COMBINACION FRECUENTE DE PUNTOS EN DIVERSOS TRATAMIENTOS

1. SANYINJIAO (SP 6), GUANYUAN (CV 4), QIHAI (CV 6).


Main effect and clinical purpose

This point combination is commonly used as a general tonic for Qi and Blood. It is therefore frequently used in cases of severe lassitude, anemia, impotence, spermatorrhea and the like.

Because of this point combination's main effect, it is used with a tonifying manipulation and/or moxa.


Case history
Mr. A.M. of Arab origin, age 27, occupation: building worker, married for two years.
Complaint infertility, spermatorrhea especially at night and premature ejaculation.


Diagnostic features
1. Red face, cold feet.
2. Feels generally fine, except sometimes dribbling urine.
3. Pulse slippery, big.
4. Tongue pale, soft
5. Abdominal tenderness under umbilicus and right hypochondriac region.


Diagnosis
1. Weakness and looseness of the "gate of sperm" ("Ming Men"), due to excessive sexual intercourse and hard physical labor.
2. Excitement of Heart Fire.

Treatment
1. Sanyinjiao (SP 6), Gyanyuan (CV 4), Qihai (CV 6) and Taling (P 7).
2. Refrain from sexual intercourse until spermatorrhea subsides.


Explanation

Sanyinjiao, Guanyuan and Qihai together tonify the Yuan Qi thus enlivening the sperm and strengthening the Ming Men. Taling is used to decrease Heart Fire and thereby helps the patient control his sexual enthusiasm. Taling was punctured against the flow of Qi, i.e. needle pointed proximally, in order to cause sedation.


Results

After two sessions the spermatorrhea ceased. After three months the patient’s wife became pregnant.


2. HEGU (LI 4), YINGXIANG (LI 20), ZUSANLI (ST 36), NEITING (ST 44), XIANGU (ST 43) [43].

Main effect and clinical purpose

This is a point combination based on the law "one point above two points below" (see previous chapter). Its purpose is to clear obstruction from the Yang Ming system, mainly sinusitis.

It has a clear sedating effect and is therefore used for excess patterns characterized by Heat and Dampness.


Case history

Mrs. S.A., age 40, has suffered from chronic sinusitis for 12 years. She had some 4 5 acute incidents each year, for which various antibiotics had been prescribed. Twice she had undergone nasal operations and sinus pumping without long term satisfactory results.

She came to see me three years ago, suffering an acute attack which did not respond to antibiotic remedies. She had a low fever, felt very weak and sick and had unbearable pain around the supra-orbital area, especially of her left eye. Mrs. S.A. had a purulent yellow, foul smelling nasal discharge, dry mouth and constipation.

Both her pulse and tongue indicated an excessive Damp-Heat condition. Her pulse was also weak and indicated her general weakness.

Mrs. S. received six treatments. The prescription was built from the above combination, with the addition of Zanshu (B 2). Zanshu was manipulated by a dispersion technique, i.e. was punctured in three directions one after the other, and then was left intact.

Zanshu was chosen due to its local effect, in order to disperse the purulent liquid around the eyes' orbit.

After two treatments Mrs. S. experienced significant relief and after the fifth appointment she proclaimed that she was free of all symptoms. Hence, she was given another treatment to consolidate the effect and the treatment was terminated.

During the last three years Mrs. S. suffered one more attack which responded to treatment in the same fashion.



3. JIANYU (LI 15), JIANEILING (EXTRA), JIANLIAO (T 14)

Main effect and clinical purpose

The combination above is a point cluster of the shoulder. It is frequently used to disperse stagnation in the shoulder joint and to facilitate the flow of Qi there.

The cluster is usually effective in cold stagnation of the shoulder or Damp Bi (cases of frozen shoulder, perifocal inflammation of the shoulder joint etc.). It may also be of value for traumatic pain from sports or accidents.


Case history

Mrs. D.B., a teacher by profession, was born in 1951. On April 18, 1990 she consulted me, complaining of severe pain in her right shoulder which hindered her sleep and disabled her right hand preventing almost any movement.

X ray examination at "Rambam" Hospital in Haifa revealed excessive calcium deposits in the shoulder joint, hence she had been advised to undergo the calcium pumping operation, as well as steroid injections to the affected joint.

Mrs. D. was reluctant for such "adventures" as she expressed it, and since she had had a previous successful experience in my clinic for another problem, she made an appointment.

An examination by means of Chinese medicine brought me to the diagnosis of a Cold Bi condition in the shoulder, and kidney hypo-functioning (Kidney Yang Xu).

The main signs were:

1. Fear of cold in general and especially a need for warmth around both shoulders.
2. Pallid face and lips.
3. Pale, wet tongue, with a thin white fur.
4. Thin, soft and deep pulse, weak on third position.

The only sign which did not match the diagnosis entirely, was the pulse, which should have been tighter. Nevertheless, I interpreted the thin pulse as a sign of a Blood Xu to some extent due to her kidney Yang Xu condition which prevented her from a proper creation of blood. The relative weakness and depth of the pulse was due to her kidney weakness.

The prescription for treatment was:

Right side: Tiaokou (ST 38), Jianyu (LI 15), Jianliao (T 14), Jianneiling.
Both: Taixi (K 3), Shenshu (B 23).

Tiaokou is an excellent empirical point for acute shoulder pain. It was inserted toward Chengshan (B 57) and manipulated for 5 minutes (46).
on Jianyu I burnt four moxa balls on top of the needle, in every treatment session.

The three cluster points of the shoulder were manipulated by the dispersal "Huici” pattern (see above). This was done prior to the application of moxa, and in order to disperse the stagnant Cold which lodged in the area.

Taixi and Shenshu were chosen to stimulate and reinforce kidney Yang. In order to ensure a full impact on kidney Yang, three moxa balls were burnt over the left Shenshu needle.

