The Ninth Round (November, 2009)
Questions:
- What is the difference between Tung’s palm diagnosis and other styles of palm diagnosis?
- How to master and learn Master Tung’s bloodletting technique well?
- What needs to be paid attention to when conducting the bloodletting therapy?
- When bleeding at the inner cheek, which side shall be chosen? Some say the affected side, and some say the healthy side. What is your opinion?
- Could you talk about the reasons the Heart opens into the orifices of the ears, and how that relates to bloodletting therapy and acupuncture?
- Does the location of the extraordinary point Huofuhai (33.07) match that of the Shousanli (LI10)? Do the point name and the location have any special implication or meaning to the treatment?
- Both Muhuo point and the Daoma of Linggu and Dabai treat the sequela of stroke. What are the common reasons?
1. What is the difference between Tung’s palm diagnosis and other styles of palm diagnosis?
Answer: The Tung’s palm diagnosis was firstly made public in words in the Zhong Yi Yen Jiao (The Researches of the Chinese Medicine) in 1978, volume one. It was written by my student Dr. Yen Wu-Cun in accordance with my teachings and writings. The content was not exactly same as that currently circulated on the internet. Mine teachings and writings were the practical information resulted from experimenting, proving, and revising from Master Tung’s original teachings. In response to many students’ request, I started to teach palm diagnosis in some doctoral programs in the recent years.
Tung’s palm diagnosis is closely related to channels (Jing-Luo). It is not difficult to learn Tung’s palm diagnosis if one understands well the hand-foot same name channels and the extraordinary connections of the Zhang Fu organs. The readers may refer to the article “The Discussion on the Tung’s Palm Diagnosis” authored by Dr. Tsai Ming-Zong published in the Symposium of Master Tung’s Extraordinary Points in 1999. His article has details on the relations between channels and palm diagnosis. The differences between Tung’s palm diagnosis and others are generally described as follows.
1. Different Location/Regions Definition: The location definition in general palm diagnosis may accord to the eight trigrams, palmer lines, or other self-defined system. The Zang Fu locations in Tung’s palm diagnosis are different from those currently populated styles. In Tung’s palm diagnosis, other than the Zang Fu eight trigrams, the San Jiao locations, including the vertical and horizontal San Jiaos, are even more emphasized. Tung’s palm diagnosis particularly emphasized in the channel localization. If one understands the same name channel communication, and the extraordinary connections of the Zang Fu organs, he will not have difficulties realizing Tung’s palm diagnosis.
2. Different Diagnosis Methods: General palm diagnosis more focuses on the lines, including those major lines such as Heaven line (Love Line), Human line (Wisdom Line)….and minor lines such as vertical, horizontal, island, and obstruction liens, ...etc. Master Tung also observed the changes of color and luster, and flecks, but he most focused on the blue veins and shadow in every region, and secondly focused on the overall palm color and the temperature, muscle thickness or thinness, and indentation or convex in every region. For example, the plumpness or concaveness in the range of the trigram Gen-mountain region, or Venus mount, reflects a person’s constitution (vitality) and kidney qi, either strong or weak. If the muscle along the edge of palm of the Houxi (SI3) area is lack of elasticity or is concave, the diagnosis is kidney qi deficiency. If the little finger is too short, it is also diagnosed as kidney qi deficiency.
3. Different action/purpose: Master Tung often needled in accordance with the veins and the shadows. For example, the elevated blue veins along the edge of the palm about the Yuji point (LU10), can be diagnosed according to the upper, middle and lower positions to the shoulder or neck and upper back pain. Needle directly on the site of the elevated veins on the palm can treat the related pains. This was as a result of the discovery of the Chongzi and Chongxian points. Also, if the elevated blue veins are around the middle and lower Jiao regions, plus the palm temperature is lower, the diagnosis is Spleen and Kidney Yang deficiency and the treatment is to needle Linggu and Shenguan. If the palm temperature is high and there are many blue veins, the diagnosis is Liver and Kidney Yin deficiency with exuberant fire. And the treatment is to needle the Shenguan, Renhuang and Huoying points. (Back to Top)
2. How to master and learn Master Tung’s bloodletting technique well?
Answer: All the descendants of the Master Tung know well that the major feature of Master Tung’s treatment is bloodletting technique. Without the knowledge and the skills to perform the bloodletting technique, one can not call himself a descendant of Master Tung. The bloodletting technique can be used to judge if the Tung’s students learned the true teachings from the Master.
