Point Selection 1

8/6/2019 Point Selection 1

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Clinical Point Selection,

Week 1CAM: 373-397Page 2 of Handouts

Lorraine Wilcox L.Ac.

[email protected]



Before we turn to CAM, a littlereview...



3

What causes illness?

• External factors: evils- wind, cold, fire (heat),dampness, dryness,

and summerheat. If notexpelled, they cancause internaldamage, or sometimes

they directly hit theinternal organs.



4


• Internal factors:emotions such as anger,

joy, thinking too much,

anxiety, sadness, fear,and fright. Thesedirectly affect the organsand movement of qi (theqi mechanism ).



5

The Qi Mechanism (氣機 qi ji)



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• Neither-external-nor-internal factors: diet,

exercise/activity/work,rest, sex, trauma, etc.These easily affect the

organs.



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• Pathologically formed evils are

produced when there is imbalance, andthey cause further pathology: blood stasis,qi stagnation, food stagnation, phlegm,turbid fluids (rheum), internally generatedwind, heat, cold, dampness, etc.

• Constitutional issues.



辯證 Pattern Identification



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Pattern Identification

• Pattern identification is identifying the

basic disharmony behind a set of clinicalmanifestations.

• The four examinations are used. Then thediagnostic information is classified. Allsigns and symptoms must be taken into

account.• Looking for relationships is more important

than looking for causes.



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Pattern Identification

Pattern (証 or證 zheng4): This refers to the

whole pattern of the symptoms or signsthat manifest at one point in time. It is thecomplete picture.

• In some cases, the pattern is the cause ofdisease (for example, exterior invasion of

wind-cold) but not necessarily: kidney yinvacuity may be caused by aging orlifestyle.



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The pattern itself lets us understand the cause or

the root, the location and nature of the disease,and the circumstances of the evil and the right qi.

It also implies the treatment principle.

with dampnessvacuityqispleen

evil qiright qisubstancelocation

• Treatment principle: Supplement spleen qi,transform dampness.



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Pattern IdentificationSymptom/sign (症 zheng4): any

manifestation, symptom, or sign, such asfever, cough, shortness or breath,abdominal pain, or diarrhea.

• A symptom has little diagnostic value on itsown. Diarrhea could be due to damp-heat,cold-damp, spleen qi vacuity, spleen yangvacuity, or spleen and kidney yang vacuity.

• The symptom of diarrhea cannot be treatedwithout understanding it within its context orpattern.



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症 versus証

(both pronounced zheng4)

• In many cases in Chinese language,症

(here, symptom/sign) and証 (here, pattern)are interchangeable, but in medicine, thereis a difference.



14

Pattern IdentificationDisease (病 bing4): There are two types of

disease. – A Western disease is something like hypertension,multiple sclerosis, or hepatitis B.

– Chinese medicine also has the concept of disease.There are traditional names of diseases, for example,painful periods, cough, headache, constipation.Perhaps you could generally think of this as the chiefcomplaint, but sometimes it is not. A patient maycome in complaining of infertility (a Chinese disease),

but you may find that they also suffer from painfulperiods and constipation (which are also Chinesediseases). Chinese ‘diseases’ are often consideredsymptoms by Western medicine.



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Pattern Identification• Different individuals may have different patterns

for the same Chinese disease, or one individualmay have different patterns over the course of

the same disease.

indigestionkidney vacuity

painful periodscold in the uteruspre-menstrual irritabilityLiver qi

depression

liver blood stasisPainful

periods

異病同治。Different diseases have the same

treatment.

同病異治。The same disease has

different treatments.



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Pattern Identification• Only certain patterns are possible for each

Chinese disease. Therefore, whether or not youknow the name of the Western disease, take the

main clinical symptoms and find the

corresponding Chinese disease or diseases.Then check which patterns are possible andfocus your questioning on confirming or denying

these patterns.• If more than one disease manifests, look first for

one pattern that covers more than one of these

diseases.



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Pattern Identification• We can combine disease differentiation

and pattern differentiation for preciseassessment of disease.

– A disease name summarizes thecharacteristics or symptoms of a disease.

– A pattern name integrates the nature, cause,and location of the disease.



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Pattern Identification• The most common type of pattern

identification in the style called TCM isorgan pattern identification .

