Body-Mind Mapping in Chinese Medicine · Giovanni Maciocia presents: Body-Mind Mapping in Chinese Medicine Maryland Acupuncture Society, November 15, 2009 CD & Handouts edited by:

Giovanni Maciocia presents:

Body-Mind

Mapping

in Chinese Medicine

Maryland Acupuncture Society, November 15, 2009 CD & Handouts edited by: L. Francesca Paik

©2009 Giovanni Maciocia

Body-Mind Mapping in Chinese Medicine

Table of Contents Page

VERTEXChannels 1Diagnosis 7Patterns 10Point Selection 11

OCCIPUT and NECKAnatomy 19Channels 20Energetic anatomy 21Diagnosis 22Patterns 23Diseases 24Points 27

Eye System 28FACE 32

Channels 33Diagnosis 35Interrogation 36Patterns 38Diseases 39Points 40Sinusitis 45

THROAT and NECKChannels 48Diagnosis 51Interrogation 52Patterns 56Goiter 57Hyperthyroid 60Points 61

CHESTChannels 64Diagnosis 66Interrogation 67Palpation 69Patterns 70Diseases 71Points 74

Resonating PointsYang Channels 78Crossroads/ Pathways of Qi 80Resonating Points 81

i

Track List

Disc 1 Body-Mind Mapping: Vertex Page01 Opening Remarks02 Introduction03 VERTEX 104 Potential of energy 105 Yin ch to head 306 Muscle Channels 407 Legalist 508 Back to channels 5

Disc 2 Vertex con't01 Back to Channels con't 602 Diagnosis 703 Feeling of Heaviness of Head 804 Summary of patterns 1005 Point Selection for HA 1106 Ex frontal HA 1107 Points on head, Du-20 1208 Du-21, Du-19, Du-23 1309 Du-24 14

Disc 3 Vertex con't & Occiput and neck01 Prefrontal cortex & Balance btw shen and hun 1402 Back to Du-24 1503 BL-7, BL-8, GB-15, GB-17, GB-18, ST-8 1604 Questions 1905 Spirit cannot be obstructed 1906 OCCIPUT AND NECK 1907 Channels 1908 Energetic Anatomy 2109 Diagnosis 2210 Patterns 2311 Diseases 25

Disc 4 Occiput and neck con't & Face01 Questions, yin xu 2602 Back to pts for diseases 2703 Points BL-10, GB-20 2704 Eye System 2805 Remaining points 2906 Q threading 3207 FACE 3208 Channels 3209 Pathology of Face Summary 3310 Back to Channels 3411 Diagnosis 3512 Interrogation 3613 Treatment Chong Mai 3714 Facial Pain 37

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Disc 5 Face con't & Throat01 Patterns 3802 Diseases 3903 Sinusitis 4504 Points 4005 THROAT 4806 Diagnosis 5207 Patterns 5608 Questions 57

Discs 6-9: See Thyroid and Prostate Handouts

Disc 10 Connection 3 Yang Channels & Questions01 Tai Yang, Shao Yang, Yang Ming and bi syndrome 7702 Pathways of Qi 8003 Questions 8204 Q Masses 8205 Questions 82

iii

1

Day 1 VERTEX AND SKULL

GIOVANNI MACIOCIA

D1 T3

CHANNELS (1)

The vertex is the most Yang area of the body where most of the Yang channels converge.

The "Correct Seal of Medical Circles" says:

"The head is like Heaven [being at the top]: the clear Qi of the three Yang channels [Greater Yang, Lesser Yang and Bright Yang] and the six Yang organs as well as the Blood and Essence of the three Yin channels [Greater Yin, Lesser Yin and Terminal Yin] and the five Yin organs, all reach it. It is affected by the six external pathogenic climates as well as by internal pathogenic factors."

CHANNELS (2)

The head is the highest part of the body not only anatomically but also energetically according to the flow of Qi in the 12 channels. It is, in fact, the area of maximum potential of energy in the circulation of Qi in the channels. Qi circulates in the channels because there is a difference of potential between the chest and the head. If we consider the first four channels, for example, we see that Qi starts at the chest area in the Lung channel: this is the area of minimum potential of energy. In order to understand this we can visualize a certain amount of water at the bottom of a hill, where its potential of producing energy is minimal. If we slowly carry this water up the hill, gradually its potential of producing energy will increase, as we know. When the water reaches the top of the hill, its potential of producing (hydroelectric) energy will be maximum.

D1 T4 CHANNELS (3)

The bottom of the hill corresponds to the chest, half-way up the hill corresponds to the hands (or feet) and the top of the hill corresponds to the head. Thus, from the Lung channel in the chest, Qi starts to move upwards towards the head. At the fingertips, Qi changes polarity, i.e. it flows from the Yin Lung channel to the Yang Large Intestine channel, but it is still flowing towards the head and its potential is increasing. When it reaches the head the potential is at its maximum and it then starts decreasing as it flows towards the feet.

2

CHANNELS (4)

At the feet, Qi changes polarity, i.e. it flows from the Yang Stomach channel to the Yin Spleen channel, but its potential is still decreasing as it flows towards the chest area. When it reaches the chest the potential is minimum (the water has reached the bottom of the hill again). The Qi from the Spleen channel then connects internally with the Heart channel and a new 4-channel cycle starts in exactly the same way. The cycle of Qi in the first four channels can be seen in Figure 1.2:

HAND

FEET

CHEST

HEAD

Arm Yin

Arm Yang

Leg Yin

Leg YangLU

LI

ST

SP

MAXIMUM POTENTIAL

ENERGY

MINIMUM POTENTIAL

ENERGY

HAND FEET

CHEST

HEAD

Arm Yin

Arm Yang

Leg Yin

Leg Yang

LU

LI ST

SP

MAXIMUM POTENTIAL

ENERGY

MINIMUM POTENTIAL

ENERGY

AVERAGE POTENTIAL

ENERGY

Hand Foot FootHand FootHand

LU LI LVGBTBPKIBLSIHESPST

Tai Yin Shao Yin Jue Yin

Yang Ming Tai Yang Shao Yang

3

CHANNELS (6)

The implication of all this is that the head is the area of maximum potential of Qi and therefore intrinsically prone to rising of energy (or pathogenic factors) to the top, for example:

the rising of Liver-Yang, Liver-Fire...

Liver-Wind...

...or Heart-Fire.

Conversely, clear Yang Qi failing to rise to the top may lead to the obstruction of the head by Phlegm or Dampness.

CHANNELS (6)

The head is also the area of concentration of Yang energy as all the Yang channels directly meet and join up in the head. In fact, as far the superficial pathways are concerned, only Yang channels reach the head.

For this reason the head is variously called "the confluence of Yang" or "the Palace of Yang" or "the Palace of clear Yang.“(2) Thus, energetically, the vertex area is most prone to too much Yang or the opposite, i.e. clear Yang not rising.

CHANNELS (7)

THREE AREAS IN A NUTSHELL

OCCIPUT: WIND

However, Yin Qi obviously also reaches the head but only internally. Of the Yin channels only the Heart and Liver reach the head internally (deep pathway). All the other Yin channels reach the head indirectly via their divergent channels as each Yin divergent channel merges with its related Yang divergent channelat the neck area. Thus both the clear Yang from the Yang organs and the pure essences from the Yin organs reach the head

THROAT: QI STAGNATION

VERTEX: YANG

D1 T5

YIN DIVERGENT

ZANG

YIN DIVERGENT

YANG MAIN CHANNEL

YANG DIVERGENT

NECK

YANG DIVERGENT

FU

FU

YANG DIVERGENT

YANG MAIN CHANNEL

ZANG

NECK

(HE, LU, KI)

DIVERGENT CHANNELS

YANG MAIN CHANNEL

YIN MAIN CHANNEL

YANG DIVERGENT YIN DIVERGENT

FU

ZANG ZANG

•NECK

•(Only HE, LU, KI)

DIVERGENT CHANNELS

4

LARGE INTESTINE

The Muscle channel of the Large Intestine comes up from the side of the neck to the vertex and cross over to connect with the mandible on the opposite side.

D1 T6

STOMACH

The Stomach Main channel connects with Du-24 Shenting on the head.

The Stomach Divergent channel goes to the head and connects with the eye

BLADDER

The Bladder Main channel flows over the vertex. The Bladder Muscle channel also flows over the top of the head and down to connect with eye.

TRIPLE BURNER

The Triple Burner Main channel flows over the temporal region of the skull.

The Triple Burner Divergent channel separates from the temporal region to go over to the vertex. The Triple Burner Muscle Channel goes over the temporal region.

GALL BLADDER

The Gall Bladder Muscle channel flows from the temporal region to the vertex.

The Gall Bladder Main channel flows over the temporal region twice, once more on the side, once more towards the top.

5

DU MAI

The Du Mai flows over the vertex: a branch enters the brain at Du-16 Fengfu and exits at Du-20 Baihui. The Sea of Marrow is synonymous with the Brain as it is

Marrow that fills up the Brain. Symptoms of deficiency are related to obfuscation of the sense orifices due to their not being nourished by Marrow. As Kidney-Jing is the origin of Marrow, those symptoms are also symptoms of Kidney deficiency (dizziness, tinnitus, blurred vision, weak legs). The Sea of Marrow is related to the Du Mai which flows in the spine and into the Brain: for this reason, the points of the Sea of Marrow (Du-20 Baihui and Du-16 Fengfu) are on the Du Mai.

SEA OF MARROWExcess:Full of vigour, great physical strength.

Deficiency:Dizziness, tinnitus, weak legs, blurred vision, desire to lie down.

Points: DU-20 (upper), DU-16 (lower).

[Addition to original handout]

D1 T7

The Sea of Marrow is synonymous with the Brain as it is Marrow that fills up the Brain. Symptoms of deficiency are related to obfuscation of the sense orifices due to their not being nourished by Marrow. As Kidney-Jing is the origin of Marrow, those symptoms are also symptoms of Kidney deficiency (dizziness, tinnitus, blurred vision, weak legs). The Sea of Marrow is related to the Du Mai which flows in the spine and into the Brain: for this reason, the points of the Sea of Marrow (Du-20 Baihui and Du-16 Fengfu) are on the Du Mai.

SEA OF MARROWExcess:Full of vigour, great physical strength.

Deficiency:Dizziness, tinnitus, weak legs, blurred vision, desire to lie down.

Points: DU-20 (upper), DU-16 (lower).

[Addition to original handout]D1 T8

6

YANG QIAO MAI

Ascends over the face to curve around the side of the head towards the top (Bladder channel) to connect with G.B.-20 Fengchi.

Questions

D2 T1

7

YIN QIAO MAI

Ascends over the face to connect with the eye and then enter the brain.

YANG WEI MAI

Ascends over the side of the neck to connect with the Gall-Bladder channel and flow from G.B.-13 Benshento G.B.-20 Fengchi (and then to Du-15 Yamen and Du-16 Fengfu).

DIAGNOSIS: OBSERVATION

Psoriasis

Psoriasis frequently affects the top of the head, usually in chronic cases when there is Blood deficiency and Dryness with white scales.

D2 T2 DIAGNOSIS: INTERROGATION

Headache

Headache only on the vertex is not that common. The most commoncause is liver-Blood deficiency if it is dull; if it is sharp in nature, it is due to Liver-Yang rising or Liver-Wind.

Itching

Itching in the vertex is due to Wind-Heat in the skin: this may occur with Blood Heat (Shi) or as a consequence of Blood deficiency (Xu).

Dizziness

Shi causes: Liver-Yang rising, Liver-Wind (severe), Phlegm (with muzziness and heaviness).

Xu causes: Liver-Blood deficiency, Kidney deficiency.

Less common causes: Heart and Spleen deficiency or Stomach- and Spleen-Qi deficiency.

FEELING OF DISTENSION OF THE HEAD

Liver-Yang rising

Feeling of distension of the head, headache, dizziness, tinnitus, irritability, Wiry pulse.

Liver-Fire

Feeling of distension of the head, propensity to outbursts of anger, headache, red face, Red tongue with yellow coating, Wiry-Rapid pulse.

FEELING OF COLD OF THE HEAD

This includes an actual feeling of cold of the head but also a propensity to wearing a hat and a strong dislike of wind.

Governing Vessel Empty and Cold

Feeling of cold of the head and back, cold limbs, feeling cold, sore back, weak knees, pale complexion.

Cold in the Liver Channel

Feeling of cold of the head, vertical headache, bluish complexion, cold hands and feet, Deep-Tight pulse.

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FEELING OF HEAT OF THE HEAD

Liver-Fire

Feeling of heat of the head, thirst, mental restlessness, bitter taste, propensity to outbursts of anger, headache, red face, Red tongue with yellow coating, Wiry-Rapid pulse.

Kidney-Yin deficiency with Empty Heat

Feeling of heat of the head especially in the evening, dizziness, tinnitus, sore back, night-sweating, 5-palm heat, Red tongue without coating.

Day 1 – Break 1

FEELING OF HEAVINESS OF THE HEAD

A feeling of heaviness of the head is always caused by Dampness or Phlegm obstructing the head.

Damp-Phlegm

A feeling of heaviness of the head and body, dizziness, blurred vision, somnolence, a feeling of oppression of the chest, nausea, Swollen tongue with sticky coating, Slippery pulse.

Damp-Heat

A feeling of heaviness of the head and body that is worse in the afternoon, a feeling of oppression of the chest, thirst with no desire to drink, dark urine, sticky-yellow tongue coating, Slippery-Rapid pulse.

D2 T3

NUMBNESS OF THE HEAD

Blood deficiencyNumbness of the skin of the head, blurred vision, dizziness, dull complexion, Pale tongue, Choppy or Fine pulse.

Damp-PhlegmNumbness of the skin of the head, a feeling of heaviness of the head, dizziness, a feeling of oppression of the chest, Swollen tongue with sticky coating, Slippery pulse.

Liver-WindUnilateral numbness of the head, giddiness, tremors, headache, Deviated tongue, Wiry pulse.

9

SHAKING HEAD

Liver-WindShaking of the head, dizziness, tremor of the hand, tinnitus, tongue Deviated, Wiry pulse. Other clinical manifestations depend on the background patterns which could be Liver-Yang rising or Liver-Fire.

Empty-Wind from Blood deficiencySlight shaking of the head, slight tremor of the hand, dizziness, poor memory, blurred vision, Pale and Thin tongue, Choppy or Fine pulse.

Empty-Wind from Yin deficiencySlight shaking of the head, slight tremor of the hand, dizziness and tinnitus, feeling of heat in the evening, night-sweating, 5-palm heat, Red tongue without coating.

BRAIN NOISE (1)

"Brain Noise" is similar to the sound of tinnitus in the ears but it is experienced in the centre of the head. The Chinese name for it is nao ting which means "brain tinnitus" and its old name was lei tou feng which means "thunder head wind."

Emptiness of the Sea of MarrowBrain noise like tinnitus, dizziness, deafness, sore back, poor memory, weak knees, difficulty in walking. This is usually, butnot always, accompanied by Kidney-Yin deficiency.

Deficiency of Qi and Blood of the Spleen and HeartBrain noise like tinnitus, dizziness, insomnia, palpitations, poor memory, appetite, loose stools, Pale tongue, Weak pulse.

Phlegm-Heat rising

Brain noise like tinnitus, a feeling of heaviness of the head, headache, dizziness, blurred vision, nausea, a feeling of oppression of the chest, Red-Swollen tongue with sticky-yellow coating, Slippery pulse.

BRAIN NOISE (2)

Liver-Qi stagnation

Brain noise like tinnitus, irritability, hypochondr ialand abdominal distension, Wiry pulse. Stagnant Liver-Qi impairs the ascending and descending of Qi, clear Qi cannot rise, turbid Qi cannot descend so that turbidity accumulates in the head.

Liver-Blood deficiencyPremature greying of the hair, blurred vision, floaters, dull headaches, Pale tongue, Choppy or Fine pulse.

Liver and Kidney deficiencyPremature greying of the hair, balding, dizziness, tinnitus, blurred vision, backache, decreased libido. Other clinical manifestations depend on whether there is Kidney-Yin or Kidney-Yang deficiency.

Kidney-Yin deficiency with Empty-HeatPremature greying of the hair, balding, dizziness, tinnitus, blurred vision, night-sweating, 5-palm heat, decreased libido, Red tongue without coating.

PREMATURE GREYING OF THE HAIR (1)

PREMATURE GREYING OF THE HAIR (2)

Qi and Blood deficiency

Premature greying of the hair, tiredness, loose stools, poor appetite, blurred vision, floaters, dull headaches, Pale tongue, Weak or Choppy pulse.

Liver-Qi stagnation

Premature greying of the hair in patches which may appear in a relatively short time, abdominal distension, irritability, Wiry pulse. This pattern is due to worry, pensiveness or anger causing Qi stagnation which turns into Heat which, in turn, damages Yin.

HAIR FALLING OUT

This refers to hair falling out gradually and uniformly (as opposed to in clumps).

Liver-Blood deficiencyGradual loss of hair, dizziness, numbness, blurred vision, scanty periods, Pale tongue, Choppy or Fine pulse.

Kidney deficiencyGradual loss of hair which may improve during pregnancy, dizziness, tinnitus, backache, tiredness. Other symptoms and signs, including pulse and tongue, depend on whether there is a deficiency of Kidney-Yin or Kidney-Yang.

Liver-FireGradual loss of hair, thirst, bitter taste, constipation, headaches, red face, Red tongue with dry-yellow coating, Wiry-Rapid pulse.

10

ALOPECIA (1)

Alopecia refers to the loss of hair falling out in clumps.

Empty Liver-Wind from Blood deficiency

Sudden loss of hair in clumps, dizziness, numbness, blurred vision, Pale tongue, Choppy or Fine pulse.

Full Liver-Wind

Sudden loss of hair in clumps, dizziness, vertigo, tinnitus, headaches, red face, Stiff tongue, Wiry pulse.

ALOPECIA (2)

Blood Heat from Liver-Fire

Hair falling out in clumps, dry hair, feeling of heat, thirst, bitter taste, Red tongue with redder sides and yellow coating, Wiry-Rapid pulse.

Liver-Blood stasis

Hair falling out in clumps, abdominal pain, hypochondrial pain, tongue with Purple sides, Wiry or Choppy pulse.

DRY AND BRITTLE HAIR (1)

Liver-Blood deficiencyDry hair without lustre, dizziness, numbness and tingling of the limbs, blurred vision, scanty periods, Pale tongue, Choppy or Fine pulse.

Kidney-Yin deficiencyDry hair without lustre, dizziness, tinnitus, backache, night-sweating, feeling of heat in the afternoon, tongue without coating, Floating-Empty pulse.

Qi and Blood deficiencyThin and brittle hair, tiredness, breathlessness, dizziness, blurred vision, loose stools, Pale tongue, Weak or Choppy pulse.

Stomach- and Spleen-Qi deficiency

Thin and brittle hair, tiredness, loose stools, poor appetite, weak limbs, epigastric distension, Pale tongue, Empty pulse.

Loss of blood

Dry and lifeless hair without lustre, dry skin, pale complexion, menorrhagia, Pale and dry tongue, Hollow pulse.

DRY AND BRITTLE HAIR (2)

PATTERNS (1)

Liver-Yang rising

The Liver channel flows to the vertex internally and Liver-Qi frequently rebels upward to cause symptoms in this area: headache, dizziness, brain noise, itching. Liver-Yang rising affects also the Gall-Bladder and Triple Burner channels on the vertex and temporal regions.

Liver-Wind

Headache, vertigo, shaking, brain noise.

Liver-Blood deficiency

Liver-Blood not reaching the head: dull headache, scaly scalp, dandruff, mild dizziness.

Liver-Wind [added]

D2 T4 PATTERNS (2)

Kidney deficiency

Kidney not reaching the head and nourishing the Brain: dull headache, dizziness, brain noise.

Excess of Yang

The vertex is prone to Excess of Yang manifesting with insomnia, agitation, mental illness, psychosis. The Yang Qiao Mai is the main vessel to absorb Excess Yang from the head: this vessel can be used in combination with any other treatment to absorb excess Yang from the head. This manifests on the pulse as a pulse that is Wiry on both cun positions (Yang Qiao Mai pulse).

11

POINT SELECTION: HEADACHES (1)

In the treatment of headaches it is essential to combine local with distal points. The more chronic or intense the headache the more local points are required. Local points are also especially required when a chronic headache appears always in the same spot. This indicates a local stasis of Blood which always calls for the use of local points to disperse it.

Generally speaking, distal points are chosen according to the pattern characterizing the headache and according to the channel involved. The two may not necessarily coincide. For example, a Liver-Yang headache nearly always manifests on the Gall-Bladder channel. We might therefore choose as distal points LIV-3 Taichong according to the pattern and G.B.-43 Xiaxi according to the channel.

D2 T5


Local points are mostly chosen according to the channel involved. For example, for headaches on the Gall-Bladder channel, one might choose G.B.-6 Xuanli as local point. Some local points may be chosen according to the location of the headache irrespective of the pattern. For example:

• Frontal headache: Du-23 Shangxing and G.B.-14 Yangbai.

• Headache on vertex: Du-20 Baihui and Du-21 Qianding.

• Occipital headache: BL-10 Tianzhu, Du-19 Houding.

• Temporal headache: G.B.-8 Shuaihu and Taiyang.

D2 T6

12


However, local points may also be chosen according to the pattern. In the example above, if the headache on the Gall-Bladder channel is caused by Liver-Yang rising, in addition to points on the Gall-Bladder channel, we might also use Du-20 Baihui as the internal pathway of the Liver channel reaches up to that point.

D2 T7 HERBS: HEADACHES

The same principles apply to herbal therapy. The "local" herbs, i.e. those that specifically affect the head, are chosen according to the channel involved (but to a certain extent also according to the pattern) and the "distal" herbs, i.e. those that treat the condition causing the headaches, are chosen according to the pattern. For example, in frontal headaches from Liver-Qi stagnation and Spleen deficiency, Bai Zhi Radix Angelicaedahuricae can be selected as a "local" herb to affect the forehead, while the Xiao Yao San Free and Easy Wanderer Powder could be selected as the main prescription to deal with the pattern causing the headaches, i.e. stagnation of Liver-Qi.

POINTS

• Du-20 Baihui

• Du-21 Qianding

• Du-19 Houding

• Du-23 Shangxing

• Du-24 Shenting

• BL-7 Tongtian

• BL-8 Luoque

• G.B.-17 Zhengying

• G.B.-18 Chengling

• G.B.-15 Toulinqi

• ST-8 Touwei

POINTS: DU-20 (1)

Hundred Meetings

Location: At the vertex, on the midline, in the depression 5 cun posterior to the anterior hairline and 7 cun superior to the posterior hairline.

Name: at the top of the body on the vertex, point of conjunction of all Yang energies, many Yang channels and the Liver channel internally. Also refers to the ability of this point to treat “100 diseases.”

Intersections: Bladder

POINTS: DU-20 (2)

Energetics: Point of the Sea of Marrow, it can nourish Sea of Marrow (Action 1); it can tonify and raise Yang (especially withmoxa cones) (Action 2); it pacifies Wind and subdues Yang (Action 3); benefits the sense organs (Action 4). Thus, this point has a dual action: it can raise Qi and Yang or do the opposite i.e. subdue rebellious Yang.

Actions

•Action 1: dizziness, brain noise, tinnitus, poor memory

•Action 2: prolapse of rectum, vagina, bladder, uterus, incontinence of urine

•Action 3: headache, wind-stroke, opisthotonos, tetany, epilepsy

•Action 4: nasal obstruction, nasal discharge, nosebleed, blurred vision.

POINTS: DU-20 (3)

Combinations

• Du-22 Xinhui: somnolence

• P-5 Jianshi, KI-7 Fuliu, KI-10 Yingu, ST-36 Zusanli: mania

• G.B.-43 Xiaxi, Du-23 Shangxing, Du-21 Qianding, S.I.-5 Yanggu, L.I.-4 Hegu, T.B.-1 Guanchong and BL-60 Kunlun: headache

• Du-19 Houding and L.I.-4 Hegu: pain of the head and occiput.

• First needle Du-20, then LIV-3 Taichong, KI-6 Zhaohai, SP-6 Sanyinjiao: acute throat pain.

13

POINTS: DU-20 (4)

• S.I.-19 Tinggong, G.B.-2 Tinghui, T.B.-21 Ermen, BL-8 Luoque, L.I.-5 Yangxi,, S.I.-2 Qingu, S.I.-3 Houxi, S.I.-4 Wangu, T.B.-3 Zhongzhu, T.B.-2 Yemen, L.I.-1 shangyang, BL-23 Shenshu: tinnitus.

• Du-23 Shangxing, Du-22 Xinhui, BL-6 Chengguang: nasal obstruction, anosmia.