First is to master the bleeding technique. The focuses are on the selections of needle tools and the targeted bloodletting sites. The thicker needle shaft the easier to hold the needle and easier to give strength. Master Tung called blood-letting technique “Dien Ci (point/dot pricking)”. The so called Dien Ci (point pricking) is to use a three-edged needle to point on the vein and then prick perpendicularly and speedily on it. With the needle slightly pressing down on the vein, the blood shall drip out easily. The most suitable target for blood-pricking is those elevated/floating blue veins. They were felt protruded outward with gentle touch. When pricking the lower extremities, Master Tung often asked the patient to lie down. However, some veins float and shown while standing but invisible while lying down, that means those veins are located in the deeper or hidden layers, then the standing position is better than lying position. In this case, if with lying position, the pricking depth has to be deeper, otherwise the blood won’t come out and also the patient might feel more pain from the pricking.
It is advisable to first congest the blood at the bleeding site then prick it. In this case, it is not necessary to squeeze the site for blood, and the blood will naturally flow out and the bleeding volume is also more. How to congest the blood? For example, when bleeding the Jing-well points, the practitioner can squeeze the finger to make the blood congested at the finger tip and then prick. With this technique, it is easy to bleed and there will not be much pain. To bleed on the back, it is easier if the point has been pressed. Because the back does not show the veins, even with this technique, sometimes the practitioner may need to squeeze or do cupping on the bleeding points to enhance the bleeding. To bleed at Taiyang point, grasp the collar for a short while to congest the blood at head, and then gently prick the point with a sharpened three-edged needle, the blood should rush out like a spring. Points located on the elbow and knee crests, such as UB40, LU5, and PC3, are easier to bleed, but if the practitioner presses on the vein before pricking, the blood is easier to flow out and the patient will feel little pain.
Secondly is to master the points. The essential tip of the point selections of the bleeding technique is “the ability of loosening up and tightening up”. The so-called “loosening up” means to broaden up. It is common to bleed all Sihua-zhong, Sihua-xia and Sihua-wai when bleeding the calf. This will reach the purpose of treating the upper, middle, and lower, the wholeness. The so-called “tightening up” means to find the most important point among numerous points. In Tung’s acupuncture, the back points are often in groups. It will be too numerous if every point is used. To refine the point selections and to amplify the effect of the major point, it is necessary if the most important point is selected. For example, the back Sanjin (three-metal) points are bled to treat the knee pain. The Sanjin (three metal) points equal to Puohu (UB42), Gaohuang (UB43), and Shentang (UB44). The most commonly used point by Master Tung in treating the knee pain was the Xinxi (heart knee) and Dan (gallbladder) points located on the middle finger, the pericardium channel. Hence, the major point among the three metal points is the Gaohuang (UB43) that is next to the Jueyinshu (UB14) (the back-shu point of Jueyin). The upper and lower points, Puohu (UB42) and Shentang (UB43), act as Daoma needles that are to strengthen the major point. From this I comprehend that Neiguan (PC6) point on the Jueyin channel is very effective in treating knee pain. (PC6 is the Luo-connecting point of the pericardium channel.) Through the extraordinary connections of the pericardium and stomach, and that the stomach channel passes the knee eye, and that PC6 is located between two tendons, PC6 is very effective in treating the knee pain. (Back to Top)
3. What needs to be paid attention to when conducting the bloodletting therapy?
Answer: One needs to pay attention to the following aspects while conducting bloodletting therapy.
1. Weather: The bleeding volume is more and the result is better in the sunny days than in the rainy and cloudy days, since the blood vessels constrict more in the latter conditions. In the sunny days of the summer, the yang qi floats outward and the blood vessel elevates upward, and hence it is the best season in a year to conduct the bloodletting therapy to treat the difficult and prolonged or miscellaneous diseases. Weizhong (UB40), Chize (LU5), and points on the back are easier to bleed in summer than in winter. Unless treating acute diseases, in the treatment of chronic diseases or pains, it is advisable to bleed the patients in good weather.
2. Food and Drink: It is not suitable for bloodletting therapy when the patient is too hungry or too full. Because when the patient is too hungry, the blood is more concentrated and will influence the volume of bleeding. Do not perform the bloodletting therapy long after the last meal, because over-hunger causes needle fainting easily.
3. Techniques: In bloodletting, simply pricking directly on the blue veins will cause bleeding. Once bleeding, the patient instead does not feel pain. If the blood does not come out, then the patient will feel pain. In this case, prick another closely surrounding vein, and the blood shall flow out. The theory is the same as punching two holes on the milk can to make the milk flow out.
