6 with needle or moxibustion technique. Stagnation of the Qi in the Stomach: Use moxibustion on LV-3 and a reducing needle technique for HT-5 and ST-44. Stagnation of the Qi in the lower abdomen with a Cold sensation: Use direct moxibustion on CV-4 for 100 cones. (This means 100 cones as a treatment course-in ancient books they described the treatment course of moxibustion as the number of cones. It could be separated into 10 or 12 treatments with only 8 to 10 cones each treatment.) Disturbance of the Qi in the Lungs: Use even movement needle technique on LU-10 and KI-3. Disturbance of the Qi in the Heart: HT-7 and PC-7 with needle treatment. Disturbance of the Qi in the Large intestine SP-3, ST-43, ST-36 with even movement technique. Disturbance of the Qi in the head: BL-10, BL-11, BL-66, and BL-65 with a reducing needle technique. Disturbance of the Qi in the limbs: Use needle and moxibustion on LI-2, LI-3, ST-44, ST-43, TW-2, TW-3, GB-43, and GB-42.

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Acupuncture and Moxibustion—A Clinical Desk Reference

Blood Hematemesis, apostaxis, hematochezia: Use needle and moxibustion technique on SP-1, PC-7, HT-7, and KI-3. Continuing apostaxis: GV-23, GV-24, and GV-14 with non-scarring direct moxibustion for 7 cones. Then, use a three-edged needle and blood let ST-29. Current treatment entails needling LI-4, ST-44, ST-36 and KI-6 with a reinforcing needle technique. Hematemesis: Needle GV-16, GV-14, CV-17, CV-12, CV-6, CV-3, and ST-36, then use moxibustion on PC-7. Hematochezia: Use direct non-scarring moxibustion on BL-17 for 15 cones. Cough with bleeding: LU-7, ST-36, ST-14, BL-12, and Bai Lao with needle treatment. Consumptive bleeding: Use moxibustion on CV-12, BL-13, and ST-36. Continuing hematochezia: Use direct moxibustion on the GV-4 for 7 cones. Body Fluids Spontaneous sweating: Needle LI-4 with a reducing needle technique followed by a reinforcing needle technique on KI-7. Less or no sweat: Needle LI-4 with a reinforcing needle technique followed by a reducing needle technique on KI-7. Night sweats: HT-6, LV-10, PC-5, CV-3, and CV-6 with an even movement needle technique. Continuing night sweats: Needle HT-6 with a reducing needle technique. Consumptive night sweats: BL-13, and Bai Lao with a reinforcing needle technique. Lack of sweat during the cold: Needle LI-4, KI-7 with a reducing needle technique. Any kind of phlegm: Needle ST-40, and CV-12. Phlegm stagnation in the chest with vomiting: CV-15, ST-36, GB-28, LV-4, and BL-21 with a reducing needle technique. Phlegm retention: Apply moxibustion on BL-43 as much as possible. Water retention with whole body swelling: LI-11, LI-4, ST-36, ST-44, LV-2, and SP-6 with a reducing needle technique.

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Commonly Used Acupuncture Points For Specific Indications

Water retention on the four extremities and face: KI-6, GV-26, LI-4, ST-36, GB-39, LI-11, CV-12, SI-4, BL-20, BL-21, and SP-6 with a reducing needle technique. Water retention in the abdominal region: BL-21, BL-20, BL-25, BL-28, CV-9, CV-12, and ST-36 with a reducing needle technique. Water retention with Qi stagnation: Needle KI-7 with a reducing needle technique and CV-8 with moxibustion. Water retention on the four extremities, chest, and abdomen: Use indirect moxibustion on CV-9, and CV-6 for a total of 100 cones during one course treatment. Shen-Spirit, Sleep, and Dreams Weakness of the Shen: Use moxibustion on CV-4, BL-43. Easily frightened: KI-2, PC-6, SP-6, GB-43, and LV-2 with a reinforcing needle technique and moxibustion. Poor memory: LU-7, BL-15, CV-12, ST-36, SI-8, and GV-20 with a reinforcing needle technique and moxibustion. Loss of Shen: HT-7, PC-9, CV-16, GV-20, SI-3, KI-4, and Gui Yan with a reducing needle technique and moxibustion. Mental disorders: CV-15, SI-3, KI-1, BL-15, GB-35, ST-36, LV-3, PC-8, CV-11 with a reducing needle technique. Madness and insanity: ST-40, LV-14, LI-6, BL-66, KI-9, SI-5, SI-3, KI-10 with a reducing needle technique, and PC-5 with direct non-scarring moxibustion for 30 cones and ST-25 with 20 cones. Mental disorder with laughing: HT-7, PC-6, CV-16, and ST-40 with a reducing needle technique. Epilepsy: BL-62 for epilepsy during the day and KI-6 for epilepsy appearing at night, with direct moxibustion for 14 cones followed by moxa on GV-20 and GB-20. Insomnia due to fright: CV-5 with a reducing needle technique Insomnia from restlessness: HT-6 with a reducing needle technique Heaviness in the body with somnolence: Using non-scarring moxibustion for 1 cone on the distal interphalangeal joint of ring finger. Insomnia due to Cold stagnation in the Gallbladder: Use an even movement needle technique on the GB-44, then use moxa-pole for 20 minutes. Nightmares: HT-7, BL-15, and ST-44 with a reducing needle technique.

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Acupuncture and Moxibustion—A Clinical Desk Reference

Voice and Speech Sudden loss of voice with asthma: LI-18, and Cv-23 with reducing needle technique. Sudden loss of voice: CV-22, LI-4, GB-36, Li-17, LV-14, TW-6, and KI-1 with a reducing needle technique. Sudden loss of voice from stagnation of Phlegm: ST-40 using a reducing needle technique. Sudden loss of voice with rebellious Qi and a stagnated sensation: KI-6 using a reducing needle technique. External Genitalia and Urination Hernia of the Cold type with abdominal pain: Use moxibustion on ST-33, KI-3, and BL-18. Any kind of hernia: Needle or use moxibustion on LV-1, LV-2, LV-3, LV-5, LV-4, ST-21, CV-4, CV-9, SP-6, and ST-36. (Use direct moxibustion on CV-4 and LV-1 for 7 cones). Hernia with painful and swollen testicles: Needle or use moxibustion on LV-5, LV-1, ST-33, KI-6, ST-38, and BL-29. Female hernia with lower abdominal pain: Needle TW-10 with a reducing technique, followed by the moxa-pole on CV-6 and CV-3 for 20 minutes. Contracting Penis: Use direct non-scarring moxibustion on LV-1, CV-4 for 10 cones, and then needle LV-4. Frequent urination: Use moxibustion on BL-23, CV-4. External genitalia swollen: Needle or use moxibustion on LV-8, KI-3, LV-1, BL-23, and SP-6. Swollen and painful Penis: Needle or use moxibustion on SP-9, LV-8, LV-2, LV-3, KI-10, Cv-3, SP-5, KI-3, and LV-1. Seminal emission: Use moxibustion on BL-23. Urine retention or leakage: Needle CV-4 with a reinforcing technique or use moxibustion. Turbid urine: Needle or use moxibustion on BL-23, CV-4, CV-3, and SP-6. Stranguria caused by disordered Qi: Needle SP-9 with a reducing technique. Yellowish or reddish urine: Use a reducing needle technique on SP-6, KI-3, BL-23, CV-6, BL-26, and CV-4. Reddish urine: PC-7 and CV-4 with a reducing needle technique. 64

Commonly Used Acupuncture Points For Specific Indications

Urine retention: Use a reducing needle technique on KI-6, LV-1, BL-39, KI-4, LV-2, BL-40, SP-9, and CV-5. Urine leaking: Use a reinforcing needle technique on CV-4, SP-6, KI-10, SP-9, CV-6, and CV-3. Stranguria caused by the passage of a urinary stone: Use a reducing needle technique on CV-4, CV-6, and LV-1. Hematuria: Use a reducing needle technique on SP-9, CV-4, and ST-29. Bed-wetting: Use moxibustion and needles on SP-9, GB-34, LV-1, and CV-2 with. Women with a painful sensation in the urinary tract: Use a warming needle technique on SP-9. Urine retention after labor: CV-2 and CV-4 with moxibustion, or needle Ah Shi points (measure from Yin Tang to the tip of the nose, then duplicate this distance from navel down).

Anus and Bowel Movement Hemorrhoid pain: Use needles or moxibustion on BL-57 and GV-1. Swollen hemorrhoids: Use needles or moxibustion on BL-56, BL-58, BL-40, BL-36, BL-2, CV-1, and SP-4. Prolapsed anus: Needle BL-25, GV-20, GV-1, GB-21, LI-4, and ST-29 with strong stimulation. Hemorrhoids complicated by an anal fistula: Use Fu Zi powder with vinegar to make a dime-size cake and put on the fistula. Heat with a moxa-pole until the cake is dry, and then put on another one--5 cakes as one treatment, 10 treatments as a course. Sudden severe diarrhea: Use moxibustion and needles on SP-1. Dysentery: Use a reducing needle technique on LV-8, KI-3, LV-3, SP-4, BL-20, and BL-27. Uncontrolled bowel movements: Use moxibustion on BL-25 and CV-4. Colitis: Use direct non-scarring moxibustion on the tip of the tailbone for 100 cones as a treatment course. Hemorrhoids with bleeding: Use moxibustion on BL-57 and KI-7. Chronic hemorrhoid: Use needles or moxibustion on BL-57, GV-1, and Er Bai. 65

Acupuncture and Moxibustion—A Clinical Desk Reference

Watery diarrhea of the Cold type: Use moxibustion on GV-14 for 5 cones. Chronic and long-term diarrhea: Use moxibustion on GV-20 for 7 cones each treatment. Chronic dysentery: Use moxibustion on ST-25 and CV-6. Constipation: Use a reducing needle technique on KI-6, TW-6, and SP-3. Constipation: Use even movement needle technique on LI-2, BL-57, SP-3, KI-4, ST-36, KI-1, BL-60, KI-6, LV-13, and CV-6. Constipation after labor: Needle CV-6, ST-36, CV-4, SP-6, and KI-10 with an even movement needle technique. Headache and Dizziness Dizziness: Select from GV-25, GV-24, GV-23, GV-21, GV-19, GB-19, GB-20, SI-5, SP-2, BL-67, BL-62, BL-65, and ST-36 with needles or moxibustion. Dizziness with an aversion to cold (patient always with hat particularly in the spring and summer): Use needles or moxibustion on GV-20, GV-24, GB-20, and ST-40. Migraine headache: Needle TW-23, GB-20, LI-4, CV-12, ST-41, and ST-36. Frontal headache: Needle GV-20, GV-23, GV-24, Tai Yang, and LI-3 with a reducing technique. Headache from Kidney Deficiency: Apply moxibustion on CV-6 for 100 cones as a treatment course. Wind in the head: Use needles or moxibustion on GV-23, GV-21, GV-20, SI-5, TW-1, and BL-62. Headache with a stiff neck and back: First, needle CV-24 with a reinforcing technique, and then use a reducing technique. Recently, GV-16 has been needled with a reducing needle technique. Headache with reddish eyes and complexion: Needle HT-5 and ST-41 with a reducing technique. Occipital headache with neck and shoulder pain: Use GV-16 with a reducing needle technique. Occipital headache with neck pain: Use GV-20, GV-19, and LI-4 with a reducing needle technique. Eyebrow pain: BL-2, LI-4, GV-23

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The Methodology of Acupuncture Point Prescriptions

THE METHODOLOGY OF ACUPUNCTURE POINT PRESCRIPTIONS The selection of which acupuncture points to be used for treatment is based on the theories of the channels and collaterals, Zang-Fu, and modern medicine. Acupuncture prescriptions include one or more points, which are selected according to the symptoms, the cause of the disease, the functions of the points, and their nature. Selecting Point Prescriptions Acccording to Meridian Theory Formulating an acupuncture point prescription according to the theory of the channels and collaterals is a very common technique and widely used in acupuncture. There are several techniques listed below: Prescriptions according to meridian distribution: For example, LU-1, LU-5, and other points of the Lung meridian can make up a prescription for Lung infection, this is known as prescription selection according to the pathway of the meridian. Prescriptions according to the theory of same-name meridians: There are a number of meridians that share the same name. These include Yang Ming, Tai Yang, Shao Yang, Tai Yin, Shao Yin and Jue Yin. For example there are two Yang Ming meridians, the hand Yang Ming meridian of Large intestine and the foot Yang Ming of Stomach. In the clinic particularly for Yang Ming syndrome it’s better to select a point prescription from both Yang Ming meridians instead of one, for example, both Yang Ming meridians are selected to treat Stomach and intestinal problems. LI-11 and ST-37 are used for acute gastritis, and LI-11 and ST-44 can reduce Yang Ming fever. Prescriptions according to the theory of Exterior-Interior related meridians: This technique is to select a point prescription from related meridians. For example, LU-5 and LI-4 as prescription to treat a common cold with fever and aversion to cold. Prescriptions according to the theory of root and branch: Each meridian has a root and connection points that distribute most of the time in beginning and end of the meridian. For example, for headache in the Tai Yang area, select BL-64, and BL-65 of the foot as the root, BL-5 or BL-6 as a branch. Prescriptions according to special point features: There are a number of techniques that are based on the special features of specific points. These include: the prescription of Yuan-source points and Luo-connecting points for meridian problems, the prescription of Front-Mu and Back-Shu for organ disorders, the prescription of Back-Shu” and Lower He-sea points for Fu-bowel problems, the prescription Front-Mu and Xi-cleft for acute organ problems including the meeting points, the Eight Confluence points and the Eight Influential points. These techniques are used in the case of special diseases. Selecting Point Prescriptions According to the Theory of the Zang-Fu This technique is designed according to the physiology and pathology of the organs and takes into account other theory of organs such as: Yin Yang, Five phases, Qi, Blood and body fluid. Making prescription according to local and distal reaction point: When an organ suffers from some disease, most of the time the symptoms appear in both a local and distant area. For example, LV-13, LV-2, and TW-6 are used to treat hypochondriac pain, which is caused by Liver Yin Deficiency. Making prescription according to theory of Organ’s physiology: TCM theory views the body as an integrated whole. According to this theory, each organ has a special relationship with others. This is why in an acupuncture treatment when one organ suffers from some disease, often the practitioner will select points of other relative organs for help. For example, reinforcing liver blood to treat dry eyes or other eye problems, reinforcement of the Lung to treat sinusitis, and building up Kidney Qi to treat retention of urine. KI-6 and HT-7 treat insomnia caused by miscommunication between heart fire and Kidney water. 67

Acupuncture and Moxibustion—A Clinical Desk Reference

Making prescription according to theory of Organ’s pathology: Acupuncture treatment and prescription selection should follow the symptoms of the organ’s pathology. For example, when liver Qi stagnation attacks the Spleen we use the four gates and SP-4 as a prescription to open stagnation of liver Qi and reinforcing Spleen Qi. Making prescription according to theory of five phases: This technique selects a prescription according to five phases theory. The practitioner selects points from 60 special “Shu” point on the twelve regular meridians. This prescription will balance the relationship between the meridians and the organs. For example, select Lu.9 to build up Lung Qi in cases of Lung Qi deficiency. Selecting Point Prescriptions According to the Theory of Modern Medicine This technique refers to the selection of treatment points according to the theory of anatomy and physiology and other modern medical theories. With the progressive integration of western and oriental medicine, more and more acupuncture techniques combine these two medical disciplines. Examples of these modern integrated techniques include point injection technique, deep point massage with surgery tools, and air-injection into injured joints. Prescriptions according to the distribution of nerves: This is a very popular technique used for patients with nerve damage or nerve pain. In this technique, the practitioner selects a prescription along the pathway of the nerve. For example, BL-54, GB-30, GB-34, BL40, BL-62, and GB-43 are used to treat sciatic nerve pain. GB-12, Qian Zheng, ST-4, ST-6, ST-7, and SI-18 treat Bell’s palsy, according to the distribution of the facial nerve. Prescriptions according to distribution of the muscles: This prescription is most often used in cases of injured or paralyzed muscles. The acupuncturist may select only one muscle or a group of muscles. For example, LI-15, TW-14, SI-8, LI-14, LI-11, TW-5, and LI-4 are used for upper arm and hand paralysis after stroke due to peripheral nerve injury. Prescriptions according to anatomic structure: Points are selected according to the injured area. For example, PC-7, LI-5, and HT-7 are selected for treatment of carpal tunnel syndrome, and GB-40, BL-60, and BL-62 are used for an ankle injury. “Xiang Cong Ci”(GB-12, GB-20, GV-16, GV-15, and GV-17) technique can be used for cervical spondylosis. Selecting Point Prescriptions According to Other Acupuncture Modalites As we know there are many other modalities in the acupuncture field. These include techniques such as Gua Sha, Cupping, Bloodletting, Electro-acupuncture, scalp acupuncture, ear acupuncture, hand and foot acupuncture, wrist-ankle acupuncture, nose acupuncture, etc. Some of them have their own special points and some of them use regular acupuncture points. For example, cupping technique is usually used on regular acupuncture points and also has its own stimulation area or it may be applied with other modalities. Ear acupuncture, and wrist-ankle acupuncture have their own points and prescriptions. Some forms of scalp acupuncture have their own points and treatment zones and some of them only use traditional acupuncture points.

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The Methodology of Acupuncture Point Prescriptions

Selecting Point Prescriptions According to Clinical Experience With over 2000 years of clinical practice, many acupuncturists developed prescriptions and techniques based on their own clinical experience. Many of these techniques were never documented formally, but were derived from oral teachings and the individual records of these ancient and modern practitioners. Some of these techniques developed from the regular meridian system and regular acupuncture points. Others were created by the practitioners and using their own special technique. The influences of these ancient practitioners have colored acupuncture therapy and have led to the development of unique acupuncture treatment techniques. For example, Ma Dan Yang (Song Dynasty 987-1067 AD) used the 13 special “ghost” points for the treatment of mental disorders, and Dou Han Qing (Jin Dynasty 1196-1280 AD) used a technique of Eight Confluence points for the eight groups of diseases. Development of meridian theory and therapy: Some of practitioners were very interested in meridian theory and created a number of techniques to further and expand the basic meridian theory for the treatment of diseases. For example, the use of the Jing-well points on the fingertips to treat disease, non-needle insertion techniques to send the Qi into the meridian, and balancing the “Qi pathway” (The theory of Qi Jie). Some forms of scalp acupuncture are derived from “Head Qi Pathway Theory”. Development of point therapy: Over time, acupuncturists discovered a lot new points different from traditional ones. For example, the point Zi Gong for the treatment of uterus problems. Development of needle technique therapy: New needling techniques were developed with changes in technology, for example the use of electroacupuncture, magnets, and laser acupuncture.

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Acupuncture and Moxibustion—A Clinical Desk Reference

SECTION TWO Acupuncture Point Prescriptions

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Abdominal Pain

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Acupuncture and Moxibustion—A Clinical Desk Reference

CHAPTER I: INTERNAL MEDICINE DISORDERS

ABDOMINAL PAIN Abdominal pain is usually defined in Traditional Chinese Medicine as a symptom manifesting as pain in the abdominal region. Causes are usually explained by both exterior infection and interior disorder of the organs. The etiological factors contributing to abdominal pain in terms of Chinese medicine are Cold, Heat, Deficiency and Excess. This section will discuss abdominal pain pattern differentiation both internal and external, excluding abdominal pain caused by OB-GYN and surgical problems. ETIOLOGY External Pathogenic Infection In TCM it is believed that Cold, Dampness, Heat, and Summer-Heat can invade the abdomen, leading to dysfunction of the Spleen and Stomach. These elements may obstruct the normal movement of the Qi and metabolism causing irregular functions of the lower digestive tract. Improper food intake Most abdominal pain is usually caused by improper food intake, which results in the abnormal movement of Qi. Improper food intake can also severely impact the Spleen Yang Qi and its functions in digestive activities. Abnormal emotional stress Although certain levels of stress to the body can be maintained without symptoms, excessive emotional activity may result in abdominal pain. According to TCM the Liver controls the flowing of the Qi, and there is a belief that any kind of abnormal or excessive emotional activity will affect the Liver. For instance, anger may trigger the Liver to attack the Spleen or Stomach. The Stomach may respond by failing to descend the Qi, while the Spleen may fail in ascending, both resulting in Abdominal Pain. Yang Qi Deficiency The digested material will not be transported or transformed due to a deficiency of Spleen Yang. Under such circumstances, water retention can occur, as well as a deficiency of Qi and Blood. This makes it difficult to warm and nourish interior organs in balance and the symptom of pain will manifest. DIAGNOSIS According to TCM pathological theory, the diagnosis of abdominal pain should focus on the quality of the pain. Is the pain accompanied by cold, hot, excess, or deficient symptoms? Pain could be caused by Qi, Blood, and Zang Fu problems. To further explain, the different qualities of pain can be diagnosed with simple definitions. For instance, Excess abdominal pain worsens with pressure to the region, whereas pressure soothes pain in Deficient abdominal pains. Pain that starts acts up when the stomach is full is excess in nature, while deficient pain usually begins with hunger. Pain that is reduced by heat is of the Cold nature, and pain reduced by cold is due to Heat. The location of the pain is also important in explaining the causes and reasons of pain. For example, if the pain appears in the lower abdomen and is related to both sides of the hypochondriac region, it is a Liver and Gallbladder problem. If the pain is mostly located around the umbilicus and lower abdomen, the Spleen, Stomach, Intestines, Kidney, or Bladder usually is the cause. The following is a list of common causes of abdominal pain with symptoms to better help identify and diagnose abdominal pain.

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Abdominal Pain due to Cold Pathogenic Influence The patient will experience acute abdominal pain, which is relieved by warmth and pressure. The pain is usually associated with loose stools, diarrhea, borborygmus, clear urine, cold limbs, fever as well as an aversion to cold that may be seen in some cases. The tongue is usually pale with a white greasy coating, and pulse is deep and tight. Abdominal pain due to Food Stagnation There are usually sensations of distending pain in the abdominal region, which are relieved by bowel movements. Usually the pain is worse with pressure and associated with vomiting. Irregular, hot, and sticky stools will be seen if Food Stagnation turns to Heat. The tongue will be red with a yellowish greasy coating, and the pulse will be fast and slippery. Abdominal pain due to Yang Qi Deficiency The patient will have chronic intermittent abdominal pain that is relieved by pressure and warmth. The symptoms are usually associated with loose stools, a pale complexion, fatigue and a sore and weak sensation in the lower back and knees that may be accompanied with Cold. The tongue will be swollen with teeth marks and a white coating, and the pulse is thin, deep, and slow. Blood Stagnation The patient will experience a bloated sensation accompanied with moving or fixed pain in the abdominal region. The pain will usually be relieved by belching and aggravated by anger or other sudden and drastic emotional changes. The patient will have a dark tongue with a white coating and a wiry or choppy pulse. TREATMENT AND PRESCRIPTIONS As with all other pains that are caused by blockage of Qi flow, the main treatment method in TCM for abdominal pain is by moving the stagnation. The following basic methods apply to the most common manifestations of abdominal pain. Abdominal Pain due to Cold Pathogenic Influence Treatment Principle: Expel the Cold and Regulate the Qi Point Prescription: CV-12, ST-36, SP-15, SP-4, and LI-4. Treat once every other day for 3 treatments as a course. Technique: Insert 1cun # 32 needles into SP-4 and LI-4 with a twist reducing needle technique. Insert a 1.5 cun. # 32 needle into CV-12, ST-36 and SP-15 with a twisting even movement needle technique and apply moxa wool to the handle of the needles for 3-5 cones. Additional points: Diarrhea and cold extremities: moxibustion on CV-8 with salt.

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Acupuncture and Moxibustion—A Clinical Desk Reference

Abdominal Pain due to Food Stagnation Treatment Principle: Resolve the Food stagnation and Release the pain. Point Prescription: CV-10, ST-20, ST-25, and LI-11. Treat once every other day for 3 treatments as a course. Technique: Insert 1.5 cun # 30 needles into CV-10 perpendicularly 1 cun deep with a twisting reducing needle technique. Insert 1.5 cun # 32 needles into ST-20, ST-25 and LI-11 with an even movement needle technique. Retain all needles for 20 minutes. Additional points: Thirst: ST-44 Sour regurgitation: GB-34. Abdominal pain due to Yang Deficiency Treatment Principle: Reinforcing the Spleen and Warming the Kidney thus releasing the pain. Point Prescription: BL-20, BL-23, LV-13, and CV-4. Treat once every other day, 5 treatments as a course. Technique: Insert 1.5 cun # 32 needles into BL-20 and BL-23 perpendicularly, 1-1.2 cun deep with lifting and thrusting reinforcing needle technique, apply moxa wool on the handle of needles for 3 cones. Insert 1 cun # 32 needles into LV-13 with twisting reinforcing needle technique. Apply indirect moxibustion with Fu Zi cake on CV-4 for 5 cones. Additional points: Loose stool: ST-35 and SP-6. Abdominal pain due to Blood Stagnation Treatment Principle: Regulate the Qi and Move the Blood. Point Prescription: LI-4, SP-10, CV-6, ST-28, BL-17, and BL-24. Treat once every other day for 5 treatments as a course. Technique: Insert 1.5 cun # 30 needles into BL-17 and BL-24 with a twisting even movement technique and apply moxa wool to the handles of the needles for 3 cones. Insert 1 cun # 30 needles into LI-4 and SP-6 with a twisting reducing needle technique. Retain the needles for 20 minutes. Additional points: Hypochondriac pain: LV-14. Upper abdominal pain: CV-12, CV-6, and CV-10.

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ADJUNCTIVE THERAPIES It is important to note at this point of the text that often the use of adjunctive therapies is very helpful in treatment of the patient. Many other types of therapies can be used in this case for the treatment of abdominal pains. Most commonly used ones are described in detail below to ensure correct applications and future reference. Ear Acupuncture Points: Large intestine, Small intestine, Stomach, Spleen, Shen Men, and Sympathetic. Select 2 to 3 points for each treatment and insert 0.5 cun # 34 acupuncture needles with a medium-level stimulation technique. Retain the needles for 30 minutes. Treat once daily, for 5 treatments as a course. Another method is to apply press-balls or inter-dermal needles in these points in the ear in the same fashion regularly after body acupuncture treatment. Moxibustion Points: CV-4, CV-8 and ST-25. Apply indirect moxibustion with salt or ginger on CV-8 and a Fu Zi cake on CV-4 for 3 to 5 cones for Yang deficiency abdominal pain. Apply direct non-scarring moxibustion on ST-25 for 6 cones to treat abdominal pain due to Cold Pathogenic Invasion. Treat once daily with 3 treatments as course. Gua Sha Treatment area: Along the Stomach meridian parallel to the navel. Apply medium stimulation Gua Sha until the skin turns a purple color or the pain is reduced. This is especially good for treating abdominal pain with fever. Treat once daily for 2 treatments as a course. Cupping technique Points: CV-8. Apply a fire cup on the CV-8 for three minutes to treat abdominal pain due to stagnation of Qi and Blood. Treat once daily, 2 treatments as a course. Scalp Acupuncture Treatment zone: Middle line of the vertex, lateral line 2 and lateral line 3 of the forehead. Insert 1.5 cun # 30 needles transversely 1 cun deep at a 30-degree angle with a fast twisting needle technique. Retain the needles for 30 minutes to one hour. Treat once daily for 3 treatments as a course.

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Acupuncture and Moxibustion—A Clinical Desk Reference

TRADITIONAL PRESCRIPTIONS AND TECHNIQUES For the pain located above navel: CV-10 and ST-24 (Author’s Clinical Experience) Insert 1.5 cun #30 needles into CV-10 and ST-24 with a twisting reducing needle technique and apply moxa wool on the handles of the needles 3 times. Treat once every other day for 3-5 treatments as course. For pain around the navel (Deficiency Cold in the Small Intestine): CV-8 (Zhen Jiu Jia Yi Jing) Apply 3 cones of indirect moxibustion with salt and ginger, or use a moxa pole on CV-8 for 20 minutes. Treat once or twice a day, 3 to 5 treatments as course. For pain located on both sides of the navel: SP-15 and ST-25. (Author’s Clinical Experience) Insert 1.5 cun #32 needles into SP-15 and ST-25 with a twisting even movement needle technique and apply moxa wool on the handles of the needles with 3 cones if the patient has Cold symptoms. Treat once very other day, 3 to 5 treatments as a course. For pain located on the lower abdomen: CV-6 and ST-27 (Author’s Clinical Experience) Insert 1.5 cun #32 needles into CV-6 and ST-27 perpendicularly 1 to 1.2 cun deep with a twisting even movement needle technique. Retain all needles for 20 minutes. One can also choose to apply moxa wool on the handles of needles with 3 cones. Treat once every other day, 3 treatments as a course. For abdominal pain located around the navel: CV-9, ST-25, CV-7, and ST-36 (Lei Jing Tu Yi) Apply direct non-scarring moxibustion on those points with 7 cones. Treat once every other day, 3 treatments as a course. For abdominal pain with borborygmus: ST-37 (Wei Shen Bao Jian) Inset 1.5 cun #30 needles into ST-37 with the “Qing Long Bai Wei” (Green Dragon Waves the Tail), which is one type of technique to move the Qi. Retain needles for 30 minutes and treat once daily for 3 treatments as a course. For abdominal pain on the both sides of the navel that travels up to the epigastric region: ST-25 (Jiu Fa Mi Chuan) Apply direct non-scarring moxibustion on ST-25 for 7 cones each treatment. Treat once daily for 3 treatments as course. For abdominal pain with Heat and yellowish urine: KI-11 (Shen Jiu Jing Lun) Insert 1.5 cun #30 needles into KI-11 with a lifting and thrusting reducing needle technique. Treat once daily for 3 treatments as a course. For lower abdominal pain with Interior Cold: CV-6, BL-27, and LV-8 (Shen Jiu Jing Lun) Apply direct non-scarring moxibustion on CV-6, BL-27, and LV-8 with 7 cones. Treat once every other day for 2 treatments as course. For lower abdominal pain with Heat and yellowish urine: KI-11 (Shen Ying Jing) Insert 1.5 cun #30 needles into Ki-11 with a lifting and thrusting reducing needle technique. Treat once daily for 3 treatments as a course. For lower abdominal pain with Cold: CV-6, BL-27, and LV-8 (Shen Jiu Jing Lun) Apply direct non-scarring moxibustion on CV-6, BL-27, and LV-8 for 7 cones. Treat once or twice daily for 3 treatments as a course.

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For acute abdominal pain: LU-7, CV-17, LV-1, LU-1, SI-1, LU-9, and SP-6 (Zhen Jiu Da Cheng) Insert 1 cun #30 needles into LV-1, SI-1, LU-9, LU-7, and SP-6 with a twisting reducing needle technique; then insert a 1.5 cun #30 needles into CV-17 with a twisting even movement needle technique. Retain all needles for 20 minutes. Treat once every other day, 2 treatments as a course. For abdominal pain around the navel: LI-8 (Shen Yin Jing) Insert 1 cun #30 needles into LI-8 perpendicularly 0.5 to 0.8 cun deep with a lifting and thrusting reducing needle technique and “He Gu Ci” (one kind of moving Qi and reducing pain technique). Retain the needles for 30 minutes. Treat just for emergency cases. For severe pain on the lower abdomen: CV-6, SP-6 (Zhen Jiu Zhai Ying Ji) Insert 1.5 cun #30 needle into CV-6 perpendicularly 1 to 1.2 cun deep with a lifting and thrusting even movement technique; then insert a 1.5 cun #30 needles into SP-6 obliquely upwards 1 cun deep at a 45 degree angle with a twisting reducing needle technique. Retain all needles for 30 minutes. Treat once daily, 3 treatments as a course. For lower abdominal pain traveling to the genital region with a cold sensation: CV-4, and BL-43 (De Xiao Fang) Apply indirect moxibustion with ginger on CV-4 and BL-43 for 5 cones. Treat once every other day, 5 treatments as a course. For bloating pain in the lower abdomen: LV-2, KI-2, ST-44, and LV-1 (Zhen Jiu Fen Yuan) Insert 1 cun #30 needles into all these points with a twisting reducing needle technique. Retain all needles for 20 minutes. Treat once every other day, 3 treatments as a course. For acute abdominal pain: SP-1 and LV-1 with direct non-scarring moxibustion for 14 cones. (Yu Long Ge) For acute bloating pain in abdominal region: CV-15, CV-13 and CV-5. (Yu Long Ge) Insert 1.5 cun #30 needles into CV-15, CV-13 and CV-5 perpendicularly 1 cun deep with a twisting reducing needle technique. Retain the needles for 30 minutes. Treat once every other day, 3 treatments as a course. CASE ANALYSIS 30 year-old female with a main complaint of acute abdominal pain for 2 days Signs and Symptoms: pain worse with pressure, loss of appetite, associated Deficiency Cold sweating, and lassitude. The tongue is pale with a white coating; the pulse is weak, thin and wiry. Diagnosis: Abdominal pain due to stagnation of Qi. Treatment Principle: Regulate Qi and Release Pain. Point Prescription: CV-6, ST-25, CV-8, CV-4, BL-23, BL-32, and CV-6. Treat once or twice daily, 3 treatments as a course Technique: Insert 1.5 cun #30 needles into CV-6 perpendicularly 1 to 1.2 cun deep with “Feng Huang Zhang Chi” (Red Phoenix spreads its Wings) technique and apply moxa pole on ST-25, CV-8 and CV-4 for 20 minutes until the pain is gone. Apply the moxa pole on BL-23, BL-32 and CV-6 to reinforce, move the Qi, and prevent the pain from coming back. Result: The pain was relieved after 1 treatment, and moxa pole was continued on the second day only to help the Qi circulation. 77

Acupuncture and Moxibustion—A Clinical Desk Reference

EVALUATION Abdominal pain is a common and complicated symptom seen in the clinic. TCM allows for many possible causes, such as Cold invading the intestines, deficiency of Spleen Yang, or stagnation of improper food intake. Acupuncture treatments are very effective to reduce the pain. Point selection is the key to treating abdominal pain. For example, points selected from the Conception vessel and the Foot Tai Yang and Foot Yang Ming meridians with reducing needle techniques usually treat abdominal pain due to a Cold invasion. Points selected from the Conception vessel, the Foot Tai Yin, the Foot Yang Ming meridians and the Back-Shu points with reinforcing needle techniques are used for deficiency of the Spleen and Kidney. Points from the Foot Tai Yin and the Foot Yang Ming meridians with reducing needle techniques and moxibustion usually treat abdominal pain due to stagnation of food. Long term and chronic abdominal pain combined with other diseases should be referred out for further examinations.

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Asthma

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Acupuncture and Moxibustion—A Clinical Desk Reference

ASTHMA Asthma is an episodic allergic pulmonary disorder. It occurs when a foreign antigen is present and contacts the respiratory system through inhalation or other forms of contact. During the attack, patients have severe Dyspnea, which is due to spasm of bronchial smooth muscles, swelling of the bronchial mucous and hyper secretion of the respiratory tract leading to bronchial obstruction. In TCM, Asthma is usually attributable to the categories of XIAO (bronchial wheezing) and CHUAN (Dyspnea). Commonly there are three major types of Asthma causing factors discussed in TCM. Of these three major factors each presents a different set of symptoms and each requires different types of treatment and prescription. Due to the broad range of asthma related disorders, the causes can be both internal as well as external. The three most common asthma causing agents are identified as: Wind Cold and Wind Heat Pathogenic Influence These invade the body and are the main cause of allergic asthma, particularly dust, pollens, or other strange smells or tastes in the air. This causes stimulation that will make the Lung fail in ascending and descending, stagnating of Lung Qi, and may cause the accumulation of water, that in some cases will turn to phlegm. Improper Food Intake When the Stomach and Spleen suffer from due food stagnation, particularly from hard to digest food, asthma may result due to phlegm forming from the stagnation, traveling upwards and being stored in the Lung. Qi Deficiency Deficiency of Kidney Qi fails in receiving the Lung Qi, which causes the Lung to fail in descending. Most of the time this kind of asthma happens when the patient has a weak body constitution or bad emotional situations. In the beginning stages of asthma, symptoms manifested are usually 'excess' in nature, and after several attacks, the symptoms tend to turn to 'deficiency'. When the attacks are deficiency in nature the main clinical manifestations are: shortness of breath, spontaneous sweating, and chills. For instance, Spleen deficiency asthma may result in stuffiness of the chest and lose stool. In Kidney deficiency the Lungs fail in receiving the Qi, resulting in asthma that worsens after activity. In the Heart there are: Heart Yang deficiency and restlessness resulting in a sensation of cold in the extremities or even loss of consciousness. Some deficiency types of asthma still can appear to have some excess symptoms such as stagnation of the breath, and chest pain. These types of asthma attacks are labeled as excess in ‘branch’ and deficiency in ‘root’. DIAGNOSIS Due to the various categories of Asthma this disorder is often confusing and hard to diagnose correctly. To help better understand the nature of these causes the list of diagnostic symptoms are separated in two major categories of asthma, the Excess type and the Deficiency type. They are both very important in understanding the nature of the patient’s Asthma attacks and to help make the best diagnosis of the patient. Excess type of asthma Asthma with Cold: Symptoms include fullness and distress in the chest, and dyspnea, that are associated with a wheezing sound in the throat, cough with thin sputum, headache, frequent attacks during the cold seasons or caused by cold. The tongue is pale with moist or greasy coating; the pulse is floating and tight. Asthma with Heat: Dyspnea with wheezing, irritability, oppressed sensation in the chest, gasping for breath, cough with yellowish thick sputum, red complexion, fever, sweating, thirst, and onset closely associated the 80

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warmer seasons. The tongue will be reddened with a yellow greasy coating, and the pulse will be slippery and rapid. Deficiency type of asthma Asthma combined with Lung Qi deficiency: Symptoms include asthma with a pale complexion and spontaneous sweating associated with aversion to cold, shortness of breath, tiredness, sneezing, and a stuffy nose. The tongue is pale with a thin white coating; the pulse is thin, fast and weak. Asthma combined with Spleen deficiency: Symptoms include asthma with a pale complexion, poor appetite associated with phlegm, lassitude, loose stool, or diarrhea. The tongue is swollen with thick greasy coating; the pulse is slow and slippery. Asthma combined with Kidney deficiency: Symptoms include asthma with a dark complexion, shortness of breath and becoming quite severe after activities, associated with heart palpitations, dizziness, ringing ear, soreness and weakness cold sensation on the low back and knees. The tongue is pale with a white, thin coating; the pulse is thin and weak. Asthma combined with Heart Qi and Yang deficiency: Symptoms include asthma with heart palpitations, sweating, restlessness, and a green or purple color on the lips, nails, and tongue. There may also be a cold or even freezing sensation in the four extremities. The tongue is dark with white coating; the pulse is tiny weakness and irregular. TREATMENT AND PRESCRIPTION Asthma with Excess Cold Treatment Principle: Expel the Cold and Relieve the asthma. Point Prescription: LU-7, LU-5, BL-12, and BL-13. Treat once daily during asthma attack, 5 treatments as a course Technique: Insert 1.5 cun #32 needles into LU-7, and LU-5 with twisting reducing needle technique, 1 cun #30 needles into BL-12, and BL-13 with lifting and thrusting reducing needing technique. Apply fire cups on the BL-12 and BL-13 for 3 minutes. Additional points for other associated symptoms: Stuffy and running nose: ST-3 and Yin Tang Shoulder and upper backaches: LI-7 Fever: SI-7 Heat-phlegm stagnation in the Lung Treatment Principle: Clear the lungs and release asthma. Point Prescription: LI-4, GV-14, ST-40, CV-17, LU-1, and LU-6. Treat once every other day during asthma attack, 7 treatments as a course. Technique: Insert a 1.5 cun #30 needle into GV-14 perpendicular 1 to 1.2 cun deep with rubbing needle technique, leading the Qi down along the spinal column without retaining the needle. Insert 1.5 cun #30 needles into LU-6 and ST-40 with lifting and thrusting reducing needle technique, and 1 cun #30 needles into LI-4 LU-1 CV-17 with twisting reducing needle technique. Retain all needles for 20 minutes. Additional points for other associated symptoms: Severe asthma: BL-13 and LU-2 with cupping technique Fever: LI-11 and SP-9 81

Acupuncture and Moxibustion—A Clinical Desk Reference

Deficiency type of asthma Treatment Principle: Built up the body energy, resolve phlegm and calm asthma. Point Prescription: Ding chuan, BL-43, BL-13, and LU-9. Treat once every other day for 10 treatments as a course. Technique: Insert 1 cun #30 needles into BL-43 and BL-13 obliquely, 0.3 cun to 0.5 cun deep with the “Qi Ci” (one kind of traditional needle technique—three needles on one point, one on the middle and other two beside) with waving technique. Retain all needles for 10 minutes. Apply indirect moxibustion with ginger for 3 cones on these two points after taking the needles out. Insert a 1 cun #32 needle into LU-9 with twisting reinforcing needle technique. Retain the needles for 10 minutes. Additional points for other associated symptoms: Lung and Spleen deficiency: BL-20 and ST-36. Lung and Kidney deficiency: BL-23 and KI-3. Lung and Heart deficiency: PC-6 and HT-7 with even movement needle technique. Apply direct non-scarring moxibustion on CV-4, CV-6, and GV-4 for 7 cones. ***If a patient has a deficient body type, and suffers from Cold, the Excess type of asthma treatment should be followed. ADJUNCTIVE THERAPIES Ear acupuncture Points: Pin chuan, Endocrine, Trachea, Sub cortex, Sympathetic Insert 0.5 cun #34 ear acupuncture needles in these points, obliquely at a 30 degree angle with twisting reducing needle technique, and retain then for 30 minutes. Treat once daily, 5 treatments as a course. Or use a press-ball instead of needles as a supplemental treatment after the body-acupuncture treatment and keeps them for 3 days in summer and 7 days in winter. Moxibustion Points: BL-13, BL-43, BL-20, and BL-23. Apply direct moxibustion on these points in the summer (middle of July), for 5 cones to treat asthma of the chronic and deficient type. Treat once daily, 3 treatments as a course. Scalp Acupuncture Treatments zone: Lateral line 1 of the forehead, middle line of the vertex, and middle line of the forehead. Insert 1.5 cun #30 needles into these lines with fast twisting needle technique or withdrawing Qi technique. Retain all needles for 1 hour to treat acute asthma attacks. Treat once every other day, 3 to 5 treatments as a course. Plum Blossom Needle Treatment area: LU-10, the Lung meridian along the forearm, and the Stomach meridian on the front of the neck. Apply weak stimulation of the plum blossom needle until red marks appear on the area to treat asthma of the deficient type. Treat once every other day, 5 treatments as a course. 82

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Gua Sha Treatment area: upper back—most often used for asthma due to Excess Heat. Apply medium stimulation of Gua Sha on both sides of the upper back (BL and GV meridians), until the red or purple marks appear. Treat once a week, 3 testaments as a course. Intra-dermal needle Points: Ding Chuan, GV-14, BL-13, BL-43, BL-15, BL-20, LU-6, LU-9, and CV-17. Insert intra-dermal needles into all these points subcutaneously, 0.3 cun deep and secure with tape. Retain them for a week, to treat deficient asthma. Treat once a week, 3 treatments as a course. TRADITIONAL PRESCRIPTIONS AND TECHNIQUE For asthma in deficiency type: LU-1, LU-2, LU-3, BL-13, and CV-20. (Zhen Jiu Jug Ying) Apply direct non-scarring moxibustion (the cone like wheat) on all these point for 7 cones. Treat once a week, 5 treatments as a course. For chronic asthma appearing every winter: GV-14, GV-12, BL-13, and BL-43. (Author's Clinical Experience) Apply direct moxibustion on the GV-14, GV-12, BL-13, and BL-43 for 7 cones. It’s best to treat in the summer (middle of July). Treat once a week for 2 treatments as a course. For chronic severe asthma: Governing vessel therapy. (Zhong Guo Zheng Jiu) Apply indirect moxibustion with garlic on the Governing vessel. Put an herbal powder (Ban Se Feng— approximately 15g) from GV-14 to GV-3. Then add the mashed garlic on the herbal powder, 3 cm high and 5 cm wide, from the GV-14 to GV-3. Put the moxa wool on the garlic, 2 cm on the bottom to 2 cm high. Light the moxa wool from the head (near GV-14), towards the tail (near GV-3) and the middle (near GV-6) for three times. Treat once a year, for 3 treatments as a course. For acute asthma: ST-9 and BL-3. (Author’s Clinical Experience) Insert a 1.5 cun #30 needle into ST-9 perpendicular, 1-1.2 cun deep with twisting even movement technique after get the Qi sensation. Insert 1 cun #30 needles into BL-3 obliquely at a 30 degree angle in the downward direction, 0.5-0.8 cun deep with a fast twisting technique for 3 minutes. Retain all needles for 20 minutes. Treat only for acute asthma attack. For chronic asthma: BL-13. (Zhen Jiu Zi Shen Jing) Insert 1 cun #30 needles into BL-13 with twisting reinforcing needle technique. Apply moxa-pole on the side of the point for 20 minutes. Treat once daily, 5 treatments as a course.

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For asthma with severe shortness of breath: CV-22, CV-21, CV-20, CV-17, ST-19, LV-13, CV-6, and GV-9. (Lie Jing Tu Yi) Apply direct non-scarring moxibustion for 7 cones on CV-6, GV-9, LV-13, and 5 cones on CV-22, CV-21, CV-20, CV-17, and ST-19. Treat once daily for 3 treatments as a course. For asthma with severe cough, phlegm and wheezing: KI-27, CV-22, CV-17, BL-13, ST-36, CV-12, BL-43, CV-4, CV-6, and ST-18 (Zhen Jiu Da Cheng) Apply direct non-scarring moxibustion on BL-13 and BL-43 for 7 cones. Insert 1 cun #32 needles into KI27, CV-22, CV-17, and ST-18 with twisting reinforcing needle technique. Insert 1.5 cun #32 needles into CV-12, CV-4, CV-6, and ST-36 with twisting reinforcing needle technique; apply moxa wool on the handle of needles for 3 cones. Treat once daily, 3 treatments as a course. The following are all prescriptions from the Zi Zhen Jing: For asthma with cough and shortness of breath: LU-2 and ST-9 For severe asthma with difficulty to lie down: CV-22 and CV-19 For asthma with stuffy sensation in the chest: BL-42 and LU-1 For asthma with rebellious of the Qi: CV-17 CV-21 used For asthma with wheezing: LV-3 Insert 1 cun #30 needles into LU-2 and ST-9 with twisting reducing needle technique, and 1.5 cun #32 needles into CV-22 and CV-19 obliquely at a 30 degree angle 1 cun deep with twisting reducing needle technique. Insert 1 cun #30 needles into LU-1 and BL-42 perpendicular, 0.5 cun deep with twisting reducing needle technique. Insert 1.5 cun #30 needles into CV-17 and CV-21 obliquely downwards 1 cun deep with fast twisting technique. Insert 1.3 cun #32 needles into LV-3 perpendicular 1 cun deep with twisting reducing needle technique. Or apply direct non-scarring moxibustion on these points as above for 7 cones during asthma in deficiency conditions. For asthma due to Excess Heat: GV-14, CV-22, KI-27, ST-18, LU-7, and ST-40. (Zhong Hua Zhen Jiu Xue) Apply a reducing needle technique on the above points and direct non-scarring moxibustion on CV-22, LU7, ST-18, CV-12, and ST-36 for 7 cones for asthma of the deficient Cold type. Insert a 1.5 cun #32 needle into CV-22 obliquely along anterior of trachea, 1 cun deep with twisting reducing needle technique, and 1 cun #30 needles into KI-27, ST-18, LU-7, and ST-40 with twisting even movement needle technique. Retain all needles for 20 minutes. Insert a 1.5 cun #30 needle into GV-14 with rubbing technique (clockwise), without retaining the needle. Treat once every other day, 7 treatments as a course. For asthma with acute chest and diaphragm pain: LU-7, GV-26, CV-22, BL-13, and ST-36. (Zhen Jiu Da Quan) Insert 1 cun #30 needles into BL-13 perpendicular, 0.5 to 0.8 cun deep with twisting reducing needle technique and take the needle out without retaining. Insert 1 cun #32 needles in LU-7, GV-26, CV-22, and ST-36 with twisting reinforcing needle technique. Retain all needles for 20 minutes. Treat once every other day, 5 treatments as a course. For patients who cannot lie down during an asthma attack: GV-10. (Jiu Fa Mi Chuan) Apply direct non-scarring moxibustion on GV-10 for 11 to 13 cones. Treat once daily, 3 treatments as a course. For children who cannot eat during an asthma attack: CV-21. (Jiu Jing) Apply wheat grain size direct non-scarring moxibustion on CV-21 for 3 cones. Treat once or twice daily for 3 treatments as a course. 84

Asthma

For asthma of the Cold type: BL-13, BL-43, and CV-22. (Zhang Shi Yi Tong) Apply indirect moxibustion with Fu Zi cake on BL-13, BL-43, and CV-22 for 3 to 5 cones. Treat once every other day, 5 treatments as a course. For patients who cannot lie down during an asthma attack: LV-14. (Yu Long Jing) For acute asthma attack: BL-12. (Yu long Jing) For asthma with a stuffy sensation in the chest: LU-1 and CV-19. (Yu long Jing) Insert 1 cun #30 needles into LV-14, BL-12, LU-1, and CV-19 with reducing twisting needle technique. Retain all needles for 30 minutes. Treat once daily, 3 to 5 treatments as a course. For asthma of the Cold type: CV-20, CV-6, CV-17, LV-14, and GV-9. (Jing Yue Quan Shu) Apply direct non-scarring moxibustion on these points for 3 cones. Treat once daily, 2 treatments as a course. For pediatric asthma with poor appetite: Si Fen (Zhong Guo Zhen Jiu) Apply a three-edged needle with fast prinking on the Si fen point, 1 to 3 mm deep, and squeeze out a little yellowish and white liquid. Treat once a week, 2 treatments as a course. For asthma with Kidney Qi deficiency: BL-43, BL-13, BL-5, Ding Chuan, BL-20, BL-23, Ying Tang, LU-5, LU-10, KI-3, and ST-40. (Author's Clinical Experience) Insert 1 cun #30 needles into BL-43, BL-13, BL-15, Ding Chuan, BL-20, and BL-23 with Qi Ci (one needle on the middle and other two each side) for each point, and apply the waving technique until red marks appear around the needles. Retain the needles for 10 minutes. Insert 1 cun #32 needles into Ying Tang, LU5, LU-10, KI-3, and ST-40 with twisting reinforcing needle technique. Retain all needles for 15 minutes. Treat twice a week, 7 treatments as a course. For asthma with Kidney Qi deficiency: KI-1. (Qian Jin Fan) Apply moxa-pole on KI-1 for 30 minutes every night before go to bed. Treat once daily, 10 treatments as a course. CASE ANALYSIS A 32 year-old female patient has a main complaint of asthma for 2 years. Her asthma attacks can occur any time randomly, and particularly during the winter nights. The attacks are associated with severe wheezing, coughing and a large amount of phlegm, stuffy sensation in the chest, and difficulty lying down. The tongue is red with yellow greasy coating; the pulse is slippery and fast. Diagnosis: Asthma due to Heat. Treatment Principle: Clear the Heat and Relieve the asthma. Point Prescription: LU-5, LU-1, LU-10, BL-13, CV-17, Ding Chuan, CV-21, CV-6, CV-12, and ST-40. Treat once daily, 3 treatments as a course. Technique: Apply bloodletting technique on LU-5 and LU-1. Insert 1 cun #32 needles into LU-10 with twisting reducing needle technique, 1.5 cun #32 needles into BL-13, Ding Chuan, CV-17, CV-21, CV-6, CV-12, and ST-40 with twisting reducing needle technique. Retain all needles for 20 minutes Result: After 3 treatments the patient’s asthma symptoms were better. The prescription was then modified to: BL-23, BL-13, CV-4, CV-12, ST-36, and CV-17 with reinforcing needle technique and moxibustion for 2 treatments. The asthma attacks in conjunction with the other symptoms were released after treatment. With additional treatments the asthma attacks should disappear completely. 85

Acupuncture and Moxibustion—A Clinical Desk Reference

EVALUATION For several thousand years, TCM has accumulated a series of rich experiences and techniques to treat asthma. Differentiating the treatment in accordance to the asthma symptoms is the key in making the correct initial diagnosis. After the diagnosis, the treatment aim should be to build up the body energy, particularly by reinforcing the Spleen and Kidney Qi for deficiency type asthma, and eliminating or expelling Pathogenic Influences in the treatment of acute asthma attacks and asthma of the Excess type. Meanwhile, the patient should be careful to stay away from allergic activities including smoking, drinking, and other specific, aggravating foods.

86

Bell’s Palsy—Peripheral Facial Paralysis

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Acupuncture and Moxibustion—A Clinical Desk Reference

BELL’S PALSY— PERIPHERAL FACIAL PARALYSIS The most common form of facial paralysis is idiopathic, i.e. Bell's palsy. The incidence rate of this disorder is about 23 per 100,000 annually, or about 1 in 60 or 70 persons in a lifetime. The pathogenesis of the paralysis is still unknown. The few autopsied cases of this disease have shown only nondescript changes in the facial nerve and not inflammatory changes, as is commonly presumed. Thus so far it is believed that this illness is a result of death in facial nerve endings. In the traditional view Chinese medicine, it’s believed to be usually caused by Wind-OPI invades the Yang Ming Meridian (Zhong Jin Lou-wind stroke in meridian). CLINICAL MANIFESTATIONS The onset of Bell's palsy is fairly abrupt, maximal weakness being attained by 48 hours as a general rule. Pain behind the ear may precede the paralysis for a day or two. Taste sensation may be lost unilaterally, and hyperacusis may appear within the first few days. In some cases there is mild cerebrospinal fluid (CSF) lymphocytosis. Totally about 80 percent of patients recover within a few weeks or months. Electromyography may be of value in distinguishing a temporary conduction defect from a pathologic interruption in the continuity of nerve fibers. Evidence of nerve failure after 10 days indicates that there has been axonal degeneration and that there will be a long delay (3 months, as a rule) before regeneration occurs and that is may be incomplete. The presence of incomplete paralysis in the first week is the most favorable prognostic sign. DIAGNOSIS The symptoms usually occur after sleep or very suddenly. The face will move on the healthy side when the patient speaks, laughs or tries to blow their nose. The paralyzed side of the face feels numb or has no sensation, muscle cramps can be felt at times, pain and distension sensation may also be felt behind the ear, and food will get stuck in the affected side. The eye on the paralyzed side will be hard to close and will be red and teary. Two-thirds of the anterior portion of the tongue may also experience loss of taste. Wind Cold The patient will have a history of exposure to wind, during sleep or driving, or from a fan are some examples. There are usually no exterior symptoms, but the pulse is floating and tight, and the tongue will be white with a thin greasy coating. Wind Heat This type of patient will often have Bell's palsy as a secondary symptom, which appears usually after flu, fever, otitis media, or gingivitis associated with a painful sensation in the ear and mastoid process. The pulse will be fast and floating, and the tongue will have a white or yellow greasy coating.

88

Bell’s Palsy—Peripheral Facial Paralysis

TREATMENT AND PRESCRIPTIONS Treatment Principle: Promote the flow of the Qi and Blood, and Expel the Wind. Point Prescription: Wind Cold: ST-2, ST-4, ST-6, GB-14, and LI-4 with moxibustion. Wind Heat: Tai Yang, SI-18, ST-6, ST-7, LI-11, and ST-44. Techniques: There are three periods to treat peripheral facial paralysis in TCM: 1. Within 2 weeks of onset: In this case, apply more needles with superficial insertion technique, meaning needle the local paralysis area with more needles with a superficial insertion of less than 0.3 cun deep, with slight twisting technique in order to move the flow of Qi and Blood, and expel the Wind from the surface of the skin. 2. Between weeks 2 and 4: During this period insert needles into the points with regular depth and technique in order to adjust, regulate, reinforce and or reduce the Qi and Blood according to the TCM diagnosis. 3. After 4 weeks: At this time the technique of needling points through and through is recommended, such as needling ST-4 through to ST-6. Electro-acupuncture is also considered beneficial at this stage for the paralyzed muscles. Additional points for other associated symptoms: Orbital wall pain: BL-2 Mastoid process pain: TW-17 and GB-12. Facial numbness: LI-20 and CV-26. Tastelessness: CV-23. ADJUNCTIVE THERAPIES Ear Acupuncture Points: Lung, Sympathetic, Face, Liver, Shen Men, and Eye. Insert 0.5 cun #34 ear needles into these points obliquely at a 45 degree angle with fast twisting needle technique. Retain all needles for 40 minutes. Treat once every other day, 7 treatments as a course. Plum Blossom Needle Points: GB-14, Tai Yang, ST-2, ST-4, ST-6, and LI-4 (all the points on the diseased side). Apply weak stimulation of plum blossom needle on these points for 5 minutes. Treat once daily, 7treatments as a course. Electro Acupuncture Points: BL-14, BL-2, Tai Yang, ST-3, SI-18, ST-6, ST-7, and ST-4. Select 2 or 3 groups of points during each treatment and apply a continuous wave for 8-10 minutes to treat the facial paralysis over a four-week period. Treat once every other day for 10 treatments as a course.

89

Acupuncture and Moxibustion—A Clinical Desk Reference

Scalp Acupuncture Treatment zone: Select the opposite side of the anterior line from the vertex to the temple (lower-2/5), and the posterior line from the vertex to the temple (lower-2/5). Insert 1.5 cun #28 or #30 needles transversely at a 30-degree angle, 1 cun deep with fast twisting technique. Retain all needles for 1 hour. Treat once every other day, 7 treatments as a course. Moxibustion Moxa-pole and warming needle technique Apply during any period of the facial paralysis, or as a supplemental treatment during or after the needle treatment. Indirect moxibustion with ginger Points: ST-6, ST-7, TW-17, GB-12, and Tai Yang. Select 2-3 points during each treatment and apply indirect moxibustion with ginger for 3 cones to treat facial paralysis due to Wind Cold. Treat once every other day, 7 treatments as a course. Direct non-scarring moxibustion Points: GB-14, SI-19, GB-2, SI-19, ST-7, ST-6, ST-4, and Tai Yang. Select 3 to 4 points from above each treatment and apply direct non-scarring moxibustion for 7 cones. Treat once every other day, 7 treatments as a course. TRADITIONAL PRESCRIPTIONS AND TECHNIQUES For facial paralysis due to Wind Cold: ST-7. (Wei Shen Bao Jian) Apply direct non-scarring moxibustion on ST-7 for 14 cones. Treat once daily, until the disease is gone. For facial paralysis due to Wind Cold: ST-2, ST-4, and ST-9. (Ru Men Shi Qing) Apply direct non-scarring moxibustion on ST-2, ST-47, and ST-9 for 5 cones. Treat once every other day for 10 treatments as a course. For facial paralysis due to Qi and Blood stagnation: ST-6, CV-26, LU-7, LU-9, LI-4, LI-2, ST-4, and TW-23. (Shen Yin Jing) Insert 1 cun #30 needles into LI-2, LI-4, LU-9, and LU-7 with twisting reinforcing needle technique, and 1 cun #32 needles into ST-6, ST-4, CV-26, and TW-23 with twisting reducing needle technique. Retain all needles for 20 minutes, or apply moxa wool on the handle of needles for 3 cones. Treat once every other day, 10 treatments as a course. For facial paralysis due to Wind invasion: ST-4, ST-6, CV-26, LI-4, SI-19, CV-24, and TW-17. (Zhen Jiu Da Cheng) Insert 1 cun #28 needles into ST-4, ST-6, CV-26, and LI-4 with twisting reducing needle technique. Retain all needles for 30 minutes. Treat once every day, 7 treatments as a course. ***If the disease comes back after one mouth, insert 1.5 cun #30 needles into SI-19, CV-24, and TW-17 with twisting reinforcing needle technique. Retain all the needles for 20 minutes. Treat once every other day, 5 treatments as a course. 90

Bell’s Palsy—Peripheral Facial Paralysis

For facial paralysis by Wind Invasion: CV-26, ST-4, ST-6, and LI-4. (Zhong Hua Zhen Jiu Xue) Insert 1.5 cun #30 needles into ST-6 and ST-4 with twisting reinforcing needle technique and apply moxa wool on the handle of needles for 3 cones. Insert 1 cun #32 needle into CV-26 obliquely towards the disease area, 0.3 cun deep with twisting even movement needle technique. Then insert a 1 cun #30 needle into LI-4 (on healthy side only) with twisting reinforcing needle technique. Retain all needles for 20 minutes. Treat once every other day, 10 treatments as a course. For the beginning stage of the facial paralysis (1 to 2 week duration): Qian Zhen, GB-12, TW-17, ST-4, ST-6, ST-7, SI-18, TW-23, CV-26, CV-24, LI-20, GB-14, BL-2, ST-2, Tai Yang, and GB-20. (Author’s Clinical Experience) Insert 1 cun #30 needles into Qian Zhen, GB-12, and TW-17 perpendicularly, 0.5 cun deep with lifting the thrusting reducing needle technique. Then insert 1 cun #32 needles into the rest of the points perpendicularly, 0.1 to 0.3 cun deep with slight twisting technique. Retain all needles for 5 minutes. Treat once every other day, 5 treatments as a course. For facial paralysis with deficiency of Qi and Blood: SI-18, ST-4, ST-6, Qian Zhen, GB-12, Tai Yang, LI-4, and ST-36 (Author’s Clinical Experience) Insert 1.5 cun #30 needles into ST-4 transversely, 1 to 1.2 cun deep towards the ST-6 direction with twisting even movement needle technique, and a 1.5 cun #30 needle into Tai Yang obliquely at a 60 degree angle towards ST-7 with twisting reinforcing needle technique. Insert 1.5 cun #32 needles into SI-18, Qian Zhen, GB-12, LI-4, and ST-36 with twisting even movement needle technique. Retain all the needles for 30 minutes. Or apply moxa wool on the handle of needles for 3 cones. Treat once every other day for 7 treatments as a course. For facial paralysis due to Wind Invasion: GB-2, PC-5, Tai Yang, TW-21, LI-4, CV-26, and CV-24. (Jing Yue Quan Shu) Insert 1 cun #30 needles into LI-4, CV-26, and CV-24 with twisting reducing needle technique. Retain all needles for 15 minutes. Apply direct non-scarring moxibustion on GB-2, PC-5, Tai Yang, and TW-21 for 14 cones. Treat twice a week, 7 treatments as a course. CASE ANALYSIS A 43-year-old male patient complained of facial paralysis for 5 days duration. Initially, it occurred after sleep one night, and his face would only move on the healthy side when he spoke, laughed or blew his nose. The paralyzed side of his face felt numb and lacked sensation. There was pain and distension behind the ear, and the food often became lodge in the paralyzed side when he ate. On the paralyzed side, the eye was hard to close, teary, and red. The tongue had also lost some sensation of taste. Associated signs were slight headache and aversion to cold. The tongue was normal with a thin white coating and the pulse was floating and wiry. Diagnosis: Facial paralysis due to Wind Cold. Treatment Principle: Expel the Wind and Cold and Promote the Qi and Blood circulation in the Yang Ming meridian. Point Prescription: LI-4, LU-5, CV-14, GB-12, ST-4, ST-6, CV-26, LI-20, Tai Yang, SI-19, and ST-3. Treatment was given once every other day for 7 treatments. Technique: 1.5 cun #30 needles were inserted into LI-4, LU-5, CV-14, and GB-12 with a lifting and thrusting reducing needle technique, and 1 cun #32 needles into ST-3, ST-4, ST-6, CV-26, LI-20, SI-19, and Tai Yang perpendicularly, 0.2 cun deep with slight twisting needle technique. All needles were retained for 30 minutes. Moxa pole was performed on the Qian Zhen point for 15 minutes. Result: After 3 treatments, the diseased side of the eye could be closed, food was not becoming caught in the mouth, the saliva was also controlled, and the tight sensation on the face had improved. Totally 6 treatments were given and the patient was discharge as all symptoms had resolved. 91

Acupuncture and Moxibustion—A Clinical Desk Reference

EVALUATION Acupuncture and moxibustion are very effective in the treatment of peripheral facial paralysis. In the beginning stage, within 2 weeks, strong stimulation techniques and electrically conducted needles should be avoided. Only treatments consisting of weak and superficial needle technique with anti-inflammatory herbs should be used to rid the local inflammation. Strong needle technique (through and through needle technique) and electroacupuncture should only be used after the fourth week; otherwise it will often cause facial spasm. Patients should keep the face and neck warm to reduce cell damage of the paralyzed side.

92

Beriberi Syndrome

93

Acupuncture and Moxibustion—A Clinical Desk Reference

BERIBERI SYNDROME Most cases of Beriberi are usually caused by malnutrition, which means the patient most likely keeps to a narrow food selection or lacks vitamin B1 in their diet. The lack of nutrients leads to attacks on the body by Damp stagnation in the foot meridians, which is caused by a Spleen deficiency or Damp Pathogenic Invasion. The main symptoms of Beriberi are sensations of weakness and edema in the legs. In TCM it is called weak foot or swollen leg. In some severe cases when the Beriberi attacks heart, the patient will feel heart palpitations, shortness of breath, nausea and/or vomiting. DIAGNOSIS The disease is usually categorized under three different patterns in TCM. Of these three patterns, the first two separate the different causes and characteristics of Beriberi symptoms. The last type is the most serious and prolonged illness in which the illness attacks the heart. Damp-Beriberi Symptoms of this type of Beriberi include swelling and edema in the leg, numb sensation on the toes traveling up the leg, and are associated with scanty urine or urinary tract infection. The tongue is swollen with a white or yellow greasy coating. The pulse is floating, fast, and weak. Dry-Beriberi Symptoms include swollen feet and legs with painful and numb sensation, associated with cramping or spasm in the muscles of the leg. The muscles will gradually atrophy until paralysis sets in, along with yellow scanty urine and constipation. The tongue is red with a thin white or no coat. The pulse is thin and fast. Beriberi invades the Heart Symptoms include painful swelling, numbness, and atrophy of the legs, with difficulty to walk. Associated symptoms are sudden shortness of breath, heart palpitations, nausea or even vomiting, stuffy sensation in the chest, upper epigastric area discomfort, coma, mental disorder, and possible unconsciousness in some severe cases. The tongue is dark red without coating and the pulse is thin, fast, and weak. TREATMENT AND PRESCRIPTIONS Damp-Beriberi Treatment Principle: Move the Qi of the foot meridians Clear Heat and Resolve Damp. Point Prescription: ST-36, SP-6, GB-34, and the Ba Feng. Treat once every other day for 7 treatments as a course. Technique: Insert 1.5 cun #32 needles into ST-36, SP-6, and GB-34 perpendicularly, 1-1.2 cun deep with lifting and thrusting even movement needle technique. Apply moxa wool on the handle of the needles for 3 cones. Insert 1 cun #30 needles into the Ba Feng perpendicularly, 0.7 cun deep with lifting and thrusting reducing needle technique. Additional points for other associated symptoms: Fever and aversion to cold: LI-4, GV-14, and TW-5. Scanty urine: SP-9 and BL-60.

94

Beriberi Syndrome

Dry-Beriberi Treatment Principle: Nourish Blood and Yin and Move the Qi in the foot meridians. Point Prescription: ST-41, ST-32, KI-7, SP-10, KI-6, and GB-39. Treat once every other day for 7 treatments as a course. Technique: Insert 1 cun #32 needles into ST-41, KI-6, KI-7, and GB-39 perpendicularly, 0.5 cun deep with twisting even movement needle technique. Then insert 1.5 cun #30 needles into ST-32 and SP-10 perpendicularly, 1-1.2 cun deep with twisting even movement needle technique. Retain all needles for 20 minutes. Additional points for other associated symptoms: Leg muscle spasm: BL-57. Low back pain: BL-40. Swollen and painful knee: Xi Yan and ST-33. Beriberi invades the Heart Treatment Principle: Subdue the Qi, Resolve the toxins and Harmonize the Heart and Lung. Point Prescription: LU-5, CV-17, PC-8, HT-7, ST-36, and KI-1. Treat once every other day for 7 treatments as a course. Technique: Insert 1.5 cun #32 needles into LU-5 perpendicularly, 1 cun deep with lifting and thrusting reducing needle technique, and a 1.5 cun #30 needle into CV-17 obliquely, 1 cun deep at a 45 degree angle towards CV-16, with twisting reducing needle technique. Insert 1 cun #32 needles into PC-8 and HT-7 with twisting even movement needle technique, and 1.5 cun #32 needles into ST-36 with twisting even movement needle technique. Finally, insert 1 cun #34 needles into KI-1 perpendicularly, 0.3 cun deep with twisting even movement needle technique. Retain all needles for 20 minutes. Additional points for other associated symptoms: Coma: GV-26. Collapse of Yang: CV-6 and CV-4 with moxibustion. ADJUNCTIVE THERAPIES Ear Acupuncture Points: Toe, Ankle, Knee, Spleen, Kidney, Intestine and Shen Men. Select 3-4 points from above each time, inserting 0.5 cun #32 ear needles into these points obliquely, 0.3 cun deep at a 45 degree angle with twisting even movement needle technique. Retain all needles for 40 minutes. Or apply press-balls on these points after regular body acupuncture treatment. Treat twice a week for 5 treatments as a course. Scalp Acupuncture Treatment zones: Lateral line 1 of vertex, Middle line of vertex, and anterior oblique line from vertex to temple. Insert 1.5 cun #30 needles into these lines transversely 1 cun deep at a 30 degree angle with fast twisting needle technique. Retain all needles for 30 minutes. Treat once every week for 5 treatments as a course.

95

Acupuncture and Moxibustion—A Clinical Desk Reference

Moxibustion Direct moxibustion: GB-31, GB-39, and KI-1. Apply direct non-scarring moxibustion on these points for 11 cones. Treat twice a week for 7 treatments as a course. Moxa pole: Ba Feng, BL-62, and BL-57. Apply moxa-pole for 15 minutes. Treat once every other day for 7 treatments as a course. Wrist and Ankle Acupuncture Treatment area: Upper 2, Upper 5, Lower 2, and Lower 5. Insert 1.5 cun #30 needles into these areas transversely, 1-1.2 cun deep at a 15-degree angle beneath the skin avoiding any sensation of the needle. Retain all needles for 40 minutes. Treat once a week for 5 treatments as a course. Bloodletting Treatment points: Ba Feng, LV-1, GB-45, and BL-40. Apply bloodletting technique on these points to squeeze 1-2 drops of blood in each treatment. Treat once a week for 3 treatments as a course. TRADITIONAL PRESCRIPTIONS AND TECHNIQUES For Beriberi with Damp-Cold: KI-6, LV-3, BL-40, and SP-6. (Zhen Jiu Da Quan) Insert 1 cun #32 needles into SP-6, KI-6, and LV-3 with twisting even movement needle technique. Apply bloodletting technique on BL-40, to squeeze 2-3 drops of blood in each treatment. For Dry Beriberi with a painful sensation in the knee, ankle and toes: KI-6, LV-7, BL-60, GB-39, BL-40, SP-6, and GB-34. (Zhen Jiu Da Quan) Insert 1.5 cun #32 needles into LV-7, GB-34, GB-39, and SP-6 perpendicularly, 1 cun deep with twisting even movement needle technique; insert 1 cun #32 needles into KI-6, BL-40, and BL-60 with twisting even movement needle technique. Treat once every other day for 7 treatments as a course. For Beriberi invading the Heart: PC-8, PC-5, and KI-1. (Qian Jing Fang) Insert 1 cun #32 needles into PC-8 perpendicularly, 0.5 cun deep with twisting reducing needle technique, and apply direct non-scarring moxibustion on PC-5 for 11 cones. Apply indirect moxibustion with Fu Zi (aconite) cake on KI-1 for 5 cones. Treat once every other day for 7 treatments as a course. For Beriberi with Damp-Heat: LV-4, GB-36, GB-31, and GB-39. (Zhen Jiu Zi Shen Jing) Insert 2 cun #30 needles into GB-31 perpendicularly 1.5 cun deep with twisting reducing needle technique and 1.5 cun #30 needles into GB-36 and GB-39 perpendicularly 1 cun deep with lifting and thrusting even movement needle technique. Insert 1 cun #32 needles into LV-4 obliquely 0.5-0.8 cun deep at a 60 degree angle towards the ST-41 direction with twisting even movement needle technique. Retain all needles for 20 minutes. Treat once every other day for 5 treatments as a course. 96

Beriberi Syndrome

For Beriberi with itching and pain: GB-31, ST-32, ST-36, LI-6, and GB-39. (Zhen Jiu Zi Shen Jing) Apply direct non-scarring moxibustion on GB-31 for 10 cones, and ST-32 ST-36 LI-6 and GB-39 for 7 cones. Treat once daily for 10 treatments as a course. For Dry Beriberi with a painful sensation in the knee, ankle and toes: KI-6, GB-33, BL-60, BL-40, GB-34, SP-6, and GB-39. (Zhen Jiu Da Cheng) Insert 1 cun #32 needles into KI-6 obliquely, 0.5 cun deep at a 60 degree angle towards the ankle with twisting even movement needle technique. Next insert 1.5 cun #30 needles into GB-33, GB-34 and GB-39 perpendicularly, 1 cun deep with twisting reducing needle technique. Finally insert 1 cun #30 needles into BL-40 and SP-6 with twisting even movement needle technique. Retain all needles for 20 minutes. Treat once every other day for 5 treatments as a course. For Beriberi with interior fever: KI-6, LV-3, BL-40, and PC-6. (Zhen Jiu Gang Yao) Insert 1 cun #32 needles into KI-6 and LV-3 with twisting reducing needle technique, and 1 cun #34 needles into PC-6 perpendicularly, 0.5 cun deep with twisting even movement needle technique. Apply bloodletting technique on BL-40, in order to squeeze 2-3 drops of blood. Treat twice a week for 3 treatments as a course. For Beriberi with a burning and painful sensation, with inability to walk: LV-1. (Jiu Fa Mi Chuan) Apply direct non-scarring moxibustion on LV-1 for 11-15 cones. Treat once daily for 3 treatments as a course. For Beriberi with swelling and a painful sensation on the foot: Ba Feng. (Wan Bing Hui Chun) Apply indirect moxibustion with garlic on the Ba Feng for 6 cones. Treat once every other day for 5 treatments as a course. For Beriberi with Damp-Heat: SP-9, SP-6, LV-3, GB-44, ST-44, and GB-31. (Author’s Clinical Experience) Insert 1.5 cun #30 needles into SP-9 perpendicularly, 1-1.2 cun deep with “Tou Tian Lian Fa” (Cool Penetration of the Sky) technique, and 1 cun #32 needles into SP-6, LV-3, GB-44, and ST-44 perpendicularly, 0.5 cun deep with twisting reducing needle technique. Insert 2 cun #30 needles into GB-31 perpendicularly, 1.5 cun deep with twisting even movement needle technique. Retain all needles for 20 minutes. Treat once every other day for 5 treatments as a course. For Beriberi invading the Heart: PC-6, CV-15, GB-34, SP-10, and SP-6. (Author’s Clinical Experience) Inset 1.5 cun #32 needles into PC-6 and CV-15 with twisting reducing needle technique, and 1.5 cun #30 needles into GB-34, SP-10, and SP-6 perpendicularly, 1 cun deep with lifting and thrusting reducing needle technique. Retain all needles for 30 minutes. Treat once every other day for 5 treatments as a course.

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Acupuncture and Moxibustion—A Clinical Desk Reference

CASE ANALYSIS (One ancient case study) This is a case about Mr. Cai, a governor of the state in the south of China. One day when he was writing, he suddenly felt a sensation like insects walking from his foot up to his back, and few minutes later he lost consciousness, falling into a coma for 10 minutes. An acupuncturist then applied direct moxibustion on GB-31 and all symptoms resolved immediately. The practitioner then explained to Mr. Cai that this is one type of beriberi that invades the Heart. According to the practitioner, the treatment must consist of over 10 year old moxa-wool burnt on PC-8, KI-1, and GB-31 for 500 cones (the course of treatment). This means 15-20 cones each treatment until 500 cones have been burnt, signifying the end of treatment. All symptoms disappeared after the 500-cone moxibustion treatment. EVALUATION Acupuncture and moxibustion used in conjunction or separately is very effective for treating beriberi disease of any pattern. A correct diagnosis is very important during the acupuncture treatment because it will directly influence the result. But for some problems related to a limited diet, the patient should pay attention to regulate their food intake to insure enough vitamin B.

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Bi Syndrome

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BI SYNDROME In the acupuncture clinic Bi Syndrome refers to the symptoms of pain, swelling, heaviness, distention and numb sensation in the muscles, joints, vessels, bone, meridians, and even in the organs and other tissues. Bi syndrome in Chinese Medicine is closely associated with other terms such as: “closing,” “obstruction,” and “stagnation.” TCM thinks Bi syndrome is mainly caused by deficiency of the Interior True Qi. In almost all cases this disorder can be identified and grouped into two categories of causes. One is External Invasion and the other is of internal origin. External Invasion: Wind, Cold, Heat and Damp Pathogenic Influences invade a deficient body and stagnate in the meridians, joints, and muscles, even bone or organs causing Bi syndrome. Most of the time Bi syndrome will happen when in patients with weak body constitutions, or when they live or work for a long time in Damp and Cold environments. Organs Disorders: Organ disorder types usually happen after suffering for a long time with Bi syndrome. In TCM it is called severe Bi. DIAGNOSIS This disorder is so abundant in its variations of symptoms and treatment that it is very hard to make the correct diagnosis without specific guidelines. In most cases, the presence of Bi syndrome is limited to two major parts of the body. In each of these two parts, the occurrence consists of a different set of symptoms that requires different approaches to treatment. Bi Syndromes in the meridians and collaterals Wind Bi This is one of the combination Bi syndromes, which means there are usually more than two External Pathogenic Influences invading the meridian. The hallmark symptoms are moving pain, which travels like wind, and the associated signs are joints that are contracted and hard to extend, fever, and aversion to cold. The tongue is normal with a thin white or a thin yellow coating; the pulse is floating and wiry. Pain Bi This is a combination Bi syndrome with Cold being a much more influential factor than the others. Symptoms of this type are usually severe pain and ache, cold and sore sensation in the joints and muscles, which is intensified by cold and reduced by rubbing the local area or by application of heat. The tongue is pale with a thin white coating; the pulse is floating and tight. Fixed Bi Another combination Bi syndrome, the predominating factor being Dampness. Hallmark symptoms include heaviness, soreness and achy sensation in the joints, which is swollen and without color change. The pain is fixed in a certain area, which is intensified by the weather changes. The tongue is swollen with a white greasy coating; the pulse is floating and weak.

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Heat Bi This type of Bi Syndrome is usually comes from the 3 types above, caused by prolonged stagnation of the Qi and Blood in the local area. The joints are swollen and painful, there is limitation of movement with Heat symptoms, such as a sore throat, dry mouth, fever (which does not change by the body sweating), and scanty, reddish urination. The tongue is red with a yellow thick greasy coating; the pulse is floating, weak, and fast. Bi Syndromes in the Organs There are five Bi syndromes in the classical book the Nei Jing. They are Pi Bi (Skin Bi), Ji Bi (Muscle Bi), Mai Bi (Blood Vessel Bi), Jing Bi (Tendon Bi), and Gu Bi (Bone Bi). Pi Bi (Skin Bi) is related to the Lung and the main symptoms are numbness and other strange sensations on the skin. It often takes place in the autumn season. Ji Bi (Muscle Bi) is related to the Spleen and the main symptoms are weakness, and heavy and painful sensations in the four extremities or other parts of the body, particularly related to the muscles. It often takes place in the later of the summer. Mai Bi (Blood Vessel Bi) is related to the Heart; the main symptoms are tingling, cold or numbness and painful sensations on the arms, legs and tips of the fingers and toes, blue colored lips, nails and tongue body. Often the patient feels short of breath and heart palpitations. It usually takes place in the summer. Jing Bi (Tendon Bi), is related to the Liver and the main symptoms are soreness and achy sensations when the tendons are moved, tendon contraction, and impotence. It often takes place in the fall. Gu Bi (Bone Bi) is related to the Kidney and the main symptoms are swelling and stiffness, or painful sensations in or on the bone, associated with frequent urination and poor memory. It often takes place in the winter. **Generally speaking Bi syndrome in the organs is of the deficiency type. TREATMENT AND PRESCRIPTIONS Bi Syndromes in the meridians and collaterals Treatment Principle: Move the Qi and Blood in the meridians, Expel the Wind, Cold and Damp Pathogenic Influences, and/or Clear the Heat. •

The combination of Ah Shi points and distal points usually serves well as the main points for the treatment of Bi syndrome due to Wind, Cold and Dampness.

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Superficial needle insertion and plum blossom needle technique are usually good to treat moving Bi.

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Long needles with a deep insertion technique, or retaining the needles for a longer time period with moxibustion are good strategies to treat Pain Bi.

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Cupping technique, moxibustion, and the regular insertion of needles are good strategies to treat Damp Bi.

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Bloodletting technique, plum blossom, and superficial needle insertion are good to treat Heat Bi.

Point Prescription: Main points: GV-14, LI-11, GB-31, and BL-62. Treat once every other day for 7 treatments as a course. Technique: Insert a 1.5 cun #32 needle into GV-14 perpendicularly, 1 cun deep with lifting and thrusting reinforcing needle technique and apply moxa wool on the handle of the needle for 3 cones. Insert 1.5 cun #32 needles into LI11 and GB-31 with twisting reducing needle technique, and 1 cun #32 needles into BL-62 obliquely towards the direction of the joint with twisting even movement needle technique. Retain all needles for 30 minutes. 101

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Additional points for associated symptoms: Shoulder pain: LI-15, TW-14, and SI-10. Elbow and arm pain: LI-4, TW-5, TW-10, and LU-5. Wrist pain: LI-5, TW-5, TW-4, and SI-4. Upper back pain: GV-26, GV-12, and GV-3. Hip pain: GV-30, GB-29, and GB-39. Thigh pain: BL-54, BL-36, and GB-34. Knee pain: Xi Yan, ST-34, SP-9, and GB-33. Ankle pain: BL-62, KI-6, GB-42, and BL-60. Additional points for other associated symptoms: Moving Bi: BL-10. Pain Bi: BL-23 and CV-4 Fixed Bi: BL-20, ST-36, and SP-9. Heat Bi: GV-14 and LI-11. Bi Syndromes in the Organs Treatment Principle: Regulate the Qi, Harmonize the Organs, and Expel the Pathogenic Influence. Point Prescription: Pi Bi (Skin Bi) Point Prescription: LU-5, LU-9, SP-6, CV-6, and Ah Shi points. Treat once daily for 3 treatments as a course. Technique: Insert 1 cun #32 needles into LU-5, LU-9, and SP-6 with twisting even movement needle technique. Insert a 1.5 cun #32 needle into CV-6 with twisting reinforcing needle technique, and apply moxa wool on the handle of needle for 3 cones. Apply medium stimulation of a plum blossom needle on the local Ah Shi areas, and then apply fire cups there for 5 minutes. Or insert 1 cun #30 needles into the local area with the “Yang Ci” technique. (This is one kind of ancient needle technique—superficial insertion, one needle in the middle four others surrounding it.) Or insert 3 cun #30 needles into the Ah Shi points transversely, 2.5 cun deep at a 15 degree angle with twisting reducing needle technique. Retain all needles for 30 minutes. Ji Bi (Muscle Bi) Point Prescription: LI-11, SP-9, SP-3, SP-10, BL-20, and Ah Shi points. Treat once every other day for 7 treatments as a course. Technique: Insert 1.5 cun #30 needles into BL-20 perpendicularly, 1 cun deep with lifting and thrusting reinforcing needle technique, and apply moxa wool on the handle of the needles for 3 cones. Insert 1.5 cun #32 needles into LI-11, SP-9, SP-10, and SP-3 with twisting reinforcing needle technique. Retain all needles for 20 minutes. Insert 1.5 cun #30 needles into local Ah Shi points with the “He Gu Ci” technique. (This is one of the ancient needle techniques, using lifting and thrusting needle technique towards different directions within the point.) Apply Electro-acupuncture with a continuous wave for 20 minutes.

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Mai Bi (Vessel Bi) Point Prescription: BL-15, BL-17, BL-18, BL-20, HT-7, PC-6, SP-6, and Ah Shi points. Treat once a week for 7 treatments as a course. Technique: Insert 1.5 cun #30 needles into BL-15, BL-17, BL-18, and BL-20 with twisting reinforcing needle technique, and apply moxa wool on the handle of the needles for three cones. Insert 1 cun #32 needles into HT-7 and PC-6 with twisting even movement needle technique. Retain all needles for 20 minutes. Insert 1 cun #30 needles into local Ah Shi points (especially blue vein areas) with the “Bao Wen Ci” technique. (This is one of the ancient needle techniques, like the bloodletting technique.) Do not retain the needles. If the patient has severe Heart Bi symptoms, apply indirect moxibustion with salt on CV-8, and moxa-pole on GV20, perform until the body temperature, pulse, and heart beat return to normal. Jing Bi (Tendon Bi) Point Prescription: KI-3, LV-8, LV-3, LI-4, LI-10, ST-36, and Ah Shi points. Treat once a week for 7 treatments as a course. Technique: Insert 1 cun #30 needles into KI-3, LV-3, and LI-4 with twisting reinforcing needle technique, along with 1.5 cun needles into LI-11 and ST-36 with lifting and thrusting reinforcing needle technique. Retain all needles for 20 minutes. Insert 1.5 cun #30 or #28 needles into local Ah Shi points with the “Guan Ci” technique. (Another of the ancient needle techniques, consisting of needles inserted near the tendons). Gu Bi (Bone Bi) Point Prescription: KI-3, KI-10, CV-4, GV-14, GV-4, BL-23, and Ah Shi points. Treat once every week for 10 treatments as a course. Technique: Insert 1 cun #30 needles into KI-3 with twisting reinforcing needle technique, 1.5 cun #30 needles into KI-10, CV-4, GV-14, GV-4, and BL-23 with lifting and thrusting reinforcing needle technique. Apply moxa wool on the handle of needles for 3 cones. Insert 1.5 cun #30 needles into local Ah Shi points with the “Shu Ci” technique. (Another of ancient needle techniques—insert the needle perpendicularly and deeply in order to move the needle like it’s massaging the bone). ADJUNCTIVE THERAPIES Moxibustion Indirect moxibustion for Heat Bi syndrome (chronic rheumatoid arthritis) Apply indirect moxibustion with garlic on the GV Meridian Apply Ban Se Fen herb powder on the GV Meridian from GV-14 to GV-2, and then put mashed garlic on the herb powder (about 2 pounds of garlic) as much as 5 cm wide and 3 cm high in size. Apply moxa wool on the garlic 2 cm wide on the bottom, and 3 cm high. Light it from GV-14, GV-2, and GV-11 until all the moxa wool is burned. Treat once every year for 3 treatments as a course. Direct moxibustion for Cold and Damp Bi syndrome Apply direct non-scarring moxibustion on local Ah Shi points and BL-11, and GV-4 for 7 cones. Treat once every other day for 7 treatments as a course.

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Scalp Acupuncture Treatment zones: Middle line of forehead, Middle line of vertex, Upper Middle line of occipital, Anterior and Posterior oblique line from vertex to temple. Select 3 lines in each treatment; insert 1.5 cun #32 needles transversely 1 cun deep with fast twisting needle technique. Retain all needles for 40 minutes, to treat pain Bi syndrome. Treat twice a week for 3 treatments as a course. Wrist and Ankle Acupuncture Treatment area: Upper 2, Upper 5, Lower 4, and Lower 1. Insert 1.5 cun #32 needles into these lines transversely, 1.2 cun deep with slow insertion needle technique, and adjust the needles to avoid any sensation. Retain all needles for 40 minutes to treat Wind and Damp Bi syndrome. Treat once every other day for 5 treatments as a course. Cupping Treatment area: Back Apply fire cups on GV-14, BL-13, BL-43, and BL-20 for 5 minutes, to treat Wind Bi syndrome. Apply moving cups along the Urinary Bladder meridian and the Conception Vessel to treat Damp Bi syndrome. Treat once every other day for 3 treatments as a course. Gua Sha Treatment area: Chest, Back, Arms and Legs. Apply medium stimulation of Gua Sha on the back, along inside of scapula, until the Sha appears. Apply weak simulation of Gua Sha technique on the PC-3 and BL-40 areas for a few minutes until red marks appear. Apply medium Gua Sha technique on the chest along the Kidney meridian until Sha appears, to treat acute Wind Bi syndrome (acute arthritis). Treat once every other day for 2 treatments as a course. Ear Acupuncture Point Prescription: Lung, Heart, Kidney, Shoulder, Knee, Wrist, Ankle, Shen Men, and Endocrine. Select 3 points with Shen Men and Endocrine in each treatment; insert 0.5 cun #32 ear needles into these points obliquely, 0.3 cun deep at a 30 degree angle, with fast twisting needle technique. Retain all needles for 40 minutes. Or apply press-balls on one side of the ear as a supplemental treatment after body acupuncture. Treat once every other day for 5 treatments as a course.

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TRADITIONAL PRESCRIPTIONS For Acute Bi syndrome with pain: ST-9. (Ji Ling Zhong Yi Za Zi) Insert 1 cun #30 needles into ST-9 perpendicularly, 0.3 to 0.5 cun deep with twisting even movement needle technique. Retain needles 3 minutes. Treat once daily for 2 treatments as a course. For Bi syndrome with pain: ST-25, CV-9, and SP-6. (Zhen Jiu Chu Fang Ji Jing) Insert 1.5 cun #30 needles into SP-6 obliquely towards the direction of meridian flow, 1.2 cun deep with twisting even movement technique until the sensation of the needle travels up to the thigh and lower abdomen region. Retain needles for 20 minutes. Insert 1.5 cun #30 needles into ST-25, and CV-9 perpendicularly, 0.8 to 1.2 cun deep with twisting even movement technique. Retain all needles for 20 minutes. Treat once every other day for 10 treatments as a course. For Bi syndrome on the toes, with difficulty and limited movement, associated with dizziness and rebellious Qi: BL-58. (Zhen Jiu Zi Shen Jing) Insert 1.5 cun #30 needles into BL-58 perpendicularly, 1 cun deep with lifting and thrusting reducing needle technique until the sensation the needle travels down to the heel. Retain the needles for 20 minutes. Or apply moxa wool on the handle of needles for 3 to 4 cones. Treat twice a week for 7 treatments as a course. For Moving Bi syndrome on the arms with painful and soreness: GB-21, LI-11, LI-10, LI-9, LI-13, LU-8, and LI-8 (Zhen Jiu Da Cheng) Insert 1.5 cun #30 needles into GB-21, LI-11, LI-10, and LI-9 perpendicularly, with lifting and thrusting reinforcing needle technique. Retain all needles for 20 minutes. Insert 1.5 cun #30 needles into LI-13, LU-8, and LI-8 perpendicularly, 0.8 to 1 cun deep with twisting reducing technique. Retain all needles for 20 minutes. Or apply moxa wool on the handle of the needles for 3 cones. Treat once every other day for 5 treatments as a course. For Wind Bi syndrome: TW-10, LU-5, SI-8, BL-40, and GB-36. (Shen Yin Jing) Insert 1.5 cun #30 needles into TW-10, LU-5, and ST-36 perpendicularly with twisting reducing needle technique. Insert 1.5 cun #30 needles into SI-8 transversely against the meridian flow, 1.2 cun deep with even movement twisting technique. Retain all needles for 30 minutes. Insert 1 cun #28 needles into BL-40 with twisting reducing technique and opening of the acupuncture whole when withdrawing the needles to make 1-2 drops of blood leak out. Treat once every week for 7 treatments as a course. For Wind Bi syndrome: CV-1, LU-9, TW-13, KI-3, and Ah Shi. (Shen Ji Zhong Lu) Insert 1.5 cun #30 needles into CV-1 and TW-13 perpendicularly, 1 cun deep with twisting even movement needle technique, and 1 cun #30 needles into LU-9 and KI-3 with lifting the thrusting reinforcing needle technique. Retain all needles for 20 minutes. Insert 1 cun #30 needles for the Ah Shi points, with waving and enlarging the acupuncture whole technique, without retaining. Treat once every other day for 5 treatments as a course. For Wind, Cold and Damp Bi syndrome: Moxibustion: GB-30, BL-20, and BL-23. (Jiu Fa Mi Chuan) Insert 1.5 cun #32 needles into GB-30, BL-20, and BL-23 perpendicularly, 1.2 cun deep with lifting the thrusting reinforcing needle technique, taking out all needles after the patient feels the Qi sensation in the points. Apply indirect moxibustion with ginger on these points for 5 cones. Treat once every week for 7 treatments as a course. 105

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For Wind Bi syndrome in the arms: Moxibustion: LI-11, TW-5, LI-4, and TW-3. (Lei Jing Tu Yi) Insert 1 cun #30 needles into LI-11, TW-5, LI-4, and TW-3 perpendicularly, 0.5 cun deep with even movement needle technique. Apply moxa wool on the handle of the needles for 5 cones. Or apply direct moxibustion on these points for 7 cones without needles. Treat once every week for 7 treatments as a course. For Wind Bi syndrome: GB-37, GB-33, BL-40, TW-10, LU-5, and SI-8. (Zhen Jiu Fen Yuan) Insert 1.5 cun #30 needles into GB-37, GB-33, and LU-5 perpendicularly, 1 cun deep with lifting and thrusting reducing needle technique, and 1 cun #32 needles into BL-40, TW-10, and SI-8 with twisting even movement needle technique. Retain all needles for 30 minutes. Treat once every other day for 5 treatments as a course. The following are all from the Shen Yin Jing. For Wind Bi syndrome with headache: BL-59. Insert 1.5 cun #32 needles into BL-59 perpendicularly, 1 cun deep with twisting reducing needle technique. For Wind Bi syndrome with arm pain: TW-10. Insert 1.5 cun #30 needles into TW-10 obliquely upwards at a 60-degree angle with twisting reducing needle technique, and apply moxa wool on the handle of needles for 3 cones. For Wind Bi syndrome with shoulder and elbow pain: SI-9 and LU-5. Insert 1.5 cun #32 needles into SI-9 and LU-5 perpendicularly, 1 cun deep with the Qing Long Bai Wei (Green Dragon Waves its Tail) technique. For Wind Bi syndrome with arm contraction: LI-11 and LI-4. Insert 1 cun #32 needles into LI-11 and LI-4 perpendicularly, 0.5 cun deep with twisting reinforcing needle technique. Treat once every other day for 3 to 5 treatments as a course for all of the above. The following are all from the Yu Long Ge. For Damp Bi syndrome: ST-40, LU-7, and ST-38. Insert 1 cun #32 needles into LU-7 transversely, 0.8 cun deep at a 30 degree angle upwards with twisting reducing needle technique. Insert 1.5 cun #32 needles into ST-40 and ST-38 perpendicularly, 1.2 cun deep with lifting and thrusting reducing needle technique, and apply moxa wool on the handle of needles for 3 cones. For Damp Bi syndrome with a sore and heavy sensation in the legs: SP-6 and ST-38. Insert 1.5 cun #32 needles into SP-6 with twisting reinforcing needle technique, and 1.5 cun #30 needles into ST-38 with lifting and thrusting reducing needle technique. Retain all needles for 30 minutes. For Damp Bi syndrome with a tight sensation in the tendons: GB-39. Insert 1.5 cun #32 needles into GB-39 perpendicularly, 1 cun deep with twisting reinforcing needle technique, and apply moxa wool on the handle of needles for 3 cones. For Damp Bi syndrome with walking problems: SP-8. Insert 1.5 cun #32 needles into SP-8 perpendicularly, 1 cun deep with twisting reducing needle technique. Retain needles for 20 minutes.

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For Damp Bi syndrome with numbness and heavy sensation in the whole body: LV-4, BL-63, and GB-39. Insert 1 cun #32 needles into LI-4 perpendicularly, 0.5 cun deep with twisting reducing needle technique, and 1 cun #32 needles into GB-39 and BL-63 with twisting reinforcing needle technique. Apply moxa wool on the handle of needles for 3 cones. For Damp Bi syndrome with weakness in the lower extremities: LV-6 and BL-40. Insert 1.5 cun #32 needles into LV-6 transversely, 1 cun deep towards the LV-5 direction with twisting reinforcing needle technique, and 1.5 cun #30 needles into BL-40 with waving needle technique. Retain all needles for 20 minutes. Treat usually once every other day for 5 treatments as a course for all of the above. For Pain Bi in the four extremities: SP-4, LI-11, GB-31, TW-5, GB-34, SP-6, and LI-10. (Zhen Jiu Da Cheng) Insert 1.5 cun #32 needles into LI-10 and TW-5 with lifting and thrusting reducing needle technique, and 1 cun #32 needles into SP-4 and SP-6 with twisting reinforcing needle technique. Insert 1.5 cun #30 needles into LI-11 and GB-34 perpendicularly, 1 to 1.2 cun deep with Tou Tian Lian Fa (Cool Penetration of the Sky) technique. Insert 2 cun #32 needles into GB-31 with twisting reducing needle technique. Retain all needles for 30 minutes. Treat once every other day for 3 treatments as a course. CASE ANALYSIS This is a case of a 39 year-old male patient with main symptoms of knee pain and swelling. It intensified recently a week ago, sharp pain bothers him day and night; he even cannot sit, sleep or walk. Severe pain is felt in the swollen areas of both knee joints, accompanied with a red color and associated with poor sleep, sore and tight back and legs. The tongue is red with a yellow thin coating; the pulse is wiry. Diagnosis: Pain Bi with Heat. Treatment Principle: Move the Qi and Blood, Reduce the Heat and Stop the pain. Point Prescription: ST-44, GB-34, ST-36, LI-4, BL-23, GV-14, LI-5, and ST-34. Treated once every other day for 3 treatments as a course. Technique: 1 cun #32 needles were inserted into ST-44 perpendicularly, 0.5 cun deep with twisting reducing needle technique, and 1.5 cun #32 needles into GB-34, ST-36, and ST-32 perpendicularly, 1 cun deep with lifting and thrusting reducing needle technique. 1 cun #32 needles were then inserted into LI-4 and LI-5 with twisting even movement needle technique. All needles were retained for 20 minutes. 1.5 cun #32 needles were then inserted into GV-14 with twisting reducing needle technique, and 1 cun #32 needles into BL-23 with twisting reinforcing needle technique. All needles were retained for 10 minutes. Results: The swelling was reduced and the red color was gone after 3 treatments; the pain was reduced to near 40%, but the patient still felt stiffness in the knee joints. 2nd Course: Point Prescription: ST-35, Xi Yan, SP-10, SP-6, LI-11, BL-24, BL-40, and BL-57. Treated twice a week for 3 treatments as a course. Technique: 1.5 cun #32 needles were inserted into ST-35 and Xi Yan obliquely, 1.2 cun deep with Long Hu Jiao Zhan, Dragon and Tiger Battle technique. 1 cun #32 needles were then inserted into SP-10, SP-6, and LI-11 with lifting and thrusting even movement needle technique. All needles were retained for 20 minutes. 1.5 cun #32 needles were then inserted into BL-24, BL-40, and BL-57 perpendicularly, 1 cun deep with lifting and thrusting even movement needle technique. All needles were retained for 10 minutes. Results: The knee joints returned to normal size and all pain and stiffness had disappeared.

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EVALUATION Needle and moxibustion techniques can directly influence the effects of treatment in regards to Bi Syndrome. In order to make the correct diagnosis, specific examination of the pulse and the tongue must first be taken into careful consideration. Such examples are the “Shao Shan Huo” technique to treat patients with Cold Bi syndrome with a pale tongue body and a deep pulse, and the “Tou Tian Liang” technique to treat patients with Heat Bi, presenting with a red tongue body and floating fast pulse. During acupuncture and moxibustion treatment, patients can perform suitable exercises, and receive other treatments, such as herbal therapy, physical therapy, etc.

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Chronic Fatigue Syndrome—Xu Lao

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Acupuncture and Moxibustion—A Clinical Desk Reference

CHRONIC FATIGUE SYNDROME—XU LAO Chronic fatigue syndrome has been known to affect most people at some point in their lives. This disorder is not simply another manifestation of a specific antigen reaction in the body. Rather insufficient Qi, Blood, Yin and Yang, or an organ disorder characterizes this condition. In TCM, it is attributed to various factors that are commonly linked to lifestyle and symptoms of other energy consuming diseases. Congenital problems This pathology is due to a genetic problem causing weakness of the Kidney Qi and Essence, or some diseases that occur in woman and babies during pregnancy. It is not uncommon to have chronic fatigue syndrome occur in a baby when he or she is born. Over working Over working and unhealthy emotional activities will cause chronic fatigue syndrome. In TCM, it is said that “reading for a long time will exhaust the Blood, lying down for a long time will exhaust the Qi, sitting a long time will exhaust the muscles, standing a long time will hurt the bone and walking a long time will easily damage the tendons.” In daily life, if people are bothered by unhealthy emotional activities, they may experience chronic fatigue as well. For instance, over-thinking will hurt the Spleen Qi; anger will impair the Liver; sadness will damage the Lung Qi; anxiety and depression will hurt the Heart Qi; and uncontrolled excessive sexual activities will hurt the Kidney Essence. Improper food intake Improper eating habits easily impair the Stomach and Spleen. Therefore, chronic fatigue syndrome will appear after a long-term deficiency of the Spleen and Stomach. After other severe diseases Some severe diseases or injuries will seriously hurt the body energy, including the Qi, Blood, Yin and Yang. After disease, if patients don’t get good rest and recuperation, more illness can occur. Long-term deficiency syndromes will lead to other organ problems. DIAGNOSIS Deficiency of Heart Blood and Spleen Qi Symptoms include heart palpitations, insomnia with many dreams or even nightmares, poor appetite, a bloated abdomen, lassitude, a pale complexion, possible chronic bleeding, or even scanty menstruation in women. The tongue is pale with a thin white coating; the pulse is thin and weak. Lung and Stomach Yin Deficiency Symptoms include a gradual weight loss, a dry mouth and throat, heat sensation in the palms and soles, night sweats, tidal fever, a poor appetite, dry heaves, and hiccupping, a dry cough or bloody phlegm and dry stool. The tongue is red and dry without a coating; the pulse is thin and fast. Deficiency of Spleen Yang Symptoms include a poor appetite, lassitude, a chilly sensation in the limbs, a pale complexion, a bloated abdomen with borborygmus, easing of symptoms with warmth and pressure, watery diarrhea containing undigested food and a large amount of clear leukorrhea in female patients. The tongue is pale with a white coating; the pulse is weak and deep. 110

Chronic Fatigue Syndrome—Xu Lao

Deficiency of Kidney Yang Symptoms include a pale complexion, a cold sensation inside and in the four extremities, dawn or early morning diarrhea, a sore and cold sensation in the low back and both knees, impotence in males and infertility in females. The tongue is pale and swollen; the pulse is deep, thin and weak. Deficiency of Yin in both the Liver and the Kidney Symptoms include dizziness and vertigo, ringing in the ear, a dry mouth and throat, a sore and achy sensation in the low back and hypochondriac region, five-heart heat, a malar flush, and scanty menstruation in females. The tongue is red without a coating; the pulse is thin and fast. TREATMENT AND PRESCRIPTION Deficiency of Heart Blood and Spleen Qi Treatment Principle: Nourish the Heart Blood, and Reinforce the Spleen Qi. Point Prescription: HT-7, CV-6, ST-36, SP-4, PC-6, BL-15, and BL-20. Treat once every other day for 7 treatments as a course. Technique: Insert 1.5 cun #32 needles into BL-15 obliquely 1 cun deep towards the spinal column, at a 60 degree angle with a twisting reinforcing needle technique, and 1.5 cun #32 needles into BL-20 perpendicularly 1 cun deep with a lifting and thrusting reinforcing needle technique. Apply moxa wool on the handles of the needles for 3 cones. Insert 1 cun #34 needles into SP-4, PC-6, and HT-7 perpendicularly, 0.3 to 0.4 cun deep with a twisting even movement needle technique. Insert 1.5 cun #32 needles into CV-6 and ST-36 perpendicularly, 1 cun deep with a twisting reinforcing needle technique, and apply moxa wool on the handles of the needles for 3 cones. Additional points for the treatment of other symptoms: Heart palpitation: PC-7 and CV-14. Severe blood deficiency: BL-17 and BL-18 with direct non-scarring moxibustion for 7 cones. For severe bleeding: SP-1 with direct non-scarring moxibustion for 9 cones. Lung and Stomach Yin Deficiency Treatment Principle: Nourish Lung Yin, and Harmonize the Stomach. Point Prescription: LU-9, ST-36, CV-4, LU-5, CV-12, BL-13, BL-43, BL-21, BL-23, and GV-12. Treat once every other day for 7 treatments as a course. Technique: Insert 1 cun #34 needles into LU-9, LU-5, ST-36 and CV-12 perpendicularly, 0.5 to 0.8 cun deep with a twisting reinforcing needle technique, and a 1.5 cun #34 needle into CV-4 with a lifting and thrusting reinforcing needle technique. Retain all needles for 20 minutes. Insert 1.5 cun #34 needles into BL-21, BL-23 and GV-12 perpendicularly, 1 cun deep with a twisting reinforcing needle technique, and 1 cun #32 needles into BL-13 perpendicularly, 0.6 cun deep with a lifting and thrusting reinforcing needle technique. Insert 1 cun #32 needles into BL-43 perpendicularly, 0.3 cun to 0.5 cun deep with the Qi Ci technique (one of the ancient needle techniques with one needle in the middle and two other on each side) and a waving needle technique. Retain all needles for 10 minutes. Additional points the treatment of other symptoms: Dry cough: GV-14 and BL-12. Interior heat: KI-2 and HT-6. Constipation: ST-25 and BL-25.

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Deficiency of Spleen Yang Treatment Principle: Warm the Spleen and Kidney Yang, and promote water metabolism. Point Prescription: SP-4, ST-36, CV-6, CV-9, BL-20, BL-18, and GV-14. Treat once every other day for 7 treatments as a course. Technique: Insert 1.5 cun #32 needles into BL-20, BL-18 and GV-14 perpendicularly, 1 cun deep with a lifting and thrusting reinforcing needle technique, and apply moxa wool on the handles of the needles for 3 cones. Insert 1 cun #34 needles into SP-4 with a twisting reinforcing needle technique, and 1.5 cun #32 needles into ST-36 with a twisting reinforcing needle technique. Apply indirect moxibustion with ginger on CV-6 and CV-9 for 5 cones. Additional points the treatment of other symptoms: Bloated abdomen: SP-15 and KI-13. Vomiting: CV-17 and SP-18. Water retention: BL-22 with direct non-scarring moxibustion for 9 cones. Deficiency of Kidney Yang Treatment Principle: Warm the Kidney Yang. Point Prescription: KI-3, ST-36, HT-7, CV-4, ST-28, BL-52, GV-4, and GV-14. Treat once every other day for 7 treatments as a course. Technique: Insert 1 cun #34 needles into KI-3 and HT-7 perpendicularly, 0.3 to 0.4 cun deep with a twisting reinforcing needle technique. Insert 1.5 cun #32 needles into ST-36 and ST-28 perpendicularly, with a lifting and thrusting reinforcing needle technique, and apply moxa wool onto the handles of the needles for 3 cones. Apply indirect moxibustion with a Fu Zi (aconite) cake on CV-4 for 5 cones. Then insert a 1.5 cun #32 needle into GV-14 perpendicularly, 1 cun deep with a lifting and thrusting reinforcing needle technique, and apply moxa wool onto the handle of the needle for 3 cones. Apply indirect moxibustion on GV-4 and BL-52 for 5 cones. Additional points the treatment of other symptoms: Seminal emission: HT-6 and LV-8. Bed-wetting: CV-6 and BL-32. Dawn diarrhea: SP-9 and KI-13. Impotence: BL-23 and BL-32. Edema: CV-9 and BL-22 with indirect moxibustion with ginger for 5 cones. Deficiency Yin of both the Liver and Kidney Treatment Principle: Nourish Kidney Yin, and Reinforce the Liver. Point Prescription: KI-3, LV-3, GV-20, CV-4, HT-4, ST-36, BL-23, BL-18, and BL-43. Treat once every other day for 7 treatments as a course. Technique: Insert 1 cun #34 needles into KI-3, LV-3, and HT-4 perpendicularly, 0.3 to 0.5 cun deep with a twisting reinforcing needle technique, and 1.5 cun #32 needles into ST-36 and CV-4 perpendicularly, 1 to 1.2 cun deep with a twisting reinforcing needle technique. Insert a 1 cun #32 needle into GV-20 obliquely, 0.7 cun deep at a 45 degree angle towards the back with a lifting and thrusting even movement needle technique. Retain all needles for 20 minutes. Insert 1.5 cun #32 needles into BL-18 and BL-23 perpendicularly, 1 cun deep with a twisting reinforcing needle technique, and 1.5 cun #32 needles into BL-43 transversely, 1 to 1.2 cun deep at a 30 degree angle towards the BL-44 direction with a twisting reinforcing needle technique. Retain all needles for 15 minutes.

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Chronic Fatigue Syndrome—Xu Lao

Additional points the treatment of other symptoms: Headache: Tai Yang and Yin Tang. Interior heat: HT-6 and KI-2. Dizziness: Si Shen Cong and BL-10. Muscle ache: SP-10, BL-17, and BL-18. Seminal emission: KI-4and GV-4. ADJUNCTIVE THERAPIES Ear Acupuncture Point Prescription: Heart, Lung, Spleen, Kidney, Liver, Shen Men, Endocrine, Sympathetic, Brain Stem, and Occipital. Select 4 to 5 points each treatment, apply press-balls to these points and let the patient press them 4 to 5 times daily. Or, insert 0.5 cun #34 ear acupuncture needles into these points obliquely, 0.3 cun deep at a 40 degree angle with a twisting reinforcing needle technique. Retain all needles for 30 minutes. Treat once every other day for 7 treatments as a course. Moxibustion Direct moxibustion: CV-6, GV-4, KI-6, GV-14, and BL-43. Apply direct non-scarring moxibustion on CV-6 and KI-6 for 9 cones and 11 cones on GV-14, BL43 and GV-4. Treat twice a week for 7 treatments as a course. Indirect moxibustion: CV-8, CV-4, GV-12, BL-23, and Shi Qi Zhui Xia. Apply indirect moxibustion with “Rou Gui” cake (Rou Gui, Fang Feng, Ding Xiang, and Bing Pian) on these points for 3 cones. Treat twice a week for 7 treatments as a course. Moxa pole: GV-20, CV-4, CV-12, and KI-1. Apply moxa-pole on KI-1 for 20 minutes, on CV-4 and CV-12 for 15 minutes, and on GV-20 for 10 minutes. Treat once every other day for 10 treatments as a course. Gua Sha Treatment area: Back and Chest. Apply weak stimulation of Gua Sha technique on the upper back from GV-15 to GV-9 and BL-10 to BL-20 and BL-49 until a red color appears and a heat sensation is produced. Apply weak stimulation of Gua Sha on the chest from CV-21 to CV-17 and KI-27 to 21 until a red color appears. Treat one or twice a week for 7 treatments as a course.

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Plum Blossom Needle Treatment area: BL-13, BL-15, BL-18, BL-43, BL-44, BL-45, BL-23, SP-6, and ST-36. Apply medium stimulation of the Plum-blossom needle technique on all back points for 5 to 7 minutes until a red color appears. Apply weak stimulation of the Plum-blossom needle technique on SP-6 and ST-36 for 5 minutes. Treat twice a week for 5 treatments as a course. Intradermal Needle Point Prescription: BL-13, BL-43, GV-14, BL-20, BL-23, CV-6, SP-6, ST-36, and CV-17. Select 5 points from the above prescription each time, and apply intradermal needles in the points selected and retain them for 5 days. Treat once a week for 5 treatments as a course. TRADITIONAL PRECRIPTIONS AND TECHNIQUES For chronic fatigue with seminal emission: CV-4, KI-13, LV-4, and CV-2. (Zhen Jiu Jia Yi Jing) Insert 1.5 cun #34 needles into KI-13 and CV-4 perpendicularly, 1 to 1.2 cun deep with a twisting reinforcing needle technique, and apply moxa wool onto the handles of the needles for 3 cones. Apply direct non-scarring moxibustion on KI-13 and LV-4 for 7 cones. Treat once every other day for 7 treatments as a course. For chronic fatigue with shortness and breath: HT-7, LU-9, BL-13, BL-15, BL-43, and CV-6. (Author’s Clinical Experience) Insert 1 cun #32 needles into HT-7 and LU-9 perpendicularly, 0.3 cun deep with a twisting reinforcing needle technique. Apply indirect moxibustion with Fu Zi (aconite) cake on CV-6 for 3 cones. Insert 1 cun #34 needles into BL-13 and BL-15 perpendicularly, 0.7 cun deep with a lifting and trusting reinforcing needle technique, and apply direct non-scarring moxibustion on BL-43 for 7 cones. Treat once every other day for 7 treatments as a course. For chronic fatigue with a hypo-active Shen: CV-4, BL-43, CV-15, KI-4, and ST-40. (Qian Jin Fang) Insert 1.5 cun #34 needles into ST-40 perpendicularly, 1 cun deep with a twisting reducing needle technique, and 1 cun #32 needles into KI-4 perpendicularly, 0.3 cun to 0.5 cun deep with a twisting even movement needle technique. Apply direct non-scarring moxibustion on CV-4, BL-43 and CV-15 for 9 cones. Treat once every other day for 7 treatments as a course. For chronic fatigue with deficiency of Blood and poor sleep: BL-13, BL-18, CV-12, ST-36, and HT-6. (Shen Yin Jing) Insert 1.5 cun #32 needles into ST-36 and CV-12 perpendicularly, 1 cun deep with a twisting reinforcing needle technique, and apply moxa wool to the handles of the needles for 3 cones. Apply direct non-scarring moxibustion on BL-13, BL-18 and HT-6 for 9 cones. Treat once every other day for 7 treatments as a course. For chronic fatigue with irregular menstruation: CV-6, CV-4, BL-17, BL-19, SP-10, and LV-3. (Zhen Jiu Da Cheng) Apply direct non-scarring moxibustion on BL-17 and BL-19 for 11 cones. Insert 1.5 cun #34 needles into CV-6 and SP-10 perpendicularly, 1 cun deep with a twisting reinforcing needle technique, and 1 cun #34 needles into LV-3 perpendicularly, 0.5 cun deep with a twisting reinforcing needle technique. Apply indirect moxibustion with ginger on CV-4 for 5 cones. Treat once a week for 5 treatments as a course. 114

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For chronic fatigue with weak urination: CV-3, ST-28, GV-4, BL-52, KI-3, SP-9, and GV-20. (Author’s Clinical Experience) Apply direct non-scarring moxibustion on GV-4 and BL-52 for 9 cones. Insert 1.5 cun #34 needles into CV-3 and ST-28 perpendicularly, 1 cun deep with a twisting reinforcing needle technique, apply moxa wool to the handles of the needles for 3 cones. Insert 1 cun #34 needles into SP-9 and KI-3 with a twisting even movement needle technique. Apply a moxa-pole on GV-20 for 20 minutes. Treat twice a week for 7 treatments as a course. For chronic fatigue with loose stool: GV-14, CV-6, LV-13, BL-23, and BL-25. (Zi Shen Jing) Insert 2 cun #32 needles into BL-23 and BL-25 perpendicularly, 1.5 cun deep with a twisting reinforcing needle technique, and apply moxa wool onto the handles of the needles for 3 cones. Apply direct nonscarring moxibustion on GV-14 for 11 cones. Insert a 1.5 cun #34 needle into CV-6 perpendicularly, 1 to 1.2 cun deep with an even movement needle technique until the sensation of Qi travels from the point, and apply moxa wool onto the handle of the needle for 3 cones. Apply direct non-scarring moxibustion on LV13 for 9 cones. Treat once every other day for 7 treatments as a course. For chronic fatigue with impotence: GV-4, GV-14, GV-9, BL-54, CV-4, KI-3, and LV-8. (Author’s Clinical Experience) Insert 1 cun #32 needles into GV-4, GV-14 and GV-9 perpendicularly, 0.7 cun deep with a lifting and thrusting reinforcing needle technique until the sensation of Qi travels along the spinal column, and apply moxa wool to the handles of the needles for 3 cones. Insert 3 cun #32 needles into BL-54 obliquely, 2 to 2.5 cun deep at a 60 degree angle towards the genital region with a twisting reinforcing needle technique until the sensation of the needle travels to the front of the lower abdomen. Retain the needles for 20 minutes. Insert 1 cun #32 needles into KI-3 and LV-8 perpendicularly, 0.5 cun deep with a twisting reinforcing needle technique. Apply indirect moxibustion with a Fu Zi (aconite) cake on CV-4 for 3 to 5 cones. Treat once a week for 5 treatments as a course. For chronic fatigue with a heavy sensation in the body: CV-9, LI-11, GV-14, SP-9, and ST-40. (Zhen Jiu Da Quan) Insert 1.5 cun #32 needles into LI-11, SP-9, ST-40 and GV-14 perpendicularly, 1 cun deep with Shao Shan Huo—Burning the Mountain, (one of the reinforcing needle techniques) until a heat sensation is produced. Apply indirect moxibustion with ginger on CV-9 for 3 cones. Treat twice a week for 7 treatments as a course. For chronic fatigue with dizziness and vertigo: BL-62, KI-6, ST-36, CV-4, BL-11, GV-14, BL-23, BL-18, and GV-20. (Author’s Clinical Experience) Insert 1.5 cun #34 needles into CV-4 and ST-36 perpendicularly, 1 to 1.2 cun deep with a twisting reinforcing needle technique. Insert 1 cun #32 needles slowly into KI-6 perpendicularly, 0.3 to 0.5 cun deep (slowly inserting the needle is one kind of moving the Qi technique) slowly inserted into the point with a twisting and pressing technique for around 3 minutes. Insert a 1 cun #34 needle into GV-20 obliquely, 0.5 cun deep at a 45 degree angle with a twisting reinforcing needle technique. Retain all the needles for 30 minutes. Insert 1 cun #32 needles into BL-62 perpendicularly, 0.5 cun deep with a twisting even movement needle technique. Insert 1.5 cun #32 needles into BL-18, BL-23 and GV-14 perpendicularly, 1 cun deep with a twisting reinforcing needle technique and apply moxa wool onto the handles of the needles for 3 cones.

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For chronic fatigue with insomnia and a tendency towards anger: SP-4, PC-6, GB-41, LI-3, GV-24, GV-16, BL-10, BL-44, BL-18 (Author’s Clinical Experience) Insert 1.5 cun #32 needles into BL-10 and BL-18 perpendicularly, 1 cun deep with a twisting reinforcing needle technique, and a 1 cun #34 needle into GV-16 perpendicularly, 0.6 cun deep with a lifting and thrusting even movement needle technique. Apply medium stimulation of the plum blossom needle technique on BL-44 for 3 minutes. Retain all needles for 10 minutes. Insert 1 cun #34 needles into SP-4 and PC-6 perpendicularly, 0.3 to 0.5 cun deep with a twisting even movement needle technique, and 1 cun #32 needles into LV-3, GV-41 and GV-24 with a twisting reducing needle technique. Retain all the needles for 20 minutes. Treat once every other day for 7 treatments as a course. CASE ANALYSIS A 42 year-old female patient has a main complaint of chronic fatigue for 5 years and had been diagnosed with a hypothyroid and chronic fatigue syndrome 3 years ago. She feels numbness and heaviness in the body and the limbs with a dull sensation on the skin. She is tired, oversleeps, and is without energy. She also has shortness of breath and heart palpitations, ringing in the ear, dizziness, a pale complexion, soreness and weakness in the back and legs, along with edema around the ankles. The tongue is swollen and pale with a white wet coating; the pulse is deep, thin and weak. Diagnosis: Insufficient Kidney Qi. Treatment Principle: Warm the Kidney Yang, and Move the Qi. Point Prescription: CV-4, GV-4, KI-5, SP-9, ST-36, GV-20, GV-14, BL-11, and BL-23. Treated twice a week for 7 treatments as a course. Technique: Insert 1.5 cun #32 needles into BL-11and GV-14 perpendicularly, 1 cun deep with a twisting reinforcing needle technique and apply direct non-scarring moxibustion on BL-23 and GV-4 for 9 cones. Insert 1.5 cun #34 needles into CV-4, ST-36, and SP-9 with a twisting reinforcing needle technique, and apply moxa wool onto the handles of the needles for 3 cones. Insert 1 cun #32 needles into KI-5 perpendicularly, 0.3 cun deep with a twisting even movement needle technique, and a 1 cun #32 needle into GV-20 obliquely, 0.5 cun deep at a 45 degree angle with a twisting reinforcing needle technique. Result: The energy improved after 7 treatments and the sleep was reduced from over 12 hours to less than 9 hours. After a three-course treatment, she felt like a normal person with normal energy. EVALUATION Acupuncture and moxibustion are very effective in treating “chronic fatigue syndrome.” But, for some cases that are caused by severe internal disorders, such as heart attack, wind stroke or severe infections, acupuncture therapy is only a supplemental treatment. In these severe cases, surgery or other immediate western medicine is recommended to avoid immediate danger. The basic principle of TCM chronic fatigue treatment is to build up the Qi, Blood, Yin and Yang. A diagnosis that is correct according to TCM theory will help make an effective prescription and determine appropriate needle techniques. During the treatment period, the patient should have continuous treatment because the body needs time to adjust to a proper functioning of the Qi and Blood. During the treatment course, practitioners should check the food intake and the emotional output of the patients to avoid allergic food reactions and bad emotional stimulation.

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Common Cold

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Acupuncture and Moxibustion—A Clinical Desk Reference

COMMON COLD The Common Cold is an infectious disease of the respiratory tract that can affect almost everyone. Under years of observation and studies it is believed to be viral in nature and remains dormant in the patient throughout his or her life until moments of immune weakness. It is characterized by a stuffy nose, rhinorrhea, cough, headache; aversion to cold, fever, and in severe cases will transfer to a febrile disease. In Traditional Chinese Medicine, the Common Cold is caused by External Pathogenic Influences, such as Wind-Cold, Wind-Heat, or Wind-Damp and so forth. Rather than having the emphasis placed on the treatment of related symptoms, TCM uses the combination of herbs and acupuncture treatments to prevent the outbreak and suppress the viral infection. DIAGNOSIS Excess types Wind-Cold A morbid condition due to Wind-Cold Pathogenic Invasion, the clinical manifestations are severe aversion to cold, slight fever, absence of sweat, headache, aching pain of extremities, stuffy nose with nasal discharge, cough with thin sputum, a thin and whitish coating of the tongue, and a floating and tight pulse. Wind-Heat Usually caused by a Wind-Heat Pathogenic Invasion, the clinical features are high fever, slight aversion to cold, headache, sore throat with congestion, expectoration of yellowish sputum, thirst with or without epitasis, a reddened tongue with a thin and yellowish coating, along with a floating and rapid pulse. Summer Damp This pathology usually occurs in cases of gastro-intestinal influenza, pertaining to the syndrome of Exterior Cold and Interior Dampness, and is marked by fever, aversion to cold, vomiting, diarrhea, a feeling of fullness and stuffiness in the chest and hypochondriac region, a thick and greasy fur on the tongue, and a floating and slippery pulse. Deficiency types Qi Deficiency This is a condition due to the body’s general Qi deficiency, in which a Pathogenic Influence attacks it. The clinical features are the usual common cold symptoms with shortness of breath, tire to speak, lassitude, dizziness, a pale and swollen tongue body with a white thin coating, and a floating and weak pulse. Blood Deficiency This is a condition due to the body’s Blood deficiency, where a Pathogenic Influence invades the body. The clinical features are the usual common cold symptoms with a pale complexion, dizziness, heart palpitations, pale lips and nails, a pale tongue body with a thin white coating, and a thin and weak pulse. Yang Deficiency A condition due to the body’s Yang Qi deficiency along with an invasion by a Pathogenic Influence. The clinical manifestations are the usual common cold symptoms with a pronounce cold sensation over the body and four extremities, a pale complexion, a swollen and pale tongue body with a white thin coating, and a deep and weak pulse. 118

Common Cold

Yin Deficiency This is a syndrome due to the body’s Yin deficiency, which allows a Pathogenic Influence to invade the body. The clinical manifestations are the usual common cold symptoms with restlessness, thirst, dry throat, heat sensation in the palms and soles, a red tongue, and a thin and fast pulse. TREATMENT AND PRESCRIPTION Excess types Wind Cold syndrome Treatment Principle: Release the Exterior and Expel the Wind-Cold. Point Prescription: LU-7, LI-20, SI-7, BL-10, GV-20, and LI-4. Treat once daily for 3 treatments as a course. Technique: Insert 1.5 cun #30 needles into SI-7 and BL-10 with a lifting and thrusting reducing needle technique. Retain all needles for 10 minutes. Insert 1.5 cun #32 needles into LU-7, LI-4, and GV-20 with a lifting and thrusting reducing needle technique, along with 1 cun #32 needles into LI-20, transversely towards the extra point Bi Tong, 0.8 cun deep with a twisting reducing needle technique. Retain all needles for 20 minutes. Additional points for other associated symptoms: Severe headache: Yin Tang and Tai Yang. Tender and achy sensation on the back: Apply fire cupping on BL-13, or a moving cups from GV14 to GV-4 and stop on the area bilateral to T-3 and retain for 5-7 minutes. Wind Heat syndrome Treatment Principle: Expel the Wind-Heat and move the stagnation of the Lung Qi. Point Prescription: LU-5, LU-10, LI-11, ST-44, GV-14, and TW-5. Treat once daily 3 treatments as a course. Technique: Insert a 1.5 cun #30 needle into GV-14 perpendicularly, 1.2 cun deep with rubbing needle technique (rub the needle clockwise) and continue until the sensation of the needle travels down along the spinal column. Retain needle for 3 minutes. Insert 1.5 cun #30 needles into LU-5, LI-11, and TW-5 with a lifting the thrusting reducing needle technique. Retain all needles for 15 minutes. Apply bloodletting on LU-10 and ST-44 to make 1 to 2 drops of blood before concluding treatment. Additional points for other associated symptoms: Severe sore throat: Use bloodletting technique on the LU-10. Children with high fever or even in a coma: GV-26 and Shi Xuan with enlarging and closing reducing technique, along with bloodletting technique on Shi Xuan.

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Summer Damp-Heat Treatment Principle: Clear the Summer-Heat and Resolve the Damp, Expel the Exterior and Harmonize the Interior. Point Prescription: LU-6, LI-4, CV-12, ST-36, and TW-5. Treat once every other day for 3 treatments as a course. Technique: Insert a 1.5 cun #30 needle into CV-12 perpendicularly, 0.8 to 1 cun deep with twisting even movement needle technique, and 1 cun #32 needles into LU-6, LI-4, ST-36, and TW-5 with a twisting reducing needle technique. Retain all needles for 20 minutes. Additional points for associated symptoms: High fever: GV-14 Heaviness or other Damp related signs: SP-9 Bloating abdomen and loose stool: ST-25 Deficiency types: Treatment Principle: Build up the body’s Qi and Expel Pathogenic Influence. Point Prescription: LU-5, LU-9, ST-40, SP-9, BL-13, BL-20, and GV-14. Treat once every other day for 3 treatments as a course. Technique: Insert 1.5 cun #30 needles into BL-13, BL-20, and GV-14 with even movement needle technique and apply moxa wool on the handle of needles for 3 cones. Insert 1 cun #32 needles into LU-5, LU-9, ST40, and SP-9 with twisting reinforcing needle technique. Retain all needles for 30 minutes. Additional points for other associated symptoms: Yang Qi Deficiency: ST-36 and BL-43 with moxibustion. Yin and Blood Deficiency: BL-13, SP-10, and KI-6 with twisting reinforcing technique.

ADJUNCTIVE THERAPIES Ear Acupuncture Points: Lung, Trachea, Inner Nose, Tip of Ear, Stomach, Spleen, and Triple Warmer. Selecting 3 points in per treatment, insert 0.5 cun #34 ear acupuncture needles into these points obliquely at a 30-degree angle with twisting reducing needle technique. Retain the needles for 30 minutes. Treat once daily for 3 treatments as a course. Scalp Acupuncture Treatment zone: Middle line of the vertex. Insert a 1.5 cun #30 needle transversely at a 30 degree angle, 1 cun deep backwards with fast twisting needle technique for 3 minutes. Retain the needle for 1 hour. Treat once daily for 2 treatments as a course.

120

Common Cold

Plum Blossom Needle Treatment area: Upper back, and Forearm. Apply medium stimulation of a plum blossom needle on the upper back from C-6 to T-7, along the GV and Bladder meridian until red marks appear. Apply weak stimulation of a plum blossom needle on the forearm along the Lung meridian from LU-5 to LU-9. Treat once daily for 3 treatments as a course. Gua Sha Treatment area: Chest: along the Stomach meridian and Conception vessel Back: along the first and second line of the Bladder meridian Neck: along the Stomach meridian Forearms: along the three Hand Yin meridians, from elbow to wrist Apply medium stimulation of Gua Sha on these areas, until dark red or purple dots (Sha) appear, for the treatment of Cold with Damp-Heat. Treat once or twice daily for 3 treatments as a course. Wrist and Ankle Acupuncture Treatment area: Upper 1 and 2: both sides of the wrist. Insert 1.5 cun #32 or #34 needles into these treatment zones subcutaneously, 1.2 cun deep, avoiding any sensation. Retain all needles for 40 minutes. Treat once daily for 2 treatments as a course. Moxibustion Direct non-scarring moxibustion Points: CV-6, GV-14, BL-13, and BL-43. Apply indirect moxibustion with ginger on CV-6, CV-4, BL-13, and BL-43 for three cones. Treat once daily for 3 treatments as a course. Moxa pole Points: CV-8, BL-13, and BL-43. Apply moxa pole on CV-8, BL-13, and BL-43 for 25 minutes, to treat Wind Cold with Lung Qi deficiency. Treat one or twice daily, 5 treatments as a course. Cupping Treatment area: Upper back. Apply fire cups on GV-14, BL-13, and BL-43 for 3 to 5 minutes, or apply a moving cup on the upper back along the Bladder meridian for 3 minutes until red marks appear. Treat once daily for 2 treatments as a course.

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TRADITIONAL PRESCRIPTIONS AND TECHNIQUES For Cold due to Wind Heat: GV-13, and BL-13. (Bai Zhen Fu) Insert a 1.5 cun #30 needle into GV-13 perpendicularly, 1 cun deep with rubbing technique (rub the needle count clockwise) until the sensation of the needle travels. Insert 1 cun #30 needles into BL-13 with lifting and thrusting reducing needle technique. Retain all needles for 15 minutes. Treat once daily for 2 treatments as a course. For Cold due to Wind Cold Pathogenic Invasion, after intake of “Gui Zhi Tang”: GB-20 and GV-16. (Shan Han Lun) Insert 1.5 cun #30 needles into GB-20 perpendicularly, 1 to 1.2 cun deep with twisting even movement needle technique, and a 1 cun #30 needle into GV-16 with twisting reducing needle technique. Retain all needles for 15 minutes. Treat once daily for 2 treatments as a course. For Cold in the Tai Yang meridian; preventing transfer to the Yang Ming meridian: ST-36 and LU-5. (Shan Han Lun) Insert 1.5 cun #30 needles into LU-5 perpendicularly, 1.2 cun deep with lifting and thrusting reducing needle technique, and 1.5 cun #32 needles into ST-36 with twisting reinforcing needle technique. Retain all needles for 20 minutes. Treat once daily for 2 treatments as a course. For Cold with fever and aversion to cold without sweat, headache, back achiness, a and floating pulse: LI-4. (Zhen Jiu Zhai Ying Ji) Insert 1 cun #30 needles into LI-4 perpendicularly, with twisting reducing needle technique for 5 minutes, or until a heat sensation has appeared in the body. Retain the needles for 15 minutes. Treat one or twice daily for 3 treatments as a course. For Cold due to Wind Cold Pathogenic Influence: LU-7, LI-20, SI-7, BL-12, GB-20, and LI-11. (Zhen Jiu Cu Fang Da Quan) Insert 1.5 cun #30 needles into GB-20 and BL-12 perpendicularly, 1 cun deep with lifting and thrusting reducing technique; take the needles out when the Qi travels. Insert 1 cun #30 needles into LU-7, LI-20, SI7, and LI-11with lifting and thrusting reducing needle technique. Retain all needles for 10-15 minutes. Treat once every other day for 3 treatments as a course. For Cold due to Wind Heat Pathogenic Influence: GV-4, LI-11, TW-5, LU-5, and LU-10. (Zhen Jiu Da Cheng) Insert a 1 or 1.5 cun #30 needle into GV-14 perpendicularly, 1 cun deep with twisting reducing needle technique and take the needle out when the Qi travels. Insert 1 cun #32 needles into LI-11, LU-5, and LU10 with twisting reducing needle technique. Retain all needles for 10 minutes. Treat once every day, 3-4 treatments as a course. For Excess of Cold: GV-14, GB-20, and BL-13. (Shen Yin Jing) Let the patient drink a cup of hot water before treatment. Insert a 1.5 cun #30 needle into GV-14 perpendicularly, 1.2 cun deep with rubbing (count-clock wise) technique; let the sensation of the needle travel on the back. Insert 1.5 cun #30 needles into GB-20 perpendicularly, 1 cun deep with twisting even movement technique, and 1 cun #32 needles into BL-13 with waving needle technique. Retain all needles for 15 minutes. Apply fire cups on GV-14 and BL-13 for 3 minutes after finishing the acupuncture treatment. Treat once daily for 3 treatments as a course.