• Du-1 Changqiang, BL-25 Dachangshu: prolapse of rectum.

• First moxa Du-20 Baihui, and then Ren-15 Jiuwei: prolapse of rectum.

• BL-25 Dachangshu, Du-1 Changqiang, G.B.-21 Jianjing, L.I.-4 Hegu, ST-30 Qichong: prolapse of rectum.

• Erbai, BL-52 Zhishi, Du-1 Changqiang: prolapse of rectum and haemorrhoids.

POINTS: DU-21 (1)

Du-21 Qianding In front of the crown

Location: At the top of the head on the midline, 1.5 cun directly anterior to Du-20 and 3.4 cun posterior to the anterior hairline.

Name: refers to the location of the point in front of the uppermost point of the skull.

Energetics: it is used mostly in Excess conditions. It extinguishes internal Wind (Action 1); it benefits the sense organs and expels external Wind (Action 2).

D2 T8

POINTS: DU-21 (2)

Actions

•Action 1: vertigo, epilepsy, clonic spasm

• Action 2: swelling of the vertex, oedema of face, invasions of Wind, runny nasal discharge.

Combinations

• Du-19 Houding, G.B.-4 Hanyan: dizziness and headache

• Du-24 Shenting: aphasia after Wind-stroke

Du-19 Houding Behind the crown

Location: At the back of the head on the midline,1.5 cun directly superior to Du-18 Qiangjian and 1.5 cun posterior to Du-20 Baihui.

Name: refers to the location of the point behind the uppermost point of the skull.

Energetics: it is used mostly in Excess conditions. It differs from Du-21 in so far as it is more for calming the Mind in Full conditions and not so much for internal Wind. It calms the Mind in Full conditions (Action 1); it extinguishes internal Wind (Action 2); it expels external Wind (Action 3).

POINTS: DU-19 (1)

POINTS: DU-19 (2)

Actions

•Action 1: mad walking, insomnia, mania

•Action 2: vertigo, headaches

•Action 3: invasions of Wind, aversion to cold, sweating

Combinations

•G.B.-4 Hanyan, Du-21 Qianting: dizziness and headache

•Du-20 Baihui and L.I.-4 Hegu: pain in the head and occiput

•HE-5 Tongli and Du-20 Baihui: pain in the head and eyes

14

POINTS: DU-23 (1)

Du-23 Shangxing Upper Star

Location: At the top of the head on the midline, 1 cun posterior to the anterior hairline and 0.5 cun posterior to Du-24 Shenting.

Name: Astar@ refers to the nose because it takes in air from Heaven (where the stars are).

Intersections: Sun Si Miao one of 13 Ghosts points.

Energetics: this point has a downward movement. It clears the nose (Action 1); if benefits the eyes (Action 2); it expels Wind(Action 3). Strangely enough, it has very few mental indications.

CombinationsPOINTS: DU-23 (2)

• Du-20 Baihui, Du-22 Xinhui, BL-6 Chengguang: nasal obstruction and anosmia.

• L.I.-20 Yingxiang, BL-5 wuchu, L.I.-19 Kouheliao: same as above

• BL-7 Tongtian: nasal obstruction and discharge

• ST-44 Neiting: eye pain

• G.B.-20 Fengchi, Du-17 Naohu, BL-9 Yuzhen, Du-16 Fengfu: pain in the eye with inability to see

•Du-24 Shenting, Du-22 Xinhui: dizziness

• G.B.-20 Fengchi, BL-10 Tianzhu: dizziness

• Du-20 Baihui, G.B.-43 Xiaxi, Du-21 Qianding, S.I.-5 Yanggu, L.I.-4 Hegu, T.B.-1 Guanchong, BL-60 Kunlun: headache

POINTS: DU-24 (1)

Du-24 Shenting Spirit Courtyard

Location: At the top of the head on the midline, 0.5 cun posterior to the anterior hairline and 0.5 cun anterior to Du-23 Shangxing.

D2 T9

D3 T1

15

Name: the names refers to the strong influence of this point on the Mind and Spirit. The courtyard was traditionally considered to be a very important part of the house as it was the one that gave the first impression to visitors; it is the entrance. Thus, this point could be said to be the Aentrance@ to the Mind and Spirit and its being a courtyard, highlights its importance.

Intersections: Bladder and Stomach channels.

Energetics: the most important aspect of this point’s energetics is its downward movement: it makes Qi descend and subdues rebellious Yang. It has a profound influence on the Mind and Spirit, both calming and stimulating (Action 1); like most Du Mai points, it extinguishes internal Wind (Action 2); like the point Du-23 nearby, it affects the nose (Action 3); it clears the eyes (Action 4).

D3 T2

POINTS: DU-24 (2)

Actions:

•Action 1: manic-depression, depression, anxiety, poor memory, insomnia

•Action 2: opisthotonos, epilepsy, dizziness, vertigo

•Action 3: clear nasal discharge (allergic rhinitis), nasal congestion, nose bleed

• Action 4: lachrymation, blurred vision.

POINTS: DU-24 (3)

Combinations

• Du-21 Qianding: aphasia after Wind-stroke

• Du-20 Baihui, Du-21 Qianding, Du-23 Shangxing, T.B.-23 Sizhukong, G.B.-20 Fengchi, L.I.-4 Hegu, BL-2 Zanzhu, ST-8 Touwei: headache

• Du-23 Shangxing and Du-22 Xinhui: headache and dizziness

• Du-23 Shangxing, KI-1 Yongquan, BL-45 Yixi, LU-10 Yuji, SP-2 Dadu: dizziness.

• BL-12 Fengmen, L.I.-4 Hegu, BL-2 Zanzhu, L.I.-20 Yingxiang, BL-67 Zhiyin, KI-20 Futonggu: clear nasal discharge

•LIV-2 Xingjian: lachrymation

16

POINTS: BL-7 (1)

BL-7 Tongtian Penetrating Heaven

Location: 1.5 cun posterior to BL-6 Chengguang, 1.5 cun lateral to the midline. (It is 1 cun anterior and 1.5 cun lateral to Du-20 Baihui).

Name: this point opens the nose and keeps it free. The nose absorbs Qi from Heaven, hence the name. Another explanation is simply that AHeaven@ refers to the top of the head which the most Yang part of the body.

Energetics: this point has a downward movement. Its main sphere of action is in clearing the nose (Action 1) and expelling internal Wind or subduing Yang (Action 2)

D3 T3 POINTS: BL-7 (2)Actions

• Action 1: nasal congestion and discharge, anosmia, nose bleed

• Action 2: headache, dizziness, deviation of mouth, sudden collapse, unconsciousness.

Combinations

• G.B.-15 Toulinqi: nasal congestion

• Du-23 Shangxing: nasal obstruction and discharge

• Du-15 Yamen and BL-59 Fuyang: heaviness of the head

• G.B.-19 Naokong and Du-17 Naohu: pain and heaviness of the head

POINTS: BL-8 (1)

BL-8 Luoque Retreating Connecting Channel

Location: 1.5 cun posterior to BL-7 Tongtian and 5.5 cun within the anterior hairline. (1.5 cun lateral and 0.5 cun posterior to Du-20 Baihui).

Name: the Bladder channel has a connection (Luo) with the Brain from this point; on the other hand, the main channel moves from the vertex downwards and also backwards (que) towards the occiput.

Energetics: this point has a downward movement. Its main sphere of action is in clearing the nose and eyes (Action 1); expellinginternal Wind or subduing Yang (Action 2); and calming the Mind (Action 3)

Actions

POINTS: BL-8 (2)

• Action 1: nasal congestion, blurred vision

• Action 2: headache, dizziness, deviation of mouth, epilepsy

• Action 3: manic-depression, disorientation

Combinations

• S.I.-19 Tinggong, G.B.-2 Tinghui, T.B.-21 Ermen, Du-20 Baihui, L.I.-5 Yangxi, S.I.-2 Qiangu, S.I.-3 Houxi, S.I.-4 Wangu, T.B.-3 Zhongzhu, T.B.-2 Yemen, L.I.-1 Shangyang, BL-23 Shenshu.

POINTS: GB-15 (1)

G.B.-15 Toulinqi [Head] Governing Tears

Location: On the forehead, directly above G.B.-14 Yangbai, 0.5 cun within the hairline, midway between Du-24 Shenting and ST-8 Touwei.

Name: the name refers to the influence of this point on the eyes. It is pre-fixed by “head” to distinguish it from G.B.-41 Zulinqi on the foot.

Intersections: Bladder and Yang Wei Mai.

Energetics: this point subdues rebellious Qi and has a descending movement. It calms the Mind and settles the Ethereal Soul (Action 1); it benefits the eyes (Action 2), extinguishes Wind (Action 3)

POINTS: GB-15 (2)

Actions

• Action 1: anxiety, insomnia, excessive dreaming, emotional fluctuation, obsessive thoughts.

• Action 2: redness and pain of the eyes, lachrymation on exposure to wind, pain on the outer corner of the eye.

• Action 3: headache, dizziness, epilepsy, Wind-stroke.

17

POINTS: GB-15 (3)

Combinations

• ST-8 Touwei, BL-1 Jingming, G.B.-20 Fengchi: lachrymation on exposure to wind

• ST-8 Touwei: lachrymation

• T.B.-3 Zhongzhu: dizziness

• LIV-3 Taichong, L.I.-4 Hegu: red eyes

• Du-20 Baihui, P-8 Laogong, KI-1 Yongquan, Du-25 Suliao: emotionally up and down.

POINTS: GB-17 (1)

G.B.-17 Zhengying Correct Nutrition (Correct Nutritive Qi)

Location: In the parietal region, on a curved line drawn between G.B.-15 Toulinqi and G.B.-20 Fengchi, following the contour of the cranium, 1.5. cun posterior to G.B.-16 Muchuang.

Name: “correct” here indicates the location of the point at the top of the head, while “nutrition” refers to Nutriti ve-Qi and the ability of this point to influence Nutritive Qi.

Intersections: Yang Wei Mai

(G.B.-15 is 0.5 cun within the hairline, in line with the pupils of the eye, G.B.-15, G.B.-16G.B.-17 and G.B.-18 are 1.5 cun from each other).

POINTS: GB-17 (2)

Energetics: this point has primarily a “lifting” act ion similar to Du-20 Baihui. However, similarly to Du-20 Baihui, it can also subdue rebellious Qi. It lifts the Mind and Spirit, calms and clears the Mind. It stimulates memory and concentration. It isindicated in depression. (Action 1); it subdues Liver-Yang (Action 2)

Actions

•Action 1: Poor memory, poor concentration, depression

• Action 2: headache, dizziness

Combinations

• P-5 Jianshi, Yintang, ST-40 Fenglong: difficulty in concentration.

POINTS: GB-18 (1)

G.B.-18 ChenglingSupporting the Spirit

Location: In the parietal region, on a curved line drawn between G.B.-15 Toulinqi and G.B.-20 Fengchi, following the contour of the cranium, 1.5. cun posterior to G.B.-17 Zhengying. (G.B.-15 is 0.5 cun within the hairline, in line with the pupils of the eye, G.B.-15, G.B.-16, G.B.-17 and G.B.-18 are 1.5 cun from each other).

Name: its name clearly refers to its deep action on the Mind and Spirit. It should be noted here that the word translated as “Spirit” is not “Shen” but “Ling”. “Ling” indicat es any supernatural power or spiritual phenomenon, apart from indicating the soul or spirit. Its old character is composed of rain, three mouths, and the character for wu, i.e. shaman (itself composed of work and two people). It therefore derives from the shouting action of a shaman to bring on rain, and by extension it could therefore be translated as “supernatural or transcendent power.” If this is so, then this point “supports the Spirit” in the sense of stimulating spiritual, or supernatural, powers.

POINTS: GB-18 (2)

Intersections: Yang Wei Mai.

18

POINTS: GB-18 (3)

Energetics: this point has a calming and descending action. It settles the Ethereal Soul and Corporeal Soul and stops obsessive thoughts (Action 1); on a physical level, it stimulates the dispersing and descending of Lung-Qi and opens the nose (Action 2).

Actions

• Action 1: obsessive thoughts, insomnia, mania.

• Action 2: nasal discharge, nose bleed, nasal congestion, breathlessness, cough.

Combination

• Du-20 Baihui, HE-7 Shenmen, KI-3 Taixi: poor memory.

POINTS: ST-8 (1)

ST-8 Touwei Head’s Safeguard

Location: at the corner of the forehead, 4.5 cun lateral to Du-24 Shenting, 0.5 cun within the hairline.

Name: the name refers to the important action of this point on head diseases and particularly Phlegm. Hence it safeguards the head from pathogenic factors.

Intersections: Gall-Bladder, Yang Wei Mai

POINTS: ST-8 (2)

Actions

• Action 2: headache, dizziness

• Action 1: headache from external Wind

• Action 3: decreased vision, eye pain, lachrymation on exposure to wind, twitching of eyelids

• Action 4: dull headaches from Phlegm, feeling of heaviness and muzziness of the head, blurred vision.

Energetics: this point makes Qi descend. It is an important point to expel Wind (Action 1); it extinguishes internal Wind and subdues Yang, important for headaches as it links Stomach, Gall-Bladder and Yang Wei Mai channels (Action 2); it benefits the eyes (Action 3); it resolves Phlegm from thehead (Action 4).

POINTS: ST-8 (2)

Combinations

• BL-2 Zanzhu: headache with eye pain

• Du-20 Baihui, Du-21 Qianding, Du-23 Shangxing, Du-24 Shenting, T.B.-23 Sizhukong, G.B.-20 Fengchi, L.I.-4 Hegu, BL-2 Zanzhu.

• BL-1 Jingming, G.B.-20 Fengchi, G.B.-15 Toulinqi.

END NOTES

(1) Wu Zhan Ren-Yu Zhi Gao 1987 Correct Seal of Medical Circles (Yi Lin Zheng Yin), Jiangsu Science Publishing House, Nanjing. Written by Ma Zhao Sheng and first published in 1605.

1979 The Yellow Emperor's Classic of Internal Medicine-Simple Questions (Huang Di Nei Jing Su Wen), People's Health Publishing House, Beijing, first published ca. 100 BC., p. 98, chapter 17

19

D3 T4 / D3 T5

Day 1 – Break 2, Lunch

OCCIPUT AND NECK

Giovanni Maciocia

D3 T6 D3 T7

ANATOMY (1)

Splenius capitis is a broad, strap-like muscle located in the back of the neck. It connects the base of the skull to the vertebrae in the neck and upper thorax.

One acting singly causes the head to rotate and bend toward one side; together, these muscles bring the head into an upright position. BL-10 Tianzhu lies between this muscle and the trapezius.

Trapezius is a flat, triangular muscle that covers the back of the neck, shoulders and thorax. The upper and lower fibres are important to the orientation of the scapula.

The upper part, acting alone, elevates the shoulder and braces the shoulder girdle when a weight is carried. The lower part draws the scapula downward. When both these muscles act together, the scapula can be brought toward the body and the head can draw directly backward.

ANATOMY (2)

20

CHANNELS (1) - Main channels

-Bladder channel

-Small Intestine channel

Hence, the occiputis very much a “Tai Yang area”

The pathway of the Du Mai is quite complex and there is contradiction between the “Simple Questions” and chapter 16 of the “Spiritual Axis” which considers the Du channel as a continuation of the Liver channel flowing down the spine.

Du Mai

In this chapter the Spiritual Axis describes the pathway of the 14 channels as a continuum, i.e. Lungs, Large Intestine, Stomach, Spleen, Heart, Small Intestine, Bladder, Kidneys, Pericardium, Triple Burner, Gall-Bladder, Liver, Du Mai and Ren Mai.

CHANNELS (2)

When the “Spiritual Axis” describes the pathway of the Liver it says:

“..travels upwards from the big toe to the liver, from here moves upwards to the lung, then throat, maxilla, nose and onward to the top of the head, then moves downwards along the midline of the neck, down the spinal column and the sacrum: this is the Governing Vessel. It then links with the genital region, passing through the pubic hair, etc…”.

CHANNELS (3)

Dr Van Nghi postulates that this is not in contradiction with the upward pathway of the Du Mai as he says that one concerns the Ying Qi (upward) and the other the Wei Qi (downward).

Ying Qi

Wei Qi

CHANNELS (3)

MUSCLE CHANNELS - CONNECTIONS


Small Intestine

Stomach

Kidney

Heart

Liver

Triple Burner

Gall-Bladder

Lung

Small Intestine

Spleen

Large Intestine

Pericardium

Bladder

Bladder

Large Intestine

Stomach

Triple Burner

Gall-Bladder

Lungs

Spleen

Heart

Kidneys

Pericardium

Liver



21

[Addition to original handout] [Addition to original handout]

ENERGETIC ANATOMY (1)The neck is made of two parts, the occiput and the throat. The occiput carries and supports the head: it is both a hinge and a pillar (see BL-10’s name). It is dominated by Yang and, in fact, it is responsible for the motility (Yang) of the head. The occiput also follows the sense of balance as it constantly adjusts the position of the head in space: it therefore permits the communication between head and Heaven (Yang). Thus, the occiput is a hinge (of Yang Qi) and the throat is a passage of Qi of practically all channels bar one on their way to or from the head. As such it is very prone to stagnation.

D3 T8The neck is a very important area of exchange of Yin and Yang on their way up to the head or down from it. All the Divergent channels reach the neck and the Yang Divergent channels meet their respective Yang Main channel in the neck while Yin Divergent channels flow into their paired Yang Divergent channel in the neck (obviously eventually merging into the Yang Main channel).

BL-10

G.B.-1

ST-9

BL-1

T.B.-16

L.I.-18

ST-1

It is an important function of the Divergent channels to regulate the balance of Yin and Yang, particularly in the neck and head: it is through the Divergent channels that the Yin channels reach the neck and head (of the Yin channels only the Heart and Liver deeppathways reach the head, interestingly Shen and Hun).

ENERGETIC ANATOMY (2)

YANG DIVERGENT

FU

FU

YANG DIVERGENT

YANG MAIN CHANNEL

ZANG

NECK

Generally, the pathway of the Yang Divergent channels follows this pattern:

they separate from their Yang Main channel

they enter the Yang organ to which they are connected and often (though not in all cases) the related Yin organ

they emerge at the neck and join their Main channel.

YIN DIVERGENT

ZANG

YIN DIVERGENT

YANG MAIN CHANNEL

YANG DIVERGENT

NECK

(HE, LU, KI)

Yin Divergent channels:•separate from their respective Yin Main channel•some connect with their respective Zang organ (Heart, Lung and Kidneys)•join the related Yang Divergent channel (e.g. KI-Divergent to BL-Divergent)•then join the related Yang Main channel on the neck

22

YANG MAIN CHANNEL

YIN MAIN CHANNEL

YANG DIVERGENT YIN DIVERGENT

FU

ZANG ZANG

•NECK

•(Only HE, LU, KI)

DIVERGENT CHANNELS

The exchange of Yin and Yang between Divergent channels in the neck takes place mostly through the Windows of Heaven points and this is an important aspect of their function. However, not all Divergent channels go through Windows of Heaven points. Interestingly, the Yin Divergent channels connect with Yang Windows of Heaven points, while the Yang Divergent channels meet with Yang Windows of Heaven points. This is a further way in which the balance and up-down movement of Yin and Yang Qi in the neck between trunk and head is regulated by both the Divergent channels and the Windows of Heaven points.


DIVERGENT WINDOWS OF HEAVEN

Lung L.I.-18

Large Intestine L.I.-18

Stomach ST-9

Spleen ST-9

Bladder BL-10

Kidneys BL-10

Pericardium T.B.-16

Triple Burner T.B.-16.

Hence, as mentioned before in a nutshell:


OCCIPUT = WIND and YANG

THROAT = QI STAGNATION

DIAGNOSIS: OBSERVATION

Eczema back of neckMany patients suffer from eczema or psoriasis on the occiput and back of neck.

Location of a skin lesion in this area indicates first of all the prevalence of Wind and secondly the prevalence of Heat, as this is Yang area.

Rigidity of the neckRigidity of the neck may indicate Liver-Qi stagnation, Liver-Yang rising or Liver-Wind.

It also indicates stagnation of Yang Qi in the region of occiput and back of neck.

Raised shouldersRaised shoulders indicate that the patient suffers from asthma. In the absence of asthma, they indicate severe emotional tension with Liver-Qi stagnation.

D3 T9

23

DIAGNOSIS: PALPATION

Palpation of the neck area very often reveals a very hard muscle: this indicates Liver-Qi stagnation or Liver -Yang rising. In some cases, it may also be due to Blood stasis, in which case it would be very hard and also very painful.

LIVER-YANG RISING

Liver-Yang rising frequently affects this area by causing stiff neck, neck-ache, dizziness and headaches. In chronic cases of stiff neck and neck-ache, Liver-Yang is a frequent cause: other symptoms will include dizziness, red sides of the tongue and a Wiry pulse. These headaches and neck-ache are usually due to emotional stress.

DIAGNOSIS: PATTERNS (1)

CLINICAL NOTE: Liver-Yang rising does not derive al ways from anger. Worry can make Liver-Yang rise.

D3 T10

INVASION OF EXTERNAL WIND


Invasion of external Wind, and especially Wind-Cold, cause a stiff neck and an occipital headache. In fact, this is one of the three cardinal symptoms of invasion of Wind-Cold in the Shang Han Lun. Wind-cold affects this area because it invades the most superficial channels first which are the Tai Yang channels: in fact, as we know, Tai Yang opens onto the Exterior and is the most superficial of the Yang channels and performs a protective function. For this reason, these channels are the first to be invaded. They are also the first to be invaded because the Wei Qi is Yang in nature and therefore performs its function particularly on the most Yang surface of the body, i.e. the back of the neck and upper back (most Yang because it is on the upper part of the body and the most Yang/superficial channels).

Tai Yang

Yang Ming

Shao Yang

EXT

INT

HINGE

KIDNEY DEFICIENCY

Kidney deficiency may cause dull, chronic headaches on the occiputthrough the Bladder channel: the headaches occur on the Bladder channel but the root is in the Kidney deficiency. These headaches are usually due to overwork or excessive sexual activity.

DIAGNOSIS: PATTERNS (3)INVASION OF COLD AND DAMPNESS

Cold and Dampness can invade the channels of this are directly without causing the exterior symptoms seen in invasion of exterior Wind. When Cold and Dampness invade the channels of this area they give rise to a pattern of Bi syndrome.


Cold contracts and the main symptom is rigidity of the neck with inability to turn the head and pronounced neck pain which is aggravated in cold weather and alleviated in hot weather and the application of heat.

Dampness may also invade the muscles of the neck, usually in combination with Cold and it causes a dull neck ache and an occipital headache with a pronounced feeling of heaviness of the head.

24


INTERNAL WIND

Liver-Wind frequently affects this area in the elderly causing vertigo, rigidity of the neck and neck ache.

LIVER-QI STAGNATIONLiver-Qi stagnation frequently affects the muscles of the neck and occiput. Stagnant Liver-Qi fails to nourish the sinews and this causes stiffness and local pain. The cause of this problem is usually emotional strain (anger, worry, guilt).


With this pattern the muscles of the neck feel tighter and harder than in Liver-Yang rising: a person suffering from

Liver-Qi stagnation will tend to suppress his or her anger more than a person

suffering from Liver-Yang rising and the anger is accumulated and stored in the neck muscles which become very tight

and painful on pressure.

DISEASES: BI SYNDROME OCCIPUT (1)

BI SYNDROME OCCIPUT

Bi syndrome of the occiput is very common and, in its beginning stages, is nearly always due to the invasion of Wind and Cold in the muscles of this area. Wind naturally invades the top part of the body and for this reason this area is frequently affected. Wind will manifest with rigidity of the neck and wandering pain while Cold will manifest with a spasm of the neck and upper back muscles and intense pain.

DISEASES: BI SYNDROME OCCIPUT (2)

Distal points:

SI-3 Houxi, T.B.-5 Waiguan, S.I.-1 Shaoze, G.B.-39 Xuanzhong, Juegu, BL-60 Kunlun.

Local points:

G.B.-20 Fengchi, BL-10 Tianzhu, Du-14 Dazhui, Du-16 Fengfu, G.B.-21 Jiangjing, S.I.-11 Tianzong. Moxa is applicable.

CLINICAL NOTE : check all SI points from SI-9 to SI- 15.

DISEASES: NECK AND TOP OF SHOULDERS (1)

Pain in the neck and shoulders is an extremely common complaint in Western patients. The neck is a crucial part of the body which readily reflects the state of tension and stresstypical of the rushed life-style of industrialized countries which causes tensing of the neck muscles and pulling of the head backwards. One only needs to observe the effortless and graceful way in which a toddler bends down to pick up something from the floor to realize the importance of the proper use of the neck.

