Other Observations

Chills and Fever

When they appear together, chills and fever indicate exterior conditions.
If chills are stronger, it is a Wind-Cold disease
If fever is stronger, it is a Wind-Hot disease
Fever without chills indicates the disease has moved inwards
When the heat enters the stomach and intestines, there is continual fever that is worse in the evenings
If a fever gets worse during the night, the situation is grave.

A patient with a sever yin deficiency develops a low grade fever every day, or a feeling of heat in the soles and palms in the afternoons and evenings, which subsides after a heavy sweat.

Irregular periods of low fever with lassitude indicated deficient Qi.
Chills and coldness in the limbs are symptoms of deficient Yang of the Kidneys

If the back of the hand is hotter than the palm it is excessive  yang
If the palm is hotter than the back of the hand, it is deficient yin.

Perspiration

If an exterior disorder has no perspiration, then the excess is confined in the Protective Qi, which is expelling the excess.
If there is sweating but no lowering of the fever, this indicates the protective Qi is too weak to expel the excess.
If there is excess sweating during the day, or spontaneous sweating, it indicates Deficient Qi.
If there is heavy sweating at night signifies Yin excess.
Continuous sweating through the day producing cold, clammy skin is a bad prognostic sign.

Head, Sense organs and other Parts of the Body

Acute headaches are usually Exterior Excess
Chronic headaches are due to Internal factors.
Violent headaches are Excess.
Dull headaches are Deficient
Headaches increased by exposure to cold are from Wind Cold
Headaches increased by hot conditions are from hyperactive Liver Yang
If the head feels like it is in a vice, the cause is Dampness (pressure)
Frontal headaches are associated with yang Brightness (St and Li)
Headaches behind the hairline are associated with Greater Yang (Si and Bl)
Headaches at the top of the head are from Liver dysfunction.
Headaches with eye dysfunctions (auras) are from Liver dysfunction.

Three Kinds of Vertigo

Hyperactive Liver Yang, feels as though one is walking on an unsteady ship.
Wind and Phlegm causes all objects to be spinning around.
Insufficient Qi and Blood causes dizziness, blurring of the vision and ringing in the ears.

Pain/Uncomfortable

Pain can indicate either a local disorder or an channel disorder.
Pain that moves around is due to Wind or Stagnant Qi.
Pain that remains in one place is from Cold, dampness or congealed blood
Pain that feels better with pressure is Deficient
Pain that feels worse with pressure is Excess.
Dampness makes the body feel heavy, swollen and lethargic
Insufficient Blood and Qi causes soreness in the muscles and tendons.

Urine/Stools

Excess urine at night is Deficient Kidney Yang, which if severe, can lead to incotinence.
Sparse urine can be caused by heat drying up the fluids, or by Bladder Qi too weak to pass the urine.
Deficient Kidney can result in dribbling urine.

When heat penetrates the body and enters the Stomach and Intestines, the abdomen feels distended and painful, constipation results.
In deficient Yin where there is an absence of fluids, constipation occurs without feeling distension.


Massive and sudden diarrhea is an Excess condition.
Chronic diarrhea is deficient spleen
Frequent diarrhea with small stools each time and immediate feeling to evacuate again as in dysentery (tenesmus) is caused by damp heat in the small intestine.
Diarrhea with pain in the abdomen that diminishes after diarrhea is congestion of food.  This arises from a Spleen/Stomach disorder that affects the functions of transformation and transportation of food.
Diarrhea with pain that does not diminish with evacuation with emotional stress is usually an imbalance between the spleen and the liver.
Diarrhea every morning at dawn is caused by deficient spleen and kidney qi.  


Diet and Appetite


Not thirsty or desiring warm drinks indicates cold.
Thirsty or desire of cold drinks indicates heat.
Absence of thirst, or only slight thirst, or spitting out immediately after drinking indicates Dampness.  This indicates weak digestion as well.

A good appetite indicates that a disease is not serious.
Lack of appetite with a distended feeling after meals is either weak spleen or damp heat in the sanjiao.
Heat in the stomach can cause one to overeat and be constantly hungry.

Certain tastes in the mouth indicate conditions of the five phases

• Bitterness - heat
• Sweetness or blandness - dampness or weak spleen
• Lack of taste - congestion of food
• Sour - dysfunction of the liver

Chest and Abdomen

Generally the same as in the head.

Compression in the chest with shortness of breath is deficient Qi.

Swollen and painful chest and sides indicates dysfunction of the liver or gall bladder.

Distension in the abdomen relieved by belching or passing gas is from stagnation of either Qi or food.

Eyes and Ears

Eyes and liver generally go together.  

Red inflammed eyes are caused by hyperactive liver yang

Loss of vision with dry, dull eyes are deficient liver and kidney yin

Ears and kidney generally go together

Progressive loss of hearing or tinnitus is usually a weakness in the kidneys.

The lesser Yang paths of Gb and Sj travel around the ear.  Hot external disease often enter the body from these areas and cause loss of hearing.

Sleep

Insufficient Heart Blood can cause insufficient sleep, heavy dreaming and palpitations of the heart.

Deficient Heart Yin makes one irritable and difficult to fall asleep

Excessive sleep can be heat in the pericardium, phlegm obstructing the opening of the energy pathways to the heart, or general deficient yang.

Medical History

The history should be noted carefully, as this puts everything into perspective, and will often reveal a weakness in a given organ or yin or yang.  General lifestyle anomalies can be brought to light (diet habits, bowel habits etc) and suggestions can be made to help the general health of the patient.

Palpation

Pressing and touching areas to determine if they are painful, inflamed, swollen, hot or cold can help determine the nature of the disorder.

Swellings that are hot and painful are yang Heat.

Cold to the touch is dampness or yin.

Hard nodules are congealed blood

Nodules with elasticity and ill-defined borders are stagnant qi. 

 

Palpation at the acupuncture points of the mu-shu points can also determine which organs are in distress.  Palpation of these acupuncture points in an area can reveal a "collapsed" feeling, or tender to the touch.

The last form of palpation is pulse diagnosis, which needs it's own entry here.

Observations, Shen, Face and Tongue

Here are some of the things that are important to getting down to a root cause.

First thing is to "look the spirit over".  This is a combination of facial expression, muscle tone, posture, mode of speech and general appearance.  If the condition is not serious, he will be spirited, good complexion, clear eyes and speech, normal posture, quick to replying to questions.

If the disease is serious, the patient's face will be dark, shows little interest in what is going on, doesn't hold normal posture, frequently pauses in talking and will be dispirited.

When one fact like speech or posture suddenly seems to change for the better, without and corresponding improvement in the other features, it is a sign the disease has entered a critical phase, because it represents a major imbalance in the body.  It is particularly grave if a seriously ill patient becomes euphoric.

Certain types of people are prone to certain disorders.  Obese people tend to suffer from diseases like Phlegm and Dampness, while thin people tend to be yin deficient.

Changes in skin color are important, as they indicate a difficulty with a particular organ.

Pale complexion reflects a deficient or cold condition
Dusky and swollen indicates deficient Qi.
Pale and lusterless indicates insufficent blood.
Red indicates heart.  Pale red in the cheeks in the afternoon is deficient heart
Flushed face and red eyes indicates excessive heat.
Yellow color is from dampness and deficiency
Bright yellow-orange is Yang Jaundice from damp heat
Yellow-black especially under the eyes is Yin jaundice from deficient kidneys and congealed blood.

Tongue diagnosis involves looking at the shape, coating and body of the tongue.  While tongue diagnosis is a little more difficult these days with good dental hygiene, you can still glean much information from the tongue.  When you see a strange color, make sure you eliminate what the patient has recently eaten or drank, such as coffee, beets, tea, chocolate.

A healthy tongue is pinkish red, neither obese or too thin or pointed, slightly moist with no fur or a thin white coating and usually without crevices.  If a person has a tongue like this, their disease is likely to be mild.

Obese tongue with teeth indentations on the side indicates deficient qi or excess dampness.
White moist coating reflects deficient qi, while a greasy coating indicates dampness.
Thin and narrow tongue indicates either insufficient yin fluids or deficient qi and yin.
Red body of tongue, disorder is deficient yin alone.
Pale body of tongue, disorder is both qi and yin are weak.

Red eruptions on the tip or edges of the tongue indicate excess heat.
Red or purplish eruptions on the sides in the liver area indicated congealed blood, pain or liver not spreading qi properly.  This is often observed in women with menstrual disorders.

Cleavage in the tongue, either superficial or deep indicate the presence of heat and/or dryness.  In a very minority of cases, it is congenital and therefore, not significant.

The color of the tongue indicates the degree of heat in the body, and indicates the condition of the Qi and blood in the body.  A normal tongue is lighter.  If darker it is called red, if still darker is called deep red.  Sometimes the tongue has areas that are dark-blue or purple.

Pale tongue signifies deficient blood and qi.
Very pale, it may be a symptom of interior cold.
A red tongue indicates the presence of interior, deficient heat.
With excessive heat, the entire tongue is red.
With deficient heat, only the tip is colored.
Dark red, heat is deep in the body.
Deep red tongue with ulcers says Fire in the Heart
Purple or dark blue patches, blockage in the flow of qi or blood.
If the patches are localized, then the disorder is limited to that organ that the position on the tongue indicates.