• This combines:

– qi, blood, and body fluid patterns – pathogenic factor (evil) patterns

– eight principles patterns

– the physiological and pathological workings ofthe five viscera and six bowels



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organ pattern identification

with dampnessvacuityqispleen

pathogenicfactor (evil)patterns

eightprinciplespatterns

qi, blood,fluidpatterns

zang-fu patterns



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Pattern Identification• Because it focuses on the organs, it is most

useful for interior patterns, although a fewexterior patterns are included, especially for thelungs.

• Pattern identification for exterior conditions ismore detailed in: – pathogenic factor (evil) patterns

– six channel patterns (cold damage)

– four levels patterns (warm disease) – triple burner patterns

– channel patterns



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Pattern Identification• Here are some important points regarding organ

pattern identification:

– It is important to understand the mechanisms ofdisease and the relationships of the organs. Youcannot simply memorize a list of signs and symptoms.

– Not all signs or symptoms are necessary to receive adiagnosis. A mild case will have fewer signs andsymptoms.

– Many times patients have a combination of more thanone pattern, but look for relationships between thevarious patterns a patient has. Look for the traditional

combination patterns, such as vacuity of heart andkidneys. – The points listed to treat a pattern are only examples.

There are many other possibilities.



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Chinese medicine is

philosophical

Don’t forget

• Holism: Be aware of the interaction of a personwith their environment (right versus evil, forexample), and internal interactions (between

organs and other aspects) within a person. – The unity of heaven and man: Heaven and earth are

a big Tai Ji ; the human body is a small Tai Ji .

– The relationship of the patient with time (day/night,four seasons, phase of the month) and space(geography, climate, weather, environment)



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Chinese medicine is

philosophical

Don’t forget

• The inseparability of body and spirit

• You can examine the exterior to know the

state of the interior.• The dynamics of change: Everything in the

universe and in the body is continuously

moving and changing. Dynamic balance.



General principles of treatment治療總則治療總則治療總則治療總則 CAM: 373-397



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1.調整陰陽

Regulation of yin and yang

Disease means yin andyang are not balanced.

Ling Shu , Chapter 5 says:

How to regulate yin andyang is most importantin acupuncture

treatment.



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Yin-Yang Balance is Health

yinyang



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Imbalance: yang repletion (hot)

yin

excessive yang:

drain it

yang

Excessive yang willeventually damage yin.



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Excessive yang damages yin

yin

insufficient yin:

nourish it

excessive yang:

drain it

yang



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Imbalance: yin repletion (cold)

excessive yin:

drain it

yin

yang

Excessive yin willeventually damageyang.



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Excessive yin damages yang

drain it

yang

insufficient yang:

fortify it

excessive yin:



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Imbalance: yin vacuity (hot)

yin

yang insufficient yin:

nourish it



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Imbalance: yang vacuity (cold)

yin

yang

insufficient yang:

fortify it



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Su Wen , Chapter 5: Treat yin for problems

in yang; treat yang for problems in yin.

• For example:

– back shu points (yang) are more frequentlyused to treat the viscera (zang – yin organs).

– mu alarm points (yin) are more frequently

used to treat the bowels (fu – yang organs).



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2.扶正祛邪 Strengthening right qi

and eliminating evils• Right qi (or righteous or upright qi): [正氣

zheng4 qi4] the sum of all healthy qi and otherhealth-promoting substances in the body:

‘antipathogenic factor.’ Supplement it. It will

prevent evils from taking hold.• Evil qi [邪氣 xie2 qi4]: Qi, mostly from the

weather, that can cause disease: ‘pathogenic

factors.’ Evils can also arise internally. Drain it. Itwill allow right qi to regain strength.



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Right Versus EvilDisease is a struggle between right versus evils



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2. Strengthening right qi and

eliminating evils• Should we strengthen the right? (In chronic

conditions, treat the root. In this case, root usually means the body’s right qi.)

• Should we drain the evil? (In acute conditions,treat the branch. In this case, branch usually

means the evil qi.)• Should we do both simultaneously? (In most

cases we can, but be aware of which points are

strengthening the right and which are drainingthe evil, and use the correct technique on eachpoint.)



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2. Strengthening right qi and

eliminating evils

• If a very weak patient has an evil,

sometimes you cannot attack the evilwithout killing the patient. In that casesupplement first and attack the evils when

the patient is stronger.



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3.分別標本

Distinguishing root and branch治病必求于本。

《素問·陰陽應象大論》To treat disease, seek its root.

Elementary Questions ,Chapter 5 (Warring StatesPeriod)

• CAM calls this primary (本ben root) and secondary (標biao branch).



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Root and Branch

Examples:

• If insufficient spleen qi leads to bleeding,spleen qi vacuity is the root and bleedingis the branch.