A toddler will bend from his or her knees and straighten up, all the time keeping the neck free and the head forward. Most adults would instinctively pull the head backwards and tighten the neck as they get up from a sitting position.


The situation is of course aggravated further for those who, in their work, have to keep their head fixed in a position of intense concentration for long periods of time. For example, typists, VDU operators, draughtsmen, assemblers of electronic components, and generally workers in many different types of factories using a production line.

25


AETIOLOGY

In discussing neck pain it is useful to distinguish acute from chronic cases.

Acute neckache is due either to invasion of Wind-Cold or to sprain. The symptoms are similar in both cases: neck ache with sudden onset, rigidity or stiffness and a limitation of movement in turning the neck from side to side. An underlying Liver pattern (either Liver-Bl ood deficiency, Liver-Yang rising or Liver-Qi stagnation) is a predisposing factor for this condition. If acute neck ache is due to exposure to climatic factors, it is invariably due to Wind because this attacks the top part of the body and causes stiffness and rigidity.

DISEASES: NECK AND TOP OF SHOLDERS (4)

Chronic neckache develops as a consequence of repeated acute attacks which are not treated properly. In chronic cases, an underlying Liver pattern is almost always present. In women it is most likely to be Liver-Blood deficiency, in men it is most likely to be Liver-Qi stagnation or Liver-Yang rising, and in the elderly it is more likely to be Liver-Fire or Liver-Wind.

Acute flare-ups of a chronic neckache are often typically elicited by exposure to wind. It is not unusual to hear patients say that they always get a neck ache during spells of windy weather, and some even say that an East wind will cause it.


TREATMENT

There are three main differences between the treatment of acute or chronic neck ache:

1) in acute cases the needles are manipulated more vigorously, i.e. with a reducing method

2) in acute cases, distal points play a more important role than in chronic cases

3) in chronic cases, it is always necessary to treat any underlying condition that might be contributing to the neck ache.


In acute cases the distal points play a primary role and they are needled with reducing method. The main distal points to use are:

-S.I.-3 Houxi is the main distal point to use when the pain is on the occiput and back of the neck, along the Bladder channel. This point expels Wind and treats the upper part of the Greater Yang channels and is especially used in acute cases.

-T.B.-5 Waiguan is the distal point to use when the pain is on the side of the neck and it can be used unilaterally on the affected side only.

-G.B.-39 Xuanzhong is very effective as a distal point when the pain is on both sides of the neck and the movement of the neck from side to side is restricted. This point should be reduced while the patient slowly moves the neck from side to side. It is very effective in freeing the neck.

D3 T11


The main local points to use are:

-BL-10 Tianzhu if the pain is on the occiput and is bilateral.

-G.B.-20 Fengchi if the pain is at the base of the neck extending to the top of the shoulders. It is especially indicated if the pain is due to Wind.

-Du-16 Fengfu is indicated if the pain is due to Wind.

-G.B.-21 Jianjing is a useful local point to use as neck ache is often associated with (or stems from) muscle tension in the top of the shoulders (trapezius muscle).

Any local point tender on pressure can also be used, and warming the affected area along a channel with a moxa stick is very effective.

26


Chronic

The main distal points to use in chronic cases are:

-BL-60 Kunlun is the main distal point for chronic neck ache. It treats not only the neck, but also the top of the shoulders and the upper back. It is particularly indicated, of course, if the pain is along the Greater-Yang channels.

-T.B.-5 Waiguan is used if the pain is unilateral on the side of the neck.

-T.B.-8 Sanyangluo is used if the area of pain involves two or three of the Yang channels of the arm.


-P-6 Neiguan is effective in women. It treats the neck by virtue of it being the Connecting point and therefore affecting the Triple Burner channel. It is particularly effective when the neck ache is associated with general nervous tension which causes the neck muscles to tense up.

-KI-4 Dazhong can be used as a distal point by virtue of it being the Connecting point and therefore in relation with the Bladder channel. It is especially useful when the neck ache is associated with a Kidney-deficiency.

-ST-40 Fenglong is the Connecting point and can be used for neck ache as a branch of the Stomach Connecting channel separates in the neck and flows to the throat.

Time

= Yin

= Empty Heat

Tongue without coating Red tongue without coating

YIN XU VS EMPTY HEATD4 T1


•Tiredness

• Dry mouth

• Night sweating

• Floating-Empty pulse

• Tongue without coating

• Feeling of heat in the evening•Malar flush•Very dry mouth with desire to drink in small sips, dry throat at night•5 palm heat•Floating-Empty and Rapid pulse• Red tongue without coating

YIN XU VS EMPTY HEATYIN XU EMPTY HEAT


YIN XU YIN XU WITH EMPTY HEAT


27


The local points to use are obviously the same as for acute cases. The main difference is that it is often necessary to use points further down the upper back such as S.I.-9 Jianzhen, S.I.-10 Naoshu, S.I.-11 Tianzong, S.I.-12 Bingfeng, S.I.-13 Quyuan, S.I.-14 Jianwaishu, S.I.-15 Jianzhongshu and T.B.-15 Tianliao. These points should always be checked for tenderness and needled if they are tender. Of the above points, S.I.-11, S.I.-13 and T.B.-15 are the ones that are most frequently tender. Warming needle or cupping are very effective in removing pain and relaxing the muscles.

D4 T2

POINTS: BL-10 (1)

BL-10 Tianzhu Heavenly Pillar

Location: 1.3 cun lateral to Du-15 on the lateral aspect of the trapezius muscles.

Name: “Heavenly” refers to the fact that this point is on the top of the body and also on a very Yang part of the body. Thus, “heavenly” indicates also its nature. “Pillar” refers to this point being like a pillar holding up the head: the pillar is also the Bladder channel which is the most Yang of the Yang channels (Greater Yang) and therefore “strong” as a pillar. The “pillar” are the two branches of the trapezius muscles or the neck itself, or the cervical spine which in ancient times was called Tian Zhu Gu, i.e. the bone of Heavenly Pillar. Finally, Tian Zhu is also the name of a star in the constellation of Draco.

D4 T3 POINTS: BL-10 (2)

Intersections and nature: Window of Heaven point.

Energetics: Small Intestine and Bladder pertain to Greater Yang which opens onto the Exterior: of the three Yang, it is the most Yang; in addition, the area on the top of the body, like the occiput, is even more Yang in relation, for example, to the inferior part of the Bladder channel. This has two main implications. On the one hand, it means that the points in this area are Yang in nature and cantherefore be used either to tonify Yang (action 1) or also to expel Yang pathogenic factors such as Wind (action 2). On the other hand, being Yang and being at the top of the body, this area suffers from rebellious Qi flowing up and points in this area can be used to subdue rebellious Qi (action 3). Being Yang in nature due to its channel polarity and position, it treats excess of Yang causing mental problems (action 4). Being situated on the hinge of the occiput and being like a gate of Yang Qi, this point re-establishes the balance in the flow of Yang to and from the head and when there is excess Yang above and deficient Yang below (action 5).

POINTS: BL-10 (3)

Indications

• Indication 1: inability to support the body

• Indication 2: Head Wind, epilepsy, febrile disease, stiffness of the neck

• Indication 3: dizziness, headache, stiff neck

• Indication 4: incessant talking, seeing ghosts

• Indication 5: soft legs, weak legs which cannotsustain the body.

28

POINTS: BL-10 (4)

Combinations

• Febrile disease without sweat: G.B.-20 Fengchi, L.I.-1 Shangyang, T.B.-5 Waiguan, Du-15 Yamen (Jia Yi Jing)

• Headache: Du-13 Taodao, BL-11 Dashu, LU-6 Kongzui, S.I.-3 Houxi (Qian Jin Yao Fang)

• Dizziness: Du-23 Shangxing, G.B.-20 Fengchi (Zhen Jiu Ju Ying, 1529).

POINTS: GB-20 (1)

G.B.-20 Fengchi Wind Pool

Location: below the occiputapproximately half-way between Du-16 and G.B.-12, in the hollow between the origins of the sternocleidomastoidand trapezius muscles.

Characteristics: point of both the Yang Qiao Mai and Yang Wei Mai.Name: “Pool” refers to the hollow where the point is situated that resembles a pool; it also refers to the fact the external Wind is supposed to accumulate here before entering the body.

POINTS: GB-20 (2)

Energetics: being at the top of the body, the area where this point is is frequently invaded by external Wind. The energetics of this point is closely linked to Wind, both external and internal but its action is inseparable from that of its being on the Yang Wei Mai. Indeed, its action in expelling external Wind is by virtue of its being a point of the Yang Wei Mai (action 1), while its action of extinguishing internal Wind is by virtue of its being on the Gall Bladder channel (action 2).

It is a major point on the Shao Yang channels: the ShaoYang is the hinge between Tai Yang (the Exterior) and Yang Ming (the Interior) and therefore regulates the Exterior and Interior (action 3). It has a specific action on the eyes (action 4) but also on other sense orifices (action 5).

POINTS: GB-20 (3)

Indications

• Indication 1: Invasions of external Wind, chills and fever, warm febrile disease without sweating

• Indication 2: Dizziness, hemiplegia, deviation of eye and mouth, lockjaw, Wind-stroke, epilepsy

• Indication 3: Alternation of chills and fever, headache

• Indication 4: Red eyes, eye pain, blurred vision, lachrymation, night blindness, reduced vision

• Indication 5: Rhinitis, nosebleed, nasal congestion and discharge, deafness, tinnitus, blocked ears.

EYE SYSTEM - LING SHU Ch. 80

BRAIN

Ling Shu Ch. 80. “The Jing and Qi of the 5 Zang and 6 Fu ascend to the eyes to give vision…They communicates with many channels constituting an Eye System (Mu Xi) which ascends to the vertex and enters the brain, then surfaces at the occiput. Therefore, when pathogenic factors enter the occiput (due to a deficiency of Blood), they penetrate this pathway to the Eye System into the brain. This causes the brain to feel like “turning” and a tightness of the Eye System.”

•Direct communication with the brain

•Connected to BL, ST, SI, GB, TB, HE and LIV channels•Interconnects with 3 Yang channels Du, BL and GB, at the occiput

•Intersects Extraordinary Vessels-Du Mai: Yintang-Ren Mai: ST-1-Yang Qiao Mai: ST-1, BL-1 (GB-20)-Yin Qiao Mai: BL-1-Yang Wei Mai: GB-14, GB-20, Du-16


D4 T4

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POINTS: DU-16 (1)

Du-16 Fengfu Palace of Wind

Location: on the midline at the nape of the neck, in the depression immediately below the external occipital protuberance.

Name: the name clearly refers to both the fact that external Wind penetrates the occiput and that this point is used to expel Wind (both external and internal). Alternative name is Guixue meaning “ghost cave”.

Intersections: Yang Wei Mai

Nature: point of the Sea of Marrow, Window of Heaven point, one of Sun Si Miao’s 13 ghost points.

D4 T5

POINTS: DU-16 (2)

Energetics: this point expels external Wind (action 1) and internal Wind (action 2) especially with regard to headaches. This point is a gate point in the movement of Yang from the occiput towards the front of the head; it is therefore prone to excess of Yang in this area particularly with mental implications (action 3). Controlling the movement of Yang from the occiputto the face, it can affect the throat (action 4). Similarly to BL-10, it is like a gate in the movement of Yang Qi to and from the head: excess of Yang in the head can be accompanied by deficiency of Yang below (action 5).

POINTS: DU-16 (3)

Indications

• Indication 1: chills and fever, aversion to cold

• Indication 2: headache, dizziness, nosebleed, upward staring eyes, hemiplegia, aphasia after Wind-stroke

• Indication 3: mania, incessant talking, mad walking, suicidal (because of Gui)

• Indication 4: aphasia after Wind-Stroke, throat pain, loss of voice

• Indication 5: numbness and weakness of the legs.

POINTS: DU-16 (4)

Combinations

• T.B.-16 Tianchuang and P-8 Laogong: throat pain (Qian Jin Yao Fang)

• Ren-24 Chengjiang: loss of voice

• L.I.-2 Erjian and L.I.-20 Yingxiang: rhinitis with nosebleed

• BL-13 Feishu (because of connection between Po and Gui): mad walking with desire to commit suicide (Qian Jin Yao Fang)

• S.I.-5 Yanggu: mad walking (Zheng Hiu Da Cheng).

POINTS: DU-15 (1)

Du-15 Yamen Door to muteness

Location: on the midline at the nape of the neck, in the depression 0.5 cun inferior to Du-16 Fengfu below the spinous process of the C-1.

Name: the name refers to its use in speech problems.

Intersections: Yang Wei Mai.

Nature: point of the Sea of Qi

POINTS: DU-15 (2)

Energetics: this point is on the Du vessels which governs all Yang energies of the body and is the intersection of all Yang channels. For this reason it can be used to clear Heat (action 1). Being at the base of the Du channel before it enters the Brain, it connects the body to the Brain and the point has a powerful mental effect (action 2). It extinguishes internal Wind (action 3) and expels external Wind (action 4). Since it mobilizes Yang Qi from the occiput towards the face, it is used for speech problems (action 5).

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POINTS: DU-15 (3)

Indications

• Indication 1: all kinds of Heat patterns

• Indication 2: mania-depression

• Indication 3: headache, Wind-stroke acute stage, epilepsy, clonic spasm

• Indication 4: chills and fever without sweating

• Indication 5: aphasia, loss of voice, flaccidity of tongue, stiffness of tongue.

Combinations

• LU-6 Kongzui: loss of voice

• T.B.-8 Sanyangluo: sudden loss of voice

POINTS: DU-17 (1)

Du-17 Naohu Brain’s door

Location: on the midline at the back of the head, 1.5 cun directly above Du-16, in the depression directly superior to the external occipital protuberance.

Name: the name refers to the influence of this point on the brain also because of its location roughly at the base of the brain.

Intersections: Bladder.

Nature: point of the Sea of Marrow.

POINTS: DU-17 (2)

Energetics: like most of the Du points on the head, it can extinguish internal Wind (action 1). While Du-15 and Du-16 control the mobilization of Yang Qi from the occiput towards the face, Du-17 does the opposite, i.e. it controls the mobilization of Yang Qi from the front towards the occiput; for this reason it treats congestion in the eyes (action 2). Its action on the eyes is obviously also related to the Eye System (hence the movement of Yang Qi from the face towards the brain and occiput). Being a point of the Sea of Marrow, it also treats headaches and eye problems of a Xu nature (action 3).

POINTS: DU-17 (3)

Indications

• Indication 1: epilepsy, chronic spasm, lockjaw

• Indication 2: eye pain, yellow eyes

• Indication 3: headache, dimness of vision, short-sightedness.

Combinations

• Du-19 Naokong and BL-7 Tongtian: headache with feeling of heaviness

POINTS: DU-14 (1)

Du-14 Dazhui Big vertebra

Location: on the midline, at the base of the neck, in the depression below the spinous process of the 7th cervical vertebra.

Name: “big vertebra” refers to the 7th cervical below which the point is situated.

Intersections: all Yang channels

POINTS: DU-14 (2)

Energetics: this point is on the Du vessel which governs all Yang energies of the body and is the intersection of all Yang channels. Its connection with all the Yang energies gives it a double action, i.e. it can be used to tonify Yang (action 1) or to clear Heat (action 2). Being at the base of the Du channel before it enters the Brain, it connects the body to the Brain and the point has a powerful mental effect (action 3). Finally, the Du vessel intersects internally with the Ren Mai which connects with the Heart and this point has an action on the Heart (action 4). Of course, the point has a deep effect on the Du vessel (action 5).

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POINTS: DU-14 (3)

Indications

• Indication 1: Deficiency sweating, lack of strength, inability to speak, shortness of breath

• Indication 2: Febrile disease, high fever, chills and fever

• Indication 3: Insomnia, manic-depression, crying-laughing, sadness, worry

• Indication 4: Heart pain, palpitations, insomnia

• Indication 5: Stiffness of spine, stiff neck, inability to turn head.

POINTS: DU-14 (4)

Combinations

• P-7 Daling, P-5 Jianshi: heart pain, sadness, Aheart feels suspended (or anxious) as in a state of hunger (Jia Yi Jing)

• KI-7 Fuliu, BL-43 Gaohuangshu (moxa): spontaneous sweating (Divine Moxibustion)

• P-7 Daling, P-6 Neiguan, P-3 Quze: chest pain (Zhen Jiu Da Cheng)

POINTS: GB-21 (1)

Location: midway between Du-14 Dazhui and the tip of the acromion, at the crest of the trapeziusmuscle.

Name: “well” refers to the depression in the shoulder where the point is situated.

Intersections: Triple Burner, Stomach, Yang Linking Vessel.

POINTS: GB-21 (2)

Energetics: the most important thing about this point is that it makes Qi descend (action 1); it obviously has a local action on the muscles of the shoulder (action 2); probably due to its lifting-Qi action, it also has a tonic action (action 3); it affects the breast (action 4).

The Hui Yuan Zhen Jiu Xue says:

“G.B.-21 Jianjing is situated on a place in the shoulders where yang Qi infuses outwards and becomes manifest from where it then penetrates in the Five Zang, it invigorates stagnant Blood, generates clear Yang Qi like a source, pacifying the channels, tonifying the Five Zang and opening the Yin orifices.”

POINTS: GB-21 (3)

Indications

• Indication 1: Cough, breathlessness, rebellious Qi, red face, leg-Qi ascending to the heart, difficult and prolonged labour, cold arms and legs after miscarriage, prolapse rectum, retention of placenta

• Indication 2: Stiff neck, pain in the shoulder and upper back, inability to raise arm

• Indication 3: the 5 Exhaustions (a state of exhaustion of each Yin organ), the 7 Injuries (overeating injuring Spleen, anger injuring the Liver, physical exertion, lifting, sitting on wet places injuring the Kidneys, catching cold and drinking cold liquids injuring the Lungs, worry, sadness and pensiveness injuring the Heart, wind, rain and cold injuring the body, shock and fright injuring the Mind), steaming bones, lumbar pain from Kidney deficiency

• Indication 4: breast pain, breast abscess, breast milk not flowing.

POINTS: GB-21 (4)

Combinations

• BL-42 Pohu: inability to turn the neck

• Ren-3 Zhongji: retention of placenta (Zhen Jiu Da Cheng)

• Du-20 Baihui, Du-1 Changqiang, BL-25 Dachangshu, L.I.-4 Hegu, ST-30 Qichong: prolapse of rectum

• Du-14 Dazhui, BL-43 Gaohuangshu, BL-20 Pishu, BL-21 Weishu, BL-13 Feishu, Ren-10 Xiawan, ST-36 Zusanli: 5 Exhaustions, 7 Injuries, Exhaustion from excessive sexual activity (Zhen Jiu Da Cheng).

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DISTAL POINTS

•BL-60 Kunlun,

•SI-3 Houxi,

•T.B.-5 Waiguan

HERBAL PRESCRIPTIONS

PRESCRIPTION FOR OCCIPUTGe GenWei Ling XianQin JiaoQiang HuoTou Gu Cao Herba Speranskiae tuberculataeJi Xue TengDang GuiSheng Di HuangBai ShaoXiang Fu

HERBS FOR OCCIPUT

Liver-Qi stagnation: Mu Xiang, Chuan Xiong, Xiang Fu, Ge Gen

External Wind: Qiang Huo, Jing Jie, Fang Feng

Internal Wind: Tian Ma, Gou Teng, Bai Ji Li

Dampness: Ge Gen, Qiang Huo

Kidney deficiency: Sheng Di Huang, Du Huo, Sang Ji Sheng

D4 T6

Day 1 – Break 3

THE FACE

GIOVANNI MACIOCIA

D4 T7

Most of the facial bones are under the influence of the Bright-Yang channels, i.e:

BONES (2)

The only exceptions are:

Stomachand

Large Intestine.

• the zygomatic bone which, in addition to the Bright-Yang channels, is also influenced by

the Small Intestine channel; and

• the sphenoid and temporal bones which are influenced by the Triple Burner channel.

D4 T8

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MUSCLES

The face contains many different types of small muscles, all of which are under the influence of the Stomach and Large Intestine Muscle channels primarily and also of the Small Intestine Muscle channel secondarily.

The superior auricular and the epicranius muscles are under the influence of the:

Triple Burner

Muscle channels.

Gall-Bladder

and

MAIN CHANNELS (1)

All the Yang channels start or end on the face and, energetically, the face therefore represents an area of concentration of Yang-Qi.

Of the Yang channels, the two that most influence the face energetics are the Stomach and Large Intestine channels.

Only two Yin channels reach the face:

the Heart channel flows to the eyes

Other Yin channels, however, do reach the face via their Divergent channels. It may be significant that, of the Yin Main channels,only the Heart and Liver reach the face, confirming the fact that the face is the mirror of the Mind (Shen) and Ethereal Soul (Hun) and readily reflects mental and emotional states.

and the Liver channel wraps around the mouth and also reaches the eyes.

MAIN CHANNELS (2) MAIN CHANNELS (3)

The fact that facial muscles allow us to assume very many different facial expressions is probably partially related to the abundance of Yang channels on the face, given that Yang is movement (although other parts of the body also contain only Yang channels , such as theback with the Du Mai and Bladder channel, only the face is intersected by all the Yang channels).

The abundance of Yang channels on the face may also explain why, in cold weather, it is the only part of the body that we do not need to protect, as it is one of the functions of Yang energy to warm the body and protect it from

invasions of external pathogenic factors.

In pathological conditions, the Yang energy of the face may be deficient or excessive.

MAIN CHANNELS (4)

When the Yang energy of the face is excessive, it manifests mostly in two ways:

When it is deficient, the face is prone to invasions of external Wind and this explains common facial pathologies such as runny nose and sinus problems which occur when Yang-Qi is deficient in the face and fails to warm and transform fluids…

…or facial paralysis which occurs when external Wind and Cold injure Yang and cause the muscles to contract.

1) On a physical level, the face is the first area to show excessive Heat with redness and a feeling of heat;

2) on a mental level, excessive Yang in the face may cause anxiety, agitation and insomnia.

YANG XU HEAT DAMPNESS

PATHOLOGY OF FACE

-Runny nose with clear nasal discharge

- Allergic rhinitis (Bi Jiu)

- Facial paralysis

- (Du Mai Xu and Cold)

-Red face

- Feeling of heat

- Thirst

- Anxiety, insomnia

- Eye infections, inflammation

- Mouth ulcers

- Gum inflammation

- Sinusitis

- Chronic ear infections, discharge (children)

-Runny nose with sticky nasal discharge

- Nasal voice (children)

D4 T9


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REN MAI

The Ren Mai circles around the mouth and enters the eyes.

A facial pathology is related to the Ren Mai, particularly when it is associated with gynaecological problems, e.g. gum disease during pregnancy, mouth ulcers before the periods, a feeling of heat in the face before the periods, acne before the periods, etc..

Energetically the Ren Mai, being Yin in nature, balances the Yang energy provided by the Yang channels in the face.

D4 T10 DU MAI

Energetically, the Du Mai, with the Yang channels of the face, contributes to protecting the face from invasions of external pathogenic factors.

• When the Du Mai is deficient, its pathology manifests often on the nose, causing allergic rhinitis with profuse, watery, nasal discharge;

• When Yang energy in the Du Mai is excessive, it may manifest with headaches or with mentalsymptoms such as anxiety, agitation or insomnia.

The Du Mai flows over the head, to the forehead, to end on the upper gum.

MUSCLE CHANNELS (1)

MY NOTES. No Yin Muscle channel reaches the face and this further corroborates the idea that it is the Yang channels which allow rich facial expressions and protection from external pathogenic factors because the Yang Muscle channels could be defined as the Yang within the Yang (i.e. they are more Yang than the Yang Main channels).

The face is richly supplied by the muscle channels of all the Yang organs and particularly the Stomach Muscle channel, which meanders up and down the cheeks and chin

MUSCLE CHANNELS (2)

The three Yang Muscle channels of the legs meet at S.I.-18.The three Yang Muscle channels of the arms meet at G.B.-13 Benshen.

In pathology, the rich supply of Yang Muscle channels in the face accounts for muscle pathologies such as paralysis (as in Bell’s palsy) and tremors or tics.

DIVERGENT CHANNELS

Of the Yang Divergent channels, some reach the neck, such as the:

while others reach the face or cranium, such as the:

Small Intestine Triple Burner And Gall-Bladder

Large Intestine Stomach And Bladder

DIVERGENT CHANNELS

• Of the Yin Divergent channels, these ones reach the face:

The function of the Yin Divergent channels in this area, is to precisely to allow Yin channels to reach areas not reached by their Main channels and therefore to balance out the predominant Yang energy of the face with some Yin energy.