Since all the Yang go to the left and all the Yin to the right, Shenshu left is also considered to belong to Yang, and was given an extra stimulation there.

Mrs. D. experienced significant pain relief following the first session and could sleep the whole night through. After the second and third treatments her condition improved even more and on the fourth, the treatment was performed without moxa.

After the fourth treatment her condition worsened, probably due to a cold change in the weather.

Five more treatments were required to establish a full recovery, all of them with moxa.








4. FENGCHI (G 20), TAIYANG (EXTRA), XINJIAN (LIV 2), YANGLINGCHUAN (G 34)

Main effect and clinical purpose

This point combination works primarily on the liver and gallbladder channels and has a strong Yang, or Fire reducing action, as well as Wind clearing, especially liver Wind from the head.

As a result of these properties, the combination is widely used to treat hypertension of liver Yang, or liver Fire origin. It may also treat headaches, migraine, or pressure behind the eye (glaucoma) stemming from the same etiology.

Case history

Mr. G., age 46 a businessman, has suffered for the past eight years from hypertension and occipital headaches. During this period he has regularly taken hypotensive drugs (50 mg Convertin), which have adversely affected his sexual abilities. With the drugs, his blood pressure was 140/110 Hg.

Mr. G. had a shiny red face, red eyes and darkish lips. He spoke loudly and was very talkative.

Examination of the tongue revealed red rims, and a slippery yellow coating.

His pulse was moderate and first and second positions of his right hand were Shi.

It was apparent that Mr. G. had an excess heat condition. The problem was whether it was of liver Yang origin, or stomach Fire. As neither of these possibilities involved other symptoms, it was decided to clear the heat from the Yangming system through a combination renowned for this purpose. The combination is: Quchi (LI 11), Zusauli (ST 36) Neiting (ST 44).
Actually, the Yangming channel was chosen to operate upon because of the pulse, which showed predominance on the right Guan position.

A few treatments were carried out by this method, but the patient showed no improvement.

The diagnosis was then reconsidered, and changed to hyperactive liver Yang. The pulse abnormality was thence interpreted as an overactivity of the right liver channel, rather than both channels, a fact which has shown itself on the right hand pulse.

The formula for treatment was thus changed to the following: Fengchi (G 20), Taiyang, Xinjian (LIV 2), Yanglingchuan (G 34), Qimen (LIV 14) on the right side only, and Fuliu (K 7).

All points, except Qimen and Fuliu, were sedated in a broad angle twirling and raise thrust manipulation. Qimen was manipulated in an even manner, in order to regulate liver Qi and Fuliu was tonified so as to tonify kidney Yin.

After the first treatment, Mr. G’s blood-pressure decreased to 140/100 Hg. and after five more treatments to 140/90 Hg. He was advised not to take any more hypotensive drugs, advice which he accepted readily, and his blood pressure remains stable.

Since Mr. G. was not prone to anger, he was only advised to regulate his diet, to exclude Yang nourishing foods (coffee, sea food, fried food, pepper, alcohol, etc.) and to tend his business in a more relaxed manner.


5. QUCHI (LI 11), XUEHAI (SP 10), WAIGUAN (T 5)

Main effect and clinical purpose

The above point combination is widely used to treat skin disorders, mainly characterized by heat and Wind of either internal or external origin.
These disorders include allergic skin reactions, various types of eczema, rash, hives, and other conditions.
With added points like Yinlingchuan (SP 9), or Sanyinjiao (SP 6), it may also treat skin conditions in which Dampness exists, i.e. weeping eczema, furunculosis, etc.

Case history

Miss O.S., age 9, has suffered for one month from a pruritic rash on her right costal surface, anteriorly and posteriorly.

Various allergic examinations did not reveal any special sensitivity and local application of ointments had not improved her condition.

Questioning revealed that the rash had appeared suddenly and that it was very itchy.

Observation showed that the rash consisted of tiny red points, giving the impression of sand on the skin. It also showed a red rimmed tongue with a very thin white moss.

The diagnosis was an externally contracted Wind-Heat, affecting the liver/gallbladder meridians. (Wind-Rash, in Chinese).

The fact that the rash appeared only on the surface of the right rib cage, along with the red rimmed tongue, pointed to the involvement of the liver and gall meridians. The sudden appearance of the disease, together with its red color, plus the thin white coating of the tongue, indicated an externally contracted Wind-Heat.

The formula chosen for treatment was: Quchi (LI 11), Xuehai (SP 10), Waignau (T 5), Talchong (LIV 3), Sanyinjiao (SP 6).

Taichong and Sanyinjiao were added to the prescription in order to resolve stagnation of the liver and hasten the recovery. This is another well known point combination, used to promote the function of the liver and spread Liver Qi.

After two treatments which were carried out on two consecutive days, there was no itchiness at all and the rash had significantly diminished.

After the fifth treatment the problem was entirely resolved.



6. NEIGUAN (P 6), TALING (P 7), LIEHCHUEH (L 7)


Main effect and clinical purpose

This point cluster helps facilitate the flow of Qi and blood to the palm and fingers. It is used in cases of Metacarpal Tunnel Syndrome, where Qi and Blood are blocked in the matacorpal joint tunnel and the symptoms exhibit numbness, pain and weakness of the fingers.

Case history

Mrs. O.T., age 35, is the owner of a goat farm and she is also the mother of case history number 5 ( see above).

A year and a half prior to her first visit to my clinic, she began experiencing numbness along the anterior medial aspect of her right arm, extending towards her fingers. It was more pronounced at night, while sleeping. Later, she experienced pain when numbness reached its climax. In the last few weeks she started having the same phenomena, though to a much milder extent, in her left hand too.

Routine checks at Nahariya Hospital revealed no signs on her cervical vertebrae, where they had projected their suspicion. The diagnosis given was of a Metacarpal Tunnel Syndrome and she was advised to undergo an operation.

On questioning, Mrs. O.T. revealed that sometimes when she awakens in the morning, she senses a sharp prick in her heart region, experiencing difficulty in breathing deeply, for a while. The sensation then disappears.

Questioning also revealed that she is in the habit of milking her goats for many hours and that she rides a motorcycle in the fields. Observation revealed a red tipped tongue with red points and red rims. She also had peeled areas. Her right palm was dry and eczematous, she said that she had been told that it was a fungal infection, but it did not respond to medications. I diagnosed her condition as follows:

1. A pre existing state of slight heat stagnation of the pericardium which gave rise to the shape of the tongue, to the stabbing pain in the chest, and to disturbances along the pericardium meridian.

2. Hard labor of milking had strained the brachial muscles, especially the flexor group. This strain had impeded the flow of Qi and blood to the palm and had laid an extra burden on the pericardium channel.

3. Due to impeded flow of Qi and blood to the palm, the palm became dry, undernourished and had developed the eczema.

The reason for aggravated numbness at night, was that rest hindered the flow of Qi and blood even more due to lack of movement or activity, thus making the numb sensation more pronounced.

The treatment was constructed from the three cluster points, plus Tanzhong (CV 17). Tanzhong was utilized to build the formula due to its task as the Mu point for the pericardium. It has a strong influence on blood circulation and is said to propel Qi in the Upper Burner, thus enhancing blood formation and Qi and blood circulation (51).

By choosing Tanzhang, I dealt with the local carpal stagnation, as well as assisting from afar by viewing the local problem in its holistic background.

After needling Neiguan I applied seven moxa cones on the point, using a layer of a paste made from flour and white pepper underneath.

After seven treatments over a two weeks period, Mrs. O.T. improved by 90% as she proclaimed.

About one year later she came to me again, saying she was afraid that her previous symptoms were returning. She was then given four more treatments, after which she felt better again.


 
7. JIANYU (LI 15), OUCHI (LI 11), HEGU (LI 4)


Main effect and clinical purpose

This frequently used point combination has been devised in accord with the principle of choosing points on the same meridian, for mutual assistance.

It is used in many different problems of the arm, involving the shoulder, arm, hand and fingers.

Its main use, however, is to invigorate the flow of Qi and blood in the upper limb, for problems such as painful Bi syndrome of different etiologies, or paralysis.

The fact that all these points are situated only on the large intestine meridian and not on one or more of the other five meridians of the arm, is because this meridian is known to have the richest supply of Qi and blood (together with its Yangming counterpart, the stomach meridian).

The Nei Jing states: "When treating flaccidity of the limbs (Wei syndrome), use points only from Yangming" (52).


Case history

Mr. G., age 63, a barber by profession, left handed, had, a month before he came to see me, a marked decrease in the power of his left hand, fingers and leg.

He had a sudden decrease of mental acuity, of his usual sense of humor, as well as physical abilities of hand and leg. Mr. G. had to cease working in his barber shop, since he was left handed.

A week before coming to me, he suddenly felt very unwell and almost lost consciousness. He could not speak properly, and suffered a staggering headache. He was taken to Nahariya Hospital where he underwent a C.T. scan of the head. The diagnosis was a cerebro vascular infarct in his right brain lobe.

Upon examination it was obvious that he had significant difficulty in moving his left fingers freely and his gait was a little clumsy. His tongue was big, red and peeled. The pulse was moderate and big at the Cun and Guan positions. Mr. G. confessed to a long history of moderate hypertension.

My diagnosis was a basic Shi condition of liver Yang, complicated by a Xu condition, after the brain damage had occurred.

The treatment principle was, therefore, to invigorate the flow of Qi and blood in his left hand and leg, subdue liver Yang and invigorate the blood circulation in general.

The points chosen for these purposes were:

Jianyu (LI 15), Ouchi (LI 11), Hegu (LI 4), Baxie (extra), Biguan (ST 31), Zusanli (ST 36) all in the left side only and, Taichong (LIV 3), Sanyinjiao (SP 6), Xuehai (SP 10) bilaterally.

Jianyu, Ouchi and Hegu were manipulated in a strong tonification. Baxie, are eight points situated between the knuckles of the fingers. These were stimulated in order to facilitate the flow of Qi and blood in the fingers.

Biguan and Zusanli are a combination of two points on the leg Yangming channel, and the principle of their choice and use is exactly the same as for the three Yangming points of the arm.

Taichong and Xuehai act on the blood level, in general. Taichong reduces liver Yang and improves blood circulation by facilitating liver Qi and Xuehai’s role in blood disorders has already been discussed in case Number 5 of this chapter.

Mr. G. felt mental improvement after the first treatment. Following this treatment he never again experienced any episode of losing consciousness or difficulty in speaking. After the third treatment, which took place during the same week, his leg returned to normal and he had lost his clumsy gait.

After the seventh treatment his hand and fingers regained their normal flexibility and strength.

Mr. G. was advised to come once a month for a check up for his liver Yang and was consulted about his way of life for the same purpose.


 
8. SHAOZE (SI 1), TANZHONG (CV 17), RUGEN (ST 18)

Main effect and clinical purpose

This point combination was mentioned in the "Great Compendium of Acupuncture and Moxibustian" (Zhenjiu Dacheng) written in 1601 in China during the Ming Dynasty by Yang Jizhow (55).

Since those ancient times the relevance of the combination has not diminished and its validity serves us today equally well.

The combination is suitable for all breast diseases, especially those of a Shi nature. It is used with great efficacy in cases of breast abscess, mastitis, benign tumors of the breast and the like. This same formula is also utilized in mastosis or agalactia (insufficient lactation) which are primarily Xu conditions.


