The Channels of Acupuncture - Maciocia [PDF]

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The of Clinical Use of the Secondary Channels and Eight Extraordinary Vessels

Giovanni Maciocia

The Channels of Acupuncture Clinical Use of the Secondary Channels and Eight Extraordinary Vessels

Giovanni Maciocia

CAc (Nanjing)

Acupuncturist and Medical Herbalist, UK Visiting Associate Professor at the Nanjing University of Traditional Chinese Medicine, Nanjing

Foreword by Richard Blackwell

CHURCHILL LIVINGSTONE

ELSEVIER

CHURCHILL LIVINGSTONE An imprint of Elsevier Limited © 2006, Elsevier Limited. All rights reserved.

The right of Giovanni Maciocia to be identified as author of this work has been asserted by him in accordance with the Copyright, Designs and Patents Act 1988 No part of this publication may be reproduced, stored in a retrieval system, or transmitted in any form or by any means, electronic, mechanical, photocopying, recording or otherwise, without the prior permission ofthe Publishers. Permissions may be sought directly from Elsevier's Health Sciences Rights Department, 1600 John F. Kennedy Boulevard, Suite 1800, Philadelphia, PA 19103-2899, USA: phone: ( + 1) 215 239 3804; fax: ( + 1) 215 239 3805; or, e-mail: [email protected]. You may also complete your request on-line via the Elsevier homepage (http://www.elsevier.com), by selecting 'Support and contact' and then 'Copyright and permission'. First published 2006 Reprinted 2007 ISBN 13: 978 0 443 07491 2 ISBN 10: 0 443 07491 7 British Library Cataloguing in Publication Data A catalogue record for this book is available from the British Library Library of Congress Cataloging in Publication Data A catalog record for this book is available from the Library of Congress Notice Knowledge and best practice in this field are constantly changing. As new research and experience broaden our knowledge, changes in practice, treatment and drug therapy may become necessary or appropriate. Readers are advised to check the most current information provided (i) on procedures featured or (ii) by the manufacturer of each product to be administered, to verify the recommended dose or formula, the method and duration of administration, and contraindications. It is the responsibility of the practitioner, relying on their own experience and knowledge of the patient, to make diagnoses, to determine dosages and the best treatment for each individual patient, and to take all appropriate safety precautions. To the fullest extent of the law, neither the Publisher nor the Author assumes any liability for any injury and/or damage to persons or property arising out or related to any use of the material contained in this book. The Publisher your source for books, journals and multimedia in the health sciences

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ENDORSEMENTS

Giovanni Maciocia has spared no effort in producing an outstanding reference book that probes and illuminates the classics with his own modern insights into acupuncture. This tome is the most comprehensive text available on the acupuncture channels and of enormous practical importance to clinicians and anyone interested in acupuncture. Another tour de force from Europe's most prolific author in Chinese medicine. Professor Alan Bensoussan, Chinese Medicine, University of Western Sydney

Giovanni Maciocia has succeeded again in distilling the essence of Chinese medicine. This book, concerning acupuncture, continues his tradition of clearly written information rooted in the traditional texts. There are many references to his personal experience as a practitioner yet always from the perspective of a solid grounding in the classics. This book is a welcome addition to the literature available for practitioners as it places acupuncture firmly in the context of the whole practice of Chinese medicine. This is a timely antidote to the current, and unhelpful, trend towards focussing on one mode of treatment or another. Dr Steve Gascoigne M.B., Ch.B., C.Ac. (Shanghai), Dip. CHM The Clinic of Chinese Medicine, Cork, Ireland

Giovanni Maciocia brings to the channels a depth of experience and understanding previously unavailable. Using painstaking research combined with lifelong clinical experience, he takes all of the channel systems and brilliantly weaves them together into a cohesive whole. The Channels is well organized, historically referenced, and above all, accessible and practical to use. Barbra Esher, AOBTA®-C1. Dipl. ABT & Ac (NCCAOM), LAc Curriculum Coordinator of the Asian Bodywork Therapy (ABT) program at the Baltimore School of Massage, VP of the Maryland Acupuncture Society (MAS), past President and Director of Education of the American Organization fo r Bodywork Therapies of Asia (AOBTA®)

Giovanni Maciocia's new book on the channels adds to his monumental work on Chinese medicine. As in his previous texts, the subject is discussed in depth with many clinical gems which are priceless for practitioners of Chinese medicine. The text explains the complex channel system with clarity, their role in physiology and their treatment. This new book will contribute to raising the level of knowledge of Chinese medicine of all acupuncturists. ·Dott. Carlo Maria Giovanardi Presidente della Federazione Italiana delle Societa di Agopuntura Direttore della Scuo1a di Medicina Tradizionale Cinese della Fondazione Matteo Ricci

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ENDORSEMENTS

Giovanni Maciocia has done it again! This fascinating book goes to a level and depth of understanding about the dynamics of Qi and the channel system never seen before in English. Written in his usual clear style it journeys through every aspect of the main channels, the eight extraordinary channels, the connecting channels, the muscle channels. the divergent channels and the cutaneous regions - from the pathways and functions, to aetiology, pathology, signs and symptoms and treatment. Of special note are twelve superb chapters that explain everything a practitioner ever wanted to know about the eight extra-ordinary channels. This is a must-have book that is bound to enrich the practice of every acupuncturist.

Angela and John Hicks Directors of the College of Integrated Chinese Medicine, Reading

useful details also turn it into an easily accessible reference tool for daily clinical work.

Dr Andreas Hoell, Wien

Giovanni Maciocia's new book on channels and collaterals is a very important contribution to the understanding of this basic theory and philosophy in Traditional Chinese medicine. Nearly every book published on Chinese medicine has chapters on channels because of their network and correlations in the body. This book is the first to describe them in such detail: the pathways, the functions. the aetiology, the relations, the symptoms and the clinical use of the main channels. the connecting, muscle, and divergent channels. and the eight extraordinary vessels. This is a brilliant book long waited for, and will be welcomed and appreciated by practitioners and students all over the world.

Pride Melle1; Director of Studies, Akupunkturegsko1en. Oslo, Norway Until now, the approach to Chinese acupuncture as practiced in the West has been quite reductionist, paying more attention to single points than to the wholeness of the channel system. This book provides acupuncturists with all the knowledge necessary to gain a more holistic view of the body. Apart from the discussion of main channels. the author provides us with precise information on difficult topics like muscle and connecting channels as well as the cutaneous regions that were hitherto unavailable in a Western language. The author's love for the topic, extensive research of the classics and vast clinical experience are ref1ected in this text. It can be used as a textbook, but numerous summary boxes and other

Giovanni has provided us with another important text for both the acupuncture student and seasoned practitioner. In his usual scholarly-practical style. he presents a comprehensive, thorough analysis of the channel system, with special emphasis on the 8 Extraordinary Channels. continually citing explanations from the classics along with his own clinical experiences and insights.

Peter Va1askatgis, Senior ProfessOI; New England School of Acupuncture

FOREWORD

Chinese medicine is an extraordinary medical tradition spanning huge tracts of history and a large proportion of humanity. Its distinctive features include its sophisticated and detailed body of theory, derived from a profound understanding of natural cycles and processes, and based on fundamental principles of polarity and transformation. It employs highly sensitive diagnostic systems. pre-eminently pulse palpation, which identify and give significance to subtle functional changes throughout the whole person. But the most distinctive single feature of Chinese medicine is its uniquely detailed description of the system of channels and collaterals which we might describe as human energetic anatomy, or more abstractly as the anatomy of influences and inter-connections. Ironically, this uniquely detailed system has been somewhat neglected recently in the West. The process of the migration of Chinese medicine to the West in the modern age has passed through various phases. It has been a difficult process, with major challenges of translation between languages and cultures. In its early stages the process was characterized by fragmented information. particularly on theory. Some of the information was incorrect or misinterpreted. However, during these early stages. particularly in the 19 60s and 70s, there was a substantial focus on the channels. It seems that this information was more readily available at this time. at least up to a certain level of detail, and often without a full understanding of the underlying concepts. This is probably because this material is easier to translate. Also. in these early stages much of the transmission from practitioners from the Far East was confined to study times of only a few days or weeks 1 , and only the most fundamental information could be transmitted in this way. Then in the 80s and 90s the focus of the transmission to the

West shifted to developing a much more detailed and rounded understanding of the theories and models of Chinese medicine. This phase was particularly characterized by a huge expansion of the literature available in Western languages, with the challenges of translation being eased somewhat by the twentieth century standardization of Chinese medicine in China itself. Ironically, at this stage many students of Chinese medicine in the West appear to have reduced their focus on channels and points in favour of the wealth of new material on theory and pattern differentiation. In this context. this book from Giovanni Maciocia is most welcome. because a detailed study of the channels is an important part of the process of development of the practitioner. Chinese medicine and indeed much of Chinese thought is greatly concerned with interconnections, relationships, and the balances and inter-influencing that occur as a result. The channel system describes the inter-connections which are so crucial in a holistic approach to our patients. Of course, the channels are central to the practice of acupuncture. A detailed understanding of the channels helps us to develop a deeper sense of the acupuncture points and their actions, and helps us to remember and contextualize those actions. Also, our knowledge of the course of the channels helps to focus our intention as we treat. But the relevance of the channels goes far beyond treatment with acupuncture. The channels provide connections between different areas, organs and functions, and so they are associated with specific patterns of disharmony, specific pulse pictures, and even with specific herbal formulae. Studying the channels helps us to develop our grasp of the inter-connections that underlie the pathology in a particular patient. Thus, knowing the channel system helps us to think in terms of connections. If we know about the Chong

viii

FOREWORD

Mai, we will be aware of the relationship between Stomach, uterus and Heart, and this in turn helps us to understand the use of Ban Xia (Rhizoma Pinelliae Ternatae) in Wen Jing Tang (Warming the Menses Decoction), and the use of Stomach channel points for arrythmia. Furthermore, as we study the luo, divergent and extraordinary channels we explore clinically useful points such as Stomach-30 and the Kidney channel points on the abdomen, which can be neglected when we focus on the main channels. Even more important, a channel perspective enables us to explore the combining of points in great detail. We move from a tendency to think of points and their actions as isolated monads, and see them increasingly as part of a web of meaningful interconnections. Also, of course, many of our patients present with channel problems as a part of their pathology. Again, a more detailed knowledge gives us a clearer insight into these problems. We may not realise, for example, that in joint pain due to bi syndrome it is primarily the luo connecting channels that are involved, that most blood stasis in the channel system is located in the deep luo channels, or that the recalcitrant Dampness which we so often diagnose in cases of post-viral fatigue is located in the cou li. Clearer information on these matters is of great help to us clinically, enabling us to form a clearer sense of exactly what is happening to our patient's qi, and hence to be both more precise and more creative in our choice of points and herbs. Chinese medicine may be traditional but it is not a fossil. It is a living medicine and part of a vital culture. It continues to evolve. In this book we can see the process of development of Chinese medicine in action. For practitioners the validity of Chinese medicine is evidenced by our daily experience of the correspondence of its models with our experience and that of our patients, and by the outcomes we see from treatment, which range from satisfactory to truly remarkable. But as Chinese medicine gains greater currency and recognition across the world, we have to do more to establish the validity of this extraordinary tradition. One fascinating aspect of this is the exploration of how knowledge is generated and modified in Chinese medicine, both in the past and the present. Light has been cast on this by the study of the history of Chinese medicine and of contemporary practice. When Judith Farquar explored the practice of Chinese medicine in modern China from the perspective of a medical anthropologist she described the

"practical logics of the clinical encounter" in which "knowledge, method, theory, even the medical archive itself, have been shown to derive their value from the practical processes in which the virtuosity of the doctor and his mastery both of his own clinical experience and that recorded in medical history are highly valued." 2 My own research has explored the development of a practitioner as a process of moving to and fro between the experience of practice and reflection on that practice in the context of Chinese medicine's diverse range of ideas and theoretical models 3 . Scheid and Bensky4 argue that in Chinese medicine the development of the practitioner's ability to heal comes from a process of self-cultivation. This process is "driven by the dialectic between personal signification [yi] and the tradition". So at one pole we have the tradition, which includes learning from teachers. profound and dedicated study of books, and the learning of treatment principles, diagnostic methods, needling methods and so on. At the other pole we have yi. This is a central concept in Chinese medicine, witness the common saying "medicine is yi" , and Sun Si Miao's statement that "those who are proficient at using yi are good doctors" 5 . Yi can be translated in many different ways, for example as signification4 , intention, and mindfulness6. Scheid and Bensky4 describe yi as "an intelligence which comes from knowing and which manifests in doing, [and] ... which goes beyond representational knowledge", and as related to "a kind of unanalysable knack which manifests itself in all kinds of craftsmanship". It is "the ability to enter into the totality of a clinical situation, view it from different angles simultaneously, match it with ideas already present in the mind, compare and contrast them, weigh up different possibilities for action and then, and only then, do exactly what is appropriate." In the historical development of Chinese medicine the development of subtle understanding and skill within the individual practitioner has been seen as vitally important, not only to the efficacy of each practitioner but also as a key driver in the development of the whole medical tradition. If the tradition is to flourish in the twenty first century, we must strive to maintain this emphasis on the importance of the development of the practitioner. This book from Giovanni Maciocia is a good example of these processes. We see much evidence of the serious and diligent scholar. The sources of the information

FOREWORD are clearly identified, and they cover a wide range of classical and modern texts. There is the usual detailed and methodical approach which we have come to expect from this author, exemplified in the discussions of bi syndrome and joint pain. In addition, Maciocia has translated and interpreted classical discussions which are rarely covered well in English language texts. A striking example of this is his presentation of the pathways of qi. So we find here much evidence of the scholar who has immersed himself in the traditional and modern material for decades. But of course the process does not end there. In keeping with the tradition, the scholar has also practised extensively and developed his virtuosity and mastery. Here we see one of the key characteristics of the way knowledge is developed in Chinese medicine, as the master practitioner passes on his own interpretation and experiences. A good example is Maciocia's discussion of the concept of two patterns of rebellious qi of the Chong Mai (penetrating vessel). The first is a full pattern and the second a mixed full and empty pattern." Both produce /i ji "internal urgency" and a range of other symptoms. As Maciocia's exposition unfolds we see how the concept of rebellious qi of the Chong Mai and its association with internal urgency has been written about for centuries. We then see how Maciocia has added to this his own clinical observations of the background underlying this phenomenon in different patients, and how he is then able to link those observations to a few brief comments in the writings of Li Shi Zhen and in the Nan Jing, illuminating those classical quotes in new and clinically useful ways. This interplay between theory and practice, and between present day clinical experience and classical texts, is key to understanding the development of Chinese medicine. I suggest that this close linking of theory and practice is also a key to Chinese medicine's enduring success. This linkage of theory and practice is also seen in the copious use of case histories in the classical and modern literature. Kaptchuk 7 observes that historically case histories were the vehicle that attempted to bridge the tension between "systematic knowledge and medical 'certainty' .. . [and] ... the 'real' clinical encounter which is always idiosyncratic and nonreplicable". He observes that most writers "seem to utilise the case history as a literate medium to move theory and practice towards one another ... There is

ix

generally a sense of the enormous value of the clinical encounter ... There is a striving in this middle ground to work out a compromise between replicability and uniqueness ." This too is reflected in the current text, with case histories being used throughout to illuminate and particularize the material. Another example of the process of evolution and innovation in Chinese medicine is the development of pulse diagnosis by Dr John Shen, and then by his student Leon Hammer8 • Again we see the combination of a serious scholarly approach to the classical and modern literature with an impressive breadth of experience in practice in the modern world. Added to this is the courage to draw on the perspectives of both Chinese medicine and biomedicine to further develop the ages-old art of pulse diagnosis. Again, as these aspects interact in the practitioner we see the development of new approaches to old material. Reminiscent of this in the current work is the way that Maciocia brings the understanding of the prostate gland from modern biomedicine into Chinese medicine theory and from there is able to generate specific treatments for prostatic hypertrophy. Here is another example of the use of modern biomedical understandings to inform the development of Chinese medicine in a way which is congruent with the tradition and keeps it alive, without attempting to absorb Chinese medicine into biomedicine. Another example of innovation is Maciocia's observations (in the chapter on the treatment of the muscle channels) on resonances between points on different yang channels, and the use of this in designing effective point combinations. This is a new idea, yet it reads as if it could be translated directly from the Nei Jing. Thus the author is drawing both on his immersion in classical thought and on modern perspectives and understanding. Other innovations include new treatment possibilities, such as the use of DU 20, BL 11, ST 3 7 and ST 39 for dizziness due to rebellious qi of the penetrating vessel. There are new perspectives on translation, such as the use of "stepping vessel" instead of "heel vessel" for the Qiao Mai. Maciocia also discusses aspects of Chinese medicine theory which are often neglected in key texts, such left-right imbalances and the treatment of structural problems. This virtuosity is evident in many other ways in this work, perhaps culminating in the chapters on the extraordinary channels. This has long been one of

x

FOREWORD

Maciocia's personal areas of interest and expertise, and we find here the most detailed exposition on thls subject available in English, and probably in any language. Again, we also see the careful sourcing of the information and the way it has developed in the clinical work of this practitioner, for example in Maciocia's discussion of the use of points contra laterally. Li Jianmin characterizes the acupuncture and moxibustion channels as '"a field of temporal spaces' that act as a pivot of many different worlds; at once analogous to the rivers of China, to astronomical movements . to rivers of blood and channels of communication, patterns against which human disharmony with different environments can be judged" 9 • Maciocia's "The Channels of Acupuncture" is an example of the master practitioner as a pivot between the worlds of classical and modern thought and the worlds of theory and practice. It is a welcome and authoritative guide to this fascinating subject. Richard Blackwell Northern College of Acupuncture York

UK

REFERENCES 1. Eckma n P (1996). 1n the Footsteps of the Yellow Emperor: Tracing the Uistory of Traditional Acupuncture. San Francisco. Cypress Book Company. 2. Farquha r J (1994). Kn owing Practice - the Clinical Encounte r of Chinese Medicine. Westview Press. Boulder a nd Oxford. 3. Blackwell Rj (2001). What Options a re Availa ble for the Treatment o r Multiple Sclerosis by Acupu ncture? MSc thesis. Held in the a tion a l Library of Wales. Aberystwyth a nd the orthern College of Acupunctu re. York 4. Scheid V a nd Bensky D ( 1998). Medicine as Signification. European [onmal of Orimtal Medicine. 2 (6). 32- 4 0. Readers are referred to this importan t a nd seminal a rticle fo r a much fuller discussion or these issues. 5. Sun Simiao (h52). Qianjin yaoji111g ("Thousa nd Ducal Formulas"). Quoted in Scheid V and Bensky D (1998). Medicine as Signification . European founwl of Oriental Medicine. 2 (6). 32-40. 6. British Acupuncture Council (20 05). Professional Acu puncture Standards. British Acupuncture Council. London. 7. Kaptchu kT] ( 1997). Preface. In MacPherson. H and Ka plchukT] (Eds.). Acupuncture in Practice- Case History Insights from the West (pp xiii-xxi). Chu rchill Livingstone, Edinburgh . 8 . !Ja mmer L. (200 1 ). Ch inese Pulse Diagnosis: A Contemporary Approach . Seattle. Washington. Eastla nd Press. 9. Li. jia nmi n 2000 . Sislwn!J Zhi \'11 (The Territory Between Life and Death ). Academ ica Sinica. Taipei. Quoted in Lo V and Shroer S (2005) Deviant Airs in "Trnrlitioual" Chiuese Mediciue. ln '/\sia n Medicine a nd Globalization" ed. Aller. ] S. Un iversity of Pennsylva n ia Press. Philadelphia.

PREFACE

This book is entirely about acupuncture. Although there is the tendency by many to consider Chinese herbal medicine as 'more powerful' than acupuncture, I personally do not think this is the case. Acupuncture and Chinese herbal medicine simply work in different ways and I consider them to be equally 'powerful'. Acupuncture is actually very difficult to practise because a successful acupuncture treatment relies on so many different variables. In fact, I would list the factors determining a successful acupuncture treatment as follows: • • • • •

correct identification of patterns correct choice of treatment principle correct choice of points balanced and harmonious combination of points correct needling technique.

I personally think that acupuncture is really an 'art' as the choice of points and their combination, besides being determined by the identification of patterns and treatment principle in the same way as herbal medicine is, are also influenced by subtle factors such as the patient's pulse and emotional state at the time of the consultation and even factors such as the season, the moon phase and the time of day. Over 32 years of acupuncture practice. I have realized that points must be chosen according to two fundamental and complementary principles: 1. The use of points according to their 'function' (whatever the acupuncture tradition followed) 2. The use of points seen within a balanced combination that takes into account the channel system.

These two ways of using acupuncture points reflect two different viewpoints, i.e. one that considers points in isolation and the other that considers the channels. In other words. a point may be seen in isolation from others and used for its 'function' (e.g. it clears Heat. it is a tonification point, it is an Earth point, etc.), or it may be used within the context of a balanced combination of points mal,,, ....

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Fig. 8.8 Target areas of Lung channel's distal points.

Fig. 8.7 Interchangeability of Yang distal points.

different actions and there is no real question of choice between them as a distal point. CLINICAL NOTE Given the close connection between Yang channels, points of Yang channels of the same polarity and opposite potential energy (e.g. Small Intestine of arm Greater Yang and Bladder of leg Greater Yang) are often interchangeable. For example, the temple is affected by T.B.-2 Yemen or G.B.-43 Xiaxi.

Selection of distal points according to target area Apart from the above factors determining the choice of distal points, a distal point is also selected according to the 'target' area it affe'cts. These target areas are

determined partly by the above factors and partly empirically. The following is a partial list of areas affected by various distal points on each channel. The correspondence between a distal point and a given area is based partly on the general principle indicated above, partly on personal communications from my teachers in Nanjing and partly on my own experience. Lung (Fig. 8.8)

Nose: LU-7 Lieque Throat: LU-ll Shaoshang Chest: LU-5 Chize, LU-6 Kongzui, LU-9 Taiyuan. La rge Intestine (Fig. 8.9)

Eye: L.I.-14 Binao Face, mouth: L.I.-4 Hegu Shoulder: L.I.-1 Shangyang Throat: L.I.-5 Yangxi.

116

PART 2: THE MAIN CHANNELS

' - - - - - - - -ST-44 (Mouth-lower teeth) Whole face

Fig. 8.9 Target areas of Large Intestine channel's distal points.

Fig. 8.10 Target areas of Stomach channel's distal points.

Stomach (Fig. 8 .10)

Throat: HE-6 Yinxi Chest: HE-3 Shaohai.

Face, mouth: ST-44 Neiting Mind: ST-40 Fenglong, ST-25 Tianshu Throat: ST-41 Jiexi Epigastrium/stomach: ST-36 Zusanli, ST-42 Chongyang, ST-40 Fenglong Heart (rhythm): ST-36 Zusanli, ST-40 Fenglong Lower abdomen: ST-34 Liangqiu.

Small Intestine (Fig. 8.13)

Ear: S.I.-1 Shaoze Eye: S.I.-6 Yanglao Neck, occiput: S.I.-3 Houxi Scapula: S.I.-4 Wangu.

Spleen {Fig. 8.11 )

Bladder {Fig. 8 .1 4)

Lips: SP-1 Yinbai Mouth: SP-3 Taibai Left hypoclwndrial region: SP-9 Yinlingquan Stomach: SP-4 Gongsun Lower abdomen: SP-8 Diji. SP-6 Sanyinjiao Uterus: SP-8 Diji, SP-6 Sanyinjiao Urinary system: SP-9 Yinlingquan.

Top of head: BL-66 Tonggu Eye: BL-67 Zhiyin, BL-66 Tonggu, BL-62 Shenmai Occiput: BL-65 Shugu Upper back: BL-60 Kunlun Lower back: BL-40 Weizhong Bladder: BL-63 Jinmen, BL-64 Jinggu Anus: BL-5 7 Chengshan, BL-58 Feiyang.

Heart {Fig. 8.12)

Kidneys (Fig. 8 .15)

Mind: HE-7 Shenmen, HE-8 Shaofu, HE-9 Shaochong Tongue: HE-5 Tongli. HE-8 Shaofu

Eye: KI-6 Zhaohai Tongue: KI-1 Yongquan

TREATMENT OF MAIN CHANNELS

(Lips) SP-3 (Mouth)

~...._+-------SP-1

~'----"fi----'- SP-9

(Left hypochondria! region) '--+-----SP-4 (Stomach) -::--f--T--SP-8, SP-6 (Lower abdomen, intestines) - , r - - - - - t - - - -SP-6, SP-8 (Uterus) - - - - - t - - - s P - 9 (Urinary system)

Fig_ 8.11 Target areas of Spleen channel's distal points.

Fig. 8.12 Target areas of Heart channel's distal points.

S.l.-4

BL-40 BL-63, BL-64 (Bladder) -------!1-BL-57, BL-58 (Anus) Fig. 8.13 Target areas of Small Intestine channel's distal points.

Fig. 8.14 Target areas of Bladder channel's distal points.

117

118

PART 2: THE MAIN CHANNELS

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Fig. 8.15 Target areas of Kidney channel's distal points.

P-6 (Mind)

Fig. 8.16 Target areas of Pericardium channel's distal points.

Throat: KI-6 Zhaohai Chest: KI-7 Fuliu, KI-9 Zhubin Umbilical area: KI-5 Shuiquan Urinary system: KI-10Yingu.

Pericardium (Fig. 8.16) Mind: P-7 Dating, P-6 Neiguan Tongue: P-8 Laogong Throat: P-8 Laogong Heart: P-6 Neiguan, P-5 Jianshi Chest: P-6 Neiguan. Triple Burner (Fig. 8.17)

Ear: T.B.-2 Yemen Temples: T.B.-3 Zhongzhu, T.B.-5 Waiguan Neck, top of shoulders: T.B.-8 Sanyangluo Shoulder joint: T.B.-1 Guanchong, T.B.-8 Sanyangluo Sides of body: T.B.-6 ZhigQu Uterus: T.B.-4 Yangchi.

Fig. 8.17 Target areas of Triple Burner channel's distal points.

TREATMENT OF MAIN CHANNELS

119

LIV-5

Y--- - - G .B.-4 (Hypochondrium)

LIV-6 r'l~----t--- LIV-!l.

LIV-6, LIV-1

Fig. 8.19 Target areas of Liver channel's distal points. Fig. 8.18 Target areas of Gall Bladder channel's distal points.

Gall Bladder {Fig. 8.18) Temple: G.B.-43 Xiaxi Eye: G.B.-44 Zuqiaoyin Ear: G.B.-43 Xiaxi Neck: G.B.-39 Xuanzhong Shoulder: G.B.-34 Yanglingquan Breast: G.B.-41 Zulinqi Hypochondria/ region: G.B.-34 Yanglingquan Hip: G.B.-41 Zulinqi.

Liver {Fig. 8.19) Top of head: LIV-3 Taichong Eye: LIV-2 Xingjian Throat: LIV-3 Taichong, LIV-5 Ligou Hypochondria/ region: LIV-3 Taichong Lower abdomen: LIV-4 Zhongfeng Hypogastric region: LIV-8 Ququan, LIV-6 Zhongdu Urinary system: LIV-5 Ligou, LIV-6 Zhongdu, LIV-1 Dadun.

Table 8.2 summarizes the main distal points for each area and it lists points from different channels: the choice of which point to use has to be guided by other factors, chiefly a proper identification of the channel and of the pattern involved. As mentioned above, the points in the table above are from different channels and the choice between them has to be further guided by the identification of patterns and channel involved. For example, two of the distal points indicated for the throat are LU-ll Shaoshang and KI-6 Zhaohai: LU-ll would be selected for a sore throat from an acute invasion of Wind-Heat, while KI-6 would be chosen for a dry throat from Yin deficiency. As another example, in the table the distal points indicated for the Heart are P-4 Ximen, P-5 Jianshi, P-6 Neiguan and HE-7 Shenmen: P-4 would be chosen if there were an irregular heartbeat, P-5 if Phlegm were obstructing the Heart, P-6 in Heart-Qi deficiency, and HE-7 for Heart-Blood deficiency.

PART 2: THE MAIN CHANNELS

120

Table 8.2

I

Distal points according to area

SUMMARY

,

DISTAL POINTS Area/organ Distal points

Face

L.l.-4 Hegu, ST-44 Neiting

Temples

T.B.-3 Zhongzhu, TB.·5 Waiguan, G.B.-43 Xiaxi

Occiput

S.l.-3 Houxi, BL-65 Shugu

Vertex

LIV-3 Taichong

Eyes

L.l.-4 Hegu, LIV-2 Taichong, HE-5 Tongli, S.l.6 Yanglao, T.B.-3 Zhongzhu

Nose

LU-7 Lieque, L.l.-4 Hegu

Teeth

L.L-4 Hegu (upper), ST-44 Neiting (lower)

Ears

T.B.-2 Yemen, T.B.-3 Zhongzhu, T.B.-5 Waiguan, G.B.-43 Xiaxi

TONGUE

P-8 Laogong, HE-5 Tongli, Kl-6 Zhaohai

THROAT

L.l.-4 Hegu, LU-11 Shaoshang, Kl-6 Zhaohai

LUNGS

LU-7 Lieque, LU-5 Chize

HEART

P-6 Neiguan, HE-7 Shenmen, P-5 Jianshi, P-4 Ximen

Stomach

P-6 Neiguan, ST-36 Zusanli, SP-4 Gongsun

Liver

LIV-3 Taichong, G.B.-34 Yanglingquan

Gall Bladder

G.B.-34 Yanglingquan, Dannangxue

Intestines

ST-36 Zusanli, SP-6 Sanyinjiao, ST-37 Shangjuxu, ST-39 Xiajuxu

Bladder

SP-6 Sanyinjiao, BL-63 Jinmen

Urethra

LIV-5 Ligou, BL-63 Jinmen

Anus

BL-57 Chengshan, BL-58 Feiyang

LOCAL POINTS 'Local' points are quite simply the points situated on the area where a problem is occurring. For example, in shoulder joint pain, the points L.I.-15 Jianyu and T.B.-14 Jianliao would be local points; similarly, in stagnation of Liver-Qi, points situated in the area overlying the liver itself (e.g. LIV-14 Qimen) are local points; in cases of epigastric pain, the points in the

• Distal points are the points situated away from the area where the problem is • In general, they are the points below the elbows and knees • In acute cases, distal points are used with reducing method to remove obstructions from the channel • In chronic cases, distal points are used to regulate Qi in the channel in combination with local points • Distal points can be selected according to five criteria: -according to channel affected (e.g. T.B .-5 for ear problems on the T.B. channel) -according to polarity of channel (e.g. one end of the channel affects the opposite end) -according to corresponding joint areas (e.g. ST-36 for the elbow) - according to correspondence between Yang channels (e.g. L.l.-4 forST channel on face).

epigastrium (e.g. Ren-12 Zhongwan and ST-21 Liangmen) are local points. In acute cases, the distal points (needled with reducing method) have the effect of removing obstructions from the channel and expelling pathogenic factors. Local points have the function of supporting the eliminating action of the distal points and focusing it on the desired area: they are usually needled with even method. For example, in treating an acute sprain of the lower back with bilateral pain on the lower back. one might choose BL-40 Weizhong as a distal point (needled with reducing method) and BL-26 Guanyuanshu as a local point (needled with even method). Sometimes distal points are needled before inserting the loca l ones. The example of ST-38 Tiaokou for acute sprain of the shoulder is a case in point: in such acute cases, ST-38 Tiaokou is needled with a strong reducing method while the patient gently rotates the shoulder: after 10 minutes of manipulation. local points are inserted. To give another example, in acute sprain

TREATMENT OF MAIN CHANNELS

121

of the lower back with pain on the midline, the distal

Table 8.3

Local points according to area

Local points Face

Yintang, ST-7 Xiaguan, ST-6 Jiache

Temples

Taiyang, G.B.-8 Shuaigu

Occiput

G.B.-20 Fengchi, BL-1 0 Tianshu

Vertex

Du-20 Baihui

Eyes

BL-1 Jingming, ST-1 Chengqi, Yuyao

Nose

Yintang, L.l.-20 Yingxiang, Bitong

Teeth

ST-4 Dicang, ST-6 Jiache, ST-7 Xiaguan

Ears

T.B.-17 Yifeng, S.l.-19 Tinggong, G.B.-2 Tinghui, TB.-21 Ermen

Tongue

Ren-23 Lianquan

Throat

Ren-22 Tiantu

Lungs

LU-1 Zhongfu, BL-13 Feishu, Ren-17 Shanzhong, Ren-22 Shanzhong

Heart

BL-15 Xinshu, BL-14 Jueyinshu, Ren-14 Juque, Ren-15 Jiuwei

Stomach

BL-21 Weishu, Ren-12 Zhongwan

Liver

BL-18 Ganshu, LIV-14 Qimen

Gall Bladder

G.B.-19 Danshu, G.B.-24 Riyue

Intestines

BL-25 Dachangshu, ST-25 Tianshu

Bladder

Ren-3 Zhongji, BL-28 Pangguangshu

Urethra

Ren-2 Qugu, BL-34 Xialiao

Anus

Du-1 Changqiang, BL-54 Zhibian, G.B.-30 Huantiao

point Du-26 Renzhong is selected and manipulated vigorously before inserting the local points. In chronic cases, distal and local points simply reinforce each other's function. Table 8.3 lists the main local points according to areas.

