The Thirteenth Round (October, 2011)

Questions:

1. What are the functions of the Yuan-origin points?
2. What should I pay attention to when performing blood-letting (bleeding) technique?
3. Why points in the stomach channel are good at treating mental diseases?
4. Why the points in the small intestine channel are good ate treating motor impairment diseases of the upper limb?
5. Please describe the meaning of “Taiyang governs the tendons” and its clinical applications.
6. Please discuss the applications of “the Pericardium governs the spirit, blood and sweat” in clinical practice.
7. Why is that only liver and heart channels travel to the head region?
8. What is the relation between the inter-promotion and inter-restriction of the five elements and the channels?
9. What is “treatment points not forming a formula (you xue wu fang)”? How to improve it?

1. Question: What are the functions of the Yuan-origin points?

Answer: The distributions of the Yuan-origin points share one feature, which is they all are located distal to the wrists in the upper extremities or to the ankles in the lower extremities. The twelve Yuan-origin points are located distal to the wrist or ankle joints. They are closely related to the Yuan-origin qi of the body and are the foundations of the Zang Fu and Jing Luo (channels and collaterals). They are the points that Yuan-origin qi flows through and lingers in. The Yuan-origin points are the places where Yuan-origin qi performs its functions. The disorders of the Zang and Fu often manifest through the twelve Yuan-origin points.

In the Ling Shu, Nine Needles and Twelve Yuan-origin Points, it says “To treat the diseases of the five Zang, the twelve Yuan-origin points shall be selected.” The statement indicates that the twelve Yuan-origin points are mainly used to treat the five Zang (organ) diseases. Through the exterior-interior relationships, they are also used to treat the six Fu (bowels) diseases. One feature of the Yuan-origin points is that they not only can tonify the deficiency but also can drain the excess, a function so called “double regulating”. Hence, the Yuan-origin points not only can be used to treat the disorders of the respectively belonged or related Zang and Fu illnesses, disorders of the limbs and body trunk, but also can treat channel disorders of their respectively belonged channels. The Yuan-origin points can treat all types of disease patterns; no matter they are deficiency, excess, cold, heat, acute, chronic, or pain types. It may be said that the Yuan-origin points are the “chief points” for the disorders of their respectively belonged channel or Zang Fu.

One meaning of the Yuan is “origin”, which indicates the original qi or the moving qi between the kidneys, the so called the fundamental qi of the life. Another meaning of Yuan is a flat stretch land. As the Yuan-origin points of the Zang organs are same as their Shu-stream points and the Yuan-origin points of the Fu bowel are proximal to the Shu-stream points, where are full of vessel qi. From the perspective of Ti Ying (body correspondence theory), those are the sites abundant with flesh, and hence the Yuan-origin points govern the qi.

The applications of the Yuan-origin points are not only broad and also with high effectiveness and quick result. In the Zhen Jiao Da Cheng (The Great Compendium of Acupuncture and Moxibustion), Zhi Zheng Zuong Yao (the Generalization of Disease Treatments), the 12 Yuan-origin points are used to a high percentage of 52% in the 151 treatment songs. Based on my personal experiences and observations, the Yuan-origin points are located at the places with abundant flesh which corresponds to the Spleen and hence can tonify the acquired foundations. As the Yuan-origin points correspond to the Yuan-qi of the San Jiao and the moving qi between the kidneys, they also tonify the constitutional foundations. That is to say the Yuan-origin points can simultaneously tonify the Spleen and Kidney, and regulate both the acquired and constitutional foundations. That is why they have very wide spectrum of indications and bear very high effectiveness. Many important points of the Tung's Acupuncture are around the Yuan-origin points. For example, Huao Zhu ((66.04) ( Taichong (LV3)), Wuanshuen Er (22.09) ( Wuan Gu (SI4)), and Linggu (22.05) (Yangxi (LI5)). (Back to Top)

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2. Question: What should I pay attention to when performing blood-letting (bleeding) technique?