Case history

Miss K., age 27, a stage actress by profession, complained of a large abscess on her left breast. A month prior to that, she had another abscess on her right thigh, on the path of the liver meridian near Yinlian (LIV 11).

She was treated at that time with antibiotics which caused the former abscess to disappear and the new one to appear on her left breast. The antibiotics, she proclaimed, had made her very weak, lethargic, and depressed.

On arrival at my clinic, she had a fever and suffered great pain in her left breast, a pain that radiated along the pericardium channel of her left arm.

The abscess was large, situated under her left nipple, inflamed and resembled a second red, big nipple.

Miss K.'s pulse was moderate and choppy, deep and weak. The Cun position on both sides was very choppy.

Her tongue was red purple with even redder rims. The inside of her eyelids showed a red shaded line on the upper part of the lids a blood stasis indication.

In reply to my question as to whether she had had any problems with her liver, she said that she had suffered a severe jaundice five years earlier.

Thus, in accordance with all the symptoms and signs, I diagnosed Miss K. as suffering from liver heat stagnation, affecting the meridian. The abscess on her left breast was of the Fire Poison category and also involved blood stagnation. This blood involvement had caused the fever and the involvement of the pericardium channel. The pericardium channel is in continuum with the liver channel, as a partner in the Chueh Yin segment.

The formula for treatment was devised as follows:

Left side: Shaoze (SI 1), Tanzhong (CV 17), Rugen (ST 18), Zulinqi (G 41), Waiguan (T 5)

Both sides:Quchi (LI 11), Zusanli (ST 36).

This formula was actually constructed from three well known point combinations.

on the first combination there is no need to elaborate, it is sufficient to say that in this case all the criteria existed in order to utilize this combination.

Zulinqi and Waiguan are the Master and Coupled points of Dai Mai the Girdle Vessel. This extra meridian harmonizes liver and gallbladder activities and its areas of influence are the waist, ribs and chest and the head. Dai Mai, as an extra-meridian, absorbs excess energy from the liver and gall channels and adjusts their functioning. Moreover, Zulinqi is indicated for liver Qi stagnation affecting the breast and that includes mastitis and abscess.

Waiguan, in addition to its role as the coupled point of the Dai Mai, is the Luo point of the hand Triple Burner (San Jiao) meridian. Its coupled (Yin-Yang) meridian is the pericardium meridian. Puncturing Waiguan may be thus used to divert excess from the pericardium and to adjust its functioning. All this is due to the Luo points' role as a "tap" that may be used to balance two coupled (Yin Yang) meridians.

Quchi and Zusanli, both situated on the Yangming segment of channels, drain excess heat, relieve fever and invigorate and regulate the blood. They are therefore widely used in hypertension due to excess heat a fact which has already been discussed in this paper.

The first session lasted thirty minutes, in which Tanzhong and Zulinqi were manipulated every ten minutes. The patient experienced a "sucking" sensation traveling from Tanzhong to the abscess. Following the treatment, she experienced the same "sucking" sensation plus pain along her left arm, for about six hours.

After six hours the abscess burst open and a great deal of pus and blood were discharged. Afterwards, she experienced a sudden relief. The pain subsided almost completely, as did the fever and the depression.

Miss K. came for six consecutive treatments thereafter, following which her breast healed completely.

Miss K. came to me a year later for a different problem and while examining her I noticed that her breast did not bear even the slightest mark of the episode she had undergone.




9. HEGU (LI 4), TIANTU (CV 22), FUTU (LI 18)

Main effect and clinical purpose

The point combination above is mainly used to treat conditions in which phlegm has accumulated in the region of the throat, giving rise to problems such as: hoarse voice, asthma with a sensation of blocked throat, lumps in the throat, goiter etc.


Case history

Miss S., age 26, also a stage actress and a close friend of Miss K. from case history number 9, was diagnosed five years before as having a benign tumor on her vocal cords.

She exhibited symptoms of hoarse voice, a fact that was not at all unwelcome in her profession and a constant sensation of mucous in her throat.

She had an odorless vaginal discharge, occasional stomachache and not very frequently also nausea.

All four methods of Chinese diagnosis revealed a state of lung and spleen Qi Xu as a basis for formation of phlegm and the obstruction of her throat by phlegm.

Her pulse was thin, soggy and weak, especially on right Cun and Guan positions.

Her tongue body was slightly flabby and covered with a thick, white, transparent and slippery coating.

Changmen (LIV 13) on the left side was tender but very ticklish, and Zhongwan (CV 12) was very tender as well.

Miss S. was a ten year smoker and used to smoke at least 20 cigarettes a day.

The principle of treatment was to eliminate phlegm in the throat and to tonify spleen and lung Qi.

I therefore chose the following points for treatment:

Hegu (LI 4), Futu (LI 18), Tiantu (CV 22), Panglianquan (extra), Liehchueh (L 7), Fenglong (ST 40)

Since there were no heat signs despite the fact that Miss S. was quite a smoker, Hegu was acted on by the warm needle technique.

Panglianquan are two points located 0.5 cun on both sides of Lianquan (CV 23). These are special points for diseases of the vocal cords. One should insert the needle there transversely, along the skin, in an upward proximal direction, until the patients feel as if they "had swallowed fish bones"…

Liehchueh and Fenglong make a very effective point-combination to treat phlegm in the upper respiratory tract. Liehchueh is the Luo point of the lung meridian and is very useful in resolving damp conditions of the lungs, as well as redirecting rebellious lung Qi. It is also the master point of the Ren Mai, the extra meridian which passes through and nourishes the throat and which is very prone to Damp Phlegmatic diseases. Liehchueh was also chosen because of the leucorrhea of the patient, a problem which is also subject to the functioning of the Ren Mai.
Fenlong is the point to treat any phlegm condition in the body, as it adjusts the functioning of the spleen and stomach meridians.

The last point combination in this formula is Hegu and Liehchueh which follow the "Host Guest" principle and have a renowned ability to harmonize the lungs, dissipate phlegm and redirect lung Qi.

The patient was instructed to cut off her cigarette consumption, as well as coffee and milk products.

She made efforts to eat more regularly and to avoid junk-food and too much salt.

Miss S. received seventeen treatments, after which all her symptoms had practically disappeared. She would not agree to undergo another examination of her vocal cords in order to check upon the tumor there. She was completely satisfied with the way she felt and said she could not care less whether or not the tumor was still there.



10. SHENSHU (B 23), WEIZHONG (B 54), KUNLUN (B 60)

Main effect and clinical purpose

This is another point combination in existence for at least 400 years. This combination was first mentioned in the "Great Compendium of Acupuncture and Moxibustion", written by Yang Jizhow in 1601, as was combination number 8 above (61).

It is structured on the principle "one point above two points below, on the same meridian" (see chapter B, number 6).

It is perhaps the most popular combination treating low back pain of any etiology. It may definitely be of great value even in cases of middle and upper back pain, with the addition of some other local points.


Case history

Mrs. D., 40 years old, married plus two children, has suffered from chronic low back pain for years. Every weather change, especially cooler, or a damper weather, had affected her body. She could not tolerate cold weather in general, apart from its effect on her lower back condition.

During the last seven years Mrs. D. has not used any contraceptives because she was certain she could no longer conceive.

Her tongue was pale, flabby with "tooth marks", and covered with a thin layer of white, damp moss.

Mrs. D.’s pulse was sunken and weak, even more so in both Chi positions.
It was apparent that her case was a kidney Yang deficiency, with Damp Cold Bi in her lower back.

Treatment was administered three times a week, based on the point combination discussed above. In addition to these points, I applied direct moxibustion on her Mingmen (GV 4), every second visit.

Following the first session her lower back improved radically and after three more treatments it did not bother her at all. The frequency of treatments was then reduced to once a week, for four more treatments.

Two months later, to Mrs. D.’s great astonishment and delight, she became pregnant.

Now Mrs. and Mr. D. have a three year old daughter in addition to their two former sons and she very seldom complains about her lower back.




11. DINGCHUAN (EXTRA), TIANTU (CV 22), TANZHONG (CV 17), NEIGUAN (P 6), FENGLONG (ST 40).


Main effect and clinical purpose

The goal of this much used point combination is to relieve wheezing and to abate phlegm from the chest and respiratory tract.

It is therefore used in cases of asthma with excessive phlegm or bronchitis, or any other lung disease characterized by much phlegm and difficult breathing.

Case history

Mrs. M., age 36, suffered since childhood from severe hay fever and urticaria on her upper back and shins.

Two years prior to her visit in my clinic, she began to experience occasional asthmatic attacks, until this condition became permanent.

Mrs. M. had a "barking" cough and wheezing and congested chest, with a sensation of lodged phlegm which could not be expectorated.

Her pulse was very soggy and slippery. Chi position was not palpable at all, and the pulse of her lungs was small and hard.

Her tongue was pink pale, wet and scalloped; the coating was white and damp.

On evaluating the different aspects of this information, I came to the conclusion that Mrs. M. was on the verge of an externally inflicted disease turning into an internal disharmony.

The history of many years of stubborn hay fever, along with the wet and white coated tongue, pointed to an external Damp, and probably Cold origin of the problem.

The Slippery and Soggy pulse, along with the scalloped tongue, suggested a weak spleen and accumulation of dampness and phlegm.

The congested pulse on the right cun position with chest stuffiness and wheezing, demonstrated a concentration of phlegm in her chest, probably phlegm which had become too viscose to allow itself to be expectorated.

The point combination above was, therefore, utilized, in order to act directly on the phlegm, disperse and eliminate it. Point Neiguan was intermittently switched with the couple Hegu (LI 4) and Liehchueh (L 7). This couple has already been discussed several times in this work. (See Chapter B, paragraph III, case history number 9.) Here it was chosen for its marked effect on redirecting rebellious Lung Qi and eliminating stagnation in the upper respiratory tract.

It is interesting to note here that whenever Mrs. M. had come to the treatment demonstrating dyspnea and wheezing, point Dingchuan, manipulated in the fashion described above, had, in five minutes, relieved her symptoms completely.

After five sessions only, the urticaria and the itchy skin have both disappeared. Her asthmatic condition improved gradually, and after ten treatments Mrs. M. reported that she had no further dyspnea nor wheezing.

I then changed her prescription in order to place an emphasis on the "BIAO" the root of her bodily condition. The principle was to tonify both lung and spleen Qi, strengthen Wei Qi, while still occasionally using points that release exterior conditions, such as: Fengmen (B 12), Fengfu (GV 16) etc.

Today, after one and a half years, Mrs. M. suffers no more from either asthma or urticaria. She nevertheless has, even though to a much lesser extent, occasional hay fever attacks.

It is very important, during the course of such treatment, to emphasize to the patient the importance of avoiding phlegm, or damp producing foods. These would be especially milk products, sweets and very sweet food, overly greasy food, fried food with much oil, and salt.

It is no less important to stress the essential role of physical exercise and breathing techniques.



12. NEIGUAN (P 6), ZUSANLI (ST 36), ZHONGWAN (CV 12)

Main effect and clinical purpose
This point combination is the basic and most fundamental prescription for all stomach complaints. Its action is to regulate and harmonize Stomach Qi, resolve gastric stagnation of any kind and redirect the rebellious Qi of the stomach.
It is therefore mainly used for gastric pain of different etiologies, nausea and vomiting, such as in the morning sickness syndrome.


Case History No. I

Miss K. was ten years old when her parents brought her to see me on emergency call. Prior to her visit she had been hospitalized for one month in the paediatric In Patient department of Rambam Hospital, Haifa, but her condition did not improve.

Miss K. suffered acute gastrodynia with occasional nausea. Her epigastric region was very tender, her face very pale and she appeared very emaciated and in great pain. Her pulse was fast and her tongue had red points on its tip and both sides.

I diagnosed her condition as a stagnation of Stomach Qi due to irregular eating habits and emotional problems.

This conclusion was reached after an interrogation, during which her parents admitted the facts. She did not have the food stagnation signs, neither phlegm, nor blood stagnation.

I applied the point combination with the addition of Liangqin (ST 34). Liangqin is the Xi Cleft point of the stomach. It is applied in cases of acute pain in the organ to which it is associated.

All the points were manipulated in the regular sedation technique.

During the first few treatments Miss K. experienced pain relief which sometimes lasted for a few hours after the treatment. After nine treatments, which were carried out over the course of eleven days, her problem was resolved completely. One year after the termination of the treatment there has been no recurrence of symptoms.





13. CHANGQIANG (GV 1), CHENGSHAN (B 57), PAIHUI (GV 20)

Main effect and clinical purpose

This point combination has indeed a long history. The first two points, Changqiang and Chengshan, were already mentioned as a combination 500 years ago, in 1529, by the physician Gao Wu in his Bai Zheng Fu (Ode of a Hundred Syndromes) (71).

This is the basic formula for treating hemorrhoids of any aetiology. This combination treats hemorrhoids symptomatically, including bleeding and prolapse, but it may need additional points in order to effectively treat the underlying cause of the hemorrhoids.


Case history

Mrs. M., age 42, suffered for several years from recurrent bleeding hemorrhoids. Her recent attack, which she defined as the severest of them all, had caught her abroad, on vacation. Various medicines prescribed for her were not of much help and she came to me suffering great pain and discomfort.

Despite the fact that Mrs. M. was a physical fitness teacher, she was slightly obese. When asked to describe the pain, she said that it had been a sharp pricking pain, with a sensation of heaviness and sinking.

Her pulse was Soggy, but Big in the Cun position. Her tongue was scalloped, somewhat purplish blue, and covered with many red points around the tip. It also had a thin yellowish layer.

As was evidenced by actually all the symptoms and signs, her case was a Damp Heat stagnation in the rectal region, plus a pre existing spleen Qi Xu pattern.

A soggy pulse and scalloped tongue are basic qualities which point out a weak spleen condition. The red points on the tongue and the yellowish cover, exhibit a Damp Heat condition. The Big pulse, that had a Soggy quality as well in the Cun position, also showed a damp excessive condition in the domain of the large intestine.

Her symptoms clearly matched those signs thus, she exhibited a case that "goes with the current". This is a Chinese saying that suggests that whenever the signs match the patient's symptoms, the case may respond well to the treatment (73).

Mrs. M. was treated twice a day by the following formula: Chengshan (B 57), Changqiang (GV 1), Quchi (LI 11), Huiyang (B35). Quchi was introduced in the formula in order to treat heat and damp in the large intestine in general, as did Huiyang, locally.

On the second day the pain decreased markedly and on the third day Quchi was substituted by Paihui (GV 20).

After five more daily treatments with the revised formula, Mrs. M. was completely cured.



14. SHENMEN (H 7), NEIGUAN (P 6), YINTAMG (EXTRA), SANYINJIAO (SP 6)


Main effect and clinical purpose

Many points and combinations exist in acupuncture for the purpose of relaxing the nervous system. This combination, however, is probably the most renowned for this purpose.

It is used to relax the heart and calm the Shen, relieve tension and anxiety and treat insomnia.


Case history
Mrs. C., age 31, gave birth to her only child three years ago, after six years of sterility. She had been treated for her sterility with hormones and did not feel well during the course of the treatment.

A year after she gave birth, she had suddenly experienced palpitations, pain in her left chest, left arm and left leg, lassitude and anxiety.

Since that time and for the last two years, her condition had not improved, despite different tranquilizers that she had been prescribed and sessions of conversations with her psychiatrist. Lately, she started having headaches in her temples and her vertex.

Mrs. C. had a very fast pulse (around 110), of choppy and wiry quality. The Cun position was soft and thin and weak, on both wrists. Liver position was choppy and wiry. Kidney position was choppy and wiry and weak.

Her tongue was purplish red, but underneath was pale. It was very flabby and the lung area showed small cracks. The tip of the tongue was red and had red pimples. However, it was moist, not dry.

Mrs. C. had a pale complexion with red cheeks and in general, she had a thin and fragile figure. Her voice was low and weak, almost a whisper.

On her first examination I measured her blood pressure which was 110/75 Hg.

It was very obvious that Mrs. C. had a depletion of Yin and blood and deficiency of Qi, in general. This conclusion was reached owing to her weak appearance, pale complexion and thin, choppy pulse. As a result, she obviously had a heart Yin/blood Xu condition, with a subsequent blazing of Heart Fire. This was evidenced by the fast pulse, palpitations, anxiety and red cheeks. The long period of Yin deficiency, led eventually to an ascending Liver Yang, which gave rise to the recent headaches.

Furthermore, I suspected that blood stagnation was developing, relying on her choppy pulse and the red pimples on her tongue tip.

The treatment plan was to put an emphasis on resolving the stagnation in the heart, reduce its fire and supplement the Yin and blood. To do so, I used the above point combination, with two additions:

1. Ximen (P 4), only on the left side, in order to invigorate the heart circulation, break the stagnation there and alleviate the pain.
2. Xingjian (LIV 2) on both sides, to reduce Liver Yang, disperse the liver, and treat the headache.