LiverSpleen Heart Pericardium

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CONNECTING CHANNELS

Of the Yang Connecting channels, only these reach the face;

and BladderLarge Intestine Stomach

of the Yin Connecting channels, only the Heart reaches the face.

it is because of the influence of the Heart Main and Connecting channels that emotional and mental problems are readily reflected on the face.

This may be another reason why the face is often described as “the banner of the Shen”

DIAGNOSIS: OBSERVATION (1)The lustre of the eyes

The lustre (shen) of the eyes refers to the brilliance, vitality, glitter and sparkle of the eyes which reflect a normal state of the Mindand Spirit and therefore, in particular, of the Heart. However, as indicated above, the Essence of the other internal organs also manifests in the eyes.

The “Great Treatise of Ophthalmology” (Yan Ke Da Quan, 1644) relates the lustre of the eyes in particular to the Fire of the Gate of Life (Ming Men):

“ brightness of the Mind manifests with brilliance of the eyes. The brightness of the Mind has its origin in the Gate of Life (Ming Men) and it emerges to the Heart through the Gall-Bladder: therefore it is a manifestation of Fire.” (from Great Treatise of Ophthalmology (Yan Ke Da Quan 1644) cited in Ma Zhong Xue 1989 Great Treatise of Chinese Diagnostic Methods (Zhong Guo Yi Xue Zhen Fa Da Quan), Shangdong Science Publishing House, p. 23. )

D4 T11

DIAGNOSIS: OBSERVATION (2)

The degree of dullness of the eyes reflects the severity and duration of the emotional problems accurately: the duller the eyes, the more severe and long-standing the emotional problems.

When the Mind and Spirit are affected by long-standing emotional problems, the eyes may lose their lustre and become somewhat dull and lacking sparkle.

In a few cases, however, the eyes can become dull and lose lustre from physical causes such as a serious disease or from a long course of chemotherapy.


The control of the eyes

“Control” of the eyes refers to the movement or lack of movement of the eyeballs.

Uncontrolled eyes may manifest either with a fixed, staring lookor with a shifty look with excessive movement of the eyeballs.

The control of the eyes is quite separate from the lustre of theeyes and one should not be surprised to see people whose eyes appear to have lustre but lack control.

Lack of control of the eyes indicates obstruction of the Mind’s orifices, usually by Phlegm which may manifest with manic behaviour.

http://www.youtube.com/watch?v=kUV5fmHIGQI

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INTERROGATON: FEELING OF HEAT OF THE FACE (1)

A feeling of heat of the face may be due to either Full or Empty Heat of any organ.

• Full Heat will manifest with a feeling of heat of the face occurring either mostly in daytime or the whole day

• Empty Heat manifests with a feeling of heat in the face occurring mostly in the afternoon and evening.

D4 T12

In women, more than men, a feeling of heat of the face is often associated with contradictory Cold symptoms or signs in other parts of the body:

For example, women frequently experience a feeling of heat of the face and cold feet or frequent urination. Women’s pathology differs from that of men and a feeling of heat of the face with contradictory cold symptoms may be due to three Main causes.

INTERROGATON: FEELING OF HEAT OF THE FACE (2)

1) It may be due to a simultaneous deficiency of Kidney-Yang and Kidney-Yin with some Empty Heat, a situation that is very common in menopausal women. In this case, the woman will experience hot flushes and a feeling of heat of the face and other Empty Heat signs such as night-sweating and 5-palm heat, but also Cold symptoms deriving from Kidney-Yang deficiency such as cold feet and frequent urination.

INTERROGATION: FEELING OF HEAT IN THE FACE

2) a deficiency of Blood giving rise to some Empty Heat: the Blood deficiency may cause some Cold symptoms, especially cold hands, and the Empty Heat deriving from it may cause a feeling of heat of the face.

3) a disharmony of the Chong Mai. When the Qi of the Chong Mai rebels upwards, it rushes to the face causing a feeling of heat in the face and, since it fails to descend to the legs in its descending branch, it causes cold feet.

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D4 T13

The five Main causes of facial pain are:

• invasion of Wind-Heat,

• invasion of Wind-Cold,

• Dampness, hot or cold

• Liver-Fire, and

• Qi deficiency with Blood stasis.

INTERROGATION: FACIAL PAIN (1)

D4 T14


Invasion of Wind-HeatThis type of facial pain is characterised by an acute onset, a severe pain on the cheeks or jaws, an objective feeling of heat of the face, headache, sore throat, aversion to cold and fever.

Invasion of Wind-Cold The facial pain due to invasion of Wind-Cold is characterised by a spastic pain of the cheeks and jaws with sudden onset, sneezing, runny nose, aversion to cold, fever and a Floating-Tight pulse.

Damp-HeatThe facial pain due to Damp-Heat is characterised by a severe pain in the cheeks and forehead, and accompanied by a sticky-yellow or greenish nasal discharge.


Liver-Fire

The facial pain due to Liver-Fire is characterised by pain in the cheeks, redness of the cheeks, thirst, bitter taste, Red tongue with redder sides and Wiry-Rapid pulse.

Qi Deficiency and Blood StasisThe facial pain due to Qi deficiency and Blood stasis is characterized by an intense pain of the cheeks, often unilateral, boring in nature and long in duration and accompanied by a dark complexion and a Purple tongue.

INTERROGATION: FEELING OF NUMBNESS/TINGLING OF THE FACE (1)

The five Main causes of numbness of the face are:

• invasion of external Wind

• internal Liver-Wind

• Stomach-Fire

• internal Wind with Phlegm

• Blood deficiency.


Invasion of external WindNumbness of the face caused by invasion of external Wind is characterised by a sudden onset and short duration and is accompanied by deviation of eye and mouth.

Internal Liver-Wind

Numbness of the face caused by internal Liver-Wind is accompanied by headache, giddiness, tremors and a Wiry pulse.

Stomach-FireNumbness of the face caused by Stomach-Fire is accompanied by intense thirst, epigastric pain and a Yellow tongue coating.

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Internal Wind and PhlegmNumbness of the face caused by internal Wind and Phlegm is accompanied by deviation of the mouth, slurred speech and hemiplegia. Elderly.

Blood DeficiencyNumbness of the face caused by Blood deficiency is accompanied by a dull-pale complexion, blurred vision, dizziness, Pale tongue and a Choppy pulse. Women

PATTERNS (1)

FULL HEATFull Heat of any organ readily manifests on the face with a red complexion. Full Heat on the face also causes many eye and mouth pathologies, such as conjunctivitis and mouth ulcers.

EMPTY HEATEmpty Heat of any organ also manifests frequently on the face with a floating-red colour or with red cheek bones. Empty Heat affecting the face is often an underlying pattern for such pathologies as trigeminal neuralgia in the elderly.

D5 T1

PATTERNS (2)

CHONG MAI PATHOLOGYRebellious-Qi of the Chong Mai is characterized by Qi rebelling upwards from the lower abdomen, up to the face causing a feeling of heat in the face and anxiety. These symptoms are related to a Chong Mai pathology, only when associated with other symptoms at the level of the throat, chest and abdomen. This pathology is more common in women.

DAMP-HEATDamp-Heat in the face is a very frequent pattern appearing in acute or chronic sinusitis and causing facial pain, stuffy nose or thick, yellow nasal discharge.

PATTERNS (3)

INVASION OF WIND-HEATWind-Cold affects the face more than Wind-Heat, as the latter causes symptoms more at the level of the throat, such as acute sore throat and cough.

INVASION OF WIND-COLDInvasion of Wind-Cold affects the face in its beginning stages causing sneezing and a profuse, nasal discharge. Invasion of external Wind-Cold in the muscles of the face, without such acute symptoms, is also a cause of peripheral facial paralysis (Bell’s palsy).

PATTERNS (4)

INTERNAL WINDInternal Wind affects the face causing pathologies such as deviation of eyes and mouth, facial paralysis, tremors and tics.

BLOOD DEFICIENCYBlood deficiency manifests frequently on the face, causing a dull-pale complexion and dry skin. Heart-Blood deficiency causes the Mind (shen) to be unrooted, giving rise to a vague anxiety, sadness and insomnia.

The duller the complexion, the more it indicates a problem affecting the Mind. Blood deficiency is often the underlying pattern in conditions of the face, such as trigeminal neuralgia, affecting the elderly.

PATTERNS (5)

YIN DEFICIENCY

Yin deficiency manifests on the face with a dry, wrinkled and withered complexion, particularly around the mouth. Yin deficiency is often the underlying pattern in conditions of the face such as trigeminal neuralgia in the elderly.

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ANTI-LIVER-QI STAGNATION CRUSADE

•Qi stagnation affects other organs besides the Liver, e.g. Heart, Lungs, Stomach, Intestines

•Qi stagnation may derive from emotions other than anger, e.g. resentment, frustration, worry, sadness, grief, guilt, etc.

•Anger overemphasised in China due to Confucian influence

•Qi stagnation over-diagnosed

•Qi stagnation is automatically considered to be the consequence of “stress”

•Xiao Yao San over-used

[picture of crusader]


DISEASES: TRIGEMINAL NEURALGIA (1)

Trigeminal neuralgia is generally caused by Fire affecting the Liver, Gall-Bladder and Stomach channels.

The upward rush of Fire in the channels of the face leads to local Qi and Blood stagnation and therefore pain.

In chronic cases, Liver-Fire may lead to the development of Wind which aggravates the pain.

D5 T2


In the elderly, the chronic retention of Fire often causes Yin deficiency and therefore malnourishment of the channels of the face: this is often an underlying pattern in trigeminal neuralgia of the elderly and one that makes the pain more chronic and difficult to treat.

The pain from trigeminal neuralgia may often be aggravated by invasions of external Wind. The pathology of trigeminal neuralgia is also characterized by rising of Qi to the face.

Very often, the above factors are either aggravated or even caused by dental work.

According to Dr. Shen, protracted dental work poses a significant stress to the channels of the face that is underestimated by most people. Such dental work may often cause stagnation of Qi and Blood in the channels of the face and either cause or aggravate trigeminal neuralgia.

This is more likely to happen when dental work is undertaken when the patient is in a state of severe Qi and Blood deficiency.


DISEASES: FACIAL PAIN (1)

The five Main causes of facial pain are:

• Invasion of Wind-Heat,

• Invasion of Wind-Cold,

• Damp-Heat,

• Liver-Fire, and

• Qi deficiency with Blood stasis.

Invasion of Wind-HeatThe facial pain due to invasion of Wind-Heat is characterised by an acute onset, a severe pain on the cheeks or jaws, an objective feeling of heat of the face, headache, sore throat, aversion to cold and fever.


Invasion of Wind-ColdThe facial pain due to invasion of Wind-Cold is characterised by a spastic pain of the cheeks and jaws with sudden onset, sneezing, runny nose, aversion to cold, fever and a Floating-Tight pulse.

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Damp-HeatThe facial pain due to Damp-Heat is characterised by a severe pain in the cheeks and forehead, and accompanied by a sticky-yellow or greenish nasal discharge. This usually corresponds to acute or chronic sinusitis and it is probably the most common cause of facial pain in the patients we see.


Liver-FireThe facial pain due to Liver-Fire is characterised by pain in the cheeks, redness of the cheeks, thirst, bitter taste, Red tongue with redder sides and Wiry-Rapid pulse.

Qi deficiency and Blood stasisThe facial pain due to Qi deficiency and Blood stasis is characterized by an intense pain of the cheeks, often unilateral, boring in nature and long in duration and accompanied by a dark complexion and a Purple tongue.

TRIGEMINAL NEURALGIA FORMULAEWIND-COLDChuan Xiong, Jing Jie, Fang Feng, Quan Xie, Wu Gong, Tian Ma, Xi Xin.WIND-COLDJing Jie, Bai Ji Li, Jiang Can, Man Jing Zi, Yan Hu Suo, Gou Teng, Shi Jue Ming, Bai Zhi, Chen Pi, Quan Xie.

YIN XU, EMPTY HEAT

Sheng Di, Xuan Shen, Shi Gao, Bai Shao, Qiang Huo, Mo Yao, Xi Xin, Sheng Ma.

YIN XU, INTERNAL WIND, BLOOD STASIS

Sheng Di, Xuan Shen, Mai Men Dong, Huai Niu Xi, Bai Zhi, Dang Gui, Chuan Xiong.

LIVER-FIRE INTERNAL WIND

Huang Qin, Huang Lian, Da Huang, Xia Ku Cao, Lian Qiao, Ban Lan Gen, Da Qing Ye, Shi Gao, Bai Zhi, Wu Gong, Quan Xie.

TRIGEMINAL NEURALGIA FORMULAE

STOMACH-FIRE INTERNAL WIND

Da Huang, Chuan Xiong, Mang Xiao, Ban Lan Gen, Jin Yin Hua, Zhi Ke, Jiang Can, Quan Xie.

YIN XU, LIVER-YANG RISING

Gou Qi Zi, Ju Hua, Sheng Di Huang, Shu Di Huang, Shan Yao, Shan Zhu Yu, Mu Dan Pi, Fu Shen, Ze Xie, Bai Zhi.

INTERNAL WIND, BLOOD STASIS

Chuan Xiong, Dang Gui, Tao Ren, Chi Shao, Bai Shao, Bai Zhi, Gou Teng, Quan Xie, Wu Gong, Ru Xiang, Mo Yao, Di Long.

BLOOD STASIS

Chuan Xiong, Tao Ren, Hong Hua, Man Jing Zi, Ju Hua, Di Long, Bai Shao, Xi Xin.

POINTS: GB-1 (1)

NameTongzi means “pupil” and liao means “depression”or “dent” so the name of this point refers to its location in the depression of the lateral orbital bone which is level with the pupil.

G.B.-1 TongziliaoPupil Crevice

LocationIn the hollow on the lateral side of the orbital margin, approximately 0.5 cun lateral to the outer canthus.

D5 T4 (for T3 see P. 44)

Energetics

POINTS: GB-1 (2)

This point can be used first of all as a local point to subdue Yang (action 1).

However, it may also be used for the opposite, i.e. to stimulatethe rising of Clear-Yang to the eyes and brain (action 2).

Thirdly, from this point, Qi enters the eyes and the eye system and it can therefore be used for many different eye diseases (action 3); the function of this point in letting Qi go in and out is confirmed by one of its alternative names that is QianguanFront Gate.

Fourthly, being on a channel pertaining to Wood, this point can expel Wind (action 4).

Actions

POINTS: GB-1 (3)

• Action 1: headache, red eyes, eye pain.

• Action 2: blurred vision, mental confusion.

• Action 3: cataract, nebula, conjunctivitis, diseases of the optic nerve.

• Action 4: excessive lachrymation when exposed to Wind, trigeminal neuralgia, facial paralysis

Combinations

• Blurred vision: L.I.-4 Hegu, G.B.-41 Zulinqi, BL-1 Jingming (Zhen Jiu Da Chen)

• Breast distension or swelling: S.I.-1 Shaoze.

41

POINTS: BL-1 (1)

NameThe name of this point simply refers to its capacity in treating a very wide variety of eye disorders and improving eyesight.

IntersectionsSmall Intestine, Stomach, Gall-Bladder, Triple Burner, Du Mai, Yin- and Yang Qiao Mai.

BL-1 Jingming Eye’s Brightness

Location0.1cun medial and superior to the inner canthus of the eye, near the medial border of the orbit.

Energetics

POINTS: BL-1 (2)

This point is a point where the Qi goes into the Yin at night and Yang-Qi comes out in the morning: this is connected to the circulation of Defensive-Qi in the twenty-four hours, circulating in the three Yang (Greater-Yang, Lesser-Yang, Bright-Yang) in the day and in the five Zang (Kidney, Heart, Lungs, Liver, Spleen) at night.

Therefore this point has the function of a passage or gate between Yin and Yang and, as such, it is a dynamic point. Because of its role as a gate between Yin and Yang in the circadian circulation of Defensive-Qi in 24 hours, this point can be used for either insomnia or somnolence.

For insomnia, reinforce KI-7 Zhaohai, reduce BL-62 ShenMai and needle BL-1 Jingming with Even method. For somnolence, reduce KI-6 Zhaohai, reinforce BL-62 ShenMai and use BL-1 Jingming with Even method. The regulation and exchange of Yin and Yang at this point also takes place via the Yin- and Yang-Heel Vessels, both of which converge at this point (action 1).

POINTS: BL-1 (3)

As this point is the convergence of many Yang channels (in fact, all of them except the Large Intestine channel), similarly to Du-14 Dazhui, it can be used to clear Heat in a wide variety of eye diseases (action 2) or to promote the rising of Clear-Yang to the eyes to treat also a wide variety of eye diseases (action 3).

Actions

POINTS: BL-1 (4)

• Action 1: insomnia, somnolence

• Action 2: redness, swelling and pain of the eyes, redness and itching of the inner canthus

• Action 3: spontaneous lachrymation, blurred vision, decreased vision, decreased night vision, floaters, myopia

Combinations

• LIV-2 Xingjian: night-blindness.

• L.I.-4 Hegu, G.B.-37 Guangming: any eye disease.

POINTS: BL-2 (1)

NameThe name of this point is based on the resemblance of the end of the eyebrow where this point is situated to a bunch of bamboo leaves. It is also possible that “bamboo” is an image for the Liver channel because Liver-Qi or Liver-Yang rise rapidly and the bamboo plant also rises and grows very rapidly. This would support the action of this point in treating the Liver channel.

LocationSuperior to the inner canthus, in a depression on the eyebrow, close to its medial end.

BL-2 Zanzhu Gathered Bamboo

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Energetics

In relation to the Liver channel, this point can promote the descending of Qi and subdue rebellious Qi (action 1). The other functions of this point are the same as Action 2 and Action 3 of the point BL-1 above.

POINTS: BL-2 (2)Actions

POINTS: BL-2 (3)

• Action 1: headache from Liver-Yang rising, facial paralysis, trigeminal neuralgia, sinusitis (frontal sinuses)

• Action 2: see BL-1 above

• Action 3: see BL-1 above

Combinations

ST-8 Touwei: headache with eye pain and twitching of the eyelid

DU-20 Baihui, Du-21 Qianding, Du-24 Shenting, Du-23 Shangxing, T.B.-23 Sizhukong, G.B.-20 Fengchi, L.I.-4 Hegu, ST-8 Touwei: one sided or generalized headache.

POINTS: ST-4 (1)

NameThe character “di” indicates here the soil from which food produce comes, rather than “Earth” in the 5-Element sense, although of course there is a connection between the two. “Cang”means “granary” and the choice of this character for this point should be seen in the context of the ancient, un-simplified character which includes the radicals for food and mouth itself. Therefore, the name of this point clearly refers to the function of the mouth of taking in the food produce which comes from the earth.

ST-4 Dicang Soil Granary

Location0.4 cun lateral to the corner of the mouth.

POINTS: ST-4 (2)

“Di” is also used in conjunction with “tian”, meanin g “heaven”and “ren” meaning “person”, i.e. tian ren di meaning “heaven”, “person” and “earth”, indicating 3 levels.

The character “di”, meaning “earth”, is also frequently used in connection and in contrast to “tian”, which means “heaven” to indicate two extreme states of Yang and Yin.

In this context, the face can be divided into three sections, the forehead corresponding to “Heaven”, the section between the eyebrows and the bottom of the nose corresponding to “person” and the section below where the mouth is corresponding to “earth”: this could be another reason for this name.

Intersections

POINTS: ST-4 (3)

Large Intestine, Yang-Heel Vessel and Ren Mai.

Energetics

The Main energetic action of this point is its ability to expel both internal and external Wind (action 1). Being a point of intersection with the Yang-Heel Vessel, it also treats certain eye diseases (action 2).

Actions

POINTS: ST-4 (4)

• Action 1: deviation of the mouth, either after a stroke or in facial paralysis, trigeminal neuralgia, contraction of the facial muscles, aphasia.

• Action 2: inability to close the eye, spontaneous movement of the eyeball, twitching of the eyelids, itchy eyes.

Combinations

ST-6 Jiache: deviation of the mouth in facial paralysis (insert the needles obliquely, ST-4 towards ST-6 and vice versa).

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POINTS: ST-6 (1)

NameThe name of this point simply and clearly refers to its locationat the angle of the jaw bone.

EnergeticsAs with ST-4 above, the Main energetic action of this point is to extinguish Wind, both internal and external (action 1). It is also one of Sun Si Miao’s “thirteen ghost points”, where it was listed under its alternative name of Guichuang meaning “ghost’s bed”.

ST-6 Jiache Jaw bone

LocationApproximately 1 fingerbreadth anterior and superior to the angle of the jaw at the prominence of the masseter muscle.

Actions

POINTS: ST-6 (2)

• Action 1: deviation of the mouth, either after a stroke or in facial paralysis, trigeminal neuralgia, contraction of the facial muscles, aphasia.

• Action 2: mania, epilepsy.

Combinations

ST-4 Dicang deviation of the mouth in facial paralysis (insert the needles obliquely, ST-4 towards ST-6 and vice versa).

POINTS: SI-18 (1)

NameThe name of this point clearly and simply refers to its location in the depression of the cheek bone.

IntersectionsMeeting point of the Yang Muscle channels of the leg. Meeting point of the Small Intestine and Triple Burner channels.

S.I.-18 Quanliao Cheek Bone Crevice

LocationDirectly below the outer canthus, in the depression at the lower border of the zygomatic bone.

Energetics

POINTS: SI-18 (2)

Actions

Facial paralysis, trigeminal neuralgia, twitching of the eyelids and toothache of the upper jaw.

Combinations

P-6: red and yellow eyes.

The Main energetic action of this point is that it expels both internal and external Wind.

POINTS: GB-13 (1)

NameThe name of this point refers to its use in calming the Mind and Spirit. Interestingly, Chapter 8 of the “Spiritual Axis”, which deals with Spirit disorders, is also called benshen. In the context of this point, “shen” may also be interpreted as “brain”, and “root” means that this point is rooted in the brain and is an intersection point of the eye system.

G.B.-13 BenshenRoot Spirit

LocationOn the forehead, 0.5 cun within the anterior hairline, two thirds of the distance between Shenting Du-24 and Touwei ST-8.

IntersectionsYang Linking Vessel. This point is also the meeting point of the three Yang Muscle channels of the arm.

POINTS: GB-13 (2)

Energetics This point could be seen as a point where Qi concentrates or gathers and this occurs in relation to the brain (action 1) and to the Mind and Spirit (action 2). It is also a point where the Jing gathers in the head (action 3). G.B-13 also extinguishes internal Wind (action 4).

ActionsAction 1: dizziness, floaters, poor memory, headache.Action 2: insomnia, anxiety, obsessive thoughts, worry.Action 3: dizziness, poor memory, senility.Action 4: epilepsy, hemiplegia, Wind-Stroke, facial paralysis, headache.

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POINTS: GB-14 (1)

NameYang refers to the fact that many Yang channels converge at thispoint and “bai” has the meaning of “clear”: this point therefore refers to the ascent of Clear Yang to the head, which it promotes.

IntersectionsTriple Burner, Stomach, Large-Intestine and Yang-Linking Vessel.

G.B.-14 Yang Bai Yang White

LocationOn the forehead, 1 cun superior to the middle of the eyebrow, directly above the pupil when the eyes are looking straight ahead.

Energetics

POINTS: GB-14 (2)

The energetics of this point are centred around Wind, i.e expelling external Wind (action 1) or extinguishing internal Wind (action 2).

Actions

• Action 1: headache from external Wind-Cold, facial paralysis.

• Action 2: unilateral headache, dizziness, Wind-Stroke, twitching of eyelids.

POINTS: YINTANG (1)

EnergeticsThe most commonly known energetic of this point is that of calming the Mind (action1). However, it also extinguishes internal Wind (action 2). Another action of this point is that it opens the nose orifice and stimulates the entering and exiting of Qi (action 3).

Yintang Hall of Impression (or Seal)

LocationAt the glabella, at the midpoint between the medial extremities of the eyebrows.

Actions

POINTS: YINTANG (2)

• Action 1: insomnia, agitation, anxiety, restlessness.

• Action 2: chronic and acute childhood fright wind, fright spasm, frontal headache, dizziness

• Action 3: nasal congestion, rhinitis.

POINTS: BITONG (1)

NameThe name of this point refers to its influence on the nasal passage and its effect of clearing them.

EnergeticsThe energetic action of this point centres around its ability to open the nose orifice and stimulate the entering and exiting of Qi in the nose (action 1).

Bitong Nose Passage

LocationAt the highest point of the naso-labial groove.

Actions

POINTS: BITONG (2)

Action 1: chronic rhinitis, blocked nose, runny nose.

Combinations

L.I.-4 Hegu, Du-23 Shangxing, BL-7 Tongtian: chronic rhinitis

CLINICAL NOTE I find this point clinically more effe ctive than L.I.-20 Yingxiang for nose problems.

