INTRODUCTION TO

MEDICAL ACUPUNCTURE STUDY GUIDE

EAST TENNESSEE STATE UNIVERSITY JAN 7TH-9TH 2011

DR. CARLOS A. SUAREZ MD, DABMA

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Cover 1

Table of Contents 2

Welcome letter 3

An Overview of Medical Acupuncture 4

Acupunture Theory 16

The Chinese Perspective of Health and Disease 17

An Introduction to Chinese Measurements 28

Table of Contents

Acupuncture Meridian Points 29

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Introduction to Medical Acupuncture Course Study Guide

Dear Participants:

I want to thank you for registering on the Introduction to Medical Acupuncture course. This course

represents a joint project between East Tennessee State University and myself to provide physicians with the

basic knowledge and kinesthetic ability to perform basic acupuncture treatments. Even though Acupuncture

is useful for many clinical conditions, we will focus on treatment of pain and anxiety in this course. It will be

carried out along 3 intensive days of theory and practice.

Due to the time constrains, I wish you to read the material enclosed so as to become acquainted to

the history, terminology and some acupuncture points that will be taught in class. This homework reading of

the material will definitively make the lectures easier and faster to present.

This home study guide has got 3 parts to it. The first part will give you an overview of what Medical

Acupuncture is. The second part will go over basic concepts of Chinese medicine and the third part will go

over the meridians and some important acupuncture points on them. You do not need to memorize all the

information, just go over it so as to familiarize yourself with it.

If you have any questions about the contents of the course please contact me at the following address: suarez_c@hotmail.com or call at 541-297-7392.

Carlos A. Suarez MD, DABMA

WELCOME LETTER

October 2010

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STUDY GUIDE

October 2010

An Overview of Medical Acupuncture by Joseph M Helms, M.D.

Modified from Essentials of Complementary and Alternative Medicine (Jonas WB, Levin JS, eds. Baltimore, Md: Williams & Wilkins; in press).

Joseph M Helms is the author of Acupuncture Energetics: A Clinical Approach for Physicians. He is the chairman of physician acupuncture training

programs of the Office of Continuing Medical Education, University of California-Los Angeles School of Medicine, and the founding president of the

American Academy of Medical Acupuncture. Dr Helms is in private practice in Berkeley, Calif.

This article defines the theoretical matrix and clinical value of the emerging complementary discipline of medical acupuncture. The acupuncture

approach most commonly integrated by physicians into conventional medical practice. Medical acupuncture respects our contemporary understand-

ing of neuromuscular anatomy and pain physiology while embracing the classical Chinese perception of a subtle circulation network of a vivifying

force called qi. This hybrid acupuncture approach expresses the best of both worlds by describing a context in which to organize patient symptoms

that usually escape attention in the standard medical evaluation. Musculoskeletal problems have been shown to be the most frequently and suc-

cessfully treated disorders; however medical acupuncture is adaptable to most clinical practices and can be used either as the primary or a comple-

mentary treatment. The physician acupuncturist can creatively intervene in a spectrum of medical disorders from early pre-morbid manifestations to

chronic organic or musculoskeletal lesions by activating the appropriate subunit of qi circulation. (Altern Ther HealthMed. 1998;4(3):35-45)

Medical acupuncture is acupuncture that has been successfully incorporated into medical or allied health practices in Western countries. It is de-

rived from Asian and European sources, and is practiced in both pure and hybrid forms. Therapeutic insertion of solid needles in various combina-

tions and patterns is the foundation of medical acupuncture. The choice of needle patterns can be based on traditional principles such as encourag-

ing the flow of qi (pronounced chee), a subtle vivifying energy, through classically described acupuncture channels, modern concepts such as re-

cruiting neuroanatomical activities in segmental distributions, or a combination of these two principles. The adaptability of classical and hybrid acu-

puncture approaches in Western medical environments is the key to their clinical success and popular appeal.

HISTORY AND DEVELOPMENT

In the United States, acupuncture has been increasingly embraced by practitioners and patients since the appearance of James Reston's land-

mark article describing his experience with successful post appendectomy pain management using acupuncture needles (The New York Times.

July 26, 1971:1,6). Before that time, acupuncture had been practiced only in urban Asian communities, discreetly and primarily by and for Asians. In

the early 1970s, widespread enthusiasm for acupuncture was fueled by reports from physician visitors to China, who witnessed surgical analgesia

using only acupuncture needles. Respect for the technique grew in the medical and scientific communities in the late1970s, when it was shown that

acupuncture analgesia was linked to the central nervous system activities of endogenous opioid peptides and biogenic amines. Since the 1970s,

guidelines for education, practice, and regulation in acupuncture have been established and implemented. State, regional, national, and interna-

tional societies have evolved to represent the interests of affinity groups of practitioners.

Acupuncture is one discipline extracted from a complex heritage of Chinese medicine-a tradition that also includes

massage and manipulation, stretching and breathing exercises, and herbal formulae, as well as exorcism of demons

and magical correspondences. The earliest major source of acupuncture's theory is the Huang Di Nei Jing (Yellow

Emperor's Inner Classic), whose oldest portions date from the Han dynasty in the 2nd century BC. The Nei Jing au-

thors regarded the human body as a microcosmic reflection of the universe and considered the physician's role that of

maintaining the body's harmonious balance, both internally and in relation to the external environment.

The Nan Jing (Classic of Difficult Issues) was written in the1st and 2nd centuries AD, also during the Han dynasty.

This text presented a unified and comprehensive system that advanced the theories of points and channels and ad-

dressed the etiology of illness, diagnosis, and therapeutic needling. The Zhen Jiu Jia Yi Jing (Comprehensive Man-

ual of Acupuncture and Moxibustion), attributed to Huang-Fu Mi in 282 AD and based on the previous texts, is the old-

est existing classical text devoted entirely to acupuncture and moxibustion (heating the acupuncture points and nee-

dles with smoldering mugwort, a dried herb).

Between the Han dynasty (206 BC-200 AD) and the Ming Dynasty (1368-1644 AD), acupuncture practice was refined

and its literature underwent continual exegesis. Research, education, clinical refinement, and collation and commen-

tary on previous classics flourished in the Ming dynasty. The Zhen Jiu Da Cheng (Great Compendium of Acupuncture

and Moxibustion) of Yang Ji Zhou, published in 1601, synthesized many classical texts as well as unwritten traditions

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of practice, and became the most influential medical text for later generations in Asia and Europe. The Da Cheng was

the source of acupuncture information transmitted to Europe in the 17th through the 19th centuries via Latin translations

by Portuguese, French, Dutch, and Danish missionaries, traders, and physicians traveling and working in China and Ja-

pan. It was also the primary source translated into French in the 20th century.

There was a flurry of primitive acupuncture experimentation by physicians in France, England, Germany, Italy, Sweden,

and the United States in the first three decades of the 19th century, which did not renew itself in Europe until a century

later and in the United States until the 1970s. The most influential impact on the development of 20th-century European

acupuncture was the work of George Soulie de Morant, a scholar-diplomat engaged in the French diplomatic service in

China between 1901 and 1917. Soulie de Morant published articles and French translations of Chinese and Japanese

medical texts, and on his return to France taught clinical applications of acupuncture to French physicians. He systemati-

cally introduced acupuncture theory from the classical texts to the French and European medical community. The com-

monly used terms "meridian and "energy" both originated in his texts as translations for the two fundamental tenets of

acupuncture: anatomy and physiology. In 20th century France and throughout much of Europe since the 1950s, clinical

acupuncture has codeveloped with biomedical science. Europe has thus served as another influence for acupuncture

approaches that integrate into the practice of conventional Western medicine.1

PRINCIPAL CLASSICAL CONCEPTS

Acupuncture has evolved over 2 millennia, both through refinements based on treatment responses and through adap-

tations to changing social situations. The language in classical Chinese medicine texts reflects nature and agrarian vil-

lage metaphors and describes a philosophy of man functioning harmoniously within an orderly universe. The models of

health, disease, and treatment are presented in terms of patients' harmony or disharmony within this larger order, and

involve their responses to external extremes of wind, heat, damp, dryness, and cold, as well as to internal extremes of

anger, excitement, worry, sadness, and fear. Illnesses likewise are described and defined poetically, by divisions of the

yin and yang polar opposites (interior or exterior, cold or hot, deficient or excessive), by descriptors attached to elemen-

tal qualities (wood, fire, earth, metal, and water), and by the functional influences traditionally associated with each of the

internal organs. The classical anatomy of acupuncture consists of energy channels traversing the body. The principal

energy pathways are named for organs whose realms of influence are expanded from their conventional biomedical

physiology to include functional, energetic, and metaphorical qualities (eg, Kidney supervises bones, marrow, joints,

hearing, head hair, will, and motivation; Spleen oversees digestion, blood production, blood-related functions such as

menstruation, and nurturing and introspection). Acupuncture anatomy is a multilayered, interconnecting network of chan-

nels that establishes an interface between an individual's internal and external environments, permitting energy to move

through the muscles and the various organs.

The most superficial of these pathways are the tendinomuscular meridians, which serve as an interface between the or-

ganism and its external environment. They provide the first defense for the body's response to climatic conditions and

external traumas. The principal meridians travel through the muscles and provide nourishment to all tissues and vitality

for animation and physical activity. The distinct meridians go directly from the surface of the body deep to the organs,

and allow the nourishment and the energy produced by the organs to circulate throughout the body. Finally, a system of

pathways called the curious meridians create connections among the principal acupuncture channels and serve as en-

ergy reservoirs for extreme conditions of emptiness or fullness. The network of energy circulation is organized into three

bilaterally symmetrical plates that divide the body into six sagittal territories of influence. Each plate manifests the energy

derived from four organs as it circulates in their anatomical territory of influence.

Figure 1 (not present) represents the schematic organization of one plate in the acupuncture energy circulation. The core

rectangle is the principal meridian subcircuit, from which the subdivisions of energy circulation are derived: tendinomus-

cular meridians on the surface, distinct meridians going to the organs, and curious meridians creating connections

among several principal meridian subcircuits. Figure 2 (not present) shows the bilateral surface tracing of one principal

meridian subcircuit. Figure 3 (not present) provides the organ associations, and thus the names, for these energy chan-

nels: Kidney-Heart (shao yin) and Small Intestine-Bladder (tai yang). Figure 4 (not present) shows the surface location of

the Kidney and Bladder tendinomuscular meridians, associated with two of the four organs involved in the shao yin-tai

yang principal meridian subcircuit. Figure 5 (not present) shows the deep pathways of the distinct meridians for the same

two organs. Each of the three bilaterally symmetrical subcircuits has a similar schematic organization. The anatomical

territory of influence shifts with the location of its sagittal plate and the organs involved in its energy circulation.

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The classical physiology of acupuncture involves a dozen internal organs that interact to produce basic energy and blood

from ingested solid and liquid nourishment, then mix in the energy from inspired air and propel the transformed energy

and blood through all the body's organs and tissues. The organs are divided into six parenchymal, energy-producing or-

gans (solid, yin), and six visceral, substance-transporting organs (hollow, yang). These organs are coupled into groups

(one yin and one yang) to make up the three symmetrical energy circulation plates. Pathology in acupuncture involves

an early manifestation of disharmony associated with the subtle influences of an organ, a disruption of the qi flow in one

of the subdivisions of the circulation network associated with an organ, or a frank disturbance in an organ's metabolic or

transport function.

Diagnosis in acupuncture involves recognizing the level of manifestation of a disturbance. Premorbid symptomatology is

organized according to the organs' subtle spheres of influence, where early energetic and functional symptoms are

linked to the organ that supervises the disturbed anatomical region or physiological function (eg, Kidney energy super-

vises head hair; premature graying or balding reflects a deficient Kidney vitality). Obstruction of the flow of energy or

blood through the principal meridians manifests as musculoskeletal pain in the territory of the channel (eg, the Bladder

principal meridian passes through the lower back; lumbar pain reflects an obstruction of qi and blood flow through that

channel). Organ pathology is identified either in conventional biomedical terms or as a disturbance in the organ's physio-

logical activities according to acupuncture terms (eg, nephrolithiasis is a disturbance in both Kidney and Bladder organs

and spheres of influence). Treatment in acupuncture involves the insertion of needles along the channels of the involved

organs to stimulate energy circulation that can influence the problem at its level of manifestation, thus restoring energetic

balance and organ function in the organism.