• Liver yin vacuity (root) can lead to liveryang rising (branch). Liver yang rising

(root) can lead to liver wind (branch).

If t t th t ll th t ill l Th



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If you treat the root, all the symptoms will resolve. Thesymptoms are like bowling pins. You don’t want to knock

them down one by one.If you hit the kingpin just right, you will knock down all thepins with one ball. This is treating the root.



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Root and Branch • 急則治標。Usually translated as, “In acute

conditions, treat the branch.”• 緩則治本。Usually translated as, “In chronic

conditions, treat the root.”

– 急 (ji2): acute, urgent, tense, quick,

– 緩 (huan3): chronic, slack, slow, gradual, moderate,

mild.

4 因時因地因人制宜



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4.因時、因地、因人制宜

Treatment of disease according to climate,season, location, and individualTreat according to the

season and weather:

• In the summer, you arelikely to use lessmoxibustion and will usefewer warming herbs.

• Also the qi flowsdifferently through theseasons, for example, inthe summer qi flows moresuperficially.

• Diet and lifestyle shouldvary with climate andseason.



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Treatment of disease according to climate,

season, location, and individual

• Treat according to the

place: here in LosAngeles there is less

cold and dampness,and more dryness andheat.



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Treatment of disease according to climate,

season, location, and individual

• Treat according to the individual (age,

sex, constitution): Herb formulas and pointformulas can be adjusted for the conditionof the patient. This gives better results

than using an unmodified formula.





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1. SupplementingTreats vacuity patterns

• Example acupuncture techniques: emphasis onclockwise or thrust. Close the point.

• Supplement kidney qi or yang: Shen Shu (UB

23), Guan Yuan (Ren 4), Tai Xi (KI 3) usingsupplementing hand technique or moxibustion.

• Nourish kidney yin: Tai Xi (KI 3), Zhao Hai (KI 6),

Zhi Shi (UB 52) using supplementing handtechnique.



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1. Supplementing• Supplement spleen-stomach qi: Zhong Wan

(Ren 12), Qi Hai (Ren 6), Zu San Li (ST 36)using supplementing hand technique ormoxibustion.

• Replenish qi-blood: Pi Shu (UB 20), Ge Shu (UB

17), Zu San Li (ST 36), San Yin Jiao (SP 6)using supplementing hand technique ormoxibustion.

• Do not supplement if evils are strong, or ifexternal evils are not yet eliminated.



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2. DrainingTreats patterns with evils and accumulations

• Example acupuncture techniques: emphasis oncounterclockwise or lift. Leave the point open.

• Dispel wind, release the exterior: Drain Feng Chi(GB 20), He Gu (LI 4).

• Induce a bowel movement to drain heat: drainQu Chi (LI 11), Tian Shu (ST 25), Feng Long(ST 40).

• Bleed related points to resolve blood stasis.• Do not drain vacuity.



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3. WarmingTreats cold patterns, warms the channels,

removes blockage, fortifies yang.

• Use moxibustion or long needle retention.

• Warm the middle jiao : moxibustion or longretention on Zhong Wan (Ren 12) and Zu San Li(ST 36).

• Collapse of yang: moxibustion on Guan Yuan(Ren 4) and She Que (Ren 8).

• Do not use for heat conditions; caution in yinvacuity.



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4. ClearingFor heat patterns. Always implies clearing heat.

• Use draining technique or let blood. Shortneedle retention.

• Heat evils: Drain Da Zhui (Du 14), Qu Chi (LI

11), He Gu (LI 4).• Heat in the organs: drain related well points or

spring points.

• Resuscitation due to heat: drain or let blood atthe hand well points or Ren Zhong (Du 26).



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5. Ascending• Raises yang and lifts what has sunken: for

prolapse, chronic loose stool, lack ofnourishment to the head and sense organs.

• Supplement and use moxibustion on points such

as Bai Hui (Du 20), Qi Hai (Ren 6), Guan Yuan(Ren 4), Zu San Li (ST 36).

• Do not use with yin vacuity and hyperactive

yang.



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6. Descending• Subdues yang, wind, fire, or counterflow.

• Descend stomach qi: even technique onTan Zhong (Ren 17), Zhong Wan (Ren12), Nei Guan (PC 6), Zu San Li (ST 36).

• Subdue the liver: drain Feng Chi (GB 20),Tai Chong (LV 3), Yong Quan (KI 1).



