Dragon Classic of Acumoxa

Dragon Classic of Acumoxa

The Zhenjiu yu long jing (The Jade and Dragon Classic of Acumoxa) was first published in 1311 by Wang Guorui, and the latest version of the text was edited by Li Ding, a famous professor of acupuncture (1), in 1994.

The book consists of three major parts: Yibai ershi yu long ge (The Jade and Dragon Song on 120 Acumoxa Points), Tianxing shiyi xue gejue (Song of Eleven Acumoxa Points that Resemble Heavenly Stars) and Liushiliu xue zhi zheng (66 Points to Treat Syndromes).

The first part lists 83 diseases from different specialties (e.g. heart pain, deafness, tinnitus, wheezing, abdominal pain, mastitis, oedema) and suggests the respective acumoxa treatment. The second part is a list of eleven extraordinarily effective acumoxa points. I will elaborate on this part of the classic below. The third part consists of twelve chapters each of which is dedicated to one channel and lists the main points with their respective indications. Additionally the Zhenjiu yu long jing contains nine other texts which are much shorter, most of them called "song" (ge, gejue) or "rhapsody" (fu).

In the Qing dynasty the Siku quanshu zongmu tiyao (General Catalogue of the Complete Texts of the Four Repositories with Descriptive Notes) (2) describes the contents of the Zhenjiu yulong jing as "inclined to the mean and involving the vulgar" and its style as "shallow and close [to ordinary language]" (3) , furthermore it is "easy and clear to read, there is no essence in the skill of its author, likewise one cannot say that it is close to what it should [be close to]." (4)

This makes Li Ding ask the rhetoric question: "Although it is close to the vulgar and not refined, its acumoxa technique is absolutely close to the practice [of acumoxa], so how can the 'mean and vulgar' be an obstacle?" (5) He continues: "It's absolutely justified to trace the great popularity of Yuan and Ming acumoxa back to the mastership of this simple and essential text" (6).

Below I recount one case of a patient suffering from post-herpetic pruritus. The simple and straightforward treatment given in this case, which is familiar to any acupuncturist working today, follows the guidelines for point selection given in the Zhenjiu yu long jing, especially in the Tianxing shiyi xue gejue (Song of Eleven Acumoxa Points that Resemble Heavenly Stars).

The patient

A male patient, age 64, presents with post-herpetic pruritus on the left cheek, paresthesia and running of the nose. After he had obtained the usual treatment for herpes zoster (aciclovir and antibiotics for bacterial superinfection), the vesicles resolved but intense pruritus remained. This woke him up several times a night so that he could not get enough sleep and after about 10 days out of hospital he had developed further problems such as restlessness and irritability. Physically the patient was in excellent shape for his age (he was a long distance runner whose training consisted of about 40km running per week). He had mild hypertension, hypoacusis and benign hyperplasia of the prostate; the only chronic ailment he suffered from was stomach problems that had been diagnosed as gastritis 20 years before and that usually became acute in the autumn. During the course of treatment he told me that he easily got cold hands and feet, but had no chill sensations.

The tongue tip was slightly red; the areas of the tongue which represent the middle and the lower burner were pale and normally had no coating, but if they had it was thin, white and moist. The pulse was replete (shi mai) as well as slippery (hua mai), in the left root (chi) position it was rather deep (chen) and deficient (xu).

The diagnosis was heat poison (re du) in the yangming channels that emerged in the face.

The chronic symptoms of gastritis and cold hands and feet together with the tongue (except for the tip of the tongue) reflected a pre-existing problem with coldness in the stomach.

Treatment

Great emphasis is placed in Chinese medicine on the importance of treating herpes zoster in the acute phase, as soon as possible after its onset. This is not only because acupuncture can be dramatically successful in resolving the disease quickly, but because especially in the elderly there is a risk that, untreated, herpes zoster can develop into post-herpetic neuralgia or neuritis. Once this is established, it is difficult to cure and prolonged treatment over years, which is not always successful, may be required.

Initially the patient could not bear to be touched in the affected area so that local treatment was not suitable. I therefore concentrated on treating distally and systemically. After the first treatment session the patient woke up only once a night (as opposed to several times before acupuncture); after a month his sleep had returned to normal. It took about 5 months to improve the symptoms sufficiently to introduce local treatment.

The following points were selected:

* Hegu L.I.-4 on the right hand: "All problems of the face and mouth can be tackled by Hegu L.I.-4." (7). The indications given for this point by the Tianxing shiyi xue gejue (Song of eleven acumoxa points that resemble heavenly stars) are "swollen face" and "heat disease without sweat coming out" (8).

* Quchi L.I.-11 on the right arm: to cool qi as well as blood and to release the exterior. The importance of combining it with Hegu L.I.-4 is stated by Li Ding (9). Likewise the use of Quchi L.I.-11 as a necessary point for "dormant papules due to one-sided wind" is emphasized in the Tian xing shiyi xue gejue (Song of eleven acumoxa points that resemble heavenly stars) (10).

* Taiyuan LU-9: to strengthen the correct qi (zhengqi) of the lung and thereby indirectly help driving the heat toxin out of the channels.