PRINCIPAL MODERN CONCEPTS

Since the late 1970s, acupuncture analgesia has been demonstrated to activate the endogenous opioid peptide system

and thereby influence the body's pain regulatory system by changing the processing and perception of noxious informa-

tion at various levels of the central nervous system. Two model systems of acupuncture analgesia have been advanced:

an endorphin-dependent system involving low-frequency, high-intensity electrical stimulation of acupuncture needles

(2~4 Hz) that is slow in onset, generalized through the body, and cumulative on subsequent stimulation; and a monoam-

ine-dependent system involving high-frequency, low-intensity electrical stimulation of acupuncture needles (70 Hz or

greater) that is rapid in onset, segmental, and not cumulative.2

By combining the neurohumoral models with other observations and speculations about the mechanism of acupuncture's

impact, a model is created of an acupuncture needle simultaneously activating multiple systems in the body's physiol-

ogy:

the nervous system, which includes peripheral afferent transmission, perivascular sympathetic fiber conduction,

and the central neurohumoral and neuropeptide mechanisms

the blood circulation system, which transmits the biomolecular elements locally and centrally, along with the bio-

chemical and cellular changes stimulated by acupuncture

the lymphatic system, which serves as a medium for ionic flow along fascial planes and perivascular interstitial

fluid circulation

the electromagnetic bio-information system, which consists of static electricity on the surface, ionic migration in

the interstitial fluid between the needles and as currents of injury at the needled site, and fascial and perineural

semiconduction throughout the body. 1

The above hybrid assemblage of descriptions creates a contemporary working model of a multisystem informa-

tion network that obliges the medical acupuncture practitioner to consider not only classical paradigms to arrive

at diagnostic and therapeutic decisions, but also to take into account neuroanatomical and neurophysiological

parameters. These considerations are of special importance in acupuncture's application in pain management,

where knowledge of dermatomal, myotomal, scierotomal, and autonomic innervation patterns is indispensable.

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PROVIDER-PATIENT INTERACTIONS

History and Physical Examination

In an acupuncture evaluation, the initial encounter with the patient is similar to that of a conventional allopathic

medical interview and examination. The patient is encouraged to speak candidly and thoroughly about the pre-

senting problems and their background. In addition to a conventional assessment and differential diagnosis, the

practitioner explores the characteristics and behaviors of the problems in an effort to link them with the gross or

subtle spheres of influence of one or several of the internal organs. In the case of musculoskeletal pain prob-

lems, the location of the pain is identified neuroanatomically and according to the acupuncture channel in whose

territory it lies. The goal of the interview is to identify the organs and energy circulation divisions involved in the

patient's disorder, whether the association be with the subtle symptoms linked to the traditional sphere of influ-

ence of the organs, with the trajectory of a meridian through a painful region, with a dense organ lesion, or with a

combination of these factors.

The patient's past medical history, childhood illnesses, family history, and review of systems are elicited during

the interview, and all information is tagged with the organ or meridian under whose supervision it falls. During

this period the acupuncturist poses questions of particular importance: possible cyclicity in the appearance of the

symptoms, seasonal exacerbations, general seasonal preferences or dislikes, positive or negative flavor affini-

ties and color affinities, response of symptoms to external climatic environments, and the lesion's response to

pressure, movement, heat, or cold.

A standard physical examination appropriate for the patient and the problem is undertaken, with several addi-

tional acupuncture inspections included. The musculoskeletal evaluation includes identification of painful muscle

knots and trigger points as well as subcutaneous nodules and bands overlying contracted muscles. Specific re-

flex points on the front and back of the trunk (mu points and shu points) correspond to the organs associated

with them. If any mu or shu points are sensitive to palpation during the physical examination, those findings also

are recorded.

In acupuncture, several diagnostic somatotopic systems that microcosmically reflect the internal organs are rou-

tinely used to evaluate the balance of relative strengths and weaknesses within the organs. Those most com-

monly employed are the reflex systems of the tongue, the radial pulse, and the external ear, inspections of which

are undertaken as part of the routine physical evaluation.

The tongue reflects the basic condition and underlying problem of the patient at the time of examination by way

of its color, body, coating, and surface irregularities. Changes in tongue qualities are easily noted from week to

week and often day to day. The tongue serves as an indicator of change in the patients as they evolve through

illness and respond to medical interventions.

The diagnostic microsystem of the radial pulse provides another means of evaluating the patient's overall condi-

tion, and of comparing the relative strengths of energetic activity in the organs and their meridians. The pulse

changes from minute to minute and therefore can be used to verify whether an input has had its intended effect

before one continues or concludes the treatment. The pulses also serve as a subjective measurement from visit

to visit, revealing the stability of the changes made through the acupuncture treatments.

Evaluation of the external ear confirms findings from the physical exam or other reflex systems, and may indi-

cate new directions for exploration during the interview and examination. The diagnostic examination includes

visual inspection, palpation with a probe, or scanning with a battery-powered electrical resistance detector. The

external ear also can be used as a treatment system in isolation or as an adjunct to body acupuncture points.

Medical Acupuncture Differential Diagnosis and Treatment Planning

Before concluding the diagnostic process, a review of past medical records, radiographs, and laboratory studies

is undertaken, and appropriate new studies are requested to confirm and specify mechanical and organic disor-

ders. From all available information, subtle and gross symptoms and characteristics are organized into affinity

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clusters, and patterns of disharmony are identified. The organ or organ's influence that is most disturbed is then

defined, as is the level of manifestation of this greatest disturbance. The energy-functional level of disturbance

involves the balance of energetic and metabolic activities of the organs and their spheres of influence, including,

especially, their psycho-emotional expressions; the channel-structural level involves skin, fascia, muscles, and

bones; and the organ level involves the metabolic or transport junctions of the organs themselves. A decision is

then made as to which division of the energy circulation network gives best access to the level of greatest distur-

bance.

The initial interview affords an understanding of the manifestations and course of the disorder as well as the pa-

tient's constitutional strengths and weaknesses. The ideal diagnostic conclusion is a clear perception of the pa-

tient's health course: the presenting problems and their origins as well as the likely future health events. An algo-

rithm of treatment approaches should be constructed. The goal of the overall treatment strategy must be kept in

mind while working with the various tactics at each session. For example, the immediate treatment plan may

address only relief of the most urgent symptoms, and long-standing problems can be addressed after change in

the presenting symptoms.

Treatment Design

The first steps in treatment design involve identifying the levels of manifestation of the patient's complaints and

establishing an order of treating the problems. Treatment strategy involves activating the appropriate layers of

the energy circulation network to address each problem on its own level of manifestation. A simple strain or

sprain may need nothing more than dispersion with needles surrounding the local lesion and an activation of the

appropriate tendinomuscular meridian. Musculoskeletal pain of long-standing duration will need placement of

needles around one of the principal meridian subcircuits to encourage energy flow, in addition to local needles to

focus on the site of the problem. Such a treatment may involve electrical stimulation of the points needled to

move the energy through the subcircuit as well as the local points. Psychosomatic or premorbid problems may

respond to the needling of several front or back mu or sho points, to a rarefied equilibration treatment based on

more arcane models of organ and energy interactions, or perhaps to an activation of energy flow through the

disturbed principal meridian subcircuit.

It is important to aim treatment at the level of manifestation of the problem being addressed. The circulation lev-

els being activated may be changed during a series of treatments to better address the presenting problem or to

introduce treatment for secondary problems. It is better to proceed slowly than with vigor, so that the patient's

response to the treatment can be properly evaluated. As with any other medical intervention, factors influencing

the outcome of a treatment include the patient's age; the duration and complexity of the presenting problem; the

presence of concurrent acute or chronic illness, medications, history of surgical interventions, lifestyle, and per-

sonal health factors; and the patient's emotional state and basic vitality. The patient's attitude toward acupunc-

ture usually does not affect the result, as it is not necessary to believe in acupuncture for it to be effective.

THERAPY AND OUTCOMES

Treatment Options

Along with the majority of physician acupuncturists in the United States, the author uses the hybrid model of

combining energy movement through the channels with local or focusing treatment. This model, known as

"acupuncture energetics," is derived from European interpretations of the Chinese classics and blended with

neuromuscular anatomy of trigger points and segmental innervation for pain treatments. Traditional Japanese

meridian acupuncture is akin to the linear energy movement programs represented in the following section, al-

though Japanese practitioners commonly needle more superficially than do Europeans or Americans.

Of the acupuncture systems currently practiced in the United States, the traditional Chinese medicine that is

taught at the training colleges in China is the most widespread. This approach to acupuncture is linked with tradi-

tional herbal prescribing as the core of the discipline, which can be an effective approach for internal medicine

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problems. The acupuncture points are selected for their traditional functions to reinforce the goals of herbal ther-

apy, rather than to move energy through the circulation network.

Five elements acupuncture is another widely practiced discipline. Imported from England, five elements acu-

puncture reflects French and other European interpretations of classical information. The greatest value of this

approach lies in its potential to assist in the repair of problems that originate in the psycho-emotional sphere.

Three somatotopic systems have established themselves as valuable disciplines, used either as exclusive ap-

proaches to acupuncture or as adjuncts to body acupuncture. Auricular acupuncture, developed in France, offers

a homuncular reflex organization of all body parts on the external ear. Korean hand acupuncture identifies a mi-

crosystem on the hand of the complete meridian circulation. Scalp acupuncture is another recent development,

several systems of which divide cranial territories into neurological regions corresponding to cerebrocortical influ-

ences on the body structures. These somatotopic systems appear to be effective for modifying neurological

problems that can be elusive to body acupuncture.

Description of Treatment

The acupuncture treatment consists of inserting fine needles into the body in patterns designed to influence the

flow of qi in one of the subdivisions of the energy circulation network. Usually only one energy subdivision is se-

lected to stimulate energy movement, along with a collection of local points to focus the attention of the energy

movement. Each subdivision of the circulation has a unique therapeutic point combination necessary for activa-

tion. The combinations involve the insertion of at least three needles - the energy moving needles - that are usu-

ally in the extremities and usually inserted bilaterally. The focusing needles are Inserted at trunk points that influ-

ence the organs being stimulated, or at muscular points tender to palpation in the region of the pain.

Needles are inserted to the depth necessary to elicit the patient's sensation of de qi, or needle grab, a dull ache

that radiates from the point. This can be 0.5 cm to 8 cm, depending on the location. The patient is positioned

comfortably', usually lying supine or prone. The acupuncture needles are left in place for 5 to 20 minutes. It is

crucial to protect the patient from energy depletion during an acupuncture treatment. The older or more fatigued

the patient, the shorter the duration of treatment must be. The energy-moving needles may be stimulated when

an additional activation of the acupuncture system is desired, such as when the problem is one of deficiency

according to acupuncture principles or when the patient has low vitality. This additional activation is accom-

plished through manual manipulation, by heating the needle with burning mugwort (moxibustion), or by connect-

ing the needles to an electrical stimulating device.

Focusing needles can likewise be stimulated through manual, thermal, or electrical means. It is common to treat

the patient using front, back, and extremity points during the course of a single treatment session. This means

that the treatment is typically divided into two sections: the energy movement section using extremity points to

activate flow through the meridians, and the section to focus the energy on one or several organs or to influence

a pain problem.

An example of preventive intervention that makes use of the traditional influences of the organs would be that of

a 33-year-old man who complains of a general diminution of energy, including decreased sexual interest, in-

creased sensitivity to cold weather, mild generalized joint aches, and a new affinity for salt. He is wearing a black

T-shirt and black underpants and has significant graying in his temples (such symptoms and presentation are

features of Kidney influence). This man's medical evaluation and laboratory tests are negative. His case is a pre-

morbid manifestation of weakness in the Kidney sphere of influence. An appropriate treatment would be to acti-

vate Kidney energy with needles and moxibustion at the shu points for Kidney on the back, bilaterally, as the first

section of the treatment. The second section could consist of creating an energy flow through the shao yin

(Kidney-Heart) and tai yang (Small Intestin~Bladder) principal meridian subcircuit by placing one needle in the

Kidney meridian, one in the Heart meridian, and one in the Bladder meridian, bilaterally in the extremities, and

manually stimulating them in addition to moxibustion. Each section would last 5 to 10 minutes, and would take

place in one session.

The local treatments for pain problems can be quite complex because, in addition to honoring the classical direc-

tive of encouraging the flow of qi and blood through the channels that traverse the painful area, neuromuscular

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anatomy must be considered. Deliberately searching for and deactivating intramuscular trigger points in the re-

gion of pain and along the myotomal distribution of the spinal segments involved in the pain is a necessary com-

ponent of the local treatment. Likewise, recruiting the neurological activity of the spinal origins of the derma-

tomal, myotomal, sclerotomal, and sympathetic innervation of the pain problem is a common local treatment for

chronic pain. In these cases, electrical stimulation is commonly used, with the frequencies ranging between 2 Hz

and 150 Hz.