4. Congesting blood at the point site: refer to question two, the technique.
5. Time: If bloodletting therapy is performed in coordinate with time, bleeding volume will be more and the result will be better. For example, when bleeding at Taiyang point, the result is best if it is performed in a good weather at eleven o’clock in the morning or at a time close to noon when the yang qi flows more on the upper part of the body. Bleeding to treat lumbago or spinal bone spur, the better time is in the afternoon. It is at Wei time period (1pm-3pm) when the qi flows to hand Taiyang small intestine channel; and Shen time period (3pm-5pm) to foot Taiyang urinary bladder channel. Hand and foot Taiyang channels travel to the back of the body, and hence it will be more effective to operate the bloodletting technique to treat sciatica or hemorrhoids during these two time periods. As far as bleeding at Shaoyang (LU11) and other Jing-well points, it is not much relevant to time. Because there are no blue veins at those locations, and they are commonly used for emergency, anytime is fine to bleed those points. (Back to Top)
4. When bleeding at the inner cheek, which side shall be chosen? Some say the affected side, and some say the healthy side. What is your opinion?
Answer: Either affected or healthy side can be chosen when treating Bell’s palsy (mouth and eye deviation). As the liver channel circulates around the inner mouth, bloodletting on either healthy or affected side works effectively since both are close to the channel. However, the result is better if bloodletting on the affected side. It is not necessary to search for the blue vein when bloodletting the oral cavity. Request the patient to open the mouth widely and prick on the membranes on the center of the side of the oral cavity. Seven or eight drops of blood are fairly enough. After the pricking, ask the patient to rinse the mouth with salty water which will sterilize the wound and at the same time enhance the muscle tone. That will increase the effectiveness. Bloodletting at the side of the oral cavity is the best method to treat facial nerve paralysis. (Back to Top)
5. Could you talk about the reasons the Heart opens into the orifices of the ears, and how that relates to bloodletting therapy and acupuncture?
Answer: The quote of the Heart opens to the ears is from Suwen, chapter four Jin Gui Zhen Yen Lun: “the color of the south is red, and enters into and communicate with the heart which opens into the orifice of the ears…” Wang Bing’s annotation was “the tongue is the official of the heart, the tongue is for speech, the tongue is not an orifice, and hence the ears are the orifice (of the heart)”. Zhang Jing Yue said “the root of the tongue belongs to the heart; but the ears belong to both heart and kidney.” They both agreed the relation between the heart and the ear orifices.
Because most yin channels do not travel to the head, the five viscera opening to the orifices on the face are in fact through their interior-exterior related yang channels. The kidney opening to the orifice ears is through the bladder channel which travels to and opens in the orifice ears. The heart channel, through its interior-exterior relation with the small intestine channel which enters into the ears, relates to the ears too.
There are quite a few ear disorders that are related to the heart. For example, the coronary heart groove on the earlobe is often used to assist the diagnosis of the coronary heart disease. Commonly seen tinnitus, and deafness are often related to the heart. For example, insomnia, hypertension, and anemia that accompany with tinnitus are more effectively treated if the heart is treated.
In Shang Han Lun, it says “Before the doctor feels the pulse, the patient presses his chest with interlaced fingers. When the doctor instructs him to cough, he fails to do it accordingly. He must be deaf. A great deficiency after profuse or repeatedly perspiration has caused the deafness.” It is effectively treated by Gui Zhi Gan Cao Tang which warms the heart yang. I often use modified Xiao Cai Hu Tang to treat ear disorders. One is because the gallbladder channel circulates and enters the ears; and another reason is based on the extraordinary connection of the heart and gallbladder. I also often select Fengshi (GB31) to treat the deafness, tinnitus and insomnia due to heart yang deficiency. The result is very good. The reason is also based on the extraordinary connection of the heart and gall bladder.
I also often prick the ear apex to bleed to treat profuse sweating. The result is very good as the heart governs the sweat. Pricking to bleed to treat insomnia is also very effective as the heart governs the spirit. Pricking to bleed to treat skin disorders is also very effective. As the urinary bladder travels to the ears, and the Taiyang governs the exterior; Shaoyang gallbladder channel circulates around the ears; and Shaoyang governs the wind, but so does the “all sores, pains, and itchiness belong to the heart”. (Back to Top)
6. Does the location of the extraordinary point Huofuhai (33.07) match that of the Shousanli (LI10)? Do the point name and the location have any special implication or meaning to the treatment?