Answer: This question was often brought up to me when I gave lectures around the world. I remember I covered this topic in the lectures given in Korea, China and the United States. In the“Answers to Readers Question”published in my website, the November, 2009 (the Ninth Round) issue, I have also answered this question, too. Blood-letting is an important component in the acupuncture. In “Huang Di Nei Jing”, the most important book in the acupuncture, almost half of the chapters mention the technique of blood-letting. Almost all contemporary books will cover the blood-letting technique as well. There are quite a lot of reference books available, some even specialize in blood-letting. One may refer to the books when in need. Here I would summarize the main points. The following things need to be paid attention to when performing the blood-letting technique. 1. Manipulation technique 2. Point location. 3. Weather and timing. 4. Situations such as starving or being full are not suitable for blood-letting. 5. Selection of the right needle (tools). 6. Pay close attention to the sterilization procedures.

Regarding the sterilization, I would like to put some extra emphasis on the following two parts.
1. Blood-letting needles (tools): Once the three-edged needle is removed from its package, it must be used immediately. Any subsequent or post processing to the needle is strictly forbidden, because it does not comply with the sterilization process regulated by the laws. I was once asked what to do if the needle was dull (not sharp enough) and unable to prick to let blood out. I once recommended them on the basis of the Chinese Medicine literature and books to use sand paper to sharpen the needle, then apply alcohol swaps to sterilize the needle. However, now I would like to repeatedly tell you that that procedure was out-dated and do not comply with the regulations. Ever since the beginning of this year, my answer to that question has been “Use the three-edged needle immediately right out of the package. Any processing to the needle is strictly forbidden.” In this case, it is extremely important to select the quality needles. When making purchase, request for samples to see if they are sharp enough. If they are not sharp enough, simply switch to another brands. Do not purchase before you are confident about the quality of the needles. It is not a right thing to treat or process the needles in any form.

2. How to handle the blood: Handle the blood strictly according to the regulations of OSHA. Do no neglect any contamination routes, no matter how minor they may seem to be. Any objects or supplies in contact with blood must be clearly labeled, handled and disposed properly. The cotton balls, gause and gloves that are soaked with blood must be disposed of as bio-hazardous waste. No persons are allowed to directly contact with the blood. They must wear gloves. I strongly advise everyone to refer to the most dated Clean Needle Technique and OSHA manuals for complete information on this part and strictly follow the regulations. (Back to Top)

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3. Question : Why points in the stomach channel are good at treating mental diseases?

Answer: It was believed that mania is due to heat in Yangming ever since the ancient times. Mental diseases are closely related to the stomach. It is often seen that those patients with mental illness have over-active digestive power. The mania can be ameliorated if the excess syndrome of the stomach is regulated. Dian (withdrawal, depression) and Kuang (mania) can be treated by needling Fengrong (ST40) or Sihuawai (77.14), and Lidui (ST45). As for neurasthenic, tonifing the stomach to enhance the absorption of the nutrients and improve the mental functions will often cure it. To treat the neurasthenic, needling Lidui (ST45), Sihuashang (77.08) (or ST36), Fenglong (ST40) (or Sihuawai (77.14)) gives good result. Those points can be used to treat continuous nightmares. Also, the source of phlegm is the spleen and stomach, and is also related to many mental disorders. The points in the stomach channel are often used to resolve the phlegm. The same reasons apply to Ban Xia Xie Xin Tang (Pinella Heart-Draining Decoction) which is good at treating dreamy sleep and mental disorders. (Back to Top)

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4. Question : Why the points in the small intestine channel are good ate treating motor impairment diseases of the upper limb?

Answer: The small intestine channel dominants among all the channels run through the region of scapula (shoulder blade). Hence it strongly controls the muscles of the upper limb. It is particularly effective in treating pains in this region. The points of this channel are most often selected to treat motor and sensory impairments of the upper limb. As the extraordinary connection of the spleen and the small intestine, needling Shenguan (77.18), a point located in the spleen channel; and Xiajuxu (ST39) (the lower He-sea point of the small intestine channel) are very effective too. To treat the shoulder pain, Huoxi (SI3), Jienzhen (SI9) are commonly needled. Bloodletting on Shuanghe (DT.16) points on the back to treat upper limb pain is also very effective. In the two of the Shuanghe (DT.16) points, the one corresponds to the small intestine back-Shu point (BL-27) is particularly effective. (Back to Top)

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5. Question : Please describe the meaning of “Taiyang governs the tendons” and its clinical applications.