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Common Cold

For Cold due to Wind Heat Invasion: GV-16, GB-20, GV-14, LI-11, ST-36, TW-6, ST-44, BL-41, and BL-42. (Author’s Clinical Experience) Insert 1.5 cun #30 needles into LI-11, ST-36, ST-44, and TW-6 with twisting reducing needle technique. Retain all needles for 10 minutes. Insert 1 cun #30 needles into GV-16, GB-20, GV-14, BL-41, and BL-42 with a waving technique until the red marks appear around the points. Retain all needles for 5 minutes. Treat once every other day for 3 treatments as a course. For Excess of Cold: GB-20, LU-7, and TW-5. (Yi Zhong Jin Jian) Insert 1.5 cun #32 needles into GB-20 perpendicular and obliquely towards the direction of the nose, 1.2 cun deep with twisting even movement technique. Insert 1 cun #32 needles transversely, 0.8 cun deep towards the elbow with twisting reducing needle technique, and 1.5 cun #30 needles into TW-5 perpendicularly, with lifting and thrusting reducing needle technique. Retain all needles for 15 minutes. Treat once daily for 2 treatments as a course. For Cold due to Wind Cold Pathogenic Invasion, with severe achy sensations on the neck and upper back: GB-20, GV-14, LI-11, LI-4, LI-20, ST-40, Bi Tong, Yin Tang, and Jia Ji C-5 to 7 (Xin Zhen Jiu Xue) Insert 1.5 cun #30 needles into C-5 to C-7 Jia Ji, GB-20, and GV-14 perpendicularly, with twisting reducing needle technique. Retain all needles for 5 to 7 minutes. Insert 1.5 cun #32 needles into LI-11 and ST-40 with lifting and thrusting reducing technique until a heat sensation appears under the points. Insert 1 cun #34 needles into LI-4, LI-20, Bi tong and Yin tang with twisting even movement technique. Retain all needles for 10 minutes. Treat once every other day for 3 treatments as a course. For Cold due to Wind Cold Pathogenic Invasion: GV-14, LU-7, and LI-4. (Author’s Clinical Experience) Insert 1.5 cun #30 needles into GV-14 perpendicularly, 1.2 cun deep with rubbing needle technique. Take the needle out after the Qi sensation travels. Insert 1 cun #32 needles into LU-7 and LI-4 with twisting reducing needle technique. Retain all needles for 15 minutes. Treat once daily for 3 treatments as a course. For Excess of Cold: GV-23 and GV-22. (Author’s Clinical Experience) Insert 1.5 cun #28 or #30 needles into GV-23 subcutaneously at a 30 degree angle, 1.2 cun deep, going through to GV-22 with a fast twisting technique, until the patient feels a heat sensation. Retain all needles for 20 minutes. Treat once every other day for 2 treatments as a course. For a cold with Lung Qi Deficiency: LU-6, BL-13, and LU-1. (Jia Yi Jing) Insert 1 cun #30 needles in BL-13 with the Qi Ci technique (one needle in the middle and other two on the side), waving the needles until the red marks appear around the points. Retain the needles for 5 minutes. Insert 1.5 cun #30 needles into LU-6 with a twisting even movement technique. Retain needles for 15 minutes. Apply bloodletting technique on LU-1. Treat once daily for 3 treatments as a course. For a cold with Qi Deficiency: GV-14, BL-13, BL-43, BL-15, BL-20, LU-5, ST-36, and CV-6 (Author’s Clinical Experience) Insert 1 cun #30 needles into GV-14, BL-13, BL-43, BL-15, and BL-20 perpendicularly, 0.5 cun deep with waving technique, until red marks appear around the needles. Retain all needles for 10 minutes, or apply moxa pole on GV-14, BL-13, and BL-43 during the retainment. Insert 1.5 cun #32 needles into LU-5, ST-36, and CV-6 with a twisting reinforcing needle technique, and apply moxa wool on the handle of needles for 3 cones. Treat once every other day for 5 treatments as a course. 123

Acupuncture and Moxibustion—A Clinical Desk Reference

CASE ANALYSIS A 34 year-old male patient has a main complaint of a cold for one day’s duration. The cold’s symptoms were combined with weakness and fatigue in the whole body. He felt chills, slight fever, and aversion to cold air. He was also suffering from stuffy nose, headache, and body aches, accompanied by cough and sore throat. The pulse was floating and fast; the tongue was white with coating. Diagnosis: Wind-Heat Pathogenic Invasion. Treatment Principle: Reinforce the Lung Qi and Expel the Wind Heat Pathogenic Invasion. Point Prescription: LU-5, LU-10, LI-11, ST-44, GV-14, BL-13, and TW-5. Treatment was once daily, 2 treatments as a course. Technique: The patient was given a half-cup of hot water before treatment. 1.5 cun #32 needles were then inserted into LU-5, LI-11, BL-13, GV-14, and TW-5 with a twisting reducing needle technique. All needles were retained for 15 minutes. Then a bloodletting technique was done on LU-10 and ST-44 to make 1 drop of blood come out. Result: The patient’s cold symptoms were resolved after 2 treatments. EVALUATION Acupuncture and moxibustion are very effective in the treatment of the common cold. Generally speaking and according to clinical research, the effectiveness is over 90%. There are two key points in the treatment. The first is a clear diagnosis, which means one must understand how to distinguish between Cold symptoms and the symptoms of other febrile diseases. The second is the building or reinforcement of the body’s True Qi and expelling of the Pathogenic Influences, especially in deficient conditions. Patients should be careful to save their energy in order to battle back other possible invasions. Here is one method of preventive treatment taken from the book, “Acupuncture Treatment Experiments— 818 Cases in the area of the Flu.” Acupuncture for preventing a cold: GV-14, LI-4, and ST-36. #32 1.5 cun needles are inserted into the points and taken out when the patient feels the Qi. The treatment was given once as a course, and no one got a cold during that time.

124

Constipation

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CONSTIPATION The definition of constipation in Chinese and Western medicine is similar - the stools are solid and difficult to evacuate and the bowel movements may only come once in several days, even with the intake of medication such as laxatives. In terms of TCM, constipation is caused by very different reasons than that of Western medicine. As the diagnostics change, so do the treatments. In almost all cases, constipation is believed to have four main causes: Heat Stagnation in the Stomach and Intestines Accumulation of Heat in the Stomach and Large Intestine is caused by Yang body constitutions, or over consumption of alcohol, hot, spicy, or greasy food. There are also times when fever or febrile disease can cause the Heat to become stagnated in the intestine after the fever has abated, which damages the Large Intestine lubricating function. Stagnation of Qi by unhealthy emotions Constipation is often caused by stagnation of Large Intestine Qi, due to over-thinking, depression, anxiousness, or other unhealthy emotional stimulation. Most of the time this kind of bowel movement is not hard in quality, but hard to pass, sticky, and containing mucus in the stool, often with tense muscle contractions in the rectum. Qi and Blood Deficiency This type of constipation most often occurs in patients of old age, or long chronic terminal diseases. It also may occur after labor with deficiency body constitutions. The Qi and Blood cannot nourish the intestine well and dryness in the intestine cannot move the bowls (In TCM this is often described as “the water can not move the boat”). Yang Deficiency Interior Cold This case is most often seen in old age patients, or those with extreme Yang deficiency. In severe disease, the Interior Cold produces stagnation in the Stomach and Large Intestine and the bowel are not able to move. DIAGNOSIS Heat Constipation Symptoms include difficulty in passing the bowels, bloated abdomen, pain in the lower abdomen upon pressure, Interior Heat with thirst, flushed face, headache, yellow urine, and foul breathe. The tongue is red with a yellow-dry coat, and the pulse is strong and slippery. Constipation due to stagnation of Qi Symptoms include difficultly in moving the bowels with stool that is not very solid, bloating, distending pain in the abdomen and hypochondriac regions, bitter taste in the mouth, blurry vision, sighing, and belching. The tongue is purple with a red tip and edges, and a thin white coating. The pulse is wiry. Qi and Blood Deficient Constipation Symptoms include discomfort in the lower abdomen, a sensation of needing to pass the stools without the ability to move them, low energy, spontaneous sweating, shortness of breath, a pale complexion, heart palpitations, dizziness, and a tongue that is pale with a thin white coat, and a pulse that is thin and weak.

126

Constipation

Constipation due to deficiency of Cold Symptoms include bowels that are hard to pass, a prolapsed anus, abdominal coldness and pain, pale complexion, frequent urination, cold extremities, and a cold lower back with soreness and weakness. The tongue is pale with a white coat and the pulse is deep and slow. TREATMENT AND PRESCRIPTION Heat Constipation Treatment Principle: Clear the Heat, Nourishes the Body Fluids. Point Prescription: LI-4, LI-11, ST-37, and SP-14. Treat once every other day for 5 treatments as a course. Technique: Insert 1.5 cun #32 needles into SP-14 perpendicularly, 1.2 cun deep with twisting reducing needle technique, and 1 cun #32 needles into LI-4, LI-11, and ST-37 with lifting and thrusting reducing needle technique. Retain all needles for 30 minutes. Additional points for treatment of associated symptoms: Fever and thirst: HT-8 and CV-23. Headache: Yin Tang. Odor breath: CV-24. Constipation due to stagnation of Qi Treatment Principle: Soothe the Liver and Regulate the Qi. Point Prescription: CV-12, GB-34, CV-6, and LV-2. Treat once every other day for 5 treatments as a course. Technique: Insert 1 cun #30 needles into LV-2 with twisting reducing needle technique, and 1.5 cun #30 needles into GB-34 with lifting and thrusting reducing needle technique. Insert 1.5 cun #32 needles into CV-12 and CV-6 perpendicularly, 1.2 cun deep with twisting even movement needle technique. Retain all needles for 20 minutes. Additional points for treatment of associated symptoms: Hypochondriac pain: LV-13 and GB-24. Bloated abdomen: SP-15. Qi and Blood Deficient Constipation Treatment Principle: Reinforce the Qi and Nourish the Blood. Point Prescription: ST-36, SP-6, CV-4, BL-20, BL-21, and BL-25. Treat twice a week for 7 treatments as a course. Technique: Insert 1.5 cun #32 needles into BL-20, BL-21, and BL-25 with twisting reinforcing needle technique; apply moxa wool on the handle of needles for 3 cones. Insert 1.5 cun #32 needles into CV-4, ST-36, and SP-6 with twisting reinforcing needle technique; apply moxa wool on the handle of needles for 3 cones. Additional points for treatment of associated symptoms: Spontaneous or night sweating: HT-6. Heart palpitation: PC-6.

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Constipation due to Yang Deficiency Interior Cold Treatment Principle: Reinforce the Kidney Yang and Move the bowels. Point Prescription: CV-6, KI-6, CV-5, BL-23, and BL-26. Treat twice a week for 5 treatments as a course. Technique: Apply indirect moxibustion with Fu Zi cake on BL-26 and CV-6 for 5 cones. Insert 1 cun #32 needles into KI-6 with a twisting reinforcing needle technique, and 1.5 cun #32 needles into BL-23 and CV-5 with twisting reinforcing needle technique, applying moxa wool on the handle of the needles for 3 cones. Additional points for treatment of associated symptoms: Prolapse of the anus: GV-1 and GV-20. Low back pain: BL-40. ADJUNCTIVE THERAPIES Ear Acupuncture Points: Large Intestine and Rectum. Insert 0.5 cun #34 needles into these points with fast and strong twisting stimulation technique. Retain all needles for 30 minutes. Treat once daily for 3 treatments as a course. Moxibustion Points: CV-8 and BL-25. Apply indirect moxibustion with salt and ginger on CV-8 for 5 cones; then apply direct non-scarring moxibustion on BL-25 for 6 cones. Treat twice a week, 5 treatments as a course. Scalp Acupuncture Treatment zone: Lateral line 2 of the forehead, Lateral line 3 of the forehead, and Middle line of the vertex. Insert 1.5 cun #30 needles into these lines transversely, 1 cun deep at a 30-degree angle, with a lifting Qi technique. Retain all needles for 40 minutes. Treat once a week for 3 treatments as a course.

128

Constipation

TRADITIONAL PRESCRIPTIONS AND TECHNIQUE The following are from the Zhen Jiu Zhi Zhen Jing: For stagnation and hard to pass bowels: KI-4 and KI-18. Insert 1 cun #32 needles into KI-4 with twisting even movement needle technique. Apply moxa wool on the handle of needles for 3 cones. Insert 1.5 cun #30 needles into KI-18 perpendicularly, 1 cun deep with twisting reducing needle technique. Retain the needles for 20 minutes. Treat twice a week for 5 treatments as a course. For dry stool due to deficiency: BL-43. Insert 1 cun #30 needles into BL-43 with the Qi Ci technique and wave the needles until red marks appear around the points. Retain the needles for 30 minutes with moxa-pole on the side. Treat twice a week for 7 treatments as a course. For constipation with Heat in the lower abdominal region: KI-15 Insert 1.5 cun #30 needles into KI-15 with twisting reducing needle technique. Retain the needles for 20 minutes. Treat once every other day for 5 treatments as a course. For stagnation of the bowels in the abdomen: CV-8. Apply indirect moxibustion with Ba Dou Rou cake (make the Ba Dou into a cake) on CV-8 for 3 cones. Treat once every week for 2 treatments as a course. For constipation due to stagnation of Qi: TW-6 and ST-36. (Za Bing Xue Fa Ge) Insert 1.5 cun #30 needles into TW-6 with lifting and thrusting reducing needle technique, and 1.5 cun #32 needles into ST-36 with twisting reinforcing needle technique. Apply moxa wool on the handle of needles for 3 cones. Treat once every other day, 5 treatments as a course. For constipation due to deficiency of Yin: KI-6 and TW-6. (Yu Long Ge) Insert 1 cun #30 needles into KI-6 with twisting reinforcing needle technique, and 1.5 cun #32 needles into TW-6 with lifting and thrusting reducing needle technique. Retain all needles for 20 minutes. Treat once every other day, 5 treatments as a course. For constipation with a fullness sensation in the chest and abdomen: CV-5. (Qian Jin Fang) Apply direct non-scarring moxibustion on CV-5 for 11 cones. Apply 100 cones as a course. For constipation with bloating in the abdomen: SP-2. (Qian Jin Fang) Apply direct non-scarring moxibustion on SP-2 for 7 cones. The treatment course follows the age. For constipation with Yin deficiency: BL-25, TW-6, and ST-40. (Zhong Hua Zhen Jiu Xue) Insert 2 or 3 cun #30 needles into BL-25 perpendicularly, 1.5 to 2 cun deep with twisting even movement needle technique, and 1.5 cun #32 needles into TW-6 and ST-40 with twisting reinforcing needle technique. Retain all needles for 20 minutes. Apply indirect moxibustion with Fu Zi (aconite) cake on BL-25 for 3 cones if the patient is with Yang deficiency. Treat once every other day, 7 treatments as a course.

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For constipation with an excess body constitution: TW-6, CV-12, ST-25, ST-36, LV-1, and ST-44. (Zhong Hua Zhen Jiu Xue) Insert 1.5 cun #32 needles into CV-12, ST-25, ST-36, and TW-6 with twisting reducing needle technique, and 1 cun #32 needles into LV-1 and ST-44 with twisting reducing needle technique. Retain all needles for 30 minutes. Treat once every other day, 5 treatments as a course. For constipation with stagnation of Qi: TW-6, GV-1, and CV-6. (Zhong Hua Zhen Jiu Xue) Insert a 1.5 cun #30 needle into GV-1 perpendicularly, (the patient may lie down on his or her side) with twisting even movement technique. Retain the needle for 20 minutes. Insert 1.5 cun #32 needles into TW-6 and CV-6 with twisting even movement technique. Retain the needles for 15 minutes. Treat once every other day, 5 treatments as a course. For constipation with stagnation of Heat and Qi: GV-1, LV-1, and GB-34. (Za Bing Xue Fa Ge) Insert a 1.5 cun #30 needle into GV-1 with twisting reducing needle technique. Retain the needle for 20 minutes. Insert 1 cun #30 needles into LV-1 perpendicularly, 0.2 cun deep with twisting reducing needle technique, and 1.5 cun #30 needles into GB-34 with twisting reducing needle technique. Retain all needles for 30 minutes. Treat once every other day, 5 treatments as a course. For excess type constipation: ST-40, ST-28, BL-54, KI-4, BL-33, BL-57, and BL-25. (Shen Yin Jing) Insert 1.5 cun #32 needles into ST-40 and ST-28 perpendicularly, 1 cun deep with lifting and trusting reducing needle technique, and 1 cun #30 needles into KI-4 with twisting reducing needle technique. Retain all needles for 20 minutes. Insert 1 or 2 cun #30 needles into BL-54, BL-33, BL-57, and BL-25 with lifting and thrusting even movement needle technique. Retain all needles for 10 minutes. Treat once every other day, 5 treatments as a course. For constipation with stagnation of Qi: TW-6 and LV-5. (Zhen Jiu Da Cheng) Insert 1 cun #32 needles into LV-5 transversely, 0.5 cun deep; just let the needles float beneath the skin. Insert 1.5 cun #32 needles into TW-6 with lifting the thrusting reducing needle technique. Retain all needles for 20 minutes. Treat once every other day, 5 treatments as a course. For deficiency type of constipation: CV-6 and ST-36. (Zhen Jiu Zhai Ying Ji) Insert 1.5 cun #30 needles into CV-6 and ST-36 perpendicularly, 1.2 cun deep with twisting reinforcing needle technique, and apply moxa wool on the handle of the needles for 3 to 5 cones. Treat once every other day, 7 treatments as a course. For constipation with deficiency of Yin: SP-3 and KI-6. (Zhen Jiu Tu Yi) Insert 1 cun #32 needles into SP-3 and KI-6 with twisting reinforcing needle technique. Retain all needles for 30 minutes. Treat twice a week, 7 treatments as a course. For constipation with stagnation of Qi: BL-57, LV-13, and BL-28. (Zhen Jiu Gang Yao) Insert 1.5 cun #30 needles for into BL-57 and BL-28 with twisting even movement needle technique, and 1 cun #32 needles into LV-13 with twisting reinforcing needle technique. Retain all needles for 20 minutes. Treat once every other day, 5 treatments as a course.

130

Constipation

The following prescriptions are from the Zhen Jiu Ru Men. For constipation with lower back pain: SP-3. Insert 1 cun #32 needles into SP-3 perpendicularly, with medium stimulation by twisting for 2 minutes. Retain all needles for 15 minutes. For constipation with abdominal pain: KI-18 and BL-28. Insert 3 cun #30 needles into BL-28 perpendicularly, 2 cun deep with twisting even movement needle technique without retaining the needles, and 1.5 cun #32 needles into KI-18 with twisting reducing needle technique. Retain all needles for 20 minutes. For constipation with abdominal pain: KI-16. Insert 1.5 cun #32 needles into KI-16 with twisting reducing needle technique and apply moxa wool on the handle of needles for 5 cones. For constipation due to stagnation of Qi and Blood: LV-13, CV-15, SP-3, TW-6, KI-6, and CV-8. Insert 1 cun #30 needles into LV-13, CV-15, SP-3, TW-6, and KI-6 with twisting even movement needle technique. Apply indirect moxibustion with Ba Dou cake on CV-8 for 3 cones. For constipation with the pain in the genital area: CV-1. Insert a 1.5 cun #34 needle into CV-1, insert the needle perpendicularly 0.5 to 0.8 cun deep with twisting reducing needle technique and retain it for 15 minutes. Treat once every other day for 5 treatments as a course For constipation with heat sensation in the lower abdominal region: KI-11 and BL-38. (Zhen Jiu Jing Lun) Insert 1.5 cun #32 needles into BL-18 with twisting reducing needle technique, and 1.5 cun #34 needles into KI-11 with reinforcing needle technique. Retain all needles for 15 minutes. Treat once every other day for 5 treatments as a course. For constipation with lower back pain: GV-2. (Zhen Jiu Jing Lun) Apply direct non-scarring moxibustion on GV-2 for 7 to 9 cones. Treat once daily for 3 treatments as a course. CASE ANALYSIS This was a case of a 57-year-old male patient with the main complaint of constipation for 13 years. The bowel movements occurred usually once every 6 or 7 days, and were associated with a pale complexion, clear frequent urine, cold sensations on the limbs and body, particularly in the abdominal region. The tongue was pale with a white greasy coating, and the pulse was deep and slow. Diagnosis: Constipation due to deficiency Cold. Treatment Principle: Warm the Middle Burner and Expel the Cold, Move the Qi and the bowels. Point Prescription: CV-12, CV-8, CV-6, ST-25, ST-37, and TW-6. Treated once every other day, 7 treatments as a course. Technique: Insert 1.5 cun #30 needles into ST-37, ST-25, and TW-6 with lifting and thrusting reinforcing needle technique; apply indirect moxibustion with Fu Zi cake on CV-12, CV-8, and CV-6 for 5 cones. Result: After the first treatment, the patient started to move his bowels with greater ease, once every other day. After 5 treatments, the constipation was gone.

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EVALUATION Acupuncture and moxibustion are very effective in the treatment of constipation, whether it is acute or chronic, particularly in Excess conditions. Regardless of the pattern, the patient should pay close attention to their food consumption. He or she should eat a healthy diet of fresh vegetables and avoid hot, spicy, and greasy food. Exercise is also important in order to increase the movement of the intestine and built up a good habit to regularly move the bowels every day.

132

Cough

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Acupuncture and Moxibustion—A Clinical Desk Reference

COUGH Cough refers to a symptom that is a resulted of a wide variety of lung diseases such as: common cold, asthma, bronchitis, lung infection, allergies, and pneumonia. Symptoms usually arise from dryness and irritation of the lung passages. In TCM, the main pathological changes are seen as the lung failing in ascending and descending Qi, or disruption causing rebellious Qi. There are two types: Exterior Pathogenic Influences Any Pathological Influence may invade the lungs and cause cough when the body has a Wei Qi deficiency, particularly Wind and Cold are two that easily obstruct the movement of Lung Qi. Internal Disorders Both deficiency and excess symptoms of the lung can cause cough. Other organs may as well, for instance: stagnation of the Liver Qi turning to Fire and attacking the Lungs. Another commonly seen organ pathology of cough is that of the Spleen failing in transportation and transformation, producing phlegm that is then stored in the Lung. That is why in the Nei jing says: “Cough will be caused by the Five Zang and the Six Fu, not only the Lungs. DIAGNOSIS In diagnosing cough, it is important to make note the time, quality, and sound of the cough and all other symptoms related to it. The following differentiations will help determine the pathology. •

Frequent cough, which is much more severe during the day than at night, and is associated with a scratchy throat and loud sound, is caused by Wind Cold or Wind Heat.

•

Chronic cough with a low voice is often Qi Deficiency.

•

Severe cough in the morning that is associated with a large amount of phlegm, and is improved upon expectoration is usually due to Dampness.

•

Cough that appears in the afternoon or evening, with light sounds and shortness of breath is often due to Lung Yin Deficiency.

•

Cough that occurs whenever the patient lies down and that is associated with asthma and shortness of breath is usually Lung Deficiency Cold.

•

Cough that is worse after intake of greasy, oily, cold, or raw food, is related to Damp-Phlegm.

•

Cough that is triggered by emotional stimulation is often due to Liver Qi stagnation or Liver Fire.

•

Cough with a large amount of phlegm with a foul smell are symptoms of Lung infection.

Observing the phlegm is also important in cough diagnosis.

134

•

Cough with less phlegm, is caused by Dry Heat, Interior Fire, or Yin deficiency.

•

Cough with a large amount of phlegm is often seeing in Damp retention, or Interior Deficiency Cold.

•

White thin phlegm appears in cough that is caused by Wind Cold.

•

Thick yellow phlegm is due to Heat stagnation in the Lung

•

White sticky phlegm that is hard to expectorate is due to Yin Deficiency Dry Heat.

•

A large amount of phlegm that is thick with a foul smell, and has a sweet taste is Damp-Phlegm.

•

If the phlegm has a salty taste, this indicates Kidney Deficiency.

Cough

•

Thick phlegm with blood is usually caused by a severe Lung infection.

Exterior Syndromes Cough due to Wind Cold Pathogenic Influence Symptoms include a strong cough, itchy throat, thin white sputum but with uneven movement, aversion to cold, fever, little or no sweat, sore and achy sensation throughout the whole body, headache, stuffy nose, and nasal discharge. The tongue is pale with a thin white coating and the pulse is floating and tight. Cough due to Wind Heat Pathogenic Influence Clinical features are severe cough with shortness of breath, sore throat, dry mouth, thick sticky yellowish sputum that is hard to expectorate, headache, fever, aversion to wind, very little sweating, and prounced thirst. The tongue is red with a yellow coating and the pulse is floating and rapid.

Interior Syndromes Cough due to stagnation of Damp-phlegm This is caused by the Spleen failing in the transportation and transformation of fluids, which leads to dampness stagnating in the Lung and the Lung failing in descending the Qi. Symptoms include severe cough in the morning, with a large amount of white thick sticky phlegm associated with a stuffy chest, fullness in the epigastric area, poor appetite and lassitude, with difficulty to lie down without the cough worsening. The tongue is swollen with a white greasy coating and the pulse is slippery or floating and weak. Cough due to Liver Fire Emotional stress or anger over a long period of time causes Liver Qi Stagnation, which then turns to Liver Fire that invades the Lung, preventing dissension of Qi, thus causing cough. Symptoms include cough with sticky phlegm that can often contain a small amount of blood, and is associated with pain and fullness in the chest and hypochondriac region, red eyes, dry itchy throat, and a bitter taste in the mouth. The tongue is red with a thin white coating and the pulse is wiry and rapid.

TREATMENT AND PRESCRIPTIONS Wind Cold Treatment Principle: Expel the Wind Cold, Open the Lung, and Resolve Phlegm. Point Prescription: LU-7, LI-4, BL-13, and TW-5. Treat once daily for 3 treatments as a course. Technique: Insert 1 cun #30 needles into BL-13 perpendicularly, 0.5-0.8 cun deep with waving technique and apply moxa wool on the handle of the needles for 3 cones. Insert 1 cun #30 needles into LU-7, LI-4, and TW-5 with twisting reducing needle technique. Retain the needles for 20 minutes. Additional points for treatment of associated symptoms: Headache: GB-20 and GV-23. Body achiness: BL-62 and LI-6.

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Wind Heat Treatment Principle: Expel the Wind Heat, Clear the Lung and Resolve the Phlegm. Point Prescription: LU-5, BL-13, LI-11, and GV-14. Treat once daily for 3 treatments as a course. Technique: Insert 1.5 cun #30 needles into BL-13 and GV-14 with lifting the thrusting reducing needle technique, and apply a fire cup for 2 or 3 minutes after taking the needles out. Insert 1.5 cun #30 needles into LI-11 and LU-5 with twisting reducing needle technique. Retain all needles for 15 minutes. Additional points for treatment of associated symptoms: Sore throat: Blood let LU-11. Inability to sweat: LI-4. Sweat with fever: ST-43 and KI-7. Damp-Phlegm Treatment Principle: Reinforce the Spleen and Lung, and Resolve the Phlegm. Point Prescription: BL-13, BL-20, LU-9, SP-3, ST-40, and LI-4. Treat once every other day for 7 treatments as a course. Technique: Insert 1 cun #30 needles into LU-9, SP-3, ST-40, and LI-4 with twisting reinforcing needle technique. Retain all needles for 20 minutes. Insert 1 cun #32 needles into BL-13 and BL-20 with lifting the thrusting reinforcing needle technique and apply moxa wool on the handle of needles for 3 cones. Additional points for treatment of associated symptoms: Fullness in the chest and epigastric region: ST-36 and PC-6. Severe cough with asthma: Ding Chuan. Liver Fire attacking the Lung Treatment Principle: Soothe the Liver and subdue the Fire, Clear the Lung, and Resolve Phlegm. Point Prescription: BL-13, BL-18, LU-8, and LV-3. Treat once every other day for 5 treatments as a course Technique: Insert 1 cun #30 needles into BL-13 and BL-18 with twisting reducing needle technique. Retain all needles for 5 minutes. Insert 1 cun #32 needles into LV-3 and LU-8 with twisting reducing needle technique. Retain all needles for 20 minutes. Additional points for treatment of associated symptoms: Sore and itchy throat: KI-6. Cough with bleeding: LU-6.

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Cough

ADJUNCTIVE THERAPIES Moxibustion: Points: BL-13, BL-12, LI-4, LU-7, and LU-9. Apply direct non-scarring moxibustion for three cones on LI-4, LU-7, and BL-13, and five cones on BL-12 and LU-9. Treat once every other day, 5 treatments as a course. Points: CV-4, CV-12, and BL-23. Used for chronic Kidney Deficiency and poor sleep with Damp cough. Apply indirect moxibustion with ginger on these points for 3-5 cones. Treat once every other day, for 5 treatments as a course. Ear Acupuncture Points: Liver, Shen Men, Lungs and Trachea. Insert 0.5 cun ear needles into these points obliquely at a 60-degree angle, with fast twisting needle technique. Retain all needles for 30 minutes. Or apply press-balls on these points after regular acupuncture treatment. Treat once every other day for 3 treatments as a course. Points: Spleen, Lung, Sub cortex, and Heart. Apply press-balls on these points, and retain them for 3-5 days. Instruct patients to press them three or four times daily. Treat once a week for 5 treatments as a course. Herbal Plaster Treatment area: upper back. Making “Ban Mao”(Chinese herb) powder the size of wheat, to put on the BL-13, BL-43, and GV-12 for 12-20 hours. It will cause small blisters on the points, which will be absorbed after few days (remember to keep the area clean to prevent infection). It will help chronic and prolonged cough. Treat once a month, 3 treatments as a course. Scalp Acupuncture Treatment zone: Lateral line 1 of the forehead, and Mid-line of the vertex. Insert 1.5 cun #28 or #30 needles into these zones subcutaneous at a 30-degree angle, 1 to 1.2 cun deep with fast twisting needle technique. Retain the needles for 1 hour. Treat once every other day for 3 treatments as a course. Wrist and Ankle Acupuncture Treatment area: upper area1, area 3 and lower area 2 and area 5. Insert 1.5 cun #30 needles transversely into these areas 1.2 cun deep without any kind of sensation. Retain all needles there for 1 hour. Treat once every other day, 5 treatments as a course

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Gua Sha Apply Gua Sha technique from BL-11 to BL-15 on both sides of the Bladder meridian, until the red colored Sha appears on the skin. This technique is for the treatment of Lung Qi and Yin Deficiency. Treat twice a week for 4 treatments as a course. Cupping Treatment points and area: CV-12, CV-17, CV-8, LU-1, BL-14, BL-13, BL-43, BL-20, or the upper back. For cough due to External Pathogenic Influences: Apply fire cups on LU-1 and CV-17 for 2 minutes, then on BL-14 and BL-43 for 3 minutes. For cough with Spleen Deficiency: Apply fire cups on GV-14, BL-13, and BL-20 for 5 minutes. Then apply cupping on CV-8 and CV-12 for 2 minutes. For cough with Qi Deficiency: Apply moving cups from BL-11 to BL-15 and BL-42 to BL-45 until red Sha appears on the skin. All of the above courses are once every other day, for 7 treatments.

TRADITIONAL PRESCRIPTIONS AND TECHNIQUE For cough with Heat-phlegm: BL-13, CV-17, LU-5, and KI-3. (Lei Jing Tu Yi) Insert 1 cun #30 needles into BL-13 with waving technique and take the needle out after the patient feels the Qi sensation. Apply fire cups for 3 minutes. Insert 1.5 cun #32 needles into CV-17, LU-5, and KI-3 with twisting reducing needle technique. Retain all needles for 10 minutes. If with hot flashes and red complexion: TW-6 along with the above points and needle technique. Treat once daily for 4 treatments as a course. For chronic cough: BL-13, ST-36, CV-17, ST-15, BL-12, and ST-12. (Zhen Jiu Da Cheng) Apply direct moxibustion on BL-13 and BL-12 for 7 cones. Insert 1 cun #30 needles into ST-36, CV-17, ST-15, and ST-12 with twisting reinforcing needle technique. Retain all needles for 30 minutes. Treat once every other day for 10 treatments as a course. For chronic cough: BL-13 and BL-43. (Zi Shen Jing) Apply direct non-scarring moxibustion on BL-43 and BL-13 for 7 cones. Treat once a week for 7 treatments as a course. For cough with shortness of breath and difficulty lying down: LU-2. (Shen Yin Jing) Insert 1.5 cun #30 needles into LU-2 perpendicularly, 1 cun deep towards the outside of the body with twisting reducing needle technique. Retain all needles for 10 minutes while applying moxa pole beside the needles. Treat once daily for 5 treatments as a course. For cough due to Wind Cold: LU-10, GB-44, BL-19, LI-1, GV-24, BL-13, BL-15, BL-18, LV-8, and LU-6. (Zhen Jiu Ju Ying) Insert 1 cun #30 needles into BL-13, BL-15, BL-18, and BL-19 perpendicularly, 0.3-0.5 cun deep with waving technique until the red marks appear near each point. Retain all needles for 10 minutes. Insert 1 cun #32 needles into LU-10, GB-44, LV-8, LU-6, and GV24 with twisting even movement technique. Retain the needles for 15 minutes. Apply bloodletting technique on LI-1. Treat twice a week for 5 treatments as a course. 138

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For cough due to Liver Fire attacking the Lung: BL-13, LU-5, GB-34, and LV-3. (Dan Qi Xig Fa) Insert 1.5 cun #32 needles into LU-5 and GB-34 perpendicularly, 1-1.2 cun deep with lifting the thrusting reducing needle technique, 1 cun #32 needles into LV-3, obliquely at a 45 degree angle towards the upward direction, 0.5-0.8 cun deep with twisting reinforcing technique. Retain all needles for 15 minutes. Insert 1 cun #30 needles into BL-13 with twisting even movement technique without retaining needles. Treat once every other day for7 treatments as a course. For cough with shortness of breath: ST-12, CV-17, and CV-15. (Zi Shen Jing) Insert a 1.5 cun #30 needle into CV-17 obliquely at a 60 degree angle, 1.2 cun deep with twisting reducing needle technique, and 1 cun #32 needles into ST-12 and CV-15 perpendicularly, 0.5-0.8 cun deep with twisting reinforcing technique. Retain all needles for 10 minutes. Treat once every other day for 7 treatments as a course For cough with hot sticky phlegm: LU-10, LU-7, and SI-1. (Author’s Clinical Experience) Apply bloodletting technique on SI-1 and then insert 1 cun #32 needles into LU-10 and LU-7 perpendicularly, 0.5 cun deep with twisting reducing needle technique. Retain all needles for 10 minutes. Treat once every other day for 5 treatments as a course. For cough with a large amount of phlegm: CV-22 and BL-13. (Shen Yin Jing) Insert a 1.5 cun #32 needle into CV-22 obliquely at a 60 degree angle, 1-1.2 cun deep with twisting even movement technique until let sensation of the needle travels to whole chest area. Retain the needle for 5 minutes. Insert 1 cun #30 needles into BL-13 with lifting and thrusting reinforcing needle technique. Retain all needles for 5 more minutes. Treat twice a week for 7 treatments as a course. For cough with rebellious Qi: CV-22 and PC-1. (Shen Yin Jing) Insert a 1.5 cun #30 needle into CV-22 obliquely, anterior of trachea, 1.2 cun deep with rubbing needle technique (counter clockwise). Insert 1 cun #30 needles into PC-1 with twisting reducing needle technique. Retain all needles for 10 minutes. Treat once every other day for 5 treatments as a course. For cough with chest pain and a stuffy sensation: LU-1, SI-2, and CV-23. (Shen Yin Jing) Insert 1 cun #30 needles into SI-2 with twisting even movement needle technique, and 1 cun #30 needles into LU-1 and CV-23 with twisting reducing needle technique. Retain all needles for 20 minutes. Treat once every other day for 5 treatments as a course. For cough with hypochondriac pain: BL-18. (Shen Yin Jing) Treat once every other day for 5 treatments as a course. For cough with insomnia: ST-12, SI-1, BL-15, and ST-14. (Yu Long Ge) Apply bloodletting technique on SI-1. Insert 1 cun #32 needles into ST-12 and ST-14 obliquely, 0.5 cun deep with twisting reinforcing needle technique. Retain all needles for 15 minutes. Insert 1 cun #30 needles into BL-15 perpendicularly, 0.8 cun deep with lifting and thrusting reducing needle technique. Retain all needles for 10 minutes. Treat once every other day for 5 treatments as a course. For chronic cough with deficiency of Qi: CV-22, KI-27, CV-20, ST-18, BL-12, BL-13, GV-12, GV-9, and LU-7. (Jiu Fa Mi Chuan) Apply direct non-scarring moxibustion for 7 cones on CV-22, and 3 cones on KI-27, CV-20, and ST-18. Apply 14 cones on BL-12, BL-14, BL-13, GV-12, and GV-9. Insert 1 cun #32 needles into LU-7 with twisting reinforcing needle technique. Retain all needles for 5 minutes. Treat once a week, 7 treatments as a course. 139

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For External cough and large amounts of phlegm: BL-11, BL-13, CV-22, LU-5, TW-5, LU-8, and SP-6. (De Xiao Fang) Insert 1 cun #30 needles into BL-11 and BL-13 perpendicularly, 0.5-0.8 cun deep with twisting reinforcing needle technique and apply moxa wool on the handles of the needles for 2 cones. Insert 1 cun #32 needles into CV-22, TW-5, LU-5, LU-8, and SP-6 with twisting even movement technique. Retain all needles for 20 minutes. Treat twice a week for 5 treatments as a course. For cough with fever and External Invasion: GB-12, BL-10, GB-20, GV-12, BL-11, BL-2, BL-13, BL-17, BL-19, PC-3, LI-4, and CV-22 (Author’s Clinical Experience) Insert 1 cun 30 # needles into GB-12, BL-10, BL-11, BL-12, BL-13, BL-19, BL-17, GB-20, and GV-12 perpendicularly, 0.3-0.5 cun deep with twisting reducing needle technique. Retain all needles for 5 minutes and then remove them while enlarging the acupuncture hole. Insert 1 cun #32 needles into PC-3, LI-4, and CV-22 perpendicularly, 0.5-0.8 cun deep with twisting reducing needle technique. Retain all needles for 10 minutes. Treat once every other day for 5 treatments as a course. For cough with red phlegm: HT-6, SI-5, KI-4, SI-2, LU-7, and Bai Lao. (Author’s Clinical Experience) Insert 1 cun #32 or #34 needles into HT-6, SI-15, KI-4, SI-2, and LU-7 with even movement technique. Retain all needles for 15 minutes and then apply direct non-scarring moxibustion on Bai Lao point for seven cones. Treat once every other day for10 treatments as a course. For cough with bleeding: BL-13 and LV-2. (Shen Jiu Jing Lun) Insert 1.5 cun #32 needles into BL-13 obliquely at a 60-degree angle, towards the spinal column, 0.8-1 cun deep with lifting and thrusting reinforcing technique until the patient feels a warm sensation under the needles. Retain all needles for 5 minutes. Apply direct non-scarring moxibustion on LV-2 for 7 cones. Treat once a week for 5 treatments as a course. For cough with deficiency of Qi: ST-36. (Mi Chuan) Apply direct non-scarring moxibustion on ST-36 for 9 cones. Treat once every day for 10 treatments as a course. For cough with shortness of breath and asthma: Fire Cup: BL-13, BL-43, and GV-14. (Author’s Clinical Experience) Apply fire cups on the BL-13, BL-43, and GV-14. Retains all cups for 5 minutes. Select 5 small size bamboo cups, boiling them in a big pot with Bai Zhu, Ma Huang, Xi Xin, Ban Xia, Bai Qian, Kuan Dong Hua, and Hong Hua for 40 minutes. Then take the cups out and put them on the points. Retain until they fall off automatically. This may be repeated 3-5 times. Treat once every other day for 10 treatments as a course.

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CASE ANALYSIS A 20 year-old male patient came in with a main complaint of cough for 3 years, which had been diagnosed as chronic bronchitis. He had a severe cough in the morning, with thick sticky white or dark phlegm that was often aggravated by weather changes. His symptoms were associated with a stuffy and full sensation in the chest and epigastric region, difficulty lying down due to the cough, poor appetite, and lassitude. The tongue was swollen with a white greasy coating and the pulse was slippery and weak. Diagnosis: Chronic cough with stagnation of phlegm. Treatment Principle: Reinforce the Spleen and Lung, and Resolve the phlegm. Point Prescription: BL-13, GB-20, LI-4, SP-4, and ST-40. The patient was treated once every other day for 5 treatments as a course. Technique: Insert 1 cun #30 needles into BL-13 with lifting the thrusting reinforcing needle technique. Retain needles for 15 minutes, then take the needles out and put fire cups on the points for 2 minutes. Insert 1.5 cun #30 needles into GB-20, with slow-fast reinforcing needle technique. Take the needles out after attaining Qi sensation. Insert 1 cun #30 needles into LI-4, SP-4, and ST-40 with twisting reinforcing needle technique. Retain all needles for 20 minutes. Result: After the first treatment, the phlegm had reduced by almost half than usual, and after 3 more treatments the cough had reduce further. All symptoms had resolved after 5 visits. EVALUATION Acupuncture and moxibustion are very effective to treat cough for most illness. Cough as a symptom in the clinic is commonly related to climate, diet and emotional changes. That is why the practitioner has to be careful about certain things that will cause an allergic reaction in the patient, such as smoking, drinking, or other very stimulating food. For some chronic cough, further examination is necessary to prevent misdiagnosis of some diseases, such as Lung TB or Cancer.

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DIABETES In Traditional Chinese Medicine diabetes is known as Xiao Ke—Wasting and Thirsting. This is a reference to the increase in drinking, eating and urinating among patients with this disease. The causes of these symptoms are due to either abnormal emotional activity, overeating of hot, spicy, or greasy foods, overwork, or excessive sexual activities. A prolonged period of abnormal emotional activity will eventually cause Heart Fire to rise and later damage the Lungs’ Yin, causing a the desire to drink. Over-eating of hot, spicy, and/or greasy foods will cause Heat to accumulate in the Stomach and Spleen, thus damaging Stomach Yin, leading to overeating. By overworking or having an overly active sexual life, the Kidney Yin can become deficient, resulting in the Kidney Qi failing to control urination, yielding the frequent urination. The following is an overview of the basic etiology of Diabetes. Improper Food Intake Most diabetes is caused by improper food intake, such as long-term excessive consumption of greasy foods, which impacts the Spleen and Stomach Qi and accumulates Heat that damages the Yin fluid of the Stomach and the whole body. Abnormal Emotional Activities Long-term unhealthy emotional stimulation causes Qi stagnation to turn to Fire, damaging the Lung and Stomach Yin. Overworking Diabetes from Kidney Yin deficiency is usually due to extreme exhaustion of the body and depletion of the Yin energy from overwork or excessive sexual activities. Deficient Fire rises to the Lungs and burns the Yin fluids. The following are some pathological changes frequently observed in the clinic: Yin deficiency as the root problem and Dry Heat as the branch Most patients have both of these patterns during the process of the disease. Dry Heat will impact Yin and deficiency of Yin makes Dry Heat worse as well. These conditions commonly happen in the Kidney, Lung and Stomach, leading patients to feel strong thirst and hunger, and experience frequent urination. In the case of severe Dry Heat in the organs, other symptoms will arise such as cataracts, deafness, and ringing in the ear. If the Dry Heat rises upward to the head, it will cause a flushed complexion, headache, restlessness, nausea and vomiting, even loss of consciousness or a stroke. This is severe Dry Heat due to extreme Yin deficiency. Deficiency of both Yang and Yin Some long-term and chronic diabetic patients have both Yin and Yang deficiency caused by chronic Yin deficiency leading to the Yang deficiency. The main symptoms will be Cold edema with an extremely deficient body constitution, and Interior Heat with a coatless red tongue.

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DIAGNOSIS Shang Xiao (Upper Warmer Lung Yin Deficiency) Symptoms include a high blood sugar level, a dry mouth and throat, a frequent desire to drink, an increased appetite, and frequent urination. The tip of the tongue is red with a thin-yellow coat, and the pulse is flooding and fast. Zhong Xiao (Middle Warmer Stomach Yin Deficiency) Symptoms include a high blood sugar level, a very ravenous appetite that's difficult to satisfy, restlessness due to Interior Heat, sweating, a thin constitution, dry stools and/or constipation. The tongue is red with a yellow-dry coat and the pulse is slippery and fast. Xia Xiao (Lower Warmer Kidney Yin Deficiency) Symptoms include high blood sugar level, frequent urination, dry mouth and tongue, associated with sore and weak sensation in the low back and knees, easy to hunger but consumes very little, dizziness, blurry vision, and malar flush. The tongue is red with little coating or without coat, and the pulse is thin and rapid. Long-term Kidney Yin Deficiency will eventually lead to Kidney Yang Deficiency, which manifests as a dark complexion, dizziness, blurry vision, insomnia, restlessness, aversion to cold, cold limbs, frequent urination with a large quantity of flow, and impotence or amenorrhea in women’s cases. The tongue is dark-pale in color and the pulse is deep, thin and weak. TREATMENT AND PRESCRIPTIONS Shang Xiao (Lung Yin Deficiency) Treatment Principle: Clear the Upper Warmer Heat, and Promote the function of the metabolism. Point Prescription: HT-8, BL-15, LU-9, BL-13, and Yi Shu. Treat twice a week for 10 treatments as a course. Technique: Insert a 1.5 cun #30 needle into Yi Shu perpendicularly, 1 cun deep with a twisting reinforcing needle technique, and 1 cun #32 needles into BL-13 and BL-15 perpendicularly, 0.8 cun deep with a lifting and thrusting even movement needle technique. Retain all needles for 15 minutes. Insert 1 cun #32 needles into LU-9 and HT-8 perpendicularly, 0.3 to 0.5 cun deep with a twisting reinforcing needle technique. Retain all needles for 15 minutes. Additional points for associated symptoms: Dry mouth: CV-24. Blurry vision: GV-23. Dizziness: GB-38. Zhong Xiao (Stomach Yin Deficiency) Treatment Principle: Clear the Heat and Regulate the Spleen and Stomach. Point Prescription: ST-44, SP-6, BL-20, BL-21, and Yi Shu. Treat once every other day for 10 treatments as a course. Technique: Insert a 1 cun #32 needle into Yi Shu perpendicularly, 0.5 to 0.8 cun deep with a twisting reinforcing needle technique, and 1.5 cun #32 needles into BL-20 and BL-21 with a lifting and thrusting reinforcing needle technique. Retain all needles for 20 minutes. 143

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Insert 1 cun #30 needles into ST-44 perpendicularly, 0.5 cun deep with a twisting reducing needle technique, and 1.5 cun #32 needles into SP-6 with a twisting even movement needle technique. Retain all needles for 20 minutes. Additional points for associated symptoms: Hunger: CV-12 and PC-6. Poor sleep: ST-36 and HT-7. Headache: ST-8, and Yin Tang. Hot flushes: KI-6 and LI-11. Xia Xiao (Kidney Yin deficiency) Treatment Principle: Reinforce the Kidney and Liver Yin, and Subdue the Heat. Point Prescription: KI-3, LV-3, BL-18, BL-23, and Yi Shu. Treat twice a week for 10 treatments as a course. Technique: Insert 1 cun #32 needles into KI-3 perpendicularly, 0.5 cun deep with a twisting reinforcing needle technique, and 1.5 cun #32 needles into LV-3 obliquely, 1 cun deep at a 45 degree angle towards KI-1 with a twisting even movement needle technique. Retain all needles for 15 minutes. Insert 1.5 cun #32 needles into Yi Shu, BL-23, and BL-18 perpendicularly 1 cun deep with a twisting reinforcing needle technique. Retain all needles for 15 minutes. Additional points for associated symptoms: Yang Deficiency: GV-4 with direct non-scarring moxibustion for 5 cones. Frequent urination: CV-4 and ST-28. Low back pain: Yao Yan, BL-28, and BL-62. ADJUNCTIVE THERAPIES Ear Acupuncture Points: Pancreas, Endocrine, Kidney, San Jiao, Hunger point, Er Mi Gen, Shen Men, and Liver. Insert 0.5 cun #34 ear needles into these points obliquely, 0.3 cun deep at a 30 degree angle with a twisting reinforcing needle technique. Retain all needles for 30 minutes. Treat once every other day for 7 treatments as a course. Moxibustion Direct Moxibustion: CV-6, CV-12, BL-13, BL-20, and BL-23. Apply direct non-scarring moxibustion on CV-6 and CV-12 for 7 cones, and on BL-13, BL-20, and BL-23 for 9 to 11 cones. Treat once a week for 7 treatments as a course. Indirect Moxibustion: CV-4, Yi Shu, and BL-23. Apply indirect moxibustion with ginger or a Fu Zi (aconite) cake on Yi Shu and BL-23 for 5 cones and on CV-4 for 3 cones. Treat once a week for 7 treatments as a course.

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Plum-Blossom Treatment area: Back Apply medium stimulation of the Plum-Blossom needle technique on the back from T-7 to T-10, along the GV and BL meridians for 5 to 10 minutes. Treat once every other day for 10 treatments as a course. TRADITIONAL PRESCRIPTIONS AND TECHNIQUES For diabetes with Lung Yin Deficiency: CV-24, BL-49, TW-1, and KI-2. (Pu Ji Fang) Insert 1 cun #30 needles into BL-49 perpendicularly, 0.3 to 0.5 cun deep with a twisting and waving needle technique. Remove the needles after stimulation. Insert a 1 cun #32 needle into CV-24 perpendicularly, 0.3 cun deep with a twisting even movement needle technique, and 1 cun #32 needles into KI-2 perpendicularly, 0.5 cun deep with a twisting reducing needle technique. Apply direct non-scarring moxibustion on TW-1 for 5 cones. Treat twice a week for 7 treatments as a course. For diabetes with Lung and Kidney Yin Deficiency: GV-26, CV-24, Jing Jing, Yu Ye, LI-11, PC-8, LV-3, LV-2, SP-5, KI-2, and KI-1 (Shen Yin Jing) Insert 1 cun #32 needles into KI-1, KI-2, LV-2 and LV-3 perpendicularly, 0.5 cun deep with a lifting and thrusting even movement needle technique, and 1 cun #30 needles into SP-5 and PC-8 with a twisting reducing needle technique. Insert 1.5 cun #32 needles into LI-11 perpendicularly, 1 to 1.2 cun deep with twisting even movement needle technique. Retain all needles for 20 minutes. Insert 1 cun #34 needles into CV-24 and GB-26 perpendicularly, 0.3 cun deep with a twisting even movement needle technique, and retain the needles for 10 minutes. Insert 1 cun #30 needles into Jing Jing and Yu Ye obliquely, 0.5 to 0.8 cun deep at a 30 degree angle towards the root of the tongue with a twisting reducing needle technique, and take out the needles while enlarging the needle hole to remove a few drops of blood. Treat once a week for 5 treatments as a course. For diabetes with lassitude: CV-24, KI-3, SI-7, TW-4, KI-6, BL-23, BL-26, and the tip of the little finger. (Shen Jiu Jing Lun) Insert 1 cun #32 needles into CV-24, KI-3, TW-4, SI-7, and KI-6 with a twisting reinforcing needle technique. Retain all needles for 20 minutes. Insert 1.5 cun #30 needles into BL-23 and BL-26 with a lifting and thrusting reinforcing needle technique. Retain all needles for 10 minutes. Finally apply direct non-scarring moxibustion to the tip of little finger for 5 cones. Treat once every other day for 7 treatments as a course. For Yin Deficient diabetes: BL-13, BL-18, BL-20, BL-23, CV-24, CV-12, CV-4, LU-9, SP-6, KI-2, and GV-4. (Zhong Guo Zhen Jiu Xue) Insert 1 cun #30 needles into BL-13, BL-18, BL-20 and BL-23 perpendicularly, 0.5 to 0.8 cun deep with a twisting reinforcing needle technique. Apply moxa pole on GV-4 for 15 minutes. Insert 1 cun #32 needles into LU-9, SP-6, and KI-2 with a twisting even movement needle technique, and a 1.5 cun #32 needle into CV-12 perpendicularly, 1 cun deep with a twisting reinforcing needle technique. Apply moxa pole to CV-4 for 15 minutes. Treat once every other day for 10 treatments as a course.

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For diabetes with Kidney Deficiency: CV-4. (Pian Que Xing Shu) Apply direct moxibustion on CV-4 for 20 cones. Treat twice a week for 10 treatments as a course. For diabetes with body heat and a yellowish color in the eyes: BL-49, GV-20, PC-9, and LV-3. (Zhen Jiu Tu Yi) Insert 1.5 cun #30 needles into BL-49 transversely, 1 cun deep towards BL-50 with a twisting reducing needle technique, and take out the needle after the sensation travels. Apply moxa pole to GV-20 for 20 minutes, and direct non-scarring moxibustion on PC-9 and LV-3 for 7 cones. Treat twice a week for 5 treatments as a course. For Zhong Xiao diabetes with increased food intake with weight loss and pain and stagnation in the abdomen: BL-20, LV-13, LI-14, SP-4, and CV-12 (Zhen Zhi Zun Shen) Insert 1 cun #32 needles into LV-13 and SP-4 perpendicularly, 0.5 cun deep with a twisting even movement needle technique, and a 1.5 cun #32 needle into CV-12 with a twisting reinforcing needle technique. Insert 1 cun #32 needles into LV-14 obliquely, 0.5 cun deep with a twisting reducing needle technique. Retain all needles for 20 minutes. Apply direct non-scarring moxibustion on BL-20 for 11 cones. Treat twice a week for 7 treatments as a course. For Xia Xiao diabetes with Kidney Deficiency: BL-28, CV-6, CV-4, BL-23, and ST-36. (Zhen Jiu Tu Yi) Insert 1.5 cun #30 needles into BL-28 and BL-23 perpendicularly, 1 cun deep with a twisting reinforcing needle technique, and apply moxa wool to the handles of the needles for 3 cones. Insert 1.5 cun #34 needles into ST-36 with a twisting reinforcing needle technique. Apply direct non-scarring moxibustion on CV-4 and CV-6 for 11 cones. Treat twice a week for 7 treatments as a course. For diabetes with Interior Heat: LU-7, BL-20, CV-12, KI-6, ST-36, TW-1, and LI-8. (Zhen Jiu Feng Yuan) Insert 1.5 cun #32 needles into LU-7 transversely, 1 cun deep at a 30 degree angle heading upwards with a twisting reinforcing needle technique, and 1.5 cun #34 needles into CV-12 and ST-36 perpendicularly, 1 cun deep with a lifting and thrusting even movement needle technique. Insert 1 cun #32 needles into LI-8 and KI-6 with a twisting reinforcing needle technique. Apply direct non-scarring moxibustion on TW-1 and BL20 for 9 cones. Treat twice a week for 10 treatments as a course. For diabetes with Interior Heat and Kidney Deficiency: Jing Jing, Yu Ye, GV-26, CV-24, CV-6, and BL-23 (Zhen Jiu Da Cheng) Insert 0.5 cun #32 needles into CV-24 and GV-26 perpendicularly, 0.3 cun deep with a twisting even movement needle technique, and a 1.5 cun #32 needle into CV-6 with a lifting and thrusting reinforcing needle technique. Apply bloodletting with 1.5 cun #28 needles, into Jing Jing and Yu Ye, till 2 or 3 drops of blood come out. Apply direct non-scarring moxibustion on BL-23 for 9 cones. Treat once a week for 5 treatments as a course. The following prescriptions are from the Author’s Clinical Experience: For diabetes with Interior Heat and edema: TW-4, TW-10, Wei Guan Xia Shu, Yi Shu, BL-23, LV-1, and GB-44. Insert 1 cun #30 needles into TW-4 and TW-10 perpendicularly, 0.3 cun deep with a twisting reducing needle technique, and 1.5 cun #30 needles into Yi Shu with a twisting reinforcing needle technique. Insert 1.5 cun #32 needles into Wei Guan Xia Shu transversely, 1 cun deep with a twisting even movement needle technique without retaining, and apply direct non-scarring moxibustion. Insert 1.5 cun #32 needles into BL23 with a lifting and thrusting reinforcing needle technique. Apply direct non-scarring moxibustion on LV-1 and GB-44 for 9 cones. Treat twice a week for 7 treatments as a course. 146

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For diabetes with Lung and Stomach Yin Deficiency: LI-11, ST-36, KI-7, CV-12, and LV-3. Insert 1.5 cun #30 needles into LI-11 perpendicularly, 1 to 1.2 cun deep with a lifting and thrusting reducing needle technique, and 1.5 cun #34 needles into ST-36 and KI-7 with a twisting reinforcing needle technique. Insert a 1.5 cun #32 needle into CV-12 perpendicularly, 1 cun deep with a twisting even movement needle technique, and 1 cun #30 needles into LV-3 with a twisting reducing needle technique. Retain all needles for 30 minutes. Treat once every other day for 10 treatments as a course. For Shang Xiao diabetes with a dry throat and mouth: CV-6, CV-4, Wei Guan, Xia Shu, TW-4, SP-5, KI-2, BL-22, BL-23, and LV-2 Insert 1 cun #32 needles into KI-2 and SP-5 with a twisting reinforcing needle technique, and a 1.5 cun #32 needle into CV-6 with a twisting reinforcing needle technique. Apply direct non-scarring moxibustion on TW-4, LV-2, Wei Guan, Xia Shu and CV-4 for 7 cones. Apply direct non-scarring moxibustion on BL-20 and BL-23 for 9 cones. Treat once a week for 5 treatments as a course. For Xia Xiao diabetes with frequent urination: BL-67, BL-23, BL-20, ST-33, KI-10, LV-8, and LV-1. Insert 1.5 cun #32 needles into LV-8 and ST-33 with a twisting reinforcing needle technique. Apply direct non-scarring moxibustion to LV-1 and BL-67 for 10 cones. Insert 1.5 cun #30 needles into BL-20 with a lifting and thrusting reinforcing needle technique, and 1 cun #32 needles into KI-10 with a twisting reinforcing needle technique. Apply direct non-scarring moxibustion on BL-23 for 9 cones. Treat once every week for 7 treatments as a course.

CASE ANALYSIS A 48 year-old female patient has a main complaint of diabetes for 1 year. Her complaint was associated with thirst, a dry mouth, frequent urination, lassitude, a weak sensation in the lower back and both legs, hot flashes, and a sensation of five hearts heat. The tongue was red with a thin yellow coating and the pulse was thin and weak. Diagnosis: Diabetes due to Yin deficiency with Interior Heat. Treatment Principle: Nourish the Yin and Clear the Interior Heat. Point Prescription: LI-11, GB-34, KI-7, LU-10, CV-12, and CV-4. Treat once every other day for 10 treatments as a course. Technique: Insert 1.5 cun #30 needles into LI-11, GB-34, and KI-7 with a lifting and thrusting reducing needle technique, and 1 cun #32 needles into LU-10 with a twisting even movement needle technique. Insert a 2 cun #32 needle into CV-4 perpendicularly, 1.5 cun deep with a twisting reinforcing needle technique, and a 1.5 cun #34 needle into CV-12 with a twisting even movement needle technique. Retain all needles for 30 minutes. Result: After a 2 courses of treatment, all symptoms had resolved. After a total of 5 courses of treatments, the blood sugar returned to normal.

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EVALUATION For over a thousand years, TCM practitioners have accumulated very rich clinical experiences and an entire theory on the treatment of diabetes. With all this knowledge and numerous clinical experiences, a collection of methods using acupuncture, moxibustion and Chinese herbal formulas have been formulated successfully. Like the treatment for many other diseases, the focus in TCM is on the preventative aspects. For instance, for diabetic patients, diet control is very important during the treatment. The patients have to control their food intake. Acupuncture and moxibustion is quite effective in the treatment of diabetes in the Shang Xiao and Zhong Xiao syndromes. It’s even more effective when combined with herbs in the treatment of Xia Xiao type diabetes. Acupuncture and moxibustion is also good at getting rid of the side effects of western medications and in preventing the disease from damaging the heart, liver, kidney, eyes and neurological system. Acupuncture and moxibustion are very effective in reducing other accompanying symptoms as well, which occur with diabetes, such as dizziness, edema, shortness of breathe, heart palpitations, spontaneous sweating, lassitude, and so forth. The effects of acupuncture and moxibustion for treating diabetes usually appear after at least 15 to 20 treatments due to the level of the illness. Once the condition is stabilized, it is likely to remain so with continuous follow-ups and a healthy life style. Acupuncture and moxibustion are only supplemental therapy for the late stage of the disease when the patient has a severe infection or even coma. In cases such as this immediate hospitalization is recommended.

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Diarrhea

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DIARRHEA Diarrhea is a condition of increased daily bowel movements or a quality change of the bowels, in which they become more watery or contain mucous. As the symptoms increase, the bowel movements become unstable and involuntary. Some western medical conditions that include diarrhea are acute and chronic enteritis, intestinal TB, dysfunction of the intestine, and allergic colitis. In TCM, this illness can be caused by an External Pathogenic Invasion, by Improper Food Intake or from a dysfunction of the Zang Fu. External Pathogenic Invasion External Pathogenic Factors invade the body, particularly a Damp-Heat that can impact the function of Stomach, intestines and Spleen, causing diarrhea. Improper Food Intake Over-eating, eating foods that are difficult to digest, or food allergies will all obstruct the Spleen and Stomach Qi. As a result, diarrhea will occur due to the Spleen Qi failing to ascend and the Stomach Qi failing to descend. Emotional problems Over-thinking, anger, stress, depression or anxiousness will stagnate Liver Qi, which may in turn attack the Spleen and Stomach, causing deficiency of Spleen Qi and diarrhea. Spleen and Stomach Deficiency Chronic diarrhea with undigested food is usually caused by weakness of the Spleen and Stomach, failing to digest the food and water properly. Insufficient Kidney Yang Kidney Yang deficient diarrhea is watery and usually occurs in older patients, or those with chronic diseases or some severe injury. Deficiency of Kidney Yang cannot warm the Spleen, Stomach and Intestine, particularly in the early morning when there is excess of Yang Qi. DIAGNOSIS Acute diarrhea The hallmark signs and symptoms of acute diarrhea are urgent bowel movements along with increased frequency and a decrease in urine output. Damp-Cold Invasion Symptoms include diarrhea associated with borborygmus, watery diarrhea with undigested food, a preference for warm drinks and warms places, and a pale tongue with a white greasy coating. In some severe cases the patient may feel a cold sensation in the body and limbs, with profuse watery diarrhea and a deep, thin or hidden pulse.

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Damp-Heat Invasion Symptoms include diarrhea associated with yellowish mucous, a burning sensation in the anus, sometimes with red and scanty urination, a hot sensation in the whole body, a preference for cold drinks and restlessness. The tongue is red with a yellow greasy or dry coating and the pulse is fast, floating, and weak. In severe cases, children patients may have convulsions or even lose consciousness. Chronic diarrhea Most chronic diarrhea develops from an acute form that was not properly treated. Spleen Deficiency With this condition, the diarrhea changes to loose stool with undigested food that is associated with a bloated abdomen and borborygmus, a pale or shallow complexion, a poor appetite, and lassitude. The tongue is pale with a white greasy coating and the pulse is slow, floating, and weak. Liver Qi attacks the Spleen This diarrhea will be related to emotional changes and is associated with tenesmus, sighing, belching, distention, and distending pain sensation on the hypochondriac and abdominal regions. The tip and edge of the tongue is red with a white coating, and the pulse is wiry. Kidney Yang Deficiency This manifests as watery diarrhea with undigested food, occurring in the early morning, sometimes referred to as “dawn diarrhea.” It is associated with moving gas, cramping and bloating in the lower abdomen, and a cold and sore sensation in the body, particularly in the lower back and legs. The tongue is pale with a wet thin white coating, and the pulse is deep and thin.

TREATMENT AND PRESCRIPTIONS Acute diarrhea Treatment Principle: Regulate the Qi of the Stomach and Intestines. Treat once daily for 3 treatments as a course. Technique: Insert 1.5 cun #30 needles into ST-25, SP-9, ST-37, and ST-39 perpendicularly, 1 cun deep with a twisting reducing needle technique and 1 cun #32 needles into LI-4 with a twisting even movement technique. Additional points for associated symptoms: Fever: ST-44, LI-1, and SI-1 with a bloodletting technique. Cold limbs with a hidden pulse: CV-8 indirect moxibustion with salt and ginger for 7 cones. Chronic diarrhea Treatment Principle: Reinforce the Spleen, Soothe the Liver, and Warm the Kidney Yang. Point Prescription: CV-12, ST-25, and ST-36. Treat once every other day for 7 treatments as a course. Technique: Insert 1.5 cun #32 needles into CV-12, ST-25, and ST-36 with a lifting and thrusting reinforcing needle technique, and apply moxa wool to the handles of the needles for 3 cones. 151

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Additional points for associated symptoms: Spleen Deficiency: BL-20 and BL-26. Liver Qi Stagnation: BL-18 and LV-2. Kidney Deficiency: BL-23 and GV-4. ADJUNCTIVE THERAPIES Scalp Acupuncture Treatment zone: Lateral line 3 of the forehead, middle line of the vertex, and lateral line 2 of the forehead. Insert 1.5 cun #30 needles into all these treatment lines transversely at a 30-degree angle, with a lifting Qi technique. Retain all needles for 30 minutes. Treat once every day for 5 treatments as a course. Ear Acupuncture Point Prescription: Small and Large Intestine, Spleen, Liver, Stomach, Kidney, Shenmen, and Sympathetic. Select 3 points from above for each treatment. Insert 0.5 cun #32 ear needles with a fast twisting needle technique. Retain all needles for 30 minutes. Treat once every day for 7 treatments as a course. Moxibustion Points: BL-23, BL-52, and GV-4. Apply indirect moxibustion with an aconite cake on BL-23, BL-52, and GV-4 for 3 cones, to treat diarrhea of a deficiency type. Treat once daily for 7 treatments as a course. Points: ST-36, CV-6, ST-25, and SP-4. Apply direct moxibustion on ST-36, CV-6, ST-25, and SP-4 for 7 cones for diarrhea due to deficiency of Kidney and Spleen. Treat once daily for 7 treatments as a course. Points: CV-6, CV-12, and ST-25. Apply moxa-pole on CV-6, CV-12 and ST-25 for 30 minutes for watery diarrhea due to DampCold. Treat 2 or 3 times daily for 5 treatments as a course. Gua Sha Treatment area: abdomen and back. Apply medium-strength stimulation of Gua Sha on the abdominal area on both sides from ST-21 to ST-28, until the Sha (red or purple sand-like dots) appear. On the following day, apply the same technique on the back from GV-14 to GV-10 and BL-18 to BL-22 until Sha appears. This technique is used in the treatment of diarrhea due to Damp-Heat. Treat once daily for 4 treatments as a course.

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Hand Acupuncture Point Prescription: Stomach, Lao Gong, and Large Intestine. Insert 1 cun #32 needles in these points perpendicularly, 0.3 cun deep with a twisting even movement technique. Retain all needles for 30 minutes for acute diarrhea. Treat once daily for 3 treatments as a course. Cupping Treatment area: CV-8, ST-25 and Back. Apply fire cups on CV-8 and ST-25 for 5 minutes for diarrhea due to Damp-Cold or deficiency of the Spleen and Kidney. Treat twice daily for 7 treatments as a course. Treatment area: Back. Apply a moving cup on the back, moving it up and down from BL-15 to BL-32 until Sha appears. Treat once every other day, 5 treatments as a course. Nose Acupuncture Point Prescription: Stomach, Small intestine, Large Intestine and Spleen. Insert 0.5 cun #34 needles into these points perpendicularly, 0.3 cun deep with a twisting even movement needle technique until the patient feels a numb sensation. Retain all needles for 30 minutes. Treat once daily for 3 treatments as a course.

TRADITIONAL PRESCRIPTIONS AND TECHNIQUE For diarrhea due to Cold that is worse in the winter and associated with pain and bloating in the abdominal and navel regions: ST-37 (Ling Shu: Chapter Xie Qi Zang Fu Bing Xing) Insert 1.5 cun #30 needles into ST-37 perpendicularly, 1.2 cun deep with a lifting and thrusting reinforcing needle technique, and apply moxa wool onto the handles of the needles for 5 cones. Treat once every other day for 5 treatments as a course. For diarrhea alternating with loose stools, caused by Spleen Deficiency: LV-3, CV-8, and SP-6. (Shen Yin Jing) Insert 1.5 cun #32 needles into LV-3 and SP-6 perpendicularly, 0.8 to 1 cun deep with a twisting reinforcing needle technique. Apply indirect moxibustion with salt (and a piece of ginger) on CV-8 for 3 cones. Treat once every other day for 5 treatments as a course. For diarrhea containing undigested food: LV-8, and LI-9. (Shen Yin Jing) Insert 1.5 cun #32 needles into LI-8 and LI-9 with a twisting reinforcing needle technique. Retain all needles for 30 minutes. Treat once every other day for 5 treatments as a course.

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For severe watery diarrhea: CV-12, and BL-23. (Zhen Jiu Feng Yuan) Insert 1.5 cun #30 needles into BL-23 perpendicularly, 1 to 1.2 cun deep with a lifting and thrusting reinforcing needle technique and remove the needles after Qi appears. Apply indirect moxibustion with Fu Zi (aconite) cake on BL-23 for 5 cones. Then insert a 1.5 cun #32 needles in CV-12 obliquely at a 45-degree angle, towards CV-11, 1.2 cun deep with a clockwise rubbing technique. Retain needles for 20 minutes and apply moxa-pole on the side. Treat once every other day for 7 treatments as a course. For diarrhea due to deficient Interior Cold: CV-4, CV-3, ST-25, SP-6, CV-12, ST-21, and CV-6. (Shen Jiu Jing Lun) Select 3 points from the above prescription; and apply indirect moxibustion with ginger for 5 cones. Treat once daily for 5 treatments as a course. For Kidney Deficient diarrhea in seniors: CV-8, CV-4, BL-20, BL-25 (Shen Jiu Jing Lun) Apply direct non-scarring moxibustion on BL-20 and BL-25 for 9 cones, and apply indirect moxibustion with Fu Zi (aconite) cake on CV-8 and CV-4 for 3 cones. Treat once every other day, 7 treatments as a course. For diarrhea in children: BL-21, CV-9, ST-25, and CV-8. (Lei Jing Tu Yi) Apply moxa-pole for 20 minutes on BL-21 and 15 minutes on CV-9, ST-25, and CV-8. Treat one or twice a day for 5 to 7 treatments as a course. For diarrhea due to improper food intake: SP-9, KI-2, ST-37, and LV-3. (Yi Xue Gang Mu) Insert 1.5 cun #30 needles into SP-9 and ST-37 with a twisting reducing needle technique and 1 cun #32 needles into KI-2 and LV-3 with a twisting even movement needle technique. Retain all needles for 30 minutes. Treat once daily for 3 treatments as a course. For turbulent acute watery diarrhea: SP-2, BL-60, LV-14, SP-9, and CV-12. (Zhen Jiu Ji Chen) Insert 1 cun #30 needles into SP-2 and BL-60 with a twisting reducing needle technique and 1.5 cun #32 needles into LV-14 transversely at a 30 degree angle, 1 cun deep with a twisting even movement needle technique. Insert 1.5 cun #32 needles into SP-9 and CV-12 perpendicularly, with a twisting even movement needle technique. Retain all needles for 30 minutes. Treat one or twice daily for 3 treatments as a course. For watery diarrhea accompanied by thirst and abdominal water retention: GV-14. (Bao Ming Ji) Apply direct non-scarring moxibustion on GV-14 for 11 cones. Treat one or twice a day for 5 treatments as a course. For watery diarrhea with Kidney Deficiency: BL-23 and BL-32. (Shen Yin Jing) Insert 1.5 cun #30 needles into BL-23 and BL-32 with a lifting and thrusting reinforcing needle technique, and apply moxa wool on the handles of the needles for 3 cones. Treat once daily for 5 treatments as a course. For severe watery diarrhea with Interior Cold: BL-23 and CV-12. (Zhen Jiu Feng Yuan) Apply indirect moxibustion with ginger on CV-12 for 5 cones. Insert 1.5 cun #30 needles into BL-23 with a lifting and thrusting reinforcing needle technique, and apply moxa-wool to the handles for 3 cones. Treat one or twice and day for 5 treatments as a course.

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For watery brown diarrhea: GB-25, CV-9, ST-36, KI-2, SP-9, BL-60, GV-1, BL-25, BL-23, LV-13, and CV-6. (Ru Men Shi Qin) Apply indirect moxibustion with ginger on CV-9 and CV-6 for 5 cones. Insert a 1.5 cun #32 needle into GV-1 perpendicularly, 1 cun deep with a twisting reducing needle technique, and 1 cun #30 needles into GB-25, BL-60, KI-2, ST-36, LV-13, and SP-9 with a twisting reinforcing needle technique. Retain all needles for 30 minutes. Insert 1.5-cun #32 needles into BL-23 and BL-25 with a lifting and thrusting reinforcing needle technique, and apply moxa wool to the needle handles for 3 cones. Treat once every other day for 7 treatments as a course. For diarrhea due to deficiency of the Spleen: LV-3, CV-8, and SP-6. (Shen Yin Jing) Insert 1.5 cun #32 needles into SP-6 and LV-3 obliquely, in an upward direction at a 60-degree angle, with a twisting even movement needle technique. Apply indirect moxibustion with salt (a piece of ginger) on CV-8 for 7 cones. Treat once every other day for 7 treatments as a course. For diarrhea due to a Wind-Cold invasion, associated with cold painful sensations in the abdominal region: LU-7, ST-25, CV-12, CV-4, and SP-6 (Zhen Jiu Da Cheng) Insert 1 cun #32 needles into LU-7 and SP-6 with a twisting reducing needle technique and 1.5 cun #32 needles into ST-25 and CV-12 with a twisting even movement technique. Apply indirect moxibustion with ginger on CV-4 for 11 cones. Treat once every other day for 3 treatments as a course. For chronic loose stool or diarrhea due to deficiency of the Spleen and Kidney: GV-20, ST-25, CV-12, and CV-6. (Wan Bing Hui Chun) Apply a moxa pole on GV-20 for 30 minutes. Insert 1.5 cun #32 needles into ST-25, CV-12 and CV-6 with a twisting reinforcing needle technique, and apply moxa wool to the needle handles for 3 cones. Treat once every other day for 7 treatments as a course. For frequent, watery diarrhea due to improper food intake or infection: ST-44, ST-25, and SP-6. (Zhen Jiu Bian Yong) Insert 1 cun #30 needles into ST-44 and SP-6 with a twisting reducing needle technique and 1.5 cun #30 needles into ST-25 with a twisting reducing needle technique. Retain all needles for 30 minutes. Treat once every other day for 3 treatments as a course. For senile patients with deficient diarrhea and a cold cramping sensation around the naval and abdominal region, associated with undigested food: CV-6, ST-36, SP-6, and GB-38. (Wei Shen Bao Jian) Apply direct non-scarring moxibustion on CV-6 for 20 cones and on ST-36, SP-6, and GB-38 for 5 cones. Treat once every other day for 5 treatments as a course. For chronic diarrhea in babies: ST-8 and BL-21. (Lei Jing Tu Yi) Apply moxa-pole on ST-8 for 15 minutes and on BL-21 for 10 minutes. Treat two or three times daily for 10 treatments as a course.

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CASE ANALYSIS A 60 year-old male patient had a main complaint of chronic diarrhea for 3 years, and had been diagnosed with chronic colitis. The diarrhea was watery and occurred every morning, often preceded by a cold sensation in the abdominal region that was associated with undigested food, borborygmus, cold sensations in the limbs and body, frequent urination, and was reduced by warmth and pressure. The tongue was pale with a wet white coating and the pulse was deep and thin. Diagnosis: Diarrhea due to Kidney and Spleen Yang Deficiency Treatment Principle: Reinforce Spleen and Kidney Yang and Reduce the frequency of the diarrhea. Prescription: ST-25, CV-6, ST-36, GV-20, BL-23, BL-20, GV-4, and GV-14. Treatment was performed once every other day for 10 treatments as a course. Technique: Insert 1.5 cun #30 needles into ST-25 and CV-6 perpendicularly, 1 to 1.2 cun deep with a lifting and thrusting reinforcing needle technique, removing the needles after the patient felt the Qi sensation. Indirect moxibustion was applied with Fu Zi (aconite) cake on ST-25 and CV-6 for 5 cones. Then 1.5 cun #32 needles were inserted into ST-36 with a twisting reinforcing needle technique. Moxa pole was then applied on GV-20 for 20 minutes. 1.5 cun #30 needles were then inserted into GV-14, BL-20, BL-23 and GV-4 perpendicularly, 1 to 1.2 cun deep with a twisting reinforcing needle technique and moxa wool was applied on the needle handles for 3 cones. Result: After 3 treatments, the diarrhea was reduced to less then 3 times a day. The symptoms were completely cured after 10 treatments. EVALUATION Diarrhea can be caused through various causes either pathogenic in nature or internally caused. Acupuncture and moxibustion are very effective in treating many kinds of diarrhea. With correct diagnosis and treatment, diarrhea can be effectively treated within a short time frame. However, it is very important for the patient to be careful of his or her lifestyle. The patient has to pay attention to improper food intake and avoid detrimental emotions. Clinically, a strong stimulation of the needle and moxibustion are more effective than a milder technique. For patients suffering from chronic diarrhea further exams are necessary to avoid misdiagnosis of some other severe disease, such as cancer.

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DIZZINESS AND VERTIGO Vertigo refers to a feeling of dizziness, something reminiscent of motion sickness or the sensation of being in a spinning room. However, there is a clear distinction between the two in TCM. Dizziness refers to a state where the person feels him or herself spinning in a stable environment. Vertigo refers to the opposite where the person is stable and experiencing the environment spinning. This is usually associated with nausea, vomiting, spontaneous sweating, headaches and lassitude. In TCM, the category of dizziness and vertigo is called “Xuan Yun”, which is generally caused by Wind, deficiency and Phlegm. Some western medical views on this sensation are usually attributed to side affects of drugs, hypertension, anemia, neurasthenia, Meniere’s syndrome, arteriosclerosis, or even brain tumors. In TCM, dizziness and vertigo are attributed to the following: Liver Yang Rising Most dizziness and vertigo is caused by a deficiency of Liver and Kidney Yin, leading the Yang to rise up with Wind and Phlegm, disrupting the Brain Palace. Liver Fire This syndrome is generally caused by stagnation of Qi due to long-term, unhealthy emotional stimulation that turns into Fire that rises up with Interior Wind and bothers the head. Qi and Blood Deficiency Generally, dizziness and vertigo caused by deficiency of Blood occurs after a long-term or chronic disease, or a loss of a large amount of blood in which the blood cannot nourish the brain well. Kidney Jing Deficiency This occurs with older people or those who are overly tired, excessively sexually active, or chronically ill. They may experience symptoms of Kidney Jing Deficiency because the Kidneys’ stored essence (Jing) produces the marrow, and the brain is considered to be the Sea of Marrow in TCM theory. Therefore, a lack of Jing can influence the brain and cause dizziness and vertigo. Phlegm stagnation Damp Invasion or weakness of the Stomach and Spleen will cause an accumulation of Phlegm that stagnates in the middle warmer, obstructing the clear Qi sent up to the brain, causing dizziness and vertigo.

DIAGNOSIS Deficiency type Dizziness caused by deficiency will be aggravated by fatigue and poor sleep, and is usually associated with a pale complexion, heart palpitations, insomnia, soreness and weakness in the lower back, and occasional ringing in the ear. The tongue is pale and swollen with a white coating and the pulse is thin and weak. In this case, there will be no sensation of the room spinning.

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Excess type This type occurs with frequent dizziness and vertigo, with more of the room spinning sensation than dizziness. It is associated with a heavy and painful sensation in the head, a tendency towards anger and restlessness, distention and a stuffy sensation in the chest and hypochondriac region, nausea, vomiting with phlegm, and a poor appetite. The tongue is red with a thick yellowish coating and the pulse is wiry or fast and slippery. TREATMENT AND PRESCRIPTION Deficiency type Treatment Principle: Reinforce the Qi and Blood and Reduce the dizziness. Point Prescription: GV-20, GB-20, BL-17, BL-23, and ST-36. Treat once every other day for 7 treatments as a course. Technique: Insert 1 cun #32 needles into GV-20 and GB-20 with a twisting reinforcing needle technique and 1.5 cun #30 needles into BL-17, BL-23, and ST-36 with a twisting even movement needle technique. Apply moxa wool to the handle of the needles for 3 to 5 cones. Apply moxa-pole to GV-20 for 10 minutes. Additional points for associated symptoms: Heart palpitations: PC-6. Insomnia: HT-7. Ringing ear: SI-19. Excess type Treatment Principle: Soothe the Liver, Subdue the Yang, Harmonize the Stomach, and Resolve the Phlegm. Point Prescription: CV-12, SP-9, LV-2, KI-5, and Yin Tang. Treat twice a week for 7 treatments as a course. Technique: Insert 1 cun #32 needles into LV-2 and Yin Tang with a twisting reducing needle technique and 1 cun #34needles into KI-3 with a twisting reinforcing needle technique. Insert 1.5 cun #32 needles into CV-12 and SP-9 with a lifting and thrusting reducing needle technique. Retain all needles for 30 minutes. Additional points for associated symptoms: Hypochondriac pain: GB-34. Headache: ST-8 and GV-20. Nausea: PC-6 and ST-36. ADJUNCTIVE THERAPIES Ear Acupuncture Point Prescription: Heart, Liver, Spleen, Stomach, Kidney, Brain point, Occiput, Shen Men, Sympathetic, and Endocrine. Select 3 to 4 points from the above in each treatment. Insert 0.5 cun #34 ear needles into these points obliquely, 0.3 cun deep at a 45 degree angle, with a fast twisting needle technique. Retain all needles for 40 minutes. Or, apply press-ball on these points (one side only) and leave for 3 to 5 days. Treat once every other day for 5 treatments as a course.

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Scalp Acupuncture Treatment zone: Middle line of the vertex, middle line of the forehead, anterior oblique line of the temple, and posterior oblique line of the temple. Insert 1 cun #30 needles into these lines transversely, 0.8 cun deep at a 30 degree angle with a fast twisting needle technique. Retain all needles for 30 minutes. Treat once every other day for 5 treatments as a course. Cupping Treatment area: Back, Chest, and Abdomen. Apply fire cups on the back near GV-14, SI-12, BL-11 and BL-44 (palpate before cupping on the back, Ah Shi points will be found near these points when the patient has dizziness and vertigo). Retain the cups for 3 minutes. Apply fire cups on CV-17 and ST-25. Retain the cups for 5 minutes. Treat once daily for 3 treatments as a course, along with other therapy. Moxibustion Moxa pole Apply moxa pole on CV-6, CV-4, GV-20, GV-4, and BL-23 for 30 minutes to treat dizziness and vertigo of the deficiency type. Treat once daily for 3 treatments as a course. Indirect moxibustion: CV-6, BL-18, BL-20, BL-23, GV-14, BL-43, and BL-48. Select 3 to 4 points from the above prescription and apply indirect moxibustion with ginger or Fu Zi (aconite) cake on these points for 3 to 5 cones for deficient dizziness and vertigo. Treat once every other day for 5 treatments as a course. Direct moxibustion: SI-1, SP-1, LI-1, ST-44, BL-62, GV-14, CV-17, GV-4, and BL-32. Select 5 points from the above prescription and apply direct non-scarring moxibustion on these points for 7 cones, to treat dizziness and vertigo for both deficiency and excess types. Treat once every other day for 5 treatments as a course. Foot Acupuncture Point Prescription: Kidney, Liver, Heart, Inner Nei Ting, Inner Tai Cong, and Head. Select 3 points each treatment from the above prescription and insert 1 cun #32 needles into these points perpendicularly, 0.3 cun to 0.5 cun deep with a twisting reinforcing needle technique to treat dizziness and vertigo for both excess and deficiency types. Or apply direct non-scarring moxibustion on these points for 7 cones. Treat once daily for 3 treatments as a course. Wrist and Ankle Acupuncture Treatment area: Upper 2, Upper 5, Lower 3, and Lower 4. Insert 1.5 cun #32 needles into these lines transversely, 1.3 cun deep at a 15 degree angle and gently adjust the direction and depth of the needles until no sensation appears near the needles. Retain all needles for 40 minutes to treat dizziness and vertigo for both deficiency and excess types. Treat once every other day for 7 treatments as a course.

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Gua Sha Treatment area: Back, Chest, Legs, and Arms. (Only select one treatment area daily.) Apply a medium-strength Gua Sha technique on the interior of the scapula and middle back from GV-14 to GV-7 until the Sha appears. Apply a mild-strength Gua Sha technique on the chest from CV-19 to CV-15 until Sha appears. Apply a medium-strength Gua Sha technique to the interior side of elbow and the BL-40 area until a red color appears. Treat once daily 3 treatments as a course. Bloodletting Point: LV-1, PC-3, LI-1, Tip of ear, and Tai Yang. Apply a bloodletting technique on these points with a lancet or a 1 cun #26 needle to treat dizziness and vertigo of the excess type. Treat once every other day for 2 treatments as a course.

TRADITIONAL PRESCRIPTIONS AND TECHNIQUE

The following prescriptions are from the Yu Long Jing. For vertigo with a sensation of a spinning room: GV-16. Insert a 1.5 cun #30needle into GV-16 perpendicularly 1 cun deep towards the chin with a twisting reducing needle technique. Retain the needle for 20 minutes. For vertigo and dizziness with vomiting and a stuffy sensation in the chest: GV-25 and BL-6. Insert 1.5 cun #32 needles into GV-25 and BL-6 transversely towards the back 1 to 1.2 cun deep with a twisting reducing needle technique. Retain all needles for 30 minutes. For vertigo and dizziness with a ringing ear, red complexion, and being too tired to speak: BL-2, ST-36, LI-4, and GB-20. Insert 1 cun #32 needles into BL-2 obliquely, 0.5 cun to 0.8 cun deep towards the point Yu Yao with a twisting reducing needle technique and 1.5 cun #32 needles into ST-36 perpendicularly, 1 cun deep with a lifting and thrusting reducing needle technique. Insert 1 cun #32 needles into LI-4 with a twisting reducing needle technique. Retain all needles for 20 minutes. Insert a 1.5 cun #32 needle into GB-20 perpendicularly, 1 cun deep towards the nose with a twisting reducing needle technique. Retain the needles for 10 minutes. Treat once every other day for 5 treatments as a course for the above techniques. For dizziness and vertigo with a heavy sensation in the head and a stuffy nose: GV-20. Insert a 1 cun #30 needle into GV-20 transversely, 0.5 to 0.8 cun deep at a 30 degree angle, towards the nose with a fast twisting needle technique for 3 minutes. For dizziness and vertigo with a stiff neck and upper back: GV-16. Insert a 1.5 cun #32needle into GV-16 perpendicularly 1 cun deep towards the chin with a twisting reducing needle technique. For dizziness and vertigo with blurry eyes: BL-66 For dizziness and vertigo with a painful sensation in the eyebrows: BL-18 and LU-3. Insert 1 cun #30 needles into BL-18 and LU-3 perpendicularly 0.5 cun deep with a twisting reinforcing needle technique.

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For dizziness and vertigo with red eyes and a headache: TW-2 and BL-2. Insert 1 cun #32 needles into TW-2 perpendicularly, 0.3 cun deep with a twisting reducing needle technique and 1 cun #32 needles into BL-2 obliquely, 0.5 cun deep towards the BL-1 direction with a twisting even movement needle technique. Retain all needles for 20 minutes. For dizziness and vertigo with a headache and tearing: GV-25. Insert a 1 cun #30 needle in GV-25 perpendicularly, 0.3 cun deep with the Qi Ci technique (three needles on one point, one is in the middle and two other needles on the sides).

The following prescriptions are from their stated sources. For dizziness and vertigo with Interior Heat and Phlegm: GV-23, GB-20, and BL-10. (Zhen Jiu Ju Ying) Insert a 1.5 cun #30 needle into GV-23 transversely, 1 cun deep at a 30 degree angle, towards the back with a fast twisting needle technique and 1.5 cun #32 needles into GB-20 and BL-10 perpendicularly, with a lifting and thrusting reducing needle technique. Retain all needles for 20 minutes. Treat once daily for 3 treatments as a course. For dizziness and vertigo with Interior Phlegm and lassitude: TW-5, LV-1, BL-18, and GV-20. (Zhen Jiu Da Quan) Apply direct non-scarring moxibustion to LV-1 for 9 cones. Insert 1.5 cun #30 needles into TW-5 with the Qing Long Bai Wei—Green Dragon Waves its Tail needle technique, and 1 cun #32 needles into BL-18 perpendicularly, 0.8 cun deep with a twisting reinforcing needle technique. Apply moxa wool to the handles for 3 cones. Insert a 1 cun #30 needle into GV-20 obliquely, 0.8 cun deep at a 45 degree angle, towards the back with a fast twisting needle technique. Retain all needles for 20 minutes. Treat once every other day for 7 treatments as a course. For dizziness and vertigo with a heavy sensation in the head: BL-67, BL-8, GV-16, TW-2, and TW-23. (Shen Yin Jing) Apply direct non-scarring moxibustion to BL-67 for 7 cones and then insert 1.5 cun #32 needles into BL-18 obliquely, towards the spinal column 1 cun deep with a twisting reinforcing needle technique. Insert a 1.5 cun #32 needle into GV-16 perpendicularly, 1 cun deep towards the chin with a twisting reducing needle technique. Retain all needles for 10 minutes. Insert 1 cun #32 needles into TW-2 with a twisting even movement needle technique and 1 cun #32 needles into TW-23 perpendicularly, 0.3 to 0.5 cun deep with a twisting reducing needle technique. Retain all needles for 10 minutes. Treat once every other day for 5 treatments as a course. For dizziness and vertigo with the sensation that the room is spinning: BL-13, BL-23, and LI-4. (Zhen Jiu Quan Shu) Insert 1.5 cun #32 needles into LI-4 perpendicularly, 1 cun deep with a twisting reducing needle technique, and 1 cun #32 needles into BL-13 and BL-23 with a twisting reinforcing needle technique. Retain all needles for 30 minutes. Treat once every other day for 7 treatments as a course. For dizziness and vertigo due to Wind: GB-42, TW-4, SI-4, and BL-2. (Shen Yin Jing) Insert 1 cun #32 needles into GB-42, TW-4 and SI-4 perpendicularly, 0.3 cun deep with a twisting reducing needle technique, and 1 cun #32 needles into BL-2 obliquely, 0.5 cun deep at a 30 degree angle towards Yu Yao with a twisting reducing needle technique. Retain all needles for 30 minutes. Treat once daily for 3 treatments as a course.

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Dizziness and Vertigo

For dizziness and vertigo due to Wind Invasion: GV-20 and GV-17. (Yi Shuo) Apply a bloodletting technique at GV-20 and GV-17 for 2 to 3 drops of blood. Treat once daily for 1 to 2 treatments as a course. For dizziness and vertigo with Phlegm and eyebrow pain: ST-40, LV-3, LI-4, GV-16, GB-20, and SI-19 (Author’s Clinical Experience) Insert 1.5 cun #32 needles into GB-20 and GV-16 perpendicularly, 1 cun deep towards the chin with a lifting and thrusting reducing needle technique. Retain all needles for 10 minutes. Insert 1.5 cun #32 needles into ST-40 perpendicularly, 1 cun deep with a twisting reinforcing needle technique, and apply moxa wool to the handles for 3 cones. Insert 1 cun #32 needles into LV-3 and LI-4 with a twisting reducing needle technique and 1.5 cun #32 needles into SI-19 with a twisting even movement needle technique. Retain all needles for 20 minutes. Treat twice a week for 5 treatments as a course. CASE ANALYSIS A 38 year-old female patient has a main complaint of dizziness for the last 2 years. It intensified one month recently and was associated with lassitude, poor sleep, a pale complexion, a poor appetite, a bloated abdomen and pale lips and nails. The tongue was pale with a thin white coating and the pulse was thin and weak. Diagnosis: Dizziness due to deficiency of Blood and Qi. Treatment Principle: Reinforce the Spleen and build up Qi and Blood. Point Prescription: GV-20, LV-3, and CV-6. She was treated twice a week for 10 treatments as a course. Technique: Insert 1.5 cun #32 needles into LV-3 obliquely, 1 cun deep towards KI-1 direction with a twisting reinforcing needle technique and a 1.5 cun #32 needle into CV-6 with a twisting reinforcing needle technique. Apply moxa pole on GV-20 for 20 minutes. Result: The symptoms were remarkably reduced after 3 treatments, and after a total of 15 treatments, all symptoms were resolved. EVALUATION In the classic book, Nei Jing, it says: “Dizziness and vertigo will not occur without deficiency, Wind and Phlegm.” This suggests that these three reasons are the most common causes of dizziness and vertigo. That is why a clear diagnosis directly influences the effects of the treatment. For example, we cannot use techniques to nourish Kidney Yin and subdue Liver Yang to treat dizziness and vertigo that is caused by Spleen deficiency and stagnation with Interior Phlegm. Acupuncture and moxibustion is very effective in treating dizziness and vertigo without any side effects or interference with other therapy. The TCM dictated treatments could be a main treatment when the patient has meridian problems and can be a supplemental treatment when the patient suffers from severe brain injury.

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DYSENTERY Dysentery is a common intestinal infection that most frequently occurs during summer and fall. TCM believes it is caused by improper food intake with an External Pathogenic Invasion, which in combination can obstruct the function of the Large Intestine. The patient’s main symptoms will be of frequent diarrhea with tenesmus. When pathogenic infections injure the Large Intestine Qi it will cause purulent mucous in bowels, and if the infection injures the Blood, a red color will be appear. Usually there are two categories of differentiating Dysentery: Contaminated Food Most infections of dysentery are due to contaminated food, which impacts the Stomach and Intestine Qi movement. External Invasion Dampness and Heat invade the intestine directly and stagnate food transport. When this infection of dysentery occurs it usually causes bleeding, mucus, and watery diarrhea. DIAGNOSIS Dysentery due to Damp-Heat Dysentery due to pathogenic Damp-Heat is characterized by abdominal pain, tenesmus, a bloody stool with mucous, a burning sensation of the anus, and scanty deep-colored urine. In the beginning of this disease, the patient will have aversion to cold then fever with restlessness and thirst. A yellowish greasy coating will be apparent on the tongue and the pulse will be slippery and rapid. Fulminate Dysentery Dysentery due to severe pathogenic invasion is characterized by frequent bowel movement with a purulent and bloody mucous, and foul smell. The associated signs are severe abdominal pain, tenesmus, high fever, thirsty, and even convulsion or coma. The tongue is dark red with a yellow greasy coating and the pulse is thin and fast. Fasting Dysentery Dysentery due to pathogenic Damp-Heat, which travels up attacks the Stomach causes anorexia and an inability to eat, vomiting upon eating and drinking, stuffy sensation in the chest, and sticky bloody and purulent mucous in the bowels. The associated signs are high fever and lassitude. The tongue is red with a yellow greasy coating and the pulse is floating, weak, and fast. Cold-Damp Dysentery Dysentery characterized by passage of a whitish, thin purulent stool, absence of fever, distending or distress in the epigastric region, dull pain in the abdomen, tenesmus, listlessness, absence of thirst, poor appetite, clear urine, slight fever, and tastelessness are associated with Cold-Damp Invasion. The tongue will be pale with a white greasy coating and the pulse will be slow.

164

Dysentery

Recurrent Dysentery Recurrent Dysentery is characterized by a long-term and repeated occurrence that appears with a purulent and bloody stool, tenesmus, and continuation of slight symptoms in between attacks. There are two types seen in TCM, Yang Deficiency and Yin Deficiency. The Yang Deficient patient will have a pale complexion, loose stool with a poor appetite, pale tongue, thin white coating, and a slow pulse. The Yin Deficient patient will have a low-grade fever, listlessness, thirst, dry throat, stool that is sticky with bloody mucous, a red tongue without coating, and a thin and fast pulse. TREATMENT AND PRESCRIPTION Treatment Principle: Clear Heat, Resolve Damp, and Regulate the Qi and Blood. Point Prescription: LI-4, ST-25, and ST-37. Treat once daily for 5 treatments as a course. Technique: Insert 1 cun #32 needles into LI-4 perpendicularly, 0.7 cun deep with twisting reducing needle technique, and 1.5 cun #30 needles into ST-37 perpendicularly, 1.2 cun deep with twisting reducing needle technique. Insert 2 cun #30 needles into ST-25 perpendicularly, 1.5 cun deep with lifting and thrusting reducing needle technique. Retain all needles for 30 minutes. Additional points for other associated symptoms: Fulminate Dysentery: GV-14 and Shi Xuan with bloodletting technique. Fasting Dysentery: CV-12 and PC-6. Cold-Damp Dysentery: SP-9 and CV-6. Recurrent Dysentery: BL-20 and BL-23 with moxibustion for Yang deficiency, and KI-6 and SP-10 for Yin Deficiency. ADJUNCTIVE THERAPIES Ear Acupuncture Point Prescription: Large Intestine, Small Intestine, Stomach, Rectum, Shen Men, Spleen, and Kidney. Select 2-3 points during each treatment. Insert 0.5 cun #32 ear needles obliquely, 0.3 cun deep at a 45 degree angle with strong twisting needle technique for acute type of dysentery, and weak twisting needle technique for deficiency type of dysentery. Retain all needles for 40 minutes. Treat once every other day for 5 treatments as a course. Scalp Acupuncture Treatment zones: Middle line of vertex, Middle line of forehead, and Lateral line 2 and 3 of the forehead. Insert 1.5 cun #32 needles into Middle line of vertex and Middle line of forehead transversely, 1 cun deep at a 30 degree angle backwards with a lifting and thrusting reducing needle technique. Insert 1 cun #30 needles into Lateral line 2 and 3 of the forehead transversely, 0.8 cun deep at a 30 degree angle towards the face with fast twisting needle technique. Retain all needles for 40 minutes. Treat once every other day for 5 treatments as a course.

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Moxibustion (For the treatment of deficient type dysentery, Cold or loss of a amount of body fluid.) Direct moxibustion: CV-6, ST-25, ST-37, SP-4, BL-20, and BL-25. Apply direct non-scarring moxibustion on these points for 11 cones in each treatment. Treat once every other day for 3 treatments as a course. Indirect moxibustion: CV-8, CV-4, ST-25, GV-4, and BL-25. Apply indirect moxibustion with salt on CV-8 for 5 cones, and with ginger on ST-25 and CV-4 for 5 cones. Apply indirect moxibustion with ginger on GV-4 and BL-25 for 5 cones. Treat once every other day for 5 treatments as a course. Moxa pole: GV-20, CV-6, ST-25, CV-12, BL-20, and BL-40. Apply moxa-pole for 10 minutes on each point. Treat once daily for 5 treatments as a course, or with other therapy together. Bloodletting Treatment area: PC-3 and BL-40. (For the treatment of dysentery due to Heat.) Apply bloodletting technique on PC-3 (looking for purple or blue veins) to squeeze 2-3 drops of blood. Then apply again on BL-40 to squeeze 5 drops of blood. Treat once every other day for 2 treatments as a course, or with other therapy together. TRADITIONAL PRESCRIPTIONS AND TECHNIQUE For general dysentery: LI-4, ST-36, and BL-29. (Za Bing Xue Fa Ge) Insert 3 cun #30 needles into BL-29 perpendicularly, 2 cun deep with twisting reducing needle technique. Retain needles for 10 minutes. Insert 1.5 cun #30 needles into ST-36 perpendicularly, 1.2 cun deep with lifting and thrusting reinforcing needle technique, and 1 cun #32 needles into LI-4 with twisting even movement needle technique. Retain all needles for 30 minutes. Treat once every other day for 5 treatments as a course. For dysentery with bloody stool: ST-44, ST-25, SP-1, CV-6, PC-6, and KI-6. (Zhen Jiu Da Cheng) Insert 1 cun #32 needles into ST-44 and KI-6 perpendicularly, 0.5 cun deep with twisting reducing needle technique, and 2 cun #30 needles into ST-25 perpendicularly, 1.5 cun deep with twisting reducing needle technique. Insert 1.5 cun #32 needle into CV-6 perpendicularly, 1.2 cun deep with twisting even movement needle technique, and 1 cun #34 needles into PC-6 obliquely, 0.6 cun deep at a 60 degree angle upwards with twisting even movement needle technique. Apply direct non-scarring moxibustion on SP-1 for 9 cones. For dysentery with purulent stool: TW-5, SP-1, ST-25, and BL-62. (Zhen Jiu Da Cheng) Insert 1.5 cun #30 needles into TW-5 and ST-25 perpendicularly, 1 to 1.2 cun deep with twisting reducing needle technique, 1 cun #32 needles into BL-62 obliquely, 0.5 cun deep at a 45 degree angle towards upwards with twisting even movement needle technique. Apply direct non-scarring moxibustion on SP-1 for 10 cones. Treat once daily for 4 treatments as a course. 166

Dysentery

For dysentery with bloody and purulent stool: CV-1 and GV-4. (Shen Jiu Jing Lun) Insert a 1.5 cun #32 needle into CV-1 perpendicularly, 1 cun deep with twisting reducing needle technique, and 1.5 cun #30 needles into GV-4 perpendicularly, 1 cun deep with twisting even movement needle technique. Apply moxa wool on the handle of needle for 3 cones. For tenesmus during dysentery: CV-11, ST-25, and KI-6. (Shen Jiu Jing Lun) Insert 1.5 cun #32 needles into CV-11 and ST-25 perpendicularly, 1 cun deep with twisting even movement needle technique, and 1 cun #32 needles into KI-6 obliquely, 0.5 cun deep at a 60 degree angle with twisting even movement needle technique. Retain all needles for 30 minutes. For chronic dysentery: BL-20, ST-25, BL-22, BL-25, ST-36, and SP-6. (Shen Jiu Jing Lun) Apply direct non-scarring moxibustion on SP-6, ST-36, and ST-25 for 9 cones. Apply indirect moxibustion with ginger or Fu Zi (aconite) cake on BL-20, BL-22, and BL-25 for 5 cones. Treat once every other day for 5 treatments as a course. For dysentery due to Damp-Heat: LI-4, ST-25, ST-37, LI-11, ST-44, and CV-12. (Zhen Jiu Chu Fang Xue) Insert 1.5 cun #32 needles into ST-25, ST-37, LI-11, and CV-12 with lifting and thrusting reducing needle technique, and 1 cun #32 needles into LI-4 and ST-44 with twisting reducing needle technique. Retain all needles for 20 minutes. Treat once every other day for 5 treatments as a course. For dysentery due to Cold-Damp: CV-12, ST-25, BL-25, CV-6, ST-36, and SP-4. (Author’s Clinical Experience) Insert 1 cun #32 needles into SP-4 perpendicularly, 0.5 cun deep with twisting reinforcing needle technique, and 1.5 cun #30 needles into ST-36 with lifting and thrusting reinforcing needle technique. Insert 1.5 cun #32 needles into CV-12, ST-25, and CV-6 perpendicularly, 1 cun deep with twisting even movement needle technique. Apply moxa wool on the handle of needles for 5 cones. Insert 3 cun #30 needles into BL-25 perpendicularly, 2-2.5 cun deep with twisting reducing needle technique and retain the needles for 10 minutes. Treat once every other day for 5 treatments as a course. For fasting dysentery: CV-12, BL-21, BL-20, ST-44, LV-13, and PC-6. (Zhen Jiu Chu Fang Xue) Insert 1.5 cun #30 needles into BL-20 and BL-21 perpendicularly, 1 cun deep with twisting reducing needle technique. Retain all needles for 15 minutes. Insert a 1.5 cun #32 needle into CV-12 perpendicularly, 1 cun deep with twisting even movement needle technique, and 1 cun #34 needles into ST-44 and PC-6 perpendicularly, 0.5 cun deep with twisting even movement needle technique. Apply direct non-scarring moxibustion on LV-13 for 9 cones. Treat once every other day for 3 treatments as a course. For chronic dysentery: LI-4, ST-36, SP-9, CV-12, CV-4, CV-8, and CV-3. (Yi Xue Gang Mu) Insert 1 cun #32 needles into LI-4 perpendicularly, 0.6 cun deep with twisting even movement needle technique, and 1.5 cun #32 needles into ST-36 and SP-9 with twisting reinforcing needle technique. Insert 1.5 cun #34 needles into CV-12 and CV-3 perpendicularly, 1.2 cun deep with twisting even movement needle technique. Apply indirect moxibustion with salt on CV-8 for 5 cones. Apply indirect moxibustion with ginger on CV-4 for 3 cones. Treat once every other day for 5 treatments as a course. For dysentery with abdominal pain: LU-7, ST-44, ST-25, and SP-6. (Zhen Jiu Da Chuan) Insert 1.5 cun #32 needles into LU-7 transversely, 1 cun deep at a 15 degree angle upwards with twisting even movement needle technique, and 1.5 cun #32 needles into ST-44 and SP-6 perpendicularly, 1 cun deep with twisting reducing needle technique. Insert 2 cun #30 needles into ST-25 perpendicularly, 1.5-1.7 cun deep with twisting reducing needle technique. Retain all needles for 30 minutes. Treat once every other day for 5 treatments as a course. 167

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For dysentery with tenesmus and purulent watery stool: KI-7 and BL-25. (Zhen Jiu Da Chuan) Insert 3 cun #30 needles into BL-25 perpendicularly, 2 cun deep with lifting and thrusting reducing needle technique, and 1.5 cun #32 needles into KI-7 perpendicularly, 1 cun deep with twisting reinforcing needle technique. Retain all needles for 30 minutes. Treat once every other day for 5 treatments as a course. For dysentery with prolapsed of anus: GV-2 and BL-57. (Zhen Jiu Da Chuan) Insert 1.5 cun #34 needles into BL-57 perpendicularly, 1 cun deep with twisting even movement needle technique, and apply moxa wool on the handle of the needles for 3 cones. Apply moxa-pole on GV-2 for 20 minutes. Treat once every other day for 5 treatments as a course. For dysentery with Qi deficiency and tenesmus: SP-4, CV-11, LV-13, and KI-7. (Lei Jing Tu Yi) Insert 1 cun #32 needles into SP-4 perpendicularly, 0.5 cun deep with twisting reinforcing needle technique, and 1.5 cun #32 needles into CV-11 and KI-7 with twisting even movement needle technique. Apply direct non-scarring moxibustion on LV-13 for 11 cones. Treat once every other day for 7 treatments as a course. For dysentery with constant fever, purulent, and bloody stool: ST-25, BL-20, SP-3, LI-3, LU-5, ST-41, and LI-8 (Cai Ai Bian Yi) Insert 1 cun #32 needles into LI-3, LI-8, ST-41, and SP-3 with twisting even movement needle technique, and 1.5 cun #30 needles into LU-5 with lifting and thrusting reducing needle technique. Next insert 2 cun #30 needles into ST-25 perpendicularly, 1.7 cun deep with twisting reducing needle technique. Retain all needles for 20 minutes. Insert 1.5 cun #30 needles into BL-20 perpendicular 1.2 cun deep with twisting even movement needle technique and apply moxa wool on the handle of the needles for 3 cones. Treat once every other day for 3 treatments as a course. For chronic dysentery due to deficiency of Yang: CV-6, CV-12, ST-28, GB-27, and SP-6. (Zhen Jiu Ju Ying) Insert 1.5 cun #32 needles into SP-6 obliquely, 1.2 cun deep at a 60 degree angle upwards with twisting even movement needle technique, and 1.5 cun #34 needles into ST-28 and CV-12 perpendicularly, 1.2 cun deep with twisting reinforcing needle technique. Apply indirect moxibustion with Fu Zi (aconite) cake on CV-6 GB-27 for 5 cones. Treat once every other day for 5 treatments as a course.

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Dysentery

CASE ANALYSIS A 28 year-old male patient presented with a main complaint of dysentery for 5 days, the diarrhea occurring over 12 times a day with severe abdominal pain, purulent and bloody tenesmus. His symptoms were associated with a stuffy sensation in the chest, poor appetite, nausea, fever, aversion to cold, body achiness and a tender sensation in the body and limbs. The tongue was red with a yellow greasy coating and the pulse was floating and slippery. Diagnosis: Dysentery due to stagnation of Damp-Heat. Treatment Principle: Expel the Exterior, Resolve the Damp-Heat, and Clear the Fu-bowel. Point Prescription: LI-4, LI-11, GB-20, ST-25, ST-37, ST-44, and CV-12. Treatment was performed once daily for 3 treatments as a course. Technique: Insert 1.5 cun #32 needles into GB-20 perpendicularly, 1-1.2 cun deep towards the nose with a lifting and thrusting reducing needle technique. Retain needles for 10 minutes. Insert 1.5 cun #30 needles into LI-11, ST-37, and CV-12 perpendicularly, 1.2 cun deep with lifting and thrusting reducing needle technique, and 1 cun #32 needles into LI-4 and ST-44 with twisting reducing needle technique. Next insert 2 cun #30 needles into ST-25 perpendicularly, 1.7 cun deep with twisting even movement needle technique, and 1.5 cun #32 needles into CV-12 perpendicularly, 1 cun deep with twisting reinforcing needle technique. Repeat the process every 3 minutes during 30 minutes of retainment. Result: The fever and pain sensation were reduced after the first course of treatment. The diarrhea lessened to 5 times a day, but the purulent mucus was still there. New Point Prescription: Same as above with the addition of GV-1 and the removal of GB-20. Treatment was given once every other day for 5 treatments as a course. Technique: Insert a 1.5 cun #32 needle into GV-1 perpendicularly, 1.2 cun deep with twisting even movement needle technique, and apply moxa pole on the side of the needle for 10 minutes. Result: The symptoms totally resolved after 5 treatments. EVALUATION Acupuncture and moxibustion are very effective for treating both bacterial and amoebic dysentery. The needle technique greatly influences the results of the treatment, as well as a proper diagnosis. Therefore, those two key points are essential to resolve before beginning treatment. In chronic cases, moxibustion will have an excellent effect, more so than needles. Treatment is better continued for 1 or 2 courses after the symptoms have entirely resolved to prevent reoccurrence.

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EDEMA Edema refers to water retention within the body, which may accumulate and stagnate in the muscles, skin, head, limbs, organs, or anywhere in the body. There are two types known in TCM, Yin Water and Yang Water retention, which include local and/or whole body edema caused by the Heart, Kidney or malnutrition problems. This stagnation of water in the body can cause a variety of symptoms based on the nature of its causes. These symptoms can vary from local pains, aches, tremors, and even fever. Of the different causes identified in TCM there are five major categories based on its symptoms and location: Wind Invasion causing the Lung to fail in its ascending and descending function A Wind Invasion obstructs the pathway of water, impacting the Lung. This is often the cause of most acute edema. In this case, the water retention usually occurs on the surface of the body, particularly in the upper body and face. It is known in Chinese as Feng Shui—Wind Water. Dampness and toxicity invade the Lung and Spleen Some skin edema is caused by Heat toxin (such as some eczema or other dermatological disorders). Infections that invade from the outside of the body and move to the inside to the organs usually invade the Lung and Spleen. The Spleen fails in transporting and transforming and the Lung fails in ascending and descending, resulting in whole body edema. Stagnation of the Spleen Often, Spleen stagnation is caused by either Dampness invading from the environment or from an improper food intake that damages the Spleen Qi. As a result, edema will appear on the surface of the body after a long period of Spleen stagnation and failure in transporting and transforming. Damp-Heat Stagnation This refers to an accumulation of water in the body that turns to Heat and stagnates in the San Jiao meridian, causing edema. Kidney Qi Deficiency Most kinds of deficiency edema are caused by deficiency of the Kidney, which fails in water metabolism. Edema will appear in the body, particularly in the lower half. DIAGNOSIS Yang Water Symptoms of Yang Water retention include water retention that starts in the head and face and then travels over the whole body, above the waist being more severe than below and is characterized by a depressed hollow that recovers quickly after being pressed. The signs associated with it are: fever, an aversion to cold and an achy sensation in the back and limbs. With a Wind-Cold Invasion, the patient will have a pale tongue with a thin white coating and the pulse will be tight and floating. With a Wind-Heat Invasion, the patient will have a sore throat with a red tongue and a yellow coating and the pulse will be floating and fast.

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Edema

Yin Water Symptoms of Yin Water include water retention that starts from the foot and travels upward. Below the waist is more severe than above, with a depressing hollow that recovers slowly. Other associated symptoms include darkened skin and scanty urine. In Spleen deficient patients, there is an accompanying bloated abdomen, loose stools, and lassitude. The tongue is pale with a white greasy coating and the pulse is slow and weak. In Kidney deficient patients, the edema is accompanied by a sore, cold, and weak sensation in the low back and limbs, lassitude, a pale tongue with a white coating, and a deep and weak pulse. Advanced stage of Edema Usually, this stage is related to kidney damage. Water retention could be throughout the whole body, particularly in the abdomen and chest, associated with scanty urination or even no urine, shortness of breath, heart palpitations, nausea, vomiting, loss of consciousness, and/or nose and bleeding gums. This is called Water-toxin attacking the Heart and Lung in TCM. TREATMENT AND PRESCRIPTIONS Yang Water Treatment Principle: Expel the Wind and Promote water metabolism. Point Prescription: BL-13, BL-22, LI-6, SP-9, and LI-4. Treat once every other day for 5 treatments as a course. Technique: Insert 1.5 cun #32 needles into BL-13 obliquely, towards the spine 1 cun deep with a lifting and thrusting reducing needle technique and then insert 1.5 cun #30 needles into BL-22 perpendicularly, 1 cun deep with the Zi Wu Dao Jiu technique. (This is one combination of needle technique. See Section 3 for details.) Retain all needles for 10 minutes. Insert 1 cun #32 needles into LI-6 and LI-4 with a twisting reducing needle technique and 1.5 cun #30 needles into SP-9 with a lifting and thrusting reducing needle technique. Retain all needles for 30 minutes. Additional points for other associated symptoms: Sore throat: LU-11 with a bloodletting technique. Facial swelling: GV-26. Yin Water Treatment Principle: Reinforce the Spleen, Warm the Kidney, Build up the Yang Qi, and Move the water. Point Prescription: BL-20, BL-23, CV-9, CV-6, KI-3, and ST-36. Treat twice a week for 7 treatments as a course. Technique: Insert 1.5 cun #32 needles into BL-20 and BL-23 with a lifting and thrusting reinforcing needle technique, and apply moxa wool on the needle handles for 3 cones. Insert a 1.5 cun #32 needle into CV-6 perpendicularly, 1.2 cun deep with a twisting reinforcing needle technique and 1.5 cun #32 needles into KI-3 and ST-36 with a twisting reinforcing needle technique. Apply moxibustion with ginger on CV-9 for 5 to 7 cones. Additional points for other associated symptoms: Bloated abdomen: CV-12. Loose stool: ST-25. Interior Cold: CV-8 and CV-4 indirect moxibustion with salt and Fu Zi (aconite) cake for 5 to7 cones.

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ADJUNCTIVE THERAPIES Ear Acupuncture Point Prescription: Kidney, Spleen, Heart, Helix, and Endocrine. Insert 0.5 cun #34 ear needles into these points obliquely, 0.3 cun deep at a 30 degree angle, with a fast twisting needle technique. Retain all needles for 40 minutes. Treat once every other day for 7 treatments as a course. Scalp Acupuncture Treatment zones: Middle line of the forehead and vertex, lateral line 1 and 2 of the forehead. Insert 1 cun #32 needles into the middle line of the forehead, the lateral line 1 and 2 of the forehead transversely towards the face, 0.5 to 0.8 cun deep at a 30 degree angle, with a fast twisting needle technique. Insert a 1.5 cun #32 needle into the middle line of the vertex transversely, 1 cun deep at a 30 degree angle towards the back with a lifting the Qi technique. Retain all needles for 40 minutes Treat once every other day for 5 treatments as a course. Moxibustion Point Prescription: CV-9, CV-12, CV-6, SP-3, Wai Huai Jian, BL-22, BL-20, and BL-32. Apply direct non-scarring moxibustion on SP-3, Wai Huai Jian, CV-12 and BL-32 for 9 cones. Or apply indirect moxibustion with ginger on CV-9, CV-6, BL-22 and BL-20 for 5 cones. Treat twice a week for 5 treatments as a course. Foot Acupuncture Points: San Jiao, Small intestine, Kidney, and Spleen. Insert 1 cun #32 needles into these points perpendicularly, 0.3 cun deep with a twisting even movement needle technique. Retain all needles for 20 minutes. Treat twice a week for 5 treatments as a course. Wrist and ankle Acupuncture Treatment area: Upper 1, Upper 5, Lower 4, and Lower 6. Insert 1.5 cun #32 needles into these lines transversely, 1.2 cun deep at a 15 degree angle, with a slow insertion needle technique to avoid any needle sensation. Retain the needles for 40 minutes. Treat twice a week for 5 treatments as a course. Gua Sha Treatment area: Back, Chest, Abdomen, BL-39, and PC-3. Apply medium stimulation of Gua Sha technique on the upper back from BL-41 to BL-45, and on the chest from CV-21 to CV-16, until the red color and purple dots—Sha appears. Apply mild stimulation of Gua Sha on the abdomen along both sides of the Stomach meridian, BL-39, and the PC-3 area, until red marks appear. Treat once a week for 3 treatments as a course.

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Edema

Cupping Treatment area: Mid-back, CV-8, and ST-25. Apply fire cups on the mid-back near BL-22, BL-50, and BL-47 and retain the cups for 3 minutes. Then apply cups on CV-8 and ST-25. Retain the cups for 5 minutes. Treat once every other day for 5 treatments as a course. TRADITIONAL PRESCRIPITONS AND TECHNIQUE For edema on the face and eyes with a high fever: KI-6, GV-26, LI-4, ST-36, GB-15, LI-11, and SP-6. (Zhen Jiu Da Cheng) Insert a 1 cun #32 needle into GV-26 perpendicularly, 0.3 cun deep with a twisting even movement needle technique and 1 cun #32 needles into GB-15 transversely, 0.5 cun deep towards the face at a 30 degree angle with a fast twisting needle technique. Insert 1.5 cun #30 needles into ST-36, LI-11, SP-6, and LI-4 with a twisting even movement needle technique. Insert 1 cun #30 needles into KI-6 obliquely, towards the center of the ankle with a twisting reinforcing needle technique. Retain all needles for 30 minutes. Treat once every other day for 5 treatments as a course. For edema accompanied by a bloated belly: GV-26 and CV-9. (Gu Jin Yi An) Insert 1 a cun #32 needle into GV-26 perpendicularly, 0.3 cun deep with a twisting reducing needle technique. Apply indirect moxibustion with ginger on CV-9 for 7 cones. Treat twice a week for 5 treatments as a course. For edema of the Yin Water type: CV-9, CV-6, BL-20, BL-23, ST-36, SP-6, and BL-39 (Zhen Jiu Chu Fang Ji Jing) Insert 1.5 cun #30 needles into BL-20, BL-23 and BL-39 perpendicularly, 1 to 1.2 cun deep with a twisting reinforcing needle technique, and apply moxa wool on the needle handles for 3 cones. Insert 1.5 cun #32 needles onto CV-9, CV-6, ST-36, and SP-9 with a twisting reinforcing needle technique. Apply moxa wool on the handles for 5 cones. Treat once every other day for 5 treatments as a course. Additional point for other associated symptoms: Upper extremity edema: LI-6. Lower extremity edema: SP-9. Foot edema: GB-42. Loose stools: ST-25. For edema around the belly: SP-9 and CV-9. (Bai Zhen Fu) Insert 1.5 cun #30 needles into SP-9, 1 to 1.2 cun deep with a lifting and thrusting reducing needle technique, and apply moxa wool on the handles for 3 cones. Apply indirect moxibustion with ginger on CV9 for 7 cones. Treat twice a week for 5 treatments as a course. For edema in the lower body: CV-9 and KI-6. (Zha Bing Xue Fa Ge) Apply direct non-scarring moxibustion on CV-9 and KI-6 for 9 cones. Treat once every other day for 5 treatments as a course.

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For edema in the whole body: GV-26, BL-21, LI-4, CV-5, ST-36, KI-7, LV-8, and KI-14. (Zhen Jiu Ju Ying) Insert 1.5 cun #30 needles into BL-21 perpendicularly, 1 cun deep with a lifting and thrusting reducing needle technique, and apply moxa wool on the handles for 3 cones. Insert 1 cun #32 needles into GV-26 and LI-4 with a twisting even movement needle technique. Insert 1.5 cun #32 needles into CV-5, ST-36, KI-7, LV-8, and KI-14 perpendicularly, 1 cun deep with a twisting even movement needle technique. Apply moxa wool on the handles for 3 cones. Treat twice a week for 5 treatments as a course. For edema in the belly: BL-20, CV-9, and BL-18. (Jing Yue Quan Shu) Apply direct moxibustion on BL-20 and BL-18 for 9 cones. Apply indirect moxibustion with Gan Sui and Da Ji (Chinese herbs) on CV-9 for 5 cones. Treat once every other day for 5 treatments as a course. For edema on the head and face: SP-4, GV-26, ST-40, ST-43, LU-7, GV-23, GB-34, and GB-17. (Shen Yin Jing) Insert 1 cun #32 needles into GV-26, SP-4 and ST-43 with a twisting reducing needle technique and 1.5 cun #32 needles into LU-7, GV-23, and GB-17 transversely, at a 30 degree angle 1 cun deep with a twisting even movement needle technique. Insert 1.5 cun #30 needles into GB-34 and ST-40 with a lifting and thrusting reducing needle technique. Retain all needles for 30 minutes. Treat twice a week for 7 treatments as a course. For edema on the head and face: GB-12, SI-18, GV-24, BL-45, GB-16, GB-20, and LI-4. (Zhen Jiu Quan Shu) Insert 1.5 cun #32 needles into GB-12, GB-20, and GB-16 with a twisting reducing needle technique and 1.5 cun #30 needles into BL-45 transversely, towards BL-46, 1 cun deep at a 30 degree angle with a twisting reducing needle technique. Retain all needles for 10 minutes. Insert 1 cun #32 needles into SI-18, GV-24, and LI-4 with a twisting even movement needle technique. Retain all needles for 20 minutes. Treat once every other day for 5 treatments as a course. For pediatric edema with a swollen belly and limbs: One cun above the navel. (Ming Tang Jiu Jing) Apply direct non-scarring moxibustion one cun above the navel for 7 cones. Treat once daily for 3 treatments as a course. The following four prescriptions are from the Zhen Jiu Chu Fang Ji Jing. For edema with heaviness and a swollen body: ST-22. Apply direct non-scarring moxibustion on ST-22 for 7 cones. Treat once every other day for 5 treatments as a course. For edema with asthma and difficulty lying down: LU-3 and SP-9. Insert 1.5 cun #30 needles into LU-3 and SP-9 perpendicularly, 1 cun deep with a lifting and thrusting reducing needle technique. Retain all needles for 20 minutes. Treat once every other day for 5 treatments as a course. For edema beneath the skin: CV-7 and ST-36. Insert 1.5 cun #32 needles into CV-7 and ST-36 perpendicularly 1.2 cun deep with a twisting even movement needle technique, and apply moxa wool on the handles for 3 cones. Treat once every other day for 5 treatments as a course. For edema with a bloated belly: CV-9, ST-33, LV-1, SP-8, LV-8, and KI-14. (Zhen Jiu Chu Fang Ji Jing) Apply direct non-scarring moxibustion on CV-9, ST-33, and LV-1 for 7 cones. Insert 1.5 cun #32 needles into LV-8, KI-14, and SP-8 with a twisting reinforcing needle technique. Apply moxa wool on the handle of needles for 3 cones. Treat once every other day for 5 treatments as a course. 174

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For edema with heaviness in the body: LV-3, LI-4, ST-44, and LV-1. (De Xiao Fang) Apply direct non-scarring moxibustion on LI-4, LV-1, and ST-44 for 7 cones, and on LV-3 for 10 cones. Treat once daily for 3 treatments as a course. For edema in the face and head: LU-1, PC-5, and LI-4. (Zhen Jiu Jing Lun) Insert 1.5 cun #32 needles into LU-1 obliquely, towards the shoulder 1 cun deep with a twisting even movement needle technique and 1 cun #34 needles into PC-5 and LI-4 with a lifting and thrusting reducing needle technique. Retain all needles for 20 minutes. Treat once every other day for 7 treatments as a course. For edema in the legs with difficulty walking: LV-3 and BL-58. (Zhen Jiu Jing Lun) Apply direct non-scarring moxibustion on LV-3 and BL-58 for 7 cones. Treat once every other day for 7 treatments as a course. For edema in the lower body: CV-8 and KI-7. (Shen Yin Jing) Apply indirect moxibustion with salt on CV-8 for 5 cones. Insert 1.5 cun #32 needles into KI-7 perpendicularly, 1 cun deep with a lifting and thrusting reducing needle technique, and apply moxa wool on the handles for 3 cones. Treat once every other day for 7 treatments as a course. For edema in the body and head: BL-20 and Sui Zhong. (De Xiao Fang) Apply direct non-scarring moxibustion on BL-20 for 10 cones, and on Shui Zhong point (the point on the black and white skin boarder, directly straight down from the inside of the ankle) for 7 cones. Treat once every other day for 5 treatments as a course. CASE ANALYSIS (Zhen Jiu Zi Shen Jing in Song dynasty, 900-1100 A.D) Dr. Wang treated Mr. Li for edema. Mr. Li suffered from edema for years, which stagnated in the face and whole body. He took a lot of herbs without any results. He asked Dr. Wang Zhi Zhong for treatment, and Dr. Wang decided to do direct moxibustion on CV-9 and CV-6 after an examination and diagnosis. The next day, he found the facial swelling to be gone when Mr. Li came. He continued with the same treatment several times until the whole body edema was gone. EVALUATION For treating edema, acupuncture and moxibustion mainly focus on regulating the function of the San Jiao, as the San Jiao regulates the pathway of water. In TCM, water metabolism is thought to be under the control of the San Jiao Qi. For treatment of Yang types of edema, acupuncturists will consider working with the Lung and Urinary Bladder meridians with a reducing needle technique. For treating Yin types of edema, acupuncturists will work with the Spleen and Kidney meridians with a reinforcing needle technique and moxibustion. If the patient has a severe infection or disease, acupuncture and moxibustion will be useful as a supplemental therapy to help increase the body energy. However in emergency cases, it is recommended for the patient to be hospitalized.

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EPIGASTRIC PAIN Epigastric pain usually refers to sensations of pain and pressure in the epigastric region of the abdomen. This type of pain is usually primarily located in the digestive tract traveling downwards. In Traditional Chinese Medicine, epigastric pain includes acute or chronic gastritis, stomach and duodenal ulcer, and gastro neurosis. The etiological factors contributing to epigastric pain are: Cold invading the Stomach The nature of Cold dominates contraction. When the Cold invades the Stomach, it will impact the Stomach Qi and cause pain. Improper Food Intake Most epigastric pain is due to excessive eating of cold, hot, spicy, or greasy foods, causing stagnation of food in the Stomach or accumulation of Heat in the Stomach. Unhealthy Emotional Activities Stagnation of Liver Qi occurs from unhealthy emotional stimulation, which attacks the Stomach and causes pain. Deficiency of Spleen and Stomach Long-term or chronic diseases or weakness in the body constitution will cause Stomach and Spleen Yang deficiency. This makes it hard to digest food after eating, causing pain. Sometimes deficiency of the Qi will cause the Blood to stagnate and hurt the Luo meridian of the Stomach, causing severe pain and bleeding symptoms in both the upper and lower GI tract. DIAGNOSIS

Excess type Pain due to a Cold Invasion Symptoms include acute epigastric pain that is relieved by warmth and aggravated by cold with a desire for warm drinks. The tongue is pale with a thin white tongue coating and the pulse is floating and wiry. Pain due to Food Stagnation Symptoms include epigastric pain, fullness and distention, acid regurgitation, vomiting of undigested food, and pain that is relieved after vomiting or a bowel movement. The tongue is red with a thick, greasy coating and the pulse is slippery. Pain due to Stagnation of Liver Qi attacking the Stomach Symptoms include epigastric distention and pain that extends to the hypochondriac region, sighing, belching, and irregular bowel movements with alternating constipation and diarrhea. The tongue is swollen with white tongue coating and the pulse is wiry.

176

Epigastric Pain

Pain due to Liver and Stomach Heat Symptoms include epigastric burning and pain, restlessness, a tendency towards anger, acid regurgitation and a dry, bitter taster in the mouth. The tongue is red with yellowish coating and the pulse is fast and wiry. Pain due to Blood Stagnation Symptoms include a fixed, sharp pain in the epigastric region that is made worse with pressure and is aggravated by food, hematemesis, and black stools. The tongue is purple with black dots and a thin white coating and the pulse is thin and choppy.

Deficiency type Pain with Stomach Yin Deficiency Symptoms include chronic epigastric pain and discomfort and a dry mouth, throat, and stools. The tongue is red with no coating and the pulse is thin and fast. Pain with Stomach and Spleen Deficient Cold Symptoms include chronic epigastric pain that is reduced with pressure and warmth, aggravated by hunger and associated with vomiting of clear fluids, a poor appetite, lassitude, cold hands and feet, and loose stools. The tongue is pale with a white coating and the pulse is slow and weak. TREATMENT AND PRESCRIPTIONS Excess type Treatment Principle: Expel the Cold, Warm the middle warmer, Clear the Heat, Resolve the stagnation, Regulate the Qi, and Soothe the Liver. Point Prescription: CV-12, ST-36, PC-6, SP-4, and LV-2. Treat once every other day for 3 treatments as a course. Technique: Insert 1.5 cun #32 needles into CV-12 and ST-36 perpendicularly, 1 to 1.2 cun deep with a twisting reducing needle technique and 1 cun #30 needles into PC-6, SP-4, and LV-2 with a twisting reducing needle technique. Retain all needles for 20 minutes. Or, apply moxa wool to the handles of the needle for 3 cones on CV12, if the patient has a Cold Invasion. Additional points for other associated symptoms: Severe pain: ST-34. Hypochondriac pain: GB-34. Thirst: CV-24 and KI-6. Restlessness: LV-3 and GV-20. Black stool: SP-10 and SP-6.

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Deficiency type Treatment Principle: Reinforce the Spleen-Stomach Qi, Warm the Yang, Expel the Cold, and Nourish the Yin. Point Prescription: BL-21, BL-20, CV-12, LV-13, ST-36, PC-6, and SP-6. Treat once every other day for 7 treatments as a course. Technique: Insert 1.5 cun #30 needles into BL-21 and BL-20 with a lifting and thrusting reinforcing needle technique. Retain all needles for 5 minutes and then remove them. Insert 1 cun #32 needles into CV-12, LV-13, ST-36, PC-6, and SP-6 with a twisting reinforcing needle technique. Retain all needles for 30 minutes. Additional points for other associated symptoms: Bitter taste in the mouth: HT-8. Burning sensation in the epigastric region: KI-3. Black stool: LV-8 and SP-6. Vomiting of blood: BL-17. ADJUNCTIVE THERAPIES Scalp Acupuncture Treatment zone: Lateral line 2 of the forehead, Lateral line 3 of the forehead, and Middle line of the vertex. Insert 1.5 cun #30 needles into these lines transversely, at a 30 degree angle with a fast twisting needle technique until the pain releases. Retain all needles for 1 to 2 hours. Treat once daily for3 treatments as a course. Ear Acupuncture Points: Spleen, Stomach, Liver Sympathetic, Shen Men, and Sub cortex. Select 2 to 3 points each treatment. Insert 0.5 cun #32 ear needles into these points with a twisting reducing needle technique until the pain is reduced. Retain all needles for 30 to 50 minutes. Treat once daily for 3 treatments as a course. Moxibustion Points: CV-12 and CV-9. Apply indirect moxibustion with salt on CV-8, and indirect moxibustion with ginger on CV-12 for 3 cones to treat epigastric pain with a Spleen deficiency. Treat once daily for 5 treatments as a course. Nose Acupuncture Points: Heart, Stomach, and Lung. Insert 0.5 cun #32 needles for these points perpendicularly, 0.2 cun deep with a twisting even movement technique. Retain all needles for 30 minutes. The pain usually disappears after 5 to 10 minutes. Treat once daily for 3 treatments as a course.

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Epigastric Pain

Gua Sha Treatment area: Mid-back and the Stomach meridian on the chest and epigastric region. Apply medium stimulation of the Gua Sha (until the skin color changes to dark red) along the meridian to treat epigastric pain due to stagnation of Heat. Treat once daily for 2 treatments as a course.

TRADITIONAL PRESCRIPTONS AND TECHNIQUE For epigastric pain with a Cold Invasion: BL-17, BL-20, BL-21, PC-6, GB-37, and GB-40. (Shen Yin Jing) Apply direct non-scarring moxibustion on these points for 5 cones. Treat once every other day for 5 treatments as a course. For acute Stomach pain with vomiting of cold clear water: LU-9, LU-10, ST-36, and ST-18. (Shen Yin Jing) Apply direct non-scarring moxibustion on LU-9, LU-10, ST-36 and ST-18 for 7 cones. Treat once daily 3 treatments as a course. For chronic epigastric pain due to deficiency of Spleen and Kidney: BL-17, BL-21, and BL-23. (Shen Yin Jing) Insert 1.5 cun #32 needles into BL-17, BL-21 and BL-23 perpendicularly, 1 cun deep with a twisting reinforcing needle technique and apply moxa wool to the handle of the needles for 3 cones. Treat once every other day for 5 treatments as a course. For pain due to stagnation of the intake of cold food: CV-12, CV-13, and ST-36. (Zhen Jiu Da Cheng) Insert 1.5 cun #30 needles into ST-36 and CV-1 perpendicularly, with the Shao Shan Huo needle technique, until a heat sensation is produced under the needles. Insert a 1.5 cun #32 needle into CV-14 with a twisting reducing needle technique. Apply moxa wool to the handles of the needles for 3 cones. Treat once every other day for 5 treatments as a course. For Stomach pain due to Deficiency Cold of the Spleen: ST-44, CV-12, CV-6, and SP-4. (Zhen Jiu Da Quan) Insert 1 cun #32 needles into ST-44 and SP-4 with a twisting reinforcing needle technique and 1.5 cun #30 needles into CV-6 and CV-12 with a twisting reinforcing needle technique. Apply moxa wool to the handles of the needles for 5 cones. Treat once every other day for 7 treatments as a course. For Stomach pain due to stagnation of food accompanied by vomiting and acid regurgitation: GB-24, CV-12, BL-20, and BL-21 (Lei Jing Tu Yi) Apply direct non-scarring moxibustion on BL-20 and BL-21 for 7 cones, and then apply the moxa-pole at GB-24 and CV-12 for 20 minutes. Treat once daily for 2 treatments as a course. For epigastric pain due to stagnation of the Liver Qi, which then attacks the Stomach: CV-12, ST-36, LV-13, GB-34, and PC-6 (Author’s Clinical Experience) Insert 1.5 cun #32 needles into PC-6, GB-34, and ST-36 with a twisting reducing needle technique, 1 cun #32 needles into CV-12 and LV-13 with a twisting even movement needle technique. Retain all needles for 30 minutes. Treat once daily for 3 treatments as a course.

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For epigastric pain due to food stagnation: CV-12, KI-18, and BL-21. (Zhen Jiu Gang Yao) Insert 1.5 cun #30 needles into BL-21 with a lifting and thrusting reducing needle technique and remove it after a Qi sensation is achieved. Insert 1 cun #32 needles into CV-12 and KI-18 with a twisting reducing needle technique. Retain all needles for 20 minutes. Treat once daily for 3 treatments as a course. For epigastric pain: ST-36. (Pi Wei Lun) For Stomach pain with food stagnation and acid regurgitation: LV-13 and GB-22. (Pi Wei Lun) Insert 1.5 cun #30 needles into ST-36 perpendicularly 1 cun deep with a lifting and thrusting reducing needle technique and 1 cun #32 needles into LV-13 and GB-22 with a twisting reducing needle technique. Retain all needles for 20 minutes. Treat once daily for 3 treatments as a course. For epigastric pain due to stagnation with Heat: GB-39. (Shen Yin Jing) Insert 1.5 cun #30 needles into GB-39 perpendicularly, 1 cun deep with a twisting reducing needle technique. Retain all needles for 10 minutes. Treat once daily 3 treatments as a course. For Stomach pain due to Cold Phlegm: BL-17. (Shen Yin Jing) Insert 1 cun #30 needles into BL-17 perpendicularly 0.5 to 0.8 cun deep with a twisting reinforcing needle technique and apply moxa wool to the handles of the needles for 3 cones. Treat once daily 3 treatments as a course. For epigastric pain with poor appetite: PC-6, LU-10, and ST-36. (Shen Yin Jing) Insert 1 cun #32 needles into PC-6 and LU-10 with a twisting even movement technique and 1.5 cun #30 needles into ST-36 with a lifting and thrusting reducing needle technique. Retain all needles for 20 minutes. Treat once daily for 3 treatments as a course. For epigastric pain with poor appetite: CV-12 and CV-13. (Jiu Fa Mi Chuan) For epigastric pain with vomiting: CV-10 and BL-19. (Jiu Fa Mi Chuan) For epigastric pain with borborygmus: LV-3. (Jiu Fa Mi Chuan) Apply direct non-scarring moxibustion for 7 cones on CV-12 and CV-13. Apply indirect moxibustion with ginger on CV-10 and BL-19 for 3 cones. Insert 1 cun #32 needles into LV-3 with a twisting reducing needle technique and apply moxa wool to the handles of the needles for 3 cones. Treat once daily for 3 treatments as a course. For epigastric pain due to stagnation of Qi: GV-6. (Author’s Clinical Experience) Insert a 1.5 cun #28 needle into GV-6 perpendicularly, 1cun deep with the Long Hu Jiao Zhan—Dragon and Tiger Battle technique. Retain the needles for 10 minutes. Treat once daily 3 treatments as a course. For acute epigastric pain: LI-4, LV-3, and CV-12. (Author’s Clinical Experience) Insert 1 cun #30 needles into LI-4 perpendicularly, 0.5 cun deep with a twisting reducing needle technique and 1.5 cun #32 needles into LV-3 obliquely upwards at a 60 degree angle 1 cun deep with an even movement needle technique. Insert 1.5 cun #32 needles into CV-12 with a twisting even movement needle technique and apply moxa wool to the handles of the needle for 3 cones. Treat once daily, 3 treatments as a course. 180

Epigastric Pain

CASE ANALYSIS A 51 year-old male patient has a main complaint of chronic epigastric pain for the last 5 years that was recently aggravated 3 days ago. The pain began 1 to 2 hours after a meal and travels to the middle back and was associated with belching, nausea, a poor appetite and dry stool. The tongue was pale with a thin white coating and the pulse was weak and deep. Diagnosis: Epigastric pain due to deficiency of Qi. Treatment Principle: Warm the middle warmer and reduce the pain. Point Prescription: CV-12, CV-13, ST-36, and PC-6. Treat once every other day, 5 treatments as a course. Technique: Insert 1.5 cun #30 needles into CV-12, CV-13, and ST-36 with a reinforcing needle technique and apply moxa-wool to the handle of the needles for 3 cones. Insert 1 cun #32 needles into PC-6 with a twisting even movement needle technique. Retain all needles for 10 minutes. Result: After 3 treatments, the pain was remarkably reduced and after a total of 6 treatments, all the pain had resolved. The patient returned with a sprained ankle for treatment one year later. The epigastric pain had still not returned. EVALUATION Acupuncture and moxibustion is good for ridding pain in the epigastric region, including that from any kind of ulcer. It has remarkable results and is very safe and effective therapy for patients. One should have good clinical experience in TCM diagnosis to understand really severe cases, such as a perforated ulcer. The diet is very important during the treatment as well. Herbal therapy will be recommended along with acupuncture in some cases.

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EPILEPSY Epilepsy is defined as paroxysmal and temporary disturbances of the brain characterized by loss of consciousness, muscle tics or other abnormal sensations and emotional behaviors. This is usually due to trauma to the brain or blood clogging the brain arteries. Clinical manifestations of the disease vary greatly. Epilepsy may be present in forms of grand mal, petit mal or infantile spasms. The grand mal is characterized by a sudden loss of consciousness and a general titanic spasm with sensations of apnea, cyanosis and foam from the mouth, usually lasting for 1-5 minutes. The patients may then fall into a sleep and become conscious a few hours later. The petit mal is characterized by a sudden and brief loss of consciousness without auras or muscle tics, accompanied by interruptions of speech and action, usually persisting for 2-10 seconds. The patient usually comes to consciousness rapidly. Infantile spasms are the lightest of the three usually characterized by involuntary spasms of muscles and head and does not always lead to loss of consciousness. In TCM, epilepsy is caused by stagnation of Phlegm and Fire, which makes Qi flow disturbed in the brain. This stagnation may result in dysfunctions in the brain and is generally characterized into three different causal groups. Emotional impact Severe fear and scary scenes cause some types of epilepsy. Fear makes the Qi sink and fright makes the Qi disturbed. Abnormal Qi movement will impact other organs such as the Liver and Kidney, making it difficult for the Yin to harmonize the Yang well. The separated Yang will ascend with Wind and Phlegm and impact the Heart Shen, causing epilepsy. Innate causes Most of the time, innate epilepsy is caused by the mother‘s severe emotional state or severe depression and anxiety during pregnancy, or by fetal brain injury during the labor. Brain injury Some trauma-induced epilepsy belongs to this category. Stagnation of Blood leads to Qi stagnation in the brain, causing epilepsy. DIAGNOSIS Although the three groups of epilepsy vary in how each is viewed and how it relates the initial causes to its nature, in TCM the clinical diagnosis of epilepsy is usually based on the immediate symptoms and stresses. Epilepsy Induced by Terror Sudden panic results in confusion with loss of self- control, accompanied by fright, alarm or restlessness with an alternating flushed and sallow complexion, a red tongue with a white coating and a wiry and rapid or slippery pulse. Epilepsy due to Accumulation of Phlegm This occurs as convulsing of the extremities during a fit of epilepsy with unconsciousness or vertigo, a headache and abdominal pain, strider produced by phlegm in the throat, salivation, a yellow face, a thick coating on the tongue, and a slippery and rapid pulse.

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Epilepsy

Epilepsy due to Blood Stasis With a history of injury during birth or trauma, epilepsy can often manifest as a paroxysmal localized headache, occasional vomiting, paroxysmal convulsions of the whole body or half the body or a localized attacked region with a dark purple tongue with black dots, the pulse is choppy, thin, and thread like. TREATMENT AND PRESCRIPTION Excess type of Epilepsy Treatment Principle: Subdue the Wind and Fire, Resolve the Phlegm and Calm the Shen. Point Prescription: GV-12, GB-13, CV-15, ST-40, and LV-3. Treat once a week for 7 treatments as a course. Technique: Insert a 1.5 cun #30 needle into GV-12 perpendicularly, 1 cun deep with a twisting rubbing needle technique (rub the needle counterclockwise) and take out of needle after sensation of the Qi travels down the spinal column. Insert 1.5 #32 needles into GB-13 obliquely, 1 cun deep at a 45 degree angle towards the back a with fast twisting needle technique and a 1.5 cun #30 needle into CV-15 perpendicularly, 1 cun deep with a twisting reducing needle technique. Insert 1.5 cun #30 needles into ST-40 with a lifting and thrusting reducing needle technique and 1.5 cun #32 needles into LV-3 obliquely, 1 cun deep at a 60 degree angle towards KI-1 with a twisting even movement needle technique. Retain all needles for 30 minutes. Additional points for other associated symptoms: During epilepsy: GV-26, ST-6, and HT-7. Technique: Insert a 1-cun #28 needle into GV-26 obliquely, 0.3 to 0.5 cun deep at a 60 degree angle in an upward direction with a fast twisting needle technique until the patient wakes up. Insert 1.5 cun #30 needles into ST-6 perpendicularly, 1 cun deep with a twisting reducing needle technique and 1 cun #32 needles into HT-7 with a twisting even movement needle technique. Retain all needles for 30 minutes. Epilepsy during the night Point Prescription: KI-6. Technique: Insert 1 cun #32 needles obliquely, 0.8 cun deep at a 45 degree angle upwards with a twisting even movement needle technique for 2 minutes, and retain the needles with other points together. Epilepsy during the day Point Prescription: BL-62. Technique: Insert 1 cun #30 needles into BL-62 perpendicularly, 0.5 cun to 0.8 cun deep with a twisting reducing needle technique for 2 minutes and retain the needles with other points together. Additional points for other associated symptoms: Aches and weakness throughout the whole body: Yao Qi, GV-20, and GB-20.

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Deficient type of Epilepsy Treatment Principle: Reinforce the Heart and Spleen, Calm the mind, and Resolve Phlegm. Point Prescription: HT-5, ST-40, BL-23, GB-34, SP-6, and GV-8. Treat twice a week for 10 treatments as a course. Technique: Insert 1.5 cun #30 needles into BL-23 and GV-8 perpendicularly, 1 to 1.2 cun deep with a lifting and thrusting reinforcing needle technique, and apply moxa wool to the handles of the needles for 3 cones. Insert 1 cun #32 needles into HT-5 perpendicularly, 0.8 cun deep with a twisting reinforcing needle technique and 1.5 cun #32 needles into ST-40, GB-34, and SP-6 with a twisting even movement needle technique. Retain all needles for 20 minutes. Additional points for other associated symptoms: In a coma during epilepsy: KI-1, GV-26, and CV-6, combined with direct moxibustion. Technique: Insert 1 cun #30 needles into KI-1 and GV-26 perpendicularly, 0.5 to 0.8 cun deep with a fast twisting needle technique until the patient wakes up. Apply direct moxibustion on CV-6 for 9 cones. Latent Epilepsy Point Prescription: CV-12, ST-36, and GV-20. Technique: Insert a 1.5 cun #32 needle into GV-20 transversely, 1 cun deep at a 30 degree angle towards the back with a lifting and thrusting reinforcing needle technique. Insert 1.5 cun #32 needles into CV-12 and ST-36 perpendicularly, 1 cun deep with a twisting reinforcing needle technique. Apply moxa wool to the handles of the needles for 3 cones. ADJUNCTIVE THERAPIES Ear Acupuncture Point Prescription: Shen Men, Heart, Spleen, Kidney, and Liver. Insert 0.5 cun #32 ear needles into these points obliquely, 0.3 cun deep at a 45-degree angle with a fast twisting needle technique. Retain all needles for 40 minutes. Repeat the twisting technique every 5 minutes during the needle retention. Treat once every other day for 7 treatments as a course. Scalp Acupuncture Treatment zones: Middle line and Lateral line 1 of the vertex; Middle line and Lateral line 2 of the forehead. Insert 1.5 cun #30 needles into these lines transversely, 1 cun deep at a 30-degree angle with a lifting Qi technique. Retain all needles for 1 hour. Treat once every other day for 10 treatments as a course. Bloodletting Points: Shi Xuan, PC-3, GV-26, Tai Yang, and Yin Tang. Apply a medium level stimulation of the bloodletting technique on these points. Start from Shi Xuan and end on Yin Tang, removing 1 or 2 drops of blood on each point. Treat only during the epilepsy.

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Epilepsy

Gua Sha Treatment area: Back, abdomen, and chest. Apply medium stimulation of Gua Sha on the back from BL-11 to BL-20 until a dark red color appears, on the chest along the CV meridian and Stomach meridian, and then on the abdominal area along both sides of the Stomach meridian from ST-22 to ST-28, until a purple color appears. Treat once a week for 3 treatments as a course. Hand Acupuncture Points: Convulsion, Headache, and Stomach. Insert 0.5 cun #34 needles into these points perpendicularly, 0.2 cun deep with a twisting reducing needle technique. Retain all needles for 10 minutes. Treat only during the epilepsy. Electro-acupuncture Points: GV-20, BL-5, and GV-24. Insert 1.5 cun #30 needles into GV-20 and GV-24 transversely, 1 cun deep at a 30 degree angle towards the back with a twisting reducing needle technique and 1 cun #32 needles into BL-5 transversely, towards the back, 0.8 cun deep with a twisting even movement needle technique. Add 2 groups of Electro-wires on the points, the negative side on GV-20 and GV-24, the positive sides on BL-5 with fast waves for 20 minutes. Treat once a week for 5 treatments as a course. Nose Acupuncture Points: Heart, Liver, Lung, and Stomach. Insert 0.5 cun #32 needles into these points perpendicularly, 0.2 to 0.3 cun deep with a fast twisting needle technique. Retain all needles for 20 minutes. Treat only during the epilepsy. Foot Acupuncture Points: Heart, Li Nei Ting, Nei Tai Chong, Kidney and Head. Insert 1 cun #32 needles into these points perpendicularly, 0.3 to 0.5 cun deep with fast twisting needle technique. Retain all needles for 30 minutes. Treat only during the epilepsy. TRADITIONAL PRESCRIPTIONS AND TECHNIQUE For epilepsy: BL-2, TW-10, SI-8, HT-7, BL-63, SP-5, LV-2, BL-66, BL-15, and SI-3. (Shen Yin Jing) Insert 1 cun #32 needles into BL-2 obliquely, 0.5 cun deep at a 45 degree angle towards the BL-1 direction, with a twisting reducing needle technique. Insert 1 cun #30 needles into TW-10, SI-8, HT-7, BL-63, SP-5, LV-2, and SI-3 with a twisting reducing needle technique. Apply a bloodletting technique on BL-66, removing 2 drops of blood. Apply direct non-scarring moxibustion on BL-15 for 11 cones. Treat once every other day for 10 treatments as a course.

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For epilepsy: KI-1, BL-15, ST-36, CV-15, CV-12, LU-11, and CV-14. (Zhen Jiu Da Cheng) Insert 1.5 cun #32 needles into KI-1and BL-15 perpendicularly, 1 cun deep with a twisting reinforcing needle technique, and apply moxa wool to the handles of the needles for 3 cones. Insert 1.5 cun #32 needles into ST-36 with a lifting and thrusting reinforcing needle technique and 1.5 cun #30 needles into CV-14, CV-15, and CV-12 perpendicularly, 1 cun deep with a twisting reducing needle technique. Apply moxa wool to the handles of the needles for 3 cones. Apply a bloodletting technique on LU-11. Treat once every other day for 10 treatments as a course. For epilepsy: CV-12. (Pian Que Xin Shu) Apply direct non-scarring moxibustion on CV-12 for 15 cones. Treat once a week for 5 treatments as a course. For epilepsy: CV-15, SI-3, KI-1, GB-37, PC-5, CV-13, LV-3, and ST-36. (Yi Xue Gang Mu) Insert 1.5 cun #30 needles into CV-15 and CV-13 perpendicularly, 1 cun deep with a twisting reducing needle technique and 1 cun #32 needles into SI-3, KI-1, PC-5, and LV-3 with a twisting reinforcing needle technique. Insert 1.5 cun #32 needles into ST-36 and GB-37 with a lifting and thrusting reinforcing needle technique. Retain all needles for 30 minutes. Treat twice a week for 10 treatments as a course. For use during epilepsy: GV-26, GV-20, and PC-5. (Qian Jin Fang) Insert a 1 cun #30 needle into GV-26 obliquely, 0.3 to 0.5 cun deep in an upwards direction at a 45 degree angle with a fast twisting needle technique and 1 cun #30 needles into PC-5 perpendicularly, 0.8 cun deep with a lifting and thrusting reducing needle technique. Apply the moxa-pole on GV-20 for 30 minutes. For epilepsy: GV-12, GB-13, and CV-15. (Bai Zhen Fu) Insert a 1.5 cun #30 needle into GV-12 perpendicularly, 1 cun deep with a lifting and thrust reducing needle technique, and retain the needle for 5 minutes. Insert a1.5 cun #30 needles into CV-15 perpendicularly, 1 cun deep with a twisting reducing needle technique and 1 cun #32 needles into GB-13 obliquely, 0.5 cun deep at a 30 degree angle towards the back with a fast twisting needle technique. Retain all needles for 20 minutes. Treat once every other day for 7 treatments as a course. For epilepsy: GV-16, GB-20, HT-5, PC-6, SP-6, and LV-3. (Author’s Clinical Experience) Insert 1.5 cun #32 needles into GV-16 and GB-20 perpendicularly, 1 cun deep with a lifting and thrusting reducing needle technique. Retain all needles for 10 minutes. Insert 1 cun #32 needles into HT-5, PC-6, and SP-6 with a twisting reinforcing needle and 1 cun #30 needles into LV-3 with a twisting reducing needle technique. Treat twice a week for 10 treatments as a course. For epilepsy: Yao Qi, GV-14, and SI-3. (Author’s Clinical Experience) Insert a 3 cun #30 needle into Yao Qi transversely, in an upward direction, 2 cun deep with a twisting reducing needle technique. Insert a 1.5 cun #30 needles into GV-14 perpendicularly, 1 to 1.2 cun deep with a lifting and thrusting reducing needle technique and 1 cun #32 needles into SI-3 with a twisting even movement needle technique. Retain all needles for 20 minutes. Treat twice a week for 7 treatments as a course.

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Epilepsy

For epilepsy: Si Shen Cong, GV-20, Yin Tang, BL-11, GV-12, BL-42, LV-3, and GV-2. (Author’s Clinical Experience) Insert 1.5 cun #30 needles into BL-11 and GV-12 perpendicularly, 1 cun deep with a twisting reducing needle technique. Insert 1 cun #30 needles into BL-42 obliquely, 0.5 cun deep at a 45 degree angle towards BL-43 with a twisting reinforcing needle technique and a 1.5 cun #30 needle into GV-2 obliquely, 1 cun deep at a 45 degree angle towards GV-1 with a twisting reducing needle technique. Retain all needles for 10 minutes. Insert 1 cun #30 needles into Si Shen Cong, Yin Tang, LV-3, and GV-20 with a twisting even movement needle technique. Retain all needles for 30 minutes. Treat twice a week for 10 treatments as a course. For epilepsy: GV-1 and PC-5. (Zhong Guo Zhen Jiu Pei Xue) Insert a 1.5 cun #32 needle into GV-1 perpendicularly, towards the head, 1.2 cun deep with a fast twisting needle technique until the sensation of the needle travels up towards the head. Insert 1.5 cun #32 needles into PC-5 perpendicularly, 1 cun deep with a twisting reinforcing needle technique. Retain the needles for 30 minutes. Treat once a week for 2 treatments as a course. For epilepsy: GV-8, GV-10, BL-18, BL-23, CV-17, and PC-6. (Zhong Guo Zhen Jiu) Inset 1.5 cun #30 needles into GV-8, GV-10, BL-18 and BL-23 perpendicularly, 1 cun deep with a twisting reinforcing needle technique. Retain all needles for 10 minutes. Insert a 1.5 cun #32 needle into CV-17 obliquely, towards CV-16, 1.2 cun deep at a 60 degree angle with a twisting reducing needle technique and 1 cun #32 needles into PC-6 with a twisting even movement needle technique. Retain all needles for 20 minutes. Treat once every other day for 10 treatments as a course. CASE ANALYSIS A 55 year-old male patient has a main complaint of epilepsy for 8 years. Every time before the epilepsy occurs, he feels a hot and burning sensation in his chest and abdominal region that is associated with a soreness and an achy sensation in his whole body after waking up. When the epilepsy is not active, he feels restless, has poor sleep, a tendency towards anger, a dry mouth, and constipation. His tongue was red with a yellow greasy coating and his pulse was strong and slippery. Diagnosis: Epilepsy due to accumulation of Phlegm and Fire. Treatment Principle: Clear the Fire and Resolve Phlegm. Point Prescription: HT-7, ST-44, GV-14, GV-12, ST-40, SI-3, and CV-15. Treatment was administered twice a week for 10 treatments as a course. Technique: Insert 1.5 cun #30 needles into GV-14 and GV-12 perpendicularly, 1.2 cun deep with a lifting and thrusting reducing needle technique. Retain all needles for 10 minutes. Insert 1 cun #32 needles into HT-7, ST-44, and SI-3 with a twisting reducing needle technique, 1.5 cun #30 needles into ST-40 and CV-15 with lifting and thrusting reducing needle technique. Retain all needles for 20 minutes. Result: Once during a treatment session, he had epileptic attack with very mild symptoms. The epilepsy was remedied following 1 year of visits and 3 course treatments.

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EVALUATION In the past few thousand years, acupuncture and moxibustion have played an important role in the treatment of epilepsy with good results in most of the cases. However, because of the occasional severe and life threatening nature of epileptic attacks, acupuncture is not always used during an emergency. In modern society, it only has been used as a supplemental therapy to treat epilepsy during the medication therapy. Acupuncture and moxibustion is very effective in reducing the symptoms during times of illness. Particularly for cases involving children, acupuncture and moxibustion can be the main alternative therapy instead of medication to control the epilepsy. Further detailed research is necessary to prove the results of acupuncture for emergency treatment of attacks. However, based on clinical experience and history of research in TCM, acupuncture does prove to be of significant use.

188

Headache

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Acupuncture and Moxibustion—A Clinical Desk Reference

HEADACHE Headaches are problematic symptoms that can affect almost everyone at some point in his or her life. For thousands of years patients suffering from this disorder complain of it as a contribution to other bodily dysfunctions. In TCM the head is the confluence of all the Yang channels and the brain is known as the Sea of Marrow, both being closely related to Kidney Essence. Thus the Kidney Essence is a crucial element in treating headaches. Because of the various different natures of headaches, the symptoms may be caused by either External pathogens or internal injury. The following is a short list of common causes that results in headaches. Wind Damp Invasion Wind Damp invades the meridians of the head and stagnates the Qi and Blood flow, causing headache. Most of the time when the Exterior symptoms are relieved, the headache will be gone. But when patients with deficient body constitutions contract headache due to External Invasion, it often causes stagnation inside of the head when the weather changes. Liver Yang (Fire) Rising Either due to Fire rising up caused by stagnation of the Liver Qi after long term negative emotional stimulation or due to excessive Yang rising up by deficiency of Kidney Yin, the result of Kidney “Water” unable to nourish Liver “Wood.” Sometimes Interior Wind rising up can also cause headache. Phlegm Stagnation Interior pathogenic Phlegm stagnates in the meridian, failing to send clear Yang Qi to the head, causing headache. In most cases, pathogenic Phlegm is formed by improper food intake, accumulation of Dampness or by deficiency of the Spleen, which fails in transportation and transformation. Blood Deficiency Lack of blood supply to the head, usually due to deficiency of Qi or after loss of a large amount of blood, such as after being wounded or labor. Blood Stagnation Stagnation of Blood in the channels and collaterals of the head impact circulation of both Qi and Blood and cause a fixed pain. Most time this type of headache occurs after a long-term disease or injury.

DIAGNOSIS Meridian Diagnosis Yang Ming Involvement: pain in forehead and/or supra-orbital bone. Shao yang Involvement: pain in the temple or migraine. Jue yin Involvement: pain in the vertex. Tai yang Involvement: pain in the back of the head.

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Headache

External Pathogenic Invasion This is characteristic of an acute headache involving the nape of the neck and back of the head, which is intensified by exposure to Wind, suggesting External disease due to invasion of pathogenic Wind and Cold. A distending headache accompanied by a flushed complexion and conjunctiva congestion is due to External attack of pathogenic Wind-Heat. A heavy sensation in the head like being tightly bound by a towel, accompanied by chilliness and fever, is caused by External attack of pathogenic Wind and Dampness. Headache due to Internal Injury Liver Yang Rising Throbbing sharp pain on the side of the head with dizziness and vertigo, hot flushes, restlessness, easy to anger, red eyes and bitter taste in the mouth, red tongue with yellow coating, and wiry pulse. Stagnation of Damp-Phlegm Tight bounded pain with a heavy sensation in the head, stuffy chest and epigastria, nausea and vomiting with phlegm, loose stool, swollen tongue with a white greasy coating, and slippery pulse. Deficiency of Blood Constant light chronic pain with dizziness reduced by rest and aggravated by fatigue, lassitude, heart palpitations, pale complexion, a pale tongue, and a thin and weak pulse. Stagnation of Blood A fixed sharp pain in the head with blurry vision and poor memory characterizes this pattern. The tongue is purple and dark with a thin white coating. The pulse is thin or choppy. TREATMENT AND PRESCRIPTION External Pathogenic Invasion Treatment Principle: Expel the Pathogenic Influences and Relieve the pain. Point Prescription: GB-20, ST-8, BL-7, LI-4, and TW-8. Treat once every other day for 3 treatments as a course. Technique: Insert 1.5 cun #32 needles into GB-20 perpendicularly, 1.2 cun deep with a twisting reducing needle technique and 1 cun #30 needles into ST-8, BL-7, LI-4, and TW-8 with twisting reducing needle technique. Retain all needles for 30 minutes. Additional points for associated symptoms: Yang Ming headache: GV-23, Yin Tang, and GB-14. Jue Yin headache: GV-20, GV-21, and Si Shen Cong. Tai Yang headache: BL-10 and GV-19. Shao Yang headache: GB-8 and Tai Yang.

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Liver Yang Rising Treatment Principle: Calm the Liver, Subdue Liver Yang, and Relieve the pain. Point Prescription: GB-4, GB-5, LV-3, and KI-3. Treat once every other day for 5 treatments as a course. Technique: Insert 1 cun #30 needles into LV-3 with lifting the thrusting reducing needle technique, and 1 cun #32 needles into KI-3 with twisting reinforcing needle technique. Insert 1.5 cun #32 needles into GB-4 and GB-5 transversely, at a 30-degree angle, backward 1 cun deep with lifting Qi technique. Retain the needles for 30 minutes. Additional points for associated symptoms: Reddish eyes: TW-1 with bloodletting. Hot flashes: ST-44. Damp-Phlegm Treatment Principle: Resolve the Phlegm and Reduce the pain. Point Prescription: CV-12, ST-40, GV-20, and Yin Tang. Treat once every other day for 3 treatments as a course. Technique: Insert 1.5 cun #30 needles into ST-40 and CV-12 with twisting reducing needle technique, and 1 cun #32 needles into GV-20 and Yin Tang, with twisting even movement needle technique. Retain all needles for 30 minutes. Additional points for associated symptoms: Vomiting: PC-6. Loose stool: ST-25. Blood Deficiency Treatment Principle: Reinforce the Qi and Blood and Reduce the pain. Point Prescription: GV-23, SP-10, ST-36, SP-6, and CV-6. Treat once every other day for 7 treatments as a course. Technique: Insert 1.5 cun #32 needles into SP-10, ST-36, SP-6, and CV-6 with twisting reinforcing needle technique, and apply moxa wool on the handle of needles 3 cones. Insert 1 cun #30 needle into GV-23 with fast twisting needle technique. Retain all needles for 30 minutes. Additional points for associated symptoms: After headache released: BL-18, BL-20, BL-23, and CV-4 with moxibustion. Blood Stagnation Treatment Principle: Move the Qi, Resolve the stagnation of Blood, and Reduce the pain. Point Prescription: Ah Shi, LI-4, and SP-6. Treat once every other day for 7 treatments as a course. Technique: Insert 1.5 cun #30 needles into Ah Shi points obliquely, at a 30 to 45-degree angle, with fast twisting needle technique until a heat sensation is produced on the local area. Insert 1 cun #32 needles into LI-4 and SP-6 with lifting and thrusting reducing needle technique. Retain all needles for 40 minutes.

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Headache

Additional points for associated symptoms: Yang Ming headache: BL-2. Shao Yang headache: Tai Yang. Tai Yang headache: TW-18. Jue Yin headache: Si Shen Cong. ADJUNCTIVE THERAPIES Ear Acupuncture Points: Occiput, Forehead, Sub cortex, and Shen Men Insert 0.5 cun #32 ear needles into these points (one side only) with fast twisting technique. Retain the needles for 30 minutes to treat chronic headache. Or apply press-ball on these points and retain them for 5 days. Treat once every other day for 7 treatments as a course. Scalp Acupuncture Treatment zones: Jue Yin headache Middle line of vertex and forehead and lateral line 1 of the vertex. Tai Yang headache occiput.

Middle line of forehead, upper middle line of the occiput, and upper lateral line of the

Shao Yang headache Anterior oblique line of the temple, posterior oblique line of the temple, anterior oblique line from the vertex to the temple, and posterior oblique line from the vertex to the temple. Yang Ming headache Middle line, lateral line 1, lateral line 2 of the forehead, and upper middle line of the occiput. Insert 1.5 cun #30 needles into the treatment lines selected with fast twisting or withdrawing Qi technique. Retain all needles for 30 to 40 minutes, repeating stimulation every 5 minutes during retainment. Treat once every other day for 5 treatments as a course. Plum Blossom Points: Ah Shi, Tai Yang, and Yin Tang. Apply a medium stimulation of plum blossom needle technique on these points for 4 minutes, to treat headache due to Liver Yang Rising and Wind-Heat. Treat once daily for 3 treatments as a course.

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Wrist and Ankle Acupuncture Treatment area: Upper 2, Upper 6, Lower 3, and Lower 5. Insert 1.5 cun #32 needles into this area transversely, 1.2 cun deep at a 15 degree angle without any needle technique and any sensation of the needle. Retain all needles for 30 minutes Treat once every other day for 5 treatments as a course. Bloodletting Treatment area: Jing-well points, back of the ear, Tai Yang, GB-4, BL-40, and PC-3. Select 3 points in each treatment according to the diagnosis and apply bloodletting technique on these points to squeeze 1 or 2 drops of blood, to treat headache due to stagnation of Blood and Heat. Treat once daily for 3 treatments as a course. Gua Sha Treatment area: Bladder meridian on the upper back, Stomach meridian on the neck, LU-5 to LU-8, and BL-40 Apply Gua Sha on these areas with medium stimulation until purple dots—Sha appears, in the treatment of headache due to Wind-Heat. Treat once daily 2 treatments as a course. Moxibustion Points: LV-13, CV-4, BL-17, BL-18, LV-1, LV-8, GV-20, BL-7, and Ah Shi. Indirect moxibustion with ginger Apply direct moxibustion with ginger on LV-13 and CV-4 for 5 cones, and BL-17 and BL-18 for 3 cones. Treat once every other day for 3 treatments as a course. Direct non-scarring moxibustion Apply direct non-scarring moxibustion on LV-1 and LV-8 for 5 cones. Treat once every other day for 3 treatments as a course. Moxa-pole Apply moxa-pole on GV-20, BL-7, and Ah Shi points for 30 minutes. Treat once daily for 3 treatments as a course. Intradermal Needles Points: LI-4, TW-5, SI-13, BL-10, and BL-60. Insert intradermal needles into these points and retain all needles for 2 to 3 days, to treat chronic headaches. Treat once in three days for 2 treatments as a course.

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Headache

TRADITIONAL PRESCRIPTIONS AND TECHNIQUE For vertex headache due to Wind Invasion: GV-20, GV-19, and LI-4. (Zhen Jiu Da Cheng) Insert a 1.5 cun #30 needle into GV-20 or GV-19. (Use one point in each treatment, obliquely at a 30degree angle, towards the back, 1.2 cun deep with lifting and thrusting reducing needle technique.) Insert 1 cun #30 needles into LI-4 with twisting reducing needle technique. Retain all needles for 30 minutes. The treatment is once every other day, 3 treatments as a course. For headache due to Wind Invasion: GV-23, GV-21, GV-20, SI-5, TW-1, BL-60, and GB-43. (Shen Yin Jing) Insert 1 cun #30 needles into BL-60, GB-43, and SI-5 perpendicularly, 0.5 cun deep with twisting reducing needle technique, and 1 cun #32 needles into TW-1 with twisting reducing needle technique. Insert 1 cun #30 needles into GV-23, GV-21, and GV-20 obliquely, backwards at a 45 degree angle, 0.5 to 0.8 cun deep with lifting Qi technique. Retain all needles for 30 minutes. Treat once every other day for 5 treatments as a course. For temporal headache due to deficiency: GB-19, GB-20, LU-7, LU-9, LI-4, and ST-41. (Shen Jiu Jin Lun) Apply direct non-scarring moxibustion on LU-7, LU-9, LI-4, and ST-41 for 5 cones and moxa-pole on GB19 and GB-20 for 30 minutes. Treat one or twice a week for 5 treatments as a course. For temporal headache due to Wind Invasion: SI-3, GB-15, TW-23, Tai Yang, LU-7, and LI-4. (Zhen Jiu Da Chuan) Insert 1 cun #32 needles into GB-15 and LU-7 transversely, 0.5 cun deep with twisting reducing needle technique, and 1 cun #30 needles into SI-3, LI-4, TW-23, and Tai Yang perpendicularly, 0.5 cun deep with twisting even movement needle technique. Retain all needles for 30 minutes. Treat once every other day for 5 treatments as a course. For headache with a painful sensation in the eyes and teeth with Interior Deficiency Wind: GB-19 and GB-17 (Pian Que Xin Shu) Apply direct non-scarring moxibustion on GB-19, for 21 cones (pain side only). Apply direct non-scarring moxibustion on GB-17 for another 21 cones, (healthy side only). Treat twice a week for 5 treatments as a course. For headache with dizziness and vertigo: SI-17, BL-10, BL-60, CV-4, and TW-1. (Pu Ji Fang) Insert 1 cun #30 needles into SI-17, BL-10, and BL-60 with twisting reducing needle technique, and 1 cun #32 needles into TW-1 with twisting even movement needle technique. Insert a 1.5 cun #32 needle into CV-4 with twisting reinforcing needle technique. Retain all needles for 30 minutes. Treat once a week for 5 treatments as a course. For headache due to stagnation of Blood: Ah Shi, ST-36, LU-7, CV-4, and GV-15. (Yi Xue Gang Yao) Insert 1 cun #30 needles into Ah Shi points with twisting reducing needle technique until a heat sensation appears under the needles. Insert 1 cun #32 needles into ST-36, LU-7, and GV-15 with twisting reducing needle technique, and a 1.5 cun #32 needle into CV-4 with twisting reinforcing needle technique and apply moxa wool on the handle of needles for 3 cones. Treat once every other day for 7 treatments as a course. For frontal headache: GV-21 and ST-41. (Zhen Jiu Fen Yuan) Insert 1 cun #30 needle into GV-21 obliquely, towards the front (nose direction) obliquely at a 30 degree angle, 0.5 cun deep with twisting reducing needle technique, and 1 cun #32 needles into ST-41 with lifting and thrusting reducing needle technique. Retain all needles for 20 minutes. Treat once a week for 5 treatments as a course. 195

Acupuncture and Moxibustion—A Clinical Desk Reference

The following prescriptions are from the Cai Ai Bian Yi. For headache with Tai Yang meridian syndrome and tight pulse: BL-8, BL-9, BL-10, and BL-64. Insert 1 cun #30 needles into BL-8 BL-9 BL-10 BL-64 with twisting reducing needle technique. Retain all needles for 20 minutes; apply moxa pole on side of BL-10 for 15 minutes. Treat once every other day for 3 treatments as a course. For headache with Shao Yang meridian syndrome, fever, and aversion to cold: GB-4 and GB-34. Insert 1.5 cun #30 needles into GB-34 perpendicularly, 1 cun deep with lifting and thrusting reducing needle technique, and 1 cun #30 needles into GB-4 with twisting reducing needle technique. Retain all needles for 15 minutes. Treat once every other day for 3 treatments as a course. For headache with Yang Ming syndrome, spontaneous sweating, aversion to cold, and a floating slow pulse: ST-5, ST-40, and ST-41 Insert 1 cun #32 needles into ST-5 and ST-41 with twisting even movement needle technique, and 1.5 cun #30 needles into ST-40 with lifting and thrusting reducing needle technique. Retain all needles for 20 minutes. Treat once every other day for 3 treatments as a course. For headache with Shao Yin syndrome and Interior Cold: KI-20. Insert 1 cun #30 needles for KI-20 with twisting reinforcing needle technique and apply moxa wool on the handle of needles for 3 cones. Or only apply direct non-scarring moxibustion on KI-20 for 10 cones. Treat once every other day for 5 treatments as a course. For vertex headache with Jue Yin syndrome and Interior Cold: LV-8. Insert 1.5 cun #32 needles into LV-8 with lifting and thrusting reinforcing needle technique, and apply moxa wool on the handle of needles for 5 cones. Treat once every other day for 5 treatments as a course. For headache with a floating pulse: SI-4 and BL-64. (Zhen Jiu Ju Ying) Insert 1 cun #30 needles into SI-4 with twisting reducing needle technique, 1 cun #32 needles into BL-64 with twisting reinforcing needle technique. Retain all needles for 20 minutes. Treat once every other day for 3 treatments as a course. For headache with a long pulse: LI-4 and ST-42. (Zhen Jiu Ju Ying) Insert 1 cun #30 needles into LI-4 with lifting and thrusting reducing needle technique, and 1 cun #32 needles into ST-42 with twisting reinforcing needle technique. Retain all needles for 20 minutes. Treat once every other day for 3 treatments as a course. For headache with a wiry pulse: TW-4, GB-20, and CV-16. (Zhen Jiu Ju Ying) Insert 1.5 cun #32 needles into GV-16 and GB-20 perpendicularly, 1 cun deep with twisting reducing needle technique, and apply moxa wool on the handle of the needles for 3 cones. Insert 1 cun #32 needles into TW-4 with twisting reducing needle technique. Retain all needles for 20 minutes. Treat once every other day, 3 treatments as a course.

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Headache

For headache with fever and aversion to cold: GV-26, GV-25, GV-7, SI-8, BL-56, GB-34, LI-6, GB-12, and GV-4 (Zhen Jiu Yi Xue) Insert 1 cun #30 needles into GV-26, GV-25, GV-7, and SI-8 with twisting reducing needle technique, and 1.5 cun #32 needles into BL-56, GB-34, LI-6, GB-12, and GV-4 with twisting reinforcing needle technique. Retain all needles for 30 minutes. Treat once every other day, 5 treatments as a course. For headache due to Wind Cold: BL-19, BL-11, LI-4, and BL-2. (Zhen Jiu Yi Xue) Insert 1 cun #30 needles into BL-19 and BL-11 perpendicularly, 0.5 to 0.8 cun deep with waving needle technique. Retain all needles for 5 minutes. Insert 1 cun #32 needles into LI-4 and BL-2 with twisting reducing needle technique. Retain all needles for 10 minutes Treat once every other day for 3 treatments as a course. For headache with fever: TW-20, GV-4, ST-43, and TW-5. (Yi Xue Ru Men) Insert 1 cun #32 needles into TW-20 GV-4 with twisting reinforcing needle technique, 1.5 cun #32 needles into TW-5 with twisting even movement technique. Apply bloodletting technique on ST-43. Treat twice a week for 5 treatments as a course. For headache due to Phlegm stagnation: TW-4 and ST-40. (Zhen Jiu Quan Shu) Insert 1 cun #32 needles into TW-4 with twisting reinforcing needle technique, and 1.5 cun #30 needles into ST-40 with lifting and thrusting reducing needle technique. Retain the needles for 20 minutes. Treat once every other day for 5 treatments as a course. For headache with Kidney Deficiency: CV-4, GV-20, GV-22, CV-6, BL-23, SI-3, LU-9, and KI-3 (Zhen Jiu Quan Shu) Apply direct non-scarring moxibustion on CV-4, GV-20, GV-22, and CV-6 for 9 cones. Insert 1 cun #32 needles into BL-23, SI-3, LU-9, and KI-3 with twisting reinforcing needle technique. Retain all needles for 30 minutes. Treat once a week for 5 treatments as a course. For headache due to Kidney Deficiency: TW-5, BL-23, GV-20, KI-3, and LU-7. (Zhen Jiu Da Chuan) Insert 1.5 cun #32 needles into BL-23 with lifting and thrusting reinforcing needle technique, and apply moxa wool on the handles of the needles for 3 cones. Insert 1 cun #32 needles into TW-5, GV-20, KI-3, and LU-7 with twisting even movement technique. Retain all needles for 30 minutes. Treat once every other day for 7 treatments as a course. For vertex headache: TW-5, GV-23, GV-20, GB-19, KI-1, and LI-4. (Zhen Jiu Da Quan) Insert 1 cun #32 needles into KI-1, LI-4, and TW-5 with twisting reducing needle technique, and 1 cun #30 needles into GV-23, GV-20, and GB-19 with lifting and thrusting reinforcing needle technique. Retain all needles for 30 minutes. Treat twice a week for 5 treatments as a course. For occipital headache with neck pain: SI-3, CV-24, GV-16, GB-20, and LI-4. (Zhen Jiu Da Cheng) Insert 1 cun #30 needles into CV-24 and GV-16 with twisting reducing needle technique, and 1 cun #32 needles into SI-3, GB-20, and LI-4 with lifting and thrusting even movement technique. Retain all needles for 30 minutes. Treat twice a week for 7 treatments as a course.

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For headache due to stagnation of Blood: GV-20, Si Shen Cong, ST-44, BL-9, and Tai Yang. (Zhen Jiu Fen Yuan) Insert 1 cun #30 needles into ST-44, BL-9, and Tai Yang with twisting reducing needle technique. Retain the needles for 20 minutes. Apply direct non-scarring moxibustion on GV-20 for 7 cones. Apply bloodletting technique on Si Shen Cong. Treat once a week for 5 treatments as a course. CASE ANALYSIS A 28-year-old female patient with the main symptom of left sided headache for 2 years has sharp pain that radiates to the left eye with tearing, and sensitivity to light. Associated signs are nausea and vomiting, particularly every morning and afternoon near sunset. The tongue was red with a thin white greasy coating and the pulse was deep and wiry. Diagnosis: Qi and Blood Stagnation in the Shao Yang meridian. Treatment Principle: Dredge the meridian and Resolve the stagnation. Point Prescription: Tai Yang(L), GB-20(L), ST-7(L), LI-4, GB-43, and KI-3. Treatment was performed once daily for 5 treatments as a course. Technique: Insert a 1.5 cun #32 needle into Tai Yang obliquely, towards the ST-7 direction, 1.2 cun deep with twisting reducing needle technique, and 1 cun #30 needles into ST-7, GB-20, and LI-4 with lifting and thrusting reducing needle technique. Insert 1 cun #32 needles into GB-43 and KI-3 with twisting reinforcing needle technique. Result: After 5 days of treatment, most of pain was resolved. But still there was a feeling of some pain near the left side of the eyebrow, along with poor sleep at night, and aggravation by Wind and Cold. Second point prescription and technique: Added LU-7, GB-37, and BL-10 with twisting reducing needle technique and a fire cups were applied on BL-10 for 3 minutes after removing the needles. Treatment was twice a week for 5 treatments as a course. Result: The headache disappeared after one course of treatments. When the patient came back 3 years later due to tennis elbow related pain, she stated she was without headache for 3 years.

EVALUATION For thousands of years, acupuncturists have accumulated a lot of effective techniques to resolve the symptoms of headaches. Because headaches can be due to various reasons, there are many different types of treatment and a proper diagnosis is important in determining if the headache is just temporary discomfort or due to a long termed illness/injury to the cranium. For treatment to be effective, it must be based off a correct diagnosis, which is based on fundamental TCM theory, and which will lead the acupuncturist to select effective needle techniques. In treating headache, one should pay attention not to use strong stimulation or Electro-acupuncture on the head when the patient has hypertension. And in some cases, further examination should be strongly recommended to understand if it is due to some severe disease, such as brain injury, stoke, or tumor.

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Heart Palpitations

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HEART PALPITATIONS Heart palpitations in Chinese Medicine are called Xin Ji and Zheng Zhong, referring to an irregular heartbeat and shortness of breath accompanied by feelings of anxiety. The causes for this disorder can be from a variety of separate, or combinations of physical and/or emotional problems. In Western Medicine, heart palpitations will appear in many cardiological problems such as coronary heart disease, rheumatic heart disease, and angina. In many emotional disorders, heart palpitations will also be a common symptom. Of the major causes, the following are some of the most common in terms of TCM. Heart Blood Deficiency This is the main cause of most heart palpitations. Because the Heart and the Blood both house the Shen— Spirit, heart palpitations result from the Blood failing to nourish the Shen. Most of the time, over-thinking or high stress can induce such a situation. Heart Qi Deficiency In the clinic, this usually occurs along with Gallbladder Qi Deficiency and could be caused by reasons such as those related to Qi Deficiency, excessive fear, fright, anger, or other severe emotional stimulation that can damage the Heart Qi. Accumulating water can turn to Phlegm with Fire attacking the Heart, causing this pattern as well. Heart Yang Deficiency This is usually caused by long-term or chronic diseases, or in some cases severe diseases that make the whole body Yang Qi deficient, leading to Heart Yang Deficiency failing to warm the Heart meridian and organ, causing heart palpitations. Water retention in the Heart This syndrome is usually due to Spleen and Kidney Yang Deficiency that fails in promoting water metabolism. Water gets retained in the Heart and disturbs the Heart Yang, causing heart palpitations. Blood stagnation in the Heart Most of the time this is caused by either Heart Yang Deficiency or an External Invasion infecting the Heart organ directly, yielding stagnation of the Heart Blood and Qi, leading to palpitations. DIAGNOSIS Heart palpitations due to Qi Deficiency Heart palpitations, shortness of breath, being easily startled, sweaty palms, a tired Shen, insomnia, a pale tongue with a thin white coating and a thin, weak and fast pulse are the signs and symptoms in this pattern. Heart palpitations due to Blood (Yin) Deficiency Heart palpitations that are aggravated by tiredness and over-thinking, a pale complexion, dizziness, blurry vision, shortness of breath, a pale tongue with a white thin coating, and a thin and fast pulse are the signs and symptoms of this pattern. If the patient presents with a low-grade fever, there may be insomnia with frequent dreams, a dry mouth, and ringing ears as well. The face will be flushed instead of pale in this case. The tongue will be red and the 200

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pulse will be thin and fast. These are signs that the patient’s condition is transforming from Blood Deficiency to Yin Deficiency. Heart palpitations due to Phlegm Heart palpitations, restlessness, a stuffy chest, dizziness, insomnia with frequent dreams and easy awakening, a bitter taste in the mouth, a cough with thick, yellow, sticky phlegm, yellowish urine, uneven bowel movements, a red tongue with a yellow, greasy coating, and a slippery and fast pulse are the signs and symptoms of this pattern. Heart palpitations due to Blood Stagnation Heart palpitations, shortness of breath (with difficulty on expiration), chest pain, a sallow complexion, a purple tongue, and purple nails and lips are the signs and symptoms. In some severe cases, the body will be cold with cold sweating and edema. The pulse is deep and fine and the tongue coating will be wet. TREATMENT AND PRESCRIPTONS Heart palpitation due to Qi Deficiency Treatment Principle: Reinforce the Qi and Calm the Heart. Point Prescription: BL-15, CV-14, PC-5, and HT-7. Treat once every other day for 7 treatments as a course. Technique: Insert 1 cun #32 needles into BL-15 with a twisting even movement needle technique, and apply moxa wool to the handles of the needles for 3 to 5 cones. Insert a 1.5 cun #32 needle into GV-14 perpendicularly, 1 cun deep with a twisting reinforcing needle technique, and apply moxa wool to the handle of the needle for 3 cones. Insert 1 cun #34 needles into PC-5 and HT-7 perpendicularly, 0.5 cun deep with a twisting reinforcing needle technique. Retain all needles for 30 minutes. Additional points for associated symptoms: Easily frightened: PC-7 and LI-11. Spontaneous sweating: BL-43 and CV-6. Heart palpitations from Blood (Yin) Deficiency Treatment Principle: Nourish the Blood and Calm the Heart. Point Prescription: BL-17, BL-20, HT-5, BL-44, and ST-36. Treat once every other day for 7 treatments as a course. Technique: Insert 1 cun #32 needles into BL-17 and BL-20 perpendicularly, 0.5 cun deep with a twisting reinforcing needle technique. Insert 1 cun #30 needles into BL-44 with the Qi Ci technique (One of the ancient needle techniques with one needle in the middle and one on each side), waving the needles for a while until a red color appears. Retain all the needles for 10 minutes. Insert 1.5 cun #32 needles into ST-36 perpendicularly, 1 cun deep with a lifting and thrusting reinforcing needle technique and 1 cun #34 needles into HT-5 obliquely, towards HT-7, 0.5 cun deep at a 60 degree angle with a twisting reinforcing needle technique. Retain all needles for 30 minutes. Additional points for associated symptoms: Hot flashes: KI-3 and KI-10. Ringing ear: TW-3 and KI-6. Five hearts heat: PC-8 and KI-2. 201

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Heart palpitations from Phlegm-Fire Treatment Principle: Clear the Fire, Resolve the Phlegm and Calm the Heart. Point Prescription: HT-4, PC-4, BL-13, LU-5, and ST-40. Treat once every other day for 10 treatments as a course. Technique: Insert 1.5 cun #32 needles into LU-5 perpendicularly, 1 cun deep with a lifting and thrusting reducing needle technique and 1 cun #32 needles into HT-4 and PC-4 with a twisting even movement needle technique. Insert 1.5 cun #30 needles into ST-40 perpendicularly, 1 cun deep with a twisting reducing needle technique. Retain all needles for 20 minutes. Insert 1.5 cun #32 needles into BL-13 obliquely towards the spine at a 60-degree angle, with a lifting and thrusting reducing needle technique. Retain needles for 10 minutes. Additional points for associated symptoms: Insomnia: ST-45. Constipation: BL-25. Heart palpitations from Blood Stagnation Treatment Principle: Resolve the Blood Stagnation and Calm the Heart. Point Prescription: PC-3, HT-3, CV-6, and SP-10. Treat once every other day for 7 treatments as a course. Technique: Insert 1.5 cun #32 needles into PC-3 and HT-3 perpendicularly, 1 cun deep with a twisting reducing needle technique and 1.5 cun #30 needles into SP-10 perpendicularly, 1 cun deep with a twisting reducing needle technique. Insert a 2 cun #32 needle into CV-6 perpendicularly, 1.5 cun deep with a twisting even movement needle technique, and apply moxa wool to the handle of needle for 5 cones. Additional points for associated symptoms: Weak pulse: PC-6 and LU-9. Edema: CV-9 with indirect moxibustion with ginger for 5 cones. ADJUNCTIVE THERAPIES Nose Acupuncture Points: Heart, Lung, and Shan Gen. Insert 0.5 cun #34 needles into these points perpendicularly, 0.3 cun deep with a fast twisting needle technique until a heat sensation is produced under the needles, or the symptoms are gone. Treat once daily for 2 treatments as a course. Ear Acupuncture Point Prescription: Shen Men, Sympathetic, Sub cortex, Heart, Stomach, and Brain point. Insert 0.5 cun #34 needles into these points obliquely, 0.3 cun deep at a30 degree angle, with a fast twisting needle technique. Retain all needles for 40 minutes. Treat once every other day for 7 treatments as a course.

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Scalp Acupuncture Treatment zones: Lateral line 1 and Lateral line 2 of the forehead, and the Middle line of the vertex. Insert 1 cun #32 needles into the Lateral line 1 and Lateral line 2, transversely towards the eyes, 0.8 cun deep at a 30 degree angle with a fast twisting needle technique. Insert 1.5 cun #32 needle into the Middle line of the vertex transversely towards the back 1 cun deep with a fast twisting needle technique. Retain all needles for 30 minutes. Treat once every other day for 3 treatments as a course. Foot Acupuncture Points: Heart, Inner Nei Ting, and Kidney. Insert 0.5 cun #32 needles into these points perpendicularly, 0.3 cun deep with a twisting reinforcing needle technique, and apply moxa wool to the handles of the needles for 3 cones. Treat once daily for 3 treatments as a course. Cupping Treatment area: Chest, Back, and Arms. Palpate the chest along the Stomach and CV meridians to find the Ah Shi points (usually near CV-18 and ST-15). Apply fire cups on these Ah Shi points for 3 minutes. Apply fire cups around HT-3 for 3 minutes. Apply moving fire cups on the upper back from BL-11 to BL-17 and retain cups on BL-14 for 5 minutes. Treat once every other day for 2 treatments as a course. Wrist and Ankle Acupuncture Treatment area: Upper 2, Upper 3, Lower 5, and Lower 2. Insert 1.5 cun #32 needles into these lines transversely, 1.2 cun deep at a 15 degree angle, and adjust the needles to get rid of any needle sensations. Retain all needles for 40 minutes. Treat once every other day for 5 treatments as a course. Moxibustion Direct moxibustion Apply direct non-scarring moxibustion on PC-6, CV-15, BL-15, and BL-14 for 7 cones. Indirect moxibustion Apply indirect moxibustion with ginger on CV-4 and CV-6 for 5 cones. Moxa pole Apply moxa pole on BL-15 and CV-12 for 20 minutes.

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TRADITIONAL PRESCRIPTIONS AND TECHNIQUE For heart palpitations accompanied with fear: PC-3, TW-8, HT-4, HT-7, LU-10, GV-20, ST-45, CV-14, and LV-13 (Shen Yin Jing) Insert 1.5 cun #32 needles into PC-3 and TW-8 perpendicularly, 1 cun deep with a twisting even movement needle technique and 1 cun #34 needles into HT-4, LU-10, and HT-7 with a twisting reinforcing needle technique. Insert 1 cun #32 needles into GV-20, CV-14, and LV-13 with a twisting even movement needle technique. Retain all needles for 30 minutes. Apply direct non-scarring moxibustion on ST-45 for 5 cones. Treat twice a week for 5 treatments as a course. For heart palpitations due to deficiency of Heart Blood: PC-6, GV-20, and HT-7. (Zhen Jiu Da Cheng) There are two methods: #1. Insert 1.5 cun #32 needles into PC-6 perpendicularly, with the sending the Qi technique (Green Dragon Waves its Tail). Then insert 1 cun #34 needles into HT-7 perpendicularly, 0.3 cun deep with twisting even movement needle technique, and finally insert a 1 cun #32 needle into GV-20 with fast twisting needle technique until the heaviness sensation appears near the needle. #2.Insert 1.5 cun #32 needles into PC-6 and HT-7 perpendicularly, 1 cun deep with a twisting reinforcing needle technique and a 1.5 cun #30 needle into GV-20 transversely, 1 cun deep at a 30 degree angle with a fast twisting needle technique. Retain all needles for 30 minutes. Treat once twice a week, for 5 treatments as a course. For heart palpitations with fright: HT-6 and BL-15. (Zhen Jiu Da Quan) Insert 1 cun #32 needles into HT-6 perpendicularly, 0.5 to 0.8 cun deep with a twisting reducing needle technique. Insert 1.5 cun #30 needles into BL-15 obliquely, towards the spinal column, 1 cun deep with a lifting and thrusting reducing needle technique, and apply moxa pole on the side of needle for 10 minutes. Treat once every other day for 3 treatments as a course. For heart palpitations due to insufficiency of Heart Blood: HT-7, BL-20, and BL-17 (Zhong Guo Zhen Jiu Chu Fang Xue) Insert 1.5 cun #32 needles into BL-20 and BL-17 with a twisting reinforcing needle technique, and apply moxa wool to the handles of the needles for 3 cones. Insert 1 cun #32 needles into HT-7 perpendicularly, 0.5 cun deep with a twisting even movement needle technique. Retain the needles for 20 minutes. Treat once every other day for 5 treatments as a course. For heart palpitations due to stagnation of Phlegm: BL-15, CV-14, ST-30, and TW-6.(Author’s Clinical Experience) Insert 1.5 cun #32 needles into BL-15 obliquely, towards the spinal column, 1 cun deep at a 60-degree angle with a lifting and thrusting reducing needle technique, and apply moxa wool to the handles of the needles for 2 cones. Insert a 1.5 cun #30 needle into CV-14 perpendicularly, 1 cun deep with a twisting even movement needle technique, and apply moxa wool to the handles of the needles for 3 cones. Insert 1.5 cun #30 needles into ST-40 and TW-6 with a lifting and thrusting reducing needle technique. Retain all needles for 20 minutes. Treat once every other day for 7 treatments as a course. For heart palpitations due to deficiency of the Heart Qi: PC-6, ST-36, BL-14, and BL-15.(Author’s Clinical Experience) Insert 1.5 cun #30 needles into BL-14 and BL-15 obliquely, towards the spinal column, at a 60-degree angle with a lifting and thrusting reinforcing needle technique, and apply moxa wool to the handles of the needles for 3 cones. Insert 1 cun #32 needles into PC-6 and ST-36 with a twisting reinforcing needle technique. Retain all needles for 30 minutes. Treat once every other day for 5 treatments as a course. 204

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For heart palpitations with deficiency of Qi: CV-4, CV-6, PC-6, and GV-20. (Jing Mai Tu Kao) Apply indirection moxibustion with ginger on CV-4 and CV-6 for 5 cones. Insert 1.5 cun #32 needles into PC-6 and GV-20 with a twisting reinforcing needle technique. Retain all needles for 30 minutes. Treat once every other day for 5 treatments as a course. For heart palpitations with restlessness and a poor memory: GV-20. (Tong Ren Zhen Jiu Tu Jing) Insert 1.5 cun #30 needle into GV-20 transversely, 1 to 1.2 cun deep with a twisting reinforcing needle technique, and apply moxa pole on the side for 15 minutes. Treat once every other day for 3 treatments as a course. For heart palpitations with difficulty lying down: CV-6, CV-7, and ST-27. (Qian Jing Fang) Insert 1.5 cun #32 needles into CV-6 and CV-7 with a lifting and thrusting even movement needle technique and 1.5 cun #30 needles into ST-27 with a twisting even movement needle technique. Retain all needles for 30 minutes. Or apply moxa wool to the handles of the needles for 3 cones. Treat once every other day for 5 treatments as a course. For heart palpitations with angina: PC-6, CV-17, CV-14, BL-14, and BL-17. (Author’s Clinical Experience) Insert 1.5 cun #30 needles into PC-6 obliquely, 1 to 1.2 cun deep towards PC-5 at a 45-degree angle, with a twisting even movement needle technique until the sensation of the Qi travels to the chest. Insert a 1.5 cun #32 needles into CV-17 obliquely, 1 cun deep towards the CV-16 direction with a lifting and thrusting reducing needle technique and a 1.5 cun #32 needle into CV-14 perpendicularly, 1 cun deep with a lifting and thrusting reinforcing needle technique. Apply moxa wool to the handles of the needles for 2 cones. Insert 1.5 cun #30 needles into BL-14 and BL-17 obliquely, towards the spinal column, 1 to 1.2 cun deep with a lifting and thrusting reducing needle technique. Retain all needles for 10 minutes. Treat once daily for 3 treatments as a course. For heart palpitations with chest pain and shortness of breath: PC-9, Shi Wang, ST-45, PC-3, LU-4, and ST-36 (Author’s Clinical Experience) Shi Wang is an extra point located in the middle of the root of the nail of the middle finger. Apply a bloodletting technique on PC-9, Shi Wang, and ST-45, and squeeze out 2 drops of blood. Insert 1.5 cun #32 needles into PC-3 with the Long Hu Jiao Zhan—Dragon and Tiger Battle technique and 1.5 cun #30 needles into LU-4 and ST-36 with a twisting even movement needle technique. Retain all needles for 30 minutes. Treat twice a week for 3 treatments as a course.

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CASE ANALYSIS A 47 year-old female patient had a main complaint of heart palpitations with anxiety for over 2 years. She had difficulty falling asleep, dizziness, nightmares, restlessness, a poor appetite and irregular bowel movements. She had a red tongue tip with a yellow greasy coating and her pulse was wiry, slippery and fast. Diagnosis: Heart palpitations due to retention of Phlegm-Fire. Treatment Principle: Resolve Phlegm and Calm the Heart. Point Prescription: BL-15, CV-14, HT-7, GB-34, ST-40, and LV-2. Treatment was administered once daily for 5 treatments as a course. Technique: Insert 1.5 cun #30 needles into ST-40 and GB-34 perpendicularly, 1 to 1.2 cun deep with a lifting and thrusting reducing needle technique and 1 cun #32 needles into LV-2 and HT-7 with a twisting even movement needle technique. Insert a 1.5 cun #32 needle into CV-14 perpendicularly, 1 cun deep with a twisting reducing needle technique. Retain all needles for 30 minutes. Insert 1 cun #30 needles into BL-15 obliquely, 1 cun deep at a 60 degree angle towards the spinal column with a lifting and thrusting reinforcing needle technique, and remove the needles without retaining them. Result: The heart palpitations decreased dramatically after 3 treatments, and all the symptoms resolved after 3 courses. EVALUATION Acupuncture and moxibustion is not only effective in controlling heart palpitations, but also in helping treat heart disease. Short-term results will show immediately on an EKG, and long-term results will occur when all the symptoms have changed. A clear diagnosis is very important for appropriate acupuncture treatments, with correct needling techniques being the key. Chinese herbal formulas are strongly recommended during acupuncture therapy in adjunction to treatment. A Chinese idiom refers to the three step therapy- first needle, second moxa, and third use herbal formulas.

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HEMORRHOIDS Generally, all small fleshy prominences that are found at the internal and external areas of the anus are called hemorrhoids, piles or hemorrhoid lumps. Hemorrhoids can be caused by a variety of reasons ranging from lack of good hygiene to internal disorders. In TCM, hemorrhoids are caused by stagnation of Qi and Blood in the local Luo meridians, which worsens with exhaustion or excessive sitting. The combinations of treatments for this problem have proven to be very successful. DIAGNOSIS Downward flow of Damp-Heat Symptoms include distending pain and prolapse of the anus, hematochezia, associated with itching and wetness locally in and around the anus, scanty urination, thirst, and restlessness. The tongue is red with a yellow greasy coating, and the pulse is rapid and slippery. Yin Deficiency with Blood-Heat Symptoms include pain around the anus with a large amount of blood in the stools, accompanied by thirst, a desire to drink, constipation, dark urine, a red tongue with a thin coating, and a rapid pulse. Prolapse due to Insufficiency of the Spleen Symptoms include a prolapsed internal hemorrhoid that is not able to return back to its original position and is accompanied by a sallow complexion, palpitations, and shortness of breath, weakness and fatigue, a pale tongue with a thin white coating and a thin, weak pulse. TREAMENT AND PRESCRIPTION Downward flow of Damp-Heat Treatment Principle: Clear the Heat and Resolve the Accumulation of the Dampness. Point Prescription: BL-32, GV-1, BL-35, BL-57, and Er Bai. Treat once every other day for 7 treatments as a course. Technique: Insert 1 cun #32 needles into Er Bai perpendicularly 0.5 cun deep with a lifting and thrusting reducing needle technique. Insert 3 cun #30 needles into BL-32 and BL-35 perpendicularly, 2 cun deep with a twisting reducing needle technique and 1.5 cun #32 needles into BL-57 and GV-1 perpendicularly, 1 cun deep with a twisting even movement needle technique. Retain all needles for 30 minutes. Additional points for associated symptoms: Painful and swollen anus: BL-54 and BL-2. Hematochezia: SP-10 and BL-24. Constipation: BL-25 and ST-37.

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Yin Deficiency with Blood–Heat Treatment Principle: Reinforce the Yin and Cool the Blood. Point Prescription: Er Bai, SP-1, GV-1, BL-57, BL-54, BL-20, BL-23, GV-4, LI-11, SP-10, ST-25, and KI-7. Treat once every other day for 7 treatments as a course. Technique: Insert 1 cun #32 needles into Er Bai perpendicularly, 0.7 cun deep with a twisting reducing needle technique and 1.5 cun #32 needles into SP-10, ST-25, LI-11 and KI-7 perpendicularly, 1 to 1.2 cun deep with a lifting and thrusting reinforcing needle technique. Apply direct non-scarring moxibustion on SP-1 for 11 cones. Insert a 1.5 cun #32 needle into GV-1 perpendicularly, 1 to 1.2 cun deep with a lifting and thrusting reducing needle technique and 3 cun #30 needles into BL-54 perpendicularly, 2 to 2.5 cun deep with a twisting reducing needle technique. Insert 1.5 cun #30 into BL-20, BL-23 and GV-4 with a lifting and thrusting reinforcing needle technique and 1.5 cun #32 needles into BL-57 with a lifting and thrusting reducing needle technique. Retain all needles for 10 minutes. Additional points for associated symptoms: Hematochezia: SP-3 and GV-28 with a bloodletting technique. Constipation: ST-37 and BL-25. Thirsty: KI-6 and CV-24. Prolapse due to Insufficiency of the Spleen Treatment Principle: Reinforce the Spleen Qi, and Relieve the hemorrhoid. Point Prescription: GV-20, SP-4, CV-6, BL-24, BL-32, BL-13, BL-20, and Er Bai. Treat twice a week for 7 treatments as a course. Technique: Insert 3 cun #30 needles into BL-24 and BL-32 perpendicularly, 2 cun deep with a twisting reinforcing needle technique and 1.5 cun #32 needles into BL-13 and BL-20 perpendicularly, 1 cun deep with a twisting reinforcing needle technique. Apply moxa wool to the handle of the needles for 3 cones. Insert a 1.5 cun #32 needle into GV-20 transversely, 1 cun deep with a twisting even movement needle technique, and apply moxa-pole on the side of the needle for 15 minutes. Insert 1 cun #34 needles into SP-4 and Er Bai perpendicularly, 0.5 to 0.7 cun deep with a twisting reinforcing needle technique. Insert a 1.5 cun #32 needle into CV-6 perpendicularly, 1 cun deep with a twisting even movement needle technique. Apply moxa wool to the handle of the needle for 3 cones. Additional points for associated symptoms: Heart palpitation: PC-6. Insomnia: HT-7. Lassitude: CV-6 and ST-36. ADJUNCTIVE THERAPY Ear Acupuncture Point Prescription: Rectum, Large intestine, and Shen Men Insert 0.5 cun #34 ear needles into these points obliquely, 0.3 cun deep at a 45-degree angle with a fast twisting needle technique. Retain all needles for 30 minutes. Or, apply press-balls on these points after body needle treatment. Treat once every other day for 5 treatments as a course.

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Scalp Acupuncture Treatment zones: Middle line and Lateral line 1 of the vertex; Lateral line 3 of the forehead. Insert 1.5 cun #32 needles into these lines transversely, 1 cun deep at a 30-degree angle with a lifting and thrusting reducing needle technique. Retain all needles for 30 minutes. Treat twice a week for 5 treatments as a course. Moxibustion Direct moxibustion: SP-1, SP-4, GV-2, BL-32, and Er Bai. Apply direct non-scarring moxibustion on SP-1 for 11 cones to stop the bleeding of the hemorrhoids and on SP-4 and Er Bai for 7 cones. Apply direct non- scarring moxibustion on BL32 and GV-2 for 9 cones. Treat twice a week for 5 treatments as a course. Indirect moxibustion: CV-4, BL-25, and BL-33. Apply indirect moxibustion with ginger on CV-4, BL-25 and BL-33 for 5 cones. Treat once every other day for 5 treatments as a course Moxa-pole: GV-20 and GV-2. Apply moxa-pole on GV-20 and GV-2 for 20 minutes. Use as a supplemental therapy along with other techniques. Plum Blossom Needle Treatment area: Sacrum, SP-4, and Er Bai. Apply medium stimulation of a Plum blossom needle on the sacrum area, particularly around GV-2, GV-3, BL-32 and BL-33, until a red color appears with a little bleeding. Apply weak stimulation of the Plum blossom needle on SP-4 and Er Bai for 2 to 3 minutes, until a red color appears. Treat once every other day for 5 treatments as a course. Gua Sha Treatment area: Low back, sacrum, Lower abdomen, BL-40, and BL-57. Apply medium stimulation of Gua Sha on the low back and sacrum along the Bladder meridian and the GV meridian from BL-21 to BL-34 and GV-5 to GV-2, until a red mark appears. Apply medium stimulation of Gua Sha on the low abdomen from ST-28 to ST-30, until a red color appears. Apply medium stimulation of the Gua Sha around BL-40 and BL-57 area until a red color with black dots appears. Treat once a week for 3 treatments as a course. Pricking Therapy Treatment area: GV-27, GV-2, and the Hemorrhoid points. Hemorrhoid points (pimples) are found from T-7 to L-5 and the sacral area with a red color. Prick them one by one, squeezing the mucous out. Apply a pricking technique to GV-27 and GV-2, pricking out a little white-colored fluid. Treat once a week for 3 treatments as a course.

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TRADITIONAL PRESCRIPTIONS AND TECHNIQUES The following prescriptions are from the Qian Jin Fang. For hemorrhoids with severe pain: BL-58 Insert 1.5 cun #32 needles perpendicularly, 1 to 1.2 cun deep with a lifting and thrusting reducing needle technique. Retain needles for 20 minutes. For hemorrhoids with irregular bowel and tenesmus: KI-7 Insert 1.5 cun #32 needles into KI-7 perpendicularly, 1 cun deep with a twisting even movement needle technique. Retain needles for 20 minutes. For hemorrhoids with Interior Heat: PC-8 Insert 1 cun #32 needles into PC-8 perpendicularly, 0.7 cun deep with a twisting reducing needle technique. Retain all needles for 20 minutes. For hemorrhoids with a swollen sensation under the axilla: BL-36, BL-40, and SI-5. Insert 3 cun #30 needles into BL-36 perpendicularly, 2 to 2.5 cun deep with a twisting even movement needle technique. Insert 1 cun #30 needles into BL-40 and SI-5 perpendicularly, 0.5 cun deep with a twisting reducing needle technique. Retain all needles for 20 minutes. Treat once every other day for 5 treatments as a course for the above prescriptions. For hemorrhoids with lassitude: GV-2. (Zhen Jiu Zi Shen Jing) Apply direct non-scarring moxibustion on GV-2 for 11 cones. Treat once daily for 5 treatments as a course. For hemorrhoids with bleeding: BL-23, GV-4, GV-1, SP-6, and BL-57. (Lei Jing Tu Yi) Insert 1.5 cun #32 needles into GV-1 perpendicularly, 1 cun deep with a lifting and thrusting reducing needle technique and 1.5 cun #32 needles into BL-23 perpendicularly, 1 cun deep with a twisting reinforcing needle technique. Apply moxa wool to the handle of the needles for 3 cones. Apply direct nonscarring moxibustion on GV-4 for 9 cones. Insert 1.5 cun #32 needles into SP-6 perpendicularly, 1 cun deep with a twisting even movement needle technique and 1.5 cun #30 needles into BL-57 perpendicularly, 1 to 1.2 cun deep with a twisting reinforcing needle technique. Retain all needles for 20 minutes. Treat once every other day for 5 treatments as a course. For hemorrhoids with pain and swelling: BL-40, BL-58, GB-37, KI-7, LV-3, GB-43, CV-6, and CV-1. (Zhen Jiu Da Cheng) Insert 1.5 cun #30 needles into BL-40, BL-58, and GV-37 perpendicularly, 1 cun deep with a twisting reducing needle technique and 1 cun #32 needles into LV-3, KI-7, and GB-43 with a twisting even movement needle technique. Insert 1.5 cun #32 needles into CV-6 perpendicularly, 1 cun deep with a twisting reinforcing needle technique and apply moxa wool to the handles of the needles for 3 cones. Insert a 1.5 cun #32 needle into GV-1 perpendicularly, 1 cun deep with a twisting reducing needle technique. Treat once every other day for 5 treatments as a course. For chronic hemorrhoids: SP-5, BL-57, and Er Bai. (Za Bing Ge) Insert 1.5 cun #32 needles into BL-57 perpendicularly, 1 cun deep with a lifting and thrusting reducing needle technique and 1 cun #32 needles into SP-5 perpendicularly, 0.5 cun deep with a twisting even movement needle technique. Insert 1.5 cun #30 needles into Er Bai perpendicularly, 1 cun deep with a twisting reducing needle technique. Retain all needles for 20 minutes. Treat once every other day for 5 treatments as a course.

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For hemorrhoids with deficient Qi: GV-20, GV-4, and BL-62. (Zhen Jiu Da Cheng) Insert 1.5 cun #32 needle into GV-20 transversely, 1 cun deep at a 30-degree angle towards GV-19 with a twisting reinforcing needle technique, and apply a moxa pole on the side of the needle for 10 minutes. Apply direct non-scarring moxibustion on GV-4 and BL-61 for 9 cones. Treat once every other day for 5 treatments as a course. For hemorrhoids with swelling and bleeding: BL-29, BL-54, and BL-57. (Lei Jing Tu Yi) Insert 3 cun #30 needles into BL-29 and BL-54 perpendicularly, 2 to 2.5 cun deep with a lifting and thrusting reducing needle technique and 1.5 cun #30 needles into BL-57 perpendicularly, 1 cun deep with a twisting reducing needle technique. Retain all needles for 30 minutes. Treat once every other day for 5 treatments as a course. For hemorrhoids from the downward flow of Damp-Heat: GV-1, BL-35, BL-57, Er Bai, GV-20, and Ji Zhong. (Author’s Clinical Experience) Ji Zhong is an extra point located 0.5 cun bilateral to L-4. Insert a 1.5 cun #30 needle into GV-1 with a twisting reducing needle technique. Repeat the process every 3 to 5 minutes during the retaining time of the needle. Insert 3 cun #30 needles into BL-35 and Ji Zhong perpendicularly, with a twisting even movement technique and 1 cun #32 needles into GV-20 and Er Bai with a lifting and thrusting even movement technique. Retain all needles for 20 minutes. Treat once daily for 5 treatments as a course. For hemorrhoids with deficient Yin and Blood-Heat: BL-35, BL-2, CV-6, LI-6, Shi Qi Zhui, and Zhi Shu. (Author’s Clinical Experience) Zhi Shu is an extra point located 1 cun bilateral to GV-4. Shi Qi Zhui is an extra point located below the 5th lumbar vertebre. Insert 3 cun #30 needles into Zhi Shu and BL-35 perpendicularly, 2 cun deep with a twisting even movement needle technique and 1.5 cun #30 needle into Shi Qi Zhui perpendicularly, 1 cun deep with a twisting reducing needle technique. Retain all needles for 20 minutes. Insert a 1.5 cun #32 needle into CV-6 perpendicularly, 1.2 cun deep with a twisting reinforcing technique and 1 cun #32 needles into LI-6 and BL-2 perpendicularly, with a twisting reducing needle. Retain all needles for 20 minutes. Treat once every other day for 5 treatments as a course. For hemorrhoids with a downward flow of Damp-Heat and excess Yin Qiao: KI-6, LU-7, and GV-1. (Zhen Jiu Ji Chen) Insert a 1.5 cun #30 needle perpendicularly, into GV-1 one cun deep with a twisting reducing needle technique and take out the needle without retaining it. Insert 1 cun #32 needles into KI-6 perpendicularly, 0.5 cun deep with a twisting even movement needle technique until the sensation of the Qi travels upwards. Then insert 1.5 cun #34 needles into LU-7 transversely, 1 cun deep at a 15 degree angle with a twisting even movement needle technique. Retain all needles for 20 minutes. Treat once daily for 3 treatments as a course. For hemorrhoids with a downward flow of Damp-Heat and excess Yin Wei: PC-6, KI-9, SP-4, and CV-1. (Zhen Jiu Ji Chen) Insert a 1.5 cun #32 needle into CV-1 perpendicularly, 1-1.2 cun deep with a twisting even movement technique and remove the needle after a sensation of Qi is achieved. Insert 1 cun #32 needles into PC-6, KI-9, and SP-4 with a twisting reducing needle technique. Retain all needles for 20 minutes. Treat once daily for 3 treatments as a course.

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Hemorrhoids

For hemorrhoids with prolapse due to an insufficient Spleen: GV-20, CV-8, BL-26, BL-46, BL-58, PC-8, and SP-3. (Author’s Clinical Experience) Insert 1.5 cun #32 needles into BL-58 perpendicularly, 1 cun deep with a twisting reducing needle technique and 3 cun #30 needles into BL-26 perpendicularly, 2 cun deep with a twisting reinforcing needle technique. Apply moxa wool to the handles of the needles for 3 cones. Apply direct non-scarring moxibustion to BL46 for 7 cones. Insert a 1 cun #32 needle into GV-20 transversely, 0.8 cun deep with a lifting and thrusting reinforcing needle technique, and apply a moxa-pole on the side for 10 minutes. Insert 1cun #32 needles into PC-8 and SP-3 perpendicularly, 0.5 cun deep with a twisting even movement needle technique. Apply a moxa-pole on CV-8 for 20 minutes. Treat once every other day for 7 treatments as a course. CASE ANALYSIS A 40 year-old male patient came into the clinic with the main complaint of hemorrhoid pain for the last year. The hemorrhoid started bleeding three months prior, and there was close to 3 ml of blood expelled during the bowel movement every time. The condition was aggravated by hot, spicy, and greasy foods and was associated with dizziness, a pale complexion, spontaneous sweating, and heart palpitations. The tongue was pale with a thin white coating and the pulse was weak. Diagnosis: Hemorrhoid bleeding due to a deficiency of the Spleen and the Blood. Treatment Principle: Build up the Spleen Qi and Relieve the hemorrhoid. Point Prescription: SP-1, ST-36, GV-20, GV-1, and BL-57. Treatment was administered once every other day for 5 treatments as a course. Technique: Insert a 1.5 cun #30 needle into GV-1 perpendicularly, 1 to 1.2 cun deep with a twisting reducing needle technique and take out the needle without retaining it. Then insert 1.5 cun #32 needles into BL-57 and ST-36 perpendicularly, 1 cun deep with a lifting and thrusting reinforcing needle technique and a 1 cun #32 needle into GV-20 transversely, 0.8 cun deep with a lifting and thrusting reinforcing needle technique. Apply direct non-scarring moxibustion on SP-1 for 11 cones. Result: The bleeding stopped after 5 treatments and the hemorrhoid was disappeared after 2 courses of treatment. Observation of the patient was continued for 1 year in the clinic along with diet therapy. The symptoms did not return. EVALUATION Hemorrhoids are a local problem, but in TCM, they are viewed in relation to the whole body’s Qi circulation. They are caused by stagnation and an excess of Yin Qi, particularly when caused by the Yin Wei and Yin Qiao meridians. When the patient has an excess of the Yin Wei meridian, usually he or she will have both Yin Wei and Cong Mai meridian excess symptoms. The sensitive pain points are usually found on PC-6, KI-9, SP-4, BL-57, and SP-5. When the patient has an excess of the Yin Qiao meridian, usually he or she will have meridian excess symptoms of both Yin Qiao and Ren Mai meridians. The sensitive and pain points will be found on KI-6, LU-7, BL58, and SP-5. That is why a correct diagnosis and effective palpation before the treatment is necessary for practitioners, and will influence the effects of the treatment directly. Acupuncture and moxibustion is very effective for treating hemorrhoids in the beginning and middle stages, and as a supplemental treatment (with herbs) in the case of surgery. The patient should avoid hot, spicy, and greasy food, wine, and cigarettes during the treatment.

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HERPES ZOSTER Herpes zoster is a kind of acute herpetic skin infection caused by the herpes zoster virus. It characteristically has an acute onset with groups of blisters crowdedly arranged in a zonal fashion along one side of nerve distribution. The blisters may break and produce yellowish liquid and spread. It is accompanied with nerve pain in the chest, waist and abdomen, or on the corner of the mouth and genital area. Direct western treatment suggests the spread of the virus is through nerve endings and prescribes anti-viral cream or nerve suppressing agents. In TCM, the outbreak of the virus is seen as an internal and systemic problem in the body. Wind-Fire Invasion Wind-Fire invades and stagnates in the surface of the skin of the Jue Yin and Shao Yang meridians, creating Heat and causing herpes. Heat-Toxin External Heat toxins invade the body, particularly at the Hand Yang Ming and Hand Tai Yin meridians, causing disharmony of Ying and Wei Qi, creating Heat. DIAGNOSIS The skin will burn and feel painful and sensitive to the touch before the herpes flare-ups. Then, groups of the herpes will appear on one side of the body, near the genitals, or around the mouth. The pain will be much worse if it occurs on the face and/or genitals. If herpes appears around the waist or the hypochondriac region, patients will often also experience a bitter taste in the mouth, a headache, dizziness and vertigo, a tendency towards anger, restlessness, a red complexion, and scanty burning urine. The tongue will be red with a yellow greasy coating and the pulse will be wiry and fast. This presentation is called Wind-Fire stagnating in the Shao yang and Jue Yin meridians. When herpes mainly appears on the chest and face, it is often associated with watery blisters, lassitude, a poor appetite and a bloated epigastric region. The tongue will be swollen with a yellow greasy coating and the pulse will be floating and fast. This is Damp Heat-toxin stagnating in the Hand Tai Yin and Yang Ming meridians. TREATMENT Wind-Fire Treatment Principle: Clear the Wind and Subdue the Fire. Point Prescription: Local Ah shi points, LV-14, LV-8, GB-43, and TW-3. Treat once every other day 5 treatments as a course. Technique: Insert 1.5 cun #32 needles on the side with the herpes with the Qi Ci technique, obliquely at a 30 to 45 degree angle towards the center of the clump. (Moxa-pole can be applied to the area of herpes during the needle retainment.) Insert 1 cun #30 needles in LV-14 obliquely, 0.5 cun deep with a twisting reducing needle technique. Insert 1 cun #32 needles on GB-43 and TW-3 perpendicularly, 0.5 cun deep with a lifting and thrusting reducing needle technique and 1.5 cun #32 needles in LV-8 perpendicularly, 1 cun deep with a waving technique. Retain all the needles for 20 minutes. Additional points for associated symptoms: Restlessness: PC-5 and HT-7. Pain on the skin: PC-6 and GB-37. Bitter taste in the mouth: GB-34 and TW-6.

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Damp-Heat Toxin Treatment Principle: Clear the Heat and Resolve Damp. Point Prescription: Local Ah shi points, ST-44, TW-5, SP-4, and GB-43. Treat once every other day 5 treatments as a course. Technique: Insert 1 cun #32 needles around the herpes perpendicularly, with a twisting reducing needle technique and 1 cun #30 needles in ST-44, TW-5, SP-4, and GB-43 with a lifting and thrusting reducing needle technique. Stimulate the needles every 5 minutes during the 20 minutes of needle retention. Additional points for associated symptoms: Fever: LI-4 and GV-14. Pain: Bloodletting technique on LI-1 and LU-11. Insomnia: PC-8 and CV-14. ADJUNCTIVE THERAPIES Ear Acupuncture Point Prescription: Liver and Shen Men Apply 0.5 cun #32 ear needles in these two points bilaterally, with a fast twisting needle technique for 5 minutes, and retain the all the needles for 15 minutes. Treat once daily for 5 treatments as a course. Scalp Acupuncture Point Prescription: Middle 2/5 of the anterior line from the vertex to the temple, Lateral line 2 of the vertex, and Lateral line 3 of the forehead. Insert 1 cun #30 needles in all the treatment lines on the scalp with a lifting and thrusting reducing needle technique, and retain the needles for 30 minutes. Treat once every other day for 3 treatments as a course Bloodletting Points: LI-1, LU-11, LV-1, and ST-45. Apply a bloodletting technique on these Jing well points, and squeeze 2-3 drops of blood from each point. Treat once every other day 3 treatments as a course, or apply along with other treatment techniques. Wrist and Ankle Acupuncture Point Prescription: Upper 2, Upper 5, Lower 4, and Lower 6. Insert 1.5 cun #32 needles subcutaneously at a 10 to 15 degree angle from the skin without any sensation, 1.2 cun deep, and retain the needles for 40 minutes. Treat once every other day for 3 treatments as a course.

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Plum Blossom Needle Points: local points. Apply Plum blossom needling around the herpes with medium-level stimulation, until a few drops of blood comes out. Treat once daily for 3 treatments as a course. Most of the time, a moxa-pole is used after plum blossom needle stimulation on herpes for approximately 20 minutes. Moxibustion Direct moxibustion: LI-1, LU-11, ST-44, and LV-1. Apply direct non-scarring moxibustion on these points for 8 cones. Treat once daily for 3 treatments as a course. Moxa-pole: Local points. Apply a moxa-pole on the local herpes area for 30 minutes, normally this is performed after a plum blossom needle treatment. Treat once daily for 3 treatments as a course.

TRADITIONAL PRESCRIPTIONS AND TECHNIQUES For herpes with Dampness and Interior Heat: BL-18, LI-11, and GV-14. (Zhen Jiu Pei Xue) Insert 1.5 cun #32 needles into BL-18 with the Dragon and Tiger Battle needle technique and a 1.5 cun #30 needle into GV-14 perpendicularly, 1 to 1.2 cun deep with a rubbing needle technique. Retain all the needles for 15 minutes. Insert 1.5 cun #30 needles into LI-11with a lifting and thrusting reducing needle technique, and retain the needles for 20 minutes. Treat once daily for 3 treatments as a course. For herpes with Wind-heat and Fire: LI-11, LI-4, and ST-36. (Zhong Hua Pi Fu Ke Zai Zhi) Insert 1.5 cun #30 needles into ST-36 perpendicularly, 1 to 1.2 cun deep with a waving needle technique, and then insert 1.5 cun #32 needles into LI-11and LI-4 perpendicularly, 1 cun deep with a lifting and thrusting reducing needle technique. Retain all the needles for 20 minutes. Treat once every other day, for 3 treatments as a course. For herpes with Damp-Heat: GV-12, LI-11, SP-9, SP-6 and plum blossom needling. (Author’s Clinical Experience) Insert a 1.5 cun #30 needle into GV 12 perpendicularly, 1 cun deep with a twisting reducing needle technique for 5 minutes, and take the needle out without retaining it. Then, insert 1.5 cun #32 needles into LI-11, SP-9, and SP-6 perpendicularly, 1 to 1.2 cun deep with a lifting and thrusting reducing needle technique. Retain all the needles for 30 minutes. Finally, apply the plum blossom needling to the local herpes area with medium-level stimulation for 3-4 minutes. Treat once every other day for 3 treatments as a course.

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For any kind of herpes: Local points Insert 1 cun #30 needles obliquely at a 20-30 degree angle from the skin towards the center of herpes cluster, surrounding the herpes at a 0.5-cun distance from its edge. Herpes above the waist: TW-6, TW-5, LI-4, and LI-11. Herpes below the waist: LV-3 and SP-6. (Zhong Guo Zhen Jiu) Insert 1.5 cun #32 needles into TW-6, TW-5, LI-11, and LI-4 with a twisting reducing needle technique, or insert 1.5 cun #30 needles into LV-3 and SP-6 with a lifting and thrusting reducing needle technique. Retain all the needles for 20 minutes. Treat once every other day for 5 treatments as a course for the above. For herpes with Wind-Heat and severe pain: LI-1 and SP-1. (Guang Xi Zhong Yi) Apply a bloodletting technique with bloodletting needles or #28 needles perpendicularly, 0.1 cun deep, allowing it to bleed naturally bleeding without squeezing until it stops. Treat once every other day for 2 treatments as a course. For herpes with Damp-Heat and severe pain: She Yan Xue. (Jiang Su Zhong Yi) She Yan Xue is an extra point on both sides of the dorsal part of the thumb joint, between the pink and white skin. Squeeze the point for a few minutes before treatment. Then, apply bloodletting needles or 1 cun #28 needles into points and make 1 to 2 drops of yellowish liquid come out. Treat once every other day, for 2 treatments as a course. For herpes with Damp-Heat: BL-40, GV-14, GV-7, LI-4, and SP-6. (Author’s Clinical Experience) Insert a 1.5 cun #30 needle into GV-7 perpendicularly, 1 cun deep with a rubbing needle technique until the sensation of needle travels downwards in the body. Insert a 1.5 cun #32 needle into GV-14 perpendicularly, 1 to 1.2 cun deep with a lifting and thrusting reducing needle technique. Apply a bloodletting technique on BL-40, and retain all the needles for 15 minutes. Insert 1 cun #32 needles into LI-4 and SP-6 with the White Tiger Shakes its Head technique, and retain all the needles for 20 minutes. Treat once every other day for 3 treatments as a course. CASE ANALYSIS A 31 year-old male patient had a chief complaint of herpes zoster for 3 days in the upper epigastric region. He felt a burning and painful sensation and was unable to handle clothing touching the skin. There were several red pimples around the area 4 by 8 cm in size. He had a dry mouth, restlessness, a red tongue with a yellow greasy coating, and a fast and wiry pulse. Diagnosis: Herpes zoster with Damp-Heat Stagnation. Treatment Principle: Soothes the Liver, Clear the Heat and Resolve the Dampness. Point Prescription: local points, TW-6, LI-4, and LV-3. Treat once daily for 3 treatments as a course. Technique: Insert 1 cun #30 needles around the herpes zoster region (6-8 needles) obliquely at 20 degree angles towards the center of the herpes, starting 0.5 cun from the edge of the herpes. Then, insert 1 cun #32 needles intoTW-6, LI-4, and LV-3 with a lifting and thrusting reducing needle technique. Retain all the needles for 40 minutes. Result: The pain was clearly reduced after 2 treatments, and the color of herpes changed from red to dark with a little black in an area. After 5 days, all the symptoms were had resolved. Only tiny scars were left. 217

Acupuncture and Moxibustion—A Clinical Desk Reference

EVALUATION Herpes zoster is one of the most common skin infection diseases. From the TCM practitioner’s point of view, it as caused by both Exterior and Interior Heat, including External Heat Invasion. The main symptoms are burning and pain on the local affected region associated with a fever, a bitter taste in the mouth, constipation, and yellow scanty urine. Most frequently it happens on the face, chest, epigastric and hypochondriac region, and occasionally on the four extremities. Acupuncture and moxibustion is very effective for treating herpes zoster. The treatment mainly focuses on clearing Heat and resolving Dampness. Point selection mostly comes from the Hand Shao Yang, Hand Yang Ming and Foot Jue Yin meridians to move the Wind and the Heat. Treatment time usually lasts less then two weeks. Over 90% of the cases will be cured within a week. Some patients could have the neuralgia for a while after the herpes is gone, however due to the nature of the infection, the treatments only cure the outbreak. The virus will remain in the nerve endings, dormant until future outbreaks. In order to reduce outbreaks it is very important for the patient to watch his or her diet and maintain a healthy immune system.

218

Hiccup

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HICCUP Hiccup is a symptom of Stomach Qi rebellion and it can occur due to any kind of reason that may lead the Qi to travel upward. In TCM, it is usually caused by internal organ problems, such as rebellion of Stomach Qi, Liver Qi attacking the Stomach, or Damp-Heat damaging the Stomach Yin. In the beginning stages of the hiccup most symptoms are of an excess nature, but in the late stage of the disorder most of the symptoms are deficient in nature. Examples of this include spasm of the esophageal by cancer or chronic nerve spasm. Rebellion of Stomach Qi This pattern is commonly caused by improper food intake; such as intake of allergic food, or overly cold, hot, and/or spicy food. All these cause the Stomach to fail in descending the Qi, resulting in hiccup. Liver Qi attacking the Stomach This pattern occurs after long-term and negative emotional stimulation, which causes the Stomach Qi to rise up instead of down. Yin and Qi Deficiency Deficiency of the Kidney and the Stomach Yin will cause Interior Heat that will dry up the Stomach fluids, resulting in a deficient Heat or Fire rising. Or at times, the Stomach may stagnate due to accumulation of Phlegm, which is produced by chronic Spleen Qi Deficiency, which tends to occur in most chronic hiccup patients. DIAGNOSIS Excess type of the Hiccup Cold Stagnation Symptoms include loud sounding hiccup, and preference for warm drinks with a cold sensation and bloating in the epigastric region and limbs, poor appetite, frequent urination, and loose stool. The tongue is pale with a white greasy coat and the pulse is slow and tight. Rebellious Stomach Fire Symptoms include loud sounding hiccup, preference for cold drinks with a bitter taste in the mouth, thirst, red complexion, constipation, and a yellowish and scanty urination. The tongue is red with a yellow coat and the pulse is fast and slippery. Liver Qi attacking the Stomach Symptoms include hiccup that is worse during the day, as emotional changes or sensitivity will be reduced during sleep and worse after waking up. The hiccup in this case is associated with belching, sighing, stuffy and painful sensations in the chest, epigastric, and hypochondriac region. The tongue is dry with a white thin coat and the pulse is wiry.

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Hiccup

Deficient type of the Hiccup Spleen Yang Deficiency Symptoms include a low sounding hiccup with shortness of breath and that are associated with weak body constitutions, pale complexion, cold sensations in the limbs, poor appetite, lassitude, and bloating in the abdomen or hiccups with vomiting of phlegm. The tongue is swollen with a wet coat and the pulse is thin and weak. Stomach Yin Deficiency Symptoms include continuous weak hiccups and are associated with a dry mouth, dry throat, restlessness, red malar flush, and spontaneous sweating. The tongue is red without a coat and the pulse is thin and fast. TREATMENT AND PRESCRIPITONS Excess type Treatment Principle: Harmonize the Stomach and Subdue the Rebellious Qi. Point Prescription: CV-12, PC-6, ST-40 and BL-17. Treat once daily for 3 treatments as a course. Technique: Insert 1.5 cun #30 needles into BL-17 perpendicularly, 1 cun deep with lifting and thrusting reducing needle technique, and retain the needles for 10 minutes. Insert 1.5 cun #30 needles into CV-12 and ST-40 perpendicularly, 1 cun deep with twisting reducing needle technique, and 1 cun #32 needles into PC-6 perpendicularly, 0.6 cun deep with twisting even movement needle technique. Retain all needles for 20 minutes. Additional points for other symptoms: Stomach Cold: ST-21 with indirect moxibustion with ginger for 3 cones. Stomach Fire: ST-43 and ST-44. Liver Qi Stagnation: LV-3 and LV-13. Deficient type Treatment Principle: Nourishing the Stomach and Regulate the Qi. Point Prescription: CV-6, BL-17, LV-13, and CV-17. Treat once every other day for 5 treatments as a course. Technique: Insert 1.5 cun #32 needles into BL-17 perpendicularly, 1 cun deep with twisting reinforcing needle technique, and apply moxa wool on the handle of needles for 3 cones. Insert a 1.5 cun #30 needle into CV-17 obliquely, 1.2 cun deep at a 45 degree angle towards CV-16 with twisting reducing needle technique. Insert 1 cun #32 needles into LV-13 perpendicularly, 0.7 cun deep with twisting even movement needle technique, and a 1.5 cun #32 needle into CV-6 with twisting reinforcing needle technique. Retain all needles for 20 minutes. Additional points for other symptoms: Yin Deficiency: KI-3 and GV-4. Yang Deficiency: CV-4 with indirect moxibustion and Fu Zi (aconite) cake.

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ADJUNCTIVE THERAPIES Ear Acupuncture Points: Diaphragm, Sympathetic, Liver, Stomach and Spleen. Insert 0.5 cun #32 ear needles into these points obliquely, 0.3 cun deep at a 45 degree angle with strong twisting needle technique. Retain all needles for 30 minutes. Treat once daily for 3 treatments as a course. The clinician may also apply press-balls or intradermal needles on the ear after regular body acupuncture treatments. Scalp Acupuncture Treatment zones: Lateral line 1 and 2 of the forehead and the Middle line of the vertex. Insert 1.5 cun #32 needle into these lines 1-1.2 cun deep at a 30 degree angle downwards, with a fast twisting needle technique. Retain the needles for 30 minutes to 1 hour. Treat once daily for 3 treatments as a course. Wrist and Ankle acupuncture Treatment area: Upper 2, Upper 5 and Lower 5. Insert 1.5 cun #32 needles into these lines transversely, 1.2 cun deep at a 15 degree angle without any needle technique and avoiding any sort of sensation. Retain the needles for 30 minutes. Treat once daily for 2 treatments as a course. Moxibustion Direct moxibustion: BL-17, BL-15, CV-17, and CV-6. Apply direct non-scarring moxibustion on these points for 7-9 cones. Treat once every other day for 3 treatments as a course. Indirect moxibustion: CV-6, CV-13, and BL-20. Apply indirect moxibustion with ginger on CV-6, CV-13, and BL-20 for 5 cones. Treat once daily for 3 treatments as a course. Hand Acupuncture Points: Stomach and Chest. Insert 1 cun #32 needle into these two points perpendicularly, 0.2-0.3 cun deep with twisting reducing needle technique. Retain the needles for 10 minutes. Treat once daily for 2 treatments as a course. Nose Acupuncture Points: Liver, Gallbladder, and Stomach. Insert 0.5 cun #34 needles into these points perpendicularly, 0.2 cun deep with twisting even movement needle technique until a heat sensation is produced under the needle. Retain all needles for 15 minutes. Treat once daily for 3 treatments as a course.

222

Hiccup

TRADITIONAL PRESCRIPTIONS AND TECHNIQUES For hiccup due to deficiency of Yang: CV-17, LU-1, CV-12, LU-5, and CV-14. (Pu Ji Fang) Apply direct non-scarring moxibustion on CV-17, LU-1, and CV-12 for 10 cones, and on LU-5 and CV-14 for 7 cones. Treat once daily for 3 treatments as a course. For hiccup due to stagnation of the Stomach Qi: LV-14, CV-17, and CV-12. (Yi Xue Gang Mu) Apply direct non-scarring moxibustion on LV-14 and CV-17 for 11 cones, and on CV-12 for 9 cones. Treat once daily for 2 treatments as a course. For hiccup due to stagnation Stomach Qi: CV-12, PC-6, and CV-22. (Zhen Jiu Chu Fang Xue) Insert a 1.5 cun #32 needle into CV-22 obliquely, 1.2 cun deep at a 45 degree angle following the trachea, and apply a twisting reducing needle technique. Insert 1 cun #32 needles into PC-6 and CV-12 perpendicularly, 0.5-0.7 cun deep with twisting reducing needle technique. Retain all needles for 20 minutes. Treat once daily for 2 treatments as a course. For chronic hiccup: a point located between the black and white skin under the nipple. (Wei Shen Bao Jian) Apply direct non-scarring moxibustion on this point for 11 cones. Treat once daily for 3 treatments as a course. For hiccup due to stagnation of Liver Qi: CV-12, CV-17, and LV-14. (Zhen Jiu Ji Chen) Insert a 1.5 cun #32 needle into CV-17 obliquely, 1.2 cun deep at a 45 degree angle towards CV-16, with a twisting reducing needle technique, and 1.5 cun #32 needles into LV-14 transversely, 1 cun deep at a 30 degree angle towards CV-12, with a twisting reducing needle technique. Insert a 1.5 cun #30 needle into CV-12 perpendicularly, 1 cun deep with twisting even movement needle technique. Retain all needles for 20 minutes. Treat once daily for 2 treatments as a course. For hiccup after childbirth: LV-14. (Zhen Zhi Zun Sheng) Apply direct non-scarring moxibustion for 7 cones. Treat once daily for 2 treatments as a course. For hiccup due to Stomach Cold: BL-20, BL-21, CV-12, ST-36, and SP-4. (Lei Jing Tu Yi) Insert 1.5 cun #32 needles into BL-20 and BL-21 perpendicularly, 1 cun deep with twisting reinforcing needle technique, and apply moxa wool on the handle of the needles for 3 cones. Insert 1.5 cun #34 needles into ST-36 perpendicularly, 1 cun deep with twisting even movement needle technique, and apply indirect moxibustion with ginger on CV-12 for 5 cones. Finally apply direct non-scarring moxibustion on SP-4 for 7 cones. Treat once daily for 3 treatments as a course. For hiccup due to Cold stagnation in the Stomach: CV-13, LV-13, BL-20, and PC-6. (Author’s Clinical Experience) Insert 1.5 cun #30 needles into BL-20 perpendicularly, 1-1.2 cun deep with Shao Shan Huo—Burning the Mountain technique and retain the needles for 10 minutes. Insert 1 cun #32 needles into LV-13 and PC-6 perpendicularly, with twisting reducing needle technique. Insert a 1.5 cun #32 needle into CV-13 perpendicularly, 1 cun deep with twisting even movement needle technique, and apply moxa wool on the handle of needle for 2 cones. Treat once daily for 2 treatments as a course.

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For hiccup due to Stomach Fire: PC-6, LI-4, LU-7, BL-17, and ST-40. (Author’s Clinical Experience) Insert 1.5 cun #30 needles into BL-20 perpendicularly, 1 cun deep with lifting and thrusting reducing needle technique, and retain the needles for 10 minutes. Insert 1 cun #34 needles into PC-6, LI-4, and LU-7 with twisting reducing needle technique, and 1.5 cun #30 needles into ST-40 with twisting reducing needle technique. Retain all needles for 20 minutes. Treat once daily for 2 treatments as a course. For hiccup due to deficiency of Yang: CV-12, LV-14, CV-6, BL-17, BL-21, and BL-23. (Author’s Clinical Experience) Insert a 1.5 cun #32 needle into CV-12 obliquely, 1.2 cun deep at a 60 degree angle towards CV-11, with twisting reinforcing needle technique, and 1 cun #32 needles into LV-14 obliquely, 0.6 cun deep at a 45 degree angle with twisting even movement needle technique. Apply indirect moxibustion with ginger on CV-6 for 3 cones. Use a fire cup on LV-14 for 2 minutes after taking out the needles. Insert 1.5 cun #32 needles into BL-17, BL-21, and BL-23 perpendicularly, 1 cun deep with twisting reinforcing needle technique, and apply moxa wool on the handle of needles for 3 cones. Treat once every other day for 3 treatments as a course. CASE ANALYSIS A 32 year-old male patient presented with a main complaint of hiccup for 1 day after waking up from anesthesia of stomach surgery. The hiccup is occurring almost 20 times per minute and he can hardly breathe and eat. The pulse was weak and floating. Diagnosis: Rebellious Stomach Qi. Treatment Principle: Harmonize the Stomach and Reduce the hiccups. Point Prescription: CV-12 and PC-6. Treat once daily for 3 treatments as a course. Technique: Insert 1.5 cun #30 needle into CV-12 perpendicularly, 1 cun deep with twisting reducing needle technique until the sensation of the Qi travels from the point. Insert 1.5 cun #34 needles into PC-6 obliquely, 1 cun deep at a 60 degree angle towards PC-5 with a twisting reinforcing needle technique. Retain all needles for 20 minutes. Result: The hiccup stopped after 3 minutes of needle retention and the breathing then became normal. Observed 3 days later at the hospital, the hiccup had never come back. EVALUATION Hiccup may appear due to anything that causes spasm or contraction of diaphragm muscle. Acupuncture and moxibustion are very effective for treating hiccup, particularly for those occurring within short duration—less than 3 days. Acupuncture is usually used for Excess cases and moxibustion for Deficient cases. In some cases, hiccup may appear in chronic disease before a change for the worse, therefore it is essential to make a clear diagnosis for successful treatment.

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Hiv

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HIV HIV is a very common viral infection that may prove to be terminal. The virus directly attacks the human immune cells to leave the body weak and defenseless against other infectious diseases. It is characterized by the infection of the AIDS virus, which does belong to one kind of febrile disease in the TCM category. Although HIV has only one cause, the patient can be differentiated according to the clinical symptoms to better treat the patient’s problems. DIAGNOSIS Wind-Heat Invasion Symptoms of this pattern include fever, sweating, muscle and joint aches and soreness, easily fatigued, swollen lymph nodes, sore throat, nausea, vomiting, headache, and diarrhea. The tongue is red with a white coat and the pulse is floating and fast. Qi Deficiency This pattern includes fever, frequent diarrhea, weight loss, fatigue, shortness of breath, dizziness or vertigo, heart palpitations, and insomnia. The tongue is red tongue with a thin coat and the pulse is weak and floating. Qi and Yin Deficiency Associated signs and symptoms for this pattern are low-grade fever, night sweats, five palm heat, swollen lymph nodes, frequent diarrhea, neuropathy, subdued speech, dry throat and mouth, shortness and breath, heart palpitations, insomnia, spontaneous sweating and night sweating, dry skin, and loose stool. The tongue is red without a coating or with less coat than normal and the pulse is thin, floating, and weak. Heat-toxin This type is usually seen in AIDS, where the patient has Kaposi’s sarcoma, pathologic leanness, fever, anemia, swollen lymph nodes, and other systemic infections, such as lung and urinary tract infections. Associated symptoms are irritable bowel movement, scanty urine, dry skin, flushed complexion, dry mouth, throat, thirst, dysphasia, and poor sleep. The tongue is purple or even dark with a greasy coat and the pulse is fast and floating. TREATMENT AND PRESCRIPTIONS Wind-Heat Treatment Principle: Expel the Wind, Clear Heat, and Open the Lung. Point Prescription: LU-5, LU-6, LI-4, BL-13, GV-14, and ST-40. Treat twice a week for 7 treatments as a course. Technique: Insert 1 cun #32 needles into BL-13 perpendicularly, 0.5 cun deep with waving needle technique, and a 1.5 cun #32 needle into GV-14 perpendicularly, 1 cun deep with rubbing technique (rub the needle count clockwise) until the sensation travels down along the spinal column. Retain all needles for 10 minutes. Insert 1.5 cun #34 needles into LU-5 and LU-6 perpendicularly, 1 cun deep with twisting even movement needle technique, and 1 cun #34 needles into LI-4 with twisting reinforcing needle technique. Insert 1.5 cun #32 needles into ST-40 perpendicularly, 1 cun deep with lifting and thrusting reducing needle technique. Retain all needles for 20 minutes. 226

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Additional points for associated symptoms: Headache: GV-24 and Tai Yang. Joint aches: BL-11, GB-20, and GB-39. Diarrhea: ST-37 and ST-25. Qi Deficiency Treatment Principle: Reinforce the Qi and Promote the circulation. Point Prescription: CV-6, LV-3, LI-4, LU-5, BL-13, BL-20, and GV-14. Treat twice a week for 7 treatments as a course. Technique: Insert a 1.5 cun #34 needle into CV-6 perpendicularly, 1 cun deep with twisting reinforcing needle technique and apply moxa wool on the handle of the needle for 3 cones. Insert 1 cun #34 needles into LV-3, LI-4, and LU-5 with twisting even movement needle technique. Retain all needles for 20 minutes. Insert 1.5 cun #32 needles into BL-20 and GV-14 perpendicularly, 1 cun deep with twisting reinforcing needle technique, and 1 cun #34 needles into BL-13 perpendicularly, 0.6 cun deep with lifting and thrusting reinforcing needle technique. Retain all needles for 10 minutes. Additional points for associated symptoms: Diarrhea: ST-25 and SP-4 with moxibustion. Depression: GV-20, Si Shen Cong, and HT-7. Poor sleep: An Mian, ST-36, and HT-7. Heart palpitations: PC-6, CV-14, and BL-15. Qi and Yin Deficiency Treatment Principle: Reinforce the Qi and Nourish Yin. Point Prescription: CV-4, ST-36, KI-3, LV-8, BL-43, BL-20, and BL-23. Treat once or twice a week for 10 treatments as a course. Technique: Insert 1.5 cun #34 needles into CV-4 and ST-36 perpendicularly, 1 cun deep with twisting reinforcing needle technique, and 1 cun #34 needles into KI-3 and LV-8 with lifting and thrusting reinforcing needle technique. Next insert 1 cun #32 needles into BL-43 with waving technique, and 1.5 cun #32 needles into BL-20 and BL-23 perpendicularly, 1 to 1.2 cun deep with twisting reinforcing needle technique. Retain all needles for 20 minutes. Additional points for associated symptoms: Fever: HT-6, KI-2, and GV-14. Diarrhea: BL-20 and BL-25. Muscle and joint aches: SP-10, BL-17, BL-20, and LI-11. Headache: KI-1, GV-20, and LI-4. Swollen lymph nodes: ST-40, LU-5, and TW-4.

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Heat-toxin Treatment Principle: Clear Heat, Resolve the Damp, and Reinforce the Qi. Point Prescription: SP-6, LI-4, TW-5, ST-40, LI-11, GV-20, GV-14, BL-40, and BL-62. Treat twice a week for 10 treatments as a course. Technique: Insert a 1.5 cun #32 needle into GV-14 perpendicularly, 1 cun deep with twisting even movement needle technique, and repeat the process every 3 minutes during the 15 minutes of needle retainment. Insert 1 cun #30 needles into SP-6, LI-4, TW-5, LI-11, and BL-62 perpendicularly, 0.5 cun deep with lifting and thrusting reducing needle technique, and 1.5 cun #32 needles into ST-40 with twisting reducing needle technique. Insert a 1.5 cun #32 needle into GV-20 transversely, 1 cun deep at a 30 degree angle towards the back with a twisting reducing needle technique. Retain all needles for 20 minutes. Additional points for associated symptoms: Fever: HT-5, KI-6, and GV-12. Headache: GB-20, Tai Yang, and Si Shen Cong. Skin Ulcer: SP-10 and BL-17. Insomnia: An Mian and HT-7. Diarrhea: ST-25 and ST-37. Thirst: CV-24 and KI-6. ADJUNCTIVE THERAPIES Ear Acupuncture Points: Lung, Stomach, Spleen, Liver, Kidney, Endocrine, Sub cortex, Shen Men, Small intestine, and Sympathetic. Select 3 to 4 points from above in each treatment. Insert 0.5 cun #34 needles into these points obliquely, 0.3 cun deep with twisting even movement needle technique. Retain all needles for 30 minutes. Treat once every other day for 7 treatments as a course. Scalp Acupuncture Treatment zones: Middle line of vertex, Lateral line 1 and 2 of the forehead, Lateral line 1 of vertex, and the Posterior oblique line from the vertex to temple. Insert 1 cun #32 needles into these lines transversely, 0.7 cun deep at a 30-degree angle with twisting even movement needle technique. Retain all needles for 40 minutes. Treat once every other day for 7 treatments as a course. Wrist and Ankle Acupuncture Treatment area: Upper 5, Upper 3, Lower 1, and Lower 6. Insert 1.5 cun #32 needles slowly into these points transversely, 1.2 cun deep without any needle technique, and adjust the needle to avoid any sensation of needles. Retain all needles for 40 minutes. Treat once every other day for 7 treatments as a course.

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Gua Sha Treatment area: Back and Chest. Apply medium-level stimulation of Gua Sha on the back from GV-14 to GV-6, and BL-11 to BL-20, until a dark red color appears. Apply weak stimulation on the chest from CV-21 to CV-17, and KI-27 to KI-22, until dark red or purple color appears. Treat once a week for 5 treatments as a course. Moxibustion Direct non-scarring moxibustion: SP-3, LV-1, CV-6, BL-23, and GV-4. Apply direct non-scarring moxibustion on SP-3 and LV-1 for 9 cones, on CV-6, BL-23, and GV-4 for 7 cones, to treat HIV with Qi and Yang deficiency. Treat once every other day for 5 treatments as a course. Indirect moxibustion: CV-8, ST-25, CV-4, and BL-20. Apply indirect moxibustion with ginger on CV-8, ST-25, and CV-4 for 3 cones, on BL-20 for 5 cones, to treat HIV with water retention. Treat once every other day for 5 treatments as a course. Moxa pole: GV-20, KI-1, and CV-4. Apply moxa-pole on GV-20, KI-1, and CV-4 for 15 minutes, to treat HIV with lassitude and insomnia. Treat once daily for 5 treatments as a course. Plum Blossom Treatment area: SP-4, LU-5, BL-40, GV-3, BL-43, Back, and Neck. Apply weak stimulation of a Plum blossom needle on SP-4, LU-5, BL-40, GV-3, and BL-43. Apply medium-level stimulation on the upper back along the GV and BL meridian for 3 minutes until a red color appears. Apply weak stimulation on the neck along the ST meridian until a red color appears. Treat twice a week for 5 treatments as a course. Foot Acupuncture Points: Heart, Kidney Liver, Stomach, and Head. Insert 1 cun #32 needles into these points perpendicularly, 0.3 cun deep with twisting even movement technique. Retain all needles for 40 minutes. Treat twice a week for 5 treatments as a course.

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EXPERIENTIAL PRESCRIPTIONS AND TECHNIQUES For HIV with stagnation of Blood: GV-14, LI-11, ST-44, and Tai Yang. (Zhen Jiu Xue) Insert a 1.5 cun #32 needle into GV-14 perpendicularly, 1 cun deep with rubbing technique (rub the needle clockwise) until the sensation of Qi travels down along the GV meridian. Insert 1.5 cun #32 needles into LI-11 perpendicularly, 1 cun deep with Long Hu Jiao Zhan—Dragon and Tiger Battle technique, one combination needle technique, until the sensation of the Qi travels. Inset 1 cun #32 needles into ST-44, and Tai Yang perpendicularly, 0.5 cun deep with twisting reducing needle technique. Retain all needles for 20 minutes. Treat twice a week for 7 treatments as a course. For HIV with deficiency of Qi and Yin: ST-36, SP-9, BL-13, BL-20, and GV-14. (Author’s Clinical Experience) Insert 1.5 cun #32 needles into GV-14 and BL-20 perpendicularly, 1 cun deep with twisting reinforcing needle technique, and 1 cun #32 needles into BL-13 with twisting reinforcing needle technique. Apply moxa wool on the handle of needles for 3 cones. Insert 1.5 cun #32 needles into ST-36 and SP-9 perpendicularly, 1 cun deep with lifting and thrusting reinforcing needle technique. Retain all needles for 20 minutes. Treat once every other day for 7 treatments as a course. For HIV due to Heat-toxin: LV-2, LI-11, SP-9, ST-40, GV-14, GV-12, BL-32, and BL-22. (Author’s Clinical Experience) Insert 2 cun #32 needles into BL-32 perpendicularly, 1.5 cun deep with lifting and thrusting reducing needle technique, and 1.5 cun #32 needles into BL-22, GV-12, and GV-14 with lifting and thrusting reducing needle technique. Retain all needles for 10 minutes. Insert 1.5 cun #32 needles into LI-11, SP-9, and ST-40 perpendicularly, 1 to 1.2 cun deep with lifting and thrusting even movement technique, and 1 cun #32 needles into LV-2 with twisting even movement needle technique. Retain all needles for 20 minutes. Treat twice a week for 7 treatments as a course. For HIV due to deficiency of Qi: CV-12, ST-36, SP-4, PC-6, GV-20, BL-20, and BL-21. (Author’s Clinical Experience) Insert 1 cun #34 needles into SP-4 and PC-6 perpendicularly, 0.3 to 0.5 cun deep with twisting even movement needle technique, and a 1.5 cun #32 needle into GV-20 transversely, 1 cun deep at a 30 degree angle backwards with twisting even movement needle technique. Insert 1.5 cun #34 needles into ST-36 and CV-12 perpendicularly, 1 cun deep with twisting reinforcing needle technique, and apply moxa wool on the handle of the needles for 3 cones. Insert 1.5 cun #32 needles into BL-20 and BL-21 perpendicularly, 1 cun deep with lifting and thrusting reinforcing needle technique, apply moxa wool on the handle of needles for 2 cones. Treat once every other day for 7 treatments as a course. For HIV with deficiency of Qi and Blood: KI-3, LV-3, KI-7, CV-4, LI-11, BL-23, BL-20, and BL-13. (Author’s Clinical Experience) Insert 1.5 cun #32 needles into LI-11, CV-4, and KI-7 perpendicularly, 1 cun deep with twisting reinforcing needle technique, and 1 cun #34 needles into KI-3 and LV-3 with twisting reinforcing needle technique. Retain all needles for 20 minutes. Insert 1 cun #34 needles into BL-23, BL-20, and BL-13 perpendicularly, 0.6 cun deep with lifting and thrusting reinforcing needle technique, and apply moxa wool on the handle of needles for 3 cones. Treat once every other day for 7 treatments as a course.

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For HIV with poor appetite and loose stool: CV-12, LV-13, CV-6, SP-4, LU-5, BL-17, and BL-25. (Author’s Clinical Experience) Insert 1.5 cun #32 needles into CV-12 and LV-13 perpendicularly, 1 cun deep with twisting reinforcing needle technique, and 1 cun #34 needles into LU-5 and SP-4 with twisting even movement needle technique. Apply indirect moxibustion with ginger on CV-6 for 3 cones. Insert 1.5 cun #32 needles into BL-17 and BL-25 perpendicularly, 1 cun deep with twisting reinforcing needle technique. Retain all needles for 10 minutes. Treat once every other day for 7 treatments as a course. For HIV with skin problems: GV-20, LI-11, ST-36, and BL-40. (Author’s Clinical Experience) Insert 1.5 cun #30 needles into GV-20 transversely, 1 cun deep with a lifting Qi technique, and 1.5 cun #32 needles into LI-11, and ST-36 perpendicularly, 1 to 1.2 cun deep with lifting and thrusting reducing needle technique. Retain all needles for 20 minutes. Apply bloodletting on BL-40, to squeeze 2 to 3 drops of blood. Treat once a week for 5 treatments as a course. For HIV with skin problems: GB-21, BL-40, GB-41, LV-2, and HT-3. (Author’s Clinical Experience) Insert 1.5 cun #30 needles into GB-21 obliquely, 1 cun deep towards the ST-12 direction with twisting reducing needle technique, and 1 cun #32 needles into GB-41, LV-2, and HT-3 with twisting even movement needle technique. Retain all needles for 20 minutes. Apply bloodletting on BL-40, to squeeze 2 to 3 drops of blood. Treat twice a week for 5 treatments as a course. CASE ANALYSIS A 35 year-old man came for treatment with a main complaint of HIV symptoms originating 2 years prior. His symptoms include low-grade fever, frequent diarrhea over 5 times a day, and weight loss: over 20 pounds in the past year. The associated symptoms were shortness of breath, insomnia, and tendency to anger, restlessness, dizziness, and heart palpitations. The tongue was red with a thin coating and the pulse was weak and floating. Diagnosis: HIV due to Qi Deficiency with Interior Heat. Treatment Principle: Reinforce the Qi, Clear the Heat, and Calm the mind. Point Prescription: LV-3, LI-4, LU-5, CV-6, ST-36, BL-13, BL-20, and BL-23. Treat twice a week for 7 treatments as a course. Technique: Insert 1 cun #34 needles into LV-3 and LI-4 perpendicularly, 0.6 cun deep with twisting even movement needle technique, and 1.5 cun #34 needles into LU-5, ST-36, and CV-6 perpendicularly, 1 to 1.2 cun deep with twisting reinforcing needle technique. Retain all needles for 20 minutes. Insert 1.5 cun #32 needles into BL-13, BL-20, and BL-23 with twisting reinforcing needle technique. Retain all needles for 10 minutes. Result: The diarrhea, appetite, and insomnia greatly improved after 1 course of treatments, and the dizziness, heart palpitations and low-grad fever was controlled after 3 course treatments. The patient felt all symptoms were gone and looked like a normal person after a total of 6 courses of treatment. He then returned to a normal work and home life. The patient still continues maintenance treatments once every 2 months by acupuncture and no symptoms have returned.

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EVALUATION Acupuncture and moxibustion are helpful in the treatment of HIV positive patients, particularly to reduce the symptoms of the HIV via increasing the body’s True Qi (increasing the immune system function), with such symptoms as low energy, diarrhea, insomnia, and headache. But most of the time acupuncture and moxibustion only works as a supplemental treatment for most AIDS patients. Acupuncture needles will not be used when the patient has severe infections on the skin and in the organs, and moxibustion is contraindicated in patients with severe Yin Deficiency symptoms, such as severe Interior Heat, a dry and dark red tongue without coating, and with a small tongue body. And above all, clean and meticulous disposal techniques must be followed to avoid contact with used needles.

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Hypchondriac Pain

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HYPOCHONDRIAC PAIN Hypochondriac pain refers to pain on one or both sides of the hypochondriac regions, the area of the Liver and Gall Bladder meridians and organs. In the Nei Jing it states, “When the disease is in the Liver and Gall Bladder, pain and discomfort will occur in the hypochondriac region.” Physiologically, the Liver controls the flow of Qi and likes freedom of movement. Any kind of emotional problem can cause stagnation of the Liver Qi and can lead to stagnation of Blood in the hypochondriac region. In TCM, the causes attributed to hypochondriac pain are many. Here are the main diffentiations: Liver Qi Stagnation This is caused by any kind of emotional problem that causes stagnation of Qi in the Liver and Gallbladder meridians near the hypochondriac region. Blood Stagnation This can be due to long-term stagnation of Qi, or by traumatic injury in the local area, which worsens the stagnation and the pain in the hypochondriac region. Liver and Gall Bladder Damp-Heat Such can occur from a Damp invasion or internal Damp retention from the Spleen failing in its transportation and transformation. After a while, the stagnation of Dampness will turn into Heat that attacks the local meridians and the Liver and Gall Bladder organs. This results in the Liver’s failure to control the smooth flow of Qi, causing pain in the hypochondriac region. Liver Yin Deficiency Chronic diseases or over-tiredness can easily make Liver Yin or Blood insufficient and unable to nourish the Liver organ and meridians. This can lead to a chronic painful sensation in the hypochondriac region. In modern medicine, it includes many diseases, including intercostals neuralgia, acute and chronic hepatitis, cholecystitis, gallbladder stones and other infective diseases. DIAGNOSIS The critical technique in diagnosing hypochondriac pain is in identifying the Exterior or Interior symptoms. Most times, Exterior symptoms are caused by Damp-Heat stagnation appearing as a fever with aversion to cold, jaundice, nausea, vomiting, a floating pulse, and a red tongue with a yellow greasy coating. With interior symptoms, the pain starts more slowly. There is no fever or aversion to cold, and is associated with Liver Qi and Blood stagnation symptoms or Liver Yin Deficiency symptoms. The quality of the pain will help to determine the syndrome: Qi Stagnation pain often has distention and distending pain that comes and goes. Damp-Heat related pain is most often fixed and aggravated by pressure, making it hard to turn over in bed. Yin and Blood Deficiency is light pain that is aggravated by fatigue and reduced by rest. Blood Stagnation pain is sharp and of fixed location that worsens at night with possible lumps in local areas.

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Hypochondriac pain due to stagnation of the Liver This is characterized by a distending pain that could alternative between the right or left side of the hypochondriac region, often related with emotional changes and associated with a stuffy chest, sighing, acid regurgitation, easily irritated or angered, and poor sleep. The tongue is pale with a white thin coating, and the pulse is tight and wiry. Hypochondriac pain due to Invasion of Damp-Heat In this case there will be a burning, painful sensation on the right side of the hypochondriac region that is associated with a fever and aversion to cold, a bitter taste in the mouth, restlessness, and nausea and vomiting with a reaction to greasy and oily food when the patient is having an acute flare up. The tongue is red with a thick yellowish coating and the pulse is fast and wiry. Hypochondriac pain due to Stagnation of Blood This pattern is characterized by a fixed pain located on the side of hypochondriac region that has an injury or history of chronic pain that is associated with a distending sensation and possible lumps in the hypochondriac area. The tongue is dark or has black or purple dots and a thin white coating, and the pulse is wiry or thin and choppy. Hypochondriac pain due to Yin Deficiency In this case there is a constant bloating pain or heaviness and swollen sensation that moves around the hypochondriac area. It is usually aggravated by tiredness or changes in body position. There will be a pale complexion, a malar flush, a low grader fever, spontaneous sweats, dizziness and vertigo, blurry vision and heart palpitations. The tongue is red with little coating or less coating, and the pulse is thin and fast.

TREATMENT AND PRESCRIPTIONS Hypochondriac pain due to stagnation of Liver Treatment Principle: Soothe the Liver and Move the Qi. Point Prescription: BL-18, CV-16, LV-14, and GB-43. Treat once every other day for 5 treatments as a course. Technique: Insert 1.5 cun #32 needles into BL-18 with a lifting and thrusting reducing needle technique, and remove the needle without retaining it. Insert 1 cun #30 needles into CV-16 and LV-14 with twisting even movement needle technique, and 1 cun #32 needles into GB-43 with twisting reducing needle techniques. Retain all needles for 20 minutes. Additional points for associated symptoms: Acid regurgitation: BL-21 and GB-34. Poor sleep: HT-7 and An Mian.

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Hypochondriac pain due to Invasion of Damp-Heat Treatment Principle: Clear Heat and Resolve Dampness. Point Prescription: LV-14, GB-24, TW-6, GB-34, and LV-3. Treat once every other day for 5 treatments as a course. Technique: Insert 1.5 cun #32 needles into TW-6 and GB-34 perpendicularly, with a lifting and thrusting reducing needle technique and 1 cun #30 needles into LV-14, GB-24, and LV-3 with a twisting even movement technique. Retain all needles for 20 minutes. Additional points for other symptoms: High fever: GV-14. Nausea or vomiting: CV-12 and ST-36. Restlessness: PC-4. Hypochondriac pain due to Stagnation of Blood Treatment Principle: Move the Blood, Regulate Qi and Release the pain. Point Prescription: SP-21, GB-25, LV-2, BL-17, and SP-6. Treat once every other day for 7 treatments as a course Technique: Insert a 1 cun #30 needle into SP-21 perpendicularly, 0.3 cun deep with a Qi Ci needle technique and wave the needle for a while without retaining it. Apply a fire cup for 2 minutes on SP-21 after taking out the needles. Insert a 1.5 cun #30 needle into BL-17 obliquely, towards the spinal column 0.8 to 1 cun deep with a twisting even movement needle technique and apply moxa wool to the handle of needle for 3 cones. Insert 1 cun #30 needles into GB-25, LV-2, and SP-6 with a twisting needle technique. Retain all needles for 20 minutes. Additional points for other symptoms: Severe pain: LI-4, LV-3, and local injury Ah Shi points Hypochondriac pain due to Yin Deficiency Treatment Principle: Nourish the Yin and Blood and Release the pain. Point Prescription: HT-6, BL-15, SP-10, and SP-6. Treat once every other day for 5 treatments as a course. Technique: Insert 1 cun #32 needles into BL-15 with a twisting reinforcing needle technique. Retain all needles for 5 minutes. Apply a fire cup on BL-15 for 2 minutes after taking out the needles. Insert 1 cun #32 needles into HT-6, SP-10, and SP-6 with a twisting reinforcing needle technique. Retain all needles for 20 minutes. Additional points for other symptoms: Tidal fever: BL-43. Dizziness: GV-20 with moxa-pole for 20 minutes.

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Hypchondriac Pain

ADJUNCTIVE THERAPIES Ear Acupuncture Points: Liver, Gallbladder, Shen Men, and Chest. Insert 0.5 cun #32 ear needles into these points obliquely, at a 45-degree angle with a strong stimulation technique on the diseased side. Retain all needles for 30 minutes. Treat once every other day, for 3 treatments as a course. Plum Blossom Treatment area: Local Ah shi points (around the hypochondriac region on the painful side), and the midback (near T-7 to T-9). Apply a medium-level stimulation technique of a plum blossom needle on the local painful areas for 5 minutes, followed by a fire cup for 2 minutes after stimulation. Apply medium-level stimulation for 3 minutes on the middle back (near T-7 to T-9). Treat once every other day for 3 treatments as a course. Scalp Acupuncture Treatment zones: Upper lateral line of the occipital, and the anterior line from the vertex to the temple. Insert 1.5 cun #30 needles into these two zones transversely, 1 cun deep at a 30-degree angle with a fast twisting needle technique. Retain all needles for 30 minutes. Treat once every other day for 3 treatments as a course. Moxibustion Point: LV-13. Apply direct non-scarring moxibustion on LV-13 for 14 cones. Or, apply moxa pole on LV-13 for 30 minutes. Treat once daily for 3 treatments as a course. Bloodletting Point: Ah Shi points Palpate to find areas of stagnation in the hypochondriac region, (tender points or lumps will be found there). Apply bloodletting techniques on local Ah Shi points and take 1 or 2 drops of blood. Apply a fire cup on the area for 1 minute. Treat once daily for 2 treatments as a course.

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TRADITIONAL PRESCRIPTIONS AND TECHNIQUES For hypochondriac pain due to stagnation of Qi and Blood: TW-6. (Nei Jing) Insert a 1.5 cun #30 needle into TW-6 (same side as the pain area) perpendicularly, 1 cun deep with the Bai Hu Yao Tou—White Tiger shakes its Head technique. Retain the needle for 30 minutes. Treat once daily for 3 treatments as a course. For hypochondriac pain with chest pains: SP-21. (Shen Yin Jing) Insert a 1 cun #30 needle into SP-21 perpendicularly, 0.3 cun with the Qi Ci technique. Retain the needle for 20 minutes and apply a fire cup after removing the needle. Treat once every other day for 7 treatments as a course. For traveling pain in the hypochondriac and chest area: GB-30 and BL-67. (Shen Yin Jing) Insert a 3 cun #30 needle into GB-30 with a twisting reducing needle technique and a 0.5 cun #32 needle into BL-67 with a twisting even movement technique. Retain all needles for 30 minutes. Treat once every other day for 7 treatments as a course. For distended and sharp pain in the hypochondriac and chest regions: SP-3 (Shen Yin Jing) Insert a 1 cun #32 needle into SP-3 perpendicularly, 0.5 cun deep with a twisting reinforcing needle technique. Retain the needles for 30 minutes. Treat once every other day for 7 treatments as a course. For hypochondriac pain due to stagnation of Qi and Heat: TW-10, PC-5, PC-7, ST-36, SP-3, GB-42, and GB-37. (Shen Yin Jing) Insert 1 cun #30 needles into TW-10, PC-5, PC-7, and SP-3 with a twisting even movement needle technique, and 1.5 cun #32 needles into ST-36, GB-42, and GB-37 with a reinforcing needle technique. Retain all needles for 30 minutes. Treat once every other day for 7 treatments as a course. For hypochondriac pain with chest pain: LV-14, LV-13, GB-42, LV-2, and KI-1. (Zhen Jiu Zhai Yin Ji) Insert a 1 cun #32 needles into KI-1 perpendicularly, 0.5 to 0.8 cun deep with a twisting reinforcing needle technique. Apply moxa wool on the handles of the needles for 3 cones. Insert 1 cun #30 needles into LV13, LV-14, GB-42, and LV-2 with a twisting reducing needle technique. Retain all needles for 30 minutes. Treat once every other day for 7 treatments as a course. For hypochondriac pain due to stagnation of Qi, influencing one’s ability to cough, speak, and move: TW-6 and BL-40 (Yu Long Jing) Insert a 1 cun #28 needle into BL-40 with a twisting technique and enlarge the acupuncture hole method in order to release a few drops of blood after taking out the needles. Insert a 1.5 cun #30 needle into TW-6 with a lifting and thrusting reducing needle technique. Retain the needles for 20 minutes. Treat once every other day for 3 treatments as a course. For hypochondriac pain due to stagnation of Liver Qi and Blood: BL-29, BL-17, GB-44, TW-4, and TW-19. (Pu Ji Fang) Insert 1.5 cun #30 needles into BL-29 and BL-17 with a reinforcing needle technique, and apply moxa wool on the handles of the needles for 3 cones. Insert 1 cun #32 needles into GB-44, TW-19, and TW-4 with a twisting reducing needle technique. Retain the needles for 20 minutes. Treat once every other day for 3 treatments as a course. 238

Hypchondriac Pain

For hypochondriac pain with deficiency of True Qi: CV-6, CV-4, LV-14, and GB-44. (Shen Yin Jing) Apply direct non-scarring moxibustion on LV-14 and GB-44 for 11 cones, and apply indirect moxibustion with Fu Zi (aconite) cake on CV-4 and CV-6 for 9 cones. Treat once daily for 3 treatments as a course. For hypochondriac pain due to deficiency of Liver Blood and stagnation of Qi: CV-13, LV-3, and LV-8. (Cai Ai Bian Yi) Insert a 1.5 cun #32 needle into CV-13 obliquely at a 45 degree angle towards the painful area with a twisting reducing needle technique. Insert 1 cun #30 needles into LV-3 and LV-8 with a twisting reinforcing needle technique. Retain all needles for 30 minutes. Treat once every other day for 5 treatments as a course. For acute hypochondriac pain: BL-18, BL-20, and BL-52. (Zhen Jiu Da Quan) Insert 1.5 cun #32 needles into BL-18 and BL-20 with a lifting and thrusting even movement needle technique and 1 cun #30 needles into BL-52 with a twisting even movement needle technique. Retain all needles for 30 minutes. Treat once daily, 2 treatments as a course. For hypochondriac pain related to the lower back: BL-23. (Zhen Jiu Da Quan) Insert a 1.5 cun #30 needle into BL-23 perpendicularly, 1 to 1.2 cun deep with a twisting reinforcing needle technique, and apply moxa wool on the handle of the needles for 3 cones. Treat once every other day, 3 treatments as a course. For severe hypochondriac pain traveling to the chest and upper epigastric region: SP-4, GB-34, LV-13, and GB-39. (Zhen Jiu Da Quan) Insert 1.5 cun #30 needles into GB-34 and GB-39 with a lifting and thrusting reducing needle technique, and 1 cun #32 needles into SP-4 and LV-13 with a twisting reinforcing needle technique. Retain all needles for 30 minutes. Treat once every other day for 5 treatments as a course For hypochondriac pain and difficulty lying down: BL-19 and LV-13. (Zhen Jiu Da Quan) Insert a 1.5 cun #30 needle into BL-19 with a lifting and thrusting reducing needle technique and a 1.5 cun #30 needle into LV-13 with a twisting reducing needle technique. Retain all needles for 10 minutes. Apply a fire cup on LV-13 after removing the needles for 1 minute. Treat once every other day, 5 treatments as a course. For hypochondriac pain worsened by cough: GB-44. (Zhen Jiu Da Quan) Apply direct non-scarring moxibustion on GB-44 for 7 cones. Treat once daily for 5 treatments as a course. For hypochondriac pain with shortness of breath and heart palpitations: LU-5 and SI-1. (Zhen Jiu Da Quan) Insert a 1.5 cun #32 needle into LU-5 with a twisting reducing needle technique and a 1 cun #32 needle into SI-1 with a twisting reducing needle technique. Retain all needles for 20 minutes. Treat once every other day for 5 treatments as a course. For hypochondriac pain with fever: TW-6, GB-34, and GB-42. (Zhen Jiu Quan Shu) Insert 1.5 cun #30 needles into TW-6 and GB-34 perpendicularly, 1.2 cun deep with the Bai Hu Yao Tou— White Tiger shakes its Head technique and 1 cun #32 needles into GB-42 with a twisting reducing needle technique. Retain all needles for 30 minutes. Treat once daily for 3 treatments as a course.

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CASE ANALYSIS A 40 year-old female patient had a main symptom of distending pain in the hypochondriac region and chest for 3 months. Symptoms originally started after a severe argument with a neighbor. The pain was located on both sides of the hypochondriac areas and moved to the chest, associated with belching, sighing, dizziness, a tendency towards anger, restlessness, and poor sleep. The tongue was red with a thin white coating and the pulse was wiry. Diagnosis: Hypochondriac pain due to stagnation of the Liver Qi. Treatment Principle: Soothe the Liver and Release the pain. Point Prescription: Liv3, LV-14, GB-34, and TW-6. Treat once every other day for 3 treatments as a course Technique: Insert a 1.5 cun #30 needle into TW-6 perpendicularly, 1 cun deep with a lifting and thrusting reducing needle technique and 1 cun #32 needles into LV-3 and LV-14 obliquely, at a 30 degree angle, with a twisting reducing needle technique. Insert a 1.5 cun #32 needle into GB-34 perpendicularly, 1 cun deep with the Long Hu Jiao Zhan—Dragon and Tiger Battle technique. Retain all needles for 20 minutes. Result: After 1 treatment the pain had been reduced almost 70% with much less belching. After treating 3 times, all symptoms were resolved. EVALAUTION Hypochondriac pain as a symptom commonly appears in association with liver and gall bladder disorders and other diseases. Acupuncture and moxibustion is very effective, particularly in treating the pain originating from Qi stagnation. However, because hypochondriac pain is only a symptom of other illnesses, the treatments for it do not always get rid of the pain completely. In some severe cases, such as severe hepatitis or cancer, acupuncture is useful only as a supplemental therapy to help reduce the pain, not in the treatment causing the hypochondriac pain.

240

Impotence

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IMPOTENCE This disorder can be attributed to a wide variety of causes, either physical or psychological. It can affect men all over the world and is a disorder that can be treated in most cases. Impotence is defined as the inability to achieve or maintain penile erection and is classified into two categories in Traditional Chinese medicine. In most cases patients suffer symptoms of either a deficient or excess nature. Emotional stimulation Depression, anxiousness and other long-term unhealthy emotions will stagnate Liver Qi and damage the Yin and Blood of both the Liver and the Kidney, causing impotence. Damp-Heat Damp-Heat accumulation usually occurs after improper food intake, or in cases of Spleen and Stomach Deficiency, which transfer to the Lower Jiao and invade the Liver meridians. Kidney Deficiency Excessive sexual activity or over work will make the Kidney Qi and Yang deficient resulting in impotence. DIAGNOSIS Deficiency type In this case there is impotence with an inability to achieve penile erection with occasional bouts of seminal emission, dizziness, ringing ears, accompanied by heart palpitations, shortness of breath, pale complexion, lassitude, weakness and sore sensations in the lower back and knees, chilliness, cold limbs, pale tongue, and a thin weak pulse. Excess type In this case there is impotence with an inability to maintain penile erection, an odorous smell in the genital region, swollen legs, yellowish or red urine accompanied by a burning sensation, a red tongue with a yellow greasy coating, and a fast and slippery pulse. TREATMENT AND PRESCRIPTIONS Deficiency type of Impotence Treatment Principle: Warm the Kidney Yang and Resolve the Impotence. Point Prescription: BL-23, CV-4, KI-3, GV-4, and GV-20. Treat once every other day for 7 treatments as a course Technique: Insert 1.5 cun #30 needles into BL-23 and GV-4 perpendicularly, 1 cun deep with twisting reinforcing needle technique, and apply moxa wool on the handle of the needles for 5 cones. Insert 1.5 cun or 3 cun needles into CV-4 perpendicularly, 1 to 2 cun deep with a moving Qi technique until the sensation of the needle travels down to the penis, and apply moxa wool on the handle of the needle for 3 cones. Insert 1 cun #32 needles into KI-3 and GV-20 with twisting reinforcing needle technique. Retain all needles for 30 minutes.