A healthy tongue has a thin coating on it.
Too much moisture to cause a semi-transparent layer is a wet coating, dampness is present
Excessive dryness of the coating indicates insufficient fluids (one of the very first symptoms of it)
If you can see the tongue through the coating, it is a thin coating, indicates the excess is mild (usually damp, heat or cold)
If you cannot see the tongue through the coating it is a thick or greasy coating, and indicates the excess is severe dampness or indigestion.
If there is no coating at all on the tongue, it is considered bare or peeled, indicates the yin fluids are seriously depleted or the stomach Qi is very weak.

The color of the coating determines the nature of the disease.  It is normally thin and white.  If the tongue looks like this, the disease is not serious, or is still at the Exterior stage.
White, wet indicates cold.
White, dry indicates the cold excess is transforming into heat.
Thick, greasy white coating indicates phlegm or dampness.
Yellow coating indicates Heat.

Other observations:

If the head hair is dry and thinning, indicates deficient kidney qi or weak blood.
The colors and moisture of the lips are similar to the body of the tongue.
If the corners of the lips do not close firmly, and the philtrum is shrunken, the Qi is close to exhaustion and the disease is probably terminal.
Drooling saliva is due to either Deficient spleen or Heat in the stomach.
Red swollen or bleeding gums are caused by stomach fire.
Pale swollen gums and loose teeth indicate deficient kidneys.

Breathing
In deficient diseases, the breathing is shallow and soft, and difficulty inhaling.
In excess diseases, the breathing is rough and heavy, with forceful exhale.
A cough that produces gurgling sounds in the throat is due to damp or phlegm
A dry hacking cough is dry heat in the lungs.

Alopathic Method

In Western Diagnosis, the logical order of proceedings is:

1. Medical History
2. Clinical examinations, including
   Inspection
   Palpation
   Percussion
   Ausculation
   Local Examination
   General Examination
3. Simple tests on urine, blood and stools are carried out as indicated
4. When the diagnosis is still not clear, more complicated tests such as x-rays, scanning, CT scans, etc are carried out
5. If the diagnosis is still not clear, more aggressive procedures, such as biopsy, laparotomy and surgical exploration are carried out
6. Finally, in event of death occuring without a diagnosis, the autopsy table is the last court of appeal.  A diagnosis can still be made, even though the patient is dead!

In TCM, the approach is a bit more holistic. 

First, the history is deferred while the patient gets a chance to get more familiar with the surroundings, as they are already anxious about their condition, and it is more difficult to share the complete story immediately.  Time is taken to establish some rapport and empathy with each other.

Mostly, this time allows the physician time to observe the patient as a whole, instead of directing attention narrowly to the part of the body that is giving symptoms.

Thus, inspection is the first procedure, to observe the body as a whole, total person.  

In my clinic, I spend a good 30-45 minutes with each patient, getting to know them, and in doing so, I learn much about them, their general disposition, what makes them tick, and hopefully, gaining that important measure of rapport and empathy.  I'm a big fan of humor to break the ice, and I found that once it's broken, patients will tell me things they have never told other practitioners.  I find it all extremely helpful in arriving at a selection of points that will benefit them the most.

How Healing Really Works (any kind of healing)

When someone who is sick goes to see the physician, either traditional or Western trained, the patient presents the practitioner with a litany of symptoms.  After examining the patient, it is now the physicians responsibility to diagnose the disorder and to administer the specific therapy.

Ideally, the specific therapy is administered with a minimum of side effects, as the cure will be that much more effective.  If side effects turn up, they usually set up a vicious circle complicating the initial picture, and making it still more difficult to diagnose, which can often lead to errors in diagnosis and therefore in treatment.

While it is the physicians' aim to cure the patient, he/she should do so in such a way that minimizes or avoids them altogether, as unwanted side effects are good for no one.

While there are many methods of therapy, such as drugs, herbs, acupuncture, homeopathic remedies, naturopathic remedies, chiropractic, manipulation, massage, surgery and so on, they each have their sphere of influence and range of usefulness.

When looking at all the above methods, it is clear that acupuncture is the least damaging to the human body.  In this light, it should be the first line of treatment in most disorders.  The use of acupuncture does not exclude any of the other modalities, and other modalities can easily be combined with it.  In my clinic, we often employ massage therapy, vitamins and supplements as well as lifestyle and dietary advice to achieve the maximum effect in the shortest period of time.

As far as the patient is concerned, it must be realized that the patient is by and large not interested in the rationale for the therapy itself.  His only concern is to get better!

It is also an error to conclude that a Western trained doctor achieves his/her success entirely through the application of his/her knowledge.  The doctor succeeds because the doctor himself is a therapeutic agent!  The patient sees him as a healer, and the physician, consciously or unconsciously, assumes this role that the patient has cast for him.

Thus, the healer is the best drug!  In 35% of all patients, they get better or have reduction in symptoms, regardless of the therapy cast their way.  This is known as placebo effect.  The simple act of asking for help with one's symptoms can often result in a cure!

While this may seem irrational on the part of our Western trained minds, it is true nonetheless that the healer is the most potent factor in the "therapy", whatever that therapy may be.  The practitioner is an indispensable element in the healer/patient relationship, with great therapeutic potential.

Thus, in the case of acupuncture, it is not the needle, but the man or woman behind the needle that initiates the cure.

Four Traditional Laws of Acupuncture

They are:

1. Mother-Son Law
2. Noon-Midnight Law (or Midday-Midnight Law)
3. Husband-Wife Law
4. Theory of Five Elements

The first 3 laws are a consequence of the circadian rhythm circulation, which states that for ever 2 hour period, starting at 3am with the lung, there is one organ in the system that is the most active.  Here is the circulation of the body:

Lu-Li-St-Sp-H-Si-Ub-K-P-Sj-Gb-Liv then back to Lu.

The mother-son law recognizes this direction of energy flow, and places significance on symptoms that get worse at particular times of the day.  This suggests that there is difficulty in handing off the energy from one organ system to another.  If the energy is blocked or hindered from flowing properly, an abnormal surplus or deficiency can result.  This affects not only that particular channel or organ, but also the channel or organs which precede and follow it.  Now, disharmony of the entire organism is caused, and disease manifests.

In the case of an insufficiency of activity of an organ, then it can be strengthened by stimulating it's Son point so that it receives more energy from it's mother organ.

There are two sets of mother-son points, as there is one set for 5-element theory and one set for Organ Clock theory.  In 5 element theory, the mother-son points follow the generating cycle, or the Shen cycle.

The Noon-Midnight Law, or Midday-Midnight Law (Tsu Wu)

This law is based on the Organ Clock.  In this case, each organ has a 2 hour period where it is the most active.  Thus, if you stimulate the organ's Horary point (Identical with each organ's own element point, such as, Lu, use metal point), good therapeutic results occur.

The points are as follows (to be memorized later in chart form and dance form)

Lu8, Li1, St36, Sp3, H8, Si5, Ub66, K10, P8, Sj6, Gb41, Liv1

The Horary points are used during the appropriate period of the Organ Clock.  Thus, when treating a lung disorder, using Lu8 between 3am and 5am is a good choice.  If the energy imbalance stems from deficiency, needling this point near the early part of this period using Bu method, or tonification method is appropriate.  If it is from excess, needling near the end of the time with Xu or reducing method is preferred.

Treatment according to Organ Clock also can correct an imbalance of an organ or channel diametrically opposite to it in the Organ Clock diagram (difficult to see in text form...).  For instance, using Ub66 at 3pm will have the opposite therapeutic influence on Lung, which starts 12 hours later at 3am.

Even when using points other than the Horary points, particularly when balancing energy is being carried out, puncturing according to Organ Clock may increase effectiveness.

It has been established that many organisms have built in biological clocks that dictate many things about their existence.  Migration of birds, mating season, moulting season, and so on are just a few examples of this.  It seems that in the application of acupuncture, the glands and other organs are stimulated to reinforce this rhythm and promote healing.

The Husband-Wife Law

While the name and it's implications may be a tad on the politically incorrect side, the Husband Wife law describes the relationship that the 12 pulses (radial pulses, 3 on each side at each deep and superficial levels) have to one another.  In TCM, the left side of the body is considered to have dominance over the right side of the body.  Thus, all organs in the left wrist pulse are considered to be dominant or "husband" in relation to the organs on the right side, the submissive organs or "wife" organs. 

See how this definition can get you into trouble?  Placate them by saying "Women are always in the right!"

Good luck with that...

While pulse diagnosis is a central pillar in TCM, it is also the most elusive, and takes the greatest amount of time to master.  Many authors from ancient to modern have attempted to describe how the pulses are supposed to feel, made attempts to quantify and measure each of these and as yet, there is still no true standard.  This is something that can only be taught from master to student, and only mastered after a great deal of time spent on the subject, feeling many thousands of pulses.

As it stands, pulse diagnosis completely defies any knowledge of anatomy or physiology we currently possess.  And yet, somehow, it is still relevant and useful when treating people!  Pulse diagnosis will be covered in another post.

The Main Energy Circulations

The Qi of the body circulates in many channels.  It is not possible to document all of them because they are so numerous and complex, that the ear, nose, hand, foot are each self-contained systems of acupuncture!  Phenomena like iridology and reflexology also demonstrate this.

It is amazing to consider that the traditional chinese physician was unaware of the nervous system as we now know it, and their postulation of the channel system must be regarded as a brilliant attempt to systematize the clinical inter-relationships of the known functions of the body!

The main channels that must be considered are:

12 Paired (Regular) channels

8 Extraordinary channels

12 Luo-Connecting channels which join each yin/yang pair of organs, the points that move energy from Yuan source point to the Luo connecting point on the partner channel.

15 Luo channels which also join the paired channels at the Luo connecting points.  From these points they interact with various parts of the body, such as Sp4 travelling up the leg to connect to the intestines and stomach.  This is why this point is useful for diarrhea.

12 Divergent channels which branch off from each of the 12 paired channels, travel through certain important tissues and eventually connect with the internal organ related to the channel from where it started, and with it's coupled organ.

12 Muscle-Tendon channels which start at the Jing-Well points of the paired channels.  These carry mainly yang energy, the influence of which explains the effect of the Jing Well points to use this Yang energy when needed in acute emergencies.  They form a complex capillary network.

Clinical Manifestations in each of the 12 regular channels

This is strong, useful clinic stuff.  Not to mention completely testable on the exam!

Lu - Hand Taiyin:

• Cough
• asthma
• hemoptysis
• congested and sore throat
• sensation of fullness in the chest
• pain in the supraclavicular fossa, shoulder, back and lateral boarder of the anterior aspect of the arm

Li - Hand Yangming

• Epistaxis
• Watery nasal discharge
• toothache
• congested and sore throat
• borborygmus
• diarrhea
• dysentery
• pain in the neck
• Pain in the anterior part of the shoulder
• Pain in the anterior border of the extensor aspect of the upper limb

St - Foot Yangming

• Borborygmus
• abdominal distension
• edema
• epigastric pain
• vomiting
• feeling of hunger
• epistaxis
• deviation of the eyes and mouth
• congested and sore throat
• fever
• mental disturbances
• pain in the chest
• pain in the abdomen
• pain in the lateral aspect of the lower limbs

Sp Foot Taiyin

• Belching
• vomiting
• epigastric pain
• abdominal distension
• loose stools
• jaundice
• sluggishness and general malaise
• stiffness and pain at the root of the tongue and mouth
• swelling and coldness in the medial aspect of the thigh and knee

H Hand Shaoyin

• Cardialgia (actually heartburn)
• palpitation
• hypochondric pain
• Insomnia
• night sweating
• dryness of the throat
• thirst
• pain in the medial aspect of the upper arm
• feverishness in the palms (5-palm heat)

Si Hand Taiyang

• Deafness
• yellow sclera
• sore throat
• swelling of the cheek
• distension and pain in the lower abdomen
• frequent urination
• pain along the posterior boarder of the lateral aspect of the shoulder and arm

Ub Foot Taiyang

• Retention of urine
• enuresis
• mental disturbances
• malaria
• Ophthalmoparesis
• Lacrimation when exposed to wind
• nasal obstruction
• rhinitis
• epistaxis
• headache
• pain in the nape of the neck
• pain in the upper and lower back
• pain in the buttocks
• pain in the posterior aspect of the legs

K Foot Shaoyin

• Enuresis
• frequent urination
• nocturnal emission
• impotence
• irregular menstruation
• asthma
• hemoptysis
• dryness of the tongue
• congested and sore throat
• edema
• lumbago
• pain along the spinal column
• pain in the medial aspect of the thigh
• weakness of the lower limbs
• feverish sensation in the soles

P Hand Jueyin

• Cardialgia (heartburn)
• palpitation
• mental restlessness
• stifling feeling in the chest
• flushed face
• swelling of the axilla
• mental disturbances
• spasm of the upper limbs
• feverishness in the palms

Sj Hand Shaoyang

• Abdominal distension
• edema
• enuresis
• tinnitus
• pain in the outer canthus
• swelling of the cheeks
• congested and sore throat
• pain in the retroauricular region
• pain in the shoulder
• Pain in the lateral aspect of the arm and elbow

Gb  Foot Shaoyang

• Headache
• pain in the outer canthus
• pain in the jaw
• blurring of the vision
• bitter taste in the mouth
• swelling of the axilla
• pain along the lateral aspect of the chest
• pain in the hypochondrium
• pain in the thigh and lower limbs

Liv Foot Jueyin

• low back pain
• fullness of the chest
• pain in the lower abdomen
• hernia
• vertical headache
• dryness of the throat
• hiccup
• enuresis
• dysuria
• mental disturbances

Manifestations of the Eight Extra-ordinary channels

Du Channel

• Stiffness and pain along the spinal column
• opisthotonus (tetanus)
• headache

Ren Channel

• Leukorrhea
• Irregular menstruation
• hernia
• enuresis
• retention of urine
• pain in the epigastric region
• pain in the lower abdomen

Chong Channel

• Colic
• Pain in the abdomen

Dai Channel

• Abdominal pain
• Weakness and pain in the lumbar region
• leukorrhea

Yangqiao Channel

• Epilepsy
• Insomnia

Yinqiao Channel

• Hypersomnia

Yangwei Channel

• Chills and fever

Yinwei

• Cardialgia or heartburn

Descriptions of each of the extra channels will follow at some point...

Theory Time

I think it's prudent to discuss the topics with which I am not as familiar with or don't use in daily clinic that are probably going to be tested.  Theories like 5 element theory are best memorized with a chart which I can't reproduce here in the blog, but I've got a good one that I put together for an acupressure course I wrote.  

What I really need to get into are the theories of point selection with regards to the TCM syndromes, but they will have to wait for a while yet.

The Great Law of Zang-Fu.

Each of the organs has it's main responsibilities in the body, or an Official Function.  In TCM, they actually came up with political figures to go with each organ!  So the next time you vote, keep some of these in mind:

Heart:  Supreme Controller or Emperor, concerned with circulation of blood and mental activity

Small Intestine:  The separator of the pure and impure (sounds like a judge to me), concerned with separation of the essence from food and transport of waste to the large intestine

Pericardium:  The protector of the Emperor, concerned with circulation of blood and mental activity

SanJiao:  The controller of temperature (and internal environment), maintains homeostasis of the body

Liver:  The official for judgement and planning:  concerned with bile secretion and transport, regulation, storage and transport of blood.

Gall Bladder:  The official for decision making, storage of bile, mental activity

Lung:  Receiver of Qi from the heavens, respiration

Large Intestine: The official for draining the dregs, excretion of wastes

Stomach:  The official for rotting and ripening (can I have that job?), ingestion, digestion and transport of food and water

Spleen:  The official for transport and distribution, digestion, water metabolism, circulation of blood, immunity

Kidney:  The controller of the storage of vital energy, regulation of blood pressure, growth of bone, cartilage, teeth, nails, head hair.  Also the promotion of new life as an extension of the genital functions.

Urinary Bladder:  The controller of water, water balance and genital functions

Each of the paired organs is responsible for a set of tissues and sense organs:

Lu/Li, skin, body hair, nose, check skin for whiteness and disorder

H/P/Si/Sj, brain, blood vessels, displays on the tongue, mouth red is imbalance color

Sp/St, soft tissues, four limbs, mouth, check lips for yellow or brown

Liv/Gb, muscles/tendons, eyes, nails show condition, look for green/blue colors for imbalance K/Ub, bone, cartilage, nails, teeth, head hair, opens to ears, inside of forearm for black!

For each organ, there is also a major emotion attached, a sound of the voice and a fluid

Lu/Li, Sadness, sobbing, mucus

H/P/Si/Sj, Joy, laughing, sweat

Sp/St, Anxiety, singing, lymph

Liv/Gb, Anger, shouting, tears

K/Ub, fear, groaning, saliva


So if someone comes into the clinic with a really loud voice, I know that their liver is out of balance.  

Extra Ordinary Points

In addition to the points on the channels, there are numerous points not on the channels that have found their place in Chinese medicine.  Some of these are located on the channels, but away from established points of those channels.

Here's a summary of the good ones!

Ex1  On the ridge of the nose, midway between the medial ends of the eyebrows.  Rhinitis, headache, eye diseases, endocrine disorders.  Some believe that this point controls pituitary functions and improves extra-sensory perception!

Ex2  Extend the curved lines of the eyebrow and lower eyelid outwards, the point lies where these two lines cross.  Indicated for headache, migraine, facial paralysis, trigeminal neuralagia.

Ex3  At the midpoint of the eyebrow, directly above the iris.  Frontal sinus, eye disorders and facial paralysis.  This point is usually punctured through and through with Gb14, but this is already a sensitive spot.

Ex4, Dangerous point.  At the junction of the lateral fourth and medial three fourths of the infra orbital boarder.  Indicated for myopia, optic nerve disorders, glaucoma and other eye disorders.

Ex5, In the depression 1 cun lateral to Ren24 on the mental foramen.  Facial paralysis, trigeminal neuralgia, lower toothache.

Ex6 Sishencong (means, the four intelligences).  1 cun each N, S, E and W of Du20.  Powerful sedative, excellent for headache, apoplexy and epilepsy.

Ex7  1 cun posterior to Sj17, it lies in the straight line that connects Sj17 to Gb20.  Good for eyes and ears.

Ex8  Anmian I and Ex9, Anmian II.  These are used together to treat insomnia.

Ex10, Jinjin and Yuye.  On the sublingual veins on either side of the root of the tongue.  With the tongue rolled upwards, prick for bleeding.  Again, try and explain that to your western minded patient...

Ex17, 0.5 cun lateral to Du14.  This is also one of the Ex21 points, but these are specific to sooth asthma.

Ex20, 2.0 cun directly above the coccyx.  Epilepsy, muscular relaxation together with Du6 electrically stimulated.

A word on electrical stimulation.  I've had many patients come to me from other acupuncturists, and they have almost all universally been uncomfortable with the concept of electrical stimulation of acupuncture points.  They don't like to be "hooked up like a car battery" and have found the sensation unpleasant.  Most do report that they felt a bit better afterwards, but also sited it as a reason why they would not return for more treatments.

Ex21.  This is a series of 28 pairs of points situated 0.5 cun lateral to each of the dorsal spines of the spinal cord, from the 1st cervical to the 4th sacral vertebra.  Excellent for pain along the spine, and spinal related disorders.  I've used this series of points with piercing to great effect.

Ex28  On the dorsum of the hand, on the webs between the 5 fingers.  Excellent for disorders of the hands and fingers, rheumatoid arthritis and polyneuropathy.

Ex30, 10 points.  0.1 cun anterior to the apex of the nail of each finger.  Same as the Jing Wells, prick to cause bleeding with 3 edge or filiform needle.  Same as Jing Wells, these are for acute emergencies such as shock, coma, heat stroke, apoplexy, fever.

Ex31,  On the midpoint of the upper boarder of the patella.  Knee problems.

Ex32,  In the depression on the medial side of the ligamentum patellae, level with St35.  These two points, together with Ex31 are excellent for correcting knee problems.

Ex33,  Special alarm point for the vermiform appendix.  It's 2 cun south of St36 on the stomach channel.  Good for appendicitis and for post operative pain after appendicectomy.

Ex35,  Distal alarm point for the gall bladder channel.  1.0 cun below Gb34 on the gall bladder channel.

Ex36  Eight points, on the dorsum of the foot, .5 cun proximal to the borders of the webs between the 5 toes, 4 on each foot.  St44, Liv2 and Gb43 are three of these points, and are needled the same way.  Obviously, these points are good for anything foot related.  Arthritis of the toes, numbness of the foot and toes, polyneuropathy.

Well.  That's the lot of them.  There's another 100 points in the ear which won't be discussed, as the important ones I already use.  Other than that, using Ah Shi points where no acupuncture point exists but pain does, is very effective.

Ren (and Stimpy)

No, I'm afraid that our beloved cartoon cat and dog will NOT be participating in todays discussion.  Today, we have the last of the regular channels, a Yin channel that runs up the center of the body, from the anus to below the mouth, also known as the "conception vessel".  The Ren channel is closely linked to the Du channel, and is similar in that there is no specific internal organ to which it relates.  However, like the Du channel, the Ren channel has influence over all of the Yin channels in the body, where Du influences Yang.

The Ren channel contains many alarm points, and is commonly used to treat the internal organs.

It has one Luo connecting point, that of Ren 15 (Jiuwei) that connects it to the Du channel.  Together with Du1, the change from polarity of Yin to Yang and vice versa occurs here.

The energy circulation of both the Ren and Du channels travels up the exterior of the body from the anus and enters the mouth, where it travels back down to the anus.  As they pass the other organs and channels, they help balance the 6 sets of coupled internal organs.  A complete energy cycle takes 24 hours.

Here we go with common points...

Ren1  Huiyin. This is in the center of the perineum, and is the subject of my post "The do not disturb Sticky".  While officially used for hemorrhoids, it also serves to send qi upwards, which can help with prolapsed organs and put them back into position.

Trust me, if someone jabbed you in this point, you'd feel the energy go up!

Ren2  Immediately above the midpoint of the superior boarder of the pubic symphysis.  Indicated for, you guessed it, genitourinary disorders!  Also good for

• Incontinence and retention of urine, chronic inflammation, nocturnal enuresis in children
• Impotence, spermatorrhea, and premature ejaculation.
• Menstrual disorders

Ren3  Alarm point for Urinary Bladder.  4 cun below the umbilicus.  Indicated for the same as Ren2

Ren4  Alarm point for Small Intestine.  3 cun below the umbilicus.  Same for Ren2 plus diarrhea.

Ren5, Alarm point for Sanjiao.  Indicated for edema and ascites, lipodystrophy and Panniculitis

Note:  A very effective combination for edema and ascites is Ren5, Ren9 Sp9 and Ub20.  There is also an edema point in the ear.

Ren6,  Tonification point, good when used with St36 and Sp6 for chronic fatigue and hypotension.  Indicated for Neurasthenia. 

Ren8.  Forbidden point for acupuncture, it is the center of the umbilicus.  It is used only as a landmark to located other acupuncture points.  Moxibustion at this point is useful to tonify and for yin disorders like chronic diarrhea.

Ren9, 1 cun above the umbilicus, specific point for edema and ascites.

Ren12, Alarm point for stomach.  Influential point for Fu organs (hollow or Yang).  Located midway between the tip of the xyphoid process and umbilicus.  Indicated for peptic ulcer, abdominal distension, flatulence (what would Freud say?) dyspepsia, nausea and vomiting.

Ren17, Influential point for the respiratory system, alarm point for the pericardium.  On the sternum, between the two nipples, level with the 4th intercostal space.  Indicated for heart disease, bronchial asthma and other lung disorders, breast disorders.

Ren22, Tiantu, dangerous point!  This is the best point for treating and acute attack of bronchial asthma or hiccup.  Treat it as a forbidden point until you gain enough experience!  

Ren23, On the midline of the neck, below the chin, midway between the adam's apple and the lower boarder of the mandible.  I use this one frequently for sore throats and such.  Also indicated for Aphasia, mutism, dysarthria, sudden loss of speech, dysphagia, speech difficulties following paralytic strokes, stammering, excessive salivation, pharyngitis, laryngitis, Pseudobulbar palsy, speech disorders from parkinson's.

Ren24, in the middle of the mental labial groove, in the depression between the point of the chin and the midpoint of the lower lip.  Indicated for facial paralysis, trigeminal neuralgia, toothache of the lower incissors, swelling of the gums, excessive salivation.  It is a good anesthetic point for tooth extraction.

Du Channel

This is one of the 8 extraordinary channels, and along with the Ren channel that runs up the front of the body, these two meridians are not paired left and right.  Together with the 12 paired channels, these are known as the 14 regular channels.  This is a Yang polarity, and as such, exerts great influence among the yang channels of the body.  The word Du in Chinese means, "The Governor".

There is only one connection with it's paired channel, the Ren channel, and that is at Du1.

Clinically, the Du channel is used to treat

• Anorectal disorders, low backache
• Immune disorders
• Infective disorders
• Mental and neurological disorders, deaf-mutism
• Oral disorders.

Because this channel runs over the spinal cord and the brain, it's functions are closely linked to the functions of the central nervous system.  Many authorities state that the Internal Organ which relates to the Du channel is the Extraordinary Organ, the Brain.

Common Points

Du1  Luo connecting point.  Midway between the tip of the coccyx and the anus.  I'll never needle this point.  I don't care how well it's indicated, I'm not needling it.  But, seeing as it's the Luo connecting point, I guess I'd better learn what it's about...  Wow, surprise surprise, it's good for Hemorrhoids!  Who knew?  Rectal prolapse.  Boy, if I had a nickle each time someone came to the clinic complaining of that one...  Oh, here's a good one, anal fissures and pruritusof the anus.  Also good for coccydynia.  

Bloody hell, please don't send people to me with these conditions!

Du3  Now this one is more my style, located where most women put their "tramp stamps".  On the midline, level with the upper boarder of the iliac crests.  Good for low backache, genitourinary disorders and impotence.  Is anyone else getting the fixation over genitourinary disorders here?  Freud would have a field day with this!

Du4  This one is between the 2nd and 3rd lumbar vertebra on the midline.  Mingmen.  Good for, you guessed it, low back ache!  Oh, and genitourinary disorders...  With so many genitourinary disorder points, which ones do  you choose???  ARRRRGGGGG!

Du6  On the midline, between the 11th and 12th thoracic vertebra.  This one is a bit more useful.  Hemorrhoids, epilepsy.  This also causes muscle relaxation in most spasmic states.  It is also used for surgery together with Du or Ex20 during abdominal surgery, both electrically stimulated.

Du11,  Shendao.  another Shen point, this one is specific for amnesia and loss of memory.  it's between the 5th and 6th thoracic vertebra.  

Du14, Dazhui.  Now this point, THIS point is good!  

• Mental disorders, epilepsy, convulsions in children, headache, migraine
• Local disorders, stiff neck, cervical spondylosis, torticollis, sprain of cervical muscles, hypotonia of the neck muscles
• Frozen shoulder with pain radiating to the back of the chest, paralysis of the upper limbs
• Pain along the thoracic (dorsal) spine, ankylosing spondylitis
• Lung disorders, bronchial asthma, bronchitis, cough, whooping cough.
• Ecxema and other skin disorders
• Infective and immune disorders, such as cold, influenza, fevers, malaria and infections

This is one of the most potent immune enhancing acupuncture points.  In very high fever, strong stimulation of the needle can help bring it down quickly, often in a matter of minutes.  It is especially useful in children who are toxic and cannot handle drugs.

