Cheng Xinnong, ed. - Chinese Acupuncture & Moxibustion.pdf

Chinese Acupunctu~:Y.--=-· and Moxibustion

FOREIGN LANGUAGES PRESS

BEIJING

Chinese Acupuncture and Moxibustion

Chinese Acupuncture and Moxibustion (Revised Edition) Chief editor CHENG XINNONG

FOREIGN LANGUAGES PRESS

BEIJING

First Edition 1987 Revised Edition 1999 Fourth Printing 2003

Written by

Deng'Liangyue, Gan Yijun, He Shuhui, Ji Xiaoping, Li Yang, Wang Rufen, Wang Wenjing, Wang Xuetai, Xu Hengze, Xue Xiuling and Yuan Jiuling Edited by

Cheng Youbang, Huang Xinming, Jia Weicheng, Li Sheng, Qiu Maoliang and Yang Jiasan Revision Editors

Zheng Qiwei, Xue Xiuling, Gu Yuebua, Li Yachan, Xu Yao, Lu Xiaozhen, Ding Xiaohong, Yi' Sumei

Home Page: http:/lwww.flp.com.cn E-mail Addresses: [emailprotected] sales @flp.com.cn

ISBN 7-119.{)1758-6 © Foreign Languages Press, Beijing, China, 1987 Published by Foreign Languages Press 24 Baiwanzhuang Road, Beijing I00037, China Distributed by China International Book Trading Corporation 35 Chegongzhuang Xilu, Beijing 100044, China P.O. Box 399, Beijing, China Printed in the People's Republic of China

FOREWORD The science of acupuncture and moxibustion is an impOrtant part of traditional Chinese medicine. For thousands of years the Chinese people have appreciated it for its nonpharmaceutical treatment, simple application, wide range of use, good curative effect, and low cost. As part of Chinese science and culture acupuncture and moxibustion have long been known in the world as a result of cultural exchange between China and other countries. However, a global interest in acupuncture and moxibustion and special enthusiasm for the subject have been growing in the past dozen years. To offer further service to the other people and help acupuncture and moxibustion enrich the world's science and culture, the Ministry of Public Health of China established three international acupuncture training centres in research institutes and colleges of traditional Chinese medicine in Beijing, Shanghai and Nanjing with the suppOrt of the Office of the Western Pacific Region of the United Nations' World Health Organization. More than 1,000 foreign students from 120 countries and regions have been trained there in less than ten years. With their strong thirst for knowledge these students were not satisfied with their basic understanding and sought more detailed information. To meet their needs, the three training centres have organized advanced training and research courses. Chinese Acupuncwre and Moxibustion, the textbook for these advanced cou rses, was compiled by the three training centres, under the supervision of the Ministry of Public Health, in accordance with their teaching programme, acupuncture theory and clinical experiences. Professor Cheng Xinnong, wellknown specilllist of Chinese acupuncture and moxibustion, headed the editorial board for the compilation of this book. Both the Chinese and English editions of Chinese Acupuncwre and Moxibustion were examined and revised by a number of specialists before publication. Based on Essentials of Chinese Acupuncwre and supplemented by the results of many years of teaching and clinical experience, Chinese Acupuncrure and Moxibustion was continuall y revised, substantiated and perfected. As a valued

scientific gift from the home of acupuncture and moxibustion, this book, we hope, will be a good teacher and helpful friend to students and practitioners of acupunctu re and moxibustion in the world.

Hu Ximing Vice-M inister of the Ministry of Public Health, Director of the State Administrat ion of Traditional Chinese Medicine, the People's Republic of China Chairman of the Ch inese Acupuncture and Moxibustion Society

September 1987

CONTENTS PREFACE TO THE REVISED EDITION PREFACE CHAPTER 1 A BRIEF HISTORY OF CHINESE ACUPUNCTURE AND MOXI· BUSTION I. THE ORIGIN OF ACUPUNCTURE AND MOXIBUSTION II. THE ACADEMIC ACCOMPLISHMENTS OF ANCIENT ACUPUNCTURE AND MOXIBUSTION III. MODERN DECLINE AND NEW LIFE OF ACUPUNCTURE AND MOXI· BUSTION IV. REIUVENA TION OF ACUPUNCTURE AND MOXIBUSTION IN NEW CHINA V. THE DISSEMINATION OF ACUPUNCTURE AND MOXIBUSTION TO THE WORLD CHAYJ'ER 2 YIN-YANG AND THE FIVE ELEMENTS I. YIN·YANG l. The Basic Knowledge of the Theory of Yin and Yang 2. Application of the Theory of Yin and Yang in Traditional Chinese Medicine II. THE FIVE ELEMENTS 1. Classification of Phenomena According to the Five Elements 2. Law of Movement of the Five Elements 3. Application of the Theory of the Five Elements in Traditional Chinese Medicine CHAPTER 3 THE ZANG·FU ORGANS I. THE FIVE ZANG ORGANS I. The Heart 2. The Liver 3. The Spleen 4. The Lung 5. The Kidney II. THE SIX FU ORGANS l. The Gallbladder 2. The Stomach

xiii XV

2 7

9 10 12 12

13 16

20 20 21 24 27 28 28 30 32 JJ 35

38 38 38

----------------------------------------------00~~[~5 3. The Small Intestine 4 The L.arce Intestine 5. The Bladder 6. The Triple Energizer

Ill. THE EXTRA FU ORGANS I. The Brain 2. The Uterus

IV. THE RELATIONSHIPS AMONG THE ZANG·FU ORGANS I. The Relationships Between the Zang Organs 2. The Relationship Between the Zang and the Fu Organs 3. The Relationship Among the Fu Organs

CHAPTER 4 QI, BLOOD AND BODY FLUID I. Ql I. Cltssifieation and Production of Qi 2. Funeuons of Qi

II. BLOOD I. Formation and Circulation of Blood 2. Functions of Blood

Ill. BODY FLUID I. Formation and Distribution of Body Fluid 2. Functions of Body Fluid (Jingyc)

IV. THE RELATIONS HIP BETWEEN Ql, BLOOD AN D BODY FLUID I. The Rcl:otionship Between Qi and Blood 2. The Relationship Between Qi and Body Fluid 3. The Relationship Between Blood and Body Fluid

CHAPTER S THE MERIDIANS AND COLLATERALS I. THE BASIC CONCEPT OF THE MERIDIANS AND COLLATERALS I. The Nomenclature of the Meridians and Collaterals and Their Composition 2. Functions or the Meridians and CoUaterals 3. Otstribution or the Founeeo Meridians 4. C)elieal Flow of Qi in the Twelve Main Mertdians

II. THE TWELVE MAIN MERIDIANS I. The Lung Meridian of Hand· Taiyin 2. The Large Intestine Meridian of Hand·Yangming 3. The Stomach Meridian of Foot·Yangming 4. The Spleen Meridian of Foot·Taiyin 5. The tleart Meridian of Hand·Shaoyin 6. The Small Intestine Meridian of Hand·Taiyana 7. The Bladder Meridian of Foot·Taiyang 8. The Ktdney Meridian of Foot·Shaoyin 9. The Pericardium Meridian of Hand·Jueyin 10 The Triple Energizer Meridian of Hand·Shooyana

39 39 39 40 41 41

42 43 47

49 51 51 51

53 54 54 54

55 55 56 56

57 57

58 59 60 60 61

64 65 65 66

68 69 69 72 7J 73

77 77

COI'TEI'ITS

lil

11 . The Gallbladder Mer~dian of Foot-Shaoyang 12. The Liver Meridian of Foot-Jueyin

Ill. THE EIGHT EXTRA MERIDIANS I. Governor Vessel 2. Conception Vessel 3. Thoroughfare Vessel 4, Bell Vessel 5. YallJ Heel Vesse! 6. Yin Heel Vessel 7. Yang lint Vessel 8. Yin lint Vessel

rv. THE TWELVE

78 81

82 83 83

83 84

85 85 88 88

DIVERGENT MERIDIANS AND FIFTEEN COLLATER-

Tbe Twelve Diverge.n t Meridians I. The First Confluence 2. The Second Confluence 3. The Third Confluence 4. The Founh Confluence 5. The Fifth Confluence 6. The Sixth Confluence

The Fifteen Collatenls I. The Three Yin Collaterals of Hand 2. The Three Yang Collaterals of Hand 3. The Three Yang Collaterals of Fool 4. The Three Yin Collatera ls of Foot 5. The Collalerals of the Conception and Governor Vessels and the Major Collateral of the Spleen

V. THE TWELVE MUSCLE REGIONS AND TWELVE CUTANEOUS REGIONS I. The Twelve Muscle Regions 2. The Twelve Cutaneous Reaions

CHAPTER 6 AN INTRODUCTION TO ACUPUNCTURE POINTS I. CLASSIFICATION AND NOMENCLATURE OF ACUPUNCfURE POINTS

88 90

90 90 94

95 96 97 97 98 99 99 99 101 101 112 liS

II . METHODS OF LOCATING ACUPUNCTURE POINTS J. Proportional Measuremen ~ 2. Anatomieal Landmarks 3. Finaer Measurement

115 115 116 11 7 118 121 121

lli. SPECIFIC POINTS

122

I. Classification of Acupuncture Points 2. Nomenclature of Acupuncture Points

J. Specific Points on the Limbs 2. Specific Points on the Head nnd Trunk Appendix: Eight l nfluentin l Points

122 123 124

i\'

CONI"EN1'S

IV. AN OUTLINE Of THE THERAPEUTIC PROPERTIES OF THE POINTS OF THE FOURTEEN MERIDIANS 1. The Remote Therapeutic Propenies of the Points 2. The local and Adjacent Therapeutic Propcttics of the Points

124 124 125

CHAPTER 7 ACUPUNCTURE POINT S OF THE TAIYIN AND YANGMING MERID IAN

135

l. THE LUNG MERIDIAN Of HAND-TAIYIN t. Zhongfu (LU 1) 4. Xiabai (LU 4) 7. Lieque (lU 7) tO. Yuji (LU 10)

2. Yunmen (LU 1) 5. Chize (LU 5) 8. Jingqu (LU 8) 11. Shaoshang (LU 11)

135

3. Tianfu (LU 3) 6. Kongzui tLU 6) 9. Taiyuan (LU 9)

II. THE LARGE INTESTINE MERIDIAN OF HAND-YANGMING 3. Sanjian ( LI 3) 1. Shangyang ( Ll 1) 2. Erjian (ll 2) 5. Yangxi (LI 5) 6. Pianti ( ll 6) 4. Hegu (ll4) 7. Wentiu (LI7) 8. Xiatian (Ll 8) 9. Sbanglian (ll9J 10. Shousanli (LI 10) 11. Quchi (ll 11) 12. Zhouliao(lll2) 14. Binao(Lll4) 15. Jianyu (Lit5) 13. Shouwuli (LI 13) 16. Jugu (LI 16) 17. Tianding (Ll 17) 18. Futu (LJ 18) 19. Kouheliao (lll9) 20. Yingxiang (Ll 20)

139

Ill. THE STOMACH MERIDIAN Of FOOT-YANGMING

145

1. Chengqi (ST 1) 4. Dicang(ST 4) 7. Xiaguan (ST 7) 10. Shuitu (ST tO) 13. Qihu (ST 13) 16. Yingchuang (ST 16) 19. Burong{ST 19) 22. Guanmen (ST 22) 25. Tianshu (ST 25) 28. Sbuidao (ST 28) 31. Biguan (ST 31) 34. Liangqiu (ST 34) 37. Shangjuxu (ST 37) 40. Fcnglong (ST 40) 43. Xiangu (ST 43)

2. Sibai tST 2) 5. Daying(ST 5) 8. Touwei (ST 8) 11. Qisbe (ST I t) 14. Kufang(ST 14) t7. Ruzhong(ST 17) 20. Chcngman (ST 10) 23. Taiyi (ST 23) 26. Wai1ing(ST 26) 29. Guilai (ST 19) 32. Futu (ST 31) 35. Dubi (ST 35 J 38. Tiaokou ( ST 38) 4J.Jiexi(ST4 1) 44. Neiting (ST 44 I

IV. THE SPLEEN MERIDIAN OF FOOT-TAIYIN 2. Dadu (SP 2) 1. Yinbai (SP I) 5. Shangqiu (SP 5) 4. Gongsun (SP 4) 7. Lougu (SP 7) 8. Oiji (SP 8 J tO. Xuebai (SP IOJ I J. Jimen tSP II) 13. Fushe (SP 13) 14. Fujic (SP 14) 17. Shidou (SP 171 16. Fuai (SP 16) 20. Zhourong {SP 20) 19. Xiongxiang(SP 19)

3. Ju liao(ST3) 6. Jiacbe (ST 6) 9. Renying (ST 9) 12. Qucpcn (ST 12) 15. Wuyi (ST 15) 18. Rugen (ST 18) 21. liangmen (ST 21) 24. Huaroumen (ST 24) 27. Daju (ST 27) 30. Qichong (ST 30) 33. Yinshi (ST 33) 36. Zusanli (ST 36) 39. Xiajuxu ($T 39) 42. Cbongyang (ST 42) 45. Lidui (ST 45) 151

3. Taibai (SP 3) 6. Sanyinjiao (SP 6) 9. Yin1ingquan (SP 9) 12. Chongmen (SP 12) 15. Daheng(SP 15) 18. Tianxi (SP 18) 21. Dabao(SP 21)

CONl'ENTS

CHAPTER 8 ACUPUNCTURE POINTS OF THE SHAOYIN AND TAIYANG ME· RIDIANS

I. THE HEART MERIDIAN OF HANI>SHAOYJN I.Jiquan (HT I ) 4. Lingdao ( HT 4) 7. Shenmen (HT 7)

2.Qingling(HT 2) 5. Tongli (HT 5J 8. Sbaofu ( HT 8)

164 164

3. Sbaobai (HT 3) 6. Yinxi (HT 6) 9. Shaochong CHT 9)

11. THE SMALL INTESTINE MERIDIAN OF HAND-TAIYANG 2. Qiangu (S I 2) 3. Houxi (SI 3 J I. Shaoze 'TJON

II. The Six Fu Organs I. The Gallbladder The gallbladder is attached to the liver with which it is externally-internally related. Its main function is to store bile and continuously excrete it to the intestines to aid digestion. When the function of the gallbladder is normal, its qi descends. Since the bile is bitter in taste and yellow in colour, upward perversion of gallbladder qi may give rise to a bitter taste in the mou th, vomiling of bitter fluid, and failure to aid the stomach and spleen in digestion, resulting in abdominal distention and loose stools. Since this function of the gallbladder is closely related to the liver's function of maintaining the free flow of qi, il is said that the liver and gallbladder together have !he function of mainta ining the free flow of qi. Similarly, the relation of the liver to emotional changes is shared by the gallbladder, and this is often taken into account in the clinic when treating emolional symptoms such as fear and palpitat ions, insomnia and dream-disturbed sleep. A lthough the gallbladder is one of the six fu organs, unlike the other five it stores bile and does not receive water or food. For this reason it is also classified as one of the "extra fu organs. ~ 2. T he Stomach The stomach is located in the epigastrium. It connects with the oesophagus above, and with the small intestine below.

Its upper outlet is the cardia, called Shangwan, and its lower outlet is the pylorus - known as Xiawan. Between Shangwan and Xiawan is Zhongwan. These three areas together make up the epigastrium. The Stomach Meridian is connected with the spleen with which it is externally-internally related. Its main function is to receive and decompose food. Food enters the mouth, passes through the oesophagus, and is received by t he stomach where it is decomposed and transmitted down to the small intes· tine. Its essential substances are transported and transformed by the spleen to supply the whole body. The stomach and spleen, therefore, act in conjunction and are the main organs carrying out the functions of digestion and absorption. Together they are known as the "acquired foundation." When the function of the stomach is normal, its qi descends. If the descending function is disturbed, there will be Jack of appetite, distend ing pain in the epigas· trium, nausea and vomiting.

3. The Smalllntestine The small intestine is located in the abdomen. Its upper end connects with the stomach, and its lower end with the large intestine. The Small Intestine Meridian communicates with the heart with which it is externally-internally related. Its main functions are reception and digestion. It receives and further digests the food from the stomach, separates the clear from the turbid, and absorbs essentia l substance and part of the water from the

food, transmitting the residue of the food to the large intestine, and of the water to the bladder. Since the small inrestine has the function of separating the clear from the turbid , its dysfunction may not only influence digestion, but also give rise tO an abnormal bowel movement and disturbance of urination.

4. The Large Intestine The large intestine is located in the abdomen. Its upper end connects with the small intestine via the ileocecum, and its lower end is the anus. The Large lntes· tine Meridian communicates with the lung with which it is externally-internally related. The main function of the large intestine is to receive the waste material sent down from the small intestine, ab· sorb its fluid content, and form the re· mainder into faeces to be excreted. Patho logical changes of the large intestine will lead to dysfunction in this transpor· tation function, resulting in loose stools or constipation.

5. The Bladder The bladder is located in the lower abdomen. Its meridian connects with the kidney with which it is externallyinternally related. The main function of the bladder is the temporary storage of urine, which is discharged from the body through qi activity when a sufficient quantity has been accumulated. This function of the bladder is performed with the assistance of the kidney qi. Disease of the bladder will lead to symptoms such as anuria, urgency of micturition and dysur-

CHfNESE ACUPUNCTURE AND MOXIUUSTION

ia; failure of the bladder to control urine may lead to frequency of micturition, incontinence of urine and enuresis.

6. The Triple Energizer The triple energizer is located "separately from rhe zang-fu organs and inside the body." It is divided inro three parts: the upper, midd le and lower energizers. Its meridian connects with the pericardium with which it is externallyimernally related . Its main functions are 10 govern various forms of qi, and serve as the passage for the flow of yuanqi and body fluid. Yuanqi originates in the kidney, but requires the triple energizer as its pathway for disrribution in order to stimulate and promote the functional activilies of the zang-fu organs and tissues of the whole body. The chapter "Sixtysixth Question" of Classics on Medical Problems, therefore, says: "The triple energizer is the ambassador of yuanqi. It circulates the three kinds of qi and distributes rhem 10 the five zang and six fu organs." The digestion, absorplion, distriburion and excrerion of food and water are performed by the joint efforts of various zang-fu organs, including the triple energizer. The chapler "The Thirly-firsl Quesrion" in the book of Classics on Medical Problems says: "The triple energizer is the passage of water and food." It is also mentioned in the eighlh chapter of Plain Questions: "The triple energizer is the irrigation official who builds waterways." The upper, middle and lower energiz-

ers combine with their related zang-fu organs, and each functions differently in order to carry out the digestion, absorption, distribution and excretion of water and food. The upper energizer dominates dispers ion and disrribution. In other words, in combination with the distributing function of t he heart and lung, the upper energizer distributes the essential qi of water and food to the whole body in order to warm and nourish the skin and muscles, tendons and bones, and regulate the skin and pores. This function is described in the eighteenth chapter of Miraculous Pivot: "The upper energizer is like a fog." Here "fog" is used to describe the allpervading vapour-like state of the clear and light essentia l qi of warer and food. The midd le energizer dominates digestion of warer and food. It refers to rhe functions of the spleen and stomach in digesting food, absorbing essential substance, evaporating body fluid, and transforming nutrient substance into nutrient blood. This function is described in the same chapter: "The middle energizer looks like a froth of bubbles." "A froth of bubbles" here refers 10 the appearance of the decomposed state of digested food. The lower energizer dominares theseparation of the clear from the turbid and the discharge of fluid and wastes from the body. This process mainly involves the urinary function of the kidney and bladder, and the defaecation function of the large intestine. The same chapter states: "The lower energizer looks like a drainage ditch."

In other words, the turbid water con· tinuously nows downward to be - dis· charged. If the water passage in the lower energizer is obstructed, there may be uri· nary reten tion, dysuria and oedema. Cl inically, the terms upper, middle and lower energizer are often applied to generalise the functions of the internal organs of the chest and abdominal cavity. Above the diaphragm is the upper ener· g.izer wh ich incl udes t he heart and lung ; between the diaph ragm and umbilicus is the middle energizer which includes the spleen and stomach; and below the umbilicus is the lower energizer which in· eludes the kidney, intestines and bladder.

III. THE EXTRA FU ORGANS The extra fu organs comprise the brain, marrow, bones, vessels, gallbladder and uterus. Since they are different from the five zang and six fu organs, they are called the "extra fu." The bones, marrow, vessels and gallbladder have been dis· cussed in the section on the zang·fu or· gans, so only the brain and uterus will be considered here.

J. The Brain The brain is located in the skull and connects with the spinal marrow. The thirty-third chapter of Miraculous Pivot says: "The brain is a sea of marrow:- Its upper pan lies beneath the scalp at the vertex at point Baihui (GV 20) and its lower part at point Fengfu (GV 16)." Baihui (GV 20) and Fengfu (GV 16) are Points of the Governor Vessel which

ascends the spinal column and enters the brain at point Fengfu (GV 16). Many points of the Governor Vessel, therefore, are indicated in pathological conditions of the brain. The brain is the organ of spirit, cons· ciousness and thinking. The seventeenth chapter of Plain Questions says: "The head is the residence of intelligence.'' This means that the brain is related to the activity of thinking. The thirty-third chapter of Miraculous Pivot says: "Deficiency of the brain leads to vertigo and dizziness." lt pointed out that hypofunction of the brain may lead to vert igo and blurred vision. Li Shizhen of the Ming Dynasty ( 1368-1644) clearly indicated that "the bra in is the palace of the mind." In the Qing Dynasty ( 1644·!9 1! ), Wang Qingren in his book Revision of Medical Classics advanced the 1heory 1hat "in tell ig· ence and memory rely on the brain." He considered that thinking, memory, vision, hearing, smelling and speaking are all dominated by the brain. Although the ancients had some knowledge of the physiology and pathol· ogy of the brain, t hey ascribed the func· tions of the brain to various zang·fu organs- the heart, liver and kidney in part icular. Many syndromes and t reatment of brain disturbances, therefore, a re included in the differentiation of syn· dromes of the zang·fu organs.

2. The Uterus The uterus, located in the lower abdomen, presides over menstruation and

nourishes the foetus. It is closely related to the Kidney Meridian, Thoroughfa re and Conception vessels. Since the uterus is related to the kidney. its reproductive function is dominated by the kidney qi. Both the Thoroughfare and Conception vessels originate from the uterus, the Conception Vessel having the function of regulating the qi of all the yin meridians. and the Thoroughfare Vessel the function of regulating the qi and blood of all the twelve regular meridians. When the kidney qi is vigorous and the qi and blood of the Thoroughfare and Conception vessels sufficient, menstruation is normal, and the uterus will perform its functions of reproduction and nourishment of the foetus. If the kidney qi is "eak, the qi and blood of the Thoroughfare and Conception vessels will be deficient, and there will be irregu lar menstruation, amenorrhoea or infertility. The uterus is also closely connected to the heart , liver and spleen. Since normal menstruation and the nourishment of the foetus rely on the blood, which is dominated by the heart. stored by the liver and controlled by the spleen, dysfunction of these organs may affect the normal function of the uterus.

IV. THE RELATIONSHIPS AMONG THE ZANG-FU ORGANS Although the zang and fu organs have different physiological functions, there is a very close relationship between them in ma in taini ng the normal functions of the body. An understanding of the theory of

the relationships between the zang and fu organs is of great significance in clinical differentiation of syndromes and treatment. l nterconnected by the meridian system, the zang and fu organs have an internally-externally linked relationship. For example, the Meridian of HandTaiyin enters the large intestine inferior· ly. and goes upward through 1he diaphragm to connect with the lung. The Meridian of Hand-Yangming enters the lung and descends to connect with the large intestine. In this way a close in ternal relationship between the lung and large intestine is maintained. The heart and small intestine, spleen and stomach, liver and gallbladder and kidney and bladder are similarly closely related. physiologically and pathologically. by means of the yin and yang meridians. The six-second chapter of Plain Quesrions therefore says: ~rhe zang organs are all connected wit h the meridians for the transmission of qi and blood." From this it can be seen that the functional activities. and internal-external relationships of the zang-fu organs. are based on the meridians system. Without the interconnecting pathways of the merid ians, each of the zang·fu organs would become an isolated and static organ. unable tO perform its functiona l activities. This interconnecting function of the me· ridians is reflected not only by the internal-eAternal connection between the zang and the fu organs, but also by relationships within the zang and the fu or· gans themselves. thus forming an inter· nal criss- of the navicular bone (2) and running behind the medial malleolus (3), it enters the heel (4). Then it as· cends along the media l side of the leg (5) to the media l side of t he poplitea l fossa (6) and goes further upwa rd along

1he postero-media l aspect of 1he lhigh (7) towards the vertebral column (Changqiang, GV I), where it enters the kidney. its pertaining organ (8). and connects with the bladder {9). The straight portion of the meridian reemerges from the kidney ( 10). Ascending and passing through the liver and diaphragm ( I I), it enters the lung (I 2),

CHAPTER S Til£ MERJDfANS AND COllATERAL"