If the above 33-year-old man also has chronic lumbar pain with an occasional L-5 radicular component, the acu-

puncture treatment will consist of an initial energy moving section involving two needles bilaterally in the extremi-

ties on the Kidney meridian, one in the Heart meridian, one in Small Intestine, and one in Bladder. The two nee-

dles in the Kidney' meridian to enhance the energetic activity in the subcircuit as well as moxa can be applied to

the other points. This section of the treatment lasts approximately 10 minutes. The second section is the local

treatment for the lumbar pain, and involves needles placed on the Bladder meridian, for example, at the L-2 level

(somatic sympathetics for lower extremities), L-4 and L-5 levels (myotomal and dermatomal levels of pain), and

at the 5-2 level (parasympathetics for lower extremities) to recruit the spinal segments involved in his pain. Elec-

trical stimulation at 4 Hz or 15 Hz can be connected among these needles. This second section lasts for 20 min-

utes.

Schedules and Results

Patient visits are usually scheduled once weekly, although two or three visits each week are not uncommon,

especially during the initial stages of an acute problem. When a favorable response lasts for the full week be-

tween visits, the interval is opened to 2 weeks. As the response stabilizes for a 2-week period, the interval is

opened again to 3 weeks, then 4 weeks. When the symptoms are stable for 4 weeks, a decision is made as to

whether the patient should return for a maintenance treatment in another month or 6 weeks or call for an ap-

pointment only if the condition returns. Chronic pain problems typically require maintenance treatments at 1-

month, 6-week, or 2-month intervals. Medical problems of lesser severity and chronicity can often be resolved

adequately and do not require maintenance treatments, although chronic medical problems-even when they re-

spond well to acupuncture-typically call for quarterly maintenance treatments.

Treatment Evaluation

During initial treatments, any change, even a transient exacerbation of symptoms, is considered a favorable re-

sponse. No response to the initial treatment can mean that the therapeutic input was not strong enough, that the

problem is deep seated and requires several treatments to influence, that the treatment design is inappropriate,

or that the problem is not accessible to acupuncture intervention. An exacerbation of symptoms after the initial

treatment usually means that the treatment decision is accurate, but that the manipulation or the duration of the

needles was too extensive. An examination of diagnostic microsystems such as the radial pulse and the tongue

gives another means for the practitioner to subjectively evaluate change in the patient's condition from visit to

visit, and thereby decide whether a change in treatment is indicated.

With the cumulative effect of the treatments, enduring improvement is the desired goal. Enduring improvement

may mean a thorough resolution of the presenting problem, or it may mean enabling the patient to function on a

plateau of discomfort that is less incapacitating or requires less medication than at the time of initial presentation.

Ideally, a dozen visits are scheduled to follow the course of the disorder and its response to acupuncture. Usu-

ally, the extent of response can be approximated by six or eight visits, but an enduring response often requires

the full schedule of visits. After the first dozen treatments, the problem and its response to acupuncture are re-

evaluated and the acupuncturist and patient decide whether to continue intensive treatments, maintain treat-

ments, or abandon the acupuncture intervention.

Acupuncture treatments are as individual as the patients and their responses to acupuncture. It is common to

stay with an initial treatment approach for at least three or four visits before modifying the approach. It is com-

mon for the patient to report changes in general well-being and vitality, or a reduction in medication, before a

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clear change in the presenting symptoms occurs. if no progress has been made by the sixth visit, it is reason-

able to consider including additional modalities to complement the acupuncture. It is best not to abandon a case

that shows reasonable hope for response to acupuncture before a full trial of 12 visits has been completed.

TREATMENT USES OF MEDICAL ACUPUNCTURE

Most Useful as Primary Therapy: Musculoskeletal Pain

In the United States, acupuncture has found its greatest acceptance and success in the management of muscu-

loskeletal pain. Acute musculoskeletal lesions such as soft tissue contusions, acute muscle spasms, muscu-

lotendinous sprains and strains, and the pain of acute nerve entrapments are among the problems most fre-

quently and successfully addressed with acupuncture. In such cases, acupuncture can legitimately serve as the

initiating therapy.

Chronic musculoskeletal pain problems are also commonly and appropriately treated with acupuncture, although

not usually as the only approach. Those problems likely to be responsive to acupuncture intervention include

repetitive strain disorders (eg, carpal tunnel syndrome, tennis elbow, plantar fascutis), myofascial pain patterns

(eg, temporomandibular joint pain, muscle tension headaches, cervical and thoracic soft tissue pain, regional

shoulder pain), arthralgias (particularly osteoarthritic in nature), degenerative disc disease with or without radicu-

lar pain, and pain following surgical intervention (both musculoskeletal and visceral). In the management of

chronic musculoskeletal pain, acupuncture offers a broad range of potential value between the conventional

therapy poles of pharmaceuticals and invasive procedures. Other chronic pain problems commonly responsive

to acupuncture include postherpetic neuralgia, peripheral neuropathic pain, and headaches from other causes.

Least Useful as Primary Therapy

Although acupuncture has been established as an effective tool to treat many forms of musculoskeletal pain, its

limitations must be recognized in dealing with the consequences of spinal cord injuries and cerebrovascular ac-

cidents. In these conditions, acupuncture's effectiveness is diminished, and the frequency of treatments is in-

creased and protracted over a longer time. Furthermore, acupuncture is usually not useful for thalamically medi-

ated pain and, apart from symptom management and general vivifying effects, is not of great value in the treat-

ment of chronic neurodegenerative diseases.

Acupuncture as a sole therapy has not shown itself to be of substantial value in severe and chronic inflammatory

and immune-mediated disorders such as ulcerative colitis, asthma, rheumatoid arthritis, and collagen-vascular

diseases, especially if those conditions have advanced to require systemic corticosteroid medication. Likewise,

acupuncture is not appropriate as the primary intervention for chronic fatigue states or HIV disease. There can

be general value, however, for the symptom control and vitality-promoting effects of acupuncture in all of these

conditions. In malignancies, acupuncture can be considered as an additional therapy to combat the secondary

effects of conventional therapy, and as an adjunct in pain management.

Adverse Effects of Acupuncture

In the hands of a medically trained practitioner, acupuncture is a fairly safe and forgiving discipline. It is difficult

to introduce new and lasting problems with an acupuncture treatment, even if the treatment is not designed as

skillfully as an experienced provider would desire. Many patients report a sensation of well-being or relaxation

following an acupuncture treatment, especially if electrical stimulation has been used. That sense of relaxation,

however, sometimes evolves into a feeling of fatigue or depression that lasts for several days. Other transient

psychophysiological responses can be light-headedness, anxiety, agitation, and tearfulness.

12

The possible risks and complications of an acupuncture treatment are undesirable consequences of penetrating

the body with a sharp instrument: syncope, puncture of an organ, infection, a retained needle. These risks can

be reduced by scrupulous sterilizing of needles, acquiring good clinical skills, understanding surface and internal

anatomy, and executing responsible clinical judgment. Pneumothorax is the most frequently reported and the

most easily produced visceral complication of acupuncture needling. Pneumoperitoneum, hemothorax, cardiac

tamponade, and penetration of the kidney, bladder, and spinal medulla have been reported, although infre-

quently.

Contact dermatitis to stainless steel needles, local inflammation, and bacterial abscesses can occur, as can

chondritis from needling points on the ear. Outbreaks of hepatitis B documented in Europe and America have

been traced to single practitioners reusing unsterilized needles.3 There have been no epidemiologically respon-

sible reports of HIV transmission through the use of acupuncture.

Preventive Value of Medical Acupuncture

Perhaps the most fertile ground for acupuncture intervention is for disorders in their premorbid state, problems

commonly encountered by primary care providers but rarely associated with positive laboratory findings, defini-

tive medical diagnoses, or successful therapies. Such states often can be described within the acupuncture di-

agnostic paradigms, and then modified through activation of the appropriate level of energy circulation. These

disorders can be loosely categorized into three groups: aesthenic states, autonomic dysregulation disorders, and

immune dysregulation disorders.

Aesthenic states include ill-defined fatigue (eg, "tired all the time, low energy"), mild depression, stress-related

myofascial symptoms (eg upper thoracic and cervical myofascial pain, muscle tension headache), and early

functional disturbances (eg. diminished libido). Autonomic dysregulation disorders may manifest as anxiety,

sleep disturbances, and bowel dysfunction. Immune dysregulation disorders include recurrent infectious and

inflammatory states without underlying frank immunodeficiency: sinusitis, pharyngitis, bronchitis, gastroenteritis,

and viral illnesses.

Some conscientious patients consult the acupuncture practitioner with what might be considered, from an allo-

pathic perspective, minor symptoms, requesting assistance to attain better health and vitality. In such instances,

the general characteristics of the patient, the presenting symptoms, the patient's past and family medical histo-

ries, and the acupuncture examination allow the acupuncturist to identify minor imbalances in the energetic ac-

tivity of the organs and energy axes. This level of subtle pathology, for which allopathic medicine has little more

than lifestyle counseling to offer, is commonly overlooked in a conventional setting. The acupuncture diagnostic

and therapeutic system, however, usually allows for an understanding of the patient and early disturbances, and

an appropriate intervention can be formulated. This form of preventive maintenance is a valuable dimension of

the subtle aspects of acupuncture.

Scope of Practice of Medical Acupuncture

Medical acupuncture is a highly adaptable discipline, and is of potential therapeutic value in many pain and gen-

eral medical conditions. Whether it is introduced as the primary or the complementary therapy depends on the

nature and severity of the presenting problem as well as the training, orientation, and practice environment of the

provider. The physician trained in medical acupuncture who sees patients early in the course of their distur-

bances can initiate treatment of a pain or medical problem with acupuncture, and introduce additional therapies

if acupuncture proves insufficient as the sole treatment. The physician who receives cases later in their evolution

and after conventional treatments have been initiated can add acupuncture to assist, or possibly replace, con-

ventional treatments.

Many patients seeking attention from acupuncture providers demand acupuncture or other unconventional inter-

ventions as the starting treatment, agreeing to conventional methods only later in their management. Other pa-

tients and many physicians wait until conventional therapies have been exhausted, and then resort to acupunc-

13

ture intervention. Acupuncture therapy is not miraculous. It has its appropriate range of applications, and, like

any other medical intervention, yields good results in well-selected early problems and less successful results

when chronicity and complexity of the presenting problems increase. Usually the best moment to initiate acu-

puncture therapy is early in the evolution of a problem; however, the flexibility and adaptability of acupuncture

allow it to be integrated at almost any stage of treatment.

In addition to the treatment of acute and chronic musculoskeletal pain and premorbid or functional problems,

medical acupuncture can be used successfully to address many diagnosable medical conditions, although it may

need to be used in collaboration with other therapies, whether conventional or unconventional. The four divisions

of medicine that appear to be most responsive to acupuncture intervention in this country are respiratory, gastro-

intestinal, gynecologic, and genitourinary.

Respiratory ailments potentially accessible to acupuncture intervention include allergic rhinitis, sinusitis, and

bronchitis. Gastrointestinal ailments include gastritis, irritable bowel syndrome, hepatitis, and hemorrhoids. Gy-

necological problems include dysmenorrhea and infertility. Genitourinary problems include irritable bladder,

prostatitis, male infertility, and some forms of impotence.

Acupuncture, particularly when applied to the external ear, has proven valuable for managing substance abuse

problems and reducing prescription narcotic analgesics. One of the most socially visible for acupuncture, this

application has gained the respect of rehabilitation programs internationally.4

For mental and emotional disturbances, acupuncture can be useful as a transient aid in early and acute emo-

tional states such as anxiety, excitability, worry, early stages of depression, and fearful states. Acupuncture

should not be considered as a primary or ongoing therapy for deep-seated or chronic psychoemotional illness,

because its effect on these conditions is not enduring.

Acupuncture as Complement, Complements to Acupuncture

Acupuncture's adaptability to the changing requirements of the patient's condition extends to its adaptability

when combined with other modalities of healthcare. This integration is an expression of the training, orientation,

and creativity of the practitioner. Acupuncture can be used as the initiating therapy for many common medical

problems and can be combined with other modalities and disciplines according to the needs of the patient and

the availability of other services. There are medical modalities in addition to allopathic pharmaceutical and surgi-

cal interventions that particularly complement the effects of acupuncture, or that acupuncture can complement.

These include physical medicine techniques in pain management, osteopathic manipulation, movement training,

herbal therapy, homeopathic remedies, and psychiatric or psychological intervention.