Answer: The Bladder channel passes along the head, posterior aspect of the neck, back, lumbar region, buttock, the posterior of the leg, and the lateral of the ankle, etc. They are the most important tendon muscular constructions among the motor functions in our body. Taxation detriment of those regions often induces various types of pains, spasms, rigidity, numbness etc. Those disorders are related to the tendons. That is why it is said the Taiyang governs the tendons. The most commonly seen disorders of the Taiyang channel are the sciatica, pain, rigidity and spasm of the nape, back, lumbar and gastrocnemius muscle. Weizhong (BL40), Zhengjin (77.01), and Chengshan (BL57) are essential points in treating tendon disorders. (Back to Top)

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6. Question: Please discuss the applications of “the Pericardium governs the spirit, blood and sweat” in clinical practice.

Answer: The Heart governs the spirit, so does the Pericardium. The Pericardium tranquilizes the heart and pacifies the spirit and treats various heart disorders. The most commonly used points are Ximen (PC4) and Neiguan (PC6). The Pericardium also governs the blood. The Pericardium channel is a fire channel and hence it treats mostly feverish diseases. The Xi-cleft point, Ximen (PC4), is good at stopping various bleeding in the upper body, for instance, to stop coughing blood. To stop nasal bleeding, needle the Ximen (PC4). To treat vomiting blood, needle Daling (PC7), Ximen (PC4). The Pericardium also governs the sweat and so it will treat night sweat due to yin deficiency. Needling Ximen (PC4) and Jienshi (PC5) to stop night sweat is effective. (Back to Top)

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7. Question: Why is that only liver and heart channels travel to the head region?

Answer: The general rule of the yin yang categorization of Zang Fu is that Zang (viscera) (to store) belong to yin and Fu (bowel) (a palace) belong to yang. However, the five Zang (belong to the yin) could be further categorized into yin and yang. In Ling Shu, Yin Yang Xi Re Yue (The Yin and Yang of Human Body relate to Moon and Sun) says “the parts above the loins are Heaven which is yang; the parts below the loins are earth which is yin”. In fact, the divider between yin and yang of the Zang is the diaphragm. The Zang in the chest are yang and those in the abdomen are yin. The chapter also says “In the five Zang, the heart is the Taiyang in yang, the lung is the Shaoyin in yang, the liver is the Shaoyang in yin, the spleen is the extreme yin in yin, and the kidney is the Taiyin in yin.” (The above quote is also seen in Ling Shu, Nine Needles and Twelve Yuan-origins). In Su Wen, Jin Gui Zhen Yen Lun (The Truth in the Collections of Books of Golden Chamber) says “the back is yang. The heart is the yang in yang; the lung is the yin in yang. The abdomen is yin. The kidney is the yin in yin and the liver is the yang in yin. The extreme yin in yin is the spleen.”

The heart and liver both are “yang viscera”. The heart is the Taiyang in yang because it is located in the chest. The liver is located in the abdomen and is the Shaoyang in yin. The lung, kidney, and spleen all are “yin viscera”. The lung is Shaoyin in yang because it is located in theS chest and back. The kidney is Taiyin in the yin because it is located in the loins. The spleen is located in the abdomen and is the extreme yin in the yin.

In the five elements, the wood and fire are light and going upward, hence they govern ascending. The earth, metal, and water are heavy and sinking and hence govern descending. The yin channels travel upward (the foot three yin channels travel from feet to the chest; while the hand three yin channels travel from the chest to the hands.). Hence, the beginning five-element of the five transport points of the yin channels start from wood and then fire. The yang channels travel downward and hence the beginning five-element of the five transport points of those channels start from metal and then water. The heart (fire) and liver (wood) channels are yin channels but yang viscera. Because they belong to wood and fire, their nature is to ascend. That is why in the yin channels, only the yang viscera, the heart and liver channels travel upward from their internal pathways to the head region (no points on those pathways though). Because both the liver and heart channels go to the head, the disorders of the heart and liver will influence the spirit and will (Shen Zhi). The hyperactivity of the liver yang (such as the cerebral hemorrhage in western medicine term) and the phlegm confusing the heart orifice (brain thrombus) both will cause stroke. To treat it, needle the Muhuo (wood fire) point and Linggu and Dabai (the wood fire nature points) of the Tung’s acupuncture. The effectiveness of the point combination is very high. (Back to Top)

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8. Question: What is the relation between the inter-promotion and inter-restriction of the five elements and the channels?