• 8

'9~0 - a-

···-- -~--

~~~ ~

1 18

{

( Fig. 11 The Bladder Meridian of Foot-Taiyang

Fig. 12 The Kidney Meridian of Foot·Shaoyin

CHAPTER 5 THE MERlDlANS AND COLLATERALS

runs along the throat ( 13) and terminates at the root of the tongue ( 14). A branch springs from the lung, joins the heart and runs in to the chest to link with the Pericardium Meridian of HandJueyin (15). (See Fig. 12)

9. The Pericard.ium Meridian of Hand-Jueyin The Perica rdium Meridian of HandJueyin originates from the chest. Emerging, it enters its pertaining organ, the perica rdium ( I ). Then, it descends through the diaphragm (2) to the abdo· men, connecting successively wi th the upper, midd le and lower energizer (i.e., Triple Energizer) ( 3). A branch arising from the chest runs inside the chest (4 ), emerges from the costa l region at a point 3 cun below the anterior axillary fold (Tianchi PC I) (5) and ascends to the axilla ( 6 ). Following the medial aspect of the uppe r arm, it runs downward between the Lung Me rid· ian of Hand·Taiying and the Heart Me· ridian of Hand-Shaoyin (7) to the cu bi· tal fossa (8), further downward to the forearm between the two tendons (the tendons of m. pa lmaris longus and m. Oexor carpi radia lis) (9), ending in the palm ( 10). From there it passes along the middle finger right down to its tip (Zhongchong PC 9) ( I I). Anot her branch arises from the palm at Laogong (PC 8) ( 12), runs along the ring finger to its tip (Guanchong, T E I ) and links with the Triple Energizer Me· ridian of Hand-Shaoyang. (See Fig. 13)

10. The Triple Energizer Meridian of Hand-Shaoyaog The T riple Energizer Meridian of Hand-Shaoyang o riginates from the ti p of the ring finger (Guanchong TE I) (I), runn ing upwa rd between the 4th and 5th metacarpal bones (2) a long the dorsa l aspect of the wrist (3) to the latera l aspect of the forearm between the radius and ulna (4). Passing through the olecranon (5) and along the lateral aspect of the upper arm (6), it reaches the shoulder region (7), where it goes across and pass· es behind the Gallbladder Meridian of Foot-Shaoyang (8). Winding over to the supraclavicu lar fossa (9), it spreads in the chest to connect with the pericardium ( 10). It then descends through the d iaphragm down to the abdomen, and joins its pertaining organ, the upper, middle and lower energizer (i.e., Triple Energiz· er) ( I I). A branch originates from the chest ( 12). Running upward, it emerges from the supraclavicular fossa ( 13). From there it ascends to the neck ( 14), running along the posterior border of the ear ( 15), and further to the corner of the an terior hairline ( 16). Then it turns downward to the check and terminates in the infraorbital region ( 17). The auricular branch arises from the retroau ricular region and enters the ear ( 18). Then it emerges in front of the ear, crosses the previous branch at the cheek and reaches the outer canthus (Sizhu· kong, TE 23) to link wi th the Gallbladder Meridian of Foot·Shaoyang ( 19). (See Fig. 14)

CIIINESE ACL'I"*UNCI'URE AND MOXIDUSnON

Fig. 13 The Pericardium Meridian of Hand·Jueyin

11. The Gallbladder Meridian of Foot-Shaoyang The Gallbladder Meridian of FootShaoyang originates from the outer canthus (Tongziliao, GB I) (I), ascends to the corner of the forehead (Hanyan, GB 4) (2), then curves downward to the retroauricular region (Fengchi, GB 20) (3) and runs along the side of the neck in

front of the Triple Energizer Meridian of Hand-Shaoyang to the shoulder (4). Turning back, it t raverses and passes behind the Triple Energizer Meridian of Hand-Shaoyang down 10 the supraclavicular fossa (5). The retroauricular branch a rises from the retroauricular region (6) and enters the ear. It then comes ou t and passes the preau ricular region (7) to the posterior

OIAPTER ; THE MERlDIANS AND COLLATERALS

------ --..

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

...

I I

~: I

v Fig. 14

The Triple EnerQizer Meridian of Hand·Shaoyang

aspect of the outer canthus (8). The branch arising from the outer canthus (9) runs downward to Daying (ST 5) (10) and meets the Triple Energizer Meridian of Hand-Shaoyang in the infraorbital region (I I). Then, passing through Jiache (ST 6) (12), it descends to the neck and enters the supraclavicular fossa where it meets the main meridian

( 13). From there it further descends into the chest ( 14), passes through the diaphragm to connect with the liver ( 15) and enters its pertaining organ , the gallbladder ( 16 ). Then it runs inside the hypochondriac region ( 17), comes out from the lateral side of the lower abdomen near the femora l artery at the inguinal region ( 18). From there it runs superfi-

CHINESE ACUPUNCnJRE AND MOXWUSTION

Fig. 15 The Gallbladder Meridian of Foot-Shaoyang

cially along the margin of the pubic hair (19) and goes transversely into the hip region (Huantiao, GB 30) (20). The straight portion of the channel runs downward from the supraclavicular fossa (21 ), passes in front of the axilla (22) along the lateral aspect of the chest (23) and through the free ends of the noating ribs (24) to the hip region where it meets the previous branch (25). Then it descends along the lateral aspect of the thigh (26) to the lateral side of the knee (27). Going further downward along the anterior aspect of the fibula (28 ) all the way tO its lower end (Xuanzhong, GB 39) (29), it reaches the anterior aspect of the external malleolus (30). It then follows the dorsum of the foot to the lateral side of the tip of the 4th toe (Foot-Qiaoyin GB 44)(31 ). The branch of the dorsum of the foot springs from Foot·Linqi (GB 41), runs between the 1st and 2nd metatarsal bones to the distal portion of the great toe and terminates at its hairy region (Dadun, LR 1), where it links with the Liver Meridian of Foot·Jueyin (32). (See Fig. 15)

12. The Liver Meridian of Foot-Jucyin

Fig. 16 The Liver Meridian of Foot -Jueyin

The Liver Meridian of Foot-Jueyin starts from the dorsal hairy region of the great toe ( Dadun, LR I)( I). Running upward along the dorsum of the foot (2), passing through Zhongfeng (LR 4), I cun in front of the medial malleolus (3), it ascends to an area 8 cun above the medial malleolus, where it runs across and behind the Spleen Meridian of Foot·Taiyin (4 ). Then it runs further upward to the medial side of the knee (5) and along the medial aspect of the thigh (6) to the pubic hair region (7), where it curves around the ex· ternal genita lia (8) and goes up to the lower abdomen (9). It then runs upward and curves around the stomach to enter the liver, its pertaining organ, and connects with the gallbladder ( 10). From there it continues to ascend, passing through the diaphragm (II), and branching out in the costal and hypochondriac region (12). Then it ascends along the posterior aspect of the throat ( 13) to the nasopharynx ( 14) and connects with the •·eye system" ( 15). Running further upward, it emerges from

CHINESE ACUPUNCTURE AND MOXIBLTSTIO K

the forehead ( 16) and meets the Governor Vessel at the vertex. The branch which arises from the ~eye system" runs downward into the cheek ( 18) and curves around the inner surface of the lips (19). The branch arising from the liver (20) passes through the diaphragm (21), runs into the lung and links with the Lung Meridian of Hand-Taiyin (22). (See Fig. 16)

III. THE EIGHT EXTRA MERIDIANS The eight extra meridians are the Governor Vessel, Conception Vessel , Thoroughfare Vessel, Belt Vessel, Yang Heel Vessel, Yin Heel Vessel, Yang Link Vessel and Yin Link Vessel. They are different from the twelve main meridians because none of them pertains to the zang organs and communicates with the fu organs of pertains to the fu organs and communicates with the zang organs. And they are not exteriorly-interiorly related. Apart from the Governor Vessel and Conception Vessel which have their own acupuncture points, the extra meridians share their points with other main meridians. Strengthening the association among the meridians, they assume the responsibility to control, join, store, and regulate the qi and blood of each meridian. Running along the midline of the back and ascending to the head and face, the Governor Vessel meets all the yang meridians. It is therefore described as "the sea of the yang meridians." Its function is

to govern the qi of all the yang meridians. Running along the midline of the abdomen and the chest , going upward to the chin, the Conception Vessel meets all the yin meridians. Thus it is called ~the sea of the yin meridians." Its function is to receive and bear the qi of the yin meridians. The Thoroughfare Vessel runs parallel to the kidney Meridian of FootShaoyin up to the infra-orbital region. Meeting all the twelve main meridians, it is termed "the sea of the twelve main meridians" or "the sea of blood." Its function is to reservior the qi and blood of the twelve main meridians. The Belt Vessel , which originates in the hypochondrium and goes around the waist as a gird le, performs a function of binding up all the meridians. The Yang Heel Vessel starts in the lateral aspect of the heel and merges into the meridian of Foot-Taiyang to ascend, while the Yin Heel Vessel starts in the medial aspect of the heel and merges into the meridian of Foot-Shaoyin to go upwards. Following their own courses, the two meridians meet each other at the inner canthus. Motion regulation of the lower limbs is their joint function. The Yang Link Vessel is connected with all the yang meridians and dominates 'the exterior of the whole body; the Yin Link Vessel is connected with all the yin meridians and dominates the interior of the whole body. The two meridians regulate the flow of qi in the yin and yang meridians, and help maintain coordination and equilibrium between the yin and yang meridians.

OW'TEil S

nre

MEIUDIA.'ward. oonnectang wt -eMCO'OIIOnQihe-V< at the 7th thotacic vertebra

et•ng With the b1«

I "'

Transverse meas- The distance between the bilateral Que pen

8cun

Between the medial border of the scapula and the posterior midline

The Longitudinal measurement of the chest and the hypochondriac region is generally based on the imereostal space.

~ "'>z

5 cun

urement

Back

Explanation

Longitudinal measurement

9cun

Chest and From the sternocostal angle to Abdomen the cemre of the umbiJjcus

Method

3 CUD

(ST 12) can be used as the substitute of the transverse measurement of the two nipples.

Tr(.!nsverse me-as- The longitudinal measurement on the back is uremcnt

based on the spinous processes of the vertebra I eolumn .In clinical practice, the lower angle of the scapula is about at the same level of the 7th thoracic vertebra, the iliac spine is about at the same level of the 4th lumbar vertebra.

!!I 1

Lateral From the end of the axillary fold Side of on the lateral side of the chest to the Chest the tip of the II th rib

12 cun

Upper Ex Between the end of the axillary fold liemitics and the transverse cubital crease Between the transverse cubital crease and the transverse wrist crease

9cun

Lower Ex From the Level or the upper border tremities of symphysis pubis tO the medial epicondyle of femur From the lower border of the medial condyle of tibia to the tip of medial malleolus From the prominence of the great trochanter to the middle of patella

Longitudinal 1 measurement

Used for the three Yin and the three Yang Meridians of the Hand .

12cun

Longitudinal

18 cun

Used for the three Yin Meridians of the Fool.

measurement

13 CUD

I 19 cun

· Longitudinal measurement I

I Between the centre of patella and the tip of lateral malleolus From the tip of the lateral malleolus to the heel

Longitudinal measurement

I. Used for the three Yang Meridians of the Foot. 2. The distance from the gluteal crease to the centre of patella is taken as 14 cun. 3. The anterior level of the centre of the patella !il is about the same level of Oubi (ST 35), and > the posterior level, about the same level of 2 Weizhong (BL 40).

~ ~

L6 CUD

~ ~

;:; Jcun

2. Anatomical Landmarks Various anatomica l landmarks on the body su rface are the basis for locating points. Those landmarks fall into two categories. I) Fixed landmarks Fixed landmarks are those that would not change with body movement. They include the five sense organs. hair, nails. nipple, umbilicus. and prominence and depression of the bones. With them, it is easy to locate poi nts. The proportional measurement is established on the basis of these anatom· icallandmarks. However. points that arc adjacent to or on such landmarks can be located directly. Examples are Yintang (Extra I) between the two eyebrows. Su· liao (GV 25) on the tip of the nose. and Shenque (CV 8) in the centre of the umbi licus. 2) Moving landmarks Moving land· marks refer to those that will appea r on ly when a body part keeps in a specific position. For instances, when the arm is flexed and the cubital crease appears, Quchi ( Ll II) can be located; and when a fist is made and the transverse palmar crease appea rs, Houxi (SI 3) can be locat· ed. Also employed in clinic arc some simple methods of point location. For example, to locate Baihui (GV 20) directly above the apexes of the ears. or Fengshi (GB 31) when at attention. 3. Finger Measurement The length and width of the patient's finger(s) are taken as a standard for point location. The following three methods are commonly used in clinic.

I) Middle finger measuremen t When the patient's middle finger is flexed, the distance between the two med inl ends of the creases of the interphalangeal joints is taken as one cun. This method is employed for measuring the vertical dist· ance to locate the limb points of the yang meridians. or for measuring the horizon· tal distance to locate the points on the back. (See Fig. 46)

2) Thumb measurement The width of the interphalangeal joint of the patient'~ thum b is taken as one cun. The method is also employed for measuring the vert i· cal distance to locate the points on the limbs. (Sec fig. 47) 3) Fou r-ringer measurement The width of the four fingers (index, middle. ring and little) close together at the level of the dorsal skin crease of the proximal interphalangeal joint of the middle finger is taken a~ three cun. It is used to locate the points on the limb and in the abdom· inal region. (See Fig. 48)

CHIN"ESE ACUPUNCTURE ANO MOXIBllSTJON

1 cun

Fig. 47

Fig. 48

III. SPECIFIC POINTS Specific points refer to those of the fourteen merid ians that have special properties and are grouped under special names. In view of their locations, they can be classified into two major groups: one on the limbs, and the other one on the head and the trunk.

1. Specific Points on the Limbs 1) Five Shu Points Each of 1he twelve main meridians has, below the elbow or knee, five specific points, namely, Jing-Well, Ying-Spring, Shu-Stream, Jing-River and He-Sea, which are termed Five Shu points in general. They are situated in the above order from the distal end of extremities tO the elbow or knee. It is said in the fi rst chapter of Miraculous Pivor that ~the qi of the twelve main meridians and fifteen collaterals flow all over the body. The flow of qi running in the meridians from the extremities to the elbow or knee is flourishing gradually." The names of the five shu points image the flow of meridian q i as the flow of water. The Jing-Well point is situated in the place where the meridian q i starts to bubble. The Ying-Spring poin t is where the meridian qi starts to gush. The ShuStream point is where the meridian qi flourishes. The Jing-River point is where the meridian qi is pouring abundantly. Finally, the He·Sea point signifies the confluence of rivers in the sea , where the meridian qi is the most flourishing. In addition , each of the six fu organs has another He-Sea point in the three yang meridians of the foot, known as the Lower He-Sea point. Chapter 4 of MiraCI/Iar Pivot says, "The Lower He-Sea Points of the stomach, large intestine, small intestine, Triple Energizer, bladder and gallbladder are Zusanli (ST 36), Shangjuxu (ST 37), Xiajuxu (ST 39), Weiyang (BL 39), Weizhong (BL 40) and Yanglingquan (GB 34) respectively. Among these points, Zusanli (ST 36), Weizhong (BL 40) and Yang-

lingquan (GB 34) overlap with the releva nt He-Sea points in the Five Shu points. The Lower He-Sea points a re most ly employed to treat the disorders of' the six fu organs in cl inic. 2) Yuan-Primary Points Each of the twelve main meridians has a YuanPrimary Point, which is located on the limbs. The Chinese character .. W. ~ (Yuan) means pri mary qi in this context. The cha pter ~The 66th Medical Problem" in Classic of Medical Problems describes the relation between the Yuan-Primary Points and Yuan-Primary Qi. The Yuan-Primary Qi. originating below the umbilicus and between the kidneys, is dispersed to the zang-fu organs and further to the limbs via Triple Energizer. The sites where the Yuan-Primary Qi is retained are Yuan-Prima ry Poims. which arc used to treat disorders of the zang-fu organs. In the yi n merid ians, the Yuan-Primary Poims overlap with the Shu-Stream Points of the Five Shu Points. Each yang meridian, however. has its Yuan-Primary Point other than the Shu-Stream Point. 3) Luo-Conneetiog Points Each of twelve main meridians has. on the limbs, a Luo-Connecti ng Point to link its ex teriorly-in teri orly related mer idia n. Each of the Governor and Conception vessels. and the Major Collateral of the ~pleen has its Luo-Connecting Poim on the trunk. They are termed "the Fifteen Luo-Connecting Poinb.- A LuoConnecting Poim is used to treat disorders involving the two cx ter iorlyillleriorly related meridians and those in the area supplied by the two mcridinns.

4 ) Xi -Cleft Points T he Xi -Cleft Point is the site where the qi and blood of the meridian are deeply converged. Each of the twelve main meridians and the four extra meridians (Yin Heel Vessel. Yang ll eel Vessel. Yin Link Vessel and Yang LinJ.; Vessel) has a Xi- where the main meridians communicate with the eight extra meridians. They are 'ciguan (PC 6). Gongsun (SP 4), Houxi (SJ 3), Shenmai (BL 62). Waiguan (TE 5), Zulinqi (G B 41 ), Lieque (LU 7) and Zhaohai ( KI 6), which are respectively connected with the Yin Link Vessel. Thoroughfa re Vessel, governor Vessel, Yang ll ee l Vessel. Yang Link Vessel, Belt Vessel, Conception Vesse l and Yin Heel Vessel. The Eight Confluent Point\ are used to treat a variety of disorder\ of the corresponding eight extra meridians.

2. S pecific Points on the H ead a nd T runk 1) Back-Shu Points Back-Shu points are specific points on the back where the qi of the respective zang-fu organs is infused. It is stated in Chapter 51 of Miraculous Pil·ot that "in the Back-Shu Points you arc looking for the reactionary spot> of tenderness and soreness, or the poin ts on which pressure exerted re-

CHIN£Sti ACUPUNCTCR£ AND MOXIBlMlON"

124

lieves pain and discomforts of the patient.~ Situated close to their respectively related zang-fu organs, the Back-Shu points present abnormal reactions to the dysfunction of their corresponding zangfu organs. They are often used for disorders of the internal organs. 2) Front-Mu Points Front·Mu points are those points on the chest and abdomen where the qi of the respective zang-fu organs is infused and converged. Located close to their corresponding zang-fu organs, the Front-Mu points play a significant role in the diagnosis and treatment of the disorders of the internal organs. 3) Crossing Points Crossing points are those at the intersections of two or more meridians. Distributed mainly on the head, face and trunk, and amounting to over ninety in total. They are key points used to treat meridian disorders of the areas where they are located.

Appendix Eight Influential Points The Eight lnOuential points are first recorded in the chapter 'The 45th Medical Problem" of Classic on Medical Problems. They are Zhangmen ( LR 13 ), Zhongwan (CV 12), Yanglingquan (GB 34), Juegu, or Xuanzhong (GB 39), Geshu (BL 17), Dazhu (BL II), Taiyuan (LU 9), and Tanzhong (CV 17), which respectively dominate the zang organs, fu organs, qi, blood, tendon, vessel, bone and marrow. They coincide with some other specific points. Clinically, the corresponding inOuemial point can be employed to treat disorders of the zang or-

gans, fu organs, qi, blood, tendon, vessel, bone or marrow.

IV. AN OUTLINE OF THE THERAPEUTIC PROPERTIES OF THE POINTS OF THE FOURTEEN MERIDIANS The therapeutic properties of the points of the fourteen meridians are generalized on the basis of the principle that the course of the meridian is amenable to treatment. Each of the points has its own therapeutic feature owing to its particular location and pertaining meridian. Generally speaking, however, all the points can be used to treat disorders of the areas where they are located , and those adjacent to their location. These a re known respectively as the local and adjacent points with therapeutic properties. In addition , some of the points ean be used to treat disorders of the area's far away from where they are located. These are known as the remote or distal points with therapeutic properties.

1. T he Remote Therapeutic P roperties of the Points The remote therapeutic properties of the points form a major regularity which is established on the basis of the meridian theory. Among the points of the fourteen meridians, those located on the limbs, especia lly below the elbow and knee joints, are effective not only for local disorde rs

CHAPTER 6 AN IN1.RODUC1'10N TO ACUPUNCTURE POII\"TS

but also for disorders of the remote zangfu organs and tissues on the course of their pertaining meridians. Some even have systemic therapeutic properties. For example, Lieque (LU 7) treats disorders not only on the upper limbs but also in the vertex, chest, lung and throat as well as exogenous diseases; Yanglingquan (GB 34) is effective not only for diseases of the lower limbs but also for hypochondrium, biliary, hepatic, and mental disorders as well as tendon abnormalities such as spasm and convulsion. For detailed information, see Table6.

2. The Local and Adjacent Therapeutic Properties of the Points All the points in the body share a common feature in terms of their therapeutic properties, namely, all have local and adjacent therapeutic properties. Each point located on a particular si te is able to treat disorders of this area and of nearby organs. For example, Yingxiang (LI 20) and Kouheliao (LI 19) located beside the nose, and the neighboring points Shangxing (GV 23), Tongtian (BL 7) can all be effective to nasal disorders. Zhongwan (CV 12) and Liangmen (ST 21) located in the epigastric region, and the nearby points Zhangmen (LR 13) and Qihai (CV 6) are used for gastric disorders. The therapeutic properties of the points on the head, face and trunk are judged according to this principle, so are those of the points on both the Conception and Governor vessels and those of the points situated bilaterally along the above two extra meridians. Owing to the

125

special distribution of the Conception and Governor vessels, their points have more systemic influence. The local and adjacent therapeutic properties of the points on the head, face and trunk are generalized in Table 7. The remote, adjacent, and local therapeutic property of these points are determined by how far away their effects reach from the location of points themselves. The therapeutic properties, remote, adjacent, or local points, are nevertheless characterized by functional regulation. Cl inical practice has proven that puncturing certain points may bring forth biphasic regulation on diversified functional abnormalities of the body. For instance, puncturing Tianshu (ST 25) relieves both diarrhea and constipation; puncturing Neiguan (PC 6) corrects both tachycardia and bradycardia. In add ition to the general therapeutic properties of points, clinical attention should also be paid to the special therapeutic properties of some points. Examples are Dazh ui (GV 14 ), which has an antipyretic effect, and Zhiyin (BL 67), which is indicated in malposition of a fetus. To sum mari ze all the points of a particular meridian are indicated in the disorders of that particular meridian. Points of the exteriorly-interiorly related meridians can be combined to treat disorders of those meridians. Neighbouring points will have sim ilar therapeutic properties. The therapeutic properties of the points on the limbs should be catagorized meridian by meridian, those points of the head, face and trunk, should be recognized in light of their locations.

i Table 6. Indications

Indications of Points of tbe Extremities "i th Relation to Meridians

Meridian

Indications of Three Meridians in Common

Indications of Two Mcridiansin Common

Indications of Individual Meridian

Name of the meridian The Three Yin Meridians of Hand

The Lung Meridian of Hand·Taiyin

The Pericardium Meridian Dtsorders of the heart and istomach of Hand·Jueyin Disorders of the heart The Heart Meridian of lland·Shaoyin The Three Yang Meridian of Hand

---------

Disorders of Chest

DISOrders of the lung and throat

Mental illness

The Large Intestine Merid·IDisorders of the forehead, face, ian of Haod·Yangming nose, mouth and teeth The Triple Energizer Me- DISOrders of the temporal and rid ian of Hand·Shaoyang hypochondriac regions The Small Intestine Merid· DISOrders of the occipital region tan of Haod·Taiyang nod scapular region and mentnl illness

Disorders of the eye, throat and febrile diseases Disorders of the ear

--r------------~

The Stomach Meridian of !Disorders of the face, mouth, f'oot·Yaogming teeth, throat, stomach and

The Three Yang Meridians of Foot

..2

intcstine 1

The Gallbladder Meridian !Disorders of the ear, temporal of Foot·Shaoyang and hypochondriac regions

McnwJ illness, febrile diseases Disorders of the eyes

~ ~

"'>

""'

g 4

"'>z

The Gallbladder Meridian Disorders of the neck, dorsaof Foot·Tu iyang lumbar region. (Back·Shu Points !a lso for zang·fu disorders.) The Spleen Meridian of Foot·Taiyin The Three Yin Meridians of Foot

D ISOrders of tbe spleen and stomach

Disorders of the external genitalia, gynaecological diseases

The Uver Merid ian of Foot·Jueyin

Disorders of the liver

The J(jdoey Meridian of Foot·Shaoyin

Disorders of the kidney, lung and throat

! ~

a >

g "' ~

~ z 7

lndicalions of Conception and Governor Vessels Meridian Conception Vessel

Indications of lndividual Meridian

Indications of Two Meridians in Common

I Prolapse of Yang, collapse. ( It is also for

Disorders of zang·fu organs, men tal illness, gynaecological disorders

general tonification.) Governor Vessel

I ApOplexy, coma, febrile diseases, disorders of I he bead and face

I ':j

128

Table 7.

CHINESE ACUPUNCTURE AND MOXlBUSTJON

Indications of Points on tbe Head, Face and Trunk with Relation to Their Locations

Locations of Points

Indications

Head. face, neck

Disorders of the brain, eye, ear, nose, mouth, teeib and throat

Chest, upper dorsal region (corresponding to the region between the lsi and 7th thoracic venebrae)

Disorders of the lung and heart

Upper abdomen, lower dorsal region (corres· poncling to !be region between !be 8th thoracic and !be 1st lumbar venebrae)

Disorders of the liver, gallbladder, spleen and stomach

Lower abdomen, lumbosacral region (cones· ponding to !be region between the 2nd lumbar and the 4th sacral vertebrae)

Disorders of the kidney, intestine, bladder and genital organs

Cl-tAPTF..R 6 AN lNTROOl.'CTION TO ACl:PUNCTURE POINTS

Hand-Jueyin Mendian

Hand-Sheoyang Meridian Fig. 49 The Indicat ions of the Points in the Upper Limbs

149

(:IJINeiE ACUPt: r->Cl'URE AND MOXIBUSTION

130

Diseases at An~01lor A$pe YANGMIN(; .\1ERIDIANS

Innervation: The pathway of the ilioingui nal nerve.

31. Biguan (ST 31) Loca tion: On the anterior side of the th igh and on the line connecting the anterosu perio r iliac s pi ne and the superiolateral corner of the patella. on the level of the perineum when the th igh is fixed, in the depression latera l to the sartorius muscle. (See Fig. 69) Indications: Pain in the thigh, muscular atrophy, motor impai rment, numbness and pain of the lower extremities. Met hod: Puncture perpendicularly Lo-1.5 inches. Moxibustion is applicable.

Biguan(ST 31) - -

Regional anatomy Vascu lature: Deeper, the branches of the lateral circumflex femora l a rtery and vein. Innervation: The lateral femoral cu· taneous nerve. 32. Futu (ST 32) Location: On the line connecting the anterior supe rior iliac spine and latera l border of the patella. 6 cun above the laterosuperior border of the patella. (See Col. Fig. 4) Ind ications: Pain in the lumbar and iliac region, coldness of the knee, paralysis or motor impairment and pain of the lower extremities, beriberi. Method: Punc tu re perpendicularly 1.0·1.5 inches. Moxibust ion is applicable. Regional anatomy Vascu latu re: The branches of the lat· eral circumflex femoral artery and vein. Innervation: The anterior and lateral femoral cutaneous nerves.

33. Yinshi (ST 33)

Liangqiu(ST34) - - - -

Fig.69

Location: When the knee is flexed, the pOint is 3 cun above the laterosuperior border of the pa tel la. on the line joining the laterosuperior border of the patella and the anterior supe rio r iliac spine. (See CoL Fig. 4) Indica tions: Numbness. soreness. mo· tor impai rment of the leg and knee. mo· tor impairmem of the lower extremities. Method: Puncture perpendicularly 0. 7-1.0 inch. Mox ibustion is appl icable. Regional anatomy Vasculature: The descend ing branch

CHJNt:SE ACUPUNCTIJRE AND MOXlOUSTION

154

of the lateral ci rcumflex femoral artery. Innervation: The anterior and lateral femoral cutaneous nerves.

34. Liangqiu (Xi-Cleft Point, ST 34) - - ZusanN (ST 36)

Location: When the knee is flexed, the point is 2 cun above the laterosuperior border of the patella. (See Fig. 69) Indications: Pain and numbness of the knee, gastric pain, mastitis, motor impairment of the lower extremities. Method: Puncture perpendicularly 0.5-1.0 inch. Moxibustion is applicable. Regional anatomy: See Yinshi (ST 33)

8 cun ~- -

--51\a.nQJuxu tST 37) •• Fongtong(ST 40) >-'t_.'M'-f-f-- TlaoMu(ST38)

-- Xi.ajuxu (ST 39)

8 """

35. Dubi (ST 35) Location: When the knee is flexed, the point is at the lower border of the patella, in the depression lateral to the patellar ligament. (See Fig. 70) Indications: Pain, numbness and motor impairment of the knee, beriberi. Method: Puncture perpendicularly 0.7-1.0 inch. Moxibustion is applicable. Regional anatomy Vasculature: The arterial and venous network around the knee joint. Innervation: The lateral sural cu· taneous nerve and the articu lar branch of the common peroneal nerve.

36. Zusanli (He-Sea Point, ST 36) Location: 3 cun below Dubi (ST 35), one finger-breadth (middle finger) from the anterior border of the tibia. (See Fig. 70) Indications: Gastric pain, vomlllng hiccup, abdominal distension, borboryg-

Flg. 70

mus, diarrhea, dysentery, constipation, mastitis, enteritis, aching of the knee joint and leg, beriberi, edema, cough, asthma, emaciation due to general deficiency, indigestion, apoplexy, hemiplegia, dizziness, insomn ia, mania. Method: Puncture perpendicularly 0.5-1.2 inches. Moxibustion is applicable. Regional anatomy Vascu lature: The anterior tibial artery and vein. Innervation: Superficially, the latera l sural cutaneous nerve and the cutaneous branch of the saphenous nerve; deeper, the deep peroneal nerve.

37. Shangjuxu (The Lower He-Sea Point of the Large Intestine, ST 37) Location: 6 cun below Dubi (ST 35), and one finger breadth (middle finger)

CHAPTER 7 ACUPUNCTURE POINTS OP THE TArYlN AND YANG.\UNG MERIDLANS

from the anterior border of the tibia. (See Fig. 70) Indications: Abdominal pain and distension, borborygmus, diarrhea, dysentery, constipation, enteritis, paralysis due to stroke, beriberi. Method: Puncture perpendicularly 0.5-1.2 inches. Moxibustion is applicable. Regional anatomy: See Zusan li (ST 36)

38. Tiaokou (ST 38) Location: 8 cun below Dubi (ST 35) and on finger breadth (middle finger) from the anterior border of the tibia. (See Fig. 70) Indications: Numbness, soreness and pain of the knee and leg, weakness and motor impairment of the foot, pain and motor impairment of the shoulder, abdomi nal pai n. Method: Puncture perpendicularly 0.5-1.0 inch. Moxibust ion is applicable. Regional anatomy: See Zusan li (ST 36)

1~5

Vasculatu re: The anterior tibial artery and vein. Innervation: The branches of the superficial peroneal nerve and the deep peroneal nerve.

40. Fenglong (Luo-Connecting Point, ST40) Location: 8 cun superior to the tip of the external malleolus, lateral to Tiaokou (ST 38) about two finger-breadth lateral to the anterior border of the tibia. (See Fig. 70) Indications: Headache, dizziness and vertigo, cough, asthma, excessive sputum, pain in the chest, constipation, mania, epilepsy, muscular atrophy, motor impairment, pain, swelling or paralysis of the lower extremities. Method: Puncture perpendicularly 0.5- 1.0 inch. Moxibustion is applicable. Regional anatomy Vasculature: The branches of the anterior tibial artery and vein. Innervation: The superficial peroneal nerve.

39. Xiajuxu (The Lower He-Sea Point of the Small Intestine, ST 39)

41. Jiexi (Jing-River Point, ST 41)

Location: 9 cun below (Dubi (ST 35) and one finger breadth (middle finger) from the anterior border of the tibia. (See Fig. 70) Indications: Lower abdomina l pain, backache referring to the testis, mastitis, numbness and paralysis of the lower extremities. Method: Puncture perpendicularly 0.5-1.0 inch. Moxibustion is applicable. Regional anatomy

Location: On the dorsum of the foot, at the midpoint of the transverse crease of the ankle joint, in the depression between the tendons of m. extensor digitorum longus and hallucis longus, approximately at the level of the tip of the external malleolus. (See Fig. 71) Indicat ions: Pain of the ankle joint, muscular atrophy, motor impairment, pain and paralysis of the lower ext remities, epilepsy, headache, dizziness and

116

Chongyang (ST 42)

foot, facial paralysis, muscular atrophy and motor impairment of the foot. Met hod: Avoid puncturing the a rtery. Puncture perpend icularly 0.3·0.5 inch. Moxibustion is applicable. Regional anatomy Vasculature: The dorsal artery and vein of foot. the dorsal venous network of foot. Innervation: Superficially, the medial dorsal cutaneous nerve of foot derived from the superf ic ial peroneal nerve; deeper, the deep peroneal nerve.

43. Xiangu (S hu-Stream Point, ST 43) flg 71

vertigo, abdominal distension, constipa· tion. Method : Puncture pe rpendicul arly 0.5-Q. 7 inch. Moxi bustion is appl icable. Regional anatomy Vasculature: The anterior tibial artery and vein. Innervation: The superficial and deep peroneal nerves.

42. Chongyang (Yuan-Primary Poi nt, ST42) Location: On the dome of the instep of the foot, between the tendons of long extensor muscle of the great toe and long extensor muscle of toes, where the pulsa· tion of the dorsal artery of foot is palpa· ble. (See Fig. 71) Indications: Pain of the upper teeth , redness and swell ing of the dors um of the

Location: In the depression distal to the junction of the second and t hird metatarsal bones. (See Fig. 71) Indications: Facial or general edema, abdomina l pa in, borborygmus, swell ing and pa in of the dorsum of t he foot. Method: Puncture perpendicularly 0.3-Q.S inch. Moxi bustion is applicable. Regional anatomy Vasculature: The dorsal venous net· work of foot. Innervation: The medial dorsal cu· taneous nerve of foot.

44. Neiting (Ying-S pring Point, ST 44) Locat ion: Proximal to the web margi n between the second and third toes. in the depression distal and lateral to the second metatarsodigital joint. (See Fig. 71) Indications: Toothache, pain in the face, deviation of the mouth. sore throat, epistaxis, gastric pai n, acid regurgitation, abdominal distension, d iarrhea, dysen· tery, const ipa tion, swelling and pa in of

CHAPTER 7 ACUPUNCTURE POINTS OF THE TAIYlN AND YANGfoiiNG MERIDIANS

the dorsum of the foot, febrile diseases. Method: Puncture perpendicularly 0.3-().5 inch. Moxibustion is applicable. Regional anatomy Vasculature: The dorsal venous network of foot. Innervation: Just where the lateral branch of the medial dorsal cutaneous nerve divides into dorsal digital nerves.

45. Lidui (Jing-Well Point, ST 45) Location: On the lateral side of the 2nd toe, 0.1 cun posterior to the corner of the nail. (See Fig. 71) Indications: Facia l swelling, deviation of the mouth, epistaxis, toothache, sore throat and hoarse voice, abdominal distension, coldness in the leg and foot, febrile diseases, dream-disturbed sleep, mania. Method: Puncture subcutaneously 0.1 inch. Moxibustion is applicable. Regional anatomy Vasculature: The arterial and venous network formed by the dorsal digital artery and vein of foot. Innervation: The dorsal digital nerve derived from the superficial peronea l nerve.

IV. THE SPLEEN MERIDIAN OF FOOT-TAIYIN 1. Yinbai (Jing-Well Point, SP 1) Location: On the medial side of the great toe, 0.1 cun posterior to the corner of the nail. (See Fig. 72) Indications: Abdominal distension,

· ~7

bloody stools, menorrhagia, uterine bleeding, mental disorders, dreamdisturbed sleep, convulsion. Method: Puncture subcutaneously 0.1 inch. Moxibustion is applicable. Regiona l anatomy Vasculature: The dorsal digital artery. Innervation: On the anastomosis of the dorsa l digital nerve derived from the superficial peroneal nerve and the plantar digital propria) nerve.

2. Dadu (Ying-Spring Point, SP 2) Location: On the medial side of the great toe, distal and inferior to the first metatarsodigital joint, in the depression of the junction of the red and white skin. (See Fig. 72) Indications: Abdominal distension, gastric pain, constipation, febrile diseases with anhidrosis. Method: Puncture perpendicularly O.I-Q.3 inch. Moxibustion is applicable. Regional anatomy Vasculature: The branches of the medial plantar artery and vein. Innervation: The plantar digital propria) nerve derived from the medial plantar nerve.

3. Taibai (Shu-Stream and Yuan-Primary Point, SP 3) Location: Proximal and inferior to the 1st metatarsophalangeal joint, in the depression of the junction of the red and white skin. (See Fig. 72) indications: Gastric pain, abdominal distension, constipation, dysentery, vomiting diarrhea, borborygmus, sluggish-

ll8

Shangcaiu (SP 5}

'-,

Flg. 72

ness, beriberi. Method: Puncture perpendicularly 0.3.0.5 inch. Moxibustion is applicable. Regional anatomy Vasculature: The dorsal venous net· work of the foot, the medial plantar artery and the branches of the medial tarsal artery. Innervation: The branches of the sa· phenous nerve and superficial peroneal nerve. 4. Gongsun (Luo-Connecting Point, Confluent Point, S P 4)

Location: In the depression distal and inferior to the base of the first metatarsal bone. at the junction of the red and white skin. (See Fig. 72) Indications: Gastric pain, vomi ting, abdominal pain and distension, diarrhea, dysentery, borborygmus. Method: Puncture perpendicularly 0.5.0.8 inch. Moxibustion is applicable. Regional anatomy Vasculature: The medial tarsal artery and the dorsal venous network o( the foot.

Innervation: The saphenous nerve and the branch of the superficial peroneal nerve. 5. Shangqiu (Jing-River Point, SP S)

Location: In the depression distal and inferior to the medial malleolus. midway between the tuberosity of the navicular bone and the tip of the media l mal leolus. (See Fig. 72) Indications: Abdominal disten sion. constipation, diarrhea, borborygmus, pain and rigidity of the tongue, pain in the foot and ankle, hemorrhoid. Method: Puncture perpendicularly 0.2.0.3 inch. Moxibustion is applicable. Regional anatomy Vasculature: The medial tarsa l artery and the great saphenous vein. Innervation: The medial crural cutaneous nerve and the branch of the s uperficial peroneal nerve.

6. S anyinjiao (S P 6) Location: 3 cun directly above the tip of the medial malleolus, pOsterior to the medial border of the tibia. (See Fig. 73)

CHAPTER 7 ACUVUNCTUR!i POINTS OF THE TAIYlN A.ND YA.NGMJNG MERIDIANS