Du15  Yamen, DANGEROUS POINT!  Forbidden, as far as I'm concerned.  While indicated for deaf-mutism, aphasia, aphonia, speech difficulties following paralytic strokes.  Instruct the patient to lean slightly forward while needling, and do not stimulate or exceed 1 cun depth.  Many acupuncture authorities suggest not retaining the needle here at all, and should any discomfort be felt, immediate removal is necessary.  You are right over top of the medulla oblongata.

Du16  Fengfu, DANGEROUS POINT!  Also forbidden.  This one is indicated for the common cold and mental disorders, and headaches.  Finger pressure here is fine.  This is one of the most vulnerable acupuncture points on the body, don't fuck with it.

Du20,  Baihui.  Now this is a point I can get behind.  In fact, I use it in 99% of all treatments.  It's translation is the "meeting of 100 points".  This point controls all other points and channels in the body.  I use it for it's sedation effects, and it's amplification effects, as it improves the response of every other acupuncture point that you chose to use. 

•  It is the very best tranquilizing and sedative point on the body.  It treats all psychiatric and neurological disorders, like schizophrenia, epilepsy, insomnia, parkinsonism, neurasthenia and all conditions where psychogenic conditions might exist, including fibromyalgia and bronchial asthma, impotence, ecxema, and every other disorder that stress makes worse.  Therefore, it treats EVERYTHING!
• Good for headaches, especially vertical headaches
• apoplexy and other cerebral vascular disorders (in their early stages)
• Loss of memory
• Distal point for anal problems
• Falling out of head hair due to pathological causes

As this is a powerful sedative and tranquilizing point, and that psychogenic factors are present in almost all diseases (even getting hit by a bus), the use of this point on a general basis with other specific points is recommended for good therapeutic results.

This point acts as "governor", having a coordinating effect when points are used on a number of different channels.

This is an excellent point to start therapy with, because the patient cannot see it and it is relatively painless.

Du23  1.0 cun above the anterior hairline, it's good for nasal obstruction and epistaxis.

Du25  At the tip of the nose, it's good for nasal obstruction and epistaxis.

Du26  At the junction of the upper third and lower two thirds of the philtrum of the upper lip, in the midline.

• This can be used as a Jing Well point for acute emergencies, such as fainting, epileptic fits, convulsions, shock, heat stroke, hysterical attack
• Acute low back ache, as a distal point.  Have the person bend forwards and backwards slightly while fingerpressure on this point can quickly relieve the backache.
• Facial paralysis, painful disorders and swelling of the face
• This point in TCM is known as the "point of reanimation" as it is used for sudden fainting
• In treatment of emergency situations, the needle may be manipulated and removed as soon as the patient can feel it.  It is not necessary to retain it longer than this
• Acupressure applied with the nail of the index finger is found to be equally effective.
• This point is the meeting point of three yang channels.

Du28  Between the gum and upper lip in the frenulum of the upper lip.  Good for pain and swelling of the gums and other oral diseases, used as a distal point for Hemorrhoids.  This point can be bled for effect instead of needled.  Explain THAT to your western medicine indoctrinated patient...

Liver... What the heck does it do anyway?

Well here's what it does in TCM.  It's got 14 points, it's a Yin channel and organ, and it originates at the medial corner of the nail bed on the big toe and runs over the dorsum of the foot, along the medial aspect of the leg and the medial side of the knee.  Then, it ascends along the medial aspect of the thigh, and reaches the inguinal region, and from here it goes to the tip of the 11th rib and runs anteriorly along the costal (rib cage) boarder to it's last point between the 6th and 7th ribs on the nipple line.  The deep branch arises from the channel in the abdomen and then runs along the stomach to enter the organs liver and gall bladder.  From the liver a branch travels upwards to connect with the eyes.  From the eyes a branch communicates with the Du channel at the vertex of the scalp, after traversing the brain.

It communicates with the gall bladder at Liv3 Yuan source and Liv5, Luo-connecting point.

In clinic, the points on the channel can treat disorders of the liver itself, and disorders to areas connected to it's deep branches, such as the eyes and brain.

The points on the leg are used to treat genitourinary disorders (just like every other point on the legs) and diseases along the channel.  Muscles and tendons are connected to the tissues of the liver, so muscles and tendons throughout the body can be treated with the liver channel.

The points on the trunk of the body are used for liver, gall bladder and spleen disorders, and pain in the flanks of the body.

Headaches and mental disorders are treated using Liv3.

Commonly used points

Liv3  Taichong.  2 cun proximal to the margin of the web of the 1st and 2nd toes.  Indicated for eye diseases, hypertension and headaches. This is a good homeostatic point, and is most effective at treating high blood pressure.  However, caution must be use as this point can cause the blood pressure to drop suddenly.  Make sure the patient is lying down if you are going to use this point, or else you'll be picking them off of the floor.  Acupuncture usually causes the body to move towards homeostasis, but this point can overshoot it!

Liv6  Xi-Cleft point.  Special Alarm point for the liver.  This is in the transverse crease of the knee joint, at the medial boarder of the semimembranosus tendon.  This is a specific point for impotence, but is a good local point for the knee too.

Liv13, Influential point for the Zang organs, Alarm point for the Spleen.  Located at the end of the 11th rib, good for liver and spleen disorders.

Liv14,  Dangerous point, alarm point for the liver.  Vertically below the nipple between the 6th and 7th ribs.  Good for hepatitis and chest pain.

Other useful points (academic, mostly)

Liv1  Jing well, wood
Liv2  Fire
Liv3  Yuan source, earth
Liv4  Metal
Liv5  Luo connecting
Liv6  Xi-Cleft
Liv8  Water
Liv13  Alarm for Spleen, Influential point for all Zang organs (Yin organs)
Liv14  Alarm point for Liver.

There are many syndromes of the liver.

Along the channel:  Pain along the channel, fullness of the chest.

As the liver channel curves around the external genitalia, the energy here is easily blocked by seiqi, or disease energy or factors.  Stagnation of the qi and blood may occur.  This causes lower abdominal symptoms and pain in the genitalia.  Frigidity or impotence may also result.

The Liver Organ Syndromes:

Four main syndromes:

1. Depression of the qi of Liver:  this is due to mental disorders.  Apart from cerebral symptoms, pain in the upper abdomen, vertical headaches and dysmenorrhea in women.
2. Excess of fire of the liver:  This is due to excess consumption of alcohol.  Clinical symptoms of headache, red eyes, bitter taste, flushed face.  A red tongue with yellow coating is often seen .  A rapid and wiry pulse may be felt.  The excess of fire may injure the blood vessels causing epistaxis and haematemesis
3. Insufficiency of the blood of the liver:  This is due to anemia following any chronic illness.  Clinically presents itself as dizziness, blurring of the vision, pallor of the skin, scanty menstrual flow in women, impotence in men, weakness of muscles and tendons, numbness of the extermities.
4. Stirring of Wind in the Liver by the Heart:  This is due to an external heat stirring up the endogenous wind.  Features include high fever, convulsions, coma and other signs of liver failure.  A deep red tongue with rapid, wiry pulse may result.

As with all paired organs, the liver and gall bladder are affected together whenever their element is attacked.

Ze Gall Bladder

Yang.

44 points.

Talks to the Liver at Gb40 (Yuan source) and Gb37 (Luo Connecting).

Getting tired of these.  Probably why I'm the least familiar with this particular meridian, it's long, and it's near the end of the book...

Meanwhile, this one gets its energy from Sj23 at the outer corner of the eye, runs to the front of the ear (the ever popular Gb2) and then zigzags over the side of the head on the scalp.  Honestly, if it's on the side of the head, doesn't that already infer that it's on the scalp?  Back in India, it flows down the back and lateral sides of the neck to the sides of the body, down the lateral leg to end on the foot at the lateral base of the 4th nail.

It's deep branch heads down from Gb1 into the deep tissues of the face and neck, enters the chest cavity through the superclavicular fossa.  Everything goes through that point.  Meanwhile, it descends further through the diaphragm to connect with the liver and the gall bladder.  Another branch starting from the gall bladder descends through the abdomen to connect at Gb30.

In clinic, the Gb meridian can treat disorders along the channel, including eye, ear, neck, mental disorders, lactation disorders, gall bladder and liver problems, pain in the gluteal region, low backache, sciatica and paralysis of the lower limbs.  Here's a good picture of the external course of the meridian on the face.  Here's a crappy version of the chart.

Gb1  0.5 cun lateral to the outer canthus of the eye.  Good for eye diseases, facial paralysis, headache and trigeminal neuralgia.

Gb2  Part of the famous points on the external canthus of the ear.  Good for migraine, ear diseases, dizziness and vertigo.

Gb8  1.5 cun above hairline at the apex of the ear.  Good for migraine, ear diseases, dizziness, vertigo.

Gb14, 1.0 cun above the center of the eyebrow.  Used for facial paralysis, frontal headache, frontal sinusitis, night blindness, glaucoma and other eye diseases.

Gb20, Good for occipital headache, common cold, influenza, stiff neck, cervical spondylosis.  This is an ah shi point for these conditions, and for painful menstruation.

Gb21, Special alarm point for gall bladder, good for pain in the shoulder, stiff neck, hyperthyroidism, uterine bleeding.  This is a dangerous point as the lung can come right under this.  Don't puncture deeply.

Gb24, Alarm point Mu-Front for the gall bladder.  On the nipple line in the 7th intercostal space, directly below Liv14 which is in the 6th intercostal space.  Cholecystitis, hepatitis, hiccup, gastritis.  Puncture obliquely, this is a dangerous point.

Gb25, Alarm point for the Kidney.  At the free end of the 12th rib.  Good for nephritis, costal pain, abdominal distension and flatulence.

Gb26, At the level of the umbillicus, on a vertical line drawn from the free end of the 11th rib.  Good for pelvic disorders, costal pain and back pain.

Gb30.  Huantiao.  THE sciatic point.  Also good for prolapse lumbar disc, paralysis of the lower limbs and disorders of the hip joints.

Gb31, at the tip of the finger when the hand is down the side on the leg.  Good for paralysis of the lower limbs.

Gb34, Yanglingquan.  Influential point for muscles and tendons.  Good for hemiplegia, pain or paralysis of the lower limbs, diseases of the gall bladder, muscle and tendon disorders, mental disorders, epilepsy and headaches.

Gb37  Luo connecting point, 5 cun above the tip of the lateral malleolus, on the anterior boarder of the fibula.  Good for eye disorders!

Gb39  Xuanzhong or Juegu.  Influential point for bone marrow.  It's 3 cun above the tip of the lateral malleolus, on the posterior boarder of the fibula.  Good for paralysis of the lower limbs, stiffness of the neck and disorders of the marrow.  The concept of marrow also extends to cerebralspinal fluid.

Gb40  Yuan source point.  Try this picture.  Good for ankle pain and pain in the chest.

Gb41  Good for pain of the foot, breast disorders and ear disorders

Other useful points

Gb21  Special alarm point for gall bladder
Gb24  Alarm point for gall bladder
Gb25  Alarm point for liver
Gb34  Influential point for muscles and tendons
Gb36  Xi Cleft point
Gb37  Luo connecting point
Gb38  Fire point
Gb39  Influential point for marrow
Gb40  Yuan source point
Gb41  Wood point
Gb43  Water point
Gb44  Metal point

There is an extra point Dannang lies on the gall bladder meridian, and is also an alarm point for gall bladder.

Syndromes of the gall bladder

Along the channel, includes, eye disorders, parietal headache, bitter taste, pain along the superficial pathway.

Of the gall bladder organ:  closely related to liver syndromes. 

Syndrome of Damp heat in the gall bladder and liver:  This is usually due to prolonged indulgence in alcohol, rich and excessively spiced foods.  This causes a depression of the functions of both the liver and the gall bladder.  Symptoms are pain in the hypocondrium, jaundice, bitter taste in the mouth, nausea and vomiting.  The tongue coating can be greenish yellow and sticky.

Ew.

Sanjiao or Triple Heater or Three Burner or Tri Warmer or whatever you want to call it...

The Sanjiao doesn't really have a good translation, so I just stick with the Chinese name, Sanjiao.  Not only does it not translate well, it doesn't even have it's own organ!  Instead, it refers to the 3 body cavities, the upper Jiao, which includes the lung and heart, the middle jiao, with stomach, spleen and liver and gall bladder, and the lower jiao with small and large intestines and bladder.

Instead of an organ, the Sanjiao refers to the homeostasis function of the body.  The Sanjiao promotes harmony among the organs, and keeps all of the passageways open between them.

Because there is no equivalent in western medicine, some authorities equate the 3 burners to

1. Cardiorespiratory
2. Digestive
3. Metabolic excretory and reproductive functions.

It starts on the lateral corner of the nail on the ring finger, and travels up the hand and arm more or less between the small intestine and large intestine channels.  From the shoulder, it runs up the side of the neck, circles around the root of the external ear and ends at the outer corner of the eyebrow, Sj23.

The deep circulation of this meridian runs over the supraclavicular fossa, branches internally to connect with the Pericardium, and then connects with all of the three body cavities and their organs.

Each of the three body cavities also connects with a branch that traverses the thigh and communicates with the point Ub39, the lower He-Sea point for Sj.

It communicates with it's paired organ, the pericardium at Sj5, Luo connecting and Sj4, Yuan source.

In clinic, this meridian can treat

• Disorders of the ear
• Constipation
• Paralysis, pain and polyneuropathy of the upper limb
• Pain in the shoulder and back of the chest
• Eye diseases

In the upper chest cavity, chest pain, intercostal neuralgia, pain from fracture of the ribs, herpes zoster of the chest area.

In the middle and lower body cavity (abdominal and pelvic), constipation.

Disorders along the channel can be treated, such as paralysis of the upper limb, shoulder disorders, stiff neck and ear and eye disorders.

Commonly used points:

Sj3, on the dorsum of the hand, in the depression between the heads of the 4th and 5th metacarpal bones.  This point is best located with a closed fist.  Good for ear disorders, paralysis of the upper limbs.

Sj5.  2 cun proximal to the midpoint of the dorsal transverse crease of the wrist, between the radius and ulna.  Good for paralysis of the upper limb, temporal headache, ear disorders, stiff neck.

Sj6.  3 cun proximal from that wrist fold we just talked about.  Specific point for constipation.

Sj8.  1 cun up from Sj6.  Good for pain in the costal region (rib cage), acupuncture anesthesia for thoracic surgery

Sj14.  With the arm abducted (raised) to a horizontal position, in the posterior depression of the origin of the deltoid muscle from the lateral boarder of the acromion.  Here's a good picture of the whole meridian.  This one is good for shoulder pain, pain in the arm and paralysis of the arm.

Sj17.  In the depression behind the ear lobe, between the angle of the mandible and the mastoid process.  Good for ear problems and facial paralysis.

Sj20. Endocrine point.  On the scalp at the apex of the ear when the ear is pulled forward.  Excellent point to help correct endocrine disorders, especially pituitary disorders, such as dwarfism.  Now that, I'd like to see...

Sj21.  Above the supertragic notch.  Used together with Si19 and Gb2, for everything ear.

Sj23.  In the depression at the end of the eyebrow.  Good for eye disease, temporal headache and frontal sinusitus

Sj1  Jing well point, Metal point
Sj2  Water point
Sj3  Wood point
Sj4 Yuan Soruce point
Sj6 Xi-cleft point
Sj10,  Earth point

Syndromes of the San Jiao

On the channel, pain along the channel, ear and eye disorders.

The organ Sanjiao, includes disorders of all the Zang-Fu organs.

Off to work, then gall bladder meridian!  Speaking of gall bladders, here's to my old buddy, Jason Blanchard.  May he recover quickly from his VERY recent gall bladder surgery!

Pericardium

Another Yin channel, this one with only 9 points, the same as the Heart channel.  It starts 1 cun lateral to the nipple and runs along the front of the upper limb between the Lung channel and the Heart channel and ends on the tip of the middle finger at P9.  This leads to the only acupuncture joke that I know of. 

How do acupuncturists give each other the finger?

They simply say, P9. 

We didn't laugh in class either...

But, it's useful to know that this channel communicates with the Sj channel at P7 (Yuan Source point) and P6, Luo connecting point.

In clinic, it's good for:

• Heart diseases, especially angina pectoris, palpitation, rhythm disorders and endocrine disorders.
• Upper abdominal disorders such as gastritis, peptic ulcers, nausea, vomiting and morning sickness
• Mental disorders such as schizophrenia, nervous instability.
• Diseases along the channel

It is valuable to note that in TCM, the heart and pericardium are associated with the brain functions, even though the brain is listed only as an "extraordinary organ".  Treatment of brain disorders therefore, falls to the main channels of the heart and pericardium.  In some cases, it may be appropriate to choose points from the Du and Urinary bladder and stomach channels, as they all run on the scalp and thus, over the brain.  For brain protocols, usually the following are chosen:  H7, P6, Du20 (a staple of mine), Du11 and the points on the three yang channels which run from the head to the foot, Ub62, Ub15, Gb34 and St40.

Here are the frequently used points.

P3, In the anti cubital crease, on the medial (ulnar) boarder of the biceps tendon.  Good for angina pectoris, palpitation and anxiety.  This point can be bled for chronic yin disorders or fever.

P4, Xi-Cleft point.  5 cun proximal to the midpoint of the wrist crease between the tendons of the palmaris longus and the flexor carpi radialis muscles.  As a Xi-Cleft point, it may be used to treat acute heart disease, such as angina pectoris, pericarditis, tachycardia and other disorders of cardiac rhythm or acute depression or hysteria.  This point is an excellent anesthesia point for heart surgery!

P6, Neiguan.  Luo connecting point, one of the 6 important distal points.  2 cun proximal to the midpoint of the wrist and between the two main tendons.  Indicated for plenty!

• Heart disease, angina pectoris, palpitation, carditits, endocrine disorders
• brain disorders, mental disorders, epilepsy, hysteria, insomnia anxiety
• distal point for chest and upper abdominal area, pain in the chest, hiccups, nausea, vomiting, gastritis, peptic ulcer, discomfort due to hiatus hernia.
• Morning sickness, hyperemesis gravidarum 
• Numbness of the forearm and hands
• Acupuncture anesthesia in thyroidectomy and cardiac surgery

P7, Yuan source point.  At the midpoint of the wrist crease between the two tendons listed above.  Diseases of the wrist joint, early carpal tunnel syndrome without positive objective neurological signs.

