Chapter Id

AETIOLOGY AND PATHOGENESIS

The subject of aetiology is the study of the seven emotions, improper diet, over strain,
causative factors of disease, whilst the study lack of physical exercise, traumatic injuries,
of pathogenesis concerns the actual bodily bites by insects or wild animals, as well as
processes whereby disease occurs, develops stagnated blood and phlegm fluid. The
and changes. Traditional Chinese medicine symptoms and signs of any disease reflect
holds that there is normally a state of relative the pathological reactions of the affected
equilibrium between the human body and body to certain causative factors. The
the external environment on the one hand, causative factors, therefore, are studied both
and among the zang-fu organs within the as the objective causes of disease, and in the
body on the other'hand. This equilibrium is specific ways they affect the body. On the
not static, but is in a state of constant self- basis of this undersiaadiiig, traditional
adjustment, and in this way the normal Chinese medicine is able to identify the
physiological activities of the body are causative factors of disease by analysing the
maintained. If external influences exceed the clinical manifestations. This is known as
powers of adaptibility of the organism, or if "seeking the causative factors by differen-
the body itself is unable to adjust to tiating symptoms and signs." The study of
changing conditions, then this relative aetiology, therefore, is based on developing
equilibrium will be lost, and disease will a profound understanding of the character-
develop. Whether a disease occurs or not, istic clinical manifestations produced by
whilst associated with the presence of the each causative factor.
various causative factors, is primarily
determined by the physiological adaptibility
of the body to the natural environment. This
is the basic viewpoint of traditional Chinese 1. The Six Exogenous Factors
medicine regarding pathogenesis.
Wind, cold, summer heat, damp, dryness
and fire (mild heat and heat) are the six
climatic changes found in nature. Under
I. AETIBOLOGY normal conditions, they do not produce
pathological changes in the body and are
Numerous factors can cause disease, and thus known as the "six types of qi" in the
these include the six exogenous factors, the natural environment. These six types of qi
Chapter 11 Aetiology and Pathogenesis 245

will only cause disease if either the climatic wind to invade the body, it is stated in the
changes are extreme or sudden, or if the forty-second chapter of Plain Questions:
body's resistance is low. When responsible "Wind is the leading causative factor of
for inducing disease, these six types of qi are many diseases."
known as "the six exogenous pathogenic Pathogenic wind can not only combine
factors." with the other five exogenous factors, but
All the six pathogenic factors, when also with phlegm to form wind phlegm.
affecting the body, invade from the exterior Facial paralysis, for example, is mostly seen
via the skin, mouth or nose. For this reason, as a consequence of the obstruction of wind
the pathological reactions they induce are phlegm in the meridians.
known as "exogenous diseases." b) Wind is a yang pathogenic factor and
Diseases due to the six exogenous factors is characterized by "upward and outward
are closely related to seasonal changes in the dispersion." It can therefore easily invade
weather and to living environment. For the upper part of the body, i.e. the head and
example, heat syndromes mostly occur in face, and the exterior portion of the body,
summer, cold syndromes in winter, and leading to impairment of the opening and
damp syndromes are usually caused by , closing of the pores. Clinical manifestations
prolonged exposure to damp. Another term are headache, nasal obstruction, itching or
for these syndromes is "seasonal diseases." pain in the throat, facial puffiness, aversion
Each of the six exogenous pathogenic to wind and sweating.
factors may affect the body singly or in c) Wind in nature blows in gusts and is
combination. Examples are common cold characterized by rapid changes. Disorders
due to pathogenic wind and cold, or bi caused by pathogenic wind, therefore, are
syndrome due to pathogenic wind, cold and marked by migratory symptoms, rapid
damp, etc. In the process of causing disease, . changes and abrupt onset of disease. The
the six exogenous factors may influence each migratory joint pain of wandering bi, for
other, and may also, under certain example, which is caused by pathogenic
conditions, transform into each other. For wind, is known as wind bi. Urticaria caused
example, pathogenic cold may transform by pathogenic wind is characterized by
into heat in the interior of the body, and itching of the skin and wheals which appear
prolonged summer heat may result in and disappear from place to place.
dryness by consuming the yin of the body, d) Wind is characterized by constant
etc. The properties of the six exogenous movement. Moving pathogenic wind in the
factors and their specific pathological body can cause dizziness, vertigo, fremitus,
influences on the body are described as convulsions and opisthotonos. Examples
follows: are tetanus and deviation of the mouth and
1) Wind Wind is the predominant qi of eyes with spasm of the facial muscles.
spring but may also occur in any of the four 2) Cold Cold, the predominant qi of
seasons. Wind may easily invade the body winter, may occur in other seasons but not as
after sweating, or whilst sleeping. severely. Thin clothing, exposure to cold
a) Wind is the primary exogenous- after sweating, being caught in rain, and
pathogenic factor in causing disease, since wading in water in cold winter can give rise
cold, damp, dryness and heat all depend on to invasion of pathogenic cold.
 Chinese Acupuncture and Moxibustion

a) Cold is a yin pathogenic factor which to speak and lassitude.

consumes the yang qi of the body. As a result \Severe invasion of summer heat may
the warming function of the body will be disturb the mind, resulting in sunstroke with
impaired, resulting in symptoms such as cold the symptoms of sudden collapse and coma.
limbs, cold pain in the epigastric and c) Since summer is often characterized by
abdominal regions, diarrhoea containing high humidity, pathogenic summer heat is
undigested f~cjb,i i i ~ i i ~ sf ~ dl af~ ckzr frequently scrmbin~dwith pathogenic damp-
urine, etc. Clinical manifestations of summer heat and
b) Cold is characterized by contraction damp include dizziness, heaviness in the
and stagnation, resulting in impairment of head, suffocating sensation in the chest,
the opening and closing of the pores, nausea, poor appetite, loose stools and
spasmodic contraction of tendons and general lassitude, in addition to fever,
meridians, and impaired circulation of qi restlessness and thirst.
and blood. Accompanying symptoms 4) Damp Damp is the predominant qi
include pain, aversion to cold, lack of of late summer-the period between
sweating and restricted movement of the summer and autumn- which in China is a
limbs. hot, rainy season with abundant damp
3) Summer Heat Summer heat is the everywhere. Many diseases related to
predominant qi of summer, and unlike the invasion by pathogenic damp occur at this
other exogenous factors, is only seen in its time. Damp diseases may also be induced by
own season. Summer heat diseases, are living ir? d a z p conditions and places,
induced by excessively high temperatures, wearing clothes made damp by sweat or
overexposure to the blazing sun whilst rain, frequent exposure to water, and
working, and working or staying for too periods of prolonged rain.
long in podrly ~entilatedplaces. a) Damp is characterized by heaviness
a) Summer heat, characterized by and turbidity. Patients often complain of
extreme heat, is a yang pathogenic factor dizziness, a heavy sensation in the head as
which is transformed from fire. Clinical though it had been wrapped in a piece of
manifestations characterized by yang heat cloth, heaviness of the body as though it
include high fever, restlessness, thirst, were carrying a heavy load, and soreness,
profuse sweating and a surging pulse. pain and heavy sensations in the joints.
b) Summer heat is characterized by There may be turbid discharges from the
upward direction, dispersion and consump- body, such as suppurating sores, weeping
tion of body fluid. It usually affects the head ' eczema, profuse purulent leukorrhoea with

and eyes, causing dizziness and blurred a foul odour, turbid urine and stools
vision. Due to its dispersing function, containing mucus and even blood.
pathogenic summer heat may cause the b) Damp is characterized by viscosity and
pores to stay open. The excessive sweating stagnation. Patients affected by pathogenic
, that causes may consume body fluid damp usually have a stubborn sticky tongue
resulting in thirst with a strong desire to coating, a viscous stool that is difficult to
drink, dry mouth and tongue, scanty deep- excrete, and obstructed urination. Diseases
yellow urine. In addition, there will be due to pathogenic damp tend to be
svm~tomsof qi deficiency such as reluctance prolonged and intractable, such as fixed bi
 Chapter 11 Aetiology and Pathogenesis

syndrome, damp fever (intestinal typhoid) direction. Clinical manifestations include

and eczema. high fever, restlessness, thirst, sweating,
c) Damp is a yin pathogenic factor which mouth and tongue ulcers, swollen and
impairs yang and easily obstructs qi painful gums, headache and congestion of
circulation. Clinical manifestations include the eyes. Restlessness, insomnia, mania,
a full sensation in the chest, epigastric emotional excitement and coma or delirium
distention, difficult and scanty urination may occur if pathogenic fire disturbs the
and hesitant bowel movements with viscous mind.
stools. Since the spleen "likes dryness and b) Pathogenic fire often consumes yin
dislikes damp," pathogenic damp is likely to fluid. Burning pathogenic fire heat can
impair spleen yang, leading to distention consume yin fluid and force it to the exterior
and fullness in the epigastrium and of the body, leading to insufficiency of body
abdomen, poor appetite, loose stools, fluid. Clinically; apart from high fever, there
reduced urination and oedema, due to poor may be thirst with desire to drink, dry lips
transportation and transformation and and throat, constipation and deep-yellow
inadequate dispersion of body fluids. scanty urine.
5) Dryness Dryness is the predominant c) Invasion by fire stirs up wind and
qi of autumn, and in China often occurs in causes disturbance of blood. Excess of fire
this season which is usually very dry. heat affects the Liver Meridian and deprives
a) Dryness consumes body fluid resulting the tendons and meridian of nourishment,
in dryness of the nose and throat, dry mouth thus stirring up the liver wind. Clinical
with thirst, chapped skin, withered body manifestations include high fever, coma,
hair, constipation and reduced urination. convulsion of the four limbs, neck rigidity,
b) Pathogenic dryness often impairs the opisthotonos and upward staring of the
function of the lung, the "delicate" zang, eyes. These symptoms are known as
which has the function of dispersing, "extreme heat stirring up wind."
descending and moistening. Dryness When pathogenic fire heat disturbs blood,
invades the lung through the nose or mouth. it speeds up blood circulation and gives rise
- When lack of moisture impairs the to very rapid pulse. In severe cases, blood is
dispersing and descending functions of the forced out of the vessels, leading to epistaxis,
lung, there may be a dry cough with scanty spitting of blood, bloody stool, haematuria,
sticky or bloody sputum. uterine bleeding and meno'rrhagia. Patho-
6) Fire (mild heat and heat) Fire, caused genic fire heat may stay in and rot the blood
by excess of yang qi, often occurs in summer, and flesh, thus creating carbuncle, furuncle,
but may be seen in other seasons. Fire, mild boil and ulcer.
heat and heat vary in degree. Of the three, In addition to the six exogenous
fire'is the most severe and mild heat the least pathogenic factors occurring in nature, there
severe, yet they all share similar also exist some extremely infectious noxious
characteristics. The terms of fire heat and epidemic factors. Although the character-
mild-heat heat, therefore, are often used to istics of these are similar to those of mild-
describe their common features. heat heat, they are severely toxic and can
a) Fire is a yang pathogenic factor result in the sudden onset of severe diseases
characterized by burning and upward such as plague. The medic4 literature of
 Chinese Acupuncture and Msxibustion

traditional Chinese medicine describes internal organs, resulting in the following

epidemics of many diseases recognised by clinical manifestations and pathology:
modern medicine, such as smallpox, cholera, "Anger injures the liver, joy injures the
diphtheria and toxic dysentery. heart, grief and melancholy injure the lung,
In addition to diseases caused by the six worry injures the spleen, and fear and fright
exogenous pathogenic factors, there are injure the kidney."
many diseases caused by functional 6b A i--nccc
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rlrvyl tn ~ ' Z C P
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disturbances of the zang-fu organs which it to move slowly; grief drastically consumes
nevertheless share similar clinical manifesta- it; fear causes it to decline; fright causes it to
tions. These pathological changes are be deranged, and worry causes it to
therefore referred to as endogenous wind, stagnate."
cold, damp, dryness and fire (heat) in order Many of these relationships are validated
to avoid ambiguity. Descriptions of these by clinical observation, but a concrete
pathogenic factors are ignored here and are analysis of each individual case is necessary
covered in the chapter on the differentiation to confirm which internal organ is impaired
of syndromes of the zang-fu organs. and what pathological changes in the qi have
developed.
The heart, liver and spleen are most
closely involved with pathological changes
2. The Seven Emotional Factors resulting from the seven emotional factors,
although any of the five za~lgorgans m y be
The seven emotional factors in traditional affected. For example, excessive joy or fear
Chinese medicine are joy, anger, mel- may cause mental disturbance and
ancholy, worry, grief, fear and fright. These dysfunction of the heart in dominating
are normal emotional responses of the body mental activities. Clinical manifestations
to external stimuli, and do not normally include palpitations, insomnia, dream-
cause disease. Severe, continuous or disturbed sleep and mental confusion, and in
abruptly occurring emotional stimuli, severe cases, abnormal laughing and crying
hokever, which surpass the regulative and mania. Prolonged anger or depression
adaptability of the organism, will affect the can impair the liver's function of
physiological functions of the human body, maintaining the free flow of qi. Clinical
especially when there is a preexisting manifestations include distention and pain
oversensitivity to them. The qi and blood of in the hypochondriac region, irascibility,
the zang-fu organs will be disrupted leading belching, sighing, the sensation of a foreign
to disease. The seven emotional factors body in the throat, and irregular
differ from the six exogenous factors in that menstruation. In severe cases, bleeding due
they directly affect the zang-fu organs, qi to impairment of the blood vessels may
and blood. For this reason, they are occur. Worry, grief and melancholy often
considered to be the main causative factors affect the transporting and transforming
of endogenous diseases. function of the spleen, causing epigastric
Ancient doctors believed that different and abdominal distention, anorexia, etc.
emotional factors tend to affect the The seven emotional factors may cause
circulation of qi and blood of specific functional derangement of the heart, liver or
Chapter 11 Aetiology and Pathogenesis

spleen individually, or may impair the iodine). Overindulgence in cold or raw food
function of more than one of these zang can easily injure spleen yang leading to the
organs. For example, worry can injure both development of interior cold and damp with
heart and spleen, whilst prolonged the symptoms of abdominal pain and
depression and anger may cause disharmony diarrhea. Overindulgence in alcoholic drink
between the liver and spleen. or greasy, sweet and highly flavoured food
may produce damp heat, phlegm and
3. Improper Diet, Overstrain, Stress stagnation of qi and blood. When the
functions of the spleen and stomach are
and Lack of Physical Exercise
impaired, there may be pathological changes
I) Improper diet Although food is of such as full sensation in the chest with
course necessary for maintaining life, profuse sputum, dizziness, vertigo, bleeding
improper diet may be one of the causative haemorrhoids and carbuncles.
factors of disease,and may affect the body in c) Intake of unclean food If unclean,
the following three ways: decayed or poisonous food is eaten, the
a ) Overeating and malnutrition The functions of the spleen and stomach will be
quantity of food consumed should be impaired, resulting in pain and distention in
appropriate to the requirements of the body. the epigastric and abdominal regions,
Either voracious eating or insufficient food nausea, vomiting, borborygmus and
intake may result in disease. If more food is diarrhoea. Unclean food may also cause
eaten than the digestive system can properly parasitic diseases or food poisoning.
digest,. the function of the spleen 2) Overstrain, stress or lack of physical
and stomach will be impaired. Clinical exercise Normal physical exertion and rest
manifestations include foul belching, sour do not cause disease, and indeed form the
regurgitation, distention and pain of the basic conditions for building up the
epigastric and abdominal regions, loss of constitution and preventing disease.
desire to eat, vomiting and diarrhoea. The Overstrain and stress or lack of physical
forty-third chapter of Plain Questions states: exertion, however, may cause disease, the
"Overeating will inevitably impair the thirty-nineth chapter of Plain Questions
gastro-intestinal function." Insufficient says: "Overstrain or stress consume the vital
food intake will fail to provide the basis for energy of the body." Prolonged overstrain
the manufacture of qi and blood. In the long or stress will weaken the antipathogenic qi
run, there will be loss of weight and and result in clinical manifestations such as
weakness of antipathogenic qi. loss of weight, lassitude, disinclination to
b) Overindulgence in -particular speak, palpitations, insomnia, dizziness and
foods The human body can only obtain its blurred vision.
nutritional needs when food intake is Excessive sexual activity will injure the
balanced. Overindulgence in one particular kidney qi, resulting, in symptoms of
food may result in various forms of deficiency such as soreness and weakness of
malnutrition or other diseases. For example, the lumbar region and knee joints, dizziness,
continuous intake of polished rice may tinnitus, impotence, ejaculatio praecox,
result in beriberi. The inhabitants of inland lassitude and irregular menstruation.
plateaus run a greater risk of suffering from An excessively comfortable life and lack
simple goiter through drinking only of physical exercise can impair the
"Shashui" (drinking water lacking in circulation of qi and blood, weaken the
 , Chinese Acupuncture and Moxibustion

function of the spleen and stomach, and sap fluid is the short form of the combination of
body resistance. Clinical manifestations the two.
include softening of the bones and tendons, Diseases caused by phlegm fluid include
poor energy, poor appetite, lassitude, numerous syndromes involving either
obesity, and shortness of breath on exertion. substantial or non-substantial phlegm fluid.
They may also induce other diseases. Clinical manifestations vary according to
c
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4. Traumatic Injury and Insect or phlegm in the lung, for example, may cause
Animal Bites cough with profuse sputum and asthmatic
Traumatic injuries include gunshots, breathing; phlegm afflicting the heart may
incisions, contusions, scalds, burns, and lead to palpitations, coma and depressive
sudden contracture or sprain due to carrying and manic psychosis; obstruction of the
heavy loads. These can result in muscular meridians, bones and tendons by phlegm
swelling and pain, stagnation of blood, may cause tuberculosis of the cervical lymph
bleeding, injury to the tendons, fracture of nodes, subcutaneous nodules, suppurative
the bones, dislocation of the joints, etc. inflammation of deep tissues, numbness of
Invasion of exogenous pathogenic qi into the limbs and body, and hemiplegia; phlegm
the affected areas, profuse bleeding, or fluid affecting the head and eyes may cause
injury to the internal organs can even cause dizziness, vertigo, and blurred vision.
coma or convulsions. '
Accumulation of phlegm and qi in the throat
Insect or animal bites including the bites may Ie2d to a ''fereigfi b ~ d yse~lsatlon."
of poisonous snakes, wild beasts and rabid Retained fluid attacking the skin and
dogs may result in bleeding, pain and muscles may cause oedema, general aching
broken skin in mild cases, and toxicosis or and a heavy sensation of the body; retention
even death in severe cases. of fluid in the chest and hypochondrium
may cause cough, asthmatic breathing,
5. Phlegm Fluid and Stagnant Blood distention and pain there; retained fluid
spreading to the stomach and intestines may
Phlegm fluid and stagnant blood are the lead to nausea, vomiting of sticky fluid,
pathological products of dysfunction of the discomfort in the epigastrium and abdomen,
zang-fu organs. Both of them, however, and borborygmus.
having been produced, further affect the Diseases caused by phlegm fluid cover a
zang-fu organs and tissues -either directly wide range, referring not only to those with
or indirectly -and cause numerous dis- such symptoms as visible sputum, but also to
eases. Phlegm fluid and stagnant blood are those with clinical manifestations character-
therefore considered to be a . kind of ized by phlegm fluid. General clinical
pathogenic factor. manifestations include spitting of profuse
1) Phlegm fluid Phlegm fluid results sputum or sticky fluid, a rattling sound in
from accumulation of body fluid -due to the throat, a full sensation in the epigastric
dysfunction of the lung, spleen and kidney and abdominal regions, vomiting, dizziness
and impairment of water metabolism. and vertigo, palpitations, a sticky tongue
Phlegm is turbid and thick, whilst retained coating andza string-taut rolling pulse.
fluid is clear and dilute. The term phlegm 2) Stagnant blood Stagnant blood is
Chapter 11 Aetiology and Pathogenesis 25 1

mainly caused by impaired blood circulation being due to disharmony of yin and yang
due to either coldness or deficiency or and conflict between pathogenic qi and
stagnation of qi. Traumatic injuries may antipathogenic qi. Antipathogenic qi,
cause internal bleeding which accumulates known as zheng qi, refers to the functional
and is not dispelled, leading to stagnant activities of the human body as well as to its
blood. ability to resist disease. Pathogenic qi,
The clinical manifestations of stagnant known as xie qi, refers to all the various
blood vary according to the area affected. causative factors of disease. For disease to
Stagnant blood in the heart, for example, occur, there must be present both a relative
may result in a suffocating sensation in the weakness of antipathogenic qi and the
chest, cardiac pain and green purplish lips. presence of pathogenic qi. Whilst both
Stagnant blood in the lung can cause chest together constitute the two major factors
pain and haemoptysis. Stagnant blood in the underlying the occurrence of disease,
gastro-intestinal tract can lead to haema- however, antipathogenic qi is primary, being
temesis and bloody stool. Stagnant blood in the internal factor that allows the invasion of
the liver may cause hypochondriac pain and the external factor i.e. pathogenic qi. The
palpable masses in the abdomen. Stagnant seventy-second chapter of Plain Questions
blood in the uterus can cause dysmenor- states: "Pathogenic qi cannot invade the
rhoea, irregular menstruation, and a dark body if the antipathogenic qi remains
red menstrual flow with clots. Stagnant strong." The thirty-third chapter of the same
blood on the body surface may cause a book further states: "The antipathogenic qi
purplish or green colour of the skin and must be weak if invasion of pathogenic qi
subcutaneous haematoma. takes place. "
~iseases*due to stagnant blood, although This dialectical approach, which pays
they can be varied, share certain common attention to both internal and external
characteristics: conditions, in particular, the former, has
a) Pain which is worse with pressure and played a major role in traditional Chinese
stabbing in nature. medicine in understanding the nature of
b) Bleeding which is deep or dark purple disease and guiding clinical practice.
in colour containing clots. Although diseases may be very com-
c) Ecchymoses or petechiae, accom- plicated and varied, they can be generalized
panied by pain in the affected parts, and understood in terms of pathological
indicate stagnant blood retained in the
* processes in the following three ways:
superficial portion of the body. The tongue disharmony of yin and yang, conflict
may be deep purple in colour or show purple between antipathogenic qi and pathogenic
spots. qi, and abnormal descending and ascending
d) There may be fixed purplish masses of qi. These three aspects of the development
accompanied by pain. of disease are closely interconnected.

HI. PATHOGENESIS 1. Disharmony of Yin and Yang

The onset of disease can be generalized as Disharmony of yin and yang refers to
 Chinese Acupuncture and Moxibustion

pathological changes involving either excess and pathogenic qi refers to the struggle
or deficiency of yin or yang, occurring when between the body's powers of resistance and
the body is invaded by pathogenic qi. any pathogenic factors. This struggle has
Disease will not occur unless the body is significance not only in relation to the onset
invaded by pathogenic factors which cause of disease, but also to its progression and
derangement of yin and yang in the interior. transformations. To some extent this
Yin-yang disharmony, i.e. excess or struggle CZE be described as the main focus
deficiency of either yin or yang, is mainly for the onset, progression and transfom-
manifested in the form of cold and heat, and ation of disease. Invasion of pathogenic qi
excess and deficiency syndromes. In general, results in conflict between the antipatho-
heat syndromes of excess type will occur in genic qi and the pathogenic qi which
cases of excess of yang, and co?-l syndromes destroys the yin-yang harmony of the body
of excess type in cases of excess of yin. Cold and causes functional disturbance of the
syndromes of deficiency type will occur in zang-fu organs and meridians, derangement
cases of deficiency of yang, and heat of qi and blood and abnormal ascending and
syndromes of deficiency type in cases of descending of qi, leading to various
deficiency of yin. In addition, in the course pathological changes. These mainly manif-
of the progression of disease, cold est as excess or deficiency syndromes.
syndromes may manifest some false heat Syndromes of excess type are likely to occur
symptoms, in which excess of yin walls off if there is both hyperactivity of pathogenic-qi
yang, and heat syndromes some false cold and suficiency of antipathogenic qi.
symptoms in which excess of yang walls off Syndromes of deficiency type, or syndromes
yin. of deficiency mixed with excess, are likely to
All the contradictions and changes occur if there is excess of pathogenic qi and
accurring in the disease process can be deficiency of antipathogenic qi. The twenty-
generalized in terms of yin and yang. Thus eight chapter of Plain Questions states:
all the zang-fu organs and meridians are "Hyperactivity of pathogenic qi causes
classified in terms of yin and yang; and qi syndromes of excess type and consumption
and blood, nutrient qi and defensive qi, of essential qi will lead to syndromes of
exterior and interior, ascending and deficiency type." Excess here mainly refers
descending of qi reflect yin and yang to hyperactivity of pathogenic qi, i.e. the
contradictions. Functional disturbance, pathological reaction dominated by excess
derangement between qi and blood and of pathogenic qi. It is commonly seen in the
between nutrient and defensive qi all belong early and middle stages of diseases due to
to disharmony of yin and yang, which invasion of the exogenous pathogenic
underlies the whole disease process and is factors, and diseases caused by retention of
the decisive factor in the occurrence and phlegm fluid, stagnant blood and water
development of disease. damp as well as retention of food.
Deficiency mainly refers to insufficiency of
antipathogenic qi which is the pathological
2. Conflict Between Antipathogenic Qi reaction dominated by decline of antipa-
and Pathogenic Qi ,
thogenic qi. It is commonly seen in diseases
The conflict between antipathogenic qi resulting from prolonged weakness of body
Chapter 11 Aetiology and Pathogenesis

constitution, poor function of the zang-fu and failure of its normal ascending function;
organs, and deficiency of qi, blood and body insomnia and palpitations caused by
fluid due to a lingering disease. disharmony between heart and kidney; and
syncope due to derangement of qi, blood,
yin and yang. Other examples are inability of
the kidney to receive qi, upward floating of
3. Abnonnal Descending or Ascending yang, failure of clear yang to ascend, and
of Qi sinking of the qi of the middle jiao. All of
these can be generalized as pathological
Ascending, descending, outward and changes caused by abnormal ascending and
inward movement are the basic forms of the descending of qi.
transmission of qi in its circulation through Whilst all the zang-fu organs are involved
the body. Abnormal ascending and in the ascending and descending of qi, the
descending refers to pathological states of spleen and stomach qi plays an especially
the zang-fu organs, meridians, yin and yang, important role. This is because spleen and
qi and blood in which they fail to maintain stomach provide the material basis for the
their normal state of governing ascent and acquirqd constitution. The spleen and
descent of qi. stomach lie in middle jiao which connects
The functional activities of the zang-fu with the other zang-fu organs in the upper
organs and meridians, and the relationships and lower jiaos, and forrn the pivot of the
between the zang-fu organs, meridians, qi, mechanism for ascending and descending of
blood, yin and yang are maintained by the qi. The physiological functions of the human
ascending, descending, outward and inward body can be maintained only when both the
movement of qi circulation. Examples of ascending function of spleen qi and the
this are the descending and dispersing descending function of stomach qi are
function of lung qi; the spleen's function of normal. Harmonious functioning of the
sending up clear essence of food to the lung; spleen and stomach is therefore essential to
the stomach's function of sending down the ascending, descending, outward and
partially digested food; the harmony inward movement of the qi of the whole
between the heart and kidney and between body. Neither aspect exists in isolation,
fire (heart) and water (kidney). Abnormal however, the ascending of spleen qi and
ascending or descending of qi may affect the descending of stomach qi must cooperate
five zang and six fu organs, the interior and with the ascending and descending
the exterior of the body, the four limbs and movement of the qi of the other zang-fu
the nine openings, leading to a variety of organs. If the ascending and descending
pathological changes. Common examples functions of spleen and stomach fail, the
include cough, asthmatic breathing, and a clear yang will not be disseminated, acquired
suffocating sensation in the chest caused by essence cannot be stored, the clean qi in the
failure of lung qi to descend and disperse; atmosphere and food cannot be received,
belching and nausea caused by abnormal and substances such as turbid phlegm will
ascent of stomach qi; loose stools and not be dispelled from the body. Numerous
diarrhoea caused by dysfunction of the diseases will result. An understanding of the
spleen in transportation and transformation influence of the ascending and descending
254 Chinese Acupuncture and Moxibustion

functions of spleen and stomach on the therefore essential in clinical practice when
physiological activities of the whole body is regulating the functions of these two organs.
 Chapter 12

DIAGNOSTIC METHODS

There are four diagnostic methods, determine the causative factors and nature
namely, inspection, auscultation and of the disease, thus providing basis for
olfaction, inquiring and palpation. further differentiation and treatment.
Inspection refers to the process in which Inspection, auscultation and olfaction,
the doctor observes with his eyes the inquiring and palpation are the four
systemic and regional changes in the approaches to understand the pathological
patient's vitality, colour and appearance. conditions. They can not be separated, but
Auscultation and olfaction determine the relate to and supplement one another. In the
pathological changes by listening and clinical situation, only by combining the
smelling. Inquiring means to ask the patient four can a comprehensive and systematic
or the patient's companion about the onset understanding of the condition of the
and progression of the disease, present disease be gained and a correct diagnosis
symptoms and signs, and other conditions made. Any inclination to one aspect while
related to the disease. Palpation is a method neglecting the other three is one-sided,
of diagnosis in which the pathological therefore, is not suggested.
condition is detected by feeling the pulse and
palpating the skin, epigastrium, abdomen,
hand, foot and other parts of the body. I. INSPECTION
As human body is an organic entity, its
regional pathological changes may affect the Inspection is a method of diagnosis in
whole body, and the pathological changes of which the doctor understands and pre-
the internal organs may manifest themselves dicts the pathological changes of inter-
on the body surface. The Medical Book by nal organs by observing abnormal
Master of Danxi says: "One should observe changes in the patient's vitality, colour,
and analyse the external manifestations of appearance, secretions and excretions. In
the patient in order to know what is their long-term medical practice, the
happening inside the body, for the disease of Chinese physicians realized the close
internal organs must have its manifestations relationship between the external part of the
on the body surface." By making analysis body, especially the face and tongue, and
and synthesis of the pathological conditions the zang-fu organs. Any slight changes
,,lied by applying the four diagnostic appearingin these areas can tell pathological
methods, the doctor, therefore, can conditions in various 'parts of the body.
 Chinese Acupuncture and Moxibustisn

Inspection of the exterior of the body, these changes is valuable for diagnosing
therefore, is of much help indiagnosis. disease.
Here are the descriptions of the
indications of the five discolorations.
A red colour often indicates heat
1. Observation of the Vitality syndromes, which may be of deficiency type
--
"1 "f nvnrscc
b *bbOO ~ l mWhen
t f yv
L.J ~.
r r f h entire
I-^-
~
------ face is red,
Vitality is the general manifestation of the it is a sign of a heat syndrome of excess type
vital activities of the human body, and the resulting from either exposure to exogenous
outward sign of relative strength of qi and pathogenic factors with the symptom of
blood of the zang-fu organs, which take fever, or hyperactivity of yang of zang-fu
essential qi as the basis. By observing organs. The presence of malar flush
vitality, one may get a rough idea of the accompanied by tidal fever and night
strength of the antipathogenic qi of the sweating suggests an interior heat syndrome
human body and severity of the disease; this due to yin 'deficiency.
is highly significant for the prognosis. A pale colour indicates cold syndromes of
If the patient is fully conscious and in deficiency type and loss of blood. A pale
fzip.By good spirits, responds keenly with a complexion is often due to yin excess or yang
sparkle in the eyes, the patient is vigorous deficiency. A bright white face with a puffy,
and the disease is mild. If the patient is bloated appearance is a sign of deficiency of
spiritless with duii eyes and sliiggish y2r.g qi. If the pa!e face is withered, it
response or even mental disturbance, the signifies blood deficiency.
patient lacks vigour and the disease is severe. A yellow colour indicates syndromes of
deficiency type and damp syndromes. When
the entire body, including the face, eyes and
2 Observation of the Coloaas skin, is yellow, it is jaundice. If the
yellowness tends toward bright orange, it is
Both the colour and lustre of the face are called yang jaundice resulting from damp
observed. There are five discolorations, heat. If the yellow is smoky dark, it is called
namely, blue, yellow, red, pale and dark yin jaundice resulting from either cold damp
grey. Observation of the lustre of the face is or long-term stagnation of blood. A pale
to distinguish whether the complexion is yellow complexion without brightness is a
bright and moist or dark and haggard. sign of deficiency of both qi and blood.
People of different races have different A blue colour indicates cold syndromes,
skin colours, and there is wide variation painful syndromes, stagnation of blood and
among people of the same race. However, a convulsion. A pale complexion with a blue
Bustrous skin with natural colour is tinge is seen in a syndrome of excessive yin
considered normal. and cold with the symptom of severe pain in
The colour and lustre of the face are the the epigasrium and abdomen. Blue purplish
outward manifestations of the relative face and lips with the intermittent pain in the
strength of qi and blood of the zang-fu precordial region or behind the sternum are
organs. Their changes often suggest various due to stagnation of the heart blood. Blue
pathological conditions. Observation of purplish face and lips accompanied by high
Chapter 12 Diagnostic Methods

fever and violent movement of the limbs in whole, an active patient is usually
children are signs of infantile convulsion. manifesting a yang syndrome, whilst a
A dark grey colour indicates deficiency of passive manner is usually yin. For instance,
the kidney and stagnation of blood. A pale a patient suffering from the lung syndrome
and dark complexion accompanied with of excess type with excessive phlegm is likely
lumbar soreness and cold feet suggests to sit there with the extended neck; whilst a
insufficiency of the kidney yang. A dark patient with deficiency of qi manifesting as
complexion without brightness, accom- shortness of breath and dislike of speaking
panied by scaly skin signifies prolonged tends to sit there facing downward. Violent
stagnation of blood. movement of the four limbs is mostly
Generally speaking, a lustrous and moist present in wind diseases such as tetanus,
complexion indicates that the disease is mild, acute and chronic infantile convulsion. The
qi and blood are not deficient, and the occurrence of weakness, motor impairment
prognosis is good; whilst a dark and haggard and muscular atrophy of the limbs suggests
complexion suggests that the disease is wei syndromes. The presence of pain,
severe, essential qi isslready injured, and the soreness, heaviness and numbness in the
prognosis is poor. tendons, bones and muscles accompanied by
As to the clinical significance of the colour swelling and restricted movement of the
of secretions and excretions, such as nasal joints points to bi syndromes. The
discharge, sputum, urine and vaginal appearance of numbness and impaired
discharge, those clear and white in colour movement of the limbs on one side of the
generally denote deficiency and cold, while body indicates hemiplegia or wind stroke. .
those turbid and yellow in colour indicate
excess and heat.
4. Observation of the Five Sense Organs

I) Observation sf the eye The liver

3. Observation of the Appearance opens into the eye, and the essential qi of the
five zang and six fu organs all goes up into
Appearance refers to the body shape the eye. Therefore, abnormal changes in the
which can be described as strong, weak, eye are not only associated with the liver, but
heavy or skinny; and to the movement and also reflect the pathological changes of other
posture related to disease. zang-fu organs. Apart from the expression
Overweight with mental depression of the eye, attention should also be paid to
mostly suggests deficiency of qi and excess of the appearance, colour and movement of the
phlegm damp. A thin person with dry skin eye. For instance, redness and swelling of the
indicates insufficiency of blood. Great loss eye are often due to wind heat or liver fire.
of weight in the course of a long illness Yellow sclera suggests jaundice. Ulceration
indicates the exhaustion of the essential qi. of the canthus denotes damp heat. Upward,
The patient's movement and posture are straight forward or sideways staring of the
outward manifestations of the pathological eye is mostly caused by disturbance of liver
changes. There is a variation of movement wind.
and posture in different diseases. But on the 2) Qbsesvatiom of the nose This is to
 Chinese Acupuncture and Moxibustion

observe the appearance and discharge of the ulcer spots are due to excessive toxic heat in
nose. The flapping of the ala nasi is often the lung and stomach. A bright red throat
present in asthmatic breathing due to either with a mild soreness suggests yin deficiency
heat in the lung or deficiency of qi of both leading to hyperactivity of fire. If there
the lung and kidney. Clear nasal discharge is occurs a false membrane over the throat,
due to exposure to wind cold, whilst turbid which is greyish white in colour, hard to
,nasal discharge to wind heat. Prolonged ----- ----
1 G l l l U VC,
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turbid nasal discharge with stinking smell and regrows immediately, it indicates
suggests chronic rhinitis or chronic sinusitis. diphtheria resulting from heat in the lung
3) Observation of the ear Due attention consuming yin.
is paid to the colour of the ear and
conditions of the internal ear. Dry and
withered auricles, burnt black in colour, 5. Observation of the Tongue
, present in the patient with a prolonged or
severe illness, are due to consumption of the Observation of the tongue, also known as
kidney essence not allowing it to nourish tongue diagnosis, is an important procedure
upwards. Purulent discharge in the ear, in diagnosis by inspection. It provides
known as "TinEr" (suppurative infection of primary information for the Chinese
the ear), is mostly caused by damp heat of physicians to make diagnosis.
the liver and gallbladder. 1) Physiology of the tongue The tongue
4) Observation of the gums Pale gums directly or indirectly @onnc~+Ls -dr;+k
L I ~l l l a u y -mmv

indicate deficiency of blood. Redness and zang-fu organs through the meridians and
swelling of the gums are due to flaring up of collaterals. The deep branch of Heart
a the stomach fire. If redness and swelling of ~ e r i d i a nof' Hand-Shaoyin goes to the root
the gums are accompanied by bleeding, it is of the tongue; the Spleen Meridian of Foot-
due to injury of the vessels by the stomach Taiyin traverses the root of the tongue and
fire. spreads over its lower surface; the Kidney
5) Observation of the Lips and mouth Meridian of Foot-Shaoyin terminates at the
This is to observe the changes of the lips and root of the tongue. So the essential qi of the
mouth in colour, moisture and appearance. zang-fu organs can go upward to nourish the
Pale lips denote deficiency of blood. Blue tongue, and pathological changes of the
purplish lips suggest either retention of cold zang-fu organs can be reflected by changes
or stagnation of blood. Dry lips, deep red in in tongue conditions. This is why the
colour, indicate excessive heat. Sudden observation of the tongue can determine the
collapse with open mouth is deficiency, pathological changes of the internal organs.
whilst sudden collapse with lock jaw is Observation of the tongue includes the
excess. tongue proper and its coating. The tongue
6) Observation of the throat The focus is proper refers to the muscular tissue of the
on abnormal changes of the throat in colour tongue, which is also known as the tongue
and appearance. Redness and swelling of the body. The tongue coating refers to a layer of
throat with soreness denote accumulation of 6 ' m ~ over~ ~ "the tongue surface, which is
heat in the lung and stomach. Redness and produced by the stomach qi.
swelling of the throat with yellow or white A normal tongue is of proper size, soft in
Chapter 12 Diagnostic Methods
quality, free in motion, slightly red in colour Deep red tongue: A deep red tongue
and with a thin layer of white coating which indicates an extreme heat condition. In
is neither dry nor over moist. exogenous febrile diseases, it indicates
The tongue is divided into four areas, invasion of the ying and xue (blood) systems
namely, tip, central part, root and border. by pathogenic heat. In endogenous diseases,
The tip of the tongue often reveals the it indicates yin deficiency leading to
pathological changes of the heart and lung; hyperactivity of fire.
its border reveals those of the liver and Purple tongue: A blue purple tongue
gallbladder; its central part reveals those of indicates stagnation of blood which is
the spleen and stomach; and its root reveals related to either cold or heat. A deep blue
those of the kidney. This method of purplish tongue, dry and lustreless, is related
diagnosing the pathological changes of the to heat, whilst a pale purplish and moist
zang-fu organs by dividing the tongue into tongue is related to cold. The presence of
corresponding areas is clinically significant. purplish spots on the tongue surface also
2) Tongue diagnosis indicates stagnation of blood.
a) Tongueproper This is to observe the ii) Form of the tongue proper
colour and form of the tongue proper. Swollen tongue: A swollen tongue is
i) Colour of the tongue proper larger than normal. If a swollen tongue is
Pale tongue: A pale tongue is less red delicate in quality and pale in colour, and
than a normal tongue, and indicates with tooth prints on the border, it indicates
syndromes of deficiency type and cold yang deficiency of the spleen and kidney.
syndromes caused by deficiency of yang qi The condition is due to impaired circulation
or insufficiency of qi and blood. of body fluid producing harmful water,
Red tongue: A red tongue is bright red retained fluid, phlegm and damp. If a
and redder than a normal tongue. It swollen tongue is deep red in colour
indicates various heat syndromes including occupying the entire space of the mouth, it
interior heat syndromes of excess type and indicates excessive heat in the heart and
interior heat syndromes of deficiency type spleen. If a swollen tongue is blue purplish
due to yin deficiency. and dark, it indicates toxicosis.

- Kidney

-- - - Spleen and S t o r

Liver and gallbladder db -

P

Fig. 134
 Chinese Acupuncture and Moxibustion

Thin tongue; A thin tongue is smaller 'Thick coating and thin coating: The
and thinner than normal. A thin and pale tongue coating is considered thin if the
tongue indicates deficiency of qi and blood. tongue proper can indistinctly be seen
A thin, dry and deep red tongue indicates through it, and considered thick if the
hyperactivity of fire due to deficiency of yin tongue proper can not be seen through it.
in which body fluid is consumed. One can understand the severity of the
Cr~cked toague: Irregn!ar streaks or pathsgenic fzctors and progrsssio~ef the
cracks on the tongue indicate excessive heat pathological conditions by distinguishing
consuming body fluid if the tongue is deep the thickness and thinness of the tongue
red in colour, and indicate deficiency of coating. Generally speaking, a thin tongue
blood if the tongue is pale. A cracked tongue coating is present if the superficial portion of
may be present in a normal person. If so, the the body is affected in a disease, or if the
cracks are not deep, and remain there a 1 the disease is due to deficiency of the anti-
time unchanged. This is considered normal. pathogenic qi. Retention of damp, phlegm
Thorny tongue: The papillary buds over or food in the interior, or inward
the surface of the tongue swell up like transmission of the pathogenic factor from
thorns. A thorny and red tongue indicates the exterior may produce a thick tongue
accumulation of pathogenic heat in the coating. Thickening coating indicates
interior. The more severe the pathogenic inward transmission of the pathogenic
heat is, the more enlarged and profuse the factor from the exterior, and is a sign of
thrns v4iH be. aggraxcitinr?nf the disease. Thinning c ~ a t i n g
Deviated tongue: A deviated tongue points to gradual elimination of the
indicates windstroke or early threatening pathogenic factor, and is a sign s f alleviation
signs of windstroke. of the pathological conditions.
Rigid tongue: A rigid tongue lacks Moist coating and dry coating: One can
flexibility and is difficult to protrude, retract understand the condition of the body fluid.
or roll. A rigid tongue seen in exogenous by distinguishing the moisture and dryness
febrile diseases often indicates invasion of of the tongue coating. A normal tongue
the pericardium by heat, retention of turbid coating is moist and lustrous, which is the
phlegm in the interior, or excessive manifestation of normal dissemination of
pathogenic heat consuming body fluid. A the body fluid. A dry tongue coating, which
rigid tongue present in endogenous diseases looks coarse and feels lacking moisture
indicates wind stroke or early threatening indicates consumption of body fluid due to
signs of windstroke. excessive heat or consumption of yin fluid
Flaccid tongue: A flaccid tongue is weak not allowing it to nourish upwards. If there
in motion, and often indicates extreme is excessive moisture over the tongue
deficiency of qi and blood or consumption surface, and the saliva dribbles when the
of yin fluid depriving the tongue of the tongue is stuck out in a severe case, it is a
nourishment. If a flaccid tongue is pale, it slippery tongue coating. The condition is
indicates deficiency of qi and blood. If it is caused by upward flooding of harmful water
deep red, it indicates collapse of yin. and damp.
b ) Tongue coating: Sticky coating and granular coating: Both
i) Quality of the tongue coating sticky and granular tongue coating help
Chapter 12 Diagnostic Methods

deduce the turbid damp in the intestines and resulting from cold and damp. If a grey
stomach. It is a sticky coating if the tongue is coating is yellowish and dry, it signifies
covered by a turbid layer of fine greasy consumption of body fluid due to excessive
substance which is hard to be scrubbed. A heat. If a grey coating is whitish and moist, it
sticky tongue coating is often seen in implies retention of cold damp in the interior
syndromes resulting from retention of or retention of phlegm and fluid. As a grey
turbid damp and phlegm or retention of coating often develops into a black coating,
food. It will be a granular coating if the a greyish black coating is seen.
granules on the tongue surface are coarse, Black coating: A black coating indicates
loose and thick like residue of making soy interior syndromes due to extreme heat or
bean curds, and easily scrubbed. A pasty excessive cold. A black coating is often the
tongue coating often results from excessive outcome s f the further development of a
yang heat bringing the turbid qi in the yellow coating or a grey coating. It is present
stomach upwards. It is also seen in at the severe stage of an illness. If a black
syndromes caused by retention of turbid coating is yellowish and dry, possibly with
phlegm or retention of food. thorns, it signifies consumption of body
Peeled coating: The tongue with a part of fluid due to extreme heat. A pale black and
its coating peeling off is known as slippery coating implies excessive cold due to
"geographic tongue." It is a sign of yang deficiency.
consumption of qi and yin of the stomach. If 3) Precautions in tongue diagnosis
the entire coating peels off leaving the a) As each disease undergoes a com-
surface mirror smooth, the condition is plicated process, the conditions of the
known as glossy tongue. It is a sign of tongue proper and its coating are .the
exhaustion of the stomach yin and severe manifestations of interior complicated
damage of the stomach qi. pathological changes. The conditions of the
ii) Colour of the tongue coating tongue proper mainly reflect deficiency or
White coating: A thin and white coating excess of the zang-fu organs and relative
is normal. Yet a white coating may appear in strength of the essential qi. The conditions of
an illness. If so, it indicates exterior the tongue coating reflects the depth and
syndromes and cold syndromes. A thin and nature of the invading pathogenic factors. A
white coating is present in exterior cold comprehensive analysis of the conditions of
syndromes, whilst a thick and white coating both the tongue proper and its coating is
is seen in interior cold syndromes. required on the basis of their respective
Yellow coating: A yellow coating indications. The condition of the tongue
indicates interior syndromes and heat proper and that of its coating are generally
syndromes. The deeper yellow the coating is, conformable; the disease to be indicated is
the more severe pathogenic heat it indicates. often the outcome of combining the two.
A light yellow coating points to mild heat; a For instance, retention of heat of excess type
deep yellow coating to severe heat; a burnt in the interior produces a red tongue with a
yellow coating to accumulation of heat. dry and yellow coating; a pale tongue with a
Grey coating: A grey coating indicates moist and white coating is often present in
interior syndromes, and may be seen in cold syndromes of deficiency type. But such
interior heat syndromes or syndromes situations as the condition of the tongue
 Chinese Acupuncture and Moxibustion

proper does not agree with the condition of speech in feeble 'voice accompanied by
its coating may occur. Only by a listlessness suggests a syndrome of
comprehensive analysis can reliable deficiency type of the heart resulting from
.
information be provided for furthur ' severe damage of the heart qi.
differentiation of syndromes. b) Listening to the respiration Feeble
b) It is desirable to observe the tongue in breathing indicates deficiency of qi. Forceful
direct ngtural light- The patient is required and coarse breathing accompanied by 2 loud
to protrude the tongue naturally. voice suggests a syndrome of excess type due
c) Some food and drugs may colour the to excessive pathogenic heat in the interior.
tongue coating, and the thickness and . Feeble asthmatic breathing accompanied
. moisture of the tongue coating may change by shortness of breath indicates deficiency of
after eating or scraping the tongue. the qi of the lung and kidney, pertaining to
Attention should be paid to the exclusion of deficiency type asthma. Coarse asthmatic
false phenomena induced by such factors in breathing in loud tones with the preference
the clinical situation. for exhalation suggests retention of
pathogenic factor in the lung impairing the
functions of qi. This belongs to asthma of
excess type.
c ) Listening to the cough Cough is the
11. AUSCULTATION AND manifestation of dysfunction of the lung in
OLFACTION dispersing and descending leading to
upward perversion of qi. Cough in a coarse
Auscultation and olfaction refer to voice indicates a syndrome of excess type,
listening and smelling. cough in a feeble voice suggests a syndrome
of deficiency type. Unproductive cough or
cough with a small amount of thick sputum
implies injury s f the lung by pathogenic
1. Listening dryness or dryness of the lung due to yin
deficiency.
a ) Listening to the speech In general,
speaking lustily indicates syndromes of
excess type, while speaking feebly and in low
tones indicates those of'deficiency type. A 2. Smelling
hoarse voice or loss of voice in a severe case
may be of deficiency type or of excess type. If Stench smell of a secretion or excretion
they are present in exogenous diseases with a usually indicates heat syndromes of excess
sudden onset, they are of excess type. type; less s t i n k i n ~smell suggests cold
Chronic or recurrent onset in endogenous syndromes of deficiency type; foul and sour
diseases are of deficiency type. smell. implies retention of food. Different
Incoherent speech in loud voice odours should be identified in order to
accompanied by impaired consciousness deduce the nature of the disease. The source
indicates a syndrome of excess type due to of the odour should also be traced for
disturbance of the mind by heat. Repeated determining the locality of the disease.
Chapter 12 Diagnostic Methods
- -

2) Alternatechills and fever The patient

111. INQUIRING may notice alternate attacks of chills and
fever. This is the representative symptom of
Inquiring is asking the patient or the intermediate syndromes. The patient may
patient's companion about the disease also complain of a bitter taste in the mouth,
condition in order to understand the thirst and fullness and stuffiness in tk;e chest
pathological process. and hypochondrium.
I

Inquiries are made systematically with High fever following chills occurring at a
questions focused on the chief complaint of definite time of the day suggests malaria.
the patient according to the knowledge 3) Fever without chills Fever may occur
necessary in differentiating a syndrome. without chills. Persistent high fever with
Inquiring covers a wide range of topics. aversion to heat instead suggests interior
Here is a brief introduction to inquiring heat syndromes of excess type due to
about the present illness. transmission of the pathogenic factors from
the exterior to the interior with excessive
heat in the interior. The accompanying
I. Chills and Fever symptoms and signs are profuse sweating,
severe thirst and a surging pulse. If fever
Apart from confirming the presence of occurs or becomes worse at a fixed hour of
chills and fever, we need to ask such the day just like the sea waves, it is known as
questions as which is more severe, when they tidal fever. Tidal fever in the afternoon or
occur and what symptoms and signs evening, accompanied by night sweating and
accompany them, for this information is a red tongue with little moisture indicates
necessary for further differentiation of deficiency of yin; afternoon fever with
syndromes; constipation and fullness and pain in the
I) Chins accompanied by fever Simulta- abdomen suggests excess heat of the
neous occurrence of chills and fever at the Yangming Meridian.
beginning of the disease indicates exogenous 4) Chills without fever The subjective
exterior syndrome. It is the manifestation of feeling of chills without fever indicates
invasion of the body surface by the interior cold syndrome of deficiency type.
pathogenic factor and its contending with The patient may also have chilled
the antipathogenic qi. Exterior syndromes appearance, cold limbs and a deep, slow and
resulting from exposure to path0gen.i~wind weak pulse.
cold usually manifest as severe chills and
mild fever with the accompanying
symptoms and signs such as absence of
sweating, headache and general aching, and 2. Perspiration
a superficial, and tense pulse. Exterior
syndromes due to invasion by pathogenic The patient should, first of all, be asked
wind heat are characterized by mild chills whether sweating is present or not. Further
and severe fever; the patient also reveals inquiring deals with the feature of sweating
thirst, sweating and a superficial and rapid and its accompanying symptoms and signs.
pulse. Absence of sweating in exterior
 Chinese Acupuncture and Moxibustioa

syndromes indicates invasion by pathogenic the spleen and stomach caused by retention
cold; presence of sweating in exterior of food or retention of pathogenic damp.
syndromes suggests either exterior syn- Excessive appetite and getting hungry
dromes of deficiency type resulting from easily in a skinny patient indicate excessive
exposure to pathogenic wind, or exterior stomach fire.
heat syndromes due to invasion by Hunger with no desire to eat or eating a
--Ad- -
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symptoms and signs are considered in of the stomach yin producing internal heat
differentiation. of deficiency type.
Sweating that occurs during sleep and Lack of thirst during an illness suggests
stops upon wakening is known as night that body fluid is not consumed. It is present
sweating. It usually indicates deficiency of in cold syndromes or syndromes in which
yin with hyperactivity of yang heat. The pathogenic heat is not noticeable. The
patient may also present tidal fever and a red presence of thirst indicates consumption of
tongue with little coating. body fluid or retention of phlegm damp in
Frequent sweating which is worse on the interior preventing body fluid from
slight exertion is known as spontaneous ascending. Further analysis is based on
sweating. It is a sign of deficiency of qi and features of thirst, amount of drinks to be
deficiency of yang. The patient may also taken and the accompanying symptoms and
exhibit chills, listlessness and lassitude. signs.
E'rzlfiise swe~itiiigaeeompaiiied by high bitter tiiS+Le in+La
L11b 111" uI11
t uo~a!!y 130 I

fever, mental restlessness, thirst with indicates hyperactivity of the fire of the liver
preference for cold drinks and a surging and gallbladder. A sweetish taste and
pulse indicates interior heat syndromes of stickiness in the mouth imply damp heat in
excess type resulting from excessive yang the spleen and stomach. Sour regurgitation
heat in the interior expelling the sweat out. means retention of heat in the liver and
Profuse sweating accompanied by listless- stomach. Tastelessness points to deficiency
ness, feeble energy, cold limbs and a deep of the spleen with its impaired function of
and thready pulse in a severe case is a critical transportation.
sign indicating total exhaustion of yang qi.

4. Defecation and Urination

3. Appetite, Thirst and Taste
As the doctor does not observe the change
Poor appetite present in the patient with a in -defecation and urination of the patient
prolonged illness manifesting as emaciation, directly, it is necessary to make inquiries.
loose stools, lassitude and a pale tongue with Constipation due to dryness of stool
a thin white coating indicates weakness of usually indicates accumulation of heat or
the spleen and stomach; poor appetite consumption of body fluid. Loose stool
accompanied by stuffiness in the chest, suggests deficiency of the spleen or retention
fullness in the abdomen and a thick, sticky of damp in the spleen. Watery stool with
tongue coating suggests stagnation of qi of undigested food implies deficiency of yang
 Chapter 12 Diagnostic Methods

of the spleen and kidney. Bloody stool with of qi stagnation. It often occurs in the chest,
mucus and tenesmus results from damp heat epigastric, hypochondriac and abdominal
in the intestines and stagnation of qi in the regions. But headache with a distending
intestinal tract. sensation in the head is due to upward
Yellow urine generally indicates heat disturbance by fire and heat.
syndromes, while clear and profuse urine Pricking pain: Pricking pain, sharp in
indicates absence of the pathogenic heat in nature and fixed in location, is a sign of
an illness, or cold syndromes. Turbid urine stagnation of blood. It usually occurs in the
suggests downward infusion of damp heat chest, epigastric, hypochondriac and lower
or downward leakage of turbid essence. Red abdominal regions.
urine implies injury of the vessels by heat. Weighty pain: Pain with a heavy
Clear urine increased in volume means sensation is a sign of damp blocking qi and
infirmity of the kidney qi and dysfunction of blood, as damp is characterized by
the bladder in controlling urine, while scanty heaviness. It is often present in the head,
yellow urine with urgent and painful four limbs and lumbar region.
urination means downward infusion of Colicky pain: Colicky pain is a sign of
damp heat into the bladder. Dribbling abrupt obstruction of the qi by substantial
urination or retention of urine in a severe pathogenic factors.
case is present not only in syndromes of Pulling pain: Pulling pain . which is
deficiency type due to exhaustion of the spasmodic in nature and short in duration
kidney qi with its impaired function of often relates to the disorders of the liver. It is
controlling urine, but also in syndromes of caused by liver wind.
excess type caused by obstructed qi activities Burning pain: Pain with a burning
of the bladder due to downward infusion of sensation and preference for coolness often
damp heat, stagnant blood or stones. occurs in the hypochondriac regions on both -
sides and epigastric region. It results from
invasion of the collaterals by pathogenic fire
and heat or from excessive yang heat due to
yin deficiency.
Pain is one of the most common Cold pain: Pain with a cold sensation
symptoms complained of by the patient. and preference for warmth often occurs in
Apart from a thorough understanding of the the head, lumbar, epigastric and abdominal
history and accompanying symptoms and regions. It is caused by pathogenic cold
signs, the nature and locality of pain must be blocking the collaterals or lack of warmth.
asked. Differentiation of the nature of the and nourishment in the zang-fu organs and
pain is significant for deducing its etiology meridians due to deficiency of yang qi.
and pathology, while identification of the Dull pain: Dull pain is not severe. It is
locality of the pain helps determine diseased bearable lingering and may last for a long
zang-fu organs and meridians. time. It is usually present in cold syndromes
8 ) Nature of the pain of deficiency type.
Distending pain: Distending pain mani- Hollow pain: Pain with a hollow
festing as severe distension, mild pain and sensation is caused by deficiency of blood
, moving from place to place is a typical sign leading to emntiness of vessels and
 Chinese Acupuncture and Moxibustion

retardation of blood circulation. Jueyin. So according to the locality of the

2) Locality of the pain Headache: Head is pain, the diseased zang-fu organs and
the meeting place of all the yang meridians meridians can be identified.
and brain is the sea of marrow. Qi and blood Abdominal pain caused by retention of
of the five zang and six fu organs all go up cold, accumulation of heat, stagnation of qi,
into the head. If the pathogenic factors stagnation of blood, retention of food or
invade the head an$ block the yang, or parasi'liz &iseases is excess i:., natnre, ;z4E,ile
if stagnation of qi and blood in endogenous that caused by deficiency of qi, deficiency of
diseases blocks the meridians and deprives blood or deficiency of cold is deficiency in
the brain of the nourishment, headache will nature.
ensure. In cases of deficiency of qi and Lumbago: The kidney resides in the
blood, head fails to be nourished, and the sea lumbar region. Lumbago may result from
of marrow becomes empty; headache due to obstruction of the meridians in the local
this is of deficiency type. Headache due to area; besides, deficiency of the kidney failing
disturbance of the clear yang by the to nourish the lumbar region is often the
pathogenic factor is mostly of excess type. cause.
Chest pain: As the heart and lung reside Pain in the four limbs: Pain in the four
in the chest, chest pain indicates the limbs may involve joints, muscles or
pathological changes of the heart and lung. meridians. It is casued by retardation of qi
Hypochondriac pain: The hypochon- and blood circulation due,to invasion of the
driac region is traversed by the Liver and exogenom p~tEc?ge~?ic f~ct~rs.
Gallbladder Meridians. Obstruction or Besides, the duration of pain and its
undernourishment of these meridians may response to pressure should also be asked.
produce hypochondriac pain. Generally, persistent pain in a recent disease
Epigastric pain: Epigastrium (wan) or pain which is aggravated by pressure
refers to the upper abdomen in which the indicates syndromes of excess type.
stomach situates. It is divided into three Intermittent pain in a prolonged illness or
regions, namely, Shangwan, Zhongwan and pain which is alleviated by pressure often
Xiawan (upper, middle and lower wan occurs in syndromes of deficiency type.
respectively). Epigastric pain may result
from iilvasion of the stomach by pathogenic
cold, retention of food in the stomach or 6. Sleep
invasion of the stomach by the liver qi.
Abdominal pain: Abdomen is divided Insomnia means either difficulty in falling
into upper abdomen, lower abdomen and asleep, or inability to sleep soundly, waking
sides of the lower abdomen. The upper easily and being unable to fall asleep again.
abdomen refers to the area above the Insomnia accompanied by dizziness and
umbilicus and pertains to the spleen. The palpitations usually indicates failure of
area below the umbilicus is the lower blood to nourish the heart due to deficiency
abdomen and pertains to the kidney , of both the heart and spleen. Insomnia
bladder, large and small intestines and accompanied by restlessness in mind and
uterus. Both sides of the lower abdomen is dream-disturbed sleep suggests hyperactiv-
traversed by the Liver Meridian of Foot- ity of the fire of the heart. Difficulty in
Chapter 12 Diagnostic Methods

falling asleep due to an uncomfortable and stagnation of blood due to cold; dull pain in
empty sensation in the stomach or gastric the lower abdomen during or after the
discomfort after a full meal implies period which is alleviated by pressure is due
derangement of the stomach qi leading to to deficiency of qi and blood.
mental restlessness. 2) Leukorrhea Attention is paid to the
If lethargy is accompanied by dizziness, it colour, amount, quality and smell of
indicates accumulation of phlegm damp in leukorrhea.
the interior. A situation of being half asleep Watery leukorrhea whitish in colour and
with general lassitude suggests deficiency of profuse in amount indicates deficiency
the yang of the heart and kidney. syndromes and cold syndromes; thick
leukorrhea yellow or red in colour with
offensive smell suggests excess syndromes
7. Menses and Lenkorrhea and heat syndromes.

Women patients are also asked about the

menses and leukorrhea, and for married
women the obstetric history.
I) Menses Inquiring in this aspect
covers menstrual cycle and period, amount, Palpation is a method of diagnosis in
colour and quality of flow and the which the pathological condition is detected
accompanying symptoms and signs. If it is by palpating, feeling and pressing certain
necessary, questions concerning the date of areas of the body. It is discussed under the
the last menstrual period and age of headings of feeling the pulse and palpation
menopause should be asked. of different parts of the body.
Menses of a shortened cycle, excessive in
amount, deep red in colour and thick in
quality relates mainly to excessive heat in the 1. Feeling the Pulse
blood; light coloured menstrual flow
profuse in amount and thin in quality The location for feeling the pulse at the
indicates failure of qi to command blood. A present time is above the wrist where the
prolonged cycle with scanty purplish dark radial artery throbs. It is divided into three
discharge or blood clots suggests stagnation regions: cun, guan and chi (Fig. 135 ) The
of blood due to cold; thin scanty and light- region opposite to the styloid process of the
coloured flow implies deficiency of blood. radius (the bony eminence behind the palm)
Irregular menstrual cycle is a sign of is known as guan, that distal to guan (i.e.
disharmony of the Chong and Ren between guan and the wrist joint) is cun and
(Conception Vessel) Meridians due to that proximal to guan is chi. There have been
obstruction of the liver qi. in different ages various descriptions
Bre-menstrual or menstrual distending concerning the relationship between these
pain in the breasts and lower abdomen three regions and their corresponding zang-
which intensifies on pressure means fu organs. They are fundamentally
stagnation of qi and blood; cold pain in the conformable. It is generally acknowledged
lower abdomen during the period points to that the three regions of cun, guan and chi of
 Chinese Acupuncture and Moxibustion

Left hand

ney

Right hand

Fig. 135

the left hand reflect respectively the short arms, the three fingers are placed more
conditions of the heart, liver and kidney; and closely. The method of "feeling the pulse in
those of the right hand reflect the conditions the guan region with one finger" is adopted
of the lung, spleen and kidney. in infantile cases, for a baby's pulse is not
In feeling the pulse, let the patient take divided into these three regions.
either sitting or supine position with the arm The pulse is palpated by exerting three
placed approximately on a level with the different finger forces, first lightly
heart, wrist extended and palm facing (superficial palpation), then moderately
upward. This position facilitates smooth (middle palpation) and finally heavily (deep
circulation of qi and blood. The doctor, by palpation). Generally the finger force of the
the side of the patient, first locates the guan same strength is exerted on the three regions
region with the middle finger, then the cun at the same time and then feel the three
and chi regions with the index and ring regions separately according to the actual
fingers. The three fingers are slightly flexed, pathological conditions.
presenting the shape of an arch. The finger The pulse is differentiated in terms of
tips are kept on the same horizontal level depth (superficial or deep), speed (rapid or
and the pulse is felt with the palmar side of slow), strength (forceful or weak), shape
the fingers. The space between each two (thick or thready, soft or hard) and rhythm.
fingers depends upon the height of the Different conditions of the pulse indicate
patient. If the patient is tall and has long different syndromes.
arms, it is desirable to separate the fingers A normal pulse is smooth, even and
accordingly. If the patient is short and has forceful with the frequency of four beats per
Chapter 12 Diagnostic Methods

breath. However, the pulse may vary due to quick, with more than five beats per breath
age, sex, body constitution, emotional state (more than ninety beats per minute). A
and climatic changes. Due attention should rapid pulse indicates heat syndromes.
be paid to distinguishing it from an Induced by pathogenic heat, the blood
abnormal pulse. circulation is accelerated, the result being a
Abnormal pulse readings and their rapid pulse. If excess heat is retained in the
clinical significance are as follows. interior 'and the antipathogenic qi is still
1) SaapesficiaP pulse (fu mai) A super- strong, their struggle will induce a rapid and
ficial pulse can be easily felt with gentle forceful pulse. Deficiency of yin in a
touch. It indicates exterior syndromes, and prolonged illness produces deficiency-heat
is present at the early stage of exogenous in the interior, presenting a rapid and weak
diseases. Invasion of the body surface by the pulse. A rapid pulse may also be induced by
exogenous pathogenic factor creates its outward floating of deficiency-yang. In this
contending with wei qi. The pulsation is case, the pulse feels rapid, large, weak and
superficially situated, hence the superficial empty.
pulse. A superficial pulse may also be 5) Pulse of deficiency type (xu wai) It is
present in prolonged endogenous diseases. the general term for all the forceless pulses
In this case, the pulse is superficial, large and felt on the three regions at the three levels of
weak, indicating outward floating of yang pressure.
qi. This is a critical sign of the disease. The pulse indicates syndromes of
2) Deep 1pmBse (chew mai) A deep pulse is deficiency type due to deficiency of qi and
felt only on heavy pressure. It indicates blood. Deficiency of qi 'and-blood implies '
interior syndromes. If the pulse is deep and weakness in activating blood circulation,
forceful, it indicates interior syndromes of thus producing a pulse of deficiency type.
excess type. When the pathogenic factor 6) Pulse of excess type (shi mai) It is the
invades the interior of the body, qi and general term for all the forceful pulses felt on
blood circulation is blocked, presenting a the three regions at the three levels of
deep and forceful pulse. If the pulse is deep pressure.
and weak, it indicates interior syndromes of The pulse indicates syndromes of excess
deficiency type. type. The struggle waged by the strong
3) Slow pulse (chi mai) The rate is slow, antipathogenic qi against the hyperactive
with less than four beats per breath (less than pathogenic factor brings on excessive qi and
sixty beats per minute). A slow pulse blood, thus creating a pulse of excess type.
indicates cold syndromes. Qi contracts and PI) Surging pulse (lholrag mai) A surging
blood flow stagnates on exposure to cold. pulse is broad, large and forceful like roaring
The retarded circulation of qi and blood waves which come on powerfully and fade
produces a slow pulse. If the slow pulse is away. ]if a surging pulse lacks the
forceful, it indicates an interior syndrome of momentum of roaring waves, it is called
excess type caused by retention of yin cold in large pulse.
the interior. If the slow pulse is weak, it A surging pulse indicates excessive heat,
indicates an interior syndrome of deficiency and often occurs together with a rapid pulse.
type due to deficiency of yang qi. Excessive heat in the interior dilates the
4) Rapid pulse (shu mai) The rate is blood vessels and accelerates qi and blood
 Chinese Acupuncture and Moxibustion

circulation, thus producing a surging pulse. liver qi tightening the vessels; that in painful
8) Thready pulse (xi mai) A thready syndrome is due to tightness of the
pulse feels like a fine thread but is very meridians and vessels; that in retention of
distinct and clear. It indicates deficiency due phlegm and fluid in the interior is due to
to overstraiil and stress or deficiency of qi dysfunction of qi in transportation.
and blood. It is often present in patients with 12) Tense pulse (jiw mai) A tense pulse
weak body ~ u ~ i s i i i i i i i cii;i ~ o p;olc-ged P n f i I o fifiht
A A L. Z A
~ ~ l-
~ t ? df n r r ~ f like 2 stretched
- - - --- - rope.
illness manifesting as yin deficiency and It indicates cold, pain and retention of food.
blood deficiency. Deficiency of yin and As cold is characterized by contraction,
blood means the inability to fill the vessels. the vessels contract on exposure to cold, thus
Qi is also deficient and unable to activate the producing a tense pulse. The pulse is also
blood circulation, hence the thready pulse. present in painful syndromes, for painful
9) Rolling pulse (hua mai) A rolling syndromes are usually caused by pathogenic
pulse feels smooth and flowing like pearls cold.
rolling on a dish. It indicates phlegm and 13) Soft pulse (ru mai) A soft pulse is
retained fluid, retention of food and excess superficial and thready, and hits the fingers
heat. When excess type pathogenic factor is without strength. It indicates damp
retained in the interior, the qi and blood disorders.
circulation is activated, resulting in a Pathogenic damp is characteristically
smooth and flowing pulse. This pulse often viscous and stagnant, its invasion of the
occurs iri w s m a d~ri;lg pregfiimcy, vessels l?!ccks qi and blood and gives rise to a
indicating sufficient and harmonious qi and superficial, thready and forceless pulse.
blood. 14) Weak pulse (ma, wai) A weak pulse
10) Hesitant pulse (se mail A hesitant is deep and thready, and hits the fingers
pulse feels rough and uneven. It indicates without strength. It indicates various
stagnation of qi, stagnation of blood, syndromes due to deficiency of both qi and
impairment of essence and deficiency of blood.
blood. Stagnation of qi and blood means When blood is deficient, it fails to fill the
blockage of vessels and impaired circulation vessels: when qi is deficient, the pulse is
of blood. This condition produces a hesitant deprived of strength. So the pulse feels deep,
and forceful pulse. When the essence is thready and forceless.
impaired and blood is insufficient, the 15) Abrupt pulse (cun mrai) An abrupt
vessels are not filled and blood circulation is pulse feels hurried and rapid with irregular
retarded. This condition creates a hesitant missed beats. It indicates excessive yang
and weak pulse. heat, stagnation of qi and blood, and
11) String-taut pulse (xuan mai) A retention of phlegm or food.
string-taut pulse feels taut, straight and long, Excessive yang heat means failure of yin
giving the feeling of a string of a violin. It to restrain yang and thus produces an
indicates disorders of the liver and abrupt pulse. If this pulse is present in heat
gallbladder, painful syndromes, and phlegm syndromes of excess type due to stagnation
and retained fluid. of qi and blood, retention of phlegm or food,
A string-taut pulse in disorders of the liver or swelling and pain, it is abrupt and
and gallbladder is due to disturbance of the forceful. An abrupt and weak pulse is a sign
Chapter 12 Diagnostic Methods

of prostration. syndromes, a superficial and rapid pulse

16) Knotted pulse (jie mail A knotted indicates exterior heat syndromes.
pulse is slow with irregular missed beats. It
indicates excessive yin, accumulation of qi,
retention of cold phlegm and stagnant
blood. 2. Palpation of Different Parts of the
Cold phlegm and stagnant blood block Body
the vessels, while excessive yin means failure
of yang to arrive. Hence the knotted pulse. Included is palpation of the epigastrium,
17) Regularly intermittent pulse (dai mai) abdomen, hand, foot and acupuncture .
A regularly intermittent pulse is slow and points.
weak with missed beats at regular intervals. 1) Palpation of the epigastrium
It is associated with declining zang qi; it also ~ ~ i ~ a s t r refers
i u m to the upper abdomen, is
indicates wind syndromes, painful syn- also known as "below the heart." If this area
dromes and disorders due to emotional fear feels hard and pain is aggravated on
and fright, or traumatic contusions and pressure, it indicates syndromes of excess
sprains. type; when there is fullness in this area with a
The declining of the qi of the zang means painless reaction to pressure, and the area
insufficiency of qi and blood and may create feels soft, it indicates syndromes of
discontinuation of qi flowing in the vessels. deficiency type.
Therefore the pulse is slow and weak with 2) Palpation of the abdomen
regular missed beats at long intervals. The Abdominal pain which is alleviated by
presence of a regularly intermittent pulse in pressure is associated with deficiency, while
wind syndromes, painful syndromes and that aggravated by pressure is related to
disorders due to emotional fear and fright or excess. Abdominal distension and fullness
traumatic contusions and sprains is due to with tympanic note on percussion indicate
disturbance of the heart qi leading to stagnation of qi if the abdomen does not feel
discontinuation of the qi flowing in the hard on pressure and the urination is
vessels. normal. If the abdomen feels like a rubber
As the process of a disease is complex, the bag containing water, and dysurine is
above described abnormal pulses do not present, it suggests accumulation of fluid.
often appear in their pure form, the Hmmovable hard masses in the abdomen
combination of two pulses or more is often with pain at a definite site indicate
'

present. The condition of a number of pulses stagnation of blood. Unfixed soft masses or
present at the same time is called the intermittent feeling of an indefinite mass
complicated pulse. The indication of a in the abdomen with unfixed painful areas
complicated pulse is the combination of indicate stagnation of qi.
indications of each single pulse. For 3) Palpation of acupuncture points
instance, a superficial pulse indicates This method of palpation can be traced back
exterior syndromes, and a tense pulse to the early medical book The Internal
indicates cold syndromes, a superficial and a Classic. One of its parts Miraculous Pivot
tense pulse, therefore, indicates exterior cold says: "In order to see if the Back-Shu Point is
syndromes. As a rapid pulse indicates heat located with accuracy, one may press the
272 Chinese Acupuncture and Moxibustion

region to see if the patient feels sore or if the Clinical practice in the recent years has
patient's original soreness gets relieved, in demonstrated that during an illness
which case, the point has been located with tenderness or sensative reactions may occur
accuracy. The fifteenth chapter of the same along the courses of the involved meridians
book also states, "When the five zang organs or at certain points where the qi of the
are diseased, the symptoms will manifest meridian is converged. In gastralgia, for
themselves in the conditions of the tweive instance, ie~ideinesslilaji occiii. iii '?+cisliiii (E
Uuan-Primary Points with which they are 21) and Zusanli (S 36); in disorders of the
connected. If we fully grasp the connections liver there may be tenderness at Ganshu (B
between the zang organs and their 18) and Qimen (Eiv 14): while in
corresponding Yuan-Primary Points as well appendicitis, it may occur at Shangjuxu (S
as the latter's external manifestations, there 37) the lower He-Sea Point of the large
will be no difficulty for us to understand the intestine. These signs may assist in making
nature of the diseases of the five zang dignosis for disorders of internal organs.
organs.''
 Chapter 13
DIFFERENTIATION OF SYNDROMES

Differentiation of syndromes is the according to eight principles is the general

method in traditional Chinese medicine of method. Differentiation according to the
recognizing and diagnosing diseases. In theory of qi and blood and that according to
accordance with the basic knowledge of the theory of zang-fu organs are mainly
traditional Chinese medicine, this method concerned with endogenous diseases, while 7

entails making a comprehensive analysis of differentiation according to the theory of

the symptoms and signs obtained by meridians and collaterals is principally
applying the four diagnostic methods, in concerned with disorders of meridians and
order to clarify their internal relationships, collaterals. Each method has its own
and ascertain their causes and nature as well features and lays stress on a particular aspect
as the relative strength of the antipathogenic while connecting with and supplementing
qi and pathogenic factor, and the direction the others. It is essential to understand and
of the pathological development. possess a thorough knowledge, through
Differentiation of syndromes and deter- clinical practice, of the basic contents and
mination of treatment are inseparable, one characteristics of each method.
relating to the other. The former is the
premise and foundation of the later. The
methods of treatment, so determined, may
1 DIFFERBENTIIBATBTON OF
in turn test the validity of the differentiation.
Correct differentiation is a prerequisite for SYNDROMES ACCORDING TO
applying appropriate methods and attaining 3iEIGHI' PRINCIPLES
anticipated results.
There are a number of methods in The eight principles refer to eight basic
traditional Chinese medicine for different- categories of syndromes, namely, yin and
iating syndromes, including differentiation yang, exterior and interior, cold and heat,
according to eight principles, differentiation and deficiency and excess. In differentiation
according to the theory of qi and blood, of syndromes according to eight principles,
differentiation according to the theory of these eight categories are applied in
zang-fu organs and differentiation accord- analysing various pathological manifesta-
ing to the theory of meridians and tions determined by applying the four
collaterals, etc. Of these, differentiation diagnostic methods, indicating the location
 Chinese Acupuncture and Moxibustion

of the disease, its nature and the relative The skin, hair, muscles and their
strength of the pathogenic factor and interspaces, and the superficial portion of
antipathogenic qi. meridians and collaterals of the human body
The application of the eight principles belong to the exterior, while the five zang
forms the basis link, categorizinga variety of and six fu organs pertain to the interior.
clinical manifestations in a general way. It is 1) Exterior syndromes Exterior syn-
thus possible to understand and solve dromes refer to pathological conditions
complicated problems systematically in the resulted from the invasion of the superficial
process of making diagnosis. portion of the body by exogenous
Although this method classifies patholog- pathogenic factors. They are marked by
ical conditions into eight categories, they are sudden onset of symptoms with short
inseparable and interconnected. Attention duration, and are often seen at the early
should be paid to this in the clinical situation stage of exogenous diseases. The chief
in order to ensure a correct and manifestations are an intolerance to cold (or
comprehensive recognition of disease. wind), fever, a thin tongue coating and a
superficial pulse. The accompanying
I. Exterior and Interior symptoms and signs are headache, general
aching, nasal obstruction and cough.
The categories of exterior and interior Clinical manifestations may vary according
form two principles which are used to to the invading pathogenic factors and the
determine the depth of the diseased area and I, A --- +:+
*.,:+m
U O U ~LVIISULLLIVII af the patient. They are
to generalize the direction of the manifested as cold, heat, deficiency and
development of a disease. excess. (Tab. I I) i

Table 11. D i f f e r e n ~ a ~ofo Cold, Heat, Defickwcy and Excess in Zxterior Syndromes

Syndromes Symptoms and signs in common Distinguishing symptoms and signs

Severe chills, mild fever, no sweating,

Exterior cold absence of thirst, thin, white and moist
tongue coating, superficial and tense pulse.

Chills, fever, headache, general Mild chills, severe fever, no sweating or

Exterior heat aching, thin tongue coating, sweating, thirst, thin and yellow tongue
superficial pulse. coating, superficial and rapid pulse.

Exterior deficiency Sweating.

Exterior excess No sweating.

Chapter 13 Differentiation of Syndromes

2) Interior syndromes Interior syn- be transmitted to the interior, giving rise to

dromes refer to pathological conditions interior syndromes. This is known as
resulted from the transmission of exogenous "transmission from the exterior to the
pathogenic factors to the interior of the body interior." Pathogenic factors in some
to affect zang-fu organs, or from the interior syndromes may be transmitted from
functional disturbances of zang-fu organs. the interior to the superficial portion of the
Interior syndromes cover a wide range of body. This is known as "transmission fro~n
pathological conditions and may occur in the interior to the exterior." The occurrence
the following three conditions: transmission of the transmission mainly depends upon the
of persistent pathogenic factors from the relative strength of the pathogenic factor
exterior to the interior of the body to invade and antipathogenic qi. The transmission of
zang-fu organs; direct attack on zang-fu pathogenic factors from the exterior to the
organs by exogenous pathogenic factors; interior is often due to weakened body
drastic emotional changes, improper diet resistance to disease, or to hyperactivity of
and overstrain and stress, all of which affect the pathogenic factors, improper care, or
zang-fu organs directly, leading to incorrect or delayed treatment. The
functional disturbances. For details of transmission of interior pathogenic factors
interior syndromes, refer to the differenti- to the interior is often the result of correct
ation of deficiency and excess, and to the treatment and care, and strengthened body
'
differentiation of syndromes according to resistance to disease. Generally speaking,
the theory of zang-fu organs. the inward transmission of pathogenic
3) Diffceseantiation sf exterior and interior factors indicates an aggravation of the
sywdromes The accompaniment of aver- disease, while the outward transmission
sion to cold with fever, and changes in represents a tendency of pathogenic factors
tongue coating and pulse are highly in the interior being expelled, thus indicating
significant for differentiating exterior and an alleviation of the disease.
interior syndromes in exogenous febrile In the process of the development of
diseases. Generally, fever accompanied by disease, there is a condition known as "the
aversion to cold suggests exterior syn- exterior and interior being diseased
dromes; fever with no aversion to cold, or simultaneously." This may appear at the
aversion to cold with no fever indicates early stage of a disease, when both exterior
interior syndromes. A thin and white tongue and interior syndromes are seen at the same
coating, possible with red tongue borders, is time. This also occurs when exogenous
often seen in exterior syndromes. The pathogenic factors are transmitted to the
appearance of other abnormal qualities of interior, while the exterior syndromes are
tongue coating often indicates interior still present. Prolonged endogenous diseases
syndromes. A superficial pulse suggests complicated with recent exogenous diseases,
exterior syndromes; a deep pulse suggests or exogenous diseases inducing acute
interior syndroines. attacks of chronic endogenous diseases may
4) The relationship between exterior and also be the causes. As exterior and interior
interior symndromes In given conditions, syndromes are usually complicated with
exogenous pathogenic factors, if they are not cold, heat, deficiency and excess, many
expelled from the exterior of the body, may different syndromes are exhibited in "the
 Chinese Acupuncture and Moxibustion

exterior and interior being diseased deficiency of yin in the interior of the body.
simultaneously," for example, exterior cold Since cold and heat syndromes are
complicated with interior heat, exterior opposite in nature, the symptoms and signs
deficiency with interior excess, and exterior
they manifest are entirely different. Cold
excess with interior deficiency. syndromes are revealed by aversion to cold,
5) Intermediate syndromes Intermediate preference for warmth, tastelessness in the
syndromes refer to paiho:ogi--;calconditions--- ---- - - - C AP-:_--
1- -- -- - - 1 2 If,-
-11
ILIW ULIL,
aust;ll~;t:w1 i11113t, pallul, L U ~ Ulrrllb~,
---A*^

in which exogenous pathogenic factors fail lying with the body curled up, loose stools,
to be transmitted completely to the interior,
clear urine which is increased in volume, pale
while the antipathogenic qi is not strong tongue, white and moist coating, slow or
enough to expel the pathogenic factors to the
tense pulse. Heat syndromes manifest as
body surface. The pathogenic factors thus fever, preference for coolness, thirst with
remain between the exterior and interior. preference for cold drinks, redness of face
The chief clinical manifestations are and eyes, irritability, restlessness, constipa-
alternate chills and fever, discomfort and tion, deep-yellow and scanty urine, red
fullness in the chest and hypochondriurn, tongue with yellow and dry coating, and
vomiting, anorexia, bitter taste in the rapid pulse.
mouth, dry throat, blurred vision and Deciding whether a syndrome is of heat or
string-taut pulse. For details, refer to thecold nature cannot be based on one clinical
Shaoyang Syndrome in the chapter manifestation alone. The correct conclusion
"Differentiatios ef Syndmmcs _A_ccc?rding is reached after yr~ref~! ~ S s e r ~ a f i oofna!! the
to the Theory of the Six,Meridians." clinical manifestations. Of these, the
presence of cold, heat and thirst and the
conditions of complexion, four limbs,
2. Cold and Heat defecation, urination, tongue coating and
pulse are the most important. Table 12 ex-
Cold and heat are the two principles used plains the differentiation of cold and heat
to differentiate the nature of a disease. conditions of excess type in interior
According to the fifth chapter of Plain syndromes.
Questions: "Predominance of yang gives rise 2) The relationship between cold and ltaeat
to heat, and predominance of yin gives rise syndromes Although cold syndromes and
to cold." Cold and heat syndromes are heat syndromes are opposite in nature, they
concrete manifestations of excess and have a close relationship. They can exist
deficiency of yin-yang. Distinguishing simultaneously, manifesting as complicated
between cold and heat syndromes is syndromes of cold and heat. In given
important for guiding treatment. conditions, they can also be transformed
I) Cold syn&omes and heat syndromes into each other, presenting either trans-
Cold syndromes are pathological conditions formation of cold syndromes into heat, or of
resulted from exposure to exogenous .heat syndromes into cold. When the disease
pathogenic cold or from deficiency of yang has developed to a very severe stage,
in the interior of the body. Heat syndromes syndromes of true heat and false cold or true
are pathological conditions caused by cold and false heat may appear.
invasion of exogenous pathogenic heat or by a ) Complicated syndromes of cold and
Chapter 13 Differentiation of Syndromes 277

Table 12. Differentiation of Cold and Heat Syndromes

Cold syndromes Heat syndromes

Pallor, aversion to cold, absence of thirst or Red complexion, fever, thirst with preference
drinking a little hot drinks, loose stools, clear for cold drinks, constipation, deep-yellow and
urine increased in volume scanty urine.

Pale tongue with white and moist coating. Red tongue with yellow and dry coating.

Slow pulse. Rapid pulse.

heat The patient may have simultaneous to cold, general aching, no' sweating, white
signs of heat in the upper half of the body, tongue coating and superficial and tense
and of cold in the lower half. The syndrome pulse. If this pathogenic cold goes deep into
like this is known as "heat above with cold the interior of the body and turns into heat,
below." This is one of the most frequently cold signs such as aversion to cold will
seen complicated syndromes of cold and subside, but fever persists and other heat
heat. Clinically the "heat above" manifests signs such as irritability, thirst and yellow
as suffocation and heat sensation in the chest tongue coating will occur in succession. This
and a frequent desire to vomit, whilst the indicates the transformation of exterior cold
"cold below" presents abdominal pain into interior 'heat.
which can be alleviated by warmth, and - In transformation of a heat syndrome into
loose stools. The syndrome is often due to a cold, the heat syndrome occurs first and
complicated etiology involving both cold gradually changes into a cold syndrome. An
and heat. This leads to a pathological example is abrupt appearance of cold limbs,
disharmony of yin and yang of various zang- pallor, and a deep and slow pulse in the
fu organs, and manifests'as excess of yang in patient with high fever, profuse sweating,
the upper part of the body and excess of yin thirst, irritability, and a surging and rapid
in the lower part. pulse. These are the manifestations of the
Other frequently seen complicated transformation of a heat syndrome into a
syndromes are cold on the exterior with heat cold one. -
in the interior, and heat on the exterior with The mutual transformation of cold and
cold in the interior. heat syndromes takes place in certain
b) Transformation of cold and heat conditions, depending crucially on the
syndromes In transformation of a cold relative strength of the pathogenic factor
syndrome into heat, the cold syndrome and antipathogenic qi. Generally speaking,
occurs first and gradually changes into a transformation of cold into heat results from
heat syndrome. An example is exposure to - a strengthening of the antipathogenic qi and
exogenous pathogenic cold which may lead hyperactivity of yang qi. Constitutional
to an exterior cold syndrome and produce deficiency of yang, or exhaustion of yang qi
such symptoms and signs as fever, aversion during the course of a disease, may lead to a
 Chinese Acupuncture and Moxibustion

failure of the antipathogenic qi in resisting whether the patient likes cold drinks or hot
the pathogenic factor, thus giving rise to drinks; whether the chest and abdomen are
transformation of a heat syndrome into a warm or not; whether the urine is clear or
cold one. yellow; and whether the patient wants to
c) True and false phenomena in cold and cover up the body or not.
heat syndromes True heat with false cold
refers to a syndrome in which there is heat in
the interior of the body and false cold on the 3. Deffadency and Excess
exterior. The syndrome is manifested as cold
limbs, but a burning sensation in the chest Deficiency and excess are the two
and abdomen; no aversion to cold, but principles which are used to generalize and
aversion to heat; and a deep but forceful distinguish the relative strength of the anti-
pulse. In addition, there is thirst with pathogenic qi and pathogenic factor.
preference for cold drinks, irritability, dry According to the twenty-eighth chapter of
throat, foul breath, scanty, deep-yellow Plain Questions, "hyperactivity of the
urine, constipation and a deep red tongue pathogenic factor causes excess; consurnp-
with yellow dry coating. In this syndrome, tion of essential qi causes deficiency."
excessive internal heat hinders the yang qi Distinguishing whether a syndrome is of
from reaching the exterior. deficiency type or of excess type forms the
True cold with false heat refers to a basis for the determination of promoting the
syndrome in wliich ihcre is rca! cold io ths aiitipsthogealc q cr eliminating the
interior and false heat on the exterior. pathogenic factor in the treatment.
Clinical manifestations are feverishness of 1) Syndromes of deficiency type and
the body, flushed face, thirst and a syndromes of excess type Deficiency refers
superficial pulse. However, the patient to insufficiency of the antipathogenic qi, and
wants to cover up the body in spite of the therefore syndromes of deficiency type refer
feverishness, wants to take warm drinks to to pathological conditions resulted from
relieve the thirst, and has a superficial and deficiency of the antipathogenic qi. Excess
weak pulse. In addition, there are other cold refers to hyperactivity of the pathogenic
signs such as clear urine, loose stools and a factor, and therefore syndromes of excess
pale tongue with white coating. In this type refer to pathological conditions in
syndrome, excessive yin cold in the interior which the pathogenic factor is hyperactive,
forces the yang qi to the exterior. while the antipathogenic qi remains strong.
It is clear that the appearance of a disease a ) Syndromes of deficiency type
does not necessarily reflect its essential Insufficiency of the antipathogenic qi of the
nature in these types of syndromes. Careful human body may manifest as deficiency of
observation and analysis should be made, if yin, deficiency of yang, deficiency of qi or
the false and true phenomena are to be deficiency of blood, which may form
differentiated accurately. Attention should different syndromes. For syndromes of qi
be paid to the following points: Whether the deficiency and blood deficiency, refer to
pulse is forceful or weak; whether the tongue differentiation of syndromes according to
is pale or red; whether the tongue coating is the theory of qi and blood. The chief clinical
moist or dry; whether there is thirst or not; manifestations of syndromes of yin
Chapter 13 Differentiation of Syndromes 279

deficiency and yang deficiency are described b) Syndromes of yang deficiency and
as follows: syndromes of yin deficiency They general-

Table 13. Differentiation of Syndromes of Yin Deficiency and Yang Deficiency

Deficiency of yin
I Deficiency of yang

Afternoon fever, malar flush, heat sensation in Chills, cold limbs, listlessness, lassitude,
the palms and soles, night sweating, dryness spontaneous sweating, absence of thirst, clear
' of the throat and mouth, yellow urine, dry stools. urine increased in volume, loose stools.

Red tongue with little coating. Pale tongue with white coating.

Thready and rapid pulse. Weak pulse.

-

ize pathological conditions resulted from by excess of yin and excess of yang.
deficiency of yang and yin of the body. c ) Syndromes of excess type In syn-
According t o the inter-consuming- dromes of excess type, the clinical
supporting relationship of yin and yang, manifestations vary with the nature of the
deficiency of yang leads to a relative excess invading exogenous pathogenic factors and
of yin, and deficiency of yin leads to a areas of the human body they invade. The
relative excess of yang. In addition to the following factors are mainly considered in
clinical manifestations of deficiency type, distinguishing syndromes of deficiency type
cold signs are seen in deficiency of yang, and from those of excess type: Body shape, spirit,
heat signs are seen in deficiency of yin. strength of voice and breath, response to
However, they are essentially different from pressure on painful areas, tongue coating
cold and heat syndromes caused respectively and pulse. (Tab. 14)

Table 84. Differentiation sf Syndromes of Deficiency Type and Syndromes of Excess Type

Syndromes of deficiency type Syndromes of excess type

Emaciation, listlessness, lassitude, feeble Sturdiness, agitation, sonorous voice, coarse

breathing, dislike of speaking, pallor, breathing, distension and fullness
palpitations, shortness of breath, insomnia, poor in the chest and abdomen, pain aggravated
memory, spontaneous and night sweating, noct- by pressure, constipation or
urnal emission, nocturnal enuresis, pain tenesmus, dysuria.
alleviated by pressure.

Dry tongue with no coating or Thick and sticky tongue coating.

little coating.

Pulse of deficiency type. Pulse of excess type.

 Chinese Acupuncture and Moxibustion

2) The relationship between syndromes of and produce endogenous pathogenic

deficiency type and syndromes of excess ' factors, thus eliciting various syndromes of
type While syndromes of deficiency type excess type. Excess resulting from deficiency
and syndromes of excess type are essentially like this is also known as deficiency
different, they are also interconnected, and complicated with excess, or as deficiency of
one may affect the other. The clinical the root cause with excess of manifestations.
manifestations are described as follows. In deficiency of qi of the spieefi and kifig, f ~ r
a ) Complication of deficiency and example, dysfunction in transportation,
excess When deficiency of the antipatho- transformation, dispersing and descending
genic qi and excess of the pathogenic factor may produce endogenous pathogenic
manifest at the same time, this is known as a factors such as phlegm, retained fluid,
syndrome complicated with deficiency and harmful water or damp.
excess. c ) True and false phenomena in deficiency
Either deficiency of the antipathogenic qi and excess False phenomena may appear
or excess of the pathogenic factor may in syndromes of deficiency type and those of
predominate in complicated syndromes. excess type. Special care should be taken to
There are also complicated syndromes in distinguish them.
which deficiency of the antipathogenic qi True excess with false deficiency refers to
and excess of the pathogenic factor are on a syndrome of excess type -which is
equal terms. Appropriate methods of accompanied by symptoms and signs similar
treatment are determined i i the bzsis af LV
+ A s y ~ d r ~9 ~ fe i type. A n
distinguishing which predominates and example is accumulation of dryness and heat
which is -more urgent. in the intestines and stomach, which hinders
6) Transformation of deficiency and circulation of qi and blood, and elicits such
excess Although the pathogenic factor in symptoms and signs as indifference, a cold
syndromes of excess type may gradually sensation of the body, cold limbs, and deep
. subside, the antipathogenic qi is already and slow pulse. But further examination of
injured due to delayed or incorrect the patient will show a sonorous voice,
treatment, thus transforming syndromes of coarse breathing, deep, slow but forceful
excess type into syndromes of deficiency pulse, distension and fullness in the
type. An example is a heat syndrome of abdomen, constipation, and red tongue with
excess type which manifests as high fever, burnt-yellow coating. All this reveals that
thirst, sweating and superficial and rapid the accumulation of dryness and heat is the
pulse. If the disease persists for a long time underlying cause of the pathological
and consumes body fluid, this may changes, while the symptoms and signs
transform into a syndrome of deficiency indicating the syndrome of deficiency type
type showing emaciation, pallor, feebleness, are false phenomena.
little tongue coating or no coating, and True deficiency with false excess refers to
thready and weak pulse. a syndrome of deficiency type whch is
In syndromes of deficiency type, accompanied by symptoms and signs similar
insufficiency of the antipathogenic qi may to a syndrome of excess type. Deficiency of
impair the functions of certain zang-fu qi of tlle spleen and stomach, for example,
organs in distribution and transformation, may lead to weakness in transportation and
Chapter 13 Differentiation of Svndromes

transformation and give rise to distension, syndromes of yin deficiency, syndromes of

fullness and pain in the abdomen and string- yang deficiency.
taut pulse. However, the distension and I) Yin syndromes and yang syndromes
fullness in the abdomen may be improved at Yin syndromes refer to pathological
times, while they usually persist in conditions resulting from deficiency of yang
syndromes of excess type. In addition, the qi in the body and retention of pathogenic
abdominal pain is not aggravated by cold. Yang syndromes refer to pathological
pressure, and is sometimes alleviated by conditions caused by hyperactivity of yang
pressure. The pulse is string-taut, but it is qi in the body and excess of pathogenic heat.
also weak on heavy palpation. So deficiency Syndromes of deficiency type and cold.
of the middle jiao leading to dysfunction in syndromes come within yin syndromes;
transportation is the underlying cause of the syndromes of excess type and heat
pathological changes, while the distension, syndromes come within yang syndromes.
fullness and pain in the abdomen indicating Generally speaking, so far as clinical
a syndrome of excess type are false manifestations are concerned, those charac-
phenomena. terized by excitation, fidgeting, hyperactiv-
Distinguishing between true and false ity and bright complexion fall into the
phenomena in deficiency and excess requires category of yang syndromes, while those
careful examination of the patient's pulse, characterized by inhibition, quiescence,
tongue and other symptoms and signs. hyperactivity and sallow complexion fall
Factors such as the strength of the pulse, into the category of yin syndromes.
toughness of the tongue and response to 2) Collapse of yin and collapse sf
pressure on the painful area must be yang Collapse of yin refers to pathological
assessed. In addition, the causative factors conditions resulting from massive consump-
of the disease and medication taken before tion of yin fluid. Collapse of yang refers to
should be considered. pathological conditions caused by extreme
exhaustion of yang qi in the body.
Both collapse of yin and collapse of yang
are critical syndromes in the process of a
4. Yin and Yang disease. They may result from the further
aggravation of yin deficiency and yang
Yin and yang form a pair of principles deficiency. They may also occur as a result of
used to generalize categories of syndromes. an abrupt aggravation in acute diseases, e.g.
Being the key link in the application of the severe vomiting and diarrhoea or great loss
eight principles, yin and yang are used to of blood may elicit collapse of yin, and
summerize the other three pairs of profuse sweating may cause collapse of
principles. Exterior, heat and excess fall into Yaw.
the category of yang, while interior, cold and As yin and yang depend upon each other,
deficiency fall into the category of yin. Yin in the case of collapse of y'in, the yang qi has
and yang are also used to explain some of the nothing to depend upon, and therefore it
pathological changes of the zang-fu organs dissipates from the body. In collapse of
and tissues, e.g. syndromes of collapse of yang, yin fluid is also consumed. However,
vin, syndromes of collapse of yang, the predominating factors in the two
282 Chinese Acupuncture and Moxibustion

syndromes are different, and corresponding occur initially, sweating may be seen in the
methods of treatment must be adopted. both syndromes. The distinguishing points
In addition to the various critical are described as follows:
symptoms and signs of the disease which

Collapse of Yin I Collapse of Yang

Sticky sweat, feverishness of the body, warm I Profuse cold sweat like pearls, coolness of the
hands and feet, shortness of breath, irritabil- 1 body, cold hands and feet, feeble breathing,
ity, restlessness, thirst with preference for ' listlessness, absence of thirst or preference for
cold drinks. hot drinks.

Red and dry tongue. Pale and moist tongue.

Thready, rapid and weak pulse. Thready and fading pulse.

11. DIFFERENTIBATION OF sinking of qi, stagnation of qi and perversion

SYNDROMES ACCORDIPiG TO of qi.
THE THEORY OF QI 1) Syndrome of deficiency of qi
BLOOD The syndrome of deficiency of qi refers to
pathological changes resulting from hypo-
function s f zang-fu organs.
This method of differentiation uses the Clinical manifestations: Dizziness, blurr-
theory of qi and blood to analyse and ing of vision, dislike of speaking, lassitude,
categorize the -pathological
- - changes of qi
-- --
spontaneous sweating, all of which are
and blsod into syndromes. worse on exertion; a pale tongue and a pulse
Although they form the material basis for of deficiency type.
the functional activities of zang-fu organs, at Etiology and pathology: This syndrome is
the same time, qi and blood depend upon often due to weakness after long illness,
zang-fu organs for their production and feebleness in old age, improper diet, or
circulation. Therefore disorders of qi and excess of strain or stress. Insufficiency of the
blood may affect zang-fu organs, and antipathogenic qi and hypofunction of
disorders of zang-fu organs may affect qi zang.fu organs result in dislike of speaking
and blsod. and lassitude. Deficiency of qi also implies
weakness of qi in propelling blood normally,
1. Syndromes of Qi hence qi and blood fail to go upward to
nourish the head and eyes, the result being
There are many pathological changes of dizziness and blurring of vision. In case of
qi, but they may generally be classified into weakness of defensive qi, it fails to control
four syndromes, namely, deficiency of qi, the opening and closing of pores,
 Chapter 13 Differentiation of Syndromes 283

spontaneous sweating occurs. Because obstruction of qi, which is the primary cause
exertion further consumes qi, it will also of distension and pain. These symptoms
cause aggravation of the above symptoms. have the following features: Distension is
The pale tongue is a consequence of the more severe than pain; both distension and
deficient nutrient qi which fails to go upward pain wax and wane with no fixed position;
to nourish the tongue, and the deficient type and the onset is often related to emotions
pulse is due to weakness of qi in moving and the symptoms may be alleviated
blood. temporarily by belching or flatus.
2) Syndrome of sinking of qi Sinking of qi As stagnation of qi has varied causes and
is one of the pathological changes resulting may involve different zang-fu organs, there
from deficiency of qi. It is characterized by a exist, aside from distension, stuffiness and
weakness in holding ability within the pain, separate clinical manifestations. For
category of qi deficiency. Since it often details, refer to the chapter dealing with
occurs in the middle jiao, it is also known as differentiation of syndromes according to
- "sinking of qi of the middle jiao." the theory of zang-fu organs.
Clinical manifestations: Dizziness, blurr- 4) Syndrome off perversion of qi In the
ing of vision, lassitude, a bearing-down syndrome of perversion of qi, there is a
distending sensation in the abdominal dysfunction of the qi in ascending and
region, prolapse of the anus or uterus, discending which leads to upward
gastroptosis and renal ptosis, a pale tongue, disturbance of the qi of zang-fu organs. This
a pulse of the deficient type. syndrome often refers to pathological
Etiology and pathology: The etiology of changes resulting from upward disturbance
sinking of qi is the same as that of deficiency of the qi of the lung and stomach, and from
of qi. Dizziness, blurring of vision, lassitude, excessive ascending of the qi of the liver.
the pale tongue and pulse of the deficient Clinical manifestations: Upward dis-
type are common symptoms and signs in the turbance of the lung qi manifests as
syndrome of deficiency of qi. The bearing- coughing and asthmatic breathing. Upward
down distending sensation in the abdominal disturbance of the stomach qi gives rise to
region, prolapse of the anus or uterus, belching, hiccups, nausea and vomiting.
gastroptosis and renal ptosis are all possible Excessive ascending of the liver qi causes
outcomes of weakness in holding ability. headache, dizziness and vertigo, coma,
'

3) Syndrome of stagnation of qi The hemoptysis and hematemesis.

syndrome of stagnation of qi occurs when qi Etiology and pathology: Upward dis-
in a certain portion of the body or of a turbance of the lung qi is often due to
specific zang-fu organ is retarded and invasion of exogenpus pathogenic factors or
obstructed. to retention of phlegm in the lung. In either
Clinical manifestations: Distension and case, the lung qi fails in its function to
pain. disperse and descend, but instead ascends
Etiology and pathology: This syndrome is and disturbs, giving rise to coughing and
often due to mental depression, improper asthmatic breathing.
diet, invasion of exogenous pathogenic Retention of fluid, phlegm or food in the
factors, or sprains and contusions. stomach, or' invasion of the stomach by
Hindrance of qi circulation is followed by exogenous pathogenic factors may all block
 Chinese Acupuncture and Moxibustion

qi circulation and deprive the stomach qi of consequence of insufficient blood in the

its function in descending. Upward vessels.
disturbance of the stomach qi produces 2) Syndrome of stagnation of blood
belching, hiccups, nausea and vomiting. Stagnation of blood refers to the
Injury of the liver by anger leads to accumulation of blood in a local area due to
excessive ascent of the liver qi and further, to hindrance of the blood circulation or to
upward disturbance of qi and fire or the cxti-av;;sakd blc=d ; E Q ~
liver, producing headache, dizziness and dispersed or immediately expelled from a
vertigo, and even coma, hemoptysis and fixed location in the body.
hematemesis in severe cases. Clinical manifestations: Pain, mass
tumours, hemorrhage, and ecchymoses or
petechice.
2. Syndromes of Blood Etiology and pathology: There are many
causes of stagnation of blood, such as
There are three syndromes of blood, sprains and contusions, hemorrhage,
namely, deficiency of blood, stagnation of retardation of qi circulation leading to
blood and heat in the blood. retardation of blood circulation, defi-
1) Syndrome of deficiency of blood ciency of qi causing a weakness in the
The syndrome of deficiency of blood occurs normal movemeht of blood, and invasion of
when there is insufficient blood to nourish the blood system by pathogenic cold or heat.
zafig-Fi crgsfis zfid ~ ~ s r i d i s i ~ s . Pain, which is the main symptom, occurs
Clinical manifestations: Pallor or sallow as a consequence of obstruction by stagnant
complexion, pale lips, dizziness, blurring of blood. The pain is fixed in location and
vision, palpitations, insomnia, numbness of stabbing in nature. Accumulation of
the hands and feet, a pale tongue and a stagnant blood in the,local area forms mass
thready pulse. tumours which have fixed positions and are
Etiology and pathology: This syndrome is firm on palpation. Obstruction of vessels by
often due to weakness of the spleen and stagnant blood does not permit blood to
stomach, hence qi and blood have an circulate along the normal courses, and
insufficient source, or due to excessive blood hence induces hemorrhage.
loss, or drastic emotional changes which Hemorrhage of this sort occurs repeatedly
consume yin blood. Deficiency of blood and consists of purplish dark flow and may
deprives the head, eyes and face of exhibit clots. Stagnation of blood may also
nourishment, causing dizziness, blurring of manifest with purplish spots on the skin and
vision, pallor or sallow complexion and pale tongue.
lips. Blood, failing to nourish the heart, may Cold, heat, excess and deficiency may all
lead to disturbance of the mind, palpitations be causative factors of stagnation of blood,
and insomnia appear. Numbness of the hence syndromes associated with these
hands and feet originates from the lack of factors will be present along with the
nourishment of meridians and collaterals. symptoms and signs listed above.
The pale tongue is a result of the deficiency 3) Syndrome of heat in the blood
of blood depriving . the tongue of Heat in the blood refers to the syndrome
nourishment, whilst the thready pulse is a which results either from endogenous heat in
Chapter 13 Differentiation of Syndromes

the blood system or from invasion of the to the theory of wei ( II defense), qi
blood system by exogenous pathogenic heat. ( vital energy), ying ( nutrient) and
Clinical manifestations: Mental restless- xue ( & blood).
ness, or mania in severe cases, a dry mouth This method of differentiation of
with no desire to drink, deep-red tongue, syndromes employs the theory of qi and
rapid pulse, possible occurrence of various blood with flexibility in the analysis of acute
hemorrhagic syndromes, profuse menstrual febrile diseases. Acute febrile diseases often
flow in women. occur when body resistance is weak and
Etiology and pathology: This syndrome is there is invasion of the human body by
often due to either invasion of exogenous febrile pathogen or pestilential factors. They
pathogenic heat or to obstruction of liver qi are characterized by abrupt onset of
turning into fire. Hyperactivity of heat in the symptoms and are liable to injure yin and
blood disturbs the mind and results in undergo frequent changes.
mental restlessness or even mania in severe In the Qing Dynasty, Ye Tianshi
cases. Consumption of yin blood leads to a attributed the occurrence of febrile diseases
dry mouth, but since heat is not in the qi to the dysfunction of the wei, qi, ying and
system, the patient does not want to drink. xue systems. Basically, he utilized the theory
Excessive heat accelerates the blood of wei, qi, ying and xue to analyse
circulation and hence a deep-red tongue and pathogenesis and differentiate syndromes,
rapid palse appear. Hyperactive heat in the to identify the transmission and transform-
blood system easily causes injury of the ation of febrile diseases, and thus to
blood vessles, the result of which is epistaxis, determine treatment. Wei, qi, ying and xue
hemoptysis, hematemesis, hematuria and not only generalize the pathological
profuse menstrual flow in women. manifestations of febrile diseases, but also
Acupuncture and moxibustion may represent four different stages of patholog-
regulate qi and blood. As stated in the first ical development in terms of the depth and
chapter of Miraculous Pivot, "Fine needles severity of disease. The most superficial is
are applied to clear obstructions in the wei stage; the next in depth is the qi
meridians and colaterals and to regulate qi stage; deeper still is the ying stage, and
and blood." Another medical classic the xue stage occurs when the disease
Precious Sujydernentary Prescriptions holds, lies deepest. Diseases of the wei and qi
"All diseases start from stagnation of qi and stages are mild and superficial, whilst
blood. Needling may promote smooth diseases of the ying and xue stages are deep
circulation of qi and blood.. . ." In and severe.
acupuncture clinics, suitable points are 1. Syndrome of the wei stage The
selected, and different techniques of syndromes of the wei stage refers to
needling and moxibustion are adopted to pathological changes resulting from dys-
regulate qi and blood and to restore their function of defensive qi due to invasion of
harmonious states. the muscles and body surface by exogenous
febrile pathogen. The wei system is the
Appendix exterior defense of the human body and
includes the skin and muscles on the-body
Differentiation of syndromes according surface. As it functions to readjust body
 Chinese Acupuncture and Moxibustion

temperature and resist exogenous patho- ian of Hand-Yangming, the Du Meridi-

genic factors, it is closely related to defensive an and the Bladder Meridian of Foot-
qi and the lung. Invasion by pathogenic Taiyang.
factors may result in pathological changes of 2. Syndromes of the qi stage The
the lung and defensive qi. syndromes of the qi stage are interior heat
Principal clinical manifestations are fever, syndromes in which the febrile pathogen is
Piid aversiGfi t s =i;;d ar;d ~ ~ 1E,ea&rvhe,
6, trzwzitted a to affect zaaag-far
cough, absence of sweating or sligh, organs. In this stage there is fierce
mild thirst, swelling and pain of the throat, contension between the excessive patho-
red tongue tip and borders, a thin and white genic factor and the strong antipathogenic
tongue coating, and a superficial and rapid qi, which manifests in hyperactivity of yang
pulse. and heat.
This syndrome is often seen at the early As invasion of the qi system by the
stage of acute febrile diseases. The retention pathogenic factor involves different zang-fu
of febrile pathogen at the body surface organs, various related pathological manif-
hinders defensive qi resulting in fever and estations will occur. Frequently seen
slight aversion to wind and cold. syndromes of the qi stage are retention of
Dysfunction of defensive qi in opening and heat in the lung, retention of heat in the chest
closing the pores leads to either absence of or and diaphragm, retention of heat in the
only slight sweating. Hindrance of defensive stomach, and retention of heat in the
qi ltlay also i d u c e distrarbqce of the qi of intestinal tract.
the meridians, which may further cause The main pathological manifestations of
headache. Furthermore, as the skin and syndromes of the qi stage are fever, aversion
body hair are related to the lung, hindrance to heat as opposed to aversion to cold, a red
of defensive qi may lead to dysfunction of tongue with a yellow coating and a rapid
the lung in dispersing, which manifests as pulse. These are often accompanied with
coughing. The throat is the gateway of the mental restlessness, thirst and deep-yellow
lung, so invasion of the lung by febrile urine.
pathogen may give rise to swelling and pain In retention of heat in the lung, cough,
of-the throat. Slight thirst is a consequence asthmatic breathing, chest pain, and
of the consumption of body fluid by febrile expectoration of thick yellow sputum may
pathogen. Red tongue borders and tip, thin be seen. Retention s f heat in the chest and
and white tongue coating, and superficial diaphragm may present mental restlessness
and rapid pulse are signs of exterior heat. and uneasiness. .In retention of heat in the
The principle of treatment is to relieve the stomach, there may appear high fever,
exterior syndromes with cool and pungent dysphoria, thirst with preference for cold
mild diaphoreties and to dissipate sweat drinks, profuse sweating, a dry and yellow
through the wei system. The method of tongue coating, a rapid and rolling pulse or
promoting lung qi in dispersing and superficial, large and forceful pulse.
descending is used in conjunction. If Retention of heat in the intestinal tract may
acupuncture is applied, points are mainly exhibit tidal fever, constipation or faecal
selected from the Lung Meridian of impaction with watery discharge, fullness,
Hand-Taiyin, the Large Intestine Merid- hardness and pain in the abdomen, a dry,
Chapter 13 Differentiation of Syndromes

yellow or even burnt-black tongue coating black tongue coating with thorns, and deep
with thorns on the tongue, and a deep and and forceful pulse of the excess type.
forceful pulse of the excess type. The principle of treatment is to clear heat
The common feature in syndromes of the from the qi system. Points are selected from
qi stage is excessive heat. As febrile pathogen the Du Meridian, Yangming Meridians of
invades the qi system and causes a vigorous Hand and Foot, and meridians related to the
struggle between the antipathogenic qi and diseased organs or areas. The method to
the pathogenic factor, excessive yang and treat excessive heat in the stomach and
heat appear in the form of fever with retention of heat in the intestinal tract is
aversion to heat, deep-yellow urine, a red identical to that used from syndromes of the
tongue with a yellow coating and a rapid Yangming Meridian and Yangming fu
pulse. Since the pathogenic factor has left organ in the differentiation of syndromes
the body surface, there is no aversion to according to the theory of the six meridians.
cold. Consumption of body fluid by In principle, points of the Lung Meridian
excessive heat leads to thirst. Disturbance of of Hand-Taiyin and Large Intestine
the mind by heat gives rise to mental Meridian of Hand-Yangming are used for
restlessness. Retention of heat in the lung retention s f heat in the lung. Points of the
impairs the lung's function in descending, Pericardum Meridian of Hand-Jueyin,
resulting in disorders of qi which manifest as Heart Meridian of Hand-Shaoyin and
coughing and chest pain. The heat in the Stomach Meridian of Foot-Yangming are
lung condenses body fluid to phlegm, usually selected for retention of heat in the
presenting profuse, thick and yellow chest and diaphragm.
sputum. Retention of heat in the chest and 3. Syndrome of the ying stage The
diaphragm hinders the passage of qi, and syndrome of the ying stage is more severe
restlessness and uneasiness become appa- and marked by further penetration of febrile
rent. When the exterior is affected by pathogen. Ying refers to the qi in the blood,
excessive heat, a persistent high fever occurs. which flows internally to the heat. The
Heat in the interior forces out the body fluid syndrome of the ying stage is thus
and profuse sweating results. Consumption characterized by injury of ying yin and
of body fluid by excessive heat gives rise to disturbance of the mind. Chief manifest-
dysphoria, thirst with preference for cold ations are feverishness of the body which is
drinks, and dry, yellow tongue coating. worse at night, dryness of the mouth without
Excessive movement of qi and blood due to a strong desire to drink, mental restlessness,
hyperactive interior heat causes rolling and insomnia, deep-red tongue and thready,
rapid pulse or superficial, large and forceful rapid pulse. In severe cases, faint skin rashes,
pulse. retention of heat in the intestinal tract delirium and cama may occur.
combines with wastes and blocks the qi of fu This syndrome is often a consequence of
organs, resulting in fullness, hardness and the inward transmission of diseases from the
pain in the abdomen, constipation or faecal qi system, which has not been correctly
impaction with watery discharge. Excess of treated. The further penetration of febrile
the Yangming fu organ with interior pathogen injures the ying yin (nutrient yin),
hyperactivity of heat and dryness manifests the outcome of which is feverishness of the
as afternoon fever, dry, yellow or even burnt body which is worse at night, and dry mouth
 Chinese Acupuncture and hiloxibustion

without a strong desire to drink. As nutrient mainly from the Du (Governor Vessel)
qi flows to the heart, heat in the ying system Meridian, Yangming Meridians of Hand
disturbs the heart, giving rise to mental and Foot, Shaoyin Meridian of Mead and
restlessness and insomnia. Delirium is a sign Jueyin Meridians of Hand and Foot.
of invasion of the pericardium by
pathogenic heat, whilst faint skin rashes
appear due io injury of the blood vesse!s liy
heat. The deep-red tongue and thready, I DIFFERENTIATION OF
rapid pulse are also signs of invasion of the 0 A TO
ying system by heat. THE THEORY OF ZMG-FU
The method of treatment is to clear off
heat from the ying system. Acupuncture or ORGANS
bleeding by pricking the vessels may be
adopted as auxiliary methods. Points are The differentiation of syndromes accord-
mainly used from the Heart Meridian of ing to the theory of zang-fu organs is used to
Hand-Shaoyin, the Pericardium Meridian analyze and synthesize the clinical data
of Hand-Jueyin and the Du (Governor obtained by applying the four diagnostic
Vessel) Meridian. methods. In this way the diseased zang-fu
4) Syndrome of the xne stage The organs are identified, and the causes and
syndrome of the xue stage represents further nature of the disease are ascertained.
dcve!qment cf the invasisz ~ ??he, f ying However diversified the types of diseases,
system by the pathogenic factor. It arises and complex the clinical manifestations may
from excessive heat stirring the blood and be, their mechanisms are attributed to the
further disturbing the mind. dysfunction of zang-fu organs along with
Chief manifestations are burning heat of the impairment of the qi, blood or body fluid
the body, mania, delirium, obvious skin produced by the zang-fu organs. In making
rashes; or hematemesis, hemoptysis, a differentiation clinically, the diseased
epistaxis, bloody stools and hematuria; dark organs should be identified first on the basis
deep-red .tongue. of their physiological functions and
As the heart dominates the blood and pathological char~teristics,and then the
houses the mind, injury of ying blood by nature of the disease such as cold or heat and
heat leads to a burning sensation of the body deficiency or excess is distinguished
and dark deep-red tongue. Excessive heat according to the eight principles. Reliable
stirs the blood causing obvious skin rashes, information is thus provided for deterrnin-
hematemesis, hemoptysis, bloody stools and ing treatment. The differentiation of
hematuria heat in the xue system also syndromes according to the theory of zang-
disturbs the mind, the result being mania fu organs is therefore closely combined, in
and delirium. clinical application, with the eight principles
' The method of treatment is to cool the and the theory of qi and blood.
blood and to eliminate toxins. Acupyncture The zang-fu organs are interrelated and
may assist by eliminating heat, promoting their diseases may affect one another. A
mental resuscitation, relieving convulsion disease may be confined to a single zang or
and calming the mind. Points are selected fu organ, or two or more organs may be
Chapter 13 Differentiation of Syndromes 289

diseased at the same time. Proceeding from indicates deficiency of the heart yang.
the concept of the unity of the organism, Profuse sweating, cold limbs, feeble
attention should be paid to the interrelation breathing, a feeble fading pulse and mental
and mutual influence of zang-fu- organs cloudiness or even coma are all critical signs
when making a differentiation. Only in this of prostration of the heart yang.
way can a comprehensive and correct Etiology and pathology: They are usually
diagnosis be made. caused by gradual declining of the heart qi
after a long illness, damage of yang qi by an
1. Syndromes of the Heart and Small abrupt severe disease or weakness of the qi
Intestine of zang due to old age or to congenital
deficiency. Insufficiency of the heart qi or
The physiological functions of the heart heart yang implies weakness of the heart in
are dominating blood and vessels, and propelling the blood, which explains
housing the mind. Path'ological changes palpitations and shortness of breath.As
manifesting as disturbance of blood exertion consumes qi, they become worse on
circulation and abnormal mental activities exertion. Insufficiency of blood in the vessels '
come within the diseases of the heart. Since due to weakness of blood circulation leads to
the heart opens into the tongue, pathological a thready and weak pulse. A missed-beat
changes of the tongue such as inflammation pulse is produced by discontinuation .of the<
or ulceration of the tongue can be treated on qi of vessels due to weakness of the heart in
the basis of differentiation of syndromes of propelling the blood. In case of deficiency of
the heart. qi and yang, the muscles and body surface
The physiological functions of the small fail to be controlled, spontaneous sweating
intestine are dominating digestion and results. Deficiency of qi leads to
dividing the "clear" from the "turbid." hypofunction of zang-fu organs, bringing on
Therefore the disorders of the small intestine listlessness and lassitude. Deficiency of the
are actually included in the disorders of the heart yang deprives the blood of warmth
spleen. The syndrome of pain due to the and gives rise to retardation of blood
disturbance of the qi of the small intestine is circulation, the accompanying symptoms
described here only. and signs being chills, cold limbs, cyanosis of
1) Deficiency of the heart qi, deficiency of lips and a purplish dark tongue. Extreme
the heart yang Clinical manifestations: deficiency of yang creates an abrupt
Both deficiency of the heart qi and prostration and severe dissipation of zong
deficiency of the heart yang may exhibit (pectoral) qi from the body with critical
palpitations and shortness of breath, which signs of profuse sweating, cold limbs, feeble
become worse on exertion, spontaneous breathing, mental cloudiness or even coma,
sweating and a thready, weak pulse or and a feeble fading pulse.
a missed-beat pulse. Deficiency of the heart 2) Deficiency of the heart blood, deficiency
qi also manifests as listlessness, lassitude and of the heart yin Clinical manifestations:
a pale tongue with white coating. The Both deficiency of the heart blood and
accompaniment of chills, cold limbs, deficiency of the heart yin may manifest as
cyanosis of lips and a pale, swollen and palpitations, insomnia, dream-disturbed
delicate tongue or a purplish dark tongue sleep and poor memory. If there are also
 Chinese Acupuncture and Moxibustion

pallor, pale lips, dizziness and vertigo, a pale mental irritation, exposure to cold after over
tongue and a thready and weak pulse, this strain and stress, or excessive indulgence in
suggests deficiency of the heart blood. The greasy food and alcoholic drinking, for all of
accompaniment of mental restlessness, which may elicit accumulation of phlegm
dryness of the mouth, heat sensation in the and stagnation of blood. Stagnation s f
palms, and soles, tidal fever, night sweating, blood in the vessel of the heart creates
a red tongue and a threauy and rapid piike pajpita:ions a& cardiac pais (stabbing pa-11
indicates deficiency of the heart yim. if stagnation of blood predominates; stuffy
Etiology and pathology: They often result pain if accumulation of phlegrh predomi-
from a weak body constitution, asthenia nates). As the Heart Meridian of Hand-
after a long illness or mental irritation which Shaoyin traverses the shoulder region and
consumes the heart blood and heart yin. the medial aspect of the arm, referred pain
Insufficiency of yin blood deprives the heart there occurs. Stagnation of the heart blood
of nourishment, leading to palpitations and may cause retardation of general blood
poor memory. Disturbance of the mind circulation, which is the cause of cyanosis of
results in insomnia and dream-disturbed the face, lips and nails, a purplish dark
sleep. Blood deficiency with inability to tongue or purplish spots on the tongue and a
newish upwards may produce dizziness and thready and hesitant pulse or a missed-beat
vertigo, pallor, pale lips, and a pale tongue. pulse. ~ e f i c i e ' n cof
~ the heart yang and
The insufficient blood in the vessels is the stagnation of the heart blood hinder yang qi
cause of a thready and weak -yl l l c p uAdu. fro= reaching the four limbs and body
Insufficiency of the heart yin produces surface, and thus inducing cold limbs and
deficiency type heat in the interior, which spontaneous sweating.
causes mental restlessness, dryness of the 4) Hype~a~tivityof the heart fire
mouth, heat sensation in the palms and Clinical manifestations: Mental restlessness,
soles, malar flush, tidal fever, night insomnia, flushed face, thirst, ulceration and
sweating, a red tongue and a thready and pain of the mouth and tongue, hot and deep
rapid pulse. yellow urine; hesitant m d painful urination
3) S$aga&tiowof the heart blood Clinical in severe cases; a red tongue and a rapid
manifestations: Palpitations, intermittent pulse.
cardiac pain (stabbing or stuffy in nature in Etiology and pathology: The syndrome is
the precordial region or behind the sternum) often due to mental depression which turns
which often refers to the shoulder and arm, a into fire in prolonged cases; to retention in
purplish dark tongue or purplish spots on the interior of the body of exogenous
the tongue and a thready and hesitant pulse pathogenic factors turning into fire; or to
or a missed-beat pulse. In severe cases there excessive indulgence in pungent and hot
may occur cyanosis of face, lips and nails, b o d , cigarette smoking or alcoholic
cold limbs and spontaneous sweating. drinking, all of which produce heat and fire
Etiology and pathology: The syndrome over a long period of time. The heart fire
often results from insufficiency of the heart produced in the interior attacks the heart
qi and heart yang which causes retardation and results in disturbance of the mind, which
of blood circulation. The attack may be is the cause of mental restlessness and
induced and the disease aggravated by insomnia. As the tongue is the sprout of the
Chapter 13 Differentiation of Syndromes

heart, the hyperactive heart fire flares behaviour, insomnia, dream-disturbed

upwards and causes ulceration and pain of sleep, a yellow, sticky tongue coating and a
the mouth and tongue. Consumption of rolling, rapid and forceful pulse.
body fluid by fire and heat gives rise to thirst, 6) Pain doe to disturbance of the qi of the
hot and deep yellow urine, and even hesitant smal intestine Clinical manifestations:
and painful urination in severe cases. Acute pain of the lower abdomen,
Flushed face, a red tongue and a rapid pulse abdominal distension, borborygmus; or
are the outcomes of hyperactivity of bearing-down pain in the testes referring to
pathogenic heat which accelerates the blood the lumbar region; a white tongue coating
circulation. and a deep string-taut pulse.
5) Derangement sf the mimd (''phlegm Etiology and pathology: The syndrome is
misting the heart," "phlegm-fire disturbing often due to improper diet, lack of care in
the XrPearV9) Clinical manifestations: The wearing clothing appropriate to the weather,
syndrome of "phlegm misting the heart" or carrying excessive weights. These may
often displays mental depression and give rise to obstruction and sinking of the qi
dullness, or incoherent speech, weeping and of the small intestine. Obstruction of the qi
laughing without an apparent reason, or of the small intestine brings on acute pain of
sudden collapse, coma and gurgling with the lower abdomen, abdominal distension
sputum in the throat. A white, sticky tongue and borborygmus. Sinking of the qi of the
coating and a string-taut and rolling pulse small intestine effects bearing-down pain in
are preszift. the testes referring to the lumbar region. The
The syndrome of "phlegm-fire disturbing white tongue coating and the deep, string-
the heart" often exhibits derangement of the taut pulse are both signs of stagnation of qi.
mind, mania, aggressive and violent Since the heart functions to dominate the
behavior, insomnia, dream-disturbed sleep, blood and vessels and to house the mind,
flushed face, coarse breathing, constipation, pathological changes with palpitations,
deep-yellow urine, a yellow, sticky tongue insomnia and mental disorders as the main
coating and a rolling, rapid and forceful symptoms and signs are treated according to
pulse. differentiation of syndromes of the heart.
Etiology and pathology: The syndrome of Points are mainly selected from the Heart
"phlegm misting the heart" is often due to Meridian of Hand-Shaoyin and the
mental depression which results in Pericardium Meridian of Hand-Jueyin. The
retardation of qi circulation and consequent corresponding Back-Shu Points are also
inability of qi in distributing body fluid. The used. The syndromes of the small intestine
accumulation of body fluid forms phlegm, often manifest themselves in disturbance of
which mists the heart and produces the the digestive function. The deficiency
above symptoms and signs. Once the syndromes of the small intestine are
obstructed qi turns into fire, which changes included in the deficiency syndromes of the
body fluid to phlegm by condensation, the spleen. Their treatment is directed at the
phlegm and fire intermingle and disturb the spleen and stomach. The heat syndrome of
mind, the result would be the occurrence of excess type of the small intestine is similar to
excessive phlegm fire in the interior which hyperactivity of the heart fire. The painful
manifests as mania, aggressive and violent syndrome due to disturbance of the qi of the
292 Chinese Acupuncture and Moxibustion

small intestine may be included in the cough with yellow purulent sputum, thirst,
syndromes of accumulation of cold in the sore throat; possibly with heat sensation of
Liver Meridian. The suitable Back-Shu, the body and aversion to wind; headache, a
Front-Mu and Lower He-Sea Points are thin, yellow tongue coating and a
generally selected as the main points and superficial, rapid pulse.
points of the Spleen, Stomach, Heart and Etiology and pathology: The syndrome is
Liver Meridisars are usen in combination: due h invasion of the lung system by
according to actual pathological conditions. exogenous pathogenic wind complicated
with either cold or heat. Invasion of the lung
by wind cold impairs the lung's function in
dispersing and descending and produces
2. Syndromes of the Lung and Large cough with mucoid sputum. As the lung
Intestine opens into the nose, invasion of the lung by
pathogenic cold affects the corresponding
The lung is the hub of vital energy. It orifice and gives rise to nasal obstruction
dominates qi, in particular, zong (pectoral) with watery nasal discharge. Since the lung is
qi, which is formed in the lung; it controls closely related to the skin and hair, invasion
respiration and takes charge of dispersing of the body surface by wind cold causes
and descending; it relates externally to the disharmony of ying (~mtrieni)qi and we:
skin and hair and opens into the nose. (defensive) qi, producing chills and fever,
Pathological changes of the lung mainly absence of sweating, and heat and body
manifest as insufficiency of zong (pectoral) aches. A thin, white tongue coating and a
qi and dysfunctions in respiration, superficial, tense pulse are both signs of
dispersing and descending. As the lung is a wind cold affecting the body surface.
delicate organ and most susceptible to cold Invasion of the lung by wind heat impairs
or heat, and it relates to the skin and hair, it the function of the lung in dispersing and
is often the first organ to be affected when descending, manifesting as cough with
exogenous pathogenic factors invade the yellow purulent sputum. The consumption
body. of body fluid by pathogenic heat is the cause
The large intestine functions to transmit of thirst. Upward disturbance of wind heat
the waste products and excrete them from generates sore throat. The invasion of the
the body. Pathological changes of the large body surface by wind heat impedes wei
intestine mainly manifest as dysfunctions in (defensive) qi, which explains heat sensation
transmission. of the body, aversion to wind and headache.
1 I~vasisn of the g by pathogenic A thin, yellow tongue coating and a
wind Clinical manifestations: Invasion of superficial, rapid pulse are both signs of
the lung by wind cold displays such signs as wind heat affecting the body surface.
cough with mucoid sputum, absence of 2 R e of phlegm d m in the
thirst, nasal obstruction, watery nasal luni Clinical manifestations: Cough with
discharge; possible chills and fever; absence much frothy or white, sticky sputum,
of sweating, headache, a thin, white tongue fullness and stuffiness in the chest, gurgling
coating and a superficial, tense pulse. with sputum in the throat, shortness of
Invasion of the lung by wind heat generates breath or asthmatic breathing; orthopnea in
Chapter 13 Differentiation of Syndromes

severe cases; a white, sticky tongue coating blocks the vessels of the lung, which leads to
and a rolling pulse. decomposition and thereby produces pus,
. Etiology and pathology: This syndrome is effecting expectoration of bloody pus.
often due to recurrent attacks of cough Consumption of body fluid by pathogenic
following exposure to exogenous pathogenic heat gives rise to dryness of the mouth and
factors. This impairs the lung's function in yellow urine. Failure of the lung qi in
disseminating body fluid, the accumulation descending is the cause of constipation. A
the syndrome may result from the dysfunc- yellow, sticky tongue coating, a red tongue
tion of the spleen in transportation, which and a rolling, rapid pulse are all signs of
leads to the formation of phlegm damp. retention of phlegm heat in the interior.
When this remains in the lung, the above 4) Deficiency of the Lung qi Clinical
symptoms will be induced or become manifestations: Feeble cough, shortness of
above symtoms will be induced or become breath which is worse on exertion, clear
worse on exposure to pathogenic wind cold. dilute sputum, lassitude, lack of desire to
Phlegm damp blocks the passage of qi and talk, low voice, aversion to wind, frigid
impairs the function of the lung qi, bringing appearance, spontaneous sweating, a pale
on cough with much sputum, stuffiness in tongue with thin, white coating and a weak
the chest, asthmatic breathing, gurgling with pulse of the deficient type.
sputum in the throat, and in severe cases, Etiology and pathology:-Thissyndrome is
orthopnea. Expectoration of frothy or often due to a prolonged cough which
white, sticky sputum, a white, sticky tongue damages the qi and gradually leads to
coating and a rolling pulse are all signs of weakness of the lung qi. Or it may be due to
retention of phlegm damp in the interior. overstrain and stress, or to weakness of yuan
3) Retentiom sf phlegm heat in the (primary) qi after a prolonged illness,
luwg Clinical manifestations: Cough, asth- either of which may cause insufficiency of
matic and coarse breathing; flapping of ala lung qi and impairment of the lung's
nasi in severe cases; yellow, thick sputum or function in dominating qi. Feeble cough
expectoration of foulsmelling bloody pus; results from weakness of the lung qi and
chest pain on coughing, dryness of the impairment of the lung's function in
mouth, yellow urine, constipation, a red dominating qi and in descending. Shortness
tongue with yellow, sticky coating and a of breath and asthmatic breathing are the
rooling, rapid pulse. outcome of lack of qi following impairment
Etiology and pathology: This syndrome is of the lung's function in dominating qi.
often due to invasion of exogenous Insufficiency of the lung qi does not allow
pathogenic wind heat, or invasion of wind the qi to perform its function in distributing
cold which goes to the interior of the body body fluid, the accumulationm of which forms
and turns into heat after a period of clear and dilute sputum. Weakness of wei
retention. Heat in the lung changes body (defensive) qi at the body surface produces
fluid into phlegm by condensation. The aversion' to wind, frigid appearance,
phlegm and heat intermingle and impair the spontaneous sweating. Lassitude, lack of
descending h c t i o n of the lung, the result desire to talk, low voice, a pale tongue with
being cough, asthmatic breating, chest pain thin, white coating and a weak pulse of the
and yellow, thick sputum. Phlegm heat deficient type are all signs of deficiency of qi.
294 Chinese Acupuncture and Moxibustion '

5 ) Insufficiency of the Lung yin intake of unclean food, all of which may
Clinical manifestations: Unproductive injure the spleen, stomach and intestines.
cough, cough with a small amount of sticky Abdominal pain is the outcome of retention
sputum, or cough with blood tinged sputum; of pathogenic damp heat in the intestines,
dryness of the mouth and throat, afternoon which results in retardation of qi circulation.
fever, malar flush, night sweating, heat Damp heat injures the blood vessels of the
s e ~ i s ~ irsl :the
~ ~pzlms
~ and soles, a red intestinal tract and thus creates blood and
tongue with a small amount of coating and a mucus in the stools. Retention of damp heat
thready, rapid pulse. in the large intestine impairs its function of
Etiology and pathology: This syndrome is transmission, eliciting diarrhoea with
often due to a prolonged cough which yellow, watery stools, burning sensation in
consumes the lung yin; to overstrain and the anus and scanty, deep yellow urine.
stress; or to invasion of exogenous Consumption of body fluid by excessive heat
pathogenic dryness which causes insuffici- gives rise to fever and thirst. A yellow, sticky
ency of the lung yin and, further, the tongue coating and a rolling, rapid pulse or a
production of deficiency type heat in the soft, rapid pulse are all signs of retention of
interior. Consumption of yin deprives the damp heat in the interior.
lung of moisture and allows upward 7) Cowsramption sf the fluid of the large
disturbance of the lung qi, the !result being intestine Clinical manifeststations: Dfy
cough with a small amount of sputum, stools, constipation, dryness of the mouth
dryness of the mouth and throat. Injury of and throat, a red tongue with little moisture
the lung vessels by cough produces blood or with a dry yellow coating and a thready
tinged sputum. Deficiency of yin leads to pulse.
hyperactivity of fire, resulting in afternoon Etiology and pathology: The syndrome
fever, malar flush, night sweating and heat often occurs to people in old age, to women
sensations in the palms and soles. A red after delivery, or in the late stage of a febrile
tongue with a small amount of coating, and disease when there is consumption of body
a thready rapid pulse are both signs of heat fluid. Insufficiency of fluid in the large
due to deficiency of yin. intestine leads to dryness, thus constipation
6 ) Damp heat in the a g e irratestime ensues. Dryness of the mouth and throat, a
Clinical manifestations: Abdominal pain, red tongue with little moisture or with a dry
tenesmus; blood and mucus in the stools, or, yellow coating and a thready pulse are all
diarrhoea with yellow, watery stools; a signs of deficiency type heat due to
burning sensation of the anus; scanty deep- consumption of fluids.
yellow urine; possible fever and thirst; a To treat syndromes of the lung, points of
yellow, sticky tongue coating and a rolling, the Lung Meridian of Hand-Taiyin and its
rapid pulse or soft, rapid pulse. Back-Shu Point are often used as main
Etiology and pathology: This syndrome points. To treat its syndromes of excess type,
often occurs in summer and autumn when points of the Large Intestine Meridian of
pathogenic summer heat, damp and toxic Hand-Yangming may be used in addition.
heat invade the intestines and stomach. It Reducing manipulation method is applied;
may also be due to irregular food intake, cupping or bleeding methods may also be
excessive eating of raw and cold food, or used to promote smooth circulation of the qi
Chapter 13 Differentiation s f Syndromes

of meridians.and to restore the functions of 1) Deficiency of the spleen qi Clinical

the lung qi in dispersing and descending. The manifestations: Sallow complexion, emaci-
lung's syndromes of deficiency type are ation, lassitude, dislike of speaking, reduced
treated by combining points of the involved appetite, abdominal distension, loose stools;
meridians, such as the Spleen ~ e r i d i a nof or a bearing-down sensation in the
Foot-Taiyin and the Kidney Meridian of abdominal region, viscera ptosis, prolapse
Foot-Shaoyin, with reinforcing or even- of the anus; a pale tongue with a thn, white
movement methods. The Back-Shu, Front- coating and a slowing-down, weak or soft,
Mu and Lower He-Sea points are mainly thready pulse.
used to treat syndromes of the large Etiology and pathology: The syndrome is
intestine. As the large intestine is closely due to weakness after a prolonged illness, to
related to the spleen and stomach in its overstrain and stress or to improper diet, all
physiological functions, the relevant points of which damage the spleen qi. Weakness of
of the Stomach Meridian of Foot-Yangming the spleen qi implies . hypofunction in
and of the Spleen Meridian of Foot-Taiyin transportation and transformation, which
may be added according to the symptoms gives rise to reduced appetite, abdominal
and signs. distension and loose stools. Dysfunction of
the spleen in transportation and transform-
ation produces an insufficient source of qi
3. Syndromes of the Spleen and and blood, the result being -sallow
Stapmsach complexion, emaciation, lassitude and
dislike of speaking. Weakness after a .
The spleen functions to dominate prolonged illness hinders the spleen qi in
transportation and transformation and ascending, and instead it sinks, resulting in
control blood. When its qi ascends, its bearing-down sensation in the abdominal
function is normal. So pathological changes region and possible prolapse of the uterus,
of the spleen often manifest as dysfunction prolapse of the anus, gastroptosis or renal
in transportation and transformation and in ptosis. A pale tongue with thin, white
controlling blood and as sinking of the coating, and a slowing-down, weak pulse or
spleen qi. a soft thready pulse are all signs of deficiency
The stomach functions to receive and of qi.
digest food. When its qi descends, its 2) Dysfunction of the spleen in controlling
function is normal. So pathological changes blood Clinical manifestations: Pale com-
of the stomach often manifest as dysfunction plexion, lassitude, dislike of speaking,
of its qi in descending and as poor digestion. purpura, bloody stools, excessive menstrual
The spleen and stomach dominate flow, uterine bleeding, a pale tongue and a
reception, digestion, transportation and thready, weak pulse.
transformation by sending the "clear" Etiology and pathology: This syndrome is
upwards and bringing down the "turbid." due to weakness after a prolonged illness, or
They serve as the source of qi and blood, to overstrain and stress, either of which may
which nourish the whole body. That is why weaken the spleen's function in controlling
the spleen and stomach are called the blood. Deficiency of the spleen implies
"source of acquired constitution." impairment of its function in transportation
 Chinese Acupuncture and Moxibustion

and transformation, which produces an distension in the epigastrium and abdomen,

insufficient source of qi and blood, that loss of appetite, sticky saliva, heaviness of
explains pale complexion, lassitude and the head and body, loose stools or
dislike of speaking. Weakness of the spleen diarrhoea, a white, sticky tongue coating
qi indicates inability of the spleen to control and a soft pulse.
blood, which leaks 'from the vessels and thus Etiology and pathology: This syndrome
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manstrual flow and uterine bleeding. A pale in the rain, sitting and sleeping in a damp
tongue and a thready, weak pulse are both place or excessive eating of raw and cold
signs of deficiency of qi and blood. food. The syndrome may also result from
3) Deficiency of the spleen yang Clinical excessive endogenous damp. In all these
manifestations: Pallor, the four limbs being cases, the yang of the middle jiao may be
not warm; poor appetite; abdominal strained and the function of the spleen in
distension which is worse after eating or dull transportation and transformation im-
pain in the abdominal region which is better paired. Invasion of the spleen by cold damp
with warmth and pressure; loose stools; a impairs the spleen's function in transporta-
pale and delicate tongue with white coating tion and transformation, resulting in
and a deep, slow pulse. fullness and distension in the epigastrium
Etiology and pathology: This syndrome is and abdomen, loss of appetite, loose stools
a further development of deficiency of the or diarrhoea. As damp is characterized by
spleen qi. It may also result from the intake heaviness and viscosity>blockage of the cold
of excessive raw and cold food or greasy and damp produces sticky saliva, and heaviness
sweet food; or from excessive administration of the head and body. A white, sticky tongue
of herbs of cold nature, both of which coating and a soft pulse are both signs of
damage the spleen yang. Deficiency of the excessive damp in the interior.
spleen yang impairs the spleen's function in 5 Damp hieat i~ the spleem and stomach
transportation and transformation, bring- Clinical manifestations: Fullness and
ing on reduced appetite, abdominal distension in the epigastrium and abdomen,
distension and loose stools. Insufficiency of loss of appetite, nausea, vomiting, bitter
the spleen yang causes stagnation of yin cold taste and sticltiness in the mouth, heaviness
and blockage of qi, the result being a dull of the body, lassitude; bright yellow face,
pain in the abdominal region. The patient eyes and skin; loose stools, scanty, yellow
likes warmth and pressure in a cold urine, a yellow, sticky tongue coating and a
syndrome of deficiency type. Deficiency of soft, rapid pulse.
the spleen yang is unable to warm up the qi Etiology and pathology: This syndrome is
and blood and to promote their smooth often due to invasion of exogenous
circulation, thus pallor ensues and the four pathogenic damp heat. It may also result
limbs are not warm. A pale and delicate from excessive indulgence in greasy and
tongue with white coating and a deep slow sweet food, or alcoholic drinking, all of
pulse are both signs of deficiency of the which may produce damp heat in the
spleen yang. interior. Retention of damp heat in the
4) Hmvasiasw of &Bas: spleen by cold damp stomach and spleen impairs their functions
Clinical manifestations: Fullness and in reception, digestion, transportation and
Chapter 13 Differentiation of Syndromes

transformation, causing hllness and reflux of clear fluid or vomiting after eating;
distension in the epigastriurn and abdomen, a white, slippery tongue coating and a slow
loss of appetite, nausea, vomiting and loose pulse.
stools. Excessive damp heat gives rise to a Etiology and pathology: This syndrome is
sticky and bitter taste in the mouth and often due to a constitutional deficiency of
scanty yellow urine. As damp is the stomach yang complicated by invasion
characterized by heaviness and viscosity, of exogenous pathogenic cold; or to intake
blockage of the qi by damp leads to of excessive raw and cold food which causes
heaviness of the body and lassitude. Damp retention of cold in the stomach. Retention
heat stirs up the bile which, therefore, of cold in the stomach blocks the stomach qi
permeats the muscles and skin, presenting and produces epigastric fullness and pain,
bright yellow face, eyes and skin. A yellow which are worse on exposure to cold but
sticky tongue coating and a soft rapid pulse better to warmth, for exposure to cold may
are both signs of retention of damp heat in aggravate the retention while exposure to
the interior. warmth may disperse cold an$ effect a
6) Retention of food i the stomach smooth circulation of qi. Impairment of
Clinical manifestations: Distension, fullness yang qi in a prolonged disease implies .
and pain in the epigastriurn and abdomen, inability of yang qi to distribute body fluid.
foul belching sour regurgitation,, and Thus the retained fluid is formed. If the
anorexia. There may be vomiting and retained fluid remains in the stomach and
hesitant bowel movements. The tongue also disturbs upward, reflux of clear fluid
coating is thick and sticky, and the pulse is and vomiting after eating follow. A white,
rolling. slippery tongue coating and a slow pulse are
Etiology and pathology: This syndrome both signs of deficient yang complicated
may be due to irregular food intake, with retention of cold and fluid in the
voracious eating or eating of food which is interior.
difficult to digest. Retention of food in the 8 H e y of fire im the stomach
stomach blocks the qi passage in the Clinical manifestations: Burning sensation
epigastriurn and abdomen and thus causes and pain in the epigastric region; sour
distension, fullness and pain there. regurgitation and an empty and uncom-
Dysfunction in digesting food brings the fortable feeling in the stomach; thirst with
turbid qi upward, which is the cause of foul preference o r cold drinks; voracious
belching, sour regurgitation, anorexia and appetite and getting hungry easily;
vomiting. Retention of the turbid part of the vomiting, foul breath; swelling and pain or
food blocks the Barge intestine and impairs ulceration and bleeding of the gums;
its function in transmission, resulting in constipation, scanty yellow urine; a red
hesitant bowel movements. A thick, sticky tongue with yellow coating and a rapid
tongue coating and a rolling pulse are both pulse.
signs of retention of food. Etiology and pathology: This syndrome
7) Retention of fluid. im the stomach dae $0 may result from excessive eating of hot and
cold Clinical manifestations: Epigastric greasy food which turns into heat and fire, or
fullness and pain which are worse on from emotional depression which leads to
exposure to cold and better to warmth; invasion. of the stomach by the liver fire.
 Chinese Acupuncture and Moxibustion

Hyperactivity of fire in the stomach burns food, the consequence is hunger with no
body fluid and thus produces burning pain desire to eat. With deficiency of stomach yin
in the epigastric region and thirst with the fluids fail to be sent upwards, creating
preference for cold drinks. If obstruction of dryness of the mouth and throat.
the liver qi turns into heat, it may impair the Constipation, a red tongue with little
function of the stomach in descending, thus moisture and thready rapid pulse are all
causing sour regurgitation and ail eapij; &glisof defi&encyof yir; prcdacing i~terior
and uncomfortable feeling in the stomach. heat.
Hyperactivity of heat in the stomach may Since the spleen and stomach are related
result in hyperfunction of the stomach in externally and internally, disease of either of
digesting food, that is the reason for them often affect the other. The Back-Shu,
vdracious appetite and getting hungry Front-Mu, Yuan-Primary, Luo-Connecting
easily. Excessive heat in the stomach may and He-Sea Points of the Spleen Meridian of
make the stomach qi disturb upward, Foot-Taiyin and Stomach Meridian of
vomiting ensues. Since the Stomch Meridian Foot-Yangming are used as the main points.
traverses the gums, upward disturbance of They are combined with points from the
the stomach fire along the meridian causes Liver Meridian of Foot-Jueyin and the
foul breath, swelling and pain or ulceration Pericardium Meridian of Hand-Jueyin.
and bleeding of the gums. ~onstipation,' Reinforcing or reducing needling technique,
scanty yellow urine, a red tongue with yellow or moxibustion is applied according to
coating, a d a rzpid p!se are a!! signs of actl~a!r,sfiQit,in~s.
hyperactivity of fire and heat in the interior.
9) H~~sufficiencyof the stomach yin
Clinical manifestations: Burning pain in the
4. Syndromes of the Liver'amd
epigastric region, an empty and uncom-
fortable sensation in the stomach, hunger Gallbladder
with no desire to eat; or dry vomiting and
hiccups; dryness of the mouth and throat; The liver functions to promote the free
constipation; a red tongue with little flow of qi, dominate the tendons and open
moisture and a thready rapid pulse. into the eye. Pathological changes of the
Etiology and pathology: This syndrome liver mainly manifest themselves in
may be due to hyperactivity of heat in the dysfunctions of the liver in storing blood and
stomach which consumes the stomach yin or in promoting the free flow of qi, and in
to consumption of the yin fluid by persistent disorders of the tendons. .
pathogenic heat at the late stage of a febrile The gallbladder functions to store and
disease. Consumption of the stomach yin excrete the bile and thus assist in the
deprives the stomach of moisture and digestion of food. The qi of the gallbladder is
impairs its function of descending, the result closely related to the human emotions. Since
being burning pain in the epigastric region, the gallbladder and liver are externally and
an empty and uncomfortable sensation in internally related, the two organs are often
the stomach, dry vomiting and hiccups. diseased at the same time.
Insufficiency of fluid in the stomach impairs 1) Stagnation of the Ever qi Clinical
the function of the stomach in receiving manifestations: Mental depression; irrita-
Chapter 13 Differentiation of Syndromes 299

bility; distending or wandering pain in the 2) Flare-up of the h e r fire Clinical

costal and hypochondriac regions; disten- manifestations: Distending pain in the head;
sion of the breasts; stuffiness in the chest; dizziness and vertigo; redness, swelling and
sighing; epigastric and abdominal distension pain of the eyes; a bitter taste and dryness in
and pain; poor appetite; belching; or the mouth; irritability; burning pain in the
possibly a foreign body sensation in the costal and hypochondriac regions; tinnitus
throat; irregular menstruation and dysmen- like the sound of waves; yellow urine and
orrhea in women; a thin, white tongue constipatioy; hematemesis, hemoptysis or
coating and a string-taut pulse. In prolonged epistaxis; a red tongue with yellow coating
cases, there may be pricking pain in the and a string-taut, rapid pulse.
costal and hypochondriac regions or Etiology and pathology: This syndrome
palpable mass may be present. The tongue is may be due to obstruction of the liver qi
purplish dark in colour, or there are purplish turning into fire with upward disturbance of
spdts on the tongue. the qi and fire or to excessive indulgence in
Etiology and pathology: The syndrome is cigarette smoking, alcoholic drinking or
often due to mental irritation which impairs grea'sy food, which may lead to
the function of the liver in promoting the accumulation of heat and production of fire.
free flow of qi and results in stagnation of the Since fire is characterized by upward
liver qi, leading to retardation of the qi movement, the effect of the liver fire on the
circulation, . thus presenting mental de- head and eyes may produce distending pain
pression, irritability, distending pain in the in the head, dizziness and vertigo, redness,
costal and hypochondriac regions and swelling and pain of the eyes and a bitter
breasts, stuffiness in the chest and sighing. taste and dryness in the mouth. The liver
Transverse invasion of the spleen and relates to the emotion of anger and
stomach by the liver qi produces epigastric irritability is the consequence of hyperactiv-
and. abdominal distension and pain, poor ity of the liver fire. Excessive liver fire burns
appetite and belching. Retardation of the qi the Liver Meridian and brings about a
circulation allows damp to collect and burning pain at the costal and hypo-
phlegm may be formed; the phlegm and qi chondriac region. When the liver fire attacks
may accumulate in the throat, resulting in a the ear along the Gallbladder Meridian,
foreign body sensation in the throat. there may be tinnitus, which has abrupt
Affected by dysfunction of qi, the onset, sounds like waves and is not alleviated
circulation of both qi and blood is retarded by pressure. The injury of blood vessels by
and disharmony of the Chong and Ren the liver fire may produce hematemesis,
(Conception Vessel) Meridians may result. hemoptysis or epistaxis. Yellow urine,
This can cause irregular menstruation and constipation, a red tongue with yellow
dysmenorrhea. Long standing obstruction coating and a string-taut, rapid pulse are all
of the liver qi, leading to stagnation of qi and signs of hyperactivity of the liver fire in the
blood, may elicit palpable masses, interior.
accompanied by pricking pain in the costal 3) Rising of the liver yang Clinical
and hypochondriac regions, a purple tougue manifestations: Headache with distending
or a tongue with purplish spots, and a string- sensation in the head, dizziness and vertigo,
taut pulse. tinnitus, flushed face and red eyes,
 Chinese Acupuncture and Moxibustion

irritability, insomnia with dream-disturbed dysphasia, a red and tremulous tongue and a
sleep, palpitations, poor memory, soreness string-taut, rapid pulse. In severe cases there
and weakness of the low back and knees, a may be sudden collapse, coma, stiffness of
red tongue and a string-taut, thready and the tongue, aphasia, deviation of the mouth
rapid pulse. and eye, and hemiplegia.
Etiology and pathology: This syndrome Etiology and pathology: This syndrome
may hc h e tc. ESE~Z! depression, anger and often occurs to patients with a constitutional
anxiety. They produce obstruction of the deficiency of yin and excess of yang. It may
liver qi which later turns into fire. The fire be induced by such factors as drastic
consumes the yin blood in the interior and emotional changes, overstrain and stress
does not allow yin to restrain yang. The and excessive alcoholic drinking, all of
syndrome may also result from consti- which may further consume yin and give rise
tutional deficiency of the yin of the liver and to abrupt rising of yang. Subsequently the
kidney, in which case, the liver yang fails to liver wind is produced. The disturbance of
be restrained. Excessive ascending of the the head and eyes by the liver yang produces
yang and qi of the liver is the cause of dizziness, vertigo and headache. The
headache with distending sensation in the tendons may be deprived of nourishment by
head, dizziness and vertigo and tinnitus. either insufficiency of the liver yin or
Hyperactivity of the liver yang may produce constitutional excess of phlegm leading to
redness of the face and eyes, and irritability. obstruction of qi and blood, and this may
when there is deficiency of yin leading to cause numbness or tremor of the limbs, and
excess of yang, the mind fails to be nourished dysphasia. Sudden onset of rising liver yang
and the harmonious state of yin and yang is may stir up wind and produce upward
broken. As a result, such symptoms. as movement of qi and blood, which, in
palpitations, poor memory, insomnia with combination with phlegm fire, clouds the
dream-disturbed sleep ensue. Deficiency of "clear cavity," and thus creating sudden
the yin of the liver and kidney deprives the collapse and coma. Invasion of the
tendons and bones of nourishment and thus meridians by wind phlegm hinders the qi and
brings on soreness and weakness of the low blood circulation and brings on stiffness of
back and knees. A red tongue and a string- the tongue with aphasia, deviation of the
taut, rapid pulse are both signs of deficiency mouth and eye and hemiplegia. A red tongue
of yin leading to hyperactivity of fire. and a string-taut, rapid pulse are both signs
4) stirring of the h e r wind in the of hyperactivity of the liver yang.
interior The occurrence of such symptoms b) Extreme heat stirring wind Clinical
and signs as dizziness and vertigo, manifestations: High fever, convulsion, neck
convulsion, tremor and numbness, as a part rigidity, upward staring of the eyes; in severe
of a process of pathological changes is cases, opisthotonus, coma and lock jaw; a
referred to as liver wind, which may result deep-red tongue and a string-taut, rapid
from hyperactivity of the liver yang, extreme pulse.
heat and deficiency of blood. Etiology and pathology: This syndrome
a ) Liver yang turning into wind Clinical may occur in exogenous febrile diseases
manifestations: Dizziness and vertigo, where excessive pathogenic heat stirs up the
headache, numbness or tremor of the limbs. liver wind. If excessive pathogenic heat
Chapter 13 Differentiation of Syndromes 301

induces high fever, this may scorch the thready pulse.

tendons, producing convulsion, neck Etiology and pathology: This syndrome
rigidity, upward string of the eyes and may be due to insufficient production of
opisthotonos. Disturbance of the mind by blood, to excessive loss of blood or to
heat leads to coma. A deep-red tongue and a consumption of the liver blood by a
string-taut, rapid pulse are both signs of prolonged 'illness. Deficiency of tlie liver
disorders of the liver with excessive heat. blood deprives the heat and eyes of
c) Deficiency of blood producing wind .nourishment and may result in pallor,
Deficiency of the liver blood deprives dizziness and vertigo, blurring of vision,
the tendons of nourishment and thus stirs up dryness of the eyes and night blindness.
deficiency type wind in the interior. For When the liver blood fails to nourish the
clinical manifestations, etiology and pat- limbs and tendons, there may be numbness
hology refer to the syndrome of insufficiency of the limbs and spasms of the tendons.
of the liver blood. Insufficiency of the liver blood empties the
5) Weteaation of .cold ian the Liver sea of blood, thus bringing on scanty
Meridlliam Clinical manifestations: Lower menstrual flow and amenorrhea. A pale
abdominal distending pain, with bearing- tongue and a thready pulse are the
down sensation in the testes; the scrotum consequence of deficiency of blood.
may be contracted; this pain can be 7) Damp heat im the Ever and
aggravated by cold and alleviated by gallbladder Clinical manifestations: Hypo-
warmth; the tongue coating is white and chondriac distension and pain, bitter taste in
slippery and the pulse deep and string-taut. the mouth, poor appetite, nausea, vomiting,
Etiology and pathology: This syndrome is abdominal distension, scanty and yellow
due to invasion of the Liver Meridian by urine, a yellow, sticky tongue coating and a
exogenous pathogenic cold which blocks the string-taut, rapid pulse. In addition there
qi and blood circulation. The Liver may be yellow sclera and skin of the entire
Meridian curves around the external body or fever. The occurrence of eczema of
genitalia and passes through the lower scrotum, swelling and burning pain in the
abdominal region. As cold is characterized testes or yellow foul leukorrhea with
by contraction and stagnation, invasion of pruritus vulvae suggests damp heat in the
the meridian by cold may block the qi and Liver Meridian.
blood circulation and thus leading to pain. Etiology and pathology: This syndrome
Cold disperses with warmth and thus pain is may be due to invasion of exogenous
relieved; when cold accumulates, the pain pathogenic damp heat or to excessive eating
becomes worse. A white, slippery tongue of greasy b o d which produces damp heat in
coating and a deep, string-taut pulse are the interior. In either case, damp heat
both signs of interior cold. accumulates in the liver and gallbladder.
6) Hnslafficcieacy of the liver blood Clinical The accumulation of damp heat impairs the
manifestations: Pallor, dizziness and function of the liver and gallbladder in
vertigo, blurring of vision, dryness of the promoting the free flow of qi. causing
eyes, night blindness, numbness of the limbs, hypochondriac pain. The upward overflow
spasms of the tendons, scanty menstrual of the qi of the gallbladder leads to a bitter
flow or amenorrhea, a pale tongue and a taste in the mouth. The accumulation of
 Chinese Acupuncture and Moxibustion

damp heat alsdimpairs the function of the 5. Syndromes of the Kidney and .
spleen and stomach in ascending and Bladder
descending, eliciting poor appetite, nausea,
vomiting and abdominal distension. Down- The kidney functions to store essence,
ward infusion of damp heat into the bladder serving as the source of reproduction and
brings on scanty, yellow urine. A yellow, development; to dominate water metabol-
sticky tongue coating and a sirinrg-iaiit, ism, thlis mai:~taining the ihsrlanse of the
rapid pulse are both signs of damp heat in body's fluid; to dominate bones and produce
the liver and gallbladder. Once the function marrow, thus keeping the bones healthy and
of the liver and gallbladder in promoting the strong; and to open into the ear, the urino-
free flow of qi is impaired, the bile, instead of genital orifice and the anus. Therefore, the
circulating along its normal route, spreads kidney is regarded as the congenital
to the exterior-and results in yellow sclera foundation of life. Pathological changes of
and skin of the entire body. The presence of the kidney most often manifest as
damp heat induces the qi to stagnate and dysfunction in storing essence, disturbance
fever may appear. Since the Liver Meridian in water metabolism, abnormality in
curves around the external genitalia, growth, development and reproduction.
downward infusion of damp heat along the The physiological function of the bladder
Liver Meridian may produce eczema of the ' is to store and discharge urine. So
scrotum, or swelling and pain of the testes; pathological changes of the bladder chiefly
and h ' w o a z z , pruit.L;s vz!vze and ye!!nw mznifest as abnormal urination.
-
foul leukorrhea may result. I) Deficiency of the Kidney qi
%

The pathological changes of the liver Clinical manifestations: Soreness and

cover a wide range. Since the liver and weakness of the lumbar region and knee
gallbladder are externally and internally joints, frequent urination with clear urine,
relatea, disorders of the liver may affect the dribbling of urine after urination or
gallblhdder, and vice versa. The two organs enuresis; incontinence of urine in severe
4'
may thus be diseased at the same time. cases; spermatorrhea and premature
Principally needling is applied to treat their ejaculation in men; clear, cold leukorrhea in
disorders. Points of the Liver Meridian of women; a pale tongue with white coating
Foot-Jueyin and Gallbladder Meridian of and a thready, weak pulse.
Foot-Shaoyang are often used, accom- Etiology and pathology: This syndrome
panied by relevant points of the Spleen, may be due to weakness of the kidney qi in
Stomach, Kidney, Ren (Conception Vessel) old age or insufficiency of the kidney qi in
and Du (Governor Vessel) Meridians childhood. It may also result from over-
according to symptoms and signs. strain and stress, or prolonged illnesses,
Reducing method is used for syndromes both of which may lead to weakness of the
of excess type; reinforcing method for kidney qi. As the kidney resides in the
syndromes of deficiency type; even- . lumbar region, when the kidney qi is
movement method for syndromes com- deficient, it may fail to nourish this areti and
plicated between deficiency and excess or give rise to soreness and weakness of the
syndromes of deficiency of the root cause lumbar region and knee joints. Weakness of
with excess of manifestations. the kidney qi implies an inability of the
Chapter 13 Differentiation of Syndromes

bladder to control.urination, hence frequent Etiology and pathology: (This syndrome

urination with clear urine, dribbling after may be d-ae to a prolonged illness, or to
urination, enuresis and incontinence of excessive sexual activity. It may also occur in
urine. Deficiency of the kidney qi weakens the late stage of febrile diseases. In these
its function of storage, and thus cases the kidney yin is consunkd. Deficiency
spermatorrhea, premature ejaculation, and of the kidney yin weakens the kidney in its
clear, cold leukorrhea result. A pale tongue function of producing marrow, dominating
with white coating and a thready, weak pulse bones and nourishing the brain; the result is
are both signs of deficiency of the kidney qi. dizziness, tinnitus, poor memory, soreness
2) I[nsufficiency of the kidney yang and weakness of the lumbar region and knee
Clinical manifestations: Pallor, cold limbs, joints. Deficiency of yin produces endogen-
soreness and weakness of the lumbar region ous heat, hence afternoon fever, malar flush,
and knee joints, imp0tence, infertility, night sweating, dryness of the mouth, yellow
dizziness, tinnitus, a pale tongue with white urine and constipation. Disturbance in the
coating and a deep, weak pulse. interior by heat of the deficiency type is the
Etiology and pathology: This syndrome cause of nocturnal emission. Disturbance of
may be due to a constitutional deficiency of the mind by heat leads to insomnia. A red
yang, or weakness of the kidney in old age. It tongue with little coating and a thready,
may also be due to a prolonged illness, or to rapid pulse are both signs df deficiency of yin
excessive sexual activity, both of which may leading to endogenous heat.
injure the kidney and produce deficiency of 4) Damp heat in the bladder Clinical
the kidney yang. In yang deficiency, the manifestations: Frequency and urgency of
warming function of yang is impaired, hence urination, burning pain in the urethra,
cold limbs and pallor. Deficiency of the dribbling urination or discontinuation of
kidney yang deprives the bones, ears, brain, urination in mid-stream; turbid urine, deep-
marrow of nourishment and may cause yellow in colour, hematmria; or stones in the
soreness of the lumbar region and weakness urine; possible lower abdominal distension -

of the knee joints, dizziness and tinnitus. and fullness or lumbago; a yellow, sticky
When the kidney yang is insufficient, the tongue coating and a rapid pulse.
reproductive function is impaired with Etiology and pathology: This syndrome
impotence in men, and infertility (due to may be due to invasion of exogenous
cold uterus) in women resulting. A pale pathogenic damp-heat which accumulates in
tongue with white coating and a deep, weak the bladder. It may also result from excessive
pulse are both signs of insufficiency of the eating of hot, greasy and sweet food, lead-
kidney yang. ing to downward infusion of damp heat
3) Insufficiency of the kidney yin Clinical to the bladder. Accumulation of damp heat
manifestations: Dizziness, tinnitus, insom- impairs the function of the bladder, resulting
nia, poor memory, soreness and weakness of in frequency and urgency of urination,
the lumbar region and knee joints, nocturnal burning pain in the urethra, dribbling
emission, dryness of the mouth, afternoon urination and yellow urine. Condensed by
fever, malar flush, night sweating, yellow heat, the impurities in the urine form stones,
urine, constipation, a red tongue with little which cause sudden discontinuation of
coating and a thready, rapid pulse. urination in mid-stream, turbid urine or
 Chinese Acupuncture and Moxibustion

stones in the urine. Damp heat may injure plicated syndromes of the zang-fu organs are
the vessels and thus hematuria occurs. described as fol.lows.
Blockage of the bladder is the cause of lower 1) Disharmony between the heart and
abdominal distension and fullness. Since a ikidnaey Clinical manifestation:Mental rest-
disorder of a fu organ may affect its lessness, insomnia, palpitations, poor
corresponding zang organ, lumbago memory, dizziness, tinnitus, dryness of the
appears. A yellow, stick j; tzlrgrre coating and threzt, E G T C ~ ~ S E~f the humbar region,
a rapid pulse are both signs of accumulation spermatorrhea in dreams, tidal fever, night
of damp heat in the interior. sweating, a red tongue with little coating and
When the kidney yin and kidney yang are a thready, rapid pulse.
properly stored and kept from leaking, the Etiology and pathology: The syndrome is
kidney functions effectively. Syndromes of often due to prolonged illnesses, overstrain
the kidney are mostly of deficiency type; and and stress, or excessive sexual activity, all of
this is reflected in treatment. The Back-Shu which may injure the yin of the heart and
Point of the kidney and points s f the Ren kidney. It may also result from drastic
and u Meridians and the Meridian of emotional changes leading to obstruction of
Foot-Shaoyin are mainly selected. Points of qi which turns into fire. The heart fire may
the Spleen Meridian sf Foot-Taiyin, become hyperactive in the upper part of the
Stomach Meridian of Foot-Yangrning, body and fail to infuse downwards to
Liver Meridian of Foot-Jueyin and Lung harmonize the kidney. The resulting
i d cf Ez~d-Tziiyi1n are used in imbalance between the heart and kidney
combination. Moxibustion and reinforcing disturbs the regulation of water and fire.
needling technique are applied for deficiency When the kidney yin is insufficient, it may
of yang qi. Only needling with reinforcing or fail to rise up to hakmonize the heart. The
even-movement technique is applied for resulting hyperactivity of the heart fire may
deficiency of yin. Since the syndromes of the disturb the mind and manifest as mental
bladder often involve the kidney, the two restlessness, insomnia and palpitations.
organs are often treated at the same time. Consumption of the kidney essence leads to
The Back-Shu Point and Front-Mu Point of emptiness of the sea of marrow and
the bladder and points of the Ren Meridian, produces dizziness, tinnitus and poor
the Kidney Meridian of Foot-Shaoyin and memory. Undernourishment of the lumbar
Spleen Meridian of Foot-Taiyin are needlea region causes soreness of the back.
with even-movement or reducing method. Disharmony between the heart and kidney
leads to disturbance of deficiency type fire
and produces weakness in controlling the -
release of sperm with the symptom of
Comp~eatedSyndromes of Zamg-Fu spermatorrhea in dreams. A dry throat, tidal
Organs fever, night sweating, a red tongue with little
coating and a thready, rapid pulse are all
Syndromes in which two organs or more signs of deficiency of yin leading to
are diseased at the same time, or in hyperactivity of fire.
succession, are known as "complicated 2) Deficiency of the qi of the lung and
syndromes." The commonly seen com- Mdney Clinical manifestations: Asthmatic
Chapter 13 Differentiation of Syndromes

breathing, shortness of breath, and more Etiology and pathology: This syndrome is
exhalation than inhalation, all of which often due to prolonged cough which injures
become worse on exertion; low voice, cold the lung, giving rise to insufficiency of the
limbs, blue complexion, spontaneous yin fluid, which spreads from the lung to the
sweating, incontinence of urine due to severe kidney. It may also result from overstrain
cough; a pale tongue with thin coating and a and stress, which consumes the kidney yin
weak pulse of deficiency type. and thus prevents the kidney yin from
Etiology and pathology: This syndrome is nourishing the lung. In either case,
often due to prolonged cough which affects deficiency of the yin of both organs results.
the lung and kidney in succession, resulting Insufficiency of the lung yin deprives the
in deficiency of qi of both organs. It may also lung of moisture, resulting in cough with a
be due to overstrain and stress which,injures small amount of sputum and dryness of the
the kidney qi and impairs the kidney's mouth and throat. Deficiency. of yin
function of receiving qi. The lung controls produces endogenous heat eliciting tidal
respiration and the kidney dominates the fever, rnalar flush and night sweating. Injury
reception of qi. "The lung is the commander of the lung vessels by deficiency type heat
of qi and the kidney is the root of qi." With may produce blood-tinged sputum. Insuf-
deficiency of the qi of the lung and kidney, ficiency of the kidney yin brings on soreness
there may be asthmatic breathing, shortness and weakness of the lumbar region and knee
of breath, and more exhalation than joints, and nocturnal emission. A red tongue
inhalation, a11 of which become worse on with little coating and a thready, rapid pulse
exertion. Deficiency of the lung leads to are both signs of deficiency of yin producing
weakness of zong (pectoral) qi, causing low endogenous heat.
voice. Yang qi, being deficient, fails to warm 4) Deficie~racyof the yia of the liver and
up the exterior, resulting in cold limbs and a kidwgy Clinical manifestations: Dizziness,
blue complexion. Deficiency of qi may cause blurring of vision, dryness of the throat,
weakness of wei (defensive) yang, which tinnitus; heat sensation in the chest, plams
explains spontaneous sweating. Weakness and soles; soreness and weakness of the
of the kidney qi may impair the function of lumbar region and knee joints; rnalar flush,
the bladder in controlling urine, inconti- night sweating; nocturnal emission; scanty
nence of urine in coughing appears. A pale menstrual flow; a red tongue with little
tongue with thin coating and a weak pulse of coating and a thready, rapid pulse.
deficiency type are both signs of deficiency Etiology and pathology: This syndrome is
of yang qi. often due to drastic emotional changes and
3) Deficiency of the yin of the brag and overstrain and stress which injure yin blood;
kidney Clinical manifestations: Cough or to a prolonged illness which consumes the .
with a small amount of sputum, or with yin of the liver and kidney. Deficiency of the
blood-tinged sputum; dryness of the mouth yin of the liver and kidney deprives the head
and throat; soreness and weakness of the and eyes of nourishment and thus produces
lumbar region and knee joints; tidal fever, dizziness, blurring of vision and tinnitus.
malar flush, night sweating, nocturnal Deficiency of yin produces endogenous heat
emission; a red tongue with little coating and and thus results in heat sensation in the
a thready, rapid pulse. chest, palms and soles, malar flush, night
 Chinese Acupuncture and Moxibustion

sweating, dryness of the throat, a red tongue severe cases, facial puffiness and edema of
with little coating and a thready, rapid pulse. the feet; a pale tongue with white coating
Disturbance by deficiency type fire in the Etiology and pathology: This syndrome is
interior causes raocturnal emission. Defi- often due to prolonged cough which may
ciency of the yin of the liver and kidney leads cause deficiency of the lung and later affect
to a disturbance of the regulation of the the spleen; or the deficiency of the spleen
Chong znd Wen Meridia~s,hence the ccaaaty which weakens the source of the lung qi.
menstrual flow. Deficiency of qi implies hypofunction of
5) Deficiency of the yang of the spleen and zang-fu organs; that is the reason for general
kidney Clinical manifestations: Pallor, lassitude. Deficiency of qi does not allow
cold limbs; soreness and weakness of the normal distribution of body fluid, the
lumbar region and knee joints; loose stools accumulation of which forms phlegm damp.
or diarrhoea at dawn; facial puffiness and The retention of phlegm damp in the lung
edema of the limbs; a pale swollen delic; + impairs the lung's function in descending
tongue with thin white coating and a deep and thus produces cough with profuse,
weak pulse. dilute and white sputum. Dysfunction of the
Etiology and pathology: This syndrome is spleen in transportation manifests as poor
often due to a prolonged illness which appetite and loose stools. Deficiency of both
consumes qi and injures yang, the disease the lung and spleen impairs the function of
spreading from the spleen to the kidney. It qi in circulating fluid, resulting in
may also result from deficiency of the kidney accumulation of harmful water and damp
yang with the spleen yang failing to be and producing facial puffiness and edema of
warmed and thus producing injury of the feet. A pale tongue with white coating and a
yang qi of both organs. Dysfunction of the- weak pulse are both signs of deficiency of qi.
yang of the spleen and kidney in providing 7) Imbalance between the e and
warmth causes pallor, cold limbs and spleen Clinical manifestations: Distension,
soreness and weakness of the lumbar region fullness and pain in the costal and
and knee joints. Insufficiency of yang qi does hypochondriac regions; mental depression
not allow normal digestion, transportation or irritability; poor appetite, abdominal
and transformation of food; the result is distension, loose stools; a thin tongue
loose stools or diarrhoea at dawn. coating and a string-taut pulse.
Deficiency of yang qi implies inability to Etiology and pathology: This syndrome is
transport and transform body fluid; the often due to injury of the liver by mental
result is accumulation of harmful water and depression or irritation, or to injury of the
damp on the body surface, which manifests spleen by irregular food intake or overstrain
as facial puffiness and edema of the limbs. A and stress. In both cases, the liver qi invades
pale swollen and delicate tongue with thin the spleen transversely, resulting in an
white coating and a deep, weak pulse are imbalance between the two organs.
both signs of deficiency of yang. Dysfunction of the liver in promoting the
6) Deficiency of the qi of the long a d free flow of qi produces distension, fullness
spleen Clinical manifestations: General and pain in the costal and hypochondriac
lassitude; cough with profuse, dilute, white regions, mental depression or irritability.
sputum; poor appetite, loose stools; in Invasion of the spleen by the liver qi impairs
 Chapter 13 Differentiation of Syndromes

the spleen's function of transportation; poor blood is consumed and the spleen qi is
appetite, abdominal distension 'and loose weakened. On the other hand, a weakness of
stools result. A string-taut pulseis a sign of the spleen qi may fail to provide a source for
- liver disorders. the production of qi and blood, and thus
8) Disharmony between the liver amd make the heart blood even more defi&ient.
stomach Clinical manifestations: Disten- Deficiency of qi and blood causes sallow
sion and pain in the costal, hypochondriac complexion, general lassitude, a pale tongue
and epigastric regions; belching, acid with thin, white coating and a thready, weak
regurgitation, an empty and uncomfortable pulse. Deficiency of the heart blood deprives
sensation in the stomach; mental depression the heart and mind of nourishment, eliciting
or irritability; a thin tongue coating and a palpitations, poor memory, insomnia and
string-taut pulse. dream-disturbed sleep. When deficiency of
Etiology and pathology: This syndrome is the spleen impairs its function of
often due to injury of the liver by mental transportation, there may be reduced
depression or irritation, and injury of the appetite, abdominal distension and loose
stomach by irregular food intake or stools. Deficiency of qi and blood may
overstrain . and stress. The resulting weaken the Chong Meridian, and manifest
, hyperactivity of the liver and weakness of as .scanty menstrual flow or even
the stomach, therefore, leads to disharmony amenorrhea. Weakness of the spleen qi
between the liver and stomach. Dysfunction implies inability of the spleen in controlling
of the liver in promoting the free flow of qi blood, and thus results in profuse menstrual
produces mental depression or irritability, flow.
and distension, fullness and gain in the 88) Imvasion of the g by the liver
costal and hypochondriac regions. Invasion fire Clinical manifestations: Burning pain
of the stomach by the liver qi impairs the in the coital and hypochondriac regions;
descending function of the stomach, paroxysmal cough or even hemoptysis in
manifesting as distension and pain in the severe cases; quick temper, irritability,
epigastric region, belching, acid regurgita- restlessness, heat sensation in the chest,
tion . and an empty and uncomfortable bitter taste in the mouth; dizziness, red eyes;
sensation in the stomach. A string-taut pulse a red tongue with thin yellow coating and a
is a sign of disorders of the liver. string-taut, rapid pulse.
9 Deficiency sf both the heart amd 'Etiology and pathology: This syndrome is
spleen Clinical manifestations: Sallow often due to mental depression leading to
complexion, general lassitude, palpitations, obstruction of the liver qi which turns into
poor memory, insomnia, dream-disturbed fire. The upward invasion of the lung by the
sleep, reduced appetite, abdominal disten- liver fire results in this syndrome.
sion, loose stools; irregular menstruati on in Obstruction of qi turns into hyperactive fire
women; a pale tongue with thin, white and impairs the liver's function in
coating and a thready weak pulse. promoting the free flow of qi, manifesting as
Etiology and pathology: This syndrome 'burning pain in the costal and hypo-
may be due to poor recuperation after an chondriac regions, quick temper and
illness; chronic hemorrhage; or worry, irritability. Upward invasion of the lung by
overstrain and stress. In any case, the heart the liver qi and fire impairs the lung's
 Chinese Acupuncture and Moxibustion

descending function, leading to paroxysmal often accompanied by symptoms and signs

cough. Injury of the vessels of the lung by of these two organs. The main clinical
fire and heat creates hemoptysis. Flaring up manifestations are severe aversion to cold,
of the liver fire gives rise to restlessness, heat mild fever or absence of fever, a heavy
sensation in the chest, bitter taste in the sensation in the head as if it were tightly
mouth, dizziness and red eyes. A red tongue wrapped by a cloth, heaviness of the limbs
---ILL -
W l L l l LlU11, I)'CllUW
n
~ U ~
o9 ~ cfr;rPm-tqrat,
L LUIIU
d b '"""
L A u~. r r~i n s a d frttnk, a stifling sensation in the chest,
rapid pulse are both signs of hyperactivity of absence of thirst, dull facial expression,
the liver fire in the interior. epigastric fullness and distension, poor
appetite, borborygmus, loose stools, a
Appendix: Differentiation of syndromes white, sticky tongue coating and a soft,
according to the theory of sarsjieo. slowing-down pulse.
T h s syndrome is often due to invasion of
Differentiation of syndromes according pathogenic damp which remains in the
to the theory sf samjiao. muscles and body surface, and blocks the
This method of differentiation is based spleen qi internally. Invasion of the muscles
upon the method of differentiating and body surface by pathogenic damp
syndromes according to the theory of wei, hinders wei yang, resulting in severe
qi, ying and xue in conjunction with the aversion to cold, although accumulation of
principles governing transmission and damp Pleat may also lead to fever. Heaviness
t r z ~ s f e ~ ~ t inf
o racute
r febrile diseases. of the head as if it were tightly wrapped by a
Acute febrile diseases result from the cloth is found when damp is lodged in the
invasion of different febrile pathogens in the head. Retention of damp in the muscles and
four seasons of a year. There are various body surface causes haviness of the limbs
types of acute febrile diseases with different and trunk. Obstruction by d a n p of yang qi
features, for the invading pathogenic factors in the chest produces a stifling sensation in
in the four seasons are different and the the chest. Since excessive damp does not
patients' constitutional reaction to these consume body fluids, no thirst appears. The
pathogenic factors varies. So far as the turbid damp clouding the clear yang gives
nature of the disease is concerned, there are rise to dull facial expression. Retention of
two categories, namely, febrile pathogens, damp in the spleen and stomach impairs
and damp heat. Pathological changes their functions of reception, digestion,
resulting from febrile pathogens are transportation and transformation, mani-
analysed with the theory of wei, qi, ying and festing as epigastric fullness and distension,
xue, while the differentiation of pathological poor appetite, borborygmus and loose
changes due to damp heat is described stools. As this is still at the early stage of the
below. disease, damp has not yet turned into heat.
1 Damp beat in the upper jiao Damp Damp obstructing qi circulation produces a
heat in the upper jiao is the early stage of sticky white tongue coating and a soft,
invasion of the organism by damp heat. The slowing-down pulse.
disease is often located in the lung, skin and If damp has not turned into heat, the
hair. As damp is closely related to the spleen method of treatment is to warm and disperse
and stomach, damp heat in the upper jiao is damp on the exterior and in the interior. If
Chapter 13 Differentiation of Syndromes

heat signs are already pronounced, the causes retardation of qi circulation and
method of treatment is to disperse heat and hence dysfunction in ascending and
resolve damp. In acupuncture treatment, descending.This results in distension and
points are mainly selected from the fullness in the chest and epigastrium,
Uangming Meridians of Hand and Foot and nausea, vomiting and anorexia. Heat
the Taiyin Meridians of Hand and Foot consumes body fluid, but as damp
according to symptoms and signs. , dominates over heat, there is a thirst with
2) Damp heat in the middle jiao Damp desire to drink only a little. Retention of
heat in the middle jiao is the middle stage of damp heat in the middle jiao impairs the
a damp heat disease, which exhibits mainly spleen's function in transportation. This
symptoms and signs of invasion of the spleen aspect of retardation of qi circulation is
and stomach by damp. Obstruction of the evidenced in the scanty and deep-yellow
middle jiao may affect both the upper and urine and the loose but hesitant stools.
.
lower jiao, thus manifesting as fever which is Obstruction of theclear cavity by damp heat
indistinct at the first touch of the skin, but gives rise to a dull facial expression with few
becomes pronounced after being felt for a words said, or mental cloudiness, the sticky
rather long time; or fever which recurs after white tongue coating with a yellow tinge and
reduced by sweating; or fever which is more the soft, rapid pulse are both signs of damp
pronounced in the afternoon. In addition heat.
there may be heaviness of the limbs and The method of treatment is to clear off
trunk, distension and fullness in the chest heat, resolve damp and promote the smooth
and epigastrium, nausea, vomiting, anorex- circulation of qi. In acupuncture treatment,
ia, thirst with desire to drink only a little, the main points are selected from the Spleen
scanty and deep-yellow urine, losse but Meridian of Foot-Taiyin a i d the Stomach
hesitant stools; and in severe cases, dull Meridian of Foot-Yangming.
facial expression with few words said or 3) Damp heat in the Bower @;asDamp heat
mental cloudiness; a sticky white tongue lodged in the lower jiao mainly affects the
coating with a yellow tinge and a soft, rapid large intestine and bladder and hence
pulse. manifests as abnormal urination and
This syndrome may result from defecation. The symptoms and signs are
transmission of damp heat in the upper jiao, retention of urine, thirst with desire to drink
or from invasion of pathogenic summer heat only a little, constipation, hardness and
and damp. In either case the spleen and fullness in the lower abdomen, a sticky
stomach are injured. It may also be due to yellow or white tongue coating and a soft
improper diet which produces damp heat. rapid pulse.
Excessive damp heat with heat wrapped in Damp heat retained in the bladder
damp gives rise to fever which is indistinct at impairs its function of controlling urine, this
the first touch of the skin, and becomes explains retention of urine. Accumulation of
pronounced after being felt for a rather long damp in the lower jiao prevents body fluid
time; and to fever which is worse in the from rising and a thirst with desire to drink
afternoon. Damp heat is lingering and only small quantities ensues. Damp retained
difficult to be resolved, this is the cause of in the large intestine impairs its function of
recurrent fever. Retention of damp heat transmission, blocking the qi of the fu organ
 Chinese Acupuncture and Moxibustion

and causing constipation and hardness and the twelve meridians are described as
fullness in the lower abdomen. The sticky follows.
yellow or white tongue coating and the soft, a) The Lung Meridian of Hand-Taiyin
rapid pulse are both signs of damp heat. Cough, asthmatic breathing, hemoptysis,
The method of treatment is to cond~lctthe congested and sore throat, a sensation of
turbid downwards and relieve accumula- fullness in the chest; pain in the
--
LIVll.
T- - --=-----+x,-a
abUpUllbLUlb
+ran+-au.+
LlbULbldULLL9
r.r\;t?tc
y U l A l L U
9rp
U LW s ~ p r ~ r i z v i r ~fassaj
i z ~ . shoulderj back and
mainly selected from the Ren Meridian, anterior border of the medial aspect of the
Bladder, Spleen and Stomach Meridians. am.
b) The Large Intestine Meridian of Hand-
Yangming Epistaxis, watery nasal dis-
charge, toothache, congested and sore
IV, DIFFERENTIATION OF throat; pain in the neck, anterior part of the
shoulder and anterior border of the lateral
SYNDROMES ACCORDING TO aspect of the upper limb; borborygmus,
THE THEORY OF MERIDIANS abdominal pain, diarrhea and dysentery.
AJYD COLLATERAL$ c ) The Stomach Meridian of Foot-
Yangpning Borborygrnus, abdominal dis-
This method uses the theory of meridians tension, edema, epigastric pain, vomiting,
and collaterals* to identify pathological 'hunger, epistaxis, deviation of the mouth,
chzages accnrding ?B the arem traversed by congested and sore throat; pain in the chest,
them and according to their related zang-fu abdomen and lateral aspect of the lower
organs. As meridians are the main pathways limbs; fever and mania.
in the system, their pathological manifesta- d) The Spleen Meridian of Foot-
tions may be used as primary evidence in Taiyin Belching, vomiting, epigastric pain,
making differentiation. abdominal distension, loose stools, jaun-
dice, heaviness of the body, lassitude,
stiffness and pain in the root of the tongue,
swelling and coldness in the medial aspect of
1. Pathological Manifestations of the the thigh and knee.
Twelve Meridians e ) The Heart Meridian of Hand-Shaoyin
Cardiac pain, palpitations, hypochondriac
As each of the twe1;ve meridians is pain, insomnia, night sweating, dryness of
identified by its specific pathway and its the throat, thirst, pain in the medial aspect of
relation with the specific zang-fu organ, the the upper arm and heat sensation in the
pathological manifestations of disorders of palms.
the twelve meridians may be grouped under ) The Smckll Intestine Meridian of Hand-
two headings: Tckiyang Deafness, yellow sclera, sore
Dysfunction of the zang-fu organ to throat, swelling of the cheeks, distension and
which the diseased meridian is related. pain in the lower abdomen and pain in the
Disorders of the area supplied by the posterior border of the lateral aspect of the
meridian. shoulder and a m .
Hence, the pathological manifestations of g ) The Bladder Meridian of Foot-
Chapter 13 Differentiation of Syndromes
Taiyang Retention of urine, enuresis,
manic and depressive mental disorders, 2. Pathological Manifestations of the
malaria, pain of the eyes, lacrimation when Eight Extra Meridians
exposed to wind, nasal obstruction,
rhinorrhea, epistaxis, headache; and pain in The eight extra meridians function to
the nape, back, low back, buttocks and strengthen the relationship between the
posterior aspect of the lower limbs. twelve regular meridians and regulate their
h ) The Kidney Meridian of Foot- qi and blood. They are closely related to the
Shaoyin Enuresis, frequent urination, liver and kidney as well as the extra ordinary .
nocturnal emission, impotence, irregular organs such as the uterus, brain and
menstruation, asthmatic breathing, hernop- marrow. On the basis of their physiological
tysis, dryness of the tongue, congested a d functions and the areas they traverse, the
sore throat, edema, pain in the lumbar pathological manifestations of the eight
region and in the posteriomedial aspect of extra meridians are briefly described below.
the thigh, weakness of the lower limbs and a) The Du (Governor Vessel) Meridian
heat sensation in the soles. Stiffness and pain in the spinal column,
i ) The Pericardium Meridian of Hand- opisthotonos, headache and epilepsy.
Jueyin Cardiac pain, palpitations, mental 6) The Ren (Conception Vessel)
restlessness, stuffiness in the chest, flushed Meridian Eeukorrhea, irregular henstru-
face, swelling in the axilla, depressive and ation, infertility in both women and men,
manic mental disorders, spasm of the upper hernia, nocturnal emission, enuresis,
limbs and heat sensation in the palms. retention of urine, 6ain in the epigastric
jl The Sanjiao (Triple Energizer) region and lower abdomen, and pain in the
Meridian of Hand-Shaoyang Abdominal genital region.
distension, edema, enuresis, dysuria, c) The Chong Meridian Spasm and
deafness, tinnitus, pain in the outer canthus, pain in the abdomen, irregular menstru-
swelling of the cheeks, congested and sore ation, infertility in both women and men,
throat; and pain in the retroauricular region, and asthmatic breathing.
shoulder, and lateral aspect of the arm and d) The Dai Meridian Distension and
elbow. fullness in the abdomen, weakness of the
k) The Gallbladder Meridian of Foot- lumbar region, leukorrhea, prolapse of the
Shaoyang Headache, pain in the outer uterus; and muscular atrophy, weakness and
canthus, pain in the jaw, blurring of vision, motor impairment of the lower limbs.
bitter taste in the mouth, swelling and pain e) The Yangqiao Meridian Epilepsy,
in the supraclavicular fossa, pain in the insomnia, redness and pain in the inner
axilla; and pain along the lateral aspect of canthus, pain in the back and lumbar region,
the chest, hypochondrium, thigh and lower eversion of the foot and spasm of the lower
limbs. limbs.
I ) The Liver Meridian of Foot-Jueyin df)The Yimqiao Meridian Epilepsy,
Low back pain, fullness in the chest, pain lethargy, pain in the lower abdomen; pain in
in the lower abdomen, hernia, vertical the lumbar and hip regions referring to the
headache, dryness of the throat, hiccups, public region; spasm of the lower limbs and
enuresis, dysuria and mental disturbance. inversion of the foot.
312 Chinese Acupuncture and Moxibustion

g) The Yangwei Meridian Exterior g ) The Collateral of Foot- Yangming

syndromes such as chills and fever. Depressive and manic mental disorders,
h) The Yinwei Meridian Interior syn- muscular atrophy and weakness in the lower
dromes such as chest pain, cardiac pain and leg, congested and sore throat, and sudden
stomachache. hoarseness of voice.
h) The Collateral of Foot-Taiyang
Xzsa! obstructdon, watery nasal discharge, ,
3. Pathological Manifestations of the headache, pain in the back and epistaxis.
Fifteen Colllaterals i) The Collateral of Foot-Shaoyang
Coldness in the foot, paralysis of the lower
Each of the fourteen meridians (i.e. the limbs and inability to stand erect.
twelve regular meridians, the Ren Meridian j) The Collateral of Foot-Taiyin
and Du Meridian, has a collateral, and in Abdominal spasm, and cholera with
addition there is the Major Collateral of the vomiting and diarrhoea.
spleen. They branch off from their respective k) The Collateral of Foot-Shaoyin
meridians on the four extremities and Retention of urine, lumbago, mental
circulate over the body surface. They restlessness and stifling sensation in the
function to strengthen the relation between chest.
each pair of externally and internally related 1) The Collateral of Foot-Jueyin
meridians and transport qi and blood to Priapism, pruritus in the public region,
various iisszzs and srgms ~f the h ~ ~ 2 swelling
2 of the testes .and hernia.
body. Supplementary to the pathological rn)The Collateral of Ren Meridian
manifestations of the meridians, the Distending pain and pruritus of abdominal
pathological manifestations of the col- skin tissues.
laterals are listed below. n) The Collateral of the Du Meridian
a ) The Collateral of Hand-Taiyin Heat Stiffness of the spinal column, a heavy
sensations in the wrist and palm, shortness sensation in the head, and tremor of the
of breath, enuresis and frequent urination. head.
b) The Collateral of Hand-Shaoyin o ) The Major Collateral of the Spleen
Fullness in the chest and diaphragm -and General aching, and weakness of the joints
aphasia. of the four limbs.
c ) The Collateral of Hand-Jueyin
Cardiac pain and mental restlessness.
d ) The Collateral of Wand-Yangming
Toothache, deafness, a cold sensation in the Appendix: Differentiation of syndromes
teeth, and a stifling sensation in the chest
according to the theory of the six
and diaphragm. meridians
e ) The Collateral of Hand-Taiyang
Weakness of joints, muscular atrophy and Differentiation of syndromes according
motor impairment of the elbow, and warts to the theory of the six meridians and
on the skin. subsequent determination of treatment
f ) The Collateral of Hand-Shaoyang belong to the theoretical system expounded
Spastic or flaccid cubital joint. in the book On Febrile Diseases Due to
Chapter 13 Differentiation of Syndromes

Invasion of Cold. It represents the water and dysuria may appear. The
development and application of the theory downward transmission of dryness and heat
of meridians and collaterals from The of the stomach, the fu of Yangming, may
I~zternalClassic. This method is mainly used lead to symptoms and signs of the
in the differentiation of exogenous diseases. gastrointestinal tract such as constipation,
h e pathological manifestations of these and abdominal pain which is aggravated by
exogenous diseases at different stages of pressure. Pathogenic invasion of the
development are classified into six gallbladder, the fu of Shaoyang, may give
syndromes according to their character- rise to a bitter taste in the mouth and
istics. These are Taiyang, Yangming and hypochondriac pain. Similarly, differenti-
Shabyang syndromes, and Taiyin, Shaoyin ation of the three yin syndromes is based
and Jueyin syndromes. The former three are upon pathological changes of the five zang
known as the three yang syndromes, while organs. Examples are deficiency of the
the latter three are referred to as the three yin spleen yang in Taiyin syndrome, deficiency
syndromes. of the heart and kidney is Shaoyin syndrome
Differentiation of syndromes according and disturbance of the liver qi in Jueyin
to the theory of six meridians is closely syndrome. Thus, it can be seen that
related to the meridians and zang-fw organs. differentiation of syndromes according to
In terms of the meridians, the Taiyang, the theory of the six meridians reflects
Yangming and Shaoyang Meridians traverse pathological changes of the meridians and
the posterior, anterior and lateral aspects of zang-fu organs. Integral to this method of
the body respectively. Consequently differentiation is the analysis of the stages of
Taiyang syndrome may exhibit neck rigidity pathological development, including rules
and pain in the posterior aspect of the head governing the transmission and transform-
and neck; Yangming syndrome may ation of diseases that result from the
manifest as flushed face, and fullness and invasion of exogenous pathogenic cold. Hn
pain in the abdomen; and in Shaoyang this context it cannot be equated with
syndrome, fullness and distension in the differentiation of syndromes according to
costal and hypochondriac regions are the theories of meridians and collateral-s,
present. As for the three yin syndromes, the and zang-fu organs.
abdominal pain and diarrhoea of Taiyin Differentiating syndromes according to
syndrome, the dryness of the mouth and the six meridians entails making an analysis
throat of Shaoyin syndrome, and the pain and synthesis of various pathological
and heat sensation in the heart, and vertical manifestations of exogenous diseases and
pain of Jueyin syndrome all relate to areas their development in terms of the strength of
the three yin meridians traverse. When resistance to the disease, the virulence of the
correlated to the zang-fu organs, the three pathogenic factors and the depth of disease.
yang syndromes identify pathological In this way, the pathology is determined,
changes of the six fu organs. The bladder, for which subsequently serves as a guide to
example, is the fu organ of Taiyang. 'When treatment. In the three yang syndromes, the
pathogenic factors are transmitted from the antipathogenic qi is strong and the
meridian to the fu organ, hence affecting the pathogenic factor is hyperactive; the disease
function of the bladder, retention of harmful tends to be active, manifesting syndromes of
 Chinese Acupuncture and Moxibustion

heat and excess nature. Treatment is aimed manifests as stiffness and pain of the
at eliminating the pathogenic factors. In the posterior aspect of the head and neck. A
three yin syndromes, the pathogenic factor is superficial pulse appears when the
hyperactive, while resistance to the disease is pathogenic factor invades the muscles and
weak; the disease tends to be inactive body surface, and the antipathogenic qi
manifesting syndromes of cold and moves outwards to resist it. As patients have
deficiency nature. In this case rhe emphasis &ffcrcii~ LVuUr
*ATT ~nficti~-xi+i,-.*~
~"LIULLLULIVLLU the
of the treatment is laid on promoting the invading pathogenic factors may differ in
antipathogenic qi. nature and severity, pathological changes
Although syndromes of the six meridians and clinical manifestations of the Taiyang
differ, they are interrelated. Generally, syndrome will vary. Sweating with a
exogenous diseases develop from the superficial and slowing-down pulse suggests
exterior to the interior. However, there are invasion of Taiyang by wind, while absence
exceptions such as concurrent diseases in of sweating with a superficial and tense pulse
which there is a simultaneous onset of points to invasion of Taiyang by cold.
disease in two or three meridians; Acupuncture treatment is aimed at
overlapping of diseases in which another eiiminating exterior syndromes and promot-
meridiag is affected even before the ing smooth circulation of the qi of the
previously affected meridian has been cured; meridian. Points are selected from the Du
direct invasion of one of the six meridians by Meridian and the Taiyang Meridians of
exogenous pathogenic fzctors; 2nd trans- H ~ n zrzd
d Foot.
mission of diseases between a pair of 2) Shaoya~agsyndrome The Shaoyang
externally and internally related meridians. syndrome is an outcome of the transmission
In order to arrive at a correct diagnosis and and transformation of the Taiyang
hence to obtain the anticipated results from syndrome. The pathogenic factors have
treatment, a good command of the basic and left the exterior represented by Taiyang,
complicated syndromes is required. but yet they have not reached the interior
8 ) Taiyang syndrome The Taiyang syn- represented by Yangming. Since the
drome is an exterior syndrome often seen at pathogenic factors remain between the
the initial stage of exogenous disease. The exterior and interior, the Shaoyang
main pathological manifestations are fever, syndrome is actually an intermediate
aversion to cold, stiffness and pain at the syndrome. Its main pathological manifesta-
posterior aspect of the head and neck, and a tions are alternate chills and fever, fullness in
superficial pulse. the costal and hypochondriac regions,
Taiyang dominates the exterior of the anorexia, mental restlessness, vomiting, a
body, serving as the screen to the six bitter taste in the mouth, dryness of the
meridians. When pathogenic wind cold throat, blurring of vision and a string-taut
invades the body, Taiyang is the first to be pulse.
affected. Hindrance of wei yang from When the pathogenic factor invades
dispersing induces fever and aversion to Shaoyang, it contends with the antipatho-
cold. Injury of the Taiyarig Meridian by genic qi' between the exterior and the
pathogenic factors leads to disorders of the interior. Subsequently, the qi circulatioln is
qi of the meridian, which, by its pathway, hindered and its ascending and descending
Chapter 13, Differentiation of Syndromes

function is impaired. Alternate chills and hyperactivity of endogenous heat, which

fever are the outcome of the struggle results in high fever and flushed face. Heat
between the pathogenic factor and the anti- expells and consumes body fluids, which
pathogenic qi. Pathogenic invasion of the results in profuse sweating, extreme thirst
Shaoyang Meridian specifically leads to and a dry, yellow tongue coating. Excessive
disorders of the qi of the meridian, which, as Yangming heat disturbs the mind, which is
determined by its pathway, manifests as expressed as mental- restlessness and
fullness in the costal and hypochondriac irritability. The strength of both the
regions. Anorexia and vomiting are due to antipathogenic qi and the pathogenic factor
upward disturbance of the stomach qi, when accompanied with vigorous endogenous
the pathogenic factor in Shaoyang has heat causes the superficial and forceful
reached the stomach. Inward disturbance of pulse. The method of treatment is to clear off
Shaoyang fire results in mental restlessness. heat using points of the Yangming
Upward attack of the fire of the gallbladder Meridians of Hand and Foot and the Du
along the Shaoyang Meridian produces a Meridian.
bitter taste in the mouth, dryness of the b) The syndrome of the Yangming fu
throat and blurring of vision. Obstruction of organ exhibits pathological manifestations
the qi of the liver and gallbladder causes such as feverishness of the body which is
string-taut pulse. The method of treatment is more pronounced in the afternoon,
to harmonize Shaoyang by selecting points constipation, fullness and pain in the
from the Shaoyang and Jueyin meridians. abdomen aggravated by pressure, restless-
3) Yangming syndrome The Yangming ness, delirium, a dry yellow tongue coating
syndrome represents a stage of extreme or burnt-yellow coating with thorns on the
struggle between the antipathogenic qi and tongue, and a deep and forceful pulse of
the pathogenic factor. It is an interior heat excess type.
syndrome of excess type. In terms of When the interior heat of Yanganing
location and characteristics of pathological mingles with the dry faeces, the qi of the fu
manifestations, the Yangming syndrome organ is obstructed producing constipation
can be classified into two categories, namely, and a fullness, also pain in the abdomen
syndrome of the Yangming Meridian and which may be aggravated by pressure. The
syndrome of the Br'angming fu organ. accumulation of heat in the interior and
Insubstantial heat spreading all over the flourishing of the qi of the Yangming
body suggests the syndrome of the Meridian in the afternoon combine to
Yangming Meridian; substantial heat exhibit feverishness of the body which is
accumulating in the fu organs indicates the more pronounced in the afternoon. The
syndrome of the Yangming fu organ. upward attack of pathogenic dryness and
a) The main pathological manifestations heat mixed with turbid qi disturbs the mind,
of the syndrome of the Yangming Meridian manifesting as restlessness and delirium. The
are high fever, profuse sweating, extreme . dry yellow tongue coating or burnt-yellow
thirst, flushed face, mental restlessness, a coating with thorns on the tongue, and the
dry, yellow tongue coating and a superficial deep, forceful pulse of excess type are the
and forceful pulse. consequences of consumption of body fluid
Pathogenic invasion of Yangming leads to by excessive heat and accumulation of dry
 Chinese Acupuncture and Moxibustion

faeces in the interior. The method of are used.

purgation is used in the treatment. 5) Sbaoyiw syndrome The Shaoyin syn-
Principally, the Front-Mu Points and Lower drome refers to pathological changes of the
He-Sea Points of the Yangrning Meridians heart and kidney. When Shaoyin is diseased,
of Hand and Foot are selected. Points of the the antipathogenic qi is extremely deficient.
Spleen Meridian of Foot-Taiyin may be That is why the Shaoyin syndrome is
used in conjunction. characterized by systemic weakness. Tn the
4) Taiyin syndrome The Taiyin syn- Shaoyin syndrome, there is hypofunction of
drome refers to a cold syndrome of the heart and kidney, manifesting either as
deficiency type resulting from deficiency of deficiency of yang leading to excess of yin or
the spleen qi and retention of cold dampin deficiency of yin leading to hyperactivity of
the interior. Its . main pathological fire. When yang is deficient and yin is
"

manifestations are abdominal fullness, excessive, the pathogenic factors, influenced

vomiting, poor appetite, diarrhoea, ab- by excessive yin, turn into cold. When yin is
dominal pain which is alleviated with deficient leading to hyperactivity of fire, the
warmth or pressure, absence of thirst, a pale pathogenic factors turn into heat.
tongue with a white coating, and a slow or a ) The cold syndrome of Shaoyin This
slowing-down pulse. syndrome principally exhibits aversion to
This syndrome is often due to cold, lying in' a curled up position,
constitutional deficiency of the spleen yang, listlessness with desire to sleep, cold limbs,
,a:e-nt -
U11LbL 1nvasi912 by pztlhngenic cold or diarrhoea with undigested food, absence of
inappropriate treatment of the three yang thirst or preference for hot drinks, profuse,
syndromes. clear urine, a pale tongue with white coating
Insufficiency of the yang of the middle and a deep, feeble and thready pulse.
jiao implies not only dysfunction of the This syndrome is often due to deficiency
spleen in transportation and transform- of yang of the heart and kidney complicated
ation, hence resulting in retention of cold with direct invasion of Shaoyin by
damp in the interior, but also abnormal exogenous pathogenic cold.
ascent and descent of qi which is the cause of Deficiency of yang implies failure to warm
abdominal fullness and pain, diarrhoea, up the body, the consequences are aversion
vomiting and a poor appetite. As it is acold to cold, lying in a curled up position and cold
syndrome of deficiency type, the abdominal limbs. Furthermore, insufficiency of yang qi
pain can be alleviated by warmth on: leads to listlessness with a desire to sleep.
pressure. This is also the cause of the a6sence Deficiency of yang of Shaoyin deprives the
of thirst, the pale tongue with white coating spleen of warmth, therefore impairing its
and the slow or slowing-down pulse. function in transportation and transform-
The method of treatment is to warm up ation and causing diarrhoea with undigested
the middle jiao and to disperse cold. The food. Deficiency of yang leading to excess of
Back-Shu, Front-Mu and He-Sea Points of cold may also manifest as absence of thirst.
the Spleen Meridian of Foot-Taiyin and the But thirst may appear if yang deficiency of
Stomach Meridian of Foot-Yangming are the lower jiao does not allow upward
selected as well as points from the Ren distribution of body fluids, or if excessive
. Meridian. Both needling and moxibustion diarrhoea consumes body fluids. In either
Chapter 13 Differentiation of Syndromes 3 17

case, the patient prefers hot drinks and does antipathogenic qi is exhausted, and there is
not drink large quantities. Copious, clear derangement of the balance between yin and
urine, a pale tongue with white coating and a yang. Hence this manifests principally as a
deep, and thready pulse are all signs of yang complicated syndrome of cold and heat. The
deficiency resulting in yin excess. main symptoms and signs are emaciation,
The method of treatment is to recover thirst, feeling of a stream of air ascending to
yang and eliminate cold. Points are selected the chest region, a hot and painful sensation
from the Ren Meridian, Kidney Meridian of in the chest, hunger with no desire to eat,
Foot-Shaoyin and Spleen Meridian of Foot- cold limbs, diarrhoea, and vomiting or
Taiyin. Both acupuncture and rnoxibustion vomiting of round worms.
should be used with the emphasis placed on In this syndrome, there is heat in the liver
moxibustion. and gallbladder, and cold and deficiency in
b) The heat syndrome of Shaoyin The the stomach and intestine. The syndrome is
main pathological manifestations are characterized by complication of cold and
mental restlessness, insomnia, dryness of the heat, disturbance of qi and poor
mouth and throat, deep-yellow urine, a red transportation and transformation of food.
or deep-red tongue, and a rapid, thready Consumption of body fluids by pathogenic
pulse. heat induces emaciation and thirst. Upward
This syndrome is often due to persistence movement of yang heat gives rise to a feeling
of pathogenic heat which consumes the of a stream of air ascending and a hot and
kidney yin, or to constitutional deficiency of painful sensation in the chest. Hyperfunc-
yin complicated with pathogenic invasion tion of the liver in promoting the free flow of
which subsequently turns into heat. qi results in hunger. But the stomach and
Deficiency of the kidney yin leads to intestines are cold and deficient which does
hyperactivity of the heart fire and a not allow normal digestion and transmission
disturbance s f the balance between water of food; this explains hunger with no desire
and fire, this explains mental restlessness to eat. Disturbance of qi in the stomach and
and insomnia. As heat consumes the kidney intestines may cause vomiting and
yin, dryness of the mouth and throat, a red diarrhoea. When yang qi fails to reach the
or deep-red tongue ensue. Deficiency of yin four limbs, there will be cold.
and hyperactivity of fire give rise to a rapid, The warming method is combined with
thready pulse. the method of clearing off heat in the
The method of treatment is to nourish yin treatment; the method of simultaneous
and clear off fire. Points are selected from elimination and reinforcement is adopted.
the Heart Meridian of Hand-Shaoyin and Points are selected from the Liver Meridian
Kidney Meridian of Foot-Shaoyin. of Foot-Jueyin, Ren Meridian and
6) Jneyin syndrome Jueyin means that Gallbladder Meridian of Foot-Shaoyang.
yin is on the verge of extinction, while yang is Points of the Spleen Meridian of Foot-
starting to grow, and that there is yang Taiyin are used in conjunction.
within yin. When Jueyin is diseased, the
 Chapter 14
ACUPUNCTURE TECIflVIQUES

Acupuncture is a procedure by which alloy, etc., but most of them are made of
diseases can be prevented and treated stainless steel. A filiform needle may be
through proper insertion of needles into divided into five parts:
points accompanied by different manipu- I) Handle the part webbed with filigree
lations. Today those commonly used are either of copper or stainless steel;
filiform needle, cutaneous needle, intrader- 2) Tail the part at the end of the handle;
ma1 needle, and three-edged needle, in which 3) Tip the sharp point of the needle;
the filifm-m needle is widely and mostly used. 4) Body the part between the handle
In this chapter the following information is and the tip; and
given. 5 ) Root the demarcation line between
ure body a d the handle.
~t

The length and gauge refer to the

dimension of the needle body.
I. PILIFORM NEEDLE The common filiform needles vary in
length and diameter.
1. The Structure and Specification Needles from Nos. 26-32 in diameter and
1-3 cun in length are most frequently used in
The filiform needles are widely used at clinic. The needle tip, in general, should be
present in clinic. It is made of gold, silver, as sharp as a pine needle, the body is round

Table 16. Length

Table 17. Gauge

Chapter 14 Acupuncture Techniques 319

without some strength exerted by the fingers

and conduct manipulations. An appropriate
finger force is the guarantee to minimize the
pain and raise the therapeutic effects. The
training of fingers may start with a short and
thick filiform needle, progressing to a finer
and longer one before clinical application.
1) Practise with sheets of paper Fold
fine and soft tissues into a small packet
about 5 x 8 cm in size and 1 cm in thickness,
then bind the packet with gauze thread.
Hold the paper packet in the left hand and
the needle handle with the right hand. Insert
Fig. 136 the needle into the packet and rotate in and
out clockwise and counter-clockwise. At the
and smooth, flexible and resilient, which is beginning, if you feel the needle stuck or
valued as the best quality. The filiform dificult to rotate, take it easy and continue
needles should be well stored to avoid the exercise until you feel it easy to insert and
damage. The damaged needles may cause rotate the needle. As your finger force grows
discomfort to patient or bring about stronger, the thickness of the paper packet
accidents. The needle tip should be may be increased. (See Fig. 13'9)
preserved with special care by observing the 2) Practise with a cotton cushion Make a
following instructions. cotton cushion of about 5-6 cm. in diameter .
1) Unused needles are suggested to store wrapped in gauze. Hold the cushion with the
in a box with layers of gause or in a tube with left hand and needle handle with the right
dry cotton balls placed at the both ends to hand. Insert the needle into it and practise a
protect the needle tip. rotating lifting and thrusting procedure.
2) On boiling water sterilization, needles
should be bound steadily by gauze in case
the needle tip hits against the wall of an
autoclave.
3) On manipulation, insertion of the
needle should be neither too forceful nor too -
fast to prevent it from getting bent. If the
needle tip touches the bones, the needle
should be withdrawn a little to avoid
bending.

2. Needling Practice

As the filiform needle is fine and flexible, it

is very difficult to insert it into the skin Fig. 137
320 Chinese Acupuncture and Moxibustion

According to the required postures during acupuncture and moxibustion, prolonged

acupuncture and the reinforcing and retaining of the needle, and in prevention of
reducing approach, practise the basic fainting, bent needle, stuck needle or broken
manipulation techniques. This purpose is to needle. The selection of a proper posture is
practise the different manipulations in therefore of importance clinically. Gener-
acupuncture. (See Fig. 1 38) ally, the practitioner must be able to work
'3j prac$ise"n yo-u- owii bedy Tbds may x~;ith=-stbi~dranceand the pstieaat is re!axed
follow the manipulation methods on the and feels comfortable. The commonly-used
paper packet and the cotton cushion so as to postures adopted in the clinic are as follows:
have personal experience of the needling a) Sitting in flexion: suitable for the
sensation in clinical practice. Only by this points on the head, neck and back.
can the practitioner really possess and 6) Sitting erect with elbows resting on a
produce beneficial results in acupuncture table: suitable for the points on the head,
treatment. arm and shoulder. (See Fig. 140)
c) Lateral recumbent: suitable for the
points at the lateral side of the body. ,
3. Preparations Prior to Treatment (See Fig. 141) -
d ) Supine posture: suitable for the
1) Inspection of the instruments Needles of points on the head and face, chest and
various size, trays, forceps, moxe wool, jars, abdominal region. and areas of the four
ski.ilizcd cotton bd!, 75% alsohe! or 1, .5% limbs. (See Fig. 142)
iodine tincture, or 2% gentian violet, etc. e ) Prone posture: suitable for the points
should be carefully inspected and prepared on the head, neck, back, lumbar and buttock
before use. regions, and the posterior region of the
2) Posture of the patient An appropriate lower limbs. (See Fig. 143)
posture of a patient is significant in correct 3) Sterilization:
location of points, manipulation for a ) Needle sterilization:
Autoclave sterilization:
Needles should be sterilized in an
autoclave at 1.5 atmospheric pressure and
125OC for 30 minutes.
Boiling sterilization:
Needles and other instruments are boiled
in water for 30 minutes. This method is easy
and effective without any special equipment.
Medicinal sterilization:
Soak the needles in 75% alcohol from 30-
60 minutes. Then take them out and wipe off
the liquid from the needles with a piece of
dry cloth. At the same time, the needle tray
and forceps which have directly contacted
with the filiform needles should also be
Fig. 138 sterilized in the same way. Besides, needles
Chapter 14 . Acupuncture Techniques

Fig. 140 Setting errect with elbows

Fig. 139 Sitting in flexion resting on a table

Fig. 141 Lateral recumbent

Fig. 142 Supine

Fig. 143 Prone

322 Chinese Acupuncture and Moxibustion

used to treat some infectious cases should be

sterilized and stored in separate place.
b) Skin disinfection:
The area on the body surface selected for
+
needling must be sterilized. Generally,
points on the local area must be sterilized
75y0 or first 2.576 c:.-. ? A A
r cy. 1-r7
and then it is removed by a 70% alcohol
cotton ball. If the disinfected area is function of the right hand." It is further
accidently polluted, a second sterilization is stated in Lyrics of Standard Profoundities
imperative. The practitioner's fingers should that: "Press heavily with the left hand to
be sterilized routinely. disperse qi and insert the needle gently and
slowly to avoid pain." These explanations
show the importance of the coordination of
METHODS
I1 P O X D ~ ~ Q ;: the right -and left hands on insertion.
According to the length of the needle and the
Various needling techniques and location of the point, different methods of
manipulati~iis, which attach importance insertion are employed.
to insertion and withdrawal of the nee- 1) Inserting the needle aided by the
dle, have been summarized by practitioners pressure of the finger of the pressing
based on their experience in the past h a Press beside the acq'-?nc?'-?repnhf
dynasties. with the nail of the thumb or the index finger
of the left hand, hold the needle with the
right hand and keep the needle tip closely
against the nail, and then insert the needle
into the point. This method is suitable for
puncturing with short needles such as for
The needle should be inserted coordi- needling Neiguan (P 61, Zhaohai (K 6), etc.
nately with the help of both hands. The
posture for insertion should be correct so
that the manipulation can be smoothly
done. Generally the needle should be held
with the right hand known as the puncturing
hand. The left hand known as the pressing
hand pushes firmly against the area close to
the point. In the first chapter of Miraculous
Pivot, it says: "Needle must be inserted into
the body with the right hand assisted by the
left hand." In the book Classic on Medical
Problems, it is said that: "An experienced
acupuncturist believes in the important
function of the left hand, while an
Fig. 145
inexperienced believes in the important
Chapter 14 Acupuncture Techniques 323

2) Inserting the needle with the help of the the point is located with the .thumb and
puncturing and pressing hands Hold the index finger of the left hand, hold the needle
needle tip with the thumb and the index with the right hand and insert it into the
finger of the left hand, leaving 0.2-0.3 cm. of point rapidly to a required depth. This
its tip exposed, and hold the needle handle method is suitable for the points on the
with the thumb and index finger of the right abdomen where the skin is loose, such as
hand. As the needle tip is directly over the Tianshu (S 25), Guanyuan (Ren 4), etc.
selected point, insert the needle swiftly into 4) Inserting the needle by pinching the
the skin with the left hand, meanwhile the skin Pinch the skin up around the point
right hand presses the needle downward to with the thumb and index finger of the left
the required depth. This method is suitable hand, insert the needle rapidly into the point
for puncturing with long needles, such as with the right hand. This method is suitable
those used in needling Huantiao (G 30), for puncturing the points on the head and
Zhibian (B 54), etc. face, where the muscle and skin are thin,
3) Inserting the needle ' with the fingers such as Zanzhu (B 2), Dicang (S 4), Yintang
stretching the skin Stretch the skin where (Extra), etc.

Fig. 146 Fig. 147

Fig. 148
324 Chinese Acupuncture and Moxibustion

2. Angle and depth of insertion obliquely to form an angle of approximately .

45' with the skin surface. Points such as
Lieque (L 7) in the upper extremity, Jiuwei
In the process of insertion, angle and (Ren 15) of the abdominal region, Qirnen
depth are especially important in acupunc- (Liv 14) of the chest, and the points on the
ture. Correct angle and depth help to induce back, are often needled in this way.
the needling sensation, bring about the c/ hrOriz"7.jfat kii8 -vt'i2 G s treiis i.'zrsz
desired therapeutic results and guarantee insertion) :
safety. Different angles and depth at the This method is commonly used in the
same point punctured . produce varied areas where the muscle is thin, such as
needling sensation and theapeutic effects. Baihui (Du 20), Touwei (S 8) on the head,
Appropriate angle and depth depends upon Zanzhu (B 2), Yangbai (B 14) on the face,
the location of the points, the therapeutic Tanzhong (Ren 17) on the chest, etc.
purpose, the patient's constitution and the 2) Depth of needle insertion Generally, a
type of figure, fat or thin. proper depth of needling induces better
1) The angle formed by the needle and the needling sensation without hurting the
skin surface Generally, there are three important viscerae. In clinic the depth of
kinds: perpendicular, oblique and insertion mostly depends upon the
horizontal. constitution of the patient, the location of
-
a ) Perpendicular:
rerpendicular, in which thc iieedle is
points and the pathological condition. For
+LI-. ~ elubl
~1 C l j~ \ ~aurrvrll16
V1 + ~ ~ rnm lllUVll~ f f ~ ~f
~ , rlpGrienclr
"a "Y Jt - ; ~
inserted perpendicularly, forming a 90' qi and blood, or for infants with delicate
angle with the skin surface. Most points on constitution, and such areas as the head, face
the body can be punctured in this way. and back region, shallow insertion is
6 ) Oblique: advisable. For the young and middle-aged
This method is used for the points close to with strong or fat constitutions, or for the
the important viscerae or where the muscle is points on the four extremities, buttocks and
thinner. Generally, the needle is inserted abdominal region, deep insertion is adopted.

Perpendicular Oblique Horizontal

Fig. 149
Chapter 14 Acupuncture Techniques

3. Manipulations and Arrival of Qi the meridian. It is described in Compendium

(Needling Reaction) of Acupuncture and Moxibustion that "the
related meridian is pushed up and down to
Manipulations: Needle manipulations promote the circulation of qi and blood".
may induce needling reaction, for which The main purpose of this method is to
several methods should be applied. encourage the movement of qi through the
The arrival of qi refers to soreness, related meridian and facilitate its sensation
numbness or a distending feeling around the at the point. It is used in patients whose
point after the needle is inserted to a certain needling sensation is delayed.
depth. At the same time the operator may b ) Plucking:
feel tenseness around the needle. Pluck the handle of the needle lightly,
1)The fundamental waa~gu8atiolotechni- causing it to tremble and strengthening the
Ques stimulation to obtain qi. In Compendium of
a ) Lifting and thrusting: Acupuncture and Moxibustion, it says:
After the needle tip penetrating the skin "First, pluck the handle of the needle, after
surface, the needle body is perpendicularly the arrival of qi, insert the needle a bit
lifted and thrust in the point. This, known as deeper. This is the reinforcing method." It is
lifting and thrusting, is applied only when also pointed out in Questions and Answers on
the needle is inserted to a certain depth. But Acupuncture and Moxibustion that: "If qi
it is not appropriate to lift and thrust too does not flow smoothly, pluck the needle
much, otherwise, local pain or damage of the lightly and make qi travel faster."
local tissues may take place. The plucking method used to promote qi
b ) Twirling or rotating: flow is for patients with retarded qi'
After the needle has reached its desired sensation due to qi deficiency.
depth, twirl and rotate the needle backward c) Scraping:
and forward continuously. Generally, the When the needle is retained the thumb
needle is rotated with an amplitude from and index finger of the left hand support the
180" to 360'. Rotating clockwise or counter- body of the needle where it enters the skin,
clockwise alone may twine the muscle fibers while the thumb of the right hand is placed
and produce pain. on the tail end to hold the needle steady, then
2) Waiting for and prom~btingqi If qi scrap the handle with the nail of the index or
fails to arrive after manipulation, some middle finger of the right hand upward from
measures have to be taken, such as downward or vice versa. Scraping is used to
temporarily retaining the needle and then spread the needling sensation.
rotating again until qi is obtained. This is d) Shaking:
called "waiting for qi." If, after the insertion Shaking of the needle can strengthen the
and manipulation of the needle, the patient needling sensation. In the book Questions
does not feel or only has little needling and Answers on Acupuncture and Moxibus-
sensation, the method of promoting qi tion, it is said that "shaking is an aid for qi
should be used. The six auxiliary flow." Moreover, shaking the needle may be
manipulations are seen below. used as an auxiliary method for reducing, i.e.
a ) Pressing: before withdrawal of the needle, shake the
Slightly press the skin along the course of needle to drive the pathogenic factors out. In
 Chinese Acupuncture and Moxibustion

Compendium of Acupuncture and Moxibus- Lyrics of Standard Profoundities says: "It

tion, it says, "First, shake the handle of the seems a fish bites on fishing pulling the line
needle to cause arrival of qi. When qi arrives, downward." This is a vivid description to
withdraw the needle a little, which is known whether the arrival of qi is obtained or not.
as the reducing method." b ) Factors influencing the arrival of qi:
e ) Hying: i) Inaccurate location of the points:
r- &a,
Irr ~ l l euuun rr--,_.-
I.,K-.t
i i 1"~fedicii;~,
n ~ r_re.u u u ~iii ~~ it If, is very iplport,aztto yizts
says: "Twirling the needle quickly for three correctly in acupuncture treatment. In case
times is known as 'flying'." Twirl the needle of inaccurate location, the required needling
and separate the thumb and index finger sensation will be affected.
from it for several times until the needling ii) Improper depth of the needle insertion:
sensation is strengthened. A given depth of insertion to each point is
f ) Trembling: required. Either too deep or too shallow
Hold the needle with the fingers of the affects the arrival of qi.
right hand and apply quick lift-thrust iii) Imperfect manipulation:
movement in small amplitude to cause The needle manipulation is requisite for
vibration. It is stated in Classic of Divine the arrival of qi. The operator should
Resonance that "hold the needle with the practise it perfectly, otherwise, the expected
thumb and index finger of the right hand, lift effects can not be achieved.
and thrust it rapidly and lightly in a iv) Weak constitution and dull sensation:
L.--Ll:-
LI ~lllullrlg -;.Vrayto prom~teqi." T h e r e h e it I:: chzpter 67 f M e Pivet if
is applied to strengthen the needling describes, "An individual with abundant
sensation and activate the flow of qi and yang qi may have a quick needling sensation;
blood. a healthy person responds with a normal
3) Arrival of qi In the process of rate to acupuncture, neither quick nor slow;
acupuncture, no matter what manipulation and a man with excessive yin and deficient
it is, the arrival of qi must be achieved. In the yang, (i.e. delicate constitution and dull
first chapter of Miraculous Pivot, it is sensation) may have a slow needling
described that "acupuncture therapy does sensation." For severe cases there may not
not take effect until the arrival of qi." In Ode appear the needling sensation, and the
ofColden Needle it is said: "Quick arrival of therapeutic results are bad.
qi suggests good effects in treatment; slow Acupuncturists in the past dynasties
arrival of qi shows retarded effects in attached importance not only to the arrival
treatment." It indicates that the arrival of qi of qi, but also to the activity of the "spirit qi"
is especially important in acupuncture in the meridians. In Compendium of
treatment. Acupuncture and Moxibustion it is said, "In
a ) Signs o f the arrival of qi: case of arrival of the spirit qi, a tense feeling
When the patient feels soreness, appears under the needle." The first chapter
numbness, heaviness and distension around of Miraculous Pivot says, " A point is the
the point, or their transmission upward and place where the spirit qi enters and flows
downward along the meridians, it is a sign of out." The function of acupuncture is to reg-
the arrival of qi. Meanwhile, the operator ulate the meridian qi. The arrival of qi is a
should feel tenseness around the needle. manifestation of the normal activity of the
Chapter 14 Acupuncture Techniques

spirit qi. Therefore, it is important in the excess-syndrome. The method which is

observation of the therapeutic effects. able to invigorate the body resistance and to
strengthen the weakened physiological
function is called reinforcing, while that
which is able to eliminate the pathogenic
factors and to harmonize the hyperactive
4. Retaining and Withdrawing the physiological functions is known as the
Needle reducing. Clinically, reinforcing or reducing
method is applied according to the
functional conditions of the patient.
I) Retaining "Retaining7' means to Under different pathological conditions
hold the needle in place after it is inserted to acupuncture may produce different regulat-
a given depth below the skin. Pathological ing functions, or the effects of the
conditions decide the retaining and its reinforcing and reducing: If an individual is
duration. In general, the needle is retained subject to a collapse condition, acupuncture
for fifteen to twenty minutes after the arrival functions to rescue yang from collapse;
of qi. But for some chronic, intractable, when an individual is under a condition of
painful and spastic cases, the time for internal pathogenic heat, acupuncture
retaining of the needle may be appropriately functions to expel the heat outwards.
prolonged. Meanwhile, manipulations may Acupuncture can not only relieve the
be given at intervals in order to strengthen stomach and intestine spasms, but also
the therapeutic effects. For some diseases strengthen the stomach and intestine .
the duration may last for several hours. For peristalsis. This dual regulating function is
patients with a dull needling sensation, closely related to the condition of anti-
retaining the needle serves as a method to pathogenic factors of the human body. If it is
wait for qi to come. vigorous, the meridian qi is easy to be
2) Withdrawing On withdrawing the activated and' the regulating function is
needle, press the skin around the point with good. On the contrary, if it is lowered, the
the thumb and index finger of the pressing meridian qi is difficult to be excited and the
hand, rotate the needle gently and lift it regulating function is poor.
slowly to the subcutaneous level, then, Acupuncture is an approach which can
withdraw it quickly and press the punctured promote the transformation of the internal
point for a while to prevent bleeding. environment of the human body. For this
purpose certain manipulations are created.
Acupuncturists in past ages developed and
summarized a lot of reinforcing and
reducing methods which are still commonly
5. Reinforcing and Reducing Methods used in clinic.
31) The basic reinfoacing and reducing
Reinforcing and reducing are two methods
corresponding methods based on the guide a ) Reinforcing and reducing by lifting and
line set in Internal Classic, i.e. reinforcing for thrusting the needle:
the deficiency-syndrome and reducing for In Classic on Medical Problems, it states,
 Chinese Acupuncture and Moxibustion

"Heavy pressing of the needle to a deep rotated gently and slowly by the thumb. The
region is known as reinforcing, while right rotation is just in the opposite way.
forceful lifting of the needle to the superficial c) The reinforciazg and reducing achieved
region is known as reducing. It tells the by rapid and slow insertion and withdrawal of
reinforcing from the reducing by the force the needle:
and speed used. After the needle is inserted This is another kind of reinforcing and
to a given depth a d the nsedling se~satinn, reducing methods distinguished by the speed
appears, the reinforcing is obtained by of insertion and withdrawal of the needle. In
lifting the needle gently and slowly, while the first chapter of Miracular Pivot, it says
thrusting the needle heavily and rapidly. The that "inserting the needle slowly and
reducing is achieved by lifting the needle withdrawing it rapidly is the reinforcing
forcefully and rapidly while thrusting the method, and inserting the needle rapidly and
\
needle gently and slowly. withdrawing it slowly is the reducing
&) Reinforcing and reducing by twirling method." Ira the third chapter of Miraculous
and rotating the needle: Pivot the same explanation is given. During
The reinforcing and reducing of this kind manipulations the reinforcing method is
can be differentiated by the amplitude and performed by inserting the needle to a given
speed used. When the needle is inserted to a depth slowly and lifting it rapidly just
certain depth, rotating the needle gently and beneath the skin, and a moment later
slowly with small amplitude is called the withdraw it. The reducing method is
reizf~rcizg,QII tht: cn~trary,mtating the ~erformedjust in a opposite procedure.
needle rapidly with large amplitude is d ) The reinforcing and reducing achieved
known as the reducing. In the seventy-third by keeping the hole open or close:
chapter of Miraculous Pivot, it says, In Chapter 53 of Plaikz Questions, it says
"Twirling the needle slowly is the reinforcing that "excess is due to the entrance of the
and twirling the needle rapidly to promote pathogenic factor into the human body
the flow of qi is the reducing method." In whereas deficiency is due to exit of the vital
addition, the reinforcing and reducing qi ." On withdrawing of the needle, shake it
methods are distinguished by clockwise or to enlarge the hole and allow the pathogenic
counter-clockwise rotation of the needle. In factor going out. This is called the reducing
other words, the right rotation is the method. Conversely, pressing the hole
reducing method, and the left rotation is the quickly to close it and preventing the vital qi
reinforcing method. In Guide to Acupuncture from escaping is called the reinforcing
it describes, "Rotating the needle forward method.
with the thumb means the reinforcing; e ) The reinforcing and reducing achieved
rotating the needle backward with the by the direction the needle tip pointing to:
thumb means the reducing." Of course, In Compendium of Acupzcncttkre and
twirling of the needle doesn't follow on Moxibustion, it says, "The three yang
direction. There is a difference only between meridians of hand run from the hand up to
the speed of rotation and the force used. For the head. The needle tip pointing
example, in forth turning, the needle is downwards, i.e. against the meridian course,
rotated forcefully and rapidly by the thumb, is known as the reducing method. The
however, in back turning, the needle is opposite direction of the needle tip pointing
Chapter 14 Acupuncture Techniques

to, i.e. following the running course of the superficial, medkm and deep. sequences,,
meridian, is known as the reinforcing and lifted once. At a depth of 0.5 cun and the
method." arrival of qi achieved the needle is lifted and
f) The reinforcing and reducing achieved thrust for nine times. Then the needle is
by means of respiration: inserted to a depth of 1 cun and lifted and
In Chapter 27 of Plain Questions, it states, thrust for another nine times. After that the
"The reinforcing is achieved by inserting the needle is inserted to a depth of 1.5 cun, and
needle when the patient breathes in and lifted and thrust for nine times too.
withdrawing the needle when the patient Repeated operations can be conducted for
breathes out. The reducing is achieved in an several times until a warm feeling is got.
opposite way." Quickly withdraw the needle and press the
In addition to the above-mentioned hole.
methods, even reinforcing and reducing b ) "Penetrating-heaven coolness":
movement is also used in clinic. This method This method is derived from the reducing
is used in treating diseases which are procedures of slow and rapid insertion,
a typical to deficiency or excess nature. Lift, lifting and thrusting and keeping the hole
thrust and rotate the needle evenly. and open or close. When this method is
gently at moderate speed to cause a mild employed, the patient has a cool sensation at
sensation and withdraw the needle at the punctured part. This method is usually
moderate speed as well. applied to the excess syndrome and heat
2) Comprehensive reinforcing and reduc- syndrome. After it is inserted quickly to a
ing methods certain depth, the needle is repeatedly lifted
a ) Setting the mountain on fire: thrice according to the deep, medium and
This method is derived from the superficial sequences and thrust once. At a
reinforcing procedures of slow and rapid depth of 1.5 cun and the arrival of qi
insertion, lifting and thrusting and keeping achieved the needle is lifted quickly and
the hole open or close. When it is applied, the thrust slowly for six times. After that the
patient feels warm at the punctured part. needle is lifted to a depth of 1 cun and given
This method is often used to treat the the same operation. Then the needle is
diseases of deficiency-cold nature. During further lifted to a depth of 0.5 cun and given
the operation, after the needle is inserted the same operation too. Repeated operation
slowly beneath the skin the needle is can be conducted for several times until a
repeatedly thrust thrice according to the cool feeling is got.

Setting t h e m o u n t a i n o n trre Penetrating heaven coolness

Superficial Superficial
----e---------

Medium
1t - - - -
---------
Medium

Deep
Lf Deep

Fig. .I 50
 Chinese Acupuncture and Moxibustion

Chengqi (S 1) located below the eyeball,

pRECAUT'0NS9 'ONTRA- Jiuwei (Ren 15) near the important viscera,
H?JDICATIoNS AND Jimen (Sp 11) near the femoral artery, etc.
M&d'&-kGEMENT OF POSSIBLE These points should generally be punctured
ACCIDENTS IN ACUPUNCTURE obliqukly or horizontally to avoidaccident s.
TREATMENT'
2. Management of Possible Accidents
I. Precautions amd ConHain&cations
in Acupunchue Treatment Although acupuncture is safe and free
from side-effects, some accidents may take
1) Pt is advisable to apply few needles or place owing to negligence of the
to delay giving acupuncture treatment to the contraindications, imperfect manipulations,
patients who are either famished or or want of the knowledge of anatomy. If an
overeaten, intoxicated, overfatigued or very accident really occurs, the practitioner
weak. should keep calm. As long as he solves the
2) It is contraindicated to puncture points problem in time, serious consequences can
on the lower abdomen and lumbosacral be avoided. The possible accidents are seen
region for women pregnant under three as follows:
months. After three months pregnancy it is I) Fainting
contraindicated to needle the points or? the a : This Is often due to nervous
upper abdomen and lumbosacral region, tension, delicate constitution, hunger,
and those points causing strong sensation fatigue, improper position or to the too
such as Megu (LI 4), Sanyinjiao (Sp 6), forceful manipulation.
Kunlun (B 60) and Zhiyin (B 67). Manifestations: During acupuncture
3) Points on the vertax of infants should treatment, there may appear dizziness,
not be needled when the fontanel is not vertigo, palpitation, short breath, fidgets,
closed. In addition, retaining of needles is nausea, pallor, cold sweating, weak pulse. In
forbidden since the infants are unable to severe cases, there may be cold extremities,
cooperate with the practitioner. drop of blood pressure, and loss of
4) Needling should avoid the blood consciousness.
vessels to prevent bleeding. Points of the Management: When fainting aurae such
chest and back should be carefully needled as dizziness, vertigo, fidgets and nausea
to avoid injury of the vital organs. In appear, stop needling immediately and
Chapter 16 of Plain Questions, it says, "If withdraw all the needles. Then help the
you puncture the points at the chest and patient to lie down, and offer him some
abdominal region, you should avoid hurting warm or sweet water. The symptoms will
the five zang organs." disappear after a short rest. In severe cases,
5) Historic medical literature of the past in addition to the above management, press
contraindicates certain points on the human hard with the fingernail or needle Shuigou
body for puncture or deep puncture. Most of (Du 26), Zhongchong (14 9), Suliao (Du 25),
these points are located close to the vital Neiguan (P 6) and Zusanli (S 36), or apply
organs or large blood vessels. such as moxibustion to Baihui (Du 20), Qihai (Ren
Chapter 14 Acupuncture Techniques 331

6) and Guanyuan (Ren 4). Generally, the management of the stuck needle.
patient will respond, but if not, other Manifestations: It is difficult to lift,
emergency measures should be taken. thrust, rotate and withdraw the needle. At
2) Stuck needle the same time, the patient feels pain.
Cause: This may arise from nervousness, Management: When the needle is bent,
strong spasm of the local muscle after the lifting, thrusting, and r ~ t a t i n gshall in no
insertion of the needle, twirling the needle case be applied. The needle may be removed
with too large amplitude or in one direction slowly and withdrawn by following the
only, causing muscle fibers to bind, or from course of bend. In case the bent needle is
a change of the position of the patient after caused by the change of the patient's
the insertion of the needles. posture, move him to his original position,
Manifestations: After the needle is relax the local muscle and then remove the
inserted, it is found at times difficult or needle. Never try to withdraw the needle
impossible to rotate, lift and thrust the with force.
needles. This situation is known as stuck Prevention: Perfect insertion and gentle
needle. manipulation are required. The patient
Management: Ask the patient to relax. If should have a proper and comfortable
the needle is stuck due to excessive rotation position. During the retaining period,
in one direction, the condition will release change of the position is not allowed. The
when the needle is twirled in the opposite needling area shall in no case be impacted or
direction. If the stuck needle is caused by the pressed by an external force.
tension of 'the muscle temporarily, leave the 4) Basken needle
needle in place for a while, then withdraw it Cause: This may arise from the poor
by rotating, or by massaging the skin near quality of the needle or eroded base of the
the point or by inserting another needle needle, from too strong manipulation of the
nearby to transfer the patient's attention. needle, from strong muscle spasm, or a
'

If the stuck needle is caused by the sudden movement of the patient when the
changing of the position of the patient, the needle is in place, or from withdrawing a
original posture should be resumed and then stuck needle.
withdraw the needle. Manifestations: The needle body is
Prevention: Sensitive patients should broken during manipulation and the broken
be encouraged to release their tensions. part is below the skin surface.
Avoid the muscle tendons during insertion. Management: When it happens, the
Twirling with too large amplitude or in one patient should be asked to keep calm to
direction only shall in no case be allowed. In prevent the broken needle from going deeper
the process of manipulation, the posture of into the body. If the broken part protrudes
the patient should remain original. from the skin, remove it with forceps or
3) Beamt needle fingers. If the broken part is at the same level
Cause: This may result from unskillful of the skin, press the tissue around the site
manipulation or too forceful manipulation, until the broken end is exposed, then remove
or the needle striking the hard tissue, or a it with forceps. If it is completely under the
sudden change of the patient's posture for skin, surgery should be resorted to.
different reasons, or from an impro~er Prevention: To prevent accidents, careful
 Chinese Acupuncture and Molribustiom

inspection of the quality of the needle should of manipulations, of which all but the
be made prior to the treatment to reject the _- technique in the mouth are
warming
needles which are not in conformity with the adopted in today's acupuncture treatment.
'
requirements specified. The needle body 1) Needle iwsertiorm assisted by the $hmb
should not be inserted into the body mail: Before the needle is inserted, press
completely, and a little part should be heavily on the point with the thumb nail to
3: -- --- -
urspt;rSG qi iifid 1UIUUU. - T- :~1113 .w
,.,.a y
exposed outside the skin. On needit: 111

. insertion, if it is bent, the needle should be puncturing does not damage the defensive
withdrawn immediately. Never try to insert qi. This approach functions in four aspects:
a needle with too much force. fixing the point to be needled; dispersing qi
5 ) Hematasma and blood to avoid injuring the defensive qi;
Cause: This may result from injury of the distracting the patient's attention to reduce
blood vessels during insertion, or from pain; avoiding bleeding.
absent pressing of the point after 2) ~ u e ~ l ~ insertion
ve and nnanipda~@n
withdrawing the needle. Hold the needle handle with the rig& hand,
Manifestations: Local swelling, disten- thrust and rotate it deep into the muscles
sion and pain after withdrawal of the needle. with force. After three breathings, lift the
Management: Generally, a mild hema- needle to the part just below the skin. After
toma will disappear by itself. If the local another three breathing, the needling
swelling and pain are serious, apply local sensation may appear. Then other
pressing, or light massage, or wariliiag m~nipulatiansE a y be fo!!otved.
moxibustion to help disperse the hematoma. 3 Warming the needle h the mouth
Prevention: Avoid injuring the blood (omitted)
vessels. 4) Entering of &he needle a) Before
6 ) After-effect needling, the patient and practitioner should
Cause: It is mostly due to the unskilled keep even breath to calm the mind. b) The
manipulation and forceful stimulation. point should be located accurately, for
Manifestations: After withdrawal of the example, points of the yang meridians on the
needle, there may remain an uncomfortable four extremities should be located between
feeling of soreness and pain, which may the tendons and bones, while those of the yin
persist for a long period. meridians on the four extremities located at
Management: For the mild cases, press the place with the fingers responding to the
the local area, and for severe cases, in arteries.
addition to pressing, moxibustion is applied 5 ) Pressing After the insertion and
I
to the local area. manipulation of the needle, but the patient
Prevention: Too forceful manipulation does not feel the needling sensation, lightly
shall in no case be applied. press the skin with fingers along the course
of the meridian on which the point is
located, both above and below. The purpose
Appendix: Yang Ji;ahoam9sTwelve
is to make smooth flow of qi and blood and
Manipulations
to facilitate the arrival of qi.
Yang Jizhou, an acupuncturist of the 6 S t If an inserted needle is
lvfing Dynasty, summarized the twelve kinds difficult to lift, thrust or even withdraw, the
Chapter 14 Acupuncture Techniques

needle is stuck by the pathogenic factors. %V. THE THREE-EDGED

Scratch the needle with the thumb nail up NEEDLE
and down along the course of the meridian
to dispel the pathogenic factors from the
meridians.
7) Withdrawing On withdrawal of the
needle, the practitioner should concentrate The three-edged needle is developed from
his mind and pull the needle slowly to the the sharp needle of the Nine Needles created
three levels. For reinforcing, heavy thrusting in the ancient times. The needle is shaped in a
is applied, while for reducing, forceful round handle, a triangular head and a sharp
withdrawal is used. tip. (See Fig. 151)
8) Twisting A needle should not be
twisted too tight, otherwise, it will be
entangled by the muscles, causing sharp 2 Indications
pain. In stagnation of qi twist the needle to
promote smooth flow of qi and blood, and The three-edged needle functions to
to disperse the defensive qi. promote the smooth Row of qi and blood in
9) Turningt To treat the disease in the meridians, dispel blood stasis and eliminate
upper region, turn the needle forthward to the heat. It is advisable to treat blockage of
make qi ascend, and to treat the disease in the meridians, blood stasis, excess syndrome
the lower region, turn the needle backward and heat syndrome, such as high fever, loss
to make qi descend. Lifting the.needle to the of consciousness, sore throat, local
middle level, and turning the needle congestion or swelling.
backward is the reinforcing method, and
vice versa. The purpose is to promote
smooth flow of qi. 3. Manipulations
10) Wetailrning Before withdrawing the
needle, keep the needle subcutaneously for a There are three kinds of manipulations.
while, then withdraw it. The purpose is t o 1) Spot pricking: This is a method
keep the qi stable at the punctured part. known as collateral pricking in ancient times
11) Shaking When the needle is used to treat disease by pricking the small
withdrawn in the level, shake the needle vessels with a three-edged needle to obtain a
twice at each level to enlarge the punctured little bloodletting. During the operation
hole. hold the handle of the three-edged needle
12) P o b g On withdrawal sf the with the right hand, prick swiftly about 0.05-
needle, be sure that it is not stuck tightly. 0.1 cun deep at the area for bloodletting and
Then use the fingers to lift the needle out withdraw the needle immediately. After
carefully -as if "pulling a tiger's tail." pricking, press the punctured hole with a dry
cotton ball until the bleeding stops. This is
the most widely used method in clinics, for
example, pricking Weizhong (B 40) to treat
lumbago due to stagnation of blood,
Fig. 151 The Three-edged Needle pricking Shaoshang (k 11) to treat sore
 Chinese Acupuncture and Moxibustion

throat, pricking Quze (P 3) and Weizhong (B

40) to treat acute vomiting, pricking Taiyang
(Extra) or apex of the ear to treat acute
conjunctivitis.
2) Clumpy pricking Prick around a
small area or a reddened swelling, then press
the skin to make the decayed biuud escape.
This method is mostly used for carbuncles,
erysipelas, etc.
3) Pricking During the operation,
pinch up the local skin with the left hand,
prick the skin 0.5 cun deep with a three-
edged needle to make bleed. If there is no
bleeding, press the punctured part until
bleeding occurs. This method is mostly used
to treat multiple follicucitis. For multiple
carbuncles of the neck, try to find the red
Needle Needle
spots at the both sides of the vertebra, and
then prick them with a three-edged needle Fig. 152 The Cutaneous Needle
till bleeding. I

rzeed2es inlaid onto the end of a handle. It is

used to prick the skin superficially by
4, Precautions tapping to promote the smooth flow of qi in
the meridians and regulate the functions of
1) Aseptic operation is applied to prevent the zang-fu organs.
infection. I) The seven-star needle Composed of
2) For spot pricking, the operation should seven short stainless steel needles attached
be slight, superficial, and rapid. Bleeding vertically to a handle five to six inches long.
should not be excessive. Avoid injuring the 2) The plum-blosom needle Composed
deep large arteries. of five stainless steel needles in a bundle and
3) Pricking shall in no case be applied for attached to a handle perpendicularly one
those with weak constitution, for pregnant foot long.
women and those susceptible to bleeding. . The tip of the needles should not be too
sharp, but on the same level with'equal space
between them, otherwise, pain or bleeding
may happen during tapping.
$7. THE CUTAJVEOUS NEEDLE

I. Needle

The cutaneous needle is also known as the This superficial tapping is particularly
plum-blossom needle and seven-star needle, suitable to treat disorders of the nervous
which is made of five to seven stainless steel system and skin disease. It is used for
Chapter 14 Acupuncture Techniques

headache, dizziness and vertigo, insomnia, VI. THE INTRADERMAE

gastrointestinal disease, gynecological dis-
ease, skin disease, painful joints and
NEEDLE THERAPY
paralysis.
1. Needle
a

3. Manipulation The intradermal needle is a kind of short

needle made of stainless steel wire, especially
After routine and local sterilization, hold used for embedding in the skin. There are
the handle of the needle and tap vertically on two types: the thumbtack type and grain-like
the skin surface with a flexible movement of type. The intraderrnal needle is also known
the wrist. (Fig. 153) The tapping may be as "embedding needle," developed from the
light or heavy. Tap slightly until the skin ancient method of needle retaining. It can
becomes congested, or tap heavily until exert the continuous stimulation produced
slight bleeding appears. The area to be by the implanted needle.
tapped may be along the course of the 1) The thumbtack-type needle, which is
meridians, or on the points selected, or on about 0.3 cm long with a head like a
the affected area, or along the both sides of thumbtack; and
the spinal column. 2) The grain-like needle, about 1 cm long
with a head like a grain of wheat.

--Q
1 ) Thurnback 2) Grain-like

Fig. 154 The Intradermal Needle

Fig. 153

2. Indications

It is mostly used in clinic to treat some

chronic or painful diseases which need long .
1) The tips of the needles should be even time retaining of the needle, such as
and free from any hooks. On tapping, the headache, stomachache, asthma, insomnia,
tips of the needles should strike the skin at a enuresis, abnormal menstruation, dysmen-
right angle to the surface to reduce pain. orrhen, etc.
2) Sterilize the needles and the local area
to be treated. After heavy tapping, the local
skin surface should be cleaned and sterilized 3. Manipulation
to prevent infection.
3) Tapping is not allowed to apply to the The grain-like needle is applied to points
local trauma and ulcers. or tender spots on various parts of the body
 336 Chinese Acupuncture and Moxibustiofl

while the thumbtack-type needle is generally arrow, often used for superficial diseases.
applied to the ear region. Embed the 2) Round needle, 1.6 inches long with a
sterilized needle into the point, leaving its oval-rounded tip, used for disorders of the
handle lying flat on the skin surface, and muscles or for massage treatment.
fixing it with a piece of adhesive tape. 3) Blunt needle, 3.5 inches long with a
round needle body and slightly sharp tip,
used hr bivvd vessels G'rsease a i d pressing
purpose.
1) The duration of implantation depends 4) Sharp-edged needle, 1.6 inches long
on the pathological conditions in different with a triangle needle body and a sharp and
seasons. In iummer, the needles are pyramid tip, served as a scalpel for heat-
generally retained for one to two days toxin abscesses or for blood-letting.
because of excessive sweating which is likely 5) Sword-shaped needle, 4 inches long,
to cause infection. In autumn or winter, the 0.25 inch wide, shaped as a sword, used for
retaining duration may be longer according pain and drainage of pus.
to the need in specific cases. 6) Wound-sharp needle, 1.6 inches long
2) Try to avoid embedding the intrader- with a thin round body and a slightly large
, rnal needle. at the joints to prevent pain on head, mainly used for sudden attack of
,

, motion. rheumatic arthritis and pain.

3) In the purulent infected area or skin 7) Filiform needle, 1.6 inches long with a
ulcers it is not allowed to embed the needle. sharp tip ar;b a thin body, ased k r cdd, heat
4) During the embedding period, keep and painful conditions.
the area around the needle clean to prevent 8) Long needle, 7 inches long with a
infection. round and sharp tip and big body, used to
treat disorders of the deep tissue or
persistent bi-syndrome.
9) Large needle, 4 inches long with a
VII. THE NINE NEEDLES IPi slightly round tip shaped as a stick, used to
THE ANCIENT TIMES treat joint disorders due to the retention of
THE NEEDEmG METHODS water.
LISTED ITVI'ERNAL
CLASSIC
2. The Needling Methods Listed in
8. The Nine Needles in the Ancient Times Internal Classic

The nine needles are those of different Many .different needling methods are
forms used in the ancient times. In Chapter 7 described in Internal Classic,, in which the
of Miraculo~s~Pivot, it is stated that "each of seventh chapter of Miraculous Pivot has
the nine needles, long, short, big or small, concentrated a lot of needling methods
has its specific usage." including the location of the points.
1) The arrow-head needle, 1.6 inches long 1) The nine needling methods In .
with a round head and sharp tip like an Chapter 7 of Miracular Pivot, it says, "There
Chapter 14 Acupuncture Techniques

are nine ways of needling applied to cope Miraculous Pivot it says, "There are twelve
with nine different diseases." needlings in respmse to various diseases of
a) Shu-point needling, used in treatment the twelve regular meridians."
of disorders of the five zang organs, by a) Coupled puncture, a method in which
which the needle is inserted at Ying-(Spring) the needle is inserted at two corresponding
Points of the yin meridians and the Shu- points in the frontal and posterior regions of
points. Strictly speaking, this is a combining the body respectively in order to treat
method in selection of points. cardialgia and thoracodynia.
b) Distant needling, used in treatment of b) Trigger puncture, used to treat
disorders of the six fu organs, by which the wandering pains. When pains are not
needle is inserted at the points in the upper localized in one definite area, perpendicular
region distant from the affected regions insertion of the needle into the .affected
located below. The Lower He-(Sea) Points regions should be applied with no immediate
of the six fu organs of the three yang withdrawal, and the needle may be removed
meridians of foot are often selected. This is a after a pressure has been applied to the
combining method in selection of points. affected region with the left hand.
c) Meridian needling, used to treat an c) Lateral puncture, a method to needling
affected meridian by needling along that one side of the painful muscle, and shaking
meridian or the meridian related to the the needle forward and backward, anteriorly
affected part. and posteriorly, right and left so as to
d) Collateral needling, used to cause expand the needle hole and relax the muscle.
bleeding of the subcutaneous small vessels to This method is used to treat rheumatic
eliminate blood stasis and treat the collateral pains.
diseases. d) Triple puncture, a method in which the
e) Crack needling, used to needle the needles are inserted at three spots
space between two muscles to treat muscular simultaneously, with one in the centre and
pain. two on both sides to treat rheumatism
0 Evacuation needling, used with a caused by cold pathogenic factor that
sword-shaped needle to perform surgical attacks the body on a small scale but with a
operation and remove purulent blood. deep penetration.
g) Shallow needling, used to treat e) Quintuple puncture, a method in
superficial disorders. The cutaneous needle which the needles are inserted at five spots
used is developed from this method. with one in the centre and the four scattered
h) ContralateraI needling, indicating the around it. This method is applied to treat a
needling applied to the points on the right relatively large area disorders caused by cold
side when the affected region is on the left or pathogenic factor.
vice versa. f) Straight puncture across the skin, a
i) Heat needling, used with a red-hot method in which the skin in the region in
needle to treat rheumatism. The fire which the points involved are located is
puncture developed from this method is now pushed up with the fingers, and then the
used to treat scrofula and ulcers of yin needle is inserted at the points and across the
nature. skin. This method is used to treat diseases
2) The twelve needlings In Chapter 7 of caused by the cold pathogenic factor with
 Chinese Acupuncture and Moxibustion

the superficial invasion. withdrawal of the needle without any injury

g) Shu-point puncture, a method in of the muscles. This technique is developed
which the needle is perpendicularly inserted in response to the diseases associated with
into a few points deeply and withdrawn the lungs, and it is a technique which
rapidly to treat heat condition caused by functions to reduce the superficial
excess of qi. pathogenic factors used in treatment of fever
4 .-.
n) snort puncture, a method iii which :hi Axln+nn v * m P n . ? i r p c
-- -0"
fspfnrq ptaaaoh
n g f h n m ~ Y P ; rrwvrvAu,
UUb L U b A W 5 b l l W U u p u b l r w b v a r l v

needle is inserted with slight shaking down and asthma.

to the bone that suffers from rheumatism. b) Leopard-spot puncture, a technique in
And then the needle is gradually pushed which needles are used to pierce small blood
further into the body until its tip reaches the vessels around the affected area to evacuate
region close to the affected bones. After that, the points on the left, on the right, in the
the needle is moved up and down as if rub- front, on sludged blood. This technique is
bing the bones. This method is applied to developed in response to the disease
treat bone rheumatism caused by cold. associated with the heart by virtue of the fact
i) Superficial puncture, a method in that the heart is in control of the blood and
which an oblique or shallow insertion is blood vessels. This method may be used to
zpplied to treat muscular spasms caused by treat swellings and pains.
cold. c) Joint puncture, a technique in which
j) Yin puncture, a method in which the the needle is inserted rapidly into the muscles
needling is applied tzl Taixi (K 31, a point ~f argunr! the jei~l,t,s~f the extremities, but to
the Kidney Meridian of Foot-Shaoyin on avoid bleeding, to treat rheumatism of
both feet behind the medial malleolus to tendons. This technique is developed in
treat cold limbs and cold conditions. response to the diseases associated with the
k) Adjacent puncture, a method in which liver by virtue of the fact that the liver is in
the needling is applied to the affected part control of tendons.
vertically and laterally with one needle each d) Hegu puncture, a technique in which
to treat prolonged rheumatism. the needle is inserted into the muscles of the
1) Repeated shallow puncture, a method affected area, obliquely right and left just
in which the needle is repeatedly inserted like the claws df the chicken to cure
vertically and superficially and withdrawn rheumatic pain of the muscles. This
rapidly to cause bleeding of the affected part technique is developed in response to the
in treating carbuncles and erysipelas. diseases associated with the spleen by virtue
3) The five needling techniques In the of the fact that the spleen is in control of the
seventh chapter of Miraculous Pivot, it muscles.
describes, "There are five needling e) Shu-point puncture, a technique in
techniques developed to treat various which the needle is thrust deeply to the bone
diseases associated with the five zang to treat osteal pain. This technique is
organs." , developed in response to the diseases
a) Extreme shallow puncture, a technique associated with the kidney by virtue of the
involving shallow insertion and immediate fact that t'he kidney is in control of the bones.
 Chapter 15
MOXIBUSTION AND CUBPING

Moxibustion treats and prevents diseases Qizksu is known as the best kind for moxa
by applying heat to points or certain as the climate and soil is good for its
locations of the human body. The mateiial growth. The leaves of the Qizhou Artemisia
used is mainly "moxa-wool" in the form of a are thick with much more wool. Moxa cones
cone or stick. For centuries, moxibustion and sticks made of this kind of Artemisia are
and acupuncttire have been combined in thought the top quality used in moxibustion.
clinical practice, thus they are usually In A New Edition of Materia Medica
termed together in Chinese. Chapter 73 of appears the following description: "The
Miraculous Pivot states, "A disease that moxa leaf is bitter and acrid, producing
may not be treated by acupuncture may be warmth when used in small amount and
treated by rnoxibustion." In Introduction to strong heat when used in large amount. It is
Medicine it says, "When a disease fails to of pure yang nature having the ability .to
respond to medication and acupuncture, restore the primary yang from collapse. It
moxibustion is suggested." can open the twelve regular meridians,
Cupping is a therapeutic approach by travelling through the three grin meridians to
attaching small jars in which a vacuum is regulate qi and blood, expel cold and
created. Cupping, sometimes used in dampness, warnl the uterus, stop bleeding, '

combination with acupuncture, is elucidated warm the spleen and stomach to remove
herewith. stagnation, regulate menstruation and ease
the fetus.. . When burned, it penetrates all
the meridians, eliminating hundreds of
I. THE MATERULS AND diseases." Yang can be activated by the
lNJPK~~~NS Artemisia leaf for its warm nature. The acrid
OF ~~MWLJS3'HON odour s f the leaf can travel through the
meridians, regulate qi and blood, and expel
cold from the meridians, and its bitter nature
1- The Property of Arkmisia Vulaga*s resolves dam~ness.As a result it is used as a
Msxa necessary material in moxibustion treat-
ment. In addition, the moxa wool can
Artemisia Vulgaris is a species of produce mild heat, which is able to penetrate
chrysanthemum. The one produced in deeply into the muscles. If it is replaced by
 34Q Chinese Acupuncture and Moxibustion

. other materials, an intolerable burning pain flowing of yang qi so as to lead the qi and
will result, and the effect is found poor than blood to go downward. In Chapter64 of
the moxa wool. Miraculous Pivot, it is pointedoutthat "when
there is an excess of qi in the upper portion,
the qi should be brought downward by
needling the points in the lower portion." If
+La A;nn.-Aa- ;n Ax-, C-A * G n ; n - m , :- +L, ..--n,
Ll1b U b 3 U l U b l
1J LlUb L V Ub11blbllbY 111 L l l C Uppbl

portion and excess in the lower portion of

1) TO warm meridians amd expd the body and due to sinking of qi caused by
cold Abnormal flow of qi and blood in the deficiency, such as prolapse of anus,
,i

body is usually resulted from cold and heat. prolapse of uterus, prolonged diarrheoa, etc,
Cold causes slow flow or even stagnation of moxibustion to Baihui (Du 20) may lead
qi, and heat results in rapid flow of qi. yang qi to flow upward.
"Normal heat activates blood circulation 3 T . strerragthew yang from collapse
and cold impedes its smooth flow." Since Yang qi is the foundation of the human
stagnation of qi and blood is often relieved body. If it is in a sufficient condition, a man
by warming up the qi, moxibustion is the lives a long life; if it is lost, death occurs.
right way to generate the smooth flow of qi Yang disorder is due to excess of yin, leading
with the help of the ignited moxa wool. In to cold, deficiency and exhaustion of the
Chapter 75 of Miraculous Pivot it says, primary qi characterized by a fatal pulse. At
ar stagnation of "vmd in t
CCE-a-
ircssds this mxxent, m~zrib-wtioz -YY 9nrPned C ~ F ,
cannot be treated by warming-up with reinforce yang qi and prevent collapse. In
moxibustion, it cannot be treated by Chapter 73 of Miraculous Pivot it says,
acupuncture." In Chapter 48 of Miraculous "Deficiency of both yin and yang should be
Pivot it states, "Depressed symptoms should treated by moxibustion."
be treated by moxibustion alone, because 4) To prevent diseases and keep Bncea1tb-y
depression is due to blood stagnation caused In Precious Prescriptions appears the
by cold, which should be dispersed by following description: "Anyone who travels
moxibustion." It is easy to understand that in the southwest part of China, such as
moxibustion functions t o , warm up the Yunnan and Sichuan provinces, should have
meridians and promote blood circulation. mo~ibustion at two or three points to
Therefore, it is mostly used in clinic to treat prevent sores or boils and to avoid
diseases caused by cold-dampness and
persistent diseases caused by pathogenic
cold penetrating into the deep muscles.
2) To induce the smooth flow of qi and
blood Another function of moxibustion is
to induce qi and blood to flow upward or
downward. For example, moxibustion is
given to Yongquan (K 1) to treat the
disorders caused by excess in the upper part
and deficiency in the lower part of the body
and liver yang symptoms due to upward Fig. 155.
 Chapter 15 Moxibustinn and Cupping

Fig. 156

pernicious malaria, epidemic diseases and smallest is as big as a grain of wheat; the
pestilence." It is often said, "If one wants (S medium size is about half a date stone, and
36) to be healthy, you should often have the largest is the size of the upper part of the
moxibustion over the point Zusanli (S 36)". thumb. The two smaller cones are suitable
, In Notes on Bian Que 's Moxibustion, it says, for direct moxibustion, while the largest for
"When a healthy man often has moxibustion indirect moxibustion. (See Fig. 155)
to the points of Guangyuan (Ren 4), Qihai 2) Making of msxa stick It is much
(Ren 6) Mingmen (Du 4) and Zhongwan more, convenient to use moxa sticks than
(Ren 12), he would live a very long life, at moxa cones. Simply roll moxa wool (other
least one hundred years' life." Clinical herbal medicine may be mixed in) into the
practice has proved that moxibustion is very shape of a cigar, using paper made of
much helpful in preventing disease and mulberry bark. (See Fig. 156)
keeping healthy.
11. CLASSIFICATION OE

From the ancient times until now rich

clinical experience has been gained in the
Moxa wool, moxa cones, moxa sticks, moxibustion therapy. At first only the moxa
matches and a tray should be ready cones were used. But now various
beforehand. approaches have been developed and used
1) Making of moxa cones Place a small clinically, i.e. moxibustion with maxa cones,
amount of moxa wool on a board, knead with moxa sticks, and with warming needle.
and shape it into a cone with the thumb, I. Moxibustion with Moxa Cone
index and middle fingers in three sizes. The Moxibustion with moxa cones may be direct

( Scarring moxibustion
' Moxa cones
[ Direct moxibustion Nonscarring moxibustion

Moxibustion
( Indirect moxihustion Ginger insulation

Garlic insulation
Moxa sticks Salt insulation
Warming needle Monkshood cake insulation
 Chinese Acupuncture and Moxibustion

or indirect. Direct moxibustion is to place a festering and scar after healing. Indications
moxa cone directly on the skin and ignite it, are certain chronic diseases such as asthma.
while indirect moxibustion is to place a b ) Nonscarring rnoxibustion:
moxa cone indirectly on the skin but A moxa cone is placed on a point and
insulated with some different medical ignited. When half or two thirds of it is burnt
substances. The names are nomenclatured or the patient feels a burning discomfort,
according to the names of the different reilioiie the eoiie aiid piace aiisthcr sne. X o
. medical substances, for example, ginger used blister should be formed and there should be
as the insulator is called moxibustion with no festering and scar formation. Indications
ginger; salt used for insulation is called are diseases of chronic, deficient and .cold
moxibustion with salt. One msxa cone used nature such as asthma, chronic diarrhoea,
at one point is called one unit. indigestion, etc.
1) Direct mo~busQionA moxa cone 2 Inmdiaect wnoxibosticlm
place directly on the point and ignited The ignited moxa cone does not rest on
is dalled direct moxibustion, and the skin directly but is insulated from the
is also known as "open moxibustion," which skin by one of four types of materials.
was widely used in the ancient times with a ) Moxibustion with ginger:
better results. This type of rnoxibustion is Cut a slice of ginger about 0.5 cm thick,
subdivided into scarring moxibustion and punch numerous holes on it and place it on
nonscarring moxibustion according to the point selected. On top of this piece of
wktiier the local sear is famed or f i ~after
i ginger, a large moxa coce is. plzcec! and
moxibustion. (Fig. 157) ignited. When the patient feels it scorching,
a ) Scarring moxibustion (also known as remove it and light another. This method is
"festering moxibustion"): indicated in symptoms caused by weakness
Prior to moxibustion, apply some onion of the stomach and spleen such as diarrhoea,
or garlic juice to the site in order to increase abdominal pain, painful joints and
the adhesion of the moxa cone to the skin, symptoms due to yang deficiency.
then put the moxa cone on the point and b ) Moxibust ion with garlic:
ignite it until it completely burns out. Repeat Cut a slice of garlic about 0.5 cm thick (a
this procedure for five to ten units. This large single clove of' garlic is desirable),
method may lead to a local burn, blister, punch holes in it, put it on the point with the

Fig. 157 Fig. 158

Chapter 15 Moxibustion and Cupping

Fig. 159

ignited moxa cone above. Renew the cone for moxibustion with the moxa cone ignited
when the patient feels it scorching. This and burnt on the top of it. Since it is of heat
method is indicated in scrofula, tuberculosis, nature, the monkshood may warm yang and
the early stage of skin ulcer with boils, expel cold. This method is only suitable to
poisonous insect bite, etc. treat deficient, and persistent yin-cold
c ) Moxibustion with salt: syndromes, such as impotence and
This is usually applied at the umbilicus, so ejaculatio precox caused by declination of
it is also called "moxibustion at Shenque the Mingmen fire.
point." Fill the umbilicus with salt to the
level of the skin, place a large moxa cone on
the top of salt and then ignite it. (If the 2. Moxibustisnm with Moxa Sticks
patient's umbilicus is not concave in shape, a
piece of wet noodle can be put around the Apply a lighted moxa stick over the select-
umbilicus then fill salt in it. The moxa cone ed point. It is easy to control heat and time
can be placed and ignited on the top of it.) during moxibustion, and the therapeutic ef-
This method is effective in cases of fect is good, so it is often used today. This
abdominal pain, vomiting and diarrhoea, method includes two kinds: mild-warn mo-
pain around the umbilicus, pain caused by xibustion and sparrow-pecking moxibu-
hernia, prolonged dysentery, etc. In stion.
addition, moxibustion with salt has the 1) Mild-warn moxibustion
function to restore yang from collapse, e.g. Apply an ignited moxa stick over the
symptoms of excessive sweating, cold limbs point to bring a mild warmth to the local
and undetectable pulse. Large moxa cones area for five to ten minutes until the local
may be used successively until sweating area is red. (Fig. 160)
stops, pulse restores and the four extremities 2) "Spari-ow-pe~king~~ moxibustion
get warm. (Fig. 159) When this method is applied, the ignited
d ) Moxibustion with monkshood cake: moxa stick is rapidly pecked over the point,
A coin-sized cake made of monkshood paying attention not to burning the skin. In
powder mixed with alcohol, is punched with addition, the ignited moxa stick may be
numerous holes in it, and placed on the site evenly moved from left to right or in circular
 Chinese Acupuncture and Moxibustion

Fig. 160 Fig. 161

movement. (Fig. 1 62) A p p d i r : The Great Monad Herbal

3) Moxib~rstionwith azl~miwiwgaeedhe Stick and Thunder-Fire Herbal
Moxibustion with warming needle is a Moxa Stick
method of acupuncture combined with
moxibustion, and is used for conditions in 1) The Great Monad Herbal Moxa Stick
which both the retaining of the needle and
Compositions:
moxibustion are needed. The manipulation
150 g of moxa wool,
is as follows:
10 g of sulphur,
After the arrival of qi and with the needle 5 g of musk,
retained in the point, wrap the needle handle 5 g of Resina Boswelliae Carterii,
with a unit of moxa wool and ignite it to 5 g of Myrrha,
cause a mild heat sensation around the 5 g of Colophonium,
point. This method functions to warm the
5 g of Cassia Twig,
meridians and promote the free flow of qi 5 g of Eucommia Bark,
and blood so as to treat painful joints caused 5 g of Bitter Orange,
by cold-damp, numbness with cold 5 g of Spina Gleditsiae,
sensation and paralysis. (Fig. 162) 5 g of Herba Asari,
5 g of Rhizoma Ligustici Chuanxiong,
5 g of Radix Angelicae Pubescentis,
5 g of Squama Manitis,
5 g of Realgar,
5 g of Radix Angelicae Dahuricae, and
5 g of Scorpion.
These herbs are nixed together and
groundinto fine powders, put some powders
Fig. 162 on a piece of paper and cover it with another
Chapter 15 Moxibustion and Cupping

piece of paper..Several layers of fine powder that it is wrapped up with a sheet of thin
covered with several layers of paper are paper and fixed with egg white. The stick is
made, then put a layer of clean moxa wool dried in a cool place without sunshine.
on the top and tightly roll them together like Avoid leakage of the roll.
a fire cracker in shape, and naste the outside Compositions:
with a piece of white mulberry paper. The 100 g of moxa wool,
whole stick is fixed by the egg white, and 15 g of Eagle Wood,
dried in a cool place without sunshine. 15 g of Radix Inulae Melenii,
Leakage should be avoided. 15 g of Resina Boswelliae Carterii,
Method: The area for moxibustion 15 g of Notopterygium,
should be examined and marked. Burn one 15 g of Dried ginger, and
stick completely and rapidly put the ignited 15 g of Squama Manitis.
stick in a piece of dry cloth which has been
folded into seven layers. Then direct the These herbs should be ground into fine
cloth with the ignited moxa stick in it to the powder, and a little musk is added after
skin to produce a heat sensation on the sieving.
affected area and make it penetrate into the The method and indications are the same
deep muscles. If the patient feels it scorching, as those of the Great Monad Herbal moxa
the stick may be lifted a little. When the heat stick.
sensation becomes normal, press and iron
the affected area until the heat on the ignited
end extinguishes. Ignite another stick and go 111. APPLICATION OF
on ironing the affected area. In order to get MOXIBUSTION
good results and keep the heat on the
affected area, it is better to prepare two
sticks in turn for use. This method can warm
and promote the free flow of qi and blood,
dispel cold and dampness. It is, therefore,
used for painful joints caused by wind, cold The Precious Prescriptions points out that
and dampness, and for prolonged diseases "Moxibustion is generally applied to yang
and pains such as abdominal pain, portion first, then yin portion; clinically it is
dysmenorrhea, hernia, etc. applied to the upper part first and then the
2) Thunder-fire moxa stick Get two lower part." Treat the back first, the
sheets of paper ready. One is thick, the other abdominal region second; the head and
is thin. One sheet is paralleld with the other body first and the four extremities second.
which has been already folded into double But the sequence should be given according
layers. On the top of the double-folded to the pathological conditions.
paper, place a layer of clean moxa wool. The volume for moxibustion, including
Slightly tap it with a wooden ruler or a the size of moxa cone or duration of the
rattan stick until it spreads squarely with moxa stick application should be in parallel
even thickness. Then put some. herbal to the patients' pathological conditions,
powders on the moxa wool and roll them general constitution, age and the site where
together like a fire cracker in shape. After moxibustion is to be applied. Generally,
 Chinese Acupuncture and Moxibustion

three to seven moxa cones are used for each Large blisters should be punctured and
point, and ten to fifteen minutes for the drained. If pus is formed, the blister should
application of moxa stick. be dressed to prevent further infection.

1 CUPPING METHOD
1) Excess syndrome, and heat syndrome
Cupping is a therapy in which a jar is
(including high fever caused by common
attached to the skin surface to cause local
cold or heat due to yin deficiency) are not
congestion through the negative pressure
,
allowed to be treated by moxibustion. It is
created by introducing heat in the form of an
stated in Treatise on Febrile Diseases that "a
ignited material. In the ancient times in
patient with feeble and rapid pulse should
China, cupping method was called "horn
not be treated by moxibustion. Although the
method."
heat of moxibustion is weak, strong internal
The animal horn was used to dispel pus.
impact may produce," indicating that
Along with continual development in
improper moxibustion may bring bad
clinical practice, the materials for making
results.
jars and the methods have been greatly
2) Scarring moxibustion should not be
improved. The range of indications has been
applied to the face and head, and the area in
expanded, since this method is simple and
the vicinity of the large blood vessels.
the therapeutic effect is good. This therapy
According to the recordings of ancient
literature, there are certain points which are was attracted with great attention and
advisable to acupuncture but not suitable applied in a large scale by the broad masses,
for moxibustion, because most of them are and also used as an auxillary method of
close to the vital organs or arteries. acupuncture and rnoxibustion.
Examples are Jingming (B I), close to. the
eyeball, and Renying (S 9), above a large 1. Types of Jars
artery.
3) The abdominal region and lumbo- There are a great variety of jars, but the
sacral region of the pregnant woman are not cornonly used clinically are as follows:
allowed to use moxibustion. 1) Bamboo jar Cut down a section of
bamboo 3-7 cm in diameter and 8-10 cm in
length, forming a cylinder shaped as a drum.
3. Management After Moxibustion One end is used as the bottom, and the other
as the opening. The rim of the jar should be
After moxibustion, different degrees of made smoothly. The bamboo jar is light,
burns may remain in the local region, or economical, easy to make and availabe in
there is only a slight red sign of burning many places.
which will disappear very soon. But 2) Glass cup Since the glass cup is
sometimes, a few blisters result on the skin transparent, the local congestion at the site
surface. Take care not to let small blisters for moxibustion can be seen so as to control
break. They can be healed by tvrnselves. the treatment.
Chapter 15 Moxibustion and Cupping

In addition, cupping may be combined with

the bloodletting technique. First sterilize the
The cupping method has the function of area for cupping and prick a small vein with
warming and promoting the free flow of qi a triangular needle or intrademal needle,
and blood in the meridians, dispelling cold and the cupping follows.
dampness, diminishing swellings and pains.
In clinics, the cupping method is mainly used
to treat Bi syndrome caused by wind
dampness, such as pain of the low back,
shoulders, and leg, gastrointestinal dis- 1) The patient should select a comfor-
orders such as stomachache, vomiting, and table position. Cups in different sizes are
diarrhoea, and the lung disease such as used according to the cupping location.
cough and asthma. Generally, the areas where the muscle is
The cupping method combined with abundant and elastic, free from hairs and
bloodletting is suitable to treat acute sprains bone ridges are selected.
acconipanied by blood stasis. 2) The burning flame should be stronger
enough to create a vacuum. Hold the cup
with the rim close to the local area and cup it
to the skin rapidly and deftly, otherwise,
3. Manipulations there will be no therapeutic effects.
3) It is not advisable to apply cupping to
I) Fire throwing method Throw a piece the patient with skin ulcer, edema, or on an
of ignited paper or an alcohol cotton ball area overlying large blood vessels, to the pat-
into the cup, then rapidly place the mouth of ient with high fever and convulsion; or to the
the cup firmly against the skin on the desired abdominal and sacral regions of the
location. This method is applied to the pregnant women.
lateral side of the body, otherwise the 4) It is not suitable to apply cupping to
burning paper or cotton ball may fall and the patient susceptible to spontaneous
hurt the skin. bleeding or endless bleeding after trauma.
2) Fire twinkling method Clamp a 5) After cupping, there is a blood stasis
cotton ball soaked with 95% alcohol with or bruise at the local area. Generally, it will
the forceps or nippers, ignite it and put it disappear several days later. Small blisters
into the cup, and immediately take it out and occurring on the skin will absorb naturally
place the cup on the selected position. several days later. If the blisters are severe,
Generally, the cup is sucked in place for draw out the liquid by a sterile syringe, apply
ten minutes. The skin becomes congested gentian violet and cover them with gause to
with violet coloured blood stasis formation. prevent infection.
On withdrawing the cup, hold the cup with In case cupping is combined with
the right hand, and press the skin around the bloodletting, remove the blood from the
rim of the cup with the left hand to let air in. punctured hole with a dry cotton ball.
 Chapter 116
A GENERAL INTRODUCTION TO
ACUPUNCTURE TREATMENT
Acupuncture therapy takes the theories of preponderance or discomfiture of yin and
traditional Chinese medicine as guidance to yang. Regulation of yin and yang is
treat patients with acupuncture and therefore a fundamental principle in clinical
moxibustion based upon differentiation of treatment. In the fifth chapter of Miraculous
syndromes. This chapter deals mainly with Pivot, it points out that "how to regulate yin
the general laws of acupuncture therapy. and yang is most important in acupuncture
The descriptions for the principles of treatment."
treatment, the methods, the basic guidelines Yang in excess makes yin suffer and yin in
for prescription and selection of points are excess makes yang suffer. Excessive heat
8s fC!!lC!ws: (yang) is likely to injure yin essence, while
excessive cold (yin) is likely to damage
yang qi. In treatment, reduce excessive
I. GENERAL PRINCIPLES OF heat or expel cold through the methods of
TREATMENT "removing the excess" and "reducing the
preponderance." On regulating the pre-
ponderance of yin or yang, attention should
The general principles of treatment are be paid to the condition whether a
worked out under the guidance of the corresponding yin or yang deficiency exists.
holistic concept and differentiation of If one is deficient, consideration should be
syndromes. The general principles are of given to both yang reduction and yin
universal significance in decision of the reinforcement, dispelling cold and warming
treating methods and priscriptions. yang simultaneously.
Yin in deficiency fails to control yang,
manifested by deficiency heat syndrome and
1. Reglalation of Yin and Uang yang hyperactivity due to yin deficiency.
Yang in deficiency fails to control yin, as
The occurrence of any diseases is, shown in deficiency cold syndrome and
fundamentally speaking, due to the relative excess of yin due to yang deficiency. In the
imbalance of yin and yang. Namely, the fifth chapter of Plain Questions, it says,
normal inter-consuming-supporting rela- "Treat yin for yang problems and treat yang
tionship between them is disturbed by either for yin problems," indicating that
Chapter 14 A General Introduction to Acupuncture Treatment 349

hyperactivity of yang due to yin deficiency factors are removed, the body resistance will
should be treated by strengthening yin to be reinforced. Since they are closely related
control yang, while cold (yin) due to yang to each .other, strengthening the body
deficiency should be treated by reinforcing resistance is beneficial to dispelling the
yang to control yin. If they are both pathogenic factors and vice versa.
deficient, yin and yang should be reinforced. Clinically, the condition of the pathogenic
In treating diseases marked by yin or yang factors and antipathogenic factors should be
deficiency, try to achieve yang from yin and carefully observed, upon which, strengthen-
achieve yin from yang, because they are ing the body resistance first or dispelling the
interdependent. For example, the Front- pathogenic factors first can be determined.
Mu Points and Back-Shu Points are used For patients with weak body resistance but
respectively to regulate and replenish yin qi pathogenic factors not yet strong enough,
and yang qi of the zang-fu organs. the body resistance is strengthened first. For
Yin and yang are considered the general patients with excessive pathogenic factors
principle for differentiation of syndromes. but body resistance not yet damaged, the
In a broad sense, "relieving deficiency by the prime task is to eliminate the pathogenic
tonifying method, reducing excess, dispel- factors. But for patients with weak body
ling cold by the warming method, nutrient resistance and excessive pathogenic factors
and defensive qi regulation, and qi and as well, both methods should be employed
blood promotion" all fall into the aspect of simultaneously. Try to distinguish what is
regulation of yin and yang. Acupuncture primary from what is secondary. For those
therapy is to apply different techniques of with weak body resistacce priority should be
manipulations to points to treat diseases by placed on building body resistance and do
means of regulating yin and yang. something to get rid of the pathogenic
factors, and vice versa. When the patient is
in a relatively critical condition attacked by
2. Strengthening the. Body Resistance excessive pathogenic factors, and the body
and Eliminating the Pathogenic Factors resistance is too weak, for which the
pathogenic factors are not eliminated,
The course of a disease is actually the strengthen the body resistance first and then
process of struggle between the antipatho- remove the pathogenic factors. If the patient
genic factors and pathogenic factors. is in a very 'poor condition with excessive
Mobilizing the antipathogenic factors to pathogenic factors, but with weak body
defeat the pathogenic factors is the right way resistance, eliminate the pathogenic factors
to cure the disease. Therefore, strengthening +-st, and then strengthen the body
the body resistance and eliminating the resistance.
pathogenic factors are also the important
principles in clinical treatment.
To strengthen the body resistance is to 3. Distinguishing the Primary from the
reinforce the antipathogenic qi and build up Secondary
health. Once the body resistance against
disease is strengthened, the pathogenic The conception of the primary and the
factors are eliminated. Once the pathogenic secondary are relative to each other
 Chinese Acupuncture and Moxibustion

involving different meanings. In terms of the although their symptoms are alike, the
antipathogenic factors and pathogenic etiology and pathogenesis are different,
factors, the former is the primary, and the .different methods therefore should be used
latter is the secondary. Judged by the to treat the root cause. For instance,
etiology and manifestation, the etiology is headache due to liver yang hyperactivity
the primary, and the manifestation is the should be treated by nourishing yin to
- -- - + L o -- qi
( a hRth
lrkaduvnu r ~ H ~ p hV
secondary. As to the iocaiization of a lesion, L ~;UULCy a l l g ,
v u L
Q P ~ F
wWUVV- V J

the internal portion is the primary, and the and blood deficiency should be treated by
external is the secondary. As for the clinical reinforcing qi and blood. However headache
course of a disease the original is the ficausedby invasion of the meridians by wind
primary, while the complication is the cold must be treated by diminishing wind
secondary. This concept represents the two cold. This is called "treating the same disease
opposite aspects of one entity during the with different methods."
course of a disease. The symptom is Under certain circumstances, the symp-
generally the phenomenon and the toms are very critical, if not treated
secondary aspect, the root cause is generally immediately, they shall affect the treatment
the nature and the primary aspect. of the root cause or perhaps cause death, in
Clinically, a disease should be assessed this case it is .necessary to observe the
according to such different situations of the principle of "treating the symptoms first
primary, the secondaj, the root cause, the when they are acute, and treating the root
symptoms, the acute, and the chronic so as caiiss whci; these sympt~ms2re relieved."
to ascertain the main aspect sf the For example, a patient with chronic cough
contradictions, and thus treated accord- and asthma caught a common cold,
ingly. Under general circumstances, the accompanied with fever and aversion to
primary or root cause should be found first, cold, common cold should be treated first
but if the symptoms are acute, they should because it is the acute aspect. After the
be treated first. If the symptoms and root common cold is relieved, treat chronic cough
cause are both serious, they should be taken and asthma which are the primary aspect.
into account at the same tige. But if the primary and secondary aspects are '

Trying to find out the primary or root both serious, they must be treated at the
cause is of importance. In clinic, the nature same time.
and the primary aspect of adisease should be Prevention is also an important aspect in
well commanded so as to treat the root treating the primary aspect. It includes
cause. Some diseases, although their prevention before the attack of a disease and
symptoms are different, the etiology and prevention from deterioration after occur- '
pathogenesis are the same, so they can be rence of a disease. China has long rich
treated by the same method. For example, in experience in health care, such as Qigong,
case of sore throat due to yin deficiency of Taiji, 'Baduanjin, etc. Acupuncture and
the kidney and low back pain due to yin moxibustion is also one of the traditional
deficiency of the kidney, the treatment to remedies to prevent diseases. Zusanli (S 34),
nourish the kidney yin is adopted. This is for example, is an important tonifying point.
called "treating different diseases with the Moxibustion to it is not only good for
same method." For some other diseases, preserving health, but also good for
 Chapter 16 A General Introduction to Acupuncture Treatment 35 1

preventing many kinds of diseases. important. o r instance, treatment of

Importance is attached to early diagnosis malaria is usually applied two to three hours
and treatment of disease for fear sf its before its attack, and dysmenorrhea is
negative development. During the preven- usually treated beforc the menstrual periods.
tion and treatment of diseases, doctors are 2) Geographical IIocatisns The appro-
' requested to know the laws of their priate therapeutic methods should be
occurrence and development and the ways determined according to different geograph-
s f their transmission. It is recorded in ical locations. Climate and life style vary in
Treatise On Febrile Disease, "If the illness is different regions, so do the physiological
going to invade other meridians, needle activities and pathological changes, there-
Foot-Yangming Meridian to stop the fore, the methods of treatment should be
development." The importance of prevent- different. In Chapter 12 of Plain Questions it
ing diseases from transmission is clearly says, ""Pn the north.. .people live in
stated here. highlands and mountains, exposed to bitter
wind and severe cold. People there prefer
outdoor dwelling and milk, that's why they
4. Treatment of Diseases According to are susceptible to gastric distention due to ,

Climatic and Seasonal Conditiws, accumulation of cold for which rnoxibustion

Geographical Locations and the is advisable." "In the south. ...it is damp,
Individual Condition foggy and dewy, people there prefer to sour
taste and preserved food, so they have tight
The climatic and seasonal conditions, muscles and red skin. People in this region
geographical locations, patient's age, are susceptible to cramps of tendons and
constitution and others must be taken into rheumatism, for which acupuncture is
consideration to determine an appropriate advisable." The above shows that -
method in acupuncture treatment. therapeutic methods are closely related to
1) Climatic and seasonal conditions 112 geographical locations, life style and nature
accordance with the characteristics of of diseases.
climate and seasons, appropriate therapeu- 3) Individual comditia~lras Treatment is
tic methods are used. It is said in Chapter 9 also based on age, sex and constitution. For
of Miraculous Pivot, "In spring, the path- exa.mgle, men and women are different in
ogenic factors are most likely to attack physiology, women have menstruation,
the superficial layer; in summer, they are pregnancy and puerperal problems, so the
most likely to attack the skin; in- autumn, points should be carefully selected when
they are most likely to attack the muscles; treatment is given. People of different ages
and in winter, they are most likely to attack are different in physiology and pathology.
the tendons and bones. In treatment of such As to constitution, there are strong, weak,
disorders, the techniques should remain more heat, more cold. Besides, the sensitivity
consistent with the seasons." Generally, in to acupuncture varies individually. In the
spring and summer, shallow acupuncture is Chapter 38 of Miraculous Pivot, it says, "A
applied, and in autumn and winter, the deep middle-aged strong person with sufficient qi
acupuncture is preferrsd. and blood, and hard skin may, if being
In addition, the acupuncture time is also attacked by the pathogenic factors, be
 Chinese Acupuncture and Moxibustion

treated by a deep needling with the needle Pivot that "yin and yang deficiency should
retained for some time." It says again, be treated by moxibustion." The commonly-
"Since an infant has weak muscles and less used reinforcing methods are as follows:
volume of blood and qi, acupuncture For reinforcing kidney qi, Shenshu (B 23),
treatment is given twice a day with shallow Guanyuan (Ren 4), Taixi (K 3), etc. are used
needling and weak stimulation." It is-further either with the reinforcing method or
in Chapter 5 of PYftr"ik"crr/GiisPhG: ----------------
rncaxikrla~finn
that "a deep needling with the needle For reinforcing qi of the spleen and
retained for some time should be applied to stomach, Zhongwan (Ren 12), Qihai (Ren
physical labourers, whereas, slow insertion 6), Zusanli (S 36), etc. are used either with
of the needle should be given to mental the reinforcing method or moxibustion.
workers." For replenishing qi and blood, Pishu (B
20), Geshu (B 1 7), Zusanli (S 36), Sanyinjiao
(Sp 6), etc. are used either with the
reinforcing method or moxibustion.
1 THERAPEUTIC METHOD For nourishing kidney yin, Taixi (K 3),
Zhaohai (K 6), Zhishi (B 52), etc. are used
The therapeutic methods are worked out. with the reinforcing method. But the
under the guidance of the treating principles reinforcing method shall in no case be used if
and differentiation of syndromes, including the pathogenic factors are excessive and
se!ection of points and applicatidn of strong, or if the pathogenic f2ctors are not
acupuncture and moxibustion. Acupunc- yet completely eliminated, or if the
ture therapy concerns the theory, method, deficiency syndrome is associated with
prescription and point. Clinically, the four excessive and strong pathogenic factors.
are closely related to one another.
According to Internal Classic and other
medical literature as well as the clinical
experiences, there are six kinds of
therapeutic methods, namely, the reinforc- The reducing method is to dispel the ,
ing, reducing, warming, clearing, ascending pathogenic factors and remove stagnation in
and descending. order to help restore the body resistance,
and is advisable to the excess syndrome. In
the tenth chapter ofA4iraculousPivot, it says
1. Reinforcing that "excessive and strong pathogenic
factors should be eliminated by the reducing
The reinforcing method is used to method," and it says again in the first
strengthen the body .resistance and the zang- chapter of Miraculous Pivot that "in
fu organs and replenish yin, yang, qi, blood acupuncture therapy.. . the excessive and
with acupuncture and moxibustion. It is strong pathogenic factors must be dispelled"
indicated to the deficiency-syndrome. It is and "fullness should be relieved." It is stated
said in Chapter 10 of 1Wiraculous.Pivot that in the fifth chapter of Plain Questions that
"reinforcing is applied in case of deficiency," "blood stagnation should be treated by
and said again in Chapter 73 of Miraculous bleeding."
Chapter 16 A General I[ntr~ductionto Acupuncture Treatment 353

The commonly used reducing methods The commonly used warming methods
are as follows: are as follows:
For dispelling wind to relieve the exterior Remove cold from the meridians by
syndrome, Fengchi (G 20), Hegu (LI 41, etc. warmth. Acupuncture with needle retaining
are needled with the reducing method. or moxibustion is applied to the points along
For promoting defecation and reducing the meridian affected by the pathogenic
heat, Quchi (LI ll), Tianshu (S 25) and cold.
Fenlong (S 40) are needled with the reducing For warming the middle jiao to dispel
method. cold, Zhongwan (Ren 12) and Zusanli (S 36)
For invigorating blood circulation and are punctured with needle retaining or
removing blood stasis, the corresponding moxibustion.
points are pricked to bleed to treat blood For restoring yang from collapse,
stagnation. moxibustion is applied to'Guanyuan (Ren 4)
For removing indigestion, Jianli (Ren 1I), and Shenque (Ren 8) to treat cold
Zusanli (S 36) and Sifeng (Extra) are extremities due to the decline of yang qi.
punctured with the reducing method. But the warming method cannot be used
But the reducing method shall not be for heat syndromes, and moxibustion
applied to the deficiency syndrome or to should be carefully used for syndrome of yin
cases of deficiency complicated with the deficiency.
excess syndrome.

4. Clearing
3. Warming
The clearing method, known as a
The warming method is used to warm the febrifugal approach, is used to clear off the
meridians and remove obstructions from pathogenic heat for resuscitation, or for
them, warm and nourish yang qi, warm the heat syndromes. In Chapter 74 of Plain
middle jiao to dispel cold and restore yang Questions, it states that '"eat syndromes
from collapse, etc. It is applied for cold should be treated by swift needling."
syndromes. In Chapter 74 of Plain Compendium of Acupuncture and Moxibus-
Questions, it says, "Cold syndromes.should tion says that "the internal pathogenic heat
be treated by the warming method," and must be cleared off."
says again in the tenth chapter of the same The commonly used clearing methods are
book that "retain needles for cold as follows:
syndromes." In Chapter 73 of the same book For dispelling the pathogenic heat,
it states that "if the regular meridians Dazhui (Du l4), Quchi (%I 1 1) and Hegu (LI
become tight, moxibustion is applied." In 4) are often needled with the reducing
Chapter 64 of Miraculous Pivot, it points out method.
that "in case of coagulation, give warmth For heat syndromes in the zang-fu organs,
and promote the free flow of qi," and further the Jing-(Well) Point and Ying-(Spring)
stated in Chapter 48 of the same book that Point of the affected meridians are often
"moxibustion is applied in case of cold in needled with the reducing method or blood-
letting.
 354 Chinese Acupuncture and Moxibustion

For clearing off heat and resuscitation, flow of qi should be checked by the
Renzhong (Du 26) and the twelve Jing- descending method." In Chapter 64 of
(Well) Points (L 11,H 9,P 9,LI I , SJ 1, and SI Miraculous Pivot, it says, "Conduct the qi
1 on both sides) are needled with the downward if it is excessive in the upper
reducing method or bloodletting. part," and says again in Chapter 19 of the
same book, "Apply acupuncture to Zusanli
A L - ^----.--
/O --.I--
(3 JV, LV m a n G L ~ G~ G ~ V G L L G Ui
9.3A- A--P
of the
stomach descend." In clinics, the commonly
5. Ascending used descending methods are as follows:
For regulation of the stomach by keeping
The ascending method is used to raise its -perverted qi to descend, Tanzhong (Ren
yang qi and lift the zang-fu organs from 17), Zhongwan (Ren 12), Neiguan (P 6) and
sinking. It is for failure of ascending pure Zusanli (S 36) are needled with the even
yang and sinking of the qi in the middle jiao. movement.
Chapter 74 of Plain Questions says that For soothing the liver and subduing liver
"prolapse must be treated by the ascending yang. Fengchi (620), Taichong (Liv 3) and
method." In Chapter 10 of Miraculous Yongquan (K 1) are needled with the
Pivot, it says that "gtosis must be treated by reducing method.
moxibustion." The Chapter 74 of the same But the descending method cannot be
book points out "qi decending from the used for deficiency syndroms or deficiency
upper portioa must be corrected b y pushing syndrome in f i e upper part and excess in the
4 it up." lower part of the body. In' addition, the
Clinically, acupuncture with the reinforc- descending method can be subdivided into
ing method and rnoxibustion is applied to many approaches, but they are not discussed
the local points in combination with Baihui in this section.
(Du 20), Qihai (Ren 6) Guanyuan (Ren 6),
Zusanli (S 36), etc. to treat dizziness and
vertigo due to failure of pure yang in
ascending, sinking of qi from the middle
jiao, visceroptosis, prolapse of rectum and 111. THE BASIC PRINCIPLES
prolonged dysentery. FOR PRESCRIPTION AND
But the ascending method shall not be
used for patients with yin deficiency and
SELECTION OF POINTS
yang hyperactivity.

Acupuncture and moxibustion is a

therapy by needling or moxibustion to
6. Descending certain points of the human body.
Therefore, proper prescription including
The descending method is used to make selection and combination of points and the
the upward perverted qi go down and to method of treatment employed are
subdue yang. In Chapter 74 of Plain significant to the curative effects. In
Questions, it says that "upward perverted prescription, points should be selected
 . -.
Chapter 16 A General Introduction to Acupuncture Treatment 355

according to their functions and the planned 2) Number of points in a prescription

method should be decided on basis of
differentiation of syndromes. The following Diseases vary in their occurrence and
is an brief introduction to the basic development. Different prescriptions are
principles for prescription and selection of used according to the different ,individuals
points. and diseases. It is stated in Chapter 74 of
Plain Questions that "diseases may appear in
severity or mildness, treatment should be
given according to individual conditions,
1. Acupuncture Prescription and prescriptions may be large or small." In
Chapter 59 of Miraculous Pivot it says that
"diseases are changeable, thus there are
1) What is an acupuncture prescription countless methods of treatment to be
Acupuncture prescription refers to the considered by reference to the condition. A
desired plan to be conducted in treating mild case should be treated by selecting a few
certain diseases. The selection of points and points, while a severe case treated by
methods used are included. The prescription selecting many points." Generally, there are
should list the combination of points, five acupuncture prescriptions according to
methods of manipulation - reinforcing or the number of points selected. They are "big
reducing, duration and frequency of prescription," "small prescription," "odd
treatment, etc. Generally, a list of points in prescription," "even prescription," and
the order from upper to lower portion of the '"compound prescription." The big prescrip-
body, from the back to the abdominal tion refers to the selection of a great number
region, or from the most important ones tc of points, and is applied to a wide range of
the secondary ones should be made. Then disorders in the zang-fu organs, meridians
put down a particular point on one side or and collaterals. For intance, a prescription
bilateral sides, methods of manipulation, for hemiplegia caused by windstroke and
duration of needle retaining and course of epilepsy are often treated by selection of a
treatment, ete large number of points. A small prescription
In the prescription, the following symbols refers to the selection of less points and is
are commonly used for methods of widely used in common ailments, such as
manipulation: malaria and epigastric pain.A compound
T or+ stands for reinforcing; prescription refers to the application of two
or-stands for reducing; or more than two groups of points with
I o r 2 stands for even movement; different functions for complicated cases
- stands for cutaneous needle; which have two or over two symptoms
* stands for imbedding needle; simultaneously. For instance, when head-
5. stands for bleeding with a three-edged ache appears at the same time with
needle; diarrhoea, the prescriptions for both should
A stands for moxibustion; be used. In addition, an "odd prescription"
x stands for moxibustion with moxa indicates only a point is used. For instance,
sticks; Ximen (P 4) is prescribed to treat cardiac
9 stands for warming needle. pain. Shuigou (Du 26) is for pain in the back
 Chinese Acupuncture and Moxibustion

and lumbar region. Moreover, an even exterior and interior relationship of yin and
prescription means a pair of points selected, yang and the function of points.
e.g. the combination of Back-(Shu) Point There are three categories of point
with Front-(Mu) Point, Yuan-(Primary) selection:
Point with Luo-(Connecting) Point, and 1) Selection of nearby points Nearby
points in the upper part with the Eight refers to the local area of the disease or the
Confluent Poi~itsiii the lower part of the 2djazeEtares of tile disezse.
body. a ) Selection of local points Local refers
to the vicinity of the disease. For example,
Jingming (B 1) and Zanzhu (B 2) are selected
for eye disease; Juliao (S 3) and Yingxiang
2. Principles for Point Selection (LI 20) for nose disease; Tinggong (SI 19)
and Tinghui (G 2) for ear disease; Zhongwan
Selection of points along the course of (Ren 12) for epigastric disease and Taiyang
meridians is the basic principle in (Extra) for headache. When there is an ulcer,
acupuncture treatment, which is performed wound or scar in the local area, select
according to the theory of that diseases are adjacent points instead of the local.
related to meridians. In application there are 6) Selection of adjacent points: Ad-
three methods of point selection, namely, jacent refers to the location close to the
selecting points from the affected meridian, diseased area. For instance, Shangxing
seiecting points from the related meridian, (E:: 23) 2nd Tongtian (B 7 ) 2re selected
and selecting points from several meridians. for nose disease; Fengchi (G 20) and
The first refers to a selection of points on the Fengfu (Du 16) for headache; and
diseased meridian to which one of the organs Zhangmen (Liv 13) and Tianshu (S 25) for
is related. The second refers to a selection of gastric pain. The adjacent points may be
points not only from the affected meridian, used independently or in combination with
but also from the meridian related to the the local points. Points from the head and
affected meridian according to the relations trunk selected for problems of the five sense
between the zang-fu organs and meridians. organs and zang-fu organs are within this
Generally, points of the exteriorly-interiorly category.
related meridians or points of the "mother- 2) Selection of distant points Distant
son" related meridians are selected refers to a location far from the diseased
according to the theory of Five Elements. area. Generally, these points are located
The third is used for symptoms caused by below the elbows and knees. It is said in
several diseased meridians, i.e. when a Chapter 70 of Plain Questions, "Points on
patient does not respond to the selected the lower portion should be selected for the
points of one or two meridians, points of upper problems, points on the upper should
other meridians should be used too. Since be selected for the lower problems, and
point selection along the meridians is guided points on the side of the body should be
by the theory of the zang-fu organs and selected for middle problems." For example,
meridians it is essential to have a full Zusanli (S 36) is selected to treat epigastric
understanding of physiology and pathology, and abdominal disorders, Hegu (El 4) is
the running course of the meridians, the selected to treat facial disorders, Xingjian
Chapter 16 A General Introduction to Acupuncture Treatment 357

(Liv 2) is selected to treat swelling and red Selection of the distant 'points forms an
eyes, and Baihui (Du 20) is selected to treat important part in the point selection. For
chronic dysentery (Table 19) example, points on the four extremities are
selected for disorders of the head, trunk and
zang-fu organs. The system of meridians is a
crisscross network running longitudinally
and transversely, superficiallyand deeply. In
combination of points, different approaches
are conducted, such as combining the above
with the below, combining the left with the
right (or crossing combination), combining
the exterior with the interior, and combining
the local with the distant.
Selecting points on the left side to treat
disorders on the right side and vice versa is
known as the crossing combination of
points. It is clearly analyzed in the fifth
chapter of Plain Questions as the
"contralateral puncture" (see Chapter 14).
3) Selection of symptomatic points: This,
refers to the selection of the corresponding
points according to some prominent
symptoms. For example, Dazhui (Du 14)
and Quchi (LI 11) are selected to treat fever,
and Shuigou (Du 26) and Yongquan (K 1)
are selected to treat loss of consciousness in
emergent cases.
Selection of the empirical points falls into
this category. For example, Sifeng (Extra) is
selected to treat infantile indigestion.
Moxibustion applied to Erbai (Extra) is for
hemorrhage of hemorrhoids (Table 20.)

IV. APPLICATION OF SPECIFIC

POINTS

Specific points are those on the fourteen

meridians with specific treating significance.
They are indicated in various diseases.
Clinically, they can be used flexibly
according to the above-mentioned prin-
 Chinese Acupuncture and Moxibustion

Table 20. Example for Symptomatic Point Selection

Symptoms Points
, Fever Dazhui (Du 14), Quchi (L I 1I), Hegu (L 14)
Coma Shuigou (Du 26), Shixuan (Extra)
XT: -..+:.,.,,...,
-L+
lu l g l l ~3 w G ~ L L ~ I ~ Hmxi (S I 3 j j Yimi (H 6)
Clenched jaws Xiaguan (S 7), Jiache (S 6), Hegu (L I 4)
Cough, asthma Tiantu (Ren 22), Dingchuan (Extra) ,

Suffocated chest Tanzhong (Ren 17), Neiguan (P 6)

Cardiac pain Neiguan (P 6), Ximen (P 4)
Hypochondriac pain Zhigou (S J 6), Yanglingquan (G 34)
Abdominal distention Qihai (Ren 6), Zusanli (S 36)
Constination Zhigou (S J 6), Zhaohai (K 6)
Convulsion Megu (L I 4), Taichong (Liv 3)
Epistaxis Shangxing (Du 23), Hegu (L I 4)

ciples in point selection. Speciric points bear called sea points." The sixty-eight problem
different names as mentioned in the chapter in Classic on Medical Problems says that
"General Introduction to Points." Here is a "Jing-(Well) Points are indicated in the
further exploration into their characteristics fullness of the chest; Ying-(Spring) Points in
in the clinical application. the febrile diseases; Shu-(Stream) Points in
the heavy sensation of the body and painful
joints; Jing-(River) Points in cough and
1. Specific Points on the Four Extremites asthma due to pathogenic cold and heat; and
He-(Sea) Points in diarrhea due to
1) The Five-Shu Points These are five perversive flow of qi." Generally speaking,
points of the twelve regular meridians Jing-(Well) Points are indicated in mental
located below the elbow and knee, namely, illness related to the zang organs; Ying-
Jing-(Well), Ying-(Spring), Shu-(Stream), (Spring); Shu-(Stream) and Jing-(River)
Jing-(River) and He-(Sea). They are imaged Points are indicated in disorders along the
by the ancients as the flowing water, outer course of the affected meridians.
representing the volume of qi in the Points on the yin meridians are indicated in
meridians. They are located in an order from the disorders of the internal organs. The He-
below to above and the qi in them increases (Sea) Points are indicated in problems
one by one. It is described in the first chapter related to the fu organs, the Lower He-(Sea)
of Miraculous Pivot, "The points at which qi Points are taken as the main points.
springs up are called well points; the points
where qi flows copiously are called spring
points; the points where qi flows like a The ~smbinmationof Mother and Son
stream are called stream points; the points Points for Reinforcing and Reducing
where qi flows through are called river
points; and the points where qi gathers are In addition to the selection of the Five Shu
Chapter 16 A General Introduction to Acuvuncture Treatment 359

Points according to their therapeutic with the reinforcing method. (Taiyuah

properties, the Five Shu Points can be attributes to earth. The lung pertains to
selected according to the interpromoting, metal, which is promoted by earth, so
interacting, overacting and counteracting Taiyuan is the mother point of the Lung
relations of the Five Elements to which they Meridian.) When the Lung Meridian is
are respectively attributed. The Jing-(Well), involved in an excess syndrome with abrupt
Ying-(Spring), Shu-(Stream), Jing-(River) onset of cough, dyspnea, coarse voice, stuffy
and He-(Sea) Points of the yin meridians are sensation in the chest, failure to lie flat, and
attributed to the Five Elements in the order superficial slippery forceful pulse, Chize (L
of wood, fire, earth, metal and water, but 5), the "son point" of the Lung Meridian is
those of the yang meridians in the order of used with the reducing method. Chze
metal, water, wood, fire and earth. Based on attributes to water, which is promoted by
the interpromoting relation of the Five metal, so Chize is the son point of the Lung
Elements, each meridian has a "mother" Meridian.
point and a "son" point. For instance, the b) Reinforcing or reducing the related
Lung Meridian relates to metal, the meridian:
"mother" of metal is earth, then the "mother Reinforcing or reducing the related
point" of the Lung Meridian is Taiyuan (L meridian is applied on the basis of the
9) which attributes to earth. The "son" of relations of the Five Elements of the zang-fu
metal is water, so the "son point" of the organs. For example, the deficiency
Lung Meridian is Chize (L 5) which syndromes of the Lung Meridian can be
attributes to water. The "mother point" of a treated by reinforcing Taibai (Sp 3), the
meridian has a reinforcing effect, while the earth point of the Spleen Meridian, which
"son point" has a reducing effect. relates to the Lung Meridian (the spleen
Reinforce the mother for deficiency pertains to earth; the lung pertains to metal,
syndrome and reduce the son for excess which is promoted by earth). In contrast, the
syndrome when this principle is applied for excess syndrome of the Lung Meridian can
treatment, but differentiation of syndromes be treated by reducing Yingu (K lo), the
should be done to see the affected meridian water point of the Kidney Meridian, which
and organ, as well as the presentation of relates to the Lung Meridian. (The kidney
excess and deficiency before the selection of pertains to water, the lun,gpertains to metal,
points. In practice the two methods are used: which promotes water.) In addition, the
reinforcing or reducing the affected mother and son points can be selected from
meridian and reinforcing or reducing the. the exteriorly-interiorly related meridians.
related meridian. For example, the deficiency syndrome of the
a) Reinforcing or reducing the affected Lung Meridian can be treated by reinforcing
meridian: Quchi (L I 1I), the mother point of the Large
For example, when the Lung Meridian is Intestine Meridian, but the excess syndrome
involved in a deficiency syndrome with of the Lung Meridian can be treated by
symptoms of chronic cough, asthma on reducing Erjian (L I 2), the son point of the
exertion, weak voice, profuse sweating and Large Intestine Meridian. (The large
thready weak pulse, the "mother point" of intestine pertains to metal. Erjian attributes
the Lung Meridian Taiyuan (L 9) is used to water, which is promoted by metal.)
 360 Chinese Acupuncture and Moxibustion

Table 21. The Five Shu Points of the Yin Meridians

I I1 111
(Wood) (Fire) (Earth) (Metal) (Water)
Jing-(Well) Ying-(Spring) Shu-(Stream)

-rl Lung Shaoshang Yuji Taiyuan Jingqu I Chize

std o $ Hand-Taiyin (L 11) (E 10) (L 9) (L 8) 1 (L 5)

8 Pericardium
Hand-Jueyin
03
Heart Shaochong Shaofu Shenmen
Hand-Shaoyin (H 9) (H 8) 03[ 7)
;; Spleen Yinbai Taibai

Liver Zhongfeng Ququan

Foot-Jueyin (Liv 1) (Liv 4) (Eiv 8)
2%
cu Kidney Yongquan Rangu Taixi Fuliu Yingu
2 Foot-Shaoyin (K 1) (K 2) (K 3)

Table 22. The Five S h Points of the Yang Meridianas,

Five Shu P I1 I11 HV I V

(Metal) (Water) (Wood) (Fire) (Earth)
Meridian Point Jing-(Well) Ying-(Spring) Shu-(Stream) Jing-(River) We-(Sea)
- Sanjian Yangxi 1 Quchi

(L 1 3) (L 1 5) (E 1 11)

Zhigou Tianjing
(SJ6) . (SJlO)
1
E+ 2 1 Hand-Taiyang
Small Intestine Shaoze
(S I 1)
Qiangu
( s 1 2)
Houxi
( s 1 3)
Yanggu
(S 1 5)
Xiaohai
(S 1 8)
Neiting Xiangu Jiexi Zusanli
(S 44) (S 43)

'
0"
11 Gallbladder
1 Zuqiaoyin
1 Xiaxi Zulinqi

, , 2, 1 ,
Foot-Shaoyang (G 44) (G 43) (G 41)
E + I

Zutonggu
---[ Foot-Taiyang (B 66)
Chapter 16 A General Introduction to Acupuncture Treatment.

Table 23. The 66Mothea9'

and 66$om99
Poi~atsfor Reinforcing sand Reducing

Mother Point Son Point

Meridian
(Reinforcing) (Reducing)

Lung Meridian of Taiyuan (E 9) Chize (L 5)

Hand-Taiyin

Large Intestine Meridian Quchi (L H 11) Erjian (E 1 2)

of Hand-Yangming

Stomach Meridian Jiexi (S 4) kidui (S 45)

of Foot-Yangming

Spleen Meridian Dadu (Sp 2) Shangqiu (Sp 5)

of Foot-Taiyin

Heart Meridian of Shaochong (H 9) Shenmen (I37)

Hand-Shaoyin

Small Intestine Meridian (S~

~%QUX H 3) Xiaohai (S 1 8)
of Hand-Taiyang

Bladder Meridian Zhiyin (B 67) Shugu (I3 65)

of Foot-Taiyang

Kidney Meridian of Fuliu (I( 7) Yongquan (K I)

Foot-Shaoyin

Pericardium Meridian of Zhongchong (P 9) Daling (P 7)

Hand-Jueyin

Sanjiao Zhongzhu (S J 3) Tianjing (S J 10)

Meridian of Hand-Shaoyang

Gallbladder Meridian of Xiaxi (G 43) Yangfu (G 38)

Foot-Shaoyang

Liver Meridian of Ququan (Eiv 8) Xingjian (Liv 2)

Foot-Jueyin
 Chinese Acupuncture and Moxibustion

2) The Lower He-(Sea) Points Shangjuxu (S 37); biliary pain and vomiting
of the Six Fa Organs The Lower He- are treated by Yanglingquan (G 34).
(Sea) Points refer to the six He-(Sea) 3) The Yuan-(Primary) Points The Yuan-
primary) Points are located in the vicinity
Points pertaining to the six fu organs
of the wrist and ankle. The twelve Yuan-
along the three yang meridians of foot. (Primary) Points are closely related to the
In the fcaurth chapter caf IViracglczs GTr- mn-m
11 VC. L a u t j
,.-A
a d l u
+ha
n;v
L L L ~ u 5C4113, nvrrd f h n s r u1u
r\rmnf.in
3 1 1~ WL U+IU L I L ~ J
n m

Pivot it says, "The six fu organs, i.e. the points where the primary qi of the zang-
stomach, large intestine, small intestine, fu organs is retained. Disorders of the zang-
gallbladder, bladder and Sanjiao are closely fu organs are usually relieved by needling the
related to the three yang meridians of foot twelve Yuan-(Primary) Points. The first
on each of which thdre is a Lower He-(Sea) chapter of Miraculous Pivot says, "WWh the
Point." At the same time, the three yang five zang organs are diseased, the symptoms
meridians of foot communicate with the will manifest themselves in the conditions of
three yang meridians of hand. The stomach, the twelve Yuan-(Primary) Points with
bladder and gallbladder pertain to the three which they are connected. Each of the five
yang meridians of foot, while the large zang organs is connected with its own Yuan-
intestine, small intestine and Sanjiao not (Primary) Point. For this reason, if we fully
only communicate with the three yang grasp the connections between zang organs
meridians of hand, but also closely and their corresponding Yuan-(Primary)
zofinect With the three yang meridians of Bcir?ts 2s we!! a~ the latter's external
foot. The stomach communicates with manifestations, there will be no difficulty for
Zusanli (S 36); the large intestine with us to understand the nature of the diseases of
Shangjuxu (S 37); the small intestine, with the five zang organs.. .The twelve Yuan-
Xiajuxu (S 39), all pertaining to the Stomach (Primary) Points are effective for treating
Meridian of Foot-Yangming. The large the diseases of the five zang and six fu
intestine and the small intestine pertain to organs." Similar to the Shu-(Stream) Points
the stomach. It means that their there is a Yuan-(Primary) Point on the yang
physiological activities work upward and meridians. The Yuan-(Primary) Points are
downward. The bladder and Sanjiao closely related to Sanjiao and primary qi.
communicating with Weizhong (B 30) and The primary qi originates from the
Weiyang (B 3 1) respectively pertain to the kidneys, distributing over the whole body
Bladder Meridian of Foot-Taiyang, owing and concerning the qi activities. It travels
to the water passage of Sanjiao connected over each yang meridian through Sanjiao.
with the bladder. The gallbladder communi- The place where the primary qi is centred is
cates with Yanglingquan (G 34), a point of the location of the Yuan-(Primary) Point.
the Gallbladder Meridian of Foot- Therefore, they are indicated in deficiency
Shaoyang. As it is mentioned in the fourth and excess syndromes of their respective
chapter of Miraculous Pivot,"The disorders related organs.
of the six fu organs can be treated by the He- 4) The Luo-(Connecting) Points The Lus-
(Sea) Points." For example, gastric pain and (Connecting) Points are situated at the
sour regurgitation are treated by Zusanli (S places where the meridians are distributed
36); dysentery or appendicitis is treated by and the cross of the two exteriorly-interiorly
Chapter 16 A General Introduction to Acupuncture Treatment
363
Table 24. The Lower He-(Sea) Points Pertaining to the Six Fu Organs

Six Fu-Organs Lower He-(Sea) Point

Stomach Zusanli (S 36)
Large intestine Shangjuxu (S 37)
Small intestine Xiajuxu (S 39)
Gallbladder Yanglingquan (G 34)
Bladder Weizhong (B 40)
Sanjiao Weiyang (B 39)
- -

Table 25. The Yuan-(Primary) Points

Meridian Yuan-(Primary) Point

Lung Meridian of Hand-Taiyin Taiyuan (L 9)

Large Intestine Meridian of Hand-Yangrning Hegu (L 1 4)
Stomach Meridian of Foot-Yangrning Chongyang (S 42)
Spleen Meridian of Foot-Taiyin ' Taibai (Sp 3)

Heart Meridian of Hand-Shaoyin Shenmen (H 7)

Small Intestine Meridian of Hand-Taiyang Wangu (S I 4)
Bladder Meridian of Foot-Taiyang Jinggu (B 64)
Kidney Meridian of Foot-Shaoyin Taixi (K 3)
Pericardium Meridian of Wand-Jueyin Daling (P 7)
Sanjiao ~ e i i d i a nof Hand-Shaoyang Yangchi (S J 4)
Gallbladder Meridian of Foot-Shaoyang Qiuxu (G 40)
Liver Meridian of Foot-Jueyin Taichong (Liv 3)

related meridians. On the limbs, each of the Meridian, but also those of the Stomach
twelve regular meridians has a Luo- Meridian. In addition, these are Luo-
(Connecting) Point, which connects with its (Connecting) Points of the Ren and Du
respective exteriorly-interiorly related Meridians and a major Luo-(Connecting)
meridians. That's why the Luo- Point of the Spleen on the trunk. Jiuwei (Ren
(Connecting) Points are indicated in the 15) is the Luo-(Connecting)Point of the Wen
syndromes of their respective exteriorly- Meridian, the collateral of which is
interiorly related meridians. Guide to the distributed on the abdomen to connect the qi
Classics of Acupuncture states that "the Luo- of the abdomen. Changqiang (Du 1) is the
(Connecting) Points are located between Euo-(Connecting) Point of the Du
two meridians. . .If thky are punctured, Meridian, with its collaterals ascend-
symptoms of the exteriorly-interiorly related ing bilaterally along the spine, and is dis-
meridians can be treated." For example, the tributed on the head, joining the
spleen and stomach are exteriorly-interiorly Bladder Meridian of Foot-Taiyang in the
related, Gongsun (Sp 4), the Luo- vicinity of scapula to connect the qi of the
(Connecting) Point of the Spleen Meridian back. Dabao (Sp 21) is the Luo-
can treat not only the diseases of the Spleen (Connecting) Point of the Spleen Meridian,
364 Chinese Acupuncture and Moxibustisn

the collateral of which is distributed on the are diseased, but the former is affected first,
hypochondrium to connect the qi and blood Taiyuan (L 9), its Yuan-(Primary) Point is
of the body. Therefore, Jiuwei (Ren 115) can selected as a main point, and Pianli (kg 61,
be used for abdominal disease; Chamgqiang the kuo-(Connecting) Point of the Large
(Du 1) for back disorders, and Dabao (Sp Intestine Meridian is used as a combining
21) for all the joint problems. point. On the contrary, if the Large Intestine
kIeridian is diseased first and then the Lung
Meridian, Wegu (LP 41, the Yuan-(Primary)
Point should be prescribed as a main point,
The Gombipinaeion sf the Yuan-(Primary) while Lieque (L '71, the Luo-(Connecting)
Points and the Lua-(Connec~mg)Points Point as a combining point. This method is
adopted when the externally-internally
The Yuan-(Primary) Points and Luo- related meridians are affected. And it is
(Connecting) Points may be used independ- known as the combination of the exterior-
ently or in combination. The combination of interior points.
them is called the "host and guest 5) The M-(Cleft) Pohts The Xi-(Cleft)
combination," which is applied according to Points are those located at the sites where qi
the occurring order of the diseases on the and blood in the m-esidians is converged and
exteriorly-interiorly related meridians. accumdated. There are sixteen Xi-(Cleft)
When a meridian is first affected, its Yuan- Points in all of the twelve regular meridians.
(Primary) Point is used, while for second In addition, they cars be foufid oil each
affected meridian, its Luo-(Connecting) Yangqias, Yinqiao, Yangwei and Yinwei
Point is used. For instance, both the Lung Meridians. The Xi-(Cleft) Points are used
Meridian and the Large Intestine Meridian primarily in treatment of the acute diseases

Table 26. The Eua-(Commecting) Points

Lung Meridian of Hand-Taiyin Lieque (L 7 )

Large Intestine Meridian of Wand-Yarnwing Pianli (E 1 6)
Stomach Meridian of Foot-Yanagming Fenglong (S 40)
Spleen Meridian of Foot-Taiyin Gongsun (Sp 4)
Heart Meridian of Hand-Shaoyin Tongli (H 5)
Small Intestine Meridian of l3and-T'aiyang Zhizheng (S 11 7)
Bladder Meridian of Foot-Taiyang Feiyang (B 58)
Kidney Meridian of Foot-Shaoyin Dazhong (K 4)
Pericardium Meridian of Hand-Jueyin Neiguan (P 4)
Sanjiao Meridian of Hand-Shaoyang Waiguan (S J 5)
Lives Meridian of Foot-Jueyin . Guangming (G 37)
Gallbladder Meridian of Foot-Shaoyang Ligsu (Liv 5)
Ren Meridian Jiuwei (Ren 15)
Du Meridian Changqiang (Du 1)
The Major Luo-(Connecting) Point of the Spleen Dabao (Sp 21)
Chapter 16 A General Introduction to Acupuncture Treatment 365

appearing in their corresponding organs. connects with the Chong Meridian; and
For example, Ksngzui (k 6), the Xi-(Cleft) Weiguan (P 6) sf the Pericardium Meridian
Point of the Lung Meridian of Hand-Taiyin links with the Yinwei Meridian. These two
is effective to hemoptysis; Wenliu (LH '7) of meridians are confluent in the chest, heart
the Large Intestine Meridian of Hand- and stomach. Zulinqi ( 41) of the
Yangming is helpful to borborygmus and Gallbladder Meridian connects with the Dai
abdominal pain; Liangqiu (S 34) of the Meridian, and Waiguan ( 9 5) of the
Stomach Meridian of F6ot-Yangming Sanjiao (Triple Energizer) Meridian con-
works for epigastric pain, Ximen (B 4) of the nects with the Yangqiao Meridian. These
Pericardium Meridian of Hand-Sueyin is two meridians are confluent at the outer
effective to cardiac pain and fullness s f the canthus, retroauricle, cheek, shoulder and
chest. diaphragm. Mouxi (S 1 3) of the Small
6) The Eight Confladlent Paints;of the Eight Intestine Meridian leads to the Bu
Exha M e The Eight Confluent (Governor Vessel) Meridian, and Shenmai
Points are those in the extremities (lB 62) of the Bladder Meridian connects
connecting the eight extra meridians. with the Yangqiao Meridian. The two
Gongsun (Sp 4) of the Spleen Meridian meridians are confluent at the inner canthus.

Table 27. The Xi-(Cleft) Point$

I Meridian I Xi-(aeft) Point

Three Yin Lung Meridian of Hand-Taiyin Kongzui (L 6)
Meridians Pericardium Meridian of Hand-Jueyin Xmen (P 4) .
of Hand Heart Meridian of Hand-Shaoyin Yinxi (H 6)

Three Yang Large Intestine Meridian of Hand-Yangming Wenliu (L 1 7)

Meridians Sanjias Meridian sf Hand-Shaoyang Huizong (S J 7)
of Foot Small Intestine Meridian of Hand-Taiyang Yanglao (S I 6)

Three Yin Stomach Meridian of Fost-Yangming Liangqiu (S 34)

Meridians Gallbladder Meridian of Foot-Sbaoyang Waiqiu G 36)
of ]Foot Bladder Meridian of Foot-Taiyang Jinmen (B 63)

.Three Yang Spleen Meridian of Foot-Taiyin Diji (Sp 8)

Meridians Liver Meridian of Foot-Jueyin Zhongdu (Liv 6)
of Hand Kidney Meridian of Foot-Shaoyin Shuiquan (K 5)

Yangqiao Meridian
Extra Yinqiao Meridian
Meridians Yangwei Meridian
Yinwei Meridian
346 Chinese Acupuncture and Modbustion

nape, ear, shoulder and back. Lieque (L 7) of are considered the most important.". In
the Lung Meridian leads to the Ren practice, the Eight Confluent points may be
(Conception Vessel) Meridian, and Zhaohai used independently. For instance, problems
(K 6) of the Kidney Meridian connects with of the Du Meridian are treated by Houxi (S 1
the Yinqiao Meridian. The two meridians 3), disorders of the Chong Meridian are
are confluent in the lung system, throat and treated by Gongsun (Sp 4) or the Confluent
diaphragm. The Eight Confluent Points are Point on the upper liiiib ciii~kUe c~mLuincd
indicated in diseases of the extra meridians with the Confluent Point on the lower limb.
and their related regular meridians For example, Neiguan (I? 6) is combined
according to their connexions. Introduction with Gongsun (Sp 4) to treat diseases of the
to Medicine says that "among the 360 points heart, chest and stomach. Mouxi (S I 3) is
on the whole body, 66 points located at the combined with Shenmai (I3 62) for diseases
four extremities are important, and among of the neck, shoulder, back and inner
these 66 points, the Eight Confluent points canthus.

Table 28. The Eight Cbnfluent Points of the Eight Extra Meridians

2. Specific Points on the Head and Trunk When the zang-fu organs are diseased, there
appears a tenderness in the corresponding
1) Back-Shu Points The specific points Back-Shu Point. In Chapter 5 1 of Miracul-
on the back are called the Back-Shu Points, ous Pivot, it says, "In order to make sure of
where the qi of the zang-fu organs is infused. the point located accurately, one may press
They are named in accordance with their the part to see if the patient's original pain
corresponding zang-fu organs, such as the gets relieved, if so, the point has been located
Back-Shu Point of the heart is called Xinshu correctly." The Back-Shu Points are
(B 15); the Back-Shu Point of the lung is indicated in diseases of the corresponding
called Feishu (B 13); the Back-Shu Point of zang-fu organs. For instance, Feishu (B 13)
the liver is called Ganshu (B 18) and so on. may be used for the problems of the lung;
Chapter 16 A General Introduction to Acupuncture Treatment 367

Ganshu (B 18)is used for the problems of the used to treat the problems of five zang
liver, etc. In addition, the Back-Shu Points organs, and the Front-Mu Points are
can be used for the illness of the sense mainly effective to the problems of six fu
organs. For instance, Ganshu (B 18), the organs. For example, Xnshu (B 15) is
Back-Shu Point of the liver, may be chosen helpful to the heart diseases; Ganshu (B 18)
to treat eye troubles, as eye is the opening of works for the liver diseases; Zhongwan (Ren
the liver. Shenshu (B 23), the Back-Shu 12) is effective to the stomach diseases and
Boint of the kidney, can be prescribed to Tianshu (S 25) is good for the large intestine
treat ear disorders, as ear is the opening of diseases.
the kidney. This is one of the methods to treat yang
2) The Front-(Mu) Points The Front- disease from yin and vice versa (Table 29)
(Mu) Points are those located at the chest
and abdomen, where the qi of the zang-fu
organs is infused. Since they are situated
closely to their respective related zang-fu
organs, any problems of the zang-fu organs The Combinratiomof the Back-Shu Poimts
can be seen in the corresponding Front- and the Front-Mb Points:
(Mu) Points. For instance, a tenderness may
appear in Riyue (G 24) or Qimen (Liv 14) if
the gallbladder is affected, and if the
stomach is diseased, there is a tenderness in The Back-Shu Points and the Front-Mu
Zhongwan (Ren 12). Therefore, the Front- Points may be used independently or in
(Mu) Points are mainly applied to treat combination. Whenever an internal organ is
disorders of the zang-fu organs and in the affectedj the Back-Shu Point or the Front-
local areas. For example, liver disorders Mu Point pertaining to that organ may be
associated with hypochondriac pain may be prescribed. The application of both may
treated by needling Qimen (Liv 14), and strengthen the therapeutic effects. For
abdominal pain due to large intestine instance, Weishu (B 21) on the back and
disorders may be relieved by needling Zhongwan (Ren 12) om the abdomen may be
Tianshu (S 25). selected for gastric disorders; or Pang-
The Back-Shu Points and the Front-Mu guangshu (B 28) in the sacral region and
Points work for diseases of the zang-fu Zhongji (Ren 3) in the lower abdomen for
organs. In addition, they are of different disorders of the bladder.
nature of yin and yang. The Back-Shu 3) The Eight Influential Points of the Eight
Points located on the back pertain to yang, Tissues The Eight Influential Points refer to
while the Front-Mu Points located on the the specific points which have particular ef-
chest and abdomen pertain to yin. It is stated fects in treatment of disorders relating to the
in the sixty-seventh problem of Classic on zang, fu organs, qi, blood, tendon, pulse and a

Medical Problems, "Diseases of the zang vessels, bone and marrow. Each of the Eight
organs (yin) are manifested in the Back-Shu Influential Points overlaps the other point.
Points, and the diseases of fu organs (yang) It is said in Classic on Medical Problems,
are manifested in the Front-Mu Points." "Zhongwan (Ren 12) is the Influential Point
Therefore, the Back-Shu Points are mainly of the fu organs; Zhangmen (Liv 13) is the
368 Chinese Acupuncture and Moxibustion

Influential Point of the zang organs; syndrome, Tanzhong (Ren 17), the
Yanglingquan (G 34) is the Influential Point Influential Point of qi is applied." In clinics,
of tendons; Xuanzhong (G 39) is the they are used not only for heat syndromes,
Influential Point of marrow; Geshu (U 17) is but also for a 1 kinds of diseases of the eight
the Influential Point of blood; Dazhu (I3 11) tissues. For example, Zhangmen (Liv 13)
is the Influential Point of bone; Taiyuan (L may be selected for diseases of the zang
71 is tbc a Pnint nf pulse and organs and Geshu (I3 17) may be used for
vessels; and Tanzhong (Ren 17) is the disorders of blood.
Pnfluential Point of qi. For interior heat

Table 29. The Back-Shu Points and Front-(Mu) Points

Internal Organs Back-Shu Point Front-(Mu) Point

Lung Feishu (B 13) Zhongfu (L 1)
Pericardium Jueyinshu (B 14) Tanzhong (Ren 17)
Heart Xnshu (I3 15) Juque (Ren 14)
Liver Ganshu (I3 18) Qimen (Eiv 14)
Gallbladder Danshr? (El 19) Riyue (G 24)
Spleen Bishu (B 20) Zhangmen (Liv 13)
Stomach Weishu (B 21) Zhongwan (Ren 12)
s2rrjiao Sanjiaoshu (B 22) Shimen (Wen 5)
Kidney Shenshu (B 23) Jingrnen (G 25)
Large Intestine Dackangshu (B 25) Tianshu (S 25)
Small Intestine Xaochangshu (I3 27) Guanyuan (Ren 4)
Bladder Pangguangshu (B 28) Zhongji (Rela 3)

4) The Crossing Points The Crossing

h i n t s refer to those located at the
intersection of two or more meridians,
including the ta;velve regular meridians and
the eight extra meridians. There are about
ninety crossing points and most of them are
distributed on the trunk, the head and the
face. They can be used to treat disorders of
the pertaining meridians and the intersected
meridians. Generally, they are often used to
treat the diseases appearing simultaneously
in meridians intersecting each other. For
example, Guanyuan (Ren 4) and Zhongji
(Ren 3) located at the intersection of three
yin meridians and the Ren Meridian may be
used to treat diseases of the three foot yin
Chapter 16 A General Introduction to Acupuncture Treatment 369

meridians. Sanyinjiao (Sp 6), a crossing edited by Wang Bing, Medical Highlights,
point in the three foot yin meridians is used the Illustrated Manual of Acupoints on the
for diseases of the Liver, Spleen and Kidney New Bronze Figure, Compendium of
Meridians. Acupunclure, and illustrated Supplement to
The number of the Crossing Points the Classzfied Classics. The following is
increased after the publication of Systematic made based on Systematic Classic of
Classic of Acupu~cture, Plain Questions Acupuncture.
370 Chinese Acupuncture and Moxibustion

Binao (LI 14)

I I I I I I I I I I

""0" indicates the meridian of origin and ''g " the crossing meridian.
Chapter 16 A General Introduction to Acupuncture Treatment

The Crossing Points on the Yin Meridians

372 Chinese Acupuncture and Moxibustion

Zhaohai (K 6) 0 Promoted by
Yinqiao
Jiaoxin (K 8) 0 Xi-(Cleft) of
J yhqiao
Zhubin (K 9) 0 Xi-(Cleft) of Yinwei
L
J I
 Chapter 17
INTERNAL DISEASES

I. EMERGENCY DISEASES AND strain and stress, or invasion of exogenous

SYNDROMES CAUSED BY pathogenic wind, all leading to upsurge of
EXOGENOUS PATHOGENIC liver yang and heart fire, which makes qi and
blood go upward together with turbid
FACTOR
phlegm, disturbing the mind and resulting in
this disease. In mild cases there are only
I. Wind Stroke symptoms showing dysfunction of the
meridians and collaterals, while in severe
cases both dysfunction of zang-fu organs -
Wind stroke is an emergency case
manifested by falling down in a fit with loss and that of the meridians and collaterals are
of consciousness, or hemiplegia, slurred manifested. The syndrome indicating the
speech and deviated mouth. It is attack on the zang-fu organs may be
characterized by abrupt onset with subdivided into tense (excess) type and
pathological changes varying quickly like flaccid (deficiency) type.
the wind, from which the term "wind Tense (excess) syndrome results from'
stroke" comes. disturbance of the mind by the phlegm heat,
or collection of kxcessive fire in the heart and
Etiology and Pathogenesis liver, while flaccid (deficiency) syndrome
Wind stroke often occurs in the aged who results from deficiency of the primary qi or
are in poor health, with deficiency of qi and collapse of the kidney yang. In untreated or
blood, or deficiency in the lower part of the improperly treated cases, the tense
body and excess in the upper part. It may be syndrome tends to become flaccid and the
caused by deficiency of the kidney yin due to prognosis is often poor.
sexual indulgence, or by irregular food
intake, which impedes the transportation Differentiation
and transformation function of the spleen, a) Attack on the zang-fu organs:
leading to production of phlegm from i) Tense syndrome:
accumulated dampness and transformation Main manifestations: Falling down in a fit
into heat. Then there appears imbalance of with loss of consciousness, tightly closed
yin and yang in the zang-fu organs. Other hands and clenched jaws, flushed face.
causative factors are exasperation, agita- coarse breathing, rattling in the throat,
tion, alcohol indulgence or overeating, over retention of urine, constipation, red tongue
 Chinese Acupuncture and Mofibustion

with thick yellow or dark grey coating, have been restored, yet there exists
string-taut, rolling and forceful pulse. stagnation of qi and blood in the meridians
Analysis: Wind stirred up by upsurge of and collaterals.
liver yang sends qi and blood upwards, Main manifestations: Hemiplegia, numb-
which together with the accumulated ness of the limbs, deviated mouth, slurring
phlegm fire disturb the mind, leading to of speech, accompanied by headache,
c l l d d ~ mIli~cc sf c s g ~ c i \.x,~jhh
U U U U W A I l V U U
g ~ ~ di~ziness,
~ ~ ti"D""J
~mhtlxr ~ vertigo, twitching o f m-mr.lec, red
closed hands and clenched jaws, flushed eyes and flushed face, thirst, dryness of the
face, coarse breathing, retention of urine throat, irritability, string taut and rolling
and constipation. Excessive wind phlegm pulse.
brings about rattling in the throat. Red Analysis: Wind phlegm enters the
tongue with thick yellow coating or dark meridians and collaterals due to imbalance
grey coating, string-taut, rolling and forceful of yin and yang, or after treatment the
pulse are the signs of wind combined with functions of the affected zang-fu organs
phlegm fire. have been restored, but wind phlegm still
ii) Flaccid syndrome: blocks the meridians and collaterals, causing
Main manifestations: Falling down in a fit retarded circulation of qi and blood. Hence
and sudden loss of consciousness with appe,ars hemiplegia, numbness of the limbs,
mouth agape and eyes closed, snoring but deviated mouth and slurring of speech. If
feeble breathing, flaccid paralysis of limbs, complicated with upsurging of liver yang,
Incnntinence of urine, flaccid tongue, and upward disturbance of wind yang, the
thready, weak pulse, and in severe cases cold symptoms are headache, dizziness, vertigo
limbs, or flushing of face as rouged, fading and twitching of muscles. If there is excessive
or big floating pulse. fire in the heart and liver, there may be red
Analysis: Severe weakness of primary qi, eyes and flushed face, thirst, dryness of the
separation of yin and yang and exhaustion throat and irritability. Stagnation of wind
of qi in the zang organs are indicated in phlegm in the meridians and collaterals
mouth agape, eyes closed, snoring but feeble leads to a string-taut and rolling pulse.
breathing, flaccid paralysis, and incont-
inence of urine. Flaccid tongue and thready
weak pulse suggest the deficiency of blood Treatment
and prostration of the. kidney yang. If a ) Attack on the zang-fu organs:
complicated with cold limbs, flushed face, i) Tense syndrome
fading or big floating pulse, it is a criticzl Method: Points of the Du Meridian, the
case, indicating exhaustion of yin in the Liver Meridian of Foot-Jueyin and the
lower portion of the body and upward going twelve Jing-(Well) points are selected as the
of the isolated yang. main points to promote resuscitation,
b ) Attack on the meridians and collaterals reduce wind and fire and resolve phlegm.
There are two categories. One is that only Either reducing method or pricking, to cause
the meridians and collaterals are attacked- little bleeding, is applied.
without the zang-fu organs being involved. Prescription: Baihui (Du 20), Shuigou
The other is that after wind stroke the (Du 26), Fenglong (S 40), Taichong (Liv 3),
functions of the affected zang-fu organs Yongquan (K l), twelve Jing-(Well) points
Chapter 17 Internal Diseases

on both hands (L 11, H 9, P 9, LI 1, SJ 1, SI Explanation: Shenque (Ren 8), Qihai

1). (Ren 6) and Guanyuan (Ren 4) are located
Supplementary Points: on the lower abdomen along the Ren
Clenched Jaws: Xiaguan (S 7), Jiache (S Meridian and are the main points effective
6), Hegu (L 14) for collapse. Heavy moxibustion applied on
Aphasia and stiffness of tongue: Yamen Guanyuan (Ren 4), a meeting point of the
(Du 1S),Lianquan(Ren 23),and Tongli (HS). Ren Meridian and three yin meridians, can
Explanation: As the condition is due to strengthen the primary qi, and restore yang
disturbance of the heart by phlegm fire from collapse.
associated with upsurging of liver yang and b ) Attack on the meridians and collaterals:
upward flowing of qi and blood, Baihui (Du Method: Points along the Du Meridian
20) and Shuigou (Du 26) are selected to and the yang meridians of the affected side
regulate qi of the Du Meridian, effecting are mainly used to regulate qi and blood,
resuscitation, Yongquan (K 1) is selected to remove obstruction from the meridians and
conduct the heat downward, and Taichong collaterals and reduce the wind. Needle with
(Liv 3) to subdue the upsurging of qi in the even movement first from the healthy side
Liver Meridian and pacify the liver yang. and then the affected side.
Pricking the twelve Jing-(Well) points on Prescription: Baihui (Du 20), Tongtian (B
both hands, where qi of the three yin and 7), Fengfu (Du 16).
three yang meridians meet, may dispel heat Upper limbs: Jianyu (LI 15), Quchi (LI
and regain consciousness. The spleen and 11), Waiguan (SJ 5), Hegu (LI 4).
stomach are the source of phlegm Lower limbs: Huantiao (G 30), Yangling-
production. Fenglong (S 40), the Luo- quan (G 34), Zusanli (S 36), Jiexi (S 41).
(Connecting) point of the Stomach Supplementary points:
Meridian can invigorate the functions of the Upward disturbance of wind yang:
spleen and stomach and help to resolve the Reducing is applied to Fenchi (G 20) and
turbid phlegm. Since the Yangming Taichong (Liv 3), and reinforcing to Taixi
Meridians of Hand and Foot supply the (K 3) and Sanyinjiao (Sp 6).
cheeks, Xiaguan (S 7), Jiache (S 6) and Hegu Excessive fire in the heart and liver:
(LI 4) are chosen to promote the circulation Reducing is applied to Daling (P 7) and
of qi and blood for relieving the clenched Xingjian (Liv 2), and reinforcing to Taixi (K
jaws. Yamen (Du 15) and Lianquan (Ren 3)-
23), being local and adjacent points of the Deviated mouth: Dicang (S 4), Jiache (S
tongue, and Tongli (H 5), the Luo- 6).
(Connecting) point of the Heart Meridian, Explanation: Du Meridian is the sea of all
may relieve stiffness of tongue. yang meridians. Baihui (Du 20),Fengfu (Du
ii) Flaccid syndrome 16) combined with Tongtian (B 7) can
Method: Moxibustion is applied to points eliminate wind and remove obstruction
of the Ren Meridian to restore yang from from the meridians and collaterals. Since the
collapse. yang meridians dominate the exterior of the
Prescription: Shenque (Ren 8), Qihai body and qi, points of the yang meridians
(Ren 6) (indirect moxibustion with salt), are selected to regulate qi and blood of the
Guanyuan (Ren 4). body and promote smooth circulation in the
 Chinese Acupuncture and Moxibustion

upper and lower portions of the body. For Etiolsgy and Pathogenesis
the upper disturbance of wind yang, Fengchi a) Deficiency type:
(G 20) and Taichong (Liv 3) are selected to Syncope of this type is often caused by
reduce the wind and pacify the liver. general deficiency of the primary qi and
Reinforcing applied to Taixi (K 3) promotes failure of clear yang in ascending due to
the production of the kidney yin to nourish overstrain or grief and fright, or by
the liver. Reinforcing applied to Sanyinjiao ,==haiisiisn of qi %fter .

(Sp 6) nourishes yin and pacifies yang. b ) Excess type:

For excessive fire in the heart and liver, It is due mainly to emotional
reducing Daling (P 7) and Xingjian (Liv 2) disturbances, such as anger, fear and fright,
can eliminate the fire, while reinforcing to leading to deranged flow of qi, which rushes
Taixi (K 3) nourishes yin to reduce the fire. upwards to the heart and chest, blocking the
Dicang (S 4) and Jiache (S 6) are selected for windpipe and disturbing the mind, or due to
the purpose of promoting a free circulation upsurging of liver yang, and upward flowing
of qi in the meridians and collaterals around of qi followed by perversion of blood flow
the facial region. after a fit of anger, leading to disturbance of
the mind, and resulting in loss of
Remarks consciousness.
a) Wind stroke is referred to cerebral
hemorrhage, thrombosis, embolism, sub- Differentiation
arzchnoid hemorrhage, etc. When the acute 2) Eeficimcy s;lndro,?ze:
stage is over, there may be sequelae, such as Main manifestations: Feeble breathing
hemiplegia, monoplegia, aphasia, etc. with mouth agape, spontaneous sweating,
b )Prophylactic measures for wind stroke: pallor, cold limbs, deep and thready pulse.
The old aged with deficiency of qi and Analysis: Dizziness, vertigo, loss of
excessive phlegm, or with manifestations -of consciousness, feeble breathing are the
upsurging of liver yang marked by dizziness symptoms caused by deficiency of primary
and palpitations, may have prembnitory qi with sudden perversion of its flow, sinking
symptoms such as stiff tongue, slurred of qi in the spleen and stomach and failure of
speech and numbness of the finger tips. the clear yang in ascending. Cold limbs are
Attention should be paid to diet and life style caused by failure of yang qi to reach there.
and avoid overstraining. Frequent Weakness of primary qi and disabilities of
moxibustion on Zusanli (S 36) and vital qi in controlling the pores are shown in -
Xuanzhong (G 39) may prevent an attack of spontaneous sweating, and mouth agape.
wind stroke. Deep thready pulse also suggests deficiency
of vital qi.
2. Syncope b ) Excess syndrome:
Main manifestations: Coarse breathing,
Syncope is manifested by sudden fainting, rigid limbs, clenched jaws, deep and excess-
pallor, cold limbs and loss of consciousness, type pulse.
which are often resulted from emotional Analysis: Perversion of qi after a fit of
excitement, fright, or debilitation and anger makes qi activity impeded and blood
overstraining. rushing upward together with qi to disturb
, Chapter 17 Internal Diseases

the mind, and hence occur sudden collapse, Explanation: Shuigou (Du 26) and
loss of consciousness, clenched jaws and Zhongchong (P 9) are used to promote
rigid limbs. Obstruction of qi in the lung resuscitation. Hegu (LI 4) and Taichong
gives rise to coarse breathing. Deep and (Liv 3) are the points for regulating the
excess-type pulse is a sign of excess circulation of qi and blood. Laogong (P 8)
syndrome. and Yongquan (K 1) promote a clear mind
Syncope manifestated by sudden loss of and smooth flow of qi and blood.
consciousness should be distinguished from Remarks
wind stroke and epilepsy. This condition includes simple fainting,
Wind stroke: Loss of consciousness is postural hypotension, hypoglycemia, hys-
complicated by hemiplegia and deviated teria, etc.
mouth. Usually there are sequelae after
,

restoration to consciousness.
3. Sunstroke
Epilepsy: Loss of consciousness is
accompanied by convulsions, expectoration
Sunstroke is an acute case occurring in
of frothy saliva or yelling. When the ,
summer, manifested by high fever,
consciousness is regained the patient;
irritability, nausea, or even followed by
becomes as normal as usual.
collapse and loss of consciousness. The
onset of this disease is due mostly to
Treatment
prolonged exposure to the sun, or to an
a ) Deficiency syndrome:
environment with high temperature.
Method: Points of the Du and
Pericardium Meridians are selected as the Etiology and Pathogenesis
main points to promote resuscitation, Summer heat, a pathogenic factor, is
reinforce qi and invigorate yang. Reinforc- prevalent in summer time when the weather
ing is applied in acupuncture, combined with is scorching. Long exposure to the sun and
moxibustion. to an environment with high temperature
Prescription: Shuigou (Du 26), Baihui damages qi. Invasion of pathogenic summer
(Du 20), Neiguan (P 6), Qihai (Ren 6), heat in a condition of lower resistance brings
Zusanli (S 36). about sunstroke. Summer heat is a
Explanation: Shuigou (Du 26), Baihui pathogenic factor of yang nature with a
(Du 20) and Neiguan (P 6) are the points for tendency to attack the human body quickly.
resuscitation. Qihai (Ren 6) and Zusanli (S Therefore the onset is abrupt and the
36) are good for reinforcing qi and changing of the pathological condition is
invigorating yang. rapid. Pathogenic summer heat is likely to
b) Excess syndrome: damage the primary qi and consume the
Method:Reducing is applied to points of body fluid, leading to exhaustion of qi and
the Du and Pericardium Meridians to yin. Furthermore, pathogenic summer heat
promote resuscitation and regulate the flow may penetrate the pericardium and disturb
of qi. the mind, followed by impairment of
Prescription: Shuigou (Du 26), Hegu (LI consciousness. Sunstroke, according to its
4), Zhongchong (P 9), Laogong (P 8), clinical manifestations, may be classified
Taichong (Liv 3), Yongquan (K 1). into mild and severe types.
 chinese Acupuncture and Moxibustion

Differentiation Explanation: Dazhui (Du l4), the meeting

a ) Mild type: point of the Du Meridian and all yang
Main manifestations: Headache, dizzi- meridians, Weizhong (B 40), also named
ness, profuse sweating, hot skin, coarse Xuexi, and Quchi (LB 11), an important
breathing, dry mouth and tongue, dire point for eliminating heat, are used to dispel
thirst, superficial, large and rapid pulse. the summer heat. Neiguan (P 6), the Luo-
Analysis: Pathogenic summer hear tends p i n t sf FGzyiaFVaeri&iZE=f
jcoiiiieciiilg-)
,to attack the head and gives rise to headache Hand, is chosen to reduce the fire and to
and dizziness. Hot skin results from the protect the heart.
accumulation of pathogenic summer heat in b ) Severe type:
the body surface. Profuse sweating, coarse Method: Reducing is applied to the points
breathing, dry mouth and tongue, dire thirst of the Du Meridian to promote
are all due to evaporation of body fluid by resuscitation, and to dispel the summer heat.
the summer heat. Superficial, large and Prescription: Shuigou (Du 26), Baihui
rapid pulse is a sign showing the presence of (Du 20), Shixuan (Extra), Quze (P 3),
the pathogenic summer heat. Weizhong (I3 40).
b ) Severe type: Explanation: Summer heat is a patho-
Main manifestations: Headache, dire genic factor of yang nature, which is apt to
thirst, and shortness of breath at first, and attack the pericardium and disturb the
then collapse, loss of consciousness, mind. Shuigou (Du 26) and Baihui (Du 20)
sweating, deep and forceless pulse. are seleeked ";promote res~scitat,icn.Quze
Analysis: This syndrome mostly occurs in. (P 6), the We-(Sea) point of Hand-Jueyin,
those doing physical labour in the scorching Weizhong (B 40), the He-(Sea) point of Foot
suranmer sun. Overfatigue plus the attack of Taiyang are pricked superficially to remove
summer heat results in lowered body the heat from the blood. Blood letting at
resistance and excessiveness of the Shixuan (Extra) can reduce heat and
pathogenic factor with consumption of qi promote resuscitation.
and body fluid. So there are headache, dire
thirst and shortness of breath at the very Remarks
beginning. The pathogenic summer heat can a ) This illness includes thennoplegia,
rapidly penetrate into the interior, affecting thermospasm, heliosis, etc.
the pericardium and disturbing the mind. b ) Scraping therapy: It is a popular
Therefore loss of consciousness follows. treatment for mild sunstroke. Dip a smooth
Sweating and deep, forceless pulse indicate spoon into water or vegetable oil and scrape
exhausti011 of qi and body fluid. the both sides of the spine, the neck,
intercostal spaces, shoulder regions, cubital
Treatment and axilla' fossae until purplish red colour
a ) Mild type: appears.
Method: Reducing is applied to the points
of the Du, Pericardium and Large Intestine
Meridians to eliminate the summer heat.
Prescription: Dazhui (Du 141, Neiguan (I? ~ o m m o ncold is an exogenous ailment
6), Quchi (LI 11), Weizhong (I3 40). with headache, nasal obstruction, aversion
 Chapter 17 Internal Diseases

to wind and fever as its main manifestations. Main manifestations: Chills, fever,
It often results from lowered superficial anhidrosis, headache, soreness and pain of
resistance and invasion of the exogenous the limbs, nasal obstruction, running nose,
pathogenic factors. It may occur in any itching of the throat, cough, hoarse voice,
season. According to the difference in profuse thin sputum, thin white tongue
weather, pathogenic factors and body coating, superficial and tense pulse.
constitution, the manifestations can be Analysis: Invasion of the body surface by
classified into two types: wind cold and wind pathogenic wind and cold impairs the
heat. dispersing function of the lung and affects
the nose, causing nasal obstruction and
Etiology and Pathogenesis discharge. Pathogenic cold is of yin nature,
This disease is often due to delicate which is likely to damage yang. Impairment
constitution and weakened body resistance of superficial yang is manifested by exterior
which makes the body inadaptable to symptoms such as chills, fever, anhidrosis,
intense changes of the weather with headache, even soreness and pain of the
abnormal cold or warmth. Then the limbs. Thin white tongue coating and
exogenous pathogenic wind invades the superficial tense pulse are the signs showing
body through the pores, skin, mouth and the invasionbf the lung and the superficial
nose, leading to manifestations related to defensive system by pathogenic wind and
lung and the defensive function. Very often cold.
pathogenic wind combined with other b ) Wind heat:
pathogenic hctors like pathogenic cold Main manifestations: Fever, sweating,
causes a wind cold syndrome, or with slight aversion to wind, pain and distending
pathogenic heat causes a wind heat sensation of the head, cough with yellow,
syndrome. Invasion of exogenous patho- thick sputum, congested and sore throat,
genic wind and cold may retard the hng's thirst, thin white or yellowish tongue
dispersing function and block the pores, coating, superficial and rapid pulse.
while invasion of exogenous pathogenic Analysis: Pathogenic wind heat often
wind and heat may impair the lung's attacks the body through the nose and
descending function by the evaporating mouth. The lung is involved first.
heat, and lead to abnormal functioning of Pathogenic wind of yang nature is
the pores. In addition, since the patient's characterized by upward and outward
body build is different and the internal and dispersion. When a fight goes on between
external causes are mutually influenced, the the pathogenic wind heat and the body
manifestations after invasion by the resistance, fever, slight aversion to wind and
pathogenic factors must be varied. For sweating result. When the pathogenic wind
patients with yang deficiency, wind cold heat attacks the head, symptoms like gain
syndrome is mostly seen, while for those and distending sensation occur in the head.
with yin deficiency, wind heat syndrome is In case the lung fails in dispersing and
. often found. descending, there appears cough with
yellow, thick sputum. When the pathogenic
Differentiation wind heat stifles the air passage, there is
a ) Wind cold: congested sore throat with thirst. Thin,
380 Chinese Acupuncture and Moxibustion

white or yellowish tongue coating, and Prescription: Dazhui (Du 14), Quchi (Ll
superficial rapid pulse are the signs showing 1I), Waiguan (SJ 5), Hegu (LI 4), Yuji (L
the lung and the defensive system being lo), Shaoshang (L 11).
attacked by the pathogenic wind heat. . Explanation: The Du Meridian is the sea
of all the yang meridians. Dazhui (Du 14), a
Treatment point where all the yang meridians meet, is
a) W-ind coid: used to eliminate neat and other patnogenic
Method: Reducing is applied to the points factors of yang nature. Hegu (LI 4) and
of the Du, Taiyang and Shaoyang.Meridians Quchi (LI 11) are the Yuan-(Primary) point
to eliminate wind cold and relieve exterior and the He-(Sea) point of the Yangming
symptoms. Even movement combined with Meridian of Hand respectively. Since the
moxibustion is applied to patients with Yangming and Taiyin Meridians of Hand
weakened constitutions. are externally and internally related,
Prescription: Fengfu (Du 16), Fengmen reducing applied to these two points can
(B 12), Fengchi (G 20), Lieque (L 7), Hegu clear lung qi and reduce heat. Yuji (L lo), the
(LI 4). Ying-(Spring) point of the Lung Meridian,
Explanation: Fengfu (Du 16) is used to in combination with Shaoshang (L 1I), can
relieve the exterior symptoms, eliminate eliminate heat from the lung and ease the
wind and check headache. Fengmen (B 12), throat. Waiguan (SJ 5), the Luo-
a point of the Taiyang Meridian which (Connecting) point of the Shaoyang
dominates the surface of the whole body, is Meridian of Hand connecting with the
selected to regulate the circulation of qi in Yangwei Meridian, can dispel pathogenic
this meridian, to eliminate'wind cold and to factors of yang nqture in the exterior of the
relieve chills and fever. As the pathogenic body and eliminate heat.
cold has attacked the surface of the body,
and the lung is the organ related to the skin Remarks
and hair, Lieque (k 7), the Luo- a) The above treatment can also be used
(Connecting) point of the Lung Meridian, is for other viral and bacterial infections of the
used to promote the dispersing function of upper respiratory tract as well as influenza.
the lung and to check cough. Fengchi (G 20), However, common cold should be
a point at the intersection of the Foot distinguished from other infectious diseases
Shaoyang and Yangwei Meridians, of which with similar symptoms at the early stage.
the latter dominates yang and the exterior, is b) Prophylactic measures: Moxibustion
used to eliminate wind cold. Since the Taiyin is applied daily to Fengmen (B 12) or Zusanli
and Yangrning Meridians are externally and (S 36) to prevent common cold during its
internally related, Hegu (LI 4), the Yuan- prevalence.
(Primary) point of the Yangming Meridian,
is used to eliminate the pathogenic factors
and relieve the exterior symptoms. Malaria is a disease characterized by
b ) Wind heat: paroxysms of shivering chills and high fever
Reducing is applied to the points of the occurring at regular intervals, mostly found
Du, Shaoyang and Yangming Meridians to in late summer and early autumn, but also
eliminate wind heat. sporadically occurring in other seasons. The
Chapter 17 Internal. Diseases

causative factor is the malarial pestilential of qi and blood caused by improper

factor. The recurrence of chills and fever transportation and transformation function
varying with the condition of yin and yang of the spleen and stomach as a result of
and body constitution, may be once every irregular food intake. Zhang Jingyue once
day, every second day or every third day, said: "Malaria is an exogenous disease. . . .
known respectively as quotidian malaria, Only in the condition of delicate health, or
tertian malaria and quartan malaria overstrain and stress, is one apt to be
according to the interval between attacks. In attacked by the malarial pathogenic factor."
chronic cases there may be a mass in the In. a word, the causative factor is the
hypochondriac region, termed "malaria pestilential factor, but the condition of body
with splenomegaly." resistance plays a very important role. One
with the body resistance vigorous enough to
Etiology and Pathogenesis prevent the invasion by pathogenic factors
The disease is believed to be caused seldom suffers from malaria, whereas one
mainly by the malarial pestilential factor with lowered body resistance is apt to be
together with invasion of pathogenic wind, attacked.
cold, summer heat and dampness. Improper
food intake, overstrain and stress, and Differentiation
irregular daily life can predispose one to Main manifestations: Paroxysms of
'

malaria by weakening the body resistance. shivering chllls and high fever with general
Invasion of the Shaoyang Meridian by the hot sensation, preceded by yawning and
pathogenic factors causes ying-wei dishar- lassitude. There appear intolerable head-
mony, resulting in malaria. ache, flushed face and red lips, stifling
a) The pestilential factor together with feeling in the chest and hypochondriac
the pathogenic wind cold, summer heat, and region, bitter taste and dry mouth, and dire
dampness invades the body, resides in the thirst. At the end of the paroxysm the patient
+portionbetween the exterior and interior, breaks out in profuse perspiration and fever .
and moves outward and inward between subsides with the body felt cool. Thin, sticky
ying and wei. When they move inward to and yellow tongue coating, string-taut and
struggle with yin, there are chills, and when rapid pulse. In chronic cases a mass in the
they move outward to fight with yang, there hypochondriac region -splenomegaly . is
is fever. It is clear that the paroxysm of chills usually found.
and fever depends on the struggle between Analysis: Occurrence of shivering chills
the antipathogenic factors and pathogenic and high fever is due to the fight of the
factors. If the pathogenic factors and the pathogenic factors against ying and wei in
antipathogenic factors are separated from the portion between the exterior and interior
each other, or if the pathogenic factors avoid of the body. There appears an interval
fighting with the ying and wei, there appears between paroxysms of chills and fever if the
an interval between the paroxysms. pathogenic factors avoid fighting with ying
b) Only when the body resistence is weak, and wei. Yawning, lassitude and chills with
the pestilential factor invades the body. shivering are caused by the invasion of
Weakened body resistance may be due to pathogenic factors which suppress yang qi.
abnormal daily life, overstrain, or deficiency General hot sensation, intolerable headache,
 382 Chinese Acupuncture and Moxibustion

flushed face and red lips indicate that the Explanation: Dazhui (Du 14), the meeting
accumulated pathogenic cold has turned point of the three yang meridians and the Du
into heat. The stifling feeling in the chest and Meridian, can promote the circulation of qi
hypochondriac region, and bitter taste in the in the yang meridians and help to eliminate
mouth suggest that the pathogenic factors in pathogenic factors, in combination with
the Shaoyang Meridian and in the portion Taodao ( u 13), which can remove
hetween the exterior and interior impair the obstruction from the Du Meridian and
circulation of qi and blood. Thirst results regulate yin and yang. They are the chief
from the consumption of the body fluids by points for malaria. Yemen (SJ 2) and Zulinqi
heat. Thin, sticky and yellow tongue (G 41), two points along the Shaoyang
coating, string-taut and rapid pulse are the Meridians can harmonize qi of the
signs related to the presence of cold and heat Shaoyang Meridians. Houxi (SI 3), a point
and the contradiction between the of Taiyang Meridian of Hand, can activate
antipathogenic factors and pathogenic the circulation of qi in the Taiyang and the
factors. The chronic case with a mass formed Du Meridians and drive pathogenic factors
in the hypochondriac region is due to out. Jianshi (P 5), a point of Jueyin Meridian
deficiency of qi and blood and stagnation of of Hand, is an empirical point for malaria.
excessive phlegm in the meridians and Combination of all the above mentioned
collaterals. points can promote the circulation of qi in
the yang meridians, and help to eliminate '

Treatment pathogenic factors, relieve both the

Method: Reducing is applied to the points symptoms, harmonize ying and wei, and
of the Du and Shaoyang Meridians to check malaria. Quchi (LI 1l), a point of
regulate the Du Meridian and to harmonize Yangming Meridian of Hand, combined
the Shaoyang Meridians. Treatment is given with Dazhui (Du 14) can dispel heat.
two hours prior to the paroxysm. If chills are Zhangmen (Eiv 13), the influential point
-
predominant during the paroxysm, acup- dominating zang organs can regulate qi in
uncture is advised to combine with the zang organs. Pigen, an extra point, is
moxibustion. If fever is the dominant selected to treat the mass in the
symptom, acupuncture alone is employed. hypochondriac region.
Prescription: Dazhui (Du 14), Taodao Acupuncture treatment of tertian malaria
(Du 13), Houxi (S I 3), Jianshi (P 5), Yemen has achieved better effects. Pernicious
(S 9 2), Zulinqi (G 41). malaria should be treated by acupuncture in
Supplementary points: combination with mehicine.
High fever: Quchi (L I 11) with reducing
method.
Malaria with splenomegaly: Needling of
Zhangmen (Liv 13) and moxibustion at IIe ZANG-FU SYNDROMES
Bigen (Extra).
High fever with delirium and mental I. Cough
confusion:
Prick the twelve Jing-(Well) points (L 11, Cough, a main symptom of the lung
. H 9 , P 9 , L I 1 , S I 1 , S I 1). problems, may result either from attack by
Chapter 17 Internal Diseases

exogenous pathogenic factors disturbing the by internal injury in clinic results from
dispersion of qi of the lung, or from dryness of the lung with deficiency of yin,
disorders of the lung itself or other diseased and blockage of the lung by phlegm.
zang-fu organs affecting the lung.
Differemtia~ow
Etiology and Pathogenesis a ) Invasion by the exogenous pathogenic
a ) Invasion by the exogenous pathogenic jactors:
factors: i) Wind-cold type:
The lung dominates qi and is regarded as Main manifestations: Cough, itching of
an umbrella protecting the five zang organs. the throat, thin and white sputum, aversion
Upward it connects the throat and has its to cold, fever, anhidrosis, headache, nasal
opening in the nose, governing respiration. obstruction and discharge, thin, white
Externally it associates with the skin and tongue coating and superficial pulse.
hair. Once the lung is attacked by the Analysis: Cough, itching of the throat,
exogenous pathogenic factors, the qi of the thin and white sputum, nasal obstruction
lung is blocked and fails to descend, thus and discharge result from the attack of the
resulting in cough. lung by pathogenic wind cold, which is
Since the weather changes in different stagnated in the respiratory tract, affecting
seasons, the exogenous pathogenic factors the dispersion of the qi of the lung.
attacking the human body are various. Headache, aversion to cold, fever and
Cough is therefore divided into two types: anhidrosis are due to wind cold affecting the
wind cold and wind heat. skin and hair, and residing on the body
b ) Internal injury: surface. Thin, white tongue coating and .
Cough resulted from functional impair- superficial pulse indicate the presence of the
ment of the zang-fu organs falls into the pathogenic factors staying in the lung and in
category of cough due to internal injury, the superficial part of the body.
such as cough caused by dryness of the lung ii) Wind-heat type:
with deficiency of yin leading to failure of Main manifestations: Cough with yellow,
the qi of the lung to descend, or by disorders thick sputum, choking cough, thirst, sore
of the other organs affecting the lung. For throat, fever, or headache, aversion to wind,
example, in case of weakened spleen yang, sweating, thin, yellow tongue coating,
the accumulated dampness may be turned superficial and rapid pulse.
into phlegm which goes upward to the lung, Analysis: In case of the attack of the lung
affecting the normal activities of qi and by the pathogenic wind heat, the function of
leading to cough. Stagnation of liver qi may the lung in clarifying the passage and
be turned into fire, which flares up and sending down the qi is impaired. The fluids
injures the lung fluid, also resulting in are heated'and turned into phlegm, and so
cough. As said in Internal Classic: "Cough cough with yellow, thick sputum or choking
can be caused by disturbance not only of the cough takes place. When the heat in the lung
lung, but of any other zang-fu organs." No injures body fluid, thirst and sore throat
matter which zang-fu organ is dysfunc- occur. When the pathogenic factors stay in
tioned, cough may result if the lung is the skin and hair, their conflict with the body
affected. The commonly seen cough caused resistance gives rise to headache, aversion to
 Chinese Acupuncture and Moxibustion

wind, sweating and fever. Thin, yellow yin of the lung with endogenous heat,
tongue coating, and superficial rapid pulse afternoon fever and malar flush may be
are the signs of wind heat staying in the lung present. Red tongue, thin coating, and
and in the superficial part of the body. thready rapid pulse are the signs indicating
b ) Internal injury: deficiency of yin and dryness of the lung.
i) Blockage of the lung by phlegm:
c--,n P,,,,L
A A^:- -- ,- : - e n .
lvnalll ~ l l a u ; l ~LaCLruua.
a LLJ ugu "';"
W L L ~ n'-n
L ~ L V = Taeataepat
f&e, white and sticky sputum, stuffiness and a ) Invasion by exogenous pathogenic
depression of the chest, loss of appetite, factors:
white, sticky tongue coating and rolling Method: Select the points from the Taiyin
pulse. and Yangming Meridians of Hand as the
Analysis: "The spleen is considered as the principal ones. Both acupuncture and
source in the production of sputum and the moxibustion are applied in case of wind
lung as a container to store it." If the spleen cold, while only acupuncture is used in case
fails in its transformation and transpor- of wind heat to activate the dispersing
tation, the water dampness will no longer be function of the lung and to relieve the
transported and then gathered to form symptoms.
phlegm, which goes upward to the lung, Prescription: Lieque (L 7), Hegu (LI 4),
affecting the qi of the lung and causing its Feishu (B 13).
failure in descending. The result is cough Supplementary points:
with prsfuse sputnrn or with white, sticky Pain 2nd swelling of the throat:
sputum. If water dampness stays in the Shaosbang (L 11).
middle jiao, impairing its activity, there may Fever and aversion to cold: Dazhui (Du
be stuffiness and depression of the chest and 14), Waiguan (SJ 5).
loss of appetite. White, sticky tongue Explanation: The Taiyin and Yangming
coating and rolling pulse are due to internal Meridians of Hand are exteriorly-interiorly
obstruction by the phlegm. related. Lieque (L 7), the Luo-(Connecting)
ii) Dryness of the lung with deficiency of point, and Hegu (LI 4), the Yuan-(Primary)
yin: point, are selected in combination with
Main manifestations: Dry cough without Feishu (B 13) to strengthen the functional
spwtum or with scanty sputum, dryness of activities of the lung, to relieve symptoms
the nose and throat, sore throat, spitting and to eliminate the exogenous pathogenic
blood or even coughing blood, afternoon factors, resulting in smooth flow of qi of the
fever, malar flush, red tongue, thin coating, lung and the normal dispersing function of
thready and rapid pulse. the lung.
Analysis: Dryness is easy to consume the 6) Internal injury:
body fluid. If the lung is injured by dryness, i) Blockage of the lung by phlegm:
the function of the lung will be impaired, Method: Select the Back-Shu point and
manifested by dry cough without sputum or the points of the Yangming Meridian of
with scanty sputum, dryness of the nose and Foot as the principal points. Both
throat, or sore throat. If the lung vessels are reinforcing and reducing methods should be
injured by dryness, blood in the sputum or considered in acupuncture treatment, or
hemoptysis results. If there is deficiency of combined with moxibustion to strengthen
Chapter 17 Internal Diseases 385

the function of the spleen and to resolve Kidney Meridian of Foot-Shaoyin curving
phlegm. around the genital organ. The two points
Prescription: Feishu (B 13), Zhongwan located up and down are selected as a
(Ren 12), Chize (L 5), Zusanli (S 36), combination of the Eight Confluent points
Fenglong (S 40). to nourish yin, eliminate dryness, clear the
Explanation: The Back-Shu point and the throat and descend the lung qi. Kongzui (L
Front-Mu point are the points where qi of 6), the Xi-(Cleft) point of the lung, is
the zang-fu organs converges. Feishu (B 13) indicated in acute cases of the lung. Geshu
and Zhongwan (Ren 12) are selected in (B 17) is a blood point of the Eight
combination with Zusanli (S 36), the He- Influential Points. The two points are used
(Sea) point of Yangming Meridian of Foot, in combination to stop bleeding.
to strengthen the function of the spleen and
harmonize the stomach, remove dampness
and resolve phlegm. Chize (L 5), the He- a) If cough is accompanied by fever and
(Sea) point of the Lung Meridian, is able to asthma, see "Common Cold" and
reduce the pathogenic factors from the lung "Asthma."
and relieve cough. Fenglong (S 40), the Euo- b) Cough is often seen in common cold,
(Connecting) point of the .Yangming acute and chronic bronchitis, pneumonia,
Meridian of Foot, is selected to strengthen bronchiectasis and pulmonary tuberculosis.
smooth transport of qi in the spleen and c) Cupping:
stomach. Thus the body fluids are normally Fengmen (B 12), Feishu (B 13).
distributed following the free flow of qi and d) Cutaneous needle:
phlegm is resolved. Tap along the Du Meridian and the
ii) Deficiency of yin with dryness of the . Bladder Meridian on the upper part of the
lung: back till the skin becomes red or bleeds
Method: Select the Back-Shu point and slightly.
Front-Mu point of the Lung Meridian as the
principal points. Even-movement is applied
in acupuncture treatment to nourish yin, 2. Asthma
eliminate dryness and descend lung qi.
Prescription: Feishu (B 13), Zhongfu (L Asthma is a common illness characterized
l), Lieque (L 7), Zhaohai (K 6). by repeated attacks of paroxysmal dyspnea
Supplementary points: with wheezing.
Kongzui (L 6) and Geshu (B 17) in case of Generally speaking, it involves a variety
coughing blood. of disorders resulting from disturbance of qi
Explanation: The selection of Feishu (B activities, and can be divided into two types:
13) and Zhongfu (L 1) is a method of deficiency and excess.
combining Back-Shu point and Front-Mu
point. It is used to regulate the lung passage Etiology and Pathogemesis
and descend lung qi. Lieque (L 7), the Luo- The causative factors are varied from the
(Connecting) point of the Lung Meridian of exogenous pathogenic factors to weakened
Hand-Taiyin, is connected with the Ren body resistance. Asthma due to exogenous
Meridian. Zhaohai (K 6) is a ~ o i n of t the pathogenic factors is of excess type, and that
 Chinese Acupuncture and Msxibustion

due to weakened body resistance is of early stage, absence of thirst, white tongue
deficiency type. coating, superficial and tense pulse.
a ) Excess type: Analysis: The lung is in charge of
Wind-cold type: It denotes asthma due to respiration and is associated with the skin
invasion of wind cold, which impairs the and hair, which are first attacked by wind
smooth flow of the lung qi, injures the skin cold in the invasive procedure. If wind cold
A
, a,:, ,A
, ,,I,,,
allu I I ~ I Iallu
,,,
,, ,I,,,A c;,,~
l l l a ~ b aL I L ~~ U I L . D L.IW~C.CL.
,.I+
U I I I ~ ~
ic t k IUzB, sizgnzticn of ;I,Y* -**-
~nrl
the lung and the superficial defensive system failure of the lung qi in dispersing result in
are weakened, the lung qi fails to disperse cough with thin sputum and rapid
and descend, leading to cough. breathing. If wind cold still resides in the
Phlegm-heat type: It refers to asthma due superficial part of the body to make the
to failure of the spleen in transformation and pores close, there appear chills, fever,
transportation, resulting in productiop of headache and anhidrosis. Since the wind
phlegm from the accumulated dampness. cold has nat transformed into heat yet, thirst
Long-standing retention of phlegm turns is absent. White tongue coating, superficial
into heat, or excessive fire of the lung and tense pulse are the signs of wind cold
evaporates the fluids to phlegm. When the staying in the lung and the defensive system.
phlegm fire stays in the lung, the lung qi is ii) Phlegm-heat type:
stagnated and the normal activity of the lung Main manifestations: Rapid and short
is impaired. Failure of the lung qi in breathing, strong and coarse voice, cough
descending Ic;;nct;,an results in asthma. with thick yellow s p t u n . ~sensltion
, ef chsst
b ) Deficiency type: stuffiness, fever, restlessness, dryness of the
i) Lung deficiency: A prolonged and mouth, thick yellow or sticky coating,
protracted cough can weaken and injure the rolling and rapid pulse.
lung qi. Overstrain and internal injury can Analysis: Phlegm heat turned from
also bring about deficiency of the lung qi. In dampness or long-standing phlegm fire
either case, shortness of breath and dyspnea gathered in the lung blocks the air passage,
may occ.ur. causing impairment of the lung qi, and thus
ii) Kidney deficiency: Overwork and presenting rapid and short breathing, strong
sexual indulgence can injure the kidney. A and coarse voice, and cough with thick
severe or chronic disease weakens the body yellow sputum. When the phlegm stays in
resistance and damages the essential qi. the lung, sensation of chest stuffiness
Long-standing asthma also affects the appears. Fever, restlessness and dryness of
kidney. In any of the above cases, failure of the mouth are due to the presence of the fire
the kidney in receiving qi may give rise to heat. Thick yellow or sticky coating, rolling
asthma. and rapid pulse are the signs of the phlegm
heat. I

Differentiation b ) Deficiency type:

a ) Excess type: i) Lung deficiency:
i) Wind-cold type: Main manifestations: Short and rapid
Main manifestations: Cough with thin breathing, feeble voice, weak and low sound
sputum, rapid breathing, accompanied by of coughng, sweating on exertion, pale
chills, fever, headache, and anhidrosis at the tongue, pulse of deficiency type.
Chapter 17 Internal Diseases

Analysis: The lung dominates qi. When Meridian and located in the vicinity of the
there is deficiency of the lung qi the function lung. They are able to clear the lung and
of the lung is impaired. There appear short eliminate wind. Dazhui (Du 14), Lieque (L
and rapid breathing, feeble voice, weak and 7) and Negu (LI 4) are in function to
low sound of coughing. When the lung qi is eliminate wind and cold, clear the lung and
weak, and the superficial defensive system is soothe asthma.
not strong, even mild exertion will induce b) Phlegm heat:
sweating. Pale tongue and pulse of Method: Points of the Hand-Taiyin and
deficiency type are the signs of deficiency of Foot-Yangming Meridians are selected as
the lung qi. the principal points with reducing method
ii) Kidney deficiency: applied to resolve phlegm, reduce heat and
Main manifestations: Dyspnea on soothe asthma.
exertion after longstanding asthma, severe Prescription: Feishu (B 13), Dingchuan
wheezing, indrawing of the soft tissues of (Extra), Tiantu (Ren 22) Chize (E 5),
the neck, short breath, lassitude and Fenglong (S 40).
weakness, sweating, cold limbs, pale tongue, Explanation: Chize (L 5), the He-(Sea)
deep and thready pulse. point of the Hand-Taiyin Meridian, is able
Analysis: Long-standing asthma affects to reduce phlegm heat and soothe asthma.
the kidney which is the source of qi. The Fenglong (S 40), a point of the Foot-
kidney in lowered functioning fails to receive Yangming Meridian, is able to strengthen
qi, and therefore dyspnea on exertion, severe the spleen function and resolve phlegm.
wheezing and short breath appear. When Feishu (I3 13) is applied to clear the lung and
there is deficiency of the kidney qi in a regulate the flow of qi. Tiantu (Ren 22) is in
chronic case, emaciation and lassityde function to descend qi and resolve phlegm.
happen. Exhausted kidney yang may lead to Dingchuan (Extra) is an empirical point to
weakening of the superficial defensive yang, pacify breathing.
and hence swearing. If the yang qi fails to c ) Deficiency type :
warm up the body surface, cold limbs i) Lung deficiency:
appear. Pale tongue, deep and thready pulse Method: Points of the Hand-Taiyin and
are the signs OK weakened kidney yang. Foot-Yangming Meridians are selected as
the principal points with reinforcing method
Treatment applied to strengthen the lung qi.
a ) Wind cold: Moxibustion is also advisable.
Method: Points of the Hand-Taiyin and Prescription: Feishu (B 13), Taiyuan (L 9),
Hand-Uangming Meridians are selected as Zusanli (S 36), Taibai (Sp 3).
the principal points. Reducing method is Explanation: Taiyuan (L 9), the Yuan-
applied in combination with moxibustion to (Primary) point of the Lung Meridian, is
eliminate wind cold and soothe asthma. able to reinforce the lung qi. Feishu (B 13)
Prescription: Feishu (B 1 3 , Fengrnen (B used in acupuncture and moxibustion, can
12), Dazhui (Du 14), Lieque (L 7), Hegu (LI strengthen the lung qi. Zusanli (S 36) is the
4). He-(Sea) point of the Stomach Meridian of
Explanation: Feishu (B 13) and Fengmen Foot-Yangming. Taibai (Sp 3) is the Yuan-
(B 12) are the points of the Foot-Taiyang (Primary) point of the Spleen Meridian. The
 Chinese Acupuncture and Moxibustion

lung pertains to metal and the spleen to asthmatic bronchitis, obstructive pulmon-
earth, which is able to promote metal. ary emphysema and dyspnea present in
"Reinforce the mother in case of some other diseases. However, for
deficiency." Zusanli (S 36) and Taibai (Sp 3) symptomatic dyspnea, a combined treat-
are selected here to strengthen the lung ment should be taken into account.
through invigorating the spleen and
stomach.
ii) Kidney deficiency: 3. Epigashic Pain
Method: Points of the Foot-Shaoyin and
Ren Meridians are selected as the principal Epigastric pain is a common symptom,
points with reinforcing method applied to often characterized by repeated recurrence.
strengthen the kidney function in receiving Since the pain is close to the cardia, it was
qi. Moxibustion is also advisable. also named "cardio-abdominal pain" or
Prescription: Taixi (K 3), Shenshu (B 23), "cardiac pain" in ancient times.
Feishu (B 13), Tanzhong @en 17), Qihai
(Ren 4). Etiology and. Pathogenesis
Supplementary points: a) Irregular food intake, preference for
Persistent asthma: Shenzhu (Du 12), raw and cold food and h ~ n g e rinjcre the
Gaohuang (I3 43) spleen and stomach, causing failure of the
Deficiency of the spleen: Zhongwan (Ren spleen in transportation and transformation
1 3 , Pishu (B 20). and failure of the stomach qi in descending,
Explanation: Taixi (K 31, the Yuan- then pain appears.
(Primary) point of the Kidney Meridian, is b) Anxiety, anger and mental depression
able in combination with Shenshu (B 23) to damage the liver, causing failure of the liver
strengthen the primary qi of the kidney. in dominating free flow of qi, adversely
Tanzhong (Ren 17), the qi point of the Eight attacking the stomach, impeding its activity
Influential Points, and Feishu (B 1 3 , the and hindering its qi descending, then pain
Back-Shu point of the lung, are needled to appears.
reinforce qi and pacify breathing. Qihai c) Generally lowered functioning of the
@em 61, an important point to reinforce qi, spleen and stomach, due to invasion of
is able to regulate qi in the lower jiao, pathogenic cold, which is stagnated in the
reinforce the kidney, strengthen the primary stomach, causes failure of the stomach qi in
qi, invigorate yang and control essence. descending, then pain occurs.
Puncture on these points strengthens the
kidney in receiving qi and pacify breathing. Dsfferem~a~om
Moxibustion on Shenzhu (Du 12) and a ) Retention of food:
Gaohuang (I3 43) may relieve chronic Main manifestations: Distending pain in
asthma, while moxibustion on Zhongwam the epigastrium, aggravated on pressure or
(Ren 12) and Bishu (B 20) may strengthen after meals, belching with fetid odour,
'the function of the spleen and reinforce qi. anorexia, thick, sticky tongue coating, deep,
forceful or rolling pulse.
Remarks Analysis: Retention of h o d in the
This condition includes bronchial asthma, stomach makes the stomach qi fail to
 Chapter 1 7 Internal Diseases

descend, then distending pain in the weak, general lassitude occurs, as well as the
epigastrium and belching with fetid odour regurgitation of thin fluid. Since the
occur. Retention of food is an excess condition is due to deficiency and cold, pain
condition, pain is therefore aggravated upon is relieved on pressure and by warming.
pressure. Since the stomach is injured by rhin, white coating and deep slow pulse are
retention of h o d , pain becomes worse after the signs of lowered function of the spleen
meals and anorexia appears. Thick, sticky and stomach with cold stagnation.
tongue coating, deep, forceful or rolling
pulse are the signs of retention of food. Treatment
b ) Attack of the stomach by the liver qi: a ) Retention of food:
Main manifestations: Paroxysmal gain in Method: The Front-(Mu) point of the
the epigastrium, radiating to the hypo- stomach and the points of the Yangming
chondriac regions, frequent belching Meridian of Foot are selected with reducing
accompanied by nausea, vomiting, acid method applied to remove retention, pacify
regurgitation, abdominal distension, anor- the stomach and relieve pain.
exia, thin, white tongue coating, deep, Prescription: Jianli (Wen 1I), Neiguan (P
string-taut pulse. 6), Zusanli (S 36), Inner-Neiting (Extra).
Analysis: Stagnation of the liver qi makes Explanation: Zhongwan (Ren 12) is the ,

the liver fail to dominate the free flow of qi. Front-(Mu) point of stomach, Zusanli (S
If the depressed liver qi attacks the stomach, 36), the Lower He-(Sea) point of -the
pain in the epigastrium appears. As the Liver Stomach and Neiguan (P 61, a Confluent
Meridian locates along both hypochondriac Point. They are indicated in stomach, heart
regions, the pain is wandering and may be and chest disorders, and used in
referred to both hypochondriac regions. In combination to pacify the stomach and
' case of stagnation of the qi, belching occurs, relieve pain. Inner-Neiting (Extra) is an
even symptoms like nausea, vomiting, acid empirical point to treat retention of food.
regurgitation, abdominal distension and b ) Attack of the stomach by the h e r yi:
anorexia may appear. Thin, white tongue Method: Points of Jueyin and Yangming
coating and deep string-taut pulse are the Meridians of Foot are selected as the
signs of attack of the stomach by the principal points with the reducing method
perversive liver qi. applied to rem'ove the stangnation of liver qi,
c ) Deficiency of the stomach with to pacify the stomach and to relieve pain.
stagnation of cold: Prescription: Qimen (Eiv 14), Zhongwan
Main manifestations: Dull pain in the (Ren 12), Neiguan (P 6), Zusanli (S 36),
epigastrium, which may be relieved by Taichong (Liv 3).
pressure and warmth, general lassitude, Explanation: Qimen (Liv 14) is the Front-
regurgitation of thin fluid, thin, white (Mu) point of the liver and Taichong is the
tongue coating, deep, slow pulse. Yuan-(Primary) point of the Liver
Analysis: Lowered function of the spleen Meridian. The two are used in combination
and stomach with cold invasion retards to remove the stagnation of liver qi, regulate
transportation and transformation, so dull the flow of qi and relieve pain. Zusanli (S
pain appears in the epigastrium. The spleen 36), Zhongwan (Ren 12) and Neiguan (P 6)
dominates the limbs. If the spleen yang is are applied to pacify the stomach, relieve
 Chinese Acupuncture and Moxibustion

pain and check vomiting. the stomach. It may occur in many diseases,
c) Deficiency of the stomach with but the most comnlvn causes are retention of
stagnation of cold: food, attack of the stomach by the liver qi
Method: The Back-Shu points and points and hypofunction of the spleen and
of the Ren Meridian are selected as the stomach.
principal points with both acupuncture and
E G ~ B y~ g2nd PstBa~gp~gsis
moxibustion to warm up the middle jiao,
Overeating of raw, cold and greasy food
dispel cold and regulate the flow of qi and
leads to upward perversion of the stomach
relieve pain.
qi, resulting in vomiting.
Prescription: Zhongwan (Ren 12), Qihai
Emotional disturbance and depression of
(Ren 6), Pishu (I3 20), Neiguan (P 6), Zusanli
the liver qi harm the stomach, impairing the
(S 36), Gongsun (Sp 4).
downward movement of the stomach qi,
Explanation: Acupuncture and moxibus-
causing vomiting.
tion at Zhongwan (Ren 12) and Zusanli (S
Weakness of the spleen and stomach or
36) warm the middle jiao, dispel cold,
overstrain leads to hypofunction of the
regulate the flow of qi and relieve pain.
stomach in transportation and transfor-
Neiguan (P 6) and Gongsun (Sp 4), the
mation, them causing retention of food. The
Confluent Points, are indicated to treat
stomach qi ascends instead of descends.
stomach disorders. Moxibustion on Pishu
(B 20) strengthens the spleen, pacifies the Differentiatiow
stomach, dispels cold and relieves pain. a ) Retention of food:
Indirect moxibustion with ginger on Qihai Main manifestations: Acid fermented
(Ren 6) is most desirable in the treatment of vomitus, epigastric and abdominal disten-
chronic gastric pain due to cold of deficiency sion, belching, anorexia, loose stool or
type, as ginger and moxa together have the constipation, thick, granular tongue coat-
function of dispelling cold. ing, rolling and forceful pulse.
Analysis: Retention of food impedes the
Wemarks function of the spleen and stomach in
a) Epigastric pain is a symptom found in transportation and transformation. Since qi
peptic ulcer, gastritis, gastric neurosis and in the middle jiao is stagnated, there appear
diseases of the liver, gallbladder and epigastric and abdominal distension,
pancreas. belching and anorexia. Retention of food
b) Cupping: Cupping is applied with leads to upward flowing of the turbid qi, so
large or medium-sized cups mainly to the add fermented vomitus, and loose stool or
upper abdomen or Back-Shu points for ten constipation occur. Thick, granular tongue
to fifteen minutes. coating and rolling, forceful pulse are the
signs of retention of food.
b) Attack of the stomach by the liver qi.
4. Vomiting Main manifestations: Vomiting, acid
regurgitation, frequent belching, distending
Vomiting is a common symptom in clinic, pain in the chest and hypochondriac regions,
resulting from the failure of the stomach qi irritability with an oppressed feeling, thin,
to descend, or from other disorders affecting sticky tongue coating, string-taut pulse.
C.hapter 17 Internal Diseases 39 1

Analysis: Depressed liver qi attacks the function of the spleen and warm up the
stomach, causing upward perversion of the middle jiao.
stomach qi, so there occur vomiting, acid Prescription: Zhongwan ( R g 12),
regurgitation, frequent belching, distending Zusanli (S 36), Neiguan (P 6), Gongsun (Sp
pain in the chest and hypochondriac regions. 4)-
In case of stagnation of the liver qi, Supplementary points:
irritability with an oppressed feeling occurs. Retention of food: Xiawan (Ren 10). .
Thin, sticky tongue coating and string-taut Attack of the stomach by the liver qi:
pulse are the signs of the stagnation of the Taichong (kiv 3).
liver qi. Weakness of the spleen and siomach:
c ) Hypofunction of the spleen and Pishu (B 20).
stomach: Persistent vomiting: Jinjing, Yuye
Main manifestations: Sallow complexion, (Extra).
vomiting after a big meal, loss of appetite, Explanation: Zusanli (S 36) is the He-
lassitude, weakness, slightly loose stool, pale (Sea) point of the Stomach Meridian and
tongue, thin, white tongue coating, thready Zhongwan (Ren 121, the Front-Mu point of
and forceless pulse. the stomach. The two points used together
Analysis: Weakness of the spleen and are effective in pacifying the stomach and
stomach leads to hypoactivity of the yang in activating the descent of qi. Neiguan (P 6)
the middle jiao, which fails to receive food and Gongsun (Sp 4), one of the pair-points
and water, so vomiting appears after a big of the Eight Confluent points, relieve the
meal. If the spleen fails in transportation and fullness of the chest and stomach. Xiawan
transformation, the essentials of water and (Wen lo), a point located in the epigastrium,
food no longer supply the body for is able to regulate the stomach qi and remove
nourishment, there may appear lassitude, stagnation by applying reducing method
weakness, loss of appetite and slightly loose Needling at Taichong (Liv 3), the Yuan
stool. Bale tongue, thin white tongue (Primary) point of the Liver Meridian
coating, and thready and forceless pulse are regulates the function of the liver. Pishu (B
the signs of weakness of the spleen and 20), a point where the spleen qi is infused,
stomach. used in combination with Zusanli (S 36) and
Gongsun (Sp 4), may reinforce the spleen qi
and invigorate the qi in the middle jiao to
Treatment perform the function of transportation and
Method: The points of Yangrning and transformation and to restore the normal
Taiyin Meridians of Foot are selected as the activities of qi. Pricking Jinjing(Extra) and
principal points to activate the descent of qi Yuye(Extra) to cause bleeding is an
and to pacify the stomach. For retention of experienced method for checking vomiting.
food, reducing is indicated, for attack of the
stomach by the liver qi, even movement is
usually used to soothe the liver and regulate Remarks
the flow of qi, and for weakness of the spleen Vomiting as described here may be found
and stomach, reinforcing combined with in acute and chronic gastritis, cardiospasm,
moxibustion is used to strengthen the pylorospasm and neurotic vomiting.
392 Chinese Acupuncture and Moxibustion

5. Hiccup the chest and hypochondrium, thin tongue

coating, string-taut and forceful pulse.
Hiccup is an involuntary spasm of the Analysis: The liver qi, if stagnated, will
glottis and diaphragm, causing the attack the stomach, causing upward
characteristic sound. Occasional attack of perversion of stomach qi, therefore, hiccup,
hiccup suggests a mild case and can be distending pain in the chest and
f a .#j8,-mEt, pLedjrvatLiGIi)
bllt jf it hypoc;holi~i-iiim,and feeling oppress;"ri
"f

persists, treatment is required. Hiccup is appear. String-taut and forceful pulse is a

mostly caused by irregular diet, stagnation sign of stagnation of qi due to depression of
of the liver qi and presence of cold in .the the liver.
stomach, leading to upward perversion of' c ) Cold in the stomach:
the stomach qi instead of descending. - Main manifestations: Slow and forceful
hiccups which may be relieved by heat and
Etiology and. Pathogenesis aggravated by cold, discomfort in the
Irregular food intake causes failure of the epigastrium, white, moist tongue coating,
stomach qi to descend, or emotional slow pulse.
frustration stagnates the liver qi, leading to Analysis: The stomach q i fails to descend
upward perversion of the stomach qi. because of stagnated cold, so hiccup is
The attack of the stomach by cold, oveC fsrcehl. In case of disturbance of the
eating of raw and cold food, or taking drugs stomach q4, discomfort in the epigastrium
~f C G ! ~nstP~:e gives rise t , retzi~ing
~ ~f the securs. If csld gets heat, smso"l circu1a"Lia
stomach yang and upward perversion of qi. of qi results, and then hiccup is relieved; but
if cold gets worse, hiccup is aggravated.
Differcemtiatim White, moist tongue coating a d slow pulse
a ) Retention offood: indicate the presence of cold in the stomach.
Main manifestations: Loud hiccups,
epigastric and abdominal distension, Treatment
anorexia, thick, sticky tongue coating, Method: The points of the Stomach
rolling and forceful pulse. Meridian and some other points related are
Arialysis: Retention of food in the selected as the principal points. Reducing is
stomach disturbs the function of the spleen applied for retention of food and stagnation
and stomach in transportation and of qi, while both acupuncture and
transformation and impedes the qi activities msxibustisn are used for cold in the
in the middle jiao. "The stomach is in stomach. The treatment is aimed at
normal function when its qi descends." pacifying the stomach, facilitating the
Failure of its qi to descend may lead to loud descent of qi and checking hiccup.
hiccups, epigastric and abdominal disten- Prescription: Geshu (B 171, Zhongwan
sion, and anorexia. Thick, sticky tongue (Ren 12), Neiguan (P 6), Zusanli (S 36).
coating, and rolling, forceful pulse are the Supplementary points:
signs of retention of food. Retention of food: Juque (Ren 14), Pnner-
b) Stagnation of qi: Neiting (Extra).
Main manifestations: Continual hiccups, Stagnation of qi: Tanzhong (Ren 17),
distending pain and feeling of oppression in Taichong (Liv 3).
Chapter 17 Internal Diseases

Cold i.n the stomach: Shangwaln (Ren 13). and transformation function, resulting in
Explanation: Zhongwan (Ren 12), abdominal pain.
Neiguan (P 6) and Zusanli (% 36) may pacify b) Hypoactivity of the spleen yang or
the stomach, subdue the ascending qi and general deficiency of yang qi leads to
relieve the oppression feeling in the chest. impairment of transportation and trans-
Geshu (B 17) is able to check the perversive formation, and stagnation of cold
ascending of qi and stop hiccup. Juque (Ren dampness, resulting in abdominal pain.
14) and Inner-Neiting (Extra) pacify the c) Retention s f food due to voracious
stomach and rempve stagnation. Tanzhong eating or intake of too much fatty and hot
(Ren 11 7) relieves the depressed feeling in the food impedes the function s f the stomach
chest and diaphragm and checks hiccup. and intestines in transmission and digestion,
Taichong (Liv 3) may pacify the liver qi. nutrients and wastes mixing together to
Moxibustion to Shangwan (Ren 13) may obstruct qi, resulting in pain.
warm the middle jiao to dispel cold, promote
the smooth distribution of yang and check
hiccup. Differemtiatiom
a ) Accumukcktion of cold:
Remarks
Main manifestations: Sudden onset of
Cupping:
violent abdominal pain which responds to
Commonly used points: Geshu (B 17),
warmth and gets worse by cold, loose stool,
Geguan (B 461, Ganshu (B 181, Zhongwan
absence of thirst, clear and profuse urine,
(Ren P2), Rugen (S B 8).
cold limbs, t h n white tongue coating, deep,
tense or deep, slow pulse.
Analysis: Cold is of yin nature and
6. Abdominal Pain characterized by causing contraction and .-

stagnation. If cold enters the. body, yang qi

Abdominal pain is a frequently encoun-
tered symptom in clinic, often accompanied will get obstructed, then sudden violent pain
and cold limbs appear. Since cold stays
with many zang-fu disorders, of which
inside, thirst is absent. Clear and profuse
dysentery, epigastric pain, appendicitis, and
urine and loose stool are due to weakness of
gynecologic diseases will be discussed in
other sections. In this section only the stomach and spleen yang and failure in
accumulation of cold, Eypoactivity of the transportation and transformation. The
spleen yang and retention of food are flow of yang qi is usually obstructed by cold
and facilitated by warmth, so pain responds
related.
to warmth but gets worse by cold. Deep,
tense or deep, slow pulse, and thin white
Etiology and Pathogenesis tongue coating are the signs of accumula-
a) Since cold is characterized by causing tion of cold.
contraction and stagnation, accumulation b) H ~ p o a c t i v i tof~ ~the spleen yang:
of cold due to invasion of the abdomen by Pdain manifestations: Intermittent dull
the pathogenic cold or injury of the stomach pain which may be relieved by warmth or by
and spleen yang due to overeating of raw pressure and aggravated by cold or by
and cold food impairs the transportation hunger and fatigue, lassitude, aversion to
 Chinese Acupunctyre and Moxibustion

cold, thin, white tongue coating, deep, Explanation: Zhongwan (Ben 12),
thready pulse. Zusanli (§ 36) and Gongsun (Sp 4) are used
Analysis: Intermittent dull pain which to strengthen the function of the spleen and
may be relieved by warmth or by pressure stomach, and to warm and promote the flow
and aggravated by cold or by hunger and of qi in the fu organs. Indirect rnoxibustion
fatigue indicates cold of deficiency type. with salt is applied to warm the stomach &d
--
Hypoactivity of the spleen yang causes loose dispel coid.
stool and aversion to cold. If the spleen qi is b ) Hypoactivity of the spleen yang:
weak, lassitude occurs. Thin white tongue Method: The Back-Shu points and the
coating and deep, thready pulse also indicate I
points of the Ren Meridian are selected as
cold of deficiency type. the principal points with reinforcing method
c ) Retention of food: applied in combination with moxibustion to
Main manifestations: Epigastric and warm and activate the spleen and stomach
abdominal distending pain which is yang. -
aggravated by pressure, anorexia, foul Prescription: Pishu (B 20), Weishu (B 21),
belching and sour regurgitation, or Zhongwan (Ren 12), Zhangmen (Liv 13),
abdominal pain accompanied by diarrhea Qihai (Wen 6), Zusanli (S 36).
2nd relieved aftsr defecation, sticky tongye
Explanation: Pishu (B 20) and Zhangmen
coating, rolling pulse. ,
(Liv 13), Weishu (B 2 1) and Zhongwan (Ren
Analysis: In case of retention of food in 12) are selected, known as combinations of
the intestines and stomach, epigastric and the Back-Shu and Front-Mu points. Both
abdominal distending pain occurs. Pain is acupuncture and moxibustion are used to
aggravated by pressure because of excess invigorate the spleen and stomach yang.
condition. Anorexia is due to retention of Qihai (Ren 6) and Zusanli (S 36) are needled
food, foul belching and sour regurgitation to strengthen the function of the spleen and
due to indigestion of food. Pain is relieved stomach.
after diarrhoea because the circulation of qi
in the fu organs becomes smooth. Sticky c ) Relention of food:
tongue coating is due to retention of food Method: The points of the Wen Meridian
and collection of dampness, while rolling and Yangming Meridian of Foot are
pulse is the sign of indigestion. selected as the principal points with reducing
method applied to remove retention of food.
Treatment Prescription: Zhongwan (Ren 12),
a) Accumulation of cold: Tianshu (S 25), Qihai (Ren 6), ~ i s a n l(S
i 36),
Method: Points of the Ren Meridian, Inner-Neiting (Extra).
Taiyin and Yangming Meridians of Foot are Explanation: Zhongwan (Ren 12),
selected as the principal points with reducing Zusanli ( 36), Tianshu (S 25) and Qihai
method applied in combination with (Ren 6) are applied to regulate the flow of
moxibustion to warn the stomach and the stomach qi. Inner-Neiting (Extra) is an
dispel cold. empirical point to treat indigestion. The
Prescription: Zhongwan (Ren 12), above points are used together to remove
Shenque (Ren 8), Zusanli (S 36), Gongsun retention of food and relieve pain by
(SP 4). promoting the flow of qi.
Chapter 17 Internal Diseases 395

7. Diarrhoea In the latter case, however, the diarrhoea is

also often related to dampness.
Diarrhoea refers to abnormal frequency Excessive intake of food, particularly
and liquidity of fecal discharges. It is usually greasy food, leading to impairment of the
due to disorders of the spleen, stomach, stomach and spleen in transportation and
large and small intestines. In light of the transformation, or eating of raw, cold, dirty
manifestations of the disease and the course, food, injuring the spleen and stomach, all
it is clinically divided into acute and chronic. bring about diarrhoea.
The former is mostly caused by indigestion Diarrhoea may also be caused by
due to excessive eating or improper diet and weakened function of the spleen and
attack of external cold dampness, leading to stomach due to irregular daily life or other
dysfunction in transmission of intestinal factors. Since the spleen has the function in
contents, or caused by invasion of damp transformation and transportation, diar-
heat in summer or autumn; the latter is rhoea may occur if this function is affected.
caused by deficiency of the spleen and The spleen yang is closely related to the
stomach, leading to failure in transportation kidney yang. The fire of Mingmen (Vital
and transformation. gate) (kidney yang) may help the spleen and
It is essential to distinguish diarrhoea and stomach to "digest and transform food into
dysentery. chyme." In case the kidney yang is weak, the
Etiology and Pathogenesis spleen yang is weak as well and fails to digest
The causative factors are complicated, but and transform food into chyme, thus
functional disturbance of the spleen and diarrhoea occurs. Zhang Jingyue said: "The
stomach is inevitably involved pathogeneti- kidney is the passgate of the stomach and
cally. The stomach dominates receiving food makes the urino-genital orifice and the anus
while the spleen dominates transportation as its openings. The passing of both urine
and transformation. In case the spleen and and stool is dominated by the kidney. Now
stomach are diseased, the normal digestion the kidney yang is weak, leading to decline of
and absorption of food is impaired, leading Mingmen (Vital gate) fire, and excess of
to mixing of food essence and wastes. When cold; therefore, diarrhoea occurs."
they descend through the large intestine,
diarrhoea occurs. -Differentiation
As to the factors of diarrhoea due to a ) Acute diarrhoea
functional disturbance of the spleen and i) Cold-dampness:
stomach, there are many as follows. Main manifestations: Watery diarrhoea,
Diarrhoea may be caused by the six abdominal pain and borborygmi, chilliness
exogenous pathogenic factors, among which which responds to warmth, absence of thirst,
mostly by cold, dampness and summer heat. pale tongue, white tongue coating, deep,
The spleen is in preference to dryness but slow pulse.
dislikes dampness, which usually causes Analysis: When the cold-dampness
diarrhoea. Besides the superficial portion of attacks the stomach and the intestines,
the body and the lung, the stomach and disturbing the function of the spleen in
intestines may be affected by the pathogenic sending food essence and water upward and
cold or summer heat, resulting in diarrhoea. that of the stomach in sending the contents
 Chinese Acupuncture and Moxibustion

downward, the food essence and the waste Analysis: Retention of food impairs the
can not be separated, moving downward stomach function in sending its contents
together through the large intestine, so downwards and the transmitting function of
watery diarrhoea with borborygmi occurs. If the intestines, so there are epigastric and
the qi of the stomach and intestines is abdominal fullness and distension, ab-
stagnated, abdominal pain appears. Cold- dominal pain and borborygmi. After the
dampness is a combination of yin undigested food turns putrid, diarrhoea with
pathogenic factors and easy to damage yang offensive fetid stools, belching and anorexia
qi. When yang qi is blocked, chilliness which occur. After the wastes are discharged,
responds to warmth and absence of thirst abdominal pain relieves. Thick filthy tongue
occur. Pale tongue, white tongue coating, coating, and rolling, rapid or deep, string-
and deep, slow pulse are the signs of excess taut pulse are the signs of retention of food.
of internal cold. b ) Chronic diarrhoea:
ii) Damp heat: i) Deficiency of the spleen:
Main . manifestations: Diarrhoea. with Main manifestations: Loose stool with
abdominal pain, yellow, hot and fetid stools, undigested food, anorexia, epigastric
burning sensation in the anus, scanty urine, distress after eating, sallow complexion,
or accompanied by general feverish feeling, lassitude, pale tongue, white tongue coating,
thirst, yellow, sticky tongue coating, rolling thready, forceless pulse.
and rapid pulse. Analysis: In case of weakness of the spleen
Analysis: When the intestines and and stomach, the spleen qi fails to ascend
stomach are attacked by the damp heat in and digestion is impaired; therefore, loose
summer or autumn, the transmitting and stool with undigested food appears. As the
transformation function is disturbed, and weakened spleen fails to digest and transport
diarrhoea appears. If the damp heat pours the food, anorexia and epigastric distress
down, diarrhoea happens as soon as the after eating occur. Persistent diarrhoea
abdominal pain is brought about. If the heat further weakens the spleen and stomach,
stays in the intestines, there appear affecting the production of food essence and
diarrhoea with yellow, hot and fetid stools formation of qi and blood, and thus
and burning sensation in the anus. When resulting in the sallow complexion and
excessive heat evaporates the dampness, lassitude. Pale tongue, white tongue coating,
there are scanty urine, general feverish and thready, forceless pulse are the signs of
feeling and thirst. Yellow, sticky tongue weakness of the spleen and stomach.
coating, and rolling, rapid pulse are the signs ii) Deficiency of the kidney:
of excess of damp heat. Main manifestations: Pain below the
iii) Retention of food: umbilicus, borborygmi and diarrhoea
Main manifestations: Abdominal pain usually occurring at dawn, relieved after-
relieved after bowel movements, borboryg- bowel movements, and aggravated by cold,
mi, diarrhoea with fetid stools, epigastric abdominal distension sometimes, cold lower
and abdominal fullness and distension, extremities, pale tongue, white tongue
belching, anorexia, thick filthy tongue coating, deep, forceless pulse.
coating, rolling, rapid or deep, string-taut Analysis: Pain below the umbilicus and
pulse. diarrhoea with borborygmi at dawn are due
Chapter 17 Internal Diseases

to hypoactivity of the kidney yang and the and stomach, dispel cold, regulate the flow
declined Mingmen fire. Zhang Jingyue of qi and resolve dampness. Neiting (S 44)
stated: "Yin should be at maximum in case and Yinlingquan (Sp 9) are needled to
yang qi is not restored. The stomach fails to eliminate damp-heat from the large
hold its contents because of the declined intestine. For retention of food; Inner-
Mingmen fire, thus diarrhoea results." Nelting (Extra) is used to regulate the
Abdominal aversion to cold, and sometimes function of the spleen and stomach and
distension, cold lower extremities, pale remove retention.
tongue, white tongue coating, deep, b ) Chronic diarrhoea:
forceless pulse are the signs of deficiency of i) Deficiency of the spleen:
the yang qi in the spleen and stomach. Method: The points of the Spleen
Meridian and some other points concerned
are selected as the principal points with the
Treatment reinforcing method and moxibustion to
a ) Acute diarrhoea: strengthen the function of the spleen and
Method: The points of the Yangming stop diarrhoea.
Meridian of Foot are selected as the Prescription: Pishu (B 20), Zhangmen
principal points. (Liv 13), Taibai (Sp 3), Zhongwan (Ren 12),
Cold-dampness: Reducing method in Zusanli (S 36).
combination with moxibustion (with ginger) Explanation: Pishu (B 20), a Back-(Shu)
is applied to warm the stomach and resolve point of the spleen, Zhangmen (Liv 13), the
dampness. Front-(Mu) point of the spleen, Taibai (Sp
Damp heat: Reducing is used to eliminate 3), the Yuan-(Primary) point of the Spleen
heat and dampness. Meridian, in combination with Zhongwan
Retention of food: Reducing is used to (Ren 12) the Front-(Mu) point of the
regulate the function of the spleen and stomach, and Zusanli (S 36), the He-(Sea)
stomach and remove stagnation. point of thi Stomach Meridian, are needled
Prescription: Tianshu (S 25), Zusanli (S with moxibustion to invigorate the spleen
34). yang, strengthen the function of transpor-
Supplementary points: tation and transformation and stop
Cold dampness: Zhongwan (Ren 12), diarrhoea.
Qihai (Ren 6). ii) Deficiency of the kidney:
Damp heat: Neiting (S 44), Yinlingquan Method: The points of the ~ i d d e ~
(SP 9). Meridian, Ren and u Meridians are
Retention of food: Inner-Neiting (Extra) selected as the principal points with the
Explanation: Tianshu (S 25), the Front- reinforcing method and moxibustion to
(Mu) point of the large intestine is applied to warm and reinforce the kidney yang.
regulate the transmitting function of the Prescription: Shenshu (B 23), Pishu (B
intestines. Zusanli (S 36), the He-(Sea) point 20), Mingmen (Du 4), Guanyuan (Ren 4),
of Yangming Meridian of Foot, is used to Taixi (K 3), Zusanli (S 36).
adjust the flow of the stomach qi. Explanation: Shenshu (B 23) is the Back-
Moxibustion to Zhongwan (Ren 12) and (Shu) point of the kidney and Taixi (K 3) is
Qihai (Ren 6) is applied to warm the spleen the Yuan-(Primary) point of the Kidney
 Chinese Acupuncture and Moxibustion

Meridian. Needling to these two points with invades the stomach and intestines,
the reinforcing method can warm the kidney impeding the flow of their qi and blood. Pus
yang and invigorate the kidney qi. and blood are formed from the stagnated qi
Moxibustion to Mingmen (Du 4) and and blood in struggling against heat
Guanyuan (Ren 4) is able to reinforce the dampness, and hence occurs dysentery. In
Mingmen fire and strengthen the kidney case dampness is preponderant to heat,
.;zag so as to warm "che spleen ar,d kidney white dysentery results, in case heat
and promote digestion. This is known as a preponderant to dampness, red dysentery
treatment of the root cause. Pishu (B 20) and appears, and in case both dampness and heat
Zusanli (S 36) are used to strengthen the are excessive, red-white dysentery occurs.
spleen function and stop diarrhoea. Preference for fatty and sweet food,
internal accumulation of damp heat plus
Remarks irregular diet, or intake of unclean food
This condition may be involved in acute leads to stagnation of qi and blood in the fu
and chronic enteritis, indigestion, intestinal organs, which turns into pus and blood in
parasitic diseases, diseases of the pancreas, the stool and results in dysentery.
liver and biliary tract, endocrine and Excessive intake of raw, cold, or dirty
metabolic disorders, and neurotic troubles. food leads to internal accumulation of cold
dampness, impeding the stomach and
8. Dysentery intestines. The stagnated qi in the large
intestine also injures the blood, leading to
Dysentery is characterized by abdominal discharge of pus and blood and resulting in
pain, tenesmus and frequent stools cold-damp dysentery.
containing blood and mucus. It is a common Although the above-mentioned etiologi-
epidemic disease in summer and autumn. It cal factors can be classified into the
'is called "red-white dysentery," "bloody exogeneous pathogenic factors and food
dysentery," "purulent and bloody dysen- intake, the two are usually mutually
tery" or "heat dysentery," and known as affected.
"persistent dysentery" if it lasts for a long The disease is in the intestine, but closely
time, and "intermittent dysentery7' if it related to the stomach. If the epidemic toxic
comes on and off. and damp heat attack the stomach, which
The common patterns ,are damp-heat fails to receive food, food-resistant
dysentery, cold-damp dysentery, food- dysentery occurs. If dysentery lasts longer,
resistant dysentery and intermittent the body resistance is weaker and the spleen
dysentery. qi becomes more insufficient, persistent or
This disease is often due to the invasion by intermittent dysentery therefore appears.
the epidemic damp heat and internal injury ~iffesentia~asn
by intake of raw, cold and unclean food, a ) Damp-heat dysentery:
which hinders and damages the stomach and Main manifestations: Abdominal pain,
intestines. tenesmus, mixing of pus and blood in stool,
burning sensation of the anus, scanty and
Etiology and Pathogenesis yellow urine, or chills, fever, restlessness,
The summer epidemic heat dampness thirst, yellow, sticky tongue coating, rolling,
Chapter 17 Internal Diseases

rapid or soft, rapid pulse. excessive cold.

Analysis: In case the damp heat stagnates c ) Food-resistant dysentery:
in the intestines, the qi and blood are Main manifestations: Frequent stools
blocked, leading to disturbance of with blood and pus, total loss of appetite,
transmission, so abdominal pain and nausea, vomiting, yellow, sticky tongue
tenesmus occur. When the blood vessels of coating, soft, rapid pulse.
the intestine are injured by damp heat, Analysis: This condition is developed
blood, pus and mucus appear in stools. from the damp-heat dysentery. The
Burning sensation of the anus, and scanty epidemic summer heat dampness, when
yellow urine are also manifestations of accumulated in the intestines, may attack
down-pouring of damp heat. When the the stomach and impair its function in
summer heat and dampness attack the body, sending its contents downwards. Thus the
the body resistance will fight against it, so stomach fails to receive food, and the
there are chills and fever. In case of excess of appetite is totally lost. The stomach qi
pathogenic heat, restlessness and thirst ascends instead of descends, so nausea and
result. Sticky tongue coating and rolling or vomiting occur. Yellow, sticky tongue
soft pulse indicate dampness, while yellow coating, and soft, rapid pulse are the signs of
tongue coating and rapid pulse suggest heat. dlamp heat.
b) Cold damp dysentery: d) Intermittent dysentery:
Main manifestations: Difficult defeca- Main manifestations: Dysentery occur-
tion, white mucus in stools, preference for ring on and off, difficult to cure, lassitude,
warmth and aversion to cold, mostly aversion to cold, somnolence, anorexia, pale
accompanied with fullness in the chest and tongue, sticky coating, soft pulse.
epigastrium, lingering abdominal pain, Analysis: In case of the weakened body
tastelessness in the mouth, absence of thirst, resistance with existence of the pathogenic
white, sticky tongue coating, deep, slow factors impairing the transmitting function
pulse. of the stomach and intestine, the condition is
Analysis: Accumulation of internal cold complicated with mixed deficiency and
dampness damages the spleen and stomach excess, and so the disease is lingering and
and blocks the qi flow of the large intestine. recurrent. When the spleen yang is weak,
Cold is characterized by causing contraction and the qi is short, there may be lassitude,
and stagnation, while dampness is aversion to cold and somnolence. Soft pulse
characterized by turbidity, so there are and persistent sticky coating are the signs of
fullness in the chest and epigastrium, continuing presence of dampness.
difficult defecation, white mucus in stools.
Cold dampness is a yin pathogenic factor Treatment
and apt to damage yang qi. When the yang Method: The points of Yangming
qi is blocked and fails to disperse, preference Meridians of Hand and Foot as well as the
for warmth, aversion to cold and lingering Front-(Mu) point and Lower He-(Sea) point
abdominal pain result. Tastelessness in the of the large intestine are selected as the
mouth, absence of thirst, sticky tongue principal points to remove stagnation from
coating are the signs of accumulation of the intestines. Reducing is used for the
dampness. Deep, slow pulse is the sign of damp-heat dysentery, both acupuncture and
 Chinese Acupuncture and Moxibustion

moxibustion are used for the cold-damp moxibustion may warm the spleen and
dysentery, and acupuncture and moxibus- stomach and eliminate the intestinal
tion, with both reinforcing and reducing stagnation. Guanyuan (Ren 4), the Front-
methods, are used for the persistent (Mu) point of the small intestine, is applied
dysentery. to separate the food essence from the waste,
Prescription: Tianshu (S 25), Shangjuxu reinforce qi and activate yang.
/CI A,-,\

(3 3 I ) .
Damp-heat dysentery: Quchi (L I 1l), Remarks
Hegu (L I 4) are added. This condition includes acute and chronic
Cold-damp dysentery: Zhongwan (Ren bacillary and amebic dysentery.
12) is added with moxibustion to Qihai (Ren
6) and Yinlingquan (Sp 9).
Food-resistant dysentery: Zhongwan
(Wen 12) and Neiguan (P 6) are added. 9. Abdominal Distention
Intermittent dysentery: Pishu (B 20),
Weishu (B. 21), Guanyuan (Ren 4) and Abdominal distention is common in
Zusanli (S 36) are added. clinic. Distention and fullness are likely to
Supplementary points: occur in both the upper and lower abdomen.
Fever: Dazhui (Du 14). The stomach .is located in the upper
Tenesmus: Zhonglushu (B 29). abdomen, while the small and large
?solapse of rectum: Bailiui (Du 29) with intestines are in the lower; they jointly
, moxibustion, Changqiang (Du 1). complete the storage, digestion, and
'

Explanation: It is recorded in Internal assimilation of food and excretion of the

Classic that the He-(Sea) points are applied wastes. Once the stomach and intestines lose
for the diseases of the fu organs. Therefore, their functions, abdominal distention and
Tianshu (S 25), the Front-(Mu) point of the pain, belching, vomiting, etc. will occur.
large intestine, and Shangjuxu (S 37),, the This section deals with the syndromes
We-(Sea) point of the large intestine, are mainly manifested by abdominal distention
selected as the principal points to remove due to disorders of the stomach and
stagnation of qi in the large intestine. intestines.
Dampness will be resolved in case qi is
regulated. Quchi (L I 11) and Hegu (L I 4) Etiology and Pathogenesis
may dispel the damp heat from the stomach a) Irregular or excessive food intake
and intestines. Moxibustion to Zhongwan impairs the stomach and intestines, causing
(Ren 12) and Qihai (Ren 6) is applied to dysfunction of transportation and trans-
warm the spleen and stomach, remove cold formation, thus the retained food is
and regulate the flow of qi. Yinlingquan (Sp stagnated and blocks the flow of qi, or the
9) is needled to strengthen the spleen stagnated food turns into heat, which enters
function to resolve dampness. For food- the stomach and intestines, causing
resistant dysentery, Zhongwan (Ren 12) and abdominal distention.
Neiguan (P 6) are used to pacify the stomach b) Because of the weakened function of
and resolve dampness. Acupuncture with the spleen and stomach or general debility
both reinforcing and reducing methods and due to long illness, the spleen and stomach
Chapter 17 Internal Diseases 40 1

fail in their transporting functions, so the and forceless pulse are signs of qi deficiency
circulation of qi in the stomach and in the spleen and stomach.
intestines is impaired, resulting in ab-
dominal distention. Treatment
In addition, abdominal distention may Method: The points of Yangming
also follow an abdominal operation. Meridian of Foot are selected as the
principal points. The excess condition is
Differentiation treated by the reducing method to regulate
a ) Excess condition the qi flow in the fu organs while the
Main manifestations: Persistence of deficiency condition is treated by the
distention and fullness in the abdomen, reinforcing method or combined with
which is aggravated by pressure, abdominal moxibustion to invigorate the function of
pain, belching, foul breath, dark yellow the stomach and spleen and to adjust the
urine, constipation, sometimes associated circulation of qi to relieve the distention.
with fever, vomiting, yellow thick tongue Prescription: Zhongwan (Ren 12),
'

coating, rolling, rapid and forceful pulse. Tianshu (S 25), Zusanli (S 36), Shangjuxu (S
Analysis: Indigested food retained in the 37).
Supplementary points: T.
stomach gives rise to distention and fullness
Excess condition: Hegu (E 1 4), Qihai
in the epigastrium, foul breath, belching,
(Ren 6), Yinlingquan (Sp, 9).
and even vomiting, and when it is retained in
Deficiency condition: Guanyuan (Ren 4),
the intestines, there will be fullness and pain
Taibai (Sp 3).
in the abdomen and constipation. Retention
Explanation: Application of Zhongwan
of food is an excess condition. This is why
(Ren 12), the Front-(Mu) point of the
the pain is aggravated by pressure. Fever,
stomach, Zusanli (S 36), the Lower He-(Sea)
dark yellow urine, yellow thick tongue
point of the stomach, Tianshu (S 25), the
coating, rolling, rapid and forceful pulse are
Front-(Mu) point of the large intestine and
the signs of excessive heat in the stomach. Shangjuxu (S 37), the Lower He-(Sea) point
b ) Deficiency condition of the large intestine, are used as a
Main manifestations: Abdominal disten- combination of Front-(Mu) and Lower He-
tion relieved by pressure, borborygmi, loose (Sea) points to regulate the function of the
stools, loss of appetite, lassitude, listlessness, stomach and intestines in order to maintain
clear urine, pale tongue with white coating normal flow of qi and relieve the distention.
and forceless pulse. Hegu (L 14) and Qihai (Ren 6) are combined
to adjust the circulation of qi, while
Analysis: Qi deficiency of the spleen and Yinlingquan (Sp 9) can eliminate damp heat.
stomach results in dysfunction of transport- Taibai (Sp 3) and Guanyuan (Ren 4) are
ation and transformation. Consequently beneficial to strengthen the spleen and
there are loss of appetite, borborygmi and stomach and to help transportation and
loose stools. Pain relieved by pressure is due transformation.
to deficiency. Failure in creating qi and
blood due to impaired transportation and Remarks
transformation is the cause of lassitude and This condition is involved in gas-
listlessness. Pale tongue with white coating, troptosis, acute gastrectasia, enteroparaly-
 Chinese Acupuncture and Moxibustion

sis, intestinal obstruction, gastrointestinal the muscles, and spreading to the skin which
neurosis, etc. turns yellow as if it were smoked."
Yin jaundice can also result from an
improperly treated yang jaundice which
leads to injury of the yang qi, hypoactivity of
the spleen yang, and internal collection of
10, Jaundice --I1 A,,,,,,,
LUIU u a l l l y l l ~ a a .

Jaundice is mainly manifested by yellow

discoloration of the sclera, skin and urine, Diffeaeantiretim
resulted from the dampness in the spleen and a) Yang jaundice:
heat in the stomach, leading to abnormal Main manifestations: Lustrous yellow
circulation of the bile which spreads to the skin and sclera, fever, thirst, scanty dark
skin surface. It is divided into yang jaundice yellow urine, heaviness of the body, fullness
and yin jaundice according to its nature. in the abdomen, stuffiness of the chest,
nausea, yellow, sticky tongue coating,
string-taut, rapid pulse.
Etiology and Pathogenesis Analysis: Steaming of the damp heat
The seasonal and epidemic pathogenic makes the bile spread to the skin surface.
factors accumulate in the spleen and Heat being a yang pathogenic factor, makes
stomach, leading to internal formation and the yellow discoloration of the skin lustrous.
coiiection of damp heat. Da~npiressafter Fever, thirst, scanty dark ye!!ow mice are
mixed with heat is apt to penetrate deeper, due to excessive damp heat, which damages
while heat mixed with dampness is apt to get the body fluid, and disturbs the activity of
more exuberant. The liver and gallbladder the bladder. When the dampness is collected,
are steamed by the heat in the spleen and the pure yang fails to be distributed and
stomach, leading to overflow of the bile to heaviness of the body results. In case of
the skin surface, thus jaundice appears. obstruction of the qi in the fu organs,
Irregular diet injures the spleen and fullness in-the abdomen occurs. Stuffiness of
stomach, causing disturbance in transpor- the chest and nausea are due to the steaming
tation and transformation and internal of damp heat, leading to upward perversion
formation. of dampness, which transforms of the turbid contents of the stomach.
into heat. Damp heat stains the skin yellow. Yellow sticky tongue coating is due to
Overstrain or general weakness of the accumulation of damp heat, and string-taut,
spleen qi may give rise to hypoactivity of the rapid pulse due to excessive heat in the liver
yang in the middle jiao, leading to failure in and gallbladder.
transportation and transformation and b) Yin jaundice:
stagnation of cold dampness, thus yin Main manifestations: Sallow skin,
jaundice results. As said in A Guide to the heaviness of the body, weakness, loss of
Clinic Treatment, "The cause of yin jaundice appetite, epigastric stuffiness, lassitude,
is the dampness produced from cold water. aversion to cold, absence of thirst, pale
If the spleen yang fails to resolve the tongue,' thick, white tongue coating, deep
dampness, the normal distribution of bile is slow pulse.
impaired, affecting the spleen, soaking into Analysis: The stagnation of cold
Chapter 17 Internal Diseases . 403

dampness in the spleen and stomach Pishu (B 20) and Yanggang (B 48) may
impedes the distribution of yang qi, leading resolve cold dampness by warmth and treat
to overflow of the bile, thus the skin is jaundice.
sallow. In case the dampness stays in the
spleen, the spleen yang is hypoactive and the Remarks
transporting and transforming function is This condition is seen in acute icteric
impaired, therefore, heaviness of the body, hepatitis, obstructive jaundice and hemoly-
weakness, loss of appetite and epigastric tic jaundice. Acupuncture and moxibustion
stuffiness occur. Aversion to cold - and are more effective to treat hepatogenic
lassitude are due to weakness of the yang qi. jaundice.
Since this case is of cold-damp nature, thirst
is absent. Pale tongue, thick white tongue
coating are due to deficiency of yang failing 11. Constipation
to resolve dampness. Deep, slow pulse is a
sign of cold dampness staying in the yin Constipation is mainly caused by the
system. disturbed transmitting function of the large
intestine and also related to the function of
- Treatment the spleen, stomach and kidney. In view of
Method: The points of Taiyin, Yangming '
the difference in etiology and pathogenesis,
and Shaoyang Meridians are selected as the this illness can be divided into two types:
principal points. Reducing is applied to deficiency and excess.
remove heat and dampness in yang jaundice,
while even movement with moxibustion is Etiology and Pathogenesis
used to warm the middle jiao and resolve After food is digested by the spleen and
dampness in yin jaundice. stomach, its refined nutrients are as-
Prescription: Yinlingquan (Sp 9), Zusanli similated, and the wastes are egested
(S 36), Ganshu (B 18), Danshu (B 19), through the transmission of the large'
Zhiyang (Du 9). intestine. If the stomach and intestines aTe
Supplementary points: diseased, various kinds of constipation'
Yang jaundice: Taichong (Liv 3), occur in the following conditions: internal
Y anglingquan (G 34). accumulation of dryness and heat,
Yin jaundice: Moxibustion to Pishu (B stagnation of qi, deficiency of qi with
2O), Yanggang (B 48). inability of transmission, bload deficiency
Explanation: Yinlingquan (Sp 9) and with dryness of the intestines, and
Zusanli (S 36) are used to strengthen the agglomeration of cold.
spleen and resolve dampness. Ganshu (B Constitutional yang preponderance, or
18), Danshu (B 19) and Zhiyang (Du 9) are indulgence in alcohol and spicy greasy food
important points to treat jaundice. Since the may lead to accumulation of heat in the
damp heat resides in the gallbladder, stomach and intestines. Or after some febrile
Yanglingquan (G 34) is selected to reduce diseases, the remnant heat and insufficiency
heat, and used in combination with of body fluids give rise to dryness and heat in
Taichong (Liv 3) to regulate the flow of qi in the intestines, and in addition, there may be
the liver and gallbladder. Moxibustion to disturbance of fluid distribution to the lower
404 Chinese Acupuncture and Moxibustion

jiao. Constipation is present in any of the which consumes the body fluid or
above cases. stagnation of qi, disturbing the normal
Emotional factors, such as anxiety and function of the large intestine, constipation '

depression, or lack of movement can cause may result. Fever and dire thirst indicate
stagnation of qi, impairing the transmitting internal preponderance of pathogenic heat.
function of the large intestine. As a result, When the heat in the stomach and intestines
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move downward, and hence constipation. yellow and dry tongue coating reveals the
The coexistent deficiency of qi and blood damage of the body fluid by the heat, while
can result from internal injury by overstrain the rolling and forceful pulse is a sign of
or improper food intake, or happen after an excess in the interior. Emotional disturbance
illness or delivery or in the aged people. Qi leads to stagnation of qi in the liver and
deficiency results in weakness of the large spleen, thus resulting in frequent belching,
intestine in transmission, while blood and fullness and distending pain in the
definciency give's rise to shortage of body abdomen or hypochondrium. Since the
fluid, then the large intestine can no longer spleen fails in transportation and transform-
be moistened. Apparently both qi and blood ation, there is loss of appetite. Thin, sticky
deficiency can cause difficult evacuation of tongue coating and string-taut pulse are the
the feces, and hence constipation. signs of disharmony between the liver and
Constitutional debility or senile decay spleen.
resuits iii reteation of the endogenzliiscold iii b ) DP,f!ckncy condition:
the stomach and intestines. Consequently Main manifestations: In cases of
the yang qi is obstructed and the body fluid deficiency of qi and blood, pale and
fail in distribution. Difficulty of the large lustreless complexion, lips and nails,
intestine in transmission leads to dizziness and palpitation, lassitude, short-
constipation. ness of breath, pale tongue with thin coating,
thready and weak pulse; in cases of
Differentiatiow agglomeration of cold, pain and cold
a) Excess condition sensation in the abdomen, preference for
Main manifestations: Infrequent and warmth and aversion to cold, pale tongue
difficult defecation from every three to five with white and moist coating, deep slow
days, or even longer. In case of pulse.
accumulation of heat, there zre fever, dire Analysis: Constipation can be caused
thirst, foul breath, rolling and forceful pulse, either' by qi deficiency, resulting in failure of
yellow, dry tongue coating; in case of the large intestine in transmission, or by
stagnation of qi, there are fullness and' blood deficiency -with shortage of body
distending pain in the abdomen and fluid unable to moisten the large intestine.
hypochondriac regions, frequent belching, Endogenous cold stays in the stomach and
loss of appetite, thin sticky tongue coating intestines, leading to agglomeration of yin
and string-taut pulse. qi, failure of yang qi in transportation, and
Analysis: The large intestine is concerned weakened transmission of the large
with transmission. When there is accumul- intestine, and hence difficulty of defecation.
ation of heat in the stomach and intestines, Deficiency of qi and blood fails to ascend to
Chapter 17 Internal Diseases

nourish the upper portion, so there are pale are different, but they are common in
and lustreless complexion and lips, lassitude impairing the transmitting function of the
and shortness of breath. In case of blood large intestine. Therefore, Dachangshu (B
deficiency, the heart is poorly nourished, 25) and the Front-(Mu) point of the large
hence palpitation. When the head and eyes intestine are applied to promote the flow of
fail to be nourished, dizziness results. Since qi in the large intestine, the transmission can
the nail is the external manifestation of the be regained when the qi of the fu organ flows
liver, there will be lustreless nails when the smoothly. Zhigou (S 9 6) can promote the
liver blood is insufficient. When cold is flow of qi in the three jiao. When the qi in the.
agglomerated, the circulation of qi is three jiao is in normal circulation, the qi of
impeded, this accounts for the cold pain in the fu organ will circulate freely. Zhlgou (S J
the abdomen. Cold is of yin nature, and 6) combined with Zhaohai (K 6) is a
disorders caused by cold can be relieved by principal point in treating constipation.
warmth, so there is preference for warmth Quchi (L I 11) and Hegu (L I 4) can reduce
and aversion to cold. Pale tongue with thin the heat from the large intestine. Zhongwan
coating, thready weak pulse are the signs of (Ren 2 , the Influential Point of the fu
insufficiency of qi and blood, while pale organs, is selected to lower the qi of the fu
tongue with white, moist coating shows the organ. The reducing method applied to
internal cold due to yang deficiency. Taichong (Liv 3) is to soothe the liver qi.
Reinforcing to Pishu (B 20), Weishu (B 21)
Treatment and Zusanli (S 36) is able to reinforce qi in
Method: TheBack-(Shu) and Front-(Mu) the spleen and stomach. Once the spleen and
points of the Large Intestine Meridian are stomach qi is vigorous, qi and blood can be
mainly selected. For the excess condition the produced as a natural consequence, so this is '

reducing method is applied to eliminate the the approach bf treating the root cause of
heat, moisten the intestine, and remove the constipation in deficiency conditions.
stagnation of qi, while for deficiency Moxibustion to Shenque (Wen 8) and Qihai
condition, the reinforcing method is used to (Ren 6) is offered to reduce cold and loosen
reinforce qi and nourish blood, and moisten the bowels.
the intestines for defecation. Constipation
due to cold can be relieved by moxibustion
to warm the fu organ for defecation.
Prescription: Dachangshu (B 25), Tianshu
12. Prolap& of Rectum
(S 25), Zhigou (S J 6), Zhaohai (K 6).
Prolapse of rectum likely happens to
Accumulation of heat: Quchi (L ]I
infants, the old aged, and those with general
Hegu (L H 4).
debility after a long illness.
Stagnation of qi: Zhongwan (Ren
Taichong (Liv 3).
Deficiency of qi and blood: Pishu (B 20), Etiology and Pathogenesis
Weishu (B 21), Zusanli (S 36). This disease is mostly caused by deficiency
Agglomeration of cold: Moxibustion to of the primary qi, sinking of the spleen and
Sheftque (Ren 8) and Qihai (Ben 6). stomach qi and disability of restraining due
Explanation: The causes of constipation to long-standing diarrhoea or dysentery, or
 Chinese Acupuncture and Moxibustion

due to constitutional weakness after severe (B 25) can replenish the qi of the large
diseases. intestine. Baihui (Du 20) is the meeting point
of the Du Meridian and the three yang
Differemtiation meridians, and qi pertains to yang, subjected
Main manifestations: The onset is slow, to to the Du Meridian, therefore moxibustion
start with distending and draggling to Baihui (Du 20) can invigorate yang qi,
sensation of reciurri during defecation, and and i;;lpl-ove the e!evat,ir;,g a ~ crmtrxtino
d D

returning to normal after the bowel function. Changqiang (Du l), a point of the
movement. If it is sustained without proper collateral of the Du Meridian, located near
treatment, recurrence may happen by the anus, is selected as a local point. Zusanli
overstrain and the prolapsed rectum fails to (S 36) can reinforce qi for elevation. The
return spontaneously without the aid of the combination of Baihui (Du 20), Changqiang
hand. (Du 1) and Zusanli (S 36) follows a .
Sometimes there are lassitude, weakness principle -to elevate when there is
of limbs, sallow complexion, dizziness and subsidence.
palpitation. The tongue is pale with white
coating, and the pulse thready and feeble. Remarks
Analysis: Deficiency of the primary qi Picking therapy: Pick any spot on the
leads to the sinking of the spleen qi, and paraspinal muscle bilaterally in between the
failure of the large intestine in holding itself third lumbar vertebra and the second sacral
in its normal posiiioii; SO the rectiii~i vertebra.
prolapses. Insufficiency of the spleen and
stomach qi brings about dysfunction of
transportation and transformation, causing 13. Edema
deficiency of qi and blood, thus lassitude
and weakness of the limbs appear. Qi Subcutaneous retention of fluid which
deficiency fails to nourish the upper portion leads to puffiness of the head, face, eyelids,
of the body. Dizziness results from the limbs, abdomen and even the whole body is
failure of nourishing the head and eyes, and called edema. The causative factors are
palpitation from the failure of nourishing invasion of the body by the exogeneous
the heart. Pale tongue with white coating, pathogenic wind and water dampness, and
thready and feeble pulse are the signs of qi internal injury by food or overstrain, which
deficiency. results in disturbance of water circulation
and overflow of water. Since the water
Treatmeqt circulation in the body is related to the
Method: points of the Du Meridian are regulatory function of the lung qi,
mainly applicable with the reinforcing transporting function of the spleen qi,
method and moxibustion. activity of the kidney qi and water
Prescription: Baihui (Du 20), Da- communication of the three jiao, the
changshu (B 25), Changqiang (Du 1), ' functionalederangementof the lung, spleen,
Zusanli (S 36). kidney and three jiao may lead to edema.
Explanation: Rectum is the distal part of Clinically edema is divided into two
the large intestine. Reinforcing Dachangshu patterns: yin edema and yang edema,
Chapter 11 7 Internal Diseases

according to their etiology and However, the prolonged yang edema may
pathogenesis. lead to gradual weakness of the body
resistance and increased water retention,
Etiology and Pathogenesis and turn into yin edema. Pathogenetically,
a) Invasion of the wind upon the lung edema is closely related to the dysfunction of
causes dysfunction of the lung in dispersion. the lung, spleen and kidney.
The lung dominates the surface of the body
and is associated with the skin and hair. If Differentiation
the lung is attacked by wind, the lung qi fails a) Yang edema:
to regulate the water passages and send the Main manifestations: Abrupt onset of
water down to the bladder, leading to the edema with puffy face and eyelids and then
confrontation between wind and water and anasarca, lustrous skin, accompanied by
the overflow of water to the superficial part chills, fever, thirst, cough, asthma 'and
of the body, and thus edema appears. reduced urine output, thin white tongue
b) Living in a damp place, wading coating, superficial or rolling, rapid pulse.
through water or drenching by rain makes Analysis: In case of internal accumulation
water dampness attack the body. Irregular of water and external invasion by wind,
food intake causes failure of the spleen in confrontation between them causes an
normal transportation and transformation abrupt onset of edema starting from the
and impairment of downward flow of water upper portion of the body, as the wind is a
dampness. hn either case there may be pathogenic factor of yang nature a n d .
overflow of water dampness to the charaterized by upward going. If the
superficial part of the body, resulting in function of the bladder is impaired, the urine
edema. output is reduced. When tne wind water
c) Overstrain injures the spleen, leading to attacks the lung, cough, asthma, aversion to
gradual weakness of the spleen qi, which wind and chills result. If heat is dominant,
fails to distribute the essence to the lung and there are thirst, fever and rolling rapid pulse.
to the whole body. Water is also retained if Thin white tongue coating and superficial
the spleen function in transporting and pulse indicate wind water of cold nature.
transforming fluid is impaired. Once the b) Yin edema:
spleen fails to control water and lets it flow Main manifestations: Insidious onset of
over, edema results. edema, at first on the pedis dorsum or
d) Indulgent sexual activities damage the eyelids, and then over the whole body,
kidney qi, and also the function of the especially remarkable below the lumbar
bladder. Retention of water follows and region, accompanied by sallow complexion,
edema results. aversion to cold, cold limbs, soreness of the
According to the above-mentioned, back and loins, general weakness, epigastric
edema resulting from invasion by wind, fullness, abdominal distension, loss of
drenching by rain and irregular food intake appetite, loose stools, pale tongue, white
is of yang nature, while that resulting from coating, deep, thready pulse.
overstrain, internal injury and indulgent Analysis: Because of weakness of yang in
sexual activity, leading to weakness of the the spleen and the kidney, yin is in excess and
spleen and kidney, is of yin nature. qi fails to transport water, causing overflow
 Chinese Acupuncture and Moxibustion

of water dampness in the lower portion of regulate the qi activity of the sanjiao and
the body, and hence appears pitting edema water passages.
which is especially remarkable below the b) Yin edema:
lumbar region. In case of lowered function Method: The points of the Spleen and
of the spleen and kidney, qi is unable to Kidney Meridians are selected as the
nourish the face, so the complexion is principal points. Reinforcing in combina-
sallow. Weakened kidney yang with tion with moxibustion is applied to warm the
declined Mingmen fire is insufficient to spleen and kidney.
warm the body, so there is aversion to cold Prescription: Pishu (B 20), Shenshu (B
with cold limbs. The lumbus is the house of 23), Shuifen (Ren 9), Guanyuan (Ren 4),
the kidney. If the kidney qi is weakened and Fuliu (K 7), Zusanli (S 36).
water dampness excessive, soreness is felt in Supplementary points:
the back and loins. In case of hypoactivity of Facial puffiness: Shuigou (Du 26).
the spleen yang, the function of Edema on the pedis dorsum: Zulinqi (6
transportation and transformation is weak, 41), Shangqiu (Sp 5).
so epigastric fullness, loss of appetite, Explanation: Yin edema is caused by
abdominal distension and loose stools result. decline of the kidney yang that fails to
Pale tongue, iirhite coating, deep, threzdy control water and by weakness of the spleen
pulse are also signs of deficiency of the qi that leads to impairment of transporta-
spleen and kidney yang with excess of water tion in the middle jiao. Acupuncture and
dampness. moxibusiion to Pishu (B 26j, Siienshu (3 23j
and Fuliu (K 7) may warm the primary yang
Treatment of the spleen and kidney and remove cold
a ) rang edema: water. Moxibustion to Shuifen (Ren 9) and
Method: The points of the Lung and Guanyuan (Ren 4) may promote the water
Spleen Meridians are selected as the circulation and reinforce the primary qi
principal points. Even movement is applied respectively. Reinforcing on Zusanli (S 36)
to clear the lung, relieve the exterior promotes the transporting and tranforming
symptoms and remove the retained fluid. function of the spleen and stomach,
After the exterior symptoms are relieved, restoring normal distribution of the fluid.
refer to method for yin edema.
Prescription: Lieque (L 7), Hegu (L I 4), Wemarks
Pianli (k I 6), Yinlingquan (Sp 9), Weiyang In the context of edema, acute and chronic
(B 39). nephritis and malnutrition are included.
Explanation: Edema above the lumbus
should be treated by diaphoresis, therefore,
kieque (L 7) and Hegu (L 1 4) are used to 4 Nochrnalg Enuresis
clear the lung and relieve the exterior
symptoms by diaphoresis, while edema Nocturnal enuresis is referred to
below the lumbus should be treated by involuntary discharge of the urine occurring
diuresis, then Pianli (kI 6) and Yinlingquan at night and during sleep. As a morbid
(Sp 9) are applied to remove dampness and condition, it is mostly seen in chldren over
promote diuresis. Weiyang (B 39) is able to the age of three years and occasionally in
Chapter 17 Internal Diseases

adults. It is mainly caused by deficiency of the essence of food to nourish the whole
kidney qi with disability of the bladder to body. This is why the complexion is sallow
restrain the urine discharge. and the patient is lacking in strength. Pale
tongue with white coating, and thready
Etiology and Pathogemesis pulse weak at chi region are signs of
The normal excretion of urine is mainly deficiency.
concerned with the activities of the kidney qi
and the restraining function of the bladder. Treatment
The kidney is in charge of micturition and Method: The Back-(Shu) and Front-(Mu)
defecation, and responsible for the forma- points of the kidney and bladder are selected
tion of urine, while the bladder stores and as the principal points, with reinforcing or
excretes urine. If the kidney qi is insufficient, moxibustion to strengthen the kidney and
it will be unable to maintain the function of reinforce qi.
the bladder in restraining the urine Prescription: Shenshu (B 123)~Pang-
discharge, and thus occurs enuresis. Ancient guangshu (B 28), Zhongji (Ren 3),
doctors therefore. believed that enuresis is Sanyinjiao (Sp 6), Dadun (Liv 1).
due to deficiency. As stated in General Supplementary points: a

Treatise on the Etiology and Symptomology Enuresis with dreams: Shenmen (H 7).
of Diseases: "Enuresis is caused by cold in Loss of appetite: Pishu (B 20), Zusanli (S
the bladder of deficiency type, which renders 36).
the. bladder unable to restrain the urine Explanation: The kidney is exteriorly-
discharge." Dai Sigong once said, interiorly related to the bladder, so the Back-
"Involuntary urination during sleep is due (Shu) points of the kidney and bladder are
to cold in the kidney causing incontinence of applied. Zhongii (Ren 3) is the Front-(Mu)
urine." point of the bladder. Combined use of the
above three points contributes to reinforce
Differentiation the kidney qi and the restraining function.
Main manifestations: Involuntary mictu- Sanyinjiao (Sp 6) is added to adjust the qi of
rition during sleep with dreams, once in the three yin meridians. Moxibustion to
several nights in mild cases, or several times Dadun (Liv l), the Jing-(Well) point of the
a night in severe cases; sallow complexion, Liver Meridian which curves round the
loss of appetite, and weakness in the genitals, can promote the circulation of qi of
prolonged cases, pale tongue, white coating, the meridian and strenghthen the therapeu-
thready pulse weak at the chi region. tic effect.
Analysis: Deficiency of the kidney qi with
failure of the bladder in restraining the urine Remarks
discharge causes nocturnal enuresis. Long The chief causative factor of this disease is
duration of the disease undermines the the underdevelopment of cerebral mictu-
kidney qi, and consequently the spleen falls rition centre and treatment of acupuncture
into loss of warming, its function of and moxibustion provides satisfactory
transportation and transformation being effect. As for enuresis caused by organic
disturbed. Therefore, the appetite is lost. diseases, such as deformity of urinary tract,
Deficiency of the spleen qi fails to distribute cryptorachischisis, organic cerebral diseases
 Chinese Acupuncture and Mopribustion

and oxyuriasis, the treatment should be is difficult, painful and incontinent, known
. given to the primary disease. as dysuria caused by dysfunction of qi.
Indulgent sexual activities or mental stress
leading to deficiency of the kidney qi, or
sinking of the spleen qi due to deficiency,
5 . Urination Disturbance causes painful urination which often recurs
on overstrain, known as dysuria caused by
Urination disturbance is manifested by overstrain.
frenquency of urination, painful urination
and incontinence of urination, resulting Differentiaanion
mainly from accumulation of heat in the . a ) Dysuria caused by calculi:
bladder, and sometimes also from emotional Main manifestations: Occasional pre-
factors and deficiency of the kidney. sence of calculi in the urine, dysuria, dark
According to the clinic manifestations, yellow turbid urine, or sudden interruption
urination disturbance is divided into five of urination, unbearable pricking pain
kinds, i.e. dysuria caused by calculi, dysuria during urination, pain of the lumbus and
caused by qi dysfunction, dysuria with milky abdomen, or presence of blood in the urine,
urine, dysuria caused by overstrain and normal tongue coating.
painful urination with blood. Analysis: When the gravel and stones
formed by damp heat fail to be discharged in
Etiology and Pathogenesis the urine, dark yeiiow turbid urine and
Eating too much fatty or sweet food or painful urination occur. If a large stone
drinking too much alcohol leads to obstructs the outer orifice of the bladder,
accumulation of damp heat in the lower jiao, urination may suddenly be interrupted,
where the urine is condensed into calculi, accompanied by unbearable pain. In case
which may be either small as gravel or large the calculi cause internal injury, bloody
as stones, staying in various portions of the urine appears. When the calculi have been
urinary tract from the kidney to the bladder formed, the signs of internal heat may
or the urethra, causing dysuria. sometimes become obscure and the tongue
In case the damp heat accumulates in the coating-turns to normal.
bladder, or the heart fire shifts to the b ) Dysuria caused by qi dysfunction:
bladder, the heat injures the blood vessels Main manifestations: Difficult and
and forces the blood to extravasate, then hesitant urination, fullness and pain of the
painful urination with blood results. If the lower abdomen, thin, white tongue coating,
damp heat accumulates in the lower jiao, deep, string-taut pulse.
impairing the control of the flow of the Analysis: Emotional depression leads to
chylous fluid, viscous urine like milk qi dysfunction, failure of the liver in qi
appears, known as dysuria with milky urine. spreading and stagnation of qi in the
Damage of the liver by anger, production bladder. So there are fullness and pain of the
of fire from stagnated qi or obstruction of qi lower abdomen, and difficult and hesitant
due to stagnation, leading to accumulation urination. In case of depression of the qi in
of qi and fire in the lower jiao, impedes the the liver, deep, string-taut pulse occurs.
activity of the bladder. Therefore, urination c ) Painful urination with blood:
Chapter 17 Internal Diseases 41 1
Main manifestations: Hematuria with Zhongji (Ren 3), Yinlingquan (Sp 9).
pain and urgency of micturition, burning Supplementary points:
sensation and pricking pain in urination, Dysuria caused by calculi: Weiyang (B
thin, yellow tongue coating, rapid, forceful 39).
pulse. Dysuria caused by qi dysfunction:
d ) Dysuria with milky urine: Xingjian (Eiv 2).
Main manifestations: Cloudy urine with Painful urination with blood: Xuehai (Sp
milky or creamy appearance, urethral lo), Sanyinjiao (Sp 4).
burning pain in urination, red tongue Dysuria with milky urine: Shenshu (B 23),
proper, sticky coating, thready, rapid pulse. Zhaohai (K 6).
Analysis: This condition is due to Dysuria caused by overstrain: Baihui (Du
downward shift of damp heat, which 20), Qihai (Ren 6), Zusanli (S 36).
accumulates in the bladder and affects the qi Explanation: Urination trouble is chiefly
function. The bladder fails to check the due to affections of the bladder, so Pang-
downward flow of fatty liquid, so there are guangshu (B 28) and Zhongji (Ren 3), the
cloudy urine with milky or even creamy Front-(Mu) point of the bladder, are
appearance and urethral burning pain in needled to promote the activity of the
urination. Red tongue proper, sticky bladder. Yinlingquan (Sp SP), the He-(Sea)
coating, thready rapid pulse are the signs of point of the Spleen Meridian, is combined to
deficiency of kidney yin and stagnation of promote diuresis, restoring the qi function
damp heat. and free urination. Dysuria caused by calculi
e) Dysuria caused by overstrain: is due to the accumulation of damp heat in -
Main manifestations: Difficulty in the lower jiao and condensation of urine.
urination with dribbling of urine, occurring. Therefore, Weiyang (B 39), a point of the
off and on, exacerbated after overwork, and Bladder Meridian of Foot-Taiyang .and also
usually refractory to treatment, weak pulse. the Lower He-(Sea) point of sanjiao, is
Analysis: Overstrain, indulgence in sex applied to reduce damp heat from the lower
and drinking, or taking too much drugs cold jiao and strengthen the function of the
in nature for treating other kinds of dysuria bladder. Xingjian (kiv 2), the Ying-(Spring)
lead to deficiency of the spleen and kidney, point of the Liver Meridian, is used to dispel
and failure of the yang qi to ascend. That is the fire from the Liver Meridian and relieve
why urination is exacerbated after overwork pain for dysuria caused by qi dysfunction.
and refractory to treatment. Weak pulse is Xuehai (Sp 10) and Sanyinjiao (Sp 6) are
the sign of qi deficiency. applied to remove the heat from the lower
I
jiao and stop bleeding. If dysuria with milky
Treatment urine lasts longer, deficiency -of the kidney
Method: The Back-(Shu) and Front-(Mu) fails to check the downward flow of fatty
points of the bladder are selected as the liquid, so Shenshu (B 23) and Zhaohai (K 6)
principal points. Reducing alone or are needled. to reinforce the kidney qi.
combination of reinforcing and reducing Dysuria caused by overstrain is due "to
methods is applied to promote the activity of weakness of both spleen and kidney. Baihui
the bladder. (Du 20), the meeting point of all the yang
Prescription: Pangguangshu (B 28), meridians, in combination with Qihai (Ren
412 Chinese Acupuncture and Moxibustion

6) and Zusanli (S 36) may reinforce the qi of damaging the zang organs, causes retention
the spleen and kidney. of urine too.

Differemtiation
Remarks a ) Accumulation of heat in the bladder:
This morbid condition includes urinary Main manifestations: Scanty hot urine or
infection and urolithiasis. retention of urine, distension and fullness of
the lower abdomen, thirst but without desire
to drink, constipation, red tongue with
yellow coating, rapid pulse.
86. Retention of Urine Analysis: In case of accumulation of heat
in the bladder, scanty hot urine or retention
of urine appears. When water and heat
combined together, impair the function of
Retention of urine is a disease manifested the bladder, distension and fullness of the
by difficult urination, distending pain in the lower abdomen occur. Since the body fluid
lower abdomen and even blockage of urine. fails to be normally distributed, thirst results
The mild case refers to difficulty in urination but there is no desire to drink. Red tongue
and dripping of urine, while the severe case with yellow coating, rapid pulse, or
to failure in urination with distension and constipation are due to accumulation of heat
feeling of urgency. in the lower jiao.
This disease results from dysfunction of qi b ) Decline of Mingrnen fire:
in the bladder. As said in Internal Classics: Main manifestations: Dribbling urina-
"The bladder is in charge of storing liquid. tion, attenuating in force of the urine
Normal urination suggests the qi is in discharge, pallor, listlessness, chilliness
function. Its dysfbnction causes retention of below the lumbus, weakness of the loins and
urine. " knees, pale tongue, deep, thready pulse weak
at the chi region.
Etiology and Pathogenesis Analysis: Dribbling urination, attenua-
Heat accumulates in the bladder, or heat ting in force of the urine discharge is due to
of the kidney shifts to the bladder. deficiency of the kidney yang which affects
Accumulation of heat in the bladder the transmitting function. Pallor, listlessness
impedes the qi function and leads to and pale tongue are due to decline of the
retention of urine. Mingmen fire and failure of qi in reaching
The kidney and the bladder are exteriorly- the bladder.
interiorly related. The function of the c ) Damage of the qi of the meridian:
bladder depends upon the warming function Main manifestations: Dribbling urination
of the kidney yang. In case of weakness of or retention of urine, distension and dull
the kidney yang and decline of Mingmen pain in the lower abdomen, purplish spots
fire, the bladder may be too weak to on the tongue, hesitant, rapid pulse.
discharge the urine. Analysis: After a traumatic injury or
Traumatic injury or surgical operation surgical operation on the lower abdo-
hindering the qi of the meridians or men, the qi of the Bladder Meridian is
Chapter 17 Internal Diseases 413

damaged and blood stasis occurs, so Guanyuan (Ren 4) is to invigorate the

there appear dribbling urination, reten- kidney qi. Urination will be free in smooth
tion of urine, distension and pain in the qi circulation. Since deficiency of the kidney
lower abdomen. Purplish spots on the qi makes sanjiao fail to promote the
tongue, hesitant, rapid pulse are the signs of circulation of water, Yangchi (S J 4), the
blood stasis. Yuan-(Primary) point of sanjiao, is needled
to strengthen the 'function of sanjiao and
Treatment promote circulation of water.
a ) Accumulation of heat in the bladder:
c ) Damage of the qi in the meridian:
Method: The Back-(Shu) points and
Method: The Front-(Mu) point of the
Front-(Mu) points are selected as the
principal points. Reducing method is bladder is selected as the principal point.
applied to remove heat and promote Even movement is applied to promote
diuresis. circulation of the qi in the meridian and
Prescription: Pangguangshu (B 28), restore the function of the bladder.
Zhongji (Ben 3), Sanyinjiao (Sp 6), Weiyang Prescription: Zhongji (Ren 3), Sanyinjiao
(I3 39). (Sp 6), Shuidao (S 28), Shuiquan (K 5).
Explanation: Pangguangshu (B 28), the Explanation: A traumatic injury or
Back-(Shu) point of the bladder, and surgical operation can injure the blood
Zhongji (Ren 3), the Front-(Mu) point of vessels and impede the activity of the
the bladder, are needled to reduce heat from bladder, thus urodialysis appears. Zhongji
the bladder and adjust its function. (Ren 3), the Front-(Mu) point of the
Sanyinjiao (Sp 6) may dispel heat from the bladder, is needled to adjust the function of
lower'jiao. Weiyang (B 39), the Lower He- the bladder and promote urination.
(Sea) point of sanjiao, promotes the Sanyinjiao (Sp 6) may promote the
circulation of water. These points, used circulation of blood and qi in the meridian.
together, reduce heat and promote diuresis. Shuiquan (K 5), the Xi-(Cleft) point of the
b ) Decltne of the Mingmen Fire: Kidney Meridian of Foot-Shaoyin, com-
Method: The points relating to the bined with Shuidao (S 28), may promote
Kidney Meridian are selected as the urination, and relieve distension and pain.
principal points. Reinforcing or moxi-
bustion is applied to warm the kidney yang.
Prescription: Mingmen (Du 4), Shenshu
17. Impotence
(14 23), Baihui (Du 20), Guanyuan (Ren 4),
(Appendix: Seminal Emission)
Yangchi (S J 4).
Explanation: In case of deficiency of the Impotence is referred to lack of copulative
kidney qi and decline of the Mingmen fire, power in males.
the kidney qi should be reinforced, sc
Mingmen (Du 4) and Shenshu (B 23) are Etiology and Pathogenesis
needled to reinforce the kidney yang. Impotence. is generally due to indulgence
Moxibustion to Baihui (Du 20) and in sex or excessive masturbation, which
 Chinese Acupuncture and Msxibustion

makes Mingmen fire decline and exhausts deficiency gives rise to soreness and
the kidney essence. It may also be due to weakness of the loins and knees. Only with
fear, fright or worry, which damages the qi the help of the activity of the kidney, can
of the heart, spleen and kidney. Just as said ,
normal urination be performed. If the
in Treatment of Internal Disorders: "The kidney yang fails in controlling urination,
inability of penis to erect is due to the injury there appears frequent urination. Bale
ef $be $ SrgaEs, whish is pAainlx~ ~ B ~ ~ withP P P o and deen
b -' a7 r
9

caused by the exhaustion of kidney essence thready pulse are the signs of yang
from indulgent sexual activity, or by worry insufficiency. If the heart and spleen qi is
damaging the mind, or by fright leading to damaged, there is poor production of qi and
dysfunction of the kidney." . blood. If blood is inadequate for nourishing
Greasy food and wine may damage the the heart, palpitations and insomnia occur.
functio~l of the spleen and stomach in b) Downward flowing of damp heat:
transportation and transformation, causing Main manifestations: Inability of the
dampness to turn into heat. The damp heat penis to erect, complicated with bitter taste
drives downward to make the penis unable in the mouth, thirst, hot and dark red urine,
to erect, resulting in impotence. However, soreness and weakness of the lower
impotence of the damp heat type is not very extremities, yellow, sticky tongue coating,
common. %hang Jingyue said, "Seven to soft, rapid pulse.
eight out of ten impotent patients are caused Analysis: The penis consists of two
by the decline of fire. O ~ l ag few of them are cylindrical bodies. As said izr Internal
due to excess of fire." Classic: "If the damp heat stagnates in the
penis, the major body becomes soft and
Diifferemtiatioa .short, and the small body gets loose and
a ) Decline of Mingmen Fire: long. The former is known as contracture,
Main manifestations: Failure of the penis while the latter known as atrophy and
in erection, or weak erection, pallor, cold weak." The downward flowing of the damp
extremities, dizziness, listlessness, soreness heat makes the cylindrical bodies loose and
and weakness of the loins and knees, weak, resulting in inability of the penis to
frequent urination, pale tongue with w l t e erect. If the damp heat ascends, there will be
coating, deep thready pulse: If the heart and bitter taste in the mouth or thirst. If the
spleen qi is damaged, palpitations and damp heat is transmitted to the small
insomnia may be present.. intestine, and then to the bladder, hot and
Analysis: The kidney dominates repro- dark red urine occurs. Soreness and
duction and opens into the urethra, weakness of the lower extremities, yellow,
spermatic duct and the anus. Insufficiency of sticky tongue coating, and soft, rapid pulse
the kidney yang and the decline of Mingmen indicate the presence of damp heat.
fire wither up the reproductive ability,
leading to impotence. Owing to yang Treatment
deficiency, the body cannot be warmed, a ) Decline of Mingmen Fire:
resulting in pallor, cold extremities, Method: Points of the Ren and Kidney
dizziness, and listlessness. As the lumbar Meridians are selected as the principal
region is the house of the kidney, kidney points. Reinforcing method with moxibus-
Chapter 17 Internal Diseases

tion is applied to invigorate the kidney yang. Appendix: Seminal Emission

Prescription: Guanyuan (Ren 4), Ming-
men (Du 4), Shenshu (B 23), Taixi (K 3). Seminal emission may be divided into two
Supplementary points: For damage of the types: nocturnal emission and spermator-
qi of the heart and spleen: Xinshu (B 1 9 , rhea. Generally, in adult males, unmarried
Shenmen (H 7), Sanyinjiao (Sp 6). or married, occasional emissiop is not
Explanation: Guanyuan (Ren 4) is the pathological.
meeting,point of the Ren Meridian and the a ) Nocturnal emission:
three foot yin meridians. Reinforcing is used Nocturnal emission is mainly due to
to promote the primary qi and invigorate the overcontemplation or excessive sexual
kidney function. Mingmen (Du 4), Shenshu activities which lead to disharmony between
(B 23) and Taixi (K 3) are used to strengthen the heart and kidney. If the heart fire fails to
the kidney yang. Xinshu (B 15), Shenmen (H descend and control the kidney water, the
7) and Sanyinjiao (Sp 4) are good for kidney water cannot ascend and cool the
activating the qi of the heart and spleen. heart fire. When water deficiency and fire
b ) Downward flowing of damp heat: excess disturb the essence, nocturnal
Method: Points of the Ren and Spleen emission happens in dreams. Moreover,
Meridians are selected as the principal there are dizziness, palpitation, listlessness,
points. Reducing method is applied to lassitude and scanty yellow urine, red
eliminate the damp heat. tongue, and thready, rapid pulse. Treatment
Prescription: Zhongji (Ren 31, Sanyinjiao is given by applying acupuncture with
(Sp 6), Yinlingquan (Sp 9), Zusanli (S 36). reducing method to the points of the Heart
Explanation: This condition is caused by Meridian of Hand Shaoyin and with
.
the downward flowing of damp heat from reinforcing method to the points of the
the Spleen Meridian, Zhongji (Ren 3), Kidney Meridian of Foot Shaoyin.
Sanyinjiao (Sp 6) and Yinlingquan (Sp 9) are Prescription: Shenmen (H 7), Xinshu (B
therefore selected to soothe and regulate the 15), Taixi (K 3), Zhishi (B 52).
qi of Spleen Meridian to eliminate the damp Explanation: Shenmen (H 7) and Xinshu
heat. Zusanli (S 36) is the He-(Sea) point of (B 15) are needled to lower the heart fire and
the Stomach Meridian of Foot Yangming. harmonize the heart and kidney. Taixi (K 3)
Because of the interior-exterior relationship is used to activate the kidney qi, and Zhshi
between the Spleen and Stomach Meridians, (B 52) to control the essence.
Zusanli (S 36) is chosen to dispel dampness b ) Spermatorrhea:
by improving the function of the spleen in Spermatorrhea is usually due to damage
transportation and transformation. Heat of the kidney after a prolonged illness,
will disappear when dampness is dispelled. indulgent sexual activity, or stubborn
The above points combined together are nocturnal emission. In exhaustiofi of the
suitable for the treatment of impotence kidney essence, the loss of yin affects yang.
caused by damp heat. The primary qi of the kidney becomes
insufficient, the storage of essence fails and
Remarks seminal fluid is discharged involuntarily.
Impotence in most cases is a functional Clinical manifestations are frequent sper-
disorder, for instance, sexual neurasthenia. matorrhea at day or night, particularly if
 Chinese Acupuncture and Moxibustion

there is a desire for sex, pallor, lassitude, anxiety cause exhaustion of blood and
listlessness, pale tongue, and deep, thready, disturb the mind. As a result, insomnia
weak pulse. Treatment is given by applying follows."
acupuncture with reinforcing method and b) Congenital deficiency, indulgent sexual
moxibustion to the points mainly selected activity, or a prolonged illness damages the
from the Foot-Shaoyin (Kidney) and Ren kidney yin. The kidney water fails to ascend
Meridians to strengthen the kidney and smooth]y to the heart to check the heart fire,
control the essence and seminal fluid. and the heart yang is therefore hyperactive
Prescription: Shenshu (B 23), Dahe (K alternatively. A violent emotional fit can
12), Sanyinjiao (Sp 6), Guanyuan (Wen 4), induce flaring of the heart fire which fails to
Qihai (Wen 6). descend to the kidney to control the kidney
, Explanation: Shenshu (B 23) and water. The kidney yin is therefore deficient.
Sanyinjiao (Sp 6) are needled to reinforce the Def-lciencyof kidney yin injures the will and
Fidney qi. Guanyuan (Ren 4), the meeting excess of the heart fire disturbs the mind. In
boint of the Ren and three foot yin either case there is a disharmony between the
meridians, and Qihai (Ren 6) ,are two heart and the kidney, and hence insomnia.
important points for invigoration. Moxibus- c) Emotional depression causes the
tion applied to these two points can warm stagnation of qi in the liver. The stagnant qi
and strengthen the primary yang. Dahe (K of long duration is transformed into fire,
12) is combined to assist the control of the which flares up to disturb the mind, and then
kidney essence. insomnia occurs.
d) Irregular food intake damages the
spleen and stomach. The accumulated
8 . Insomnia undigested food produces phlegm heat in the
(Appendir: Poor Memory) middle jiao, which in turn -causes
dysfunction of the stomach and insomnia, as
Insomnia has different patterns: difficulty stated in Internal Classic' that sleep is
in falling asleep after retiring, early awaken- disturbed if the function of the stomach is in
ing, intermittent waking through the period disharmony.
of attempted sleep, and even inability to In summary, insomnia is related to
sleep all the night. dysfunction of the heart, spleen, liver and
Insomnia is often accompanied by kidney, although there are many other
dizziness, headache, palpitation, poor causative factors. Blood is made from food
memory and mental disorders. essence and supplies the heart with
Etiology and Pathogenesis nourishment. Blood is stored in the liver and
a) Anxiety and overwork damage the the liver is soothed by the blood. Blood is
heart and spleen. Blood is exhausted and the controlled by the spleen, where production
mind is disturbed in case of damage of the of essence from blood continues. The '
heart, while qi and blood production essence is stored in the kidney. When the
becomes poor in case of deficiency of the kidney essence ascends to the heart and the
spleen qi. Blood deficiency is unable to heart qi descends to the kidney. With
nourish the heart, leading to insomnia. Just harmonious condition between the heart
as Zhang Jingyue described, "Overwork and and kidney, the mind is at ease. Whenever
Chapter 17 Internal Diseases

there is anxiety, depression, or overwork to flaring up of the ministerial fire due to

damage the heart, spleen, liver or kidney, deficiency of the kidney yin.
essence and blood are consumed and c) Upward disturbance of the liver fire:
mutually affected, resulting in insomnia. Main manifestations: Irritability, dream-
disturbed sleep, fright and fear accompanied
Differentiation with headache, distending pain in the costal
a ) Deficiency of both the heart and spleen region, bitter taste in the mouth and string-
qi: taut pulse.
Main manifestations: Difficulty in falling Analysis: The liver fire flares up to disturb
asleep, dream-disturbed sleep, palpitation, the mind, causing dream-disturbed sleep,
poor memory, lassitude, listlessness, anore- fright and fear. When the flaring fire of the
xia, sallow complexion, pale tongue with a liver attacks the head, headache occurs. The
thin coating, thready, weak pulse. liver qi in long stagnation is transformed
Analysis: When there is impairment of the into fire, leading to irritability. The liver fire
heart and spleen, blood is insufficient to flares up with upward flow of the bile,
house the mind, so dream-disturbed sleep, producing bitter taste in the mouth. When
poor memory and palpitation occur. Sallow the fire stagnates in the Liver Meridian,
complexion and pale tongue are manifes- there is distending pain in the costal region.
tations of a poor blood supply which is The string-taut pulse is a sign of hyper-
unable to nourish the upper part of the body. activity of the liver.
Dysfunction of the spleen and stomach in d) Dysfunction of the stomach:
transportation and transformation causes Main manifestations: Insomnia, suffocat-
anorexia. Deficiency of qi and blood leads to ing feeling and distending pain in the
qi declining and blood shortage, resulting in epigastric region, belching, or difficult
lassitude, listlessness, thready and weak defecation, sticky tongue coating, and
pulse. rolling pulse.
b) Disharmony between the heart and Analysis: With the dysfunction of the
kidney: spleen and stomach in transportation and
Main manifestations: Restlessness, in- transformation, the food accumulates in the
somnia, dizziness, tinnitus, dry mouth with middle jiao, obstructing the passage, and
little saliva, burning sensation of the chest, thus giving rise to suffocating feeling and
palms and soles, red tongue, thready rapid distending pain in the epigastric region and
pulse, or nocturnal emission, poor memory, difficulty in defecation. Therefore, sleep is
palpitation, low back pain. disturbed. The undigested food staying in
Analysis: Restlessness, poor memory, the middle jiao forms dampness and
palpitation, nocturnal emission and low produces phlegm, so the tongue coating is
back pain are due to deficiency of the kidney sticky aAd the pulse rolling.
and hyperactivity of the heart fire. Dry
mouth with little saliva, burning sensation of Treatment
the chest, palms and soles, red tongue and Method: Points of the Heart Meridian are
thready rapid pulse are the signs of yin selected as the main points to calm the heart
deficiency in the lower jiao with fire flaring and soothe the mind.
up. Dizziness and tinnitus result from the Deficiency of the heart and spleen:
 Chinese Acupuncture and Moxibustion

Reinforcing method with moxibustion in of the liver and gallbladder. The

combination is applied to strengthen the combination of Weishu (B 21) and Zusanli
heart and spleen. (S 36) is to regulate the stomach and soothe
Disharmony between the heart and the mind.
kidney: Even movement is applied to
harmonize the heart and kidney. Remarks
LT?'i~,am-d &cku-ba-ms~ cf liver fire: Tapping-needhg: Tap Sishenchong
Reducing is applied to subdue the liver fire. (Extra), Back-(Shu) points or Huatuojiaji
Dysfunction of the stomach: Reducing is (Extra) slightly from above downward two
applied to regulate the stomach qi. to three times. Treat once daily or every
Prescription: Skenmen (H 7), Sanyinjiao other day. Ten treatments constitute a
(Sp 6), Anmian (Extra). course. Next course of treatment begins
Supplementary points: after an interval of two to three days.
Deficiency of the heart and spleen: Pishu
(B 20), Xinshu (B 15), Yinbai (Sp 1,
moxibustion with small moxa cones). Appendix: Poor Memory
Disharmony between the heart and
kidney: Xinshu (B 1 9 , Shenshu (B 23), Taixi Poor memory is a trouble characterized
(K 3). by the functional decline of the brain,
Upward disturbance of the liver fire: hypomnesia and forgetfulness. It differs
Ganshu (I3 181, D a n s h (R 19!, Wangu (G from lack of intellegence and natural
12). endowments. The condition in most cases is
Dysfunction of the stomach: Weishu (B caused by insufficiency of the heart and
21), Zusanli (S 36). spleen and deficiency of the kidney essence.
Explanation: Shenmen (H 7), the Yuan- As Wang Yang said, "Essence and will are
(Primary) point of the Heart Meridian, both stored in the kidney. If the kidney
calms the heart and soothes the mind. essence is deficient, the will is weakened.
Sanyinjiao (Sp 6), the crossing point of the Poor memory appears when the will fails to
Liver, Spleen and Kidney Meridians,
, cooperate with the heart." In Prescriptions
regulates the three meridians. Anmian Based on Three Pathogenic Factors, it says:
(Extra) is an extra point for insomnia. "The spleen dominates the recollection and
Xinshu (B 15), the Back-(Shu) point of the thinking. Recollection refers to the power of
heart, and Pishu (B 20), the Back-(Shu) calling back the past facts to the mind, and
point of the spleen, are combined to thinking depends also on the action of the
reinforce the spleen and nourish the heart. heart.. . . Since the spleen is troubled,
Yinbai (Sp I), the Jing-(Well) point of the collection is impaired, and the mind is
Spleen Meridian, is effective for dream- uneasy, so memory is poor." The heart and
disturbed sleep. Xnshu (B 15) reduces heart spleen dominate the blood. Overthinking
fire. Shenshu (B 23j and Taixi (K 3) reinforce injuring the heart and spleen consumes
kidney water. The combination of these blood and leads to poor memory. The
points is to harmonize the heart and kidney. kidney dominates essence and marrow,
The combination of Ganshu (B 18), Danshu which can be consumed or exhausted by
(B 19) and Wangu (G 12)is to subdue the fire indulgent sexual activitv. The brain is
Chapter 17 Internal Diseases

therefore poorly nourished, causing forget- dangerous environments. In Chapter 19

fulness. The old aged also tend to have poor of Plain Questions, it says: "Fright
memory due to the kidney decline. makes qi disturbed because the heart has
The treatment is mainly to replenish the nothing to rely on, the mind has no place to
blood of the heart and reinforce the spleen house and the thinking has nothing to focus
and kidney. Reinforcing method is applied on." There are other pathogenic factors
to Sishencong (Extra), Xinshu (B 1 9 , Pishu causing palpitation, such as internal
(B 20), Zusanli (S 36), Shenshu (B 23), and accumulation of phlegm heat, mental
Zhaohai (K 6). depression and anger, dysfunction of the
Explanation: Sishencong (Extra) is an stomach and upward perversion of phlegm
empirical point for treatment of poor fire.
memory. Xinshu (B 15) and Pishu (B 20) are b ) Insufficiency of qi and blood:
applied to strengthen the heart and spleen. Persistent disease, weak constitution, loss
Shenshu (B 23) and Zhaohai (K 6) promote of blood, or overthinking damages the heart
the .kidney essence, produce marrow and and spleen, and impedes the production of qi
replenish the brain. Zusanli (S 36) reinforces and blood. Deficiency of qi and blood fails
the spleen and stomach in transportation to nourish the heart, which affects the
and transformation, and replenishes qi and housing of the mind, causing palpitation.
blood. c ) Hyperactivity of the fire due to yin
deficiency:
Injury of kidney yin by indulgent sexual
activity, or debility after a prolonged disease
renders the kidney water unable to check the
19. Palpitation
heart fire. Disharmony between the heart
and kidney with flaring fire disturbing the
mind causes palpitation.
Palpitation refers to unduly rapid action d ) Retention of harmful fluid:
of the heart which is felt by the patient and Retention of harmful fluid due to
accompanied by nervousness and rest- depression of the heart yang or due to
lessness. , deficiency of the spleen and kidney yang
Mild palpitation is mostly due to a sudden disturbs the heart, resulting in palpitation.
fright and overstrain. The general condition
is comparatively good and the symptoms are
of short duration. A serious case is often due Differentiation:
to prolonged internal injury. The general a ) Disturbance of the mind:
condition is comparatively poor and the Main manifestations: Palpitation, feat
symptoms are severe. and f;ight, irritability, restlessness, dream-
disturbed sleep, anorexia, white, thin tongue
Etiology and Pathogenesis coating, a little bit rapid pulse. In cases of
a) Disturbance of the mind: phlegm heat, yellow, sticky tongue coating,
A timid person is likely to have rolling, rapid pulse.
palpitation when he or she is frightened by Analysis: Fear makes the qi flow
strange noises, surprising objects, or disordered, and fright makes qi descend. A
 Chinese Acupuncture and Moxibustion

disturbed mind is out of self-control, so the chest and epigastric region, lassitude,
there are palpitation, fear and fright, dream- weakness, cold extremities, white tongue
disturbed sleep, irritability and restlessness. coating, string-taut, rolling pulse. In case sf
White thin tongue coating and a little bit deficiency of yang in the spleen and kidney,
rapid pulse are the signs of disturbance of scanty urine, thirst without desire to drink,
the mind. Yellow sticky coating, and rolling, white, slippery tongue coating, deep, string-
rapid pulse indicate the presence of phlegm taut or rapid puise.
heat. Analysis: Accumulation of dampness
b ) Insufficiency of qi and blood: forms the harmful fluid, which depresses the
Main manifestations: Palpitation, lustre- heart yang. When the yang qi is unable to
less complexion, dizziness, . blurring of reach the extremities, they are cold and
vision, shortness of breath, lassitude, pale weak. White tongue coating, string-taut,
tongue with tooth prints, thready, weak or rolling pulse suggest the presence of harmful
intermittent pulse. fluid. Unsmooth circulation of qi resulting
Analysis: Palpitation is due to insuffi- from yang deficiency of the spleen and
ciency of qi and blood, which fails to nourish kidney gives rise to scantiness of urine and
the heart. Lustreless complexion is due to thirst without desire to drink. White,
the insufficient qi and blood unable to l c s t e slippery touguq coating and deep, string-
the complexion. Dizziness is due to the poor taut pulse are due to yang deficiency of the
nourishment of the brain by the insufficient spleen and kidney and retention of fluid.
qi and blood. The heart dominates the biood Rapid puise indicates the decliiie of the h e a t
and vessels and is manifested in the tongue. Yaw.
Therefore insufficient qi and blood makes
the tongue pale with tooth prints, and the Treatment
pulse thready, weak or intermittent. Method: The Back-(Shu) and Front-(Mu)
d ) Fire hyperactivity due to yin deficiency: points of the heart, and points of the Heart
Main manifestations: Palpitation, rest- and Pericardium Meridians are selected as
lessness, irritability, insomnia, dizziness, the main points. Even movement is applied
blurring of vision, tinnitus, red tongue with for disturbance of the mind to clam the
little coating, thready, rapid pulse. heart. Reinforcing is used for insufficiency
Analysis: Kidney yin in-deficiency state of qi and blood to nourish the heart and ease
fails to check the heart fire, leading to the mind. Reinforcing combined with
disturbance of the mind,, and resulting in reducing is applied for fire hyperactivity due
palpitation, irritability and insomnia. When to yin deficiency to nourish yin and subdue
yin deficiency is present in the lower part of the fire. For retention of harmful fluid,
the body, and yang hyperactivity in the reducing method is applied first and then
upper, there may be dizziness and tinnitus. reinforcing in combination with moxibus-
Red tongue with little coating, and thready tion to warm yang and dissolve the harmful
rapid pulse are the signs of yang fluid. -
hyperactivity due to yin deficiency. Prescription: Xinshu (B 15), Juque (Ren
e ) Rentention of harmful fluid: 14), Shenmen (H 7), Neiguan (P 6).
Main manifestations: Palpitation, ex- Supplementary points:
pectoration of mucoid sputum, fullness in Disturbance of the mind: Tongli (P 5),
Chapter 17 Internal Diseases

Qiuxu (G 40); if accompanied with phlegm 20. Manic-Depressive Disorder

heat: Fenglong (S 40), Danshu (B 19).
Insufficiency of qi and blood: Pishu (B Depressive disorder is manifested by
20), Weishu (B 21), Zusanli (S 36). mental dejection, reticence or incoherant
Fire hyperactivity due to yin deficiency: speech, while manic disorder by shouting,
Jueyinshu (B 14), Shenshu (B 23), Taixi (K restlessness and violent behaviours. As
3). described in Classic on Medical Problems,
Retention of harmful fluid: Shuifen (Ren depressive disorder is caused by excessive
9), Guanyuan (Ren 4), Shenque (Ren 8), yin, while manic disorder by abundant yang.
Yinlingquan (Sp 9). The most important etiological factor of
Explanation: The combination of Shen- manic-depressive disorder is -emotional
men (H 7), the Yuan-(Primary) point of the injury. Pathogenetically, phlegm plays the
Heart Meridian, and Xinshu (B 12) with primary role. Depressive disorder is due to
Juque (Ren 14), the Front-(Mu) point of the stagnation of phlegm combined with qi,
heart, and Neiguan (P 6), the Luo- while manic disorder is due to phlegm fire.
(Connecting) point of the Pericardum Although they are different in symptomat-
Meridian can regulate qi and blood of the ology, they are related to each other. A
heart to ease the mind. The combination of prolonged depressive disorder, in which fire
Tongli (H 5), the Luo-(Connecting) point of is produced by phlegm stagnation, may
the Heart Meridian, and Qiuxu (G 40), the change into manic disorder, while a
Yuan-(Primary) point of the Gallbladder protracted manic disorder, in which the
Meridian, can calm the mind and regulate stagnated fire is gradually dispersed, but the
the gallbladder. Fenglong (S 40), the Luo- phlegm is still existing, can change into
(Connecting) point of the Stomach depressive disorder. Therefore, they are
Meridian, and Danshu (B 19), the Back- termed together as manic-depressive.
(Shu) point of the gallbladder, can dissolve
phlegm and dispel heat. Pishu (B 20) and
Weishu (B 21) can regulate the spleen and Etiollogy and Pathogenesis:
stomach to promote qi and blood a) Depressive disorder:
production. Zusanli (S 36) is an important In most cases it is caused by over-
point to reinforce qi and blood. Shenshu (B contemplation and emotional depression,
23) and Taixi (K 3) can replenish kidney yin. which lead to dysfunction of the lives and
Jueyinshu (B 14) can clear heart fire. spleen. There are sragnant liver qi and '

Guanyuan (Ren 14), Shuifen (Ren 9) and accumulated fluid due to impaired
Yinlingquan (Sp 9) can invigorate the heart transportation, which turns into phlegm.
yang, strengthen the spleen and remove the Then the phlegm pervertedly goes upward to
harmful fluid. invade the mind.
b) Manic disorder:
Remarks In most cases it is caused by anger that
Palpitation described here may be injures the liver, leading to its failure in
involved in neurosis, functional disorders of dispersing. The stagnated qi transforms into
the vegetative nervous system and cardiac fire, which evaporates the body fluid to
arrhythmia' of various origins. produce phlegm fire. The phlegm fire
 Chinese Acupuncture and Moxibustion

pervertedly rushes upward and disturbs the sticky tongue coating, string-taut, rolling
mind. and rapid pulse.
In addition, this disease has a hereditary
trend and often a positive family history. Treatment
a ) Depressive disorder:
Differentiation: Method: Even movement is applied to the
a ) Depressive disorder: -,oints of the E e x t arrd Liver Mpridia~st~
Main manifestations: Gradual onset, soothe the liver, calm the heart and dissolve
emotional dejection and mental dullness at the phlegm.
the initial stage, followed by incoherent Prescription: Xinshu (B 15), Ganshu (B
speech, changing moods, or muteness, IS), Pishu (B 20), Shenmen (H 7), Fenglong
somnolence, anorexia, thin, sticky tongue (S 40).
coating, string-taut, thready or string-taut Explanation: This condition is caused by
rolling pulse. the stagnation of phlegm and qi, which
Analysis: Overcontemplation and emo- injures the heart, liver and spleen. Xinshu (B
tional dejection make the liver qi stagnated 15) is used to clear the heart, Ganshu (B 18)
- and the spleen qi fail to ascend. The to remove the liver stagnation, Pishu (B 20)
stagnated qi collzbila_ed with the phlegm to promote the spleen qi circulation,
disturbs the mind, leading to mental Shenmen (H 7) and Fenglong (S 40) to
disorders. The stagnated phlegm in the dissolve the phlegm for calming the mind.
middle jiao gives rise to anorexia and thin, b ) A4azI'c diserder:
sticky tongue coating. String-taut thready or Method: Reducing is applied-to the main
string-taut rolling pulse is due to the points of the Du Meridian and Pericardium
accumulation of phlegm and qi. Meridian of Hand Jueyin to calm the heart,
b) Manic disorder: ease the mind, reduce the heat and dissolve
Main manifestations: Sudden onset, the phlegm.
irritability, being easy to anger, insomnia, Prescription: Dazhui (Du 14), Fengfu (Du
loss of appetite, followed by excessive motor 16), Shuigou (Du 26), Neiguan (P 6),
activity with increased energy and violent Fenglong (S 40).
behaviours, yellow, sticky tongue coating. Supplementary points:
String-taut, rolling and rapid pulse. Mania with extreme heat: Prick the twelve
Analysis: Anger damages the liver. The Jing-(Well) points on hand (L 11, H 9, P 9, L
liver fire flares up and agitates the phlegm I 1, S J 1, S I 1) to bleeding for reducing heat.
heat of Yangming to disturb the mind. Explanation: Dazhui (Du 14) and
Therefore, the patient is irritable, unable to Shuigou (Du 26) are used to reduce heat for
fall asleep and easy to anger. Because of the clearing the mind. Fengfu (Du 16) is selected
disturbance of the mind by the phlegm heat, for mental disorders as Miraculous Pivot
violent behaviours take place. The limbs are states: "The brain is the sea of marrow, its
the foundation of all the yang actions. upper part reaches the vertex of the cranium,
Preponderant yang makes the limbs more and its lower part reaches point Fengfu (Du
energetic, thus, the physical strength and 1 ) Neiguan (P 6) is combined with
motor activity are increased. The combina- Fenglong (S 40) to clear the heart and
tion of phlegm and heat, leads to yellow, dissolve the phlegm.
Chapter 17 Internal Diseases

Remarks flow of qi, or irregular food intake damaging

a) The condition described here includes the spleen and stomach, makes the damp-
the depressive and manic types of ness of food and drinks accumulate as
schizophrenia in modern medicine. phlegm, which combined with the stagnated
b) Thirteen points for manic-depressive liver qi, disturbs the mind and causes
disorder: Prick to bleed according to the epilepsy.
order of Shuigou (Du 26), Shaoshang (L 1I), c) Epilepsy may result from hereditary
Yinbai (Sp l), Daling (P 7), Shenmai (B 62), factors, but in most of tEe hereditary cases it
Fengfu (Du 16), Jiache (S 6), Chengjiang comes on in early childhood.
(Ren 24), Laogong (P 8), Shangxing (Du 23),
Huiyin (Ren l), Quchi (L I 11), and Differentiation
Shexiazhongfeng (an extra point located at a ) During seizure
the midline of the under side of the tongue). Main manifestations: A typical seizure is
preceded by dizziness, headache and
suffocating sensation in the chest, and
21. Epilepsy immediately followed by falling down with
loss of consciousness, pallor, clenched jaws,
Epilepsy occurs in seizures, manifested by upward staring of the eyes, convulsion, foam
falling down in a fit, loss of consciousness, on the lips, screaming as pigs or sheep, and
foam on the lips, or screams with eyes even incontinence of urine and feces.
staring upward, and convulsions. After Gradually, the patient regains consciouse-
some minutes, consciousness returns, and ness, and the symptoms disappear. Apart
the patient's condition becomes normal. from fatigue and weakness, the patient can .
Besides the typical seizures, there may be live a normal life. White sticky tongue
variations. It can be a momentary loss of coating, and string-taut, rolling pulse.
attention or consciousness with eyes staring Analysis: Dizziness, headache and
directly forward, or prolonged loss of suffocated sensation in the chest are the
consciousness associated with convulsions prodromal symptoms which show the
and foam on the lips. Epileptic fits may upward perversion of the wind phlegm. The
occur at any time, in various frequency and liver wind stirs up with the phlegm to disturb
with different severity. It is often preceded the mind. Therefore, there are loss of
by an "aura" of dizziness, depression consciousness, convulsions and upward
sensation of the chest, and listlessness. staring of the eyes. The foam on the lips is
Generally speaking, epilepsy is an excess owing to the ascending wind phlegm. White,
condition, but frequent recurrence can lower sticky tongue coating and rolling pulse are
the body resistance. the signs of retaining of the phlegm. Since
the wind phlegm is irregularly accumulated
Etiology and Pathogenesis and dispersed, the seizures are paroxysmal,
a) Fear and fright: Fear makes qi and the patient behaves as normal after the
disordered and fright makes qi descend, seizure.
affecting the liver and kidney and leading to b ) After seizure:
stirring of the deficiency wind. Main manifestations: Listlessness, lustre-
b) Dysfunction of the liver in smoothing less complexion, dizziness, palpitation,
 Chinese ~ c u ~ u n c t uand
r e Moxibustion

anorexia, profuse sputum, weakness and Prescription: Xinshu (B 1 9 , Yintang

soreness of the loins and limbs, pale tongue (Extra), Shenmen (H 7), Sanyinjiao (Sp 6),
with white coating and thready, rolling Taixi (K 31, Yaoqi (Extra).
pulse. Supplementary points:
Analysis: Listlessness is due to damage of Daytime seizure: Shenmai (B 62).
the vital qi by frequent epileptic fits. With Night seizure: Zhaohai (K 6).
insufficiency of blood, the complexion is Phlegm stagnation: Zhongwan (Ren 12):
lustreless. There is dizziness if the brain lacks Fenglong (S 40).
blood supply, and palpitation if the heart is Severe deficiency of qi and blood:
poorly supplied with blood. Due to the Guanyuan (Ren 4), Zusanli (S 36).
depression of the spleen yang, the food Explanation: Xinshu (B 1 9 , Yintang
cannot be transformed into essence, and (Extra) and Shenmen (H 7) are used for
dampness and phlegm are produced, so nourishing the heart and easing the mind,
there are anorexia and profuse sputum. and Sanyinjiao (Sp 6) and Taixi (K 3), for
Deficiency of the kidney essence causes strengthening the spleen and reinforcing the
soreness and weakness of the loins and kidney. Yaoqi (Extra) is an empirical point
limbs. Pale tongue with white coating and for epilepsy. Shenmai (B 62), a point of
thready, rolling pulse suggest consumption Yangqiao Meridian, is needled for the
of qi and blood and accumulation of phlegm daytime seizure, while Zhaohai (K 6), a
dampness. point of Yinqiao Meridian, is needled for
night seizure. Zhongwan (Ren 12) and
Fenglong (S 40) are applied to regulate the
Treatment stomach and dissolve the phlegm.
a ) During seizure: Guanyuan (Ren 4) and Zusanli (S 36) are
Method: Points of the Du, Ren and Liver used to regulate and replenish qi and blood.
Meridians are selected as the main points
with reducing method to dissolve the
phlegm, induce resuscitation, soothe the Remarks
liver and dispel the wind. The above description refers to many
Prescription: Shuigou (Du 26), Jiuwei types of epileptic seizures including grand
(Ren 15), Jianshi (P 5), Taichong (Liv 3), mal, petit mal, psychomotor and focal
Fenglong (S. 40). seizures. For secondary epilepsy, the
Explanation: Shuigou (Du 26) and Jiuwei primary disease should be treated actively.
(Ren 15) are used for resuscitation. Jianshi
(P 5), Fenglong (S 40) and Taichong (Liv 3)
are used to calm the heart, ease the mind, 2 2 Dizziness
dissolve the phlegm and dispel the wind.
b ) After seizure: The mild case can be relieved by closing
Method: Points of the Heart, Spleen and one's eyes, while the serious case has an
Kidney Meridians are selected as the main illusion of bodily movement with rotatary
points with even movement to nourish the sensation like sitting in a sailing boat or
heart, ease the mind, strengthen the spleen moving car, and, even accompanied by
and reinforce the kidney. nausea, vomiting and sweating.
Chapter 17 Internal Diseases

Etiology and Pathogenesis causing hyperactivity of the liver yang,

a ) Hyperactivity of the liver yang: which transforms into fire. When the fire
The liver is analogized as wind and wood, flares up, flushed face, red eyes and
characterized by movement and ascending. irritability appear. The spirit stored in the
Overcontemplation, anxiety, depression or liver is upset by disorders of the liver, then
anger can damage the liver yin, resulting in dream-disturbed sleep occurs. The red
hyperactivity of liver yang. Dizziness occurs tongue proper with yellow coating, bitter
in case the liver yang moves as the wind and taste in the mouth, string-taut, rapid pulse
ascends to attack the brain. Or the kidney are the signs of yin deficiency resulting in fire
water, generally in deficiency, fails to hyperactivity.
nourish the liver. Dizziness occurs in case the b ) Deficiency of qi and blood:
liver is lack of nourishment, which leads to Main manifestations: Dizziness accom-
hyperactivity of liver yang. In both panied by pallor and lustreless complexion,
situations there is deficiency in the lower but weakness, palpitation, insomnia, pale lips
excess in the upper part of the body. and nails, lassitude, pale tongue proper,
b ) Deficiency of qi and blood: thready and weak pulse. Dizziness occurs.
The heart and spleen are damaged by mostly after a serious disease or loss of blood
overwork and over contemplation in case of and is aggravated by overwork. Loss of
a weak constitution after a disease. The consciousness happens in severe cases.
damaged spleen fails to produce qi and Analysis: Dizziness is inevitable because
blood, leading to deficiency. In case the deficiency of qi and blood fails to nourish
brain is poorly nourished by qi and blood, the brain. The heart dominates the blood
dizziness occurs. and is manifested in the complexion. The
c ) Interior retention of phlegm dampness: spleen dominates the transportation and
In a person with generally abundant transformation to manufacture qi and
phlegm dampness, irregular food intake and blood. If the heart and spleen are injured, qi
overwork damage the stomach and the and blood will be insufficient, thereby, the
spleen, impairing their function in complexion is lustreless, and the lips and the
transportation and transformation and nails are pale. Deficiency of blood leads to
leading to production of dampness and palpitation and insomnia. Deficiency of qi
phlegm. Then the stagnant phlegm and qi gives rise to weakness, lassitude, anorexia,
may impede the ascending of clear yang and and is aggravated by overwork. Pale tongue
the descending of the turbid yin,'and thus and thready, weak pulse are the signs of
dizziness occurs. deficiency of qi and blood.
c ) Interior retention of phlegm dampness:
Main manifestations: Dizziness with a
a ) Hyperactivity of liver yang: heavy feeling of the head and suffocating
Main manifestations: Dizziness ag- sensation in the chest, nausea, profuse
gravated by anger, irritability, flushed face, sputum, anorexia, somnolence, white, sticky
red eyes, tinnitus, bitter t a s t e b the mouth, tongue coating, soft, rolling pulse.
dream-disturbed sleep, red tongue proper Analysis: Dizziness with a heavy feeling of
with yellow coating, string-taut, rapid pulse. the head is the sign of the pure yang
Analysis: Anger damages the liver yin, disturbed by phlegm dampness. Suffocating
426 Chinese Acupuncture and Moxibustion

sensation in the chest and nausea are caused points of the spleen and stomach are selected
by qi obstructed in the middle jiao. Anorexia as the main points with even movement to
and somnolence are due to the spleen yang resolve phlegm and eliminate dampness.
deficiency. White, sticky tongue coating, Prescription: Touwei (S 8), Pishu (B 20),
soft and rolling pulse are the signs of phlegm Zhongwan (Ren 12), Neiguan (P 6),
dampness. Fenglong (S 40).
Explanation: Pishu (B 20) and Zhongwan
Treatment (Ren 12) are needled to strengthen the spleen
a ) Hyperactivity of liver yang: and stomach for eliminating dampness.
Method: Points of the Liver Meridian and Fenglong (S 40), the Luo-(Connecting)
Kidney Meridian are selected as the main point of the stomach, is to make qi descend
points to nourish yin and pacify yang. and resolve phlegm. Touwei (S 8) is for
Reinforcing and reducing methods are dizziness. Neiguan (P 6) is for relaxing the
applied with either one first according to the chest, regulating qi and harmonizing the
condition of the disease. stomach to -check vomiting.
Prescription: Fengchi (G 20), Ganshu (B
18), Shenshu (B 23), Taixi (K 3), Xingjian Remarks
(Liv 2). a) Dizziness may be explained as
Explanation: The reinforcing method. derangement of the equilibrium of the senses
applied to Shenshu (B 23) and Taixi (K 3) is in modern medicine. Clinically, the
to replenish the kidney water, while the symptom is mostly seen in hypertention,
reducing to Ganshu (B 18), Xingjian (Liv 2) arteriosclerosis, neurosis, and otogenic
and Fengchi (G 20) is to pacify the liver diseases.
Yaw. b) Tapping needling:
b ) Deficiency of qi and blood: Main points: Baihui (Du 20), Taiyang
Method: Points of the Wen Meridian and (Extra), Yintang (Extra), and Huatuojiaji
the Bladder and Stomach Meridians are (Extra).
selected as the main points with reinforcing Method: Tap once or twice daily with
in combination with moxibustion to moderate stimulation. Five to ten treat-
replenish qi and blood. ments constitute one course.
Prescription: Baihui (Du 20), Pishu (B 20),
Guanyuan (Ren 4), Zusanli (S 36),
Sanyinjiao (Sp 6).
Explanation: Moxibustion to Baihui (Du
20), which is located at the vertex, is to make Melancholia is a general term for
qi and blood ascend to the head to nourish disorders resulted from emotional de-
the brain and check dizziness. Guanyuan pression and stagnation of qi. The
(Ren 4) is used to strengthen the primary qi. symptoms due to emotional frustration, and
Pishu (B 20) and Sanyinjiao (Sp 6) are for depression of qi which lead to stagnation of
invigorating the spleen and stomach to blood, accumulation of phlegm, retention of
produce qi and blood. food, collection of fire, and disharmony of
c) Interior retention of phlegm dampness: the zang-fu organs fall into this category.
Method: The Back-(Shu) and Front-(Mu) Zhu Danxi said, "There is no disease when
 Chapter 17 Internal Diseases

qi and blood are in harmony. Once lower abdomen and curves around the
. depression occurs, disease results." stomach and then branches out in the costal
and hypochondriac regions. In case of
Etiology and Pathogenesis: stagnation of the qi of the liver, there may
Generally speaking, melancholia is caused appear distress in the chest, hypochondriac
by emotional injuries resulting in dishar- pain and abdominal distension. If the
mony of the activity of the zang organs. As stomach qi fails to descend, belching and
said in Chapter 28 of Miraculous Pivot: anorexia occur. When the liver qi
"Grief, sorrow, worry and anxiety disturb encroaches the spleen, abdominal pain,
the mind and disturbance of the mind will vomiting and abnormal bowel movement
affect all the five zang and six fu organs." result. Thin, sticky tongue coating and
a) Depressed anger may give rise to many string-taut pulse are the signs of disharmony
-
disorders of the liver with impairment of the between the liver and stomach.
free flow of qi. Then the liver qi may go b) Transformation ofdepressed qi intofire:
upward to attack-the mind, or conquer the Main manifestations: Headache, dryness
spleen and stomach, or counteract the lung, and bitter taste in the mouth, irritability,
or go downward to the intestines, leading to distress of the chest, hypochondriac
various illnesses. distension; acid regurgitation, cpnstipation,
b) Too much worry may depress the liver red eyes, tinnitus, red tongue with yellow
and suppress the spleen, causing the failure coating, string-taut, rapid pulse.
of the spleen in transportation and Analysis: When the depressed qi is
transformation, which brings about ac- transformed into fire, it flares up along the
cumulation of dampness and phlegm and Liver Meridian, resulting in headache, red
retention of undigested food. Agglomera- eyes and tinnitus. When the liver fire
tion of the dampness, phlegm and evaporates the fluid and heat accumulates
undigested food in a long duration is apt to in the stomach and intestines, dryness and
produce fire. Overanxiety may also lead to bitter taste in the mouth and constipation
dysfunction of the qi and consumes yin occur. If the liver is hyperactive, it will
(nutrients and blood,) generating many encroach the stomach, leading to failure of
symptoms. the stomach in descending function, then
distress of the chest, hypochondriac
Differentiation distension, and acid regurgitation occur.
a) Depression of the qi in the liver: Irritability, yellow tongue coating, string-
Main manifestations: Mental depression, taut, rapid pulse are the signs of the fire in
distress of the chest, hypochondriac pain, the liver.
abdominal distension, belching, anorexia, c) Stagnation of phlegm (also known as
or abdominal pain, vomiting, abnormal globus hystericus) :
bowel movement, thin, sticky tongue Main manifestations: Feeling of a lump
coating, string-taut pulse. choking in the throat, hard to spit it out or to
Analysis: In case of emotional injury, the swallow it, thin, sticky tongue coating,
liver fails to be harmonious and flourishing, string-taut, rolling pulse.
so mental depression appears. The Liver Analysis: The depressed liver qi acts over
Meridian of Foot-Jueyin runs up to the the spleen and stomach, leading to
 Chinese Acupuncture and Moxibustion

disturbance of transportation and trans- flow of qi. Ganshu (B 18) and Taichong (Liv
formation. Dampness derived from the 3) are the Back-(Shu) point and Yuan-
water and food taken is gathered and turned (Primary) point of the liver respectively.
into phlegm, which combined with qi, stays When used in combination, they may soothe
in the throat, giving rise to choking feeling. the liver and remove depression. Zhongwan
Thin, sticky tongue coating and string-taut, (Ren 12) and Zusanli (S 36) may harmonize
rolling pulse are the signs of the stagnation the stomach and make the stom~ch qi
of phlegm with qi. descend. Gongsun (Sp 4), the Luo-
d ) Insufficiency of blood (also known as (Connecting) point of the Spleen Meridian,
hysteria) : may strengthen the spleen and harmonize
Main manifestations: Grief without the stomach.
reasons, capricious joy or anger, suspicions, b ) Transformation of depressed qi intofire:
liability to get frightened, palpitation, Method: Points of the Liver, Gallbladder
irritability, insomnia, or sudden distress of and Stomach Meridians are selected as the
the chest, hiccup, sudden aphonia, convul- principal points. Reducing method is used to
sion, or loss of consciousness in severe cases, dispel the fire from the liver and strengthen
thin, white tongue coating, string-taut, the stomach function.
thready pulse. Prescription: Shangwan (Ren 13), Zhigou
Analysis: Because of overcontemplation (S J 6), Yanglingquan (G 34), Xingjian (Liv
and emotional frustration, the qi function is 2), Xiaxi (G 43).
impaired and the blood is gradually Explanation: Xingjian (Liv 2) md Ximi
consumed, leading to poor nourishment of (G 43), the Ying-(Spring) points of the Liver
the mind, thus the above-mentioned and Gallbladder Meridians, may dispel fire
symptoms occur. In case the qi is blocked, from the liver and gallbladder. Zhigou (S J 6)
there may be sudden distress of the chest, in combination with Yanglingquan (G 34)
hiccup, sudden aphonia and convulsian. may treat . distress of the chest, hypo-
Thin white tongue coating, and string-taut chondriac distension, bitter taste in the
thready pulse are the signs of a long- mouth and constipation. Shangwan (Ren
standing stagnation of qi that damages 13) may harmonize the stomach and
blood. regulate the flow of qi to treat acid
regurgitation.
Treatment c ) Stagnation of phlegm:
a ) Depression of qi in the'liver: Method: Points of the Liver Meridian and
Method: The Influential point of qi and Ren Meridian are selected as the .principal
the points of the Liver Meridian are selected points. Even movement is applied to soothe
as the principal points. Even movement is the liver, remove the depression, regulate the
applied to soothe the liver, strengthen the flow of qi and resolve phlegm.
spleen and harmonize the stomach. Prescription: Tiantu (Ren 22), Tanzhong
Prescription: Ganshu (B 18), Tanzhong (Ren 17), Neiguan (P 6), Fenglong (S 40),
(Ren 17), Zhongwan (Ren 12), Zusanli (S Taichong (Liv 3).
36), Gongsun (Sp 4), Taichong (Liv 3). Explanation: Taichong (Liv 3) is applied
Explanation: Tanzhong (Ren 17), the to soothe the liver and remove the
Influential point of qi, is able to regulate the depression. Tiantu (Ren 22) is needled to
Chapter 17 Internal Diseases

descend the qi and treat the throat trouble. used for resuscitation.
Neiguan (P 6) is used to remove depression
from the chest and regulate the flow of qi. Remarks
Tanzhong (Ren 17), the Influential point of This condition is seen in hysteria and
qi, Fenglong (S 40), the Luo-(Connecting) neurosis in Western medicine.
point of the stomach, used together, may
promote the circulation of qi and resolve
phlegm.
d ) Insufficiency of blood: 111. DISEASES OF HEAD, .
Method: Points of the Heart and Liver TRUNK AND LUMBAR REGIONS
Meridians are selected as the principal
points. Even movement is applied to nourish
blood, soothe the liver and refresh and
tranquilize the mind. 1. Headache
'
Prescription: Juque (Ren 14), Shenmen
(H 7), Sanyinjiao (Sp 6), Taichong (Liv 3). Headache is a subjective symptom. It can
Supplementary points: be induced by various acute and chronic
Distress of the chest: Neiguan (P 6), diseases. As it covers a wide sphere, this
Tanzhong (Ren 17). section only deals in detail with headache as
Hiccup: Gongsun (Sp 4), Tiantu (Ren 22). the predominant symptom. If headache is an
Sudden aphonia: Tongli (H 5), Lianquan accompanying symptom in the development
(Ren 23). of a certain disease, it will disappear
convulsion.: Hegu (L I 4), Yanglingquan automatically as soon as the disease is cured.
(G 34). This type of;headache is not to be discussed
Loss of consciousness: Shuigou (Du 26), here.
Yongquan (K I). The head is the place where all the yang
Explanation: Taichong (Liv 3) is selected meridians of hand and foot meet, and qi and
to soothe the liver and remove depression. blood of the five zang organs and six fu
~ u ~ u e ' ( 14),
~ e nthe Front-(Mu) point of the organs all flow upward to the head. Attacks
Heart Meridian, Shenmen (H 7), the Yuan- of endogenous or exogenous factors may
(Primary) point, combined with Sanyinjiao cause headache due to derangement of qi
(Sp 6) of the Spleen Meridian, may nourish and blood in the head and retardation of
blood, refresh and tranquilize the mind. circulation of qi in the meridians that
Neiguan (P 6) and Tanzhong (Ren 17) may traverse the head. Headache caused by
remove the depression of the chest. Gongsun exogenous pathogenic factors is mostly due
(Sp 4) and Tiantu (Ren 22) causes the qi to to invasion of pathogenic wind into the
descend and checks hiccup: Tongli (H 5 ) and meridians and collaterals. It is said: "When
Lianquan (Ren 23) are effective in the the pathogenic wind invades the human
treatment of aphonia. Hegu (L I 4) is taken body, it first attacks the upper portion of the
to regulate the flow of qi. Yanglingquan (G body." Headache caused by endogenous
34), the Influential point of the tendons, is . factors often originates from hyperfunction
used to check convulsion and relieve pain. of the liver yang, or deficiency of both qi and
Shuigou (Du 26) and Yongquan (K 1) are blood.
 Chinese Acupuncture and Moxibustion

Etiology and Pathogenesis coating are the signs of meridians and

a) Invasion of pathogenic wind into the collaterals being invaded by pathogenic
upper meridians and collaterals causes wind.
derangement and obstruction of qi and b ) Headache due to upsurge of liver-yang:
blood. With stagnation in the collaterals, Main manifestations: Headache, blurred
sudden weather change or exposure to wind vision, severe pain on the bilateral sides of
usually precipitates an attack of headache. the head, irritability, hot temper, flushed
b) In patients with excessive yang of body face, bitter taste in the mouth, string-taut
constitution, headache may be caused by and rapid pulse, reddened tongue with
upsurge of liver yang due to stagnation of qi yellow coating.
or injury of the liver after a fit of anger, Analysis: Headache and blurred vision
which damages the yin. are due to rising of excessive liver-yang
c) Headache may also be caused by which attacks the head. Bitter taste in the
deficiency of both qi and blood because of mouth suggests accumulation of heat in the
irregular food intake, overstrain and stress, Gallbladder Meridian derived from the
poor health with a chronic disease, or upsurge of liver-yang which affects the
congenital deficiency. Deficiency of qi gallbladder, as the liver and gallbladder are
prevents the clear yang from ascending, and externally and internally related. Severe pain
deficiency of blood does not nourish the on the bilateral sides of the head is because
mind, so there is headache. the Gallbladder Meridian travels bilaterally
on the side of the head. String-taut and rapid
Differentiation pulse, reddened tongue with yellow coating
a ) Headache due to invasion of pathogenic are signs of heat in the gallbladder and liver.
wind into the meridians and collaterals: c) Headache due to deficiency of both qi
Main manifestations: Headache occurs and blood:
on exposure to wind. The pain may extend.to Main manifestations: Lingering head-
the nape of the neck and back regions. It is a ache, dizziness, blurred vision, lassitude,
violent, boring and fixed pain, accompanied lustreless face, pain relieved by warmth and
by string-taut pulse and thin white tongue aggravated by cold, overstrain or mental
coating. Such a syndrome is also termed stress, weak and thready pulse, pale tongue
"head wind." with thin and white coating.
Analysis: Pain comes from obstruction of Analysis: Lingering headache is due to the
qi in the meridians and collaterals on the head being affected by the deficiency of qi
head caused by invasion of the exogenous that fails to make the clear yang ascend and
pathogenic wind. Owing to the excess of the the turbid yin descend. Pain aggravated by
pathogenic factor, the pain is' violent and overstrain and stress is due to further
boring. Wind is a yang pathogenic factor consumption of qi. Lassitude, pain which is
and apt to attack the upper portion of the relieved by warmth and aggravated by cold
body. So the pain caused by wind may suggest failure in distribution of yang qi.
extend to the nape of the neck and back Lustreless face, dizziness and blurred vision
region. The fixed pain is due to blood indicate poor nourishment of the face and
stagnation derived from qi stagnation, head due to deficiency of blood. Pale tongue
String-taut pulse and thin white tongue with thin white coating and weak, thready
Chapter 17 Internal Diseases

pulse are signs of deficiency of both qi and ming Meridians of Hand and Foot.
blood. Temporal headache -points of the Shao-
Clinically, varieties of headache should beyang Meridians of Hand and Foot.
also differentiated according to the locality Parietal headache -points of the Tai-
and the related meridians and collaterals. yang Meridians of Hand and Foot plus
Pain in the occipital region and nape of the those of the Jueyin Meridian of Foot.
neck is related to the Bladder Meridian of b ) Headache due to upsurge of liver
Foot-Taiyang, pain at the forehead and yang:
supraorbital region is related to the Stomach Method: Select points of Jueyin and
Meridian of Foot-Yangming, pain in Shaoyang Meridians of Hand and Foot as
bilateral or unilateral temporal region is the principal points to pacify the liver yang.
related to the Gallbladder Meridian of Foot- Puncture with the reducing method.
Shaoyang, and that in the parietal region is Prescription: Fengchi (G 20), Baihui (Du
related .to the Liver Meridian of Foot- 20), Xuanlu (G 5), Xiaxi (G 43), Xingjian
Jueyin. (Liv 2).
Explanation: The Jueyin Meridian of
Treatment Foot reaches the parietal region and the
a) Headache due to invasion of pathogenic .Shaoyang Meridians run up to the bilateral
wind into meridians and collaterals: sides of the head. Combining the local points
Method: To dispel the wind, remove with distal points can reduce heat in the
obstruction in the meridians and collaterals, meridians and pacify the liver yang.
regulate the qi and blood and check the pain c ) Headache due to deficiency of both qi
by puncturing the local points combined and blood:
with distal points along the related Method: To tonify and regulate circula-
meridians. The reducing method with needle tion of qi and blood, promoting the clean qi
retention is used. to ascend and the turbid qi to descend by
Prescription: Occiptal headache: Fengchi needling points of the Du and Ren
(G 201, Kunlun (B 60), Houxi (S I 3). Meridians and the corresponding Back- .
Frontal headache: Touwei (S 8), Yintang (Shu) points. Puncture with the reinforcing
(Extra), Shangxing (Du 23), Hegu (L I 4), method.
Neiting (S 44). Prescription: Baihui (Du 20), Qihai (Ren
Temporal headache: Taiyang (Extra), 6), Ganshu (B 18), Pishu (B 20), Shenshu (B
Shuaigu (68), Waiguan (S J 5), Zulinqi* (G 23), Zusanli (S 36).
41). Explanation: Qihai (Ren 6) is chosen to
Parietal headache: Baihui (Du 20), Houxi tonify the primary qi, and Baihui (Du 20) is
(S I 3), Zhiyin (B 67), Taichong (Liv 3). for lifting up the clean yang. Ganshu (B 18),
Explanation: The above prescriptions are Pishu (B 20), and Shenshu (B 23) are the
formulated by combining local points with points associated with the liver, spleen and ,

distal points according to the location of kidney. Since the liver stores blood, the
headache and the affected meridian. spleen controls blood, and the kidney stores
Occipital headache -points of the Tai- and produces essence and blood, these three
yang Meridians of Hand and Foot. points can be used to strengthen essence in
Frontal headache -points of the Yang- the kidney and to tonify qi and blood.
 Chinese Acupuncture and Moxibustion

Zusanli (S 36), punctured with the "When pathogenic cold comes and stays in
reinforcing method, can benefit the stomach the meridians it impedes and slows down the
which is the productive source of qi and circulation. If it lodges outside the vessels,
blood. the blood supply is decreased, and if it
remains in the vessels, the passage of qi is
Remarks obstructed, resulting in a sudden attack of
a) L
-1 TanAnohn
I I b U U U W L L b
f i p p p p r o A;CF9CFc "I
;r? x T r P & f i T x C
V W U U L 0 111 V U l l U ULl U I U W C + . U W U
F..-l;r7
YUllL.
77

modern internal medicine, surgery, neu- Facial pain may also arise from excessive
rology, psychosis, ear, nose, throat, etc. fire of the liver and stomach which flares up
Acupuncture gives gratifying results in and attacks the face. The fire in the stomach
migraine, and in vascular and neurotic is produced by retention of food caused by
headache. irregular food intake. The fire of the liver is
b) Tapping with cutaneous needles and due to the stagnation of qi in the liver.
cupping method: Furthermore, facial pain may be due to
Main points: Area along L1 to S 4 deficiency of yin producing excess of fire in
Secondary points: Fengchi (G 20), the patients with a body constitution of yin
Taiyang (Extra), Yangbai (G 14). deficiency and excessive sexual activity
Method: Tap on the area from L1 to S 4. which consumes essence. In addition,
Then tap on the local area and along the diseases of the teeth, mouth, ear, nose, or
afflicted meridians. For acute pain, Taiyang mental disorders may also induce facial
(Extra) and Yangbai lG \- 14) may be tapped pan
to slight bleeding, then apply cupping. -
Differentiation
a) Facial pain due to invasion by
2. Facial Pain pathogenic wind and cold:
Main manifestations: Abrupt onset of
Facial pain is a kind of severe pain pain occurs like an electric shock. The pain is
occurring in transient paroxysms in a certain cutting, boring and intolerable, but transient
facial region. It mostly occurs in one side of and paroxysmal. Each attack lasts a few
the forehead, maxillary region or mandi- seconds or one to two minutes. It may recur
bular region. The onset is abrupt like an several times a day. Tender points can be
electric shock, and the pain is cutting, found on the supraobital -foramen, in-
burning and intolerable. Frequent recurre- fraorbital foramen, cheek foramen, lateral
. nce denotes a chronic disease. In most cases side of ala nasi, angle of the mouth, and
it starts after middle age in women. nasolabial groove, where pressure induces
the attack of pain. The pain is often
Etiology and Pathogenesis accompanied by local spasm, running nose
A sudden attack of this disease is due to and lacrimation, salivation, or by exterior
invasion of the meridians and collaterals on symptoms with string-taut and tense pulse.
the face by pathogenic wind cold which Analysis: Pain is caused by the
contracts the meridians and collaterals and obstruction of circulation of qi and blood in
retards the circulation of qi and blood. In the meridians and collaterals on the face due
Chapter 38 of Plain Questions, it says: to invasion of pathogenic wind and cold.
Chapter 17 Internal Diseases

Pain aggravated by pressure suggests that tongue with little coating are signs of
the pathogenic factors are in excess. Burning deficiency of yin with flaming fire.
pain comes from the fierce fight between the
antipathogenic qi and pathogenic factors. Treatment
String-taut and tense pulse is the sign of Method: Select the local points in
invasion by pathogenic wind cold. En- combination with distal points according to
dogenous wind heat comes from prolonged the location of pain and the meridians
accumulation of exogenous pathogenic cold affected. For facial pain due to invasion of
wind, giving rise to spasm, running nose, pathogenic wind and cold, reducing method
lacrimation and salivation. is used to promote the circulation of qi and .
b ) Facial pain due to excessive fire in the blood in the diseased area. For facial pain
liver and stomach: due to excessive fire in the liver and stomach,
Main manifestations: The attack o f pain the points along the Foot-Jueyin and
as described above is accompanied by Yangming Meridians are punctured with the
irritability, hot temper, thirst, constipation, reducing method to bring down the fire. For
yellow and dry tongue coating, and string- facial pain due to deficiency of yin and
taut, rapid pulse. excessive fire, the points along the Foot-
Analysis: Irritability and hot temper are Shaoyin Meridian should be added and
due to fire caused by prolonged depression punctured with the reinforcing method to
of the liver qi. Burning pain is caused by nourish the yin and to dissipate the fire.
endogenous heat coming from prolonged Prescription: Pain at supraorbital region:
retention of food in the stomach, which rises Yangbai (G 14), Taiyang (Extra), Zanzhu (B
to the face through the Stomach Meridian. 2), Waiguan (S J 5).
Thirst and constipation are due to heat in the Pain at maxillary region: Sibai (S 2),
stomach. Yellow dry tongue coating, string- Quanliao (S I 18), Yingxiang (L I 20), Hegu
taut and rapid pulse are signs of (L I 4).
accumulation of fire in the liver and Pain at mandibular region: Xiaguan (S 7),
stomach. Jiache (S 6), Daying (S 5), Jiachengjiang
c) Facial pain due to deficiency of yin and (Extra), Megu (L 1 4).
excessive fire: Supplementary points:
Main manifestations: Insidious pain, Invasion by pathogenic wind and cold:
emaciation, malar flush, soreness in the Fengchi (G 20).
lumbar region, lassitude, pain aggravated by Excessive fire in the liver and stomach: .
fatingue, thready and rapid pulse, reddened Taichong (Liv 3), Neiting (S 44).
tongue with little coating. Deficiency of yin and excessive fire:
Analysis: The kidney stores essence and Zhaohai (K 6), Sanyinjiao (Sp 6).
dominates water. When the kidney essence is Explanation: The above prescriptions are
insufficient, lassitude, soreness in the lumbar formulated by combining the local points
region and emaciation occur. Insufficiency with the distal points according to the
of kidney water fails in controlling fire, location of pain and the meridians affected.
which flares up along the meridians and For instance, Xiaguan (S 7), Jiache (S 6) and
reaches the face, causing malar flush and Jiachengjiang (Extra) are the points located
facial pain. Thready, rapid pulse, reddened at the mandibular region. Hegu (L I 4) and
 Chinese Acupuncture and Moxibustion

Waiguan (S J 5) are the points along the more frequently in males.

and-yangming and Hand-Shaoyang Etiology and Pathogenesis
Meridians which go upward to the facial
Deviation of the eye and the mouth is due
region. The above prescription has the effect
to paralysis of the facial muscles caused by
of promoting circulation of qi of the
the attack of pathogenic wind and cold on
meridians and collaterals in the affected
Yangming and Shaoyang Meridians, which
U IWU,and the faanrtinn nf -r ~ d l l r i n gp----
arPa --I- a -La-.
I&- - I-V aa V ---
xrp ----
w 2nd
leads to mainutrition of the muscle regions
relieving pain. Fengchi (G 20), the meeting
of the meridians.
point of the Foot-Shaoyang and Yangwei
Meridians, can be used to dispel wind and to
check pain. Taichong (Liv 3) and Neiting (S Main manifestations: Sudden onset,
44) can be chosen for the purpose of usually right after waking up, incomplete
eliminating excessive fire in the liver and closure of the eye in the affected side,
stomach. Zhaohai (K 6) and Sanyinjiao (Sp drooping of the angle of the mouth,
6) nourish the yin and reduce the fire. For a salivation and inability to frown, raise the
chronic disease, local points on the affected eyebrow, close the eye, blow out the cheek,
side can be punctured with the reinforcing show the teeth or whistle, and in some cases
method, shallow insertion and needle pain in the mastoid region or headache, thin
retention. Or the reducing method with long white tongue coating, superficial tense or
retaining of needles can be applied to the superficial slow pulse.
corresponding local points of the healthy Analysis: It Is known that the Foot and
side. Hand Yangming and Shaoyang Meridians
Remarks supply the facial region, and the Muscle
a) Facial pain is referred tp trigeminal Meridians of Hand and Foot Yangming and
neuralgia in modern medicine. Shaoyang also reach the forehead, cheek,
b) Acupuncture is effective in pain of and the front of the ear. The above
primary trigeminal neuralgia. For secon- manifestations of deviation of the eye and
dary trigeminal neuralgia accompanying the mouth are due to the flaccidity of
intracranial diseases or lesions of the affected muscles leading to the imbalance of
nervous system, in which the pain is usually facial muscles between the two sides. The
continuous with paroxysms of aggravation, paralytic muscles are caused by stagnation
treatment should be aimed at its primary of qi in the meridians and malnutrition of
cause. the regions of the muscle meridians after the
invasion of pathogenic wind and cold.

3. Deviation of Eye and Mouth Treatmemt

. Method: To eliminate wind and remove
Deviation 'of the eye and the mouth is the obstruction of meridians by applying
derived from invasion of the meridians and even-movement mainly to the points of
collaterals and muscle meridians in the facial Hand and ~~~t Yangming Meridians, and
region by exogeneous pathogenic wind and also to the points of Shaoyang Meridians.
cold. It can occur in patients of any age, but Prescription: Yifeng (S J 17), Yangbai (G
mostly at the age of twenty to forty and 7 141, Taiyang (Extra), Quanliao (S I 18),
Chapter 17 Internall Diseases

Xiaguan (S 7), Dicang (S 41, Jiache (S 6), d) If the healthy side of the face is stiff,
Wegu (k H 4). shallow puncture and needle retaining at the
Supplementary points: local points of the healthy side can be
Headache: Fengchi (620). applied in combination with needling of the
Difficulty in frowning and raising the affected side.
eyebrow: Zhanzhu (B 2), Sizhukong (S J 23).
Incomplete closing of the eye: Zanzhu 4B
2), Jingming (B I), Tongziliao (G 11, Yuyao 4. Pain in Hypochondriac Region
(Extra), Sizhukong (S 9 23).
Difficulty in sniffing: Yingxiang (LI 20). Hypochondriac pain is a subjective
Deviation sf the philtrwm: Wenzhong (Du symptom commonly seem in the clinic. It
26). may be unilateral or bilateral. The classic
Inability to show the teeth: Juliao (S 3). book Miraculous Pivot points out: "Patho-
Tinnitus and deafness: Tianghui (G 2). genic factors in the liver give rise to
Tenderness at the mastoid region: Wangu hypochondriac pain." Chapter 22 of Plain
(G 121, Waiguan (S J 5). Questions says: "When the liver is diseased,
Explanation: Heglm (k H $1, the Yuan- it causes pain below the ribs on both sides,
(Primary) point of the Layge Intestine and then refers to the lower abdomen." As
Meridian of Hand-Yamgming, can eliminate the meridian oC the liver supplies the
pathogenic wind from the head and facial hypochondriac regions, and the liver is
region. Wangu (G 12) and Tinghui (G 2) can externally and internally related with the
eliminate wind and relieve headache. gallbladder, the occurrence of hypo-.
Yangbai (61 4 , Taiyang (Extra), Zanzhu (B chondriac pain is mostly concerned with
21, Sizhukong (S J 231, Tongziliao (G I), disorders of the liver and gallbladder.
Yuyao (Extra), Juliao (% 3), Renzhong (Du
26), Dicang (S 4), Jiache (S 61, Yingxiang (I, IE&ioBogyand. Pathogenesis
1 20) and Quanliao (S 9 117) are all local a) The liver is situated in the .
points o f the involved meridians and have hypochondriac region. Its meridians supply
the effect s f elininating wind and invigorat- bilateral hypochondriac regions. If it is
ing circulation of meridians. diseased, it will cause hypochordriac pain.
The liver is the organ in the category of wind
Remarks and wood of Five Elements, and prefers to
a) This condition is seen in peripheral be in a harmonious state with free flow of qi.
facial paralysis or Bell's palsy in modern Emotional depression may restrain the liver
medicine. function, causing poor circulation of qi in
b) In long-standing cases, the warming the meridians, often resulting in hypo-
needle or moxibustion may be used to the chondriac pain.
points Taiyang (Extra), Jiache (St6), Dicang b) The prolonged stagnation of the liver
(S 41, Juliao (S 33, and Xiaguan (S 7). qi, or traumatic injuries such as sprain and
c) Cupping: Cupping may be used as an contusion may cause stasis of blood in
adjuvant method to acupuncture. The collaterals, resulting in hypochondriac pain.
affected side may be treated with small cups c) Poor health associated with chonic
once every three to five days. disease, overstrain and stress, may cause
 Chinese Acupuncture and M~xibustion

deficiency of essence and blood, which in signs of blood stagnation.

turn produces poor nourishment of the liver b) Deficiency type:
and its collaterals, resulting in hypo- Main manifestations: Dull pain lingering
chondriac pain. in the costal and hypochondriac region,
dryness of the mouth, irritability, dizziness,
Differentiation blurring of vision, red tongue with little
a ) Excess iype. cuatirig, weak, rapid thready"u'Glsc.
i) Stagnation of qi: Analysis: Dull pain in the costal and
Main manifestations: Distending pain in hypochondriac region indicates deficiency
the costal and hypochondriac region, stifling s f essence and blood which causes poor
sensation in the chest, sighing, poor nourishment of the collaterals of the liver.
appetite, bitter taste in the mouth, thin white Dryness of the mouth and irritability suggest
tongue coating, string-taut pulse. Severity of deficiency of yin with endogenous heat.
the symptoms varies with the changes of Dizziness and blurring of vision are due to
emotional state. the shortage of essence and blood. Red
Analysis: Distending pain in the costal tongue with little coating, and weak or rapid
and hypochondriac region suggests obstruc- and thready pulse are signs of deficiency of
tion of the collaterals due to failure of the essence and blood with endogenous heat.
liver in maintaining the free flow of qi.
Severity of the symptoms varies with the Treatment
--- ----
emoiional state LUGLitUbt; of "I--
me; GIGS~ a ) Excess type:
relationship between emotional changes and Method: Points are mainly selected from
stagnation of qi. Stifling sensation in the Jueyin and Shaoyang Meridians of Foot to
chest and sighing indicate uneven qi activity. remove the stagnation of liver qi and the
Poor appetite shows that the spleen is being obstruction in the collaterals. Needling with
attacked by the liver qi. Thin white tongue reducing method is to be applied.
coating and string-taut pulse are the signs of Prescription: Qimen (Liv 14), Zhigou (S J
depression of the liver. 6), Yanglingquan (G 34).
ii) Stagnation of blood: Supplementary points:
Main manifestations: Fixed stabbing pain Stagnation of qi: Taichong (Liv 3), Qiuxu
in the hypochondriac region, intensified by (G 40). ,'

pressure and at night, dark purplish tongue Stagnation of blood: Geshu (B 17),
proper, deep and hesitant pulse. Ganshu (I3 18).
Analysis: Fixed stabbing pain in the Explanation: The Shaoyang Meridian
hypochondriac region is caused by supplies the.latera1 aspect of the body, so
stagnation of blood following stagnation of Zhigou (S J 6) and Yanglingquan (G 34) are
qi in the hypochondriac region. Pain used to relieve pain by regulating the qi of
intensified at night suggests that blood as a the Shaoyamg Meridian. Qimen (Eiv 141, the
yin factor is apt to stagnate at night which is Front-(Mu) point of the Liver Meridian,
the yin time of a day. Pain due to stagnation eases the liver and relieves pain in the
of blood is a condition of excess, so it is hypochondrum. Taichong (Liv 3) and Qiuxu
aggravated by pressure. Dark purplish (G 40) regulate the qi of the liver and
tongue proper, and deep, hesitant pulse are gallbladder. Geshu (B 17) and Ganshu (B
Chapter 17 Internal Diseases

18) can activate blood circulation and kidney for the lumbus is the seat of the
remove stasis. kidney.
b ) Deficiency type: Clinically, low back pain can be found in
Method: Nourish essence and blood, various diseases. This section only deals with .
invigorate circulation of qi, and relieve pain the following etiological factors: 1. Invasion
by applying reinforcing method to points of of exogenous pathogenic cold and damp; 2.
the Foot-Sueyin Meridian and Back-(Shu) Deficiency of qi of the kidney; and 3. Sprain
points. or contusion.
Prescription: Qimen (Liv 14), Ganshu (B
18), Shenshu (B 23), Zusanli (S 36), EiioHogy and Pathogenesis
Sanyinjiao (Sp 6), Taichong (Liv 3). a ) Invasion by pathogenic cold and damp:
Explanation: Ganshu (B 18), the Back- In this case low back pain is due to
(Shu) point of the liver, Shenshu (B 231, the obstruction of circulation of qi in meridians
Back-(Shu) point of the kidney, Qimen (kiv and collaterals. The precipitating factors
14), the Fron"L(Mu) point of the liver, may be living in cold and damp places,
Taichong (Liv 3), the Yuan-(Primary) point exposure to the rain or wading in water, or
of the Liver Meridian, used in combination, being drenched with sweat.
can nourish essence and blood, readjust the b) Deficiency of the kidney qi:
liver and relieve pain. Zusanli (S 36) and ]In this case low back pain is generally due
Sanyinjiao (Sp 6) strengthen the function of to excessive sexual activity that consumes
the spleen and stomach which are the main essence and qi, resulting in poor nourish-
source of producing qi and blood. ment of the meridians in the lumbar region.
c ) Trauma due to sprain or corztusion:
Remarks
Trauma may cause injury of qi and blood
a) Hypochondriac pain is seen in diseases in the meridians and colla.terals, leading to
of the liver and gallbladder, contusion of the
stagnation of'qi and blood, thus producing
hypochondriac region, intercostal neuralgia
low back pain.
and costal chondritis.
b) Application of Huatuojiaji points of Differentia$ioa
the corresponding segments gives gratifying a ) Cold danzp:
effect to relieve pain in the treatment of - Main manifestations: Low back pain
intercostal neuralgia. usually occuring after exposure to cold and
c) Cutaneous needling: Tap the skin over damp and aggravated on rainy days, heavy
the affected hypochondriac area, and then sensation and stiffness of the muscles in the
apply cupping. This method is indicated in dorsolumbar region, limitation of extension
hypochondriac pain due to sprain or and flexion of the back, pain radiating
contusion. It has the action of removing I
downwards to the buttocks and lower limbs,
stasis and relieving pain. cold feeling of the affected area, white and
sticky tongue coating, deep and weak, or
deep and slow pulse.
Analysis: Pathogenic cold and damp
Low back pain (pain in the lumbar region) characterized by viscosity and stagnation
is closely associated with disorders of the block the meridians and collaterals, causing
 Chinese Acupuncture and Moxibustion

retarded circulation of qi and blood. This insomnia. Deficiency of yin causes excessive
produces heaviness, cold sensation and pain internal heat, which gives rise to the
in the lumbar region and limitation of following symptoms: flushed face, feverish
extension and flexion of the back. sensation in the chest, palms and soles,
Stagnation of qi and blood becomes worse dryness of the mouth and throat, reddened
on cloudy and rainy days, and so does the tongue with little coating, thready weak or
pain. Accumuiation of cold and damp gives ihready rapid piilse.
rise to the white sticky tongue coating and c ) Trauma:
the deep, weak or deep, slow pulse. Main manifestations: History of sprain of
b ) Kidney deficiency: the lumbar region, rigidity and pain of the
Main manifestations: Insidious onset of lower back which7is generally fixed in a
protracted pain and soreness, accompanied certain area, and is aggravated by pressure
by lassitude and weakness of the loins and and by turning the body, pink or dark
knees, aggravated by fatigue and alleviated purplish tongue proper, string-taut hesitant
by bed rest. In case of deficiency of kidney pulse.
yang, cramp-like sensation in the lower Analysis: Muscular strain in the lumbar
abdomen, pallor, normal taste in the mouth, region causes retardation of qi and blood
cold limbs, pale tongue, deep thready or and further leads to stagnation of blood in
deep slow pulse. In case of deficiency of the meridians and collaterals. The result is
kidney yin, irritability, insomnia, dry mouth the fixed severe pain which can be
and throat, fiushed face, feverish sensation aggravated t j,pressure. String-taut p!se is
in the chest, palms and soles, reddened associated with pain, dark purplish tongue
tongue proper with scanty coating, thready proper and hesitant pulse are signs of blood
weak or thready rapid pulse. stasis.
Analysis: The lumbar region is said to be
the "dwelling house of the kidney." The Treatmeat
kidney dominates the bones, produces Method: Points are mainly selected from
marrow and stores essence. When the kidney the Du and the Foot-Taiyang Meridians to
has insiufficient essence, the bone is lacking promote the circulation of qi and blood, to
of marrow, and the result is soreness and relieve pain, to relax the muscles and to
pain in the lumbar region accompanied by activate the blood circulation in the
weakness of the knees. Over strain and stress colaterals. Acupuncture and moxibustion
consume essence and qi, and make the pain are applied together for cold-damp type. in
worse. Pain is lessened by bed rest, which case of deficiency of the kidney yang, apply
makes qi quiescent. In case of deficiency of needling with reinforcing method and
kidney yang, the kidney fails to warm the moxibustion. For deficiency of the kidney
lower abdomen and the limbs. This gives rise yin, puncture with reinforcing method, For
to cramp-like sensation in the lower traumatic low back pain, apply reducing
abdomen and cold limbs. Deficiency of yang method or pricking to cause bleeding.
causes pallor, pale tongue, deep thready or Prescription: Shenshu (B 23), Yaoyang-
deep slow pulse. When yin is deficient, guan (Du 3), Weizhong (I3 40).
kidney water is unable to ascend to reduce Supplementary points:
the heart fire. This results in irritability and Cold damp: Dachangshu (B 25), Guan-
Chapter 17 Internal Diseases

yuanshu (B 26). 6. Bi Syndromes

Deficiency of the kidney yang: Mingmen
(Du 4), Yaoyan (Extra). Bi syndromes are the syndromes
Deficiency of the kidney yin: Zhishi (B characterized by obstruction of qi and blood
52), Taixi (M 3). in meridians and collaterals due to invasion
Traumatic injury: Renzhong (Du 26), of pathogenic wind, cold and damp, and
Yaotongxue (Extra), Ahshi point. manifested by soreness, pain, numbness and
Explanation: The low back is the heavy sensation of the limbs and joints, and
"dwelling house of the kidney." Shenshu (B limitation of movement.
23) can be selected to tonify the qi of the Clinically, bi syndromes are common in
kidney. Moxibustion may also be applied to the areas where the weather is cold, wet and
this point to eliminate cold and damp. windy, occurring in persons of either sex and
Yaoyangguan (Du 3) is a local point. any age. In mild cases there are only soreness
Weizhong (B 40) is one of "Four 'Key and pain in limbs and joints, aggravated by
Points," and an important distal point for the change of weather. In severe cases the
the treatment of low back pain. Dachangshu soreness and pain are marked and recur
(B 25) and Guanyuanshu (B 26) can dispel repeatedly, accompanied by swelling of the
wind and cold, remove obstruction in joints and even deformity and limitation of
meridians, and relieve pain. Combination of movement.
acupuncture and moxibustion applied to Bi syndromes may be classified into four
Mingmen (Du 4) and Vaoyan(Extra) can types according to etiology and manifest-
tonify the kidney yang and strengthen the ations: 1. Wandering bi is characterized by
kidney essence as well. Zhishi (B 52) and migrating pain and caused chiefly by
Taixi (K 3) are selected for the purpose of pathogenic wind; 2. Painful bi is character-
nourishing the kidney yin. As the Du ized by severe pain and caused chiefly by
Meridian travels along the spine, Renzhong pathogenic cold; 3. Fixed bi is character-
(Du 26) is a distal point effective for treating ized by marked soreness, numbness and
rigidity and pain of the lumbar region. heaviness and caused chiefly by pathogenic
Yaotongxue (Extra) is an empirical point damp; and 4. Heat bi is characterized by
used in treating sprain of the lumbar region. heat manifestations and sudden onset.

Etiology and Pathogenesis

Remarks a) Attack of pathogenic factors on
a) Low back pain may be seen in renal individuals with weakened body resistance:
diseases, rheumatism, rheumatoid arthritis, Bi syndromesare caused by obstruction of
hyperplastic spondilitis, muscle strain or qi and blood due to 1. invasion of the .
traumatic injury of the lumbar region. meridians and collaterals by pathogenic
b) When the lumbar vertebrae are wind, cold and damp; 2. general weakness
diseased, the corresponding Huatuojiaji of the body with deficiency of yang qi; and
points may be punctured perpendicularly 3. dysfunction of the pores, and weakness of
1.O-1.5 inches. Needles are retained. Here, defensive yang. The book Prescriptions for
acupuncture therapy is only a supplemew Succouring the Sickness points out, "It is
tary method of treatment. because of weakness of the body with poor
 Chinese Acupuncture and Moxibustion

function of the pores that invasion of wind, but no local redness and hotness, thin and
cold and damp to produce Bi syndromes is white tongue coating, string-taut and tense
possible." pulse.
b ) Body constitution: Analysis: Severe pain is due to retarded
The body constitution differs in the circulation of qi and blood in the meridians
natures of heat and cold. In case of the body and collaterals caused by excessive cold.
constitution with cxuberaiii yaiig iji ail6 is a qrin f2r,f,0F,
accumulated heat, invasion of pathogenic characterized by causing contraction. The
wind, cold and damp will give rise to heat pain is localized because of the congealing
bi. Furthermore, long-standing wind, cold effect' of cold. Pain alleviated by warmth
and damp Bi syndromes may turn into heat suggests that heat improves the circulation
Bi as the pathogenic factors in the meridians of blood. Cold causes further stagnation of
and collaterals are transformed into heat. blood, and hence aggravates the pain. The
absence of local redness and hotness is
Differentiation character is ti^ of affection by pathogenic
a ) Wa~zderingbi: cold. String-taut and tense pulse is
Main manifestations: Wandering pain in associated with cold and pain. White tongue
the joints, especially the wrists, elbows, coating is a aign-of pathogenic cold.
knees and ankles; limitation of movement, c ) Fixed hi:
chills and fever, thin and sticky tongue Main manifestations: Numbness and
coatiing, s~perficia1and tight or superficia! heavy sensaticn of the limbs, soreness and
and slow pulse. fixed pain of the joints, aggravated on
Analysis: Pain in the joints is a common cloudy and rainy days, white and sticky
manifestation of all the Bi syndromes caused tongue coating and soft pulse.
by wind, cold and damp that obstruct qi and Analysis: Pathogenic damp is character-
blood circulation in meridians and ized by heaviness. When it is in an excessive
collaterals. As stated in Chinese medicine, state, it invades the limbs and joints, causing
"There is pain if there is obstruction." retarded circulation of qi and blood, and
Wandering pain is due mainly to invasion by resulting in numbness and heaviness.
pathogenic wind which is characterized by Pathogenic damp is a yin factor,
constant movement and changes. Chills and characterized by viscosity and stagnation.
fever result from the struggle between So the pain caused by damp is also fixed in
antipathogenic factors and pathogenic location. The condition becomes worse on
factors after the invasion. Superficial tense cloudy and rainy days for the weather
or superficial slow pulse indicates invasion change brings about more stagnation of qi
of exogenous pathogenic wind on the and blood. Soft pulse and white sticky
exterior of body; and thin and sticky tongue tongue coating indicate the presence of
coating shows the initial stage of invasion by pathogenic damp.
pathogenic wind, cold and damp. d ) Heat bi:
b ) Painful bi: Main manifestations: Arthralgia involv-
Main manifestations: Severe stabbing ing one dr several joints, local redness,
pain in the joints, alleviated by warmth and swelling and excruciating pain with
aggravated by cold, with fixed localization limitation of movement, accompanied by
Chapter 17 Internal Diseases

fever and thirst, yellow tongue coating, Pain in the shoulder joint: Jianyu (LI 1 9 ,
rolling and rapid pulse. Jianliao (SJ l4), Jianzhen (SJ 19), Naoshu
Analysis: Local redness, swelling and pain (SI io).
of the joints are the result of the Pain in the scapula: Tianaong (SI 1I),
transformation of pathogenic factors into Bingfeng (SI 121, Jianwaishu (SI 14),
heat. Movement is limited because of Gaohuang (B 43).
swelling and deformity of joints. Fever, Pain in the elbow: Quchi (LI 1I), Chize
thirst, yellow tongue coating, rolling and (IS), Tianjing (SJ lo), Waiguan (SJ 5b, Hegu
rapid pulse are the signs of excessive heat. (ea 4).
, In addition, bi syndromes may also be Pain in the wrist: Yangchi (S9 41, Yangxi
classified according to the locality of the (L%S), Yanggu (SH §), Waiguan (SJ 5 ).
diseased area as follows: Stiffness s f the fingers: Yanggu (Sl 5),
Skin bi: Numbness of the skin with cold Hegu (Ll 4), Houxi (SH 3).
sensation. Numbness and pain in the fingers: Houxi
Muscle bi: Soreness, numbness and pain of (SI 3), Sanjian I(. 3), Baxie (Extra).
the muscles. Pain in the lumbar region: Renzhong (Du
Tendon bi: Soreness, gain and stiffness of 26), Shenzhu (Du 1 3 , Yaoyangguam (Du 3).
the tendons and muscles. Pain in the hip joint: Huantiao (G 30), .
Vessel bi: Pain due to blockage of vessels. Juliao (G 29), Xuanzhong (G 39).
Bone bi: . Soreness, heaviness and pain of Pain in the thigh region: Zhibian (B 541,
joints whjch fail to perform their functions
L Chengfu (B 36), Yanglingquan (G 34).
of lifting, extension and flexion. Pain in the knee joint: Heding (Extra),
Dubi (S 3 9 , Medial Xiyan (Extra),
'ITreatmemt Yanglingquan (G 34), Yinlingquan (Sp 9).
Ahshi points together with the local and Numbness and pain in the leg: Chengshan
distal points along the yang meridians (B 57), Feiyang (I3 558).
supplying the diseased areas are selected for Pain in the ankle: Jiexi (S 411, Shangqiu
the purpose of eliminating wind, cold and (Sp 51, Qiuxu (G 40), Kunlun (B 60), Taixi
damp. Wandering bi, heat bi and tendon 4K 3).
bi are mainly treated by the reducing Numbness and pain in the toes: Gongsun
method. Subcutaneous nsedles may also be (Sp 4), Shugu (I3 651, Bafeng (Extra).
applied. For painful bi and vessel bi, it is Pain in the back: Shuigou (Du 261,
better to use moxibustion, and apply Shenzhu (Du 12), Yaoyangguan (Du 3). ,
needling as an adjuvant treatment with deep General pain: Houxi (SI 3), Shenmai (B
insertion and prolonged retaining of the 62), Dabao (Sp 21), Geshu (B 17), Jianyu (LI
needles. For severe pain, intrademal IS), Quchi (LI 1 I), Hegu (LI 4), Yangchi (SJ
~eedlesor indrect moxibustion with ginger 4), Huantiao (G 30), Yanglingquan (G 341,
may be used. Fixed bi, skin bi, muscle bi Xuanzhong (G 39), Siexi (S 41).
and bone bi may also be treated by Supplementary points: 1. Wandering bi,
combined acupuncture and moxibustion, or vessel bi: Geshu (B 17), Xuehai (Sp 10);
together with warming needle, or tapping 2. Painful bi: Shenshu (B 231, Guanyuan
plus cupping. (Wen 4); 3. Fixed bi: Zusanli (S 36),
Prescriptions: Shangqiu (Sp 5); 4. Heat bi: Dazhui (Du
 Chinese Acupuncture, and Moxibustion

14), Quch (%I 11); 5. Tendon bi: fire and relieve the painful bi. Uanglingquan
eYanglingquan (G 34); and 4. Bone bi: (G 40), the Influential Point of the tendon, is
Dazhu (I3 1I), Xuanzhong (G 39). used to treat the tendon bi. Dazhu (B 1I),
Explanation: The above prescriptions are the Influential Point of the bone,
formulated by selection of the local and Xuanzhong (G 39), the Influential Point of
distal points on the--meridians supplying the the marrow, can be used together in treating
L l -l ~bone bi.
*L
diseased areas. 'lhe principie of the
treatment is to remove obstruction from the
meridians and collaterals and to regulate Remarks
ying (nutrient qi) and wei (defensive qi) for a) Bi syndromes may include such
elimination of wind, cold and damp. When diseases as rheumatic fever, rheumatic
the skin and muscles are diseased, shallow arthritis, rheumatoid arthritis, fibrositis,
insertion should be used. When bones and neuralgia and gout.
tendons are affected, deep insertion with ,
b) Cutaneous needle and cupping: Heavy
retaining of the needles is recommended. tapping to induce slight bleeding along the
The methods of acupuncture and moxibus- two sides of the spine or the local area of the
tion depend on symptoms and signs. Houxi affected joint plus cupping is often used for
($1 3) comunicates with the Dr?Meridian, the treatment of skin bi and muscle bi
and Shenmai (B 6) with the Yangqiao associated with numbness, and bone bi
Meridian. They are a set of the Eight characterized by stiffness and limitation of
Confluent points for the treatment wn" the moveme~tcr defemity of the J"""' inin+

. diseases of the shoulder, back, lumbar c) Acupuncture is effective in treating

region, legs, musc9es, tendons and bones. mild bi syndromes. For severe cases, a long
Dabao (Sp 21) is the major kuo- period of treatment is necessary. In chronic
(Connecting) point of the spleen wl~ich cases with exhaustion of ying (nutrient qi)
connects qi of the whole body, and Geshu (B and wei (defensive qi) and undernourish-
17) is the Influential Point of the blood. ment of tendons and muscles, the bi
Combination of these two points can be used syndrome may turn into a wei syndrome.
to treat general pain. Dazhui (Du 14) and
Quchi (LH 11) are used to treat heat bi.
Geshu (El 17) and Xuehai (Sp 10) have the 7. Wei Syndromes
function of activating and nourishing the
blood. The selection is based on the The wei syndrome is characterized by
principle: "Wind will be naturally flaccidity or atrophy of the limbs with motor
eliminated if blood circulates smoothly. impairment. It is allso called '6flaccidlame,"
Fengchi (G 20), the most important point o r the leg is usually involved. The wei
for dispelling wind, can be combined with syndrome was first described in Chapter
Geshu (B 17) and Xuehai (Sp 10) to treat 44 of Plain Questions as a syndrome mainly
wandering bi and vessel bi. Shangqiu (Sp caused by heat in the lung with the lobes
5) and Zusanli (S 36) strengthen the function scorched. The physicians of later genera-
of spleen and stomach and eliminate damp tions further developed this theory. Zhallg
to relieve the fixed bi. Guanyuan (Ren 4) Jingyue (1 156-1228A.D.) pointed out, "It is
and Shenshu (B 23) strengthen the kidney not a few cases of wei syndromes that are
Chapter 17 Internal Diseases

due to the injury of primary qi leading to eventually transformed into heat which
deficiency of essence which fails to irrigate, damages the muscles and tendons. Hence,
or deficiency of blood which fails to the muscles and tendons become flaccid.
nourish." The wei syndromes may also be caused by
On the treatment of wei syndromes, excessive intake of greasy food which
Chapter 44 of Plain Questions puts forward produces internal accumulation of damp-
the theory: "Only points along the heat, resulting in stagnation of qi and blood
Yangning Meridians are selected in treating in the meridians and collaterals.
wei syndromes." The stomach is believed to c) Deficiency of yin in the liver andkidney:
be the sea of water and food, and the source Since the liver stores blood and controls
of acquired essence. The Foot-Yangming the tendons, and the kidney stores essence
Meridian is enriched with qi and blood. The and dominates the bones: prolonged illness
twelve meridians, tendons, bones, and or indulgent sexual activity causes loss of
muscles need the acquired qi and blood for essence and blood, resulting in malnutrition
nourishment, while the production of blood of the tendons. Conditions affecting the
in the liver and essence in the kidney depends proper function of the liver and kidney may
upon the transformation of water and food. therefore also give rise to the wei syndrome.
Therefore, regulating the function of the d ) Trauma:
Stomach Meridian of Yangrning is the main Contusion causes injury of the meridians
principle in treating the wei syndromes. In and leads to retarded flow of qi and blood in
clinical practice, treatment is determined the meridians. As a result, the *musclesand
according to differentiation of the syndrome tendons are poorly nourished, and become
as well as locality, etiology and pathogenesis flaccid. Thus occurs the wei syndrome.
of the disease. In a chronic bi syndrome
there may be prolonged motor impairment Differentiation
of the joint because of pain. In this case there a ) Heat in the lung:
develops muscular atrophy or flaccidity of Main manifestations: Muscular flaccidity
the limb on account of disuse. It should be of the lower limbs with motor impairment,
differentiated from the wei syndrome which accompanied by fever, cough, irritability,
is characterized by absence of pain. thirst, scanty and brownish urine, reddened
tongue with yellow coating, thready and
Etiology aid Pathogenesis rapid or rolling and rapid pulse.
a) Burning heat in the lung: Analysis: Fever and cough are the results
The muscular flaccidity or atrophy of the of the invasion of the lung by the pathogenic
limb results from malnourishment of the heat. Irritability, thirst and scanty, brownish
tendons due to exhaustion of body fluid. urine indicate that the body fluid has been
This condition may be caused by invasion of damaged by the internal heat. Muscular
the lung by exogenous pathogenic heat, or flaccidity and motor impairment result from
excessive heat remaining in the lung after an malnutrition of the tendons and rnusc~esand
illness. damage o f . essence and body fluid. The
b) Damp heat: thready, rapid pulse and reddened tongue
Exogensus pathogenic damp invades in with yellow coating indicate that the body
the body, and the accumulation of damp is fluid has been injured by heat. The rolling,
 Chinese Acupuncture and Moxibustion

rapid pulse is associated with excessive heat. Reddened tongue, thready and rapid pulse
b ) Damp heat: are signs of deficiency of yin of the liver and
Main manifestations: Flaccid or slight kidney.
swollen legs, a little hot sensation on touch, d ) Trauma:
general heaviness, sensation of fullness in Main manifestations: History of trauma,
the chest and epigastric region, painful flaccid paralytic limbs, may be accompanied
urination, hot and brownish urine, yellow with incontinence of urine and feces, relaxed
sticky tongue coating, soft and rapid pulse. or hesitant pulse, pink or dark purplish
Analysis: Flaccidity of the legs is due to tongue with thin white coating.
the stagnation of qi and blood in the tendons Analysis: Flaccid paralytic limbs arise
and muscles caused by prolonged accuanula- from obstruction of the circulation of qi and
tion of internal damp-heat. General blood at the injured site of trauma.
heaviness is also due to accumulation of Incontinence of urine and feces is mainly due
damp-heat. When damp-heat is accumulat- to dysfunction of the kidney which fails to
ed in the chest, fullness sensation in the chest control urine and feces. In case of trauma,
and epigastrium results. Hot, brownish the Du Meridian which dominates the yang
urine, and painful urination suggest the qi of the whole body is affected, and the qi
downward flow of damp heat. Yellow sticky activity of all zarig-fu organs may be
tongue coating, and soft rapid pulse are impaired, including the function of the,
signs of damp-heat. kidney in controlling urine and feces.
) Dejiciency of yin of the liver and Damage of qi of the kidney causes
kidney: incontinence of urine and feces. Hesitant
Main manifestations: Muscular flaccidity pulse and dark purplish tongue indicate
of the lower limbs with motor impairment, blood stasis.
combined with soreness and weakness of the
lumbar region, seminal emission, prosper- Treatment
mia, leukorrhoea, dizziness, blurring of Method: Main points are selected from
vision, reddened tongue, thready and rapid the Yangming Meridians to promote
pulse. circulation of qi in the meridians, and to
Analysis: In deficiency of yin of the liver nourish the tendons and bones. If heat or
and kidney the muscles, tendons and bones damp heat in the lung is the main etiological
are poorly nourished by essence and blood, factor, the reducing method should be used
and hence occurs muscular flaccidity with to dissipate heat. Hn case of deficiency of yin
motor impairment. Soreness and weakness in the liver and kidney, the reinforcing
of the lumbar region, seminal emission and method should be employed. For trauma,
leukorrhoea are the result of deficiency of puncture the points on the affected side with
essence in the kidney. Since the kidney is even movement.
located in the Burnbar region, it stores Prescription:
essence, and its meridians connect with the Upper limb: Jianyu (LI 1 9 , Quchi (EI 1 I),
Chong Meridian and the Ren Meridian. Hegu (LI[ 4), Waiguan (SJ 5).
Dizziness and blurring of vision are caused Lower limb: Biguan (S 311, Huantiao (G
by preponderance of yang in the liver arising 30),Xuehai (Sp lo), Liangqiu (S 341.1,Zusanli
from deficiency of yin in the kidney. (S 361, Uanglingquan (G 34), Jiexi (S 411,
Chapter 17 Internal Diseases

Xuanzhong (G 39). used to dissipate heat from the lung. Pishu

Supplementary points: (B 20) and Yinlingquan (Sp 9) eliminate
Heat in the lung: Chize (k5),Feishu (B 13). damp heat. Ganshu (B 18) and Shenshu (B
Damp heat: Pishu (B 20), Yinlingquan (Sp 23) are chosen to tonify the yin in the liver
9)- and kidney. Huatuojiaji points are selected
Deficiency of yin in the liver and kidney: to regulate qi in the Du Meridian. Zhongji
Ganshu (B 18), Shenshu (B 23). (Ren 3) and Sanyinjiao (Sp 6) are taken to
Trauma: Huatuojiaji points at the adjust the qi in the kidney and bladder.
corresponding level of spinal injury. Dachangshu (B 25) and Ciliao (B 32)
Incontinence of urine: Zhongji (Ren 3), improve the function of the large intestine.
Sanyinjiao (Sp 6).
Incontinence of feces: Dachangshu (B 25),
Ciliao (B 32). a) The wei syndrome is seen in acute
Explanation: In the above prescription myelitis, progressive myatrophy, myathenia
points the Yangming Meridians are gravis, multiple neuritis, sequellae of
predominating. This is based upon the poliomyelitis, periodic paralysis, hysterical
statement in Internal Classic: "Only points paralysis, traumatic paraplegia, etc.
along the Yangming Meridians are selected b) Since the wei syndrome needs a long
to treat paralysis of the limbs." period of treatment, the patients should
Yanglingquan (G 34) and Xuanzhong (G cooperate with the doctor during the
3 9 , the Influential Points of tendon and treatment. Tapping with subcutaneous
marrow respectively, are added to enhance needles in the affected areas and along the
the effect of nourishing the tendons and affected meridians may also be added to the
bones. Feishu (I3 13) and Chize (6, 5) are treatment.
 Chapter I8
GYNECOLOGICAL
I. GYNECOLOGICAL DISEASES
Ren Meridians by excessive heat, bringing
1. Irregular Menstruation about antedated menstruation.
ii) Qi deficiency:
Irregular menstruation refers to any This is caused by overexertion, improper
abnormal change in menstrual cycle, in diet leading to weakness of the spleen qi and
quantity and color of flow, and other insufficient qi in the middle jiao, which fails
accompanying symptoms. Commonly seen to control the menstrual flow, resulting in
cases are antedated and postdated antedated menses. Dr. Zhang Jingyue
menstruation, irregular menstrual cycle. pointed out, "If the pulse does not reflect
Menstruation earlier than due time by seven excessive heat internally it meqns
to eight days, or even twice a month, is antedated menstruation is causea by qi
regarded as antedated menstruation, while deficiency of the heart and spleen that fail to
menses later than due time by eight to nine control the blood."
days or even once every forty to fifty days is b) Postdated menstruation:
considered as postdated menstruation. i) Blood deficiency:
Menopathy is caused by many factors, The blood may be marred due to chronic
such as the exogenous pathogenic cold, heat hemorrhage, debility resulted from chronic
and damp, emotional disturbances - diseases and multiparity . Irregular diet and
worries, depressed rage, indulgence in overexertion may injure the spleen and
sexual life, grand rnultiparity, etc., leading to stomach, causing insufficiency of blood in
the disharmony between qi and blood and the Chong and Ren Meridians. Finally,
the injury of the Chong and Wen Meridians. postdated menstruation occurs.
ii) Cold in the blood:
Etiology and Pathogemsis It is due mostly to constant yang
a ) Antedated menstruation: deficiency and internal growth of cold, or
i) Heat in the blood: due to overtake of raw and cold food,
It is due to abundance of the internal heat, exposure to rain and cold during the
yin deficiency and yang excess, or overtake menstrual periods. Then the pathogenic cold
of pungent food, overdosage of the warm invades the Chong and Ren Meridians,
property drugs acting on uterus, or to fire impeding the free flow of blood, hence the
transformed from stagnated liver qi, etc. All menstrual cycle delays.
of these lead to the injury of the Chong and iii) Qi stagnation:
Chapter 18 Gynecological and Other Diseases

It is due to emotional depression, light red menses in shortened cycle,

disturbing the qi activity and resulting in qi lassitude, palpitation, shortness of breath,
stagnation. The stagnated qi impairs the subjective empty and heavy sensation in the
smooth flow of blood which leads to lower abdomen, pale tongue with thin
abnormal function of the Chong and Ren coating, weak pulse.
Meridians. The sea of blood cannot be filled Analysis: The spleen qi dominates the
up at due time, and postdated menstruation middle jiao and controls blood. Qi
'occurs. insufficiency fails to check the blood, there
c ) . Irregular nzenstrual cycles: occurs disturbance of the Chong and Ren
i) Qi stagnation in the liver: Meridians, leading to profuse, thin and light
It is due usually to depressed rage that red menses in shortened cycle. Lassitude,
hurts the liver and disturbs the storage of shortness of breath and empty heavy
blood, which leads to dysfunction of the sensation are manifestations of qi defi-
blood in the Chong, Ren Meridians and ciency. Palpitation and pale tonbue account
uterus, hence irregular menstrual cycles. for blood deficiency, and the weak pulse is a
ii) Kidney deficiency: sign of qi deficiency.
It is due to marriage at an immature age, b ) Postdated menstruation:
indulgence of sexual life, grand mltiparity, i) Blood deficiency:
etc., which consume the essence and blood. Main manifestations: Scanty and light red
The kidney qi fails to conduct its Function in menses in delayed cycle, empty and painful
storing essence and adjusting the Chong and feeling in the lower abdomen, emaciation,
Ren Meridians, resulting in irregular sallow complexion, lusterless skin, dizziness
menstrual cycles. and blurred vision, palpitation and
insomnia, pink tongue with little coating,
Differemtiation weak and thready pulse.
a ) Antedated menstruation: \ Analysis: Owing to a chronic disease,
i Heat in blood: weak body constitution or chronic
Main manifestations: Shortened cycle, hemorrhage, blood cannot form the timely
dark red and thick blood flow in large tide in the sea of blood, bringing about
quantities, restlessness, fullness in the chest, scanty and light red menses in delayed cycle.
brown urine, reddened tongue with yellow When the blood fails to nourish the uterus,
coating, rapid and forceful pulse. there is an emptiness and pain in the lower
Analysis: Dark red, thick and profuse abdomen. When the meridians, vessels,
menses indicate internal excessive heat, muscles and skin are undernourished, there
which impairs the heart and liver, leading to may appear emaciation, sallow complexion
restlessness and fullness in the chest. When and lustreless skin. When the liver and heart
the heat shifts from the heart down to the fail to be nourished by blood, dizziness,
small intestine there appears scanty and blurred vision, palpitation and insomnia
dark yellow urine. The yellow tongue occour. If the tongue is malnourished and
coating and the rapid pulse are signs of the vessels are not filled up, there present
internal heat. pink tongue and weak thready pulse.
ii) Qi deficiency: ii) Cold in the blood:
Main manifestations: Profuse, thin and Main manifestations: Scanty and dark-
 Chinese Acupuncture and Moxibustion

coloured menses in delayed cycle, colic pain Analysis: Depressed rage injuries the
in the lower abdomen, slightly alleviated by function of the liver, leading to unsmooth
warmth, cold limbs, thin and white tongue, flow of qi and blood and disturbance in the
deep and slow pulse. sea of blood, and finally to the alteration of
Analysis: The invasion of pathogenic cold menstrual cycles and quantity of blood flow.
during menstruation impedes blood flow, The stagnation of liver qi causes impeded
leading to scanty and dark-cslornred menses flow of blood; bringing about diffictalt
in delayed cycle. Cold in the uterus hinders menstruation, distension in the hypo-
the smooth flow of qi and blood and then chondriac region and breast, and distending
there appears colic pain. Cold, yin by nature, pain in the lower abdomen. Frequent
injures yang qi and brings about cold limbs. sighing may help to relieve the stagnated qi.
Thin and white tongue coating, deep and String-taut pulse is a typical sign of liver qi
slow pulse are signs of cold syndromes. stagnation.
iii) Qi stagnation: ii) Kidney deficiency:
Main manifestations: Scanty and dark red Main inanifestations: Scanty, light red
menses in delayed cycle, distending pain in blood flow in altering cycles, dizziness and
the lower abdomen, mental depression, tinnitus, weak and aching of the lower back
stuffy chest alleviated by belching, and knees, frequent night urination, loose
distension in the hypochondria and breast stools, pale tongue with thin coating, deep +

region, thin, white tongue coating and and weak pulse.

string-taut pulse. Analysis: When there is insufficiency of
Analysis: Stagnated qi of the liver brings kidney qi, disharmonized Chong and Ren
about retarded blood flow and results in Meridians bring on the derangement of the
scanty and delayed menses with distending flow and ebb of tide in the sea of blood,
pain in the lower abdomen. When the qi fails resulting in the alteration of menstrual
to travel smoothly, mental depression and cycles. Insufficient kidney qi decreases the
stuffy chest present. Since the Liver essence and blood, leading to scanty, thin
Meridian runs through the costal and and light red menses. Since the kidney
hypochondriac regions, the stagnated liver dominates bones, generates marrow, and
qi gives rise to the distension in the has its opening in the ear, and the Kidney
hypochondrium and breast. String-taut Meridian runs through the waist, deficiency
pulse is a typical sign of liver disorder and qi condition of the kidney causes lack of
stagnation. marrow, impairs audibility and mal-
c ) Irregular menstrual cycles: nourishes the waist, bringing on dizziness,
i) Qi stagnation in the liver: tinnitus, sore and weak in knees and the
Main manifestations: Alteration of lower back. When the kidney fails to control
menstrual cycles and quantity of blood flow, urination and defecation there appear
thick, sticky, and purple colored menses frequent urination and loose stools. Pale
difficult to flow, distension in the tongue with thin coating and deep weak
hypochondriac region and breast, distend- pulse indicate kidney yang deficiency.
ing pain in the lower abdomen, mental
depression, frequent sighing, thin white Treatment
tongue coating and string-taut pulse. a ) Antedated menstruation:
Chapter 18 Gynecologicall and Other Diseases

i) Meat in the blood: blood and when it is abundant blood is

Method: Points of the Spleen and Kidney totally controlled by it. Sanyixajiao (Sp 6),
Meridians are selected as the principal Zhongwam (Ren 12) and Zusanli (S 36) are
points. Acupuncture wit11 the reducing chosen to build up the spleen' qi, and
method is applied to regulate the-Chong and strengthen spleen qi, controls blodd. All the
Ren Meridians and, clear off heat from points applied together attain the purpose of
blood. replenishing qi and controlling blood.
Prescription: Quchi (& H 11), Zhongji (Ren b) Postdated menstruation:
3), Xuehai (Sp lo), Shuiquan (K 5). i) Blood deficiency and cold in the blood:
Supplementary points: Method: Points of the Ren a Foot-
Liver qi transforming into fire: Xingjian Taiyin Meridians are selected as the
(Liv 2). principal points. In case of blosd deficiency,
Yin deficiency with internal heat: Wangu acupuncture is applied with the reinforcing
(K 2). method lo replenish qi and nourish blood.
Explanation: Quchi (E 1 11) is the He- Moxibustion is also advisable. In case s f
Sea Point of the Hand-Yangming Meridian cold in the blood, acupuncture is given with
while Xuehai (Sp 10) is the Jing-River Point the even movement. Strong stimulation of
of the Foot-Taiyin Meridian. When they are moxibustion is used to warm up the
used together, heat is removed from blood. meridians and disperse cold.
Zhongji (Ren 3), the intersecting point of the Prescription: Guanyua~a(Ren 4), Qihai
three yin meridians of foot, works to (Ren 61, Sanyinjiao (Sp 6).
regulate the Chong and Ren Meridians and Supplementary points:
remove internal heat from the lower jiao. Dizziness and blurred vision: Baihni '

Shuiquan (K 51, Xi-Cleft Point of the (m 2017

Kidney Meridian, strengthens yin, reduces Palpitation and insomgia: Shenmen (H 7).
heat and regulates menses. A11 the points Explanadon: Guanyuan (Ren 4 ) an
used together serve the purpose of clearing intersecting point of the three yin meridians
off heat and regulating menstruation. of h o t connects the uterus. When the
Xingjian (L 2) is added to clear away the reinforcing method is applied to Guanyuan
heat from the lives in case of stagnated liver (Ren 4) and Samyingia~(Sp 6), qi and blood
qi transforming into fire. Rangu (R 2) is are promoted, the Chong and Ren -
used to nourish grin, reduce heat and to Meridians are regulated and then cold is
regulate menses. dispelled from them. Qihai (Ren 6) assists to
ii) Qi deficiency: adjust qi and blood so that the Chong and
Method: Select the main points from the ]Wen Meridians are well regulated and
Ren, Foot-Taiyin and Foot-Yangming menses comes on time. Baikui (Du 20) helps
Meridians to replenish qi so as to restore its ascend qi and biood, nourishing the head
function in controlling blood. Acupuncture and eliminating dizziness and blurred vision.
is applied with the reinforcing method. Shenrnen (H 7) pacifies the mind in case of
Prescription: Qihai (Ren 61, Sanyinjiao palpitation and insomnia.
(Sp 41, Zhongwan (Ren 12), Zusanli (S 36). ii) Qi stagnation:
Explanation: Qihai (Ren 6) can regulate qi Method: Points of the Foot-Jueyina and
of the whole body. Qi is the commander of Foot-Yangrning Meridians are selected as
 Chinese Acupuncture and Moxibustion

the principal points. Acupuncture is applied 5) and Ligou (Liv 5) remove stagnation of
with the reducing method to activate qi and the liver qi and treat disordered menses. The
. blood flow. irregular menstrual cycles will be removed
Prescription: Tianshu (S 25), Qixue (K once the liver restores its normal function
13), Diji (S 8), Taichong (Liv 3). and the Chong and ]Wen Meridians are
Supplementary points: harmonized. Tanzhong (Ren 17) and Qimen
F--ll-,,, ,d' ik, ,LA,+. AT,: ,
,,
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Pl U l l l l C 3 3 W I L l l C L l l C 3 L . 1 Y C l ~ U Q L l \I ' T I .
/T
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n v a ;anl-lrllrr/e
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MA
fkn ur~nnn+;ra+;n+l en
L I L ~ ~ I ~ D U A ~ ~ L ~LW
W L I

Distension in the hypochondriac region soothe the liver and relieve the stagnated qi
and breast: Qimen (Liv 94). of the liver and distending pain in the
Analysis: Tianshu (S 25) and Qihai (Ren hypochondriac region and breast. Shenmen
6) are located on the Foot-Yangming (H 7) and Taichong (Liv 3) ease the mind
Meridian. Qixue (K 13) can promote qi and and relieve depression.
blood flow and regulate the Chong and Ren ii) Kigney deficiency:
Meridians. Diji (Sp 8), a qi point of the Method: Points on the Ren and Foot-
blood system can adjust blood atid qi Shaoyin Meridians are selected as the
circulation. Taichong (Liv 3), the Yuan- principal points. Acupuncture is given with
(Primary) Point of the Liver Meridian can the reinforcing method. Moxibustion is used
soothe the liver and regulate liver qi. The to replenish the kidney qi and regulate the
points are used together to achieve free flow Chong and Ren Meridians.
of qi and blood. Neiguan (P 6) is chosen to Prescription: Guanyuan (Wen 4), Shenshu
rzn;c.;e fe;!!ness fro= the chest aad adjxst qi . (9 231, fia~xi:: (K 8).
Qimen (Eiv 14) is added to regulate qi so as Supplementary points:
to weed out the distension in the Sore and weak low back and knees:
hypochondriac region and breast. Yaoyan (Extra), Yingu (K 10).
c ) Irregular menstrual cycles: Dizziness and tinnitus: Baihui (Du 201,
i) Qi stagnation in the liver: Taixi (K 3).
Method: Points of the Ren and Jueyin Explanation: Shenshu (B 23) the Back-
Meridians. are selected as the principal Shu point of the kidney, can strengthen
points to ease the liver and regulate the congenital essence when used together with
Chong and Ren Meridians. Acupuncture is Guanyuan (Wen 4) and Jiaoxin (K 8). The
given with the even movement. irregular mehstrual cycles get redressed
Prescription: Qihai (Ren 6), Siman (K 14), naturally once the kidney can carry out well
Jianshi (P 5), Ligou (Eiv 5). its function in storing essence. Yaoyan
Supplementary points: (Extra) aims at the sore and weak low back
Distension in the hypochondriac region and knees, while Yingu (K 10) strengthens
and breast: Tanzhong (Ren 17), Qimen (Liv the bones through kidney activation. Taixi
14). (K 3) and Baihui (Du 20) are added to
Mental depression: Shenmen (M 71, promote marrow and nourish the brain by
Taichong (Liv 3). means of tonifying kidney to treat dizziness
Explanation: Qihai (Wen 6) and Siman (K and tinnitus.
14) can promote the flow of qi and blood,
regulate Chong and Ren Meridians. Remarks
Located on the Jueyin Meridians, Jianshi (I? Included in this disorder is the irregular
Chapter 18 Gynecological and Other Diseases

menorrhea resulted from dysfunction of menses with clots, distending pain in the
antehypophysis or from ovarian lower abdomen, alleviated by passing out
dysfunction. the clots, distension in the hypochondriac
region and breast, purplish tongue with
2. Dysmenorrhea purple spots on its edge, deep and string-taut
Dysmenorrhea refers to the pain pulse; pain and cold feeling in the lower
appearing in the lower abdomen and lower abdomen referring to the waist and back,
back before, after or during menstruation. alleviated by warmth, scanty dark red
The pain, sometimes intolerable, occurring menses with clots, sticky and white tongue
during the cycle of menses is known as coating, deep string-taut pulse.
painful menstruation. Analysis: The depressed liver qi gives rise
Dysmenorrhea is principally ascribed to to the distending pain in the lower abdomen,
the impeded flow of qi and blood in the hypochondriac region and breast, and
uterus. Deficienicy or stagnation of qi and scanty and impeded menses. Qi stagnation
blood may cause unsmooth flow of inevitably leads to blood stasis, so the
menstruation. Dysmenorrhea is clinically menses appears dark purple with clots. The
classified into dificiency and excess type. release of clots helps to weed out a little
stagnation, alleviating the pain. Purplish
Etiology and Pathogenesis
tongue with purple spots on its edge, deep
a ) Excess syndrome:
and string-taut pulse are signs ' of qi
It is due to stagnation of the liver qi, which
stagnation and blood stasis. When the cold ,
fails to carry the free flow of blood. The
and damp retain in the uterus and surround
impaired flow of blood causes disharmony
the blood, there present impeded scanty
between the Chong and Ren Meridians and
menses with clots and pain in the lower
stagnation of blood in the uterus, resulting
abdomen. Since the uterus connects with the
in pain. Another cause is the affection of
kidney, severe pain refers to the waist and
external cold or intake of,pold drinks during
back. Warmth alleviates the pain for it
menstrual periods, which hurts the lower
accelerates the flow of blood. White tongue
jiao, and makes the cold retain in the uterus.
coating, deep and string-taut pulse are signs
Finally there appears retarded menstruation
of collection of internal cold and damp.
with pain.
b ) Deficiency syndrome: b ) Deficiency syndrome:
In circumstances of qi and blood Main manifestations: Dull pain appearing
deficiency due to either weak body-build or by the end of or after menstruation,
chronic disease, menstruation drains up the alleviated by warmth and pressure, pink,
sea of blood and deprives the uterus from scanty and thin menses, thready and weak
nourishment, then pain occurs. pulse accompanied by aversion to cold, cold
extremities, pale complexion, palpitation
Differentiation and dizziness.
I

a ) Excess syndrome: Analysis: When qi and blood is

Main manifestations: Pain in the lower insufficient the sea of,blood is nbt able to
abdomen, usually starting before menstru- provide enough nutrients to the uterus. This
ation, retarded and scanty and dark purple is the cause of dull . pain, which can be
 Chinese Acupuncture and Moxibustion

alleviated by pressure and warmth. §imam (K 14), Shuidao (S 28) to regulate the
Deficiency of both qi and blood also gives Chong and Ren Meridians and remove
ground to scanty pink and thin menses. blood stasis and pain Moxibustion applied
Severe deficiency of qi and blood causes the to Guilai (S 29) ar Daju (S 27) warms up
failure of the heart and head to be nourished, the related meridians and eliminates pain in
leading to palpitation, dizziness and pale the lower abdomen. The above points used
m*
compexion. m e weakened yang qi after a e flow of yi,
together are to p i o ~ ~ i o ithe
chronic disease is the cause of aversion to remove blood stasis, warm up meridians and
cold and cold extremities. Thready and weak dissipate cold. Thus dysmenorrhea gets
pulse indicates deficiency of both qi and cured when the Chong and Ren Meridians
blood. are well adjusted.
b ) Dejiciency syndrome:
Treatment Method: Points of the Ren, Spleen and
a ) Excess syndrome: Kidney Meridians are selected as the
Method: Acupuncture is given with the principal points. Acupuncture is given with
reducing method. Points of the Ren and the reinforcing method and moxibustion to
Foot-Taiyin Meridians are selected as the regulate qi and blood, warm up and nourish
principal points. Both acupuncture and the Chong and Ren Meridians.
moxibustion are used in case of cold Prescription:'Guanyuan (Ren 4), Bishu (B
syndromes to adjust qi activities, invigorate 20), Shenshu (B 23), Zusanli (S 36),
biood flow and restore the functions of Saayinjiao jSp 6).
meridians. Explanation: Guanyuan (Ren 4) is an
Prescription: Zhongji (Ren 3), Ciliao (B intersecting point of the three foot-yin
32), Hegu (L 1 4), Xuehai (Sp 1O), Diji (Sp 8), meridians. When moxibustion is applied to
Taichong (Liv 3). it and Shenshu (I3 23), it may warm up,the
Supplementary points: lower jiao, benefit essence, blood and finally
Distending pain in the lower abdomen: the Chong and Ren Meridians. Pishu (B 20),
Siman (K 14), Shuidao (S 28). Zusanli (S 36) and Sanyinjiao (Sp 6) grouped
Pain with cold feeling in the lower together can tonify the spleen and stomach,
abdomen: Guilai (S 291, Daju (S 27). and benefit qi and blood. Dysmenorrhea is
Explanation: Zhongji (Ren 3) serves to naturally removed when the uterus is
regulate the qi in the Chong and Ren nourished by abundant qi and blood, and
Meridians. When it is applied together with the balanced equilibrium of the Chong and
Xuehai (Sp lo), Diji (Sp 8), the Xi-(Cleft) Ren Meridians.
Point of the Spleen Meridian, may
invigorate blood flow and menstruation.
Taichong (Liv 3), the Yuan-(Primary) Point Remarks
of the Liver Meridian can free the stagnated This disorder often involves in path-
liver qi, paired with Hegu (L I 4) can regulate ological changes of the genitalia, and relates
qi and blood flow and eliminate pain. Ciliao to endocrinal and neuropsychiatrical
(B 32) is an empirical point for factors. If dysmenorrhea is secondary,
dysmenorrhea. For distending pain in the treatment should be given to the primary
lower abdomen it is used together with cause.
Chapter 18 Gynecological and Other Diseases

3. Amenorrhea purple tongue coating with purplish spots on

its borders, deep string-taut pulse.
Menstrual flow begins at about fourteen Analysis: Worry and anger cause qi
in healthy girls. Menstruation that does not stagnation and failure of it to control blood,
come until 18 or suppression of bringing on blockage of the Chong and Ren
menstruation for over three months is called Meridians and amenorrhea. The abnormal
amenorrhea. Stop of menses during function of qi gives rise to lower abdominal
gestation period and lactation period is of distending pain and fullness in the chest and
normal physiolo- epigastrium. Blood stasis retaining in the sea
gical phenomena. The causative factors of of blood hinders menstrual flow, manifested
amenorrhea fall into deficiency and excess by the abdominal pain aggravated by
types. The deficiency type is mostly seen due pressure and hard mass in the lower
to deficiency of blood, and the excess type is abdomen. Purple tongue coating with
caused by excessive pathogenic factors purplish spots on its borders and deep
obstructing the passage of menses. string-taut pulse are signs of stagnation of qi
The clinical differentiation and treatment and blood.
are usually conducted in the light of blood b ) Blood depletion:
stagnation and blood depletion. Main manifestations: Delayed menstrual
cycle, gradual decrease of menses and
Etiology and Pathogenesis amenorrhea, sallow complexion in pro-
a ) Blood stagnation: longed cases, lassitude, vertigo and
It is due to the seven emotional dizziness, poor appetite, loose stools, dry
disturbances, stagnation of liver qi, resulting skin, pale tongue with white coating, slow
in retardation of both qi and blood in the weak pulse, all of which are signs of
uterus and obstruction in the passage of deficiency of qi and blood; dizziness and
menses. tinnitus, sore and weak low back and knees,
b) Blood depletion: dry mouth and throat, hot sensation in the
Improper intake of food or overstrain palms, soles and epigastrium, afternoon
undermines the reproducing source of qi and fever and night sweating, pale tongue with
blood, sev6re or chronic diseases that little coating, string-taut and thready pulse,
consume blood, or by grand multipara or all of which are signs of deficiency of essence
indulgence in sexual life that exhaust essence and blood.
and blood, all of which may drain the sea of Analysis: Blood is transferred from food
blood, deprive the Chong and Ren through the function of transportation and
Meridians of nourishment and result in transformation of the spleen, and dysfunc-
amenorrhea. tion of the spleen leads to blood deficiency.
Differentiation Blood deficiency causes malnutrition of the
a ) Blood stagnation: Chong and Ren Meridians and the voidness
Main manifestations: Absence of menses in the sea of blood. Hemorrhage causes
for months, lower abdominal distending exhaustion of blood, and finally delayed
pain aggravated by pressure, hard mass in menstrual cycle and the gradual decrease of
lower abdomen, distension and fullness in menses till amenorrhea. Blood deficiency
the chest and hypochondriac region, dark fails to nourish the muscles, skin and head,
 Chinese Acupuncture and Moxibustion

bringing on sallow complexion, dry skin, (K 14) may be added when there is pain and
vertigo and dizziness and lassitude. hard mass in the lower abdomen aggravated
Dysfunction of transportation and trans- on pressure.
formation of the spleen gives rise to poor b ) Blood depletion:
appetite and loose stools. Pale tongue with Method: Select points of the Ren, Liver,
white coating and slow, weak pulse are signs Spleen and Kidney Meridians. Acupuncture
""-4
~J~UUU
An-I,.+:--
l L l . S i ~ c e h e kidney is wed t,r/itl., h e rei~?ferr,l~?g IIIS~~Z~.
dominates bone and marrow, while the Moxibustion is applied sometimes to tonify
brain is the sea of marrow, deficiency in the blood and restore menses.
kidney may lead to dizziness, tinnitus, sore Prescription: Guanyuan (Ren 4), Ganshu
and weak low back and knees. Yin (B 18), Pishu (I3 20), Shenshu (B 23), Zusanli
deficiency produces internal heat manifested (S 36), Sanyinjiao (Sp 6).
by the dry mouth and throat, hot sensation - Explanation: The spleen, the foundation
in palms, soles and epigastrium, afternoon of the acquired essence, abstracts nutrient
fever and the night sweating. Pale tongue particles from food and transforms them
and string-taut thready pulse are signs of into qi and blood. When blood supply is
deficiency of essence and blood. abundant the menstrual cycle is normal. So
Pishu (B 20), Zusanli (S 36) and Sanyinjiao
Treatment (Sp 6) are selected to strengthen the function
a ) Blood stagnation: of the spleen and stomach. The kidney is the
Pdethsd: Points af the Ren, Fcct-Taiyang f~undationef s e g g e ~ i t dessmce, a d ample
and Foot-Jueyin Meridians are selected as kidney qi guarantees sufficient qi and blood.
the principal points. Acupuncture with the For this reason Shenshu (B 23) and
reducing method is used to remove the Guanyuan (Ren 4) are chosen to replenish
stagnation and regulate the circulation of qi kidney qi. Ganshu (I3 18) is selected to
and blood in the meridians. promote the blood in the liver, where blood
- Prescription: Zhongji (Ren 3), Guilai (S is stored. When the spleen, liver and kidney
29), Xuehai (Sp lo), Taichong (Liv 3), Hegu carry out well their functions of controlling
(L I 4), Sanyinjiao (Sp 6). blood, storing blood and essence respecti-
Supplementary points: vely, the Chong and Ren Meridians are we1
Pain in the lower abdomen with hard mass nourished and amenorrhea is cured.
aggravated by pressure: Siman (K 114).
Explanation: Zhongji (Ren 4), an Remasks
intersecting point of the three foot-yin Included in this disease is amenorrhea
meridians, may regulate the Chong and Ren resulted from endocrinal and neuropsy-
Meridians and dredge the blockage from the chiatrical factors.
lower jiao. Guilai (S 29) is chosen as a local
point to remove blood stasis from the uterus. 4. Uterine Bleeding
Xuehai (Sp 10) and Taichong (Eiv 3) applied
together can regulate the liver qi, and relieve Vaginal hemorrhage beyond menstrual
stagnation and stasis. Hegu (L I 4 )and period, either copious or continuously
Sanyinjiao (Sp 6) can get qi and blood down dripping, is generally defined as metror-
to restore the normal menstruation. Siman rhagia. The copious bleeding with a sudden
 Chapter 18 Gynecological and Other Diseases 455
-

onset is referred to as profuse metrorrhagia, coating, rapid pulse.

and the scanty bleeding with a gradual onset Analysis: The blood escape is due to
as continuous scanty uterine bleeding. excessive internal heat. When the heat
Although they are different in manifesta- disturbs the mind there present fidgets and
tions, the two are intertransmutable during insomnia. Dizziness is caused by the upward
the process of the disease course. Chronic going of heat. Red tongue with yellow
profuse bleeding consumes qi and blood, coating and rapid pulse are signs of heat in
leading to continuous scanty bleeding, the blood.
whereas prolonged scanty bleeding becomes . b) Qi deficiency:
worse, it inevitably turns to profuse Main manifestations: Sudden profuse
bleeding. In terms of severity, the profuse bleeding or continuous scanty bleeding
bleeding is severe and the scanty bleeding is marked by light red and thin blood,
comparatively mild. It says in Recipes for lassitude, shortness of breath, apathy,
Saving Lives, "Vaginal bleedings are of the anorexia, pale tongue, thready weak pulse.
same scope of a disease, while the mild one is Analysis: It is caused by the failure of the
called continuous scanty bleeding and the qi in control of blood and the disordered
severe one is named profuse metrorrhagia." Chsng and Wen Meridians. Lassitude,
shortness of breath and apathy are
Etiology and Pathogenesis manifestations of qi deficiency in the middle
a ) Excessive heat: jiao. Anorexia derives from the dysfunction
The causative factors may be constant of the spleen in transportation and
excess of yang, exposure to external transformation. The light-coloured and thin
pathogenic heat, indulgence in spicy food blood is due to failure of blood to be warmed
. and disturbance of the seven emotions, etc.,
up. The pale tongue and thready weak pulse
which transform into internal fire. The. are signs of deficiency of qi and blood.
Chong and Ren Meridians are injured by
heat and there appears bleeding. It may also Treatment
be due to exasperation that hurts the liver. a ) Excessive heat:
Abundant liver fire expels the blood out of Method: Mainly select points of the Ren
its shedding house, causing metrorrhagia. and Foot-Taiyin Meridians. Acupuncture
b ) Qi deficiency: with the reducing method is used to clear off
Worries, irregular intake of food and heat and stop bleeding.
overstrain may damage the spleen qi. A Prescription: Zhongji (Ren 3), Xuehai (Sp
weakened spleen is unable to restrict blood, lo), Yinbai (Sp l), Ququan (Liv 8).
instablizes the activities of the Chong and Supplementary points:
Ren Meridians and finally metrorrhagia Affection of external heat: Quchi (L I 11).
presents. Excessive heart fire: Shaofu (H 8).
Differentiation Excessive liver fire: Taichong (Liv 3).
a ) Excessive heat: Explanation: Zhongji (Ren 3), the
Main manifestations: Sudden onset s f meeting point of the three foot yin meridians
profuse or prolonged continuous vaginal and the Ren and Chong Meridians, is used
bleeding in deep red colour, fidgets, to adjust the qi of the Chong and Ren
insomnia, dizziness, red tongue with yellow Meridians so as to check the escape of blood.
456 Chinese Acupuncture and Moxibustion

Yinbai (Sp l), the Jing-(Well) Point of the Remarks

Spleen Meridian, is often helpful to This disease includes functional uterine
metrorrhagia. Ququan (Liv 8) functions to bleeding due to ovarian dysfunction, but
sooth and regulate the liver qi. Xuehai used organic disorders of the reproductive system
(Sp 10) with the reducing method may must be excluded.
remove heat from blood to stop bleeding.
~ i clear
i\ii the points fu~ictioiiingi o g ~ t hcan 5. PP,GT%~Leakssshezi
heat, rkduce fire, regulate meridians and
Morbid leukorrhea is a disease symp-
cease bleeding. In case of varied symptoms,
tomized by persistent excessive mucous
Quchi (L I 11) is added to dissipate the
vaginal discharge.
pathogenic heat, and Shaofu (H 8) is used to
The chief causative factors of leukorrhea
clear away the heart fire, and Taichong (Liv
are deficiency of the spleen qi and stagnation
3) to reduce the liver fire.
of the liver qi, downward infusion of damp
b ) Qi deficiency:
heat or kidney qi deficiency, leading to
Method: Select the points of the Ren and
dysfunctions' of the Chong, Ren and Dai
Foot-Taiyin Meridians as the principal
Meridians, and leukorrhea. The ancient
points. Acupuncture with the reinforcing
doctors classified the condition by its'colour
method and moxiblastion are employed to
into white, yellow, red, red-white and multi-
promote the restricting function of qi.
coloured leukorrhea, among which white
Prescription: Baihui (Du 20), Guanyuan
and yellow leukorrhagia are commonly seen
jiien 41, Zusanii (S 361, Sanyinjiao (Sp 6),
in clinic.
Yinbai (Sp l), Yangchi (S J 4). I

Supplementary points: Etiology and Pathogenesis

Spleen qi deficiency manifested by a ) Deficiency in the spleen:
anorexia and loose stools: Pishu (B 20), Improper diet and overstrain hinder the
Weishu (B 21). spleen qi from transforming and transport-
Explanation: Guanyuan (Ren 4) can ing nutrient particles, which accumulate in
adjust the Chong and Ren Meridians, the lower jiao and turn to damp and finally
promote the restricting function of qi and leukorrhea appears.
stop uterine bleeding. Sanyinjiao (Sp 6), b ) Deficiency in the kidney:
Yinbai (Sp 1) and Zusanli (S 36) are together Constant deficiency of kidney qi, grand
used to tonify the spleen and foster the multipara, dysfunctions of the Dai and Ren
restriction of qi on blood. Moxibustion Meridians lead to leukorrhea.
applied to Baihui (Du 22) helps the c ) Damp heat:
ascending of yang qi, an application of the The presence of excessive damp due to
principle of using upper points for lower deficiency in the spleen, changes into heat.
disorders. Yangchi (S J 4) is the Yuan- Prolonged stagnated liver qi may transform
(Primary) Point of the Sanjiao Meridian, into heat and amalgamate with the damp.
which maintains the qi in general. Needling The downward infusion of damp heat turns
Yangchi (S J 4) with the reinforcing method out to be leukorrhea.
may build up the functions of the Chong and Differentiation
Ren Meridians and foster the restriction of a ) Deficiency in the spleen:
qi on blood. Main manifestations: Profuse thick, white
Chapter 18 Gynecological and Other Diseases

or- light yellow vaginal discharge without yellow colour, bitter taste in the mouth, dry
smell, pale or sallow complexion, lassitude, throat, irritability with a feverish sensation,
poor appetite and loose stools, edema in the palpitation, insomnia, yellow coating,
lower limbs, pale tongue with white sticky string-taut and rapid pulse.
coating, slow weak pulse. Analysis: The downgoing damp and heat
Analysis: On account of deficiency in the hurt the Ren and Dai Meridians. This is the
spleen, the downward infusion of water and cause of leukorrhagia. The pathogenic heat
damp form leukorrhea. With deficiency in amalgamated with damp gives rise to the
the spleen, the sapped yang qi in the middle yellow colour, visicosity and stench of the
jiao gives rise to poor appetite, loose stools whites and the itching in the vulva.- The
and edema in the lower limbs, lustreless and internal accumulation of the pathogenic
pale or sallow complexion, cold extremities damp is the cause of dry stools and scanty
and lassitude. Pale tongue with white sticky yellow urine. Soft rapid pulse and yellow
-coating and slow pulse are signs of sticky tongue coating are signs of damp and
deficiency in the spleen. heat. There appear irritability, bitter taste in
b ) Deficiency in the kidney: the mouth and dry throat, when the
Main manifestations: Profuse and pathogenic heat is transformed from the
continuous discharge of thin and transpar- stagnated liver qi. Heat in the blood causes
ent whites, severe soreness of the low back, reddish leukorrhea. When heat disturbs the
cold sensation in the lower abdomen, mind there present irritability, feverish
frequent and excessive urine, loose stools, sensation, palpitation and insomnia. The
pale tongue with thin coating, and deep string-taut rapid pulse and yellow coating
pulse. imply accumulated heat in the Liver
Analysis: Deficient kidney yang causes Meridian.
Dai and Ren Meridians to slacken its
restriction of essence, resulting in the Treatment
continuous vaginal discharge. The dimmed a ) Deficiency in the spleen:
fire in the Mingmen is too weak to warm up Method: Main points are selected from
the bladder and spleen and brings on the Ren, Foot-Taiyin and Yangming
frequent urine in large volume and loose Meridians. Acupuncture with the reinforc-
stools. Sore low back is due to a weakened ing method and moxibustion is used to build
kidney that is situated here. When the weak up the spleen and remove damp, regulate
kidney yang fails to keep the uterus warm, Ren Meridian and stabilize Dai Meridian.
there appears a cold sensation in the lower Prescription: Daimai (B 26), Qihai (Ren
abdomen. Pale tongue with thin white 6), Baihuanshu (B 30), Yinlingquan (Sp 9),
coating and deep pulse are signs of Zusanli (S 36).
deficiency of the kidney yang. Explanation: Daimai (B 26), an inter-
c ) Damp heat: secting point of the Dai and Foot-Shaoyang
Main manifestations: Sticky, viscous and Meridians, stabilizes the Dai Meridian and
stinking yellow leukorrhea in large quantity, is a cure for leukorrhagia. Qihai (Ren 6)
itching in the vulva, dry stool, scanty and regulates qi, resolves damp, adjusts the Ren
yellow urine, soft and rapid pulse, sticky Meridian and stabilizes the Dai Meridian.
yellow coating, or leukorrhea in reddish Baihuanshu (B 30) is selected as an adjacent
 Chinese Acupuncture and Moxibustion

point to check leukorrhagia. Yinlingquan and reduces the liver fire. The above points
(Sp 9) and Zusanli (S 36), major points in grouped together serve the purpose of
this prescription, are paired to build up the clearing heat, resolving damp, adjustingathe
spleen and remove damp. Ren Meridian and stabilizing the Dai
b ) Deficiency in the kidney: Meridian. Ligou (Liv 5) cures the itching in
Method: Select points mainly from the the vulva by removing damp and heat away
Wen and Foot-Shaoyin Meridians. Acu- from the Liver -Meridian. Xuehai (Sp iuj
puncture with the reinforcing method and eliminates reddish leukosrhea by clearing
moxibustion are used to promote yang qi, heat from blood. In case of excessive heat,
tonify the kidney and stablize the Ren and Quchi (L I 11) is used to clear the heat. The
Dai Meridians. right usage of the auxilliary point can
Prescription: Shenshu (B 23), Guanyuan enhance the therapeutic results.
(Ren 4), Dahe (K 12), Daimai (B 26), Fuliu Remark
(K 7). This disease covers infections in the
Explanation: Shenshu (I3 23), Guanyuan reproductive organs such as vaginitis,
(Ren 4), Dahe (K 12) and Daimai (I3 26), a cervicitis, endornetritis and anexitis, etc.
combination of adjacent and distal points,
are applied together to promote yang qi and
tonify the kidney so as to restore its storing
6. Morning Sickness
function, and stabilize the Ren and Dai
Meridians, and finally check leukorrhaga. Mor~ifigsickfieas is merked by a group of
Daimai (B 26) is selected aiming at symptoms including nausea, vomiting,
leukorrhagia. dizziness, anorexia within the first trimester
of gestation. It is a commonly seen disorder
c ) Damp heat:
Method: Mainly select points from the appearing in early stage of pregnancy.
Ren and Foot-Taiyin Meridians. Acupunc- Severe condition may emaciate the
ture with the reducing method is employed pregnanted woman very quickly and trigger
to clear heat, remove damp, adjust the Ren off other diseases.
Meridian and stabilize the Dai Meridian. The factors are due mostly to deficiency of
Prescription: Zhongji (Ren 3), Ciliao (B stomach qi, upward flux of the fetal qi
32), Sanyinjiao (Sp 6), Taichong (Eiv 3). invading the stomach, and perversive flow of
Supplementary points: stomach qi.
Itching in the vulva: Ligou (Liv 5). Etiology and Pathogenesis
Reddish leukorrhea: Xuehai (Sp 10). It is caused by constant deficiency of the
Excessive heat: Quchi (L 1 11). stomach qi, ceasation of menstruation after
Explanation: Zhongji (Wen 3) is the pregnancy and hyperfunction of the Chong
Front-(Mu) Point of the bladder. It works to Meridian, which further affect the
clear damp heat of the lower jiao when it is Yangming Meridian, leading to perversive
applied with the reducing method. Ciliao (I3 flowing of the feeble stomach qi together
32) clears heat and resolves damp to check with the qi in the Chong Meridian, hence
leukorrhagia. Sanyinjiao (Sp 6), an nausea and vomiting. In some cases, when
intersecting point of the three yin meridians the blood flows to nurture the fetus there
of foot tonifies the spleen, removes damp results in insufficient liver blood and
Chapter 18 Gynecological and Other Diseases

hyperactivity of liver yang accompanied by chest and hypochondrium, frequent belch-

weakened spleen and stomach, leading td ing and mental depression. Dizziness and
nausea and vomiting. eye distension are consequence of the
upward influx of the liver qi. The liver and
Differentiation gallbladder are interiorly-exteriorly related.
a) Deficiency in the spleen and stomach: When there is internal liver heat fire of the
Main manifestations: Nausea and gallbladder discharges, resulting in vomiting
vomiting of liquid or indigested food of bitter or sour liquid. Yellowish coating
immediately after meals, fullness and and string-taut slippery pulse are signs of
distending feeling in the chest, lassitude and disharmony between the liver and stomach.
sleepiness, pale tongue with white coating,
slippery and weak pulse during the first Treatment
trimester of pregnancy. a ) Deficiency in the spleen and stomach:
Analysis: Blood centred in the lower Method: Select points mainly from
abdomen after pregnancy, the qi of the the Foot-Yangming and Foot-Taiyin
Chong Meridian gushes upward and the Meridians. Acupuncture with the even
stomach qi is unable to descend due to the movement is applied to build up the spleen,
weakened spleen and stomach. The stomach harmonize the stomach and quell the
qi does not go downward, instead, upward perversive flowing of qi so as to check
with the qi of the Chong Meridian, causing vomiting.
nausea, anorexia and vomiting right after Prescription: Zhongwan (Ren 12),
intake of food. Weakened spleen and Shangwan (Rep 13), Neiguan (P 6), Zusanli
stomach leads to the insufficiency of yang qi (S 36), ~ o n g s u n(Sp 4).
in the middle jiao, manifested by fullness -Explanation: Zhongwan (Ren 12), the
and distension in the epigastrium, lassitude Coafluential Point of the fu organs and
and sleepiness, and vomiting of liquid. Bale Front-(Mu) Point of the stomach, functions
tongue with white coating and weak slippery to harmonize the stomach when adopted
pulse are signs of deficiency in the spleen and together with Shangwan (Ren 13). Zusanli
stomach after pregnancy. (S 36), the He-(Sea) Point of the Stomach
b ) Dislzarmony between the liver and MeridiBn, can tonify the spleen, harmonize
stomach: the stomach and quell the adversive flow of
Main manifestations: Vomiting of bitter the stomach qi. Gongsun (S 4) is the Luo-
or sour liquid, epigastric fullness and (Connecting) Point of the Spleen Meridian
hyperchondriac pain, frequent belching and as well as the Confluential Point linking the
sighing, mental depression, dizziness and eye Chong Meridian. When it is paired with
distension, yellowish tongue coating and Neiguan (P 6), it amplifies its function of
string-taut slippery pulse in the early stage of quelling the upward going of stomach qi and
gestation. checking vomiting. All the points grouped
Analysis: The stagnated liver qi travels together achieve the aim of tonifying the
adversely along the Liver Meridian via the spleen, harmonizing the stomach, descend-
stomach to diaphram, hypochondrium and ing the stomach qi and stopping vomiting.
chest, which causes nausea, vomiting, h ) Disharrnonj~ between the liver and
epigastric fullness, distending. pain in the stomach:
 Chinese Acupuncture and Moxibustion

Method: Select points chiefly from the Etiology and Pathogenesis

Foot-Yangming and Jueyin Meridians. a ) Deficiency of qi and blood:
Acupuncture with the even movement is Weak constitution with insufficient qi,
used to relieve liver stagnation and exhaustion through premature contraction,
harmonize the stomach so as to check premature amniorrhea, and depletion of
vomiting. blood due to hemorrhage, all lead to
Prescription: Tanzhong (Ken i 7j, Zhong- prolonged iaboiir. In LTi:iide~.jt~idIi~g sf
wan (Ren 12), Neiguan (P 6), Zusanli (S 36), Childbirth, it says, "Physical weakness and
Taichong (Liv 3). early exertion of force have exhausted the
Explanation: Since deficiency in the mother before the baby is delivered and thus
spleen and stomach and upward flow of liver the baby gets stuck. Dryness in the vagina
qi are significant to the disease, Zhongwan also brings about difficult delivery."
(Ren 12) and Zusanli (S 36) are used to b ) Qi stagnation and blood stasis:
tonify the spleen and harmonize the Fear or too much worry over the
stomach, Tanzhong (Ren 17) the Influential forthcoming delivery retards qi and
Point of qi, is to bring qi down. Neiguan (P stagnates blood. Extreme leisure during
6), Taichong (Liv 3) from the Jueyin gestation leads to impaired flow of qi and
Meridians are to sooth the liver, regulate the blood. Affection of external cold during
qi, counteract the abnormal upflow of qi and delivery hinders the circulation of qi and
check vomiting. blood. All of them are causative factors of
prolonged labour. just as Goiden Mirror of
Remarks - Medicine says, "Prolonged labour derives
a) Acupuncture should not be applied to from various factors such as seeking comfort
many points, nor with strong stimulation and ease and too much sleep, both of which
when the fetus is still young in the early stage lead to retarded flow of qi; or from fright
of gestation, lest the fetal qi should be and worry over the oncoming labour ... and
affected. obstruction of vagina by blood stasis from
b) It is appropriate to keep the patient in an injured uterus."
bed and away from raw, cold or greasy food.
In the hope of adjusting and replenishing the Differentiation
stomach qi, multiple meals with a little a ) Deficiency of qi and blood:
intake of food is advisable. Main manifestations: Dull and paroxzy-
smal labour pains with mild weighing and
distending sensation, or profuse hemor-
7. Prolonged Labour rhage in light colour, pale complexion,
(Appendix: Malposition of Fetus) lassitude, palpitation, shortness of breath,
pale tongue, weak pulse.
Analysis: Since both qi and blood are
Parturition lasting over twenty-four deficient and the puerperant is too weak to
hours is defined as prolonged labour. It is have uterus contraction, there are mild
often due to weak contraction and forceless abdominal pain, mild heavy and distending
contraction of the womb, or narrow pelvic sensation, and the delivery duration is
fetal and malposition of fetus. prolonged. Qi deficiency leads to profuse
 b

Chapter 18 Gynecological and Other Diseases

hemorrhage in light colour, pale com- reducing method to regulate qi and blood,
plexion, lassitude, palpitation, and short- activate qi so as to quicken the delivery.
ness of breath. Pale tongue and weak pulse Prescription: Hegu (L I 4), Sanyinjiao (Sp
are signs of deficiency of qi and blood. 6), Zhiyin (B 67).
b ) Qi stagnation and blood stasis: Explanation: Hegu (L I 4) is the Yuan-
Main manifestations: Sharp pains in the (Primary) Point of the Hand-Yangming
waist and abdomen, scanty hemorrhage in Meridian and Sanyinjiao (Sp 6) is an
dark red colour, prolonged delivery course, intersecting point of the three foot yin
dark bluish complexion, depressive mood, meridians. The two paired together may
fullness in the chest and epigastruim, regulate qi and blood, clear off stasis and
frequent nausea, dark tongue, deep forceful speed up the delivery. Zhiyin (B 67) is an
pulse. effective and empirical oxytocic point.
Analysis: The retarded circulation of qi Remarks
and blood gives rise to the sharp pain in the Acupuncture and moxibustion carry an
waist and abdomen and course of oxytocic effect to the prolonged labour due
delivery. The stagnated qi does not ascend as to weak uterine contraction.'Measures other
usual, bringing about the dark bluish than acupuncture and moxibustion should
complexion, fullness and distension in the be taken in case of prolonged labour caused
chest and epigastrium, and frequent nausea. by uterine deformity or contracted pelvis.
The dark tongue, deep and forceful pulse'
Appendix: Malposition of Fetus
indicate qi stagnation and blood stasis.
Malposition of fetus refers to the lying of
the fetus in uterus for thirty weeks after
Treatment
conception. It is usually seen in multipara or
a ) Deficiency of qi and blood:
Method: Points are chiefly chosen from those with lax abdominal wall. No
the Foot-Yangming and Foot-Taiyang symptoms are found in most cases. It is only
Meridians. Acupuncture is given with the made known by prenatal examination. The
.

reinforcing method with moxibustion to commonly seen are breech, transverse

tonify qi and blood, and quicken the position, etc.
delivery. Treatment
Prescription: Zusanli (S 36), Sanyinjiao Zhiyin (B 67) is selected.
(Sp 6), Zhiyin (B 67). Method: Moxibustion is applied to Zhiyin
Explanation: Zusanli (S 36) and (B 67) bilaterally for fifteen to twenty
Sanyinjiao (Sp 6) may generate qi and blood minutes while the pregnant woman sits in
and tonify the spleen and stomach, while chair or lies supinely in bed with the belt
Zhiyin (B 67) is an effective and empirical unclasped. Give the treatment once or twice
oxytocic point. The three points thus used every day till the fetal position is corrected.
together fulfil the set purpose of tonifying qi Zhiyin (B 67) is the Jing-(Well) Point of the
and blood and quickening the delivery. Foot-Taiyang Meridian, and an empirical
b ) Stagnation of qi and blood: point for fetal malposition. The reported
Method: Points are chiefly chosen from success rate is over 80%. It works more
- the Hand-Yangming and Foot-Taiying effectively in multiparae than primiparae.
Meridians. Acupuncture is given with the Moxibustion is much more widely adopted
 Chinese Acupuncture and Moxibustion

than acupuncture, the latter is sometimes meridians, and obstructed flow of milk,
served for the same purpose though. finally bringing on the insufficient lactation.
There are many causative factors of the The book The Literati's Care of Parents
fetal malpositisn, they should be examined goes, "Sobbing, crying, grief, anger,
carefully. Other measures should be taken if depression lead to obstruction of the milk
the malposition is resulted from such factors passage."
as contracted peivis, uterine deformity, etc. Differeratiation
a ) Deficiency of qi and blood:
8. Insaafficient Lactation Main manifestations: Hnsufficient secre-
(Appendix: Lactifuge Delactation) tion of milk after delivery or even absence of
milk, or decreasing secretion during
Insufficient lactation refers to the lactation period, no distending pain in the
common clinical symptom that milk breast, pale complexion, dry skin,
secretion of a nursing mother is insufficient palpitation, lassitude, poor appetite, loose
to feed the baby. In some cases there may stools, pale tongue with little coating, weak
even be no secretion of milk at all. Ancient and thready pulse.
people named it as lack of milk and halted Analysis: Because of the deficiency of qi
milk flow due to deficiency of qi and blood and blood, the weakened transforming
or to stagnation of the liver qi. It is clinically source of milk leads to scanty secretion
devided into deficiency and excess types. without distension in breasts. Hnsufficient qi
and blood makes pale face and dry skin.
Etiology and Pathogenesis Palpitation ensues on malnutrition of the
a ) Deficiency of qi and blood: heart and blood. Dysfunction of the spleen
Milk is transformed from qi and blood, and insufficiency of qi in the middle jiao give
the origin of which are nutrient substances rise to lassitude, poor appetite and loose
of food or the acquired essence. Either the stools. Pale tongue and weak thready pulse
weakness of the spleen and stomach or are signs of deficiency of both qi and blood.
profuse loss of qi and blood during delivery b ) Liver qi stagnation:
may effect the formation of milk. Zhang Main manifestations: Absence of milk
Jingyue in his book Observations of Women secretion after delivery, distending pain in
points out, "The qi and blood in women's breast, mental depression, chest distress and
Chong and Ren Meridians turn into menses hypochondriac pain, epigastric distension,
when it descends, and transform into milk loss of appetite, pink tongue and string-taut
when it ascends. The delayed or insufficient pulse.
secretion of milk after delivery is due to the Analysis: Liver carries out the dispersing
insufficiency of qi and blood. Those who function of qi. Mental depression after
have no milk secretion definitely suffer from delivery impairs liver qi, which obstructs the
the weakness of the Chong and Ren milk flow, leading to the distending pain in
Meridians.'' the breast, and hypochondriac pain.
b ) Liver qi stagnation: Disharmony of the stomach causes
It is caused by mental depression after epigastric distension and loss of appetite.
delivery impaired dispersing of the liver qi, String-taut pulse is another sign of stagnated
disorder of qi and blood, blockage of the liver qi .
Chapter 18 Gynecological and Other Diseases

Treatment of soup, and to apply correct nursing

Method: Mainly select the points from the method.
Foot-Yangming Meridian. Acupuncture is
given with reinforcing method and Appendix: kzhctifarge
rnoxibustion in case of deficiency of qi and Those who do not want to nurse the infant
blood to tonify the qi and blood so as to after delivery can check milk secretion by
promote lactic secretion. Acupuncture with acupunctufe.
either reducing or even movement or with Point selection: Zulinqi (B 41), Guang-
appropriate moxibustion in case of liver qi ming (B 37).
stagnation is to remove the stagnation of Ten-minute moxibustion is applied to
liver qi, free obstruction from the meridians each point after acupuncture. Treatment is
and promote secretion of milk. given once every day, three to five
Prescription: Rugen (S 28), Tanzhong treatments in the following day.
(Ren 17), Shaoze (S P 1).
Supplementary Points:
Deficiency of qi and blood: Pishu (B 20), 9. Prolapse of Uterus
Zusanli (S 36), Sanyinjiao (Sp 6).
Liver qi stagnation: Qimen (Liv 14), Prolapse of uterus refers to descent of the
Neiguan (P 6), Taichong (Liv 3). uterus into the vagina, or descent of the front
Explanation: Since breast is where Foot- wall of the vagina with the uterus. Usually it
Yangming Meridian passes and Rugen (S is the result of the sinking of inadequate qi,
28) is located on the Stomach Meridian of kidney qi deficiency, instable Chong and
Foot-Yangming at the breast, Rugen (S 28) Ren Meridians, and the loss of restriction by
is used here to restore the free flow of qi in Dai Meridian.
the Yangrning Meridian so as to promote
the lactic secretion. Tanzhong (Ren 17), the Etiology and Pathogenesis
Confluential Point of qi, serves to regulate qi Its occurrence is often due to insufficiency
and promotes the flow of milk. Shaoze (S I 1) of the qi in the middle jian caused by weak
is an effective and empirical lactogenic constitution, or early physical labour after
point. Pishu (I3 20), Zusanli (S 36) and delivery before qi and blood are fully
Sanyinjiao (Sp 6) are used to regulate and restored, or exhaustion in delivery, 'or
tonify spleen and stomach, promote the overstrain to counteract constipation, all of
transformation of milk from blood. Qimen which bring about sinking of qi, which fails
(Liv 14) and Taichong (Liv 3) are to remove to keep the uterus in position. Another cause
stagnation of liver qi. Neiguan (P 6) is added is frequent pregnancy and delivery, and
to regulate qi flow in the chest and restore indulgence in sexual life overconsuming the
the free flow of milk. kidney qi and incur the loss of restriction by
the Dai Meridian and weakened functioning
of the Chong and Ren Meridians, hence
Remarks prolapse of uterus.
While receiving acupuncture for insuffi-
cient lactation, the mother should also be Differentiation
advised to have nutrient diet, to take plenty a) Qi deficiency:
 Chinese Acupuncture and Moxibustion

Main manifestations: Drop of the uterus 6), Zhongwan (Ren 12), Zusanli (S 36),
in the vagina or out of the vulva several Guilai (S 29).
inches, sinking sensation in the lower Explanation: Baihui (Du 20) is located at
abdomen, lassitude, palpitation, shortness the vertex on the Du Meridian. Its selection
of breath, frequent urine, leukorrhagia, pale indicates to "use upper points for the lower
tongue with thin coating, weak pulse. disorders." Qihai (Ren 6) is selected to
Analysis: Since tine qi is too weak to qi so as strengthzn its sustaining
conduct its sustaining function of uterus, function. Zhongwan (Ren 12) and Zusanli
prolapse of uterus appears. It is relieved by (S 36) are used to build up the qi of the
lying down and aggravated by prolonged middle jiao. Guilai (S 29) is used as a local
standing, with a sinking sensation in the point to lift the uterus.
lower abdomen and frequent urine. The b ) Kidney deficiency:
weakened spleen and stomach lead to Method: Points are mainly selected from
lassitude. Malnutrition of heart results in the Ren and Foot-Shaoyin Meridians.
palpitation and shortness of breath. The Acupuncture is given with the reinforcing
downward going of pathogenic damp turns method and moxibustion to replenish the
to excessive leukorrhea. Pale tongue and kidney qi so as to keep the uterus in position.
weak pulse are signs of qi deficiency. Prescription: Guanyuan (Ren 4), Zigong
b) Kidney deficiency: (Extra), Ququan (Liv 8), Zhaohai (K 6).
Main manifestations: Prolapse of uterus, Explanation: Guanyuan (Ren 4) is a point
sore and weak low back and iegs, bearing coiieei-ning with t primary qi, and
sensation in the lower abdomen, dryness in functions to benefit kidney and lift the
the vagina, frequent urine, dizziness, uterus. Zigong (Extra) is an extra point
tinnitus, pink tongue, deep weak pulse. effective for prolapse of uterus. Ququan (Liv
Analysis: The kidney is located at the low 8) and Zhaohai (K 6) paired together can
back. With the kidney in deficiency, the tonify the kidney, nourish the tendons and
Chong and Ren Meridians become sustain the uterus.
weakened, and the Dai Meridian loses its
restricting function, thus there appear the Remarks
prolapse of uterus, frequent urine, sore and The patient should be advised to avoid
weak low back and legs. Dizziness, tinnitus overstrain when receiving acupuncture
and dry vagina derive from the insufficiency treatment. Rest can amplify the therapeutic
of essence and blood. Deep weak pulse and effect.
pink tongue are signs of kidney deficiency.

Treatment
a) Qi deficiency: 11. PEDIATRIC DISEASES
Method: Points are chiefly chosen from
the Ren and Foot-Yangming Meridians.
Acupuncture is applied with reinforcing I. Infantile Convulsion
method and moxibustion to replenish qi,
and restore the prolapsed uterus in place. Infantile convulsion is commonly seen in
.
Prescription: Baihui (Du 20), Qihai (Ren pediatrics, manifested by series of muscle
 Chapter 18 Gynecological and Other Diseases

contractions accompanied by impairment of 6) Chronic infantile convulsion:

consciousness. Its onset is gradual. In most cases it is
It can be brought about by various causes, associated with a deficiency condition, such
including invasion of seasonal pathogenic as persistent dysentery, severe vomiting and
factors, accumulation of internal phlegm- diarrhoea, or excessive administration of
heat, protracted vomiting and diarrhoea, purgatives cold or cool in nature that injures
deficiency condition of the spleen with the spleen and stomach, damaging the
hyperfunction of the liver. It occurs in any source of essential nutrients, and leading to
season, mostly in those aged from one to deficiency of blood which fails to nourish the
five. Since the onset may be either sudden or liver. As a result, the wind caused by the
gradual and the symptoms may show a condition of deficiency is stirred up
deficiency condition or an excess condition, internally, giving rise to convulsion. In
infantile convulsion can be classified into addition, the chronic infantile convulsion
"
two types: acute and chronic. can also be the result of the acute cases that
have not been treated properly.

Etiology and Pathogenesis Differentiation

a ) Acute infantile convulsion: a) Acute infantile convulsion:
i) Invasion of seasonal pathogenic factors: Main manifestations: Unconsiousness,
The skin and muslces of infants are frail, upward gazing, lockjaw, neck rigidity,
hence they are easily attacked by external opisthotonos, contracture of limbs, rapid
pathogenic wind, which turns into fire in the and string-taut pulse.
interior. Infants always have excess activity If fever, headache, cough, congested
of the liver, the heat therefore is liable to stir throat, thirst, and irritability are present, the
up liver wind, thus wind and fire bring about convulsion is due to the invasion of
the impairment of consciousness and exogenous pathogenic heat.
convulsion. The exogenous pathogenic heat If fever, anorexia, vomiting, abdominal
can also penetrate deep into the distention and pain, sputum gurgling in the
pericardium, or the body fluid is consumed throat, constipation or defecation with
I by heat and turned into phlegm which stinking smell are present, it is due to phlegm
blocks the mind, resulting in loss of heat.
consciousness and convulsion. If there is no fever, but cold limbs,
ii) Accumulation of phlegm fire: disturbed sleep or lethargy, crying and
Irregular food intake leads to stagnation fearing after waking, and intermittent
in the stomach and intestines, obstructing contraction of muscles, the convulsion is
the flow of qi and producing phlegm heat probably caused by sudden fright.
which turns into wind, hence the disease. Analysis: Invasion of pathogenic heat can
iii) Sudden fright: be transmitted internally to the pericardium,
Infants have weak mind with insufficient so the fever is accompanied with irritability
vital qi. Sudden seeing of strange things and or impaired consciousness. Since there is
hearing of strange sounds may disturb their constitutional excess of liver in infancy, the
qi and blood and stir their mind, causing pathogenic heat can induce the liver wind.
convulsion. With the help of the fire the liver wind stirs
 Chinese Acupuncture and Moxibustion

upwards, resulting in upward gazing, 14), Quchi (k I 1l), Twelve Jing-(Well)

lockjaw, and neck rigidity. Accumulation of Points (L 11, L 1 1 , H 9, S 1 1 , P 9, S J 1).
phlegm heat and turbid dampness in the Convulsion due to phlegm heat: Qimai (S
stomach and intestines obstructs the J 18), Zhongwan (Ren 12); Hegu (L 1 4),
circulation of qi, thus causing anorexia, Fenglong (S 40).
vomiting, abdominal distention and gain, Convulsion due to fright: Sishencong
and constipation. Fright h a m s the m i d , (Extr~),Lmgnng (P 8)j Vnlngquan (M 1).
hence there is crying with fear. Explanation: Yintang (Extra) has a
b ) Chronic infantile convulsion: sedative action, while Shuigou (Du 26) can
Main manifestations: Emaciation, pale regulate the Du Meridian and promote
complexion, lasssitude, lethargy with eyes resuscitation. Puncturing Taichong (Liv 3)
open, intermittent convulsion, cold limbs, with reducing method is to subdue the liver
loose stool containing undigested food, clear wind. An excess of pathogenic heat can be
and profuse urination, deep and weak pulse. brought down by puncturing Dazhui (Du
Analysis: Chronic illness damages the 14) and Quchi (E I 11). The application of
spleen and stomach, causing disorders in Twelve Jing-(Well) Points can eliminate the
digestion and transportation, thus there are heat from all the meridians. For those with
emaciation, pallor and lassitude. Insuffi- excessive phlegm heat, Zhongwan (Ren 12),
ciency of the source of essential nutrients Fenglong (S 40) and Hegu (L I 4) are used to
gives rise to the deficiency of yin and blood, regulate the spleen and stomach for
sc th2t the liver f d s to be no~rish~,d, 2nd removing the phlegm heat. Combination
consequently the wind caused by the with Qimai (S 9 18) clears away the heat from
condition of deficiency is stirring. Therefore, the Sanjiao Meridian to relieve convulsion.
the victim has lethargic sleep with open eyes Sishencong (Extra) has the action of
and intermittent convulsion. The kidney is tranquilization for those suffering from
also involved in a long-standing case. Yang fright. The supplementary points, Laogong
deficiency of the kidney and spleen is (P 8) and Yongquan (K l), are used to calm
manifested by loose stools with undigested down the mind and stop convulsion.
food, profuse and clear urination, cold limbs b) Chronic infantile convulsion:
and deep forceless pulse. Method: Points of Ren and Du Meridians
are selected as the principal points. The
Treatment reinforcing method and moxibustion are
a ) Acute infantile convulsion: applied to adjust yin and yang for sedation
Method: Points of the Du Meridian and and relief of convulsion.
the Liver Meridian of Foot Jueyin, are Prescription: Baihui (Du 20), Shenting
selected as the principal points. The (Du 24), Guanyuan (Ren 4), Sanyinjiao (Sp
reducing method is applied to promote the 6), Zusanli (S 36).
restoration of consciousness, eliminate heat Supplementary points:
and suppress wind. Yang deficiency of the spleen and kidney:
Prescription: Yintang (Extra), Shuigou Pishu (B 20), Shenshu (B 23), Zhongwan
(Du 26), Taichsng (Liv 3). (Ren 12).
Supplementary points: Deficiency of blood: Taichong (Liv 3),
Invasion of pathogenic heat: Dazhui (Du Rangu (K 2).
Chapter 18 Gynecological and Other Diseases 467

Explanation: Since chronic infantile invasion of exogenous pathogenic factors or

convulsion is due to the condition of internal injury of milk and food. It may
deficiency, Baihui (Du 20) and Shenting (Du occur in any season, but more frequently in
24) are used for tranquilization, and summer and autumn.
Guanyuan (Ren 4), Sanyinjiao (Sp 6) and
Zusanli (S 36) to reinforce body resistance Etiology and Pathogenesis
and alleviate convulsion. Application of , The weak spleen and stomach of childern
Pishu (B 20) and Zhongwan (Ren 12) builds are apt to be injured by irregular diet,
up the spleen and stomach and strengthens contaminated food, or improper attending.
the source of essential nutrients. Shenshu (B Dysfunction of the spleen and stomach i n
23) is combined with the above points to transportation and transformation leads to
reinforce the kidney and invigorate the yang indigestion. The undigested food and,water
in order to dispel the cold. Taichong (Liv 3) can not be separated but go together into the
and Rangu (K 2) nourish yin and blood to large intestine. This accounts for the
subdue the wind and stop convulsions. diarrhoea. It says in Chapter 43 of PIain
Questions, "Overintake of milk and food
Remarks will harm the intestines and the stomach."
a) Acute infantile convulsion is involved Therefore, internal damage by food is an
in the infections of the central nervous important factor of diarrhoea. Since the
system and toxic encephalopathies, e.g. zang-fu organs of infants are delicate, the
epidemic cerebrospinal meningitis and attack of exogenous pathogenic factors can
pneumonia with toxemia. Acupuncture has also give rise to impairment of transporta-
a certain antipyretic and antispasmotic tion and transformation function of the
effect. However, it is necessary to make the spleen and stomach, and hence diarrhoea.
diagnosis timely and adopt a comprehensive
treatment. Differentiation
b) Chronic infantile convulsion is mostly Main manifestations: Abdominal disten-
caused by long duration of vomiting and sion is accompanied by borborygmi and
diarrhoea, metabolic disorders, mal- frequent fits of pain. The fit of pain is
nutrition and chronic infections of the followed by bowel movements, and the pain
central nervous system, or transmitted from will be relieved after defecation.
acute convulsion. So the comprehensive There are several times of defecation a day
treatment should also be adopted. with sour and putrid feces. The diarrhoea
caused by overfeeding is marked by presence
of undigested milk and food in the fecal
2. Infantile ~iarrhoea discharge, frequent eructation, anorexia,
sticky tongue coating, rolling and full pulse.
Infantile diarrhoea is a common disease in In diarrhoea caused by damp heat, there are
pediatrics, characterized by disharmony of loose stools with yellow colour and offensive
the spleen and stomach with frequent bowl .smell, abdominal pain, fever and thirst,
movements, and loose or watery feces. Since burning sensation at the anus, scanty and
the children's spleen and stomach are weak, dark urine, yellow and stick tongue coating,
this disease is easily caused by either rolling and rapid pulse.
 Chinese Acupuncture and Moxibustion

Analysis: Undigested milk or food Analysis: Tianshu (S 25) is a point of the

accumulated in the intestines and the Stomach Meridian of Foot Yangming, and
stomach causes abdominal distension with also the Front-(Mu) Point of the large
borborygmi and frequent attacks of pain intestine, while Shangjuxu (S 37) is the
with the desire of emptying the bowels. The Lower He-(Sea) Point of the large intestine.
pain is relieved after defecation as the food The combination of these two points can
I " .
s i a g ~ ~ iisi ~S ~G i ~ ~ Y Eremeved.
L ~ ~ Stagna- regulate the intestines and check diarrhoea.
tion of food leads to putrefaction, making Sifeng (Extra) can promote digestion to
the feces sour and putrid. The weakened remove the stagnation, and strengthen
spleen and stomach fail to digest food, hence transportation to stop diarrhoea. If the
there is undigested milk or food in the feces. diarrhoea is due to overfeeding, Jianli (Ren
The putrid turbidity may ascend, so there is 11) and Qihai (Ren 6) are combined in order
frequent eructation. Dysfunction of the to remove the stagnation of food, alleviate
spleen and stomach in transportation and abdominal distension and fullness, and
transformation gives rise to anorexia. The reinforce the spleen and stomach. If the
sticky tongue coating and rolling pulse are diarrhoea is caused by damp heat, Quchi (L I
both the signs of food retention. 11) Hegu (L I 4) are used to clear away the
The pathogenic damp heat accumulated heat, and Yinlingquan (Sp 9) to eliminate
in the stomach and the intestines causes dampness and check diarrhoea.
I impairment of transportation. When the
damp heat flows clownwzrd, there are Ieese Remarks
stools with yellow colour and offensive a) Attention should be paid to severe
smell, and abdominal pain. Accumulation diarrhoea which may lead to the critical
of damp heat in the stomach and intestines condition of the damage of both yin and
brings on fever and thirst. Burning sensation yang, collapse of qi and exhaustion of yin.
at the anus and scanty dark urine are also b) The diet should be restricted and a light
due to the downward flow of damp heat. diet of small quantity is preferable.
Yellow sticky tongue coating and rolling
rapid pulse are signs of damp heat.

Treatment
Method: Points of Foot Yangming Infantile malnutrition is characterized by
Meridian are mainly recommended with in- emaciation, sparse hair, distended belly with
and-out puncturing to adjust the spleen and outstanding blue veins, loss of appetite, and
stomach, eliminate damp heat and stop listlessness.
diarrhoea. The cardinal causes of this disease are
Prescription: Tianshu (S 25), Shangjuxu irregular intake of food, improper nursing,
(S 37), Sifeng (Extra). parasitosis, and general debility due to a
Supplementary points: chronic illness which injures the spleen and
Diarrhoea due to overfeeding :Jianli (Ren stomach.
1l), Qihai (Ren 6).
Diarrhoea due to damp heat: Quchi (L I Etiology and Pathogenesis
1I), Hegu (L 1 4), Yinlingquan (Sp 9). Irregular intake of food may impair the
Chapter 18 ~ ~ n e c o l o ~ iand
c a lOther Diseases

spleen and stomach. It is important to feed Analysis: Long retention of undigeste-d

the children regularly with suitable food. food or milk causes production of heat, so
Irregular food intake with indulgent there is slight fever or tidal fever in the
ingestion of greasy, sweet, raw and cold food afternoon and crying with irritability. When
usually leads to retention of undigested the spleen fails in transportation, the damp
food. Long-standing food retention heat is liable to be accumulated, hence there
damages the spleen and stomach, so that the are loose bowel movements with offensive
refined nutrient from food and milk fails to odour, rice-water-like urine, dryness of the
be transported. Thus the qi and blood in mouth and abdominal distension. Impair-
zang-fu organs are lack of nourishment, ment of the spleen and stomach results in
resulting in malnutrition and emaciation anorexia and the long time stagnation causes
with insufficiency of qi and fluid. potbelly and protruding umbilicus. The
Malnutrition may also be due to improper impaired spleen and stomach fail to digest
feeding or feeding with indigestible food food and transport the refined nutrients to
which in the long run will bring on nourish zang-fu organs, qi and blood, skin,
emaciation, deficiency of qi and fluid, and muscles and hair. This is manifested by
retardation of development. In addition, sallow complexion, emaciation, scaly dry
improper nursing after a chronic disease or skin and sparse hair. The grimy and sticky
parasitosis may also impair the functions of tongue coating reveals the internal retention
the spleen and stomach and consumes body of food, while the complete loss of coating
fluid. Thus food can not be digested, and demonstrates exhaustion of body fluid.
stagnancy of undigested food will lead to Weak pulse indicates impairment of the
transformation into heat and ultimately to spleen and stomach. Parasites in the
malnutrition. abdomen disturb the stomach and
intestines, resulting in abnormality of food
Differentiation ingestion and craving for unnatural food.
Main manifestations: Gradual onset of
slight fever or tidal fever in the aft~rnoon, Treatment
dryness of the mouth, abdominal distension, Method: Points of Foot Taiying and Foot
diarrhoea with offensive odour, rice-water- Yangming Meridians are selected to
like urine, crying with irritability, and reinforce the spleen and remove the
anorexia. Then, distended belly with stagnation. Superficial pricking with
protruding umbilicus due to internal filiform needles is applied and the needles
stagnation, sallow complexion, emaciation, are not retained.
scaly and dry skin, sparse hair, dirty and Prescription: Xiawan (Ren 1O), Weishu (B
sticky coating of the tongue, or complete 21), Pishu (B 20), Zusanli (S 36), Sifeng
loss of coating, and weak pulse. The above (Extra), Taibai (Sp 3).
symptoms are related to deficiency of the Supplementary points:
spleen and stomach. If there is abnormal Baichongwo (Extra) for parasitosis.
intake of food with irregular hunger or Analysis: Infantile malnutrition is after all
satiety, or craving for unnatural articles of due to dysfunction of the spleen and
food, the malnutrition is probably due to stomach in transportation and transform-
parasitosis. ation. If the spleen and stomach are active in
 Chinese Acupuncture and Moxibustion

function, the food stagnation can be stage of this disease there are flaccidity of
removed and the source of essential tendons, atrophy of muscules and deformity
nutrients can be regained. So Xiawan (Ren of bones.
10) is applied to harmonize'the stomach and
eliminate heat. Zusanli (S 36), the Lower Me- Differentiation
(Sea) Point of the stomach, is used to build Main manifestations: Paralysis may occur
up earth and to replenish the qi in the middle in any part of the body, especially in the
jiao. Taibai (Sp 3), the Shu-(Stream) Point of lower limb with'weakness of the muscles and
the Spleen Meridian, is employed to cold skin. Paralysis of the abdominal
reinforce the spleen and remove the muscles is revealed by bulging of the
stagnation. Sifeng (Extra) is an extra point abdomen during crying. In a chronic case
beneficial for treating infantile malnutrition. there is muscular atrophy of the affected
Application of Pishu (B 20) and Shenshu (B part with deformity of the trunk, and the
23) can invigorate the qi of spleen and paralysis is intractable.
stomach and restore their function of Analysis: All the limbs and the skeleton of
transportation and transformation. Bai- the human body rely on the nourishment of
chongwo (Extra) is a special point to treat qi and blood that circulate in the meridians
- parasitosis. and collaterals. When the pathogenic factors
attack the meridians and collaierals, ying
(nutrient qi) and wei (defensive qi), qi and
4. Infantile Paaalysis blood lose their normal flow, and tendons,
vessels and muscles fail to be nourished.
Infantile paralysis is in the range of "wei Therefore, the limb becomes paralytic and
syndrome." What is stated here is the the skin cold. Long standing of the disease
sequellae of poliomyelitis. The causative not only leads to muscular atrophy by
factor of this disease is the invasion of impaired qi and blood supply, but also
epidemic pathogenic factors, which injure exhausts the essence and blood, and affects
the meridians. the liver and kidney. The liver dominates
tendons while the kidney is in charge of
Etiology and Pathogenesis bones, so the injury of the lives and kidney
This disease is mainly due t,o invasion of causes poor nourishment of the tendons and
pathogenic wind, dampness and heat. These bones. As the result, the tendons become
epidemic pathogenic factors invading the flaccid while the bones deformed, and the
lung and stomach through the mouth and paralysis is intractable.
nose, accumulate and turn into heat which
gets into and obstructs the meridians. Treatment
Consequently qi and blood fail to circulate Method: Points of Hand and Foot
normally to nourish tendons, vessels and Yangming Meridians are selected as the
muscles, hence there is paralysis of the limbs. principal points to regulate the circulation of
Long-lasting illness will lead to deficiency of qi in the meridians so as to nourish the
essence and blood and affect the liver and tendons and bones. The methods of
kidney, so the tendons and muscles are reducing, reinforcing and even movement
withered. This is the reason why in the later can be adopted in different cases. Points of
Chapter 18 Gynecological and Other Diseases

diseased side are punctured usually, but in a 26), Sanyinjiao (Sp 9), Kunlun (B 60), are all
long course of treatment, the healthy side local points to remove the obstruction of
and the affected side of the body can be meridians for a smooth flow of qi. Wuatuo-
needled alternatively. jiaji points, the extra points with the action
Prescription: of adjusting the functions of the zang-fu
Paralysis of the upper limb: organs and removing the obstruction of
Jianyu (L I 15), Quchi (L I 1I), Hegu meridians, are also used as the local points.
(L 1 4), Waiguan (S J 5), Dazhui (Du 14),
Tianzhu (B 10). Remarks
Paralysis of the lower limb: This disease should be treated as early as
Biguan (S 3 I), Zhusanli (S 36), Jiexi (S 41), possible, in combination with the functional
Huantiao (G 30), Yanglingquan (G 34), exercises for strengthening the therapeutic
Xuanzhong ( 39), Sanyinjiao (Sp 6), effect.
Kunlun (B 60), Muatuojiaji points at the
lumbar region (0.5 cun lateral to the lumbar
vertebrae from the first to the fifth). 5. Mumps
Paralysis of abdominal muscles:
Eiangmen (S 21), Tianshu (S 25), Daimai Mumps is an acute infectious disease
(G 26), Guanyuan (Ren 4). characterized by painful swelling in the
Supplementary points: parotid region, caused by epidemic wind
Contracted knee: Yinshi (S 33). heat. It happens in all the seasons of a year,
Reverse flexion of knee: Chengfu (B 36), but mostly in winter and spring. It is more
Weizhong (B 40), Chengshan (B 57). frequently seen among preschool children,
Inversion of foot: Fengshi (G 31), but seldom in those under two years.
Shenmai (B 62), Qiuxu (B 40).
Eversion of foot: Zhaohai (K 6), Taixi Etiology and Pathogenesis
(K 3). Mumps is mainly due to invasion of the
Difficult intorsion and extorsion of hand: epidemic pathogen which enters the body
Yangchi (S J 4), Yangxi (L I 5), Houxi (S I 3), via the mouth and nose. Together with
Sidu (S 9 9), Shaohai (H 3). phlegm fire it obstructs the collaterals of
Drop of wrist: Sidu (S J 9), Waiguan Shaoyang Meridians, causing abnormal
(S .J 5). circulation of qi and blood and bringing on
Analysis: This prescription follows the pain and swelling in the parotid region,
principle in internal classic that "only select probably associated with chills and fever.
the points of Yangming Meridians for the
treatment of paralysis" Yanglingquan (G Differentiation
34), the Influential Point of tendons, and Main manifestations: At the onset there
Xuarizhong (G 39), the Influential Point of are chills and fever, redness, pain and
bones, are used to enhance the function of swelling in unilateral or bilateral parotid
nourishing the tendons and bones. Other regions, and dysmasesia. When the
points such as Dazhui ( n u 14), Tianzhu (B pathogenic heat is intense, the redness, pain
lo), Waiguan (S 9 51, Huantiao (G 30), and swelling in the parotid region are more
Eiangmen (S 21), Tianshu (S 25), Daimai (G marked, and there are pain and swelling of
 Chinese Acupuncture and Moxibustion

the testis, high fever with irritability, dryness (S J 17), the meeting point of Hand and Foot
of the mouth and constipation, dark urine, Shaoyang Meridians, is used to resolve the
yellow tongue coating, and superficial and local stagnation of qi and blood. Since the
rapid pulse. Hand Yangming Meridian travels up to the
Analysis: Since the disease is caused by face, Jiache (S 6), Quchi (L I I 1) and Hegu (L
exogenous attack of the epidemic patho- 1 4) are applied to eliminate the pathogenic
genic heat, there is the exterior syndrome of heat. YVaiguan (S j 5j, the meeting point of
chills and fever at the beginning. Hand Shaoyang Meridian and Yangwei
Agglomeration of the pathogenic heat in the Meridian, is employed in combination with
Shaoyang collaterals results in the redness, the points from Yangming Meridian, to
pain and swelling in the parotid region, and expel the wind, dissipate the agglomeration,
dysmasesia. If the pathogenic heat is intense, and clear away the pathogenic heat. Lieque
it will consume the fluid of the Yangming (L 7) is combined to disperse wind and
collaterals, resulting in dryness of the alleviate the exterior symptoms for those
mouth, constipation, dark urine, etc. The suffering from chills and fever. Dazhui (Du
Shaoyang Meridians are interiorly- 14) and Twelve Jing-(Well) Points are used
exteriorly related with the Jueyin Meridians to bring down the high fever. Taichong (Liv
and the Foot Jueyin Meridian winds around 3) and Ququan (Liv 8) regain the normal
the genital organs, so when the pathogenic circulation of qi in Foot Jueyin Meridian for
factor is transmitted internally to the Jueyin those with the pain and swelling of testis.
Meridian, there are redness, sweiiing and Remasks
pain of the testis. Yellow tongue coating and a) Mumps is also called epidemic
superficial rapid pulse are signs of invasion parotitis. Acupuncture and rnoxibustion
of pathogenic heat. provides satisfactory effect.
b) Moxibustion with Medulla Junci.
Treatment
Point: Jiaosun (S J 20)
Method: Points of Shaoyang and Method: Two pieces of rush pith soaked
Yangming Meridians are mainly re-
with vegetable oil are ignited and aimed at
commended. The superficial puncturing
the point Jiaosun (S J 20). Remove them
with reducing method is adopted to expel quickly as soon as there is a sound of
wind and heat and remove the
burning of the skin. Usually the swelling will
agglomeration.
subside after one treatment. The treatment
Prescription: Jiache (S 6), Yifeng (S J 17),
can be repeated the next day if the swelling is
Waiguan (S J 5), Quchi (LI l 1), Hegu (L 14).
not completely gone.
Supplementary points:
Chills and fever: Lieque (L 7).
High fever: Dazhui (Du 14), Twelve Jing- 111. EXTERNAL DISEASES
(Well)Points(L 11, L I 1,P9, S J 1 , H 9 , S I
1).
Swelling and pain of testis: Taichong (Liv I. Urticaria
3), Ququan (Liv 8).
Analysis: Mumps is located in the area Urticaria is commonly seen in clinic. It is
pertaining to Shaoyang Meridians. Yifeng an eruption of the skin characterized by
Chapter 18 Gynecological and Other Diseases

transitory, flat-topped wheals which look the following types according to clinical
like measles or are as large as broad beans. It symptoms:
is apt to appear after exposure to wind, so a ) Wind heat:
traditional Chinese medicine terms it "wind Main manifestations: Red rashes with
wheal." Because it comes and goes, it is also severe itching, superficial and rapid pulse.
named "hidden rash." In some cases it may Analysis: Red colour indicates heat;
repeatedlyoccur and have not been cured for itching is caused by wind. Superficial and
months or years. rapid pulse is a sign of wind heat.
Its etiology and symptoms are described b ) Wind damp:
clearly in ancient literature, e.g. in the book Main manifestations: White or light red
of Synopsized Prescriptions of Golden rashes accompanied by heaviness of the
Chamber it says, "If the pathogenic qi body, superficial and slow pulse, white and
attacks the meridians, hidden rash with sticky tongue coating.
itching would appear." Analysis: White or light red rashes and
heaviness of the body indicate stagnation of
Etiology and Pathogenesis wind damp in the skin and muscles. White
a) It is due to stagnation of dampness in sticky tongue coating and superficial slow
the skin and muscles which are again pulse are signs of wind damp.
attacked by wind heat or wind cold. The c ) Accumulation of heat in the stomach and
confrontation against dampness is going on intestines:
between the skin and muscles, so there Main manifestations: Red rashes com-
appears wind wheal. plicated by abdominal or epigastric pain,
b) It may be caused by accumulated heat constipation or diarrhoea, thin yellow
in the stomach and intestines with further tongue coating and rapid pulse.
attack of the pathogenic wind which could Analysis: Red colour shows heat.
neither be dispersed from the interior nor Epigastric and abdominal pain with
removed from the exterior. So pathogenic constipation suggests accumulated heat in
wind heat stays between the skin and the stomach and intestines, which causes the
muscles, and results in wind wheal. obstruction of qi in the fu organs. Rapid
c) It may also be due to intestinal pulse and yellow tongue coating indicate
parasitosis such as ascariasis, ancy- existence of interior heat.
lostomiasis, fasciolopsis, etc, or due to
intake of fish, shrimp or crab leading to Treatment
dysharmony of the spleen and stomach with Method: The reducing method is applied
accumulation of damp heat in the skin and to disperse wind damp and eliminate heat in
muscles. the blood. Points of the Spleen and Large
Intestine Meridians are selected as the
Differentiation principal points. Tapping on the diseased
Abrupt onset with itching wheals of area with a "plum-blossom" needle is ,

various size or with pimples rising one after advisable.

another. It might be aggravated or lessened Prescription: Quchi (L I 11), Hegu (L I 4),
by the changing of weather. Acute Weizhong (B 40), Xuehai (Sp lo), Sanyinjiao
conditions subside quickly. It is divi'ded into (SP 6).
 Chinese Acupuncture and Moxibustion

Supplementary points: head is mostly evoked by wind heat, that in

Wind heat: Dazhui (Du 14). the hypochondriac, lumbar and hip regions
Wind damp: Yinlingquan (Sp 9). is usually caused by liver fire, that on the leg
Accumulated heat in the stomach and by damp heat, and in new-born babies by
intestine: Tianshu (S 25), Zusanli (S 36). internal heat.
Explanation: Wind rash is mainly caused
by stagnation of the pathogenic wind, heat Din"feaeni;iation
or damp in the skin and muscles or due to Main manifestations: Rapid onset of a
'accumulated damp heat in the stomach and well demarcated patch of redness, hotness
intestine, so points Quchi (L 1 11) and Hegu and burning pain, rapidly extending in size;
(L I 4) of Mand-Yangming Meridian are change in colour of the patch from bright red
used to disperse the pathogenic factors from to dull red in several days and then healing
the skin and muscles. Xuehai (Sp 10) and with desquamation. If accompanied by
Weizhong (B 40) are combined with the chills, fever, acute headache, red tongue
former points to eliminate heat in the blood, proper with thin yellow coating, and
Sanyinjiao (Sp 6) is to remove dampness, superficial rapid pulse, it is a wind heat
Dazhui (Du 14), the point where all the yang syndrome. If accompanied by fever,
meridian meet, is used to reduce heat, and irritability, thirst, stuffy sensation in the
Yinlingquan (Sp 9) removes damp. The chest, poor appetite, constipation, dark
reducing method applied to Tianshu (S 25) urine, yellow sticky tongue coating, soft and
and Zusanii (S 36) is to dredge the rapid pulse, it is a damp lieat syncli-cjme.
accumulated heat from the stomach and High fever, vomiting, delirium and
intestines. convulsion indicate invasion of the
pathogenic factors into the interior of the
body.
2. Erysipelas (Appmdir: Herpes Zoster) Analysis: Erysipelas is caused by invasion
of exogenous wind heat or damp heat from
Erysipelas is an acute contagious the stomach and intestines into the blood,
infectious skin disease characterized by skin and muscles. Therefore the affected
sudden onset of chills, fever, local redness skin is red and 'painful. If it is caused by
and swelling which may take place on any exogenous wind heat stagnating in the skin
site of the body and rapidly extend. and muscles, there are chills and fever. If it is
caused by damp heat in the stomach and
Etiology and Pathogenesis intestines, there are high fever, thirst, stuffy
Erysipelas is mostly due to accumulated sensation in the chest, poor appetite,
damp 'heat in the spleen and stomach constipation and dark urine. When the
flowing downward to the leg; or due to pathogenic factor penetrates into the
obstruction of qi and blood in meridians pericardium, delirium and convulsion occur.
caused by pathogenic wind and toxic heat.
Therefore the pathogenic heat infects the Treatment
blood, and then the skin and muscles. Or it is Method: Points of the Yangming
due to invasion of toxin into the wound in Meridian are selected as the principal points.
the skin. The erysipelas arising in face and The reducing method is applied to eliminate
Chapter 18 Gynecological and Other Diseases

heat and relieve toxin, or prick the points to and gallbladder or affection of exogenous
bleed. toxin. At the onset there is stabbing pain of
Prescription: Quchi(L I 1I), Hegu (L I 4), the affected skin, which soon becomes
Quze (P 3), Weizhong (B 40), Xuehai (Sp erythematous. Patches of blisters in the size
lo), Ashi points. of mump-beans or soybeans are evolved,
Supplementary points: forming a bandlike distribution with
Wind heat: Fengchi (G 20). clearcut interspaces between the patches.
Damp heat: Zusanli (S 36), Yinlingquan The blisters are thick-walled and their
(SP 9). contents are transparent at first, but turn
Fever: Dazhui (Du 14). turbid in five to six days. Resolution of the
Pathogenic toxin attacking the interior: cutaneous lesions after decrustation without
Twelve Jing-(Well) points (L 11, L I 1, P 9, S scar formation occurs in about ten days. In
J 1, H 9, S I I), Laogong (P 8). some cases pain lasts longer.
Constipation: Zhigou (S J 6). Treatment
Explanation: Quchi (L I 11) and Hegu (L I
Firstly, the head and the tail of the
4) disperse wind heat from the Yangming
location of herpes zoster should be
Meridians. Reducing Xuehai (Sp 10) and
distinguished. The area where the skin
bloodletting of Weizhong (B 40), Quze (kI
1e;ions first appeared is considered as the
1I) and Ashi points are to clear off heat from
tail, while the extending part of herpes as the
the blood, i.e. "eliminating the accumulted
head of its locality. Prick the skin around
heat by reducing method." The reducing
herpes zoster with a three-edged needle to
method used to Zusanli (S 36) and
cause a little bleeding: five pricks at 0.5 cun
Yinlingquan (Sp 9) is to dispel damp heat.
from the head of the herpes zoster area and
Pricking the twelve Jing-(Well) points to
then five pricks at 0.5 cun from the tail, and
cause bleeding and reducing Laogong (P 8)
also several pricks along both sides. Then
are to expel heat from the skin and heart.
select Quchi (L I 1I), Xuehai (Sp lo),
Reducing Dazhui (Du 14) and Fengchi (C
Weizhong (B 40), Yanglingquan (G 34),
20) remove the pathogenic heat and relieve
Taichong (Eiv 3).
exterior symptoms. Zhigou (S J 6) is used for
Explanation: Pricking the skin around
constipation by removing heat.
herpes zoster with a three-edged needle to
Remasks cause bleeding is to reduce the pathogenic
Strict sterilization is necessary to avoid toxin. Quchi (L I 11) dispels wind and clears
infection. If ulcer occurs due to mixed off heat. Xuehai (Sp 10) and Weizhong (B
infection, or if there is septicaemia or 40) eliminate heat in the blood.
' pyemia, comprehensive treatment should be
Yanglingquan (G 34) and Taichong (Liv 3)
applied. reduce damp heat from the liver and
Appendix: Herpes Zoster gallbladder.
Herpes zoster occurs mainly in the lumbar
and hypochondriac regions with small red 3. Boil and '6Red-TBhaead
vesicles like beads forming a girdle around
the waist. It is mostly caused by endogenous Boil frequently occurs on the face, head
damp heat, hyperactivity of fire in the liver and extremities. It has different names
 Chinese Acupuncture and Moxibustion

according to its location and form, e.g. portion of the body, there are chills and
"philtrum boil" if it is located at the median fever. Toxicity and heat travel along the
line of the upper lip, "snake-head boil" if it vessels and bring about a red thread-like line
occurs at the finger tip which looks like the extending proximally. High fever, restless-
head of a snake, "red-thread boil" if there is ness and impairment 'of consciousness are
a red line extending outward from the boil. due to invasion of the pathogenic heat and
L-U_-I
A -:AT- .
X I L I L ~ iilio the pei-ieardiiim. Rcddciicd
Etiology and Pathogenesis tongue with yellow coating and rapid pulse
Boil is usually caused by fatty and spicy are signs of toxic heat.
food or contamination of the skin. The
former may lead to accumulation of heat in Treatment
zang-fu organs and $hen production of Method: Points of the Du and Hand-
endogenous toxicity. The latter may result in Yangming Meridians are selected as the
invasion of the exogenous toxic factor and principal points. The reducing method or
stagnation of qi and blood. It would be pricking with a three-edged needle to cause
dangerous if the pathogenic toxic factor is bleeding is used. For red-thread boil, prick
transmitted into the meridians and the zang- with a three-edged needle to cause bleeding
fu organs. at two-inch intervals along the red line
proximally towards the focus.
Differentiatiow Prescription: Lingtai (Du 10), Shenzhu
l ---
n -a :r - - --
1llallifestatio11~:
4

Boil on the head, pii ;2j, "'- ; 4), Meg.; (L I 41,

~ l l ~ l e i(P
face or extremity first appears like a grain of Weizhong (I3 40).
millet in yellow or purple colour. A blister or Supplementary points:
pustula with a hard base iseformed,usually Points may be selected along the
accompanied by tingling. Later there is meridians related to the location of the boil,
increased redness, swelling and pain with e.g. boil on the face: Shangyang (6, I I),
burning sensation, often accompanied by Quchi (L I 11); on the tip of fingers: Quchi (L
chills and fever. Sometimes a red thread-like 1 11), Yingxiang (L I 20); on temporal
line extends proximally if the boil toxicity region: Yanglingquan (G 3 9 , Zuqiaoyin (G
attacks the interior, there will be high fever, 44); and on the fourth or fifth toe:
restlessness, dizziness, vomiting, impaired Yanglingquan (G 34), Tinghui (G 2).
consciousness, reddened tongue with yellow Explanation: Lingtai (Du 10) is an
coating, and rapid pulse, indicating that the empirical point for the treatment of boil.
toxicity is deeply rooted. Shenzhu (Du 12) readjusts the qi of all the
Analysis: When the toxic heat stays in the yang meridians in order to disperse heat.
skin and muscles and drops into the Ximen (P 4), the Xi-(Cleft) Point of the
meridians, resulting in stagnation of qi and Pericardium Meridian is effective for
blood, a swollen induration is formed. Since eliminating heat in the blood and stopping
the stagnation is not severe, there is only pain, and Hegu (L I 4) for removing the
mild tingling. Further accumulation of heat exogenous pathogenic factors from the
and toxicity causes aggravation of redness, exterior of the body. Weizhong (B 40) is
swelling and burning pain. Since the effective for clearing away toxin from the
pathogenic factors are in the exterior blood. These points used together act on
Chapter 18 Gynecological and Other Diseases

relieving toxicity and dispersing heat. fever, headache, nausea, and dire thirst.
Pricking the points to cause bleeding expels Growing of the lump with local bright
toxin and heat from the blood. Points redness and intermit tent throbbing pain
combined with the main ones are used to indicates suppuration.
remove the obstruction of qi and blood of Analysis: Since the stagnated liver qi and
the local meridians. The selection of points obstructed lactation lead to producion of
along the meridians related to diseased area heat, there occurs redness, swelling, and pain
is based upon the following theory: "The of the breast with difficult lactation. The
therapeutic effect will reach where the confrontation between the exogenous
meridian is opened up." pathogenic factors and the body resistance
causes chills, fever and headache. The
Remarks pathogenic heat in the stomach disturbs the
Another effective method for treating boil descending of the stomach qi, manifested by
is to prick and tilt with a three-edged needle nausea and dire thirst. Unrelieved
into small papules found alongside the stagnation of milk may produce heat.
thoracic vertebrae. Treatment is given once "Extreme heat causes putrid muscle, and
a day. pus follows." So there is growing of the lump
in the breast with bright redness, burning
and intermittent throbbing pain.
4. Breast Albscess
Treatment
Breast abscess is an acute purulent Method: The reducing method is applied
disorder of the breast mostly found in to regulate the qi of the Liver and Stomach
lactation period after delivery. It is rare in Meridians, remove stagnation and disperse
the duration of pregnancy. heat. Points of Foot-Jueyin, Foot-Shaoyang
and Foot-Yangming Meridians are selected
Etiology and Pathogenesis as the principal points.
It is caused by retention of milk in the Prescription: Jianjing (G 2 I), Tanzhong
breast due to mental depression affecting the (Ren 17), Rugen (S 18), Shaoze (S 1 l),
qi of the liver or due to overtaking of fatty Zusanli (S 36), Taichong (Liv 3).
food that brings about stagnation of heat in Supplementary points:
the Stomach Maridian or due to obstruction Chills and fever: Hegu (L I 4), Waiguan
of the milk duct after invasion of exogenous (S J 5).
toxic fire into the breast through the rupture Distension and pain in the breast; Zulinqi
of the nipple. (G 41).
Explanation: The nipple is on the Liver
Differemtiation Meridian, and the breast is located in the
Main manifestations: Redness, swelling area where the Stomach Meridian is
and pain of the breast, mostly occurring distributed. The breast abscess is caused by
after delivery. At the early stage when the pathogenic heat in the stomach and the
abscess has not yet been formed, there is a stagnation of liver qi. That is why Taichong
lump in the breast accompanied by swelling, (Liv 3) is used to remove the stagnation,
distension, pain, difficult lactation, chills, Zusanli (S 36) and Rugen (S 18) are to lower
 Chinese Acupuncture and Moxibustion

the stomach fire in order to eliminate the big meal. All these factors may give rise to
accumulation of pathogenic factors in the dysfunction of the intestines in transmission
Yangming Meridian. Tanzhong (Ren 17) is with accumulation of damp heat and
to regulate the activity of qi and remove stagnation of qi and blood, which in
obstruction of lactation. Foot-Shaoyang combination will lead to suppuration and
Meridian runs along the chest and abscess formation.
hvnnchnndri2c
--, - - - - -- - -regions,
I- - - -- - so Jiar??'ing(G 21) is
used to adjust qi circulation and remove Differentiation
obstruction of qi in the chest and Main manifestations: At the onset there is
hypochondriac regions, being an effective sudden paroxysmal pain in the upper
point in treating the breast abscess. Shaoze abdomen or around the umbilicus. Soon the
(S 1 1) is an empirical point for the treatment pain becomes continuous and localized in
of the breast abscess. Hegu (L I 4) clears the the right lower abdomen near Tianshu (S
heat away from the Yangming Meridian. 25), accompanied by .tenderness, mild
Waiguan (S J 5) connecting the Yangwei contracture of the abdominal wall, difficulty
Meridian is used to treat chills and fever. in extension of the right leg, fever, chills,
Zulinqi (G 41) spreads qi and blood and nausea, vomiting, constipation, dark urine,
removes obstruction of lactation so as to thin, sticky and yellow tongue coating, rapid
relieve distension and pain in the breast. and forceful pulse. If the pain is severe and
there is contracture of the abdominal wall
Remarks with marked tenderness or palpable mass,
This condition corresponds to acute accompanied by high fever and spontaneous
mastitis in modern medicine. sweating, forceful and rapid pulse, the
condition is serious.
Analysis: Intestinal abscess is due to
5. Intesti~tmalAbscess accumulation of damp heat and stagnation
of qi and blood that obstructs the pathway
Intestinal abscess is an acute abdominal of the stomach and intestines. So it is
disorder occurring in the intestines. manifested by localized abdominal pain and
According to the ancient literature, it can be tenderness. Intestinal abscess mostly occurs
classified into large-intestinal abscess and in the appendix which is located in the right
small-intestinal abscess. The abscess with lower abdomen, and hence severe ab-
pain around Tianshu (S 25) is known as dominal pain is present in this quadrant.
"large-intestinal abscess," while that with Stagnation of qi and blood, imbalance
pain around Cuanyuan (Ren 4) is named between the nutrient qi and defensive qi, and
"small-intestinal abscess." Because exten- confrontation between the pathogenic
sion of the right leg is limited, it is also called factors and the body resistance result in
"leg-contracted intestinal abscess." fever and chills. When the stomach qi fails to
descend, there are nausea and vomiting.
Etiology and Pathogenesis Yellow-sticky tongue coating and rapid,
Intestinal abscess is caused by irregular forceful pulse indicate an excess syndrome
intake of food, retention of undigested food, caused by accumulation of damp heat in the
undue cold and warmth, or running after a stomach and intestines. Sharp pain with
Chapter 18 Gynecological and Other Diseases

contracture of the abdominal wall, acute simple appendicitis in modern

tenderness, local mass, high fever, medicine, for which acupuncture treatment
spontaneous sweating, and rapid forceful is considered effective. If there is appendicial
pulse indicate suppuration with collection of abscess or tendency to perforate, other
pus and extreme heat in the Yangming therapeutic measures should be resorted to.
Meridians. For chronic appendicitis, the above-
mentioned points may also be used.
Treatment Acupuncture is given once a day or every
Method: To disperse damp heat, regulate other day. Moxibustion may be applied
qi circulation and stop pain by reducing locally at the same time.
method. Points of the Yangming Meridians
are selected as the principal points. Needles
are retained for a long time from thirty to
one hundred twenty minutes. Manipulation
is given every ten minutes, and treat every six
to eight hours. When the symptoms and
signs are alleviated, treatment should be Goiter denotes an enlargement of the
given once daily with needles retained for thyroid gland, causing a swelling in the front
thirty minutes. part of the neck, which is not accompanied
Prescription: Tianshu (S 25), Quchi (L I by pain, ulceration or skin discolouration.
1I), Lanwei (Extra), Shangjuxu (S 37). According to the records of ancient
Supplementary points: literature, it can be classified as "qi goiter,"
Fever: Dazhui (Du 14), Hegu (k 1 4). "flesh goiter" and "stone goiter." In this
Vomiting: Neiguan (P 6), Zhongwan section only '"i goiter" and flesh goiter" are
(Ren 12). discussed.
Explanation: Lanwei (Extra) is an
empirical point in treating the intestinal
abscess. Shangjuxu (S 371, the lower He- Etiollogy and Pathogenesis
(Sea) Point of the large intestine, together Goiter may be caused by exasperation,
with Tianshu (S 25), the Front-(Mu) Point anxiety or mental depression which leads to
of the large intestine, are used to remove stagnation s f qi and accumulation of fluid
accumulation of damp heat from the forming phlegm. It also occurs in certain
intestines and to promote qi circulation and localities where the soil and water are not
stop pain. Quchi (L I 1I), the He-(Sea) Point good. In the book General Treatise on the
of the Large Intestine Meridian, is used to Etiology and Pathogenesis, it says: "M oun-
eliminate heat from the intestines. Dazhui tainous areas with black soil where the
(Du 14) and Hegu (L I 4) are used to spring takes its source are not good for
strengthen the antipyretic action. Neiguan permanent dwelling, because drinking the
(P 6) and Zhongwan (Ren 12) are used to spring water causes goiter." Generally
harmonize the stomach and stop vomiting. speaking, qi goiter is mostly caused by
drinking mountainous water and qi
Remarks stagnation, and flesh goiter by stagnation of
"Intestinal abscess" is chiefly referred to qi and accumulation of phlegm damp.
 Chinese Acupuncture and Moxibustion

Differentiatioraa Sanjiao dominates the qi of the whole body.

Main manifestations: Qi goiter is marked So Naohui (S J 13) is used to remove
by diffusive swelling in the neck, soft, obstruction from the meridians in order to
gradually increasing in size with unclear relieve qi stagnation and phlegm accumu-
margins, normal colour, absence of pain; in lation for the goiter. Tianding (L I 17),
'
some cases big and drooping, accompanied Tianrong (S I 17) and Tiantu (Ren 22) are
with dyspnea and hoarseness of voice. The located on the neck. Puncturing them is tr?
size of the goiter usually changes with regulate the local circulation of qi and
emotions. blood, to remove blood stasis and disperse
Flesh goiter often occurs in individuals agglomeration. Hegu (k I 4) and Zusanli (S
below forty , more frequently in women 36) belong respectively to the Hand and
than in men, a few oval movable lumps Foot Yangming Meridians, which pass
below the Adam's Apple with smooth through the neck region. They have the
surface and without pain, accompanied by action of promoting qi circulation in the
exophthalmos, hot temper, irritability, Yangming Meridians and eliminating
tremor of the hands, sweating, stuffiness in stagnation of qi and blood. Tanzhong (Ren
the chest, palpitation, string-taut, slippery 17) is an Influential Point of qi, and
and rapid pulse, and irregular menstruation. Taichong (Liv 3) is the Yuan-(Primary)
Point of the .fiver Meridian. Both are used
to regulate the circulation of the liver qi.
Treatment henh hen (H 7) is the Yuan-(Primary) Point
Method: Activiate blood circulation and of the Heart Meridian, and Neiguan (P 6),
remotre blood stasis, and disperse the the Luo-(Connecting) Point of the
agglomeration through promoting the qi Pericardium Meridian. They are effective for
circulation by reducing method. Points of palpitation. Sizhukong (S 9 23), Zanzhu (B
Hand Shaoyang and Yangming Meridians 2) and Jingming (B 1) are local points.
are selected as the principal points. Fengchi (G 20) connects with the eye region.
Prescription: Naohui (S J 13), Tianding (L These four points are used together to
I 17), Tianrong (S I I?), Tiantu (Ren 22), readjust the circulation of qi and blood in
Hegu (L I 4), Zusanli (S 36). the eye region so as to control
Supplementary points: exophthalmos. Sanyinjiao (Sp 6) and Fuliu
Liver-qi stagnation: Tanzhong (Ren 17), (K 7) are used to reinforce yin and check
Taichong (Liv 3) with even movement. yang in order to relieve irritability, boulimia
Palpitation: Neiguan (P 6), Shenmen (H and excessive perspiration.
7) with the reinforcing method.
Exophthalmos: Sizhukong (S J 23), Remarks
Zanzhu (B 2), Jingming (I3 l), Fengchi (G 1. The morbid condition described here
20) with even movement. refers to simple goiter and hyperthyroidism
Mot temper, anxiety and sweating: in modern medicine.
Sanyinjiao (Sp 6) and Fuliu (K 7) with 2. The method of puncturing with several
even movement. needles surrounding the goiter and with one
Explanation: Naohui (S J 13) is a point of needle in the center has a fairly good effect of
the Sanjiao Meridian of Hand-Shaoyang. reducing the goiter.
Chapter 18 Gynecological and Other Diseases

7. Sprain and Contusion meridians may be combined to ease tendons

(Appendix: Torticollis) and activiate blood circulation, relieving
swelling and pain. Apply needling plus
Sprain and contusion here refer to the moxibustion to the local points and needling
injury of soft tissues, such as skin, muscles alone to the distal points.
and tendons of the trunk or limbs without Prescription: Ashi points.
fracture, disl~cationor wound. Supplementary points:
Main manifestations are pain and Neck: Tianzhu (B lo), Houxi (S 1 3).
swelling of the injured areas, a n d motor Shoulder joint: Jianjing (G 21), Jianyu
impairment of the joints. (L I 15).
Elbow joint: Quchi (L I 1l), Hegu (E 1 4).
Etiology and Pathogenesis Wrist joint: Yangchi (S J 4), Waiguan (S J
Local stagnation of qi and blood in the 5)-
meridians of diseased areas is due to injury Hip joint: Huantiao (G 30), Yangling-
of tendinous tissues and joints by violent quan (G 34).
movement, awkward posture of the body, Knee joint: Dubi (S 3 3 , Neiting (S 44).
bruise, falling, traction or overtwisting. Ankle joint: Jiexi (S 41), Qiuxu (G 40),
Kunlun (B 60).
Differentiation Explanation: Local and distal points from
Main manifestations: Local swelling and the affected meridians are selected to
pziin, redness or ecchymosis. A new injury is promote the circulation of qi and blood in
slightly swollen with tenderness. Large area the meridians. Moxibustion to the local
of swelling together with motor impairment points promotes the circulation of qi and
of the joints is found in serious cases. Old blood by warmth so as to relieve swelling
injury is characterized by absence of marked and pain, and to speed up the recovery of the
swelling but repeated recurrence due to injuried tissues.
invasion of exogenous pathogenic wind,
cold and damp. The injury mostly happens Remarks
in the shoulder, elbow, wrist, back, hip, Needling can be applied to the healthy
knee, and ankle. side at the area corresponding to the affected
Analysis: Sprain or contusion at any place. area. When manipulating the needle, ask the
of the body is due to tendinous injury with 'patient to move the sprained joint.
local qi stangation and blood stasis, Alleviation or subsidence of pain may be
manifested by swelling and pain with expected.
tenderness. In a protracted case, qi and
blood are consumed, and their circulation in Appendix: Torticofis
the meridians tends to be further obstructed Torticollis here refers to wry neck caused
by exposure to wind, cold and damp. That is by an awkward sleeping posture or attack of
why pain is exacerbated in bad weather. wind cold on the nape that leads to
disturbance of local circulation of qi in the
Treatment meridians. Its main manifestations are
Ashi points are used as the principal stiffness and pain of the neck and nape, and
points. Local and distal points of involved wry neck towards one side with motor
482 Chinese Acupuncture and Moxibustion

impairment. kidney qi and failure of essential qi to ascend

Method: Points of the Du Meridian and to the ear.
Taiyang Meridians are selected as the
principal points. The reducing method and Differentiation
moxibustion are applied to Dazhui (Du 14), a ) Excess type:
Tianzhu (B lo), Jianwaishu (S I 14), Main manifestations: Sudden deafness,
Xuanzhong (C 39), Houxi (S I 3) to expel distension sensation and constant ringing in
wind and disperse cold, and to relax tendons the ear that can not be eliminated by
and activiate blood and qi circulation in the pressing. In the case of upward perversion of
meridians. Kunlun (B 60) and Lieque (L 7) pathogenic wind fire of the liver and
are added for inability of flexion and gallbladder, there are flushed face, dry
extension. Zhizheng (SI 7) is added for mouth, irritability and hot temper, forceful
difficulty in rotating the neck so as to and string-taut pulse. In the case of invasion
promote the qi circulation of Taiyang by exogenous pathogenic wind, there appear
Meridians. Cupping may be applied after headache and superficial pulse.
needling, or Laozhen (Extra) is used alone Analysis: The pathogenic fire of the liver
for stiff neck. and gallbladder that flames up along the
related meridians results in deafness,
tinnitus, headache, flushed face, bitter taste
in the,mouth and dryness of the throat.
IV. DISEASES OF EYES, Hyperfunction of the liver causes hot
EARS, NOSE AND THROAT temper, and irritability is brought about by
the pathogenic heat disturbing the mind.
Forceful and string-taut pulse indicates the
11. Deafness and Tinnitus excess condition of the liver and gallbladder.
When the pathogenic wind attacks the
Both deafness and tinnitus are auditory exterior of the body and obstructs the
disturbances. Tinnitus is characterized by orifices, deafness, tinnitus and headache
ringing sound in the ears felt by the patient occur. Superficial pulse is a sign of invasion
and deafness is failing or loss of hearing. of the exogenous pathogenic wind.
Because of the similarities between these two b ) Deficiency type:
conditions in etiology and treatment, they Main manifestations: Protracted deaf-
are discussed together. ness, intermittent tinnitus aggravated by
strain and eliminated by pressing, dizziness,
Etiology and Pathogenesis soreness and aching of the lower back,
Deafness and tinnitus can be divided into seminal emission, excessive leukorrhea,
two types: deficiency and excess. The excess thready and weak pulse.
type is caused by fury or fright with upward Analysis: Hypofunction of the kidney
rush of wind fire of the liver and gallbladder makes essential qi fail to ascend and fill up
that obstructs the qi circulation in the the orifices, so there are deafness, tinnitus
Shaoyang Meridians or caused by invasion and dizziness. The loin is the house of the
of pathogenic wind blocking the orifice. The kidney, so hypofunction of the kidney
deficiency type is due to deficiency of the causes soreness and aching of the lower
Chapter 18 Gynecological and. Other Diseases

back. Deficiency of the kidney qi with various diseases, most of which seen in
impaired restraining function or deficiency acupuncture clinic are neural.
of yin with flaming up of the asthenic fire
that stimulates the seminal organs causes
emission. Since the kidney loses its function
of restricting the Dai Meridian, there is 2. Congestion, Swelling and Pain
excessive leukorrhea. Thready and weak of the Eye
pulse are signs of deficiency condition.
Congestion, swelling and pain of the eye is
Treatment an acute condition in various external eye
Method: Points of Shaoyang Meridians of disorders.
Hand and Foot are used as the principal
points. The reducing method is applied for Etiology and Pathogenesis
excess condition, while the reinforcing This condition is mostly due to exogenous
method for deficiency condition. Moxibus- pathogenic wind heat causing obstruction of
tion is also advisable. qi circulation in the meridians, or due to
Prescription: Yifeng (S J 17), Tinghui (G preponderance of fire in the liver and
2), Xiaxi (G 43), Zhongzhu (S J 3). gallbladder which flares up along the related
Fire preponderance in the liver and meridians, causing qi stagnation and blood
gallbladder: Xinejian (Liv 2), Zulinqi (641). stasis in the meridians.
Invasion of exogenous pathogenic wind:
Waiguan (S J 5), Megu (L I 4). Differentiation
Hypofunction of the kidney: Shenshu (B Main manifestations: Congestion, swel-
23), Mingmen (Du 4), Taixi (K 3). ling and pain of the eye, photophobia,
Explanation: The Shaoyang Meridians of lacrimation and sticky discharge. In the case
Hand and Foot travel to the ear region, so of wind heat, there occur fever, superficial
points of Shaoyang Meridians are used, e.g. and rapid pulse. In the case of
Zhongzhu (S J 3), Yifeng (S J 17) of Hand- preponderance of fire in ' the liver and
Shaoyang, Tinghui (G 2) and Xiaxi (G 43) of gallbladder, there are bitter taste in the
Foot-Shaoyang, to regulate the qi mouth, irritability with feverish sensation,
circulation in the meridians. In the constipation and string-taut pulse.
prescription, two local and two distal points Analysis: When the pathogenic wind heat
are combined. Xingjian (Liv 2) and Zulinqi attacks the eye, congestion, swelling and
(G 4 1) are used to clear away the pathogenic pain of the eye, photophobia, lacrimation
fire from the liver and gallbladder, and to and sticky discharge take place. Headache,
connect the upper and lower portions of the fever and superficial-rapid pulse are also
body. Waiguan (S J 5) and Hegu (L 14) expel signs of exogenous attack of the pathogenic
pathogenic wind. Shenshu (B 23), Mingmen wind heat. The liver has its specific body
(Du 4) and Taixi (Liv 3) reinforce the opening in the eyes, and the Gallbladder
essential qi of the kidney. Meridian starts at the outer canthus.
Upward disturbance of fire in the liver and
Remarks gallbladder may bring about congestion,
Tinnitus and deafness may be present in swelling and pain of the eye, bitter taste in
484 Chinese Acupuncture and Moxibustion

the mouth, and irritability. String-taut pulse 3- Thick and Sticky Nasal Discharge
is a sign of the liver trouble.
It is accompanied by nasal obstruction
and loss of the sense of smell. ,

Treatment
Method: Distal and local points are used
in combination to disperse wind heat. Etiology and Pathogenesis
Occurrence of thick sticky azszl discharge
Needling is given with the reducing method.
is related to the attack of pathogenic factors
Prescription: Jingming (B I), Fengchi (G
on the lung which has its specific body
20), Taiyang (Extra), Hegu (L 1 4), Xingjian
opening in the nose. Exogenous wind cold
(Liv 2).
may transform into heat. Sometimes, the
Supplementary points:
lung is directly attacked by wind heat. Both
Wind-heat:Waiguan (S J 5).
may lead to dysfunction of the lung and
Fire preponderance in the liver: Taichong
invasion of the pathogenic factors upon the
(Liv 3).
nose through the upper respiratory tract.
Explanation: The liver has its specific
body opening in the eyes; Shaoyang,
Yangming and Taiyang Meridians all run up Differentiation
to the eye region. Therefore Fengchi (G 20) Main manifestations: Nasal obstruction,
and Hegu (L I 4) are used to regulate the qi loss of the sense of smell, yellow fetid nasal
circulation of the Yangming and Shaoyang discharge, thick and sticky, accompanied by
cough, dull pain in the fcrehe9.1 ranid
--7 -ltrA pulse,
Meridians in order to dispel wind and heat.
Jingming (B 1) is where the Taiyang and reddened tongue with thin, white and sticky
Yangming Meridians meet, and is used to coating.
disperse the local accumulated heat. Analysis: Pathogenic heat accumulated in
Xingjian (Liv 2), the Ying-(Spring) Point of the lung impedes the descending of the lung
the Liver Meridian, can conduct the qi of the qi, then pathogenic heat rushes up to the
Jueying Meridian downward so as to nose, causing nasal obstruction. Pathogenic
remove the heat from the liver. Taiyang heat consumes the body fluid and changes it
(Extra), an adjacent point to the eye region, into phlegm and mucus, so there is turbid
is pricked to bleed to reduce heat and relieve and fetid nasal discharge. Cough results
swelling. In case of wind heat, Waiguan (S J from adverse flow of the lung qi. When
5) is used to clear it away from the head and extreme heat in the lung and stomach further
eyes. Taichong (Liv 3), the Yuan-(Primary) disturbs the upper orifices, pain with
Point of the Liver Meridian, is selected to distension occurs in the forehead. Reddened
clear o f f . the fire from the liver and tongue and rapid pulse are signs of
gallbladder.' pathogenic heat in the lung.

Treatment
Remarks Method: Points of the Hand-Taiyin and
This condition is involved in acute Hand-Yangming Meridians are selected as
conjunctivitis, pseudomenbranous conjunc- the principal points to smooth the flow of
tivitis, epidemic kerato-conjunctivitis, etc. in the lung qi and expel pathogenic wind heat
modern medicine. by applying the reducing method.
Chapter 18 Gynecological and Other Diseases

Prescription: Lieque (L 7), Yingxiang (L I with preference for cold drink, constipation,
20), Bitong (Ext~a),Hegu (L 1 4), Yintang foul breath, reddened tongue with yellow
(Extra). coating, forceful and rapid pulse.
Explanation: Lieque (L 7) smoothes the Analysis: Extreme heat in the lung goes up
flow of the lung qi and eliminates the to the nose, forcing blood to rush out of the
pathogenic wind. The Hand-Yangming vessels. The heat also causes dysfunction of
Meridian is exteriorly-interiorly related to the lung in spreading and descending of qi.
the Hand-Taiyin Meridian, and travels by The reverse flow of qi results in cough.
the sides of nose. So Hegu (L I 4) and Reddened tongue and rapid pulse are signs
Yingxiang (L 1 20) are selected to regulate of heat in the lung. Sometimes epistaxis
the qi circulation in the Hand-Yangming occurs when the stomach fire flares up along
Meridian and to clear away the heat from the meridians to the nose, and injures the
the lung. Yintang (Extra) is close to the nose, blood vessels. Thirst and preference for cold
and Bitong (Extra) is located at the sides of drinking are caused by the stomach heat
the nose. Both have the action of removing consuming the fluid. Exhaustion of fluid
the obstruction and eliminating heat from causes constipation. The stomach heat
the nose. makes foul breath. Irritability and
restlessness are due to extreme heat in the
Remarks Yangming Meridians disturbing the heart
This condition corresponds to chronic mind. Reddened tongue with yellow coating
rhinitis and chronic nasosinusitis in modern and forceful rapid pulse are signs of the
medicine. stomach heat.
b) Deficiency of yin with preponderance of
fire:
4. Epistaxis Main manifestations: Epistaxis accom-
panied by malar flush, dryness of the mouth,
Etiology and Pathogenesis feverish sensation of the palms and soles,
The lung qi flows up to the nose. The afternoon fever, night sweating, thready and
Foot-Yangming Meridian starts at the side rapid pulse.
of the nose. If there is accumulated wind Analysis: When deficiency of the kidney
heat in the lung or pathogenic fire in the yin causes the asthenic fire to flare up to the
stomach, they would rush upward to the nose, blood vessels are injured, resulting in ,

nose. If there is yin deficiency leading to up- epistaxis. Malar flush, dryness,of the mouth,
flaring of the asthenic fire, the blood would feverish sensation of the palms and soles,
flow up together with the fire. All of these and afternoon fever are manifestations of
cause blood to rush out of the vessels, the asthenic fire associated with yin
resulting in epistaxis. deficiency. Night sweating is also due to the
asthenic fire that forces the moisture to be
Differentiation given off. Thready and rapid pulse is a sign
a ) Extreme heat in lung and stomach: of yin deficiency.
Main manifestations: Epistaxis accom-
panied by fever, cough, reddened tongue, Treatment
superficial and rapid pulse; or dire thirst Method: Points of the Hand-Yangming
 Chinese Acupuncture and Moxibustion
and Du Meridians are selected as the
principal points. The reducing method is
applied to clear off the heat and stop Toothache is a common ailment. It may
bleeding for extreme heat in the lung and be due to wind fire, stomach fire, asthenic
stomach. The even movement is used to fire, and dental caries.
nourish yin and descend the fire for
deficiency of yin with preponderance cf fiE. Ethology Pathssgewesis
The Hand and Foot Yangming Meridians
Prescription: Yingxiang (L I 20), Hegu go into the upper and lower gums
(L I 4), Shangxing (Du 23). respectively. Toothache may be due to
Supplementary points: flaring up along the meridians of the
Heat ih the lung: Shaoshang (L 11). pathogenic fire transformed from patho-
Heat in the stomach: Neiting (S 44). genic heat in the large intestine and stomach,
Deficiency of yin with preponderance of or from exogenous pathogenic wind that
fire: Zl~aohai(K 6). attacks and accumulates in the Yangming
Meridians. The kidney controls bones and
Explanation: The Hand-Yangming the teeth are the odds and ends of the bones.
Meridian and Hand-Taiyin Meridian are Deficiency of the kidney yin with flaring up
exteriorly and interiorly related. The Hand- of the asthenic fire may also give rise to
Yangrning Meridian connects with the toothache. Sometimes toothache is due to
Foot-Yangming Meridian. So Yingxiang (L dental caries caused by overintake of sour
1 20) and Hegu (L P 4) are seclected to clear and sweet food.
off heat and stop bleeding. The Du Meridian
is the sea of all the yang meridians. Extreme
Differentiation
yang forces blood to rush out. So Shangxing
a ) Toothache due to stomach fire:
(L I 20) is used to reduce heat of the Du
Main manifestations: Severe toothache
Meridian. The lung has its specific body
accompanied by foul breath, thirst,
opening in the nose. Shaoshang (L 1I), the
constipation, yellow tongue coating,
Jing-(Well) Point of the Lung Meridian, is
forceful and rapid pulse.
used to reduce heat of the lung. Neiting (S
Analysis: Accumulated heat in the
44), the Ying-(Spring) Point of the Stomach
stomach and intestines results in con-
Meridian, is good for eliminating the
stipation. Upsurging of the stomach heat
stomach fire. Zhaohai (K 6), one of the
causes yellow tongue coating and foul
Confluential Points of the Eight Extra
breath. Thirst is due to the exhaustion of
Meridians, has the action of nourishing yin body fluid by heat. Severe toothache is due
and reducing fire.
to the stomach heat flaring up along the
meridians. Forceful and rapid pulse also
Remarks indicates the stomach fire.
Epistaxis may be caused by trauma, nasal b ) Toothache caused by wind fire:
disorders and acute febrile diseases. In Main manifestations: Acute toothache
addition to acupuncture treatment, other with gingival swelling accompanied by chills
therapeutic measures should be adopted and fever, superficial and rapid pulse.
according to its primary cause. Analysis: The exogenous pathogenic wind
Chapter 18 Gynecological and Other Diseases

invades the Yangming Meridians and turns selected.

into fire. Then occurs the toothache with Prescription: Yemen (S J 2), Fengchi (G
gingival swelling. When the exogenous 20), Hegu (L 14), Jiache (S 6), Xiaguan (S 7),
pathogenic factors struggle against the body Waiguan (S J 5).
resistance in the muscles and skins, there are Explanation: Waiguan (S J 5) is the Ying-
'

chills and fever as exterior symptoms. (Spring) Point of the Sanjiao Meridian of
Superficial and rapid pulse is a sign of wind- Hand-Shaoyang. Fengchi (G 20) is used to
fire. dispel wind and clear off fire. Hegu (L I 4),
c ) Toothache caused by deficiency of the Jiache (S 6) and Xiaguan (S 7) are selceted to
kidney yin: regulate the qi circulation in the Yangming
Main manifestations: Dull pain off and Meridians of Haild and Foot and to
on, loose teeth, absence of foul breath, eliminate heat for relieving pain.
reddened tongue, thready and rapid pulse. c) Toothache caused by deficiency of the
Analysis: The-kidney controls bones and kidney yin:
the teeth are the odds and ends of the bones. Method: The even movement is applied to
The kidney in deficiency state fails to keep nourish yin and lower the fire. Points of the
the teeth strong, so they are loose. Flaring up Foot-Yangming and Foot-Shaoyin Meri-
of the asthenic fire leads to dull pain. Since dians are selected.
nothing is accumulated in the stomach, there Prescription: Jiache (S 6), Xiaguan (S 7),
is no foul breath. Thready, rapid pulse and Taixi (I< 3).
reddened tongue are due to heat caused by Explanation: The teeth relate to the
yin deficiency. kidney and are situated at the place where
the Stomach Meridian and Large Intestine
Treatment Meridian go through. Thus Taixi (K 3) is
a ) Toothache due to stomach fire: used to nourish yin of the kidney and lower
Method: The reducing method is applied the asthenic fire. Jiache (S 6) and Xiaguan (S
to eliminate heat and stop pain. Points of 7) relieve pain by regulating the qi in the
Hand-Uangming Meridian are selected. meridians.
Prescription: Hegu (k I 4), Jiache (S 6),
Neiting (S 44), Xiaguan (S 7). Remarks
Explanation: Hegu (L I 4) of the contra- Toothache described here is involved in
lateral side is used to disperse pathogenic acute and chronic pulpitis, dental caries,
heat from the Hand-Yangming Meridian. peridental abscess and pericoronitis.
Neiting (S 44), the Ying-(Spring) Point of
the Stomach Meridian, is used to reduce the
fire in the stomach. Xiaguan (S 7) and Jiache 6. Sore Throat
(S 6) are local points to stop pain and
regulate the qi circulation in the Foot- Sore throat is commonly seen. It can be
Yangming Meridian. divided into two types: excess and
b ) Toothac/ze caused by wind fire: deficiency.
Method: The reducing method is applied
to dispel wind and clear off heat. Points of Etiology and Pathogenesis
the Sanjiao Meridian of Hand-Shaoyang are The throat communicates with the
 Chinese Acupuncture and Moxibustion

stomach and the lung through the moisten the throat, the throat is slightly
esophagus and the trachea respectively. Sore congested with mild pain on and off and
throat of excess type (excess of heat) is due to with dryness more marked at night. Feverish
exogenous pathogenic wind heat that sensation in the palms and soles, reddened
scorches the lung system or due to the and furless tongue, thready and rapid pulse
accumulated heat in the Lung and Stomach are signs of deficiency of yin that causes yang
Meridims that distcrhs ~ p w a r d S. ~ r tkrmat
e preponderance.
of deficiency type (deficiency of yin) is due to
the exhaustion of the kidney yin that fails to Treatment
flow upward to moisten the throat, while the a ) Syndrome of excess of heat:
asthenic fire flares up instead. Method: To disperse wind and eliminate
heat by puncturing the points of Hand-
Differentiation Taiyin and Foot-Yangming Meridians with
a ) Syndrome of excess of heat: the reducing method.
Main manifestations: Abrupt onset with Prescription: Shaoshang (L 1l), Hegu
chills, fever, headache, congested and sore (L I 4), Neiting (S 44), Tianrong (S I 17).
throat, thirst, dysphagia, constipation, Explanation: Pricking Shaoshang (L 11)
reddened tongue with thin yellow coating, to let a few drops of blood out is used to clear
superficial and rapid pulse. off the heat from the lung and relieve pain.
Analysis: Exogenous pathogenic wind Hegu (L I 4) disperses exterior pathogenic
heat invades the exterior portion of the factors from the Lung Meridian and the
body, leading to chills, fever and headache. accumulated heat from the Yangming
After having been transmitted to the lung Meridians. Neiting (S 44), the Ying-(Spring)
system the pathogenic wind heat causes sore Point of the Stomach Meridian, reduces heat
throat and dysphagia. The lung is exteriorly- in the stomach. Tianrong (S I 17) is a local
interiorly related with the large intestine. point used to ease the pain of a sore throat.
Since the pathogenic heat consumes the b ) Syndrome of deficiency of yin:
body fluid, there are symptoms of thirst and Method: To nourish yin and descend fire
constipation. Reddened tongue with thin by puncturing with the reinforcing method
yellow coating, superficial and rapid pulse at points of Shaoyin Meridians of Hand and
are signs of the pathogenic wind heat Foot as the principal points.
invading the lung. Prescription: (a) Taixi (K 3), Yuji (L lo),
b ) Syndrome of deficiency of yin: Lianquan (Ren 23) (b) Zhaohai (K 6 ),
Main manifestations: Gradual onset Lieque (L 7), Futu (L I 18).
without fever or with low fever, slightly The above two prescriptions may be used
congested throat with intermittent pain or alternatively.
pain during swallowing, dryness of the Explanation: Taixi (K 3) is the Yuan-
throat, more marked at night, feverish (Primary) Point of the Kidney Meridian
sensation in the palms and soles, reddened which runs up to the throat. Yuji (L 10)is the
and furless tongue, thready and rapid pulse. Ying-(Spring) Point of the Lung Meridian.
Analysis: The Kidney Meridian of Foot- Combination of the two points nourishes yin
Shaoyin travels to the throat. Because the and reduces the fire. Zhaohai (K 6) and
kidney yin is insufficient to run up to Lieque (L 7), a pair of the Eight Confluent
Chapter 18 Gynecological and Other Diseases

Points, relieve sore throat by leading the nutrients to nourish the eyes in deficiency of
asthenic fire downward. Futu (L I 18) and the liver and kidney yin. The lumbus is the
Lianquan (Ren 23) are local points for seat of the kidney. When the kidney is in a
relieving pain. deficiency state, there is aching of the lower
back. Deficiency of the kidney yin may lead
Remarks to nocturnal emission when there is
Sore throat as described here is involved hyperactivity of the asthenic fire, and to
in acute tonsilitis, acute and chronic dizziness and tinnitus when there is yang
pharyngitis. preponderance. Thready and weak pulse, '

reddened tongue with scanty coating arc'

signs of yin deficiency.
b ) Deficiency of qi and blood:
Main manifestations: Blurred vision,
7. Optic Atrophy weakness of breath, disinclination to talk,
lassitude, poor appetite, loose stools,
Optic atrophy is a chronic eye disorder thready and weak pulse, pale tongue with .
marked by gradual degeneration of the thin white coating.
vision acuity. At the early stage there is only Analysis: The essential qi of all the zang-
blurring of vision, but at the late stage the fu organs flows up to the eyes. When qi and
eyesight may be totally lost. blood in a deficiency state can not nourish
the eyes, the vision becomes blurred. Qi
Etiology and Pathogenesis deficiency of the spleen and stomach causes
a) Deficiency of the kidney and liver yin weakness of breath, disinclination to talk,
leads to consumption of the essence and lassitude, poor appetite and loose stools.
blood that nourish the eyes. Thready and weak pulse, pale tongue with
b) Dysfunction in transportation and thin and white coating are signs of deficiency
transformation of the spleen due to irregular of qi and blood.
diet and overstrain results in inadequate c ) Stagnation of the liver qi:
supply of the essential nutrients for the eyes. Main manifestations: Blurred vision,
c) Dysfunction of the liver with emotional depression, dizziness, vertigo,
stagnation of qi and blood in emotional hypochondriac pain, .bitter taste in the
troubles causes failure of the essential qi to mouth, dry throat and string-taut pulse.
flow upwards to nourish the eyes. Analysis: The liver has its specific body
opening in the eyes. Stagnation of the liver qi
Differentiation causes general obstruction of qi and blood
a ) Deficiency of the liver and kidney yin: which fail to ascend to nourish the eyes. So
Main manifestations: Dryness of the eyes, the vision is blurred. The Liver Meridian
blurred vision, dizziness, tinnitus, nocturnal passes by the hypochondriac region, so there
emission, aching of the lower back, thready is hypochondriac pain when the liver qi is
and weak pulse, reddened tongue with stagnated. Retarded qi may turn into fire,
scanty coating. which flares up to cause dizziness, vertigo,
Analysis: Dryness of the eyes and blurred bitter taste in the mouth and dry throat.
vision are due to failure of the essential String-taut pulse is the sign of a liver disease.
 Chinese Acupuncture and Moxibustion

Treatment Stagnation of the liver qi: Qimen (Liv 14),

Method: To reinforce the liver and kidney Taichong (Liv 3), Yanglingquan (G 34).
and nourish qi and blood by puncturing the Explanation: The Foot-Shaoyang and
points of the Foot-Shaoyang and Taiyang Taiyang Meridians connect with the eye
Meridians with reinforcing method for region, so Fengchi (G 20), Guangming (G
deficiency of the liver and kidney yin and 37), Jingming (B 1) are selected to regulate
deficieiicy of qi arrd G h d . Eves movemciii the qi circuiation in the meridians and to
is applied to the same points to remove the improve the eyesight. Qiuhou (Extra) is an
stagnation of the liver qi. extra point effective for eye diseases.
Prescription: Fengchi (G 20), Jingming (B Ganshu (B 18), Shenshu (B 23), Taixi (K 3)
I), Qiuhou (Extra), Guangming (G 39). and Taichong (Liv 3) are used to reinforce
Deficiency of the liver and kidney yin: the yin of the liver and kidney. Zusanli (S 36)
Taichong (Liv 3), Taixi (K 3), Ganshu (B and Sanyinjiao (Sp 6) reinforce qi and blood.
18), Shenshu (B 23). Qimen (Liv 14), Taichong (Liv 3) and
Deficiency of qi and blood: Zusanli (S 38), Yanglingquan (G 34) remove stagnation of
Sanyinjiao (Sp 6). the liver qi.
 EARACUPUNCTURETHERAPY
.
Ear acupuncture therapy treats and composed of a plate of elastic cartilage, a
prevents diseases by stimulating certain thin layer of fat and connective tissue
points on the auricle with needles. supplied by numerous nerves. The main
Ear acupuncture therapy has long been nerves are the great auricular and the lesser
used in China, and is recorded in Chapter 24 occipital derived from the second, third and
of Miraculous Pivot that "Jue headache with fourth cervical spinal nerves, the auricule-
the symptoms of acute pain in the head, and temporal branch of the trigeminal nerve,
hot sensations in the vessels in front of and vagus, t'he mixed branch of the facial nerve
behind the ear should be treated by and the glossopharyngeal nerves, and
bloodletting in order to reduce the heat, then sympathetic nerves.
to be followed by needling at the points of To facilitate location of ear points, the
Foot Shaoyang Meridian." In the twentieth anatomical structures of the auricular
chapter of Miraculous Pivot it says, "When surface relating to ear acupuncture are
the pathogenic factor attacks the liver, it will briefly described as follows:
cause pain in the ribs on both sides. . .for the
pain caused by internal blood stagnation . . . 1. Helix: The prominent rim of the
needle at the blue vessels around the ear to auricle.
relieve the dragging pain." In other classical 2. Helix tubercle: A small tubercle at
medical literature there are descriptions on the posterior-inferior aspect of the
stimulating certain auricular areas with helix.
needle, moxibustion, massage, and herbal 3. -Helix cauda: The inferior part of the
suppository to treat and prevent diseases. helix, at the junction of the helix and
Those methods are still used as folk the lobule.
remedies. 4. Helix crus: A trahsverse ridge of helix
continuing backward into the ear
1, ANATOMICfi cavity.
5. Antihelix: An elevated ridge anterior
TERMINOLOGY OF THE and parallel to the helix. Its upper
.AURICULAR SURFACE part branches out into the superior
and inferior antihelix crus. It includes
Ear is an organ of hearing symmetrically the principal part of antihelix.
on both sides of the head. The auricle is 6. The principal part of antihelix: The
 Chinese Acupuncture and Moxibustion

roughly vertical portion of the antihelix.

antihelix. 11. Tragus: A small, curved flap in front
7. Superior antihelix crus: The superior of the auricle.
branch of the bifurcation of the an- 12. Supratragic notch: The depression
tihelix. between the helix crus and the upper
8. Inferior antihelix crus: The anterior border of the tragus.
braxh =f the b i f ~ z ; s ~sft ithe
~ ~ ti- 1 . LAxrr',itrag.is:
A l!a,Ts ~n.n..--
Vk'Y"-
helix. site to the tragus and inferior to the
9. Triangular fossa: The triangular de- ear lobe.
pression between the two crura of the 14. Intertragic notch: The depression
antihelix. between the tragus and antitragus.
10. Scapha: The narrow curved depres- 15; Helix notch: The depression between
sion between the helix and the the antitragus and antihelix.

Superior antihelix crus

Triangular fossa

Inferior antihelix crus

Cymba concha

Helix crus

Supratragic notich

Tragus

Intertragic notch

Fig. 163 Anatomical Structure of the Auricular Surface

 Ear Acupuncture Therapy

16. Ear lobe: The lowerest part of the the head and facial region, those on the
auricle where there is no cartilage. scapha to the upper limbs, those on the
17. Concha: The hollow formed by the antihelix and its two crura to the trunk and
. antitragus, between the anterior part lower limbs, and those in the cavum and
of the helix and inferior antihelix crus. cymba conchae to the internal organs. (See
18. Cymba concha: The concha superio Fig. 164)
to the helix crus. 1) Helix Crus and Helix: Points include
19. Cavum concha: The concha inferior Middle Ear on Helix Crus, Lower Rectum.
to the helix crus. Urethra, External Genitalia, Ear Apex and
20. Orifice of the external auditory Helix 1-6 on helix.
meatus: The opening in the cavum 2) Scapha: Points include Finger, Wrist,
concha shielded by the tragus. Elbow and the corresponding parts of the
2 1. The superior auricular root: The area upper limbs.
where the superior border of auricle 3) Antihelix: It includes the correspond-
attaches to the scalp. ing site of the trunk and the lower limbs.
22. The inferior auricular root: The area 4) Tragus: Point Nose is on the outer
where ear lobe attaches to the face. aspect of Tragus. At its border are points
(See Fig. 163) Superior Tragic Apex and Inferior Tragic
Apex. Points Throat and Internal N.ose are
on the inner aspect of Tragus.
11. AURICULAR POINTS 5) Antitragus: Points Forehead, Occiput
and Temple are on the outer aspect of
Auricular points are specific stimulating Antitragus. At the tip of the border of
points on the auticle. When disorders occur Antihelix is the Point Middle Border. Point
in the internal organs or other parts of the Brain is on the inner aspect of Antihelix.
body, various reactions may appear at the 6) Intertragic Notch: Point Intertragic
corresponding areas of the auricle, such as Notch is inferior to the orifice of external
tenderness, decreased cutaneous electric auditory meatus and on the intertragic
resistance, morphological changes, and notch. The areas anterior-inferior and
discoloration. Therefore, these sites are also posterior-inferior to the intertragic notch
referred to as tender spots, conductant orderly are points Anterior Intertragic
points or reflex spots. Thus, making a Notch, Posterior Intertragic Notch and
diagnosis, those phenomena can be taken Inferior Intertragic Notch.
into consideration. Stimulating the sensitive 7) Triangular Fossa: Points include Ear-
sites serves to prevent and treat diseases. Shenmen, Triangular Depression and
Superior Triangle.
I. Distribution of Aaaricular Points 8) Cymba Conchae and Cavum
1
Conchae: They are the corresponding areas
Ear points are distributed on the auricle in for various internal organs. Point Digestive
a certain pattern. The following is a Tract is around helix crus. Posterior to the
summary of the distribution of auricular external auditory meatus is the Mouth
points: point, then respectively are points
Points located on the lobule are related to Esophagus, Cardiac Orifice, Stomach,
494 Chinese Acupuncture and Moxibustion

Duodenum, Small Intestine, Appendix, is at the posterior aspect to Points Stomach'

Large Intestine, etc. Point Stomach is at the and Duodenum. Above Point Small
area where helix crus terminates. Point Liver Intestine is Kidney. Point Bladder is above

Triangular ~ossa' Hip 0

Helix*

Pharyns and Larynx

0
Nose Lung
Internal Nose

Helix4

- - -1- - --- Lower Root of Auricle

Helix6

Fig. 164 Schematic Diagram of Distribution of Anricular Points

Ear Acupuncture Therapy 495

large intestine. Between Liver and Kidney is Auricular Vagus Nerve, Superior Root of
Point Pancreas. Point Spleen is inferior to Auricle and Inferior Root of Auricle, etc.
Boint Liver and close to the border of 2- Location, Action and Indications of
antihelix. In the centre of cavum is Point
Ear Acupoints
Heart. Between Point Heart and Boint
Mouth is Point Trachea. Among Points Numerous writings about the name,
Intertragus, Brain and Lung there is Point location, action and indications of ear
Sanjiao. acupoints have been recorded in Chinese
9) Ear Lobe: In the middle of ear lobe is medical literature for centuries. In recent
Point Eye. Above this Point is Point Tongue, years new ear acupoints have been reported,
in front of it are the four points of ear lobe. but these reports vary. The table in the
Posterior to Point Eye is Point Internal Ear, appendix for location, action and
inferior to it is Boint Tonsil, and at the indications of ear acupoints is made
posterior-superior aspect of Point Eye is according to the International Standardiza-
Point Cheek. tion of Ear Acupoints established by All-
10) The back of auricle: There are Points China Society of Acupuncture and
Groove of Inferior Antihelix Crus, Root of Moxibustion.
Appendix: Location, Action and Indications of Ear Acupoints
I
Anotomical Name of Point Former Name Location Action and
Portion Indications
Middle Ear Diaphragm Helix crus. Descending upward
reversive qi of stom-
ach, expelling wind
and regulating the
function of dia.- I
phragm.
Indications: hiccup,
jaundice, symptoms
and diseases of diges-
tive system and skin.
1 Lower Portion of I On the end of helix Constipation, anus
Rectum approximate to su- prolapse, external and
perior tragic notch. internal hemarrhoids,
tenesmus.
Urethra On helix at level with, Enuresis, frequent, ur-
the lower border of: gent and painful urina-
inferior antihelix crus. ' tion, retention of
urine.
Helix , Crus Extenal Genitalia On helix at level with Inflammation of ex-
and Helix I the upper border of ternal genital organs,
inferior antihelix crus. eczema of the peri-
I neum, impotence.
 Chinese Acupuncture and Moxibustion

' Front Ear Apex Area between Ear External and internal
Apex and Superior hemarrhoids (It is used
Root of Auricle. as assistant diagnosis
for hemarrhoids).
Ear Apex At the tip of auricle Removing heat and
and superior to helix wind, anti-spasmotism
when folded towards and analgesia, pacify-
tragus. ing liver and cleanng
vision.
Indications: fever, hy-
pertension, inflamma-
tion of eyes, painful
diseases.
Liver Yang At auricular tubercle. Liver qi stagnation,
liver yang prepond-
erance.
Helix 1-6 Region from lower ~larifiin~ heat and
border of auricular relieving pain, pacify-
tubercle to midpoint of ing liver and removing
lower border of lobule wind.
is divided into five Indications: fever, ton-
equal parts. The points sillitis, hypertension.
marking the divisions
are respectively Helix
1, Helix 2, Helix 3,
Helix 4, Helix 5, Helix
6.
Finger At the top of scaphaPain and dysfunction
at corresponding area
of the body.
Interior Tubercle Midpoint between Expelling wind and
Finger and Wrist. stopping itching.

Wrist Midway between Pain and dysfunction

Elbow and Finger. at corresponding area
1 of the body.
Scapha Elbow Midway between Fin- Pain and dysfunction
ger and Clavicle. at corresponding area
of the body.
Shoulder Midway between Pain and dysfunction
Elbow and Clavicle. at corresponding area
of the body.
Clavicle On scapha at level with1 Pain at corresponding
Ear Acupuncture Therapy 497
helix-tragic notch. 'area, peripheral arthri-
tis of the shoulder,
Takayashu's disease-
(pulseless disease).
Toe Superior and lateral Pain and dysfunction
angle of superior anti- of corresponding area
helix crus. of the body.
Superior Heel Superior and medial Heel pain.
Antihelix angle of superior of
Crus Ankle antihelix crus. Ankle sprain, pain and
Midway between heel dysfunction at corre-
and knee. sponding area of the
body.
Knee Middle portion at Pain and dysfunction
superior antihelix crus. sat corresponding area
of the body (such as
sprain and arthritis of
1 the knee joint).
1 Hip I At inferior 113 of the Pain at corresponding
/ superior antihelix crus. area.
Inferior Anti- 1 Buttocks At lateral 113 of the Pain at corresponding
I
helix Crus I inferior antihelix crus. area.
i Ischium At medial 213 of the Sciatica
inferior antihelix crus
I End of Inferio~ Sympathetic The terminal of in- Antispasmotism and
Antihelix Crus Nerve ferior antihelix crus. analgesia, nourishing
yin and supporticg
Yaw-
Indications: pain of
internal organs, gal-
pitation, spontaneous
sweating, night
sweating; functional
disorders of autono-
mous nerve system.
A curved line from hel- Strengthening spine
ixtragic notch to the and nourishing mar-
Cervical branching area of su- row.
Vertebrae perior and inferior Indications: pain at co-
Thoracic antihelix crus can be rresponding part of
Antihelix Vertebrae divided into 3 equal the spine.
Sacral segments. The lower
Vertebrae 113 of it is Cervical
Vertebrae, the middle
 Chinese Acupuncture and Moxibustion

113 is Thoracic Ver-

tebrae, and the upper
113 is Lumbosacral
Vertebrae.
Neck On the border of Strained neck, wry
cavum conchae of neck, pain or dysfunc-
(1~rviralVertebrae- tion of the neck.
Chest On the border of Pain and stuffiness of
cavum conchae of the chest, or pain at the
Thoracic Vertebrae. corresponding part of
the body.
Abdomen On the border of Abdominal or gyne-
cavum conchae of cological diseases,
Lumbosacral Verte- lumbago-
brae.
Ear-Shenmen At bifurcating point Sadation, easing mind,
between superior and relieving pain, clearing
inferior antihelix crus, heat.
and at the lateral i / 3 of
Triangular Triangular Tiankui triangular fossa. Supporting yang and
Fossa Depression Uterus Semi- In the triangular fossa nourishing essence,
nal Palace. and in the depression! regulating menstru-
close to the midpoint ationand harmonizing
of helix. blood.
Indications: gyne-
cological diseases and
symptoms, impotence,
L prostatis, etc.
Superior Triangle Lowering At the superior-lateral Pacifying liver and
Blood angle of Triangular removing wind. Hndic-
Pressure Fossa. ation: hypertension.
Superior Tragus Ear On the supratragic Nourishing kidney-
notch close to helix. water, subduing liver
Yaw.
Indications: ear dis-
ease, dizziness and
vertigo.
Nose External In the centre of lateral Removing obstruc-
Nose aspect of tragus. tions from the
meridians in the nose
region.
Indications: brandy-
nose or nose furuncles,
Ear Acupuncture Therapy

nasal obstruction, and

, other nose problems.
Tragus Supratragic Apex At the tip of upper Reducing heat and
protuberance on bor- relieving pain.
der of tragus.
Infratragic Apex At the tip of lower Reducing heat and
tubercle on border of relieving pain, anti-
tragus. spasmotism and expel-
ling wind.
Pharynx-Larynx Upper half of medi Clarifying obstruc-
aspect of tragus. tions of the pharynx
and largnx.
Indications: acute and
chronic pharyngitis
and chronic laryngitis
and tonsillitis.
Internal Nose Lower half of media Removing obstruc-
aspect of tragus. tions of the nose.
Indications: allergic
rhinitis and other nose
diseases.
Antitragic Apex At the tip of antitragic Strengthening the lung
and stopping asthma,
clearing up heat and
antitoxic, and expel-
ling wind.
Indications: asthma,
bronchitis, parotitis
and itching skin.
Middle Border Midpoint between Replenishing brain
antitragic apex and and easing mind.
helix-tragic notch. Indications: oligo-
phrenia (incomplete
development of in-
telligence), enuresis,
etc.
Occiput At posterior superior Sedation and anal-
corner of lateral aspect gesia, easing mind and
of antitragus. removing wind.
Indications: dizziness,
headache, insomnia,
etc.
Antitragus
I On antitragus between
Forehead and i
Sedation and anal-
gesia.
 Chinese Acupuncture and Moxibustion

Occiput.
P
Indication: Shaoyang
headache.
At anterior inferior Sedation and anal
Fmehead
corner of lateral aspect gesia.
of antitragus. Indication: Yangming
headache.
Erain Reinforcing marrow
and replenishing
brain, relieving pain
and easing mind.
Indications: oligoph-
renia, insomnia,
dream disturbed sleep,
tinnitus due to kidney
deficiency.
Mouth Close to posterior Clearing up heart fire,
superior border removing pathogenic
orifice of
, auditory meatus. Indications: facial par-
alysis, stomatitis, etc.
Periphery Esophagus At medial 213 of Regulating function of
helix.crus iaf'fio; zspect cf hefix di~phr2,m and har-
crus. monizing stomach.
Indications: dysphag-
ia, esophagitis, etc.

Cardiac Orifice At area where heli Harmonizing stomach

crus terminates. and replenishing sple-
en, reinforcing middle
jiao and easing mind.

Indications: insomnia,
gastritis, gastroduo-
denal ulcer and other
diseases and symp-
toms of gastric region.

Duodenum t lateral 113 of super- Warming middle jiao

aspect of helix crus. and harmonizing stomach.
I s Indications: duodenal
ulcer, pylorospasm, etc.
Small Intestine At middle 113 of super- Reinforcing spleen and
ior aspect of helix crus. harmonizing middle jiao,
nourishing heart and
 Ear Acupuncture Therapy

producing blood.
Indications: indigestion, pal-
pitation, etc.
Appendix Between Small Intestine and Clearing up damp heat from
Earge Intestine lower jiao. .
Indications: appendicitis,
diarrhoea, etc.
Large Intestine At medial 113 of superior Clearing up lower jiao,
aspect of helix crus. replenishing lung-qi.
Indications: diarrhoea,
constipation.
Liver At posterior aspect of Clearing up liver and
Stomach and Duodenum. brightening vision, promot-
ing smooth circulation of qi
and blood to relax muscles
and tendons.
Indications: liver-qi stagna-
tion, eye diseases and
disorders of lateral-lower
Bbdomen.
Cymba Pancrease Between Liver and Kidney. Replenishing gallbladder
.. Conchae and building up stomach,
removing liver-qi stagnation
and liver-wind.
Indications: diseases and
symptoms of bile duct,
pancreasitis, migraine, etc.
Kidney On the lower border of Reinforcing kidney and
inferior antihelix crus, di- promoting hearing, streng-
rectly above Sm.all Intestine. thening bone and filling up
marrow.
Indications: nephritis, lum-
bago, tinnitus, diplacusis,
spermatorrhea, impotence,

Ureter Between
Bladder.
Kidney and
etc.
ureter.
I1
Stone and colic pain of

Bladder On the lower border of Replenishing lower jiao and

reinforcing lower sap.
inferior antihelix crus, dir-
Indications: lower back
ectly above Earge Intestine. ,

pain, sciatica, cystitis,

enuresis, retention of urine.
Angle of Cymba At medial superior angle 'clarifying lower jiao, re -
Conchae of Cymba moving obstruction
 Chinese Acupuncture and Moxibustion

Conchae. from the urethra

Indication: prostatitis.
Middle Periphery In the center of Regulating middle jiao
Cymba Umbilicus Cymba Conchae. and harmonizing
Conchae spleen.
Indications: low fever,
a b d s x i ~ a ldistensisn,
ascariasis of bile duct,
impaired hearing,
parotitis, etc.
. Heart In the central de- Tranquilizing heart
pression of cavum and easing mind, regu-
conchae. lating ying-blood, re-
lieving pain and
itching.
Indications: insomnia,
palpitation, hysteria,
night sweating, angina
pectoris, etc.
Cavum Lung Around Heart. Promoting smooth cir-
Conchae culation of qi and
blood, diuresis, rein-
, forcing deficiency and
I
clearing up heat, nour-
I ishing skin and hair.

'
'
Indications: cough and
asthma, skin diseases,
I
hoaseness of voice;
commonly used point
of acupuncture
anesthesia.
Trachea In the area of Lung, Stopping cough and
between Mouth and dispelling phlegm.
Heart. Indications: cough and
asthma.
Spleen Inferior to Liver, at Digesting food, pro-
lateral and superior ducing ying-blood,
aspect of cavum nourishing muscles,
conchae. building up spleen qi.
Indications: ab-
dominal diarrhoea,
distension, chronic in-
digestion, stamotitis,
functional uterus
bleeding, etc.
Sanjiao Superior to Removing obstruction
Intertragus. from the water pass-
Ear Acupuncture Therapy 503

ages, clearing up heat

and stopping itching.
Intertragus Endocrine At the base of cavum Removing liver-qi
conchae in the inter- stagnation, regulating
menstruation and ac-
tiviating blood circu-
lation, expelling
pathogenic wind, rein-
forcing lower jiao.
Indications: skin dis-
eases, impotence, ir-
regular menstruation,
climacteric syndrome,
dysfunction of endo-
crine, etc.
Frontal Tragic Eye 1 On lateral and anterior Clearing up liver and
Notch side af intertragic brightening vision. In-
notch. dications: glaucoma,
pseudomyopia and
other eye diseases.
Lower Tragic Elevating On the inferior aspect Reinforcing qi and
Notch Blood Pres of intertragic notch. elevating yang.
sure Point I Indication: hypoten-
, sion.
Ear Lobule Back Tragic Eye 2 On lateral and inferior Clearing up liver fire
Notch aspect of intertragic and brightening
notch. vision.
Indications: arne-
tropia, external eye
' inflamation, etc.
Cheek On the ear lobe, at , Removing obstruc-
posterior and superior tions from the
aspect of Eye. I meridians on facial
region.
Indications: facial par-
alysis and other facial
problems.
Tongue In the centre of 2nd 1 Clearing up heart fire.
section of lobule. Indication: glossitis.
I
Jaw

Section 4 of Ear
1
In the centre of 3rd Toothache, submandi-
section of lobule. bular arthritis, etc.
1

Neurasthenic In the 4th section o f , Communicating water

Lobe Point ear lobe. with fire, tranquilizing
heart and easing mind.
 Chinese Acupuncture and Moxibustion

Indications: tooth-
ache, neurasthesnia.
In the 5th section of Brightening vision.
ear lobe. Indications: acute con-
junctivitis, electric
ophthalmia, myopia
2nd ether eye diseases.
Internal Ear In the 6th section of Relieving vertigo and
the ear lobe. improving hearing.
Indications: tinnitus,
impaired hearing,
auditory vertigo, etc.
Tonsil In the 8th section of Relieving throat
the ear lobe. problems.
Indication: acute
tonsillitis.
Upper Root of Middle Stasis At the upper border of Relieving pain and
Auricle or Spinal theauricularroot. asthma.
Cord Indications: headache,
abdominal pain,
asthma.
Lower Root of Spinal Cord On the lower border o f Relieving pain and
Auricle the juncture between asthma.
the ear lobe and the Indications: headache,
cheek. ' abdominal pain,
asthma.
Root of Auricular At the junction of Openning orifice and
Vagus Norve retroauricle and mas- relieving pain, easing
toid, level with helix zang-fu organs.
crus. Indications: headache,
nasal obstruction, as-
cariasis of bile duct,
etc.
Back Auricle Groove of Inferior Groove for Through the backside Pacifying liver and
Helix Crus Lowering of superior antihelix descending reversing
Blood crus and inferior anti- qi of the liver, relieving '

Pressure helix crus, in the skin disease.

depression as a "Y" Indications: hyper-
form. tension, skin diseases.
\

Heart At the upper back of Clearing and reducing

the ear. heart fire, tranquiliz-
ing heart and easing
I mind, relieving pain.
I I Indications: furuncles,
Ear Acupuncture Therapy
I
insomnia, dream-
disturbed sleep, hyper-
tension, headache. etc.
Spleen in the middle at the1 Building up spleen and
harmonizing stomach,
producing ying-blood
and nourishing
muscles.
Indications: ab-
dominal distension,
diarrhoea, indigestion,
etc.
Liver On the back of ear, Removing liver-qi
lateral aspect stagnation and har-
Spleen. monizing stomach,
nourishing tendons.
and activiating blood
circulation.
Indications: distension
and fullness of chest
and hyperchondriac
region, acute appendi-
citis, soreness and
aching of the lower
back, etc.
Reinforcing lung and
Lung On the back soothing asthma,
of the ear, at clearing up heat,
medial aspect relieving problems of
of Spleen. skin and hair.
Indications: asthma,
diseases and symp-
toms of digestive sys-
tem, fever, etc.
Kidney At the lower Nourishing kidney
part of the water, improving hear
retroauricle. ing, strengthening
bone, filling up
marrow.
Indications: headache,
insomnia, dizziness,
vertigo, irregular
menstruation.
 Chinese Acupuncture and Msxibustion

3. Examination Methods acupuncture anesthesia. This chapter

of Ear Acupuncture mainly deals with its application to clinical
treatment and disease prevention.
When an internal organ or a part of the
body is diseased, reactions can be detected
at the corresponding areas on the auricle. 1. Principles for Seiection of Points
For example, a reaction can be detected at
Point Stomach when the stomach is ill. Point selection can be on the following
Clinical practice has proven that bases:
stimulating these reaction points yields 1) Selection sf points according to
good therapeutic results. Therefore,
,
disease Location Auricular points corres-
detecting reaction points should be ponding to the diseased areas are selected
combined with consulting an auricular for treatment, e.g. Point Stomach for
acupoint chart in the application of ear gastralgia, Point Shoulder for shoulder pain.
acupuncture. The following are commonly 2 Selection of points according to the
used methods of detection: theories of traditional Chinese medicine
I) Detecting the tender spot Press According to the theories of zang-fu or
with a probe or the handle of a filifom meridians and csllaterals, corresponding
needle the disease-related corresponding auricular points are selected for treatment,
area, to ascertain the most sensitive point. e.g. Point Lung can be selected for skin
2) Observing by naked eye Look for diseases because the lung domimtes the skin
any abnormality or discolorat'ion of the and hair; Point small Intestine for arrythmia
auricle such as scaling, blisters, papulae, as the heart is exteriorly-interiorlyrelated to
hard nodules, pigmentation, or morpholo- the small intestine; Point Gallbladder for
gical changes such as in blood vessels of temporal headache as the temporal region is
the auricle. supplied by the Gallbladder Meridian of
3) Detecting electrical changes Obser- Foot-Shaoyang; Point Liver for pain,
ving changes in electrical resistance, redness and swelling of the eyes, since the
capacity, and potential at auricular points. liver opens to the eyes.
The most commonly used method is to 3 Selection sf points according to
determine the conductant point of skin clinical experience e.g. Point Ear Apex can
resistance by instrument. Those auricular be selected for pain, redness and swelling of
points with low electrical resistance can be the eyes; Points Helix 2,4, and 6 for pain and
displayed on a screen, or by an indicator, swelling of the throat.
or by sound, through the apparatus. This
is used for clinical diagnosis.
2. Manipulation Methods of Ear
Acupuncture
1 . CLINICAL APPLICATION
OF EAR ACUPUNCTURE Different methods have been developed
on the basis of filiform needling, such as
Ear acupuncture is used for prevention embedding needles and needling with .
and treatment of disease, and also for electrical stimulation. However, filiform
Ear Acupuncture Therapy

needling remains the most widely used. 2 Migraine Selection of points: Fore-
The technique is performed as follows: head, Temple, Occiput, Ear-Shenmen.
1) Probing the sensitive spot and aseptic Secondary points: Neck, Heart, Liver,
After diagnosis and point Ear Apex and Helix 6. Apply electric
prescription detect the sensitive spots by acupuncture once every other day. Select 3
probing or by an electric acupoint detector. to 5 points for each treatment. During an
When tenderness or low electrical resistance attack, bloodletting on Helix 6 and Ear
areas are found, then mark the spot for Apex can be added.
needling. Auricular points should be 3) Stiff neck Find tenderness or most
swabbed with 75% alcohol or 20% iodine as sensitive spot at Forehead and Cervical
routine asepsis. Vertebrae. Apply strong stimulation.
2) Method of needle insertion Stabilize Needles are retained for 60 minutes, during
the auricle with the left hand. Hold the which the patient should exercise the neck by
filiform needle of 0.5 or 1 cun with the right moving it about. Apply needling plus
hand and insert swiftly and perpendicularly moxibustion on the tender spot of the neck
into the point avoiding penetration through region. Alleviation or subsidence of pain
the ear. Generally, a sensation of pain, and may be expected. Treat once daily.
occasionally heat, distension, soreness, or 4) Acute sprain Selection of points:
heaviness are felt. Patients experiencing Ear-Shenmen, Brain, and Tender spots
these sensations usually obtain satisfactory corresponding to sprained areas. Apply
therapeutic results. If acupuncture sensation strong stimulation with filiform needle.
does not appear, then the direction of Needles are retained for 30 to 60 minutes,
needling should be adjusted to obtain treat once daily. After needle insertion,
sensation. patient may have congestion or heat
3) Retention and removal of sensation of the auricle; the patient should
needles Needles are usually retained for 25 then exercise the affected area. At the same
to 30 minutes, but in cases with severe pain time, warm moxibustion or massage can be
or chronic seizures, needles may be retained added to enhance the therapeutic effect.
for a longer period, or needle embedding 5 ) Sciatica Selection of points: Ischium.
may be applied. After the needle is removed, Puncture the affected side first. If there is not
press the puncture hole with a dry cotton much improvement, needle the same
ball to avoid bleeding, swab with iodine at auricular point of the healthy side. Apply '

once to avoid infection. strong stimulation. Needles are retained for

1 to 2 hours, treat once daily or every other
day.
3. Prescriptions for Common Diseases 6) Phantom limb pain Selection of
points: Ear-Shenmen, Forehead, Brain,
1) Headache Selection of points: Fore- other auricular points of corresponding
head, Occiput and Brain, Middle Border, - areas. Several needles may be inserted at one
Ear Apex. Apply strong stimulation with point. Give strong stimulation with a
filiform needles. Needles are retained for 30 filiform needle. If necessary, treatment can
to 40 minutes. Ten treatments constitute a. be increased twice or three times per day,
course. with 3 to 5 days constituting a course.
508 Chinese Acupuncture and Moxibustion

7) Postoperative incision pain Selection administered.

of points: Ear-Shenmen, Brain, Ear Apex, 2 Colic pain due tap ureteral calculus
Lung and other ear points corresponding to Selection of points: Kidney, Abdomen, End
operative incision. Apply strong stimulation of Inferior Antihelix Crus and Brain.
with a filiform needle or electric Puncture the affected side first, then the
acupuncture. Needles are retained 1 to 2 healthy side. If there is not much relief, apply
hours, treat once daily. strong stimulation with ieteiiiioii of needles
8) Postoperative abdo&nal Bieteosion for 20 to 40 minutes or with electric
Selection of points: Large Intestine and acupuncture.
Small Intestine, Stomach, End of Inferior 13) Pain caused by cancer OK tumor
Helix ems, and Spleen. Apply strong Selection of points: Brain, Heart, Ear Apex
stimulation with intermittent rotation of and other auricular points corresponding to
needles or with electric acupuncture. the pathological areas.
Needles are retained for one to two hours. Secondary points: End of Inferior
9) Perifoed inflammation of the Antihelix Crus, Liver and Ear-Shenmen.
shou%der Selection of points: Shoulder, Choose 4 to 6 points for each treatment; use
Clavicle, Infra Tragic Apex. both sides alternatively.Treat once daily. Or
Secondary points: Liver, Spleen and apply acupoint ,injection with 0.1-0.3 ml
Brain, Tender spots in the cavum conchae. Dolantin subcutaneously and obliquely
Treat once daily with a filifom needle or from Ear-Shenmen to the anterior and
eiectric acupuncture. Choose 3 or 4 points inferior aspect of this point. Afier injection,
for each treatment. Treatment course varies remove the needle slowly in order to avoid
according to the individual disease the out flow of drug from the needle hole.
condition. 14) Transfusion reactism Selection (of
10) Acute e~olecystitis and. gallstones points: Ear-$henmen, Pnfratragic Apex and
Selection of points: Penetrating the right Brain. Apply strong stimulation with a
Ear-Shenmen towards Abdomen, End of filiform needle. Continue the retenton of
Inferior Helix Crus and Gallbladder; needles for 30 minutes after the stopping of
penetrating Gallbladder 0.2 cm below chills.
towards Duodenum, and the left Gallblad- 15) Acute bacterial dysentery Selection
der penetrating towards Duodenum. Give of points: Large Intestine, Small Intestine
electric stimulation for 20 to 40 minutes once and Lower Portion of Rectum. Apply strong
a day. Three to 5 treatments are considered stimulation with a filifom needle. Treat
as a course. once or twice a day for 3 to 7 days.
11) Ascarisasis in the b%ary duct 16) Tertisn malaria Selection of points:
Selection of points: Liver, Gallbladder, lnfratragic Apex, Brain and Intertragus.
Duodenum and Root of Auricular Vagus Treat once daily or every other day or two
Nerve. Puncture right side first. Stimulate hours before estimated time of attack.
left side if there is not much improvement in Retain needles until the attack is over.
pain. During retention, rotate the needles Rotate the needles twice or three times
once every five to ten minutes. After during retention.
abdominal pain stops, western medication 17) Epidemic parotitis (mumps)
or Chinese medicinal herbs shou%d be Selection of points: Antitragic Apex,
Ear ~ c u ~ u n c t uTherapy
re

Cheek, Subcortex and Brain. Apply strong needle, electric acupuncture or needle
stimulation with a filiform needle. Treat embedding can be used according to
once or twice daily. Three days constitute a different conditions. Treat once daily or
treatment course. Scorching moxibustion every several days. Choose 4 or 5 points for
with oily herbal lampwick also can be each treatment. Ten treatments are
applied on Ear Apex or between Small considered as a course. A one-week rest
Intestine and Kidney. Moxibustion can be interval is instituted between courses.
applied on the affected side for swelling of 22) Hiecough Selection of points: Sensi-
one side, or bilaterally for mumps of both tive spots near Middle Ear or Root of
sides. Moxibustion is given once a day until Auricular Vagus Nerve. Puncture with
swelling subsides. strong stimulation. For refractory cases
18) Bronchial asthma Selection of needle embedding is applied following
points: Lung, Trachea, Infratragic Apex, filiform needling.
Antitragic Apex and Ear-Shenmen. 23) Vomiting Selection of points: Stom-
Secondary points: Root of Auricular ach, Liver, Spleen and Ear-Shenmen. Treat
Vagus Nerve, Kidney, Sanjiao and Large once daily, for severe cases twice or three
Intestine. Apply strong stimulation with a times per day. One course is composed of 3
filiform needle. One treatment is given daily to 5 treatments. Use mild stimulation during
during an attack. Choose 4 or 5 points early stage of treatment.
bilaterally or unilaterally for each treatment 24) Chronic gastiitis Selection of
with retention of needles for 30 minutes. points: Stomach, End of Inferior Antihelix
After the stabilization of condition, Crus and Lung.
treatment is reduced to once every other day. Secondary points: Liver, Spleen, Mouth
During remission needle embedding can be and Intertragus. Embedding method with
applied to consolidate effectiveness. herbal seeds or any kind of granules is
19) Acute bronchitis Selection of points: applied after filiform needling or electric
Lung, Trachea and Ear-Shenmen. acupuncture. Needle once daily with 3 to 5
Secondary points: Occiput, Infratragic points each time.
Apex and Root of Auricular Vagus Nerve. 2 Gastric or duodenal ulcer Selection
Treat once daily or every other day with a of points: Stomach or Duodenum, End of
fiiiform needle. Choose 3 or 4 points Inferior Antihelix Crus, Brain and Mouth.
bilaterally for each treatment. Secondary points: Sanjiao, Ear-Shen-
20) Paroxysmal tachycardia Selection men, Liver, Spleen and Middle Ear. Filifom
of points: Heart, End of Inferior Antihelix needling is applied at 3 to 5 points each time.
Crus, Ear-Shenmen and Brain. Apply mild In the acute stage treat once daily, and
stimulation. Retain needles for 30 to 60 during remission once every other day.
minutes. Rotate needles twice or three times 24) Acute diarrhoea Selection of points:
during needle retention. Treat once daily. Large Intestine (puncture three needles) and
21) Hypertension Selection of points: Stomach. Stimulation is given according to
Infratragic Apex, Groove of Inferior the patient's constitution. For severe cases
Antihelix Crus, Helix and Ear-Shenmen. treat once every 2 to 4 hours, and reduce to
Secondary points: Intertragus, Fore- once every other day or twice a week after
head, Temple, Liver and Kidney. Filiform relief of symptoms. Retain needles for 30
'
 Chinese Acupunctu~eand Moxibustion

minutes. to different symptoms. For aphasia add

27) Enuresis Selection of points: Kid- Heart and Spleen, and for dysphagia add
ney, Bladder, Liver and Brain. A filiform Mouth, Root of Auricular Vagus Nerve,
needle or electric acupuncture is applied at 3 and Throat. Treat once every other day after
or 4 points for each treatment. Treat once stabilization of diseased condition and
daily or once every other day, and reduce to recovery from unconsciousness. One course
once a week after therapeutic effect is stable of treatment is cnmposed nf 1 in 20
28) Neuaasthemia Selection of points: sessions.
Ear-Shenmen, Heart, Brain and Middle 32) Dysmenorrhea Selection of points:
Border. Depression in Triangular Fossa, Intertragus
Secondary points: Kidney, Liver and and Root of Auricular Vagus Nerve. Choose
Intertragus. Apply mild stimulation with a on2 or two pairs of points and treat once
filiform needle or electric acupuncture once daily by strong stimulation with a filiform
daily. Choose 4 or 5 points and use needle or electric acupuncture. Retain the
alternatively at each treatment. needles until acute pain is relieved.
29) Hysteria Selection of points: Heart, 33) Func$iassaall bleeding s f uterus
Brain, Occiput and Middle Border. Principal points: Depression in Triangular
Secondary points: Liver, Intertragus. Fossa, Hntertragus and Ear-Shenmem.
Eas-Shenmen and other corresponding Secondary p i n t s : Spleen, Brain, Liver
points. During an attack apply strong and Middle Ear. Treat once daily with a
stimulation with a filiform needle or electric ' filiform needle at 3 to 5 points. Retain the
acupuncture. Choose 3 or 4 points on both needles for 30 to 40 minutes. Ten treatments
ears according to different symptoms. constitute one course.
Retain the needles for 20 minutes. Treat 3 4 ImsufEdemt Ractati~m Selection of
once every other day. Ten treatments points: Puncture the most painful spot at
constitute a course. Mild stimulation should Chest with mild sGmulation. Retain the
be given during the recovery stage. needles for 15 minutes. Treat once or twice
30) Fsdal neuritis Selection of points: daily for B to 3 days.
Eye, Cheek, Liver and Mouth. 35 g of the s k i Selection of
Secondary points: Spleen, Forehead, points: Ear-Shenmen, Lung, Brain, In-
Ear-Shenmen and Infiatragic Apex. During fratragic Apex and Interior Tubercle.
acute stage apply mild stimulation with a Secondary points: Liver, Spleen, Heart,
filiform needle to 3 to 5 points on the Intertragus, Pancreas and Gallbladder.
affected side for each treatment. After being Treat once every other day by filidbrm
treated forsseveral days, change to electric needling or electric acupuncture. Choose 3
acupuncture with low frequency or dense- to 5 pairs of points at each treatment, five to
dispersion wave-form. Treat once daily or ten treatments constitute a course. If it is
once every other day. necessary to continue the treatment, one
3 Sequelae of cerebra~vascularaccident week of rest should be instituted after one
Selection of points: Brain, Middle Border, course of treatment. Ernbedding method
Liver, Sanjiao, and other auricular pdints with herbal seeds or other granules is also
corresponding to the paralytic sides of the applicable once every week.
body. Secondary points are added according 36) Urticaria Selection of points:
Ear A c ~ ~ p u n c t u Therapy
re

Interior Tubercle, Infratragic Apex, Anti- subsidence.

tragic Apex and Liver. Apply strong 41) Acute conjunctivitis Selection of
stimulation with a f'iliform needle. Treat points: Bloodletting ori Ear Apex or s n
once daily or every other day. Ten minor veins of retroauricle. Treat once or
treatments are considered one course. twice daily. Or puncture Eye, Ear-Shenmen
Severe itching may be treated twice or thrice and Ear Apex with a filiform needle and
per day. For chronic urticaria, patients strong stimulation. Retain the needles for 30
should persist in a prolonged course of minutes.
therapy. 42) Electric sphthalmalgia rand snow
37) Weara~dermsatitis Selection of points: blindness Selection of points: Puncture
Lung, Infratragic Apex, Intertragus and Eye with a filiforrn needle and strong
other corresponding points. Treat once daily stimulation. Retain the needle for 15 to 30
or every other day. Retain the needles for minutes. Or use electric acupuncture on Eye,
one to two hours. Needle embedding is also Liver and Kidney for 15 to 20 minutes.
applicable. For severe itching treatment may 43) Congestive glaucoma Selection of
be applied twice daily. One additional points: Bloodletting on Groove of Lower-
course of treatment should be administered ing Blood Pressure or Ear Apex. Treat once .
after symptoms are controlled in order to daily or every other day. Or select Eye,
consolidate the therapeutic effect. Liver, Anterior Tragic Notch or Posterior
38) Herpes zostea Selection of points: Tragic Notch. Use filiform needles or
Lung, Brain, Pntertragus and other embedding granules at these points.
corresponding points. Apply strong stirnula- 44) Timaitus and impaired hearing
tion with a filiform needle. Retain the Selection of points: Ear, Liver and Kidney,
needles for two hours. Treat once or twice unilateral or bilateral. Apply strong
daily, and reduce to once every other day stimulation with a filiform needle or electric
after relief of symptoms. Ten treatments acupuncture once daily or every other day.
constitute a course. Retain the needles for 30 to 60 minutes. One
39) Veiraraca plawa Selection of points: course consists of 15 to 20 treatments.
Ear-Shenmen, Lung, Brain, Large Intestine, 45) Acute tomsiUitis Selection of points:
Occiput and Intertragus. Use needle Bleeding the veins s f retroauricle Ear Apex,
embedding at two or three points for each qr Helix 3,4, and 6 once every day. Or
treatment. Retain the needles one to three needling Throat and Helix 4 and 6 with
days. Ten treatments constitute one course. strong stimulation once or twice per day.
40) Stye Selection of points: Ear Apex. Retain the needles for one hour. Needle
Apply strong stimulation with a filiform embedding can be added after filiform
needle. Retain the needle for 15 to 20 needling.
minutes. Treat once or twice daily. Or select 46) Hoarseness Selection sf points:
Anterior Tragic Notch, Posterior Tragic Lung, Throat, Neck, Trachea, Heart, Large
Notch and Liver of the affected side. Electric Intestine and Kidney. Apply mild stimula-
acupuncture is applied once daily with tion at 2 or 3 pairs of points. Five treat-
retention of needles for 15 to 20 minutes. ments compose one course.
Treatment should be administered promptly 47) Toothache Selection of points:
after the onset of stye, to ensure swifter AIsgly strong stimulation at Ear Apex with a
512 Chinese Acupuncture and Moxibustion

filiform needle. Retain the needle for 20 and appropriate measures should be taken
minutes. Or apply strong stimulation at such as applying 2% iodine or orar
Cheek with a filiform. needle. Retain the administration of anti-inflammation drugs.
needle for 30 minutes. Needling is contraindicated if frost-bite or
inflammation is present on the auricle in
order to avoid diffusion or inflammation.
3. E?r mupula_c'.furp1s E Q ,1ldy1~~&
~ fCPr
women during pregnancy if there is a history
1. If sudden dizziness, nausea, stuffiness of miscarriage. Aged and weak patients with
of the chest or other fainting symptoms oc- hypertension and arteriosc~erosis should
cur during treatment, the patient should be have proper rest before and after needling.
managed in the same manner as during 4. While there are extensive indications
ordinary body acupuncture. During initial for ear acupuncture, it still has its
visits, patients should be in a reclining limitations. The therapeutic effects for some
position in order to avoid fainting. diseases are not satisfactory, or only
2. Strict antisepsis is necessary to avoid symptomatic relief is achieved, therefore, in
infection of the auricle. In case of treating some disorders, it is necessary to
inflammation or redness of the needle hole combine some other therapies.
or distension and pain of the auricle, timely
 ACUPUNCTURE ANALGESIA

Acupuncture analgesia (abbreviated to therefore, is more suitable to the aged

A.A.) is an analgesic method built on the patients with weak constitution, and the
basis of relieving pain and regulating the patients with cardiac, pulmonary, hepatic or
physiological {unction of the human body renal condition and those who are too sick to
by needling. The procedure produces an sustain drug anaesthesia.
absence of pain by stimulating certain points
when the patient undergoes an operation in
full consciousness. It is considered an 2. Reduced Physiological Disturb.ance
important achievement in the successful and Rapid Recovery
integration of traditional Chinese and
Western medicine. As acupuncture functions to regulate the
physiological condition of the human body,
doctors are able to take immediate measures
1. THE CHARACTERISTICS OF with acupuncture according to the
ACUPUNCTURE ANALGESIA subjective signs of the patient to avoid the
physiological disturbance caused by severe
pain. Blood pressure, pulse and respiration
rates during the operation remain relatively
I. Safe in Wide Indications
stable in most cases. After the operation,
patients' physiological state remain normal,
Extensive clinical practice has proven that as manifested in early regaining of appetite
is c o m ~ l e t e lsafe-
~ and ambulatory activities, and satisfactory
of 'perations with healing of wound. All these are conducive to
acupuncture analgesia have been carried out . an early recovery.
in China and none of them led to death
attributed to needling. Acupuncture anal-
gesia does not produce any side-effects and 3. Subjective Cooperation of the Patient
accidents which might happen when drug and Improvement of Operative Results
anaesthesia is employed. What is more, it
does not result in respiratory tract infection, The patient under acupuncture analgesia
gastrointestinal dysfunction, abdominal is mentally alert and able to communicate
distension and retention of urine. It, with the surgeons. This enables the surgeon
 Chinese Acupuncture and Moxibustion

to judge operative results as the operation retraction of internal organs in an

proceeds. During thyroidectomy, for introabdominal operation. In this case,
instance, the patient's phonation may be administrating a small dose of anesthetic
tested; in total laryngectomy, the swallowing drug or puncturing some acupoints will
movement can be checked; in eye surgery for relieve the pain and discomforts of the
strabismus, eyeball movement can be patients.
bA
5 w,,,,,,
,bU
n 12 ainputzatioii of i-iigemiwai
f ,9 4 ; ~ ~ ~ .

sensory root and craniocerebral operation,

the limits of facial anesthetic region can be 11. PREOPERATIVE
observed. The close coordination between PREPARATIONS FOR
the patient and surgeon ensures the desirable ACUPUNCTURE ANALGESIA
operative results.

4. Simple Apparatus and Easy 1. Explanatory Work to the Patient

to Popularize
Acupuncture analgesia does not require As the patient under acupuncture
any sophisticated medical equipment and is analgesia is mentally alert during the
not restrained by preferential environment. surgical operation, it is essential to consider
The only requisites for success are to observe his attitude toward acupun6ture analgesia
ar?d his ~ W i P d dbehavicir beeaiisc these
the patient's pain endurance carefully, select
well-indicated cases, locate the points may affect \his physiological function, pain
accurately and puncture skillfully. The endurance and ability to accept the
practice across the nation has proven that operation. It is necessary to let the patient
acupuncture analgesia is more practical in know in detail the characteristics, methods,
backward regions where emergency surgery process, effects of acupuncture analgesia,
is possibly delayed due to lack of necessary the operative procedures, and the reaction
medical equipment. and sensation caused by needling. It is also
Acupuncture analgesia was created in the important to make the patient mentally
1950's in China. With researching for more relaxed so that he can cooperate with the
than twenty years, some noteworthy surgeons to ensure the successful operative
experiences have been accumulated. Like results.
any other science and technology,
acupuncture analgesia has a long way to go
from imperfection to perfection. Though the 2. Preliminary Test of Needling
mechanism of acupuncture analgesia has and Pain Endurance
been preliminarily outlined, further studies
are still needed to reach a thorough Before acupuncture analgesia, one or
explanation. Acupuncture analgesia is able more points may be selected on the body of
to raise pain threshhold and endurance, but the patient for preliminary test of needling.
there still exist some drawbacks, such as With this, the patient can experience the
incomplete analgesia and muscular tension needling sensation, free his nervousness
which is likely to cause discomforts due to from acupuncture analgesia and adapt
Acupuncture Analgesia

himself to the needling stimulation. On the 111. PRINCIPLES OF

other hand, when he knows the tolerance of SELECTING POINTS FOR
the patient, the surgeon can decide the
method and intensity of stimulation in the ACUPUNCTURE ANALGESIA
operation. Also, physical or chemical
stimulation can be applied to measure the Since it is through stimulating certain
patient's pain endurance. Anyway, the particular acupoints of the body that the
purpose of pain endurance test is for precise acupuncture analgesia works, it is important
determination of the stimulation intensity in for the operators to be well versed in the
acupuncture analgesia. appropriate needling stimulation as well as
the accurate point location.
The commonly used methods in selecting
3. Practice of Deep Breathing points are summarized as follows:

1. Selecting Points According to the

Instruct the patient under thoracic-
Theory of Meridians
abdominal operation to practise slow, deep
abdominal breathing before operation. It
can relieve stuffiness of the chest, heavy Traditional Chinese medicine holds that
sensation and dyspnea after the chest is the twelve regular meridians connect
opened up. In abdominal surgery, deep interiorly with the zang-fu organs and
breathing helps to ease the patient of the exteriorly with the four limbs. Each of the
meridians has its own pathway and connects
muscular spasm, nausea and vomiting
caused by retraction of internal organs. with the other in view of the exterior-interior
relationship. The method of selecting points
along the meridians is therefore based on the
concept embodied in the theory of the
meridians "where a meridian traverses, there
4. Preoperative Plra of Acupuncture is a place amenable to treatment.m
Analgesia

2. Selecting Points According to

The close cooperation between the Syndrome Differentiations.
acupuncturists, surgeons and nursing staff is
indispensable for successful operation with Traditional Chinese medicine emphasizes
acupuncture analgesia. The patient's the concept of the organic integrity of the
psychological state, case history and focus of human body. When any portion of the body
infection should be brought to thorough is diseased, various symptoms and signs may
analysis and discussion. Prediction of the be manifested through the meridians
problems possibly occuring under operation connecting with that portion. In acupunc-
and corresponding emergency measures will ture therapy, it is important to apply the
guarantee a safe operation on a fully theory of zang-fu organs and theory of
conscious patient. meridians to syndrome differentiations, so is
 Chinese Acupuncture and Moxibustion

it in acupuncture analgesia. Before selecting instance, Hegu (L 1 4) and Neiguan (P 6) are

the points, symptoms and signs of a disease points of the adjacent segmentation in
must be differentiated and then their thyroidectomy, while Neiting (S 44) and
relation with the zang-fu organs and Zusanli (S 36) are points in the remote
meridians be found out. Attention should segmentation. Futu (L H 18) is regarded as a
also be paid to the patient's responses that point for direct stimulation of the cutaneous
may be elicited in the operative procedure. cervical nerve plexus, known as stimulating
For example, in the chest operation, the the nerve trunk within the same
patient is likely to experience palpitation, segmentation. The implication of selecting
shortness of breath and anxiety in the points in the adjacent and remote
preoperative period or during the operation. segmentation in acupuncture analgesia is
According to the theory of traditional different from that of selecting the
, Chinese medicine, these symptoms are neighbouring and distal points in acupunc-
caused by the disturbance of heart qi. Thus, ture therapy. The latter only denotes the
Ximen (P 4) and Neiguan (P 6) are usually relative distance between the location of the
selected to tranquilize the heart, sedate the points chosen and the affected area to be
mind and regulate the heart qi. treated. Selecting points f a - from the
affected site is known as the method of
selecting distant points, while selecting
3. Selecting Points Aceording to points near the affected site is known as the
Segmental Innervation method of selecting adjacent points. Neither
method is related to segmental nerves of the
Clinical practice and scientific experi- puncturing site and operative site. For
ments with acupuncture analgesia show that example, for analgesia in thyroidectomy ,
the nervous system is involved in pain Hegu (L 1 4) and Neiting (P 6) are chosen as
suppression and physiological regulation of adjacent points according to segmental
acupuncture analgesia. In other words, the innervation; but from the point of view of
functional integrity of nervous system is a the relative distance between these points
prerequisite to produce needling sensation and the operative site on the neck, they are
and analgesic effect. Based on the relation of considered as distant points.
the segmental innervation between the
puncturing site and the operative site, there
are three 'ways to select points, i.e. 1) 4. Selecting Auricular Points
selecting points in the adjacent segmenta-
tion, or in an area that is supplied by the This is .to select the corresponding
same spinal nerve or an adjacent nerve that auricular areas according to the operative
supplies the operative site; 2) selecting points site and its involved internal organs. For
in a remote segmentation, that is in an area example, auricular Stomach Point is chosen
not supplied by the same or adjacent spinal for subtotal gastrectomy. Auricular points
nerve of the operative site; 3) stimulating the are also selected according to the theory of
nerve trunk within the same segmentation, zang-fu organs. For instance, "the lung
that is to stimulate directly the peripheral dominates skin and hair; and Lung Point is
nerve which supplies the operative site. For often chosen in various operations; while the
Acupuncture Analgesia

kidney dominates the bone," and Kidney needle, and the current will get through to
Point is often selected in orthopedic surgery. the body. Clinically, the electric pulsating is
Moreover, reaction spots on the auricle divided into continuous, sparse-dense and
may be selected as well. When an internal intermittent three kinds, mostly in the form
organ or area of the body is affected, some of biphasic spike or rectangular wave 0.5 to 2
reaction spots with tenderness, reduction of msc. in width. But biphasic sinusoid or
electro-resistance, deformation of auricular irregular sound wave may also be used. The
structure and discoloration may occur on frequencies of electric pulse are of two kinds:
the corresponding auricular areas. These two to eight times per second and forty to
reaction spots may be chosen for acupunc- two hundred times per second. The
ture analgesia. stimulation force should be adjusted
According to therapeutic experience, Ear- according to the patient's tolerance.
Shenmen and Inferior Crus, i.e. Sympathetic Generally, acupuncture analgesia requires
Nerve Point are effective for sedation and powerful stimulation which may be
pain suppression. They are therefore widely increased gradually up to the highest limit,
used in auricular acupuncture analgesia. the one which the patient can stand. Each
time of continuous electro-stimulus can not
be too long, in case it produces too much
stimulation to destroy patient's needling
IV. MANIPULATION sensation. If a longer electro-stimulus is
TECHNIQUES needed, the intermittent electric pulsating
can be selected. The stimulation should be
Based on the arrival of qi, hand- started from zero and added to the desired
manipulation and electro-pulsating stimula- level gradually and when it is turned down, it
tion are commonly used in acupuncture should be reduced slowly. It is not advisable
analgesia. to produce abrupt stimulus, which may
make the patient unbearable.

1. Hand Manipulation
3. Induction and Retaining
This is the basic stimulative method. Even of the Needle
if electro-stimulation is applied, it is also
started with hand manipulation. The Needling or electric stimulation manipu-
electro-apparatus is not employed until the lated on the selected points for a desirable
patient feels the needling sensation. Wand length of time prior to the operation is
manipulation is to lift-thrust and twist- known as induction. The intensity of
rotate needling stimulation should be proper and
2. Electric Stimulation induction period is about twenty minutes, or
longer if the result of pain endurance test is
After the desired needling response is unfavourable. By means of induction, the
obtained by the hand manipulation, the patient may adapt himself to the stimulus of
outlet of the electric acupuncture apparatus acupuncture analgesia. At the same time, it
is attached to the handle of the filiform can also regulate the function of various
 Chinese Acupuncture and Moxibustion

internal organs of the body, preparing the children subcutaneously or intramuscularly;

patient for surgical operation. At certain Hyoscine is given 0.3 mg for adults
operative stages when the operative stimulus subcutaneously or intramuscularly with the
is mild, hand manipulation may be stopped exception of the aged and infants.
or the current for electric stimulation cut off. 2. Adjuvants during operations: Some
This is so called retaining of the needle. proper adjuvants are given according to
nr Un fyiLnLr nU +L;Lnuml Ln D n-A A; rLva-+
Bei"zlrelkle zlpzra:;on prszeer2sts a zlf
iFF;Wa~c.w~f n f ~ml an
U I L L b L b L L L DLUfjbr) U L U L L U U l l l L lL l l L

vigorous stimulation, it is necessary to reactions the patients .show. Adjuvants for

restart the hand manipulation or electric local analgesia are mainly administered,
stimulation so as to maintain and strengthen for instance, Neocaine (Procaine Hydro-
the analgesic effect. chloride), Lidocaine (Xylocaine), Dicaine
(Pantocaine), etc., for local infiltration and
blockage. The amount of the adjuvants
being used should be as small as possible so
V. ADJUVANTS as to lessen patients' discomforts. Heavy
doses of some sedatives will not only do
In order to enhance the effect of harm to the health of the patient, but also
acupuncture analgesia and guarantee the cause unconsciousness or hybnotism. The
operation to go on smoothly, some patient will be unable to communicate and
adjuvants in small doses should be given to cooperate with the surgeons, and thus the
aimosi every case of acupuncture analgesia. result ef the zcupunctiire znalgesia a d the
Though some operation with acupuncture operation will be affected.
analgesia can be done without the help of
any adjuvants, the analgesia effect will be
more favourable if small doses of adjuvants VI. REMARKS
are administered before or during the
operation. 1. Because the patient is fully conscious
1. Adjuvants for preoperative administra- during the operation under acupuncture
tions: Usually Dolantin is given intra- analgesia, surgeons should preoperatively
muscularly or dropped intravenously fifteen make the whole procedure of the operation
to thirty minutes prior to an operation, known to the patient so as to gain the
generally 50 mg dose each time for adults, patient's cooperation. Surgeons should
and 0.5 mg each kg body weight for children. have an amiable attitude, well-prepared
When necessary, Promethazine (Phenergan) measures, observing blood pressure, pluse .
is added at the same time, 25 mg for adults, and respiration rate attentively during the
and 0.5 mg each kg body weight for children; operation, and reducing the patient's
or Chlorpromazine (Wintermin) 12.5 mg for discomforts as far as possible.
adults, and 0.5 mg each kg body weight for 2. The patient's chief complaint should be
children. attended during the operation. When
Atropine and Hyoscine (Scopolamine) discomfort occurs, appropriate measures
are used in order to keep the respiratory should be taken in time to relieve it, and the
tract unblocked. Atropine is given 0.5 mg for patient should be comforted to maintain his
adults, and 0.01 mg each kg body weight for confidence. The amount of the adjuvants
Acupuncture Analgesia 519

should be proper, either overdose or under- subcutaneously in the incision region before
dose is harmful to the patient's health or to the skin incision in some operations.
the preceeding of the operation. - 4. Patients may r-gain appetite and
3. In order to promote the effect and ambulatory activity soon after an operation
lessen the subcortex bleeding, an appropri- under the guidance of the medical workers
ate dosage of physiological saline with the besides general nursing care, and-those are
addition of a little adrenal may be used conducive to an early recovery.

SOME EXAMPLES OF SELECTING POINTS FOR ACUPUNCTURE ANALGESIA

Operation 1 Selecting Points

Cranial operation A. Xiangu (S 43), Zulinqi (G 41), Taichong (Liv 3),

Quanliao (S I 18). (A11 on the diseased side.)
B. Hegu (L I 4), Neiguan (P 6), Quanliao (S I 18).

Retina ~ e t a c h m e n t A. Negu (L I 4), Zhigou (S J 6). (Both on the diseased

side.)
B. Auricular points: Forehead towards Eye 1 (~nterior.
Intertragic Notch), Eye 2 (posterior Intertragic
Notch), Yangbai (G 14 ) towards Yuyao (Extra). (All
on the diseased side.)

A. Hegu (L I 4) (Bilaterally)
Operations of trichiasis for entropion B. Taichong (Liv 3). Guangming (G 37).
Correction of strabismus A. Hegu (L I 4), Zhigou (S J 6), Yangbai (G 14) towards
Yuyao (Extra), Sibai (S 2) towards Chengqi(S 1). (All
on the diseased side with electric stimulation.)
B. Hegu(k I 4), Zhigou (S J 6), Houxi(S I 3), Jingmen
(G 25).

Cataract couching . A. Hegu(L I 4), Waiguan (S J 5)

towards Neiguan (B 6). (Both, on the diseased side.)
. Hegu(L I 4), Zhigou(S J 6). (Both on the diseased
side.)

Enucleation of eyeball A. Hegu(E 11 4), Waiguan(S J 51, Houxi (S I 3). (All on

the diseased side. If the eyeball is sensitive, administer
1% dicaine for surface anaesthesia during the
operation.)
B. Auricular points: Lung, Liver, Kidney, Eye 1, Eye 2,
Ear-Shemmen, Sympathetic Nerve (Inferior Antihelix
Crus).
--

I
Iridectomy ii
A. Hegu(E I 4), Waiguan (S J 5), Neiting (S 44). (All
 Chinese Acupuncture and Moxibustion

\ bilaterally. At the fjrst two points, give hand

manipulation. For tl-lelast one, retain the needle after
needling sensation is produced.)
1
Shortening of sclera A. Hegu(L 11 4), Zhigou (S J 6), Yangbai(G 14) towards

1 Yuyao(Extra), Sibai(S 2) towards Chengqi(S I). (All

on the diseased side with electric stimulation .)
3. 'rilegu (E P 4j, Zhigou (S .I6j. (Both on rhe diseased side
with electric stimulation.)

Replantation of pterygium A. Auricular points: Eye, Liver. (Both on the diseased

side.)

Exenteration of orbit A. Wegu(L I 4) (Bilaterally), Zhigou (S J 6).

Auricular points: Forehead towards

I Eye I , Ear-Shenmen towards Sympathetic

Nerve. (Both bilaterally.)

Resection of tumour in parotid glands A. Fenglong(S 40), Y angfu(G 38), F u y a b ~(B 591,
Xiangu(S 43), Taichong (Liv 3), Xiaxi (G 43). (All
bilaterally. Needles are retained after needling
sensation is produceQ.)
B. Neiting(S 4413Neiguan(P 6) towards Waiguan(S J 5).

Operation in the submaxillary region A. Fenglong(S 40), Yamgfu(G 38), Fuyang(B 59),
'Taichong(Liv 3), Gongsun(Sp 4), Weiguan(P 6).
(All on the diseased side.)
B. Auricular points: Maxillary, Kidney, Ear-Shenmen
towards Sympathetic Nerve, Lung.

Plastic operation of the tempromendi- A. Fenglong(S 40), Yangfu(G 38), Fuyang(B 59),
bulas joint Taichong(kiv 3), Gongsun(Sp 4), Hegu
(I,14). (The first four points on both sides and the last
two on the diseased side.)
I

Resection of the mixed tumour of

the palate 1 A Hegu(L 1 4), Neiguan(I' 6). Gongsun(Sp 4).

Radical mastoidectomy A. Waiguan(S J 5), Yanglingquan(G 34).

(Both bilaterally with electric stimulation.)
B. Hegu(L 1 4), Zhigou(S 9 6). (Both on the diseased
side.)
Auricular points: Ear-Shenmen, Lung, Kidney,
Ear(Tragion). (All on the diseased side. In the
induction period use the auricular points only.)
I
Operation to expose the tympanic I A. Hegu(L I 4), Houxi(S I 3), Waiguan(S 5 5). (All on
Acupuncture Analgesia

cavity both sides.)

-- -

Tympanotomy A. Hegu(L I 4). (Bilaterally or on the diseased

side.)
B. Waiguan(S J 5 ) towards Neiguan(P 6), Yang-
lingquan(6 34), Hegu(L I 4).

Total laryngectomy A. Auricular points: Ear-Shenmen towards Sympathetic

Nerve, Forehead towards Ear-Asthma(at the apex
of antitragus), Adrenal (at lower tubercle on border
of Tragus), Hegu(L I 4), Zhigou(S J 6). (All
on the left side.)
B. Hegu(L I 4), Neiguan(P 6), Renying(S 9).

Tonsillectomy A. Auricular points: Throat, Tonsil. (Both bilaterally.)

B. Hegu(L 1 4). (Bilaterally).

Tooth extraction A. For upper teeth: Jiache(S 6), Quanliao(S I 18).

t '
i
For lower teeth: Daying(S 5).

Lateral nasal incision A. Hegu(L I 4), Zhigou(S J 6), Juliao (S 3) towards

Sibai(S 2). (All on the diseased side.)

Radical maxillary sinusotomy A. Hegu(L I 4), Zhigou(S J 6). (During the induction
period, Juliao(S 3) towards Dicang is added.)
B. Hegu(1L 1 4), Neiguan(P 6), Neiting(S 44),
Yingxiang(L I 20).

Radical frontal sinusotomy A. Yangbai(6 14) towards Zanzhu(B 2), Juliao

(S 3) towards Sibai(S 2), Hegu(L I 4),
Zhigou(S J 6). (All on the diseased side.)

Nasal polypectomy A. Hegu(L I 4) or Yingxiang(E I 20).

(Bilaterally or on the diseased side.)
B. Auricular points: Lung, Nose, Ear-Shenmen towards
Sympathetic Nerve.

Resection of thyroid adenoma A. Hegu(L I 4), Neiguan(P 6).

B. FutLl(L I 18).
Auricular points: Ear-Shenmen, Lung,
Neck, Endocrine(1ntertragus).

Separation of mitral valve A. Neiguan(P 6), Hegu(L I 4), Zhigou(S J 6).

(All on the diseased side.)

,Resection of pericardium A. Hegu(L I 4), Neiguan(B 6). (Both bilaterally.)

 Chinese Acupuncture and Moxibustion

Pneumonectomy A. Binao(k Y 14). (On ihe diseased side.)

B. Hegu(L 1 4), Neiguan(P 6) or Waiguan(S J 5 )

towards Neiguan (P 6), Sanyangluo(S J 8)

towards Ximen(1P 4).

Gastric operation A. Zusanii(S 36j, Shangjuxu(S 37). (Bilateraliy or on

the diseased side.)
B. Auricular points: Ear-Shenmen, Lung, Sympathetic
Nerve, Gastric. (All on the left side.)

Splenectomy A. Megu(L I 4), Zusanli(S 36), Sanyinjiao (Sp 6),

Taichong(Liv 3). (All on the diseased side.)
B. Auricular points: Lung, Spleen, Sympathetic Nerve,
Ear-Shenmen, Sanjiao.

Appendectomy A. Shangjuxu(Sp 37), Lanwei(Extra). (All bilaterally.)

B. Negu(L I 4), Neiguan(P 6), ~ o n ~ s u d !4).
~p
I
(All bilaterally .)

Merniorrhaphy A. Zusamli(S 34); Weidao(G 28). (Both bilaterally.)

B. Yizrlingqw~(Sp9, 6). (Brat.1_GI?
Szirryifij??-zr>(Sp
the diseased side.)

Cesarean section A. Zusanlli(S 36), Sanyinjiao(Sp 6), Daimai (G 26),

Weirnadian(Extra), located at the midpoint of the line
joining Yinlingquan (Sp 9) and internal malleolus.
(All bilaterally.)
B Auricular points: Ear-Shenmen, Lung, Uterus
(Triangular fossa), Abdomen.

Panhysterectomy with resection A. Yaoshu(Du 2), Mingmen(Du 4), Daimai (G 26),

of appendixes of the uterus Zusanli(S 36), Sanyinjiao(Sp 6), Zhongliao(B 23)
or l o ( 2 (All bilaterally.)
B. Auricular points: Uterus, Lung, Ear-Shenmen,
Abdomen, Endocrine(in cavum conchae), External
Genitals.
- -7

Tubal ligation A. Zusanli(S 361, Foot-Zhongdu(Liv 4). (Both

bilaterally.)
B. ZusanEi(S 361, Sanyinjiao(Sp 61, Daimai(G 26),
Qiecou(peri-incision acupuncture).

Hemorrhoidectomy A. Sanyinjiao(Sp 6), CiIiao(l3 22), Chengshan(B 51).

B. Auricular points: Lung, Lower Portion of Rectum.
(Both on the diseased side with electric stimulation.)
Acupuncture Analgesia

Nephrectomy A. Hegu(L H 4), Neiguan(P 6), Zusanli(S 36),

Sanyinjiao(Sp 6), Taickong(Liv 3). (A11 on the
diseased side.)
B. Auricular points: Ear-Shenmen, Lung, Waist, Ureter.
(All on the diseased side.)

Clore-reduction of shoulder joint A. Auricular points: Shoulder towards Shoulder Joint,

Ear-Shenmen, Sympathetic Nerve, Kidney. (A11 on
the diseased side.)
B. Wegu(L I 4). (Bilaterally.)
Auricular points: Shoulder, Arm. (Both bilaterally.)

Open-reduction of fracture of A. %ianzhen(S1 9), Jianyu(E 1 B 5),

the humerus Houxi (S 1 3), Hegu(E I 4), Neiguan(P 6).
B. Auricular points: Ear-Shenmen, Lung, Arm, Elbow.

Amputation of forearm A. Chize(L 5), QingPing(H 2). (Both bilaterally.)

Internal fixation of fractures of the A. Zusanli(S 36), Fenglong(S 40), Fuyang (B 59),
fen~uralneck with three-flanged nail Waiqiu(G 361, Juegu(Xuanzhong G 39), Sanyinjiao
($a, 6), Qiuxu(G 401, Xiangu(S 43). (A11 sn the
diseased side with electric stimulation.)
B. Auricular points: Ear-Shelamen, Sympathetic Nerve,
Coxa, Ischium Lung, Kidney.

Resection of valvula sernilunaris A. Futu(S 32), Yinlingquan(Sp 9), Yanglingquan(G 34),

and fusion of articnalatio genus Xuehai(Sp lo), Liamgqiu(S 34), Sanyinjiao(Sp 4),
Huantiao (G 381, Fengshi(G 31).
B Auricuhs points: Sympathetic Nerve, Kidney,
Knee, Lung.

Amputation of lower portion of leg A. Huantias(G 30), Zhibian( B 54), Fengshi(G 31),
Yanglingquan(G 34), Uinglingquan(Sp 9),
Sanyinjias(Sp 6).
. Auricular points: Ear-Shenmen, Lung, Kidney,
Jschium towards Sympathetic Nerve. (All on the
diseased side with electric stimulation.)
 BIBLIOGRAPHY

Historical Publications Imperial Encyclopaedia of Medicine

(Ztz!,@\3 >
Huangdi 's Internal Classic ( B???F$93 ) Medical Records as a Guide to Diagnosis
Miraculous Pivot (Z@) (@iiZ%%)
Plain Questions ( %S4 Recipes for Saving Lives (?%&s)
Classic on 81 Medical Problems(/\+-@ Systematic Classic of Acupuncture (R&EQ
gz!) 223)
Classic on Pulse (Btf;22) A Treatise on the Three Categories of
Complete Collection of Acupuncture and Pathogenic Factors of Disease (=a f ~ )
Moxibus tion Ye Tianshi Gynecology ( D t X fBH-)
Synopsis of Prescriptions from the Golden Secrets for Delivery Methods (%ih.~L+k
Chamber (&EZ@).
Treatise on Febrile Disease (B%&) Recent Publications
Treatment of Different Kinds of Diseases
CB%%iG&) Acupuncture and Moxibustion (@&+) ,
Exposition of the Fourteen Meridians first edition, edited by Shanghai Col-
(+Elt2EB) lege of Traditional Chinese Medicine,
Emergency Moxibustion Therapy (a3&g) published b y People's Medical Pub-
Highlights of Acupuncture (%&%%) lishing House, 1974, Beijing.
Compendium of Acupuncture and Moxi- A Textbook on Acupuncture and Mox-
bustion (%&A&) ibustion (%&+i#X) , first edition,
Guide to the Classic of Acupuncture (Re edited by Acupuncture Teaching
%%> Group, Shanghai College of Tradi-
Illustrated Appendices to the Classic of tional Chinese Medicine, published
Categories (gg2 g$) by Shanghai Science and Technology
Illustrated Manual of Acupoints on Publishing House, 1960, Shanghai.
Bronze Figure (fjjA$f%z+j-&~g2) Acupuncture and Moxibustion ($j-&+),
+
Elementary Medicine ( E A 1'7) first edition, edited by Nanjing Col-
Medical Highlights (4b 6 )
& b g
lege of Traditional Chinese Medicine,
Popular Prescriptions (E%?T ) published by Shanghai Science and
Questions and Answers Concerning Acu- T e c h n o l ~ gPublishing
~ House, 1979,
puncture and Moxibustion (%&WE$) Shanghai.
A Medical Book by Master Dmxi (fi>g,~, Annotations On Sy~tematic Chssic of
&) Acupuncture ( H & 'fl Z ~ ~ E ,RVol. )
 Chinese Acupunctu~eand Moxibustion

1, first edition, edited by Shandong itional Chinese Medicine, published

College of Traditional Chinese Medi- by Shanghai People's Publishing
cine, published by People's Medical House, 1975, Shanghai.
Publishing House, 1979, Beijing. Acupuncture and Moxibustion, Vo'ol.I Me-
Anatomical Charts for Acupuncture and ridian Theory (@&+%-#ggt&+
,W,fGXjbGSiiGz I ) , fixst ig), first edition, edited by Shanghai
edition, charted by Editorial and College of Traditional Chinese Medi-
Charting Croup of Anatomical cine, published by People's Medical
Charts for Acupuncture and Moxi- Publishing House, 1962, Beijing.
bustion, Zhejiang Medical Universi- Acupuncture and Moxibustion, V d 2
ty, Zhejiang College of Traditional Acupoints ( $ f - & ~ ~ f ~ - @ j - ! & ~ < W )
Chinese Medicine, published by Zhe- edited by Shanghai College of Trad-
jiang People's Publishing House, itional Chinese Medicine, published
1979, Hangzhou. by People's Medical Publishing
Paper Abstracts of the National Sympo- House, 1962, Beijing.
sium on Acupuncture and Moxibustion Meridians and Coll'ollateraks-A Course of
and Acupuncture Anesthesia (4B$j- I0 Lectures (93?&-[-i%) , first edi-
i i , edited by tion, edited by Editorial Group
Academic Section, National Sympo- of "Meridians and Co%Iatelra8s"-A
sium on Acupuncture and Moxibus- Course of 10 Lectures, published by
tion and Acupuncture Anesthesia, Shanghai People's Publishing House,
1979, Beijing. 1976, Shanghai.
Anatomical Charts of Acupoints .of the Essentials of Chinese Acupuncture ( +
14 Meridians (+P%$Rf$j&$$JBm), +$&+&g ) , published by People's
edited and charted by Shanghai Col- Medical Publishing House, 1979,
lege of Traditional Chinese Medicine, Beijirag.
Shanghai Research Institute of Trad-
 CROSS INDEX OF ACUPOINTS (PINYIN)

a
Anrnian (Extra 13) Dabao (Sp 21)
I Dachangshu (B 25)
B Dadu (Sp 2)
Bafeng (Extra 40) Dadun (Liv 1)
Baichongwu (Extra 35) Dahe (K 12)
Baihuanshu (B 30) Daheng (Sp 15)
Baihui (Du 20) Dairnai (G 26)
Bailao (Extra 16) Daju (S 27)
Benshen (G 13) Daling (P 70)
Biguan (S 3 1) Dannangxue (Extra 39)
Binao (LI 14) Danshu (B 19)
Bingfeng (LI 12) = Dazhu (B 11)
Bitong (Extra 10) Daying (S 5)
Bizhong (Extra 32) Dazhong (K 4)
Bulang (K 22) Dazhui (Du 14)
Burong (S 19) Dicang (S 4)
Diji (Sp 8)
Dingchuan (Extra 14)
Diwuhui (G 42)
Changqiang (Du 1)
Duiduan (Du 27)
Chengfu (B 36)
Dubi (S 35)
Chengguang (B 6)
Dushu (B 16)
Chengjiang (Ren 24)
Chengjin (B 56)
Chengling (G 18)
Chengman (S 20) Erbai (Extra 31)
Chengqi (S 1) Erheliao (SJ 22)
Chengshan (B 57) Erjian (Extra 4)
Chize (L 5) Ermen (SJ 21)
Chongrnen (Sp 12)
Chongyang (S 42)
Ciliao (B 32) Feishu (B 13)
 Chinese Acupuncture and Moxibustion

Feiyang (B 58) Huagai (ken 20)

Fengchi (G 20) Huangmen (B 51 )
Fengfu (Du 16) Huangshu (K 16)
Fenglong (S 40) Huantiao (G 30)
Fengmen (B 12) Huanmen (B 47)
F'engshi (G 3 1j U T x x ~ ~ m ~ i t S n m c4lZvfs-a
w '?A)
I I U C ( l 1 L l l V l l ~ \ U A L I U &7/

Fuai (Sp 16) Huaroumen (S 24)

Fubai (G 10) Huatuojiaji (Extra 15)
Fufen (B 41) Huiyang (B 35)
Fujie (Sp 14) Huiyin (Ren 1)
Fuliu (K 7) Huizong (SJ 7)
Fushe (Sp 13) Hunmen (B 47)
Futonggu (K 20)
Futu (S 32)
Futu (LI 18) Jiache (S 6)
Fuyang (B 59) Jiachengjiang (Extra 8)
Fuxi (B 38) Jianjing (G 2 1)
G Jianli (Ren 11)
JianIiao (SJ 14j
Ganshu (B 18) Jianqian (Extra 23)
Gaohuang (B 43) Jianshi (P 5)
Geguan (B 46) Jianwaishu (SI 14)
Geshu (B 17) Jianyu (LI 15)
Gongsun (Sp 4) Jianzhen (SI 9)
Guanchong (SJ 1) Jianzhongshu (SI 15)
Guangrning (G 37) Jiaosun (SJ 20)
Guanmen (S 22) Jiaoxin (K 8)
Guanyuan (Ren 4) Jiexi (S 41)
Guanyuanshu (B 26) Jimai (Liv 12)
Guilai (S 29) Jimen (Sp 11)
Jinggu (B 64)
Jingmen (G 25)
Hanyan (G 4) Jingming (B 1)
Heding (Extra 38) Jingqu (L 8)
Hegu (LI 4) Jinjin (Extra 9)
Henggu (K 11) Jinmen (B 63)
Heyang (B 55) Jinsuo (Du 8)
Houding (Du 19) Jiquan (H 1)
Hquxi (SI 3) Jiuwei (Ren 15)
I
Cross Index of Acupoints

Jizhong (Du 6) Naohui (SJ 13)

Juegu ( G 39) Naokong (G 19)
Jueyinshu (B 14) Naoshu (SJ 18)
Jugu (LI 16) Neiguan ( P 6)
Juliao (S 3) Neiting (S 44)
Juliao ( G 29)
Juque (Ren 14)
Pangguangshu (B 28)
Pianli (LI 6)
Kongzui (L 6) Pigen (Extra 20)
Kouheliao (LI 19) Pishu (B 20)
Kufang (S 14) Pohu (B 42)
Kunlun (B 60) Bushen (B 61)

Lanweixue (Extra 37) Qianding (Du 21)

Laogong ( P 8) Qiangjian (Du 18)
Liangmen (S 21 ) Qiangu (SI 2)
Liangqiu (S 34) Qianzheng (Extra 11)
Lianquan (Ren 23) Qichong (S 30)
Lidui (S 45) Qihai (Ren 6)
Lieque (L 7) Qihaishu (B 24)
Ligou (Liv 5) Qihu (S 13)
Lingdao (H 4) Qimai (SJ 18)
Lingtai (Du 10) Qimen (Liv 14)
Lingxu (K 24) Qinglengyuan (SJ 11)
Lougu (Sp 7) Qingling (H 2)
Luoque (B 8) Qishe (S 11)
Luozhen (Extra 28) Qiuhou (Extra 7)
Luxi (SJ 19) Qiuxu (G 46)
Qixue (K 13)
Quanliao (SI 18)
Meichong (B 3) Qubin (G 7)
Mingmen (Du 4) Quchai (B 4)
Muchuang (G 16) Quchi (LI 11)
Quepen (S 12)
Qugu (Ren 2)
Ququan (Liv 8)
Naohu (Du 17) Quyuan (SI 13)
 Chinese Acupuncture and Moxibustion

Quze (P 3) Shidou (Sp 17)

Shiguan (K 18)
Shimen (Ren 5)
Rangu (K 2) Shiqizhui (Extra 18)
Renying (S 9) Shixuan (Extra 24)
rr- - -- - /n--
- -3.
nxenznuI1g qL\
( v u LO) Shousanli (LI 10)
Riyue (G 24) Shouwuli (LI 13)
Rugen (S 18) Shuaigu (B 8)
Ruzhong (S 17) Shufu (K 27)
Shugu (B 65)
Shuidao (S 38)
Shuifen (Ren 9)
Sanjian (LI 3) Shuigou (Du 26)
Sanjiaoshu (B 22) Shuiquan (K 5)
Sanyangluo (SJ 8) Shuitu (S 10)
Sanyinjiao (Sp 6) Sibai (S 2)
Shengguan (G 3) Sidu (SJ 9)
Shangjuxu (S 37) Sifeng (Extra 25)
Shanglian (LI 9) Siman (K 14)
Shanglianquan (Extra 3) Sishencong (Extra 6)
Shangliao (B 3 1) Sizhukong (SJ 23)
Shangqiu (Sp 5) Suliao (Du 25)
Shangqu (K 17)
Shangwan (Ren 13)
Shangxi (Du 23)
Shangyang (LI 1) Taibai (Sp 3)
Shaochong (H 9) Taichong (Liv 3)
Shaofu (H 8) Taixi (K 3)
Shaohai (H 3) Taiyang (K 1)
Shaoshang (L 11) Taiyuan (L 9)
Shaoze (SI 1) Tanzhong (Ren 17)
Shencang (K 25) Taodao (Du 13)
Shendao (Du 1 1) Tianchi (P 1)
Shenfeng (K 23) Tianchong (G 9)
Shenque (Ren 8) Tianchuang (SI 16)
Shenmai (B 62) ~ i a n d i n(LI
~ 17)
Shenmen (H 7) Tianfu (L 3)
Shenshu (B 23) Tianjing (SJ lo),
Shentang (B 44) Tianliao (SJ 15)
Shenting (Du 24) Tianquan (P 2)
Cross Index of Acupoints

Tianrong (SI 17) Xiajuxu (S 39)

Tianshu (S 25) Xialian (LI 8)
Tiantu (Ren 22) Xialiao (B 34)
Tianxi (Sp 18) Xiawan (Ren 10)
Tianyou (SJ 16) Xiaxi (G 43)
Tianzhu (B 10) Ximen (P 4)
Tianzong (SI 11) Xiangu (S 43)
Tiaokou (S 38) Xiaochangshu (B 27)
Tinggong (SI 19) Xiaohai (SI 8)
Tinghui ( G 2) Xiaoluo (SJ 12)
Tongli (H 5 ) Xingjian (Liv 2)
Tongtian (B 7) Xinhui (Du 22)
Tongziliao ( G 1) Xinshu (B 15)
Toulinqi (G 15) Xiongxiang (Sp 19)
Touqiaoyin (G 11) Xuanji (Ren 21)
Touwei (S 8) Xuanli (6 6)
Xuanlu (G 5)
Xuanshu (Du 5)
Waiguan (SJ 5) Xuanzhong (G 39)
Wailing (S 26) Xuehai (Sp 10)
Waiqui (G 36)
Wangu (G 12)
Wangu (SI 4) Yamen (Du 15)
Weicang (B 50) Yangbai (G 14)
Weidao (G 28) Yangchi (SJ 4)
Weiguanxiashu (Extra 17) Yangfu (G 38)
Weishu (B 21) Yanggang (B 48)
Weiyang (B 39) Yanggu (SI 5 )
Weizhong (B 40) Yangjiao (G 35)
Wenliu (LI 7) Yanglao (SI 6)
Wuchu (B 5) Yanglingquan (G 34)
Wushu (G 27) Yangxi (LI 5)
Wuyi (S 15) Yaoqi (Extra 19)
Yaoshu (Du 2)
Yaotongxue (Extra 29)
Xiguan (Liv 7) Yaoyan (Extra 21)
Xiyan (Extra 36) Yaoyangguan (Du 3)
Xiyangguan (G 33) Yemen (SJ 2)
Xiaguan (S 7) Yifeng (SJ 17)
 Chinese Acupuncture and Moxibustion

Yiming (Extra 12) Zhengying (G 17)

Yinbai (Sp 1) Zhibian ( B 54)
Yinbao (Liv 9) Zhigou (SJ 6)
Yindu ( K 19) Zhishi (B 52)
Yingchuang (S 16) Zhiyang (Du 9)
Ying:: (K !O) Zhiyin ( B 67)
--

Yingxiang (LI 20) Zhizheng (SI 7)

Yinjiao (Ren 7) Zhongchong (P 9)
Yinjiao (Du 28) Zhongdu ( G 32)
Yinlian (Liv 11) Zhongdu (Liv 6)
Yinlingquan (Sp 9) Zhongfeng (Liv 4)
Yinmen (B 37) Zhongfu (L 1)
Yinshi (S 33) Zhongji (Ren 3)
Yintang (Extra 2) Zhongkui (Extra 26)
Yinxi (H 6) Zhongquan (Extra 30)
Yishe (B 49) Zhongshu (Du 7)
Yixi (B 45) Zhongiing (Ren 16)
Yongquan (K 1) Zhongwan (Ren 12)
Youmen (I(21 ) Zhongzhu (K 15)
Yuanye ( G 22) Zhongzhu (SJ 3)
Yuji (L 10) Zhoujian (Extra 33)
Yunmen ( L 2) Zhouliao (LI 12)
Yutang (Ren 18) Zhourong (Sp 20)
Yuyao (Extra 5) Zhubin (K 9)
Yuye (Extra 9) Zigong (Ren 19)
Yuzhen (B 9) Zigongxue (Extra 22)
Yuzhong (K 26) Zulinqi (G 41)
Zuqiaoyin (G 44)
Zusanli (S 36)
Zanzhu (B 2) Zutonggu (B 66)
Zhangmen (Liv 13) Zuwuli (Liv 10)
Zhaohai ( K 6)
Zhejin (G 23)
 INDEX

Abdominal distention 400 Back-shu points 116

Abdominal pain 393 Bent needle 331
Abnormal descending and ascending of Bi syndromes 245, 257, 439
qi 251 Bian Que's Medical Experiences 6
Abrupt pulse 270 Bian stone 1, 2
Academy of Traditional Chinese Medi- Big prescription 355
cine 8 Black coating 261
Acquired foundation 35 Bladder 36
Acquired qi 46 Blood 46, 48
Acupoints 188 Blood is the mother of qi 52
Acupuncture analgesia 513 Bloody dysentery 398
Acupuncture Chart from Lateral and Body fluid 46, 50
Posterior Views 4 Boil 475
Acupuncture Points in Internal Classic Bone bi 441
4 Bones 37
Adjacent puncture 338 Book of Changes, The 11
Aethlogy 244 Brain 37
All-China Association of Acupuncture Breast abscess 477
and Moxibustion 10 Broken needle 331
Alternate chills and fever 263 Burning pain 265
Amenorrhea 3 14
Anatomical landmarks 111
Anger 248
Antedated menstruation 446 Canon of Acupuncture 4, 9
Antipathogenic qi 15, 25 1 Canon of Acupuncture and Moxibustion for
Arrival of qi 57 Children's Diseases 5
Ascending method 354 Canon of Moxibustion and Acupuncture
Ashi Points 109 Preserved in Pillow 3
Asthma 385 Canon on the Origin of Acupuncture and
Attack on the meridians and collater- Moxibustion 5
als 374 Cardiac pain 388
Attack on the zang-fu organs Cardio-abdominal pain 388
373, 374 Charts of Acupuncture and Moxibus-
Auscultation 262 tion 9
 Chinese Acupuncture and Moxibustion

Charts of Three Views 4 Congenital qi 46

Checking function 48 Congestion 483
Chen Hui 6 Constipation 403
Cheng Dan'an 7 Constitutional deficiency 297
Chinese two-hour time on the basis of Consumption of the fluid or the large
Heavenly Stems and Earthly Branch- intestine 294
es) 6 Continuous scanty uterine bieediiig 455
Chunyu Yi 3 Contralateral needling 337
Classic on Medical Problems 26, 36, 37, Cough 382
48, 49, 51, 115, 116, 322, 326, 358, Counteracting 23
367, 421 Coupled puncture 337
Classic of Divine Resonance 326 Crack needling 337
Clear cavity 300 Cracked tongue 260
Clearing method 353 Crossing combination of points 357
Clumpy pricking 334 Crossing points 116
Cold 244, 248, 276, 345 Cui Zhidi 5
Cold pain 265 Cun 114
Cold syndrome of' Shasyin 3 16 Cupping 346
Gold syndromes 245, 276 Cutaneous regions 94
Cold-damp dysentery 398
Colicky pain 265
Collapse of yang 28 1
Collapse of yin 28 1 Damp 244, 246, 248
Collateral needling 337 Damp heat in the bladder 303
Collateral pricking 333 Damp heat in the large intestine 294
Collaterals 53 Damp heat in the liver and gallblad-
Collection of Ancient Works, A 18 der 301
Combination of the exterior-interior Damp heat in the lower jiao 309
points 364 Damp heat in the middle jiao 309
Commentary on the spring and autumn Damp heat in the spleen and sto-
annals 1 mach 296
Compendium of Acupuncture 369 Damp heat in the upper jiao 308
Compendium of Acupuncture and Moxi- Damp syndromes 245
bustion 6, 1l 1, 325, 326, 328, 353 Damp-heat dysentery 398
Complete Collection of Acupuncture and Daoying 53
Moxibustion, A 6 Deafness 482
Complicated pulse 27 1 Decline of antipathogenic qi 252
Complicated syndromes 304 Deep pulse 269
Compound prescription 355 Deep red tongue 259
Conflict between antipathogenic qi and Defensive function 48
pathogenic qi 251, 252 Defensive qi 55
Congenital foundation 33, 302 Deficiency 278
Index

Deficiency of antipathogenic qi 252 Diarrhoea 395

Deficiency of blood 284 Differentiation of syndromes 273, 288
Deficiency of blood producing wind Direct Guidebook of Medicine 34
301 Direct moxibustion 342
Deficiency of both the heart and Disharmony between the heart and kid-
spleen 307 ney 304
Deficiency of kidney essence 33 Disharmony between the liver and sto-
Deficiency of kidney qi 33 mach 307
Deficiency of qi 28 1 Disharmony of liver and spleen 42
Deficiency of the heart blood 289 Disharmony of yin and yang 25 1
Deficiency of the heart qi 289 Dispelling cold by the warming meth-
Deficiency of the heart yang 289 od 349
Deficiency of the heart yin 289 Distal points 117
Deficiency of the kidney qi 302 Distant needling 337
Deficiency of the lung qi 293 Distending pain 265
Deficiency of the qi of the lung and Dou Hanqin 6
kidney 304 Dou Cai 6
Deficiency of the qi of the lung and Downward infusion of damp heat 265
spleen 306 Downward leakage of turbid essence
Deficiency of the spleen qi 295 265
Deficiency of the spleen yang 296 Dr. Norman Bethune 7
Deficiency of the yang of the spleen and Dribbling urination 265
kidney 306 Dry coating 260
Deficiency of the yin of the liver and Dryness 244, 247, 248
kidney 305 Dull pain 265
Deficiency of the yin of the lung and Dysentery 398
kidney 305 Dysfunction of the spleen in controlling
Deficiency of yang 252 blood 295
Deficiency of yang leading to cold syn- Dysmenorrhea 45 1
dromes 16 Dysuria caused by calculi 410
Deficiency of yang of both spleen and Dysuria caused by overstrain 41 1
kidney 43 Dysuria caused by qi dysfunction 410
Deficiency of yin 252 Dysuria with milky urine 4 11
Deficiency of yin leading to heat syn-
dromes 16
Deng Xiaoping 8
Depressive disorder 42 1 Ear acupuncture 491
Derangement of the mind 291 Edema 406
Descending method 354 Eight confluent points 116
Deviated tongue 260 Eight influential points 116
Deviation of the eye and the mouth 434 Eight principles 273
Diagrams of Meridians and Points 4 Eliminating the pathogenic factors 349
 Chinese Acupuncture and Moxibustif

Embedding needle 335 False cold 276

Emperor Liangwu 9 False cold symptomes 252
Endogenous wind 248 False heat 2'76
Epigastric pain 388 False heat symptomes 252
Epistaxis 485 Fear 248
Erysipelas 477 Febrifugal approach 353
~ 3 3 ~ 1 1 b c32
E
,"
,
,,
,
Festericg mraxbbustican 242
Essential qi 256 Fifteen collaterals 88
Essentials of Points, Acupuncture and Mox- Filiform needles 318
ibustion 3, 4 Finger measurement 114
Evacuation needling 337 Fire 244, 247, 248
Even prescription 355 Five discolorations 256
Excess 278 Five elements 11, 18, 22, 24
Excess of pathogenic qi 252 Five shu points 115
Excess of yang 252 Fixed bi 439
Excess of yang leading to heat syn- Fixed bi syndrome 246
dromes 16 Fixed landmarks 111
Excess sf yin 252 Flaccid lame 441
Excess of yin leading to cold syn- Flaccid syndrome 374
dromes 16 Flaccid tongue 260
Excess of yin leading to deficieficji s f Flare-t;p cf the liver fire 299
yang 12 Flesh goiter 479
Excessive heat in the small intestine 43 Flying 326
Exemplary Collection of Acupuncture and Food-resistant dysentery 398
Moxibustion, An 6 Four-finger measurement 114
Exogenous diseases 245 Fright 248
Experimental Institute of Acupuncture- Front-mu points 116
Moxibustion Therapy 8 Fu Xi 1
Exposition of the Fourteen Meridians 5 Functional disturbances of the zang-fu
Exterior 274 organs 248
Exterior syndromes 274
Extra points 108
Extraordinary fu organs 37
Extraordinary points 108 Gallbladder 35, 37
Extreme heat stirring up wind 247 Gao Wu 6
Extreme heat stirring wind 300 General Treatise on the Etiology and
Extreme shallow puncture 338 Symgtomology of Diseases 409
Eye system 65 Geographic tongue 26 1
Globus hystericus 427
Glossy tongue 261
Goiter 479
Facial pain 432 Golden Mirror of Medicine 6, 460
Index

Granular coating 260 Huangdi's Canon of Acupuncture 3

Great monad herbal moxa stick 344 Hungdi's Canon of Eighty-One Difficult
Grey coating 26 1 Problems 3
Grief 248 Huangdi's Internal Classic 3
Guide to Acupuncture 328 Huangfu Mi 4
Guide to the Classics of Acupuncture 363 Hyperactivity of fire in the stomach 297
Guide to the Clinic Treatment, A 402 Hyperactivity of pathogenic qi 252
Hyperactivity of the heart fire 290
Hyperactivity of yang leading to deficien-
cy of yin 12
He Ruoyu 6 Hypochondria pain 435
Head wind 430 Hysteria 428
Headache 265, 429
Health Bureau of the People's Govern-
ment in Northern China 8
Health Department of Jinan Military Illustrated Manual ofAcupoints on the New
Area Command 8 Bronze Figure 369
Heart 26 Illustraied Manual on the Points for Acu-
Heart and kidney 40 puncture and Moxibustion on a New
Heart and liver 40 Bronze Figure 5
Heart and lung 39 Illustrated Supplement of the Classifed '

Heart and small intestine 43 Classics 369

Heart and spleen 40 Illustrated Supplement to Systematic Corn-
Heart system 65 pliation of the Internal Classic, An 6
Heat 276 Illustrated Supplement to the Classifed
Heat bi 439 Classics 13
Heat dysentery 398 Illustration of the Bronze Figure with
Heat in the blood 284 Chinese and Western Medicien 7
Heat needling 337 Imbalance between the liver and
Heat syndrome of shaoyin 3 18 spleen 306
Heat syndromes 245, 276 Imbalance of yin and yang 16
Hegu puncture 338 Imperial Medical Bureau 5
Herpes zoster 475 Imperial Medical College 7
Hesitant pulse 270 Impotence 4 13
Miccup 392 Improper diet 244, 248, 249
Hidden rash 473 Inability of the kidney to receive qi 253
Historical records 3 Indirect moxibustion 342
Hollow pain 265 Infantile convulsion 464
Horn method 346 Infantile diarrhoea 467
Most and guest combination 364 Infantile malnutrition 468
Hua Tuo 3, 4, 9 Infantile paralysis 470
Huang Di l Inquiring 263
 Chinese Acupuncture and Moxibustion

Insomnia 416 Jueyin syndrome 3 17

Inspection 255
Institute of Acupuncture and Moxibus-
tion 8
Insufficiency of the kidney yang 303 Kidney 32
Insufficiency of the kidney yin 303 Kidney and bladder 45
T eL- L
P ef the I ~ v P h~ h o d -201
. c3- pUaLf fL; ~l ;We rl pWr w
llWJ ..-
bll" 11. "A vlvv... Knotted pulse 27 1
Insufficiency of the lung yin 294
Insufficiency of the stomach yin 298
Insufficient lactation 462
Interacting 23 Lack of physical exercise 244
Interior 274 Lactifuge 459
Interior syndroines 275 Large intestine 36
Intermediate syndromes 276 Large pulse 269
Intermittent dysentery 398 Large-intestinal abscess 478
Intermittent pain 265 Lateral puncture 337
Internal Classic 336,352, Leg-cont~actedintestinal abscess 478
International Acupuncture Training Leopard-spot puncture 338
Courses 18 Li Shizhen 38
International Peace Hospital 7 Ei Xuechuan 6
lnterprmcpting 23 Ling YEE? 6
Intestinal abscess 478 Listening 262
Intraderma1 needle 335 Listening to the cough 262
Introduction to medicine 326, 339, 366 Listening to the respiration 262
Invasion of the lung by liver fire 42 Literati's Care of Parents, The 462
Invasion of the lung by pathogenic Eiu Zhongheng 7
wind 292 Liver 28
Invasion of the lung by the liver Liver and gallbladder 43
fire 307 Liver and kidney 43
Invasion of the spleen by cold Liver and lung 41
damp 296 Liver and spleen 42
Irregular menstrual cycles 447 kiver yang turning into wind 300
Irregular menstruation 446 Local and adjacent therapeutic
properties 117
Eow back pain 437
Lung 31
Jaundice 402 Lung and kidney 42
Sing 5 1 * Lung and large intestine 44
Jingluo 53 Lung meridian of hand-taiyin 60
Jingye (body fluid) 51 Euo-connecting point 115
Joint puncture 338 Lyrics of standard profoundi-
Joy 248 ties 326
Index

Mumps 471
Muscle bi 44 1
Malaria 380 Muscle regions 94, 95
Malaria with splenomegaly 381
Malposition of fetus 461
Manic disorder 42 1
Mao Zedong 7, 8 New Acupuncture 8
Marrow 34, 37 New Collection of Moxibustion Therapyfor
Medical Book by Master of Danxi, Emergency, A 5
The 255 New Edition of Meteria Medica, A 339
Medical Highlights 369 Newly Compiled Acupuncture 8
Medical Secrets of An Official, The 5 Night sweating 264
Melancholy 248 No. 3 Han Tomb at Mawangdui, Hunan
Meridian needling 337 Province 3
Meridian qi 326 Nocturnal emission 4 15
Meridians 53 Nocturnal enuresis 408
Metrorrhagia 454 Non-substantial phlegm fluid 250
Mi Yun 9 Nonscarring moxibustion 342
Middle finger measurement 114 Notes on Bian Que's moxibustion 341
Mild-warm moxibustion 343 Nourishing function 48
Ministerial fire 4 17 Nutrient qi 55
Ministry of Public Health 8
Minute collaterals and superficial colla-
t e r a l ~ 90
Miraculous Pivot 2, 3, 16, 26, 27, 29, 3 1, Observations of women 462
34, 37, 38, 48, 49, 52, 53, 55, 57, 58, 96, Odd prescription 355
9 1 1 , 1 1 5 , 116, 271, 285, 322, 326, Olfaction 262
328, 336-340, 348, 351-355, 358, 362, Open moxibustion 342
366, 422, 427, 435 Opium War 7
Moist coating 260 Optic atrophy 285
Morbid leukorrhea 456 Over strain 244
Morning sickness 458 Overacting 23
Moving landmarks 111
Moxibustion Method for Consumptive Di-
seases 5
Moxibustion Methods for Emergencies 5 Pain of the eye 483
-Moxibustion at shenque point 343 Painful bi 439 '

Moxibustion with garlic 343 Painful menstruation 45 1

Moxibustion with ginger 342 Painful urination with blood 410
Moxibustion with monkshood cake 343 Pale tongue 259
Moxibustion with salt 343 Palpation 267
Moxibustion with warming needle 344 Palpita tion 4 19
 Chinese ~ c u ~ u n c t u r e ' a nMoxibustion
d

Pasty tongue coating 260 Pulling pain 265

Pathogenesis 244 Pulse of deficiency type 269
Pathogenic factors 15 Pulse of excess type 269
Pathogenic qi 251 Purple tongue 259
Peeled coating 261 Purulent and bloody dysentery 398
Penetrating-heaven coolness 329
Persistent dysentery 398
Perversion of qi 283
Philtrum boil 476 Qi 46
Phlegm fluid 250 Qi goiter 479
Phlegm misting the heart 291 Qi is the commander of blood 51
Phlegm-fire disturbing the heart 29 1 Qi point 108
Plain Questions 2-4, 11-16, 19, 21, 25-28, Qihua (activities of qi) 48
30, 31, 33, 34, 37-39, 41, 42, 47-50, 55, Qin Yueren (Bian Que) 3
105, 106, 109, 245, 249, 251, 252, 276, Quan Yuanqi 1
278, 328, 329, 348, 351-357, 369, 419, Questions and Answers Concerning Acu-
432, 435, 441, 442, 467 puncture and Moxibustion 6
Plucking 325 Questions and Answers on -Acupuncture and
Plum-blossom needle 334 Moxibustion 325
Poor memory 418 ~ u i n t ' u ~puncture
le 337
Postdated menstruation 446
Practical Acupuncture and Moxibustion 8
Precious Supplementary Prescriptions 57
Precious Prescriptions 340, 345 Rapid pulse 269
Prescriptions Worth a Thousand Gold for Recipes for saving lives 455
Emewencies 4 Red tongue 259
Prescriptions based on three pathogenic Red-thread boil 476
factors 418 Red-white dysentery 398
Prescriptions for Emergencies 4 Reducing 327-329
Prescriptions for Universal Relief 6 Reducing excess 349
Prescriptions for succouring the sick- Reducing the preponderance 348
ness 439 Regular points 108
Pressing 325 Regularly intermittent pulse 27 1
Pricking pain 265 Regulation of yin and yang 348
Primary 349 Reinforcing 327-329
Profuse metrorrhagia 465 Reinforcing method 352
Prolapse of rectum 405 Reinforcing or reducing the affected me-
Prolapse of uterus 463 ridian 359
Prolonged labour 460 Reinforcing or reducing the related me-
Promoting function 48 ridian 359
Proportional measurements 1I1 Relationship between blood and body
Prostration of the heart yang 289 fluid 52
 Index

Relationship between qi and blood 5 1 Selecting points from the related meridi-
Relationship between qi and body an 356
fluid 52 Selection of adjacent points 356
Relieving deficiency by the tonifying Selection of distant point 356
method 349 Selection of local points 356
Remote 117 Selection of nearby points 356
Remote therapeutic properties 117 Selection of symptomatic points 357
Removing the excess 348 Selection of the empirical points 357
Repeated shallow puncture 338 Seminal emission 4 15
Retention of cold in the liver meridi- Setting the mountain on fire 329
an 301 Seven emotional factors 248
Retention of fluid in the stomach due to Seven emotions 244 .
cold 297 Seven-star needle 334
Retention of Tood 252 Shaking 325
Retention of food in the stomach 297 Shallow needling 337
Retention of phlegm damp in the Shangwan 35
lung 292 Shaoyang syndrome 3 14
Retention of phlegm fluid 252 Shaoyin syndrome 316
Retention of phlegm heat in the Short puncture 338
lung 293 Shu-point needling 337
Retention of urine 265, 412 Shu-point puncture 338
Revision of Medical Classics 38 Sinking of qi 283
Revolution of 1911, The 7 Sinking of the qi .of the small intes-
a s Rigid tongue 259 tine 291
Rising of the liver yang 299 Six Volumes on Acupuncture Prescrip-
Rolling pulse 270 tions 6
Six exogenous factors 244
Six exogenous pathogenic factors 245
Six types of qi 244
Sanjias 36 Skin*bi 441
Scarring moxibustion 342 Slippery tongue coating 260
Scraping 325 Slow pulse 269
Seasonal diseases 245 Small intestine 36
Secondary 349 Small prescription 355
Secret of Moxibustion for Abscess and Ul- Small-intestinal abscess 478
cer 5 Smelling 262
Seeking thei causative factors by differen- Snake-head boil 476
tiating symptoms and Signs 244 Soft pulse 270
Selecting points from several meridi- Sore throat 487
ans 356 Source of Acupuncture and Moxibustion,
Selecting points from the affected merid- The 6
ian 356 Source of acquired constitution 295
 Chinese Acupuncture and Moxibustion

Southern Song Dynasty 6 Syncope 376

Sparrow-pecking moxibustion 343 Syndrome of the xue stage 288
Specific points 115 Syndrome of the yangming fu or-
Spermatorrhea 4 15 gan 315
Spirit qi 326, 327 Syndrome of the yangming meridian
Spleen 29, 247 315
Spleen and kidney 43 Syndrome of the ying stage 287
Spleen and lung 41 Syndromes of collapse of yang 28 1
Spleen and stomach 44 Syndromes of collapse of ying 281
Spontaneous sweating 264 Syndromes of deficiency type 278
Spot pricking 333 Syndromes of excess type 278
Sprain and contusion 48 1 Syndromes of the qi stage 286
Stagnant blood 250 Syndromes of the wei stage 285
Stagnated blood 244 Synopsized prescriptions of golden cham-
Stagnation s f blood 284 ber 471
Stagnation of liver qi leading to deficien- Systematic Classic of Acupuncture 369
cy of the spleen 42 Systematic Classic of Acupuncture and
Stagnation of qi 283 Moxibuskkon 4
Stagnation of the heart blood 290
Stagnation of the liver qi 298
Sticky coating 260
Stirring of the liver wind in the inter- Taiyang syndrome 3 14
ior 300 Taiyin syndrome 3 16
Stomach 35 Tang Shicheng 7
Stone goiter 479 Techniques and Principles of Electro-
Straight puncture across the skin 337 Acupuncture, The 7
Strengthening the body resistance 349 Tendon bi 441
String-taut pulse 270 Tense pulse 270
Stuck needle 331 Tense syndrome 373
Study of Electro-acupuncture 7 Theory of the five elements 22, 23
Substantial 250 Theory of yin-yang 11, 14-16, 18
Sufficiency of antipathogenic qi 252 Thick coating 260
Summer heat 245, 246 Thick sticky nasal discharge 484
Sun Simiao 4 Thin coating 260
Sunstroke 377 Thin tongue 260
Superficial pulse 269 Thorny tongue 260
Superficial puncture 338 Thready pulse 270
Supplement to the Prescriptions Worth a Three yang syndromes 3 13
Thousand Gold9A 4 Three yin syndromes 3 13
Surging pulse 269 Thumb measurement 114
Swelling 483 Thunder-fire moxa stick 345
Swollen tongue 259 Tidal fever 256, 263
Index

Tinnitus 482
Tongue coating 258, 260
Tongue proper 258, 259 Waiting for qi 325
Toothache 499 Wandering bi 245, 439
Torticollis 486 Wang Ji 6 ,

Traumatic injuries 244 Wang Qingren 38

Traumatic injury 259 Wang Tao 5
Treatise on Febrile and hfisce~[aneous Wang Weiyi 5
Diseases 3 Wang Zhizhong 5
Treatise on Febrile Diseases 346, 35 1 Wang bing 369
Treatment of Internal Disorders 4 14 Warming function 48
Warming method 353
Trembling 326 Weak pulse 270
Trigger puncture 337 Wei syndrome 441
Triple puncture 237 *
Wei syndromes 257
True cold 276 Weighty pain 265
True cold with false heat 278 Weiqi (defensive qi) 46, 47
True deficiency with false excess 280 White coating 26 B
True excess with false deficiency 280 Wind 244, 245
True a 276 Wind bi 245
True heat with false cold 285 Wind stroke 373
a 53 Wind wheal 473
Twelve cutaneous regions 105 World Health Organization 10
nvelve divergent meridians 83 Worry 248

Understanding of childbirth 460

Unproductive cough 262
Upward perversion of qi 262 Xi Hong 5
Urination d~sturbance 4 10 Xi-cleft point 116
Urticaria 4'72 Xiawaas 35
Uteanne bleeding 454 Xie qi 251
uterus 37 Xu Feng 6
XU Qiufu 4
v Xu Shuxiang 4
Xu Wenbo 4
Vessel bi 441 XU Xi 4
Vessels 37
Vitality 256
Vomiting 390
544 Chinese Acupuncture and Moxibustion

Yang Jie 6 Yuanqi 36, 46

Yang Jizhou 6 Yuanqi (primary qi) 46, 47
Yang Shangshan 4
Yang edema 407
Yang jaundice 256, 402
Yangming syndrome 3 15. Zang 25
Ye 51 Zang Xiang 25
Yellow coating 261 Zhang Ji 6
Yin 281 Zhang Jiebin 6
Yin edema 407 Zhang Zhongjing 3
Yin jaundice 256, 402 Zhang's General Medicine 49
Yin puncture 338 Zhen Quan 4
Yin syndromes 28 1 Zheng Qi 251
Yin-yang figure 14 Zhi Cong 9
Yingqi 49 Zhongwan 35
Yingqi (nutrient qi) 46, 47 Zhu De 8
Yuan-primary point 115 Ziwuliuzhu 6
Yuan-primary points 115 Zongqi (pectoral qi) 46, 47
Yuan-primary qi 115 Zou Yin 9