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DISTAL POINTS

ST-44 Neiting

LU-7 Lieque

L.I.-4 Hegu

T.B.-5 Waiguan

SINUSITISThe sinuses are mucosa-lined cavities in the skull communicating with the nasal cavities. There are four pairs of sinuses, i.e. the ethmoidal, frontal, maxillary and sphenoidal sinuses. The frontal and maxillary sinuses, especially the latter ones, are more prone to infection and inflammation. The condition of sinusitis broadly corresponds to the old Chinese medical category of Bi Yuan which literally means "nose pool". As we have seen in the chapter on allergic rhinitis, the differentiation and treatment of Bi Yuan are often used to diagnose and treat allergic rhinitis, which is a mistake since Bi Yuan corresponds more closely to sinusitis.

Bi Yuan is sometimes also called Nao Louwhich means "brain discharge" since the profuse and purulent discharge from the nose was considered to come from the brain. Interestingly, Hippocrates and his disciples also thought that the evil humour (of sinusitis) arose in the brain and from there descended into the nasal cavities.

D5 T3 – skipped ahead

BI YAN

“Nose inflammation”

Modern term for rhinitis

BI YUAN “ Nose Pool”

Ancient term for purulent nasal discharge = sinusitis

Modern Chinese books mistakenly use this term for rhinitis

BI JIU

Ancient term for profuse, white, watery nasal discharge = allergic rhinitis

NAO LOU� � “ Brain trickling”

Ancient term for purulent nasal discharge = sinusitis

AETIOLOGY AND PATHOLOGY1) REPEATED INVASIONS OF WIND-HEAT OR WIND-COLDRepeated invasions of external Wind, whether Wind-Heat or Wind-Cold but more frequently Wind-Heat, impair the dispersing and descending of Lung-Qi in the nasal passages so that fluids stagnate in the nose and sinuses. The long-term stagnation of fluids leads to Phlegm and Heat which manifest with a yellow, purulent nasal discharge.

Repeated invasions of external Wind are the main cause of sinusitis especially when the person does not take care or have extra rest during such invasions.

From a Western medical perspective, infections from the common cold or influenza viruses frequently cause secondary infections in the sinuses, especially the maxillary sinuses. For anatomical reasons, sinus infection is liable to become chronic. In fact, the openings through which the maxillary sinuses communicate with the nasal cavities are narrow, and inflammatory oedema of the mucosa lining them often prevents adequate drainage of the infected sinuses. As a result, resolution of sinus infection is often slow and incomplete so that, when the next viral infection from common cold or influenza occurs, the already infected and inflamed sinuses will be affected again. Thus, repeated infections by the common cold or influenza viruses will lead to chronic sinusitis.

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2) DIETExcessive consumption of greasy-hot foods leading to Phlegm and Heat may predispose one to sinusitis. This type of food may lead to the formation of Damp-Heat in the Stomach and Spleen which may be carried upwards to the sinuses via the Stomach channel.

However, this can only be a predisposing factor in the development of sinusitis, the repeated invasions of Wind being the necessary condition.

DIET• The excessive consumption of Damp-producing foods

affects the Spleen and leads to Dampness which may cause dull headaches on the forehead and a typical feeling of heaviness in the head. Damp-producing foods include all greasy foods, fried foods, milk, cheese, butter, cream, ice-cream, bananas, peanuts, sweets and white sugar.

• The way in which food is eaten also influences the energy of the internal organs. Eating too quickly or while discussing work, leads to retention of food in the Stomach and to sharp headaches on the forehead. Eating irregularly or too late at night induces a deficiency of Stomach-Yin and may cause dull headaches on the forehead.

DIFFERENTIATION AND TREATMENT

The patterns discussed will be:1) WIND-HEAT2) LUNG-HEAT3) LIVER AND GALL-BLADDER FIRE4) STOMACH AND SPLEEN DAMP-HEAT

It should be remembered that all the above patterns are of the Excess type and the formulae used are aimed at expelling pathogenic factors. However, in chronic cases, there is always an underlying deficiency, especially of the Spleen, which needs to be addressed. In such cases, all the formulae indicated below need to be modified with the addition of Spleen-Qi tonic herbs such as Bai Zhu Rhizoma Atractylodis macrocephalae, Dang Shen Radix Codonopsis pilosulae, or Huang Qi Radix Astragali membranacei.

With acupuncture, the points indicated below will have to be integrated by the addition of points to tonify the Spleen such as ST-36 Zusanliand BL-20 Pishu.

1) WIND-HEATClinical manifestationsStuffed nose, yellow-sticky or purulent nasal discharge, headache, diminished sense of smell, aversion to cold and fever.Tongue: Red sides and/or front.Pulse: Floating-Rapid.This corresponds to an acute attack of sinusitis following an invasion of Wind-Heat. Treatment principleRelease the Exterior, expel Wind-Heat and restore the dispersing and descending of Lung-Qi.AcupunctureL.I.-11 Quchi, L.I.-4 Hegu, L.I.-20 Yingxiang, Bitong, Du-23 Shangxing, BL-12 Fengmen. Reducing method.

Herbal treatmenta) PrescriptionHE YE Folium Nelumbinis nuciferae6gNIU BANG ZI Fructus Arctii lappae6gBO HE Herba Menthae 6gSHI CHANG PU Rhizoma Acori graminei 6gSHI GAO Gypsum fibrosum 12gLIAN QIAO Fructus Forsythiae suspensae 6gXUAN SHEN Radix Scrophulariae ningpoensis 4.5gJIE GENG Radix Platycodi grandiflori4.5gXIN YI HUA Flos Magnoliae liliflorae4.5g

b) PrescriptionXIN YI HUA Flos Magnoliae liliflorae 9gBAI ZHI Radix Angelicae dahuricae 9gCHAI HU Radix Bupleuri 6gJING JIE Herba seu Flos Schizonepetae tenuifoliae 4.5gBO HE Herba Menthae 6gJIE GENG Radix Platycodi grandiflori 6gMA HUANG Herba Ephedrae 6gHUANG QIN Radix Scutellariae baicalensis6gSHAN ZHI ZI Fructus Gardeniae jasminoidis6gLONG DAN CAO Radix Gentianae scabrae6gYU XING CAO Herba Houttuyniae cordatae9gJIN YIN HUA Flos Lonicerae japonicae 9gGUA LOU Semen Trichosanthis 6gCHUAN XIONG Radix Ligustici wallichii4.5g

2) LUNG-HEATClinical manifestationsSticky-yellow or purulent nasal discharge, tenderness over maxillary sinuses, flushed face, feeling of heat, thirst, headache.Tongue: Red with sticky-yellow coating.Pulse: Slippery and Full, though possibly only on the right Front position.

This is a condition of chronic sinusitis when repeated invasions of Wind-Heat have impaired the dispersing and descending function of the Lungs so that fluids stagnate in the sinuses and give rise to Phlegm-Heat. Principle of treatmentRestore the dispersing and descending of Lung-Qi, clear Lung-Heat. AcupunctureL.I.-11 Quchi, L.I.-4 Hegu, LU-10 Yuji, LU-7 Lieque, L.I.-20 Yingxiang, Bitong, Du-14 Dazhui. Reducing method.

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Herbal treatmentPrescriptionXIN YI QING FEI YINMagnolia Clearing the Lungs DecoctionXIN YI HUA Flos Magnoliae liliflorae9gHUANG QIN Radix Scutellariae baicalensis9gSHAN ZHI ZI Fructus Gardeniae jasminoidis6gSHI GAO Gypsum fibrosum12gZHI MU Radix Anemarrhenae asphodeloidis6gJIN YIN HUA Flos Lonicerae japonicae6gYU XING CAO Herba Houttuyniae cordatae6gMAI MEN DONG Tuber Ophiopogonis japonici6g

3) LIVER AND GALL-BLADDER FIREClinical manifestationsYellow-purulent nasal discharge, bloodshot eyes, red face, headache on temples and cheeks, dizziness, a bitter taste, dry stools, irritability.Tongue: Red with redder sides, sticky-yellow coating.Pulse: Wiry, Slippery and Rapid.

This condition is due to Liver and Gall-Bladder Fire rising to the nose and the brain. Fire condenses the fluids in the nose and leads to Phlegm-Heat. The Gall-Bladder channel flows through the brain and Gall-Bladder Fire causes what is considered to be a discharge of purulent fluid from the brain.Treatment principleClear Liver and Gall-Bladder Fire, restore the descending of Lung-Qi.AcupunctureLIV-2 Xingjian, G.B.-43 Xiaxi, LU-7 Lieque, L.I.-4 Hegu, Bitong, G.B.-15 Toulinqi. Reducing method.

Herbal treatmenta) PrescriptionQING GAN TOU DING TANGClearing the Liver and Penetrating the Crown (of the head) DecoctionLING YANG JIAO Cornu Antelopis4.5gSHI JUE MING Concha Haliotidis12gCHAN TUI Periostracum Cicadae4.5gSANG YE Folium Mori albae 6gBO HE Herba Menthae3gXIA KU CAO Spica Prunellae vulgaris 6gMU DAN PI Cortex Moutan radicis4.5gXUAN SHEN Radix Scrophulariae ningpoensis3gJIE GENG Radix Platycodi grandiflori3gCHEN PI Pericarpium Citri reticulatae3g

b) PrescriptionLONG DAN BI YUAN FANGGentiana "Nose Pool" FormulaLONG DAN CAO Radix Gentianae scabrae6gHUANG QIN Radix Scutellariae baicalensis6gXIA KU CAO Spica Prunellae vulgaris 6gYU XING CAO Herba Houttuyniae cordatae9gJU HUA Flos Chrysanthemi morifolii6gBAI ZHI Radix Angelicae dahuricae6gCANG ER ZI Fructus Xanthii 6gHUO XIANG Herba Agastachis4.5gYI YI REN Semen Coicis lachryma jobi 15gCHE QIAN ZI Semen Plantaginis6gJIE GENG Radix Platycodi grandiflori6g

4) STOMACH AND SPLEEN DAMP-HEATClinical manifestationsSticky-yellow nasal discharge, red cheeks, thirst, dry lips, impaired sense of smell, a feeling of heaviness and muzziness of the head, a frontal headache, a sticky taste, a feeling of oppression of the chest and epigastrium.Tongue: sticky-yellow coating in the centre.Pulse: Slippery.Treatment principleClear Heat, resolve Dampness, harmonize the Stomach, tonify the Spleen.

AcupunctureRen-12 Zhongwan, BL-20 Pishu, Ren-9 Shuifen, SP-9 Yinlingquan, BL-22 Sanjiaoshu, L.I.-11 Quchi, L.I.-4 Hegu, Ren-13 Shangwan, Bitong. Even method, except on the first two points which should be reinforced.

Herbal treatmentPrescriptionCANG ER BI DOU YAN FANGXanthium Sinusitis FormulaCANG ER ZI Fructus Xanthii 9gHUANG QIN Radix Scutellariae baicalensis9gPU GONG YING Herba Taraxaci mongolici cum radice6gGE GEN Radix Puerariae9gJIE GENG Radix Platycodi grandiflori6gBAI ZHI Radix Angelicae dahuricae3gCHE QIAN ZI Semen Plantaginis9gGAN CAO Radix Glycyrrhizae uralensis3g

TT REMEDY: WELCOME FRAGRANCE

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BIAO

DAMPNESS

BEN

•ST-SP XU

•LU-QI XU

•KI-YANG XU

DISTAL

•L.I.-4 Hegu

•L.I.-11 Quchi

•LU-7 Lieque

LOCAL

•Bitong

L.I.-20 Yingxiang

•Du-23 Shangxing

•ST-8 Touwei

•G.B.-13 Benshen

•ST-36, SP-3, Ren-12, BL-20

•LU-7, LU-9, BL-13

•KI-3, KI-7, Ren-4, BL-23

THREE TREASURES

BIAO: WELCOME FRAGRANCE

BEN: PROSPEROUS EARTH

CENTRAL MANSION

STRENTHEN THE ROOT


Herbs that reach the face:

Chai Hu (ears)Bai Zhi (face)Xin Yi Hua (nose)Cang Er Zi (nose)Jie Geng (face)Ju Hua (eyes)

THROAT AND NECK

GIOVANNI MACIOCIA

D5 T5

The throat is an area of convergence of practically all channels with the only exception of the Bladder channel: in fact all the other eleven channels course either through the front or the side of the throat.

Of the 8 Extraordinary vessels, all go through the centre or theside of the throat with the exception of the Du and Dai Mai. Thus, being influenced by so many channels and therefore internal organs, the throat reflects clearly conditions of Yin-Yang, Heat-Cold and Deficiency-Excess and is an important diagnostic area. The throat is influenced particularly by the Lungs, Stomach, Large Intestine, Liver, Kidneys and Ren Mai channels.

CHANNELS (1)

There are, however, signs that the ancient Chinese doctors were aware of such differentiation. For example, even as early as 100 BC, the “Spiritual Axis”said in chapter 69: “The throat is the passage for food and drink; the throat is also where Qi goes up and down.” It is interesting that the Chinese text uses two different terms for the these two phrases, the former being yan-hou and the latter hou-long, both translated as “throat” in modern texts.

Although Chinese medicine talks about “throat” in general without distinguishing pharynx (related to both respiratory and digestive systems)...... from larynx

(pertaining to the respiratory system)

CHANNELS (2)

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Bearing in mind the dual function of the throat in respect of respiratory and digestive systems, generally speaking, one can differentiate two broad types of throat problems, one related to the respiratory system and in Chinese medicine to the Lungs and Kidney channels, the other related to the digestive system and in Chinese medicine to the Stomach and Large Intestine channels. Chronic sore throats in adults are more commonly related to the Lung and Kidney channels, while in children more to the Stomach and Large Intestine channels.

CHANNELS (3)

With regard to Heat and Cold, the throat is much more prone to Heat (whether Full or Empty) than to Cold.

LUNGS

The Lung channel starts in the epigastric area and ascends to the chest and throat on its way to LU-1 Zhongfu.

The Lung Divergent channel goes through the throat.

LARGE INTESTINE

The Large Intestine channel goes over the side of the throat on its way up to the nose.

The Large Intestine Divergent channel goes through the throat.

STOMACH

The Stomach channel goes over the side of the throat on its way down from the face.

The Stomach Luo channel terminates at the throat (and around the neck).

SPLEEN

The Spleen channel goes through the throat on its way from the chest to the underside of the tongue.

The Spleen Divergent channel goes through the throat and ends in the tongue.

The Heart Divergent channel goes through the throat on its way up to the eye where it connects with the Small Intestine channel.

HEART

The Heart channel goes over the throat on its way from the chest to the face and eye.

The Heart Luo channel also goes through the throat on its way to the eye.

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SMALL INTESTINE

The Small Intestine channel goes over the side of the neck on its way up to the face and ear.

KIDNEYS

The Kidney channel goes through the throat on its way up from the chest to the root of the tongue

PERICARDIUM

The Pericardium Divergent channel ascends through the throat from the chest to go to the ear region to join the Triple Burner channel.

LIVER

The Liver channel ascends through the throat and side of neck on its way up to the top of the head.

REN MAI

The Ren Mai obviously goes through the throat.

CHONG MAI

The ascending branch of the Chong Mai flows through the throat on its way up to the face.

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DU MAI

The ascending branch of the Du Mai (“Simple Questions”) ascends from the lower abdomen to the chest and goes through the throat on its way to the mouth and eye (could be Ren Mai).

YIN QIAO MAI

Yin Qiao Mai runs upwards alongside the Adam’s apple in front of ST-9 Renying on its way up to the inner canthus of the eye.

YIN WEI MAI

In women, the Ren Mai and Chong Mai also go through the front of the throat and their pathology influences the development of goitre through menstrual irregularities. That is why women with goitre outnumber men by 8:1.

The Yin Wei Mai goes over the throat at points Ren-22 Tiantu and Ren-23 Lianquan.


SWELLING OF THROAT (THYROID)

In Chinese called Ying. Ancient books mentioned Shi Ying (Stone Goitre), Lao Ying (Exhaustion Goitre), TuYing (Earth Goitre), You Ying (Worry Goitre) and Qi Ying (Qi Goitre).

There are records of goitre in Chinese medicine as early as 3rd century BC. The name Ying appears in a book from the Warring States period. The book says:

SWELLING OF THROAT (THYROID)

“There are more people with bald head and with goitre in places of light water.”

This statement shows that the ancient Chinese were aware of environmental goitre. Another book tells the following story:

“A man called Jia Gui developed goitre due to anger. The goitre grew large and he wanted a doctor to remove it. The minister Cao Cao persuaded him not to have the operation by saying that 9 out of 10 people who have had the operation died.”


The “General Treatise on the Aetiology and Symptomatology of Diseases” (Zhu Bing Yuan Hou Zhong Lun, 610 AD) illustrates the cause of goitre as emotional stress and environment by saying;

“Goitre results from worry leading to Qi stagnation. It may alsobe caused by drinking sandy water, the sand follows Qi into the channels and vessels and accumulates in the neck.”

The book “Thousand Golden Ducat Prescriptions” (Qian Jin Yao Fang) record dozens of formulae for goitre recommending the use of Hai Zao, Kun Bu, and thyroid of sheep and dear.

It also said:

“Do not live long in mountainous regions with black earth and spring water. Drinking such water for a long time may cause goitre.”

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This shows that ancient doctors had an understanding of the role of iodine in thyroid disease even though they obviously didnot know about iodine.

The book “Treatise on the Three Categories of Aetiology of Diseases” (San Yin Ji Yi Bing Zheng Fang Lun) has a different classification of goitre:

“Goitre that feels hard and tough and does not move is called Stone Ying. A goitre that does not change the colour of the skin is called Muscle Ying. That with exposed sinews is called Sinews Ying. That with exposed vessels is called Blood Ying. That which changes size according to emotions is called Qi Ying”.

It also says:

“In all five types of goitre do not break [Blood] as this may cause a massive discharge of pus and blood and untimely death.”


Another books says:

“All three herbs Hai Zao, Kun Bu and Hai Dai are from the sea. Eat at least two of them often and goitre will be prevented.”

Another book mentions the use of Huang Yao Zi to cool Blood, drain fire, dissolve goitre and dispel Toxin.

The book also asks people to look in the mirror and stop taking Huang Yao Zi when the goitre disappears or measure the size of the goitre with a thread every day to know exactly the results of the tincture.


Another book considers Qi stagnation, Phlegm and Blood stasis as the Main pathogenic factors in simple goitre. So the treatment method should be to move Qi, invigorate Blood, resolve Phlegm and soften masses. The book mentions the formula Hai Zao Yu Hu Tang that is still widely used today.

Another book says:

“Simple goitre results from Qi and Blood stagnation. It is a disease that develops slowly for years; it is called Ying because the skin is enlarged like a cherry stone [Ying Tao].”


Diagnosis by observation and palpation

- Soft goitre with indistinct edges, varying in size with emotional state: Qi stagnation

- Large, soft and smooth mass: Phlegm

- Hard, nodular mass that is immovable and grows rapidly, dark skin over mass: Blood stasis.

- Small or medium-size goitre, relatively soft, slippery under the finger: Liver-Fire (with Phlegm).

REDNESS


A redness of the throat in the front always indicates that the patient suffers from Heat or Empty-Heat usually from emotional problems.

In case of Heat, the red colour is “solid”...

... whereas if it is from Empty-Heat, the red colour is “floating.”

This Heat or Empty-Heat usually derives from emotional stress and it is common to see such a patient become red on the neck as they talk about their problems and symptoms.

D5 T6 INTERROGATION (1)

PHLEGM IN THE THROAT

Phlegm with Qi stagnation

Phlegm in the throat, a feeling of lump in the throat, a feeling of fullness and distension of the chest, slight breathlessness, inability to lie down, sticky tongue coating, Wiry-Slippery pulse.

Phlegm obstructing the clear orifices

Phlegm in the throat, a feeling of oppression of the chest, dull headache as if the head was full of cotton-wool, dizziness, blurred vision, rattling sound in the throat, expectoration of phlegm, difficulty in speech, nausea, vomiting, Swollen tongue with sticky tongue coating, Slippery pulse.

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INTERROGATION (2)

Phlegm-Heat

Phlegm in the throat, a feeling of oppression of the chest, a feeling of heat, thirst with no desire to drink, breathlessness, a rattling sound in the throat, expectoration of yellow sputum, Red and Swollen tongue with sticky-yellow coating, Slippery-Rapid pulse.

Phlegm-Fire and Wind

Phlegm in the throat, a feeling of oppression of the chest, a feeling of heat, thirst with no desire to drink, breathlessness, a rattling sound in the throat, expectoration of yellow sputum, dizziness, giddiness, numbness of the limbs, Red, Swollen and Deviated tongue with sticky-yellow coating, Slippery-Rapid-Wiry pulse.

Spleen- and Kidney-Yang deficiency

INTERROGATION (3)

Scanty phlegm in the throat, expectoration of white-watery phlegm, a rattling sound in the throat, cold limbs, feeling cold, backache, dizziness, tinnitus, weak knees, Pale and Swollen tongue with sticky coating, Deep and Weak pulse.

SORE THROAT

INTERROGATION (4)

When diagnosing sore throat, the first thing to establish is whether it is of external or internal origin: obviously a sore throat of external origin has a sudden onset and short duration. In external invasions of Wind a sore throat generally points to Wind-Heat rather than Wind-Cold, especially if it is very severe: other symptoms would include aversion to cold, a fever (or body hot to touch), headache, sneezing and a Floating-Rapid pulse.

A sore throat from internal origin is usually due to Heat which may be Full or Empty: in general, the sore throat from Full Heat is very severe and the throat is red and swollen, while that from Empty Heat is less severe, worse in the evening and associated with dryness. However, a chronic sore throat may also arise from a long-standing Yin deficiency, also without Empty Heat.

INTERROGATION (5)

In children, external Wind-Heat, compared to Wind-Cold, has a stronger tendency to cause interior Heat after the initial stage; if the Heat is not cleared properly after the initial stages, it has a strong tendency to give rise to residual pathogenic factor.

INTERROGATION (6)

When diagnosing a child presenting with a recurrent, chronic sore throat the two most common causes are either residual Heat in the Lung channel following an invasion of Wind-Heat or an accumulation of Heat in the Stomach and Large Intestine channels due to retention of Food.

In case of residual Heat in the Lung channel, the child will present with a history of repeated invasion of Wind-Heat, usually treated with antibiotics and other manifestations may include a cough, thirst, a feeling of heat, red cheeks and disturbed sleep.

In the case of sore throat from accumulation of Heat in the Stomach and Large Intestine channels, there will be no history of repeated invasions of Wind-Heat, but a history of digestive upsets such as vomiting and regurgitation of food and other manifestations may include abdominal pain, constipation, epigastric pain and disturbed sleep.

INTERROGATION (7)

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In adults, the most common chronic sore throat is that from Kidney- and/or Lung-Yin deficiency with Empty Heat: this sore throat is not very severe, is worse in the evening, and is associated with dryness of the throat and other Yin deficiency manifestations. A chronic sore throat may also be caused simply by Qi and Yin deficiency without Empty Heat: in this case the sore throat is mild, it comes in bouts, caused by overwork and is associated with other Qi and Yin deficiency manifestations.

INTERROGATION (8)Severe sore throat with swelling: Full-Heat in Stomach and Intestines

Chronic mild sore throat: Kidney- and/or Lung-Yin deficiency with Empty-Heat

Chronic mild sore throat aggravated by overwork: severe Qi and Yin deficiency

Recurrent, chronic sore throat in children: residual Heat in Lung channel or Heat in Stomach and Large Intestine channel

INTERROGATION (9)

SORE THROAT

External

Internal HEAT

FULL HEAT

EMPTY HEAT

WIND-HEAT

RESIDUAL HEAT

ST and L.I.

LU and KI

ST and LU

DRY THROAT

INTERROGATION (10)

Excluding external invasions of Wind-Heat which may cause a dry throat, the most common cause of chronic dryness of the throat is a deficiency of Yin of the Lung and/or Kidneys: in fact, in these situations, a dry throat is an important symptom confirming the diagnosis of Yin deficiency. A chronic dryness of the throat from Full Heat, may be related to the Stomach channel but this is much less common than the former type.

Chronic dryness of the throat may also be related to the Liver and Gall-Bladder channels and be caused by Heat in the Liver and Gall-Bladder or by the Lesser Yang syndrome within the 6 Stages or the Gall-Bladder Heat pattern at the Qi level within the 4 Levels

ITCHY THROAT

INTERROGATION (11)

Itchiness of the throat with sudden onset is always related to invasion of Wind, which may be Wind-Cold, Wind-Heat or Wind-Dryness. Chronic itchiness of the throat is usually due to Lung-Yin deficiency or Lung Dryness: in this case the itchy feeling of the throat is worse in the evening and is associated with a desire to drink water in small sips.