Note, this point is often combined with H7 and Lu9 for anything wrist.  This goes to show you that anytime the meridians pass over a joint, the acupuncture points in the region treat that joint

P8  In the palm, between the tips of the middle and ring finger as these touch the central region of the palm when lightly clenching the fist.  This is good for disorders of the palm, rheumatic arthritis of the hand and carpal joints, Dupuytren's contracture, excessive sweating of the palm.  Fair warning, this point is painful!

Here's the list:

P3 Water point
P4 Xi-cleft point
P5 Metal point
P6 Luo connecting point, distal point
P7 Yuan source point, Earth point
P8 Fire point
P9 Jing well, wood point

Here are all the main sedative and tranquilizing points of the body!!! 

Du20
Sishenchong, Ex6
H7
P6
Ub62
Ub15 (Heart Shu)
Gb34 (hm!)
St40
Du11
Ex8, Ex9 Anmian I and II
Yaoqi, Ex20

Li4 also has potent sedative and tranquilizing effects in addition to being the best analgesic.

The deep circulation of the pericardium originates from the organ, which is the protector of the heart.  It communicates with all three body cavities and further connects with the tongue and brain via the same internal pathways as the heart.

Syndromes of the Pericardium

Well, there are no syndromes really, as they are all the same for the heart. 

That's it for me tonight.  On to the Sanjiao tomorrow, the triple warmer!

Kidney Channel

Yin polarity, with 27 points, connects to the Ub at K3, Yuan source point and K4, Luo connecting point.  It starts on the sole of the foot, travels on the medial side of the ankle where it makes a loop.  It passes along the medial side of the popliteal fossa, and up the posteromedial aspect of the thigh, reaches the front of the abdomen close to the midline to end in the upper part of the chest.

Clinical uses:

• Genitourinary disorders.  In TCM, the kidney controls the genital functions, which includes the adrenal glands, and particularly the stress mechanisms.
• Low back pain, pain and paralysis of the lower extremities
• Excess Lung disorders, Water (K) is the son of Metal (Lu)
• Edema, excessive sweating (disorders of elemental water)
• Convulsions and other acute emergencies (at K1)
• Bone, cartilage and nail disorders, ear disorders, alopecia.  The Kidney is connected to each of these tissues and controls the head hair and ears.

Common points

K1, Yongquan, Jing Well point.  On the sole of the foot, this point is the most effective of all the Jing Wells, and is your first choice for needling in the case of fainting, coma, shock, hysteria, eplieptic attack, infantile convulsions, cyclical vomiting, hyperemesis gravidarum and other acute emergencies.  It is a local point for plantair fascitis, plantar warts and excessive sweating of the sole of the foot.

K3, Taixi, Yuan Source point.  Genital and urinary disorders, impotence, low back ache, disorders of the ankle.  In acute asthma or in cases of frequent asthma attacks (excess of the lung) mild stimulation here or at K7 has good effect.

K5, Xi-Cleft point, 1 cun below K3  Indicated for renal colic.  Use strong stimulation at this point

K6, Zhaohai, 1.0 cun south of the tip of the medial malleolus.  Good for genito-urinary disorders, edema of the ankle.

K7, Fuliu.  2 cun proximal to K3 on the medial boarder of the calcaneus tendon.  Good for excessive sweating and acute bronchial asthma.  Note, for excessive sweating, use this point with Li4 and H6, plus the local points where there is excessive sweating, Palm Lu10, P8, H8, Axilla, H1, Sole, K1.  The specific points for edema and ascites may also be used.

K10, Yingu.  At the popliteal crease on the medial boarder of the semitendinosus.  Good for knee problems, impotence, baldness or alopecia.

Specific points not already listed:

K1, Yongquan, Jing Well point, Wood point
K2, Fire point
K3, Yuan Source point, Earth point
K4, Luo connecting point
K5, Xi-cleft point
K7, Metal point
K10, Water point.

From the last point K27 the energy flows to P1.

The Kidney and Urinary bladder are related to bone, cartilage and to head hair.  The kidney is also connected to the sense organs and the ears.

The deep circulation branches to communicate to Du1 and then enters the kidney organ, and then the urinary bladder.  A branch ascends from the kidney to reach the pharynx and then terminates at the root of the tongue.

Kidney Syndromes

A On the Channel:  Feverish sensation of the soles, weakness of the lower limbs, irregular menstruation, impotence, nocturnal emissions, sore throat

B  The Organ:  Two main Syndromes:

1: Weakness of the Qi of the Kidney.  This is due to asthenia (exhaustion) after a long illness.  Insufficiency of the kidney yin occurs, measured by urinary disorders, nocturnal eneuresis, infertility and asthmatic breathing.  A thready pulse may occur.  Alopecia often occurs.

2:  Insufficiency of the Yang of the Kidney.  This may be to excessive sexual activity.  Symptoms include low backache, joint disorders, impotence and edema of the legs.  Chronic pharyngitis, bone and cartilage  and joint disorders may occur.  Loss of hearing, tinnitus, vertigo and chronic ear infections may also often occur.  A pale tongue with a deep thready pulse may occur.

In clinic the kidney channel may be used in treating:

1. Disorders of the Kidney
2. Other genitourinary disorders
3. Urinary bladder disorders
4. Disorders along the urinary bladder channel (coupled channel)
5. Excess lung disorders, such as asthma, Kidney is the son of Metal.
6. Excess disorders of the Heart and Brain and Small intestine disorders (water controls fire)
7. Disorders of the liver and gall bladder diseases along their channels (wood is the son of water)
8. Ear disorders (Kidney opens to the ears)
9. Disorders affecting bone and head hair (related tissues)

This is an example of how one channel has a multiplicity of functions.  This wide spectrum of therapeutic latitude shows why no two acupuncturists in the world will use the same combination of points to treat any one disorder.  Ulitmately, it is up the the acupuncturist's experience and the response of the patient that dictates treatment and point selection.

On to the Pericardium!

The Bladder

Who knew the Bladder, or Ub or Bl for short, could be connected to so much?  It's the longest meridian on the body, has a Yang polarity (hollow) and has an astounding 67 points!  It starts on the face in the inner canthis of the eye, travels up to the inner edge of the eyebrow, and continues over the head close to the centerline of the body or Du meridian.  It continues down along either side of the spine, 1.5 cun to be exact, down to the first sacral foramen and to each of them to the fourth sacral foramen where it deviates obliquely to the mid line to reach the coccyx.  It then continues down the back of the leg to the point Ub40.  A second external branch starts at Ub10 at the occipital, and runs parallel but 3 cun from the mid line.  Points start from 41 to end at 54 on this channel.  It passes over the buttock and continues down the leg to meet Ub40 at the popliteal fossa then descending over the calf muscles and reaches the foot after passing behind the lateral malleolus.  It continues down the lateral boarder of the foot and ends at the lateral corner of the little toenail.

It communicates with the Kidney meridian at Yuan source point Ub64, and Luo connecting point Ub58.  It's clinical uses cover almost the entire human condition, as it communicates with every internal organ as it passes along the spinal cord, and interacts with the nerve ganglia which supplies each internal organ at that level.  These particular points are the Back-Shu points, and they become tender in disorders, which also makes them alarm points.  If one needles Front-Mu points with the corresponding Back-Shu point, then distal points are not required.  This is the basis of Japanese style acupuncture which focuses on abdomen and back points.

In clinic, the points on the face are for eye disorders.  Points on the back treat each of the internal organs (see above), point in the lumbar region are for low back pain and genito urinary disorders, while points on the lower limbs are used for pain, muscle cramps and other local disorders, while those below the knee serve as distal points for the treatment of disease on the proximal course of the channel.

The points on the scalp are rarely used, and the same with the outer row of bladder points on the back.  Just about every other point is fair game though...

Here we go with the details!

Ub1, Dangerous point, indicated for diseases of the eye.  0.1 cun medial and superior to the inner canthus.  Don't stimulate this needle for any reason, unless you like blind patients.

Ub2, indicated for diseases of the eye, sinusitis, frontal headache and Dr. Pye uses this to help with hyper or hypo tension.  Needle pointed towards Ub1 for this effect.

Ub10, level with Gb21 but 1.3 cun lateral to Du15.  Indicated for stiff neck, occipital headache, sore throat and cervical spondylosis.  This point is rarely used, but massage therapists and chiropractors perform neck bridging at this point.

Ub11  Dashu:  Influential point for bone and cartilage.  Good for pain in the shoulder girdle area, arthritis of the joints.  This is used in ALL joint, bone and cartilage disorders.  It is one of my personal favorites.  I have used this point in conjunction with Du14, Li4, Li11, St36, Sp6, St44 to help treat fibromayalgia, with great success.

Ub13  Feishu:  Lung Shu point, at T3.  This is the first of the Shu points.  As such, each of the shu points can be use to treat any disorder that the corresponding organ or organ channel is related to.  In this case, lung disease, nose disorders, skin disorders and lesions of the soft tissues of the dorsal spine.

Ub14 Jueyinshu Pericardium Shu point, at T4.  This can treat Heart disease and brain disorders

Ub15 Xinshu Heart Shu Point, at T5.  Can treat Heart disease, neurasthenia (a psychological disorder that sounds really similar to fibromaylagia, characterized by lassitude, depression, general aches and pains, memory loss and headaches), hysteria, epilepsy, schizophrenia, insomnia, anxiety, addictions, behavioral disorders.