Answer: From the direct perspective (view) the Huofuhai point does not fall on the location of the Shousanli (LI10). But it does overlaps onto the Shousanli (LI10) with its particular way of locating the point. Its indications and functions listed in Master Tung’s book also match those of the Shousanli (LI10). “Huofu”, literally “fire fu-viscera”, indicates Sanjiao fu-viscera. The point is defined on the Sanjiao channel, but is located with the arm twisted and then falls onto the Large Intestine channel and matches the Shousanli point. Master Tung’s original book lists that its major indication is to supplement or tonify, and functions same as Zusanli (ST36) if moxibustion is performed. The point is located at the region with abundant and thick muscles and hence is named “Hai (sea).” Master Tung’s book indicates the location of the point as “the flesh bulges when pressure is applied, at the border of the protuberant flesh (of the radius.)” The “flesh bugles” indicates that the abundance of the flesh on the location. The site with abundant flesh will be able to treat spleen-stomach related disorders, and functions to supplementing qi. “The border of the protuberant flesh” indicates the point is related to sinew. The differences between the sinew and flesh have been explained in details in the Advanced Tung’s Acupuncture Seminar. They are involved with the applications and elucidations of the five-body-tissue needling method (Body Correspondence Needling Method). Here I would point out some key points. First, Jin is the flesh that can generate strength. According to the explanation in Shuo Wen Jie Zi (Explaining Simple and Analyzing Compound Character), it says Ji is Roe (flesh). As for Jin, it says Jin is the strength of Roe (flesh). Secondly, Jin (sinew) is the stripe-shaped flesh, for example, Zhenjin (77.01) and Zhenzhong (77.02) points. Thirdly, Jin (sinew) refers to the particularly bulged muscle/flesh. Juong Roe refers to the particularly bulged big muscle. For example, deltoid muscle, triceps brachii, gastrocnemius, those chunky shaped muscles belong to this category. Huofuhai point is located on the border of the protuberant flesh, a particularly bulged flesh. Hence, it is able to treat tendon/sinew related disorders according the “sinew treats sinew.” And in fact it treats both sinew/tendon and flesh simultaneously. It is superb effective in treating tennis elbow if combined with posterior Quchi (posterior LI11) which treats bone particularly. Besides, Huofuhai point although is defined on the San Jiao channel, instead it is located on the large intestine channel. Hence, it treats both Shaoyang (Sanjiao) and Yangming (large intestine) simultaneously. Yangming channels are with abundant qi and blood; and hence this point is very good at regulating qi and blood. (Back to Top)
7. Both Muhuo point and the Daoma of Linggu and Dabai treat the sequela of stroke. What are the common reasons?
Answer: Stroke is closely related to wind (wood) and phlegm (fire). There are only two yin channels that travel to the head, which are wood (liver) and fire (heart) channels. Liver wind (wood) and phlegm fire (fire) are two main reasons of wind stroke. Wood fire channels and wood fire points are best selections for treating wind stroke and its sequela.
Muhuo (wood fire) point is named because first it is on the fire (pericardium) channel, and located closely to the Jing-well wood point. Another reason is that the point is located in between the Jing-well (wood) and Ying-spring (fire) points on the pericardium. Muhuo point is located closely to the Zhongchong (PC1) point and has the functions to strengthen the heart and invigorate the blood. It also strengthens and enhances other points that are used to treat the sequela of the stroke. Supplementing wood fire or Muhuo has the effect of warming the yang (for the same reason, supplementing the mental and water (Jingshui) equals nourishing the yin). This is similar to that prescribing the Bu Yang Huan Wu Tang and Zhen Wu Tang to treat the stroke or its sequela.
Dabai and Linggu points are also between wood and fire points. Dabai is closely attached to the Sanjien (LI3) point, and has same attributes or nature as those of Sanjien (LI3) point. Linggu point is between Hegu (LI4) (belongs to wood) and Yangxi (LI5) (belongs to fire) points. It is located in between the wood and fire and bears the natures of the two elements. Another explanation is that Linggu is located closely to the Yangxi (belongs to fire) and has the nature of the fire element. In this case, Dabai belongs to wood while Linggu to fire. Using both of them is as supplementing the wood and fire, and hence creates the effect of warming the yang. Its function is like using the Bu Yang Huan Wu Tang and Zhen Wu Tang to treat the hemiplegia.
Muhuo point and Dabai-Linggu points both have the natures of the wood and fire and hence can treat wood-fire related diseases such as the sequela of the stroke. Muhuo point is located closely to the Jing-well point and hence can open the brain orifice. Linggu and Dabai are needled closely attached to the bone which corresponds to the kidney and communicates with the brain and hence can dredge and invigorate the qi and blood of the brain. However, Muhuo point is located in between the Jing-well and Ying-spring points and hence is more suitable for newly developed diseases and is not suitable for long needle retention. Dabai point is the Shu-stream point while Linggu is in between the Yuan-source point (Hegu LI4) and Jing-river point (Yangxi LI5), and both of them are needled attached to the bone; hence they are suitable for both newly-developed and chronic diseases and also are suitable for long needle retention. (Back to Top)
ACADEMIC FORUM
The Seventh Round
The Sixth Round