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HOARSE VOICE

INTERROGATION (12)

In acute cases, hoarse voice is due either to external invasion of Wind-Heat or to Lung-Heat, which may develop from such an invasion. In invasions of external Wind the presence of a hoarse voice by itself indicates Wind-Heat rather than Wind-Cold because the throat is a place where Heat easily accumulates. In such cases, a hoarse voice is accompanied by sore throat, aversion to cold, fever, a Red tongue in the front or sides and a Floating-Rapid pulse.

Hoarse voice may also occur with acute Lung-Heat after an invasion of Wind-Heat: in such a case, a hoarse voice will be accompanied by sore throat, a feeling of blockage of the throat, cough with scanty-yellow sputum, chest pain, a Red tongue with dry-yellow coating and an Overflowing-Rapid pulse.

INTERROGATION (13)

In chronic cases, by far the most common cause of a hoarse voice is a deficiency of Yin of both Lungs and Kidneys: in such cases, hoarse voice is accompanied by dry throat at night, itchy throat, weak voice, dizziness, tinnitus, night-sweating, a tongue without coating and a Floating-Empty pulse. This pattern is more common in the elderly.

A less common cause of chronic hoarse voice (also in the elderly) is an accumulation of Phlegm and Blood stasis in the throat, in which case there will also be a sore throat, a feeling of obstruction of the throat, thickening of the vocal chords, nodules on the vocal chords, a swelling of the throat, a Purple tongue and a Wiry pulse.

FEELING OF FOREIGN BODY IN THE THROAT

INTERROGATION (14)

The feeling of foreign body in the throat is defined as a feeling as if there was a piece of meat stuck in the throat which is not relieved by swallowing or coughing and without any redness, pain or swelling of the throat. This is commonly referred to as the Plum Stone Syndrome, i.e. the patient feels as if there was a plum stone stuck in the throat although the first reference to this syndrome in the “Discussion of Cold Induced Diseases” mentions a piece of meat rather than a plum stone.

INTERROGATION (15)

This symptom is nearly always caused by a stagnation of Qi due to emotional problems: modern Chinese text books always relate this to stagnation of Liver-Qi and to emotional problems such as anger, repressed anger or frustration but it may also be due to Lung-Qi stagnation and failure of Lung-Qi to descend caused by emotions such as worry, sadness or grief. Whatever the emotion or the channel involved, when due to Qi stagnation the feeling of foreign body in the throat comes and goes according to the emotional state of the patient.

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PALPATION

-Soft goitre with indistinct edges, varying in size with emotional state: Qi stagnation

-Large, soft and smooth mass: Phlegm

-Hard, nodular mass that is immovable and grows rapidly, dark skin over mass: Blood stasis.

-Small or medium-size goitre, relatively soft, slippery under the finger: Liver-Fire (with Phlegm).

PATTERNS (1)

QI STAGNATION

Qi stagnation is a frequent pattern appearing in the throat. Nearly all channels flow upwards through the throat and this area is therefore easily affected by any slowing of circulation of Qi. It is important to remember that Qi stagnation affects not only the Liver but also the Lungs, Stomach, Intestines, Heart and Spleen. With regard to the throat, this is particularly affected by Qi stagnation of the Liver, Lungs, Stomach and Heart.

Liver

Liver-Qi stagnation affecting the throat is a very common occurrence causing a feeling of obstruction of the throat, a feeling of foreign body, a difficulty in swallowing together with irritability and depression. This is called the “plum-stone syndrome.”

D5 T7

PATTERNS (2)

Lungs

Lung-Qi not descending and stagnating in the throat is also common and is due to worry, sadness and grief. The “plum-stone syndrome” (with its associated formula Ban Xia Hou Po Tang) was actually originally related to Lung-Qi rather than Liver-Qi and the feeling in the throat was described as feeling like having a piece of roast meat stuck in the throat (rather than a plum-stone) and causing nausea in women. This is described in the Jin Gui Yao Lue by Zhang Zhong Jing chapter 22. This pattern is also a type of Qi-Phlegm, i.e. a Phlegm so non-substantial to be at the borderline and almost like Qi stagnation.

With time, this can lead to actual lumps such as nodules on the vocal cords.

PATTERNS (3)

Stomach

Stomach-Qi not descending also accumulates in the throat giving rise to nausea and a feeling of obstruction of the throat.

Heart

Heart-Qi not descending may also accumulate in the throat also causing a feeling of obstruction in the throat and a feeling of “palpitations” in the throat , i.e. the heart feels like it is beating in the throat. This derives from fear, worry and anxiety. It also causes nausea.

BLOOD STASIS

PATTERNS (4)

Blood stasis is a further stage of Qi stagnation in the throat. It usually derives from Liver-Qi stagnation or Heart-Qi stagnation in the throat. The symptoms are a pronounced feeling of obstruction in the throat, difficulty in swallowing, nodules, goitre, irritability and agitation.

PATTERNS (5)

PHLEGM

Phlegm is a very common pathogenic factor in the throat. It can be:

Qi-Phlegm related to Qi stagnation (of Liver, Lungs, Stomach, Heart) manifesting with a feeling of obstruction in the throat

Damp-Phlegm related to Lungs, Spleen and Kidneys and manifesting with actual phlegm in the throat (often in the morning) and a feeling of oppression of the chest

Phlegm-Fluids related to Lungs, Spleen and Kidneys and manifesting with the expectoration of white-watery phlegm, a feeling of obstruction in the throat and nausea

Phlegm-Heat related especially to the Lungs and manifesting with actual phlegm in the throat that is difficult to expectorate and a feeling of heat.

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Heat

Full Heat is very common in the throat: indeed, the throat cannot have Cold.

PATTERNS (6)

Wind-Heat

This the most common cause of acute sore throat, due to invasion of Wind-Heat in the Lung channel. This symptom is one of the differentiating symptoms of Wind-Heat from Wind-Cold.

Stomach

Stomach-Heat and Stomach-Fire also may accumulate in the throat causing chronic pharyngitis or tonsillitis that are common in children.

Lungs

Lung-Heat may accumulate in the throat usually as residual pathogenic factor after repeated invasions of Wind. This may cause chronic laryngitis and hoarse voice.

PATTERNS (7)

Intestines

Heat of the Intestines may also knot in the throat and cause chronic tonsillitis: this is common in children.

EMPTY HEATEmpty-Heat is also common in the throat and is related to the Lungs, Stomach or Heart.

PATTERNS (8)

LungsLung Empty Heat in the throat is very common and is a common cause of chronic sore or dry throat, especially in the elderly.

StomachStomach Empty Heat may affect the throat causing a chronic sore throat associated with digestive symptoms such as acid regurgitation (hiatus hernia).

HeartHeart Empty Heat may cause a chronic sore throat accompanied by a feeling of palpitations, a feeling of the heart beating in the throat, anxiety and insomnia.

D5 T8

GOITRE (1)

GENERAL ACUPUNCTURE POINTS

• Ah Shi points, four points inserted on the top, bottom, left and right of the thyroid, oblique towards the centre

• Local points ST-11 Qishe, Ren-22 Tiantu, Ren-23 Lianquan, L.I.-17 Tianding, ST-9 Renying, L.I.-18 Futu, S.I.-17 Tianrong, ST-10 Shuitu, extra point Ping Ying (0.7 cun lateral to the space between 4th and 5th cervical vertebrae), extra point Shang Tian Zhu (0.5 cun above BL-10)

• Hua Tuo Jia Ji points

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End Day 1

GOITRE (2)

ANCIENT ACUPUNCTURE PRESCRIPTIONS

• Zhen Jiu Jia Yi Jing: S.I.-17 Tianrong

• Zhen Jiu Da Quan: LU-7 Lieque, L.I.-18 Futu, Ren-22 Tiantu, L.I.-17 Tianrong, ST-12 Quepen, KI-27 Shufu, Yingshu (?), Ren-17 Shanzhong, L.I.-4 Hegu, Shixuan (bleeding).

• Qian Jin Yao Fang: T.B.-13 Naohui, LU-3 Tianfu, ST-11 Qishe.

• Zhen Jiu Pi Sheng Jing: G.B.-10 Fubai and ST-11 Qishe.

QI STAGNATION AND PHLEGM (also called QI GOITRE)

GOITRE (3)

Clinical manifestations

Goitre that is relatively soft and not painful, often neckache, a feeling of oppression of the chest, sighing, hypochondrialdistension and pain, the size of the goitre may fluctuate according to emotional state. Tongue: Swollen with a sticky coating. Pulse: Wiry.

Heart: palpitations, anxiety, chest discomfort, feeling of constriction in the throat.

Lungs: sighing, dry cough, feeling of constriction and/or lump in the throat, slight breathlessness, sadness.

Liver: irritability, a feeling of lump in the throa t, depression.

Treatment principle

GOITRE (4)

Regulate Qi, eliminate stagnation, soothe the Liver, make Lung-Qi descend, make Heart-Qi descend, resolve Phlegm, dissolve goitre.

Acupuncture

GOITRE (5)

T.B.-6 Zhigou, G.B.-34 Yanglingquan, LIV-3 Taichong, P-6 Neiguan, HE-5 Tongli, LU-7 Lieque, L.I.-4 Hegu, L.I.-11 Quchi, G.B.-20 Fengchi, BL-60 Kunlun (Shao Yang and Tai Yang to invigorate Blood and remove obstructions from channels), Ren-22 Tiantu, ST-40 Fenglong, SP-6 Sanyinjiao, Ren-12 Zhongwan, BL-18 Ganshu, BL-15 Xinshu, Ren Mai (LU-7 Lieque and KI-6 Zhaohai), Chong Mai (SP-4 Gongsun and P-6 Neiguan), points surrounding the goitre, Hua Tuo Jia Ji points, L.I.-17 Tianding.

Heart: HE-5 Tongli, HE-7 Shenmen, Ren-15 Jiuwei.

Lungs: LU-7 Lieque, L.I.-4 Hegu, Ren-17 Shanzhong, LU-3 Tianfu.

Liver: see above.

HERBAL TREATMENT

GOITRE (6)

Prescription:

SI HAI SHU YU WAN - Four Seas Soothe Stagnation Pill

Herbs: Mu Xiang Radix Aucklandiae lappae

Hai Dai Zosteramarina

Chen Pi Pericarpium Citrireticulatae Hai Zao Herba

Sargassii

Hai Ge Ke Concha Cyclinaesinensis

Hai Piao Xiao Os Sepiae

Kun Bu Thallus Algae

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LIVER-QI STAGNATION, SPLEEN-QI DEFICIENCY AND PHLEGM

GOITRE (7)

Clinical manifestationsLarge, soft goitre, depression, irritability, feeling of oppression of the chest and hypochondrium, difficulty in swallowing, feeling of lump in throat, loose stools, irregular periods, pre-menstrual tension. Pulse Wiry.

Treatment principleSoothe the Liver, move Qi, tonify Spleen-Qi, soften masses, resolve Phlegm.

AcupunctureT.B.-6 Zhigou, G.B.-34 Yanglingquan, LIV-3 Taichong, P-6 Neiguan, Ren-12 Zhongwan, BL-20 Pishu, Ren-22 Tiantu.

PHLEGM AND BLOOD STASIS

GOITRE (8)


Goitre that is hard, possibly with nodules, painful, dark skin, a feeling of oppression of the chest, insomnia, anxiety. Tongue: Swollen, Purple, sticky coating. Pulse: Wiry.

Treatment principle

Regulate Qi, invigorate Blood, eliminate stasis, resolve Phlegm, soften hardness, dissolve goitre.

GOITRE (9)

Acupuncture

T.B.-6 Zhigou, G.B.-34 Yanglingquan, LIV-3 Taichong, Ren-22 Tiantu, SP-10 Xuehai, BL-17 Geshu, P-6 Neiguan, BL-18 Ganshu, Chong Mai (SP-4 Gongsun and P-6 Neiguan), ST-40 Fenglong, Ren-12 Zhongwan, SP-6 Sanyinjiao, L.I.-17 Tianding.

Three Treasures remedy

LIMPID SEA plus RED STIRRING

LIVER-FIRE BLAZING WITH PHLEGM-HEAT

GOITRE (10)


Small or medium-size goitre, relatively soft, slippery under the finger, mental restlessness, insomnia, thirst, feeling of heat, irritability, red eyes, tremor of hands, red face, bitter taste. Tongue: Red, red sides and tip, dry-yellow coating. Pulse: Rapid and Wiry.

Treatment principle

Drain Fire, clear the Liver, resolve Phlegm, soften hardness, dissolve goitre, calm the Mind.

GOITRE (11)

Acupuncture

LIV-2 Xingjian, HE-8 Shaofu, Ren-22 Tiantu, L.I.-4 Hegu, ST-40 Fenglong, SP-6 Sanyinjiao, HE-7 Shenmen, P-7 Daling, L.I.-17 Tianding. Wang Xue Tai (Zhong Guo Zhen Jiu Da Quan): SP-6 Sanyinjiao, KI-6 Zhaohai, KI-7 Fuliu(according to him nourishes Yin and clears Heat), P-5 Jianshi, LIV-3 Taichong. If ST-Heat: ST-44 Neiting; tremor of hands: G.B.-34 Yanglingquan; if goitre big: ST-10 Shuitu and extra Ping Ying (0.7 cun lateral to the space between 4th and 5th cervical vertebrae); exophthalmos: extra Shang Tian Zhu (0.5 cun above BL-10) and G.B.-20 Fengchi.

Three Treasures remedy

DRAIN FIRE plus CLEAR THE SOUL

HEART- AND LIVER-YIN DEFICIENCY WITH PHLEGM

GOITRE (12)


Goitre that may be large or small, relatively soft, slow onset, palpitations, insomnia, feeling of heat in the afternoon, night-sweating, tremor of hands, dry eyes, blurred vision, tiredness. Tongue: Red without coating. Pulse: Floating-Empty, relatively Overflowing on left cun.

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GOITRE (13)

Treatment principle

Nourish Yin, nourish Heart and Liver, nourish Liver-Blood, calm the Mind, soften the Liver, resolve Phlegm, soften hardness, dissolve goitre.

Acupuncture

Ah Shi points, P-6 Neiguan, ST-36 Zusanli, L.I.-4 Hegu, HE-7 Shenmen, SP-6 Sanyinjiao, LIV-3 Taichong, Ren-4 Guanyuan, KI-6 Zhaohai, L.I.-17 Tianding. Ren Mai (LU-7 Lieque and KI-6 Zhaohai).

HYPERTHYROIDISM (1)

Acupuncture

According to the Shanghai Municipal Acupuncture and Channels Research Group (Zhong Yi Za Zhi, 9,1984, p. 58) the Main pathology of hyperthyroidism is yin deficiency of Liver and Kidneys with Empty Heat in Liver and Heart. Treatment principle is to nourish Water and reduce Wood and Fire.

The Main points used are KI-10 Yingu, KI-7 Fuliu, SP-6 Sanyinjiao and KI-3 Taixi in tonification and HE-7 Shenmen, P-7 Daling, P-8 Laogong and P-5 Jianshi in reduction. Local points for goitre are ST-10 Shuitu (most important one according to them), Ping Ying (extra point level with the space between 4th and 5th cervical vertebrae and 7 fen lateral to it) and Shang Tian Zhu (extra point 5 fen above BL-10). Other distal points are L.I.-4 Hegu and ST-40 Fenglong.

1) EMPIRICAL PRESCRIPTION (Zhong Yi Za Zhi, 1,1987, p.16)

Chai Hu Radix Bupleuri 6gHuang Qin Radix Scutellariae baicalensis 9gBan Xia Rhizoma Pinelliae ternatae 6gDang Shen Radix Codonopsis pilosulae 15gZi Su Geng Ramulus Perillae frutescentis 6gHou Po Cortex Magnoliae officinalis 9gLai Fu Zi Semen Raphani sativi 9gChen Pi Pericarpium Citri reticulatae 6gYu Jin Tuber Curcumae 9gKu Ding Cha Herba Ilecis cornutae 6gGan Cao Radix Glycyrrhizae uralensis 3gFor Liver-Qi stagnation.

HYPERTHYROIDISM (2) HYPERTHYROIDISM (3)

2) EMPIRICAL PRESCRIPTION (Zhong Yi Za Zhi, 1,1987, p. 16)

Zhen Zhu Mu Concha margaritiferae 60g (sic)Gou Teng Ramulus Uncariae 9gJiang Can Bombyx batryticatus 9gShan Zhi Zi Fructus Gardeniae jasminoidis 9gHuang Qin Radix Scutellariae baicalensis 9gXia Ku Cao Spica Prunellae vulgaris 12gZhu Ru Caulis Bambusae in Taeniis 15gDan Shen Radix Salviae miltiorrhizae 15gChi Shao Radix Paeoniae rubrae 9gYe Jiao Teng Caulis Polygoni multiflori 15gBi Yu San 24g (Hua Shi, Gan Cao, Qing Dai)For Liver-Fire.

HYPERTHYROIDISM (4)

3) EMPIRICAL PRESCRIPTION (Zhong Yi Za Zhi, 1,1987, p. 16)

Tai Zi Shen Radix Pseudostellariae 15gMai Men Dong Tuber Ophiopogonis japonici 15gWu Wei Zi Fructus Schisandrae chinensis 9gGou Qi Zi Fructus Lycii chinensis 15gShou Wu Radix Polygoni multiflori 15gShan Yao Radix Dioscoreae oppositae 15gZhen Zhu Mu Concha margaritiferae 30gYu Zhu Rhizoma Poligonati odorati 15gBai Wei Radix Cynanchi baiwei 9gChi Shao Radix Paeoniae rubrae 9gGan Cao Radix Glycyrrhizae uralensis 5g

DR. WEI ZI XIAO EXPERIENCE (Zhong Yi Za Zhi, 6, 199 5, p. 334)

HYPERTHYROIDISM (5)

Treatment principles are:

• Nourish Yin (Sheng Di Huang, Dang Gui, Gou Qi Zi, Nu Zhen Zi, Han Lian Cao, Tian Men Dong, Mai Men Dong, Bie Jia, Bai Shao, Ji Xue Teng)

• Clear Heat (Heart, causing palpitations, insomnia, anxiety: Huang Lian, Shan Zhi Zi, Lian Xin, Bai Zi Ren; Stomach causing thirst and hunger: Shi Gao, Zhi Mu, Gan Cao, Huang Lian, Huang Qin; liver causing dizziness, blurred vision, irritability, tremor: Hu ang Qin, Long Dan Cao, Xia Ku Cao, Ci Shi, Mu Li)

• Eliminate stagnation (Chai Hu, Xiang Fu, Yu Jin, Fu Ling, Bai Zhu)

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HYPERTHYROIDISM (6)

For goitre he uses Si Qi Tang plus Gui Zhi, E Zhu, Chuan Shan Jia, Bai Jie Zi, Mu Li. For exophthalmos he drains Dampness, resolve Phlegm, eliminates stasis and expels Wind using Mu Tong, Ze Xie, Bai Jie Zi, ban Xia, Zhe Bei Mu, E Zhu, Chi Shao, Yi Mu Cao, Ju Hua, Mu Zei Cao, Bai Ji Li.

Finally, he uses Hai Zao 20-30g per day

CLINICAL STUDIES (1)

Journal of Chinese Medicine (Zhong Yi Za Zhi), 11, 1992, p. 28.

115 cases of nodules on thyroid with hyperthyroidism, raised T3 and T4. Formula used: Chai Hu 240g, Xia Ku Cao 300g, Shan Ci Gu 200g, Chen Pi 200g, Gui Jian Yu Herba Euonymi alati(break Blood) 200g, Ban Xia 200g, Zhe Bei Mu 200g, Hai Zao 200g, Kun Bu 200g.

Journal of Chinese Medicine (Zhong Yi Za Zhi), 9, 1984, p. 47.

98 cases of hyperthyroidism, raised T3 and T4. Treatment principle adopted was to tonify Qi and nourish Yin. Formula; Huang Qi 30-45g (sic), Bai Shao 12g, Sheng Di Huang 15g, Xiang Fu 12g, Xia Ku Cao 30g, Shou Wu 20g. If Spleen-Qi deficiency: Shan Yao, Bai Zhu. If Heart-Fire: Huang Lian. If Liver-Fire: Long Dan Cao.

CLINICAL STUDIES (2)

Journal of Chinese Medicine (Zhong Yi Za Zhi) 91,1993, p. 542.

Formula used: Fu Zi, Yin Yang Huo, Rou Gui, Fu Ling, Bai Zhu, Gan Jiang, Huang Qi, Dang Gui, Sheng Di Huang, Shu Di Huang, Shan Zhu Yu, Bai Shao.

Chinese Acupuncture and Moxibustion (Zhong Guo Zhen Jiu) 5,1986, p. 15.

129 cases of hyperthyroidism. Compared three groups of points:

•Ah Shi points around goitre and ST-10 Shuitu

•P-6 Neiguan, P-5 Jianshi, ST-36 Zusanli, SP-6 Sanyinjiao

•Ah Shi points around goitre, P-6 Neiguan, P-5 Jianshi, ST-36 Zusanli, SP-6 Sanyinjiao.

Best results were obtained with third group.

POINTS: REN-22 (1)

Ren-22 Tiantu “Heavenly chimney”

Location: on the midline, in the centre of the supra-sternal fossa, 0.5 cun superior to the suprasternalnotch.

Name: the “chimney” is the trachea; “heavenly” refers to the “movement” of the trachea towards to the top of the body (tu also means “dash forward”, “project”, “stick out”).

Intersections: meeting point with Yin Wei Mai. Point of Window of Heaven.

POINTS: REN-22 (1)

Energetics: the Main feature of this point is that it makes Qi descend (Action 1). The throat is overlying both the pharynx (related to the digestive system) and the larynx (related to the respiratory system): this point makes Qi descend primarily in relation to the latter (Action 2), but secondarily also the latter (Action 3). Thus, it is an important point to make Lung-Qi descend because the Lung channel goes up to the throat coming from the abdomen before emerging at LU-1. As it makes Qi descend, it helps to resolve Phlegm (Action 4). As a point of the Ren Mai, it has an influence on the Ren Mai channel in the face and root of tongue (Action 5).

Actions

•Action 1: obstruction of the chest, feeling of fullness of the chest, pain in the heart region, plum-stone Qi.

•Action 2: cough, asthma, breathlessness

•Action 3: oesophageal constriction, vomiting.

•Action 4: rattling sounds in throat, phlegm in throat, goitre.

•Action 5: red face, dark veins under tongue, feeling of heat in the face, throat ulcers, dry throat, hoarse voice, sudden loss of voice.

POINTS: REN-22 (3)

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POINTS: REN-22 (4)

Combinations

•Ren-17 Shanzhong, P-1 Tianchi, ST-41 Jiexi and S.I.-15 Jianzhongshu: rebellious Qi cough.

•Ren-17 Shanzhong: asthma, inability to sleep, agitation.

•Ren-17 Shanzhong: breathlessness, cough.

•BL-13 Feishu: hoarse voice.

•LU-11 Shaoshang and L.I.-4 Hegu: swollen and painful throat.

•T.B.-16 Tianchuang: feeling of heat of the face.

Ren-23 Lianquan “Clean spring”

POINTS: REN-23 (1)

Location: on the anterior midline of the neck, in the depression above the hyoid bone.

Name: the name refers to the saliva and the point’s influence on production of saliva.

Intersections: Yin Wei Mai.

Energetics: it makes Qi descend in a similar way to Ren-22 (Action 1). It influences the saliva (Action 2). It influences the tongue and voice (Action 3).

POINTS: REN-23 (2)

Actions

•Action 1: cough, rebellious Qi, breathlessness

•Action 2: excessive salivation, dry mouth, thirst

Combinations

•KI-2 Rangu and KI-10 Yingu: swelling of the tongue with difficulty in speaking

POINTS: REN-23 (2)



POINTS: REN-23 (2)


•Action 3: swelling of the tongue, difficulty in speaking, loss of voice, loss of voice following Wind-stroke, contraction of root of tongue.


POINTS: REN-23 (2)


POINTS: ST-9 (1)

ST-9 Renying “Person’s Welcome”

Location: level with the tip of and 1.5 cun lateral to the laryngeal prominence, in the depression between the anterior border of the sternocleidomastoid muscle and the lateral border of the thyroid cartilage. It is between the carotid artery and the lateral border of the thyroid cartilage.

Name: Ying means “welcome” but can also be translated as “predict” or “calculate.” In this latter sense, the name could be translated as “Predicting a Person” or “Person’s [state] predicting”: this interpretation makes sense as this point was palpated for pulse diagnosis in ancient times before the Nan Jing established the practice of using the radial artery for pulse diagnosis.