Management of chronic musculoskeletal pain offers many occasions in which therapeutic modalities can be

combined. A physical therapist experienced in myotherapy can extend the impact of an acupuncture treatment

directed at relaxation of contracted muscles and fascial tension patterns. The conventional spray and stretch,

trigger point infiltration, and transcutaneous electrical nerve stimulation techniques of physical medicine combine

well with acupuncture therapy. Osteopathic manipulative therapy and its subspecialty of cranial therapy also can

be productively combined with the musculoskeletal applications of acupuncture. Hatha yoga postures assist pa-

tients with biomechanical rehabilitation and maintenance of results, and the breathing exercises assist with re-

laxation and stress reduction. Movement therapy such as the Feldenkrais, Alexander, and Aston approaches

also can be useful adjunctive activities during rehabilitation.

With chronic medical problems, the traditions of herbal therapies and homeopathic remedies can be usefully

combined with acupuncture treatments. Chinese herbal formulae, when prescribed according to the classical

patterns of disharmony of internal organs, can serve as protopharmaceutical substrates to enhance and prolong

the effects of acupuncture treatments. Herbal formulae can accomplish lasting change or maintenance that can-

not be achieved with needles alone.

Homeopathic remedies are generally used in low-potency form to treat acute problems, middle-potency form to

treat chronic medical problems, and high-potency form to treat problems that have a core psycho-emotional dis-

14

turbance. These remedies can be used to specify and enhance the acupuncture treatments and have capability

in high potency to effect enduring changes in the patient's emotional configuration. It is sometimes necessary to

work in collaboration with a psychiatrist or psychotherapist who is both sensitive to the acupuncture process and

can serve in a guiding role for the patient.

ORGANIZATION

Training and Quality Assurance

In the United States, acupuncture is performed by physician as well as nonphysician practitioners. In 35 states,

the practice of acupuncture is included in the scope of a physician's medical or osteopathic license, and no regu-

lations or restrictions are imposed on medical practitioners. The 15 other states require physicians practicing

acupuncture either to demonstrate evidence of participation in training programs of 200 to 300 hours or simply to

register with the board of medicine with evidence of formal training. From these loose regulations of physician

practitioners, it is clear that the degree of acupuncture training and experience among physicians varies from

state to state and individual to individual.

The American Academy of Medical Acupuncture (AAMA) represents the education, legislation, and professional

interests of physicians who are well trained in acupuncture. Full membership in the AAMA requires 220 hours of

formal training and 2 years of clinical experience. This standard follows the physician-training guidelines estab-

lished in the constitution of the World Federation of Acupuncture-Moxibustion Societies, an international society

guided by the World Health Organization. The AAMA has established a proficiency examination as the first of a

two-part board certification examination. Membership eligibility in the AAMA has become the standard of physi-

cian credentialing for state registration, hospital privileges, liability insurance, and third-party reimbursement. It is

likely that the proficiency examination will also become a requirement for participation in managed care pro-

grams (American Academy of Medical Acupuncture; Los Angeles, Calif).

The practice of acupuncture by nonphysicians is regulated in at least 33 states, and another dozen states have

statutes pending. The educational prerequisites and training requirements vary widely from state to state, and

have been in a flux of improvement during the past decade. Approximately 30 colleges are accredited by the

National Accreditation Commission for Schools and Colleges of Acupuncture and Oriental Medicine. Most of the

programs span 3 years of didactic and clinical training. All states except California and Nevada that license non-

physician acupuncturists recognize the national examination developed by the National Commission for the Cer-

tification of Acupuncture and Oriental Medicine. There are two main national societies (the American Association

of Acupuncture and Oriental Medicine in Catasaugua, Pa; and the National Acupuncture and Oriental Medicine

Alliance in Olalla, Wash), together with many regional, state, and local organizations, that represent the interests

of the licensed acupuncturist communities.

The World Health Organization has adopted guidelines on basic training for physician and nonphysician provid-

ers, standards for safe practice, and clinical indications for acupuncture. The training guidelines reflect the mini-

mum hours expected in most member nations and are consistent with regulations enacted in the United States;

2500 hours for nonphysician acupuncturists and 200 hours for physicians. The basic curriculum is founded on

the classical tradition of acupuncture requiring a firm knowledge of the acupuncture points and channels and the

traditional models of diagnosis and treatment. A basic knowledge of Western biomedical science is also encour-

aged in the curriculum.5

Reimbursement Status

Whereas no national standard currently exists for the third-party insurance industry regarding acupuncture,

many policies recognize acupuncture as a legitimate and reimbursable procedure. Because of the popular and

professional demand for acupuncture services, it is likely that insurance reimbursement will become more uni-

form with time. Medical acupuncture, particularly as practiced by an experienced medical provider, integrates

creatively into many of the disciplines of medicine. Traditional Chinese medicine integrates less smoothly into

15

conventional settings because the herbal diagnostic model that is fundamental to traditional Chinese medicine is

alien to most Western physicians' thinking.

Back to TOP

PROSPECTS FOR THE FUTURE

The potential for medical acupuncture is just beginning to be understood. Future clinical research and utiliza-

tion evaluations should clarify, how best to integrate acupuncture into the conventional healthcare system. Medi-

cal acupuncture offers the opportunity to expand contemporary medicine to treat conditions for which current

interventions are either ineffective or have undesirable secondary effects. Because of its usefulness and adapta-

bility to so many aspects of allopathic medicine, medical acupuncture will likely' be integrated with increasing

frequency into private and institutional practices.

References

(To return to reading after referencing footnote, use the Back button of your browser.)

1. Helms JM. Acupuncture Energetics: A Clinical Approach for Physicians. Berkeley, Calif: Medical Acupuncture

Publishers: 1995.

2. Stux G. Pomeranz B. Acupuncture: Textbook and Atlas. Berlin, Germany: Springer-Verlag: 1987; 1-26.

3. Norheim AJ. Adverse effects of acupuncture: a study of the literature for the years 1981-1994. J Altern Comple-

ment Med. 1996; 2(2) 291-297.

4. Culliton PD, Kiresuk TJ. Overview of substance abuse acupuncture treatment research. J Altern Complement

Med. 1996; 2(1): 149-159.

5. Helms JM. Report on the World Health Organization's consultation on acupuncture. Med Acupunct. 1997; 9(1):

44-46.

16

The Chinese Perspective of Health and Disease

Health is a state of balance. Illness and disease are states of being out of balance.

It is interesting to note that in Western medicine there is no broad or all-encompassing theory with which to

understand illness and disease. There are some good models such as the bacterial or viral understanding of infectious

diseases, with not good understanding that links together different diseases.

Eastern modalities, such as Chinese medicine, Tibetan medicine and Aryuvedic medicine, in contrast with

Western medicine, have broad theories of health and disease. The concept of balance is central to the notion of health.

When the body falls off balance, then disease and illness arise. Health is defined as a state of balance or harmony in the

body and mind. In contrast, in Western medicine, health is described as the absence of disease.

Implicit within the notion that health means balance, is the idea that the treatment methods should bring the

body INTO A STATE OF BALANCE.

While Western medicine excels in emergency medicine and acute conditions, Chinese medicine deals better

with chronic, “lower level” problems.

Rather than concentrating on individual or a group of symptoms, Chinese medicine focuses on patterns of im-

balance. For a Western medicine practitioner, a urinary tract infection is basically caused by bacteria in urine. For the

Chinese medicine practitioner it makes all the difference the environmental factors that surround the problem and the

associated symptoms. The Chinese practitioner will be interested in knowing if there is frequency, dysuria, scanty uri-

nation, dark colored urine and if the patient feels angry and has a headache. This pattern, for example is called Liver Qi

stagnation descending as damp heat. So, for the Chinese practitioner, the bladder environment was that of damp heat.

While Chinese practitioners do not deny there are bacteria in the urine, they also are interested in what is out of bal-

ance in the body and the bladder ) to encourage the bacteria to be present.

Another example would be a man diagnosed with gastric ulcer. For a Western medicine practitioner the treat-

ment might be with a proton pump inhibitor or H2 blocker. The Chinese practitioner will go even further and asking

him if he felt hot or cold. Heat is an obvious indication of an excess condition. Cold is an indicator of a deficiency. This

apparently simple question makes all the difference to treat the patient. If, for example, the patient feels cold and has

an ulcer, the classic recommendation of drinking a glass of cold milk out of the refrigerator would generate MORE PAIN

for the patient. Milk is good to soothe HOT ulcers. For COLD ulcers, it makes them worse.

Chinese Medicine Basics

Please bear in mind that due to how old Chinese medicine is, most of these concepts are theoretical. In ancient China, human body dissections were not popular, so most of these notions and concepts belong to an elaborate and somewhat “poetic” rationalization of how the body works. Chinese medicine explains how the body works and then explains how things get out of balance. Then, through acupuncture or Chinese herbs, the balance is restored.

17

ACUPUNCTURE THEORY

October 2010

In this section we will go over 3 important aspects of Chinese medicine.

1. We will go over basic aspects of it, including philosophy and use of each meridian.

2. We will go over the Chinese measurements.

3. We will go over the main acupuncture points within each meridian.

18

The Chinese Perspective of Health and Disease

Health is a state of balance. Illness and disease are states of being out of balance.

It is interesting to note that in Western medicine there is no broad or all-encompassing theory with which to understand

illness and disease. There are some good models such as the bacterial or viral understanding of infectious diseases, with not good

understanding that links together different diseases.

Eastern modalities, such as Chinese medicine, Tibetan medicine and Aryuvedic medicine, in contrast with Western medi-

cine, have broad theories of health and disease. The concept of balance is central to the notion of health. When the body falls off

balance, then disease and illness arise. Health is defined as a state of balance or harmony in the body and mind. In contrast, in

Western medicine, health is described as the absence of disease.

Implicit within the notion that health means balance, is the idea that the treatment methods should bring the body INTO

A STATE OF BALANCE.

While Western medicine excels in emergency medicine and acute conditions, Chinese medicine deals better with chronic,

“lower level” problems.

Rather than concentrating on individual or a group of symptoms, Chinese medicine focuses on patterns of imbalance. For

a Western medicine practitioner, a urinary tract infection is basically caused by bacteria in urine. For the Chinese medicine practi-

tioner it makes all the difference the environmental factors that surround the problem and the associated symptoms. The Chinese

practitioner will be interested in knowing if there is frequency, dysuria, scanty urination, dark colored urine and if the patient feels

angry and has a headache. This pattern, for example is called Liver Qi stagnation descending as damp heat. So, for the Chinese

practitioner, the bladder environment was that of damp heat. While Chinese practitioners do not deny there are bacteria in the

urine, they also are interested in what is out of balance in the body and the bladder ) to encourage the bacteria to be present.

Another example would be a man diagnosed with a gastric ulcer. For a Western medicine practitioner the treatment

might be with a proton pump inhibitor or H2 blocker. The Chinese practitioner will go even further and asking him if he felt hot or

cold. Heat is an obvious indication of an excess condition. Cold is an indicator of a deficiency. This apparently simple question

makes all the difference to treat the patient. If, for example, the patient feels cold and has an ulcer, the classic recommendation of

drinking a glass of cold milk out of the refrigerator would generate MORE PAIN for the patient. Milk is good to soothe HOT ulcers.

For COLD ulcers, it makes them worse.

Chinese Medicine Basics Please bear in mind that due to how old Chinese medicine is, most of these concepts are theoretical. In ancient China, human

body dissections were not popular, so most of these notions and concepts belong to an elaborate and somewhat “poetic” rationali-zation of how the body works. Chinese medicine explains how the body works and then explains how things get out of balance. Then, through acupuncture or Chinese herbs, the balance is restored.

19

Let’s define first the basic substances in Chinese medicine.

1. Qi (Vital Energy or Life Force) Qi is the vital energy or life force that flows through the body's Meridians, Yin Yang organs, and is responsible for moving the blood. It has got a myriad of subtypes. Qi can transform, trans-port, hold, raise, protect, and warm. Qi also has a normal flow or direction of movement associated with each Yin and Yang organ.

2. Xue (Blood) Blood is the densest of the vital substances, flowing through the vessels to moisten and nourish the Yin Yang organs, the tendons and muscles, the skin, and the sensory organs. Blood is the mother of Qi, and houses the Shen (Mind).

3. Jing (Essence) The refined and precious substance that is the material basis for all life. It influences our con-stitution, reproduction, growth and development, and our longevity. It is the foundation for the production of Qi and aids in the production of marrow. There is both Prenatal and Postnatal Jing.

4. Shen ( Mind/Spirit ) Manifests in the eyes. Housed by the heart.

The Ten Principles of Chinese Medicine

The Ten Principles are four pairs of polar opposites: Yin-Yang, Interior-Exterior, Deficiency-Excess, Hot – Cold and Wetness-dryness.