Sanyinjiao was the only point that was reinforced in order to tonify the Yin.

Mrs. C.'s condition improved gradually, with some regressions, over a period of one month of treatments. When her headaches subsided, together with the chest pain, the point prescription was changed as follows:

Shenmen (H 7) and Neiguan (P 6) were left in order to continue the treatment of calming the Shen and further facilitate Heart Qi. To Sanyinjiao, I added Guanyuan (CV 4) and Qihai (CV 6), in order to strengthen her constitution and general health. The last three points also form a point combination, which was discussed in combination number one of this work.

After one more month, Mrs. C. felt much improvement in all respects and the treatment was therefore terminated.



Addendum
Six months later Mrs. C. became pregnant, and in her second month she had recurrence of headaches, chest pain, together with morning sickness.
She received five more treatments in the course of two weeks, after which all her symptoms had disappeared again.

She gave birth to her second child in due course, without any complications.



15. ZHIGOU (T 6), QIMEN (LIV 14), YANGLINGQUAN (G 34), TAICHONG (LIV 3)

Main effect and clinical purpose
This point combination is used to regulate the liver and gallbladder meridians, to remove obstruction from their passages, and to resolve stagnation of Liver Qi.
Therefore, it is often used in cases of flank pain, oppression and discomfort in the chest and distension of the breasts.

Besides this it may also treat sciatica which occurs along the route of the Gallbladder meridian, or paralysis of one side of the body associated with this meridian.


Case history
Mr. E. age 48, was a psychologist who had decided, a month prior to his visit at my clinic, to learn how to fly. Thus, he enrolled in a sky gliding course and in his first attempt to take off, he broke three ribs on his left side. After a month of suffering severe pain and sleepless nights, his X ray examination did not show any improvement. So, when he came to me for treatment, he was already weak and exhausted, not to mention his sincere repentance for his heroic aspirations.

Mr. E. was given a course of six treatments, during two weeks, after which his pain and distension had left him completely. A week later he underwent another X ray examination which showed, this time, completely healed ribs.

His treatments included our point combination, with the addition of Dazhu (B 11), and Shenshu (B 23).

The point-combination was chosen because the broken ribs were in the domain of the Shao Yang and Chueh Yin channels. The combination, as already explained, has the ability to resolve stagnation and invigorate the Qi and blood in the flanks and costal region.

Dazhu was added due to its task as the confluent point of the bones and the effect it has on repairing skeletal damage and strengthening the bone structure.

Shenshu, as the Back Shu point of the kidneys, joined the formula in order to strengthen the patient in general and to reinforce the kidneys which, according to T.C.M., rule the bones. Thus, by reinforcing the kidneys, the bones are also tonified.




16. ZHIGOU (T 6), ZHAOHAI (K 6), TIANSHSU (ST 25)

Main effect and clinical purpose
This combination of points has a special effect on regulating the function of the intestines and eliminating constipation.


Case history
Mrs. K, age 45, suffered for many years from constipation. Sometimes she did not have a bowel movement for a whole week. In addition she complained of halitosis and much gas in the abdomen. A month before our first appointment, she started experiencing weakness and sometimes even palpitations. She was slightly obese and had puffy bags below her eyes.

Observation also revealed a bright red tongue, purplish in the center, with many red prickles around the tip and sides. It was peeled and slightly scalloped in the sides. The pulse was regular and soft, with the kidney position deep and weak.

These symptoms were evidently a Yang within Yin condition, or a Xu condition giving rise to Shi symptoms.

The basic pattern, as evidenced by the soft pulse, puffy eye bags, scalloped tongue and obesity, pointed out a spleen Qi Xu. Spleen Qi Xu affects the transformation transportation (Yun-Hua) function of the spleen, giving rise to obesity and lazy bowel movements hence constipation.

Long term constipation causes stagnant Qi in the large intestine, which in turn develops into heat. Heat causes dryness of the intestines, hard stools, and may also cause blood stasis. Mrs. K. showed a shiny red tongue with a purplish center and red prickles. All these signs pointed to a heat stagnation, probably with congealed blood inside too.

The treatment given to Mrs. K. included our point-combination to treat the basic stagnation and to lubricate the intestines. In addition, other points were combined, in order to form a comprehensive formula.

Dachangshu (B 25) The Back Shu point of the large intestine, in order to activate the bowel and disperse the heat therefrom. Dachangshu and Tianshu together, make another point combination, based on the Shu Mu principle, that has a strong draining effect on the bowel.

Taichong (LIV 3) and Sanyinjiao (SP 6) were also added as another point combination. These points regulate the Qi, disperse stagnant Qi and blood and tonify both the liver and spleen.

Zusanli (ST 36) is perhaps the most important point to tonify spleen Qi and strengthen its transportation function. In addition, it has a strong influence on constipation, it tonifies the blood and strengthens its circulation in the gastro intestinal tract.

Mrs. K. has been treated several times during the past three years. She usually received a few treatments based on the above prescription. Her constipation improved for a year or so, until the next time.

It is very important to educate the patient regarding the proper life habits for dealing with constipation. Fiber-rich foods are essential, along with Yin supplementing foods, such as: whole wheat, vegetables, fruit, oils, dried fruit, almonds, and so on. Physical exercise is essential for people with weak abdominal muscles and, no less, regular eating habits.



17. YINBAI (SP 1), QIHAI (CV 6), XUEHAI (SP 10), SANYINJIAO (SP 6)

Main effect and clinical purpose
This combination has a strong effect on the blood. Most of the points here have a regulating effect on the blood, and as a whole, it is used for astringent purposes. It arrests bleeding from any of the body nine orifices, but particularly uterine bleeding, or bleeding of the digestive tract.