Basic principles forprescription andselection of points

Basic principles for prescription



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Basic principles for prescription

and selection of points1. Acupuncture Prescriptions: Treatment

plan (different than treatment principle):point selection, hand technique, number ofpoints, etc.

2. Principles for point selection: local,adjacent, and distal points, symptomaticpoints

For acupuncture-moxibustion



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For acupuncture-moxibustion,

choose:• Local points: the address on the envelope. If

you do not also use distal points, this is likesending an empty envelope. It will get there, but

there is no message inside. Local points oftentreat the branch. These are like the guiding herbin a formula; they take the effect of the pointformula to the affected site.

• Distal points: the message in the envelope.These are often points to treat the root, orrelated to the affected site by channel pathway.

Local points: the address on the envelope



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Local points: the address on the envelope

Distal points: the message in the envelope

For acupuncture-moxibustion



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For acupuncture moxibustion,

choose:• Modality: Acupuncture, moxibustion, cupping,

bleeding, etc. Each one gives a different

message. Which modality will you use on eachpoint?

• Technique: Drain or supplement? Direct orindirect moxibustion? etc. Each one gives adifferent message. Which technique will you useon each point? Some points may need to besupplemented and others drained within thesame treatment.

• Balance: Look at the overall treatment. Is itbalanced for this patient? Is it balanced overall?

Local Adjacent and Distal



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Local, Adjacent, and Distal

Points (examples)

聽會 GB 2,

翳風 SJ 17風池 GB 20

中渚 SJ 3,

俠溪 GB 43Ear

地倉 ST 4,

頰車 ST 6顴髎 SI 18

合谷 LI 4,

解溪 ST 41Mouth, cheek

迎香 LI 20上星 Du 23列缺 LU 7,

厲兌 ST 45Nose

睛明 UB 1目窗 GB 16養老 SI 6,

太沖 LV 3Eye

天柱 UB 10大椎 Du 14后溪 SI 3,

昆侖 UB 60Nape

太陽 Tai Yang ,

率谷 GB 8風池 GB 20

外関 SJ 5,

足臨泣 GB 41Temples

陽白 GB 14百會 Du 20合谷 LI 4,

內庭 ST 44

Forehead

LocalAdjacentDistalRegion




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Points (examples)

長強 Du 1白環俞 UB 30承山 UB 57Rectum

腎俞 UB 23,

大腸俞 UB 25次髎 UB 32

委中 UB 40,

后溪 SI 3Low back

関元 Ren 4天樞 ST 25

三陰交 SP 6,

曲泉 LV 8

Lower

abdomen

中脘 Ren 12梁門 ST 21内関 PC 6,

足三里 ST 36

Upper

abdomen

期門LV 14

章門LV 13

支溝 SJ 6,

陽陵泉 GB 34Rib-sides

膻中 Ren 17中府 LU 1内関 PC 6,

豐隆 ST 40Chest

廉泉 Ren 23,

天容 SI 17天柱 UB 10

魚際 LU 10,

照海 KI 6Throat

LocalAdjacentDistalRegion

Point Formulas for Symptoms



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(examples)

膻中 Ren 17,内関 PC 6Sensation of suffocation in the chest天突 Ren 22,定喘 Ding ChuanCough, asthma

下關 ST 7,頰車 ST 6,合谷 LI 4Clenched jaws

后溪 SI 3,陰郤 HT 6Night sweating

人中 Du 26,十宣 Shi XuanComa

大椎 Du 14,合谷 LI 4,曲池 LI 11Fever

FormulaSymptom




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(examples)

二白 Er Bai (moxibustion)Bleeding hemorrhoids

四縫 Si Feng (prick)Digestive problems in children

上星 Du 23,合谷 LI 4Epistaxis合谷 LI 4,太沖 LV 3Convulsions

支溝 SJ 6,照海 KI 6Constipation

氣海 Qi Hai,足三里 ST 36Abdominal distention

支溝 SJ 6,陽陵泉 GB 34Rib-side pain

内関 PC 6,郤門 PC 4Cardiac pain

FormulaSymptom

The Five Shu (Transport) Points



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五腧穴

diseases of the bowels(use lower he sea),

bleeding

disease in thestomach from

irregular eating

counterflow qi, diarrhea(mostly related to the

yang organs)

He Sea (yinwater, yang

earth)

changes in the voicecough, dyspnea, chillsand fever

Jing River(yin metal,

yang fire)

intermittent orprolonged disease(eight treat malaria)

heaviness in the body,painful joints

Shu Stream(yin earth,yang wood)

changes in color(complexion)

heat in the bodyYing spring(yin fire,yang water)

clear heat, openorifices, other end of

channel, spiritdisorders

disease in the

viscera (yin organs)

fullness below the heart

(treats the chest ingeneral)