ADJACENT POINTS

SUMMARY

Adjacent points are points that surround the affected area: by definition. they are therefore near the local points. For example, in a case of shoulder joint pain, L.I.-1 5 Jianyu and T.B.-14 Jianliao are local points while LU-2 Yunmen and S.I.-11 Tianzong are adjacent points. Adjacent points are sometimes added to local points for various reasons. These can be summarized as follows: - according to their energetic action - above the affected joints -according to joint anatomy - in herpes zoster -according to 'horizontal' movement of Qi. I shall give below some examples of the use of adjacent points in practice.

Use of adjacent points for their energetic action Adjacent points are sometimes chosen partly because they are in the vicinity of the problem area and partly for their energetic action. A very good example of this is the use of G.B.-20 Fengchi for eye problems. Another example would be that of L.I.-11 Quchi for problems of the lower arm as this point benefits the sinews in general.

LOCAL POINTS • Local points are those situated on the area where the problem is, e.g. L.l.-15 Jianyu for a shoulder problem, or Ren-12 Zhongwan for a problem in the epigastrium • In acute cases, local points support the distal points' action in removing obstructions from the channel • In chronic cases, they help distal points to regulate Qi in that area.

Use of adjacent points above the affected joint When treating musculoskeletal problems an adjacent point situated above the joint is frequently selected. This has the effect of promoting the circulation of Qi through the joint to expel pathogenic factors. For example. when treating tendinitis of the elbow. L.I.-12 Zhouliao is used; when treating a problem of the knee, ST-34 Liangqiu is added .

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Us~ f adjacent points according to JOint anatomy In certain joint problems the use of adjacent points is important owing to the anatomy of that joint. A good example of this is the shoulder joint. Many shoulder joint problems stem from the scapulohumeral articulation, while the obvious local points L.l.-15 Jianyu and T.B.-14 Jianliao are near the acromioclavicular articulation. Thus , assuming the Large Intestine is the one that is affected, although we should select local points such as L.l.-15 Jianyu and distal points such as L.l.-1 Shangyang, I always add adjacent points from the Small Intestine channel on the scapula such as S.l.-11 Tianzong, S.l.-13 Quyuan or S.l.-10 Naoshu because these will affect the scapulohumeral articulation.

Use of adjacent points in herpes zoster

TREATMENT EXAMPLE ACUTE HERPES ZOSTER Let us assume a patient presents with acute herpes zoster with lesions on the right hypochondria! region (a very common location). Our pattern diagnosis is that the pathogenic factors are Wind-Heat-Dampness in the Lesser Yang channels. We can select the fol lowing points (all on the affected side): • T.B .-6 Zhigou for two reasons: because it expels Wind-Heat and because it treats the lateral costal region • G.B .-34 Yanglingquan to expel Wind and resolve Damp-Heat it also treats the hypochondria! region • Four local points inserted horizontal ly in a cross fashion around each of the largest lesions • Huatuojiaji points of the affected dermatome (Fig. 8.20).

The treatment of herpes zoster ('shingles') is a good example of the use of adjacent points. In fact, the standard acupuncture protocol for acute herpes zoster used at the Nanjing Hospital for Traditional Chinese Medicine is a three-pronged approach as follows: 1. Distal points chosen from the affected channel

(usually the Lesser Yang channels) and also according to their energetic action (e.g. T.B.-6 Zhigou and G.B.-31 Fengshi to expel Wind) 2. Local points surrounding the herpetic lesions with horizontal insertion 3. Adjacent points in the form of Huatuojiaji points of the affected dermatomes.

Use of adjacent points according to 'horizontal' movement of Qi As will be discussed in greater detail in Chapter 20 (Treatment of the Muscle channels), when treating a channel one can select adjacent points from the channels of the same polarity (i.e. Yin or Yang) , opposite potential energy (i.e. of arm or leg) and different energetic depth. An example will clarify this. Suppose we are treating facial pain along the Stomach channel and we select ST-7 Xiaguan as a local and L.l.-4 Hegu as a distal point: these two points pertain to the Bright Yang channels, which is where the problem is situated.

Huatuojiaji points Fig. 8.20 Treatment

of acute herpes zoster.

TREATMENT OF MAIN CHANNELS

The Bright Yang opens onto the Interior, the Greater Yang opens onto the Exterior and the Lesser Yang is the hinge. These three (or six) channels communicate with each other so that there is a flow of Qi among them: I call this flow of Qi a 'horizontal' flow in a particular area, as opposed to the flow of Qi along a channel, which I call 'vertical'. Thus, when we needle L.I.-4 Hegu and ST-7 Xiaguan for facial pain we stimulate the 'vertical' flow of Qi in the Stomach channel in the face and we remove obstructions (e.g. stagnation of Qi or Cold) from the Stomach channel in the face. In order to facilitate the removal of the obstruction, it is useful to stimulate also the 'horizontal' flow of Qi: to do this, we can select adjacent points from one of the other Yang channels to facilitate the flow of Qi among the Greater Yang, Bright Yang and Lesser Yang channels. In the above example of facial pain on the Bright Yang channels, we can select G.B.-2 Tinghui and/or S.I.-18 Quanliao as adjacent points to stimulate the horizontal flow of Qi between the Bright Yang, Lesser Yang and Greater Yang: this will have the effect of enhancing the power of ST-7 Xiaguan and L.I.-4 Hegu in removing obstructions from the channel (Fig. 8.21).

SUMMARY

123

Lesser Yang

Fig. 8.21 Horizontal flow of Qi in the face .

ADJACENT POINTS • Adjacent points surround the affected area • Adjacent points may be used for five different reasons - according to their energetic action - above the affected joints - according to joint anatomy - in herpes zoster -according to 'horizontal' movement of Qi .

AH SHI POINTS The term ~h Shi' point was first coined by Sun Si Miao in the 'Thousand Golden Ducats Prescriptions' (AD 652). ~h' is an interjection and 'shi' means 'to be' or 'is'. ~h Shi' is the expression a Chinese patient uses when the doctor, pressing various areas of his or her skin, finds a tender spot that elicits pain and the patient exclaims: 'Ah shit', i.e. 'That's it!' Therefore, the ~h

Shi point' could be translated as the 'That's it! ' point. However, I shall leave the term untranslated. Ah Shi points do not have a fixed location and may be outside the channels: quite simply they are the tender points found on palpation by the doctor. Although the term was introduced by Sun Si Miao, the concept is very ancient as Chapter 13 of the 'Spiritual Axis' says very tersely: 'Wherever tllere is tenderness there is n point. ' 2 It is significant that Chapter 13 of this book deals with the Muscle channels and the above statement is repeated for each Muscle channel when their treatment is discussed. In fact, use of the Ah Shi points is extremely important especially in muscular problems. The logic behind the use of the Ah Shi points is simply that, if there is tenderness on palpation, it indicates an obstruction of the channel in that area; this obstruction could be due to Qi or Blood stagnation or to pathogenic factors such as Cold, Wind or Dampness.

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SUMMARY

Table 8.4

Origins and Concentrations

AH SHI POINTS

• Ah Shi points are points tender on pressure • 'Wherever there is tenderness on pressure, there is a point' ('Spiritual Axis') • Tenderness on palpation indicates an obstruction of the channel (which can be removed by use of an Ah Shi point together with a distal point) • The term was coined by Sun Si Miao (AD 652) • Ah Shi points do not have fixed locations and may lie outside the channels • Ah Shi points may be anywhere on the surface of the body because there is no part of the surface of the body that is not irrigated by the Connecting channels • Ah Shi points are particularly important in the treatment of the Muscle channels.

The reason Ah Shi points are found also outside the channels is that the whole body is covered by a network of Connecting (Luo) channels (see Ch. 12). There is no part of the body that is not covered by a Connecting channel. When projected onto the surface of the skin, these energetic areas form the Cutaneous Regions (see Ch. 23).

ORIGIN AND CONCENTRATION OF CHANNELS (GEN JIE) The Origin and Concentration of channels is described in Chapter 5 (itself called 'Gen fie', i.e. 'Origin and Concentration') of the 'Spiritual Axis'. It says: 'When pathogenic factors invade the channels. they give rise to innumerable diseases; if one does not know the Origin and Concentration l of the chm111els] the five Yin and six Yang organs are damaged, the axis will fail, the opening and closing [of the channels] will be disrupted, Yin and Yang are severely injured and will not be able to recover . .. the Greater Yang lws its Origin at BL-6 7 Zhiyin and its Concentration at the point Ming Men by the eye [i. e. BL-1 Jingming]: tlze Briglzt Yang has its Origin at ST-45 Lidui and its Concentration on tlzeforehead in front of the ear: the Lesser Yang has its Origin at G. B.-44 Zuqiaoyin and its Concentration at t!Je 'Window Cover' in the ea1: 1'/ze

Channels

Origin (Gen)

Concentration (Jie)

Greater Yang

BL-67 Zhiyin

BL-1 Jingming

Bright Yang

ST-45 Lidui

On the forehead in front of t he ear (ST-8 Touwei)

Lesser Yang

G.B.-44 Zuqiaoyin

In the ear

Greater Yang opens [on tlze Exterior]. the Bright Yang closes [on the Interior], the Lesser Yang is the axis.' 3 Dr Ma Shi of the Ming dynasty says of the Origins and Concentrations: ·Where the Qi of tlze channels begins it is the Origin; where it converges, it is the Concentration.' 4 Table 8.4 summarizes the Origin and Concentration areas of the Yang channels from Chapter 5 of the 'Spiritual Axis'. It is important to note that when this chapter of the 'Spiritual Axis' refers to the 'Greater Yang', 'Bright Yang' and 'Lesser Yang', it refers both to the arm and the leg channels, e.g. the Greater Yang includes both Bladder and Small Intestine (Figs 8.22-8 .24). As we can see [rom the above list, all the Origins are in the limbs and the Concentrations in the head: therefore Origins and Concentrations are another way in which the channels integrate different structures of the body and harmonize Above and Below. Other texts talk about Four Origins (in the four limbs) and Three Concentrations (head, chest and abdomen). The concept of Origin and Concentration is closely related to the varying energetic depth of the three Yang channels, i.e. Greater Yang (opening onto the Exterior), Bright Yang (opening onto the Interior) and Lesser Yang (being the 'axis' or 'hinge'). Thus, when Chapter 5 of the 'Spiritual Axis' quoted above says that 'the axis will fail, the opening and closing [of the channels] will be disrupted'. 'axis' refers to the regulating function of the Lesser Yang channels, 'opening' refers to the capacity of the Greater Yang channels to communicate properly with the Exterior and 'closing' refers to the capacity of the Bright Yang channels to communicate properly with the Interior. When these three functions are harmonized. pathogenic factors will not invade the body.

TREATMENT OF MAIN CHANNELS

Origin ST-45 Fig. 8.22 Origin and Concentration of Greater Yang.

Fig. 8.23 Origin and Concentration of Bright Yang.

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PART 2: THE MAIN CHANNELS

Clinical application I translate the word fie (in Gen-Jie) as 'Concentration' rather than 'Termination' or 'End'. The book 'Great Treatise of Chinese Acupuncture' confirms this when it explains the meaning of fie as 'to gather ' or 'to converge'. 5 I believe this translation reflects their nature and their clinical application. In fact, whereas Chapter 52 of the 'Spiritual Axis' lists 12 Roots and Branches (one for each channel), 6 Chapter 5 lists the Origins and Concentrations of the Yang channels without distinguishing between arm and leg channels. For example, it will give the Origin and Concentration of the 'Greater Yang' channels rather than those of the Small Intestine and Bladder channels. I therefore see the fie of the channels as an area of concentration or convergence of Qi of both arm and leg channels rather than as a point of termination of the channel. This means that the points in the areas of Concentration can particularly be used to affect both the arm and the leg channels, e.g. Small Intestine and Bladder within the Greater Yang. For example, the point ST-8 Touwei is the Concentration of the Bright Yang channels and it therefore affects both Stomach and Large Intestine channels: it is used for many problems of the face stemming from a pathology of both these channels and for Phlegm obstructing the head.

Concentration

SUMMARY ORIGIN AND CONCENTRATION OF CHANNELS

Origin G.B.-44 Fig. 8.24 Origin and Concentration of Lesser Yang.

• Origins and Concentrations (Gen-Jie) are described in Chapter 5 of t he 'Spiritual Axis' • This chapter lists on ly the Origins and Concentrations of t he Ya ng channels • Origins are the beginning of the channel (B L-67 for the Greater Yang, ST-45 for the Bright Yang and G.B.-44 for the Lesser Yang) • Concentrations are areas of convergence of Qi towards the opposite extremity of the channel in the head (BL-1 for t he Greater Yang, ST-8 for the Bright Yang and the ear for the Lesser Yang) • Origins and Concentrations harmonize and regulate opposite ends of the channel.

TREATMENT OF MAIN CHANNELS

Table 8.5

127

Roots and Branches of the channels

Channels

Root (Ben)

Branch (Biao)

Leg Greater Yang

5 cun above the heel

BL-1 Jingming

Leg Bright Yang

ST-45 Lidui

ST-9 Renying

Leg Lesser Yang

G.B.-44 Zuqiaoyin

In the ear

Leg Lesser Yin

3

Leg Terminal Yin

5 cun above LIV-2 Xingjian

Leg Greater Yin

4

Arm Greater Yang

Behind external malleolus

Arm Lesser Yang

2 cun above space between 4th and 5th fingers

cun above and medial to the internal malleolus

Back-Transporting point (BL-23 Shenshu) Back-Transporting point (BL-18 Ganshu)

cun above and in front of LIV-4 Zhongfeng

Back-Transporting point (BL-20 Pishu) and root of tongue 1 cun above BL- 1 Jingming

Between upper corner behind ·the ear and the end of the eyebrow

Arm Bright Yang

Elbow bone (L.I.-11 Quchi)

Above lower jaw

Arm Greater Yin

LU-9 Taiyuan

Artery below the axilla

Arm Lesser Yin

Tip of head of ulna (HE-7 Shenmen)

Back-Transporting point (BL-15 Xinshu)

Arm Terminal Yin

Between two tendons 2

cun above palm

ROOT AND BRANCH OF CHANNELS Table 8.5 summarizes the Root and Branch points of the channels from Chapter 52 of the 'Spiritual Axis'. Please note that most authors interpret the 'malleolus' as being the wrist bone in the case of the Small Intestine channel; this makes sense as this channel would then be in line with all the others. As we can see from the list of Roots, in contrast to the Origins, 10 of the 12 Roots are not the beginning points of the channel and most of the Roots are above the Origins. This shows that the Root is somewhat different from the Origin of a channel: whereas the latter is the end (last) point of the channel, the former is more like a point where the Qi of the channel gathers before its ascent towards the top of the body (Figs 8.2 5-8.36). Please note that the concept of Root and Branch (as well as that of Origin and Concentration) is independent of the direction of flow of the channel: whether a channel flows from (such as the Small

(P-6 Neiguan)

3

cun

below the axilla (P-1 Tianchi)

Intestine) or towards (such as the Bladder) the extremities, its Root is below and its Branch above. Therefore we should not confuse the Root of a channel with its beginning: for example, the Root of the Lung channel is not LU-1 Zhongfu but LU-9 Taiyuan and its Branch is above, i.e. an area below the axilla.

Clinical application The Roots of the channels are areas where the Qi of the channel gathers on its way towards the upper body. For example, the Root of the Bladder is 5 cun above the heel (maybe BL-59 Fuyang); that of the Kidneys is 3 cun above the internal malleolus, etc. This explains the dynamic action of points such as BL-59 Fuyang, KI-7 Fuliu, SP-6 Sanyinjiao, L.l.-11 Quchi, etc. Indeed, it is worth noting that the Roots of four of the Hand channels, i.e. L.l.-11 Quchi for the Large Intestine, LU-9 Taiyuan for the Lungs, HE-7 Shenmen for the Heart and P-6 Neiguan for the Pericardium, are all very powerful, dynamic and important points. The fact that they are Root points is a further explanation of their important action.

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PART 2: THE MAIN CHANNELS

Fig. 8.26 Root and Branch of Large Intesti ne chan nel. Fig. 8.25 Root and Branch of Lung channel.

Another point worth noting is that the Branches differ from the Concentrations in that they are not necessarily the end of the channels in the head and chest. Indeed, four of the Branches are in the back at the level of the relevant Back-Transporting points (Kidneys, Liver, Spleen and Heart). In conclusion, although there are similarities between the Roots and Origins (as they are both at the extremities of the limbs) and between the Branches and Concentrations (as they are both in the head and chest), there are also differences between the two. First, the Roots are generally above the Origins: secondly, the Branches are generally outside (or lateral to) the Concentrations. Therefore, the Roots and Branches contribute to harmonizing and regulating the Upper and Lower parts of the body, while the Origins and Concentrations contribute to harmonizing and regulating the two opposite poles of the channels. In treatment, the connection between Roots and Branches (and that between Origins and Concentrations) allows us to use points at one end of the body to affect

another part. Generally speaking, this principle of treatment is applied (with exceptions) only in 'one direction'. i.e. the points of the extremities (at Roots and Origins) treat disorders of the head and trunk (Branches and Concentrations). This is by far the most common use of these areas in practice. However, there are also examples of points of the head and trunk (on Branches and Concentrations) affecting the lower end of the channels (Roots and Origins). The following are a few examples: • G.B.-10 Fubai for atrophy of the muscles of the legs 7 • BL-42 Pohu for rigidity and pain of the joints8 • Ren-4 with moxa for paralysis of the legs 9 • Du-20 Baihui for prolapse of the uterus. bladder or anus • Du-26 for acute sprain of the lower back • BL-1 0 Tianzhu for inability of the legs to support the body.

TREATMENT OF MAIN CHANNELS

Root ST-45 Fig. 8.27 Root and Branch of Stomach channel.

129

130

PART 2: THE MAIN CHANNELS

Branch ---;:.------1

BL-15

Fig. 8.29 Root and Branch of Heart channel.

Fig. 8.28 Root and Branch of Spleen channel.

Fig. 8.30 Root and Branch of Small Intestine channel.

TREATMENT OF MAIN CHANNELS

Fig. 8.31 Root and Branch of Bladder channel.

131

132

PART 2: THE MAIN CHANNELS

•I •I • I

•I •I

;· I

• • •I •

• I

I

·-•· I I

I

~-· Le I

• Fig. 8.33 Root and Branch of Pericard ium channel.

Fig. 8.32 Root and Branch of Kidney channel.

Fig. 8.34 Root and Branch of Triple Burner channel.

TREATMENT OF MAIN CHANNELS

Root GB-44

Fig. 8.35 Root and Branch of Gall Bladder channel.

Fig. 8.36 Root and Branch of Liver channel .

133

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PART 2: TH E MAIN CHANNELS

SUMMARY ROOT AND BRANCH OF CHANNELS

• Roots and Branches (Ben-Biao) of channels are described in Chapter 52 of the 'Spiritual Axis'; it lists 12 Roots and 12 Branches, one for each channel • Most of the Roots are above the beginning of the channel • The Branches do not always coincide with the ends of the channel • Four of the Branches are in the back at the level of the Back-Transporting points • Roots and Branches harmonize and regulate t he Upper and Lower parts of the body • Generally, the energet ic relationship between t he Root and Branches in treatment works mostly in one 'direction', i.e. the lower affects the upper part of the body • However, there are exceptions, e.g. G.B.-1 0 for atrophy of the muscles of the leg, Du-20 Baihui for prolapse of t he uterus or bladder, etc.

Pathways ofQi

PATHWAYS OF Ql Chapter 52 of the 'Spiritual Axis' introduces the concept of 'Pathways of Qi' (Qi Jie). It says: 'The chest has Pathways of Qi. the abdomm lws Pathways of Qi, the head has Pathways of Qi, the lower legs have Pathways of Qi. The Qi in the head converges in tlze brain; tlze Qi in the chest converges in tlze breast and Back-Transporting point; the Qi in the a!Jdomen converges at the Back-Transporting points, tile Penetrating Vessel and tlze arteries 0 11 either side of the umbilicus; the Qi in tlze lower legs converges at the point Qijie (ST-30 Qicho11g), the point BL-57 Chengs/wn and tlze areas above and below tlze external malleolus.' 10 See Figure 8.3 7. The concept of 'Pathways of Qi' is important clinically. Pathways of Qi are strategic areas where Qi gathers, concentrates and, most of all, circulates in a given area. The proper circulation of Qi relies on the Pathways of Qi being open and fluent. Conversely, the Pathways of Qi are areas where Qi is liable to become stagnant. The Pathways of Qi are clinically important also for another reason: they provide another dimension to the circulation of Qi in the body. While there is a

Fig. 8.37 The Pathways

of Qi.

'vertical' circulation of Qi in the channels between the Roots and Branches and between the Origins and Concentrations, there is also a 'horizontal' movement of Qi in each section of the body and the four Pathways of Qi are part of this horizontal movement of Qi. This horizontal movement of Qi is complementary to and coordinated with the vertical movement of Qi in the channels. For example, the Pathway of Qi of the head refers to the movement of Qi between the occiput and the face and between the brain and the face; the Pathways of Qi of the chest establish a connection between the upper back and the chest; the Pathways of Qi of the abdomen contribute to the horizontal movement of Qi between the lower back and the abdomen; the Pathways of Qi of the lower legs integrate the circulation of Qi between the legs, the lumbosacral region and the lower abdomen (Fig. 8.38).

TREATMENT OF MAIN CHANNELS

Head

Chest

Abdomen

Pathways of

135

Such a horizontal movement of Qi in the Pathways of Qi allows us to use points of one area to treat another area within a particular Pathway of Qi. For example, the Pathways of Qi of the head allow us to use G.B.-20 Fenchi to treat the eyes and brain; the Pathways of Qi of the chest allow us to use BL-13 Feishu for chest problems or LU-2 Yunmen for upper back problems; the Pathways of Qi of the abdomen allow us to use BL-25 Dachangshu for abdominal problems; the Pathways of Qi of the lower legs allow us to use BL-40 Weizhong for lumbar pain. The 'Study of Acupuncture' clearly mentions the horizontal circulation of Qi when discussing the Pathways of Qi: 'The circulation of Qi in the clwnnels is both vertical and lwrizontal.' 11 If we analyse the indications of various points in the four areas of head, chest, abdomen and leg, we find many examples of points in the front of the body acting on the back of the body and vice versa. This clearly indicates a horizontal movement of Qi in each area between front and back: this movement of Qi in each area constitutes the 'Pathways of Qi'. I shall give some examples of points in each area below.

Pathways of Qi of the head The Pathways of Qi of the head converge in the brain: when these pathways are clear and open, Qi circulates well; when they are obstructed, Qi stagnates and the person will experience headaches, muzziness and heaviness of the head, and dizziness. The Eye System (Mu Xi) plays a role in the movement of Qi in the Pathways of Qi of the head. The Eye System (Mu Xi) is described in Chapter 80 of the 'Spiritual Axis': 'Tize Essence and Qi of the jive Zang and six Fu ascend to tile eyes to give vision ... They communicate with many channels constituting an Eye System (Mu Xi) which ascends to the vertex, enters tlze brain and then swjaces at llze occiput.' 12 See Figure 32.7 in Chapter 32. There are three main clusters of points associated with the Eye System:

Qi

Lower legs

Fig. 8.38 Qi circulation in the Pathways of Qi.

• Periorbital: BL-1 Jingming, ST-1 Chengqi, G.B.-1 Tonziliao, T.B.-23 Sizhukong, Yuyao, BL-2 Zanzhu and G.B.-14 Yangbai (Fig. 32.9) • Temporal: ST-8 Touwei, G.B.-4 Hanyan, G.B.-5 Xuanlu, G.B.-6 Xuanli, G.B.-7 Qubin (see Fig. 32.9) • Occipital: Du-16 Fengfu, G.B.-20 Fengchi, BL-10 Tianzhu (see Fig. 32.10).

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The Eye System plays a role in the regulation of Yang and Yin Qi in the eyes: in particular, it ensures that Yang Qi is carried away from the eyes at the appropriate times. All the above points of the Eye System are automatically important points of the Pathways of Qi of the head as they promote and regulate the communication between points around the eyes and points at the back of the head. Other important points of the Pathways of Qi of the head are (Fig. 8.39): • G.B.-20 Fengchi: this point is part of the Eye System and plays an important role in the movement of Qi between the occiput and the eyes. This movement is also facilitated by this point's being a point of the Yang Stepping Vessel (Yang Qiao Mai). • Du-16 Fengfu: this has among its indications 'swelling and pain of the throat', which confirms that this point facilitates the movement of Qi between the occiput and the front of the head and neck. This function is also due to this point's being a point of the Yang Linking Vessel (Yang Wei Mai). • Ren-22 Tiantu: this has an10ng its indications 'swelling of the back of the neck', which clearly 'resonates' with Du-16 Fengfu's indication of 'swelling and pain of the throat'. These two indications clearly indicate that there is a 'horizontal' movement of Qi between these two points. Du-17 Naolw: this has among its indications many eye problems ('blurred vision. myopia, eye pain, excessive lachrymation, yellow sclera'), which clearly indicates a 'movement' of Qi from this point towards the eyes. Moreover, if we analyse the indications of points around the eyes, we see that BL-2 Zanzhu, for example. affects the back of the head (see below). • BL-2 Zanzhu: this has among its indications 'pain and stiffness of the neck'. which again clearly indicates the existence of a 'horizontal' movement of Qi between this point and the previous one, Du-17 Naohu. • Du-24 Shenting: this has indications related to the nose ('nasal discharge and congestion'. 'nosebleed') and the eyes ('lachrymation', 'blurred vision'), showing that from this point there is a forward movement of Qi towards the face.

Fig. 8.39 Pathways of Qi of the head with thei r points.

Pathways of Qi of the chest The Pathways of Qi of the chest converge in the breast and Back-Transporting point (presumably BL-13 Feishu). When these pathways are clear and Qi circulates well, the chest is free of phlegm and the person breathes well; when the pathways are blocked and Qi stagnates in the chest, the person suffers from a feeling of oppression of the chest. chest pain. breathlessness or breast lumps in women. Important points of the Pathways of Qi of the chest are (Fig. 8.40): • Ren-17 Slwnzhong: this is the most important chest point of the Pathways of Qi of the chest. It is a point of concentration of Qi in the Upper Burner because of its many natures. In fact. it is the Front Collecting (Mu) point of the Pericardium, Front Collecting (Mu) point of the Upper Burner, Gathering (Hui) point for Qi and