242

Impotence

Additional points for associated symptoms: Dizziness and vertigo: SP-6 and LV-8. Backache: BL-32 and BL-52. Insomnia: HT-7 and CV-15. Frequent urination: SP-9 and TW-6. Excess type of Impotence Treatment Principle: Resolve Damp-Heat, Promote urination and Resolve the Impotence. Point Prescription: CV-3, ST-28, SP-9, SP-6, BL-32, BL-54, and BL-40. Treat once every other day for 7 treatments as a course. Technique: Insert 1.5 or 3 cun #30 needles into CV-3 and ST-28 perpendicularly, 1 to 2 cun deep with lifting and thrusting reducing needle technique until the sensation of the needle travels down to the tip of the penis. Insert 1.5 cun #32 needles into SP-9 and SP-6 with twisting reducing needle technique. Retain all needles for 30 minutes. Insert 3 cun 30 # needles into BL-32 and BL-54 perpendicularly, 2 cun deep with lifting and thrusting reducing needle technique, and 1 cun #32 needles into BL-40 with twisting reducing needle technique. Retain all needles for 10 minutes. Additional points for associated symptoms: Fever: LI-11, GV-14, and LV-3. Spontaneous sweating: HT-6, ST-36, and BL-15. Headache: LI-4, LV-3, and Yin Tang. ADJUNCTIVE THERAPIES Moxibustion Direct moxibustion: CV-4, SP-6, GV-4, and BL-23. Apply direct non-scarring moxibustion on CV-4 and SP-6 for 11 cones, and on GV-4 and BL-23 for 7 cones to treat impotence due to Kidney Deficiency. Treat once every other day for 7 treatments as a course. Indirect moxibustion: CV-4 and ST-28. Apply indirect moxibustion with Fu Zi (aconite) cake on CV-4 and ST-28 for 5 cones to treat impotence due to Kidney Deficiency. Treat is once every other day for 7 to 10 treatments as a course. Moxa-pole: CV-3, SP-9, and LV-3. Apply moxa-pole on CV-3, SP-9, and LV-3 for 20 minutes to treat impotence due to Damp-Heat. Treat once daily for 5 to 7 treatments as a course.

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Ear Acupuncture Points: Kidney, Liver, Heart, Shen Men, Sub cortex, and Brain. Select 2 or 3 points from above for the use of each treatment. Insert 0.5 cun #32 ear needles into these points obliquely, 0.3 cun deep at a 30-degree angle with fast twisting technique. Retain all needles for 40 minutes. Treat once every other day for 5 treatments as a course. TRADITIONAL PRESCRIPTIONS AND TECHNIQUES For impotence due to Kidney Deficiency: GV-4, BL-23, CV-6, and KI-2. (Lei Jing Tu Yi) Insert 1.5 cun #32 needles into BL-23 with lifting and thrusting reinforcing needle technique, and apply moxa wool on the handle of the needles for 3 cones. Apply direct non-scarring moxibustion on GV-4 for 9 cones. Insert 1 cun #32 needles into KI-2 perpendicularly, 0.5 cun deep with twisting even movement needle technique. Insert 1.5 or 2 cun #32 needle into CV-6 perpendicularly, with twisting even movement needle technique until the Qi travels down to the penis and apply moxa wool on the handle of the needle for 3 cones. Treat twice a week for 5 treatments as a course. For impotence due to deficiency of Ming Men Fire: GV-20, BL-17, BL-20, BL-23, GV-4, GV-3, CV-4, and CV-3. (Zhong Guo Zhen Jiu) Apply moxa-pole on these points for 15 minutes. Treat once every other day for 5 treatments as a course. For impotence due to Yang Deficiency: BL-23, CV-4, BL-18, SP-6, LV-3, CV-2, and KI-1. (Cai Ai Xin Bian) Apply direct non-scarring moxibustion on BL-23, CV-4, BL-18, SP-6, and LV-3 for 3 cones, and then on CV-2 for 7 cones, and finally on KI-1 for 5 cones. Treat once every other day for 5 treatments as a course. For impotence due to stress: CV-4, SP-6, BL-18, BL-23, and ST-36. (Author’s Clinical Experience.) Insert 1.5 cun #30 needles into BL-18 and BL-23 perpendicularly, 1 cun deep with lifting and thrusting reinforcing needle technique, and apply moxa wool on the handle of needles for 3 cones. Insert 1.5 cun #32 needles into CV-4 and ST-36 with twisting even movement needle technique. Retain all needles for 20 minutes. Apply intradermal needles on SP-6. Treat once a week for 3 treatments as a course. For impotence due to Kidney Yang Deficiency: KI-10, SP-6, ST-30, CV-2, and BL-43. (Yu Long Jing) Insert 1 cun #32 needles into KI-10 perpendicularly, 0.5 cun deep with twisting reinforcing needle technique, and apply moxa wool on the handles of the needles for 3 cones. Insert 1.5 cun #32 needles into ST-30 and CV-2 perpendicularly, 1 cun deep with twisting even movement needle technique, and 1.5 cun #30 needles into SP-6 with lifting and thrusting reducing needle technique. Retain all needles for 20 minutes. Apply direct non-scarring moxibustion on BL-43 for 9 cones. Treat once every other day for 7 treatments as a course. For impotence with a painful sensation in the testicles: KI-2, LV-3, CV-7, and ST-29. (Shen Yin Jing) Insert 1 cun #32 needles into KI-2 and LV-3 with twisting reinforcing needle technique. Insert 1.5 cun #30 needles into ST-29 and CV-7 perpendicularly, 1 to 1.2 cun deep with lifting and thrusting reducing needle technique. Apply moxa wool on the handle of needles for 3 cones. Treat twice a week for 7 treatments as a course.

244

Impotence

For impotence due to Damp-Heat: CV-3, SP-6, BL-22, BL-20, BL-32, and TW-5. (Zhen Jiu Chu Fang Xue) Insert 1.5 cun #30 needles into TW-5 and SP-6 with lifting and thrusting reducing needle technique. Insert a 3 cun #32 needle into CV-3 perpendicularly, 2 cun deep with twisting reducing needle technique, and apply moxa wool on the handle of needle for 3 cones. Insert 1.5 cun #30 needles into BL-20 and BL-22 with twisting even movement needle technique, and 3 cun #30 needles into BL-32 with twisting reducing needle technique. Retain all needles for 10 minutes. Treat once every other day for 5 treatments as a course. For impotence due to deficiency of Yang: KI-12, HT-7, SP-6, GV-20, BL-52, GV-4, BL-15, and BL-18. (Tong Xuan Zhi Yao Fu) Insert 1 cun #34 needles into HT-7 with twisting even movement needle technique, and 1.5 cun #32 needles into SP-6 obliquely, 1 cun deep at a 60 degree angle towards SP-7 with lifting and thrusting reinforcing needle technique. Insert a 1 cun #32 needle into GV-20 transversely, 0.5 cun to 0.8 cun deep at a 30 degree angle towards backwards with twisting reinforcing needle technique. Insert 1.5 cun #32 needles into KI-12 perpendicularly, 1 cun deep with twisting reinforcing needle technique, and apply moxa wool on the handle of needles for 3 cones. Treat twice a week for 7 treatments as a course. For impotence due to Damp-Heat: LV-4, KI-12, SP-9, and LI-11. (Author’s Clinical Experience) Insert 1 cun #30 needles into LV-4 with twisting reducing needle technique, and 1.5 cun #32 needles into KI-12, SP-9, and LI-11with lifting and thrusting reducing needle technique. Retain all needles for 20 minutes. Treat once every other day for 7 treatments as a course. For impotence caused by stress: LI-5, TW-4, LV-4, CV-6, CV-17, BL-43, BL-45, and BL-52. (Author’s Clinical Experience) Insert 1 cun #32 needles into LI-5, TW-4, and LV-4 perpendicularly, with twisting reducing needle technique. Insert a 1.5 cun #30 needle into CV-6 perpendicularly, 1 cun to 1.2 cun deep with twisting even movement needle technique, and a 1.5 cun #32 needle into CV-17 obliquely, 1 cun deep towards the CV-16 direction with twisting reducing needle technique. Retain all needles for 20 minutes. Apply direct non-scarring moxibustion on BL-43, BL-45, and BL-52 for 8 cones. Treat once every other day for 7 treatments as a course. For impotence due to deficiency and stagnation of the Qi: CV-4, SP-6, GV-4, and BL-28. (Author’s Clinical Experience) Insert 1.5 cun #32 needles into SP-6 perpendicularly 1 cun deep with twisting reducing needle technique. Insert a 3 cun #30 needle into CV-4 perpendicularly, 2 to 2.5 cun deep with twisting reinforcing needle technique until the sensation of the needle travels to the tip of the penis. Apply moxa wool on the handle of needle for 3 cones. Insert 3 cun #30 needles into BL-28 perpendicularly, 2 to 2.5 cun deep with twisting even movement needle technique until the sensation of the needle travels away from the body, and a 1.5 cun #32 needle into GV-4 perpendicularly, 0.8 to 1 cun deep with twisting reinforcing needle technique. Apply moxa wool on the handle of needles for 2 cones. Treat once every other day for 7 treatments as a course.

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Acupuncture and Moxibustion—A Clinical Desk Reference

CASE ANALYSIS A 28 year-old married male patient entered the clinic with a main complaint of impotence for 1 year. The patient symptoms consisted of the absence of a morning erection, associated with dizziness, ringing in the ear, pale complexion, lassitude, a weak and sore sensation in the low back and both legs, chilliness, and frequent urination. The tongue was pale with a thin wet coating and the pulse was thin, deep, and weak. Diagnosis: Impotence due to deficiency of the Ming-Men Fire (Kidney Yang Deficiency) Treatment Principle: Warm the Kidney Yang. Point Prescription: BL-23, GV-4, CV-4, and SP-6. Treat once every other day for 10 treatments as a course. Technique: Insert 1.5 cun #32 needles into BL-23 perpendicularly, 1 cun deep with twisting reinforcing needle technique, and apply moxa wool on the handle of the needles for 3 cones. Apply direct non-scarring moxibustion on GV-4 for 9 cones. Insert a 3 cun #32 needle into CV-4 perpendicularly, 2 to 2.5 cun deep until the sensation of the needle travels to the penis, and apply moxa wool on the handle of needle for 3 cones. Insert 1 cun #32 needles into SP-6 perpendicularly, 0.8 cun deep with twisting reinforcing needle technique. Result: The body started to become warmer, and the patient began to have a morning erection for a bit after 7 treatments. All symptoms resolved totally after 2 courses of treatments and he and his wife conceived a boy 2 years later. EVALUATION Impotence is usually caused by an overly active sexual life or chronic masturbation, which leads to Kidney Qi Deficiency, or Liver and Heart Blood Deficiency. Some impotence cases are caused by injury to the brain, spinal cord or sexual nerves. Acupuncture and moxibustion is very effective for the treatment of functional impotence, and correct diagnosis is very important before beginning any treatment because of its direct influence in selecting a correct point prescription and needle technique. Meanwhile a healthy sexual life is important for patients as well, which means sexual activity less than once a week for patients with Kidney Yang Deficiency. After impotence is improved, continued treatment once a month with acupuncture and moxibustion is important to prevent any symptoms from returning.

246

Insomnia

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Acupuncture and Moxibustion—A Clinical Desk Reference

INSOMNIA Insomnia refers to a major clinical case. Every year millions of people around the world suffer from insomnia, a disorder characterized by inability to sleep, with fatigue, and restlessness. Although the symptoms are usually universal in all patients, insomnia can vary greatly in severity. Some patients may only suffer for a night, others for days if not weeks. In some severe cases, a patient may not even be able to sleep at all. In Traditional Chinese Medicine, insomnia is viewed as being caused by an imbalance of Yin and Yang and a disturbance of the Shen. This may take the form of a disharmony between the Heart Fire and Kidney Water, or a Heart Blood Deficiency, or a Kidney Jing Deficiency, or Liver Fire with Damp stagnation by the Spleen. Some sleep problems are caused by fever, cough, and pain. Treatment in that case should focus on the primary disease, with insomnia acquiring only a supplemental treatment. DIAGNOSIS Deficiency of Heart and Spleen Difficulty falling asleep with many dreams or nightmares, easily waking up with heart palpitations associated with poor memory, spontaneous or night sweating, pale complexion, lassitude, a full sensation in the epigastric region, and loose stool are all tell-tale signs of this condition. The tongue is pale with a thin white coat, and the pulse is thin and weak. Imbalance between Heart-Fire and Kidney-Water (Xin Shen Bu Jiao) Difficulty falling asleep and very easily waking up, associated with restlessness, five heart heat, fear, night sweating, dry throat and mouth, dizziness and ringing ear, poor memory, lassitude, a sore and weak sensation in the low back and both legs are indications of this disharmony. The tongue is red with no coat, and the pulse is thin and fast. Disharmony of Stomach Signs of this situation are difficulty falling asleep or superficial sleep associated with discomfort and bloating in the epigastric region, even vomiting with phlegm, dizziness, and vertigo. The tongue is red with a yellow thick coat, and the pulse is slippery. Liver fire Rising Difficulty falling asleep and easily waking up associated with headache, tendency to anger, restlessness, red eyes and ringing ears, and a bitter taste in the mouth are typical indications. The tongue is red with a thin yellow coat and the pulse is wiry and fast.

248

Insomnia

TREATMENT AND PRESCRIPTONS Deficiency of Heart and Spleen Treatment Principle: Reinforce the Qi and Nourish the Blood. Point Prescription: BL-20, BL-15, HT-7, and SP-6. Treat twice a week for 7 treatments as a course. Technique: Insert 1.5 cun #32 needles into BL-20 and BL-15 perpendicularly, 1 cun deep with a twisting reinforcing needle technique, and apply moxa wool on the handles of needles for 3 cones. Insert 1 cun #32 needles into HT-7 and SP-6 with a twisting reinforcing needle technique. Additional points for associated symptoms: Nightmares: BL-42 and BL-43. Poor memory: BL-52 and GV-20 with a moxa pole for 20 minutes Imbalance between Heart-Fire and Kidney-Water Treatment Principle: Nourish the Yin and Subdue the Fire. Point Prescription: PC-7, KI-3, HT-7, and LV-3. Treat twice a week for 7 treatments as a course. Technique: Insert 1 cun #32 needles into PC-7 and HT-7 with a twisting reducing needle technique. Insert 1 cun #32 needles into KI-3 and LV-3 with a twisting reinforcing needle technique, or apply moxa wool on the handles of needles for 3 cones. Additional points for associated symptoms: Dizziness and vertigo: GB-20. Ringing ear: SI-19. Seminal emission: BL-52. Disharmony of Stomach Treatment Principle: Harmonize the Stomach and Resolve the Phlegm. Point Prescription: CV-12, ST-40, ST-45, and SP-1. Treat once every other day for 3 treatments as a course. Technique: Apply bloodletting techniques on ST-45 and SP-1. Then insert a 1.5 cun #32 needle into CV-12 perpendicularly, 1 cun deep with a twisting reducing needle technique and 1.5 cun #30 needles into ST-40 with a twisting even movement needle technique. Retain all needles for 30 minutes. Additional points for associated symptoms: Nausea and vomiting: PC-6. Dizziness: Yin Tang and LI-4.

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Acupuncture and Moxibustion—A Clinical Desk Reference

Liver Fire Rising Treatment Principle: Sooth the Liver and Subdue the Fire. Point Prescription: LV-2, GB-45, GB-20, and HT-7. Treat once every other day for 5 treatments as a course. Technique: Insert 1.5 cun #32 needles into GB-20 perpendicularly, 1 cun deep towards the nose with a lifting and thrusting reducing needle technique without retaining and then insert 1 cun #32 needles into LV-2 and HT-7 with a twisting even movement needle technique. Retain all needles for 20 minutes. Apply a bloodletting technique on GB45 before the treatment is over. Additional points for associated symptoms: Ringing ear: TW-17 and TW-3. Headache and red eyes: Tai Yang and TW-4. ADJUNCTIVE THERAPIES Ear Acupuncture Points: Sub cortex, Heart, and Spleen, Brain point, and Endocrine. Insert 0.5 cun #34 ear needles into these points obliquely, 0.3 cun deep at a 45-degree angle with fast twisting needle technique until a heat sensation is produced in the ear. Retain all needles for 40 minutes. Or apply press-balls on these points as a supplemental treatment, and retain them for 3 days. Treat once every other day for 5 treatments as a course. Scalp Acupuncture Treatment zone: Middle line and Lateral line 1 of the vertex, Lateral line 3 of the forehead, and Anterior line of the temple. Insert 1 cun #32 needles into these lines transversely, 0.8 cun deep with fast twisting needle technique. Retain all needles for 40 minutes. Treat once every other day for 3 treatments as a course. Moxibustion Moxa pole: GV-20 and KI-1. Apply moxa pole on GV-20 and KI-1 for 20 minutes before going to bed. Treat once daily for 5 treatments as a course. Moxa cone: LV-3, KI-2, and HT-7. Apply direct non-scarring moxibustion on LV-3, KI-2, and HT-7 for 6 cones. Treat once daily for 5 treatments as a course. Foot Acupuncture Points: Nei Tai Cong, Heart, and Kidney. Insert 0.5 cun #34 needles into these points perpendicularly, 0.3 cun deep with a twisting reducing needle technique, and apply moxa pole on the side for 15 minutes. Treat once daily for 3 treatments as a course.

250

Insomnia

Cupping Treatment area: Back and CV-12. Apply cups on BL-15, BL-43, BL-23, GV-4, and CV-12 and retain all cups for 3 minutes, or apply moving cups on the back and move it up and down along BL meridian. Treat once daily for 3 treatments as a course. TRADITIONAL PRESCRIPITONS AND TECHNIQUES For insomnia with difficulty falling asleep: GV-24, CV-5, and ST-27. (Zhen Jiu Xue Jian Bian) Insert 1.5 cun #32 needle into GV-24 transversely, 1 cun deep at a 30 degree angle towards the back with a twisting even movement needle technique and 1.5 cun #32 needles into CV-5 and ST-27 perpendicularly, 1.2 cun deep with a twisting reinforcing needle technique. Retain all needles for 20 minutes. Treat once every other day for 5 treatments as a course. For insomnia with light sleep: SP-4. (Zhen Jiu Xue Jian Bian) Insert 1 cun #32 needles into SP-4, 0.3 to 0.5 cun deep with a twisting reinforcing needle technique, and apply moxa wool on the handles of needles for 2 cones. Treat once every other day for 5 treatments as a course. For insomnia due to a Heat sensation in the chest: KI-1. (Zhen Jiu Xue Jian Bian) Insert 1 cun #32 needles into KI-1 perpendicularly, 0.5 cun deep with a twisting reinforcing needle technique, and apply moxa wool on the handles of the needles for 3 cones. Treat once every other day for 5 treatments as a course. For insomnia due to fright: CV-5. (Zhen Jiu Jia Yi Jing) Insert a 1.5 cun #32 needle into CV-5 perpendicularly, 1.2 cun deep with a lifting and thrusting reinforcing needle technique, and apply moxa wool on the handle of the needle for 3 cones. Treat twice a week for 5 treatments as a course. For insomnia and easily waking up: BL-38. (Zhen Jiu Jia Yi Jing) Insert 1 cun #32 needles into BL-38 with a twisting reducing needle technique, and apply moxa pole on the side for 20 minutes. Treat twice a week for 5 treatments as a course. For insomnia with heart palpitations and poor memory: PC-6, TW-2, BL-43, ST-41, and HT-7. (Shen Jiu Jing Lun) Insert 1 cun #32 needles into TW-2 and HT-7 perpendicularly, 0.3 cun deep with a twisting even movement needle technique. Apply direct non-scarring moxibustion on PC-6, ST-41, and BL-43 for 9 cones. Treat twice a week for 7 treatments as a course. For insomnia due to insufficient Heart Blood: CV-12, CV-6, SP-6, GV-20, and HT-5. (Zhen Jiu Xue Jian Bian) Insert a 1 cun #32 needle into GV-20 obliquely at a 45-degree angle, 0.5 cun deep with a twisting reinforcing needle technique. Insert 1.5 cun #32 needles into CV-12 and CV-6 with a twisting even movement needle technique. Insert 1 cun #32 needles into SP-6 and HT-5 with a twisting reinforcing needle technique. Retain all needles for 30 minutes. Treat once every other day for 7 treatments as a course.

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For insomnia due to interior Fire with a burning sensation in the chest: HT-5, PC-6, and SP-6. (Zhen Jiu Xue Jian Bian) Insert 1.5 cun #32 needles into SP-6 perpendicularly, 1 cun deep with a lifting and thrusting reducing needle technique. Insert 1 cun #32 needles into HT-5 and PC-6 with a twisting reducing needle technique. Retain all needles for 20 minutes. Treat twice a week for 5 treatments as a course. For insomnia: ST-30, LV-13, SP-1, LU-3, BL-13, GV-14, SP-6, and SP-9. (Shen Yin Jing) Insert 1.5 cun #32 needles into ST-30, SP-9, and SP-6 perpendicularly, 1 cun deep with a twisting reinforcing needle technique. Insert 1 cun #32 needles into LV-13 and LU-3 with a twisting reducing needle technique. Retain all needles for 20 minutes. Insert a 1.5 cun #30 needle into GV-14 perpendicularly, 1 cun deep with a twisting reducing needle technique and 1 cun #30 needles into BL-13 perpendicularly, 0.5 cun deep with a twisting even movement needle technique. Apply direct non-scarring moxibustion on SP-1 for 9 cones. Treat once every other day for 5 treatments as a course. For insomnia due to Blood Deficiency and stagnation of Liver Qi: BL-45 and CV-5. (Zhen Jiu Chu Fang Xue) Apply direct non-scarring moxibustion on BL-45 for 9 cones and on CV-5 for 5 cones. Treat once daily for 7 treatments as a course. For insomnia: HT-7, BL-15, and SP-6. (Zhen Jiu Chu Fang Xue) Insert 1 cun #30 needles into BL-15 perpendicularly, 0.5 to 0.8 cun deep with a lifting and thrusting reinforcing needle technique, and remove the needles after the Qi travels. Insert 1 cun #32 needles into HT-7 perpendicularly, 0.5 cun deep with a twisting even movement needle technique and 1.5 cun #32 needles into SP-6 perpendicularly, 1 cun deep with a lifting and thrusting reinforcing needle technique. Retain all needles for 20 minutes. Treat twice a week for 5 treatments as a course. For insomnia due to Liver Yang Rising: GV-14, GB-20, HT-7, and LV-3. (Zhen Jiu Pei Xue Liao Fa) Insert a 1.5 cun #32needle into GV-14 perpendicularly, 1 cun deep with a rubbing needle technique (rub the needle counter clockwise) until the sensation of the needle travels. Insert a 1.5 cun #32 needle into GB20 perpendicularly, 1 cun deep towards the direction of the nose with a twisting reducing needle technique. Retain all needles for 10 minutes. Insert a 1 cun #32 needles into HT-7 with a twisting even movement needle technique, and insert a 1 cun #30 needle into LV-3 with a twisting reducing needle technique. Retain all needles for 20 minutes. Treat once every other day in the afternoon for 5 treatments as a course. For insomnia: Tip of ear, Shen Men, Heart, Liver, Spleen, and Sub cortex. (Author’s Clinical Experience) Select one ear only, rub the tip of the ear until it looks red and apply a bloodletting technique on it to squeeze out 2 to 3 drops of blood. Apply press-balls on the other points. Treat twice a week (switch ears each treatment) for 4 treatments as a course. For insomnia due to Liver Fire: LV-2, GB-34, LV-13, and GV-20. (Author’s Clinical Experience) Insert a 1 cun #32 needle into LV-2 perpendicularly, 0.3 cun deep with a twisting reducing needle technique, and apply moxa wool on the handle of the needle for 2 cones. Insert a 1.5 cun #30 needle into GB-34 perpendicularly, 1.2 cun deep with a lifting and thrusting reducing needle technique and a 1 cun #32 needle into LV-13 with a twisting even movement needle technique. Insert a 1.5 cun #32 needle into GV-20 with a lifting Qi technique. Retain all needles for 20 minutes. Treat once every other day for 7 treatments as a course.

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Insomnia

For insomnia due to Yin Deficiency: HT-4, KI-1, CV-14, and BL-23. (Author’s Clinical Experience) Insert 1 cun #32 needles into HT-4 perpendicularly, 0.5 cun deep with a twisting reducing needle technique and 1 cun #32 needles into KI-1 perpendicularly, 0.5 cun deep with a twisting reinforcing needle technique. Insert a 1.5 cun #32 needle into CV-14 perpendicularly, 1 cun deep with a twisting reducing needle technique and a 1.5 cun #32 needle into BL-23 with a lifting and thrusting reinforcing needle technique. Retain all needles for 30 minutes, and apply moxa pole on KI-1 for 15 minutes. Treat twice a week for 7 treatments as a course. CASE ANALYSIS A 35 year-old female patient has had the main symptom of insomnia for 2 years with difficulty falling asleep and easily waking up, which has intensified the last month to the point of not even sleeping over night, associated with a headache, lassitude, hot flashes, and heart palpitations. The tongue was red with little coating, and the pulse was thin and fast. Diagnosis: Insomnia due to Yin Deficiency. Treatment Principle: Nourish the Yin and Subdue the Fire. Point Prescription: KI-6, HT-7, Ying Tang, BL-15, and BL-23. Treat once every other day for 5 treatments as a course. Technique: Insert a 1 cun #30 needle into BL-15 perpendicularly, 0.5 to 0.8 cun deep with twisting and lifting and thrusting reducing needle techniques and a 1.5 cun #32 needle into BL-23 with a lifting and thrusting reinforcing needle technique. Retain all needles for 10 minutes. Insert a 1 cun #32 needle into KI-6 slowly (which means putting the needle on the point and slowly twisting and pressing the needle into the point, taking nearly 2 minutes), 0.3 cun deep with a twisting reinforcing needle technique. Insert 1 cun #32 needles into HT-7 and Yin Tang with twisting even movement needle techniques. Retain all needles for 20 minutes. Result: After 2 treatments, the patient was able to sleep over 4 hours at night, but would still wake up and have difficulty falling back asleep. After 2 courses of treatments all the symptoms disappeared. EVALUATION Acupuncture and moxibustion are very effective for treating any type of insomnia in combination with other symptoms. It can regulate the functioning of the organs, balance Yin and Yang, harmonize Wei Qi and Ying Qi and calm the Shen. There are critical principles in treating insomnia clinically. Most of the time, the treatment will focus on the reason causing the insomnia—the root treatment. Point prescriptions will most frequently consider two angles, one for the root and another to calm the mind. It is best to treat the patient in the afternoon between three and seven o’clock. Sometimes, acupuncture and moxibustion will be a supplemental therapy when the insomnia is secondary to another disease, for example: cancer pain, severe infection, severe injury, etc.

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Acupuncture and Moxibustion—A Clinical Desk Reference

LIN SYNDROME—STRANGURIA Lin syndrome or stranguria refers to irregular urination that is slow and painful. In TCM it is usually caused by urinary tract infections, kidney stones or dysfunction of the organs. Dysfunctions of the urinary tract organs such as Kidney and Urinary Bladder Qi Deficiency or Spleen and Kidney Deficiency may be a major cause. Frequent scanty urination with burning, pain, or distension in the genital area during urination is the main symptom, and is included some western medicine diseases, such as acute cystitis, acute pyelonephritis, and chronic pyelonephritis. Damp-Heat Both a Damp-Heat Invasion or Damp-Heat produced by a Spleen Deficiency can impact the Urinary Bladder, causing Lin syndrome with Heat and a burning sensation. Kidney and Spleen Deficiency A deficiency of the Kidney and the Spleen fails in transforming the essence of the food and water, resulting in cloudy, unclean urine. Kidney Qi Deficiency Most of the time, this will happen in older people. Deficiency of the Kidney Qi makes it hard to move and pass the urine, causing urinary incontinence. Interior Heat Long-term accumulation of heat will burn or damage the blood Luo meridians, causing urination with pain and bleeding. DIAGNOSIS Stranguria with Heat Symptoms include uneven and frequent urination that is yellowish in color with a scanty amount of fluid, burning sensations upon urination, lower abdominal bloating and distention, a red tongue with a greasy yellow coating and a floating and fast pulse. Fever and aversion to cold, bitter taste, and constipation may occur in some cases. Stranguria with Stones (Uropsammus) This manifests as acute pain in the urinary tract and lower abdomen upon urination. The flow of the urine may be interrupted, depending upon positional changes of the body, with a yellowish or red urinary color, and white or yellow tongue coating and a wiry and tight pulse. If the stone is located in the upper urinary tract, the patient might present with severe lower back or abdominal pain, a pale complexion, nausea, vomiting and cold sweats. Stranguria with Blood (Hematuria) This is acute, frequent, red urination with sensations of heat and burning pain, lower abdominal bloating and distention, a red tongue with a yellow greasy coating and a thin and fast pulse.

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Lin Syndrome—Stranguria

Stranguria with Qi Stagnation (Urinary Incontinence) Symptoms include distension and bloating in the genital region, difficulty in emptying the urinary bladder or intermittent urinary flow with symptoms of Qi deficiency (such as lassitude, low energy, shortness of breath that is aggravated by activity, a pale tongue and a thin and weak pulse). Stranguria with Cloudy and Turbid Urine (Galacturia) This syndrome is described as cloudy and turbid urine mixed with blood or clots and associated with uneven urination, a dry mouth, a red tongue with a greasy white coating and a floating and weak pulse.

TREATMENT AND PRESCRIPTION Treatment Principle: Regulate the Urinary Bladder Qi, Clear Heat and Promote urination and Reduce pain. Point Prescription: BL-28, CV-3, SP-9, LV-3, and KI-3. Treat once every other day for 7 treatments as a course. Technique: Insert 1.5 or 2 cun #30 needles into BL-28 with a lifting and thrusting even movement needle technique, and retain the needles for 10 minutes. Insert 1.5 cun #32 needles into CV-3 and SP-9 perpendicularly, 1 cun deep with a lifting and thrusting reducing needle technique and 1 cun #32 needles into LV-3 and KI-3 with a twisting even movement needle technique. Retain all needles for 30 minutes. Additional points for associated symptoms: Fever: LI-4 and TW-5. Urinary stones: BL-39 and KI-2. Blood in the urine: SP-10 and SP-6. Deficiency with difficulty emptying the Bladder: CV-6 and ST-28 with moxibustion. Cloudy and Turbid Urine (Galacturia): BL-24 and GV-20 with moxibustion. ADJUNCTIVE THERAPIES Electro-acupuncture Points: BL-23 and SP-6. (For any kind of painful urination, or with stones) Apply Electro-acupuncture with slow-fast waves with the negative side (black color) connecting to BL-23 and the positive side to SP-6 for 20 minutes to treat any kind of painful urination with stones. Treat once every other day for 3 treatments as a course.

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Acupuncture and Moxibustion—A Clinical Desk Reference

Ear Acupuncture Points: Urinary Bladder, Kidney, Occipital, and Sympathetic. Insert 0.5 cun ear needles in these points with a twisting even movement needle technique. Retain all needles for 1 hour. Treat once every other day for 7 treatments as a course. Or, apply press-ball to these points, pressing each point 1 to 2 minutes each time, 5 times daily. It is better to press them 20 minutes after drinking near 250cc of water. Retain the balls in the ear for 3 days. Treat once a week for 3 treatments as a course. Scalp Acupuncture Treatment zones: Middle line and Lateral line 1 of the vertex, and Lateral line 3 of the forehead. Insert 1.5 cun #30 needles into these lines transversely, 1 cun deep at a 30-degree angle with a lifting the Qi technique. Retain all needles for 30 to 40 minutes. Treat once every other day for 7 treatments as a course.

Bloodletting Treatment points: BL-40, BL-67, and KI-4. Used for painful urination with Heat. To treat painful urination with Heat, look for purple veins near these points, and apply a bloodletting technique and expel 2 drops of blood from each point. Treat twice a week for 3 treatments as a course. Moxibustion (For Qi or Yang Deficiency) Direct moxibustion: CV-4, SP-4, BL-32, and GV-4. Apply direct non-scarring moxibustion on CV-4 and SP-4 for 7 cones, and BL-32 and GV-4 for 9 cones. Treat once every other day for 7 treatments as a course. Indirect moxibustion: CV-8, ST-28, and CV-3. Apply indirect moxibustion with ginger on CV-8, ST-28, and CV-3 for 3 cones. Treat twice a week for 5 treatments as a course. Moxa pole: GV-20, SP-6, and CV-3. Apply moxa-pole on GV-20 for 15 minutes and on SP-6 and CV-3 for 20 minutes. Treat once every other day for 5 treatments as a course.

256

Lin Syndrome—Stranguria

TRADITIONAL PRESCRIPTIONS AND TECHNIQUES For stranguria with Heat: CV-4 and ST-30. (Dong Yuan Shi Shu) Insert a 1.5 cun #32 needle into CV-4 perpendicularly, 1 to 1.2 cun deep with a lifting and thrusting reducing needle technique and 1.5 cun #32 needles into ST-30 with a twisting even movement needle technique. Retain all needles for 30 minutes. Treat once every other day for 5 treatments as a course. For stranguria with Heat: KI-7 and CV-3. (Zhen Jiu Da Quan) Insert 1.5 cun #30 needles into KI-7 perpendicularly, 1 cun deep with a lifting and thrusting even movement needle technique and a 2 cun #30 needle into CV-3 with a twisting reducing needle technique. Retain all needles for 20 minutes. The treatment is once every other day, 7 treatments as a course. For stranguria with bleeding: BL-32. (Zhen Jiu Da Quan) Insert 3 cun #30 needles into BL-32 obliquely towards the front of the genitals, 2 cun deep with a twisting reducing needle technique or with Electro-stimulation for 20 minutes. The treatment is once every other day, 7 treatments as a course. For blood in the urine with pain: KI-6, KI-10, KI-1, and SP-6. (Zhen Jiu Da Quan) Insert 1 cun #32 needles into KI-1 obliquely towards LV-3 with a twisting even movement needle technique. Retain the needles for 10 minutes. Insert 1 cun #32 needles into KI-6 with a twisting reinforcing needle technique and 1.5 cun #32 needles into KI-10 and SP-6 with a twisting even movement technique. Retain all needles for 20 minutes. The treatment is once every other day, 7 treatments as a course. For urinary incontinence: KI-8, KI-1, CV-5, and GB-34. (Shen Yin Jing) Insert 1.5 cun #30 needles into KI-8 perpendicularly, 1 cun deep with a lifting and thrusting reducing needle technique and 1 cun #32 needles into KI-1 with a twisting reducing needle technique. Insert 1.5 cun #30 needles into CV-5 and GB-34 with a twisting even movement needle technique. Retain all needles for 30 minutes. Treat once every other day for 7 treatments as a course. For stranguria with stones: CV-4 and LV-1. (Zhen Jiu Zi Shen Jing) Apply direct non-scarring moxibustion on CV-4 and LV-1 for 7 cones. Treat once daily 30 cones as a course. For stranguria: LU-7, LV-4, BL-17, BL-19, BL-20, BL-23, and CV-6. (Shen Jiu Jin Lun) Apply direct non-scarring moxibustion on BL-17, BL-19, BL-20, and BL-23 for 5 cones and on LU-7, LV-4 and CV-6 for 7 cones. Treat once every other day for 3 treatments as a course.

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For stranguria: KI-7, BL-39, LV-1, ST-30, LV-4, GV-1, BL-28, CV-3, KI-2, LV-3, SP-11, BL-52, BL-33, CV-6, and ST-36. (Zhen Jiu Zhi Zhi) Insert 1.5 cun #32 needles into KI-7, ST-36, CV-6, LV-3, ST-30, and SP-11 perpendicularly, 1 cun deep with a twisting even movement needle technique and a 1 cun #32 needles into GV-1 perpendicularly, 0.8 cun deep with a twisting reducing needle technique. Retain all needles for 20 minutes. Insert 1 cun #30 needles into LV-4 and KI-2 with a twisting reducing needle technique. Insert a 3 cun #32 needle into CV-3 perpendicularly, 2 cun deep with a twisting reducing needle technique, and apply moxibustion to the handles of the needles for 3 cones. Insert 1.5 cun #30 needles into BL-39, BL-52, BL-33, and BL-28 perpendicularly, 1 to 1.2 cun deep with a lifting and thrusting reducing needle technique. Retain all the needles for 10 minutes. Apply direct non-scarring moxibustion on LV-1 for 7 cones. Treat twice a week for 5 treatments as a course. For stranguria: KI-10, CV-4, SP-6, and SP-9. (Zhen Jiu Da Cheng) Insert 1 cun #32 needles into KI-10 and SP-6 with a twisting reducing needle technique and 1.5 cun #32 needles into CV-4 and SP-9 with a lifting and thrusting even movement needle technique. Retain all needles for 30 minutes. Treat once every other day for 7 treatments as a course. For stranguria with Heat: ST-25, CV-4, CV-12, LV-1, SP-6, and BL-40. (Yi Xue Gang Yao) Insert 1.5 cun #32 needles into ST-25, CV-4, and CV-12 with a twisting reducing needle technique. Retain the needles for 20 minutes. After removing all of the needles, apply a bloodletting technique on LV-1, SP-6 and BL-40. Treat once a week for 3 treatments as a course. For stranguria with a Blood and Qi Deficiency: BL-17, BL-19, BL-20, BL-23, CV-6, CV-4, LV-1, PC-5, SP-10, KI-7. (Lei Jing Tu Yi) Insert 1 cun #30 needles into BL-17, BL-19, BL-20, and BL-23 perpendicularly, 0.5 cun to 0.8 cun deep with a twisting reinforcing needle technique, and apply moxa wool to the handles of the needles for 3 cones. Insert 1.5 cun #32 needles into CV-6 and CV-4 with a twisting reinforcing needle technique, and 1.5 cun #32 needles into PC-5, KI-7, and SP-10 with a twisting reinforcing needle technique. Retain all needles for 20 minutes. Apply direct non-scarring moxibustion on LV-1 for 5 cones. Treat once every other day for 7 treatments as a course. For stranguria with incontinence, Kidney Qi Deficiency, pain that travels to ST-30, and that is aggravated with exhaustion or after sexual activity: SP-6, BL-23, and KI-11. (Zhen Jiu Bian Yi) Insert 1.5 cun #32 needles into BL-23 perpendicularly, 1 to 1.2 cun deep with a lifting and thrusting reinforcing needle technique, and apply moxa wool to the handles of the needles for 3 to 5 cones. Insert 1.5 cun #30 needles SP-6 and KI-11 obliquely upward, 1 cun deep at a 60-degree angle, with a twisting even movement technique. Retain all the needles for 30 minutes. Treat once every other day for 7 treatments as a course. For stranguria with stone: CV-4, KI-13, LV-1, and SP-6. (Zhen Jiu Bian Yi) Apply direct non-scarring moxibustion on CV-4, KI-13 and LV-1 for 7 to 9 cones. Insert 1.5 cun #32 needles into SP-6 with a twisting reducing needle technique. Retain the needles for 20 minutes. Treat once every other day for 5 treatments as a course.

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Lin Syndrome—Stranguria

For stranguria with blood: KI-7, CV-4, and BL-32. (Zhen Jiu Da Chuan) Insert 1.5 to 3 cun #30 needles into BL-32 obliquely towards the genitals, 1 to 2 cun deep with a twisting reducing needle technique, retain the needles for 30 minutes or use an Electro-stimulation machine for 20 minutes on slow-fast waves. Insert 1.5 cun #32 needles into KI-7 and CV-4 with a lifting and thrusting reinforcing needle technique. Retain all needles for 30 minutes. Treat once every other day for 7 treatments as a course. For stranguria after bleeding has stopped but with a continuing painful sensation in the genital region: KI-6, KI-10, and SP-6. (Zhen Jiu Da Chuan) Insert 1 cun #30 needles into KI-6, KI-10, and SP-6 with a twisting reinforcing needle technique, and apply moxa wool to the handles of the needles for 5 cones. Treat once every other day for 5 treatments as a course. For urination with a burning sensation: KI-7. Insert 1.5 cun #30 needles into KI-7 obliquely towards SP-9, 1 to 1.2 cun deep at a 60-degree angle, with a lifting and thrusting reducing needle technique. Retain needles for 30 minutes. For a burning and bloated sensation in the lower abdominal region with difficulty urinating: ST-30. Insert 1.5 cun #32 needles in ST-30 perpendicularly, 1 to 1.2 cun deep with a twisting reducing needle technique, and retain the needles for 20 minutes. For stranguria with dribbling and difficulty emptying the bladder: Wai Huai Jian (an extra point located on the outermost tip of the lateral malleolus) SP-9, and KI-13. (Shen Yin Jing) Apply direct non-scarring moxibustion on Wai Huai Jian for 9 to 11 cones. Insert 1.5 cun #32 needles into SP-9 and KI-13 with a twisting reinforcing needle technique. Retain all the needles for 20 minutes. Treat once every other day for 7 treatments as a course. For stranguria with bloating in the lower abdomen and difficulty passing urine: CV-8. (Dan Xi Xin Fa) Apply indirect moxibustion with warm salt (warm the salt before using it) on CV-8 for 7 cones. Treat once daily for 3 treatments as a course. CASE ANALYSIS A 35 year-old male patient had a main complaint of left, sharp lower back sharp pain, which traveled down the leg for 1 day. He felt pain during urination, had a pale complexion, spontaneous sweats, nausea and difficulty sitting and standing. His tongue was red with a white coating and his pulse was tight and wiry. Diagnosis: Upper Urinary Tract Stone Treatment Principle: Reduce the pain and Promote urination. Point Prescription: Ear Acupuncture: Kidney and Abdomen. Treat once daily for 2 treatments as a course. Technique: Insert 0.5 cun ear needles into the Kidney and Abdomen obliquely, 0.4 cun deep at a 45-degree angle with a fast twisting needle technique, and retain the needles for 1 hour. Result: After 10 minutes of retaining the needles, the patient felt distention and numbness in the left lower back and lower abdominal regions, and the radiating painful sensation was gone after 20 minutes. All pain was gone after 40 minutes. It took one treatment only.

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EVALUATION Acupuncture and moxibustion is fairly effective in treating stranguria, particularly for acute infectious diseases (such as acute cystitis, acute pyelonephritis, or fungal infections). It is very effective for treating pain during urination with chronic prostatitis and chronic pyelonephritis. If the kidney stones are large with a diameter greater than 1.5 cm, acupuncture will be useful only as a supplemental therapy. A correct diagnosis, with correct needling techniques, is very important before and during the treatment. It will directly influence the effect of the acupuncture.

260

Low Back Pain

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Acupuncture and Moxibustion—A Clinical Desk Reference

LOW BACK PAIN External injury and internal injury are two main reasons for lower back pain in TCM. External injury refers to any trauma, accident, or External Invasion of the meridians that will lead to stagnation of Blood and Qi in the local meridians, collaterals, muscles, and tendons. Internal injury means low back pain due to internal causes, such as Kidney Deficiency, which fails in nourishing the back, urinary stones, or Blood Stagnation in the Intestines or other organs. Cold-Damp Invasion External Cold-Damp invades the meridians of the back when a patient sweats or stays in a damp environment for a long period of time. Back Injury Low back pain due to any kind of physical movement, sprain of the back muscles, tendons and/or meridians, leading to stagnation of Blood and Qi. Kidney Deficiency In Traditional Chinese Medicine, the low back is the house of the Kidney and that is why any kind of Kidney problem will cause low back pain, particularly in Kidney Jing Deficiency, Qi Deficiency or even Kidney Yin and Yang Deficiency. This pattern is common in senior citizens with a Kidney Deficient history. DIAGNOSIS Cold-Damp Invasion Symptoms of lower back pain due to this pattern include soreness and a heavy and tender sensation in the low back with inability to bend or move. Sometimes the pain may travel down to the hip, buttocks, and popliteal fossa. The pain will be aggravated by weather changes, with a swollen tongue and a white greasy coat, along with a deep and weak pulse. Kidney Deficiency Long-time or chronic lower back pain is usually the hallmark sign of Kidney Deficiency syndrome. Lassitude, a cold sensation in the four extremities, impotence, pale tongue with white coating, and a deep, thin and weak pulse indicated Kidney Yang Deficiency syndrome. Long-time or chronic low back pain with restlessness, Interior Heat, yellowish urine, and a red cracked tongue without coating, thin and rapid pulse indicated Kidney Yin Deficiency syndrome. Back Injury In this case, patients will usually have a history of a fixed sharp pain; inability to move the back, and pain that is aggravated by tiredness or low energy. There may be purple veins near the BL-40 area and the tongue will have black or purple dots. The pulse is wiry or choppy.

262

Low Back Pain

TREATMENT AND PRESCRIPTIONS Cold-Damp Invasion Treatment Principle: Expel the Cold and Resolve the Damp, and Warm the meridians. Point Prescription: GV-3, BL-23, BL-40, and BL-10. Treat once every other day for 3 treatments as a course. Technique: Insert a 1.5 cun #30 needle into GV-3 perpendicularly, 1.2 cun deep with the Long Hu Jiao Zhan— Dragon and Tiger Battle technique, and apply moxa wool on the handle of the needle for 3 cones. Insert 1.5 cun #32 needles into BL-10 and BL-23 perpendicularly, 1 cun deep with lifting and thrusting even movement technique, and apply moxa wool on the handle of needles for 3 cones. Apply bloodletting on BL-40 after finishing all the points in the treatment. Additional points for associated symptoms: Severe back pain: BL-62 and BL-37. With Cold and Damp Invasion: BL-10 and LU-5. Kidney Deficiency Treatment Principle: Reinforcing the Kidney Yin or Yang and Relieve the pain. Point Prescription: GV-4, BL-52, KI-3, and CV-6. Treat twice a week for 7 treatments as a course. Technique: Insert a 1.5 cun #32 needle into CV-6 perpendicularly, 1.2 cun deep with twisting reinforcing needle technique, and 1 cun #32 needles into KI-3 with twisting reinforcing needle technique. Apply moxa wool on the handle of needles for 2 cones. Insert a 1.5 cun #32 needle into GV-4 with twisting reinforcing needle technique, and apply indirect moxibustion with Fu Zi (aconite) cake on BL-52 for 3 cones. Additional points for associated symptoms: Insomnia: BL-15 and HT-7. Impotence: CV-4, SP-6, and BL-23. Kidney Yang Deficiency: Use reinforcing needle technique and moxibustion. Kidney Yin Deficiency: Use reinforcing needle technique without moxibustion when the patient has lowgrade fever or Interior Heat. Injury (Blood Stagnation) Treatment Principle: Resolve the Blood Stasis, Move the Qi, and Relieve the pain. Point Prescription: BL-17, BL-32, Ah Shi, GV-26, and SI-3. Treat once every other day for 7 treatments as a course. Technique: Insert a 1 cun #32 needle into GV-26 obliquely, 0.3 cun deep at a 60-degree angle towards the nose with twisting even movement needle technique for 1 minute, and then 1 cun #32 needles into SI-3 with twisting reducing needle technique. Meanwhile let patient move the back for a while until the symptoms are reduced. Insert 1.5 cun #30 needles into Ah Shi points with lifting and thrusting reducing needle technique, and apply a fire cup on it after removing the needles. Insert 1.5 cun #32 needles into BL-17 and BL-32 with twisting reinforcing needle technique. Retain all needles for 20 minutes. Treat once every other day for 5 treatments as a course. Additional points for associated symptoms: Severe pain: bloodletting technique on the BL-40. Blood Deficiency: SP-6 and SP-10. 263

Acupuncture and Moxibustion—A Clinical Desk Reference

ADJUNCTIVE THERAPIES Ear Acupuncture Points: Shen Men, Sub cortex, Spinal column, Thigh, Back, Kidney, Liver, Heart, and Helix. Select 3 points from the above in each treatment, inserting 0.5 cun #32 needles into theses points obliquely, 0.3 cun deep at a 45-degree angle, with fast twisting needle technique for 2 minutes. Retain all needles for 40 minutes. It is better for the patient to perform back movement during the retainment of the needles. Treat once daily for 3 treatments as a course. Scalp Acupuncture Treatment zones: Upper Middle Line and Upper Lateral Line of the occiput, Middle Line and Lateral Line 1 of the vertex, and the Anterior Oblique Line from the vertex to the temple. Select 3 treatment lines from above in each treatment, inserting 1.5 cun #30 needles into these lines transversely, 1 cun deep at a 30-degree angle, with lifting Qi technique for acute injury and fast twisting needle technique for chronic injury. Retain all needles for 1 hour. Treat once every other day for 5 treatments as a course. Hand Acupuncture Point Prescription: Back pain point and Spinal column. Insert 1 cun #32 needles into the Back Pain point perpendicularly, 0.3 to 0.5 cun deep with twisting reducing needle technique, and 1 cun #34 needles into the Spinal column points with twisting even movement needle technique. Retain all needles for 30 minutes. Treat once every other day for 3 treatments as a course. Foot Acupuncture Point Prescription: Inner Tai Cong and Kidney, Insert 1 cun #32 needles into these points perpendicularly, 0.3 cun deep with twisting reducing needle technique. Or apply direct non-scarring moxibustion on these points for 7 cones. Treat once every other day for 5 treatments as a course. Wrist and Ankle Acupuncture Treatment area: Upper 5, Upper 6, Lower 4, and Lower 5. Insert 1.5 cun #32 needles into these areas transversely, 1.2 cun deep at a 15-degree angle, with slow insertion technique and adjust to prevent any sensation of the needle. Treat once every other day for 5 treatments as a course. Nose Acupuncture Point Prescription: Shan Gen, Kidney, and Lung. Insert 0.5 cun #34 needles perpendicularly, 0.3 cun deep with twisting reducing needle technique. Retain all needles for 40 minutes. Treat once daily 2 treatments as a course. 264

Low Back Pain

Moxibustion Points: GV-4, BL-23, CV-6, BL-62, BL-11, CV-4, GV-20, and Ah Shi. Direct non-scarring moxibustion Apply direct non-scarring moxibustion on GV-4, BL-23, CV-6, BL-62, and BL-11 for 7 cones. Indirect moxibustion Apply indirect moxibustion with ginger or Fu Zi (aconite) cake on CV-4, GV-4, Shi Qi Zhui Xia, and Ah Shi point(s) for 3 cones. Moxa pole Apply moxa-pole on GV-20 and the Ah Shi for 15 minutes. Or apply the Lei Huo Zhen—one kind of big moxa pole with herbs inside) on the Ah Shi points for 7 cones. Cupping Treatment area: Back Apply fire cups on BL-25, Shi Qi Zhui Xia, and BL-23 and retain them for 5 minutes. Or apply a firemoving cup on the back and move up and down along BL and GV meridians for 5 minutes, retaining the cup on the Ah Shi point for 3 minutes. Apply several water cups on the back along BL meridian (boiling several bamboo cups in the big pot with the following herbs: Chuan Wu, Cao Wu, Fang Feng, Hong Hua, Du Huo, Qiang Huo, Hai Feng Teng, and Hu Zhang). Retain the cups until they fall when cooling off. Treat once daily for 2 treatments as a course, or use with other technique together. Bloodletting Point: BL-40, PC-3, GV-3, and Ah Shi. Select one of these points and local Ah Shi points and apply bloodletting to squeeze 2 drop of blood. Apply a Pi Zhen—one of the ancient 9 needles or a Feng Zhen—another of the ancient 9 needles, called three edged needle on the Ah Shi point, to make several drops of blood come out and add a fire cup on it. Retain the cup for 2 minutes. Treat once every other day for 2 treatments as a course, or use with other technique together. Gua Sha Treatment area: Sacrum, BL-40, LU-5, BL-18, and ST-5. Apply Gua Sha on these areas with medium-level stimulation, until Sha appears. (purple or black dots) Treat once every other day for 2 treatments as a course.

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TRADITIONAL PRESCRIPTIONS AND TECHNIQUES For low back pain by injury: LU-5, LI-11, LI-4, LI-10, SP-9, LV-3, ST-36, CV-5, and BL-40. (Shen Yin Jing) Insert 1.5 cun #30 needles into LU-5 perpendicularly, 1 to 1.2 cun deep with lifting and thrusting reducing needle technique, scraping the handle of needles for 3 minutes. Insert 1.5 cun #32 needles into LI-11, LI10, SP-9, ST-36, CV-5, and LI-4 with twisting even movement needle technique. Retain all needles for 20 minutes. BL-40 will be used when the patient has deficiency of Qi and Blood. Treat once every other day for 5 treatments as a course. For low back pain by injury: GB-41, BL-23, BL-40, and GV-6. (Zhen Jiu Da Quan) Apply bloodletting technique on BL-40 (have the patient stand facing a wall with their hands braced on the wall, heels lifted up slightly) in order to expel 2 or 3 drops of blood. After finishing the bloodletting, have the patient lie down on the treatment table and insert 1 cun #30 needles into BL-23 and GV-6 with twisting reinforcing needle technique. Then insert 1.5 cun #32 needles into GB-41 with twisting reducing needle technique as well. Retain all needles for 20 minutes. Treat once every other day for 2 treatments as a course. For low back pain due to stagnation of Blood: BL-40 and BL-23. (Dan Xi Xin Fa) Apply bloodletting on BL-40 (looking for purple floating veins near the point) for few drops of blood. Apply indirect moxibustion with ginger on BL-23 for 5 cones. Treat once a week for 3 treatments as a course. For low back pain with Kidney Deficiency: GV-6 and BL-23. (Lei Jing Tu Yi) Apply direct non-scarring moxibustion on GV-6 BL-23 for 7 cones. Treat once every other day for 7 treatments as a course. For low back pain due to injury: LU-5, BL-40, GV-26, GB-34, BL-64, BL-62, and BL-34. (Yi Xue Gang Mu) Insert 1.5 cun #30 needles into LU-5 with lifting and thrusting reducing needle technique, and a 1 cun #34 needle into GV-26 obliquely, 0.3 cun deep at a 60-degree angle towards the nose. Retain all needles for 10 minutes. Insert 1 cun #30 needles into BL-40, BL-64, and BL-62 with twisting reducing needle technique, and 1.5 cun #30 needles into GB-34 and BL-34 with lifting and thrusting reducing needle technique. Retain all needles for 10 minutes. Treat once every other day for 3 treatments as a course. For low back pain with Blood Stagnation: BL-40, BL-23, and BL-62. (Zhen Jiu Ju Ying) Apply direct non-scarring moxibustion on BL-23 and BL-62 for 7 cones, and apply bloodletting on BL-40. Treat once a week for 3 treatments as a course. For low back pain due to Kidney Deficiency: BL-23, BL-29, and GV-2. (Wei Shen Bao Jian) Apply direct non-scarring moxibustion on BL-23, BL-29, and GV-2 for 9 cones. Treat once every other day for 5 treatments as a course. For low back pain due to stagnation of Qi and Blood: GB-21, GB-30, ST-33, ST-36, BL-40, BL-57, GB-38, BL-62, BL-23, and GV-2 (Zhen Jiu Ju Ying) Insert 1.5 cun #30 needles into BL-57, GB-38, and BL-62 with twisting reducing needle technique, and 1.5 cun #32 needles into BL-23 and GV-2 with twisting reinforcing needle technique. Retain all needles for 20 minutes. Apply indirect moxibustion with ginger on GB-21, GB-30, ST-33, ST-36, and BL-40 for 3 cones. Treat once every other day for 3 treatments as a course. 266

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For low back pain due to Deficiency of the Kidney: KI-7. (Tian Yuan Tai Yi Ge) Insert 1.5 cun #30 needles into KI-7 perpendicularly, 1 cun deep with the Zi Wu Dao Jiu—one of the combined needle techniques and retain the needles for 20 minutes. Treat once daily for 3 treatments as a course. For low back pain due to Deficiency of the Kidney: BL-23, BL-40, KI-3, and BL-30. (Zhen Jiu Da Cheng) Insert 1 cun #30 needles into BL-23 and KI-3 with twisting reinforcing needle technique, and 1.5 cun #32 needles into BL-30 with lifting and thrusting even movement needle technique. Apply moxa-pole on BL-40 for 15 minutes. Treat once every other day for 7 treatments as a course.

The following prescriptions are from the Yi Xue Gang Mu. For low back pain that suddenly gets worse, where the patient can’t move: BL-62. Insert 1 cun #30 needles into BL-62 obliquely, 0.5 cun deep at a 60-degree angle upward with twisting reducing needle technique. Retain needles for 20 minutes. For low back pain with stiffness in spinal column: BL-23 and GV-4. Apply direct non-scarring moxibustion on BL-23 and GV-4 for 9 cones. For low back pain located in the interior of the spinal column: BL-52 and LV-2. Insert 1 cun #32 needles into LV-2 perpendicularly, 0.5 cun deep with twisting even movement needle technique. Apply moxa-pole on BL-52 for 15 minutes. For low back pain that travels to the upper back: LI-4. Insert 1.5 cun #32 needles into LI-4 perpendicularly, 1 cun deep with twisting reducing needle technique. Retain needles for 20 minutes. For low back pain that travels to the lower body: BL-62 and KI-7. Insert 1.5 cun #32 needles into KI-7 perpendicularly, 1 cun deep with twisting reinforcing needle technique, and 1 cun #32 needles into BL-62 perpendicularly, 0.5 cun deep with twisting even movement needle technique. Retain all needles for 20 minutes. For severe low back pain in the whole low back area: GB-40, LI-4, and BL-62. Inset 1 cun #32 needles into GB-40, BL-62, and LI-4 with twisting reducing needle technique. Retain all needles for 20 minutes. Treat one or twice a week for 5 treatments as a course for all of the above. The following prescriptions are from the Qian Jin Fang. For low back pain with stiff muscles: GV-11, GV-6, GV-2, GV-1, BL-11, BL-17, CV-9, BL-20, BL-26, and BL-27. Insert 1 cun #30 needles into GV-11, GV-6, GV-2, and GV-1 perpendicularly with twisting reinforcing needle technique, and 1.5 cun #32 needles into BL-11, BL-17, BL-20, BL-26, and BL-27 with twisting even movement needle technique. Retain all needles for 10 minutes. Insert a 1.5 cun #32 needle into CV-9 perpendicularly, 1 cun deep with twisting reinforcing needle technique, and apply moxa wool on the handle of needle for 3 cones. Treat twice a week for 5 treatments as a course. For low back pain and aversion to cold: BL-34, BL-53, and BL-39. Insert 1.5 cun #30 needles into BL-34, BL-53, and BL-39 perpendicularly, 1.2 cun deep with twisting reducing needle technique, and apply moxa wool on the handle of needles for 2 cones. Treat once every other day for 3 treatments as a course. 267

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For low back pain with a stiff and tender sensation in the interior of the spinal column: BL-52 and BL-63. Insert 1 cun #32 needles into BL-63 perpendicularly, 0.3 cun to 0.5 cun deep with twisting reducing needle technique, and apply direct non-scarring moxibustion on BL-52 for 7 cones. Treat once every other day for 3 treatments as a course.

The following prescriptions are from the Zhen Jiu Zi Shen Jing. For low back pain due to Cold-Damp: GV-2, BL-26, ST-30, BL-31, BL-34, and GB-29. Insert a 1 cun #30 needle into GV-2 with twisting reducing needle technique and take it out when a heavy or heat sensation is produced. Then apply a fire cup there for 2 minutes. Insert 1.5 cun #32 needles into BL-26, BL-31, and BL-34 with twisting reducing needle technique, and 3 cun #30 needles into GB-29 with twisting even movement needle technique. Retain all needles for 10 minutes. Insert 1.5 cun #32 needles into ST-30 perpendicularly, 1.2 cun deep with twisting reinforcing needle technique. Retain needles for 10 minutes. Treat once every other day for 3 treatments as a course. For low back pain with inability to move: ST-36, ST-33, GB-38, and LV-5. Insert 1.5 cun #32 needles into ST-36, ST-33, and GB-38 with lifting and thrusting even movement needle technique, and 1 cun #32 needles into LV-5 transversely, 0.5 cun deep with twisting reducing needle technique. Retain all needles for 10 minutes. Treat one daily 2 treatments as a course. For low back pain due to stagnation of Qi: LU-5. Insert 1.5 cun #32 needles into LU-5 perpendicularly, 1 to 1.5 cun deep with twisting, lifting and thrusting reducing needle technique. Continue the needle technique every 5 minutes during the 30 minutes of retainment. Treatment can be performed with other points at the same time as well. For low back pain with muscle weakness and lassitude: GB-20. Insert 1 cun #32 needles into GB-20 perpendicularly, 0.5 cun deep with twisting reducing needle technique. Retain the needles for 10 minutes. Treatment may be performed with other points at the same time as well. For low back pain due to injury: LV-13, BL-40, and BL-62. (Lei Jing Tu Yi) Apply bloodletting technique on BL-40 to make 2 drops of blood come out. Insert 1 cun #32 needles into LV-13 with twisting reducing needle technique. Retain needles for 20 minutes. Apply direct non-scarring moxibustion on BL-62 for 7 cones. Treat once daily for 3 treatments as a course. For low back pain with deficiency of the Kidney: GV-2 and CV-6. (Zhen Jiu Zhai Ying Ji) Apply indirect moxibustion with Fu Zi (aconite) cake on CV-6 for 5 cones, as well as a moxa-pole on GV-2 for 15 minutes. Treat once every other day for 5 treatments as a course. For acute low back injury: GV-26. (Author’s Clinical Experience) Let the patient sit on the desk and hang the feet without any support on the back. Insert a 1 cun #32 needle into GV-26 obliquely, towards the nose at a 60 degree angle with Que Zuo—Sparrow Pecking technique. Meanwhile encourage the patient to do back movement during the 5 minutes the needle is retained. Treat only once when there is acute pain or add with another prescription. 268

Low Back Pain

For acute low back injury: LU-5 and GB-34. (Author’s Clinical Experience) Let the patient sit on a desk and hang the feet without any support on the back. Insert a 3 cun #30 needle into GB-34 (injured sided only) perpendicularly, 2 cun deep towards the SP-9 direction, until a radiating sensation appears, helping the patient move the back (back and forth). Retain the needle for 3 minutes. Insert 1.5 cun #32 needles into LU-5 (patient sitting in a chair) perpendicularly, 1 cun deep with lifting and thrusting reducing needle technique and retain the needles for 20 minutes. Treat only once during the acute phase, or with another prescription. For acute low back injury: BL-1. (Author’s Clinical Experience) Insert 1 cun #32 needles into BL-1 perpendicularly, 0.5 to 0.8 cun deep with twisting reinforcing needle technique, and retain the needles for 20 minutes. Treat only once during the acute phase, or with another therapy. CASE ANALYSIS A female patient who was 35 years old, entered the clinic with a main complaint of low back pain for 2 days, caused by carrying a baby. She could not move and was only able to take some medicine to decrease the pain. The pain was severe and the patient refused to do any exam that required movement. The pulse was wiry and fast and the tip of the tongue was red with a thick white coating. Diagnosis: Back pain due to injury. Treatment Principle: Move the stagnation of Qi and Release the pain. Point Prescription: Scalp acupuncture (Upper middle line of occiput) to Release the pain and Move the Qi. Treat once daily 2 treatments as a course. Technique: Palpate the back of the head near the occipital area along the line and find Ah Shi points. Insert 1.5 cun #30 needles transversely, 1 to 1.2 cun deep at a 35-degree angle, downwards with a lifting Qi technique for 3 minutes. Then ask the patient to start moving the injured area. Retain the needles for 40 minutes. Result: After 3 minutes of needle technique, the pain was reduced immediately and upon removal of the needle after 40 minutes, the pain had completely disappeared. The next day the patient called back to say that no pain or even any discomfort had returned. EVALUATION Acupuncture and moxibustion are very effective for treating low back pain symptoms in both acute and chronic types. For some internal injury, the treatment will focus on the primary cause, which is usually the reason for the pain, not the treatment of the low back itself. For example, when low back pain is caused by a kidney stone, the treatment should involve more points along the Spleen and Kidney meridians and not just on the local low back area. On the other hand a correct diagnosis and needle technique will help the practitioner select the best point prescription and increase the effect of the treatment, and will also avoid misdiagnosis because some severe diseases require acupuncture with other therapies, such as cancer, TB, and other severe infections.

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Acupuncture and Moxibustion—A Clinical Desk Reference

PULMONARY TUBERCULOSIS TCM considers Pulmonary Tuberculosis as one of the most serious and infectious diseases. It easily infects persons with weak body constitutions. In the ancient times, TCM practitioners thought it was caused by two reasons: weak body constitutions and infection by TB bacteria, which means that if the body is healthy, people should not contract this disease. In the process of the disease, they thought TB bacteria infected the Lung and damage the Lung Yin first (drying the Lung), causing the Lung to fail in its function of ascending and descending. Cough then appears by rebellious Lung Qi, phlegm forms by Interior Deficient Fire, and then chest pain and hemoptysis due to the injury of the Lung meridian circulation. In some cases the disease can develop quickly and have dangerous results. DIAGNOSIS Acute Stage Symptoms include cough, fatigue, anorexia, weight loss, and light hemoptysis with phlegm. The tongue is red with a thin coating and the pulse is floating and fast. Chronic Stage Symptoms include severe and frequent dry cough with little phlegm or hemoptysis, malar flush and red dry lips, tidal fever in the afternoon, dry mouth and throat, night sweating, insomnia, chest pain, and spermatorrhea will appear in male patients, cessation of menstruation in females. The tongue is red without coating and the pulse is thin and fast. Severe or Late Stage Symptoms include hemoptysis in large amount, difficulty breathing, edema in the lower extremities, poor appetite, loose stool, heart palpitations in some cases, and spontaneous cold sweating with an irregular pulse and other symptoms of exhausted Yang. TREATMENT AND PRESCRIPTIONS Treatment Principle: Reinforcing Lung Yin and Qi and Resolve the cough. Point Prescription: LU-9, BL-13, BL-43, ST-36, SP-6, and KI-3. Treat once every other day for 5 treatments as a course. Technique: Insert 1 cun #32 needles into BL-43 perpendicularly with the Qi Ci—one ancient needle technique, where one needle is in the middle and two others are inserted beside it. Wave the needles until red marks appear. Insert 1 cun #30 needles into BL-13 perpendicularly, 0.7 cun deep with lifting and thrusting reinforcing needle technique. Retain all needles for 10 minutes. Insert 1 cun #32 needles into LU-9 and KI-3 perpendicularly, 0.3 cun deep with twisting reinforcing needle technique, and 1.5 cun #32 needles into ST-36 and SP-6 perpendicularly, 1 cun deep with twisting even movement needle technique. Retain all needles for 20 minutes. Additional points for associated symptoms: Cough with more phlegm: LU-5. Tidal fever: LU-10. Hemoptysis: LU-6. Night sweating: HT-6. Dry throat: KI-6. 270

Pulmonary Tuberculosis

Emission: BL-52. Cold limbs: CV-4 with moxibustion. ADJUNCTIVE THERAPIES Ear Acupuncture Point Prescription: Lung, Spleen, Kidney, Endocrine, and Shen Men. Insert 0.5 cun #32 ear needles obliquely, 0.3 cun deep at a 45-degree angle with twisting even movement needle technique. Retain all needles for 30 minutes. Treat once every other day for 5 treatments as a course. Moxibustion (Used for patients without Yin Deficient signs.) Direct moxibustion: GV-12 and BL-43. Apply direct non-scarring moxibustion on GV-12 and BL-43 for 9 cones. Treat once every other day for 7 treatments as a course. Indirect moxibustion: CV-6, CV-12, BL-13, and BL-23. Apply indirect moxibustion with Fu Zi (aconite) cake on CV-6 and CV-12 for 5 cones, and on BL13 and BL-23 for 3 cones. Treat once every other day for 5 treatments as a course. Gua Sha Treatment area: Back and Arm. Apply medium-level Gua Sha on the upper back from GV-14 to GV-9 and from BL-42 to BL-44 until red marks appear. Then apply weak stimulation Gua Sha on the arm near the LU-5 area until a red color appears. Treat twice a week for 5 treatments as a course. Plum Blossom Points: SP-6, SP-9, LU-5, LU-9, BL-13, BL-43, and BL-20. Apply weak stimulation of plum blossom needle technique on SP-6, SP-9, LU-5, and LU-9 until a red color appears. Then apply medium stimulation of plum blossom needle technique on BL-13, BL-43, and BL-20 until a red color with a little blood appears. Treat once every other day for 5 treatments as a course.

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TRADITIONAL PRESCRIPTIONS AND TECHNIQUES For pulmonary TB with cough and hemoptysis: Bai Lao, BL-13, CV-12, and ST-36. (Zhen Jiu Da Cheng) Insert 1.5 cun #32 needles into Bai Lao perpendicularly, 1-1.2 cun deep with the Shao Shan Huo—Burning on the Mountain technique until a heat sensation is produced under the needle. Insert 1 cun #32 needles into BL-13 perpendicularly, 0.8 cun deep with lifting and thrusting even movement needle technique until the sensation of the needle travels down along the spinal column. Retain all needles for 15 minutes. Insert 1.5 cun #32 needles into CV-12 and ST-36 with twisting reinforcing needle technique. Retain all needles for 20 minutes. Treat once every other day for 5 treatments as a course. For pulmonary TB with tidal fever and night sweating: Four Flowers points. (Yi Xue Zhen Chuan) Apply direct non-scarring moxibustion on the Four Flowers points for 9 to 11 cones. Treat twice a week for 3 treatments as a course. For pulmonary TB with chronic cough: BL-13 and GV-12. (Jiu Fa Mi Chuan) Apply direct non-scarring moxibustion on BL-13 and CV-12 for 9 cones. Treat once every other day for 5 treatments as a course. For pulmonary TB with phlegm and hemoptysis: LU-10, LU-5, PC-5, HT-7, LU-9, PC-8, LV-8, KI-3, KI-2, LV-3, BL-13, BL-18, and BL-20. (Zhen Yin Jing) Insert 1 cun #32 needles into LU-10, PC-5, HT-7, LU-9, PC-8, KI-3, LV-3, and KI-2 with twisting reinforcing needle technique. Insert 1.5 cun #32 needles into LU-5 and LV-8 with lifting and thrusting even movement needle technique. Retain all needles for 20 minutes. Apply direct non-scarring moxibustion on BL-13 for 20 cones, and on BL-18 and BL-20 for 3 cones. Treat once a week for 5 treatments as a course. For pulmonary TB with deficient body constitution: CV-4. (Pian Que Xin Shu) Apply direct moxibustion on CV-4 for 15 to 20 cones in each treatment, until accumulate to 500 cones as a course. For pulmonary TB with hemoptysis: LU-7, LU-9, LU-5, ST-36, and GV-13. (Author’s Clinical Experience) Insert a 1.5 cun #30 needle into GV-13 perpendicularly, 1-1.2 cun deep with twisting reinforcing needle technique until the sensation of the needle travels down along the spinal column. Take out the needle and then apply a fire cup on the point for 3 minutes. Insert 1.5 cun #32 needles into LU-7 transversely upward 1 cun deep at a 15-degree angle with twisting even movement needle technique. Insert 1.5 cun #32 needles into ST-36 and LU-5 perpendicularly, 1 cun deep with twisting reinforcing needle technique, and 1 cun #34 needles into LU-9 with twisting reinforcing needle technique. Retain all needles for 20 minutes. Treat once every other day for 5 treatments as a course. For pulmonary TB with cough and shortness of breath: BL-42 and Qu Lao. Qu Lao is an extra point located three cun above SP-21.) Insert 1 cun #30 needles into BL-42 perpendicular 0.3-0.5 cun deep with twisting reducing needle technique. Apply direct non-scarring moxibustion on Qu Lao for 7 cones. Treat twice a week for 7 treatments as a course.

272

Pulmonary Tuberculosis

For pulmonary TB with Interior Heat and deficiency of Yin and Qi: KI-1, CV-17, GV-20, BL-43, ST-36, and CV-12. (Zhen Jiu Da Cheng) Insert a 1.5 cun #32 needle into CV-17 obliquely, 1-1.2 cun deep downward at a 60-degree angle with twisting even movement needle technique, and 1.5 cun #34 needles into CV-12, ST-36, and GV-20 with twisting reinforcing needle technique. Retain all needles for 15 minutes. Insert 1.5 cun #32 needles into BL-43 obliquely, 1 cun deep at a 30-degree angle towards the BL-44 direction with twisting reinforcing needle technique, and 1 cun #32 needles into KI-1 perpendicularly, 0.6 cun deep with twisting even movement needle technique. Retain all needles for 10 minutes. Treat once every other day for 5 treatments as a course. For pulmonary TB with chronic cough and interior fever: BL-15, BL-18, BL-14, BL-22, and San Zhui Gu Shang. (Lei Jing Tu Yi) San Zhui Gu Shang is an extra point located between T-2 and T-3. Insert a 1.5 cun #30 needle into San Zhui Gu Shang perpendicularly, 1 cun deep with twisting reducing needle technique until the sensation of the needle travels from the needle. Insert 1 cun #32 needles into BL15, BL-14, and BL-18 perpendicularly, 0.5-0.8 cun deep with lifting and thrusting reinforcing needle technique, and 1.5 cun #32 needles into BL-22 perpendicularly, 1-1.2 cun deep with twisting even movement needle technique. Retain all needles for 15 minutes. Treat one every other day for 5 treatments as a course. For pulmonary TB with deficiency of Qi and Yang: CV-4, LU-1, and BL-23. (Author’s Clinical Experience) Apply direct non-scarring moxibustion on LU-1 for 11 cones. Apply indirect moxibustion with Fu Zi (aconite) cake on CV-4 for 7 cones, and on BL-23 for 5 cones. Treat once every week for 20 treatments as a course. For pulmonary TB with night sweating and Interior Heat: HT-6, BL-42, BL-43, GV-9, and KI-3. (Author’s Clinical Experience) Insert 1 cun #30 needles into BL-42 and BL-43 perpendicularly with the Qi Ci method and waving technique until a red color appears around the needle. Insert a 1.5 cun #32 needle into GV-9 perpendicularly, 1 cun deep with twisting reinforcing needle technique. Retain all needles for 15 minutes. Insert 1 cun #32 needles into HT-6 and KI-3 perpendicularly, 0.3 cun deep with twisting even movement needle technique. Retain all needles for 20 minutes. It’s better to treat the patient in the afternoon between 5 to 7 PM, once every other day for 7 treatments as a course. For pulmonary TB with Yin Deficiency: GV-13, GV-4, BL-13, and BL-23. (Author’s Clinical Experience) Apply a 1.5 cun #32 needle for GV-13 perpendicularly, inserting the needle 1 to 1.2 cun deep with twisting reducing needle technique. Insert 1 cun #32 needles in GV-4, BL-13, and BL-23 with lifting and thrusting reinforcing needle technique and retain all needles for 20 minutes. Treat once every other day for 10 treatments as a course.

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For pulmonary TB with Qi and Yin Deficiency: LU-3, LU-5, ST-36, CV-6, BL-3, BL-13, and BL-23. (Author’s Clinical Experience) Insert 1 cun #32 needles into BL-3 transversely, 0.5 cun deep at a 30-degree angle towards the BL-2 direction with twisting even movement needle technique. Insert 1.5 cun #32 needles into LU-3, ST-36, and LU-5 perpendicularly, 1 cun deep with twisting reinforcing needle technique. Insert a 1.5 cun #34 needle into CV-6 perpendicularly, 1-1.2 cun deep with lifting and thrusting reinforcing needle technique. Retain all needles for 20 minutes. Insert 1 cun #32 needles into BL-13 perpendicularly, 0.5 cun deep with lifting and thrusting even movement needle technique, and 1.5 cun #32 needles into BL-23 with lifting and thrusting reinforcing needle technique. Retain all needles for 10 minutes. Treat twice a week for 7 treatments as course. CASE ANALYSIS A 32 year-old male patient presented with the main complaint of pulmonary TB for 2 years which was controlled by antibiotics, but he still had a bad cough and hemoptysis that was associated with night sweating, low grade fever, weight loss, chest pain, poor appetite, insomnia, and heart palpitations. The tongue was red without coating and the pulse was floating, fast, and weak. Diagnosis: Lung Yin Deficiency Treatment Principle: Reinforce the Lung Yin and Resolve the cough. Point Prescription: BL-13, BL-43, ST-36, KI-3, LU-5, LV-13, SP-6, and HT-6. Treat once every other day for 5 treatments as a course. Technique: Insert 1 cun #30 needles into BL-13 perpendicularly, 0.5-0.8 cun deep with lifting and thrusting reinforcing needle technique, and 1.5 cun #30 needles into BL-43 obliquely, 1 cun deep at a 45-degree angle towards the BL-44 direction with twisting even movement needle technique. Retain all needles for 10 minutes. Insert 1 cun #34 needles into HT-6 and KI-3 perpendicularly, 0.3 cun deep with twisting even movement needle technique, and 1.5 cun #32 needles into LU-5, SP-6, ST-36, and LV-13 with twisting reinforcing needle technique. Retain all needles for 20 minutes. Result: All symptoms improved after one course of treatment and the pulmonary TB was clinically healed after a total of three courses of treatment. EVALUATION Acupuncture and moxibustion are effective for treating of pulmonary TB, particularly for reducing the clinical symptoms, such as night sweating, cough, hemoptysis, and chest pain. Most of the time in modern civilized societies, acupuncture and moxibustion will play only a role as a supplemental treatment or will be used for some patients who are allergic to antibiotics. Acupuncture and moxibustion will help increase the body’s True Qi in order to recover the health of the body and that is why it is the most effective treatment in the early stage of the disease. However, due to the lack of immediate results to rescue patients with severe TB, acupuncture serves only as supplemental therapy in these cases.

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Madness and Insanity

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Acupuncture and Moxibustion—A Clinical Desk Reference

MADNESS AND INSANITY There is no single word for Psychology within Traditional Chinese Medicine. There are however, two words used in TCM to describe mental disorders with abnormal behavior. One is called Dian, which means mental patients characterized by catatonia—a Yin type of mental disorder when the patient is in a catatonic state of none movement. The other is Kuang, which refers to madness and insanity—a Yang type of mental disorder opposite to Dian. In this disorder patients are characterized by mania and excessive behavior and emotional fluctuations. They are both part of mental disorders. Dian and Kuang in TCM involve the Heart Shen being misted or obstructed by stagnation of phlegm and Qi, or the accumulation of Phlegm-Fire disturbing the Yang Ming meridians. As a result, the Heart fails in controlling the Shen and mental disorders form. Dian—Catatonia This is most often due to long-term severe and harmful emotional stimulation, which impacts the Heart Shen. Or, it could also be caused by Interior Phlegm stagnation misting the Heart Shen. Kuang—Mania This is typically an acute syndrome, when compared with Dian and is due to Phlegm-Fire and Liver Fire Rising and bothering the Shen. Within TCM pathology, Dian is considered to be a Yin type of mental disorder, which is caused by stagnation of Phlegm and Qi and Kuang is a Yang type of mental disorder, which is caused by rising Phlegm-Fire as was previously noted. However, in the clinic these two types of mental disorders could transform into others under certain circumstances. DIAGNOSIS Dian—Catatonia This mental disorder is characterized by abnormal behavior, mental depression, a trance, a tendency towards suspicion and delusion, abnormal crying, sadness, and movements. The tongue is red with a greasy coating and the pulse is slippery. As there is an inclination towards Qi and Blood Deficiency, the patient will often have insomnia, be easily frightened, and have a dull affect, a poor appetite, and a pale complexion. In this case the tongue is pale with a thin white coat and the pulse is thin and wiry. Kuang—Mania The patient will have a flushed complexion, dysphoria, anger and paraphasia, may even run around nude, and suffer from insomnia. The tongue is red with a yellow dry or greasy coating and the pulse is fast and slippery. Long-term it will damage the Yin from the stagnation of Fire and the patient will have restlessness, be easily frightened, and suffer poor sleep. The tongue in this case will be red without a coat and the pulse will be thin and fast.

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TREATMENT AND PRESCRIPTIONS Dian—Catatonia Treatment Principle: Regulate the Qi, Resolve the Phlegm, and Calm the Heart’s Shen. Point Prescription: HT-7, PC-7, Yin Tang, CV-17, ST-40, and SP-6. Treat once every other day for 10 treatments as a course. Technique: Insert 1 cun #32 needles into HT-7 and PC-7 perpendicularly, 0.5 cun deep with a twisting reducing needle technique and 1.5 cun #32 needles into Yin Tang transversely, 1 cun deep at a 30-degree angle towards the nose with a twisting reducing needle technique. Insert a 1.5 cun #30 needle into CV-17 obliquely towards CV-16 with a lifting and thrusting reducing needle technique and 1.5 cun #32 needles into SP-6 and ST-40 with a lifting and thrusting reinforcing needle technique. Retain all needles for 30 minutes, and repeat the needle technique every 5 minutes. Additional points for associated symptoms: Blurry eyes: BL-1 and BL-2. Ringing ear: SI-19. Crying and sadness: LU-9 and LU-1. Kuang—Madness and Insanity Treatment Principle: Subdue the Liver Fire, Calm the Heart, and Resolve the Phlegm. Point Prescription: PC-8, GV-26, CV-13, KI-4, and LV-2. Treat once daily for 5 treatments as a course. Technique: Insert a 1 cun #28 needle into GV-26 perpendicularly, 0.3 cun deep with a fast twisting needle technique and 1 cun #30 needles into PC-8, LV-2, KI-4 perpendicularly, 0.5 cun deep with a twisting, lifting and thrusting reducing needle technique. Insert a 1.5 cun #32 needle into CV-13 with a twisting even movement needle technique. Retain all needles for 30 minutes, and repeat the needle technique every 5 minutes. Additional points for associated symptoms: Severe Heat: GV-14 and GV-20. Severe madness: LV-3 and TW-6. Insomnia: Yin Tang and An Mian.

ADJUNCTIVE THERAPIES Ear Acupuncture Points: Heat, Sub cortex, Kidney, Forehead, Occipital, and Shen Men. Insert 0.5 cun #32 ear needles into these points obliquely, 0.3 cun deep at a 45-degree angle with a fast twisting needle technique for Kuang (madness) and with a twisting reinforcing needle technique for Dian (stupemania/catatonia). Retain all needles for 30 minutes. Or, apply Electro-stimulation on Sub cortex and Kidney with fast-slow waves for 30 minutes. Treat once daily for 5 treatments as a course.

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Scalp Acupuncture Treatment zones: Middle line of the forehead and vertex, Upper Middle line of the occipital, Lateral line 3 of the forehead, and Anterior line of the temple. Insert 1.5 cun #30 needles into these lines transversely, 1 cun deep at a 30-degree angle with a fast twisting reducing needle technique. Retain all needles for 40 minutes, and repeat the needle technique every 10 minutes. Treat once every other day for 5 treatments as a course. Nose Acupuncture Points: Heart, Kidney, Lung, and Gall Bladder. Insert 0.5 cun #32 needles into these points perpendicularly, 0.3 cun deep with a fast twisting needle technique. Retain all needles for 20 minutes. Treat once every other day for 5 treatments as a course. Foot Acupuncture Points: Li Nei Ting, Liver, Heart, Head, and Small intestine. Insert 1 cun #32 needles into these points perpendicularly, 0.3 to 0.5 cun deep with a twisting reducing needle technique. Retain all needles for 30 minutes, and repeat the needle technique every 5 minutes. Moxibustion Direct non-scarring moxibustion: Apply direct non-scarring moxibustion on Gui Ku (“Ghost Crying” point, located on the dorsal top of the inter-phalange articulation of the thumb), KI-1, and LI-11 for 7 cones. Treat once daily for 3 treatments as a course. Indirect moxibustion: Apply indirect moxibustion with ginger or a Fu Zi (aconite) cake on CV-4, GV-4, GV-14, and BL45 for 3 cones. Treat once every other day for 5 treatments as a course. Moxa pole: Apply a moxa pole to GV-20 and KI-1 for 20 minutes. Treat once daily for 7 treatments as a course. Usually this is performed along with other therapeutic techniques. Gua Sha Treatment area: Chest, Back, and Leg. Apply medium stimulation of Gua Sha on the chest along the CV, Stomach, and Kidney meridians until a dark red or purple color appears. Apply medium stimulation on the back from GV-14 to GV-7 and BL-41 to BL-46 until a dark red or purple color appears. Apply medium stimulation around BL-40 until a dark red color appears. Treat once every other day for 3 treatments as a course.

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Bloodletting Prescription 1: PC-3, PC-9, HT-9, LU-11, LI-1, and Yin Tang. Prescription 2: LV-1, BL-67, SP-1, BL-40, Tai Yang, and the Tip of the ear. Apply bloodletting techniques on these points, squeezing out 1 or 2 drops of blood. Treat once daily, changing the prescription every day for 5 treatments as a course. TRADITIONAL PRESCRIPTIONS AND TECHNIQUES For Dian: GV-23, GV-20, GB-20, LI-11, LU-5, TW-4, SI-4, ST-41, BL-62, BL-60, SP-5, KI-2, BL-66, and BL-57. (Shen Yin Jing) Insert 1 cun #28 or #30 needles for all these points perpendicularly, 0.3 cun deep with a twisting reducing needle technique. Remove the needles without retaining, and try to enlarge the holes as the needles come out. Apply a moxa pole on GV-20 for 30 minutes. Treat once daily for 5 treatments as a course. For Dian when the patient doesn’t like to see people: Gui Ku (extra point). (Wan Bing Hui Chun) Gui Ku—the Ghost Crying point is located on the dorsal top of the inter-phalange articulation of the thumb. Tie the two thumbs together with a rope, and then apply direct moxibustion on Gui Ku for 7 cones. Treat once daily for 2 treatments as a course. For Kuang: SI-8, PC-5, HT-7, LI-4, SI-3, KI-7, and TW-24. (Shen Yin Jing) Insert 1.5 cun #32 needles into SI-8 obliquely, 1 cun deep at a 40-degree angle towards SI-7 with a twisting reducing needle technique and 1 cun #32 needles into HT-7, LI-4, and SI-3 with a twisting reducing needle technique. Insert 1.5 cun #30 needles into KI-7 with a lifting and thrusting reinforcing needle technique and 1 cun #30 needles into TW-24 perpendicularly, 0.5 cun deep with a twisting reducing needle technique. Retain all needles for 30 minutes. Treat once every other day for 7 treatments as a course. For Kuang when the patient doesn’t recognize family members: CV-14. (Zhen Jiu Da Cheng) Insert a 1.5 cun #30 needle into CV-14 perpendicularly, 1 cun deep with a lifting and thrusting reducing needle technique, and retain the needle for 15 minutes. Repeat the needle technique every 5 minutes during the retainment. Treat once every other day for 5 treatments as a course. For Kuang with severe heart palpitations: PC-6, HT-9, BL-15, CV-12, and Shi Xuan. (Zhen Jiu Da Cheng) Insert 1.5 cun #32 needles into PC-6 obliquely, 1 cun deep at a 60-degree angle upwards with a twisting even movement needle technique and a 1.5 cun #30 needle into CV-12 perpendicularly, 1 cun deep with a lifting and thrusting reducing needle technique. Insert 1.5 cun #30 needles into BL-15 obliquely, 1 cun deep at a 60-degree angle towards the spinal column direction with a lifting and thrusting reducing needle technique, and retain the needles for 10 minutes. Apply a bloodletting technique on HT-9 and Shi Xuan, squeezing out 1 or 2 drops of blood out of each point. Treat once every other day for 5 treatments as a course.

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For both Dian and Kuang in the stage of attack: the Thirteen Ghost points for Dian and Kuang. (Qian Jin Fang) GV-26, LU-11, SP-1, PC-7, BL-62, GV-16, ST-6, CV-24, PC-8 GV-23, CV-1, LI-11, and Hai Quan. Insert 1 cun #28 needles into GV-26, LU-11, BL-62, CV-24, and CV-1 perpendicularly, 0.3 cun deep with a fast twisting needle technique and 1 cun #30 needles into SP-1, GV-16, PC-8, and GV-23 perpendicularly, 0.2 cun deep with an even movement needle technique. Insert 1 cun #30 needles into ST-6 and PC-7 perpendicularly, 0.5 cun deep with a twisting reducing needle technique, and 1 cun #28 fire-needles into LI11 perpendicularly, 0.5 cun deep. Apply a bloodletting technique on Hai Quan (extra points: Jing Jing and Yu Ye), and squeeze out a few drops of blood. Treat just in this circumstance. For Kuang: LI-11, GB-39, Bai Lao, and KI-1. (Zhen Jiu Da Cheng) Insert 1.5 cun #28 needles into LI-11 with a twisting, lifting and thrusting reducing needle technique and 1.5 cun #32 needles into GB-39 with a twisting even movement needle technique. Retain all needles for 20 minutes. Insert 1.5 cun #30 needles into Bai Lao perpendicularly, 1 to 1.2 cun deep with a lifting and thrusting reinforcing needle technique and 1 cun #32 needles into KI-1 perpendicularly, 0.5 cun deep with a twisting even movement needle technique. Retain all needles for 10 minutes. Treat once every other day for 7 treatments as a course. For Dian: BL-58 and ST-24. (Pu Ji Fang) Insert 1.5 cun #30 needles into BL-58 with a twisting even movement needle technique, and retain needles for 10 minutes. Insert 1.5 cun #32 needles into ST-24 perpendicularly 1 cun deep with a lifting and thrusting reducing needle technique. Apply moxa wool to the handles of the needles for 3 cones. Treat once every other day for 5 treatments as a course. For Kuang with violence: CV-14 and BL-15. (Pian Que Xing Shu) Apply direct moxibustion on BL-15 for 5 cones. Apply direct non-scarring moxibustion on CV-14 for 12 cones. Treat once every other day for 3 treatments as a course. For Dian: GV-12 and GB-13. (Bai Zhen Fu) Insert a 1.5 cun #30 needle into GV-12 perpendicularly, 1 cun deep with the Long Hu Jiao Zhan—Dragon and Tiger Battle technique, and retain the needle for 10 minutes. Insert 1.5 cun #32 needles into GB-13 transversely, 1 cun deep towards BL-15 with a fast twisting needle technique. Retain the needles for 30 minutes. Treat once every other day for 5 treatments as a course. For Kuang: GV-20, KI-10, PC-5, ST-36, and KI-7. (Shen Jiu Jing Lun) Apply a moxa-pole on GV-20 for 20 minutes. Apply direct non-scarring moxibustion on KI-10 and KI-7 for 7 cones. Insert 1.5 cun #32 needles into PC-5 and ST-36 perpendicularly, 1 cun deep with a lifting and thrusting reducing needle technique, and apply moxa wool to the handles of the needles for 3 cones. Treat once every other day for 5 treatments as a course. For Kuang where the patient wants to kill people: PC-5, GV-12, and SI-3. (Shen Yin Jing) Insert a 1.5 cun #28 needle into GV-12 perpendicularly, 1 cun deep with a rubbing technique (rub the needle counter-clockwise) until the sensation of the needle travels down along the spinal column. Insert 1.5 cun #32 needles into SI-3 perpendicularly, 1.2 cun deep towards PC-8 direction with a twisting reducing needle technique, and insert 1.5 cun #30 needles into PC-5 perpendicularly, 1 cun deep with a twisting reducing needle technique. Retain all needles for 20 minutes. Treat once every other day for 5 treatments as a course.

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For Kuang with divagation: KI-9, LI-9, BL-60, and CV-14. (Shen Jiu Jing Lun) Insert a 1.5 cun #30 needle into CV-14 perpendicularly, 1 cun deep with a twisting reducing needle technique, and apply moxa wool to the handles of the needles for 2 cones. Insert 1.5 cun #32 needles into KI-9 and LI-9 with a lifting and thrusting reducing needle technique and 1 cun #32 needles into BL-60 with a twisting reducing needle technique. Retain all needles for 20 minutes. Treat once every other day for 5 treatments as a course. For Kuang with unconsciousness: LI-11, GV-26, KI-1, and LI-4. (Zhen Jiu Yi Xue) Insert 1 cun #30 needles into KI-1 and GV-26 with a fast twisting needle technique and 1.5 cun #30 needles into LI-11 and LI-4 with a lifting and thrusting reducing needle technique, until the patient wakes up. Treat just in this circumstance. For Dian: ST-23, PC-9, HT-7, CV-13, GV-12, KI-4, ST-41, and GB-38. (Cai Ai Bian Yi) Insert 1.5 cun #30 needles into ST-23, CV-13, GB-38, and GV-12 perpendicularly, 1 cun deep with a twisting even movement needle technique, and apply moxa wool to the handles of the needles for 3 cones. Apply direct non-scarring moxibustion on PC-9 and KI-4 for 7 cones. Insert 1 cun #32 needles into HT-7 and ST-41 with a twisting reducing needle technique. Treat once every other day for 4 treatments as a course. For Dian: KI-6, LV-8, CV-6, PC-6, GV-14, BL-18, and BL-13. (Author’s Clinical Experience) Insert a 1.5 cun #30 needle into GV-14 perpendicularly, 1 to 1.2 cun deep with a rubbing needle technique (rub the needle counter-clockwise) until the sensation of the needle travels down along the spinal column. Insert 1.5 cun #32 needles into BL-13 and BL-18 obliquely, 1 cun deep at a 60-degree angle towards the spinal column with a lifting and thrusting reinforcing needle technique. Retain all needles for 10 minutes. Insert 1 cun #32 needles into KI-6, LV-8, and PC-6 with a twisting even movement needle technique and a 1.5 cun #32 needle into CV-6 with a twisting reinforcing needle technique. Retain all needles for 20 minutes. Treat once every other day for 5 treatments as a course. For Kuang: Bai Lao, GV-14, GV-16, GB-20, GV-15, GB-12, BL-42, GV-9, CV-15, LV-3, LI-4, and Yin Tang. (Author’s Clinical Experience) Insert 1.5 cun #32 needles into Bai Lao, GV-14, GV-16, GB-20, GV-15, GB-12, and GV-9 perpendicularly, 1 cun deep with a twisting reducing needle technique and 1 cun #30 needles into BL-42 with a twisting even movement needle technique. Retain all needles for 10 minutes. Insert 1 cun #30 needles into LV-3 and LI-4 with a lifting and thrusting reducing needle technique and a 1.5 cun #32 needle into CV-15 perpendicularly, 1 cun deep with a twisting reducing needle technique. Insert a 1 cun #32 needle into Yin Tang obliquely, 0.5 cun deep with a twisting even movement needle technique. Retain all needles for 15 minutes. Treat once every other day for 5 treatments as a course.

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CASE ANALYSIS A 19 year-old female patient had a main complaint of a mental disorder for 1 year and was diagnosis with “Stupemania”. Her father mentioned that it might be caused by some family problems that caused her to be depressed for a few years. One-year prior, she stopped talking to everyone and had insomnia, abnormal crying or laughing, dysmimia, a poor appetite, and irregular urination and bowel movements. The tongue was red with a yellow thick greasy coating, and the pulse was wiry and slippery. Diagnosis: Dian due to stagnant Qi and deficiency of the Heart and Spleen Blood. Treatment Principle: Calm the Shen, Nourish the Blood, and Resolve the stagnation. Point Prescription: The 13 Ghost points (by Dr. Sun Si Miao in his book Qian Jing Fang, 700-900 A.D) Treat once daily for 3 treatments as a course. Technique: Insert 1 cun #28 needles into GV-26, GV-23, CV-24, and ST-6 perpendicularly, 0.3 cun deep with a fast twisting reducing needle technique and then take the needles out. Insert 1.5 cun #30 needles into LI-11, PC-8, PC-7, BL-62, and CV-16 with a twisting reducing needle technique and then take the needles out. Insert 0.5 cun #28 needles into SP-1 and LU-11 with a bloodletting technique, removing 2 drops of blood. Insert 1.5 cun #28 needles into Jing Jing and Yu Ye with a bloodletting needle technique. Insert a 1 cun #32 needle into CV-1 perpendicularly, 0.8 cun deep with a twisting reducing needle technique and take the needle out. Result: After one course of treatment, her sleep improved and the abnormal crying and laughing was reduced. Her Shen was a little clearer than before. After two courses of treatments her appetite increased and the bowel and urine normalized. The prescription was then changed: CV-1, GV-26, PC-9, and LU-11 were left out, and PC-5, SI-1, ST-40, and BL-13 were added. After another 2 courses of treatments following the new prescription, she was cured. Two years later, she visited the clinic and was normal with her emotions and her life. EVALUATION Since 500 B.C, TCM practitioners battled with mental disorder problems. They thought those with uncanny powers bothered other peoples’ Shen, causing these disorders, which was often referred to as a ghost. That is why the 13 Ghost points were invented, and they are proved very effective in treating mental disorders. During the treatment of Kuang, be careful to prevent any needle accidents (such as broken or stuck needles, and fainting during the treatment). It’s better to start treatment when the patient has some pre-symptoms, such as severe insomnia, restlessness, abnormal emotional changes, etc. Also, Chinese herb formulas are strongly recommended to take along with the acupuncture. Acupuncture and moxibustion is now mostly a supplemental therapy in treating mental problems. It’s pretty popular and effective when applied to the pre-symptoms or recovery period. Because acupuncture treatments cannot easily and directly sedate or control behaviors, the patient should be placed on medication for violent or disruptive habits. The correct diagnosis will directly influence the effects of the treatment, which must follow TCM theory. Usually, the treatment course will be set less than 5 treatments, because the symptoms will change much quicker than other diseases.

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Malaria

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MALARIA Malaria is a common infectious disease that has proven to be fatal without treatment. During modern times, great achievements have been made in terms of battling this disease. This disease is parasitic in nature and is most common in warm humid climates. As western medicine and TCM describes, malaria is an infectious disease of the blood caused by the malarial mosquito (plasmodium). TCM also refers to it as Malaria Evil Qi. DIAGNOSIS Symptoms of malaria start with chills, achy sensation in the whole body, muscle spasm and shaking, and then a high fever appears that is associated with headache, flushed complexion, thirst, the fever abating after profuse sweating. If in the type of Damp-Phlegm, the patient will feel a stuffy sensation in the chest and epigastric region and will be associated with nausea or vomiting or cough. If the malaria invades interior body organs, the symptoms will be characterized by high fever and unconsciousness, even convulsion. The chronic malaria patient usually has a deficient body constitution and has associated signs such as a pale complexion, poor appetite, fatigue, and a mass in the abdomen. Usually the symptoms occur at the same time every day, or every other day, and the pulse is wiry and tight, the tongue red with thin yellow coating. Upon a blood test the plasmodium (malarial parasite) can be found. TREATMENT AND PRESCRIPITON Treatment Principle: Harmonizing Shao Yang, and Resolve the malaria. Point Prescription: GV-14, SI-3, TW-2, and LI-11. Treat 1 or 2 hours before malaria starts 10 treatments as a course. Technique: Insert 1.5 cun #30 needle into GV-14 perpendicularly, 1-1.2 cun deep with rubbing needle technique, (rub the needle count clockwise) until the sensation of the Qi travels down along the spinal column. Insert 1 cun #32 needles into SI-3 and TW-2 perpendicularly, 0.5 cun deep with twisting reducing needle technique, and 1.5 cun #30 needles into LI-11 perpendicularly, 1.2 cun deep with lifting and thrusting reducing needle technique. Additional points for associated symptoms: Fever: Shi Xuan with bloodletting technique. Damp-phlegm: BL-13 and ST-40. Convulsion: PC-6 and GV-26. Chronic malaria: BL-20, BL-21, and ST-36. Mass in the abdomen: LV-13 and Pi Gen. ADJUNCTIVE THERAPIES Ear Acupuncture Points: Sub cortex, Endocrine, Liver, Spleen, and Sympathetic. Insert 0.5 cun #32 ear needles into these points obliquely, 0.3 cun deep at a 45-degree angle with twisting reducing needle technique. Retain all needles for 40 minutes. Treat one hour before malaria happened for 5 treatments as a course.

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Malaria

Scalp Acupuncture Treatment zones: Anterior oblique line from the vertex to the temple, Middle line and Lateral line 2 of the forehead. Insert 1.5 cun #30 needles into these lines transversely, 1 cun deep at a 30-degree angle with fast twisting needle technique. Retain all needles for 30 minutes. Treat one hour before malaria happened for 5 treatments as a course. Moxibustion Direct moxibustion: GV-12, BL-17, LV-13, and PC-5. Apply direct non-scarring moxibustion on GV-12 and BL-17 for 11 cones, and on LV-3 and PC-5 for 7 cones. Treat once every other day for 7 treatments as a course. Indirect moxibustion: CV-12, CV-6, BL-20, and GV-14. Apply indirect moxibustion with ginger on BL-20 and GV-14 for 5 cones, and on CV-12 and CV-6 for 3 cones. Treat once every other day for 5 treatments as a course. Gua Sha Treatment area: Mid-back, LV-13, and SP-9. Apply medium-level Gua Sha on the mid-back area from BL-15 and GV-12 to BL-20 and GV-6 until a dark red color appears. Apply weak Gua Sha on LV-13 and SP-9 area until a red color appears. Treat twice a week for 5 treatments as a course. TRADITIONAL PRESCRIPTIONS AND TECHNIQUES For malaria with high fever: GV-14, GV-13, and LI-4. (Zhen Jiu Da Cheng) Insert 1.5 cun #30 needles into GV-14 and GV-13 perpendicularly, 1-1.2 cun deep with twisting reducing needle technique, and 1 cun #32 needles into LI-4 perpendicularly, 0.5 cun deep with twisting even movement needle technique. Retain all needles for 15 minutes. Treat 2 hours before onset of malarial symptoms for 7 treatments as a course. For malaria with high fever: GV-14, PC-5, SI-3, and KI-7. (Zhen Jiu Chu Fang Xue) Insert 1.5 cun #28 needle into GV-14 perpendicularly, 1-1.2 cun deep with rubbing technique (rub the needle count clockwise) until the sensation of the Qi travels down along the spinal column and then take out the needle. Insert 1 cun #30 needles into PC-5 and SI-3 perpendicularly, 0.5-0.8 cun deep with twisting reinforcing needle technique, 1 cun #32 needles into KI-7 perpendicular 0.5-0.8 cun deep with twisting reinforcing needle technique. Retain all needles for 20 minutes. Treat once a day for 5 treatments as a course. For malaria with more cold (chills) then fever: SP-4, SI-3, LI-11, and PC-8. (Zhen Jiu Da Quan) Insert 1 cun #30 needles into SP-4 obliquely, 0.5-0.8 cun deep towards the KI-1 direction with twisting reducing needle technique, and 1 cun #32 needles into SI-3 and PC-8 perpendicularly, 0.5 cun deep with twisting even movement needle technique. Insert 1.5 cun #30 needles into LI-11 perpendicularly, 1-1.2 cun deep with lifting and thrusting reducing needle technique. Retain all needles above for 20 minutes. Treat once every day 2 hours before the onset of malarial symptoms for 5 treatments as a course. 285

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For malaria with more fever then cold (chills): SP-4, LI-11, GB-39, and Bai Lao. (Zhen Jiu Da Quan) Insert 1.5 cun #30 needles into Bai Lao perpendicularly, 1-1.2 cun deep with lifting and thrusting reinforcing needle technique, and take the needle out after the patient feels the sensation of the Qi traveling towards GV-14. Insert 1 cun #32 needles into LI-11, SP-4, and GB-39 with twisting reducing needle technique. Retain all needles for 20 minutes. Treat 2 hours before the onset of malarial symptoms for 7 treatments as a course. For malaria with frequent cold (more chills then fever): KI-4, SI-3, LI-11, and Bai Lao. (Zhen Jiu Da Cheng) Insert 1 cun #32 needles into KI-4 and SI-3 perpendicularly, 0.5 cun deep with twisting even movement needle technique, and 1.5 cun #30 needles into LI-11 and Bai Lao perpendicularly, 1-1.2 cun deep with lifting and thrusting reducing reinforcing needle technique. Retain all needles for 20 minutes. Treat 2 hours before the onset of malarial symptoms for 7 treatments as a course. For malaria with fever: CV-12 and GV-14. (Shen Yin Jing) Insert 1.5 cun #28 needle into GV-14 perpendicularly, 1-1.2 cun deep with rubbing technique until the sensation of the Qi travels from the point, then take the needle out. Insert a 1.5 cun #32 needle into CV-12 perpendicularly, 1-1.2 cun deep with slow and fast reinforcing needle technique. Retain all needles for 20 minutes. Treat once daily for 5 treatments as a course. For chronic malaria: LV-13 and BL-20. (Lei Jing Tu Yi) Apply direct non-scarring moxibustion on LV-13 for 11 cones and on BL-20 for 9 cones. Treat twice a week for 10 treatments as a course.

The following are from the Yi Xue Ru Men. For malaria with foot Tai Yang meridian symptoms—back pain and headache and the cold originating from the back: BL-40. Apply bloodletting technique on BL-40, to squeeze 2-3 drops of blood in each treatment. For malaria with foot Shao Yang meridian symptoms—fever and alternating cold associated with heart palpitations, and profuse sweating: GB-43. Insert 1.5 cun #32 needles into GB-43 obliquely, 1 cun deep towards GB-42 with twisting even movement needle technique. For malaria with foot Yang Ming symptoms—cold starting first then high fever and profuse sweating: ST-42. Inset 1 cun #30 needles into ST-42 perpendicularly, 0.3 cun deep with twisting even movement needle technique. For malaria with foot Tai Yin symptoms—depression, poor appetite, cold alternating with fever, and vomiting: SP-4. Insert 1.5 cun #32 needles into SP-4 perpendicularly, 1 cun deep towards KI-1 with twisting reinforcing needle technique. For malaria with foot Shao Yin meridian symptoms—frequent vomiting and more frequent cold sensations then fever: KI-3. Insert 1 cun #32 needles into KI-3 perpendicularly, 0.5 cun deep with twisting reinforcing needle technique. For malaria with foot Jue Yin meridian symptoms—bloated low abdomen and retention of urine: LV-3. Insert 1.5 cun #32 needles into LV-3 obliquely, 1 cun deep towards KI-1 with lifting and thrusting reducing needle technique.

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Malaria

For malaria with fever and alternating cold: PC-5. (Qian Jin Fang) Smash fresh “Han Lian Cao” and put it on PC-5. Cover it with plaster until a blister appears. Treat once a week for 3 treatments as a course. For malaria with fever and alternating cold: GV-20, LU-8, and SI-2. (Shen Yin Jing) Insert a 1 cun #30 needle into GV-20 obliquely, 0.5-0.8 cun deep at a 45-degree angle towards GV-19 with twisting reducing needle technique, and 1 cun #30 needles into LU-8 and SI-2 perpendicularly, 0.5 cun deep with twisting even movement needle technique. Retain all needles for 20 minutes. Treat 2 hours before onset of malarial symptoms for 5 treatments as a course. For malaria with fever and nausea or vomiting: LI-4, SP-4, LI-11, GV-14, and GV-12. (Zhen Jiu Ju Ying) Insert 1 cun #32 needles into LI-4 and SP-4 perpendicularly, 0.5-0.8 cun deep with twisting reinforcing needle technique, and 1.5 cun #30 needles into LI-11, 1-1.2 cun deep with lifting and thrusting reducing needle technique. Retain all needles for 20 minutes. Insert 1.5 cun #32 needles into GV-14 and GV-12 perpendicularly, 1 cun deep with twisting even movement needle technique and take out the needles after the sensation of the Qi travels along spinal column, and apply direct non-scarring moxibustion on these two points for 9 cones. Treat 2 hours before the onset of malarial symptoms for 5 treatments as a course.

The following is from the Zhen Jiu Da Quan. Malaria with Heart symptoms: heart palpitation, restlessness, more cold then fever: HT-7, SP-4, BL-15, and Bai Lao. Insert 1 cun #32 needles into HT-7 and SP-4 perpendicularly, 0.5 cun deep with twisting reinforcing needle technique. Retain all needles for 20 minutes. Insert 1.5 cun #30 needles into Bai Lao perpendicularly, 1 cun deep with twisting even movement needle technique, and 1 cun #32 needles into BL-15 perpendicularly, 0.5-0.8 cun deep with lifting and thrusting reinforcing needle technique. Retain all needles for 10 minutes. Malaria with Liver symptoms: pale complexion, sighing, fever and aversion to cold: LV-4, SP-4, BL-18, and GB-39. Insert 1.5 cun #30 needles into BL-18 perpendicularly, 1 cun deep with twisting reinforcing needle technique, and apply moxa wool on the handle of needles for 3 cones. Insert 1 cun #32 needles into SP-4, LV-4, and GB-39 with twisting even movement needle technique. Retain all needles for 15 minutes. Malaria with Spleen symptoms: abdominal pain, borborygmus, diarrhea or poor appetite: SP-4, BL-20, ST-36, SI-3, GV-12, and BL-43 Insert 1.5 cun #32 needles into BL-20 perpendicularly, 1-1.2 cun deep with lifting and thrusting reinforcing needle technique. Apply direct non-scarring moxibustion on BL-43 for 9 cones. Insert 1 cun #32 needles into SP-4 and SI-3 perpendicularly, 0.5 cun deep with twisting even movement needle technique, and 1.5 cun #32 needles into ST-36 and CV-12 with twisting reinforcing needle technique. Retain all needles for 20 minutes. Malaria with Lung symptoms: interior cold sensations in the whole body, chills, and pale complexion: LU-7, SP-4, BL-13, and LI-4 Insert 1 cun #32 needles into SP-4 and LI-4 perpendicularly, 0.5 cun deep with twisting even movement needle technique, and 1 cun #34 needles into LU-7 obliquely, 0.5 cun deep at a 30-degree angle towards LU-5 with twisting reinforcing needle technique. Retain all needles for 15 minutes. Apply direct nonscarring moxibustion on BL-13 for 9 cones.

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Malaria with Kidney symptoms: painful sensations in the low back and spinal column as well as constipation: SP-4, KI-5, BL-23, and BL-62 Insert 1 cun #32 needles into SP-4 and KI-5 perpendicularly, 0.3-0.5 cun deep with twisting even movement needle technique. Retain all needles for 15 minutes. Insert 1.5 cun #32 needles into BL-23 perpendicularly, 1-1.2 cun deep with lifting and thrusting reinforcing needle technique and apply moxa wool on the handle of needles for 3 cones. Insert 1 cun #32 needles into BL-62 with twisting even movement needle technique. Malaria with Stomach symptoms: poor appetite with hunger, bloating in the epigastric region: SP-4, ST-45, BL-21, and SP-2 Insert 1 cun #32 needles into SP-4 and SP-2 with twisting even movement needle technique. Apply bloodletting technique on ST-45 and squeeze 1 drop of blood out. Insert 1.5 cun #30 needles into BL-21 perpendicularly, 1-1.2 cun deep with lifting and thrusting reducing needle technique. Retain needles for 5 minutes. Malaria with Gall Bladder symptoms: aversion to cold, restlessness, and nightmares: SP-4, GB-42, BL-19, and LV-14 Insert 1 cun #32 needles into SP-4 and GB-42 perpendicularly, 0.5 cun deep with twisting reducing needle technique, and 1 cun #30 needles into LV-14 perpendicularly, 0.5 cun deep with twisting even movement needle technique. Retain all needles for 15 minutes. Insert 1.5 cun #30 needles into BL-19 perpendicularly, 1 cun deep with twisting reinforcing needle technique, and apply moxa wool on the handle of needles for 35 cones. CASE ANALYSIS Dr. Zhang Zi He (A.D. 1156-1228) treated a male patient with chronic malaria for 3 years with fever and interior cold, who had received a lot of other treatments before he visited him. His malaria was associated with fatigue, shortness of breath, and weight loss. In the Nei Jing chapter of needle technique for malaria, it states: “Perform bloodletting on the ten fingers if chronic malaria is hard to cure”. Dr. Zhang applied the bloodletting technique on the “Shi Xuan” points first and then applied direct moxibustion on SP-20 when the patient’s malaria symptoms started. The symptoms of malaria and his disease were remedied after one treatment. EVALUATION For a thousand years TCM practitioners have accumulated a lot effective experiences for the treatment of malaria, particularly with the use of acupuncture and moxibustion. There is a special chapter talking about how to treat malaria in the Nei Jing, which means 2,000 years ago people paid more attention to this infectious disease and had already set up a systematic therapy from theory and each technique. In modern society, as medicine developed, acupuncture and moxibustion is most often time used with medication. Sometimes acupuncture and moxibustion still play an important role in treating some chronic malaria patients or those whom the medication proved ineffective.

288

Multiple Sclerosis

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MULTIPLE SCLEROSIS Multiple Sclerosis belongs to the Wei and Jing syndrome category in TCM. The cause could be either Exterior Invasion, such as Wind-Heat or Damp-Heat or interior reasons, such as stagnation of Blood and Qi, Spleen Qi Deficiency or Kidney Yin and Yang Deficiency. This disorder is incredibly common among patients of all race, age, and gender. It is usually caused from demyelination of the nervous cells in the Central Nervous System. DIAGNOSIS Liver Yang Rising This pattern is marked by weak sensations in one of more extremities, painful sensation in the eyes, particularly when the eyes move, associated with headache, red eyes, restlessness and insomnia, easy to anger, ringing in the ear, bloating in the abdomen, and bitter taste in the mouth. The tongue is red with a yellow coat and the pulse is wiry and fast. Liver Blood Deficiency This signs associated with this pattern are weak and numb sensations in the limbs, face, and body, as well as double vision, ataxia, and paralysis in some severe cases. Secondary symptoms are dizziness and vertigo, lassitude, pale complexion, trembling, insomnia, heart palpitations, and dry skin, mouth, and eyes. The tongue is pale with a thin coat and the pulse is thin and weak. Damp Heat In this case, numbness, weak and swollen sensations in one or more limbs, sensory disturbance particularly in the legs, ataxia, and paralysis in some severe cases are the main symptoms. Other associated symptoms include heaviness and achy sensations in the whole body, stuffy chest with phlegm, bloated abdomen, loose and sticky stool, scanty and yellowish urine, headache, vertigo and insomnia in some cases. The tongue is swollen with a yellow or a white greasy coat and the pulse is slippery and fast.

TREATMENT AND PRESCRIPTIONS Liver Yang Rising Treatment Principle: Subdue Liver Fire and Move the stagnation of Qi and Blood. Point Prescription: LV-3, GV-20, LI-4, GB-34, and TW-5. Treat twice a week for 7 treatments as a course. Technique: Insert 1 cun #32 needles into LV-3, 0.5 to 0.8 cun deep at an oblique 45-degree angle towards KI-1 with twisting reinforcing needle technique, as well as 1 cun #32 needles into LI-4 and TW-5 perpendicularly, 0.7 cun deep with lifting and thrusting reducing needle technique. Insert 1.5 cun #30 needles into GB-34 perpendicularly, 1 to 1.2 cun deep towards SP-9 with lifting and thrusting reinforcing needle technique, and a 1.5 cun #30 needle into GV-20 transversely, 1 cun deep at a 30-degree angle backwards with a lifting Qi technique. Retain all needles for 30 minutes. Additional points for associated symptoms: Headache: Ah Shi and GB-4. Eye pain: LV-8, LV-5, and Tai Yang. Trembling in the limbs: GB-20, GB-31, and BL-12. Poor sleep: HT-7 and An Mian. 290

Multiple Sclerosis

Liver Blood Deficiency Treatment Principle: Nourish Liver Blood and Subdue Interior Wind. Point Prescription: GB-20, KI-3, LV-8, BL-18, BL-17, BL-20, and BL-23. Treat twice a week for 7 treatments as a course. Technique: Insert 1 cun #30 needles into BL-18, BL-17, BL-20, and BL-23 perpendicularly, 0.8 cun deep with lifting and thrusting reinforcing needle technique until the sensation of Qi spreads from the points, and apply moxa wool on the handle of the needles for 3 cones. Insert 1 cun #32 needles into KI-3 and LV-8 perpendicularly, 0.5 cun deep with twisting reinforcing needle technique. Insert a 1.5 cun #32 needle into GV-20 transversely, 1 cun deep at a 30degree angle backwards with a twisting reinforcing needle technique. Retain all needles for 20 minutes. Additional points for associated symptoms: Blurry eyes: GB-38, LI-4, and Qiu Hou. Trembling: GV-14 and GV-20. Heart palpitation: PC-6 and HT-7. Numbness in the limbs: LI-11, SP-9, Ba Feng, and Ba Xie. Damp-Heat Treatment Principle: Clear the Heat, Resolve Damp, and Move the Qi and Blood. Point Prescription: CV-3, ST-25, LI-11, SP-9, BL-20, BL-13, GV-14, and BL-28. Treat once every other day for 5 treatments as a course. Technique: Insert a 3 cun #32 needle into CV-3 perpendicularly, 2 cun deep with twisting reducing needle technique, and 1.5 cun #32 needles into ST-25 perpendicularly, 1 cun deep with lifting and thrusting reducing needle technique. Insert 1.5 cun #30 needles into LI-11 and SP-9 perpendicularly, 1 to 1.2 cun deep with lifting and thrusting reducing needle technique. Retain all needles for 20 minutes. Insert a 1.5 cun #30 needle into GV-14 perpendicularly, 1 to 1.2 cun deep with rubbing technique (rub the needle count clockwise) until the sensation of the Qi travels down along the spinal column. Insert 1 cun #32 needles into BL-13 with twisting even movement needle technique, and 1.5 cun #30 needles into BL-28 and BL-20 perpendicularly with lifting and thrusting reinforcing needle technique. Retain all needles for 10 minutes. Additional points for associated symptoms: Vertigo: ST-40, CV-17, and BL-13. Heavy sensation in the body: TW-5 and GB-34. Aches and pains in the limbs: LI-4 and LV-3.

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ADJUNCTIVE THERAPIES Ear Acupuncture Points: Brain stem, Heart, Sub cortex, Shen Men, Neck, and Spine. Insert 0.5 cun #34 ear needles into these points obliquely, 0.3 cun deep with fast twisting needle technique, or apply Electro-stimulation with fast frequency waves on the needles for 20 minutes. Or apply press-balls on the ear as a supplemental treatment with other body needles together. Treat once every other day for 7 treatments as a course. Scalp Acupuncture Treatment zone: Middle line and Lateral line 1 of the vertex, Upper middle line of the occiput, and the Oblique anterior line from the vertex to temple. Insert 1.5 cun #30 needles into these lines transversely, 1 cun deep with fast twisting needle technique for 3 to 5 minutes. Retain all needles for 40 minutes. Treat once a week for 10 treatments as a course. Gua Sha Treatment area: Back, Abdomen, and Leg. Apply medium-level Gua Sha on the upper back form GV-15 to GB-21 bilaterally, and then GV-14 to GV7 and BL-11 to BL-18 until a purple color appears. Apply a weak stimulation level of Gua Sha on the leg near the GB-40 area until a red color appears. Treat once every other day for 5 treatments as a course. Plum Blossom Points: GV-14, BL-11, BL-43, GV-4, CV-21, CV-17, and SP-6. Apply medium-level stimulation of Plum blossom needle on GV-14, BL-11, BL-43, and GV-4 for 5 minutes. Apply weak simulation on CV-21, CV-17, and SP-6 for 5 minutes. Treat once every other day for 10 treatments as a course. Cupping Water cups: BL-13, BL-15, BL-18, BL-23, BL-43, GV-14, and GB-21. Apply water cups, one of the cupping techniques where bamboo cups are boiled in the big pot with Chinese herbs and then the hot cups are taken out and put on these points until they fall off on their own. This is used to treat MS with deficiency of Yin or Yang. Fire cups: GV-14, BL-43, GV-4, GV-9, BL-52, and Shi Qi Zhui Xia. Apply fire cups on these points for 5 minutes to treat MS with stagnation of Heat. Moving cups: Back. Apply moving cups on the back from GV-14 to GV-9 and BL-11 to BL-20 until a dark red color appears. This is used to treat MS with deficiency.

292

Multiple Sclerosis

PRESCRIPTION AND TECHNIQUE EXPRERIENCE For MS with deficiency of Qi: CV-6, ST-36, GV-14, BL-13, GB-20, and BL-58. (Author’s Clinical Experience) Insert 1.5 cun #32 needles into BL-13 obliquely, 1 cun deep at a 60-degree angle towards the spinal column with twisting reinforcing needle technique. Insert 1.5 cun #30 needles into GV-14 and GB-20 perpendicularly, 1 cun deep with twisting reinforcing needle technique, and 1.5 cun #34 needles into BL-58 perpendicularly, 1 cun deep with twisting even movement needle technique. Retain all needles for 15 minutes. Insert 1.5 cun #32 needles into CV-6 and ST-36 perpendicularly, 1 to 1.2 cun deep with twisting reinforcing needle technique and apply moxa wool on the handle of the needles for 3 cones. Treat once every other day for 7 treatments as a course. For MS with Damp-Heat: ST-25, SP-9, LI-11, GV-12, GV-9, GV-3, and BL-32. (Author’s Clinical Experience) Insert 1.5 cun #32 needles into ST-25 perpendicularly, 1.2 cun deep with lifting and thrusting reducing needle technique, and 1.5 cun #30 needles into SP-9 and LI-11 perpendicularly, 1.2 cun deep with lifting and thrusting reducing needle technique. Retain all needles for 20 minutes. Insert 1.5 cun #30 needles into GV-12, GV-9, and GV-3 perpendicularly, 1 cun deep with twisting even movement needle technique, and 2 cun #32 needles into BL-32 perpendicularly, 1.7 cun deep with lifting and thrusting reducing needle technique. Retain all needles for 15 minutes. Treat once every other day for 7 treatments as a course. For MS with paralysis of limbs: LI-11, TW-5, ST-36, GB-39, CV-6, GV-14, GV-7, and GV-4. (Author’s Clinical Experience) Insert 1.5 cun #30 needles into LI-11, TW-5, ST-36, and GB-39 perpendicularly, 1 to 1.2 cun deep with twisting even movement needle technique and apply electro-acupuncture with intermittent waves, the main points being LI-11 and ST-36 for 25 minutes. Insert a 1.5 cun #32 needle into CV-6 perpendicularly, 1 cun deep with twisting reinforcing needle technique, and apply moxa wool on the handle of needle for 3 cones. Insert 1.5 cun #32 needles into GV-14, GV-7, and GV-4 perpendicularly, 1 to 1.2 cun deep with twisting even movement needle technique until the sensation of Qi travels. Retain all the needles for 10 minutes. Treat once every other day for 10 treatments as a course. For MS with paralysis of limbs: LV-3, LI-4, SP-6, PC-5, SP-9, LU-5, CV-4, BL-13, BL-20, and BL-18. (Author’s Clinical Experience) Insert 1 cun #32 needles into LI-4, LV-3, PC-5, and SP-6 perpendicularly, 0.6 cun deep with the Zi Wu Dao Jiu (one combination needle technique) technique. Insert 1.5 cun #32 needles into SP-9, LU-5, and CV-4 perpendicularly, 1 cun deep with lifting and thrusting reinforcing needle technique and apply moxa wool on the handle of the needles for 3 cones. Insert 1.5 cun #32 needles into BL-13, BL-20, and BL-18 with twisting reinforcing needle technique. Apply moxa wool on the handle of the needles for 3 cones. Treat once every other day for 10 treatments as a course. For MS with deficiency of Blood and Yin: KI-6, LV-3, LV-8, HT-7, PC-4, SP-10, BL-17, BL-18, BL-20, BL-23. (Author’s Clinical Experience) Insert 1 cun #32 needles into KI-6, HT-7, and LV-8 perpendicularly, 0.7 cun deep with twisting reinforcing needle technique, and 1.5 cun #34 needles into LV-3 obliquely, 1 cun deep at a 45-degree angle towards KI1 with twisting reinforcing needle technique. Insert 1.5 cun #32 needles into PC-4 and SP-10 perpendicularly, with twisting even movement needle technique. Retain all needles for 20 minutes. Insert 1.5 cun #34 needles into BL-17, BL-18, BL-20, and BL-23 perpendicularly, 1 cun deep with twisting reinforcing needle technique. Retain all needles for 10 minutes. Treat once every other day for 7 treatments as a course. 293

Acupuncture and Moxibustion—A Clinical Desk Reference

For MS with deficiency of Blood and Yin: SP-6, ST-36, CV-4, LV-13, GV-14, BL-43, GV-8, and GV-4. (Author’s Clinical Experience) Insert 1.5 cun #32 needles into GV-14, GV-8, and GV-4 perpendicularly, 1 cun deep with twisting reinforcing needle technique. Insert 1 cun #32 needles into BL-43 with the Qi Ci technique—one ancient needle technique where one needle is in the middle and the other two are beside it. Then apply waving technique until a red color appears. Retain all needles for 15 minutes. Insert 1.5 cun #34 needles into SP-6, ST-36, CV-4, and LV-13 perpendicularly, 1 cun deep with twisting reinforcing needle technique. Retain all needles for 20 minutes. Treat once every other day for 7 treatments as a course. For MS with speech problems: CV-23, GV-20, HT-5, SP-4, LU-2, BL-11, and Bai Lao. (Author’s Clinical Experience) Insert 1.5 cun #32 needles into CV-23 obliquely, 1.2 cun deep at a 45-degree angle towards the root of the tongue with the Qi Ci needle technique (see explanation in the previous prescription). Insert 1 cun #32 needles into SP-4 and LU-2 perpendicularly, 0.7 cun deep with twisting reducing needle technique, and a 1.5 cun #30 needle into GV-20 transversely, 1 cun deep at a 30-degree angle with fast twisting needle technique. Retain all needles for 20 minutes. Insert 1.5 cun #32 needles into BL-11 and Bai Lao perpendicularly, 1.2 cun deep with lifting and thrusting reinforcing needle technique. Retain all needles for 10 minutes. Treat once every other day for 7 treatments as a course. For MS with Liver and Kidney Deficiency: CV-4, GV-4, GV-8, GV-12, GV-14, BL-18, BL-23, KI-3, and LV-8. (Author’s Clinical Experience) Insert 1.5 cun #32 needles into GV-12, GV-14, GV-8, and GV-4 perpendicularly, 1 cun deep with twisting reducing needle technique, and 1.5 cun #30 needles into BL-18 and BL-23 perpendicularly, 1 cun deep with lifting and thrusting reducing needle technique. Apply moxa wool on the handle of the needles for 3 cones. Insert 1.5 cun #32 needles into CV-4 and LV-8 perpendicularly, 1 cun deep with twisting reinforcing needle technique, and 1 cun #32 needles into KI-3 with twisting reinforcing needle technique. Apply moxa wool on the handle of the needles for 3 cones. Treat once every other day for 7 treatments as a course. For MS with Interior Deficiency Wind: LV-3, LI-4, LV-8, SP-10, BL-17, BL-18, BL-23, GB-20, and BL-10. (Author’s Clinical Experience) Insert 1.5 cun #32 needles into GB-20 perpendicularly, 1 to 1.2 cun deep towards the chin with lifting and thrusting reducing needle technique, and 1.5 cun #34 needles into BL-10 perpendicularly, 1 cun deep with twisting even movement needle technique. Insert 1.5 cun #34 needles into BL-17, BL-18, and BL-23 perpendicularly, 1 cun deep with lifting and thrusting reinforcing needle technique. Retain all needles for 10 minutes. Insert 1 cun #30 needles into LV-3 and LI-4 perpendicularly, with lifting and thrusting reducing needle technique, and 1.5 cun #34 needles into LV-8 and SP-10 with twisting reinforcing needle technique. Retain all needles for 20 minutes. Treat once every other day for 10 treatments as a course.

294

Multiple Sclerosis

For MS with stagnation of Qi and Blood: CV-6, ST-36, LI-11, GV-20, SP-6, BL-43, GV-4, and BL-18. (Author’s Clinical Experience) Insert 1.5 cun #32 needles into GV-4 and BL-18 perpendicularly, 1 to 1.2 cun deep with lifting and thrusting reinforcing needle technique. Insert 1.5 cun #32 needles into BL-43 obliquely, 1 cun deep at a 40degree angle towards BL-44 with twisting reinforcing needle technique, and apply moxa-pole on the side of the needles for 15 minutes. Insert 1.5 cun #32 needles into CV-6, ST-36, and SP-6 perpendicularly, 1 cun deep with twisting reinforcing needle technique, and a 1 cun #32 needle into GV-20 transversely, 0.7 cun deep with lifting and thrusting reinforcing needle technique. Retain all needles for 20 minutes. Treat once every other day for 10 treatments as a course. For MS with stagnation of Qi and Blood: GV-14, GV-9, BL-43, BL-13, LI-11, SP-9, and CV-4. (Author’s Clinical Experience) Apply indirect moxibustion with ginger on the GV-14, GV-9, BL-13, and BL-43 for 3 cones. Insert 1.5 cun #32 needles into SP-9 and LI-11 perpendicularly, 1 to 1.2 cun deep with lifting and thrusting reinforcing needle technique. Apply direct non-scarring moxibustion on CV-4 for 9 cones. Treat twice a week for 7 treatments as a course.

CASE ANALYSIS A 42 year-old female patient came in with the main complaint of MS for 2 years. She felt weak, experienced trembling, and a tight and achy sensation in the muscles, particularly on the arms and legs. Other associated symptoms included blurry eyes, dizziness, headache, restlessness, poor sleep, hot flushes, sticky and hot bowel movements, and yellow scanty urine. The tongue was red with a yellow greasy coating and the pulse was slippery. Diagnosis: MS with stagnation of Damp-Heat. Treatment Principle: Clear Heat and Resolve the Damp. Point Prescription: ST-25, SP-9, CV-3, LI-11, GV-12, GV-9, GV-3, BL-32, and BL-23. Treatment was given once every other day for 7 treatments as a course. Technique: Insert a 3 cun #32 needle into CV-3 perpendicularly, 2 cun deep with twisting even movement needle technique, and 1.5 cun #32 needles into ST-25, SP-9, and LI-11 perpendicularly, 1.2 cun deep with lifting and thrusting reducing needle technique. Retain all needles for 20 minutes. Insert 1.5 cun #30 needles into GV-12, GV-9, and GV-3 perpendicularly, 1 cun deep with twisting even movement needle technique, and 1.5 cun #32 needles into BL-23 perpendicularly, 1 cun deep with lifting and thrusting reinforcing needle technique. Insert 2 cun #32 needles into BL-32 perpendicularly, 1.7 cun deep with lifting and thrusting reducing needle technique. Retain all needles for 15 minutes. Result: Most of symptoms were reduced particularly the Damp-Heat stagnation signs, which were almost totally relieved after one course treatment. But the muscles still felt tight and weak with hyper-tendon reflexes. Therefore a second prescription was then employed.

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Second Point Prescription: GV-14, GV-12, GV-9, GV-4, GV-20, LI-11, ST-36, SP-6, and CV-6. Treatment was given twice a week for 7 treatments as a course. Technique: Insert 1.5 cun #30 needles into GV-14, GV-12, GV-9, and GV-4 perpendicularly, 1 cun deep with twisting, lifting, and thrusting even movement needle technique until the sensation of the needles travels along the GV meridian. Retain all needles for 10 minutes. Insert 1.5 cun #32 needles into LI-11, ST-36, SP-6, and CV-6 perpendicularly, 1 cun deep with twisting reinforcing needle technique, and a 1 cun #32 needle into GV-20 obliquely, 0.5 cun deep backwards with fast twisting needle technique. Retain all needles for 20 minutes. Result: The symptoms of MS were almost gone after 2 courses of treatments, and the patient went back to normal work. Upon revisit after 2 years for a new allergy problem the MS symptoms still had not returned. EVALUATION Acupuncture and moxibustion is very effective to reduce the symptoms of MS, and recently it has been shown to be much more effective than any medications. However, the actual treatment progress and trauma to the brain from the disorder can be only observed through a MRI. Acupuncture is the first choice for treating MS and the effectiveness of the treatments usually will be felt after 5-7 treatments, and is directly related with a correct diagnosis and suitable needle technique, particularly techniques performed on the GV meridian. In some emergency cases, such as severe infections, convulsions, tics, or coma, acupuncture and moxibustion will not be used until the acute and severe symptoms are reduced.

296

Neck Pain

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Acupuncture and Moxibustion—A Clinical Desk Reference

NECK PAIN Neck pain is a common symptom seen in the acupuncture clinic. This syndrome does not necessitate a disorder, infection, or illness like most other common clinical symptoms. However, it can be caused by all of them. Although it has many causes, in TCM neck pain basically refers to the stagnation of the Qi and Blood in the meridians. DIAGNOSIS Stiff Neck Stiff neck most commonly occurs in adults due to improper sleep position or pillow placement under the head, or at times may be related to Cold Invasion. Improper Sleep Position Pain and stiffness, or tightness usually occurring in the morning in the local area, particularly in the scapular and nape region are the signs of this pattern. Unilateral pain of the neck or upper back often severely restricts neck motion and causes the head to tilt towards the painful side. The patient must move the entire body instead of rotating the neck to the side. The tongue is usually normal and the pulse is tight or wiry. Wind Cold Invasion When the neck stiffness and pain are caused by a Wind Cold Invasion, the patient will have accompanying symptoms associated with External Invasion such as aversion to cold and wind, headache, and possibly slight fever. The tongue is pale with a thin white coating and the pulse is floating and fast. Neck Injury In this case, the patient presents with a history of injury-either acute or chronic. A constant dull pain or discomfort sensation in the neck and shoulder can be transferred to the arm or fingers. At times the patient will experience weakness and/or atrophy in either a single muscle or a specific muscle group. Other symptoms may include dizziness and vertigo. Acute Injury The patient complains of constant, fixed pain in a specific area of the neck after obvious injury. The discomfort may travel down to the arm or up to the eyes, ears, throat or side of the scalp. The injured muscles may be swollen and contracted. In severe cases X-ray will show structural changes in the cervical column. The patient can barely move the neck without pain and may also experience nausea and dizziness. The tongue is red on the tip and edges with a white coating, and the pulse is wiry or weak and rapid. Chronic Injury In this case, the patient has no obvious injury history. The neck symptoms may have been caused by overuse and improper posture at work or by degenerative changes. Both lead to stagnation of the Qi and Blood in the local neck meridians. The neck may feel stiff and/or constant dull ache or numbness with a shooting sensation to the shoulders and arms may be present. Coughing, bowel movement or sudden neck movements aggravate the pain. Other possible symptoms include dizziness, vertigo, tinnitus, ear pain, or myoatrophy in the upper extremities. The tongue is slightly swollen with teeth-marks, and the pulse is weak or tight. 298

Neck Pain

TREATMENT AND PRESCRIPTIONS Stiff Neck Treatment Principle: Move the Qi and Blood and Reduce the pain. Point Prescription: Luo Zhen, SI-3, GB-39, and Ah Shi. Treat once every day for 2 treatments as a course. Technique: Reducing needle technique and moxibustion. Use 1 cun #32 needles for Luo Zhen, SI-3, and GB-39 on the painful side of the body. Insert the needles perpendicularly, 0.5-0.8 cun deep with twisting reducing needle technique while the patient moves the stiff neck area, then retain the needles for 10 minutes after the pain has reduced. Use a 1.5 cun #30 needle for local Ah Shi points with warming needle technique using 3 cones or by applying Moxa-pole (only on the Ah Shi points) for 15 minutes. Additional points for associated symptoms: Headache due to Wind Cold: LI-4 and TW-5. Scapular area pain: LI-15 and SI-12. Upper back pain: BL-11 and SI-13. Neck Injury Acute Injury Treatment Principle: Move the Qi and Resolve the Blood Stagnation. Point Prescription: GV-24, GV-17, SI-3, TW-5, BL-62, plus Moxa pole. Treat once every day for 2 treatments as a course. Technique: Reducing needle technique and moxibustion. Insert 1.5 cun #30 needles into GV-24 and GV-17 against the flow of the meridian with lifting and thrusting, twisting, and even movement technique until the needle moves easier in the point, and then instruct the patient to move the neck while obtaining Qi. Next insert 1 cun #32 needles into SI-3, TW-5, GB-34, and BL-62 with lifting and thrusting reducing needle technique. Retain all needles for 20 minutes. Apply moxa-pole to the local Ah Shi points for 15 minutes. Additional points for associated symptoms: Severe pain with nausea: PC-6 and ST-36 with warming needle technique. Shoulder and upper back pain: GB-21, GV-12, and SI-12. Chronic Injury Treatment Principle: Move the Qi and Blood and Reduce the pain and muscle spasms. Point Prescription: Xiang Cong Ci (GB-12, GB-20, GV-16, GV-15, GV-17, 2 needles between GB-12 and GB-20 and 2 needles between GB-20 and GV-16, total of 15 needles) Treat once every other day for 5 treatments as a course. Technique: Reinforcing needle technique and moxibustion. Use 1.5 cun #30 or #32 needles for all points and needle perpendicularly, 1 to 1.2 cun deep with even movement technique. Retain needles for 20 minutes.

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Acupuncture and Moxibustion—A Clinical Desk Reference

ADJUNCTIVE THERAPIES Plum Blossom Treatment area: Ah Shi point, and Upper back. Apply weak stimulation with a Plum Blossom needle on the painful and spasm area for 3 minutes. Next apply medium stimulation to Ah Shi points of the shoulder and upper back for 2 minutes. Then use cupping on the local area and retain them for 2 minutes. Treat once every day for 2-3 treatments. Ear Acupuncture Points: Shen men, Sub cortex, Cervical vertebrae, Upper back, and Sympathetic. Insert 0.5 cun #32 needles obliquely at a 60-degree angle within the skin to a depth of 0.3 cun, applying twisting reducing technique for 2-3 minutes. Meanwhile instruct the patient to move the neck until the pain is reduced, then retaining all needles for 1 hour. Treat once every day for 2-3 treatments. Moxibustion (For stiff neck due to External Invasion and cervical vertebra degenerative changes) Use indirect moxibustion with ginger on GV-14 and BL-10 for 3-5 cones in each treatment. Then use cups on other Ah Shi points for 1 minute after the moxa therapy. Treat once every day for 5 treatments as a course. Scalp Acupuncture Treatment zones: Middle line of vertex and forehead, Lateral line one of the vertex, and the Upper lateral occipital line. Insert 1.5 cun #32 needles into these lines transversely, 1 cun deep at a 30-degree angle with fast twisting needle technique and retain all needles for 30 minutes. Treat twice a week for 5 treatments as a course. Gua Sha Treatment area: Upper back and Nape. Apply weak stimulation of the Gua Sha on the nape area along the BL and GV meridians until red marks appear. Then apply medium-level stimulation on the upper back from GV-14 to GV-10 and from BL-11 to BL-17 and GB-21 until dark red marks appear. Treat once every other day for 2 treatments as a course. Cupping Points: GV-14, GB-21, BL-11, and SI-12. Apply fire cups on these points for 5 minutes. Treat once daily for 3 treatments as a course.

300

Neck Pain

TRADITIONAL PRESCRIPTIONS AND TECHNIQUES For severely restricted range of motion of the neck due to pain related to the shoulder and upper back: GV-14. (Lei Jin Tu Yi) Insert a 1.5 cun #30 needle into GV-14 perpendicularly, 1-1.2 cun deep with twisting reducing needle technique or the Long Hu Jiao Zhan—Dragon and Tiger Battle technique. Next, lift the needle up to just beneath the skin and let the patient move the neck. This is considered one movement. Generally 2-3 movements will be required. Treat once every other day for 3 treatments as a course For neck pain and aversion to cold with shoulder and arm pain: SI-3. (Tong Xuan Zhi Yao Fu) Insert 1 cun #30 or #32 needles into SI-3 on the painful side, with lifting and thrusting reducing needle technique. After obtaining the Qi sensation, retain the needles for 15 minutes or until the neck pain is reduced. Treat once every other day for 3 treatments as a course. For neck pain with Cold Damp Invasion, or stagnation in the meridians due to Qi and Blood Deficiency: GB-39 and Ah Shi. (Qian Jing Fang) Apply direct non-scarring moxibustion on GB-39 for 10 cones. Treat once a day for 5 treatments as a course. Alternately, use a 1 cun #30 needle for GB-39 on the painful side. Insert the needle obliquely at a 45-60 degree angle, 0.8 cun deep with twisting reducing technique until the Qi moves upwards. Next, use fire cups on the local Ah Shi points. Retain the needle for 20 minutes. Treat once a day for 2-3 treatments as a course. For acute neck pain severely restricting movement: SI-1, SI-2, SI-3, SI-5, SI-8, GB-12, BL-62, and BL-2. (Qian Jing Fang) Insert 1 cun #30 needles perpendicularly into SI-1, SI-2, SI-3, SI-5, and SI-8 with even movement technique while the patient moves the neck. Then insert 1 cun #32 needles for BL-62, GB-12, and BL-2 with twisting reducing needle technique. Retain all needles for 15 minutes. Treat once a day for 3 treatments as a course.

The following prescriptions are from the Zi Shen Jin. For stiff neck with restricted front to back motion: BL-64 and BL-11. For stiff neck with restricted right or left motion: BL-42, GB-21, SI-3, and TW-16. For a contracted muscles on the nape of the neck: BL-10. For nape, shoulder, and upper back pain: TW-8. For each treatment above, the practitioner should use only three points from the above listing. Example: BL-64, GB-21, and TW-8 are chosen. Insert 1 cun #30 needles about 0.5 cun deep with twisting even movement technique until the Qi sensation is obtained. Retain the needles for 20 minutes. Treat once every day for 3 treatments as a course. For neck pain with tight muscles on the midline of the upper back: CV-24, GV-16, and SI-3. (Yi Xue Gang Mu) Insert 1 cun #30needle into SI-3 with twisting reducing needle technique while the patient moves the neck. Retain this needle. Next insert 1 cun #28or #30 needles for CV-24 and GV-16 to 0.3 cun deep. Using two hands simultaneously stimulate the front and back of head with twisting even movement technique. Retain the needles for 15 minutes, twisting the needles every 5 minutes. Treat once every day for 3 treatments as a course.

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The following two prescriptions are from the Ling Shu, Chapter Zha Bin. For neck pain with restricted forward and backward motion: Foot Tai Yang meridian. For neck pain with restricted right and left motion: Hand Tai Yang meridian. Palpate the meridian and choose 2-3 points-both local and distal. Insert 1 or 1.5 cun #30 needles into distal points using even movement needle technique, and use 1 or 1.5 cun #30 needles for the local points with warming needle technique for 3-4 cones. Treat once every day for 2-3 treatments as a course. For chronic neck injury with dizziness and dull pain in the muscles: GB-39, GB-34, CV-6, TW-5, BL-3, SI-13, GB-20, GB-21, and Jia Ji (C1-7) (Author’s Clinical Experience) For Jia Ji, GB-20, GB-21, and SI-13 use 1 cun #30 needles inserted perpendicularly, 0.5-0.8 cun deep with twisting reinforcing needle technique and retain for 10 minutes. For GB-39, GB-34, TW-5, BL-3, and CV6, use 1.5 cun #32 needles with twisting even movement needle technique. Retain all needles for 20 minutes. Treat once every other day for 5 treatments as a course. CASE ANALYSIS #1. A 55 year-old man presented with a main complaint of neck pain for 3 hours since awakening that morning. Neck movement to the right and backward was difficult and painful. Tongue and pulse were normal. Diagnosis: Qi and Blood stagnation in the Gallbladder Meridian. Point Prescription: TW-5. Apply acu-pressure on TW-5 for 2 minutes, while the patient moved the neck in the painful directions. Result: Pain was resolved after 2 minutes and did not return. #2. A 35 year-old woman presented with the main complaint of chronic neck pain for 5 years. Her history includes a car accident when she was 17. The pain was located on the nape, upper back, and both shoulders, particularly on the right side. At times her arms felt numb and shooting pain traveled down from the neck. The pulse was wiry and the tongue was pale with a white thick coating. Diagnosis: Qi and Blood stagnation in the local neck meridians. Treatment Principle: Move the Qi and Blood and Reduce the pain. Point Prescription: Xiang Cong Ci, CV-4, ST-36, TW-5, GB-39, SI-13, and GB-21. Treat twice a week for 7 treatments as a course. Result: The pain completely resolved after 2 courses of treatment. EVALUATION Neck pains are one of the most common problems seen in the acupuncture clinic. The nature of the pain can lead to irritability, dysfunction, and headaches. Understanding the causes of neck pain and arriving at the correct diagnosis and the pathway of the meridians is the key to the appropriate curative treatment. Thus it is very important to first determine the nature and cause of the originating pain. There are instances where acupuncture will be useful as supplemental therapy in order to palliate neck pain due to chronic structural spine problems or tumors. Complete resolution often does not occur in these cases. X-rays should be done to confirm these chronic conditions. This will aid in diagnosis.

302

Obesity

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Acupuncture and Moxibustion—A Clinical Desk Reference

OBESITY In modern civilized society it is very common to see people who are over weight. Most of the current research shows it may be related to the daily habits of certain lifestyles and the diet of the culture, as well as unhealthy emotional activity. In TCM theory it is related to the following factors: Unhealthy Eating Habits Over eating and uncontrolled eating makes for over-retainment of nutritious substances in the body leading to obesity. It may also occur in individuals who have an addiction to some special food, particularly junk food, or greasy oily food that leads to obesity due to fat accumulation. Unhealthy Emotional Activity When patients with depression, anxiety, stress or other unhealthy emotional stimulation that they are not able to control well, they may increase their food intake in order to release these negative emotions. For example, when someone quits smoking, the can put on over 20 or 30lbs while dealing with negative emotions that are brought about do to the detoxification. Liver and Gallbladder Qi Stagnation Unhealthy emotional or other physical reasons, which make the Liver and Gallbladder Qi stagnate can cause the secretion of bile to be decreased, slowing the digestion of food in the intestines and stomach. The body then over absorbs the stagnate food causing obesity. Qi and Yin Deficiency Chronic Qi and Yin Deficiency will lead to decreased body metabolism and as a result, edema will appear and stagnate the whole body metabolism, leading to weight gain. Blood Stagnation Infection, bleeding, trauma or other problems can disrupt digestion leading to obesity. For example, after pancreatitis, the swollen and stagnate pancreas decreases secretion of trypsase. DIAGNOSIS Improper Food Intake Over weight with frequent desire for food and difficulty controlling food and drink addictions. Associated signs and symptoms are bloating in the abdominal region, irregular bowel movement, heart palpitations, and shortness of breath aggravated after physical activity. The tongue is swollen with a greasy coating and the pulse is slippery and weak. Unhealthy Emotional Activity Over weight with unhealthy emotional activities, such as anxiousness, depression, stress or restlessness, or being in the process of withdrawing from cigarettes and other drugs. Symptoms associated with this pattern are a stuffy sensation in chest, epigastric, and hypochondriac region, irritable bowel movement, borborygmus, and belching, sighing, dream disturbed sleep, and morning fatigue. The tongue is dark with thick coating and the pulse is wiry or tight.

304

Obesity

Liver and Gallbladder Qi Stagnation Over weight with distension, stuffy sensation in the hypochondriac and chest region, bloating abdomen, hypochondriac pain, cholecystitis, irritability, tendency to anger, poor sleep with nightmare, irregular sweating. In some woman cases irregular menstruation will common appear, and PMS. The tongue is red and swollen in the edge with thick coating; pulse is wiry or slippery. Qi and Yin Deficiency Over weight with deficiency, such as lassitude, shortness of breath, heart palpitations particularly after physical activities, edema, and body aches. These main symptoms are associated with dizziness, blurry vision, poor memory, and concentration difficulty in work and study. The tongue is red with white thin coating or a greasy coating and the pulse is weak and fast. Blood Stagnation The main symptom is obesity with swollen organs or associated with past trauma/injury. Associated signs and symptoms are fixed pain, heavy sensation throughout the body, irregular bowel movement, dark complexion, even purple lips, and nails. The tongue is dark or purple in color with a thin white coating and the pulse is choppy or wiry. TREATMENT AND PRESCRIPTION Improper Food Intake Treatment Principle: Harmonize the Stomach and Spleen, and Calm the mind. Point Prescription: ST-34, SP-6, CV-12, LU-7, GV-20, and HT-7. Treat twice a week for 10 treatments as a course. Technique: Insert 1.5 cun #32 needles into ST-34 perpendicularly, 1 to 1.2 cun deep with lifting and thrusting reducing needle technique, and insert 1 cun #32 needles into SP-6 with twisting reinforcing needle technique. Then insert a 1.5 cun #32 needle into CV-12 perpendicularly with twisting reducing needle technique and 1 cun #34 needles into LU-7 obliquely, upwards against the flow of the meridian with twisting even movement needle technique. Finally apply 1 cun #32 needles on GV-20 and HT-7 with twisting reinforcing needle technique. Retain all the needles for 25 minutes. Additional points for other symptoms: Stomach Heat: ST-44 and LI-3. Frequent desire of food in the mouth: CV-23 and SP-4. Anxious feeling: ST-9, GV-23, and PC-6. Unhealthy Emotions Treatment Principle: Soothe the Liver, Calm the mind, and move the Qi. Point Prescription: LI-4, LV-3, LU-5, ST-36, SP-7, and Yin Tang. Treat once every other day, for 7 treatments as a course. Technique: Applying 1.5 cun #32 needles for LV-3 obliquely towards KI-1 direction, 1 cun deep with the Sparrow pecking technique, and 1 cun #34 needles into LI-4 with lifting and thrusting reducing needle technique. Then insert 1.5 cun #32 needles into LU-5, SP-7, and ST-36 perpendicularly, 1 to 1.2 cun deep with waving needle technique. Finally insert a 1 cun #34 needle into Yin Tang obliquely, towards the tip of nose with twisting reinforcing needle technique. Retain all the needles for 30 minutes.

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Additional points for other symptoms: Insomnia: GV-20, HT-7, and An Mian. Headache: Tai Yang, GB-8, GV-23, and BL-10. Anxiousness: PC-6, CV-14, BL-13, and BL-42. Depression: GV-14, BL-11, BL-43, and BL-23. Nausea: CV-12, PC-5, and BL-20. Liver and Gallbladder Qi Stagnation Treatment Principle: Move the stagnation of Qi and Promote metabolism. Point Prescription: GB-34, LV-2, LV-13, CV-13, BL-18, BL-19, and BL-23. Treat once every other day for 10 treatments as a course. Technique: Insert 1.5 cun #30 needles into GB-34, CV-13, and LV-13 perpendicularly with twisting reducing needle technique, and 1 cun #34 needles into LV-2 with twisting reducing needle technique. Than apply 1.5 cun #32 needles for BL-18, BL-19, and BL-23 perpendicularly with bending needle technique making the sensation of needles travel along the BL meridian. Additional points for other symptoms: Irritable bowel movement: ST-25 and TW-6. Restlessness and insomnia: HT-7 and GB-44. Headache: GB-13, ST-8, and Yin Tang. Bloating abdomen: CV-6 and CV-12. Qi and Yin Deficiency Treatment Principle: Reinforce Qi and Yin, Promote the circulation of Qi and Blood. Point Prescription: SP-6, KI-6, LU-9, TW-4, CV-6, ST-28, and LU-1. Treat once twice a week for 10 treatments as a course. Technique: Insert 1 cun #32 needles into SP-6 obliquely towards the SP-7 direction with twisting reinforcing needle technique, along with 1 cun #30 needles into KI-6 perpendicularly, 0.2-0.3 cun deep with Moving the Qi technique. Then insert 1 cun #32 needles into LU-9 and TW-4 perpendicularly, 0.3 to 0.4 cun deep with twisting even movement needle technique, and insert a 1.5 cun #30 needle into CV-6 and ST-28 with lifting and thrusting even movement technique. Finally apply 1.5 cun #32 needles into LU-1 obliquely towards the shoulder direction at a 60degree angle to the skin, 1 cun deep with rubbing needle technique. Retain all the needles for 25 minutes. Additional points for other symptoms: Restlessness: CV-14 and GV-23. Shortness of breath and heart palpitations: PC-6 and ST-36. Edema: CV-9 and BL-22 indirect moxibustion with ginger for 5 cones. Irritable bowel movement: TW-6, LV-3, and ST-25.

306

Obesity

Blood Stagnation Treatment Principle: Promote Blood circulation, Resolve the stagnation, and Reinforcing the Qi. Point Prescription: SP-4, LI-4, LV-8, TW-5, CV-6, and CV-19. Treat once twice a week, for 10 treatments as a course. Technique: Insert 1.5 cun #32 needles into SP-4 perpendicularly, 1 to 1.2 cun deep with the White Tiger shakes its Head technique, and 1 cun #32 needles into LI-4, LV-8, and TW-5 perpendicularly, 0.5 to 0.8 cun deep with twisting reducing needle technique. Then insert a 1.5 cun or 3 cun (depending on the patient’s size) needle in CV-6 perpendicularly, 1.2 cun deep with lifting and thrusting reducing needle technique. Finally apply a 1.5 cun #32 needle on CV-19 obliquely towards CV-18, 1 cun deep with the Inserting the Qi technique. Retain all the needles for 30 minutes. Additional point for other symptoms: Edema: SP-9, LI-11, and LV-13. Insomnia: GV-20, An Mian, and HT-7. Leg pain: LV-3, Ba Feng, and ST-34. Bloating abdomen: CV-6 and CV-12. Shortness of breath: CV-17, PC-6, and PC-8. ADJUNCTIVE THERAPIES Ear Acupuncture Points: Liver, Stomach, Shen Men, Endocrine, Heart, and Brain stem. Select 3-4 points in each treatment, applying 0.5 cun #34 ear needles for these points, obliquely at a 60degree angle to the skin with a fast twisting technique (over 200times/min) and retain all needles for 1 hour. Treat once every other day for 10 treatments as a course. Every treatment can use only one side of ear. Intradermal Needles Points: SP-4, LU-7, PC-6, BL-13, GV-14, and GV-8. Apply intradermal needles in these points, and retain them for 1 week in winter and 2-3 days in summer, 5 treatments as a course. Cupping Treatment area: CV-8, ST-28, and upper and mid-back. Apply fire cups on CV-8 and ST-28 for 5 minutes, then use moving cups both sides of the BL meridian from BL-11 to BL-20 until red marks appear on the meridian. Treat twice a week for 5 treatments as a course. Bloodletting Points: LV-1, ST-45, LI-1, SI-1, PC-3, BL-40, and Tai Yang. Select 2 to 3 points in each treatment, applying bloodletting technique and squeeze 3-4 drops of blood from each point. Treat once every other day, for 5 treatments as a course.

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Acupuncture and Moxibustion—A Clinical Desk Reference

Foot Acupuncture Points: Li Nei Ting, Liver, Stomach, Intestine, and Head. Before the needle treatment, massage these points to warm up the foot and reduced the pain threshold. Then apply 0.5 cun #34 needles for these points perpendicularly, 0.3 to 0.4 cun deep with twisting even movement needle technique. Retain all the needles for 40 minutes. Treat twice a week, for 10 treatments as a course. (Or apply acu-pressure technique instead of needles if patient is adverse to needle treatment.) Scalp Acupuncture Treatment zone: Lateral line 3 of forehead, and Middle and Lateral line 2 of the vertex. Insert 1.5 cun #32 needles into these treatment zones obliquely, at 45-degree to the skin with a withdrawing Qi technique and retain the all the needles for 50 minutes. Treat once every other day, for 10 treatments as a course. TRADITIONAL PRECRIPTONS AND TECHNIQUES For over weight due to disharmony of the Stomach and Spleen: ST-34 and SP-6. (Zhen Jiu Zi Shen Jing) Insert 1.5 cun #30 needles into ST-34 perpendicularly, 1 to 1.2 cun deep with lifting and thrusting reducing needle technique, and then insert 1 cun #32 needles into SP-6 with twisting reinforcing needle technique. Retain all the needles for 20 minutes. Treat once every other day, for 7 treatments as a course. (According to the author’s experience, it is better to apply ear press balls after the treatments.) For over weight due to water retention: TW-4, SP-5, LV-8, PC-3, and ST-25. (Author’s Clinical Experience) Insert 1 cun #30 needles into TW-4 and SP-5 perpendicularly, 0.3 cun deep only with the Inserting Qi technique until the sensation of needle travels from the points. Then insert 1 cun #32 needles into LV-8 and PC-3 perpendicularly with the Zi Wu Dao Jiu—Mortar and Pestle technique. Finally insert 1.5 cun #32 needles into ST-25 perpendicularly, 1.2 cun deep with lifting and thrusting reducing needle technique. Retain all the needles for 20 minutes. Treat twice a week for 10 treatments as a course. For over weight due to phlegm stagnation: ST-40, LV-13, TW-6, and CV-17. (Bai Zhen Fu) Insert 1.5 cun #30 needles into ST-40, TW-6, and LV-13 perpendicularly, 1 cun deep with the Zi Wu Dao Jiu needle technique. Then insert a 1.5 cun #32 needle into CV-17 obliquely towards CV-16 with rubbing technique. Retain all the needles for 20 minutes. Treat twice a week, for 10 treatments as a course. For over weight due to a Stomach and Spleen disharmony: LI-10, ST-36, LV-3, and SP-8. (Biao You Fu) Insert 1 cun #32 needles into LI-10 perpendicularly with twisting reducing needle technique and 1.5 cun #30 needles into ST-36 with lifting and thrusting even movement needle technique. Then insert 1.5 cun #32 needles into SP-8 perpendicularly with lifting and thrusting reinforcing needle technique, and 1 cun #34 needles into LV-3 with even movement twisting needle technique. Treat once every other day, for 7 treatments as a course.

308

Obesity

For over weight with Blood Stagnation: SP-10, SP-6, ST-40, BL-17, BL-19, and BL-23. (Author’s Clinical Experience) Insert 1.5 cun #30 needles into SP-10 and SP-6 with the White Tiger shakes its Head technique, and insert 1.5 cun #32 needles into ST-40 perpendicularly, 1 cun deep with twisting even movement technique. Retain the needles for 15 minutes. Then insert 1.5 cun #32 needles into BL-17, BL-19, and BL-23 perpendicularly, 1 cun deep with lifting and thrusting even movement and waving technique until red marks appear near the points. Retain all the needles for 10 minutes. Treat once every other day for 7 treatments as a course. For over weight due to Liver and Gallbladder Qi Stagnation: LV-4, GB-43, LV-14, LV-13, ST-25, BL-18, BL-15, and BL-19 (Zhong Guo Zhen Jiu) Insert 1 cun #32 needles into LV-4 and GV-43 with twisting even movement needle technique and 1.5 cun #32 needles into ST-25 with lifting and thrusting reducing needle technique. Then insert 1.5 cun #32 needles perpendicularly into LV-13 about one cun deep, and transversely insert into LV-14 along the edge of the rib, applying electric stimulation with irregular waves for 20 minutes. Finally insert 1 cun #30 needles into BL-15, BL-18, and BL-19 with waving technique retaining all the needles on the back for 10 minutes. Treat once every other day, for 10 treatments as a course. For over weight due to stagnation of the Liver Qi: GV-14, BL-11, BL-10, BL-43, BL-45, BL-23, LV-3, CV-14, ST-25, and Yin Tang (Author’s Clinical Experience) Apply 1.5 cun #32 needles on GV-14, BL-11, and BL-10 perpendicularly, 1 cun deep with twisting even movement needle technique, and then insert 1 cun #32 needles into BL-43, BL-45, and BL-23 perpendicularly, 0.3 to 0.4 cun deep with waving technique. Retain all the needles for 10 minutes. Then insert 1 cun #32 needles into LV-3, CV-14, and Yin Tang with twisting even movement technique, and 1.5 cun #32 needles into ST-25 with lifting and thrusting reducing needle technique. Retain all the needles for 15 minutes. Treat twice a week, for 10 treatments as a course. For over weight due to food addiction: CV-24, CV-21, LI-14, TW-10, ST-34, and SP-6. (Zhe Jiang Zhong Yi Zha Zhi) Insert 1.5 cun #32 needles into LI-14, ST-34, TW-10, and SP-6 perpendicularly, 1 cun deep with twisting reducing needle technique. Then insert a 1 cun #32 needle into CV-21 obliquely downwards with fast twisting needle technique. Finally insert a 1 cun #32 needle into CV-24 perpendicularly, 0.2 cun deep with twisting even movement needle technique. Retain all the needles for 20 minutes. Treat once every other day, for 7 treatments as a course. For over weight complaints with edema: LI-4, LV-3, SP-9, LI-11, TW-14, LI-15, GB-29, ST-25, and GV-13. (Author’s Clinical Experience) Insert 1.5 cun #30 needles into SP-9, LI-11, TW-14, and LI-15 with the Zi Wu Dao Jiu technique, and 1 cun #34 needles into LI-4 and LV-3 with twisting even movement needle technique. Then insert 1.5 cun #32 needles into GB-29 and ST-25 perpendicularly, 1.2 cun deep with the Zi Wu Dao Jiu needle technique. Retain all the needles for 20 minutes. Insert a 1.5 cun #30 needle into GV-13 with twisting reducing needle technique and take out the needle when the sensation of the Qi travels. Treat once every other day, for 5 treatments as a course.

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For over weight due to food addiction: BL-10, BL-20, BL-43, BL-49, GV-9, LU-5, LV-8, CV-19, and CV-23. (Author’s Clinical Experience) Insert 1 cun #32 needles into BL-10, BL-20, and GV-9 perpendicularly, 0.5 cun deep with waving needle technique, and 1 cun #32 needles into BL-43 and BL-49 perpendicularly, 0.3 cun deep with the Qi Ci technique. Retain all the needles for 10 minutes. Then insert 1 cun #30 needles into LU-5, LV-8, and CV-19 with twisting even movement needle technique, finally applying a 1 cun #32 needle into CV-23 with Flying needle technique until the saliva increases. Retain all the needles for 20 minutes. Treat once every other day, for 7 treatments as a course. CASE ANALYSIS A 55-year-old white female patient (5’ 05”) came to my acupuncture clinic in order to reduce her weight. Since menopause her OBGYN doctor put her on hormone replacement that increased her weight to over 195 pounds from her regular 115 pounds. She felt tired, experienced lassitude, dizziness, and vertigo at times, she had difficulty concentrating during work, had edema, and shortness of breath, and heart palpitations. These main symptoms were associated with stress and more frequent dream at night, and sleepiness during the day. The tongue was swollen, red in the tip and edges and her pulse was deep and weak. Diagnosis: Over weight due to Qi and Yin Deficiency. Treatment Principle: Reinforce the Qi and Yin and Promote circulation. Point Prescription: SP-6, ST-36, KI-3, LU-9, TW-4, CV-6, ST-28, Yin Tang, BL-13, BL-20, BL-15, and BL-23. Treat once a week for 10 treatments as a course Technique: Insert 1.5 cun #32 needles into BL-13, BL-20, BL-15, and BL-23 perpendicularly, 0.7–1.2 cun deep (BL-20 and BL-23 1.2 cun deep and the others 0.7 cun) with waving technique and lifting, thrusting, reducing technique. Retain all the needles for 10 minutes. Then insert 1.5 cun #30 needles into SP-6, ST-36, CV-6, and ST-28 perpendicularly, 1 to 1.2 cun deep with lifting and thrusting reducing needle technique, and apply 1 cun #34 needles into KI-3, LU-9, and TW-4 with twisting reinforcing needle technique. Finally insert a 1 cun #34 needle into Yin Tang obliquely towards the nose with twisting even movement technique. Result: After one course treatment (10 times), she gradually stopped her drugs and the weight reduced from 195 to 155 pounds. After a second course treatment, her weight dropped to 125 pounds. The rest of the treatment helped to recover from the loose belly skin only (acupuncture is very effective to recover that kind of loose skin instead of plastic surgery). EVALUATION Acupuncture is very effective for the treatment of over weight patients. The treatment effects come from two aspects: •

Helping some physical problems, such as helping soothe the Liver Qi and help increase Gallbladder and other digestion related functions in order to help food stagnation pass the digestive tracts, as well as resolving Blood Stagnation and water retention to promote metabolism.

•

Helping emotional problems, to reduced food desire, addiction, and craving of some specific food, calming the mind and getting rid of anxiousness, stress, and depression.

It is very important to encourage patients to keep a routine life and schedule, good emotions, normal exercise, and healthy eating habits within the course of treatment as well as insist on a whole section/course of treatment in order to obtain the best results.

310

Proctoptosia—Anal Prolapse

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Acupuncture and Moxibustion—A Clinical Desk Reference

PROCTOPTOSIA—ANAL PROLAPSE Proctoptosia refers to prolapse of the anus. This is a very serious yet common disorder in which the patient’s rectum actually falls out of the anus. In TCM anal prolapse is caused by Middle Warmer Qi Deficiency, usually after chronic diarrhea, or another chronic diseases. It most commonly occurs in senile patients, children, or women after labor. DIAGNOSIS Deficiency type The patient will feel a swollen and burning sensation after bowel movement with little prolapses, particularly when tired or experiencing emotional difficulty. As the disease develops, the symptoms worsen, often with severe prolapse that is hard retract and associated signs such as pale complexion, lassitude, heart palpitations, and dizziness. The tongue is pale with a thin white coating and the pulse is thin, floating, and weak. Excess type Symptoms usually appear after acute hemorrhoids or frequent diarrhea with tenesmus and a painful and burning sensation in the local area. The tongue is red with a thin yellow coating and the pulse is fast and wiry. TREATMENT AND PRESCRIPTIONS Deficiency type Treatment Principle: Reinforce the Lung and Spleen Qi. Point Prescription: GV-20, GV-1, LU-9, SP-3, BL-20, BL-13, BL-24, and CV-6. Treat once twice a week for 7 treatments as a course. Technique: Insert 1.5 cun #30 needles into GV-1 perpendicularly, 1 cun deep with twisting reinforcing needle technique, and a 1.5 cun #32 needle into GV-1 obliquely, 1 cun deep at a 45-degree angle towards GV-19 direction with lifting and thrusting reinforcing needle technique. Insert 1 cun #34 needles into LU-9 and SP-3 perpendicularly, 0.3-0.5 cun deep with twisting reinforcing needle technique and apply moxa-pole on CV-6 for 20 minutes. Insert 1 cun #32 needles into BL-13 perpendicularly, 0.5-0.8 cun deep with twisting even movement needle technique, and 1.5 cun #32 needles into BL-20 and BL-24 perpendicularly, 1-1.2 cun deep with twisting reinforcing needle technique and apply moxa wool on the handle of needles for 3 cones. Additional points for associated symptoms: Poor sleep: HT-7 and An Mian. Heart palpitation: PC-6 and ST-36. Dizziness: KI-3 and LV-8.

312

Proctoptosia—Anal Prolapse

Excess type Treatment Principle: Clear the Heat and Resolve the Damp. Point Prescription: GV-1, BL-25, BL-32, BL-40, ST-25, ST-40, and SP-6. Treat once every other day for 7 treatments as a course. Technique: Insert a 1.5 cun #30 needle into GV-1 perpendicularly, 1-1.2 cun deep with lifting and thrusting reducing needle technique, and take the needle out after the Qi travels near the anus area. Insert 1.5 cun #30 needles into BL25, BL-32, and BL-40 with twisting reducing needle technique. Retain all needles for 10 minutes. Insert 1.5 cun #32 needles into ST-25, ST-40, and SP-6 with twisting reducing needle technique. Retain all needles for 20 minutes. Additional points for associated symptoms: Fever: LI-11. Severe prolapse: GV-20 and TW-6. Painful and itching sensation on the anus: LV-2 and SP-2. ADJUNCTIVE THERAPIES Pricking Technique Treatment area: Low back Look for some dots in red or black color, 1-1.5 cun bilateral from L-3 to S-2, apply a pricking technique with a three-edge needle, to squeeze out some yellowish liquid. Treat once every week for 3 treatments as a course Ear Acupuncture Points: Rectum, Sub cortex, Shen Men, and Large intestine. Insert 0.5 cun #32 ear needles into these points obliquely, 0.3 cun deep at a 45-degree angle with twisting even movement needle technique. Retain all needles for 30 minutes. Treat once every other day for 5 treatments as a course. Scalp Acupuncture Treatment zones: Middle and Lateral line of the vertex. Insert 1.5 cun #30 needles into these lines transversely, 1 cun deep with lifting and thrusting reinforcing needle technique. Retain all needles for 40 minutes. Treat twice a week for 5 treatments as a course. Cupping Treatment area: Low back and Lower abdomen. Apply fire moving cups on the low back from L-2 to S-4 along the BL and GV meridians up and down until red marks appear, then apply fire cups on CV-6 and ST-25 for 3 minutes. Treat once every other day for 7 treatments as a course.

313

Acupuncture and Moxibustion—A Clinical Desk Reference

Moxibustion Direct moxibustion: SP-3, LI-3, GV-2, and GV-3. Apply direct non-scarring moxibustion on SP-3 and LI-3 for 5 cones, and on GV-2 and GV-3 for 11 cones. Indirect moxibustion: GV-2, CV-6, and ST-28. Apply indirect moxibustion with Fu Zi (aconite) cake on GV-2 for 5 cones and on CV-6 and ST-28 for 3 cones. Moxa-pole: GV-20, ST-37, and GV-1. Apply moxa pole on these points for 15 minutes. Treat one or twice a week for 7 treatments as a course. TRADITIONAL PRESCRIPTIONS AND TECHNIQUE For Proctoptosia with cold sensation in the abdomen: PC-6, GV-20, GV-4, GV-1, and BL-57. (Zhen Jiu Da Quan) Insert a 1.5 cun #32 needle into GV-1 perpendicularly, 1-1.2 cun deep with twisting reducing needle technique and take the needle out after the sensation of the Qi travels to the anus. Insert 1.5 cun #32 needles into BL-57 perpendicularly, 1 cun deep with twisting reinforcing needle technique. Apply direct non-scarring moxibustion on GV-4 for 9 cones. Insert 1.5 cun #32 needles into PC-6 perpendicularly, 1 cun deep with twisting even movement needle technique, and apply moxa wool on the handle of the needles for 3 cones. Insert a 1 cun #30 needle into GV-20 obliquely, 0.5-0.8 cun deep towards GV-19 direction with twisting reinforcing needle technique, and apply moxa-pole on the side of point for 15 minutes. Treat once every other day for 7 treatments as a course. For Proctoptosia with cold-watery diarrhea: CV-9. (Lei Jing Tu Yi) Apply direct non-scarring moxibustion on CV-9 for 20 cones. Treat twice a week for 5 treatments (100 cones) as a course. For Proctoptosia with deficiency of Qi and Blood: CV-8, GV-1, and ST-9. (Zhen Jiu Feng Yuan) Apply indirect moxibustion with ginger on CV-8 for 5 cones, direct non-scarring moxibustion on CV-9 for 10 cones and apply moxa-pole on GV-1 for 20 minutes. Treat twice a week for 7 treatments as a course. For Proctoptosia with chronic severe hemorrhoids: GV-20, GV-1, Er Bai, and Jing Gong. (Zhen Jiu Da Cheng) Insert 1 cun #32 needles perpendicularly, 0.5-0.8 cun deep with twisting reducing needle technique into Er Bai and Jing Gong—an extra point located 3 cun bilateral from CV-3, often called Zi Gong in women, but called Jing Gong for men. Insert a 1.5 cun #32 needle into GV-20 transversely, 1 cun deep at a 30-degree angle towards GV-19 with twisting reinforcing needle technique, and a 1.5 cun #32 needle into GV-1 perpendicularly, 1 cun deep with twisting even movement needle technique, applying moxa-pole on the side for 20 minutes. Treat once every other day for 5 treatments as a course. For paedatric proctoptosia: GV-20, GV-2, and CV-8. (Zhen Jiu Zi Shen Jing) Apply moxa-pole on GV-20 for 15 minutes and apply direct non-scarring moxibustion on GV-2 for 3 cones. Then apply indirect moxibustion with salt and ginger on CV-8 for 3 cones. Treat once a week for 2 treatments as a course.

314

Proctoptosia—Anal Prolapse

For Proctoptosia with deficiency of the Qi: GV-20, SP-4, ST-30, BL-38, and GV-2. (Zhen Jiu Da Quan) Insert 1.5 cun #32 needles into BL-38 perpendicularly, 1.2 cun deep with twisting reducing needle technique, and apply direct non-scarring moxibustion on GV-2 for 11 cones. Insert 1.5 cun #32 needle into GV-20 obliquely, 1 cun deep at a 45-degree angle and apply moxa-pole on the side for 10 minutes. Insert 1.5 cun #32 needles into ST-30 perpendicularly, 1 cun deep with twisting reinforcing needle technique, 1 cun #34 needles into SP-4 perpendicularly, 0.5 cun deep with even movement needle technique and apply moxa wool on the handle of needles for 3 cones. Treat once every other day for 7 treatments as a course. For Proctoptosia with deficiency of the Kidney: GV-4, BL-57, BL-20, BL-23, and Yao Yan. (Lei Jing Tu Yi) Insert 1.5 cun #32 needles into BL-20, BL-23, and BL-57 perpendicularly, 1 cun deep with twisting reinforcing needle technique, and apply direct non-scarring moxibustion on GV-4 and Yao Yan for 9 cones. Treat once every other day for 7 treatments as a course. For Proctoptosia with watery diarrhea and deficiency of Qi: CV-4, CV-8, ST-25, BL-32, BL-57, and GV-14. (Qian Jing Fang) Insert 1.5 cun #32 needles into ST-25 perpendicularly, 1-1.2 cun deep with twisting even movement needle technique and apply moxa wool on the handle of needles for 3 cones. Apply indirect moxibustion with salt and ginger on CV-8 for 5 cones, and with ginger on CV-4 for 5 cones. Insert 2 cun #30 needles into BL-32 perpendicularly, 1.8 cun deep with twisting reinforcing needle technique, and apply moxa wool on the handle of the needles for 3 cones. Insert 1.5 cun #32 needles into BL-57 and GV-14 with twisting even movement needle technique. Treat once every other day for 5 treatments as a course. For Proctoptosia with deficiency of Qi: LU-5, SP-8, BL-58, and BL-54. (Author’s Clinical Experience) Insert 1 cun #34 needles into LU-5 perpendicularly, 0.5-0.8 cun deep with twisting reinforcing needle technique, and 1.5 cun #32 needles into SP-8 perpendicularly, 1 cun deep with twisting even movement needle technique. Retain all needles for 20 minutes. Insert 3 cun #30 needles into BL-54 obliquely, 2.5 cun deep at a 70-degree towards front genital region with twisting even movement needle technique and apply moxa wool on the handle of needles for 3 cones. Insert 1 cun #32 needles into BL-58 with lifting and thrusting reinforcing needle technique. Retain all needles for 15 minutes. Treat once every other day for 5 treatments as a course. For Proctoptosia with Damp-Heat: BL-25, BL-40, BL-22, SP-6, SP-9, and ST-25. (Author’s Clinical Experience) Insert 2 cun #30 needles into BL-25 perpendicularly, 1.5-1.8 cun deep with twisting reducing needle technique, and 1 cun #30 needles into BL-40 with the open-close acupuncture whole reducing needle technique. Insert 1.5 cun #32 needles into BL-22 perpendicularly, 1 cun deep with twisting reinforcing needle technique. Retain all needles for 15 minutes. Insert 1.5 cun #32 needles into SP-6 and SP-9 perpendicularly with lifting and thrusting reducing needle technique, and 1.5 cun #30 needles into ST-25 perpendicularly with twisting even movement needle technique. Retain all needles for 20 minutes. Treat once every other day for 5 treatments as a course.

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Acupuncture and Moxibustion—A Clinical Desk Reference

CASE ANALYSIS A 42-year-old male patient presented with the main complaint of Proctoptosia for 16 years, caused by chronic dysentery. Six years ago the problem became much worse, taking over 10 minutes to put it back every time he moved his bowels. Associated signs and symptoms were a pale complexion, lassitude, dizziness and vertigo, and heart palpitations. The tongue was pale and swollen with a white thin coating and the pulse was thin and weak. The prolapsed rectum was red and over 5 cm long. Diagnosis: Proctoptosia with deficiency of the Qi. Treatment Principle: Reinforce the Qi. Point Prescription: TW-6, CV-6, CV-4, ST-36, GV-20, and GV-1. Treat once every other day for 10 treatments as a course. Technique: Insert 1.5 cun #32 needles into TW-6 perpendicularly, 1 cun deep with twisting even movement needle technique, and 1.5 cun #34 needles into ST-36 perpendicularly, 1 cun deep with twisting reinforcing needle technique. Apply indirect moxibustion with ginger on CV-4 and CV-6 for 5 cones. Insert a 1 cun #30 needle into GV-20 obliquely, 0.8 cun deep at a 45-degree angle backwards with twisting reinforcing needle technique and apply moxa pole on the side for 15 minutes. Then insert a 1.5 cun #32 needle into GV-1 perpendicularly, 1.2 cun deep with twisting reducing even movement needle technique and take the needle out when the sensation travels towards anus. Result: The symptoms improved after 5 treatments and the rectum returned after one course of treatments. All was cured after 2-courses of treatment. EVALUATION Acupuncture and moxibustion is very effective for treating Proctoptosia, particularly due to Qi Deficiency or chronic hemorrhoids, such as in senile patients, children, and women after labor. During the treatment the patient should keep good habits of bowel movement and do some exercise. Sometimes it is necessary for acupuncture to be performed with herbal therapy and others therapies when the prolapsed rectum is infected. Usually if the disorder is not severe enough to threaten the patient’s life, it is recommended to seek TCM therapy because most western treatments dictate surgery.

316

Shoulder Pain

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Acupuncture and Moxibustion—A Clinical Desk Reference

SHOULDER PAIN Shoulder pain is a chronic, inflammatory, and possibly degenerative disease of the shoulder joint capsule and the surrounding soft tissues. It is principally due to exposure to Cold, trauma, and chronic strain of the shoulder. In Traditional Chinese Medicine, shoulder pain is classified as a Bi syndrome—meaning that a WindCold-Damp Pathogenic Influence has caused the shoulder pain. DIAGNOSIS In diagnosing shoulder pain, the key factor is distinguishing which Pathogenic Influence is most dominant. •

If Wind is predominant the tendons will mainly be affected manifesting as tendonitis. The pain may travel up from the shoulder to the upper back and nape area, or travel down to the arm and fingers.

•

If Cold is predominant, the bone will be affected with the main symptom being a severe, deep, cold pain in the shoulder that is aggravated by cold and reduced by warmth.

•

If Dampness is predominant, the muscle is mostly affected. The shoulder pain in this case will be a more constant dull pain and the local muscle will be swollen and painful to the touch.

Later stage shoulder pain is referred to as frozen shoulder in TCM. In these cases there is severe stagnation in the joint. Pain in the shoulder radiates to the neck and back, worsens at night, and is aggravated by movement of the shoulder. Active and passive movements of the shoulder joint in all directions are greatly limited, especially abduction, lateral rotation and backward extension. TREATMENT AND PRESCRIPTION Wind-Cold-Damp Invasion Treatment Principle: Expel the Wind, Cold, and Damp, and Reduce the pain. Point Prescription: LI-15, SI-9, TW-14, LI-11, and TW-5. The treatment is once every other day for 5 to 7 treatments as a course. Technique: Insert 1.5 cun #30 needles into LI-15, SI-9, and TW-14, puncturing perpendicularly in the direction of HT-1 (towards the inside of the shoulder joint) 1.2 cun deep with lifting and thrusting reducing needle technique or with Long Hu Jiao Zhan—Dragon and Tiger Battle technique. Retain the needles for 20 minutes. Alternately use warming needle technique for 3 cones after the patient feels the Qi and a warm sensation in the shoulder joint. Use 1 cun #30 needles for LI-11 and TW-5 with twisting even movement technique then retain the needles for 20 minutes. Additional points for associated symptoms: Anterior shoulder pain: LU-5 and LU-9. Posterior shoulder pain: SI-3 and SI-8. Qi and Blood Deficiency: CV-6 and ST-36.

318

Shoulder Pain

ADJUNCTIVE THERAPIES Scalp Acupuncture Treatment zones: Anterior oblique line from the vertex to temple and Lateral line 1 of the vertex. (healthy side) Insert 1.5 cun #30 needles into these lines transversely, 1-1.2 cun deep with lifting and thrusting reducing needle technique, meanwhile let the patient move the painful arm as large an amplitude as possible. Retain all needles for 40 minutes. Treat once a week for 3 treatments as a course. Ear Acupuncture Points: Shoulder, Shoulder joint, Clavicle, Ah shi points, and Sub cortex. Select 2-3 points during each treatment. Insert 0.5 cun #32 needles obliquely at a 60-degree angle using fast twisting technique. Have the patient move the stiff shoulder joint during needle insertion, and then retain the needles for 20 minutes. Treat once every other day for 7 treatments as a course. Cupping Points: Ah Shi points. First quickly puncture the point using a blood letting needle or three edge needle and expel 2-3 drops of blood, then apply a fire cup on this area for 1 minute. Treat once a week for 3 treatments as a course. Electro-Acupuncture Point: Ah Shi points. Look for two Ah Shi points on the local shoulder joint: the primary painful point is found as the patient moves the shoulder and the another one will be found by the practitioner’s palpation. Insert 1.5 cun 30 # needles into the points perpendicularly, 0.8-1.2 cun deep with twisting even movement technique. Attach the negative end of the wire to the primary point. Stimulate using dense disperse wave pattern for 20 minutes. Treat once every other day for 5 treatments as a course.

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Acupuncture and Moxibustion—A Clinical Desk Reference

DIAGNOSIS AND TREATMENT OF SHOULDER PAIN ACCORDING TO MERIDIAN DISTRIBUTION Yang Ming Type Shoulder pain located in the LI-15 and LI-16 area. Patient can barely abduct the arm. Point Prescription: Main points are ST-38 through to BL-57. Supplemental points include LI-15 through to HT-1, SI-4, TW-14, and LI-11. Treat once every other day for 3 treatments as a course. Technique: Insert a 3 cun #30 needle perpendicularly into ST-38 toward BL-57 to a depth of 2-2.5 cun with lifting and thrusting or twisting reducing needle technique. Meanwhile have the patient move the shoulder joint until a warm sensation on the palm is felt. Then insert a 2 cun or 3 cun #30 needle into LI-15 perpendicularly towards HT1 with twisting reducing needle technique. Retain the needles for 20 minutes. Use 1 cun #30 needles for SI-4, TW-14, and LI-11 inserting with twisting even movement technique. Retain the needles for 20 minutes after the patient feels the Qi sensation. Tai Yang Type Shoulder pain that occurs in the posterior aspect of the shoulder joint, usually with the motion of crossover adduction. The patient will have difficulty crossing the affected arm over to touch the other shoulder. Point Prescription: Main points are SI-6 towards PC-6 or SI-3 towards PC-8, and BL-58 towards BL-62. Supplemental points include SI-13, SI-10, and SI-9. The treatment is once every other day for 7 treatments as a course. Technique: Insert a 1 cun #32 needle into SI-6 0.3-0.5 cun deep perpendicularly towards PC-6 with twisting reducing technique. Meanwhile have the patient move the shoulder. Retain the needle for 20 minutes. Then insert a 3 cun #30 needle into BL-58 subcutaneously towards BL-62 to a 2 cun depth without any technique. Next insert 1.5 cun #30 needles into SI-13, SI-10, and SI-9 perpendicularly to a depth of 1.2 cun using twisting even movement technique and retain the needles for 20 minutes after patient feels the Qi sensation. Shao Yang Type Shoulder pain located mainly on the lateral aspect of the shoulder with lateral or outward rotation of the arm being the most difficult. Point Prescription: Main points are TW-5 through to PC-6, and GB-34. Supplemental points include TW-14, TW-1, GB-20, and GB-21. The treatment is once every other day for 7 treatments as a course. Technique: Insert a 1.5 cun #30 needle into TW-5 perpendicularly towards PC-6 to a depth of 1 cun with twisting even movement technique while the patient moves the shoulder joint. Retain the needle for 20 minutes. Next insert a 1.5 cun #30 needle into GB-34 towards SP-9 to a depth of 1.2 cun with lifting and thrusting reducing needle technique. Then, insert 1.5 cun #32 needles into TW-14, TW-13, GB-20, and GB-21, puncturing 0.8-1.2 cun deep with twisting reducing needle technique. Retain all needles for 20 minutes.

320

Shoulder Pain

Tai Yin Type Shoulder pain with a dull achy sensation on the anterior and lateral aspects of shoulder. The patient cannot lift the arm and move it backwards. Point Prescription: Main points are LU-7 through to LU-9, and SP-8. Supplemental points include Jian Nei Ling, LU-1, and LU-5. Treatment is once every other day for 7 treatments as a course. Technique: Insert 1.5 cun #30 needle into LU-7 subcutaneously towards LU-9 to a depth of 0.8-1.2 cun with twisting reinforcing needle technique. Next insert a 1 cun #30 needle for SP-8 using twisting reinforcing technique. Then insert 1.5 cun #30 needles into Jian Nei Ling, LU-5, and LU-1 perpendicularly with twisting even movement technique. Retain all needles for 30 minutes. Jue Yin Type Shoulder pain located at the lower anterior area of the shoulder near Jian Nei Ling point. The arm has difficulty moving forward. Point Prescription: Main points are PC-6 and LV-3. Supplemental points are Jian Gen and PC-2 Treat once every other day for 7 treatments as a course. Technique: Insert 1 cun #32 needles into PC-6 and LV-3 perpendicularly, 0.5 cun deep with twisting reinforcing needle technique. Insert 1.5 cun #30 needles for Jian Gen and PC-2 with even movement needle technique. Retain all needles for 30 minutes. TRADITIONAL PRESCRIPTIONS AND TECHNIQUES For severe shoulder pain: LI-15, TW-10, LI-11, SI-5, TW-1. (Shen Yin Jin) Insert 1.5 cun #30 needle into LI-15 perpendicularly, 1.2 cun deep with Long Hu Jiao Zhan—Dragon and Tiger Battle technique for 3 sets. Then withdraw the needle beneath the skin let the patient move the shoulder. Re-insert the needle and repeat the procedure for another 3 sets. Apply moxa wool on the handle of the needle for 3 cones. Retain the needle for 20 minutes. Insert 1 cun 30 # needles into TW-10, LI-11, and SI-5 perpendicularly, about 0.5 cun deep with lifting the thrusting reducing needle technique. Retain the needles for 20 minutes. Puncture TW-1 using a 0.5 cun #26 needle and expel 1-2 drops of blood, then close the point. The treatment is once every other day for 7 treatments as a course.

The following techniques are from the Zhen Zhi Zun Shen. For shoulder and arm pain when raising the shoulder/arm close to the head: LI-15 and SI-4. For shoulder and arm soreness with a heavy sensation: TW-6, TW-1, and SI-12. For shoulder pain related to the neck, scapula and arm: KI-1. For a shoulder that is difficult to move: LI-16. Insert 1.5 cun #30 needles into local points with lifting thrusting reducing needle technique or twisting reducing technique. Insert 1 cun #30 needles into distal points with twisting even movement technique or the Qing Long Bai Wei—Green Dragon Waves its Tail technique in order to move the Qi. Treatment is once every other day for 7 treatments as a course.

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Acupuncture and Moxibustion—A Clinical Desk Reference

For swelling, pain, and burning sensation in the shoulder and upper back region: TW-14, BL-12, BL-11, and TW-3. (Zhen Jiu Da Cheng) Insert 1.5 cun #28 needles into TW-14, BL-12, and BL-11 perpendicularly, 0.8-1.2 cun deep with twisting reducing needle technique. Insert 1 cun #30 needles into TW-3 obliquely towards TW-4 with twisting even movement technique. Retain all needles for 20 minutes. The treatment is twice a week for 7 treatments as a course. For pain and heaviness in the shoulder which inhibits the raising motion of the arm: LI-11and TW-14. (Zi Shen Jin) Insert a 1.5 cun #30 needle into LI-11 with lifting and thrusting reducing technique while the patient moves the shoulder. Next insert a 1.5 cun #28 needle into TW-14 with the Long Hu Jiao Zhan—Dragon and Tiger battle technique. Retain the needles for 20 minutes. Treatment is once every day for 7 treatments as a course. For sensations of bone fracture in the shoulder: SI-6 and BL-10. (Qian Jing Fan) Insert a 1.5 cun #30 needle into BL-10 perpendicularly, 1 cun deep with rubbing technique until the Qi travels down to the shoulder. Then insert a 1 cun #30 needle for SI-6 perpendicularly, 0.5 cun deep with twisting reducing technique. Retain the all the needles for 30 minutes. Apply a fire cup on the local pain area for 2 minutes after the treatment. Treatment is once every other day for 5 treatments as a course. For frozen shoulder: Jian Nei Ling and ST-38. (Author’s Clinical Experience) Insert 1.5 cun #32 needles into ST-38 obliquely, 1-1.2 cun deep at a 60-degree angle towards BL-57 with twisting even movement needle technique, meanwhile let patient move the painful shoulder in a large movement as possible for 3 to 5 minutes. Insert 2 or 3 cun #30 needle into Jian Nei Ling perpendicularly, 1.5-2 cun deep with twisting even movement needle technique, and apply moxa wool on the handle of the needles for 5 cones. Treat twice a week for 7 treatments as a course. For shoulder pain with Qi Deficiency: GB-34, ST-36, CV-6, LI-15, SI-10, and TW-14. (Author’s Clinical Experience) Insert 1.5 cun #32 needles into CV-6, GB-34, and ST-36 perpendicularly, 1-1.2 cun deep with twisting reinforcing needle technique and apply moxa-wool on the handle of needles for 3 cones. Insert 1 cun #32 needles into LI-15, SI-10, and TW-14 perpendicularly, 0.5-0.8 cun deep with twisting even movement needle technique. Retain all needles for 20 minutes. Treat once every other day for 5 treatments as a course.

322

Shoulder Pain

CASE ANALYSIS A 54 year-old female patient presented with a main complaint of right shoulder pain for 2 years. It began as a constant dull ache and heavy sensation. Recently the pain had become more severe and was accompanied by a cold sensation. The pain was worse at night and woke her during sleep. She had difficulty lifting the arm up and the local muscles were atrophied. For the past two weeks the shoulder had become progressively more frozen, limiting motion, especially abduction, extorsion (lateral rotation) and backward extension. The shoulder pain was aggravated by cold and released with warmth. Other symptoms included lower energy, dizziness, and loose bowel movement. The tongue was pale with a white coating and the pulse was weak. Diagnosis: Cold Bi Syndrome on the right shoulder with Qi and Blood Deficiency. Treatment Principle: Reinforce the Qi and Blood and Expel the Cold. Point Prescription: LI-15, SI-9, TW-14, LI-11, ST-38, CV-6, BL-43, and BL-10. Treat once every other day for 7 treatments as a course. Technique: Insert 1 cun #32 needles into LI-15, SI-9, and TW-14 to a depth of 0.5 cun with twisting reinforcing needle technique. Apply moxa wool to the handle of the needles for 3 cones each. Next insert 1.5 cun #30 needles into LI-11, ST-38, CV-6, and BL-10 perpendicularly, 1 cun deep with twisting even movement needle technique. Retain all needles for 20 minutes. Result: One course of treatment should alleviate all symptoms. EVALUATION Acupuncture and moxibustion are very effective for treating shoulder pain, especially if begun early in the pain process. Diagnosis and needle technique plays an important role in the treatment in order to make sure the shoulder pain is not a secondary problem of other organs. An X-ray exam is strongly recommended before the treatment. During the treatment course the patient should be encouraged to keep doing stretching and strengthening exercises particularly if the shoulder is frozen. However, the exercise should be monitored or at least following limitations to reduce future pain and stress on the tissue.

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Acupuncture and Moxibustion—A Clinical Desk Reference

STOP SMOKING Cigarettes are very addictive and hard to stop. During withdrawal many people could have serious physical symptoms such as headache, bloating abdomen, restlessness, nausea, etc. However, most people suffer from some psychological disorders such as anxiety, depression, stress, restlessness, or even fitful dreams in which they are smoking! Acupuncture and moxibustion treatment can help both physiological and psychological ways. The main symptoms of withdrawal may manifest as many different clinical diagnostics. The following are the most common. DIAGNOSIS Qi Stagnation Induced by withdrawal, particularly in patients’ predisposed to Liver Qi Stagnation. The main signs and symptoms are: achy and stiffness sensations in some parts of body or extremities, sighing, belching, distention and distending sensation in the chest, hypochondriac and abdominal region, irritable bowel movement with cramping or bloating sensations, and a bitter taste in the mouth. The tongue is swollen and pulse is wiry. Weakness of the Heart Shen Clinical manifestations of this pattern are heart palpitations and insomnia, along with an irregular lifestyle. Associated signs are slight temple or vertex headache, blurry vision, difficulty to focus, and restlessness. The tip and edge of the tongue will be red with thin while coating, and the pulse will be slippery or weak. Yin Deficiency The main symptoms will be hot flushes, red complexion, pale lips, dizziness and vertigo, heart palpitations with night sweating and low-grade fever, and hands or body tremors. Associated signs are nausea, loose stool, nightmares or insomnia. The tongue is pale with less or no coating and the pulse is tight and deep or irregular. TREATMENT AND PRESCRIPTIONS Along with the prescriptions below, the practitioner should make sure patients really want to quit smoking and teach them how to avoid smoking desires before beginning any treatment. Qi Stagnation Treatment Principle: Move the Qi stagnation and Calm the mind. Point Prescription: GV-20, LV-13, CV-6, LU-7, LV-5, SP-4, and TW-6. Technique: Insert 1 cun #32 needles into LV-13, CV-6, SP-4, and TW-6 perpendicularly with lifting and thrusting even movement technique, and then insert 1 cun #34 needles into LU-7 obliquely in the upward direction against the meridian flow, with twisting reducing needle technique. Finally insert a 1 cun #30 needle into GV-20 obliquely towards GV-19, 0.5 cun deep with withdrawing Qi technique. Retain all the needles for 15 minutes. Treat once every other day, for 3 treatments as a course. Additional points for other associated symptoms: Thirst: CV-24 and KI-6. Restlessness: Yin Tang and HT-7. Joint and muscle aches: GB-34 and BL-11. 324

Stop Smoking

Weakness of the Heart Shen Treatment Principle: Regulate Heart Qi and Calm the Shen. Point Prescription: LV-3, LI-4, CV-14, CV-6, GV-23, GB-13, and Tian Mei—located between LI-5 and LU-7. Technique: Insert 1 cun #30 needles into GV-23 and GB-13 perpendicularly, 0.3 cun deep with fast twisting technique (twist needles over 200 times/min), then insert 1.5 cun #32 needles into LI-4, LV-3, CV-14 and CV-6 perpendicularly, 1 to 1.2 cun deep with lifting and thrusting even movement needle technique. Finally insert 1 cun #30 needles into Tian Mei perpendicularly, 0.2-0.3 cun deep with slow twisting technique until the sensation travels up to the arms or the patient feels an increase in saliva secretion. Retain all the needles for 20 minutes. Treat once every other day, for 3 treatments as a course. Additional points for other associated symptoms: Nightmares: BL-42, BL-44, BL-10, and An Mian. Headache: GB-4 and Tai Yang. Poor memory: GV-26. Yin Deficiency Treatment Principle: Reinforce Blood and Calm the mind. Point Prescription: BL-15, BL-13, BL-23, GV-11, KI-7, HT-5, and GV-23. Technique: Insert 1 cun #32 needles into BL-15, BL-13, BL-23, and GV-11 with waving needle technique until the Qi spreads around the local area or red marks appear near the point, retaining all the needles for 10 minutes. Then insert 1.5 cun #32 needles into KI-7 and HT-5 perpendicularly with twisting reinforcing needle technique, and insert a 1 cun #30 needle into GV-23 obliquely towards GV-22 with a withdrawing Qi technique. Retain all the needles for 15 minutes. Treat twice a week for 5 treatments as a course. Additional points for other associated symptoms: Hot flushes: Four flowers. Bloating abdomen: ST-36 and CV-6. Muscle tenderness and shaking: LV-8 and LI-11. ADJUNCTIVE THERAPIES Ear Acupuncture Points: Mouth, Lung, Heart, Shoulder, Shen Men, Sympathetic, and Liver. Select 3 points in each treatment, inserting 0.5 cun #34 ear needles into these three points obliquely, at a 45degree with fast twisting needle technique and retain all the needles for 45 minutes. Treat once every other day for 5 treatments as a course. (Or apply press-balls on these points and keep for a week in the winter and 3 days in the summer. Let patients press the balls 3 times daily or whenever they feel the smoking desire.)

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Scalp Acupuncture Treatment zone: Mid-line and Lateral line 2 of the vertex, and the Upper middle line of the occiput. Apply 1 cun #32 needles for these lines, inserting the needles obliquely at a 60-degree angle with lifting and trusting even movement needle technique every 10 minutes during the 45-60 minutes retention times. Treat once every other day, for 5 treatments as a course. Plum Blossom Treatment areas: Chest (from CV-17 to CV-21), Forearm (from LU-5 to LU-7), Upper Back (from BL-11 to BL-15), and SI11 Apply plum blossom needling from the chest to forearm and upper back with medium stimulation technique, until red marks appear with one or two drops of blood in each area. Treat twice a week, 3 treatments as a course, most of the time this will be combined with another therapy. Intradermal Points: LU-7, BL-13, BL-15, and GB-39. Apply intradermal needles for these points and retain the needles for 3 days in the summer and 5 days in the winter. Treat once every week for 3 treatments as a course. Gua Sha Treatment area: PC-3, BL-40, HT-1, and ST-9. Apply Gua Sha starting from PC-3, then BL-40, then HT-1, and finally ST-9 as the last point with any kind of oil to smooth the skin. Treat once a week for 2 treatments as s course—most commonly combined with another therapy. Wrist and Ankle Acupuncture Treatment lines: Upper 1 and 6; Lower 2 and 5. Insert 1.5 cun #34 needles into these lines with transverse insertion technique without any needle technique or any sensation. Retain all the needles for 45 minutes. Treat once every other day for 5 treatments as a course. Nose Acupuncture Points: Lung, Liver, and Large Intestine. Insert 0.5 cun #34 needles into these points perpendicularly, 0.1-0.2 cun deep with twisting even movement needle technique and retain all the needles for 20 minutes. Treat once every other day for 5 treatments as a course.

326

Stop Smoking

EFFECTIVE PRESCRIPTIONS AND TECHNIQUES For stopping smoking: Tian Mei—extra point (located between LU-7 and LI-4). (TCM Magazine) Have the patient hold their breath and apply 1 cun #30 needles perpendicularly, 0.3 cun deep with twisting even movement needle technique, and have them then take a slow and long exhalation when the have felt the sensation of the needle—which in most cases travels upwards or directly to the mouth causing increased saliva. Then instruct the patient to do some breathing movement during the treatment in order to help the lung function. The patient will not like the taste of cigarettes after the treatment. Treat once daily, for 5 treatments as a course. Or apply with other points together. For severe desire to smoke: PC-6, Yin Tang, GV-20, LU-7, LI-4, and ST-36. (Zhe Jing TCM Magazine) Insert one cun #34 needles into Yin Tang obliquely towards the nose, and a 1 cun #32 needle into GV-20 obliquely towards GV-19 with fast twisting needle technique. Then insert 1 cun #32 needles into PC-6, LI4, and ST-36 perpendicularly with waving technique and 1 cun #34 needles into LU-7 obliquely upwards. Retain all the needles for 30 minutes. Treat once every other day for 5 treatments as a course. For stopping smoking: GV-20 and HT-7 with ear points Shen Men and Lung (Acupuncture Magazine) Insert a 1.5 cun #32 needle into GV-20 obliquely towards GV-19 1 cun deep with withdrawing Qi technique and then needle HT-7 with 1 cun #34 needles. Retain all the needles for 25 minutes. Add pressballs on the ear points for 7 days in winter and 4 days in the summer and let the patients press them 3-4 times a day, particularly when they desire to smoke. Treat once every other day for 3 treatments as a course. For stopping smoking: Ear points: Shen Men and Lung. (Zhen Jiu Chu Fang Ji Jing) Apply 0.5 cun #34 ear needles obliquely into Shen Men and the Lung point one side with fast twisting needle technique until a warm sensation appears, and then add electro-stimulation on these two points with high frequency waves for 20 minutes. Before the patient finishes treatment, put press-balls on the other side—same points. Retain them for 7 days. Treat twice a week for 3 treatments as a course. For stopping smoking with anxiousness: GV-20, CV-14, CV-6, HT-7, GB-39, and Tian Mei.(Author’s Clinical Experience) Insert 1 cun #30 needles into Tian Mei perpendicularly with twisting even movement needle technique, and apply a 1 cun #30 needle on GV-20 perpendicularly with fast twisting needle technique. Then insert 1 cun #32 needles into CV-14, HT-7, and GB-39 perpendicularly with twisting even movement needle technique. Retain all the needles for 30 minutes. Treat once every other day for 3 treatments as a course. For stopping smoking: Ear points: Shoulder, Mouth, Lung and Shen Men. (Author’s Clinical Experience) Apply press-balls on these ear points and tell the patient to remember where is the points are so that they can press them 1-2 minutes on each point 3-4 times a day, especially when they have desire to smoke. Treat twice a week for 3 treatments as a course. For smoking desires: TW-4, KI-6, CV-23, GV-23, and LU-7. (Author’s Clinical Experience) Insert 1 cun #30 needles into KI-6 with the Leading the Qi technique, until the patient feels the sensation of the needle traveling to the whole leg or lower abdominal region. Than apply 1 cun #34 needles into TW4, CV-23, and LU-7 with twisting reinforcing needle technique. Finally insert 1 cun #30 needles into GV-23 perpendicularly with the Qi Ci technique. Retain all the needles for 30 minutes. Treat once every other day for 4 treatments as a course.

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CASE ANALYSIS A 45 year-old male patient came to the acupuncture clinic asking for help to quit smoking. He has a 25 year smoking history, 18 years smoking in the morning on an empty stomach. He smoked over 20 cigarettes a day sometimes if he was with friends for the past 15 years. He has tried to quit twice, the longest time was 1 week, but both times felt an uncontrollable desire to smoke. Associated signs were chronic bronchitis and pulmonary emphysema—hospitalized twice in the past 3 years, low energy, irritable bowel movement, light sleep or insomnia, stuffy sensation in his chest and epigastric area, and bloated abdomen. The tongue was swollen with a white greasy coating and the pulse was tight. Treatment Principle: Move the stagnation of Qi and Calm the mind. Point Prescription: LU-7, Yin Tang, ST-36, LU-5, and Tian Mei (extra point). Ear points: Lung, Shen men, Sub cortex, Liver Treat once every other day, for 5 treatments as a course. Technique: Insert 1 cun #32 needles into ST-36 and LU-5 perpendicularly, 0.5 cun deep with twisting reinforcing needle technique, and insert 1 cun #34 needles into LU-7 and Yin Tang obliquely at a 15-degree angle with twisting even movement technique. Then apply 1 cun #30 needles into Tian Mei perpendicularly, 0.2 cun deep with twisting movement technique until the sensation travels up the forearms. After finishing the body acupuncture treatment, apply press-balls on the ear points and let him press them 3 times a day, or whenever there is the desire to smoke. Results: After one treatment he called and said he felt a bitter taste when he smoked cigarettes and only smoked 2 cigarettes that day. After the second treatment, his appetite improved considerably, particularly liking some sour and sweet food, but not cigarettes. The desire to smoke had decreased. Before the third treatment (the day of) was his first day without any cigarettes and less desire all day long. During the total 10 days of treatment he stopped smoking any cigarettes. Treatment was continued, doing 4 more treatments once a week, upon which time he was free of the habit. EVALUATION Acupuncture treatment can effectively help people stop smoking, particularly decreasing the desire for cigarettes, as well as some of the body’s physical reactions during or after quitting. It’s more beneficial to apply body acupuncture to treat the body’s physical and psychological reactions during the withdrawal and use ear acupuncture help to decrease the desire of the cigarettes. The critical technique is that the patient must insist on the whole process of therapy, meanwhile ensuring they really would like to quit, not just to decrease their cigarette smoking. According to the author’s personal 25 year’s of clinical analysis, the effective rate will be between 85-90% and the treatment will usually be within 5 times as a course.

328

Summer Heat Stroke

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Acupuncture and Moxibustion—A Clinical Desk Reference

SUMMER HEAT STROKE Summer Heat Stroke implies basically what the name suggests. This sudden disorder occurs very frequently in warm conditions and can often be fatal if not treated. Summer Heat Stroke is an acute syndrome characterized by dizziness, headache, and body aches. Summer Heat Stroke also causes a sensation of heat with no sweating, nausea, vomiting, a floating and weak pulse, and a white greasy tongue coating. In severe cases, there may be a coma with profuse cold sweating, an extremely cold body and four extremities, and a tiny and weak pulse. In TCM, Summer Heat Stroke is attributed to two reasons. Summer Heat Invasion A deficient body constitution is more likely to catch a Summer Heat Pathogenic Invasion, which stagnates in the surface of the body between the muscle and the skin layers, and holds the heat inside of the body. When the heat pathogen invades the Pericardium, it will cause a stroke and unconsciousness. Over-heating Heat and Dampness invade the internal body and the movement of the Wei Qi becomes stagnated, pushing the blood inside and causing dizziness and vomiting. DIAGNOSIS Light Summer Heat Stroke This syndrome is due to stagnation of a Summer Heat Pathogenic Influence and Dampness in the muscle and skin layers. Symptoms include dizziness, headache, a hot sensation inside the body with little or no sweating, nausea or vomiting, thirst, and lassitude. The tongue is red with a white greasy coating and the pulse is floating, weak, and fast. Severe Summer Heat Stroke This syndrome is due to a Summer Heat Pathogenic Influence invading the Pericardium. Symptoms including a high fever with no sweating, a hot or burning sensation on the surface of the skin, a red complexion and eyes, dry lips, a dry mouth, extreme thirst, even unconsciousness, restlessness, and muscle tics or convulsions. The tongue is dry with a yellow coating and the pulse is flooding and fast. If a Summer Heat Pathogenic Influence damages the Qi and Yin of the body, the patient will have profuse sweating with a pale complexion, shortness of breath, coldness in the four extremities, and possible coma. TREATMENT AND PRESCRIPITON Light Summer Heat Stroke Treatment Principle: Expel the Exogenous Summer Heat, Harmonize the Middle Burner, and Resolve the Damp. Point Prescription: GV-14, LI-4, ST-43, PC-6, and ST-36. Treat once, preventatively. Technique: Insert a 1.5 cun #32 needle into GV-14 perpendicularly, 1 to 1.2 cun deep with a twisting reducing needle technique, and remove the needle after the sensation travels down along the spinal column. Insert 1.5 cun #32 needles into LI-4, ST-43, and ST-36 with a twisting reducing needle technique and 1 cun #32 needles into PC-6 obliquely, 0.5 cun deep towards PC-5 with a twisting even movement needle technique. Retain all needles for 30 minutes. Repeat the needling technique every 5 minutes to move the Qi during needle retention. 330

Summer Heat Stroke

Additional points for associated symptoms: Headache: ST-8 and Yin Tang. Vomiting: CV-12 and SP-9. Severe Summer Heat Stroke Treatment Principle: Clear the Summer Heat, Calm the Heart, and Reduce the fever. Point Prescription: GV-20, GV-26, Shi Xuan, PC-3, BL-40, and LI-11. Treat once only. Technique: Apply a bloodletting technique on Shi Xuan, PC-3, and BL-40 with bloodletting needles. Insert a 1.5 cun #30 needle into GV-20 obliquely, 1 cun deep towards the back with a lifting Qi technique, and a 1 cun #32 needle into GV-26 perpendicularly, 0.3 cun deep with a twisting reducing needle technique. Insert 1.5 cun #30 needles into LI-11 with Tou Tian Lian Fa—Cool Penetration of the Sky needle technique. Retain all needles for 30 minutes. Repeat the needling technique every 5 minutes during needle retention. Additional points for associated symptoms: Muscle spasm or tics: GB-34. Cold limbs with profuse sweating and a fine pulse: CV-4 and CV-6 with moxibustion, and HT-6 and LU-9 with needles. ADJUNCTIVE THERAPIES Ear Acupuncture Point Prescription: Tip of the ear, Shen Men, Adrenal gland, Heart, and Occipital. Insert 0.5 cun #32 ear needles into Shen Men, Adrenal gland, Heart, and Occipital obliquely, 0.3 cun deep at a 30-degree angle with a fast twisting needle technique. Retain all needles for 20 minutes. Apply a bloodletting technique to the tip of the ear. Treat once. Gua Sha Treatment area: Back, Neck, Chest, Elbow, and Knee. Apply medium-level stimulation of Gua Sha near PC-6 and the BL-40 area until purple or black dots (Sha) appear. Apply medium-level stimulation of Gua Sha on the upper back along the Bladder meridian, the neck along the Stomach meridian, and the Chest along the Conception vessel until purple or black dots appear. Treat once. Cupping Treatment area: Upper back and Abdomen. Apply fire cups to the upper back near GV-14, BL-13, BL-15, and SI-12 and retain all cups for 5 minutes. Or, apply a sliding cup on the upper back until purple dots (Sha) appear and retain a cup on GV-14 for 3 minutes. Apply a fire cup on CV-8 for 3 minutes. Treat once.

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Acupuncture and Moxibustion—A Clinical Desk Reference

Scalp Acupuncture Treatment zones: Middle line of the vertex, Lateral line 3 of the forehead, Anterior line of the temple, and the Posterior line of the temple. Insert 1.5 cun #32 needles into these lines transversely 1 cun deep at a 30-degree angle with a fast twisting needle technique. Retain all needles for 30 minutes. Treat once. TRADITIONAL PRESCRIPTIONS AND TECHNIQUE For Summer Heat Stroke with a coma: GV-20, GV-26, HT-7, PC-9, PC-3, and BL-40. (Zhen Jiu Chu Fang Xue) Apply bloodletting techniques to PC-9, BL-40, and PC-3 and squeeze out 2 to 3 drops of blood. Insert a 1 cun #30 needle into GV-26 perpendicularly, 0.3 cun deep with a twisting reducing needle technique until the patient wakes up. Insert a 1.5 cun #30 needle into GV-20 transversely, 1.2 cun deep at a 30-degree angle with a lifting the Qi technique and 1 cun #32 needles into HT-7 with a twisting reinforcing needle technique. Retain all needles for 30 minutes. Treat once. For Summer Heat Stroke with a headache, dizziness, nausea, and consciousness: PC-6, LI-4, ST-36, and LI-11. (Author’s Clinical Experience) Insert 1.5 cun #30 needles into LI-11, LI-4, and ST-36 perpendicularly, 1 cun deep with a lifting and thrusting reducing needle technique and 1 cun #32 needles into PC-6 perpendicularly, 0.5 cun deep with a twisting even movement needle technique. Retain all needles for 30 minutes. Treat once. For Summer Heat Stroke with consciousness: CV-9, GV-14, PC-7, and BL-40. (Zhen Jiu Da Cheng) Insert a 1.5 cun #30 needle into GV-14 perpendicularly, 1.2 cun deep with a twisting even movement needle technique until the sensation of the Qi travels downwards. Insert 1 cun #32 needles into PC-7 obliquely towards PC-8 with a twisting even movement needle technique and 1 cun #30 needles into BL-40 and enlarge the acupuncture hole technique to make 1 to 2 drops of blood escape when removing the needle. Apply direct non-scarring moxibustion on CV-9 for 11 cones. Treat once. For Summer Heat Stroke with a coma: GV-26, CV-12, CV-6, LI-11, LI-4, PC-9, ST-36, and ST-44. (Zhen Jiu Feng Yuan) Apply bloodletting techniques on PC-9 and ST-44, and squeeze out 2 to 3 drops of blood. Insert a 1 cun #30 needle into GV-26 perpendicularly, 0.3 cun deep with a twisting reducing needle technique until the patient wakes up. Insert 1.5 cun #32 needles into CV-6 and CV-12 perpendicularly, 1.2 cun deep with a twisting even movement needle technique and 1.5 cun #30 needles into LI-11 and ST-36 with a lifting and thrusting reinforcing needle technique. Insert 1 cun #32 needles into LI-4 with a twisting reducing needle technique. Retain all needles for 30 minutes. Treat once. For Summer Heat Stroke with consciousness: CV-15 and CV-12. (Zhen Jiu Gang Yao) Insert 1.5 cun #32 needle into CV-12 perpendicularly, 1.2 cun deep with a lifting and thrusting reducing needle technique and a 1.5 cun #30 needle into CV-15 perpendicularly, 1 cun deep with a twisting reducing needle technique. Retain the needles for 15 minutes, and repeat this process every 3 minutes. Treat once.

332

Summer Heat Stroke

For Summer Heat Stroke with a coma and profuse cold sweats: CV-12, LV-13, CV-6, BL-11, GV-4, GV-23, PC-7, LU-5, SP-3, KI-7, and LV-8. (Cai Ai Bian Yi) Apply indirect moxibustion with ginger on CV-6, LV-13, and CV-12 until the sweating stops. Insert 1.5 cun #32 needles into LU-5, LV-8, and KI-7 perpendicularly, 1 cun deep with a twisting even movement needle technique and 1 cun #32 needles into SP-3, GV-23, and PC-7 with a twisting even movement needle technique. Retain all needles for 20 minutes. Apply direct non-scarring moxibustion on BL-11 and GV-4 for 7 cones. Treat once. For Summer Heat Stroke with a coma: GV-26, CV-24, LI-4, ST-44, GV-20, CV-3, CV-6, PC-9, LV-2, LI-11, and SI-1. (Zhen Jiu Da Cheng) Apply bloodletting techniques to SI-1 and PC-9 and squeeze out 2 to 3 drops of blood. Insert 1 cun #30 needles into GV-26 and CV-24 perpendicularly, 0.3 cun deep with a fast twisting technique until the patient wakes up. Insert 1 cun #30 needles into LV-2, ST-44, and LI-4 with a lifting and thrusting reducing needle technique and 1.5 cun #32 needles into LI-11, GV-20, CV-3, and CV-6 with a twisting even movement needle technique. Retain all needles for 20 minutes. Treat once just for in case. For Summer Heat Stroke with a body fever: LI-11 and BL-40. (Qian Zha Jian Xiao Fang) Insert 1.5 cun #30 needles into LI-11 perpendicularly, 1.2 cun deep with the Tou Tian Lian Fa—Cool Penetration of the Sky needle technique, one of the combination needle techniques to reduce Heat. Apply a bloodletting technique on BL-40 and squeeze out 5 drops of blood. Treat once. For Summer Heat Stroke with a body fever and retention of urine: LU-7, KI-10, CV-12, BL-40, CV-6, SP-9, and Bai Lao. (Zhen Jiu Da Quan) Insert 1.5 cun #32 needles into Bai Lao and KI-10 perpendicularly, 1 cun deep with a lifting and thrusting reinforcing needle technique. Apply a bloodletting technique on BL-40 and squeeze out 4 to 5 drops of blood. Insert 1.5 cun #32 needles into LU-7 transversely, 1 cun deep at a 15-degree angle towards LI-11 with a twisting reducing needle technique and 1.5 cun #32 needles into CV-12, CV-6, and SP-9 with a twisting even movement needle technique. Retain all needles for 15 minutes. Treat once. For Summer Heat Stroke with a high fever, vomiting, and profuse diarrhea: LU-7, BL-40, CV-12, LI-11, ST-36, LI-4, and Shi Xuan. (Zhen Jiu Da Quan) Apply bloodletting techniques on BL-40 and Shi Xuan. Insert 1.5 cun #32 needles into LU-7 transversely, 1 cun deep at a 15-degree angle towards LI-11 with a twisting reducing needle technique and 1.5 cun #30 needles into LI-11 and LI-4 perpendicularly, 1 cun deep with a lifting and thrusting reducing needle technique. Insert 1.5 cun #32 needles into ST-36 and CV-12 with a twisting reinforcing needle technique. Retain all needles for 15 to 20 minutes. Treat once. For Summer Heat Stroke with fever, nausea, and cold sweats: CV-6, LI-11, and SP-9. (Author’s Clinical Experience) Insert 1.5 cun #30 needles into LI-11 and SP-9 with a lifting and thrusting reducing needle technique. Insert a 2 cun #32 needle into CV-6 perpendicularly, 1.5 cun deep with a twisting reinforcing needle technique, and apply moxa wool to the handle of the needle for 3 cones. Treat once.

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CASE ANALYSIS A 32 year-old male patient had an acute attack of Summer Heat Stroke for 20 minutes. He remained conscious and had a headache, fever, shortness of breath, thirst, a dry mouth and lips, and profuse sweats. His pulse was slippery and fast. Diagnosis: Light Summer Heat Sroke. Treatment Principle: Expel the Exogenous Summer Heat and Clear Heat. Point Prescription: LI-11, CV-12, SP-9, PC-6, and CV-6. Treat once only. Technique: Insert 1.5 cun #30 needles into LI-11 and SP-9 perpendicularly, 1 to 1.2 cun deep with Tou Tian Lian Fa—Cool Penetration of the Sky needle technique and 1.5 cun #32 needles into CV-12 and CV-6 with a twisting even movement needle technique. Insert 1 cun #34 needles into PC-6 perpendicularly, 0.6 cun deep with a twisting reinforcing needle technique. Retain all needles for 20 minutes, and repeat the process every 3 minutes during the retainment of the needles. Result: The symptoms were reduced within 5 minutes. In particular, the sweating stopped. The patient felt better after the treatment, only experiencing a sensation of weakness for a few hours. EVALUATION Preventing a Summer Heat Stroke is more important than the treatment. During the acupuncture treatment, practitioners should carefully observe the temperature, pulse, breath, sweating, complexion, urination, and even possible convulsing of the patient. Acupuncture and moxibustion is every effective in treating Summer Heat Stroke by clearing the Heat and expelling the Summer Heat Pathogenic Influence. For some severe and deep comas, acupuncture is very effective in rescuing the patient on the way to the emergency room.

334

Trigeminal Neuralgia

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Acupuncture and Moxibustion—A Clinical Desk Reference

TRIGEMINAL NEURALGIA Trigeminal Neuralgia is a painful disorder caused by demyelinating lesions of nerves (in this case the Trigeminal nerves). This disorder causes painful attacks, shocks, and even paralysis of facial muscles. Trigeminal Neuralgia is in the category of “facial pain” in Traditional Chinese Medicine, which means pain caused by any reason on the facial area. In TCM theory, most facial pain is due to Wind Pathogenic Influence and stagnation of Qi and Blood. Wind Cold Pathogenic Influence Wind Cold invades the Yang Ming meridians on the face, obstructing the circulation of the Qi and Blood thus causing pain. Wind Heat Pathogenic Influence Wind Heat invades the meridians and causes water retention, which obstructs the movement of the Qi and Blood in the meridians. DIAGNOSIS Wind Cold Symptoms include electric shocks, burning and sharp pain sensations on the face that are triggered suddenly due to touching some special points during washing, brushing, dressing, or eating, and will be reduced after few minutes by rubbing or pressing. The pain will be aggravated by cold and reduced by heat, associated with a clear watery runny nose. The tongue is pale with a thin white coat and the pulse is floating and tight. Wind Heat Symptoms including electric shocks, burning and sharp pain on the face triggered suddenly by touching some special points when the patient washes, brushes, dresses or eats. Most of the symptoms appear after fever and will be reduced after a few minutes of rubbing or pressing. Associated signs are burning or hot sensations in the local pain area, tearing, and red eyes. The tongue is red with a yellow greasy coat and the pulse is floating and fast. TREATMENT AND PRESCRIPTIONS Trigeminal neuralgia due to Wind-Cold Treatment Principle: Expel the Wind-Cold and Reduce the pain. Point Prescription: GB-20, LI-4, ST-3, ST-7, and Tai Yang. Treat once every other day for 5 treatments as a course. Technique: Insert 1.5 cun #30 needles into GB-20 perpendicularly, 1-1.2 cun deep with lifting and thrusting reducing needle technique, and 1 cun #32 needles into LI-4 perpendicularly, 0.5 cun deep with twisting reducing needle technique. Insert 1 cun #32 needles into Tai Yang (painful side) perpendicularly, 0.5 cun deep with twisting reducing needle technique, and 1 cun #32 needles into ST-3 and ST-7 (painful side of the face) with twisting even movement needle technique until the sensation of the needles travels from the points. Retain all needles for 30 minutes. Additional points for associated symptoms: Pain on the forehead: TW-23 and BL-2. Pain in the maxillary area: LI-11 and SI-18. Pain in the mandibular area: CV-23 and TW-17. 336

Trigeminal Neuralgia

Trigeminal neuralgia due to Wind-Heat Treatment Principle: Expel the Wind-Heat and Reduce the pain. Point Prescription: LI-11, LI-3, ST-6, and SP-9. Treat once every other day for 3 treatments as a course. Technique: Insert 1.5 cun #30 needles into LI-11 perpendicularly, 1.2 cun deep with lifting and thrusting reducing needle technique, and 1 cun #32 needles into LI-3 perpendicularly, 0.6 cun deep with twisting reducing needle technique. Insert 1.5 cun #32 needles into SP-9 perpendicularly, 1 cun deep with twisting reducing needle technique, and 1 cun #30 needle into ST-6 (painful side of the face) perpendicularly, 0.5 cun with twisting reducing needle technique. Apply bloodletting technique on the Tai Yang (painful side only). Additional points for associated symptoms: Pain on the forehead: GB-15 and ST-8. Pain in the maxillary area: ST-7 and ST-2. Pain in mandibular area: Jia Chen Jiang and ST-4. ***Jia Chen Jiang is an extra point located one cun bilateral from CV-24.*** ADJUNCTIVE THERAPIES Ear Acupuncture Points: Face, Maxillary, Forehead, Mandibular and Shen Men. Insert 0.5 cun #32 ear needles into these points obliquely, 0.3 cun deep at a 30-degree angle with fast twisting needle technique. Retain all needles for 40 minutes. Clinicians may also apply press-balls or intradermal needles on the ear after regular body acupuncture treatment. Treat once every other day for 5 treatments as a course. Scalp Acupuncture Treatment zones: Anterior oblique line from vertex to temple, Lateral line 3 and 1 of the forehead. Insert 1.5 cun #30 needles into the lower 2/5 of the anterior oblique line from vertex to temple transversely, 1.2 cun deep with lifting and thrusting reducing needle technique. Insert 1.5 cun #32 needles into other two lines transversely, 1 cun deep with twisting reducing needle technique. Retain all needles for 40 minutes. Treat once every other day for 4 treatments as a course. Hand Acupuncture Points: Eyes, Forehead, and Migraine. Insert 0.5 cun #34 needles into these points perpendicularly, 0.2 cun deep with twisting even movement needle technique. Retain all needles for 30 minutes. Treat once daily for 3 treatments as a course.

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Acupuncture and Moxibustion—A Clinical Desk Reference

Bloodletting Treatment area: Tai Yang, SI-19, TW-17, CV-23, and LI-20 (painful side of the face). Apply bloodletting technique on these points, to squeeze 2-3 drops of blood from each point. Treat once daily for 2 treatments as a course. Gua Sha Treatment area: Upper back, TW-17, and GB-14 (painful side of the face). Apply medium stimulation of Gua Sha on the TW-17 and GB-14 areas until red marks appear. Then apply strong stimulation on the upper back near the inside of the scapula from BL-42 to BL-44 until a dark red color appears. Treat once every other day for 2 treatments as a course. Plum Blossom Treatment area: Tai Yang, ST-7, GB-3, and SI-18 (painful side of the face). Apply medium stimulation of Plum blossom needle technique on Tai Yang, ST-7, GB-3 and SI-18 until the skin color turns red. Treat once daily for 3 treatments as a course. Cupping Treatment area: Tai Yang, ST-6, and GB-12 (painful side of the face). Apply fire cups on Tai Yang, ST-6, and GB-12 for 3 to 5 minutes after plum blossom needling or regular acupuncture treatment. Electro-Acupuncture Points: Tai Yang, ST-6, SI-18, and Jia Chen Jiang (painful side of the face). Jia Chen Jiang is an extra point located one cun bilateral from CV-24. Insert a 1.5 cun #32 needle into Tai Yang obliquely, 1.2 cun deep at a 60-degree angle towards ST-7 with twisting even movement needle technique. Insert a 1 cun #32 needle into ST-6 perpendicularly, 0.7 cun deep with twisting even movement needle technique until the sensation of the needle travels. Insert a 1.5 cun #32 needle into SI-18 perpendicularly, 1 cun deep with twisting reducing needle technique, and a 1 cun #30 needle into Jia Chen Jiang obliquely, 0.7 cun deep at a 45-degree angle towards ST-6 with twisting reducing needle technique until the sensation of the needle travels. Then put the negative side of the wire on Tai Yang and SI-18, and the positive side of the wire on ST-6 and Jia Chen Jiang with irregular waves for 20 minutes. Treat once every other day for 5 treatments as a course.

338

Trigeminal Neuralgia

Moxibustion Direct moxibustion: Tai Yang, SI-18, Jia Chen Jiang, and GB-14. Jia Chen Jiang is an extra point located one cun bilateral from CV-24. Apply direct non-scarring moxibustion on these points for 7 cones. Treat once every other day for 3 treatments as a course. Moxa pole: Ah Shi, Tai Yang, GB-3, and LI-11. Apply moxa-pole on these points for 15 minutes. Treat one or twice daily for 5 treatments as a course. TRADITIONAL PRESCRIPTIONS AND TECHNIQUES For Wind-Cold Trigeminal neuralgia: TW-5, LV-3, and ST-44 (bilateral)/Yu Yao, Jia Chen Jiang, and ST-2. (pain side) (Zhen Jiu Chu Fang Xue) Jia Chen Jiang is an extra point located one cun bilateral from CV-24. Insert 1 cun #32 needles into Yu Yao obliquely, 0.3 cun deep at a 30-degree angle towards BL-2 with twisting even movement needle technique, and 1 cun #34 needles into ST-2 obliquely, 0.5 cun deep at a 60 degree angle towards ST-3 with twisting reducing needle technique. Insert 1 cun #32 needles into Jia Chen Jiang obliquely, 0.5 cun deep at a 60-degree angle towards ST-6 with fast twisting needle technique after getting the sensation of Qi. Insert 1.5 cun #32 needles into TW-5 obliquely, 1-1.2 cun deep at a 45-degree angle towards TW-7 with twisting even movement needle technique, and 1 cun #34 needles into LV-3 and ST-44 perpendicularly, 0.5 cun deep with lifting and thrusting reducing needle technique. Retain all needles for 30 minutes. Treat once every other day for 5 treatments as a course. For Trigeminal neuralgia due to Wind-Heat: ST-7, GB-2, Tai Yang (disease side), and LI-3 (bilateral). (Yi Xue Gang Mu) Insert 1.5 cun #32 needles into ST-7 and GB-2 perpendicularly, 1-1.2 cun deep with twisting even movement needle technique, and a 1.5 cun #32 needle into Tai Yang obliquely, 1.2 cun deep at a 60-degree angle towards ST-7 with twisting even movement needle technique. Insert 1 cun #32 needles into LI-3 perpendicularly, 0.5 cun deep with twisting reducing needle technique. Retain all needles for 40 minutes. For Trigeminal neuralgia with severe pain: SI-19, TW-17, and Zhi Tong. (Author’s Clinical Experience) Insert a 1.5 cun #32 needle into TW-17 (diseased side) obliquely, 1-1.2 cun deep at a 60-degree towards SI18 with twisting even movement needle technique, and a 1 cun #32 needle into SI-19 obliquely, 0.5 cun deep at a 45-degree angle towards GB-2 with twisting reducing needle technique. Insert 1.5 cun #30 needles into Zhi Tong—an extra point on the radial bone (1 cun from LI-11) obliquely, 1.2 cun deep at a 45-degree angle towards LI-11with the Long Hu Jiao Zhan—Dragon and Tiger Battle technique. Retain all needles for 40 minutes. Treat twice a week for 5 treatments as a course. For Trigeminal neuralgia due to Wind-Cold: BL-2, TW-23, LI-20, ST-6 (disease side), LI-11, and LI-4. (Author’s Clinical Experience) Insert a 1.5 cun #32 needle into BL-2 transversely, 1 cun deep at a 30-degree angle towards Yu Yao with twisting even movement needle technique, and 1 cun #30 needles into TW-23 and ST-6 perpendicularly, 0.5 cun deep with twisting reducing needle technique. Insert a 1 cun #34 needle into LI-20 obliquely, 0.5-0.8 cun deep towards SI-18 with twisting reducing needle technique. Insert 1.5 cun #32 needles into LI-11 and LI-4 with twisting reducing needle technique. Repeat this process every 5 minutes during 40 minutes needle retaining.

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Acupuncture and Moxibustion—A Clinical Desk Reference

For Trigeminal neuralgia with severe pain: SI-18, ST-2, CV-24, TW-17-affected side, LI-4, and LV-3. (Author’s Clinical Experience) Insert a 1.5 cun #32 needle into SI-18 perpendicularly, 1-1.2 cun deep with twisting reducing needle technique, and a 1 cun #32 needle into ST-2 obliquely, 0.3-0.5 cun deep at a 30-degree angle towards Tai Yang with twisting reducing needle technique. Insert a 1 cun #32 needle into CV-24 obliquely, 0.5 cun deep at a 45-degree angle towards Jia Chen Jiang with twisting even movement needle technique. Insert 1 cun #30 needles into LI-4 and LV-3 perpendicularly with lifting and thrusting reducing needle technique. Apply moxa-pole on TW-17 for 20 minutes. Treat once every other day for 5 treatments as a course. For Trigeminal neuralgia due to Wind-Heat: LI-4, GB-20, LU-7, and ST-36. (Author’s Clinical Experience) Insert 1.5 cun #30 needles into GB-20 perpendicularly, 1 cun deep towards the nose with twisting reducing needle technique, and 1 cun #32 needles into LI-4 and ST-36 perpendicularly, 0.5-0.8 cun deep with twisting even movement needle technique. Insert 1.5 cun #32 needles into LU-7 transversely, 1 cun deep at a 15-degree angle upwards with twisting reducing needle technique. Retain all needles for 30 minutes. Treat twice a week for 5 treatments as a course. For chronic Trigeminal neuralgia: ST-6, ST-7, TW-17, SI-18, BL-2, GB-14, Tai Yang, ST-36, LI-4, and TW-5. (Author’s Clinical Experience) Insert 1 cun #32 needles into ST-6, ST-7, SI-18, BL-2, GB-14, and Tai Yang on the affected side perpendicularly, 0.3 cun deep with twisting reinforcing needle technique. Insert 1.5 cun #34 needles into ST-36, LI-4, and TW-5 perpendicularly, 1 cun deep and apply moxa wool on the handle of needles for 3 cones. Apply moxa-pole on TW-17 for 20 minutes. Treat once every other day for 5 treatments as a course. CASE ANALYSIS A 35 year-old female patient presented with a main complaint of face pain for 1 year and was diagnosed with “Trigeminal neuralgia” and prescribed medications. Her symptoms consisted of sharp and burning pain on the forehead, and knife-cutting pain sensations on the face and left side of mouth. Associated signs were insomnia, frequent dreams, dry mouth and throat, fear to eat and speak in that it may cause more pain. The tongue was red without coating and the pulse was thin and wiry. Diagnosis: Trigeminal neuralgia with Interior Heat. Treatment Principle: Expel the Wind and Clear Heat. Point Prescription: ST-7, GB-14 (disease side only), GB-20, LI-4, ST-44, and SP-6. Treat once every other day for 7 treatments as a course. Technique: Insert 1.5 cun #30 needles into GB-20 perpendicularly, 1 cun deep with lifting and thrusting reducing needle technique, and 1 cun #32 needles into ST-44 and LI-4 with twisting reducing needle technique. Insert a 1 cun #32 needle into GB-14 on the affected side transversely, 0.7 cun deep at a 30-degree angle towards Yu Yao with twisting reducing needle technique. Insert a 1.5 cun #32 needle into ST-7 perpendicularly on the affected side, 1.2 cun deep with twisting reducing needle technique, and 1.5 cun #34 needles into SP-6 with twisting even movement needle technique. Retain all needles for 30 minutes. Result: The pain was gone after the first treatment, but came back after 6 hours. Since second treatment the needle retaining time from 30 minutes increased to 50 minutes. The pain was gone after 5 treatments and did not return after the one course of treatments.

340

Trigeminal Neuralgia

EVALUATION Acupuncture and moxibustion are very effective for treating Trigeminal neuralgia. A strong stimulation, reducing technique, and irregular waves of Electro-stimulation are commonly used for Excess types (the disease with short term and that comes suddenly). On the other hand for Deficient types (the disease has remained at least over 6 months along with other deficient body conditions) demands weak stimulation, moxibustion, and longer needle retention. Otherwise the symptoms will get worse. Critical techniques for these types include: correct point location with suitable stimulation and over 40 minutes of needle retention. Particularly good results will appear when patients feel comfortable sensation during the needle retention. Therefore it might be necessary to adjust the direction of the needles until it makes the patient comfortable.

341

Acupuncture and Moxibustion—A Clinical Desk Reference

URINE RETENTION Traditional Chinese Medicine considers that retention of urine may be due to any of the following: Kidney Deficiency Deficiency of Kidney Qi fails in removing the urine in the bladder, or because of a deficiency of Ming-Men Fire, weakening the Urinary Bladder Qi so that it is unable to move the water/fluids. Qi Deficiency Zhong Qi Deficiency, particularly after labor or other severe physical activities, makes the body energy weak and therefore it is hard to move the urine. Damp-Heat Stagnation Some infectious diseases or accumulation of Damp-Heat pathogenic factors can transfer down to the Urinary Bladder and obstruct the movement of the urine. Injury Any kind of injury including some surgery in the low abdominal region can sometimes cause stagnation of Qi and Blood in the Urinary Bladder meridians. DIAGNOSIS Deficiency syndrome Retention of urine or dribbling urine due to Qi Deficiency causing such signs and symptoms as bloating in the lower abdomen, pale complexion, very low energy, lower back and knee soreness and weakness, no desire to speak, loose stool, pale-swollen tongue with scalloped edges, and a weak and thin pulse. Excess syndrome Retention of urine, lower abdominal bloating and pain, restlessness, thirst, red tongue with a yellow greasy coating, and a fast pulse are characteristic of this syndrome. Due to an infection or injury there may be additional symptoms and a history of injury. TREATMENT AND PRESCRIPTIONS Deficiency syndrome Treatment Principle: Warm the Spleen and Kidney Yang, and Regulate the Qi. Point Prescription: KI-10, BL-23, BL-22, BL-24, BL-39, CV-6, and BL-20. Treat once every other day for 7 treatments as a course. Technique: Insert 1.5 cun #32 needles into BL-23, BL-22, and BL-20 perpendicularly, 1-1.2 cun deep with lifting and thrusting reinforcing needle technique. Insert 1 cun #34 needles into KI-10 and BL-39 with twisting reinforcing needle technique. Insert 3 cun #30 needles into BL-24 perpendicularly, 2 cun deep with twisting even movement needle technique and apply moxa wool on the handle of the needles for 3 cones. Apply indirect moxibustion with ginger on CV-6 for 5 cones.

342

Urine Retention

Additional point for associated symptoms: Restlessness: PC-6. Insomnia: ST-36. Excess syndrome Treatment Principle: Clear Heat, Resolve Damp, and Move the Qi. Point Prescription: SP-6, SP-9, BL-28, and CV-3. Treat once daily for 3 treatments as a course. Technique: Insert a 1.5 cun #30 needle into CV-3 obliquely, 1 cun deep at a 45-degree angle towards CV-2 with lifting and thrusting reducing needle technique, and 1.5 cun #30 needles into SP-9 and SP-6 perpendicularly, 1 cun deep with lifting and thrusting reducing needle technique. Repeat this process every 3 minutes during the 20 minutes of needle retention. Insert 3 cun #30 needles into BL-28 perpendicularly, 2.5 cun deep with twisting reducing needle technique. Retain needles for 15 minutes. Additional points for associated symptoms: Shortness of breath: LU-5 and LU-11 with bloodletting technique. Heart palpitation: PC-5. ADJUNCTIVE THERAPIES Ear Acupuncture Points: Urinary Bladder, Kidney, and San Jiao. Insert 0.5 cun #34 ear needles into these points obliquely, 0.3 cun deep at a 30-degree angle with fast twisting needle technique. Retain all needles for 40 minutes. Treat once every other day for 5 treatments as a course. Scalp Acupuncture Treatment zones: Lateral line 3 of the forehead, Lateral line 1 and Mid-line of the vertex. Insert 1 cun #30 needles into Lateral line 3 of the forehead transversely, 0.8 cun deep towards the Tai Yang direction with fast twisting needle technique. Insert a 1.5 cun #32 needle into the other lines transversely, 1 cun deep with lifting and thrusting reducing needle technique. Retain all needles for 30 minutes. Treat once every other day for 3 treatments as a course. Wrist and Ankle Acupuncture Treatment area: Upper 5, Upper 6, Lower 3, and Lower 6. Insert 1.5 cun #32 needles into these lines transversely, 1.2 cun deep at a 5-10 degree angle without any sensation and needle technique and retain the needles for 40 minutes. Treat once every other day for 5 treatments as a course.

343

Acupuncture and Moxibustion—A Clinical Desk Reference

Moxibustion (For retention of urine due to deficiency) Direct moxibustion: BL-66, BL-62, CV-4, and BL-33. Apply direct non-scarring moxibustion on BL-66 and BL-62 for 9 cones, then on CV-4 and BL-33 for 11 cones. Treat once daily for 3 treatments as a course. Indirect moxibustion: CV-3, CV-4, and BL-32 Apply indirect moxibustion with ginger or Fu Zi (aconite) cake on these points for 5 cones. Treat once every other day for 5 treatments as a course. Moxa pole: Li Niao—an extra point found by measuring the distance from Yin Tang to the tip of the nose, which distance is then measured from the navel downwards in the direction of the genitals where the point Li Niao is located. Apply moxa pole on this point for 15 minutes. Treat twice daily for 3 treatments as a course. Electro-acupuncture Point Prescription: GB-28 and ST-28. Insert 1.5 cun #30 needles into GB-28 transversely, 1.2 cun deep at a 30-degree angle towards ST-28 with twisting reducing needle technique. Insert 2 cun #32 needles into ST-28 perpendicularly, 1.5 cun deep with twisting even movement needle technique. Apply electro-stimulation on these two points with irregular waves, the negative side on GB-28. Treat once daily for 3 treatments as a course. Gua Sha Treatment area: Low back and leg. Apply medium-level stimulation of Gua Sha on the legs—along the inside of the tibia bone (Yin meridians) until red marks appear, then on the low back along the BL, and GV meridians from L-5 to S-5 until a dark red or even a purple color appears. Treat once every other day for 3 treatments as a course. Foot Acupuncture Point Prescription: Kidney, Urinary Bladder, and Small intestine. Insert 0.5 cun #32 needles into these points perpendicularly, 0.3-0.4 cun deep with twisting even movement needle technique. Retain all needles for 20 minutes. Treat once daily for 3 treatments as a course. Salt Bag (For retention of urine after labor or surgery) Treatment area: CV-3 Warm 1 pound of salt in a pan and put it into a cloth bag. Then put the bad on CV-3 within a temperature range the patient can accept. Leave it for 30 minutes. Treat twice daily for 5 treatments as a course.

344

Urine Retention

TRADITIONAL PRESCRIPTIONS AND TECHNIQUES For retention of urine due to stagnation of Qi: CV-6 and PC-7. (Zhen Jiu Da Cheng) Insert 1 cun #32 needles into PC-7 obliquely, 0.5 cun deep towards the PC-6 direction with twisting even movement needle technique. Insert a 1.5 cun #30 needle into CV-6 perpendicularly, 1-1.2 cun deep with twisting rubbing needle technique until the sensation of the Qi travels down to the Urinary Bladder. Retain all needles for 30 minutes. Treat once daily for 3 treatments as a course. For retention of urine with a painful sensation under the navel: SP-9 and CV-4. (Zhen Jiu Fen Yuan) Insert 1.5 cun #30 needles into SP-9 perpendicularly, 1.2 cun deep with lifting and thrusting reducing needle technique. Apply direct non-scarring moxibustion on CV-4 for 14 cones. Treat once daily for 3 treatments as a course. For retention of urine with rebellious Qi and shortness of breath: CV-8. (Bei Ji Jiu Fa) Apply indirect moxibustion with salt on CV-8 for 20 cones. Treat until the urine moves. For retention of urine due to injury and/or surgery: CV-3, BL-28, and SP-6. (Zhen Jiu Chu Fang Xue) Insert 3 cun #30 needles into BL-28 perpendicularly, 2.5 cun deep with twisting reducing needle technique and apply moxa wool on the handle of the needles for 3 cones. Insert 1.5 cun #32 needles into SP-6 obliquely, 1.2 cun deep at a 60-degree angle towards SP-7 with twisting even movement needle technique, and a 1.5 cun #30 needle into CV-3 obliquely, 1 cun deep towards CV-2 with twisting reducing needle technique. Apply moxa pole on the side of CV-3 for 20 minutes. Treat once daily for 3 treatments as a course. For retention of urine with a painful sensation in the low abdomen: LV-8, LV-2, and BL-54. (Zhen Jiu Zi Shen Jing) Insert 1.5 cun #30 needles into LV-8 perpendicularly, 1 cun deep with twisting reducing needle technique, and 1 cun #32 needles into LV-2 perpendicularly, 0.5 cun deep with twisting even movement needle technique. Retain all needles for 20 minutes. Insert 3 cun #30 needles into BL-54 obliquely, 2.5 cun deep at a 60-degree angle towards CV-2 with twisting reducing needle technique, retain the needles for 10 minutes. Treat once daily for 3 treatments as a course. For retention of urine due to stagnation of Qi: CV-5, CV-4, and LV-13. (Yi Xue Gang Yao) Insert 1.5 cun #32 needles into CV-5 and CV-4 perpendicularly, 1 cun deep with twisting even movement needle technique and apply moxa wool on the handle of the needles for 3 cones. Insert 1 cun #32 needles into LV-13 perpendicularly, 0.7 cun deep with twisting even movement needle technique. Treat once every other day for 3 treatments as a course. For retention of urine due to stagnation of Damp-Heat: GV-20, CV-3, KI-1, and CV-8. (Zhen Jiu Tu Y) Insert a 1.5 cun #30 needle into GV-20 transversely, 1 cun deep towards GV-19 with lifting and thrusting reducing needle technique, and a 1.5 cun #30 needle into CV-3 obliquely, 1 cun deep at a 45-degree angle towards CV-2 with lifting and thrusting reducing needle technique. Insert 1 cun #32 needles into KI-1 perpendicularly, 0.5 cun deep with twisting reinforcing needle technique. Apply indirect moxibustion with Ba Dou cake on CV-8 for 7 cones. Treat once every other day for 3 treatments as a course.

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Acupuncture and Moxibustion—A Clinical Desk Reference

For retention of urine with a bloating and painful sensation in the lower abdominal region: KI-11, ST-27, LV-13, CV-5, BL-39, SP-7, KI-1, and ST-36 (Zhen Zhi Zun Shen) Insert 1.5 cun #32 needles into KI-11, ST-27, CV-5, and LV-13 perpendicularly, 1 cun deep with twisting even movement needle technique, and 1.5 cun #34 needles into ST-36 and SP-7 perpendicularly, 1 cun deep with lifting and thrusting reinforcing needle technique. Insert 1 cun #34 needles into KI-1 perpendicularly, 0.5 cun deep with twisting even movement needle technique, and 1.5 cun #30 needles into BL-39 with twisting reducing needle technique. Retain all needles for 30 minutes. Treat once every other day for 3 treatments as a course. For retention of urine with a painful sensation in the urinary tract: CV-1, LV-3, LV-8, and LV-1. (Zhen Jiu Zhai Ying Ji) Insert a 1.5 cun #32 needle into CV-1 perpendicularly, 1 cun deep with twisting even movement needle technique, and 1.5 cun #32 needles into LV-3 obliquely, 1 cun deep at a 45-degree angle towards KI-1 with twisting reinforcing needle technique. Insert 1.5 cun #32 needles into LV-8 perpendicularly, 1 cun deep with twisting even movement needle technique. Apply direct non-scarring moxibustion on LV-1 for 11 cones. Treat once every other day for 3 treatments as a course. For retention of urine with a painful and tight sensation in the lower abdominal region: CV-5, BL-39, and KI-10. (Author’s Clinical Experience) Insert a 1.5 cun #32 needle into CV-5 perpendicularly, 1 cun deep with the Long Hu Jia Zhan—Dragon and Tiger Battle technique. Insert 1 cun #30 needles into KI-10 and BL-39 with twisting even movement needle technique. Retain all needles for 20 minutes. Treat once daily for 2 treatments as a course. For retention of urine due to paralysis: CV-3, LV-5, SP-7, BL-36, and BL-67. (Author’s Clinical Experience) Insert 1.5 cun #32 needles into SP-7 perpendicularly, 1.2 cun deep with twisting even movement needle technique, and 1 cun #30 needles into LV-5 with twisting reinforcing needle technique. Insert 2 cun #30 needles into BL-36 perpendicularly, 1.7 cun deep with lifting and thrusting reducing needle technique. Insert a 1.5 cun #30 needle into CV-3 obliquely, 1 cun deep at a 45-degree angle towards CV-2 with twisting reducing needle technique and apply moxa pole on the side for 15 minutes. Apply direct non-scarring moxibustion on BL-67 for 11 cones. Treat once every other day for 5 treatments as a course. For retention of urine with a weak and slow Kidney pulse: KI-11, BL-64, KI-6, and CV-4. (Author’s Clinical Experience) Insert 1.5 cun #32 needles perpendicularly, 1 cun deep with twisting reinforcing needle technique and apply moxa wool on the handle of the needles for 3 cones. Insert a 2 cun #30 needle into CV-4 obliquely, 1.5 cun deep at a 45-degree angle towards CV-2 with twisting even movement needle technique. Insert 1 cun #32 needles into BL-64 and KI-6 perpendicularly with twisting even movement needle technique. Retain all needles for 20 minutes. Treat once every other day for 7 treatments as a course. For retention of urine with low back pain: ST-25 and CV-2. (Author’s Clinical Experience) Insert 1.5 cun #30 needle into CV-2 perpendicularly, 1 cun deep with twisting reducing needle technique, and apply moxa wool on the handle of the needle for 5 cones. Apply indirect moxibustion with “Fu Zi” (Aconite) cake on ST-25 for 5 cones. Treat once every other day for 5 treatments as a course. For retention of the urine with a cold sensation in the low abdomen: BL-28, CV-4, SP-9, GB-39, and KI-10. (Zhen Jiu Quan Shu) Insert 1.5 cun #32 needles into SP-9 with lifting and thrusting reducing needle technique, and 1 cun #30 needles into GB-39 and KI-10 perpendicularly, 0.7 cun deep with twisting reinforcing needle technique. Apply indirect moxibustion with ginger on CV-4 and BL-28 for 5 cones. Treat once daily for 2 treatments as a course. 346

Urine Retention

For retention of urine due to nerve injury: GV-3, BL-31, BL-32, CV-4, CV-3, and LV-8. (Author’s Clinical Experience) Insert a 1.5 cun #30 needle into GV-3 perpendicularly, 1-1.2 cun deep with twisting rubbing needle technique until the sensation of Qi travels. Insert 2 cun #30 needles into BL-31 and BL-32 perpendicularly, 1.7 cun deep with lifting and thrusting reducing needle technique. Retain all needles for 15 minutes. Insert 1.5 cun #30 needles into LV-8 perpendicularly, 1 cun deep with twisting reducing needle technique. Insert 1.5 cun #30 needles into CV-4 and CV-3 with twisting even movement needle technique and apply moxa wool on the handle of the needles for 3 cones. Treat once every other day for 5 treatments as a course. For retention of urine due to stagnation of Damp-Heat: BL-28, BL-23, CV-4, SP-9, and KI-1. (Author’s Clinical Experience) Insert 1.5 cun #30 needles into BL-23 and BL-28 perpendicularly, 1.2 cun deep with lifting and thrusting reducing needle technique, and 1 cun #32 needles into KI-1 perpendicularly, 0.6 cun deep with twisting even movement needle technique. Retain all needles for 15 minutes. Insert 1.5 cun #32 needles into CV-4 and SP-9 perpendicularly with twisting even movement needle technique. Retain all needles for 20 minutes. Treat once every other day for 4 treatments as a course. CASE ANALYSIS A 72 year-old female patient presented with the main symptom of difficult urination for 3 days after the removal of a urine catheter. She had urine problems 10 days ago and got treated with a urine catheter in the hospital. The symptoms included burning and painful sensations in the lower urinary tact, a bloating sensation in the low abdomen, dry mouth, and headache. The tip of the tongue was red with a white greasy coating and the pulse was floating and fast. Diagnosis: Damp-Heat Stagnation in the Urinary Bladder. Treatment Principle: Clear Heat, Resolve Damp, and Moves the stagnation of Qi. Point Prescription: CV-6, CV-3, and SP-3. Treat once only. Technique: Insert a 2 cun #30 needle into CV-6 perpendicularly 1.5 cun deep with a twisting even movement needle technique. Insert a 1.5 cun #30 needle into CV-3 obliquely, 1.2 cun deep at a 45-degree angle towards CV-2 with a twisting and rubbing technique (rub the needle count-clockwise) until the sensation of the needle travels. Insert 1.5 cun #32 needles into SP-6 obliquely, 1.2 cun deep at a 60-degree angle towards SP-7 with lifting and thrusting reducing needle technique. Retain all needles for 20 minutes. Result: After the acupuncture treatment, she excreted nearly 500ml of urine, but it was still hard upon returning home and was accompanied by a bloated and painful sensation in low abdomen. The tongue was red with a yellow greasy coating and the pulse was thin and fast. New Point Prescription: CV-3, SP-9, LV-2, and SP-6. Treat once daily for 2 treatments as a course. Technique: Insert a 2 cun #30 needle into CV-3 obliquely, 1.5 cun deep to CV-2 with twisting reducing needle technique, and 1.5 cun #30 needles into SP-9 and SP-6 perpendicularly, 1.2 cun deep with lifting and thrusting reducing needle technique. Insert 1.5 cun #32 needles into LV-2 transversely, 1.2 cun deep through to LV-3 with twisting reducing needle technique. Retain all needles for 20 minutes. Result: She passed nearly 1000ml urine after the treatment, and the burning and painful sensations disappeared after the treatment.

347

Acupuncture and Moxibustion—A Clinical Desk Reference

EVALUATION Acupuncture and moxibustion is effective for treating retention of urine via reinforcing the Kidney and Urinary Bladder Qi, particularly in some functional problems, such as after labor and surgery, or due to infection. Acupuncture and moxibustion sometimes has magical results in treating paralysis and severe injury cases, but usually a urinary catheter will be used until the patient can move the urine on their own. Because this disorder usually occurs in patients over the age of 50, treatments will have to take care to change a patient’s incorrect lifestyle. A correct diagnosis and treatment technique will help in this treatment.

348

Urticaria

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Acupuncture and Moxibustion—A Clinical Desk Reference

URTICARIA Urticaria, also referred to as hives, are transient lesions that are round in shape and arise due to many different reasons. Normally it is just described as a kind of allergic skin disease with skin wheals as the main manifestation. The clinical manifestations are the appearance of wheals over the skin with sudden onset and rapid disappearance, leaving no trace after recovery. There is a sensation of severe itching and burning heat on the affected region. It can attack repeatedly and last for a long time. External Wind Pathogenic Invasion This pattern usually occurs in a patient with Wei Qi Deficiency, which allows Wind-Cold to easily invade the skin and stagnated in the skin and muscles turning to Heat, obstructing the Qi movement causing severe itching. Improper Food Intake This pattern is an example of one type of allergic reaction to certain food according to the different body constitutions, particularly some seafood or bad quality food products from the sea. Sometimes drug allergies or other allergies may cause this as well, such as alcohol or certain antibiotics. DIAGNOSIS External Wind Pathogenic Influence There is severe pruritus, a burning sensation, and red wheals on the affected part. The dermatographic test shows positive result, accompanied with a red tongue with thin and yellow coating and a floating and rapid pulse. Heat stagnation in the Stomach and Intestines The patient has wheals of frequent recurrences that easily become chronic and takes a long time to heal. It attacks when the patient is caught by cold; usually the patient is has a weak body constitution, pale tongue with white thin coating, and a thin and weak pulse. TREATMENT AND PRESCRIPTIONS External Wind Pathogenic Influence Treatment Principle: Expel the Wind and Harmonize the Ying and Wei. Point Prescription: LI-15, TW-4, GV-14, LU-10, and SP-6. Treat once every other day for 3 treatments as a course. Technique: Insert 1.5 cun #32 needle into GV-14 perpendicularly, 1 to 1.2 cun deep with lifting and thrusting reducing needle technique until the sensation of the Qi travels down along the spinal column, and take out the needle without retaining. Apply a fire cup on the point; retain it for 2 minutes. Insert 1 cun #32 needles into LI-15, TW-4, LU-10, and SP-6 perpendicularly, 0.5 cun deep with twisting reducing needle technique. Retain all needles for 20 minutes. Additional points for associated symptoms: Sore throat: LU-11 with bloodletting technique. Fever: LI-11 and SP-9. 350

Urticaria

Heat stagnation in the Stomach and Intestines Treatment Principle: Clear Heat and Harmonize the Ying and Wei. Point Prescription: LI-11, ST-36, SP-10, and LU-7. Treat once every other day for 5 treatments as a course. Technique: Insert 1.5 cun #30 needles into LI-11 perpendicularly, 1.2 cun deep with lifting and thrusting reducing needle technique, 1.5 cun #32 needles into ST-36 and SP-10 with twisting reducing needle technique. Insert 1 cun #32 needles into LU-7 transversely, 0.8 cun deep with twisting even movement needle technique. Retain all needles for 20 minutes. Additional points for associated symptoms: Abdominal pain: CV-11. Diarrhea: ST-25. Asthma: LU-5 and CV-17. ADJUNCTIVE THERAPIES Ear Acupuncture Point Prescription: Shen Men, Lung, Endocrine, Sub cortex, Urticaria, and Shoulder. Insert 0.5 cun #34 ear needles into these points obliquely, 0.3 cun deep at a 45-degree angle with fast twisting needle technique. Retain all needles for 40 minutes. Or apply press-balls on these points and retain them for 3 days. Treat once a week for 3 treatments as a course. Scalp Acupuncture Treatment zones: Middle line, Lateral line 1, and Lateral line 3 of the forehead, and Lateral line 1 of the vertex. Insert 1.5 cun #32 needles into these lines transversely, 1 cun deep with fast twisting needle technique. Retain all needles for 40 minutes. Treat once every other day for 3 treatments as a course. Cupping Treatment area: Back, ST-25, and CV-8. Apply a fire cup on CV-8 and take it off after 1 minute, repeat this process for 7 to 10 times on CV-8, and apply fire cups on ST-25, retaining them for 5 minutes. Apply moving fire cups on the back along Bladder meridian from BL-11 to BL-25 until a red color appears, and retain the cups on BL-25 for 3 minutes. Treat twice a week for 3 treatments as a course. Gua Sha Treatment area: PC-3, BL-40, and ST-25. Apply medium-level stimulation of Gua Sha on the PC-3, BL-40, and ST-25 areas until a dark red color or dark purple color appears. Treat twice a week for 3 treatments as a course.

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Acupuncture and Moxibustion—A Clinical Desk Reference

Plum Blossom Treatment area: LU-6, SP-6, ST-40, Chest, and Back. Apply medium stimulation of plum blossom needle technique on the chest Conception vessel and Kidney meridian until the red color appears. Next applying it on the back along BL-10, BL-11, BL-13, and BL-43 and inside of the scapular area until the dark red color appears. Then apply medium stimulation of plum blossom needle technique on LU-6, SP-6, and ST-40 for 3 minutes. Treat twice a week for 3 treatments as a course. Bloodletting Treatment area: BL-40, SI-12, BL-60, PC-3, and Tai Yang. Looking for floating blue or purple tiny veins near the BL-40, SI-12, BL-60, and PC-3 areas and apply bloodletting technique on them to squeeze out 1 or 2 drops of blood. Next apply bloodletting technique on Tai Yang just make 1 drop of blood. Treat twice a week, 3 treatments as a course for treating Urticaria with blood heat syndrome. TRADITIONAL PRESCRIPTIONS AND TECHNIQUE For Urticaria due to Wind-Heat: LI-11, PC-3, LI-4, LU-7, BL-13, LU-10, HT-7, and PC-6. (Zhen Jiu Ji Chen) Insert 1.5 cun #32 needles into BL-13 obliquely, 1 cun deep at a 60-degree angle towards the spinal column with lifting and thrusting reducing needle technique, retaining the needles for 10 minutes. Insert 1.5 cun #30 needles into LI-11 perpendicularly, 1.2 cun deep with lifting and thrusting reducing needle technique, and 1 cun #32 needles into LI-4, HT-7, and PC-6 with twisting even movement needle technique. Insert 1.5 cun #32 needles into LU-7 transversely, 1 cun deep at a 15-degree angle with twisting reducing needle technique. Apply bloodletting technique on PC-3 to squeeze 2 drops of blood. Treat once every other day for 3 treatments as a course. For Urticaria with Yang Ming Heat: SP-10, SP-6, LI-11, and LI-4. (Zhen Jiu Ju Ying) Insert 1.5 cun #30 needles into SP-10 and LI-11 perpendicularly with Tou Tian Liang Fa—Cool Penetration of the Sky technique until a cool sensation appears. Insert 1 cun #32 needles into SP-6 and LI-4 perpendicularly, 0.8 cun deep with lifting and thrusting reducing needle technique. Retain all needles for 30 minutes. Treat once every other day for 5 treatments as a course. For Urticaria with yellowish liquid and fever: LI-11, GB-39, and BL-40. (Yu Long Jing) Insert 1.5 cun #30 needles into LI-11 perpendicularly, 1.2 cun deep with twisting reducing needle technique, and 1 cun #32 needles into GB-39 perpendicularly, 0.7 cun deep with lifting and thrusting reducing needle technique. Apply bloodletting technique on BL-40 to squeeze 3 drops of blood. Treat twice a week for 4 treatments as a course. For Urticaria due to stagnation of Heat: GB-31, SP-10, BL-17, BL-19, GV-14, and LI-4. (Author’s Clinical Experience) Insert 2 cun #30 needles into GB-31 perpendicularly, 1.5 cun deep with twisting reducing needle technique until the sensation of the needles travels to the knee. Insert 1.5 cun #32 needles into SP-10 and LI-4 with twisting even movement needle technique. Retain all needles for 20 minutes. Insert a 1.5 cun #32 needle into GV-14 perpendicularly, 1 cun deep with lifting and thrusting reducing needle technique, and 1 cun #32 needles into BL-17 and BL-19 perpendicularly, 0.7 cun deep with twisting even movement needle technique, applying moxa wool on the handle of needles for 3 cones. Treat once every other day for 5 treatments as a course.

352

Urticaria

For Urticaria with deficiency of Blood: SP-6, ST-36, LI-4, LI-10, BL-20, and BL-23. (Author’s Clinical Experience) Apply indirect moxibustion with ginger on BL-20 and BL-23 for 5 cones. Insert 1.5 cun #34 needles into ST-36 and LI-10 perpendicularly, 1 cun deep with twisting reinforcing needle technique, and 1 cun #32 needles into SP-6 and LI-4 with twisting even movement needle technique. Retain all needles for 20 minutes. For Urticaria with Wind Heat: GB-20, BL-10, BL-13, LU-5, SP-9, and LI-4. (Yu Long Jing) Insert 1 cun #32 needles into GB-20 perpendicularly, 0.7 cun deep with lifting and thrusting reducing needle technique, and 1 cun #30 needles into BL-10 and BL-13 with waving technique until the red color appears near the needle. Retain all needles for 10 minutes. Insert 1.5 cun #32 needles into LU-5 and SP-9 perpendicularly, 1 cun deep with lifting and thrusting reducing needle technique, and 1 cun #32 needles into LI-4 with twisting even movement needle technique. Retain all needles for 20 minutes. Treat once every other day for 3 treatments as a course. For Urticaria with deficiency of the Qi: CV-6, ST-36, BL-13, BL-20, and GV-12. (Author’s Clinical Experience) Insert 1 cun #32 needles into BL-13, BL-20, and GV-12 perpendicularly, 0.6 cun deep with twisting reinforcing needle technique, applying moxa wool on the handle of needles for 3 cones. Insert 1.5 cun #32 needles into ST-36 perpendicularly, 1 cun deep with twisting reinforcing needle technique. Apply indirect moxibustion with ginger on CV-6 for 3 cones. Treat once every other day for 5 treatments as a course. For Urticaria with Wind-Heat: BL-67. (Author’s Clinical Experience) On the upper limbs: LI-11 and LI-4. On the chest and abdomen: CV-12. On back: BL-13 and BL-20. Male: CV-6. Female: SP-10. External Wind Evil: BL-10 and BL-13. Improper food intake: CV-12 and ST-36. (Zhong Ji Yi Kan) Insert 1 cun #30 needles into BL-67 perpendicularly, 0.1 cun deep with twisting even movement needle technique for 1 minute and remove the needle. On the other points, use a twisting reducing needle technique and retain them for 20 minutes. Treat once every other day for 3 treatments as a course. For Urticaria with Blood Heat: GV-11, SP-10, and LI-11. (Zhen Jiu Chu Fang Xue) Insert a 2 cun #30 needle into GV-11 transversely, 1.7 cun deep at a 15-degree angle straight down towards GV-9 with twisting even movement needle technique. Insert 1.5 cun #32 needles into SP-10 and LI-11 perpendicularly, 1.2 cun deep with lifting and thrusting reducing needle technique. Retain all needles for 50 minutes. Treat once every other day for 5 treatments as a course.

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CASE ANALYSIS A 35 year-old male patient presented with the main complaint of chronic Urticaria for 1 year, gradually getting worse in the past month. The main symptoms were itching and swelling on the four extremities, particularly on the arms, worse in heat or after drinking wine, and the associated signs were restlessness, and irregular bowel movement. The tongue was red with a thin yellow coating and the pulse was fast and slippery. Diagnosis: Chronic Urticaria with Blood Heat. Treatment Principle: Clear the Heat, and Resolve the itching. Point Prescription: SP-10, LI-11, ST-36, GB-31, SP-6, and LI-4. Treat once every other day for 5 treatments as a course. Technique: Insert 1.5 cun #32 needles into LI-11 and SP-10 perpendicularly, 1.2 cun deep with lifting and thrusting reducing needle technique, and 2 cun #30 needles into GB-31 perpendicularly, 1.7 cun deep with twisting reducing needle technique. Insert 1 cun #32 needles into ST-36, SP-6, and LI-4 perpendicularly, 0.6 cun deep with twisting even movement needle technique. Retain all needles for 30 minutes. Result: The symptoms had obviously reduced after 3 treatments, and all was totally resolved after 7 treatments. The patient finished treatment after 2 courses of treatment and the symptoms did not come back after 18 months of clinical observation. EVALUATION Acupuncture and moxibustion is very effective for treating Urticaria via regulating the Blood and expelling the Wind techniques. The disease must be treated in two ways: by expelling External Wind and regulating internal Blood problems because the symptoms of the disease are Wind and the reason for the cause is the Blood. As a TCM poem says, “Treating Blood before treating Wind, the Wind will automatically resolve after the Blood is moving”. During the treatment the patient should avoid allergic food, such as certain types of seafood, alcohol, cigarettes, etc. An herbal formula will often be recommended in combination with acupuncture to help this disease.

354

Vomiting

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VOMITING Normally the Qi of the Stomach descends downwards to the intestines. If the Stomach Qi ascends instead of descending, vomiting will occur. Vomiting is a common symptom that happens in many diseases, such as acute or chronic gastritis, gastric dilatation, gastro spasm, and gastro neurosis and other stomach and intestinal diseases. Also vomiting can be occasional due to stomach problems such as sudden coldness or alcohol overdose. In TCM, vomiting is mainly caused by: External Invasion Physiologically, the Stomach Qi flows downwards to the intestines. When an External Pathogenic Influence invades the Stomach, the Stomach Qi fails to descend, causing vomiting. Improper Food Intake Stagnation of food in the Stomach causes the Stomach to fail in descending the Qi. Phlegm Stagnation Pathogenic phlegm, due to a Spleen deficiency failing in transporting and transforming, can accumulate in the Stomach and block the Qi from descending. Liver Qi attacking the Stomach The Stomach fails in descending the Qi due to stagnation of Liver Qi from severe emotional stimulation. DIAGNOSIS Vomiting due to Improper Diet The main symptoms include an oppressive fullness or even pain in the epigastric region, eructation with a fetid odor and acid regurgitation, distending pain that is relieved after vomiting, borborygmus, putrid and offensive smelling stool, a thick and greasy tongue coating and a slippery and excessive pulse. Hyperactive Liver Qi attacking the Stomach Vomiting due to an emotional upset usually occurs after eating and is associated with restlessness, a tendency towards anger, distention or pain near the chest and hypochondriac region, nausea, acid regurgitation, a thin and white tongue coating and a wiry pulse. Vomiting due to Phlegm stagnation in the Stomach In this pattern, the vomiting is filled more with phlegm than food and is accompanied by a desire for warm drinks, dizziness, a pale complexion, a stuffy sensation in the chest region, lassitude, heart palpitations, dizziness and vertigo. The tongue is pale with a white coat and the pulse is slippery or weak and floating. Vomiting due to an External Pathogenic Influence attacking the Stomach Frequent vomiting with a fever, an aversion to the cold, a headache, stuffy nose and backache are symptoms due to an External Pathogenic Influence attacking the Stomach. The tongue is pale with a white thick coat and the pulse is floating, fast or tight.

356

Vomiting

TREATMENT AND PRESCRIPTIONS Vomiting due to Improper Diet Treatment Principle: Move the Qi and Resolve the stagnation of food. Point Prescription: CV-10, CV-21, ST-36, and SP-14. Treat once daily for 2 treatments as a course Technique: Insert 1.5 cun #30 needles into CV-10, ST-36, and SP-14 perpendicularly, 1 cun deep with a lifting and thrusting reducing needle technique and a 1 cun #30 needle into CV-21 obliquely downwards, 0.8 cun deep with a twisting reducing needle technique. Retain all needles for 20 minutes. Additional points for associated symptoms: Bloated abdomen: CV-6. Hyperactive Liver Qi attacking the Stomach Treatment Principle: Soothe the Liver, and Harmonize the Stomach. Point Prescription: CV-13, GB-34, LV-3, ST-34, and HT-7. Treat once daily for 2 treatments as a course. Technique: Insert 1.5 cun #30 needles into GB-34 and ST-34 perpendicularly, 1 to 1.2 cun deep with a lifting and thrusting reducing needle technique and 1 cun #32 needles into CV-13, LV-3, and HT-7 with a twisting even movement technique. Retain all the needles for 30 minutes. Additional points for associated symptoms: Hypochondriac pain: TW-6 and SP-21. Headache: GV-20 and GB-4. Vomiting due to Phlegm stagnation in the Stomach Treatment Principle: Resolve Phlegm and Reinforce the Spleen. Point Prescription: LV-13, SP-4, CV-12, and ST-40. Treat once every other day for 5 treatments as a course. Technique: Insert 1.5 cun #30 needles into ST-40 and CV-12 with a twisting reducing needle technique and apply moxa wool to the handles of the needles for 3 cones. Insert 1 cun #32 needles into LV-13 and SP-4 with a twisting reinforcing needle technique. Retain all needles for 30 minutes. Additional points for associated symptoms: Borborygmus: BL-20 and BL-25. Water retention: SP-9 and LI-11.

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Vomiting due to an External Pathogenic Influence attacking the Stomach Treatment Principle: Expel the Exterior and Harmonize the Middle Warmer. Point Prescription: GV-14, TW-5, LI-4, CV-12, SP-6, LV-3, and ST-44. Treat once daily for 2 treatments as a course. Technique: Insert a 1.5 cun #32 needle into GV-14 with a rubbing needle technique and apply moxa wool to the handle for 2 cones. Insert 1 cun #32 needles into TW-5, LI-4, CV-12, SP-6, LV-3, and ST-44 with a twisting even movement needle technique. Retain all needles for 15 minutes. Additional points for associated symptoms: Dry vomiting: Use direct non-scarring moxibustion on PC-5 for 7 cones. Dizziness and vertigo: GB-20. Vomiting up yellowish fluids: GB-40. ADJUNCTIVE THERAPIES Plum Blossom Treatment area: BL Meridian: From T-7 to T-12 on both sides of the Bladder meridian. CV meridian: From CV-9 to CV-22. ST meridian: From ST-9 to ST-25 along the meridian. Apply medium stimulation of the plum blossom needle technique on these areas for 5 minutes. Treat once daily for 2 treatments as a course. Ear Acupuncture Points: Stomach, Liver, Sympathetic, Sub cortex, and Shen men. Insert 0.5 cun ear needles into these points obliquely at a 45-degree angle, 0.3 cun deep with a twisting reducing needle technique. Retain all needles for 30 minutes. Treat once daily for 3 treatments as a course. Scalp Acupuncture Treatment zones: Lateral line 1, 2, and 3 of the forehead, Middle line of the vertex, and Lateral line 1 of the vertex. Insert 1.5 cun #32 needles into these lines transversely at a 30-degree angle, 1 cun deep with a withdrawing Qi technique. Retain all needles for 1 hour. Treat once daily for 3 treatments as a course. Gua Sha Treatment area: Chest—Conception Vessel, Abdomen—Stomach meridian, Forearm—Pericardium meridian and Lung meridian, and Thigh near the Spleen or Liver meridian. Apply medium stimulation of Gua Sha until purple dots (Sha) appear. Treat once daily for 2 treatments as a course.

358

Vomiting

Moxibustion Indirect moxibustion Apply indirect moxibustion with ginger on CV-12 and CV-6 for 5 cones to treat vomiting due to a Cold External Pathogenic Influence invading the Stomach. Treat once daily for 3 treatments as a course. Moxa-pole Apply moxa-pole on LV-13, CV-17, and LV-3 for 20 minutes to treat vomiting due to stagnation of the Liver Qi. Treat once daily for 3 treatments as a course. Direct non-scarring moxibustion Apply direct non-scarring moxibustion on CV-4, CV-15, and CV-21 for 7 cones to treat vomiting due to phlegm. Treat once daily for 3 treatments as a course.

TRADITIONAL PRESCRIPTIONS AND TECHNIQUES For vomiting with a large amount of phlegm: SP-4, ST-40, CV-17, and Zhong Kui. (Zhen Jiu Da Quan) Apply direct non-scarring moxibustion for 5 cones on Zhong Kui—extra point on the dorsal side of the middle finger, in the center of the proximal interphalangeal joint. Insert 1 cun #32 needles into SP-4 and ST-40 perpendicularly, 0.5 cun deep with a twisting even movement needle technique and 1 cun #30 needle into CV-17 with a twisting reducing needle technique. Retain all needles for 15 minutes. Treat once every other day for 5 treatments as a course. For vomiting with more clear water and stagnant phlegm in the epigastric region: SP-4, CV-15, ST-45, and CV-12. (Zhen Jiu Da Quan) Insert 0.5 cun #30 needles into ST-45 perpendicularly, 0.1 cun deep with a twisting even movement technique and 1 cun #32 needles into SP-4 with a twisting reinforcing needle technique. Insert 1.5 cun #32 needles into CV-12 and CV-15 with a twisting reinforcing needle technique and apply moxa wool on the handles of the needles for 3 cones. Or, apply indirect moxibustion with ginger for 5 cones. Treat once every other day for 5 treatments as a course. For vomiting due to rebellious Qi caused by stagnation of food with borborygmus: LV-13, CV-10, ST-36, and CV-12. (Shen Yin Jing) Apply indirect non-scarring moxibustion on CV-12 for 5 cones. Insert 1 cun #32 needles into LV-13, CV10, and ST-36 with a twisting even movement technique. Retain all the needles for 20 minutes. Treat once daily for 3 treatments as a course. For vomiting with a fever and restlessness: CV-12, GV-14, PC-9, BL-19, and GB-39. (Zhen Jiu Jin Yan Fang) Apply a bloodletting technique on PC-9 with 0.5 cun #30 needle and get 1 or 2 drops of blood out. Insert 1.5 cun #32 needles into CV-12 and GB-39 with an even-movement needle technique. Retain all needles for 10 minutes. Insert 1.5 cun #30 needles into GV-14 and BL-19 perpendicularly, 0.8-1 cun deep with a lifting and thrusting reducing needle technique. Retain all needles for 10 minutes. Apply a fire cup on GV-14 for 3 minutes after removing the needles. Treat once every other day for 3 treatments as a course.