Jing well

(yin wood,yang metal)

OtherLingshu 44Nanjing 68Point

The Five Shu Points and their



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e e o ts a d t e

Corresponding Element

EarthWaterHe Sea

FireMetalJing River

WoodEarthShu Stream

WaterFireYing spring

MetalWoodJing well

Element on YangChannels

Element on YinChannels

Category

Application of specific points



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pp p p

(point categories)

PC3PC5PC7-PC8PC9+Pericardium

KI10KI7+KI3KI2KI1-Kidneys

LU5-LU8LU9+LU10LU11Lungs

SP9SP5-SP3SP2+SP1Spleen

HT3HT4HT7-HT8HT9+Heart

LV8+LV4LV3LV2-LV1Liver

He Sea

Water

Jing River

Metal

Shu Stream

Earth

Ying Spring

Fire

Jing Well

Wood

Point

Element

五腧穴 The Five Shu Points of the Yin Channels

五腧穴 The Five Shu Points



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腧穴

of the Yang Channels

UB39SJ10-SJ6SJ3+SJ2SJ1San Jiao

UB40UB40UB60UB65-UB66UB67+Bladder

ST37LI11+LI5LI3LI2-LI1Large

Intestine

ST36ST36ST41+ST43ST44ST45-Stomach

ST39SI8-SI5SI3+SI2SI1Small

Intestine

GB34GB34GB38-GB41GB43+GB44Gallbladder

Lower

He

Sea

He

Sea

Earth

Jing

River

Fire

Shu

Stream

Wood

Ying

Spring

Water

Jing

Well

Metal

Point

Element



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Nan Jing 69《難經》 says:• 虛者補其母。 In vacuity, supplement the

mother point or channel.• 實者瀉其子。 In repletion, disperse the

child point or channel.

原穴絡穴 Yuan Luo



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原穴、絡穴 Yuanand

LuoPoints

虛里 xuliGreat luo of

stomachSP21

Great luo of

spleen

Du1DuRen15Ren

SJ5SJ4San JiaoPC6PC7Pericardium

UB58UB64BladderKI4KI3Kidneys

LI6LI4Large IntestineLU7LU9Lungs

ST40ST42StomachSP4SP3Spleen

SI7SI4Small IntestineHT5HT7Heart

GB37GB40GallbladderLV5LV3Liver

LuoYuanChannelLuoYuanChannel

Yang ChannelsYin Channels



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Application of specific points

Ren3UB28Urinary BladderLV6Liver

Ren4UB27Small IntestineGB36Gall Bladder

ST25UB25Large IntestineSJ7San Jiao

GB25UB23KidneysPC4Pericardium

Ren5UB22San JiaoKI5Kidney

Ren12UB21StomachUB63Urinary Bladder

LV13UB20SpleenSI6Small Intestine

GB24UB19Gall BladderHT6Heart

LV14UB18LiverSP8Spleen

Ren14UB15HeartST34Stomach

Ren17UB14PericardiumLI7Large Intestine

LU1UB13LungsLU6Lung

Mu PointShu PointOrganPointChannel

背腧、募穴 Back Shu and Mu Alarm Points郄穴 Xi Cleft Points

Xi Cleft Points of the



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Eight Extraordinary Vessels

KI9Yin weiKI8Yin qiao

GB35Yang weiUB59Yang qiao

八脈交會穴 Eight Extraordinary Vessels



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Confluence Point Combinations

chest, heart, stomachPC6Yin weiSP4Chong

outer canthus, behind the ear, cheek,

neck, shoulder, diaphragmSJ5Yang weiGB41Dai

lung system, throat, chest, diaphragmKI6Yin qiaoLU7Ren

inner canthus, nape, ear, shoulder, back UB62Yang qiaoSI3Du

To treat diseases of Combine

八會穴 Eight Meeting



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(Influential) Points

GB39Marrow

UB11Bone

LU9Vessels/Pulse

GB34Sinews

UB17Blood

Ren17Qi

Ren12 (also stomach’s mu point)Fu (bowels, yang organs)

LV13 (also spleen’s mu point)Zang (viscera, yin organs)

交會穴



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交會穴Crossing Points

• Too many to make a table here.

• See CAM, 3rd edition, page 393-7

Documents

Point Selection 1