TREATMENT OF MAIN CHANNELS

BL-14

~~~~~~~~~• LU-1 .-~~~~~:--.~~upper bacK

Pain 1n

137

• BL-14 Jueyinslw: this has several indications related to the chest ('heart pain'. 'feeling of oppression of the chest', 'chest pain'), which clearly indicates a horizontal movement of Qi from this point in the back towards the chest. part of the Qi movement in the Pathways of Qi of the chest. • BL-15 Xinslw: same as above. One indication for this point specifically refers to a movement of Qi from the front to the back: 'chest pain extending to the back'. • LU-1 Zhongfu: this has one indication related to the back ('pain in the upper back'). This indicates that there is a movement of Qi from this point in the front to the back. part of the Qi movement in the Pathways of Qi of the chest. In particular, the point would seem to 'resonate' with BL-13 Feishu: in fact. LU-1 has an indication relating to the upper back and BL-13 two indications relating to the chest. • BL-51 Hunngmen (in the lower back): this affects the breasts ('breast disorders', 'fullness and pain of the breasts'). This indicates a horizontal movement of Qi from the back to the breasts.

Pathways of Qi of the abdomen The Pathways of Qi of the abdomen converge in three places:

Fig. 8.40 Pathways of Qi of the chest with their point s.

point of the Sea of Qi. It is also the meeting point of the Directing Vessel, Spleen. Kidney. Small Intestine and Triple Burner channels. The breasts are part of the Pathways of Qi of the chest and Ren-17 is an important point for breast problems. • BL-13 Feishu: this has among its indications 'hot sensation of the chest' and 'chest pain'. This indicates a horizontal movement of Qi between the upper back and the chest. an important aspect of the Pathways of Qi of the chest.

• the Back-Transporting points (presumably points between BL-18 Ganshu and BL-23 Shenshu) • the Penetrating Vessel (Chong Mni) • the arteries on either side of the umbilicus (which are also part of the Penetrating Vessel). The Pathways of Qi of the abdomen are closely related to the Penetrating Vessel in both their physiology and pathology. When the Pathways of Qi of the abdomen are open and Qi flows freely, there is no stagnation in the abdomen: when they are blocked by stagnant Qi or Blood. the person experiences abdominal distension and pain and possibly abdominal masses. Women are more prone to stagnation in the abdomen, which. apart from abdominal distension and pain, may cause painful periods, endometriosis, ovarian cysts and uterine masses. The good circu lation of Qi and Blood

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in the Pathways of Qi of the abdomen depends very much on the Penetrating Vessel. Important points of the Pathways of Qi of the abdomen are (Fig. 8.41):

• Kl-16 Huangshu: the Penetrating Vessel's point beside the umbilicus, it has 'backache' among its indications besides the obvious ones of abdominal distension and pain and umbilical pain. This indicates that this point promotes the horizontal movement of Qi from the abdomen to the back, part of the Qi movement in the Pathways of Qi of the abdomen. On the other hand, several back points influence the abdomen and particularly BL-20 Pishu, BL-21 Weishu, BL-22 Sanjiaoshu and BL-23 Shenshu: this means that the point KI-16 'resonates' with these points in the back as there is a horizontal movement of Qi between them. KI-12 Dahe and KI-13 Qixue: these both have 'backache' among their indications. This indicates that these two points promote the horizontal movement of Qi from the abdomen to the lower back and, as such, they 'resonate' with the above-mentioned points of the lower back (BL-20-BL-23). BL- I 8 Ganshu: this has many indications relating to the front of the body ('epigastric pain, abdominal masses, hypogastric fullness and pain, lower abdominal pain, fullness of the chest, cough with chest pain'). This is a strong indication that this point promotes the horizontal movement of Qi from the back towards the front of the body, part of the Qi movement in the Pathways of Qi of the abdomen. • BL-23 She11shu: apart from its obvious indications related to the lower back, this point affects the abdomen in many different systems, i.e. urinary, genital. menstrual and intestinal. For this reason, BL-23 is an important point of the Pathways of Qi of the abdomen.

Pathways of Qi of the legs The Pathways of Qi of the lower legs converge at ST-30 Qichon g, BL-5 7 Chengshan and the area around the external malleolus. When these Pathways of Qi are open and clear, Qi circulates well in the legs

Fig. 8.41 Pathways of Qi of the abdomen with their points.

and the person is agile in the legs; when Qi or Blood (or both) stagnates in the Pathways of Qi of the lower legs, the person experiences a feeling of heaviness or weakness of the legs and often restless legs. Important points of the Pathways of Qi of the legs are (Fig. 8.42): • ST-30 Qigong: this is the point from where the

Penetrating Vessel emerges from the interior. It is a powerful, dynamic point that regulates the

TREATMENT OF MAIN CHANNELS

• •

•

•

139

ascending and descending of Qi. In relation to the legs and the Pathways of the Qi of the legs, this point stimulates the descending of Qi in the descending branch of the Penetrating Vessel. The descending branch of the Penetrating Vessel is important for the balance of Yin and Yang in the legs as it is the only way in which Kidney-Qi goes down to the legs (as the Kidney channel ascends from the feet). BL- 57 Chengshan: this is an important point to stimulate the movement of Qi in the legs. ST-37 Shangjuxu and ST-39 Xiajuxu: these are points that stimulate the descending of Qi to the legs. SP-6 Sanyinjiao: this is important to nourish Yin of the leg channels and therefore balance Yang. BL-40 Weizhong: this is an important point for problems of the lower back and legs (e.g. sciatica) and it establishes a communication between the legs and the lower back.

SUMMARY

·

PATHWAYS OF Ql

• Pathways of Qi (Qi Jie) are described in Chapter 52 of the 'Spiritual Axis' • There are four Pathways of Qi: of the head, chest, abdomen and lower legs • Pathways of Qi are strategic areas where Qi gathers, converges and circulates in a given area • The Pathways of Qi provide a ' horizontal' dimension to the flow of Qi • The Pathways of Qi of the head converge in the brain • The Pathways of Qi of the chest converge in the breast and Back-Transporting points • The Pathways of Qi of the abdomen converge at the Back-Transporting points and the Penetrating Vessel in the abdomen • The Pathways of Qi of t he lower legs converge at ST-30 Qichong and BL-57 Chengshan . Fig. 8.42 Pathways of Qi of the legs with their point s.

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PART 2: THE MAIN CHANNELS

NOTES l. It is an interestin g conceptthatthe distal points of the legs (further away from the affected area) are stronger than those o f the arm. This phenomenon could be compared to a lever in physics in which the longer the arm o f the lever. the easier it is to operate. 2. J 981 Spiritual Ax is (Li11g Sllll }ill!/ jj! :II&~ ). People's Jl ca lth Publishing House. Beijing. first published c. J 00 nc, p. 44--46. 3. Ibid., p. 1 6. 4 . Cited in Wan g Xue Tai 1988 Great Treatise o f Chinese Acupunctu re (ZIIo11g Guo Zlle11/iu Da Qua11

-L----- Orbicularis

~p-,f----- Risorius

'E--'-1- + -- - -0rbicularis oris

'"-:-----'"'~;::----- Scalenes

'----:-----"1--,.-+---Nasalis A----Masseter

Fig. 17.9 Stornach Muscle channel.

MORPHOLOGY AND PATHWAYS OF THE MUSCLE CHANNELS

297

SUMMARY

SUMMARY

STOMACH MUSCLE CHANNEL PATHWAY

SPLEEN MUSCLE CHANNEL PATHWAY

• It starts at the middle three toes • It converges on the dorsum of the foot • It ascends along the lateral aspect of the tibia and converges at the lateral aspect of the knee, connecting with the Gall Bladder muscle channel • It ascends the leg and converges at the hip joint • It passes through the lower ribs to reach the spine • The main branch runs along the tibia and the thigh past ST-32 Futu to converge in the genitalia • It then ascends the abdomen and chest and reaches the supraclavicular fossa (ST-12 Quepen) • It ascends the neck to the jaw, mouth and side of the nose and gathers in the cheekbone. It joins with the Bladder Muscle channel: this channel goes above the eye socket and the Stomach Muscle channel below it • Another branch separates at the jaw and gathers in front of the ear • It connects with the Muscle channels of the Gall Bladder, Large Intestine and Bladder.

• It begins at the big toe • It ascends the foot to converge at the inner malleolus • It ascends the medial aspect of the tibia to converge at the medial aspect of the knee • It follows the medial aspect of the thigh to converge in the groin before converg ing at the external genitalia • It then ascends the abdomen to converge at the umbilicus • It enters the abdomen, converges at the ribs and spreads in the chest • From the inside of the chest, a branch adheres to the spine • It connects with the Muscle channels of the Liver and Kidney.

CLINICAL NOTE The fact that the Liver Muscle channel flows to the genitals confirms the important influence of the Liver on problems of the genitalia.

SUMMARY LIVER MUSCLE CHANNEL PATHWAY CLINICAL NOTE It is interesting to note that the Spleen Muscle channel spreads in the chest and, from here, it adheres to the spine. For this reason, I use SP-3 Taibai to straighten the spine.

Liver Muscle channel (Fig. 17.11) The Liver Muscle channel originates on the dorsum of the big toe and ascends the medial side of the foot to converge at the anterior aspect of the medial malleolus; it then proceeds along the medial aspect of the tibia to converge at the medial condyle. It continues upwards along the medial aspect of the thigh to the genitals where it connects with the Spleen Muscle channel.

• It originates on t he dorsum of the big toe • It ascends to converge at the anterior aspect of the medial malleolus • It runs along the medial aspect of the tibia to converge at the medial condyle • It continues upwards along the medial aspect of the thigh to t he genitals where it connects with the Spleen Muscle channel.

Kidney Muscle channel (Fig. 17.12) The Kidney Muscle channel begins beneath the little toe and joins the Spleen Muscle channel at the inferior aspect of the medial malleolus; it converges in the heel where it joins with the Bladder Muscle channel, then ascends the leg and converges at the medial

298

PART 4: MUSCLE CHANNELS (JJNG JIN)

I

,.,.------...........

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''

\

\ \

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~

\

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\ \

\ \ \ \ \ \

\ \

\

\ \ \ \

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\ \ \ \

\

I \ \ \

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Superficial view

Deep view

Flexor digitorum longus - - ----\-lr-1-:+

Transverse abdominis ------l;;t~V~~=~ Rectus abdominis - - - - - --;:;-t-;:-'7'-;"-----:'Quadratus lumborum -------t~s.:---;;;;:;::;;;;:t!::;~;;;;..~.JW Fig. 17.10 Spleen Muscle channel.

MORPHOLOGY AND PATHWAYS OF THE MUSCLE CHANNELS

- - - - - Adductor longus

Fig. 17.11 Liver Muscle channel.

Fig. 17.12 Kidney Muscle channel .

299

300

PART 4: MUSCLE CHANNELS (JING JIN)

condyle of the tibia. It then joins with the Spleen Muscle channel and follows the medial surface of the thigh to converge at the genitals. A branch ascends along the inner aspect of the spinal column to the nape of the neck where the channel converges at the occipital bone, joining with the Bladder Muscle channel. The Kidney Muscle channel connects with the Muscle channels of the Spleen and Bladder.

CLINICAl NOTE The most notable aspect of the Kidney Muscle channel pathway is that it flows inside the whole spine, joining the Bladder Muscle channel at the occiput. This confirms the important influence of both Bladder and Kidney channel on the spine. The Bladder Muscle channel obviously affects the spine because it flows all along beside it. The Kidneys affect the spine in two ways: as an organ, they are the origin of Marrow and nourish the bones and spine; as a channel, its Muscle channel flows inside the whole spine. For this reason, in addition to the obvious points from the Bladder channel, I frequently use the point Kl-4 Dazhong to treat chronic backache occurring against a background of Kidney deficiency.

The three Yang of the arm Small Intestine Muscle channel (Fig. 17.13) The Small Intestine Muscle channel originates on the dorsum of the little finger and converges at the wrist. It then ascends the ulnar side of the forearm to the elbow where it converges at the medial border of the elbow bone {Chapter 13 of the 'Spiritual Axis' at this point says that 'wizen pressure is applied at this spot. a sensation of nwnlmess extends to the tip of the fifth jinger' 3 ) , climbing the ann to converge at the posterior aspect of the axilla. It then runs behind the axilla and surrounds the scapula.

. , _ - - - - - -Frontalis

"'-..11!- ' f f - - - - - - Masseter ~v------- Risorius

Y - - - - - - - Piatysma

lliik-----'..,._--Trapezius ,___-~-Infraspinatus

SUMMARY KIDNEY MUSClE CHANNEl PATHWAY • It begins beneath the little toe • It joins the Spleen Muscle channel at the inferior aspect of the medial malleolus • It converges in the heel where it joins with the Bladder Muscle channel • It ascends the leg and converges at the medial condyle of the tibia • It then joins with the Spleen Muscle channel and fol lows the medial surface of the thigh to converge at the gen itals • A branch ascends along the inner aspect of the spinal column to the nape of the neck where the channel converges at the occipital bone, joining w ith the Bladder Muscle channel • It connects with the Muscle channels of the Spleen and Bladder. Fig. 17.13 Small Intestine Muscle channel.

MORPHOLOGY AND PATHWAYS OF THE MUSCLE CHANNELS

A branch runs over the shoulder and ascends the neck in front of the Bladder Muscle channel, to converge at the mastoid process from where a branch enters the ear. It then ascends behind the ear to the region above, and from there descends to converge at the mandible. It then ascends to converge at the outer canthus of the eye. The Small Intestine Muscle channel connects with the Muscle channels of the Bladder, Large Intestine, Triple Burner and Stomach.

CLINICAL NOTE

The most notable aspect of the Small Intestine Muscle channel is that it covers the whole scapula and it affects four major muscles over the scapula: the /atissimum dorsi, teres major, teres minor and infraspinatus. I frequently use the Small Intestine points on the scapula (and especially S.l.-11 Tianzong) as adjacent points for chronic shoulderjoint problems.

SUMMARY SMALL INTESTINE MUSCLE CHANN EL PATHWAY

• It originates on the dorsum of the little finger • It converges at the wrist • It ascends the ulnar side of the forearm to the elbow where it converges at the medial border of the elbow bone • It ascends the arm to converge at the posterior aspect of the axilla • It then runs behind the axilla and surrounds the scapula • A branch runs over the shoulder, and ascends the neck in front of the Bladder Muscle channel, to converge at the mastoid process from where a branch enters the ear • It ascends behind the ear to the region above and from there it descends to converge at the mandible • It ascends to converge at the outer canthus of the eye • It connects with the Muscle channels of the Bladder, Large Intestine, Triple Burner and Stomach.

301

Triple Burner Muscle channel (Fig. 17.14) The Triple Burner Muscle channel begins at the ulnar side of the ring finger and converges at the dorsum of the wrist. It runs along the posterior aspect of the arm and converges at the tip of the elbow; it then ascends the lateral aspect of the upper arm and goes over the shoulder to the neck where it joins with the Small Intestine Muscle channel. A side branch runs from the angle of the mandible to reach the root of the tongue. The main branch ascends in front of the ear to join the outer canthus of the eye; it then ascends across the temple to converge at the corner of the forehead. The Triple Burner Muscle channel connects with the Muscle channel of the Small Intestine.

SUMMARY TRIPLE BURNER MUSCLE CHANNEL PATHWAY

• It begins at the ulnar side of the ring f inger • It converges at the dorsum of the wrist • It runs along the posterior aspect of the arm and converges at the tip of the elbow • It ascends the lateral aspect of the upper arm and goes over the shoulder to the neck where it joins with the Small Intestine Muscle channel • A side branch runs from the angle of the mandible to reach the root of the tongue • The main branch ascends in front of the ear to join the outer canthus of the eye • It ascends across the temple to converge at the corner of the forehead • It connects with the Muscle channel of the Small Intestine.

Large Intestine Muscle channel (Fig. 17.15) The Large Intestine Muscle channel begins at the lateral end of the second finger and converges at the dorsum of the wrist. It ascends the forearm and converges at the lateral aspect of the elbow. It then CLINICAL NOTE

It is of note that the Triple Burner Muscle channel flows to the temple: this is another reason why T.B.-5 Waiguan is such an important point for temporal headaches.

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PART 4: MUSCLE CHANNELS (JING JIN)

Temporalis- - - -+ - Orbicularis oculi- ----\,---.-'-.;1-_::_= ,lW, Masseter -----+~-=­

Risorius ------t-____,~._---=-'-'-"""' Platysma--------1--1~-~llo...

Trapezius

~.i\'l!l~~~o..---

Extensor digitorum -----1->'--1'Extensor carpi ulnaris---1-:-+-=i Flexor carpi ulnaris --J~~+,:.J--.1

Fig. 17.14 Triple Burner Muscle channel .

ascends the upper arm to converge at the shoulder; a branch goes over the shoulder bone and the scapula to attach itself to the (upper thoracic) spine. From the shoulder, the main channel ascends to the neck; from there a branch ascends across the

cheeks to converge at the cheekbone. The main branch of the Muscle channel ascends in front of the Small Intestine Muscle channel to reach the corner of the forehead; it then crosses over the top of the head to connect with the mandible on the opposite side.

MORPHOLOGY AND PATHWAYS OF THE MUSCLE CHANNELS

303

,--,.~,.-------- Galea aponeurotica w-c - + - - - - - Temporalis -4--4:,..,....f-- - - - - Orbicularis oculi

~..-!Iii~'/------ Masseter ~If-f------ Risorius

,..- A - - - - - - Platysma

·:-lr'IH'l-- - Biceps brachii

.1 • -*--- Brachioradialis n..l-'11--- Extensor carpi radialis longus

Extensor digitorum

Fig. 17.15 Large Intestine Muscle channel.

CLINICAL NOTE The Large Intestine Muscle channel flows over the head and to the other side like headphones. This probably is an added reason for the importance of L.l.-4 Hegu in the treatment of headaches.

SUMMARY lARGE INTESTINE MUSCLE CHANNEL PATHWAY

• • • • • •

It begins at the lateral end of the second finger It converges at the dorsum of the wrist It ascends the forearm and converges at the lateral aspect of the elbow It ascends t he upper arm to converge at the shoulder A branch goes over the shoulder bone and the scapula to attach itself to the [upper thoracic] spine From the shou lder, the main channel ascends to the neck; from there a branch ascends across the cheeks to converge at the cheekbone • The main branch of the Muscle channel ascends in front of the Small Intestine Muscle channel to reach the corner of the forehead • It then crosses over the top of the head to connect with the mandible on the opposite side • It connects with the Muscle channels of the Small Intestine, Bladder and Stomach.

304

PART 4: MUSCLE CHANNELS (JJNG JJN)

The Large Intestine Muscle channel connects with the Muscle channels of the Small Intestine, Bladder and Stomach.

The three Yin of the arm Lung Muscle channel {Fig.l7.16) The Lung Muscle channel originates on the thumb and ascends to converge at the thenar eminence; it then travels along the lateral side of the radial pulse [ Cun Kou] and ascends the lateral side of the inner forearm to converge inside the elbow. It continues along the anterolateral aspect of the upper arm to enter the chest below the axilla and emerge in the region of the supraclavicular fossa (ST-12 Quepen). It runs laterally to the shoulder where it converges.

It then descends to the supraclavicular fossa {ST-12)

and enters the chest to scatter through the cardia and converge in the lowest ribs. The Lung Muscle channel connects with the Muscle channels of the Heart and Pericardium.

CLINICAL NOTE

The Lung Muscle channel spreads all over the chest: this is a further explanation of the importance of the Lung channel for chest symptoms. As it controls all the muscles of the chest and upper ribs, it explains the sense of breathlessness and discomfort of the chest experienced by patients who are overcome by worry, sadness and grief (emotions that injure the Lung).

SUMMARY LUNG MUSCLE CHANNEL PATHWAY • It originates on the thumb • It ascends to converge at the thenar em inence • It travels along the lateral side of the radial pulse and ascends the lateral side of the inner forearm to converge inside the elbow • It continues along the anterolateral aspect of the upper arm to enter t he chest below t he axi lla and emerge in the region of the supraclavicular fossa (ST- 12 Quepen) • It runs laterally to the shou lder where it converges • It t hen descends to the supraclavicular fossa (ST- 12) and enters t he chest to scatter t hrough the cardia and converg e in t he lowest ribs • It connect s with the Muscle channels of the Heart and Pericardium.

Pericardium Muscle channe l (Fig. 17.17)

Fig. 17.16 Lung Muscle channel.

The Pericardium Muscle channel originates at the tip of the middle finger and runs together with the Lung Muscle channel to converge at the medial side of the elbow. It then runs up the medial side of the upper arm to reach the area below the axilla where it converges before descending to scatter over the anterior and posterior aspects of the ribs. A branch enters the axilla, disperses inside the chest and converges at the diaphragm.

MORPHOLOGY AND PATHWAYS OF THE MUSCLE CHANNELS

305

SUMMARY PERICARDIUM MUSCLE CHANNEL PATHWAY • It originates at the tip of the middle finger • It runs together with the Lung Muscle channel to converge at the medial side of the elbow • It runs up the medial side of the upper arm to reach the area below the axilla where it converges • It descends to scatter over the anterior and posterior aspects of the ribs • A branch enters the axilla, disperses inside the chest and converges at the diaphragm • It connects with the Muscle channel of the Lung.

Fig. 17.17 Pericardium Muscle channel.

CLINICAL NOTE A notable aspect of the Pericardium Muscle channel is its spreading to the diaphragm: this explains the effect of P-6 Neiguan on digestive and respiratory symptoms such as belching, hiccup and sighing.

The Pericardium Muscle channel connects with the Muscle channel of the Lung.

Heart Muscle channel (Fig. 17.18) The Heart Muscle channel originates at the radial aspect of the little finger and converges at the wrist. It ascends to converge first at the medial aspect of the elbow and then at the axilla. It enters the axilla.

Fig. 17.18 Heart Muscle channel.

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PART 4: MUSCLE CHANNELS (JING JIN)

SUMMARY HEART MUSCLE CHANNEL PATHWAY

• It originates at the radial aspect of the little finger • It converges at the wrist • It ascends to converge first at the medial aspect of the elbow and then at the axilla • It enters the axi lla, joins with the Lung Muscle channel and travels up to the centre of the chest passing through the inside of the breast • It descends across the diaphragm to terminate at the umbilicus • It connects with the Muscle channel of the Lung.

- Large Intestine: connects with the Small Intestine, Bladder and Stomach Muscle channels - Lung: connects with the Heart and Pericardium Muscle channels - Pericardium: connects with the Lung Muscle channel -Heart: connects with the Lung Muscle channel. I have grouped the Muscle channels into two groups of Yang and Yin channels as, when represented in diagrammatic form, they form an interesting diagram (Fig. 17.19). Figure 17.19 clearly shows how the interrelationships among the Yang channels are much denser and more numerous than those among the

Bladder

joins with the Lung Muscle channel and travels up to the centre of the chest passing through the inside of the breast. It then descends across the diaphragm to terminate at the umbilicus. The Heart Muscle channel connects with the Muscle channel of the Lung.

Small Intestine Large Intestine Triple Burner

CONNECTIONS As is evident from the pathways of the Muscle channels, each Muscle channel joins or connects with many others as follows: - Bladder: connects with the Large Intestine, Small Intestine, Gall Bladder, Stomach and Kidney Muscle channels - Gall Bladder: connects with the Stomach and Bladder Muscle channels - Stomach: connects with the Gall Bladder, Large Intestine and Bladder Muscle channels -Spleen: connects with the Liver and Kidney Muscle channel -Liver: connects with the Spleen Muscle channel - Kidneys: connects with the Spleen and Bladder Muscle channels - Small Intestine: connects with the Bladder, Large Intestine, Triple Burner and Stomach Muscle channels -Triple Burner: connects with the Small Intestine Muscle channel

Gall Bladder Stomach Kidneys Heart Lungs Spleen Liver Pericardium

Fig. 17.19 Interrelationships of Muscle channels.

MORPHOLOGY AND PATHWAYS OF THE MUSCLE CHANNELS

Yin channels. As we shall see, this is significant in practice as it reflects the fact that the Yang Muscle channels have the important function of promoting the movement of Qi among the three Yang channel groups of Greater Yang, Bright Yang and Lesser Yang. For reasons explained in Chapter 2, the relationship between, and Qi movement among, the Yang channels, is closer than that between, and among, the Yin channels of Greater Yin, Lesser Yin and Terminal Yin. The close and dense interrelationships among the Yang Muscle channels confirm this; indeed, the close interrelationships among the Yang Muscle channels is another way in which the interrelationships among the Yang Main channels are rendered dense. It is interesting to note that skeletal muscles act in groups rather than singly. In particular, prime movers within a group of muscles produce movement; antagonist muscles within a group relax while the prime mover is contracting; synergist muscles within a group contract at the same time as the prime mover. This action in groups presents an interesting correlation with the ancient Chinese grouping of Muscle channels in groups of three. The Western concept of groups of muscles is a lso mirrored in the close interrelationship between Muscle channels, not only within each group of three, but also between groups (see Figure 17. 7).

SUMMARY MEETING POINTS OF THE MUSCLE CHANNELS

• S.l.-18 Quanliao (or ST-7 Xiaguan): three Yang of the leg • Ren-3 Zhongji: three Yin of the leg • G.B.-13 Touwei: three Yang of the arm • G.B.-22 Yuanye: three Yin of the arm.

Apart from the above Meeting points of the Muscle channels, one other point, ST-12 (Quepen) is a crossing point of four Muscle channels, i.e. the Bladder, Gall Bladder, Stomach and Large Intestine. This is probably a further explanation of this point's action in promoting the descending of Qi.

THE MUSCLES ALONG THE MUSCLE CHANNEL PATHWAYS Tables 17.3 to 1 7.14 are lists of the muscles affected by each Muscle channel. .-Table 17.3

Location

MEETING POINTS The Muscle channels meet at certain points as follows: • the three Yang of the leg: S.I.-18 Quanliao (or ST-7 Xiaguan) • the three Yin of the leg: Ren-3 Zhongji • the three Yang of the arm: G.B.-13 Touwei • the three Yin of the arm: G.B.-22 Yuanye. The use of these points is particularly important in chronic conditions when pathology of a Muscle channel affects neighbouring Muscle channels. Typical examples of this are: sciatica on the Bladder, Gall Bladder and Stomach channels, elbow tendinitis on the Large Intestine and Triple Burner channels, shoulder-joint ache on the Large Intestine and Triple Burner channels, and ache on the top of the shoulders and neck on the Small Intestine, Large Intestine and Triple Burner channels.

307

Bladder Muscle channel

Muscle Superficial

Deep

Foot and leg Soleus Peroneus Longus Gastrocnemius Plantaris Semitendinosus Biceps Femoris Adductor Magnus Gluteus Maximus Gluteus Medius

Peroneus Tertius Peroneus Brevis Tibialis Posterior Flexor Digitorum Longus Popliteus Semimembranosus Quadratus Femoris Obturator lnternus Piriformis

Back

Erector Spinae Spinalis Longissimus capitis Longissimus cervicis Serratus Posterior Inferior lntertransversarii Interspinalis Iliocostalis Semispinalis Serratus Posterior Superior Splenius Cervicis Splenius Capitus Suboccipital Muscles

Latissimus Dorsi Trapezius Infraspinatus Teres Major Teres Minor Deltoid

I

Continued

308

PART 4: MUSCLE CHANNELS (JING JIN)

Table 17.3

I

Bladder Muscle channel-cont'd

Table 17.5

Muscle Location

Superficial

Head and neck

Occipitalis Levator Anguli Oris Frontalis Buccinator Orbicularis Oculi Scalenes Omohyoid Procerus Nasalis Levator Scapulae Levator Labii Subclavius Superioris Alaeque Nasi Levator Labii Superioris Zygomaticus Major Risorius Platysma Sternocleidomastoid Pectoralis Major Latissimus Dorsi

Chest

I

Table 17.4

Location

Pectoralis Minor External Oblique Serratus Anterior External lntercostals Internal lntercostals

Gal l Bladder Muscle channel

Muscle Superficial Dorsal Interossei Extensor Digitorum Brevis

Leg

Peronius Tertius Peronius Brevis Peronius Longus Tibialis Anterior Quadriceps Femoris Vastus Lateralis Tensor Fascia Latae Gluteus Maximus Gluteus Medius

Extensor Digitorum Longus

Trunk

External Oblique Latissimus Dorsi Pectoralis Major

Internal Oblique Teres Major Serratus Anterior Pectoralis Minor External lntercostals Internal lntercostals

Muscle Superficial

Deep

Foot

Dorsal interossei Extensor Digitorum Brevis

Leg

Extensor Digitorum Longus Tibialis Anterior Soleus Vastus Medialis Rectus Femoris Vastus Lateralis Sartorius Tensor Fascia Latae Pectineus Popl1teus

Abdomen External Oblique Rectus Abdominis Diaphragm

l

Deep

Foot and Ankle

Neck and Head

Location

Deep

Stomach Muscle channel

Scalenes: Anterior, Deltoid Medial and Posterior Trapezius Sternocleidomastoid Lateral Pterygoid Posterior Auricular Temporalis Masseter Zygomaticus Major Zygomaticus Minor Levator Labii Superioris Orbicularis Oculi

Extensor Hallucis Longus Vastus Intermedius Adductor Longus Adductor Magnus Adductor Brevis Iliopsoas Psoas Major Psoas Minor Iliacus Quadratus Lumborum Internal Oblique Transversus Abdominis Quadratus Lumborum

Back

External Oblique Latissimus Dorsi Gluteus Medius

Chest

Pectoralis MaJor

Internal lntercostals

Neck and Face

Sternocleidomastoid Platysma Depressor Anguli Oris Risorius Masseter Zygomaticus Major Zygomaticus Minor Levator Labii Superioris Nasalis Orbicularis Oculi Temporal is

Subclavius Omohyoid Scalenes Stylohyoid Digastric Buccinator Medial Pterygoid Lateral Pterygoid

I

Table 17.6

Location

Spleen Muscle channel

Muscle Superficial

I

Deep

Foot and Leg

Extensor Hallucis Longus Tibialis Anterior Flexor Digitorum Longus Soleus Gastrocnemius Vastus Medialis Rectus Femoris Sartorius Pectineus

Adductor Longus Adductor Magnus Adductor Brevis Vastus Intermedius Obturator Externus Psoas Major Psoas Minor

Abdomen

Rectus Abdominis

Internal Oblique

MORPHOLOGY AND PATHWAYS OF THE MUSCLE CHANNELS

I

Table 17.7

Location Foot

Muscle Superficial

I I

Deep

Flexor Digitorum Longus Soleus Gastrocnemius Vastus Medialis Sartorius Rectus Femoris

Table 17.9

Location Hand and Arm

Back

Neck and Head

Small Intestine Muscle channel

Muscle Superficial

l

Muscle Superficial

[

Deep

Foot

Flexor Digitorum Brevis Lumbricals Abductor Hallucis Abductor Digiti Minimi

Adductor Hallucis Flexor Hallucis Brevis Plantar Interossei Flexor Digiti M inimi Brevis Quadratus Plantae

Leg and Groin

Soleus Gastrocnemius Sartorius Gracilis Adductor Longus Pectineus Psoas Major Rectus Abdominis

Flexor Digitorum Longus Adductor Magnus Adductor Brevis Obturator Externus

I Adductor Magnus Adductor Longus Pectineus Obturator Externus Psoas Major

Kidney Muscle channel

Table 17.8

Location

Dorsal Interossei Extensor Hallucis Brevis

Leg

~

Liver Muscle channel

309

~

Table 17.10

Triple Burner Muscle channel

Muscle Superficial

Deep

Deep

Location

Abductor Pollicis Brevis Flexor Carpi Ulnaris Flexor Digitorum Profundus Brachialis Triceps Brachii Deltoid

Flexor Pollicis Brevis Flexor Digitorum Profundus Coracobrachialis Teres Major

Hand

Dorsal Interosseus

Arm and Shoulder

Extensor lndicis Flexor Digitorum Profundus Supinator

Trapezius

Infraspinatus Teres Major Teres Minor Rhomboideus Major

Extensor Carpi Ulnaris Extensor Digiti Minimi Anconeus Extensor Carpi Radialis Longus Triceps Brachii Delto1d

Neck and Head

Trapezius Sternocleidomastoid Platysma Masseter Zygomaticus Major Orbicularis Oculi Temporalis

Levator Scapulae Stylohyoid Digastric Medial Pterygoid Lateral Pterygoid

Sternocleidomastoid Levator Scapulae Posterior Auricular Temporalis Masseter Platysma Zygomaticus Major Orbicularis Oculi

Splenius Capitis Middle Scalene Buccinator Risorius

l

310

r

PART 4: MUSCLE CHANNELS (JING JIN)

Table 17.11

Large Intestine Muscle channel

lI

Table 17.13

Muscle

Muscle

Location

Superficial

Hand and Wnst

Dorsal Interosseus

Arm

Extensor Digitorum Extensor Carpi Radialis Longus Extensor Carpi Radialis Brevis Brachioradialis Brachialis Biceps Brachii Deltoid

Extensor Pollicis Brevis Abductor Pollicis Longus Supinator Supraspinatus Subscapularis

Shoulder and Neck

Trapezius Sternocleidomastoid

Scalenes Levator Scapulae

Face and Head

Platysmus Buccinator Masseter Medial Pterygoid Risorius Lateral Pterygoid Zygomaticus Major Zygomaticus Minor Levator Labii Superioris Orbicularis Oculi Nasalis Temporalis Masseter

Upper Back

Deep

Trapezius Deltoid Latissimus Dorsi

Table 17.12

Pericardium Muscle channel

I

Levator Scapulae Supraspinatus Rhomboideus Minor Rhomboideus Major Infraspinatus

Location

Superficial

Deep

Hand

Lumbricals

Palmar Interosseus (Carpal Tunnel)

Arm

Palmaris Longus Flexor Digitorum Superficial is Flexor Carpi Radialis Palmaris Longus Pronator Teres Biceps Brachii

Flexor Digitorum Profundus Brachia lis

Chest

Pectoralis Major Latissimus Dorsi External Oblique

Coracobrachialis Teres Major Pectoralis Minor Serratus Anterior External lntercostals Internal lntercostals

I

Table 17.14 Muscle Superficial

Deep

Hand and Arm

Flexor Digiti Minimi Brevis Abductor Digiti Minimi Flexor Carpi Ulnaris Palmaris Longus Biceps Brachii Triceps Brachii Coracobrachialis

Opponens Digiti Minimi Flexor Digitorum Profundus Brachial is Teres Major

Chest and Abdomen

Pectoralis Major Rectus Abdominis

Pectoralis Minor Subscapularis Serratus Anterior External lntercostals Internal lntercostals Transversus Abdominis Internal Oblique

Muscle Superficial

Deep

Hand and wrist

Abductor Pollicis Brevis

Opponens Digiti Minimi

Arm

Abductor Pollicis Longus Brachioradialis Biceps Brachii Deltoid

Pronator Quadratus Flexor Digitorum Superficial is Pronator Teres Supinator Brachial is Coracobrachialis

Chest

Pectoralis Major Latissimus Dorsi Serratus Anterior External Oblique

Teres Major Subscapularis Subclavius Pectoralis Minor External lntercostals Internal lntercostals

I