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For vomiting from rebellious of Qi: Main points: CV-12, PC-6, ST-36, and SP-4. (Zhen Jiu Jing Yan Fang) Supplemental points Heat type of vomiting: LI-4 and ST-44. Cold type of vomiting: CV-13 and BL-21. Phlegm type of vomiting: CV-17 and ST-40. Improper food intake: CV-10 and CV-21. Liver Qi attacking: GB-34 and LV-3. Spleen and Stomach Deficiency: BL-20 and LV-13. External Heat Pathogenic Influence: Jing Jing Yu Ye (extra point under the tongue) and PC-8. Insert 1 cun #32 needles into PC-6, ST-36, and SP-4 with a twisting even movement technique and 1.5 cun #34 needle into CV-12 perpendicularly, 1-1.2 cun deep with a twisting reducing needle technique. Retain all needles for 20 minutes. Treat once daily, 3 treatments as a course.

The following three prescriptions are from the Zi Shen Jing. For vomiting due to stagnation of food and water in the Stomach: SP-5, KI-21, and KI-20. Insert 1 cun #32 needles into SP-5, KI-21, and KI-20 with a twisting reducing needle technique. Retain all needles for 20 minutes. Apply a moxa-pole on KI-21 and KI-20 for 10 minutes after removing the needles. Treat once daily for 3 treatments as a course. For vomiting due to an Exterior Pathogenic Influence: LU-11 and PC-8. Apply a bloodletting technique on LU-11 first. Insert 1 cun #34 needles into PC-8 with a twisting even movement needle technique. Retain all needles for 10 minutes. Treat once daily for 2 treatments as a course. For vomiting with a full sensation in the chest: KI-3 and KI-4. Insert 1 cun #32 needles into KI-3 and KI-4 with a twisting reinforcing needle technique. Retain all needles for 30 minutes. Treat once every other day for 3 treatments as a course. For vomiting due to stagnation of food: CV-10, CV-12, and CV-13. (Pi Wei Lun) Insert 1.5 cun #32 needles into CV-10, CV-12 and CV-13 perpendicularly, 1 cun deep with a twisting reducing needle technique until the sensation of the needle spreads around the points. Retain all needles for 20 minutes. Treat once daily for 2 treatments as a course.

360

Vomiting

The following three prescriptions are from the Shen Yin Jing. For vomiting with difficulty swallowing: BL-17, CV-17, CV-15, BL-21, and CV-16. Apply direct non-scarring moxibustion 5 cones on BL-17, CV-17, CV-15, BL-21, and CV-16 Treat once daily for 2 treatments as a course. For vomiting with a poor appetite: SP-1 and BL-15. Insert 1 cun #32 needles into SP-1 and BL-15 with a twisting even movement needle technique. Retain all needles for 20 minutes. Treat once daily for 3 treatments as a course. For vomiting from rebellious Qi: LV-13, CV-10, ST-36, and CV-12. Insert 1.5 cun #32 needles into LV-13, CV-10, and ST-36 with a twisting reducing needle technique, and apply a moxa-pole on CV-12 for 20 minutes. Treat once daily for 3 treatments as a course. For vomiting with stagnation of food and acid-regurgitation: GB-24, CV-12, BL-20, and BL-21. (Lei Jin Tu Yi) Apply direct non-scarring moxibustion on GB-24 for 7 cones and on CV-12, BL-20, and BL-21 for 5 cones. Treat once every other day for 2 treatments as a course. For vomiting with difficulty swallowing: BL-17, BL-21, and CV-15. (Shen Jiu Jing Lun) Apply direct non-scarring moxibustion on BL-17 for 11 cones, 7 cones on BL-21, and CV-15. Treat once every other day for 3 treatments as a course. For vomiting due to over-thinking and stagnation of Qi in the chest region: BL-50. (De Xiao Fang) Apply moxa-pole on BL-50 for 30 minutes. Treat once daily for 3 treatments as a course. For vomiting due to an Exterior Cold Pathogenic Influence: CV-17, CV-6, LU-5, and ST-36. (Zhen Jiu Quan Shu) Insert 1.5 cun needles into ST-36 perpendicularly, 1 cun deep with a twisting reinforcing needle technique, and apply moxa wool to the handles of the needles for 3 cones. Insert 1.5 cun #32 needles into CV-17, CV6 and LU-5 with a twisting even movement needle technique. Retain all needles for 20 minutes. Treat once every other day for 3 treatments as a course. For vomiting up large amounts of phlegm: SP-4, ST-40, CV-17, and Zhong Kui. (Zhen Jiu Da Quan) Insert 1 cun #32 needles into SP-4, ST-40, and CV-17 with a twisting reducing needle technique, and apply direct non-scarring moxibustion on Zhong Kui for 7 cones. Treat once every other day for 3 treatments as a course. For vomiting due to Gall Bladder Heat with rebellious Qi: SP-6. (Zhen Jiu Ju Yin) Insert 1.5 cun #30 needles into SP-6, 1 cun deep with a twisting reducing needle technique and apply moxa wool to the handles for 5 cones. Treat once every other day, 5 treatments as a course. For vomiting due to an Exterior Pathogenic Invasion transferred into the interior organs, causing rebellious Qi: BL-14 and SP-6. (Zhen Jiu Ju Yin) Insert 1.5 cun #30 needles into SP-6, 1 cun deep with a twisting reducing needle technique and apply moxa wool to the handles for 5 cones. Apply direct non-scarring moxibustion on BL-14 for 10 cones. Treat once every other day, 5 treatments as a course. 361

Acupuncture and Moxibustion—A Clinical Desk Reference

For vomiting due to excessive alcohol with large amounts of phlegm: CV-12, CV-17, and GB-8. (Shen Jiu Jing Lun) Insert 1.5 cun #32 needles into CV-12 and CV-17 with a twisting reducing needle technique, and 1 cun #32 needles into GB-8 obliquely at a 45-degree angle towards the back, 0.5 cun deep with a twisting even movement needle technique. Retain the needles until the symptoms have changed. For frequent vomiting: PC-7. (Shu Wen) Insert 1 cun #32 needles into PC-7 perpendicularly, 0.3 cun deep with a twisting reducing needle technique, and apply moxa wool to the handles for 5 cones. Treat once daily for 2 treatments as a course.

The following prescriptions are from the De Xiao Fang. For baby vomiting and diarrhea: TW-18. Insert 0.5 cun #34 needles into TW-18 perpendicularly, 0.2 cun deep with a twisting reducing needle technique and take the needle out immediately without retaining. Treat one or twice daily for 5 treatments as a course. For baby vomiting up milk: CV-16. Apply a moxa-pole on CV-16 for 10 minutes. Treat twice daily for 6 treatments as a course. For baby vomiting with a fever: ST-16, CV-14, CV-9, and CV-7. Apply a moxa-pole on ST-16, CV-14, CV-9, and CV-7 for 5 minutes. Treat once daily for 3 treatments as a course.

The following prescriptions are from the Author’s Clinical Experience. For vomiting during surgery: PC-6 and TW-8. Insert 1.5 cun #30 needles into PC-6 and TW-8 perpendicularly, 1 cun deep with a twisting even movement technique. Retain all needles for 10 minutes. Treat only during surgery. For vomiting with a fever and a thin pulse in the Cun position: LU-1. Apply moxa-pole on LU-1 for 30 minutes. Treat once daily for 2 treatments as a course. For vomiting with Heat and a fast pulse in the Cun position: Wei Guan. Insert 1.5 cun #32 needles into Wei Guan perpendicularly, 1 to 1.2 cun deep with a twisting reducing needle technique. Retain the needle for 20 minutes. Treat once daily for 2 treatments as a course. For vomiting with a fever and aversion to cold with restlessness: CV-12, SP-5, GV-14, PC-9, BL-19, and GB-39. Insert 1 cun #32 needles into SP-5, BL-39, and CV-12 with a twisting reducing needle technique. Retain the needles for 10 minutes. Insert 1.5 cun #32 needles into GV-14 and BL-19 with a twisting even movement needle technique without retaining the needles. Apply a bloodletting technique on PC-9. Treat once every other day for 3 treatments as a course.

362

Vomiting

CASE ANALYSIS A 45 year-old female patient has a main complaint of vomiting with epigastric pain for 5 years. The frequent vomiting and epigastric pain is aggravated by emotional changes, particularly from anger and depression, and is associated with bloating in the chest and hypochondriac region, restlessness, and a tendency towards anger and poor sleep. Her tongue is red with a yellow greasy coating, and her pulse is wiry and fast. Diagnosis: Vomiting due to the Liver Qi attacking the Stomach. Treatment Principle: Soothe the Liver, Harmonize the Stomach, Descend the Qi, and Resolve the vomiting. Point Prescription: CV-12, PC-6, ST-36, SP-4, LV-3, and GB-34. Treat once daily for 7 treatments as a course. Technique: Insert 1.5 cun #30 needles into CV-12, ST-36, and GB-34 with a twisting even movement technique and 1 cun #32 needles into PC-6, SP-4, and LV-3 with a twisting reducing needle technique. Repeat the needle techniques every 10 minutes during the 30 minutes of needle retention. Result: The symptoms were reduced within 3 treatments and gone after 6 treatments. The treatments were concluded after 7 sessions. EVALUATION Acupuncture and moxibustion are very effective for treating vomiting. Acupuncture needles are commonly used for acute syndromes, such as rebellious Qi. Both chronic as well as just occasional vomiting can be treated very effectively within the first initial treatments. Moxibustion is commonly used for deficient or cold symptoms. A correct diagnosis and needling technique is the key to reducing the vomiting. Acupuncture and moxibustion will not mask the primary symptoms during and after the vomiting stops. Patients should try to avoid improper food intake and regulate themselves well during weather changes. Also anything that may damage the Stomach Qi such as extreme cold food, alcohol, and hot food should be avoided.

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Acupuncture and Moxibustion—A Clinical Desk Reference

WEI SYNDROME—FLACCIDITY PARALYSIS SYNDROME Wei means dysfunction and atrophy of the body tissues in TCM. This disorder of the muscle and skin can appear suddenly and cause the patient to lose large amounts of muscle control. It refers to myoatrophy, skin atrophy, tendon atrophy, bone atrophy, etc. and includes some Western Medicine diseases, such as multiple neuritis, myasthenia gravis, and progressive myodystrophia. In TCM, Wei syndrome is related to: Excess Heat in the Lung and Stomach The Lung fails in sending fluids (Jing Ye) to the skin while the Spleen and Stomach fail in nourishing the muscles due to stagnation from Excess Heat. Damp-Heat Invasion A Damp Pathogenic Influence stagnating in the skin muscles and even in the joints and meridians for a long time will turn into Heat, causing tendon weakness and flaccidity. Kidney and Liver Yin Deficiency In TCM physiology, the Liver dominates tendons and the Kidney dominates bone. Yin deficiency of the Liver and Kidney organs causes an inability to nourish the tendons and bones, resulting in flaccid paralysis. DIAGNOSIS The main symptoms of the Wei Zhen are flaccid myoatrophy, weakness of the muscle, and even paralysis. It could happen to a single limb, one side of the body, or on all four extremities (most commonly on the lower extremities). With mild symptoms, the patient will feel a weakness in the muscles. In severe cases, there will be dysfunction or even paralysis of the muscles.

Beginning Stage of Wei Syndrome Lung and Stomach Heat Besides the main symptoms above, there will be an accompanying fever, cough, restlessness, thirst, diarrhea and scanty urine with a burning sensation. The tongue is red with a yellow coat and pulse is big and fast. Damp-Heat Invasion Associated symptoms include a sense of heaviness and soreness in the body, a fever accompanied by sweating, turbid urination, and a stuffy chest. The diseased limb is aggravated by hot and relieved by cold. The tongue is swollen with a yellow greasy coat and the pulse is floating, weak, and fast. Liver and Kidney Deficiency Muscles slowly get worse without the presence of any Exterior symptoms (such as fever, aversion to hot or cold.) The tongue and pulse are usually normal in the beginning stages.

364

Wei Syndrome—Flaccidity Paralysis Syndrome

Late Stage of Wei Syndrome Insufficiency of both the Liver and Kidney This syndrome is associated with a pale complexion, soreness, and weakness in the lower back and spinal column, dizziness and blurry vision, heart palpitations, and spontaneous sweating. The tongue is red without a coating, and the pulse is thin and weak. Deficiency of both the Spleen and Stomach This is associated with a sallow complexion, shortness of breath, a poor appetite, and loose stools, all while the diseased limb atrophies along with edema. The tongue is pale and swollen with a white coat, and the pulse is floating and weak. TREATMENT AND PRESCRIPTION Treatment technique: Select points mainly from the Yang Ming-Tai Yin meridians and foot Shao Yin and Jue Yin. Use a reducing needle technique. Point Prescription: LI-15, LI-11, LI-4, ST-41, ST-31, ST-34, ST-36, and LI-5. Treat once every other day for 7 to 10 treatments as a course. Technique: Insert 1.5 cun #30 needles into LI-11, LI-15, ST-31, ST-34, and ST-36 with a twisting reinforcing needle technique and 1 cun #32 needles into LI-4, LI-5, and ST-41 with a twisting reinforcing needle technique. Retain all needles for 30 minutes. Additional points for associated symptoms: Lung Heat: LU-5 and BL-13. Stomach Heat: ST-44 and CV-12. Damp Heat: SP-9 and BL-20. Liver and Kidney Deficiency: BL-23, BL-19, GB-39, and GB-34. ADJUNCTIVE THERAPIES Ear Acupuncture Points: Brain, Sub cortex, Shen men, Spinal column, Spleen, and Liver. Insert 0.5 cun #32 ear needles into these points obliquely, 0.3 cun deep with a fast twisting needle technique. Retain all needles for 30 minutes. Or apply press-balls on these points for 3 days. Treat once every other day for 5 treatments as a course. Scalp Acupuncture Treatment zone: Middle line of the vertex, anterior oblique line from the vertex to the temple (opposite side of paralysis), posterior oblique line from the vertex to the temple (opposite side of paralysis), lateral line 1 of the vertex, and middle line of the forehead. Insert 1.5 cun #32 needles into these lines transversely, 1 cun deep at a 30-degree angle with a fast twisting needle technique. Retain all needles for 40 minutes. Treat twice a week for 7 treatments as a course.

365

Acupuncture and Moxibustion—A Clinical Desk Reference

Plum Blossom Treatment area: Back and Arm and Leg Yang Ming meridians. Apply medium stimulation of the plum blossom needle technique on BL-13, BL-18, BL-20, and BL-21 for 5 minutes. Use sliding fire cups on these points after the plum blossom needle treatment. Apply medium stimulation from the plum blossom needle on the arms and legs along the Yang Ming meridians for 5 to 7 minutes. Treat once every other day for 10 treatments as a course. Cupping Treatment area: Back, CV-8, ST-28, and LU-1. Apply a sliding fire cup on the back along the BL and GV meridians, going up and down several times until a dark red color appears. Retain the cup on GV-14 or GV-3 for 5 minutes. Apply fire cups on CV-8 for 2 minutes and on ST-28 and LU-1 for 3 minutes. Treat once every other day for 7 treatments as a course. TRADITIONAL PRESCRIPTIONS AND TECHNIQUES The following four prescriptions are from the Chi Sui Xuan Zhu. For Wei Syndrome with fever, red urine, lower body atrophy, and a red complexion: BL-15, HT-9, SI-1, LU-9, BL-23, GB-30, and GB-34 Insert 1 cun #32 needles into LU-9 perpendicularly, 0.3 cun deep with a twisting reinforcing needle technique and 1 cun #30 needles into BL-15 perpendicularly, 0.5 cun deep with a twisting even movement needle technique. Insert 1.5 cun #30 needles into BL-23 and GB-34 with a lifting and thrusting reducing needle technique and 3 cun #30 needles into GB-30 with a twisting reducing needle technique. Retain all needles for 30 minutes. Apply a bloodletting technique on HT-9 and SI-1. Treat once every other day for 7 treatments as a course. For Wei syndrome with tendon contractions and Liver Heat symptoms: BL-18, BL-23, GB-34, LV-2, and KI-1. Insert 1 cun #30 needles into BL-18 and BL-23 perpendicularly, 0.5 cun deep with a twisting even movement needle technique and 1 cun #32 needles into KI-1 with a twisting reinforcing needle technique. Retain all needles for 15 minutes. Insert 1.5 cun #32 needles into GB-34 with a lifting and thrusting reducing needle technique and 1 cun #32 needles into LV-2 with a twisting reducing needle technique. Retain all needles for 20 minutes. Treat once every other day for 7 treatments as a course. For Wei syndrome with muscular atrophy, thirst, and Spleen deficiency symptoms: BL-20, SP-9, PC-6, CV-12, SP-6, and KI-7. Insert 1.5 cun #30 needles into BL-20 perpendicularly, 1 cun deep with the Shao Shan Huo—Burning Fire on the Mountain technique until a heat sensation is produced under the needles and the then remove the needles without retaining them. Insert 1.5 cun #32 needles into SP-9, SP-6, CV-12, and KI-7 with a twisting even movement needle technique. Retain all needles for 20 minutes. For Wei syndrome with bone atrophy below the waist, a black complexion, and Kidney deficient symptoms: BL-23, GB-30, GB-31, GB-34, GB-39, and KI-1 Insert 1.5 cun #32 needles into BL-23 perpendicularly, 1 cun deep with a lifting and thrusting reinforcing needle technique and 3 cun #30 needles into GB-30 with a twisting even movement needle technique. Insert 1.5 cun #32 needles into GB-31, GB-34, and GB-39 perpendicularly, 1 cun deep with a lifting and thrusting reducing needle technique and 1 cun #32 needles into KI-1 with a twisting reinforcing needle technique. Retain all needles for 30 minutes. Treat once every other day for 7 treatments as a course. 366

Wei Syndrome—Flaccidity Paralysis Syndrome

For Wei syndrome with a weak back, contracted muscle and tendon, and an Interior Deficient fever: GV-2 and BL-34. (Qian Jing Fang) Apply direct non-scarring moxibustion on these points for 9 cones. Treat once every other day for 5 treatments as a course. For Wei syndrome with a fever: LI-11, TW-3, ST-36, GB-37, BL-62, and LI-4. (Zhen Jiu Zhi Zhi) Apply 1.5 cun #30 needles into LI-11 perpendicularly, 1 cun deep with the Long Hu Jiao Zhan—Dragon and Tiger Battle technique and 1.5 cun #32 needles into ST-36 and GB-37 with a twisting reinforcing needle technique. Insert 1 cun #32 needles into LI-4, TW-3, and BL-62 with a twisting reducing needle technique. Retain all needles for 30 minutes. Treat once every other day for 5 treatments as a course. For Wei syndrome due to Damp-Heat: GV-20, GV-16, LI-10, LV-2, GB-30, and TW-11. (Zhen Jiu Ju Ying) Apply 1.5 cun #30 needle into GV-20 transversely, 1 cun deep with a lifting Qi technique and 1 cun #32 needle into GV-16 perpendicularly, 0.5 cun deep with a twisting reducing needle technique. Insert 3 cun #30 needles into GB-30 with a twisting reducing needle technique and 1 cun #32 needles into LV-2 with a twisting even movement needle technique. Insert 1.5 cun #30 needles into LI-10 and TW-11 perpendicularly, 1 cun deep with a lifting and thrusting reducing needle technique. Retain all needles for 30 minutes. For Wei syndrome with Kidney and Liver deficiency: ST-36, GV-14, BL-43, BL-23, and LV-2. (Zhen Jiu Gang Yao) Apply a bloodletting technique on LV-2 and insert 1.5 cun #32 needles into ST-36 perpendicularly, 1 cun deep with a twisting reinforcing needle technique, and apply moxa wool to the handles of the needles for 3 cones. Insert a 1.5 cun #32 needle into GV-14 perpendicularly, 1 to 1.2 cun deep with a rubbing needle technique until sensation of the needle travels down along the spinal column, and apply moxa wool to the handles of the needles for 3 cones. Insert 1.5 cun #32 needles into BL-43 transversely at a 30-degree angle, towards BL-44, 1 cun deep with a twisting reinforcing needle technique and 1.5 cun #30 needles into BL-23 with a lifting and thrusting reinforcing needle technique. Retain all needles for 30 minutes. Treat once every other day for 10 treatments as a course. For Wei syndrome due to deficiency of Qi: ST-36 and SP-6. (Jiu Fa Mi Chuan) Apply direct non-scarring moxibustion on ST-36 for 11 cones, on SP-6 for 5 cones. Treat once daily 7 treatments as a course. For Wei syndrome with Interior Heat: LI-4, TW-10, BL-23, GB-30, KI-2, and GB-32. (Cai Ai Bian Yi) Insert 1.5 cun #30 needles into TW-10 obliquely, 1 cun deep at a 45-degree angle towards TW-13 with a twisting reducing needle technique and 1 cun #32 needles into LI-4 and KI-2 with a twisting even movement needle technique. Insert 3 cun #30 needles into GB-30 perpendicularly, 2.5 cun deep with a twisting reducing needle technique and 1.5 cun #32 needles into BL-23 and GB-32 with a twisting even movement needle technique. Retain all needles for 30 minutes. Treat once every other day for 30 minutes as a course. For Wei syndrome with numbness and a dull sensation on the hands and feet: GB-42, LV-3, LI-11, PC-7, LI-4, LI-10, TW-2, and SP-9 (Zhen Jiu Da Quan) Insert 1 cun #30 needles into GB-42 and LV-3 with a twisting reducing needle technique and 1 cun #32 needles into LI-4, TW-2, and PC-7 with a twisting reducing needle technique. Insert 1.5 cun #30 needles into LI-11, LI-10, and SP-9 perpendicularly, 1 cun deep with a lifting and thrusting reducing needle technique. Retain all needles for 30 minutes. Treat twice a week for 7 treatments as a course.

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For Wei syndrome with paralysis of legs: GB-39 and GB-30. (Yu Long Jing) Insert 1.5 cun #30 needles into GB-39 perpendicularly, 1 cun deep with the Zi Wu Dao Jiu—Mortar and Pestle technique and 3 cun #30 needles into GB-30 with a twisting reducing needle technique. Apply Electro stimulation on these two points, with the negative side on GB-30 and slow- fast waves for 30 minutes. Treat once every other day for 7 treatments as a course. For Wei syndrome with paralysis of the legs: ST-36, SP-6, KI-7, and LV-3. (Zhen Jiu Feng Yuan) Insert 1.5 cun #32 needles into LV-3, 1 cun deep towards KI-1 with a twisting even movement needle technique and 1.5 cun #30 needles into ST-36, SP-6, and KI-7 perpendicularly, 1 cun deep with a twisting reinforcing needle technique. Retain all needles for 30 minutes. Treat twice a week for 7 treatments as a course. For Wei syndrome with profuse sweating: LI-10 and ST-30. (Pi Wei Lun) Apply a bloodletting technique at LI-10 and ST-30 to treat Wei syndrome with profuse sweating. For Wei syndrome with sweating that is hard to stop: LI-9 and GB-40. (Pi Wei Lun) Insert 1.5 cun #32 needles into LI-9 perpendicularly, 1 cun deep with a twisting reducing needle technique and 1 cun #30 needles into GB-40 with a twisting even movement needle technique. Retain all needles for 20 minutes. Treat during the symptoms only. CASE ANALYSIS A 60 year-old male patient has a main complaint of paralysis of the legs for the last 6 months. He has associated numbness, coldness, and pain in the hands and feet. The paralysis started on both legs, with the muscles gradually becoming weaker with dysfunction and heaviness that is aggravated by both hot and cold stimulation. He has lassitude, a poor appetite, loose stools, a bloated abdomen, poor sleep, dizziness and headaches. The tongue was pale with a white greasy coating and the pulse was thin and weak. Diagnosis: Wei syndrome due to Dampness and Spleen Deficiency. Treatment Principle: Reinforce the Spleen, Resolve the Damp, and promote blood circulation. Point Prescription: CV-12, BL-20, BL-21, LI-4, SP-6, LV-3, SP-9, LI-11, TW-5, ST-36, and GB-34. Treat once every other day for 15 treatments as a course. Technique: Insert 1.5 cun #30 needles into BL-20 and BL-21 perpendicularly, 1 cun deep with a lifting and thrusting reinforcing needle technique, and apply moxa wool to the handles of the needles for 3 cones. Insert 1 cun #30 needles into LV-3 and LI-4 with a twisting reducing needle technique and 1.5 cun #30 needles into SP-9, GB-34, TW-5, and LI-11 with a lifting and thrusting reducing needle technique. Insert 1.5 cun #32 needles into SP-6 and SP-36 with a twisting reinforcing needle technique and a 1.5 cun #30 needles into CV-12 perpendicularly, 1 cun deep with a twisting reinforcing needle technique. Apply electro-stimulation on GB-34-LV-3 and LI-11-LI-4 with continuous waves, and apply moxa wool on CV-12 for 5 cones. Result: All symptoms improved after 2 courses of treatment, and all symptoms were cured after another 3 courses of treatment.

368

Wei Syndrome—Flaccidity Paralysis Syndrome

EVALUATION “Select Yang Ming meridians to treat ‘Wei’ syndrome.” This is a famous sentence from the Nei Jing—Ling Shu: Chapter Gen Jie, which means to use the more Qi and Blood related meridians for treating paralysis problems. Chinese-style acupuncturists not only use Yang Ming meridians for treating Wei syndrome, but they also use other meridians and techniques for this chronic disease and have very good results. Wei syndrome includes all flaccid paralysis, such as polio, multiple neuritis, myasthenia gravis, and other flaccid paralysis caused by neurological system infections or accidents. Acupuncture treatment should be used as early as possible, and both the patient and the practitioners have to patiently work together until the symptoms improve. Acupuncture effects usually will appear after 10 to 15 treatments. It’s better to use acupuncture alongside exercise and physical therapy. With acute flare-ups of Wei syndrome, we generally do not use any moxibustion therapy or hot patches.

369

Acupuncture and Moxibustion—A Clinical Desk Reference

WIND STROKE Wind-stoke is a very dangerous and common disorder that affects many patients in the clinic. Its onset is very quick and the symptoms are very changeable. Similar to the nature of the Wind syndromes, main clinical manifestations are sudden loss of consciousness and waking up with paralysis one side of the body and face, most of the time with speech problems as well. TCM thinks Wind-stroke is due to pathogenic Wind, Fire, and Dampness, Deficiency and stagnation of Qi, stagnation of the Blood, and deficiency of the Yin. Underlying disease mechanisms are deficiency of both Liver and Kidney Yin, which lead the upper body to Excess and the lower body to Deficiency, causing the rebellious Qi and stagnation of Blood in some parts of the meridians and brain—leading to stroke. Fire Interior Fire refers to Liver and Heart Fire, which are caused by either long term stagnation of Liver Qi, due to abnormal emotional activities, or by Interior Heat, such as long term Yin Deficiency and long term stagnation of Blood. Phlegm Phlegm is usually produced by over eating or long term improper food intake, making the Spleen fail in transportation and transformation, and as a result the stagnation of water forms into Phlegm being retained in the middle warmer. After long-term stagnation it will turn to Heat and damage the Yin of the body. It often travels and stagnates in some parts of the body, even in the brain when accompanied by Liver Fire. Wind This refers to both Exterior Wind and Interior Wind. The Exterior Wind means an External Pathogenic Influence has directly stagnated in some part of the meridians or brain—causing stroke. And Interior Wind, which is caused by either Liver Fire and long term stagnation of Liver Qi, or extreme Blood and Yin Deficiency which will cause Phlegm and Blood Stasis to take up in some part of the meridians and brain. Rebellious Qi This is due to abnormal emotional activities and/or long-term unhealthy emotional stimulation, which make the Yin of the Liver and Heart deficient causing rebellious Qi. Blood stagnation This is caused most often by Interior Heat and Fire, which dries the body fluids, or deficiency of Qi failing to move the Blood. Wind-Stroke involves pre-stroke symptoms such as dizziness, headache, or abnormal sensation on the face and limb(s), and a feeling of restlessness. During the stroke symptoms include those of all kinds of western medicine CVA.

370

Wind Stroke

DIAGNOSIS TCM divides Wind-stroke into two types, the more severe one with unconsciousness is called stroke in the organs (Zhong Zang Fu) and the light one without the process of the coma is called stroke in the meridians (Zhong Jing Lou). After the appearance and duration of an acute stroke, all future clinical manifestations are referred to as sequelea of the stroke. Stroke in Meridians (Zhong Jing Lou) Mild stroke, consciousness is maintained, although patients could have hemiplegia and numb sensations on one side of the body—associated with facial paralysis sometimes, stiff tongue, and ease to anger, along with a red tongue with a yellow greasy coat, and wiry or slippery pulse. Stroke with coma (Zhong Zang Fu) This is a severe case of stroke, with sudden unconsciousness and coma. There are two types noted in TCM: Tense Type (Bi) Unconsciousness, clenched hands and jaws, red complexion, labored breathing with gurgling phlegm in the throat, constipation, and retention of urine. The pulse is slippery and fast. Flaccid Type (Tuo) Deep coma with eyes, mouth, and hands flaccid and open, enuresis, uncontrolled bowel movements, weak breathing, extremely cold extremities, and pulse is hidden and weak. Sequelea of Stroke After an acute condition and the emergency has been stabilized, the patient may still have facial paralysis, hemiplegia, pain and numbness in the hands and feet, a red tongue with a yellow coating, and a pulse on the healthy side of body that is wiry whereas the paralyzed side is weak—this is called sequelea of stroke. TREATMENT AND PRESCRIPTION Stroke attacking the Meridians (Zhong Jing Lou) Treatment Principle: Regulate Qi and Blood, and Dredge the meridians. Point Prescription: LI-15, LI-11, LI-4, TW-5, GB-30, GB-34, ST-36, ST-41, and BL-60. (Select the points on the diseased side only.) Treat once every other day for 10 treatments as a course. Technique: Insert 1.5 cun #28 needles into LI-15, LI-11, GB-34, and ST-36 with lifting and thrusting reinforcing needle technique. Insert 1 cun #30 needles for LI-4, TW-5, ST-41, and BL-60 with twisting reducing needle technique and a 3 cun #30 needle for GB-30 with even movement technique. Retain all the needles for 30 minutes. Additional points for associated symptoms: Upper limb paralysis: TW-14, TW-4, and SI-3. Lower limb paralysis: GB-31 and GB-39. Long time disease: GV-14, SI-1, GV-3, BL-30, PC-3, PC-7, LV-8, KI-3, Ba Xie, and Ba Feng. Speech problem: CV-23 and HT-5. Numb sensations on the skin: Plum blossom needle with weak stimulation in the affected areas. 371

Acupuncture and Moxibustion—A Clinical Desk Reference

Stroke with Coma (Zhong Zang Fu) Tense Type (Bi) Treatment Principle: Move the stagnation of Qi and Blood and Open the orifices. Point Prescription: GV-26, the 12 Jing-well points, LV-3, ST-40, and PC-8. (Select points bilaterally.) Treat only in emergency. Technique: Insert 1 cun #30 needles for GV-26, LV-3, and PC-8 with strong twisting needle technique and 1.5 cun #30 needles for ST-40 with lifting and thrusting reducing needle technique. Perform bloodletting on the 12 Jing-well points after needle treatment. Additional points for associated symptoms: After becoming conscious: Remove the needles above and add GV-20, Yin Tang, GB-31, SP-6, and LI-4. Clenched jaw: ST-6 and ST-4. Difficulty swallowing: KI-6 and CV-22. Speech problems: GV-15 and HT-5. Flaccid Type (Tuo) Treatment Principle: Recuperate depleted Yang and Rescuing the patient from collapse. Point Prescription: CV-4 and CV-8 with indirect moxibustion with salt, continuing until the patient wakes up, and the temperature and the pulse return to normal. Additional points for associated symptoms: Spontaneous sweating: HT-6. Snoring sleep: BL-62. Uncontrolled urine: ST-28, SP-6, and ST-36. Deficiency Yang: GV-4, BL-24, BL-23, and KI-1 with direct non-scarring moxibustion until the body feels warm. Sequelae of Stroke Treatment Principle: Dredge the meridians and Move the Qi and Blood. Point Prescription: CV-6, GV-14, GV-4, BL-23, GV-20, LI-11, and ST-36. Treat once twice a week for 7 treatments as a course. Technique: Insert 1.5 cun #32 needles into GV-14, GV-4, and BL-23 with twisting reinforcing needle technique and apply moxa wool on the handle of the needles for 3 cones. Insert 1.5 cun #30 needle into GV-20 backwards against meridian flow, 1.2 cun deep with lifting Qi technique, and 1.5 cun #32 needles into CV-6, LI-11, and ST-36 with lifting and thrusting reinforcing needle technique. Retain all the needles for 30 minutes. Additional points for associated symptoms: Facial paralysis: ST-4, ST-6, LI-4, Tai Yang, and TW-17. Poor sleep: HT-7 and An Mian. Easy to anger: LV-3, TW-5, BL-43, and BL-45.

372

Wind Stroke

ADJUNCTIVE THERAPIES Ear Acupuncture Point Prescription: Brain, Occipital, Shen men, Upper limb, Low limb, Shoulder, Neck, Heart, Liver, Kidney, Sympathetic, Sub cortex. Selecting 3 to 5 points in each treatment, insert 0.5 cun #32 ear needles into these points with fast twisting needle technique until a hot sensation is felt under the needles. Retain the needles for 40 minutes. Treat once every other day, 7 treatments as a course. Scalp Acupuncture Point Prescription: Middle line of vertex, Anterior oblique line from the vertex to temple, Posterior oblique line from vertex to temple, and Lateral line 1 of the vertex. Selecting treatment zones on the healthy side with 1.5 cun #28 needles, begin the treatment. Insert the needles at the angle of 30-degrees into the treatment zones with fast twisting needle technique. At the same time, tell the patient to exercise one’s limbs actively. Retain the needles for 2 hours. Treat once every other day, 10 treatments as a course. Eye Acupuncture Point Prescription: Upper warmer, Middle warmer, Lower warmer, Heart, Liver, and Kidney. Insert 0.5 cun #32 needles into these points obliquely or transversely, 0.2 cun deep and retain the needles for 30 minutes after the patient feels the sensation of the Qi. Treat once daily, 5 treatments as a course. Nose Acupuncture Point Prescription: Heart, Liver, Gall bladder, Lung, and Kidney. Insert 0.5 cun #32 needles into these points perpendicularly, 0.1 to 0.2 cun deep with twisting reducing needle technique. Retain all the needles for 30 minutes. Treat once every other day, 7 treatments as a course. Foot Acupuncture Point Prescription: Li Nei Ting, Nei Tai Cong, San Jiao, Head, and Kidney. Insert 1 cun #32 needles into these points perpendicularly, 0.5 cun to 0.8 cun deep with twisting reducing needle technique. Retain all the needles for 20 minutes. Treat once every other day, 5 to 7 treatments as a course. Moxibustion Use direct non-scarring moxibustion on GV-20, TW-4, LI-12, LI-15, and ST-36 for 11 cones. Treat once every other day, 5 treatments as a course. Electro-Acupuncture Apply fast-slow waves on the scalp and ear points for 20 minutes in each treatment. And apply continues waves on the four extremities selecting points according to the distribution of the muscles and nerves for 20 minutes. Treat once very other day for 10 treatments as a course. 373

Acupuncture and Moxibustion—A Clinical Desk Reference

TRADITIONAL PRESCRIPTIONS AND TECHNIQUES The following prescriptions are from the Author’s Clinical Experience. For stroke in both tense and flaccid types: GV-26, PC-9, KI-1, GV-20, CV-6, and CV-4. Additional points Clenched jaw: ST-6. Upper extremity paralysis: LI-15, TW-14, LI-11, and LI-4. Weakness of the hand: SI-4 and SI-3. Swollen hand: Shi Xuan. Weakness of the shoulder: GV-14, LI-16, and SI-10. Lower extremity paralysis: Shi Qi Zhui Xia, GB-30, Huan Zhong, BL-40, BL-35, ST-36, and GB39. Weakness in the leg: ST-32, He Ding, Xi Yan, and BL-57. Weakness of the toes: Ba Feng and KI-3. For tense type of stroke: Insert 1 cun #28 needles into GV-26 obliquely upward, 0.5-0.8 cun deep with fast twisting reducing needle technique (twist the needle over 200/per minute). Insert 1 cun #28 needles into KI-1 perpendicularly, 0.8 cun deep with twisting and lifting and thrusting reducing needle technique until the patient wakes up. Use bloodletting technique on PC-9 with a three-edge needle, squeezing out 3-5 drops of blood. For flaccid type of stroke: Insert a 1.5 cun #30 needle into GV-20 subcutaneously against the meridian flow, 1.2 cun deep with fast twisting technique (twist the needle over 200/per minute). Insert 1 cun #28 needle into GV-20 obliquely upward, 0.5 cun deep with twisting reducing needle technique and keep doing the needle technique every 3 minutes during the retaining of the needles. Apply indirect moxibustion with salt on CV-4 and ginger on CV-6, until the patient wakes up, and the pulse and body temperature recover. Additional points for upper extremity paralysis: Insert 1.5 cun #30 needles into ST-6 perpendicularly, 0.8-1 cun deep with the Long Hu Jiao Zhan—Dragon and Tiger Battle technique, and retain the needles for 30 minutes for clenched jaws. Insert 1.5 cun or 2 cun #30 needles into LI-15 and TW-14 perpendicular towards HT-1 with twisting reinforcing needle technique, and apply the moxa wool on the handle of the needles for 3 cones. Insert 1.5 cun #30 needles into LI-11 perpendicularly, 1.2 cun deep with rubbing (twisting count clock wise) technique to let the sensation of the needle travel down to the finger and retain the needles for 30 minutes. Insert 1 cun #32 needles into LI-4 with twisting reinforcing needle technique (or insert 1.5 cun #32 needle go through to PC-8 with the same technique. Additional points for weakness of the hand: Insert 1.5 cun #32 needles into SI-3 perpendicularly, 0.8-1.2 cun deep with twisting reinforcing needle technique. Insert 1 cun #30 needles into SI-4 with twisting reducing needle technique. Retain all the needles for 30-40 minutes or with Electro-stimulation on continuous wave. Additional points for swollen hands: Use a three-edge needle or 1 cun #26 needle on Shi Xuan making 2-3 drops of blood. Additional points for weakness of the shoulder: Insert a 1.5 cun #30 needle into GV-14 perpendicularly, 1.2 cun deep with rubbing needle technique (rub the needle clockwise after getting the Qi sensation and until the sensation travels). Insert 1 cun #32 needles into LI-16 perpendicularly with twisting reinforcing needle technique. Insert 1.5 cun #30 needles into SI-10 with lifting the thrusting reinforcing needle technique. Retain all the needles for 40 minutes. Additional points for lower extremity paralysis: 374

Wind Stroke

Insert 1.5 cun #30 needles into Shi Qi Zhui Xia, BL-40, ST-36, and GB-39 perpendicularly with twisting reinforcing needle technique. Insert 3 cun #30 needles into Huang Zhong, GB-30, and BL-35 perpendicularly, 2-2.5 cun deep with twisting reducing needle technique. Retain all the needles for 40 minutes or with Electro-stimulation on continuous wave. Additional points for weakness of the leg: Insert 1.5 cun #30 needles into ST-32, He Ding, Xi Yan, and BL-57 perpendicularly with twisting reinforcing needle technique or with Electro-stimulation on intermittent wave. Additional points for weakness of the toes: Insert 1 cun #30 needles into Ba Feng and KI-3 perpendicularly, 0.8 cun deep with twisting reinforcing needle technique or apply moxa wool on the handle of the needles for 3 cones. Treat once every other day for 10 treatments as a course.

The following prescriptions are from the Zhen Jiu Da Cheng. For wind stroke in a coma with clenched jaw and intense symptoms: LU-11, LI-1, PC-9, SI-1, TW-1, and HT-1. Use bloodletting technique on LU-11, LI-1, PC-9, SI-1, TW-1, and HT-1 squeezing out 2 to 3 drops of blood. The treatment is only used in emergency. For wind stroke with inner leg muscle spasms: SP-6. Use direct moxibustion on SP-6 for 10 cones in each treatment, 40 cones as a course. For wind stroke with outer leg muscle spasms: GB-39. Use direct moxibustion on GB-39 for 10 cones in each treatment, 30 cones as a course. For wind stoke with leg weakness: BL-60. (Zhen Jiu Da Cheng) Insert 1.5 cun #32 needles into BL-60 with twisting reducing needle technique. Retain the needles for 20 minutes. For wind stroke in a coma with collapse of Yang, uncontrolled bowls and urine: CV-8. (Jing Yue Quan Shu) Indirect moxibustion with salt and ginger Use salt (it’s better to dry it in the pot for a while) on CV-8, and a piece of ginger above, and then apply large moxa-cones on it until the patient wakes up. For Sequelea of wind stroke: LI-4, LI-11, GB-21, GB-30, SP-10, SP-9, GB-34, ST-36, GB-39, and BL-62. (Yu long Jing) Insert 1.5 cun #32 needles into all these points on the healthy side of the body with twisting reinforcing or lifting and thrusting reinforcing needle technique. Retain all the needles for 10 minutes. Then insert 1.5 cun #30 needles into all these point on the disease side of the body for disease side of body with lifting and thrusting reducing needle technique. Retain all the needles for 30 minutes. Treat once every other day for 10 treatments as a course. For Sequelae of stroke with symptoms of arm contractions and difficulty extending: LI-10 and SI-4. (Jiu Fa Mi Chuan) Apply direct moxibustion on LI-10 and SI-4 for 20 cones each treatment. Treat once daily for 7 treatments as a course. For Sequelae of stroke patients who feel itching sensations and weak sensations on the hands and feet: BL-62, TW-13, SI-4, LI-4, LV-2, GB-31, and GB-34 (diseased side of the body) (Zhen Jiu Da Quan) Insert 1 cun #30 needles into BL-62, SI-4, LI-4, and LV-2 with twisting reducing needle technique, and 1.5 cun #32 needles into TW-13, GB-31, and GB-34 with lifting and thrusting reducing needle technique. Retain all the needles for 30 minutes. Treat once twice a week, 5 treatments as a course. 375

Acupuncture and Moxibustion—A Clinical Desk Reference

For Sequelae of stroke: Main points: PC-6, GV-26, and SP-6. Supplemental points: HT-1, BL-40, LU-5, GB-20, GB-12, LI-4, and CV-23. (Shanghai Zhong Yi Zha Zhi) Insert 1 cun #32 needles into PC-6 perpendicularly, 0.8 cun deep with twisting reducing needle technique and then into GV-26 obliquely towards the nose, 0.3 to 0.5 cun deep with vibrating technique until the eyes get wet or tear. Insert 1.5 cun #30 needles into SP-6 with lifting and thrusting reinforcing needle technique. Retain the needles for 30 minutes. Insert 1.5 cun #30 needles into HT-1, LU-5, BL-40, GB-20, GB-12, and CV-23 with lifting and thrusting reducing needle technique and 1 cun #32 needles into LI-4 obliquely towards LI-3, 0.8 cun deep with twisting reducing needle technique and retain all the needles with main points. Treat once every other day, 10 treatments as a course. For Sequelae of stroke: GV-20, Paralysis I, Paralysis II, GV-26, and CV-23. (Author’s Clinical Experience) Insert 1.5 cun #30 needles into Paralysis I and II (Paralysis I is located between HT-7 and HT-3 and Paralysis II is located 1.5 cun above GB-33) perpendicularly, 1 to 1.2 cun deep with twisting even movement needle technique. Insert 1 cun #32 needles into GV-20, GV-26, and CV-23 with twisting reducing needle technique. Retain all the needles for 40 minutes. Treat once every other day, 10 treatments as a course. For stroke with consciousness problems: GV-26, GV-24, GB-42, and LI-4. (Shen Yin Jing) Insert 1 cun #30 needles into GV-26 and GV-24 with twisting reducing needle technique, and 1 cun #32 needles into GB-42 and LI-4 with twisting reinforcing needle technique. Retain all needles for 30 minutes. Treat once daily for 10 treatments as a course. For Sequelae of stroke with body and facial paralysis: Qian Zhen, ST-7, GV-20, GB-30, LU-7, LI-11, GB-31, and LV-3. (Shi Yi De Xiao Fang) Apply direct non-scarring moxibustion on Qian Zhen—an extra point located 1 cun anterior to the ear lobe, for 7 cones on the healthy side. Insert a 1.5 cun #32 needle into ST-7 on the diseased side of the body, perpendicularly 1 cun deep with twisting reducing needle technique. Insert 1.5 cun #30 needle into GV-20 with fast twisting needle technique, 1.5 cun #32 needles into LU-7, LI-11, GB-31, and LV-3 with twisting reducing needle technique on the diseased side and twisting reinforcing needle technique on the healthy side of the body. Insert a 3 cun #30 needle into GB-30 on the diseased side with twisting reducing needle technique. Retain all needles for 30 minutes. Treat once every other day, 10 treatments as a course.

376

Wind Stroke

CASE ANALYSIS A 54-year-old male patient entered the clinic with a main complaint of paralysis for 5 months, started by Wind-stroke without coma, and loss of consciousness. Paralysis and numbness were felt on the left side of the body and face and was associated with headache, dizziness, nausea, tiff tongue, constipation, and high blood pressure. The tongue was red with a yellow thick dry coating and the right pulse was strong and wiry and the left pulse was deep and weak. Diagnosis: Wind Stroke (Zhong Jing Lou) Treatment Principle: Regulate Qi and Blood, and Dredge the stagnation in the meridians. Point Prescription: LV-3, LI-4, PC-6, ST-36, CV-23, and SP-6. Technique: Insert 1.5 cun #32 needles into ST-36, SP-6, CV-23, and PC-6 perpendicularly, 1 cun deep with twisting reinforcing needle technique and 1 cun #30 needles into LV-3 and LI-4 with twisting reinforcing needle technique on the healthy side (right side). Retain the needles for 20 minutes. Then use same points on the diseased side of the body (left side) with lifting and thrusting reducing needle technique and retain the needles for 30 minutes. Treat once every other day, 10 treatments as a course. Result: After one course of treatment, the paralysis and numbness were 90% resolved. The patient then rested for 2 weeks before starting the second course of treatments, in which all the symptoms were resolved. EVALUATION For thousands of years people used acupuncture and moxibustion to treat Wind-stoke patients and got remarkable effects and successful experiences. In modern society most of the stroke patients will be sent to the emergency room, and acupuncture usually is supplemental. Acupuncture and moxibustion will play an important role in the treatment of sequelae of Wind-stroke in the rehabilitation time to help dysfunction of meridians and the body. Scalp acupuncture is used most of the time to help move the paralyzed body and body acupuncture usually works for balancing Yin and Yang, promoting the circulation of Qi, and resolving stagnation of Blood. Generally speaking, the Wind-stroke in the meridians (Zhong Jing Lou) will be much easier treated then Wind-stroke in the organs (Zhong Zang Fu). TCM pays more attention in preventive medicine and trying to help with some pre-stroke symptoms, when people who are over 50 years old have Liver Yang Rising and/or Kidney Yin Deficiency syndrome, often associated with dizziness, numbness, and twitching sensations on the fingers or occasional speech problems. Application of acupuncture on GB-31 and ST-36 is good preventative treatment.

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YU SYNDROME—EMOTIONAL DISORDER Yu syndrome is one form of behavior and/or emotional change in a human being. This psychological disorder is very hard to define due to its ambiguous nature. The complexity of Yu syndrome is that it can describe symptoms of anxiety, depression, and even mania. In TCM, Yu syndrome is attributed to stagnation of Qi and can include severe stress, depression, anxiety, hysteria and Zang Zao, which includes hysteria and other emotional problems related with dysfunction of internal organs. Beginning Stages Most of Yu syndromes start with unhealthy emotional stimulation. It can be excess joy, anger, grief, fear, sadness, fright, or over-thinking. All these emotions will impact movement of the Qi, causing physical responses, such as plum pit Qi, chest stuffiness, a headache, a bloated abdomen, insomnia, dizziness, etc. Later Stages Long-term Yu syndrome will impact some organs internally, which is referred to as Zang Zao in Chinese. When the patient has a Spleen Deficiency, the main symptom is phlegm. With a Kidney Deficiency, the main symptom is disharmony between the Heart Fire and Kidney Water. Stagnation of Qi obstructs the Kidney Water from ascending to nourish the Heart Fire and the Heart Fire from descending to warm the Kidney Water. DIAGNOSIS Plum Pit Symptoms appear as dysphoria, depression, stress associated with a stuffy feeling in the chest and the sensation of a foreign object being lodged in the throat, like a plum-pit that is hard to expel or swallow (without influencing eating and drinking), sighing, and an inclination towards paranoia. The tip and edge of the tongue is red with a white greasy coat, and the pulse is wiry or slippery. Zang Zao This syndrome can resemble a trance, abnormal emotions with crying or abnormal anger and laughter that is aggravated by any emotional stimulation. The tongue is red with a white thin coating and the pulse is thin and floating. There will be a tendency towards Heart and Spleen Blood Deficiency. The patient can feel a bloating sensation on the epigastric and abdominal region, a poor appetite, heart palpitations, insomnia, lassitude, restlessness and may have a pale complexion. The tongue is pale with a thin coat, and the pulse is thin and weak. With a Heart and Kidney Yin Deficiency, the patient will feel more dizziness and vertigo, ringing ear, malar flushes, heat sensation in the five hearts, a sore and weak sensation in the low back and both legs and insomnia with dysphoria. The tongue is red without a coat and pulse is thin and fast.

378

Yu Syndrome—Emotional Disorder

TREATMENT AND PRESCRIPTIONS Plum Pit Treatment Principle: Soothe the Liver, Move the stagnation of Qi, Clear the Fire and Resolve the Phlegm. Point Prescription: LV-3, CV-17, ST-40, LU-10, and HT-7. Treat twice a week for 7 treatments as a course. Technique: Insert 1 cun #32 needles into LV-3, LU-10, and HT-7 perpendicularly, 0.3 cun to 0.5 cun deep with a twisting reducing needle technique. Insert 1.5 cun #30 needles into CV-17 obliquely, 1.2 cun deep at a 45-degree angle downwards with a lifting and thrusting reducing needle technique and 1.5 cun #32 needles into ST-40 with a twisting reducing needle technique. Retain all needles for 30 minutes. Additional points for associated symptoms: Dry throat: LI-19 and LI-1. Insomnia: ST-45 with direct non-scarring moxibustion for 8 cones. Zang Zao Treatment Principle: Reinforce the Qi and Yin, and Calm the Heart Shen. Point Prescription: BL-17, KI-23, BL-15, PC-6, and SP-6. Treat once every other day for 10 treatments as a course. Technique: Insert 1.5 cun #30 needles into BL-17 and BL-15 obliquely, 1 cun deep towards the spinal column at a 60degree angle with a lifting and thrusting even movement needle technique, and apply moxa wool to the handles of the needles for 3 cones. Insert 1 cun #32 needles into KI-23, PC-6, and SP-6 perpendicularly, 0.5 to 0.8 cun deep with a twisting even movement needle technique. Retain all needles for 30 minutes. Additional points for associated symptoms: In a trance: GV-26 and PC-9. Trembling limbs: LV-3 and GB-34. Stiff muscles: GV-20 and PC-7. Locked jaw: LI-4 and ST-6. Hiccup: CV-12 and ST-36. Deafness: GB-2 and TW-3. Aphonia: HT-5 and CV-23.

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Acupuncture and Moxibustion—A Clinical Desk Reference

ADJUNCTIVE THERAPIES Ear Acupuncture Points: Brain, Brain stem, Heart, Liver, Shen Men, and Endocrine. Insert 0.5 cun #32 ear needles into these points obliquely, 0.3 cun deep at a 45-degree angle with a twisting reducing needle technique. Retain all needles for 40 minutes. Or apply press-balls on one side of ear for 3 days. Treat once a week for 5 treatments as a course. Scalp Acupuncture Treatment zones: Middle line of the vertex, lateral line 1 of the vertex, lateral line 3 of the forehead, anterior line of the temple. Insert 1.5 cun #30 needles into these lines transversely, 1 cun deep with a fast twisting needle technique. Retain all needles for 40 minutes. Treat once every other day for 7 treatments as a course. Wrist and Ankle Acupuncture Treatment area: Upper 2, Upper 6, Lower 3, and Lower 5. Insert 1.5 cun #32 needles into these areas transversely, 1.2 cun deep at a 15-degree angle without any particular needling technique and avoid any sensation of the needles. Retain all needles for 30 minutes to 1 hour. Treat once every other day for 7 treatments as a course. Cupping Points: CV-17, CV-12, BL-13, BL-15, and BL-20. Apply fire cups on CV-17 and CV-12 for 3 minutes and on BL-13, BL-15, and BL-20 for 5 minutes. Treat once daily for 3 treatments as a course, or with other techniques together. Moxibustion Direct moxibustion: LV-1, SP-4, BL-23, and BL-18. Apply direct non-scarring moxibustion on LV-1 and SP-4 for 5 cones and on BL-23 and BL-18 for 9 cones. Treat once every other day for 5 treatments as a course. Indirect moxibustion: CV-6, CV-12, and BL-43. Apply indirect moxibustion with a Fu Zi (aconite) cake on CV-6 and CV-12 for 3 cones and on BL43 for 5 cones. Treat once daily for 3 treatments as a course. Moxa pole: GV-20, KI-1, and CV-4. Apply moxa-pole on GV-20 for 10 minutes, on KI-1 and CV-4 for 20 minutes. Treat once daily for 3 treatments as a course.

380

Yu Syndrome—Emotional Disorder

TRADITIONAL PRESCRIPTIONS AND TECHNIQUES For plum pit: PC-5 and SP-6. (Zhen Jiu Da Cheng) Insert 1.5 cun #32 needles into PC-5 perpendicularly, 1 cun deep with a twisting even movement needle technique and 1 cun #34 needles into SP-6 with a twisting reinforcing needle technique. Treat once every other day for 5 treatments as a course. For Zang Zao with grief and crying: GV-20 and GV-26. (Shen Yin Jing) Insert a 1 cun #32 needle into GV-26 perpendicularly, 0.3 cun deep with a twisting reinforcing needle technique. Apply a moxa-pole on GV-20 for 20 minutes. Treat once daily for 2 treatments as a course. For Zang Zao with a trance: GV-26, LI-4, and KI-1. (Bai Zhen Fu) Insert a 1 cun #28 needle into GV-26 perpendicularly, 0.3 cun deep with a twisting even movement needle technique and 1 cun #32 needles into LI-4 and KI-1 with a twisting reducing needle technique. Retain all needles for 20 minutes. Treat once daily for 2 treatments as a course. For plum pit with Interior Heat: LV-13, TW-6, LV-2, SP-4, and CV-17. (Zhen Jiu Za Zhi) Insert 1 cun #32 needles into SP-4 and LV-2 perpendicularly, 0.5 cun deep with a twisting even movement needle technique. Insert 1.5 cun #32 needles into LV-13 and TW-6 perpendicularly, 1 cun deep with a twisting reducing needle technique and 1.5 cun #30 needle into CV-17 obliquely, 1 cun deep downwards at a 60-degree angle with a twisting even movement needle technique. Retain all needles for 20 minutes. Treat twice a week for 5 treatments as a course. For Zang Zao with a poor appetite and lassitude: CV-12, ST-25, LV-3, and Yin Tang. (Bai Zhen Fu) Insert 1 cun #34 needles into LV-3 and Yin Tang with a twisting even movement needle technique. Insert 1.5 cun #32 needle into ST-25 and CV-12 perpendicularly, 1 to 1.2 cun deep with a lifting and thrusting reinforcing needle technique, and apply moxa wool to the handles of the needle for 3 cones. Treat twice a week for 5 treatments as a course. For Zang Zao with aphasia: HT-5, CV-22, ST-9, and LI-4. (Zhen Jiu Chu Fang Xue) Insert 1 cun #30 needles into HT-5 and LI-4 perpendicularly, 0.8 cun deep with a twisting reducing needle technique. Insert 1.5 cun #32 needle into CV-22 obliquely, 1 cun deep at a 60-degree angle following the direction of the trachea with a twisting even movement needle technique and 1.5 cun #32 needles into ST-9 perpendicularly, 1 cun deep with a twisting reinforcing needle technique. Retain all needles for 20 minutes. Treat once daily for 5 treatments as a course. For Zang Zao with Yin Deficiency: KI-6, LV-8, HT-7, BL-23, GV-14, and Bai Lao. (Author’s Clinical Experience) Insert 1.5 cun #32 needles into GV-14 and Bai Lao perpendicularly, 1 cun deep with a lifting and thrusting even movement needle technique and 1.5 cun #32 needles into BL-23 with a twisting reinforcing needle technique. Retain all needles for 10 minutes. Insert 1 cun #32 needles into KI-6, LV-8, and HT-7 perpendicularly, 0.5 cun deep with a twisting even movement needle technique. Retain all needles for 20 minutes. Treat once every other day for 7 treatments as a course. For plum pit with insomnia: SP-9, LI-11, CV-19, and An Mian. (Author’s Clinical Experience) Insert 1.5 cun #32 needles into SP-9 and LI-11 perpendicularly, 1 to 1.2 cun deep with a lifting and thrusting reducing needle technique and 1.5 cun #34 needle into CV-19 transversely, 1 cun deep towards CV-18 with a twisting even movement needle technique. Insert 1 cun #32 needles into An Mian perpendicularly, 0.5 cun deep with a twisting reinforcing needle technique. Retain all needles for 30 minutes. Treat twice a week for 5 treatments as a course. 381

Acupuncture and Moxibustion—A Clinical Desk Reference

For plum pit with bad depression: BL-22, BL-18, BL-42, GV-12, LI-4, LV-3, CV-22, and ST-28. (Author’s Clinical Experience) Insert 1.5 cun #30 needles into BL-22, BL-18, and GV-12 perpendicularly, 1 cun deep with a lifting and thrusting reducing needle technique and 1.5 cun #32 needles into BL-42 obliquely, 1 cun deep at a 30degree angle towards BL-43 with a twisting reinforcing needle technique. Retain all needles for 15 minutes. Insert 1.5 cun #32 needle into CV-22 obliquely, 1 cun deep at a 60-degree angle following the trachea with a rubbing needle technique (rub the needle counter- clockwise) until the sensation of needle spreads over into the chest. Insert 1 cun #34 needles into LV-3 and LI-4 with a twisting reducing needle technique and 1.5 cun #32 needles into ST-28 with a twisting reducing needle technique. Retain all needles for 20 minutes. Treat once every other day for 7 treatments as a course. For Zang Zao with anxiety attacks: TW-4, LI-5, GB-41, SP-5, LV-8, LI-11, CV-17, and GV-24. (Author’s Clinical Experience) Insert 1 cun #30 needles into TW-4, LI-5, GB-41, SP-5 perpendicularly, 0.3 to 0.5 cun deep with a twisting Dao Qi technique (one of the ancient needle techniques using a slow twisting and lifting and thrusting until the Qi travels along the meridian). Insert 1.5 cun #32 needles into LV-8, LI-11, and CV-17 with a lifting and thrusting even movement needle technique and 1.5 cun #30 needle into GV-24 transversely, 1 cun deep towards the back at a 30-degree angle with a fast twisting needle technique. Retain all needles for 30 minutes. Treat once every other day for 7 treatments as a course. CASE ANALYSIS A 55 year-old female patient had a main complaint of severe depression for over 5 years since her son died. Symptoms included a refusal to take any medication, talk or exercise, along with crying and locking herself in her room, a poor appetite, nightmares with crying and shouting in her sleep, lassitude, and restlessness. Her tongue was red with a yellow thick greasy coat and her pulse was slippery. Diagnosis: Zang Zao due to accumulation of Phlegm. Treatment Principle: Soothe the Liver, Reinforce the Spleen, and Resolve Phlegm. Point Prescription: GV-14, HT-7, GB-20, and ST-40. Treat once daily for 7 treatments as a course. Technique: Insert 1.5 cun #30 needles into GV-20 and GB-20 perpendicularly, 1.2 cun deep with a lifting and thrusting reducing needle technique. Retain all needles for 15 minutes, and repeat the needle technique every 5 minutes during needle retention. Insert 1 cun #32 needles into HT-7 obliquely, 0.8 cun deep towards PC-7with a twisting even movement needle technique and 1.5 cun #30 needles into ST-40 with a lifting and thrusting reducing needle technique. Retain all needles for 30 minutes. Result: She had quite peaceful sleep after the first treatment, and her behavior changed after 5 treatments. She was back to normal after a total of 3 courses of treatment. Treatment was performed once every other day from the second course. EVALUATION Yu syndrome was treated with acupuncture and moxibustion during ancient times for a few thousand years. This disorder typically included many emotional problems in the psychological field, such as depression, anxiety, sadness, over-thinking, and a tendency towards anger, fear, and hysteria. Acupuncture and moxibustion is effective for treating these problems, or with some Traditional Chinese herb formulas, such as “Xiao Yao Wan,” “Xiao Chai Hu Tang” and “Yue Ju Wan.” A clear diagnosis is the key to increasing the effect of acupuncture and moxibustion, as well as in preventing some severe diseases, such as esophageal tumors, brain tumors, or other infectious diseases. The family and relatives, as well as the social environment must support the treatment.

382

Acne

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Acupuncture and Moxibustion—A Clinical Desk Reference

CHAPTER II: E.E.N.T DISORDERS

ACNE Acne is a chronic inflammation of hair follicles and sebaceous glands that often occur among adolescents. Its clinical characteristics manifest as papulars, nodules, and acne on the face. At the beginning, they are papular in a normal skin color. They gradually become red inflammatory papulars and nodules. The larger ones may form into acne. Some white fatty substances can be squeezed out from them. When they further develop, they can turn into red and hard nodules, called acne indurate. If some acne gathers and coalesces under the deeper subcutaneous tissue, it is called acne conglobate. If they further develop, the fat substances inside will not be able to be discharged, and then they may become small skin cysts, called cystic acne. If they have secondary infections, they will form into small abscesses and ulceration. And there will be scars left. In mild cases, they will be no unusual feeling, but in serious cases there will be light itching and pricking pain. This inflammation usually occurs on the face and the torso among teenagers. Often acne can recover spontaneously after adolescence. In accordance with TCM theory, its cause is often Wind Heat or Damp Heat accumulation in the Lungs, Stomach, and Cong or Ren meridians. DIAGNOSIS The following is a list of commonly diagnosed causes for the presence of acne. Among these causes, each has a distinct set of characteristics and symptoms that can be observed. These distinct collections of characteristics serve as a guide to help identify the cause of this skin disorder. Stagnation of Qi and Blood Acne located on the face that feels hot and itchy, associated with restlessness, tendency to anger, poor sleep, constipation, and aggravated by intake of stimulating food. The tongue is red with a yellow greasy coating and the pulse is thin and wiry. Wind-Heat stagnating in the Lung Meridian There are red papules, tubercles, acne, with inflammatory infiltration around them, mostly distributes in the forehead or near the side of the nose, accompanied with burning sensation, running and/or stuffy nose, allergies, ease to catch cold, and sneezing. The tongue is red with a thick yellow coating and the pulse is floating and fast. Damp-Heat Stagnation in the Spleen and Stomach In this pattern skin lesions that are mainly characterized as acne, indurative acne, and cystic acne, that are mostly distributed near cheek area (near ST-7 to SI-18) with dark or red color are the characteristic symptoms. Sometimes they may become watery when the blister is broken. Associated signs are poor sleep and constipation. The tongue is red with a yellow greasy coating and the pulse is slippery and fast. Disharmonies of the Cong and Ren Meridians The acne in this case could be distributed anywhere on the face and upper back, along with malar flush, scattered inflammatory nodules, acne, abscesses, and furuncles on the face with scars and itchiness. Associated signs are restlessness, poor sleep, stress, and in female patient cases it will worsen during the menstrual cycle. The tongue is dark with black or purple dots and the pulse is wiry or choppy.

384

Acne

TREATMENT AND POINT PRESCRIPTIONS Stagnation of Qi and Blood Treatment Principle: Move the stagnation of Qi and Resolve the stagnation of Blood. Point Prescription: LV-3, LI-4, TW-5, LI-15, LV-8, BL-17, and BL-13. Treat once every other day for 10 treatments as course. Technique: Insert 1 cun #32 needles into LV-3 and LI-4 perpendicularly, 0.5-0.8 cun deep with lifting and thrusting reducing needle technique, and 1.5 cun #30 needles into TW-5 obliquely, 1 cun deep towards the TW-6 direction with twisting reducing needle technique. Insert 1.5 cun #32 needles into LI-15 and LV-8 with twisting even movement needle technique. Retain all needles for 20 minutes. Insert 1 cun #30 needles into BL-13 and BL-17 perpendicularly, 0.5-0.8 cun deep with twisting even movement needle technique. Retain all needles for 10 minutes. Additional points for other associated symptoms: Stuffy sensation in the chest and hypochondriac area: GB-34 and CV-17. Headache: GV-20 and Tai Yang. Poor sleep: LV-2 and HT-7. Damp-Heat Stagnation in the Lung Meridian Treatment Principle: Clear Lung Heat and Move the Qi. Point Prescription: LU-5, LI-4, GV-14, and BL-13. Treat once every other day for 10 treatments as course. Technique: Insert 1.5 cun #30 needles into LU-5 perpendicularly, 1-1.2 cun deep with lifting and thrusting reducing needle technique, and 1 cun #32 needles into LI-4 perpendicularly, 0.5 cun deep with twisting reducing needle technique. Retain all needles for 15 minutes. Insert a 1.5 cun #30 needle into GV-14 perpendicularly with lifting and thrusting even movement needle technique, and 1 cun #30 needles into BL-13 with waving technique, until the red marks appear around the needles. Apply a fire cups on GV-14 and BL-13 for 3 minutes. Additional points for other associated symptoms: Stuffy nose: LI-20. Itching: LU-7. Headache: GV-24. Damp-Heat Stagnation in the Stomach and Spleen Treatment Principle: Resolve Damp-Heat and Harmonize the Stomach and Spleen. Point Prescription: ST-40, SP-6, LI-11, BL-20, BL-21, and BL-13. Treat once every other day for 10 treatments as a course. Technique: Insert 1.5 cun #30 needles into ST-40, LI-11, and SP-6 perpendicularly, 1 cun deep with lifting and thrusting reducing needle technique. Retain all needles for 20 minutes. Insert 1.5 cun #30 needles into BL-20 and BL-21 perpendicularly, 1 cun deep with twisting reinforcing needle technique, and 1 cun #32 needles into BL-13 perpendicularly, 0.5-0.8 cun deep with twisting even movement needle technique. Retain all needles for 10 minutes. Additional points for other associated symptoms: Poor appetite: ST-36 and CV-12. Constipation: TW-5 and ST-25. Foul taste in the mouth: CV-23 and HT-5. 385

Acupuncture and Moxibustion—A Clinical Desk Reference

Disharmony of the Cong and Ren Meridians Treatment Principle: Regulate Qi and Blood, and Harmonize the Cong and Ren meridians. Point Prescription: CV-4, SP-6, LI-11, PC-6, ST-8, BL-17, BL-19, and BL-20. Treat once every other day for 7 treatments as a course. Technique: Insert a 1.5 cun #32 needle into CV-4 perpendicularly, 1-1.2 cun deep with twisting reinforcing needle technique, and 1.5 cun #30 needles into SP-6 obliquely, 1 cun deep at a 60-degree angle towards SP-7 with twisting reducing needle technique. Insert 1 cun #34 needles into PC-6 and ST-8 with twisting even movement needle technique. Retain all needles for 20 minutes. Insert 1.5 cun #32 needles into BL-17, BL-19, and BL-20 perpendicularly, 0.8-1 cun deep with twisting even movement needle technique. Retain all needles for 10 minutes. Additional points for other associated symptoms: Irregular menstruation: SP-4 and KI-3. Scars on the face: ST-7 with warming needle technique. Itching and blisters: TW-5 and TW-14. ADJUNCTIVE THERAPIES Ear Acupuncture Point Prescription: Lung, Liver, Shoulder, Shen Men, and Sub cortex. Insert 0.5 cun #34 ear needles into Lung, Liver, and Shen Men obliquely, 0.3 cun deep at a 60-degree angle with twisting reinforcing needle technique. Insert 0.5 cun #32 needles into Shoulder and Sub cortex obliquely, 0.3 deep with fast twisting needle technique. Repeat this process every 10 minutes during 40 minutes needle retaining time. Or apply press-ball on these points after regular acupuncture treatment. Treat once every other day for 5 treatments as a course. Wrist and Ankle Acupuncture Treatment area: Upper 2, Upper 6, Lower 5, and Lower 1. Insert 1.5 cun #32 needles into these treatment areas transversely, 1.2 cun deep at a 10-15-degree angle avoiding any sensation of the needles. Retain all needles for 40 minutes. Treat once every other day for 5 treatments as a course. Scalp Acupuncture Treatment zone: Lateral line 3 of the vertex, Posterior line from vertex to temple, and Middle line of forehead. Insert 1.5 cun #32 needles into these lines transversely, 1 cun deep at a 30-degree angle with twisting reducing needle technique. Retain all needles for 30 minutes. Treat once every other day for 5 treatments as a course. Moxibustion Direct moxibustion: BL-13, BL-20, GV-14, and GV-12. Apply direct non-scarring moxibustion on BL-13 and BL-20 for 7 cones and on GV-14 and GV-12 for 11 cones. 386

Acne

Treat once a week for 3 treatments as a course. Moxa pole: Apply moxa-pole on ST-7 near the acne area for 20 minutes. Treat once every other day for 5 treatments as a course. Plum Blossom Treatment area: Back, Arm, BL-40, and Tai Yang. Apply medium level stimulation of a plum-blossom needle on the back from GV-14 to GV-9 and BL-11 to BL-17 until red marks with a little blood appears. Then apply weak stimulation on the arm from LU-5 to LU-6, BL-40, and Tai Yang until red marks appear. Treat twice a week for 4 treatments as a course. Bloodletting Treatment area: LI-1, ST-45, SP-1, and Upper back. Apply bloodletting technique on the LI-1, ST-45, and SP-1 to squeeze out 1-2 drops of blood. Look for black dots or purple tiny veins near both the scapular and upper back, and then apply bloodletting technique to squeeze 2-3 drops of black blood from there. Treat once a week for 3 treatments as a course. Or apply with other therapy together. Foot Acupuncture Treatment area: Lung, Li Nei Ting, Head, and Liver. Insert 1 cun #34 needles into these points perpendicularly, 0.3-0.5 cun deep with twisting reducing needle technique. Retain all needles for 30 minutes. Treat once twice a week for 5 treatments as a course. TRADITIONAL PRESCRIPTIONS AND TECHNIQUE For acne due to Wind Heat: LI-11, LI-4, GV-14, and BL-13. (Zhen Jiu Da Quan) Insert 1.5 cun #30 needles into LI-11 perpendicularly, 1-1.2 cun deep with the Chi Feng Ying Yuan—Red Phoenix Spread its Wings needle technique, and 1 cun #32 needles into LI-4 with twisting even movement needle technique. Retain all needles for 20 minutes. Insert 1.5 cun #32 needles into GV-14 perpendicularly, 1-1.2 cun deep with lifting and thrusting reducing needle technique. Insert 1 cun #32 needles into BL-13 perpendicularly, 0.5 cun deep with the Qi Ci technique—one of the ancient needle techniques where one needle is on the point and two other needles are on each side in order to increase the sensation of the Qi. Retain all needles for 15 minutes. Treat twice a week for 5 treatments as a course. For acne due to stagnation of Qi and Blood: LU-5, LU-7, LV-3, SP-10, and ST-7. (Author’s Clinical Experience) Insert 1.5 cun #32 needles into LU-5 perpendicularly, 1 cun deep with twisting reducing needle technique, and 1 cun #32 needles into LU-7 obliquely, 0.8 cun deep upwards with twisting even movement needle technique. Insert 1 cun #32 needles into LV-3 and ST-7 perpendicularly, 0.5-0.8 cun deep with twisting reducing needle technique, and 1.5 cun #30 needles into SP-10 perpendicularly, 1 cun deep with twisting reducing needle technique. Retain all needles for 20 minutes. Treat twice a week for 5 treatments as a course.

387

Acupuncture and Moxibustion—A Clinical Desk Reference

For acne due to disharmony of Cong and Ren meridians: GB-20, BL-13, BL-23, CV-4, SP-6, and ST-8. (Zhen Jiu Feng Yuan) Insert 1.5 cun #34 needles into GB-20 perpendicularly, 1 cun deep towards the nose direction with twisting even movement needle technique, and 1 cun #32 needles into BL-13 perpendicularly, 0.5-0.8 cun deep with lifting and thrusting reducing needle technique. Insert 1.5 cun #32 needles into BL-23 perpendicularly, 1 cun deep with twisting reinforcing needle technique, and apply moxa-wool on the handle of needles for 3 cones. Insert 1 cun #32 needles into SP-6 and ST-7 with twisting reducing needle technique, and a 1.5 cun #34 needle into CV-4 perpendicularly, 1-1.2 cun deep with twisting even movement needle technique, and apply moxa-wool on the handle of needles for 3 cones. Treat twice a week for 7 treatments as a course. For acne due to Damp-Heat: ST-36, TW-6, LV-13, GB-21, BL-20, and Tai Yang. (Author’s Clinical Experience) Insert 1 cun #30 needles into ST-36, TW-6, and LV-13 perpendicularly, 0.5-0.8 cun deep with twisting even movement needle technique, and 1 cun #32 needles into Tai Yang perpendicularly, 0.5 cun deep with twisting reducing needle technique. Retain all needles for 15 minutes. Then insert 1.5 cun #30 needles into GB-21 perpendicularly, 1 cun deep towards ST-11 with twisting reducing needle technique, and 1.5 cun #32 needles into BL-20 with lifting and thrusting reinforcing needle technique. Retain all needles for 10 minutes. Treat twice a week for 5 treatments as a course. For acne due to stagnation of Qi and Blood: BL-15, BL-13, BL-18, BL-20, and BL-23. (Zhen Jiu Chu Fang Xue) Select 3 points in each treatment. Massage and squeeze the point first until the a red-mark appears and then apply bloodletting technique on these points to squeeze 2-3 drops of blood. Treat once every other day for 6 treatments as a course. For acne due to Blood Heat: Quan Jian, BL-13, LU-10, LI-11, BL-15, GB-21, and SP-9. (Author’s Clinical Experience) Insert 1.5 cun #30 needles into GB-21 perpendicularly, 1 cun deep with twisting reducing needle technique, and 1 cun #30 needles into BL-13 and BL-15 perpendicularly, 0.5-0.8 cun deep with waving technique. Retain all needles for 10 minutes. Then insert 1.5 cun #32 needles into LI-11 and SP-9 with lifting and thrusting reducing needle technique, and 1 cun #32 needles into LU-10 perpendicularly, 0.5 cun deep with twisting reducing needle technique. Apply direct non-scarring moxibustion on Quan Jian—an extra point located on the tip of third metacarpal bone for 6 cones. Treat once every week for 5 treatments as a course. For acne due to Heat Stagnation: LU-5, LI-4, SP-4, and SP-9. (Author’s Clinical Experience) Insert 1 cun #34 needles into SP-4 perpendicularly, 0.5 cun deep with twisting even movement needle technique, and 1.5 cun #30 needles into SP-9 perpendicularly, 1-1.2 cun deep with lifting and thrusting reducing needle technique. Insert 1.5 cun #32 needles into LU-5 perpendicularly, 1 cun deep with twisting reducing needle technique, and 1 cun #32 needles into LI-4 perpendicularly, 0.5-0.8 cun deep with twisting even movement needle technique, and apply electro-stimulation with intermittent waves—the negative side on LU-5 for 20 minutes. Treat twice a week for 7 treatments as a course. For acne due to Qi and Yin Deficiency: CV-17, GV-20, BL-23, BL-20, LU-9, and LU-3. (Zhen Jiu Chu Fang Xue) Insert 1.5 cun #32 needles into BL-20 and BL-23 perpendicularly, 1 cun deep with twisting reinforcing needle technique. Retain all needles for 10 minutes. Then insert a 1.5 cun #32 needle into CV-17 obliquely, 1 cun deep at a 45-degree angle in the CV-16 direction with twisting reinforcing needle technique, along with 1 cun #34 needles into LU-9 and LU-3 perpendicularly, 0.3-0.5 cun deep with twisting reinforcing needle technique. Retain all needles for 20 minutes. Treat once every other day for 7 treatments as a course.

388

Acne

For acne with constipation: TW-6, ST-25, LI-10, SP-6, and Rectum point in the ear. (Author’s Clinical Experience) Insert 1.5 cun #30 needles into TW-5, LI-10, and SP-6 perpendicularly, 1 cun deep with twisting even movement needle technique, and 1.5 cun #32 needles into ST-25 perpendicularly, 1.2 cun deep with lifting and thrusting reducing needle technique. Retain all needles for 20 minutes. Apply press-balls on Rectum point in the ear and instruct the patient to press it 3 times daily. Treat once a week for 5 treatments as a course. CASE ANALYSIS A 25 year-old female patient complained of acne that had been manifesting on her skin for over 5 years. The acne was mainly distributed on the forehead and cheek area with itching and burning sensations, was dark red in color and often filled with pus. Associated signs were restlessness, constipation, dry mouth, and poor sleep. The tongue was red with a yellow thin coating and the pulse was deep and wiry. Diagnosis: Acne due to Damp-Heat. Treatment Principle: Clear Heat and Resolve the stagnation of Dampness and Blood. Point Prescription: LI-11, LI-4, GV-14, BL-13, SP-6, and SP-9. Treat once every other day for 5 treatments as a course. Technique: Insert 1.5 cun #32 needles into GV-14 and BL-13 perpendicularly, 0.8 – 1 cun deep with lifting and thrusting reducing needle technique. Retain all needles for 10 minutes. Then insert 1.5 cun #30 needles into LI-11 and SP-9 perpendicularly, 1-1.2 cun deep with lifting and thrusting reducing needle technique, along with 1 cun #34 needles into LI-4 and SP-6 with twisting even movement needle technique. Retain all needles for 20 minutes. Result: The symptoms were much improved after 5 treatments, however there was a little new acne growing. All the acne was resolved after 5 courses of treatment and the skin look and felt smooth. EVALUATION Acupuncture and moxibustion is very effective for treating acne by means of regulating the Qi and Blood. The most critical step in correct treatment is to make a correct diagnosis in accordance to TCM theory. Once the diagnosis is made correctly, it will help to make a correct principle of treatment and an effective point prescription. During the treatment it is often best to not change the prescription and points until much later on when treatment has proven to be ineffective. This is because most effect will not appear until after 10–15 treatments. Herbs and other therapies usually work very well in conjunction with acupuncture without any bad interference.

389

Acupuncture and Moxibustion—A Clinical Desk Reference

ACUTE CONJUNCTIVITIS Acute conjunctivitis is a disorder of the eyes that is also known as “red-eyes”. Usually it is a symptom commonly caused by Heat Invasion in terms of TCM. It is one of the most common diseases to occur in the eye. Western medical understanding is that it is caused by a pathological bacterial or viral invasion. Its principle manifestations of symptoms are photophobia, foreign body sensation, conjunctive congestion, and purulent secretion. DIAGNOSIS According to TCM there are usually two common causes of Acute Conjunctivitis. Each cause is usually accompanied with its own derived set of symptoms. However, due to the similarity of these symptoms it is important to note the subtle differences in order to make the correct diagnosis. Wind Heat in the Lung Meridian Symptoms include redness, swelling, and pain of the eye, tearing, profuse eye secretions of mucus, and possibly headache, and fever. The tongue is red and the pulse is floating and rapid. Wind Heat in the Liver and Gallbladder Meridian Manifestations include redness, swelling, and pain of the eye, profuse mucous eye secretion, and bitter taste in the mouth, constipation, dizziness, and headache. The patient may also be irritable and easily angered. The tongue is red with a yellow, greasy coating and the pulse is wiry and slippery. TREATMENT AND PRESCRIPTIONS For both types of Wind Heat Treatment Principle: Expel the Wind Heat and Clear the eyes. Point Prescription: LI-4, LV-3, BL-1, and Tai Yang. Treat once every day for 3 treatments as a course. Technique: Insert 1 cun #32 needles into BL-1 and Tai Yang perpendicularly, 0.3 cun deep with twisting reducing needle technique. Next insert 1.5 cun #32 needles into LI-4 and LV-3 using lifting thrusting reducing needle technique. Retain all needles for 30 minutes. Additional points for other associated symptoms: Fever and aversion to cold: LU-11 and GV-23. Liver and Gallbladder Fire: LV-2 and GB-43. ADJUNCTIVE THERAPIES Ear Acupuncture Points: Eye, Eye1, Eye2, and Liver. Use 0.5 cun ear needles for all points. Insert the needles obliquely with fast twisting needle technique and retain them for 30 minutes. Treat the patient for once every day for 3 treatments as a course.

390

Acute Conjunctivitis

Scalp Acupuncture Treatment zones: Lateral line 1 of forehead and Lateral line 1 of the vertex. Insert 1.5 cun #30 needles into these two lines with fast twisting needle technique or lifting Qi needle technique. Retain all the needles for 30 to 40 minutes. Treat for once every other day for 3 treatments as a course. Cupping Points: GB-21, GV-14, and SI-11. Insert 1 cun #30 needles into all points with twisting reducing needle technique. Do not retain needles. Next, apply fire cups on these points and retain the cups for 3 minutes. The treatment is once every day for 3 treatments as a course. TRADITIONAL PRESCRIPTIONS AND TECHNIQUES For acute conjunctivitis: SI-5 and BL-67. (Yi Xue Gang Mu) Insert 1 cun #30 needles into both points to a depth of 0.1 cun with twisting reducing needle technique. Do not retain needles. Next apply direct non-scarring moxibustion on these two points for 7 cones each. Treat once every day for 3 treatments as a course. For acute conjunctivitis: Da Gu Kong, Xiao Gu Kong, and Tai Yang. (Yu Long Ge) Use indirect non-scarring moxibustion on Da Gu Kong and Xiao Gu Kong for 7 cones each. Next insert a 1 cun #30 needle into Tai Yang with twisting reducing needle technique and enlarge the acupuncture hole when taking the needle out. For acute conjunctivitis due to Liver and Gallbladder Heat: LI-4, ST-36, Tai Yang, BL-1, BL-2, and TW-23. (Shen Shi Yao Han) Insert 1 cun #30 needles into LI-4, ST-36, Tai Yang, and BL-1 with reducing twisting needle technique and retain the needles for 30 minutes. If the condition does not change, then insert 1 cun #30 needles into BL2 and TW-23 with twisting reducing needle technique. Treat once every day for 3 treatments as a course. For acute conjunctivitis due to Excess Heat:

(Zhen Jiu Chu Fan Da Quan)

Main points: LI-14 and Tip of the ear. Supplemental points: LI-4, LV-3, BL-1, Tai Yang, GV-23, and GB-20. Insert a 1.5 cun #30 needle into LI-14 obliquely upwards, 0.3 cun deep with twisting reducing needle technique for a while, then further insert the needle another 0.3 cun deep using the same needle technique. If the symptom is still there, insert another 0.3 cun deep with same technique. Most patients will feel much better during the manipulations. Next extract 2 drops of blood from the tip of the ear using a bloodletting needle. If necessary use 1 cun #32 needles for other supplemental points with reducing twisting needle technique and retain all the needles for 30 minutes. Treat once every day for 3 treatments as a course.

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Acupuncture and Moxibustion—A Clinical Desk Reference

CASE ANALYSIS A 31-year-old female patient presented with the main complaint of conjunctivitis for 2 days. The eye was red and swollen, accompanied by severe tearing and photophobia. Other symptoms also included headache, poor sleep, restlessness, bitter taste in the mouth, and a bloated abdomen. The tongue was red with a yellow coating and the pulse was wiry and fast. Diagnosis: Acute conjunctivitis due to Liver Fire Treatment Principle: Subdue the Liver Fire and Reduce the swelling and pain. Prescription: LI-14, LI-4, LV-3, GB-20, and Bloodletting on the tip of ear. Treat the patient once daily for 3 treatments as course. Technique: Insert 1.5 cun # 32 needles into LI-14 obliquely, 1 cun deep at a 45-degree angle upward with twisting reducing needle technique until the sensation of the pain is reduced. Insert 1 cun #32 needles into LI-4 and LV-3 perpendicularly with lifting and thrusting reducing needle technique, and 1.5 cun #32 needles into GB-20 perpendicularly, 1 cun deep towards the nose with twisting reducing needle technique. Retain all needles for 10 minutes. Apply bloodletting technique on the tip of ear (on the disease side only) and squeeze 3 drops of blood. Result: After one treatment all symptoms were reduced. Three treatments cleared all the manifestations of pus and other secretions. EVALUATION Treatment of acute conjunctivitis with acupuncture is very successful and effective, especially when using LI-14 and bloodletting as the main points in the treatment. During the treatment period and the time in between, the patient should try to keep his or her eyes clean and avoid strong light stimulation. Usually without severe infections and injury to the eye, the disease should clear up within a few initial treatments.

392

Aphonia

393

Acupuncture and Moxibustion—A Clinical Desk Reference

APHONIA Aphonia is a disorder that refers to sudden voice changes that make it difficult to speak or causes the patient to loose their voice. The illness affects the patient’s speech by attacking the throat, larynx, and vocal fold. Also other diseases, such as hysteria can commonly cause aphonia. TCM views it to be related to the over use of the patient’s voice, External Pathogenic Invasion, or emotional stress. Lung Qi and Yin Deficiency can also cause aphonia through disorder of the Qi movement in the throat, and stagnation of Phlegm in the throat and larynx region. DIAGNOSIS To help effectively treat this disorder, it is important to be able to make the correct diagnosis. There are two basic types of syndromes that commonly cause this disorder. These syndromes are Excess Syndrome and Deficiency Syndrome. Based on their separate and distinct set of symptoms it is easy to identify the two. Excess Syndrome External Invasion Sudden loss of voice associated with itching and soreness in the throat and larynx, and nasal discharge and congestion. The tongue is pale with a thin yellow coating and the pulse is floating and fast. Emotional stimulation Sudden loss of voice associated with negative emotions, restlessness, tendency to anger, dizziness and vertigo, headache, dry month, and stuffy sensation in the chest and hypochondriac region. The tongue is red with a thin yellow coating and the pulse is wiry. Deficiency Syndrome Aphonia caused by other chronic problems and diseases that slowly and gradually developed, often associated with sore throat, dry mouth, tidal fever, night sweating, dry cough, heart palpitations, and ringing in the ear. The tongue is red without coating and the pulse is thin and fast. TREATMENT AND PRESCRIPTION Excess Syndrome Treatment Principle: Open the Lung Qi and Release the stagnation. Point Prescription: LU-10, LU-5, BL-10, LI-18, LV-3, HT-5, and GV-14. Treat once every other day for 3 treatments as a course. Technique: Insert 1 cun #32 needles into LU-10, LV-3, and HT-5 perpendicularly, 0.5 cun deep with twisting reducing needle technique, and 1.5 cun #32 needles into LU-5 and LI-18 perpendicularly, 1-1.2 cun deep with twisting even movement needle technique. Retain all needles for 15 minutes. Insert 1.5 cun #32 needles into BL-10 perpendicularly, 1 cun deep with lifting and thrusting reducing needle technique, and a 1.5 cun #30 needle into GV14 perpendicularly, 1-1.2 cun deep with rubbing technique (rub the needle count-clockwise) until the sensation of the needle travels from the point. Additional points for treatment of associated symptoms: Headache: GV-23 and LI-4. Cough: CV-17 and BL-13. Painful and stuffy sensation in the chest and hypochondriac regions: TW-6 and SP-4.

394

Aphonia

Deficiency Syndrome Treatment Principle: Reinforce Lung and Kidney Yin and Release the stagnation. Point Prescription: KI-3, LU-9, BL-13, BL-23, KI-24, LU-1, BL-43, GV-12, and CV-6. Treat once every other day for 7 treatments as a course. Technique: Insert 1 cun #32 needles into BL-43 obliquely, 0.3-0.5 cun deep at a 30-degree angle with twisting reinforcing needle technique, and 1 cun #30 needles into BL-13 perpendicularly, 0.5 cun deep with lifting and thrusting reinforcing needle technique. Insert 1.5 cun #32 needles into BL-23 and GV-12 perpendicularly, 1 cun deep with twisting reinforcing needle technique. Retain all needles for 10 minutes. Insert 1 cun #32 needles into KI-3 and LU-9 perpendicularly, 0.3 cun deep with twisting reinforcing needle technique, and then 1 cun #30 needles into KI-24 and LU-1 perpendicularly, 0.3-0.5 cun deep with twisting reducing needle technique. Insert 1.5 cun #32 needles into CV-6 perpendicularly, 1-1.2 cun deep with lifting and thrusting reinforcing needle technique. Retain all needles for 20 minutes. Additional points for associated symptoms: Night sweating: KI-6 and HT-6. Hot flushes: GV-4. Dry cough: LU-5. ADJUNCTIVE THERAPIES Ear Acupuncture Point Prescription: Lung, Throat, Neck, Trachea, Large Intestine, and Kidney. Select 3 points in each treatment with 0.5 cun #32 ear needles, insert the needles obliquely, 0.3 cun deep at a 60-degree angle with fast twisting needle technique. Repeat the process every 5 minutes during 40 minutes of needle retention. Or apply press-balls after regular body acupuncture treatment. Treat once every other day for 5 treatments as a course. Scalp Acupuncture Treatment zones: Middle line of the forehead, Lateral line 1 of the forehead, and Middle line of the vertex. Insert 1.5 cun #32 needles into Middle line of forehead and Lateral line 1 of forehead transversely, 1 cun deep downwards towards the face with fast twisting needle technique. Insert a 1.5 cun #30 needle into middle line of vertex transversely, 1.2 cun deep at a 30-degree angle backwards (GV-19 direction) with lifting and thrusting reinforcing needle technique. Repeat this process every 10 minutes during 30 minutes needle retaining time. Treat once every other day for 3 treatments as a course. Wrist and Ankle Acupuncture Treatment lines: Upper 1, Upper 3, Lower 1, and Lower 3. Insert 1.5 cun #32 needles into these lines transversely, 1.2 cun deep at a 15-degree angle without doing any needle technique and avoid any sensation of the needle. Retain all needles for 40 minutes. Treat once every other day for 3 treatments as a course.

395

Acupuncture and Moxibustion—A Clinical Desk Reference

Gua Sha Treatment areas: Upper back, Neck, and Arm. Apply medium level stimulation of Gua Sha on the upper back from GV-14 to GV-5, and from BL-11 to BL-18 until Sha appears. Apply weak stimulation on the neck near ST-9 until red marks appear. Apply medium stimulation on the arms near the PC-3 area until the dark red color appears. Treat once every other day for 2 treatments as a course. Nose Acupuncture Point Prescription: Lung, Liver, Kidney, and Heart. Insert 0.5 cun #34 needles into these points perpendicularly, 0.3 cun deep with twisting even movement needle technique. Retain all needles for 30 minutes. Treat once every other day for 3 treatments as a course. Bloodletting Treatment point: LU-11, LI-1, and ST-45. Apply bloodletting technique on these points and squeeze 1 to 2 drops of blood from each point, to treat loss of voice in Excess Syndrome. Treat once every other day for 2 treatments as a course. TRADITIONAL PRESCRIPTIONS AND TECHNIQUE For loss of voice due to stagnation of Qi: LI-18, Jing-well, and Yu Ye. (Ling Shu Han Ren) Insert 1 cun #30 needles into LI-18 perpendicularly, 0.5-0.8 cun deep with twisting reducing needle technique. Apply bloodletting technique on the Jing-well and Yu Ye, making 2-3 drops of blood. Treat once only during the acute time. For loss voice due to deficiency of Qi: ST-10, ST-9, CV-23, LI-18, PC-5, LI-4, LI-2, ST-6, and SP-6. (Zhong Guo Zhen Jiu) Insert 1 cun #32 needles into ST-10, ST-9, and LI-18 perpendicularly, 0.5 cun deep with twisting reducing needle technique, and a 1.5 cun #32 needle into CV-23 obliquely, 1 cun deep at a 60-degree angle towards the root of the tongue with twisting even movement needle technique. Insert 1 cun #34 needles into LI-4 and LI-2 with twisting even movement needle technique, and 1 cun #32 needles into PC-5, ST-6, and SP-6 perpendicularly, 0.5 cun deep with twisting reinforcing needle technique. Retain all needles for 20 minutes. Treat once every other day for 7 treatments as a course. For Aphonia due to Wind-Cold: ST-9, ST-10, LI-4, and ST-40. (Zhen Jiu Chu Fang Xue) Insert 1 cun #32 needles into ST-9 and ST-10 perpendicularly, 0.5 cun deep with twisting even movement needle technique until the sensation of the needle travels into the larynx area. Insert 1 cun #34 needles into LI-4 perpendicularly, 0.5 cun deep with twisting reducing needle technique, and 1.5 cun #32 needles into ST-40 with lifting and thrusting reducing needle technique. Retain all needles for 20 minutes. Treat once every other day for 3 treatments as a course. For Aphonia due to stagnation of Qi: GV-15, GB-20, LU-5, and LV-3. (Author’s Clinical Experience) Insert 1.5 cun #32 needles into GV-15 and GB-20 perpendicularly, 1 cun deep with twisting reducing needle technique, and apply moxa wool on the handle of needles for 3 cones. Insert 1.5 cun #32 needles into LU-5 perpendicularly, 1 cun deep with twisting reducing needle technique, and 1 cun #32 needles into LV-3 with lifting and thrusting reducing needle technique. Retain all needles for 15 minutes. Treat once every other day for 5 treatments as a course. 396

Aphonia

For Aphonia due to stagnation of Heat and Phlegm: CV-22, CV-23, LI-11, SP-9, and Zhen Ying. (Zhong Guo Zhen Jiu) Zhen Ying is an extra point 1 cun bilateral from CV-23. Insert a 1.5 cun #32 needle into CV-22 obliquely, 1 cun deep at a 60-degree angle in front of the trachea downwards with twisting even movement needle technique, and 1.5 cun #32 needles into CV-23 and Zhen Ying perpendicularly, 1 cun deep with twisting reinforcing needle technique. Insert 1.5 cun #30 needles into LI-11 and SP-9 perpendicularly, 1-1.2 cun deep with lifting and thrusting reducing needle technique. Retain all needles for 20 minutes. Treat once every other day for 5 treatments as a course. For Aphonia due to Lung Yin Deficiency: LI-17, LU-10, KI-6, ST-36, LV-3, and ST-9. (Zhen Jiu Da Chuan) Insert 1 cun #32 needles into LI-17 perpendicularly, 0.5 cun deep with vibrating technique after getting the sensation of the Qi, and 1.5 cun #32 needles into ST-9 perpendicularly, 1 cun deep with twisting even movement needle technique. Insert 1 cun #32 needles into LU-10, LV-3, and KI-6 with twisting even movement needle technique, and 1.5 cun #34 needles into ST-36 with twisting reinforcing needle technique. Retain all needles for 20 minutes. Treat once every other day for 5 treatments as a course. For Aphonia due to stagnation of Heat-Phlegm: BL-3, GV-24, ST-10, LI-11, and HT-5. (Author’s Clinical Experience) Insert 1 cun #32 needles into BL-3 and GV-24 transversely, 0.5-0.8 cun deep at a 30-degree angle towards the BL-2 direction with fast twisting needle technique, and 1 cun #32 needles into ST-10 perpendicularly, 0.5-0.8 cun deep with twisting reducing needle technique. Insert 1.5 cun #32 needles into LI-11 perpendicularly, 1.2 cun deep with lifting and thrusting reducing needle technique, and 1 cun #34 needles into HT-5 perpendicularly, 0.5 cun deep with twisting even movement needle technique. Retain all needles for 20 minutes. Treat once every other day for 3 treatments as a course. CASE ANALYSIS A 46 year-old male singer presented with the main complaint of aphonia for over 3 days due to frequent singing. Associated signs were restlessness, tendency to anger, and stuffy sensation in the chest and upper epigastria region. The tongue was swollen with a white greasy coating and the pulse was wiry and floating. The E.N.T examination showed a swollen vocal fold. Diagnosis: Aphonia due to stagnation of Qi and Phlegm. Treatment Principle: Regulate the Qi and Resolve Phlegm. Point Prescription: CV-23, ST-9, ST-40, and LU-5. Treat once every other day for 5 treatments as a course. Technique: Insert a 1.5 cun #32 needle into CV-23 obliquely, 1 cun deep at a 60-degree angle towards the direction of the root of the tongue with twisting even movement needle technique, and 1.5 cun #32 needles into ST-9 perpendicularly, 1 cun deep with twisting reinforcing needle technique. Insert 1.5 cun #30 needles into ST-40 and LU-5 perpendicularly, 1.2 cun deep with lifting and thrusting reducing needle technique. Retain all needles for 20 minutes. The patient was advised to take a rest from singing and avoid stimulating foods during the course of treatment. Result: The symptoms were improved after 1 treatment; all symptoms were resolved after 5 treatments and the patient was able to return to his singing.

397

Acupuncture and Moxibustion—A Clinical Desk Reference

EVALUATION Acupuncture and moxibustion can be very effective for treating of aphonia, particularly for patients suffering from functional aphonia or overuse due to their occupation, such as a teacher or a singer. Acupuncture and moxibustion can get rid of edema and congestion in the voice box by regulating the body’s functions as a whole. The patient should rest during the course of acupuncture treatment and also a correct examination by an E.N.T. doctor is important to avoid some severe diseases such as cancer or permanent injury of larynx nerves.

398

Deafness

399

Acupuncture and Moxibustion—A Clinical Desk Reference

DEAFNESS Deafness is a symptom that affects the ear. Although this may be caused by many different reasons in Western Medicine such as infections or trauma to the ear, it is viewed and treated very differently in TCM. Generally in TCM this symptom is considered to be associated with Qi stagnation in the Shao Yang meridian that is caused by Liver and Gallbladder Fire rising up, severe emotional changes such as: sudden anger, severe anxiety, and fear. In some cases it is due to Heat Phlegm rising and stagnating in the ear, or Kidney Jing Deficiency, which interferes with the Kidney’s ability to nourish the ear. In terms of diagnosis, the illness is seen under three different patterns. Exterior Causes Sudden loud voice or noise can stagnate the Qi movement in the meridians near the ear, causing Blood Stagnation and deafness. Liver and Gallbladder Fire Severe emotional stimulation, such as sudden and severe anger, fearfulness, and fright will obstruct the Shao Yang meridian Qi causing deafness. Phlegm Stagnation Upward flow of Dampness due to stagnation of Qi or deficiency of the Spleen stagnates the Qi in the meridians close to the ear, causing deafness. Kidney Jing Deficiency The Kidney Jing (Essence) is unable to reach the ear, failing to nourish the ear causing deafness. Most of the time this type occurs in seniors when they have Kidney deficient body constitutions. DIAGNOSIS Excess Syndrome Symptoms include sudden deafness due to disease, a feeling of stiffness and distension in the ear, sometimes occurring with a loud sound. In the case of Excess Fire of Liver and Gallbladder, associated signs are red complexion, dry month, restlessness, ease to anger, red tongue with a thin yellow coating, and a wiry pulse. In the accumulation of the Phlegm-Heat, the associated signs are a stuffy sensation in the chest with more phlegm, a swollen tongue with a greasy coating, and a slippery and fast pulse. Deficiency Syndrome Deafness caused by chronic diseases, with intermittent light or low pitch sound that is aggravated by fatigue and reduced by pressure. Associated signs are dizziness, sore and weak sensations in the low-back and knees. The tongue is red or pale with less coating or a white coating. The pulse is weak.

400

Deafness

TREATMENT AND PRESCRIPTION Excess Syndrome Treatment Principle: Clear Liver Fire and Resolve the Phlegm. Point Prescription: SI-19, TW-17, TW-3, and GB-43. Treat twice a week for 7 treatments as a course. Technique: Insert a 1.5 cun #32 needle into the diseased side of TW-17 obliquely, 1.2 cun deep following the direction of the ear canal with twisting even movement needle technique, and a 1.5 cun #32 needle into the diseased side of SI-19 perpendicularly, 1.2 cun deep with twisting even movement needle technique. Insert 1 cun #32 needles into TW-3 and GB-43 perpendicularly, 0.5 cun deep with twisting reducing needle technique. Retain all needles for 30 minutes. Additional points for treatment of associated symptoms: Liver and Gallbladder Fire: LV-2 and GB-41. Stagnation of Heat-Phlegm: ST-40 and PC-8. Headache: GV-20 and GB-20. Deficiency Syndrome Treatment Principle: Reinforce the Kidney Jing and Regulate the Qi. Point Prescription: TW-17, SI-19, BL-23, CV-4, and KI-3. Treat once a week for 10 treatments as a course. Technique: Insert 1.5 cun #34 needles into TW-17 and SI-19 perpendicularly, 1.2 cun deep with twisting reinforcing needle technique. Apply moxa wool on the handle of needles for 2 cones. Insert 1 cun #32 needles into KI-3 perpendicularly, 0.5 cun deep with twisting reinforcing needle technique. Apply indirect moxibustion with Fu Zi (aconite) cake on CV-4 for 3 cones. Insert 1.5 cun #32 needles into BL-23 perpendicularly, 1 cun deep with lifting and thrusting reinforcing needle technique, retain needles for 10 minutes. Additional points for treatment of associated symptoms: Kidney Deficiency: GB-42 and ST-36. Dizziness and vertigo: GV-4 and BL-43. ADJUNCTIVE THERAPIES Ear Acupuncture Point Prescription: Shen Men, Sympathetic, Liver, Kidney, Heart, Brain, Sub cortex, and Occipital. Select 3 to 4 points during each treatment. Insert 0.5 cun #32 ear needles at 45-degree angle with ear using fast twisting technique. Retain all needles for 40 minutes. Or apply press-ball on the points and retain them for 3 to 5 days. Treat once every other day for 5 treatments as a course. Scalp Acupuncture Treatment zones: Anterior oblique line and Posterior oblique line of the temple, Middle line of the forehead, Middle line of the vertex. Insert 1.5 cun #32 needle into these treatment lines transversely, 1 cun deep at a 30-degree angle with fast twisting needle technique. Retain all needles for 30 minutes. Treat once every other day for 7 treatments as a course. 401

Acupuncture and Moxibustion—A Clinical Desk Reference

Moxibustion (Deficient Type Tinnitus and Deafness) Direct moxibustion: GV-4, BL-23, SP-3, and CV-4. 7 cones.

Use direct non-scarring moxibustion on GV-4 and BL-23 for 11 cones, and on SP-3 and CV-4 for Treat once every other day for 5 treatments as a course.

Indirect moxibustion: CV-4, BL-52, BL-43, and GV-7. Apply indirect moxibustion with ginger on BL-52, BL-43, and GV-7 for 3 cones. Next apply indirect moxibustion with ginger on CV-4 for 5 cones. Treat once every other day for 5 treatments as a course. Moxa pole: SI-19, ST-7, TW-17, GV-20, and GB-20. Apply moxa-pole on each of these points for 10 minutes. Treat once daily for 5 treatments as a course. Gua Sha Treatment area: Neck, Back, and Abdomen. Apply medium level stimulation of Gua Sha on the neck along the BL and GV meridians from GV-16 to GV-12, and BL-10 to BL-12 until red marks appear. Apply medium stimulation of Gua Sha on the back along the BL and GV meridians from GV-7 to GV-4, and BL-17 to BL-23 until red or purple spots appear. Treat once a week for 3 treatments as a course. Electro-acupuncture Point Prescription: SI-19, TW-17, TW-19, and GB-12. Insert 1.5 cun #32 needles into SI-19 and TW-17 perpendicularly, 1 cun deep along the ear canal with twisting even movement needle technique, and apply electro-acupuncture with irregular waves, the negative side on TW-17. Insert a 1 cun #32 needle into TW-19 obliquely, 0.7 cun deep backwards with twisting reducing needle technique, and a 1.5 cun #32 needle into GB-12 perpendicularly, 1.2 cun deep with twisting reinforcing needle technique, applying electric stimulation with irregular waves, the negative side on GB-12. Retain all needles for 20 minutes. Treat once a week for 5 treatments as a course. Cupping Treatment area: GV-14, BL-42, BL-20, BL-23, CV-8, and CV-17. Apply fire cups on GV-14, BL-42, BL-20, and BL-23 for 5 minutes. Next apply fire cups on CV-8 and CV17 for 2 minutes. Treat once daily for 4 treatments as a course.

402

Deafness

TRADITIONAL PRESCRIPTIONS AND TECHNIQUE For congenital deafness: TW-21, TW-17, GV-15, TW-3, TW-5, LI-11, and GV-20. (Author’s Clinical Experience) Insert a 2 cun #32 needle into TW-21 (disease side only or bilateral if deafness involved two ears) obliquely, 1.5 cun deep at a 45-degree angle towards GB-2 with twisting reducing needle technique. Insert a 1.5 cun #32 needle into TW-17 perpendicularly, 1 cun deep along the ear canal with twisting reducing needle technique. Insert a 1.5 cun #30 needle into GV-15 perpendicularly, 1 cun deep towards CV-23 direction with twisting even movement needle technique, and 1 cun #32 needles into TW-3, TW-5, and LI-11 with twisting even movement needle technique. Insert a 1.5 cun #32 needle into GV-20 transversely, 1 cun deep at a 30-degree angle towards GV-19 with lifting and thrusting reducing needle technique. Retain all needles for 30 minutes. Treat twice a week for 10 treatments as a course. For deafness due to traumatic injury: SI-19, GV-14, ST-36, and BL-23. (Author’s Clinical Experience) Insert a 1.5 cun #30 needle into SI-19 (disease side only) obliquely, 1.2 cun deep towards GB-2 at a 75degree angle with twisting reducing needle technique. Insert a 1.5 cun #32 needle into GV-14 perpendicularly, 1 cun deep with twisting even movement needle technique until the sensation of the needle travels up. Insert 1.5 cun #32 needles into ST-36 and BL-23 with twisting reinforcing needle technique. Retain all needles for 30 minutes. Treat once every other day for 7 treatments as a course. For deafness due to drugs: Yi Ming, TW-21, TW-18, TW-9, GB-20, and LI-4. (Author’s Clinical Experience) Yi Ming is an extra-point located 1 cun behind TW-17. Insert 1.5 cun #30 needles into Yi Ming perpendicularly, 1 cun deep with twisting even movement needle technique, and 1.5 cun #32 needles into TW-21 obliquely, 1.2 cun deep towards GB-2 at a 75-degree angle with twisting reducing needle technique. Insert 1 cun #32 needles into TW-18, LI-4, and TW-9 perpendicularly, 0.5 cun deep wither twisting reducing needle technique. Insert 1.5 cun #32 needles into GB-20 perpendicularly, 1.2 cun deep towards CV-24 with lifting and thrusting reducing needle technique. Retain all needles for 30 minutes. Treat twice a week for 10 treatments as a course. For deafness due to otitis media: TW-17, GB-2, ST-7, LI-11, ST-36, and SP-6. (Author’s Clinical Experience) Insert a 1.5 cun #30 needle into TW-17 (disease side) perpendicularly, 1 cun deep with twisting even movement needle technique, and a 1.5 cun #32 needle into GB-2 obliquely, 1 cun deep towards TW-21 at a 75-degree angle with twisting even movement needle technique. Apply moxa wool on the handle of needles for 3 cones. Insert 1.5 cun #32 needles into ST-7, LI-11, ST-36, and SP-6 with twisting reducing needle technique. Retain all needles for 30 minutes. Treat once every other day for 7 treatments as a course. For deafness due to infectious diseases: TW-21, TW-20, GV-20, TW-5, and Tai Yang. (Author’s Clinical Experience) Insert 1.5 cun #30 needles into TW-21 obliquely, 1.2 cun deep towards GB-2 at a 75-degree angle with twisting reducing needle technique, and 1 cun #32 needles into TW-20 transversely, 0.7 cun deep towards TW-19 direction with twisting reducing needle technique. Insert a 1.5 cun #30 needle into GV-20 transversely, 1 cun deep with lifting and thrusting reducing needle technique, and 1.5 cun #30 needles into Tai Yang obliquely, 1.2 cun deep towards ST-7 direction with twisting even movement needle technique. Insert 1.5 cun #32 needles into TW-5 with twisting reducing needle technique. Retain all needles for 30 minutes. Treat once every other day for 7 treatments as a course.

403

Acupuncture and Moxibustion—A Clinical Desk Reference

For acute deafness: TW-9 and TW-16. (Yi Xue Gang Mu) Insert 1.5 cun #30 needles into TW-9 perpendicularly, 1 to 1.2 cun deep with lifting and thrusting reducing needle technique, and 1.5 cun #32 needles into TW-16 perpendicularly, 1 cun deep with twisting reducing needle technique. Retain all needles for 30 minutes. Treat once every other day for 5 treatments as a course. For deafness due to infectious diseases: SI-19, TW-17, GB-42, ST-36, and TW-14. (Zhen Jiu Chu Fang Xue) Insert 1.5 cun #32 needles into SI-19 and TW-17 perpendicularly, 1.2 cun deep with twisting reducing needle technique, and 1 cun #32 needles into GB-42 perpendicularly, 0.5 cun deep with twisting even movement needle technique. Insert 1.5 cun #32 needles into ST-36 and TW-14 perpendicularly, 1 cun deep with twisting even movement needle technique. Retain all needles for 30 minutes. Treat once every other day for 7 treatments as a course. For deafness with deficiency of the Kidney: SI-19, BL-23, SI-5, TW-17, and TW-4. (Zhen Jiu Zi Shen Jing) Apply direct non-scarring moxibustion on TW-17 and BL-23 for 11 cones. Insert 1.5 cun #32 needles into SI-19 perpendicularly, 1 cun deep with twisting reinforcing needle technique, and 1 cun #32 needles into SI5 and TW-4 perpendicularly, 0.5 cun deep with twisting even movement needle technique. Retain all needles for 20 minutes. Treat once every other day for 10 treatments as a course. CASE ANALYSIS A 60 year-old male patient presented with the main complaint of deafness for 10 years, with need of a hearing aid. Recently the hearing aid was not helpful and he began to hear a loud sound in the interior of his ears day and night. Associated signs were dizziness and poor sleep. The tongue was red with a yellow coating and the pulse was wiry. Diagnosis: Deafness due to deficiency of the Kidney. (Nervous deafness) Treatment Principle: Dredge the Triple Warmer Meridian Qi, Reinforce the Kidney Qi, and Clear Heat. Point Prescription: TW-21, TW-17, LI-4, GB-42, ST-36, BL-23, and GV-4. Treat once every other day for 7 treatments as a course. Technique: Insert 1.5 cun #30 needles into TW-21 obliquely, 1.2 cun deep towards GB-2 at a 75-degree angle with twisting reducing needle technique until the sensation of the needle travels to the interior of the ear. Insert 1.5 cun #32 needles into TW-17 perpendicularly, 1 cun deep following the direction of the ear canal with twisting even movement needle technique. Insert 1 cun #32 needles into LI-4 and GB-42 perpendicularly with twisting reducing needle technique, and 1.5 cun #32 needles into BL-23, ST-36, and GV-4 with twisting reinforcing needle technique. Result: The loud sound was greatly reduced after one course treatment and he began to hear well after 3 courses of treatment. EVALUATION Acupuncture and moxibustion is helpful for treating nervous deafness and deafness caused by other functional problems. However, it is not effective for treating organic deafness, meaning deafness with perforation of the tympanic membrane, or other interior ear structure damage. During the treatment, the depth of the needle is very important, especially the local points, such as SI-19, TW-21, and TW-17. These points need over 1 cun deep insertion and the acupuncturist must lead the sensation of the needle to travel to the interior of the ear, otherwise the effects are minimal. Usually effects will be apparent after 10 treatments, but if after 20 treatments there is still no effect, acupuncture will most likely not work well for this type of patient. Keeping good emotional balance and local ear massage will also help during the course of acupuncture treatments.

404

Sinusitis

405

Acupuncture and Moxibustion—A Clinical Desk Reference

SINUSITIS Sinusitis is called Bi Yuan in TCM, or Nao Lou—which means brain leaking. It describes symptoms of inflammation and stagnation of the sinus passages. The side effects of this disorder may lead to impairment of daily functions such as sleep, exercise, or concentration. Sinusitis manifestations may include rhinitis, nasal obstruction, and nasosinusitis. Under the clinical diagnostics of TCM, there are usually two identifiable causes of sinusitis. Wind Cold Invasion Wind Cold External Pathogenic factors invade the Lung, stagnating the Lung Qi, and causing failure in descention. This leads the ascending to turn to Heat rising up to the nasal cavity and passages. Liver Gallbladder Heat Interior Liver and Gallbladder Excess Heat with stagnation of Phlegm that rises up, stagnating in the Lung and nose. DIAGNOSIS Wind Heat attacking the Lungs Symptoms include a thick, yellowish, foul-smelling nasal discharge, reduced olfaction, dull frontal headache, fever, and aversion to cold, cough with yellowish sputum and a dry throat. The tongue tip is red with a yellow coating and the pulse is fast and floating. Damp Heat in the Spleen Meridian Symptoms include a profuse amount of yellowish, thick nasal discharge, foul odor, reduced olfaction, abdominal distention, and a heavy sensation in the head and whole body that is associated with poor appetite, abdominal bloating, and yellowish or reddish colored urine. The tongue is red with a yellow greasy coating and the pulse is fast and slippery. Heat stagnated in the Liver and Gallbladder Symptoms include a thick, yellowish, foul-smelling nasal discharge, loss of sense of smell, distending pain in the head and hypochondriac region, bitter taste in the mouth, dry throat, tinnitus, and blurry vision. The tongue is red with a yellow coating and the pulse is fast and wiry. Spleen Qi Deficiency Symptoms include a large amount of white or light yellow nasal discharge, and severe stuffy nose with reduced olfaction. Associated signs are fatigue, lassitude, sallow complexion, poor appetite, bloating in the abdomen, and loose stool. The tongue is pale with a thin white coating and the pulse is slow and weak. Lung Qi Deficiency with Cold Symptoms include a white nasal discharge, stuffy nose, symptoms aggravated by Cold or Wind, spontaneous sweating, aversion to cold, shortness of breath, and fatigue. The tongue is pale with a thin white coating and the pulse is weak.

406

Sinusitis

TREATMENT AND PRESCRIPTIONS Wind Heat attacking the Lung Treatment Principle: Expel the Wind Heat and Open the Lung Qi. Point Prescription: LU-7, LI-4, LI-20, and Yin Tang Treat once every other day for 5 treatments as a course. Technique: Use 1 cun #30 needles with twisting reducing needle technique. Retain all needles for 20 minutes. Additional points for associated symptoms: Frontal headache: BL-2. Damp Heat in the Spleen Meridian Treatment Principle: Clear the Spleen, Reduce the Heat, and Resolve the Damp Point Prescription: SP-9, LI-11, CV-9, LI-20, and Yin Tang. Treat once every other day for 5 treatments as a course. Technique: Insert 1.5 cun #30 needles into SP-9, LI-11, and CV-9 perpendicularly with lifting and thrusting reducing needle technique, and insert 1 cun #32 needles into LI-20 and Yin Tang with twisting reducing needle technique. Retain all the needles for 20 minutes. Additional points for associated symptoms: Headache: LI-4 and GV-23. Diarrhea: ST-25 and ST-40. Stagnation of Heat in the Liver and Gallbladder Treatment Principle: Clear and Reduce the Liver and Gallbladder Fire. Point Prescription: LV-3, GB-20, Yin Tang, GV-23, and LI-20. Treat once every other day for 5 treatments as a course. Technique: Insert 1.5 cun #30 needles into GB-20 perpendicularly towards the nose 1.2 cun deep with twisting reducing technique. Use 1 cun #32 needles for LV-3, Yin Tang, GV-23, and LI-20 with twisting reducing needle technique. Retain all the needles for 20 minutes. Additional points for associated symptoms: Headache: GV-20, Tai Yang, and LI-4. Hypochondriac pain: GB-34 and GB-42. Spleen Qi Deficiency Treatment Principle: Reinforce the Spleen Qi and Move the Damp Stagnation. Point Prescription: ST-36, SP-4, CV-12, GV-23, and LI-20. Treat once or twice a week for 7 treatments as a course. Technique: Insert 1.5 cun #32 needles into ST-36 and CV-12 perpendicularly, 1 to 1.2 cun deep with lifting and thrusting reinforcing needle technique. Use moxa wool on the handle of the needles for 3 cones. Insert 1 cun #32 needles into SP-4, GV-23, and LI-20 with twisting even needle technique. Retain all needles for 20 minutes. Additional points for associated symptoms: Deficient Cold: Moxa on BL-20, BL-21, and GV-14. Stuffy nose: Moxa on GV-23. 407

Acupuncture and Moxibustion—A Clinical Desk Reference

Lung Qi Deficiency with Cold Treatment Principle: Warm the Lung Qi and Expel the Wind Cold Point Prescription: GV-14, BL-11, BL-13, BL-43, LI-20, LU-9, and ST-36. Treat once or twice a week for 7 treatments as a course. Technique: Insert 1.5 cun #30 needles into GV-14, BL-11, BL-13, and ST-36 with twisting reinforcing needle technique. Retain the needles and apply moxa wool on the handle of the needles for 3 cones. Insert 1 cun #32 needles into LU-9 and LI-20 with twisting reinforcing needle technique. During the treatment warm BL-43 with a moxa pole for 15 minutes. Additional points for associated symptoms: Spontaneous sweating: CV-6 and LU-5. Wind Cold: BL-10 and LU-7. ADJUNCTIVE THERAPIES Ear Acupuncture Points: Nose, Lung, Forehead, and Adrenal gland. Using 0.5 cun ear needles puncture the points obliquely with fast twisting technique until the ear gets warm. Retain the needles for 30 minutes. Treat once every other day for 7 treatments as a course. Scalp Acupuncture Treatment zones: Middle line of Vertex, and Lateral line 1 of Vertex. Use 1.5 cun #30 needles for these two lines. Insert the needles obliquely towards the forehead with fast twisting technique. Retain the needles for 30 minutes. Treat once every other day for 7 treatments as a course.

TRADITIONAL PRESCRIPTIONS AND TECHNIQUES For large amounts of nasal discharge and stuffy nose: GV-26 and TW-16. (Zhen Jiu Zi Shen Jing) Insert 1.5 cun #30 needles into TW-16 perpendicularly, 1-1.2 cun deep with twisting even movement technique. Insert a 1 cun #32 needle into GV-26 using twisting reinforcing needle technique. Retain all needles for 20 minutes. Treat one or twice a week for 3 treatments as a course. For any type of sinusitis: (Zhen Jiu Da Cheng) Main points: GV-23 and GV-16. Supplemental points: LI-19, GB-20, GV-26, GV-20, BL-12, and Bai Lao. Insert a 1.5 cun #30 needle into GV-23 obliquely with the flow of the meridian to a depth of 0.8-1 cun using twisting reducing needle technique. Insert a 1 cun #30 needle into GV-16 (note: the point opposite the nose) with twisting reducing needle technique. Then insert 1 cun #30 needles into LI-19, GV-26, and GV-20 with twisting even movement technique and insert 1.5 cun #30 needles into GB-20, BL-12, and Bai Lao using twisting reinforcing technique. Retain all needles for 20 minutes. Treat once every other day for 7-10 treatments as a course. 408

Sinusitis

For sinusitis due to Wind-Heat Invasion: GV-23, BL-4, LI-4, BL-12, and Yin Tang. (Lei Jing Tu Yi) Insert 1 cun #30 needles into LI-4 (or painful point between LI-3 and LI-4) perpendicularly to a depth of 0.5 cun with twisting reinforcing needle technique after the patient feels the Qi sensation. Then insert 1 cun #30 needles into GV-23, BL-4, BL-12, and Yin Tang using twisting even movement needle technique. Retain all the needles for 20 minutes. Treat once every other day for 7 treatments as a course. For chronic sinusitis: Moxibustion on GV-20. (Zhen Jiu Da Cheng) Use direct non-scarring moxibustion on GV-20 for 7-9 cones the size of a wheat seed for each treatment. Alternately, use a moxa pole on GV-20 for 20 minutes each treatment. Treat once every other day for 10 treatments as a course. For sinusitis by Wind-Heat Invasion stagnated in the Lung: GV-14 and GV-11. (Author’s Clinical Experience) Insert 1.5 cun #30 needles into GV-14 and GV-11perpendicularly to a 1-1.2 cun depth with lifting and thrusting reducing needle technique. Retain the needles for 20 minutes. Treat once every other day for 10 treatments as a course. For chronic sinusitis: GV-23, LI-20, ST-40, and LU-5. (Author’s Clinical Experience) Insert 1.5 cun #30 needle into GV-23 backward at a 30-degree angle to the skin obliquely, 1 cun deep with twisting, lifting, and thrusting even movement needle technique until a heat sensation produced under the needle. Insert 1.5 cun #32 needles into ST-40 and LU-5 with lifting and thrusting reducing needle technique and 1 cun #34 needles into LI-20 obliquely through towards Bi Tong, 0.8 cun deep with twisting reducing needle technique. Retain all the needles for 40 minutes. Treat twice a week for 7 treatments as a course. For sinusitis with headache: Tai Yang, GB-20, GB-12, GV-14, GV-17, Yin Tang, LI-4, and LV-3. (Author’s Clinical Experience) Insert 1.5 cun #32 needles into GB-20 and GB-12 perpendicular towards the direction of the chin, 1 cun deep with lifting and thrusting reducing needle technique, and a 1 cun #30 needle into GV-17 towards GV16 obliquely, 0.8 cun deep with twisting even movement needle technique. Insert a 1.5 cun #32 needle into GV-14 perpendicularly, 1 to 1.2 cun deep with rubbing needle technique. Retain all the needles for 10 minutes. Then insert 1 cun #32 needles into Tai Yang perpendicularly, 0.5 cun deep with twisting reducing needle technique. Next, insert a 1 cun #32 needle into Yin Tang obliquely toward the nose, 0.8 cun deep with twisting even movement needle technique. Finally, insert 1.5 cun #32 needles into LV-3 and LI-4 perpendicularly, 1 cun deep with lifting and thrusting reducing needle technique. Retain all the needles for 30 minutes. Treat once every other day, for 7 treatments as a course.

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Acupuncture and Moxibustion—A Clinical Desk Reference

CASE ANALYSIS A 39-year-old male patient presented with a main complaint of sinusitis for 7 years. In the last 3 years the symptoms had been getting worse. The patient could not breathe through his nose, had no olfaction, and continuously had a thick, yellow nasal discharge. He went through three sinus surgeries but improvement only lasted a few months and then symptoms became worse once again. Associated symptoms included a dull frontal headache and shortness of breath. The tongue was pale with a white coating and the pulse was weak. Diagnosis: Sinusitis due to Lung Qi Deficiency. Treatment Principle: Reinforce the Qi and Move stagnant Qi. Point Prescription: LU-9, LI-4, and LI-20. Technique: For all points use a 1 cun #32 needle with twisting reinforcing needle technique until the patient feels the Qi. Apply the same technique for needle manipulation every 5 minutes during the entire 30-minute needle retention time. Treat once every day for 10 treatments as a course. Result: The patient improved after 5 treatments, the symptoms completely resolving after 8 treatments. Another 2 treatments were performed to secure the results. EVALUATION Acupuncture and moxibustion is very effective for treating both acute and chronic sinusitis. Moxibustion is more effective for chronic disease and acupuncture excels for an acute problem. Although correct diagnosis is the key to treatment success, proper needle technique is also very important to attain positive results. But acupuncture and moxibustion is only a supplemental therapy for treating sinusitis after surgery. Other factors such as the loss of olfactory nerves and nasal infections may also require direct and immediate attention.

410

Sore Throat

411

Acupuncture and Moxibustion—A Clinical Desk Reference

SORE THROAT Sore throats can occur in anyone under different conditions. The nature of this topic of discussion is not so much a disorder or a disease than a symptom. In TCM, a sore throat is caused either by an External Wind Pathogenic Influence or an Internal Yin, Qi, or Blood Deficiency. Some western medical diseases with the symptom of sore throat include viral or bacterial infections, acute and chronic tonsillitis, or acute and chronic pharyngitis. Wind Heat Invasion Wind-Heat can invade the Lungs, with the Heat directly burning the Lung Yin, causing a sore throat. Stomach Heat Usually, this is due to long-term intake of hot and spicy or greasy foods, or excessive alcohol intake. Stagnation of food turns to Heat, which rises and burns the fluid in the Lung, causing a sore throat. Kidney Yin Deficiency Yin liquid fails to rise and nourish the Lung and Heart. At the same time, Interior Deficient Fire rises and burns the Lung, causing a sore throat. DIAGNOSIS Wind Heat Symptoms include a reddish, painful, and swollen throat, fever, aversion to cold, tonsils that are red and swollen or coated with yellow-white pus, a cough with thick phlegm and dysphasia due to the sensation of something being stuck in the throat. The tongue is red with a white coating and the pulse is floating and fast. Excessive Heat Symptoms include a severe sore throat causing dysphasia, a high fever, thirst, constipation, and dark red urine. The palatal tonsils are red, swollen, and covered with a yellow-white phylogenic membrane that can be easily wiped off. The sub maxillary lymph nodes are enlarged and accompanied by ozostomia. The tongue is red with a thick yellow, sticky coating and the pulse is full and rapid. Deficiency Heat This condition is due to a Yin Deficiency of the Kidney, Lung, or other organs. Clinical manifestations include a slightly sore throat with a burning heat sensation and a greater feeling of swelling than pain, a foreign body sensation in the throat, dry mouth and lips, a malar flush, five-hearts heat, itchiness in the throat, and a cough with little sputum. The tongue is red without a coating, and the pulse is thin and fast.

412

Sore Throat

TREATMENT AND PRESCRIPTIONS Wind Heat Treatment Principle: Expel the Wind and Clear the throat. Point Prescription: LU-5, LU-11, LI-4, and LI-11. Treat once every day for 3 treatments as a course. Technique: Insert 1.5 cun #30 needles into LI-11, LI-4, and LU-5 with a lifting and thrusting reducing needle technique. Then, use a bloodletting needle to pierce LU-11 to clear the Lung heat. Additional points for associated symptoms: Hoarseness of voice: LU-7 and LI-18. Excessive Heat Treatment Principle: Clear the Heat from the Stomach and Lung, and Resolve the sore throat. Point Prescription: LI-1, ST-44, CV-22, and ST-40. The treatment is once daily for 3 treatments as a course. Technique: Begin by bloodletting LI-1 and ST-44 to clear the Yang Ming Heat. Then, insert 1.5 cun #30 needles into ST-40 and CV-22 with a reducing, twisting needle technique. Retain the needles for 20 minutes. Additional points for associated symptoms: Constipation: ST-37 Deficiency Heat Treatment Principle: Nourish the Yin, Subdue the Fire, and Clear the throat. Point Prescription: KI-3, KI-6, and LU-10. Technique: Insert 1 cun #32 needles into KI-3, KI-6, and LU-10 with a reinforcing twisting needle technique. Retain the needles for 30 minutes. Treat once every other day for 5 to 7 treatments as a course. Additional points for associated symptoms: Dry throat: CV-23. Five hearts heat: HT-8 and KI-2. ADJUNCTIVE THERAPIES Ear Acupuncture For a Wind-Heat or Excessive Heat type of sore throat Points: Throat, tonsil, and helix 1-6. Use 0.5 cun ear needles for all points. Insert the needles obliquely at a 60-degree angle to the skin, with medium or strong twisting stimulation for 2 to 3 minutes. Retain all the needles for 1 hour. The treatment is once every day for 3 treatments as a course.

413

Acupuncture and Moxibustion—A Clinical Desk Reference

Scalp Acupuncture For Wind-Heat or Excessive Heat type of sore throat Treatment zones: Middle line of the forehead, Lateral line 1 of the forehead, Upper Middle line of the occipital Use 1 cun #30 needles for all points. Insert the needles transversely at a 30-degree angle to the skin with a fast twisting needle technique for 2 to 3 minutes. Retain the needles for 1 hour. The treatment is once every day for 3 treatments as a course. Hand Acupuncture (For any type of sore throat) Points: Head and Throat. Insert 0.5 cun #32 ear needles or intradermal needles into these points with a twisting even movement technique. Retain the needles for 30 minutes. The treatment is once every other day for 5 treatments as a course. TRADITIONAL PRESCRIPTIONS AND TECHNIQUES For an acute sore throat: (Author’s Clinical Experience based on the Zhen Jiu Chu Fan Da Quan) Ear Acupuncture: Three special points on the helix (see diagram) for sore throat. If the sore throat is unilateral, treat the ear on the affected side only. If the sore throat is bilateral, use points on both ears. Use 0.5 cun #32 needles for all three points. Insert the needles obliquely, 0.2 to 0.3 cun deep with a fast twisting needle technique until the patient feels numbness or a hot sensation in the ear. Retain the needles for 1 hour. The treatment is once every day for 3 treatments as a course. For stagnation or the sensation of a foreign body in the throat: GB-12, SI-17, St.11, LI-17, LU-5, LI-4, LI-1, LI-3, LI-5, TW-3, SP-4, KI-2, and GB-38. (Zhen Jiu Jia Yi Jing) For each treatment, select 4 to 5 points depending on the symptoms. Insert the needles with an even movement technique, and retain for 30 minutes. Also, choose 1 point on the end of the extremities to perform bloodletting. Treat once every other day for 5 treatments as a course. For Kidney Yin Deficiency sore throat: KI-1 and KI-2. (Qian Jing Yao Fang) Insert 1 cun #32 needles into KI-1 and KI-2 perpendicularly, 0.5 cun deep with a twisting reinforcing needle technique. Retain the needles for 30 minutes. Treat once every other day for 7 treatments as a course. For acute tonsillitis: LI-4, LU-11, and Ah shi points below the thumb nail—3 points in line. (Zhen Jiu Da Cheng) Insert a 1 cun #30 needle into LI-4 with a twisting reducing needle technique. Then perform blood letting on LU-11 and the Ah shi point using a three-edge needle. Retain the needle on LI-4 for 20 minutes. Treat once every day for 3 treatments as a course. For a one-sided sore throat: LU-11, LI-4, and CV-23. (Zhen Jiu Da Cheng) Insert 1.5 cun #30 needles into LI-4 and CV-23 with a lifting and thrusting reducing needle technique. Retain the needles for 20 minutes. Follow this with bloodletting LU-11. Treat once every day for 3 treatments as a course. 414

Sore Throat

For Excessive Heat and Wind-Heat types of sore throat: LI-5, SI-8, and TW-3. (Shen Jiu Jing Lun) Apply direct non-scarring moxibustion for 7 cones each on all points. Treat once every other day for 2 treatments as a course. For a sore throat due to Excessive Heat: LI-4, ST-44, and LI-11. (Xin Yi Liao Fa Shou Ce) Perform a bloodletting technique on ST-44. Then, insert 1.5 cun #32 needles into LI-4 and LI-11 with a lifting the thrusting reducing needle technique, and retain the needles for 30 minutes. Treat once every day for 3 treatments as a course. For a sore throat due to Excessive Heat: GB-20, BL-9, BL-11, LU-5, LU-11, and LI-1. (Zhen Jiu Xue) Insert 1.5 cun #30 needles into GB-20, BL-9, BL-11, and LU-5 with a strong twisting needle technique. Retain the needles for 30 minutes. Use bloodletting needles for LU-11 and LI-1 and extract 1 to 2 drops of blood. Treat once every day for 3 treatments as a course. For a sore throat with difficulty speaking (dysphonia): LI-10, LI-6, LI-11, TW-3, and ST-40. (Zhen Jiu Zi Shen Jing) Insert 1.5 cun #30 needles into LI-10, LI-11, LI-6, and ST-40 with a twisting reducing needle technique. Next, insert a 1 cun #32 needle into TW-3 with a twisting even movement technique. Retain all needles for 30 minutes. Treat once every day for 3 treatments as a course. For a sore throat with a stagnant sensation: HT-7, LI-4, and GB-20. (Zhen Jiu Zi Shen Jing) Insert a 1.5 cun #30 needle into GB-20 perpendicularly towards the nose to a depth of 1 to 1.2 cun. Apply the “rubbing needle” technique- rub the needle clockwise until a tight sensation of the needle is felt. At this point stop rubbing and hold the handle of the needle tightly for 1 minute then release. Next, insert 1 cun #32 needles into HT-7 and LI-4 with a twisting reducing needle technique. Retain all the needles for 30 minutes. Treat once every day for 3 treatments as a course. For a sore throat with Exterior or Interior Heat: SI-17, ST-11, BL-11, BL-17, LU-2, LU-5, LI-2, ST-45, KI-1, and KI-2. (Zhen Jiu Zi Shen Jing) For each treatment, select 3 to 5 points according to the symptoms of the patient. Use 1 cun #30 needles with a twisting reducing needle technique, and retain all needles for 30 minutes. Treat once every day for 3 treatments as a course. For a sore throat with Exterior or Interior Heat: LI-4, KI-1, CV-22, and ST-40. (Zhen Jiu Ju Ying) Insert 1.5 cun #30 needles into ST-40, CV-22, and LI-4 with a lifting and thrusting reducing needle technique. Next, insert a 1 cun #32 needle into KI-1 with a twisting even movement technique. Retain all needles for 30 minutes. Treat once every day for 3 to 4 treatments as a course. For a sore throat with a fever and aversion to cold: BL-9, CV-23, CV-22, SI-5, LI-4, SI-3, LI-3, LU-11, TW-1, ST-36, ST-40, SP-6, and LV-3 (Lei Jing Tu Yi) Select 4 to 5 points for each treatment, according to the patient’s symptoms. Use 1 cun #32 needles for most of the points with a twisting reducing needle technique. Apply a bloodletting technique to LU-11 and TW-1. Retain all needles for 30 minutes. Treat once every day for 3 treatments as a course. For bilateral tonsillitis: LU-11, Jing Jing, and Yu Ye. (Zhen Jiu Da Cheng) Apply a bloodletting technique on all points using a three-edge needle. Treat once every day for 2 treatments as a course. 415

Acupuncture and Moxibustion—A Clinical Desk Reference

For unilateral tonsillitis: LU-11, LI-4, and KI-5. (Zhen Jiu Da Cheng) Insert 1 cun #30 needles into LI-4 and KI-5 with a twisting even movement needle technique. Retain the needles for 30 minutes. Next, use a bloodletting technique on LU-11. Treat once every day for 3 treatments as a course. For a Yin deficiency sore throat which is aggravated at night: KI-3, KI-6, and LU-10. (Zhong Guo Zhen Jiu Chu Fan Xue) Insert 1 cun #32 needles into all points perpendicularly, 0.3 to 0.5 cun deep with a twisting reinforcing needle technique. Retain the needles for 30 minutes. Treat once every other day for 7 treatments as a course. Additional points for associated symptoms: Dry throat: TW-2. Severe pain in the throat: LU-11. (Bloodletting technique) For sore throat: LU-10 and TW-2. (Author’s Clinical Experience) Insert 1 cun #32 needles into LU-10 and TW-2 perpendicularly, 0.5 cun deep with a twisting reinforcing needle technique for 1 minute. Stimulate the needles every 5 minutes during 30 minutes of needle retention. Treat once every other day for 3 treatments as a course. CASE ANALYSIS A 26 year-old male patient entered the clinic and presented with a main complaint of a sore throat for 3 days. The throat felt painful and swollen and was associated with a fever, aversion to cold, a cough with thick phlegm, and constipation. Upon observation, the palatal tonsils appear red and swollen with yellow-white dots of pus on them. The patient also feels a stagnant sensation in the throat that is causing dysphasia. The tongue is red with a yellow coating, and the pulse is floating and fast. Diagnosis: Sore throat due to Wind-Heat Invasion. Treatment Principle: Expel the Wind-Heat and Clear the throat. Point Prescription: LU-11, LU-5, LI-4, ST-43, and TW-1. Technique: Insert 1 cun #30 needles into LU-5, LI-4, and ST-43 with a reducing twisting needle technique. Repeat the needle technique every 10 minutes during the 30 minutes of needle retention. Next, apply a bloodletting technique to LU-11 and TW-1 using a three-edge needle. Treat once every day for 3 treatments as a course. Result: The fever and swelling in the throat was reduced greatly after two treatments. All symptoms were resolved after 3 treatments. EVALUATION Acupuncture and moxibustion are very effective in treating sore throat caused by either Excess or Deficiency. However, due to the broad range of causes that may lead to sore throat, the diagnosis is crucial in treatment. Anything from slight weather shifts or severe respiratory infections may all lead to sore throat. The needle technique greatly influences the results of the treatment. Correct diagnosis is also important before treatment occurs because acupuncture may mask the sore throat symptoms of serious illnesses such as cancer.