Answer: According to the Ling Shu, chapter 10 Jing Mai (on Channels), “the hand Taiyin Lung channel starts from the middle Jiao and winds downward to connect with the Large Intestine….” Here, the middle Jiao includes the spleen and stomach. The text implies the meaning of “earth generates the metal”. It says the Spleen channel as “….another branch reached up from the stomach to pass through the diaphragm and enter the heart.” This described the communication between the Spleen and the Heart, in which means the fire generates the earth. In the description of the Hand Shaoyin channel, it says “the branch running straightly forward ascends from the heart system to the lung.” This may explain the “fire restrains the metal.” As far as the Kidney channel, it says “the Kidney channels runs straightly from the Kidney and ascends through the liver and diaphragm and enter the lung….; its branch separates in the lung, joins with the heart, and disperses in the chest to link with the Pericardium channel.” This statement describes the relations of the Liver and Kidney, Lung and Kidney, and Heart and Kidney, etc. The Liver channel says “its branch separates from the liver, crosses the diaphragm and spread in the Lung.” This connects to the “metal restrains the wood.” (Back to Top)

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9. Question: What is “treatment points not forming a formula (you xue wu fang)”? How to improve it?

Answers: Many people knows “prescribed herbs not forming a formula (you yao wu fang) and “a formula without modified herbs (you fang wu yao)” while learning herbal prescriptions. The same problems happen to acupuncture too. The so called “using a formula without modified herbs (you fang wu yao)” means rigidly using the formula without changes or modifications according to individual patient’s condition. As the “prescribed herbs not forming a formula (you yao wu fang)” means merely gather a bunch of herbs without following any principles. Some acupuncture treatments fall into the above two circumstances. The acupuncturist merely puts one needle here, one there, without any principles. It is like shooting birds in the dark (making random attempts). One needs to understand the principles of herbal combination to successfully prescribe an effective formula. The same applied to acupuncture too. For instance, some acupuncturists needle Linggu (22.05), Dabai (22.04), Jioil (88.25), Xinmen (33.11), Shouwujin (33.08), Shouxienjin (33.09), Biyi (1010.22), etc. all together to treat sciatica. Sometimes they even add more points from the 14 channels. This is a typical example of gathering a bunch of points without principles. Certainly the treatment result will not be good. Acupuncture needs to be like prescribing a formula. It is said “Having Songs of Tang Tou Formulas (sets of prescriptions) in mind, one needn't to worry in clinic.” One needs to have sets of point prescriptions in mind as basis before selecting treatment points.

First is to memorize the application principles of the special points. For example, for the Five Transport points, one can memorize the texts in the Ling Shu in chapter 44 (’The Sequence of Qi and the Four Seasons within a Single Day’): When the disease is at the Zang, needle the Jing-Well point. If manifesting as a change in the color, needle the Ying-Spring point. When the disease attacks intermittently, needle the Shu-Stream point. When the disease manifests as changes in the patient’s voice, needle the Jing-River point. If there is disease of the stomach and irregular appetite, needle the He-sea point. In Ling Shu, in chapter 4 Disease Patterns of Zangfu as Caused by Pathogenic Qi says: the Ying-spring and Shu-stream points treat the exterior channels; and He-sea points treat the internal Fu. Classic of Difficulties (68th Difficulty) says “Jing-well points for fullness below the heart, Ying-spring points for heat of the body, Shu-stream points for heaviness of the body and pain of the joints, Jing-River points for dyspnea, cough, chills and fever, He-Sea points for rebellious Qi and diarrhea. If one can memorize those texts, he/she can apply them to the clinic practice potentially. Whenever encounter the pain, first select the Shu-stream point of the disease channel, because Shu-stream points govern the pain syndromes. When encounter the diseases of qi reverse, select the He-sea points of the channel. For example, cough is the qi reverse of the Lung, so first thing is to select the He-sea point of the Lung, Chize (LU5) to treat it. Hiccup, the qi reverse of the Spleen, select the He-sea point of the Spleen, Yinlingquan (SP9), or Jienshi (PC5) in the Pericardium channel, because “the disease manifested with voice (sound) change, select the Jing-river points, and also that the communication of the Pericardium and the stomach.

