The Of: Giovanni Maciocia

5. Ibid .. p. JJ 9. 6. Spiritual Axis p. 100. 7. Shang hai College of Traditional Chinese Medicine J 974 A Study of Ac upun cture (ZIIe11 }i11 X11e lt ~ ~ ). People's Healt h Publishing I lo use. Beijing. p. 55. 8. Ibid .. p. 55. 9. Ibid .. p. 55. 1 0. Spiritua l Ax is. p. 101. 11. A Study of Acupuncture. p. 54. 12. Spiritual Axis. p. 1 51.

CHAPTER 9

THE FIVE TRANSPORTING (SHU) POINTS ENERGETIC ACTIONS OF THE FIVE TRANSPORTING POINTS 144 Well (Jing) point 144 Spring (Ying) point 144 Stream (Shu) point 145 River (Jing) point 145 Sea (He) point 145 ACTIONS OF THE FIVE TRANSPORTING POINTS FROM THE CLASSICS 146 According to Chapter 68 of the 'Classic of Difficulties' 146 According to the 'Spiritual Axis' 148 According to the seasons as in Chapter 44 of the 'Spiritual Axis' and Chapter 61 of the 'Simple Questions' 150 According to the Five-Element character of the points as in Chapters 64 and 69 of the 'Classic of Difficulties' 151 SUMMARY

153

The Five Transporting points (Shu points) are the points that lie between the fingers and elbows or between the toes and knees. They are assigned to the Five Elements so that they are mostly known in the West as 'Element points' or sometimes 'command points'. In France they are known as 'antique points'. The Chinese name for these points is 'Shu' ~llii , which is nearly the same character as for the BackTransporting points. whose name means 'transporting'. As we have seen earlier. at the fingertips and toes Qi changes polarity as it changes from Yin to Yang in the hands and from Yang to Yin in the feet. ln the arm channels, Qi is rising from the chest to the head (via the fingers), in the leg channels it is descending from the head back to the chest (via the toes). As Qi changes polarity at the fingers and toes. the points in these areas are particularly dynamic and

they are generally used in Full conditions to expel pathogenic factors. However. the change of polarity does not occur abruptly at the tips of the fingers and toes, and a whole section of the arm below the elbow and of the leg below the knee is affected by this change of polarity. If we compare the channel to a river. at the fingers and toes it is like a turbulent mountain spring, swirling around with great force. The in!1uence of such 'swirling' movement is felt up to the elbow and knee (see below). At the elbows and knees, the spring has become wider and calmer and Qi becomes deeper and therefore calmer. For this reason, and because there is a change in polarity, all the points below the elbow and knee are more dynamic: the more distal the point, the more dynamic. Although this discussion is centred on the Five Transporting (Shu) points, their dynamic nature is shared with other points below the elbows and knees which are not Transporting points. such as LJ.-1 0 Shousanli or G.B.-35 Yangjiao. In order to illustrate the nature of the points, the ancient Chinese compared the section of channel between fingers / toes and elbows/knees to a river, starting from a 'well' point at the tips of the fingers or toes, getting gradually larger and deeper and ending in a 'sea' point at the elbows or knees. Thus from fingers/ toes to elbows/ knees there is a progression in the size and depth of the channel: it is narrowest and most superficial at the fingers/toes and widest and deepest at the elbows/ knees. It is important to note that this progression of size and depth of the channel is irrespective of the direction of now of the channel, i.e. it applies equally to Yin or Yang channels of both arms and legs. Even though the Yin channels of the hand now downwards towards the fingers, and the Yang channels of the hand now upwards towards the chest. the comparison of the channel to a river, with its spring-head at the fingers 141

142

PART 2: THE MAIN CHANNELS

Well

YIN Qi plunges deep into body

Qideepens

YANG

Sea

Fig. 9.1 The channel as a river.

SwiftQi

0 Well (Nail points) Flow of Qi is wider and deeper, Pathogenic Factors diverted to joints

Sea (Elbows, knees)

Qi is vast, slow. Movement is inward, centripetal

Fig. 9.2 The channel as a river.

and its delta at the elbows applies equally to both. Exactly the same applies to the leg channels (Figs 9.1 and 9.2). The implication of this is that the section of channel between fingers/toes and elbows/knees is more superficial than the rest, and this is one of the reasons for the importance of the points lying along its path. The energetic action of the points situated along this section of a channel is much more dynamic than other points and this explains their frequent use in clinical practice. Their dynamism is also the result of the change in polarity occurring at the fingers and toes. One could conceivably practise acupuncture using

only these points. As one may have experienced many times, the effect of. say, UV-3 Taichong is far more dynamic than, for instance, UV-10 Wuli or LIV-ll Yinlian (situated on the thigh). The other implication of the fact that the section of channel between fingers/toes and elbows/knees is more superficial is that this section represents the connection between the body and the environment. It is the section of channel which is influenced most promptly and directly by climate and exterior pathogenic factors. For this reason the points along this section of channel are more directly related to the seasons and can be used according to their cycle.

THE FIVE TRANSPORTING (SHU) POINTS

For the same reason, the points along this section of channel are the points of entry of exterior pathogenic factors such as Cold, Dampness and Wind. Another reason for the dynamism of the points in this section of the channel is that at the tips of fingers and toes the energy changes polarity from Yin to Yang or vice versa. Due to this change of polarity, the Qi of the channel is more unstable and therefore more easily influenced (Fig. 9.3). Even though we normally say that this change of polarity takes place at the fingers and toes, it cannot take place immediately at one single point and the inertia from one channel at its end carries on to a certain extent through the next channel up to the elbow or knee. For example, the Lung channel ends at the tip of the thumb where the polarity changes to Yang and the energy flows into the Large Intestine channel. This change from Yin to Yang polarity cannot take place instantly in one point at the thumb-tip, but the inertia from the Lung channel is, to a certain extent, carried through to the initial section of the Large Intestine channel. This can be compared to the meeting of two rivers: when two wide rivers meet, they do not just merge at the point of junction, but often the current from one river carries on flowing independently within the second river for some time. The progression of the Five-Element points along the channel is probably in relation to this change of polarity, as the second point belongs to Fire in Yin channels and to Water in Yang channels. This might be because the second point represents that at which the inertia of the incoming channel is felt most strongly and manifests itself most clearly. For example, the Lung channel inertial movement continues into the Large Intestine channel particularly at the second point along the channel, which therefore belongs

LU-11

Fig. 9.3 Change of polarity at fingers and toes.

143

to Water, reflecting the Yin character of the Lung channel. Similarly, the second point of Yin channels belongs to Fire reflecting the inertia of the incoming Yang channels. Thus, the second point along the channel represents the point of maximum inertia from the previous channel, after which the inertia becomes less and less and disappears totally at the fifth point along the channel. This explains the particularly unstable state of the energy in the end/beginning section of a channel at the tips of fingers and toes. This instability is another reason accounting for the dynamism of the points along it and is made use of in practice. Another characteristic of the Five Transporting points (and also of other points below the elbows and knees) is that they tend to affect the Connecting (Luo) channels. This is because the section of channel below the elbow and knee is more superficial (than in other parts of the body) and the Connecting channels are situated on the surface of the body. The nearer a point is to the fingers and toes, the more it affects the Connecting channels.

Three reasons for the dynamism of points at t he end/beginning of a channel are: • channel is more superficial • change from Yin to Yang (and vice versa) • second point in contrast wit h polarity of channel (Water for Yang and Fire for Yin channels).

Five of the points situated along this section of channel are particularly important, and they are called the Five Transporting points; they also coincide with what we call the Element points. However, the dynamic of these points is irrespective of their Five-Element character. Each of the five points occupying the same location along the channel has a name. The names I will use are: WELL point Uing) : the point at the tips of fingers or toes SPRING point (Ying): the second point of the five (in all cases it is the second point along the channel)

144

PART 2: THE MAIN CHANN ELS

STREAM point (Shu): the third point of the five (in all cases it is the third point along the channel, except for the Gall Bladder channel where it is the fourth) RIVER point Uing): the fourth point of the five, not always the fourth point along the channel SEA point (He): the fifth point of the five (in all cases it is the point at the elbows and knees). Although these names do not represent a literal translation of the Chinese terms I have preferred them to literal translations that might have created some confusion. The use of the above names is also justified by the analogy of these points with stages in the course of a river found in Chapter 1 of the 'Spiritual Axis', where it says that 'at the Well points Qi flows out, at the Spring points it slips and glides, at the Stream points it pours, at tile River poi11ts it moves, at the Sen poi11ts it enters' .1 The 'Classic of Difficulties' gives the same description in Chapter 69. 2 The actual meanings of their names are: JING # =well YING ~ =spring (of water), pool (of water) SHU ~f,j = to transport JING g = to pass through HE ~ =to unite. to join. These names are in relation with the energetic action of these points, which will be discussed below.

ENERGETIC ACTIONS OF TH E FIVE TRANSPORTING POINTS Each of the five Transporting points has a specific energetic action within the channel's dynamics, which explains the meaning of these points' names.

unstable state here, so that it can be easily and readily influenced and changed. This explains the use of these points in acute situations, as the Well points tend to be used to eliminate pathogenic factors quickly in acute conditions. For example, they are used to extinguish internal Wind in the acute stage of Wind-stroke. According to the 'Classic of Difficulties' the movement from these points is 'outward', i.e. at these points the energy of the channel tends to go outwards in a centrifugal movement. 3 The outward, centrifugal tendency of the Well points is exploited to eliminate pathogenic factors quickly as they pass through these points. Several examples can be cited, such as the use of LU-ll Shaoshang for fainting, P-9 Zhongchong for fainting and heat-stroke, HE-9 Shaochong and S.I.-1 Shaoze for loss of consciousness, SP-1 Yinbai for convulsions, KT-1 Yongchuan for loss of consciousness and infantile convulsions and L.I.-1 Shangyang for loss of consciousness. The extra points Shixuan situated at the fingertips have actions that are equivalent to those of the Well points: the Shixuan points are used to extinguish internal Wind in acute conditions (e.g. acute state of Wind-stroke).

SUMMARY WELL (JlNG) POINTS

• • • • • • • •

Point of departure of Qi At tips of fingers and toes (except Kl-1) Channel is most superficial and thinnest Change of polarity (Yin to Yang or vice versa) Dynamic Used to expel pathogenic factors Centrifugal movement Wood point in Yin channels and Metal point in Yang channels.

Well (ling) point

Spring (Ying) point

The Well point is the point of departure of Qi (in the sense outlined above and therefore applying to both Yin and Yang channels of arm and leg). At this point the channel is at its most superficial and thinnest and the energy changes polarity from Yin to Yang or vice versa. Because the energy is more superficial and changes polarity. the Well point has a particularly dynamic effect when needled. The energy is at its most

At the Spring point, the Qi of the channel is very powerful and full of potential energy ready to manifest, like the swirling movement of water in a mountain spring. Hence the 'Spiritual Axis' says that at this point the Qi 'slips' or 'glides', i.e. it is swift. Because of this nature, the Spring points are also very dynamic and powerful points and they can quickly change situations: all of them have a particularly strong action

THE FIVE TRANSPO RTING (SHU) POINTS

and they are generally used to eliminate pathogenic factors (whether interior or exterior) and in particular to clear Heat. Because of their dynamism, these points are to be used sparingly. The Spring points of the feet are more powerful than those of the hands and, if there is a choice, those of the hands are to be chosen first. For example, in deciding on a distal point to affect the temples in migraine headaches due to rising of Liver-Yang, one might have a choice between using the Gall Bladder or Triple Burner channel Spring point (G.B.-43 Xiaxi or T.B.-2 Yemen respectively): the Triple Burner Spring point is slightly less powerful and dynamic than that of the Gall Bladder channel and therefore it might be preferred, especially in a case of first treatment. Of course, this does not mean that the Spring point of a hand channel is always to be preferred to that of a foot channel as, in many cases, one does not have a choice, or one might deliberately want to have a particularly strong effect.

145

SUMMARY STREAM (SHU) POINTS

• Third point along channel (except G.B.-41 Zu linqi) • Qi 'pours', flow becomes bigger and deeper • Pathogenic factors enter through this point • Defensive Qi concentrates at this point • Earth point in Yin channels and Wood point in Yang channels.

after coming a long distance from its source. At these points, exterior pathogenic factors are deviated towards joints, bones and sinews: this is probably why this point is called Jing which, in this case, means 'to pass through'.

SUMMARY SUMMARY SPRING (Y/NG) POINTS

• Second point from fingers or toes • Dynamic • Like the swirling movement of a mountain spring at its source • Clear Heat • Fire points in Yin channels and Water points in Yang channels.

RIVER (J/NG) POINTS

• Qi of channel is much bigger and deeper • Qi flows like a current • Pathogenic factors are deviated towards joints and sinews at these points • Metal point in Yin channels and Fire point in Yang channels.

Sea (He) point

Stream (Shu) point At the Stream point, the Qi of the channel pours through, it swirls and the flow begins to increase and deepens slightly within the channel. At this point, the flow of Qi is rapid and large enough to carry other things with it, hence its name 'transporting' .4 Exterior pathogenic factors can be 'transported' into the Interior and penetrate deeper in the channels. On the other hand, at these points Defensive Qi gathers.

River (ling) point At this point the Qi of the channel is much bigger, wider and also deeper. The Qi flows like a large current

At this point the Qi of the channel is vast and deep, it collects, comes together and joins the general circulation of the body, like a large river flowing into the sea. According to Chapter 65 of the 'Classic of Difficulties', at this point the Qi has an inward, centripetal movement (as opposed to the outward, centrifugal movement of the Well point). 5 Compared with and contrasted to the Well points, the Sea points are much less dynamic and their effect slower and less dramatic. This is due to the fact that at the Sea points, Qi flows much more slowly, more inwardly and deeper, so that it is not so unstable and cannot be quickly and easily affected. Table 9.1 summarizes the names and functions of the Five Transporting points.

146

PART 2: THE MAIN CHANNELS

SUMMARY

o

· SUMMARY

SEA (HE) POINTS

THE FIVE TRANSPORTING POINTS

• Qi of the channel is vast and deep • Qi of the channel goes deep in the body and joins general Qi circulation • Centripetal movement • Less dynamic than other Transporting points • Water point in Yin channels and Earth point in Yang channels.

• All Five Transporting points are situated between the fingers and elbows, the toes and knees • Each of the Five Transporting points is related to one of the Five Elements • The section of channel where the Five Transporting points are situated is like a river, starting at the fingers and toes and ending at the elbows and knees • The depth and size of channels progress from the fingers/toes to elbows/knees, i.e. they are thinnest and most superficial at the f ingers/ toes and thickest and deepest at the elbows/ knees • The channel changes polarity at the fingers and toes, i.e. from Yin to Yang and vice versa • The change in polarity and superficial ity of the channel at the extremities accounts for the particularly dynamic action of the points at the tips of fingers and toes • The Five Transporting points are called Well (Jing), Spring (Ying), Stream (Shu), River (Jing) and Sea (He) • The first point (Wel l) has a centrifugal movement and the last point (Sea) a centripetal one • All Five Transporting points affect the Connecting (Luo) channels; the more distal they are, the more they affect the Connecting channels.

Summary of nature and actions of the Five Transporting points

Table 9.1

Pinyin

Chinese

Literal meaning

My terminology

Jing

#

Well

Well

Ying

~

Spring, pool

Spring

Shu

~ij,j

To transport

Stream

Jing

~~

To pass through

River

He

..6.

To unite, to join

Sea

~z

r=l

ACTIONS OF THE FIVE TRANSPORTING POINTS FROM THE CLASSICS We can discuss the clinical use of the Five Transporting points from four different viewpoints: • according to Chapter 68 of the 'Classic of Difficulties' • according to the 'Spiritual Axis', Chapters 4, 6 and 44 • according to the seasons as in Chapter 61 of 'Simple Questions' and Chapter 44 of 'Spiritual Axis' • according to the Five-Element character of the points as in Chapters 64 and 69 of th e 'Classic of Difficulties'.

According to Chapter 68 of the 'Classic of Difficulties' Chapter 68 of the 'Classic of Difficulties' deals with the use of the Five Transporting points and gives

guidelines that are still valid and widely followed today. These are: WELL points: used for 'fullness under the heart' SPRING points: used for 'hot sensations of the body' STREAM points: used for 'feeling of heaviness and joint pain' RIVER points: used for 'breathlessness. cough and hot and cold sensations' SEA points: used for 'rebellious Qi and diarrhoea'. 6 We can expand on the clinical use of these points as follows.

THE FIVE TRANSPORTING (SHU) POINTS

Well points The Well points Uing) are used for irritability, mental restlessness and anxiety. This applies both to Yin and to Yang channels. The Well points have a particularly strong effect on the mental state and quickly change the mood. Examples of Well points used in this way are P-9 Zhongchong (irritability, insomnia), HE-9 Shaochong (mental disorders, anxiety, manic-depression), SP-1 Yinbai (hysteria, insomnia), ST-45 Lidui (insomnia, mental confusion) and KI-1 Yongquan (anxiety).

Spring points The Spring points (Ying) are used for febrile diseases or to clear Heat. They are very widely used to clear Heat and practically all of them have this action. It is important to note that their Heat-clearing action is irrespective of their Five-Element character. For example, HE-8 Shaofu is a Fire point and ST-44 Neiting is a Water point, but they both clear Heat by virtue of being Spring points. Virtually all Spring points clear Heat in their respective channel and organ. Examples of widely used points are HE-8 Shaofu and P-8 Laogong to drain Heart-Fire. LIV-2 Xingjian to drain Liver-Fire, ST-44 Neiting to clear Stomach-Heat, KI-2 Rangu to clear Kidney Empty-Heat. and LU-10 Shaoshang to clear Lung-Heat or to expel Wind-Heat.

Stream points The Stream points (Shu) are used for Painful Obstruction Syndrome (Bi Syndrome), especially from Dampness. This applies to Yang channels more than Yin ones. Examples are: L.I.-3 Sanjian, T.B.-3 Zhongzhu and S.I.-3 Houxi for Painful Obstruction Syndrome of the fingers and ST-43 Xiangu for the toes. These points can be used not only as local points for Painful Obstruction Syndrome of fingers and toes, but also as distal points to clear Wind and Dampness from the channels. For example, ST-43 Xiangu is an important distal point to clear Wind-Dampness and Heat from the channels; S.I.-3 Houxi, T.B.-3 Zhongzhu and L.I.-3 Sanjian can all be used as distal points to clear obstructions from Dampness and Cold from the respective channels.

River points The River points Uing) are used for cough, asthma and upper respiratory diseases. This applies more to Yin

147

than Yang channels, and among the Yang channels it applies more to the Bright Yang channels. Examples are: LU-8 Jingqu for cough and asthma, SP-5 Shangqiu for dry cough, ST-41 Jiexi and L.I.-5 Yangxi for sore throat of an Excess nature. The River point P-5 Jianshi is used for hot and cold sensations.

Sea points The Sea points (He) are used for all stomach and intestinal diseases. This applies mostly to Yang channels, but also to Yin ones. Obvious examples of Sea points of Yang channels treating stomach and intestinal problems are ST-3 6 Zusanli and G.B.-34 Yanglingquan. The Sea points of the Yin channels of the leg also treat problems of the Yang organs as SP-9 Yinlingquan, KI-10 Yingu and LIV-8 Ququan can all clear Damp-Heat in the Bladder or Intestines. Finally, the Sea points of the Pericardium channel P-3 Quze can also clear Heat in the Intestines. Other digestive indications of the Sea points are indicated below in the section on Chapter 44 of the 'Spiritual Axis'. In addition to these Sea points, the Yang channels of the arm also have so-called Lower-Sea points. These are: - ST-3 7 Shangjuxu for the Large Intestine - ST-39 Xiajuxu for the Small Intestine - BL-39 Weiyang for the Triple Burner. These three points are directly connected to their respective organs and function like Sea points, i.e. they treat problems of the Yang organs. In particular, ST-3 7 Shangjuxu is used for chronic diarrhoea and Damp-Heat of the Large Intestine, ST-39 Xiajuxu for intestinal pain and BL-39 Weiyang for enuresis (if reinforced when the Lower Burner is Deficient) or retention of urine and oedema (if reduced when the Lower Burner is in Excess). The 'Spiritual Axis' deals with the use of BL-39 Weiyang in Chapter 2: 'Weiymzg {BL-3 9] receives tlze Lower Bume1; if it is in Excess tlzere is retention of urine. if it is Deficient tlrere is enuresis or incontinence. Tire point is to /Je reduced in Lire fo rmer cnse nnd reinforced in the lntler' .7 The 'Spiritual Axis' lists all the Sea points in Chapter 4 and it gives ST-3 7 Shangjuxu for the Large Intestine, ST-39 Xiajuxu for the Small Intestine and BL-39 Weiyang for the Triple Burner. 8 These three points therefore function as Sea points for the Large Intestine, Small Intestine and Triple

148

PART 2: THE MAIN CHANNELS

Burner and their Upper Sea points (L.I.-11 Quchi. S.I.-8 Xiaohai and T.B.-10 Tianjing) mostly treat channel problems of the neck, shoulders and face (but not exclusively).

The Yang channels of the arm (Small Intestine, Large Intestine and Triple Burner) have two sets of Sea points: • the Upper-Sea points (S.I.-8, L.l.-11, T.B.-1 0) used mostly for problems of the neck, shoulders, face and head • the Lower-Sea points (ST-39, ST-37 and BL-39) used mostly for problems of the relevant organs (Small Intestine, Large Intestine and Triple Burner).

SUMMARY THE FIVE TRANSPORTING POINTS ACCORDING TO CHAPTER 68 O F THE 'CLASSIC OF DIFFICU LTIES'

• Well points: 'fullness under the heart' (irritability, mental restlessness, insomnia) • Spring points: 'hot sensations of the body' (clear Heat) • Stream points: 'feeling of heaviness and joint pain' (Painful Obstruction Syndrome from Dampness) • River points: 'breathlessness, cough, hot and cold sensations' (cough, asthma) • Sea points: 'rebellious Qi and diarrhoea' (digestive disorders).

According to the 'Spiritual Axis' Chapter 44 The 'Spiritual Axis' says in Chapter 44: 'Yin organs correspond to Winte1; use the Well points; colours con·espond to Spring. use Spring points; seaso11s correspond to Swn111er, use the Stream points; sounds correspond to Late Sun111ze1; use the River points; j1avours correspond to Autumn, use the Sea points . . . When the Yin organs are a}Jected use the Well points; when the disease ejfects a

clzmzge in the complexion co/ow: use tlze Spring points; when the disease manifests intermittently, use the Stream points; when the disease a}Jects the voice and there is stagnation of Qi and Blood in the channels, use the River points; wizen the Stomach is affected and there are digestive disorders, use tire Sea poi11ts'.9 These rules are fairly straightforward and have some points in common with those from Chapter 68 of the 'Classic of Difficulties'. The 'Spiritual Axis' recommends the use of the Well points in Yin organ diseases: this is similar to their recommendation in the 'Classic of Difficulties' for mental restlessness and irritability, particularly if deriving from a Heat pattern. The use in the 'Spiritual Axis' of the River points for problems of the voice coincides with that in the 'Classic of Difficulties' for problems of the throat. The use of the Sea points is also practically the same in the two classics. However, the 'Spiritual Axis' recommendations are much less followed in clinical practice than those from the 'Classic of Difficulties' as they are of lesser practical significance. The particular use of the Five Transporting points recommended in Chapter 44 of the 'Spiritual Axis' does not have an important clinical relevance. For example, the use of the Well points for problems of the Yin organs is not generally followed and, in fact, it contradicts Chapter 6 of the same book which recommends using the Spring and Stream points for problems of the Yin organs. The suggested use of the Spring points when there is a change in the complexion colour and of the Stream points when the disease is intermittent are also not of great clinical relevance. The use of the River points for voice problems is reflected in the indications of several of these points: -

L.I.-5 Yangxi: raving, laughter. ST-41 Jiexi: raving. P-5 Jianshi: loss of voice, halting speech. SP-5 Shangqiu: impaired speech. laughter, sighing. HE-4 Lingdao: loss of voice. KI-7 Fuliu: curled tongue with inability to speak T.B.-6 Zhigou: sudden loss of voice. LIV-4 Zhongfeng: sighing.

The use of the Sea points for digestive disorders is common and there are many examples of such points: - LU-5 Chize: vomiting. diarrhoea, abdominal distension - L.I.-11 Quchi: abdominal distension and pain - ST-36 Zusanli: all digestive disorders

THE FIVE TRANSPORTING (SHU) POINTS -

SP-9 Yinlingquan: diarrhoea HE-3 Shaohai: vomiting with foamy saliva BL-40 Weizhong: vomiting, diarrhoea KI-7 Fuliu: diarrhoea, abdominal distension, borborygmi P-5 Quze: diarrhoea, vomiting due to Summer-Heat T.B.-10 Tianjing: vomiting pus and blood G.B.-34 Yanglingquan: vomiting LIV-8 Ququan: diarrhoea.

SUMMARY CHAPTER 44 of 'SPIRITUAL A XIS'

• Well points: for Yin organs • Spring points: when there is a change in complexion colour • Stream points: for intermittent symptoms • River points: when voice is affected • Sea points: for Stomach diseases.

Chapter 4 The 'Spiritual Axis' gives other guidelines to the use of the Five Transporting points, some of them in contradiction with other chapters of the same book. It says in Chapter 4: 'The divergent /Jranclzes of the Yang channels reach into tlze Interior and connect with the Yang organs . .. the Spring and Strea111 points [together) treat channel problems, the Sea points treat organ problems'. 10 It then goes on to cite the Sea points of the Yang channels, listing only the Lower-Sea points for the Yang channels of the arm, Large Intestine, Small Intestine and Triple Burner, i.e. ST-3 7 Shangjuxu, ST-39 Xiajuxu and BL-39 Weiyang. The Spring and Stream points of the Yang channels are frequently used in the treatment of Painful Obstruction Syndrome (Bi syndrome) as the Stream point is known for concentration of Defensive Qi and the Spring point is powerful and may be used to move the Qi of the channel and to expel pathogenic factors. in particular Heat.

SUMMARY CHAPTER 4 of ' SPIRITUAL AXIS'

• Spring and Stream points (of Yang cha nnels) together: for channel problems • Sea (Lower) points: for internal (Yang) organ problems.

The use of the Yang Sea points is in agreement with the use of these points according to the 'Classic of Difficulties' and to Chapter 44 of the 'Spiritual Axis' itself, i.e. to treat problems of the Yang organs them-

selves. This method is frequently applied in clinical practice and examples have been given above.

Chapter 6 Chapter 6 of the 'Spiritual Axis' gives yet different recommendations for the clinical use of the Five Transporting points. It says: 'In the Interior there are five Yin and six Yang organs, in the Exterior there are bones, sinews and skin. Both in the Interior and Exterior there is Yin and Yang. Within the Interior; the five Yin organs pertain to Yin and the six Yang organs pertain to Yang; within the Exterior sinews and bones pertain to Yin and the skin pertains to Yang. For diseases of Yin within Yin [i.e. Yin organs], use tlze Spring and Stream points of the Yin channels togethe1: For diseases of Yang within Yang [i.e. the skin], use tl1e Sea points of the Yang channels. For diseases of Yin within Yang (i.e. sinews and bones j, use the River points of the Yin channels. For diseases of Yang within Yin {i.e. the Yang organs], use the Connecting points'. 11 To summarize (Fig. 9.4):

- Yang within Yang: Skin -use the Sea points of Yang channels (e.g. L.I.-11 Quchi) - Yin within Yang: Sinews and bones- use the River points of Yin channels (e.g. SP-5 Shangqiu) - Yang within Yin: Yang organs- use the Connecting (Luo) points of Yang channels

Yang within Yang = Skin = Sea points of Yang channels - - - - - - Yin within Yang = Sinews/Bones = River points of Yin channels - - - - - - Yang within Yin = Yang organs = Connecting points - - - - --

149

Yin within Yin =Yin organs = Spring and Stream points of Yin channels

Fig. 9.4 Use of Five Transporting points according to Chapter 6 of 'Spiritual Axis'.

150 -

PART 2: THE MAIN CHANNELS

Yin within Yin: Yin organs- use the Spring and Stream points of Yin channels in combination (e.g. LIV-2 Xingjian and LIV-3 Taichong).

These recommendations are only partially applied in clinical practice. The Spring and Stream points are frequently used together to clear Heat from the Yin organs; sometimes the Spring point can be reduced to clear Heat, and the Stream point torrified to nourish the Yin of the channel. A good example is the use of LIV-2 Xingjian (reduced to drain Liver-Fire) and LIV-3 Taichong (reinforced to nourish Liver-Yin). This technique can be used to nourish Liver-Yin and subdue Liver-Yang in headaches, or to nourish Liver-Yin and clear Liver-Fire in urinary diseases caused by Liver-Fire and Bladder-Heat. The Sea points of the Yang channels, especially the Upper Sea points (such as L.I.-11 Quchi, S.I.-8 Xiaohai and T.B.-10 Tianjing) are frequently used to treat the 'skin', i.e. to release the Exterior in invasions of exterior pathogenic factors. In particular, L.I.-11 and T.B.-1 0 are used to release the Exterior and expel Wind-Heat. L.I.-11 Quchi is an important point for skin diseases as it cools Blood. The following are examples of indications of these points for skin diseases: - L.I.-11 Quchi: erysipelas, urticaria, dry-scaly skin, itchiness, herpes zoster - BL-40 Weizhong: sores, erysipelas, eczema, urticaria - T.B.-10 Tianjing: urticaria. The River points of the Yin channels are frequently used to treat problems of sinews and bones, i.e. in Painful Obstruction Syndrome. One reason for this is that the Qi at these points is diverted to sinews, bones and joints. The following are examples of indications related to joint and sinews problems in River points of the Yin channels:

SUMMARY CHAPTER 6 of 'SPIRITUAL AXIS'

• Spring and Stream points (of Yin channels) together: for Yin organ problems • River points (of Yin channels): for sinews and bones • Sea points (of Yang channels): for skin problems • Connecting (Luo) points (of Yang chan nels): for the Yang organs.

The rule of using the Connecting points to treat problems of the Yang organs is not widely followed as the Lower-Sea points would be preferred in this case.

According to the seasons as in Chapter 44 of the 'Spiritual Axis' and Chapter 61 of the 'Simple Questions' Chapter 44 of the 'Spiritual Axis' gives guidelines as to the use of the Five Transporting points according to the seasons. It says: ' In Winter use the Well points, in Spring use the Spring points, in Sumlller use the Stream points, in Late Summer use the River points, in Autumn use the Sea points'. 12 See Figure 9.5.

Stream points

- SP-5 Shangqiu: pain and contraction of sinews, Bone Painful Obstruction Syndrome (Bi Syndrome), feeling of heaviness with joint ache - HE-4 Lingdao: spasms - KI-7 Fuliu: atrophy of the legs - LIV-4 Zhongfeng: contracted sinews, lumbar pain. Of course, the River points of the Yang channels also treat joint and sinew problems and the chief example among them is ST-41 Jiexi.

River points

Spring points

Well points

Fig. 9.5 Use season.

of the

Sea points

Five Transporting points according to

THE FIVE TRANSPORTING (SHU) POINTS

SUMMARY

151

o

FIVE TRANSPORTING POINTS ACCORDING TO SEASONS

• • • • •

Well points: in W inter Spring points: in Spring Stream points: in Summer River points: in Late Summer Sea points: in Aut umn .

These rules find only limited application in clinical practice as it is not always possible to choose points according to the cycle of seasons; such a choice might conflict with the requirements of treatment according to the actual condition of the patient. However, these guidelines may be followed more closely when giving preventive seasonal treatments to patients who seek treatment to keep well rather than for specific conditions. Chapter 61 of the 'Simple Questions' discusses the use of the Five Transporting points according to the seasons: 'In Autumn. use tile River points to dmin Yin pathogenic factors and Ore Sen points to dmin Yang pathogenic factors . . . In Winter; use tlze Well points to subdue rebellious Yin Qi and the Spring points to strengthen Yang Qi'. 13 These instructions, in contradiction with those from Chapter 44 of the 'Spiritual Axis', are not widely followed.

According to t he Five-Element character of the points as in Chapters 64 and 69 of the 'Classic of Difficulties' The Five Transporting points are also used according to their Five-Element character. This was established in the 'Classic of Difficulties' for the first time. In Chapter 64 it says that the Yin channels' Well point belongs to Wood and the Yang channels' Well point belongs to Metal. 14 There are two ways of using the Five Transporting points according to the Five Elements: - according to the relationship of Mother and Child in the Five Elements - according to pathogenic factors corresponding to the Five Elements. Use of the Five Transporting points according to the Generating Cycle (Mother-Child)

Fig. 9.6 Tonification and drainage points according to Mother and Child within the Generating cycle of the Five Elements.

The use of the Five Transporting points according to their Five-Element character was discussed in Chapter 69. It tersely says: 'In case of Deficiency tonify the MoUrer; in case of Excess drain tile Clzild' .15 In accordance with this theory, therefore, every channel has a tonification and drainage point corresponding to its Mother Element and its Child Element respectively (Fig. 9.6). Following this principle and keeping in mind the Generating cycle of the Five Elements, in case of Deficiency of a channel we can choose the point on that channel corresponding to the 'Mother' Element in order to torrify it. In case of Excess, we would choose the point corresponding to the 'Child' Element in order to drain it. For example, if the Liver is deficient. the Liver belongs to Wood. Water is the Mother of Wood, we therefore select (and reinforce) the point LIV-8 Ququan, which corresponds to Water. If the Liver were in Excess, we would choose (and reduce) the point LIV-2 Xingjian corresponding to Fire. as Fire is the Child of Wood (Fig. 9. 7). Table 9. 2 lists the tonification and drainage points according to the Mother-Child relationship in the Five Elements. It must be stressed, however, that the needle technique is all-important when torrifying or draining (i.e. reinforcing method to torrify and reducing method to drain); in other words we cannot rely only on the tonification or drainage character of a point, in order to torrify or drain .

152

PART 2: TH E MAIN CHANN ELS

FIRE

/ WOOD

WATER Fig. 9.7 Example of tonification and drainage points in the Liver channel.

Furthermore. the tonification or drainage character of a point is very often overridden by its other characteristics, so that the rule of torrifying and draining according to tonification and drainage points is subject to many exceptions. For example, HE-9 Shaochong and P-9 Zhongchong are tonification points but are more often used for draining instead in acute cases. by virtue of their being the Well points. HE-7 Shenmen is the drainage point but is more often used to tonify Heart Blood to nourish the Mind. L.I.-11 Quchi is the tonification point, but it also cools Blood and releases the Exterior and is more often used as a draining point. SP-2 Dadun is the tonification point, but would not be the most indicated point to torrify the Spleen, as SP-3 Taibai, Ren-12 Zhongwan, ST-36 Zusanli or BL-20 Pishu would be much better for this purpose. SP-2, on the contrary, is often used in febrile diseases to clear Heat and promote sweating. BL-6 7 Zhiyin is the tonification point but again, owing to its being a Well point, is often used to

I

Table 9.2

Tonification and drainage points

Channel

Tonification (Mother)

Drainage (Child)

Lungs

LU-9 Taiyuan

LU-5 Chize

Large Intestine

L.l.-11 Quchi

L.l.-2 Erjian

Stomach

ST-41 Jiexi

ST-45 Lidui

Spleen

SP-2 Dadu

SP-5 Shangqiu

Heart

HE-9 Shaochong

HE-7 Shenmen

Small Intestine

S.l.-3 Houxi

S.l.-8 Xiaohai

Bladder

BL-67 Zhiyin

BL-65 Shugu

Kidneys

Kl-7 Fuliu

Kl-1 Yongquan

Pericardium

P-9 Zhongchong

P-7 Daling

Triple Burner

T.B.-3 Zhongzhu

T.B.-1 0 Tianjing

Gall Bladder

G.B.-43 Xiaxi

G.B.-38 Yangfu

Liver

UV-8 Ququan

LIV-2 Xingjian

SUMMARY FIVE TRANSPORTING POINTS ACCORDING TO THE FIVE ELEMENTS

• Tonification and drainage points according to Mother-Child relationships • Use of Element points to expel relevant pathogenic factors.

drain in acute cases, or also to subdue rising Qi which is causing headaches.

Use of the Five Transporting Points according to pathogenic factors Apart from being applied in the theory of tonification and drainage points. the Five-Elemen t points are also used in another very common way to eliminate pathogenic factors. There is a correspondence between the Five Elements and pathogenic factors (Fig. 9.8): WOOD corresponds to Wind FIRE corresponds to Heat or Fire EARTH corresponds to Dampness

THE FIVE TRANSPORTING (SHU) POINTS

METAL corresponds to Dryness WATER corresponds to Cold. In accordance with this correspondence, the FiveElement points can be used to expel the relevant pathogenic factors (whether Exterior or Interior). The only exception is the Metal point, which is not used to eliminate Dryness. The reason for this lies in the very nature of Dryness. While Heat, Fire, Wind, Dampness and Cold are pathogenic factors that manifest as an Excess pattern, Dryness manifests as a Deficiency of Body Fluids, and the way to correct this is by nourishing fluids rather than by 'expelling' Dryness. The application of this correspondence between the Five Elements and pathogenic factors is mostly used in Excess patterns to eliminate the relevant pathogenic factor (Table 9.3). It also applies rather more to Yin than Yang channels, but not exclusively. This method of using the Element points to expel the relevant pathogenic factors can be applied to some of the points of Yang channels too. In particular, some of the Wood points are used to subdue Interior Wind, such as S.I.-3 Houxi, other Wood Yang points are used to expel Exterior Wind in Painful Obstruction Syndrome (e.g. L.I.-3 Sanjian and ST-43 Xiaxi) and some of the Fire points are used to clear Heat, such as L.I.-5 Yangxi and ST-41 Jiexi. Table 9.4 summarizes the actions and functions of the Five Transporting points according to the various view points discussed above.

~ ~

(:\ ~

153

SUMMARY FIVE TRANSPORTING POINTS TO EXPEL PATHOGENIC FACTORS

• Wood: Wind • Fire: Heat or Fire • Earth: Dampness • Metal: none • Water: Cold.

SUMMARY We can now summarize the actions of the Five Transporting points according to the various perspectives explored above. These are illustrated in Figure 9.9, which uses the Lung channel as an example.

Well points Chapter 68 of the 'Classic of Difficulties': For 'fullness under the heart', mental restlessness, anxiety. Chapter 44 of 'Spiritual Axis': To treat Yin organs. According to seasons: In Winter. According to pathogenic factors and Five Elements: To expel Wind.

Spring points Chapter 68 of 'Classic of Difficulties': For 'hot sensations of the body', to clear Heat. Chapter 44 of 'Spiritual Axis': When there is a change in the complexion. Chapter 4 of the 'Spiritual Axis': For channel problems (together with Stream point). Chapter 6 of the 'Spiritual Axis': For Yin organs problems (together with Stream point). Spring point of Yin channels. According to seasons: In Spring. According to pathogenic factors and Five Elements: To clear Heat.

Stream points

Fig. 9.8 Correspondence of pathogenic factors to Five Elements.

Chapter 68 of 'Classic of Difficulties': For 'feeling of heaviness and joint pain'. to resolve Dampness, Painful Obstruction Syndrome. Chapter 44 of 'Spiritual Axis': When there are intermittent symptoms. Chapter 4 of the 'Spiritual Axis': For channel problems (together with Spring point).

154

PART 2: TH E MAIN CHANNELS

Table 9.3

Points to eliminate pathogenic factors according to the Five Elements

Element

Point

Pathogenic factor

Use

Wood

All Yin channels Wood points Yang channels Wood points

Wind

Extinguish Internal Wind (acute stage of Wind-stroke) Expel Exterior Wind in Painful Obstruction Syndrome

Fire

HE-8 Shaofu LU-10 Yuji P-8 Laogong LIV-2 Xingjian SP-2 Dadu Kl-2 Rangu L.l. -5 Yangxi

Heat or Fire

Expels Summer-Heat or drains Heart-Fire Expels Wind-Heat or clears Lung-Heat Expels Summer-Heat or drains Heart-Fire Drains Liver-Fire Clears Heat in febri le diseases Clears Empty-Heat, cools Blood Clears Heat in Large Intestine and Damp-Heat in Painful Obstruction Syndrome Resolves Damp-Heat in Painful Obstruction Syndrome Clears Stomach Heat and Damp-Heat in Painful Obstruction Syndrome

Dampness Phlegm

Not used to resolve Phlegm

S. l.-5 Yanggu ST-41 Jiexi

Earth

• Water

HE-7 Shenmen

Resolves Phlegm from Heart Resolves Phlegm from Lung Resolves Dampness Resolves Dampness Not used to resolve Phlegm Resolves Dampness Resolves Dampness Resolves Dampness Resolves Damp-Heat Resolves Dampness in Upper Burner Resolves Dampness in Upper Burner

P-7 Daling LU-9 Taiyuan SP-3 Taibai LIV-3 Taichong Kl-3 Taixi ST-36 Zusanli G.B.-34 Yanglingquan BL-40 Weizhong L. l.-11 Quchi S.l.-8 Xiaohai TB.-10 Tianjing HE-3 Shaohai P-3 Quze LU-5 Chize LIV-8 Ququan SP-9 Yinlingquan Kl-10 Yingu

Cold

Chapter 6 of the 'Spiritual Axis ': For Yin organ problems (together with Spring point). Stream points of Yin channels. According to seasons: In Summer. According to pathogenic factors and Five Elements: To resolve Dampness or Phlegm.

River points Chapter 68 of 'Classic of Difficulties': For 'breathlessness, cough and hot and cold sensations', cough , asthma. Chapter 44 of 'Spiritual Axis': When voice is affected. Chapter 6 of the 'Spiritual Axis': For sinews and bones. River points of the Yin channels. According to seasons: In Late Summer.

Not used to expel Cold Not used to expel Cold Expels Cold from Lungs Expels Damp-Cold from Lower Burner Expels Damp-Cold from Lower Burner Expels Damp-Cold from Lower Burner

Sea p oints Chapter 68 of 'Classic of Difficulties': For 'rebellious Qi and diarrhoea', digestive disorders. Chapter 44 of 'Spiritual Axis': For Stomach diseases. Chapter 4 of the 'Spiritual Axis': For Internal (Yang) organ problems. Chapter 6 of the 'Spiritual Axis': For skin problems. Sea points of Yang channels. According to seasons: In Autumn. According to pathogenic factors and Five Elements: To expel Cold.

THE FIVE TRANSPORTING (SHU) POINTS

Table 9.4

155

Summary of nature and actions of Five Transporting points

Stream

River

Sea

Qi is swift, slips; Qi goes out minute trickle like spri ng-head; Qi of channel comes from a spring; Qi begins to flow; out; Qi is small, superficial Qi flows swiftly

Qi pours like water flowing from surface to depth; Qi irrigates the body

Qi moves, goes like water freely flowing in a river; Qi flowing in the channels; Qi is bigger

Qi enters like many river streams returning to the sea; Qi of channel comes to an end; Qi is vast and deep, it comes together

'Spiritual Axis' Chs 2 and 6

Point of departure of Qi

Point of convergence

Point of entry of pathogenic factors

Concentration point

Qi joins body circulation

'Classic of Difficulties' Ch. 68

Fullness under heart; mental irritation

Hot sensation, Heat diseases

Heavi ness of body, painful JOints, Painful Obstruction Syndrome

Breathlessness, coughing, feeling hot and cold; Lung diseases

Rebellious Qi, diarrhoea, digestion; diseases of Yang organs

'Spiritual Axis' Ch.44

When Yin organs are affected

When illness manifests on the complexion

When illness is characterized by amelioration and aggravation

When illness reflects in the voice

For Stomach diseases

'Spiritual Axis' Ch. 4

Exterior diseases (Yang channels)

Exterior diseases (Yang channels)

'Spiritual Axis' Ch. 6

For Yin organs (Yin channels)

For Yin organs (Yin channels)

Description

Well

'Spiritual Axis' Ch.1 Other descriptions

Spring

Nan Jing ch 68: Ling Shu ch 44: Seasons: Pathogenic factors:

fullness under heart treat Yin organs Winter Wind

• • River Stream

Nan Jing ch 68: hot sensations of body Ling Shu ch 44: change in complexion Ling Shu ch 4: channel problems (with Stream point) Ling Shu ch 6: Yin organs problems (with Stream point) Seasons: Spring Pathogenic factors: Heat

Nan Jing ch 68: feeling of heaviness, joint pain Ling Shu ch 44: intermittent symptoms Ling Shu ch 4: channel problems (with Spring point) Ling Shu ch 6: Yin organs problems (with Spring point) Seasons: Summer Pathogenic factors: Dampness or Phlegm

Fig. 9.9 Summary of actions of Five Transporting points from various classics.

Interior diseases (Yang organs) For sinews and bones

For skin

Nan Jing ch 68: breathlessness cough, hot - cold Ling Shu ch 44: voice affected Ling Shu ch 6: sinews and bones Seasons: Late Summer

• Sea

Nan Jing ch 68: Ling Shu ch 44: Ling Shu ch 4: Ling Shu ch 6: Seasons: Pathogenic factors:

diarrhoea stomach Yang organ problems skin Autumn Cold

156

PART 2: TH E MAIN CHANN ELS

NOTES 1. 19 81 Spiritual Axis (Li11g Shu ji11g lX!
8. 9. 10. 11. 12. 13.

Ibid .. p. 14. Ibid .. p. 86. Ibid .. p. 14. lbid .. p.l 8-19. Ibid .. p. 86. 1979 The Yellow Emperor's Classic of Internal Medicine - Simple Questions (1/uniiiJ Di Nei ji11g S11 We11 jt %' pg t£ ¥ ICJ ). People's Health Publishing I lou se. Beij ing. first published c. 100 BC. p. 330. 14. Classic of DiiTiculties. p. 139. 15. Ibid .. p. 15 .1.

CHAPTER 10

CATEGORIES OF POINTS

SOURCE (YUA N) POINTS 757 Chapter 1 of the 'Spiritual Axis' 157 Chapter 66 of the 'Classic of Difficulties'

759

CONNECTIN G (LUO) POINTS 759 Use of the Connecting points in conjunction with the Source points 160 Use of the Connecting points on the ir own according to Chapter 10 of the 'Spiritual Axis' 161 Use of the Connecting points according to their energetic influence 162 BACK-TRANSPORTING (SHU) POINTS 164 FRONT-COLLECTING (MU) POINTS 167 ACCUMU LATION (Xi) POINTS 169 GATHERI NG (HUI) POINTS 170 POINTS OF THE FOUR SEAS 170 W INDOW OF HEAVE N POINTS 171 12 HEAVENLY STAR POINTS OF MA DAN YANG SUN Sl M IAO'S 13 GHOST POINTS 173 POINTS OF THE EYE SYSTEM (MU XI) 173 FIVE COMMAND POINTS 775

173

SOURCE (YUAN) POINTS The nature and use of the Source points is dealt with in the first chapter of the 'Spiritual Axis' and in Chapter 66 of the 'Classic of Difficulties'. In order to understand the use of the Source points. it is worth looking at these two chapters closely. The Source (Yuan) points are: -

LU-9 Taiyuan L.I.-4 Hegu ST-42 Chongyang SP-3 Taibai HE-7 Shenmen S.I.-4 Wangu

-

BL-64 Jinggu KI-3 Taixi P-7 Daling T.B.-4 Yangchi G.B.-40 Qiuxu LIV-3 Taichong.

Chapter 1 of the 'Spiritual Axis' This chapter makes two statements in connection with the Source points. one regarding their use in diagnosis, the other in treatment. The first statement says: ·Select the Source points when tlze jive Yin organs are diseased' . 1 This clearly indicates that the Source points directly affect the Yin organs. The other statement says: 'If the jive Yin organs are diseased, abnormal reactions will appear at the 12 Source points. lf we know the correspondence of Source points to the relevant Yin organ. we can diagnose when a Yin organ is diseased.' 2 This statement clearly indicates that the Source points are in relation with the Original Qi (Yuan Qi) and that changes on the skin over the Source points indicate abnormalities in the functioning of Yin organs and can therefore be used for diagnosis. Abnormalities which can be observed on the Source points include swellings, redness. congested blood vessels (common on KI-3 Taixi), varicose veins, a deep sunken dip around the point (also commonly seen on KI-3), whiteness, a bluish colour or very l1accid skin. When the 'Spiritual Axis' proceeds to list the Source points. however, it gives different points from the ones we usually consider. The 'Spiritual Axis' lists the Source points as: - LU-9 Taiyuan for the Lungs - P-7 Daling for the Heart - SP-3 Taibai for the Spleen

2 points 2 points 2 points

157

158

PART 2: TH E MAIN CHANN ELS

- LIV-3 Taichong for the Liver - KI-3 Taixi for the Kidneys

2 points 2 points

Total

10 points

- Ren-15 Jiuwei, Source point for Fat tissue (Gao) - Ren-6 Qihai, Source point for Membranes (Huang ) Grand total

1 point 1 point 12 points.

Regarding these last two points, the 'Spiritual Axis' says: 'Tile Original Qi of Fat tissues fGao] gathers at Jiuwei {Ren-15 ], the Original Qi of Membranes {Huang] gathers at Qi/rai fRen-6}'. 3 Although the book uses a different name, (Boyang), for Ren-6 , this is the old name for Qihai, i.e. Ren-6. Ren-15 and Ren-6 are also considered the Source points for the chest and the abdomen, and are the Source points for all the Yin and all the Yang organs respectively. 'Gao' may also indicate the area below the heart (controlled by Ren-15) and 'Huang ' the area above the diaphragm (controlled by Ren-6) . Ren-15 is used for mental-emotional problems arising from disharmonies of the Yin organs (e.g. Heart-Yin deficiency) , such as anxiety, mental restlessness or insomnia, and is an extremely useful point to calm the Mind. Ren-6 is used in Deficiency conditions of the Yang organs as it strongly tonifies Yang Qi. The surprising element in this chapter is that the 'Spiritual Axis' mentions Source points only for the Yin organs. This is because the Qi of the Source points stems from the Original Qi, which is related to the Yin organs, and in particular the Kidneys. The Source points are therefore used mostly to torrify the Yin organs. However, it should be said that Chapter 2 of the 'Spiritual Axis' itself does mention the Source points of the Yang channels as we know them today.4 In contrast, the Source points of the Yang organs do not have a similar function and do not torrify the Yang organs in the same way as the Yin Source points torrify the Yin organs. The Yang Source points are mostly used in Excess patterns to expel pathogenic factors. For example, L.I.-4 Hegu may be used to release the Exterior and expel Wind , S.I.-4 Yanggu to move stagnant Liver-Qi and stop pain in the costal region, BL-64 Jinggu to expel Damp-Heat from the Lower Burner, G.B.-40 Qiuxu for stagnation of LiverQi, ST-42 Chongyang to expel Wind from the face in facial paralysis and T.B.-4 Yangchi to clear Gall

Bladder Heat causing deafness or to regulate the Lesser Yang. Of course, the Source points of the Yang channels can also be used to torrify the relevant Yang organs (as Chapter 66 of the 'Classic of Difficulties' says), but this is not their main use, and they would not be the best points for this purpose. To torrify the Yang organs, the Lower-Sea points would be the best choice. However, one exception springs to mind: T.B.-4 Yangchi. As we will see below, Chapter 66 of the 'Classic of Difficulties' says that the Original Qi springs forth from between the Kidneys through the intermediary of the Triple Burner. Therefore, the Triple Burner is like the emissary of the Original Qi; as the Source points are in direct contact with the Original Qi, T.B.-4 can therefore be used to strengthen the Original Qi, and is particularly used in this way in Japanese acupuncture. It is interesting to note, however, that none of the indications from old Chinese texts refers to a torrifying action of this point on the Original Qi. The other surprising statement in this chapter is the mention of P-7 Daling as the Source point of the Heart. This is because in the times when the 'Spiritual Axis' was written the Heart and Pericardium were considered as a single organ, hence the constant reference to 'five Yin and six Yang organs'. It was only later that the Pericardium and Heart were split into two separate organs to preserve the symmetry of 12 organs and 12 channels. In the Yin channels, the Source points coincide with the Stream points, i.e. the third point from the distal end of the channel; in the Yang channels, the Source point follows the Stream point (Shu) and is therefore the fourth point from the distal end of the channel (except for the Gall Bladder channel, in which the Source point is the fifth from the distal end).

SUMMARY SOURCE POINTS: 'SPIRITUAl AXIS'

• The Source points are in re lation with the Original Qi • They can be used in diagnosis as they reflect the state of the Original Qi of each Yin organ • They are used in treatment mostly to tonify the Yin organs • The Source points of the Yin organs are more important than those of the Yang organs.

CATEGORIES OF POINTS

Chapter 66 of the 'Classic of Difficulties' This chapter of the 'Classic of Difficulties' lists the 12 Source points as we know them, i.e. one for each of the 6 Yin and 6 Yang organs. The only difference between its listing of the Source points and normal practice nowadays is that it lists both P-7 and HE-7 as Source points for the Heart. 5 'This is due again to the fact that in those times the Heart and Pericardium were considered as one organ, and the Pericardium could not therefore have a Source point. The rest of this short chapter clarifies the relation between Original Qi, Triple Burner and Source points. It says: 'Tize Original Qi is the Motive 1-'orce [Dong Qij situated between the two kidneys. it is life-giving and is the root of the 12 channels. The Triple Burner causes the Original Qi to differentiate [for its different uses around the body]: the Original Qi passes through the Tl1ree Bunzers and tlzen spreads to i11e jive Yi11 a11d six Yang organs and their channels. The places where the Original Qi stays are tlze Source [Yuan] points'. 6 This chapter therefore confirms that the Source points are in relation with the Original Qi. In contrast with Chapter 1 of the 'Spiritual Axis', the 'Classic of Difficulties' says that the Source points can be used to tonify both Yin and Yang organs. In particular, the role of the Triple Burner as the 'ambassador' or 'avenue' through which the Original Qi arises from in between the two Kidneys, differentiating into its various forms to spread to the five Y in and six Yang organs, explains a particular use of the Source point of the Triple Burner channel, T.B.-4 Yangchi. As mentioned above, this point can be used to tonify Original Qi directly and activate its circulation in the channels. Combined with the Source point of

159

the Stomach, ST-42 Chongyang, T.B.-4 strongly tonifies Qi and the Original Qi.

CONNECTING (LUO) POINTS There are 16 Connecting channels, one for each of the 12 main channels, one for the Directing Vessel and one for the Governing Vessel, one 'Great Connecting' channel for the Spleen and one 'Great Connecting' channel for the Stomach. 7 However, there are only 15 Connecting points as no mention is made of a Connecting point for the Great Connecting channel of the Stomach. The Connecting channels and Connecting points are discussed in detail in Chapters 12 to 16; they are mentioned here only briefly to be seen in the context of categories of points. The Connecting points are: -

LU-7 Lieque L.I.-6 Pianli ST-40 Fenglong SP-4 Gongsun HE-5 Tongli S.I.-7 Zhizheng BL-58 Feiyang KI-4 Dazhong P-6 Neiguan T.B.-5 Waiguan G.B.-3 7 Guangming LIV-5 Ligou Du-1 Changqiang for the Governing Vessel (Du Mai) Ren-15 Jiuwei for the Directing Vessel (Ren Mai) SP-21 Dabao Great Connecting channel of the Spleen.

The pathways of the Connecting channels in broad lines are as follows:

SUMMARY SOURCE (YUAN) POINTS: 'CLASSIC OF DIFFICULTIES' • The Source points are in relation with the Original Qi • Origina l Qi reaches the Internal Organs, 12 channels and fina lly the 12 Source points through the intermediary of the Triple Burner • The Source points tonify both Yin and Yang organs.

• Lung Connecting channel: from LU-7 Lieque to the thenar eminence • Large Intestine Connecting channel: from L.I.-6 Pianli to the teeth and ears • Stomach Connecting channel: from ST-40 Fenglong to the neck • Spleen Connecting channel: from SP-4 to the stomach and intestines • Heart Connecting channel: from HE-5 Tongli to the tongue and eyes

160

PART 2: THE MAIN CHANNELS

• Small Intestine Connecting channel: from S.I.-7 Zhizheng to the shoulder • Bladder Connecting channel: from BL-58 Feiyang to the Kidney channel on the leg • Kidney Connecting channel: from KI-4 Dazhong to the pericardium • Pericardium Connecting channel: from P-7 Daling to the heart • Triple Burner Connecting channel: from T.B.-5 Waiguan to the pericardium in the chest • Gall Bladder Connecting channel: from G.B.-3 7 Guangming to the dorsum of the foot • Liver Connecting channel: from LIV-5 to the external genitalia • Governing Vessel Connecting channel: from Du-1 Changqiang to the spine and occiput • Directing Vessel Connecting channel: from Ren-15 to the abdomen • Great Connecting channel of the Spleen: from SP-21 Dabao to the chest and ribs. Each of the 12 Connecting channels related to the Main channels departs from its relevant Connecting point and branches out travelling upwards along a separate trajectory. The Connecting channels are called Luo Mai: the meaning of Luo implies 'network'. The Main channels are called Jing Mai; the meaning of Jing implies 'line', 'route' or 'way'. Chapter 17 of the 'Spiritual Axis' confirms that the Connecting channels are 'horizontal' or 'crosswise': 'The Main channels are in the Interior. tlzeir branches are horizontal [or crosswise] Jo r111ing tlze Co nnecting channels' .8 The Connecting channels are more superficial than the Main channels and they run in all directions, horizontally rather than vertically, like a net. In particular, they fill the space between the skin and muscles, i.e. the Cou Li space. There are three ways of using the Connecting points. The Connecting point can be used in conjunction with the Source point of its interiorly- exteriorly related channel, it can be used on its own. according to the symptomatology of the Connecting channels themselves , or it can be used to affect the area influenced by the Connecting channel. Let us now discuss these three ways of using the Connecting points.

Use of the Connecting points in conjunction with the Source points Since each Connecting channel joins with its interiorly---exteriorly related channel (e.g. Lungs-Large Intestine), the Connecting point can treat not only the channel to which it belongs, but also its interiorlyexteriorly related channel. In other words, when we use LU-7 Lieque we affect not only the Lung channel but also the Large Intestine channel. In fact, in this example, it is precisely for this reason that LU-7 affects the head and face. i.e. through the Large Intestine channel. In fact. the Connecting channel that departs from LU-7 goes to the thenar eminence and this could not explain the effect of this point on the head. When a Source point is used to torrify a given channel/organ, the Connecting point of its interiorlyexteriorly related channel can be used to strengthen the treatment. The Connecting point is thus chosen as a secondary point to reinforce the action of the Source point, chosen as the main point to treat the primarily affected channel. For example, in the case of Lung-Qi deficiency we may choose to use the Lung channel Source point, i.e. LU-9 Taiyuan. and reinforce its action by using the Connecting point of its interiorly---exteriorly related channel, i.e. L.I.-6 Pianli. This technique finds its rationale in the pathway of the Connecting channels as these join up with their interiorly-exteriorly related channels. This is also ref1ected in the fact that the symptomatology of each Connecting channel often includes symptoms of its interiorly---exteriorly related channel. The 'Great Compendium of Acupuncture' 9 (Zhen Jiu Da Cheng , 1601) discusses the combination of Source point with associated Connecting point and calls this combination Guest-Host method. the Source point being the Host and the Luo point the Guest. It should be noted that the Source point is the main point. meaning that the choice of points is determined by the pathology of the Host. i.e. the Source point of the diseased channel. The symptoms are as follows. listing the Host first (Source point) and the Guest second (Connecting point): - LU-9 Taiyuan and L.I.-6 Pianli: feeling of oppression of the chest, hot palms. co ugh, swelling of the throat, dry throat, sweating, shoulder pain, pain in the breasts, expectoration of phlegm, breathlessness

CATEGORIES OF POINTS

- L.I.-4 Hegu and LU-7 Lieque: toothache, swollen gums, yellow eyes, dry mouth, runny nose, epistaxis, swollen throat, shoulder pain - SP-3 Taibai and ST-40 Fenglong: stiff tongue, acid refiux, vomiting, abdominal distension, feeling of heaviness, constipation. weakness, swelling of lower limbs - ST-42 Chongyang and SP-4 Gongsun: abdominal distension and fullness, feeling of oppression of the chest. epistaxis, phlegm, foot pain, ankle pain - HE-7 Shenmen and S.I.-7 Zhizheng: heart pain, dry throat, thirst, yellow eyes, dry mouth, hot palms, palpitations, vomiting of blood, fright - S.I.-4 Wangu and HE-5 Tongli: stiff neck, swelling and pain of throat, shoulder pain, deafness, yellow eyes, pain on lateral side of upper arms - KI-3 Taixi and BL-58 Feiyang: dark complexion, no thirst, desire to lie down, decreased vision, feeling of heat, backache, weakness of lower limbs, shortness of breath, timidity (literally 'Heart and Gall Bladder shivering and dithering') - BL-64 Jinggu and KI-4 Dazhong: eye pain, neck ache, pain from neck to back to lower limbs, mania, epilepsy, opisthotonos, pain in eyebrow region, epistaxis, yellow eyes, contraction of tendons, prolapse ani - T.B.-4 Yangchi and P-6 Neiguan: tinnitus, deafness, swelling of throat, dry throat, swelling of eyes, earache, sweating, pain between scapulae, elbow pain, constipation, incontinence of urine, retention of urine - P-7 Daling and T.B.-5: contracture of palms, arm pain, inability to extend arm, fullness of chest, swelling of axilla, palpitations, red face, yellow eyes, laughing and crying without reason, mental restlessness, heart pain, hot palms - LIV-3 Taichong and G.B.-3 7 Guangming: abdominal distension and hypogastric swelling in women, chest fullness, vomiting, hernia, urinary retention or incontinence - G.B.-40 Qiuxu and LIV-5 Ligou: dull complexion, headache, eye pain, swelling of neck, goitre, hypochondria! pain, swelling and sweating of axilla. The combinations I personally use most are described below with the relevant symptoms: - L.I.-4 Hegu and LU-7 Lieque: restore the descending of Lung-Qi, expel Wind, treat headaches

161

- T.B.-4 Yangchi and P-6 Neiguan: regulate the Triple Burner, move Liver-Qi, calm the Mind - SP-3 Taibai and ST-40 Fenglong: torrify the Spleen and resolve Phlegm - LIV-3 Taichong and G.B.-3 7 Guangming: brighten the eyes in Liver patterns - BL-64 Jinggu and KI-4 Dazhong: treat sciatica (BL-64 on affected side, KI-4 on opposite one).

SUMMARY COMBINATION OF SOURCE (Yuan) AND CONNECTING (Luo) POINTS • Mentioned in the 'Great Compend ium of Acupuncture, 1601' as 'Guest-Host' combination • The Source point is taken as main point to treat affected channel, e.g. LU-9 Taiyuan • The Connecting point of interiorly-exteriorly related channel is added to reinforce treatment, e.g. L.l.-6 Pianli.

Use of the Connecting points on their own according to Chapter 10 of the 'Spiritual Axis' The use of the Connecting points by themselves is based on the Full or Empty symptomatology of each Connecting channel. The Full and Empty symptoms of the Connecting channels are described in Chapter 10 of the 'Spiritual Axis' .10 These are listed in Table 10.1. The indications of the Connecting points according to the Full and Empty symptoms from Chapter 10 of the 'Spiritual Axis' do not have the same clinical relevance for all points. For example, the indications for L.I.-6 PianU ('sensation of cold in teeth. fullness and congestion in the chest') are not of great clinical significance. The indications with greater clinical significance are as follows: - ST-40 Fenglong: insanity (Full) - SP-4 Gongsun: abdominal pain (Full), abdominal distension (Empty) - HE-5 Tongli: aphasia (Empty) - KI-4 Dazhong: backache (Empty) - P-6 Neiguan: chest pain (Full) - LIV-5 Ligou: genitalia problems (Full), itching genitals (Empty).