Indications: Abdominal pain, borborygmus, abdominal distension, diarrhea, dysmenorrhea, irregular menstruation, uterine bleeding, morbid leukorrhea, prolapse of the uterus, sterility, delayed labour, nocturnal emission, impotence, enuresis, dysuria, edema, hernia, pai11 in the external genitalia, muscular atrophy, motor impairment, paralysis and pain of the lower extremities, headache, dizziness and vertigo, insomnia. Method: Puncture perpendicularly 0.5-1.0 inch. Moxibustion is applicable. Acupuncture on this point is contraindicated in pregnant women. Regional anatomy Vasculature: The great saphenous vein, the posterior tibial artery and vein. Innervation: Superficially, the medial crural cutaneous nerve; deeper, in the posterior aspect, the tibial nerve.

l$9

lingquan (SP 9) and the medial malleolus. (See Fig. 73) Indications: Abdominal pain and distension , diarrhea, edema, dysuria, nocturnal emission, irregular menstruation, dysmenorrhea. Method: Puncture perpendicularly 0.5-1.0 inch. Moxibustion is applicable. Regional anatomy Vasculature: Anteriorly, the great saphenous vein and the branch of the genu suprema artery; deeper, the posterior tibial artery and vein. Innervation: See Sanyinjiao (SP 6).

9. Yinlingquan (He-Sea Point, SP 9)

7. Lougu (SP 7) Location: 6 cun from the tip of the medial malleolus, on the line connecting the tip of the medial malleolus and Yinlingquan (SP 9), posterior to the medial border of the tibia. (See Fig. 73) Indications: Abdominal distension, borborygmus, coldness, numbness and paralysis of the knee and leg. Method: Puncture perpendicularly 0.5-1.0 inch. Moxibustion is applicable. Regional anatomy: See Sanyinjiao (SP 6).

YinlinOQue_n (SP 9) _

Oij;(SP 8} - - -

7 """

lougu(SP7) - -

Sanyln~ao(SPB) - - -

8. Diji (Xi-Cleft Point, SP 8) Location: 3 cun below Yinlingquan (SP 9), on the line connecting Yin-

Fig. 73

Bcun

CHlNESE ACUPUNCTURE AND MOXIO.USTIO.~

160

Location: On the lower border of the medial condyle of the tibia, in the depression posterior and inferior to the midia l condyle of the tibia. (See Fig. 73) Indications: Abdominal pain and distension , diarrhea, dysemery, edema, jaundice, dysuria, enuresis, incontinence of urine, pain in the external genita lia, dysmenorrhea, pain in the knee. Method: Puncture perpendicularly 0.5-1.0 inch. Moxibustion is applicable. Regional anatomy Vasculature: Anteriorly, the great saphenous vein, the genu suprema artery; deeper, the posterior tibial artery and vein. Innervation: Superficially, the medial crural cutaneous nerve ; deeper, the tibial nerve.

lO. Xuehai (SP 10) Location: When the knee is nexed, the point is 2 cun above the mediosuperior border of the patella, on the bulge of the medial portion of m. quadriceps femoris. Or when the patient's knee is nexed, cup your right palm to his left knee, with the thumb on the medial side and with the other four fingers directed proximally, and the thumb forming an angle of 45• with the index finger. The point is where the tip of your thumb rests. (See Fig. 74) Indications: Irregular menstruation, dysmenorrhea, uterine bleeding, amenorrhea, urticaria, eczema, erysipelas, pain in the medial aspect of the thigh. Method: Puncture perpendicularly 0.5-1.2 inches. Moxibustion is applicable. Regiona l anatomy

Xuehaii SP 10)

Fig. 74

Vasculature: The muscular branches of the femoral anery and vein. Innervation: The anterior femoral cutaneous nerve and the muscu lar branch of the femora l nerve.

ll. Jimen (SP II) Location: 6 cun above Xuehai (SP 10), on the line drawn from Xuehai (SP 10) to Chongmen (SP 12). (See Co l. Fig. 5 ) Indications: Dysuria, enuresis, pain and swelling in the inguinal region, muscu lar atrophy, motor impairment, pain and paralysis of the lower extremities. Method: Puncture perpendicularly 0.5-1.0 inch. Moxibustion is applicable. Regiona l anatomy Vasculature: Superficially, the great saphenous vein ; deeper on the lateral side, the femoral artery and vein. Innervation: The anterior femoral cutaneous nerve ; deeper, the saphenous nerve.

12. C hongmen (SP l 2) Location: Superior to the lateral end

CHAPTI!R 7 ACUPUNCTURE POINTS OF

TAlYlN Ar\'0 YANGMir\'(i Mli:iUOIANS

of the inguinal groove, lateral to the pulsating external iliac artery, at the level of the upper border of symphysis pubis, 3.5 cun lateral to Qugu (CV 2). (See Col. Fig. 6) Indications: Abdominal pain, hernia, dysuria. Method: Avoid puncturing the artery. Puncture perpendicularly 0.5-l.O inch. Moxibustion is applicable. Regional anatomy Vasculature: On the medial side, the femoral artery. Innervation: Just where the femoral nerve traverses.

13. Fushe (SP 13) Location: 4 cun below the centre of the umbilicus, 0.7 cun superior to Chongmen (SP 12), 4 cun lateral to the anterior midline. (See Col. Fig. 6) Indications: Lower abdominal pain. hernia. Method: Puncture perpendicularly 0.5-l.O inch. Moxibustion is applicable. Regional anatomy Innervation: The ilioinguinal nerve.

14. Fujie (SP 14) Location: !.3 cun below Daheng (SP 15), 4 cun lateral to the anterior midline, on the lateral side of m. rectus abdominis. (See Col. Fig. 6) Indications: Pain around the umbilical region, abdominal distension, hernia, diarrhea, constipation. Method: Puncture perpendicular ly 0.5-1.0 inch. Moxibustion is applicable. Regional anatomy

161

Vasculature: The eleventh intercostal artery and vein. Innervation: The eleventh intercostal nerve.

15. Daheng (SP 15) Location: 4 cun latera l to the center of the umbilicus, lateral tom. rectus abdominis. (See Fig. 75) Indications: Abdominal pain and dis· tension, diarrhea, dysentery, constipa· tion. Method: Puncture pe rpendicularly 0. 7-1.2 inches. Moxibustion is applicable. Regional anatomy Vascu lature: The tenth intercostal ar· tery and vein. Innervation: The tenth intercostal nerve.

16. Fuai (SP 16) Location: 3 cun above the centre of the umbi licus, and 4 cun lateral to the anterior midline. (Col. Fig. 6) Indications: Abdomina l pain, indiges· tion, constipation, dysentery. Method: Puncture perpendicularly 0.5-1.0 inch. Moxibustion is applicable. Regional anatomy Vasculature: The eighth intercostal artery and vein. Innervation: The eighth intercostal nerve.

17. Shidou (SP 17) Location: In the fifth intercostal space, 6 cun lateral to the anterior mid· line. (See Col. Fig. 6)

Daheng(SP 15) - - - -

'\'- ...- / F'og. 75

Indications: Fullness and pain in the chest and hypochondriac region. Method: Puncture obliquely 0.3.0.5 inch. Moxibustion is applicable. Regional anatomy Vasculature: The thoracoepigastric vein. Innervation: The lateral cutaneous branch of the fifth intercostal nerve.

18. Tianxi (SP 18) Location: In the fourth intercostal space, 6 cun lateral to the anterior mid· Iine. (See Col. Fig. 6) Indications: Fullness and pain in the chest and hypochondrium, cough. hie· cup, mastitis, insufficient lactation. Method: Puncture obliquely 0.3.0.5 inch. Moxibustion is applicable. Regional anatomy Vasculature: The branches of the lat·

era I thoracic artery and vein, the thoracoepigastric artery and vein, the fourth in· tercostal artery and vein. Innervation: The lateral cutaneous branch of the fourth intercostal nerve.

19. Xiongxiang (SP 19) Location: In the third intercostal space, 6 cun lateral to the anterior mid· line. (See Col. Fig. 6) Indica tions: Fullness and pain in the chest and hypochondriac region. Method: Puncture obliquely 0.3.0.5 inch. Moxibustion is applicable. Regional anatomy Vasculature: The lateral thoracic ar· tery and vein. the third intercostal artery and vein. Innervation: The lateral cutaneous branch of the third intercostal nerve.

QlAP'TI!R 1' Aa..tPUNC'Tl'RE

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nte

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20. Zbourong (SP 20) Location: In the second intercostal space, 6 cun lateral to the anterior midline. (See Col. Fig. 6) Indications: Fullness in the chest and hypochondriac region, cough, hiccup. Method: Puncture obliquely O.Hl.5 inch. Moxibustion is applicable. Regional anatomy Vasculature: The lateral thoracic artery and vein, the second intercostal ar· tery and vein. Innervation: The muscular branch of the anterior thoracic nerve, the lateral cutaneous branch of the second intercostal nerve.

21. Oabao (Major Luo-Connecting Point of the S pleen, S P 2l) Location: On the latera l side of the chest and on the middle aKillary line, in the 6th intercostal space. (See Col. Fig. 6} Indications: Pain in the chest and hypochondriac region, asthma, general aching and weakness. Method: Puncture obliquely 0.3~.5 inch. Moxibustion is applicable. Regional anatomy Vascu lature: The thoracodorsal artery and vein, the seventh intercostal artery and vein. Innervation: The seventh intercostal nerve and the terminal branch of the long thoracic nerve.

Chapter 8

ACUPUNCTURE POINTS OF THE SHAOYIN AND TAIYANG MERIDIANS Vasculature: Laterally, the axillary artery. Innervation: The ulnar nerve, median nerve and medial brachial cutaneous nerve.

The Heart Meridian of Hand-Shaoyin going from the chest to the hand and the Small Intestine Meridian of HandTaiyang going from the hand to the head are exteriorly and interiorly related, so are the Bladder Meridian of FootTaiyang running from the head to the foot and the Kidney Meridian of FootShaoyin running from the foot to the abdomen (chest). The four meridians are mainly distributed on the extremities and in the posterior aspect of the trunk. Their acupuncture points are described as follows:

2. Qingling (HT 2) Location: When the elbow is flexed , the point is 3 cun above the medial end of the transverse cubital crease (Shaohai HT 3), in the groove media l tom. biceps brachii. (See Col. Fig. 7) Indications: Pain in the cardiac and hypochondriac regions. shoulder and arm. Method: Puncture perpendicularly 0.3-o.s inch. Moxibustion is applicable. Regional anatomy Vasculature: The basilic vein, the superior ulnar collateral artery. Innervation: The medial antebrachial cutaneous nerve, the medial brachial cutaneous nerve and the ulnar nerve.

I. THE HEART MERIDIAN

OF HAND-SHAOYIN 1. Jiquan (HT 1) Location: When the upper arm is abducted, the point is in the centre of the axilla, on the medial side of the axillary artery. (See Col. Fig. 7) Indications: Pain in the costal and cardiac regions, scrofula, cold pain of the elbow and arm, dryness of the throat. Method: Avoid puncturing the axillary artery. Puncture perpendicularly 0.5-1.0 inch. Moxibustion is applicable. Regional anatomy

3. Shaohai (He-Sea Point, HT 3) Location: With the elbow flexed, at the midpoint of the line connecting the medial end of the cubital crease and the medial epicondyle of humerus. (See Fig. 76) 1(\f

Vasculature: Deeper, the posterior tibial artery and vein. Innervation: The medial sural and me· dial crural cutaneous nerves, deeper, the tibial nerve.

10. Yingu (He-Sea Point, KilO) Location: When the knee is nexed, the point is on the medial side of the poplit· eal fossa, between the tendons of m. semi· tendinosus and semimembranosus, at the level with Weizhong (Bl 40). (See Fig. 91) Indications: Impotence, hernia, uter· ine bleeding, dysuria, pain in the knee and popliteal fossa, mental disorders.

Method: Puncture perpendicularly 0.8·1.0 inch. Moxibustion is applicable. Regional anatomy Vasculature: The medial superior gen· icular artery and vein. Innervation: The medial femoral cu· taneous nerve.

II. Henggu (Kl 11) Location: 5 cun below the umbilicus, on the superior border of symphysis pub· is, 0.5 cun latera l to Qugu (CV 2). (Col. Fig. 12) Indications: Fullness and pain of the lower abdomen, dysuria enuresis, noctur· nal emission, impotence, pain of geni· talia. Method: Puncture perpendicularly 0.5·1.0 inch. Moxibustion is applicable. Regional anatomy Vasculature: The inferior epigastric artery and external pudenda l artery. Innervation: The branch of the iliohypogastric nerve.

12. Dahe (KI 12) Swn

Zhubin(KI9)3cur. 2cun

Fig.91

Location: 4 cun below the umbilicus, 0.5 cun lateral to Zhongji (CV 3). (See Fig. 92) Indications: Nocturnal emission, im· potence, morbid leukorrhea, pain in the external genitalia, prolapse of uterus. Method: Puncture perpendicularly 0.5·1.0 inch. Moxibustion is applicable. Regional anatomy Vasculature: The muscular branches of the inferior epigastric artery and vein. Innervation: The branches of subcos· tal nerve and the iliohypogastric nerve.

CHAl'T£ll 8 ACtJPl:NCT\:RE POIJ>'TS 01 ntE SHAOYIN M 1l TAJYAIfuangsllu t KI 16}

_A_ ~·"· . .

4cun

Fig. 92

al pain, steri lity. Method: Puncture perpendicularly 0.5·1.0 inch. Moxibustion is applicable. Regional anatomy Vasculature: The branches of the su· perio r epigastric artery and vein. Innervation: The eighth intercosta l nerve.

19. Yindu (KI 19) Location: 4 cun above the umbilicus, 0.5 cun lateral to Zhongwan (CV 12). (See Col. Fig. 12) Indications: Borborygmus, abdom inal pain, epigastric pain, constipation, vomi t· in g. Method: Puncture perpendicularly 0.5·1.0 inch. Moxibustion is applicable. Regional anatomy: See Shiguan

( KI 18).

20. Futonggu (KI 20) Location: 5 cun above the umbilicus, 0.5 cun lateral to Shangwan (CV 13). (See Col. Fig. 12) Indications: Abdominal pain and dis· tension, vomiting, indigestion. Method: Punctu re perpendicularly 0.5·1.0 inch . Moxibustion is applicable. Regional anatomy: See Sh iguan (Kl 18).

21. Youmen (KI 21) Location: 6 cun above the umbilicus, 0.5 cun latera l to Juque (CV 14). (Col. Fig. 12) Indications: Abdominal pain and dis·

CHAI"''D 8 AOJPUNC'ruRE POIN1'5 Of nf! SHAOvtN AN"D TAIYANG loi£JUOIANS

tension, indigestion, vomiting, diarrhea, nausea, morning sickness .. Method: Punctu re perpendicularly 0.3.0.7 inch. To avoid injuring the liver, deep insertion is not advisable. Moxibus· tion is applicable. Regional anatomy Vasculature: See Shiguan ( IU 18). Innervation: The seventh intercostal nerve.

22. BuJang (K122) Location: In the fifth intercosta l space, 2 cun lateral to the Conception Vessel. (See Col. Fig. 12) Indications: Cough, asthma, disten· sion and fullness in the chest and hypochondriac region vomiting, anorexia. Method; Puncture obliquely 0.3.0.5 inch. To avoid injuring the heart, deep insertion is not advisable. Moxibustion is applicable. Regional anatomy Vasculature: The fifth intercostal ar· tery and vein. Innervation: The anterior cutaneous branch of the fifth intercostal nerve ; deeper, the fift h intercostal nerve.

23. Shengfeng (Kl 23) Location: In the fourth intercostal space, 2 cun lateral to the anterior mid· line. (See Col. Fig. 12) Indications: Cough, asthma, fullness in the chest and hypochondriac region, mastitis. Method: Puncture obliquely 0.3.0.5 inch. Moxibustion is applicable.

197

Regional anatomy Vasculature: The fourth intercostal artery and vein. Innervation: The anterior cutaneous branch of the fourth intercostal nerve; deeper, the fourth intercostal nerve.

24. Liogxu (Kl 24) Location: In the third intercostal space, 2 cun latera l to the anterior mid· line. (See Col. Fig. 12) Indications: Cough, asthma, fullness in the chest and hypochondriac region, mastitis. Method: Puncture obliquely 0.3.().5 inch. Moxibustion is applicable. Regiona l anatomy Vasculature: The third intercostal ar· tery and vein. Innervation: The anterior cutaneous branch of the third intercostal nerve ; deeper, the third intercostal nerve.

25. Sheocang (Kl 25) Location: In the second intercostal space, 2 cun latera l to the anterior mid· line. (See Col. Fig. I 2) Ind ications: Cough, asthma, chest pain. Method: Puncture obliquely 0.3.0.5 inch. Moxibustion is applicable. Regional anatomy Vasculature: The second in tercostal artery and vein. Innervation: The anterior cutaneous branch of the second intercostal nerve; deeper, the second intercostal nerve.

198

26. Yuzhoog (Kl 26)

Location: In the first intercostal space, 2 cun lateral to the anterior mid· line. (See Col. Fig. 12) Indications: Cough, asthma, accumu· lation of phlegm, fullness in the chest and hypochondriac region. Method: Puncture obliquely 0.3.0.5 inch. Moxibustion is applicable. Regional anatomy Vasculature: The first intercostal ar· tery and vein. Innervation: The anterior cutaneous branch of the first intercostal nerve, the medial supraclavicular nerve; the first

intercostal nerve. 27. S hufu (Kl 27)

Location: In the depression on the lower border of the clavicle, 2 cun lateral to the anterior midline. (See Col. Fig. 12) Indications: Cough, asthma. chest pain. Method: Puncture obliquely 0.3.0.5 inch. Moxibustion is applicable. Regiona l anatomy Vasculature: The anterior perforating branches of the internal mammary artery and vein. Innervation: The medial supraclavicu· Jar nerve.

Chapter 9 ACUPUNCTURE POINTS OF JUEYIN AND SHAOYANG MERIDIANS region. Method: Puncture obliquely 0.2·0.4 inch. Deep puncture is not advisable. Moxibustion is applicable. Regional anatomy Vasculatu re : The thoracoepigastric vein, the branches of the latera l thoracic artery and vein. Innervation: The muscular branch of the anterior thoracic nerve, the fourth intercostal nerve.

The Pericardium Meridian of Hand· Jueyin and the Triple Energizer Meridi· an of Hand·Shaoyang are externally· internally related, the former runs from chest to hand and the laner goes from hand to head. The Gallbladder Meridi· an of Foot·Shaoyang runs from head to foot, while the Liver Meridian of Foot· Jueyin goes from foot to abdomen (chest). These two meridians are also externally-internally related. The above four meridians are mainly distributed in the lateral aspects of the trunk and the four limbs. The points of the four merid· ians are described as follows:

2. Tianquan (PC 2) Location: 2 cun below the level of the amerior axilla ry fold, between the two heads of m. biceps brachi i. (See Col. Fig. 13) Indications: Card iac pain, distension of the hypochondriac region, cough, pain in the chest, back and the medial aspect of the arm. Method: Puncture pe rpend icula rly 0.5-{).7 inch. Moxibustion is appl icable. Regiona l anatomy Vascu lature: The muscular branches of the brachial a rtery and vein. Innervation: The medial brachial cu· taneous nerve and the muscu locutaneous nerve.

I. THE PERICARDIUM

MERIDIAN OF HAND-JUEYIN l. Tianchi (PC 1) Location: In the fourth intercostal space, I cun lateral to the nipple and 5 cun lateral to the anterior midline. (See Col. Fig. 13) Indications: Suffocating sensation in the chest, pain in the hypochondriac re· gion, swelling and pain of the axillary 199

200

CHINESE ACUPUN'CTUR£ :\NO MOX!Hli'STIOI'\

3. Quze (He-Sea Point, PC 3)

4. Ximen (Xi-Cleft Point, PC 4)

Location: On the transverse cubita l crease, at the ulnar side of the tendon of m. biceps brachii. (See Fig. 93) Indications: Cardiac pain, palpitation, febrile diseases, irritability, stomachache, vomiting, pain in the elbow and arm, tremor of the hand and arm. Method: Puncture perpendicula rly 0.5-().7 inch, or prick with a three-edged needle to cause bleeding. Moxibustion is applicable. Regional anatomy Vasculature: On the pathway of the brachial artery and vein. Innervation: The median nerve.

Location: 5 cun above the transverse crease of the wrist, on the line connecting Quze (PC 3) and Daling (PC 7), between the tendons of m. palmaris longus and m. flexor carpi radialis. (See Fig. 93) Indications: Ca rdiac pain , palpitation, epistaxis, hematemesis, haemoptysis chest pain, furuncle, epilepsy. Method: Puncture perpendicularly 0.5-1.0 inch. Moxibustion is applicable. Regional anatomy Vasculature: The median artery and vein; deeper, the anterior interosseous artery and vein. Innervation: The medial antebrachial

auzetPC3l - - - - 7 cun

5 cun

Fig. 93

OIAPTER 9 ACUPUNCTURE POINTS OP JUEYIN AND SHAOYANG MERlDIANS

201

cutaneous nerve; deeper, the median nerve; deepest, the anterior interosseous nerve.

Method: Puncture perpendicularly 0.5-Q.8 inch. Moxibustion is applicable. Regional anatOmy: See Jianshi (PC 5).

5. Jianshi (Jing-Rive.r Point, PC 5)

7. Daling (Shu-Stream and Yuan-Primary Point, PC 7)

Location: 3 cun above the transverse crease of the wrist, between the tendons of m. palmaris longus and m. flexor carpi radialis. (See Fig. 93) Indications: Cardiac pain, palpitation, stomachache, vomiting, febrile diseases, irritability, malaria, mental disorders, epilepsy, swelling of the axilla, contracture of the elbow and arm. Method: Puncture perpendicularly 0.5-1.0 inch. Moxibustion is applicable. Regional anatomy Vasculature: The median artery and vein; deeper, the anterior interosseous artery and vein. Innervation: The medial and lateral antebrachial cutaneous nerves, the palmar cutaneous branch of the median nerve; deeper, the anterior interosseous nerve.

6. Neiguan (Luo-Connecting Point, the Eight Confluent Point, PC 6) Location: 2 cun above the transverse crease of the wrist, between the tendons of m. palmaris longus and m. flexor radialis. (See Fig. 93) Indications: Cardiac pain, palpitation, stuffy chest, pain in the hypochondriac region, stomachache, nausea, vomiting, hiccup, mental disorders epilepsy, insomnia, febrile diseases, irritability, malaria, contracture and pain of the elbow and arm.

Location: In the middle of the transverse crease of the wrist, between the tendons of m. palmaris longus and m. flexor carpi radialis. (See Fig. 93) Indications: Cardiac pain, palpitation, stomachache, vomiting, mental disorders. epilepsy, stuffy chest, pain in the hypochondriac region, convulsion, insomnia, irritability, foul breath. Method: Puncture perpendicularly 0.3·0.5 inch. Moxibustion is applicable. Regional anatomy Vasculature: The palmar arterial and venous network of the wrist. Inner vation: Deeper, the median nerve.

8. Laogong (Ying-Spring Point, PC 8) Location: At the center of the palm, between the 2nd and 3rd metacarpal bones, but close to the latter, and in the part touching the tip of the middle finger when a fist is made. (See Fig. 94) Indications: Cardiac pain, mental disorder, epilepsy, gastritis, foul breath, fungus infection of the hand and foot, vomiting, nausea. Method: Puncture perpendicularly 0.3-Q.5 inch. Moxibustion is applicable. Regional anatomy Vasculatu re: The Common palmar digital artery. Innervation: The second common pal·

mar digital nerve of the median nerve. 9. Zhongcbong (Jing-Well Point,

II. TRIPLE ENERGIZER MERIDIAN OF HAND-SHAOYANG

PC9) Location: In the centre of the tip of the middle finger. (See Fig. 94) Indications: Cardiac pain, palpitation, loss of consciousness, aphasia with stiff· ness and swelling of the tongue, febrile diseases, heat stroke, convulsion, feverish sensation in the pa lm. Method: Puncture superficially 0.1 inch or prick with a three-edged needle to cause bleeding. Moxibustion is applica· ble. Regional anatomy Vasculature: The arterial and venous network formed by the palmar digital propria! artery and vein. Innervation: The pa lmar digita l propria! nerve of the median nerve.

1. Guanchong (Jing-WeU Poin t, TE I) Location: On the lateral side of the ring finger, about 0.1 cun from the cor· ner of the nail. (See Fig. 95) Indications: Headache, redness of the eyes, sore throat, stiffness of the tongue, febrile diseases, irritability. Method: Puncture superficially 0. I inch, or prick with a three-edged needle to cause bleeding. Moxibustion is applicable. Regional anatomy Vasculature: The arterial and venous network formed by the palmar digital propria! artery and vein. Innervation: The palmar digital propria! nerve derived from the ulnar nerve. 2. Yemen (Ying-Spring Point, T E 2)

Fig 94

Location: When the fist is clenched, the point is located in the depression proximal to the margin of the web between the ring and small fingers, at the junction of the red and wh ite skin. (See Fig. 95) Indications: Headache, redness of the eyes, sudden deafness, sore throat. mala· ria, pain in the arm. Method: Puncture obliquely 0.3.0.5 inch towards the inLerspace of the metacarpal bones. Moxibustion is applicable. Regional anatomy Vascu lature: The dorsal d igital artery of the ulnar artery.

:!OJ

ulnar nerve. 4. Yangchi (Yuan-Primary Point, TE4)

ZhOnQlhut TE 3} ...t~- - -

Yemen(TE 2)- - - -

Guonci>Ong(TE 1) - - - - - - -

Fig. 95

Innervation: The dorsal branch of the ulnar nerve. 3. Z hongzhu (Shu-Strea m Point, TE 3)

Location: When the fist is clenched, the point is on dorsum of the hand between the fourth and fifth metacarpal bones. in the depression proximal to the fourth metacarpophalangeal joint. (See Fig. 95) Indications: Headache, redness of the eyes, deafness, ti1mitus, sore throat, febrile diseases, pain in the elbow and arm, motor impairment of fingers. Method: Puncture perpendicularly 0.3-o.s inch. Moxibustion is applicable. Regional anatomy Vasculature: The dorsal venous network of hand and the fourth dorsal metacarpal artery. Innerva tion: The dorsa l branch of the

Location: On the transverse crease of the dorsum of wrist, in the depression lateral to the tendon of m. extensor digitorum communis. (See Fig. 95 ) Indications: Pain in the arm, shoulder and wrist, malaria, deafness, thirst. Method: Puncture perpendicularly 0.3-o.s inch. Moxibustion is applicable. Regional anatomy Vasculature: The dorsal venous network of the wrist and the posterio r carpal artery. Innervation: The terminal branch of the posterior antebrachial cutaneous nerve and the dorsal branch of the ulnar nerve.

5. Waiguao (Luo-Coonecting Point, the Eight Confluent Point, T E 5)

Location: 2 cun proximal to the dorsal crease of the wrist, on the line connecting Yangchi (TE 4) and the tip of olecranon. between the radius and ulna. (See Fig. 96) Ind ications: Febrile diseases. headache, pain in the cheek, strained neck, deafness, tinnitus. pain in the hypochondriac region, motor impairment of the elbow and arm, pain of the fingers, hand tremor. Method: Puncture perpendicularly 0.5-1.0 inch. Moxibustion is applicable. Regional anatomy Vasculature: Deeper, the posterior and anterior antebrachial interosseous ar-

CI-IINF.SE ACUPUNCTURE ANO M0 X18uei'TION

teries and veins. Innervation: The posterior antebrachial cutaneous nerve; deeper, the poste· rior interosseous nerve and the anterior interosseous nerve.

heavy sensation of the shoulder and back, sudden hoarseness of voice. Method: Puncture perpendicularly 0.8-1.2 inches. Moxibustion is applicable. Regional anatomy: See Waiguan (TE 5).

6. Zhigou (Jing-River Point, TE 6) Location: 3 cun proximal to the dorsal crease of the wrist, on the line connecting Yangchi (TE 4) and the tip of olecranon, between the radius and ulna, on the radial side of m. extensor digitorum. (See Fig. 96) Indications: Tinnitus, deafness, pain in the hypochondriac region, vomiting, constipation, febrile diseases, aching and

7. Huizong (Xi-Cleft Point, T E 7) Location: At the level with Zhigou (TE 6), on the ulnar side of Zhigou (TE 6 ), on the radial border of the ulna. (See Fig. 96) Indications: Deafness, pain in the ear, epilepsy, pain of the arm. Method: Puncture perpendicularly 0.5- LO inch. Moxibustion is applicable.

, Huizoog CTE 7)

9 en

.-"

Zhlgoo CTE 6)

- - W&iogu&n(TE 5)

3cun

Fig. 96

Regional anatomy Vasculature: The posterior antebrachial interosseous artery and vein. Innervation: The pOSterior and medial antebrachial cutaneous nerves: deeper, the posterior and anterior interosseous nerves. 8. Sanyangluo (TE 8)

Location: 4 cun proximal to the dorsal crease of the wrist, between the radius and ulna. (See Col. Fig. 14) Indications: Deafness, sudden hoarseness of voice, pain in the chest and hypochondriac region, pain in the hand and arm, toothache. Method: Puncture perpendicularly 0.5-1.0 inch. Moxibustion is applicable. Regional anatomy: See Huizong (TE 7).

9. Sidu (TE 9) Location: On the lateral side of the forearm, 5 cun below the olecranon, between the radius and ulna. (See Col. Fig. 14) Indications: Deafness, toothache, migraine, sudden hoarseness of voice, pain in the forearm. Method: Puncture perpendicularly 0.5·1.0 inch. Moxibustion is applicable. Regional anatomy: See Huizong (TE 7).

I 0. Tia njing (He-Sea Point, TE 10)

Location: When the elbow is nexed, the point is in the depression about I cun superior to the olecranon. (See Fig. 97)

- - TlttnjingtTE 10}

Fig. 97

Indications: Migraine, pain in the neck, shoulder and arm, epilepsy, scrofula, goiter. Method: Puncture perpendicularly 0.3-Q.5 inch. Moxibustion is applicable. Regional anatomy Vasculature: The arterial and venous network of the elbow. Innervation: The posterior brachial cutaneous nerve and the muscular branch of the radia l nerve. 11. Qingleogyuan (TE 11)

Location: I cun above Tianjing (TE 10) when the elbow is nexed. (Sec Col. Fig. 14) Indications: Motor impairment and pain of the shoulder and arm, migraine. Method: Pu ncture pe rpendicularly 0.3-Q.5 inch. Moxibustion is applicable.

CHlN.ESE ACUPUNCTURE AND MOXIBUSTION

206

Regional anatomy Vasculature: The terminal branches of the median collateral artery and vein. Innervation: The pOsterior brachia l cutaneous nerve and the muscular branch of the radial nerve.

12. Xiaoluo (TE 12) Location: On the line joining the olecranon and Jianliao (TE 14), midway between Qinglengyuan (TE II ) and Naohui (TE 13). (See Col. Fig. 14) Indications: Headache, neck rigidity. motor impairment and pain of the arm. Method: Punct ure perpendicularly 0.5-0.7 inch. Moxibustion is applicable. Regional anatomy Vasculature: The median collateral artery and vein. Innervation: The pOsterior brachial cutaneous nerve and the muscular branch of the radial nerve.

13. Naobui (TE 13) Loc.ation: On the line joining Jianliao (TE 14) and the olecranon, on the paste· rior border of m. deltoideus. (See Col. Fig. 14) Indications: Goiter, pain in the shoulder and arm. Method: Punct ure perpendicularly 0.5-0.8 inch. Moxibustion is applicable. Regional anatomy Vasculature: The median collateral artery and vein. Innervation: The pOSterior brachial cutaneous nerve, the muscular branch of the radial nerve; deeper, the radial nerve.

14. Jianl iao (TE 14) Location: On the shoulder, pOsterior to Jianyu (LI 15), in the depression inferior and pOsterior to the acrom ion when the arm is abducted. (See Fig. 97) Indications: Pain and motor impa irment of the shoulder and upper arm. Method: Puncture perpendicularly 0.7-1.0 inch. Moxibustion is applicable. Regional anatomy Vasculature: The muscular branch of the pOSterior circumflex humera l artery. Innervation: The muscular branch of the axillary nerve.

15. Tianliao (TE 15) Locat ion: Midway between Jianjing (GB 21) and Quyuan (S I 13), on the superior angle of the scapula. (See Col. Fig. 14) Indications: Pain in the shoulder and elbow, stiffness of the neck. Method: Punctu re perpendicularly 0.3-0.5 inch. Moxibustion is applicable. Regional anatomy Vasculature: The descending branch of the transverse cervical artery; deeper, the muscular branch of the su prascapu lar artery. Innervation: The accessory nerve and the branch of the suprascapu lar nerve.

16. Tianyou (TE 16) Location: On the lateral side of the neck, directly below the pOsterior border of mastoid process, on the level of the mandibular angle, and on the pOsterior border of sternocleido mastoid muscle.

CHAPTI!It 9 ACUPUNCTIJR£ POr.NTS OF JUEYIN AND SHAOVANG MERIDIANS

(See Col. Fig. 14) Indications: Headache, neck rigidity, facia l swelling, blurring of vision, sudden deafness. Method: Puncture perpendicularly 0.3-Q.S inch. Moxibustion is applicable. Regional anatomy Vasculature : The posterior auricular artery. Innervation : The lesser occipital nerve.

17. Yifeng (TE 17) Location: Posterior to the lobule of the ear, in the depress ion between the mandible and mastoid process. (See Fig. 98) Indications: Tinni tus, deafness, otorrhea, facial paralysis, toothache, swelling of the cheek, scrofula, t rismus. Method: Puncture perpendicu larly 0.5-1.0 inch. Moxibustion is appl icable.

Regional anatomy Vasculature: The posterior auricular artery and vein, the externa l jugular vein. In nervation : The great auricu lar nerve ; deeper, the site where the facial nerve perforates ou t of the stylomastoid foramen.

18. Qimai (TE 18) Location: In the centre of the mastoid process, at the junction of the middle and lower t hird of the curve formed by Yifeng (TE 17) and Jiaosun (TE 20) posterior to t he helix. (See Col. Fig. 14) Indicat ions: Headache, t innitus, deafness, infantile convulsion. Met hod: Punct ure s ubcutaneously 0.3-0.5 inch or prick with a t hree-edged need le to cause bleeding. Moxibustion is applicable. Regiona l anatomy Vasculatu re: The posterior auricular

Fig. 98

CIUNESE ACtlPlJNC'ruRE AND MOXIBUSTION

artery and vein. Innervation: The posterior auricular branch of the great auricu lar nerve.

19. Luxi (TE 19) Location: Posterior to the ear, at the junction of the upper and middle third of the curve formed by Yifeng (TE 17) and Jiaosun (TE 20) behind the helix. (See Col. Fig. 14) Indications: Headache, tinnitus, deaf· ness, pain in the ear, infantile convulsion. Method: Puncture obliquely 0.3-Q.S inch. Moxibustion is applicable. Regiona l anatomy Vasculature: The posterior auricular artery and vein. Innervation: The anastomotic branch of the great auricular nerve and the lesser occipital nerve.

20. Jiaosun (TE 20) Location: Directly above the ear apex, within the hair line. (See Fig. 98) Indications: Tinnitus, redness, pain and swell ing of the eye, swelling of gum, toothache, parotitis. Method: Puncture subcutaneously 0.3-Q.S inch. Moxibustion is applicable. Regional anatomy Vasculature: The branches of the su· perficial temporal artery and vein. Innervation: The branches of the au· riculotemporal nerve.

21. Ermen (TE 21) Location: In the depression anterior to the supratragic notch and behind the

posterior border of the condyloid process of the mandible. The point is located with the mouth open. (See Col. Fig. 14) Indications: Tinnitus, deafness, otor· rhea, toothache, stiffness of the lip. Method; Puncture perpendicularly 0.3-Q.S inch. Moxibustion is applicable. Regional anatomy Vasculature: The superficial temporal artery and vein. Innervation: The branches of the auriculotemporal nerve and facial nerve.

22. Erheliao (TE 22) Location: Anterior and superior to Er· men (TE 2 1), at the level with the root of the auricle, on the posterior border of the hairline of the temple where the superfi· cial temporal artery passes. (See Col. Fig. 14) Indications: Migraine, tinnitus, Jockjaw. Method: Avoid puncturing the artery, puncture obliquely 0.1.0.3 inch. Moxibus· tion is applicable. Regional anatomy Vasculature: The superficia l temporal artery and vein. Innervation: The branch of the au ri· cu lotemporal nerve, on the course of the temporal branch of the facial nerve.

23. Sizhukong (TE 23) Location: In the depression at the lat· eral end of the eyebrow (See Fig. 98) Indications: Headache, redness and pain of the eye, blurring of vision. twitching of the eyelid, toothache, facial paral· ysis.

Method: Puncture subcutaneously 0.3-{).5 inch. Regional anatomy Vasculature: The fronta l branches of the superficial temporal artery and vein. Innervation: The zygomatic branch of the facial nerve and the branch of the auriculotemporal nerve.

Method: Puncture subcutaneously

O.Hl.5 inch. Regiona l ana tomy Vascu lature: The zygomaticoorbital artery and vein. Innervation: The zygomaticofacial and zygomaticotemporal nerve, the temporal branch of the facial nerve.

2. Tinghui (GB 2)

lll. THE GALLBLADDER MERIDIAN OF FOOT-SHAOYANG

Location: Anterior to the intertragic notch, at the posterior border of the condyloid process of the mandible. The point is located with the mouth open. (See Fig. 99) Indications: Deafness, tinnitus, toothache, motor impairment of the temporomandibular joint, mumps, deviation of the eye and mouth. Method: Puncture perpendi cularly 0.5-oogteng(LA41

1\.Aifllll

- - - Ta>ehong(LA 3J

-- Xlngjian(LR2l

Fig. 109

Location: Anterior to the medial ma lleolus, midway between Shangqiu (SP 5) and J iexi (ST 4 1), in the depression on the medial side of the tendon of m. tibialis anterior. (See Fig. 109) Indications: Hernia, pain in the external genitalia, nocturnaJ emission, reten• • • uon of unne, dtstending pain in the hypochondrium. Met hod: Pu ncture perpendicula rly 0.3-o.s inch. Moxibustion is applicable. Regiona l anatomy Vasculature: The dorsaJ venous network of the foot and the anterior medial malleolar artery.

m Innervation: The branch of the medial dorsal cutaneous nerve of the foot and the saphenous nerve.

nous nerve.

5. Ligou (Luo-Connecting Point, LR 5)

Location: 7 cun above the tip of the medial malleolus, on the midline of the medial surface of the tibia. (See Fig. 110) Indications: Abdominal pain, hypochondriac pajn, djarrhea, hernia, uterine bleeding, prolonged lochia. Method : Puncture subcutaneous ly 0.5-0.8 inch. Moxibustion is applicable. Regional anatomy Vasculature: The great saphenous vein. Innervation: The branch of the saphenous nerve.

Location: 5 cun above the tip of the medial malleolus, on the midline of the medial surface of the tibia. (See Fig. 110) Indications: Retention of urine, enuresis, hernia, irregular menstruation, leukorrhea, pruritus valvae. weakness and atrophy of the leg. Method: Puncture subcutaneously 0.3-{).5 inch. Moxibustion is applicable. Regional anatomy Vasculature: Posteriorly, the great saphenous vein. Innervation: The branch of the saphe-

X-n(LR7J .

6 ....

Zt>ooQdu (LR 61 -

Ugclu(LR51 -

6. Zhongdu (Xi-Cleft Point, LR 6)

7. Xiguan (LR 7) Location: Posterior and inferior to the medial condyle of the tibia, in the upper portion of the medial head of m. gastrocnemius, I cun posterior tO Yinlingquan (SP 9). (See Fig. 110) Indication: Prun of the knee. Method: Puncture perpendicularly 0.5-1.0 inch. Moxibustion is applicable. Regional anatomy Vasculature: Deeper, the posterior tibial artery. In nervation: The branch of the medial sura l cutaneous nerve; deeper, the tibial nerve.

7 ....

8. Ququan (He-Sea Point, LR 8)

Fig. 110

Location: When knee is nexed, the point is at the medial end of the transverse poplitea l crease, posterior to the medial epicondyle of the tibia, in the

~22::,.4--------------------=CH~liu lGV 12) - - -

Ungtai (GV 10) - -

Thorasic vertebrae

Lumber vertebrae

Saeral vertebl'lt

Fig. 114

Method: Puncture perpendicularly 0.5-1.0 inch. Moxibustion is applicable. Regional anatomy: See Yaoyangguan (GV 3).

5. Xuanshu (GV 5) Location: Below the spinous process

of the fi rst lumbar vertebra. (See Col. Fig. 19) Indications: Pain and stiffness of the lower back, diarrhea, indigestion. Method: Punctu re perpendicu larly 0.5-1.0 inch. Moxibustion is applicable. Regiona l anatomy: See Yaoyangguan (GV 3).

6. Jizhong (G V 6) Location: Below the spinous process of the eleventh thoracic vertebra. (See Col. Fig. 19) Indications: Pain in the epigastric region, diarrhea, jaundice, epilepsy, stiff· ness and pain of the back. Method: Puncture perpendicularly 0.5·1.0 inch. Regional anatomy Vasculatu re: The posterior branch of the eleventh intercostal artery. Innervation: The medial branch of the posterior ramus of the eleventh thoracic nerve.

7. Z hoogshu (GV 7) Location: Below the spinous process of the tenth thoracic vertebra. (See Col. Fig. 19) Indications: Pain in the epigastric re· gion, low back pain, stiffness of the back. Method: Puncture perpendicularly 0.5-1.0 inch. Moxibustion is applicable. Regional anatomy Vasculature: The posterior branch of the tenth intercostal artery. Innervation: The medial branch of the posterior ramus of the tenth thoracic nerve.

8. Jinsuo (GV 8) Location: Below the spinous process of the ninth thoracic vertebra. (See Figs. 113 and 114) Indications: Epilepsy, stiffness of the back, gastric pain. Met hod: Puncture perpendicularly

0.5·1.0 inch. Moxibustion is applicable. Regional anatomy Vasculature: The posterior branch of the nin th intercos tal artery. Innervation: The medial branch of the posterior ramus of the ninth thoracic nerve. 9. Zhiyang (GV 9) Location: Below the spinous process of the seventh thoracic vertebra, approx· imately at the level with the inferior an· gle of the scapula. (See Figs. 113 and 114) Indications: Jaundice, cough, asthma, stiffness of the back, pain in the chest and back. Method: Puncture obliquely upward 0.5·1.0 inch. Moxibustion is applicable. Regional anatomy Vasculature: The posterior branch of the seven th intercostal a rtery. Innervation: The medial branch of the posterior ramus of the seventh thoracic nerve.