Location

Lung Muscle channel

Location

Heart Muscle channel

I

NOTES l. J 98 1 Spiritua l Axis (Ling Shu jing !>!. m~ ).People's Health Publishing House. Beijing. first published c. 100 Be. p. 43-4 7. 2. Deadma n 1'. AI-Khafaji M 1998 A Manual of Acupuncture. journal of Chinese Medicine Publications. Hove. England 3. Spiritual Axis. p. 45.

I

CHAPTER 18

MUSCLE CHANNELSFUNCTIONS AND AETIOLOGY FUNCTIONS OF THE MUSCLE CHANNELS 311 They protect the body from trauma 311 They sustain the body in its erect position 311 They maintain the integrity of the body by connecting the '100 bones' 311 They govern the movement of joints and allow movement of the body 311 They contribute to the integration of the surface of the body with the Interior 312 They contribute to the integration and connection among the three Yang channels (Greater Yang, Bright Yang and Lesser Yang) and among the three Yin channels (Greater Yin, Lesser Yin and Terminal Yin) 312 They are nourished by the Main channels 313 AETIOLOGY OF THE MUSCLE CHANNELS 313 External pathogenic factors 313 Trauma 314 Overuse and repetitive use 314 Internal Organ problems transmitted to the Muscle channels 314

FUNCTIONS OF THE MUSCLE CHANNELS The functions of the Muscle channels can be described as follows.

They protect the body from trauma The muscle mass of the body protects the Internal Organs from trauma and prevents injury to them or the bones except in cases where the trauma is such that it exceeds the muscular protection of the body. In fact, minor or major trauma is a frequent aetiological factor in disease of the Muscle channels.

They sustain the body in its erect position The muscles help the bones to maintain the erect posture of the body. In fact, a slackening and atrophy of the muscles causes a person's body to lose its capacity to remain erect.

They maintain the integrity of the body by connecting the '100 bones' Each of the skeletal muscles originates from a bone and inserts into a bone. The muscles therefore contribute to maintaining the integrity of the body and of the skeletal system by connecting the bones (which the ancient Chinese ca lled the '100 bones'). This function of the muscles is not purely a mechanical one but also an energetic one. As the muscles are part of the Muscle channels where Qi and Blood circulate and as the bones are important sites of Blood circulation, the Muscle channels contribute to maintaining the integrity of the bone system and to promoting the circulation of Qi and Blood in muscles and bones.

They govern the movement of joints and allow movement of the body The muscles govern the movement of the bones and joints. Again, from the point of view of Chinese medicine, this is as much an energetic as a mechanical function. Qi and Blood flowing in the Muscle channels allow the movement of joints. Moreover, joints are sites of convergence of Qi and Blood of the Muscle channels and of the bones.

311

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PART 4: MUSCLE CHANNELS (JING JIN)

They contribute to the integration of the surface of the body with the Interior As mentioned above. the Muscle channels are part of the 'Exterior' of the body {in addition to the Connecting channels and the skin itself). Therefore, together with the Connecting channels, the Muscle channels contribute to integrating the Exterior with the Main channels and with the Interior of the body. However, it should be said that this function is performed primarily by the Connecting channels and that the Muscle channels play only a secondary role in this. As explained in the previous chapter {Ch. 17), the Muscle channels constitute the 'Exterior' of the body in a different sense than the Connecting channels (see Fig. 17.1). The Connecting channels constitute the 'Exterior' of the body more in an energetic than in a physical sense: they are the superficial channels running in all directions that are between the Main channels and the skin. They are the channels through which pathogenic factors penetrate the body initially and the channels where the Defensive Qi circulates. The Connecting channels are directly connected to the Main channels and, indeed, they are the main route through which pathogenic factors may penetrate into the Main channels. In contrast to the Connecting channels. the Muscle channels are part of the 'Exterior' of the body, more in an anatomical than an energetic sense. Muscle channels are also easily invaded by external pathogenic factors: however. such invasions manifest primarily with muscular symptoms such as ache, pain or stiffness without the general symptoms of invasion of the Defensive-Qi portion (aversion to cold. fever, sore throat. etc.) which occur when the Connecting channels are invaded.

with the Greater Yang and Greater Yin representing the exterior of the Yang and of the Yin channels respectively; the Bright Yang and Lesser Yin representing the interior of the Yang and of the Yin channels respectively; and the Lesser Yang and Terminal Yin representing the hinge of the Yang and of the Yin channels respectively (see Table 17.2). There is a constant movement of Qi from the Exterior to the Interior and vice versa within the Yang and within the Yin channels: this movement is one aspect of the general entering and exiting of Qi within the Qi Mechanism (Qi Ji). For example, the Large Intestine channel runs on the anterior aspect of the neck, the Triple Burner on the lateral side and the Small Intestine on the posterior side (Fig. 18.1); these represent the Interior (Bright Yang), Hinge (Lesser Yang) and Exterior (Greater Yang) of the Yang channels respectively. This movement of Qi among the Exterior, Hinge and Interior involves all channels, i.e. Muscle, Connecting and Main channels. However, as the Muscle channels often overlap with each other and as each Muscle channel is connected with several others, forming a dense web of relationships (see Figure 17.19), the Muscle channels play an important role in ensuring the smooth movement of Qi among the Exterior (Greater Yang and Greater Yin). Hinge (Lesser Yang and Terminal Yin) and Interior (Bright Yang and Lesser Yin).

7""'"':.' Tai Yang : : Opens onto 1 I extenor I I

I :

'

They contribute to the integration and connection among the three Yang channels (Greater Yang, Bright Yang and lesser Yang) and among the three Yin channels (Greater Yin, lesser Yin and Terminal Yin) As mentioned in previous chapters. there is a progression of depth within the Yang and the Yin channels

I I

.:......!. shao Yang I ' :'Hinge' 1 I I 1

Yang Ming Opens onto interior

Fig. 18.1 Greater Yang, Bright Yang and Lesser Yang in the neck.

MUSCLE CHANNELS - FUNCTIONS AND AETIOLOGY

SUMMARY FUNCTIONS OF THE MUSCLE CHANNELS

• They protect t he body from trauma • They sustain the body in its erect position • They maintain the integrity of the body by connecting the '1 00 bones' • They govern the movement of joints and allow movement of the body • They contribute to the integration of the surface of the body with the Interior • They contribute to the integration and connection among the three Yang channels (Greater Yang, Bright Yang and Lesser Yang) and among the three Yin channels (Greater Yin, Lesser Yin and Terminal Yin) • They are nourished by the Main channels.

They are nourished by the Main channels Although it is said that the Muscle channels do not connect with the Interior, as explained above there is naturally an energetic relationship between the Muscle and the Main channels. The Muscle channels rely on the Main channels for their warmth, nourishment and moisture; in other words, Qi and Blood of the Main channels warm and moisten the muscles.

313

Muscle channels for a long time. Chapter 13 of the 'Spiritual Axis' says: 'Cold in the Muscle channels causes contraction and spasm; Heat causes muscle slackness and weakness.' 1 Acute invasion of Cold is a very common cause of Muscle-channel pathology bringing about stiffness and pain: if someone wakes up in the morning with a sudden pain and stiffness of a muscle, that is most probably a typical case of invasion of Cold in the Muscle channels. The pain deriving from Cold in the muscles is typically alleviated by the application of heat and aggravated by exposure to cold. If the acute invasion of Cold in the muscles is not treated, this may become chronic and Cold may be retained in the muscles for a long time causing repeated bouts of ache and stiffness of the muscles. This is more likely to occur in persons with a constitutional tendency to Yang deficiency.

Wind Wind also contracts the Muscle channels and causes spasm, pain and facial paralysis. In particular, external Wind in the Muscle channels of the face may cause facial paralysis as Wind can cause movement (tremors) or its opposite (paralysis). An invasion of Wind in the Muscle channels is characterized by a generalized muscle ache and contraction as opposed to Cold, which causes a more localized pain and contraction.

Dampness

AETIOLOGY OF THE MUSCLE CHANNELS Causes of disease of the Muscle channels are as follows.

External pathogenic factors External pathogenic factors invading only the Muscle channels do not cause any exterior symptoms such as aversion to cold and fever. sore throat. Floating pulse, etc. The symptoms of exterior invasions are a manifestation of Connecting-channel not Musclechannel pathology.

Cold Invasion of Cold in the Muscle channels will cause contraction, spasms and pain. Cold may stay in the

Dampness invades the Muscle channels causing a dull ache and a feeling of heaviness. Acute Dampness may also frequently become chronic, in which case Dampness settles in the muscles and causes a chronic, dull ache and a characteristic feeling of heaviness. The muscle ache deriving from Dampness is typically aggravated by exposure to damp weather. Dampness in the Muscle channels is a cause of the common symptom of muscle ache seen in chronic postviral fatigue syndrome.

SUMMARY AETIOLOGY OF TH E MUSCLE CHANNELS

• Cold: contraction , spasm, pain • Wind: contraction, pain, paralysis • Dampness: muscle ache, heaviness.

314

PART 4: MUSCLE CHANNELS (JING JIN)

Trauma

SUMMARY

Trauma causes Qi stagnation in the Muscle channels; if severe, it will cause local Blood stasis in the Muscle channels. The main manifestations are pain and local swelling. If the trauma causes Qi stagnation, the pain is not severe and is accompanied by a feeling of local distension; if the trauma causes Blood stasis, the pain is more severe and is stabbing in nature. The Blood stasis deriving from trauma may also become chronic, leading to chronic pain in the area.

AETIOlOGY OF MUSClE CHANNEl PROBlEMS • External pathogenic factors: -Cold -Wind -Dampness • Trauma • Overuse and repetitive use • Internal organ problems transmission.

Overuse and repetitive use Overuse and repetitive use of a joint are common causes of pathology of the Muscle channels causing pain and tingling. This, and the overuse and repetitive use of muscles, is a common cause of pathology of the Muscle channels in Western patients; the repetitive use of small muscles such as those used in typing or in handling a mouse for many hours a day is an unnatural use of a group of muscles which our bodies were not designed for. This often leads to Qi stagnation (from a Western perspective, inflammation) in the muscles, causing contracture, spasm and pain. As mentioned before, it should be remembered that in such problems, it is usually not only the Muscle channels that are involved, but also the Connecting channels.

Internal Organ problems transmitted to the Muscle channels Although the Muscle channels do not connect directly with the Internal Organs, problems of the organs can, in time, be transmitted to the Muscle channels. For example, Liver-Yang rising will cause a stiffness in the neck muscles, Liver-Wind will cause contraction of the muscles , a deficiency of the Stomach and Spleen will cause a flaccidity of the muscles, etc.

NOTES 1. 198 1 Spiritua l Axis (Ling Shu jing lll, ij! ~ ) .Peo pl e's Health Publishin g House, Beijing. first published c. 100 BC. p. 46-47.

CHAPTER 19

PATHOLOGY AND SYMPTOMS OF MUSCLE CHANNELS PATHOLOGY 375 SYMPTOMS 375 Three Yang channels of the leg 37 5 Three Yin channels of the leg 376 Three Yang channels of the arm 316 Three Yin channels oft he arm 3 77

PATHOLOGY The pathology of the Muscle channels involves two basis conditions of Fullness or Emptiness. Fullness manifests with pain, contracture, stiffness and hardness; Emptiness manifests with slackness, flaccidity and a dull ache. Tingling may be due to Full conditions such as Phlegm in the muscles or to Empty conditions such a deficiency of Blood. Chapter 13 of the 'Spiritual Axis' says: 'When Yang is in spasm, there is ina/Jility to /Jend: wizen Yin is in spasm, inability to extend. ' 1 This statement refers to the muscles of the Yang and Yin surfaces of the body and to all joints. When the muscles of a Yang surface are tight, the joint cannot be flexed; when the muscles of a Yin surface are tight, the joint cannot be extended. When the muscles of the back are tight, the patient cannot bend forwards; when the muscles of the front are tight, the person cannot bend backwards.

SYMPTOMS The symptoms and signs described in the 'Spiritual Axis' are as follows. 2

Three Yang channels of the leg Bladder Muscle channel When the Bladder Muscle channel is diseased there is strain of the little toe muscle, swelling and pain of the heel, contracture in the popliteal region, backward bending of the spine (opisthotonos), occipital stiffness, inability to raise the shoulder, pain from the axilla to supraclavicular fossa (ST-12 Quepen), and an inability to turn the head from side to side. For treatment, apply rapid insertion and withdrawal of a hot needle; repeat the treatment as long as is necessary for the pain to subside. This condition is called Spring Painful Obstruction Syndrome (Bi m, Syndrome).

Gall Bladder Muscle channel When the Gall Bladder Muscle channel is diseased there is strain of the fourth toe muscle extending to the lateral side of the knee on rotation, inability to bend or extend the knee, muscle spasm in the popliteal fossa , strained muscles of the pelvis, pain in the sacrum extending up to the hypochondrium, and then up to the supraclavicular fossa (ST-12 Quepen), breast and neck; if there is contraction of the Muscle channel extending from the left to the right side, the right eye cannot open: that is because the Muscle channel that runs on the right temple, runs side by side with the Yang Stepping Vessel (Yang Qiao Mai). The channel on the left side extends to the right: when the left side channel is diseased at the corner of the forehead, the right foot cannot move. This [phenomenon] is called mutual intersection of the Muscle channels. For treatment, apply rapid insertion and withdrawal of a hot needle; repeat the treatment as long as

315

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PART 4: MUSCLE CHANNELS (JING JIN)

is necessary for the pain to subside. This condition is called Spring Painful Obstruction Syndrome (Bi Syndrome).

Stomach Muscle channel When the Stomach Muscle channel is diseased, there is strain of the middle toe muscle. stiffness of the foot and ankle, twisted muscles of the thigh in the region of ST-32 Futu, swelling of the anterior aspect of the thigh, hernial-like diseases, contracture of the abdominal muscles up to the supraclavicular fossa (ST-12 Quepen), deviation of the mouth, inability to close the eye; if the muscles are affected by Heat, this relaxes them and the eye cannot open. If the cheek muscles are contracted by Cold, the corner of the mouth moves; if they are slackened by Heat, the mouth is deviated . To treat in a condition of contraction of the muscles, spread horse fat on the cheek and apply a tincture of cinnamon; in a condition of slackening of the muscles, drive a hook from the mulberry tree on the slack corner of the mouth. Then make a fire with green mulberry-tree charcoal in a pit deep enough for the patient to sit in and feel warmth. Apply the ointment to warm up the contracted cheek. Then give the patient a drink of wine and a meal of meat. If the patient cannot drink wine, get him or her to drink a sma ll amount. After that, massage the diseased region three times and one can thus effect a cure. For treatment, apply rapid insertion and withdrawal of a hot needle; repeat the treatment as long as is necessary for the pain to subside. This condition is called Spring Painful Obstruction Syndrome (Bi Syndrome).

Three Yin channels of the leg

Spleen Muscle channel When the Spleen Muscle channel is diseased. there is strain of the muscle of the big toe, pain in the internal malleolus, twisting pain in the leg, pain in the medial aspect of the knee and thigh, pain in the genitalia, pain from the umbilicus to the hypochondrium on both sides, and pain inside the thoracic vertebrae region. For treatment, apply rapid insertion and withdrawal of a hot needle; repeat the treatment as long as necessary for the pain to subside. This condition is called Autumn Painful Obstruction Syndrome (Bi Syndrome).

Kidney Muscle channel When the Kidney Muscle channel is diseased, there is strain of the muscles on the sole of the foot. pain and twisted muscles along the course of the channel, epilepsy, and infantile convulsions. If the disease is in the back, the head cannot be bent forwards; if in the front, the head cannot be tipped backwards. When the Yang [channels] are affected, the back cannot be bent forwards, while when the Yin [channels] are affected, the back cannot be bent backwards. For treatment. apply rapid insertion and withdrawal of a hot needle; repeat the treatment as long as is necessary for the pain to subside. This condition is called Autumn Painful Obstruction Syndrome (Bi Syndrome).

Liver Muscle channel When the Liver Muscle channel is diseased, there is strain of the muscle of the big toe, pain in front of the internal malleolus, pain in the medial aspect of the knee, pain due to twisted muscles in the medial aspect of the thigh, disorders of the genitalia. impotence due to internal injury [excessive sexual activity], contraction of the genitals if injured by Cold, and slackness if injured by Heat. For treatment, one must move the fluids to clear Yin Qi. Apply rapid insertion and withdrawal of a hot needle; repeat the treatment as long as is necessary for the pain to subside. This condition is called Autumn Painful Obstruction Syndrome (Bi Syndrome).

Three Yang channels of the arm

Small Intestine Muscle channel When the Small Intestine Muscle channel is diseased , there is strain of the muscle of the little finger, pain in the posterior aspect of the elbow, pain on the medial aspect of the arm up to the area below the axilla. pain in the posterior aspect of the axilla, pain from the scapula to the neck. tinnitus, pain from the ear to the mandible, poor vision, stiffness of the neck, atrophy of muscles [of the neck] and swelling of the neck. For treatment, apply rapid insertion and withdrawal of a hot needle; repeat the treatment as long as is necessary for the pain to subside. This condition is called Summer Painful Obstruction Syndrome (Bi Syndrome).

PATHOLOGY AND SYMPTOMS OF MUSCLE CHANNELS

Triple Burner Muscle channel When the Triple Burner Muscle channel is diseased, there is strain and twisting pain of the muscles along the course of the channel and a curled tongue. For treatment, apply rapid insertion and withdrawal of a hot needle; repeat the treatment as long as is necessary for the pain to subside. This condition is called Summer Painful Obstruction Syndrome (Bi Syndrome).

Large Intestine Muscle channel When the Large Intestine Muscle channel is diseased. there is strain and pain of the muscles along the course of the channel, inability to raise the shoulder and inability to turn the head from side to side. For treatment, apply rapid insertion and withdrawal of a hot needle; repeat the treatment as long as is necessary for the pain to subside. This condition is called Summer Painful Obstruction Syndrome (Bi Syndrome).

Three Yin channels of the arm Lung Muscle channel When the Lung Muscle channel is diseased, there is strain and pain in the muscles along the course of the channel, breathlessness, pain in the hypochondrium and vomiting of blood. For treatment, apply rapid insertion and withdrawal of a hot needle; repeat the treatment as long as is necessary for the pain to subside. This condition is called Winter Painful Obstruction Syndrome (Bi Syndrome).

317

For treatment, apply rapid insertion and withdrawal of a hot needle; repeat the treatment as long as is necessary for the pain to subside. This condition is called Winter Painful Obstruction Syndrome (Bi Syndrome).

Heart Muscle channel When the Heart Muscle channel is diseased, there is strain and pain in the muscles along the course of the channel. For treatment. apply rapid insertion and withdrawal of a hot needle; repeat the treatment as long as is necessary for the pain to subside. If the patient is vomiting blood, it indicates that the condition cannot be treated and that it will result in death. If the disease is caused by Cold, contracture of the muscles will result; when it is caused by Heat, the muscles slacken. they cannot be contracted and the penis cannot be raised [impotence]. When the muscle cramp is in the Yang [channels of the back], the back is arched backwards; when it is in the Yin [channels of the abdomen], the patient bends the body but is unable to extend the back. The heated needle is used for contractions of the Muscle channels caused by Cold; when the Muscle channels are slackened by Heat. the heated needle should not be used. This condition is called Winter Painful Obstruction Syndrome (Bi Syndrome).

Pericardium Muscle channel

NOTES

When the Pericardium Muscle channel is diseased. there is strain and pain of the muscles along the course of the channel. breathlessness and chest pain.

l. 1981 Spiritual Axis (Ung S/111 Jing ill, 'II&!£ ). People's Health Publishing House. Beijing. first published c. 100 BC. p. 47. 2. Ibid .. p. 43- 47.

CHAPTER 20

TREATMENT OF MUSCLE CHANNELS CLINICAL SIGNIFICANCE 319 Harmonization and regulation of Yin and Yang channels 319 Regulation of Yang channels: horizontal f low of Qi 319 Exchange of Qi among Muscle channels in pathology 324 Upper Meeting points 324 TREATMENT 325 Massage 325 Gua Sha 325 Cupping 325 Acupuncture 325 THE MUSCLE CHANNELS IN THE TREATMENT OF PAINFUL OBSTRUCTION (B~ SYNDROME 326 Aetiology of invasion of Muscle channels 326 Pathology of external invasions of Muscle channels 326 Treatment of exterior invasions into Muscle channels 327

Treatment of the Muscle channels is very important primarily in musculoskeletal conditions and in Painful Obstruction (Bi) Syndrome.

CLINICAL SIGNIFICANCE

Harmonization and regulation of Yin and Yang channels An important aspect of the clinical significance of the Muscle channels is the role they play in regulating and harmonizing Yang and Yin Qi within the three Yang and three Yin channel systems respectively. i.e. Greater Yang, Lesser Yang, Bright Yang, Greater Yin. Lesser Yin and Terminal Yin. This is facilitated by the fact that

each Muscle channel connects with at least one other Muscle channel, as indicated earlier (see Fig. 17.19). The movement and interchange of Qi among the three Yang and the three Yin is an essential part of the movement of Qi between the Exterior and the Interior: this is part of the entering and exiting of Qi within the Qi Mechanism. Although such movement occurs also in the Main channels, due to the close relation among them, the Muscle channels play an important role in strengthening and promoting such movement.

SUMMARY HARMONIZATION AND REGULATION OF YIN AND YANG CHANNELS

• The Muscle channels f acilitat e t he movement of Qi among the t hree Yang (Greater Yang, Lesser Yang, Bright Ya ng) and among the th ree Yin channels (Greater Yin, Terminal Yin and Lesser Yin) • The movement of Qi among the t hree Yang and t he three Yin is part of the entering and exiting of Qi in t he Qi M echan ism.

Regulation of Yang channels: horizontal flow of Qi The regulating, harmonizing and connecting function of the Muscle channels is particularly evident in the Yang channels. As we have seen, there is a variation in energetic depth among the Yang channels: the Greater Yang 'opens' onto the Exterior (i.e. it is the most superficial of the Yang channels), the Bright Yang 'opens' into the Interior (i.e. it is the deepest of the Yang channels) and the Lesser Yang is the 'hinge' or

319

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PART 4: MUSCLE CHANNELS (JING JIN)

'axis' between the other two (i.e. it is at an intermediate energetic depth). These three energetic depths are reflected in the location of the Yang channels. For example, if we look at the three Yang of the arm, we can see that the Small Intestine channel (Greater Yang) flows on the lateral side of the arm, the Large Intestine channel (Bright Yang) on the medial side and the Triple Burner in between the two. The picture is even clearer if we consider the three Yang of the leg. In fact. the Bladder channel (Greater Yang) flows on the posterior surface of the leg; the Stomach (Bright Yang) channel flows on the medial side and, indeed, in the trunk, it flows on the abdomen and chest (a Yin surface); the Gall Bladder channel flows in between the two. In each part of the body, therefore, there is a movement of Qi between the Greater Yang, Bright Yang and Lesser Yang channels: I call this the 'horizontal' movement of Qi when compared to the 'vertical' movement of Qi in a particular channel. For example, if we look at the shoulder area, the upward movement of Qi in the Large Intestine, Triple Burner or Small Intestine channel is a 'vertical' movement of Qi between the fingers and the head; the movement of Qi between the Small Intestine (Greater Yang), Large Intestine (Bright Yang) and Triple Burner (Lesser Yang) channels is a 'horizontal' movement of Qi. When the channels are obstructed, we remove obstructions by using a distal and a local point; this combination promotes the vertical movement of Qi in the channel. To strengthen the effect of the treatment, it is advisable to remove obstructions exploiting also the horizontal movement of Qi by promoting the exchange of Qi among the Greater Yang, Bright Yang and Lesser Yang channels. An example will clarify this. Let us assume we are treating a shoulder problem occurring clearly along the Large Intestine channel and we therefore use L.I.-1 Shangyang as a distal point and L.I.-15 Jianyu as a local point. This combination has the effect of stimulating the ascending and descending of Qi along the Large Intestine channel, which will result in the removal of pathogenic factors. I call this the 'vertical' movement of Qi in the body. In order to reinforce the treatment further, it is advantageous to stimulate also what I call the 'horizontal' movement of Qi, i.e. that among the Greater Yang (which opens onto the Exterior), the Bright Yang

Fig. 20.1 Flow of Qi among the Greater Yang, Bright Yang and Lesser Yang in the shoulder.

(which opens onto the Interior) and the Lesser Yang (which is the hinge). In the shoulder, this could be achieved simply by using the adjacent point T.B.-14 Jianliao (Lesser Yang) and S.I.-11 Tianzong (Greater Yang). The use of these adjacent points will have the effect of stimulating the 'horizontal' circulation of Qi in the shoulder area among the Greater Yang (on the scapula), the Lesser Yang and the Bright Yang: this will contribute to the elimination of pathogenic factors from the area (Fig. 20.1). This regulation and exchange among the Yang channels is another way in which points from different Yang channels 'resonate with each other'. This concept requires an explanation. I have noticed an interesting phenomenon that seems to be valid especially for the Yang channels and especially (although not exclusively) on the head, face, neck and chest. If one looks at the indications for a point on, say, a Greater Yang channel on the face or head, one will find obviously many indications relative to the area the point is situated in. However, one often also finds some indications relative to areas of the Bright Yang or Lesser Yang channels (Fig. 20.2). Let us assume that a point on a Greater Yang channel, besides the obvious indications related to its Greater Yang area, has some indications relative to a Lesser Yang adjacent area; if we look at the indications of points in that area, we will often find a point that. besides having obvious indications relevant to the area it is situated in. will also have some indications relative to the area of the Greater Yang point. When

TREATMENT OF MUSCLE CHANNELS

AREA'A' Greater Yang area point - Indications

AREA'S' Lesser Yang area point- Indications

a) Relevant to area

a) Relevant to area

b) Relevant to area

b) Relevant to area

c) Acting on another area

c) Acting on another area

('8'), e.g. Lesser Yang

('!>:), e.g. Greater Yang area

321

AREA 'A'- Greater Yang S.l.-16 -Indications

AREA '8'- Yang Ming ST-11 -Indications

a) Relevant to area: shoulder pain radiating to neck, stiff neck with difficulty in turning the head

a) Relevant to area: swelling and pain of throat, goitre

b) Acting on another area, i.e. Bright Yang: throat pain and goitre

b) Acting on Greater Yang area: stiffness of the neck with inability to turn the head

Fig. 20.2 Resonating points. Fig. 20.4 Example of resonating points (2): S.l.-16 Tianchuang and ST-11 Qishe

thls happens, I say that those two points 'resonate' with each other. Therefore, when I treat local problems on a Yang channel (e.g. Greater Yang) I always check to see whether there are resonating points in adjacent areas from other Yang channels (e.g. Lesser Yang). Some examples wi.ll clarify this. Let us consider the pair of points of G.B.-2 Tinghui (Lesser Yang) and ST-7 Xiaguan (Bright Yang). The indications for G.B.-2 Tinghui (a Lesser Yang point near the ear) include obvious, ear-related ones such as 'tinnitus, deafness and ear discharge' but also some less obvious indications related to the teeth and mouth such as 'toothache and deviation of mouth' (a Bright Yang area). ST-7 Xiaguan (a Bright Yang point) includes obvious indications such as 'lockjaw, toothache and swelling of gum' but also some ear-related indications such as 'deafness, tinnitus. and ear discharge and pain' (Fig. 20.3). We can therefore say that these two points 'resonate' with each other and would therefore make a good combination to promote the now of Qi between the Lesser Yang and the Bright Yang channels. Therefore, when treating a local problem of the teeth or mouth in the Bright Yang area we can select

AREA 'A'- Lesser Yang G.B.-2 -Indications

AREA '8'- Bright Yang ST-7 -Indications

a) Relevant to area: tinnitus deafness, ear discharge b) Acting on another area, i.e. Bright Yang: toothache, deviation of mouth

a) Relevant to area: lockjaw, toothache, swelling of gum b) Acting on Lesser Yang area: deafness, tinnitus, ear discharge, ear pain

Fig. 20.3 Example of resonating points (1): G.B.-2 Tinghui (Lesser Yang) and ST-7 Xiaguan (Bright Yang).

ST-7 Xiaguan as a local point and G.B.-2 Tinghui as an adjacent point. Let us consider another example concerning S.I.-16 Tianchuang and ST-11 Qishe (Fig. 20.4). The indications for S.I.-16 Tianchuang (a Greater Yang point) include obvious, area-related ones such as 'shoulder pain radiating to the neck' or 'stiff neck with difficulty in turning the head' but also 'throat pain and goitre'; if we look at Bright Yang points on the front of the neck we find that the indications for ST-11 Qishe include 'stiffness of the neck with an inability to turn the head'. Therefore these two points 'resonate' with each other and, when treating a local problem of the neck in the Greater Yang area (for which we use S.I.-16), we can select ST-11 as an adjacent point to stimulate the movement of Qi between the Greater Yang and Bright Yang areas. Table 20.1 illustrates some examples of 'resonating' points from Yang channels; Table 20.2. illustrates some examples of 'resonating' points between mixed channels. The phenomenon of 'resonating points' is another reason for using adjacent points from neighbouring Yang channels when treating a certain area to facilitate the 'horizontal' movement of Qi between Yang areas, i.e. between Greater Yang, Lesser Yang and Bright Yang. However. it should be stressed that, when treating musculoskeletal problems in Yang areas. it is advantageous to combine the local points with adjacent points (even if they are not 'resonating' points) on Yang channels of the same polarity and different amounts of Qi to promote the horizontal movement of Qi between the Greater Yang. Bright Yang and Lesser Yang.

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PART 4: MUSCLE CHANNELS (JING JIN)

Table 20.1

Examples of 'resonating' points on Yang channels

Couple

Greater Yang

5.1.-16 Tianchuang 5T-11 Qishe

5.1.-16 a) Greater Yang area: shoulder pain radiating to the neck, stiff neck with difficulty in turning the head b) Bright Yang area: throat pain and goitre

G.B.-2 Tinghui 5T-7 Xiaguan

5.1.-11 Tianzong G.B.-22 Yuanye

Lesser Yang

Bright Yang 5T-11 a) Bright Yang area: swelling and pain of t hroat, goitre b) Greater Yang area; stiffness of the neck with inability to turn the head

G.B.-2 5T-7 a) Lesser Yang area: tinn itus, a) Bright Yang area: lockjaw, toothache and swelling of deafness, ear discharge gum b) Bright Yang area: toothache, deviation of mouth b) Lesser Yang area: deafness, t innitus, and ear discharge and pain 5.1.-11 a) Greater Yang area: pain in the shoulder and scapula b) Lesser Yang area: fullness of chest and hypochondrium, swelling of breast

T.B.-13 Naohui 5T-1 0 5huitu

G.B.-22

a) Lesser Yang area: hypochondria! pain, swelling of axilla b) pain of shoulder, pain in arm T.B.- 13 a) Lesser Yang area: pai n in the shoulder and arm b) Bright Yang area: goitre

T.B.-13 Naohui 5T-12 Quepen

T.B.- 13 a) Lesser Yang area: pain in the shoulder and arm b) Bright Yang area: goitre

5T-1 0

a) Bright Yang area: Goitre, scrofula of neck b) Lesser Yang area: pain in the shoulder 5T-12

a) Bright Yang area: Goitre, scrofu la of neck b) Lesser Yang area: pain in the shoulder and arm

BL-26 Guanyuanshu 5T-28 5huidao

BL-26 a) Greater Yang area: lumbar pain b) Bright Yang area: urinary problems

5T-28 a) Bright Yang area: urinary and gynaecological problems b) Greater Yang area: pain of lumbar vertebrae, shoulder and back

BL-23 5henshu 5T-12 Quepen

BL-23 a) Greater Yang area: lumbar pain b) Bright Yang area: asthma, cough

5T-12 a) Bright Yang area: chest pain, cough, asthma b) Greater Yang area: lumbar pain

T.B.-16 Tianyou 5T-12 Quepen

T.B.-16 a) Lesser Yang area: sudden deafness b) Bright Yang area: swell ing of supra-clavicular fossa

5T-12 a) Bright Yang area: chest pain, cough, asthma b) Lesser Yang area: pain of shoulder and neck

I

TREATMENT OF MUSCLE CHANNELS

Table 20.1 Couple

323

Examples of 'resonating' points on Yang channels- cont'd

Greater Yang

TB .-23 Sizhukong l.l.-20 Yingxiang

BL-2 Zanzhu l.l.-20 Yingxiang

BL-2 a) Greater Yang area: eye problems, headache b) Bright Yang area: nosebleed, rhinitis

G.B.-14 Yangbai BL-2 Zanzhu

BL-2 a) Greater Yang area: eye problems b) Lesser Yang area: headache

BL-2 Zanzhu ST-8 Touwei

BL-2 a) Greater Yang area: pain of eyebrow. blurred vision. lachrymation b) Bright Yang area: frontal headache

Table 20.2

Lesser Yang

Bright Yang

TB .-23 a) Lesser Yang area: eye problems b) Bright Yang area: toothache

l.l.-20 a) Bright Yang area: toothache, deviation of mouth, swelling of lip b) Lesser Yang area: heat and redness of eyes l.l.-20 a) Bright Yang area: nasal congestion and discharge, rhinitis b) Greater Yang area: heat and redness of eyes

G.B.-14 a) Lesser Yang area: headache b) Greater Yang area: eye pain

ST-8 a) Bright Yang area: frontal headache, b) Greater Yang area: bursting eye pain, lachrymation

Examples of 'resonating' points on mixed channels

Couple

First channel

Second channel

Du-16 Fengfu Ren-22 Tiantu

Du-16 Fengfu a) Governing Vessel area: headache, invasion of wind b) Directing Vessel area: swelling and pain of throat

Ren-22 Tiantu a) Directing Vessel area: fullness of chest, chest pain, asthma, rattling sound in throat, goitre b) Governing Vessel area: swelling of the back of the neck

SP-12 Chong men BL-30 Baihuanshu

SP-12 Chongmen a) Spleen channel area: abdominal pain, hernial disorders b) Bladder channel area: haemorrhoids

BL-30 Baihuanshu a) Bladder channel area: lumbar pain, coccyx pain, prolapse of rectum, difficult defecation b) Spleen abdominal channel area: menstrual problems, difficult urination

Du-17 Naohu Bl-2 Zanzhu

Du-17 Naohu a) Governing Vessel area: headache, neck pain, epilepsy b) Bladder channel area: blurred vision, myopia, eye pain

BL-2 Zanzhu a) Bladder channel area: eyebrow pain, blurred vision, lachrymation, swelling and pain of eye, itchy eyes b) Governing Vessel area: haemorrhoids, pain and stiffness of neck

LU-1 Zhongfu BL-13 Feishu

LU-1 Zhongfu a) Lung channel area: cough, asthma, chest pain b) Bladder channel area: pain of upper back

BL-13 Feishu a) Bladder channel area: pain in upper back, crooked spine, lumbar pain b) Lung channel area: cough, asthma, chest pain, chest fullness

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SUMMARY REGULATION OF YANG CHANNELS: HORIZONTAL FLOW OF Ql

• For musculoskeletal problems in Yang areas, combine t he local points with adjacent points on Yang channels of the same polarity and different amount of Qi (e.g. Greater Yang and Lesser Yang) to stimulate the 'horizontal' f low of Qi among t he Greater Yang, Bright Yang and Lesser Yang channels • 'Resonating' points are points from two Yang channels of different amounts of Qi (e.g. Greater Yang and Lesser Yang) that have reciprocal indications • Example: the indications for G.B.-2 Tinghui (Lesser Yang) include ear-related ones such as 'tinnitus, deafness and ear discharge' but also some less obvious indications related to the teet h and mout h such as 'toothache and deviat ion of mouth' (a Bright Yang area); ST-7 Xiaguan (Bright Yang) includes indications such as 'lockjaw, toothache and swelling of gum' but also some ear-related indications such as 'deafness, tinnitus, and ear discha rge and pain' • The phenomenon of 'resonating points' is another reason for using adjacent points from neighbouring Ya ng channels when t reating a certai n area to facilitate the 'horizontal' movement of Qi between Greater Yang, Lesser Yang and Bright Yang .

the Bladder, Gall Bladder and Stomach channels simultaneously. The use of the meeting points of the Muscle channels is particularly important in such cases (see below). Many other examples can be given: indeed in tendinomuscular problems, more than one Muscle channel is usually affected. For example, problems of the shoulders and neck very frequently affect the Greater Yang and Lesser Yang channels, and problems of the elbow and arm often affect Bright Yang and Lesser Yang areas, etc. It is actually relatively unusual for only one Muscle channel to be affected in any given pathology. The exchange between Muscle channels may also occur between Yang and Yin channels; a good example of this is a hip pain on the Gall Bladder channel extending to the groin along the Liver and Spleen Muscle channels.

SUMMARY EXCHANGE OF Ql AMONG MUSCLE CHANNELS IN PATHOLOGY

• Pathology of the Muscle channels f requently involves more tha n one channel • Example: sciatica manifesting on t he Bladder, Gall Bladder and Stomach channels simu ltaneously.

Upper meeting points It is important in Muscle channel problems to treat

Exchange of Qi among Muscle channels in pathology As we have seen in Chapter 17, there is a dense web of relationship among the Muscle channels, each Muscle channel communicating with several others; this web of relationships is particularly dense for the Yang Muscle channels (see Fig. 17.19). The exchange of Qi among the three Yang channels is also an important aspect of the pathology of the Muscle channels because the close physiological relationships among the Muscle channels mean that pathology of one channel may easily extend to others, especially in chronic conditions. A very good example of this is chronic sciatica, which often manifests on

the upper meeting points of the Muscle channels in order, in part, to strengthen the effect of distal and local points, and again in part to facilitate the exchange and regulation of Qi among the Yang channels. In chronic tendinomuscular problems, I therefore use a distal point to clear the channel combined with a local point to remove obstructions from the affected area. I call this the 'vertical' movement of Qi in the channel. I then use an adjacent point on another channel of the same polarity to promote the 'horizontal' movement of Qi among the three Yang or among the three Yin channels as described above. In addition, in chronic conditions, I use the u pper meeting point of the affected channels, i.e. S.I.-18 Quanliao (or ST-7 Xiaguan) for the three Yang of

TREATMENT OF MUSCLE CHANNELS

the leg, G.B.-13 Touwei for the three Yang of the arm, G.B.-22 Yuanye for the three Yin of the arm, and Ren-3 Zhongji for the three Yin of the leg. For example, in treating tendinitis of the elbow joint on tbe right side with pain on both the Large Intestine and Triple Burner Muscle channel areas, I would use L.I.-1 Shangyang or T.B.-8 Sanyangluo as a distal point and L.I.-11 Quchi and T.B.-10 Tianjing as local points. S.I.-8 Xiaohai as an adjacent point to stimulate the horizontal movement among Greater Yang, Bright Yang and Lesser Yang channels, and G.B.-13 Benshen on the right side. CLINICAL NOTE The Meeting points of the Muscle channels are : • three Yang of the leg: S.l.-18 Quanliao (or ST-7 Xiaguan) • three Yang of the arm: G.B.-13 Touwei • three Yin of the arm: G.B. -22 Yuanye • three Yin of the leg: Ren-3 Zhongji .

SUMMARY UPPER MEETING POINTS The upper meeting points of the Muscle channels are important for treating Muscle channel problems, partly to strengthen the effect of distal and local points and partly to facilitate the exchange and regu lation of Qi among the Yang channels.

TREATMENT Chinese medicine is rich in treatment modalities that affect the Muscle channels:

Massage Massage is especially indicated in Full conditions of the Muscle channels to relieve stiffness and cramp.

Gua Sha Gua Sha is excellent to eliminate Cold from the muscles.

325

Cupping Cupping eliminates Cold and stagnation of Qi/Biood from the muscles. It also expels Wind from the muscles.

Acupuncture The Muscle channels are involved in all cases of muscular pathologies such as sprain of a muscle, stiffness, flaccidity, and spasm. Two common conditions that involve pathology of the Muscle channels are Painful Obstruction (Bi) Syndrome and repetitive strain injury (RSI). In Painful Obstruction Syndrome, the muscles are obstructed by pathogenic factors such as Wind , Cold or Dampness, which in chronic cases leads to local stagnation of Qi/Blood in the joints. Stagnation of Qi in the Muscle channels leads to muscle ache and distension, while Blood stasis in the Muscle channels leads to pain. In RSI, there is a complex pathology of stagnation involving tendons, muscles and nerves; the Muscle channels are involved displaying symptoms of Qi stagnation. It is important to realize that both in Painful Obstruction Syndrome and in RSI, three types of channels are involved, i.e. the Muscle, Connecting and Main channels. Thus, it is often difficult to separate the pathology of one from the other. In general, the Muscle channels are simply treated by needling a distal point with reducing method in acute cases, and even method in chronic cases and local Ah Shi points with -relatively superficial needling. Relatively superficial needling affects the Muscle channels and is used in Empty conditions with reinforcing method and in Full conditions with reducing method. The acupuncture treatment of Muscle channels consists in using a distal point (often the Well point) and local, adjacent and Ah Shi points. The treatment of Muscle channels may also be based on a distinction between a Full condition and an Empty one. If the Muscle channel is Full (characterized by severe pain and rigidity) one can drain local points superficially and moxa the Main channel either on the opposite side or the same side, e.g. Source (Yuan) point. If the Muscle channel is Empty (characterized by a dull ache and flaccidity) one can torrify the Muscle channel with moxa cones on aching points and reduce

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the Main channel by draining a point such as its Well point. Chapter 13 of the 'Spiritual Axis' recommends using the Hot (or Fire) needle on painful points of the Muscle channels. 1

CLINICAL NOTE • Relat ively superficial needling affects the Muscle channels • The acupunct ure treatment of M uscle channels consists in using a distal point (often the Well point) and local, adjacent and Ah Shi points • If the Muscle channel is Full, drain local points superf icially and moxa the Main channel • If the M uscle channel is Empty, tonify the Muscle channel with moxa cones on achy points and reduce t he Main channel by drain ing a point such as its Well poi nt.

SUMMARY TREATMENT

• • • •

Massage Gua sha Cupping Acupuncture.

THE MUSCLE CHANNELS IN THE TREATMENT OF PAINFUL OBSTRUCTION (BI) SYNDROME Painful Obstruction (Bi) Syndrome is discussed more fully in Chapter 3 7. Here, it is discussed not in general but only in connection with the Muscle channels. 'Painful Obstruction (Bi) Syndrome' indicates pain, soreness or numbness of muscles, tendons and joints from invasion of external Wind, Cold or Dampness. Painful Obstruction Syndrome is an affliction of the channels alone, not the Internal Organs. The pain and soreness are caused by obstruction in the circulation of Qi and Blood in the channels by exterior Wind, Cold or Dampness. The Muscle channels integrate muscles and sinews within the channel system. They are involved in any muscular pathology such as muscular weakness, ache

or stiffness that may appear in Painful Obstruction Syndrome.

Aetiology of invasion of Muscle channels This is by definition invasion of external pathogenic factors such as Wind, Cold or Dampness.

Wind Wind is the most pernicious of all pathogenic factors and one that is almost always combined with the others. In relation to the Muscle channels, Wind causes stiffness and wandering pain in several groups of muscles.

Cold Cold causes contraction, spasm and pain of the muscles; the pain is distinctly alleviated by the application of heat to the muscle. A good example of an acute invasion of Cold in the Muscle channels is that of an acute torticollis, i.e. an acute severe stiffness and pain of the neck with inability to turn the neck.

Dampness Dampness settles in the muscles causing ache, swelling, numbness and a feeling of heaviness. All three pathogenic factors of Wind, Cold and Dampness can settle in the muscles and the Muscle channels to become chronic.

Pathology of external invasions of Muscle channels Since very ancient times Painful Obstruction Syndrome has been classified according to the predominant pathogenic factor, i.e. Wind, Cold or Dampness. However, a different classification of Painful Obstruction Syndrome appears in the 'Yellow Emperor's Classic of Internal Medicine - Simple Questions'. The 'Simple Questions' in Chapter 43 classifies Painful Obstruction Syndrome according to the tissue and organ affected. It says: 'The jive Yin organs are related to the jive tissues where a chronic disease can lodge iiself In Bone Painjill Obstruction Syndrome the pathogenic factor reaches the Kidneys; in Sinew Painful Obstruction Syndrome it reaches the Liver; in Blood Vessel Painful Obstruction Syndrome it reaches the Heart; in Muscle Painful ObsirucUon Syndrome it reaches the Spleen and in

TREATMENT OF MUSCLE CHANNELS

Skin Painful Obstruction Syndrome it reaches the Lungs. '2 It then says: 'Painful Obstruction Syndrome in the bones is serious, in the blood vessels it leads to Blood stasis, in the sinews it causes stiffness, in the muscles it leads to weakness and in the skin it causes Cold. ' 3 The 'Simple Questions' thus classifies Painful Obstruction Syndrome according to the tissue affected and it deduces which tissue is affected by the main manifestation, i.e. bone deformities in Bone Painful Obstruction Syndrome, Blood stasis in Blood Vessel Painful Obstruction Syndrome, stiffness in Sinew Painful Obstruction Syndrome, weakness in Muscle Painful Obstruction Syndrome and feelings of cold in Skin Painful Obstruction Syndrome. It also determines a difference in severity between the different types. In the same chapter it says: 'When Painful Obstruction Syndrome affects the organs it causes death; when it is situated in the bones or sinews it becomes chronic; when it is situated in the muscles or skin it easily goes. '4 Therefore, according to the above chapter of the 'Simple Questions' in the case of the muscles and Muscle channels, Painful Obstruction Syndrome causes a feeling of weakness of the muscles. However, it is important to understand that the classification of Painful Obstruction Syndrome according to tissues involved should not be taken rigidly: in clinical practice, different tissues and different types of channels are involved. In Painful Obstruction Syndrome, and especially in chronic conditions, it is unlikely that we would see pathology of the Muscle channels only (although it may be more likely in acute conditions). More often than not, the Muscle, Connecting and Main channels are all involved, particularly the first two types. An involvement of the Muscle channels will cause muscle ache and stiffness: the pain is more diffuse in muscle groups rather than being located in the joints. Other manifestations depend on the pathogenic factor involved: if Wind, there will be stiffness and wandering ache; if Cold, there will be more severe pain and contraction and spasm; if Dampness, there will be heaviness and swelling of the muscles. An involvement of the Connecting channels will cause joint pain. Other manifestations depend on the pathogenic factor involved: if Wind, more than one joint is affected with the pain moving from joint to joint; if Cold, there will be severe joint pain and possibly inability to extend or abduct a limb; if Dampness, there will be ache and swelling of a joint.

327

Treatment of exterior invasions into Muscle channels The aim of the treatment is simply to expel the pathogenic factors which have invaded the channels, and eliminate the resulting local stagnation of Qi and Blood in the channels. As a general principle, since the three pathogenic factors of Wind, Cold and Dampness are usually all present in Painful Obstruction Syndrome (although with the predominance of one or two) , the treatment is aimed at expelling Wind, scattering Cold and resolving Dampness. In relation to the Muscle channels, the treatment depends on the pathogenic factor involved. In cases of Wind, apart from needling, cupping would be appropriate; in cases of Cold, moxa on needles is an excellent method to expel Cold from the muscle; in cases of Dampness, apart from needling, cupping is also indicated. In terms of Transporting (Shu) points, the following are the best points to expel the relevant pathogenic factor from the Muscle channels:

- Wind: the Well Uing) point - Cold: the Sea (Sea) point - Dampness: the Stream (Shu) or River Uing) points.

SUMMARY THE MUSCLE CHANNELS IN THE TREATMENT O F PAINFUL OBSTRUCTION (8/) SYNDROME

The Muscle channels are involved in any muscular pathology such as muscular weakness, ache or stiffness that may appear in Painful Obstruction Syndrome

Aetiology of invasion of Muscle channels

Wind • Stiffness and wandering pain in several groups of muscles

Cold • Cold causes contraction, spasm and pain of the muscles; the pain is distinctly alleviated by the application of heat to the muscle

Dampness • Ache, swelling, numbness and a feel ing of heaviness Continued

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PART 4 : MUSC LE CHANNELS (JING JIN)

Pathology of external invasions of Muscle channels • Bone Pai nful Obstruction Syndrome (Kidneys): bone deformities • Blood Vessel Painful Obstruction Syndrome (Heart): Blood stasis • Sinew Painful Obstruction Syndrome (Liver): stiffness • Muscle Pa inful Obstruction Syndrome (Spleen): weakness • Skin Painful Obstruction Syndrome (Lungs): feeling of cold . An involvement of the Muscle channels will cause muscle ache and stiffness: the pain is more diffuse in muscle groups rather than being located in the joints. Other manifestations depend on the pathogenic factor involved: if W ind, there will be stiffness and wandering ache; if Cold, t here will be more severe pain and contraction and spasm; if Dampness, there wi ll be heaviness and swelling of the muscles.

Treatment of exterior invasions into Muscle channels • Wind: apart from needling, cupping is appropriate • Cold: moxa on needles • Dampness: apart from needling, cupping is also indicated • In terms of Transporting (Shu) points, the following are the best points to expel the relevant pat hogenic factor from the Muscle channels: -Wind: t he Wel l (Jing) point - Cold: the Sea (Sea) point - Dampness: the Stream (Shu) or River (Jing) points.

*

NOTES

m

1. 1981 Spiritual Axis (Ling SIIu]ing ~ t~ ). People's Health Publishing House. Beijing, first published c. 100 BC. p. 43-47.

2. 1979 The Yellow Emperor's Classic of Internal Medicine- Simple P'l i£ :¥ liiJ ). People's Questions (Huang Di Nei finy Su Wen Jil' Health Publishing House. Beijing. first published c. 100 BC, p. 241. 3. lbid .. p.241. 4. Ibid., p. 243.

PART 5

DIVERGENT CHANNELS (JING BIE) 21 Morphology of Dive rg ent chan nels 331 22 Functions an d cl inica l use of th e Divergent channels 341

Part 5 deals with the pathways and functions of the Divergent channels. Unlike the Connecting and the Muscle channels, the Divergent channels do not have their own specific treatment modalities and their clinical importance lies primarily in explaining certain connections among organs that could not be explained by reference to other types of channels.

CHAPTER 21

MORPHOLOGY OF DIVERGENT CHANNELS PATIERN OF CIRCULATI ON OF THE DIVERGENT CHAN NELS 331 PATHWAYS OF THE DIVERGENT CHANN ELS 335 Bladder Divergent channel 335 Kidney Divergent channel 336 Gall Bladder Divergent channel 336 Liver Divergent channel 336 Stomach Divergent channel 337 Spleen Divergent channe l 337 Small Intestine Divergent channe l 338 Heart Divergent channel 338 Triple Burner Divergent channel 339 Pericardium Divergent channel 339 Large Intestine Divergent channel 339 Lung Divergent channel 339

The Divergent channels are called Ji ng Bie ( !£ jjlj ) in Chinese. The name literally means 'divergences fro m the Main channels' rather than 'Divergent channels'. The Divergent channels are discussed in Chapter 11 of the 'Spiritual Axis' .1

PATIERN OF CIRCULATION OF THE DIVERGENT CHANNELS The Divergent channels run deeper than the Main channels. All of them start near the lower end of the Main channels, all enter the Internal Organs and all emerge at the neck; thus, all the Divergent channels run from the lower to the upper part of the body. As a general pattern, the Yang Divergent channels follow a pathway different from that of the Yin ones. Generally, the pathway of the Yan g Divergent channels follows the following pattern (Fig. 21.1): • They separate from their respective Yang Main channel.

• They enter the Yang organ to which they are connected and often (though not in all cases) the related Yin organ. • They then emerge at the neck where they join their related Main channel. Generally, the pathway of the Yin Divergent channels follows the following pattern (Fig. 21.2): • They separate fro m their respective Yin Main channel. • Some (Heart, Lung and Kidneys) connect with their respective Yin organ . • They join the related Yang Divergent channel (e.g. Kidney Divergent to Bladder Divergent). • They then join the related Yang Main channel on the neck. From the above general patterns two observations can be made: • In the end. all Divergent channels (whether Yin or Yang) join with the six Yang Main channels • All Yang Divergent channels join with the respective Yang organ and the related Yin organ (Fig. 21.3). The Divergent channels have departure and meeting points. They also have entering and exiting points: where they converge, they enter and where they depart, they exit. They start from Yang channels and return to them; they harmonize Interior and Exterior and regulate the flow of Qi to and from the head. The Divergent channels' pathways are described in Chapter 11 of the 'Spiritual Axis' as pairs with the same Yin-Yang pairing as that of the Main channels. 331

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PART 5: DIVERGENT CHANNELS (JING 8/E)

Yang Divergent

Yin Divergent

Neck

Yang Divergent Yang Main channel

Yin Divergent

Fig. 21 .1 Pattern of Yang Divergent channels pathway.

Yang Divergent Yang Main channel Fig. 21.2 Pattern of Yin Divergent channe ls pathway.

The order in which they are described, however, is different and it is as follows: Bladder/ Kidney Gall Bladder/Liver Stomach/Spleen Small Intestine/ Heart Triple Burner/ Pericardium Large Intestine/Lung. As we have seen in Chapter 1 7, this order is the same as that in which the Muscle channels' pathways are listed in Chapter l3 of the 'Spiritual Axis'; i.e.: • three Yang channels of the leg (Bladder, Gall Bladder and Stomach) (Fig. 21.4) • three Yin channels of the leg (Spleen, Liver and Kidney) (Fig. 21.4) • three Yang channels of the arm (Small Intestine, Triple Burner and Large Intestine) (Fig. 21.5)

• three Yin channels of the arm (Lung, Pericardium and Heart) (Fig. 21.5). The six pairs of Divergent channels have points of convergence in the upper part of the body (which I shall call Upper Meeting points) as follows (Fig. 21.6): Channels

Upper Meeting point

Bladder/Kidney Gall Bladder/Liver Stomach/Spleen

BL-10 Tianzhu G.B.-1 Tongziliao ST-1 Chengqi (or ST-9 Renying) BL-1 Jingming T.B.-16 Tianyou L.I.-18 Futu

Small Intestine/Heart Triple Burner/Pericardium Large Intestine/Lungs

Four of the six couples of Divergent channels have a Lower Meeting area of which only two are specific

MORPHOLOGY OF DIVERGENT CHANNELS

333

Fig. 21.3 Pattern or Yang and Yin Divergent channel pathway.

Neck

Yang Divergent

Yin Divergent

Yang Main channel

Yin Main channel

Neck

Neck

Neck

Pubis

Popliteal fossa

BL Main

Thigh

Kl Main

G.B. Main

Fig. 21 .4 Schematic representation of Divergent channels of leg.

Foot

LIV Main

Thigh

ST Main

SP Main

PART 5: DIVERGENT CHANNELS (JING 8/E)

334

Head Shoulder

Axilla

Axilla

Hand

S.l. Main

HE Main

T.B. Main

P Main

Fig. 21 .5 Schematic represent at ion of Divergent channels of arm.

Gall Bladder/

Large Intestine/Lungs Fig. 21 .6 Upper Meeting points of Divergent channels.

L.l . Main

LU Main

MORPHOLOGY OF DIVERGENT CHANNELS

r

BL-40: Bladder/Kidneys

Pubis: Gall Bladder/Liver

Thighs: Stomach/Spleen

Axilla: Small Intestine/Heart

Fig. 21.7 Lower Meeting points of Divergent channels.

points; these are the areas (or points) where the Qi of the pair of channels converges before diverging upwards. The Lower Meeting points are (Fig. 21.7):

Channels Bladder/Kidney Gall Bladder/Liver Stomach/Spleen Small Intestine/Heart Triple Burner/Pericardium Large Intestine/Lung

Lower Meeting point Popliteal fossa (BL-40 Weizhong) Pubis (Ren-2 Qugu) Thigh Axilla None None

PATHWAYS OF THE DIVERGENT CHANNELS The pathways of the Divergent channels as described in Chapter 11 of the 'Spiritual Axis' (and in the same order) are as follows.

Bladder Divergent channel (Fig. 21.8) • It diverges from the Bladder Main channel in the

popliteal fossa • It goes to the anus • It ascends to connect with the bladder and kidneys • It ascends along the spine and disperses in the

heart • It emerges in the neck to rejoin the Bladder Main

channel. Fig. 21.8 Bladder Divergent channel.

335

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PART 5: DIVERGENT CHANNELS (JING 8/E)

Kidney Divergent channel (Fig. 21.9)

Gall Bladder Divergent channel (Fig. 21.10)

• It diverges from the Kidney Main channel in the

popliteal fossa • It ascends to connect with the kidneys where it

crosses the Girdle Vessel (Dai Mai) • It emerges at the neck where it converges with the Bladder Divergent channel • It ascends to the root of the tongue.

• It diverges from the Gall Bladder Main channel

on the thigh • It enters the pubis where it converges with the

Liver Divergent channel • It ascends and connects with the gall bladder

and liver • It crosses the heart • It connects with the Gall Bladder Main channel

at the neck and reaches the outer corner of the eyes.

liver Divergent channel (Fig. 21.11) • It diverges from the Liver Main channel on the

foot • It ascends to the pubic region where it converges

with the Gall Bladder Main channel.

Fig. 21 .9 Kidney Divergent chan nel.

Fig. 21.1 0 Gall Bladder Divergent channel.

MORPHOLOGY OF DIVERGENT CHANNELS

337

Fig. 21.12 Stomach Divergent channel.

Stomach Divergent channel (Fig. 21.12) • It diverges from the Stomach Main channel on

the thigh • It ascends to the abdomen and enters the stomach and spleen, and then the heart • It reaches the neck. where it unites with the Stomach Main channel • It enters the eye.

Spleen Divergent channel (Fig. 21.13) Fig. 21.11 Liver Divergent channel.

• It diverges from the Spleen Main channel in the

middle of the thigh • It joins with the Stomach Divergent channel at

the neck • It reaches the tongue.

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PART 5: DIVERGENT CHANNELS (JING 8/E)

Fig. 21.13 Spleen Divergent channel.

Fig. 21.14 Small Intestine Divergent channel.

Small Intestine Divergent channel (Fig. 21.14) • It diverges from the Small Intestine Main

channel at the shoulder • It enters the axilla and connects with the heart • It descends to the abdomen where it connects with the small intestine.

Heart Divergent channel (Fig. 21.15) • It diverges from the Heart Main channel at the

axilla • It enters the chest and connects with the heart • It merges with the Small Intestine Divergent

channel at the neck • It enters the inner corner of the eye. Fig. 21 .15 Heart Divergent channel.

MORPHOLOGY OF DIVERGENT CHANNELS

339

Fig. 21.16 Triple Bu rner Divergent channel. Fig. 21.17 Pericardium Divergent channel.

Triple Burner Divergent channel (Fig. 21.16)

large Intestine Divergent channel (Fig. 21.18)

• It diverges from the Triple Burner Main channel

on the head and goes to the vertex • It descends to the clavicle and joins the Three

Burners.

Pericardium Divergent channel (Fig. 21.17)

• It diverges from the Large Intestine Main

channel on the hand • It ascends to L.I.-15 and travels to the spine • It crosses to the supraclavicular fossa and

ascends to the throat and neck where it unites with the Large Intestine Main channel • A branch from the clavicle connects with the lungs and large intestine.

• It diverges from the Pericardium Main channel

below the axilla • It enters the chest and communicates with the

Three Burners • It ascends to the throat and neck where it joins the Triple Burner Divergent channel • It goes behind the ears.

lung Divergent channel (Fig. 21.19) • It diverges from the Lung Main channel at the

axilla and passes anterior to the Heart channel in the chest

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PART 5: DIVERGENT CHANNELS (J!NG 8/E)

Fig. 21.18 Large Intestine Divergent channel.

• It connects with the lungs and disperses iu the

large intestiue • It ascends from the lungs to the throat and

converges with the Large Intestine channel at the neck. Fig. 21 .19 Lung Divergent channel.

NOTES ~ ~ t£ ). People's Health Publishing House. Beijing. first published c. 100 BC, p. 100.

l. 1981 Spiritual Axis (Ling Shu]ing

CHAPTER 22

FUNCTIONS AND CLINICAL USE OF THE DIVERGENT CHANNELS BALANCING YIN AND YANG 341 Balancing Yin and Yang in the Interior 342 Balancing Yin and Yang in the head 342 HARMONIZING YIN AND YANG 343 INTEGRATING AND CONNECTING THE INTERNAL ORGANS 344 Treating a Yang channel for a problem in a Yin channel/organ or vice versa 344 Connection between Stomach and Heart 344 The Heart Divergent channel and the inner canthus of the eye 344 The Bladder Divergent channel and the anus 345 The Bladder Divergent channel and the heart region 345 The Pericardium Divergent channel and the neck and head 345 The Gall Bladder Divergent channel and the Heart 345 The Pericardium Divergent channel and the throat 345 The Yang channels of the leg and the Heart 345 THE CLINICAL APPLICATION OF THE SIX PAIRS OF DIVERGENT CHANNELS 345 Bladder and Kidneys 347 Gall Bladder and Liver 348 Stomach and Spleen 349 Small Intestine and Heart 349 Triple Burner and Pericardium 350 Large Intestine and Lungs 351

The main function of the Divergent channels is to balance and integrate. They balance Qi in the sense that they play an important role in the balancing of Yin and Yang at a deep level and in balancing the 11ow of Qi between the body and the head; they integrate in the sense that they connect and integrate organs among themselves.

The Divergent channels do not have their own points (in the way the Connecting channels do) and they do not have their own pathology (in the way the Connecting channels do ). 1 Please note that, contrary to what I did for the Muscle and Connecting channels, there will be no discussion of aetiology, pathology or treatment of the Divergent channels. This is because, unlike the Connecting and Muscle channels, the Divergent channels do not have a pathology that is separate from that of the Main channels. Neither do the Divergent channels have their own points (as do the Connecting channels) although the Yin-Yang pairs of Divergent channels have Meeting poirlts. Apart from such Meeting points, the Divergent channels are treated through the points of the Main channels. The main clinical significance of the Divergent channels lies in allowing connections between various organs and channels which provide the explanation of the clinical use of certain points; for example. the use of BL-5 7 Chengshan for the anus because the Divergent channel flows to the anus (which neither the Connecting nor the Mairl channels of the Bladder do). However, I shall discuss the clinical application of the Divergent channels particularly through their Meeting points. In order to highlight the clinical significance of the Yin- Yang pairs of Divergent channels, I have included six figures which illustrate the Yin-Yang pairs (Figs 22.1 to 22.6).

BALANCING YIN AND YANG In terms of energetic depth, the Divergent channels balance Yin and Yang ir1 the Interior; ir1 terms of energetic zone, they balance Yin and Yang in the head.

341

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PART 5: DIVERGENT CHANNELS (JING BIE)

Balancing Yin and Yang in the Interior

SUMMARY BALANCING YIN AND YANG IN THE INTERIOR

A major aspect of the physiology of the Divergent channels is that they balance Yin and Yang in the Interior and the Internal Organs. Like the Connecting channels, they balance Yin and Yang but they do so in the Interior, whereas the Connecting channels harmonize Yin and Yang in the Exterior. As we shall see, the Eight Extraordinary Vessels also balance Yin and Yang and, as we have seen, the Connecting channels balance Yin and Yang in the limbs. Let us therefore explore the different ways in which these three types of channels balance Yin and Yang. The Connecting channels balance Yin and Yang primarily in the limbs and at a more superficial level than the other two classes of channels. The Eight Extraordinary Vessels balance Yin and Yang primarily in the trunk and at a deeper level than the Connecting channels; however, they also balance Yin and Yang at a superficial level in the abdomen and especially in the Membranes (Huang). In terms of energetic zone, the Divergent channels balance Yin and Yang primarily in the head; in terms of energetic depth, they balance Yin and Yang in the Interior and in the Internal Organs. They also strengthen the connection between Yin and Yang organs. We can therefore construct a table highlighting the difference among these three types of channel in terms of energetic zone and energetic depth (Table 2 2.1).

Balancing Yin and Yang in the head Superficially, the head contains only Yang channels, and internally only the deep pathways of the Heart and Liver reach the head. The Yin Divergent channels are therefore particularly important for carrying Yin Qi up to the head; this is the only way that Yin Qi

Table 22.1

• The Divergent channels balance Yin and Yang in the Interior and the Internal Organs • In terms of energetic zone, the Divergent channels balance Yin and Yang primarily in the head • In terms of energetic dept h, they balance Yin and Yang in the Interior and in t he Internal Organs • They strengthen the connection between Yin and Yang organs.

reaches the head. In fact, as we have seen, all the Yin Divergent channels join the associated Yang Divergent channel in the neck area and this, in turn, then joins its relevant Main channel (e.g. the Kidney Divergent channel joins the Bladder Divergent channel at the neck and this, in turn, rejoins the Bladder Main channel). The balancing of Yin and Yang in the head is also achieved through the Upper Meeting points of the Divergent channels. These points are as follows: Meeting point BL-10 Tianzhu G.B.-1 Tongziliao ST-1 Chengqi (or ST-9 Renying) BL-1 Jingming Small Intestine/Heart Triple Burner/Pericardium T.B.-16 Tianyou Large Intestine/Lungs L.I.-18 Futu

Channels Bladder/Kidney Gall Bladder/Liver Stomach/Spleen

As can be seen, all the Upper Meeting points are on Yang channels and they are all strategic, important points. By providing a meeting of the Yin- Yang pairs of Divergent channels, these points facilitate the rising

Differences between the Yin-Yang balancing action of the Connecting channels, Extraordinary Vessels and Divergent channels Connecting channels

Extraordinary Vessels

Divergent channels

Energetic zone

Limbs

Trunk

Head

Energetic depth

Superficial

Deep and superficial

Deep, in the Interior and the Internal Organs

FUNCTIONS AND CLINICAL USE OF THE DIVERGENT CHANNELS

of Yin Qi to the head and they therefore contribute to the balance of Yin-Yang in the head. Please note that 'balancing Yin-Yang in the head' does not only mean balancing the quantity of Yin-Yang in the head, but it also implies balancing and regulating the ascending (a Yang movement) and descending (a Yin movement).

'Balancing Yi n-Yang in t he head' does not only mean balancing the quantity of Yin-Yang in the head, but it also implies ba lancing and regu lating the ascending (a Yang movement) and descending (a Yin movement).

If we take ST-9 as the Upper Meeting point of the Stomach and Spleen Divergent channels, we see that four of the six Upper Meeting points are also Window of Heaven points. These are:

-

BL-10 Tianzhu (Bladder and Kidney) ST-9 Renying (Stomach and Spleen) T.B.-16 Tianyou (Triple Burner and Pericardium) L.I.-18 Futu (Large Intestine and Lungs).

As one of the main functions of the Window of Heaven points is to regulate the ascending/descending of Qi to and from the head, this is an additional way in which the Divergent channels balance Yin and Yang in the head. By virtue of their dual nature of being both Meeting points of the Yin-Yang pairs of Divergent channels and Window of Heaven points, these four points are particularly indicated to regulate Yin-Yang in the head in every way. The connection of these four Window of Heaven points with the Divergent channels also enhances their clinical significance as it means that. among this class of points. they are particularly important for regulating and balancing Yin and Yang in the head. In clinical practice, this means that these four Window of Heaven points would, for example, be important in the treatment of headaches. In fact, all headaches may be classified as being due to one of four situations of imbalance of Yin- Yang in the head: - Excess of Yang in the head (e.g. Liver-Yang rising) -Deficiency of Yang (e.g. Stomach-Yang deficiency) - Excess of Yin (e.g. Dampness or Phlegm)

343

-Deficiency of Yin (Kidney-Yin deficiency or LiverBlood deficiency). For the same reason, these four points would be important to use in other pathologies of the head such as chronic dizziness and hypertension. CLINICAL NOTE Four of the Upper Meeting points of the Divergent channels are Window of Heaven points (BL-10, ST-9, T.B.-16 and L.l.-18): by virtue of their dual nature as Meeting points of the Divergent channels and Window of Heaven points, they are particularly effective in regulating and balancing Yin-Yang in the head.

SUMMARY BALANCING YIN AND YANG IN THE HEAD

• The Yin Divergent channels carry Yin Qi up to the head: this is the only way Yin Qi reaches the head • Ba lancing Yin and Yang in the head is also achieved through the Divergent channels Upper Meeting points • 'Balancing Yin-Yang in the head' does not only mean balancing the quantity of Yin-Yang in t he head, but it also implies balancing and regu lating the ascending (a Yang movement) and descending (a Yin movement) • Four of t he six Upper Meet ing points are also W indow of Heaven points (B L-1 0, ST-9, T.B.-16 and L.l.-18) • This is an additional way in which t he Divergent channels balance Yin and Yang in the head • These fou r Window of Heaven points ca n be used in the treatment of headaches, chronic dizziness and hypertension.

HARMONIZING YIN AND YANG The Divergent channels strengthen the relationship between Yin and Yang organs because all the Yang Divergent channels flow to the respective Yang and related Yin organ. Thus. the Divergent channels not only 'balance' Yin and Yang but also strengthen the

344

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connection between Yin and Yang channels; this gives us flexibility in clinical practice, enabling the use of points on Yang channels for symptoms of Yin channels and vice versa. From this point of view, the function of the Divergent channels is similar to that of the Connecting channels, i.e. to strengthen the connection between pairs of YinYang channels. However, the Connecting channels enable this connection more superficially and especially in the limbs; the Divergent channels enable this connection more deeply and especially in the Interior and in the Internal Organs. Several examples can be given of the use of Yang points to treat problems of Yin channels or vice versa making use of the connection provided by the Divergent channels. Some are reported below. - LU-7 Lieque can be used for shoulder problems along the Large Intestine channel (the Lung Divergent channel converges with the Large Intestine channel at the neck). - L.I.-4 Hegu can be used to expel Wind in the Lung's Defensive-Qi portion in acute invasions of exterior Wind (the Large Intestine Divergent channel flows to the Lungs from the clavicle area). -Many Stomach points (e.g. ST-36 Zusanli and ST-25 Tianshu) can tonify the Spleen (the Stomach Divergent channel enters the Spleen). - KI-4 Dazhong can treat neckache along the Bladder channel (the Kidney Divergent channel joins the Bladder channel at the neck). - P-6 Neiguan is very good for treating neck and shoulder problems along the Triple Burner channel (the Pericardium Divergent channel joins with the Triple Burner channel at the neck). - G.B.-34 Yanglingquan is excellent for treating stagnation of Liver-Qi (the Gall Bladder Divergent channel joins with the Liver organ). - G.B.-26 Daimai can treat genital problems (the Gall Bladder Divergent channel joins with the Liver Divergent channel in the area of the pubis).

SUMMARY HARMONIZING YIN AND YANG • The Divergent channels strengthen t he relationship between Yin and Yang organs • This allows us in practice to use Yang points to treat Yin orga ns and vice versa.

INTEGRATING AND CONNECTING THE INTERNAL ORGANS The Divergent channels integrate some channels with organs with which they are not connected through the Main channels; this explains many connections we make in clinical practice.

Treating a Yang channel for a problem in a Yin channel/organ or vice versa The Divergent channels enable us to use a Yang channel to treat a problem of a Yin channel/organ or vice versa. In other words, through the Divergent channels many connections between Yin and Yang channels are established and these are exploited in practice. For example, LU-7 Lieque can be used for problems of the Large Intestine channel on the face, or L.I.-11 Quchi for a fever from Wind-Heat in the Lung's Defensive-Qi portion; both these uses are enabled by the pathways of the Divergent channels. Other examples are the use of L.I.-11 Quchi for cough and asthma and of LU-10 Yuji for constipation and diarrhoea. Further examples were given above.

Connection between Stomach and Heart I always treat the Stomach for heart problems such as palpitations, tachycardia or irregular heartbeat. This connection can be explained only through the Divergent Stomach channel's flowing to the heart, as the Heart Main channel does not go to the stomach and the Stomach Main channel does not go to the heart. This connection also explains th e mentalemotional effect of many Stomach points (e.g. ST-40 Fenglong or ST-25 Tianshu). Moreover, because of the connection between the Stomach Divergent channel and the Heart, some Stomach points are effective in treating insomnia associated with digestive disharmonies; for example, both ST-36 Zusanli and ST-40 Fenglong can treat insomnia associated with digestive problems.

The Heart Divergent channel and the inner canthus of the eye The fact that the Heart Divergent channel reaches the inner canthus of the eye explains the diagnostic

FUNCTIONS AND CLINICAL USE OF THE DIVERGENT CHANNELS

significance of this area's being related to the Heart (which does not happen via the Heart Main channel).

The Bladder divergent channel and the anus The fact that the Bladder Divergent channel reaches the anus explains the use of BL-5 7 Chengshan and BL-58 Feiyang for haemorrhoids (the Bladder Main channel does not go to the anus).

The Bladder Divergent channel and the heart region

345

The Yang channels of the leg and the Heart It is interesting to note that all three Leg Yang

Divergent channels (Bladder, Gall Bladder and Stomach) go to the heart. As the Small Intestine naturally connects with the Heart, four Yang channels flow through the Heart. The Qi of these Yang channels gives the Heart the Yang Qi that is necessary for its pumping action. More importantly, on a psychic level, the Yang channels give the Heart the Yang Qi that provides the Mind (Shen) with drive, expansiveness, and outward movement.

The Bladder Divergent channel flows to the heart region: this establishes a connection between these two organs and also strengthens the clinically important connection between Kidneys and Heart.

THE CLINICAL APPLICATION OF THE SIX PAIRS OF DIVERGENT CHANNELS

The Pericardium Divergent channel and the neck and head

Let us now discuss the clinical significance and application of the Divergent channels. One of the most important aspects of the Divergent channels in the clinic is their integration of Yin and Yang channels within each pair. The six pairs of Divergent channels are:

The Pericardium Divergent channel flows into the Triple Burner channel in the neck; this explains the effect of the Pericardium points (especially P-6 Neiguan) on the neck and head. I frequently use this point as a distal point for headaches from Liver-Yang rising.

The Gall Bladder Divergent channel and the Heart The Gall Bladder Divergent channel goes to the Heart: a connection between these two organs is not evident from any other channel. This explains the use of G.B.-40 Qiuxu for Heart patterns and especially for the pattern of Gall Bladder Qi Deficiency manifesting with timidity, fearfulness, insomnia and difficulty in making decisions: this pattern involves a deficiency of the Gall Bladder and of Heart-Qi.

The Pericardium Divergent channel and the throat Some Pericardium points are indicated for throat problems and this can be explained only by means of the Pericardium Divergent channel as the Pericardium Main channel does not go to the throat (e.g. P-5 Jianshu for loss of voice).

Upper Meeting points 1. Bladder/Kidneys BL-10 Tianzu G.B.-1 2. Gall Bladder/ Liver Tongziliao 3. Stomach/Spleen ST-1 Chengqi 4 . Small Intestine/ BL-1 Jingming Heart 5. Triple Burner/ T.B.-16 Pericardium Tianyou 6. Large L.I.-18 Futu Intestine/Lungs

Lower Meeting points BL-40 Weizhong Pubis (Ren-2 Qugu) Thigh Axilla None None

As we have seen, each pair has an Upper Meeting point and four pairs have also Lower Meeting points. These Meeting points are an important way in which we can treat the Divergent channels. What clinical situations and signs lead us to use the Divergent channels? As one of their most important functions is to strengthen the connection between a Yang and a Yin channel within each pair, the Divergent channels are treated particularly when there are overlapping clinical manifestations of a Yin and a Yang organ within a pair. For example, if a patient suffers from a Kidney-Yang deficiency with symptoms such as lower backache,

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SUMMARY INTEGRATING AND CONNECTING THE INTERNAL ORGANS

• The Divergent channels integrate some channels with organs with which they are not connected t hrough the Main channels and this explains many connections we make in clinical practice. • Treating a Yang channel for a problem in a Yin channel/organ or vice versa: (LU-7 Lieque for problems of the Large Intestine channel on the face, or L.l.-11 Quchi for a fever from Wind-Heat in the Lung's Defensive-Qi portion) • Connection between Stomach and Heart: -treat the Stomach for heart problems such as palpitations, tachycardia or irregular heartbeat - mental-emotional effect of many Stomach points (e.g. ST-40 Fenglong or ST-25 Tianshu) • The Heart Divergent channel and the inner canthus of the eye • The Bladder divergent channel and the anus: BL-57 Chengshan and BL-58 Feiyang for haemorrhoids • The Bladder divergent channel and the heart region • The Pericardium Divergent channel and the neck and head: P-6 Neiguan for neckache and headache • The Gall Bladder Divergent channel and the Heart: G.B.-40 Qiuxu for Heart patterns and especially for the pattern of Gall Bladder Qi Deficiency manifesting with timidity, fearfulness, insomnia and difficulty in making decisions • The Pericardium Divergent channel and the throat: P-5 Jianshu for loss of voice • The Yang channels of the leg and the Heart: - All three Leg Yang Divergent channels (Bladder, Gall Bladder and Stomach) go to the heart. As the Small Intestine naturally connects w ith the Heart, four Yang channels flow through the Heart -The Qi of these Yang channels gives the Heart the Yang Qi that is necessary for its pumping action.

dizziness, tinnitus, feeling cold and frequent urination , then we treat only the Kidneys; but if the same patient, in addition, also suffers from urinary difficulty, pronounced urinary frequency and occasional urinary incontinence, then it is appropriate to treat both the Kidneys and the Bladder and the Divergent channels can help us achieve that. Please note that in this example, we considered 'frequent urination' as a symptom of Kidney-Yang deficiency whereas the other urinary symptoms (difficulty, incontinence) point us to a Bladder pattern. Therefore an important sign that leads us to use the Meeting points of the Divergent channels is the combinations of pathology of both the Yin and the Yang channel within a pair. Moreover, the pathways of the Divergent channels explain the energetic action of certain points that could not otherwise be explained by reference to the Main channels. For example, the Gall Bladder and Liver Divergent channels connect at the pubis and the Gall Bladder Divergent channel goes to G.B.-1; this explains the effect of Liver-channel points on headaches and eye problems. For example, the Upper Meeting point of the Lung and Large Intestine Divergent channels is L.I.-18 Futu (situated near the throat) and this reinforces the influence of the Lung channel on the throat area. Besides strengthening the connection between paired Yin and Yang channels, the Divergent channels, through their Upper Meeting points, have the other important function of balancing and regulating the flow of Qi to and from the head. As the Yin- Yang pairs of channels are connected also through the Connecting (Luo) points, what is the difference between the action of the Meeting points of the Divergent channels and the Connecting points? As they both connect Yin-Yang pairs of ch annels, how do they differ? In my opinion, the Connecting points connect Yin- Yang pairs of channels at a more superficial level

CLINICAL NOTE

The Connecting (Luo) points connect Yi n-Yang pairs of channels at a superficial level and in the limbs; the Meeting points of the Divergent channels connect the Yin- Yang pairs of channels at a deep level, in the Interior. Moreover, they also connect the Yin-Yang pairs of Internal Organs.

FUNCTIONS AND CLINICAL USE OF THE DIVERGENT CHANNELS

and in the limbs; in contrast, the Meeting points of the Divergent channels connect the Yin-Yang pairs of channels at a deep level, in the Interior. Moreover, they also connect the Yin-Yang pairs of Internal Organs. Let us now discuss some clinical applications of each pair of Divergent channels from both points of view, i.e. that of strengthening the connection between paired Yin and Yang channels and that of balancing Yin and Yang in the head and regulating the flow of Qi between the body and the head.

347

"!1--- - -BL-10 Upper Meeting point

Bladder and Kidneys (Fig. 22.1) The Bladder and Kidney Divergent channels perform an important role in strengthening the connection between these two channels. The two channels originate from the popliteal crease behind the knee in the region of BL-40 Weizhong. This is an added explanation of the action of this point in the treatment of lower backache: it activates not only the Bladder channel but also the Kidney channel. As chronic lower backache nearly always occurs against a background of Kidney deficiency, this point will simultaneously activate the Bladder channel and torrify the Kidney channel. Moreover, the Kidneys control the bones and therefore the spine and this point will strengthen that particular Kidney function. The Upper Meeting point BL-10 Tianzhu regulates the ascending and descending of the Qi of these two channels to and from the head also by its virtue of being a Window of Heaven point. If Kidney-Qi does not rise to the head and the Brain there will be poor memory and concentration, dizziness and depression. BL-10 Tianzhu can stimulate the rising of Kidney-Qi to the Brain. On the other hand, if there is Excess Yang in the Bladder channel (manifesting with headaches), BL-10 Tianzhu can stimulate the descending of Qi from the head. As the Upper and Lower Meeting points are both on the Bladder channel, these two points have a particularly strong effect; they communicate with each other to regulate the ascending and descending of Qi along the Bladder channel along the whole spine. These two points are an important way in which the Bladder and Kidneys communicate and in which the Bladder channel sustains the spine. These points can be used together to treat stiffness and pain of the occiput or pain in the popliteal fossa.

Fig. 22.1 Bladder and Kidney Divergent channels.

TREATMENT EXAMPLE A patient suffers from lower backache, dull occipital headaches, urinary frequency and diff iculty and a slight urinary incontinence. There is a definite Kidney def iciency. Use the following poi nts: -BL-10 Tianzhu and BL-40 Weizhong to t reat t he back and the Bladder and Kidney channels simultaneously - BL-23 Shenshu (Back-Transporting point of the Kidneys) and Ren-3 Zhongji (Front-Collecting point of the Bladder).

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Finally, as the Bladder Divergent channel flows through the heart, the Divergent channels of the Bladder and Kidneys also strengthen the communication between the Heart and Kidneys, which is of crucial clinical importance. As the Bladder channel enters the brain, the Kidney and Bladder Divergent channels strengthen the relationship between the Kidneys, Marrow and the Brain.

...._,~-'r---G.B.-1

Upper Meeting point

Gall Bladder and Liver (Fig. 22.2) If we consider the Upper Meeting point of these two Divergent channels (G.B.-I Tongziliao), we can see how the connection between these two channels allows the Liver channel to influence the head and the eyes. Although the Liver Main channel's internal pathway does reach the eyes and the top of the head, it does not 11ow to the lateral side of the head (where

TREATMENT EXAMPLE A woman suffers from typical headaches from Liver-Yang rising: the headaches are throbbing in nature and are accompanied by a feeling of distension of the head and irritability. The pulse is Wiry. The headaches occur on the lateral side of the head along the Gall Bladder channel and also in the eye. With the headaches, the patient experiences blurred vision and sees 'flashing lights'. In addition, this patient also suffers from hypochondria! distension (in the Ga ll Bladder channel's area) and excessive vaginal discharge. Use the following points: -G.B.-1 Tongziliao, Upper Meeting point, to treat the Gall Bladder and Liver channels simultaneously - Ren-2 Qugu, Lower Meeting point, to strengthen the relationship between the Gall Bladder and Liver channels and t reat the vaginal discharge -LIV-3 Taichong and G.B.-43 Xiaxi to subdue Liver-Yang (G.B.-43 as a distal point to affect the other end of the channel, i.e. the area of G.B.-1 and G.B.-5 Xuanlu) - T.B.-5 Waiguan and P-6 Neiguan to subdue Liver-Yang.

(l

- --+-Lower Meeting point

L Gall Bladder Divergent

L uver Divergent

Fig. 22.2 Gall Bladder and Liver Divergent channels.

the Gall Bladder channel flows). Therefore the connection between the Gall Bladder and Liver Divergent channels allows us to use points from the Liver channel to treat temporal headaches along the Gall Bladder channel. The regulation of the ascending and descending of Qi to and from the head is an important aspect of

FUNCTIONS AND CLINICAL USE OF TH E DIVERGENT CHANNELS

this pair of channels. When Excess Yang rises to the head, the person may develop headaches from LiverYang rising; through the point G.B.-1 Tongziliao, this couple of Divergent channels regulates Yin and Yang in the head. The connection between the Gall Bladder and Liver Divergent channels in the pubis explains the convergence of these two channels in the pathology of the genitalia especially when it is due to the infusing of Dampness.

Stomach and Spleen (Fig. 22.3) The pair of Divergent channels of Stomach and Spleen greatly strengthens the connection between these two organs and channels. In fact, the Stomach Divergent channel flows through the Spleen.

----!::::J---- ST·1 Upper Meeting point

349

TREATMENT EXAMPLE A patient suffers from a clear deficiency of both Stomach and Spleen, experiencing the following symptoms: general tiredness, a feeling of weakness of the limbs, poor digestion, a tendency to loose stools and a desire to lie down. The pulse is Weak. The feeling of weakness of the legs is very pronounced. Use the following points: -ST-31 Biguan and SP-12 Chongmen, both in the region of the thigh, which is the area of Lower Meeting of the Spleen and Stomach Divergent channels -ST-25 Tianshu and ST-36 Zusanli to tonify the Stomach and Spleen and strengthen the legs.

The connection between the two channels takes place in the thigh (Lower Meeting point) and in the face at the eyes (ST-1, Upper Meeting point). The Lower Meeting point explains the important effect of Stomach and Spleen points to strengthen the legs. Although the Lower Meeting point of the Stomach and Spleen Divergent channels is in the thigh, ST-30 Qichong is also a point where both Stomach and Spleen Divergent channels enter in the body cavity of the trunk: this, together with its being the point of the Sea of Food, explains the importance of this point in treating digestive problems from Stomach and Spleen disharmony. The Spleen Divergent channel strengthens the relationship of the Spleen channel with the tongue: hence the use of SP-3 Taibai for tongue problems.

Small Intestine and Heart (Fig. 22.4)

I-- -+-+--- - Stomach Divergent 1----\- - -Spleen Divergent

Lower Meeting point (thigh) Fig. 22.3 Stomach and Spleen Divergent channels.

The pair of Divergent channels of the Heart and Small Intestine has great clinical significance both in diagnosis and in treatment. The upper connection between these two channels is at BL-1 Jingming; this explains the influence of the Heart channel on the inner corner of the eye. In facial diagnosis, the connection of the symptom of redness of the inner canthus of the eye to the Heart channel is found in many books, old and new. Although both the Main and the Connecting channels of the Heart flow to the eye, it is only the

350

PART 5: DIVERGENT CHANNELS (J!NG 8/E)

TREATMENT EXAMPLE

( Fig. 22.4 Small Intestine and Heart Divergent channels.

Divergent channel that flows specifically to BL-1 Jingming. Therefore, the point BL-1 Jingming is a meeting point not only of the Small Intestine and Bladder (Greater Yang) but also of the Small Intestine and Heart by virtue of their Divergent channels. This means that this point regulates the balance of Yin and Yang in the eyes (Small Intestine and Bladder being Yang and Heart being Yin). 'Balancing Yin and Yang in the eyes' has repercussions on the actual eyes (redness, itching, pain) and on sleep. In fact, Excess of Yang in the eyes will cause insomnia while Excess of Yin causes sleepiness. The Lower Meeting point of these two Divergent channels is equally significant. The Divergent channels of the Heart and Small Intestine meet in the axilla area; the Heart Divergent channel diverges from the Heart Main channel in the axilla and goes to the heart itself to then join the Small Intestine Divergent

A man suffers from a feeling of constriction of t he chest that extends to the scapula in t he back and to the neck. The ECG is normal and no abnormality of the coronary arteries is suspected. He is under great stress both from work and from his personal life. He frequently suffers from severe neckache w ith difficulty in turn ing the neck. His digestion is poor and he suffers f rom borborygmi and abdominal distension. His pulse is Wiry. This constellation of symptoms is due to pathology of both Heart and Small Intestine channels; in terms of patterns, there is Qi stagnation in the Heart and Small Intestines. Use the following points: -HE-1 Jiquan to t reat the Lower Meeting area of the Heart and Small Intestine Divergent channels -BL-1 to treat the Upper Meeting point of these two Divergent channels. The use of the Lower and Upper Meeting points will stimulate the balance of Yin and Yang in the neck area to relieve the neckache and in the chest and scapula and the feeling of constriction of the chest -S.I.-1 Shaoze as a distal point to rel ieve the Qi stagnation in the Small Intestine channel -S.I.-7 Zhizhen, Connecting (Luo) point to relieve the Qi stagnation in the Small Intestine and Heart channels -Ren-4 Guanyuan, Front-Collecting point of the Small Intestine, to treat the Qi stagnation in the Small Intestine organ.

channel in the neck. This close connection between these two channels explains the radiation of heart pain to the scapula, upper back and neck. The Heart Divergent channel strengthens the connection between the Heart channel and the throat, hence the use of HE-5 Tongli or HE-8 Shaofu for problems of the throat and vocal cords (pharyngitis, laryngitis, etc.).

Triple Burner and Pericardium (Fig. 22.5) The Triple Burner and Pericardium Divergent channels do not have a Lower meeting point. Their Upper

FUNCTIONS AND CLINICAL USE OF THE DIVERGENT CHANNELS

351

TREATMENT EXAMPLE A woman suffers fro m ch ronic temporal headaches and a severe stiffness of the neck after a hysterectomy. She also experiences a feeling of tightness of the chest and insomnia. Use the following points: - T.B .-16 Tianyou, Upper Meeting point of t he Triple Burner and Pericardium channels to treat both channels; th is w ill t reat the headache and stiffness of the neck -P-6 Neiguan to open the chest.

This is an important way in which the Upper Meeting point of this pair of Divergent channels strengthens the relationship between the Triple Burner and Pericardium channels. Moreover, the Upper Meeting point has also the important function of balancing Yin and Yang in the head and regulating the ascending and descending of Qi to and from the head. For this reason, the Upper Meeting point T.B.-16 Tianyou can be used for LiverYang rising causing headaches, dizziness, tinnitus or ear problems. The convergence of the Pericardium with the Triple Burner channel in the area of T.B.-16 Tianyou explains the use of Pericardium points (such as P-6 Neiguan) for neck pain. As the Triple Burner Divergent channel goes to the vertex and as it is connected with the Pericardium Divergent channel, some Triple Burner points (e.g. T.B.-3 Zhongzhu) can be used to lift the spirits in depression.

Large Intestine and Lungs (Fig. 22.6) Fig. 22.5 Triple Burner and Pericardium Divergent channels.

Meeting point is T.B.-16 Tianyou, which is also a Window of Heaven point. The Upper Meeting point of these two channels has great clinical significance because it explains the definite effect of Pericardium points on the neck, ear and lateral side of the head. For example, I frequently use P-6 Neiguan for temporal headaches from LiverYang rising occurring on the Triple Burner channel.

The Divergent channels of the Large Intestine and Lungs do not have a Lower Meeting point. Their Upper Meeting point is L.I.-18 Futu, which is also a Window of Heaven point. This pair of Divergent channels strengthens the relationship between both the channels and the organs of Large Intestine and Lungs, as the Large Intestine Divergent channel flows through the lungs and the Lung Divergent channel flows through the large intestine.

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..---'4~L.I. -18

Upper Meeting point To spine

l.l.-15

Large Intestine Divergent

Fig. 22.6 Large Intestine and Lung Divergent channels.

The close relationship between these two channels fostered by their Divergent channels explains the clinical use of Lung points to affect the neck, shoulders and face. Lu-7 Lieque, especially, affects the face, neck and shoulder. Both Large Intestine and Lung points are important to regulate the ascending and descending of Qi to and from the head, and this function is partly due to their Upper Meeting point L.I.-18 Futu. which is a Window

TREATMENT EXAMPLE A patient suffers from allergic rhinitis and asthma. He also experiences stiffness and pain of the shoulder. Use the following points: -L.I. -18 Futu, Upper Meeting point of the Large Intestine, to treat both the Lungs and Large Intestine in order to affect the asthma and the shoulder pain -LU-1 Zhongfu, Front-Collecting point of the Lungs, to treat the Lungs -LU-7 Lieque and L.l.-4 Hegu to promote the descending and diffusing of Lung-Qi; L.l.-4 will affect the Large Intestine channel but also the Lungs by way of the Divergent channel.

of Heaven point. As these two channels regulate the ascending and descending of Qi to and from the head, they can help to subdue rebellious Qi when it affects the face and head causing headaches. For this reason, LU-7 Lieque and L.I.-4 Hegu can both be used to help to subdue Liver-Yang rising.

NOTES 1. Wang Xue Tai 198 8 Great Treatise of Chinese Acupu ncture (Zhong Guo Zhen ]iu Da Qunn

~-l---- Hepatogastric

ligament Gastrophrenic ligament ~-- Spleen

Gastrosplenic ligament Stomach Lesser omentum Duodenum

' - - - --

Greater omentum

Fig. 27.13 The Membranes (Huang) in the abdomen.

DIRECTING VESSEL (REN MAl)

the former indicating the body cavities, the latter meaning 'patterns': in this case, 'muscle patterns' (Rou Li) simply indicates the muscle fibres. CLINICAL NOTE

The Membranes (Huang) have three functions: they anchor the organs, they connect the organs among themselves and they wrap the organs. The 'C lassic of Categories' says: 'The Membranes [Huang} are in between the abdominal cavities and the muscle patterns [Li as in Cou Li}, they extend up and down in the crevices.'

With reference to the two points Ren-15 and Ren-6, these are the Source points of Fat Tissue and Membranes respectively, which means that these points and the whole Directing Vessel on the abdomen are embryologically related to the development of connective tissue. Using these points can therefore act at a deep energetic level to regulate and equalize tensions and weaknesses in the Membranes of the abdomen and thorax. Bearing in mind that the superficial fascia are thinnest on the Yang surfaces and extremities and thickest on Yin surfaces. the Membranes acquire particular importance in the abdomen: the Directing Vessel gives us a way to act on the deeper fascia of abdomen and thorax, while the Five Transporting (Shu) points in arms and legs act more on the head, neck and limbs themselves. In other words. again the Extraordinary Vessels perform a function of integration of various structures into the channel system. 16 Thus, from this point of view, the Extraordinary Vessels present an additional component to Chinese medical anatomy integrating the vast structure of connective tissue with the Internal Organs and channels. We are used to considering Chinese medicine, with its concept of Qi. as emphasizing function to the detriment of structure, and used to thinking of the body as a system of channels through which Qi Oows to the organs. The system seen in this way is rather theoretical, unrealistic and abstract and it does not take into account anatomical reality. The ancient Chinese did consider structure as well as function and they did not overlook the vast network and connections provided by the connective tissue in between organs. Qi does not now in channels leading to organs in a 'vacuum': all the channels and organs are linked, wrapped, padded and integrated by

461

layers of Membranes (Huang), the connective tissue of Western medicine. As the Extraordinary Vessels control the Fat Tissue and Membranes, this confirms their function of regulating and integrating various structures and energies with the channels and Internal Organs system. Qi easily stagnates in the Membranes in the abdomen causing distension and pain: the opening and coupled points of the Directing Vessel (LU-7 and KI-6) can eliminate stagnation from the abdominal Membranes. CLINICAL NOTE

Qi stagnation in the abdomen involves also the Membranes (Huang) in the abdomen creating a condition of tension in them.

The pattern of rebellious Qi of the Penetrating Vessel also involves the abdominal Membranes and this will be discussed in the next chapter (Ch. 28).

SUMMARY THE DIRECTING VESSEL CONTROLS FAT TISSUE AND THE MEMBRANES

• The Membranes anchor the organs, connect the organs and wrap the organs • They fill the spaces, especially in the abdominal cavity, between the organs and the muscles • They correspond to the connective tissues of the abdomen, e.g. fascia, mesentery, omentum, stroma • Ren-6 Qihai is the Source point of the Membranes • The Directing and Penetrating Vessels influence the Membranes • Membranes are subject to stagnation, manifesting often in a Penetrating Vessel's pathology.

The Directing Vessel and the male genital system The penis The Directing Vessel Oows at the front of the body over the external genitalia and therefore the testicles and penis in men. The Directing Vessel represents

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PART 7: EIGHT EXTRAORDINARY VESSELS

the inl1uence of Kidney-Yin on the penis and testis: it is the channel through which Kidney-Yin provides Essence. Thus, the Directing Vessel represents the Yin aspect of Essence. The Directing Vessel can be used to treat problems of the male genitalia occurring against a background of Kidney-Yin deficiency.

The prostate It can be postulated that, in men, the prostate is the

organ equivalent to the Uterus in women. Therefore the three vessels that arise in the lower abdomen, the Governing, Directing and Penetrating Vessels, all l1ow through a man's prostate on their way down to Ren-1 Huiyin. In my opinion, when considering the physiology and pathology of the prostate gland in Chinese medicine, the seminal vesicles should be assimilated with the prostate (see Fig. 28.22).

Just as the ovaries in women are related to the Kidney-Essence. so is the prostate in men. Jointly with the seminal vesicles, the prostate produces about 90% of the seminal fluid. Just as the Governing and Directing Vessels in women represent the Yang and Yin aspect of the menstrual cycle, in men both these two vessels influence the prostate and the production of seminal l1uid. Sperm is a form of Essence and, as such, it is part of the Yin essences (and therefore the Directing Vessel); Kidney-Yin and the Directing Vessel provide the male genital system with Essence and they therefore play an important role in the production of sperm. A deficiency of Kidney-Yin and of the Directing Vessel may cause abnormalities of the sperm such as a reduced sperm count. In the presence of a background of Kidney-Yin deficiency, tllis can be boosted by using the Directing Vessel with its opening and coupled points (LU-7 on the left and KI-6 on the right) together with Ren-4 Guanyuan and KI-13 Qixue.

SUMMARY THE DIRECTING VESSEL AND THE MALE GENITAL SYSTEM

Combination of Governing and Directing Vessel points

The penis • The Directing Vessel f lows at the f ront of t he body over the externa l genitalia and therefore the t esticles and penis in men • The Directing Vessel represents t he influence of Kidney-Yin on t he penis and test is • The Directing Vessel can be used to treat problems of t he male genitalia occurring against a background of Kidney-Yin deficiency.

As discussed in Chapter 26, the Governing and Directing Vessels are like two branches of one channel. one Yang. the other Yin, both originating from the same place and both flowing to the Heart. They could really be seen as one channel with a Yang part and a Yin part. Therefore the balancing of points from the Governing and Directing Vessels is a very important aspect of Yin-Yang and, as the Governing Vessel is in the back and the Directing Vessel in the front, of Back-Front balancing and a very effective treatment in practice. Finally, as these two vessels both l1ow upwards to the head and the Governing Vessel flows into the brain, combining their points also has a very powerful and important menta l effect, which can be either lifting or calnling. The following are examples of combination of points from the Governing and Directing Vessels.

The prostate • The prostate is the organ equiva lent to the Uterus in women • The seminal vesicles should be assi milated with the prostate • In men, the Governing and Direct ing Vessels influence the prost ate and the production of seminal fluid • Sperm is a form of Essence and, as such, it is part of the Yin essences (and t herefore the Directing Vessel) • A deficiency of Kidney-Yin and of the Di recting Vessel may ca use abno rm alities such as a reduced sperm count (LU-7 and Kl -6, Ren-4 and Kl-13).

-

Du-14 Dazhui and Ren-4 Guanyuan, both with direct moxa cones: to tonify and warm Yang. Du-14, with moxa, warms all the Yang channels and the Heart, while Ren-4, with moxa, tonifies and warms Kidney-Yang, which is the foundation for all the Yang energies of the body. Thus this

DIRECTING VESSEL (REN MAl)

-

-

-

-

-

-

-

-

combination tonifies the Heart- and Kidney-Yang and Yang Qi in general. Du-16 Fengfu and Ren-24 Chengjiang: to treat occipital headache. 17 Du-1 9 Houding and Ren-15 Jiuwei: to calm the Spirit. Du-19 calms the Spirit and extinguishes (internal) Wind while Ren-15 calms the Spirit and nourishes the Heart. This combination has a powerful calming effect as Ren-15 nourishes and Du-19 calms. Ren-15 will also relieve anxiety manifesting with a feeling of oppression in the chest. Du-20 Baihui and Ren-15 Jiuwei: to calm the Spirit and lift mood. This combination can simultaneously calm the Spirit (Ren-15) and improve the mood and lift depression (Du-20). It is an excellent combination for mental depression with anxiety. Du-20 Baihui and Ren-12 Zhongwan: to torrify the Stomach and Spleen and lift mood. This combination is good to lift depression occurring against a background of deficiency of Stomach and Spleen. Du-20 Bailwi and Ren-4 Guanyuan: to calm the Spirit, nourish the Kidneys, strengthen the Original Qi and lift mood. This combination lifts mood and relieves depression by nourishing Kidney-Yin and strengthening the Original Qi. It is suitable for depression and anxiety occurring against a background of Kidney-Yin deficiency. It also lifts Qi when it is sinking and is therefore used for excessive menstrual bleeding caused by deficiency and sinking of Qi. Du-20 Bailwi and Ren-6 Qihai: to torrify and raise Qi. Ren-6 tonifies Qi in general while Du-20 raises Qi: the combination of these two points is excellent to torrify and raise Qi in case of pro lapses or simply sinking of Qi. However, its use need not be confined to such conditions; it also has a powerful mood-lifting effect in depression. Du-20 Bailwi and Ren-3 Zhongji: to torrify and raise Qi in the Bladder. This combination is used for urinary problems deriving from deficiency and sinking of Qi in the Bladder manifesting with frequency of urination without pain or with only very slight pain, slight incontinence of urine, and a bearing-down feeling in the lower abdomen. Yintang and Ren-4 Guanyuan: to calm the Spirit and nourish the Kidneys: this combination is similar to

463

the previous one as it roots Qi in the Lower Burner by nourishing the Kidneys and strengthening the Original Qi. Whilst the previous combination is better for anxiety and worrying, this one is better for insomnia. - Du-24 Shenting and Ren-4 Guanyuan: to nourish the Kidneys, strengthen the Original (Yuan) Qi and calm the Spirit. This combination calms the Spirit by nourishing Kidney-Yin and strengthening the Original Qi. It is suitable for severe anxiety occurring against a background of Kidney-Yin deficiency. It is particularly indicated for anxiety as it roots Qi in the Lower Burner and draws it downwards away from the head and the Heart where it harasses the Mind. - Du-24 Shenting and Ren-15 Jiuwei: to calm the Mind and nourish the Heart. I use this

SUMMARY COMBINATION OF GOVERNING AND DIRECTING VESSEL POINTS

• Du-14 Dazhui and Ren-4 Guanyuan to tonify and warm Yang • Du-16 Fengfu and Ren-24 Chengjiang to treat occipital headache • Du-19 Houding and Ren-15 Jiuwei to calm the Spirit • Du-20 Baihui and Ren-15 Jiuwei to calm the Spirit and lift mood • Du-20 Baihui and Ren-12 Zhongwan to tonify the Stomach and Spleen and lift mood • Du-20 Baihui and Ren-4 Guanyuan to calm the Spirit, nourish the Kidneys, strengthen the Original Qi and lift mood • Du-20 Baihui and Ren-6 Qihai to tonify and raise Qi • Du-20 Baihui and Ren-3 Zhongji to tonify and raise Qi in the Bladder • Yintang and Ren-4 Guanyuan to calm the Spirit and nourish the Kidneys • Du-24 Shenting and Ren-15 Jiuwei to calm the Mind and nourish the Heart • Du-24 Shenting and Ren-4 Guanyuan to nourish the Kidneys, strengthen the Orig inal (Yuan) Qi and calm the Spirit • Du-26 Renzhong and Ren-3 Zhongji to move Qi in the Bladder.

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combination to calm the Mind and nourish the Heart when the patient is depressed and anxious and suffers from mental-emotional problems occurring against a background of Deficiency. - Du-26 Renzhong and Ren-3 Zhongji: to move Qi in the Bladder. This combination is used for Qi stagnation in the Bladder causing frequency of and difficulty in urination, a feeling of distension in the hypogastrium, and a slight ache before urination.

The pulse of the Directing Vessel The pulse of the Directing Vessel is Long, Tight, Fine on both Front positions, extending down to Middle position (see Figure 25.4). The 'Pulse Classic' (MaiJing, AD 280) says: 'When the pulse feels like pellets horizontally on [both] Front position, it indicates [a pathology ofl tlze Directing Vessel. There will be finger-shaped Qi masses in the abdomen harassing the heart upwards, inability to bend forward or backward and tenseness [of the abdomen].' 18 The same text describes another pulse quality of the Directing Vessel: 'When the pulse is Tight, Pille, Full nlld Long on [both] Middle positiolls, it indicates [a pathology ofl the Directing Vessel. There will be abdomillal pain from the umbilicus to the pubis, pain in tire genitals. Trent the point 3 cwi below the umbilicus [Ren-4 Gunnyunn]. ' 19

SUMMARY CLINICAL APPLICATIONS OF THE DIRECTING VESSEL

• • • • • • • • • •

Nourish Yin Regulate the Uterus Regu late life cycles Move Qi in the Lower Burner and Uterus Promote the descending of Lung-Qi and the Kidney's receiving of Qi Promote the transformation, transportation and excretion of fluids Activate the Triple Burner Control Fat Tissue and Membranes Combination of Directing and Governing Vessel points Pulse of the Directing Vessel.

CLASSICAL INDICATION S Pathology Chapter 29 of the 'Classic of Difficulties' says: 'The Directing Vessel's diseases consist in intemnl stagnation which can give rise to, in men, the seven kinds of Hernial and Genito-Urinary Disorders (Shan) and. in women. to alxlominal masses (from Qi stagnation, i.e. Jia of Zheng-Jin and Ju of Ji-Ju].' 20 Chapter 60 of the 'Simple Questions' says similarly: 'Diseases of tile Directing Vessel cause the seven kinds of Hernial and Genito-Urinary disorders [Shan] in men and nbdomillal masses Urom Qi stagllation] in women {Jia and Juj. ' 21 The ~C of Acupuncture' Uia Yi Jing, AD 282) says: 'Diseases of the Directing Vessel include the seven types of Hernial alld Genito-Urinary Disorder (Shan) in men mzd abdominal masses Urom Qi stagnation) in women (of the Jia andJu type].' 22 The 'Pulse Classic' (Mai Jing, AD 280) says: 'When the Directing Vessel is diseased there are accumulations {in the abdomen]: in men, the seven kinds of Hernial and Genito-Urinary Disorders (Shan): in women, abdominal masses Urom Qi stagnation] of the Jia or Ju type. ' 23 The 'Pulse Classic' says: 'If both Front-position pulses feel like small pellets, this is a Directing Vessel's pulse. This causes finger-shaped accumulations of Qi in the abdomen which may surge up towards the heart. There will be inability to bend the body and rigidity. If the pulse feels Tight, Pille, Full and Long up to the Middle Position, it is a Directing Vessel's pulse. There will be umbilical pain mdiatillg dowllwnrds to the pubic bone and a severe pain in the gellitals.' 24 The 'Golden Mirror of Medicine' (Yi Zong Jin Jian, 1742) gives the following clinical manifestations for the Directing Vessel: 'Haemorrhoids, swelling of the anus. dysentery, coughing of sputum with blood, toothache, swollen throat. difficult urination, chest and abdominal pain, difficulty in swallowing with choking semntion, aphasia after labow; backache. cold abdomen, dead fetus that cannot be expelled with Qi rising to the diaphragm. ' 25 Li Shi Zhen gives the indications of the Connecting channel of the Directing Vessel: 'Whm the Connecting cilanllel of the Directing Vessel is full there is pain on tile skin of the abdomen: when it is empty there is itching over the abdomen. ' 26 The 'Classic of Categories' says: 'Diseases of the Directing Vessel include t/1e seven types of Hernial and

DIRECTING VESSEL (REN MAl )

Genito-Urinary Disorders [Shan] i11me11 and leucorrhoea and abdominal masses Urom Qi stag11atioll. i. e. Jia-Ju] ill women ... it is white-red leucorrhoea. These are abdominal masses of tire Jia type fas in Zheng-Jiaj and of tlze Ju type [as in Ji-Ju]. m Zhang Jing Yue therefore clarifies specifically that the abdominal masses in a Directing Vessel's pathology are of the non-substantial type from Qi stagnation. In fact, there are two terms to indicate 'abdominal masses' , i.e. Zheng-Jia and Ji-Ju, in which 'zheng' and 'ji' indicate actual, fixed masses (from Blood stasis, which I call 'Blood Masses'), and 'Jia' and 'Ju' indicate non-substantial abdominal masses that come and go (from Qi stagnation, which I call 'Qi Masses'). Generally, Zheng-Jia refers to abdominal masses in gynaecological conditions, whereas Ji-Ju occur in both men and women. The 'Gatherings from Eminent Acupuncturists' (Zhen Jiu Ju Ying, 1529) lists the following symptoms and signs for the Directing Vessel (using LU-7 Lieque and KI-6 Zhaohai) indicating in brackets the organ involved: • diarrhoea with cold pain (Spleen) • abdominal pain from Blood lumps in women (Liver) • feeling of heaviness and pain of the throat (Stomach) • retention of dead fetus (Liver) • feeling of heaviness and pain of teeth (Stomach and Large Intestine) • spasm and pain in the small intestine (Small Intestine) • hypochondriallump and pain (Liver) • spitting of pus and blood (Lungs) • coughing with cold phlegm (Lungs) • chord-like mass beside the umbilicus (Stomach) • stagnation of food, not descending (Stomach) • stabbing abdominal pain (Spleen) • pain in heart region and abdomen (Spleen) • borborygmi (Large Intestine) • itchy, painful and bleeding haemorrhoids (Large Intestine) • heart pain during an acute Warm disease (Spleen) • postpartum backache (Kidneys) • postpartum psychosis (Heart) • postpartum aphasia (Pericardium) • inability to digest rice and grains (Spleen)

465

• hypochondriallump in men from alcoholism (Stomach and Liver) • swelling, pain and abscess of breast (Stomach) • blood clots in women (Liver and Kidneys) • Warm disease (Wen Bing) not abating (Gall Bladder) • incessant vomiting (Spleen, Stomach) • blood in urine (Small Intestine) • difficult urination (Bladder) • constipation (Large Intestine) • blood in stools (Large Intestine) • epigastric and abdominal pain (Heart and Stomach) • lumps (Heart and Stomach).28

Point combinations The following are point combinations for LU-7 Lieque and KI-6 Zhaohai given in the 'Great Compendium of Acupuncture' (Zhen Jiu Da Cheng). It should be noted that the text indicates LU- 7 as the 'host' point to be combined with KI-6 Zhaohai the 'guest' point: 'Needle [LU- 7] as Host [point] 8 fen deep to treat diseases of tlze heart. abdomen. lzypoclwndriwn and the fi ve Yin Organs; cotn/Jille with KI-6 Zlzaolzai as Guest [point].' 29 The 'Great Compendium of Acupuncture' also specifies the order of needling, i.e. the host point (LU-7) first: ·First needle LU-7 Lieque as Host point. then needle KI-6 Zlzaolzni second as Guest point.' 30 The indications and combinations given for these two points in the 'Great Compendium of Acupuncture' are as follows (i.e. the points indicated below are needled in addition to LU-7 and KI-6): -foul-smelling nasal discharge: L.I.-11 Quchi, Du-23 Shangxing, Du-20 Baihui, BL-12 Fengmen, L.I.-20 Yingxiang - polyps in nose, nasal obstruction: Yintang, L.I.-20 Yingxiang, Du-23 shangxing, BL-12 Fengmen - invasion of Wind, flushed face, fever, headache: HE-5 Tongli, L.I.-11 Quchi, Juegu (extra point near G.B.-39 Xuanzhong), L.I.-4 Hegu -invasion of Wind-Cold, cough, fullness of the chest: Ren-17 Shanzhong, BL-12 Fengmen, L.I.-4 Hegu, Du-16 Fengfu - invasion of Wind, hot limbs, headache: LU-8 Jingqu, L.I.-11 Quchi. L.I.-4 Hegu, BL-40 Weizhong

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PART 7: EIGHT EXTRAORDINARY VESSELS

-abdominal pain, diarrhoea: ST-44 Neiting, ST-25 Tianshu, SP-6 Sanyinjiao -red and white diarrhoea, feeling of cold in the abdomen: ST-28 Shuidao, Ren-6 Qihai, ST-26 Wailing, ST-25 Tianshu, SP-6 Sanyinjiao, ST-36 Zusanli -redness and swelling of breasts: S.I.-1 Shaoze, P-7 Daling, Ren-17 Shanzhong -swollen, painful and abscessed breast after childbirth: LU-1 Zhongfu, Ren-17 Shanzhong, S.I.-1 Shaoze, LIV-1 Dadun -feeling of cold and pain in abdomen, incessant diarrhoea: ST-25 Tianshu, Ren-12 Zhongwan, Ren-4 Guanyuan, SP-6 Sanyinjiao - abdominal pain from Blood stasis in women with uterine bleeding: BL-18 Ganshu, BL-23 Shenshu, BL-17 Geshu, SP-6 Sanyinjiao - cough with white sputum, pain in the chest: BL-13 Feishu, Ren-17 Shanzhong. ST-36 Zusanli -cough with blood-tinged sputum: BL-12 Fengmen, LU-9 Taiyuan, Ren-17 Shanzhong -asthma with phlegm: ST-40 Fenglong, KI-2 7 Shufu, Ren-17 Shanzhong, ST-36 Zusanli - asthma, gasping for breath, urgent sensation in chest: Ren-26 Renzhong, Ren-22 Tiantu, BL-13 Feishu, ST-36 Zusanli - asthma, inability to lie flat: KI-2 7 Shufu, BL-12 Fengmen, LU-9 Taiyuan, Ren-17 Shanzhong, LU-1 Zhongfu, ST-36 Zusanli -nasal obstruction with loss of smell: L.I.-20 Yingxiang, Du-23 Shangxing, BL-12 Fengmen - clear nasal discharge, space between skin and muscles (Cou Li) not 'tight', sneezing: Du-24 Shenting, BL-13 Feishu, LU-9 Taiyuan, ST-36 Zusanli -carbuncles in nipple: ST-18 Rugen, S.I.-1 Shaoze, G.B.-21 Jianjing, Ren-17 Shanzhong -choking pain in chest: P-7 Daling, P-6 Neiguan, Ren-17 Shanzhong, ST-36 Zusanli - goitre: Ren-22 Tiantu, L.I.-18 Futu, S.I.-16 Tianchuang, ST-12 Quepen, KI-2 7 Shufu, Ren-17 Shanzhong, L.I.-4 Hegu, Shixuan -mouth ulcers: Shixuan, Ren-26 Renzhong, Ren-24 Chengjiang, L.I.-4 Hegu -tongue ulcers from Heat in Triple Burner: T.B.-1 Guanchong, T.B.-5 Waiguan, Ren-26 Renzhong, L.I.-20 Yingxiang, ST-4 Dicang -foul breath: HE-9 Shaochong, HE-5 Tongli. Ren-26 Renzhong, Shixuan.

CLINICAL NOTE ClASSIC POINT COMBINATIONS

• Ou-23 Shangxing: this point is mentioned for every nasal symptom, confirming the modern practice of using Du-23 to clear the nose (foul nasal discharge, polyps in nose, nasal obstruction, loss of smell) • ST-25 Tianshu: the point ST-25 is mentioned three times for diarrhoea, confirming its modern use as an important point in stopping diarrhoea • 5.1.-1 Shaoze: the point S.l.-1 is ment ioned three times in connection with the breast (redness and swelling of breast, swollen and abscessed breast, carbuncles in nipples) confirming its use as an empirical point for the female breast.

SUMMARY ClASSICAL INDICATIONS FOR THE DIRECTING VESSEL

• Classic of Difficulties: internal stagnation

•

•

•

•

which, in men, can give rise to the seven kinds of Hernial and Genito-Urinary Disorders [Shan] and, in women, to abdominal masses [from Qi stagnation, i.e. Jia and Ju] Simple Questions: seven kinds of Hernial and Genito-Urinary Disorders [Shan] in men and abdominal masses [from Qi stagnation] in women 31 Pulse Classic: finger-shaped accumu lations of Qi in the abdomen which may surge up towards the heart, inability to bend the body and rigidity, umbilical pain radiating downwards to the pubic bone and severe pain in the genitals Golden Mirror of Medicine: haemorrhoids, swelling of the anus, dysentery, cough ing of sputum with blood, toothache, swollen throat, difficult urination, chest and abdomina l pain, difficulty in swallowing with choking sensation, aphasia after labour, backache, cold abdomen, dead fetus that cannot be expelled with Qi rising to the diaphragm Classic of Categories: seven types of Hernial and Genito-Urinary Disorders [Shan] in men and leucorrhoea and abdominal masses in women, white-red leucorrhoea .

DIRECTING VESSEL (REN MAl)

THE POINTS OF THE DIRECTING VESSEL The points of the Directing Vessel are illustrated in Figure 2 7.14. I shall discuss all the important points of the Directing Vessel according to my experience.

Ren-1 Huiyin Meeting of Yin Nature Beginning point of Directing, Penetrating and Governing Vessels (Ren Mai, Chong Mai, Du Mai). One of the Sun Si Miao Ghost points.

Actions • Regulates the two lower orifices and genitalia and resolves Dampness • Promotes resuscitation • Calms the Mind and opens the Mind's orifices • Nourishes Yin.

467

Indications • Difficult urination and defecation, enuresis, impotence, pain in penis, sweating of genitals, swelling of testicles, swelling of vulva and vagina, prolapse of rectum. haemorrhoids, pain in anus, pain in urethra, itching and pain of perineum, Hernial and Genito-Urinary Disorders (Shan) • Coma, unconsciousness from drowning • Manic-depression.

Comments Ren-1 is the point where the three Extraordinary Vessels, the Directing, Governing and Penetrating Vessels (Ren Mai, Du Mai and Chong Mai), emerge from the Interior: for this reason, it is a dynamic point with a powerful action in moving Qi and Blood and also in subduing rebellious Qi (as in mental problems). Some of its indications (epilepsy, manic-depression, haemorrhoids, prolapse of anus) reflect Governing Vessel pathology. Ren-1 resolves Dampness in the genital area and in the urethra and anus; it can be used for vaginal discharge, pruritis vulvae or itching of scrotum, urinary difficulty, difficulty in defecation, etc. As one of Sun Si Miao's Ghost points. it calms the Mind and opens the Mind's orifices and it can be used in manic-depression.

SUMMARY REN- 1: SUMMARY OF FUNCTIONS

• Regulates the two lower orifices and genitalia and resolves Dampness (difficu lt urination and defecation, enuresis, impotence, pain in penis, sweating of genitals, swelling of testicles, swelling of vulva and vagina, prolapse of rectum, haemorrhoids, pain in anus, pain in urethra, itching and pain of perineum, Hernial and Genito-Urinary Disorders) • Promotes resuscitation (coma, unconsciousness from drowning) • Calms the Mind and opens the Mind's orifices (manic-depression) • Nourishes Yin. Fig. 27.14 Points of the directing vessel.

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PART 7: EIGHT EXTRAORDINARY VESSELS

This point also nourishes Yin and benefits the Kidney-Essence: it is used for incontinence, enuresis and nocturnal emissions deriving from Yin deficiency. It is an empirical point to promote resuscitation after drowning.

Ren-2 Qugu Curved Bone

On the other hand, this point has a 'firming' and consolidating action on the Essence. It treats seminal emissions and premature ejaculation in men and chronic vaginal discharge in women. It also tonifies the Kidneys and the Essence as the indication 'Exhaustion of the five Yin Organs' shows. Ren-2 is a good alternative to the use of Ren-1 to treat urination, resolve Dampness and firm the Essence.

Nature Meeting point of Directing Vessel and Liver channels

Actions • Benefits the Bladder and regulates urination • Consolidates the Essence • Strengthens the Kidneys and the Essence.

Indications • Dribbling of urine, difficult urination, retention of urine, enuresis, itchy scrotum, contraction of penis, pain in genitalia, vaginal itching, Hernial and Genito-Urinary Disorders (Shan) • Seminal emissions, premature ejaculation, chronic vaginal discharge, impotence • Exhaustion of the five Yin Organs.

Comments Ren-2 has a dual function. On the one hand, it resolves Dampness in the urinary system and treats Hernial and Genito-Urinary Disorders (Shan) in a similar way to Ren-l.

SUMMARY REN-2: SUMMARY OF FUNCTIONS • Benefits the Bladder and regulates urination (dribbling of urine, difficult urination, retention of urine, enuresis, itchy scrotum, contraction of penis, pain in genitalia, vaginal itching, Hernial and Genito-Urinary Disorders [Shan]) • Consolidates the Essence (seminal emissions, premature ejaculation, chronic vaginal discharge, impotence) • Strengthens the Kidneys and the Essence (exhaustion of the five Yin Organs).

Ren-3 Zhongji Middle Pole Nature Front Collecting (Mu) point of the Bladder. Meeting point of Directing Vessel, Spleen, Liver and Kidneys channels. Meeting point of the three Yin Muscle channels of the leg.

A ctions • Resolves Dampness from the Lower Burner • Promotes the Bladder function of Qi transformation • Benefits the Uterus and regulates menstruation • Strengthens the Kidneys and nourishes the Essence.

Indications • Genital itching, pain in the genitals, excessive vaginal discharge, Hernial and Genito-Urinary Disorders (Shan) • Retention of urine. frequent urination, dark urine. pain on urination • Infertility. irregular periods, amenorrhoea, excessive uterine bleeding, abdominal masses in women (Zheng ]ia), retention of placenta, retention of lochiae, persistent lochial discharge • Lower backache, dizziness, tinnitus, weak knees, deficiency of Original Qi (Yuan Qi).

Comments Ren-3 is a very important point for Genito-Urinary problems. It is the main point to affect the Bladder and its function of Qi transformation. It can therefore be used for any urinary problem, particularly acute ones. It is more frequently used with reducing method in Excess patterns. However, it can also be used with reinforcing method to strengthen the Bladder.

DIRECTING VESSEL (REN MAl)

Th is point is specific to resolve Dampness from the Bladder and is used for such symptoms as pain and burning on urination and interrupted 11ow of urine. It clears Heat from the Bladder and is usually combined with some distal points for such symptoms as fever, burning on urination and blood in the urine. To treat these problems, it is often combined with SP-6 Sanyinjiao, SP-9 Yinlingquan or LIV-5 Ligou, depending on the presenting pattern. Ren-3 also affects the Uterus and menstruation and it can be used in many menstrual irregularities both to strengthen the Directing Vessel and to invigorate Blood in the Uterus for such problems as painful periods, retention of placenta, abdominal masses, etc. Finally, Ren-3 has also a general tonic effect on the Kidneys and the Original Qi: however, I personally use this point more for Excess than for Deficiency patterns and more to invigorate Blood and resolve Dampness than to nourish Blood. For Deficiency patterns, I tend to use Ren-4 Guanyuan more.

SUMMARY REN-3: SUMMARY OF FUNCTIONS

• Resolves Dampness from the Lower Burner (genital itching, pain in the genitals, excessive vaginal discharge, Hernial and Genito-Urinary Disorders [Shan]) • Promotes the Bladder function of Qi transformation (retention of urine, frequent urination, dark urine, pain on urination) • Benefits the Uterus and regulates menstruation (infertility, irregular periods, amenorrhoea, excessive uterine bleeding, abdominal masses in women [Zheng Jia], retention of placenta, retention of lochiae, persistent lochial discharge) • Strengthens the Kidneys and nourishes the Essence (lower backache, dizziness, tinnitus, weak knees, deficiency of Original Qi [Yuan Qi].

Ren-4 Guanyuan Gate to the Original Qi Nature Front Collecting (Mu) point of the Small Intestine. Meeting point of Directing Vessel, Spleen, Liver and Kidney channels. Meeting point of the Directing and Penetrating Vessels.

469

Actions • Nourishes Blood and Yin • Strengthens the Kidneys • Strengthens the Uterus and regulates menstruation • Benefits Original Qi (Yuan Qi) • Benefits the Bladder • Subdues rebellious Qi in the Penetrating Vessel • Regulates the Small Intestine • Strengthens the Kidney's receiving of Qi • Roots the Mind (Shen) and the Ethereal Soul (Hun).

Indications • Lower backache, weak knees, dizziness, tinnitus. feeling of cold in the back, darkness of face, frequent urination, impotence • Infertility, cold sensation in the vagina, amenorrhoea, bleeding in pregnancy, persistent lochial discharge • Retention of urine, dark urine, painful urination, blood in the urine • Feeling of cold in the lower abdomen, Running Piglet Syndrome, abdominal fullness, umbilical pain • Diarrhoea, undigested food in the stools, incontinence of stools in the elderly • Cough, coughing of blood, breathlessness • Fear, fright, insomnia.

Comments Ren-4 is an extremely important point. It is one of the most powerful points for tonifying Qi and Blood and strengthening the body and mind . First of all, it can be used to tonify Blood and Yin in any pattern of deficiency of Blood and/ or Yin. It n ourishes Yin first because the Directing Vessel controls all the Yin channels and secondly because Ren-4 is the meeting point of the Directing Vessel with the Liver, Spleen and Kidney channels. 'Darkness of face ' in the above indications is a sign of Kidney-Yin deficiency. Besides this, Ren-4 also strengthens the Yang when used with direct moxibustion, and can be used in this way to rescue Yang in the acute stages of Wind-stroke

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PART 7: EIGHT EXTRAORDINARY VESSELS

due to collapse of Yang. It can therefore be used in any pattern from deficiency of Yang, particularly Kidney-Yang. Ren-4 is probably the main point for affecting the Uterus and menstruation, so it is used for most menstrual disorders such as amenorrhoea, or scanty, irregular, heavy or painful periods (especially from Qi stagnation or Dampness). Ren-4 also has a long history of use for infertility. In menstrual and gynaecological problems in general, I usually use Ren-4 in combination with the opening points of the Directing Vessel, i.e. LU-7 Lieque and KI-6 Zhaohai. Ren-4 tonifies the Kidneys and Original Qi (Yuan Qi) and is a very powerful point for strengthening the general level of energy and the Kidneys. It is thus an important point to treat chronic diseases or patients with a poor constitution. Ren-4 can torrify both Kidney-Yang (with direct moxibustion) and Kidney-Yin. Ren-4 can calm the Mind (Shen) and settle the Ethereal Soul (Hun) by nourishing Blood and Yin. It can strengthen the Lower Burner in persons who are very anxious, especially if such anxiety derives from Yin deficiency. This point tonifies the Qi of the Lower Burner, thus rooting Qi downwards and subduing the rising of Qi to the head, which happens in severe anxiety. In this way it has a powerful calming effect. Ren-4 can root the Ethereal Soul and can be used for a vague feeling of fear at night, which is said to be due to the floating of the Ethereal Soul. Its Kidney-tonic action extends also to that of strengthening the Kidney's receiving of Qi so that Ren-4 is an important point to torrify the Kidneys in chronic asthma. In such cases, it is often combined with KI-13 Qixue. Some of the indications for Ren-4 pertain to the Penetrating Vessel as this vessel goes through this point. The Penetrating Vessel's indications for Ren-4 are a feeling of cold in the lower abdomen, Running Piglet Syndrome. abdominal fullness and umbilical pain. When it is used to subdue rebellious Qi in the Penetrating Vessel I combine this point with the opening points of the Penetrating Vessel, i.e. SP-4 Gongsun and P-6 Neiguan. Finally, Ren-4 also affects the Bladder and is used for problems similar to those indicated by Ren-3. However, although both Ren-3 and Ren-4 affect Bladder and Uterus, I personally use Ren-3 more for Bladder problems and Ren-4 more for the Uterus.

To summarize, Ren-4 is probably the most important tonic point of the body as it tonifies all forms of Qi as follows: • • • • • • • •

Qi Yang Blood Yin Essence Uing) Original Qi (Yuan Qi) Kidney-Yin and Kidney-Yang Directing Vessel and Penetrating Vessel (Ren Mni and Chong Mni) • Defensive Qi (Wei Qi) • Nutritive Qi (Yi11g Qi). It is useful to compare the actions of Ren-3 Zhongji

and Ren-4 Guanyuan: Ren-3

Ren-4

Affects the Bladder Mostly to reduce Excess patterns Mild general tonic effect No effect on the Mind

Affects the Uterus Mostly to tonify in Deficiency patterns Strong general tonic effect Powerful calming effect on the Mind Tonifies Original Qi Does not resolve Dampness Can tonify Yang

No effect on Original Qi Resolves Dampness Clears Heat

Ren-5 Shimen Stone Door Nature Front Collecting (Mu) point of the Triple Burner.

Actions • Opens the Water passages and promotes the transformation and excretion of fluids in the Lower Burner • Regulates Qi in the Lower Burner • Regulates the Uterus • Strengthens Original Qi.

Indications • Difficult urination, retention of urine, painful urination, dark urine, oedema, diarrhoea,

DIRECTING VESSEL (REN MAl )

SUMMARY

0

REN-4: SUMMARY OF FUNCTIONS

• Nourishes Blood and Yin • Strengthens the Kidneys (lower backache, weak knees, dizziness, tinnitus, feeling of cold in the back, darkness of face, frequent urination, impotence) • Strengthens the Uterus and regulates menstruation (infertility, cold sensation in the vagina, amenorrhoea, bleeding in pregnancy, persistent lochial discharge) • Benefits Original Qi • Benefits the Bladder (retention of urine, dark urine, painful urination, blood in the urine) • Subdues rebellious Qi in the Penetrating Vessel (feeling of cold in the lower abdomen, Running Piglet Syndrome, abdominal fullness, umbilical pain) • Regulates the Small Intestine (diarrhoea, undigested food in the stools, incontinence of stools in the elderly) • Strengthens the Kidney's receiving of Qi (cough, coughing of blood, breathlessness) • Roots the Mind (Shen) and the Ethereal Soul (Hun) (fear, fright, insomnia).

471

Triple Burner and rouses the Original Qi to circulate to all the organs and channels. It can therefore be used to tonify Original Qi in persons with Kidney deficiency and a poor constitution. We can see therefore that the location of Ren-5 just above Ren-4 Guanyuan makes sense. As Ren-4 is the seat of the Original Qi and the Triple Burner is the emissary of the Original Qi on its way to all the organs, it is understandable that the Front-Collecting point of the Triple Burner, Ren-5, is located immediately above Ren-4. Indeed, there is a symmetry with the location of BL-22 Sanjiaoshu, Back-Transporting point of the Triple Burner: this is, in fact, located immediately above BL-23 Shenshu, also a seat of the Original Qi (Fig. 27.15). Another important function of the Triple Burner (and specifically the Lower Burner) is to transform and excrete fluids, and to ensure that the Water passages of the Lower Burner are open. Ren-5 stimulates this function of the Triple Burner. and specifically the Lower Burner: its use is therefore indicated for oedema of the abdomen, urinary retention, difficult urination, diarrhoea or vaginal discharge. The Triple Burner relies on the smooth movement of Qi and ascending/descending and entering/exiting of Qi in all cavities of the body: from this point of view, its function is similar to that of the Liver in relation to the smooth flow of Liver-Qi. Ren-5 stimulates the free

genital itching, swelling of scrotum, swelling of vulva, swelling of penis Twisting pain in the lower abdomen. Hernial and Genito-Urinary Disorders (Shan), umbilical pain, retraction of testicles, Running Piglet Syndrome • Persistent lochial discharge, abdominal masses, heavy periods. stone-like hardness of lower abdomen • Exhaustion.

Internal organs

t t

Triple Burner

Comments In order to understand the function of this point, one must recall the role of the Triple Burner in relation to Original Qi (Yuan Qi). The Original Qi arises from between the Kidneys and spreads to the five Yin and six Yang organs via the intermediary of the Triple Burner. Ren-5 is the Front Collecting (Mu) point of the

~

Motive force (Original Qi)

a

Ren-5 Ren-4 b

BL-22

BL-23

Fig. 27.15 Location of Ren-5 and BL-22 in relation to Triple Burner and Original Qi .

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PA RT 7: EIG HT EXTRAORD INARY VESSELS

llow of Qi and the entering/exiting of Qi in the lower abdomen; when this function is impaired there may be pain in the lower abdomen, Hernial and GenitoUrinary Disorders (Shan) , umbilical pain, and Running Piglet Syndrome for which this point is indicated. It is worth noting the presence of the word 'Men' (i.e. 'door') in the point's name: generally, all points with 'door' in their name promote the entering and exiting of Qi. It is also said that Ren-5 is like a 'door' through which the Qi of the Directing Vessel goes in and out. Ren-5 is used for menstrual disorders but its action is not so strong and general as that of Ren-4 Guanyuan. With regard to menstrual disorders, the main difference between these two points is that Ren-5 is better when there is Dampness in the Lower Burner or Phlegm in the Uterus.

SUMMARY '

REN-5: SUMMARY OF FUNCTIONS • Opens the Water passages and promotes the transformation and excretion of fluids in the Lower Burner (difficult urination, retention of urine, painful urination, dark urine, oedema, diarrhoea, genital itching, swelling of scrotum, swelling of vulva, swel ling of pen is) • Reg ulates Qi in the Lower Burner (twisting pain in t he lower abdomen, Hernial and GenitoUrinary Disorders [Shan]. umbilical pain, retraction of test icles, Running Piglet Syndrome) • Reg ulates t he Uterus (persistent lochial discharge, abdominal masses, heavy periods, st one-like hardness of lower abdomen) • Strengthens Original Qi (exhaustion).

Indications • Qi deficiency, Original Qi deficiency, collapse of Yang, tiredness. cold limbs, loose stools, weak voice • Prolapse of uterus. profuse menstrual bleeding from Qi deficiency, chronic and persistent vaginal discharge, frequent urination, incontinence of urine, a feeling of bearing down • Hernial and Genito-Urinary Disorders (Shan), umbilical pain, abdominal pain.

Comments Ren-6 is a major point of the body. First of all, it has a powerful torrifying effect on Qi and Yang, especially if used with direct moxibustion. It can be used for extreme physical and mental exhaustion and depression. It tonifies Kidney-Yang and the Original Qi and this point is especially effective when treated with direct moxa cones and can therefore be used for such symptoms as chilliness, loose stools, profuse pale urination, physical wealmess, mental depression, and lack of will-power. Ren-6 also raises sinking Qi and is used in all cases of sinking of Qi in the lower abdomen causing prolapse of uterus, profuse menstrual bleeding from Qi deficiency, chronic and persistent vaginal discharge, frequent urination, incontinence of urine, and a feeling of bearing down.

SUMMARY REN-6: SUMMARY OF FUNCTIONS

Ren-6 Qihai Sea of Qi Na t ure Source point for Membranes (Huang).

Actions • • • •

Tonifies Qi and Yang Raises sinldng Qi Tonifies Original Qi (Yuan Qi) Regulates Qi in the Lower Burner.

• Tonifies Qi and Ya ng (Qi deficiency, Original Qi deficiency, collapse of Yang, tiredness, cold limbs, loose stools, weak voice) • Raises sinking Qi (prolapse of uterus, profuse menstrual bleeding from Qi deficiency, chronic and persistent vag inal discharge, frequent urination, incontinence of urine, a feeling of bearing-down) • Tonifies Orig inal Qi (Yuan Qt) • Regulates Qi in the Lower Burner (hernial and Genito-Urinary Disorders [Shan]. umbilical pain , abdominal pain).

DIRECTING VESSEL (REN MAl )

Besides torrifying Qi, Ren-6 also moves Qi and eliminates stagnation in the Lower Burner. It can therefore be used for lower abdominal pain deriving from stagnation of Qi. Combined with G.B.-34 Yanglingquan, it moves stagnant Qi in the lower abdomen and relieves pain and distension in this area. It will be useful to compare the actions of Ren-6 Qihai with those of Ren-4 Guanyuan:

Ren-4 Nourishes Blood and Yin No effect in moving Qi Affects Uterus Tonifies the Kidneys

Ren-6 Tonifies Qi and Yang Moves Qi and eliminates stagnation Affects Intestines Tonifies the Spleen

Ren-7 Yinjiao Yin Crossing Nature Meeting point of Directing Vessel and Kidney channels. Meeting point of Directing and Penetrating Vessels.

Actions • • • •

Regulates the Uterus and menstruation Regulates the Penetrating Vessel Resolves Dampness from the Lower Burner Nourishes Yin.

473

Penetrating Vessel and it is therefore used to invigorate Blood in the Penetrating Vessel to treat painful periods. Ren-7 resolves Dampness in the Lower Burner and can be used for a wide range of Hernial and GenitoUrinary Disorders (Shan) of the Bladder and genitalia such as retraction of testicles, itching of genitals from Dampness and retention of urine. In my experience, Ren-7 can be used to nourish Kidney-Yin and I use it frequently to do that in menopausal problems. Its name 'Yin Crossing' indicates that it is a concentration of Yin Qi as the meeting point of the Directing and Penetrating Vessels and the Kidney channel. According to the 1\ Study of Acupuncture' 32 at this point the Qi of the Original Yang intersects with Yin. In fact, it is here that the essence of Tian Gui (menstrual blood in women and sperm in men) meets Yin Qi; the Water separates upwards and mixes with the essence of the Directing Vessel while Yang Qi descends. The Original Yin infuses into the Lower Dan Tian, Water and Fire cross each other. hence the name 'Yin Crossing'. It is this crossing of Original Yang and Original Yin at this point that explains its dual functions in nourishing Yin and in moving Yang to resolve Dampness.

SUMMARY REN-7: SUMMARY OF FUNCTIONS

Indications • Heavy periods, painful periods. irregular periods, amenorrhoea, infertility • Hardness and pain of the abdomen. Running Piglet Syndrome. chest pain, hypogastric pain, umbilical pain • Hernial and Genito-Urinary Disorders (Shan). retraction of testicles, itching of genitals from Dampness, retention of urine and faeces • Menopausal hot flushes.

• Regulates the uterus and menstruation (heavy periods, painful periods, irregular periods, amenorrhoea, infertility) • Regulates the Penetrating Vessel (hardness and pain of the abdomen, Running Piglet Syndrome, chest pain, hypogastric pain, umbilical pain) • Resolves Dampness from the Lower Burner (hern ial and Genito-Urinary Disorders [Shan]. retraction of testicles, itching of genitals from Dampness, retention of urine and faeces) • Nourishes Yin (menopausal hot f lushes).

Comments Ren-7 regulates the Uterus a nd menstruation in two ways. First, it influences the Uterus and menstruation as a Directing Vessel's point and, from this point of view, it is used for irregular periods, heavy periods and infertility. Secondly, it is a meeting point with the

Ren-8 Shenque Spirit Palace Nature None.

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PART 7: EIGHT EXTRAORDINARY VESSELS

Actions • Rescues Yang o Strengthens the Spleen o Tonifies Original Qi (Yuan Qi).

Indications o

o

o

Loss of consciousness from Wind-stroke, Collapse of Yang Cold in the abdomen. diarrhoea, borborygmi, diarrhoea in the elderly and children, prolapse of rectum Infertility.

Commen ts Ren-8 strongly tonifies Yang. It is used to rescue Yang in the acute stage of Wind-stroke of the flaccid type characterized by collapse of Yang. In other situations it can be used for severe deficiency of Kidney-Yang and of the Original Qi with internal Cold and extreme weakness. Ren-8 also strengthens Spleen-Yang and is particularly used for chronic diarrhoea from Spleen-Yang deficiency. I have translated the word Shen as 'Spirit' rather than 'Mind' as, in this case, Shen refers not to the Shen of the Heart (which I translate as 'Mind') but to the sum-total of Mind (Shen), Ethereal Soul (Hun), Corporeal Soul (Po), Intellect {Yi) and Will-power (Zhi). This is confirmed by the fact that there is an extra point 1 cun from Ren-8 that is called Hun She, i.e. !\bode of the Ethereal Soul'. It is worth exploring the meaning of this point's name as it sheds lights on its nature and functions. The 'Great Dictionary of Chinese Acupuncture' reports an explanation of the meaning of this point from an old text: 'Ren-8 is the Abode of the Spirit {Sherr She]. Heaven is above, Earth is !Jelow. Person is in the Middle; on both sides there is KI- 13 Qixue and KI-1 6 Huangslw. Above there is Ren- 9 Slwifen and Ren-1 0 Xiawan: below tlzere is Ren-4 Guanyumz [here called Bao Men) and Ren-3 Zlwngji. The umbilicus is in the cmtre like an ope11ing of a door tlzrouglz wlziclz the Spirit collllllWiicates witlz the Pre-Heaven Essence. Wizen mother and father 1111ite. a fet us is formed. the umbilical cord is fa nned linking tlze fetus to tlze mother's Gate of Life [Ming

Men]like a lotus stem. The Pre-Heaven Essence generales Water mul the Kid11eys: like a11 unopened lotus flower. the Five Elements come into being and the mother's Qi is transferred. In 10 1110nths the fetus is fully formed. the Spirit infuses through the centre of the umbilicus and forms a new lzwnan being. ' 33 According to this image, Ren-8 is at the centre of an energetic vortex with three levels: Heaven above (Ren-9 and Ren-10). Earth below (Ren-4 and Ren-7) and Person in the centre (Ren-8), with KI-13 and KI-16 on either side like watch-towers guarding the entrance to the Imperial Palace {Fig. 27.16). I translated the word Que in this point's name as 'Palace' (rather than 'gate' or 'gateway' as do most authors) to indicate the energetic importance of this point, i.e. like an Imperial Palace that is the residence of the Spirit. The word que also implies the idea of an open space, something empty: this is the space through which the fetus was connected to the mother's Gate of Life (Ming Men). the space through which the Spirit entered the fetus and was nourished by the mother.

/

Ren-1 0 Heaven

//,-Ren-9 Palace ---- -----, • ', • Kl-16,-e'e • Kl-16 Ren-8

.

/

---

! Watchtowersi

:l _

Ren-7

·~Ren-4

Kl-1}• • /• Kl-13

. - - - -Supraspinatus tendon 1>-++--Deltoid - ' c ' - - -..,.-'---""'--1-+-++--."-1-

lnfraspinatus

Fig. 37.9 Acromioclavicular articulat ion. (By permission from Drake 2005 Gray's Anatomy for Students, Churchill Livingstone)

_,.7.-----f--t--Teres minor

• deltoid: Bladder, Gall Bladder. Small Intestine, Triple Burner. Large Intestine, Lung • infraspinatus: Bladder, Small Intestine, Large Intestine • teres minor: Bladder, Small Intestine • supmspinatus: Large Intestine • subscapularis: Large Intestine, Lung. Fig. 37.7 Rotator cuff muscles.

PAINFUL OBSTRUCTION (81) SYNDROME (TRAUMA, SPORT INJURIES, REPETITIVE STRAIN INJURY)

Transverse humeral ligament Head of humerus

Tendon of biceps brachii muscle (long head)

Fig. 37.1 0 Glenohumeral articulation. (By permission from Drake 2005 Gray's Anatomy for Students, Churchill

Livingstone)

From this list and from Table 3 7.1, we can see that the three Muscle channels that influence the most muscles of the shoulder are the Large Intestine, Small Intestine and, surprisingly, Bladder Muscle channels. The Muscle channels affecting the shoulder joint are obviously those of the three Arm channels, i.e. Large Intestine, Triple Burner and Small Intestine. However, there are other Muscle channels affecting the shoulder: The Bladder Muscle channel has a branch that separates on the back and ascends to the posterior axillar y crease and then reaches the acromion [at L.I.-15 Jianyu]: yet another branch crosses beneath the axilla and ascends the chest to emerge at the supraclavicular fossa [ST-12 Quepen]; these two branches join at the neck, forming like a 'holster' strap circling the shoulder (see Fig. 17. 7). This particular branch of the Bladder Muscle channel explains the use of BL-58 Feiyang as a distal point for acute rigidity and pain of the shoulder. The Gall Bladder Muscle channel skirts the anterior part of the deltoid muscle (see Fig. 17.8). This pathway

Extensor carpi ulnaris- ------'

Extensor retinaculum- - - - --'la-"

Fig. 37.11 Muscle channels of the shoulder.

665

666

PART 8: THE INTEGRATION OF MUSCLE AND CONNECTING CHANNELS IN PRACTICE

Muscle channels affecting shoulder muscles

Table 37.1 Trapezius

Deltoid

Infraspinatus

Bladder

./

./

./

Gall Bladder

./

./

Small Intestine

./

./

Triple Burner

./

./

Large Intestine

./

./

Lung

Supraspinatus

Teres Minor

Subscapularis

./

./

./

./

./

explains the use of G.B.-34 Yanglingquan as a distal point for rigidity and pain of the shoulder. The Lung Muscle channel skirts the anterior part of the deltoid muscle (see Fig. 17.16). LU-7 Lieque can be used as a distal point for shoulder pain when this occurs along the anterior aspect of the shoulder. A pathology of the Muscle channels of the shoulder manifests with stiffness and rigidity: if abduction of the arm is difficult, the Large Intestine Muscle channel is involved: if touching the other shoulder with the affected arm is difficult, the Lung Muscle channel is involved; if touching the tip of the scapula on the same side is dillicult, the Small Intestine or Bladder channel is involved.

SUMMARY MUSCLE CHANNELS OF THE SHOULDER

• Trapezius: Bladder, Gall Bladder, Small Intestine, Triple Burner. Large Intestine • Deltoid : Bladder, Gall Bladder, Small Intestine, Triple Burner, Large Intestine, Lung • Infraspinatus: Bladder, Small Intest ine, Large Intestine • Teres minor: Bladder, Small Intestine • Supraspinatus: Large Intestine • Subscapularis: Large Intestine, Lung.

./

./

The Connecting channels of the channels that flow into the shoulder affect the articulations of the shoulder: in particular the Large Intestine Connecting channel affects the acromioclavicular articulation and the Small Intestine Connecting channel the glenohumeral articulation. CLINICAL NOTE

The Large Intestine Connecting channel affects the acromioclavicular articulation (U-15 Jianyu) and the Small Intestine Connecting channel the glenohumeral articulation (S.I.-1 0 Naoshu, S.l.-1 1 Tianzong and S.l.-13 Quyuan). As we have seen, the Connecting channels are particularly prone to stagnation of Qi or stasis of Blood and the shoulder joint is frequently affected by these pathologies. As discussed in Chapter 12, while the Main channels can course through the large joints. the Connecting channels, being restricted to the space outside the Main channels and being like a 'net' of small channels, cannot course through the large joints: this results in Qi/Blood stagnation in these joints. The shoulder joint is a place where Qi and Blood are 'trapped' in the Connecting channels resulting in

SUMMARY CONNECTING CHANNELS OF THE SHOULDER

Connectingchanne~

The main Connecting channels that affect the shoulder are those of the Large Intestine, Triple Burner, Small Intestine and Lungs, in order of importance.

• • • •

Large Intestine Triple Burner Small Intestine Lung.

PAINFUL OBSTRUCTION (8/) SYNDROME (TRAUMA, SPORT INJURIES, REPETITIVE STRAIN INJURY)

667

stagnation of Qi or Blood, or both. Qi stagnation in the shoulder manifests with pain; Blood stasis manifests with an intense pain that is often worse at night and a pronounced rigidity of the joint.

Distal points The main distal points for the Muscle channels of the shou lder according to the channel involved are (Fig. 37.12):

- L.I.-1 Shangyang for the Large Intestine - S.I.-3 Houxi for the Small Intestine - T.B.-1 Guanchong for the Triple Burner. The main distal points for the Connecting channels according to the channel involved are: - L.I.-6 Pianii for the Large Intestine - S.I.-7 Zhizheng for the Small Intestine - T.B.-5 Waiguan for the Triple Burner. Other distal points to be considered are: - ST-38 Tiaokou: this is a distal point for acute rigidity and pain of the shoulder joint. It is usually needled first with the patient sitting up (on the same side as the affected shoulder). The needle is manipulated vigorously with reducing method while the patient gently moves the arm up and down. This manipulation is continued for about 10 minutes and it is then followed by the treatment with local points. The needling of ST-38 Tiaokou removes obstructions from the Large Intestine Connecting channel (due to the relationship between the Large Intestine and the Stomach within the Bright Yang) . ST-38 is therefore selected when the Large Intestine channel in the shoulder is primarily affected. - G.B .-34 Yanglingquan: this is used as a distal point for acute rigidity and pain of the shoulder. G.B.-34 is needled in the same way as ST-38 Tiaokou. G.B.-34 is selected if the Triple Burner Connecting channel in the shoulder is primarily affected. - BL-58 Feiyang: this point is selected as a distal point for acute rigidity and pain of the shoulder and it is needled with the same procedure as for ST-38 Tiaokou. It is selected when the Small Intestine Connecting channel in the shoulder is primarily affected. - LU-7 Lieque can be used as a distal point for shoulder problems when both the Large Intestine

G.B.-34

Fig. 37.12 Distal points for t he shoulder.

and Lung Connecting channels are involved and the shoulder pain radiates towards the anterior part of the shoulder. - G.B.-13 Touwei. upper Meeting point of the three Ann Muscle channels: I add this point to the distal and local points in chronic cases to facilitate the movement of Qi among the three arm Yang channels.

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PART 8: THE INTEGRATION OF MUSCLE AND CONNECTING CHANNELS IN PRACTICE

- Connecting point of related Yin channel on the other side. In chronic cases, I frequently add the Connecting point of the related channel on the opposite side. For example, if the shoulder problem occurs along the Large Intestine channel on the right side, I would select LU-7 Lieque on the left side; if the main affected channel were the Triple Burner on the right, I would add P-6 Neiguan on the left. The rationale behind this is that, in chronic cases, pathogenic factors have penetrated deeper and often into the corresponding Yin channel. Using the Connecting point of the related Yin channel will help to push pathogenic factors outwards towards the surface.

• Jianneiling

Du-14 S.l.-15 S.l.-14

LJ-15- ----."'-· T.B.-14---+-+' s.L-1 o----.~1-" S.L-12- - f --t--....r f S.L-11 --t---t----t----T-'

SUMMARY DISTAL POINTS FOR TH E SHOULDER

Muscle channels • L. l.-1 Shangyang for the Large Intestine • S.l. -3 Houxi for the Small Intestine • T.B.-1 Guanchong for the Triple Burner Connecting channels • L.l.-6 Pian li for the Large Intestine • S.l.-7 Zhizheng for the Small Intestine • T. B.-5 Waiguan for the Triple Burner • ST-38 Tiaokou • G.B.-34 Yanglingquan • BL-58 Feiyang • LU-7 Lieque • G.B.-13 Touwei, upper Meeting point of the t hree Arm Muscle channels • Connecting point of related Yin channel on the other side.

Local points - L.I.-1 5 Jianyu: this is a major local point when the Large Intestine Connecting channel is affected. It affects the acromioclavicular articulation and the rotator cuff muscles. - T. B.- I 4 Jianliao: this is selected when the Triple Burner Connecting channel is affected. - S.I.-10 Naoshu: this is selected when the Small Intestine Connecting channel is affected (see below). - Jianneiling extra point (on the anterior aspect of the shoulder joint, midway between L.I.-15 Jianyu and

Fig. 37.13 Local and adjacent points for the shoulder.

the anterior axillary crease): this point is used if the pain occurs on the anterior aspect of the shoulder joint (from involvement of the Lung Muscle channel). See Figure 3 7.13.

Adjacent points S.I.-11 Tianzong is an important adjacent point: in shoulder problems, I always palpate this point to check for tenderness even if the channel involved is the Lar ge Intestine or Triple Burner channel. I do tills because the loca l points L.I.-15 Jianyu and T.B.-14 Jianliao

SUMMARY LOCAL POINTS FOR THE SHOULDER

• • • •

L.l.-15 Jianyu T.B .- 14 Jianliao S.l.-1 0 Naoshu Jianneiling extra point.

PAINFUL OBSTRUCTION (B/) SYNDROME (TRAUMA, SPORT INJURIES, REPETITIVE STRAIN INJURY)

affect the acromioclavicular articulation while S.I.-10 Naoshu and S.I.-11 Tianzong affect the glenohumeral articulation and the rotator cuff muscles. I find the use of some Small Intestine channels on the scapula essential in the treatment of shoulder-joint problems. I generally use S.I.-11 while the patient is sitting so that I can apply moxa on the needle.

669

SUMMARY ADJACENT POINTS FOR THE SHOU l DER

S.l.-11 Tianzong S.l.-13 Quyuan.

TREATMENT EXAMPLE SHOUlDER

A patient has been suffering from pain in the left shoulder for 4 years. The shoulder joint is stiff and abduction of the arm is painful and difficult The muscles around the shoulder are very stiff and tender on pressure. The pain is aggravated at night and it is alleviated by the application of heat. The joint pain is severe and stabbing. On examination, many muscles are tender on pressure and especially the top of the trapezius and the deltoid over a wide area. Several Muscle channels are involved: the Large Intestine, Triple Burner, Sma ll Intestine and Gall Bladder. This is a case of Painful Obstruction Syndrome originally from invasion of Cold: this is confirmed by t he fact that the problem is confined to one joint only and that it is alleviated by the application of heat Due to the long duration of the problem, the stagnation of Qi has progressed to the Deep (Blood) Connecting channels giving rise to Blood stasis. The Blood stasis is evidenced by the rigidity of the joint, the stabbing nature of the pain and its aggravation at night Three classes of channels are involved: the Muscle channels (because of the stiffness), the Connecting channels and the Deep (Blood) Connecting channels. I select the following distal points: • L.l.-1 Shangyang on the left to remove obstructions from the Large Intestine Muscle channel • L.l.-6 Pianli on the left to remove obstructions from the Large Intestine Connecting channel (both superficial and deep) • T.B.-8 Sanyangluo on the left to affect all three channels of the arm • L.l.-7 Wen liu, Accumulation point, on the left to remove obstructions from the channel and move Qi and Blood • LU-7 Lieque, Connecting point, on the right to support the action of the Large Intestine points on the left • G.B .-13 Benshen, Meeting point of the three Arm Yang Muscle channels, on the left to promote the horizontal movement of Qi among the three Yang Muscle channels • G.B.-34 Yanglingquan on the right side for two reasons: first because it frees the shoulder joint, and secondly because it is the Gathering point of Sinews • LIV-3 Taichong on the right to balance the Large Intestine and Triple Burner points on the left side. This has the effect of balancing Yin and Yang, arm and leg channels and Left and Right. Moreover, LIV-3 will also invigorate Blood and eliminate Blood stasis. I select the fol lowing local and adjacent points: • L.l.-15 Jianyu • T.B.-14 Jianliao also to promote the horizontal movement of Qi between the Bright Yang (Large Intestine) and Lesser Yang (Triple Burner and Gall Bladder) • S.l.-11 Tianzong and S.l.-13 Quyuan on the left to affect the glenohumeral joint, which is affected by Blood stasis (Fig. 37 .14).

670

PART 8: THE INTEGRATION OF MUSCLE AND CONNECTING CHANNELS IN PRACTICE

• S.I.-11

among the three Yang, i.e. Greater Yang. Bright Yang and Lesser Yang and among the three Yin, i.e. Greater Yin, Lesser Yin and Terminal Yin. This has the effect of further effecting the removal of obstructions from the affected channel. In the case of the shoulder, I select adjacent points on other Yang channels to facilitate the 'horizontal' movement of Qi between the Bright Yang. Lesser Yang and Greater Yang channels (see Ch. 20). For example, if the Large Intestine channel is affected , I may select an adjacent point from the Lesser Yang {Triple Burner) or Greater Yang (Small Intestine), i.e. either T.B.-14 Jianliao or S.I.-10 Naoshu.

Neck In musculoskeletal problems, the neck differs from other joints such as the elbow or knee in that it is frequently affected not only by external pathogenic factors but also by pathology of the Internal Organs, particularly the Liver. In fact, the neck contains a large number of muscles and Liver-Qi stagnation or Liver-Yang rising frequently affects the neck causing muscle ache and stiffness (and, of course, headaches).

Muscles The muscles of the neck are as follows (Fig. 3 7.15): Back of neck: • Superficial: trapezius, splenius capitis, splenius cervicis • Deep: longissimus capitis, suboccipital muscles, semispinatus capitis. levator scapulae, longissimus cervicis

SUMMARY MUSCLES OF THE NECK

Fig. 37.14 Shoulder treatment example.

S.I.-13 Quyuan is another important adjacent point. It is nearly always very tender on palpation. Like S.I.-11

it affects the glenohumeral articulation and the rotator cuff muscles. I generally needle S.I.-13 with the patient sitting so that I can apply moxa on the needle. When selecting adjacent points, I always bear in mind stimulating the 'horizontal' movement of Qi

Back of neck • Superficial: trapezius, splenius capitis, splenius cervicis • Deep: longissimus capitis, suboccipital muscles, semispinatus capit is, levator scapulae, longissimus cervicis Lateral side of neck • Superficial: sternocleidomastoid, trapezius • Deep: splenius capitis, levator scapulae, scalenes, omohyoid.

PAINFUL OBSTRUCTION (81) SYNDROME (TRAUMA, SPORT INJURIES, REPETITIVE STRAIN INJURY)

Triple Burner channel

Large Intestine channel

Fig. 37.15 Muscles

of the

671

channel

neck.

Lateral side of neck: • Superficial: sternocleidomastoid, trapezius • Deep: splenius capitis. levator scapulae, scalenes, omohyoid

Muscle channels The Muscle channels affecting each muscle are as follows (Fig. 37.1 6):

• trapezius: Bladder, Gall Bladder, Small Intestine, Triple Burner. Large Intestine • splenius capitis: Bladder, Small Intestine • splenius cervicis: Bladder • suboccipital muscles: Bladder • longissimus capitis: Bladder • suboccipital muscles: Bladder • levator scapulae: Bladder, Small Intestine, Triple Burner, Large Intestine • longissimus cervicis: Bladder • scalenes: Bladder, Small Intestine, Large Intestine, Gall Bladder, Stomach • sternocleidomastoid: Small Intestine, Triple Burner, Large Intestine, Bladder, Gall Bladder, Stomach • omohyoid: Bladder, Stomach.

'------· RI~·~rl"'

Fig. 37.16 Muscle channels

channel

of t he neck.

As can be observed from t he above list, the Bladder Muscle affects all muscles of the neck. both of its posterior and lateral aspects. Table 3 7.2 summarizes the connections between each muscle and the Muscle channels coursing through it: as can be observed, besides the Bladder, the next Muscle channel that affects the most muscles is the Small Intestine. This observation is reflected in the impor tance of the points from the Bladder and Small Intestine channels as distal points for neck problems. Another aspect that is evidenced by the Table is that two muscles of the lateral side of the neck, i.e. the scalenes (deep muscles) and the sternocleidomastoid (superficial muscle) , are affected by all six Muscle channels. As we have seen above, there are six Muscle channels that affect the neck: Bladder, Gall Bladder, Small Intestine, Triple Burner, Large Intestine, Stomach. These are distributed as follows between the posterior and the lateral aspect of the neck.

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PART 8: THE INTEGRATION OF MUSCLE AND CONNECTING CHANNELS IN PRACTICE

Table 37.2

Muscle channels affecting neck muscles

Bladder

Gall Bladder

Small Intestine

Triple Burner

Large Intestine

Trapezius

./

./

./

./

./

Splenius capitis

./

Splenius cervicis

./

Suboccipital muscles

./

Levator scapulae

./

Longissimus cervicis

./

Longissimus capitis

./

Sternocleidomastoid

./

Omohyoid

./

Scalenes

,/

./

./

./

./

./

,/

./

,/ ,/

,/

Posterior aspect of neck:

I·

Stomach

Bladder, Small Intestine.

Lateral aspect of the neck: • Gall Bladder, Small Intestine, Triple Burner, Large Intestine and Stomach.

SUMMARY MUSCLE CHANNELS OF THE NECK

• Trapezius: Bladder, Gall Bladder, Small Intestine, Triple Burner. Large Intestine • Splenius capitis: Bladder, Small Intestine • Splenius cervicis: Bladder • Suboccipital muscles: Bladder • Longissimus capitis: Bladder • Suboccipital muscles: Bladder • Levator scapulae: Bladder, Small Intestine, Triple Burner, Large Intestine • Longissimus cervicis: Bladder • Scalenes: Bladder, Small Intestine, Large Intestine, Gall Bladder, Stomach • Sternocleidomastoid: Small Intestine, Triple Burner, Large Intestine, Bladder, Gall Bladder, Stomach • Omohyoid: Bladder, Stomach.

,/

,/

,/

However, the separation between the Muscle channels affecting the posterior and the lateral sides of the neck is not so rigid: for example, the levator scapulae (on the posterior aspect of the neck), is i.nlluenced not only by the Bladder and Small Intestine Muscle channels, but also by the Muscle channels of the Triple Burner and Large Intestine. A pathology of the Muscle channels of the neck manifests with stiffness, rigidity and pain. This is a very common condition in both acute and chronic cases. In acute conditions, neck problems are caused by invasion of Wind and/or Cold or trauma. In chronic conditions, neck problems are caused by Qi stagnation in the Muscle channels deriving from poor posture and emotional stress. Emotional stress frequently affects the muscles of the neck. In particular, emotions such as anger, resentment, frustration, worry, fear and anxiety cause Qi to rise to the neck and head leading to stagnation of Qi in the neck. This causes a chronic ache and stiffness of the neck.

Connecting channels The principal Connecting channels affecting the neck are as follows:

1·• Bladd" Gall Bladder

PAINFUL OBSTRUCTION (BI) SYNDROME (TRAUMA, SPORT INJURIES, REPETITIVE STRAIN INJURY)

• • • •

CLINICAL NOTE

Considering the large number of muscles and of Muscle channels converging in the small area of the neck, in neck problems, a pathology of the Muscle channels is primary compared to that of the Connecting channels. In other words, we can say that a pathology of the muscles obviously reflects a pathology of the Muscle channels. while one of the joints reflects primarily a pathology of the Connecting channels and secondarily one of the Muscle channels.

Distal points The main distal points for the neck Muscle channels according to the channel involved are (Fig. 3 7. 17): -

SUMMARY

Stomach Small Intestine Triple Burner Large Intestine.

Pathology of the Connecting channels of the neck includes Qi stagnation or Blood stasis. The main difference between the pathology of the Muscle and Connecting channels of the neck lies in muscle stiffness: a pathology of the Muscle channels always causes a pronounced stiffness of the muscles whereas that of the Connecting channels causes primarily pain. Of course pain is also a symptom of Muscle-channel pathology, but the more intense the pain the more the Connecting channels are involved. Moreover, whenever there is Blood stasis. the Connecting (and not the Muscle) channels are involved: Blood stasis manifests with an intense, stabbing pain that is often aggravated at night and rigidity of the neck. Considering the large number of muscles and Muscle channels converging in the small area of the neck, another interesting observation can be made: in neck problems, a pathology of the Muscle channels is primary compared to that of the Connecting channels precisely because the neck is so richly provided with many large and small muscles. By comparison, in problems of joints such as the elbow, shoulder or knee, Qi stagnation or Blood stasis in the joint is a primary pathology and that is always a pathology of the Connecting channels.

BL-67 Zhiyin: this point affects the Bladder Muscle channel in the neck treating neck ache

673

CONNECTING CHANNELS OF THE NECK

• • • • • •

Bladder Gall Bladder Stomach Small Intestine Triple Burner La rge Intestine.

- S.I.-1 Slwoze: this point treats the Small Intestine Muscle channel and frees the neck. -G. B.-44 Zuqiaoyin: this point affects the Muscle channel of the Gall Bladder and it works on the neck and head. - T.B.-1 Guanzhong. - L.l.-1 Slwnyang. The main distal points for the Connecting channels of the neck according to channel are: BL-60 Kunlun: this is the main distal point to remove obstructions from the Connecting channels of the neck. It affects primarily the posterior aspect of the neck. - BL-64 ]inggu: this point affects the neck and upper back. -G. B.-39 Xuanzhong: this is a distal point to remove obstructions from the Connecting channel of the Gall Bladder in the neck. It is used when the neck pain occurs on the lateral sides and there is pronounced rigidity with inability to turn the neck. The needles are inserted bilaterally and manipulated with a reducing method for about 10 minutes while the patient is asked to turn the neck gently from side to side. - Juegu extra point: this point is located on the Gall Bladder channel and is above G.B.-39 Xuanzhong. It is located by palpating the fibula; at a certain point, the fibula disappears under the muscle and cannot be felt any longer: the name of the point means 'disappearing bone'. The point is situated on the fibula at the point where it cannot be palpated any longer. It is used in the same way as G.B.-39 Xuanzhong. In my experience. the extra point Juegu is more effective than G.B.-39 to treat neck ache. - S.I.-3 Houxi: this is the main point on the Small Intestine channel for neck problems. It treats both

-

674

PART 8: THE INTEGRATION OF MUSCLE AND CONNECTING CHANNELS IN PRACTICE

------+---L.I.-7 e+- -T.B.-7 .--+- - -T.B.-5 ' - ! - - -U-6

S.l.-3

Ai---- - -T.B.-1 '--------U-1

.r-+-----:ST-40 - +-----G.B.-36 J..---G.B.-39 •e.~f---- BL-59

-+-

- - BL-60

b

BL-67

G.B.-44

- --1--- -BL-64 Fig. 37.17 Distal points for the neck.

the posterior and the lateral aspects of the neck. It removes obstructions from the Small Intestine

Connecting channel and treats Painful Obstruction Syndrome: it is particularly effective in expelling Wind.

- S.I.-7 Zhizheng: this is the Connecting point and removes obstructions from the Small Intestine Connecting point. - T.B.-5 Waiguan: this is an important point to remove obstructions from the Triple Burner

PAINFUL OBSTRUCTION (B/) SYNDROME (TRAUMA, SPORT INJURIES, REPETITIVE STRAIN INJURY)

-

-

-

-

-

-

-

-

Connecting channel. It eliminates Qi stagnation and Blood stasis from the Connecting channel; it has the added function of expelling Wind from the channel. L.l.-6 Pianli: this is used to remove obstructions from the Large Intestine Connecting channel. ST-40 Fenglong: this removes obstructions from the Stomach Connecting channel and it can treat neck ache because the Connecting channel ascends to the nape of the neck (besides flowing to the front of the neck). Other distal points include the following: BL-59 Fuyang is the Accumulation (Xi) point of the Bladder channel. Like all Accumulation points. it can be used to boost the removal of obstructions from the Connecting channel. It is therefore used to boost the action of another Bladder distal point (such as BL-60 Kunlun). S.I.-6 Yanglao, Accumulation point of the Small Intestine, is used to boost the action of another Small Intestine point (such as S.I.-3 Houxi). S.I.-6 has many indications related to the arm, shoulder and neck. G.B.-36 Waiqiu, Accumulation point of the Gall Bladder, is used to boost the action of another Gall Bladder point (such as G.B.-39 Xuanzhong). It is indicated for pain of the neck. T.B.-7 Huizong, Accumulation point of the Triple Burner, is used to boost the action of another Triple Burner point (such as T.B.-5 Waiguan). L.I.-7 Wenliu, Accumulation point of the Large Intestine, is used to boost the action of another Large Intestine point (such as L.I.-6 Pianli). S.I.-18 Quanliao is the Meeting point of the three Leg Yang Muscle channels and it will therefore affect the Bladder, Gall Bladder and Stomach Muscle channels. The Meeting point is used in chronic cases when two or three of the Muscle channels are involved. G.B.-13 Benshen is the Meeting point of the three Arm Yang Muscle channels and it will therefore affect the Large Intestine, Triple Burner and Small Intestine channels. The Meeting point is used in chronic cases when two or three of the Muscle channels are involved.

Local points -

BL-10 Tianzhu: this is an important local point for neck ache deriving from the Bladder channel. It affects the whole Bladder channel in the back. It is

675

SUMMARY DISTAL POINTS FOR THE NECK

Muscle channels

• • • • •

BL-67 Zhiyin s.l.-1 Shaoze G.B.-44 Zuqiaoyin T.B.-1 Guanzhong L.l.-1 Shanyang

Connecting channels

• • • • • • • • • • • • • • •

BL-60 Kunlun BL-64 Jinggu G.B.-39 Xuanzhong Juegu extra point S.l.-3 Houxi S.l.-7 Zhizheng T.B.-5 Waiguan L.l.-6 Pianli ST-40 Fenglong BL-59 Fuyang S.l.-6 Yanglao G.B.-36 Waiqiu T.B.-7 Huizong L.l.-7 Wenliu S.l.-18 Quanliao (Meeting point of the three Leg Yang Muscle channels) • G.B.-13 Benshen (Meeting point of the three Arm Yang Muscle channels).

also one of the 'exit' points of the Eye System which means that it stimulates the horizontal movement of Qi from the face towards the occiput (see Ch. 10). -G. B.-20 Fengchi: this is an important local point for neck ache deriving from the Gall Bladder channel. It affects the whole Bladder channel in the back. It is also one of the 'exit' points of the Eye System which means that it stimulates the horizontal movement of Qi from the face towards the occiput. It is also a point of the Yang Linking Vessel and it expels Wind and subdues Yang: it is therefore indicated for neck ache and stiffness deriving from Liver-Yang rising. - T.B.-15 Tianliao: this is an important local point for neck problems. It is nearly always tender on pressure. Being a point of the Lesser Yang (the 'hinge' between the Greater Yang and Bright

676

PART 8: THE INTEGRATION OF MUSCLE AND CONNECTING CHANNELS IN PRACTICE

Yang), it will affect also the Small Intestine and Large Intestine channels. - S.I.-16 Tianchuang: this is a good local point for neck problems, especially those deriving from Liver-Yang rising. In fact, it is a Window of Heaven point and, as such, it regulates the ascending and descending of Qi to and from the head. It affects more the posterior aspect of the neck. - T.B.-16 Tianyou: this is a good local point for neck problems, especially those deriving from Liver-Yang rising. In fact, it is a Window of Heaven point and, as such, it regulates the ascending and descending of Qi to and from the head. It affects more the lateral aspect of the neck. See Figure 3 7.18.

G.B.-21

a G.B.-20--__,. BL-10--__,.

G.B.-211=====~~~~~!;;

T.B.-15

S.l.-10, ----f--1~-.

S.l.-131----t----+--r---------'

S.l.-11---+-+---+--'