* Zusanli ST-36: to harmonize qi and blood as well as to cool blood (together with Xuehai SP-10); at the same time it was used in this case to improve the underlying condition of cold in the stomach, a treatment approach which is in perfect accordance with the Tianxing shiyi xue gejue (Song of eleven acumoxa points that resemble heavenly stars) (11). In the same paragraph on ST-36 it also says that all kinds of diseases due to 'gu' in the qi level can be treated very well by Zusanli ST-36. (12)

Under the influence of western patterns of pathophysiology 'gu' is understood as a "poisonous condition" caused by parasites; in this case I took the liberty of applying this concept to a "poisonous condition" caused by a virus. Both--parasites and viruses--have in common that they are physical entities (13) that penetrate the human body so that herpes zoster and its sequelae could also be understood as a gu-disease.

The treatment was completed with Xuehai SP-10 to cool blood and Sanyinjiao SP-6 to nourish blood.

The areas of subcortex and shenmen in the left ear were needled during the treatment session, and tiny magnetic balls were pasted onto the auricular areas cheek and lung for 12 hours (14).

In the second sequence of the treatment--after five months--the focus was placed on local points: This change from systemic to local was possible when the side of the nose and the cheek were much less sensitive than at the beginning. What remained was a very small hypoaesthetic area on the wing of the nose ranging from Yingxiang L.I.-20 to a point lateral from Suliao DU-25, an ahshi point. Xuehai SP-10 and Sanyinjiao SP-6 were omitted.

Treatment details

Duration of the treatment: 30 minutes per session.

Frequency: Once weekly.

Duration: 1 year (with a break of 1 month between the two sequences).

Needling technique: draining technique (xie fa): Quchi L.I.-11 and Hegu L.I.-4; replenishing technique (bu fa): Taiyuan LU-9, Zusanli ST-36, Sanyinjiao SP-6, Xuehai SP-10 (15). Needle size: 0.25 x 40 mm (with tube) for the body points; 0.16 x 10 mm the face and ear.

Conclusion

In summary it can be said that the basis of treatment was the classical points of the Zhenjiu yu long jing (The Jade and Dragon Classic of Acumoxa), which are described by the text as having the potential of "melting snow with hot water" (16) , a metaphor for "doing something easily".

Local treatment was started at a relatively late stage. In retrospect I regard this long lasting first stage as a necessary preparation for the latter stage which could not be entered earlier because of a strong aversion even to being touched in the area involved.

Compared to the use of carbamazepin and other psychopharmacological drugs that make up the standard treatment for postherpetic neuralgia and pruritus in western medicine, the period of treatment described here -although a whole year--is still shorter and the risk of side effects is lower.

References

(7) Mian kou hegu shou ("All problems of the face and mouth can be tackled by Hegu L.I.-4"): According to Li Ding this famous sentence which can be found in acupuncture textbooks today is an abbreviation of a thought that was first expressed in the Zhenjiu yu long jing: "For any kind of illness in the face or on the head once you needle Hegu L.I.-4 the result is absolutely outstanding". (cf. Li Ding: Zhenjiu xue yi nan p. 182)

(8) cf. Li Ding: Zhenjiu yu long jing p.79.

(9) "Diseases of head, face, ear, eye, mouth and nose are all mastered by Quchi L.I.-11 and Hegu L.I.-4." The author quotes Zabing xue fa ge (Song of Acumoxa on Miscellaneous Diseases), a short text which was published after the Zhenjiu yu long jing (Jade and Dragon Classic on Acumoxa). Although Li Ding does not go into detail here, this text seems to stand in the tradition of "songs on acumoxa points" just like the shorter texts in the Zhenjiu yu long jing mentioned in the introduction. (cf. Li Ding: Zhenjiu xue yi nan. p. 182).

(10) Li Ding: Zhenjiu yu long jing. p. 79. On reading this passage of the text carefully one can easily conclude that the author of the text describes what we nowadays call "herpes zoster". Literally the passage translates as: "Dormant papules due to wind on one half of the body can definitely be cured by acumoxa [on quchi]".

(11) cf. Li Ding: Zhenjiu yu long jing. p.76.

(12) 'Gu' literally translates as "poisonous" or "poisonous insect"; it is a concept that became extremely important with the Wenbing School (School of Warm Diseases). See 'Gu Syndrome: Driving Out Demons and Snakes, A Forgotten Clinical Approach to Chronic Parasitism' by Heiner Fruehauf, Journal of Chinese Medicine, no. 57, May 1998.

(13) "Physical" as opposed to external pathogenic factors without a "body", e. g. "liu qi" (six qi);

(14) The patient did not want to walk around with the plasters in public thus I treated him in the evening and he removed them the next morning.

(15) Replenishing and draining techniques as defined in Zhenjiu xue p.170.

(16) Li Ding: Zhenjiu yu long jing. p.76.

Franz Zehentmayr studied sinology at the University of Vienna, Fudan University Shanghai, and Cambridge University, western Medicine at the University of Vienna, and acupuncture at Shanghai University of Traditional Chinese Medicine. He is a general practitioner, presently working as a trainee at the University of Salzburg, Institute of Radiotherapy and Radiooncology.