Case history
Mrs. H., age 30, has tried since she was 27 years old to become pregnant. At the age of 19 she had gone through an artificial abortion and according to her doctors, this was the reason why she could not retain her pregnancies. Since the age of 27, she has had four miscarriages. 48 hours before her visit to my clinic she had had another miscarriage, followed by heavy bleeding, pain and nausea.

I observed a tall, slim woman, very pale, and very much in pain. Her lips were pale and dull and her finger nails were white. The pulse was moderate, wiry and weak, while the tongue was bright red.

Mrs. H. also told me that she had a very weak digestion and that she felt weak most of the time. She suffered from heartburn, swollen and painful gums, and dry mouth. Her periods were always accompanied by excessive bleeding and contained blood clots.

It was obvious that Mrs. H. suffered a basic spleen stomach disharmony, caused by spleen Qi Xu. The spleen deficiency caused deficient blood and an impairment of the spleen function of retaining the blood, or the fetus.

The first goal of the treatment was to stop the massive bleeding and the pain which followed the miscarriage. The second phase was planned to strengthen the spleen, tonify Yin and blood and re-harmonize stomach and spleen functioning.

Thus, in the first treatment I used the point combination with an addition of Hegu (LI 4) and Taichong (LIV 3). This combination was supposed to "open the four gates", which means to regulate Qi and blood in the whole body and to stop the pain.

In the second day Mrs. H. had much less pain and less bleeding. The second treatment was constructed of the same point combination, excluding Hegu and Taichong. Instead Zhiyin (B 67) and ZhongJi (CV 3) were added. These points were added in order to cause the uterus to expel the remaining tissue of the dead fetus.

The next day there was almost no bleeding at all, but she felt contractions in her lower abdomen. Thus, the same formula was applied to her once again and in the next day she expelled some very big blood clots.

Two days later, when she came to me again, there was no pain at all and no bleeding. Her pulse had changed dramatically and the wiry quality remained only at the stomach position.




18. TIANSHU (ST 25), SHANGJUXU (ST 37), SHANGQIU (SP 5), YINLINGQUAN (SP 9)

Main effect and clinical purpose
This combination is a classical point combination to clear damp and heat from the intestines. It is therefore used to treat problems such as chronic diarrhea, dysentery, enteritis and colitis.

Case history
Please refer to the case history described in my article: The Astringent Quality of Point Paihui in my homepage:                                        http://www.acumedico.com/colitis.htm
The article was originally published in Sept. 1989 in the Journal of Chinese Medicine in England.

Even though point Shangqiu is missing from the point combination in this article, I decided to bring this case history as it is, for the following reasons:

• The case history is very relevant to the examples of the disharmony for which this point combination is used.
• Point Shangqiu has been substituted in the initiative formula of the case history by Sanyinjiao (SP 6) because of the blood and Yin deficiency pattern exhibited by the patient. Nevertheless, Sanyinjiao is also capable of performing the functions Shangqiu such as transforming damp stagnation in the intestines and strengthening the spleen. Its advantage, however, lies in its powerful influence over the spleen, an influence which makes it a better associate for Yinlingquan in most cases.
• This case history includes some other common point-combinations as well, also relevant to the treatment of Damp Heat dysentery like stagnations. They are mentioned and discussed briefly throughout the article.
• This case history has been written by me as an article for the magazine, and it is more comprehensive and detailed than any of the case histories introduced so far in this work. It encompasses many facets of both diagnosis and treatment in T.C.M., as well as an interesting treatment process. It was therefore considered fitting as the last accord in this work.


LISTADO DE PUNTOS A TENER EN CUENTA EN ACUPUNTURA
 

Zhongfu LU-1	Enhances Lung Qi.
Chize LU-5	Drains heat in lung and transforms phlegm.
Lieque LU-7	Increase pulmonary ventilation, regulate vasomotor function.
Taiyuan LU-9	Tonify and regulate lung.
Yuji LU-10	Clears heat from throat.
Hegu LI-4	Disorders of face and sense organs; headache; ease pain.
Shousanli LI-10	Supplements qi and blood (use with ST36). Harmonize Stomach.
Quchi LI-11	For fever and heat in the body; hypertension; disorders of upper limb; vomiting/diarrhea.
Jianyu LI-15	Shoulder problems.
Yingxiang LI-20	Opens nose, clears heat.
Tiangshu ST-25	Regulates function of intestines; helps edema, fluid stagnation from Spleen deficiency.
Qichong ST-30	GP: diarrhea and constipation.
Futu ST-31	GP: hips, joint problems, local pain, lumbar & iliac pain.
Liangqui ST-34	For acute stomach pain, belching, etc.
Zusanli ST-36	Tonifies Qi and Blood; benefits the Stomach.
Shangjuxu ST-37	Regulates Stomach and Intestines; clears and cools Damp Heat.
Tiaokou ST-38	GP: shoulder pain.
Fenglong  ST-40	Phlegm point.
Jiexi ST-41	Clears Stomach heat.
Neiting ST-44	Drains Stomach heat.
Taibai SP-3	Helps with digestion, Helps the Spleen and Stomach.
Gongsun SP-4	Regulates the Chong Mai; Regulates Spleen and Stomach.
Shangqiu SP-5	GP: soft tissue around ankle. Fortifies Spleen and removes dampness.
Sanyinjiao SP-6	Tonifies Qi and Blood; main point for gynaecological disorders. Treats 3 Yin Meridians; Good for Dampness.
Yinlingquan SP-9	For dampness in the body.
Xuehai SP-10	Regulates the blood and removes blood stasis.
Tongli HT-5	Regulates Heart Qi; regulates rhythm of heart.
Yinxi HT-6	POC for night sweats; nourishes Heart Yin.
Shenmen HT-7	For cardiac pain, insomnia.
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