416

Sty—Hordeolum

417

Acupuncture and Moxibustion—A Clinical Desk Reference

STY—Hordeolum A sty or hordeolum, is an inflamed swelling of a skin gland on the edge of an eyelid. This inflamed swelling can be very irritating to a patient due to symptoms of pain, itchiness, and irritation. This type of inflammation in TCM, is considered to be an Excess condition involving either Wind-Heat or Damp-Heat. Wind-Heat Invasion Wind-Heat invades the eyelid and the blood circulation is stagnated within the meridians that surround the eyes, causing pain and a burning sensation. Damp-Heat Excessive eating of hot, spicy, or greasy foods impact the Spleen and Stomach functions. Dampness accumulates and turns to Heat, which travels up to the eyes and causes pain and burning. DIAGNOSIS Wind-Heat Invasion Manifestations include slight redness of the eyelid, various levels of pain, severe swelling and indurations of the affected area. There may also be itching and an uncomfortable sensation of there being a foreign object in the eyelid. The tongue is red with a thin white coating, and the pulse is floating and rapid. Damp-Heat in the Spleen and Stomach This type of Stye develops more rapidly with redness and a burning sensation in the eyelid. There is distending pain and swelling with larger indurations present. The tongue is red with a yellow greasy coating and the pulse is rapid and slippery. TREATMENT AND PRESCRIPTIONS Wind-Heat Invasion Treatment Principle: Clear the Heat and Expel the Wind and Damp. Point Prescription: BL-1, BL-2, LV-2, and Tai Yang. Treat once daily for 3 to 5 days. Technique: Insert 1 cun #32 needles perpendicularly in BL-1 and obliquely in BL-2 towards BL-1. Apply a twisting reducing needle technique. Use 1 cun #30 needles for LV-2 and Tai Yang with a lifting and thrusting reducing method. Retain all needles for 30 minutes. Additional points for associated symptoms: Headache: GB-20. Aversion to cold: TW-5.

418

Sty—Hordeolum

Damp-Heat in the Spleen and Stomach Treatment Principle: Clear the Heat and Resolve the Damp. Point Prescription: LI-4, ST-1, ST-2, and SP-9. Technique: Insert 1 cun #32 needles into ST-1 and ST-2 with a twisting reducing needle technique. Insert 1.5 cun #30 needles into LI-4 and SP-9 with a lifting and thrusting reducing method. Retain all needles for 30 minutes. ADJUNCTIVE THERAPIES Ear Acupuncture Points: Eye, Liver, Spleen, and the Superior Tip of the ear. Insert 0.5 cun ear needles obliquely at a 60-degree angle to the skin using a fast twisting needle technique. Retain all needles for 30 minutes. Using a lancet, extract 1 to 3 drops of blood from the tip of the top of the ear, folded forward. Additionally, perform bloodletting at a tiny vein bulge on the back of the ear, if it is present. Treat once daily for 3 treatments as a course. Cupping Treatment area: GV-14. Perform bloodletting on GV-14, and place fire cups on the pricked area for 3 minutes. Treat once daily for 2 days. Pricking Therapy Treatment area: Scapular area. Locate a sesame size, pink colored area on the scapular region contra lateral to the diseased eye (the left scapula treats the right eye). Prick the area once every day for 2 treatments as a course. Plum Blossom Points: Yu Yao, ST-1, ST-2, Qiu Hou, and Tai Yang. Use a plum blossom needle with weak stimulation on Yu Yao, ST-1, ST-2, Qiu Hou, and Tai Yang on the affected side, drawing a small amount of blood on Tai Yang. Treat once every day for 3 treatments as a course.

419

Acupuncture and Moxibustion—A Clinical Desk Reference

TRADITIONAL PRESCRIPTIONS AND TECHNIQUES For a Stye with pain and a burning sensation: Ah Shi points on the upper back. (Zhen Jiu Ju Ying) To reduce the heat in the Tai Yang meridian, let out blood on any tiny red spots on the upper back. For a Stye with more itching then pain: TW-10 and LI-4. (Zhen Jiu Yan Jiu Jing Zhan) Select TW-10 on the healthy side and LI-4 on the diseased side. Insert 1.5 cun #30 needles into both points with a reducing lifting and thrusting technique. Retain the needles for 30 minutes. Treat once every day for 3 treatments as a course. For the beginning stages of a Stye: Tai Yang. (Zhen Jiu Yan Jiu Jing Zhan) Use bloodletting and release 2 to 3 drops of blood from Tai Yang on the side of the diseased eye. Treat once every other day for 2 treatments as a course. For a Stye with pain and a burning sensation: Ah Shi points for the Stye. (Author’s Clinical Experience) Inspect both sides of the upper back from T-7 to T-12, looking for dark red or red colored spots. Usually, 3 to 5 red spots are apparent. Using a three-edged needle, prick the spots and squeeze out blood until no more exudes (possibly 1-2 drops will come out). Treat once every other day for 3 treatments as a course. CASE ANALYSIS A 24 year-old male patient presented in the clinic with the main complaint of a sty for 1 day. The inner canthus was red and swollen. He also had a fever, red eyes, itching and pain in the local area, and increased tearing of the eyes. The tip of the tongue was red with a white thin coating and the pulse was floating and fast. Diagnosis: Stye due to a Wind-Heat Invasion Treatment Principle: Expel the Wind-Heat. Point Prescription: LI-4, TW-8, and a bloodletting technique on the tip of ear. Treat once a day for 2 treatments as a course. Technique: Insert 1.5 cun #30 needles into LI-4 on the diseased side and into TW-8 on the healthy side with a lifting and thrusting reducing needle technique. Retain the needles for 30 minutes. Use a three-edge needle to extract 2 drops of blood from the tip of the ear on the diseased side. Result: After one treatment, the pain and itching was gone and the burning sensation was reduced. All symptoms were resolved after the second treatment. EVALUATION Acupuncture is very effective for treating Stye infections within 2 or 3 treatments. Usually under the correct diagnosis and treatment the Stye will reduce in size and disappear within the first two initial weeks. However, due to the infectious nature of this problem, it is very important to inform the patient to be careful of spreading infection and breakage of the swelling. Good hygiene behaviors should be adapted and followed during treatment. Also in most cases, bloodletting produces better results than regular needle therapy, without any side effects.

420

Tinnitus

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Acupuncture and Moxibustion—A Clinical Desk Reference

TINNITUS Tinnitus is defined as the perception of sound or audio sensations when the environment has no sound. The audio stimulations are usually described as a buzzing, ringing, or a beating tone that is low enough be mistaken yet loud enough to be constantly noticed. In Traditional Chinese Medicine, tinnitus is generally considered to be associated with Qi Stagnation in the Shao Yang meridian or with Kidney Jing deficiency failing to nourish the ear. Stagnation may be caused by Liver and Gallbladder Fire rising up due to severe emotional changes, and may also manifest with a phlegm component. High pitch tinnitus usually appears in deficiency cases in TCM and is related to nervous tinnitus in western medical designations. Low pitch tinnitus often appears in excess cases in TCM and is related to western medicine’s conduction tinnitus. DIAGNOSIS

EXCESS SYNDROMES Wind Heat attacks the Lung Symptoms include a low pitch tinnitus, a reduction in hearing, distention and a stuffy sensation in the ear, a stuffy or runny nose, and cough. The tongue is red with a thin yellow coating and the pulse is floating and fast. Liver Fire Manifestations include an acute onset of loud, thunderous tinnitus associated with dizziness and vertigo, restlessness, distention and achy sensations in the chest and hypochondriac regions, red complexion, red eyes, bitter taste in the mouth, dry throat, constipation, and scanty, yellowish urine. The tongue is red with a yellow coating and the pulse is fast and wiry. Liver Yang Rising Manifestations include tinnitus with a pulsing quality, hearing difficulty, dizziness and blurry vision, red complexion and eyes, weakness and soreness of the low-back and both knees, sore and dry throat, insomnia, and poor memory. The tongue is red with less or no coating and the pulse is thin and fast. Phlegm and Damp stagnation in the Middle Warmer Manifestations include high pitch tinnitus with a blocked sensation in the ear, heaviness sensation in the head and whole body, bloating and distention in the epigastrium and abdomen, poor appetite, loose stool, lassitude, and cough with phlegm. The tongue body is pale and swollen with a white greasy coating. The pulse is slippery. Stagnation of Heat and Phlegm Manifestations include a loud, low pitch tinnitus, a stuffy sensation in the ear, difficulty hearing, a dull heavy headache, fullness and stuffiness in the chest and epigastrium, cough with yellow sputum, dizziness and nausea or vomiting of phlegm. The tongue is red with a yellow greasy coating and the pulse is wiry and slippery. Stagnation of Qi and Blood Manifestations include loud, high pitch tinnitus, pain and distention in the ear, reduced hearing, headache, dizziness, fullness and distention sensation in the chest and hypochondriac regions, restlessness, and ease to anger. The tongue is purple with black dots and the pulse is wiry or choppy. 422

Tinnitus

DEFICIENCY SYNDROMES Deficiency of both Heart and Spleen Symptoms include a stuffiness in the ear with a high pitch tinnitus that is aggravated when fatigued, shortness of breath, no desire to speak, heart palpitations, poor appetite, loose stool, and lassitude. The tongue is pale with a white thin coating and the pulse is thin and deep. Heart Blood Deficiency Symptoms include a continuous high pitch tinnitus aggravated by fatigue, heart palpitations, insomnia with excessive dreaming, and a pale complexion. The tongue is pale with a thin white coating. The pulse is weak. Kidney Yin Deficiency Symptoms include a chronic, continuous high pitch tinnitus, dizziness, blurry vision, weakness and soreness of the low back and knees, insomnia or dream-disturbed sleep, and irregular menstruation. The tongue is red without coating and the pulse is thin and fast. Kidney Yang Deficiency Symptoms include a mild, high pitch tinnitus with stuffiness in the ear, reduced hearing, cold sensation on the whole body and four extremities, edema on the face and legs, impotence, and dribbling of urine. The tongue is pale and swollen with a wet white coating and the pulse is thin and deep. Disharmony between Heart and Kidney Symptoms include a constant high pitch tinnitus worse at night, reduced hearing, insomnia, poor memory, heart palpitation, weakness and soreness of the low back and knees, hot flushes, and night sweats. The tongue is red without coating and the pulse is thin and fast. TREATMENT AND PRESCRIPTIONS Excess Syndrome Treatment Principle: Clear the Liver Fire and Resolve the Phlegm. Point Prescription: TW-17, GB-2, TW-3, and GB-43. The treatment is once every other day for 7 to 10 treatments as a course. Technique: Insert 1.5 cun #30 needles into TW-17 and GB-2 perpendicularly along the ear canal 1 to 1.2 cun deep with twisting even movement technique. Next insert 1 cun #32 needles into TW-3 and GB-43 with reducing needle technique. Retain all the needles for 30 minutes. Additional points for associated symptoms: Liver and Gallbladder Fire: LV-3 and GB-40. Phlegm Heat Stagnation: ST-40 and PC-8. Wind Heat OPI: LI-11, LU-7, and BL-13. Blood Stasis: SP-10, SP-6, and BL-17. Qi Stagnation: LU-5, TW-6, and LV-3.

423

Acupuncture and Moxibustion—A Clinical Desk Reference

Deficiency Syndrome Treatment Principle: Reinforce the Kidney Essence Point Prescription: SI-19, TW-17, BL-23, CV-4, and KI-3. The treatment is twice a week for 7 treatments as a course. Technique: Reinforcing needle technique and moxibustion Insert 1 cun #30 needles into SI-19 and TW-17 perpendicularly, 0.8 cun deep with reinforcing twisting needle technique and with moxa wool on the needle handles for 3 to 5 cones. Next insert 1 cun #32 needles into BL-23, CV-4, and KI-3 with twisting reinforcing needle technique and moxa wool on the needle handles for 3 cones. Additional points for associated symptoms: Qi Deficiency: CV-6, ST-36, and BL-24. Poor sleep: HT-7 and GV-20. Poor digestion: LI-4, ST-36, and CV-12. Night sweating: HT-6 and KI-6. Dizziness and vertigo: GV-20 and BL-20. Blood Deficiency: SP-6, BL-17, BL-18, and BL-20. Heart palpitation: PC-6, CV-15, and Yin Tang. ADJUNCTIVE THERAPIES Ear Acupuncture Points: Sub cortex, Endocrine, Liver, and Kidney. Insert 0.5 cun #32 ear needles into all points obliquely at a 45 to 60-degree angle with fast twisting needle technique until a heat sensation is produced on the ear. Retain all the needles for 1 hour. The clinician may treat only the affected side depending on the patient’s condition or both sides as needed. The treatment is once every other day for 10 treatments as a course. Electro-Acupuncture Points: SI-19 and TW-17. Insert 1.5 cun #30 needles into SI-19 and TW-17 perpendicularly along the ear canal 1 to 1.2 cun deep. Attach the leads to the handle of needles and apply a fast waves for 20 minutes. The treatment is once every other day for 5 treatments as a course. Scalp Acupuncture Treatment zones: Anterior line of the temple, Posterior line of temple, and Middle line of vertex. Insert 1.5 cun #28 needles into these two areas transversely at a 30-degree angle to the skin with fast twisting needle technique for 3 to 5 minutes. Retain the needles for 1 hour during each treatment. The treatment is once every week for 7 treatments as a course.

424

Tinnitus

TRADITIONAL PRESCRIPTIONS AND TECHNIQUES For deficiency type tinnitus: GV-20, LI-4, SI-4, TW-3, SI-3, ST-36, BL-62, and BL-23. (Zhen Jiu Ji Chen) Insert a 1.5 cun #30 needle for GV-20 obliquely towards the back against the meridian flow 1 to 1.2 cun deep with lifting the thrusting reinforcing needle technique. Next insert 1 cun #32 needles for LI-4, SI-4, TW-3, SI-3, ST-36, and BL-62 with twisting even movement needle technique. Retain all the needles for 40 minutes. Then apply direct non-scarring moxibustion on BL-23 for 9 cones in each treatment. The treatment is once every other day for 7 treatments as a course. Additional points for associated symptoms: Heart palpitation and insomnia: BL-15 with moxibustion. For both Excess and Deficiency types of tinnitus: TW-17, TW-7, ST-7, and SI-16. (Zhen Jiu Jia Yi Jing) Insert 1.5 cun #30 needles into all points perpendicularly with twisting even movement needle technique. Retain the needles for 30 minutes. The treatment is once every other day for 7 treatments as a course. For Excess type of tinnitus: Er ling—an extra point located between GB-20 and GB-12. (Zhen Jiu Wen Xian Ji) Supplemental points: TW-17 and SI-19. (Zhen Jiu Wen Xian Ji) Insert a 1 cun #28 needle into Er ling obliquely towards the ear 0.5 cun deep with strong stimulation until the sensation of the needle transfers to the ear. Next insert 1 cun #30 needles into TW-17 and SI-19 perpendicularly, 0.8 cun deep with medium stimulation technique. Retain all needles for 30 minutes. The treatment is once every other day for 7 treatments as a course. For both tinnitus and deafness: GV-23, TW-17, SI-19, BL-23, TW-5, LI-4, and LI-6. (Lei Jing Tu Yi) Apply direct non-scarring moxibustion on GV-23 and TW-17 for 7 cones each treatment. Next insert 1 cun #30 needles into other points with twisting reinforcing needle technique. The treatment is once every other day for 7 treatments as a course. For tinnitus due to Wind Heat: SI-19, LI-4, TW-5, and GB-42. (Author’s Clinical Experience) Insert a 1 cun #30 needle into SI-19 perpendicularly, 0.8 cun deep with twisting reducing needle technique. Next insert 1.5 cun #30 needles into LI-4, TW-5, and GB-42 perpendicularly, 1 cun deep with lifting and thrusting reducing needle technique. Retain all needles for 30 minutes. The treatment is once every other day for 3 treatments as a course. For tinnitus due to Qi Stagnation: TW-17, TW-18, ST-36, GB-42 (Yi Xue Gang Mu) Insert 1.5 cun #30 needles into TW-17 and ST-36 to a depth of 1 cun with twisting reinforcing needle technique. Next insert 1 cun #32 needles for TW-18 and GB-42 with twisting even movement needle technique. Retain all needles for 20 minutes. The treatment is twice a week for 10 treatments as a course.

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Acupuncture and Moxibustion—A Clinical Desk Reference

CASE ANALYSIS A 55 year-old female presented with the main complaint of tinnitus for 5 years. The tinnitus had a soft high pitch sound, which became worse with fatigue and stress. It was particularly loud at night. Associated symptoms included dizziness and vertigo, poor memory, blurry vision, and frequent urination. The tongue was pale with a thin white coating and the pulse was thin and deep. Diagnosis: Tinnitus due to Kidney Jing Deficiency Treatment Principle: Reinforce the Kidney Jing and Warm the Kidney Yang. Point Prescription: TW-17, SI-19, CV-4, GV-4, KI-3, BL-23, and GV-14. Technique: Reinforcing needle technique and moxibustion The treatment is once every other day for 7 treatments as a course. Result: After one course of treatment the patient’s tinnitus was reduced, particularly at night. She could sleep well. The tinnitus was totally resolved after 3 courses of treatment. EVALUATION Acupuncture and moxibustion are effective for treating tinnitus. The accuracy of diagnosis will be directly related to the result of the therapy. The nature of tinnitus is hard to determine because symptoms of phantom sound may occur in daily life due to many other reasons other than a serious disorder. In treating tinnitus with acupuncture, local points will usually be the main points and require deep insertion technique. Distal points will work best with superficial insertion and moving Qi technique. Acupuncture and moxibustion are to be used only as a supplemental therapy for ear anatomy structure and auditory nerve damage.

426

Amenorrhea

427

Acupuncture and Moxibustion—A Clinical Desk Reference

CHAPTER III: O.B.G.Y.N DISORDERS

AMENORRHEA The term Amenorrhea refers to both primary Amenorrhea and secondary Amenorrhea. The former applies to those who have never menstruated until they are 18 years old, while the latter refers to those whose menses have increased for over three months after the formation of menstrual cycle. TCM thinks most of the time amenorrhea is caused by: Insufficiency of the Liver and Kidney Innate Kidney and Liver Deficiency can not fill up the Chong and Ren meridians to begin menstruation, or by the overly tired due to excessive labor, or long term and/or chronic diseases leading to Kidney Essence and Liver Blood Deficiency. Deficiency Blood and Qi Prolonged Blood and Qi Deficiency could be caused by many reasons such as: being consistently overly tired, bad emotional stimulation, or other long-term severe diseases. As the result the body’s weakness the Chong and Ren meridian will experience this deficiency. Yin Deficiency Any Yin Deficient body constitutions or long-term intake of dry hot herbs will damage the Interior Yin fluids causing amenorrhea. Qi and Blood Stagnation Stagnation of Qi and Blood in the Chong and Ren meridians obstructs the flow of Blood to the uterus. Most of the time this kind of stagnation is due to negative emotional stimulation and Liver Qi Stagnation. Damp Stagnation Sometimes amenorrhea can be caused by stagnation of Dampness and Phlegm. It’s commonly seen in overweight patients due to over-intake of greasy or indigestion causing foods. DIAGNOSIS

Stagnation type Stagnation of Qi and Blood Symptoms are primary amenorrhea accompanied by fidgeting and ease to anger, feeling of fullness in the chest and hypochondria, distending pain in the lower abdomen, ecchymoses along the tongue edges, and a deep and choppy pulse. Stagnation of Cold and Blood The predominate symptoms in this case are cold extremities and aversion to cold, cold and pain in the lower abdomen, preference for warmth, along with a tongue that is pale or dark with a thin white coating and deep slow pulse. Stagnation of Phlegm and Blood The predominate symptoms of this case are a swollen body, fullness and stuffy sensation in the chest and hypochondria, lassitude, more uterine discharge, a tongue with greasy coating, and a slippery pulse.

428

Amenorrhea

Deficiency type Deficiency of the Liver and Kidney Symptoms usually appear with primary amenorrhea in a girl over 18 years old, or delayed menstrual cycle with scanty menstruation leading gradually to amenorrhea. Accompanied signs are constitutional debility, lassitude in loins and legs, dizziness, tinnitus, hot flushes and night sweating, reddish tongue with little fur, and a deep and thready pulse. Deficiency of the Heart and Spleen Gradual delay of menstruation with very little blood which is thin and reddish, leading to amenorrhea and accompanied by dizziness, heart palpitations, shortness of breath, fatigue, poor appetite, loose stool, insomnia, a pale tongue body with a thin coating, and a thin and weak pulse. Blood Deficiency Amenorrhea accompanied by emaciation and pale complexion, dizziness, blurred vision, lusterless hair, a pale tongue with very little coating, and deep and moderate pulse. TREATMENT AND PRESCRIPTIONS Insufficient Blood Treatment Principle: Reinforce the Qi and Build up the Blood. Point Prescription: BL-18, BL-20, BL-17, BL-23, CV-4, ST-36, and SP-6. Treat once every other day, 10 treatments as a course. Technique: Insert 1.5 cun #30 needles into CV-4, ST-36, and SP-6 with twisting reinforcing needle technique and apply moxa wool on the handle of the needles for 3 cones. Then insert 1 cun #32 needles into BL-17, BL-18, BL-20, and BL-23 with lifting and thrusting reinforcing needle technique. Retain the needle and applying moxa wool on the handle of needles for 3 cones. Additional points for treatment of associated symptoms: Insufficiency of the Liver and Kidney: BL-43, KI-2, GV-4, and LV-8. Insufficiency of the Heart and Spleen: PC-6, CV-12, and SP-9. Blood Stagnation Treatment Principle: Soothe the Liver and Regulate Qi; Reinforce the Spleen and Resolve Phlegm. Point Prescription: CV-3, SP-8, LI-4, SP-6, LV-3, and ST-40. Treat twice a week for 7 treatments as a course. Technique: Insert a 1.5 cun or a 2 cun #32 needle into CV-3 perpendicularly, 1 to 1.5 cun deep with twisting reducing needle technique and 1 cun #30 needles into LV-3, LI-1, SP-8, SP-6, and ST-40 with twisting reducing needle technique. Retain the needles for 20 minutes. Additional points for treatment of associated symptoms: Qi Stagnation: CV-6 and SP-14. Cold Stagnation: CV-4 with moxibustion. Phlegm Stagnation: BL-32.

429

Acupuncture and Moxibustion—A Clinical Desk Reference

ADJUNCTIVE THERAPIES Ear Acupuncture Points: Zi Gong, Endocrine, Sub cortex, Liver, Kidney, Spleen and Stomach. Selecting 3 or 4 points in each treatment with 0.5 cun #32 ear needles, insert the needles obliquely at a 30degree angle with fast twisting needle technique. Retain the needles for 40 minutes. Treat once every other day, 10 treatments as a course. Plum Blossom Treatment areas: •

Governing Vessel: from GV-2 to GV-5.

•

Bladder meridian: on the low back and sacrum area.

•

Spleen meridian: from SP-6 to SP-8.

Apply medium-level stimulation with plum blossom needles on each meridian for 3 minutes. Treat once every other day, 7 treatments as a course. Moxibustion Points: CV-4 and Zi Gong. Apply indirect moxibustion with ginger on CV-4 and Zi Gong for 5 cones to treat amenorrhea due to stagnation of Cold and Blood. Treat twice a week, 7 treatments as a course. Electro-stimulation Points: BL-32, ST-28, and SP-10. Insert 3 cun #30 needles into BL-32 perpendicularly, 2 cun deep with reducing twisting needle technique and add electro-stimulation to the needles with continuous waves for 20 minutes. Then insert 2 or 3 cun #32 needles into ST-28 perpendicularly, 1.5 cun deep to get the Qi and 1.5 cun #32 needles into SP-10 perpendicularly, 1.2 cun deep with twisting disperse technique. The negative side of the wires goes on SP10 and the positive on ST-28 with continued waves for 15 minutes. Treat once every other day, 7 treatments as a course.

430

Amenorrhea

TRADITIONAL PRESCRIPTIONS AND TECHNIQUE For amenorrhea by stagnation of Blood: CV-1, KI-6, and GB-26. (Zhen Jiu Jia Yi Jing) Insert 1.5 cun #32 needle into CV-1 perpendicularly, 1 cun deep with twisting even movement technique and 1 cun #30 needles for KI-6 and GB-26 with twisting reducing needle technique. Retain all needles for 30 minutes. Treat twice a week, 7 treatments as a course. For amenorrhea by Stagnation of Blood or Deficiency of Blood: LI-11, TW-6, ST-36, and SP-6. (Yi Xue Gang Mu) Insert 1.5 cun #30 needles into LI-11 and SP-6 with twisting reducing needle technique and 1.5 cun #32 needles into ST-36 and TW-6 with lifting and thrusting reinforcing needle technique. Retain all needles for 30 minutes. Treat once every other day, 7 treatments as a course. For amenorrhea by deficiency of Blood: GV-2 and KI-6. (Shen Jiu Jing Lun) Apply direct non-scarring moxibustion on GV-2 and KI-6 for 9 cones. Treat twice a week, 5 treatments as a course. For amenorrhea by stagnation of the Phlegm and Blood: LI-4, CV-5, SP-10, and ST-30. (Zhen Jiu Ji Chen) Insert 1.5 cun #32 needles into CV-5, SP-10, and ST-30 perpendicularly, 1 to 1.2 cun deep with twisting reducing needle technique and 1 cun #32 needles into LI-4 with twisting reducing needle technique. Retain all needles for 30 minutes. Treat once every other day, 7 treatments as a course For Amenorrhea with shallow complexion, vomiting, and Blood Deficiency: SP-6, LI-11, TW-5, and ST-36. (Zhen Jiu Ju Ying. Za Bing Ge) Insert 1.5 cun #32 needles into SP-6 and LI-11 perpendicularly, 1 to 1.2 cun deep with lifting and thrusting reducing needle technique, and 1.5 cun #32 needles into ST-36 and TW-5 with twisting reinforcing needle technique. Retain all needles for 30 minutes. Treat twice a week for 7 treatments as a course. For Amenorrhea due to Phlegm Stagnation: CV-3, SP-9, BL-30, BL-20, GB-26, and SP-4. (Bai Zhen Fu) Insert 3 cun #30 needles into BL-30, 1.5 to 2 cun deep with lifting and thrusting reducing needle technique and 1.5 cun #32 needles for BL-20 with twisting reinforcing needle technique. Retain the needles for 10 minutes. Insert 1.5 cun #32 needles into CV-3, SP-l9, and GB-26 perpendicularly, 1 cun deep with twisting even movement technique, and 1 cun #32 needles into SP-4 with twisting reinforcing needle technique. Retain all needles for 20 minutes Treat twice a week, 7 treatments as a course. For Amenorrhea due to stagnation of Blood: LI-4, SP-6, and CV-4. (Zhen Jiu Jia Yi Jing) Insert 1.5 cun #30 needles into LI-4 and SP-6 with twisting reducing needle technique and 3 cun #32 needle into CV-4 perpendicularly, 2.5 cun deep with twisting reinforcing needle technique and apply moxa wool on the handle of needle for 3 cones. Treat once every other day for 5 treatments as a course.

431

Acupuncture and Moxibustion—A Clinical Desk Reference

For amenorrhea due to deficiency of the Liver and Kidney: CV-4, BL-23, BL-32, GV-4, GB-26, SP-8, BL-23, KI-15, and SP-6. (Author’s Clinical Experience) Insert 1.5 or 2 cun 30 # needles into BL-32 perpendicularly into the patient, 1 to 1.5 cun deep with rubbing technique, until the sensation travels to the front of the body. Insert 1.5 cun #32 needles into GV-4 and BL-23 with twisting reinforcing needle technique. Apply moxa wool on the handle of the needles for 2 cones. Insert 2 cun #32 needles into CV-4 perpendicularly with twisting reinforcing needle technique, and 1 cun #34 needles into GB-26, SP-8, KI-15, and SP-8 perpendicularly with twisting reinforcing needle technique. Apply moxa wool on the handle of needle for 3 cones on CV-4. Retain all needles for 30 minutes. Treat once a week, 10 treatments as a course. CASE ANALYSIS A 28-year-old female patient with the main complaint of amenorrhea for 7 months enters the clinic. Usually the menstruation was delayed until it eventually stopped. Associated signs were lassitude, weakness and a sore sensation in the low back and both legs, poor appetite, dizziness and vertigo, tendency for anger, thirst, and constipation. The tongue was pale with a thin coating and the pulse was deep and thready. Diagnosis: Secondary amenorrhea due to Kidney and Liver Deficiency Treatment Principle: Reinforce the Kidney and Liver; Regulate the Chong and Ren meridians. Point Prescription: BL-17, BL-18, BL-20, BL-23, CV-4, SP-6, and ST-25. Treat once every other day for 7 treatments as a course. Technique: Insert 1 cun #32 needles into BL-17, BL-18, BL-20, and BL-23 with twisting reinforcing needle technique, and apply moxa wool on the handle of the needles for 3 cones. Insert 1.5 cun #32 needles into CV-4, SP-6, and ST25 with lifting and thrusting reinforcing needle technique. Retain all needles for 20 minutes. Apply moxa wool on handle of CV-4 for 3 cones. Result: The period returned after 6 treatments. In total, 2 courses of treatment were need for her to return to normal. EVALUATION Amenorrhea could be caused by many factors, such as: anemia, TB, or other heart and kidney diseases. A correct TCM diagnosis is very important before beginning the treatment in order to get rid of the cause, and also the ability to understand the difference between early pregnancy and amenorrhea. Acupuncture and moxibustion are very effective for treating secondary functional amenorrhea.

432

Dysmenorrhea

433

Acupuncture and Moxibustion—A Clinical Desk Reference

DYSMENORRHEA Dysmenorrhea, as described by TCM, refers to the pain in the lower abdomen and in the lower back that women have during or after menstrual periods. The patients can sometimes faint as a result of these pains in severe cases. It has been customary to classify cases of dysmenorrhea into two main groups: primary and functional. Primary dysmenorrhea refers to a situation that is not caused by organic diseases and secondary dysmenorrhea refers to a situation caused by organic diseases in the reproductive system, including some western medicine diseases such as endometriosis, ante version of the uterus, retroversion of the uterus, pelvic inflammation, and other uterine diseases. In the TCM clinic, it may be caused by: Qi and Blood Stagnation Pain caused by stagnation of Qi and Blood, especially in the Ren Mai and Chong Mai. Patients could have long-term distressing emotional stimulation, which can cause Liver Qi stagnation as well. Cold Pathogenic Influence induces stagnation in the uterus Most of the Cold pathogens come from an External Cold or excessive eating of frozen foods during the period, making the blood stagnate in the uterus and causing pain. Damp-Heat pouring into the Lower Warmer Interior Damp-Heat usually originates from improper food intake or a Damp-Heat Pathogenic Influence and travels downward into the Ren and Chong meridians, stagnating the blood circulation in the uterus and causing pain. Qi and Blood Deficiency There is an empty “Sea of Blood” in the Ren and Chong meridians due to deficiency of both Blood and Qi that could be caused by long-term or chronic diseases or a weak body constitution. As a result, it is hard to move the Blood before or during menstruation. Liver and Kidney Deficiency Insufficiency of the Chong and Ren meridians is often caused by an innate Kidney Qi Deficiency or by over exertion in both life and labor. As a result, the Blood and Essence of the Kidney cannot fill the uterus, and it causes pain. DIAGNOSIS Stagnation of Cold and Dampness Symptoms include distending pain in the lower abdomen before or during menstruation, which can be relieved by warmth but worsened by pressure. Associated signs are a painful sensation in the lower back and spinal column, and a scanty menstrual flow that is clotted and dark in color. The tongue is pale with a white and greasy coating and the pulse is deep and tense. Blood Stasis due to Stagnation of the Qi Symptoms include distending and throbbing pain in the lower abdomen one or two days before or during menstruation that is associated with a full sensation in the chest, breast, and hypochondriac region, an uneven menstrual flow with dark, purple blood clots, that is relieved after the clots are expelled. There is ecchymoses on the tongue body and the pulse is wiry, choppy, and deep. 434

Dysmenorrhea

Insufficiency of the Liver and Kidney Symptoms include a vague pain in the lower abdomen for 1 or 2 days before, during or even after menstruation with pressure relieving it. The menstrual flow is scanty with reddish, thin blood, accompanied by a lack of vitality and asthenia, dizziness, tinnitus, a pale complexion, and a sore or achy sensation in the low back. The tongue is pale with little or no coating and the pulse is thin and deep. TREATMENT AND PRESCRIPTION Stagnation due to Cold and Dampness Treatment Principle: Warm the Cold, Move the Damp and Release the pain. Point Prescription: CV-3, ST-28, and SP-8. Treat once every other day for 5 treatments as a course, starting a week before the period. Technique: Insert 1.5 cun #30 needles into SP-8 perpendicularly, 1 cun deep with a twisting reducing needle technique until the pain sensation decreased. Insert 2 or 3 cun #30 needles into CV-3 and ST-28 with a lifting the thrusting even movement technique. Apply moxa wool to the handles of the needles for 5 cones. Additional points for other associated symptoms: Severe pain: BL-32 and ST-29. Pain related to the lower back: BL-23 and GV-4. Blood Stasis due to Stagnation of the Qi Treatment Principle: Soothe the Liver and Regulate the Qi and menstruation. Point Prescription: CV-6, LV-3, and SP-6. Treat once every other day for 5 treatments as a course, starting a week before the period. Technique: Insert 1 cun #30 needles into LV-3 and SP-6 perpendicularly, 0.5 to 0.8 cun deep with a twisting reducing needle technique. Insert 1.5 or 2 cun #32 needle into CV-6 with a twisting even movement needle technique, until the sensation of the needle spreads around CV-6. Apply moxa wool to the handles of the needle for 3 cones. Additional points for other associated symptoms: Bloated abdominal region: CV-6, KI-13, and SP-8. Hypochondriac pain: GB-34 and GB-38. Stuffy sensation in the chest: PC-6. Insufficiency of the Liver and Kidney Treatment Principle: Reinforce the Kidney and Liver and Regulate menstruation. Point Prescription: BL-18, BL-23, CV-4, ST-36, and KI-6. Treat once every other day for 7 treatments as a course, starting the first day of the period. Technique: Insert 1.5 cun #32 needles into BL-18 and BL-23 perpendicularly, 1 cun deep with a twisting reinforcing needle technique, and apply moxa wool to the handles of the needles for 5 cones. Insert 1 cun #32 needles into KI6 and ST-36 with a twisting reinforcing needle technique and 1.5 cun #32 needle into CV-4 with a twisting reinforcing needle technique. Apply moxa wool to the handles of the needles for 3 cones. Additional points for other associated symptoms: Dizziness and ringing ear: GB-39 and KI-3. Lower abdominal pain: KI-12 and Zi Gong. 435

Acupuncture and Moxibustion—A Clinical Desk Reference

ADJUNCTIVE THERAPIES Gua Sha For Dysmenorrhea due to stagnation of Qi and Blood: Treatment area: low back and sacrum. Apply Gua Sha technique on the lower back and sacrum until purple or black dots appear (Sha). Treat once in the first day of the period. Plum-Blossom Treatment area: Inside of the tibia bone from SP-6 to SP-9 and the low back and sacrum from L-4 to S-5. Apply medium stimulation of the plum blossom needle technique 2 to 3 minutes from SP-6 to SP-9 and strong stimulation for 1 or 2 minutes from L-4 to S-5. Apply a fire cup between L-5 and S-1 for 2 minutes after the plum blossom needle treatment. Treat once a week, starting the first day of the period. Bloodletting For Dysmenorrhea due to stagnation of Qi and Blood: Treatment area: LV-1, GB-44, and purple or black dots on the sacrum. Palpate from L-5 to S-1, looking for purple or black dots, and apply a bloodletting technique on it to squeeze out 1 to 2 drops of blood. Treat once every other day, 2 treatments as a course, starting the first day of the period. Scalp Acupuncture Treatment zones: Lateral line 3 of the forehead, and Middle line of the vertex. Insert 1.5 cun #30 needles into these lines perpendicularly, 1 cun deep with a lifting Qi technique. Retain all needles for 1 hour. Treat once every other day for 2 treatments as a course. Moxibustion Moxa-pole: CV-4 and SP-6. Apply moxa-pole on CV-4 and SP-6 when the pain starts during menstruation for 20 minutes or until the pain decreases. Treat once daily, until the period finished. Indirect moxibustion: CV-4 and Zi Gong. Apply indirect moxibustion with ginger on CV-4 and Zi Gong for 7 cones. Treat once every other day, starting 3 to 5 days before the period, 5 treatments as a course. Direct moxibustion: SP-4, LV-1, and SP-8. Apply direct non-scarring moxibustion on SP-4, LV-1, and SP-8 for 9 cones. Treat once daily for 7 treatments as a course, starting the first day of menstruation.

436

Dysmenorrhea

Ear Acupuncture Points: Zi Gong, Endocrine, Sympathetic, and Kidney. Insert 0.5 cun #32 ear needles into these points with a fast twisting needle technique until the ear feels a warm sensation. Retain the needles for 40 minutes. Treat once every other day for 5 treatments as a course, starting the first day of the period. Cupping Treatment area: BL-32, L-5 and below, and CV-8. Apply fire cups on these points for 5 minutes. Treat once daily for 5 treatments as a course, starting the first day of the period. TRADITIONAL PRESCRIPTIONS AND TECHNIQUES For treatment of Dysmenorrhea with distention and pain in the lower abdominal region that travels to the genitals, the back, and both sides of the hip area: ST-28. (Zhen Jiu Jia Yi Jing) Insert 1.5 or 2 cun #32 needles into ST-28 perpendicularly, 1.2 to 1.5 cun deep with a twisting reducing needle technique and apply moxa wool to the handles of the needles for 5 cones. Treat once every other day for 5 treatments as a course, starting when the pain comes. For Dysmenorrhea during the period accompanied by dizziness: KI-6, GB-35, ST-44, and LI-4. (Zhen Jiu Da Cheng) Insert 1 cun #32 needles into KI-6 perpendicularly, 0.3 cun deep with a twisting reinforcing needle technique and let the sensation of the needle travel up the leg. Insert 1 cun #30 needles into ST-44, GB-35, and LI-4 with a twisting reducing needle technique. Retain all needles for 20 minutes. Treat once every other day for 5 treatments as a course, starting the first day of the period. For Dysmenorrhea with dizziness and a headache: ST-44. (Shen Jiu Jing Lun) Apply direct non-scarring moxibustion on ST-44 for 11 cones. Treat once daily, 3 treatments as a course. For Dysmenorrhea from stagnation of Qi and Blood: PC-6, SP-4, SP-6, and ST-29. (Shan Xi Zhong Yi) Insert 1 cun #32 needles into PC-6 and SP-4 with a twisting even movement needle technique, and 1.5 cun #30 needles into SP-6 and ST-29 with a lifting and thrusting reducing needle technique. Retain all needles for 30 minutes. Treat once daily during the pain times 3 treatments as a course. For Dysmenorrhea due to stagnation of the Qi and Blood: SP-6, CV-3, SP-10, BL-23, GB-26, GV-4, ST-36, and LV-3. (Author’s Clinical Experience) Insert a 2 cun #32 needle into CV-3 perpendicularly, 1.5 cun deep with a twisting reducing needle technique and apply moxa wool to the handles of the needles for 3 cones. Insert 1 cun #30 needles into SP-6 and LV3 with a twisting reinforcing needle technique, and 1.5 cun #30 needles into ST-36, SP-10, and GB-26 with a twisting even movement needle technique. Retain all needles for 20 minutes. Insert 1.5 cun #30 needles into BL-23 and GV-4 perpendicularly, 1 cun deep with a lifting and thrusting reinforcing needle technique, and apply moxa wool to the handles of the needles for 3 cones. Treat once daily, 3 treatments as a course; starting the first day pain comes. For Dysmenorrhea with severe pain: BL-32. (Author’s Clinical Experience) Insert 3 cun #30 needles into BL-32 perpendicularly, 2 to 2.5 cun deep (it depends on the patient’s size) with a twisting reducing needle technique until the Qi sensation travels to the front of the lower abdomen. Apply an electro machine from one BL-32 to another with slow -fast waves for 20 minutes. 437

Acupuncture and Moxibustion—A Clinical Desk Reference

Treat once daily for 3 treatments as a course, starting the first day pain comes. For Dysmenorrhea from stagnation of the Qi: CV-3, BL-32, and SP-8. (Author’s Clinical Experience) Insert 2 or 3 cun #30 needles into BL-32 perpendicularly, 2 cun deep with a twisting reducing needle technique and apply moxa wool to the handles of the needles for 3 cones. Insert 1.5 cun #32 needle into CV-3 and SP-8 with a lifting and thrusting reducing needle technique and apply moxa wool to the handles of the needles for 3 cones. Treat once every other day for 5 treatments as a course, starting a week before the period. For Dysmenorrhea by stagnation of Qi and Blood: Below L-5. (Author’s Clinical Experience) Insert 1.5 cun or 2 cun #30 needle into the space below L-5—an extra point named: Shi Qi Zhui Xia, perpendicularly, 1.2 to 1.5 cun deep with a twisting needle technique for 1 or 2 minutes. Retain the needle for 40 minutes. Treat once daily for 3 treatments as a course. CASE ANALYSIS A 25 year-old female patient had a main complaint of dysmenorrhea for 4 years. Her menstrual flow was very uneven and scanty with dark and purple blood clots. It was associated with bloating, a painful sensation in the chest, breast and hypochondriac region, sighing, belching, nausea, and vomiting sometimes from the severity of the pain. The tongue was red with ecchymoses, and the pulse was wiry and choppy. Treatment Principle: Move the Qi and Blood, Regulate the menstruation and Relieve the pain. Point Prescription: PC-6, SP-8, SP-6, CV-3, and LV-3. Treat once daily starting with the first day the pain comes, for 5 treatments as a course. Technique: Insert a 1.5 cun #32 needle into CV-3 with a lifting and thrusting reducing needle technique, and apply moxa wool to the handle of the needle for 3 cones. Insert 1 cun #30 needles into PC-6, SP-8, SP-6, and LV-3 with a twisting reducing needle technique. Retain all needles for 30 minutes. Result: After 2 courses of treatment, the dysmenorrhea was gone and it never returned. EVALUATION Acupuncture and moxibustion is very effective for the treatment of dysmenorrhea. A correct diagnosis, according to TCM theory, will help practitioners make a correct point prescription. It is helpful to understand some difficult and dangerous diseases, such as cancer and severe uterine infections that may also cause similar symptoms. The best treatment time is either a week before or a week after menstruation, which will help to move the Qi and Blood, get rid of stagnation, and relieve the pain. During the menstruation, patients should avoid stressful emotional stimulation and overwork, should keep the low abdomen warm, and not drink or eat frozen food or water.

438

Eclampsia

439

Acupuncture and Moxibustion—A Clinical Desk Reference

ECLAMPSIA Women during the third trimester of pregnancy, before or after delivery, usually experience vertigo, syncope, tetany, and general rigidity with superduction. The collection of symptoms in TCM is called Eclampsia. The disorder pertains to the categories of Ren Shen Xian Zheng (Eclampsia) in TCM, believed to be caused by Liver Yang Rising and water retention during pregnancy. Liver and Kidney Yin Deficiency Generally pregnant women in the middle of later stage of pregnancy with Yin Deficient body constitutions, and Interior Yang that easily rises are the patients who most frequently experience eclampsia. Blood Deficiency During pregnancy most of the Blood goes to nourish the fetus, and the lack of Blood supply to the Liver causes Liver Wind to stir due to the Blood Deficiency. DIAGNOSIS Up stirring of Liver Wind During the third trimester of pregnancy the presenting symptoms in this case are flush in the face, palpitations, irritability, sudden onset of convulsion or coma in severe cases, and a red tongue with a thin yellow coating, along with a wiry, slippery and rapid pulse. Mental disturbance due to Phlegm-Fire In the third trimester of pregnancy, or during delivery, the patient suddenly goes into a coma, convulsions, with coarse breathing and wheezing. The tongue is red with a yellow and greasy coating, and the pulse is wiry and slippery. TREATMENT AND PRESCRIPTIONS Up stirring of Liver Wind Treatment Principle: Nourish the Yin and Blood and Subdue the Liver Yang. Point Prescription: GV-20, GB-20, PC-6, LV-3, SP-6, and KI-3. Treat just in case. Technique: Insert 1 cun #30 needles into LV-3, KI-3, PC-6, and SP-6 perpendicularly, 0.5 to 0.8 cun deep with twisting even movement needle technique, and 1.5 cun #32 needles into GV-20 and GB-20 with lifting and thrusting reducing needle technique. Retain all needles for 20 minutes. Additional points for other associated symptoms: Unconsciousness: GV-26 and KI-1. Clutch jaw: ST-6 and ST-7. Convolution and tics: GB-34 and LV-8.

440

Eclampsia

Mental disturbance due to Phlegm-Fire Treatment Principle: Clear the Shen and Resolve Phlegm. Point Prescription: GV-14, HT-7, PC-6, SP-9, ST-40, LI-11, and LI-4. Treat just in case. Technique: Insert 1.5 cun #30 needle into GV-14 perpendicularly, 1 to 1.2 cun deep with twisting reducing needle technique until the sensation of the Qi travels downward along the spinal column, then remove the needle. Insert 1.5 cun #30 needles into SP-9, ST-40, LI-11, and LI-4 perpendicularly, 1 cun deep with twisting reducing needle technique, and 1 cun #32 needles into HT-7 and PC-6 perpendicularly with twisting even movement needle technique. Retain all needles for 30 minutes. Additional points for other associated symptoms: Dizziness and vertigo: Si Shen Cong and Yin Tang. Unconsciousness: GV-26 and the Four Gates. Stagnation of Phlegm in the throat and chest: CV-13 and CV-22. ADJUNCTIVE THERAPIES Ear Acupuncture Points: Liver, Kidney Shen Men, Sub cortex, and Occiput. Insert 0.5 cun #32 ear needles into these points obliquely, 0.3 cun deep at a 45-degree angle with fast twisting needle technique. Repeat the process every 5 minutes during 40 minutes needle retention. Treat once daily for 3 treatments as a course. (As prevention treatment) Electro Acupuncture Points: LI-11, LI-4, SP-6, and SP-4. Insert 1.5 cun #30 needles into LI-11 and LI-4 perpendicularly, 1 cun deep with twisting reducing needle technique, and 1.5 cun #32 needles into SP-6 and SP-4 with twisting even movement needle technique. Apply Electro wires on these points, the negative side of the wire on LI-11 and SP-6 with irregular waves (fast-slow wave) for 40 minutes. Treat just in case. Scalp Acupuncture Treatment zones: Middle line of vertex, Lateral line 1 of vertex, Middle line of forehead, Lateral line 3 of forehead. Insert 1.5 cun #30 needles into these lines transversely, 1 cun deep at a 30-degree angle with lifting and thrusting reducing needle technique. Repeat this process every 10 minutes during 1 hour of needle retention. Treat just in case. Nose Acupuncture Points: Heart, Lung, Kidney, and Gallbladder. Insert 0.5 cun #34 needles into these points perpendicularly, 0.3 cun deep with fast twisting needle technique. Retain all needles for 30 minutes. Treat just in case. 441

Acupuncture and Moxibustion—A Clinical Desk Reference

Foot Acupuncture Points: Liver, Li Nei Ting, Kidney, Stomach, and Heart. Insert 0.5 cun #32 needle into these points perpendicularly, 0.3 cun deep with twisting reducing needle technique. Retain all needles for 30 minutes. Treat just for in case. TRADITIONAL PRESCRIPTIONS AND TECHNIQUES For Eclampsia due to accumulation of Damp-Heat: GV-20, Yin Tang, GV-26, PC-6, LV-3, ST-40, SP-6, and LI-11. (Shen Yin Jing) Insert 1 cun #32 needles into Yin Tang and GV-26 with twisting reducing needle technique, and 1 cun #30 needles into LV-3, SP-6, and PC-6 perpendicularly, 0.8 cun deep with twisting reducing needle technique. Insert 1.5 cun #32 needles for ST-40 and LI-11 with lifting the thrusting reducing needle technique. Retain all needles for 40 minutes. Treat just for in case. For Eclampsia in coma and convulsion: GB-39 and KI-3. (Yi Xue Ru Men) Insert 1 cun #30 needles into KI-3 with the Yin Ci technique (one of the ancient needle techniques—insert the needles into both sides of the body at the same time with two hands) with a twisting reducing needle technique. Insert 1.5 cun #30 needles into GB-39 perpendicularly, 1 cun deep with twisting even movement needle technique. Repeat this process every 5 minutes during 40 minutes needle retention. Treat just for incase. For Eclampsia in coma and convulsion: Si Shen Cong, GV-20, PC-6, and GB-20. (Zhen Jiu Chu Fang Ji Jing) Insert 1.5 cun #30 needles into Si Shen Cong and GV-20 transversely, 1 cun deep at a 30-degree angle with fast twisting needle technique, and 1 cun #32 needles into PC-6 perpendicularly, 0.7 cun deep with twisting reducing needle technique. Insert 1.5 cun #32 needles into GB-20 perpendicularly, 1 cun deep towards nose direction with lifting and thrusting reducing needle technique. Retain all needles for 1 hour. Treat just for in case. For Eclampsia before parturient period: LI-4, SP-6, LI-11, GV-20, and Yin Tang. (Author’s Clinical Experience) Insert 1.5 cun #30 needle into GV-20 transversely, 1 cun deep with lifting and thrusting reducing needle technique, and a 1 cun #32 needle into Yin Tang obliquely, 0.5 cun deep downwards with twisting reducing needle technique. Insert 1.5 cun #32 needles into LI-4 and SP-6 perpendicularly, 1 cun deep with twisting reducing needle technique. Repeat this process every 3 minutes during 40 minutes of needle retention. Treat just for in case. For Eclampsia due to stirring up of Liver Fire: LV-3, LI-4, LI-11, SP-9, and GV-20. (Author’s Clinical Experience) Insert a 1.5 cun #30 needle into GV-20 transversely, 1.2 cun deep at a 30-degree angle with lifting and thrusting reducing needle technique, and 1.5 cun #32 needles into LI-11 and SP-9 perpendicularly, 1.2 cun deep with twisting reducing needle technique. Insert 1 cun #30 needles into LI-4 and LV-3 perpendicularly, 0.7 cun deep with lifting and thrusting reducing needle technique. Repeat this process every 5 minutes during the 30 minutes of needle retention. Treat just for in case.

442

Eclampsia

CASE ANALYSIS A 36-year-old female patient 5 months pregnant presented with eclampsia on March 5th, 1989. She had suddenly fallen into a coma and that was associated with convulsions for 4 minutes. On March 6th she came to the hospital still with nausea, dizziness, tinnitus, rebellious Qi in the epigastric area, and poor sleep. The tongue was red with a yellow coating and pulse was wiry and fast. Diagnosis: Eclampsia due to up stirring of Liver Wind. Treatment Principle: Calm the Liver and Subdue the Wind. Point Prescription: Si Shen Cong, GV-20, LV-3, PC-6, and KI-3. Treat once every week for 2 treatments as a course. Technique: Insert 1 cun #30 needles into Si Shen Cong and GV-20 obliquely, 0.7 cun deep at a 45-degree angle with fast twisting reducing needle technique, and 1 cun #32 needles into LV-3 and KI-3 with twisting reinforcing needle technique. Insert 1.5 cun #32 needles into PC-6 and SP-6 with twisting even movement needle technique. Repeat the process every 5 minutes during 40 minutes of needle retention. Result: The symptoms of eclampsia were resolved after 10 minutes of needle insertion. Seven days later she returned with a little dizziness and got another treatment. She had a healthy boy a little while after. EVALUATION Eclampsia usually is caused by hypertension and edema during pregnancy, and is also associated with lack of good care and treatment during the period of pregnancy. Acupuncture is very effective for in the treatment of eclampsia and is particularly effective to relieve the symptoms without any side effects. However, it is highly recommended for the patient to be in a hospital setting in order to prevent other dangerous symptoms from occurring, such as heart attack or stroke.

443

Acupuncture and Moxibustion—A Clinical Desk Reference

HYPOGALACTIA Hypogalactia refers to very little or no milk secretions of the mother after giving birth. This disorder can be disadvantageous for the newborn child, as there are many nutrients as well as antibiotics contained within. Although this is not a terribly common disorder, it does appear quiet frequently in older women. TCM regards this disorder as usually caused by Blood Deficiency after labor or by stagnation of Liver Qi. Blood Deficiency As TCM understands, the milk is transferred from Blood, so that is why any kind of Blood Deficiency will cause lack of milk, particularly when the patient with a Spleen and Stomach Deficiency cannot produce more Blood or lost a lot blood during labor. Liver Qi Stagnation Unhealthy emotional stimulation will cause stagnation of Liver Qi, because Liver controls the circulation of the Qi, and the Qi cannot transfer milk from the Blood. DIAGNOSIS Deficiency of Qi and Blood Signs: postpartum hypogalactia or agalactia, thin and clear milk, soft breasts without a feeling of fullness, dull complexion, lack of vitality, poor appetite, and a pale tongue with little coating, along with a weak and thin pulse. Stagnation of the Liver Qi Signs: postpartum hypogalactia or agalactia in severe cases, fullness and oppressed feeling in the chest and hypochondriac region, emotional depression, mild fever, anorexia, and a normal tongue with a thin and yellow coating, along with a wiry, thin, and fast pulse. TREATMENT AND PRESCRIPTIONS Deficiency of Qi and Blood Treatment Principle: Reinforce Qi and Blood and Regulate the milk secretion. Point Prescription: CV-17, ST-18, BL-20, and ST-36. Treat once every other day for 7 treatments as a course. Technique: Insert 1.5 cun #34 needle into CV-17 obliquely, 1 cun deep towards the breast (left or right side) with twisting even movement technique, lift the needle up and change the direction to do same technique for other breast. Insert 1 cun #34 needles into ST-18 and ST-36 with twisting reinforcing needle technique. Retain all needles for 15 minutes. Insert 1.5 cun #32 needles into BL-20 perpendicularly, 1 cun deep with twisting reinforcing needle technique and apply moxa wool on the handle of needles for 2 cones. Additional points for associated symptoms: Poor appetite: CV-12 and ST-25. Loss of blood: BL-18 and BL-17.

444

Hypogalactia

Stagnation of the Liver Qi Treatment Principle: Soothe the Liver and Regulate Qi. Point Prescription: CV-17, ST-18, SI-1, PC-6, and LV-3. Treat once every other day for 7 treatments as a course. Technique: Insert 1 cun #32 needles into ST-18, PC-6, and LV-3 with twisting reducing needle technique, and 0.5 cun #34 needles into SI-1with twisting even movement needle technique. Insert 1.5 cun #32 needles into CV-17 obliquely, 1 cun deep towards the breast (one side first) with lifting and thrusting reducing needle technique, then change to other direction with same technique. Retain all needles for 20 minutes. Additional points for associated symptoms: Distention in the chest and hypochondriac region: LV-14 and TW-6. Fullness and distention in the epigastric and abdominal region: CV-12 and ST-36. ADJUNCTIVE THERAPIES Moxibustion Point: SI-1 Apply direct non-scarring moxibustion on SI-1 for 7 cones, or apply moxa-pole on SI-1 for 15 minutes. Treat once daily for 5 treatments as a course. Indirect moxibustion Apply indirect moxibustion with ginger on CV-6 and CV-12 for 3 cones. Treat once every other day for 5 treatments as a course. Ear Acupuncture Points: Chest, Endocrine, Liver, and Kidney. Insert 0.5 cun #34 ear needles into these points obliquely, 0.3 cun deep with twisting reinforcing needle technique. Retain all needles for 30 minutes. Or apply press-ball on these points on one side of ear, and retain them for 3 days. Ask the patient to press three times a day before meals. Treat once a week for 3 treatments as a course. Scalp Acupuncture Treatment zones: Middle line of vertex, Lateral line 3 of forehead, and Lateral line 1 of vertex. Insert 1 cun #32 needles into these lines obliquely, 0.5 to 0.8 cun deep with fast twisting needle technique. Retain all needles for 30 minutes to treat hypogalactia with Liver Qi stagnation. Treat once every other day for 5 treatments as a course.

445

Acupuncture and Moxibustion—A Clinical Desk Reference

TRADITIONAL PRESCRIPTIONS AND TECHNIQUES For lack of milk after labor: LV-3 and KI-7. (Zhen Jiu Jia Yi Jing) Insert 1 cun #32 needles into LV-3 obliquely towards the KI-1 direction, 0.3 cun deep with twisting even movement needle technique, and 1.5 cun #32 needles into KI-7 perpendicularly, 1 cun deep with lifting and thrusting reinforcing needle technique, and apply moxa wool on the handle of needles for 2 cones. Treat once every other day for 5 treatments as a course. For agalactia: SI-1, TW-2, and TW-10. (Qian Jing Yi Fang) Insert 0.5 cun #32 needles into SI-1perpendicularly, 0.1 cun deep with twisting even movement needle technique, 1 cun #32 needles into TW-2 perpendicularly, 0.3 cun deep with twisting reducing needle technique, and 1 cun #32 needles into TW-10 perpendicularly, 0.6 cun deep with twisting even movement needle technique. Retain all needles for 30 minutes. Treat once every other day for 5 treatments as a course. For agalactia: CV-17 and SI-1. (Za Bing Ge) Apply direct non-scarring moxibustion on CV-17 SI-1 for 7 cones. Treat once daily for 5 treatments as a course. For agalactia: SI-2. (Shen Jiu Jing Lun) Apply direct non-scarring moxibustion on SI-2 for 9 cones. Treat once daily for 5 treatments as a course. For lack of milk after labor: CV-17, LI-4, and SI-1. (Zhen Jiu Da Cheng) Insert a 1.5 cun #30 needle into CV-17 obliquely, 1 cun deep with twisting reinforcing needle technique, and 1 cun #34 needles into LI-4 perpendicularly, 0.5 cun deep with twisting even movement needle technique. Retain all needles for 20 minutes. Apply direct non-scarring moxibustion on SI-1for 7 cones. Treat once every other day for 5 treatments as a course. For lack of milk after labor: SI-15, BL-42, BL-18, BL-15, and HT-7. (Xin Zhen Jiu Xue) Insert 1 cun #32 needles into BL-15 and BL-18 perpendicularly, 0.5 cun deep with twisting reinforcing needle technique. Insert 1 cun #32 needles into SI-15 and BL-42 perpendicularly with twisting even movement needle technique and apply moxa wool on the handle of needles for 3 cones. Treat once every other day for 3 treatments as a course. For agalactia: SP-10, LI-10, CV-6, BL-17, and BL-19. (Zhen Jiu Chu Fang Xue) Insert 1.5 cun #32 needles into BL-17 and BL-19 perpendicularly, 1 cun deep with twisting reinforcing needle technique, and apply moxa wool on the handle of needles for 3 cones. Insert 1.5 cun #34 needles into SP-10, LI-10, and CV-6 with lifting and thrusting reinforcing needle technique. Retain all needles for 20 minutes. Treat once every other day for 7 treatments as a course. For lack of milk after labor: GB-21, BL-11, BL-18, LI-4, and CV-17. (Author’s Clinical Experience) Insert 1.5 cun #32 needles into GB-21 perpendicularly, 0.8 to 1 cun deep with twisting reinforcing needle technique, and 1.5 cun #30 needles into BL-11 and BL-18 with twisting reinforcing needle technique. Apply moxa wool on the handle of needles for 3 cones. Insert 1 cun #32 needles into LI-4 with twisting even movement needle technique, and a 1.5 cun #32 needle into CV-17 with twisting reinforcing needle technique. Retain all needles for 20 minutes. Treat once every other day for 5 treatments as a course.

446

Hypogalactia

For lack of milk due to Liver Stagnation: LV-3, KI-23, CV-17, and GV-20. (Author’s Clinical Experience) Insert 1 cun #32 needles into LV-3 perpendicularly, 0.5 cun deep with twisting reducing needle technique, and 1 cun #34 needles into KI-23 perpendicularly, 0.3 to 0.5 cun deep with twisting reinforcing needle technique. Insert 1.5 cun #32 needles into CV-17 transversely towards one side of the breast, 1 cun deep with twisting even movement needle technique, then lift the needle up and change the direction to the other breast with same needle technique. Insert a 1 cun #32 needle into GV-20 with twisting reducing needle technique. Retain all needles for 20 minutes. Treat twice a week for 5 treatments as a course. For agalactia: BL-43, SI-15, BL-20, ST-36, and CV-17. (Author’s Clinical Experience) Apply direct non-scarring moxibustion on BL-43 for 7 cones. Insert 1.5 cun #32 needles into SI-15 and BL20 perpendicularly, 0.8 cun deep with twisting reinforcing needle technique, and apply moxa wool on the handle of needles for 3 cones. Insert 1.5 cun #32 needles into ST-34 and CV-17 with twisting reinforcing needle technique. Retain all needles for 20 minutes. Treat twice a week for 5 treatments as a course. CASE ANALYSIS A 25 year-old female patient with the main complaint of hypogalactia for one month came for treatment. She noticed decreased milk secretion a week ago since fighting with her husband. She felt distention and painful sensations in the breast, chest, and hypochondriac region that was associated with belching, restlessness, and tendency to anger, dizziness and vertigo, and poor sleep. The tongue was red with a thin yellow coating and the pulse was wiry. Diagnosis: Hypogalactia due to stagnation of Liver Qi. Treatment Principle: Soothe the Liver and Regulate milk secretion. Point Prescription: CV-17, LV-14, LV-3, and SI-1. Treat once daily for 3 treatments as a course. Technique: Insert 1 cun #30 needles into SI-1 perpendicularly, 0.1 cun deep with twisting reducing needle technique and remove the needles with the technique to enlarge the acupuncture hole to remove a drop of blood. Then apply moxa pole on the point for 10 minutes. Insert 1.5 cun #32 needle into CV-17 obliquely, 1.2 cun deep with lifting and thrusting reducing needle technique, and 1 cun #32 needles into LV-14 and LV-3 with twisting even movement needle technique. Retain all needles for 20 minutes. Result: After 3 treatments the secretion of milk returned to normal. EVALUATION Acupuncture and moxibustion is very effective to help hypogalactia, particularly within 20 days of labor, the effective rate is over 95%, but as the time passes the effective rate will decrease, and after 6 months the rate could be only 5 %. Which means earlier treatment is the key of the effectiveness of acupuncture therapy in these cases. Secretion of milk will usually be increased after 2 to 70 hours. The main points are CV-17, SI-1, and ST-18, with weak stimulation, and the needle retention time has not shown to be a direct influence to effectiveness, therefore, the needles are usually retained for only 15 to 20 minutes. Meanwhile, the patient should keep a good mood and spirits and take more protein rich food.

447

Acupuncture and Moxibustion—A Clinical Desk Reference

INFERTILITY Infertility is a very common disorder that is directly related to age and the balance of hormonal levels. Traditional Chinese Medicine believes that infertility could be caused by Kidney Deficiency (Kidney Yang Deficiency and Kidney Yin Deficiency) that fails in nourishing the Chong and Ren meridians, creating a weak uterus, or weakness in the Ming Men Fire, which leads to a Cold uterus. One other cause could be stagnation of Dampness and Cold, which leads to an irregular menstruation. In modern medicine, infertility is divided into primary infertility and secondary infertility. Kidney Deficiency Infertility caused by an innate Kidney Qi and Essence Deficiency or by other prolonged diseases. The Yang Qi cannot warm the uterus, and the Essence and Blood cannot nourish it. Sometimes, Interior Heat can stagnate in the uterus due to Kidney Yin Deficiency as well. Liver Stagnation Infertility due to disharmony of Chong and Ren meridians, which is caused by Liver Stagnation, which fails in adjusting the Blood after a long-term or severe emotional episodes. Damp-Phlegm Phlegm and Dampness stagnate in the uterus and the meridians, impacting the Chong and Ren meridians ability to send Blood down to the uterus. Blood Stagnation Infertility due to Blood Stagnation in the uterus occurs with irregular menstruation or dysmenorrhea. Stagnation of Blood in the uterus makes it difficult to become pregnant and can easily cause a miscarriage if already pregnant. DIAGNOSIS Infertility due to Deficiency of the Kidney Symptoms include irregular menstruation that is light in amount and color and associated with lassitude, dizziness, and ringing ear, and weakness and soreness in the low back and legs. The tongue is pale with a white thin coat and the pulse is deep and weak. Infertility due to a Cold uterus Symptoms include delayed menstruation that is scanty in amount and dark or even black in color, associated with a cold and painful sensation in the lower abdominal region, a cold sensation inside the whole body, including the four extremities, frequent urination, and weakness in the low back. The tongue is pale with a thin coat, and the pulse is deep and slow. Infertility due to Blood Deficiency Symptoms include a scanty or delayed menstruation that is associated with a weak body constitution, dizziness, a tendency towards anger, a sensation of distention and fullness in the chest and breast, heart palpitations, insomnia, a pale complexion, dry skin, and a dry throat. The tongue is pale and the pulse is deep and thin.

448

Infertility

Infertility due to stagnation of Phlegm and Interior Cold Symptoms include delayed menstruation with a very uneven flow, light red in color with clots, and is associated with distention and fullness in the chest and hypochondriac region, a tendency towards anger, restlessness, being over weight, dizziness and vertigo, and heart palpitations. There can be a thick, sticky, and large amount of uterine discharge in this case. The tongue is dark with purple or black dots and a white greasy coat. The pulse is tight or choppy. PRESCRIPTION AND TREATMENTS Infertility due to Deficiency of the Kidney Treatment Principle: Reinforce the Kidney Qi and Regulate the Chong and Ren meridians. Point Prescription: BL-23, KI-13, and KI-2. Treat twice a week, 10 treatments as a course. Technique: Insert 1.5 cun #32 needles into BL-23 perpendicularly 1 to 1.2 cun deep with a lifting and thrusting reinforcing needle technique. Apply moxa wool to the handles of the needles for 5 cones. Insert 1.5 cun #32 needles into KI-13 with a twisting reinforcing needle technique and 1-cun #32 needles into KI-2 with a twisting even movement needle technique. Apply moxa wool to the handles of the needles for 3 cones on KI-13. Additional points for associated symptoms: Dizziness and ringing ear: GV-20 and KI-3. Weakness and soreness in the lower back: Yao Yan and KI-10. Infertility due to a Cold uterus Treatment Principle: Warm the uterus and Expel the Cold. Point Prescription: CV-7, CV-2, GV-4, and CV-6. Treat once every other day, 7 to 10 treatments as a course. Technique: Insert a 1 cun #32 needle into GV-4 perpendicularly, 0.5 to 0.8 cun deep with a twisting reinforcing needle technique and apply moxa wool to the handles of the needles for 5 cones. Insert 1.5 cun #32 needles into CV-2 and CV-7 with a twisting reinforcing needle technique. Retain needles for 10 minutes. Apply indirect moxibustion with a Fu Zi cake (aconite) on CV-6 for 7 cones. Additional points for associated symptoms: Delayed menstruation: ST-28 and ST-29. Sore and weakness in the low back: BL-23 and GV-4 with moxibustion. Infertility due to Deficiency of Blood Treatment Principle: Reinforce the Blood and Kidney Jing; Regulate the Chong and Ren meridians. Point Prescription: CV-4, ST.13, Zi Gong, SP-6, and ST-36. Treat once every other day, 10 treatments as a course. Technique: Insert 1.5 cun #32 needles into SP-6 and ST-36 with a twisting reinforcing needle technique and 1 cun #32 needles into ST-13 perpendicularly, 0.5 cun deep with a twisting reinforcing needle technique. Insert 2 cun #32 needles into Zi Gong with a lifting and thrusting reinforcing needle technique. Apply indirect moxibustion with a Fu Zi cake (aconite) on CV-4 for 7 to 9 cones. Additional points for associated symptoms: Heat sensation from Blood Deficiency: SP-10. Dizziness and heart palpitations: GV-20 and HT-7. 449

Acupuncture and Moxibustion—A Clinical Desk Reference

Infertility due to stagnation of Phlegm and Interior Cold Treatment Principle: Resolve the stagnation of Phlegm and Blood, and Regulate the menstruation. Point Prescription: CV-3, ST-30, SP-6, and ST-40. Treat twice a week, 7 treatments as a course. Technique: Insert 3 cun #32 needles into CV-3 and ST-30 perpendicularly, 2 cun deep with a twisting reducing needle technique and 1.5 cun #32 needles into SP-6 and ST-40 with a lifting and thrusting reducing needle technique. Retain all needles for 30 minutes. Additional points for associated symptoms: Uneven period: SP-8. Fullness sensation in the chest: LV-3 and PC-6. Leukorrhea: BL-31. Abdominal pain: KI-15. ADJUNCTIVE THERAPIES Ear Acupuncture Points: Endocrine, Kidney, Uterus, Sub cortex, and Ovary. Insert 0.5 cun ear needles into these points obliquely at a 60-degree angle, with a fast twisting technique. Retain all needles for 40 minutes. Treat once every other day, 10 treatments as a course. Moxibustion Indirect moxibustion: Apply indirect moxibustion with a Fu Zi cake (aconite) on CV-4, CV-6, and Zi Gong for 5 to 7 cones. Treat twice a week, 7 treatments as a course. Direct non-scarring moxibustion: Apply direct non-scarring moxibustion on CV-4, CV-7, KI-7, GV-4, and BL-23 for 9 to 11 cones. Treat once daily for 10 treatments as a course. TRADITIONAL PRESCRIPTIONS AND TECHNIQUES For infertility due to cold body constitution: CV-8. (Zhen Jiu Jia Yi Jing) Apply indirect moxibustion with salt (dry it in a pot for few minutes before using it) and ginger (a piece of ginger on the salt) for 9 cones. Treat twice a week for 7 treatments as a course. For infertility due to stagnation of Blood: CV-4. (Zhen Jiu Jia Yi Jing) Insert a 3 cun #30 needle into CV-4 perpendicularly, 2 cun deep with Long Hu Jiao Zhan—Dragon and Tiger Battle technique and apply moxa wool to the handles of the needles for 5 cones. Treat once a week for 7 treatments as a course For infertility due to deficiency of the Kidney: KI-1. (Zhen Jiu Jia Yi Jing) Rub KI-1 for 3 to 5 minutes until the point gets warm, and then insert 1 cun #32 needles into KI-1 perpendicularly, 0.5 cun deep. Apply moxa wool to the handles of the needles for 5 cones. Treat twice a week for 7 treatments as a course. 450

Infertility

For infertility due to a Cold uterus: Qi Men. (Qian Jin Yao Fang) Apply direct moxibustion on Qi Men—an extra point located 3 cun lateral to CV-4, for 10 cones. Treat once daily 100 cones as a course. For infertility: BL-32, KI-1, and SP-5. (Zhen Jiu Zi Shen Jing) Insert 2 cun #30 needles into BL-32 perpendicularly, 1.5 cun deep with a twisting reducing needle technique, and apply moxa wool to the handles of the needles for 3 cones. Insert 1 cun #32 needle into KI1 and SP-5 with a twisting reinforcing needle technique. Retain all needles for 20 minutes. Treat once every other day for 10 treatments as a course. For infertility due to a Cold uterus: KI-6, CV-3, SP-6, and Zi Gong. (Zhen Jiu Da Quan) Zi Gong is an extra point located 2 cun lateral to CV-3. Insert 1 cun #32 needles into KI-6 and SP-6 with a twisting reinforcing needle technique and a 1.5 cun #30 needle into CV-3 with a twisting reinforcing needle technique. Apply direct non-scarring moxibustion on Zi Gong for 9 cones. Treat once every other day, 10 treatments as a course. For infertility due to a Cold uterus: SP-6, SP-10, CV-6, CV-3, CV-4, BL-23, GV-4, BL-32, KI-2, KI-6, Qi Men, and Zi Gong. (Shen Jiu Jing Lun) Divide the points into two groups, and apply direct non-scarring moxibustion for 7 to 9 cones on each point. Treat once daily for 15 treatments as a course. The two groups of points should be automatically changed each time. For infertility due to deficiency of the Kidney: ST-36, BL-67, LI-4, SP-6, and CV-2. (Zhen Jiu Ji Chen) Insert 1.5 cun #32 needles into ST-36, SP-6, and LI-4 with a twisting even movement needle technique. Apply direct non-scarring moxibustion on CV-2 and BL-67 for 7 cones. Treat once every other day, 7 treatments as a course. For infertility: CV-4, SP-6, BL-23, and Zi Gong. (Zhen Jiu Bai Zhen Fu) Insert 1.5 or 2 cun #30 needles into CV-4 and Zi Gong with a twisting even movement needle technique and 1 cun #30 needles into SP-6 with a twisting reducing needle technique. Retain all needles for 20 minutes. Insert 1.5 cun #30 needles into BL-23 perpendicularly, 1.2 cun deep with a twisting reinforcing needle technique, and apply moxa wool to the handles of the needles for 5 cones. Treat once every other day for 15 times as a course. For infertility: CV-4, ST-29, SP-6, KI-13, ST-36, and BL-10. (Bei Jing Zhong Yi) Insert 2 cun #30 needles into CV-4, ST-29, and KI-13 perpendicularly, 1 to 1.5 cun deep with a twisting even movement needle technique. Insert 1.5 cun #32 needles into SP-6 obliquely upwards at a 45-degree angle, with a lifting and thrusting reinforcing needle technique. Insert 1.5 cun #30 needles into ST-36 and BL-10 perpendicularly with a twisting reinforcing needle technique. Retain all needles for 30 minutes. Treat once daily (12, 13 and 14 days after the end of a menstruation period), 3 treatments as a course.

451

Acupuncture and Moxibustion—A Clinical Desk Reference

CASE ANALYSIS A 35 year-old female has had a main complaint of infertility for 7 years (her husband proved fertile upon examination) with delayed menstruation since her first period came, usually once in a 3 to 5 month period. The menstruation was scanty in amount and light in color. Her associated symptoms were distention and pain in the low back and abdominal region, a tendency towards anger, restlessness, dizziness, lassitude, a pale complexion and a cold sensation in the body, including the four extremities. Her tongue was pale with a thin white coating, and her pulse was deep, thin, and wiry. Diagnosis: Infertility due to Deficiency of the Kidney. Treatment Principle: Reinforce the Kidney Qi and Regulate the Liver. Point Prescription: KI-8, CV-4, CV-3, ST-36, BL-23, GV-4, and LV-13. Treat once every other day, 15 treatments as a course. Technique: Insert 1.5 cun #30 needles into BL-23 and GV-4 perpendicularly, 1 cun deep with a twisting reinforcing needle technique, and apply moxa wool to the handles of the needles for 3 cones. Insert 2 cun #30 needles into CV3 and CV-4 with a twisting even movement needle technique, and 1.5 cun #32 needles into KI-8, ST-36, and LV-13 with twisting reinforcing needle technique. Retain all the needles for 20 minutes. Result: After a total of 5 courses (with a 7 day break between each course), she became pregnant and had a healthy labor. EVALUATION Thousands and thousands of infertility cases have been successfully treated by acupuncture and moxibustion. With the correct prescriptions and lifestyles, the patients will usually succeed in changing infertility. It is usually better to ask the patient to get a diagnosis and examination by an OBGYN practitioner before the treatment and prove that her husband is fertile. Understanding the case and the TCM diagnosis is important to providing an appropriate curative treatment. Herbal therapy is also recommended alongside acupuncture treatments for infertility. Herbs can help tremendously regulate the body systems and Qi.

452

Leukorrhea

453

Acupuncture and Moxibustion—A Clinical Desk Reference

LEUKORRHEA Leukorrhea refers to profuse uterine discharges with abnormal color, quality, and smell. It is often accompanied with the patient’s constitutional or local symptoms. In TCM, it is related to the Dai-mai. That is why we call it “Dai Xia”. Possible causes in TCM are: Spleen Deficiency Interior Damp Stagnation in the Ren-mai and Dai-mai can occur due to a deficient Spleen failing in transporting and transforming. The Spleen can be that impacted by improper food intake, by being overly tired, by over-thinking or stagnation of the Liver Qi. Kidney Deficiency Yin liquids can flow out because deficient Kidney Qi fails in controlling or withholding the Qi. Prolonged Kidney Qi Deficiency can occur from being overly tired or contracting long-term diseases. Damp-Heat This kind of leukorrhea is frequently caused by a Damp-Heat Invasion, or by Interior stagnation of water that turns into Heat, impacting the Ren-mai and Dai-mai and causing irregular discharge. DIAGNOSIS Leukorrhea due to deficiency of the Spleen Symptoms include a whitish or yellowish, continual sticky discharge, that has no foul smell and is associated with a pale or sallow complexion, a lack of vitality, a lack of appetite, a pale tongue with a white or greasy coating, and a moderate and weak pulse. Leukorrhea due to deficiency of the Kidney Symptoms include clear, cold, thin, and profuse continual discharge that is associated with soreness around the waist along with a cold sensation in the lower abdomen, a pale tongue with a white and thin coating, and a deep and slow pulse. Leukorrhea due to Damp-toxin Symptoms include an excessive pus-like discharge that is yellow or green in color, mixed with blood or turbid like rice-water, foul smelling, curd-like in consistency, and associated with vaginal itching, a bitter taste in the mouth, dry throat, scanty dark urine, a red tongue with a yellow and greasy coating, and a rapid or slippery and rapid pulse.

454

Leukorrhea

TREATMENT AND PRESCRIPTIONS Leukorrhea due to deficiency of the Spleen Treatment Principle: Reinforce the Spleen Qi and Resolve the Damp. Point Prescription: CV-6, GB-26, BL-30, SP-6, and ST-36. Treat once every other day for 5 treatments as a course. Technique: Insert 1.5 cun #32 needles into GB-26 perpendicularly 1 to 1.2 cun deep with a twisting reducing needle technique. Insert 1.5 cun #32 needles into CV-6, SP-6, and ST-36 with a twisting reinforcing needle technique. Retain the needles for 30 minutes. Lastly, insert 3 cun #30 needles into BL-30 perpendicularly, 2 cun deep, and apply moxa wool to the handles of the needles for 3 cones. Additional points for associated symptoms: Large amount of discharge: CV-3, SP-12 Poor appetite and loose stool: CV-12, ST-25 Leukorrhea due to deficiency of the Kidney Treatment Principle: Warm the Kidney Yang, and Reinforce the Dai-mai and Ren-mai. Point Prescription: CV-4, GB-26, BL-23, BL-32, and KI-6. Treat once every other day for 7 treatments as a course. Technique: Insert 1.5 cun #30 needles into GB-26 with a twisting even movement technique and 1.5 cun #32 needles into CV-4 and KI-6 with a twisting reinforcing needle technique. Apply moxa wool to the handle of the needle on CV-4 for three cones. Insert 1.5 cun #30 needles into BL-23 and BL-32 perpendicularly with a lifting and thrusting reinforcing needle technique. Retain the needles and apply the moxa wool to the handles of the needles for 3 cones. Additional points for associated symptoms: Large amount of discharge: KI-13 and KI-14. Soreness and weakness in the low back: Yao Yan and BL-28. Leukorrhea due to Damp-toxin Treatment Principle: Clear the Heat and Damp; Resolve the toxin and water retention. Point Prescription: GB-26, CV-3, SP-9, BL-34, and LV-2. Treat once every other day for 7 treatments as a course. Technique: Insert 1.5 cun #30 needles into BL-34 with a lifting and thrusting reducing needle technique. Retain the needles for 5 minutes. Then, insert 1.5 cun #30 needles into GB-26 with a lifting and thrusting reducing needle technique. Insert 1.5 cun #30 needles into CV-3 and SP-9 along with 1 cun #30 needles into LV-2 with a twisting reducing needle technique. Retain all needles for 30 minutes. Additional points for associated symptoms: Itching in the genital region: LV-5 and LV-3. Reddish discharge: PC-5.

455

Acupuncture and Moxibustion—A Clinical Desk Reference

ADJUNCTIVE THERAPIES Cupping Points: CV-8 and regions of the lower back and sacrum. Use a fire cup on CV-8 and leave it for 2 minutes. Then use sliding fire cups on the lower back and sacral region. Move the cup up and down along the Bladder and Governing vessel for several minutes, until the skin turns a little red. Treat once every other day, 5 treatments as a course. Points: BL-32 and Shi Qi Zhui Xia. Use bloodletting needles on BL-32 and Shi Qi Zhui Xia, squeezing out several drops of blood and then applying fire cups on these points immediately for 3 to 5 minutes. Treat once every other day, 2 treatments as a course. Moxibustion (For leukorrhea due to deficiency of the Kidney) Direct moxibustion: GV-4, CV-3, and Lou Yin—an extra point located 0.5 cun below KI-6. cones.

Apply direct non-scarring moxibustion on Lou Yin for 9 to 11 cones and on GV-4 and CV-3 for 7 Treat twice a week for 7 treatments as a course.

Indirect moxibustion: CV-8. Apply indirect moxibustion with salt on CV-8 for 5 cones. Treat twice a week for 7 treatments as a course. Scalp Acupuncture For leukorrhea due to an infection: Points: Lateral line 3 of the forehead, Lateral line 1 of the vertex, and Middle line of the vertex. Insert 1.5 cun #30 needles into these lines with a fast twisting or withdrawing Qi needle technique. Retain the needles for 40 minutes. Treat once every other day, 5 treatments as a course. Ear Acupuncture For leukorrhea due to a Damp-toxin: Points: Zi Gong, Bladder, Liver, Spleen, Kidney, Endocrine, Shen men, and Triple-warmer. Select 3 to 4 points each treatment, inserting the points obliquely with a twisting reducing needle technique. Retain the needles for 30 minutes. Treat once daily, 7 treatments as a course.

456

Leukorrhea

TRADITIONAL PRESCRIPTIONS AND TECHNIQUES For leukorrhea due to infections: BL-32 and CV-3. (Zhen Jiu Jia Yi Jing) Insert 3 cun #30 needles into BL-32 perpendicularly along the sacrum a whole 2 cun deep with a twisting reducing needle technique until the sensation of the needle travels to the front of the abdomen. Apply moxa wool to the handles of the needles for 3 cones. Insert a 1.5 or 2 cun #32 needle into CV-3 with a twisting even movement needle technique. Retain it for 20 minutes or apply moxa-pole to the side for 10 minutes. Treat once every other day, 5 treatments as a course. For leukorrhea due to Damp-toxin: GB-26, CV-4, CV-6, SP-6, BL-30, and PC-5. (Zhen Jiu Da Cheng) Insert 1.5 cun #30 needles into GB-26, CV-4, and CV-6 perpendicularly, 1 cun deep with a twisting even movement needle technique. Retain all needles for 30 minutes. Apply direct non-scarring moxibustion on PC-5 for 11 cones. Insert 3 cun #30 needles into BL-30 perpendicularly, 1.5 to 2 cun deep and apply moxa wool to the handles of the needles for 3 cones. Treat once every other day for 5 treatments as a course. For leukorrhea due to Kidney Deficiency: GV-4, CV-8, and CV-4. (Lei Jing Tu Yi) Apply direct non-scarring moxibustion on these three points for 11 cones each treatment. Treat once daily for 5 treatments as a course. For leukorrhea due to an infection: CV-2, LI-3, CV-4, KI-7, and ST-25. (Zhen Jiu Ji Chen) Apply direct non-scarring moxibustion on CV-2 for 10 cones (or moxa pole for 20 minutes) and direct nonscarring moxibustion on ST-25 for 20 cones. Insert 1 cun #30 needles into LV-3 and KI-7 with a twisting reducing needle technique and a 1.5 cun #32 needle into CV-4 with twisting an even movement needle technique. Treat once every other day, 5 treatments as a course. For Leukorrhea due to Damp-Heat: CV-6, BL-28, CV-3, and GB-26. (Zhen Jiu Zi Shen Jing) Insert 1.5 to 2 cun #30 needles into CV-6 and CV-3 perpendicularly with a twisting reducing needle technique and 1 cun #32 needles into GB-26 with a twisting even movement needle technique. Insert 2 cun #30 needles into BL-28 perpendicularly, 1.5 cun deep with a twisting reinforcing needle technique and apply moxa wool to the handles of the needles for 4 to 5 cones. Treat once every other day for 5 treatments as a course. For Leukorrhea due to a Kidney Deficiency: CV-4, SP-6, CV-6, ST-29, KI-7, Zi Gong, and CV-3. (Zhen Jiu Yan Fang Ji) Treat once daily for 3 days. On the first day, insert a 3 cun #32 needle into CV-4 perpendicularly, 2 cun deep with a twisting reinforcing needle technique and apply moxa wool to the handle of the needle for 3 cones. Insert 1.5 cun #32 needles into SP-6 with a lifting and thrusting reinforcing needle technique. Retain all needles for 30 minutes. On the second day, insert 1.5 cun #32 needles into CV-6 and KI-7 with a lifting and thrusting reinforcing needle technique, and insert 2 cun #32 needles into ST-29 with a twisting even movement needle technique. Apply moxa wool to the handles of the needles for 3 cones. On the third day, insert 2 cun #30 needles into Zi Gong perpendicularly, 1.5 cun deep with a twisting reinforcing needle technique and apply moxa wool to the handles of the needles for 3 cones. Insert 3 cun #32 needles into CV-3 with a lifting and thrusting reducing needle technique. Retain the needles for 20 minutes. After a 5-day break, repeat the same treatment.

457

Acupuncture and Moxibustion—A Clinical Desk Reference

For Leukorrhea due to Spleen Deficiency: BL-20, Shi Qi Zhui Xia, BL-40, SP-4, and SP-12. (Xin Zhen Zhi Yao Ge) Insert 1.5 cun #30 needles into BL-20 and Shi Qi Zhui Xia perpendicularly, 1 to 1.2 cun deep with a lifting and thrusting reinforcing needle technique. Retain the needles with moxa wool on the handles of the needles for 4 to 5 cones. Insert 1 cun #30 needles into BL-40 with a waving needle technique. Insert 1 cun #32 needles into SP-4 with a twisting reinforcing needle technique and 1.5 cun #32 needles into SP-12 with a lifting and thrusting reinforcing needle technique. Retain all needles for 20 minutes. Treat once every other day, 7 treatments as a course. For Leukorrhea due to Damp-Heat: LI-11, GV-14, LV-3, ST-28, CV-3, LI-4, and BL-57. (Tang Shan Zhen Jiu Za Zhi) Insert 1 cun #30 needles into LI-4 and LV-3 with a twisting reducing needle technique, and 1.5 cun #30 needles into LI-11 and ST-28 with a lifting and thrusting reducing needle technique. Retain all needles for 20 minutes. Insert 1.5 cun #30 needles into GV-14 and BL-57 with a twisting even movement needle technique. Retain all needles for 5 minutes. Treat once every other day, 5 treatments as a course. The following treatments are from the Author’s clinical experiences. For white leukorrhea: CV-4, SP-6, GB-26, CV-6, and SP-9. Insert a 3 cun #30 needle into CV-4 perpendicularly, 2 cun deep with a twisting reinforcing needle technique and 1.5 cun #32 needles into SP-6 and GB-26 with a twisting reducing needle technique. Retain all needles for 30 minutes. Treat twice a week for 5 treatments as a course For yellow leukorrhea: CV-6 and SP-9. Insert 1.5 cun #30 needles into CV-6 and SP-9 perpendicularly, 1 cun deep with a lifting and thrusting reducing needle technique. Retain all needles for 30 minutes. Treat once every other day for 5 treatments as a course. For large quantities of leukorrhea: SP-1 and ST-36. Insert 1.5 cun #32 needles into ST-36 with a lifting and thrusting reinforcing needle technique. Apply direct non-scarring moxibustion on SP-1 for 9 cones. Treat twice a week for 5 treatments as a course. For red leukorrhea: PC-5 and SP-10. Insert 1.5 cun #32 needles into PC-5 and SP-10 perpendicularly, 1 cun deep with a twisting reducing needle technique. Treat once every other day, 7 treatments as a course. For leukorrhea from infection: LV-2 and SP-9. Insert 1.5 cun #32 needles into LV-2 obliquely towards LV-3, 1 cun deep, and 1.5 cun #30 needles into SP9 with a lifting and thrusting reducing needle technique. Apply an electro machine on these two points, with the negative side on SP-9 with irregular waves for 30 minutes. Treat once every other day for 5 treatments as a course.

458

Leukorrhea

CASE ANALYSIS A 38 year-old female patient had a main complaint of leukorrhea for the last 3 years, with a large amount of brown foul discharge. It was associated with a soreness and weakness in the lower back and both legs that was worse at night, as well as cramping and bloating in the lower abdominal region, dizziness, lassitude, and poor sleep with an itching sensation in the genital region. Her tongue was dark pale with a yellow greasy coating and the pulse was weak and tight. Diagnosis: Leukorrhea due to Kidney Deficiency and stagnation of the Liver. Treatment Principle: Nourish the Kidney and Soothe the Liver; Regulate the Qi and Blood. Point Prescription: CV-4, GB-26, LV-13, SP-6, and BL-30. Treat once every other day, 7 treatments as a course. Technique: Insert 1.5 cun #32 needles into CV-4, GB-26, LV-13, and SP-6 perpendicularly, 1 cun deep with a twisting reinforcing needle technique and apply moxa wool on CV-4 for 3 cones. Insert 3 cun #30 needles into BL-30 perpendicular 2 cun deep with a twisting reducing needle technique and apply moxa wool to the handles of the needles for 5 cones. Use a fire cup on BL-30 for 3 minutes after removing the needles. Result: The symptoms were completely gone after one course of treatment. EVALUATION Acupuncture and moxibustion are very effective in treating leukorrhea due to any cause, by regulating the function of the Dai-mai. A correct diagnosis will help to avoid misdiagnosis of other serious diseases with similar symptoms, such as cancer. The patient should always stop sexual activities during the treatment to prevent any possible new infection.

459

Acupuncture and Moxibustion—A Clinical Desk Reference

MENOPAUSE Women often will experience different physical and emotional symptoms occurring before or after menopause or during the experience. In modern medicine, it is called the climacteric syndrome. In TCM, menopause is a result of the Kidney Qi declining due to age, leading to Kidney Yin and Kidney Yang Deficiency. As a result, there are four types of main syndromes in the clinic that occur from these two roots: Kidney Yin Deficiency Kidney Yin Deficiency causes most menopausal syndromes seen in the clinic. This is a result of long-term Yin Deficiency, body constitution, or just getting older in age. Consequently, Kidney Water cannot go up to harmonize the Heart Fire, causing an imbalance between Heart Fire and Kidney Water, or Kidney Water fails in nourishing Liver Wood, causing stagnation of the Liver Qi, Liver Yin Deficiency, and/or Liver Yang Rising. Kidney Yang Deficiency Some menopausal patients with Kidney Yang Deficiency symptoms have a Yang deficient body constitution or excessively consume herbs and food with a Cold nature, which results in the Ming Men Fire failing to nourishing the Spleen and Heart Yang. DIAGNOSIS Liver Yang Rising (Kidney Yin Deficiency) Symptoms include dizziness, tinnitus, paroxysms, feverishness with sweating, dysphoria with a feverish sensation in the chest, palm, and soles, restlessness with a tendency towards anger, lassitude in the loin and legs and an early or irregular menstrual cycle with a bright red color and menorrhagia, or scanty menstruation. The tongue is red with very little coating and the pulse is thin and rapid. Heart Blood Deficiency (Kidney Yin Deficiency) Symptoms include restlessness, irritability, heart palpitations, insomnia and heavy dreaming, a feverish sensation in the chest, palms and soles and a possible mental disorder. The tongue is red with very little coating and the pulse is thin and rapid. Deficiency of both the Spleen and Stomach (Kidney Yang Deficiency) Symptoms include a pale complexion, soreness of waist, cold limbs, abdominal distention, loose stool, edema of the face and limbs, and a profuse menstrual flow with dark and clotted blood. The tongue is pale with tooth marks on its margin and the pulse is deep and thin. Phlegm Stagnation (Kidney Yang Deficiency) Symptoms include a stuffy and full sensation in the chest, hypochondriac, and epigastric area, cough with phlegm, belching, acid regurgitation, edema, loose stool, soreness of the waist, and cold limbs. The tongue is pale with a greasy coating and the pulse is weak and slippery.

460

Menopause

TREATMENT AND PRESCRIPTONS Liver Yang Rising Treatment Principle: Soothe the Liver and Subdue the rising Yang; Nourish the Kidney and Liver Yin. Point Prescription: LV-3, KI-3, GV-20, and GB-20. Treat once every other day, 7 treatments as a course. Technique: Insert 1 cun #30 needles into LV-3 and KI-3 perpendicularly, 0.5 cun deep with a twisting reinforcing needle technique and 1.5 cun #30 needles into GV-20 and GB-20 with a lifting and thrusting reducing needle technique. Retain all needles for 30 minutes. Additional points for associated symptoms: Restlessness: PC-7. Hot flushes: KI-1 and KI-6. Soreness and weakness in the waist: BL-23 and Yao Yan. Heart Blood Deficiency Treatment Principle: Reinforce the Heart Blood and open communication between the Heart Yang and Kidney Yin. Point Prescription: BL-15, BL-20, BL-23, and SP-6. Treat once every other day, 10 treatments as a course Technique: Insert 1.5 cun #32 needles into BL-15, BL-20, and BL-23 with twisting reinforcing needle technique, and apply moxa wool to the handles of the needles for 3 cones. Insert 1 cun #30 needles into SP-6 perpendicularly, 0.6 cun deep with a twisting reducing needle technique. Retain needles for 20 minutes. Additional points for associated symptoms: Insomnia: HT-7 and Si Shen Cong. Heart palpitations: PC-6 and HT-5. Five-hearts heat: PC-8. Abnormal mental activities: GV-26 and PC-7. Deficiency of both the Spleen and Stomach Treatment Principle: Reinforce the Spleen and Stomach. Point Prescription: BL-20, BL-21, BL-23, CV-12, LV-13, and ST-36. Treat twice a week, 7 treatments as a course. Technique: Insert 1.5 cun #30 needles into BL-20, BL-21, and BL-23 perpendicularly, 1 cun deep with a twisting reinforcing needle technique. Apply moxa wool to the handles of the needles for 2 cones. Insert 1.5 cun #32 needles into CV-12, LV-13, and ST-36 with a twisting even movement technique. Retain all needles for 20 minutes. Additional points for associated symptoms: Bloated abdomen: CV-11 and CV-6. Loose stool: ST-25 and SP-9. Edema: indirect moxibustion on CV-4 and CV-9 with ginger for 5 cones.

461

Acupuncture and Moxibustion—A Clinical Desk Reference

Phlegm Stagnation Treatment Principle: Regulate the Qi and Resolve stagnation of the Phlegm. Point Prescription: CV-17, CV-12, CV-6, TW-6, ST-40, and SP-6. Treat twice a week for 10 treatments as a course. Technique: Insert a 1.5 cun #30 needle into CV-17 obliquely towards the abdomen at a 45-degree angle with a lifting and thrusting reducing needle technique. Insert 1.5 cun #32 needles into CV-12 and CV-6 with a twisting reinforcing needle technique and 1 cun #30 needles into TW-6, ST-40, and SP-6 with a lifting and thrusting reducing needle technique. Retain all needles for 30 minutes. Additional points for associated symptoms: Acid regurgitation: GB-34 and LV-3. Loose stool: SP-4 and ST-37. Soreness of the waist: GV-4 and BL-28. ADJUNCTIVE THERAPIES Ear Acupuncture Points: Ovary, Endocrine, Shen Men, Sympathetic, Sub cortex, Heart, Liver and Spleen. Select 3 or 5 points each treatment and insert 0.5 cun #32 ear needles obliquely, 0.2-0.3 cun deep at a 60degree angle with a fast twisting technique until the ear gets a warm sensation. Retain the needles for 30 minutes. Treat once every other day, 7 treatments as a course. As a supplemental treatment along with body acupuncture, apply press balls or inter-dermal needles on 3 to 5 points each treatment and let the patient stimulate them 2 or 3 times a day. Retain for 3 days in the summer and a week in the winter. Scalp Acupuncture Treatment zones: Lateral line 3 of the forehead, Lateral line 1 of the vertex, and Middle line of the vertex. Insert 1.5 cun #30 needles into these zones with a fast twisting needle technique. Retain all needles for 40 minutes. Treat once every other day, 10 treatments as a course. Moxibustion Points: SP-4, LV-1, KI-6, KI-7, CV-4, Zi Gong, BL-23, GV-4, BL-32, TW-4, and SI-4. Select 5 point each treatment, and apply direct non-scarring moxibustion or moxa pole on the points for 7 cones or 25 minutes. Treat once daily for 7 treatments as a course. Cupping Treatment area: Urinary Bladder and Gv meridian on the back. Apply a sliding fire-cup on the back and go up and down along the meridians for 2 to 3 minutes. Retain the cups for 2 minutes on BL-23. Treat once daily 5 treatments as a course. 462

Menopause

TRADITIONAL PRESCRIPTIONS AND TECHNIQUES For menopause with a return of delayed menstruation with profuse bleeding: ST-40 and CV-5. (Dan Xi Xin Fa) Insert 1 cun #30 needles into ST-40 perpendicularly, 0.6 cun deep with a twisting reducing needle technique to stop the bleeding and into CV-5 perpendicularly, 0.5 cun deep with a twisting reducing needle technique to stop menstruation. Retain all needles for 20 minutes. Treat once daily, 5 treatments as a course. For menopause with irregular menstruation, bleeding with dark clots, and a bloated abdomen: ST-25, CV-12, and CV-6. (Yi Bu Quan Lu Dan Xi Xin Fa) Insert 1 cun #30 needles into ST-25, CV-12, and CV-6 perpendicularly, 0.5 cun deep with a twisting reducing needle technique. Retain all needles for 30 minutes. Treat once daily for 5 treatments as a course For menopause: CV-3, SP-6, BL-23, LI-4. (Yi Xue Gang Mu) Insert a 1.5 cun #30 needle into CV-3 with a lifting and thrusting reducing needle technique and 1 cun #32 needles into SP-6 and LI-4 with a twisting even movement needle technique. Retain all needles for 20 minutes. Insert 1.5 cun #30 needles into BL-23 with a lifting and thrusting reinforcing needle technique. Apply moxa wool to the handles of the needles for 2 cones. Treat once every other day, 7 treatments as a course. For menopause with Liver Qi attacking the Spleen: SP-6, LV-3, BL-20, and BL-18. (Zhong Yuan Yi Kan) Insert 1.5 cun #30 needles into BL-20 and BL-18 with a twisting reinforcing needle technique. Retain all needles for 10 minutes. Insert 1 cun #30 needles into LV-3 obliquely upwards, 0.8 cun deep with a lifting and thrusting reducing needle technique and 1 cun #32 needles into SP-6 with a twisting reinforcing needle technique. Retain all needles for 20 minutes. Treat once every other day for 7 treatments as a course. For menopause with Heart Blood Deficiency: SP-4, LU-7, CV-17, HT-7, and GV-20. (Author’s Clinical Experience) Insert 1 cun #34 needles into Sp-4 perpendicularly, 0.3 cun deep with a twisting reinforcing needle technique and 1 cun #34 needles into LU-7 transversely, 0.5 deep at a 15-degree angle, with a twisting even movement needle technique. Insert 1 cun #32 needles into HT-7 with a twisting reinforcing needle technique and 1.5 cun #30 needle into GV-20 with a lifting and thrusting reducing needle technique. Retain all needles for 30 minutes. Treat once every other day, 7 treatments as a course. For menopause with hot flashes and heart palpitations: GV-14, BL-11, BL-43, BL-23, GV-4, LI-11, HT-6, KI-6, ST-36, and CV-4. (Author’s Clinical Experience) Insert 1 cun #32 needles into GV-14, BL-11, BL-23, and GV-4 perpendicularly, 0.5 to 0.8 cun deep with a twisting and waving needle technique and 1 cun #30 needles into BL-43 transversely towards BL-44, 0.5 cun deep with a twisting reinforcing needle technique. Retain all needles for 10 minutes. Insert 1.5 cun #32 needles into LI-11, ST-36, and CV-4 perpendicularly, 1 cun deep with a lifting and thrusting even movement needle technique and 1 cun #32 needles into HT-6 and KI-6 with a twisting reinforcing needle technique. Retain all needles for 20 minutes. Treat twice a week, 7 treatments as a course For menopause with edema and deficiency of the Spleen: SP-9, TW-6, CV-9, and GV-20. (Author’s Clinical Experience) Insert 1.5 cun #30 needle into SP-9, TW-6, and GV-20 with a twisting reducing needle technique. Apply indirect moxibustion with ginger on CV-9 for 6 cones. Treat twice a week, 7 treatments as a course.

463

Acupuncture and Moxibustion—A Clinical Desk Reference

For menopause with Liver Yang Rising: GV-20, Tai Yang, CV-4, LV-8, and KI-3. (Author’s Clinical Experience) Insert a 1.5 cun #30 needle into GV-20 transversely, 1 cun deep at a 30-degree angle with a fast twisting needle technique for 3 minutes. Insert 1.5 cun #32 needles into Tai Yang obliquely at a 45-degree angle towards GB-5 with a twisting reducing needle technique. Insert 1 cun #30 needles into CV-4, LV-8, and KI-3 perpendicularly, 0.5 cun deep with a twisting reinforcing needle technique. Retain all needles for 30 minutes. Treat once a week for 5 treatments as a course. For menopause with Yin Deficiency and Liver Stagnation: BL-62, GV-3, BL-13, and CV-4. (Author’s Clinical Experience) Insert 1 cun #32 needles into BL-62, CV-3, and BL-13 with a rubbing needle technique. Retain all needles for 10 minutes. Insert a 1.5 cun #32 needle into CV-4 perpendicularly, 1 cun deep with a twisting even movement needle technique. Retain needles for 10 minutes. Treat once daily for 5 treatments as a course. CASE ANALYSIS A 49 year-old female patient had a main complaint of menopause with irregular menstruation for the last 2 years that was accompanied by severe headaches described as pain on the vertex, bad nausea and vomiting, dizziness, restlessness, a tendency towards anger and insomnia. The tongue was red without a coating and the pulse was wiry and thin. Diagnosis: Menopause with Liver Yang Rising due to deficiency of the Kidney and Liver Yin. Treatment Principle: Calm the Liver and Subdue the Rising Yang; Nourish the Kidney and Liver Yin. Point Prescription: LV-3, KI-3, GV-20, GB-20, HT-7, Yin Tang, and SP-6. Treat once daily for 7 treatments as a course. Technique: Insert 1 cun #30 needles into LV-3, KI-3, and SP-6 perpendicularly, 0.5 cun deep with a twisting reinforcing needle technique and 1 cun #32 needles into HT-7 and Yin Tang with a twisting reducing needle technique. Insert 1.5 cun #30 needles into GV-20 and GB-20 with a lifting and thrusting reducing needle technique. Retain all needles for 20 minutes. Result: After one course of treatment, all symptoms were gone. EVALUATION Acupuncture and moxibustion are very effective for treating menopause and helping to easily cope with menopausal symptoms, such as irregular menstruation, hot flashes, heart palpitations, irritable bowel movement, and distressed emotional behavior. It is very important to begin treatment early as possible to adjust and regulate body hormone levels and emotional status. Good results will be achieved from a correct TCM diagnosis, point prescription, and needling technique. During the treatment, the patient should avoid some a poor diet and negative emotions. Herbal therapy is recommended as a supplemental treatment to the acupuncture therapy.

464

Menoxenia—Menstrual Irregularities

465

Acupuncture and Moxibustion—A Clinical Desk Reference

MENOXENIA—MENSTRUAL IRREGULARITIES Menoxenia refers to disorders of the menstrual cycle, including abnormalities in the amount, color, and nature of the menstrual blood. In this category of disorders, the most common are early menstrual cycles, delayed menstrual cycles, irregular menstrual cycles, menorrhagia, and scanty menstruation. This disorder is common and affects various women of all backgrounds. Because of the various and broad nature of this disorder, many approaches can be used to treat it, though correct diagnosis is essential. Early menstruation: Most early menstruation is due to Qi Deficiency and Blood Heat. The Qi fails in controlling the Blood flow while Blood Heat induces bleeding. Qi Deficiency “Zhong Qi” Deficiency is usually caused by an improper food intake or excessive depletion. Negative emotional stimulation can impact the Spleen Qi as well. Prolonged Spleen Qi Deficiency will lead to Kidney Qi Deficiency, so labeled—Spleen and Kidney Qi Deficiency. Blood Heat There are two types of Heat syndromes in the clinic. They are: Excess Heat and Deficient Heat. Excess Heat in relation to early menstruation can be caused by a long-term consumption of hot, spicy, and greasy food, or by Liver Stagnation. When caused by improper food intake, the Heat occurs due to an accumulation of Dampness that eventually transforms to Heat and travels to the Conception and Chong meridians. In the case of Liver Stagnation, the stagnated Qi turns to Fire that disturbs the Sea of Blood— pushing the Blood into the uterus. Deficiency Heat in relation to early menstruation is usually caused by an Interior Yin Deficiency resulting from a long-term or chronic disease, or by a heavy loss of blood that damages the Yin material inside. Late menstruation: Usually, there are both Excess and Deficient types of syndromes relating to late menstruation. Generally speaking, deficiency most often refers to Yin Deficiency, Blood Deficiency, and Yang Qi Deficiency, making it difficult for Blood to be produced. Excess types are often caused by stagnation of both Qi and Blood, or by a Cold pathogenic infection that obstructs Blood circulation. Blood Cold Blood Cold refers to Blood that cannot flow well in the meridians, easily stagnating due to an invasion of Cold after a menstrual period or labor, or from an excessive intake of frozen foods during the menstrual period, causing Blood Stagnation in the Chong and Ren meridians. Deficiency Cold Yang Deficiency can occur due to body constitution or from a long-term or chronic disease. With Deficiency of Yang, there is often failure in organ nourishment and Blood production, leading to deficiency of the Sea of Blood. Blood Deficiency In this type of late menstruation, patients often have a chronic bleeding problem or a Spleen and Stomach Deficiency, which is impacted by negative emotional stimulation or by malnutrition, or other chronic diseases. Qi Stagnation Over-thinking, anger, depression, or grief will stagnate the Qi, which will obstruct the circulation of Blood in the Chong Mai and Ren Mai. 466

Menoxenia—Menstrual Irregularities

Irregular menstruation: This refers to a period that does not come at a set time, being either early or later. In TCM, it is caused by a disharmony of the Qi and Blood. Liver Stagnation The Liver houses the Blood and dominates the flow of the Qi. When the Liver stagnates, it cannot adjust the storing of Blood well, resulting in an over flow, or an over-due flow. Most of the time, this condition is caused by severe emotional stimulation. Kidney Deficiency This can occur from an innate Kidney Qi Deficiency, from over-use, or getting older in age, resulting in the inability of the Kidney Qi to adjust the Blood in the Chong and Ren meridians. DIAGNOSIS Early Menstruation An early menstrual cycle usually starts 7 days earlier than normal, or even twice a month. Excess Heat: Symptoms include a large amount of bleeding of a dark red or purple color that is thick and sticky in quality and associated with a stuffy sensation in the chest, restlessness, a reddish complexion, a dry mouth, scanty urination, and constipation. The tongue is red with a yellowish coating and the pulse is fast and slippery. Deficiency Heat: Symptoms include bleeding that is small in amount, thick and sticky with a fresh red color, and associated with a tidal fever, night sweats, Five-Hearts Heat, and soreness and weakness in the lower back and legs. The tongue is red with little or no coating and the pulse is thin and fast. Heat Stagnation: In this case, the period could be with more or less amount of blood with a purple or dark color and clots or uneven movement. It is associated with distention and a distending sensation in the chest, breast, and hypochondriac region, a bloated painful sensation in the lower abdomen, restlessness with a tendency towards anger, a bitter taste in the mouth, and a dry throat. The tongue is red with a thin white coating and the pulse is wiry and fast. Qi Deficiency: Symptoms include a large amount of bleeding of a light red color with a thin nature and is associated with heart palpitations and shortness of breath, lassitude, poor sleep and appetite, loose stool, and a weak and sinking sensation in the lower abdomen. The tongue is pale with a white thin coating and the pulse is weak. Late Menstruation A late menstrual cycle is usually 7 days late, or even once in 40 to 50 days. Excess Cold: This manifests as late menstruation with a small amount of bleeding of a dark or even black color that is associated with coldness and pain in the lower abdomen that is reduced by warmth and pressure, chilly and cold limbs, and a pale complexion. The tongue is pale with a thin white coating and the pulse is deep and tight. Deficiency Cold: Late menstruation of this kind has light bleeding that is thin in quality and associated with a cramping sensation in the lower abdomen with a preference for warmth and pressure, frequent urination, and loose stools. The tongue is pale with a white coating and the pulse is deep and slow. Blood Deficiency: This late menstruation has little bleeding that is thin in quality and associated with a pale complexion, dizziness and vertigo, blurry vision, heart palpitations, and poor sleep. The tongue is pale with little or no coating and the pulse is thin and weak.

467

Acupuncture and Moxibustion—A Clinical Desk Reference

Qi Stagnation: This type of late menstruation is with little bleeding of dark and clotted blood that is associated with pain and distention sensations in the lower abdomen, chest, breast, and hypochondriac regions. The tongue is pale with a white thin coating and the pulse is wiry.

Irregular Menstruation The menstrual cycle does not come on time and vacillates between being early or later. Liver Stagnation: This causes irregular menstruation with more or less bleeding of a dark or purple color with uneven movement and associated with distention in the chest, breast, and hypochondriac regions, sighing, and belching. The tongue is swollen, and the tip and edges are red with a thin white coating and the pulse is wiry. Kidney Deficiency: This irregular menstruation has little bleeding that is light in color and associated with soreness and weakness in the lower back and legs, dizziness, and ringing in the ear. The tongue is pale with a white thin coating and the pulse is deep and weak. TREATMENT AND PRESCRIPTIONS Early Menstruation Treatment Principle: Clear the Heat and Regulate menstruation. Point Prescription: CV-4 and SP-10. Treat 3 times a month, once during the week prior to the period, once during the period and once in the week after the period. Technique: Insert a 1.5 or 2 cun #30 needle into CV-4 perpendicularly, 1.2 to 1.5 cun deep with a twisting even movement technique and 1.5 cun #32 needles into SP-10 with a twisting reducing needle technique. Retain the needles for 20 minutes. Additional points for associated symptoms: Excess Heat: LV-3 and LI-11. Deficiency Heat: SP-6 and KI-2. Stagnation Heat: LV-2 and SP-8. Qi Deficiency: ST-36 and BL-20. Late Menstruation Treatment Principle: Warm the meridian and Harmonize the Blood. Point Prescription: CV-6, KI-13, and SP-6. Treat 4 times a month—before, during, after, and between the periods. Technique: Insert 1.5 cun #30 needles into CV-6 and KI-13 perpendicularly, 1 to 1.2 cun deep with a twisting reinforcing needle technique, and apply moxa wool to the handles of the needles for 3 cones. Insert 1 cun #32 needles into SP-6 with a lifting and thrusting reinforcing needle technique. Retain all needles for 20 minutes. Additional points for associated symptoms: Excess Cold: ST-28 and ST-25. Deficiency Cold: GV-4 and KI-3. Deficiency blood: ST-36, BL-20, and BL-17. Qi Stagnation: LV-5. 468

Menoxenia—Menstrual Irregularities

Irregular Menstruation Treatment Principle: Reinforce the Liver and Kidney, and Regulate the period. Point Prescription: CV-4 and SP-6. Treat once every other day, 10 treatments as a course. Technique: Insert a 1.5 or 2 cun #30 needle into CV-4 perpendicularly, 1.2 to 1.5 cun deep with a twisting reinforcing needle technique, and apply moxa wool to the handles of the needles for 3 to5 cones. Insert 1 cun #30 needles into SP-6 obliquely upwards at a 60-degree angle with a lifting and thrusting reinforcing needle technique. Retain all needles for 30 minutes. Additional points for associated symptoms: Liver Stagnation: LV-3, BL-18, and LV-14. Kidney Deficiency: BL-23, KI-3, and KI-5.

ADJUNCTIVE THERAPIES Moxibustion (For deficiency types of Menoxenia) Indirect moxibustion: CV-4, Zi Gong, GV-4, and BL-32. Apply indirect moxibustion with a Fu Zi (aconite) cake on these points for 3 cones. Treat once every other day, starting from a week before the period, 7 treatments as a course. Moxa-pole: CV-4, GV-4, BL-32, and SP-6. Apply moxa-pole on CV-4 and SP-6 for 20 minutes and on GV-4 and BL-32 for 10 minutes. Treat once every other day for 5 treatments as a course. Direct moxibustion: SP-3, CV-6, Zi Gong, and BL-23. Apply direct non-scarring moxibustion on SP-3, CV-6, and Zi Gong for 9 cones and on BL-23 for 11 cones. Treat twice a week for 5 treatments as a course. Ear Acupuncture Points: Uterus, Endocrine, Ovulation, Liver, Spleen, and Kidney. Select 3 points each treatment, and insert 0.5 cun #32 ear needles with a medium-level stimulation technique. Retain the needles for 30 minutes. Treat once every other day, 7 treatments as a course. Scalp Acupuncture Treatment zones: Lateral line 3 of the forehead, Middle line of the vertex, and Lateral line 1 of the vertex. Insert 1 or 1.5 cun #30 needles into these points obliquely at a 30 to 40-degree angle with a fast twisting needle technique or insert Qi technique. Retain them for 40 minutes. Treat twice a week, 10 treatments as a course. 469

Acupuncture and Moxibustion—A Clinical Desk Reference

Pricking Technique Points: GV-3 to GV-2. Look for a spot that is red, dark, or black in color near this area, and then use the three-edge needle to prick it. Treat once a week, 3 treatments as a course. Plum Blossom Treatment area: Conception, Dai-mai, and Stomach meridians on the lower abdomen, and the Governing, and Bladder meridians on the lower back. Apply a medium stimulation of plum-blossom needles on these meridian areas for 3 to 5 minutes. Treat once every other day during the period until it ends.

TRADITIONAL PRESCRIPTIONS AND TECHNIQUES For irregular menstruation that is early or late: LV-2, GB-42, and ST-25. (Zhen Jiu Jia Yi Jing) Insert 1.5 cun #32 needles into ST-25 perpendicularly, 1 to 1.2 cun deep with a twisting even movement technique and 1 cun #32 needles into LV-2 and GB-42 with a twisting reducing needle technique. Retain all needles for 30 minutes. Treat once every other day, starting a week before the period, 7 treatments as a course. For irregular menstruation that comes late: CV-6, CV-3, GB-26, BL-23, and SP-6. (Zhen Jiu Da Cheng) Insert 1 cun #30 needles into CV-6, CV-3, and SP-6 perpendicularly, 0.5 to 0.8 cun deep with a twisting even movement technique. Retain the needles for 30 minutes. Apply direct non-scarring moxibustion on GB-26 for one cone. Insert 1.5 cun #32 needles into BL-23 with a twisting reinforcing needle technique, and apply moxa wool to the handles of the needles for 3 cones. Treat once every other day starts first day of period, 7 treatments as a course. For irregular menstruation: CV-6 and KI-6. (Lei Jin Tu Yi) Insert 1.5 cun #30 needle into CV-6 perpendicularly, 1 to 1.2 cun deep with a lifting and thrusting reinforcing needle technique and 1 cun #32 needles into KI-6 with a twisting reinforcing needle technique. Retain the needles for 40 minutes. Treat once every other day during the period, 5 treatments as a course. For irregular menstruation due to Qi Stagnation: SP-8, SP-9, BL-19, and LV-2. (Bai Zhen Fu) Insert 1 cun #30 needles into LV-2 with a twisting reducing needle technique, and 1.5 cun #30 needles into SP-8 and SP-9 with a slow and fast reinforcing needle technique. Retain all needles for 20 minutes. Insert 1 cun #30 needles into BL-19 with a lifting and thrusting reducing needle technique. Retain the needles for 5 minutes. Treat once every other day starts the first day of period, 4 treatments as a course. For irregular menstruation from Kidney Deficiency: KI-13. (Author’s Clinical Experience) Apply direct non-scarring moxibustion on KI-14 for 9-11 cones in each treatment. Treat once a month starting from the last day of the period, 6 treatments as a course.

470

Menoxenia—Menstrual Irregularities

CASE ANALYSIS A 28 year-old female patient had a main complaint of early menstruation for 2 years. Her menstrual cycle was usually a week early and sometimes even twice a month. She had heavy bleeding that was dark or purple in color and thick and clotted in nature and associated with distention and bloating in the breast and chest area, a painful sensation in the lower abdomen, a poor appetite, and insomnia with irregular bowel movements. The tongue was red with a yellowish coating and the pulse was wiry and fast. Diagnosis: Disharmony of the Chong Mai and Ren Mai from stagnation of Liver Qi and Interior Heat. Treatment Principle: Soothe the Liver and regulate the Chong and Ren. Point Prescription: SP-8, SP-6, CV-4, LI-11, LV-2, BL-18, and BL-23. Treat once every other day, starting a week before the period, for 5 treatments as a course. Technique: Insert 1 cun #30 needles into BL-18 and BL-23 with a twisting even movement needle technique. Retain all needles for 10 minutes. Insert 1 cun #32 needles into SP-8, SP-6, and LV-2 with a twisting reducing needle technique and 1.5 cun #32 needles into CV-4 and LI-11 with a lifting and thrusting reducing needle technique. Retain all needles for 30 minutes. Result: After 2 courses of treatments, the period was normal. Clinical observation was kept for 3 years with the same results. EVALUATION Menoxenia refers to disorders in the menstrual cycle, with abnormalities in the amount, color and nature of menstrual blood. In this category of disorders, the most common are early menstrual cycles, delayed menstrual cycles, and irregular menstrual cycles. The early menstrual cycle is usually caused by Heat, which could be due to stagnation of the Liver Qi or stagnation from Heat in the uterus. The delayed menstrual cycle is usually related to Cold, which stagnates in the uterus. Irregular menstruation is caused from deficiency conditions, such as Qi and Blood Deficiency, Kidney Jing and Liver Blood Deficiency, or other chronic or long-term diseases. Acupuncture and moxibustion are very effective in treating Menoxenia. The point prescription is mainly selected from the Conception and the three feet Yin meridians. Moxibustion therapy is used for both delayed and irregular menstruation. It is best to treat a week before, after, and during the period.

471

Acupuncture and Moxibustion—A Clinical Desk Reference

MORNING SICKNESS Morning sickness refers to just one of many symptoms of pregnancy. Because of the universal and general nature of this disorder, it is important to treat it as a separate condition. The condition in which nausea, vomiting, dizziness, anorexia, or prompt vomiting after eating appear during pregnancy is referred to as Pernicious Vomiting (morning sickness), TCM viewing the symptoms as rebellious Stomach Qi, which is caused by the Stomach failing to descend the Qi. Based on the differences between specific symptoms, different causes can be attributed to the disorder. Stomach fails in descending the Qi During the process of pregnancy the Chong-mai Qi is much stronger than usual and rises upward to the Stomach, as a result, the Qi causes vomiting. Liver attacks the Stomach Tendency to anger or other emotional stimulation make for stagnation of the Liver Qi, which turns to Heat and attacks the Stomach causing vomiting. Damp Stagnation Accumulation of Dampness due to a deficient Spleen failing to transport and transform the fluids, rises up to impact the Stomach causing vomiting. DIAGNOSIS Deficiency of Spleen and Stomach Qi Symptoms include nausea, vomiting, anorexia after conception, accompanied with tastelessness or vomiting of saliva, drowsiness, fullness and distension in the epigastric and abdominal area, a pale tongue with a white and moist coating, and a moderate, slippery, and weak pulse. Vomiting due to Liver Heat Symptoms include vomiting of sour or bitter (bilious) fluid after conception, distension and pain in the chest and hypochondriac region, eructation and sighing, distension of the head, dizziness, excessive thirst and bitter taste, a light red tongue with a yellowish coating, and a wiry and a slippery pulse. Vomiting due to Phlegm Stagnation Symptoms include vomiting of phlegm and water, a stuffy sensation in the chest, shortness of breath, heart palpitations, tastelessness, a swollen tongue body with a white greasy coating, and a slippery pulse.

472

Morning Sickness

TREATMENT AND PRESCRIPTIONS Deficiency of Spleen and Stomach Qi Treatment Principle: Harmonize the Stomach and Spleen, and Regulate the Qi. Point Prescription: ST-36, CV-13, CV-12, and SP-4. Treat twice a week for 3 treatments as a course. Technique: Insert 1 cun #32 needles into ST-36 and SP-4 perpendicularly, 0.5 cun deep with twisting reinforcing needle technique. Insert 1 cun #34 needles into CV-12 and CV-13 perpendicularly, 0.5 cun deep with twisting even movement needle technique. Retain all needles for 15 minutes. Additional points for associated symptoms: Loose stool: BL-20 and LI-10. Vomiting due to Liver Heat Principle of Treatment: Clear the Liver, Harmonize the Stomach, and Reduce the vomiting. Point Prescription: PC-6, LV-3, CV-12, and ST-36. Treat twice a week for 3 treatments as a course. Technique: Insert 1 cun #32 needles into ST-36 perpendicularly, 0.5 cun deep with twisting reinforcing needle technique, and 1 cun #32 needles into LV-3 obliquely at a 30-degree angle upwards, 0.3 cun deep with twisting reducing needle technique. Insert 1 cun #34 needles into PC-6 transversely at a 15 to 30 degree angle upwards, 0.3 cun deep with twisting even movement needle technique, and a 1 cun #34 needle into CV-12 perpendicularly, 0.5 cun deep with twisting even movement needle technique. Retain all needles for 30 minutes. Additional points for associated symptoms: Dizziness: GV-20. Chest pain CV-17. Poor sleep: An Mian. Vomiting due to Phlegm Stagnation Principle of Treatment: Reinforcing the Spleen, Resolve Phlegm, and Harmonize the Stomach. Point Prescription: SP-9, ST-40, ST-36, CV-12, and KI-21. Treat once or twice a week for 5 treatments as a course. Technique: Insert 1 cun #32 needles into SP-9, ST-40, and ST-36 with twisting even movement needle technique. Insert 1 cun #34 needles into CV-12 and KI-21 perpendicularly, 0.3 cun deep with twisting reducing needle technique. Retain all needles for 20 minutes. Additional point for associated symptoms: Heart palpitation: BL-15 and PC-6. Headache: GV-24 and GV-25.

473

Acupuncture and Moxibustion—A Clinical Desk Reference

ADJUNCTIVE THERAPIES Ear Acupuncture Points: Liver Stomach, Spleen, San Jiao, and Shen Men. Insert 0.5 cun #32 ear needles for these points obliquely, 0.3 cun deep at a 30 to 45 degree angle with twisting reinforcing needle technique. Retain all needles for 40 minutes. Or apply press-ball on these points and retain them for 3 to 5 days. Treat twice a week for 5 treatments as a course. Scalp Acupuncture Treatment zones: Lateral line 1 and 3 of the forehead, and the Middle line of the forehead and vertex. Insert 1 cun #32 needles into these treatment zones 0.3 to 0.5 cun deep, obliquely towards face at a 30degree angle with twisting even movement needle technique. Retain all the needles for 30 minutes. Treat twice a week for 5 treatments as a course. Foot Acupuncture Points: San Jiao, Liver, and Stomach. Apply acupressure technique on these points for 5 minutes, and apply moxa pole for another 5 minutes. Treat once daily for 7 treatments as a course. Wrist and Ankle Acupuncture Treatment area: Upper 2, Upper 5, Lower 2, and Lower 5. Insert 1 cun #32 needles into these areas transversely, 0.8 cun deep at a 10 to 15 degree angle without any technique and sensation, just let the needles quite lie there fore 30 minutes. Treat once a week for 2 treatments as a course. TRADITIONAL PRESCRIPTIONS AND TECHNIQUES For morning sickness due to Liver Heat: PC-6, CV-13, SP-9, and LV-3. (Zhen Jiu Xue Jian Bian) Insert a 1 cun #32 needle into CV-13 perpendicularly, 0.5 cun deep with twisting even movement needle technique, and 1 cun #34 needles into PC-6 obliquely, 0.3 cun deep at a 45-degree angle upwards with twisting reinforcing needle technique. Insert 1 cun #32 needles into SP-9 and LV-3 perpendicularly, 0.5 cun deep with lifting and thrusting reducing needle technique. Retain all needles for 30 minutes. Treat one or twice a week for 4 treatments as a course. For morning sickness with Phlegm: BL-19, BL-20, BL-13, LU-4, PC-7, and ST-36. (Zhen Jiu Xue) Insert 1 cun #32 needles into BL-19, BL-20, and BL-13 perpendicularly, 0.5 cun deep with twisting reducing needle technique. Retain all needles for 10 minutes. Insert 1 cun #32 needles into LU-4 with twisting reducing needle technique, and 1 cun #34 needles into PC-7 and ST-36 with twisting reinforcing needle technique. Retain all needles for 20 minutes. Treat once a week for 3 treatments as a course.

474

Morning Sickness

For morning sickness due to deficiency of the Spleen: CV-17, ST-19, CV-11, and SP-4. (Zhen Jiu Xue Shou Ce) Insert 1 cun #30 needles into CV-17 and ST-19 perpendicularly, 0.3 cun deep with twisting reducing needle technique. Insert 1 cun #32 needle into CV-11 and SP-4 perpendicularly, 0.5 cun deep with twisting reinforcing needle technique. Retain all needles for 30 minutes Treat twice a week for 5 treatments as a course. For morning sickness due to deficiency: KI-1, PC-6, and GV-20. (Xin Zhen Jiu Xue) Apply moxa pole on KI-1 for 20 minutes. Treat once daily for 5 treatments as a course. Apply moxa pole on PC-6 and GV-20 for 20 minutes if patient with severe vomiting. For morning sickness with deficiency of the Qi: SP-9, ST-40, ST-36, CV-12, KI-21, and CV-17. (Zhen Jiu Da Quan) Insert 1 cun #34 needles into SP-9, ST-40, and ST-36 with twisting reinforcing needle technique, and 1 cun #32 needles into CV-12, KI-21, and CV-17 with twisting even movement needle technique. Retain all needles for 20 minutes. Treat once every other day for 5 treatments as a course. For morning sickness due to Phlegm: ST-40, CV-12, BL-19, and LU-4. (Zhen Jiu Zi Shen Jing) Insert 1 cun #34 needles into BL-19 perpendicularly, 0.5 cun deep with twisting reducing needle technique and remove the needles without retaining. Insert 1 cun #32 needles into ST-40, CV-12, and LU-4 with twisting even movement needle technique. Retain all needles for 20 minutes. Treat twice a week for 5 treatments as a course. For morning sickness due to deficient fire of the Stomach: LI-4, CV-24, LI-1, and PC-6. (Zhen Jiu Chu Fang Ji Jing) Insert 1 cun #34 needles into LI-4 and PC-6 perpendicularly, 0.3 cun deep with twisting reducing needle technique, and 1 cun #34 needles into CV-24 and LI-1 perpendicularly, 0.2 cun deep with twisting even movement needle technique. Retain all needles for 20 minutes. Treat once every other day for 5 treatments as a course. For morning sickness due to Stomach Yin Deficiency: KI-3, LV-3, ST-36, CV-17, BL-21, and BL-17. (Yi Xue Ren Men) Insert 1 cun #32 needles into BL-17 and BL-21 perpendicularly, 0.5 cun deep with twisting reinforcing needle technique. Retain all needles for 10 minutes. Insert 1 cun #32 needle into CV-17 obliquely, 0.8 cun deep at a 45-degree angle towards CV-18 with twisting reducing needle technique, and 1 cun #34 needles into KI-3, LV-3, and ST-36 with twisting reinforcing needle technique. Retain all needles for 20 minutes. Treat once every other day for 7 treatments as a course. For morning sickness due to Liver Heat: LV-2, CV-12, GV-20, and GB-34. (Zhen Jiu Za Zhi) Insert 1 cun #32 needles into LV-2 perpendicularly, 0.3 cun deep with twisting reducing needle technique, and 1 cun #34 needles into CV-12 and GB-34 with lifting and thrusting reducing needle technique. Insert a 1 cun #32 needle into GV-20 transversely, 0.8 cun deep towards GV-19 at a 30-degree angle with lifting Qi technique. Retain all needles for 20 minutes. Treat twice a week for 7 treatments as a course. For morning sickness with stagnation of Qi: PC-6, SP-4, and GB-15. (Author’s Clinical Experience) Insert 1 cun #34 needles into SP-4 perpendicularly, 0.5 cun deep with twisting reinforcing needle technique, and apply moxa wool on the handle of the needles for 2 cones. Insert 1 cun #34 needles into PC-6 transversely towards PC-5 at a 30-degree angle with twisting even movement needle technique, and 1 cun #32 needles into GB-15 transversely downwards, 0.3 cun deep with twisting even movement needle technique. Retain all needles for 20 minutes. Treat twice a week for 5 treatments as a course.

475

Acupuncture and Moxibustion—A Clinical Desk Reference

For morning sickness due to stagnation of Damp: PC-6, SP-4, BL-22, BL-14, and BL-20. (Author’s Clinical Experience) Insert 1 cun #30 needles into BL-20, BL-14, and BL-22 perpendicularly, 0.5 cun deep with waving technique for 3 minutes and remove all the needles without retaining them. Insert 1 cun #32 needles into SP-4 and PC-6 perpendicularly, 0.3 cun deep with twisting even movement needle technique. Retain all needles for 30 minutes. Treat once every other day for 5 treatments as a course. For morning sickness due to rebellious Stomach Qi: ST-44, LV-2, GB-44, CV-12, and SP-9. (Author’s Clinical Experience) Insert 1 cun #32 needles into CV-12 and SP-9 perpendicularly, 0.5 cun deep with twisting even movement needle technique. Insert 1 cun #34 needles into ST-44, LV-2, and GB-44 perpendicularly, 0.3 cun deep with twisting reducing needle technique. Retain all needles for 20 minutes. Treat once every other day for 5 treatments as a course. CASE ANALYSIS A 30 year-old female with the main complaint of morning sickness for 2 weeks sought treatment with acupuncture. Her complaint was associated with a pale complexion, dizziness, vomiting of the phlegm and water, a stuffy sensation in the chest, poor appetite, and tastelessness. The tongue was swollen with a white greasy coating, and the pulse was slippery. Diagnosis: Conception vomiting. Treatment Principle: Reinforce the Spleen, Harmonize the Stomach, and Resolve Phlegm. Point Prescription: LV-3, ST-40, and PC-6. Treat once every three days for 3 treatments as a course. Technique: Insert 1.5 cun #34 needles into ST-40 perpendicularly, 1 cun deep with twisting reinforcing needle technique, and 1 cun #32 needles into LV-3 and PC-6 with twisting even movement needle technique. Retain all needles for 20 minutes. Result: After retaining the needles for 10 minutes, the vomiting sensation was reduced and she felts a little hungry, and all the other symptoms were reduced. All the symptoms were resolved after three treatments. EVALUATION Acupuncture and moxibustion are very effective for treating morning sickness symptoms. Correct point selection and needle technique are the key points of treatment to prevent hurting the Interior Qi, which is needed during the pregnancy. It is better to select less than 5 points in each treatment with a superficial insertion and gentle needle technique. The best treatment time is in the morning between 7 and 11 o’clock, the time of Yang Ming and Tai Yin meridian Qi flow, which means acupuncture will more easily adjust the Stomach and Spleen Qi. During the treatments the patient should avoid intake of hot food. Advise them to take room temperature to cool temperature food and drink.

476

Premenstual Tension Syndrome

477

Acupuncture and Moxibustion—A Clinical Desk Reference

PREMENSTRUAL TENSION SYNDROME Premenstrual tension syndrome includes a series of symptoms such as distending pain in the breasts, headache and dizziness, restlessness and insomnia, distention in the chest and hypochondriac region, edema, diarrhea, restless sleep and general emotional changes, which appears before or during menstruation. Liver Stagnation Long term unhealthy emotional stimulation impacts Liver causing the Liver to fail in controlling the flow of Qi and the housing of the Blood. Kidney Deficiency Over work or excessive sexual drive makes the Kidney Qi and Jing-Essence deficient, which in tern fails to nourish the Chong and Ren meridians, as well as the uterus. Yang and Qi Deficiency Cold body constitutions or improper food intake hurt the Yang Qi inside the body, and as a result the menstruation will become stuck and hard to move. Blood Stagnation Stagnation of Blood will impact circulation in the meridians and uterus, causing pain and tenderness all the time. Water retention Spleen and Lung Deficiency can cause failure in the metabolism of the water, particularly retention of water in the meridians and the uterus causing PMS. Internal Heat Yang body constitutions, or over eating some hot, spicy, or greasy food causes accumulation of Dampness that can turn to Heat, which will damage the Blood Luo meridian causing bleeding symptoms during period. Blood Deficiency General body Qi and Blood Deficiency cannot fill up the uterus before the period, resulting in stagnation, tenderness, and nausea or sometimes bad emotions.