Ub17 Keshu, Influential Blood point, Shu point for Diaphragm, at T7.  Indicated for paralysis of diaphragm, hiccups, anorexic nervosa, anemia, chronic hemorrhagic diseases, leukemia.

Ub18, Ganshu, Liver Shu point, at T9.  Good for liver disease, eye disease, muscle and tendon disorders, local problems on the spine.  It probably goes without saying that every point is good for local problems...

Ub19, Danshu, Gall Bladder Shu point, at T10.  Gall bladder diseases, local point.

Ub20, Pishu, Spleen Shu point, at T11.  Good for gastrointestinal disorders, edema, allergies, soft tissue disorders

Ub21, Weishu, Stomach Shu point, at T12.  Stomach disorders.

Ub22, Sanjiaoshu, Sj Shu point, at L1.  Abdominal distension, flatulence, loss of appetite, incontinence, local.

Ub23, Shenshu, Kidney Shu point, at L2.  Genitourinary disorders, ear disease, bone disorders, alopecia.

Ub25, Dachangshu, Large Intestine Shu, at L4, level with the upper boarder of the iliac crest.  Good for diarrhea, constipation, low backache, sciatica, paralysis of the lower extremities.

Ub27, Xiaochangshu, Small Intestine Shu, at the first posterior sacral foramen.  Low backache, enteritis, sacro-iliac diseases.  It says that it's not used much, but I use this point frequently in my low backache patients.

Off to bed...

Ub28, Pangguangshu, Urinary Bladder Shu, at the second posterior sacral foramen.  Genitourinary disorders, lumbo sacral disorders.

Ub32, Ciliao, for genitourinary disorders (dysmenorrhea, premature ejaculation, noctural enueuresis (bedwetting), hemorrhoids, sciatica

Ub36, Chengfu, in the middle of the gluteal fold.  Indicated for sciatica, paralysis of the lower limb, hemorrhoids.

Ub37, Yinmen, on the midline 6 cun south from Ub36.  Same as Ub36.

Ub40, Weizhong, One of the 6 important distal points, sciatica, lumbago, paralysis of the lower limb, genitourinary disorders, disorders of the knee, skin disease.

Ub54, At the level of the fourth sacral foramen, 3.0 cun lateral to the midline.  Genitourinary disorders, hemorrhoids, sciatica, hip disorders, paralysis of the lower limb.  (not used much)

Ub57, Chengshan, At the union of the two bellies of the gastrocnemius., 8 cun, below weizhong (Ub40)  Good for sciatica, cramps of the calf muscles, acupressure is good during pregnancy, as a needle here may cause abortion!  Also good for pain in the sole of the foot, paralysis of the lower limb, hemorrhoids. 

Ub58, Feiyang, 7 cun above Ub60 on the lateral aspect of the calf muscle, or 1 cun south and west of Ub57.  Good for opthalmoplegia.

Ub60, Midway between the prominence of the lateral malleolus and the lateral boarder of the Achilles tendon.  Good for painful disorders of the ankle region, sciatica, lumbago, paralysis of the lower limb

Ub62  Shenmai, Confluent point.  Good for convulsions, epilepsy, apoplexy, mental disorders, drug addictions, foot-drop.  This is the most important sedative and tranquilizer point of the lower limb.  I use this one frequently, as stress is really common in my clinic.

Ub67  Zhiyin, Jing-Well point.  Good to prevent breach birth, difficult labour.  Helps reinforce uterine contractions and expedite delivery at full term.  Avoid in the early months of pregnancy.  Moxibustion on the needle is indicated.


Here's a diagram of the channel and it's points. 

Here are the points that matter.

Here's the points that aren't mentioned that might be helpful...

Ub58, Feiyang, Luo connecting point
Ub60, Fire point
Ub62 Confluent point
Ub64, Yuan source point
Ub65, Wood point
Ub66, Water point
Ub67, Metal point, Jing-well.

These points will be collected and presented in another format that makes it easy to memorize. 

The rest of the meridian circulates with the Du channel at Du20 and communicates directly with the brain.  While coursing down along the paravertebral muscles, it communicates with the organs urinary bladder and the kidney.  At the back-shu points, deep communication occurs with all the other internal organs as well.

Syndromes of the Urinary Bladder

A The urinary bladder channel, lacrimation, when exposed to wind, rhinitis, epistaxis, vertical and occipital headaches, backache and sciatica.

B The Organ Urinary Bladder.  Diseases of the urinary bladder have 2 main syndromes.

Damp-heat in the urinary bladder.  Damp heat injures the urinary bladder causing frequency, urgency and pain on urination.  Blood clots may occur, renal stones may form.  The tongue is red with a black coating, the pulse may be rapid.

Disturbance in the urinary bladder functions.  This is due to a kidney insufficiency.  The symptoms are dribbling or retention of urine.  The tongue is pale and deep thready pulse may be felt.

That's the scoop.

Small Intestine

"The Small Intestine is the official who receives the abundance from the Stomach and is concerned with transforming this matter" 
-Su Wen, circa 500 BC

This is a Yang organ with 19 points.  It connects superficially with the Heart channel at Si4 (Yuan Source) and Si7 (Luo Connecting).  It starts it's superficial course at the medial corner of the nail bed of the little finger, runs on the posterior and medial aspect of the arm, zig-zags over the back of the shoulder, and runs over the side of the neck and face to end in front of the ear.

Clinically, it is used for disorders along the channel, such is deafness, swelling of the cheek, stiff neck and sore throat.  It can be used for disorders of the small intestine, but usually the lower He-Sea point is used instead (St39).

Commonly used points

Si3  (used this one today).  Confluent point of the Du Meridian.  This is on the side of the hand at the crease that pops up when you clench your fist.  It's a very painful point, and should only be used in acute stiffness of the neck, acute low backache or severe occipital headache.  This needle is strongly stimulated.

Si6  Xi-Cleft point.  Yanglao  It's in the depression on the lateral aspect of the styloid process of the ulna.  This is indicated for pain in the wrist, stiff neck, cervical spondylosis.  An acute stiff neck can be relieved by strongly stimulating this point.  It can also help with failing eyesight in the elderly.

Si9  1 cun superior to the highest point of the posterior axillary fold.  Indicated for frozen shoulder (along with Li15, Sj14, Li4, Gb34), strains of the shoulder, paralysis of the upper limb.

Si17  Tianrong  Located on the anterior boarder of the sterno-cleiodmastoideus at the level of the angle of the jaw.  Excellent for Tonsillitis, sore throat and aphasia.  Warning, this is a dangerous point!  It must be needled towards the tonsils and NOT backwards as it may affect the carotid body.

Si18, Quanliao  Good local point for pain and the best analgesic point in the head and neck regions.  It is often used for tooth extractions, ear, nose, throat and brain surgery!  It can also treat trigeminal neuralgia, facial paralysis.  You have to be careful needling this point, only .3 to .5 cun deep.  Needling too deep can pierce into the mouth cavity and cause bleeding inside the mouth.

Si19, Tinggong  I use this point frequently with patients, also piercing Sj21 and Gb2 together using through and through needling.  It's excellent for any ear disorders, deafness tinnitus, vertigo, Meniere's disease and chronic ear infections.  If needled perpendicularly, there has been a reported case of puncturing the ear drum!

Names and functions

Si1 Shaoze, Jing Well point,  Metal point
Si2 Qiangu Water point
Si3 Houxi, Wood point, Confluent point of the Du meridian
Si4 Hand-Wangu, Yuan source point
Si5 Yanggu Fire point
Si6 Yanglao Xi-cleft point
Si7 Zhizheng Luo Connecting point
Si8 Xiaohai, Earth point
Si9 Jianzhen
Si10 Naoshu
Si11Tianzong  This point has recently been researched for intractable brachalgia. (referred pain down the arm)
Si12 Bingfeng
Si13 Quyuan
Si14 Jianwaishu
Si15 Jianzhongshu
Si16 Tianchuang
Si 17 Tianrong -dangerous point if inserted backwards.  Needle towards the tonsils
Si18 Quanliao  The best regional analgesic for head and neck
Si19 Tiangong, stitched with Sj21 and Gb2 for all things ear.

From Si19, the vital energy flows onto Jianming (UB1) across the eye.  Si6 can therefore, be used to open the eyes and brighten the vision of elderly people.

The heart and small intestine are related to the blood vessels.  These two organs are also connected to tongue and mouth.  The heart and pericardium together with the blood vessels are related to the brain.  The brain is one of the extraordinary organs.

How to treat ear disorders:
Local points: Sj21, Si19, Gb2
Distal: Sj3 or Sj5, Si6, Gb41, Kidney channel points are excellent too.

As the Si channel crosses the back, it communicates with Du14.  Then, at the supraclavicular fossa a deep branch begins which connects with the heart and then descends along the esophagus passing through the diaphragm and stomach to finally reach the Si itself. 

A second deep branch stems from the Si and connects to the inferior He-Sea point, St39.  This is the preferred point to treat any small intestine disorders.

Syndromes of the Small Intestine

A:  Disorders along the channel, pain, sore throat, swelling of the cheek, deafness and lower abdominal pain.

B:  The organ itself.  Symptoms of disorders are very similar to those of spleen disorders.  As a rule, generally treat the Yin organ first and then if not successful, treat the yang organ.

Ta da!  OMG, it's time for bed.  It's 9:30pm on a Saturday night, and all my partying was done last night, and it's time to deal some serious damage to the rack monster!


Si19