Energetics: it makes Qi descend and subdues rebellious Stomach-Qi (Action 1) and also rebellious Lung-Qi (Action 2). All Windows of Heaven points subdue rebellious Qi as they are all situated in the neck region, i.e. a strategic area between the body and the head and a “bottleneck” through which practically all channels flow. (Other Window of Heaven points are LU-3 Tianfu, L.I.-18 Futu, T.B.-16 Tianyou and BL-10 Tianzhu). Being a point of the Sea of Qi also means that it is for rebellious Qi and the full symptoms of the Sea of Qi are “fullness in the chest, urgent breathing, red complexion.” ST-9 is obviously for fullness of the Sea of Qi and not emptiness (“scanty energy insufficient for speech”): presumably the other points for the Sea of Qi (Ren-17 Shanzhong and Du-15 Yamen) are for emptiness of the Sea of Qi. It resolves Phlegm in the throat (Action 3).

POINTS: ST-9 (2)

Intersections: Gall-Bladder and Stomach, Sea of Qi, Window of Heaven.

POINTS: ST-9 (3)Actions

•Action 1: headache, dizziness, red face, food poisoning, vomiting.

•Action 2: Fullness of the chest, breathlessness, asthma.

•Action 3: swelling of throat, scrofula (Phlegm-Heat and Toxic Heat), goitre (Phlegm with Qi stagnation), difficulty in swallowing (Qi-Phlegm).

Combinations

•P-6 Neiguan, T.B.-1 Guanchong, SP-6 Sanyinjiao, ST-36 Zusanli: food poisoning, headache, chest pain and breathlessness.

•L.I.-11 Quchi and ST-36 Zusanli: hypertension

•Du-20 Baihui, L.I.-11 Quchi and LIV-3 Taichong: hypertension

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POINTS: ST-10 (1)

ST-10 Shuitu “Water Prominence”

Location: on the neck, at the anterior border of the sternocleidomastoid muscle, midway between ST-9 and ST-11.

Name: the name of this point refers to the carotid artery that may be felt pulsating under this point like rushing water.

Intersections:

Energetics: this point also a descending movement and subdue rebellious Lung-Qi (Action 1). It resolve Phlegm in the throat (action 2).

Actions

•Action 1: cough, whooping cough, breathlessness

•Action 2: swelling and pain of the throat, goitre, scrofula

Combinations

•ST-11 Qishe: swelling of throat

POINTS: ST-10 (2)

POINTS: S.I-.17 (1)

S.I.-17 Tianrong “Heavenly Appearance”

Location: in the depression between the angle of the mandible and the anterior border of the sternocleidomastoid muscle.

Name: this point is one of the five (or ten) “Window of Heaven” points which are all around the neck area in a strategic position between the torso and the head (the “Heaven”).

Intersections: Point of “Window of Heaven.”

Energetics: makes Qi descend and subdues rebellious Qi of the Lungs (Action 1). It resolves Phlegm in the neck (Action 2).

POINTS: T.B.-17 (2)

Actions

•Action 1: fullness of the chest with difficulty in breathing, wheezing, asthma, cough, chest pain, vomiting

•Action 2: throat obstruction, goitre, scrofula, swelling and pain of the neck, swelling of cheeks

Combinations

•L.I.-18 Futu, Ren-23 Lianquan, BL-42 Pohu, ST-11 Qishe and BL-45 Yixi: cough, breathlessness, vomiting of foam

•L.I.-5 Yangxi: feeling of oppression of the chest with breathlessness

POINTS: L.I.-18 (1)

L.I.-18 Futu “Support the prominence”

Location: on the lateral side of the neck, level with the tip of the laryngeal prominence, between the sternal and clavicular heads of the sternocleidomastoid muscle.

Name: “prominence” refers to the laryngeal protuberance and “support”refers to this point’s action in treating problems of the larynx.

Intersections: “Window of Heaven” point.

Energetics: makes Qi descend and subdue rebellious Lung-Qi (Action 1). Resolves Phlegm from the neck (Action 2). It benefits the vocal cords (Action 3).

POINTS: L.I.-18 (2)

Actions

•Action 1: cough, wheezing, asthma

•Action 2: swelling of the throat, rattling sound in throat goitre, scrofula

•Action 3: sudden loss of voice

Combinations

•T.B.-16 Tianchuang, T.B.-6 Zhigou, G.B.-7 Qubin and HE-4 Lingdao: sudden loss of voice (Qian Jin Yao Fang)

•S.I.-17 Tianrong, Ren-23 Lianquan, BL-42 Pohu, ST-11 Qishe and BL-45 Yixi: cough, breathlessness, vomiting of foam

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THE CHEST

GIOVANNI MACIOCIA

CHANNELS (1)

The Main or Deep pathways of the following channels run through the chest:

MAIN CHANNELS

• Heart• Lung

MAIN CHANNELS

•Pericardium •Small Intestine

MAIN CHANNELS

•Triple Burner •Kidney

MAIN CHANNELS

• Stomach • Spleen

MAIN CHANNELS

• Gall-Bladder • Liver

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MUSCLE CHANNELS

CHANNELS (2)

The following Muscle channels run through the chest:

Lung Stomach Spleen

MUSCLE CHANNELS

Heart Pericardium Gall-Bladder

DIVERGENT CHANNELS

CHANNELS (3)

The following Divergent channels run through the chest:

Lung Large Intestine Stomach

DIVERGENT CHANNELS

Spleen Heart Small Intestine

Kidney

DIVERGENT CHANNELS

Pericardium Triple BurnerGall-Bladder

Liver

CONNECTING CHANNELS

The following Connecting channels run through the chest:

CHANNELS (4)

Stomach Great Luo of the Stomach

Great Luo of the Spleen

Heart

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CONNECTING CHANNELS

Kidney Small Intestine

Pericardium Triple Burner

EXTRAORDINARY VESSELS

CHANNELS (5)

The chest is influenced by the following Extraordinary meridians:

Chong Mai Du Mai Ren MaiYin Wei

MaiYin Qiao

Mai


The front of the chest is influenced by the Lung and Heart channel and by the Directing and Penetrating Vessels; the sides of the chest are influenced by the Gall-Bladder and Liver channels.

Protruding chest

The most common cause of a protruding chest is chronic retention of Phlegm in the Lungs. Other causes include: severe, chronic Liver-Qi stagnation or Blood stasis in the chest.


Sunken chest

The most common cause of a sunken chest is a deficiency of Qi or Yin of the Lungs. A Kidney deficiency may also cause a sunken chest.

Protruding sternum

The protruding sternum is either hereditary, in which case it is due to a constitutional deficiency of the Lungs and Kidneys, or it is due to retention of Phlegm in the Lungs.


Chest sunken on one side

The chest can become sunken on one side either because of a deficiency of the Lungs, specifically affecting one lung, or because of retention of Phlegm-Fluids often with Blood stasis.

Chest protruding on one side

The chest can become protruding on one side from Phlegm-Fluids in the Lungs, severe Liver-Qi stagnation or Heart-Qi deficiency with Blood stasis.


Gynaecomastia

Gynaecomastia indicates a swelling of the breast in males. It may be due to either Liver-Blood stasis or Damp-Heat in the Penetrating Vessel.

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INTERROGATION

The chest, or thorax, refers to the part of the body enclosed by the ribs and breast bone.

From the Chinese point of view, there is a difference between the front part of the chest, which is under the influence of the Heart and Lungs, and the sides of the chest, which are under the influence of the Liver and Gall-Bladder. The front of the chest is also the area where the Gathering Qi (Zong Qi) is concentrated.

INTERROGATION: CHEST PAIN (1)

Here, “chest”indicates the front of the chest.

A pain in this area is usually due to either the Heart or Lung channel and it always denotes a Full condition (even though this itself may derive from an underlying Empty condition).

A stabbing or pricking chest pain indicates Blood stasis affecting the Heart channel and this often occurs against a background of Heart-Yang deficiency: it falls under the category of Chest Painful Obstruction Syndrome.

Chest pain accompanied by cough with expectoration of profuse yellow sputum is due to Lung-Heat and this may be seen in acute lung conditions, such as bronchitis, pneumonia or pleuritis.


Chest pain can be further differentiated according to its character.

A fixed pain like needles indicates Blood stasis which is either due to Blood stasis in the Heart channel from internal conditions or to external trauma.

Chest pain accompanied by a feeling of distension of the chest itself and the hypochondrium indicates Qi stagnation and is usually accompanied by sighing and irritability.

An intermittent, chronic chest pain that comes and goes also indicates Blood stasis but suggests an underlying Empty condition of Qi or Yang deficiency.


A chest pain in the large area of the chest together with cough, breathlessness and red face indicates Lung-Heat.

Chest pain extending to the hypochondrial region may be due to Damp-Heat in the Liver and Gall-Bladder channel.

Pain in the heart region on the left side of the chest indicates either Heart-Blood stasis or Phlegm obstructing the Heart channel.

Chest pain extending to the upper back is usually due to Phlegm or Blood stasis


Summary:

Stabbing pain - Heart-Blood stasis

Chest pain with cough and yellow sputum – Lung Heat

Distending chest and hypochondrial pain – Qi stagnation

Intermittent chronic chest pain – Blood stasis

Chest and hypochondrial pain with feeling of [word not clear] - Damp-Heat in the Liver and Gallbladder

INTERROGATION: PAIN IN THE RIBS

"Pain in the ribs" refers to pain on the lateral aspect of the rib cage above the hypochondrial area.

Pain in the ribs with a pronounced feeling of distension is due to Liver-Qi stagnation

If severe it is due to Blood stasis

Pain in the ribs with a feeling of oppression and heaviness may be due to Damp-Heat in the Liver and Gall-Bladder.

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INTERROGATION: A FEELING OF OPPRESSION OF THE CHEST (1)

A feeling of oppression of the chest is the translation of the Chinese term xiong menwhich I translate as a feeling of oppression of the chest.

Western patients, at least in Anglo-Saxon countries, would seldom use this term and report this symptom as a feeling of tightness or discomfort of the chest.


A feeling of oppression of the chest accompanied by cough and expectoration of phlegm indicates retention of Phlegm in the Lungs which is the most common cause of this symptom.

A feeling of oppression of the chest without cough and without expectoration of phlegm and accompanied by slight breathlessness, sighing and a feeling of lump in the throat indicates stagnation of Lung-Qi with Lung-Qi failing to descend usually caused by emotional problems such as sadness or worry. Although a feeling of lump in the throat in usually related to Liver-Qi stagnation, stagnation of Lung-Qi caused by emotional problems is a very frequent cause of this symptom together with a feeling of oppression of the chest.


Another very common cause of a feeling of oppression of the chest is rebellious Qi of the Penetrating vessel which is more common in women.

However, in order to diagnose rebellious Qi of the Penetrating vessel, a feeling of oppression of the chest should be accompanied by other abdominal symptoms such as abdominal distension, pain around the umbilicus or epigastrictightness.

INTERROGATION: A FEELING OF HEAT OF THE CHEST (1)

Excluding external invasions of Wind-Heat, a feeling of heat of the chest is due to Full or Empty Heat of the Lung or Heart channels.

• If there is a feeling of heat in the chest, accompanied by thirst, insomnia, palpitations and agitation it indicates Heart-Fire

• If there is a feeling of heat in the evening, dry mouth at night, night-sweating and 5-palm heat, it is due to Heart Empty Heat

INTERROGATION: A FEELING OF HEAT OF THE CHEST (2)

A feeling of heat of the chest accompanied by cough, hot hands, expectoration of yellow mucus is due to Lung-Heat

A feeling of heat of the chest accompanied by night-sweating, a feeling of heat in the afternoon, 5-palm heat and a dry cough indicates Lung Empty Heat.

When we ask patients about palpitations it is important to explain to them the meaning of this symptom: most patients mistakenly identify palpitations with tachycardia, i.e. the pulse beating faster than normal.

In reality, palpitations are not related to the rate or speed of the pulse but simply indicate a subjective and uncomfortable sensation of being aware of one’s heartbeat.

INTERROGATION: PALPITATIONS (1)

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Palpitations is a symptom which is always related to the Heart and it may appear in any of the Heart patterns.

Palpitations with an acute onset may be due to external stimuli such as a fright or an overwhelming emotional upset, in which case it is called “fright palpitations” ( jing ji ).

Palpitations that extend upwards towards the chest and throat and downwards towards the umbilicus and abdomen is called zheng zhongwhich means “panic and anxiety”. This type of palpitations is due to rebellious Qi in the Penetrating Vessel affecting the Heart and it is considered a more severe type than ordinary palpitations.

INTERROGATION: PALPITATIONS (2) PALPATION

Palpation of the chest should be carried our systematically examining the following areas:

• Apical pulse

• Chest

• Breast

PALPATION: APICAL PULSE (1)

The apical pulse can be palpated in the fifth intercostal space: from a Western, anatomical point of view, it is the palpation of the left ventricle of the heart, while in ancient Chinese medicine it was called the pulsation of Xu Li which relates to the Great Connecting channel of the Stomach and reflects the state of the Gathering Qi (Zong Qi).

The pulsation of the apical pulse therefore reflects the state of the Gathering Qi


• Under normal conditions, it should be felt clearly but not be hard and it should be relatively slow: this indicates a normal state of the Gathering Qi.

•If the pulsation of the apical pulse is feeble and without strength, it indicates a deficiency of the Gathering Qi and therefore of Lungs and Heart

•If the pulsation feels too strong and hard it indicates an Excess condition of the Lungs and/or Heart. However, in some case, when the left ventricle is enlarged, the apical pulse may feel “large” but Empty and this indicates Heart-Qi deficiency.


• If the apical pulse stops and starts, it may indicate that the patient has suffered a severe shock; this sign may also be seen in alcoholism.

•The pulsation of the apical pulse should also be compared to that of the radial pulse and the two should be similar to each other, e.g. if the apical pulse feels feeble, the radial pulse should also feel Weak, Empty or Choppy. A discrepancy between the apical and the radial pulse is a poor prognostic sign and it often indicates heart disease.

• The apical pulse may become affected by short-term influences such as shock, fright or a severe outburst of anger in which case it becomes very rapid.

PALPATION: CHEST

The centre of the chest corresponds to the Heart and the rest of it to the Lungs.

Palpation of the chest reveals the state of the Heart, Lungs and Pericardium and generally speaking tenderness on palpation indicates a Full condition of one of these organs. For example:

• If the chest feels very tender even on light palpation in the centre, in the area of Ren-17 Shanzhong, it may indicate Heart-Blood stasis

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PALPATION: CHEST

• If the chest is tender on palpation in the areas around the centre, it usually indicates an Excess condition of the Lungs and often retention of Phlegm in the Lungs.

• By contrast, if palpation of the chest relieves discomfort, it indicates a Deficiency condition of the Heart or Lungs.

• if superficial palpation of the chest relieves a pain but the patient feels discomfort with a deeper pressure, it indicates a combined condition of Deficiency and Excess.

PALPATION: THE BREAST (1)

Palpation of the breasts in women is carried out when there are breast lumps.

Breast lumps may be malignant or benign and the purpose of the palpation is never to replace the Western diagnosis, i.e. we should never rely on palpation only to distinguish benign from malignant lumps.

The purpose of palpation of breast lumps in Chinese medicine is to identify the patterns causing them.

PALPATION: THE BREAST (2)

The palpation of lumps should take into consideration their hardness, their edges and their mobility:

relatively soft: Phlegm

relatively hard: Blood stasis

distinct edges: Phlegm

indistinct edges: Toxic Heat

mobile on palpation: Phlegm

immoveable on palpation: Blood stasis or Toxic Heat

PALPATION: THE BREAST (3)Small, moveable lumps with distinct edges and which change size according to the menstrual cycle normally indicate fibrocystic disease of the breast, which is usually due to a combination of Phlegm and Qi stagnation.

A single, relatively hard, moveable lump with distinct edges which may be also slightly painful usually indicates a fibroadenoma which, from the Chinese point of view is due to a combination of Phlegm and Blood stasis.

A single, hard, immoveable lump with indistinct margins, without pain, may indicate carcinoma of the breast which, in Chinese medicine, is usually due to a combination of Phlegm, Qi stagnation and Blood stasis occurring against a background of disharmony of the Penetrating and Directing Vessels

PATTERNS

The most common and clinically-relevant patterns of the chest are:

Thus, the most clinically-relevant patterns of the chest are the Full ones.

Phlegm

Blood stasis

Qi stagnation

Penetrating Vessel’s pathology

PATTERNS: PHLEGM

The chief symptom relating to Phlegm in the chest is a feeling of oppression (men); and

The chief sign is expectoration of phlegm.

Obviously, in patients suffering from chronic cough, expectoration of phlegm is an obvious sign; however, it is important to note that retention of Phlegm in the chest is indicated also by the scanty and occasional expectoration of phlegm in patients not suffering from chronic cough. For example, the slight expectoration of movement of phlegm on coughing in the morning only would also indicate retention of Phlegm in the chest.

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PATTERNS: BLOOD STASIS

Blood stasis causes chest pain which can vary from an occasional pricking sensation to a severe, stabbing pain.

This symptom often, but not always, corresponds to Western diseases such as coronary heart disease or angina pectoris.

PATTERNS: QI STAGNATION

Qi stagnation in the chest is frequently derived from the Lungs rather than Liver although the latter can also influence the chest.

Stagnant Liver-Qi affecting the chest is seen primarily in some types of asthma (especially of young people) or in women with pre-menstrual tension.

In many other cases, stagnant Lung-Qi affects the chest causing a slight breathlessness, a feeling of tightness of the chest (no Western patient will say “distension”), sighing.

Stagnation of Lung-Qi is addressed by the formula Ban Xia Hou Po Tang (Open the Heart).

PATTERNS: PENETRATING VESSEL PATHOLOGY

Rebellious Qi in the Penetrating Vessel can affect the chest causing a pronounced feeling of tightness, sighing, slight breathlessness.

This pattern can be diagnosed only in conjunction with other symptoms in the abdomen and throat.

DISEASES: ACUTE COUGH (1)

Invasion of Wind-ColdAcute cough with expectoration of white sputum, aversion to cold, fever, occipital headache, stiff neck, sneezing, body aches, tongue with thin-white coating, Floating-Tight pulse.

Invasion of Wind-HeatAcute cough with expectoration of yellow sputum, aversion to cold, fever, sore throat, sweating, slight thirst, tongue slightly Red on the front with a thin-white coating, Floating-Rapid pulse.

Invasion of Wind-DrynessAcute, dry cough, aversion to cold, fever, dry throat, itchy throat, Floating pulse.

Phlegm-Heat in the LungsAcute, barking cough following an invasion of external Wind with profuse, sticky-yellow or green sputum, shortness of breath, wheezing, a feeling of oppression of the chest, a feeling of heat, thirst, Red and Swollen tongue with a sticky-yellow coating, Slippery-Rapid pulse.

.

DISEASES: ACUTE COUGH (2)

Lung-HeatAcute, barking cough following an invasion of external Wind, expectoration of scanty yellow sputum, slight breathlessness, feeling of heat, chest ache, flaring of nostrils, thirst, red face, Red tongue with yellow coating, Overflowing-Rapid pulse

Damp-Phlegm in the LungsChronic cough with easy expectoration of profuse-white sputum, rattling sound in the throat, breathlessness, inability to lie down, a feeling of heaviness, a feeling of oppression of the chest, nausea, vomiting, Swollen tongue with sticky coating, Slippery pulse.

DISEASES: CHRONIC COUGH (1)

Phlegm-Dryness in the LungsChronic, dry cough with a weak sound and occasional, difficult expectoration of scanty sputum, dry throat, a feeling of oppression of the chest, Swollen and dry tongue, Slippery pulse.

Lung-Yin deficiencyChronic cough that is dry or with difficult expectoration of scanty sputum, dry cough, weak voice, dry throat with desire to drink in small sips, hoarse voice, night-sweating, tiredness, tongue without coating in the front, Floating-Empty pulse.

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Lung-Yin deficiency with Empty HeatChronic cough that is dry or with difficult expectoration of scanty sputum which may be blood tinged, dry mouth and throat at night, night-sweating, tiredness, malar flush, a feeling of heat or a low-grade fever in the evening, 5-palm heat, thin body, Red tongue without coating, Floating-Empty and Rapid pulse.


Lung-DrynessChronic, dry cough, dry throat, slight chest pain, hoarse voice, dry nose, dry tongue, Floating-Empty pulse.

Lung-Qi deficiencyChronic, slight cough with a weak sound, slight breathlessness, propensity to catching colds, weak voice, slight sweating, Pale tongue, Empty pulse.

Cold-Phlegm in the LungsChronic cough with expectoration of white-watery sputum, feeling cold, cold limbs, a feeling of oppression of the chest, breathlessness, pale complexion, bluish lips, inability to lie down, Pale and Swollen tongue with sticky coating, Slippery-Deep pulse.


Liver-Fire insulting the LungsChronic, barking cough, breathlessness, a feeling of fullness of the chest and hypochondrium, thirst, bitter taste, irritability, dark urine, Red tongue with redder sides and yellow coating, Deep-Full-Wiry-Rapid pulse.

Phlegm-Fluids in the LungsChronic cough with expectoration of white-watery-frothy sputum, swollen face and hands, a feeling of oppression of the chest, breathlessness, inability to lie down, Pale and Swollen tongue, Deep-Wiry pulse.

Lung-Qi deficiencySlight breathlessness, slight cough, propensity to catching colds, weak voice, slight sweating, Pale tongue, Empty pulse.

DISEASES: BREATHLESSNESS (1)

Lung-Yin deficiencySlight breathlessness with difficulty in exhaling, dry cough, weak voice, dry throat with desire to drink in small sips, hoarse voice, night-sweating, tiredness, tongue without coating in the front, Floating-Empty pulse.

Kidneys not receiving QiSlight breathlessness with difficulty in inhaling, feeling cold,cold feet, backache, dizziness, tinnitus, frequent-pale urination, Pale tongue, Weak pulse.

Lung-Qi stagnationSlight breathlessness, sighing, a feeling of tightness of the chest, sadness, worry, a feeling of lump in the throat, depression, slightly Tight Lung pulse.


Phlegm-Heat in the LungsAcute breathlessness, barking cough with profuse, sticky-yellow or green sputum, wheezing, a feeling of oppression of the chest, a feeling of heat, thirst, Red and Swollen tongue with a sticky-yellow coating, Slippery-Rapid pulse.

Damp-Phlegm in the LungsBreathlessness, wheezing, chronic cough with expectoration of profuse, white-sticky sputum which is easy to expectorate, white-pasty complexion, a feeling of oppression of the chest, shortness of breath, dislike of lying down, nausea, Swollen tongue with sticky coating, Slippery pulse.

Lung-HeatAcute breathlessness, cough with expectoration of scanty-yellow sputum, feeling of heat, chest ache, flaring of nostrils, thirst, red face, Red tongue with yellow coating, Overflowing-Rapid pulse.


Cold-Phlegm in the LungsBreathlessness, cough with expectoration of white-watery sputum, feeling cold, cold limbs, a feeling of oppression of the chest, pale complexion, bluish lips, inability to lie down, Pale and Swollentongue with sticky coating, Slippery-Deep pulse.

Kidney-Yang deficiency with PhlegmSlight breathlessness with difficulty in inhaling, cough with expectoration of white-watery sputum, feeling cold, cold feet, backache, dizziness, tinnitus, frequent-pale urination, Pale, Swollen and wet tongue, Weak and slightly Slippery pulse.

Kidney-Yang deficiency with Water overflowing to the LungsSevere breathlessness, cough with expectoration of white-watery-frothy sputum, inability to lie down, palpit ations, oedema, cold limbs, Pale, Swollen and wet tongue, Deep-Weak pulse.


Phlegm in the Lungs with Lung-Qi deficiencyShort, irregular, rapid breathing but without prono unced struggling for breath and without raising the shoulders, feeling of oppression of the chest, sputum in the throat, weak voice, propensity to catching colds, tiredness, Swollen tongue, Soggy pulse. This is called “shortness of breath” ( duan Qi) rather than “breathlessness”.

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Lung-Qi and Kidney-Yang deficiencyWeak, low, short breathing sounds, weak voice, propensity to catching cold, tiredness, backache, dizziness, tinnitus, feeling cold, weak knees, bright-white complexion, abundant-clear urination, Pale and wet tongue, Deep-Weak pulse. This is called “weakness of Qi” ( Qi shao) rather than breathlessness.


Rebellious Qi of the Penetrating VesselRapid, short breaths, cough, a feeling of tightness of the chest, palpitations, anxiety, abdominal fullness, painful periods, Firmpulse.