I 0. Liogtai (GV I 0) Locat ion: Below the spinous process of the sixth thoracic vertebra. (See Figs. JI Jandll4 ) Indications: Cough, asthma, furun· cles, back pain, neck rigidity. Method: Puncture obliquely upward 0.5·1.0 inch. Moxibustion is applicable. Regional anatomy Vasculature: The posterior branch of the sixth intercostal artery. Innervation: The medial branch of the posterior ramus of the thoracic nerve.

11. S hendao (GV 11) Location: Below the spinous process of the fifth thoracic vertebra. (See Col. Fig. 19) Indications: Poor memory, anxiety, palpitation. pain and stiffness of the back. cough, cardiac pain. Method: Puncture obliquely upward 0.5·1 .0 inch. Moxibustion is applicable. Regional anatomy Vasculature: The posterior branch of the fifth intercostal artery. Innervation: The medial branch of the posterior ramus of the fifth thoracic nerve.

12. Shenzhu (GV 12) Location: Below the spinous process of the third thoracic vertebra. (See Figs. 11 3 and 114) Indications: Cough, asthma, epilepsy, pain and stiffness of the back, furuncles. Method: Puncture obliquely upward 0.5·1.0 inch. Moxibustion is applicable. Regional anatomy Vasculature: The posterior branch of the third intercostal artery. Innervation: The medial branch of the posterior ramus of the third thoracic nerve.

13. Taodao (GV 13) Location: Below the spinous process of the first thoracic vertebra. (See Figs. 113 and 114) Indications: Stiffness of the back, headache, mala ria, febrile diseases. Met hod: Puncture obliquely upward

0.5·1.0 inch. Moxibustion is applicable. Regional anatomy Vascu lature: The posterior branch of the first intercostal artery. Innervation: The medial branch of the posterior ramus of the first thoracic nerve. 14. Dazhui (GV 14) Location: Below the spinous process of the seventh cervical vertebra, approx· imately at the level of the shoulders. (Figs. 113 and I 14) Indications: Neck pain and rigidity, malaria, febrile diseases, epilepsy. afternoon fever, cough, asthma, common cold, back stiffness. Method: Puncture obliquely upward 0.5-1.0 inch. Moxibustion is applicable. Regional anatomy Vasculature: The branch of the transverse cervical artery. Innervation: The posterior ramus of the eighth cervical nerve and the medial branch of the posterior ramus of the first thoracic nerve.

15. Yamen (GV 15) Location: 0.5 cun direct ly above the midpoint of the posterior hairline, in the depression below the spinous process of the first cervical vertebra. (See Fig. I I5) Indications: Mental disorders, epilepsy, deafness and mute, sudden hoarseness of voice, apoplexy, stiffness of the tongue and aphasia. occipital headache, neck ri· gidity. Method: Puncture perpendicularly 0.5-0.8 inch. Neither upward obliquely

CHIN":SE ACUPUKOE"T1=1006 = - - -- - - - - - - - - - - - - - - - - -..:."'c:;:l

ii) Colour of the tongue coating White coating: A thin and white coating is normal. Yet a white coa ting may appear in an illness. If so, it indicates exterior syndromes and cold syndromes. A thin and white coating is present in exterior cold syndromes, whilst a thick and white coating is seen is interior cold syndromes. Yellow coating: A yellow coating indicates interior syndromes and heat syndromes. The deeper yellow the coati ng is, the more severe pathogenic heat it indicates. A light yellow coating points to mild heat; a deep yellow coating to severe heat; a burnt yellow coating to accumulation of heat. Grey coating: A grey coating indicates interior syndromes, and may be seen in interior heat syndromes or syndromes resulting from cold and damp. If a grey coating is yellowish and dry, it signifies consumpt ion of body nuid due to excessive heat. If a grey coating is whitish and moist, it implies retention of cold damp in the interior or retention of phlegm and fluid. As a grey coating often develops into a black coating, a greyish black coating is seen. Black coating: A black coating indicates interior syndromes due to ex treme heat or excessive cold. A black coating is often the outcome of the further development of a yeiJow coating or a grey coating. It is present at the severe stage of an illness. If a black coating is yellowish and dry, possibly with thorns, it signifies consumption of body nuid due to extreme heat. A pale black and sl ippery coating implies excessive cold due to yang defi-

ciency. 3) Precautions in tongue diagnosis a) As each disease undergoes a complicated process, the conditions of the tongue proper and its coating are the manifestations of interior complicated pathological changes. The conditions of the tongue proper mainly renect deficiency or excess of the zang-fu organs and relative strength of the essential qi. The cond itions of the tongue coating reflects the depth und nature of the invading pathogenic factors. A comprehensive analysis of the conditions of both the tongue proper and its coating is required on the basis of their respective indications. The condition of the tongue proper and that of its coating are generally conformable ; the disease to be indicated is often the outcome of combining the two. For instance, retention of heat of excess type in the interior produces a red tongue with a dry and yellow coating; a pale tongue with a moist and white coating is often present in cold syndromes of deficiency type. But such situations as the condition of the tongue proper does not agree with the condition of its coating may occur. Only by a comprehensive analysis can reliable information be provided for furthur differentiation of syndromes. b) It is desirable to observe the tongue in direct natural light. The patient is required to protrude the tongue naturally. c) Some food and drugs may colour the tongue coating, and the thickness and moisture of the tongue coating may change after eating or scraping the tongue. Attention should be paid to the

exclusion of false phenomena induced by such factors in the clinical situation.

IJ. AUSCULTATION AND

OLFACTION Auscultation and olfaction refer to lis· tening and smelling.

1. Listening a) Listening to the speech In general, speaking lustily indicates syndromes of excess type, whi le speaking feebly and in low tones indicates those of deficiency type. A hoarse voice or loss of voice in a severe case may be of deficiency type or of excess type. lf they are present in exogenous diseases with a sudden onset, they are of excess type. Chronic or recur· rent onset in endogenous diseases are of deficiency type. Incoherent speech in loud voice ac· companied by impaired consciousness in· dicates a syndrome of excess type due to disturbance of the mind by heat. Repeated speech in feeble voice accompanied by list lessness suggests a syndrome of deficiency type of t he heart resulting from severe damage of the heart qi. b) Listening to the respiration Feeble breathing indicates deficiency of qi. Forceful and coarse breathing accompan· ied by a loud voice suggests a syndrome of excess type due to excessive pathogenic heat in the interior. Feeble asthmatic breathing accompan· ied by shortness of breath indicates defi· ciency of the qi of the lung and kidney,

pertaining to asthma of deficient type. Coarse asthmatic breathing in loud tones with the preference for exhalation sug· gests retention of pathogenic factor in the lung impairing the functions of qi. This belongs to asthma of excess type. c) Listening to the cough Cough is the manifestation of dysfunction of the lung in dispersing and descending leading to upward perversion of qi. Cough in a coarse voice indicates a syndrome of ex· cess type, cough in a feeble voice suggests a syndrome of deficiency type. Unprod· uctive cough or cough with a small amount of thick sputum implies injury of the lung by pathogenic dryness or dry· ness of the lung due to yin deficiency.

2. S melling Stench smell of a secretion or excre· t ion usually ind icates hea t syndromes of excess type; less stinking smell suggests cold syndromes of deficiency type; foul and sour smell implies retention of food. Different odours should be identified in order to deduce the nature of the disease. The source of the odour should also be traced for determining the locality of the disease.

III. INQUIRING Inquiring is asking the patient or the patient's companion about the disease condition in order to understand the pathological process. Inquiries are made systematically with questions focused on the ch ief complaint of the patien t accordi ng to the knowledge

l'S

necessary in differentiating a syndrome. Inquiring covers a wide range of topics. Here is a brief introd uction to inquiring about the present illness. I. Chills and Fever

Apart from confirming the presence of chills and fever, we need to ask such questions as which is more severe, when they occur and what symptoms and signs accompa ny them, for this information is necessary for further differentiation of syndromes; I) Chills accompanied by fever Simultaneous occurrence of chills and fev· er at the beginning of the disease indicates exogenous exterior syndrome. h is the manifestation of invasion of the body surface by the pathogenic factor and its contending with the antipa thogenic qi. Exterior syndromes result ing from exposure to pathogenic wind cold usually manifest as severe chills and mild fever with the accompanying symptoms and signs such as absence of sweating, headache and general aching. and a superficial and tense pulse. Exterior syndromes due to invasion by pathogen ic wind heat are characterized by mild ch ills and severe fever; the patient a lso reveals thi rst, sweating and a superficial and rapid pulse. 2) Alternate chills and rever The patient may notice alternate anacks of chills and fever. This is the representative symptom of intermediate syndromes. The patient may also complain of a bitter taste in the mou th, thirst and fullness and stuffiness in the chest and hypochon-

drium. High fever followi ng chills occurring at a defin ite time of the day suggests malaria. 3) Fever without chills Fever may occur without chills. Persistent high fever with aversion to heat instead of cold suggests interior heat syndromes of excess type due to transmission of the pathogen· ic factors from the exterior to the interior wi th excess ive heat in the interior. The accompanyi ng symptoms and signs a re profuse sweating, severe thirst and a surging pu lse. If fever occurs or becomes worse at a fixed hour of the day just like the sea waves, it is known as tidal fever. Tidal fever in the afternoon or evening, accompanied by night sweating and a red tongue with linle moisture indicates deficiency of yin: afternoon fever with con· stipation and fullness and pain in the abdomen suggests excess heat of the Yangming Meridians. 4) Chills without fever The subjective feeling of chills without fever indicates interior cold syndrome of deficiency type. The patient may also have chilled appearance, cold limbs and a deep, slow and weak pulse.

2. P ers piration The patiem shou ld. first of all, be asked whether sweating is present or not. Further inquiring deals with the feature of sweating and its accompanying symptoms and signs. Absence of sweating in exterior syndromes ind icates invasion by pa thogen· ic cold; prese nce of sweati ng in exte-

Cf-IJNESE ACUPUNC"rt; K£ ANO MOX.IRUST!ON

rior syndromes suggests either exterior syndromes of deficiency type resul ting from exposu re to pathogen ic wind, or exterior heat synd romes due to invasion by pathogen ic wind heat. The accompanying symptoms and signs are considered in differentiation. Sweating that occurs during sleep and stops upon wakening is known as night sweating. It usually indicates deficiency of yin with hyperactivity of yang heat. The patient may also present tidal fever and a red tongue with liule coa ting. Freq uent sweating which is worse on slight exertion is known as spon taneous sweating. It is a sign of deficiency of qi and deficiency of yang. The patient may also exhibit chills, listlessness and lassitude. Profuse sweating accompanied by high fever, mental restlessness, thirst with preference for cold drinks and a surging pulse indicates interior heat syndromes of excess type resulting from excessive yang heat in the interior expelling the sweat out. Profuse sweating accompanied by listlessness, feeble energy, cold limbs and a deep and thready pu lse in a severe case is a critical sign indicating total exhaustion of yang qi.

abdomen and a thick sticky tongue coating suggests stagnation of qi of the spleen and stomach caused by retention of food or retention of pathogenic damp. Excessive appetite and getting hungry easily in a sk inny patient indicate excessive stOmach fire. Hunger with no desire to eat or eating a small amount of food suggests impairment of the stomach yin producing internal heat of deficiency type. lack of thirst during an iUness suggests that body fluid is not consumed. It is present in cold syndromes or syndromes in which pathogenic heat is not noticeable. The presence of thirst indicates consumption of body fluid or retention of phlegm damp in the interior prevent ing body fluid from ascending. Further ana lysis is based on features of thirst, amoum of drinks to be taken and the accompanying symptoms and signs. A bitter taste in the mouth usually indicates hyperact ivity of the fire of the liver and gallbladder. A sweetish taste and st ickiness in the mouth imply damp heat in the spleen and stomach. Sour regurgitation means retention of heat in the liver and stomach. Tastelessness points to deficiency of the spleen with its impai red function of transportation.

3. Appetite, Thirst and Taste Poor appetite present in the patient with a prolonged illness manifesting as emaciation, loose stools, lassitude and a pale tongue with a thin white coating indicates weakness of the spleen and stomach; poor appetite aocompan ied by stuffiness in the chest, fullness in the

4. Defecation and Urination As the doctor does not observe the change in defecation and urination of the patien t di rectly, it is necessary 10 make inqu iries. Const ipation due to dryness of stools usually indicates accumulation of heat or

consumption of body fluid. Loose stools suggest deficiency of the spleen or retention of damp in the spleen. Watery stools with undigested food imply deficiency of yang of the spleen and kidney. Bloody stools with mucus and tenesmus result from damp heat in the intestines and stagnation of qi in the intestinal tract. Yellow urine generally indicates heat syndromes, while clear and profuse urine indicates absence of the pathogenic heat in an illness, or cold syndromes. Turbid urine suggests downward infusion of damp heat or downward leakage of turbid essence. Red urine implies injury of the vessels by heat. Clear urine increased in volume means infirmity of the kidney qi and dysfunction of the bladder in controlling urine, while scanty yellow urine with urgent and painful urination means downward infusion of damp heat into the bladder. Dribbling urination or retention of urine in a severe case is present not only in syndromes of deficiency type due to exhaustion of the kidney qi with its impaired function of controlling urine, but also in syndromes of excess type caused by obstructed qi activities of the bladder due to downward in fusion of damp heat, stagnant blood or stones.

5. Pain Pain is one of the most common sym~ toms complained of by the patient. Apart from a thorough understanding of the history and accompanying symptoms and signs, the natu re and locality of pain must be asked. Differentiation of the na-

ture of the pain is significant for deducing its etiology and pathology, while identification of the local ity of the pain helps determ ine diseased zang-fu organs and meridians. I) Nature of tbe pain Distending pain: Distending pain manifesting as severe distension, mild pain and moving from place to place is a typical sign of qi stagnation. It often occurs in the chest, epigastric, hypochondriac and abdominal regions. But headache with a distending sensation in the head is due to upward disturbance by fire and heat. Pricking pain: Pricking pain, sharp in nature and fixed in location, is a sign of stagnation of blood. It usually occurs in the chest, epigastric, hypochondriac and lower abdomina l regions. Weighty pain: Pain with a heavy sensation is a sign of damp blocking qi and blood, as damp is characterized by heaviness. It is often present in the head, four limbs and lumbar region. Colicky pain: Colicky pain is a sign of abrupt obstruction of the qi by substantial pathogenic factors. Pull ing pain: Pulling pain which is spasmod ic in natu re and short in duration often relates to the d isorders of the liver. It is caused by liver wind. Burning pain: Pain with a burning sensation and preference for coolness often occurs in the hypochondriac regions on both sides and epigastric region. It results from invasion of the collaterals by pathogenic fire and heat or from execs· sive yang heat due to yin deficiency. Cold pain: Pain with a cold sensation

27$

and preference for warmth often occurs in the head, lumbar, epigastric and abdomina l regions. It is caused by patho· genic cold blocking the collaterals or lack of warmth and nourishment in the zang· fu organs and merid ians due to deficien· cy of yang qi. Dull pain: Dull pain is not severe. It is bearable lingering and may last for a long period. It is usually present in cold syndromes of deficiency type. Hollow pain: Pain with a hollow sen· sation is caused by deficiency of blood leading to emptiness of vessels and retar· dation of blood circulation. 2) Locality of the pain Headache: Head is the meeting place of all the yang meridians and brain is the sea of marrow. Qi and blood of the five zang and six fu organs all go up into the head. If the pathogenic factors invade the head and block the clear yang, or if stag· nation of qi and blood in endogenous diseases blocks the meridians and de· prives the brain of the nourishment, headache wi ll ensure. In cases of deficien· cy of qi and blood , head fai ls to be nour· ished, and the sea of marrow becomes empty; headache due to this is of defi· ciency type. Headache due to disturbance of the clear yang by the pathogenic factor is mostly of excess type. Chest pain: As the heart and lung reside in the chest, chest pain indicates the pathological changes of the heart and lung. Hypochondriac pain: The hypochon· driac region is traversed by the Liver and Gallbladder Meridians. Obstruction or undernourishment of these meridians

CHINES£ ACUJ)UNCTURE AND MOXIBUSTION

may produce hypochond riac pain. Epigastric pain: Epigastrium (wan) refers to the upper abdomen in which the stomach situates. It is divided into three regions, namely, Shangwan, Zhongwan and X iawan (upper, middle and lower wan respectively). Epigastric pain may result from invasion of the stomach by pathogen ic cold, retention of food in the stomach or invasion of the stomach by the liver qi. Abdominal pain: Abdomen is divided into upper abdomen, lower abdomen and sides of t he lower abdomen. The upper abdomen refers to the area above the umbilicus and pertains to the spleen. The area below the umbilicus is the lower abdomen and pertains to the kidney, bladder, large and small intestines and uterus. Both sides of the lower abdomen is traversed by the Liver Meridian of Foot-Jueyin. So accord ing to the loca lity of the pain, the d iseased zang·fu organs and meridians can be identified. Abdominal pain caused by retention of cold, accumu lat ion of heat, stagnation of qi, stagnation of blood , retention of food or parasitic diseases is excess in nature, while that caused by deficiency of qi, deficiency of blood or deficiency of cold is deficiency in nature. Lumbago: The kidney res ides in the lumbar region. Lumbago may result from obstruction of the meridians in the local area; besides, deficiency of t he kidney fa iling to nou rish the lumbar region is often t he cause. Pain in t he four limbs: Pain in t he four limbs may involve joints, muscles or meridians. It is caused by retardation of

CHAPTER 12

DLAG~O.l"TIC

MIITH005

qi and blood circulation due to invasion of the exogenous pathogenic factors. Besides, the duration of pain and its respOnse to pressure should also be asked. Generally, persistent pain in a recent disease or pain which is aggravated by pressure indicates syndromes of excess type. Intermittent pain in a prolonged illness or pain which is alleviated by pressure often occurs in syndromes of deficiency type.

6. S leep Insomnia means either difficulty in falling asleep, or inability to sleep sound· ly, waking easily and being unable to fall asleep again. Insomnia accompanied by dizziness and palpitations usually indicates failure of blood to nourish the heart due to deficiency of both the heart and spleen. Insomnia accompanied by restlessness in mind and dream-disturbed sleep suggests hyperactivity of the fire of the heart. Difficulty in falling asleep due to an uncomfortable and empty sensation in the stomach or gastric discomfort after a full meal implies derangement of the stomach qi leading to mental restlessness. If lethargy is accompanied by dizzi· ness, it indicates accumulation of phlegm damp in the interior. A situation of being half asleep with general lassitude suggests deficiency of the yang of the heart and kidney.

7. Menses and Leukorr hea Women patients are also asked about the menses and leukorrhea, and for married women the obstetric history.

279

1) Menses Inquiring in this aspect covers menstrual cycle and period, amount, colour and quality of flow and the accompanying symptoms and signs. Jf it is necessary, questions concerning the date of the last menstrual period and age of menopause should be asked. Menses of a shortened cycle, excessive in amount. deep red in colour and thick in quality relates mainly to excessive heat in the blood; light coloured menstrual flow profuse in amount and thin in quality indicates failure of qi to command blood. A prolonged cycle with scanty purplish dark discharge or blood clots suggests stagnation of blood due to cold; thin scanty and light-coloured flow implies deficiency of blood. Irregular menstrual cycle is a sign of disharmony of the Flush and Conception vessels due to obstruction of the liver qi. Pre-menstrual or menstrual distending pain in the breasts and lower abdomen which intensifies on pressure means stagnation of qi and blood; cold pain in the lower abdomen during the period pOints to stagnation of blood due to cold; dull pain in the lower abdomen during or after the period which is alleviated by pressure is due to deficiency of qi and blood. 2) Leukorrhea Attention is paid to the colour, amount, quality and smell of leukorrhea. Watery leukorrhea whitish in colour and profuse in amount indicates deficiency syndromes and cold syndromes ; thick leukorrhea yellow or red in colour with offensive smell suggests excess syndromes and heat syndromes.

CHINESE ACUPUI'tcnJRE AND MOXIRUSTlON

IV. PALPATION Palpation is a method of diagnosis in which the pathological condition is de· tected by palpating, feel ing and pressing certain areas of the body. It is discussed under the headings of feeling the pu lse and palpation of different parts of the body.

1. Feeling the Pulse The location for feeling the pulse at the present time is above the wrist where the radial artery throbs. It is divided into three regions: cun, guan and chi (Fig. 135). The region opposite to the styloid process of the radius (the bony eminence behi nd the palm) is known as guan, that dista l to guan (i. e. between guan and the

wrist joint) is cun and that proximal to guan is chi. There have been in different ages various descriptions concern ing the relationship between these three regions and their corresponding zang· fu organs. They are fundamentally conformable. It is genera lly acknowledged that the three regions of cun, guan and chi of the left hand reflect respectively the conditions of the heart, liver and kidney; and those of the right hand reflect the conditions of the lung, spleen and kidney. In feeling the pulse, let t he patien t take either sitting or supine position with the arm placed approximately on a level with the heart, wrist extended and palm facing upward. T his position facilitates smooth circulation of q i and blood. The doctor, by the side of t he patient, first locates the guan region with the middle

' '

Liver

Leh hand

Right hand

Fig. t35

Kidney

CHAPTER 12 I)IA(iNOSll\. M£THODS

finger, then the cun and chi regions with the index and ring fingers. The three fingers are slightly flexed, presenting the shape of an arch . The finger tips are kept on the same horizontal level and the pu lse is felt with the palmar s ide of the fingers. The space between each two fingers depends upon the height of the patient. lf the patient is tall and has long arms, it is desirable to separate the fingers accordingly. If t he patient is short and has short arms, the three fingers are placed more closely. The method of "feeling the pulse in the guan region with one finger" is adopted in infantile cases, for a body's pu lse is not divided into these three regions. The pulse is palpated by exerting three different finger forces, first lightly (superficial palpation}, then moderately (middle palpation} and finally heavily (deep palpation}. Generally the finger force of the same strength is exerted on the three regions at the same time and then feel the three regions separately according to the actual pathologica l cond itions. The pu lse is differentiated in terms of depth (superficial or deep), speed (rapid or slow), strength (forceful or weak}, shape (thick or thready, soft or hard} and rhythm. Different conditions of the pulse indicate different synd romes. A normal pulse is smooth, even and forceful with the frequency of four beats per breath. However, the pulse may vary due to age, sex, body constitution, emotional state and climatic changes. Due attention should be paid to distinguishing it from an abnormal pulse.

281

Abnormal pu lse readings and their cl inica l significance are as follows. 1) Superficial pulse (fu mai) A superficial pulse can be easily felt with gentle touch. li indicates exterior syndromes, and is present at the early stage of exogenous diseases. Invasion of the body su rface by the exogenous pathogenic factor creates its contending with wei (defensive) qi. The pulsation is superficially situated, hence the superficial pulse. A superficial pu lse may also be present in prolonged endogenous diseases. In this case, the pulse is superficial, large and weak, indicating outward floating of yang qi. This is a critical sign of the disease. 2) Deep pulse (chen mai} A deep pulse is felt on ly on heavy pressure. It indicates interior syndromes. If the pulse is deep and forceful, it indicates interior syndromes of excess type. When the pathogenic factor invades the interior of the body, qi and blood circulation is blocked, presenting a deep and forceful pulse. If the pulse is deep and weak, it indicates interior syndromes of deficiency type. 3) Slow pulse (chi mai) The rate is slow, with less than four beats per breath ( Jess than sixty beatS per minute). A slow pulse indicates cold syndromes. Qi contracts and blood flow stagnates on exposure to cold. The retarded circulation of qi and blood produces a slow pulse. If the slow pulse is forceful, it indicates an interior syndrome of excess type caused by retention of yin cold in the interior. If the slow pulse is weak, it indicates an interior syndrome of deficiency type due to deficiency of yang qi.

282

4) Rapid pulse (shu mai) The rate is quick, with more than five beats per breath (more than ninety beats per minute). A rapid pulse indicates heat syndromes. Induced by pathogenic heat, the blood circu lation is accelerated, the result being a rapid pulse. Jf excess heat is retained in the interior and the antipathogenic qi is still strong, their struggle will induce a rapid and forceful pulse. Deficiency of yin in a prolonged illness produces deficiency-heat in the interior, presenting a rapid and weak pulse. A rapid pulse may also be induced by out· ward noating of deficiency-yang. In this case, the pulse feels rapid, large, weak and empty. 5) P ul se of deficiency type (xu mai) It is the general term for all the forceless pulses felt on the three regions and the three levels of pressure. The pulse indicates syndromes of deficiency type due to deficiency of qi and blood. Deficiency of qi and blood implies weakness in activating blood circulation, thus producing a pulse of deficiency type. 6) Pulse of excess type (shi mai) It is the general term for all the forceful pulses felt on the three regions at the three levels of pressure. The pulse indicates syndromes of excess type. The struggle waged by the strong antipathogenic qi against the hyperactive pathogenic factor brings on excessive qi and blood, thus creating a strong pu lse of excess type. 7) Surging pulse (bong mai) A surging pulse is broad. large and forceful like roaring waves which come on powerfully and fade away. If a surging pulse lacks

CIIINF.SF. A(:UPUNC n JRE ANO MOXIOIJSTION

the momentum of roaring waves, it is called large pulse. A surging pulse indicates excessive heat, and often occurs together with a rapid pulse. Excessive heat in the interior dilates the blood vessels and accelerates qi and blood circulation, thus producing a surging pulse. 8) Thready pulse (xi mai) A thready pulse feels like a fine thread but is very distinct and clear. It indicates deficiency due to overstrain and stress or deficiency of qi and blood. rt is often present in patients with weak body constitut ion in a prolonged illness manifest ing as yin defi· ciency and blood deficiency. Deficiency of yin and blood means the inability to fill the vessels. Qi is also deficient and unable to activate the blood circulation, hence the thready pulse. 9) Rolling pulse (hua mai) A rolling pulse feels smooth and flowing like pearls rolling on a dish. It indicates phlegm and retained fluid, retention or food and excess heat. When excess type pathogenic factor is retained in the interior, the qi and blood circulation is activated , resulting in a smooth and flowing pulse. This pulse often occurs in women during pregnancy, indicating sufficient and harmonious qi and blood. 10) Hesitant pulse (se mai) A hesitant pulse feels rough and uneven. It indicates stagnation of qi , stagnation of blood, impairment of essence and defi· ciency of blood. Stagnation of qi and blood means blockage of vessels and impai red circulation of blood. This condition produces a hesitant and forceful pulse. When the essence is impaired and

OiAP'n;:R 12 OtAGNOSTIC .\1£THODS

blood is insufficient, the vessels are not filled and blood circulation is retarded. This condition creates a hesitant and weak pulse. II) String-taut pulse (xuan mai) A string-taut pulse feels taut, straight and long, giving the feeling of a string of a violin. Jt indicates disorders of the liver and gallbladder, painful syndromes, and phlegm and retained fluid. A string-taut pulse in disorders of the liver and gallbladder is due to disturbance of the liver qi tightening the vessels; that in painfu l syndrome is due to tightness of the meridians and vessels; that in retention of phlegm and fluid in the interior is due to dysfunction of qi in transportation. 12) Tense pulse (jin mai) A tense pulse feels tight and forceful like a stretched rope. It indicates cold, pain and retention of food. As cold is characterized by contraction, the vessels contract on exposure to cold, thus. producing a tense pu lse. The pulse is also present in painful syndromes, for painful syndromes are usually caused by pathogenic cold. 13) Soft pulse (ru mai) A soft pulse is superficial and thready, and hits the fingers without strength. It indicates damp disorders. Pathogenic damp is characteristically viscous and stagnant, its invasion of the vessels blocks qi and blood and gives rise to a superficial, thready and forceless pulse. 14) Weak pulse (ruo mai) A weak pulse is deep and thready, and hits the fingers without strength. It indicates var-

283

ious syndromes due to deficiency of both qi and blood. When blood is deficient, it fai ls to fill the vessels: when qi is deficient, the pulse is deprived of strength. So the pulse feels deep, thready and forceless. 15) Abrupt pulse (cu mai) An abrupt pu lse feels hurried and rapid with irregular missed beats. It indicates excessive yang heat, stagnation of qi and blood, and retention of phlegm or food. Excessive yang heat means failure of yin tO restrain yang and thus producing an abrupt pu lse. If this pulse is present in heat syndromes of excess type due to stagnation of qi and blood, retention of phlegm or food, or swelling and pain, it is abrupt and forceful. An abrupt and weak pulse is a sign of prostration. 16) Knotted pulse (jie mai) A knotted pulse is slow with irregular missed beats. It indicates excess ive yin, accumulation of qi, retention of cold phlegm and stagnant blood. Cold phlegm and stagnant blood block the vessels, while excess ive yin means failure of yang to arrive. Hence the knotted pulse. 17) Regularly intermittent pulse (dai mai) A regularly intermittent pulse is slow and weak with missed beats at regular interva ls. It is associated with declining zang qi; it also indicates wind synd romes, painful syndromes and disorders due to emotiona l fear and fright, or traumatic contusions and spra ins. The declining of the qi of the zang means insufficiency of qi and blood and may create d iscontinuation of qi flowing in the vessels. Therefore the pulse is slow

and weak with regular missed beats at long interva ls. The presence of a regu larly intermittent pulse in wind syndromes, painful syndromes and disorders due to emotional fear and fright or traumatic contusions and sprains is due to disturbance of the heart qi leading to discontinuation of the qi nowing in the vessels. As the process of a disease is complex, the above described abnorma l pulses do not often appear in their pure form, the combination of two pulses or more is often present. The condition of a number of pulses present at the same time is called complicated pulse. The indication of a complicated pulse is the combination of indications of each single pulse. For instance, a superficial pulse indicates exterior syndromes, and a tense pulse indicates cold syndromes, a superficial and tense pulse, therefore, indicates exterior cold syndromes. As a rapid pu lse indi· cates heat synd romes, a superficial and rapid pulse indicates exterior heat syndromes.

2. Palpation of Different Parts of the Body Included is palpation of the epigastrium, abdomen, hand, foot and acupuncture points. 1) Palpation of the epigastrium Epigastrium refers to the upper abdomen. is also known as "below the hean.~ If this area feels hard and pain is aggravated on pressure, it indicates syndromes of excess type; when there is fullness in this area wi th a painless react ion to pressure, and the area feels soft, it indicates syndromes

of deficiency type. 2) Palpation of the abdomen Ab· dom ina! pain which is alleviated by pressure is associated with deficiency. wh ile that aggravated by pressure is related to excess. Abdominal distension and fullness with tympanic note on percussion indicate stagnation of qi if the abdomen does not feel hard on pressure and the urination is normal. If the abdomen feels like a rubber bag containing water, and dysurine is present, it suggests accumu lation of fluid. Immovable hard masses in the abdomen with pain at a definite site indicate stagnation of blood. Unfixed soft masses or the intermittent feeling of an indefinite mass in the abdomen with unfixed painful areas indicate stagnation of qi. 3) Palpation of acupuncture poi nts This method of palpation can be traced back tO the early medica l book The lmernal Classic. One of its pans Miraculous Pivot says: ~In order to see if the Back· Shu Point is located with accuracy, one may press the region to see if the patient feels sore or if the patient's original sore· ness gets relieved, in which case. the point has been located with accuracy." The fifteenth chapter of the same book also states, ~when the five zang organs arc diseased, the symptoms will manifest themselves in the conditions of the twelve Yuan-Primary Points with which they are connected. If we fully grasp the connections between the zang organs and their corresponding Yuan-Primary Points as well as the latter's external manifesta· lions, there will be no difficulty for us to understand the nature of the diseases of

rnAP'I'ER I Z DIAGNOSTIC r.u~niOOS

the five zang organs." Clinical practice in the recent years has demonstrated that during an illness tenderness or sensative reactions may occur along the courses of the involved meridians or at certain points where the qi of the meridian is converged. In gastralgia, for instance, tenderness may oc-

28S

cur at Weishu (BL 21) and Zusanli (ST 36); in disorders of the liver there may be tenderness at Ganshu (BL 18) and Qimen (LR 14): while in appendicitis, it may occur at Shangjuxu (ST 37), the lower He-Sea Point of the large intestine. These signs may assist in making dignosis for disorders of internal organs.

Chapter 13 DIFFERENTIATION OF SYNDROMES Differentiation of syndromes is the method in traditional Chinese medicine of recognizing and diagnosing diseases. In accordance with the basic knowledge of traditional Chinese medicine, this method entails making a comprehensive analysis of the symptoms and signs ot>tained by applying the four diagnostic methods, in order to clarify their internal relationships, and ascertain their causes and nature as well as the relative strength of the antipathogenic qi and pathogenic factor, and the direction of the patholog· ical development. Differentiation of syndromes and de· termination of treatment are inseparable, one relating to the other. The former is the premise and foundation of the Jat· ter. The methods of treatment, so deter· mined, may in turn test the validity of the differentiation. Correct differentiation is a prerequisite for applying appropriate methods and attaining anticipated re· suits. There are a number of methods in traditional Chinese medicine for differ· emiating syndromes, including differentiation according to eight principles, dif· ferentiation according to the theory of qi and blood, differentiation according to the theory of zang·fu organs and differentiation according to the theory of meridians and collatera ls, etc. Of

these, differentiation according to eight principles is the general method. Differentiation according to the theory of qi and blood and that according to the theory of zang-fu organs are mainly concerned with endogenous diseases, while differentiation according to the theory of meridians and collaterals is principally concerned with disorders of meridians and col laterals. Each method has its own features and Jays stress on a particular aspect while connecting with and supplementing the others. ft is essential to understand and possess a thorough knowledge, through clinical practice, of the basic contents and char· acteristics of each method.

I. DIFFERENTIATION OF SYNDROMES ACCORDING TO EIGHT PRINCIPLES The eight principles refer to eight basic categories of syndromes, namely, yin and yang, exterior and interior, cold and heat, and deficiency and excess. In differentiation of syndromes according to eight principles, these eight categories are applied in analysing various pathological manifestations determined by ap· plying the four diagnostic methods, in·

CHAPTER J3 OIFFERENTlAnOK OF SYNDROMES

dicating the location of the disease, its nature and the relative strength of the pathogenic factor and antipathogenic qi. The application of the eight principles forms the basis link, categorizing a variety of clin ical manifestations in a general way. It is thus possible to understand and solve complicated problems systematically in the process of making diagnosis. Although this method classifies pathological conditions into eight categories, they are inseparable and interconnected. Attention should be paid to this in the clinical situation in order to ensure a correct and comprehensive recognition of disease.

I. Exterior and Interior The categories of exterior and interior form two principles which are used to determine the depth of the diseased area and to generalize the direction of the development of a disease. Table 9.

The skin, hair, muscles and their interspaces, and the superficial portion of meridians and collaterals of the human body belong to the exterior, while the five zang and six fu organs pertain to the interior. 1) Exterior syndromes Exterior syndromes refer to pathological conditions resulted from the invasion of the super· ficial portion of the body by exogenous pathogenic factors. They are marked by sudden onset of symptoms with short duration, and are often seen at the early stage of exogenous diseases. The chief manifestations are an intolerance to cold (or wind), fever, thin tongue coat· ing and a superficial pulse. The accom· panying symptoms and signs are head· ache, general aching, nasal obstruction and cough. Clinical manifestations may vary according to the invading pathogenic factors and the body constitution of the patient. They are manifested as cold, heat, deficiency and excess (Tab. 9).

Differentiation of Cold, Heat, Deficiency and Excess in Exterior Syndromes

Syndromes Exterior cold

Exterior heat

Symptoms and signs in common Distinguishing symptoms and signs Severe chills, mild fever, no sweating, at>sence of thirst, thin, white and moist tongue coating, superficial and tense pulse.

face, eyes and skin; loose stools, scanty. yellow urine, yellow, sticky tongue coating and a soft rapid pulse. Etiology and pathology: This syndrome is often due to invasion of exogenous pathogenic damp heat. It may also result from excessive indulgence in greasy and sweet food, or alcoholic drinking, all of wh ich may produce dam p heat in the interior. Retention of damp heat in the stomach and spleen impairs their functions in reception, digestion, transportation and transfo rmation, causing fullness and d istension in the epigastrium and abdomen , loss of appetite, nausea, vomiting and loose stools. Excessive damp heat gives rise to a sticky and bitter taste in the mouth and scan ty yellow urine. As damp is characterized by heaviness and viscosity, blockage of the qi by damp leads to heaviness of the body and lassitude. Damp heat stirs up the bile wh ich, therefore, permeats the muscles and sk in, presenting bright yellow face, eyes and skin. Yellow sticky tongue coating and a soft rapid pulse are both signs of retention of damp heat in the interior. 6) Retention of food in the stomach Clinical manifestations: Distension, fullness and pain in the epigastrium and abdomen , foul belching sour regurgitation, and anorexia, vomiting and hesitant bowel movements, thick and sticky tongue coating, rolling pulse. Etiology and pathology: This syndrome may be due to irregular food intake, voracious eating or eating of food which is difficult to digest. .Retention of food in the stomach blocks the qi passage in the epigastrium and abdo-

men and thus causes distension, fullness and pain there. Dysfunction in digesting food brings the turbid qi upward, which is the cause of foul belch ing, sour regurgitation, anorexia and vomiting. Retention of the turbid pan of the food blocks the large intestine and impairs its function in transmission, resulting in hesitant bowel movements. Thick, sticky tongue coating and a rolling pulse are both signs of retention of food . 7) Retention of fluid in the stomach due to cold Clinical manifestation: Epigastric fullness and pain which are worse on exposure to cold and beuer to warmth; reflux of clear fluid or vomiting after eating; white, slippery tongue coating and a slow pulse. Etiology and pathology: This syndrome is often due to a constitutional deficiency of the stomach yang complicated by invasion of exogenous pathogenic cold; or to intake of excessive raw and cold food which causes retention of cold in the stomach. Retention of cold in the stomach blocks the stomach qi and produces epigastric fullness and pain. which are worse on exposure to cold but beuer to warmth, for exposure tO cold may aggravate the retention while exposure to warmth may disperse cold and effect a smooth circulation of qi. Impairment of yang qi in a prolonged disease implies inability of yang qi tO distribute body fluid. Thus the retained fluid is formed. If the retained fluid remains in the stomach and also disturbs upward, reflux of clear fluid and vomiting after eating follow. White, slippery tongue coating and a slow pulse are both signs of deficient

yang complicated with retention of cold and fluid in the interior. 8) Hyperactivity of fire in the stomach Clinical manifestations: Burning sensation and pain in the epigastric region; sour regurgitation and an empty and uncomfortable feeling in the stomach ; thirst with preference for cold drinks; voracious appetite and gelling hungry easily; vomiting, foul breath; swelling and pain or ulceration and bleeding of the gums; constipation. scanty yellow urine; a red tongue with yellow coating and a rapid pulse. Etiology and pathology: This syndrome may result from excessive eating of hot and greasy food which turns into heat and fire, or from emotional depression which leads to invasion of the stomach by the liver fire. Hyperactivity of fire in the stomach burns body nuid and thus produces burning pain in the epigastric region and thirst with preference for cold drinks. If obstruction of the liver qi turns into heat, it may impair the function of the stomach in descending, thus causing sour regurgitation and an empt) and uncomfortable feeling in the stomach. Hyperactivity of heat in the stomach may result in hyperfunction of the stomach in digesting food, that is the reason for voracious appetite and getting hungry easily. Excessive heat in the stomach may make the stomach qi disturb upward, vomiting ensues. Since the Stomach Meridian traverses the gums. upward disturbance of the stomach fire along the meridian causes foul breath, swelling and pain or ulceration and bleeding of the gums. Constipation, seamy yellow urine,

O HNESE ACUPUNCniR£ AND MOXIIUJS110N

a red tongue with yellow coating, and a rapid pulse are all signs of hyperactivity of fire and heat in the interior. 9) Insufficiency of tbe stomach yin Clinical manifestations: Burning pain in the epigastric region, an empty and uncomfortable sensation in the stomach, hunger with no desire to eat; or dry vomiting and hiccups; dryness of the mouth and throat; constipation; a red tongue with little moisture and a thready rapid pulse. Etiology and pathology: This syndrome may be due to hyperactivity of heat in the stomach which consumes the stomach yin or to consumption of the yin flu id by persistent pathogenic heat at the late stage of a febrile disease. Consumption of the stomach yin deprives the stomach of moisture and impairs its function of descending, the result being burn ing pain in the epigastric region, an empty and uncomfortable sensation in the stomach, dry vomiting and hiccups. Insufficiency of fluid in the stomach im· pairs the function of the stomach in receiving food, the consequence is hunger with no desire to eat. With Deficiency of stomach yin the fluids fai l to be sent upwards, creating dryness of the mouth and throat. Constipation, a red tongue with little moisture and thready rapid pulse are all signs of deficiency of yin producing interior heat. Since the spleen and stomach are re· lated externally and internally, disease of ei ther of them often affect the other. The Back-Shu, Front-Mu. Yuan-Primary, Luo-connecting and He-Sea Points of the Spleen Meridian of Foot-Taiyin and

Stomach Meridian of Foot-Yangming are used as the main points. They are combined with poims from the Liver Meridian of Foot-Jueyin and the Pericardium Merid ian of Hand -Jueyin. Reinforcing or reducing need ling technique, o r moxibustion is applied according to actual condi· tions.

4. Syndromes of the Liver and Gallbladder The liver functions to promote the free flow of qi. dominate the tendons and open imo the eye. Pathological changes of the liver mainly manifest themselves in dysfunctions of the liver in storing blood and in promoting the free flow of qi, and in disorders of the tendons. The gallbladder functions to store and excrete the bi le and thus assist in the digestion of food. The qi of the gallbladder is closely related to the human emotions. Since the gallbladder and liver are externally and internally related, the two organs are often diseased at the same time. 1) Stagnation of the lil·er qi Clinical manifestations: Men tal depression; irritability; distending or wandering pain in the costal and hypochondriac regions: distension of the breasts: stuffiness in the chest: sighing; epigastric and abdomina l distension and pain; poor appet ite: belching; or possibly a foreign body sensation in the throat; irregular menstruation and dysmenorrhea in women; thin white tongue coating and a string-taut pulse. In prolonged cases, there may be pricking pain in the costal and hypochondriac re-

~15

gions or palpable mass may be present. The tongue is purplish dark in colour, or there are purplish spots on the tongue. Etiology and pathology: The syndrome is often due to mental irritation which impairs the function of the liver in promoting the free now of qi and results in stagnation of the liver qi, leading to retardation of the qi circulation, thus presenting mental depression, irritability, distending pain in the costal and hypochondriac regions and breasts, stuffiness in the chest and sighing. Transverse invasion of the spleen and stomach by the liver qi produces epigastric and abdominal distension and pain. poor appetite and belching. Retardation of the qi circulation allows damp to collect and phlegm may be formed; the phlegm and qi may accumulate in the throat. resulting in a foreign body sensation in the throat. Affected by dysfunction of qi. the circulation of both qi and blood is retarded and disharmony of the Thoroughfare Vessel and Conception Vessel may result. This can cause irregular menstruation and dysmenorrhea. Long standing obstruction of the liver qi, leading to stagnation of qi and blood, may elicit pa lpable masses, accompanied by pricking pain in the costal and hypochondriac regions, a purple tongue or a tongue with purplish spots, and a string-taut pulse. 2) Flare-up of the liver fire Clinical manifestations: Distending pain in the head; dizziness and vertigo: redness, swelling and pain of the eyes; a bitter taste and dryness in the mouth; irritability; burning pain in the costal and hypochondriac regions; tinnitus like the sound

of waves: yellow urine and constipation; hematemesis. hemoptysis or epistaxis; a red tongue with yellow coating and a string-taut rapid pulse. Etiology and pathology: This syndrome may be due to obstruction of the liver qi turning into fire with upward disturbance of the qi and fire or to excessive indulgence in cigarette smoking, alcoholic drinking or greasy food. which may lead to accumulation of heat and production of fire. Since fire is characterized by upward movement, the effect of the liver fire on the head and eyes may produce distending pain in the head, dizziness and vertigo, redness. swelling and pain of the eyes and a bitter taste and dryness in the mouth. The liver relates to the emotion of anger and irritability is the consequence of hyperactivity of the liver fire. Excessive liver fire burns the Liver Meridian and brings about a burning pain at the costal and hypochondriac region. When the liver fire attacks the ear along the Gallbladder Meridian, there may be tinnitus, which has abrupt onset, sounds like waves and is not alleviated by pressure. The injury of blood vessels by the liver fire may produce hematemesis, hemoptysis or epistaxis. Yellow urine, constipation, a red tongue with yellow coating and a string-taut rapid pulse are all signs of hyperactivity of the liver fire in the interior. 3) Risi ng of the lher yang Clinical manifestations: Headache with distending sensation in the head. dizziness and vertigo, tinnitus, flushed face and red eyes, irritability, insomnia with dreamdisturbed sleep, palpitations, poor memo-

• jl6

ry, soreness and weakness of the low back and knees, a red tongue and a string-taut thready rapid pulse. Etiology and pathology: T his syndrome may be due to mental depression, anger and anxiety. They produce obstruction of the liver Qi which later t urns imo fire. The fire consumes the yin blood in the interior and does not allow yin to restrain yang. The syndrome may also result from constitutional deficiency of the yin of the liver and kidney, in which case, the liver yang fails to be restrained. Excessive ascending of the yang and Qi of the liver is the cause of headache with distend ing sensation in the head, dizziness and vertigo and tinnitus. Hyperactivity of the liver yang may produce redness of the face and eyes. and irritability. When there is deficiency of yin leading to excess of yang, the mind fails to be nourished and the harmon ious state of yin and yang is broken. As a result, such symptoms as palpitations, pOOr memory, insomnia with dream-disturbed sleep ensue. Deficiency of the yin of the liver and kidney deprives the tendons and bones of nourishment and thus brings on soreness and weakness of the low back and knees. A red tongue and a string-taut rapid pulse are both signs of deficiency of yin leading to hyperactivity of fire. 4) Stirring or the liver wind in the interior The occu rrence of such symptoms and signs as dizziness and yertigo, convu lsion, tremor and numbness, as a part of a process of pathological changes is referred to as liver wind, which may result from hyperactivity of the liver yang, extreme heat and deficiency of

ClUNE.'>~! ACUPUNCTURE !\SO MOXIBCSTIOK

blood. a) Liver yang turning into wind C linical manifestations: Dizziness and vertigo. headache, numbness or tremor of the limbs, dysphasia, a red and tremulous tongue and a string-taut rapid pulse. In severe cases there may be sudden collapse, coma, stiffness of the tongue, aphasia, deviation of the mouth and eye, and hemiplegia. Etiology and pathology: This syndrome often occurs to patients with a constitutional deficiency of yin and excess of yang. It may be induced by such factors as drastic emot ional c hanges, overstra in and stress and excessive alcoholic drinking, aU of which may further consume yin and give rise to abrupt rising of yang. SubseQuently the liver wind is produced. The disturbance of the head and eyes by the liver yang produces dizziness, vertigo and headache. The tendons may be deprived of nourishment by either insufficiency of the liver yin or constitutional excess of phlegm leading to obstruction of Qi and blood. and this may cause numbness or tremor of t he limbs, and dysphasia. Sudden onset of rising liver yang may stir up wind and produce upward movement of Qi and blood, which , in combination with phlegm fire, clouds the "clear cavity," and thus creating sudden collapse and coma. Invasion of the meridi ans by wind phlegm hinders the Qi and blood circulation and brings on stiffness of the tongue with aphasia, deviation of the mouth and eye and hemiplegia. A red tongue and a string-taut rapid pulse are both signs of hyperactivity of the liver yang.

CHAPTER I } OlFFf:kSN'nA1'10N OF !>YNf>ROMf$

b) Extreme hear sTirring wind C linical manifestations: High fever, convulsion, neck rigidity, upward staring of the eyes; in severe cases, opisthotonus, coma and Jock jaw; a deep-red tongue and a stringtaut rapid pulse. Etiology and pathology: This syndrome may occur in exogenous febrile diseases where excessive pathogenic heat stirs up the liver wind. If excessive path· ogenic heat induces high fever, this may scorch the tendons, producing convulsion, neck rigidity, upward string of the eyes and opisthotonos. Disturbance of the mind by heat leads to coma. A deepred tongue and a string-taut rapid pulse are both signs of disorders of the liver with excessive heat.

c) Deficiency of blood producing wind Deficiency of the liver blood deprives the tendons of nourishment and thus stirs up deficiency type wind in the interior. For clinical manifestations, etiology and pa· thology refer to the syndrome of insuffi· ciency of the liver blood. 5) Retention of cold in the Liver Me· ridian Clinical manifestations: Lower abdom inal distending pain, with bearing· down sensation in the testes; contracted scrotum ; pain aggravated by cold and alleviated by warmth; white tongue coat· ing, slippery. deep and string-taut pulse. Etiology and pathology: This syndrome is due to invasion of the Liver Meridian by exogenous pathogenic cold which blocks the qi and blood circulation. The Liver Meridian curves around the external genita lia and passes through the lower abdominal region. As cold is char· acterized by contraction and stagnation,

~ l7

invasion of the meridian by cold may block the qi and blood circulation and thus leading to pain. Cold disperses with warmth and thus pain is relieved; when cold accumulates, the pain becomes worse. White, slippery tongue coating and a deep string-taut pu lse are both signs of interior cold. 6) Insufficiency of the I iver blood C linical manifestations: Pallor, dizziness and vertigo, blurring of vision, dryness of the eyes. night blindness, numbness of the limbs, spasms of the tendons, scanty menstrual now or amenorrhea, a pale tongue and a thready pulse. Etiology and pathology: This syndrome may be due to insufficient produc· tion of blood, to excessive loss of blood or to consumption of the liver blood by a prolonged illness. Deficiency of the liver blood deprives the heat and the eyes of nourishment and may result in pallor, dizziness and vertigo, blurring of vision, dryness of the eyes and night blindness. When the liver blood fails to nourish the limbs and tendons, there may be numb· ness of the limbs and spasms of the ten· dons. Insufficiency of the liver blood empties the sea of blood. thus bringing on scanty menstrual now and amenorrhea. A pale tongue and a thready pulse are the consequence of deficiency of blood. 7) Damp heat in the lh·er and gallblad· der Clinica l manifestations : Hypochon· driac distension and pain, bitter taste in the mouth, poor appetite, nausea. vomiting, abdominal distension, scanty and yel· low urine, yellow, sticky tongue coating and a string-taut rapid pulse. In addition

j l8

there may be yellow sclera and skin of the enti re body or fever. The occurrence of eczema of scrotum, swell ing and burning pain in the testes or yellow foul leukor· rhea with pruritus vulvae suggests damp heat in the Liver Meridian. Etiology and pathology: This syn· drome may be due ro invasion of exoge· nous pathogenic damp heat or to exces· sive eating of greasy food which produces damp heat in the interior. In either case, damp heat accumulates in the liver and gall bladder. The accumulation of damp heat impairs the function of the liver and gallbladder in promoting the free flow of qi, causing hypochondriac pain. The up· ward overflow of the qi of the gallbladder leads to a bitter taste in the mouth. The accumulation of damp heat also impa irs the function of the spleen and stomach in ascending and descending, eliciting poor appetite, nausea, vomiting and abdomina l distension. Downward infusion of damp heat into the bladder brings on scanty, yellow urine. Yellow, sticky tongue coat· ing and a string-taut rapid pulse are both signs of damp heat in the liver and gall· bladder. Once the function of the liver and gallbladder in promoting the free flow of qi is impaired, the bile, instead of circulating along its normal route, spreads to the exterior and results in yel· low sclera and skin of t he enti re body. The presence of damp heat induces the qi to stagnate and fever may appear. Since the Liver Meridian cu rves around the external genitalia, downward infusion of damp heat along the Liver Meridian may produce eczema of the scrotum, or swell· ing and pain of the testes; and in women,

CIIIN~F.

ACUPUNCTURE AND MOXIOCSTION

pruritus vulvae and yellow foul leukor· rhea may result. The pathological changes of the liver cove r a wide range. Since the liver and gallbladder are externally and internally related, disorders of the liver may affect the gallbladder, and vice versa. The two organs may thus be diseased at the same time. Principally needling is applied to t reat thei r disorders. Points of the Liver Meridian of Foot·Jueyin and Gallblad· der Meridian of Foot·Shaoyang are of· ten used, accompanied by relevant points of the Spleen, Stomach, Kidney, Conception and Governor Vessels according to symptoms and signs. Reducing method is used for syn· dromes of excess type; reinforcing meth· od for syndromes of deficiency type; even-movemen t method for syndromes complicated between deficiency and ex· cess or syndromes of deficiency of the root cause with excess of manifestations.

5. Syndromes of the Kidney and Bladder The kidney functions to store essence, serving as the source of reproduction and development ; to dom inate water metabol· ism, thus maintaining t he balance of the body's fluid; to dominate bones and pro· duce marrow, thus keeping the bones healthy and strong; and to open into the ea r, the urinogenital orifice and the anus. Therefore, the kidney is rega rded as the congenital foundation of life. Pathologi· cal changes of the kidney most often manifest as dysfunction in stOring ess· ence, distu rbance in water metabolism,

CHAPttR 13 OIFFERENT lATION OF SYND ROMES

abnormality in growth, development and reproduction. The physiological function of the bladder is to store and discharge urine. So pathological changes of the bladder chiefly manifest as abnormal urination. I) Deficiency of the kidney qi C linical manifestations: Soreness and weakness of the lumbar region and knee joints, frequent urination with clear u· rine, dribbling of urine after urination or enuresis; incontinence of urine in severe cases; spermatorrhea and premature ejaculation in men; clear, cold leukorrhea i11 women; a pale tongue with white coating and a thready weak pulse. Etiology and pathology: This syndrome may be due to weakness of the kidney qi in old age or insufficiency of the kidney qi in childhood. It may also result from overstrain and stress, or prolonged illnesses, both of which may lead to weakness of the kidney qi. As the kidney resides in the lumbar region, when the kidney qi is deficient, it may fail to nourish this area and give rise to soreness and weakness of the lumbar region and knee jointS. Weakness of the kidney qi implies an inability of the bladder to control urination, hence frequent urination with clear urine, dribbling after urination, enuresis and incontinence of urine. Deficiency of the kidney qi weakens its function of storage, and thus spermatorrhea, premature ejaculation, and clear, cold leukorrhea result. A pale tongue with white coating and a thready weak pulse are both signs of deficiency of the kidney qi. 2) Insufficiency of the kidney yang

Clinical manifestations: Pallor, cold limbs, soreness and weakness of the lumbar region and knee joints, impotence, infertility, dizziness, tinnitus, a pale tongue with white coating and a deep weak pulse. Etiology and pathology: This syndrome may be due to a constitutional deficiency of yang, or weakness of the kidney in old age. 1t may also be due to a prolonged illness, or to excessive sexual activity, both of which may injure the kidney and produce deficiency of the kid· ney yang. In yang deficiency, the warming function of yang is impaired, hence cold limbs and pallor. Deficiency of the kidney yang deprives the bones, ears, brain, marrow of nourishment and may cause soreness of the lumbar region and weakness of the knee joints, dizziness and tinnitus. When the kidney yang is insufficient, the reproductive function is impaired with impotence in men, and infertility (due to cold uterus) in women result ing. A pale tongue with white coating and a deep weak pulse are both sings of insufficiency of the kidney yang. 3) Ins ufficiency of the kidney yin Clinica l manifestations: Dizziness, tinnitus, insomnia, poor memory, soreness and weakness of the lumbar region and knee joints, nocturnal emission, dryness of the mouth , afternoon fever, malar flush, night sweating, yellow urine, constipation, a red tongue with little coating and a thready rapid puIs e. Etiology and pathology: This syndrome may be due to a prolonged illness, or to excessive sexua l activity. It may also occur in the late stage of febrile diseases.

In these cases the kidney yin is consumed. Deficiency of the kidney yin weakens the kidney in its function of producing marrow, dom inat ing bones and nourishing the brain; the result is dizziness, tinnitus, poor memory, soreness and "eakness of the lumbar region and knee joints. Deficiency of yin produces endogenous heat, hence afternoon fever. malar flush, night sweating. dryness of the mouth, yellow urine and constipation. Disturbance in the interior by heat of the deficiency type is the cause of nocturnal emission. Disturbance of the mind by heat leads to insomnia. A red tongue with liule coating and a thready rapid pulse are both signs of deficiency of yin leading to endogenous heat. 4) Da mp beat in the bladder Clinical manifestations: Frequency and urgency of urination, burning pa in in the urethra. dribbling urination or discontinuation of urination in mid-stream: turbid urine, deep-yellow in colour, hematuria: or stones in the urine; possible lower abdominal distension and fullness or lumbago: yellow sticky tongue coating and a rapid pulse. Etiology and pathology: This syndrome may be due to invasion of exogenous pathogenic damp heat which accumulates in the bladder. It may also result from excessive eating of hot, greasy and sweet food, leading to downward infusion of damp heat to the bladder. Accumulation of damp heat impairs the function of the bladder, resulting in frequency and urgency of urination, burning pain in the urethra, dribbling urination and yellow urine. Condensed by heat, the impurities

in the urine form stones, which cause sudden discontinuation of urination in mid-stream, turbid urine of stones in the urine. Damp heat may injure the vessels and thus hematuria occurs. Blockage of the bladder is the cause of lower abdominal distension and fuUness. Since a disorder of a fu organ may affect its corresponding zang organ, lumbago appears. Yellow sticky tongue coating and a rapid pulse arc both signs of accumulation of damp heat in the interior. When the kidney yin and kidney yang arc properly stored and kept from leaking, the kidney functions effectively. Syndromes of the kidney are mostly of deficiency type: and this is renected in treatment. The Back-Shu Point of the kidney and points of the Conception and Governor Vessels and the Meridian of Foot-Shaoyin are mainly selected. Points of the Spleen Meridian of Foot-Taiyin, Stomach Meridian of Foot-Yangming, Liver Meridian of Foot-Jueyin and Lung Meridian of Hand-Taiyin are used in combination. Moxibustion and reinforcing needling technique are applied for deficiency of yang qi. Only needling with reinforcing or even-movemem technique is applied for deficiency of yin. Since the syndromes of the bladder often involve the kidney, the two organs are often treated at the same time. The Back-Shu Point and Front-Mu Point of the bladder and points of the Conception Vessel, the Kidney Meridian of Foot-Shaoyin and Spleen Meridian of Foot-Taiyin are needled with even-movement or reducing method.

CHAPT'£R 13 OlffSRF.NTIATION OF SYNDROMES

32 1

6. Complicated Syndromes of Zang-Fu Organs

harmony between the heart and kidney leads to disturbance of deficiency type fire and produces weakness in controlling t he release of sperm with the symptom of spermatorrhea in dreams. A dry throat, tidal fever, night sweating, a red tongue with little coating and a thready rapid pulse are all signs of deficiency of yin leading to hyperactivity of fire. 2) Deficiency of the qi of the lung and kidney Clinical manifestations: Asthmatic breathing, shortness of brea th, and more exha lation than inha lat ion, all of which become worse on exert ion; low voice, cold limbs, blue complexion, spontaneous sweat ing, incontinence of urine due to severe cough; a pale tongue with thin coating and a weak pulse of deficiency type. Et iology and pathology: This syndrome is often due to prolonged cough which affects t he lung and kidney in succession. resu lting in deficiency of qi of both organs. It may also be d ue tO overstra in and stress which injures the kidney qi and impairs the kidney's function of receiving qi. T he lung controls respiration and the kidney dominates the recept ion of qi. ''The lung is t he commander of qi and the kidney is the root of qi." With deficiency of the qi of the lung and kidney, there may be asthmatic breathing, shortness of breath , and more exha lation than inhalation, all of which be· come worse on exertion. Deficiency of the lung leads to weakness of zong (pee· w ral) qi, caus ing low voice. Yang qi, being deficient, fai ls to warm up the ex· terior, resulting in cold li mbs and a blue complexion. Deficiency of qi may cause

Syndromes in which two organs or more are diseased at the same t ime, or in succession, are known as "complicated syndromes.~ The common ly seen compl icated syndromes of the zang-fu organs are described as follows. 1) Disharmony between the heart and kidney Clinical manifestations: Mental restlessness, insomnia, pa lpitations, poor memory, dizziness. tinni tus, dryness of the th roat, soreness of the lumbar re· gion, spermatorrhea in dreams, tidal fe· ver, night sweating, a red tongue with little coating and a thready rapid pu lse. Etiology and pathology: The syndrome is often due to prolonged illnesses, overst rain and stress, or excessive sexual activity, all of which may injure the yin of the heart and kidney. It may also result from drastic emotional changes leading to obstruction of q i which turns into fire. The heart fire may become hyperactive in the upper part of the body and fail to infuse downwards to harmonize the kidney. The resu lting imbalance between the heart and kidney dist urbs the regu lation of water and fire. When the kidney yin is insufficient, it may fail to rise up to harmonize the heart. The resu lting hyperactivity of the heart fire may disturb the mind and manifest as mental restlessness, insomnia and palpitations. Consumption of the kidney essence leads to emptiness of the sea of marrow and produces dizziness, tinnitus and poor memory. Undernourishment of the lumbar region causes soreness of t he back. Dis-

322

weakness of wei (defensive) yang, wh ich explains spontaneous sweating. Weakness of the kidney qi may impai r t he function of the bladder in control ling urine, incon· tinence of urine in coughing appears. A pale tongue with th in coa ting and a weak pulse of deficiency type are both signs of deficiency of yang qi. 3) Deficiency of the yin of the lung and kidney Clinical manifestations: Cough with a sma ll an1ount of sputum, or with blood tinged sput um; dryness of the mouth and throat; soreness and weak ness of the lumbar region and knee joints; tidal fever, malar fl ush , night sweat ing, noctu rnal em ission; a red tongue with lillie coating and a thready rapid pulse. Etiology and pathology: This syn· drome is often due to prolonged cough which inju res t he lung, giving r ise to ins ufficiency of the yin fluid, which spreads from the lung to the kidney. It may also result from overst rain and stress, wh ich consumes the kidney yin and thus prevents the kidney yin from nourishing the lung. In either case, defi· ciency of the yin of both o rgans results. Insufficiency of the lung yin deprives the lung of moisture, resulting in cough wi th a small amoun t of sputum and dryness of the mouth and throat. Deficiency of yin produces endogenous heat el iciting tida l fever, ma lar fl ush and nigh t sweating. Injury of the lung vessels by deficiency type heat may produce blood-tinged spu· tum. Insufficiency of the kidney yin brings on soreness and weakness of the lu mbar region and knee joints, and noc· turnal emission. A red tongue with little coating and a t hready rapid pulse are

CI-IINt::SE :\ CL'PUNCTURI:! AND MOXIBt:STION

both signs of deficiency of yin producing endogenous heat. 4) Deficiency of the yin of the liver and kidney Clinical manifestations : Diz· ziness. blurring of vis ion, d ryness of the throat, t innitus; heat sensation in the chest, palms and soles; soreness and weakness of the lumbar region and knee joints; malar flush, night sweating ; noc· turnal emission; scan1y menstrual flow; a red tongue with little coating and thready rapid pulse. Etiology and pathology: This syn· drome is often due to drast ic emotional changes and overstrain and stress which injure yin blood ; or to a prolonged illness which consumes the yin of the liver and kidney. Deficiency of the yin of the liver and kidney deprives the head and eyes of nourishment and thus produces dizzi· ness, blurring of vision and tin nitus. De· ficiency of yin produces endogenous heat and thus results in heat sensa tion in the chest, palms and soles, malar flush. night sweating, dryness of the throat, a red tongue wit h little coating and a thready rapid pulse. Disturbance by deficiency type fire in the interior causes nocturnal em ission. Deficiency of the yin of the liver and kidney leads to a disturbance of the regula tion of the Thoroughfare and Conception Vessels, hence the scanty menstrual flow. 5) Deficiency of the yang of the spleen and kidney Cl inica l manifestations : Pal· lor, cold limbs; soreness and weakness of the lumbar region and knee joints; loose stools or diarrhoea at dawn; facial puffi· ness and edema of the limbs; a pale swol· len del icate tongue wi th thin whi te coat·

CHAPTER 13 DIFFERENTI.AT10N OF S:YNDkOMf:S

ing and a deep weak pulse. Etiology and pathology: This syndrome is often due to a prolonged illness which consumes qi and injures yang, the disease spreading from the spleen to the kidney. It may also result from deficiency of the kidney yang with the spleen yang failing to be warmed and thus producing injury of the yang qi of both organs. Dysfunction of the yang of the spleen and kidney in providing warmth causes pallor, cold limbs and soreness and weakness of the lumbar region and knee joints. Insufficiency of yang qi does not allow normal digestion, transportation and transformation of food; the result is loose stools or diarrhoea at dawn. Deficiency of yang qi implies inability to transport and transform body fluid; the resuh is accumulation of harmful water and damp on the body surface, which manifests as facial puffiness and edema of the limbs. A pale swollen and delicate tongue with thin white coating and a deep, weak pulse are both signs of deficiency of yang. 6) Deficiency of the qi of the lung and spleen Clinical man ifestations: General lassitude; cough with profuse, d ilute, white sputum; poor appetite, loose stools; in severe cases, facial puffiness and edema of the feet; a pale tongue with white coating. Etiology and pathology: This syndrome is often due to prolonged cough which may cause deficiency of the lung and later affect the spleen; or the deficiency of the spleen which weakens the source of the lung qi. Deficiency of qi implies hypofunction of zang-fu organs;

323

that is the reason for general lassitude. Deficiency of qi does not allow normal distribution of body fluid, the accumulation of which forms ph legm damp. The retention of phlegm damp in the lung impa irs the lung's function in descending and thus produces cough with profuse, di lute and white sputum. Dysfunction of the spleen in transportation manifests as pOOr appetite and loose stools. Deficiency of both the lung and spleen impairs the function of qi in circulat ing fluid, resulting in accumulation of harmful water and damp and producing facial puffiness and edema of feet. A pale tongue with white coating and a weak pulse are both signs of deficiency of qi. 7) Imbalance between the lh•er and spleen Clinica l manifestat ions: Distension, fullness and pain in the costa l and hypochondriac regions ; mental depression or irritability; poor appet ite, abdominal distension, loose stools; thin tongue coating and a string-taut pulse. Etiology and pathology: This syndrome is often due to injury of the liver by mental depression or irritation, or to injury of the spleen by irregular food intake or overstrain and stress. In both cases, the liver qi invades the spleen transversely, resulting in an imbalance between the two organs. Dysfunction of the liver in promoting the free flow of qi produces distension, fullness and pain in the costal and hypochondriac regions, menta l depression or irritability. Invasion of the spleen by the liver qi impairs the spleen's function of transportation; poor appetite, abdominal distension and loose stools re.sul!. A string-taut pulse is a sign

of liver disorders. 8) Disharmony between the liver and stomach Clinical manifes tations: Distension and pain in the costal, hypochondriac and epigastric regions; belching, acid regurgitation, an empty and uncomfortable sensation in the stomach; mental depression or irritability; a thin tongue coating and a string-taut pulse. Etiology and pathology: This syndrome is often due to injury of the liver by mental depression or irritation, and injury of the stomach by irregu lar food intake or overstrain and stress. The resulting hyperactivity of the liver and weakness of the stomach, therefore. leads to disharmony between the liver and stomach. Dysfunction of the liver in promoting the free now of qi produces menta l depression or irritability, and distension. fullness and pain in the costal and hypochond riac regions. Invasion of the stomach by the liver qi impairs the descending function of the stomach, manifesting as distension and pain in the epigastric region, belching, acid regurgitation and an empty and uncomfortable sensation in the stomach. A string-taut pu lse is a sign of disorders of the Liver. 9) Deficiency of both the heart and spleen Clinical manifestations: Sallow complexion, general lassitude, palpitations, poor memory, insomnia, dreamdisturbed sleep, reduced appetite, abdominal distension. loose stools; irregular menstruation in women; a pale tongue with thin white coating and a thready weak pulse. Etiology and pathology: This syndrome may be due to poor recuperation

after an illness; chronic hemorrhage; or worry, overstrain and stress. In any case, the heart blood is consumed and the spleen qi is weakened. On the other hand, a weakness of the spleen qi may ·fail to provide a source for the production of qi and blood, and thus make the heart blood even more deficient. Deficiency of qi and blood causes sallow complexion, general lassitude, a pale tongue with thin, white coating and a thready, weak pulse. Deficiency of the heart blood deprives the heart and mind of nourishment, eliciting palpitations, poor memory, insomnia and dream-disturbed sleep. When deficiency of the spleen impairs its function of transportation, there may be reduced appetite, abdominal distension and loose stools. Deficiency of qi and blood may weaken the Thoroughfare Vesse l, and manifest as scanty menstrual flow or even amenorrhea. Weakness of the spleen qi implies inability of the spleen in controlling blood, and thus results in profuse menstrual flow. 10) ln•'li.Sioo of the lung by tbe liver fire Clinical manifestations: Burning pain in the costal and hypochondriac regions; paroxysmal cough or even hemoptysis in severe cases; quick temper, irritability, restlessness, heat sensation in the chest, biller taste in the mouth; dizziness, red eyes; a red tongue with thin yellow coating and a string-taut rapid pulse. Etiology and pathology: This syndrome is often due to mental depression leading to obstruction of the liver qi which turns into fire. The upward invas ion of the lung by the liver fire results in this syndrome. Obstruction of