478

Premenstual Tension Syndrome

DIAGNOSIS Liver Qi Stagnation Symptoms include distention and fullness in the breasts, dizziness, headache, distending pain in the lower abdomen or chest and hypochondriac area, belching, sighing, restlessness, tendency for anger, depression and stress, even insomnia. The tongue is red on the tip and edges, with a thin white coating and the pulse is wiry. Liver and Kidney Yin Deficiency The main symptom in this category is breast distention during or after the period. It is associated with sore and weakness in the low back and both knees, dry eyes, dry throat and mouth, five hearts heat, low grade fever, and in some cases there is slight bleeding from the nose, and possible ulcer at the corner of the mouth. The tongue is red without a coating and the pulse is thin and fast. Blood Heat The main symptoms include a reddish complexion and lips, and hot sensations in the whole body before or during the period. Associated signs are restlessness, a tendency for anger, dry mouth, thirst, dry itchy skin, yellowish or scanty urination, and constipation. The tongue is red with a thin yellow coating and the pulse is slippery and fast. Qi Deficiency Symptoms include chills with slight fever, spontaneous sweating, fatigue, low spirits, shortness or breath, no energy to talk, bloated abdomen, and loose stool. The tongue is pale with a thin white coating and the pulse is thin and weak. Qi and Blood Stagnation Symptoms including low-grade fever, achy joints and pain reduced by warmth, low abdominal pain, stuffiness in the chest, epigastric, and hypochondriac region, and a heavy and swollen sensation in the whole body. The tongue is dark or black with purple dots and the pulse is deep, wiry, or choppy. Blood Deficiency Symptoms include heart palpitations, headache, dizziness, poor sleep, restlessness, lack of vitality with asthenia, numbness in the body and four extremities, or itching of the skin, excessive thin clear leukorrhea, and a scanty period with a light red color and thin quality. The tongue is pale with a thin white coat and pulse is thin and weak. Insufficient Yang of both the Kidney and Spleen Symptoms include edema in the face and limbs, dizziness and vertigo, tinnitus, bodily languor, drowsiness, loss of appetite, loose stool, abdominal distention, lassitude in the loins and legs, a light colored blood during the period with a thin quality. The tongue is swollen with teeth marks on its margin, white, and with moist coating, accompanied by a deep and slow pulse. Phlegm Stagnation with Heat Symptoms include headache, insomnia—possibly even with a mental disorder, restlessness, stuffiness in the chest, irritability, bitter taste in the mouth, and hot flushes or fever. The tongue is red with a thick yellow coating and the pulse is slippery and fast. 479

Acupuncture and Moxibustion—A Clinical Desk Reference

TREATMENT AND PRESCRIPTONS Liver Qi Stagnation Treatment Principle: Soothe the Liver and Regulate the Cong and Ren meridians. Point Prescription: CV-4, LV-13, GV-20, SP-4, LV-3, and SP-9. Treat once a week for 7 treatments as a course. Technique: Insert 1.5 cun #32 needle into CV-4 perpendicularly, 1.2 cun deep with twisting even movement needle technique, and apply moxa wool to the handle of the needle for 3 cones. Insert 1 cun #30 needles into LV-13, LV-3, and SP-4 with twisting reinforcing needle technique, and 1.5 cun #32 needles into GV-20 and SP-9 with lifting and thrusting reducing needle technique. Retain all needles for 20 minutes. Additional points for associated symptoms: Breast tenderness: TW-6 and SI-4. Tendency for anger: LV-3 and LI-4. Insomnia: An Mian and HT-7. Liver and Kidney Yin Deficiency Treatment Principle: Reinforce Kidney and Liver Yin and Regulate menstruation. Point Prescription: KI-3, LV-3, BL-18, BL-23, CV-4, SP-6, and GV-14. Treat twice a week for 10 treatments as a course. Technique: Insert 1.5 cun #32 needles into BL-18, BL-23, and GV-14 perpendicularly, 1 cun deep with twisting reinforcing needle technique. Retain all needles for 10 minutes. Insert 1 cun #30 needles into LV-3, KI-3, and SP-6 with twisting reinforcing needle technique, and 1.5 cun #32 needles into CV-4 with twisting even movement needle technique. Retain all needles for 30 minutes. Additional points for associated symptoms: Breast tenderness: TW-5 and ST-44. Dry mouth: KI-6 and CV-24. Bleeding: SP-1 with direct non-scarring moxibustion for 9 cones. Blood Heat Treatment Principle: Cool the Blood and Regulate the Cong and Ren meridians. Point Prescription: LV-2, LI-11, SP-9, CV-3, BL-17, and GV-14. Treat once every other day 5 treatments as a course starts a week before the period. Technique: Insert 1.5 cun #32 needles into BL-17 and GV-14 perpendicularly, 1 cun deep with twisting reducing needle technique. Retain all needles for 5 minutes. Insert 1.5 cun #30 needles into CV-3, SP-9, and LI-11 with lifting and thrusting reducing needle technique, and 1 cun #32 needles into LV-2 with twisting reducing needle technique. Retain all needles for 20 minutes. Additional points for associated symptoms: Hot flushes: KI-1 and HT-6. Thirst: CV-24 and KI-6.

480

Premenstual Tension Syndrome

Qi Deficiency Treatment Principle: Reinforce the Qi and Regulate menstruation. Point Prescription: SP-6, CV-6, CV-17, ST-36, BL-24, and BL-21. Treat once every other day for 7 treatments as a course. Technique: Insert 1.5 cun #32 needles into BL-24 and BL-21 perpendicularly, 1 cun deep with lifting and thrusting reinforcing needle technique, and apply moxa wool to the handle of the needles for 3 cones. Insert 1 cun #32 needles into SP-6, CV-17, and ST-36 perpendicularly, 0.5 cun deep with twisting reinforcing needle technique, and 1.5 cun #32 needles into CV-6 perpendicularly, 1 cun deep with lifting and thrusting reinforcing needle technique, applying moxa wool to the handle of the needle for 3 cones. Additional points for associated symptoms: Loose stool: ST-25 and SP-4. Shortness of breath: LU-5 and BL-13. Spontaneous sweat: BL-43 and CV-14. Qi and Blood Stagnation Treatment Principle: Resolve the Blood Stagnation and Regulate menstruation. Point Prescription: CV-4, SP-10, ST-28, LI-11, BL-17, BL-20, and Shi Qi Zhui Xia. Treat once every other day for 7 treatments as a course. Technique: Insert 1.5 cun #30 needles into CV-4 and ST-28 perpendicularly, 1 to 1.2 cun deep with twisting even movement needle technique, and 1.5 cun #30 needles into SP-10 and LI-11 with lifting and thrusting reducing needle technique. Retain all needles for 20 minutes. Insert 1 cun #32 needles into BL-17 and BL-20 perpendicularly, 0.8 cun deep with twisting even movement needle technique and retain the needles for 5 minutes. Apply a fire cup on Shi Qi Zhui Xia for 3 minutes. Additional points for associated symptoms: Severe pain: LI-4 and SP-6. Breast tenderness: ST-12 and LV-3. Blood Deficiency Treatment Principle: Reinforce Blood and Harmonize the Cong and Ren meridians. Point Prescription: SP-6, CV-4, ST-36, BL-17, BL-18, BL-20, and BL-23. Treat once every other day for 10 treatments as a course. Technique: Insert 1 cun #32 needles into BL-17, BL-18, BL-20, and BL-23 perpendicularly, 0.5 cun deep with twisting reinforcing needle technique, and apply moxa wool on the handle of the needles for 2 cones each. Insert 1.5 cun #32 needles into CV-4 and SP-6 with twisting reinforcing needle technique, and apply moxa wool on the handle of the needles for 3 cones. Insert 1.5 cun #32 needles into ST-36 with lifting and thrusting reinforcing needle technique. Additional points for associated symptoms: Dizziness and vertigo: GV-20 and Yin Tang. Insomnia: HT-7 and PC-3. Numbness limbs: LV-13 and GB-34.

481

Acupuncture and Moxibustion—A Clinical Desk Reference

Insufficient Yang of both the Kidney and Spleen Treatment Principle: Warm the Kidney and Spleen Yang, and Regulate menstruation. Point Prescription: CV-4, GV-4, LV-13, and SP-4. Treat once every other day for 10 treatments as a course. Technique: Apply direct non-scarring moxibustion on GV-4 for 11 cones. Insert 1.5 cun #32 needles into CV-4 perpendicularly, 1 cun deep with lifting and thrusting reinforcing needle technique, and apply moxa wool on the handle of the needle for 5 cones. Apply direct non-scarring moxibustion on LV-13 and SP-4 for 9 cones. Additional points for associated symptoms: Edema: indirect moxibustion on CV-9 with ginger for 5 cones. Loose stool: ST-25 ST-37 Phlegm Stagnation with Heat Treatment Principle: Reinforce the Spleen, Resolve Phlegm, Calm the mind, and Regulate the Chong and Ren-mai. Point Prescription: SP-6, CV-3, CV-15, LU-5, PC-5, BL-15, BL-20, and GV-14. Treat once every other day for 5 treatments as a course starts a week before the period. Technique: Insert 1.5 cun #30 needles into SP-6 obliquely at a 60-degree angle upward, 1 cun deep with twisting reducing needle technique, and a 3 cun #32 needle into CV-3 with twisting reducing needle technique. Insert 1.5 cun #32 needles into LU-5, PC-5, and CV-15 perpendicularly, 1 cun deep with twisting even movement needle technique. Retain all needles for 20 minutes. Insert a 1.5 cun #30 needle into GV-14 perpendicularly, 1.2 cun deep with rubbing needle technique (rub the needle count-clockwise) until the sensation of the needle travels. Insert 1 cun #32 needles into BL-15 and BL-20 with lifting and thrusting reinforcing needle technique. Retain all needles for 10 minutes. Apply a fire cup on GV-14 for 3 minutes after taking out the needle. Additional points for associated symptoms: Headache: GV-21, GV-23, and GB-20. Mental disorder: LI-4, GV-20, and GV-26.

ADJUNCTIVE THERAPIES Ear Acupuncture Points: Shen Men, Endocrine, Sub cortex, Liver, Heart and Uterus. Insert 0.5 cun #32 ear needles into these points obliquely at a 45-degree angle, 0.3 cun deep with fast twisting needle technique. Retain all needles for 40 minutes. Treat once every other day for 5 treatments as a course starts a week before period. Scalp Acupuncture Points: Middle line and Lateral line 3 of the forehead, and Middle line of vertex. Insert 1.5 cun #30 needles into these lines transversely at a 30-degree angle, 1 cun deep with fast twisting needle technique. Retain all needles for 30 minutes. Treat once every other day for 3 treatments as a course starts a week before the period.

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Premenstual Tension Syndrome

Wrist and Ankle Acupuncture Treatment area: Upper 1, Upper 3, Lower 3, and Lower 5. Insert 1.5 cun #32 needles into these areas transversely, 1.2 cun deep without any sensation and any needle technique. Adjust it if the patient feels any sensation, until no sensation is felt. Retain all needles for 40 minutes. Treat once every other day for 5 treatments as a course starts a week before period. Cupping Treatment area: Back and ST-25. Apply moving cup on back, moves up and down along Bladder meridian from BL-27 to BL-33 for 5 minutes. Apply fire cups on ST-25 for 3 minutes. Treat twice a week for 3 treatments as a course starts the first day of symptoms appears. Moxibustion (For Deficiency of Yang, Qi, and water retention during PMS) Direct moxibustion Apply direct non-scarring moxibustion on SP-4, LV-1, and LV-13 for 9 cones. Treat once every other day for 5 treatments as a course. Indirect moxibustion with ginger or Fu Zi (aconite) cake Apply indirect moxibustion with ginger or Fu Zi cake on GV-4, BL-23, BL-33, and CV-6 for 5 cones. Treat once every other day for 5 treatments as a course. Moxa pole Apply moxa pole on GV-20 and CV-4 for 25 minutes. Treat once daily during the PMS until symptoms gone. Plum Blossom Treatment area: SP-6, GV-20, and the Back. Apply medium-level stimulation of plum blossom needle technique on SP-6 and GV-20 for 5 minutes, and on the back follow the GV and BL line up and down from GV-14 to GV-7 and BL-11 to BL-17 for 5 minutes. Treat twice a week for 5 treatments as a course starts a week before period. Bloodletting (For Blood Heat type of PMS) Point Prescription: PC-3, BL-40, and GV-3. Look for tiny purple veins near the PC-3, BL-40, and GV-3 area, applying bloodletting technique there. Treat once a week for 2 treatments as a course starts a week before period.

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TRADITIONAL PRESCRIPTIONS AND TECHNIQUES For PMS with deficiency symptoms: CV-9, SP-6, BL-43, and CV-4. (Zhen Jiu Da Cheng) Apply moxibustion with ginger on CV-4 for 3 cones. Insert 1.5 cun #32 needles into CV-9 and SP-6 perpendicularly, 1 cun deep with twisting even movement needle technique, and apply moxa wool on the handle of the needles for 3 cones. Insert 1 cun #32 needles into BL-43 with the Qi Ci needle technique— one needle in the middle and another two needles on either side. Apply moxa pole on the side of the needles for 10 minutes. Treat once every other day for 7 treatments as a course. For PMS due to stagnation of the Qi: CV-17, PC-6, and SP-4. (Nan Jing) Insert a 1.5 cun #32 needle into CV-17 obliquely at a 60-degree angle downwards, 1 cun deep with twisting even movement technique, and 1 cun #32 needles into PC-6 and SP-4 perpendicularly, 0.5 cun deep with twisting reinforcing needle technique. Retain all needles for 30 minutes. Treat once every other day for 5 treatments as a course starts a week before the period. For PMS due to Qi and Blood Stagnation: CV-12 and SP-10. (Bai Zhen Fu) Insert 1.5 cun #30 needles into SP-10 perpendicularly, 1 cun deep with the Bai Hu Yao Tou—White Tiger shakes its head technique. Apply moxa wool on the handle of the needles for 3 cones. Insert a 1.5 cun #32 needle into CV-12 perpendicularly, 1 cun deep with twisting reinforcing needle technique. Retain needles for 20 minutes. Treat once every other day for 7 treatments as a course starts a week before the period. For PMS due to insufficiency of Kidney and Liver: Bai Lao, BL-23, and CV-4. (Zhen Jiu Da Cheng) Insert 1.5 cun #30 needles in to Bao Lao perpendicularly, 1 cun deep with lifting and thrusting reinforcing needle technique, and apply moxa wool on the handle of the needles for 3 cones. Insert 1 cun #30 needles into BL-23 with twisting reinforcing needle technique, and apply moxa wool on the handle of the needles for 3 cones. Insert a 3 cun #32 needle into CV-4 perpendicularly, 2 cun deep with twisting reinforcing needle technique, and apply moxa wool on the handle of the needle for 5 cones. Treat once twice a week for 7 treatments as a course. For PMS due to stagnation of Qi and Damp: KI-1, GV-20, and CV-3. (Zhen Jiu Da Quan) Insert 1 cun #32 needles into KI-1 perpendicularly, 0.8 cun deep towards LV-3 with twisting reinforcing needle technique, and apply moxa wool on the handle of the needle for 3 cones. Insert a 3 cun #32 needle into CV-3 perpendicularly, 2 cun deep with twisting reducing needle technique, and a 1 cun #30 needle into GV-20 with the lifting Qi technique. Retain all needles for 30 minutes. Treat twice a week for 5 treatments as a course starts a week before the period. For PMS due to deficiency of Kidney and Spleen: BL-11, BL-42, BL-23, and SP-8. (Zhen Jiu Da Quan) Insert 1.5 cun #30 needles into SP-8 with twisting reducing needle technique, and take out the needles after the sensation of the needles travels. Insert 1.5 cun #32 needles into BL-11 and BL-23 perpendicularly, 1 cun deep with lifting and thrusting reinforcing needle technique, and 1 cun #32 needles into BL-42 obliquely at a 45-degree angle, towards the BL-43 direction, 0.5 cun deep with waving technique. Apply moxa wool on BL-11 and BL-23 for 3 cones. Treat once every other day for 7 treatments as a course. For PMS with mental problems: LI-4, LI-11, SP-6, and GV-26. (Zhen Jiu Da Cheng) Insert 1.5 cun #30 needles into LI-11 perpendicularly, 1.2 cun deep with twisting, lifting and thrusting reducing needle technique. Insert a 1 cun #32 needle into GV-26 obliquely at a 60-degree angle upwards, 0.3 to 0.5 cun deep with twisting even movement needle technique, and 1.5 cun #30 needles into LI-4 and SP-6 with twisting reducing needle technique. Apply the needle technique every 5 minutes during the 40 minutes of treatment. Treat once every other day for 3 treatments as a course starts the first day symptoms appears. 484

Premenstual Tension Syndrome

For PMS due to stagnation of Qi and Phlegm: CV-5, TW-5, and LV-1. (Zhen Jiu Ru Men) Apply direct non-scarring moxibustion on LV-1 for 9 cones. Insert 1.5 cun #32 needle into CV-5 with twisting reducing needle technique, and 1.5 cun #30 needles into TW-5 with lifting and thrusting reducing needle technique. Retain all needles for 20 minutes. Treat once every other day for 5 treatments as a course starts a week before the period. For PMS with Interior Deficiency Heat: BL-23, GV-9, KI-2, and HT-6. (Author’s Clinical Experience) Insert 1.5 cun #30 needles into GV-9 perpendicularly, 1 cun deep with rubbing technique (twist the needle counter clockwise), and then insert 1.5 cun #32 needles into BL-23 with a twisting even movement needle technique. Retain all needles for 10 minutes. Insert 1 cun #32 needles into KI-2 perpendicularly, 0.5 cun deep with twisting reinforcing needle technique, and 1 cun #32 needles into HT-6 with twisting reducing needle technique. Retain all needles for 20 minutes. Treat twice a week for 7 treatments as a course. For PMS due to Blood Stagnation: BL-32, BL-17, BL-18, BL-63, SP-6, ST-28, and TW-5. (Author’s Clinical Experience) Insert 3 cun #30 needles into BL-32 perpendicularly, 2 cun deep with twisting reducing needle technique, and apply moxa wool on the handle of the needles for 3 cones. Insert 1 cun #30 needles into BL-17, BL-18, and BL-63 with twisting even movement technique. Retain all needles for 10 minutes. Insert 1.5 cun #30 needles into SP-6 obliquely, 1 cun deep at a 60-degree angle upwards with the Bai Hu Yao Tou—White Tiger shakes its head technique, and 1.5 cun #32 needles into TW-5 and ST-28 with twisting even movement needle technique. Retain all needles for 20 minutes. Treat once every other day for 7 treatments as a course starts a week before the period. CASE ANALYSIS A 30-year-old female patient presented with a main complaint of PMS for 3 years. One week before every period, she felt cramping and a bloating sensation in low abdomen. Symptoms associated with her complaint were a tendency for anger, sighing, distention and a distending sensation in the breast, chest, and hypochondriac region, poor appetite, loose stool, a slight headache, and dizziness. All symptoms would be reduced when the period came, which was dark in color and thick in quality with black clots. The tongue was red with a thin yellow coating and the pulse was wiry. Diagnosis: PMS due to stagnation of Liver Qi. Treatment Principle: Soothe the Liver, Regulate the Qi, and Resolve the stagnation. Point Prescription: ST-28, SP-6, LV-3, LV-13, GV-20, BL-13, and BL-18. Treat twice a week for 5 treatments as a course start the symptoms appears. Technique: Insert 1 cun #30 needles into BL-13 and BL-18 perpendicularly, 0.5 cun deep with lifting and thrusting reducing needle technique, and retain all the needles for 10 minutes. Insert 2 cun #32 needles into ST-28 perpendicularly, 1.5 cun deep with twisting even movement needle technique, and 1 cun #32 needles into SP-6, LV3, and LV-13 perpendicularly, 0.5 cun deep with twisting reducing needle technique. Insert a 1.5 cun #32 needle into GV-20 transversely, 1 cun deep at a 30-degree angle backwards, with a fast twisting needle technique. Retain all needles for 20 minutes. Result: The symptoms reduced after 2 treatments, and she had a peaceful period during the first course of treatment. All symptoms resolved after 3 courses—three months, because the treatment started the first day the symptoms appear.

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Acupuncture and Moxibustion—A Clinical Desk Reference

EVALUATION In Traditional Chinese Medicine, there is no PMS chapter in an acupuncture book. This is thought of as a combination syndrome occurring before, during, and after the menstruation, such as dysmenorrhea, irregular bleeding, edema, headache, and Qi stagnation. Acupuncture and moxibustion are very effective in the treatment of any type of PMS by a correct diagnosis and point selection, as well an effective needle technique. The patient should avoid emotional stimulation, stop alcohol, cigarette, and hot spicy food intake during treatment. Relaxed exercises and good sleep will help during the treatment as well.

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SECTION THREE Technique Reference

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Needle Control: Accidents in the Clinic

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Acupuncture and Moxibustion—A Clinical Desk Reference

CHAPTER I: TRADITIONAL NEEDLE TECHNIQUE

NEEDLE CONTROL: ACCIDENTS IN THE CLINIC Generally speaking, acupuncture is a very safe and effective treatment method when the practitioner makes appropriate selection of point, size of needle, and needle technique. But sometimes in special cases, when the practitioner does not pay enough attention to the patient and technique, accidents involving the needle may occur. This chapter is dedicated to discussing some common accidents that occur in the clinic. By explaining the nature and treatment of these accidental problems, it is hoped that this chapter will serve as a way of preventing such accidents. Fainting Problem: The first sign of fainting usually occurs during the acupuncture treatment. The patient suddenly may feel dizzy and experience vertigo, blurry vision, heart palpitations and shortness of breath. Also secondary symptoms may include cold spontaneous sweating, and stuffy sensation in the chest, nausea or vomiting, and a hidden pulse. In some severe cases, the patient may even feel extremely cold on the four extremities. The patient may faint, experience loss of muscle control in extremities, or loss of control of bowl movement and urination. Causes: When the patient suffers from Qi deficiency syndromes such as symptoms of severe of pain, exhaustion, hunger and profuse sweating, large amounts of bleeding or frequent diarrhea, they may be the most susceptible to fainting during acupuncture treatment. Another possible cause may be attributed to patients who are in improper positions during treatment and those patients who are very fearful of needles. Treatment: First stop needle insertion immediately and take out all of the needles. Release the clothes and let patient lie down on the treatment table with support under the legs to promote circulation to the brain. Another method is to let patient drink a cup of warm water, making most of the light symptoms gone after 3-5 minutes. Occasionally, moxibustion is a very effective tool. Apply moxa-pole on the GV-20 PC-6 ST-36 and KI-1 for 5-6 minutes and main symptoms of dizziness and vertigo should disappear. If the patient is already unconscious, use the points GV-26, PC-6, KI-1 and ST-36 with lifting and thrusting and twisting reducing needle technique to awake the patient. If this does not work within 5 minutes of treatment, send the patient the to emergency room immediately. Prevention: The practitioner should pay more attention to the patient’s physical body constitution, emotional activity, and their response to needle stimulation. Particularly for patients whom are new to acupuncture, the clinician must first describe in detail to the patient the expected sensations during the treatment. Usually it is better to let them lie down and relax for a few minutes before acupuncture therapy. Do not select too many points in each treatment and avoid strong stimulation in same sensitive points such as LI-4 and PC-6 when treating weakness or stagnation of Qi. It is always recommended for patient to have some energy before treatment. Therefore patients should arrive at the clinic with some food in their stomachs. During the acupuncture treatment, the practitioner should also keep watching the patient’s reactions to know the pre-fainting symptoms such as pale complexion, lassitude, stuffy chest, nausea, dizziness and vertigo, or a pulse of increasing speed. If the patient has those pre-symptoms one should stop treatment as soon as possible. The Nei Jing chapter Wu Jing explains, “never treat patients when they are in extreme deficiency, never treat patients after heavy bleeding, never treat patients after profuse sweating, and never treat a patient after severe diarrhea.” Also in the Zhong Shi chapter of the Ling Shu it states “never treat drunken patients, never treat angry patients, never treat an over-tired person, never treat immediately after a meal, never treat hungry patients, never treat thirsty patients, and never treat people who are very frightened.”

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Stuck Needle Problem: This occurs when the needle is stuck in the patient and it is hard to move via lifting or thrusting. Cause: This problem is usually caused by involuntary muscle contractions or spasms. This involuntarily muscle reflex may be caused by improper needle technique, uneven movement of finger force when moving the needle, sudden unexpected movement of the patient during treatment, or due to the patient being overly tense. Treatment: Most of the times the patient just needs to change back to the original position when the needle was first inserted and where it caused the spasm. To resolve the stagnation of the Qi, press on the side of the point where the needle is stuck until it releases. Another technique is to insert one more needle beside the stuck needle, and take out the stuck needle. If needles are tightly stuck in some point and hard to move, it is better to apply moxa-pole on the side of needle for 15-20 minutes help to move the stagnation of the Qi and then take the needle out. Prevention: Because most stuck needles are caused by the patient being overly tense, it is important to provide a good explanation of acupuncture before beginning the treatment in order to relax the patient. Explain the sensation of the needle, and how they can co-operate during the treatment when the needle is in the body. For example, when needling some points that are close to tendons and ligaments, either do not use too strong needle stimulation techniques or allow the patient to move the limbs during the retention of the needle. In some severe pain cases, be careful to use reducing needle technique and particularly pay more attention when applying rubbing or waving needle techniques. Broken Needle Problem: Most needle breaks occur after withdrawing the wrong way or due to wrong performance of needle manipulation techniques. Causes: Low quality one-time use needles are the most common cause of broken needles. It often occurs when the practitioner does not check the needle before treatment, or during the treatment applies improper needle technique that causes strong muscle contraction. Another factor may be the retention of the needle when the patient changes the position of limbs, which can cause pain, and spasm of muscles leading to a broken needle. Low quality electroacupuncture machines are another common cause of broken needles. Low quality machines will suddenly increase the output of current causing the muscle to spasm tightly. Treatment: Explain to the patient that they should not to move their body and limbs during the retention of the needle. In the case of a broken needle, take it out with forceps carefully. If the needle cannot be seen on the surface of body, the patient should go to the emergency room and check it under an X-ray. Prevention: Carefully check every needle before insertion. Select a suitable needle before treatment, meaning a needle in length that will ensure that 0.5 cm will be retained out of the body. Do not insert the entire needle into body during the treatment. For example, when the treatment calls for a one cun insertion, it is better to select a 1.5 cun needle and keep 0.5 cun outside of the body. When the needle is bent or stuck in the point, remove and do not re-use it again. The practitioner must also carefully check the electro-acupuncture machine before using it. Turn the knob to 0 before application, and during the treatment carefully watch the output of current, do not increase immediately. Stop use if the patient has a muscle spasm or severe pain from the stimulation.

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Hematoma Problem: It is common to find small or large purple Hematoma appearing on the local treatment area after acupuncture treatment if the practitioner is not careful with their needle technique. Causes: This problem is usually caused by the damage of small blood vessels by the needle during the treatment. It happens most frequently when the practitioner does not check to make sure the point location is correct or due to use of low quality needles, possibly with hook-like deformity on the tip of the needle. Treatment: General speaking, a small area of bleeding does not require treatment. It usually will resolve after a few days or after massaging the local area. In some severe cases, when the patient has large, swollen, and sometimes pain that limits the joint movements, apply an ice pack on the local area within 24 hours, and then apply a hot patch after 24 hours to help absorb the Blood stasis. Prevention: Clinicians should carefully check all needles before insertion and get rid of needles with hook-like deformities on the tip. Also, do not use strong stimulation in points, which are close to blood vessels, such as BL-1, PC-3, and LU-5. The practitioner should also be familiar with anatomic structure, moving the needle gently and avoiding strong lifting and thrusting techniques. Also be sure to watch for the floating veins on the surface of skin in order to avoid them. It is important to press a while during and after removal of the needle with Q-tips or cotton swabs. Discomfort after treatment Problem: Patient has sensations of discomfort after needle therapy such as: soreness, heaviness, numbness and pain in muscle tissue. Causes: Retaining the needle for an extensive amount of time is the most common cause of this problem. The application of improper needle technique to sensitive points is another common cause. Treatment: Massage will help a lot after treatment, particularly for local discomfort of certain points. For some severe cases one may apply needle or acupressure technique on the extra point “Wai Lao Gong” (located on the other side of palm from PC-8) for the sensation on the upper extremities, or on the LV-3 for the sensation on the lower extremities. When the discomfort sensation is in the body and head, it is better apply moxa pole on the local area for 15 minutes in order to move the stagnation of the Qi and Blood to release the discomfort sensation. Prevention: Do not apply strong needle technique when the patient has a deficiency condition. Do not insert the needle too deep. Apply the open and close acupuncture hole technique when finishing treatment and massage a while for most deficiency cases. Do not retain the needle too long. Generally, it is better to only retain the needle for 10 to 15 minutes. Injured Lung: Traumatic pneumothorax Problem: During or after acupuncture treatment some patients may feel chest pain, stuffy sensations, heart palpitations, and shortness of breath. In some severe cases patient will have difficulty breathing, the heartbeat will increase, the lips might turn purple, and the patient may even experience shock. X-ray will show a clear diagnosis for traumatic pneumothorax.

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Needle Control: Accidents in the Clinic

Causes: A practitioner who does not pay attention to the angle and depth of the needle in the points that reside in upper back or front of the chest usually causes this problem. Sometimes it will occur during the retention of the needle in the upper back, where the needle inside injures the lung automatically with the movement of the breath. Treatment: Most of the light symptoms of pneumothorax do not need to be treated unless the ruptured lung is more than 30% pressed by air. This lung pressure can be determined through chest x-rays. However to ensure the safety of the patient, a chest x-ray should be taken immediately in the emergency room after a patient is suspected of suffering from a pneumothorax due to acupuncture treatment. Prevention: The practitioner must understand the patient’s disease well and pay more attention on the depth and angle of the needle insertion. It is usually better to apply oblique and transverse insertions instead of perpendicular insertions on the upper back points. Do not retain the needle perpendicular in upper back points and chest points over 10 minutes. To understand and distinguish the difference between traumatic pneumothorax and automatic pneumothorax, and to avoid stimulating the points in patients with automatic pneumothorax history due to chronic asthma and bronchitis, is the crucial key in avoiding this common problem. Injury of other organs Problem: During treatment it is possible that the needle may injure the liver or the spleen. In such cases the patient feels bloating and radiating, traveling pain in the abdominal area that may also reflect to the upper back. Abdominal muscle spasm and rebound pain appears when patient have a large amount of bleeding. Low back pain sensations and knocking pain on the low back region after acupuncture treatment is mostly due to injury to the kidneys. In those patients urinal bleeding will be found in those patients. Severe internal organ bleeding by needle injury will also decrease the blood pressure and cause shock. Causes: This problem is commonly caused by practitioners who do not understand the patient’s body well, particularly when they have swollen organs due to certain illnesses. If the clinicians apply improper needle technique in some point that is too close to the organs, for example, needling BL-52 to treat low back pain. That point just above the kidney and if needled over 1.5 cun deep, the needle will definitely insert into kidney causing bleeding in the urine and local tissues. Sometime injury will occur during the retention of the needle as well. Occasionally when an organ moves up and down due to breathing, the tip of needle may scratch the organ. Treatment: Most of the time light bleeding does not need treatment. The symptoms will resolve after the first initial 48 hours, if the patient has good periods of rest. But in severe bleeding cases when the patient suffers from severe pain and bloating after treatment, one must send them to the emergency room as soon as possible. Prevention: Detailed examination of the patient is necessary before treatment. The clinician must understand if patient has a swollen liver or other organs with some disease. Practitioners must control the needle in safe depth, particularly when the point is near some important organs. Also avoid strong lifting and thrusting and twisting needle technique in those areas. When retaining the needle, it be should kept in a safe depth, particularly for the points close to organs.

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Acupuncture and Moxibustion—A Clinical Desk Reference

Injured brain and spinal cord Problem: During or after treatment, the patient suddenly experiences severe shooting and radiating sensations associated with severe headache, nausea, projecting vomit, even loss of consciousness in some severe cases. Causes: The practitioner did not understand anatomic structure, and applied improper needle technique in some point too close to the brain and/or spinal cord, such as CV-16, GB-20, or GV-14. It is also possible that the practitioner did not pay enough attention to the angle and depth of needle as well. Treatment: Light symptoms will resolve after rest, and if the patient has severe headache and severe vomiting, they should be sent to the emergency room as soon as possible. Prevention: One must understand anatomic structure well, and apply proper needle technique. Do not needle too deep and with too strong lifting and thrusting needle technique in points that are close to the brain and spinal cord. Take the needle out if the patient has some radiating pain and/or shooting sensation during treatment of points close to the brain or spinal cord. Injured Nerves Problem: Patients may feel numbness and a radiating sensation during or after treatment, and in some severe cases, severe shooting pain or burning sensations will appear after treatment, or myoatrophy, muscle contraction, and spasm in local nervous distribution area. Causes: The practitioner didn’t apply proper needle technique on points located on nerves or close to nerves, or used a strong needle technique, moving the needle to try to get Qi sensation during the treatment. Sometimes it is also caused by strong electro-stimulation when needle is on the nerves. Treatment: Light symptoms only require massage for recovery. When patient has severe shooting pain with burning sensations or numbness, one should apply moxa pole on the local area for 20-30 minutes, treating once every day, for 5-6 treatments as a course. If the patient has myoatrophy or spasm, one should treat as thou the patient had paralysis (treat as Jing syndrome or Wei syndrome) Prevention: Before beginning the treatment, inquire about any neurological diseases, and massage the point before inserting the needle. The practitioner must also pay more attention to the depth and angle of needle particularly with points near the spinal column and near distribution areas along the course of nerves. For example: BL-24, BL-54, GB-30, and GB-34. Do not apply strong reinforcing and reducing needle technique on points close to the nerves such as in PC-6 and LI-10 as well. Remember to change the needle depth and angle if the patient complains of numbness or shooting sensations during electro-acupuncture treatment, or reduce the volume of output.

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Needle Manipulation Techniques

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Acupuncture and Moxibustion—A Clinical Desk Reference

NEEDLE MANIPULATION TECHNIQUES In this section of the book the goal is to explain and demonstrate basic techniques of using acupuncture needles in the safest and most effective way possible. Starting with the most basic of movements, the acupuncturist will eventually acquire much more in depth techniques of treatment. Each technique of manipulating the needle will be explained in terms of its Effect, Clinical Applications, and the actual Technique itself. Fundamental Needling Technique: Basic Manipulations Twisting Twisting the needle is one of the basic techniques to get the Qi flow. This technique can be used on all the points of the body. The basic method involves inserting the needle to a certain depth depending on the disease and twisting the needle back and forth gently, waiting for Qi. It can be applied with large or small amplitude accordingly, or one can rub the needle in one direction aggressively in order to obtain the Qi. Effect: Moving the needle to obtain Qi. Clinical Applications: The technique serves as a basis for further manipulation. Technique: The handle of the needle is grasped by the thumb, index, and middle fingers and rotated evenly back and forth.

Lifting and Thrusting This is another basic technique to obtain the Qi that can be used on most parts of the body, particularly for some points located near muscles. Compared with the twisting technique, this is a little bit more aggressive, changing the angle and depth of the needle from time to time looking for the Qi. For some problems this technique will combine with twisting together, for example, when patients suffer from some paralysis problems or have very weak Qi. Effect: Moving the needle to obtain Qi. Clinical Applications: Basis for further manipulation. Technique: The needle is moved in an up and down motion in the point. Fundamental Needling Technique: Supplemental Manipulation Methods Following (Xun Fa) This technique can be used on most parts of the body, before, during or after treatment. This is the supplemental technique that helps when there is a weakness of the meridian Qi. Applying this technique before treatments can help the Qi arrive, especially when the patient has deficiency symptoms. During the treatment, it will help retain the Qi sensation in the point, which is required for effective acupuncture treatment. Effect: Moving channel Qi (It is also one kind of reinforcing technique) Clinical Applications: This technique serves to open blockages of channel Qi, or help with difficulty in obtaining Qi (For example: due to stagnation – pain on pressure, or weakness of patient, etc.). Technique: A finger presses gently with the course of the channel above and below the needle.

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Needle Manipulation Techniques

Absorbing (Se Fa) The absorbing technique can be performed in most points of the body before and during needle treatment. It is mostly used for stagnation of Qi in points after needle insertion. For example, if a patient felt the needle stuck in the point with the sharp painful sensation, one may use the absorbing method on the side of point with the helping hand on the front, back, right and left side of the needle, to avoid the pain and release the stuck needle. This technique is very commonly applied throughout acupuncture treatment, particularly for some patients who are very sensitive, or are extremely afraid of needles. Effect: Moving channel Qi (It is also one kind of dispersion technique.) Clinical Applications: Commonly used to open blockage of channel Qi. Technique: A finger presses forcefully against the flow of the channel above and below the needle.

Flicking (Tang Fa) The flicking method consists of flicking the needle by the index finger in order to keep the sensation of Qi when retaining the needle during treatment. It is most often used for points, which do not need strong stimulation, such as SI-19, GB-40, or a point located between joints where it is difficult to apply other needle techniques. It is also a good technique to treat muscle, tendon, and joint problems. Effect: Moving channel Qi. Clinical Applications: Commonly used for Qi deficiency, when it is difficult to obtain Qi. Technique: The tail of the needle is gently flicked so that the tip of the needle vibrates slightly.

Vibrating: (Zheng Zhan Fa) This technique consists of moving the needle quickly up and down, back and forth, with vibrating movement of the fingers in order to increase the movement of Qi for pain syndromes. It is of great benefit for neuralgia, such as Trigeminal neuralgia, facial nerve paralysis, or sciatic nerve pain. The vibrating method is also one of the “leading the Qi” techniques. (Dao Qi Fa) Effect: Moving channel Qi. Clinical Applications: Used for symptoms in which it is difficult to obtain Qi, or when there is weak needle sensation. Technique: The needle is grasped and vibrated rapidly with small amplitude to increase needle sensation.

Waving: (Yao Fa) The waving technique is performed for points located on the surface of body such as upper Back-Shu points. This technique can also be applied to move the meridian Qi on all the points in the four extremities. Effect: For purposes of moving, and increasing Qi flow. Clinical Applications: Difficulty obtaining the Qi or weak needle sensation and sending the Qi. Technique: For the points that are located in the four extremities, most of time the waving the tail technique is used to send the Qi to some place required for treatment. For points that are located in the upper back, it is common to wave the body or handle of needle in order to send the Qi.

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Flying: (Fei Fa) The flying technique is used for obtaining the Qi on the surface of the skin. It is one of the Qi techniques performed on the Five-Shu points. It is also used for some places that really need movement of the Qi, such as the Governing vessel points and some points located between joints. It is a good technique to calm the Shen in the treatment of some emotional problems. Effect: Moving channel Qi. Clinical Applications: Difficulty obtaining Qi, weak needle sensation, and also to calm the mind. Technique: With the thumb and index finger, do a large amplitude twist, and then suddenly flick away from handle, repeat several times.

Scraping: (Gua Bing Fa) The scraping technique moves blocked Qi in both the meridians and organs. There are three techniques: scraping with the middle finger, scraping with the index finger, or scraping with the thumb. Effect: To spread the needle sensation in order to move the Qi. Clinical Applications: Weak needle sensation and moving the Qi. Technique: Scraping with middle finger: hold the handle of needle by the thumb and index and scrape up and down the handle of needle with the nail of the middle finger. Scraping with the index finger: let the handle of needle lie down on the thumb and scrap handle with the index finger. Scraping with the thumb: let the handle of needle lie on the side of index finger and scrape with the thumb.

Sparrow Pecking: (Que Zuo Fa) This is a mild and gentle technique moving the needle just like a sparrow picking up grain from ground. The practitioner should control the needle with good rhythm when performing this in the clinic. Effect: Used to spread needle stimulation and sensation, or to move the Qi. Clinical Applications: Weak needle sensation. Technique: The needle is vibrated in small amplitude lifts and thrusts, like a sparrow pecking grain. There are two techniques: inserting the needle as a sparrow pecking with small amplitude during the insertion, and withdrawing the needle gently as a sparrow pecking with small amplitude after obtaining the sensation of the Qi.

Coiling: (Pan Fa) This needle method is used on the abdominal area for weak Qi movement when it is not possible for long needles to be used (needles at least over 2 cun long). On the other hand, this technique is also performed in the four extremities with the moving the Qi techniques, such as “tiger and dragon fly up,” to treat some severe pain syndromes due to blockage of meridian Qi. Effect: Harmonizing the Qi. Clinical Applications: Disharmony of Ying and Wei Qi. Technique: The needle is moved in a gentle large amplitude coiling motion, like wiping a plate.

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Bending: (Wan Zheng Fa) The bending method is used for increasing the sensation of Qi, adjusting Qi, and to calm the Shen. This technique combines well with the waving and vibrating methods, when treating some severe pain syndromes, such as nerve pain, muscle pain, and organ pain. There are three ways to bend the needles: bending the needle with the middle finger, the thumb, or the entire needle in the shape of a bow. Effect: Moving Qi and stopping pain. Clinical Applications: Qi blockage, pain, weak needle sensation. Technique: Bending the needle with middle finger: used to move the meridian Qi and increase Qi sensation. Bending the needle with the thumb: used to send the Qi to some part where treatment is needed. Most of the time it is combined with the pressing method. Bending the entire needle as a bow: used to keep needle stimulation for chronic pain syndromes, such as trigeminal neuralgia and frozen shoulder.

Rubbing: (Chuo Fa) This method is used for difficulty obtaining Qi to treat patients with extremely deficiency, or patients suffering from paralysis. Sometimes this technique can be used to move the Qi, help the Qi transfer somewhere needed. To correctly perform this technique, rub the needle clockwise or count clockwise, with large or small amplitude depending on the disease. Effects: Moving the Qi and stopping pain. Clinical Applications: Transfer the Qi, pain syndromes, and weak needle sensation. Technique: The thumb twists in one direction back or forward, but not too tightly, or it will cause pain. Reinforcing and Dispersion Technique It is well understood, that the effect of acupuncture is to balance the patient’s Qi movement and adjust the body from an abnormal condition to normal. The basic definition of reinforcing and reducing in the acupuncture field is: Any technique able to help hypo-activity or deficiency symptoms in the body return to normal is called reinforcing, any technique that can help hyper-activity or excess symptoms return to normal is called reducing. Reinforcing and reducing techniques are related to three aspects: the patient body constitution, the nature of the point, and the performance of the technique. Depending on the patient’s constitution, in excess or deficiency, the patient will recover from an abnormal situation after treatment. In fact, the treatment will cause the appearance of reinforcing or reducing effects in the patient. That effect is via adjustment of the patient’s Qi movement, during and after needle stimulation. This is the difference between acupuncture and herbal medicine, in which herbs or other tonic supplies exactly reinforce or reduce something in the body. The second aspect is that of the nature of the point. Depending what groups of points are selected for treatment, some points in the body will function as reinforcement, such as: CV-4, CV-6, and BL-23. Some points on the other hand, will have a reducing function, such as LI-4, GV-26, and Shi Xuan. Reinforcing and reducing technique results appear after stimulation to these specific points. Performance of different reinforcing and reducing needle techniques is the third aspect involved. This is when special needle techniques for reinforcing and reducing the movement of Qi, Blood, and body fluid are applied in order to help body re-adjust. These are the needle techniques that will be described here. There are seven basic (single style) reinforcing and reducing needle techniques that are mentioned in the Nei Jing. These seven techniques could be used individually or combined together. For example, when we apply the breathing technique, it will be in the process of treatment including the insertion, the adjustment of the needle, while moving the needle to obtain Qi, while reinforcing and reducing, and finally upon removal. In ancient times, there were two basic principles guiding the theory of needle techniques: adjusting the direction of Qi and sending the Yang Qi in or pulling the Yin Qi out. In order to reinforce and reduce by direction of Qi flow, one must focus on the movement of Qi and reinforce the insufficient or reduce the excess flow of Qi. Sending the 499

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Yang Qi down into the body, or leading the Yin Qi (Blood) out means that all the techniques that can send the Yang Qi inside the body are reinforcing techniques, and all the techniques that lead the Yin Blood out are reducing techniques. The Nei Jing states, “reinforcing is sending Yang Qi down, and reducing is leading Yin Qi up.” Reinforcing and Dispersion Technique: Single style Twisting: (Nian Zhuan Fa) Effect: Regulates Ying and Wei Qi, supports the Vital Qi, and expels pathogens. Clinical Applications: All disharmonies of Ying and Wei Qi, and blockage of channel Qi. Technique: There are three methods: a. The thumb pushes forward (reinforcing); the thumb pulls backward (dispersion). b. The thumb pushes forward with the Qi flow for the three hand Yang meridians, the three-foot Yin meridians, and the Conception vessel. The thumb pulls back, against the Qi flow for the three hand Yin meridians, the three-foot Yang meridians, and the Governing vessel. c. The handle of the needle is grasped by the thumb, index, and middle fingers. Then the needle is twisted gently with small amplitude, this is reinforcing. Twisting heavily with large amplitude, this is dispersion.

Lift and Thrust: (Ti Cha Fa) Effect: Regulate Yin and Yang, support the Vital Qi and expel pathogens. Clinical Applications: This method is used to treat all syndromes of Yin and Yang disharmony, Xu (deficiency) and Shi (excess), and Heat or Cold syndromes Technique: There are two methods: a. In order to make the Yang descend, strongly and tightly thrust, slowly and gently lift, this is the reinforcing method. In order to make the Yin ascend, slowly and gently thrust, strongly and tightly lift, this is the dispersion method. b. Reinforce by lifting and thrusting the needle gently with small amplitude. Disperse by lifting and thrusting the needle strongly with large amplitude.

Slow and Fast: (Xu Ji Fa) Effect: Regulate Yin and Yang, support the Vital Qi, and expel pathogens. Clinical Applications: This method is used to treat all syndromes of Yin and Yang disharmony, Xu and Shi (deficiency and excess), and Heat or Cold syndromes. Technique: There are two methods: a. For reinforcement, slowly enter and rapidly withdraw to let the Yang descend. Rapidly enter, slowly withdraw to let the Yin ascend and disperse. b. Slowly enter, twist with small amplitude, rapidly withdraw, and close the insertion hole quickly, in order to reinforce. Rapidly enter, twist with large amplitude, slowly withdraw and keep open the acupuncture hole, in order to disperse.

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With and Against: (Ying Shi Fa) Effect: Free and regulate Ying and Wei Qi, support the Vital Qi, and expel pathogens. Clinical Applications: Treatment of all disharmonies of Ying and Wei Qi and blockage of channel Qi. Technique: For reinforcement: angle the tip of the needle in the direction of the meridian Qi flow (angled superiorly). For dispersion: angle the tip of the needle against the meridian Qi flow (angled inferiorly).

Breathing: (Hu Xi Fa) Effect: Support the Vital Qi and expel pathogens. Clinical Applications: Usually used on abdominal points, and combined with lift and thrust reinforcing and dispersion technique. Technique: Needle, or thrust with the patient’s exhalation and withdraw, or lift upon inhalation, finally quickly closing the hole, this is the reinforcing method. Needle, or thrust with the patient’s inhalation, withdraw, or lift upon exhalation and leave the hole open, this is the dispersion method.

Open-Close Method :(Kai He Fa) Effect: Support Vital Qi, and expel pathogens. Clinical Applications: Used during needle withdrawal, it must be combined with other methods. Technique: The general understanding is to quickly close the needle hole after withdrawing in order to reinforce. For dispersion, expand the needle hole upon withdrawal, and leave it open.

Even Movement Method: (Lead the Qi) (Dao Qi Fa or Pin Bu Pin Xi Fa) Effect: Reinforce deficiency and disperse excess. Clinical Applications: For all rebellious or disordered Qi flow conditions. Technique: Gently and evenly twist, or gently lift and thrust the needle until the patient feels the Qi sensation. Reinforcing and Dispersing Techniques: Combining methods There are many complicated needle techniques from ancient China. Particularly after the Ming Dynasty, acupuncturists paid more attention to needle technique. In the Zhen Jiu Da Quan written by Dr. Xu Feng, all the complicated techniques are organized into two groups. He said that any techniques that can send the Qi to the place needed for treatment, such as the green dragon, white tiger, red phoenix and old turtle are called “Regulate Qi and Moving the Qi techniques.” Other techniques were designed to treat specific disease, such as burning fire on the mountain, cool penetration of sky, etc. and therefore were grouped together as the second group.

Burning the Mountain: (Shao Shan Huo) Effect: Reinforcing Yang and expelling the Cold. (Pure reinforcing technique). Clinical Applications: This technique is used to treat all deficiency or Cold conditions (e.g. cold, numbness, Wei or Bi syndromes), Yang Qi weakness, and dropping (sinking, prolapse) type symptoms. Components: Slow and fast, lift and thrust, twisting, open and close, and the 9-6 reinforcing methods. Technique: There are 3 methods for this technique: 501

Acupuncture and Moxibustion—A Clinical Desk Reference

A. Obtain the Qi, and divide the depth into 3 levels. Lift to the highest level, thrust strongly and lift gently 9 times, then descend to the middle level and repeat 9 times, and again at the lowest level; this is one complete repetition. This can be repeated until a heat sensation is felt. The needle is then withdrawn and the point quickly pressed closed. The twisting reinforcing method may also be combined. B. Obtain the Qi and divide the depth into 3 levels. Lift to the highest level, twist clockwise strongly and turn back gently 9 times, then descend to middle level and repeat 9 times, and again at the lowest level; this is one complete repetition. This can be repeated until a heat sensation is felt. The needle is then withdrawn and the point quickly pressed closed. C. Don't divide into levels; don't count the times, just thrust strongly with force, and lift gently until it causes heat sensation in the point.

Cool Penetration of the Sky: (Tou Tian Liang Fa) Effect: Disperse Yang and cool Heat. (Pure Dispersion Technique). Clinical Applications: Excess Yang or Heat symptoms, Heat in the muscles, bones and joints. Components: Same as above. (Burning the Mountain, Shao Shan Huo) Technique: There are three methods for this technique: a. Divide the depth into 3 levels. Descend to lowest level, get Qi, then lift strongly and thrust gently 6 times, withdraw to the middle level and repeat, and again at the highest level; this is one cycle and can be repeated until a cool sensation is felt. Then the needle is withdrawn and the point is left open. The twisting dispersion technique can be used with the above technique. b. Divide the depth into 3 levels. Descend to lowest level and get the Qi, then twist the needle countclockwise strongly and turn back gently 6 times, withdraw to the middle level and repeat, and again at the highest level. This is one complete cycle and can be repeated until a cool sensation is felt. The needle is then withdrawn and the point is left open. c. No separate levels and no counting, just lift strongly and thrust gently until a cool sensation is felt under the needle.

Yin in Yang: (Yang Zhong Ying Yin) Effect: Reinforcement and dispersion; first reinforcing then reducing. Clinical Applications: Deficiency conditions with excess symptoms - Cold changing to a Heat syndrome. Components: Slow and fast, lift and thrust, twisting, and the 9-6 method. Technique: Divide into 2 levels. At the highest level thrust strongly and lift gently 9 times, then descend to the lower level, thrust gently and lift strongly 6 times. This is one cycle. The patient should first feel warmth, then a cool sensation. Twisting can also be combined.

Yang in Yin: (Yin Zhong Ying Yang) Effect: Reinforcement and dispersion; first reducing and then reinforcing. Clinical Applications: Excess conditions with deficiency symptoms – Heat changing to a Cold syndrome. Components: Same as Yin in Yang. Technique: Divide into 2 levels. At the highest level lift strongly and thrust gently 6 times. Then withdraw to the lowest level, lift gently and thrust strongly 9 times. This is one cycle. The patient should first have a cool sensation, then a warm sensation. Twisting technique can be combined.

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Dragon and Tiger Battle: (Long Hu Jiao Zhan) Effect: Reinforcing and reducing, and open the collaterals to stop pain. Clinical Applications: Any painful condition. Components: Twisting and the 9-6 method. Technique: There are two methods for this technique: a. Obtain the Qi, twist the needle (thumb goes forward with clockwise movement) 9 times - this is the dragon. Then twist the needle (thumb goes back ward - counterclockwise) 6 times. This is the tiger. This can be repeated, or performed separately. b. Obtain the Qi. The thumb pushes forward 9 times, and then the needle is twisted back in one move until tight (but not so tight that it is painful). When the needle sensation is strong, hold the needle firmly without letting the Qi dissipate for 2-3 minutes. This will produce a slight warm sensation—therefore it is particularly good for Cold type pain. To obtain Qi, pull the thumb back 6 times then twist forward in one move until tight. When the sensation is strong, hold the needle firmly without letting the Qi dissipate, for 23 minutes. This often produces a slight cool sensation, so it is good for the Heat type of pain.

Dragon and Tiger Leap up: (Long Hu Shen Ten) Effect: Regulates Yin and Yang, opens the channels and collaterals, moves Qi, and stops the pain. Clinical Applications: Any blockage of Qi and Blood flow. Component: Twisting, lift and thrust, 9-6, slow and fast, and coiling techniques. Technique: Obtain the Qi and withdraw to the highest level. First coil left one circle, (and combine twisting technique) then thrust gently and lift strongly. Do this 9 (Yang) times and then descend to the low level. Obtain the Qi. Then coil the needle right one circle, and thrust gently and lift strongly. Finally, coil left one circle, thrust strongly, and lift gently. Do this six (Yin) times - twisting can be combined.

Mortar and Pestle: (Zi Wu Dao Jiu) Effect: Opens channel Qi flow regulates Yin and Yang. Clinical Applications: Edema, and distention from Qi blockage. Components: Twisting, lift and thrust, fast and slow, and 9-6. Technique: There are two methods for this technique: a. Obtain the Qi, thrust strongly (twisting right and left) lift gently 9 times, then lift strongly (twisting right and left) and thrust gently 6 times. b. First the acupuncturists must divide into 3 levels to obtain the Qi. At the highest level thrust strongly and lift gently twisting left 360 degree, 9 times. Then repeat at the middle and lower levels. Withdrawal needle from the lowest level, twisting right 360 degrees lifting strongly and thrust gently 6 times.

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Move and insert the Qi technique. This technique was designed for tumor, lumps and abdominal masses. Technique: There are two methods. a. Insert the needle perpendicular 1-1.2 cun deep with lifting and thrusting needle technique to obtain the Qi sensation. Then withdraw the needle to 0.5-0.8 cun in depth and bend the handle of needle towards the level of the skin. This moves the Qi towards the site needed. b. Insert the needle perpendicular 0.8 –1.2 cun deep with lifting and trusting technique to obtain the Qi. Then withdraw the needle back to the 0.3-0.5 cun area and hold the needle tightly with three fingers, adjust the breathing movement in both the patient and practitioner, and then insert the needle down to 0.8-1.2 cun slowly with pressing technique. This makes the Qi travel to the area of the tumor.

Withdraw and Send the Qi This technique is designed for any kind of paralysis. Technique: Insert the needle perpendicular 1.2 cun deep. Obtain the Qi with twisting or rubbing technique, and withdraw the needle from the Earth depth to the Heaven depth with force, in 3-5 movements, every movement near 0.2-0.3 cun in distance. This can be repeated as needed. After that, apply the sending the Qi technique, the opposite of the withdrawing technique. In other words, obtain the Qi sensation, withdraw the needle to the Heaven depth, and send it down with force in 3-5 movements to the Earth depth, every movement about 0.2-0.3 cun in distance. This can be repeated several times if the patient has good energy.

Techniques for Opening the Flow of Channel Qi Green Dragon waves its Tail: (Qing Long Bai Wei) Effect: Reinforce and move the Qi (open channels and reinforce Qi) Clinical Applications: Weakness with Qi blockage (e.g. anemia, dizziness, and tinnitus from Yang deficiency) Components: Waving, and the 9-6 method Technique: Insert to depth, obtain the Qi, then withdraw the needle to the superficial depth and with the tip of the needle pointing toward the diseased area, pull the handle of the needle downwards toward the skin. Then wave slowly back and forth with relatively large amplitude.

White Tiger Shakes His Head: (Bai Hu Yao Tou) Effect: Mainly a dispersive technique that moves blood (opens channels, links the Qi, moves blood). Clinical Applications: Heat in the blood, and blood stagnation. Move blood to distant areas for treatment. Components: Waving, lift and thrust, twisting, the 9-6 method, and the fast and slow method. Technique: There are two methods for this technique: A. Twisting the needle, insert and obtain the Qi. First use the middle finger to rock the needle six (Yin) times back and forth. Then fast lifts and thrust with small amplitude. B. Twisting the needle, insert and rub 6 times counter-clockwise after getting Qi sensation.

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Pale Turtle Examines Its Cave: (Cang Gui Tan Xue) Effect: Opens channels and moves Qi in the meridians (reinforcing technique) Clinical Applications: All diseases found in the channels, Qi stagnation and blockage, especially with weak constitutions. Components: Fast and slow, and lift and thrust. Technique and illustration: Obtain the Qi, withdraw to the skin and angle needle obliquely, and then insert in 3 motions. Withdraw in one; repeat to all four directions, or more.

Red Phoenix Looks For Source: (Chi Feng Ying Yuan) Effect: Opens channels, links Qi, primarily for opening collaterals. Clinical Applications: Removing all blockages of the Qi in the collaterals, any disease located in the collaterals. Components: Fast and slow, lift and thrust, twisting, and breathing. Technique: Insert to the lowest level and obtain the Qi, withdraw to the highest level until the needle is wobbly on its own, then re-insert to the middle level, using a combined twisting and lift and thrust method: twist and release, left and right, in and out, let the needle circling and flying.

Holding the Qi: (Liu Qi Fa) Effect: Benefits Qi warms Yang, breaks up Qi, nodes, and accumulations. (Reinforcement and dispersion) Clinical Applications: Dispersing masses, knots, nodes, and accumulations. Components: Lift and thrust, the 9-6 method, and fast and slow. Technique: Divide into two levels, insert to the depth of 0.7 cun deep, thrust strongly and lift gently, 9 (Yang) times. Then insert further to a depth of 1 cun deep, lift strongly and thrust gently 6 (Yin) times, lift to the original 0.7 cun level depth, and retain. If needle sensation is unsatisfactory, repeat.

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ANCIENT NEEDLE TECHNIQUES AND APPLICATIONS

Ling Shu – Chapter Guan Zhen In the Ling Shu, 26 needle techniques are mentioned. The nine needle techniques (Jiu Ci) follow the nine changes of disease seen in the clinic, the twelve needle techniques (Shi Er Ci) are used according to the twelve meridian symptoms, and the five needle techniques (Wu Ci) are related to the five organs and five tissues. Jiu Ci—The Nine Needle Techniques The nine needle techniques follow the nine changes of disease seen in the clinic—the nine different qualities of disease, for example Heat, Cold, Excess, Deficiency, stagnation, and External Pathogenic Influences. Shu Ci Definition: Needle the Shu points – the 5 command (Shu) points and the Back-Shu points. Clinical Indications: Organ and meridian diseases. Clinical Application A: •

Back-Shu and Jing-Well (as main points) For acute organ disease or for acute Excess Heat, slow cognition, psychological problems, and patients not responding to external stimuli (Shen problems). Technique: 1.) Disperse the Back-Shu and the Jing-Well points For Excess, hyperactive disorders, Interior Heat, and or excess pulse features and a red tongue. Lift and thrust, or use a twisting technique. Usually the Jing-Well is needled first, with a bloodletting or a dispersion technique (0.1 cun deep). 2.) Moxa Back-Shu and Jing-Well Back-Shu – indirect, with ginger Jing-Well – direct non-scarring 8-12 cones for deficient symptoms: lassitude, slow cognition (as above), hypoactive emotionally, pale lips and complexion, and cold extremities. The pulse is thin and weak. 3.) Reinforcing Back-Shu and Jing-well Jing-well – moxa pole or gentle intra-dermal needle. Back-Shu – lift and thrust with a reinforcing technique (force on the thrusting, lift gently). For organ dysfunction, like Qi and Blood deficiency, especially when it has led to stagnation, with a stuffy sensation in the chest and abdomen.

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Clinical Application B: •

Back-Shu and Ying-spring For Heat conditions, excess or deficient: night sweats, hot flashes, red complexion, headache, blurry vision, insomnia, and irregular menstruation. Technique: 1.) Reinforcing Back-Shu, disperse the Ying-spring. Deficiency Heat, for example, Kidney deficiency: needle BL-23 with twisting reinforcing technique, Reduce KI-2 with lifting and thrusting technique. 2.) Disperse Back-Shu and Ying-spring Organ Excess Heat in the LI—constipation. Disperse BL-25 and LI-2. 3.) Moxa Back-Shu and regulate the Ying-spring (even movement technique). Used for disturbance of Qi, especially mental/emotional problems. Direct non-scarring moxibustion, 9-11 cones, this calms the Qi and Blood to allow it to nourish the Shen. Manipulate the Ying-spring point to disperse the Heat.

Clinical Application C: •

Back-Shu and Shu-stream Organ disease related to whole body – meridians, muscles, hypo-metabolism –water retention, muscle and joint dysfunction with heaviness, and body aches. Technique: 1.) Moxa Back-Shu, and reinforce the Shu-stream Apply direct moxa on the Back-Shu points, 9-11 cones. Reinforce the Back-Shu, and use a weak stimulation technique on the Shu-stream, for example: Di Zhen (non-insertion) - moving Qi technique. This treats organ dysfunction, for example, irregular Qi movement, and metabolism dysfunction – weight loss or gain. It can also be used for functional problems, when the patient does not feel well overall, but has no real main complaint. 2.) Strong stimulation (like dispersion) at the Back-Shu and even movement at the Shu-stream point Used for severe conditions in the organs, like Excess stagnation, Qi/Blood stagnation, etc. Apply a twisting dispersion technique with strong stimulation. In cases of severe organ deficiency, strong stimulation on the Back-Shu is needed with 26 or 28 gauge needles until the sensation travels along Bladder channel.

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Clinical Application D: •

Back-Shu and Jing-River For patients with temperature changes – local or whole body; rebellious Stomach Qi, or Lung Qi collapse or intestinal Qi stagnation problems, especially for metabolism or circulatory system dysfunction, cold and numbness in the extremities. Technique: 1.) Moxa the Back-Shu; Reinforce the Jing-river. For meridian Qi deficiency: dizziness, cold extremities, and cold back sensations, shortness of breath, stuffiness of the chest, coughing, asthma, and insomnia. 2.) Disperse the Back-Shu; Reinforce the Jing-river Used for Qi stagnation on the surface or internal musculature – Cold/Heat changes, left/right differences, or part of body sweating (as opposed to the whole body, for example, the scapula or chest – from Qi stagnating), chilliness, aversion to cold, headache, coughing, diarrhea, bloating, or irregular menstruation. 3.) Reinforce the Back-Shu; Disperse the Jing-river For Qi movement problems: mental disorders, difficulty concentrating, over thinking, anxiety, and depression. Also for behavior changes—for example wearing more clothing when it is hot.

Clinical Application E: •

Back-Shu and He-Sea Organ disease – regulate organ and meridian function Technique: 1.) Reinforce the Back-Shu and the He-sea For use in organ deficiency of Yin, Yang, Qi, or Blood. For example, to build the Lung energy, needle BL-13 and LU-5. 2.) Disperse the Back-Shu; reinforce the He-sea For use when there is Qi stagnation from Qi deficiency, for example—Stomach deficient Cold leading to food stagnation, or Bladder deficiency leading to urinary retention. 3.) Disperse the Back-Shu and the He-sea Use when there is organ excess disease, and Qi stagnation in the organs, i.e. acute pain and blood stagnation.

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Yuan Dao Ci Definition: Distal technique. Point selection and needle technique. Clinical Indications: Organ and meridian disease Technique: For diseases above, select the Lower He-sea points (ST 36, 37, 39, GB 34, UB 39, 40) for disease of the Six Fu-Bowels. •

The Yang Ming meridian can also be used to regulate Blood. (LI and ST meridians) Use a twisting needle technique, 0.5 cun deep.

•

The Tai Yang meridians can be used to regulate Qi movement. Lift and thrust, 0.5 – 1 cun deep

•

The Shao Yang can be used to regulate essence. (Jing/bone) Use the slow and fast needle technique.

(The above techniques are based on the theory that Yang Ming dominates Blood, Tai Yang dominates Qi, and Shao Yang dominates bone and Jing) Jing Ci Definition: Treats meridian stagnation at the connection areas – where meridians meet tissue. Clinical Indications: Lumps, Blood stagnation, and pain. It is often seen in meridian, or muscular-tendon problems. Technique: After meridian diagnosis one may find knots, lumps, stagnation, swelling, water retention, or painful points. These are called “positive points”, which are then needled in this technique. Clinical Applications: see below. •

Select several points along the distribution of the whole meridian. For example, lumps found at SJ-5 – use SJ-3, SJ-4, SJ-5, etc. to needle – according to meridian distribution.

•

This technique may also be used for local therapy. Twisting is one kind of resolving technique, which can be done for at least 3-5 minutes at the stagnation or painful area.

•

Cupping may also be used at the local area, after needling or bloodletting techniques are done. This is especially effective for muscle problems, or joint injury.

Lou Ci Definition: Needle in blood vessels. This technique can be thought of as one kind of bloodletting. Clinical Indications: Excess Heat signs, or mental problems (overflowing of Shen or Qi), for example depression, excess fear, joy, etc.) Clinical Applications: Floating Lou Mai – purple colored veins. Use a pricking technique. •

Bloodletting may also be used along the distribution of the meridian, for example at the Jing-well and Hesea points.

•

Back-Shu and front Mu points may also be used with this technique, applying medium to strong stimulation plum blossom to cause a little bleeding and following up with cupping in those areas.

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Fen Ci Definition: Insert between muscle and muscle, muscle and tendon, tendon and tendon, tendon and bone. Clinical Indications: Sports injury, motor system problems, including muscular tendon problems, acute or chronic. Clinical Applications: Through to through needle technique. Shoulder paralysis: LI-15 and LI-14. Elbow: LI-11 and H-3. Knee: GB-34 and SP-9. •

Use a deep insertion between muscle and tendon—a regulate Qi technique. Insert deep into muscle and tendon, for example, in a case of Cervical Spondylosis, needle deep to the transverse process in order to disperse stagnation and pain.

•

The use of electro-acupuncture may be used to regulate musculature to treat flaccidity or tension imbalance. (Use high density to disperse pain, low density to disperse flaccidity.)

Da Xie Ci Definition: Use the Pi Zhen (needle #5) to disperse skin or dermatological problems, like Blood stagnation, lumps, ulcers, or to get rid of blood and pus. Clinical Indications: To disperse pus. (This technique belongs to dermatology, not acupuncture categories.) Clinical Applications: Disperse local stagnation – lumps, pus. •

Bloodletting with the Pi Zhen along with cupping may be used for acute or local stagnation, for example, shoulder, back, or neck pain. (This technique is very commonly used in China.)

Mao Ci Definition: Needle floating Bi syndrome on the skin. (Like plucking hair) Clinical Indications: Skin numbness, Urticaria, and itches. Also used in chronic internal organ problems, insomnia, and neurasthenia. Clinical Applications: Pediatrics – cold, night crying, bedwetting, cough, asthma, and malnutrition. Needle very quickly in out, in out, like plucking hair.

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•

Used for local skin problems due to Excess Heat diseases. For example, acute conjunctivitis or sty, one can often find red spots on the scapula and use this technique to prick them, also in the case of hemorrhoids, one can usually find red pimples or pus at the sacral area.

•

For skin problems such as psoriasis or herpes, very fast needling on the area can be employed to disperse pain. (Pricking or bleeding)

•

Neurasthenia – emotional/mental problems: stress, depression. Use light, gentle needle technique on the Back-Shu points, scalp, or 5 Shu points. Do not retain needles. This method is used to wake up or stimulate organ and meridian functioning.

Ancient Needle Techniques and Applications

Ju Ci Definition: Contra-lateral treatment, left treats right, and right treats left. For example, the disease is on the left but the right pulse is “sick” or disordered. Symptoms are manifesting on the left, like headache, leg, shoulder, or arm pain, but the left side pulse is fine. The pulse on the right, however, is disordered or weak. Therefore the treatment focus should be on the on the right side. Clinical Applications: Using opposite side 5 Shu and other points to treat symptoms of organ and meridian disease. •

Select points based on the diagnosis – ex. Right side shoulder pain where the right pulse is normal, but the left side pulse is diseased. In a case where the diagnosis determines the pain is due to deficiency of Qi and Blood – use ST-36, and LI-11 on the left side.

Cui Ci Definition: Fire Needle. Clinical Indications: Treats Bi syndrome. Cold-Damp-Pain Bi – osteoarthritis (Cold type) Clinical Applications: Fire needle technique. Burn the needle until white. Insert quickly in out, .5 cun deep. •

The use of a Fire needle with a big, round head (not sharp) can be used to quickly burn the skin, to make a scar, instead of direct scarring moxa (for those who are afraid of the moxa). Some causes for use: draining ulcers, or stimulating the whole body’s immune system.

Shi Er Ci—The Twelve Needle Techniques These twelve techniques are for use in accordance with the 12 meridian symptoms. Each meridian has its own sphere of influence—some dominate Qi, Yin, Blood, and Yang, water… Ou Ci Definition: One hand in front, the other hand in back, toward the pain area. Clinical Indications: Treats hot Bi syndrome. Clinical Applications: Mu and Shu point combinations to treat pain, and organ stagnation problems, such as Heart, chest, Stomach, and Gallbladder. •

Insert two points simultaneously, .3-.5 cun deep, with a twisting dispersion technique, while the patient does breathing exercise. (The patient is seated.)

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Needle the front first, with a lifting and thrusting dispersion technique, followed by the back point, with a twisting reinforcing or even movement technique.

Bao Ci Definition: Needle pain that is not located in one place (broad or multiple locations). The left hand palpates painful area, the right hand needles. Repeat the needling as needed. Clinical Indications: Suitable for moving pain, a lot of pain, locally or in the whole body, according to the patient’s complaints. It is used for joint, muscle, and traveling pain, and local Bi syndrome. Clinical Applications: According to meridian pathway, start at the beginning or end of the meridian, thinking of the “with” or “against” meridian technique. Ex. Pain on the Heart meridian – one can start at HT-7, moving upward to HT-1 or HT-2. The reverse direction is also applicable.

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According to the pain area – for traveling pain. Use a non-retaining technique. Ex. Neck pain - needle a neck point, remove, then needle the shoulder, remove, and continue like so, following the pain. One usually follows the meridian distribution.

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Local pain: for example—back, buttock, scapula, or shoulder pain. Needle a painful point, remove needle, and re-palpate to find another painful point or if the patient still complains of pain at the first site, then needle it once again. 3 – 4 needles at the same point or at the new pain point are not uncommon. For example—frozen shoulder, arm pain, or tendonitis – palpation shows pain at LI-10, LI-11, so needle those points accordingly. Once the pain is gone, but upon further palpation pain is still present at LI-11, needle it once again. Remove. Re-palpate. If the pain is still present at LI-10, repeat the process. One needle may make the pain travel to another place.

Hui Ci Definition: Needle beside the tendon. Clinical Indications: Treats Bi syndrome in the tendons, with contracted, tense tendons. Most often used for muscle-tendon problems: tendonitis, bursitis, and achy joints. Clinical Applications: Slowly needle on the side of the tendon, or the adjacent area, beside the tendon. For example: Knee joint arthritis – don’t needle the knee directly, but treat points on the side, like GB-34, SP-9, ST-36, SP-10 in order to let the sensation travel to the joint. This is one kind of long needle insertion technique. During the insertion, you should change direction of the needle, to get the sensation to travel. When the sensation travels to the joint, withdraw the needle, to beneath the skin, and let the patient move the joint, then needle deeply again. This technique usually treats excess symptoms of the joints, muscles, and tendons. •

One may needle very close to the tendon, even between tendon and tendon, and between muscle and tendon, to get sensation. Adding moxa pole to the treatment is also applicable. For example: chronic bursitis, tendonitis, and deficiency problems at the joint—one may needle Xi Yan through to Xi Yan or HT7 to PC-7, underneath the tendons. Use a slow insertion.

Qi Ci Definition: One needle perpendicular, and 2 needles bilaterally, on the side. Also called “San Ci” – 3 needles: 1 in the middle and 2 on the sides. Clinical Indications: Treats Cold Bi in deep areas. For example, Qi Ci on the shoulder: place the middle needle at LI-15 and then one needle on either side of it. Clinical Applications: Use in local areas, for example: the shoulder, elbow, knee, or neck—use the 3 needles around GV-14 and BL-11.

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Single point application: The Qi Ci technique can be used on the Front-Mu, Back-Shu, or special points. For example: BL-43 is a thin point that cannot be needled deeply – use 3 needles instead of one, the “1 point, 3 needles” technique. Another example is GB-30 when used for sciatica in a severe case use 3 needles in the one point in stead only one.

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Meridian therapy Qi Ci: use this technique when there is meridian pain or injury. For example, in the case of a sprained ankle, use GB-34 with 3 needles, needling every cun down the GB channel. (Three needles on a line.) Scalp acupuncture may also be used the way, with 3 needles in a zone, one following the other.

Ancient Needle Techniques and Applications

Yang Ci Definition: 5 needles total: 1 needle in the middle, 4 surrounding. Clinical Indications: Treats Cold Bi syndrome in a large area, especially on the surface for skin related problems (dermatological infections or skin Bi), and organ problems – insomnia, Headache, irritable bowels, water retention, and sympathetic nervous system disturbances. Clinical Applications: •

Apply weak stimulation (for skin Bi), for example, using plum blossom needles, along the course of the meridian.

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Medium stimulation – commonly applied on the Back-Shu points to treat associated organ disease. Five needles on one area for ache and pain. For example, for upper back or chest problems, needle BL-13, BL15, and the T4 area for the Lung and the Heart; for mid-back, needle BL-19, BL-21, and the L1 area for the Stomach and the Spleen; and for the lower back, needle BL-23, BL-25, GV-4 for Kidney and Bladder problems.

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Strong stimulation – treats blood stagnation, skin problems, psoriasis, and hair falling out. Needle superficially, .3 cun deep, with a fast twisting technique. This can result in some bleeding.

Zhi Zhen Ci Definition: Needle underneath the skin to treat Cold Pathogenic Influences on the surface – this is one special moving Qi technique. Clinical Indications: This technique is used to treat the whole body’s Cold symptoms, moving the channel Qi, and for chronic problems with emotional component, like anxiety, stress, depression, sadness, and fear. Clinical Applications: Oblique insertion 15-30 degrees toward the disease area, 1.5 – 2 cun needles. Patient feels full, distending sensation. No needle technique. •

Floating insertion less than 15 degrees (subcutaneous) between skin and muscle, in the facial layers. The patient should have pain, soreness, or a distending sensation. A special technique should be used to regulate the Qi. The meridian Qi moves in this facial area. It treats whole body aches, Heat, and other strange sensations. When applied properly it looks like a type of wrist/ankle acupuncture. (E.g. 1.5 cun needle, #30 or #32)

Shu Ci Definition: The technical process of this needle technique is performed by perpendicularly moving the needle in and out. Slow perpendicular insertion is necessary to get Qi at the deep level. After getting Qi, slowly remove. This harmonizes Yin and Yang (the lower body as Yin, the upper body as Yang). Clinical Indications: Treats Heat from excess Qi stagnation. Clinical Applications: Get Qi at deep depth, withdraw to the upper Yang level, and then insert again, repeating the movement to harmonize the Yin and Yang. One type of even movement is the lift-thrust method. For use in patients with emotional problems and disturbance in the movement of Qi, like a stuffy chest, bloated abdomen, irritable bowels, and poor sleep. Organs stagnated by an excess movement of Qi due to irrational emotions, often accompanied with Heat: Blood Heat, tongue, eyes, and lip heat sensations. •

Insert deeply to get Qi, waving the needle slowly and withdrawing, leaving the hole (which is large) open. Looks like the slow/fast, and the open/close technique.

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Duan Ci Definition: Waving insertion, slowly until close to the bone. Move the needle up and down besides the bone. Clinical Indications: Treats Bone Bi symptoms. Often used for arthritis—Bone Bi due to Kidney deficiency. Clinical Applications: Slow insertion, waving, until close to the bone (the practitioner should have good knowledge of anatomy in order to perform this technique safely and correctly). Slow waving allows you to feel what is under the skin (tendon, ligament) to allow the needle get past the tendons and ligaments, and into the hole, or cleft. For example: BL-32—needle into the Liao, at the bone and tendon. One needs to understand and feel, where the bone and tendon is. Use long needles to slowly go into the cleft, and retain needle. •

Needle close to the bone, at both sides of a joint. Use electro-acupuncture to massage the bone. For example: use Jian Nei Ling and SI-10 to create a circuit across the joint to treat shoulder problems.

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Moxa technique with Duan Ci: Apply moxa on the handle of a 1.5 – 3 cun needle, 3- 5 rounds, for the treatment of Wind-Cold-Damp Bi.

Fu Ci Definition: Needle on the side of the muscle and tendon, floating the needle obliquely. Clinical Indications: For muscle contraction with a cold sensation. Treats muscle pain and tension, like sports injuries. Clinical applications: Oblique insertion on the surface of the body in the treatment of muscle pain. Using a tiny needle (like an intra-dermal). When the muscle is in spasm, pain, or contains a hematoma, needling the muscle can be painful, so use the used of the intra-dermal is especially indicated. •

Use a deep insertion (obliquely) into the muscle for deep muscle/tendon problems, like muscle paralysis.

Yin Ci Definition: Right and left needled together. Clinical Indications: Cold extremities and low back, due to Yang Qi deficiency. Clinical Applications: Needle the Shao Yin meridian (KI-3). This technique can also be used for lassitude and weak body constitution with Cold symptoms, especially of the lower body. Use a 1 cun #32 gauge needle, to treat both KI-3 points together, with a twisting reinforcing technique. Moxa on needle—3 rounds. Pang Zhen Ci Definition: 1 needle perpendicular, and 1 on the side. This is done to increases the sensation of the needle. Clinical Indications: Chronic Bi syndrome. Use at any point where you need to increase the sensation. Clinical Applications: Back-Shu point – due to the inability to needle deeply but one needs to obtain a strong sensation, use 2 needles—the Pang Zhen Ci. Both needles should be angled 60 degrees toward one point. Scalp – 2 needles cross, in one zone Ear acupuncture – 2 needles at one point Ah shi point – 2 needles perpendicular on one point (approximately .5 cun apart) Zhang Ci Definition: In and out quickly, for bloodletting. Clinical Indications: Treats skin swelling, lumps, and pus (a kind of bloodletting technique). Clinical Applications: Use a 3-edged needle, for purple veins or a skin disorder area, for example psoriasis. 514

Ancient Needle Techniques and Applications

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Wu Ci—The 5 Needle Techniques Related to the five organs, and the five tissues (skin, vessels, tendon, muscle, bone). Needle the five tissues to treat the five organs, or needle the five organs to treat the five tissues. Ban Ci Definition: Needle superficial to get Qi from the skin. This technique is related to the Lungs. Clinical Indications: Eliminate Exterior Pathogenic Influences from the skin – fever, cold, cough, pediatric problems, and also to move meridian Qi– for emotional disturbance. Clinical Applications: Used along the course of a meridian, it is a gentle in/out technique, like plum blossom. •

For local areas like the Front-Mu and Back-Shu, it can clear Heat. Can also be used for the 5-Shu points. (“Ban” means half – meaning the needle is half in the skin, half in the muscle) Needle .1-.2 cun deep at the 5 Shu points – getting Qi from the skin only.

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For pediatrics – it is not retained. Insert and remove it quickly, .2 cun deep. Ex. Diarrhea – LI 11, CV 12, SP 6, St 36, or the Back-Shu. It’s a quick treatment – 2 minutes only.

Bao Wen Ci Definition: “Cheetah’s Color” An appearance like a blue colored tattoo. A bloodletting technique related to the Heart (blood connection). Clinical Indications: Treats emotional problems, excess Heat, joint swelling, and acute arthritis in joints, headache and sore throat. Clinical Applications: Excess Heat. Use the Front-Mu and He-sea points. This requires 5 or 6 pricks to bleed at one local area or point. Ex. CV-14, CV-15, or PC-3, the He-sea point for acute gastroenteritis and dysentery. For lower back pain – use the lower He-sea point, BL-40. •

Scalp acupuncture: The needle is also used for bloodletting, smaller amount than above, quickly insert and withdraw. For example, with pediatric ADD, needle GV 20 and GV-24)

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For joint Bi syndrome, treat the local area of pain using Ah-shi points.

Guan Ci Definition: This technique employs perpendicular needle insertion into the tendon. It is related to the Liver. Needle between tendon and tendon, tendon and bone, tendon and muscle. This is one kind of muscular-tendon therapy – needling on the tendon. Clinical Indications: Tendon Bi, bursitis, tendonitis, and joint arthritis. Clinical Applications: Palpate the tendons, to find out which needs needling. Needle perpendicularly into the tendon – this should not cause bleeding, as the tendons are not rich in blood supply. •

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Treat close to the tendon, to treat Liver blood deficiency (which may result in tendon-ache). Needling between the tendon and muscle is another application. Reinforce with other Liver points for effective treatment. For example: BL-18, LV-8, and LV-3.

Ancient Needle Techniques and Applications

He Gu Ci Definition: Chicken Claw/Finger. This technique is related to the Spleen. Clinical Indications: Treats muscle Bi. Clinical Applications: Needle into the muscle and withdraw to the surface. Change the needle insertion angle 45 degrees to both (opposite) sides. In this way, one needle is inserted in 3 directions. •

For illnesses such as muscle Bi, paralysis, spasm, contraction, and pain use a 1.5 cun needle. Needle perpendicularly at first, to get the Qi sensation.

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This technique may also be used for digestive complaints related to the Spleen, Stomach, or Large Intestine. Palpate for a sensitive point and use the same techniques as described above.

Shu Ci Definition: The needle is perpendicularly inserted into the bone. This technique is related to the Kidney. Clinical Indications: Treats Kidney, bone problems, and pain syndromes such as bone Bi. Clinical Applications: For deep insertion between joints or bones. Treats arthritic joint areas. •

Palpate the bone to find the painful point. Needle perpendicularly close to the bone (at the side).

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This treats meridian disease, and builds up the meridian and Kidney energy.

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Acupuncture and Moxibustion—A Clinical Desk Reference

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CHAPTER II: MOXIBUSTION Compared with acupuncture, moxibustion is much more effective at reinforcing the body’s Yang Qi. It is the primary technique to warm and circulate the Qi via the functioning of the meridians. It plays an important role in preventive medicine and rehabilitation as well providing effective treatment of disease.

INDICATIONS Reinforcing Yang Deficiency Moxibustion is beneficial in the treatment of Cold and deficient syndromes. In the case of Blood stagnation caused by Yang deficiency or Cold Pathogenic Invasion with such symptoms as a cold sensation in the body and limbs, frequent urination, loose stool or water retention due to deficiency of the Yang Qi, it is particularly effective. Generally in these cases, the pulse is deep and weak, or tight, and the tongue is usually pale with a wet or a white coating. Warming the Meridians in the Treatment of Bi Syndrome Moxibustion is very effective in moving the circulation of blood and in the treatment of Bi syndrome with Cold, when the patient feels stiffness and severe pain in the joints, cold hands and feet, headache, and spontaneous sweating. The pulse in these cases will be wiry and tight and the tongue will be pale with purple or black dots. Yang Qi Collapse Moxibustion can be applied in some emergency cases when a patient has Yang Qi collapse, with symptoms such as: wind stroke, fainting, severe diarrhea, vomiting, or prolapsed organs. Do not count the number of cones and do not count the time. Perform moxibustion until the patient’s body warmth and consciousness returns. Resolving Stagnation Moxibustion is very effective in the treatment of dermatological problems. For example: in the treatment of eczema, psoriasis, Leili, Jie Zhong, and lumps or tumors inside of the body, such as mastitis in the beginning stage, as well as some lumps within the skin or bone. Protecting Health In ancient times, moxibustion was very popularly applied for longevity, to prevent some diseases during certain seasons, or in travel to some place unfamiliar. Application of moxibustion on ST-36, GV-14 and CV-4 can increase the body’s immune system for such purposes.

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APPLICATIONS OF MOXIBUSTION Moxibustion with a Moxa Cone Direct Moxibustion In Traditional Chinese Medicine there are two types of direct moxibustion mentioned, scarring and nonscarring. Scarring moxibustion The scarring method involves burning moxa wool directly on the skin. This practice is not currently legal in most Western countries, although it is still commonly applied in Asia. In ancient China it was one of the main therapies in the medical field. Non-scarring moxibustion This method involves applying the moxa wool directly on the point. It is then commonly burned until the patient feels a warm sensation or a little burning and it is promptly removed. Usually the patient will feel the burning sensation when the moxa cone has burned about two-fifths of the way down. Clinical Indications Chronic Interior Cold syndrome, deficiency of organ energy, and water retention problems, such as edema, prostatitis, and fibromyalgia are the clinical indications. It is also indicated for other stagnation problems of Qi and Blood in the meridians due to some sports injuries, bursitis, tendonitis, swollen joints and low back pain.

Indirect Moxibustion The techniques of indirect moxibustion demand that the ignited moxa be insulated from the skin by other substances, such as: salt, ginger, garlic and Chinese herbs. Indirect moxibustion with ginger Prepare several slices of ginger and place where moxibustion is need. This method is usually used to treat chronic interior Cold syndromes, such as: diarrhea, abdominal pain, and Cold Bi syndrome. Indirect moxibustion with garlic Prepare several slices of garlic and place on the area indicated for treatment. Apply moxa wool to the garlic. This method is usually used to treat some skin problems, help relieve swelling, draw out the pus and stop pain, treat carbuncles, phlegm, sores and furuncles. There is one another special indirect moxibustion method with garlic in China. Prepare 1-2 pounds of smashed garlic and place on the Governing vessel from GV-3 to GV-14 (She Xiang). The garlic should be about 7cm wide and 3cm high. Finally place the moxa wool on the garlic, 3cm wide and 4cm high and ignite it from GV-14, GV-7 and GV-3. Treat once every year, 3 treatments as a course. This method is used for some chronic diseases, such as, rheumatoid arthritis, chronic asthma, bronchitis, organ prolapse, stomach cancer, etc. Indirect moxibustion with salt Most of the time this technique is applied on CV-8 to revive a patient in a severe case, such as Wind stroke of the flaccid type, loss of consciousness, severe dysentery, and other Yang Qi collapse problems. Fill the belly button with salt and add a slice of ginger on the top of salt. Place moxa wool on the ginger and ignite. Perform with as many cones needed until the patient’s temperature and pulse recovers or the cold sweat or diarrhea has stopped.

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Applications of Moxibustion

Indirect moxibustion with Fu Zi (Aconite) cake Grind the Fu Zi into powder and mixed with vinegar and rice wine to make it into a cake, about 0.2-0.3 cun thick. Place on the area needed for treatment. Apply moxibustion for 5-7 cones to treat Kidney Yang deficiency diseases, such as diarrhea, water retention or frequent urination. This method can also be used to treat some ulcers on the skin, or those of the Yin type (which is indicated by long-term disease, dark color and lack of pus.) Moxibustion with a Moxa Pole This technique uses moxa that is rolled into the shape of a pole. The end is then ignited to apply on the points needed for treatment. Most moxa poles contain herbs inside, some of them only containing pure moxa wool. Moxa Pole with Herbs Called Lei Huo Zhen (Thunder fire needle) or Tai Yi Zhen, this technique employs the moxa pole as a needle. Roll a moxa pole with herb powder as tight as possible and let it dry in a dark area, avoiding direct sunshine. Use the following herb with the moxa wool: Ren Shen, Sheng San Qi, Qian Nian Jian, Zhuan Di Feng, Rou Gui, Chuan Jiao, Ru Xiang, Mo Yao, Chuan Shan Jia, Xiao Hui Xiang, Cang Zhu, Bai Zhu, Sheng Gan Cao, and Fang Feng. Place seven layers of wet cloth on the point or area needed for treatment and put the ignited moxa pole on the wet cloth until the fire is put out. Usually this technique is applied 5-7 times on one point during treatment. Use this method to treat Bi syndrome and other pain syndromes such as arthritis, stomach pain with a cold sensation. Pure Moxa Pole Apply the moxa pole 3-4 cm from the surface of the skin or some part of body needed for treatment. Generally speaking, the moxa pole should be kept above the skin with two fingers from the free hand on either side of pole in order to detect the temperature on the patient’s skin. In the clinic this method is mostly used to treat interior Cold or stagnation problems, such as diarrhea, dizziness, deficiency of an organ and muscle and tendon injury. Warming Needle Technique Add moxa wool to the handle of the needles in order to increase the stimulation of the needle and warm up the meridian. Use this method to treat Cold type stagnation, water retention, and Yang deficiency. Normally, a distance of 3-4cm is kept between the skin and moxa wool for the most effective treatment. Prohibition of Moxibustion •

Moxibustion treatment is generally prohibited in patients with Yin deficiency especially when they have interior Heat where the tongue is dry and without coating. Moxibustion will make Yin deficiency worse.

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Moxibustion is also contraindicated in illnesses due to excess Heat. Excess Heat syndrome can damage body fluid, presenting with such dry symptoms as dry mouth, dry throat, dry skin and strong thirst.

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There are a few areas of the body that are also contraindicated for moxa treatment, such as the face and head. The reason for this is due to the fact that these areas are close to arteries or veins. Do not perform direct moxibustion on these areas.

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Moxa treatment is also contraindicated during pregnancy. Do not apply severe moxibustion (large cones or long duration) on the low back and low abdominal region of pregnant women to prevent miscarriage.

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Acupuncture and Moxibustion—A Clinical Desk Reference

COMMON USES OF DIRECT NON-SCARRING MOXIBUSTION FOR SPECIFIC DISEASES Points: SP-1 and LV-1. Indications: Any kind of chronic bleeding, such as menstrual bleeding, bloodies stool, urinary bleeding and nose bleeding. Gum bleeding can be treated this way as well. Apply 9-11 cones each treatment. Treat once every other day, for 5-7 treatments as a course. Points: LU-11 and LU-10. Indications: Lung Qi stagnation, stuffy sensation in the chest, chest pain, cough, sore throat, and phlegm retention, also for Heat stagnation in the Lung. Apply 5-7 cones each treatment. Treat once every other day for 3-4 treatments as a course. Points: GV-14, BL-13, GV-12, and BL-43. Indications: Chronic Lung symptoms, such as: chronic asthma, cough, bronchitis, chest pain and stuffy sensation, shortness of breath and heart palpitations. Apply 9-11 cones each treatment. Treat twice a week, for 5 treatments as a course. This condition is best treated in the summer. Points: Da Gu Kong. Indications: Mental disorders, possession, stress, severe anxiousness, irritability, sweating and nightmares. Apply 11 cones each treatment. Treat once every other day for 10 treatments as a course. Points: TW-10. Indications: Water retention problems, such as: edema, lymphoma, fibromyalgia and swollen lymph nodes on the neck, or edema after chemotherapy. Apply 9-11 cones each treatment. Treat twice a week for 5 treatments as a course. Points: LI-14 and TW-13. Indications: Water retention problems, particularly in the arms after breast cancer, or other types of infection due to water retention. Apply 11 cones each treatment. Treat once every other day for 5 treatments as a course.

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Common Uses of Direct Non-Scarring Moxibustion for Specific Diseases

Points: LI-15. Indications: eye problems, such as: myopia, blurry vision, high eye pressure and other eye excess and deficiency problems. Apply 7-9 cones each treatment. Treat one or twice a week for 3-5 treatments as a course. Points: LI-15, TW-14, and SI-9. Indications: shoulder problems, such as: frozen shoulder, tendonitis, bursitis, rotate cuff or other muscle and nerve problems. Apply 8-10 cones each treatment. Treat one or twice a week for 5 treatments as a course. Points: Qian Zhen and TW-17. Indications: Peripheral facial paralysis, when the patient feels achiness, twitching, has difficulty chewing food and difficultly closing the eye. Apply 10 cones each treatment. Treat twice a week for 5 treatments as a course. Points: GV-14 and GV-12. Indications: Emotional problems, such as: depression, anxiety, stress and sadness, or other light mental disorders. Apply 10-12 cones each treatment. Treat once every other day for 6 treatments as a course. Points: GV-14, GV-12, BL-13, and BL-43. Indications: Chronic Lung problems, particularly for chronic asthma, bronchitis, Lung Qi deficiency and cough. Apply 5 cones each treatment. Treat one or twice a week for 7-10 treatments as a course. Points: BL-17 and BL-19. Indications: Any kind of Blood deficiency, such as: anemia, dizziness, irregular menstruation, and other symptoms related to a Blood deficiency. Apply 11 cones each treatment. Treat twice a week for 10 treatments as a course. Points: BL-18 and BL-20. Indications: chronic hepatitis when the patient experiences tiredness, lassitude, nausea, irregular bowl movement, and hypochondriac pain. Apply 7-9 cones each treatment. Treat once a week for 5 treatments as a course.

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Points: BL-23, BL-52, and GV-4. Indications: Kidney deficiency problems, such as: chronic asthma, water retention, weakness of the low back and knees, irregular menstruation and urination, poor memory, superficial sleep or early morning diarrhea. Apply 11-13 cones each treatment. Treat twice a week for 10 treatments as a course. Points: BL-32 and below the 17th vertebra. Indications: dysmenorrhea with severe pain and cold sensation in the limbs and body with cold sweating, and a deep tight pulse. Apply 15 cones each treatment. Treat once every other day for 3 treatments as a course. Points: GV-26 and ST-28. Indications: Leukorrhea with irregular uterine discharge in large amounts or with abnormal color and foul smell. Apply 8 cones each treatment. Treat once every other day for 7 treatments as a course. Points: GV-2, BL-57, and BL-59. Indications: Hemorrhoid problems, when patients feel swollen, sinking sensations, or pain and burning sensations after moving their bowels. Apply 6-8 cones each treatment. Treat once every week for 5 treatments as a course. Points: ST-36 and SP-6. Indications: Chronic stomach and intestinal problems such as: Stomach Qi deficiency, bloating and cramping sensations in the stomach and intestines, chronic diarrhea, and vomiting of cold clear water. Apply 11 cones each treatment. Treat once every other day for 10 treatments as a course. Points: LV-5 and LV-1. Indications: Itching and eczema near or in the genital region where the patient may feel a burning and itching sensation particularly at night, often with a bitter taste in the mouth and wiry pulse. Apply 8-10 cones each treatment. Treat one or twice a week for 5 treatments as a course. Points: Tip of ear (Er Jian). Indications: Any kind of eye infection disease, such as: conjunctivitis, sty and other painful or itching problems in the eyes. Apply 3-4 cones each treatment. Treat once daily for 2-3 treatments as a course.

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Common Uses of Direct Non-Scarring Moxibustion for Specific Diseases

Points: SI-11, SI-12, and SI-13. Indications: Severe acne and rosacea with an itching and burning sensation. Apply 8 cones each treatment. Treat once every other day for 5 treatments as a course. Points: CV-3 and ST-28. Indications: Urinary problems due to deficiency, such as: incontinence, turbid urine, bed-wetting and difficulty in emptying the bladder. Apply 9-11 cones each treatment. Treat one or twice a week for 10 treatments as a course. Points: Zi Gong and CV-4. Indications: Any kind of menstruation problem due to Cold and deficiency conditions. For example: irregular menstruation, abnormal uterine discharge, dysmenorrhea, infertility, and PMS. Apply 9-11 cones each treatment. Treat twice a week for 7 treatments as a course. Points: CV-4 and CV-6. Indications: To help people with weak body constitutions, to increase the bodies True Qi or promote longevity. Apply 13-15 cones each treatment. Treat once a week for 3 treatments as a course. Points: CV-9. Indications: Water retention in the abdominal region, particularly after chemotherapy or ascites due to cirrhosis. Apply 13-15 cones each treatment. Treat once every other day for 10 treatments as a course. Points: BL-67. Indications: Malposition of the fetus, the best time for treatment is between 24-30 weeks. Apply 15–20 cones each treatment. (Or one can apply moxa pole for 25-30 minutes each treatment). Treat twice a week for 5 treatments as a course. Points: SI-1. Indications: Mastitis or breast tenderness and pain, or lack of breast milk secretion after labor. Apply 7-8 cones each treatment. Treat once daily (one finger in each day) for 5 treatments as a course.

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COMMON USES OF INDIRECT MOXIBUSTION FOR SPECIFIC DISEASES Points: CV-8 with salt. Indications: To revive the Yang Qi when the patient experiences stroke, severe vomiting, diarrhea, or loss of consciousness with profuse cold sweating. Do not count the time or number of cones, perform until the patient’s body temperature and pulse returns and the cold sweating has abated. Treat only during the emergency. Points: Governing vessel (from GV-2 to GV-14) with garlic. Indications: some long chronic diseases with Qi and Yang deficiency, such as osteoarthritis, rheumatic arthritis, chronic gastritis, diarrhea. (See chapter II Bi syndrome) Points: Local area of skin disorders with garlic. Indications: some skin problems, such as psoriasis, furuncle. Apply 4-6 cones each treatment. Treat once every other day until symptoms disappear. Points: CV-12, BL-20, and BL-21 with ginger. Indications: Stomach pain and cramping due to Cold with vomiting of clear water, poor appetite, and lassitude. Apply 7-9 cones each treatment. Treat twice a week for 5 treatments as a course. Points: CV-3 and Zi Gong Xue with ginger. Indications: Cold sensation in lower abdominal region, retention of urine, infertility, and impotence. Apply 5 cones each treatment. Treat twice a week for 5 treatments as a course. Points: Qian Zheng, Tai Yang, and GB-12 with ginger. Indications: Peripheral facial paralysis due to Wind Cold Pathogenic Invasion. Apply 5 cones each treatment. Treat once every other day, for 3 treatments as a course. Points: GV-9 with garlic. Indications: Malaria, back pain, stomach pain, Liver and Gallbladder problems. Apply 3-5 cones each treatment. Treat once every other day for 3-5 treatments as a course.

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Common Uses of Indirect Moxibustion for Specific Diseases

Points: LV-13 with ginger. Indications: Disharmony of the Liver and Spleen, such as: irritable bowel movement, cramping and bloating in the abdomen, stuffiness and tightness in the chest or hypochondriac region, irritability, and tendency towards anger. Apply 5-7 cones each treatment. Treat one or twice a week, for 5 treatments as a course. Points: BL-43 with herb powder (Se Xiang, Bai Zhu, Rou Gui). Indications: Chronic bronchitis, asthma, chronic cough, chronic fatigue syndrome, and allergic reactions. Apply 5 cones each treatment. Treat once every other day for 7 treatments as a course. Points: TW-4 with garlic. Indications: Diabetes, edema, swelling and numbness in the arms. Apply 7 cones each treatment. Treat twice a week, for 5 treatments as a course. Points: CV-6, ST-25, and BL-25 with Fu Zi cake. Indications: chronic colitis, diarrhea due to Yang deficient body constitutions. Apply 5-7 cones each treatment. Treat once every other day, for 7 treatments as a course. Points: CV-4 and GV-4 with Fu Zi cake. Indications: Kidney Yang Deficiency, with such symptoms as cold sensation in the low back and both legs, lassitude, impotence, water retention, dizziness, and poor memory. Apply 5 cones each treatment. Treat once a week, for 7 treatments as a course.

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Distribution of Auricular Points & Indications

CHAPTER III: DISTRIBUTION OF AURICULAR POINTS & INDICATIONS

SCAPHOID FOSSA Finger It treats hand injury and finger problems. It is close to the allergy area (between finger and wrist) can help It treats allergic problems particularly for some skin disorders, such as eczema, Urticaria, and psoriasis it’s commonly combined with lung and large intestine and Shen Men for skin problems. Wrist It treats wrist injury, such as painful sensation after trauma injury, carpal tunnel syndrome, swollen wrist. And also help it treats some allergic problems. Elbow It treats elbow problems, such as tennis elbow, tendonitis and arthritis. It also is a point that helps to lose weight and stop smoking. Shoulder It treats any kind of shoulder problems, such as frozen shoulder, shoulder tendonitis, bursitis, and other shoulder injuries. It is also commonly applied for stopping smoking and losing weight. Shoulder Joint It treats any kinds of shoulder problems and neck pain as well, pain located in scapular and upper back. Clavicle It treats shoulder problems and epigastric and abdominal chronic pain in deficiency body constitutions.

UPPER CRUS OF ANTIHELIX Toe It treats toe injury and bone spur, arthritis, dizziness and vertigo with brain and Shen Men. Ankle It treats ankle injury pain, joint arthritis, swollen ankle and headache. Knee It treats painful sensation the dysfunction of knee joint, such as meniscus injury, ligament problems, muscle injury and arthritis

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Buttock It treats sciatic nerve pain, muscle injury on the buttock area, S.I joint and S.L joint pain, weakness of hip and spleen Qi deficiency, blood deficiency. Ischium It treats sciatic nerve pain that travels down to the leg, muscle injury, hip pain, and back injury. When it used for calm down the mind, stress, and depression and anxious, most time combined with heart, Shen Men Sub cortex together. Sympathetic It treats all of the sympathetic nerves problems, such as irregular heart beat, irritable bowl movement, and shortness of breath, epigastric pain, restlessness, insomnia, stress and depression. Usually it is combined with other specific point treat organ’s disorders. For example, select sympathetic, abdomen, and large intestine together for when patient suffer from abdominal pain.

TRIANGULAR FOSSA Shen Men It helps to treat emotional problems, such as depression, stress, anxiety, insomnia, and heart palpitations. It is usually associated with heart, liver and Sub cortex ear points together for treatment of emotional problems. Meanwhile this point is effective to treat any the pain and cramping sensation in lower abdominal area. Uterus It’s the main point for the problems in reproductive system. For example, with sympathetic, liver and heart points to treat irregular menstruation and with urinary bladder, kidney, brain stem and Sub cortex points to treat prostatitis.

ANTIHELIX Abdomen It treats abdominal problems such as gastro-enteritis, constipation, diarrhea, dysmenorrhea and other organs problems as well as loses weight. Chest It treats chest pain, stuffy sensation in the chest, and shortness of breath, heart palpitations, costal chondritis, intercostals neuralgia and herpes zoster. Help to reduce depression and sadness in the morning. Neck It treats neck pain, such as stiff neck, neck injury, cervical spondylosis, the pain on the upper back related to scapular, stress, and back of headache. Thoracic It treats chest pain, upper back pain and muscle spasm that caused by long term stress and depressions, insomnia, anxious and heart palpitations. 530

Distribution of Auricular Points & Indications

Lumbar Sacrum It treats low back pain, kidney deficiency, back injury, paralysis, arthritis and dysmenorrhea. Thoracic Vertebra It treats upper back injury, asthma, bronchitis, coastal never pain, herpes zoster and sadness and depression with upper back painful or tight sensations. Cervical Vertebra It treats neck pain, stiff neck, and spinal column pain and spasm sensation on the whole back, cold sensation near GV-14 area and back of headache and dizziness.

TRAGUS Nose It treats inside nose pain; dry nose, Rhinitis, nose bleeding, stuffy nose, running nose and sinusitis. Throat It treats both acute and chronic sore throat, dry throat, laryngitis and tonsillitis. Inner-nose It treats stuffy nose, running nose, common Cold, sinusitis and headache. Upper Tip of Tragus It treats inflammations and pain syndrome, such as headache, fever and chest pain. Lower Tip of Tragus It treats lower blood pressure, fatigue, unconsciousness (no pulse), cough, asthma, Common Cold, summer heat stroke, malaria and mastitis.

ANTITRAGUS Calm the Asthma It treats asthma, cough, fever, chest pain, spontaneous sweating, heart palpitations, anxiety and insomnia. Brain To calm the mind and treat brain problems, such as wind stroke, ADD, poor memory, brain injury, and it is the effective point to help heart and stomach functions and treat emotional problems and stomach reflex. Brain Stem It treats emotional problems, such as depression, irrational, anxiety attack, insomnia, epilepsy. Sometimes this point used for fever, release severe cough and asthma. 531

Acupuncture and Moxibustion—A Clinical Desk Reference

Testicle It treats testicle problem particularly for men’s fertility, improve sexual energy and chronic prostatitis. Forehead To nourish brain functions, treat dizziness and vertigo, blurry vision, migraine headache, depression, hypertension and poor memory. Occiput It treats occipital headache, neck pain, poor vision, nausea and vomiting, balance problems and the pain in the scapular region related to neck, or travel down to arms. Temple It treats migraine headache, tinnitus, deafness, TMJ pain, toothache and poor vision and blurry vision. Central Rim It treats any kind of pain in the body, such as headache, chest pain, angina, arm pain or sports injury pain, digestive system pain and menstrual pain. To calm the mind help insomnia, dizziness, stress, depression or anxiety attack.

AROUND THE CRUS OF HELIX Esophagus It treats chest pain, esophagus spasm, stomach reflex, nausea, restlessness and breathing problems. Stomach It treats epigastric pain, nausea and vomiting, acid regurgitation, poor sleep, chest pain, stomach reflex, chronic gastric ulcer and upper GI bleeding. Duodenal It treats epigastric pain, vomiting, duodenal ulcer, stomach reflex, abdominal pain and poor sleep. Small Intestine It treats abdominal pain, heart palpitations, headache, UTI, retention of urine, prostatitis and low sexual energy. Large Intestine It treats constipation, diarrhea, abdominal pain, high fever, cough, eczema, and itching and dry skin. Appendix It treats appendicitis, abdominal pain, constipation, diarrhea, irregular menstruation, and hemorrhoid.

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Distribution of Auricular Points & Indications

CYMBA CONCHA Urinary Bladder It treats urinary system problems, such as painful urination, retention of urine, prostatitis, UTI, low back pain and low sexual energy. Kidney It treats urinary system and reproductive problems, such as painful urination, weakness urination and retention of urine, prostatitis, irregular menstruation, infertility, weakness sexual energy, fatigue, poor memory, tinnitus, insomnia, dizziness and vertigo, osteoarthritis, hard to focus the mind, asthma and weakness sensation in the low back and both legs. Liver It treats digestive system, blood problems and emotional problems, for example, hypochondriac pain, diarrhea, irregular menstruation, headache, dizziness, blurry vision, depression, stressful and poor memory. Spleen It treats digestive system problems, such as bloating abdomen, diarrhea, poor appetite, chronic bleeding, lassitude, weakness muscles, low energy and edema. Gallbladder (Pancreas) It treats any kinds of gallbladder problems including gallbladder infection and gallstone, pancreatitis, diabetes, migraine headache and malaria.

CAVUM CONCHA Mouth It treats ulcer in mouth, herpes on the angle of mouth, facial paralysis, Trigeminal neuralgia, toothache and face achy by allergy. Heart It treats heart palpitation, shortness of breath, insomnia, restlessness, anxiety attack, poor memory, nightmare and cardiovascular system problems. Lungs It treats lung infection diseases, common Cold, cough, and asthma, bronchitis, and shortness of breath, sadness, nightmare, eczema, Urticaria, constipation, diarrhea and stop smoking. Trachea It treats cough, bronchitis, asthma attack, chest pain, and stuffy sensation in the chest, heart palpitations, tightness chest and spontaneous sweating.

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Adrenal Gland It treats allergy problems, reduces fever and stops bleeding. It usually applies to treat allergic reaction, rheumatic fever, profuse menstruation, and menorrhagia. It is an effective point for brain problems, including the treatment of dizziness and vertigo, blurry vision, cerebella ataxia, epilepsy, difficult to focus, poor memory and low intelligence of the brain development. Sub Cortex It treats neurological system problems, digestive diseases, such as neurasthenia, vegetative nerve functional disorders, neurosis, schizophrenia, gastritis ulcer, duodenal ulcer, nausea, vomiting, abdominal bloating, diarrhea, constipation and some liver and gallbladder problems as well. It’s also It treats cardiovascular diseases, such as coronary heart disease, arrhythmia, cold hand and feet, and angina. Endocrine It treats endocrine system problems, such as: thyroid problems, diabetes, and irregular sweat. And also it is effective for treatment of allergic reactions, rheumatic diseases, cystitis, nephritis, irregular menstruation, low sexual energy and some tumor. Sometimes this point applies for edema, eczema and overweight. San Jiao It treats constipation, edema, water and phlegm retention, swollen leg, heaviness sensation on the head and limbs, diarrhea. It is an effective point for emotional problems and helps stop smoking and lose Weight.

EAR LOBE Eye 1 It treats glaucoma, myopia, and painful sensation behind eyeball. Eye 2 It treats conjunctivitis, red eyes, painful sensations in the eyes and aversion to Wind due to Cold Pathogenic Invasion. Eye It treats any kinds of eye’s problems, such as blurring vision, conjunctivitis, optical nerve atrophy and painful sensation in eyes. Toothache (1)(2) It treats toothache, gingivitis. And apply for dental surgery with under acupuncture anesthesia. Inner Ear It treats tinnitus and loses hearing ability, medium otitis, insomnia, dizziness and vertigo, migraine headache and toothache.

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Distribution of Auricular Points & Indications

Tonsil It treats tonsillitis, sore throat, and infection in upper respiratory system, headache, face pain, eyes pain and burning sensation in mouth. Upper Jaw, Lower Jaw, and Face Area It treats face achy, such as Trigeminal neuralgia, facial paralysis, acne, numbness sensation on the face and tic.

BACK OF EAR Reducing Blood Pressure It treats hypertension, headache, dizziness and vertigo, frequent urination, heat stagnation sensation in the chest and epigastric area. Er Mi Geng It treats acute stomach pain, gallbladder stone and infection, acute diarrhea, asthma, stuffy nose and abdominal pain with vomiting. Upper Ear Root It treats skin problems including psoriases, eczema, acne, urticaria, headache, sciatic, and low back pain. Middle ear root It treats skin’s problems, upper back pain, shoulder pain, cough, asthma, and chest pain. Lower Ear Root It treats headache, toothache, sore throat, stuffy nose, asthma, neck pain and dizziness.

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International Standard Scalp Acupuncture

CHAPTER IV: INTERNATIONAL STANDARD SCALP ACUPUNCTURE

Treatment Zone Distribution and Indications MS1. Middle line of the forehead Location: 1 cun long from GV-24—straight downward along the meridian. Clinical Indications: “Shen” problems including restlessness, insomnia, heart palpitations, depression, anxiety, Headache, dizziness and vertigo, sinusitis and blurry vision, hard to concentrate mind, memory lost and other mental problems. Chest pain, facial achy, eyes pain and sore throat. MS2. Lateral line 1 of the forehead Location: 1 cun long from BL-3—straight downward along the meridian. Clinical Indications: Upper warmer problems and some eye problems including chest pain, shortness of breath, heart palpitations, asthma, cough sore throat, headache, Stye, and conjunctivitis. And also can help lung infection diseases, such as cough, allergy bronchitis and pneumonia. MS3. Lateral line 2 of the forehead Location: 1 cun long from GB-14—straight downward along the meridian. Clinical Indications: Middle warmer problems including stomach, liver and gallbladder disorders such as: stomach pain, reflex, acid-regurgitation, ulcer and acute gastritis, hypochondriac pain, breast tender, nausea, vomiting, belching, bloating abdomen and headache. MS4. Lateral line 3 of the forehead Location: 1 cun long from between ST-8 and GB-14—straight downward along the meridian. Clinical Indications: Lower warmer problems including O.B GYN and reproductive system diseases, such as: low abdominal pain, Dysmenorrhea, endometrioses, irregular menstruation, retention of urine, frequent urination, mass in low abdomen, diarrhea, irregular discharge and uterus bleeding, prostatitis, irregular urination and TMJ, migraine headache. MS5. Middle line of the vertex Location: From GV-20 to GV-21. Clinical Indications: “Shen” and Low part of body’s problems including low back pain, back achy, weakness and painful sensation on the legs and foot, heel pain, frequent urination, prolapsed of organs, headache which caused by liver Yang rising up and kidney deficiency, ADD, senior dementia, insomnia, headache, restlessness, blurry vision, poor memory. Sometimes that zone used for emergency problems such as: coma, lost consciousness, and fainting and neck pain.

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MS6. Lateral line 1 of the vertex Location: 2 cun long from BL-6—backward along the meridian. Clinical Indications: “Shen” and body problems, such as: frequent urination, weakness and sore sensation on the feet, shoulder pain, numbness and abnormal sensation on the low extremities, low back pain, difficulty in urine, prolapsed of uterus, dizziness and vertigo, neck pain, headache paralysis, ADD, insomnia, heart palpitations, dementia and other mental diseases. MS7. Lateral line 2 of the vertex Location: 1.5 cun long from GB-17—backward along the meridian. Clinical Indications: Aphemia by stroke, paralysis of limbs, abnormal sensation on the limbs and body, headache, convulsion, joins achy, insomnia and other mental problems, numbness and other abnormal sensation on the upper extremities, paralysis, pain in the shoulder, elbow and wrist, acute neck injury, frozen shoulder. MS8. Anterior oblique line from vertex to temple Location: From GV-21 to GB-6. Clinical Indications: Paralysis problems after stroke or other brain injuries, upper 1/5 used for opposite side of leg paralysis, joints achy and dysfunction of muscles. Middle 2/ 5 used for opposite side of arms and body paralysis, frozen shoulder, including joints pain and dysfunction of muscles as well. Lower 2/5 used for opposite side of face and neck problems particularly for facial paralysis by central nerve damaged Aphemia, headache, TMJ, dizziness and vertigo. MS9. Posterior oblique line from vertex to temple Location: From GV-20 to GB-7. Clinical Indications: Upper 1/5 of line used to treat opposite side of low back and leg sensation problems, such as abnormal feeling, pain, sensation lost, numbness feeling on the leg, back of headache, neck pain, dizziness and vertigo. Middle 2/5 treat opposite side of upper extremity sensation problems, such as abnormal sensation, pain, numbness, and sensation lost. Lower 2/5 treat opposite side of face sensation problems, such as migraine headache, trigeminal pain, blurry vision, tinnitus, toothache, TMJ, and other sensation lost on the face and side of head. MS10. Oblique anterior line of the temple Location: From GB-4 to GB-6. Clinical Indications: Dizziness and vertigo, Meniere’s disease with vomiting, deafness, ringing ear, migraine headache, face pain, toothache, Bell’s palsy, TMJ and blurry vision, memory lost, ADD, and senior dementia. MS11. Oblique posterior line of the temple Location: From GB-8 to GB-7. Clinical Indications: Dizziness and vertigo, insomnia, headache, neck pain, abnormal sweat, ringing ear, deafness, neck pain, side of body achy, insomnia, ADD, and senior dementia.

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International Standard Scalp Acupuncture

MS12. Upper-middle line of the occiput Location: From GV-18 to GV-17. Clinical Indications: Back of headache, occipital pain, stiff neck, neck pain, middle of back pain, particularly for low back pain, dizziness and vertigo, poor memory, depression, foot pain. MS13. Upper lateral line of the occiput Location: 0.5 cun lateral and parallel to Upper-Middle line of the Occiput. Clinical Indications: 5 sensory organs problems including eyes, nose, ears and mouth, particularly for eyes problems, such as: myopia, eyes pain and itching eyes, pain in the occipital region and back of headache, low back pain on the both side of spinal column, blurry vision, glaucoma, cataract and myopia. MS14. Lower lateral line of the occiput Location: 2 cun long from BL-9—straight downward. Clinical Indications: Balance problems, which caused by cerebellum injured. And neck pain, shoulder pain and travels down to the arms, headache, dizziness and vertigo, Meniere’s disease, insomnia, emotional problems including stressful and anxious.

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Meridian Illustrations

APPENDIX 1 Meridian Illustrations Lung

Lung meridian of Hand Tai Yin 541

Acupuncture and Moxibustion—A Clinical Desk Reference

Large Intestine

Large Intestine Meridian of Hand Yang Ming

542

Meridian Illustrations

Stomach

Stomach Meridian of Foot Yang Ming

543

Acupuncture and Moxibustion—A Clinical Desk Reference

Spleen

Spleen Meridian of Foot Tai Yin

544

Meridian Illustrations

Heart

Heart Meridian of Hand Shao Yin

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Acupuncture and Moxibustion—A Clinical Desk Reference

Small Intestine

Small intestine Meridian of Hand Tai Yang

546

Meridian Illustrations

Bladder

Urinary Bladder Meridian of Foot Tai Yang

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Acupuncture and Moxibustion—A Clinical Desk Reference

Kidney

Kidney Meridian of Foot Shao Yin

548

Meridian Illustrations

Pericardium

Pericardium Meridian of Hand Jue Yin

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Acupuncture and Moxibustion—A Clinical Desk Reference

Triple Warmer

Triple warmer Meridian of Hand Shao Yang

550

Meridian Illustrations

Gall Bladder

Gall bladder Meridian of Foot Shao Yang 551

Acupuncture and Moxibustion—A Clinical Desk Reference

Liver

Liver Meridian of Foot Jue Yin

552

Meridian Illustrations

Governing Vessel

Governing Vessel

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Acupuncture and Moxibustion—A Clinical Desk Reference

Conception Vessel

Conception Vessel

554

Illustrations for the Adjunctive Therapies

APPENDIX 2 Illustrations for the Adjunctive Therapies Scalp Acupuncture

Picture 1 International Standard Scalp Acupuncture treatment Lines 555

Acupuncture and Moxibustion—A Clinical Desk Reference

Picture 2 International Standard Scalp Acupuncture treatment lines Ear

556

Illustrations for the Adjunctive Therapies

Ear Acupuncture Point Distributions

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Acupuncture and Moxibustion—A Clinical Desk Reference

General Ear Acupuncture Point

558

Illustrations for the Adjunctive Therapies

Wrist and Ankle

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560

Illustrations for the Adjunctive Therapies

Wrist and Ankle Acupuncture (Side view)

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Acupuncture and Moxibustion—A Clinical Desk Reference

Hand

Hand Acupuncture points

562

Illustrations for the Adjunctive Therapies

Foot

Foot Acupuncture points

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Acupuncture and Moxibustion—A Clinical Desk Reference

Nose

Nose Acupuncture points

564

Bibliography

BIBLIOGRAPHY

Bai Zheng Fu Yang Ji Zhou, Ming Dynasty Bao Ming Ji Wang Tao, Tang Dynasty Cai ai Bian Yi Ye Cha Shan, Qing Dynasty Dan Qi Xin Fa Zhu Dan Qi, Yuan Dynasty De Xiao Fang Wei Yi Ling, Yuan Dynasty Qu Jing Yi Jian Gong Xin, Ming Dynasty Jing Yue Quan Shu Zhang Jie Bing, Ming Dynasty Ji Ling Zhong Yi Za Zhi Ji Ling TCM magazine Jing Mai Tu kao Huang Zhu Zhai, public health press house Jiu Fa Mi Chuan Weir en nian, Song Dynasty Lei Jing Tu Yi Zhang Jiebing, Ming Dynasty Ling Shu Huang Di Nei Jing, BC

Pian que Xin Shu Dou Cai, Song Dynasty Pi Wei Lun Li dong Wan, Jin Dynasty Pu Ji Fang Peng Yong Guang, Ming Dynasty Qian Jin Fang Sun Si Mao, Tang Dynasty Qian Jin Yi fang Sun Si Mao, Tang Dynasty Run Meng Shi Qin Zhang Chong Zheng, Jin Dynasty Shan Xi Zhong Yi Shan Xi TCM magazine Shen Jiu Jing Lun Wu Yan Cheng, Qing Dynasty Shen yin Jing Chen Hui, Ming Dynasty Shen Ji Zong Lu Wang Tao, Tang Dynasty Shang Han Lun Zhang Zhong Jing, Han Dynasty Tong Ren Zhen Jiu Tu Jing Wang Wei Yi, Song Dynasty 565

Acupuncture and Moxibustion—A Clinical Desk Reference

Tong Ren Zhen Jiu

Zhen Jiu Da Quan

Wang Wei Yi, Song Dynasty

Xu Feng, Ming Dynasty

Wang Bing Hui Chun

Zhen Jiu Ji Cheng

Gong Yan Xian, Ming Dynasty

Liao Run Hong, Qing Dynasty

WeiSheng Bao Jian

Zhen Jiu gang Yao

Luo Tian Yi, Yuan Dynasty

Lou Ying, Ming Dynasty

Xing Zhen Jiu Xue

Zhen Jiu Tu Yi

Zhu Lian Guang Xi TCM College

Zhang Jie Bing, Ming Dynasty

Yue Long Ge

Zhen Jiu Da Cheng

Yang Ji Zhou, Ming Dynasty

Yang Ji Zhou, Ming Dynasty

Yi Xue gang Mu

Zhen Jiu Chu Fang Ji Jing

Li Gao, Jin Dynasty

Nan Jing TCM College

Yi Zhong Jin Jian

Zhen Jiu Feng Yuan

Wu Qian, Qing Dynasty

Li Xue Chuan, Qing Dynasty

Za Bing Ge

Zhen Jiu Zi Sheng Jing

Zhang Lu, Qing Dynasty

Wang Zhi Zhong, Song Dynasty

Zheng Zhi Zhun Sheng

Zhen Jiu Zhai Ying Ji

Wang ken Tang, Ming Dynasty

Du Si Jing, Yuan Dynasty

Zhen Jiu Bei Xue

Zhen Jiu Jing Lun

ZheJiang Zhong Yi Yao Za Zhi

Wu Yan Cheng, Qing Dynasty

Zhen Jiu Bian Yong

Zhen Jiu Ju Ying

Zhang Xi Chun, Qing Dynasty

Gao Wu, Ming Dynasty

Zhen Jiu Quan Shu

Zhen Jiu Chu Fang Da Quan

Chen Yan, Ming Dynasty

TCM research institute

Zhen Jiu Jia Yi Jing

Zhen Jiu Ru Meng

Huang Pu Mi, Jin Dynasty

Li Ting, Ming Dynasty

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Zhen Jiu Chu Fang Xue

Zhong Hua Pi Fu Ke Zha Zhi

Xiao Shao Qing, Nan Jing TCM College

PR. China magazine

Zhong Guo Zhen Jiu

Guang Xi Zhong Yi

Cheng Dan An, PR.China

Guang Xi TCM magazine, PR. China

Zhong Hua Zhen Jiu Xue

Jiang Su Zhong Yi

Zhao Er Kang, PR.China

Jiang Su TCM magazine, PR.China

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568

Index A Abdominal pain......................73, 74, 75, 78, 79, 352, 451 Acid regurgitation ............................................... 236, 463 Acne.................................................................... 385, 390 Acute conjunctivitis ............................................ 391, 393 Adjacent points ............................................................. 49 Ah Shi points ......16, 48, 49, 65, 102, 103, 104, 106, 161, 193, 195, 196, 204, 237, 238, 264, 266, 270, 300, 301, 302, 320, 421 Amenorrhea ........................................ 429, 430, 432, 433 Aphonia............................................... 380, 395, 397, 398 Asthma........................................ 37, 81, 82, 86, 352, 531 Aversion to cold.......................................................... 419 B Back-Shu points...............53, 79, 498, 507, 508, 511, 514 Beriberi ....................................................... 95, 96, 97, 98 Bi syndrome....45, 56, 101, 102, 104, 105, 106, 107, 108, 109, 319, 502, 511, 512, 513, 514, 515, 516, 519, 520, 521, 526 Bleeding................................................................ 39, 481 Blood .. VII, 5, 6, 7, 11, 12, 16, 18, 22, 23, 28, 29, 30, 37, 38, 39, 40, 43, 44, 53, 55, 56, 62, 67, 73, 74, 75, 76, 90, 91, 92, 96, 102, 108, 111, 112, 115, 117, 119, 121, 127, 128, 132, 137, 159, 160, 164, 165, 166, 177, 178, 183, 184, 191, 192, 193, 195, 196, 199, 201, 202, 203, 205, 209, 210, 214, 231, 235, 236, 237, 239, 240, 243, 247, 249, 250, 252, 253, 255, 256, 259, 263, 264, 267, 277, 283, 291, 292, 294, 295, 296, 299, 300, 302, 303, 305, 306, 307, 308, 310, 311, 315, 319, 324, 326, 337, 343, 354, 355, 370, 371, 372, 373, 378, 379, 385, 386, 387, 388, 389, 390, 401, 413, 423, 424, 425, 429, 430, 431, 432, 435, 436, 437, 438, 439, 441, 445, 449, 450, 451, 460, 461, 462, 464, 467, 468, 469, 472, 479, 480, 481, 482, 484, 485, 486, 493, 500, 501, 504, 507, 508, 509, 510, 511, 512, 514, 519, 520, 523, 535 Blood problems............................................... 38, 56, 355 Blood stagnation .....16, 37, 39, 53, 56, 91, 201, 235, 303, 371, 508, 510, 511, 519 Blurry vision ............................................................... 144 Body fluid ....................................................................VII Borborygmus .............................................................. 358 C Chronic fatigue ........................................................... 111 Conception Vessel .........34, 47, 53, 57, 60, 105, 359, 554 Conjunctivitis.............................................................. 391 Constipation ..66, 112, 127, 128, 129, 132, 203, 209, 210, 386, 414 Convulsion.......................................................... 186, 285 Cough...........15, 35, 37, 62, 135, 136, 137, 142, 271, 395 Cough and Asthma........................................................ 37 Crossing-Meeting Points............................................... 58 Crying ......................................................... 278, 279, 280 D

Diabetes ...................................................... 143, 148, 527 Diarrhea .................74, 151, 157, 228, 229, 352, 408, 516 Direct Moxibustion ............................................. 145, 520 Discomfort after treatment .......................................... 493 Distal points ................................................................ 427 Dizziness and vertigo . 164, 244, 250, 359, 402, 425, 442, 482, 538 Dysentery .............................................. 65, 165, 166, 170 Dysmenorrhea............. 435, 437, 438, 439, 530, 531, 537 E Ear acupuncture .............................................. 68, 83, 515 Eclampsia.................................................... 441, 443, 444 Edema ..........113, 171, 172, 203, 307, 308, 462, 483, 504 Eight Confluence Points................................................ 57 Eight Influential Points ................................................. 56 Epigastric pain .................................................... 177, 182 Epilepsy ........................................ 63, 183, 184, 185, 188 Extra-points................................................................... 48 Eye pain ...................................................................... 291 Eye problems ................................................................ 33 F Facial paralysis...................................................... 92, 373 Fainting ....................................................................... 491 Febrile diseases ............................................................. 33 Fever .36, 82, 95, 128, 152, 216, 228, 229, 244, 255, 256, 285, 314, 351, 391 Five Shu points ............................................................. 50 Foot Jue Yin Meridian of the Liver............................... 46 Foot Shao Yang Meridian of the Gall Bladder ............. 45 Foot Shao Yin Meridian of the Kidney......................... 42 Foot Tai Yin Meridian of the Spleen ............................ 38 Front-Mu Points ...................................................... 53, 54 G Governing Vessel.................. 34, 47, 53, 57, 60, 431, 553 H Hand Jue Yin Meridian of the Pericardium .................. 43 Hand Shao Yang Meridian of the Triple Warmer......... 44 Hand Shao Yin Meridian of the Heart .......................... 39 Hand Tai Yin Meridian of the Lung ............................. 35 Heart Diseases............................................. 33, 39, 43, 46 Heart palpitation..112, 128, 160, 201, 202, 203, 207, 210, 228, 292, 313, 344, 425, 426, 462, 474 Hematoma................................................................... 493 Hemoptysis ........................................................... 35, 271 Hemorrhoids ................................................. 65, 209, 214 He-sea points......................... 50, 52, 54, 55, 67, 510, 516 Hiccup................................................. 221, 222, 225, 380 High fever ........................................................... 121, 237 Hunger ........................................................................ 145 Hypochondriac pain ..... 75, 128, 160, 178, 235, 236, 237, 241, 358, 408, 436 Hypogalactia ....................................................... 445, 448

Deafness.............................................. 380, 401, 403, 405 569

Acupuncture and Moxibustion—A Clinical Desk Reference

I Impotence ................................... 113, 243, 244, 247, 264 Indirect Moxibustion........................................... 145, 520 Infertility ............................................. 449, 450, 451, 453 Injured brain and spinal cord ...................................... 495 Injured Nerves ............................................................ 495 Injury of other organs ................................................. 494 Insanity ....................................................................... 278 Insomnia63, 160, 203, 210, 216, 229, 244, 249, 254, 264, 278, 307, 308, 344, 380, 462, 481, 482 Irregular menstruation................................. 387, 468, 472 J Jing-river points ............................................................ 50 Jing-well points....................................... 50, 69, 195, 373 Jiu Ci........................................................................... 507 L Leg pain ...................................................................... 308 Leukorrhea...................451, 455, 456, 458, 459, 460, 524 Lin syndrome .............................................................. 255 Loose stool.....75, 172, 174, 193, 462, 463, 474, 482, 483 Luo-connecting points .................................................. 67 M Madness ................................................................ 63, 278 Malaria................................................ 285, 288, 289, 526 Mania .......................................................................... 277 Mastitis ....................................................................... 525 Menopause.................................................................. 465 Menoxenia .................................................. 467, 470, 472 Mental disorders ................................................... 63, 522 Migraine headache........................................................ 66 Morning sickness ........................................................ 473 Moxa Pole with Herbs ................................................ 521 Moxibustion....III, 3, 7, 15, 76, 83, 91, 97, 104, 106, 107, 114, 122, 129, 138, 145, 153, 161, 167, 173, 179, 195, 204, 211, 217, 223, 230, 238, 244, 251, 257, 266, 272, 279, 286, 301, 315, 340, 345, 360, 364, 374, 381, 387, 403, 410, 411, 431, 437, 446, 451, 457, 463, 470, 472, 484, 519, 520, 521 N Neck pain .................................................... 299, 303, 513 Night sweating ............................................ 271, 396, 425 Nightmares.................................................... 63, 250, 326 Numbness ........................................................... 292, 482 P PARALYSIS....................................... 365, 377, 378, 538 Plum-pit ........................................................................ 47 Poor appetite ............................................... 386, 445, 456 Poor memory ................................................ 63, 250, 326 Premenstrual tension syndrome .................................. 479 Proctoptosia ........................................ 313, 315, 316, 317 Q Qi VII, 5, 6, 7, 8, 10, 11, 12, 15, 16, 17, 18, 20, 21, 22, 24, 25, 26, 27, 28, 30, 31, 32, 34, 37, 42, 43, 46, 47, 48, 49, 50, 51, 52, 53, 54, 56, 61, 63, 64, 67, 68, 69, 73, 74, 75, 76, 77, 78, 81, 82, 83, 84, 85, 86, 87, 90, 570

91, 92, 95, 96, 101, 102, 103, 106, 108, 111, 112, 114, 116, 117, 119, 120, 121, 122, 123, 124, 125, 127, 128, 129, 130, 131, 132, 135, 136, 139, 140, 141, 142, 143, 151, 152, 153, 154, 155, 157, 159, 160, 163, 164, 165, 166, 169, 171, 172, 173, 176, 177, 178, 179, 180, 181, 182, 183, 184, 185, 187, 191, 193, 194, 196, 199, 201, 202, 205, 206, 209, 210, 213, 214, 215, 221, 222, 224, 225, 227, 228, 229, 230, 231, 232, 233, 235, 236, 237, 239, 240, 241, 243, 245, 246, 247, 250, 253, 254, 255, 256, 257, 259, 263, 264, 265, 266, 267, 269, 270, 271, 274, 275, 277, 278, 283, 285, 286, 287, 288, 291, 292, 293, 294, 295, 296, 299, 300, 302, 303, 305, 306, 307, 308, 309, 310, 311, 313, 314, 315, 316, 317, 319, 321, 322, 323, 324, 325, 326, 328, 329, 331, 332, 333, 337, 340, 343, 344, 346, 348, 349, 351, 354, 357, 358, 359, 360, 361, 362, 364, 368, 370, 371, 372, 373, 374, 375, 376, 378, 379, 380, 383, 385, 386, 387, 388, 389, 390, 392, 395, 397, 398, 401, 402, 405, 407, 408, 409, 410, 411, 413, 423, 424, 425, 426, 427, 429, 430, 431, 435, 436, 437, 438, 439, 442, 444, 445, 446, 448, 449, 450, 452, 453, 455, 456, 457, 459, 460, 461, 463, 464, 467, 468, 469, 470, 471, 472, 473, 474, 476, 477, 479, 480, 481, 482, 484, 485, 486, 487, 491, 492, 493, 495, 497, 498, 499, 500, 501, 502, 503, 504, 505, 506, 507, 508, 509, 510, 511, 512, 513, 514, 515, 516, 517, 519, 520, 521, 522, 523, 524, 525, 526, 530, 565 Qi deficiency.......12, 26, 46, 47, 54, 68, 82, 86, 119, 122, 135, 169, 256, 491, 498, 509, 515, 523, 524, 530 Qi stagnation .8, 15, 28, 47, 50, 53, 63, 68, 135, 143, 183, 241, 325, 401, 435, 446, 487, 506, 509, 514, 522 R Reinforcing and reducing techniques.................... 50, 500 Retention of urine ....................................................... 343 S Scalp acupuncture ............................... 270, 378, 513, 516 Shen ......21, 22, 31, 63, 76, 77, 78, 84, 90, 91, 96, 97, 98, 105, 106, 107, 114, 115, 116, 123, 131, 138, 139, 140, 141, 145, 146, 147, 154, 155, 156, 160, 163, 166, 168, 175, 176, 179, 180, 181, 183, 184, 185, 186, 188, 192, 194, 196, 199, 201, 203, 205, 210, 212, 216, 224, 228, 229, 238, 239, 240, 245, 249, 252, 253, 254, 258, 260, 265, 267, 269, 272, 277, 278, 280, 281, 282, 283, 287, 288, 293, 301, 302, 308, 309, 314, 315, 322, 323, 325, 326, 328, 329, 332, 338, 346, 347, 352, 359, 360, 361, 362, 363, 366, 374, 377, 380, 381, 382, 387, 392, 402, 405, 409, 416, 432, 438, 441, 442, 443, 444, 447, 452, 457, 458, 462, 463, 475, 476, 483, 499, 500, 504, 507, 508, 510, 521, 529, 530, 537, 538, 565 Shoulder pain ...................................... 103, 319, 321, 322 Shu-stream points.......................................................... 50 Sinusitis............................................................... 407, 411 Sore throat....................... 33, 35, 137, 172, 351, 413, 417 Spleen and Stomach Diseases ....................................... 38 Stiff neck..................................................................... 299 Stomach and intestine problems.................................... 44 Sudden loss of voice ............................................. 64, 395 T Tinnitus ....................................................... 403, 423, 427 Toothache.................................................................... 534

Traumatic pneumothorax ............................................ 493 Trigeminal neuralgia...337, 338, 340, 341, 342, 498, 533, 535 Tuberculosis................................................................ 271 U Urine retention ........................................................ 64, 65 Urticaria .........36, 351, 352, 353, 354, 355, 511, 529, 533 V Vomiting .....113, 179, 193, 332, 357, 358, 359, 364, 473, 474 Vomiting of blood....................................................... 179 W

Wind Stroke .......................................................... 34, 378 Wu Ci.................................................................. 507, 516 X Xi-Cleft Points .............................................................. 55 Y Yang Qi deficiency ................................. 12, 47, 119, 515 Ying-spring points ........................................................ 50 Yu syndrome....................................................... 379, 383 Yuan-Source points....................................................... 51 Z Zang Fu ..6, 9, 11, 12, 25, 48, 73, 151, 154, 372, 373, 378

Wei syndrome......................365, 367, 368, 369, 370, 495

571

Acupuncture and Moxibustion—A Clinical Desk Reference

. Cheng Xiaoming’s experience in health and healing from both an allopathic and Traditional Chinese Medical (TCM) perspective began in childhood. With a mother trained as a western M.D. and an uncle trained in TCM, he saw the best of both worlds at an early age. As a teenager, he was first introduced to studying acupuncture points through training in the martial arts, and then became fascinated by the “miraculous recoveries” he saw in his uncle’s TCM practice. These “miracles” spurred him to investigate what must be the secret healing treasures of TCM, and led him to study the Dao De Jing, Yin-Yang theory, and the concept of the body as a whole. Cheng Xiaoming studied medicine at Shanghai Traditional Chinese Medical University, in the People’s Republic of China, and then honed his skills by shadowing Master acupuncture practitioners through clinic and learning their advanced needling techniques after graduation. Trained as both an orthopedic doctor and an acupuncturist, he began teaching Traditional Chinese Medicine over 30 years ago at Zhejiang Traditional Chinese Medical University and hospital, specializing in both acupuncture and orthopedics. In 1991, Dr. Cheng’s clinical and teaching grew beyond China, and he was invited to teach at the New England School of Acupuncture in the United States. Since then, his expertise in the field of acupuncture has become well recognized in the U.S. He is currently instructing at the Harvard Medical School and is a faculty of the Integrative Care Center (ICC) at Brigham & Women’s Hospital in Boston. In addition to teaching and research, Dr. Cheng has a busy private practice in Brookline, MA. There he continues to gain clinical expertise treating patients for a variety of health issues and complaints such as pain, sports injuries, neurological disorders, emotional issues, women’s health, respiratory disorders, as well as other internal medicine diseases. Dr. Cheng has already published three significant clinical texts in Chinese: Acupuncture for Emergencies, Scalp Acupuncture, and Acupuncture Pathology & Point Prescriptions. This book is his first English-language publication.

ISBN: 1-4243-2647-8 572