Let’s explain YIN and YANG. The ancient Chinese subscribe to a concept called Yin and Yang which is a belief that

there exist two complementary forces in the universe. One is Yang which represents everything positive or masculine

and the other is Yin which is characterized as negative or feminine. One is not better than the other. Instead they are

both necessary and a balance of both is highly desirable.

This thinking is different from the duality of most religion where one state overcomes the other e.g. good over evil.

In the concept of YIN and YANG, too much of either one is bad. The ideal is a balance of both. The hot Saharan desert

for example is an example of extreme Yang while the bitter cold Antarctica is extreme Yin. Neither is desirable. Please

take a look at the table from Medscape below:

20

Yin and Yang need to be in balance. If they are not, then disease will appear. The symbol of tao

represents balance between Yin and Yang. There are states of maximum Yang ( top ) and maximum

Yin ( bottom ) and intermediate steps that have both Yang and Yin. From the picture you can infer

that both are tightly connected and cannot exist one without each other.

Qi circulates on the meridians on a given pattern and goes from Yang to Yin and then from Yin to Yang on a circular and

endless movement through the day and the night. On the body, the downflowing Yang Channels connect with the up-

flowing Yin Channels at both fingertips and toetips ( please see diagrams ).

In Chinese medicine anatomical position is with a patient standing with his upper extremities up and palms above his/

her head ( palms to the front ). In this position, the heavens are Yang and the earth is Yin. Man is the cross linking be-

21

Antero Posterior view of Qi Circulation.. On the

front it goes from bottom to top, and on the

back goes from top to bottom.

Circulation of Qi.

22

tween heaven and earth. However in a man, both Yang and Yin coexist. The head is Yang with respect to the feet, but

Yin with respect to the heavens. The feet are Yin with respect to the head, but Yang with respect to the earth. The ab-

domen is Yin, while the back is Yang ( frontal structures are Yin, back structures are Yang ). The skin is Yang, while inter-

nal organs are Yin ( internal structures are Yin, external structures are Yang ).

Heat vs Cold

These are 2 ways of our body to get out of balance. Heat and cold refer to to the sensations we have when we

feel hot or cold, but the concept goes beyond it. Having a fever or just feeling warm when the weather is hot are two

examples of heat, but most people with a Heat pattern are not aware of it. Most symptoms of disease can be cata-

logued as hot or cold. For example a headache might have either a hot or a cold pattern.

In general, we can say that cold is associated with diminished physical functions, decreased energy and de-

creased body metabolism. Heat is associated to a hyperfunction of physiological functions, increased energy and me-

tabolism. In cold, there is a decreased resistance to pathogenic elements with low or mild fevers when sick. In heat

there may be an overreaction to the body to pathogenic elements and thus a high fever.

Please take a look at the table below. A condition can be classified as cold or hot if more than 3 of these condi-

tions are met. There are times in which you can find heat characteristics within a mostly cold pattern and viceversa.

Wetness vs Dryness

Cold Hot

Pale face Red or flushed face

Feeling cold Feeling warm

Cold limbs, cold hands Warm hands, warm body

Fear and avoidance of cold Aversion and avoidance of heat

Wears more clothes Wears less clothes

Absence of thirst Thirst

Wetness or dampness in body Dryness in body

Preference for warm drinks and foods Preference for cold drinks and foods

Slow movements Quick and active movements

Withdrawn manners Active, and “out there”

Curls up Restless, agitated

Body secretions are clear, watery, odorless Body secretions are yellow, strong and foul odor

Pain is worse with cold Pain gets worse with heat

Pain gets better with warmth Pain gets better with cold

23

Another two important concepts in Chinese medicine. Wetness is a condition where fluids congest and accu-

mulate in the body. Dryness is the opposite condition. Dryness if often a symptom of heat, but sometimes it can hap-

pen without the heat.

Examples of wetness could be swelling and edema of lower limbs, pulmonary edema, sinus infections, etc. Ex-

amples of dryness would be dry brittle skin, dry mouth and tongue, etc. Please take a look at the chart below for more

examples:

Interior vs Exterior

For Chinese medicine, where disease is coming will make a difference in the treatment the practitioner gives. Please

take a look at the chart for some examples:

Excess vs Deficiency

Wetness Dryness

Feeling of heaviness, stickiness Dryness of skin, hair, mouth, throat, lips

Heaviness of head

Heaviness of arms and legs

Oppression of chest

Body secretions white or clear Reduced or absent secretions

Wetness in lungs produce cough with abundant

sputum.

Dryness in lugs produces dry coughs with little or no

sputum

Loss of appetite Localized accumulations of fluids: edema, skin

swelling, vaginal discharge

Interior Exterior

Chronic Illness Acute Illness

Gradual Onset Sudden Onset

Deap Weak Pulse Strong Superficial pulse

Deep pain myalgia

24

Likely to be the most important concept in Chinese medicine.

Please take a look at these examples:

1. Two women present with lung infections, low grade fevers, coughing up green-yellowish sputum. Both receive

antibiotics. The first woman gets better quickly, the second develops a chronic cough with copious sputum,

difficulty breathing, severe fatigue and low energy.

The first woman had an excess condition, which responded nicely to antibiotics. The second woman had a defi-

ciency condition.

The reason why antibiotics do not work on the second woman is that there is a fundamental weakness ( defi-

ciency ) in the body. To explain this through western terms, she may have a weak and deficient immune system

and the pathogenic element never goes away. Her lung Qi ( energy ) is also weak and so, her lungs do not work

properly. She has also got Qi deficiency ( fatigue and low energy ). Antibiotics do not work because the prob-

lem is not the bacteria as much as how WEAK and UNDERFUNCTIONING the body is.

2. A man suffers from mild stomach pains when he feels hungry. The pains reduce after eating or applying pres-

sure to the abdomen. He feels generally tired, weak and has poor appetite. He has got deficiency condition in

his digestive system.

3. A woman suffers from severe menstrual cramps the first day of her period. The pains are sharp and stabbing

and have a fixed location. Pressure applied to the lower abdomen makes the pain feel worse. This is an excess

condition. The pains are related to stagnation or blockage of blood in the body.

4. A man develops dysentery after a trip to India. When he returns he has recurrent problems with loose stools

and diarrhea and even worse when he eats spicy or greasy foods. Tests positive for bacteria and parasites two

times and receives 2 courses of anti parasitic and antibiotics. Yet, he still has a problem with diarrhea. The diag-

nosis is a deficiency condition. The bacteria/parasite exists in the body due to a weakness. The body immune

reaction is underfunctioning, thus allowing the pathogens to remain in the body.

Please take a look at this table to further clarify deficiency and excess patterns:

25

The Four Deficiencies of Chinese medicine

1. Qi deficiency:

All body functions require Qi: Digestion, elimination, immune reactions, etc. The most classic symptoms for Qi defi-

ciency is fatigue, weakness, shortness of breath, low voice and poor appetite.

2. Blood deficiency:

The Chinese concept of blood includes our notion of blood, however, as with Qi, it is broader. Blood is also thought

to flow through the meridians. Blood has also the function of nourishing, maintaining and moisturizing the organs

( including hair and skin ). Symptoms can include dizziness ( not enough blood to fill the brain ), scanty menstrua-

tion, insomnia, dry skin and hair.

3. Yang deficiency:

Yang has got to do with the metabolic activity of the body that produces heat. If there is no Yang, there is no heat

and the person feels cold. Yang makes fluids circulate, so if there is little Yang, there will be fluid collection ( swell-

ing ). The patient will prefer hot drinks, will be fearful of cold, will have cold limbs, diarrhea, discharge of bodily

fluis, edema.

4. Yin deficiency

It is a little more difficult to define than Yang. It could be described as the overall fluid, water, substance balance of

the body ( as opposed to Yang which represents metabolism and function ). The Yin balances the Yang, so if there is

Yin deficiency, then the body cannot balance the fire ( Yang ) of the body and the person feels hot and dry. Other

symptoms would be thirsty, aversion to heat, constipation ( dryness ), dry body fluids, red cheeks, dark and con-

centrated urine, night sweats.

Deficiency Excess

Symptoms of chronic disease Acute disease

Diseases tend to be less intense, less sharp

and less critical

Diseases more intense, sharper and critical

Pain is dull and diffuse Pain is sharper, severe and localized

Weakness on chest and abdomen Fullness of chest and abdomen, with pressure

Pain feels better with pressure or after eating Pain feels worse with pressure or after eating

Body is underactive Body is hyperactive

26

The Yin ( ZANG ) Organs on Chinese Medicine

Spleen:

Unlike Western medicine, the spleen is not an accessory organ. It is used principally for digestion and assimilation of

food into energy and metabolism of water. The Spleen raises the Qi, thus holds the organs up ( organs “falling down”:

prolapsed ) and keeps the blood on the vessels ( when blood goes out, you get edema ).

Spleen disharmony symptoms: Loss of appetite, weight loss, fatigue, heaviness, bloating, mild abdominal pain, diarrhea

or loose stools and organ prolapse.

Lungs:

Similar to Western medicine, in charged of breathing. Also bringing in the air Qi and moving air and Qi down into the

body.

Lung disharmony symptoms: coughing and phlegm accumulation.

Heart:

Has got two sides. The Yang would represent the left side of the heart, in charged of circulating blood. The Yin side of

the heart houses the Shen ( Spirit ).

Heart disharmony symptoms: palpitations, agitation, hysteria, delirium, mania, insomnia, nightmares.

Liver:

The liver in Chinese medicine has several and diverse functions. It spreads and regulates the flow of Qi in the body. It

can be considered the “great regulator” for it regulates and controls Qi and blood. It makes things happen smoothly, so

it has got to do with emotions and the nervous system. When we are under a lot of stress, the body physical function-

ing is not smooth. The Qi doesn’t circulate smoothly. The liver also STORES blood and regulates menstruation.

Liver disharmony symptoms: tension and diffuse pain ( fibromyalgia ), tension and pain on chest and ribs, anger, irrita-

bility, anxiety, depression and stress, menstrual irregularities, headaches, dizziness, ringing on ears, spasms, seizures,

tremors.

Kidney:

The root of body Qi, Yin and Yang. It is the storehouse of the body. IT is linked to lower back, bones, knees and legs.

The Kidney Yang fire regulates water metabolism including urination, Yang deficiency generates abundant clear excess

urination and occasionally swelling. Yin deficiency generates fatigue and heat symptoms.

27

Kidney disharmony symptoms: weak, sore and painful backs, chronic urinary reproductive and sexual functions, bone

problems.

Pericardium ( or Master of the Heart ): Its functions are very similar to the ones of the heart. It is there to protect the

Heart from external pathogenic invasions. The pericardium governs blood, and houses the mind, both functions being

the same as the Heart.

The Yang (FU) Organs in Chinese Medicine

Gallbladder ( related to Liver ): The Gallbladder is a Yang organ; its paired with the Liver. The pair is associated with the

element of Wood. While the Liver is associated with the emotion of anger, the Gallbladder is associated with indecision

or decisiveness

Small Intestine ( related to Heart ): The Small intestine and its paired organ, the Heart, are associated with the element

of fire and the emotions of joy or agitation. The small intestine governs the separation of the clear from the turbid. The

small intestine further digests food decomposed initially by the stomach. The clear, referring to the essence of water

and grain and to the large amount of fluid, is absorbed by the spleen and distributed to the whole, body. The turbid is

sent downwards to the large intestine, while the useless water is infused to the bladder. The disorders of the small in-

testine are attributable to failure to separate the clear from the turbid dirt the digesting process, manifesting stool and

urinary disturbance, such as abdominal pain, diarrhea, scanty urine, etc

Stomach ( related to Spleen ): The Stomach and its paired organ, the Spleen, are associated with the element of earth

and the emotions of worry and stress.

Large Intestine ( related to Lung ): Large Intestine is aYang organ and paired to Lung. The function of the Large Intestine

is to control the passage and conduction of stools. In the process, it transforms the stools and reabsorbs fluids from

them. It receives food and drink from the Small Intestine, conducts the food and drink down, and after absorbing some

of the fluids, it excretes the stools. The Large Intestine is closely related to the Lungs, in the way that Lung Qi aids in its

downward movement, therefore influencing defecation. As the Lungs control the skin, the Large Intestine also has in-

fluence on it.

Bladder ( related to Kidney ) : The Bladder is a Yang organ paired with the Kidney. Both are associated with the ele-

ment of water and the emotion of fear.

Triple Energizer or Triple Heater ( related to Pericardium ). San Jiao has been translated as "triple heater," triple

warmer (or three warmers)," and "triple burner," the latter of which is probably favored because of the involvement of

the San Jiao in metabolism. The current WHO standard term is "Triple Energizer" (TE), but many authors still prefer to

use San Jiao.