Secondly, memorize three to five classical songs or odes. For example, Bai Zheng Fu (Ode of a Hundred Patterns), Zhou Huo Ge (Song to Keep Up Your Sleeve), Biao Yo Fu (Song of Elucidate Mysteries), Xi Hong Fu (Ode of Xi Hong), Tong Xiuan Zhi Yao Fu (Ode of the Essentials of Understanding), Zha Bing Xue Fa Ge (Song of Points for Miscellaneous Diseases), Shen Yu Ge (Song More Precious Than Jade). All those are very popular and useful songs and odes. By memorizing those songs and odes myself, I gained very strong foundation in acupuncture. I also recommended my students to memorize those songs and odes so to skillfully select points in practice. Those songs and odes are set prescriptions. For example, in Xi Hong Fu (Ode of Xi Hong) and Zha Bing Xue Fa Ge (Song of Points for Miscellaneous Diseases), they both say the combination of Lei Xue (LU7) and Tai Yuan (LU9) treats the qi stabbing the two breasts, and temporal and frontal headache. The clinical experience proves it. Also, in Bai Zhen Fu (Ode of a Hundred Patterns), it says “sore throat, Yi Men (SJ2) and Yu Ji (LU10) can treat.” In my decades of clinical practice, I use Yi Men and Yu Ji to treat sore throat and always receive instant results. Another example, Za Bing Xue Fa Ge (Song of Points for Miscellaneous Diseases) says, “Urination obstruction, needling Yinlingquen (SP9) and Zusanli (ST36) will drain the urine like stream flow.” There are too many such examples to enumerate piece by piece. Those point prescriptions are very refined. They usually contain one or two points.

Having those prescriptions at hand make clinical practice convenient and create high efficacy. Besides, those prescriptions are very refined and contain only a few points. I have discussed the point combination of Tung's acupuncture in question 36. Here, I would only give a few examples. Master Tung had a formula to treat headache, Cesanli (77.22) and Shenguan (77.18), with very good clinical efficacy. Later, I developed it into Sanchayi (A.02) and Dabai (22.04) interchangeably needled on two hands to treat various headaches. The total number of points is reduced but still with good result. The reason of my development is as follows. Dabai (22.04) can treat frontal headache and facial disorders. Through the communication of large intestine and liver (Dabai pertains to wood and also communicates with liver), it is good at treating various headache. The point pertains to wood which governs wind and hence is good at treating exterior contracted diseases. Needling this point along the bone corresponds to the kidney and hence also treats chronic diseases. As for Sanchanyi (A.02), it is located in the Sanjiao channel and hence is good at treating lateral headache and Shaoyang disorders. Because of Ying-spring and Shu-stream points treat the exterior channels; it is also an essential point in treating exterior contracted diseases. Needling this point along the tendon and bone to reach the Shu-stream point where there is abundant flesh. Although needling one point, multiple points are penetrated. Hence, the functions and indications of this point are numerous and also cover the disorders of the spleen, liver and kidney. It works well on various types of headache, no matters they are due to internal injure or external contracted, but is particularly effective in the exterior contracted type. The combination of the above two points is more convenient and simpler than and is as effective as that of Cesanli (77.22), Cexiasanli (77.23) and Shenguan (77.18). This combination is developed on the principles of the five Shu points and the five tissue correspondence. Guided by the theory and proved by the clinical practice, this combination became a set prescription. (Back to Top)

(Originally published September 2011,Mastertcm.com)