162

PART 2: THE MAIN CHANNELS

Table 10.1

Full and Empty symptoms of the Connecting channels

Channel

Full

Empty

Lung (LU-7 Lieque)

Hot palms and wrists

Yawning, frequent urination, incontinence of urine

Large Intestine (L.I.-6 Pianli)

Toothache, deafness

Sensation of cold in teeth, fullness and congestion in the chest

Stomach (ST-40 Fenglong)

Full: insanity (Kuang)

Rebellious: throat obstruct ion, loss of voice

Flaccid or atrophied muscles of legs

Spleen (SP-4 Gongsun)

Full: abdominal pain

Rebellious Qi: food poisoning (Huo Luan)

Abdominal distension

Heart (HE-5 Tongli)

Fullness and oppression of chest

Aphasia

Small Intestine (S I. -7 Zhizheng)

Loose joints, atrophy of arm muscles, stiff elbow

Long, finger-shaped warts, itching scabs

Bladder (BL-58 Feiyang)

Nasal congestion, headache, backache

Clear nasal discharge, nosebleed

Kidney (KI-4 Dazhong)

Full: retention of urine

Lower backache

Pericardium (P-6 Neiguan)

Chest pain

Stiffness of the head and neck

Triple Burner (T.B.-5 Waiguan)

Spasm of the elbow

Flaccid arm muscles

Gall Bladder (G.B.-37 Guangming)

Fainting

Weak and flaccid foot muscles, difficult to stand from sitting position

Liver (LIV-5 Ligou)

Full: swelling of testicle, hernia-like disorders (Shan)

Ren Mai (Ren-15 Jiuwei)

Pain in the skin of abdomen

Itching of the skin of abdomen

Du Mai (Du-1 Changqiang)

Stiffness of spine

Heaviness of the head, tremor of head

Great Luo of Spleen (SP-21 Dabao)

Ache and pain all over body

Weak limb muscles

Great Luo of Stomach (Xu L1)

Rapid breathing, irregular breathing, sensation of knot in chest

Rebellious: irritability, depression, oppression of chest

Rebellious: abnormal erection

SUMMARY USE OF THE CONNECTING POINTS ON THEIR OWN ACCORDING TO CHAPTER 10 OF THE 'SPIRITUAL AXIS' • Connecting points used on their own • Connecting points chosen according to Full or Empty state of the Connecting channe l.

Itching of pubic region

Use of the Connecting points according to their energetic influence Use of the Connecting points to affect the superficial areas of a channel in tendinomuscular problems This is probably the most important use of the Connecting channels and points. Each channel has a 'Connecting area' which is like a network of small

CATEGORIES OF POINTS

channels in the superficial part of the body between the Main channels and the skin (see Figs 12.2 to 12.4). The term 'Connecting channel' refers to two separate entities: one is the Connecting channel itself which departs from the Connecting point and travels upwards in the pathways briefly described above; the other is the whole area of the body that lies between the Main channel and the skin. In the latter case, the Connecting channel would be more appropriately described as the 'Connecting channels area' because it does not denote an actual channel but a whole part of the body that is irrigated by the Connecting channels (see Fig. 12.9).

The 'Connecting channel' is the pathway of Qi departing from each Connecting point. The 'Connecting channels area' is the area of the body criss-crossed by the Connecting channels between the Main channels and the skin.

The pathology of this area and therefore of the Connecting channels consists primarily in invasions of external pathogenic factors causing tendinomuscular problems. Therefore, the Connecting points are extremely important to affect the superficial areas of the channels and particularly the joints. sinews, muscles and skin in tendinomuscular problems. For example, in the case of tendinitis of the elbow along the Large Intestine channel, the Connecting point L.I.-6 Pianli will affect the Connecting-channel area, i.e. the sinews and muscles situated between the Main channels and the skin, which is where the pathology of tendinitis is situated. When using Connecting points for channel problems, one may sometimes choose points on the opposite side to where the problem is; in acute cases, one chooses the same channel and the interiorlyexteriorly related channel. For example, if there is an acute pain in the right shoulder along the Large Intestine channel and some local points on the Large Intestine are used on the right side, L.I.-6 Pianli can be added on the left side to reinforce the treatment. In a chronic case, LU-7 Lieque would be used on the left side.

163

Use of the Connecting points to treat stagnation The Connecting channels (and therefore points) are not used only for superficial tendinomuscular problems. As discussed above, the Connecting channels occupy the area between the Main channels and the skin, they are 'horizontal', forming as it were a network of small channels, and they cannot penetrate through the large joints as the Main channels do. This means that the Connecting channels in this area are very prone to stagnation of Qi and stasis of Blood. Indeed, it could be said that most stagnation symptoms in the body occur in the Connecting-channels area. For example, breast distension from Qi stagnation in women occurs in the Connecting-channels area of the breast. a myoma (fibroid) in the Uterus is due to Blood stasis in the Blood Connecting channels of the Uterus. a feeling of a lump in the throat is due to Qi stagnation in the Connecting channels of the throat; and so on. Therefore the Connecting points have a very important use in moving Qi and Blood in the channels when these are affected by Qi stagnation or Blood stasis.

Needling techniques in Full and Empty Conditions of the Connecting Channels The 'Spiritual Axis' also says in the same chapter that 'Wilen the Co11necting c!Jamzels are Full they can be seen, wlze11 they are Empty they cannot be seen' . II This is due to the fact that the Connecting channels are more superficial than the main channels and branch out into the network of the smaller Superficial and Minute channels. In Full patterns, the Connecting channels and their smaller branches are congested and can therefore be seen. A greenish coloration suggests stagnation in these channels, a bluish colour indicates Cold, a reddish coloration suggests Heat, and a purple colour indicates Blood stasis. The channel pathway areas should also be palpated and they can feel cold or hot to the touch. This, together with the coloration, indicates retention of Cold or Heat in the Connecting channels and their branches, i.e. an Excess condition. In Deficiency patterns, the Connecting channels and their branches are devoid of Qi, so nothing can be observed outwardly in terms of colour, but in chronic severe cases, a flaccidity of the muscles can be observed.

164

PART 2: THE MAIN CHANNELS

SUMMARY

SUMMARY

USE OF THE CONNECTING POINTS ACCORDING TO THEIR ENERGETIC INFLUENCE

SIX WAYS OF USING CONNECTING POINTS

• Use of the Connecting points to affect the superficial areas of a channel in tendinomuscular problems • Use of t he Connecting points to eliminate stagnation of Qi and/or Blood in the Connecting-channels areas • Use of the Connecting points to drain or tonify the Superficial Connecting channels according to manifestations on the skin.

In Excess conditions of the Connecting channels the Connecting point must be reduced, and in Deficiency conditions it must be reinforced. In cases of venule and capillary congestion manifesting with macules on a Connecting channel, these blood vessels can be pricked and bled. Obviously, apart from the above uses, the Connecting points are also often used in practice according to their specific action, irrespective of their being Connecting points. For example, ST-40 Fentrlong is very much used to resolve Phlegm, irrespective of its being the Connecting point of the Stomach channel. T.B.-5 Waiguan is often used to expel Wind-Heat, P-6 Neiguan is very much used for chest problems and emotional problems, LU-7 Lieque can be used to affect the head, and so on. In conclusion, the Connecting points Lu ll basically be used in six different ways: 1. In conjunction with the Source point of the

primarily affected channel to reinforce its action 2. According to the Full-Empty symptomatology

from Chapter 10 of the 'Spiritual Axis' 3. According to their range of action in terms of energetic layers, i.e. to affect the superficial layers in channel problems 4. For stagnation of Qi and stasis of Blood in the Connecting channels areas 5. To drain or tonify the Connecting channels according to manifestations on the skin 6. According to their specific action, irrespective of their being Connecting points (e.g. ST-40 Fenglong to resolve Phlegm).

• In conjunction with the Source point of the primarily affected channel to reinforce its action • According to the Full- Empty symptomatology from Chapter 10 of the 'Spiritual Axis' • According to their range of action in terms of energetic layers, i.e. to affect the superficial layers in channel problems • For stagnation of Qi and stasis of Blood in the Connecting-channels areas • To drain or tonify the Connecting channels according to manifestations on the skin • According to their specific action, irrespective of their being Connecting points (e.g. ST-40 Fenglong to resolve Phlegm).

BACK-TRANSPORTING (SHU) POINTS The Back-Transporting (Back-Shu) points are mentioned in various chapters of the 'Yellow Emperor's Classic of Internal Medicine'. Chapter 51 of the 'Spiritual Axis' lists the Back-Transporting points of the five Yin organs.n Chapter 59 of the 'Simple Questions' discusses the Back-Transporting points of the Yang organs; 13 in all, the 'Yellow Emperor's Classic' lists 10 Back-Transporting points, leaving out BL-22 Sanjiaoshu, first mentioned in the 'ABC of Acupuncture' (AD 282), and BL-14 Jueyinshu, first mentioned in the '1000 Golden Ducats Prescriptions' (AD 652). The importance of the Back-Transporting points in treatment cannot be overemphasized. They are particularly important for the treatment of chronic diseases and, indeed, one may go so far as to say that a chronic disease cannot be treated without using these points at some time during the course of treatment. The Chinese character (Shu WI ) denoting these points means 'to transport', indicating that they transport Qi to the inner organs. Each point takes its name from the corresponding organ. For example, 'Xin' means 'Heart' and 'Xinshu' is the Back-Transporting point for the Heart. There is a Back-Transporting point for each of the Yin and Yang organs. They are located on the back, on the Bladder channel, 1.5 cun (rom the midline, level

CATEGORIES OF POINTS

with an intervertebral space. The Back-Transporting points are: - Lungs: BL-13 Feishu -Pericardium: BL-14 Jueyinshu - Heart: BL-15 Xinshu - Liver: BL-18 Ganshu -Gall Bladder: BL-19 Danshu -Spleen: BL-20 Pishu -Stomach: BL-21 Weishu -Triple Burner: BL-22 Sanjiaoshu -Kidneys: BL-23 Shenshu - Large Intestine: BL-2 5 Dachangshu -Small Intestine: BL-2 7 Xiaochangshu -Bladder: BL-28 Pangguangshu. In addition to these points, there are a few others which are situated on the Bladder channel very close to the Back-Transporting points but are not related to organs. They are related to parts of the body or channels. These are: -Governing Vessel: BL-16 Dushu -diaphragm: BL-17 Geshu -Sea of Qi: BL-24 Qihaishu -lower back and uterus: BL-26 Guanyuanshu -sacrum: BL-29 Zhonglushu - anus: BL-30 Baihuanshu. The Back-Transporting points affect the organs directly and are therefore used in Interior diseases of the Yin or Yang organs. This is a very important aspect of the clinical effect of these points. The way in which they act is quite different from that of all the other points. When treating the Internal Organs, other points work by stimulating the Qi of the channel, which then flows along the channel like a wave, eventually reaching the Internal Organs. In my experience, when we needle the Back-Transporting points, Qi goes directly to the relevant organ, not through the intermediary of its channel. For this reason, I usually retain the needle in these points a shorter time than for other body points (usually no longer than 10 minutes when used to torrify). The Back-Transporting points can be used both in acute conditions and in chronic ones, but are more frequently used in the latter. The Back-Transporting points are Yang in character and are especially used to torrify the Yang. However, they can be used for deficiency of Yin as well. Indeed, the 'Classic of Difficulties' says exactly that, i.e. that

165

CLINICAL NOTE The way in which Back-Transporting points act is quite different from all the other points. When treating the Internal Organs, other body points work by stimulating the Qi of the channel, wh ich then flows along the channel like a wave, eventually reaching the Internal Organs. In my experience, when we needle the Back-Transporting points, Qi goes directly to the relevant organ, not through the intermediary of its channel.

the Back-Transporting points are used to treat the Yin organs. Chapter 6 7 of the 'Classic of Difficulties' says: 'Yin diseases move to the Yang [area 1: Yang diseases move to the Yin fnren]. Tlze Front-Collecting /Muj points are situated on tlze Yin swj'nce [and therefore trent Yang diseases]; the Back-Transporting [Shu/ points are situated on the Yang swj'ace [and therefore treat Yin diseases]. o~ 4 According to this statement, the Back-Transporting points would be used to treat 'Yin diseases' and the Front-Collecting points 'Yang diseases'. 'Yin diseases' can mean either diseases of the Yin organs or diseases characterized by Cold: this would therefore mean that the BackTransporting points would be used to torrify the Yin organs and to give warmth. Conversely, 'Yang diseases' can mean either diseases of the Yang organs or diseases characterized by Heat: this would therefore mean that the Front-Collecting points would be used to nourish Yin or to clear Heat. These guidelines are certainly valid but they should not be followed too rigidly; in other words, the Back-Transporting points can also be used to torrify the Yin organs and clear Heat and, conversely, the Front-Collecting points to torrify the Yang and to give warmth. Yet another interpretation of 'Yin' or 'Yang diseases' could be that of chronic and acute diseases respectively: in this interpretation, the Back-Transporting points would be used for 'Yin diseases', i.e. chronic diseases, and the Front-Collecting points for 'Yang diseases', i.e. acute diseases. Although this rule should not be interpreted rigidly, it is certainly valid and finds a widespread clinical application, i.e. using the Back-Transporting points for chronic and the FrontCollecting points for acute diseases. The various uses of the Back-Transporting and Front-Collecting points are summarized in Table 10.2.

166

PART 2: THE MAIN CHAN NELS

Clinical use of Back-Transporting and Front-Collecting points

Table 10.2

Back·Transporting points

Front-Collecting points

Chapter 67 of 'Classic of Difficulties·

For 'Yin diseases'

For 'Yang diseases'

Organs

Diseases of Yin organs

Diseases of Yang organs

Heat/Cold

Cold syndromes (warm the organs)

Heat syndromes (clear Heat)

Duration of disease

Chronic diseases

Acute diseases

Another characteristic of these points is that they are used to affect the sense organ of the corresponding organ. For example, BL-18 Ganshu is the BackTransporting point of the Liver and can be used for eye diseases. In practice, the Back-Transporting points tend to produce a stronger effect than the Front-Collecting points. They are therefore very useful when the patient feels tired, exhausted or depressed. In these cases, if the Stomach and Spleen are deficient, for example, the use of BL-20 Pishu and BL-21 Weishu will produce a strong tonifying effect. The use of BL-17 Geshu and BL-19 Danshu (in Chinese called the 'Four Flowers') also has a strong tonifying effect on Qi and Blood. The point BL-23 Shenshu should be used in any deficiency of the Kidneys, particularly Kidney-Yang, as it strongly tonifies the Kidneys. Although the Back-Transporting points are mostly used to tonify the organs, they can also be used in Excess patterns to expel pathogenic factors. In particular, they can be used to subdue rebellious Qi and clear Heat. For example, the point BL-21 Weishu can be used to subdue rebellious Stomach-Qi in the case of belching, nausea or vomiting. The point BL-18 Ganshu can be used to move stagnant Liver-Qi. BL-15 Xinshu can be used to clear Heart-Fire and BL-13 Feishu to stimulate the diffusing and descending of Lung-Qi and release the Exterior. The Back-Transporting points can also be used for diagnostic purposes as they become tender on pressure

or even spontaneously tender when the corresponding organ is diseased. The 'Spiritual Axis' discusses this and other aspects of the Back-Transporting points in Chapter 51: 'The Back-Transporting point fo r the centre of the thorax is below the tip of the !Jig vertebra (Du- I 4 Dazlwi), tlwtfor the Lungs is below the 3rd vertebra. that for the Heart below the 5th vertebra, tlw tfor the diaphragm below the 7th vertebra, that for the Liver below the 9th vertebra, that for the Spleen below tlze I I th vertebra, that for the Kidneys below the I 4th vertebra, all of them are situated I .5 cun from the spine. Soreness is relieved on pressing on these points. Moxa is applied on these points, never needling. In order to tonify them o11e lets the moxa cones bum out on the skin slowly, in order to sedate them one blows on the moxa cones and then puts them out quickly .' 15 This passage establishes the use of the BackTransporting points in diagnosis when they become tender on pressure. The last statement could seem surprising as it forbids the needling of these points, which are needled so frequently in practice. The prevalent view is that prohibiting the needling of these points was an overcautious measure; the aim was to avoid their being needled too deeply. In fact, these points, and especially those on the upper part, should not be needled deeply because of possible injury to the lungs. They should be needled quite superficially (but not just under the skin) and obliquely towards the midline. Another point of interest in this passage is the mention of a method of moxibustion for drainage, contrary to the prevalent idea that moxibustion is generally used for tonification only. In addition to the above line of Back-Transporting points along the Bladder channel, there are also six other points on the outer line of the Bladder channel on the back which are particularly important. These are: - BL-42 Pohu

'Door of the Corporeal Soul' (level with BL-13 Feishu, Lungs) - BL-43 Gaohuangshu 'Gao/wang Transporting point' (level with BL-14 Jueyinshu) - BL-44 Shentang 'Hall of the Mind' (level with BL-15 Xinshu, Heart) - BL-4 7 Hunmen 'Door of the Ethereal Soul' (level with BL-18 Ganshu, Liver)

CATEGORIES OF POINTS

- BL-49 Yishe

- BL-52 Zhishi

'House of the Intellect' (level with BL-20 Pishu. Spleen) 'Room of Will Power' (level with BL-23 Shenshu, Kidneys).

Leaving aside BL-43 Gaohuangshu (described below and also in detail inCh. 3), the other five points exert a special effect on the corresponding mental aspect of each of the five Yin organs, i.e. the Corporeal Soul (Po) of the Lungs, Mind (Shen) of the Heart, Ethereal Soul (Hun) of the Liver, Intellect (Yi) of the Spleen and Will-power (Zhi) of the Kidneys. An 'Explanation of the Acupuncture Points' says that these points are like a 'window', a 'door' or a 'gate'; it says that 'the five Yin Organs are stored [or llidden] /Jut these can /Je seen from tile outside [at these points)'. 16 These points can therefore be used in emotional and psychological problems of the relevant Yin organs. It is strange that, in spite of their names linking these points to spiritual aspects of the five Yin Organs, the old texts do not report many mental-emotional indications for these points. However, in my experience, these points do have a profound mental-emotional effect as indicated below. BL-42 Pohu can be used for deep emotional problems related to sadness or grief affecting the Lungs. BL-44 Shentang can be used for emotional problems related to the Heart causing anxiety and insomnia, in particular if due to Heart-Fire or Heart Empty Heat. BL-4 7 Hunmen can be used to help a person find a sense of direction in life. It is very useful in certain cases of depression when the person feels confused and unable to plan his or her life. This point is also effective to treat other emotional problems related to the Liver manifesting with mood swings, a feeling of frustration, resentment and anger. BL-49 Yishe can be used in patients who exceed in mental work or who are prone to pensiveness. BL-52 Zhishi can be used for Kidney deficiency manifesting with great exhaustion, depression, lack of will power and a feeling of powerlessness and hopelessness. The action of these points is stronger if they are combined with the relevant Back-Transporting points of the corresponding Yin organ, e.g. BL-23 Shenshu and BL-52 Zhishi for the Kidneys. The point BL-43 Gaohuangshu is the BackTransporting point for the area between the heart

167

and the diaphragm (which is called 'Gaohuang') . However, its use can only be understood by referring to the other meaning of 'Gaohuang'. In a broader sense, 'Gao/wang' also indicates the site of any disease which is chronic and very difficult, if not impossible, to treat. This point is therefore used in very chronic diseases, particularly of the Lungs, and especially Lung-Yin deficiency. Historically, it was used for tuberculosis of the Lungs. I personally use the Back-Transporting points after using and retaining the needles in the front of the body. I would usually retain the body points approximately 20 minutes (in an adult), withdraw them, ask the patient to turn over, and then use the BackTransporting points. I generally leave these points in a shorter time, i.e. no longer than 10 minutes (in an adult) whether I am torrifying or draining. In order to drain pathogenic factors through these points, I use needling; to torrify the relevant organs through these points I use needling to nourish Blood and Yin and direct moxa cones to torrify Qi and Yang. Combining Back-Transporting with the Source points of the same organ specifically treats the Yin organs, chronic diseases and Deficiency conditions. For example, BL-13 Feishu with LU-9 Taiyuan for the Lungs, or BL-18 Ganshu with LIV-3 Taichong for the Liver. These combinations are listed in Table 11.2.

SUMMARY BACK-TRANSPORTING (SHU) POINTS

• All situated on the Bladder channel in the back • One for each Internal Organ • Affect the Internal Organs directly (rather than through their channels) • Are particularly important to tonify the Yin organs • Often used to warm the Internal Organs • For chronic diseases • Affect relevant sense organs (e.g. BL- 18 Ganshu for eyes) • Used for diagnosis (tenderness on pressure).

FRONT-COLLECTING (M U) POINTS All but one of the Front-Collecting points are located on the chest or abdomen. The Chinese character Mu

168

PART 2: THE MAIN CHANNELS

( ~ ) literally means 'to raise, collect, enlist, recruit'. In this context it has the meaning of 'collecting', i.e. the points where the energy of the relevant organs collects or gathers. These points are used both in diagnosis and in treatment. They are used in diagnosis because they become tender, either on pressure or spontaneously, when their relevant organ becomes diseased. From the diagnostic point of view, they are more important than the Back-Transporting points. In treatment, they are used either to torrify the Internal Organs or to expel pathogenic factors, often clearing Heat. The Front-Collecting points are Yin in character and are more often used in acute diseases; however, they can also be used in chronic ones. In fact, this is another possible interpretation of the statement from Chapter 6 7 of the 'Classic of Difficulties' according to which the Front-Collecting points (on a Yin surface) are used for 'diseases of Yang' (and vice versa for the Back-Transporting points). 'Diseases of Yang' can be interpreted as acute diseases, for which the Front-Collecting points are used, and 'diseases of Yin' can be interpreted as chronic diseases, for which the Back-Transporting points are used. However, as above, this rule should not be adhered to too rigidly as the Front-Collecting points can indeed be used for chronic diseases and, conversely, the Back-Transporting points for acute ones. The combination of the Front-Collecting points with the Back-Transporting points enhances the therapeutic results and provides a particularly strong treatment. If a patient is seen at rather infrequent intervals (two weeks or more), the combination of Front-Collecting and Back-Transporting points is effective in providing more lasting therapeutic results. If a patient is seen at frequent intervals (twice a week or more), it is better to alternate the use of the FrontCollecting points with that of the Back-Transporting points in each treatment session. The Front-Collecting points are:

-Kidney: G.B.-25 Jingmen -Large Intestine: ST-25 Tianshu -Small Intestine: Ren-4 Guanyuan -Bladder: Ren-3 Zhongji. The main therapeutic uses of these points are as follows: - LU-1 Zhongfu: used in acute Excess patterns of the Lungs, to clear Lung-Heat - Ren-17 Shanzhong: used to torrify and/ or move Qi in the chest - Ren-14 Juque: used in Heart patterns with anxiety to calm the Mind - UV-14 Qimen: used to move Liver-Qi when it stagnates in the hypochondrium; it harmonizes Liver and Stomach - G.B.-24 Riyue: used to clear Gall Bladder Damp-Heat in acute Excess patterns of Liver and Gall Bladder - LIV-13 Zhangmen: used to move Liver-Qi when it stagnates in the epigastrium or lower abdomen causing Spleen deficiency; it harmonizes Liver and Spleen - Ren-12 Zhongwan: widely used to torrify Stomach-Qi or Stomach-Yin and Spleen-Qi to resolve Phlegm and Dampness - Ren-5 Shimen: used in Excess patterns of the Lower Burner, such as Damp-Heat accumulating in the Lower Burner - G.B.-25 Jingmen: used in acute Excess patterns of the Bladder, to clear Heat and Dan1pness - ST-25 Tianshu: used to regulate the Intestines and stop diarrhoea and pain - Ren-4 Guanyuan: used to regulate the Small Intestine; however, this point is not much used in this capacity as it has many other important functions such as torrifying the Kidneys and Original Qi - Ren-3 Zhongji: used in acute Excess patterns of the Bladder, such as Damp-Heat. It should be noted that only three Front-Collecting

-Lungs: LU-1 Zhongfu -Pericardium: Ren-17 Shanzhong -Heart: Ren-14 Juque -Liver: UV-14 Qimen - Gall Bladder: G.B.-24 Riyue - Spleen: LIV-13 Zhangmen -Stomach: Ren-12 Zhongwan -Triple Burner: Ren-5 Shimen

points are located on the channel relevant to the corresponding organ, i.e. LIV-14 Qimen for the Liver, G.B.-24 Riyue for the Gall Bladder and LU-1 Zhongfu for the Lungs. All the others are located on channels that do not correspond to their organs: for example, the Front-Collecting point of the Small Intestine is Ren-4, while that for the Spleen is LIV-13. It follows. therefore. that with the exception of the three

CATEGORIES OF POINTS

above-mentioned points, the Front-Collecting points treat disorders of the Internal Organs but not those of their respective channels. For example, Ren-4 will treat disorders of the Small Intestine but not problems of the Small Intestine channel. Combining Front-Collecting with Sea points of the same organ specifically treats the Yang organs, acute diseases and Excess conditions. It should be borne in mind that by 'Sea points' of the Large Intestine, Small Intestine and Triple Burner is meant their Lower-Sea points, i.e. ST-3 7 Shangjuxu, ST-39 Xiajuxu and BL-39 Weiyang. A full listing of these points is given in Table 11.3.

SUMMARY FRONT-COLLEaiNG (MU) POINTS • All situated on chest or abdomen • Often used in diagnosis (tenderness on pressure or sometimes spontaneous tenderness) • Used especially (but not only) in acute diseases • Often used to clear Heat • Often combined with the Back-Transporting point to achieve a stronger treatment effect.

ACCUMULATION (XI) POINTS The Accumulation points are all located between the fingers/ toes and elbows/knees, with the exception of ST-34 Liangqiu which is above the knee. The term Xi means 'crevices' and refers to the fact that the Accumulation points are located in 'crevices' where the Qi of the channel gathers and concentrates to plunge deeper from the channel's superficial layers. At these points the Qi of the channel gathers and they are used mostly in acute patterns, especially when there is pain. They are therefore primarily indicated for channel problems and are usually reduced, as they are mostly used for Excess patterns. Another characteristic of these points is that they can be used to stop bleeding, especially in acute cases and especially for the Yin channels. The Accumulation points are: - Lungs: LU-6 Kongzui -Large Intestine: L.I.-7 Wenliu - Stomach: ST-34 Liangqiu

169

- Spleen: SP-8 Diji -Heart: HE-6 Yinxi -Small Intestine: S.I.-6 Yanglao - Bladder: BL-63 Jinmen - Kidneys: KI-5 Shuiquan -Pericardium: P-4 Xlmen -Triple Burner: T.B.-7 Huizong -Gall Bladder: G.B.-36 Waiqiu - Liver: LIV-6 Zhongdu. For example, LU-6 Kongzui is frequently used for an acute attack of asthma, ST-34 Liangqiu can be used for acute epigastric pain, SP-8 Diji for acute dysmenorrhoea, BL-63 Jinmen and LIV-6 Zhongdu for acute cystitis. The clinical application of the Accumulation points is briefly as follows. - LU-6 Kongzui: important point for acute asthma and coughing of blood - L.I.-7 Wenliu: for acute or painful syndromes of the Large Intestine channel - ST-34 Liangqiu: acute and/or painful syndromes of the breast, knee pain, acute epigastric pain - SP-8 Diji: acute episode of painful periods, excessive menstrual bleeding - HE-6 Yinxi: severe heart pain (acute), bleeding - S.I.-6 Yanglao: severe pain of shoulder and scapula, eye diseases with pain - BL-63 Jinmen: painful hernia-like disorders, acute cystitis - KI-5 Shuiquan: blood in the urine, painful periods - P-4 Ximen: severe chest pain, nosebleed, vomiting of blood, coughing of blood - T.B.-7 Huizong: pain in the arm (useful in postviral fatigue syndrome) - G.B.-36 Waiq iu: pain along the Gall Bladder channel - LIV-6 Zhongdu: painful periods, excessive menstrual bleeding, painful urination. In addition, there are four Accumulation points for four of the extraordinary vessels. i.e. the Yang and Yin Stepping Vessels (Yang and Yin Qiao Mai) and the Yang and Yin Linking Vessels (Yang and Yin Wei Mai). These are: - BL-59 Fuyang for the Yang Stepping Vessel - KI-8 Jiaoxin for the Yin Stepping Vessel - G.B.-35 Ya ngjiao for the Yang Linking Vessel - KI-9 Zhubin for the Yin Linking Vessel.

170

PART 2: THE M AIN CHANN ELS

The Qi of the extraordinary vessels accumulates at these points, which makes them particularly powerful for activating the Qi of these vessels. They can be used in combination with the opening points of the extraordinary vessels. For example, the point BL-59 Fuyang is used for sciatica on the lateral side of the leg in combination with BL-62 Shenmai when there is pronounced stiffness and inability to walk properly.

SUMMARY ACCUMULATION (X/) POINTS

• Al l located between the elbows and fingers and between the knees and toes • Used for acute conditions • Used to stop pain • Used t o stop bleeding (especial ly Yin channels).

GATHERING (HUI) POINTS The Gathering (Hui) points are points that have a special influence on certain tissues, organs, energy or Blood. The Chinese character (Hui ~ ) denoting these points means 'to gather' or 'to meet' and 'to collect'. Various types of energies or tissues 'gather' or 'concentrate' at these points. The Gathering points are: -

LIV-13 Zhangmen for the Yin organs Ren-12 Zhongwan for the Yang organs Ren-17 Shanzhong for Qi BL-17 Geshu for Blood G.B.-34 Yanglingquan for sinews LU-9 Taiyuan for blood vessels BL-11 Dashu for bones G.B.-39 Xuanzhong for Marrow.

Each of these points has a special influence on the above tissues, organs, energy or Blood. LIV-13 Zhangmen is used to affect all the Yin organs, but in particular the Spleen, and is applied for Spleen deficiency especially if accompanied by stagnation of Liver-Qi. Ren-12 Zhongwan is very frequently used to tonify Stomach and Spleen thus influencing all the Yang organs especially in digestive diseases. Ren-17 Shanzhong is used to tonify the Lungs and Heart and the Gathering Qi (Zong Qi): it is often

combined with other points to tonify Qi. Ren-17 is also a point of the Sea of Qi which is an added reason for its strong connection with Qi and particularly the Gathering Qi (Zong Qi). It can also be used to move Qi in the chest especially in emotion al problems, particularly worry and anxiety. BL-17 Geshu is used either to tonify Blood, if used only with moxa, or to invigorate Blood, if used with needle. It is also useful to move Blood locally to relieve upper backache. G.B.-34 Yanglingquan is used for weakness or stiffness of joints and Painful Obstruction Syndrome (Bi Syndrome). It is the main point to influence all sinews; for example, in contracture, stiffness or weakness of the sinews. LU-9 Taiyuan is used to tonify Lung-Qi particularly when all the pulses are deep and thin. It also stimulates the circulation as it influences the arteries and veins. BL-11 Dashu can be used for chronic arthritis to affect the bones, and for all bone diseases. It is an important point for Bone Painful Obstruction Syndrome (Bi Syndrome). G.B.-39 Xuanzhong is used to nourish Marrow and Yin in case of Wind-stroke. It is also used with moxa to prevent Wind-stroke. The above-mentioned functions of these points are only those related to their particular characteristic as Gathering points. Each of them has several other actions which may be unrelated to this particular characteristic.

SUMMARY GATHERING (HUt) POINTS

• Points that influence cert ain organs, types of Qi and tissues • The Qi of organs and tissues 'gathers' at these points.

POINTS OF THE FOUR SEAS The Four Seas are mentioned in Chapter 3 3 of the 'Spiritual Axis'. It says: 'The human body has Four Seas and 12 water channels. The water channels pour into the Seas of which there is one in the East. one in the West, one in the North and one in the South ,

CATEGORIES OF POINTS

making the Four Seas . .. there is the Sea of Marrow, Sea of Blood, Sea of Qi and Sea of Food [literally 'Water and Grain'].' 17 The symptoms and points of the Four Seas mentioned in this chapter are as follows:

Sea of Food Excess: abdominal fullness. Deficiency: hunger but no desire to eat. Points: ST-30 Qichong (upper), ST-36 Zusanli (lower).

Sea of Qi Excess: feeling of fullness of the chest, breathlessness, red face. Deficiency: shortness of breath, no desire to speak. Points: Ren-17 Shanzhong, Du-15 Yamen, Du-14 Dazhui, ST-9 Renying. Sea of Blood Excess: feeling that the body is getting larger; a sense of being unwell while being unable to pinpoint the trouble. Deficiency: feeling that the body is getting smaller; unable to pinpoint the trouble. Points: BL-11 Dashu (upper), ST-3 7 Shangjuxu and ST-39 Xiajuxu (lower).

Sea of Marrow Excess: full of vigour, great physical strength. Deficiency: dizziness, tinnitus, weak legs, blurred vision, desire to lie down. Points: Du-20 Baihui (upper), Du-16 Fengfu (lower).

SUMMARY POINTS OF THE FOUR SEAS

• Sea of Food: ST-30 Qichong (upper), ST-36 Zusanli (lower) • Sea of Qi: Ren-17 Shanzhong, Du-15 Yamen, Du-14 Dazhui, ST-9 Renyi ng • Sea of Blood: BL- 11 Dashu (upper), ST-37 Shangjuxu and ST-39 Xiajuxu (lower) • Sea of Marrow: Du-20 Baihui (upper), Du-16 Fengfu (lower).

171

W INDOW OF HEAVEN POINTS Although these points clearly form a group or 'category', they are actually not explicitly mentioned in the ancient text as a category of points. For example, modern Chinese acupuncture dictionaries have no entries for 'Window of Heaven points' . However, Chapter 21 of the 'Spiritual Axis' clearly lists some of the Window of Heaven points as a group of points with common characteristics. This chapter says: 'ST- 9 Renying is located on the artery on the side of the neck. ST-9 pertains to the leg Bright Yang channel [Stomach] and is situated in front of the muscle on the side of the neck. The point L.I.-18 Futu is on the arm Bright Yang channel [Large Intestinej located behind the muscle on the side of the neck. Nex t to it there is TB.-16 Tianyou pertaining to the an n Lesser Yang channel [Triple Burner]; still next to it is BL-10 Tianzlw of the leg Greater Yang channel [Bladder]. The channel {or blood vessel] below the axilla belongs to the arm Greater Yin [Lungs] and the point is called LU-3 Tianfu.>l 8 The same chapter then lists the symptoms for which each of these points is used: 'For headache from rebellious Yang and fullness of the chest with breathlessness, use ST-9 Renuirzg. For sudden loss of voice, use L.l. - I 8 Futu and bleed the root of tile tongue. For sudden deajizess with excess Qi, blurred vision and di111inished llenrirzg, use T B. - 16 Tianyou. /:
ST-9 Renying L.I.-18 Futu T.B.-16 Tianyou BL-1 0 Tianzhu LU-3 Tianfu are added a further five: Ren-22 Tiantu S.I.-16 Tianchuang S.I.-17 Tianrong (or G.B.-9 Tianchong) Du-16 Fengfu P-1 Tianchi.

172

PART 2: THE MAIN CHANNELS

Some doctors thought that S.I.-17 Tianrong should in fact be G.B.-9 Tianchong. This would be more logical since each of the six Yang channels would then be represented (see Fig. 10.1). With the exception of LU-3 Tianfu and P-1 Tianchi, all the points are on the neck, which confirms the nature of these points as 'gateways' of Qi between the head and the body. Seven out of these ten points contains the word 'Heaven' (Tian) in their name. The Windows of Heaven points have certain common characteristics and actions. The main common action is that of regulating the ascending and descending of Qi to and from the head. All the Windows of Heaven points except two (P-1 and LU-3) are situated on the neck, which is the strategic crossroads of Qi between the head and the torso. These points can therefore be used when there is an imbalance of Qi between the head and the body with too much Qi or too little Qi in the head. Too much Qi in the head is generally due to rebellious Qi rushing upwards and these points are widely used to subdue rebellious Qi from the head. ST-9 Renying is probably the best example of this action. Most of the Windows of Heaven points subdue rebellious Qi from the head, which can manifest in Lung-Qi, Stomach-Qi and Liver-Qi especially. The following is a brief list of the indications of the Windows of Heaven points related to subduing rebellious Qi. - ST-9 Renying: rebellious Lung-Qi (fullness of chest, breathlessness), rebellious Stomach-Qi (vomiting), rebellious Liver-Qi (headache, dizziness) - L.I.-18 Futu: rebellious Lung-Qi (cough, wheezing) - T.B.-16 Tianyou: rebellious Liver-Qi (headache, dizziness) - BL-10 Tianzhu: rebellious Liver-Qi (headache. dizziness) - LU-3 Tianfu: rebellious Lung-Qi (cough, wheezing, breathlessness) - Ren-22 Tiantu: rebellious Lung-Qi (cough, fullness of chest, breathlessness), rebellious Stomach-Qi (vomiting) - S.I.-16 Tianchuang: rebellious Liver-Qi (headache) - S.I.-17 Tianrong: rebellious Lung-Qi (cough. wheezing. breathlessness), rebellious Stomach-Qi (vomiting) - Du-16 Fengfu: rebellious Lung-Qi (breathlessness), rebellious Stomach-Qi (vomiting), rebellious Liver-Qi (headache. dizziness. head Wind)

a

r b Fig. 10.1 Window of Heaven points.

CATEGORIES OF POINTS

- P-1 Tianchi: rebellious Lung-Qi (cough, fullness of chest, breathlessness), rebellious Liver-Qi (headache). By virtue of their capacity to subdue rebellious Qi from the head, many of the Windows of Heaven points have a mental-emotional effect especially in anxiety, insomnia and mental restlessness that derives from an upward rush of Qi, e.g. in Liver-Yang rising, Liver-Fire, Heart-Fire, Kidney Empty Heat, etc. As they regulate the ascending and descending of Qi to and from the head, these points can also do the opposite. i.e. promote the rising of clear Yang to the head. The rising of clear Yang to the head will brighten the sense orifices (ears, eyes, nose, mouth) and the Mind's orifices. The points can therefore be used to open the Mind's orifices in people with slight manic behaviour, obsessions, confused thinking, confusion about life's issues, etc. An excellent source of information on the nature and functions of the Windows of Heaven points is Deadman & AI Khafaji's ~Manual of Acupuncture'. 21

SUMMARY WINDOWS OF HEAVEN POINTS • All bar two situated on the neck • Regulate the ascending and descending of Qi to and from the neck • Used for imbalances of Qi between the head and the body • Subdue rebellious Qi from the head • Calm the Mind by subduing rebellious Qi • They can also promote the rising of clear Qi to the head .

12 HEAVENLY STAR POI NTS OF MA DAN YANG The 12 Heavenly Star points were listed by Ma Dan Yang (1123-1183) during the Jin dynasty. He considered them to be the body's most important points, capable of treating most diseases and all parts of the body. They are certainly important points all of which are widely used in practice {with the possible

173

exception of BL-5 7 Chengshan). The 12 Heavenly Star points are: -

ST-36 Zusanli ST-44 Neiting L.I.-11 Quchi L.I.-4 Hegu BL-40 Weizhong BL-5 7 Chengshan LIV-3 Taichong BL-60 Kunlun G.B.-30 Huantiao G.B.-34 Yanglingquan HE-5 Tongli LU-7 Lieque.

MaDan Yang lists these points in couples as follows: -

ST-36 and ST-44 L.I.-11 and L.I.-4 BL-40 and BL-57 LIV-3 and BL-60 G.B.-30 and G.B.-34 HE-5 and LU-7.

Ma Dan Yang says about the combination of these pairs of points: 'Wilen appropriate, combine the points in pairs [e. g. ST-36 mzd ST-44); wlm zappropriate, to block Ipathogenic factors [ use one. ' 22

SUN 51 MIAO'S 13 GHOST PO INTS The Ghost points were formulated by Sun Si Miao in his '1000 Golden Ducats Prescriptions' (Qian fin Yao Fang, AD 652). 23 These points were used for severe mental illness such as manic-depression or psychosis. The points are listed in Table 10.3. Sun Si Miao's instructions were to needle left side first in men and right side first in women and withdraw them in the reverse order. Use one point at a time in succession. The points Ren-1 and Yu Men are not needled but direct moxa cones are applied to them.

POINTS OF THE EYE SYSTEM (MU XI) The Eye System (Mu Xi) is described in Chapter 80 of the 'Spiritual Axis', which says: 'The Essence and Qi of tlze five Yin and six Yang organs ascends to tlze eyes to give claritu of vision . .. it comznwzicates with many channels

174

PART 2: THE MAIN CHANNELS

Table 10.3

Sun Si Miao's 13 Ghost points

Point

Name

Alternative name

Translation

Chinese

Du-26

Renzhong

Gui Gong

Ghost Palace

.!lg

LU-11

Shaoshang

Gui Xin

Ghost True (Believe)

.!lilli

SP-1

Yinbai

Gui Yan

Ghost Eye

.!l n~

P-7

Daling

Gui Xin

Ghost Heart

.!l•L'

BL-62

Shenmai

Gui Lu

Ghost Road

.!llm

Du-16

Fengfu

Gui Zhen

Ghost Pillow

.!lf:t

ST-6

Jiache

Gui Chuang

Ghost Bed

.!l}}f:

Ren-24

Chengjiang

Gui Shi

Ghost Market

.!liP

P-8

Laogong

Gui Ku

Ghost Cave

~lli

Du-23

Shangxing

Gui Tang

Ghost Hall

.!l:iil:

Ren-1

Huiyin

GuiCang

Ghost Hidden

.!lii:

Extra

Yu Men

Gui Cang

Ghost Hidden

~ii:

U-11

Quchi

Gui Chen

Ghost Minister

~~

Extra

Hai Quan

Gui Feng

Ghost Seal

.!l1~

constituting an 'Eye System' which ascends to tile vertex and enters the brain, to then swjace at tile occiput. Tl!erefore, when pathogenic factors enter the occiput (due to a deficiency of Blood), they penetrate this pathway to the Eye System into the Brain. This causes the brain to "revolve" and brings about a tightness of the Eye System.' 24 The Eye System is closely connected to the Yang channels of the face: indeed, four Yang channels begin or end around the orbit of the eye, i.e. Bladder, Stomach, Triple Burner and Gall Bladder. Through the Eye System, these four Yang channels enter the brain, even though the Main channels are not described as doing so. Indeed, many modern Chinese books translate 'Eye System' as 'optic nerve'. Although this is a reductionist view, the Eye System certainly influences the· optic nerve; an important implication of this is that treatment of these four Yang channels is essential to treat pathologies of the optic nerve. Another implication of the Eye Sysoom is that the beginning and end points of these four Yang channels,

i.e. BL-1 Jingming, ST-1 Chengqi, T.B.-2 3 Sizhukong, and G.B.-1 Tongziliao, all influence the brain, the hypothalamus and the pituitary gland. The connection between these points and the brain explains their use in various pathologies, such as dizziness, tinnitus and mental--emotional problems. Three groups of points, all from Yang channels, influence the Eye System and they are as follows: 1. Periorbital: BL-1 Jingming, BL-2 Zanzhu. G.B.-1

Tonziliao, T.B.-23 Sizhukong, ST-1 Chengqi, Yuyao (extra point in the middle of the eyebrow) 2. Temporal: G.B.-4 Hanyan, G.B.-5 Xuanlu, G.B.-6 Xuanli, G.B.-7 Qubin. (G.B.-5 is the most important as it is in direct connection with the brain), ST-8 Touwei 3. Occipital: Du-16 Fengfu, BL-10 Tianzhu and G.B.-20 Fengfu. At these points the Eye System enters the Brain, the points can be used for brain disorders, neurological

CATEGORIES OF POINTS

SUMMARY THE EYE SYSTEM

• Starts from the eye • It is connected to the channels of Bladder, Stomach, Triple Burner, Gall Bladder around the eye • Communicates with the Brain • Emerges at the occiput • It crosses three Yang channels, i.e. the Governing Vessel, Bladder and Gall Bladder, on the occiput • Is connected to the extraordinary vessels (Governing Vessel, Yin and Yang Stepping Vessels and the Yang Linking Vessel) • Its points are used for neurological, brain and mental disorders. Points of the Eye System

• • • • • • • • • • • • • •

BL-1 Jingming BL-2 Zanzhu G.B.-1 Tonziliao T.B.-23 Sizhukong ST-1 Chengqi Yuyao (extra point in the middle of the eyebrow) G.B.-4 Hanyan G.B.-5 Xuanlu G.B.-6 Xuanli G.B.-7 Qubin (GB-5 is the most important as it is in direct connection with brain) ST-8 Touwei Du-16 Fengfu BL-1 0 Tianzhu G.B.-20 Fengfu.

disorders and mental illness (such as epilepsy, convulsions, mental illness). The Eigh t Extraordinary Vessels, especially the Governing Vessel, Yin and Yang Stepping Vessels and the Yang Linking Vessel, enter the Brain and connect with the Eye System.

175

FIVE COMMAND POINTS The Five Command points are those points that have the strongest and most general influence on a specific area. The Five Command points are: 1. ST-36 Zusanli for the abdomen 2. BL-40 Weizhong for the back 3. LU-7 Lieque for the head 4. L.I.-4 Hegu for the face 5. P-6 Neiguan for the chest.

NOTES 1. 1981 Spiritual Axis (Ling Shu jing JR.~~£ ) . People's Health Publishing House. Beijing. first published c. 100 BC. p.3. 2. lbid.. p.3. 3. Ibid.. p. 4. 4. Ibid.. p. 4-8. 5. Nanjing College of Traditional Chinese Medicine 1979 A Revised Explanation of the Classic of Difficulties (Na11 /ing ]iao Shi ;£ ~ ~ ). People's Health Publishing Houst. Beijing. first published c. AD 100. p. 143. 6. Ibid.. p. 144. 7. For a detailed description of the Connecting channels pathways. see Chapter 12. 8. Spiritual Axis. p. 50. 9. Heilongjiang Province National Medical Research Group 1984 An Explanation of the Great Compendium of Acupuncture (Zhen Jiu Da Cheng Jiao Shi H ~ :;1;: PX; f-'1 ~ ). People's Health Publishing House. Beijing. p. 627-636. The Great Compendium of Acu puncture itself. by Yang ji Zh ou was first published in 1601. 10. Ibid .. p. 37-39. 11. Ibid .. p. 39. 12. Ibid .. p. 100. 13. 1979 The Yellow Emperor's Classic of Interna l Medicine- Simple Questions (Huang Di Nei ]ing Su Wen jf 'Iii' pg ~ IDJ ). People's Health Publishing House. Beijing, first published c. 100 BC. p. 303- 312. 14. Classic of DiiTiculties. p. 146. 15. Spiritual Axis. p. 100. 16. Yue Ha n Zhen 1990 An Explanation of the Acupuncture Points Uing Xue ]ie ;£ 1\. M ). People's Hea lth Publishing House. Beijing. Origina lly published in 1654. p. 211. l 7. Spiritual Axis. p. 73. 18. Ibid., p. 56. 19. Ibid .. p. 56. 20. Ibid .. p. 7. 2 1. Deadman P. Al-Khafaji M 1998 A Manual of Acupuncture. journal of Chinese Medicine Publications. Hove. Engla nd. p. 48-50. 22. Cited in Cheng Bao Shu 1988 Great Dictio nary of Acupuncture (Zhen ]iu Da Ci Dia11 H ~ :;1;: !$Jill ). Beijing Science Publishi ng House. Beijing. p. 162. 2 3. Su n Si Miao 1982 Thousand Golden Ducats Prescriptions (Qianjin Yao Fang 'f 1ft~ People's Health Publishing House, Beijing. The Thousa nd Golden Ducats was written in AD 652. p. 327. 25. Spiritual Axis. p. 151.

*

*

n ).

CHAPTER 11

THE COMBINATION OF ACUPUNCTURE POINTS BALANCING DISTAL AND LOCAL POINTS 180 BALANCING ARM AND LEG POINTS 182 Greater Yang 183 Bright Yang 184 Lesser Yang 184 Greater Yin 184 Lesser Yin 184 Terminal Yin 185 Yin and Yang channels 185

2. 3. 4. 5.

BALANCING YIN AND YANG POINTS 186 Balancing points of externally- internally paired channels 187 Balancing unrelated Yin and Yang channe ls 188 Balancing of Connecting (Luo) and Source (Yuan) points 189 Balancing Yin and Yang according to Heavenly Stems 189 BALANCING BACK AND FRONT POINTS 191 Balancing Back-Transporting with Front-Collecting points 191 Balancing Governing and Directing Vessels 193 BALANCING LEFT AND RIGHT POINTS 194 Arm and leg channels of the same polarity Exteriorly-interiorly related channels 198 Other channels 198 Channel problems 201 CASE HISTORIES

196

205

The art of acupuncture consists in selecting the right points and combining them in a harmonious way. A successful acupuncture treatment depends on many factors among which are: 1. A correct diagnosis ('correct' within the type of acupuncture used, be it Chinese, Korean,

Five-Element, Japanese, etc.)

A correct plan of treatment A correct choice of points A balanced combination of points The appropriate needling technique.

In this chapter I will discuss point 4 above, i.e. how points are to be combined once a correct diagnosis has been made, a proper principle of treatment has been determined and the appropriate points have been selected. Combining points in a safe, effective and harmonious way is a very important part of an acupuncture treatment. Using points according to their action brings into play the particular nature of the individual points while combining points in a harmonious way draws on the channel system as a whole, and harmonizes Yin and Yang, Top and Bottom. Left and Right, and Front and Back. 1 The feeling that the patient experiences when points are combined well is unmistakable: it may be a sense of relaxation, elation, alertness or peacefulness, or a combination of all of these. Ideally, the patient should experience one or more of the above feelings during and after every treatment. If points are combined well the patient may feel during treatment as if they are connected among themselves and a needling sensation propagates from one to another. One particular patient said that the points 'felt as if forming a circle, as if they were connected'. Another felt as if 'a cool liquid was moving into her hands'. Another patient said that during the session she went 'into a very deep space'. As for the feeling experienced after an acupuncture treatment, this is described by patients in many different ways: 'I feel brighter', 'I feel deeply relaxed', 'I feel more awake', 'I feel like I bad a shower', 'I feel more grounded', 'I feel spaced out', 'I feel like I have been 177

178

PART 2: THE MAIN CHANNELS

plugged in', 'I feel very light', 'I feel very heavy', 'I feel like I am floating', 'I feel like giggling', 'I feel euphoric', 'I feel like I could dance', etc. The above are examples of actual expressions used by my patients. In order to observe the patient's reactions and sensations during the treatment, it is important to see one patient at a time or, at least, to allow for spending enough time with each patient; otherwise we will miss their reactions and comments and we will not be able to learn as much. I observe the patient while the needles are retained and, when necessary, I will occasionally change the point combinations during the treatment. In a few, unusual cases it is necessary to observe patients very closely during the treatment as their reactions change very rapidly. Case history 11.1 During an acupuncture session I observed that a patient whom I knew was normally very relaxed during the treatment, on this occasion looked slightly uncomfortable and restless. I asked her about this and she said she felt a sensation of constriction in the chest and throat. On examining the point prescription used I came to the conclusion that it was unbalanced in so far as all the points were on the legs and torso with none on the arms: on my inserting P-6 Neiguan and withdrawing Ren-12 Zhongwan, her feeling of constriction in the chest and throat disappeared within seconds.

Case history 11.2 A patient who was being treated for postviral fatigue syndrome said that her head cleared almost immediately during the acupuncture session and she felt brighter in general: this feeling came over her in a wave but disappeared after only a few minutes, being replaced by a sense of general tiredness and heaviness. On my inserting Du-20 Baihui, the wave of well-being returned, only to disappear again after a few minutes. During subsequent sessions I therefore decided to follow her sensations very closely: I wit hdrew the needles shortly after the wave of wellbeing appeared. This approach produced much better results in this case.

There are of course very many ways of choosing points: according to the Five Elements, according to pathogenic factors, according to seasons, according to tenderness, according to the theory of open points,

according to their actions, according to indications, according to the theory of the Five Transporting (Shu) points, and many others. Furthermore, there are many national variations in the style of acupuncture so that, for example, Japanese or Korean acupuncture is quite different from Chinese acupuncture. However, it could be said that all the different ways of choosing points can be narrowed down to two basic variations: selecting a point according to its particular action, function, nature or quality, or selecting a point according to its position and dynamics within the channel system.

All the different ways of choosing points can be narrow ed down to tw o basic variations: selecting a point accord ing to its particular action, f unction, nature or quality, or select ing a point according to its posit ion and dynamics w ithin the channel system.

The former approach emphasizes the role of the point in isolation from the channels, while the latter emphasizes the role of the point within the channel system. For example, one can use UV-2 Xingjian for its action of draining Liver-Fire, or as a 'sedation' point according to the Five Elements: this approach relies on an intrinsic quality of LIV-2 in draining Fire or in sedating the Liver ('because' it is the Fire point). Alternatively, one can select LIV-2 to draw Qi downwards within the Liver channel: this approach makes use of the point's dynamics within the channel. When LIV-2 is used in this way to draw Qi downwards, the fact that it is the Fire point is irrelevant, as the point is seen not in isolation but in relation to the channel's f1ow of Qi. The Chinese stress on needle manipulation (present in all acupuncture classics) is based on viewing points in isolation, e.g. ST-40 Fenglong (needled with reducing method) to resolve Phlegm or LIV-2 Xingjian to drain Liver-Fire. Over the years I have developed a style of treatment that emphasizes the role of the points within the Qi dynamics in the channels and the harmonious combination of points: in my own experience, when the combination of points is balanced, it will automatically bring into play the f1ow of Qi in the channel system achieving therapeutic results

THE COMBINATION OF ACUPUNCTURE POINTS

without the need for very strong manipulation of individual points. In other words, instead of strongly manipulating separate points, if the combination of points is right we may let the channel system 'do the work'. That is not to say, however, that the manipulation of needles is not important.

If the points are selected carefully according to channel dynamics and the combination of points is harmonious, the channel system, rather than individual points will, 'do the work' .

These two ways of looking at a point, in isolation or in relation to the channel's flow of Qi, have developed in parallel ever since the very early times of Chinese medicine. In fact, whereas the 'Yellow Emperor's Classic of Internal Medicine' (c. 100 sc) mentions at least 160 points and often refers to their 'action', the early Han dynasty's text 'Prescriptions for 52 Diseases'. excavated from Ma Wang Dui's tomb, does not mention points at all, only channels. To look at a point in isolation and to look at it in relation to the flow of Qi within the channel are not mutually exclusive methods; indeed, the best results are obtained when the two approaches are combined. For example, returning to the above instance, if we wanted to draw Qi downwards within the Liver channel, we could select LIV-1 Dadun, LIV-2 Xingjian or LIV-3 Taichong with equally good results. If the patient has symptoms of Liver-Fire, then LIV-2 is the best choice: by selecting this point we are combining the two approaches, i.e. seeing the point in isolation ('LIV-2 drains Liver-Fire'), and seeing a point's action within the flow of Qi in the channel (i.e. LIV-2 draws Qi downwards not because of a special quality but because of its position within the channel). In fact, it is good if there is more than one reason for selecting a point: this will make the treatment more powerful and will allow a reduction in the number of points used. However, selecting a point according to its en.ergetic action and its dynamics within the channel's flow of Qi needs to be integrated with yet other factors. One of these is selecting the point according to its target area. Most distal points affect a certain area and this

179

needs to be taken into account, especially when treating pain. For example, to return to the three points mentioned above, LIV-1 , LIV-2 and LIV-3 all stimulate the downward flow of Qi within the Liver channel, but they affect different areas: LIV-1 affects the Lower Burner (particularly urinary passages), LIV-2 affects the eyes and LIV-3 affects the top of the head or the face. Thus, if we are using the Liver channel to treat a Liver-related eye problem, LIV-2 would be the best point to use. If, moreover, the patient's eye problem is caused by Liver-Fire, there is an additional reason for choosing LIV-2 as it drains Liver-Fire. Thus, in this example, we are using LIV-2 for three different reasons related to three different viewpoints: -because it stimulates the downward movement of Qi within the Liver channel - because it affects the eyes - because it drains Liver-Fire. Finally, selecting a point according to the above criteria is still not enough. The next and final step is to combine different acupuncture points from different channels in a harmonious, effective, safe and powerful way. To return to the above example of a patient with an eye problem from Liver-Fire, using LIV-2 only may not be enough: we may need to combine it with other points. This may be necessary either to balance LIV-2 energetically or to treat another symptom. For example, if the patient, besides having an eye problem from Liver-Fire, also suffers from dry mouth and restless sleep from the same cause, we may combine LIV-2 with L.I.-4 Hegu. This combination would be particularly desirable for several reasons: 1. From the point of view of energetic action, L.I.-4 calms the Mind. 2. From the point of view of target area, L.I.-4 affects the mouth, thus relieving thirst and dry mouth. 3. From the point of view of channel dynamics, L.I.-4 also draws Qi downwards. 4. From the point of view of combination of points, L.I.-4 combines well with LIV-2 for three reasons: a. they combine Top and Bottom b. they combine Yin and Yang c. they combine two heavenly stems (this will be explained later).

180

PART 2: THE MAIN CHANNELS

SUMMARY THE FOUR FUNDAMENTAL FACTORS GUIDING THE CHOICE OF POINTS

• The energetic action of the point (e.g. draining Liver-Fire) or its quality (e.g. 'sedation point') • The dynamics of the flow of Qi in the channel (e.g. drawing Qi downwards) • The target area of the body affected by the point • The combination of points from different channels.

Thus, to summarize, there are basically four different factors in the selection of points: 1. The energetic action of the point (e.g. draining

Liver-Fire) or its quality (e.g. 'sedation point') 2. The dynamics of the flow of Qi in the channel (e.g. drawing Qi downwards) 3. The area of the body affected by the point 4. The combination of points from different channels. Point 1 above has already been discussed in the 'Foundations of Chinese Medicine' and will not be repeated here. 2 Points 2, 3 and 4 will be discussed in detail below.

Rising and descending of Qi Before discussing the principles governing the combination of points, it is useful to consider the rising and descending of Qi in each channel. An awareness of the rising and descending movement of Qi in the channels is essential to give a balanced acupuncture treatment. Many pathological conditions are due to a derangement in the direction of movement of Qi. The Qi of certain organs naturally descends while that of others naturally ascends. Organs whose Qi descends are the Stomach, Lungs, Heart and Kidneys: the only organ whose Qi normally ascends is the Spleen. The Liver is different: in so far as its Qi spreads in all directions, it may be said, from some points of view, to ascend. If Qi ascends when it should descend or vice versa. it is called 'rebellious Qi'. Symptoms of rebellious Qi in each organ are as follows:

-Stomach: hiccups, belching, nausea, vomiting, sour regurgitation

-Lungs: cough, breathlessness, asthma

-Heart: palpitations, bitter taste, anxiety, breathlessness - Kidneys: asthma, urinary retention - Spleen: loose stools, diarrhoea, prolapse of an organ, dragging-down sensation - Liver: headaches, dizziness, tinnitus, irritability, bitter taste, shouting, sighing, hypoch ondria\ distension and pain, abdominal pain, hypogastric distension and pain. The main points which stimulate the descending of Qi in each channel are:

- Stomach: Ren-13 Shangwan, Ren-10 Xiawan, ST-34 Liangqiu, ST-44 Neiting, ST-45 Lidui, L.I.-4 Hegu -Lungs: LU-7 Lieque. LU-5 Chize, LU-1 Zhongfu -Heart: HE-5 Tongli, HE-8 Shaofu, HE-9 Shaochong, Ren-15 Jiuwei -Kidneys: KI-7 Fuliu, KI-1 Yongquan, Ren-4 Guanyuan - Liver: LIV-14 Qimen, LIV-3 Taichong, LIV-2 Xingjian, LIV-1 Dadun. The main points which stimulate the ascending of Qi of the Spleen are: - Ren-12 Zhongwan, Ren-6 Qihai, Du-20 Baihui, BL-20 Pishu. As mentioned above, a correct and harmonious combination of points in one treatment is an essential part of the art of acupuncture. If we choose points only according to their actions, even if our choice is correct from that point of view, it will not be enough to give a balanced treatment.

BALANCING DISTAL AND LOCAL POINTS Barring some exceptions (when distal points are on the upper part of the body) distal points are on the arms below the elbows and on the legs below the knees. When compared with such distal points, local points, which are simply those where the problem is situated. can obviously be in any part of the body, but in general terms they are on the head and trunk (see Ch. 8). For example, in a case of facial pain, L.I.-4 Hegu is a distal point and ST-6 Jiache a local one: however, in a case of pain in the index finger, then L.I.-4 Hegu is a local point.

THE COMBINATION OF ACU PUNCTURE POINTS

Being on the lower arm and leg, distal points are more dynamic than the local points on the trunk. Whilst distal points should always be used both in acute and in chronic cases, local points need not be used in every case. The most common approach, however, is to combine distal with local points. In acute cases, the distal points have the effect of removing obstructions from the channel and expelling pathogenic factors and they are therefore usually needled with reducing method. The local points have the function of supporting the eliminating action of the distal points and focusing it on the desired area: they are usually needled with even method. For example, in treating an acute sprain of the lower back with bilateral pain there, one might choose BL-40 Weizhong as a distal point (needled with reducing method) and BL-26 Guanyuanshu as a local point (needled with even method). Sometimes distal points are needled before inserting the local ones. For example, ST-38 Tiaokou is inserted first and needled with reducing method for paln and rigidity of the shoulder. To give another example, in acute sprain of the lower back with pain on the midline, the distal point Du-26 Renzhong is selected and manipulated vigorously before inserting the local points.

CLINICAL NOTE

EXAMPLES OF DISTAL POINTS IN ACUTE CONDITIONS In acutely painful conditions, distal points are often inserted first and manipulated with a strong reducing method; often, the patient is asked to move the affected joint gently while the distal point is manipulated. • ST-38 Tiaokou for acute pain and rigidity of the shoulder joint ('frozen shoulder') along the Large Intestine channel • BL-58 Feiyang for acute pain and rigidity of the shoulder joint ('frozen shoulder') along the Small Intestine channel • G.B.-34 Yanglingquan for acute pain and rigidity of the shoulder joint ('frozen shoulder') along the Triple Burner channel • G.B.-39 Xuanzhong (or extra point Juegu) for acute pain and rigidity of the neck • Du-26 Renzhong for acute lumbar sprain with pain and rigidity of the lumbar spine.

181

In chronic cases, distal and local points simply reinforce each other's function. In Full, chronic conditions, the distal points remove obstructions from the channel and the local points direct the distal points' action to a specific area. In Empty, chronic conditions, the distal and local points simply reinforce each other's function. The following is a list of the main distal and local points according to areas (Table 11.1). This table lists points (rom different channels and the choice of which point to use has to be guided by other factors, chiefly a proper identification of the channel involved. It should be borne in mind that this table lists only the main distal and local points for each area according to my experience: obviously, other practitioners will draw on their own experience and other points can also be used. As mentioned above, the points in Table ll.l above are from different channels and their choice has to be further guided by the identification of patterns and channel involved. For example, two of the distal points indicated for the throat are LU-ll Shaoshang and KI-6 Zhaohai: LU-ll would be selected in sore throat from acute invasions of Wind-Heat, whereas KI-6 would be chosen for a dry throat from Yin deficiency. As another example, the distal points indicated in the table for the Heart are P-4 Ximen, P-5 Jianshi, P-6 Neiguan and HE-7 Shenmen: P-4 would be chosen if there were an irregular heartbeat, P-5 if Phlegm were obstructing the Heart, P-6 in Heart-Qi deficiency, and HE-7 for Heart-Blood deficiency.

SUMMARY BALANCING DISTAL AND LOCAL POINTS • With few exceptions, distal points are below the elbows and knees • The most common method is to combine distal with local points • In acute cases, distal points remove obstructions from the channel and local points direct Qi to the area • In chronic problems, distal and local point s reinforce each other in regulating Qi in the channel • Choice of a distal point has to be guided by two factors: the channel involved and the pattern.

182

PART 2: THE MAIN CHANNELS

Table 11.1

Distal and local points according to areas

Area/organ

Local points

Distal points

Face

Yintang, ST-7 Xiaguan, ST-6 Jiache

L.l.-4 Hegu, ST-44 Neiting

Temples

Taiyang, G.B.-8 Shuaigu

T.B.-3 Zhongzhu, T.B.-5 Waiguan, G.B.-43 Xiaxi

Occiput

G.B.-20 Fengchi, BL-1 0 Tianshu

S.l.-3 Houxi, BL-65 Shugu

Vertex

Du-20 Baihui

LIV-3 Taichong

Eye

BL-1 Jingming, ST-1 Chengqi, Yuyao

L.l.-4 Hegu, LIV-2 Taichong, HE-5 Tongli, S.l.-6 Yanglao, T.B.-3 Zhongzhu

Nose

Yintang, L.l .-20 Yingxiang, Bitong

LU-7 Lieque, L.l .-4 Hegu

Teeth

ST-4 Dicang, ST-6 Jiache, ST-7 Xiaguan

L.l.-4 Hegu (upper), ST-44 Neiting (lower)

Ear

T.B.-17 Yifeng, S.l.-19 Tinggong, G.B.-2 Tinghui, T.B.-21 Ermen

T.B.-2 Yemen , T.B.-3 Zhongzhu, T.B.-5 Waiguan, G.B.-43 Xiaxi

Tongue

Ren-23 Lianquan

P-8 Laogong, HE-5 Tongli, Kl-6 Zhaohai

Throat

Ren-22 Tiantu

L.l.-4 Hegu, LU-11 Shaoshang, Kl-6 Zhaohai

Lungs

LU-1 Zhongfu, BL-13 Feishu, Ren-17 Shanzhong, Ren-22 Shanzhong

LU-7 Lieque, LU-5 Chize

Heart

BL-15 Xinshu, BL-14 Jueyinshu, Ren-14 Juque, Ren-15 Jiuwei

P-6 Neiguan, HE-7 Shenmen, P-5 Jianshi, P-4 Ximen

Stomach

BL-21 Weishu, Ren-12 Zhongwan

P-6 Neiguan, ST-36 Zusanli, SP-4 Gongsun

Liver

BL- 18 Ganshu, LIV-14 Qimen

LIV-3 Taichong, G.B.-34 Yanglingquan

Gall Bladder

G.B.-19 Danshu, G.B.-24 Riyue

G.B.-34 Yanglingquan, Dannangxue

Intestines

BL-25 Dachangshu, ST-25 Tianshu

ST-36 Zusanli , SP-6 Sanyinjiao, ST-37 Shangj uxu, ST-39 Xiajuxu

Bladder

Ren-3 Zhongji, BL-28 Pangkuangshu, Ren-2 Qugu, BL-32 Ciliao

SP-6 Sanyinjiao, BL-63 Jinmen

Urethra

Ren-2 Qugu, BL-34 Xialiao

LIV-5 Ligou, BL-63 Jinmen

Anus

Du-1 Changqiang, BL-54 Zhibian, G.B.-30 Huantiao

BL-57 Chengshan, BL-58 Feiyang

BALANCING ARM AND LEG POINTS Arm and leg points can be balanced using the following channels: a. Greater Yang b. Bright Yang c. Lesser Yang

d. Greater Yin e. Lesser Yin f. Terminal Yin g. Yin and Yang channels. Balancing arm and leg channels is an importan t part of a harmonious acupuncture treatment. When we insert a needle in the body there is an initial rush of

THE COMBINATION OF ACU PUNCTURE POINTS

Qi upwards: for this reason, a proper balance of points on the upper and lower parts of the body ensures a smooth flow of Qi during the treatment. The reason for the initial upwards rush of Qi when we insert a needle is probably due to the fact that three types of channels all flow from the extremities to the head, i.e. the Muscle and Divergent channels and the Extraordinary Vessels. Also, as we have seen, the first two channels in a four-channel cycle (the arm channels) have a rising potential energy, while the second two channels (the leg channels) have a decreasing potential energy. Thus, the balancing of points from the arm and leg channels achieves an equalization of flow of Qi in the channels and regulates the ascending and descending of Qi. The importance of balancing points of arm and leg channels is illustrated by the example given below. In asthma, it is especially important to balance leg with arm points and pay attention to using enough arm points. This is because all points send an initial rush of Qi upwards and the 'column' of Qi rushing upwards is that much higher in leg points.

Case history 11.3 An asthmatic patient felt a tightness of the chest during the session. The points used were LU-7 Lieque on the right, Kl-6 Zhaohai on the left (Directing Vessel's opening points), ST-40 Fenglong and SP-6 Sanyinjiao bilaterally. I concluded that not enough arm points were being used; on insertion of P-6 Neiguan the tight feeling in the chest cleared immediately.

Arm and leg Yang channels Because the Yang channels are joined directly and superficially, the arm channel and the leg channel within each cycle could be considered as forming one channel. e.g. Large Intestine and Stomach (Bright Yang), Small Intestine and Bladder (Greater Yang) and Triple Burner and Gall Bladder channels (Lesser Yang). This means that the points on the related Yang channels are somewhat interchangeable and they affect a common area covered by the two channels. For example, the points L.I.-4 Hegu and ST-44 Neiting affect the face, gums and mouth. Other examples are given below.

183

Because the Yang channels communicate directly and superficially on the head, with one arm channel flowing upwards (e.g. Large Intestine) and one leg channel flowing downwards (e.g. Stomach), their points are particularly good to harmonize Above and Below and to regulate the ascending and descending of Qi. For example, L.I.-4 Hegu regulates the ascending and descending of Qi, especially in combination with ST-36 Zusanli. Another example is the combination of T.B.-6 Zhigou and G.B.-34 Yanglingquan to harmonize the Lesser Yang and regulate the ascending and descending in the Three Burners and the combination of S.I.-3 Houxi and BL-62 Shenmai to harmonize the Greater Yang channels in the back. The leg channels' distal points are stronger than the arm channels' distal points. This is because the former are at a stage of the cycle when Qi is flowing downwards towards the area of minimum potential; these points therefore have a stronger downwarddrawing movement and are more powerful than the arm channels' distal points. For example, if one were treating a problem of the gums or mouth (be it gum ulcers, toothache, herpes simplex, etc.), one could use L.I.-4 Hegu or ST-44 Neiting: the latter point has a stronger effect than the former. Of course, one can also use both points to have an even stronger effect. The close connection between paired Yang channels of arm and leg, and the fact that they affect a common area, makes for many possible combinations of points which harmonize Top and Bottom. The following combinations, aU of which harmonize the rising and descending of Qi, are given as examples:

Greater Yang (Small Intestine and Bladder) - S.I.-3 Houxi and BL-60 Kunlun: to harmonize the rising and descending of Qi and expel Wind: this combination affects the upper back, the back of the neck and the occiput. - S.l.-6 Yanglao and BL-66 Tonggu: to harmonize the rising and descending of Qi and expel Wind from the Greater-Yang channels: this combination affects the eyes. - S.l.-2 Qiangu and BL-66 Tonggu: this combination affects the knees especially when they are affected by Damp-Heat. - S.I.-4 Wangu and BL-64 ]inggu: this combination affects the bladder.

184

PART 2: THE MAIN CHANNELS

Bright Yang (Large Intestine and Stomach)

- T.B.-6 Zhigou and G.B.-41 Zulinqi: this combination affects the breast.

- L.I.-4 Hegu and ST-36 Zusanli: to harmonize the rising and descending of Qi and to regulate digestion; this combination affects the Stomach and epigastrium. It is particularly indicated when rebellious Stomach-Qi occurs against a background of Stomach deficiency. - L.I.-4 Hegu and ST-44 Neiting: to harmonize the rising and descending of Qi: this combination affects the face, gums and mouth. This combination is particularly indicated in Full conditions. - L.I.-10 Slwusanli and ST-36 Zusanli: to harmonize the rising and descending of Qi and to strengthen the Bright Yang channels: this combination has a general tonic effect (as L.I.-10 has a tonic effect somewhat sin1ilar to ST-36) and invigorates the channels. It is good to invigorate the channels in postviral fatigue syndrome and Atrophy (Wei) Syndrome. - L.I.-11 Quchi and ST-43 Xiangu: to benefit sinews and expel Wind-Damp-Heat in Heat Painful Obstruction (Bi) Syndrome.

The combination of points from arm and leg Yang channels is also used in the Yang Extraordinary Vessels as their opening and coupled points are all points from paired arm and leg Yang channels: -Governing Vessel (Du Mai): S.I.-3 Houxi and BL-62 Shenmai -Yang Stepping Vessel (Yang Qiao Mai): BL-62 Shenmai and S.I.-3 Houxi -Yang Linking Vessel (Yang Wei Mai): T.B.-5 Waiguan and G.B.-41 Zulinqi -Girdle Vessel (Dai Mai): G.B.-41 Zulinqi and T.B.-5 Waiguan. Obviously combining points from the arm and leg channels also applies to arm and leg Yin channels within the same cycle (e.g. Lung and Spleen) and to points from different channels. The following are examples of combinations of points from arm and leg Yin channels within the same cycle.

Greater Yin (Lungs and Spleen) lesser Yang (Triple Burner and Gall Bladder) -

-

-

-

T.B.-6 Zhigou and G. B.-3 1 Fengshi: to harmonize the Lesser Yang, expel Wind, regulate Qi and eliminate stagnation: this combination affects the sides of the body and is good for herpes zoster from Wind-Heat. T.B.-4 Yangchi and G.B.-40 Qiuxu: to harmonize the Lesser Yang channels and regulate the rising and descending of Qi. This combination affects the temples and is good for Lesser Yang headaches. It also strengthens the Gall Bladder's mental aspect, i.e. courage, determination and the capacity of making decisions. T.B.-5 Waiguan and G.B.-43 Xiaxi: these points affect the temples and subdue Liver-Yang. It is particularly indicated for headaches occurring on the Gall Bladder channel from Liver-Yang rising. T.B.-2 Ennen and G.B.-43 Xiaxi: this combination affects the ear. T. B. -6 Zhigou and G. B.-34 Yanglingquan: this combination affects the hypochondrium and costal region.

- LU-9 Taiyuan and SP-6 Sanyinjiao: to nourish Yin of the Lungs, Stomach and Spleen and moisten dryness. - LU-7 Lieque and SP-9 Yinlingquan: to open the Water passages and treat urinary retention or pain on urination. - LU-9 Taiyuan and SP-3 Taibai: to tonify Qi in general and the Original (Yuan) Qi (as these points are both Source points).

lesser Yin (Heart and Kidneys) - HE-7 Shenmen and KI-3 Taixi, both Source points: to harmonize Heart and Kidneys, nourish Heart- and Kidney-Yin and calm the Mind. - HE-6 Yinxi and KI-7 Fuliu: to harmonize Heart and Kidneys, nourish Heart-Yin and stop night-sweating. - HE-7 Shenmen and KI-9 Zhubin: to harmonize Heart and Kidneys, nourish the Kidneys, relieve oppression of the chest and calm the Mind. This combination is very calming. I use this combination particularly to promote the communication between Heart and Kidneys.

THE COMBINATION OF ACU PUNCTURE POINTS

Terminal Yin (Pericardium and Liver) - P-6 Neiguan and LIV-3 Taichong: to harmonize the Terminal Yin, move Liver-Qi, open the chest and stimulate the Ethereal Soul (when its 'coming and going' is hampered by Liver-Qi stagnation). - P-7 Daling and LIV-3 Taichong: to harmonize the Terminal Yin, calm the Mind and settle the Ethereal Soul.

-

Yin and Yang channels The following are examples of combinations of points, one from a Yang, the other from a Yin channel. - P-6 Neiguan and ST-36 Zusanli: to harmonize the Middle Burner and subdue rebellious Stomach-Qi. This combination is very effective in a variety of Stomach problems. but especially those characterized by rebellious Stomach-Qi deriving from emotional problems. It is also suitable for rebellious Stomach-Qi occurring against a background of Stomach deficiency. - L.I.-4 Hegu and LIV-3 Taichong (both Source points and called the 'Four Gates'): to harmonize Top and Bottom, regulate the ascending and descending of Qi, expel Wind from the face, calm the Mind and settle the Ethereal Soul. - T. B.-4 Yangchi and ST-42 Clwngyang: to torrify the three Burners, strengthen the Stomach and regulate the uterus. This last function is due to the Triple Burner's role as the avenue through which the Original Qi emerges from between the Kidneys (Ch. 66 of the 'Classic of Difficulties'). 3 Also. the term Chong within the name of the point ST-42 Chongyang refers to the Chong Mai, i.e. the Penetrating Vessel which emerges from the uterus, and indicates that this extraordinary vessel goes through this point. - P-6 Neiguan and ST-40 renglong: to regulate the Middle Burner, subdue rebellious Stomach-Qi, resolve Phlegm, calm the Mind and harmonize the rising and descending of Qi. This combination is excellent for Excess patterns of the Stomach characterized by rebellious Stomach-Qi and not necessarily by Phlegm. It also has a powerful calming effect and is very good in Stomach problems deriving from emotional problems. This combination relaxes the chest and can also treat sprain of the rib muscles. It may be compared with

-

-

-

185

the combination P-6 and ST-36 mentioned above: the combination of P-6 and ST-40 is better for Excess patterns, while P-6 and ST-36 is better for Deficiency patterns. L.I.-4 Hegu and LIV-2 Xingjian: to regulate the rising and descending of Qi, clear Heat, drain Fire, calm the Mind and benefit the eyes. This combination, similar in effect to the Four Gates (L.I.-4 and LIV-3), is excellent to treat eye problems deriving from Liver-Fire against a background of Liver-related emotional problems. LU-7 Lieque and BL-63 ]inmen: to open the Water passages, promote urination and stop urinary pain. This combination is used in retention of urine or Painful-Urination Syndrome with Dampness obstructing the Water passages. LU-7 Lieque and KI-7 Fuliu: to stimulate the descending of Lung-Qi and the Kidneys grasping of Qi. This combination is good to treat asthma from Lung and Kidney deficiency. HE-5 Tongli and SP-3 Taibai: to stimulate the Mind (Shen) and Intellect (Yi) and to strengthen memory and concentration. This combination is good to strengthen memory and concentration in patients with Heart- and Spleen-Blood deficiency. It may also be used to boost memory and concentration in students before an exam: in this case it should be combined with BL-15 Xinshu, BL-20 Pishu and Du-20 Baihui: this combination strengthens the Intellect (Yi) that resides in the Spleen.

Although balancing arm and leg channels is a very important part of a harmonious acupuncture treatment. there are situations when the dynamics of the channel system is exploited to draw Qi upwards or downwards by needling only the top or bottom half of the body. For example, if there is Fullness above and Emptiness below from a deficiency of Kidney-Yin and flaring up of Heart Empty Heat (red face, insomnia, anxiety, dizziness. back-ache, night-sweating, etc.), one might deliberately choose an unbalanced point prescription, i.e. only KI-1 Yongquan to draw Qi downwards and subdue Empty Heat. In contrast, in prolapse of the uterus from sinking Spleen-Qi, one might choose only a point on the top of the body, e.g. Du-20 Baihui to raise Qi. Finally, another case when balancing of Top and Bottom is not used is when one uses only a distal point in acute sprains - for example, Du-26 Renzhong for

186

PART 2: THE MAIN CHANNELS

SUMMARY BALANCING ARM AND LEG POINTS

• Balancing arm and leg points is important to balance the Upper and Lower parts of the body • Points of related Yang channels of the same quantity of energy and opposite potential energy (e.g. Sma ll Intestine and Bladder within the Greater Yang) are particularly important to balance Upper and Lower parts of the body • Distal points of related Yang channels are almost interchangeable (e.g. L.l.-4 Hegu and ST-44 Neiting) • The leg distal points are stronger than the arm ones.

acute sprain of the lower back, or ST-38 Tiaokou for acute sprain of the shoulder.

channel cycle (see Fig. 2.5), the Yin channels are the beginning and end of the cycle (e.g. Lung and Spleen channels), i.e. the phases of preparation and recuperation. The Yang channels (e.g. Large Intestine and Stomach channels) are in the middle of the cycle, i.e. the phase of activity and dispersal (Fig. 11.1). Furthermore, superficially, only the Yang channels reach the head, which is the area of maximum potential energy. In keeping with the principle that Yang corresponds to activity and Yin to inertia, the number of points in the channels reflects the nature of Yin channels as phases of preparation and recuperation, and that of Yang channels as phases of activity and dispersal: in fact, there are more than twice as many Yang points (218) as Yin points (91), excluding the Governing and Directing Vessels. If we include the points of these two extraordinary vessels, the proportion is about the same, i.e. 246 Yang against 115 Yin points. If we look at the whole cycle of 12 channels, as explained in Chapter 2 (see Figs 2.6 and 2. 7), we can

BALAN CING YIN AND YANG POINTS Balancing points according to their Yin or Yang character is very important. The Yin or Yang character of a point is related to the Yin-Yang dynamics of the channel system. As we have seen, within each four-

There are more than twice as many Yang as Yin points: this reflects the Yang nature of activity and dispersal and the Yin nature of conservation and recuperation .

YANG

YIN

ARM YIN Preparation

ARM YANG Activity

LEG YANG Dispersal

LEG YIN Recuperation

Fig. 11.1 Preparation, activity, dispersal and recuperation in the cycle of four channels.

THE COMBINATION OF ACU PUNCTURE POINTS

see that the names of Bright Yang, Lesser Yin, etc. reflect the quantity of Yin and Yang in each part of the day. Thus, there is maximu m Yin ('Greater Yin') and average Yang ('Bright Yang') energy in the first cycle (morning), maximum Yang ('Greater Yang') and minimum Yin ('Lesser Yin') energy in the middle cycle (midday), and average Yin ('Terminal Yin') and minimum Yang ('Lesser Yang') energy in the third cycle (evening). See Figures 2. 10 to 2.12. The implication of all this in practice is that it is important to balance Yin with Yang points in order to equalize the flow of Yin and Yang in the channels. As Yang points exceed Yin ones, it is especially important not to use an excessive number of Yang points without balancing them with Yin ones. Using too many Yang points may make the patient edgy and nervous, whereas using too many Yin points may make the person tired. As Yin points may be used to torrify Yang organs or energies (e.g. LU-9 Taiyuan can torrify the Defensive Qi), and Yang points can torrify Yin organs (ST-36 Zusanli to torrify the Spleen), this gives us greater freedom in the choice of points when we are trying to balance Yin and Yang. CLINICAL NOTE Using too many Yang points may make the patient edgy and nervous, whereas using too many Yin points may make the person tired .

Balancing Yin and Yang can be seen from different points of view: a. Balancing points of externally-internally paired channels b. Balancing unrelated Yin and Yang channels c. Balancing of Connecting (Luo) and Source (Yuan) points d. Balancing Yin and Yang according to Heavenly Stems.

Balancing points of externallyinternally paired channels The following are some examples of balancing of Yin and Yang points fro m externally-internally paired channels:

- LU-9 Taiyuan and L.I. -4 Hegu, both Source points, to balance Yin and Yang, torrify the Lungs,

187

strengthen the Defensive Qi. consolidate the Exterior and stop sweating. L.I.-4 Hegu in this case is used not to release the Exterior but, in combination with LU-9 Taiyuan to consolidate the Exterior. -LU-ll Shaoshang and L.I.-4 Hegu: to expel WindHeat and relieve sore throat. Contrary to the above combination, in this case, L.I.-4 Hegu is used to release the Exterior. - ST-36 Zusanli and SP-4 Gongsun: to regulate the Middle Burner and subdue rebellious Stomach-Qi in Excess patterns of the Stomach. - HE-7 Shenmen and S.I.-5 Yanggu: to nourish the Heart. calm the Mind and open the Mind's orifices. This combination is particularly good to give clarity to the Mind and help the patient to make decisions by discriminating between choices. - LIV-3 Taichong and G.B.-34 Yanglingquan: to move Liver-Qi, eliminate stagnation and stimulate the Ethereal Soul when its 'coming and going' is hampered by Liver-Qi stagnation. This combination is excellent to move Liver-Qi deriving from emotional problems and causing moodiness and depression on a mental level and distension on a physical level. - SP-8 Diji, SP-6 Sanyinjiao, ST-28 Shuidao and ST-29 Guilai: to resolve Dampness and eliminate stasis from the Lower Burner, stop pain and arrest uterine bleeding. This combination treats the gynaecological system in women especially in Full patterns. - LU-3 Tianfu and L.I.-4 Hegu: to treat epistaxis. 4 - ST-45 Lidui and SP-1 Yinbai : to calm the Mind. This combination is used for insomnia and restless sleep with nightmares. 5 - HE-6 Yinxi and S.I.-3 Houxi: to stop night-sweating from Heart-Yin deficiency. 6 - KI-8 Jiaoxin and BL-55 Heyang: to torrify Qi to hold Blood. This combination is used to stop excessive uterine bleeding from Qi deficiency.7 - G.B.-30 Huantiao, LIV-2 Xingjian and G.B.-31 Fengshi: to treat Painful Obstruction (Bi) Syndrome with pain in the lower back and legs. 8 - LU-5 Chize and L.I.-11 Quchi: to clear Lung-Heat and stimulate the descending of Lung-Qi. This combination can be used to clear Lung-Heat in acute conditions with a cough, a fever and expectoration of profuse, sticky, yellow sputum. - ST-36 Zusanli and SP-6 Sanyinjiao: to torrify Stomach- and Spleen-Qi and Qi and Blood in

188

-

-

-

PART 2: THE MAIN CHANNELS

general. Thls simple combination is excellent to torrify Qi and Blood in general, especially in women. The effect is enhanced by the use of moxa on the needles. ST-39 Xiajuxu and SP-6 Sanyinjiao: to stop lower abdominal pain. BL-63 Jimnen and KI-10 Yirzgu: to open the Water passages and stop urinary pain. This combination can be used for Damp Painful-Urination (Lin) Syndrome causing slight urinary retention and burning on urination occurring against a background of Kidney-Yin deficiency. P-6 Neiguan and T.B.-6 Zhigou: to regulate Qi, eliminate stagnation in the Three Burners, open the chest and calm the Mind. Thls combination can be used for stagnation of Liver-Qi, deriving from emotional stress and affecting the hypochondrium and chest and causing a feeling of oppression of the chest and sighing. It can also be used for sprain of the rib muscles. T.B.-3 Zlwngzhu and P-6 Neiguan: to move Qi, eliminate stagnation, open the Mind's orifices, calm the Mind and llft-the mood. This combination is very good to treat m~ntal depression and confusion deriving Crorh long-standing, suppressed emotional problems. T.B.-3 Zhongzhu and P-7 Daling: to move Qi, eliminate stagnation, open the Mind's orifices, calm the Mind, settle the Ethereal Soul and lift the mood. This combination is similar in its effect to the previous one. The main difference is that this combination is more calming whereas the previous one is more moving. G.B.-43 Xiaxi and LIV-3 Taichong: to subdue Liver-Yang. This combination is very good to treat temporal headaches from Liver-Yang: LIV-3 subdues Liver-Yang, while G.B.-43 affects the temporal area.

-

-

-

-

(

-

-

-

-

-

Balancing unrelated Yin and Yang channels The following are examples of a combination of unrelated Yin and Yang channels. - LU-9 Taiyuan and ST-36 Zusanli: to tonify Lung- and Stomach-Qi and Qi in general. The Stomach is the origin of Food Qi (Gu Qi) and the Lungs govern the Gathering Qi (Zong Qi): the

-

combination of these two channels therefore powerfully tonifies Qi. L.I.-11 Quchi and SP-10 Xuehai: to clear Heat and cool Blood. This combination is excellent to cool Blood in skin diseases. ST-36 Zusanli, KI-3 Taixi and SP-6 Sanyinjiao: to nourish Stomach- and Kidney-Yin. ST-36 Zusanli and P-6 Neiguan: to harmonize the Middle Burner and subdue rebellious Stomach-Qi: thls combination has already been mentioned in connection with balancing arm and leg channels. ST-40 Fenglong and P-6 Neiguan: to regulate the Middle Burner, subdue rebellious Stomach-Qi, resolve Phlegm, calm the Mind and harmonize the rising and descending of Qi: this combination has already been mentioned above in connection with balancing arm and leg channels. ST-40 Fenglong and P-5 Jianshi: to resolve Phlegm from the Heart, calm the Mind and open the Mind's orifices. This combination can be used when the Mind is obstructed by Phlegm and the person is confused: in severe cases thls can lead to mania or schizophrenia. SP-5 Shangqiu and G.B.-40 Qiuxu: to treat Painful Obstruction Syndrome or a sprained ankle. HE-7 Shenmen and G.B.-40 Qiuxu to torrify Qi of the Heart- and Gall Bladder, calm the Mind and strengthen the Gall Bladder's capacity for the making of decisions. This combination is particularly indicated to treat the pattern of 'deficiency of the Gall Bladder' which causes timidity, lack of decisiveness, fearfulness and insomnia. S.I.-4 Wangu and LIV-3 Taichong: to move Liver-Qi in the hypochondrium and scapula. This combination is good when stagnation of Liver-Qi causes a pain in the hypochondrium extending to the scapula. S.I.-1 Shaoze and LIV-3 Taic/wng: to move Liver-Qi in the breast. This combination is good when stagnation of Liver-Qi affects the breast causing premenstrual distension or retention of milk in nursing mothers. BL-63 Jinrnen and LIV-6 Zhongdu: to stop urinary pain related to the Liver channel. L.I.-4 Hegu and KI-7 Fuliu: to regulate sweating. This combination of points can either stimulate sweating (by reinforcing KI-7 and reducing L.l.-4)

THE COMBINATION OF ACUPUNCTURE POINTS

or stop sweating (by reinforcing L.I.-4 and reducing KI-7).

Balancing of Connecting (Luo) and Source (Yuan) points Balancing Connecting and Source points is an important aspect of the general principle of balancing Yin and Yang. This consists in selecting first the Source (Yuan) point of the channel treating the main condition (the 'Host' point) and then the Connecting (Luo) point of its related channel (the 'Guest' point), in order to boost the effect of the Source point. For example, if one is treating Lung-Yin deficiency and the Source point LU-9 Taiyuan is selected, L.I.-6 Pianli can be added to strengthen the effect of LU-9. Thus, the Source point is used as a primary point and the Connecting point as a secondary one. See also Chapter 16 on treatment of the Connecting channels. The following are some of the most important and frequently used combinations of Source and Connecting points.

- L.I.-4 Hegu and LU-7 Lieque: to restore the descending of Lung-Qi, and release or consolidate the Exterior. This combination is often used to release the Exterior in invasions of Wind-Cold. On a mental level. this combination settles the Corporeal Soul and has a releasing effect on repressed emotions. - P-6 Neiguan and T.B.-4 Yangchi: to regulate the Three Burners, move Liver-Qi and calm the Mind. This is a very good combination for moving Liver-Qi indirectly and calming the Mind. It particularly affects and relaxes the muscles of the top of the shoulders and neck and therefore relieves headaches deriving from that area. - ST-40 Fenglong and SP-3 Taibai: to torrify the Spleen and resolve Phlegm. This combination is very good especially in Stomach conditions with Phlegm; it also resolves Phlegm from the brain due to the distal position of SP-3 near the end of the channel (and therefore affecting the other extremity). - G.B.-37 Guangming and LIV-3 Taichong: to brighten the eyes in Liver patterns. - KI-4 Dazhong and BL-64 Jinggu: to treat sciatica (using BL-64 on the affected side and KI-4 on the other).

189

Balancing Yin and Yang according to Heavenly Stems Each channel is associated with a Heavenly Stem, Yang channels with Yang stems and Yin channels with Yin stems, as follows: 1. Gall Bladder Liver Small Intestine Heart Stomach

2. 3. 4. 5.

6. Spleen

7. 8. 9. 10.

Large Intestine Lungs Bladder Kidneys.

Balancing Yin and Yang points according to Heavenly Stems simply means balancing points of channel 1 with 6, 2 with 7, 3 with 8, 4 with 9, and 5 with 10, as follows : Gall Bladder-Spleen Small Intestine-Lungs Stomach-Kidneys Large Intestine-Liver Bladder- Heart. It will be noticed that this essentially consists in

balancing a Yang channel's points with those from the Yin channel which is controlled by it in the Controlling cycle of the Five Elements (Fig. 11.2).

FIRE

Fig. 11.2 Balancing of Yin and Yang points according to Heavenly St ems.

190

PART 2: THE MAIN CHANNELS

This method stresses the importance of balancing Yang points with Yin ones, rather than the other way round. For example, if one uses several points from the Gall Bladder channel in one treatment it would be wise to balance them with one or two from the Spleen channel; but if one uses several points from the Spleen channel it is not necessary to balance them with points from the Gall Bladder channel. The explanation for this is in the Five-Element Controlling cycle and in the theory of Yin-Yang: it is necessary to balance Yangchannel points (Yang corresponding to activity and, in disease, to an 'attack' or 'invasion') with those of the Yin channel which is controlled by it to prevent the Yang channel from overacting on the Yin one. For example, suppose one is treating a patient with sciatica occurring along the Gall Bladder channel. One selects G.B.-30 Huantiao, G.B.-29 Juliao, G.B.-31 Fengshi and G.B.-34 Yanglingquan. It might be a good idea to balance these four Gall Bladder points with perhaps one on the Spleen channel, say SP-3 Taibai or SP-6 Sanyinjiao (Fig. 11.3). It is even better if the

Spleen point can be chosen according to the condition of the patient rather than just for the sake of balancing the Gall Bladder points. For example. say that the patient with sciatica also suffers from insomnia from Blood deficiency, then SP-6 Sanyinjiao would be a good choice to balance the Gall Bladder points as it would not only perform a balancing function but also treat insomnia. Another example could be that of a patient with chronic shoulder inllammation with pain radiating down the arm. The patient is treated with L.I.-15 Jianyu, L.I.-14 Binao, L.I.-11 Quchi and L.I.-4 Hegu. As four Large Intestine points are being used, it might be necessary to balance these with a point of the Liver channel: LIV-3 Taichong might be an especially suitable choice as this point would also relax the inllamed shoulder's sinews. In addition, using LIV-3 will also balance Upper with Lower as all the Large Intestine points are in the arm and LIV-3 is in the leg (Fig. 11.4). In the previous example when Gall Bladder points are balanced with SP-6 Sanyinjiao, this point could be used on the opposite side; this would achieve the effect of balancing Top and Bottom, Yin and Yang, the Heavenly Stems, and Left and Right. It would therefore be a very harmonious combination . Another example of balancing according to the Heavenly Stems could be that of a patient being treated for sciatica along the Bladder channel with BL-54 Zhibian, BL-36 Chengfu, BL-37 Yinmen and BL-40 Weizhong: these Bladder points could be balanced with a point from the Heart channel such as, say, HE- 7

SUMMARY BALANCING YIN AND YANG POINTS • Balancing of Yin and Yang points is important to equalize the flow of Qi in Yin and Yang channels • Balancing of internally-externally related channels (e.g. Stomach and Spleen) • Balancing of unrelated Yin and Yang channels (e.g. Stomach and Lungs) • Balancing of Connecting (Luo) and Source (Yuan) points • Balancing of Yin and Yang according to Heavenly Stems (e.g. Gall Bladder and Spleen). Fig. 11.3 Balancing Gall Bladder with Spleen points.

THE COMBINATION OF ACUPUNCTURE POINTS

191

BALANCING BACK AND FRONT POINTS Balancing Back and Front is another aspect of balancing of Yin and Yang (because Back is Yang and Front is Yin) but it is best discussed separately. Balancing Back and Front has two aspects:

a. Balancing Back-Transporting with Front-Collecting points b. Balancing Governing and Directing Vessels

Balancing Back-Transporting with Front-Collecting points

Fig. 11.4 Balancing Large Intestine and Liver point s.

Shenmen. This would be all the more indicated if the patient were tense and anxious. In fact, especially in men, the point HE-7 Shenmen has an excellent effect in relaxing the muscles of the back.

The Back-Transporting points have been discussed in the previous chapter (see Ch. 10). The BackTransporting points are points where Qi gathers and infuses to the Internal Organs. Because these points are on the Yang side of the body and, furthermore, on the Bladder channel which pertains to the Greater Yang and which circulates Defensive Qi over the whole back, they can be used, with moxa, to warm the Internal Organs. The Front-Collecting (Mu) points are points where the Qi of the Internal Organs gathers. They are all on the Yin side of the body and can be used to clear Heat. Traditionally, the Back-Transporting points, which are Yang in character, were used for Yin diseases: the term 'Yin diseases' can be interpreted in different ways, i.e. it could mean chronic, Cold, Deficiency or Yin-organ disease. The Front-Collecting points, which are Yin in character, were recommended for Yang diseases; the term 'Yang diseases' can be interpreted in different ways, i.e. it could mean acute. Heat, Excess or Yang-organ disease. Chapter 6 7 of the 'Classic of Difficulties' in fact says: 'Yin diseases rcac!J the Yang and Yang diseases reach the Yin; for this reason, the Front-Collecting points are on the Yin surface and tile Back-Transporting points on the Yang swjnce.' 9 The implication of this statement is that, as Yin diseases reach the Yang, the Back-Transporting points are used to treat Yin diseases, and, as Yang diseases reach the Yin, the Front-Collecting points are used to treat Yang diseases. However, this is by no means an absolute rule and both sets of points can be used for Yin or Yang diseases, intended in the broad meaning indicated above (see also Ch. 10).

192

PART 2: THE MAIN CHANNELS

Combining Back-Transporting with Front-Collecting points will balance Yin with Yang, and Nutritive (Ying) with Defensive (Wei) Qi. This combination provides a particularly strong treatment of the Internal Organs in chronic conditions. For example, the combination of Ren-12 Zhongwan withBL-21 Weishu, respectively Front-Collecting and Back-Transporting points of the Stomach, provides a strong tonification of the Stomach {if needled with reinforcing method or used with moxa). The Back-Transporting and Front-Collecting points were discussed in Chapter 10. CLINICAL NOTE COMBINATION OF BACK-TRANSPORTING AND FRONT-COLLECTING POINTS

The combination of Back-Transporting and FrontCollecting points is particularly effective to treat problems of the Internal Organs, especially those of a Deficient nature: • Lungs: BL-13 Feishu and LU-1 Zhongfu • Heart: BL-15 Xinshu and Ren-14 Juque • Liver: BL-18 Ganshu and LIV-14 Qimen • Spleen: BL-20 Pishu and LIV- 13 Zhangmen • Kidneys: BL-23 Shenshu and G.B.-25 Jingmen.

If treatment is given fairly frequently, say two or three times a week, then Back-Transporting points can be alternated with Front-Collecting points on a lternate sessions, as the use of both sets of points in each session would be too strong. If treatment is given more infrequently, say fortnightly or less, then Back-Transporting and Front-Collecting points could be combined in one session. Back-Transporting points are best used with a short retention of needles of. say, about 10 minutes or less in an adult. or with moxa only. In children, I reduce the retention time in proportion to their age: the younger they are, the shorter the retention of the needle in the Back-Transporting point. In children under 3, I do not retain the needle at all and just insert it. obtain deqi and then withdraw it. If needles are left in these points for longer, they may tend to have a reducing effect and make the patient very tired. In a Deficiency condition, if one is in doubt it is best to use the Back-Transporting points w ith moxa only (unless, of course, there are signs of Heat or Empty Heat).

CLINICAL NOTE I personally leave the needles in the BackTransporting points for only a short time in cases of tonification, i.e. no longer than 10 minutes. This is because Qi at these points infuses d irectly into the Internal Organs without going through the channels in the limbs.

There are also two other ways of combining the Back-Transporting and Front-Collecting points: the former can be combined with the Source (Yuan) points and the latter with the Sea (He) points. Combining Back-Transporting and Source points of the same organ specifically treats the Yin organs, chronic diseases and Deficiency conditions; for example, BL-13 Feishu with LU-9 Taiyuan for the Lungs, BL-18 Ganshu with LIV-3 Taichong for the Liver. BL-23 Shenshu with KI-3 Taixin (a very common and effective combination) for the Kidney. etc. These combinations are listed in Table 11.2. Combining Front-Collecting and Sea points of the same organ specifically treats the Yang organs, acute diseases and Excess conditions. It should be borne in mind that here 'Sea point' of the Large Intestine, Small

Table 11.2

Combination of Back-Transporti ng and Source points

Channel

Back-Transporting points

Source points

Lungs

BL-13 Feishu

LU-9 Taiyuan

Large Intestine

BL-25 Dachangshu

L.l.-4 Hegu

Stomach

BL-21 Weishu

ST-42 Chongyang

Spleen

BL-20 Pishu

SP-3 Taibai

Heart

BL-15 Xinshu

HE-7 Shenmen

Small Intestine

BL-27 Xiaochangshu

S.l.-4 Wangu

Bladder

BL-28 Pangguangshu

BL-64 Jinggu

Kidneys

BL-23 Shenshu

Kl-3 Taixi

Pericardium

BL-14 Jueyinshu

P-7 Daling

Triple Burner

BL-22 Sanjiaoshu

T. B. -4 Yangchi

Gall Bladder

BL-19 Danshu

G.B.-40 Qiuxu

Liver

BL-18 Ganshu

LIV-3 Taichong

THE COMBINATION OF AC UPUNCTURE POINTS

Table 11 .3

Combination of Front-Collecting and Sea points

Channel

Front-Collecting points

Sea points

Lungs

LU-1 Zhongfu

LU-3 Chize

Large Intestine ST-25 Tianshu

ST-37 Shangjuxu

Stomach

Ren-12 Zhongwan

ST-36 Zusanli

Spleen

LIV-13 Zhangmen

SP-9 Yinlingquan

Heart

Ren-14 Juque

HE-3 Shaohai

Small Intestine Ren-4 Guanyuan

ST-39 Xiajuxu

Bladder

Ren-3 Zhongji

BL-40 Weizhong

Kidneys

G.B.-25 Jingmen

Kl-10 Yingu

Pericardium

Ren-17 Shanzhong

P-3 Quze

Triple Burner

Ren-5 Shimen

BL-39 Weiyang

Gall Bladder

G.B.-24 Riyue

G.B.-34 Yanglingquan

Liver

LIV-14 Qimen

LIV-8 Ququan

Intestine and Triple Burner means their Lower-Sea points, i.e. ST-3 7 Shangjuxu, ST-39 Xiajuxu and BL-39 Weiyang. A full listing of these points is given in Table 11.3. The polarity of Back-Front and specifically BackTransporting points against Front-Collecting points can also be made use of in correcting the ill effects of a treatment. For example, supposing too many BackTransporting points have been used, or maybe the needles have been left in for too long and the patient feels very tired after the treatment, then this effect can be corrected by using one or two points in the front and specifically some Front-Collecting points.

Balancing Governing and Directing Vessels Balancing points from the Governing and Directing Vessels is a very important aspect of Yin-Yang and Back-Front balancing. The Governing Vessel governs all the Yang channels while the Directing vessel governs all the Yin channels: thus points on these two channels acquire special importance in balancing Front and Back.

193

These two channels are also particularly suited for combining as their pathways arise from the same area between the Kidneys and cross over internally so that they could be seen as one circuit. As these two vessels flow upwards from Ren-1 Huiyin but also downwards internally, the combining of their points also regulates the ascending and descending of Qi. Finally, as these two vessels both flow upwards to the head and the Governing Vessel flows into the brain, the combining of their points also has a very powerful and important mental effect. which can be either excitatory or calming. The following are examples of combinations of points from the Governing and Directing Vessels. -

-

-

-

-

-

Du-19 Houding and Ren-15 Jiuwei: to calm the Mind. Du-19 calms the Mind and extinguishes (internal) Wind while Ren-15 calms the Mind and nourishes the Heart. This combination has a powerful calming effect as Ren-15 nourishes and Du-19 calms. Ren-15 will also relieve anxiety that manifests with a feeling of oppression in the chest. Du-20 Baihui and Ren-15 Jiuwei: to calm the Mind and to lift mood . This combination can simultaneously calm the Mind with Ren-15 and improve the mood and lift depression with Du-20. It is an excellent combination for mental depression with anxiety. Du-20 Baihui and Ren-12 Zlwngwan: to torrify the Stomach and Spleen and lift mood. This combination is good to lift depression occurring against a background of deficiency of Stomach and Spleen. Du-20 Baihui and Ren-6 Qihai: to tonify and raise Qi. Ren-6 tonifies Qi in general while Du-20 raises Qi: the combination of these two points is excellent to torrify and raise Qi in case of prolapses. However, its use need not be confined to such conditions; it also has a powerful mood-lifting effect in depression. Du-20 Baihui and Ren-4 Guanyuan: to calm the Mind. to nourish the Kidneys, to strengthen the Original Qi and to lift mood. This combination lifts mood and relieves depression by nourishing Kidney-Yin and strengthening the Original Qi. It is suitable for depression and anxiety occurring against a background of Kidney-Yin deficiency. Du-20 Baihui and Ren-3 Zhongji: to lift Qi in cases of Qi sinking and affecting the Bladder: this causes a frequent and urgent urination (without pain) and

194

-

-

-

-

-

PART 2: THE MAIN CHANNELS

slight incontinence. This combination lifts Qi in the Bladder when there is a background of Spleen and Kidney deficiency. Du-26 Renzhong and Ren-3 Zhongji: to move Qi in the Bladder when there is Qi stagnation in this organ. This combination is effective to treat Qi stagnation in the Bladder causing hypogastric distension and frequent-urgent urination with some pain before micturition. Du-14 Dazhui and Ren-4 Guanyuan. both with direct moxa cones: to torrify and warm Yang. Du-14, with moxa, warms all the Yang channels and the Bladder, while Ren-4, with moxa, tonifies and warms Kidney-Yang, which is the foundation for all the Yang energies of the body. Thus this combination tonifies the Bladder and Kidney-Yang and Yang Qi in general. Du-16 Fengfu and Ren-24 Chengjiang to treat occipital headache. 10 Du-24 Shenting and Ren-4 Guanyuan: to nourish the Kidneys, to strengthen the Original Qi (Yuan Qi) and to calm the Mind. This combination calms the Mind by nourishing Kidney-Yin and strengthening the Original Qi (Yuan). It is suitable for severe anxiety occurring against a background of Kidney-Yin deficiency. It is particularly indicated for anxiety as it roots Qi in the Lower Burner and draws it downwards away from the head and the Heart where it harasses the Mind. Du-24 Shenting and Ren-15 Jiuwei: to calm the Mind and settle the Ethereal Soul (Hun). This combination has the dual effect of calming the Mind but also lifting mood and boosting memory and concentration. Yintang and Ren-4 Guanyuan: to calm the Mind and to nourish the Kidneys: this combination is similar to the previous one as it roots Qi in the Lower Burner by nourishing the Kidneys and strengthening the Original Qi. Whilst the previous combination is better for anxiety and worrying, this one is better for insomnia.

BALANCING LEFT AND RIGHT POINTS Balancing Left and Right provides one of the most interesting options in treatment. The polarity Left- Right surfaces in many aspects of Chinese medicine. Left and Right are two aspects of the Yang-Yin polarity, Left corresponding to Yang and Right to Yin.

SUMMARY BALANCING BACK AND FRONT POINTS

• The balancing of Back-Transporting (Back-Shu) with Front-Collecting (Mu) points balances Yang and Yin, Defensive Qi (Wei Qt) and Nutritive Qi (Ying Qt) • This combination is particularly used for problems of Internal Organs • The Back-Transporti ng points are frequently combined with Source (Yuan) points • The Front-Collect ing points are frequently combined with the Sea (He) points • Balancing Governing (Ou) and Directing (Ren) Vessels is part of the balancing of Yang and

Yin.

There are several 'reasons' (if they can be called such) for this. One is related to a myth about the origin of the Left-Right imbalance in the ancient Chinese cosmos. According to ancient Chinese views, the sky was like an inverted bowl rotating on its own axis above the earth. Legends tell of a mythical being called Kong Kong who tore a hole in the sky and tilted it towards the East so that the sun shone less in the North-West. This meant that there was a predominance of Heaven (Yang) in the East (= Left) and a predominance of Earth (Yin) in the West(= Right). Thus, the following polarity was established: Yang = Heaven = East = Left Yin = Earth = West = Right. Chapter 6 of the 'Simple Questions' establishes the cardinal points and their reference to Left-Right: 'The Sage stands facing South .. .'u Thus, he has the East to his left and the West to his right. 12 Hence the following polarity: South = East = Left = Yang North = West = Right =Yin. In Chapter 5, the same book confirms the East-West (and Left-Right) imbalance created by the mythical Kong Kong and applies it to the human body: 'Right and Left are two aspects of Yin- Yang . . . Heaven is lesser in the North and West [and therefore Right] ... for this reason the right ear and eye [belonging to Heaven] are not as good as the left ones. Earth is lesser in the South and East {and therefore Left] ... for this reason the left hand

THE COMBINATION OF ACUPUNCTURE POINTS

and foot [/Jelonging to Earth] are not as good as tile right ones . .. Therefore when pathogenic factors attack the /Jody the right side of the upper /Jody and the left side of the lower body will suffer more severely . .. ' 13 The Left-Right polarity is also defined by the energetic sphere of the Extraordinary Vessels. The Governing and Directing Vessels flowing along the midline of the body, the former along the back and the latter along the front, divide it into left and right sides. The Yang Stepping and Yin Stepping Vessels (Yang and Yin Qiao Mai), associated with the Governing and Directing Vessels respectively, harmonize Left and Right. Thus, there is a correspondence between Back and Left (Governing Vessel and Yang Stepping Vessel) and between Front and Right (Directing Vessel and Yin Stepping Vessel). The Governing and Directing Vessels represent the earliest embryological separation of left and right sides of the body for, as soon as a spermatozoon penetrates the ovum, it defines the median plane of Governing and Directing Vessels and therefore divides the body into left and right sides. As both the Governing and Directing Vessels originate from the Kidneys and these are considered in Chinese medicine to be the only organ with two separate viscera (the Lungs being seen as one viscus) on left and right sides, balancing Left and Right is also an important aspect of balancing Kidney-Yin and Kidney-Yang. 14 As mentioned earlier, left and right sides are determined early in the development of the human embryo: this has to be done if organs are to end up functioning correctly in the appropriate sides of the body. Left and right sides are never energetically identical as there is always an imbalance between them. The ancient Chinese cosmology, as we have seen, attributed this to a 'lack of Heaven' on the right side and a 'lack of Earth' on the left side. The Left-Right imbalance can be easily seen on the face in the difference between the left eye and the right, and the left ear and the right, in the left testicle's being lower than the right, one kidney's being placed higher than the other, the difference in function between left and right sides of the brain, etc. Furthermore, Left is traditionally associated with Yang and the male element, and Right with Yin and the female element. In fact, if we look at the cycle of the 12 Earthly Branches corresponding to the daily cycle of 24 hours, conception was thought to occur at the Earthly Branch Si (sixth Branch). If we start

1

1

1

1

1

1

1

1

1

1

GB

LIV

LU

L.l.

ST

SP

HE

S.l.

BL

Kl

TOWARDS RIGHT

1 P

195 1 T.B.

TOWARDS LEFT

TOWARDS LEFT Fig. 11.5 Cycle of Earthly Branches and conception .

from the first Branch Zi, the male element needs to go through 30 Branches (in order to be a multiple of 10) moving towards the left, and the female element needs to go through 20 Branches moving towards the right, in both cases counting the starting Branch (Fig. 11.5). Furthermore, according to ancient Chinese ideas, pregnancy lasted 10 (lunar) months and, if we take each Branch to correspond to a month, the female embryo moves towards the right from the Branch Si to the Branch Shen (this branch corresponding to female, Autumn and the number 7), and the male embryo moves towards the left from the Branch Si to the Branch Yin (this Branch corresponding to male, Spring and the number 8). The correspondences between left and male and between right and female are used in the balancing of opening points of the Extraordinary Vessels and can be used for the Left-Right balancing of other channels as well. This will be explained shortly. The Left-Right balancing of Connecting points will be discussed in Chapter 16, that of Extraordinary Vessels in Chapter 24 and that of the Divergent channels in Chapter 22. I shall now discuss Left-Right balancing from the following points of view:

a. arm and leg channels of the same polarity b. exteriorly- interiorly related channels

196

PART 2: THE MAIN CHANNELS

c. other channels d. channel problems.

Using points unilaterally, balancing them between Left and Right, presents us with the opportunity of creating very interesting and balanced combinations of points. Needling points unilaterally, balancing Left and Right, has several advantages: a. it makes for a particularly dynamic effect

b. it balances Left and Right and therefore Yang and Yin c. it allows us to reduce the total number of points used.

Far from reducing the effect of the treatment, using points unilaterally makes the treatment more dynamic and powerful: it is like applying a force to the tangents of two opposite poles of a circle, making it spin {Fig. 11.6). Since using points unilaterally and balanced between Left and Right has a particularly dynamic effect, I generally do this for points which are intended to move Qi or Blood; I use bilaterally points to torrify Qi and Blood, although not exclusively so. For example, if a woman patient presented with symptoms of insomnia, anxiety and premenstrual tension due to stagnation of Liver-Qi from emotional problems occurring against a background of Qi and Blood deficiency, one could needle P-6 Neiguan on the right and LIV-3 Taichong on the left to move Liver-Qi, calm the Mind and settle the Ethereal Soul. and ST-36 Zusanli and SP-6 Sanyinjiao, both bilaterally, to torrify Qi and Blood.

When needling unilaterally. the laterality can be chosen according to various criteria:

a. according to painful side: needle distal and local points on the painful side and balance them with some points on the other side (e.g. L.I.-15. L.I.-11 and L.I.-4 on the right and UV-3 on the left) b. according to sex and arm-leg: needle an arm-channel point on the left for men and on the right for women and a leg-channel point on the other side (e.g. P-6 Neiguan on the right in women and left in men, and LIV-3 on the opposite side) c. according to Yin-Yang: needle a Yin point on the left (the Yang side) and a Yang point on the right (the Yin side).

Arm and leg channels of the same polarity Arm and leg channels of the same polarity are those of Greater Yang (Small Intestine and Bladder), Greater Yin (Lung and Spleen), etc. Since the channels within each of these pairs are closely connected, unilateral needling is particularly effective. Examples of combinations of Yang arm and leg channels have already been given above, so they will be discussed here only briefly. (Fig. 11. 7)

Bright Yang - L.I.-4 Hegu and ST-36 Zusanli: to harmonize the rising and descending of Qi and regulate digestion. L.I.-4 could be used on the right in a woman and on the left in a man, with ST-36 on the opposite side, as explained above. - L.I.-4 Hegu and ST-44 Neiting: to harmonize the rising and descending of Qi, with the same laterality as above. - L.I.-11 Quchi and ST-43 Xiangu: to benefit sinews and expel Wind-Damp-Heat in Heat Painful Obstruction Syndrome.

Greater Yang

Fig. 11.6 Effect of unilateral needling .

- S.I.-3 Houxi and BL-60 Kunlun: to harmonize the rising and descending of Qi and expel Wind. Needle S.I.-3 on the right in a woman and on the left in a man, and BL-60 on the opposite side.

THE COMBINATION OF ACUPUNCTURE POINTS

197

Lesser Yang -

T. B.-6 Zhigou and G.B.-31 Fengshi: to harmonize the Lesser Yang, expel Wind, regulate Qi and eliminate stagnation. Needle T.B.-6 on the right for a woman and on the left for a man, and G.B.-31 on the opposite side. - T.B.-4 Yangchi and G.B.-40 Qiuxu: to harmonize the Lesser Yang channels and regulate the rising and descending of Qi. Needle with the same laterality as above.

Greater Yin - LU-9 Taiyuan and SP-3 Taibai, both Source points: to torrify Qi. Needle LU-9 on the right for a man and on the left for a woman. - LU-5 Chize and SP-10 Xuehai: to cool Blood, especially in chronic skin diseases. LU-5 clears Heat and affects the skin (by virtue of the Lung's governing the skin) and SP-10 cools Blood. Needle LU-5 on the right in a woman and the left in a man, and SP-10 on the opposite side.

Terminal Yin - P-6 Neiguan and LIV-3 Taichong: to move Liver-Qi, eliminate stagnation deriving from repressed emotions, calm the Mind and settle the Ethereal Soul. Needle P-6 on the right in a woman and on the left in a man, and LIV-3 on the opposite side. The left-right unilateral needling of these two points produces particularly good results. - P-7 DaZing and LIV-3 Taichong: to move Liver-Qi, eliminate stagnation deriving from emotional stress (especially the breaking-up of relationships), calm the Mind and settle the Ethereal Soul. Use with the same laterality as above. - P-3 Quze and LIV-3 Taichong: to clear Heat and cool Blood in skin diseases. Fig. 11.7 Left-Right combination of arm and leg channels of same polarity.

- S.I.-6 Yanglao and BL-66 Tonggu: to harmonize the rising and descending of Qi and expel Wind from the Greater-Yang channels. Needle with the same laterality as above.

Lesser Yin - HE-7 Shenmen and Kl-3 Taixi: to harmonize Heart and Kidneys and calm the Mind. Needle HE-7 on the right in women and on the left in men, and KI-3 on the opposite side. - HE-6 Yinxi and KI-7 Fuliu: to nourish Heart-Yin and Kidney-Yin and stop night-sweating. Needle with the same laterality as above.

198

PART 2: THE MAIN CHANNELS

Exteriorly-interiorly related channels The exteriorly-interiorly related channels are the Lung and Large Intestine, Stomach and Spleen, etc. (Fig. 11.8): to needle points of these channels balancing Left and Right unilaterally will also balance Yin and Yang. These points could be further balanced by needling Yin points on the Yang side (i.e. left) and Yang points on the Yin side (i.e. right). Examples of such combinations have already been given above and will only be listed here:

-

LU-7 Lieque and L.I.-4 Hegu: to release the Exterior and expel Wind LU-5 Chize and L.I.-11 Quchi: to clear Heat and cool Blood in skin diseases LU-9 Taiyuan and L.I.-4 Hegu LU-ll Shaoshang and L. I. -4 Hegu ST-36 Zusanli and SP-4 Gongsun

- HE-7 Shenmen and S.I.-5 Yanggu - LIV-3 Taichong and G.B.-34 Yanglingquan - SP-8 Diji, SP-6 Sanyinjiao, ST-28 Shuidao and ST-29 Guilai - LU-3 Tianfu and L.I.-4 Hegu 15 - ST-45 Lidui and SP-1 Yinbai 16 - HE-6 Yinxi and S.I.-3 Houxi 17 - KI-8 Jiaoxin and BL-55 Heyang 18 - G.B.-30 Huantiao, LIV-2 Xingjian and G.B.-31 Fengshi 19 - LU-5 Chize and L.I.-11 Quchi - ST-36 Zusanli and SP-6 Sanyinjiao - ST-39 Xiajuxu and SP-6 Sanyinjiao - BL-63 ]inmen and KI-10 Yingu - P-6 Neiguan and T.B.-6 Zhigou - T.B.-3 Zhongzlw and P-6 Neiguan - T.B.-3 Zlwngzhu and P-7 Daling - G.B.-43 Xiaxi and LIV-3 Taichong.

Other channels The practice of unilateral needling, balancing Left and Right, can be applied to any channel. combining it with any of the principles discussed so far. For example, Left-Right balancing can be combined with Yin-Yang, arm-leg or Heavenly Stem balancing. The combination of Left-Right can be achieved in several ways: -combining points of same polarity on the same half (top or bottom) of the body - combining points of different polarity on the same half (top or bottom) of the body - combining points of same polarity in different halves (top and bottom) of the body - combining points of different polarity in different halves (top and bottom) of the body. A few examples will be given for each of these; more examples will be given within the case histories below. In all the following examples, one point is used on one side and the other on the opposite side.

Left- Right combining of points of same pola rity on same half of the body -

Fig. 11 .8 Left-Right combination of exteriorly- interiorly related channels.

LU-7 Lieque and P-6 Neiguan: to settle the Corporeal Soul and Ethereal Soul and lift mood. This combination is excellent for emotional problems, such as sadness and grief, affecting the Lungs (and therefore Corporeal Soul), the Liver (and therefore Ethereal Soul) and the Heart. These two points

THE COMBINATION OF ACUPUNCTURE POINTS

-

-

-

-

-

have a dynamic, centrifugal effect, and, on the emotional level, they help patients to express their emotions and get in touch with their sadness and grief. They affect the Ethereal Soul. which is housed in the Liver, via the Pericardium to which the Liver is related. This is particularly effective in those cases when sadness has affected the Liver as well as the Lungs. LU-7 Lieque and HE-7 Shenmen: to settle the Corporeal Soul and to calm the Mind. These two points have a balanced, coordinated effect, as LU-7 brings emotions out and HE-7 calms them down. The combination is therefore suitable in emotional problems such as worry and grief affecting Lungs and Heart and causing anxiety. L.I.-4 Hegu and S.I.-5 Yanggu to: calm the Mind and to subdue rebellious Qi. This combination is particularly useful for those who are anxious and confused about choosing a direction to take in life. ST-36 Zusanli and G.B. -34 Yanglingquan: to torrify Stomach-Qi and to move Liver-Qi. This combination is used in conditions characterized by deficiency of Stomach- and Spleen-Qi and stagnant Liver-Qi invading the Stomach and causing bad digestion, epigastric distension and nausea. KI-3 Taixi (with reinforcing method) and LIV-3 Taichong (with reducing method): to nourish the Kidneys and to subdue Liver-Yang or Liver-Wind. KI-2 Rangu and LIV-3 Taichong: to cool Blood. This combination can be used in a wide variety of Liver-related problems deriving from Blood-Heat. such as menorrhagia or skin diseases. (Fig. 11.9).

Left-Right combining of points of different polarity on the same half of the body -

LU-7 Lieque and S.I.-5 Yanggu: to settle the

Corporeal Soul and to calm the Mind. This combination is useful to treat emotional problems such as worry affecting Lungs and Heart; in particular, it helps the person to see issues clearly and make choices. - G.B.-34 Yanglingquan and LlV-3 Taichong: to move Liver-Qi, to calm the Mind and to settle the Ethereal Soul. This combination is excellent to move Liver-Qi on a physical level (hypochondria! or abdominal distension), and on an emotional level (moodiness, depression, premenstrual tension). It

199

Fig. 11 .9 Left-Right combination of points of same polarity on the same half of the body.

can be su itably combined with local points to target the area affected: Ren-12 Zhongwan for the epigastrium, LIV-14 Qimen for the hypochondrium and Ren-6 Qihai for the lower abdomen (Fig. 11.10).

Left-Right combining of points of same polarity in different halves of the body These combinations have already been mentioned when discussing the balancing of arm and leg points. Any of those combinations, and especially those that move Qi, invigorate Blood or regulate Qi, can be used unilaterally and crossed over.

- S.l.-5 Yanggu and G.B.-40 Qiuxu: this combination has a marked mental effect in helping the person to discriminate between choices (with S.I.-5) and finding the strength to act upon the chosen course (G.B.-40). The unilateral, Left- Right needling of

200

PART 2: THE MAIN CHANNELS

Fig. 11.10 Left-Right combination of points of different polarity on the same half of the body.

these two points adds a dynamic dimension to the combination and contributes to its moving effect on the mental level. thus helping the person to

resolve an indecision which may have been going -

on for a long time. HE-7 Shenmen and LIV-3 Taichong: to calm the Mind and to settle the Ethereal Soul. This combination has a powerful calming effect and is suitable for anxiety and worry related to Heart and Liver patterns (Fig. 11.11).

Left-Right combining of points of different polarity in different halves of the body These combinations will balance arm and leg channels, Yin and Yang, and Left and Right. - LU-9 Taiyuan and ST-36 Zusanli: to tonify Lung- and Stomach-Qi.

Fig. 11 .11 Left-Right combination of points of the same polarity in different halves of the body.

- L.I.-4 Hegu and LIV-3 Taichong: this combination has already been explained above and it also represents a balancing according to the Heavenly Stems. - L.I.-4 Hegu and KI-7 Fuliu: this combination, explained previously, regulates sweating.

THE COMBINATION OF ACUPUNCTURE POINTS

201

- HE-7 Shenmen and G.B.-40 Qiuxu: to calm the Mind and strengthen Will-power. This combination is effective in helping a person to gain the strength to act on decisions: it is indicated when the indecision (or rather the inability to act on a decision) causes great mental anguish. - P-6 Neiguan and ST-36 Zusanli: to regulate the Middle Burner and calm the Mind. This combination is effective for Empty-type Stomach patterns especially if caused by emotional problems. - P-6 Neiguan and ST-40 }(mglong: to regulate the Middle Burner, resolve Phlegm and calm the Mind. This combination is effective for Full-type Stomach patterns deriving from emotional stagnation. It is also very effective for bruising of the rib muscles.(Fig. 11.12)

Channel problems When treating painful channel syndromes. it is often useful to balance the points on the affected side with one or two points on the opposite side. This may be necessary or desirable to balance Top with Bottom, or Yin with Yang, or the Heavenly Stems. or simply to treat another condition. We can therefore distinguish six possible situations for balancing the points treating a painful channel problem with one or two points on the opposite side: 1. Balancing the affected channel with its related,

2.

3. 4.

5. 6.

opposite-limb channel of the same polarity (e.g. Large Intestine with Stomach) Balancing according to the Heavenly Stems Balancing with an appropriate Gathering (Hui) point Balancing according to accompanying pattern Balancing according to the Connecting (Luo) points Balancing according to duration in Windstroke. Fig. 11.12 Left- Right combination of points of different polarity in different halves of the body.

Balancing the affected channel with its related, opposite-limb channel of the same polarity This means balancing Large Intestine with Stomach, Lungs with Spleen. etc. For example, supposing we are treating a patient with a chronic shoulder problem

on the right side using L.l.-15 Jianyu , Jianneiling, L.I.-11 Quchi and L.I.-4 Hegu on the right side, we could balance these points with ST-36 Zusanli on the left side (Fig. 11.13). Another example could be that of G.B.-30 Huantiao, G.B.-31 Fengshi and G.B.-34

202

PART 2: THE MAIN CHANNELS

Yanglingquan all on the left side to treat sciatica on that side, balanced by T.B.-6 Zhigou on the right side (Fig. 11.14). The Left-Right balancing of points in treating channel problems can be used according to the correspondence of joints between shoulder and hip, elbow and knee, and wrist and ankle. Bearing in mind this correspondence between joints and arm-leg channels of the same polarity, the local points on one joint can be balanced by the use of a point of its related, opposite-limb channel of the same polarity on the corresponding joint on the opposite half of the body and on the opposite side. An example will make this clearer. Assuming we are treating tennis elbow on the right side with L.I.-12 Zhouliao, L.I.-11 Quchi and L.I.-10 Shousanli on the right, we can balance these points with ST-36 Zusanli on the left side. We choose this point because it is on the related channel of the same polarity and, in the correspondence of joints, the knee corresponds to the elbow. The use of ST-36 will not only balance the treatment but also boost its effectiveness as ST-36 assumes the role of distal point. By using ST-36 on the opposite side we are also balancing Top and Bottom. Another example: assuming we are treating a patient with a sprained wrist and we use T.B.-5 Waiguan, T.B.-4 Yangchi and T.B.-3 Zhongzhu on the left side, we can needle G.B.-40 Qiuxu on the right side, based on the correspondence between wrist and ankle. Table 11.4 lists the points based on the correspondence between joints and related leg-arm channels of the same polarity.

Balancing according to the Heavenly Stems This method, which has already been described, can be used to balance points treating a channel problem. For example, if we are using S.I.-8 Xiaohai, S.I.-7 Zhizheng and S.I.-3 Houxi to treat a painful elbow on one side, we can balance these points with a Lung channel point on the opposite side, e.g. LU-9 Taiyuan.

Balancing with an appropriate Gathering (Hui) point Fig . 11.13 Left-Right combination of points of affected channel with those of related channel of the same polarity (Large Intestine and Stomach).

Points on one side treating a channel problem can be balanced with an appropriate Gathering point on the opposite side. For example, if we are using L.I.-15 Jianyu, L.I.-14 Binao and L.I.-11 Quchi for

TH E COMBINATION OF ACUPUNCTURE POINTS

203

Table 11.4

Correspondence of joint point s on upper and lower parts of the body

Joint

Arm

Leg

L.l. - 15 Jianyu T.B.- 14 Jianliao S.l.-1 0 Naoshu LU-2 Yunmen HE-1 Jiquan P-2 Tianquan

ST-31 Biguan G.B.-30 Huantiao BL-36 Chengfu SP- 12 Chong men Kl-11 Henggu LIV-11 Yinlian

Hip

Shoulder Large Intestine Triple Burner Small Intestine Lung Heart Pericardium

Elbow Large Intestine Triple Burner Small Intestine Lung Heart Pericardium

Knee L.l.-11 Quchi T.B.- 10 Tianjing 5.1.-8 Xiaohai LU-5 Chize HE-3 Shaohai P-3 Quze

Wrist Large Intestine Triple Burner Small Intestine Lung Heart Pericardium

ST-36 Zusanli GB-34 Yangl ingquan BL-40 Weizhong SP-9 Yinlingquan Kl- 10 Yingu LIV-8 Ququan

Ankle L.l.-5 Yangxi T.B.-4 Yangchi S.l.-5 Yanggu LU-9 Taiyuan HE-6 Yinxi P-7 Daling

ST-41 Jiexi G.B.-40 Qiuxu BL-60 Kunlun SP-5 Shangqiu Kl-5 Shuiquan LIV-4 Zhongf eng

Balancing according to accompanying pattern

Fig. 11.14 Left-Right combination of points of affected channel with those of related channel of the same polarity (Gall Bladder and Triple Burner).

a shoulder problem characterized by inflammation of the tendons, we can balance these points with G.B.-34 Yanglingquan, Gathering point for sinews, on the opposite side.

The balancing point on the side opposite the one where the channel problem is can be chosen according to an accompanying syndrome or an underlying condition. For example, if we are using L.I.-15 Jianyu, L.I.-11 Quchi and L.I.-4 Hegu on one side and the patient also suffers from stagnation of Liver-Qi, we could balance these points with LIV-3 Taichong on the opposite side: this would simultaneously treat the stagnation of Liver-Qi and balance Left and Right, Top and Bottom, and Yin and Yang. As another example, if we are treating a patient suffering from chronic Painful Obstruction Syndrome of one hand with swollen joints, using T.B.-4 Yangchi and L.I.-3 Sanjian on one side, and the tongue is Swollen with a sticky coating, we could balance these points with SP-9 Yinlingquan and ST-40 Fenglong on the opposite side to help to resolve Dampness and Phlegm. This combination would balance Yin and Yang, Top and Bottom, and Left and Right.

204

PART 2: THE MAIN CHANNELS

As another example, if we are treating a patient with tennis elbow with L.I.-11 Quchi and L.I.-10 Shousanli on one side, and this patient also suffers from Spleen-Qi deficiency, we could balance these points with ST-36 Zusanli on the opposite side. Bearing in mind the correspondences mentioned in the first point above. this would also help the elbow. If the same patient suffered from Kidney deficiency, we could select KI-3 Taixi instead. This combination would balance Yin and Yang, Top and Bottom, and Left and Right.

Balancing according to the Connecting (Luo) points This has already been mentioned before. In acute cases, the local points on one side can be balanced with the Connecting point of the same channel on the opposite side. For example: L.I.-11 Quchi, L.I.-10 Shousanli and L.I.-4 Hegu on one side and L.I.-6 Pianli (Connecting point on the opposite side). See Figure 11.15.

Fig. 11.16 Left-Right combination of Connecting points in chronic conditions.

In chronic cases the local points on one side can be balanced with the Connecting point of the interiorlyexteriorly related channel on the opposite side. For example: T.B.-14 Jianliao, T.B.-13 Naohui and T.B.-5 Waiguan on one side with P-6 Neiguan on the opposite side. See Figure 11.16.

Balancing according to duration in Wind-stroke

Fig. 11.15 Left- Right combination of Connecting points in acute conditions.

In treating paralysis following Wind-stroke sometimes the healthy side is needled in conjunction with the paralysed side. In treating paralysis, the duration of the condition can determine the side of needling. If the Wind-stroke occurred within the previous 3 months, the points of the paralysed side are needled with reducing method and the corresponding points of the healthy side are needled with reinforcing method. If the Wind-stroke occurred more than 3 months previously, the points

THE COMBINATION OF ACUPUNCTURE POINTS

SUMMARY BALANCING LEFT AND RIGHT

• Left is Yang and Right is Yin • Balancing Left and Right helps to balance Yang and Yin • Balancing Left and Right in: -arm and leg channels of same polarity and quantity of Qi (e.g. Small Intestine and Bladder or Greater Yang) -exteriorly-interiorly related channels (e.g. Large Intestine and Lungs) - other channels: i. Left-Right combining of points of same polarity on same half of the body ii. Left-Right combining of points of different polarity on same half of the body iii. Left-Right combining of points of same polarity in different halves of the body iv. Left-Right combin ing of points of different polarity in different halves of the body -channel problems: i. Balancing the affected channel with its related, opposite-limb channel of the same polarity ii. Balancing according to the Heavenly Stems iii. Balancing with an appropriate Gathering (Hw) point iv. Balancing according to accompanying pattern v. Balancing according to the Connecting (Luo) points vi. Balancing according to duration in Wind-stroke.

of the affected side are needled with reinforcing method and moxa. and the corresponding points of the healthy side with reducing method.

CASE HISTORIES The following are case histories illustrating examples of combinations of points according to the principles given above. As these case histories are given mostly

205

to illustrate point combinations, the emphasis will be on description of the treatment rather than the diagnosis. Only one or two treatment sessions are described as an example illustrating the application of the principle of combination of points: in each case, obviously, several sessions were necessary. Case histo ry 11 .4 A 47-year-old woman had been suffering from palpitations for 9 months. She felt her heart racing and missing beats and had a fluttering sensation just below the heart region. ECG tests showed no abnormality in the heart. Apart from this, she had no other symptoms and she felt generally quite well. Her periods had stopped a year before. Her tongue was very Pale and her pulse was very Weak on the right Kidney and on the Stomach position . Her palpitations were due to a Yang deficiency of Stomach and Kidneys. Both these organs have an influence on the Heart and particularly on the heart's rate. The Stomach influences the Heart via the Great Connecting channel of the Stomach wh ich flows from the Stomach to the left ventricle of the heart: the beat which can be felt on the apex of the heart is called 'Xuli' in Chinese medicine and is thought of as the actual beating of this channel. The Kidneys provide Water and Fire as the foundation of the Heart and a Kidney deficiency very often affects the Heart: it is not by chance that the palpitations started after her periods stopped and her Kidney energy declined. The points used were the following (Fig. 11.17): -

-

P-4 Ximen on the right and ST-40 Fenglong on the left to regulate the Heart's rhythm and the Great Connecting channel of the Stomach which, as explained above, is responsible for the beating of the heart. Such a combination balances Yin and Yang, arm and leg chan nels, and Left and Right. Points of these two channels combine particularly well as they both flow to the Stomach. ST-36 Zusanli, SP-6 Sanyinjiao and Kl-3 Taixi, all bilateral, to tonify the Stomach, Qi and Blood and Kidney-Yang (moxa was used on Kl-3).

The first two points were used unilaterally to have a more moving and calming effect, while the ton ifying points were used bilaterally. During the treatment she felt a tingling sensation around the points and a profound relaxing feeling.

206

PART 2: THE MAIN CHANNELS

Fig. 11.17 Case history of points combination, woman, 47. Fig. 11.1 8 Case history of points combinat ion, man, 54.

Case history 11 .5 A man of 54 complained of dizziness and poor memory following two serious accidents to his head. He was also very tense and suffered from insomnia and slight impotence. His pulse was slightly Wiry, especially on both Front positions, and Weak on both Kidney positions. The points used were the following (Fig. 11.18): -

BL-62 Shenmai on the left and S.l.-3 Houxi on the right to open the Yang Stepping Vessel. This

extraordinary vessel was used because it affects the brain and removes obstructions f rom the head. It would therefore eliminate the stagnation in the brain caused by the traumas. It is also indicated when both Front positions of the pulse are Wiry20 - HE-7 Shenmen on the left and Kl-6 Zhaohai on the right to harmonize Heart and Kidneys and to calm the Mind. This combination of points from two arm-leg channels of the same polarity balances

THE COMBINATION OF ACUPUNCTURE POINTS

207

Left and Right, and arm and leg channels. These points were used unilaterally to make the combination more moving and calming . In terms of indications, HE-7 wou ld help his sleep and Kl-6 the impotence. These two points are also balanced with the opening points of the Yang Stepping Vessel as their positions cross over on the limbs; furthermore these two combinations w ill balance Greater Yang (S.I.-3 and BL-62) with Lesser Yin (HE-7 and Kl-6), i.e. the utmost and most exterior Yang with the utmost and most interior Yin. Finally, Kl-6 was chosen also to co-ordinate with the Ya ng Stepping Vessel as this vessel removes Excess Ya ng from the head and Kl-6 brings Yin Qi to it. - SP-6 Sanyinjiao and Kl-3 Taixi bilatera lly, to nourish the Kidneys. These were used bilaterally as they are tonifying . In terms of indications, SP-6 would also help the insomnia. - G.B.-12 Wangu, bilaterally, as a local point to eliminate stagnation from the head and help the insomnia . A subsequent treatment consisted of: -

-

-

BL-62 Shenmai on the left and S.l.-3 Houxi on the right to open the Yang Stepping Vessel HE-7 Shenmen on the left and Kl-6 Zhaohai on the right to harmonize Heart and Kidneys and calm the Mind . SP-6 Sanyinjiao and Kl-3 Taixi bilaterally, to nourish the Kidneys. In terms of indications, SP-6 would also help the insomnia. Yintang to calm the Mind and promote sleep.

Case history 11.6 A 45-year-old woman suffered from exhaustion and stiffness of the neck. These symptoms were due to long-standing emotional problems (sadness and grief) depleting Qi and Blood. The main patterns were deficiency of Stomach-, Lung- and Spleen-Qi, and Blood deficiency. The points used were (Fig. 11 .19): -

Ren-12 Zhongwan to tonify Stomach and Spleen. LU-7 Lieque on the right and P-7 Daling on the left to calm the Mind and settle the Corporeal Soul. This combination of points is particularly good for emotional problems such as sadness and grief affecting the Lungs and Heart. LU-7 has

Fig. 11.19 Case history of points combination, woman, 45.

-

a centrifugal movement bringing out repressed emotions or allowing the person to get in touch with his or her grief, and P-7 has a centripetal movement, calming the Mind. These points were used unilaterally to make the combination simultaneously more moving and more calm ing. ST-36 Zusanli and SP-6 Sanyinjiao, bilaterally, to tonify Qi and Blood and strengthen Stomach and Spleen.

208

PART 2: THE MAIN CHANNELS

A subsequent treatment, when she complained of stiffness of the neck, consisted of the following combination: -

Ren-12 Zhongwan to tonify the Stomach and Spleen. - LU-7 Lieque on the right and P-7 on the left for the same reasons as above. - T.B.-5 Waiguan on the right and G.B.-39 Xuanzhong on the left, to benefit the sinews, expel Wind and relieve stiffness of the neck. This combination of two points from related arm-leg channels of the same polarity balances Left and Right, and arm and leg channels. The Lesser Yang channels are particularly indicated to relieve stiffness of the neck and shoulders not only because they affect the area of stiffness but also because they benefit sinews. - ST-36 Zusanli and SP-6 Sanyinjiao, bilaterally, for the same reasons as above.

• Ren-6

During this treatment she felt extremely relaxed and said she felt as if she was floating. For yet another treatment the following points were used: -

Ren-12 Zhongwan. ST-36 Zusan li and SP-6 Sanyinjiao. Du-20 Baihui to raise Qi and lift mood. T.B.-8 Sanyangluo on the right and G.B.-39 Xuanzhong on the left to regulate the Lesser Yang, benefit the sinews and relieve stiffness of the neck. This combination balances Left and Right, and arm and leg channels. The point T.B.-8 relaxes all the Yang channels in the neck area and is excellent for stiffness of this area. After the treatment she said she felt as if she had had a neck massage.

Case history 11.7 A man aged 41 suffered from 'irritable bowel syndrome' with symptoms of distension, flatu lence and loose stools. He was a very tense person with a stressful job. The main patterns involved were Liver-Qi stagnation and Spleen-Qi deficiency. The points used in one treatment were (Fig. 11.20): -

SP-4 Gongsun on the left and P-6 Neiguan on the right to open the Penetrating Vessel (Chong Mai) and regulate the Middle and Lower Burner. This extraordinary vessel is indicated in Full patterns of the Stomach and Intestines.

Fig. 11.20 Case history of points combination, man, 41.

-

-

Ren-6 Qihai to move Qi in the lower abdomen. This point targets the action of the previous two to the lower abdomen. HE-7 Shenmen on the left and LIV-3 Taichong on the right to calm the Mind, settle the Ethereal Soul and move Liver-Qi. This combination balances arm and leg channels, and Left and Right. It is particularly good to calm anxious persons down as it settles both the Mind and the Ethereal Soul. The unilateral use, one on the right, the other on

THE COMBINATION OF ACUPUNCTURE POINTS

L

209

the left, is particularly effective, and it also crosses over the opening points of the Penetrating Vessel (SP-4 and P-6).

Case history 11.8

A 13-year-old girl suffered from food intolerance, being unable to eat several common foods which caused a rash. She also suffered from eczema. The main pattern was Stomach-Heat. The points selected for the first treatment were: -

-

L.l.-4 Hegu on the right and ST-44 Neiting on the left to clear Stomach-Heat. This combination of points from related arm-leg channels of the same polarity, balances Left and Right, and arm and leg channels. The points were used unilaterally to make the effect more dynamic in clearing Heat; also, this being the first treatment, and given the young age of the patient, it allowed us to reduce the number of needles. Ren-12 Zhongwan to regulate the Middle Burner.

After eight treatments and some herbal decoctions, her food intolerance was completely cured and she was able to eat foods that had previously been impossible for her to eat. ST-36

Case history 11.9

•

• ST-36

A 73-year-old woman had been suffering from trigeminal neuralgia affecting the right side of the face. This took place against a background of KidneyYin deficiency, as very often occurs in the elderly. The points used were: -

L.l.-4 Hegu on the right and LIV-3 Taichong on the left to expel Wind (as trigeminal neuralgia is a manifestation of Wind) from the face . The points were used unilaterally to make the combination more dynamic in expelling Wind; L.l.-4 was needled on the right side as that was the side affected by the neuralgia. - SP-6 Sanyinjiao and Kl-3 Taixi, bi laterally, to nourish Kidney-Yin. During the treatment she felt a tingling around the needles and a flutter over the face.

Fig. 11.21 Case history of points combination, woman, 47.

dizziness and tinnitus. The main pattern was Heart and Kidneys not harmonized. The main points used were (Fig. 11.2 1): -

Case history 11 .10

A woman aged 47 suffered from menopausal hot flushes, insomnia, palpitations, night-sweating,

-

LU-7 Lieque on the ri ght and Kl-6 Zhaohai on the left to open the Directing Vessel (Ren Mai), regulate Qi and Blood in the uterus and nourish the Kidneys. It is essential to use this extraordinary vessel in menopausal problems. HE-6 Yinxi on the left and Kl-7 Fuliu on the right to harmonize Heart and Kidneys, nourish Heart-Yin

210

-

PART 2: THE MAIN CHANNELS

and stop night-sweating. This combination of points from related arm-leg channels of the same polarity, balances Left and Right, and arm and leg channels. ST-36 Zusanli and SP-6 Sanyinjiao, bilaterally, to tonify Blood and the Kidneys. Du-24 Shenting and Ren-15 Jiuwei to calm the Mind. These two points balance the Directing and Governing Vessels.

Du-20

During the treatment she went into a deep state of relaxation and fell fast asleep.

Case history 11.11 A 59-year-old woman had been suffering from a central, lower abdominal pain for many years. This had been thoroughly investigated and, from the point of view of biomedicine, no cause could be found. On interrogation, I found that she experienced a bearing-down feeling. I concluded that the pain was of an Empty nature and was due to deficiency and sinking of Spleen- and Kidney-Qi and, because of the location of the pain, I treated the Directing Vessel (Ren Mal). I used the following point combination: -

LU-7 on the right and Kl-6 on the left to open the Directing Vessel (Ren Mai). Ren-6 Qihai both as a local point and as a point to lift Qi. Du-20 Baihui to lift Qi and also to combine the Directing with the Governing Vessel (Du Ma1). See Figure 11.22.

After the first treatment there was already a big improvement; after three treatments the pain had completely gone.

Case history 11 .12 A woman aged 45 suffered from irregular periods and excessive uterine bleeding: these problems started with the onset of the menopause. She also had emotional stress related to relationship difficulties. The main pattern was deficiency of Liver and Kidneys. The points used in one treatment were: -

LU-7 Lieque on the right and Kl-6 Zhaohai on the left to open the Directing Vessel (Ren Mai), regulate the uterus and nourish the Kidneys. This extraordinary vessel is very important in menopausal problems.

Fig. 11.22 Case history of points combination, woman, 59.

THE COMBINATION OF ACUPUNCTURE POINTS

-

P-7 Daling on the left and Kl-3 Taixi on the right to calm the Mind, settle the Ethereal Soul and tonify the Kidneys. This combination balances Left and Right, and arm and leg channels: the points are used with the above laterality to cross over with the opening points of the Directing Vessel (LU-7 on the right and Kl-6 on the left). P-7 is particularly useful in emotional stress deriving from relationship difficulties. - Ren-4 Guanyuan and Kl-13 Qixue to nourish the Kidneys, tonify the uterus, strengthen the Original Qi and benefit the Essence. - ST-36 Zusanli and SP-6 Sanyinjiao to tonify Qi and Blood and strengthen Qi to hold Blood.

Although she was an extremely tense person, she fell into a state of deep relaxation during the treatment and, in fact, only one treatment was enough to cure her night-sweating.

Case history 11.14 A woman aged 63 suffered from mild Damp Painful Obstruction (Bi) Syndrome of the left hand with some pain, stiffness and swell ing. She had sought treatment mostly for preventive purposes. Apart from the Damp Painful Obstruction Syndrome, the main pattern was Kidney deficiency. The points used for two sessions were: -

During the treatment she said that she 'felt like circuits in her body rather than individual points'. She had had several other sessions before so that she was quite an experienced and particularly sensitive patient.

-

Case history 11.13 A 43-year-old woman also suffered from menopausal problems with hot flushes and night-sweating. Her "tongue, however, was very Pale and, apart from the night-sweating, she felt generally cold and her pulse was Slow and Wiry. She was a very tense person. The main patterns were Kidney-Yang deficiency and stagnation of Liver-Qi from emotional stress. The points used in one session were: LU-7 Lieque on the right and Kl-6 Zhaohai on the left to open the Directing Vessel, ton ify the uterus and nourish the Kidneys. - HE-6 Yinxi on the left and Kl-7 Fuliu on the right to harmonize Heart and Kidneys and stop nightsweating. This combination of points from two related arm-leg channels of the same polarity, balances Left and Right, and arm and leg channels. The points were used with this laterality to cross over with LU-7 and Kl-6. - Ren-4 Guanyuan with direct moxa cones to tonify Kidney-Yang, strengthen the Original Qi, tonify the uterus and benefit the Essence. - ST-36 Zusanli on the left and SP-6 Sanyinjiao on the right to tonify Qi and Blood and nourish the Kidneys. This combination, althoug h tonifying, was used with unilateral points to make it more moving, as her pulse was not too empty.

-

211

LU-7 Lieque on the right and Kl-6 Zhaohai on the left to open the Directing Vessel (Ren Mai) and nourish the Kidneys. T.B .-4 Yangchi on the left and Kl-7 Fu liu on the right to expel Wind-Dampness from the hand and tonify the Kidneys. This combination balances Left and Right, Yin and Yang, and arm and leg channels.

During the first session she felt a 'stirring sensation' and the second time a 'pulsing sensation ' below the umbilicus.

Case history 11.15 A 39-year-old woman suffered a brownish pigmentation of the skin, abdominal pain and distension, throbbing headaches on the temples, heavy periods with clotting and pain, constipation, blurred vision, dizziness, poor memory and premenstrual tension. Her tongue was Pale and Thin and her pulse was Choppy. All her problems were Liver related and all stemmed original ly from Liver-Blood deficiency: this gave rise to Liver-Yang rising (throbbing headaches), stagnation of Liver-Qi and Liver-Blood (premenstrua l tension, painful periods with clotting, abdominal distension and pain, and constipation) and Blood Heat (brown pigmentation). The symptoms of Liver-Blood deficiency were poor memory, blurred vision, t iredness, dizziness, Pale-Thin tongue and Choppy pulse. Du ring one session the following points were used: -

LU-7 Lieque on the right and Kl-6 Zhaohai on the left to open the Directing Vessel, regulate the uterus, move Qi in the lower abdomen and nourish Liver and Kidneys .

212 -

-

PART 2: THE MAIN CHANNELS

P-6 Neiguan on the left and LIV-3 Taichong on the right to move Liver-Qi and Liver-Blood and to eliminate stagnation. This combination of points from t wo related arm-leg channels of the same polarity, balances Left and Right and arm and leg channels. These points were used unilaterally to make the combination more moving and the points were crossed over with LU-7 and Kl-6. LIV-8 Ququan, ST-36 Zusanli and SP-6 Sanyinjiao, bilaterally, to tonify Blood and nourish the Liver. These points were used bilaterally because they are tonifying.

During the session she said she felt very relaxed and as if she 'had been plugged in'.

Case history 11.1 6 A man aged 37 suffered from an urticaria-like red and itchy rash all over the body. This was due to WindHeat affecting the Blood. There was a background of Stomach-Yin deficiency, his tongue being completely Peeled with a Stomach crack in the centre. The points used in one session were : -

-

-

T.B.-6 Zhigou on the right and G.B.-31 Fengshi on the left to expel Wind-Heat. This combination of points from two related arm- leg channels of the same polarity, balances Left and Right, and arm and leg channels. It is excellent for clearing Wind-Heat in the Blood that is causing rashes. L.l.-1 1 Quchi on the left and SP-1 0 Xuehai on the right to cool the Blood in the skin. This combination harmonizes Left and Right, Yin and Yang, and arm and leg channels. ST-36 Zusanli and SP-6 Sanyinjiao, bilaterally, to nourish Stomach-Yin.

Case h istory 11.18 A 32-year-old woman sought treatment mostly for mental-emotional problems. She was at a time of life marked by confusion about issues, relationships and goals, and suffered from a lack of determination in acting on her decisions. Thus, the problem was twofold: on the one hand, she could not distinguish clearly between issues leading to indecision, and on the other hand, even if she did come to any decision she did not have the courage to act on it. This situation caused her great anxiety. In terms of patterns, there was a Spleen and Kidney deficiency. The points used in one session were: -

S.l.-5 Yanggu on the right and G.B.-40 Qiuxu on the left: the first point helps in distinguishing issues clearly and the latter in summoning the courage to act on decisions. This combination balances Left and Right, and arm and leg channels. The unilateral use of the points enhances their moving effect, which is particularly important in this case on a mental level to unblock the situation - ST-36 Zusanli on the right and Kl-3 Taixi on the left to tonify the Kidneys and the Spleen. These points were used unilaterally, even though they are ton ifying, to enhance the moving effect on a mental level. - Du-24 Shenting and Ren-15 Jiuwei were used to calm the Mind. This combination harmonizes Yin and Yang, Back and Front, and Directing and Governing Vessels. She had three sessions and after the treatment decisions regarding her something which she had

(using the same points) she took some important relationships and career, been trying to do for years.

Case hist o ry 11 .1 9 Case history 11.17 A 22-year-old woman suffered from an acute aggravation of chronic eczema of the Damp-Heat type. The points used were simi lar to the ones used for the previous patient

A 47-year-old man suffered from chronic lower backache on the midline. At the time of consultation he had sprained his right knee. The main pattern was Kidney deficiency. The points used in this session were:

-

-

-

T.B.-6 Zhigou on the right and G.B.-31 Fengsh i on the left to expel Wind and clear Heat. L.l.-11 Quchi on the left and SP-1 0 Xuehai on the right to cool Blood in the skin. SP-9 Yinlingquan, bilaterally, to resolve DampHeat.

-

ST-34 Liangqiu, ST-35 Dubi, ST-36 Zusan li and SP-9 Yinlingquan, all on the right side, to benefit sinews of the knee and eliminate stagnation. S.l. -3 Houxi on the left and BL-62 Shenmai on the right to open the Governing Vessel, tonify the Kidneys and strengthen the back.

l

Kl-3 Taixi on the left, to tonify the Kidneys. Using this point on the side opposite the sprained knee achieves the purpose of balancing Left and Right, Yin and Yang and the Heavenly Stems (Stomach and Kidney).

Case history 11 .20 A man aged 56 suffered from exhaustion, backache, depression and impotence. His tongue was Red and Peeled, except on the root where it had a stickyyellow coating. The main patterns were deficiency of Kidney-Yin with Damp-Heat in the Lower Burner. The points used in one session were: -

S./.-3 Houxi on the left and BL-62 Shenmai on the right to open the Governing Vessel, tonify the Kidneys, strengthen the spine and lift mood. This extraordinary vessel has a strengthening effect on the Mind and Will-power when these are affected by a Kidney deficiency. This vessel was therefore used to treat the backache and the Will-power, even though there was a deficiency of Kidney-Yin. - Ren-4 Guanyuan and Du-20 Baihui to nourish Kidney-Yin and lift mood. This combination balances Front and Back, Directing and Governing Vessels, and Yin and Yang. It is effective in relieving depression occurring against a background of Kidney deficiency. - ST-36 Zusanli and Kl-3 Taixi, bilaterally, to tonify Qi and nourish the Kidneys. This combination balances Yin and Yang. - SP-9 Yinlingquan, bilaterally, to drain Damp-Heat in the Lower Burner. This, in addition to the deficiency of Kidney-Yin, can be a contributory factor in causing impotence. - BL-23 Shenshu and BL-52 Zhishi, bilaterally, to nourish the Kidneys, strengthen Will-power and lift mood. This combination is excellent to affect the mental aspect of the Kidneys, i.e. Will-power, which encompasses drive and determin ation, and thus lift depression. This patient fell fast asleep while the front points were being retained and reported that the back points woke him up and made his brain feel much brighter.

Case history 11.21 A 54-year-old woman complained of a backache on the left side extending to the loin just below

THE COMBINATION OF ACUPUNCTURE POINTS

213

the twelfth rib; this pain had started 3 weeks earlier. Her spine showed a pronounced deviation to one side in the lumbar area and her left leg was shorter than the right. Her pulse was Firm (i .e. Wiry at a deep level), especially Wiry on both Rear positions, and slightly Overflowing on the Heart position. The points used in one session were as follows: -

Kl-6 Zhaohai on the right and LU-7 Lieque on the left to open the Yin Stepping Vessel (Yin Qiao Mai) and absorb excess Yin. This condition is evidenced by the Firm quality of the pulse which indicates stagnation in the Interior at the Yin level. The Yin Stepping Vessel also harmonizes Left and Right and corrects structural imbalances between the left and right sides of the body: it is therefore often indicated in musculoskeletal problems characterized by such imbalances, as it was in this case with a deviation of the lumbar vertebrae and a difference in length between the right leg and the left. The use of the Yin Stepping Vessel is also indicated by the Wiry quality on both Rear positions, according to the 'Study of the Eight Extraordinary Vessels' by Li Shi Zhen 2 1 - HE-6 Yinxi on the right and Kl-2 Rang u on the left to harmonize Heart and Kidneys. This combination of points from two related arm-leg channels of the same polarity harmonizes Left and Right, and arm and leg channels. These two points were selected on the basis not of any particular pattern, but purely of the presenting energetic imbalance as mirrored by the pulse. The Overflowing quality on the Heart pulse and the Wiry one on the Kidney pulse show a breakdown of interaction between Heart and Kidneys with an accumu lation of Qi in the lower part (causing the backache) and an 'escape' of Qi in the upper part. HE-6, Accumulation point, was selected to remove obstructions, which is one of the functions of such points, and Kl-2, Spring point, was chosen because the Spring points drain Qi downwards. Both Accumulation and Spring points are particularly dynamic and the combination of the two makes for an especially moving treatment in energetic terms. The unilateral use of the points enhances thei r moving effect. - SP-6 Sanyinjiao, bilateral ly, was used to provide some tonification to balance the other points which are strongly moving.

214

PART 2: THE MAIN CHANNELS

During the treatment she felt a vibration in the loin region. After this first treatment, the backache went from the loin region and was confined to the sacroiliac region. I repeated the same points as above adding: -

BL-23 Shenshu, bilaterally, to strengthen the back. BL-26 Guanyuanshu and BL-40 Weizhong, both on the left, to remove obstructions from the back channels on the left side.

Her backache was completely gone after these two treatments and her pulse became much more balanced.

Case history 11.22

A 58-year-old man suffered from impotence and anxiety. He was a very tense person and his tension aggravated his impotence, while his sexua l inadequacy made him more tense, thus establishing a selfperpetuating vicious circle. His pulse was very Wiry and Full but slightly Weak on both Rear positions and his tongue had a very Red tip. The main patterns were Heart-Fire, stagnation of Liver-Qi and some Kidney deficiency. The points used in one session were: -

-

-

S.l.-3 Houxi on the left and BL-62 Shenmai on the right to open the Governing Vessel and strengthen the Kidneys. HE-7 Shenmen on the right and LIV-3 Taichong on the left to calm the Mind, settle the Ethereal Soul and relieve stagnation of Liver-Qi. Kl-3 Taixi bilaterally to tonify the Kidneys.

Case history 11.23 A woman aged 70 suffered from chronic sinusitis and constipation. Her tongue had a very sticky-white coating and her pulse was Slippery. The main patterns were retention of Dampness affecting the sinuses, against a background of Spleen-Qi deficiency and retention of food. The points used in one session were: -

-

SP-4 Gongsun on the right and P-6 Neiguan on the left to open the Penetrating Vessel, regulate the Spleen and relieve retention of food. L.l.-4 Hegu on the right and ST-40 Fenglong on the left to regulate the ascending and descending of Qi in the Bright Yang channels (to help the sinuses) and resolve Dampness.

-

Yintang as a local point to free the sinuses. ST-36 Zusanli and SP-6 Sanyinjiao t o tonify Stomach and Spleen to resolve Dampness.

Case history 11.24 A 25-year-old woman complained of pa inful periods with dark-clotted menstrual blood and backache. She did not have any other symptoms and her pulse was Weak on the left Rear position and slightly Overflowing on the Heart position. Her tongue had a Heart crack and a Red tip with red points. The main patterns were Heart-Fire from emotional stress and a constitutional Kidney deficiency. The points used in one session were: -

P-7 Daling on the right and L/V-3 Taichong on the left to calm the Mind and settle the Ethereal Soul. ST-36 Zusanli on the left and Kl-3 Ta ixi (with warm needle) on the right to tonify Kidney-Yang. SP-6 Sanyinjiao bilaterally to nourish the Kidneys and calm the Mind.

NOTES 1. 1 compare an acupuncture treatment to a painting. The attributes of a beautiful painting are three: technique. colour and composition. Similarly. a good acupuncture treatment depends on a good needle technique. good choice of individual points and good balance of the points, equivalent to the technique. colour and composition of a painting respectively. 2. Maciocia G. 2005 The Foundations of Chinese Medicine. Churchill Livingstone. Edinburgh. 3. Nanjing College of Traditional Chinese Medicine 19 79 A Revised Explanation of the Classic of Difficulties (Nan]ing fiao Shi ~ ~ !if ). People's Health Publishing House. Beijing. first published c. AD 100. p. 144. 4. Gao Wu 1529 Gathering of Eminent Acupuncturists (Zhen Jiuju Ying H ~ ~ 5€ ) cited in Chen You Bang 1990 Chinese Acupuncture Therapy (Zhong Guo Zhen]iu Zhi Liao Xue

*

THE COMBINATION OF ACUPUNCTURE POINTS shade in the back. However. this means that the polarity Yin- Yang for Right-Left needs to be reversed as the East (Yang) would be on the right side and West (Yin) on the left. 13. Simple Questions. p. 44. 14. The Chinese correspondence between Back and Left (Yang) and Front and Right (Yin ) seems to be confirmed by recent discoveries in palaeontology. Accord ing to these theories the a ncestor of all vertebrates (500 million yea rs ago) was Cotlwmocystis elizae. which was strikingly asymmetrical between left and right. Its own ancestor. which lived on the sea bed, had been perfectly symmetrical between left and right. For some reason. it flipped onto its right side. which became its front. so that its left side became its back. This means that all an imals that evolved from Cotlwmocystis elizae-like organisms. including verteb rates such as huma ns. have a left and a right that were originally their back and front respectively. See R.P.S. Jefferies

15. 16. 17. 18. 19. 20.

21.

215

1 991 Two types of bilateral symmetry in the Metazoa: chordate and bilaterian. Natura l History Museum. London. Gathering of Eminent Acupu ncturists. cited in Chinese Acupuncture Therapy. p. 215. Ibid. Ibid . Ibid. The ABC of Chi nese Medicine cited in ibid. Wang Luo Zhen 1985 A Compilatio n of t he 'Study of the Eight Extraord inary Vessels' (Qi ]ing Bn Mai Kno ]ino Z/111 l!lf ~£ J\ II>}:~~ il ). Shanghai Science Publishing House. Shang hai. p. 109 . The 'Study of the Eight Extraordinary Vessels' (Qi j ing Ba Mni Kno l!lf ~ }\ Jlil: ::1;' ) by Li Shi Zhen was published in 1578. Ibid .. p. 110.

PART 3

CONN ECTING CHANNELS (LUO MAl) 12 Morphology and pathways of Connecting channels 219 13 Physiology of the Connecting channels 235 14 Aetiology and diagnosis of the Connecting channels 247 15 Pathology of Connecting channels 247 16 Treatment of the Connecting channels 267

Part 3 deals with the morphology, functions, pathology and treatment of the Connecting channels (Luo Mai). Apart from the Extraordinary Vessels, the Connecting channels are probably the most important and most clinically relevant secondary channels. Their pathology is very wide ranging and the treatment methods very important. A special feature of this Part is the discussion of the deeper level of the Connecting channels, i.e. the Deep (Blood) Connecting channels, which , to my knowledge, has received no mention in any Westernlanguage textbook of Chinese medicine.

CHAPTER 12

MORPHOLOGY AND PATHWAYS OF CONNECTING CHANNELS MORPHOLOGY OF CONNECTING CHANNELS 219 PATHWAYS OF THE CONNECTING CHANNELS PROPER The three Yin of the arm 224 The three Yang of the arm 226 The three Yang of the leg 227 The three Yin of the leg 229 Directing and Governing Vessels 231 Great Connecting channels of the Spleen and Stomach 232

224

they fHI the space between skin and muscles, i.e. the Cou Li space (Fig. 12.2). Within the space between the Main channels and the skin that is occupied by the Connecting channels there are also, however, degrees of depth. On the superficial layers just below the skin there are smaller Connecting channels called Minute (Sun) and Superficial (Fu) Connecting channels (Fig. 12.3).

MORPHOLOGY OF CONN ECTING CHANNELS The Connecting channels are called Luo Mai: Luo means 'network'. The Main channels are called Jing Mai and Jing means 'line', 'route', or 'way'. Therefore, the Main channels are compared to routes or lines, which implies a vertical flow of Qi, while the Connecting channels are compared to a network of channels flowing in all directions, which implies a horizontal flow of Qi. Chapter 17 of the 'Spiritual Axis'confrrms that the Connecting channels are 'horizontal' or 'crosswise': 'The Main channels are in the Interior, their horizontal [or crosswise] branches are the Connecting channels.' 1 See Figure 12.1. The Connecting channels are more superficial than the Main channels and they run in all directions rather than 'vertically' as the Main channels do. In particular,

The Main channels have a 'vertical' f low of Qi; the Connecting channels have a 'horizontal' fl ow of Qi.

'\'U\H"'!ft--Connecting channel

Fig. 12.1 Vertical and horizontal flow of Qi in the Main and Connecting channels.

219

220

PART 3: CONNECTING CHANNELS (LUO MAl)

Space between skin- - - . - - - - - - - -? and muscles

Skin

Fig. 12.2 The Connecting channels and the space between skin and muscles.

Minute and superficial connecting channels Connecting channel

Fig. 12.3 The Superficial and Minute Connecting channels.

The main branches of the Connecting channels are called bie, i.e. 'divergent' (the same character as that used for 'Divergent' channels). Chapter 17 of the 'Spiritual Axis' says: 'The Main channels are in tile Interior; their l!orizontal for crosswise] branches are the Connecting cl!anne/s: branching out from these are the Minute Connecting channels.' 2 Chapter 10 of the 'Spiritual Axis' says: 'The more superficial branches of

the channels which can be seen are the Connecting channels.' 3 As the Minute and Superficial channels spread all over the body in a dense network of very small channels, there is no part of the body that is not irrigated by Superficial and Minute channels and no channel that does not communicate with Superficial and Minute channels. In fact, Chapter 58 of the

MORPHOLOGY AND PATHWAYS OF CONNECTING CHANNELS

Fig. 12.4 Energetic layers of the Connecting channels.

Space between skin and muscleDEFENSIVE-QI LEVEL DEFENSIVE-QI LEVEL

Superficial Connecting channel

I

Ql LEVEL BLOOD LEVEL

Connecting channel

Main channel

Deep Connecting channel

Fig. 12.5 The energetic layers of Main and Connecting channels and types of Qi.

'Simple Questions' says: 'The Minute Luo [Sun Luo] communicate with the 365 points.'4 There is also a deeper layer of Connecting channels. which lies beyond that of the Main channels. The channels in this deeper layer can be called the Deep Connecting channels and they are energetically related to the blood vessels and Blood in general (Fig. 12.4). Several sayings of Chinese medicine imply a deeper layer of Qi, beyond the Main channels, that is related to the Deep Connecting channels: for example, 'Old disease reaches the Luo', 'Patlwgenic factors go from Main clrannels to the Connecting (Luo) channels', 'In the beginning of a disease the pathogenic factor is at the Qi level in tiLe Main channels; in late stages, it enters the Blood level in tiLe Connecting (Luo) clzannels', 'Chronic disease reaclzes the Connecting (Luo) channels'.5 See Figures 12.5 and 12.6. Thus, if we think for example of the cross-section of a limb, the levels of Connecting channels are as follows:

YANG su?erf icial Luo

Superficia l l ll 0

- Superficial and Minute Connecting channels - Connecting channel proper - Main channel -Deep (Blood) Connecting channel.

YIN Fig. 12.6 The energetic layers of Main and Connecting channels.

221

222

PART 3: CONNECTING CHANNELS (LUO MAl)

CLINICAL NOTE There is a deeper layer of Connecting channels, which lies beyond the Main channels: these are the Deep Connecting channels, which are related to Blood and blood vessels. Most Blood stasis in the body occu rs in the Deep Connecting channels. For example, a myoma ('fibroid') in the uterus is due to Blood stasis in the Deep Connecting channels in the uterus; a breast fibroadenoma or carcinoma is due to Blood stasis in the Deep Connecting channels of the breast. etc.

Chapter 66 of the 'Spiritual Axis' mentions the different energetic layers in connection with the invasion of external pathogenic factors: 'When pathogenic factors invade the body, they invade the skin first. When the skin is relaxed the space bet ween the skin and muscles is open which allows the pathogenic factors to move from the hair to a deeper level; when they do so, the hair stands on end, the patient shivers and there is pain in the skin. If the patlwgenic factor is not expelled, it enters the Connecting channels; when it is there, there is muscular pain; when the pain ceases, tile Main channels will be painful instead. If the pathogenic factor is not expelled, it enters the Main channels; when it is there, .the patient shivers and is startled.· 6 The passage goes on to describe how the pathogenic factor progresses from the Main channels to the 'acupuncture points' to cause pain in the limbs and stiffness of the back, then to the Penetrating Vessel causing heaviness and pain, then to the Stomach and Intestines causing abdominal distension and diarrhoea, then to the Membranes and finally to the 'blood vessels' causing abdominal masses Ui) from Blood stasis. When the pathogenic factor is in the 'blood vessels' it is in the Deep Connecting channels that are related to Blood and the blood vessels: at this energetic level that involves Blood, Blood masses Ui of Ji-Ju) are formed

from Blood stasis. This is due to Blood stasis in the Deep Connecting channels. We can relate the three layers in the channel network to the three types of Qi, i.e. Defensive Qi, Nutritive Qi and Blood: -on the surface, the Connecting channels = Defensive-Qi level - in the centre, the Main channels = Qi and Nutritive-Qi level - in the Interior, the Deep Connecting channels Blood level.

=

The 12 Main channels are situated between the Yang and Yin Connecting channels. It is through the Yin and Yang Connecting channels that Nutritive (Ying) and Defensive (Wei) Qi, and Qi and Blood of the Main channels spread in all directions, permeating and irrigating the Internal Organs. It is also through the Connecting channels that the essence of the Internal Organs is transported to the Main channels and, through them, to the whole body (Fig. 12. 7). The Connecting channels cannot penetrate the big joints of the body (as the Main channels do) and they are therefore restricted to the spaces in between the deep pathway of the Main channels and the surface of the body. The Connecting channels also fill the spaces and 'cavities' of the body which are all part of the Triple Burner. This means that most of the stagnation in the body actually occurs in the Connecting channels because they are 'constricted' in these spaces (as they cannot course through the large joints) and because they are formed like a net which easily 'catches' pathogenic factors or in which Qi and/or Blood become stagnant. Chapter 10 of the 'Spiritual Axis' says: 'The Connecting channels cannot course through the large joints: in order to [enter and] exit they must move by alternate routes. They then enter and come together again under the skin and therefore they can be seen from the outside. Superficial Yang Connecting channel

- - - - - - - - - - - - - - - - - - - - - - - - - - - - Yang Connecting channel - - - - - - - - - - - - - - - - - - - - - - - - - - - - Main Yang channel Deep Yang Connecting channel ------------------------------------------------------------------------------------------------------------Fig. 12.7 The energetic layers of Yin and Yang Main and Connecting channels.

YANG

Deep Yin Connecting channel Main Yin channel YIN Yin Connecting channel Superficial Yin Connecting channel

MORPHOLOGY AND PATHWAYS OF CONNECTING CHANNELS

223

CLINICAL NOTE The Connecting channels cannot course through the large joints (as the Main channels do) but are restricted to the spaces between the Main channels and the skin and the cavities of the Triple Burner. In practice, this means that the Connecting channels area is particularly prone to stagnation also because the 'network' of channels can easily 'trap' Qi or Blood or pathogenic factors. One could say that most stagnation in the body, whether of Qi or Blood, occurs in the Connecting channels.

It is very important to clarify a question of terminology: the term 'Connecting channel' can actually refer to two different entities: - I t refers to the Connecting channels that depart

Fig. 12.8

Connecting channels and joints.

To needle tlze Connecting channel one must needle ahove tlze accumulation where Blood is concentrated. Even if there is no blood accumulation, one must prick to cause !Jleeding quickly to drain the pathogenic factors out: if this is not done, Painful Obstruction [Bi) syndrome may develop.' 7 See Figure 12. 8.

from each Connecting (Luo) point with a defmite trajectory described in Chapter 10 of the 'Spiritual Axis' (described below). For example, the Lung Connecting channel departs from LU-7 Lieque and scatters over the thenar eminence. I shall call these 'Connecting channels' or 'Connecting channels proper'. - I t refers to the whole area of the body where the Connecting channels f1ow, i.e. the area between the Main channels and the surface. Each channel therefore has a Connecting-channel area that covers the whole pathway of the Main channel. This area follows the whole trajectory of the Main channel and not just the actual Connecting channels described in Chapter 10 of the 'Spiritual Axis'. I shall call this the 'Connecting-channel area'. See Figure 12.9.

LU-7 Lieque Connecting channel area

Fig. 12.9

Difference between Connecting channel and Connecting-channel area.

224

PART 3: CONNECTING CHANNELS (LUO MAl)

SUMMARY The term 'Connecting channel' refers to two different entities: • t he Connecting channels that depart from each Connecting (Luo) point with a definite trajectory described in Chapter 10 of the 'Spiritual Axis' (e.g. the Lung Connecting channel departing from LU-7 Lieque and scattering over the thenar eminence) • t he whole area of the body where the Connecting channels f low, i.e. the area between the Main channels and the surface. See Figure 12.9.

PATHWAYS OF THE CONNECTING CHANNELS PROPER The pathways of the Connecting channels proper are described in Chapter 10 of the 'Spiritual Axis' (the same chapter that describes also the pathways of the Main channels). The pathways as described in this chapter are listed below. 8 Chapter 10 of the 'Spiritual Axis' mentions 15 Connecting channels; the Great Connecting channel of the Stomach is mentioned only in Chapter 18 of the 'Simple Questions'. This chapter says: 'The Great Connecting channel of the Stomach is called Xu Li. It penetrates the diaphragm; it com ~ects with tile lungs and exits below tlze left breast. One can feel its pulsation by hand: it is tile place where the Gathering Qi (Zong Qi) of the vessels [or channels] is situated.' 9 As explained above, the pathways described below are strictly what I call the 'Connecting channels proper', i.e. the trajectories departing from each Connecting point. In addition to these, for each Main channel, there is an overlying area of Connecting channel between the Main channel and the skin (see Fig. 12.9). I shall list the channels in the order of their listing in Chapter 10 of the 'Spiritual Axis', i.e.

MORPHOLOGY OF CONNECTING CHANNELS

• The Main channels are called Jing Mai and jing means 'route', 'way', i.e. a straight line with an implied 'vertical' flow of Qi • The Connecting channels are called Luo Mai and luo means 'network', i.e. a widespread system of smal l channels w ith an implied 'horizontal' flow of Qi • The Connecting channels are more superficial than the Main channels, lying between them and the skin. • Within this space, the Superficial (Fu) and Minute (Sun) channels are the more superficial parts of the Connecting channels • There is a deeper layer of Connecting channels beyond that of the Main channels: these are the Deep Connecting channels which are related to Blood and blood vessels • The Deep Connecting channels are involved in the pathology of chronic diseases, often with Blood stasis • The Connecting channels, Main channels and Deep Connecting channels correspond to the three types of Qi: Defensive Qi, Nutritive Qi and Blood respectively • The Main channels are situated between the Yang and Yin Connecting channels and it is through these that Nutritive Qi, Defensive Qi and Blood spread in all directions, permeating and irrigating the Internal Organs • The Connecting channels cannot penetrate and pass through the large joints but are restricted to the 'spaces' between the skin and muscles and also the 'cavities' of the body: this means that they are particularly prone to stagnation .

The three Yin of the arm a. The three Yin of the arm b. The three Yang of the arm c. The three Yang of the leg d. The three Yin of the leg e. Directing and Governing Vessels f. Great Connecting channel of the Spleen.

Lung Connecting channel (Fig. 12.10) • It departs from LU-7 Lieque. • It follows the Lung channel into the palm. • It scatters over the thenar eminence.

MORPHOLOGY AND PATHWAYS OF CONNECTING CHANNELS

Fig. 12.10 Lung Connecting channel.

CLINICAL NOTE Some Connecting channels, such as the Lung one, seem to have a rather insignificant trajectory. However, the clinical importance of LU-7 goes far beyond that of its Connecting channel. LU-7 is a major point to make Lung-Qi descend and is also used for pathologies of the head. Moreover, it is the opening point of the Directing Vessel (Ren Mai).

Heart Connecting channel (Fig. 12.11) • • • •

It departs from HE-5 Tongli. It connects with the Small Intestine channel. It follows the Heart channel to the heart. It then llows to the tongue and the eye.

225

Fig. 12.11 Heart Connecting channel.

CLINICAL NOTE By virtue of the Connecting channel, HE-5 is the best point of the Heart channel to influence the tongue and eye in Heart-related pathologies of these organs. For example, HE-5 is used for tongue ulcers or for speech difficulty after a stroke.

Pericardium Connecting channel (Fig.l2. 12) • It departs from P-6 Neiguan in the inside of the

forearm. • It flows up with the Main channel to the

pericardium and then the heart.

226

PART 3: CONNECTING CHANNELS (LUO MAl)

CLINICAl NOTE

Fig. 12.12 Pericardium Connecting channel.

The three Yang of the arm Large Intestine Connecting channel

P-6 Neiguan is a point of major clinical significance and many of its functions are due to it being the Connecting point. The clinical significance of this point lies in its dual nature of 'hinge'. In fact, the Pericardium channel, together with the Liver, pertains to the Termina l Yin (Jue Yin) which is the 'hinge' between the Greater Yin (Tai Yin) and Lesser Yin (Shao Yin): being the hinge means, besides other things, that the Termina l Yin channel can affect also the Greater and Lesser Yin channels. Incidentally, this is partly why P-6 Neiguan (on a Terminal Yin channel) is the opening point of the Yin Linking Vessel (Yin Wei Mal) which links all the Yin channels. Moreover, Connecting points establish a connection between Yin and Yang channels, i.e. P-6 Neiguan connects the Pericardium channel with the Triple Burner channel. So, P-6 Neiguan is an 'intermediary' point for two reasons: it is the intermediary between Greater Yin and Lesser Yin and also the intermediary between Pericardium and Triple Burner. It is therefore, so to speak, the 'hinge of the hinge'. Its double nature of intermediary point renders P-6 Neiguan a very dynamic point and its dynamism is particularly evident in the mentalemotional sphere. In fact, this point has a very dynamic psychological action moving Qi on an emotional level, stimulating the 'coming and going' of the Ethereal Soul (Hun) and lifting mood.

{Fig. 12.13) • It departs from L.I.-6 Pianli. • It joins with the Lung channel 3 cun above the

Small Intestine Connecting channel (Fig. 12.14)

wrist. • It ascends the arm through L.I.-15 Jianyu to the

jaw and cheek where it divides, one branch going to the teeth, the other to the ear where it joins the Ancestral Vessel (zong mai). 10

• It departs from S.I.-7 Zhizheng. • It connects with the Heart channel. • It flows up the arm and reaches the shoulder at

L.I.-15 Jianyu.

CliNICAL NOTE CLINICAl NOTE

As the Connecting channel of the Large Intestine flows to t he teeth, L.l.-6 Pianli is a good distal point for teeth, jaw and cheek problems.

S.l.-7 Zhizheng is an effective distal point for inflammation of the sinews of the medial condyle ('tennis elbow' of the medial condyle aspect of the arm).

MORPHOLOGY AND PATHWAYS OF CONNECTING CHANNELS

Fig. 12.13 Large Int est ine Connecting channel.

227

Fig. 12.15 Triple Burner Connecting channel.

Triple Burner Connecting channel (Fig. 12.15) • It departs from T.B.-5 Waiguan. • It flows up the posterior aspect of the arm and to

the shoulder. • It flows to the centre of the chest and connects

with the Pericardium.

The three Yang of the leg Stomach Connecting channel (Fig. 12.16) • It departs from ST-40 Fenglon g 8 cun above the

external malleolus. • It flows up the leg and a branch joins with the

Spleen channel. • It then flows up the torso to the nape of the neck

and head where it converges with the Qi of other channels. • It then flows down to the throat. Fig. 12.14 Small Intestine Connect ing channel.

228

PART 3: CONNECTING CHANNELS (LUO MAl)

CLINICAL NOTE Much that was said about P-6 Neiguan with regard to Yin channels applies equally to T.B .-5 Waiguan with regard to Yang channels as the Triple Burner channel pertains to the Lesser Yang (Shao Yang) which is the hinge between the Greater Yang (Tai Yang) and Bright Yang (Yang Ming). In fact, the Triple Burner channel, together with the Gall Bladder, pertains to the Lesser Yang which is the 'hinge' between the Greater Yang and Bright Yang: being the hinge means, besides other things, that the Lesser Yang channel can affect also the Greater and Bright Yang channels. Incidentally, this is partly why T.B.-5 Waiguan (on a Lesser Yang channel) is the opening point of the Yang Linking Vessel (Yang Wei Ma1) which links all the Yang channels. Moreover, Connecting points establ ish a connection between Yin and Yang channels, i.e. T.B .-5 Waiguan connects the Triple Burner channel with the Pericardium channel. So, T.B .-5 Waiguan is an 'intermediary' point for two reasons: it is the intermediary between Greater Yang and Bright Yang and also the intermediary between Pericardium and Triple Burner. It is therefore, so to speak, the 'hinge of the hinge'. Its double nature of intermediary point renders T.B.-5 Waiguan a very dynamic point t hat can harmonize the Yang, subdue Liver-Yang and expel both internal and external Wind . Finally, the equivalence between P-6 Neiguan and T.B.-5 Waiguan is evidenced by their names, the former meaning ' Inner Gate' and the latter 'Outer Gate'.

CLINICAL NOTE The pathway of the Stomach Connecting channel is clinically significant. First, the Connecting channel flows to the neck from ST-40 Fenglong : this point can in fact be used for neck-ache deriving from a Stomach channel disharmony. Secondly, the Connecting channel flows to the head: this explains the use of ST-40 Fenglong to eliminate Phlegm from the head and Brain where it can cloud the Mind causing mental confusion, muzziness, agitation and, in extreme cases, manic behaviour. Thirdly, the Connecting channel flows to the throat. This makes ST-40 Fenglong useful to treat goitre from Phlegm deriving from a def iciency of the Spleen and Stomach.

Fig. 12.16 Stomach Connecting channel.

MORPHOLOGY AND PATHWAYS OF CONNECTING CHANNELS

229

Fig. 12.17 Bladder Connecting channel.

Bladder Connecting channel (Fig. 12.17) Fig. 12.18 Gall Bladder Connecting channel.

• It departs from BL-58 Feiyang. • It connects with the Kidney channel.

CLINICAl NOTE The Bladder channel is the main one to treat for backache and sciatica. BL-58 Feiyang is an effective distal point for lower backache and sciatica particularly when there is Qi stagnation and Blood stasis (manifesting with pronounced stiffness and aggravation at night). Being the Connecting point, this point has a dynamic effect in eliminating stagnation from the Connecting channel all along the Bladder channel.

Gall Bladder Connecting Channel (Fig. 12.18) • It departs from G.B.-3 7 Guangming. • It connects with the Liver channel. • It llows down and scatters in the dorsum of the

foot.

• It connects with the Stomach channel. • It enters the abdomen and connects with the

Intestines and Stomach.

CLINICAl NOTE The fact that the Spleen Connecting channel f lows to the Stomach and Intestines makes SP-4 Gongsun a very important point to use in problems of these two organs in a wide variety of digestive problems, especially those of a Fu ll nature. SP-4 Gongsun is the opening point of the Penetrating Vessel.

Kidneys Connecting Channel (Fig. 12.20) • It departs from KI-4 Dazhong behind the

internal malleolus.

The three Yin of the leg

• It encircles the heel and connects with the

Spleen Connecting channel (Fig. 12.19)

• It follows the Kidney channel up and reaches the

Bladder channel. Pericardium.

• It departs from SP-4 Gongsun 1 cun behind the

big-toe joint.

• It then llows down to the back to spread in the

lumbar vertebrae.

230

PART 3: CONNECTING CHANNELS (LUO MAl)

Fig. 12.20 Kidney Connecting channel.

CLINICAL NOTE

Fig. 12.19 Spleen Connecting channel.

The trajectory of the Kidney Connecting channel is clinically significant for two factors. First, it f lows to the Pericardium and this explains the strong mentalemotional effect of Kl-4 Dazhong. I use this point whenever there is anxiety occurring against a background of Kidney deficiency. Second, the Kidney Connecting channel flows into the lumbar vertebrae and this makes Kl-4 Dazhong a very useful point to use in chronic backache deriving from a Kidney deficiency.

MORPHOLOGY AND PATHWAYS OF CONNECTING CHANNELS

Liver Connecting channel (Fig. 12.21) • It departs from LIV-5 Ligou in the inside of the leg. • It connects with the Gall Bladder channel. • It flows up to the genitals.

231

CliNICAL NOTE As the Liver Connecting channel flows to the genitals, I use LIV-5 Ligou in a variety of problems of this area such as vaginitis, urinary difficulty and excessive vaginal discharge.

Directing and Governing Vessels Directing Vessel (REN MAl, Fig. 12.22) • It departs from Ren-15 Jiuwei. • It scatters over the abdomen.

CLINICAL NOTE The Connecting channel of the Directing Vessel spreads over the upper abdomen. I use this point in mental-emotional problems when the patient experiences tightness just below the xiphoid process.

Fig. 12.21 Liver Connecting channel.

Fig. 12.22 Directing Vessel (Ren Mai) Connecting channel.

232

PART 3: CONNECTING CHANNELS (LUO MAl)

I

I

I

I I I I I I I I

I I I I I I I I

~

~

,, : /I

I

I

I

I\

I

I \

I

:

I

I

I

~

I

I / I I I I

\

~

1\

I I

I \ J \

I

I

: :

/

\

I

)

,. I

\

I\ I \ I \

: :

/ /

'\

~

/I I I I I

/

\

~\

,J,

\

I I I I

I \ I \ I \ I \

I I I I I I I I

I I I I I I I I

: : \

\

,,,

I

\

\

I

Fig. 12.24 Great Connect ing channel of the Spleen.

Fig. 12.23 Governing Vessel (Ou Mai) Connecting channel.

Governing Vessel (Du Mai, Fig. 12.23) • • • • •

It departs from Du-1 Changqiang. It flows up the sides of the spine. It reaches the neck and spreads over the occiput. It scatters on the vertex. It connects with the Bladder in the scapular

region on both sides. • It penetrates the spine.

Great Connecting channels of the Spleen and Stomach Great Connecting channel of the Spleen (Fig. 12.24) • It departs from SP-21 Dabao 3 cun below the

axilla. • It spreads in the chest and hypochondrium.

Fig. 12.25 Great Connect ing channel of the Stomach.

MORPHOLOGY AND PATHWAYS OF CONNECTING CHANNELS

Great Connecting channel of the Stomach (Fig. 12.25)

NOTES l. 1981 Spiritual Axis (Ling Sh11 jing

• • • •

It starts in the chest. It penetrates the diaphragm. It connects with the lungs. It exits below the left breast.

2. 3. 4.

5.

CliNICAL NOTE The Classics do not give a point for the Great Connecting channel of the Stomach, but I use ST-40 Fenglong as a Connecting point for this channel. As the Great Connecting channel of the Stomach is the Xu Li, i.e. the beating of the fifth ventricle of the Heart, in my experience, ST-40 is an effective distal point for problems of the heart (e.g . arrhythmia).

233

6. 7.

8. 9. 10.

m

~ ~£ ).People's Health Publishing House. Beijing. first published c. 100 Be, p. 50. Ibid .. p. 50. Ibid .. p. 37. 1979 The Yellow Emperor's Classic of Internal Medicine- Simple Questions (HIIali!J Ti Nei jing S11 Wen ~ %' p;j ~£ jl foi] ). People's llealth Publishing House. Beijing. 11rst published c. 100 BC, p. 301. Zhou Xiao Qing ' Identification of Patterns of Diseases of the Connecting Channels' (Luo Bing Bian Zlleng ~ f.ij iiE ). in 'journal of Chinese Medicine' (Zhong Vi Za Zhi q:. IJii: ~ ;t ). China Association of Traditional Chinese Medicine and China Academy of Traditional Ch inese Medicine. Beijing. Vol. 38. No. J 0. J 997. p. 584. Spiritual Axis. p. 121. Ibid .. p. 3 7. Ibid .. p. 3 7- 39. Simple Questions. p. lll. The Ancestral Vessel (Zong Mai J!;jc ) is a term that indicates the convergence of the Qi of a lithe Yin and Yang Internal Organs in both the ear and the eye. It is mentioned in Chapter 28 of the 'Spiritua l Axis'.

m

*

CHAPTER 13

PHYSIOLOGY OF THE CONNECTING CHANNELS BALANCING YIN AND YANG IN THE LIMBS 235 NOURISHMENT 236 PROTE CTION 237 WARMING 238 CONNECTING AND HARMONIZING EXTERIOR WITH INTERIOR 238 CONNECTING AND HARMONIZING LEFT AND RIGHT SIDES OF THE BODY 239 MAKING OF BLOOD 239

The Connecting channels, comprising the Superficial and Minute channels, flow all over the body. They penetrate and irrigate Interior and Exterior, they connect with the Main channels, they enter the Internal Organs and they circulate Qi and Blood. The Connecting channels occupy both a superficial and a deep space within the body above and below the Main channels.

BALANCING YIN AND YANG IN THE LIMBS One of the main functions of the Connecting channels is to balance Yin and Yang in the arms and legs, i.e. they absorb Excesses or augment Deficiencies of Yin and Yang in the limbs. As we have seen in Chapter 2, Qi flows from the chest to the head due to a difference of energy potential between these two areas. Qi flows through the hands on its way up to the head and through the feet on its way back to the chest. The fingers and toes are areas where Qi changes polarity, from Yin to Yang and Yang to Yin respectively. Although the change of polarity takes place at the fingertips and toes, it does not happen suddenly and abruptly only in these areas: in fact, the whole

lower limb (below the elbow and below the knee) should be seen as the area where the change of polarity occurs. For example, the Lung channel ends at LU-ll Shaoshang and flows into the Large Intestine channel at L.I.-1 Shangyang; however, the change of polarity from Yin to Yang does not occur abruptly at the fingertip. In fact, the Yin influence of the Lung channel manifests itself in the Large Intestine channel beyond L.I.-1 Shangyang: similarly for the Yang influence of the Large Intestine channel in the Lung channel area in the forearm (Fig. 13.1). Therefore, the limbs are areas where Yin and Yang are in a state of flux and change; the Connecting channels play the important role of ensuring the balance of Yin and Yang Qi in the limbs. For example, a stagnation of Cold or Dampness in a joint represents Excess of Yin Qi; and the Connecting channels, by harmonizing Yin and Yang, generally prevent that stagnation from occurring. Obviously, when the pathogenic factor is stronger than the body's Qi or when there is an inner imbalance between Yin and Yang, stagnation may occur in the limbs.

Yang influence in Yi n channel Fig. 13.1 Mutual Yin-Yang influence in the channels of the forearm.

235

236

PART 3: CONNECTING CHANNELS (LUO MAl)

Thus, under normal, physiological conditions, the Connecting channels in the limbs maintain the balance between Yin and Yang Qi and therefore prevent any stagnation in the limbs and the joints. Stagnation may occur either when external pathogenic agents are strong enough to upset the proper balancing function of the Connecting channels or when these are affected by an internal imbalance between Yin and Yang that allows pathogenic agents to affect the body. 'Regulating Yin and Yang' implies also regulating the ascending (a Yang movement) and descending (a Yin movement) of Qi to and from the head. Clear Qi needs to ascend to the head to brighten the sense orifices and the Brain, and turbid Qi needs to descend from the head. If these movements are impaired, Dampness and/or Phlegm may settle in the head. CLINICAL NOTE As the Connecting channels balance Yin and Yang Qi in the limbs, Connecting (Luo) points are frequently used to regulate the ascending and descending of Qi to and from the head. 'Regulating Yin and Yang' implies also regulating the ascending (a Yang movement) and the descending (a Yin movement) of Qi to and from the head. For example, LU-7 Lieque can regulate the ascending and descending of Qi and promote the ascending of clear Qi t o and the descending of turbid Qi from the head. For this reason, it can be used for headaches from Dampness or Phlegm.

It should be noted that other channels balance Yin and Yang Qi in other parts of the body. The Divergent channels harmonize Yin and Yang internally in the organs and in the head (i.e. it is mostly through the Divergent channels that Yin energy reaches the head). The Extraordinary vessels harmonize Yin and Yang in the abdomen. Thus, three sets of channels balance Yin and Yang as follows:

• The Connecting channels balance Yin and Yang in the limbs. • The Divergent channels balance Yin and Yang in the organs and in the head (Ch. 21). • The Extraordinary Vessels balance Yin and Yang in the abdomen (Ch . 24).

SUMMARY BALANCING YIN AND YANG IN THE LIMBS • Qi changes polarity at fingers (from Yin to Yang) and toes (from Yang to Yin) • The influence of the change of polarity of Qi at the fingers and toes extends over the forearm (below the elbow) and the lower leg (below the knee) • The Connecting channels ensure the balance and harmonization of Yin and Yang Qi in the limbs • Balancing Yin and Yang also implies regulating the ascending (a Yang movement) and the descending (a Yin movement) of Qi to and from the head.

NOURISHMENT The Connecting channels, together with their Minute and Superficial channels, make sure that the Qi of the channels reaches all the peripheral and surface areas of the body, much as arterioles and capillaries nourish the tissues with the blood deriving from the arteries. Thus, although the Connecting channels have an important protecting function, which may be compared with and contrasted to the nourishment function of the Main channels, they also nourish the tissues in the superficial parts of the body which are irrigated by the Minute and Superficial Connecting channels and the Connecting channels proper. In particular, the Connecting channels irrigate and nourish the space between the skin and muscles (cou li). Defensive Qi has a protective function and circulates primarily in the Connecting channels, while Nutritive Qi has a nourishment function and circulates primarily in the Main channels. However, these two different functions of Connecting and Main channels should not be interpreted too rigidly as the Connecting channels have the important function of nourishing the more superficial tissues above the level of the Main channels. Likewise, the Nutritive Qi (and therefore the Main channels) plays a role in protecting the body from invasion of pathogenic factors. The Connecting channels nourish not on ly the superficial areas of the body overlying the Main channels but also the deep areas underlying the

PHYSIOLOGY OF THE CONNECTING CHANNELS

237

- - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - Superficial Connecting channel

L - - - - - - - -- - -- - - - -- - - - - - - -- - - - - --

Connecting channel

L - - - - - - - - - - - - - - -- - - - - - - - - - - - - - - - Main channel

L - -- - - - - - - - - -- -- - - - - - - - - - - - - - -- 1

Deep Connecting channel

Fig. 13.2 Nourishment function of the Connecting channels.

Main channels. In fact. the Deep (Blood) Connecting channels flow in the layer below the Main channels and are particularly connected to Blood. They therefore play a role in the nourishment of deep tissues by Blood (Fig. 13.2). The 12 main channels are situated between the Yang and Yin Connecting channels. It is through the Yin and Yang Connecting channels that Nutritive and Defensive Qi, and Qi and Blood of the Main channels spread in all directions. permeating and irrigating the Internal Organs. It is also through the Connecting channels that the essence of the Internal Organs is transported to the Main channels and, through them, to the whole body.

The Connecting channels have a nourishing function: they nourish the superficial area above the Main channels and the deep areas below them. In particu lar, they allow the nourishment of deep tissues by Blood .

SUMMARY NOURISHMENT

• The Connecting channels irrigate and nourish the superficia l areas of t he body overlying the Main channe ls • The Deep Connecting channels irrigate and nou rish the deep areas of the body underlying the Main channels.

PROTECTI ON As the Connecting channels irrigate the surface of the body and the space between skin and muscles, they protect the body from invasion of external pathogenic factors. For this reason. they are the first to be invaded by external pathogenic factors . For example, when we suffer an invasion of external Wind, the Connecting channels are the first to be invaded. The protective function of the Connecting channels is closely related to the circulation of Defensive Qi outside the Main channels. The 'Spiritual Axis' in Chapter 18 says: 'Tize lwman being receives Qifrom food: this enters the stomach, is transported to the Lungs {i. e. the Food-Qij ... it is transformed into Qi, the refined part becomes Nutritive Qi, tlze coarse part becomes Defensive Qi. Nutritive Qi flows in the blood vessels (and clwnnelsj, Defensive Qiflows outside the clwnnels.' 1 The 'Simple Questions' in Chapter 43 says: 'Oefm sive Oi is de rived ji·om tlze coarse part of foo d and wate1; it is ~ippery in nature, hence it cannot enter the channels. It tlrerefore circulates under tire skin , in between the muscles, it vaporizes in between the membranes and diffu ses over tire chest and abdomen.' 2 Thus, the protective function of the Connecting channels is intimately connected with the Defensive Qi and its circulation in the space between skin and muscles.

SUMMARY CLINICAL NOTE

As the Connecting channels are the first to be invaded by external pathogenic factors, LU-7 Lieque is a major point to expel Wind from the Lung 's Defensive-Qi portion.

PROTECTION

The Connecting channels are connected to the Defensive Qi and they play a role in the protection of the body from invasion of pathogenic factors.

238

PART 3: CONNECTING CHANNELS (LUO MAl)

WARMING As the Connecting channels irrigate the space between skin and muscles and that between the Main channels and the skin, they warm the muscles. This function is closely related to the circulation of Defensive Qi outside the Main channels in the space between the skin and muscles. Defensive Qi is Yang in nature, and the Connecting channels, being more superficial than the Main channels, are also Yang in nature. Yang provides Heat and therefore the Connecting channels and the Defensive Qi warm the body and in particular the muscles. Besides warming the muscles, the Connecting channels and the Defensive Qi regulate the body's temperature by regulating sweat. In Chinese medicine, sweat comes from the space between the skin and muscles where the Defensive Qi circulates in the Connecting channels. By controlling the opening and closing of the pores, and therefore the person's sweating, the Defensive Qi and the Connecting channels regulate the body's temperature. Chapter 4 7 of the 'Spiritual Axis' says: 'The Defensive Qi warms the muscles, fills the skin, fertilizes the space between skin and muscles and regulates the opening and closing [of the pores].' 3

SUMMARY

their deep pathway. In fact, the Connecting channels irrigate not only the superficial spaces between the Main channels and the skin but also the deep layers beyond the Main channels. We can relate the three layers in the channel network to the three types of Qi, i.e. Defensive Qi, Nutritive Qi and Blood: -on the surface, the Connecting channels = Defensive-Qi level - in the centre, the Main channels = Qi and Nutritive-Qi level - in the Interior, the Deep Connecting channels = Blood level (Fig. 13.3). Thus. the Connecting channels (including the Superficial and Minute Connecting channels) irrigate both the surface of the body above the Main channels (the Exterior) and the deep layers below the Main channels (the Interior). Because of this, the Connecting channels are an important vehicle through which the Exterior and Interior of the body communicate with each other and are harmonized. Indeed, through the Connecting ch annels the Exterior and Interior of the body communicate and interact with each other. For example, although we always stress that Defensive Qi has the function of protecting the Exterior of the body, Nutritive Qi, in the Interior of the body, definitely also plays a role in that function. Similarly, although Defensive Qi circulates on the Exterior, it does flow into the Yin

WARMING The Connecting channels and Defensive Qi circu lating in them warm the muscles and the body.

SUMMARY CONNECTING AND HARMONIZING EXTERIOR WITH INTERIOR

CONNECTING AND HARMONI ZIN G EXTERIOR WITH INTERIO R The Connecting channels connect and harmonize the various layers of the channels system thanks to

Flowing both in the superficial areas of the body overlying the Main channels and the deep areas underlying the Main channels, the Connecting channels harmonize and connect Exterior and Interior.

Connecting channel

Defensive Qi

--------------------------------------------------------- Nutritive Qi Main channel

Deep Connecting channel

Blood L-----------------------------------------------------~

Fig . 13.3 Relationship between channels and types of Qi .

PHYSIOLOGY OF THE CONNECTING CHANNELS

(and therefore the Interior) at night. It is through the Connecting channels that the interaction between the Exterior and Interior of the body occurs.

CONNECTING AND HARMONIZING LEFT AND RIGHT SIDES OF THE BODY As the Connecting channels are linked together in a manner resembling a 'net' (luo) and they occupy the superficial layers of the body, they extend all over the surface spanning both sides of the body. By contrast, the Main channels run along definite 'routes' Uing) in quite separate left and right trajectories (Fig. 13.4). Chapter 63 of the 'Simple Questions' mentions 'contrary needling' (Miu Ci, literally 'wrong [side] needling') for the Connecting channels. It says: 'When the pathogenic factors are in the Connecting channels, the left side in}i1ses into the right and vice versa: although the Co111recting channels are connected wiih the Main clwmrels on the left and right side and on the upper and lower side, they spread into the four limbs with no regular residence

239

and without entering the points of the Main channels. This is why reverse needling should be applied. ' 4 In other words, because the Connecting channels occupy the body cavities in a net-like way, they connect the left and right sides of the body and therefore pathogenic factors on one side can cause symptoms on the opposite side. This is not the case with the Main channels which are more like two sets of pathways in which the right and left sides are completely separate and not connecting (except in the head). I translate Miu Ci as 'contrary needling'. In physiology, the Connecting channels therefore connect and harmonize the fiow of Qi and of Yin and Yang between the left and right sides of the body.

SUMMARY CONNECTING AND HARMONIZING LEFT AND RIGHT SIDES OF THE BODY

As the Connecting channels are structured like a net, they span the left and right sides of the body at the superficial level: therefore they connect and harmonize the left and right sides of the body.

MAKING OF BLOOD The Deep (Blood) Connecting channels play a role in the making of Blood. When Blood is made in the Middle Burner, it fiows into the Blood Connecting channels first, and from there 'percolates' into the Main channels. Thus, the Deep Connecting channels play a role in the making and the circulation of Blood (Fig. 13.5). The Penetrating Vessel is the Sea of Blood, which is also involved in the making and moving of Blood. For this reason, the Penetrating Vessel influences all the Deep (Blood) Connecting channels.

Left

Right

Bladder Main channel Fig. 13 .4 Connecting channels spanning left and right sides of t he body.

Fig. 13.5 Role of Connecting channels in making of Blood.

240

PART 3: CONNECTING CHANNELS (LUO MAl)

SUMMARY

NOTES

MAKING OF BLOOD

1. 1981 Spiritual Axis (Ling Shu ]ing ll! ;t1& t~ ). People's Health

• When Blood is made in the Middle Burner, it flows into the Blood Connecting channels first, and from there it 'percolates' into the Main channels. Thus, the Deep Connecting channels play a role in the making and the circulation of Blood. • The Penetrating Vessel is the Sea of Blood, which is also involved in the making and moving of Blood. For this reason, the Penetrating Vessel influences all the Deep (Blood) Connecting channels.

Publishing House. Beijing. first published c. 100 sc. p. 51. 2 . 1979 The Yellow Emperor's Classic of Internal Medicine- Simple Questions (Huang Di Nei ]ing Su Wen jl' 'Iii' l:f:J t~ ~ icl ). People's Health Publishing House, Beijing. first published c. l 00 Be, p. 245. 3. Spiritual Axis. p. 89. 4. Simple Questions. p. 344.

CHAPTER 14

AETIOLOGY AND DIAGNOSIS OF THE CONNECTING CHANNELS AETIOLOGY 241 External pathogenic factors Trauma 242 Emotional stress 242

Cold 241

DIAGNOSIS 243 By interrogation 243 By observation 243 By palpation 245

Cold is a common aetiological factor affecting the Connecting channels. In the beginning stages of invasion from external Cold, this pathogenic factor is lodged in the superficial Connecting channels, causing pain and contraction. The pain is typically aggravated by exposure to cold and alleviated by the application of heat.

AETIOLOGY

External pathogenic factors

Wind There are two possible modes of Wind invading the body. It may invade the Defensive-Qi portion and the Connecting channels, causing symptoms of external Wind invasion (aversion to cold and fever). In the beginning stages of invasion of Wind, it is only the Connecting channels that are affected (Fig. 14.1). External Wind may also invade the Connecting channels of the face directly causing facial paralysis or numbness without any of the above exterior symptoms, i.e. aversion to cold and fever.

,

,

,, ,

External Wind

CLINICAL NOTE

In the beginning stages of invasion of Wind, only the Connecting channels (and the Connectingchannel area) are affected. As the Lungs control the Defensive-Qi portion, it is t he Lung Connecting chan nel that is especially affected. It is for this reason that LU-7 Lieque is such an important point to expel exterior W ind.

Fig. 14.1 External Wind invading the Defensive-Qi portion and Connecting-channels area.

241

242

PART 3: CONNECTING CHANNELS (LUO MAl)

CLINICAl NOTE There are two modes of invasion of Wind in the Connecting channels: •

•

Invasion of Wind in the Connecting channels in t he Defensive-Qi portion (such as in a common cold) w ith symptoms of aversion to cold and fever. Use LU-7 Lieque and L.l.-4 Hegu Invasion of Wind in the Connecting channels without aversion to cold and fever: this causes numbness if only the Superficial Connecting channels are involved and pa ralysis if t he Connecting channels proper are involved. Use the Connecting points of the channels reaching the face, i.e. L.l.-6 Pianli, T.B .-5 Waiguan (which also specifically expels Wind), ST-40 Fenglong .

CLINICAl NOTE Cold in the Connecting channels causes contraction and pain. For example, an acute neckache is often due to invasion of Cold in the Connecting channels . One can use the Connecting point as a dista l point and direct moxa cones (or moxa stick) on the affected site.

CLINICAl NOTE Dampness in the Connecting channels in the space between the skin and muscles is a very common occurrence in practice. It is frequently seen in postviral fatigue syndrome, causing muscle ache and heaviness. To elim inate Dampness in the Connecting channels I use the Connecting point of the Stomach ST-40 Fenglong , points to resolve Dampness (SP-9 Yinlingquan, Ren- 12 Zhongwan, Ren-9 Shuifen) and local points on the affected limbs.

SUMMARY EXTERNAl PATHOGENIC FACTORS • Wind: common cold or facial para lysis (or facial numbness on ly) • Cold: severe pa in in the jo ints aggravated by exposure t o co ld and alleviat ed by the app lication of heat • Summer-Heat acute aversion to cold, fever, cough • Dampness: acute Painful Obstruction (Bi) Syndrome with ache, heaviness and swelling of joints and muscle ache • Heat fa inting (Heat in t he Perica rdium Connecting channel) .

Summer-Heat Summer-Heat invades the Lung Connecting channel, causing a cough.

Dampness In the beginning stages, Dampness affects the Connecting channels obstructing the space between the skin and muscles and causing muscle ache and heaviness. Dampness in the space between the skin and muscles (energetically related to the Connecting channel area) is frequently seen in post-viral fatigue syndrome. Dampness in the Connecting channels is also seen in the acute state of Painful Obstruction (Bi) Syndrome; in the later stages, the Main channels are also involved.

Heat Heat blocks the Connecting channels of the Pericardium, causing fainting.

Trauma Trauma injures the Connecting channels causing either Qi stagnation or Blood stasis which manifests with pain and bruising with purple colour. A light trauma causes Qi stagnation and it affects the Connecting-channel area; severe trauma causes Blood stasis and it affects the Deep (Blood) Connecting channels.

Emotional stress The first effect of emotional stress on the body's Qi is Qi stagnation. Each emotion has a different effect on Qi: for example, anger makes Qi rise, sadness dissolves Qi, fear makes Qi descend, etc. However, all emotions initially lead to some Qi stagnation; even the emotions that deplete Qi (such as sadness and grief) will have this effect to some degree (as Qi deficiency and stagnation may coexist).

AETIOLOGY AND DIAGNOSIS OF THE CONNECTING CHANNELS

SUMMARY

o

SUMMARY

TRAUMA

AETIOLOGY

• Trauma injures the Connecting channels causing either Qi stagnation or Blood stasis which manifests with pain and purple-coloured bruising • The Connecting points are effective distal points to eliminate Qi stagnation or Blood stasis.

• External pathogenic factors • Trauma • Emotional stress.

All emotions lead to some Qi stagnation initially and affect the Connecting channe ls.

Emotions cause Qi stagnation and impair the Qi mechanism, causing stagnation of Qi in the Connecting channels initially. As we have seen, the Connecting channels are like a 'net' of small capillary-like channels running in all directions; as such, they are very prone to stagnation. Indeed, it could be said that most stagnation in the body occurs in the Connecting channels. For example, stagnation of Qi deriving from repressed anger may cause stagnation of Qi in the Connecting channels of the breasts in women leading to breast distension. Stagnation of Qi in the Connecting channels of the abdomen (Liver, Spleen and Kidneys) causes abdominal distension.

SUMMARY

243

By interrogation Severe pain indicates a Full condition of the Connecting channels, generally due to invasion of the Connecting channel by Wind, Cold or Dampness. Dull aching of the channel indicates an Empty condition and is usually experienced in chronic conditions. A feeling of heaviness of the muscles indicates retention of Dampness in the space between skin and muscles, i.e. in the Connecting-channels area. A feeling of distension denotes Qi stagnation in the Connecting channels; a stabbing, fixed pain indicates Blood stasis in the Deep Connecting channels.

SUMMARY INTERROGATION

• Severe pain: Full condition of the Connecting channels, generally due to invasion of Wind, Cold or Dampness • Du ll ache: Empty condition (usual ly chronic) • Feeling of heaviness of the muscles: retention of Dampness in the space between skin and muscles, i.e. in the Connecting-channe ls area • Feeling of distension: Qi stagnation in the Connecting channels • Stabbing, fixed pain: Blood stasis in the Deep Connecting channels .

EMOTIONS

Emotions cause Qi stagnation and impair the Qi mechanism, resu lting in stagnation of Qi in the Connecting channels .

DIAGNOSIS The condition of the Connecting channels can be diagnosed primarily from interrogation, observation and palpation.

By observation The blood vessels (venules) visible on the surface of the skin are always a reflection of the Connecting channels. When they become visible, the blood vessels are an expression of the percolation of the Deep (Blood) Connecting channels towards the surface of the skin. It should be noted that, although the blood vessels that become visible on the surface of the skin are situated in the Superficial Connecting channels,

244

PART 3: CONNECTING CHANNELS (LUO MAl)

they reflect a pathology of the Deep (Blood) Connecting channels: in other words, the Blood pathology (Heat, Cold or stasis) at the level of the Deep Connecting channels causes the Blood at this deep level to 'percolate' upwards towards the surface to manifest on the skin at the level of the Superficial Connecting channels. Chapter 10 of the 'Spiritual Axis' says: 'The Main channels are deep and hidden between the muscles and cannot be seen; only the Spleen channel can be seen as it emerges from above the internal malleolus and it has no place to hide. The Co nnecting channels are supe1jicial and can be seen.' 1 Chapter 10 of the 'Spiritual Axis' also says: 'When the Connecting channels are greenish-bluish it indicates Cold and pain; when they are red it indicates Heat. '2

Fig. 14.2 Skin lesions and Connecting channels.

The above quotations from the 'Spiritual Axis' make the very important point that the Main channels do not manifest on the skin, whereas the Connecting channels do; this means that any sign on the skin reflects a pathology of the Connecting channels (including the Deep Connecting channels). One should observe first of all the colour of the skin itself. Apart from the blood vessels that might be visible, the colour of the skin itself reflects the condition of the Connecting channels; red indicates Heat, green indicates pain, purple indicates Blood stasis, and bluish indicates Blood stasis and pain. As for visible venules, the interpretation is the same, i.e. red ones denote Heat, purple ones Blood stasis, bluish ones Cold and/or Blood stasis.

AETIOLOGY AND DIAGNOSIS OF THE CONNECTING CHANNELS

245

SUMMARY The Main channels cannot be seen on t he skin; the Con nect ing channels can.

Then one should observe any skin lesions that there might be. Skin lesions may be located at the level of the Superficial Connecting channels (e.g. macules, wheals, psoriasis plaques, dermatofibromas, scales, or ulcers) or at the level of the Connecting-channel area proper (papules, vesicles, pustules, or cysts). See Figure 14.2. Macules are a reflection of the Deep (Blood) Connecting channels: red macules indicate Blood Heat. while purple ones indicate Blood stasis, and bluish macules indicate pain and Blood stasis. Papules generally indicate Heat in the Connecting channels. Vesicles indicate Dampness in the space between skin and muscles and in the Connecting channels. Pustules indicate Toxic Heat in the Connecting channels.

OBSERVATION

Skin • • • •

Red: Heat Green: pain Purple: Blood stasis Bluish: Blood stasis and pain

Venules • Red: Heat • Purple: Blood stasis • Bluish: Cold and/or Blood stasis

Skin lesions • Macules: - Red: Blood Heat - Purple: Blood stasis -Bluish: pain and/or Blood stasis • Papules: Heat • Vesicles: Dampness in the space between skin and muscles and in the Connecting channels • Pustules: Toxic Heat.

By palpation

PALPATION

Stiffness and hardness of the skin of the limb indicates a Full condition of the Connecting channels while f1accidity indicates a condition of Emptiness of the Connecting channel.

• Stiffness and hardness of the skin of the limbs: Ful l condition of the Connecting channels • Flaccidity: Emptiness of the Connecting channels.

NOTES 1. 1981 Spiritual Axis (Ling Shu } ing ~:IIi\~~ ) . People's Hea lth Publishing House. Beijing. first published c. 100 BC. p. 3 7. 2. [bid .. p. 3 7.

CHAPTER 15

PATHOLOGY OF CONNECTING CHANNELS INVASION OF EXTERNAL PATHOG ENIC FACTORS Wind 248 Dampness 248 Cold 249 Summer-Heat 249

24 7

FULLNESS AND EM PTIN ESS OF THE CONNECTING CHANN ELS 249 Ql STAGNATI ON IN THE CONN ECTING CHANNELS 250 BLOOD STASIS IN THE CONNECTING CHANNELS 252 THE CONNECTI NG CHAN NELS IN THE PATHOLOGY OF LUMPS 254 THE CONNECTING CHANN ELS AND BLEEDING 254 THE CONNECTING CHANN ELS AND PHLEGM 256 FULL- EM PTY AND HOT-COLD SYMPTOMS OF THE CONN ECTING CHAN NELS 256 Full conditions of the Connecting chan nels 256 Empty cond itions of the Connecting channels 257 Cold conditions of the Connecting channels 257 Heat conditions of the Connecting channels 257

INVASION OF EXTERNAL PATHOGENIC FACTORS External pathogenic factors generally invade the Connecting channels first; they also invade the Muscle channels as well. If it is only the Muscle channels that are invaded, the main symptoms are simply stiffness and pain of the muscles without any internal manifestations such as sore throat, fever, etc. Thus, through their Superficial and Minute branches, down to the Connecting channels proper, the Connecting channels represent the way of penetration of pathogenic factors into the Main channels and then the Internal Organs. Chapter 62 of the 'Simple Questions' says: 'External pathogenic factors penetrate the skin .first, then the Minute Connecting channels, when

these are full they go to the Connecting channels prope1; when these are full they go to the Main channels.' 1 Chapter 66 of the 'Spiritual Axis' also describes the route of penetration of pathogenic factors: 'When pathogenic factors invade the body they penetrate the skin first, when the skin is loosened, the space between skin and llluscles {Cou Lij is open and pathogenic factors will penetrate the hair causing this to stand up. The pathogenic factors then enter the Connecting channels which causes 111Uscle ache; the pathogenic factors will then enter the Main cllannels.' 2 See Figure 15.1.

The Co nnectin g channel s are the f irst to be invaded by exte rn al pathogeni c factors and they are the vehicle t hrough which pathogenic fa ctors penetrate t he Mai n channels and Internal Organs.

Pathogenic factors generally enter the Yang Connecting channels first, then the main channels, then the Yin Connecting channels, and then the Internal Organs. In the beginning stage of an invasion of pathogenic factors the superficial Connecting channels are affected , the onset is sudden, the disease is relatively easy to treat and its course is short. In the later stages, the pathogenic factors penetrate the Deep Connecting channels, the disease is more severe, chronic, difficult to treat and is characterized by Blood stasis, Phlegm and Deficiency. Therefore, chronic disease reaches the Connecting channels, causes pain, and involves Blood stasis, Phlegm and Deficiency. When discussing the pathology of the Connecting channels, it is important to differentiate their superficial from their deep layer, and therefore, superficial from deep pathology. 247

248

PART 3: CONNECTING CHANNELS (LUO MAl) External pathogenic factor

Superficial Connecting channel Connecting channel Main channel Deep Connecting channel

~

"

----------~~------------------------------------~

.-----------~~------------------------------------~

L-------------------------------------------------~

Fig. 15.1 Progression of external pathogenic factors in channels.

The superficial pathology involves invasions of external pathogenic factors, or trauma; the deep pathology involves Blood stasis, Phlegm and Deficiency. In the beginning stages of an invasion of external pathogenic factors, the Connecting channels are full (because they are obstructed by the pathogenic factors); in later stages, the pathogenic factors move from the Connecting channels (which become empty) to the Main channels (which become Full). Thus, in the beginning stages of an invasion of pathogenic factors, the Connecting point of the affected channel should be reduced; while in the later states, it should be reinforced. The main external pathogenic factors penetrating the Connecting channels are Wind. Dampness and Cold. Other less common ones include Summer-Heat.

• Stomach: aversion to cold, fever, sore throat, swollen tonsils, jaw ache (or facial paralysis/ numbness).

CLINICAL NOTE

The clinical manifestations of invasion of external Wind in its beginn ing stages involve pu rely the Connecting-channels area. Wind invades the Lung's Defensive-Qi portion fi rst and it is for this reason that LU-7 Lieque (a Connecting point) is such an important point to expel exterior Wind.

Dampness

Wind When Wind penetrates a Connecting channel it causes the typical initial symptoms of invasion of Wind, i.e. aversion to cold, fever (skin hot to touch), sore throat, Floating pulse, etc. Wind generally invades the Lungs, Large Intestine and Stomach Connecting channels. Other symptoms of invasion of the Connecting channels by Wind include facial paralysis and numbness, which occur without exterior symptoms of aversion to cold and fever. The symptoms of invasion of Wind in the Connecting channels are: • Lungs: sore throat, aversion to cold, fever, sneezing, cough • Large Intestine: aversion to cold, fever, sneezing, jaw ache, headache (or facial paralysis/ numbness)

Invasion of external Dampness in the beginning stages also causes aversion to cold and fever and. in addition, nausea, vomiting, diarrhoea, a feeling of heaviness and swollen glands. It invades primarily the Large Intestine, Stomach, Spleen and Liver channels. The clinical manifestations of acute invasion of Dampness in the Connecting channels are: • Large Intestine: aversion to cold, fever, diarrhoea, abdominal heaviness, swollen glands in abdomen (mesenteric adenitis) • Stomach: aversion to cold, fever, nausea, vomiting. epigastric heaviness, swollen glands in neck • Spleen: aversion to cold , fever, abdominal heaviness, diarrhoea • Liver: aversion to cold, fever, hypogastric heaviness, frequent-burning urination.

PATHOLOGY OF CONNECTING CHANNELS

If Dampness is not expelled, it easily becomes chronic, settling either in the space between the skin and muscles or in the joints. The settling of Dampness in the space between the skin and muscles (energetically corresponding to the Connecting-channels area proper) is often seen in postviral fatigue syndrome.

Cold External Cold causes pain and contraction. It invades primarily the Connecting channels of Stomach, Large Intestine and Uterus usually without the exterior symptoms of aversion to cold and fever. • Stomach: severe epigastric pain, vomiting • Large Intestine: severe abdominal pain, diarrhoea • Uterus: severe acute dysmenorrhoea.

Summer-Heat Summer-Heat may invade primarily the Lungs and Pericardium Connecting channels: • Lungs: aversion to cold, fever, cough • Pericardium: aversion to cold, fever, fainting.

FULLNESS AND EMPTINESS OF THE CONNECTING CHANNELS The Fullness of Connecting channels derives either from an external pathogenic factor or from internal Qi or Blood stagnation, which themselves may derive from emotional stress. Full ness of a Connecting channel deriving from an external pathogenic factor may last a relatively short time and this condition is therefore generally acute; after some time. the pathogenic factor moves from the Connecting channel (which becomes empty) to the Main channel (which becomes Full). Emptiness of a Connecting channel is the consequence of a long-standing pathogenic factor that has progressed to the Interior, or of an internal deficiency of Qi and Blood. Emptiness of the Connecting channels is seen in chronic conditions. The symptoms of Fullness and Emptiness of the Connecting channels are discussed in Chapter 10 of

249

SUMMARY INVASION OF EXTERNAL PATHOGENIC FACTORS

• External pathogenic factors invade the Connecting channels before the Main channels • The route of penetration of external pathogenic factors goes through the Superficial Connecting channels, the Connecting-channels area proper, the Main channels, the Deep Connecting channels, and the Internal Organs

W ind • Lungs: sore throat, aversion to cold, fever, sneezing, cough • Large Intestine: aversion to cold, fever, sneezing, jaw ache, headache (or facial paralysis/numbness) • Stomach: aversion to cold, fever, sore throat, swollen tonsils, jaw ache (or facial paralysis/ numbness) Dampness • Large Intestine: aversion to cold, fever, diarrhoea, abdominal heaviness, swollen glands in abdomen (mesenteric adenitis) • Stomach: aversion to cold, fever, nausea, vomiting, epigastric heaviness, swollen glands in neck • Spleen: aversion to cold, fever, abdominal heaviness, diarrhoea • Liver: aversion to cold, fever, hypogastric heaviness, frequent-burning urination.

Cold • Stomach: severe epigastric pain, vomiting • Large Intestine: severe abdominal pain, diarrhoea • Uterus: severe acute dysmenorrhoea

Summer-Heat • Lungs: aversion to cold, fever, cough • Pericardium: aversion to cold, fever, fainting.

the 'Spiritual Axis' 3 and these are listed in Table 15.1. It should be pointed out that these are the clinical manifestations arising from pathology of the actual Connecting channel proper, rather than the Connectingchannels area (see Fig. 12.9).

250

PART 3: CONNECTING CHANNELS (LUO MAl)

Table 15.1

Symptoms of Fullness and Emptiness of the Connecting channels

Channel

Full

Empty

Lung (LU-7)

Hot palms and wrists

Yawning, frequent urination, incontinence of urine

Large Intestine (L.I.-6)

Toothache, deafness

Sensation of cold in teeth, fullness and congestion in chest

Stomach (ST-40)

Full: insanity (Kuang)

Rebellious: throat obstruction, loss of voice

Flaccid or atrophied muscles of legs

Spleen (SP-4)

Full: abdominal pain

Rebellious: food poisoning (Huo Luan)

Abdominal distension

Heart (HE-5)

Fullness and oppression of chest

Aphasia

Small Intestine (S.I.-7)

Loose joints, atrophy of arm muscles, stiff elbow

Long, finger-shaped warts, itching scabs

Bladder (BL-58)

Nasal congestion, headache, backache

Clear nasal discharge, nosebleed

Kidneys (KI-4)

Full: retention of urine

Lower backache

Pericardium (P-6)

Chest pain

Stiffness of the head and neck

Triple Burner (T.B.-5)

Spasm of the elbow

Flaccid arm muscles

Gall Bladder (G.B.-37)

Fainting

Weak and flaccid foot muscles, difficult to stand from sitting position

Liver (LIV-5)

Full: swelling of testicle, hernia (Shan)

Ren Mai (Ren-15)

Pain in the skin of abdomen

Itching of the skin of abdomen

Du Mai (Du-1)

Stiffness of spine

Heaviness of the head, tremor of head

Great Connecting of Spleen (SP-21)

Ache and pain all over body

Weak limb muscles

Great Connecting of stomach (Xu Lt)

Rapid breathing, irregular breathing, sensation of knot in chest

Rebellious: irritability, depression, oppression of chest

Rebellious: abnormal erection

SUMMARY FULLNESS AND EMPTINESS O F THE CONNECTING CHANNELS

• The Fullness of Connecting channels derives either from an external pathogenic factor or from int erna l Qi or Blood stagnation; generally acute • Emptiness of a Connecting channel is the consequence of a long-standing pathogenic factor that has progressed to the Interior, or of an internal deficiency of Qi and Blood; generally chronic.

Itching of pubic region

Ql STAGNATION IN THE CONNECTING CHANNELS As mentioned above, the Connecting channels are like a 'net' of small capillary-like channels running in all directions: as such, they are very prone to stagnation. Indeed, it could be said that most stagnation in the body occurs in the Connecting channels. The Connecting channels cannot penetrate the big joints of the body (as the Main channels do) and they are therefore restricted to the spaces in between the deep pathways of the Main channels and the surface of the body (Fig. 15.2). The Connecting channels

PATHOLOGY OF CONNECTING CHANNELS

251

Liver Connecting channel

Fig. 15.2 Course of Main and Connecting channels through joints.

also fill the spaces and 'cavities' of the body which are all part of the Triple Burner. This means that most of the stagnation in the body actually occurs in the Connecting channels because they are 'constricted' in these spaces (as they cannot course through the large joints) and because they form as it were a net which easily 'catches' pathogenic factors or in which Qi and/or Blood become stagnant (Fig. 15.3).

Skin

Large joint

Main channel

ll/lr.-cto---Space between joint and skin; joint cavities

Connecting channel Fig. 15.3 Stagnation of Qi in the Connecting channels.

Most Qi stagnation in the body occurs in the Connecting channels.

Chapter 10 of the 'Spiritual Axis' says: "The C01mecting c/znnnels cannot course through the large joints; in order to [enter and] exit they must move by alternate routes. They then enter and come together again under the skin and therefore they can be seen from the outside. To needle the Connecting channel one must needle above the accumulation wlrere Blood is concentrated. Even if there is 110 blood accwnulation, one must prick to cause bleeding quickly to drain the pathogenic factors out: if this is not done, Painful Obstruction Syndrome {Bi) may develop.'4 The clinical manifestations of Qi stagnation in the Connecting channels are as follows: • Lung Connecting channel: feeling of tightness and distension of the chest • Large Intestine Connecting channel: abdominal distension, bitty stools • Stomach Connecting channel: epigastric distension • Spleen Connecting channel: abdominal distension • Heart Connecting channel: feeling of distension in the heart region • Small Intestine Connecting channel: abdominal distension, borborygmi

252

PART 3: CONNECTING CHANNELS (LUO MAl)

• Bladder Connecting channel: hypogastric distension, feeling of distension before urination • Kidney Connecting channel: lower backache • Pericardium Connecting channel: feeling of tightness and distension of the chest • Triple Burner Connecting channel: feeling of distension in the Three Burners • Gall Bladder Connecting channel: hypochondria! distension • Liver Connecting channel: hypochondria! distension • Uterus Connecting channel: painful periods.

BLOOD STASIS IN TH E CONNECTING CHANNELS Blood stasis in the Connecting channels may derive from Qi stagnation, Cold or Heat obstructing the Connecting channels. Blood stasis is a pathology that takes a long time to come about and it is therefore seen only in chronic diseases. As we have seen, the deep layer of the Connecting channels (the Deep Connecting channels) is related to Blood; in particular, this layer of the Connecting channels is responsible for the circulation of Blood and is therefore affected by Blood stasis in chronic diseases. We can therefore say that practically all Blood stasis in the body occurs in the Deep Connecting channels (Fig. 15.4).

Fig. 15.4 Blood stasis in the Deep Connecting channels.

SUMMARY Ql STAGNATION IN THE CONNECTING CHANNELS

• Lung Connecting channel : feeling of tightness and distension of t he chest • Large Intestine Connecting channel: abdominal distension, bitty stools • Stomach Connecting channel: epigastric distension • Spleen Connecting channel: abdom inal distension • Heart Connecting channel: feeling of distension in the heart region • Small Intestine Connecting channel : abdominal distension, borborygmi • Bladder Connecting channel: hypogastric distension, feel ing of distension before urination • Kidney Connecting channel : lower backache • Pericardium Connecting channel : feeling of tightness and distension of the chest • Triple Burner Connecting channel: feel ing of distension in the Three Burners • Gall-Bladder Connecting channel: hypochondria! distension • Liver Connecting channel: hypochondria! distension • Uterus Connecting channel : painfu l periods.

PATHOLOGY OF CONNECTING CHANNELS

CLINICAL NOTE All Blood stasis occurs in the Deep Connecting channels. For this reason, Connecting points are frequently used to invigorate Blood.

Blood stasis in the Connecting chan nel causes pain, swelling and masses. Ye Tian Shi thought that chronic diseases from retention of pathogenic factors for a long time damage the Blood Connecting channels. Ye Tian Shi often referred to the role of Connecting channels in chronic diseases with Blood stasis. He said:

'In the beginning of a disease the pathogenic factor is at the Qi level in the main channels; in late stages, it enters the Blood level in the Connecting channels.' 'Chronic disease reaches the Connecting channels.' 'Chronic disease ojten has Blood stasis.' 'Pain is due to Qi and Blood within the Connecting channels not being harmonized. ' 'Chronic pain is due to the Connecting and Qi and Blood not circulating well. '5 The clinical manifestations of Blood stasis in the Connecting channels are as follows: • Lung Connecting channel: cough with spitting of blood, chest pain • Large Intestine Connecting channel: dark blood in the stools, abdominal pain • Stomach Connecting channel: vomiting of dark blood, epigastric pain • Spleen Connecting channel: dark blood in the stools, abdominal pain • Heart Connecting channel: stabbing chest pain • Small Intestine Connecting channel: abdominal pain • Bladder Connecting channel: stabbing pain on urination, blood in urine • Kidney Connecting channel: stabbing lower backache that is worse at night • Pericardium Connecting channel: stabbing chest pain • Triple Burner Connecting channel: stabbing pain in the Three Burners • Gall Bladder Connecting channel: stabbing hypochondria] pain

253

• Liver Connecting channel: stabbing hypochondria] pain, hard breast lumps • Uterus Connecting channel: painful periods, dark menstrual blood with clots, myomas. In addition, a major manifestation of Blood stasis in the Connecting channels may be lumps. Lumps from Blood stasis are fixed and hard on palpation; they are not always painful. Examples of lumps fro m Blood stasis in the Connecting channels are: - myoma: Blood stasis in the Connecting channels of the Uterus - fibroadenoma or carcinoma of the breast: Blood stasis in the Connecting channels of the breast - carcinoma of the bowel: Blood stasis in the Connecting channels of the Large Intestine

SUMMARY

0

BLOOD STASIS IN THE CONNECTING CHANNE LS

• Lung Connecting channel: cough with spitting of blood, chest pain • Large Intestine Connect ing channel: dark blood in the stools, abdominal pain • Stomach Connecting channel: vomiting of dark blood, epigastric pain • Spleen Connecting channel: dark blood in t he stools, abdominal pain • Heart Connecting channel: stabbing chest pain • Smal l Intestine Connecting channel : abdominal pa in • Bladder Connecting channel: stabbing pain on urination, blood in urine • Kidney Connecting channel: stabbing low er backache that is worse at night • Pericardium Connecting channel : stabbing chest pain • Triple Burner Connecting channel: stabbing pain in the Three Burners • Gall Bladder Connecting channel: stabbing hypochondria! pain • Liver Connecting channel: stabbing hypochondria! pain, hard breast lumps • Uterus Connecting channel: painful periods, dark menstrual blood wit h clots, myomas.

254

PART 3: CONNECTING CHANNELS (LUO MAl )

- carcinoma of the stomach: Blood stasis in the Connecting channels of the Stomach -carcinoma or adenoma of the thyroid: Blood stasis in the Connecting channels of the Liver, Directing Vessel and Stomach.

THE CONNECTING CHANNELS IN THE PATHOLOGY OF LUMPS Many lumps are due to accumulation of Qi and Blood in the Connecting channels, which are like a network of small channels running in all directions. For this reason, they are easily prone to accumulations and therefore lumps. These lumps are generally due to either Blood stasis (in which case they are hard on palpation) or Phlegm (in which case they are soft on palpation). See Figure 15.5. Examples of lumps due to accumulation in the Connecting channels are breast lumps, swellings, nodules or carcinoma of the thyroid, lipomas (involving superficial Connecting channels), myomas (involving the Deep, Blood Connecting channels) and swelling of lymph nodes. Thus, an example of a lump in the Superficial Connecting channels is a lipoma; in the Connecting channel area proper, a cyst; in the Deep Connecting channels. a myoma. carcinoma or adenoma. The accumulation and therefore formation of lumps is encouraged by the very structure of Connecting channels. running in all directions w,e a net in the spaces and cavities of the body. Chapter 66 of the 'Spiritual Axis' discusses the role of the Connecting channels in the pathology of abdominal masses: 'Abdominal masses are due to nccwmLlation in the Minute Connecting channels of the nbdomen; the

nbdominal mass can move up nnd down as it is in the Connecting c/wnnels which are supe1jicial and loose and tlzey cannot detain nnd fix the mass which comes and goes and eventually enters the Stomach nnd Intestines.' 6 Examples of lumps in the Connecting channels are: - a relatively soft myoma: Phlegm and Blood stasis in the Connecting channels of the Uterus - fibroadenoma or carcinoma of the breast: Blood stasis in the Connecting channels of the breast - cyst of the breast: Phlegm in the Connecting channels of the breast - carcinoma of the bowel: Blood stasis in the Connecting channels of the Large Intestine - carcinoma of the stomach: Blood stasis in the Connecting channels of the Stomach -carcinoma or adenoma of the thyroid: Blood stasis in the Connecting channels of the Liver, Directing Vessel and Stomach - a soft goitre: Phlegm in the Connecting channels of the Liver, Directing Vessel and Stomach - swelling of lymph nodes of the neck: Phlegm in the Connecting channels of the Stomach, Large Intestine and Triple Burner - swelling of lymph nodes of the groin: Phlegm in the Connecting channels of the Liver, Spleen and Kidneys - cysts: Phlegm in the Connecting channels -lipoma: Phlegm in the Superficial Connecting channels.

THE CONNECTING CHANNELS AND BLEEDING The deeper parts of the Connecting channels are connected to Blood and play a role in bleeding. Chapter

Lipoma

Superficial Connecting channel

'-.....___..../ Connecting channel

Main channel

( . : ood \Bl

\:::Y

I

L-----------~~----------------------------------~

Fig. 15.5 Lumps in Connecting channels.

Deep Connecting channel

PATHOLOGY OF CONNECTING CHANNELS

SUMMARY

0

255

Bleeding upwards (nosebleed, coughing of blood, vomiting of blood)

THE CONNECTING CHANNELS IN THE PATHOLOGY OF LUMPS

Examples of lumps in the Connecting channels are: • a relatively soft myoma: Phlegm and Blood stasis in the Connecting channels of the Uterus • fibroadenoma or carcinoma of the breast Blood stasis in the Connecting channels of the breast • cyst of the breast Phlegm in the Connecting channels of the breast • carcinoma of the bowel: Blood stasis in the Connecting channels of the Large Intestine • carcinoma of the stomach: Blood stasis in the Connecting channels of the Stomach • carcinoma or adenoma of the thyroid: Blood stasis in the Connecting channels of the Liver, Directing Vessel and Stomach • a soft goitre: Phlegm in the Connecting channels of the Liver, Directing Vessel and Stomach • swelling of lymph nodes of the neck: Phlegm in the Connecting channels of the Stomach, Large Intestine and Triple Burner • swelling of lymph nodes of the groin: Phlegm in the Connecting channels of the Liver, Spleen and Kidneys • cysts: Phlegm in the Connecting channels • lipoma: Phlegm in the Superficial Connecting channels.

66 of the 'Spiritual Axis' says: 'Wilen tile Yang Blood Connecting are injured Blood overflows outwards and tlzere is epistaxis; when the Yin Blood Connecting are injured Blood overflows inwards and there is blood in the stools. ' 7 See Figure 15.6. Red inner corners of the eyes are related to the Blood Connecting channels. The 'Classic of Categories' (Lei Jing) says: 'Tile essence of the Blood Connecting

CLINICAL NOTE As the Deep Connecting channels are involved in the pathology of bleeding, the Connecting points are frequently used to stop bleeding.

Bleeding downwards (blood in urine or stools, heavy menstrual bleeding) Fig. 15.6 Bleeding from Connecting channels.

channels goes to tile Heart, tile Heart is related to the colour red. this makes the Connecting channels of the inner comer of the eye red.' 8 The connection between Blood Connecting channels and blood is used in treatment when the superficial venules appearing on the skin are bled. Bleeding these venules releases blockages of the Blood Connecting channels and is used for Heat and Full conditions. Bleeding of the vein over or near BL-40 Weizhong is an example of bleeding of the su perficial Blood Connecting channels to release stagnation in the Connecting channel, in this case of the Bladder. Chapter 7 of the 'Spiritual Axis' says: 'Pricking of tlze Connecting channels consists in pricking the small Blood Connecting channels 0 11 the surface. ' 9 The Deep {Blood) Connecting channels are involved in bleeding either when they are Empty or when they are affected by Heat: in the former case, deficient Qi in the Deep Connecting channels fails to hold Blood and this leaks out causing bleeding; in the latter case,

256

PART 3: CONNECTING CHANNELS (LUO MAl)

~ Numbness/

Heat in the Deep Connecting channels agitates the Blood and causes it to spill out of the vessels. The first is an Empty cause of bleeding and the latter a Full one: in both cases, the Connecting channels are involved either because they are Empty or because they are affected by Heat. Examples of bleeding due to pathology of the Deep Connecting channels are: -Lung Deep Connecting channel: coughing of blood or nosebleed -Liver and/or Stomach Deep Connecting channel: nosebleed -Bladder and/or Liver Deep Connecting channel: blood in the urine -Uterus Deep Connecting channel: excessive menstrual bleeding with flooding - Large Intestine and/ or Spleen Deep Connecting channel: blood in the stools - Superficial Connecting channels in the skin: bleeding under the skin (petechiae).

L-.:.:_J

tingling

Lumps

Blurred vision, nasal obstruction, diminished hearing, slurred speech, aphasia Fig. 15. 7 Phlegm in Connecting channels.

Apart from lumps, Phlegm in the channels manifests primarily with numbness and/ or tingling of the limbs. Of course, there are other causes of numbness/ tingling of the limbs. Also, as Phlegm easily obstructs the sense orifices, Phlegm in the Connecting channels may cause blurred vision, nasal obstruction, diminished hearing and slurred speech or aphasia (Fig. 15.7).

SUMMARY THE CONNECTING CHANNELS AN D BLEEDING

SUMMARY

Examples of bleeding due to pathology of the Deep Connecting channels are:

THE CONNECTING CHANNELS AND PHLEGM

• Lung Deep Connecting channel : coughing of blood or nosebleed • Liver and/or Stomach Deep Connecting channel: nosebleed • Bladder and/or Liver Deep Connecting channel: blood in the urine • Uterus Deep Connecting channel: excessive menstrual bleeding with flooding • Large Intestine and/or Spleen Deep Connecting channel: blood in the stools • Superficial Connecting channels in the skin : bleeding under the skin (petechiae).

• Tingling of the skin: Phlegm in the Superficial Connecting channels • Aphasia after Wind-stroke : Phlegm in the Connecting channel of the Heart • Blurred vision, nasal obstruction, diminished hearing.

FULL- EMPTY AND HOT-COLD SYMPTOMS OF THE CONNECTING CHANNELS Full conditions of the Connecting channels

THE CONNECTING CHANNELS AND PHLEGM Phlegm may affect the Connecting channels in various ways. Phlegm can cause lumps (which are usually soft on palpation) and this pathology has already been discussed above.

When discussing Full conditions of the Connecting channels we must distinguish between the Superficial Connecting channels, the Connecting channels proper and the Deep Connecting channels. The Superficial (Fu) Connecting channels become generally Full when they are invaded by external pathogenic factors and this pathology has been

PATHOLOGY OF CONNECTING CHANNELS 257

discussed above. The Superficial Connecting channels are the first to be invaded by external pathogenic factors. The Connecting channels proper (i.e. the layer below the Superficial Connecting channels and above the Main channels) may be Full also from external pathogenic factors when these move from the Superficial Connecting channels towards the Interior. The Connecting channels are also Full when there are cysts or lipomas. Full conditions of the Deep Connecting channels include primarily Blood stasis whether it manifests with lumps or not. For example, painful periods with dark menstrual blood indicate Blood stasis in the Deep Connecting channels of the Uterus; a myoma is also a manifestation of severe Blood stasis in these Connecting channels.

Empty conditions of the Connecting channels Empty conditions of the Connecting channels occur in chronic, long-standing diseases long after the invasion of pathogenic factors has progressed through the superficial Connecting, Yang Connecting, Main channels and Yin Connecting channels. Connecting channels become Empty only in very chronic diseases. Empty conditions of the Connecting channels are often characterized by bleeding from Deficiency, i.e. chronic bleeding from Qi or Yin deficiency: this happens when the Deep (Blood) Connecting channels are deficient. Empty conditions of the Connecting channels may also manifest with chronic sweating from Qi deficiency: this happens when the Connecting channels are deficient in the space between the skin and muscles.

Cold conditions of the Connecting channels Cold conditions of the Connecting channels are characterized by a Cold-type severe, cramping pain due to blockage of the Connecting channels by Cold: this may affect both the Connecting channels area proper on the surface or the Deep Connecting channels. The pulse is Tight and Slow. Examples of Cold in the Deep Connecting channels are: -Stomach Deep Connecting channels: epigastric pain with sudden onset, vomiting of clear fluids

-Gall Bladder Deep Connecting channels: hypochondria! pain, vomiting, feeling cold - Pericardium Deep Connecting channels: chest pain extending to the back, feeling of tightness of the chest, cold hands - Abdominal Deep Connecting channels (Spleen, Liver and Kidneys): abdominal masses, abdominal pain, cold feet. An example of Cold in the Connecting channels proper is chronic retention of Cold in the joints causing chronic Painful Obstruction (Bi) Syndrome.

Heat conditions of the Connecting channels Full Heat in the Connecting channels causes rebellious Qi, Blood stasis and vomiting or coughing of blood. Rebellious Qi of the Connecting channels causes cough, stomach pain and abdominal distension. Empty Heat in the Blood Connecting channels causes dryness of the Blood. We must differentiate the clinical manifestations according to the location of the Heat. Heat can be: - in the Connecting-channels area proper - in the Deep Connecting channels of the Internal Organs -in the abdominal Membranes (Huang).

Heat in the Connecting-channels area proper Heat in the Connecting-channels area proper is generally seen in chronic Heat Painful Obstruction (Bi) Syndrome when the joints are painful, hot, swollen and red. Heat in the joints is generally a transformation of Wind, Cold or Dampness and is usually associated with Dampness (hence the swelling of the joints).

Heat in the Deep Connecting channels Heat in the Deep Connecting channels affects the Blood causing bleeding. This is a Full type of bleeding from Heat as opposed to the Empty type of bleeding mentioned above that occurs when the Deep Connecting channels are Empty. When Heat affects the Yang Deep Connecting channels there is bleeding upwards (vomiting or coughing of blood and nosebleed); when it affects the Yin Deep Connecting channels there is bleeding downwards, i.e. blood in the stools or urine and excessive menstrual bleeding.

258

PART 3: CONNECTING CHANNELS (LUO MAl)

SUMMARY

.

FULL-EMPTY AND HOT- COLD SYMPTOMS OF TH E CONNECTING CHANNELS

Full conditions of the Connecting channels • The Superficial (Fu) Connecting channels become generally Full when they are invaded by external pathogenic factors • The Connecting channels-area proper may be Full also from external pathogenic factors when these move from the Superficial Connecting channels towards the Interior; the Connecting channels are also Full when there are cysts or lipomas • Full conditions of the Deep Connecting channels include primarily Blood stasis. Empty conditions of the Connecting channels • Empty conditions of the Connecting channe ls occur in chronic, long -standing diseases long after the invasion of pathogenic factors has progressed through the superficial Connecting, Yang Connecting, Main channe ls and Yin Connecting channels • Empty cond itions of the Connecting channels are often characterized by bleeding from Deficiency. Empty cond itions of the Connecting channels may also manifest with chronic sweating from Qi deficiency: this happens when the Connecting channels are deficient in the space between the skin and muscles. Cold conditions of the Connecting channels • Stomach Deep Connecting channels: epigastric pain with sudden onset, vomiting of clear fluids • Gall-B ladder Deep Connecting channels : hypochondria! pain, vomiting, feeling of co ld • Pericardium Deep Connecting channels : chest pain extending to the back, feeling of tightness of the chest, cold hands • Abdominal Deep Connecting channels (Spleen, Liver and Kidneys): abdominal masses, abdominal pain, cold feet. Heat conditions of the Connecting channels Heat in the Connecting-channels area p roper • Heat in the Connecting-channels area proper is generally seen in chronic Heat Painfu l Obstruction (Bt) Syndrome when the joints are painful, hot, swollen and red .

Heat in the Deep Connecting channels of the Internal Organs • Lung Deep Connecting channel : coughing of blood or nosebleed, red face, thirst • Liver and/or Stomach Deep Connecting channel: nosebleed, red eyes, bitter taste, thirst • Bladder and/or Liver Deep Connecting channel : blood in the urine, hypogastric pain, thirst • Uterus Deep Connecting channel : excessive menstrual bleeding with flooding, dark-red blood, thirst, irritability • Large Intestine and/o r Spleen Deep Connecting channel : blood in the stools, abdominal pain, foulsmelling stools, thirst. Heat in the abdominal Membra nes (Huang) • Heat in the abdomina l Membranes affects the Penetrating Vessel causing rebe ll ious Qi in th is vessel. This manifests with various symptoms at different levels of the abdomen, i.e. the hypogastrium, lower abdomen, epigastrium and chest. It is generally characterized by a feeling of fullness, distension or pain or a comb ination of these .

PATHOLOGY OF CONNECTING CHANNELS

Examples of Heat in the Deep Connecting channels are: - Lung Deep Connecting channel: coughing of blood or nosebleed, red face, thirst -Liver and/or Stomach Deep Connecting channel: nosebleed, red eyes, bitter taste, thirst -Bladder and/ or Liver Deep Connecting channel: blood in the urine, hypogastric pain, thirst - Uterus Deep Connecting channel: excessive menstrual bleeding with nooding, dark-red blood, thirst, irritability - Large Intestine and/or Spleen Deep Connecting channel: blood in the stools, abdominal pain, foul-smelling stools, thirst.

Heat in the abdominal Membranes (Huang) Heat in the abdominal Membranes affects the Penetrating Vessel causing rebellious Qi in it. This manifests with various symptoms at different levels of the abdomen, i.e. the hypogastrium, lower abdomen,

259

epigastrium and chest. It is generally characterized by a feeling of fullness, distension or pain or a combination of these. This pattern is described in detail in the chapter on the pathology of the Penetrating Vessel.

NOTES 1. 19 79 The Yellow Emperor's Classic of Internal Medicine- Simple Questions (Huang Di Nei jing Su Wen '1\l' \'i'i' pg ~ ~ iiiJ ). People's Health Publishing House, Beijing, first published c. 100 BC. p. 340. 2 . 1981 Spiritual Axis (Ling Shujing ill. ;Kg t£ ). People's Health Publishing House. Beijing, first published c. 100 Be. p. 121. 3 . Ibid .. p. 3 7. 4. Ibid .. p. 3 7. 5. Yi Fa Yin 1996 Characteristics of Diseases of the Connecting Channels according to Ye Gui. in journal of Traditiona l Chinese Medicine (Zhong Yi Za Zhi $ lli ~ $ ). China Association of Traditional Chinese Medicine and China Academy of Traditional Chinese Medicine. Beijing. vol3 7. no12. p. 713. 6 . Spiritual Axis .. p. 122. 7. Ibid .. p. 121. 8. Zhang jie Bin (also called Zhang Jing Yue) 1982 Classic of Categories (Lei jing ~ t2 ). People's Healtb Publishing House. Beijing. first publisbed in 1624, p. 596. 9. Spiritual Axis., p. 21.

CHAPTER 16

TREATMENT OF THE CONNECTING CHANNELS STOP BLEEDING 261 MENTAL EFFECT 262 EXTERNAL INVASIONS OF PATHOGENIC FACTORS 265 Exterior invasion of Connecting channels in the Defensive-Qi portion 265 Exterior invasion of Connecting channels of the face by Wind without exterior symptoms 266 Exterior invasion of Connecting channels of the body by external Cold 266 LUMPS 266 Thyroid swelling {goitre) 267 Myoma 267 Lipoma 268 Lymph-node swelling 268 BREAST PATH OLOGY 268 THE CONNECTING CHANNELS AND BLOOD STASIS 269 THE CONNECTING CHANNELS AND THE EIGHT EXTRAORDINARY VESSELS 271 NEEDLING TEC HNIQUES 272 'Shu' points of Connecting channels 273 Pricking the Connecting channels 273 Combining Connecting points with Source (Yuan) points 274 Using the Connecting points on the opposite side 275 THE CONNECTING CHANNELS AND THE PENETRATING VESSEL 276 THE CONNECTING CHANN ELS AND HERBAL THERAPY 277 Full conditions of the Connecting channels 277 Empty conditions of the Connecting channels 278 Treatment methods and herbs 278

The Connecting channels have a very wide clinical application in acupuncture practice. As we shall see, treating the Connecting channels does not simply involve using the Connecting points.

Remember: 'treating the Connect ing channels' does not simply involve using the Connecting points. For example, pricking local points superficially t reats the Con nect ing channels.

STOP BLEEDING As we have seen, the Deep (Blood) Connecting channels are situated at a deep level beyond the Main channels: this level corresponds to Blood. For this reason. in most conditions of bleeding, the Deep Connecting channels are involved. When the Yang Connecting channels are injured there is bleeding upwards (nose, cough, vomit, under the skin); when the Yin Connecting channels are injured there is bleeding downwards (stools, urine, uterine). See Figure 16.1. The Connecting points are very important in the stopping of bleeding: the Connecting points of Yin channels more so because the Yin Connecting channels are particularly related to Blood. It should be noted that the Connecting points can stop the bleeding whatever its cause and pattern, i.e. they can stop the bleeding that derives from Qi deficiency or bleeding that derives from Blood Heat. The Connecting points can stop the bleeding both in acute and in chronic cases. The following are examples of the use of Connecting points for bleeding syndromes. • LU-7 Lieque: coughing of blood, blood in urine • L.I.-6 Pianli: nosebleed

261

262

PART 3: CONNECTING CHANNELS (LUO MAl) Bleeding upwards (cough, vomit, nosebleed)

SUMMARY STOP BLEEDING

Pathology of Blood Yang Luo channels

Pathology of Blood Yin Luo channels

Bleeding downwards (urine, menses, stools) Fig. 16.1 Bleeding pathology of the Connecting channels.

• • • • • • • •

SP-4 Gongsun: blood in stools HE-5 Tongli: uterine bleeding BL-58 Feiyang: bleeding haemorrhoids KI-4 Dazhong: coughing of blood, uterine bleeding T.B.-5 Waiguan: nosebleed LIV-5 Ligou: red vaginal discharge, uterine bleeding Ren-15 Jiuwei: coughing of blood Du-1 Changqiang: vomiting of blood.

The above are examples of Connecting points whose indications include some form of bleeding. However, apart from the above examples, all Connecting points can be used in the stopping of bleeding. For example, excessive uterine bleeding implies a pathology of the Yin Connecting channels because it is bleeding downwards: as the three main Yin channels that course through the Uterus are Liver, Spleen and Kidney, the points that stop excessive menstrual bleeding are LIV-5 Ligou, SP-4 Gongsun and KI-4 Dazhong.

MENTAL EFFECT Many Connecting points have a powerful mentalemotional effect because they strongly move Qi and Blood. In particular, as the Connecting channels occupy the superficial areas of the body above the

• The Connecting points can stop bleeding both when it is caused by Qi deficiency and when it is caused by Blood Heat. • A pathology of the Yang Connecting channels causes bleeding upwards; one of the Yin Connecting cha nnels, downwards. • Most Connecting points can be used to stop bleeding: - LU-7 Lieque: coughing of blood, blood in urine - L.l.-6 Pianli: nosebleed - SP-4 Gongsun: blood in stools - HE-5 Tongli: uterine bleeding - BL-58 Feiyang: bleeding haemorrhoids - Kl-4 Dazhong: coughing of blood, uterine bleeding - T.B.-5 Waiguan: nosebleed - LIV-5 Ligou : red vaginal discharge, uterine bleeding - Ren-15 Jiuwei : coughing of blood - Du-1 Changqiang: vomiting of blood.

Main channels, the Connecting points have a powerful 'centrifugal' effect on Qi towards the Exterior: on a mental-emotional level, this means that the Connecting points strongly move Qi and promote and regulate the 'movement' of the Ethereal Soul (Hun) which will have a particular effect in our relationships (i.e. 'movement' towards other people). For this reason, the Connecting points are particularly effective to treat the mental-emotional problems deriving from relationship difficulties (Fig. 16.2). The following are examples of mental-emotional indications for some of the Connecting points. LU-7 Lieque This point has a strong calming effect on the Corporeal Soul (Po) and also a strong moving effect on Qi in the chest. It is especially relevant in treating sadness, grief and worry. The point has a strong 'centrifugal' effect, which may bring on an outpouring of emotional release from the patient. It is particularly indicated in cases in which the person bears his or her problems in silence and keeps them inside. As mentioned above, LU-7 tends to stimulate a

TREATMENT OF THE CONNECTING CHANNELS

263

Fig. 16.2 Emotional effect of P-6 Neiguan . Fig. 16.3 Emotional effect of LU-7 Lieque.

beneficial outpouring of repressed emotions. Weeping is the sound associated with the Lungs according to the Five Elements, and those who have been suppressing their emotions may burst out crying either at or shortly after the use of this point. ' Tendency to crying' is listed as a prominent indication for LU-7 in the :An Explanation of the Acupuncture Points'.1 The Lungs are the residence of the Corporeal Soul (Po) and this point will release the Corporeal Soul's emotional tensions manifested on a physical level with tense shoulders, shallow breathing and a feeling of oppression in the chest. These symptoms are often due to excessive worrying over a long period of time preventing the free breathing of the Corporeal Soul and constraining the Lung energy. LU-7 will calm the Mind, settle the Corporeal Soul, open the chest and release the tension deriving from repressed emotions (Fig. 16.3). CLINICAl NOTE LU-7 Lieque has a powerful emotional effect in allaying sadness and grief, and promoting the outpouring of repressed emotions.

Clinical manifestations include mania. I personally use this point often in combination with S.I.-7 to move Qi in people who are fearful or anxious and are at a time of life marked by emotional confusion and indecision.

L.I.-6 Pianli

Clinical manifestations include manic depression (Dian-Kuang). Apart from this extreme

ST-40 Fenglong

CLINICAl NOTE L.l.-6 Pianli and 5.1.-7 Zhizheng can help a person to clarify confusing emotional issues; for example, the confusion about a difficult relationship which one knows is not right but which one is afraid to end.

example, ST-40 has a profound calming effect on the Spirit especially when the Mind (Shen) is obstructed by Phlegm. However, the Phlegm-resolving effect of this point should not be overemphasized as it also calms the Spirit in general. It calms the Spirit by subduing rebellious Stomach-Qi and opening the chest: it particularly calms the Mind (Shen of the Heart) and the Corporeal Soul (Po). It is excellent in combination with LU-7 Lieque for worry and with P-6 Neiguan for depression. ST-40 can also be used to subdue rebellious Qi of the Stomach and Lungs when the person is very anxious, and the anxiety re!1ects on the Stomach function, with such symptoms as tightness of the epigastrium, a feeling of knots in the Stomach or, as some people say, a feeling of 'butterl1ies in the stomach'. Clinical manifestations include manic depression, insomnia and restlessness. This point calms the Mind also by subduing rebellious Qi of the Penetrating Vessel, which causes anxiety (called Li ]i in the context of the clinical manifestations of rebellious Qi of the Penetrating Vessel).

SP-4 Gongsun

264

PART 3: CONNECTING CHANNELS (LUO MAl)

CLINICAL NOTE

CLINICAL NOTE

ST-40 Fenglong is an excellent point to open the Mind's orifices when they are clouded by Phlegm. Apart from the extreme example of manic depression, clouding of the Mind by Phlegm causes a mental confusion, a certain loss of insight, a confusion about one's direction in life, an inability to see emotional issues clearly, etc. ST-40 resolves Phlegm from the Mind by harmonizing Stomach-Qi. This point has a strong moving effect on the Spirit and its action could be compared to that of Yuan Zhi Radix Polygalae, a herb that is pungent, opens the Mind's orifices and promotes the movement of the Ethereal Soul (Hun).

Kl-4 Dazhong is a good point to harmonize Kidneys and Heart in emotional problems. The Heart houses the Mind (Shen) and the Kidneys the W ill-power (Zhi). The Kidneys provide the drive, determination and will-power to pursue our goals; the Heart provides the Kidneys with its insight and mentalemotional integration. Kl-4 will stimulate the drive, determination and Will-power and promote the communication between Heart and Kidneys: in order to do this, I often combine Kl-4 with HE-7 Shenmen or HE-5 Tongli.

HE-5 Tongli Clinical manifestations include sadness, vexation, anger, fright, agitation, depression and palpitations. I use HE-5 Tongli frequently to calm the Spirit and torrify Heart-Qi and Heart-Blood. However, being a Connecting point, it is also excellent to move Heart-Qi when there is Heart-Qi stagnation from sadness, grief and worry.

CLINICAL NOTE

HE-5 Tongli has the dual effect of ton ifying the Heat and nourishing the Mind and of moving Heart-Qi when it is stagnant from worry. It also promotes the movement of the Ethereal Soul (Hun) when the person is depressed.

S.I.-7 Zhizheng Clinical manifestations include manic depression, fear, fright, sadness and anxiety. As mentioned above, I personally use this point often in combination with S.I.-7 to move Qi in people who are fearful or anxious and at a time of life of emotional confusion and indecision. KI-4 Dazhong Clinical manifestations include palpitations, agitation, dementia, mental retardation, anger, fright, fear, depression, and a desire to close the door and stay at home. KI-4 Dazhong is an excellent point to treat fear and anxiety deriving from (or associated with) a Kidney deficiency. This point can be used both to calm the Mind and to 'lift' the spirit when the person is exhausted and depressed from a chronic Kidney deficiency.

LIV-5 Ligou Clinical manifestations include a feeling of lump in the throat, depression, fright, fear. palpitations and worry. CLINICAL NOTE

Although LIV-5 Ligou is an important point for treating problems of the genitals occurring against a background of Liver patterns, this point also has an important mental-emotional effect. Being a Connecting point and therefore with a 'centrifugal' movement as explained above, it can stimulate the 'coming and going' of the Ethereal Soul (Hun), which is housed in the Liver. It is in the nature of the Ethereal Soul to 'wander', to 'come and go': this coming and going of the Ethereal Soul provides the Mind (Shen) with ideas, dreams, aims, inspiration, intuition, creativity, insight. When this coming and going is impaired (which may occur from Liver-Qi stagnation, or Liver-Qi and Liver-Blood deficiency), the person is depressed; when the coming and going is excessive (as when there is Fire), the person tends towards ' manic' behaviour. Looking at the indications of LIV-5 Ligou, we can see that it is used for depression and we can therefore see that this point stimulates the coming and going of the Ethereal Soul.

Ren-15 ]iuwei Clinical manifestations include manic depression, palpitations, anxiety, insomnia and fright. I use this point very frequently to calm the Spirit and nourish the Heart. It has a profound calming effect at the same time as torrifying the Heart. It also relaxes the chest and relieves oppression of the Corporeal Soul (Po). It is especially effective for sadness, grief and

TREATMENT OF THE CONNECTING CHANNELS

depression from Heart-Blood deficiency, Heart-Qi or Lung-Qi stagnation. This point nourishes all Yin organs and it calms the Spirit particularly in Deficiency of Yin or Blood, or both. It has a very powerful calming action in severe anxiety, worry, emotional upsets, fears or obsessions. Although its classic indications show that it can be used to open the Mind's orifices in serious mental conditions from a Full condition (e.g. manic depression). I personally use this point in mentalemotional states occurring against a background of deficiency of Blood or Yin.

CLINICAL NOTE I use Ren-15 Jiuwei very frequently for anxiety, worry and depression occurring against a background of Blood or Yin deficiency. I am also guided to the use of this point when the mental-emotional stress manifests itself on a physical level in the chest and in the area just below the xiphoid process.

Du-1 Changqiang mania and fright.

Clinical manifestations include

SUMMARY MENTAL EFFECT • LU-7 Lieque: sadness, grief and worry, tendency to crying • U-6 Pianli: mania • ST-40 Feng long: manic depression • SP-4 Gongsun: manic depression, insomnia, restlessness • HE-5 Tongli: sadness, vexation, anger, fright, agitation, depression, palpitations • S.l.-7 Zhizheng: manic depression, fear, fright, sadness, anxiety • Kl-4 Dazhong: palpitations, agitation, dementia, mental retardation, anger, fright, fear, depression, desire to close the door and stay at home • LIV-5 Ligou: feeling of lump in the throat, depression, fright, fear, palpitations, worry • Ren-15 Jiuwei: manic depression, palpitations, anxiety, insomnia, fright • Du-1 Changqiang: mania, fright.

265

EXTERNAL INVASIONS OF PATHOGENIC FACTORS There are two basic types of invasion of external pathogenic factors in the Connecting channels: an invasion of the Defensive-Qi portion (by Wind , Cold, Dampness or Summer-Heat) with the exterior symptoms of aversion to cold and fever; or an invasion of the Connecting channels without exterior symptoms. The latter has two types: an invasion of the Connecting channels of the face causing facial paralysis and/or numbness; and an invasion of the Connecting channels by external Cold, causing severe acute pain without the exterior symptoms of aversion to cold and fever. The latter invasion usually occurs in the Stomach, Intestines or Uterus causing acute epigastric pain, abdominal pain or dysmenorrhoea (Fig. 16.4).

Exterior invasion of Connecting channels in the Defensive-Qi portion An exterior invasion of the Connecting channels in the Defensive-Qi portion is caused by Wind, Cold, Dampness or Summer-Heat and it starts with symptoms of aversion to cold and fever. In the beginning stages of invasion, the superficial Connecting channels are full (because the pathogenic factors lodge there first). Treatmen t of the Connecting channels in the beginning stages of exterior invasions consists in using not only the Connecting points but also points along the channel superficially to drain the superficial Connecting channels of the pathogenic factors.

Defensive-Qi portion (Wind, Cold, Dampness, Summer-Heat)

Connecting channels of face

Connecting channels of body (Cold in stomach, intestines, uterus)

Aversion to cold, fever

Facial paralysis or numbness

Epigastric pain (Stomach) abdominal pain (Intestines) dysmenorrhoea (Uterus)

Fig. 16.4 Invasion of external pathogenic factors in Connecting channels.

266

PART 3: CONNECTING CHANNELS (LUO MAl)

~

The most common points are as follows: -Wind invasion: T.B.-5 Waiguan, LU-7 Lieque plus superficial needling of points along the Greater Yang channels of the upper back and shoulders. Cupping also expels Wind from the superficial Connecting channels. - Cold invasion: LU-7 Lieque plus superficial needling of points along the Greater Yang channels of the upper back and shoulders. Cupping also expels Cold from the superficial Connecting channels. -Dampness invasion: T.B.-5 Waiguan, ST-40 Fenglong, SP-4 Gongsun plus superficial needling of points along the Greater Yang and Bright Yang channels of the arms, upper back and shoulders.

Exterior invasion of Connecting channels of the face by Wind without exterior symptoms Wind may invade the Connecting channels of the face without the exterior symptoms of aversion to cold and fever: thls causes facial paralysis and/or numbness. If it is only the Superficial Connecting channels that are invaded, it will only cause numbness; if the Connecting channels proper are invaded, there is facial paralysis. The main Connecting points to use are T.B.-5 Waiguan and LU-7 Lieque. In addition, use points on the face superficially to drain Wind from the face's superficial Connecting channels.

Exterior invasion of Connecting channels of the body by external Cold External Cold can invade the Connecting channels of the Stomach, Intestines or Uterus without causing the exterior symptoms of aversion to cold and fever. Such an invasion causes acute epigastric pain and vomiting (if in the Stomach), acute abdominal pain and diarrhoea (if in the Intestines), and acute dysmenorrhoea (if in the Uterus). The points that can be used are as follows: - Stomach: ST-40 Fenglong, plus moxa box on Ren-11 Jianli -Large Intestine: SP-4 Gongsun, plus moxa box on abdomen (Ren-6 Qihai) -Uterus: SP-4 Gongsun, LIV-5 Ligou and KI-4 Dazhong plus moxa box on lower abdomen (Ren-4 Guanyuan). See Figure 16.5.

Acute epigastric

~ pain, vomiting

Acute abdominal pain, diarrhoea

~ ~~~~enorrhoea

ST-40

SP-4

SP-4, LIV-5, Kl-4

Fig. 16.5 Invasion of external Cold in the Connecting channels.

SUMMARV,iJi ... EXTERNAL INVASIONS OF PATHOGENIC FACTORS

• Exterior invasion of Connecting channels in Defensive-Qi portion: aversion to cold, fever -Wind: T.B.-5 Waiguan and LU-7 Lieque -Cold: LU-7 Lieque -Dampness: T.B.-5 Waiguan, ST-40 Fenglong and SP-4 Gongsun • Exterior invasion by Wind of the face's Connecting channels wit hout ext erior symptoms: numbness of the face or facial paralysis • Exterior invasion of Connecting channels of the body by external Cold -Stomach: ST-40 Fenglong, moxa on Ren- 11 (epigastric pain and vomiting) - Intestines: SP-4 Gongsun, moxa on Ren-6 (abdominal pain and diarrhoea) - Uterus: SP-4 Gongsun, LIV-5 Ligou and Kl-4 Dazhong, moxa on Ren-4 (dysmenorrhoea).

LUMPS As the Connecting channels are reticular and take the shape of a network of small channels, their space is easily prone to stagnation and accumulation of Qi, Fluids and Blood. This accumulation may give rise to lumps or swellings. Examples of such swellings are thyroid swelling, myomas, lipomas and lymph-node swelling. In fact, most swellings and lumps are due to stagnation of Qi, Blood or Fluids in the Connecting

TREATMENT OF THE CONNECTING CHANNELS

Lipoma

267

Superficial Luo

~~-~~~-----------------------------

Luo channel

0

Main channel

~

I

V....:::::m-a-ss::::::._ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ __! Deep Luo (blood Luo)

L __ _ _ _ _ _ _ _ _

Fig. 16.6 Lumps in the Connecting channels.

channels: superficial lumps are due to stagnation in the superficial Connecting channels whereas lumps in the internal organs are due to stagnation in the deep, Blood Connecting channels. Cysts are due to swellings in the Connecting-channels area proper (Fig. 16.6). The main points to treat swellings in the Connecting channels are as follows:

Myoma A myoma is a prime example of a mass from Blood stasis (a Blood mass of the zheng or ji type). This is due to Blood stasis in the Connecting channels of the Kidneys, Liver and Spleen (Fig. 16.8). The main points to use are SP-4 Gongsun, LIV-5 Ligou and KI-4 Dazhong.

Thyroid swelling (goitre) This may be a simple goitre, nodules or carcinoma. A swelling of the thyroid is usually due to Qi stagnation with Phlegm; if the lump is hard there is also Blood stasis. The Connecting channels involved in such swellings are primarily the Directing Vessel (Ren Mai), Liver, Large Intestine and Stomach (Fig. 16. 7). The main points that can be used are: LIV-5 Ligou, L.I.-6 Pianli and ST-40 Fenglong.

LIV-5, SP-4, Kl-4

LIV-5, LIV-6, ST-40 Fig. 16.7 Thyroid swelling.

Fig. 16.8 Myoma.

268

PART 3: CONNECTING CHANNELS (LUO MAl)

Lipoma A lipoma is a classic example of swelling from Phlegm because it is soft and movable. A lipoma is due to accumulation of Phlegm under the skin in the Superficial Connecting channels area. The main points to use are ST-40 Fenglong and SP-4 Gongsun.

Lymph-node swelling A swelling of the lymph nodes is usually due to stagnation of Qi and retention of Dampness or Phlegm, or both, in the Connecting channels. The main points to use are SP-21 Dabao and SP-4 Gongsun as general points, plus other Connecting points according to location.

-neck: L.I.-6 Pianli, T.B.-5 Waiguan, S.I.-7 Zhizheng (Fig. 16.9) -groin: LIV-5 Ligou, SP-4 Gongsun, KI-4 Dazhong (Fig. 16.10).

BREAST PATHOLOGY The female breast is strongly influenced by the Connecting channels of the Liver, Stomach, Directing

LIV-5, SP-4, Kl-4 Fig. 16.10 Groin lymph-node swelling .

SUMMARY LUMPS • Thyroid swelling: Qi stagnation with Phlegm in the Connecting channels -points: LIV-5 Ligou, L.l.-6 Pianli, ST-40 Feng long • Myoma: Blood stasis in the Deep (Blood) Connecting channel - points: SP-4 Gongsun, LIV-5 Ligou, Kl-4 Dazhong • Lipoma: Accumulation of Phlegm in the Superficial Connecting channels - points: ST-40 Fenglong, SP-4 Gongsun • Lymph-node swelling: Qi stagnation w ith Dampness and/or Phlegm -points: neck: L.l.-6 Pianli, T.B.-5 Waiguan , S.l.-7 Zhizheng groin: LIV-5 Ligou, SP-4 Gongsun, Kl-4 Dazhong.

Vessel (Ren Mai) and Penetrating Vessel (Chong Mai). From the point of view of Chinese medicine, the female breast is made up of the following structures:

Ll-6, TB-5, Sl-7 Fig. 16.9 Axilla lymph-node swelling.

• Fat (Gao): the adipose tissue of the breast • Membranes (Huang): connective tissue (compartments that house the glandular lobules)

•

TREATMENT OF THE CONNECTING CHANNELS

269

and the breast in particular. The main herbs that have this function are:

Blood vessels: Chong Mai and Blood Luo

Connective tissue: Huang -

Liver

Chong Mai, Ren Mai and Breast Luo

Fig. 16.11 Structure of the female breast.

• Stomach channel: milk ducts and glandular lobules • Liver channel: nipple • Directing Vessel: milk ducts • Penetrating Vessel: milk ducts • Penetrating Vessel: blood vessels and Blood Luo. (Fig. 16.11). In particular, the Connecting channels of the Stomach, the Liver, and the Directing and Penetrating vessels make up the breast, and its network of glandular lobules and milk ducts resembles the network of Connecting channels. The Penetrating Vessel exerts a particular influence on the breast because it affects all Connecting channels. The main Connecting points affecting the breast are SP-4 Gongsun, LIV-5 Ligou and ST-40 Fenglong. SP-4 Gongsun affects the breast also by virtue of its being the opening point of the Penetrating Vessel (Chong Mai): this vessel disperses over the chest and breast and it affects the female breast and lactation. As for herbal treatment, a number of herbs have a particular action in removing obstructions from the Connecting channels of the breast: the latter phrase 'removing obstructions from the Connecting channels of the breast', is a translation of the concise but descriptive Chinese term tong ru Luo, literally meaning 'penetrating the breast's Connecting [channels)' . All these herbs move Qi and Blood in the Penetrating Vessel because of the relation between this channel and the Connecting channels and blood vessels in general,

• • • • • • •

Ju Luo Medulla Citri reticulatae Lu Lu Tong Fructus Liquidambaris taiwanianae Chuan Shan Jia Squama Manitis pentadactylae2 Mu Tong Caulis Mutong 3 Si Gua Luo Fasciculus vascularis Luffae Lou Lu Radix Rhapontici seu Echinops Tong Cao Medulla Tetrapanacis papyriferi.

It is interesting to note that incorporated in some of

these herb names are the words Luo for Connecting channels and Tong for 'removing obstructions'. Moreover, the structure of these herbs when dried resembles a network of channels running in all directions, just as the network of Connecting channels does. In some of them, the structure even resembles the network of the breasts with its lobules, milk ducts and connective tissue compartments. In particular Ju Luo Medulla Citri reticulatae, i.e. the soft fibrous tissue lining the inside of the rind in tangerines, bears a close resemblance to the connective tissue inside the breast, and the whole fruit may be taken to represent the breast itself (Fig. 16.12).

THE CONNECTING CHANNELS AND BLOOD STASIS The Deep Connecting channels, and especially the Yin Connecting channels, easily suffer from Blood stasis. The 12 main channels are situated between the Yang and Yin Connecting channels. It is through the Yin and Yang Connecting channels that Nutritive and Defensive Qi, and Qi and Blood of the main channels spread in all directions, permeating and irrigating the

Orange pith

Si Gua Luo

Fig. 16.12 Herbs that remove obstructions from the breast's Connecting channels.

270

PART 3: CONNECTING CHANNELS (LUO MAl)

SUMMARY BREAST PATHOLOGY • Female breast influenced by the Connecting channels of Liver, Stomach, Directing Vessel (Ren Mai) and Penetrating Vessel (Chong Mai) • Main Connecting points affecting the breast are SP-4 Gongsun, LIV-5 Ligou and ST-40 Fenglong • Herbs that enter the breast's Connecting channels to remove obstructions: - Ju Luo Medulla Citri reticu/atae - Lu Lu Tong Fructus Liquidambaris taiwanianae - Chuan Shan Jia Squama Manitis pentadactylae4 - Mu Tong Cau/is Mutong5 - Si Gua Luo Fasciculus vascularis Luffae - Lou Lu Radix Rhapontici seu Echinops -Tong Cao Medulla Tetrapanacis papyriferi.

Internal Organs. It is also through the Connecting channels that the essence of the Internal Organs is transported to the main channels and, through them, to the whole body. As the Connecting channels are like a net occupying the body cavities, and because they transport Qi and Blood between the Yang Connecting, Yin Connecting and Main channels, in chronic diseases the Deep Connecting channels are easily affected by Blood stasis.

Blood stasis may occur in the Connecting channels through invasion of pathogenic factors in the channels, a change in the composition or quality of the Blood due to Cold or Heat, or injury by trauma (Fig. 16.13). In chronic diseases, Blood stasis is frequently the result of a pathology of the Deep Connecting channels. For example, Ye Tian Shi mentions 'The Liver Connecting channel causes stasis'. ' The Gall Bladder Connecting channel causes bloody vaginal discharge', 'Inju ry to the Liver and Spleen Connecting channels causes Blood stasis', 'Blood stasis affects the Stomach Connecting channel' . Hence the saying 'In the beginning of a disease the Main channels and Qi are affected; at the chronic stage Blood and the Connecting channels are affected' ;6 'Connecting channels' here refers to the Deep (Blood) Connecting channels. Therefore, all Connecting points, but particularly those of the Yin channels, can be used to invigorate Blood and eliminate Blood stasis in chronic diseases. To invigorate Blood, the most important of all the Yin Connecting points is SP-4 Gongsun because it is the opening point of the Penetrating Vessel (see below). The following are examples of Connecting points that are used for Blood stasis and bleeding.

- LU-7 Lieque: retention of lochiae, retention of dead fetus, inability to speak after childbirth - SP-4 Gongsun: abdominal pain, irregular periods, retention of placenta/lochiae - HE-5 Tongli: chest pain, pain in the heart region - BL-58 Feiyang: swollen and painful haemorrhoids - KI-4 Dazlwng: irregular periods External pathogenic factors trauma

YANG {

----------8-~_:.:.~ -io~-~-o----------. ~: :~: ~: ~: 11 Main Nutritive Qi _ _ _ _ _ _ _ _ _ _........._ _ _ _ _ _ _ _ _ _ Blood Yang deep luo }

-------------------------------Yin deep luo

YIN {

Main Luo proper

--------------------------------------------------------------Superficialluo

Nutritive Qi Defensive Qi

ll '- - - - "

E)-+ Blood

Defensive Qi

HeaVCold Fig. 16.13 Blood stasis in the Deep Conneding channels.

TREATMENT OF THE CONNECTING CHANNELS

271

- LIV- 5 Ligou: swelling and pain of the testicles, painful periods, irregular periods - Ren-15 Jiuwei: chest pain. pain radiating from the heart to the back - LIV-3 Taichong: abdominal pain, irregular/ painful periods. CLINICAL NOTE

Blood stasis is a very common and important pathological condition in chronic diseases. It should never be underestimated and many diseases are treated by invigorating Blood. In gynaecology, Blood stasis is extremely common in dysmenorrhoea, endometriosis, myomas and infertility. Blood stasis may potentially lead to serious diseases (e.g. coronary heart disease, cancer).

SUMMARY THE CONNECTING CHANNELS AND BLOOD STASIS • The Deep (Blood) Connecting channels affect Blood • In chronic conditions, Blood stasis occurs in the Deep Connecting channels • All Connecting points can invigorate Blood and eliminate stasis • SP-4 Gongsun is t he most impo rt ant of the Connecting points to invigorate Blood because of its being the opening point of the Penetrating Vessel.

balance Yin-Yang in the limbs

THE CONNECTING CHANN ELS AND THE EIGHT EXTRAORDI NARY VESSELS The Eight Extraordinary Vessels have the function of regulating Qi and Yin-Yang in the trunk: they function like the reservoirs that regulate the flow of water from rivers. In particular, they absorb excess Qi (Yin or Yang) from the Main channels to channel it into their 'reservoirs' much as reservoirs absorb the overflow of water from rivers in times of heavy rainfall. The Extraordinary Vessels perform the function of regulating the quantity of Yin and Yang in the trunk; the Connecting channels perform the same function but in the limbs (Fig. 16.14).

Fig. 16.14 Balance of Yin-Yang in Connect ing channels and Extraordinary Vessels.

However, the Eight Extraordinary Vessels' function of absorbing excess Qi from the main channels involves also the Connecting channels. Ye Tian Shi said that 'Th rough the Connecting c/wnnels Qi penetrates the

272

PART 3: CONNECTING CHANNELS (LUO MAl)

Extraordinary Vessels continuously'. 7 He also said that the Eight Extraordinary Vessels 'pertain' to the Connecting channels and, specifically, the Yin Connecting channels (Fig. 16.15). This is a partial explanation as to why four of the opening points of the Extraordinary Vessels are Connecting points, i.e. SP-4 Gongsun (Penetrating Vessel, Chong Mai), LU-7 Lieque (Directing Vessel, Ren Mai), P-6 Neiguan (Yin Linking Vessel, Yin Wei Mai) and T.B.-5 Waiguan (Yang Linking Vessel, Yang Wei Mai). See Figure 16.16.

NEEDLING TECHNIQUES Treatment of the Connecting channels generally involves use of the distal Connecting point with reducing method in acute conditions and reinforcing

SUMMARY THE CONNECTING CHANNELS AND THE EIGHT EXTRAORDINARY VESSELS

• The Eight Extraordinary Vessels' function of absorbing excess Qi from the main channels involves also the Connecting channels • The Eight Extraordinary Vessels 'pertai n' t o the Connecting channels and specifically to the Yin Connect ing channels • Four of the opening point s of the Ext raordinary Vessels are Connecting points: SP-4 Gongsun (Penetrating Vessel, Chong Mai), LU-7 Lieque (Directing Vessel, Ren Mai), P-6 Neiguan (Yin Li nking Vessel, Yin Wei Mai) and T.B .-5 Waiguan (Yang Linking Vessel, Yang Wei Mai) .

Yin Connecting channels

Limbs

Fig. 16.15 Connection between Connecting channels and Extraordinary Vessels.

TREATMENT OF THE CONNECTING CHANNELS

Sl-3 Du Mai

S.l.

HE

LU-7 Ren Mai

~

G!J

G.B.-41 Dai Mai

~

~

SP-4 Chong Mai

~

~

~

~

0

[2!]

BL-62 Yang Qiao Mai

Kl-6 Yin Qiao Mai

P-6Yin WeiMai

273

T.B.-5 Yang WeiMai

Extraordinary vessels Limbs

Trunk

Fig. 16.16 Connection between Connecting channels and Extraordinary Vessels in the pulse.

method in chronic conditions. In addition to this, the local points should be needled superficially to release congestion and accumulation in the superficial Connecting channels. Thirdly, the Blood Connecting channels can be drained by pricking and bleeding venules that appear on the surface of the skin. Various needling methods to affect the Connecting channels are mentioned in the Classics.

'Shu' points of Connecting channels

the surface of the skin are situated in the Superficial Connecting channels, they reflect pathology of the Deep (Blood) Connecting channels: in other words, the Blood pathology (Heat, Cold or stasis) at the level of the Deep Connecting channels causes the Blood at this deep level to 'percolate' upwards towards the surface to manifest on the skin at the level of the Superficial Connecting channels (see also Ch. 14). See Figure 16.17. The method of pricking the blood vessels that are visible on the skin is used for Full conditions of the Connecting channels to clear Heat, cool Blood or

The 'Simple Questions' mentions the Shu (the same character as in Back-Shu points) points of the Connecting channels. These are the Shu points of the Minute (Sun) Connecting channels, which should be needled in summertime. Chapter 16 of the 'Simple Questions' says: 'In summertime needle the Shu points of the Minute Connecting channels.' 8 The 'Classic of Categories' says: 'The Shu of the Connecting channels are the points of the Minute Connecting channels; in swnmerti111e, Qi is in the Minute Connecting channels. '9

Pricking the Connecting channels 'Pricking the Connecting channels' is one of the methods of needling. It consists of pricking and bleeding the venules that appear on the surface of the skin; these appear at the level of the Superficial and Minute Connecting channels. As mentioned in Chapter 14, by definition the Connecting channels are visible whereas the Main channels are not. It should be noted that, although the blood vessels that become visible on

Superficial Luo

Blood vessels Blood level

Luo Main channel Deep (Blood) Luo

Fig. 16.17 Skin manifestation of Deep Connecting channels.

274

PART 3: CONNECTING CHANNELS (LUO MAl)

invigorate Blood. Chapter 7 of the 'Spiritual Axis' says: 'Pricking the Connecting clwnnels consists in pricking tire blood vessels of tire supe1jicial Connecting clrmmels. >~o Chapter 10 of the 'Spiritual Axis' says: 'To needle the Connecting clzawrels one 111ust needle above tl1e accwnulation where !Jlood is concentrated. Even if there is 110 !Jlood accumulation. one must prick to cause bleeding quickly to drain the pathogenic factors out: if this is not done. Painful 0 /Jstruction (Bi) Syndrome may develop." u Pricking the venules appearing on the skin also invigorates Blood, cools Blood and removes obstructions from the Connecting channels. The bleeding of the venules on the point BL-40 Weizhong is a good example of the use of this technique: bleeding this point invigorates and cools Blood in the Bladder channel and is used in backache with pronounced stiffness and rigidity (itself a sign of Blood stasis).

Combining Connecting points with Source (Yuan) points The Connecting points may be combined with Source (Yuan) points to assist treatment of the associated channel. For example, if there is a Lung deficiency and we needle the Source point of the Lung, i.e. LU-9 Taiyuan, we can associate this with L.I.-6 Pianli to assist the treatment of the Lungs. It is perhaps this combination of points that led some Western authors to introduce the concept of a 'transversal' Connecting channel (linking the Connecting point with the Source point of its associated channel), which is not mentioned in Chinese literature (Fig. 16.18). The following are the combinations of Connecting and Source points which I personally use most frequently:

-

L.I.-4 Hegu and LU-7 Lieque: to restore the descending of Lung-Qi, expel Wind, regulate the

LU - 9 Taiyuan

1-I

Yuan point selected to treat presenting problem (e.g. feeling of oppression of chest, hot palms, cough, dry throat, pain in the breasts, expectoration of phlegm, breathlessness)

L.l.- 6 Pianli

-

Luo point selected to assist Yuan point of associated channel

Fig. 16.18 Combination of Source (Yuan) and Connecting (Luo) points.

-

-

ascending and descending of Qi to and from the head. Used for common cold symptoms, sneezing, allergic rhinitis, chronic headaches, asthma, wheezing, breathlessness T.B.-4 Yangchi and P-6 Neiguan: to regulate the Triple Burner, move Liver-Qi, calm the Spirit. On a physical level, used for hypochondria!, epigastric or breast distension, pre-menstrual distension; on a mental-emotional level, used for depression from Liver-Qi stagnation, anxiety, worry SP-3 Taibai and ST-40 Fenglong: to tonify the Spleen and resolve Phlegm LIV-3 Taichong and G.B.-37 Guangming: to brighten the eyes in Liver patterns BL-64 Jinggu and KI-4 Dazhong: to treat sciatica (BL-64 on affected side, KI-4 on opposite one).

The 'Great Compendium of Acupuncture' (Zhen Jiu Da Cheng, 1601) discusses the combination of Source point with associated Connecting point and calls this combination guest-host method, the Source point being the host and the Connecting point the guest. It should be noted that the Source point is the main point, i.e. the choice of points is determined by the pathology of the host (the Source point of the diseased channel). The symptoms are as follows (listing the host first and the guest second): - LU-9 Taiyuan and L.I.-6 Pianli: feeling of oppression of the chest, hot palms, cough, swelling of the throat, dry throat, sweating, shoulder pain, pain in the breasts, expectoration of phlegm, breathlessness - L.I.-4 Hegu and LU-7 Lieque: toothache, swollen gums, yellow eyes, dry mouth, runny nose, epistaxis, swollen throat, shoulder pain - SP-3 Taibai and ST-40 Fenglong: stiff tongue, acid reflux, vomiting, abdominal distension, feeling of heaviness, constipation, weakness, swelling of lower limbs - ST-42 Chongyang and SP-4 Gongsun: abdominal distension and fullness, feeling of oppression of the chest. epistaxis, phlegm, foot pain, ankle pain - HE-7 Shenmen and S.I.-7 Zhizheng: heart pain, dry throat, thirst, yellow eyes, dry mouth, hot palms, palpitations, vomiting of blood, fright - S.l.-4 Wangu and HE-5 Tongli: stiff neck, swelling and pain of throat, shoulder pain, deafness, yellow eyes, pain on lateral side of upper arms - KI-3 Taixi and BL-58 Feiyang: dark complexion, no thirst, desire to lie down, decreased vision, feeling of

TREATMENT OF THE CONNECTING CHANNELS

-

-

-

-

-

heat, backache, weakness of lower limbs, shortness of breath, timidity (Xin Dan Zhan fing literally means 'Heart and Gall-Bladder shivering and dithering') BL-64 finggu and KI-4 Dazhong: eye pain, neck-ache, pain from neck to back to lower limbs, mania, epilepsy, opisthotonos, pain in eyebrow region, epistaxis, yellow eyes, contraction of tendons, prolapse ani T.B.-4 Yangchi and P-6 Neiguan: tinnitus, deafness, swelling of throat, dry throat, swelling of eyes, earache, sweating, pain between scapulae, elbow pain, constipation, incontinence of urine, retention of urine P-7 DaZing and T.B. Waiguan-5: contracture of palms, arm pain, inability to extend arm, fullness of chest, swelling of axilla, palpitations, red face. yellow eyes, laughing and crying without reason, mental restlessness, heart pain, hot palms LIV-3 Taichong and G.B.-37 Guangming: abdominal distension and hypogastric swelling in women, chest fullness, vomiting, hernia, urinary retention or incontinence G.B.-40 Qiuxu and LIV-5 Ligou: dull complexion, headache, eye pain, swelling of neck, goitre, hypochondria! pain, swelling and sweating of axilla.U

275

spread into tlze four./imbs witlz no regular residence and without entering tlze points of the Main channels. Tlzis is why contrary needling should be app/ied.' 13 In other words, because the Connecting channels occupy the body cavities in a net-like way and on the surface of the body, the left and right sides of the body are connected through the Connecting channels at the superficial level and therefore pathogenic factors on one side can cause symptoms on the opposite side. This is not the case with the Main channels, which are more like lines, and are pathways in which the right and left side are completely separate and not connecting (except in the head). See Figure 13.4. Therefore, especially in acute conditions, one can needle the Connecting point on the side opposite to where the symptoms manifest. The same chapter of the 'Simple Questions' gives the symptomatology of each channel (reported inCh. 15) recommending the needling of the Connecting point of the opposite side. For example, for an acute pain of the right shoulder joint along the Large Intestine, one can use L.I.-6 Pianli on the left side as a distal point (Fig. 16.19).

Using the Connecting points on t he opposite side For the difference between fu Ci (opposite needling of Main channels) and Miu Ci (reverse needling of Connecting channels) see Su Wen Chapter 63, p. 345 and Zhe Jiu Da Cheng p. 80. Chapter 63 of the 'Simple Questions' discusses 'opposite needling' (Ju Ci, literally 'Big Needling') which is used for the Main channels and 'contrary needling' (Miu Ci literally 'wrong [side] needling') used for the Connecting channels. It says: 'If pathogenic factors enter tlze Minute COI!IIecting dzmznels and stay there. they block tlze passages of the Connecting channels wlzich are therefore wwble to flow into tlze Main channels; under suclz circumstances, the patlwgenic factors overj1ow into the Connecting channels musing strange diseases. Wlzm tlze patlwgmic factors are in tlzc Connecting channels. tlze left side infuses into tlze right and vice versa; a/tlzough tlze Connecting clznrmels f on each side of tlzc l1ody] are connected witlz tlze Main channels on the left and right sides and on tlze upper and lower sides, tlzcy

Fig. 16.19 Needling of opposite Connecting point in acute conditions.

276

PART 3: CONNECTING CHANNELS (LUO MAl)

In chronic conditions, I often use the Connecting point of the associated channel on the opposite side. For example, if I am treating an elbow or shoulder problem on the right side affecting the Large Intestine channel with several Large Intestine local points, I may use the Connecting point of the Lung channel on the left side. The rationale behind this is that, in chronic conditions, the Connecting channels have become empty because the pathogenic factors have progressed either to the Main channels or to the Yin Connecting channels. Thus, the affected side is 'empty' in relation to the other side. By using the Lung Connecting point we equalize the channels between right and left and we also drain the Yin Connecting channel, which is likely to be full, and equalize Yang and Yin Connecting channels (Fig. 16.20).

Ll-15

CLINICAL NOTE

In acute tendinomuscular conditions (e.g. pain in right shoulder on Large Intestine channel), I often use the Connecting point of the affected channel on the opposite side (e.g. L.l.-6 Pianli on the left); in chronic conditions, I often use the Connecting point of the associated channel on the opposite side (e .g. LU-7 Lieque on the left).

SUMMARY NEEDLING TECHNIQUES

• Shu points of Connecting channels • Pricking the Connecting channels (venules) • Combining Connecting points with Source (Yuan) points • Using t he Connecting points on the opposite side.

THE CONNECTING CHANNELS AND THE PENETRATING VESSEL Of the Eight Extraordinary Vessels, the Penetrating Vessel is the one that is most closely related to the Connecting channels for various reasons. - The Penetrating Vessel is called the Avenues of Qi of the abdomen, indicating that it controls all the channels of the abdomen including all Connecting channels.

Fig. 16.20 Needling of opposite Connecting point of associated channel in chron ic conditions.

- The Penetrating Vessel controls the Membranes (Huang), which are also under the influence of the Connecting channels of the abdomen. - The Penetrating Vessel controls all Connecting channels including and especially all superficial. Minute and Blood Connecting channels. - The Penetrating Vessel is the Sea of Blood and controls all Blood Connecting channels. For these reasons, SP-4 Gongsun influences all Superficial. Minute and Blood Connecting channels and is an important point to use especially in chronic conditions with Blood stasis in the Connecting channels. Other Penetrating Vessel points also influence the Blood Connecting channels and invigorate Blood in the Penetrating Vessel and the Blood Connecting channels: - KI-13 Qixue: irregular periods, abdominal pain, running piglet syndrome (rebellious Qi of the Penetrating Vessel). - KI-14 Siman: abdominal pain, running piglet syndrome, irregular periods, coagulated blood causing pain, retention of lochiae.

TREATMENT OF THE CONNECTING CHANNELS

SUMMARY 1'HE CONNEaiNG CHANNELS AND THE PENETRATING VESSEL

• The Penetrating Vessel is closely related to the Connecting channels in its physiology and pathology • SP-4 Gongsun influences all Connecting channels • In particular, SP-4 Gongsun influences all Deep (Blood) Connecting channels and it invigorates Blood • Many others of the Penetrating Vessel 's abdominal points invigorate Blood in t he Deep Connecting channels of the abdomen.

- KI-15 Zhongzhu: irregular periods. - KI-16 Huangshu: stabbing abdominal pain. - KI-17 Shangqu: abdominal masses, stabbing abdominal pain. - KI-18 Shiguan: postpartum abdominal pain, stabbing hypochondria! pain, coagulated blood in the uterus, stabbing abdominal pain. - KI-19 Yindu: epigastric pain, stabbing abdominal pain, coagulated blood in the uterus. - KI-21 Youmen: abdominal pain, chest pain, coughing blood. - KI-25 Shencang: chest pain.

277

Qi. It should be noted that Tong here does not have the meaning of 'moving downwards' (Gong Xia ), nor of opening the Water passages by promoting diuresis (Tong Li), but rather of regulating and harmonizing Qi and Blood by 'removing obstructions by restoring correct direction of Qi Oow' (Tong Shun). The four main treatment methods for Full conditions of the Connecting channels are as follows.

1. Remove obstructions from the Connecting channels with pungent and moistening herbs The removing of obstructions from the Connecting channels with some pungent and some moistening herbs is used when long-term Qi and Blood stagnation in the Connecting channels has given rise to Heat and dryness. The clinical manifestations are hypochondria! pain, stomach pain, depression, and bleeding from Heat.

2. Remove obstructions from the Connecting channels with warm-pungent herbs The removing of obstructions from the Connecting channels with warm-pungent herbs is used for Yin pathogenic factors (e.g. Cold) causing Blood stasis in the Connecting channels. Warm-pungent herbs have the effect of invigorating Blood in the Deep (Blood) Connecting channels when Blood stasis is caused by Cold. The clinical manifestations are stomach pain, Painful Obstruction (Bi) Syndrome. and abdominal masses.

THE CONNECTI NG CHANN ELS AND HERBAL TH ERAPY

3. Remove obstructions from the Connecting channels with pungent-fragrant herbs

We must distinguish Full from Empty conditions of the Connecting channels.

The removing of obstructions from the Connecting channels with pungent-fragrant herbs is used for Cold or Phlegm-Fluids in the Connecting channels. The clinical manifestations are stomach pain, chest pain, hypochondria) pain, abdominal masses, headache, and depression.

Full conditions of the Connecting channels The chief treatment method is to use herbs with pungent taste, called Tong Luo Fa i.e. 'penetrating the Connecting channels' or 'removing obstructions from ilie Connecting channels'. The pungent taste moves, scatters and opens (i.e. removes obstructions): this removes stagnation of Qi or Blood from the Connecting channels, it regulates and relaxes the Qi mechanism. it expels pathogenic factors and it restores the Upright

4 . Remove obstructions from the Connecting channels with insect or animal drugs The removing of obstructions from the Connecting channels is used for chronic Blood stasis with deficiency of the Upright Qi. Insect drugs can invigorate Blood and eliminate stasis (e.g. Wu Ling Zhi Excrementum

278

PART 3: CONNECTING CHANNELS (LUO MAl)

Trogopteri seu Pteromi, Shui Zhi Hirudo, Tu Bie Chong Eupolyphaga seu Steleophaga and Meng Chong Tabanus). Tu Bie Chong and Meng Chong also 'break-up Blood' and dissolve masses. The clinical manifestations are hypochondria! pain, stomach pain, abdominal masses and headache.

the Blood (not from Blood Deficiency but from stagnant Blood obstructing the vessels and preventing Blood from taking its place) and some Yin deficiency. One therefore uses moistening herbs to nourish Yin, sweet herbs to tonify Qi and Blood, and pungent herbs to remove stagnation.

Empty conditions of the Connecting channels

3. Remove obstructions from the Connecting channels, tonify, clear and moisten

The Connecting channels are in an Empty condition in chronic diseases. Connecting channels become Empty either when a deficiency of the body's Qi in the Internal Organs and Main channels affects the Connecting channels, or when external pathogenic factors invading the Connecting channels move towards the Interior so that the Connecting channels become Empty in relation to the Main channels. When the Connecting channels are Empty one must combine the treatment methods of 'removing obstructions from the Connecting channels' (Tong Luo) with tonifying. There are four possible treatment methods for Empty conditions of the Connecting channels:

1. Remove obstructions from the Connecting channels and tonify the body's Qi with some pungent and some sweet herbs The removing of obstructions from the Connecting channels and the torrifying of the body's Qi with some pungent and some sweet herbs is used for chronic stagnation in the Connecting channel with deficiency of the Upright Qi (Zheng Qi). This treatment method is often used to treat epigastric and abdominal pain from a condition of Deficiency and Cold in the Stomach accompanied by chronic stagnation of Qi or Blood.

2. Remove obstructions from the Connecting channels and tonify and moisten The removing of obstructions from the Connecting cnanne[s and the torrifying and moistening is used for Empty conditions of the Connecting channels with Yin deficiency. This treatment method is used for complex, chronic conditions characterized by chronic stagnation in the Connecting channels accompanied by deficiency of Qi and Blood; the chronic Blood stasis in the Deep Connecting channels leads to Dryness of

This treatment method combines four actions: - the removing of obstructions from the Connecting channels with pungent herbs - the tonifying of Qi and Blood with sweet herbs - the moistening and nourishing of Yin with moistening herbs - the clearing of Heat with cold herbs. This treatment method is used also for complex, chronic conditions with deficiency of Qi and Blood, Blood stasis giving rise to Dryness (not from Blood Deficiency but from stagnant Blood obstructing the vessels and preventing Blood from taking its place), and Heat deriving from long-term stagnation. Clinical manifestations may include chronic hypochondria!, epigastric or abdominal pain that is worse at night, a vague feeling of hunger without desire to eat, and a dry mouth without desire to drink or with desire to gargle.

4. Remove obstructions from the Connecting channels and tonify with warm moistening herbs The removing of obstructions from the Connecting channels and the tonifying with warm moistening herbs is used for Empty conditions of the Connecting channels with Cold. Warm herbs are used to warm Yang and pungent herbs to move Blood. Moistening herbs are used because the long-term Blood stasis may lead to Dryness. Clinical manifestations may include vomiting of blood, chest pain, Flooding and Trickling (heavy menstrual bleeding of the Beng Lou typ e) , d mmk diarrhoea, anal prolapse, and blood in urine.

Treatment methods and herbs Ye Tian Shi advocates making Qi descend, eliminating stagnation, removing obstructions from the Connecting

TREATMENT OF THE CONNECTING CHANNELS

channels with pungent herbs, and moistening Blood, i.e. simultaneously remove obstructions from the Connecting channels with pungent herbs and moistening. Ye Tian Shi's directions are particularly aimed at the treatment of chronic conditions that have reached the Deep (Blood) Connecting channels: as the Deep Connecting channels are related to Blood and because often chronic Blood stasis leads to Dryness, Ye Tian Shi advocates that the moistening method be combined with the pungent herbs that eliminate stagnation. 14 Ye Tian Shi also said that 'torrifying should be combined with removing obstructions' and, on the other hand, 'attacking [pathogenic factors] should be moderate'. The former means that tonification should not be based on the use of too many sticky and sweet herbs; the latter, that draining should not use too many bitter herbs. Therefore, one would not use Huang Qin Radix Scutellariae or Huang Lian Rhizoma Coptidis to drain Fire; not Sheng Jiang Rhizoma Zingiberis recens or Fu Zi Radix Aconiti latera lis praeparata to warm; not Ren Shen Radix Ginseng to torrify; and not Bai Shao Radix Paeoniae Alba and Sheng Di Huang Radix Rehmanniae to nourish as they are too sticky. In general, one should not use the sour, bitter or sweet taste, but only primarily pungent and secondarily salty. The two key actions are 'moving with pungent taste' and 'moistening'.

279

Ye Tian Shi recommends the following herbs for pathology of the Connecting channels:

-for Yin pathogenic factors: Dang Gui Radix Angelicae sinensis, Gui Zhi Ramulus Cinnamomi, Xie Bai Bulbus Allii macrostemi -for strong pathogenic factors: Ding Xiang Flos Caryophilli, Lu Jiao Jiao Cervi Comus Colla, Chuan Jiao Pericarpium Zanthoxyli, Quan Xie Scorpio, Xi Xin Herba Asari -for Cold or Phlegm Fluids: Gao Liang Jiang Rhizoma Alpiniae ojficinarum, Pu Huang Pollen Typhae, Yan Hu Suo Rhizoma Corydalis - for chronic pathogenic factors causing Heat and Dryness: Xuan Fu Hua Flos Inulae, Dang Gui Wei Radix Angelicae sinensis ('tail'), Cong Bai Bulbus Alliifistulosi, Tao Ren Semen Persicae, Hong Hua Flos Carthami tinctorii, Bai Zi Ren Semen Biotae; moisten withE Jiao Colla Corii Asini, Huo Ma Ren Semen Cannabis, Mu Dan Pi Cortex Moutan -for Empty Cold: Xiao Hui Xiang Fructus Foeniculi, Dang Gui Radix Angelicae sinensis, Gou Qi Zi Fructus Lycii, Lu Jiao Shuang Cervi Cornu degelatinatum, Rou Gui Cortex Cinnamomi, Rou Cong Rong Herba Cistanches, Hu Tao Rou Semen Juglandis - for chronic Blood stasis: Tu Bie Chong Eupolyphaga seu Steleophaga. Meng Chong Tabanus -for Cold and Blood stasis: use pungent-warm herbs.

SUMMARY CONNECTING CHANNELS AND HERBAL THERAPY

Full conditions of the Connecting channels • The chief treatment method is to use herbs with pungent taste, called tong Luo fa, i.e. 'Penetrating the Connecting channels' or 'removing obstructions from the Connecting channels'. This removes stagnation of Qi or Blood from the Connecting channels, it regulates and relaxes the Qi mechanism, it expels pathogenic factors and restores the Upright Qi. • Remove obstructions from the Connecting channels with pungent and moistening herbs: the removing of obstructions from the Connecting channels with some pungent and some moistening herbs is used when long-term Qi and Blood stagnation in the Connecting channels has given rise to Heat and dryness. • Remove obstructions from the Connecting channels with warm-pungent herbs: the removing of obstructions from the Connecting channels with warm-pungent herbs is used for Yin pathogenic factors (e.g. Cold) causing Blood stasis in the Connecting channels. • Remove obstructions from the Connecting channels with the pungent- fragrant herbs: the removing of obstructions from the Connecting chan nels with pungent-fragrant herbs is used for Cold or Phlegm-Fluids in the Connecting channels. Continued

280

PART 3: CONNECTING CHANNELS (LUO MAl)

• Remove obstructions from the Connecting channels with insect or animal drugs: the removing of

obstructions from the Connecting channels is used for chronic Blood stasis with deficiency of the Upright Qi . Insect drugs can invigorate Blood and eliminate stasis (e.g. Wu Ling Zhi Excrementum Trogopteri seu Pteromi, Shui Zhi Hirudo, Tu Bie Chong Eupolyphaga seu Steleophaga and Meng Chong Tabanus).

Empty conditions of the Connect ing channels • When the Connecting channels are Empty one must combine the treatment method of 'removing obstructions from the Connecting channels' (tong Luo) with tonifying. • Remove obstructions from the Connecting channels and tonify the body's Qi with some pungent and some sweet herbs: the removing of obstructions from the Connecting channels and the ton ifying of

the body's Qi with some pungent and some sweet herbs is used for chron ic stagnation in the Connecting channel with deficiency of the Upright Qi (Zheng Q1). • Remove obstructions from the Connecting channels and tonify and moisten: the removing of obstructions from the Connecting channels, and the tonifying and moistening is used for Empty conditions of the Connecting channels with Yin deficiency. • Remove obstructions from the Connecting channels, tonify, clear and moisten: this treatment method combines four actions: -the removing of obstructions from the Connecting channels with pungent herbs - the tonifying of Qi and Blood with sweet herbs -the moistening and nourishing of Yin with moistening herbs -the clearing of Heat with cold herbs • Remove obstructions from the Connecting channels and tonify with warm moistening herbs: the removing of obstructions from the Connecting channels and the tonifying with warm moistening herbs is used for Empty cond itions of the Connecting channels with Cold . The warm herbs warm Yang and pungent herbs move Blood. Moistening herbs are used because the long-term Blood stasis may lead to Dryness.

Treatment methods and herbs • Ye Tian Shi advocates making Qi descend, eliminating stagnation, removing obstructions from the Connecting channels with pungent herbs, moistening Blood, i.e. simultaneously removing obstructions from the Connecting channels with pungent herbs and moistening. Ye Tian Shi's directions are particu larly aimed at the treatment of chronic conditions that have reached the Deep (Blood) Connecting channels: as the Deep Connecting channels are related to Blood and because often chronic Blood stasis leads to Dryness, Ye Tian Shi advocates that the moistening method be combined with the pungent herbs that eliminate stagnation.

All the herbs with Teng in their name (meaning 'vine') enter the Connecting channels: all of them are used for Painful Obstruction (Bi) Syndrome.

NOTES 1. Yue Ha n Zhen 1990 An Expl<mation of the Acupuncture Points Uing Xue fie t£ 1\ M ). People"s Health Publishing House. Beijing. Origina lly published in 1654. p. 31. 2. Please note that. at the time of writing (2005). Chuan Shan jia cannot legally be used because it comes from a protected animal species.

3. Please note that. at the time of writing (2005). no species of Mu Tong may be used in Europe or the USA. This is due to the possibility of one of its species containing aristolochic acid. 4. Please note that. at t he time of writing (2005). Chuan Shan ]ia cannot legally be used because it comes from a protected a nima l species. 5. Please note that. at the time of writing (2005). no species of Mu Tong may be used in Europe or the USA. This is due to the possibility of one of its species containing aristolochic acid. 6. Yi Fa Yin 1996 Characteristics of Diseases of the Connecting Cha nnels according to Ye Gui. in journal of Traditional Chinese Medicine (Zhong Yi Za Zhi <j:l 12< ~ ~ ). China Association of Traditiona l Chinese Medicine and China Academy of Traditional Chinese Medicine. Beijing. vol 37. no 1 2. p. 713. 7. Ibid .. p. 713

TREATMENT OF THE CONNECTING CHANNELS

*

8. 1979 The Yellow Emperor's Classic of Internal Medicine - Simple Questions (Huang Di Nei ]ing Su Wen :M i1'l i£ ¥ fii] ). People's Health Publishing House, Beijing. first published c. 100 Be. p. 92. 9. Zbang jie Bin (also called Zhang Jing Yue) 1982 Classic of Categories (Lei Jing ~ ~~ ). People's Health Publishing [-louse. Beijing. first published in 1624. p. 225. 10. 1981 Spiritual Axis (Ling Shu ]ing ]lt lli\ ~~ ) .People's Health Publishing House. Beijing. first published c. 100 sc, p. 21. 11. Ibid .. p. 37.

281

12. Heilongjiang Province ational Medical Research Group 1984 An Explanation of the Great Compendium of Acupuncture (Zilen ]iu Da Cheng ]iao Shi H ~ ::k lilt & "' ). People's Hea lth Publishing House, Beijing. p. 62 7-636. The Great Compendium of Acupuncture itself. byYang]i Zhou was first published in 1601. 13. Simple Questions. p. 344-345. 14. Characteristics of Diseases of the Connecting Channels according to Ye Cui. p. 715.

PART4

MUSCLE CHANNELS (JING JIN) 17 18 19 20

Morphology and pathways of the Muscle channels 285 Muscle channels- fu nctions and aetiology 311 Pathology and symptoms of Muscle channels 315 Treatment of Muscle channels 319

The Muscle channels are not as important and as clinically relevant as the Connecting channels. However, in the fields of musculoskeletal problems and of Painful Obstruction (Bi) Syndrome, they are extremely important. Part 4 deals with the pathways, nature, functions, pathology and treatment of the Muscle channels.

CHAPTER 17

MORPHOLOGY AND PATHWAYS OF THE MUSCLE CHANNELS MORPHOLOGY 285 They are on the surface of the body 285 They do not connect with the Internal Organs 287 They all originate at the extremities 289 They broadly follow the course of the Main channels 289 They follow the contours of the major muscles overlying the Main channels 289 They are grouped into four groups of three channels each of the same polarity (Yin or Yang) and same potential of energy (leg or arm) 290 PATHWAYS OF THE MUSCLE CHANNELS The three Yang of the leg 292 The three Yin of the leg 295 The three Yang of the arm 300 The three Yin of the arm 304

291

CONNECTIONS 306 MEETING POINTS 307 THE MUSCLES ALONG THE MUSCLE CHANNEL PATHWAYS 307

I translate the word Jin in Jing Ji n as 'muscles' rather than 'sinews' (as I do for the tissue controlled by the Liver). The word ]in can mean both 'muscles' and 'sinews': I choose two different translations of the same term as I believe that, in the con text of the channels, this word clearly refers to the muscles, whereas in the context of tissues controlled by the Internal Organs it refers to sinews.

The Muscle channels are not just 'muscles' : they are also channels and, as such, they contribute to the general circulation of Qi and Blood.

MORPHOLOGY The Muscle channels have the following characteristics:

The Muscle channels are discussed in Chapter 13 of the 'Spiritual Axis' 1 and are called Jing ]in ( ~£ M), which could be translated as 'channel-like muscles' or 'muscles of the channels': indeed, as we shall see below, the Muscle channels are essentially the skeletal muscles of the body as seen in ancient Chinese medicine and therefore the term 'channel-like muscles' (rather than 'muscle channels') would be a more accurate translation of their name. However, the Muscle channels are much more than just the muscles of Western medicine as they form an integral part of the channel system and perform specific important functions in the circulation of Qi and Blood and in the adaptation of the body to the external environment.

• • • •

They are on the surface of the body. They do not connect with the Internal Organs. They all originate at the extremities. They broadly follow the course of the Main channels (with exceptions, e.g. Bladder Muscle). • They follow the contours of the major muscles overlying the Main channels. • They fall into four groups of three channels each of the same polarity (Yin or Yang) and the same potential of energy (leg or arm).

They are on the surface of the body The Muscle channels are on the surface of the body and they are therefore part of what is called the 285

286

PART 4: MUSCLE CHANNELS (JING JIN)

'Exterior' of the body, as opposed to the 'Interior' of the body, which comprises the Internal Organs. However, the Muscle channels constitute part of the 'Exterior' of the body in a different sense than for the Connecting (Luo) channels (Fig. 17.1).

The Connecting channels constitute the 'Exterior' of the body more in an energetic sense than a physical one: they are the superficial channels running in all directions that are between the Main channels and the skin. It is through them that pathogenic factors penetrate the body initially and the channels where the Defensive Qi circulates. Because they are directly connected to the Main channels, indeed, they form the main route by which pathogenic factors may penetrate those Main channels. The Connecting channels also run in the space between the skin and muscles, a description that again, should be understood more in an energetic than an anatomical sense. Therefore, in this context, the 'muscles' as in the 'space between the skin and muscles' are not the same 'muscles' as in the Muscle channels. The 'muscles' as in the 'space between skin and muscles' signify primarily an energetic layer and indicate a certain energetic depth, i.e. one that is between the energetic layers of skin and sinews; the 'muscles' as in Muscle channels are the actual skeletal muscles, some of which are next to the skin and some of which are deeper. By contrast to the Connecting channels, the Muscle channels are part of the 'Exterior' of the body more in an anatomical than in an energetic sense. Muscle channels are also easily invaded by external pathogenic factors; however, such invasions manifest primarily with muscular symptoms such as ache, pain or stiffness without the general symptoms of invasion of the Defensive-Qi portion (aversion to cold . fever, sore throat, etc.) which occur when the Connecting channels are invaded.

The 'muscles' as in the 'space between the skin and muscles' are not the same 'muscles' as in the Muscle channels.

Fig. 17.1 Muscle channels and the Exterior of the body.

Although also superficial, the Muscle channels do not have the same energetic significance as the Connecting channels: although 'channel-like' in nature, they are simply the skeletal muscles overlying the bones. There is no direct connection between the Muscle channels and the Main channels in the same way as there is between the Connecting channels and the Main channels (which is strengthened by the

MORPHOLOGY AND PATHWAYS OF THE MUSCLE CHANNELS Space between skin and "muscle" "Muscle" Actual muscle

Skin

287

Organs. The statement that the Muscle channels 'do not connect with the Internal Organs' simply means that the Muscle channels do not circulate in the Interior and do not reach the Internal Organs in the same way as the Main, Divergent and Connecting

Fig. 17.2 Energetic difference between Muscle and Connecting channels.

existence of Connecting points). Figure 17.2 illustrates the energetic difference between the Muscle channels and Connecting channels. To put it differently, the Connecting channels are more like 'channels' than are the Muscle channels. It is not by chance that the Muscle channels are listed and gathered into four groups of three channels each; this would seem to confirm that the Muscle channels are the groups of skeletal muscles of these four areas of the body, i.e. the lateral- posterior surface of the legs, the lateral-posterior surface of the arms. the medial surface of the legs, and the medial surface of the arms (Fig. 17.3).

They do not connect with the Internal Organs The Muscle channels do not connect with the Internal Organs in the same way that the Connecting, Main and Divergent channels do: all the latter channels go to an Internal Organ. In contrast, the Muscle channels represent broad areas and groups of muscles that cover the bones and lie under the skin. Their very grouping into four groups of three channels of the same potential (arm or leg) and same polarity (Yin or Yang) reinforces the idea that they are simply muscular body areas that do not connect with the Internal Organs. However, that is not to say that the Internal Organs cannot influence the Muscle channels and, indeed, they do. As explained above, although the Muscle channels are simply the muscles overlying the channels, they are also energetic areas where Qi and Blood circulate: as such, they must be capable of being influenced by the Internal Organs. This means that there is a relation between the Muscle channels and the Internal

Stomach Muscle channel

Fig. 17.3 Four groups of Muscle channels.

Continued

288

PART 4: MUSCLE CHANNELS (J!NG JIN)

Lung Muscle channel

Small Intestine

Pericardium Muscle channel

channel

Large Intestine Muscle channel

Fig. 17.3-Cont'd

channels do. However, that does not mean that the Internal Organs do not influence the Muscle channels. As we shall see below, there is a relationship of mutual interchange between the Muscle channels and the Main channels, and through these therefore also with the Internal Organs. Indeed, the Main channels nourish, warm and irrigate the muscles.

Although not directly connected to the Muscle channels, the Internal Organs do influence the Muscle channels.

A very common example of the influence of the Internal Organs on the Muscle channels is the muscle tightness and stiffness that can occur on the neck and shoulders as a result of Liver-Yang rising. Another

Spleen Muscle channel Fig. 17.3-Cont'd

Liver Muscle channel

Kidney Muscle channel

MORPHOLOGY AND PATHWAYS OF THE MUSCLE CHAN NELS 289

example could be that of the muscle slackness deriving from Spleen deficiency. In fact, the relationship between the Internal Organs and Muscle channels works mostly in one direction, i.e. from the Internal Organs to the Muscle channels: whereas the former can and do influence the latter, the opposite is not true. In this respect, the Muscle channels are very different from the Connecting channels, in that the latter are a definite route of penetration of pathogenic factors from the Exterior to the Internal Organs.

The Internal Organs affect the Muscle channels but not vice versa .

They all originate at the extremities The Muscle channels all flow from the extremities towards the top of the body: more than an energetic flow, this probably reflects the size of the muscles, being thinnest at the extremities and thickest in the thighs, upper arms and shoulders. The fact that all Muscle channels start from the extremities should not be interpreted as meaning that Qi and Blood flow only from the extremities towards the top; the flow of Qi and Blood occurs in both directions, which accounts for the fact that traumas at the extremity of a channel may affect the upper part of the channel and vice versa.

They broadly follow the course of the Main channels With some exceptions (e.g. the Bladder Muscle channel), the Muscle channels broadly follow the course of the Main channels. However, as certain muscles are very broad (e.g. trapezius), the inf1uence of a Muscle channel may well extend to more than one Main channel. It is indeed for this reason that the Muscle channels are so closely interconnected. This also probably explains why the Muscle channels are gathered into groups of three contiguous channels, e.g. the three Yang Muscle channels of the leg. For example, the Small Intestine Muscle channel 11ows over the trapezius covering an area that includes

Fig. 17.4 Area of Small Intestine Muscle channel on the trapezius.

the Main channels of the Large Intestine, the Triple Burner and the Small Intestine itself (Fig. 17.4).

They follow the contours of the major muscles overlying the Main channels The Muscle channels broadly follow the contours of the muscles lying over the relevant channel: however, the Muscle channels often span muscles that overlie more than one Main channel. For example, the Small Intestine Muscle channel flows along the following superficial and deep muscles:

Superficial: Abductor Pollicis Brevis Flexor Carpi Ulnaris

Deep: Flexor Pollicis Brevis Flexor Digitorum Profundus Flexor Digitorum Profundus Coracobrachialis Brachialis Infraspinatus Triceps Brachii Teres Major Deltoid Teres Minor Trapezius Rhomboideus Major Sternocleidomastoid Splenius Capitis Levator Scapulae Middle Scalene Posterior Auricular Buccinator

290

PART 4: MUSCLE CHANNELS (JING JIN)

Temporalis Masseter Platysma Zygomaticus Major Orbicularis Oculi

Risorius

• three Yin Muscle channels of the leg (Spleen, Liver and Kidney) • three Yang Muscle channels of the arm (Small Intestine, Triple Burner and Large Intestine) • three Yin Muscle channels of the arm (Lung, Pericardium and Heart).

Some of these muscles lie over others: for example, the deltoid muscle partly overlies the infraspinatus muscle. Moreover, some of these muscles lie over the pathway of other Muscle channels too; for example, the trapezius and deltoid lie also over part of the Large Intestine Muscle channel.

The Muscle channels of each group are listed from the most exterior channels (Greater Yang and Greater Yin) to the most interior channels (Bright Yang and Lesser Yin) with the intermediate ones in the middle (Lesser Yang and Terminal Yin). See Table 17.2. In essence, the Muscle channels are nothing but the muscles overlying the Main channels. However, the Muscle channels are more than just the muscles as we know them in Western anatomy: they also have the characteristics of channels in so far as they participate in the circulation of Qi and are integrated into the channel system. As we have seen in the chapters on the pathways of the Muscle channels, the Muscle channels play an important role in the circulation and linking of Qi among the Yang and Yin channels respectively. It is important to state that the 'Muscle' channels described in the 'Spiritual Axis' correspond only to the skeletal, striated muscles and not to the smooth

They are grouped into four groups of three channels each of the same polarity (Yin or Yang) and same potential of energy (leg or arm) As mentioned above, the Muscle channels are gathered into four groups of three channels each of the same potential (arm or leg) and same polarity (Yin or Yang) as follows. They will be listed in the order given in Chapter 13 of the 'Spiritual Axis' (Table 17.1): • three Yang Muscle channels of the leg (Bladder, Gall Bladder and Stomach)

Table 17.1

Order of listing of Muscle channels

Greater Yang Greater Yin

l esser Yang Terminal Yin

Bright Yang Lesser Yin

3 Yang of leg

Bladder

Gall-Bladder

Stomach

3 Yin of leg

Spleen

Liver

Kidney

3 Yang of arm

Small Intestine

Triple Burner

Large Intestine

3 Yin of arm

Lung

Pericardium

Heart

Table 17.2

Exterior, Int erior and hinge of Yang and Yin channels

Yang

Yin

Exterior

Interior

Hinge

Greater Yang (Small Intestine

Bright Yang (Large Intestine

and Bladder)

and Stomach)

Lesser Yang (Triple Burner and Gall Bladder)

Greater Yin (Lungs and Spleen)

Lesser Yin (Heart and Kidneys)

Terminal Yin (Pericardium and Liver)

MORPHOLOGY AND PATHWAYS OF THE M USCLE CHANNELS

SUMMARY MORPHOLOGY OF MUSCLE CHANNELS

• • • •

They are on the surface of the body They do not connect wit h t he Internal Organs They all originate at the extremities They broadly follow the course of the Main channels (with exceptions, e.g. Bladder M uscle) • They follow t he contours of the major muscles overlying the Main channels • They are grouped into four groups of th ree channels each of the same polarity (Yi n or Yang) and same potential of energy (leg or arm).

muscles that are located in the Internal Organs. The smooth muscles are responsible for the contractility of hollow organs, such as blood vessels, the gastrointestinal tract, the bladder, or the uterus. Smooth muscles lack the cross-striations of the skeletal, striated muscles (hence the name smooth). In Chinese medicine, the smooth muscles are part of the Internal Organs systems.

PATHWAYS OF THE MUSCLE CHANNELS

291

The following are the pathways of the Muscle channels as described in Chapter 13 of the 'Spiritual Axis'. The 'Spiritual Axis' relates the four groups of Muscle channels to seasons as follows: -

three Yang channels of the leg: Spring three Yin channels of the leg: Autumn three Yang channels of the arm: Summer three Yin channels of the arm: Winter.

Rather than referring to a seasonal cycle, the above relationship with the seasons refers to a polarity of Spring-Autumn for the leg channels (Yang and Yin respectively) and of Summer- Winter for the arm channels (Yang and Yin respectively). See Figure 17.5. Therefore, the relationship of each group of channels to a season is purely symbolic and does not have clinical significance. A key word in the description of the pathways of the Muscle channels in the 'Spiritual Axis' is Jiie ( ~ ), which in this context I translate as 'converge' (Deadman translates this word as 'bind' 2 ). The Muscle channels have areas of 'convergence' where each of them is itself channelled into a smaller stream: these areas are particularly important in treatment, as they are more reactive than other areas. The 'convergence' of the Muscle channels is somewhat equivalent to the Western concept of 'insertion' of muscles. Each muscle has an origin (a bone to which it is attached and

While the Divergent and Connecting channels are coupled in Yin- Yang pairs, the Muscle channels are divided into four groups of three channels of the same polarity (Yang or Yin) and same potential of energy (leg or arm) as follows: - three Yang Muscle channels of the leg (Bladder, Gall Bladder and Stomach) -three Yin Muscle channels of the leg {Spleen, Liver and Kidneys) - three Yang Muscle channels of the arm {Small Intestine, Triple Burner and Large Intestine) -three Yin Muscle channels of the arm (Lung, Pericardium and Heart). All the Muscle channels flow from the extremities towards the top. Each Muscle channel connects with at least one other Muscle channel; as we will see, this has important implications in the Muscle channels' role of regulating the flow of Qi amongst channels.

Fig. 17.5 Relationship between Muscle channels and seasons.

292

PART 4: MUSC LE CHANNELS (JING JIN)

from which it originates) and an insertion (the site of attachment of a muscle on the bone that it moves) . Figure 17.6 shows the origin and insertion of the semitendinosus muscle on the thigh as an example. However, that is not to say that the sites of 'convergence' described in Chapter 13 of the 'Spiritual Axis' always coincide with the insertion of skeletal muscles. As stated above, the 'muscles' of the Muscle channels described in the 'Spiritual Axis' correspond

only to the skeletal, striated muscles and not to the smooth muscles that are located in the internal organs. The pathways listed below are a direct translation from Chapter 13 of the 'Spiritual Axis' and, for this reason, I have kept the original descriptions of bones rather than the ones found in modern books, e.g. the Small Intestine Muscle channel converges at the 'medial border of the elbow bone' rather than the 'medial condyle of the humerus'.

The three Yang of the leg Bladder Muscle channel (Fig. 17.7) The Bladder Muscle channel originates at the little toe and ascends past the lateral malleolus and the lateral side of the lower leg to converge at the lateral aspect of the knee. Another branch starts below the lateral malleolus and converges at the heel, then ascends along the Achilles tendon to the lateral aspect of the popliteal fossa. A branch ascends along the lateral surface of the calf to reach the medial side of the popliteal fossa and runs parallel with the above-mentioned branch in the popliteal fossa; these two branches join in the gluteal region and ascend to converge at the buttock. The channel then ascends along the sides of the spine to the occiput, where a branch converges at the root of the tongue. The main ascending branch continues upwards to converge at the occipital bone and then ascends over the crown of the head to converge at the side of the nose; it then circles the eye orbit and converges at the cheekbone. Another branch separates on the back and ascends to the posterior axillary crease and then reaches the

CliNICAL NOTE The Bladder Muscle channel pathway is notable in so far as it deviates from the underlying Main channel. In fact, in the middle back, a branch deviates from the Main Muscle channel to run laterally over the latissimus dorsi, teres and deltoid muscles, one sub-branch going under the axi ll a and another over the shoulder, reuniting in the front, forming like a holster under the axilla. The branch going over the shoulder explains the use of BL-58 Feiyang as a distal point for acute pain and rigidity of the shoulder. Fig. 17.6 Origin and insertion of semitendinosus muscle.

MORPHOLOGY AND PATHWAYS OF THE MUSCLE CHANNELS

293

t\l~~....,..,.;j~----- Orbicularis oculi J/'!!1~-..iE;:::;.-v.t:+------Nasalis

Gluteus medius------i'r:V Gluteus maximus --+-.,._

Fig. 17.7 Bladder Muscle channel.

acromion (at L.I.-15 Jianyu); yet another branch crosses beneath the axilla and ascends the chest to emerge at the supraclavicular fossa (ST-12 Quepen); it then ascends to the inferior ridge of the mastoid process (G.B.-12 Wangu) behind the ear. Finally.

another branch, after emerging from the supraclavicular fossa , rises to the cheekbone alongside the nose. The Bladder Muscle channel connects with the Muscle channels of the Large Intestine, Small Intestine, Gall Bladder, Stomach and Kidney.

294

PART 4: MUSCLE CHANNELS (JING JIN)

SUMMARY BLADDER MUSCLE CHANNEL PATHWAY

• It starts at the little toe • It ascends the lateral side of the lower leg to converge at the lateral aspect of the knee • A branch starts below the lateral malleolus and converges at the heel, then ascends to the popliteal fossa • A branch ascends along the lateral surface of the calf to reach the medial side of the popliteal fossa : these two branches join in the gluteal region and ascend to converge at the buttock • The united branch ascends along the sides of the spine to the occiput, where a branch converges at the root of the tongue • The main ascending branch conti nues upwards to converge at the occipital bone and then ascends over the crown of the head to converge at the side of the nose; it then circles the eye orbit and converges at the cheekbone • Another branch separates on the back and ascends to the posterior axillary crease and then reaches the acromion (at L.l.-15 Jianyu) • Another branch crosses beneath the axilla and ascends the chest to emerge at the supraclavicular fossa (ST-12 Quepen); it then ascends to the inferior ridge of the mastoid process (G.B.-12 Wangu) behind the ear • Another branch, after emerging f rom the supraclavicular fossa, rises to the cheekbone alongside the nose • It connects with the Muscle channels of the Large Intestine, Small Intestine, Gall Bladder, Stomach and Kidney.

Gall Bladder Muscle channel (Fig. 17.8) The Gall Bladder muscle channel begins at the fourth toe. con nects with the anterior part of the lateral malleolus, and ascends along the lateral aspect of the leg to converge at the lateral aspect of the knee. A branch begins in the upper portion of the fibula and ascends along the lateral aspect of the thigh: there it separates, one branch running anteriorly of it to converge in the area above ST-32 Futu, and another runn ing posteriorly to converge at the sacrum.

The main branch ascends the lateral side of the body across the ribs and travels to the an terior border of the axilla, linking first with the breast and then converging at the supraclavicular fossa (ST-12 Quepen). Another branch ascends from the axilla, passes through the supraclavicular fossa (ST-12 Quepen), and rises in front of the Bladder Muscle channel, passing behind the ear, and carrying on to the corner of the forehead. It then continues to the vertex of the head where it meets its bilateral counterpart, descends to the chin and then goes up to the cheekbone. Another branch reaches the outer canth us of the eye. The Gall Bladder Muscle channel con nects with the Muscle channels of the Stomach and Bladder.

CLINICAL NOTE It is worth noting that a large branch of t he Gall Bladder Muscle channel runs over the gluteus maximus muscle (the buttock muscle). This explains the effect of the Gall Bladder channel points (e.g. G.B.-30 Huantiao) in the treatment of sciatica that starts from the buttock muscle.

Stomach Muscle channel (Fig. 17.9) The Stomach Muscle cha nnel starts at the middle three toes and converges on the dorsum of the foot; it then ascends along the lateral aspect of the tibia and converges at the lateral aspect of the knee, connecting with the Gall Bladder muscle channel. It ascends the leg and converges at the hip joint. It then passes through the lower ribs to reach the spine. The main branch runs along the tibia and the thigh past ST-32 Futu to converge in the genitalia. It then ascends the abdomen and chest and reaches the supraclavicular fossa (ST-12 Quepen); then it ascends the neck to the jaw, the mouth and the side of the nose and gathers in the cheekbone. It joins with the Bladder Muscle ch annel: this channel goes above the eye socket and the Stomach Muscle channel below

CLINICAL NOTE An interesting aspect of the Stomach Muscle channel is that a branch goes to the back and enters the spine. Perhaps this is another reason why, in my experience, points of the Stomach and Spleen (especially ST-36 Zusanli and SP-3 Taibai) can influence the spine.

MORPHOLOGY AND PATHWAYS OF THE MUSCLE CHANNELS

295

Trapezius - - - - - - - - -+ Sternocleidomastoid - - - - - - - r'----:::::-.--Hir- '\

+t..---- - - 1-'E!roneus longus Hlf"t--- - - Extensor digitorum

longus Iliff - - - -- Tibialis anterior

Fig. 17.8 Gall Bladder Muscle channeL

it. Another branch separates at the jaw and gathers

in front of the ear.

The Stomach Muscle channel connects with the Muscle channels of the Gall Bladder. Large Intestine and Bladder.

The three Yin of the leg Spleen Muscle channel (Fig. 17.10) The Spleen Muscle channel begins at the big toe and ascends the foot to converge at the inner malleolus.

296

PART 4: MUSCLE CHANNELS (JING JIN)

SUMMARY

.

GALL BLADDER MUSCLE CHANNEL PATHWAY

• It begins at the fourth toe • It connects with the anterior part of the lateral malleolus, ascends along the lateral aspect of the leg to converge at the lateral aspect of the knee • A branch begins in the upper portion of the fibula and ascends along the lateral aspect of the thigh • Here it separates, one branch run ning anteriorly to converge in the area above ST-32 Futu • The second branch runs posteriorly and converges at the sacrum • The main branch ascends the lateral side of the body across the ribs and travels to the anterior border of the axilla • It links f irst with t he breast, and then converges at the supraclavicu lar fossa (ST-12 Quepen) • Another branch ascends from t he axilla and passes through the supraclavicula r fossa (ST-12 Quepen) • It ascends in front of the Bladder Muscle channel, passing behind the ear, and then rises to the corner of the forehead • It then continues to the vertex of the head, descends to the chin and then goes up. to the cheekbone • Another branch reaches the outer canthus of the eye • It connects with the Muscle channels of the Stomach and Bladder.

~>-L----- Orbicularis

~p-,f----- Risorius

'E--'-1- + -- - -0rbicularis oris

'"-:-----'"'~;::----- Scalenes

'----:-----"1<,-----Sternocleidomastoid +---Deltoid ---~--11~-Pectoralis

major

\U ------'\l-1--!4-+-Tensor fasciae latae

l• i+----Vastus lateralis ...l.J--lt----Rectus femoris t t----\'1-t+- - - Vastus medialis

It ascends the medial aspect of the tibia to converge

at the medial aspect of the knee; it follows the medial aspect of the thigh to converge in the groin before converging at the external genitalia. It then ascends the abdomen to converge at the umbilicus; it enters the abdomen, converges at the ribs and spreads in the chest. From the inside of the chest, a branch adheres to the spine. The Spleen Muscle channel connects with the Muscle channels of the Liver and Kidney.

oculi

>--,.-+---Nasalis A----Masseter

Fig. 17.9 Stornach Muscle channel.

MORPHOLOGY AND PATHWAYS OF THE MUSCLE CHANNELS

297

SUMMARY

SUMMARY

STOMACH MUSCLE CHANNEL PATHWAY

SPLEEN MUSCLE CHANNEL PATHWAY

• It starts at the middle three toes • It converges on the dorsum of the foot • It ascends along the lateral aspect of the tibia and converges at the lateral aspect of the knee, connecting with the Gall Bladder muscle channel • It ascends the leg and converges at the hip joint • It passes through the lower ribs to reach the spine • The main branch runs along the tibia and the thigh past ST-32 Futu to converge in the genitalia • It then ascends the abdomen and chest and reaches the supraclavicular fossa (ST-12 Quepen) • It ascends the neck to the jaw, mouth and side of the nose and gathers in the cheekbone. It joins with the Bladder Muscle channel: this channel goes above the eye socket and the Stomach Muscle channel below it • Another branch separates at the jaw and gathers in front of the ear • It connects with the Muscle channels of the Gall Bladder, Large Intestine and Bladder.

• It begins at the big toe • It ascends the foot to converge at the inner malleolus • It ascends the medial aspect of the tibia to converge at the medial aspect of the knee • It follows the medial aspect of the thigh to converge in the groin before converg ing at the external genitalia • It then ascends the abdomen to converge at the umbilicus • It enters the abdomen, converges at the ribs and spreads in the chest • From the inside of the chest, a branch adheres to the spine • It connects with the Muscle channels of the Liver and Kidney.

CLINICAL NOTE The fact that the Liver Muscle channel flows to the genitals confirms the important influence of the Liver on problems of the genitalia.

SUMMARY LIVER MUSCLE CHANNEL PATHWAY CLINICAL NOTE It is interesting to note that the Spleen Muscle channel spreads in the chest and, from here, it adheres to the spine. For this reason, I use SP-3 Taibai to straighten the spine.

Liver Muscle channel (Fig. 17.11) The Liver Muscle channel originates on the dorsum of the big toe and ascends the medial side of the foot to converge at the anterior aspect of the medial malleolus; it then proceeds along the medial aspect of the tibia to converge at the medial condyle. It continues upwards along the medial aspect of the thigh to the genitals where it connects with the Spleen Muscle channel.

• It originates on t he dorsum of the big toe • It ascends to converge at the anterior aspect of the medial malleolus • It runs along the medial aspect of the tibia to converge at the medial condyle • It continues upwards along the medial aspect of the thigh to t he genitals where it connects with the Spleen Muscle channel.

Kidney Muscle channel (Fig. 17.12) The Kidney Muscle channel begins beneath the little toe and joins the Spleen Muscle channel at the inferior aspect of the medial malleolus; it converges in the heel where it joins with the Bladder Muscle channel, then ascends the leg and converges at the medial

298

PART 4: MUSCLE CHANNELS (JJNG JIN)

I

,.,.------...........

I I

,,

', '

',,

',, ''

''

\

\ \

\ \ \ \

• •- -Rectus abdominis ' -I - - - Iliacus

~

\

\

\ \

\ \ \ \ \ \

\ \

\

\ \ \ \

\

\ \ \

\ \ \ \

\

I \ \ \

\ \ \ \ \ \ \ \

\

\

',

Superficial view

Deep view

Flexor digitorum longus - - ----\-lr-1-:+

Transverse abdominis ------l;;t~V~~=~ Rectus abdominis - - - - - --;:;-t-;:-'7'-;"-----:'Quadratus lumborum -------t~s.:---;;;;:;::;;;;:t!::;~;;;;..~.JW Fig. 17.10 Spleen Muscle channel.

MORPHOLOGY AND PATHWAYS OF THE MUSCLE CHANNELS

- - - - - Adductor longus

Fig. 17.11 Liver Muscle channel.

Fig. 17.12 Kidney Muscle channel .

299

300

PART 4: MUSCLE CHANNELS (JING JIN)

condyle of the tibia. It then joins with the Spleen Muscle channel and follows the medial surface of the thigh to converge at the genitals. A branch ascends along the inner aspect of the spinal column to the nape of the neck where the channel converges at the occipital bone, joining with the Bladder Muscle channel. The Kidney Muscle channel connects with the Muscle channels of the Spleen and Bladder.

CLINICAl NOTE The most notable aspect of the Kidney Muscle channel pathway is that it flows inside the whole spine, joining the Bladder Muscle channel at the occiput. This confirms the important influence of both Bladder and Kidney channel on the spine. The Bladder Muscle channel obviously affects the spine because it flows all along beside it. The Kidneys affect the spine in two ways: as an organ, they are the origin of Marrow and nourish the bones and spine; as a channel, its Muscle channel flows inside the whole spine. For this reason, in addition to the obvious points from the Bladder channel, I frequently use the point Kl-4 Dazhong to treat chronic backache occurring against a background of Kidney deficiency.

The three Yang of the arm Small Intestine Muscle channel (Fig. 17.13) The Small Intestine Muscle channel originates on the dorsum of the little finger and converges at the wrist. It then ascends the ulnar side of the forearm to the elbow where it converges at the medial border of the elbow bone {Chapter 13 of the 'Spiritual Axis' at this point says that 'wizen pressure is applied at this spot. a sensation of nwnlmess extends to the tip of the fifth jinger' 3 ) , climbing the ann to converge at the posterior aspect of the axilla. It then runs behind the axilla and surrounds the scapula.

. , _ - - - - - -Frontalis

"'-..11!- ' f f - - - - - - Masseter ~v------- Risorius

Y - - - - - - - Piatysma

lliik-----'..,._--Trapezius ,___-~-Infraspinatus

SUMMARY KIDNEY MUSClE CHANNEl PATHWAY • It begins beneath the little toe • It joins the Spleen Muscle channel at the inferior aspect of the medial malleolus • It converges in the heel where it joins with the Bladder Muscle channel • It ascends the leg and converges at the medial condyle of the tibia • It then joins with the Spleen Muscle channel and fol lows the medial surface of the thigh to converge at the gen itals • A branch ascends along the inner aspect of the spinal column to the nape of the neck where the channel converges at the occipital bone, joining w ith the Bladder Muscle channel • It connects with the Muscle channels of the Spleen and Bladder. Fig. 17.13 Small Intestine Muscle channel.

MORPHOLOGY AND PATHWAYS OF THE MUSCLE CHANNELS

A branch runs over the shoulder and ascends the neck in front of the Bladder Muscle channel, to converge at the mastoid process from where a branch enters the ear. It then ascends behind the ear to the region above, and from there descends to converge at the mandible. It then ascends to converge at the outer canthus of the eye. The Small Intestine Muscle channel connects with the Muscle channels of the Bladder, Large Intestine, Triple Burner and Stomach.

CLINICAL NOTE

The most notable aspect of the Small Intestine Muscle channel is that it covers the whole scapula and it affects four major muscles over the scapula: the /atissimum dorsi, teres major, teres minor and infraspinatus. I frequently use the Small Intestine points on the scapula (and especially S.l.-11 Tianzong) as adjacent points for chronic shoulderjoint problems.

SUMMARY SMALL INTESTINE MUSCLE CHANN EL PATHWAY

• It originates on the dorsum of the little finger • It converges at the wrist • It ascends the ulnar side of the forearm to the elbow where it converges at the medial border of the elbow bone • It ascends the arm to converge at the posterior aspect of the axilla • It then runs behind the axilla and surrounds the scapula • A branch runs over the shoulder, and ascends the neck in front of the Bladder Muscle channel, to converge at the mastoid process from where a branch enters the ear • It ascends behind the ear to the region above and from there it descends to converge at the mandible • It ascends to converge at the outer canthus of the eye • It connects with the Muscle channels of the Bladder, Large Intestine, Triple Burner and Stomach.

301

Triple Burner Muscle channel (Fig. 17.14) The Triple Burner Muscle channel begins at the ulnar side of the ring finger and converges at the dorsum of the wrist. It runs along the posterior aspect of the arm and converges at the tip of the elbow; it then ascends the lateral aspect of the upper arm and goes over the shoulder to the neck where it joins with the Small Intestine Muscle channel. A side branch runs from the angle of the mandible to reach the root of the tongue. The main branch ascends in front of the ear to join the outer canthus of the eye; it then ascends across the temple to converge at the corner of the forehead. The Triple Burner Muscle channel connects with the Muscle channel of the Small Intestine.

SUMMARY TRIPLE BURNER MUSCLE CHANNEL PATHWAY

• It begins at the ulnar side of the ring f inger • It converges at the dorsum of the wrist • It runs along the posterior aspect of the arm and converges at the tip of the elbow • It ascends the lateral aspect of the upper arm and goes over the shoulder to the neck where it joins with the Small Intestine Muscle channel • A side branch runs from the angle of the mandible to reach the root of the tongue • The main branch ascends in front of the ear to join the outer canthus of the eye • It ascends across the temple to converge at the corner of the forehead • It connects with the Muscle channel of the Small Intestine.

Large Intestine Muscle channel (Fig. 17.15) The Large Intestine Muscle channel begins at the lateral end of the second finger and converges at the dorsum of the wrist. It ascends the forearm and converges at the lateral aspect of the elbow. It then CLINICAL NOTE

It is of note that the Triple Burner Muscle channel flows to the temple: this is another reason why T.B.-5 Waiguan is such an important point for temporal headaches.

302

PART 4: MUSCLE CHANNELS (JING JIN)

Temporalis- - - -+ - Orbicularis oculi- ----\,---.-'-.;1-_::_= ,lW, Masseter -----+~-=­

Risorius ------t-____,~._---=-'-'-"""' Platysma--------1--1~-~llo...

Trapezius

~.i\'l!l~~~o..---

Extensor digitorum -----1->'--1'Extensor carpi ulnaris---1-:-+-=i Flexor carpi ulnaris --J~~+,:.J--.1

Fig. 17.14 Triple Burner Muscle channel .

ascends the upper arm to converge at the shoulder; a branch goes over the shoulder bone and the scapula to attach itself to the (upper thoracic) spine. From the shoulder, the main channel ascends to the neck; from there a branch ascends across the

cheeks to converge at the cheekbone. The main branch of the Muscle channel ascends in front of the Small Intestine Muscle channel to reach the corner of the forehead; it then crosses over the top of the head to connect with the mandible on the opposite side.

MORPHOLOGY AND PATHWAYS OF THE MUSCLE CHANNELS

303

,--,.~,.-------- Galea aponeurotica w-c - + - - - - - Temporalis -4--4:,..,....f-- - - - - Orbicularis oculi

~..-!Iii~'/------ Masseter ~If-f------ Risorius

,..- A - - - - - - Platysma

·:-lr'IH'l-- - Biceps brachii

.1 • -*--- Brachioradialis n..l-'11--- Extensor carpi radialis longus

Extensor digitorum

Fig. 17.15 Large Intestine Muscle channel.

CLINICAL NOTE The Large Intestine Muscle channel flows over the head and to the other side like headphones. This probably is an added reason for the importance of L.l.-4 Hegu in the treatment of headaches.

SUMMARY lARGE INTESTINE MUSCLE CHANNEL PATHWAY

• • • • • •

It begins at the lateral end of the second finger It converges at the dorsum of the wrist It ascends the forearm and converges at the lateral aspect of the elbow It ascends t he upper arm to converge at the shoulder A branch goes over the shoulder bone and the scapula to attach itself to the [upper thoracic] spine From the shou lder, the main channel ascends to the neck; from there a branch ascends across the cheeks to converge at the cheekbone • The main branch of the Muscle channel ascends in front of the Small Intestine Muscle channel to reach the corner of the forehead • It then crosses over the top of the head to connect with the mandible on the opposite side • It connects with the Muscle channels of the Small Intestine, Bladder and Stomach.

304

PART 4: MUSCLE CHANNELS (JJNG JJN)

The Large Intestine Muscle channel connects with the Muscle channels of the Small Intestine, Bladder and Stomach.

The three Yin of the arm Lung Muscle channel {Fig.l7.16) The Lung Muscle channel originates on the thumb and ascends to converge at the thenar eminence; it then travels along the lateral side of the radial pulse [ Cun Kou] and ascends the lateral side of the inner forearm to converge inside the elbow. It continues along the anterolateral aspect of the upper arm to enter the chest below the axilla and emerge in the region of the supraclavicular fossa (ST-12 Quepen). It runs laterally to the shoulder where it converges.

It then descends to the supraclavicular fossa {ST-12)

and enters the chest to scatter through the cardia and converge in the lowest ribs. The Lung Muscle channel connects with the Muscle channels of the Heart and Pericardium.

CLINICAL NOTE

The Lung Muscle channel spreads all over the chest: this is a further explanation of the importance of the Lung channel for chest symptoms. As it controls all the muscles of the chest and upper ribs, it explains the sense of breathlessness and discomfort of the chest experienced by patients who are overcome by worry, sadness and grief (emotions that injure the Lung).

SUMMARY LUNG MUSCLE CHANNEL PATHWAY • It originates on the thumb • It ascends to converge at the thenar em inence • It travels along the lateral side of the radial pulse and ascends the lateral side of the inner forearm to converge inside the elbow • It continues along the anterolateral aspect of the upper arm to enter t he chest below t he axi lla and emerge in the region of the supraclavicular fossa (ST- 12 Quepen) • It runs laterally to the shou lder where it converges • It t hen descends to the supraclavicular fossa (ST- 12) and enters t he chest to scatter t hrough the cardia and converg e in t he lowest ribs • It connect s with the Muscle channels of the Heart and Pericardium.

Pericardium Muscle channe l (Fig. 17.17)

Fig. 17.16 Lung Muscle channel.

The Pericardium Muscle channel originates at the tip of the middle finger and runs together with the Lung Muscle channel to converge at the medial side of the elbow. It then runs up the medial side of the upper arm to reach the area below the axilla where it converges before descending to scatter over the anterior and posterior aspects of the ribs. A branch enters the axilla, disperses inside the chest and converges at the diaphragm.

MORPHOLOGY AND PATHWAYS OF THE MUSCLE CHANNELS

305

SUMMARY PERICARDIUM MUSCLE CHANNEL PATHWAY • It originates at the tip of the middle finger • It runs together with the Lung Muscle channel to converge at the medial side of the elbow • It runs up the medial side of the upper arm to reach the area below the axilla where it converges • It descends to scatter over the anterior and posterior aspects of the ribs • A branch enters the axilla, disperses inside the chest and converges at the diaphragm • It connects with the Muscle channel of the Lung.

Fig. 17.17 Pericardium Muscle channel.

CLINICAL NOTE A notable aspect of the Pericardium Muscle channel is its spreading to the diaphragm: this explains the effect of P-6 Neiguan on digestive and respiratory symptoms such as belching, hiccup and sighing.

The Pericardium Muscle channel connects with the Muscle channel of the Lung.

Heart Muscle channel (Fig. 17.18) The Heart Muscle channel originates at the radial aspect of the little finger and converges at the wrist. It ascends to converge first at the medial aspect of the elbow and then at the axilla. It enters the axilla.

Fig. 17.18 Heart Muscle channel.

306

PART 4: MUSCLE CHANNELS (JING JIN)

SUMMARY HEART MUSCLE CHANNEL PATHWAY

• It originates at the radial aspect of the little finger • It converges at the wrist • It ascends to converge first at the medial aspect of the elbow and then at the axilla • It enters the axi lla, joins with the Lung Muscle channel and travels up to the centre of the chest passing through the inside of the breast • It descends across the diaphragm to terminate at the umbilicus • It connects with the Muscle channel of the Lung.

- Large Intestine: connects with the Small Intestine, Bladder and Stomach Muscle channels - Lung: connects with the Heart and Pericardium Muscle channels - Pericardium: connects with the Lung Muscle channel -Heart: connects with the Lung Muscle channel. I have grouped the Muscle channels into two groups of Yang and Yin channels as, when represented in diagrammatic form, they form an interesting diagram (Fig. 17.19). Figure 17.19 clearly shows how the interrelationships among the Yang channels are much denser and more numerous than those among the

Bladder

joins with the Lung Muscle channel and travels up to the centre of the chest passing through the inside of the breast. It then descends across the diaphragm to terminate at the umbilicus. The Heart Muscle channel connects with the Muscle channel of the Lung.

Small Intestine Large Intestine Triple Burner

CONNECTIONS As is evident from the pathways of the Muscle channels, each Muscle channel joins or connects with many others as follows: - Bladder: connects with the Large Intestine, Small Intestine, Gall Bladder, Stomach and Kidney Muscle channels - Gall Bladder: connects with the Stomach and Bladder Muscle channels - Stomach: connects with the Gall Bladder, Large Intestine and Bladder Muscle channels -Spleen: connects with the Liver and Kidney Muscle channel -Liver: connects with the Spleen Muscle channel - Kidneys: connects with the Spleen and Bladder Muscle channels - Small Intestine: connects with the Bladder, Large Intestine, Triple Burner and Stomach Muscle channels -Triple Burner: connects with the Small Intestine Muscle channel

Gall Bladder Stomach Kidneys Heart Lungs Spleen Liver Pericardium

Fig. 17.19 Interrelationships of Muscle channels.

MORPHOLOGY AND PATHWAYS OF THE MUSCLE CHANNELS

Yin channels. As we shall see, this is significant in practice as it reflects the fact that the Yang Muscle channels have the important function of promoting the movement of Qi among the three Yang channel groups of Greater Yang, Bright Yang and Lesser Yang. For reasons explained in Chapter 2, the relationship between, and Qi movement among, the Yang channels, is closer than that between, and among, the Yin channels of Greater Yin, Lesser Yin and Terminal Yin. The close and dense interrelationships among the Yang Muscle channels confirm this; indeed, the close interrelationships among the Yang Muscle channels is another way in which the interrelationships among the Yang Main channels are rendered dense. It is interesting to note that skeletal muscles act in groups rather than singly. In particular, prime movers within a group of muscles produce movement; antagonist muscles within a group relax while the prime mover is contracting; synergist muscles within a group contract at the same time as the prime mover. This action in groups presents an interesting correlation with the ancient Chinese grouping of Muscle channels in groups of three. The Western concept of groups of muscles is a lso mirrored in the close interrelationship between Muscle channels, not only within each group of three, but also between groups (see Figure 17. 7).

SUMMARY MEETING POINTS OF THE MUSCLE CHANNELS

• S.l.-18 Quanliao (or ST-7 Xiaguan): three Yang of the leg • Ren-3 Zhongji: three Yin of the leg • G.B.-13 Touwei: three Yang of the arm • G.B.-22 Yuanye: three Yin of the arm.

Apart from the above Meeting points of the Muscle channels, one other point, ST-12 (Quepen) is a crossing point of four Muscle channels, i.e. the Bladder, Gall Bladder, Stomach and Large Intestine. This is probably a further explanation of this point's action in promoting the descending of Qi.

THE MUSCLES ALONG THE MUSCLE CHANNEL PATHWAYS Tables 17.3 to 1 7.14 are lists of the muscles affected by each Muscle channel. .-Table 17.3

Location

MEETING POINTS The Muscle channels meet at certain points as follows: • the three Yang of the leg: S.I.-18 Quanliao (or ST-7 Xiaguan) • the three Yin of the leg: Ren-3 Zhongji • the three Yang of the arm: G.B.-13 Touwei • the three Yin of the arm: G.B.-22 Yuanye. The use of these points is particularly important in chronic conditions when pathology of a Muscle channel affects neighbouring Muscle channels. Typical examples of this are: sciatica on the Bladder, Gall Bladder and Stomach channels, elbow tendinitis on the Large Intestine and Triple Burner channels, shoulder-joint ache on the Large Intestine and Triple Burner channels, and ache on the top of the shoulders and neck on the Small Intestine, Large Intestine and Triple Burner channels.

307

Bladder Muscle channel

Muscle Superficial

Deep

Foot and leg Soleus Peroneus Longus Gastrocnemius Plantaris Semitendinosus Biceps Femoris Adductor Magnus Gluteus Maximus Gluteus Medius

Peroneus Tertius Peroneus Brevis Tibialis Posterior Flexor Digitorum Longus Popliteus Semimembranosus Quadratus Femoris Obturator lnternus Piriformis

Back

Erector Spinae Spinalis Longissimus capitis Longissimus cervicis Serratus Posterior Inferior lntertransversarii Interspinalis Iliocostalis Semispinalis Serratus Posterior Superior Splenius Cervicis Splenius Capitus Suboccipital Muscles

Latissimus Dorsi Trapezius Infraspinatus Teres Major Teres Minor Deltoid

I

Continued

308

PART 4: MUSCLE CHANNELS (JING JIN)

Table 17.3

I

Bladder Muscle channel-cont'd

Table 17.5

Muscle Location

Superficial

Head and neck

Occipitalis Levator Anguli Oris Frontalis Buccinator Orbicularis Oculi Scalenes Omohyoid Procerus Nasalis Levator Scapulae Levator Labii Subclavius Superioris Alaeque Nasi Levator Labii Superioris Zygomaticus Major Risorius Platysma Sternocleidomastoid Pectoralis Major Latissimus Dorsi

Chest

I

Table 17.4

Location

Pectoralis Minor External Oblique Serratus Anterior External lntercostals Internal lntercostals

Gal l Bladder Muscle channel

Muscle Superficial Dorsal Interossei Extensor Digitorum Brevis

Leg

Peronius Tertius Peronius Brevis Peronius Longus Tibialis Anterior Quadriceps Femoris Vastus Lateralis Tensor Fascia Latae Gluteus Maximus Gluteus Medius

Extensor Digitorum Longus

Trunk

External Oblique Latissimus Dorsi Pectoralis Major

Internal Oblique Teres Major Serratus Anterior Pectoralis Minor External lntercostals Internal lntercostals

Muscle Superficial

Deep

Foot

Dorsal interossei Extensor Digitorum Brevis

Leg

Extensor Digitorum Longus Tibialis Anterior Soleus Vastus Medialis Rectus Femoris Vastus Lateralis Sartorius Tensor Fascia Latae Pectineus Popl1teus

Abdomen External Oblique Rectus Abdominis Diaphragm

l

Deep

Foot and Ankle

Neck and Head

Location

Deep

Stomach Muscle channel

Scalenes: Anterior, Deltoid Medial and Posterior Trapezius Sternocleidomastoid Lateral Pterygoid Posterior Auricular Temporalis Masseter Zygomaticus Major Zygomaticus Minor Levator Labii Superioris Orbicularis Oculi

Extensor Hallucis Longus Vastus Intermedius Adductor Longus Adductor Magnus Adductor Brevis Iliopsoas Psoas Major Psoas Minor Iliacus Quadratus Lumborum Internal Oblique Transversus Abdominis Quadratus Lumborum

Back

External Oblique Latissimus Dorsi Gluteus Medius

Chest

Pectoralis MaJor

Internal lntercostals

Neck and Face

Sternocleidomastoid Platysma Depressor Anguli Oris Risorius Masseter Zygomaticus Major Zygomaticus Minor Levator Labii Superioris Nasalis Orbicularis Oculi Temporal is

Subclavius Omohyoid Scalenes Stylohyoid Digastric Buccinator Medial Pterygoid Lateral Pterygoid

I

Table 17.6

Location

Spleen Muscle channel

Muscle Superficial

I

Deep

Foot and Leg

Extensor Hallucis Longus Tibialis Anterior Flexor Digitorum Longus Soleus Gastrocnemius Vastus Medialis Rectus Femoris Sartorius Pectineus

Adductor Longus Adductor Magnus Adductor Brevis Vastus Intermedius Obturator Externus Psoas Major Psoas Minor

Abdomen

Rectus Abdominis

Internal Oblique

MORPHOLOGY AND PATHWAYS OF THE MUSCLE CHANNELS

I

Table 17.7

Location Foot

Muscle Superficial

I I

Deep

Flexor Digitorum Longus Soleus Gastrocnemius Vastus Medialis Sartorius Rectus Femoris

Table 17.9

Location Hand and Arm

Back

Neck and Head

Small Intestine Muscle channel

Muscle Superficial

l

Muscle Superficial

[

Deep

Foot

Flexor Digitorum Brevis Lumbricals Abductor Hallucis Abductor Digiti Minimi

Adductor Hallucis Flexor Hallucis Brevis Plantar Interossei Flexor Digiti M inimi Brevis Quadratus Plantae

Leg and Groin

Soleus Gastrocnemius Sartorius Gracilis Adductor Longus Pectineus Psoas Major Rectus Abdominis

Flexor Digitorum Longus Adductor Magnus Adductor Brevis Obturator Externus

I Adductor Magnus Adductor Longus Pectineus Obturator Externus Psoas Major

Kidney Muscle channel

Table 17.8

Location

Dorsal Interossei Extensor Hallucis Brevis

Leg

~

Liver Muscle channel

309

~

Table 17.10

Triple Burner Muscle channel

Muscle Superficial

Deep

Deep

Location

Abductor Pollicis Brevis Flexor Carpi Ulnaris Flexor Digitorum Profundus Brachialis Triceps Brachii Deltoid

Flexor Pollicis Brevis Flexor Digitorum Profundus Coracobrachialis Teres Major

Hand

Dorsal Interosseus

Arm and Shoulder

Extensor lndicis Flexor Digitorum Profundus Supinator

Trapezius

Infraspinatus Teres Major Teres Minor Rhomboideus Major

Extensor Carpi Ulnaris Extensor Digiti Minimi Anconeus Extensor Carpi Radialis Longus Triceps Brachii Delto1d

Neck and Head

Trapezius Sternocleidomastoid Platysma Masseter Zygomaticus Major Orbicularis Oculi Temporalis

Levator Scapulae Stylohyoid Digastric Medial Pterygoid Lateral Pterygoid

Sternocleidomastoid Levator Scapulae Posterior Auricular Temporalis Masseter Platysma Zygomaticus Major Orbicularis Oculi

Splenius Capitis Middle Scalene Buccinator Risorius

l

310

r

PART 4: MUSCLE CHANNELS (JING JIN)

Table 17.11

Large Intestine Muscle channel

lI

Table 17.13

Muscle

Muscle

Location

Superficial

Hand and Wnst

Dorsal Interosseus

Arm

Extensor Digitorum Extensor Carpi Radialis Longus Extensor Carpi Radialis Brevis Brachioradialis Brachialis Biceps Brachii Deltoid

Extensor Pollicis Brevis Abductor Pollicis Longus Supinator Supraspinatus Subscapularis

Shoulder and Neck

Trapezius Sternocleidomastoid

Scalenes Levator Scapulae

Face and Head

Platysmus Buccinator Masseter Medial Pterygoid Risorius Lateral Pterygoid Zygomaticus Major Zygomaticus Minor Levator Labii Superioris Orbicularis Oculi Nasalis Temporalis Masseter

Upper Back

Deep

Trapezius Deltoid Latissimus Dorsi

Table 17.12

Pericardium Muscle channel

I

Levator Scapulae Supraspinatus Rhomboideus Minor Rhomboideus Major Infraspinatus

Location

Superficial

Deep

Hand

Lumbricals

Palmar Interosseus (Carpal Tunnel)

Arm

Palmaris Longus Flexor Digitorum Superficial is Flexor Carpi Radialis Palmaris Longus Pronator Teres Biceps Brachii

Flexor Digitorum Profundus Brachia lis

Chest

Pectoralis Major Latissimus Dorsi External Oblique

Coracobrachialis Teres Major Pectoralis Minor Serratus Anterior External lntercostals Internal lntercostals

I

Table 17.14 Muscle Superficial

Deep

Hand and Arm

Flexor Digiti Minimi Brevis Abductor Digiti Minimi Flexor Carpi Ulnaris Palmaris Longus Biceps Brachii Triceps Brachii Coracobrachialis

Opponens Digiti Minimi Flexor Digitorum Profundus Brachial is Teres Major

Chest and Abdomen

Pectoralis Major Rectus Abdominis

Pectoralis Minor Subscapularis Serratus Anterior External lntercostals Internal lntercostals Transversus Abdominis Internal Oblique

Muscle Superficial

Deep

Hand and wrist

Abductor Pollicis Brevis

Opponens Digiti Minimi

Arm

Abductor Pollicis Longus Brachioradialis Biceps Brachii Deltoid

Pronator Quadratus Flexor Digitorum Superficial is Pronator Teres Supinator Brachial is Coracobrachialis

Chest

Pectoralis Major Latissimus Dorsi Serratus Anterior External Oblique

Teres Major Subscapularis Subclavius Pectoralis Minor External lntercostals Internal lntercostals

I

Location

Lung Muscle channel

Location

Heart Muscle channel

I

NOTES l. J 98 1 Spiritua l Axis (Ling Shu jing !>!. m~ ).People's Health Publishing House. Beijing. first published c. 100 Be. p. 43-4 7. 2. Deadma n 1'. AI-Khafaji M 1998 A Manual of Acupuncture. journal of Chinese Medicine Publications. Hove. England 3. Spiritual Axis. p. 45.

I

CHAPTER 18

MUSCLE CHANNELSFUNCTIONS AND AETIOLOGY FUNCTIONS OF THE MUSCLE CHANNELS 311 They protect the body from trauma 311 They sustain the body in its erect position 311 They maintain the integrity of the body by connecting the '100 bones' 311 They govern the movement of joints and allow movement of the body 311 They contribute to the integration of the surface of the body with the Interior 312 They contribute to the integration and connection among the three Yang channels (Greater Yang, Bright Yang and Lesser Yang) and among the three Yin channels (Greater Yin, Lesser Yin and Terminal Yin) 312 They are nourished by the Main channels 313 AETIOLOGY OF THE MUSCLE CHANNELS 313 External pathogenic factors 313 Trauma 314 Overuse and repetitive use 314 Internal Organ problems transmitted to the Muscle channels 314

FUNCTIONS OF THE MUSCLE CHANNELS The functions of the Muscle channels can be described as follows.

They protect the body from trauma The muscle mass of the body protects the Internal Organs from trauma and prevents injury to them or the bones except in cases where the trauma is such that it exceeds the muscular protection of the body. In fact, minor or major trauma is a frequent aetiological factor in disease of the Muscle channels.

They sustain the body in its erect position The muscles help the bones to maintain the erect posture of the body. In fact, a slackening and atrophy of the muscles causes a person's body to lose its capacity to remain erect.

They maintain the integrity of the body by connecting the '100 bones' Each of the skeletal muscles originates from a bone and inserts into a bone. The muscles therefore contribute to maintaining the integrity of the body and of the skeletal system by connecting the bones (which the ancient Chinese ca lled the '100 bones'). This function of the muscles is not purely a mechanical one but also an energetic one. As the muscles are part of the Muscle channels where Qi and Blood circulate and as the bones are important sites of Blood circulation, the Muscle channels contribute to maintaining the integrity of the bone system and to promoting the circulation of Qi and Blood in muscles and bones.

They govern the movement of joints and allow movement of the body The muscles govern the movement of the bones and joints. Again, from the point of view of Chinese medicine, this is as much an energetic as a mechanical function. Qi and Blood flowing in the Muscle channels allow the movement of joints. Moreover, joints are sites of convergence of Qi and Blood of the Muscle channels and of the bones.

311

312

PART 4: MUSCLE CHANNELS (JING JIN)

They contribute to the integration of the surface of the body with the Interior As mentioned above. the Muscle channels are part of the 'Exterior' of the body {in addition to the Connecting channels and the skin itself). Therefore, together with the Connecting channels, the Muscle channels contribute to integrating the Exterior with the Main channels and with the Interior of the body. However, it should be said that this function is performed primarily by the Connecting channels and that the Muscle channels play only a secondary role in this. As explained in the previous chapter {Ch. 17), the Muscle channels constitute the 'Exterior' of the body in a different sense than the Connecting channels (see Fig. 17.1). The Connecting channels constitute the 'Exterior' of the body more in an energetic than in a physical sense: they are the superficial channels running in all directions that are between the Main channels and the skin. They are the channels through which pathogenic factors penetrate the body initially and the channels where the Defensive Qi circulates. The Connecting channels are directly connected to the Main channels and, indeed, they are the main route through which pathogenic factors may penetrate into the Main channels. In contrast to the Connecting channels. the Muscle channels are part of the 'Exterior' of the body, more in an anatomical than an energetic sense. Muscle channels are also easily invaded by external pathogenic factors: however. such invasions manifest primarily with muscular symptoms such as ache, pain or stiffness without the general symptoms of invasion of the Defensive-Qi portion (aversion to cold. fever, sore throat. etc.) which occur when the Connecting channels are invaded.

with the Greater Yang and Greater Yin representing the exterior of the Yang and of the Yin channels respectively; the Bright Yang and Lesser Yin representing the interior of the Yang and of the Yin channels respectively; and the Lesser Yang and Terminal Yin representing the hinge of the Yang and of the Yin channels respectively (see Table 17.2). There is a constant movement of Qi from the Exterior to the Interior and vice versa within the Yang and within the Yin channels: this movement is one aspect of the general entering and exiting of Qi within the Qi Mechanism (Qi Ji). For example, the Large Intestine channel runs on the anterior aspect of the neck, the Triple Burner on the lateral side and the Small Intestine on the posterior side (Fig. 18.1); these represent the Interior (Bright Yang), Hinge (Lesser Yang) and Exterior (Greater Yang) of the Yang channels respectively. This movement of Qi among the Exterior, Hinge and Interior involves all channels, i.e. Muscle, Connecting and Main channels. However, as the Muscle channels often overlap with each other and as each Muscle channel is connected with several others, forming a dense web of relationships (see Figure 17.19), the Muscle channels play an important role in ensuring the smooth movement of Qi among the Exterior (Greater Yang and Greater Yin). Hinge (Lesser Yang and Terminal Yin) and Interior (Bright Yang and Lesser Yin).

7""'"':.' Tai Yang : : Opens onto 1 I extenor I I

I :

'

They contribute to the integration and connection among the three Yang channels (Greater Yang, Bright Yang and lesser Yang) and among the three Yin channels (Greater Yin, lesser Yin and Terminal Yin) As mentioned in previous chapters. there is a progression of depth within the Yang and the Yin channels

I I

.:......!. shao Yang I ' :'Hinge' 1 I I 1

Yang Ming Opens onto interior

Fig. 18.1 Greater Yang, Bright Yang and Lesser Yang in the neck.

MUSCLE CHANNELS - FUNCTIONS AND AETIOLOGY

SUMMARY FUNCTIONS OF THE MUSCLE CHANNELS

• They protect t he body from trauma • They sustain the body in its erect position • They maintain the integrity of the body by connecting the '1 00 bones' • They govern the movement of joints and allow movement of the body • They contribute to the integration of the surface of the body with the Interior • They contribute to the integration and connection among the three Yang channels (Greater Yang, Bright Yang and Lesser Yang) and among the three Yin channels (Greater Yin, Lesser Yin and Terminal Yin) • They are nourished by the Main channels.

They are nourished by the Main channels Although it is said that the Muscle channels do not connect with the Interior, as explained above there is naturally an energetic relationship between the Muscle and the Main channels. The Muscle channels rely on the Main channels for their warmth, nourishment and moisture; in other words, Qi and Blood of the Main channels warm and moisten the muscles.

313

Muscle channels for a long time. Chapter 13 of the 'Spiritual Axis' says: 'Cold in the Muscle channels causes contraction and spasm; Heat causes muscle slackness and weakness.' 1 Acute invasion of Cold is a very common cause of Muscle-channel pathology bringing about stiffness and pain: if someone wakes up in the morning with a sudden pain and stiffness of a muscle, that is most probably a typical case of invasion of Cold in the Muscle channels. The pain deriving from Cold in the muscles is typically alleviated by the application of heat and aggravated by exposure to cold. If the acute invasion of Cold in the muscles is not treated, this may become chronic and Cold may be retained in the muscles for a long time causing repeated bouts of ache and stiffness of the muscles. This is more likely to occur in persons with a constitutional tendency to Yang deficiency.

Wind Wind also contracts the Muscle channels and causes spasm, pain and facial paralysis. In particular, external Wind in the Muscle channels of the face may cause facial paralysis as Wind can cause movement (tremors) or its opposite (paralysis). An invasion of Wind in the Muscle channels is characterized by a generalized muscle ache and contraction as opposed to Cold, which causes a more localized pain and contraction.

Dampness

AETIOLOGY OF THE MUSCLE CHANNELS Causes of disease of the Muscle channels are as follows.

External pathogenic factors External pathogenic factors invading only the Muscle channels do not cause any exterior symptoms such as aversion to cold and fever. sore throat. Floating pulse, etc. The symptoms of exterior invasions are a manifestation of Connecting-channel not Musclechannel pathology.

Cold Invasion of Cold in the Muscle channels will cause contraction, spasms and pain. Cold may stay in the

Dampness invades the Muscle channels causing a dull ache and a feeling of heaviness. Acute Dampness may also frequently become chronic, in which case Dampness settles in the muscles and causes a chronic, dull ache and a characteristic feeling of heaviness. The muscle ache deriving from Dampness is typically aggravated by exposure to damp weather. Dampness in the Muscle channels is a cause of the common symptom of muscle ache seen in chronic postviral fatigue syndrome.

SUMMARY AETIOLOGY OF TH E MUSCLE CHANNELS

• Cold: contraction , spasm, pain • Wind: contraction, pain, paralysis • Dampness: muscle ache, heaviness.

314

PART 4: MUSCLE CHANNELS (JING JIN)

Trauma

SUMMARY

Trauma causes Qi stagnation in the Muscle channels; if severe, it will cause local Blood stasis in the Muscle channels. The main manifestations are pain and local swelling. If the trauma causes Qi stagnation, the pain is not severe and is accompanied by a feeling of local distension; if the trauma causes Blood stasis, the pain is more severe and is stabbing in nature. The Blood stasis deriving from trauma may also become chronic, leading to chronic pain in the area.

AETIOlOGY OF MUSClE CHANNEl PROBlEMS • External pathogenic factors: -Cold -Wind -Dampness • Trauma • Overuse and repetitive use • Internal organ problems transmission.

Overuse and repetitive use Overuse and repetitive use of a joint are common causes of pathology of the Muscle channels causing pain and tingling. This, and the overuse and repetitive use of muscles, is a common cause of pathology of the Muscle channels in Western patients; the repetitive use of small muscles such as those used in typing or in handling a mouse for many hours a day is an unnatural use of a group of muscles which our bodies were not designed for. This often leads to Qi stagnation (from a Western perspective, inflammation) in the muscles, causing contracture, spasm and pain. As mentioned before, it should be remembered that in such problems, it is usually not only the Muscle channels that are involved, but also the Connecting channels.

Internal Organ problems transmitted to the Muscle channels Although the Muscle channels do not connect directly with the Internal Organs, problems of the organs can, in time, be transmitted to the Muscle channels. For example, Liver-Yang rising will cause a stiffness in the neck muscles, Liver-Wind will cause contraction of the muscles , a deficiency of the Stomach and Spleen will cause a flaccidity of the muscles, etc.

NOTES 1. 198 1 Spiritua l Axis (Ling Shu jing lll, ij! ~ ) .Peo pl e's Health Publishin g House, Beijing. first published c. 100 BC. p. 46-47.

CHAPTER 19

PATHOLOGY AND SYMPTOMS OF MUSCLE CHANNELS PATHOLOGY 375 SYMPTOMS 375 Three Yang channels of the leg 37 5 Three Yin channels of the leg 376 Three Yang channels of the arm 316 Three Yin channels oft he arm 3 77

PATHOLOGY The pathology of the Muscle channels involves two basis conditions of Fullness or Emptiness. Fullness manifests with pain, contracture, stiffness and hardness; Emptiness manifests with slackness, flaccidity and a dull ache. Tingling may be due to Full conditions such as Phlegm in the muscles or to Empty conditions such a deficiency of Blood. Chapter 13 of the 'Spiritual Axis' says: 'When Yang is in spasm, there is ina/Jility to /Jend: wizen Yin is in spasm, inability to extend. ' 1 This statement refers to the muscles of the Yang and Yin surfaces of the body and to all joints. When the muscles of a Yang surface are tight, the joint cannot be flexed; when the muscles of a Yin surface are tight, the joint cannot be extended. When the muscles of the back are tight, the patient cannot bend forwards; when the muscles of the front are tight, the person cannot bend backwards.

SYMPTOMS The symptoms and signs described in the 'Spiritual Axis' are as follows. 2

Three Yang channels of the leg Bladder Muscle channel When the Bladder Muscle channel is diseased there is strain of the little toe muscle, swelling and pain of the heel, contracture in the popliteal region, backward bending of the spine (opisthotonos), occipital stiffness, inability to raise the shoulder, pain from the axilla to supraclavicular fossa (ST-12 Quepen), and an inability to turn the head from side to side. For treatment, apply rapid insertion and withdrawal of a hot needle; repeat the treatment as long as is necessary for the pain to subside. This condition is called Spring Painful Obstruction Syndrome (Bi m, Syndrome).

Gall Bladder Muscle channel When the Gall Bladder Muscle channel is diseased there is strain of the fourth toe muscle extending to the lateral side of the knee on rotation, inability to bend or extend the knee, muscle spasm in the popliteal fossa , strained muscles of the pelvis, pain in the sacrum extending up to the hypochondrium, and then up to the supraclavicular fossa (ST-12 Quepen), breast and neck; if there is contraction of the Muscle channel extending from the left to the right side, the right eye cannot open: that is because the Muscle channel that runs on the right temple, runs side by side with the Yang Stepping Vessel (Yang Qiao Mai). The channel on the left side extends to the right: when the left side channel is diseased at the corner of the forehead, the right foot cannot move. This [phenomenon] is called mutual intersection of the Muscle channels. For treatment, apply rapid insertion and withdrawal of a hot needle; repeat the treatment as long as

315

316

PART 4: MUSCLE CHANNELS (JING JIN)

is necessary for the pain to subside. This condition is called Spring Painful Obstruction Syndrome (Bi Syndrome).

Stomach Muscle channel When the Stomach Muscle channel is diseased, there is strain of the middle toe muscle. stiffness of the foot and ankle, twisted muscles of the thigh in the region of ST-32 Futu, swelling of the anterior aspect of the thigh, hernial-like diseases, contracture of the abdominal muscles up to the supraclavicular fossa (ST-12 Quepen), deviation of the mouth, inability to close the eye; if the muscles are affected by Heat, this relaxes them and the eye cannot open. If the cheek muscles are contracted by Cold, the corner of the mouth moves; if they are slackened by Heat, the mouth is deviated . To treat in a condition of contraction of the muscles, spread horse fat on the cheek and apply a tincture of cinnamon; in a condition of slackening of the muscles, drive a hook from the mulberry tree on the slack corner of the mouth. Then make a fire with green mulberry-tree charcoal in a pit deep enough for the patient to sit in and feel warmth. Apply the ointment to warm up the contracted cheek. Then give the patient a drink of wine and a meal of meat. If the patient cannot drink wine, get him or her to drink a sma ll amount. After that, massage the diseased region three times and one can thus effect a cure. For treatment, apply rapid insertion and withdrawal of a hot needle; repeat the treatment as long as is necessary for the pain to subside. This condition is called Spring Painful Obstruction Syndrome (Bi Syndrome).

Three Yin channels of the leg

Spleen Muscle channel When the Spleen Muscle channel is diseased. there is strain of the muscle of the big toe, pain in the internal malleolus, twisting pain in the leg, pain in the medial aspect of the knee and thigh, pain in the genitalia, pain from the umbilicus to the hypochondrium on both sides, and pain inside the thoracic vertebrae region. For treatment, apply rapid insertion and withdrawal of a hot needle; repeat the treatment as long as necessary for the pain to subside. This condition is called Autumn Painful Obstruction Syndrome (Bi Syndrome).

Kidney Muscle channel When the Kidney Muscle channel is diseased, there is strain of the muscles on the sole of the foot. pain and twisted muscles along the course of the channel, epilepsy, and infantile convulsions. If the disease is in the back, the head cannot be bent forwards; if in the front, the head cannot be tipped backwards. When the Yang [channels] are affected, the back cannot be bent forwards, while when the Yin [channels] are affected, the back cannot be bent backwards. For treatment. apply rapid insertion and withdrawal of a hot needle; repeat the treatment as long as is necessary for the pain to subside. This condition is called Autumn Painful Obstruction Syndrome (Bi Syndrome).

Liver Muscle channel When the Liver Muscle channel is diseased, there is strain of the muscle of the big toe, pain in front of the internal malleolus, pain in the medial aspect of the knee, pain due to twisted muscles in the medial aspect of the thigh, disorders of the genitalia. impotence due to internal injury [excessive sexual activity], contraction of the genitals if injured by Cold, and slackness if injured by Heat. For treatment, one must move the fluids to clear Yin Qi. Apply rapid insertion and withdrawal of a hot needle; repeat the treatment as long as is necessary for the pain to subside. This condition is called Autumn Painful Obstruction Syndrome (Bi Syndrome).

Three Yang channels of the arm

Small Intestine Muscle channel When the Small Intestine Muscle channel is diseased , there is strain of the muscle of the little finger, pain in the posterior aspect of the elbow, pain on the medial aspect of the arm up to the area below the axilla. pain in the posterior aspect of the axilla, pain from the scapula to the neck. tinnitus, pain from the ear to the mandible, poor vision, stiffness of the neck, atrophy of muscles [of the neck] and swelling of the neck. For treatment, apply rapid insertion and withdrawal of a hot needle; repeat the treatment as long as is necessary for the pain to subside. This condition is called Summer Painful Obstruction Syndrome (Bi Syndrome).

PATHOLOGY AND SYMPTOMS OF MUSCLE CHANNELS

Triple Burner Muscle channel When the Triple Burner Muscle channel is diseased, there is strain and twisting pain of the muscles along the course of the channel and a curled tongue. For treatment, apply rapid insertion and withdrawal of a hot needle; repeat the treatment as long as is necessary for the pain to subside. This condition is called Summer Painful Obstruction Syndrome (Bi Syndrome).

Large Intestine Muscle channel When the Large Intestine Muscle channel is diseased. there is strain and pain of the muscles along the course of the channel, inability to raise the shoulder and inability to turn the head from side to side. For treatment, apply rapid insertion and withdrawal of a hot needle; repeat the treatment as long as is necessary for the pain to subside. This condition is called Summer Painful Obstruction Syndrome (Bi Syndrome).

Three Yin channels of the arm Lung Muscle channel When the Lung Muscle channel is diseased, there is strain and pain in the muscles along the course of the channel, breathlessness, pain in the hypochondrium and vomiting of blood. For treatment, apply rapid insertion and withdrawal of a hot needle; repeat the treatment as long as is necessary for the pain to subside. This condition is called Winter Painful Obstruction Syndrome (Bi Syndrome).

317

For treatment, apply rapid insertion and withdrawal of a hot needle; repeat the treatment as long as is necessary for the pain to subside. This condition is called Winter Painful Obstruction Syndrome (Bi Syndrome).

Heart Muscle channel When the Heart Muscle channel is diseased, there is strain and pain in the muscles along the course of the channel. For treatment. apply rapid insertion and withdrawal of a hot needle; repeat the treatment as long as is necessary for the pain to subside. If the patient is vomiting blood, it indicates that the condition cannot be treated and that it will result in death. If the disease is caused by Cold, contracture of the muscles will result; when it is caused by Heat, the muscles slacken. they cannot be contracted and the penis cannot be raised [impotence]. When the muscle cramp is in the Yang [channels of the back], the back is arched backwards; when it is in the Yin [channels of the abdomen], the patient bends the body but is unable to extend the back. The heated needle is used for contractions of the Muscle channels caused by Cold; when the Muscle channels are slackened by Heat. the heated needle should not be used. This condition is called Winter Painful Obstruction Syndrome (Bi Syndrome).

Pericardium Muscle channel

NOTES

When the Pericardium Muscle channel is diseased. there is strain and pain of the muscles along the course of the channel. breathlessness and chest pain.

l. 1981 Spiritual Axis (Ung S/111 Jing ill, 'II&!£ ). People's Health Publishing House. Beijing. first published c. 100 BC. p. 47. 2. Ibid .. p. 43- 47.

CHAPTER 20

TREATMENT OF MUSCLE CHANNELS CLINICAL SIGNIFICANCE 319 Harmonization and regulation of Yin and Yang channels 319 Regulation of Yang channels: horizontal f low of Qi 319 Exchange of Qi among Muscle channels in pathology 324 Upper Meeting points 324 TREATMENT 325 Massage 325 Gua Sha 325 Cupping 325 Acupuncture 325 THE MUSCLE CHANNELS IN THE TREATMENT OF PAINFUL OBSTRUCTION (B~ SYNDROME 326 Aetiology of invasion of Muscle channels 326 Pathology of external invasions of Muscle channels 326 Treatment of exterior invasions into Muscle channels 327

Treatment of the Muscle channels is very important primarily in musculoskeletal conditions and in Painful Obstruction (Bi) Syndrome.

CLINICAL SIGNIFICANCE

Harmonization and regulation of Yin and Yang channels An important aspect of the clinical significance of the Muscle channels is the role they play in regulating and harmonizing Yang and Yin Qi within the three Yang and three Yin channel systems respectively. i.e. Greater Yang, Lesser Yang, Bright Yang, Greater Yin. Lesser Yin and Terminal Yin. This is facilitated by the fact that

each Muscle channel connects with at least one other Muscle channel, as indicated earlier (see Fig. 17.19). The movement and interchange of Qi among the three Yang and the three Yin is an essential part of the movement of Qi between the Exterior and the Interior: this is part of the entering and exiting of Qi within the Qi Mechanism. Although such movement occurs also in the Main channels, due to the close relation among them, the Muscle channels play an important role in strengthening and promoting such movement.

SUMMARY HARMONIZATION AND REGULATION OF YIN AND YANG CHANNELS

• The Muscle channels f acilitat e t he movement of Qi among the t hree Yang (Greater Yang, Lesser Yang, Bright Ya ng) and among the th ree Yin channels (Greater Yin, Terminal Yin and Lesser Yin) • The movement of Qi among the t hree Yang and t he three Yin is part of the entering and exiting of Qi in t he Qi M echan ism.

Regulation of Yang channels: horizontal flow of Qi The regulating, harmonizing and connecting function of the Muscle channels is particularly evident in the Yang channels. As we have seen, there is a variation in energetic depth among the Yang channels: the Greater Yang 'opens' onto the Exterior (i.e. it is the most superficial of the Yang channels), the Bright Yang 'opens' into the Interior (i.e. it is the deepest of the Yang channels) and the Lesser Yang is the 'hinge' or

319

320

PART 4: MUSCLE CHANNELS (JING JIN)

'axis' between the other two (i.e. it is at an intermediate energetic depth). These three energetic depths are reflected in the location of the Yang channels. For example, if we look at the three Yang of the arm, we can see that the Small Intestine channel (Greater Yang) flows on the lateral side of the arm, the Large Intestine channel (Bright Yang) on the medial side and the Triple Burner in between the two. The picture is even clearer if we consider the three Yang of the leg. In fact. the Bladder channel (Greater Yang) flows on the posterior surface of the leg; the Stomach (Bright Yang) channel flows on the medial side and, indeed, in the trunk, it flows on the abdomen and chest (a Yin surface); the Gall Bladder channel flows in between the two. In each part of the body, therefore, there is a movement of Qi between the Greater Yang, Bright Yang and Lesser Yang channels: I call this the 'horizontal' movement of Qi when compared to the 'vertical' movement of Qi in a particular channel. For example, if we look at the shoulder area, the upward movement of Qi in the Large Intestine, Triple Burner or Small Intestine channel is a 'vertical' movement of Qi between the fingers and the head; the movement of Qi between the Small Intestine (Greater Yang), Large Intestine (Bright Yang) and Triple Burner (Lesser Yang) channels is a 'horizontal' movement of Qi. When the channels are obstructed, we remove obstructions by using a distal and a local point; this combination promotes the vertical movement of Qi in the channel. To strengthen the effect of the treatment, it is advisable to remove obstructions exploiting also the horizontal movement of Qi by promoting the exchange of Qi among the Greater Yang, Bright Yang and Lesser Yang channels. An example will clarify this. Let us assume we are treating a shoulder problem occurring clearly along the Large Intestine channel and we therefore use L.I.-1 Shangyang as a distal point and L.I.-15 Jianyu as a local point. This combination has the effect of stimulating the ascending and descending of Qi along the Large Intestine channel, which will result in the removal of pathogenic factors. I call this the 'vertical' movement of Qi in the body. In order to reinforce the treatment further, it is advantageous to stimulate also what I call the 'horizontal' movement of Qi, i.e. that among the Greater Yang (which opens onto the Exterior), the Bright Yang

Fig. 20.1 Flow of Qi among the Greater Yang, Bright Yang and Lesser Yang in the shoulder.

(which opens onto the Interior) and the Lesser Yang (which is the hinge). In the shoulder, this could be achieved simply by using the adjacent point T.B.-14 Jianliao (Lesser Yang) and S.I.-11 Tianzong (Greater Yang). The use of these adjacent points will have the effect of stimulating the 'horizontal' circulation of Qi in the shoulder area among the Greater Yang (on the scapula), the Lesser Yang and the Bright Yang: this will contribute to the elimination of pathogenic factors from the area (Fig. 20.1). This regulation and exchange among the Yang channels is another way in which points from different Yang channels 'resonate with each other'. This concept requires an explanation. I have noticed an interesting phenomenon that seems to be valid especially for the Yang channels and especially (although not exclusively) on the head, face, neck and chest. If one looks at the indications for a point on, say, a Greater Yang channel on the face or head, one will find obviously many indications relative to the area the point is situated in. However, one often also finds some indications relative to areas of the Bright Yang or Lesser Yang channels (Fig. 20.2). Let us assume that a point on a Greater Yang channel, besides the obvious indications related to its Greater Yang area, has some indications relative to a Lesser Yang adjacent area; if we look at the indications of points in that area, we will often find a point that. besides having obvious indications relevant to the area it is situated in. will also have some indications relative to the area of the Greater Yang point. When

TREATMENT OF MUSCLE CHANNELS

AREA'A' Greater Yang area point - Indications

AREA'S' Lesser Yang area point- Indications

a) Relevant to area

a) Relevant to area

b) Relevant to area

b) Relevant to area

c) Acting on another area

c) Acting on another area

('8'), e.g. Lesser Yang

('!>:), e.g. Greater Yang area

321

AREA 'A'- Greater Yang S.l.-16 -Indications

AREA '8'- Yang Ming ST-11 -Indications

a) Relevant to area: shoulder pain radiating to neck, stiff neck with difficulty in turning the head

a) Relevant to area: swelling and pain of throat, goitre

b) Acting on another area, i.e. Bright Yang: throat pain and goitre

b) Acting on Greater Yang area: stiffness of the neck with inability to turn the head

Fig. 20.2 Resonating points. Fig. 20.4 Example of resonating points (2): S.l.-16 Tianchuang and ST-11 Qishe

thls happens, I say that those two points 'resonate' with each other. Therefore, when I treat local problems on a Yang channel (e.g. Greater Yang) I always check to see whether there are resonating points in adjacent areas from other Yang channels (e.g. Lesser Yang). Some examples wi.ll clarify this. Let us consider the pair of points of G.B.-2 Tinghui (Lesser Yang) and ST-7 Xiaguan (Bright Yang). The indications for G.B.-2 Tinghui (a Lesser Yang point near the ear) include obvious, ear-related ones such as 'tinnitus, deafness and ear discharge' but also some less obvious indications related to the teeth and mouth such as 'toothache and deviation of mouth' (a Bright Yang area). ST-7 Xiaguan (a Bright Yang point) includes obvious indications such as 'lockjaw, toothache and swelling of gum' but also some ear-related indications such as 'deafness, tinnitus. and ear discharge and pain' (Fig. 20.3). We can therefore say that these two points 'resonate' with each other and would therefore make a good combination to promote the now of Qi between the Lesser Yang and the Bright Yang channels. Therefore, when treating a local problem of the teeth or mouth in the Bright Yang area we can select

AREA 'A'- Lesser Yang G.B.-2 -Indications

AREA '8'- Bright Yang ST-7 -Indications

a) Relevant to area: tinnitus deafness, ear discharge b) Acting on another area, i.e. Bright Yang: toothache, deviation of mouth

a) Relevant to area: lockjaw, toothache, swelling of gum b) Acting on Lesser Yang area: deafness, tinnitus, ear discharge, ear pain

Fig. 20.3 Example of resonating points (1): G.B.-2 Tinghui (Lesser Yang) and ST-7 Xiaguan (Bright Yang).