There are three "burning spaces":

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The upper burner - corresponding to the thoracic cavity. This space includes Fei (lungs) and Xin (Heart), and is

associated with respiration.

The middle burner - corresponding to the upper part of the dorsal cavity. This space includes Stomach, Spleen,

Hepatic Portal System, various secretory pancreatic cells, perhaps the duodenum, portions of the lymphatic

system and is associated with digestion.

The lower burner - corresponding to the lower part of the dorsal cavity. This space includes small intestine,

large intestine, Kidneys and Bladder and is associated with elimination.

29

An Introduction to Chinese Measurements

In Medical Acupuncture, we speak of a Chinese Inch or a cun. This is a measurement that is dependant on the patient’s size. We

can define one CUN as the width of a person's thumb at the knuckle, whereas the width of the two forefingers denotes 1.5 cun and

the width of 4 fingers side-by-side is three cuns.

If we go to the actual body, you will find that certain lengths of the body measure a certain number of cuns. This way it becomes

easier to calculate where a point will be from a set location.

SET Distances:

1. Axillar Fold to elbow: 9 cun

2. Elbow to wrist: 12 cun

3. Center of sternum to end of clavicle: 8 cun

4. Nipple to nipple: 8 cun

5. Xiphoid process to umbilicus: 8 cun.

6. Umbilicus to symphysis pubis: 5 cun

7. Greater trochanter to Center of patella: 19 cun

8. Center of patella to Lateral maleolus: 16 cun.

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Lung Meridian Points The lung meridian is a yin meridian and is paired with the large intestine yang meridian. The lung meridian

governs the lungs and breathing. On the inhale, the lungs take air from the universe and turn it into energy

in the body and on the exhale they expel waste from the body.

The lungs are very sensitive to emotional feelings and turmoil. When people are experiencing excessive

sadness and grief, this can lead to imbalances and illness in the lungs. The lungs are also sensitive to

changes in the environment such wind, dampness and coldness. There is very little protection between the

air we breathe and our lungs leaving them susceptible to imbalances in the lungs and the lung meridian

when conditions are extreme.

The lung channel originates from the lateral aspect of the chest near the arm pit. It then travels along the

anterior-medial aspect of the upper arm, passing the cubital region and arrives at the radial side of the wrist

containing the radial artery for pulse palpation. Passing the thenar eminence, it travels along the radial

border of the palm ending at the medial side of the tip of the thumb.

Important lung meridian points-

LU-1 Central Treasury – Use: This is an alarm point and is usually tender and sensitive when respiratory

problems are present. Location: 6 cun lateral to anterior midline level with the 1st intercostal space, 1 cun

below LU 2. Caution: needle oblique to avoid lungs.

LU-2 Cloud Gate – Use: Regulates Lung, disperses lung heat, good for asthma. Location: 6 cun lateral to

the anterior midline below the clavicle in the depression medial to the coracoid process. needle oblique to

avoid lungs.

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LU-5 Cubit Marsh – Use: This is a sedative point used for a calming affect and to cool excess energy.

Location: On the cubital crease, in the depression lateral to biceps brachii tendon.

LU-7 Broken Sequence – Use: This point is a powerful lung point and opens the surface of the body and can

be used to get rid of excess cold and wind. It also connects to the large intestine. Location: 1.5 cun above

the transverse crease of the wrist, superior to the styloid process of the radius.

LU-8 Channel Ditch – Use: Disperses Heat in lung, good for throat, stops cough. Location: 1 cun above the

transverse crease of the wrist in the hollow on the lateral side of the radial artery.

LU-9 Great Abyss – Use: This is an influential point for the vessels and one of the 8 influential points in the

body. This point is a confluence for the lungs and the large intestine making it possible for both channels to

be stimulated here. Location: On transverse crease of the wrist on the lateral side of the radial artery.

LU11 Lesser Merchant – Use: This point can be good for removing excess energy and can have a calming

affect. This is a TING POINT, which are usually only used in emergencies such as fainting or more sever

acute problems because they are painful areas to needle. Location: 0.1 cun posterior to the nail on the

radial side of the nail.

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Large Intestine Meridian Points The large intestine meridian is a yang meridian and is paired with the lung yin meridian. The main

function of the large intestine and its meridian is to process waste and pass it through the body. When

there are blockages in the large intestine meridian, they often manifest as digestion and abdominal

trouble because these processes are closely tied together.

The large intestine channel starts from the tip of the index finger. Running upward along the radical

aspect of the index finger, it passes through the inter-space of the first and second metacarpal bones,

and ascends along the lateral anterior aspect of the upper arm to the highest point of the shoulder. It

then travels along the anterior border of the acromion, then descends to the supraclavicular fossa.

From the supraclavicular fossa it travels upward to the neck and to the cheek, then it curves around

the upper lip and exits at the corner of the mouth, where it crosses the opposite large intestine

channel at the philtrum. it ends at the side of the nose, where is connects with the stomach channel .

LI-1 Shangyang: Useful for heat, pain, stagnation,

especially at the opposite end of the channel, for

eye and ear pain and inflammation, toothache.

0.1 cun posterior to the corner of the nail on the

radial side of the index finger. TING POINT

LI-4 Union Valley- This is one of the most used

points in acupuncture and it is a very important

analgesic point. This point is often used in treating

pain and can be used to treat pain in all parts of

the body, specially the head. It also promotes the

flow of energy in the upper body and is good for

treating coldness and dampness in the head and

lungs. Location 4 cun inferior to the anterior

axillary fold, 1 cun inferior to LU3 on radial side of

biceps brachii muscle. MASTER POINT

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LI-11 Pool at the Bend- This is a very important point in enhancing the immune system and is frequently

used to treat colds and infections. Location 0.1 cun posterior to the nail on the radial side of the nail.

MASTER POINT.

LI-15 Jianyu . Use : rotator cuff injuries, adhesive capsulitis, frozen shoulder, any ROM issues. Location:

Anterior and inferior to the acromion, on the upper portion of the deltoid muscle, in a depression

formed when the arm is in full abduction.

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Stomach Meridian Points The stomach meridian is a yang meridian and paired with the spleen yin meridian. Both meridians are

earth elements and work together to process nutrients and feed the body. Unbalances in the stomach

meridian can manifest as problems such upset stomach, excessive hunger, or poor appetite.

The stomach channel starts directly below the pupil between the eyeball and the infraorbital ridge.

Running downward along the lateral side of the nose, to the lateral corner of the mouth. Curving

posterior to the anterior angle of the mandible. Then it travels to the posterior aspect of the mandible

ascending in front of the ear and following the anterior hairline, it reaches the forehead. It then runs

along the throat and enters the supraclavicular fossa. The straight line of the channels separates the

supraclavicular fossa and runs downward along the middle mammillary line. It travels to the side of

the umbilicus and descends to the inguinal groove. Running downward it travels along the anterior

aspect of the thigh and reaches the knee. From there is continues further down along the anterior

border of the lateral aspect of the tibia to the dorsum of the foot and reaches the lateral side of the tip

of the second toe.

Important Stomach Meridian points –

ST1 thru ST8 - Use: These points are all on the face and

head and are often used for the many disorders in the

head and face area such as toothaches, headaches, eye

disorders and sinus problems. Location: Face and Head.

ST-1-Tear Container – Use: As a Replacement for Bl-1 in

Tendinomuscular meridians. Eye problems.

Directly below the pupil between the eyeball and the

infraorbital ridge.

ST-21 – Beam Gate - Use: Location: 2 cun lateral to the

midline lateral to CV12, 4 cun above the umbilicus.

ST-25 – Celestial Pivot - Use: Location: 2 cun lateral to the

midline lateral to CV8 at the level of the umbilicus.

ST-30 – Surging Qi Use: Location: 2 cun lateral to the midline lateral to CV2, level with symphysis

pubis.

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ST-36 - Zusanli – Leg Three Li: Use: This is a very powerful and

frequently used acupuncture point that is helpful for a number of

imbalances in the abdominal region as well as strengthening the

blood and the energy in the stomach meridian, tonifies Qi and

blood, psychological and emotional disorders. Location: 3 cun

below ST35 one finger width lateral from the anterior crest of the

tibia, in the tibialis anterior muscle. COMMAND POINT. Strongest

point in the body.

ST-40 – Bountiful Bulge - Use: this point is often used to

dissipate excessive heat and dampness from the stomach

meridian and helps clear unfocused thinking and many abdominal

disorders. Location: 8 cun superior to the tip of the external

malleous, one finger width lateral to ST38.

ST-44 – Inner Court - Use: This is a very important and well-

used general analgesic point used for toothaches, headaches, as

well as discomforts in the abdominal region. Location: At the

proximal end of the web between the 2nd and 3rd toes in the

depression distal and lateral to the 2nd metatarsodigital joint.

ST-45 – Severe Mouth - TING POINT. Use: Release heat a/or

move stagnation from the channel and organ - headaches,

toothaches, facial pain, TMJ, breast pain. Agitation and insomnia

with heat signs - calms the spirit. Location: 0.1 cun posterior to the corner of nail on the lateral

side of the 2nd toe.

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Spleen Meridian Points

The spleen meridian is a yin meridian and is paired with the stomach yang meridian. The spleen

meridian is an earth element and has strong nurturing qualities. Being paired to the stomach meridian

and having nourishment qualities, imbalances in this meridian can manifest as digestive and stomach

problems.

The stomach channel starts directly below the pupil between the eyeball and the infraorbital ridge.

Running downward along the lateral side of the nose, to the lateral corner of the mouth. Curving

posterior to the anterior angle of the mandible. Then it travels to the posterior aspect of the mandible

ascending in front of the ear and following the anterior hairline, it reaches the forehead. It then runs

along the throat and enters the supraclavicular fossa. The straight line of the channels separates the

supraclavicular fossa and runs downward along the middle mammillary line. It travels to the side of

the umbilicus and descends to the inguinal groove. Running downward it travels along the anterior

aspect of the thigh and reaches the knee. From there is continues further down along the anterior

border of the lateral aspect of the tibia to the dorsum of the foot and reaches the lateral side of the tip

of the second toe.

Important Spleen Meridian points –

SP-1 Hidden White - Use: Local Point and Tendinomuscular meridian. Location: 0.1 cun posterior to

the corner of the nail, on the medial side of the great toe. TING POINT

SP-4 Yellow Emperor- Use: This point passes to the stomach meridian and is used to treat a number

of imbalances associated with the digestive system. It also dispenses excess heat and dampness in

the spleen meridian. Location: In a depression distal and inferior to the 1st metatarsal bone at the

junction of the red and white skin.

SP-6 Three Yin Crossing- Use: This point is where the 3 yin meridians in the ankles (spleen, kidney,

liver) cross. This point is used in many acupuncture treatments for disorders in all 3 of the meridians

that cross here. Location: 3 cun directly above the tip of the medial malleolus on the posterior border

of the tibia. Contraindicated to needle during pregnancy.

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SP-9 Yin Mound Spring- Use: This

point is used to clear dampness in

the spleen meridian and also for knee

problems such as inflammation and

pain. Location: On the lower border

of the medial condyle of the tibia, in

the depression between the posterior

border of the tibia and gastrocnemius

muscle.

SP-10 Sea of Blood- Use: This is an

important immune strengthening

point and is used for a variety of

disorders such as blood infections,

allergies and skin infections.

Location: With the knee in flexion, 2

cun superior to the superior border of

the patella, on the budge of the

medial portion of the quadriceps

femoris muscle.

SP-21 Great Embracement-Use:

Great Luo of the Spleen. Mentioned

classically that when this point is

deficient, all the joints are flaccid, and when excess, pain all over the body.Pain of the thoracic region.

Location: On the midaxillary line, 6 cun inferior to the anterior axillary crease. Midway between the

axilla and the free end of the eleventh rib.

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Heart Meridian The heart meridian is a yin meridian and is paired with the small intestine yang meridian. The heart’s

physical job is to move blood, pumping and moving blood non-stop with every heartbeat. The heart

has to be physically very strong and powerful because it has a constant job to keep pumping blood

throughout the entire life of a person.

The mental and spiritual qualities of the heart are very powerful. A person with a healthy heart is a

happy and grateful person and a person with a weak heart often leads a miserable life. In today's

modern societies, many people suffer from imbalances of the heart due to living lifestyles that are not

in our hearts just to "pay the bills". Modern society can also be very lonely for many people, which can

also lead to a weak heart.

The heart channel starts in the center of axilla. From there is goes along the posterior border of the

medial aspect of the upper arm . Passing through the cubital region, it descends to the pisiform region

proximal to the palm and enters the palm. Then it ends at the medial aspect of the tip of the little

finger.

Important Heart meridian points-

HT-1 Highest Spring. Uses: Regulate Qi flow from the torso to the arm and vice versa - cold,

numbness, pain in shoulder a/or arm, Frozen shoulder, Pain a/or distention of the upper thoracic

area.Location: Center of axilla on the medial side of the axillary artery. Avoid axillary artery!

HT-3 Lesser Sea. Uses: Pain, numbness, tremors, etc. of the lower arms a/or hands - Parkinson's,

stroke. Spirit disorders as - epilepsy, depression, anxiety, nervousness, poor memory, fuzzy thinking,

redness of the eyes, mouth ulcerations . Location: With elbow flexed, at the medial end of the

transverse cubital crease. MASTER POINT

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HT-7 Spirit Gate – This point can be very effective in treating many emotional and mental disorders

such as addiction, anxiety, sleeplessness and depression. On the ulnar end of the transversecrease of

the wrist, in the small depression between the pisiform and ulna bones. MASTER POINT

HT-9 Lesser Surge – This is a TING POINT and is usually only used in emergencies such as fainting or

other extreme disorders caused by excessive heat. 0.1 cun posterior to the corner of the nail on the

radial side of the little finger.

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Small Intestine Meridian The small intestine is a yang meridian and is paired with the heart yin meridian. The main job of the

small intestine is to process the nutrients out of food for use by the body. Imbalances in the small

intestine meridian can lead to problems such as digestion troubles, abdominal pain and also appetite

problems such as over eating or poor appetite.

The small intestine channel starts at the ulnar aspect of the tip of the little finger, and travels along

the ulnar border of the hand dorsum upward to the posterior border of the lateral aspect of the upper

arm. It passes through the cubital region curving around the scapular region. Then turning downward

to the supraclavicular fossa and ascends to the neck. Travels up to the cheek going through the outer

canthus of the eye, and ends anterior to the tragus of the ear.

Important Small Intestine meridian points

SI-1 Lesser Marsh – Uses: clear heat from the

opposite end of the channel, for eye redness,

earache, tinnitus, sore throat, stiff tongue. Location:

0.1 cun posterior to the corner of the nail on the

ulnar side of the little finger. TING POINT

SI-3 Back Ravine – Uses: This point is used

frequently to clear wind and dampness. It is also

used to help relieve tension in the neck area. Pain in

the scapula, arm a/or hand combine with local

points. Stiff neck, cervical strain/sprain, pain of the

back or neck.Occipital headaches, Night sweats,

Clears heat and excess from the ears and eyes, eye

redness, inflammation, visual dizziness, earache,

tinnitus. Calms the spirit. Location: When a loose

fist is made, at the ulnar end of the distal palmar

crease proximal to the 5th metacarpal phalangeal

joint at the junction of the red & white skin. MASTER

POINT

40

SI-6 Nursing the Aged – Use: This point is used to

help clear tension from the neck and shoulder area.

Location: Dorsal to the head of the ulna in the body

cleft on the radial side of the styloid process, found

with the palm facing the chest.

SI-9 True Shoulder – Use: this point is used

frequently to relieve shoulder problems such as

stiffness and aches in the shoulder joint. Location: 1

cun above the posterior end of the axillary fold,

posterior and inferior to the shoulder joint, found

with the arm adducted.

SI-10 Upper Arm Shu

SI-11 Celestial Gathering

SI-12 Grasping the Wind These Points are useful as LOCAL POINTS ONLY FOR

SI-13 Crooked Wall SHOULDER PAIN.

SI-14 Outer Shoulder Shu

SI-15 Central Shoulder Shu

SI-18 Cheek Bone Hole – Use: this point is used often to clear wind from the facial area and treat

problems such as toothaches, frontal headaches and sinus problems. Location: Directly below the

outer canthus of the eye in a depression on the lower border of the zygoma.

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Urinary Bladder Meridian Points The urinary bladder meridian is a yang channel and is paired kidney yin channel. The element is water

and the urinary bladder system controls the storage and excrement of urine from the body. The

urinary bladder meridian is the largest meridian in the body. The Shu points have strong connections

to the corresponding organs and can be used to treat certain conditions in the organs.

The urinary bladder channel of the Foot-Taiyang originates from the inner canthus of the eye. Passing

through the forehead, it flows up to the vertex. It bifurcates above the posterior hairline into two lines.

One line runs from the posterior aspect of the neck downward along the medial border of the scapula

(3 cun lateral to the back mid-line). Passing through the gluteal region. Another line runs straight

downward (1.5 cun lateral to the mid-line of the back) to the lumbar region. From there it descends

along the posterior aspect of the thigh to the popliteal fossa. Descending to the posterior aspect of the

gastrocnemius muscle and further to the posterior inferior aspect of the lateral malleolus. Ending at

lateral posterior side of the tip of the little toe.

Important Urinary Bladder meridian points-

BL-1- Bright Eyes - Use: Main point for all eye

disorders especially from wind (internal or

external), excess, heat. Eye pain, strain,

redness, swelling, itching, twitching, blurry

vision, etc. Location: In a depression, .1 cun

above the inner canthus of the eye.

BL-2- Bamboo Gathering – Use: Can be used to

relieve pain and pressure from the sinuses and

the front of the head. Also for red eyes.

Location: On the medial end of the eyebrow,

directly above the inner canthus of the eye (on

the supraorbital notch).

BL-10 - Celestial Pillar – Use: This point is

frequently used to clear wind and can be used to

treat migraines and neck aches. Neck issues, stiffness , occipital headache. Location: 1.3 cun lateral

42

to GV15 and 0.5 cun above the posterior hairline, in a depression on the lateral aspect of the trapezius

muscle.

BL-11 - Great Shuttle – Use: Has a variety of uses such as treating asthma, cough, occipital

headaches and joint disorders. Special Point for bones ( HUI Point ) Location: 1.5 cun lateral to GV13

level with the spinous process of T1. (from the midline to the medial border of the scapula is

considered 3 cun).

BL-13 - Lung Shu – Use: is a Shu point of the lung and can be used to treat asthma, cough and

various other lung illnesses. Location: 1.5 cun lateral to GV12 level with the spinous process of T3.

BL-14 – Pericardium Shu - Use: For all heart conditions: palpitations, anxiety, stress, etc. Location:

1.5 cun lateral to midline level with the spinous process of T4.

BL- 15 - Heart Shu – Use: is a Shu point of the heart and can be used to treat heart diseases and

mental imbalances such as anxiety and depression. Main point for all heart, blood and circulatory

related issues of an excess or deficient nature. Main point for all heart related emotional issues:

palpitations, anxiety, stress, poor memory and insomnia. Location: 1.5 cun lateral to GV11 level with

the spinous process of T5.

BL-18 - Liver Shu – Use: Main point for all Liver related conditions: hepatitis, jaundice, cirrhosis, Blood

stagnation, Qi stagnation, etc. Main point for eye problems, pain, itching, dryness, redness, blurred

vision, visual dizziness, twitching. anger, depression, irritability, frustration, stress a/or PMS.

Location: 1.5 cun lateral to GV 8 level with the spinous process of T9.

BL-19 - Gall Bladder Shu - Use: is a Shu point of the gall bladder and can be used to relieve excess

heat and dampness from the gall bladder and treat fever, chills and nausea, hepatitis, cholecystitis,

jaundice, vomiting, flank pain and distension, bitter taste in the mouth. Pain along the GB meridian

(sides of the body) from any etiology, intercostal neuralgia, rib pain, trauma, herpes zoster,

indecision, timidity. Location: 1.5 cun lateral to GV 7, level with T10.

BL-20 - Spleen Shu – Use: is a Shu point of the spleen and can be used to strengthen the spleen and

stomach, nourishes the blood, and is beneficial for many stomach disorders. low energy, fatigue,

prolapses, damp related conditions a/or bleeding disorders. Also for fatigue, lack of appetite,

abdominal bloating a/or distention, undigested food in the stools, chronic diarrhea a/or belching.

Location: 1.5 cun lateral to GV 6, level with T11.

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BL-21 - Stomach Shu – Use: is a Shu point of the stomach and can be used to treat a wide variety of

stomach disorders such as digestion problems and gas, food stagnation, abdominal distention,

borborygmus, mouth ulcers, vomiting, belching, nausea, etc. Location: 1.5 cun lateral to GV line,

level with T12.

BL-23 - Kidney Shu – Use: is a Shu point of the kidney and can be very beneficial for urogenital

disorders. For all Kidney related issues which effect the brain, bone, hair, teeth a/or hearing. Male

deficiency related sexual problems: impotence, premature ejaculation, sterility, exhaustion following

ejaculation. Female sexual and reproductive disorders: dysmenorrhea, amenorrhea, cold uterus,

frigidity, infertility, leukorrhea. Tonification point in deficiency conditions: exhaustion, weakness and

chronic fatique. Main point for acute or chronic low back pain, sprains or strains. Useful for Kidney

related ear issues: tinnitus, deafness, chronic ear infections. Location: 1.5 cun lateral to GV 4, level

with L2.

BL-25 - Large Intestine Shu – Use: is a Shu point of

the large intestine and can be used to treat disorders

in the large intestine such as diarrhea and

constipation also menstruation. Location: 1.5 cun

lateral to GV 3, level with L4.

BL-27 - Small Intestine Shu – Use: is a Shu point of

the small intestine and can be used to treat intestinal

disorders and is a beneficial point for sciatica. Main

point for all Small Intestine related issues: damp

heat effecting the bladder (difficult or painful

urination, hematuria, dark urine), damp heat

effecting the intestines (diarrhea, dysentery).

Location: 1.5 cun lateral to midline level with the

first posterior sacral foramen.

BL-28 - Bladder Shu – Use: is a Shu point of the

bladder and can be used to treat urogenital

disorders, lower back pain and sciatica. Main point

for all Bladder issues: from damp heat (painful a/or

dark urination), from cold (frequent urination,

incontinence). For dampness anywhere in the body,

44

combine with SP 9 to expel dampness through urination. Location: 1.5 cun lateral to midline level

with the second posterior sacral foramen.

BL-40 - Bend Middle – Use: As the Lumbar Command Point, useful for all

lumbar related issues: acute low back pain, sprain, muscle spasms, etc.

Main point for heat conditions such as summer heat, heatstroke and heat

exhaustion. Good local point for leg or knee pain. Location: Midpoint of the

transverse crease of the popliteal fossa, between the tendons of biceps

femoris and semitendinosis.

BL-60 - Kun Lun Mountains - Use: Main point for pain anywhere along the

spine. Main point for chronic low back pain a/or problems of pain a/or

numbness in the lower limbs.Main point for headache and other excesses

effecting the head. Induce labor or promote discharge of a retained

placenta. Location: In a depression between the tip of the external

malleolus and the achilles tendon.

BL-62 - Extending Vessel – Use: this point is frequently used to help with

mental imbalances and sleep disorders.

With SI 3 for low back pain, difficulty

walking, spinal problems as well as

wind-cold effecting the taiyang

channels: stiff neck a/or shoulders,

occipital headache, etc. Insomnia,

nervousness.Location: In a depression

directly below the external malleolus.

BL-67 - Reaching Yin Use: Clears pain a/or stagnation from the opposite end of the channel:

headache, eye pain, sinus pain, etc. Use with moxa to adjust breech fetal position (generally indirect

moxa for 10-20 minutes 1x/day). Location: 0.1 cun posterior to the corner of the nail on the lateral

side of the little toe. TING POINT.

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Kidney Meridian Points

The kidney meridian is a yin meridian and is paired with the urinary bladder yang meridian. It is a

water element and is very important in maintaining and processing your body’s fluids. One of the

important functions the kidneys provide is to filter toxins out of the blood supply. Many illnesses,

especially in the lungs, can be traced back to weak kidney energy and functions.

The kidney channel starts from the interior aspect of the little toe (On the sole of the foot, depending

on the text.), and runs through a depression in the lower aspect of the tuberosity of the navicular

bone. It travels behind the medial malleolus and encircles the malleolus. Ascending along the medial

side of the leg, it passes the medial side of the popliteal fossa and goes further upward along the

posterior-medial aspect of the thigh. Traveling to the superior border of the symphysis pubis forming a

straight line 0.5 cun from the midline. It ascends diverging at the

diaphragm, ending In a depression on lower border of clavicle 2 cun

from the midline.

Important Kidney Meridian points –

KI-1 Gushing Spring – Use: descends rising LR fire

and excess LR Yang, headaches, tinnitus, cools

empty heat from KI Yin Deficiency, chronic sore

throat, tonify Kidney Yin, insomnia, palpitations,

rage, loss of consciousness. Location: On the sole of

the foot, in a depression when the foot is in plantar

flexion at the junction of the anterior 1/3 and

posterior 2/3 of line connecting base of 2nd and 3rd toes and the

heel. TING POINT.

*A point called KI-1’ is described to exist on the medial aspect of

the distal phalanx of the 5th toe at 0.1 inch from the toe nail and is

used more frequently clinically.

46

KI-3 Great Ravine – Use: This is a helpful point for many urogenital disorders and helps strengthen

and balance the energy in the kidney meridian. Location: In depression midway between the tip of the

medial malleolus and the attachment of the achilles tendon, level with the tip of the medial malleolus

KI-7 Recover Flown – Use: this point is helpful to strengthen the yang energy in the kidney meridian

and is helpful for treating lower back pain and bladder problems. Location: 2 cun above KI3 on the

anterior border of the achilles tendon.

KI-10 Yin Valley - Use: clear damp-heat in the lower warmer, urgent/difficult urination, genital

pain/itching, uterine bleeding. Location: at the medial side of the popliteal fossa when the knee is

flexed, between the tendons of semitendinosus and semimembranosus muscles level with BL54.

KI-27 Shu Mansion – Use: open and relax the chest, asthma, constricted breathing, cough, tonify KI

deficiency in adrenal exhaustion, fatigue, lowered immunity, local for neck a/or jaw pain. Location: In

depression on lower border of clavicle, 2 cun lateral to the midline.

47

Pericardium or Master of the Heart Meridian The pericardium is a yin meridian a paired with the triple heater yang meridian. The main job of the

pericardium meridian is to work with the heart and control excessive energy in the heart. Imbalances

in the pericardium meridian can often times lead to cardiac and blood circulation problems.

The pericardium channel originates in the chest lateral to the nipple. It then ascends to the axillary

fossa and runs along the medial aspect of the upper arm, passing through the cubital fossa. It goes

further downward to the forearm between the tendons of the m. palmaris longus and m. flexor carpi

radialis. It enters the palm and passes along the middle finger to its tip.

Important Pericardium meridian points-

PC-1 Celestial Pool – Use: Window of the Sky Point, fullness of the chest, headache, axillary sweating,

blurred vision. Breast disorders, insufficient lactation. Location: 1 cun lateral to the nipple in the 4th

ICS.

PC-6 Inner Pass – Use: is a helpful point in treating excessive heat in the upper abdominal region such

as heartburn and ulcers. Opens and relaxes the chest, chest tightness, asthma, angina, palpitations.

Insomnia and other spirit disorders of an excess or deficient nature, mania, nervousness, stress, poor

memory. Nausea, seasickness, motion sickness, vomiting, epigastric pain. Carpal Tunnel Syndrome.

Location: 2 cun above the wrist crease between the tendons of palmaris longus and flexor carpi

radialis . MASTER POINT

PC-7 Great Mound – Use: this is a sedative point and is frequently used to treat mental conditions

such as insomnia, schizophrenia and bi-polar conditions. Cooling heat that is effecting the Heart of a

deficient or excess nature. Clears Ying and Blood heat, fever deep in the body that is drying up fluids.

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Carpal Tunnel Syndrome. Sweat issues (too much or too little), hot flashes. . Location: In the middle

of the wrist crease between the tendons of palmaris longus and flexor carpi radialis.

PC-9 Central Hub- Use: Clearing heat in the Heart. Stiff tongue, speech disorders, especially those

arising after a stroke. Restoring consciousness . Location: In the center of the tip of the middle finger

( some locate it 0.1 cun posterior to the corner of the nail on the carpal side of the middle finger).

TING POINT.

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Triple Heater or San Jiao Meridian The triple heater meridian is a yang meridian and is paired with the pericardium yin meridian. The

triple heater meridian gets its name from having 3 heating sections. The upper section is in the head

and neck area, the middle section is in the chest area and the bottom section is in the navel area. The

job of the Triple Heater Meridian is to regulate the

flow of energy in these three regions.

The triple heater channel originates from the tip of

the ring finger. It travels upward between the

fourth and fifth metacarpal bones and along the

dorsal side of the wrist and the lateral side of the

forearm between the radius and ulna, it passes

through the olecranon. Then it runs along the

lateral aspect of the upper arm and reaches the

shoulder region. Crossing over the shoulder, it

enters the supraclavicular fossa. It then ascends to

the neck, running along the posterior border of the

ear. It crosses from the superior aspect of the ear

to the corner of the forehead. Then it turns

downward to the cheek and terminates In the

depression at the lateral end of the eyebrow.

Important Triple Heater Meridian points-

TH-1 Passage Hub- Uses: Entry Point. Use similar to TH-3 . Location: 0.1 cun posterior to the corner

of the nail on the ulnar side of the ring finger. TING POINT.

TH-3 Central Islet – Uses: This point is frequently used for disorders in the ears such as tinnitus and

deafness especially those arising from a Liver issue such as Qi Stagnation or Liver Yin Deficiency.

Distal point for temporal headaches, shoulder a/or upper back pain, pain a/or inflammation in the

throat. Location: With fist clenched on dorsum of the hand between the 4th and 5th metacarpal bones

in a depression proximal to the 4th Metacarpalphalangeal joint.

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TH-5 Outer Pass – Uses: this is a very important point for

many general imbalances such as migraines, common

colds, fevers and arthritis, stiffness or pain in the posterior

and lateral aspects of the neck. Location: 2 cun above TH 4

between the radius and the ulna on the TH 4 - TH 10 line.

MASTER POINT.

TH-8 Three Yang Connection – Uses: this is an important

point for treating various types of chest pain, sudden

deafness, acute or chronic loss of voice, aphasia. Location:

4 cun above TH 4 between the radius and ulna.

TH-14 Shoulder Bone Hole – Use: this is an important point

that can be used to help shoulder problems and pain.

Location: On shoulder, posterior to LI 15, in a depression

inferior and posterior to the acromion when arm is

abducted.

TH-17 Wind Screen – Use: this point is frequently used to

treat ear conditions such as aches, infections and ringing.

Location: Posterior to lobule of ear in depression between the mandible and mastoid process.

TH-23 Silk Bamboo Hole – Use: Eye pain, redness, swelling, twitching, drooping eyelid. Liver Wind or

Liver Fire headache, combine with local points. Location: In a depression at the lateral end of the

eyebrow.

51

Gall Bladder Meridian Points The gall bladder meridian is a yang meridian and is paired with the liver yin meridian. The gall bladder

helps digest food and stores bile produced by the liver. The gall bladders element is wood, the color is

green and the sense organ is the eye.

The gall bladder channel starts from the outer canthus of the eye, and desends to the anterior aspect

of the ear. Then ascends to the corner of the forehead, and then winds downward posterior to th ear.

Then arches forward to the forehead at the midpoint of the eyebrow. It then runs above the hairline to

the lateral side of the neck. Travels highest point of the trapezius muscle. From there it further

descends to the axilla and enters the chest. It then travels interiorly in the hypochondriac region,

emerging at the lateral side of the lower abdomen near the femoral artery in the inguinal region. Then

it curves along the margin of the public hair and runs transversely into the hip region. It then travels

downward along the lateral side of thigh to the lateral side of the knee. Further descending along the

anterior aspect of the fibula, it reaches the lower end of the fibula, and the anterior aspect of the

lateral malleolus. Following the dorsum of the foot, it terminates at the lateral side of the fourth toe's

tip.

Important Gall Bladder meridian points-

GB-1 Pupil Bone Hole – Use: this is a useful point for

treating frontal headaches and eye disorders.

Location: 0.5 cun lateral to the outer canthus of the

eye in a depression on the lateral side of the orbit.

GB-2 Auditory Convergence – Use: this point is used

frequently to treat ear problems and dizziness.

Location: Anterior to the intertragic notch at the

posterior border of the condyloid process of the

mandible with the mouth open.

GB-13 Use: Collecting Point for tendinomuscular

meridians Yang arm. Location: 0.5 cun within the

hairline on the forehead, 3 cun lateral to GV4. Midway

between ST8 and BL4.

52

GB-14 Yang White – Use: this is a very important point for treating eye

disorders and headaches. Location: On the forehead directly above the

pupil, 1 cun above the midpoint of the eyebrow.

GB-20 Wind Pool – Use: this point can help eliminate wind and cold and

treat disorders such as common cold, dizziness and eye problems.

Location: In the depression created between the origins of the

Sternocleidomastoid and Trapezius muscles, at the junction of the

occipital and nuchal regions. Lateral and level with GV16.

GB-21 Shoulder Well – Use: this point can be used to treat shoulder pain,

occipital headaches and imbalances in the chest such as asthma.

Location: Midway between the spinous process of C7 (GV14) and the

acromion process at the highest point of the trapezius muscle.

GB-24 Sun and Moon – Use: this point can be used to treat certain

upper abdominal symptoms such as vomiting, heartburn and acid reflux.

Location: Directly below the nipple in the 7th intercostal space, inferior to

LV14.

GB-25 Capital Gate – Use: this point can be used to dispel dampness

from the kidney meridian and is useful for treating symptoms such as

diarrhea and urinary retention. Location: On the lateral side of the

abdomen, at the lower border of the free end of the 12th rib.

GB-30 Jumping Round – Use: this point can be used to help treat lower

back pain and pain in the legs. Location: At the junction of the lateral 1/3

and medial 2/3 of the distance between the greater trocanter and the

hiatus of the sacrum (GV2)

GB-34 Yang Mound Spring – Use: is a very important point in treating liver and mental disorders and

is a useful point for pain in the joints and tendons. Location: In a depression anterior and inferior to

the head of the fibula.

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GB-39 Suspended Bell – Use: this point is frequently used to nourish the kidney yin, and the marrow

in blood disorders. Location: 3 cun above the tip of the lateral malleous in a depression between the

posterior border of the fibula and the tendons of peroneous longus and brevis muscles.

GB-40 Hill Ruins – Use: this point can be useful in treating disorders and pain in the ankle joints.

Location: Anterior and inferior to the lateral malleous in a depression on the lateral side of the

extensor digitorum longus tendon.

GB-41 Foot Overlooking Tears – Use: this point is sometimes used to treat headaches, migraines and

disorders in the ears. Location: On the dorsum of the foot, in the depression between the fourth and

fifth metatarsal bones.

GB-44 Use: insomnia w/nightmares, LR/GB heat, fullness below the heart, sense organ issues, pain,

inflammation, speech disorders, stiff tongue. Location: 0.1 cun posterior to the corner of the nail on

the lateral side of the fourth toe. TING POINT.

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Liver Meridian Points

The liver meridian is a yin meridian and is paired with

the gall bladder yang meridian. The main job of the

liver meridian is to keep the energy in the entire body

regulated. When there are deficiencies in the liver

meridian, it can lead to depression and sluggishness.

Over abundance of energy in the liver meridian can lead

to anger, shouting and conflicts.

The liver channel originates on the lateral side of the

great toe. Ascending along the dorsum of the foot, it

flows further upward to the anterior aspect of the

medial malleolus. Then it runs upward to the medial

side of the knee and along the medial aspect of the

thigh into the pubic region. From there it curves around

the external genitalia and crosses the midline up to the

lower abdomen. Ending directly below the nipple.

Important Liver meridian points-

LR-1 Large Pile – Use: revival; moves Qi in genital

region; menstrual bleeding from excess or deficiency;

LR Qi stagnation; emotional imbalances . Location: On

the lateral side of the great toe, 0.1 cun from the corner

of the nail. TING POINT.

LR-3 Great Surge –Use: this is a very important point

for the liver and gall bladder meridian. It is used to

dissipate wind and treat a number of things such as

headaches, hypertension and mental disorders.

Location: On dorsum of the foot in a depression distal

to the junction of the 1st and 2nd metatarsal bones.

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LR-8 Spring at the Bend – Use: this point can be used to strengthen the blood, expel excess heat and

treat ailments such as knee pain and mental disturbances. Location: When the knee is flexed, the

point is found above the medial end of the transverse popliteal crease, posterior to the medial

epicondyle of the tibia in a depression on the anterior border of the insertions of the

semimembraneous and semitendoneous muscles.

LR-13 Item Gate – Use: this point can be used to treat digestion disorders such as vomiting,

constipation and diarrhea. Location: On the lateral side of the abdomen below the free end of the 11th

rib.

LR-14 Cycle Gate – Use: this point can be used for many imbalances in the chest area such as cough,

chest pain and emotional problems like anger and irritability. Location: Directly below the nipple, 4

cun lateral to the midline in the 6th intercostal groove.