CH.APTI'::H l j 0JFt1;1H::NTIATI0N OF SYNI)ItO Mt::.o;;

qi turns into hyperactive fire and impairs the liver's function in promoting the free now of qi, manifesting as burning pain in the costal and hypochondriac regions, quick temper and irritability. Upward invasion of the lung by the liver qi and fire impairs the lung's descending function, leading to paroxysmal cough. Injury of the vessels of the lung by fire and heat creates hemoptysis. Flaring up of the liver fire gives rise to restlessness, heat sensation in the chest, bitter taste in the mouth, dizziness and red eyes. A red tongue with thin yellow coating and string-taut rapid pulse are both signs of hyperactivity of the liver fire in the interior.

Appendix: Differentiation of

syndromes according to the theory of the triple energizer Differentiation of syndromes according to the theory of the triple energizer. This method of differentiation is based upon the method of differentiating syndromes according to the theory of wei, qi , ying and xue in conjunction with the principles governing transmission and transformation of acute febrile diseases. Acute febrile diseases result from the invasion of different febrile pathogens in the four seasons of a year. There are various types of acute febrile diseases with different features, for the invading pathogenic factors in the four seasons are different and the patients' constitut ional reaction to these pathogenic factors varies. So far as the nature of the disease is

325

concerned, there are two categories, namely, febrile pathogens, and damp heat. Pathological changes resulting from febrile pathogens are analysed with the theory of wei, qi, ying and xue, while the differentiation of pathological changes due to damp heat is descri bed below. l ) Damp heat in the upper energizer Damp heat in the upper energizer is the early stage of invasion of the organism by damp heal. The disease is often located in the lung, skin and hair. As damp is closely related to the spleen and stomach, damp heat in the upper energizer is often accompanied by symptoms and signs of these two organs. The main clinical manifestations are severe aversion to cold, mild fever or absence of fever, a heavy sensation in the head as if it were tightly wrapped by a cloth, heaviness of the limbs and trunk, a stifling sensation in the chest, absence of thirst, dull facial expression, epigastric fullness and distension , poor appetite, borborygmus, loose stools, white sticky tongue coating and a soft slowing-down pulse. This syndrome is often due to invasion of pathogenic damp which remains in the muscles and body surface, and blocks the spleen qi internally. Invasion of the muscles and body surface by pathogen ic damp hinders wei yang, resulting in severe aversion to cold, a lthough accumulation of damp heat may a lso lead to fever. Heaviness of the head as if it were tigh tly wrapped by a cloth is found when damp in the muscles and body surface causes heaviness of the limbs and trunk. Obstruction by damp of yang qi in the chest produces a stifling sensation in the

OUSetl ACL'PtiNC1\..'RE A.~D MOXIDI.'~TIO'O

chest. Since excessive damp does not con· sume body flu ids, no thirst appears. The turbid damp clouding the clear yang gives rise to dull facia l expression. Reten· tion of damp in the spleen and sto· mach impairs their functions of re· ception, digestion, transportation and transformation. manifesting as epigastric fullness and distension, poor appetite, borborygmus and loose stools. As this is still at the early stage of the d isease, damp has not yet turned into heat. Damp obstructing qi circulation produces sticky white tongue coating and a soft slowing· down pulse. If damp has not turned into heat, the method of treatment is to warm and dis· perse damp on the exterior and in the interior. If heat signs are already pronounced. the method of treatment is to disperse heat and resolve damp. In acu· pu ncture treatment, points arc mainly se· lected from the Yangming Meridians of Hand and Foot and the Taiyin Meridians of Hand and Foot according to symptoms and signs. 2) Damp beat in the middle energizer Damp heat in the middle energizer is the middle stage of a damp heat di· sease, which exhibits mainly symptoms and signs of invasion of the spleen and stomach by damp. Obstruction of the middle energizer may affect both the upper and lower energizer, thus manifesting as fever which is indistinct at the first touch of the skin, but becomes pronounced after being felt for a rather long time: or fever which recurs after reduced by sweat ing; or fever which is more pronounced in the afternoon. In addition

there may be heaviness of the limb; and trunk, distension and ful lness in the chest and epigastrium, na usea, vom iting. anor· exia, ihirst wit h desire to drink only a little, scanty and deep-yel low urine. loose but hesitant stools; and in severe cases, dull facial expression with few words said or mental cloudiness; a sticky white tongue coating with a yellow tinge and a soft rapid pulse. This syndrome may result from trans· mission of damp heat in the upper ener· gizer, or from invasion of pathogenic summer heat and damp. In either case the spleen and stomach are injured. It may also be due to improper diet which produces damp heat. Excessive damp heat with heat wrapped in damp gives rise to fever which is indistinct at the first touch of the skin, and becomes pronounced af· ter being felt for a rather long time; and to fever which is worse in the afternoon. Damp heat is lingering and difficult to be resolved, this is the cause of recurrent fever. Retention of damp heat causes re· tardation of qi circulation and hence d)S· function in ascending and descending. This results in distension and fullness in the chest and epigastrium, nausea, vom· it ing and anorexia. Heat consumes body fluid, but as damp dominates ove r heat. there is a thirst with desire to drink only a little. Retention of damp heat in the middle energizer impairs the spleen's function in transportation. This aspect of retardation of qi circulation is evidenced in the scanty and deep-yellow urine and the loose but hesitant stools. Obstruction of the clear cavity by damp heat gives rise to a dull facia l expression with few words

said, or memal cloudiness, the sticky white tongue coating with a yellow tinge and the soft rapid pulse arc both signs of damp heat. The method of treatment is 10 clear off heat, resolve damp and promote the smooth circulation of qi. In acupuncture treatment, the main pointS are selected from the Spleen Meridian of Foot·Taiyin and the Stomach Meridian of FootYangming. 3) Damp heat in the lower energizer Damp heat lodged in the lower energize r mainly affectS the large intestine and bladder and hence manifests as abnormal urination and defecation. The symptoms and signs are retention of urine, thirst with desire to drink only a little, constipation, hardness and fullness in the lower abdomen, a sticky yellow or whi te tongue coating and a soft rapid pu lse. Damp heat retained in the bladder impairs its function of controlling urine, this explains retention of urine. Accumulation of damp in the lower energizer prevents body nuid from rising and a thirst with desire to drink only small quantities ensues. Damp retained in the large intestine impairs its function of tra nsmission, blocking the qi of the fu organs and causing constipation and hardness and fu llness in the lower abdomen. The sticky yellow or white tongue coating and the soft, rapid pulse are both signs of damp heat. The method of treatment is to conduct the turbid downwards and relieve accumula tion. In acupuncture treatment, points are mainly selected from the Conception Vesse l, Bladder, Spleen and

Stomach Meridians.

IV. DIFFERENTIATION OF SYNDROMES ACCORDING TO THE THEORY OF MERIDIANS AND COLLATERALS This method uses the theory of meridians and collaterals to identify pathological changes according 10 the areas traversed by 1hem and according to 1heir related lang-fu organs. As meridians are the main pathways in the system. their pathological manifestations may be used as primary evidence in making differentiation.

l. Pathological Manifestations of the Twelve Main Meridians As each of the twelve main meridians is identified by its specific pathway and its relation with the specific zang·fu organ, the pathological manifestations of disorders of the rwelve meridians may be grouped under two headings: Dysfunction of the zang-fu organ 10 wh ich the diseased meridian is rela ted. Disorders of the area supplied by the meridian. Hence. the pathological manifestations of the twelve meridians are described as follows. a) Tire L11ng Meridian of Hand-Taiyin Cough, asthmatic breathing, hemoptysis, congested and sore throat, a sensation of full ness in the chest; pain in the supraclavicular fossa, shoulder. back and ante-

l.!8

rior border of the medial aspect of the arm. b) The Large Intestine Meridian of Hand-Yangming Epistaxis, watery nasal discharge, toothache, congested and sore throat: pain in the neck, anterior pan of the shoulder and anterior border of the lateral aspect of the upper limb; borborygmus. abdominal pain, diarrhea and dysentery. c) The Stomach Meridian of FootYangming Borbo rygmus, abdom inal distension, edema, epigastric pain. vomiting, hunger, epistaxis, deviation of the mouth, congested and sore throat; pain in the chest, abdomen and anterior border of the lateral aspect of the lower limbs; fever and mania. d) Tire Spleen Meridian of Foot-Taiyin Belching, vomiting, epigastric pain. abdominal distension, loose stools, jaundice, heaviness of the body, lassitude, stiffness and pain in the root of the tongue, swelling and coldness in the medial aspect of the thigh and knee. e) Tht Heart Meridian of HandShaoyin Cardiac pain, palpitation. hypochondriac pain, insomnia, night sweating, dryness of the throa t, thirst, pain in the medial aspect of the upper arm and heat sensation in the pa lms. f) The Small lmestine Meridian of Hand-Taiyang Deafness, yellow sclera, sore throat, swelling of the cheeks, distension and pain in the lo\ler abdomen and pain in the posterior border of the lateral aspect of the shoulder and arm. g) The Bladder Meridian of FootTatyang , Retention of urine, enuresis, manic and depressive mental d isorders,

malaria, pain of the eyes, lacrimation when exposed to wind, nasal obstruction, rhinorrhea, epistax is, headache: and pain in the nape, back, low back, buttocks and posterior aspect of the lower limbs. ir) Tire Kidney Meridian of FootShaoyin Enuresis. frequent urination. nocturnal emission. impotence. irregular menstruation. asthmatic breathmg. hemoptysis, dryness of the tOngue, congested and sore throat, edema, pain in the lumbar region and in the postcriomedial aspect of the thigh, weakness of the lower limbs _ _ __ _ __ _ _ _ __ _ _ __ _ _ _ _~H::c9

acupuncture treatment.

3. Preparations Prior to Treatment

Fig. 137

ture and the reinforcing and reducing approach, practise the basic manipula· tion techniques. This purpose is to prac· tise the different manipulations in acu· puncture {Fig. 138). 3) Practise on your own body This may follow the manipulation methods on the paper packet and the cotton cushion so as to have personal experience of the needling sensation in clinical practice. Only by this can the practitioner really possess and produce beneficial results in

Fig. 138

I ) Inspection of the instruments Nee· dies of various size, t rays, forceps, moxe wool, jars, sterilized cotton ball, 7596 al· cohol or 1.596 iodine tincture, or 296 gentian violet. etc. should be carefully inspected and prepared before use. 2) Posture of tbe patient An appropriate posture of a patient is significant in correct loca tion of points, manipu lation for acupuncture and moxibustion , prolonged retaining of the needle, and in prevention of fainting, bent needle, stuck needle or broken needle. The selection of a proper posture is therefore of importance clinically. Generally, the practition· er must be able to work wi thout hindr· ance and the patient is relaxed and fee ls comfortable. The common ly-used postures adopted in the clinic are as follows : a) Sluing in flexion: suitable for the points on the head, neck and back (Fig. 139). b) Sluing erect with elbows resting on a table: suitable for the points on the head, a rm and shou lder (fig. 140). c) Lateral recumbem: suitable for the points at the lateral side of the body (Fig. 141 ). d) Supine pos/1/re: suitable for the points on the head and face, chest and abdominal region, and areas of the four limbs (fig. 142). e) Prone posture: suitable for the points on the head, neck, back, lumbar a nd buttock regions, and the posterior region of the lower limbs (Fig. 143).

Fig. 140 Sorting errect with elbows rest•ng on a table

Fog. 139 Sitting in rl•xion

Fig. 141 Leteral recumbent

F ig. 142 Supine

Fig. 143 Prone

OW"'!!I 14 ACUPUNCTUR£ TtCHhiQII!l>

3) Sterilization:

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Shenting (GV 24)

Shuigou (GV 26)

Bai.hui (GV 20)

Naohu (GV 17)

Fengfu (GV 16)

Yamen (GV IS)

Oazbui (GV 14)

Taodao (GV 13)

X X

Cbangqiang (GV I) 0

Knotting at Shaoyin

Jingming (BL I)

Dazhu (BL II)

Fengmeo (BL 12) Fufen (BL 41)

0 0

CHAPTER

GENERAL

INTRODUCTION

ACUPUNCTURE

TREATMENT

395

Fuyang(BL 59)

X X

Xi-(Cleft) of Yang Heel Vessel

Shenmai (BL 62)

Promoted by Yang Heel Vessel

Pucan (BL 61)

X X

Root of Yang Heel Vessel

Jinmen (BL 63)

X X

Collateral of Yang Link Vessel

Naoshu (SI 10)

Bingfeng (SI 12)

Quanliao (SI 18)

Tinggong(SI 19)

Tongziliao (GB 1)

Shangguan (GB 3)

Hanyan (GB 4)

x x

Xuanli (GB 6)

Qubin (GB 7)

Shuaigu (GB 8)

Fubai (GB 10)

Touqiaoyin (GB 11)

Wangu (GB 12)

Benshen (GB 13)

Yangbai (GB 14)

Muchuang (GB 16)

Zhengying (GB 17)

Chengling (GB 18)

Naokong (GB 19)

Fengchi (GB 20)

Jianjing (GB21)

Toulinqi (GB 15)

J96

Q IL"ESE ACUPUSCTl,.;R£ AND &.IOX18l.'$TIO._'

Hunntiao (GB 30)

Meeting wilh FoolTaiyin

!Uyue (GB 24)

Daimai (G B 26)

Wusbu (GB 27)

We1dao (GB 28)

Juliao(GB 29)

-Yangjiao (GB 35)

Tianliao (TE 15)

0 X

Jiaosun (TE 20)

Xi-{ Cleft) of Yang Link Vessel

-Yifeng (TE 17)

Erbeliao(TE 22)

Cheogqi (ST I)

JuiJao (ST 3)

Oicang (ST 4)

Xiaguan (ST 7)

Touwei (ST 8)

Qichong (ST 39)

Meeting with Conceplion Vessel

I Staning point or

Thoroughfare Vessel Binao (Lll4)

Jianyu (Lll5)

Jugu (Lil6)

Yingxiang (LI 20)

Meeting with I be collateral of HandYangming

• "0" indicates the meridian of origin and •x " the crossing meridian.

CHAPTER 16 A GF.NER.At. JNTROOUCTION TO ACUPUNCTURE TREATMENT

Tbe Crossing P oints on the Yin Meridians

Meridian

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Chengjiang (CV 24) 0

Meeting with FootYangming

Lianquan (CV23)

Tiantu (CV 22)

Shangwan (CV 13)

Meeting with FootYangming & HandTaiyin

Zhongwan (CV 12)

Promoted by HandTaiyang, Sbaoyang & Foot-Yangming

Xiawan (CV 10)

Yinjiao (CV 7)

Guanyuan (CV 4)

Zhongji (CV 3)

Qugu(CV2)

Huiyin (CV 1)

X X

Sanyinjiao (SP 6)

Chongmen (SP 12)

Fusbe (SP 13)

Dabeng(SP 15)

Fuai (SP 16)

Zhongfu (L U 1)

Along with Governor & Thoroughfare Yessets

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Zhangmcn ( LR 13) Qimeo (LR 14) Tiancbi ( PC I )

Meeting with Foot· Shaoyang

0 X

Meeting with Foot· Shaoyang

Hcnggu(K.l II)

Oahe( KI 12)

Qi.tue ( Kl 13)

Siman(K114)

Zhongzhu ( K115}

Huangsbu (K116)

Shangqu (K11 7)

Yindu (K119)

Futonggu (Kl 20)

Youmen(Kl21)

Zhaohai ( Kl 6)

Promoted by Yin Heel Vessel

Jiaoxin ( Kl 8)

Xi-(Ciefl) of Yin Heel Vessel

Zhubin ( KI 9)

Slliguan ( K.l 18)

Xi-(Ciefl)ofYin Link Vessel

Chapter 17 INTERNAL DISEASES I. EMERGENCY DISEASES AND SYNDROMES CAUSED BY EXOGENOUS PATHOGENIC FACTORS

strain and stress, or invasion of exogenous pathogenic wind, all leading to upsurge of liver yang and heart fire, wh ich makes qi and blood go upward together with turbid ph legm, disturbing the mind and resulting in this disease. In mild cases there are only symptoms showing dysfunction of the meridians and collaterals, while in severe cases both dysfunction of zang-fu organs and that of the meridians and collaterals are manifested. The syndrome indicating the attack on the zangfu organs may be subdivided into tense (excess) type and flaccid (deficiency) type. Tense (excess) syndrome results from disturbance of the mind by the phlegm heat, or collection of excessive fire in the heart and liver, while flaccid (deficiency) syndrome resu lts from deficiency of the primary qi or collapse of the kidney yang. In untreated or improperly treated cases, the tense syndrome tends to become flaccid and the prognosis is often poor.

1. Wind Stroke Wind stroke is an emergency case manifested by falling down in a fit with loss of consciousness, or hemiplegia, slurred speech and deviated mouth. Jt is characterized by abrupt onset with pathologica l changes varying quickly like the wind, from which the term "wind stroke" comes.

Etiology and Pathogenesis Wind stroke often occurs in the aged who are in poor health, with deficiency of qi and blood or deficiency in the lower part of the body and excess in the upper part. It may be caused by deficiency of the kidney yin due to sexual indulgence, or by irregular food intake, which impedes the transportation and transformation function of the spleen, leading to production of phlegm from accumu lated dampness and transformation into heat. Then there appears imbalance of yin and yang in the zang-fu organs. Other causative factors are exasperation, agitation, alcohol indulgence or overeating, over

Differentiation a) Attack on the zang-fu organs: i) Tense syndrome: Main manifestations: Falling down in a fit with loss of consciousness, tightly closed hands and clenched jaws, flushed face, coarse breathing, rattling in the throat, retention of urine, constipation, 399

CHINESE! ACUVUNCTUR£ AND MOXIBUSTION

red tongue with thick yellow or dark grey coating, string·taut, rolling and forceful pulse. Analysis: Wind stirred up by upsurge of liver yang sends qi and blood up· wards, which together with the accumu· lated phlegm fire disturb the mind, lead· ing to sudden Joss of consciousness with tightly closed hands and clenched jaws, flushed face, coarse breathing, retention of urine and constipation. Excessive wind phlegm brings about ratting in the throat. Red tongue with thick yellow coating or dark grey coating, string-taut, rolling and forceful pulse are the signs of wind com· bined with phlegm fire. ii) Flaccid syndrome: Main manifestations: Falling down in a fit and sudden loss of consciousness with mouth agape and eyes closed, snor· ing but feeble breathing, flaccid paralysis of limbs, incontinence of urine, flaccid tongue, thready, weak pulse, and in sev· ere cases cold limbs, or flushing of face as rouged, fading or big floating pulse. Analysis: Severe weakness of primary qi, separation of yin and yang and ex· haustion of qi in the zang organs are indicated in mouth agape, eyes closed, snoring but feeble breathing, flaccid par· alysis, and incontinence of urine. Flaccid tongue and thready weak pulse suggest the deficiency of blood and prostration of the kidney yang. If complicated with cold limbs, flushed face, fading or big floating pulse, it is a critical case, indicating ex· haustion of yin in the lower portion of the body and upward going of the isolat· ed yang. b) A/lack on the meridians and co/later·

a/s

There are two categories. One is that only the meridians and collaterals are attacked without the zang·fu organs being involved. The other is that after wind stroke the functions of the affected zang·fu organs have been restored, yet there exists stagnation of qi and blood in the meridians and collaterals. Main manifestations: Hemiplegia, numbness of the limbs, deviated mouth, slurring of speech, accompanied by head· ache, dizziness. vertigo, twitching of muscles, red eyes and flushed face, thirst, dryness of the throat, irritability, string· taut and rolling pulse. Analysis: Wind phlegm enters the me· ridians and collaterals due to imbalance of yin and yang, or after treatment the functions of the affected zang·fu organs have been restored, but wind phlegm still blocks the meridians and collaterals, causing retarded circulation of qi and blood. Hence appears hemiplegia, numb· ness of the limbs, deviated mouth and slurring of speech. If complicated with upsurging of liver yang, and upward dis· turbance of wind yang, the symptoms are headache, dizziness, vertigo and twitch· ing of muscles. If there is excessive fire in the heart and liver, there may be red eyes and flushed face, thirst, dryness of the throat and irritability. Stagnation of wind phlegm in the meridians and collar· erals leads to a string-taut and rolling pulse.

Treatment a) A/lack on the zang·fu organs: i) Tense syndrome

CHAPTER 17 INTERNA~ 0 1SEA$f.$

Method: Points of the Governor Vessel, the Liver Meridian of Foot-Jueyin and the twelve Jing-(Well) points are selected as the main points to promote resuscitation, reduce wind and fire and resolve phlegm. Either reducing method or pricking, to cause little bleeding, is applied. Prescription: Baihui (GV 20), Shu igou (GV 26), Fenglong (ST 40), Taichong (LR 3), Yongquan (KI 1), twelve Jing-(Well) points on both hands (LU II, HT 9, PC 9, L1 I , TE I, Sl 1). Supplementary Points: C lenched Jaws: Xianguan (ST 7), Jiache (ST 6), Hegu (LI 14). Aphasia and stiffness of tongue: Yamen (GV 15), Lianquan (CV 23), and Tongli (HT 5). Explanation: As t he condition is due to disturbance of the heart by phlegm fire associated with upsurging of liver yang and upward nowing of qi and blood, Baihui (GV 20) and Shuigou (GV 26) are selected to regulate qi of the Governor Vessel, effecting resuscitation, Yongquan (Kl I) is selected to conduct the heat downward, and Taichong (LR 3) to subdue the upsurging of qi in the Liver Merid ian and pacify the liver yang. Pricking the twelve Jing-(Well) points on both hands, where qi of the three yin and three yang meridians meet, may dispel heat and regain consciousness. The spleen and stomach are the source of phlegm production. Fenglong (ST 40), the Luo (Connecting) point of the Stomach Meridian can invigorate the functions of the spleen and stomach and help to resolve the turbid phlegm. Since the Yangming Meridi-

4(11

ans of Hand and Foot supply the cheeks, Xiaguan (ST 7), J iache (ST 6) and Hegu (LI 4) are chosen to promote the circulat ion of qi and blood for relieving the clenched jaws. Yamen (GV 15) and Lianquan (CV 23), being local and adjacen t points of the tOngue, and Tongli (HT 5), the Luo-(Connecting) point of the Heart Meridian, may relieve st iffness of tongue. ii) Flaccid syndrome Method: Moxibust ion is applied to points of the Conception Vessel to restore yang from collapse. Prescription: Shenque (CV 8), Qihai (CV 6) (indi rect moxibustion with salt), Guanyuan (CV 4). Explanat ion: Shenque (CV 8), Qihai (CV 6) and Guanyuan (CV 4) are located on the lower abdomen along the Conception Vessel and are the main points effective for collapse. Heavy moxibustion applied on Guanyuan (CV 4), a meet ing point of the Conception Vessel and three yin meridians, can strengthen the primary qi, and restore yang from collapse. b) Auack on the meridians and co/later-

als: Method: Points a long the Governor Vessel and the yang meridians of the affected side are mainly used to regulate qi and blood, remove obstruction from the merid ians and collaterals and reduce the wind. Needle with even movement first from the healthy side and then the affected side. Prescription: Baihui (GV 20), Tongtian (BL 7), Fengfu (GV 16). Upper limbs: Jianyu (LI 15), Quchi (LI II), Waiguan (TE 5), Hegu (LI 4). Lower limbs: Huantiao (GB 30),

Yanglingquan (GB 34), Zusanli (ST 36), Jiexi (ST 41 ). Supplementary points: Upward disturbance of wind yang: Reducing is applied to Fenchi (G B 20) and Taichong (LR 3), and reinforcing to Taixi (KI 3) and Sanyinjiao (SP 6). Excessive fire in the heart and liver: Reducing is appl ied to Dating (PC 7) and Xingjian ( LR 2), and reinforcing to Taixi (Kl 3). Deviated mouth: Dicang (ST 4 ). Jiache (ST 6). Explanation: Governor Vessel is the sea of all yang meridians. Baihui (GV 20), Fengfu (GV 16) combined with Tongtian (BL 7) can eliminate wind and remove obstruction from the meridians and collaterals. Since the yang meridians dominate the exterior of the body and qi, points of the yang meridians a re selected to regu late qi and blood of the body and promote smoot h circulat ion in the upper and lower ponions of the body. For the upper disturbance of wind yang, Fengchi (G B 20) and Taichong (LR 3) are select· ed to reduce the wind and pacify the liver. Reinforcing applied to Taixi (KJ 3) promotes the production of the kidney yin to nourish the liver. Reinforcing applied to Sanyinjiao (SP 6) nourishes yin and pacifies yang. For excessive fire in the heart and liver, reducing Dating (PC 7) and Xing· jian (LR 2) can eliminate the fire, while reinforcing to Taixi ( KJ 3) nourishes yin to reduce the fire. Dicang (ST 4) and Jiache (ST 6) are selected for the purpose of promoting a free circulation of qi in the meridians and collaterals around the

facial region. Remarks a) Wind stroke is referred to cerebral hemorrhage, thrombosis, embolism, su· barachnoid hemorrhage, etc. When the acute stage is over, there may be se· quelae, such as hemiplegia, monoplegia, aphasia, etc. b) Prophylactic measures for wind stroke: The old aged with deficiency of qi and excessive phlegm, or with manifestations of upsurging of liver yang marked by dizziness and palpitations, may have premonitory symptoms such as stiff tongue. slurred speech and numbness of the fin· ger tips. Attention should be paid to diet and life style and avoid overstraining. Frequen t moxibustion on Zusanl i (ST 36) and Xuanzhong (G B 39) may preven t an attack of wind stroke.

2. Syncope Syncope is manifested by sudden fainting, pallor, cold limbs and loss of consciousness, which are often resulted from emotional excitement. fright, or debilitation and overstraining. Etiology and Pathogenesis a) Deficiency type:

Syncope of this type is often caused by genera l deficiency of the primary qi and fa ilure of clear yang in ascending due to over strain or grief and fright, or by exhaust ion of qi after profuse bleeding. b) Excess type:

It is due mainly tO emotional disturb-

CI-IJ\PTER 17 INTERNAL DISEASES

ances, such as anger, fear and fright, leading to deranged now of qi, which rushes upwards to the heart and chest, blocking the windpipe and disturbing the mind, or due to upsurging of liver yang, and upward flowing of qi followed by perversion of blood flow after a fit of anger, leading to disturbance of the mind, and resulting in loss of consciousness. Differentiation

a) Deficiency syndrome: Main manifestations: Feeble breath· ing with mouth agape, spontaneous sweating, pallor, cold limbs, deep and thready pulse. Analysis: Dizziness, vert igo, Joss of consciousness. feeble breathing are the symptoms caused by deficiency of pri· mary qi with sudden perversion of its flow, sinking of qi in the spleen and stomach and failure of the clear yang in ascending. Cold limbs are caused by failure of yang qi to reach there. Weakness of primary qi and disabil ities of vital qi in controlling the pores are shown in sponraneous sweating, and mouth agape. Deep thready pulse also suggests deficiency of vital qi.

b) Excess syndrome: Main manifestations: Coarse breath· ing, rigid limbs, clenched jaws, deep and excess-type pulse. Analysis: Perversion of qi afte r a fit of anger makes qi activity impeded and blood rushing upward together with qi to disturb the mind, and hence occur sud· den collapse, loss of consciousness, clenched jaws and rigid limbs. Obstruction of qi in the lung gives rise to coarse

breathing. Deep and excess-type pulse is a sign of excess syndrome. Syncope manifested by sudden loss of consciousness shou ld be distinguished from wind stroke and epilepsy. Wind stroke: Loss of consciousness is complicated by hemiplegia and deviated mouth. Usually there are sequelae after restoration to consciousness. Epilepsy: Loss of consciousness is accompanied by convuls ions, expectoration of frothy sa liva or yeJJing. When the consciousness is regained the patient becomes as normal as usual. Treatment

a) Deficiency syndrome: Method: Points of the Governor Vessel and Pericardium Meridian are selected as the main points to promote resuscitation, reinforce qi and invigorate yang. Reinforcing is applied in acupuncture, combined with moxibustion. Prescription: Shuigou (GV 26), Baihui (GV 20), Neiguan (PC 6), Qihai (CV 6 ), Zusanli (ST 36 ). Explanation: Shuigou (GV 26), Bai· hui (GV 20) and Neiguan (PC 6) are the points for resuscitation. Qihai (CV 6) and Zusanli (ST 36) are good for reinforcing qi and invigorating yang.

b) Excess syndrome: Method: Reducing is applied to points of the Governor Vessel and Pericardium Meridian to promote resuscitation and regulate the flow of qi. Prescription: Shuigou (GV 26), Hegu (LI 4 ), Zhongchong (PV 9), Laogong (PV 8), Taichong (LR 3), Yongquan (KI I).

CHIN£.~E

Explanation: Shuigou (GV 26) and Zhongchong (PC 9) are used to promote resuscitation. Hegu (LI 4) and Taichong (LR 3) are the points for regulating the circulation of qi and blood. Laogong (PC 8) and Yongquan (Kl I) promote a clear mind and smooth flow of qi and blood. Remarks This condition includes simple fainting, postural hypotension, hypoglycem ia, hysteria, etc.

3. Sunstroke Sunstroke is an acute case occurring in summer, manifested by high fever, irritability, nausea, or even followed by collapse and loss of consciousness. The onset of this disease is due mostly to prolonged exposure to the sun , or to an environment wit h high temperature.

Etiology and Pathogenesis Summer heal, a pathogenic factor, is prevalent in summer time when the weather is scorching. Long exposure to the sun and to an environment with high temperature damages qi. Invasion of pathogenic summer heat in a condition of lower resistance brings about sunstroke. Summer heat is a pathogenic factor of yang nature with a tendency to attack the human body quick ly. There· fore the onset is abrupt and the changing of the pathological condition is rapid. Pathogenic summer heat is likely to dam· age the primary qi and consume the body fluid, leading to exhaustion of qi and yin. Furthermore, pathogenic summer heat

ACUPUNCTURE AND

MOXJB~IION

that may penetrate the pericardium and disturb the mind, followed by impairment of consciousness. Sunstroke, according to its clinical manifestations, may be classified into mild and severe types. Differentiation a) Mild type: Main manifestations: Headache, dizziness, profuse sweating, hot skin, coarse breathing, dry mouth and tongue, dire thirst, superficial, large and rapid pulse. Ana lysis: Pathogenic summer heat tends to attack the head and gives rise to headache and dizziness. Hot skin results from the accumulation of pathogenic summer heat in the body surface. Profuse sweating, coarse breathing, dry moUlh and tongue, dire thirst are all due to evaporation of body fluid by the summer heat. Superficial, large and rapid pulse is a sign showing the presence of the pathogenic summer heat. b) Severe type: Main manifestations: Headache, dire thirst, and shortness of breath at first, and then collapse, loss of consciousness, sweating, deep and forceless pulse. Analysis: This syndrome mostly occurs in those doing physical labor in the scorching summer sun. Overfatigue plus the attack of summer heat results in low· ered body resistance and excessiveness of the pathogenic factor with consumption of qi and body fluid. So there are headache, dire thirst and shortness of breath at the very beginning. The pathogenic summer heat can rapidly penetrate into the interior. affecting the pericardium

CHAPT£1t 17 lt-...,-EkNAL DISEASES

and disturbing the mind. Therefore loss of consciousness follows. Sweating and deep, forceless pu lse indicate exhaustion of qi and body fl uid.

Treatment a) Mild type:

Method: Reducing is applied to the points of the Governor Vessel, Pericardium and Large Intestine Meridians to eliminate the summer heat. Prescription: Dazhu i (GV 14 ), Neiguan (PC 6), Quchi (LI I I), Weizhong (BL 40). Explanation: Dazhui (GV 14), the meeting point of the Governor Vessel and all yang meridians, Weizhong (BL 40), also named Xuexi, and Quch i (LI II), an important point for elim inating heat, are used to dispel the summer hear. Neiguan (PC 6), the Luo-(Connecting) point of Jueyin Merid ian of Hand, is chosen to reduce the fire and to protect the heart. b) Severe type: Method: Reducing is applied to the points of the Governor Vessel to promote resuscitation, and to dispel the summer hear. Prescription: Shuigou (GV 26), Baihui (GV 20), Shixuan (Extra), Quze (PC 3), Weizhong (BL 40). Explanation: Summer heat is a pathogenic factor of yang natu re, which is apt to attack the pericardium and distu rb the mind. Shuigou (GV 26) and Baihui (GV 20) are selected to promote resuscitation. Quze (PC 6), the He-{ Sea) point of HandJueyin, Weizhong (BL 40), the He-{Sea) point of Foot Taiyang are pricked super-

ficially to remove the heat from the blood. Blood letting at Shixuan (Extra) can reduce heat and promote resuscitation. Remarks a) This illness includes thermoplegia, thermospasm, heliosis, etc. b) Scraping therapy: It is a popular treatment for mild sunstroke. Dip a smooth spoon into water or vegetable oil and scrape the both sides of the spine, the neck, intercostal spaces, shoulder re· gions, cubita l and axil la fossae until pur· plish red color appears.

4. Common Cold Common cold is an exogenous ailment with headache, nasal obstruction, aver· s ion to wind and fever as its main mani· festations. It often results from lowered superficial resistance and invasion of the exogenous pathogenic factors. It may occur in any season. According to the difference in weather, pathogenic factors and body constitution, the manifestations can be classified into two types: wind cold and wind heat. Etiology and Pathogenesis Th is disease is often due to delicate consti tution and weakened body resist· ance which makes the body inadaptable to intense changes of the weather with abnormal cold or warmth. Then the exogenous pathogenic wind invades the body through the pores, skin, mouth and nose, leading to manifestations related to lung and the defensive function. Very often

OliN~

pathogenic wind combined with other pathogenic factors like pathogenic cold causes a wind cold syndrome, or with pathogenic heat causes a wind heat syn· drome. Invasion of exogenous pathogenic wind and cold may retard the lung's d is· persing function and block the pores, while invasion of exogenous pathogenic wind and heat may impair the lung's des· cending function by the evaporating heat, and lead to abnormal funct ioning of the pores. In addition, si nce the patient's body build is different and the interna l and external causes are mutually influ· enced, the manifestations after invasion by the pathogenic factors must be varied. For patients with yang deficiency, wind cold syndrome is mostly seen, while for those with yin deficiency, wind heat syn· drome is often found. Differentiation a) Wind cold: Main manifestations: Ch ills, fever, an· hidrosis, headache, soreness and pain of the limbs, nasal obstruction, running nose, itching of the throat, cough, hoarse voice, profuse thin sputum, thin white tongue coating, superficia l and tense pu lse. Analysis: Invasion of the body surface by pathogenic wind and cold impairs the dispersing function of the lung and af· fects the nose, causing nasal obstruction and discharge. Pathogenic cold is of yin nature, which is likely to damage yang. Impairment of superficial yang is man· ifested by exterior symptoms such as chi lls, fever, an hidrosis, headache, even soreness and pain of the limbs. Thin

ACUPUNCtURE ANO MOXI H~IOK

wh ite tongue coating and superficial tense pulse are the signs showing the invasion of the lung and the superficial defensive system by pathogen ic wind and cold. b) Wind hear: Main manifestations: Fever, sweating, slight aversion to wind, pain and distend· ing sensation of the head , cough with yellow, thick sputum, congested and sore throat, thirst , thin white or yellowish tongue coating, superficial and rapid pulse. Analysis: Pathogenic wind heat often attacks the body through the nose and mouth. The lung is involved first. Patho· genic wind of yang nature is character· ized by upward and outward dispersion. When a fight goes on between the patho· genic wind heat and the body res istance, fever, slight aversion to wind and sweat· ing result. When the pathogenic wind heat attacks the head, symptoms like pain and d istending sensation occur in the head. In case the lu ng fai ls in dispersing and descending, there appears cough with yellow, thick spu tum. When the pathogenic wind heat stines the air passage, there is congested sore throat wi th thirst. Thin, white or yellowish tongue coating, and superficia l rapid pulse a re the signs showing the lung and the defensive system being attacked by the pathogenic wind heat. Treatment a) Wind cold: Method : Reducing is applied to the points of the Governor Vessel, Taiyang and Shaoyang Meridians to eliminate

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CHAPTER 17 INTERNAL DISeASES

wind cold and relieve exterior symptoms. Even movement combined with moxibus· tion is applied to patients with weakened constitutions. Prescription: Fengfu (GV 16), Feng· men (BL 12), Fengchi (GB 20), Lieque (LU 7), Hegu ( Ll 4). Explanation: Fengfu (GV 16) is used to relieve the exterior symptoms, elimi· nate wind and check headache. Fengmen (BL 12), a point of the Taiyang Meridian which dominates the surface of the whole body, is selected to regulate the circula· tion of qi in this meridian, to eliminate wind cold and to relieve chills and fever. As the pathogenic cold has attacked the surface of the body, and the lung is the organ related to the ski n and hair, Lieque {LU 7), the Luo-(Connecting) point of the Lung Meridian, is used to promote the dispersing function of the lung and to check cough. Fengchi (GB 20), a point at the intersection of the Foot Shaoyang and Yang Link Vessels, of which the latter dominates yang and the exterior, is used to eliminate wind cold. Since the Taiyin and Yangming Meridians are ex· ternally and internally related, Hegu {LJ 4), the Yuan·{Primary) point of the Yangming Meridian, is used to elim inate the pathogenic factors and relieve the exterior symptoms. b) Wind heat: Reducing is applied to the points of the Governor Vessel, Shaoyang and Yangming Merid ians to eliminate wind heat. Prescription: Dazhui {GV 14), Quchi (LI I I), Waiguan (TE 5), Hegu (LJ 4), Yuji {LU 10), Shaoshang (LU 1 I).

Explanation: The Governor Vessel is the sea of all the yang meridians. Dazhui (GV 14), a point where all the yang me· ridians meet, is used to eliminate heat and other pathogenic factors of yang na· ture. Hegu (LI 4) and Quchi (Ll 11) are the Yuan·(Primary) point and the He· (Sea) point of the Yangming Meridian of Hand respectively. Since the Yangming and Taiyin Meridians of Hand are exter· naJJy and internaJJy related, reducing applied to these two points can clear lung qi and reduce heat. Yuji (LU 10), the Ying· (Spring) poim of the Lung Meridian, in combination with Shaoshang (LU 11), can el iminate hea t from the lung and ease the throat. Waiguan (TE 5), the Luo· (Connecting) point of the Shaoyang Me· ridian of Hand connecting with the Yang Link Vessel, can dispel pathogenic fac· tOrs of yang nature in the exterior of the body and el iminate heat.

Remarks a) The above treatment can also be used for other viral and bacterial infec· tions of the upper respiratory tract as weJJ as influenza. However, common cold should be distinguished from other infec· tious diseases with similar symptoms at the early stage. b) Prophylactic measures: Moxibus· tion is applied daily to Fengmen ( BL 12) or Zusanli (ST 36) to prevent common cold during its prevalence.

5. Malaria Malaria is a disease characterized by paroxysms of shivering chills and high

CHINESE: ACUPUNCT\lKE AND MOXliJUSTION

fever occurring at regular intervals, most· ly found in late summer and early au· tumn, but also sporadically occurring in other seasons. The causative factor is the malarial pestilential factor. The recur· renee of chills and fever varying with the condition of yin and yang and body con· stitution, may be once every day, every second day or every third day, known respectively as quotidian malaria, tertian malaria and quartan malaria according to the interval between attacks. In chronic cases there may be a mass in the hypo· chondriac region, termed "malaria with splenomegaly."

Etiology and Pathogenesis The disease is believed to be caused mainly by the malarial pestilential factor together with invasion of pathogenic wind, cold, summer heat and dampness. Improper food intake, overstrain and stress, and irregular daily life can predis· pose one to malaria by weakening the body resistance. Invasion of the Shaoyang Meridian by the pathogenic factors causes ying·wei disharmony, resulting in malaria. a) The pestilential factor together with the pathogenic wind cold, summer heat, and dampness invades the body, resides in the portion between the exter· ior and interior, and moves outward and inward between ying and wei. When they move inward to struggle with yin, there are chills, and when they move outward to fight with yang, there is fever. It is clear that the paroxysm of chills and fever depends on the struggle between the antipathogenic factors and pathogen-

ic factors. If the pathogenic factors and the antipathogenic factors are separated from each other, or if the pathogenic factors avoid fighting with the ying and wei, there appears an interval between the paroxysms. b) Only when the body resistance is weak , the pestilential factor invades the body. Weakened body resistance may be due to abnormal daily life, overstrain, or deficiency of qi and blood caused by im· proper transportation and transforma· tion function of the spleen and stom· ach as a result of irregular food intake. Zhang Jingyue once said: "Malaria is an exogenous disease .... Only in the condi· tion of delicate health, or overstrain and stress, is one apt to be attacked by the malarial pathogenic factor." In a word , the causative factor is the pestilential factor, but the condition of body resistance plays a very important role. One with the body resistance vigo· rous enough to prevent the invasion by pathogenic factors seldom suffers from malaria, whereas one with lowered body resistance is apt to be attacked. Differentiation Main manifestations: Paroxysms of shivering chills and high fever with general hot sensation, preceded by yawning and lassitude. There appear intolerable headache, nushed face and red lips, sti· ning feel ing in the chest and hypochon· driac region, bitter taste and dry mouth , and dire thirst. At the end of the parox· ysm the patient breaks out in profuse perspiration and fever subsides with the body felt cool. Thin, sticky and yellow

CtlAmR 17 INTI';RNAI,. 0 1$W.F..$

tongue coating, string-taut and rapid pulse. In chronic cases a mass in the hypochondriac region-splenomegaly is usually found. Analysis: Occurrence of shivering chills and high fever is due to the fight of the pathogenic factors against ying and wei in the portion between the exterior and interior of the body. There appears an interval between paroxysms of chills and fever if the pathogenic factors avoid fighting with ying and wei. Yawning, lassitude and chills with shivering are caused by the invasion of pathogenic factors which suppress yang qi. General hot sensation, intolerable headache, nushed face and red lips indicate that the accu· mulated pathogenic cold has turned into heat. The sti fling feeling in the chest and hypochondriac region, and bitter taste in the mouth suggest that the pathogenic factors in the Shaoyang Meridian and in the portion between the exterior and in· terior impair the circulation of qi and blood. Thirst results from the consump· tion of the body fluids by heat. Thin, sticky and yellow tongue coating, string· taut and rapid pulse are the signs related to the presence of cold and heat and the contradiction between the antipathogen· ic factors and pathogenic factors. The chronic case with a mass formed in the hypochondriac region is due to deficiency of qi and blood and stagnation of exces· sive phlegm in the meridians and collater· als.

Treatment Method: Reducing is applied to the points of the Governor Vessel and Shao·

yang Meridians to regulate the Governor Vessel and to harmonize the Shaoyang Meridians. Treatment is given two hours prior to the paroxysm. If chills are predominant during the paroxysm, acupuncture is advised to combine with moxibus· tion. If fever is the dominant symptom. acupuncture alone is employed. Prescription: Dazhui (GV 14), Taodao (GV 13), Houxi (S I 3), Jianshi (PC 5), Yemen (TE 2), Zulinqi (GB 41). Supplementary points: High fever: Quchi (L I II ) with reduc· ing method. Malaria with splenomegaly: Needling of Zhangmen (LR 13) and moxibustion at Pigen (Extra). High fever with delirium and mental confusion: Prick the twelve Jing-{Well) points (LU II, HT9, PC9, L I I, TE I, S I 1). Explanation: Dazhui (GV 14), the meeting point of the three yang meridi· ans and the Governor Vessel, can promote the circu lation of qi in the yang meridians and help to eliminate pathogenic factors, in combination with Taodao (GV 13), which can remove obstruction from the Governor Vessel and regulate yin and yang. They are the chief points for malaria. Yemen (TE 2) and Zulinqi (GB 41), two points along the Shaoyang Meridians can harmonize qi of the Shaoyang Meridians. Houxi (SI 3), a point of Taiyang Meridian of Hand, can activate the circulation of qi in the Taiyang Meridian and the Governor Vessel and drive patogenic factors out. Jianshi (PC 5), a point of Jueyin Meridian of Hand, is an empirica l point for malaria.

CHINES£ ACUPUNCTURE AND MOXIBUSTION

410

Combination of all the above mentioned points can promote the circulation of qi in the yang meridians, and help to eliminate pathogenic factors, relieve both the symptoms, harmonize ying and wei, and check malaria. Quchi ( Ll I I), a point of Yangming Meridian of Hand, combined with Dazhui (GV 14) can dispel heat. Zhangmen ( LR 13), the innuential poi nt dominating zang organs can regu late qi in the zang organs. Pigen, an extra point, is selected to treat the mass in the hypOchondriac region. Acupuncture treatmenl of tertian malaria has ach ieved better effects. Pernicious malaria should be treated by acupuncture in combination with medicine.

II. ZANG-FU SYNDROMES I. Cough Cough, a main symptom of the lung problems, may result either from attack by exogenous pathogenic factors disturbing the dispersion of qi of the lung, o r f rom disorders of the lung itself or other diseased zang-fu organs affecting the lung.

Etiology and Pathogenesis a) Invasion by the exogenous pathogenic factors: The lung dominates qi and is regarded as an umbrella protecting the five zang organs. Upward it connects t he throat and has its opening in the nose, govern ing respiration. Externally it associates with the skin and hair. Once the lung is attacked by the exogenous pathogen-

ic factors, the qi of the lung is blocked and fa ils to descend, thus resulting in cough. Since the weather changes in different seasons, the exogenous pathogenic factors auacking the human body are various. Cough is therefore d ivided imo two types: wind cold and wind heat. b) lntemal injury: Cough resulted from functional impairment of the zang-f u organs falls into the category of cough due to internal injury, such as cough caused by dryness of the lung with deficiency of yin leading to fa ilure of the qi of the lung to descend, or by disorders of the other organs affecting the l ung. For example, in case of weakened spleen yang, the accumulated dampness may be turned into phlegm which goes upward to the lung, affecting the normal activities of qi and leading to cough. Stagnation of liver qi may be 1urned inlo fire, wh ich flares up and injures the lung fl uid, also resulting in cough. As sa id in Internal Classic: "Cough can be caused by disturbance not only of !he lung, but of any other zang-fu organs.~ No matler which zang-fu organ is dysfunctioned, cough may result if the lung is affected. The commonly seen cough caused by internal injury in cl inic resulrs from dryness of t he lung wilh deficiency of yi n, and blockage of the lung by phlegm.

Differentiation a) Invasion by the exogenous pathogenic factors: i) Wind-cold type: M ain manifestalions: Cough, itching

otA.PTER I" L"lTEJtNAL OJS!ASES

of the throat, thin and white sputum, aversion to cold, fever, anhidrosis. head· ache, nasal obstruction and discharge, thin, white tongue coating and superficial pulse. Analysis: Cough, itching of the throat, thin and white sputum, nasal ob· struction and discharge result from the allack of the lung by pathogenic wind cold, which is stagnated in the respiratory tract, affecting the dispersion of the qi of the lung. Headache, aversion to cold, fever and anhidrosis are due to wind cold affecting the skin and hair. and residing on the body surface. Thin, white tongue coating and superficial pulse indicate the presence of the pathogenic factors stay· ing in the lung and in the superficia l part of the body. ii) Wind-heat type: Main manifestations: Cough with yel· low, thick sputum, choking cough, thirst. sore throat, fever, or headache. aversion to wind, sweating, thin, yellow tongue coating, superficial and rapid pulse. Analysis: In case of the attack of the lung by the pathogenic wind heat, the function of the lung in clarifying the passage and sending down the qi is im· paired. The nuids are heated and turned into phlegm, and so cough with yellow, thick sputum or choking cough takes place. When the heat in the lung injures body fluid, thirst and sore throat occur. When the pathogenic factors stay in the skin and hair, their conflict with the body resistance gives rise to headache, aversion to wind, sweating and fever. Thin, yel· low tongue coating, and superficia l rapid pulse arc the signs of wind heat staying

in the lung and in the superficial part of the body. b) Internal injury: i) Blockage of the lung by phlegm: Main manifestations: Cough with profuse, white and sticky sputum, stuffiness and depression of the chest, Joss of appe· tit e. white, sticky tongue coating and roll· ing pulse. Analysis: ..The spleen is considered as the source in the production of sputum and the lung as a container to store it ... If the spleen fails in its transformation and transportation. the water dampness will no longer be transported and then gath· ered to form phlegm, which goes upward to the lung, affecting the qi of the lung and causing its failure in descending. The result is cough with profuse sputum or with wh ite. sticky sputum. If water dampness stays in the middle energizer, im· pairing its activity, there may be stuffi· ness and depression of the chest and Jots of appeti te. White. sticky tongue coating and rolling pulse are due to internal obstruction by the phlegm. ii) Dryness of the lung with deficiency of yin: Main manifestations: Dry cough with· out sputum or with seamy sputum, dry· ness of the nose and throat , sore throat, spitting blood or even coughing blood, afternoon fever, malar flush, red tongue, thin coating, thready and rapid pulse. Analysis: Dryness is easy to consume the body fluid. If the lung is injured by dryness, the function of the lung will be impaired. manifested by dry cough with· out sputum or with scanty sputum, dry· ness of the nose and throat, or sore

412

throat. If the lung vessels are injured by dryness, blood in the sputum or hemop· tysis results. If there is deficiency of yin of the lung with endogenous hea t, after· noon fever and malar flush may be present. Red tongue, thin coating, and thready rapid pulse are the signs indicat· ing deficiency of yin and dryness of the lung. Treatment a) Invasion by exogenous pathogenic factors: Method: Select the points from the Taiyin and Yangming Meridians of Hand as the principal ones. Both acupuncture and moxibustion are applied in case of wind cold, while only acupuncture is used in case of wind heat to activate the dispersing function of the lung and to relieve the symptoms. Prescription: Lieque (LU 7), Hegu (LI 4), Feishu (BL 13). Supplementary points: Pain and swelling of the throat: Shaoshang ( LU I I). Fever and aversion to cold: Dazhui (GV 14), Waiguan (TE 5). Explanation: The Taiyin and Yang· ming Meridians of Hand a re exteriorlyinteriorly related. Lieque (LU 7}, the Luo-{Connecting) point, and Hegu (Ll 4), the Yuan-(Primary) point, are selected in combination with Feish u (BL 13) to strengthen the functiona l activities of the lung, to relieve symptoms and to elimi· nate the exogenous pathogenic factors, resulting in smooth flow of qi of the lung and the norma l dispersing function of the lung.

CH INESE ACUPUr\CTURE AND MOXIBUSTfON

b) Internal injury: i) Blockage of the lung by phlegm: Method: Select the Back-Shu point and the points of the Yangming Meridian of Foot as the principal points. Both reinforcing and reducing methods should be considered in acupuncture treatment, or combined with moxibustion to strengthen the function of the spleen and to resolve phlegm. Prescription: Feishu (BL 13}, Zhongwan (CV 12), Chize (LU 5), Zusanli (ST 36 ), Fenglong (ST 40). Explanation: The Back-Shu point and the Front-Mu point are the points where qi of the zang-fu organs converges. Feishu (BL 13) and Zhongwan (CV 12) are selected in combination with Zusanli (ST 36), the He-( Sea) point of Yangming Me· rid ian of Foot, to st rengthen the function of the spleen and harmonize the stomach, remove dampness and resolve phlegm. Chize ( LU 5). the He-(Sea) point of the Lung Meridian , is able to reduce the pathogenic factors from the lung and relieve cough. Fenglong (ST 40), the Luo(Connecting) point of the Yangming Me· ridian of Foot. is selected to strengthen smooth transport of qi in the spleen and stomach. Thus the body fluids are normally distributed following the free flow of qi and phlegm is resolved. ii) Deficiency of yin with dryness of the lung: Method: Select the Back-Shu point and Front-Mu point of the Lung Meridian as the principal points. Even-movement is applied in acupunc· ture treatment to nourish yin, eliminate dryness and descend lung qi.

CIIAPTER 17 INTERNAL DISEASES

Prescription: Feishu (BL 13), Zhong· fu (LU I ), Lieque (LU 7), Zhaohai (Kl 6). Supplementary points: Kongzui (LU 6) and Geshu (BL 17) in case of coughing blood. Explanation: The selection of Feishu (BL 13) and Zhongfu (LU I) is a method of combining Back·Shu point and Front· Mu point It is used to regulate the lung passage and descend lung qi. Lieque (LU 7), the Luo-(Connecting) point of the Lung Meridian of Hand·Taiyin, is con· nected with the Conception Vessel. Zhaohai (Kl 6) is a point of the Kidney Meridian of Foot·Shaoyin curving around the genital organ. The two points located up and down are selected as a combination of the Eight Confluent points to nourish yin, eliminate dryness, clear the throat and descend the lung qi. Kongzui (LU 6), the Xi-( Cleft) point of the lung, is indicated in acute cases of the lung. Geshu (BL 17) is a blood point of the Eight Influential Points. The two points are used in combination to stop bleeding. Remarks a) If cough is accompanied by fever and asthma, see "Common Cold" and "Asthma." b) Cough is often seen in common cold, acute and chronic bronchitis, pneu· monia, bronchiectasis and pulmonary tuberculosis. c) Cupping: Fengmen (BL 12), Feishu (BL 13). d) Dermal needle therapy : Tap along the Governor Vessel and the Bladder Merid ian on the upper part

4 1~

of the back till the skin becomes red or bleeds s lightly.

2. Asthma Asthma is a common illness character· ized by repeated attacks of paroxysmal dyspnea with wheezing. Generally speaking, it involves a variety of disorders resulting from disturbance of qi activit ies, and can be divided into two types: deficiency and excess. Etiology and Pathogenesis The causative factors are varied from the exogenous pathogenic factors to weakened body resistance. Asthma due to exogenous pathogenic factors is of excess type, and that due to weakened body resistance is of deficiency type. a) Excess type: Wind·cold type: It denotes asthma due to invasion of wind cold, which impai rs the smooth flow of the lung qi, injures the skin and hair, and makes the pores closed. Since the lung and the superficial defensive system are weakened, the lung qi fails to disperse and descend, leading to cough. Phlegm-heat type: It refers to asthma due to failure of the spleen in transformation and transportation, resulting in production of phlegm from the accumu· lated dampness. Long-standing retention of phlegm turns into heat, or excessive fire of the lung evaporates the fluids to phlegm. When the phlegm fire stays in the lung, the lung qi is stagnated and the normal activity of the lung is impaired. Failure of the lung qi in descending func-

414

tion results in asthma. b) Deficiency type: i) Lung deficiency: A prolonged and protracted cough can weaken and injure the lung qi. Overstrain and internal injury can also bri ng about deficiency of the lung qi. In either case, shortness of breath and dyspnea may occur. ii) Kid ney deficiency: Overwork and sexual indulgence can injure the kidney. A severe or chronic disease weakens the body resistance and damages the essen tial qi. Long-standing asthma also affects the kidney. In any of the above cases, fai lure of the kidney in receiving qi may give rise to asthma. Differentiation a) Excess rype: i) Wind-cold type: Main manifestations: Cough with thin sputum, rapid breathing. accompan ied by chi lls, fever, headache, and anhidrosis at the early stage, absence of thirst, whi te tongue coating, superficial and tense pulse. Analysis: The lung is in charge of respiration and is associated with the skin and hair, wh ich are first attacked by wind cold in the invasive procedure. If wind cold resides in the lung, stagnation of qi and failure of the lung qi in dispersing result in cough with thin sputum and rapid breathing. If wind cold st ill resides in the superficial part of the body to make the pores close, there appear chi lls, fever, headache and anhidrosis. Since the wi nd cold has not transformed into heat yet, thirst is absent. White tongue coating, superficial and tense pulse are the

CHINES£ ACUJ>UNCntRE ANO MOXIOUSTIOI\"

signs of wind cold staying in the lung and the defensive system. ii) Phlegm-heat type: Main man ifestations: Rapid and short breathing, strong and coarse voice, cough with thick yellow sputum, sensation of chest stuffiness fever, restlessness, dryness of the mouth, thick yellow or sticky coating. rolling and rapid pu lse. Analysis: Phlegm heat turned from dampness or long-standing ph legm fire gathered in the lung blocks the air passage, causing impai rment of the lung qi , and thus presenting rapid and short breathing, strong and coarse voice, and cough with thick yellow sputum. When the phlegm stays in the lung, sensation of chest stuffiness appears. Fever, restlessness and dryness of the mouth are due to the presence of the fi re heat. T hick yellow or sticky coating, rolling and rapid pulse a re the signs of the phlegm heat. b) Deficiency type: i) Lung deficiency: Main man ifestations: Short and rap· id breathing, feeble voice, weak and low sound of cough ing, sweating on exertion, pa le tongue, pulse of deficiency type. Analysis: The lung dominates qi. When there is deficiency of the lung qi the function of the lung is impai red. There appear short and rapid breathing, feeble voice, weak and low sound of cough ing. When the lung qi is weak, and the superficial defensive system is not strong, even mild exertion will induce sweating. Pale tongue and pulse of deficiency type are the signs of deficiency of the lung qi. ii) Kidney deficiency:

41S

Main manifestations: Dyspnea on exertion after long-standing asthma, severe wheezing, indrawing of the soft tissues of the neck, short breath, lassitude and weakness. sweating, cold limbs, pale tongue, deep and thready pulse. Analysis: Long-standing asthma affects the kidney which is the source of qi. The kidney in lowered functioning fails to receive qi, and therefore dyspnea on exertion, severe wheezing and short breath appear. When there is deficiency of the kidney qi in a chronic case, emaciation and lassitude happen. Exhausted kidney yang may lead to weakening of the superficial defensive yang, and hence sweating. If the yang qi fails to warm up the body surface, cold limbs appear. Pale tongue, deep and thready pulse are the signs of weakened kidney yang. Treatment a) Wf11d cold:

Method: Points of the Hand-Taiyin and Hand-Yangming Meridians are selected as the principal points. Reducing method is applied in combination with moxibustion to eliminate wind cold and soothe asthma. Prescription: Feishu ( BL 13), Fengmen ( BL 12), Dazhui (GV 14), Lieque (LU 7}, Hegu (LI 4). Explanation: Feishu (BL IJ) and Fengmen (BL 12) are the points of the Foot-Taiyang Meridian and located in the vicinity of the lung. They are able tO clear the lung and eliminate wind. Dazhu i (GV 14), Lieque (LU 7) and Hegu (LI 4) are in function to el iminate wind and cold, clear the lung and soothe asth-

ma. b) Phlegm heat: Method: Points of the Hand-Taiyin and Foot-Yangming Meridians are se lected as the principal points with reducing method applied to resolve phlegm, reduce heat and soothe asthma. Prescription : Feishu ( BL 13 ), Dingchuan (Extra), Tiantu (CV 22), Chizc (LU 5), Fenglong (ST 40). Explanation: Chize (LU 5), the He(Sea) point of the Hand-Taiyin Meridian, is able to reduce phlegm heat and soothe asthma. Fcnglong (ST 40). a point of the Foot-Yangming Meridian, is able to strengthen the spleen function and resolve phlegm. Feishu (BL 13) is applied to clear the lung and regulate the now of qi. Tiantu (CV 22) is in function to descend qi and resolve phlegm. Dingchuan (Extra) is an empi rical point to pacify breathing. c) Deficiency type:

i) Lung deficiency: Method: Points of the Hand-Taiyin and Foot-Yangming Meridians are selected as the principal points with reinforcing method applied to strengthen the lung qi. Moxibustion is also advisable. Prescript ion: Feishu (BL 13}, Taiyuan (LU 9), Zusanli (ST 36), Taibai (SP 3). Explanation: Taiyuan (LU 9), the Yuan-{Primary) point of the Lung Meridian, is able to reinforce the lung qi. Feishu ( BL 13) used in acupuncture and moxibustion, can strengthen the lung qi. Zusanli (ST 36) is the He-(Sea) point of the Stomach Merid ian of Foo tYangm ing. Taibai (SP 3) is the Yuan( Primary) point of the Spleen Merid ian.

The lung pertains to metal and the spleen to earth, which is able to promote metal. "Reinforce the mother in case of deficiency." ZusanJi (ST 36) and Taiba i (SP 3) are selected here to strengthen the lung through invigorating the spleen and stomach. ii) Kidney deficiency: Method: Points of the Foot-Shaoyin Meridian and Conception Vessel are selected as the principal points with reinforcing method applied to strengthen the kidney function in receiving qi. Moxibustion is also advisable. Prescription: Taixi ( KI 3), Shenshu (BL 23), Feishu ( BL 13), Tanzhong (CV 17). Qihai (CV 6). Supplementary points: Persistent asthma: Shenzhu (GV 12), Gaohuang (BL 43). Deficiency of the spleen: Zhongwan (CV 12), Pishu (BL 20). Explanation: Taixi (KI 3), the Yuan(Primary) point of the Kidney Meridian, is able in combination with Shenshu ( BL 23) to strengthen the primary qi of the kidney. Tanzhong (CV 17), the qi point of the Eight Lnnuential Points, and Feishu (BL 13), the Back-Shu point of the lung, are need led to reinforce qi and pacify breathing. Qihai (CV 6), an importan t point to reinforce qi, is able to regulate qi in the lower energizer, reinforce the kidney, strengthen the primary qi, invigorate yang and control essence. Puncture on these points strengthens the kidney in receiving qi and pacify breathing. Moxibustion on Shenzhu (GV 12) and Gaohuang (BL 43) may relieve chronic asthma, while moxibustion on Zhongwan

(CV 12) and Pishu (BL 20) may strengthen the function of the spleen and reinforce qi. Remarks This condition includes bronchial asthma, asthmatic bronchitis, obstructive pulmonary emphysema and dyspnea present in some other diseases. However, for severe dyspnea, a combined treatment should be taken into account.

3. Epigastric Pain Epigastric pain is a common symptom, often characterized by repeated recurrence. Since the pain is close to the cardia. it was also named ~cardio abdominal pain" or "cardiac pain" in ancient times. Etiology and Pathogenesis a) Irregular food intake, preference for raw and cold food and hunger injure the spleen and stomach. causing failure of the spleen in transportation and transformation and failure of the stomach qi in descending, then pain appears. b) Anxiety, anger and mental depression damage the liver, causing failure of the liver in dominating free flow of qi , adversely auacking the stomach, impeding its activity and hindering its qi descending, then pain appears. c) Generally lowered functioning of the spleen and stomach, due tO invasion of pathogenic cold, which is stagnated in the stomach. causes failure of the stomach qi in descending. then pain occurs.

.,. Differentiation a) Retention offood:

Main manifestations: Distend ing pain in the epigastrium, aggravated on pressure or after meals, belching with fetid odor, anorexia, thick, sticky tongue coating, deep. forceful or rolling pulse. Analysis: Retention of food in the stomach makes the stomach qi fail to descend, then distending pain in the epigastrium and belching with fetid odor occur. Retention of food is an excess condition, pain is therefore aggravated upon pressure. Since the stomach is injured by retention of food, pain becomes worse after meals and anorexia appears. Thick, sticky tongue coating, deep, forceful or rolling pulse are the signs of retention of food. b) A/lack of the stomach by the liver qi:

Main manifestations: Paroxysmal pain in the epigastrium, radiating to the hypochondriac regions, frequent belching accompanied by nausea, vomiting, acid regurgitation, abdominal distension. anorexia. thin. white tongue coating. deep, string-taut pulse. Analysis: Stagnation of the liver qi makes the liver fail to dominate the free flow of qi. If the depressed liver qi at· tacks the stomach, pain in the epigastrium appears. As the Liver Meridian locates along both hypochondriac re· gions, the pain is wandering and may be referred to both hypochondriac regions. In case of stagnation of the qi, belching occurs. even symptoms like nausea, vomiting. acid regurgitation. abdominal distension and anorexia may appear. Thin, white tongue coating and deep st ring-tau t

pulse are the signs of attack of the stomach by the perversive liver qi. c) Deficiency of the stomach with stagnation of cold:

Main manifestations: Dull pain in the epigastrium, which may be relieved by pressure and warmth, general lassitude, regurgitation of thin fluid, thin, white tongue coating. deep, slow pulse. Analysis: Lowered function of the s pleen and stomach with cold invasion retards transportation and transformation, so dull pain appears in the epigastrium. The spleen dominates the limbs. If the spleen yang is weak, general lassitude occurs, as well as the regurgitation of thin fluid. Since the condition is due to deficiency and cold, pain is relieved on pressure and by warming. Thin, white coating and deep slow pulse are the signs of lowered function of the spleen and stomach with cold stagnation. Treatment a) Retell/ion offood:

Method: The Front-{Mu) pOint of the stomach and the points of the Yangming Meridian of Foot are selected with reducing method applied to remove retention, pacify the stomach and relieve pain. Prescription: Jianli (CV II ), Neiguan (PC 6), Zusanli (ST 36), lnner-Nciting (Extra). Explanation: Zhongwan (CV 12) is the Front-{Mu) point of stomach, Zusanli (ST 36), the Lower He-(Sea) point of the Stomach and Neiguan (PC 6), a Confluent Point. They are indicated in stomach, heart and chest disorders, and used in combination to pacify the stomach and

CliiNESE ACUPUI\.CTUR.e AND MOXJ.UUSTION

~ 18

relieve pain. lnner-Neiting (Extra) is an empirical point to treat retention of food. b)Attack of the stomach by the fiver qi:

Method: Points of Jueyin and Yangming Meridians of Foot are selected as the principal points with the reducing method applied to remove the stagnation of liver qi, to pacify the stomach and to relieve pain. Prescription: Qimen (LR 14), Zhong· wan (CV 12), Neiguan (PC 6), Zusanl i (ST 36), Taichong (LR 3). Explanation: Qimen (LR 14) is the Front-(Mu) point of the liver and Tai· chong (LR 3) is the Yuan·(Primary) point of the Liver Meridian. The two are used in combination to remove the stag· nation of liver qi, regulate the flow of qi and relieve pain. ZusanJi (ST 36 ), Zhong· wan (CV 12) and Neiguan (PC 6) are applied to pacify the stomach, relieve pain and check vomiting. c) Deficiency of the stomach with stagnation of cold:

Method: The Back-Shu points and points of the Conception Vessel are se· Jected as the principal points with both acupuncture and moxibustion to warm up the midd le energizer, dispel cold and regulate the flow of qi and relieve pain. Prescription: Zhongwan (CV 12), Qihai (CV 6), Pishu (BL 20), Neiguan (PC 6), Zusanli (ST 36), Gongsun (SP 4 ). Explanation: Acupuncture and moxibustion at Zhongwan ( CV 12) and ZusanJi (ST 36) warm the middle energizer, dispel cold, regulate the flow of qi and relieve pain. Neiguan (PC 6) and Gong· sun (SP 4 ), the Confluent Points, are indicated to treat stomach disorders.

Moxibustion on Pishu (BL 20) strengthens the spleen, pacifies the stomach, dispels cold and relieves pain. Indirect moxibustion with ginger on Qihai (CV 6) is most desirable in the treatment of chronic gastric pain due to cold of defi· ciency type, as ginger and moxa together have the function of dispelling cold. Remarks a) Epigastric pa in is a symptom found in peptic ulcer, gastritis, gastric neurosis and diseases of the liver, gallbladder and pancreas. b) Cupping: Cupping is applied with large or medium-sized cups mainly to the upper abdomen or Back-Shu points for ten to fifteen minutes.

4. Vomiting Vomiting is a common symptom in clinic, resulting from the failure of the stomach qi to descend, or from other disorders affecting the stomach. It may occur in many diseases, but the most common causes are retention of food, attack of the stomach by the liver qi and hypofunction of the spleen and stomach. Etiology and Pathogenesis Overeating of raw, cold and greasy food leads to upward perversion of the stomach qi, resulting in vomiting. Emotional disturbance and depression of the liver qi harm the stomach, impair· ing the downward movement of the stom· ach qi, causing vomiting. Weakness of the spleen and stomach or overstrain leads to hypofunction of the

CHAP"rt:Jt 17 INTERNAL DISEASES

stomach in transportation and transfor· mation, then causing retention of food. The stomach qi ascends instead of des· cends.

Differentiation a) Retention of food: Main manifestations: Acid fermented vomitus, epigastric and abdominal distension, belching, anorexia, loose stOol or constipation, thick, granu lar tOngue coat· ing, rolling and forceful pulse. Analysis: Retention of food impedes the function of the spleen and stomach in transportation and transformation. Since qi in the middle energizer is stagnated, there appear epigastric and abdominal distension, belching and anorexia. Reten· tion of food leads to upward flowing of the turbid qi, so acid fermented vomitus, and loose stool or constipation occur. Thick, granular tongue coating and roll· ing, forceful pulse are the signs of reten· tion of food . b) Attack of the stomach by the liver qi: Main manifestations: Vomiting, acid regurgitat ion, frequent belching, distend· ing pain in the chest and hypochondriac regions, irritability with an oppressed feeling, thin, sticky tongue coating, string-taut pulse. Analysis: Depressed liver qi attacks the stomach, causing upward perversion of the stomach qi, so there occur vomit· ing, acid regurgitation, frequent belching, distending pain in the chest and hypochondriac regions. In case of stag· nation of the liver qi, irritability with an oppressed feeling occurs. Thin, sticky tongue coating and string-taut pulse are

419

the signs of the stagnation of the liver qi. c) Hypofunction of the spleen and stom· ach: Main manifestations: Sallow complex· ion , vom iting after a big meal, loss of appetite, lassitude, weakness, slight· ly loose stool , pale tongue, thin , white tongue coating, thready and forceless pulse. Analysis: Weakness of the spleen and stomach leads to hypoactivity of the yang in the middle energizer, which fails to receive food and water, so vomiting ap· pears after a big meal. If the spleen fails in transportation and transformation, the essentials of water and food no longer supply the body for nourishment, there may appear lassitude, weakness, los of appetite and slight ly loose stool. Pale tongue, thin white tongue coating, and thready and forceless pulse are the signs of weakness of the spleen and stomach.

Treatment Method: The points of Yangming and Taiyin Meridians of Foot are selected as the principa l points to activate the des· cent of qi and to pacify the stomach. For retention of food, reducing is indicated, for attack of the stomach by the liver qi, even movement is usually used to soothe the liver and regulate the flow of qi, and for weakness of the spleen and stomach, reinforcing combined with moxibustion is used to strengthen the function of the spleen and warm up the middle energizer. Prescription: Zhongwan (CV 12), Zusan li (ST 36), Neiguan (PC 6), Gongsun (SP 4). Supplementary points:

•lO

Retention of food: Xiawan (CV 10). Allack of the stomach by the liver qi: Taichong (LR 3). Weakness of the spleen and stomach: Pishu (BL 20). Persistent vomiting: Jinjing. Yuye (Extra). Explanation: Zusanli (ST 36) is the He-(Sea) point of the Stomach Meridian and Zhongwan (CV 12), the Front·Mu point of the stomach. The two points used together are effective in pacifying the stomach and activating the descent of qi. Neiguan (PC 6) and Gongsun (SP 4). one of the pair·points of the Eight Con· nuent points, relieve the fullness of the chest and stomach. Xiawan (CV 10), a point located in the epigastrium, is able to regulate the stomach qi and remove stagnation by applying reducing method needling at Taichong (LR 3), the Yuan (Primary) point of the Liver Meridian regulates the function of the liver. Pishu ( BL 20), a point where the spleen qi is infused, used in combination with Zusan· Ii (ST 36) and Gongsun (SP 4), may reinforce the spleen qi and invigorate the qi in the middle energizer to perform the function of transportation and transfor· mation and to restore the normal activi· ties of qi. Pricking Jinjing (Extra) and Yuye {Extra) to cause bleeding is an ex· perienced method for checking vomiting. Remarks Vomiting as described here may be found in acute and chronic gastritis, card iospasm, pylorospasm and neurotic vomiting.

5. H iccup Hiccup is an involuntary spasm of the glottis and diaphragm, causing the char· acteristic sound. Occasional auack of hie· cup suggests a mild case and can be removed without medication. but if it persists, treatment is required. Hiccup is mostly caused by irregular diet, stagna· tion of the liver qi and presence of cold in the stomach, leading to upward per· version of the stomach qi instead of des· cending. Etiology and Pathogenesis Irregular food intake causes failure of the stomach qi to descend. or emotional frustration stagnates the liver qi, leading to upward perversion of the stomach qi. The auack of the stomach by cold, overeating of raw and cold food, or tak· ing drugs of cold nature gives rise to retaining of the stomach yang and upward perversion of qi. Differentiation a) Retell/ion of food:

Main manifestations: Loud hiccups, epigastric and abdominal distension, an· orexia, thick, sticky tongue coating, roll· ing and forceful pulse. Analysis: Retention of food in the stomach disturbs the function of the spleen and stomach in transportal ion and transformation and impedes the qi activ· ities in the middle energizer. "The stomach is in normal function when its qi descends." Failure of its qi to descend may lead to loud hiccups, epigastric and abdominal distension, and anorexia.

421

CJ-IAP'rER 17 INTERNAL DISEASES

Thick, sticky tongue coating, and rolling, forceful pulse are the signs of retention of food.

b) Stagnation of qi: Main manifestations: Continual hie· cups, distending pain and feeling of oppression in the chest and hypochon· drium, thin tongue coating, string-taut and forceful pu lse. Analysis: The liver qi, if stagnated, will attack the stomach, causing upward perversion of stomach qi, therefore, hie· cup, distending pain in t he chest and hypochondrium, and feel ing of oppres· sion appear. String-taut and forceful pu lse is a sign of stagnation of qi due to depression of the liver.

c) Cold in the stomach: Main manifestations: Slow and force· ful hiccups which may be relieved by heat and aggravated by cold, discomfort in the epigastrium, white, moist tongue coating, slow pulse. Analysis: The stomach qi fails to des· cend because of stagnated cold, so hiccup is forceful. In case of disturbance of the stomach qi, discomfort in the epigas· trium occurs. If cold gets heat, smooth circulation of qi results, and then hiccup is rel ieved; but if cold gets worse, hiccup is aggravated. White, moist tongue coat· ing and slow pulse indicate the presence of cold in t he stomach.

Treatment Method: The paints of the Stomach Meridian and some other paints related are selected as the principa l paints. Re· ducing is applied for retention of food and stagnation of qi, while both acupunc·

t ure and moxibustion are used for cold in the stomach. The treatment is aimed at pacifying the stomach, facilitating the descent of qi and checking hiccup. Prescription: Geshu (BL 17), Zhong· wan (CV 12), Neiguan ( PC 6), Zusanli (ST 36). Supplementary paints: Retention of food: Juque (CV 14), lnner·Nciting (Extra). Stagnation of q i: Tanzhong (CV 17), Taichong (LR 3). Cold in the stomach: Shangwan (CV 13). Explanat ion: Zhongwan (CV 12), Nei· guan (PC 6) and Zusanli (ST 36) may pacify the stomach, subdue t he ascending qi and relieve the oppression fee ling in the chest. Geshu (BL 17) is able to check the perversive ascending of qi and stop hiccup. Juque (CV 14) and Inner·Neiting (Extra) pacify the stomach and remove stagnat ion. Tanzhong (CV I 7) relieves the depressed feeling in the chest and diaphragm and checks hiccup. Taichong (LR 3) may pacify the liver qi. Moxibus· tion to Shangwan (CV 13) may warm the midd le energizer to dispel cold , promote the smooth distri bution of yang and check hiccup. Remar ks Cupping therapy: Common ly used points; Geshu ( BL 17), Geguan ( BL 46), Ganshu (BL 18), Zhongwan (CV 12), Rugen (ST 18).

6. Abdominal Pain Abdominal pa in is a frequently en·

422

countered symptom in clinic, often ac· companied with many zang·fu disorders, of which dysentery, epigastric pain, appendicitis, and gynecologic diseases will be discussed in other sections. In this section only accumulation of cold, hy· poactivity of the spleen yang and reten· tion of food are related. Etiology and Pathogenesis a) Since cold is characterized by causing contraction and stagnation, accumu· lation of cold due to invasion of the abdomen by the pathogenic cold or injury of the stomach and spleen yang due to overeating of raw and cold food im· pairs the transportation and transfor· marion function, resulting in abdominal pain. b) Hypoactivity of the spleen yang or general deficiency of yang qi leads to impairment of transportation and trans· formation, and stagnation of cold dampness, resulting in abdominal pain. c) Retention of food due to voracious eating or intake of too much fatty and hot food impedes the function of the stomach and intestines in transmission and digestion, nutrients and wastes mix· ing together to obstruct qi, resulting in pain. Differentiation a) Accumulation of cold: Maio manifestations: Sudden onset of violent abdominal pain which responds to warmth and gets worse by cold, loose stool, absence of thirst, clear and profuse urine, cold limbs, thin white tongue coat· ing, deep, tense or deep, slow pulse.

CHINES£ ACUPUI'\CI'URE AND MOXIBUSTION

Analysis: Cold is of yin nature and characterized by causing contraction and stagnation. If cold enters the body, yang qi will get obstructed, then sudden vi· olent pain and cold limbs appear. Since cold stays inside, thirst is absent. Clear and profuse urine and loose stool are due to weakness of the stomach and spleen yang and failure in transportation and transformation. The flow of yang qi is usually obstructed by cold and facilitated by warmth, so pain responds to warmth but gets worse by cold. Deep, tense or deep, slow pulse, and thin white tongue coating are the signs of accumulation of cold. b) Hypoactivity of the spleen yang: Main manifestations: Intermittent dull pain which may be relieved by warmth or by pressure and aggravated by cold or by hunger and fatigue, lassitude, aversion to cold , thin , white tongue coal· ing, deep, thready pulse. Analysis: Intermittent dull pain which may be relieved by warmth or by pressure and aggravated by cold or by hunger and fatigue indicates cold of deficiency type. Hypoactivity of the spleen yang causes loose stool and aversion to cold. If the spleen qi is weak, lassitude occurs. Thin while tongue coating and deep, thready pulse also indicate cold of deficiency type. c) Retention of food: Main manifestations: Epigastric and abdominal distending pain which is ag· gravated by pressure, anorexia, foul belching and sour regurgitation, or abdominal pain accompanied by diarrhoea and relieved after defecation , sticky

tongue coating, rolling pu lse. Analysis: In case of retention of food in the intestines and stomach, epigastric and abdomina l distend ing pain occurs. Pain is aggravated by pressure because of excess condition. Anorexia is due to retention of food, foul belch ing and sou r regurgitation due to indigestion of food . Pain is relieved after diarrhoea because the circu lation of qi in the fu organs becomes smooth. Sticky tongue coat ing is due to retention of food and collection of dampness, while rolling pulse is the sign of indigestion.

Treatment a) Accumulation of cold: Method: Points of the Conception Vessel, Taiyin and Yangming Meridians of Foot are selected as the principa l points with reducing method applied in combination with moxibustion to warm the stomach and dispel cold. Prescription : Zhongwan (CV 12), Shenque (CV 8), Zusanli (ST 36 ), Gongsun (SP 4 ). Explanation: Zhongwan (CV 12), Zusanli (ST 36) and Gongsun (SP 4) are used to strengthen the function of the spleen and stomach, and to warm and promote the flow of qi in the fu organs. Indirect moxibustion with salt is applied to warm the stomach and d ispel cold. b) Hypoactivity of the spleen yang: Method: T he Back-Shu points and the poi nts of the Conception Vessel are selected as the pri ncipal points with reinforcing met hod applied in combina tion with moxibust ion to warm and activate the spleen and stomach yang.

Prescription: Pishu (BL 20), Weishu ( BL 2 1), Zhongwan (CV 12), Zhangmen (LR 13), Qihai (CV 6), Zusan li (ST 36). Explanation : Pis hu (BL 20) and Zhangmen (LR 13), Weishu ( BL 21) and Zhongwan (CV 12) are selected, known as combinations of the Back-Shu and Front-Mu points. Both acupuncture and moxibustion are used to invigorate the spleen and stomach yang. Qihai (CV 6) and Zusanli (ST 36) are need led to strengthen the function of the spleen and stomach. c) Retention of food : Method: The points of the Conception Vessel and Yangming Meridian of Foot are selected as the principa l points with red ucing method applied to remove retention of food. Prescri ption: Zhongwan (CV 12), Tianshu (ST 25), Qihai (CV 6), Zusanl i (ST 36), lnner-Neit ing (Extra). Explanation: Zhongwan (CV 12), Zusanli (ST 36), Tianshu (ST 25) and Q ihai (CV 6) are applied to regu late the flow of t he stomach qi . Inner-Neiting (Extra) is an empi rica l point to treat ind igestion. The above points are used together to remove retention of food and relieve pain by promot ing the flow of q i.

7. Diarrhoea Diarrhoea refe rs to abnormal f requency a nd liquidity of fecal discharges. It is usually due to disorders of the spleen, stomach, large and small intestines. In light of the manifestations of the d isease and the course, it is cl inically d ivided into acute and chron ic. The former is mostly

424

caused by indigestion due to excessive eating or improper diet and attack of external cold dampness, leading to dys· function in transmission of intestinal contents, or caused by invasion of damp heat in summer or autumn; the latter is caused by deficiency of the spleen and stomach, leading to failure in transporta· tion and transformation. It is essential to distinguish diarrhoea and dysentery. Etiology and Pathogenesis The causative factors are complicated, but functional disturbance of the spleen and stomach is inevitably involved path· ogenetically. The stomach dominates re· ceiving food while the spleen dominates transportation and transformation. In case the spleen and stomach are diseased, the normal digestion and absorption of food is impaired, leading to mixing of food essence and wastes. When they des· cend through the large intestine, diar· rhoea occurs. As to the factors of diarrhoea due to functional disturbance of the spleen and stomach, there are many as follows. Diarrhoea may be caused by the six exogenous pathogenic factors, among which mostly by cold, dampness and summer heat. The spleen is in preference to dryness but dislikes dampness, which usually causes diarrhoea. Besides the su· perficial portion of the body and the lung, the stomach and intestines may be affected by the pathogenic cold or sum· mer heat, resulting in diarrhoea. In the latter case, however, the diarrhoea is also often related to dampness.

Ci-IINE$E ACUPUNCTURE AND MOXJBUSTION

Excessive intake of food, particularly greasy food, leading to impairment of the stomach and spleen in transportation and transformation, or eating of raw, cold, dirty food, injuring the spleen and stom· ach , all bring about diarrhoea. Diarrhoea may also be caused by weakened function of the spleen and stomach due to irregular daily life or other factors. Since the spleen has the function in transformation and transpor· tation, diarrhoea may occur if this func· tion is affected. The spleen yang is closely related to the kidney yang. The fire of Mingmen (Vital gate) (kidney yang) may help the spleen and stomach to "digest and trans· form food into chyme." In case the kid· ney yang is weak, the spleen yang is weak as well and fails to digest and transform food into chyme, thus diarrhoea occurs. Zhang Jingyue said: "The kidney is the passgate of the stomach and makes the urino-genital orifice and the anus as its openings. The passing of both urine and stool is dominated by the kidney. Now the kidney yang is weak, leading to dec· line of Mingmen (Vital gate) fire, and excess of cold; therefore, diarrhoea oc· curs." Differentiation a) Acute diarrhoea i) Cold-dampness: Main manifestations: Watery diar· rhoea, abdominal pain and borborygmi, chilliness which responds to warmth, abs· ence of thirst, pale tongue, white tongue coating, deep, slow pulse. Analysis: When the cold-dampness at·

CHAP'Il.R 17 INT£RNAL

DL~EASES

tacks the stomach and the intestines, disturbing the function of the spleen in sending food essence and water upward and that of the stomach in sending the contents downward, the food essence and the waste can not be separated, moving downward together through the large intestine. so watery diarrhoea with borborygmi occurs. If the qi of the stomach and intestines is stagnated, abdominal pain appears . Cold-dampness is a combinat ion of yin pathogenic factors and easy to damage yang qi. When yang qi is blocked, ch illiness which responds to warmth and absence of thirst occur. Pale tongue, white tongue coating, and deep, slow pulse are the signs of excess of interna l cold. ii) Damp heat: Main manifestations: Diarrhoea wi th abdomina l pain, yellow. hot and fetid stools, burning sensation in the anus, scanty urine, or accompanied by general feverish feeling, thirst, yellow, sticky tongue coating, rolling and rapid pulse. Analysis: When t he intestines and stomach are attacked by the damp heat in summer or autumn, the transmitting and transformation function is disturbed, and diarrhoea appears. If the damp heat pours down, diarrhoea happens as soon as the abdominal pain is brought about. If the heat stays in the intestines. there appear diarrhoea with yellow, hot and fetid stools and burning sensation in the anus. When excessive heat evaporates the dampness, there are scanty urine, genera l feverish feeling and thirst. Yellow, st icky tOngue coating, and rolling, rapid pulse are the signs of excess of damp heat.

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iii) Retention of food: Main manifestat ions: Abdominal pain relieved after bowel movements, borborygmi, diarrhoea with fetid stools, epigastric and abdomina l fullness and distension, belching, anorexia, thick filthy tongue coating. rolling, rapid or deep, string-taut pulse. Ana lysis: Retention of food impairs the stomach function in sending its contents downwards and the transmitting function of the intestines, so there are epigastric and abdominal fullness and distension, abdomina l pain and borborygmi. After the undigested food turns putrid, diarrhoea with offensive fetid stools, belching and anorexia occur. After the wastes are discharged, abdominal pain relieves. Thick filthy tongue coating, and rolling, rapid or deep, string-taut pu lse are the signs of retention of food.

b) Chronic diarrhoea: i) Deficiency of t he spleen: Main manifestat ions: Loose stool with undigested food, anorexia, epigastric distress after eating, sallow complexion , lassitude, pale tongue. white tongue coating, thready, forceless pu lse. Analysis: In case of weakness of the spleen and stomach, the spleen qi fails to ascend and d igestion is impaired; therefore, loose stool with undigested food appears. As the weakened spleen fai ls to digest and transport the food, anorexia and epigastric distress after eating occur. Persistent diarrhoea further weakens the spleen and stomach, affecting the production of food essence and formation of qi and blood, and thus resulting in the sallow complexion and lassitude. Pale

tongue, white tongue coating, and thready, forceless pulse are the signs of weakness of the spleen and stomach. ii) Deficiency of the kidney: Main manifestations: Pain below the umbilicus, borborygmi and diarrhoea usually occurring at dawn, relieved after bowel movements, and aggravated by cold, abdominal distension sometimes, cold lower extremities, pale tongue, white tongue coating, deep, forceless pulse. Ana lysis: Pain below the umbilicus and diarrhoea with borborygmi at dawn are due to hypoactivity of the kidney yang and the declined Mingmen fire. Zhang Jingyue stated: -vin should be at maximum in case yang qi is not restored. The kidney fails to hold its contents be· cause of the declined Mingmen fire, thus diarrhoea results." Abdominal aversion to cold, and sometimes distension, cold lower extremities, pale tongue, white tongue coating, deep, forceless pulse are the signs of deficiency of the yang qi in the spleen and stomach. Treatment a) Acute diarrhoea: Method: The points of the Yangming Meridian of Foot are selected as the prin· cipal points. Cold-dampness: Reducing method in combination with moxibustion (with gin· ger) is applied to warm the stomach and resolve dampness. Damp heat: Reducing is used to elimi· nate heat and dampness. Retention of food : Reducing is used to regulate the function of the spleen and stomach and remove stagnation.

Prescription: Tianshu (ST 25), Zusan· Ji (ST 36). Supplementary points: Cold dampness: Zhongwan (CV 12), Qihai (CV 6). Damp heat: Neiting (ST 44 ), Yin· lingquan (SP 9). Retention of food: Jnner·Neiting (Ex· tra) Explanation: Tianshu (ST 25), the Fronl-(Mu) point of the large intestine is applied to regulate the transmitting func· tion of the intestines. Zusanli (ST 36), the He·( Sea) point of Yangming Meridian of Foot, is used to adjust the now of the stomach qi. Moxibustion tO Zhongwan (CV 12) and Qihai (CV 6) is applied to warm the spleen and stomach, dispel cold, regulate the now of qi and re· solve dampness. Neiting (ST 44) and Yinlingqunn (SP 9) are needled to elimi· nate damp-heat from the large intesti ne. For retention of food; lnner·Neiting (Ex· tra) is used to regulate the function of the spleen and stomach and remove reten· tion. b) Chronic diarrhoea: i) Deficiency of the spleen: Method : The points of the Spleen Me· ridian and some other points concerned are selected as the principal points with the reinforcing method and moxibustion to strengthen the function of the spleen and stop diarrhoea. Prescription: Pishu (BL 20). Zhang· men (LR 13), Taibai (S P 3), Zhongwan (CV 12). Zusanli (ST 36). Explanation: Pishu (BL 20). n Back· (Shu) point of the spleen. Zhangmen (LR 13 ), the Front-( Mu) point of the spleen,

Taibai (SP 3), the Yuan-( Primary) pOint of the Spleen Meridian, in combination with Zhongwan (CV 12) the Front{Mu) point of the stomach, and Zusa nli (ST 36), the He-(Sea) pOint of the Stomach Meridian, are needled with moxibustion to invigorate the spleen yang, strengthen the function of transpOnmion and transformation and stop diarrhoe~. ii) Deficiency of the kidney: Method: The pOints of the Kidney Meridian, Conception and Governor vessels are selected as the principal points with the reinforcing method and moxibustion to warm and reinforce the kidney yang. Prescription: Shenshu (BL 23). Pishu (BL 20). Mingmen (GV 4 ). Guanyuan (CV 4), Taixi (KI 3). Zusanli (ST 36). Expla nation: Shenshu (BL 23) is the Back-(Sh u) poin t of the kidney and Taixi (Kl 3) is the Yuan-( Primary) pOint of the Kidney Meridian. Needling to these two points with the reinforcing method can warm the kidney yang and invigorate the kidneyqi. Moxibustion to Mingmen (GV 4 ) and Guanyuan (CV 4) is able to reinforce the Mingmen fire and strengthen the kidney yang so as to warm the spleen and kidney and promote digestion. This is known as a treatment of the root ca use. Pishu (BL 20) and Zusanli (ST 36) are used to strengthen the spleen function and stop diarrhoea. Remarks This condition may be involved in acute and chronic enteritis. indigestion. intestinal parasitic diseases. diseases of the pancreas, liver and biliary tract. endo-

crine and metabolic disorders, and neurotic troubles.

8. Dysentery Dysentery is characterized by abdominal pain. tenesmus and frequent stools containing blood and mucus. It is a common epidemic disease in summer and autumn. It is called "red-white dysentery," "bloody dysentery,~ "purulent and bloody dysentery" or "heat dysemery," and known as "persistent dysentery~ if it lasts for a long time, and "intermittent dysentery~ if it comes on and off. The common patterns a re damp-heat dysentery. cold-damp dysentery, foodresistant dysentery and intermittent dysentery. This disease is often due to the invasion by the epidemic damp heat and internal injury by intake of raw, co ld and unclean food. which hinders and damages the stomach and intestines. Etiology and Pat hogenesis The summer epidemic heat dampness invades the stomach and intest ines. impeding the flow of their qi and blood. Pus and blood are formed from the swgnated qi and blood in struggl ing against heat dampne>s. and hence occurs dy>entery. In case dampness is prepOnderant to heat. white dysentery results. in case heat prepOnderant to dampness. red dysentery appears. ;md in case both dampness and heat are excessive. red-white dysentery occurs. Preference for fatty and swee t food, internal accumulation of damp heat plus

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irregular diet, or intake of unclean food leads to stagnation of qi and blood in the fu organs, wh ich turns into pus and blood in the stool and results in dysentery. Excessive intake of raw, cold, or dirty food leads to internal accumulation of cold dampness, impeding the stomach and intestines. The stagnated qi in the large intestine also injures the blood. leading to discharge of pus and blood and resulting in cold·damp dysentery. Although the above-mentioned etio· logical factors can be classified into the exogenous pathogenic factors and food intake, the two are usually mutually af· fected. The disease is in the intestine, but closely related to the stomach. If 1he epidemic toxic and damp heat attack the stomach, which fails to receive food, food-resistant dysentery occurs. If dysen· tery lasts longer, the body resistance is weaker and the spleen qi becomes more insufficient, persistent or intermiuent dysentery therefore appears. Differentiation a) Damp-heat dysentery: Main manifestations : Abdominal pain, tenesmus, mixing of pus and blood in stool, burning sensation of the anus, scanty and yellow urine, or chills, fever, restlessness, thirst, yellow, sticky tongue coating, rolling, rapid or soft, rapid pulse. Analysis: In case the damp heat stag· nates in the intestines, the qi and blood are blocked, leading to disturbance of transmission, so abdominal pain and tenesmus occur. When the blood vessels

of the intestine are injured by damp heat. blood, pus and mucus appear in stools. Burning sensation of the anus, and sca nty yellow urine are also manifestations of down-pouring of damp heat. When the summer heat and dampness attack the body, the body resistance will fight against it, so there are chills and fever. In case of e.>.cess of pathogenic heat. rest· lessness and thirst result. Sticky tongue coating and rolling or soft pu lse indicate dampness. whi le yellow tongue coating and rapid pulse suggest heat. b) Cold damp dysentery: Main manifestations: Difficult defcca· tion. white mucus in stools. preference for warmth and aversion 10 cold. mostly accompanied with fullness in the chest and epigastrium, lingering abdominal pain, tastelessness in the mouth, absence of thirst. white, sticky tongue coating, deep, slow pu lse. Analysis: Accumulation of internal cold dampness damages the spleen and stomach and blocks the qi now of the large intestine. Cold is characterized by causing contraction and stagnation, while dampness is characterized by turbidity, so there are fullness in the chest and epigastrium, difficult defecation. white mucus in stools. Cold dampness is a yin pathogenic factor and apt to damage yang qi. When the yang qi is blocked and fails to disperse, preference for warmth, aversion to cold and lingering abdominal pain result. Tastelessness in the mouth, absence of thirst, sticky tongue coating are the signs of accumulation of dampness. Deep, slow pulse is the sign of ex· cessive cold.

CHAPTER l7 lNTF.RKAL DISEASES

c) Food-resistalll dysentery: Main manifestations: Frequent stools with blood and pus, total loss of appetite, nausea, vomiting, yellow, sticky tongue coating, soft, rapid pulse. Analysis: This condition is developed from the damp-heat dysentery. The epidemic summer heat dampness, when accumulated in the intestines, may attack the stomach and impair its function in sending its contents downwards. Thus the stomach fails to receive food, and the appetite is totally lost. The stomach qi ascends instead of descends, so nausea and vomiting occur. Yellow, sticky tongue coating, and soft, rapid pulse are the signs of damp heat.

d) lmermittent dysentery: Main manifestations: Dysentery occurring on and off, difficult to cure, lassitude, aversion to cold, somnolence, anorexia, pale tongue, sticky coating, soft pulse. Ana lysis: In case of the weakened body resistance with existence of the pathogenic factors impairing the transmitting function of the stOmach and intestine, the condition is complicated with mixed deficiency and excess, and so the disease is lingering and recurrent. When the spleen yang is weak, and the q i is short, there may be lassitude, aversion to cold and somnolence. Soft pulse and persistent st icky coating are the signs of continuing presence of dampness. Treatment Method: The points of Yangming Me· ridians of Hand and Foot as well as the Front-(Mu) point and Lower He-{Sea)

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point of the large intestine are selected as the principa l points to remove stagnation from the intestines. Reducing is used for the damp-heat dysentery, both acupuncture and moxibustion are used for the cold-damp dysentery, and acupunctu re and moxibustion, with both reinforcing and reducing methods, a re used for the persistent dysentery. Prescription: Tianshu (ST 25), Shangjuxu (ST 37). Damp-heat dysentery: Quchi (L I II ), Hegu (L I 4) are added. Cold-damp dysentery : Zhongwan (CV 12) is added with moxibustion to Qihai (CV 6) and Yinlingquan (SP 9). Food-resistant dysentery: Zhongwan (CV 12) and Neiguan ( PC 6) are added. Intermittent dysentery: Pishu ( BL 20), Weishu (BL 21), Guanyuan (CV 4) and Zusan li (ST 36) are added . Supplementary points: Fever: Dazhui (GV 14). Tenesmus : Zhonglushu (BL 29). Prolapse of rectum: Baihui (GV 20) with moxibustion, Changqiang (GV I). Explanation: It is recorded in /merna! Classic that the He-(Sea) points are applied for the diseases of the fu organs. Therefore, Tianshu (ST 25), the Front(Mu) point of the large intestine, and Shangjuxu (ST 37), the He-(Sea) point of the large intestine, are selected as the principal points to remove stagnation of qi in the large intestine. Dampness will be resolved in case qi is regulated. Quchi (L J II ) and Hegu ( L I 4) may dispel the damp heat from the stomach and intestines. Moxibustion to Zhongwan (CV 12) and Qihai (CV 6) is applied to wa rm the

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spleen and stomach, remove cold and regulate the flow of qi. Yinl ingquan (SP 9) is need led to strengthen the spleen function to resolve dampness. For foodresistant dysentery, Zhongwan (CV 12) and Neiguan (PC 6) are used to pacify the stomach and resolve dampness. Acupuncture with both reinforcing and reducing methods and moxibustion may warm the spleen and stomach and eliminate the intestinal stagnation. Guanyuan (CV 4), the Front·(Mu) point of the small intestine, is applied to separate the food essence from the waste, reinforce qi and activate yang.

impairs the stomach and intestines, caus· ing dysfunction of transportation and transformat ion, thus the retained food is stagnated and blocks the flow of qi, or the stagnated food turns into heat, which enters the stomach and intestines, caus· ing abdominal distemion. b) Because of the weakened function of the spleen and stomach or general debility due to long illness, the spleen and stomach fail in their transporting func· tions. so the circulation of qi in the stom· ach and intestines is impai red, resulting in abdominal distention. In addition, abdominal distention may also follow an abdominal operation.

Remarks

This condition includes acute and chronic bacillary and amebic dysentery.

9. Abdominal Distention Abdominal distention is common in clinic. Distention and fullness are likely to occur in both the upper and lower abdomen. The stomach is located in the upper abdomen, while the small and large intestines are in the lower; they jointly complete the storage, digestion, and assi· milation of food and excretion of the wastes. Once the stomach and intestines lose their functions, abdomina l distention and pain, belching, vomiting, etc. will occur. This section deals with the syndromes mainly manifested by abdominal distention due to disorders of the stomach and intestines. Etiology and Pathogenesis a) Irregular or excessive food intake

Differentiation a) Excess condition Main manifestations: Persistence of distention and fullness in the abdomen. which is aggrava ted by pressure, abdom· ina I pain. belching, foul breath, dark yellow urine, constipation, sometimes asso· ciated with fever, vomiting, yellow thick tongue coating. rolling, rapid and forceful pulse. Analysis: Undigested food retained in the stomach gives rise to distention and fullness in the epigastrium, foul breath, belching, and even vomiting, and when it is retained in the intestines, there will be fullness and pain in the abdomen and constipation. Retention of food is an ex· cess condition. This is why the pain is aggravated by pressure. Fever, dark yel· low urine, yellow thick tongue coating, rolling, rapid and forceful pulse are the signs of excessive heat in the stomach. b) Deficiency condition

CHAPTER 17 INTERNAL DlS.EASES

Main manifestations: Abdominal distention relieved by pressure, borborygmi, loose stools, loss of appetite, lassitude, listlessness, clear urine, pale tongue with white coating and forceless pulse. Analysis: Qi deficiency of the spleen and stomach results in dysfunction of transportation and transformation. Consequently there are loss of appetite, borborygmi and loose stools. Pain relieved by pressure is due to deficiency. Failure in creating qi and blood due to impaired transportation and transformation is the cause of lassitude and listlessness. Pale tongue with white coating, and forceless pulse are signs of qi deficiency in the spleen and stomach. Treatment Method: The points of Yangming Meridian of Foot are selected as the principal points. The excess condition is treated by the reducing method to regulate the qi flow in the fu organs while the deficiency condition is treated by the reinforcing method or combined with moxibustion to invigorate the function of the stomach and spleen and to adjust the circu lation of qi to relieve the distention. Prescription: Zhoogwan (CV 12), Tianshu (ST 25), Zusanli (ST 36), Shangjuxu (ST 37). Supplementary points: Excess condition: Hegu (L I 4), Qihai (CV 6), Yinlingquan (SP 9). Deficiency condition: Guanyuan (CV 4 ), Taibai (SP 3). Explanation: Application of Zhongwan (CV 12), the Front-(Mu) point of the stomach, Zusanl i (ST 36 ), the Lower

He-(Sea) point of the stomach, Tianshu (ST 25), the Front-(Mu) point of the large intestine and Shangjuxu (ST 37), the Lower He-(Sea) point of the large intestine, are used as a combination of Front-(Mu) and Lower He-(Sea) points to regulate the function of the stomach and intestines in order to maintain normal flow of qi and relieve the distention. Hegu (L I 4) and Qihai (CV 6) are combined to adjust the circulation of qi, whi le YinJingquan (SP 9) can el iminate damp heat. Taibai (SP 3) and Guanyuan (CV 4) are beneficial to strengthen the spleen and stomach and to help transportation and transformation. Remarks This condition is involved in gastriptosis, acute gastrectasia, enteroparalysis, intestinal obstruction, gastrointestinal neurosis, etc.

10. Jaundice Jaundice is mainly manifested by yellow discoloration of the sclera, skin and urine, resulted from the dampness in the spleen and heat in the stomach, leading to abnorma l circulation of the bile which spreads to the skin surface. It is divided into yang jaundice and yin jaundice according to its nature. .Etiology and Pathogenesis The seasonal and epidemic pathogenic factors accumulate in the spleen and stomach, leading to internal formation and collection of damp heat. Dampness after mixed with heat is apt to penetrate

Cl·lfNeiE ACUPUNCTURE AND ,\o10XIBUSTION

deeper, while heat mixed with dampness is apt to get more exuberant. The liver and gallbladder are steamed by the heat in the spleen and stomach, leading to overflow of the bile to the skin surface, thus jaundice appears. Irregular diet injures the spleen and stomach, causing disturbance in trans· portation and transformation and inter· nal formation of dampness, which trans· forms into heat. Damp heat stains the skin yellow. Overstrain or general weakness of the spleen qi may give rise to hypoactivity of the yang in the middle energizer, leading to failure in transportation and transfor· mation and stagnation of cold dampness, thus yin jaundice results. As said in A Guide to the Clinic Treatment, "The cause of yin jaundice is the dampness produced from cold water. If the spleen yang fails to resolve the dampness, the normal dis· tribution of bile is impaired, affecting the spleen, soaking into the muscles, and spreading to the skin which turns yellow as if it were smoked." Yin jaundice can also result from an improperly treated yang jaundice which leads to injury of the yang qi, hypoactiv· ity of the spleen yang, and internal col· lection of cold dampness.

Differentiation a) Yang jaundice: Main manifestations: Lustrous yellow skin and sclera, fever, thirst, scanty dark yellow urine, heaviness of the body, full· ness in the abdomen, stuffiness of the chest, nausea, yellow, sticky tongue coat· ing, string-taut, rapid pulse.

Analysis: Steaming of the damp heat makes the bile spread to the skin sur· face. Heat being a yang pathogenic factor makes the yellow discoloration of the skin lustrous. Fever, thirst scanty dark yellow urine are due to excessive damp heat, which damages the body fluid, and disturbs the activity of the bladder. When the dampness is collected, the pure yang fails to be distributed and heaviness of the body results. In case of obstruction of the qi in the fu organs, fullness in the abdomen occurs. Stuffiness of the chest and nausea are due tO the steaming of damp heat, leading to upward perversion of the turbid contents of the stomach. Yellow sticky tongue coating is due to accumulation of damp heat, and stringtaut, rapid pulse due to excessive heat in the liver and gallbladder. b) Yin Jaundice: Main manifestations: Sa llow skin, heaviness of the body, weakness, loss of appetite, epigastric stuffiness, lassitude, aversion to cold, absence of thirst, pale tongue, thick. white tongue coating, deep slow pu lse. Analysis: The stagnation of co ld dampness in the spleen and stomach impedes the distribution of yang qi, lead· ing to overflow of the bile, thus the skin is sallow. In case the dampness stays in the spleen, the spleen yang is hypoactive and the transporting and transforming function is impaired, therefore, heaviness of the body, weakness, loss of appetite and epigastric stuffiness occu r. Aversion to cold and lassitude are due to weakness of the yang qi. Since this case is of cold-damp nature, thirst is absent. Pale

tongue, thick white tongue coating are due to deficiency of yang fa iling to resolve dampness. Deep, slow pulse is a sign of cold dampness staying in the yin system.

lytic jaundice. Acupuncture and moxibustion are more effective to treat hepatogenic jaundice.

Treatment Method: The points of Taiyin, Yangming and Shaoyang Meridians are selected as the principal points. Reducing is applied to remove heat and dampness in yang jaundice, while even movement with moxibustion is used to warm the middle energizer and resolve dampness in yin jaundice. Prescription: Yinlingquan (SP 9), Zusanli (ST 36), Ganshu (BL 18), Danshu (BL 19), Zhiyang (GV 9). Supplementary points: Yang jaundice: Taichong (LR 3), Yanglingquan (GB 34). Yin jaundice: Moxibustion to Pishu (BL 20), Yanggang (BL 48). Explanation: Yinlingquan (SP 9) and Zusanli (ST 36) are used to strengthen the spleen and resolve dampness. Ganshu (BL 18), Danshu (BL 19) and Zhiyang (GV 9) are important points to treat jaundice. Since the damp heat resides in the gallbladder, Yanglingquan (G B 34) is selected to reduce heat, and used in combination with Taichong (LR 3) to regulate the now of qi in the liver and gallbladder. Moxibustion to Pishu ( BL 20) and Yanggang (BL 48) may resolve cold dampness by warmth and treat jaundice.

Constipation is mainly caused by the disturbed transmining function of the large intestine and also related to the function of the spleen, stomach and kidney. In view of the difference in etiology and pathogenesis, this illness can be di· vided into two types: deficiency and ex· cess.

Remarks This condition is seen in acu te icteric hepatitis, obstructive jaundice and hcmo-

11. Constipation

Etiology and Pathogenesis After food is digested by the spleen and stomach, its refined nutrients are assimilated. and the wastes are egested through the transmission of the large intestine. If the stomach and intestines are diseased, va rious kinds of constipation occur in the following conditions: inter· nal accumulation of dryness and heat, stagnation of qi, deficiency of qi with inability of transmission, blood deficiency with dryness of the intestines, and agglomeration of cold. Constitutional yang preponderance. or indulgence in alcohol and spicy greasy food may lead to accumulation of heat in the stomach and intestines. Or after some febrile diseases, the remnant heat and insufficiency of body fluids give rise to dryness and heat in the intestines, and in addition, there may be disturbance of fluid distribution to the lower energiz· er. Constipation is present in any of the above cases. Emotional factors, such as anxi ety and

CHJNES£ ACUPlJNCTUR£ ANI) MOXJOUSTION

depression, or Jack of movement can cause stagnat ion of qi, impairing the transmitting function of the large intestine. As a result, the wastes are retained inside and unable to move downward, and hence constipation. T he coexistent deficiency of q i and blood can result from interna l injury by overstrain or improper food intake, or happen after an illness or delivery or in the aged people. Qi deficiency results in weakness o( the large intest ine in transmission, whi le blood deficiency gives rise to shortage of body fluid, then the large intestine can no longer be moistened. Apparently both qi and blood deficiency can cause difficult evacuation of t he feces, and hence constipation. Constitutional debility or senile decay results in retention of the endogenous cold in the stomach and intestines. Consequently the yang qi is obstructed and the body fluid fail in distribution. Difficulty of the large intestine in transmission leads to constipation.

Differentiation a) Excess condition Main manifestations: Infrequent and difficult defecat ion from every three to five days, or even longer. In case of accumulation of heat, there are fever, dire thirst, foul breath, rolling and forceful pulse, yellow, dry tongue coating; in case of stagnat ion of qi, there are fullness and distending pain in the abdomen and hypochondriac regions, frequent belch ing, loss of appetite, t hin sticky tongue coating and string-taut pu lse. Analysis: The large intestine is con·

cerned with t ransmission. When there is accumu lation of heat in the stomach and intestines, which consumes the body fluid, or stagnation of qi , disturbing the normal function of the large intestine, constipation may result. Fever and dire thirst indicate internal preponderance of pathogenic heat. When the heat in the stOmach and intestines causes evaporation, there is foul breath. The yellow and dry tongue coating reveals the damage of the body flu id by the heat, whi le the rolling and forceful pulse is a sign of excess in the interior. Emotional disturbance leads to stagnation of qi in the liver and spleen, thus resulting in frequent belching, and fullness and distending pain in the abdomen or hypochondrium. Since the spleen fails in transportation and transformation, there is loss of appetite. Thin, sticky tongue coating and string-taut pulse are the signs of dishar· mony between the liver and spleen.

b) Deficiency condition: Main manifestations: In cases of deficiency of qi and blood, pa le and lustreless complexion, lips and nails, dizziness and palpitation, lassitude, shortness of breath, pale tongue with thin coating, thready and weak pulse; in cases of agglomeration of cold, pain and cold sensation in the abdomen, preference for warmth and aversion to cold, pa le tongue with white and moist coating, deep slow pulse. Analysis: Constipation can be caused either by qi deficiency, resu lting in failure of the large intestine in transmission, or by blood deficiency with shortage of body fluid unable to moisten the large

CHAmR I? lNTERNAL DISEASES

intestine. Endogenous cold stays in the stomach and intestines, ·leading to agglomeration of yin qi, failure of yang qi in transportation, and weakened transmission of the large intestine, and hence difficulty of defecation. Deficiency of qi and blood fails to ascend to nourish the upper portion, so there are pale and lustreless complexion and lips, lass itude and shortness of breath. In case of blood deficiency, the heart is poorly nourished , hence palpitation. When the head and eyes fail to be nourished, dizziness results. Since the nail is the external manifestation of the liver, there will be lustreless nails when the liver blood is insufficient. When cold is agglomerated, the circulation of qi is impeded, this accounts for the cold pain in the abdomen. Cold is of yin nature, and disorders caused by cold can be relieved by warmth, so there is preference for warmth and aversion to cold. Pale tongue with thin coating, thready weak pulse are the signs of insufficiency of qi and blood, while pale tongue with white, moist coating shows the internal cold due to yang deficiency.

Treatment Method: The Back-{Shu ) and Front(Mu ) points of the Large Intestine Meridian are mainly selected. For the excess condition the reducing method is applied to eliminate the heat, moisten the intestine, and remove the stagnation of qi, while for deficiency condition, the reinforcing method is used to reinforce qi and nourish blood, and moisten the intestines for defecation. Constipation due to

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cold can be relieved by moxibustion to warm the fu organ for defecation. Prescription: Dachangshu ( BL 25), Tianshu (ST 25), Zhigou (TE 6), Zhaohai (KJ 6). Accumulation of heat: Quchi (l I II), Hegu ( L I 4). Stagnation of qi: Zhongwan (CV 12), Taichong (LR 3). Deficiency of qi and blood: Pishu (BL 20), Weishu (BL 21), Zusanli (ST 36). Agglomeration of cold: Moxibustion to Shenque (CV 8) and Qihai (CV 6). Explanation: The causes of constipation are different, but they are common in impairing the transmitting function of the large intestine. Therefore, the Back(Shu) point Dachangshu (BL 25) and the Front-(Mu) point T iansh u (ST 25) of the large intestine are applied to promote the flow of qi in the large intestine, the transmission can be regained when the qi of the fu organ flows smoothly. Zhigou (TE 6) can promote the flow of qi in the three energizers. When the qi in the three energizers is in normal circulation, the qi of the fu organ will circulate freely. Zhigou (TE 6) combined with Zhaohai (KI 6) is a pair of principal points in treating const ipation. Quchi (L I II) and Hegu (L I 4) can reduce the heat from the large intestine. Zhongwan (CV 12), the Influential Point of the fu organs, is selected to lower the qi of the fu organ. The reducing method applied to Taichong ( LR 3) is to soothe the liver qi . Reinforcing to Pishu (BL 20), Weishu (BL 21) and Zusanl i (ST 36) is able to reinforce qi in the spleen and stomach. Once the spleen and stomach qi is vigorous, qi and blood

Cheng Xinnong, ed. - Chinese Acupuncture &amp; Moxibustion.pdf - PDFCOFFEE.COM (2025)

Cheng Xinnong, ed. - Chinese Acupuncture & Moxibustion.pdf - PDFCOFFEE.COM (2025)