Liver-Fire insulting the LungsRapid, short breaths, cough, a feeling of tightness of the chest, headaches, dizziness, tinnitus, irritability, propensity to outbursts of anger, red face, thirst, bitter taste, constipation, dark urine, Red tongue with redder sides and dry-yellow coating, Wiry-Rapid pulse.

Cold-Phlegm in the LungsWheezing, cough with expectoration of white sputum, cold limbs, rattling sound in the throat, a feeling of oppression of the chest, nausea, pale-bluish complexion, Pale and Swollen tongue with sticky coating, Slippery-Deep pulse.

DISEASES: WHEEZING (1)

Phlegm-Heat in the LungsNoisy wheezing, barking cough with profuse, sticky-yellow or green sputum, shortness of breath, a feeling of oppression of the chest, a feeling of heat, thirst, Red and Swollen tongue with a sticky-yellow coating, Slippery-Rapid pulse.

Damp-Phlegm in the LungsWheezing, chronic cough with expectoration of profuse, white-sticky sputum which is easy to expectorate, rattling sound in the throat, white-pasty complexion, a feeling of oppression of the chest, shortness of breath, dislike of lying down, nausea, Swollen tongue with sticky coating, Slippery pulse.


Lung-Yang deficiency with PhlegmSlight wheezing, expectoration of white watery sputum, breathlessness, rattling sound in the throat, cold limbs, worse on exercise, pale face, sweating, feeling cold, propensity to catching colds, Pale and wet tongue, Deep-Weak and slightly Slippery pulse.

Lung-Yin deficiency with PhlegmSlight wheezing, expectoration of scanty sputum, breathlessness, a feeling of heat in the evening, dry throat, night-sweating, tongue without coating, Floating-Empty and slightly Slippery pulse.


Lung-Qi deficiency with PhlegmChronic wheezing, shortness of breath, slight cough, weak voice, spontaneous daytime sweating, dislike to speak, pale complexion, propensity to catching colds, a feeling of oppression of the chest, sputum in the throat, Pale and Swollen tongue, Soft pulse.

Spleen-Qi deficiency with PhlegmSlight, chronic wheezing, sputum in the throat, a feeling of oppression of the chest, poor appetite, tiredness, slight abdominal distension, pale complexion, loose stools, Pale and Swollen tongue, Soft pulse.


Kidney-Qi deficiency with PhlegmChronic wheezing, backache, feeling cold, dizziness, tinnitus, tiredness, weak knees, pale-profuse urination, a feeling of oppression of the chest, sputum in the throat, Pale and Swollen tongue, Weak-Deep and slightly Slippery pulse.

Heart-Blood stasisStabbing or pricking chest pain, palpitations, purple lips, dark complexion, Purple tongue, Choppy pulse.

DISEASES: CHEST PAIN (1)

Heart-Yang deficiencyA feeling of discomfort or very slight pain of the chest, cold hands, palpitations, pale face, sweating, Pale and wet tongue, Deep-Weak pulse.

Heart-Yang deficiency with PhlegmDull chest pain, a feeling of oppression or tightness of the chest, cold hands, palpitations, pale face, sweating, Pale and Swollen tongue with sticky coating, Deep-Weak-Slippery pulse.

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Phlegm-Heat in the LungsChest pain, a feeling of oppression of the chest, shortness of breath, barking cough with profuse, sticky-yellow or green sputum, wheezing, a feeling of heat, thirst, Red and Swollen tongue with a sticky-yellow coating, Slippery-Rapid pulse.


Liver-Qi stagnationDull chest and hypochondrial distension and pain, hypochondrial or epigastric distension, irritability, moodiness, Wiry pulse.

Rebellious Qi in the Penetrating VesselDull chest pain, a feeling of tightness of the chest, palpitations, anxiety, a feeling of lump in the throat, abdominal and umbilical fullness, epigastric fullness, irregular periods, painful periods, a feeling of energy rising in the abdomen to the chest, a feeling of heat in the face, nausea, Firm pulse.


Lung-Qi stagnationSlight chest pain, a feeling of tightness of the chest, sadness,worry, sighing, slight breathlessness, a feeling of lump in the throat, depression, slightly Tight Lung pulse.

Damp-Heat in the Liver and Gall-Bladder channelsChest pain extending to the hypochondrium, a feeling of oppression and heaviness of the chest, bitter taste, thirst, irritability, unilateral sticky-yellow tongue coati ng, Wiry-Slippery-Rapid pulse.

Please note that this particular feeling is sometimes described as a “feeling of tightness” of the chest by many patients.

DISEASES: FEELING OF OPRESSION OF THE CHEST (1)

Phlegm in the Lungs

A feeling of oppression of the chest, breathlessness, Swollen tongue with sticky coating, Slippery pulse. Other symptoms and signs depend on whether there is Cold-Phlegm, Damp-Phlegm or Phlegm-Heat (see above).

Lung-Qi stagnation

A feeling of oppression of the chest, slight chest pain, a feeling of tightness of the chest, sadness, worry, sighing, slight breathlessness, a feeling of lump in the throat, depression, pulse slightly Tight in the right-Front position.

Liver-Qi stagnationA feeling of oppression and distension of the chest and hypochondrium, epigastric distension, irritability, moodiness, Wiry pulse.

DISEASES: FEELING OF OPRESSION OF THE CHEST (2)

Rebellious Qi in the Penetrating vesselA feeling of oppression of the chest, dull chest pain, a feeling of tightness of the chest, palpitations, anxiety, a feeling of lump in the throat, abdominal and umbilical fullness, epigastric fullness, irregular periods, painful periods, a feeling of energy rising in the abdomen to the chest, a feeling of heat in the face, nausea, Firm pulse.

Heart-Yang deficiency with PhlegmA feeling of oppression or tightness of the chest, slight chest pain or discomfort, cold hands, palpitations, pale face, sweating, Pale and Swollen tongue with sticky coating, Deep-Weak-Slippery pulse.

Liver-Qi stagnation

Bouts of sighing preceded by emotional problems, long sighs, hypochondrial or epigastric distension, irritability, moodiness, depression, Wiry pulse.

DISEASES: SIGHING

Lung-Qi stagnation

Short sighs, sadness, grief, worry, a feeling of tightness of the chest, a feeling of lump in the throat, slight shortness of breath, pale face, pulse slightly Tight in the right-front position.

Spleen- and Heart-Qi deficiency

Short sighs, spontaneous sweating, sadness, depression, tiredness, slight shortness of breath, dislike of speaking, palpitations, poor appetite, loose stools, Pale tongue, Empty pulse.

POINTS-LU-1 (1)

LU-1 Zhongfu Central Palace

LocationOn the lateral aspect of the chest, in the first intercostal space, 6 cun lateral to the midline, 1 cun inferior to LU-2 Yunmen.

Intersections: reunion of Lung and Spleen channels, Front-Mu point of Lungs.

Name: “ Zhong Fu” is another name for the Stomach. One reason for this name is that the Lung channel starts in the Middle Burner: as the Lung channel starts at this point, this is the point where it emerges from the Middle Burner. Therefore, this is a point where the “Central Qi” ( Zhong Qi) of the Stomach gathers. This point is the Front-Collecting point of the Lungs (Mu) and, in this context, Fuimplies also Mu, i.e. gathering or collecting, another reference to the gathering or collecting of Stomach-Qi at this point.

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POINTS-LU-1 (2)

Energetics: the main feature of this point is that it makes Lung-Qi descend; the Lungs are compared to a canopy or lid and, as such, they are naturally in charge of descending of Qi and this point, being the uppermost in the Lung channel would have a strong descending action (Action 1). It is also an important point to resolve Phlegm from the Lungs (Action 2). Since it is the point where Stomach-Qi gathers or collects (because the channel emerges from the Middle Burner at this point), this point also makes Stomach-Qi descend (Action 3). The Lungs control the diffusing and descending of fluids and this point is an important one for this function; this is closely related to its function of making Qi descend (fluids are moved and transformed by Qi) (Action 4).

POINTS-LU-1 (3)

Actions:

1. Cough, wheezing, asthma, breathlessness, feeling of fullness of the chest

2. Expectoration of phlegm, feeling of oppression of the chest

3. Vomiting, difficulty in swallowing, retching, abdominal distension

4. Oedema of face and hands.

POINTS-LU-1 (4)

Combinations

• ST-12 Quepen, BL-11 Dashu, BL-12 Fengmen: Heat in the chest

• LU-2 Yunmen, BL-13 Feishu, LIV-14 Qimen, SP-1 Yinbai, BL-47 Hunmen, P-7 Daling: chest pain (Qian Jin Yao Fang)

• P-5 Jianshi, L.I.-4 Hegu: swelling of face (Qian Jin Yao Fang)

• ST-22 Guanmen, HE-7 Shenmen: enuresis (QianJin Yao Fang).

POINTS: LU-2 (1)

LU-2 Yunmen Cloud Door

LocationOn the antero-lateral aspect of the chest, below the lateral extremity of the clavicle, 6cun lateral to the midline, in the centre ofthe hollow of the delto-pectoral triangle.

Name: Yun means “cloud” and here it symbolizes two things, firstthe Heavenly Qi which the Lungs breathe in, secondly the fluidspertaining to the Upper Burner which are compared to a “mist”.The use of the word “door” implies that at this point Qi and othersubstances go in and out. In this case, it means first that through thispoint the Qi of the Lungs emerges (in a similar way to LU-1), andsecondly, that through this point the fluids are regulated (“go in andout”). The word “door” also often implies a mental use.

POINTS: LU-2 (2)

Energetics: As the name “door” implies, Qi and other substances go in and

out through this point. This has three main meanings:

a) in relation to Qi, through this point Lung-Qi goes in and out and this point can not only make Lung-Qi descend but also “release” it when it is congested, as its use in venting Heat in the 4 limbs demonstrates (action 1);

b) in relation to fluids, through this point the Lung fluids are regulated;

c) in relation to the Mind, through this point the mental aspect of the Lungs goes in and out (action 3).

POINTS: LU-2 (3)

Actions

1. Action 1: cough, wheezing, breathlessness2. Action 2: swelling of face and hands3. Action 3: oppressive and agitated sensation in the chest,

upsurge of Qi to the heart

NoteMain difference with LU-1 is that a) not for Phlegm; b) moremental; c) not only descend Qi but also “vent” Qi and clearHeat.

CombinationsL.I.-15 Jianyu, BL-40 Weizhong, Du-2 Yaoshu: Heat in the 4limbs (Su Wen, chapter 61).

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ST-12 QuepenEmpty Basin

Location: In the supraclavicular area, posterior to the superior border of the clavicle and at its midpoint, 4 cun lateral to the midline, on the mamillaryline.

Name: the name refers to the hollow above the clavicle resembling an empty basin.

Intersections: all the other Yang channels excluding the Bladder.

Energetics: the main characteristic of this point is its action in making Qi descend (Action 1); it is in connection with the Penetrating Vessel and, as it makes Qi descend, it is contraindicated in pregnancy (Action 2).

POINTS: ST-12 (2)

Actions

1. Cough, coughing of blood, breathlessness

2. Feeling of fullness of the chest, feeling of obstruction of the throat (rebellious Qi of the Penetrating Vessel).

Combinations

Ren-17 Shanzhong: cough.

Ren-17 ShanzhongChest Centre

Name: the name clearly refers to its location in the centre of the chest.

Intersectionsmeeting point with Spleen, Kidney, Small Intestine and Triple Burner channels. Front-Mu point of the Pericardium, Hui-Gathering point of Qi, point of the Sea of Qi.

LocationOn the midline of the sternum, in a depression level with the junction of the fourth intercostalspace and the sternum.

EnergeticsThis point has two main and opposite energetic actions as a) it makes Qi descend and moves Qi (Action 1) and b) it tonifies Qi (Action 2).

The essence of this point is its action on Qi being the Sea of Qi,the Gathering (Hui ) point for Qi and the centre of the UpperBurner as this point is also called Upper Qihai (the name of Ren6 Qihai). Being on the Directing Vessel and in between thebreasts, this point also affects the breasts and moves Qi and istherefore used for breast problems of a Full nature (Action 3).

Actions1. Breathlessness, wheezing, cough, asthma, chest pain, coughing

of blood2. Qi Xu, weak voice, dislike to speak3. Agalactia (from Qi stagnation), breast abscess, distension and

pain of the breasts.

Ren-15 JiuweiTurtledove Tail

Location: On the midline of theabdomen, 7 cun above theumbilicus and 1 cun below thesternocostal angle.

Name: the xyphoid process looks like the tail of a dove whilethe ribcage looks like its wings, hence the name. Anotherinterpretation of the name could be that the dove tail is theConnecting channel of the Directing Vessel which spreadsout like the tail of a dove.

Intersections: this point is the Connecting point of the RenMai and the Source point of Fat (Gao, chapter 1 of LingShu).

Energetics: this point stimulates the descending of Qi in relation to the Heart (Action 1) and the Lungs (Action 2). Besides stimulating the descending of Qi, however, this point is also a nourishing point for the Heart and Mind (Action 3).

Actions

1. Manic behaviour, a feeling of oppression of the chest, chest pain, pain in heart region

2. Wheezing, breathlessness, feeling of fullness in the chest, cough, coughing of blood

3. Insomnia, anxiety, depression from Heart Xu conditions.

Combinations

Du-20 Baihui: prolapse of rectum in children

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KI-23 ShenfengSpirit Seal

KI-24 Lingxu Spirit Ruin

LocationIn the third intercostal space, 2 cun lateral to the midline.

LocationIn the fourth intercostal space, 2 cun lateral to the midline.

KI-25 ShencangSpirit Storehouse

LocationIn the second intercostal space, 2 cun lateral to the midline.

Name: the names of these three points all refer to the Heart and Shenor Ling. Fengalso refers to the Kidneys.

Energetics: the energetics of these three points can be considered together.

•Firstly, they all promote the descending of Lung-Qi and the communication between Lungs and Kidneys (Action 1) which is all important in chronic asthma. •Secondly, they all calm the Mind and Spirit (Action 2). •Thirdly, they all promote the communication between Heart and Kidneys, which is important on a physical level for the balance between Fire and Water and on a mental level for the proper balance between Zhi and Shen(Action 3).

Actions1. Feeling of fullness of the chest, cough, breathlessness, wheezing, chest painful obstruction2. Agitation, anxiety in Full Heart patterns3. Depression

DISTAL POINTS

LU-7 LiequeST-40

Fenglong

P-6 Neiguan

P-7 Daling


BAN XIA HOU PO TANG Open the Heart

QING QI HUA TAN TANG Ringing Metal

QING ZAO JIU FEI TANG

BEI MU GUA LOU TANG

XIAO XIAN XIONG TANG

WEN DAN TANG Clear the Soul

Last part of Day 2

D10 T1

78

There is a progression of depth within the Yang and the Yin channels with the Greater Yang and Greater Yin representing the exterior of the Yang and of the Yin channels respectively; the Bright Yang and Lesser Yin representing the interior of the Yang and of the Yin channels respectively; and the Lesser Yang and Terminal Yin representing the hinge of the Yang and of the Yin channels respectively.

There is a constant movement of Qi from the Exterior to the Interior and vice versa within the Yang and within the Yin channels: thismovement is one aspect of the general entering and exiting of Qiwithin the Qi Mechanism (Qi Ji). For example, the Large Intestine channel runs on the anterior aspect of the neck, the Triple Burner on the lateral side and the Small Intestine on the posterior side: these represent the Interior (Bright Yang), Hinge (Lesser Yang) and Exterior (Greater Yang) of the Yang channels respectively.

INTEGRATION AND CONNECTION AMONG THE 3 YANG CHANNELS AND AMONG THE 3 YIN CHANNELS

Small Intestine

Stomach

Kidney

Heart

Liver

Triple Burner

Gall-Bladder

Lung

Small Intestine

Spleen

Large Intestine

Pericardium

Bladder

Bladder

Large Intestine

Stomach

Triple Burner

Gall-Bladder

Lungs

Spleen

Heart

Kidneys

Pericardium

Liver


Tai Yin

Jue Yin

ShaoYin

Tai Yang

ShaoYang

Yang Ming

Exiting of Qi

Entering of Qi

TAI YANG (Tai Yin)Opens into Exterior

YANG MING (ShaoYin)Opens into interior

SHAO YANG (Jue Yin)Hinge

[this slide has been corrected]

Tai Yang, Yang Ming and Shao Yangin the neck

Tai Yang

ShaoYang

Yang Ming

79

TAIYANG, SHAOYANG, YANGMING CHANNELS

YANG MING

SHAO YANG

TAI YANG

TAI YANG

SHAO YANG

YANG MING

Opens onto Exterior

“Hinge”

Opens onto Interior

TA

I YA

NG

This movement of Qi among the Exterior, Hinge and Interior involves all channels, i.e. Muscle, Luo and Main channels. However, as the Muscle channels often overlap with each other and as each Muscle channel is connected with several others forming a dense web of relationships, the Muscle channels play an important role in ensuring the smooth movement of Qi among the Exterior (Tai Yang and Tai Yin), Hinge (Shao Yang and Jue Yin) and Interior (Yang Ming and Shao Yin).

Entering of Qi

Exiting of Qi

TAI YANGYANG MING

SHAO YANG


Small Intestine

Stomach

Kidney

Heart

Liver

Triple Burner

Gall-Bladder

Lung

Small Intestine

Spleen

Large Intestine

Pericardium

Bladder

Bladder

Large Intestine

Stomach

Triple Burner

Gall-Bladder

Lungs

Spleen

Heart

Kidneys

Pericardium

Liver


ProblemLocal point

Distal point

“Vertical” view of Qi movement

“Horizontal” view of Qi movement

TAI YANG

Opens onto the Exterior

SHAO YANG

is the hinge

YANG MING

Opens into the Interior

When the channels are obstructed, we remove obstructions by using a distal and a local point: this combination promotes the vertical movement of Qi in the channel. To strengthen the effect of the treatment, it is advisable to remove obstructions exploiting also the horizontal movement of Qi by promoting the exchange of Qi among the Greater Yang, Bright Yang and Lesser Yang channels.

To reinforce the treatment further, it is best to stimulate the “horizontal” movement of Qi. In the shoulder, this could be simply achieved by using the adjacent point T.B.-14 Jianliao (Lesser Yang) and S.I.-11 Tianzong (Greater Yang). The use of these adjacent points will contribute to the elimination of pathogenic factors from the area

This regulation and exchange among the Yang channels is another way in which points from different Yang channels “resonate with each other”.

For example; a shoulder problem occurring clearly along the Large Intestine channel would be treated with L.I.-1 Shangyang as a distal point and L.I.-15 Jianyu as a local point. This combination has the effect of stimulating the ascending and descending of Qi along the Large Intestine channel which will result in the removal of pathogenic factors: this is the “vertical” movement of Qi in the body.

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Pain acromio-claviculararticulation on L.I.-15 Jianyu

-Distal point: L.I.-1 Shangyang (to activate ascending and descending of Qi)

- Local point: L.I.-15 Jianyu

- Adjacent point: T.B.-14 Jianliao, S.I.-10 Naoshu or S.I.-11 Jianzong (to activate entering-exiting of Qi through Tai Yang, Shao Yang and Yang Ming) (choose also according to tenderness)

..

..

LI-15TB-14

SI-11

SI-10Tai Yang

Shao Yang

Yang Ming THE CONCEPT OF “STREETS”, “AVENUES” OR “CROSSROADS” (JIE )

Chapter 52Spiritual Axis

“ In the chest Qi has streets; in the abdomen Qi has streets; in the head Qi has streets; in the lower legs Qi has streets. Therefore if [there is a problem with] Qi in the head, stop it at the brain; if [there is a problem with] Qi in the chest, stop it at the front of the chest and at the Back-Transporting points; if [there is a problem with] Qi in the abdomen, stop it at the Back-Transporting points and at the Chong Mai on the right and left of the umbilicus which is the Moving Qi [or Dong Qi]; if [there is a problem with] Qi in the lower legs, stop it at ST-30 Qichong [here called Qijie] and at BL-57 Chengshan.”

The Chong Mai controls all the channels (“streets”) of the abdomen and the alternative name of ST-30, “Avenues of Qi” (Qijie), is significant. The Qi of the Chong Mai emerges from the deep abdomen at this point, which has a powerful dynamic effect on the circulation of Qi in the channels of the abdomen. The Chong Mai is also sometimes called “Sea of Avenues of the Abdomen”.


D10 T2

Let us assume that a point on a Greater Yang channel, besides the obvious indications related to its Greater Yang area, has some indications relative to a Lesser Yang adjacent area:

If we look at the indications of points in that area, we will often find a point that, besides having obvious indications relevant to the area it is situated in, will also have some indications relative to the area of the Greater Yang point. When this happens, I say that those two points “resonate” with each other. Therefore, when I treat local problems on a Yang channel (e.g. Greater Yang) I always check to see if there are resonating points in adjacent areas from other Yang channels (e.g. Lesser Yang).

Area “A”Greater Yang area point –

indications a) Relevant to areab) Relevant to areac) Acting on another area

(“B”) e.g. Lesser Yang

Area “B”Lesser Yang area point -indications a) Relevant to areab) Relevant to areac) Acting on another area

(“B”) e.g. Greater Yang

Some examples will clarify this. Let us consider the pair of points of G.B.-2 Tinghui (Lesser Yang) and ST-7 Xiaguan (Bright Yang).

Area “A” Lesser YangG.B.-2 Tinghui - indications a) Relevant to area: tinnitus,

deafness and ear dischargeb) Acting on another area (i.e.

Bright-Yang): toothache, deviation of mouth

We can say that these two points “resonate” with each other and would therefore make a good combination to promote the flow of Qi between the Lesser Yang and the Bright Yang channels.

Therefore, when treating a local problem of the teeth or mouth in the Bright Yang area we can select ST-7 Xiaguan as a local point and G.B.-2 Tinghui as an adjacent point.

Area “B” Bright-Yang ST-7 Xiaguan- indications a) Relevant to area: lockjaw,

toothache and swelling of gumb) Acting on another Lesser Yang

area: deafness, tinnitus, and ear discharge and pain

Let us consider another example concerning S.I.-16 Tianchuang and ST-11 Qishe.

Therefore, these two points “resonate” with each other and, when treating a local problem of the neck in the Greater-Yang area (for which we use S.I.-16) we can select ST-11 as an adjacent point to stimulate the movement of Qi between the Greater Yang and Bright Yang areas.

Area “A” Greater YangS.I.-16 Tianchuang- indications a) Relevant to area: shoulder pain

radiating to the neck or stiff neck with difficulty in turning the head

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

Area “B” Bright-Yang ST-11 Qishe- indications a) Relevant to area: swelling

and pain of throat, goitreb) Acting on Greater Yang

area: stiffness of the neck with inability to turn the head

The phenomenon of “resonating points” is another reason for using adjacent points from neighbouring Yang channels when treating a certain area

to facilitate the “horizontal” movement of Qi between Yang areas, i.e. between Greater Yang, Lesser Yang and Bright Yang.

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UPPER BACK - CHEST“RESONATING” POINTS

POINTS ON BACK POINTS ON FRONT

TAI YANG AND SHAO YANGYANG MING AND

SHAO YANG

• S.I.-11: chest, ribs

• S.I.-12: cough

• T.B.-15: chest

• G.B.-21: cough

• ST-12: shoulder, back

• G.B.-22: shoulder

• G.B.-23: neck, shoulder, upper back

ARM “RESONATING” POINTS

POINTS ON ARM POINTS ON NECK

SHAO YANG YANG MING

• T.B.-13 NaohuiShoulder, armGoitre, scrofula

• ST-10 ShuituScrofula, goitrePainful shoulder

• ST-12 QuepenScrofula, goitreShoulder, arm

POINTS ON LOWER BACK POINTS ON FRONT

TAI YANG YANG MING

LOWER BACK “RESONATING” POINTS

• BL-23 ShenshuLumbar region painAsthma, cough

• BL-26 GuanyuanshuLumbar painUrination

• BL-53 BaohuangLumbar painUrination, uterus

• BL-54 ZhibianLumbar painUrination

• ST-12 QuepenChest, cough, asthmaLumbar pain

• ST-28 ShuidaoLumbar pain

GynaecologicalUrination

• ST-30 QichongLumbar pain

PATHWAYS OF QI ( QI JIE ) � �

PATHWAYS OF QI ( QI JIE )

Under influence of Chong Mai

PATHWAYS OF QI ( QI JIE )

Under influence of Chong Mai

ST-37

ST-39SP-6

BL-13BL-14BL-15

BL-51 Huangmen

Ren-17

LU-1

ST-30

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D10 T3

D10 T4

D10 T5

End Day 2

Documents

Body-Mind Mapping in Chinese Medicine · Giovanni Maciocia presents: Body-Mind Mapping in Chinese Medicine Maryland Acupuncture Society, November 15, 2009 CD & Handouts edited by: