George T. Lewith MA MRCGP MRCPIn the first section we discussed the principles of Chinese medicine which will enable a traditional diagnosis to be made. This knowledge provides a basis for treatment.
Diseases fall into two main groups, diseases of the channels and collaterals, and diseases of the zang and fu organs.
Diseases of the Channels and Collaterals
These are the diseases of the superficial channels of the body—arthritis and acute strains are examples of this type of disease. The internal yin and yang balance is normal but the flow of qi and blood through the channels is disrupted. This usually presents with pain and is called a disease of ‘bi’ or blockage of the channels. If the flow of qi and blood is restored then the pain will go. This is the main therapeutic principle that is applied for this type of disease.
Diseases of the Zang and Fu Organs
These are the diseases of the internal organs of the body where there is an imbalance of the yin and yang within the body. Neurasthenia and asthma are clear examples of this type of disease. To treat these problems it is essential to be able to make a clear traditional diagnosis and to know the rules of point selection.
Diseases that Combine Zang and Fu, and Channel Disorders
A disease of pain, such as migraine, may combine these two ideas. Migraine is usually a disorder of the gan-liver but there is also a blockage of the flow of qi and blood in the channels around the temple, resulting in pain. The channels and collaterals, and the zang fu, will therefore both require treatment in this disease.
II. Principles of Point Selection
Diseases of the Channels and Collaterals
The principle of treatment for these diseases is to select the local points (Ah shi points or acupuncture points), and also a distal point on the channel that crosses the painful area. The local painful points are quite simple to find when the patient is examined, but the distal points are a matter of experience. There are no rules for the selection of these distal points, they have just been handed on to us as a product of empirical experience.
Local points
The local points are outlined in the discussion on each disease. There are common painful points in each type of disease and these are included in the prescriptions. The disease may not be typical, and the local points may vary a little, so do not follow the prescription blindly but examine the painful area and use the points that seem most relevant. The tender point, or the Ah shi point (both mean the same thing) also has a part to play in this type of disease. If you find a very tender area that does not seem to be an acupuncture point then use it as well as the local acupuncture points. The tender point is often an acupuncture point that you have not learnt.
Distal points
These are part of the basic grammar of acupuncture and they just have to be learnt. The easiest way to do this is to give a list of the most important distal points, with their uses.
Houxi (SI 3) This point may be used for pain over the small intestine channel, especially pain from cervical syndrome that is referred to the scapular area.
Hegu (LI 4) This point may be used for pain over the large intestine channel and it is also a very important point for facial pain, headache and sinusitis.
Quchi (LI 11) This is often used as a distal point for referred pain from the shoulder or neck.
Waiguan (SJ 5) This is the most important distal point in the upper limb. If there is pain in the upper limb that is not on a channel then this point may be used. It is also used when there is pain over the Sanjiao channel.
Weizhong (UB 40) This point is used for low back pain, or any pain over the lower part of the urinary bladder channel.
Kunlun (UB 60) This point is used for upper thoracic, cervical pain or headache, i.e. pain over the upper part of the urinary bladder channel.
Yanglingquan (GB 34) This may be used for any pain over the gall bladder channel, such as migraine.
Neiting (St 44) This is used for pain over the stomach channel such as facial pain, abdominal pain or hip pain radiating down the front of the leg.
These are the most important distal points. For some diseases of ‘hi’ no distal points are used, and the common diseases where these exceptions apply are knee pain, ankle pain, wrist pain, hand pain and foot pain. In these diseases use only the local points as outlined in the prescriptions. Sometimes the local acupuncture points may not be tender until they are carefully examined.
Diseases of the Zang and Fu Organs
On the basis of traditional diagnosis the acupuncturist will be able to decide what organ is diseased and what pathogen is causing that disease. He will then know which channel to use to correct the problem, and whether to sedate or tonify a particular organ. He must also dispel the pathogen, for instance, in cases of cold, he will need to warm with moxa or cupping or both.
There are many different rules that can be applied in order to select a point for a particular disease, but an experienced acupuncturist will often select only a few points. Initially this will be very confusing to a beginner, but as more clinical experience is obtained then it will slowly become clear that experience is the basis of many prescriptions. There are no dogmatic rules governing point selection for the zang fu diseases but there are several groups of special points that represent each organ. The most therapeutically useful groups are discussed and listed.
Back shu and front mu points
These points represent the surface points of the organs, the mu points are on the front and the shu points are on the back. If the zang organs are diseased (yin organs) then the back shu points are particularly effective, and if the fu organs are diseased (yang organs) then the front mu points are useful.
The shu points can be alternated with points on the ventral surface of the body, as outlined in some of the prescriptions. The back shu points are particularly useful in treating a zang disorder when it is associated with back pain, primarily because the position of the patient for acupuncture is much simpler.
The back shu points are prefixed by the Chinese name for the organ, for instance pi means spleen and pishu is the back shu point for the spleen; wei means stomach and weishu is the back shu point for the stomach.
Table I
Lung
Feishu (UB 13)
Zhongfu (Lu 1)
Pericardium
Jueyinshu (UB 14)
Shanzhong (Ren 17)
Heart
Xinshu (UB 15)
Jujue (Ren 14)
Liver
Ganshu (UB 18)
Qimen (Liv 14)
Gall Bladder
Danshu (UB 19)
Riyue (GB 24)
Spleen
Pishu (UB 20)
Zhangmen (Liv 13)
Stomach
Weishu (UB 21)
Zhongwan (Ren 12)
Sanjiao
Sanjiaoshu (UB 22)
Shimen (Ren 5)
Kidney
Shensh (UB 23)
Jingmen (GB 25)
Large intestine
Dachangshu (UB 25)
Tianshu (St 25)
Small intestine
Xiaochangshu (UB 27)
Guanyuan (Ren 4)
Urinary bladder
Pangguangshu (UB 28)
Zhongji (Ren 3)
Yuan source points
These points are near the wrist and the ankle. They are very useful points for treating diseases of their respective organs, for instance Taixi (K 3) and Taichong (Liv 3) are points commonly used for diseases of the gan-liver and shen-kidney; both are yuan source points. See Table II.
Luo connecting points
Each channel is connected internally and externally with another channel; for instance the lung and large intestine channels are connected The luo connecting point is the actual connection between these two channels, so the diseases of the connected channel can be treated by using the luo connecting point; for instance disease of the large intestine channel may be treated by using Lieque (Lu 7).
Table II
Lung Channel
Taiyuan (Lu 9)
Pianli (LI 6)
Large intestine channel
Hegu (LI 4)
Lieque (Lu 7)
Stomach channel
Chongyang (St 42)
Gongsun (Sp 4)
Spleen channel
Taibai (Sp 3)
Fenglong (St 40)
Heart Channel
Shenmen (H 7)
Zhizheng (SI 7)
Small intestine channel
Hand-Wangu (SI 4)
Tongli (H 5)
Urinary bladder channel
Jinggu (UB 64)
Dazhong (K 4)
Kidney channel
Taixi (K 3)
Feiyang (UB 58)
Pericardium channel
Daling (P 7)
Waiguan (SJ 5)
Sanjiao channel
Yangchi (SJ 4)
Neiguan (P 6)
Gall bladder channel
Qiuxu (GB 40)
Ligou (Liv 5)
Liver channel
Taichong (Liv 3)
Guangming (GB 37)
Influential points
These points are often used when a disease relates to a specific tissue or organ. Zhongwan (Ren 12) is often used when there is abdominal pain because it is the influential point for the fu organs.
There are other groups of points, such as the Xi-cleft points or the lower He points, but they are of limited clinical value. The most important and frequently used groups of points have been mentioned.
Table III
Zang organs
Zhangmen (Liv 13)
Fu organs
Zhongwan (Ren 12)
Qi (respiratory system)
Shanzhong (Ren 17)
Blood
Geshu (UB 17)
Tendon
Yanglingquan (GB 34)
Bone
Dazhu (UB 11)
Marrow
Xuanzhong (GB 39)
Arterial pulse
Taiyuan (Lu 9)
The law of the five elements
No acupuncture book is complete without this, although we did not make a great deal of use of this law in our course.
There are five elements in traditional Chinese philosophy: wood, fire, earth, metal and water. Wood is represented by the liver and gall bladder, water the kidney and urinary bladder, fire the heart and small intestine, earth the spleen and stomach, and metal the lung and large intestine. There is a creating and destroying cycle for these elements.
Table IV (a)
Large intestine Metal
Shang-yang (LI 1)
Erijan (LI 2)
Sanjian (LI 3)
Yangxi (LI 5)
Quchi (LI 11)
Sanjiao Fire
Guan-chong (SJ 1)
Yemen (SJ 2)
Zhongzhu (SJ 3)
Zhigou (SJ 6)
Tianjing (SJ 10)
Small Intestine Fire
Shaoze (SI 1)
Qiangu (SI 2)
Houxi (SI 3)
Yanggu (SI 5)
Xiaohai (SI 8)
Stomach Earth
Lidui (St 45)
Neiting (St 44)
Xiangu (St 43)
Jiexi (St 41)
Zusanli (St 36)
Gall Bladder Wood
Foot-Qiaoyin (GB 44)
Xiaxi (GB 43)
Foot-Linqi (GB 41)
Yangfu (GB 38)
Yang-lingquan (GB 34)
Urinary Bladder Water
Zhiyin (UB 67)
Tonggu (UB 66)
Shugu (UB 65)
Kunlun (UB 60)
Weizhong (UB 40)
Table IV (b)
Lung Metal
Shaoshang (Lu 11)
Yuji (Lu 10)
Taiyuan (Lu 9)
Jingqu (Lu 8)
Chize (Lu 5)
Pericardium Fire
Zhong-chong (P 9)
Laogong (P 8)
Daling (P 7)
Jianshi (P 5)
Quze (P 3)
Heart Fire
Shao-chong (H 9)
Shaofu (H 8)
Shenmen (H 7)
Lingdao (H 4)
Shaohai (H 3)
Spleen Earth
Yinbai (Sp 1)
Dadu (Sp 2)
Taibai (Sp 3)
Shangqiu (Sp 5)
Ying-lingquan (Sp 9)
Liver Wood
Dadun (Liv 1)
Xingjian (Liv 2)
Taichong (Liv 3)
Zhongfeng (Liv 4)
Ququan (Liv 8)
Kidney Water
Yougquan (K 1)
Rangu (K 2 )
Taixi (K 3)
Fuliu (K 7)
Yingu (K 10)
Each channel has a point on it that represents each of the five elements. For the zang organs the jing-well points are wood, the yung-spring points are fire, the shu-stream points are earth, the jing-river points are metal and the he-sea points are water. For the fu organs jing-well is metal, yung-spring is water, shu-stream is wood, jing-river is fire and he-sea is earth.
These points, and the system they entail, may be used to tonify or sedate an organ. Wood creates fire, so fire is the ‘son’ of wood and wood is the ‘mother’ of fire. If the organ has a xu disease then the ‘mother’ point is used to tonify the diseased organ, for instance, if there is xu of xin-heart (fire) then use the mother point (wood) to tonify the heart. The wood point on the heart channel is Shaochong (H 9). If there is a shi disease of the xin-heart (fire) use the ‘son’ point (earth) to sedate the xin-heart. The earth point on the heart channel is Shenmen (H 7). Shenmen (H 7) is nearly always used for diseases of the xin-heart because most diseases of the xin-heart are shi in nature.
This law is explained at great length in many other texts, and the foregoing gives you a basic idea of what it entails. This, in fact, is the extent to which it was touched on in the course we attended.
Points according to symptoms
In diseases of the zang and fu organs there are many points that can be used for symptoms such as nausea. There are also some very useful points that can be used to dispel various pathogens. In this section we list some of the more useful points:
Taiyuan (Lu 9) can be used for cough, haematemasis and nasal obstruction.
Neiguan (P 6) can be used for palpitations, nausea, vomiting and insomnia.
Shenmen (H 7) can be used for palpitations, insomnia and diseases of the xin-heart.
Hegu (LI 4) can be used for fever, rhinitis, facial nerve paralysis and the dispersal of wind.
Waiguan (SJ 5) can be used for colds, fever, headache and strained neck.
Houxi (SI 3) can be used for tinnitus and malaria.
Sanyinjiao (Sp 6) can be used for disorders of the pi-spleen, impotence, irregular menstruation, enuresis, dysuria and insomnia.
Taichong (Liv 3) can be used for headaches, vertigo, eye diseases, pain in the costal and hypochondriac region, insomnia and diseases of the gan-liver.
Taixi (K 3) can be used for enuresis, dysuria, inspiratory dyspnoea, tinnitus, tooth cavities, chronic diarrhoea, poor vision, vertigo and impotence. This is an important point in deficiency diseases and diseases of the shen-kidney.
Zusanli (St 36) can be used for diseases of pi-spleen and general tonification.
Baibui (Du 20) can be used for headaches, dizziness, lifting (in vaginal or rectal prolapse), and mental diseases.
Quchi (LI 11) can be used for dispersing wind and heat.
Fenglong (St 40) can be used for resolving damp and phlegm.
Dazhui (Du 14) can be used for resolving fever and malaria.
Shanzhong (Ren 17) can be used for asthma, bronchitis and hiccoughs.
Zhongwan (Ren 12) can be used for disorders of the fu organs, such as vomiting or abdominal pain.
Guanynan (Ren 4) can be used for general tonification, diseases of xu, enuresis and impotence.
Qihai (Ren 6) can be used as a point of general tonification.
Yintang (Extra) can be used for insomnia and neurasthenia.
A combination of the rules of point selection, as well as selecting the points according to the symptoms, has been used to make up the prescriptions in the following sections. Many of the points that are listed as points according to symptoms have complex traditional reasons behind their selection. They have been shown to be useful points by using a combination of traditional medicine and Chinese experience. The choice of prescription for a particular disease is not always easy and experience may be the most important factor in making that choice.
III. The Tender or Ah Shi Point
The tender point is called the Ah shi point by the Chinese. A tender point(s) is often found in painful diseases and the acupuncturist will be guided to this point(s) by and through clinical examination and experience. In many cases the Ah shi point(s) may be felt as a pea-sized nodule(s) under the skin, or the patient may draw the attention of the acupuncturist to a painful area.
The Ah shi point(s) should always be used, especially in diseases of pain, along with local acupuncture points. In some cases they may replace the use of the acupuncture points as none of the acupuncture points will be near the affected area, or none of them may be tender.
The Ah shi point(s) should be treated as an acupuncture point(s) and used as part of a normal prescription with other local and distal points. The acupuncturist must also remember that the Ah shi point(s) will often change from treatment to treatment and the patient should be examined thoroughly on each occasion.
IV. Stimulation of Acupuncture Points
Acupuncture is not the only way to stimulate an acupuncture point. Classical traditional medicine also involves the use of cupping and moxa to stimulate the points, and in some diseases these methods are preferable to using a needle. Certain points are impracticable for cupping, such as points on the arm and leg, and other points are forbidden to moxa, such as Jingming (UB 1).
When the needle is inserted the acupuncturist must be aware of the underlying tissues and organs. When a needle is being used on a point that is over the lung it must be inserted obliquely to avoid the danger of a pneumothorax. Common sense and a knowledge of basic anatomy should avoid any untoward accidents. The needle must also be sterilized properly so that there is no possibility of transmitting serum hepatitis.
It is important to remember that the piece of skin into which you insert the needle is relatively unimportant as long as the needle stimulates the acupuncture point. The needle for Shenmen (H 7) can be inserted in several different ways but the acupuncture point has been stimulated only if the needling sensation is felt. The actual acupuncture point is always underneath the skin, and it may be an inch or more deep to the dermis. The best method of knowing that you have stimulated an acupuncture point is to obtain deqi over that point. This means that the tip of the needle is the best point locator that the acupuncturist has at his disposal.
Stimulation of the Needle
Deqi
Deqi means needling sensation. This sensation is difficult to describe unless you have actually felt it; it is not pleasant though it is not painful. Deqi is slightly different for each point. Points on the head usually have a burning or pricking sensation, whereas points on the limbs usually have a bursting, sore, full or numb sensation when they are stimulated. The needling sensation can travel up or down the channel.
The needle is stimulated by a perpendicular and rotary movement, lifting and thrusting the needle whilst it is being rotated. The only way to become competent at obtaining deqi is to practice
Unless the acupuncturist obtains deqi over each acupuncture point used then the acupuncture point has not been stimulated, and this means that the acupuncture is of questionable value.
Electrical stimulation
It is impossible to be dogmatic about the use of electrical stimulation as so much work is being done in this area at the moment. The Chinese are not the best people to give a clear picture of the use of stimulators. In general the stimulator is used in anaesthesia and when it is used therapeutically it is used for conditions of severe pain, acute conditions, scalp acupuncture, and conditions where ordinary needling has failed. The Chinese do not use it very much for treating disease.
Manual stimulation
The reducing method is used in acute or shi diseases, and the reinforcing method is used in chronic or xu diseases. Strong stimulation is approximately equivalent to the reducing method and weak stimulation is roughly equivalent to the reinforcing method. This is all dependent on the individual as strong stimulation of a sensitive patient may be equivalent to weak stimulation of a less sensitive person. In weak stimulation the manipulation of the needle should be stopped as soon as the patient feels deqi, in strong stimulation the needle should be stimulated until the needling sensation is intense.
Reactions
If a patient is overstimulated then this may cause a temporary worsening of the condition. This is transitory and indicates a response to acupuncture. If this occurs then stimulate less forcefully next time.
Patients receiving acupuncture for the first time
Because of the possibility of a reaction stimulate the needles gently on the first visit. Needles are usually inserted proximally first, but in those receiving treatment for the first time it is less distressing to use the distal points first.
Moxibustion and Cupping
Both moxibustion and cupping are methods of stimulating an acupuncture point. They are nearly always used in diseases of cold where the main treatment is to warm the affected area. The indications for moxa and cupping are mentioned in the treatment of each specific disease, but in general cupping is usually the preferred method of warming a point, and where this is impracticable, such as on a limb or on the face, moxa is used.
Moxa is made from the dried leaves of Artemesia Vulgaris, and the older the moxa the more effective it is. Moxa can be used in several different forms. Loose moxa, or moxa punk, can be made into small cones and burnt on the skin (it is removed before it burns) or it may be burnt on a slice of ginger or garlic.
Moxa sticks may also be used. These are rolls of moxa which can be used to heat the skin directly, or they can be cut and burnt on the end of a needle. This method of warm handling allows heat to travel directly into the acupuncture point.
Cupping is simply the use of partially evacuated glass or bamboo cups over the acupuncture point. A partial vacuum is created inside the cup by a flame, and with an adroit flick of the hand the cup is put on to the skin.
A course of treatment usually comprises eight sessions; these sessions are every day, or sometimes more frequently in acute diseases, but they may be less frequent in chronic diseases. More than one course of treatment may be needed and there should be a rest of a week or so between each course.
In the sections on each disease recommendations have been made when the rule of daily treatment does not apply.
In general two or three treatments are given to consolidate the effects of acupuncture (after the symptoms have gone), so strict adherence to the length of treatment may not be needed. In the West treatment is less frequent.
Jim Strohecker
Daniel Redwood DC