ST-7 Xiaguan as a local point and G.B.-2 Tinghui as an adjacent point. Let us consider another example concerning S.I.-16 Tianchuang and ST-11 Qishe (Fig. 20.4). The indications for S.I.-16 Tianchuang (a Greater Yang point) include obvious, area-related ones such as 'shoulder pain radiating to the neck' or 'stiff neck with difficulty in turning the head' but also 'throat pain and goitre'; if we look at Bright Yang points on the front of the neck we find that the indications for ST-11 Qishe include 'stiffness of the neck with an inability to turn the head'. Therefore these two points 'resonate' with each other and, when treating a local problem of the neck in the Greater Yang area (for which we use S.I.-16), we can select ST-11 as an adjacent point to stimulate the movement of Qi between the Greater Yang and Bright Yang areas. Table 20.1 illustrates some examples of 'resonating' points from Yang channels; Table 20.2. illustrates some examples of 'resonating' points between mixed channels. The phenomenon of 'resonating points' is another reason for using adjacent points from neighbouring Yang channels when treating a certain area to facilitate the 'horizontal' movement of Qi between Yang areas, i.e. between Greater Yang, Lesser Yang and Bright Yang. However. it should be stressed that, when treating musculoskeletal problems in Yang areas. it is advantageous to combine the local points with adjacent points (even if they are not 'resonating' points) on Yang channels of the same polarity and different amounts of Qi to promote the horizontal movement of Qi between the Greater Yang. Bright Yang and Lesser Yang.

322

PART 4: MUSCLE CHANNELS (JING JIN)

Table 20.1

Examples of 'resonating' points on Yang channels

Couple

Greater Yang

5.1.-16 Tianchuang 5T-11 Qishe

5.1.-16 a) Greater Yang area: shoulder pain radiating to the neck, stiff neck with difficulty in turning the head b) Bright Yang area: throat pain and goitre

G.B.-2 Tinghui 5T-7 Xiaguan

5.1.-11 Tianzong G.B.-22 Yuanye

Lesser Yang

Bright Yang 5T-11 a) Bright Yang area: swelling and pain of t hroat, goitre b) Greater Yang area; stiffness of the neck with inability to turn the head

G.B.-2 5T-7 a) Lesser Yang area: tinn itus, a) Bright Yang area: lockjaw, toothache and swelling of deafness, ear discharge gum b) Bright Yang area: toothache, deviation of mouth b) Lesser Yang area: deafness, t innitus, and ear discharge and pain 5.1.-11 a) Greater Yang area: pain in the shoulder and scapula b) Lesser Yang area: fullness of chest and hypochondrium, swelling of breast

T.B.-13 Naohui 5T-1 0 5huitu

G.B.-22

a) Lesser Yang area: hypochondria! pain, swelling of axilla b) pain of shoulder, pain in arm T.B.- 13 a) Lesser Yang area: pai n in the shoulder and arm b) Bright Yang area: goitre

T.B.-13 Naohui 5T-12 Quepen

T.B.- 13 a) Lesser Yang area: pain in the shoulder and arm b) Bright Yang area: goitre

5T-1 0

a) Bright Yang area: Goitre, scrofula of neck b) Lesser Yang area: pain in the shoulder 5T-12

a) Bright Yang area: Goitre, scrofu la of neck b) Lesser Yang area: pain in the shoulder and arm

BL-26 Guanyuanshu 5T-28 5huidao

BL-26 a) Greater Yang area: lumbar pain b) Bright Yang area: urinary problems

5T-28 a) Bright Yang area: urinary and gynaecological problems b) Greater Yang area: pain of lumbar vertebrae, shoulder and back

BL-23 5henshu 5T-12 Quepen

BL-23 a) Greater Yang area: lumbar pain b) Bright Yang area: asthma, cough

5T-12 a) Bright Yang area: chest pain, cough, asthma b) Greater Yang area: lumbar pain

T.B.-16 Tianyou 5T-12 Quepen

T.B.-16 a) Lesser Yang area: sudden deafness b) Bright Yang area: swell ing of supra-clavicular fossa

5T-12 a) Bright Yang area: chest pain, cough, asthma b) Lesser Yang area: pain of shoulder and neck

I

TREATMENT OF MUSCLE CHANNELS

Table 20.1 Couple

323

Examples of 'resonating' points on Yang channels- cont'd

Greater Yang

TB .-23 Sizhukong l.l.-20 Yingxiang

BL-2 Zanzhu l.l.-20 Yingxiang

BL-2 a) Greater Yang area: eye problems, headache b) Bright Yang area: nosebleed, rhinitis

G.B.-14 Yangbai BL-2 Zanzhu

BL-2 a) Greater Yang area: eye problems b) Lesser Yang area: headache

BL-2 Zanzhu ST-8 Touwei

BL-2 a) Greater Yang area: pain of eyebrow. blurred vision. lachrymation b) Bright Yang area: frontal headache

Table 20.2

Lesser Yang

Bright Yang

TB .-23 a) Lesser Yang area: eye problems b) Bright Yang area: toothache

l.l.-20 a) Bright Yang area: toothache, deviation of mouth, swelling of lip b) Lesser Yang area: heat and redness of eyes l.l.-20 a) Bright Yang area: nasal congestion and discharge, rhinitis b) Greater Yang area: heat and redness of eyes

G.B.-14 a) Lesser Yang area: headache b) Greater Yang area: eye pain

ST-8 a) Bright Yang area: frontal headache, b) Greater Yang area: bursting eye pain, lachrymation

Examples of 'resonating' points on mixed channels

Couple

First channel

Second channel

Du-16 Fengfu Ren-22 Tiantu

Du-16 Fengfu a) Governing Vessel area: headache, invasion of wind b) Directing Vessel area: swelling and pain of throat

Ren-22 Tiantu a) Directing Vessel area: fullness of chest, chest pain, asthma, rattling sound in throat, goitre b) Governing Vessel area: swelling of the back of the neck

SP-12 Chong men BL-30 Baihuanshu

SP-12 Chongmen a) Spleen channel area: abdominal pain, hernial disorders b) Bladder channel area: haemorrhoids

BL-30 Baihuanshu a) Bladder channel area: lumbar pain, coccyx pain, prolapse of rectum, difficult defecation b) Spleen abdominal channel area: menstrual problems, difficult urination

Du-17 Naohu Bl-2 Zanzhu

Du-17 Naohu a) Governing Vessel area: headache, neck pain, epilepsy b) Bladder channel area: blurred vision, myopia, eye pain

BL-2 Zanzhu a) Bladder channel area: eyebrow pain, blurred vision, lachrymation, swelling and pain of eye, itchy eyes b) Governing Vessel area: haemorrhoids, pain and stiffness of neck

LU-1 Zhongfu BL-13 Feishu

LU-1 Zhongfu a) Lung channel area: cough, asthma, chest pain b) Bladder channel area: pain of upper back

BL-13 Feishu a) Bladder channel area: pain in upper back, crooked spine, lumbar pain b) Lung channel area: cough, asthma, chest pain, chest fullness

324

PART 4: MUSCLE CHANNELS (JING JIN)

SUMMARY REGULATION OF YANG CHANNELS: HORIZONTAL FLOW OF Ql

• For musculoskeletal problems in Yang areas, combine t he local points with adjacent points on Yang channels of the same polarity and different amount of Qi (e.g. Greater Yang and Lesser Yang) to stimulate the 'horizontal' f low of Qi among t he Greater Yang, Bright Yang and Lesser Yang channels • 'Resonating' points are points from two Yang channels of different amounts of Qi (e.g. Greater Yang and Lesser Yang) that have reciprocal indications • Example: the indications for G.B.-2 Tinghui (Lesser Yang) include ear-related ones such as 'tinnitus, deafness and ear discharge' but also some less obvious indications related to the teet h and mout h such as 'toothache and deviat ion of mouth' (a Bright Yang area); ST-7 Xiaguan (Bright Yang) includes indications such as 'lockjaw, toothache and swelling of gum' but also some ear-related indications such as 'deafness, tinnitus, and ear discha rge and pain' • The phenomenon of 'resonating points' is another reason for using adjacent points from neighbouring Ya ng channels when t reating a certai n area to facilitate the 'horizontal' movement of Qi between Greater Yang, Lesser Yang and Bright Yang .

the Bladder, Gall Bladder and Stomach channels simultaneously. The use of the meeting points of the Muscle channels is particularly important in such cases (see below). Many other examples can be given: indeed in tendinomuscular problems, more than one Muscle channel is usually affected. For example, problems of the shoulders and neck very frequently affect the Greater Yang and Lesser Yang channels, and problems of the elbow and arm often affect Bright Yang and Lesser Yang areas, etc. It is actually relatively unusual for only one Muscle channel to be affected in any given pathology. The exchange between Muscle channels may also occur between Yang and Yin channels; a good example of this is a hip pain on the Gall Bladder channel extending to the groin along the Liver and Spleen Muscle channels.

SUMMARY EXCHANGE OF Ql AMONG MUSCLE CHANNELS IN PATHOLOGY

• Pathology of the Muscle channels f requently involves more tha n one channel • Example: sciatica manifesting on t he Bladder, Gall Bladder and Stomach channels simu ltaneously.

Upper meeting points It is important in Muscle channel problems to treat

Exchange of Qi among Muscle channels in pathology As we have seen in Chapter 17, there is a dense web of relationship among the Muscle channels, each Muscle channel communicating with several others; this web of relationships is particularly dense for the Yang Muscle channels (see Fig. 17.19). The exchange of Qi among the three Yang channels is also an important aspect of the pathology of the Muscle channels because the close physiological relationships among the Muscle channels mean that pathology of one channel may easily extend to others, especially in chronic conditions. A very good example of this is chronic sciatica, which often manifests on

the upper meeting points of the Muscle channels in order, in part, to strengthen the effect of distal and local points, and again in part to facilitate the exchange and regulation of Qi among the Yang channels. In chronic tendinomuscular problems, I therefore use a distal point to clear the channel combined with a local point to remove obstructions from the affected area. I call this the 'vertical' movement of Qi in the channel. I then use an adjacent point on another channel of the same polarity to promote the 'horizontal' movement of Qi among the three Yang or among the three Yin channels as described above. In addition, in chronic conditions, I use the u pper meeting point of the affected channels, i.e. S.I.-18 Quanliao (or ST-7 Xiaguan) for the three Yang of

TREATMENT OF MUSCLE CHANNELS

the leg, G.B.-13 Touwei for the three Yang of the arm, G.B.-22 Yuanye for the three Yin of the arm, and Ren-3 Zhongji for the three Yin of the leg. For example, in treating tendinitis of the elbow joint on tbe right side with pain on both the Large Intestine and Triple Burner Muscle channel areas, I would use L.I.-1 Shangyang or T.B.-8 Sanyangluo as a distal point and L.I.-11 Quchi and T.B.-10 Tianjing as local points. S.I.-8 Xiaohai as an adjacent point to stimulate the horizontal movement among Greater Yang, Bright Yang and Lesser Yang channels, and G.B.-13 Benshen on the right side. CLINICAL NOTE The Meeting points of the Muscle channels are : • three Yang of the leg: S.l.-18 Quanliao (or ST-7 Xiaguan) • three Yang of the arm: G.B.-13 Touwei • three Yin of the arm: G.B. -22 Yuanye • three Yin of the leg: Ren-3 Zhongji .

SUMMARY UPPER MEETING POINTS The upper meeting points of the Muscle channels are important for treating Muscle channel problems, partly to strengthen the effect of distal and local points and partly to facilitate the exchange and regu lation of Qi among the Yang channels.

TREATMENT Chinese medicine is rich in treatment modalities that affect the Muscle channels:

Massage Massage is especially indicated in Full conditions of the Muscle channels to relieve stiffness and cramp.

Gua Sha Gua Sha is excellent to eliminate Cold from the muscles.

325

Cupping Cupping eliminates Cold and stagnation of Qi/Biood from the muscles. It also expels Wind from the muscles.

Acupuncture The Muscle channels are involved in all cases of muscular pathologies such as sprain of a muscle, stiffness, flaccidity, and spasm. Two common conditions that involve pathology of the Muscle channels are Painful Obstruction (Bi) Syndrome and repetitive strain injury (RSI). In Painful Obstruction Syndrome, the muscles are obstructed by pathogenic factors such as Wind , Cold or Dampness, which in chronic cases leads to local stagnation of Qi/Blood in the joints. Stagnation of Qi in the Muscle channels leads to muscle ache and distension, while Blood stasis in the Muscle channels leads to pain. In RSI, there is a complex pathology of stagnation involving tendons, muscles and nerves; the Muscle channels are involved displaying symptoms of Qi stagnation. It is important to realize that both in Painful Obstruction Syndrome and in RSI, three types of channels are involved, i.e. the Muscle, Connecting and Main channels. Thus, it is often difficult to separate the pathology of one from the other. In general, the Muscle channels are simply treated by needling a distal point with reducing method in acute cases, and even method in chronic cases and local Ah Shi points with -relatively superficial needling. Relatively superficial needling affects the Muscle channels and is used in Empty conditions with reinforcing method and in Full conditions with reducing method. The acupuncture treatment of Muscle channels consists in using a distal point (often the Well point) and local, adjacent and Ah Shi points. The treatment of Muscle channels may also be based on a distinction between a Full condition and an Empty one. If the Muscle channel is Full (characterized by severe pain and rigidity) one can drain local points superficially and moxa the Main channel either on the opposite side or the same side, e.g. Source (Yuan) point. If the Muscle channel is Empty (characterized by a dull ache and flaccidity) one can torrify the Muscle channel with moxa cones on aching points and reduce

326

PART 4 : M USCLE CHA NNELS (JING JIN)

the Main channel by draining a point such as its Well point. Chapter 13 of the 'Spiritual Axis' recommends using the Hot (or Fire) needle on painful points of the Muscle channels. 1

CLINICAL NOTE • Relat ively superficial needling affects the Muscle channels • The acupunct ure treatment of M uscle channels consists in using a distal point (often the Well point) and local, adjacent and Ah Shi points • If the Muscle channel is Full, drain local points superf icially and moxa the Main channel • If the M uscle channel is Empty, tonify the Muscle channel with moxa cones on achy points and reduce t he Main channel by drain ing a point such as its Well poi nt.

SUMMARY TREATMENT

• • • •

Massage Gua sha Cupping Acupuncture.

THE MUSCLE CHANNELS IN THE TREATMENT OF PAINFUL OBSTRUCTION (BI) SYNDROME Painful Obstruction (Bi) Syndrome is discussed more fully in Chapter 3 7. Here, it is discussed not in general but only in connection with the Muscle channels. 'Painful Obstruction (Bi) Syndrome' indicates pain, soreness or numbness of muscles, tendons and joints from invasion of external Wind, Cold or Dampness. Painful Obstruction Syndrome is an affliction of the channels alone, not the Internal Organs. The pain and soreness are caused by obstruction in the circulation of Qi and Blood in the channels by exterior Wind, Cold or Dampness. The Muscle channels integrate muscles and sinews within the channel system. They are involved in any muscular pathology such as muscular weakness, ache

or stiffness that may appear in Painful Obstruction Syndrome.

Aetiology of invasion of Muscle channels This is by definition invasion of external pathogenic factors such as Wind, Cold or Dampness.

Wind Wind is the most pernicious of all pathogenic factors and one that is almost always combined with the others. In relation to the Muscle channels, Wind causes stiffness and wandering pain in several groups of muscles.

Cold Cold causes contraction, spasm and pain of the muscles; the pain is distinctly alleviated by the application of heat to the muscle. A good example of an acute invasion of Cold in the Muscle channels is that of an acute torticollis, i.e. an acute severe stiffness and pain of the neck with inability to turn the neck.

Dampness Dampness settles in the muscles causing ache, swelling, numbness and a feeling of heaviness. All three pathogenic factors of Wind, Cold and Dampness can settle in the muscles and the Muscle channels to become chronic.

Pathology of external invasions of Muscle channels Since very ancient times Painful Obstruction Syndrome has been classified according to the predominant pathogenic factor, i.e. Wind, Cold or Dampness. However, a different classification of Painful Obstruction Syndrome appears in the 'Yellow Emperor's Classic of Internal Medicine - Simple Questions'. The 'Simple Questions' in Chapter 43 classifies Painful Obstruction Syndrome according to the tissue and organ affected. It says: 'The jive Yin organs are related to the jive tissues where a chronic disease can lodge iiself In Bone Painjill Obstruction Syndrome the pathogenic factor reaches the Kidneys; in Sinew Painful Obstruction Syndrome it reaches the Liver; in Blood Vessel Painful Obstruction Syndrome it reaches the Heart; in Muscle Painful ObsirucUon Syndrome it reaches the Spleen and in

TREATMENT OF MUSCLE CHANNELS

Skin Painful Obstruction Syndrome it reaches the Lungs. '2 It then says: 'Painful Obstruction Syndrome in the bones is serious, in the blood vessels it leads to Blood stasis, in the sinews it causes stiffness, in the muscles it leads to weakness and in the skin it causes Cold. ' 3 The 'Simple Questions' thus classifies Painful Obstruction Syndrome according to the tissue affected and it deduces which tissue is affected by the main manifestation, i.e. bone deformities in Bone Painful Obstruction Syndrome, Blood stasis in Blood Vessel Painful Obstruction Syndrome, stiffness in Sinew Painful Obstruction Syndrome, weakness in Muscle Painful Obstruction Syndrome and feelings of cold in Skin Painful Obstruction Syndrome. It also determines a difference in severity between the different types. In the same chapter it says: 'When Painful Obstruction Syndrome affects the organs it causes death; when it is situated in the bones or sinews it becomes chronic; when it is situated in the muscles or skin it easily goes. '4 Therefore, according to the above chapter of the 'Simple Questions' in the case of the muscles and Muscle channels, Painful Obstruction Syndrome causes a feeling of weakness of the muscles. However, it is important to understand that the classification of Painful Obstruction Syndrome according to tissues involved should not be taken rigidly: in clinical practice, different tissues and different types of channels are involved. In Painful Obstruction Syndrome, and especially in chronic conditions, it is unlikely that we would see pathology of the Muscle channels only (although it may be more likely in acute conditions). More often than not, the Muscle, Connecting and Main channels are all involved, particularly the first two types. An involvement of the Muscle channels will cause muscle ache and stiffness: the pain is more diffuse in muscle groups rather than being located in the joints. Other manifestations depend on the pathogenic factor involved: if Wind, there will be stiffness and wandering ache; if Cold, there will be more severe pain and contraction and spasm; if Dampness, there will be heaviness and swelling of the muscles. An involvement of the Connecting channels will cause joint pain. Other manifestations depend on the pathogenic factor involved: if Wind, more than one joint is affected with the pain moving from joint to joint; if Cold, there will be severe joint pain and possibly inability to extend or abduct a limb; if Dampness, there will be ache and swelling of a joint.

327

Treatment of exterior invasions into Muscle channels The aim of the treatment is simply to expel the pathogenic factors which have invaded the channels, and eliminate the resulting local stagnation of Qi and Blood in the channels. As a general principle, since the three pathogenic factors of Wind, Cold and Dampness are usually all present in Painful Obstruction Syndrome (although with the predominance of one or two) , the treatment is aimed at expelling Wind, scattering Cold and resolving Dampness. In relation to the Muscle channels, the treatment depends on the pathogenic factor involved. In cases of Wind, apart from needling, cupping would be appropriate; in cases of Cold, moxa on needles is an excellent method to expel Cold from the muscle; in cases of Dampness, apart from needling, cupping is also indicated. In terms of Transporting (Shu) points, the following are the best points to expel the relevant pathogenic factor from the Muscle channels:

- Wind: the Well Uing) point - Cold: the Sea (Sea) point - Dampness: the Stream (Shu) or River Uing) points.

SUMMARY THE MUSCLE CHANNELS IN THE TREATMENT O F PAINFUL OBSTRUCTION (8/) SYNDROME

The Muscle channels are involved in any muscular pathology such as muscular weakness, ache or stiffness that may appear in Painful Obstruction Syndrome

Aetiology of invasion of Muscle channels

Wind • Stiffness and wandering pain in several groups of muscles

Cold • Cold causes contraction, spasm and pain of the muscles; the pain is distinctly alleviated by the application of heat to the muscle

Dampness • Ache, swelling, numbness and a feel ing of heaviness Continued

328

PART 4 : MUSC LE CHANNELS (JING JIN)

Pathology of external invasions of Muscle channels • Bone Pai nful Obstruction Syndrome (Kidneys): bone deformities • Blood Vessel Painful Obstruction Syndrome (Heart): Blood stasis • Sinew Painful Obstruction Syndrome (Liver): stiffness • Muscle Pa inful Obstruction Syndrome (Spleen): weakness • Skin Painful Obstruction Syndrome (Lungs): feeling of cold . An involvement of the Muscle channels will cause muscle ache and stiffness: the pain is more diffuse in muscle groups rather than being located in the joints. Other manifestations depend on the pathogenic factor involved: if W ind, there will be stiffness and wandering ache; if Cold, t here will be more severe pain and contraction and spasm; if Dampness, there wi ll be heaviness and swelling of the muscles.

Treatment of exterior invasions into Muscle channels • Wind: apart from needling, cupping is appropriate • Cold: moxa on needles • Dampness: apart from needling, cupping is also indicated • In terms of Transporting (Shu) points, the following are the best points to expel the relevant pat hogenic factor from the Muscle channels: -Wind: t he Wel l (Jing) point - Cold: the Sea (Sea) point - Dampness: the Stream (Shu) or River (Jing) points.

*

NOTES

m

1. 1981 Spiritual Axis (Ling SIIu]ing ~ t~ ). People's Health Publishing House. Beijing, first published c. 100 BC. p. 43-47.

2. 1979 The Yellow Emperor's Classic of Internal Medicine- Simple P'l i£ :¥ liiJ ). People's Questions (Huang Di Nei finy Su Wen Jil' Health Publishing House. Beijing. first published c. 100 BC, p. 241. 3. lbid .. p.241. 4. Ibid., p. 243.

PART 5

DIVERGENT CHANNELS (JING BIE) 21 Morphology of Dive rg ent chan nels 331 22 Functions an d cl inica l use of th e Divergent channels 341

Part 5 deals with the pathways and functions of the Divergent channels. Unlike the Connecting and the Muscle channels, the Divergent channels do not have their own specific treatment modalities and their clinical importance lies primarily in explaining certain connections among organs that could not be explained by reference to other types of channels.

CHAPTER 21

MORPHOLOGY OF DIVERGENT CHANNELS PATIERN OF CIRCULATI ON OF THE DIVERGENT CHAN NELS 331 PATHWAYS OF THE DIVERGENT CHANN ELS 335 Bladder Divergent channel 335 Kidney Divergent channel 336 Gall Bladder Divergent channel 336 Liver Divergent channel 336 Stomach Divergent channel 337 Spleen Divergent channe l 337 Small Intestine Divergent channe l 338 Heart Divergent channel 338 Triple Burner Divergent channel 339 Pericardium Divergent channel 339 Large Intestine Divergent channel 339 Lung Divergent channel 339

The Divergent channels are called Ji ng Bie ( !£ jjlj ) in Chinese. The name literally means 'divergences fro m the Main channels' rather than 'Divergent channels'. The Divergent channels are discussed in Chapter 11 of the 'Spiritual Axis' .1

PATIERN OF CIRCULATION OF THE DIVERGENT CHANNELS The Divergent channels run deeper than the Main channels. All of them start near the lower end of the Main channels, all enter the Internal Organs and all emerge at the neck; thus, all the Divergent channels run from the lower to the upper part of the body. As a general pattern, the Yang Divergent channels follow a pathway different from that of the Yin ones. Generally, the pathway of the Yan g Divergent channels follows the following pattern (Fig. 21.1): • They separate from their respective Yang Main channel.

• They enter the Yang organ to which they are connected and often (though not in all cases) the related Yin organ. • They then emerge at the neck where they join their related Main channel. Generally, the pathway of the Yin Divergent channels follows the following pattern (Fig. 21.2): • They separate fro m their respective Yin Main channel. • Some (Heart, Lung and Kidneys) connect with their respective Yin organ . • They join the related Yang Divergent channel (e.g. Kidney Divergent to Bladder Divergent). • They then join the related Yang Main channel on the neck. From the above general patterns two observations can be made: • In the end. all Divergent channels (whether Yin or Yang) join with the six Yang Main channels • All Yang Divergent channels join with the respective Yang organ and the related Yin organ (Fig. 21.3). The Divergent channels have departure and meeting points. They also have entering and exiting points: where they converge, they enter and where they depart, they exit. They start from Yang channels and return to them; they harmonize Interior and Exterior and regulate the flow of Qi to and from the head. The Divergent channels' pathways are described in Chapter 11 of the 'Spiritual Axis' as pairs with the same Yin-Yang pairing as that of the Main channels. 331

332

PART 5: DIVERGENT CHANNELS (JING 8/E)

Yang Divergent

Yin Divergent

Neck

Yang Divergent Yang Main channel

Yin Divergent

Fig. 21 .1 Pattern of Yang Divergent channels pathway.

Yang Divergent Yang Main channel Fig. 21.2 Pattern of Yin Divergent channe ls pathway.

The order in which they are described, however, is different and it is as follows: Bladder/ Kidney Gall Bladder/Liver Stomach/Spleen Small Intestine/ Heart Triple Burner/ Pericardium Large Intestine/Lung. As we have seen in Chapter 1 7, this order is the same as that in which the Muscle channels' pathways are listed in Chapter l3 of the 'Spiritual Axis'; i.e.: • three Yang channels of the leg (Bladder, Gall Bladder and Stomach) (Fig. 21.4) • three Yin channels of the leg (Spleen, Liver and Kidney) (Fig. 21.4) • three Yang channels of the arm (Small Intestine, Triple Burner and Large Intestine) (Fig. 21.5)

• three Yin channels of the arm (Lung, Pericardium and Heart) (Fig. 21.5). The six pairs of Divergent channels have points of convergence in the upper part of the body (which I shall call Upper Meeting points) as follows (Fig. 21.6): Channels

Upper Meeting point

Bladder/Kidney Gall Bladder/Liver Stomach/Spleen

BL-10 Tianzhu G.B.-1 Tongziliao ST-1 Chengqi (or ST-9 Renying) BL-1 Jingming T.B.-16 Tianyou L.I.-18 Futu

Small Intestine/Heart Triple Burner/Pericardium Large Intestine/Lungs

Four of the six couples of Divergent channels have a Lower Meeting area of which only two are specific

MORPHOLOGY OF DIVERGENT CHANNELS

333

Fig. 21.3 Pattern or Yang and Yin Divergent channel pathway.

Neck

Yang Divergent

Yin Divergent

Yang Main channel

Yin Main channel

Neck

Neck

Neck

Pubis

Popliteal fossa

BL Main

Thigh

Kl Main

G.B. Main

Fig. 21 .4 Schematic representation of Divergent channels of leg.

Foot

LIV Main

Thigh

ST Main

SP Main

PART 5: DIVERGENT CHANNELS (JING 8/E)

334

Head Shoulder

Axilla

Axilla

Hand

S.l. Main

HE Main

T.B. Main

P Main

Fig. 21 .5 Schematic represent at ion of Divergent channels of arm.

Gall Bladder/

Large Intestine/Lungs Fig. 21 .6 Upper Meeting points of Divergent channels.

L.l . Main

LU Main

MORPHOLOGY OF DIVERGENT CHANNELS

r

BL-40: Bladder/Kidneys

Pubis: Gall Bladder/Liver

Thighs: Stomach/Spleen

Axilla: Small Intestine/Heart

Fig. 21.7 Lower Meeting points of Divergent channels.

points; these are the areas (or points) where the Qi of the pair of channels converges before diverging upwards. The Lower Meeting points are (Fig. 21.7):

Channels Bladder/Kidney Gall Bladder/Liver Stomach/Spleen Small Intestine/Heart Triple Burner/Pericardium Large Intestine/Lung

Lower Meeting point Popliteal fossa (BL-40 Weizhong) Pubis (Ren-2 Qugu) Thigh Axilla None None

PATHWAYS OF THE DIVERGENT CHANNELS The pathways of the Divergent channels as described in Chapter 11 of the 'Spiritual Axis' (and in the same order) are as follows.

Bladder Divergent channel (Fig. 21.8) • It diverges from the Bladder Main channel in the

popliteal fossa • It goes to the anus • It ascends to connect with the bladder and kidneys • It ascends along the spine and disperses in the

heart • It emerges in the neck to rejoin the Bladder Main

channel. Fig. 21.8 Bladder Divergent channel.

335

336

PART 5: DIVERGENT CHANNELS (JING 8/E)

Kidney Divergent channel (Fig. 21.9)

Gall Bladder Divergent channel (Fig. 21.10)

• It diverges from the Kidney Main channel in the

popliteal fossa • It ascends to connect with the kidneys where it

crosses the Girdle Vessel (Dai Mai) • It emerges at the neck where it converges with the Bladder Divergent channel • It ascends to the root of the tongue.

• It diverges from the Gall Bladder Main channel

on the thigh • It enters the pubis where it converges with the

Liver Divergent channel • It ascends and connects with the gall bladder

and liver • It crosses the heart • It connects with the Gall Bladder Main channel

at the neck and reaches the outer corner of the eyes.

liver Divergent channel (Fig. 21.11) • It diverges from the Liver Main channel on the

foot • It ascends to the pubic region where it converges

with the Gall Bladder Main channel.

Fig. 21 .9 Kidney Divergent chan nel.

Fig. 21.1 0 Gall Bladder Divergent channel.

MORPHOLOGY OF DIVERGENT CHANNELS

337

Fig. 21.12 Stomach Divergent channel.

Stomach Divergent channel (Fig. 21.12) • It diverges from the Stomach Main channel on

the thigh • It ascends to the abdomen and enters the stomach and spleen, and then the heart • It reaches the neck. where it unites with the Stomach Main channel • It enters the eye.

Spleen Divergent channel (Fig. 21.13) Fig. 21.11 Liver Divergent channel.

• It diverges from the Spleen Main channel in the

middle of the thigh • It joins with the Stomach Divergent channel at

the neck • It reaches the tongue.

338

PART 5: DIVERGENT CHANNELS (JING 8/E)

Fig. 21.13 Spleen Divergent channel.

Fig. 21.14 Small Intestine Divergent channel.

Small Intestine Divergent channel (Fig. 21.14) • It diverges from the Small Intestine Main

channel at the shoulder • It enters the axilla and connects with the heart • It descends to the abdomen where it connects with the small intestine.

Heart Divergent channel (Fig. 21.15) • It diverges from the Heart Main channel at the

axilla • It enters the chest and connects with the heart • It merges with the Small Intestine Divergent

channel at the neck • It enters the inner corner of the eye. Fig. 21 .15 Heart Divergent channel.

MORPHOLOGY OF DIVERGENT CHANNELS

339

Fig. 21.16 Triple Bu rner Divergent channel. Fig. 21.17 Pericardium Divergent channel.

Triple Burner Divergent channel (Fig. 21.16)

large Intestine Divergent channel (Fig. 21.18)

• It diverges from the Triple Burner Main channel

on the head and goes to the vertex • It descends to the clavicle and joins the Three

Burners.

Pericardium Divergent channel (Fig. 21.17)

• It diverges from the Large Intestine Main

channel on the hand • It ascends to L.I.-15 and travels to the spine • It crosses to the supraclavicular fossa and

ascends to the throat and neck where it unites with the Large Intestine Main channel • A branch from the clavicle connects with the lungs and large intestine.

• It diverges from the Pericardium Main channel

below the axilla • It enters the chest and communicates with the

Three Burners • It ascends to the throat and neck where it joins the Triple Burner Divergent channel • It goes behind the ears.

lung Divergent channel (Fig. 21.19) • It diverges from the Lung Main channel at the

axilla and passes anterior to the Heart channel in the chest

340

PART 5: DIVERGENT CHANNELS (J!NG 8/E)

Fig. 21.18 Large Intestine Divergent channel.

• It connects with the lungs and disperses iu the

large intestiue • It ascends from the lungs to the throat and

converges with the Large Intestine channel at the neck. Fig. 21 .19 Lung Divergent channel.

NOTES ~ ~ t£ ). People's Health Publishing House. Beijing. first published c. 100 BC, p. 100.

l. 1981 Spiritual Axis (Ling Shu]ing

CHAPTER 22

FUNCTIONS AND CLINICAL USE OF THE DIVERGENT CHANNELS BALANCING YIN AND YANG 341 Balancing Yin and Yang in the Interior 342 Balancing Yin and Yang in the head 342 HARMONIZING YIN AND YANG 343 INTEGRATING AND CONNECTING THE INTERNAL ORGANS 344 Treating a Yang channel for a problem in a Yin channel/organ or vice versa 344 Connection between Stomach and Heart 344 The Heart Divergent channel and the inner canthus of the eye 344 The Bladder Divergent channel and the anus 345 The Bladder Divergent channel and the heart region 345 The Pericardium Divergent channel and the neck and head 345 The Gall Bladder Divergent channel and the Heart 345 The Pericardium Divergent channel and the throat 345 The Yang channels of the leg and the Heart 345 THE CLINICAL APPLICATION OF THE SIX PAIRS OF DIVERGENT CHANNELS 345 Bladder and Kidneys 347 Gall Bladder and Liver 348 Stomach and Spleen 349 Small Intestine and Heart 349 Triple Burner and Pericardium 350 Large Intestine and Lungs 351

The main function of the Divergent channels is to balance and integrate. They balance Qi in the sense that they play an important role in the balancing of Yin and Yang at a deep level and in balancing the 11ow of Qi between the body and the head; they integrate in the sense that they connect and integrate organs among themselves.

The Divergent channels do not have their own points (in the way the Connecting channels do) and they do not have their own pathology (in the way the Connecting channels do ). 1 Please note that, contrary to what I did for the Muscle and Connecting channels, there will be no discussion of aetiology, pathology or treatment of the Divergent channels. This is because, unlike the Connecting and Muscle channels, the Divergent channels do not have a pathology that is separate from that of the Main channels. Neither do the Divergent channels have their own points (as do the Connecting channels) although the Yin-Yang pairs of Divergent channels have Meeting poirlts. Apart from such Meeting points, the Divergent channels are treated through the points of the Main channels. The main clinical significance of the Divergent channels lies in allowing connections between various organs and channels which provide the explanation of the clinical use of certain points; for example. the use of BL-5 7 Chengshan for the anus because the Divergent channel flows to the anus (which neither the Connecting nor the Mairl channels of the Bladder do). However, I shall discuss the clinical application of the Divergent channels particularly through their Meeting points. In order to highlight the clinical significance of the Yin- Yang pairs of Divergent channels, I have included six figures which illustrate the Yin-Yang pairs (Figs 22.1 to 22.6).

BALANCING YIN AND YANG In terms of energetic depth, the Divergent channels balance Yin and Yang ir1 the Interior; ir1 terms of energetic zone, they balance Yin and Yang in the head.

341

342

PART 5: DIVERGENT CHANNELS (JING BIE)

Balancing Yin and Yang in the Interior

SUMMARY BALANCING YIN AND YANG IN THE INTERIOR

A major aspect of the physiology of the Divergent channels is that they balance Yin and Yang in the Interior and the Internal Organs. Like the Connecting channels, they balance Yin and Yang but they do so in the Interior, whereas the Connecting channels harmonize Yin and Yang in the Exterior. As we shall see, the Eight Extraordinary Vessels also balance Yin and Yang and, as we have seen, the Connecting channels balance Yin and Yang in the limbs. Let us therefore explore the different ways in which these three types of channels balance Yin and Yang. The Connecting channels balance Yin and Yang primarily in the limbs and at a more superficial level than the other two classes of channels. The Eight Extraordinary Vessels balance Yin and Yang primarily in the trunk and at a deeper level than the Connecting channels; however, they also balance Yin and Yang at a superficial level in the abdomen and especially in the Membranes (Huang). In terms of energetic zone, the Divergent channels balance Yin and Yang primarily in the head; in terms of energetic depth, they balance Yin and Yang in the Interior and in the Internal Organs. They also strengthen the connection between Yin and Yang organs. We can therefore construct a table highlighting the difference among these three types of channel in terms of energetic zone and energetic depth (Table 2 2.1).

Balancing Yin and Yang in the head Superficially, the head contains only Yang channels, and internally only the deep pathways of the Heart and Liver reach the head. The Yin Divergent channels are therefore particularly important for carrying Yin Qi up to the head; this is the only way that Yin Qi

Table 22.1

• The Divergent channels balance Yin and Yang in the Interior and the Internal Organs • In terms of energetic zone, the Divergent channels balance Yin and Yang primarily in the head • In terms of energetic dept h, they balance Yin and Yang in the Interior and in t he Internal Organs • They strengthen the connection between Yin and Yang organs.

reaches the head. In fact, as we have seen, all the Yin Divergent channels join the associated Yang Divergent channel in the neck area and this, in turn, then joins its relevant Main channel (e.g. the Kidney Divergent channel joins the Bladder Divergent channel at the neck and this, in turn, rejoins the Bladder Main channel). The balancing of Yin and Yang in the head is also achieved through the Upper Meeting points of the Divergent channels. These points are as follows: Meeting point BL-10 Tianzhu G.B.-1 Tongziliao ST-1 Chengqi (or ST-9 Renying) BL-1 Jingming Small Intestine/Heart Triple Burner/Pericardium T.B.-16 Tianyou Large Intestine/Lungs L.I.-18 Futu

Channels Bladder/Kidney Gall Bladder/Liver Stomach/Spleen

As can be seen, all the Upper Meeting points are on Yang channels and they are all strategic, important points. By providing a meeting of the Yin- Yang pairs of Divergent channels, these points facilitate the rising

Differences between the Yin-Yang balancing action of the Connecting channels, Extraordinary Vessels and Divergent channels Connecting channels

Extraordinary Vessels

Divergent channels

Energetic zone

Limbs

Trunk

Head

Energetic depth

Superficial

Deep and superficial

Deep, in the Interior and the Internal Organs

FUNCTIONS AND CLINICAL USE OF THE DIVERGENT CHANNELS

of Yin Qi to the head and they therefore contribute to the balance of Yin-Yang in the head. Please note that 'balancing Yin-Yang in the head' does not only mean balancing the quantity of Yin-Yang in the head, but it also implies balancing and regulating the ascending (a Yang movement) and descending (a Yin movement).

'Balancing Yi n-Yang in t he head' does not only mean balancing the quantity of Yin-Yang in the head, but it also implies ba lancing and regu lating the ascending (a Yang movement) and descending (a Yin movement).

If we take ST-9 as the Upper Meeting point of the Stomach and Spleen Divergent channels, we see that four of the six Upper Meeting points are also Window of Heaven points. These are:

-

BL-10 Tianzhu (Bladder and Kidney) ST-9 Renying (Stomach and Spleen) T.B.-16 Tianyou (Triple Burner and Pericardium) L.I.-18 Futu (Large Intestine and Lungs).

As one of the main functions of the Window of Heaven points is to regulate the ascending/descending of Qi to and from the head, this is an additional way in which the Divergent channels balance Yin and Yang in the head. By virtue of their dual nature of being both Meeting points of the Yin-Yang pairs of Divergent channels and Window of Heaven points, these four points are particularly indicated to regulate Yin-Yang in the head in every way. The connection of these four Window of Heaven points with the Divergent channels also enhances their clinical significance as it means that. among this class of points. they are particularly important for regulating and balancing Yin and Yang in the head. In clinical practice, this means that these four Window of Heaven points would, for example, be important in the treatment of headaches. In fact, all headaches may be classified as being due to one of four situations of imbalance of Yin- Yang in the head: - Excess of Yang in the head (e.g. Liver-Yang rising) -Deficiency of Yang (e.g. Stomach-Yang deficiency) - Excess of Yin (e.g. Dampness or Phlegm)

343

-Deficiency of Yin (Kidney-Yin deficiency or LiverBlood deficiency). For the same reason, these four points would be important to use in other pathologies of the head such as chronic dizziness and hypertension. CLINICAL NOTE Four of the Upper Meeting points of the Divergent channels are Window of Heaven points (BL-10, ST-9, T.B.-16 and L.l.-18): by virtue of their dual nature as Meeting points of the Divergent channels and Window of Heaven points, they are particularly effective in regulating and balancing Yin-Yang in the head.

SUMMARY BALANCING YIN AND YANG IN THE HEAD

• The Yin Divergent channels carry Yin Qi up to the head: this is the only way Yin Qi reaches the head • Ba lancing Yin and Yang in the head is also achieved through the Divergent channels Upper Meeting points • 'Balancing Yin-Yang in the head' does not only mean balancing the quantity of Yin-Yang in t he head, but it also implies balancing and regu lating the ascending (a Yang movement) and descending (a Yin movement) • Four of t he six Upper Meet ing points are also W indow of Heaven points (B L-1 0, ST-9, T.B.-16 and L.l.-18) • This is an additional way in which t he Divergent channels balance Yin and Yang in the head • These fou r Window of Heaven points ca n be used in the treatment of headaches, chronic dizziness and hypertension.

HARMONIZING YIN AND YANG The Divergent channels strengthen the relationship between Yin and Yang organs because all the Yang Divergent channels flow to the respective Yang and related Yin organ. Thus. the Divergent channels not only 'balance' Yin and Yang but also strengthen the

344

PART 5: DIVERGENT CHANNELS (JING 8/E)

connection between Yin and Yang channels; this gives us flexibility in clinical practice, enabling the use of points on Yang channels for symptoms of Yin channels and vice versa. From this point of view, the function of the Divergent channels is similar to that of the Connecting channels, i.e. to strengthen the connection between pairs of YinYang channels. However, the Connecting channels enable this connection more superficially and especially in the limbs; the Divergent channels enable this connection more deeply and especially in the Interior and in the Internal Organs. Several examples can be given of the use of Yang points to treat problems of Yin channels or vice versa making use of the connection provided by the Divergent channels. Some are reported below. - LU-7 Lieque can be used for shoulder problems along the Large Intestine channel (the Lung Divergent channel converges with the Large Intestine channel at the neck). - L.I.-4 Hegu can be used to expel Wind in the Lung's Defensive-Qi portion in acute invasions of exterior Wind (the Large Intestine Divergent channel flows to the Lungs from the clavicle area). -Many Stomach points (e.g. ST-36 Zusanli and ST-25 Tianshu) can tonify the Spleen (the Stomach Divergent channel enters the Spleen). - KI-4 Dazhong can treat neckache along the Bladder channel (the Kidney Divergent channel joins the Bladder channel at the neck). - P-6 Neiguan is very good for treating neck and shoulder problems along the Triple Burner channel (the Pericardium Divergent channel joins with the Triple Burner channel at the neck). - G.B.-34 Yanglingquan is excellent for treating stagnation of Liver-Qi (the Gall Bladder Divergent channel joins with the Liver organ). - G.B.-26 Daimai can treat genital problems (the Gall Bladder Divergent channel joins with the Liver Divergent channel in the area of the pubis).

SUMMARY HARMONIZING YIN AND YANG • The Divergent channels strengthen t he relationship between Yin and Yang organs • This allows us in practice to use Yang points to treat Yin orga ns and vice versa.

INTEGRATING AND CONNECTING THE INTERNAL ORGANS The Divergent channels integrate some channels with organs with which they are not connected through the Main channels; this explains many connections we make in clinical practice.

Treating a Yang channel for a problem in a Yin channel/organ or vice versa The Divergent channels enable us to use a Yang channel to treat a problem of a Yin channel/organ or vice versa. In other words, through the Divergent channels many connections between Yin and Yang channels are established and these are exploited in practice. For example, LU-7 Lieque can be used for problems of the Large Intestine channel on the face, or L.I.-11 Quchi for a fever from Wind-Heat in the Lung's Defensive-Qi portion; both these uses are enabled by the pathways of the Divergent channels. Other examples are the use of L.I.-11 Quchi for cough and asthma and of LU-10 Yuji for constipation and diarrhoea. Further examples were given above.

Connection between Stomach and Heart I always treat the Stomach for heart problems such as palpitations, tachycardia or irregular heartbeat. This connection can be explained only through the Divergent Stomach channel's flowing to the heart, as the Heart Main channel does not go to the stomach and the Stomach Main channel does not go to the heart. This connection also explains th e mentalemotional effect of many Stomach points (e.g. ST-40 Fenglong or ST-25 Tianshu). Moreover, because of the connection between the Stomach Divergent channel and the Heart, some Stomach points are effective in treating insomnia associated with digestive disharmonies; for example, both ST-36 Zusanli and ST-40 Fenglong can treat insomnia associated with digestive problems.

The Heart Divergent channel and the inner canthus of the eye The fact that the Heart Divergent channel reaches the inner canthus of the eye explains the diagnostic

FUNCTIONS AND CLINICAL USE OF THE DIVERGENT CHANNELS

significance of this area's being related to the Heart (which does not happen via the Heart Main channel).

The Bladder divergent channel and the anus The fact that the Bladder Divergent channel reaches the anus explains the use of BL-5 7 Chengshan and BL-58 Feiyang for haemorrhoids (the Bladder Main channel does not go to the anus).

The Bladder Divergent channel and the heart region

345

The Yang channels of the leg and the Heart It is interesting to note that all three Leg Yang

Divergent channels (Bladder, Gall Bladder and Stomach) go to the heart. As the Small Intestine naturally connects with the Heart, four Yang channels flow through the Heart. The Qi of these Yang channels gives the Heart the Yang Qi that is necessary for its pumping action. More importantly, on a psychic level, the Yang channels give the Heart the Yang Qi that provides the Mind (Shen) with drive, expansiveness, and outward movement.

The Bladder Divergent channel flows to the heart region: this establishes a connection between these two organs and also strengthens the clinically important connection between Kidneys and Heart.

THE CLINICAL APPLICATION OF THE SIX PAIRS OF DIVERGENT CHANNELS

The Pericardium Divergent channel and the neck and head

Let us now discuss the clinical significance and application of the Divergent channels. One of the most important aspects of the Divergent channels in the clinic is their integration of Yin and Yang channels within each pair. The six pairs of Divergent channels are:

The Pericardium Divergent channel flows into the Triple Burner channel in the neck; this explains the effect of the Pericardium points (especially P-6 Neiguan) on the neck and head. I frequently use this point as a distal point for headaches from Liver-Yang rising.

The Gall Bladder Divergent channel and the Heart The Gall Bladder Divergent channel goes to the Heart: a connection between these two organs is not evident from any other channel. This explains the use of G.B.-40 Qiuxu for Heart patterns and especially for the pattern of Gall Bladder Qi Deficiency manifesting with timidity, fearfulness, insomnia and difficulty in making decisions: this pattern involves a deficiency of the Gall Bladder and of Heart-Qi.

The Pericardium Divergent channel and the throat Some Pericardium points are indicated for throat problems and this can be explained only by means of the Pericardium Divergent channel as the Pericardium Main channel does not go to the throat (e.g. P-5 Jianshu for loss of voice).

Upper Meeting points 1. Bladder/Kidneys BL-10 Tianzu G.B.-1 2. Gall Bladder/ Liver Tongziliao 3. Stomach/Spleen ST-1 Chengqi 4 . Small Intestine/ BL-1 Jingming Heart 5. Triple Burner/ T.B.-16 Pericardium Tianyou 6. Large L.I.-18 Futu Intestine/Lungs

Lower Meeting points BL-40 Weizhong Pubis (Ren-2 Qugu) Thigh Axilla None None

As we have seen, each pair has an Upper Meeting point and four pairs have also Lower Meeting points. These Meeting points are an important way in which we can treat the Divergent channels. What clinical situations and signs lead us to use the Divergent channels? As one of their most important functions is to strengthen the connection between a Yang and a Yin channel within each pair, the Divergent channels are treated particularly when there are overlapping clinical manifestations of a Yin and a Yang organ within a pair. For example, if a patient suffers from a Kidney-Yang deficiency with symptoms such as lower backache,

346

PART 5: DIVERGENT CHANNELS (JJNG BIE)

SUMMARY INTEGRATING AND CONNECTING THE INTERNAL ORGANS

• The Divergent channels integrate some channels with organs with which they are not connected t hrough the Main channels and this explains many connections we make in clinical practice. • Treating a Yang channel for a problem in a Yin channel/organ or vice versa: (LU-7 Lieque for problems of the Large Intestine channel on the face, or L.l.-11 Quchi for a fever from Wind-Heat in the Lung's Defensive-Qi portion) • Connection between Stomach and Heart: -treat the Stomach for heart problems such as palpitations, tachycardia or irregular heartbeat - mental-emotional effect of many Stomach points (e.g. ST-40 Fenglong or ST-25 Tianshu) • The Heart Divergent channel and the inner canthus of the eye • The Bladder divergent channel and the anus: BL-57 Chengshan and BL-58 Feiyang for haemorrhoids • The Bladder divergent channel and the heart region • The Pericardium Divergent channel and the neck and head: P-6 Neiguan for neckache and headache • The Gall Bladder Divergent channel and the Heart: G.B.-40 Qiuxu for Heart patterns and especially for the pattern of Gall Bladder Qi Deficiency manifesting with timidity, fearfulness, insomnia and difficulty in making decisions • The Pericardium Divergent channel and the throat: P-5 Jianshu for loss of voice • The Yang channels of the leg and the Heart: - All three Leg Yang Divergent channels (Bladder, Gall Bladder and Stomach) go to the heart. As the Small Intestine naturally connects w ith the Heart, four Yang channels flow through the Heart -The Qi of these Yang channels gives the Heart the Yang Qi that is necessary for its pumping action.

dizziness, tinnitus, feeling cold and frequent urination , then we treat only the Kidneys; but if the same patient, in addition, also suffers from urinary difficulty, pronounced urinary frequency and occasional urinary incontinence, then it is appropriate to treat both the Kidneys and the Bladder and the Divergent channels can help us achieve that. Please note that in this example, we considered 'frequent urination' as a symptom of Kidney-Yang deficiency whereas the other urinary symptoms (difficulty, incontinence) point us to a Bladder pattern. Therefore an important sign that leads us to use the Meeting points of the Divergent channels is the combinations of pathology of both the Yin and the Yang channel within a pair. Moreover, the pathways of the Divergent channels explain the energetic action of certain points that could not otherwise be explained by reference to the Main channels. For example, the Gall Bladder and Liver Divergent channels connect at the pubis and the Gall Bladder Divergent channel goes to G.B.-1; this explains the effect of Liver-channel points on headaches and eye problems. For example, the Upper Meeting point of the Lung and Large Intestine Divergent channels is L.I.-18 Futu (situated near the throat) and this reinforces the influence of the Lung channel on the throat area. Besides strengthening the connection between paired Yin and Yang channels, the Divergent channels, through their Upper Meeting points, have the other important function of balancing and regulating the flow of Qi to and from the head. As the Yin- Yang pairs of channels are connected also through the Connecting (Luo) points, what is the difference between the action of the Meeting points of the Divergent channels and the Connecting points? As they both connect Yin-Yang pairs of ch annels, how do they differ? In my opinion, the Connecting points connect Yin- Yang pairs of channels at a more superficial level

CLINICAL NOTE

The Connecting (Luo) points connect Yi n-Yang pairs of channels at a superficial level and in the limbs; the Meeting points of the Divergent channels connect the Yin- Yang pairs of channels at a deep level, in the Interior. Moreover, they also connect the Yin-Yang pairs of Internal Organs.

FUNCTIONS AND CLINICAL USE OF THE DIVERGENT CHANNELS

and in the limbs; in contrast, the Meeting points of the Divergent channels connect the Yin-Yang pairs of channels at a deep level, in the Interior. Moreover, they also connect the Yin-Yang pairs of Internal Organs. Let us now discuss some clinical applications of each pair of Divergent channels from both points of view, i.e. that of strengthening the connection between paired Yin and Yang channels and that of balancing Yin and Yang in the head and regulating the flow of Qi between the body and the head.

347

"!1--- - -BL-10 Upper Meeting point

Bladder and Kidneys (Fig. 22.1) The Bladder and Kidney Divergent channels perform an important role in strengthening the connection between these two channels. The two channels originate from the popliteal crease behind the knee in the region of BL-40 Weizhong. This is an added explanation of the action of this point in the treatment of lower backache: it activates not only the Bladder channel but also the Kidney channel. As chronic lower backache nearly always occurs against a background of Kidney deficiency, this point will simultaneously activate the Bladder channel and torrify the Kidney channel. Moreover, the Kidneys control the bones and therefore the spine and this point will strengthen that particular Kidney function. The Upper Meeting point BL-10 Tianzhu regulates the ascending and descending of the Qi of these two channels to and from the head also by its virtue of being a Window of Heaven point. If Kidney-Qi does not rise to the head and the Brain there will be poor memory and concentration, dizziness and depression. BL-10 Tianzhu can stimulate the rising of Kidney-Qi to the Brain. On the other hand, if there is Excess Yang in the Bladder channel (manifesting with headaches), BL-10 Tianzhu can stimulate the descending of Qi from the head. As the Upper and Lower Meeting points are both on the Bladder channel, these two points have a particularly strong effect; they communicate with each other to regulate the ascending and descending of Qi along the Bladder channel along the whole spine. These two points are an important way in which the Bladder and Kidneys communicate and in which the Bladder channel sustains the spine. These points can be used together to treat stiffness and pain of the occiput or pain in the popliteal fossa.

Fig. 22.1 Bladder and Kidney Divergent channels.

TREATMENT EXAMPLE A patient suffers from lower backache, dull occipital headaches, urinary frequency and diff iculty and a slight urinary incontinence. There is a definite Kidney def iciency. Use the following poi nts: -BL-10 Tianzhu and BL-40 Weizhong to t reat t he back and the Bladder and Kidney channels simultaneously - BL-23 Shenshu (Back-Transporting point of the Kidneys) and Ren-3 Zhongji (Front-Collecting point of the Bladder).

348

PART 5: DIVERGENT CHANNELS (JING 8/E)

Finally, as the Bladder Divergent channel flows through the heart, the Divergent channels of the Bladder and Kidneys also strengthen the communication between the Heart and Kidneys, which is of crucial clinical importance. As the Bladder channel enters the brain, the Kidney and Bladder Divergent channels strengthen the relationship between the Kidneys, Marrow and the Brain.

...._,~-'r---G.B.-1

Upper Meeting point

Gall Bladder and Liver (Fig. 22.2) If we consider the Upper Meeting point of these two Divergent channels (G.B.-I Tongziliao), we can see how the connection between these two channels allows the Liver channel to influence the head and the eyes. Although the Liver Main channel's internal pathway does reach the eyes and the top of the head, it does not 11ow to the lateral side of the head (where

TREATMENT EXAMPLE A woman suffers from typical headaches from Liver-Yang rising: the headaches are throbbing in nature and are accompanied by a feeling of distension of the head and irritability. The pulse is Wiry. The headaches occur on the lateral side of the head along the Gall Bladder channel and also in the eye. With the headaches, the patient experiences blurred vision and sees 'flashing lights'. In addition, this patient also suffers from hypochondria! distension (in the Ga ll Bladder channel's area) and excessive vaginal discharge. Use the following points: -G.B.-1 Tongziliao, Upper Meeting point, to treat the Gall Bladder and Liver channels simultaneously - Ren-2 Qugu, Lower Meeting point, to strengthen the relationship between the Gall Bladder and Liver channels and t reat the vaginal discharge -LIV-3 Taichong and G.B.-43 Xiaxi to subdue Liver-Yang (G.B.-43 as a distal point to affect the other end of the channel, i.e. the area of G.B.-1 and G.B.-5 Xuanlu) - T.B.-5 Waiguan and P-6 Neiguan to subdue Liver-Yang.

(l

- --+-Lower Meeting point

L Gall Bladder Divergent

L uver Divergent

Fig. 22.2 Gall Bladder and Liver Divergent channels.

the Gall Bladder channel flows). Therefore the connection between the Gall Bladder and Liver Divergent channels allows us to use points from the Liver channel to treat temporal headaches along the Gall Bladder channel. The regulation of the ascending and descending of Qi to and from the head is an important aspect of

FUNCTIONS AND CLINICAL USE OF TH E DIVERGENT CHANNELS

this pair of channels. When Excess Yang rises to the head, the person may develop headaches from LiverYang rising; through the point G.B.-1 Tongziliao, this couple of Divergent channels regulates Yin and Yang in the head. The connection between the Gall Bladder and Liver Divergent channels in the pubis explains the convergence of these two channels in the pathology of the genitalia especially when it is due to the infusing of Dampness.

Stomach and Spleen (Fig. 22.3) The pair of Divergent channels of Stomach and Spleen greatly strengthens the connection between these two organs and channels. In fact, the Stomach Divergent channel flows through the Spleen.

----!::::J---- ST·1 Upper Meeting point

349

TREATMENT EXAMPLE A patient suffers from a clear deficiency of both Stomach and Spleen, experiencing the following symptoms: general tiredness, a feeling of weakness of the limbs, poor digestion, a tendency to loose stools and a desire to lie down. The pulse is Weak. The feeling of weakness of the legs is very pronounced. Use the following points: -ST-31 Biguan and SP-12 Chongmen, both in the region of the thigh, which is the area of Lower Meeting of the Spleen and Stomach Divergent channels -ST-25 Tianshu and ST-36 Zusanli to tonify the Stomach and Spleen and strengthen the legs.

The connection between the two channels takes place in the thigh (Lower Meeting point) and in the face at the eyes (ST-1, Upper Meeting point). The Lower Meeting point explains the important effect of Stomach and Spleen points to strengthen the legs. Although the Lower Meeting point of the Stomach and Spleen Divergent channels is in the thigh, ST-30 Qichong is also a point where both Stomach and Spleen Divergent channels enter in the body cavity of the trunk: this, together with its being the point of the Sea of Food, explains the importance of this point in treating digestive problems from Stomach and Spleen disharmony. The Spleen Divergent channel strengthens the relationship of the Spleen channel with the tongue: hence the use of SP-3 Taibai for tongue problems.

Small Intestine and Heart (Fig. 22.4)

I-- -+-+--- - Stomach Divergent 1----\- - -Spleen Divergent

Lower Meeting point (thigh) Fig. 22.3 Stomach and Spleen Divergent channels.

The pair of Divergent channels of the Heart and Small Intestine has great clinical significance both in diagnosis and in treatment. The upper connection between these two channels is at BL-1 Jingming; this explains the influence of the Heart channel on the inner corner of the eye. In facial diagnosis, the connection of the symptom of redness of the inner canthus of the eye to the Heart channel is found in many books, old and new. Although both the Main and the Connecting channels of the Heart flow to the eye, it is only the

350

PART 5: DIVERGENT CHANNELS (J!NG 8/E)

TREATMENT EXAMPLE

( Fig. 22.4 Small Intestine and Heart Divergent channels.

Divergent channel that flows specifically to BL-1 Jingming. Therefore, the point BL-1 Jingming is a meeting point not only of the Small Intestine and Bladder (Greater Yang) but also of the Small Intestine and Heart by virtue of their Divergent channels. This means that this point regulates the balance of Yin and Yang in the eyes (Small Intestine and Bladder being Yang and Heart being Yin). 'Balancing Yin and Yang in the eyes' has repercussions on the actual eyes (redness, itching, pain) and on sleep. In fact, Excess of Yang in the eyes will cause insomnia while Excess of Yin causes sleepiness. The Lower Meeting point of these two Divergent channels is equally significant. The Divergent channels of the Heart and Small Intestine meet in the axilla area; the Heart Divergent channel diverges from the Heart Main channel in the axilla and goes to the heart itself to then join the Small Intestine Divergent

A man suffers from a feeling of constriction of t he chest that extends to the scapula in t he back and to the neck. The ECG is normal and no abnormality of the coronary arteries is suspected. He is under great stress both from work and from his personal life. He frequently suffers from severe neckache w ith difficulty in turn ing the neck. His digestion is poor and he suffers f rom borborygmi and abdominal distension. His pulse is Wiry. This constellation of symptoms is due to pathology of both Heart and Small Intestine channels; in terms of patterns, there is Qi stagnation in the Heart and Small Intestines. Use the following points: -HE-1 Jiquan to t reat the Lower Meeting area of the Heart and Small Intestine Divergent channels -BL-1 to treat the Upper Meeting point of these two Divergent channels. The use of the Lower and Upper Meeting points will stimulate the balance of Yin and Yang in the neck area to relieve the neckache and in the chest and scapula and the feeling of constriction of the chest -S.I.-1 Shaoze as a distal point to rel ieve the Qi stagnation in the Small Intestine channel -S.I.-7 Zhizhen, Connecting (Luo) point to relieve the Qi stagnation in the Small Intestine and Heart channels -Ren-4 Guanyuan, Front-Collecting point of the Small Intestine, to treat the Qi stagnation in the Small Intestine organ.

channel in the neck. This close connection between these two channels explains the radiation of heart pain to the scapula, upper back and neck. The Heart Divergent channel strengthens the connection between the Heart channel and the throat, hence the use of HE-5 Tongli or HE-8 Shaofu for problems of the throat and vocal cords (pharyngitis, laryngitis, etc.).

Triple Burner and Pericardium (Fig. 22.5) The Triple Burner and Pericardium Divergent channels do not have a Lower meeting point. Their Upper

FUNCTIONS AND CLINICAL USE OF THE DIVERGENT CHANNELS

351

TREATMENT EXAMPLE A woman suffers fro m ch ronic temporal headaches and a severe stiffness of the neck after a hysterectomy. She also experiences a feeling of tightness of the chest and insomnia. Use the following points: - T.B .-16 Tianyou, Upper Meeting point of t he Triple Burner and Pericardium channels to treat both channels; th is w ill t reat the headache and stiffness of the neck -P-6 Neiguan to open the chest.

This is an important way in which the Upper Meeting point of this pair of Divergent channels strengthens the relationship between the Triple Burner and Pericardium channels. Moreover, the Upper Meeting point has also the important function of balancing Yin and Yang in the head and regulating the ascending and descending of Qi to and from the head. For this reason, the Upper Meeting point T.B.-16 Tianyou can be used for LiverYang rising causing headaches, dizziness, tinnitus or ear problems. The convergence of the Pericardium with the Triple Burner channel in the area of T.B.-16 Tianyou explains the use of Pericardium points (such as P-6 Neiguan) for neck pain. As the Triple Burner Divergent channel goes to the vertex and as it is connected with the Pericardium Divergent channel, some Triple Burner points (e.g. T.B.-3 Zhongzhu) can be used to lift the spirits in depression.

Large Intestine and Lungs (Fig. 22.6) Fig. 22.5 Triple Burner and Pericardium Divergent channels.

Meeting point is T.B.-16 Tianyou, which is also a Window of Heaven point. The Upper Meeting point of these two channels has great clinical significance because it explains the definite effect of Pericardium points on the neck, ear and lateral side of the head. For example, I frequently use P-6 Neiguan for temporal headaches from LiverYang rising occurring on the Triple Burner channel.

The Divergent channels of the Large Intestine and Lungs do not have a Lower Meeting point. Their Upper Meeting point is L.I.-18 Futu, which is also a Window of Heaven point. This pair of Divergent channels strengthens the relationship between both the channels and the organs of Large Intestine and Lungs, as the Large Intestine Divergent channel flows through the lungs and the Lung Divergent channel flows through the large intestine.

352

PART 5: DIVERGENT CHANNELS (JING BIE)

..---'4~L.I. -18

Upper Meeting point To spine

l.l.-15

Large Intestine Divergent

Fig. 22.6 Large Intestine and Lung Divergent channels.

The close relationship between these two channels fostered by their Divergent channels explains the clinical use of Lung points to affect the neck, shoulders and face. Lu-7 Lieque, especially, affects the face, neck and shoulder. Both Large Intestine and Lung points are important to regulate the ascending and descending of Qi to and from the head, and this function is partly due to their Upper Meeting point L.I.-18 Futu. which is a Window

TREATMENT EXAMPLE A patient suffers from allergic rhinitis and asthma. He also experiences stiffness and pain of the shoulder. Use the following points: -L.I. -18 Futu, Upper Meeting point of the Large Intestine, to treat both the Lungs and Large Intestine in order to affect the asthma and the shoulder pain -LU-1 Zhongfu, Front-Collecting point of the Lungs, to treat the Lungs -LU-7 Lieque and L.l.-4 Hegu to promote the descending and diffusing of Lung-Qi; L.l.-4 will affect the Large Intestine channel but also the Lungs by way of the Divergent channel.

of Heaven point. As these two channels regulate the ascending and descending of Qi to and from the head, they can help to subdue rebellious Qi when it affects the face and head causing headaches. For this reason, LU-7 Lieque and L.I.-4 Hegu can both be used to help to subdue Liver-Yang rising.

NOTES 1. Wang Xue Tai 198 8 Great Treatise of Chinese Acupu ncture (Zhong Guo Zhen ]iu Da Qunn