Part Ⅲ Acupuncture and Moxibustion Treatment

Chapter 6  General Introduction to Acupuncture and Moxibustion Treatment

 6.1 Therapeutic Effect of Acupuncture and Moxibustion

Acupuncture and moxibustion therapy has been widely used in the treatment of 461 diseases, with a good effect on more than 100 kinds of diseases, covering the internal medicine, surgery, orthopedics, gynecology, pediatrics and other clinical subjects. The therapeutic effect of acupuncture and moxibustion is realized by dredging meridians and collaterals, strengthening body resistance function, eliminating pathogenic factors and balancing theyin and yang.

6.1.1 Dredging Meridians

Dredging meridians is to make blood stasis in meridians smooth and play its normal physiological role, which is the most basic and direct therapeutic effect of acupuncture. “Inside the body, meridians belong to the internal organs; outside the body, meridians contact limbs.” Running qi and blood is one of its main physiological functions. When meridians play the normal physiological role, the blood runs smoothly to nourish organs, body surface skin and limbs. When meridians are of dysfunction and blood running is blocked, it will affect the normal physiological function; then body develops pathological changes which result in diseases. If meridian qi is not smooth and blood running is blocked, it is often manifested by pain, numbness, swelling,ecchymosis and other symptoms. The application of acupuncture and moxibustion to dredge the meridian, is mainly based on the pathway of meridians to select appropriate acupoints and acupuncture techniques, including three-edge needle pricking to bleed, skin needle tapping, cupping etc. Thus it comes to the effect of curing diseases by smoothing the meridians, recovering qi and blood to normal function.

6.1.2 Harmonizing Yin and Yang

Harmonizing yin and yang by acupuncture refers to the situation where acupuncture and other methods are applied with the support of the function of meridians,acupoints and the manipulation of acupuncture, to correct

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excessive or deficient yin and yang for the balance. It is the fundamental purpose of acupuncture and moxibustion eventually. Yin-yang theory is an important part of the basic theory of TCM, playing an instructional role in the understanding of the human body, disease, syndrome differentiation and so on. The mechanism of occurrence of diseases is very complicated, but in general it can be concluded into the imbalance of yin and yang. If six evils, seven emotions and other factors lead to the excessiveness or deficiency of yin and yang in body, and the loss of relative balance of yin and yang, it disorders the functions of organs and meridians and finally causes diseases. “ Yin is excessive and then yang be ill; yang is excessive, and thenyin be ill.” Aimed at the main pathological change in disease, acupuncture and moxibustion method is applied to regulate the excessiveness or deficiency of yin and yang, so as to recover the balance of yin and yang and to achieve the purpose of curing disease. It is recorded in Ling Shu, “The main point of using acupuncture, is to adjust the balance of yin and yang, and consequently the body is full of vital qi and integrated with vital qi into one.”

The role of acupuncture and moxibustion to reconcile yin and yang, is mainly  achieved with the support of the meridian property of yin and yang, meridians ’ acupoints  and manipulation of acupuncture. For instance, toothache is caused by excessive  stomach fire, which belongs to the  syndrome of excessive yang heat. In this   case,  stomach fire  should be cleared,  and  apply reducing method to needle Neiting (ST 44)  of Foot Yangming stomach meridian. In  case of stomachache due to the cold evil, which belongs to the syndrome  of excessive yin evils, expel the cold evil to warm the stomach and select the points  of foot  Yangming  stomach meridian. Strephenopodia caused by stroke, can result from slow yang and rapid yin according to the meridian syndrome. In the treatment, it is a need to reinforce yang meridians and reduce yin meridians  for the balance by the acupuncture manipulation. The emergence of insomnia is usually caused by excessive yang, while  that of drowsiness  is  often  caused  by  excessive  yin.  As  yangqiao  meridian  and  yinqiao  meridian  dominate the role of eyelid in eye  opening and closing, take Zhaohai (K  16) of yingqiao meridian to treat  insomnia  with reinforcing method and Shenmai (BL 62) of yangqiao meridian with reinforcing method to treat drowsiness.

6.1.3 Strengthening Vital Qi and Eliminating Pathogenic Factors

The role of acupuncture and moxibustion in strengthening vital qi and eliminating pathogenic factors is to support body's vital qi and dispel pathogenic factors. The process of occurrence, development and outcome of a disease is essentially the one of struggle between vital qi and pathogenic actors. If vital qi defeats pathogenic factors and pathogenic factors fade, then the disease will be relieved. If vital qi is defeated by pathogenic factors, the disease will be aggravated. Therefore, strengthening vital qi and eliminating pathogenic factors is not only the basic guarantee for altering disease for the better, but also the process of acupuncture treatment for disease.  The effect to cure diseases by acupuncture and moxibustion relies on its role of strengthening vital qi and eliminating pathogenic factors. It is recorded in Su Wen, “If vital qi exists in the body, pathogenic factors can not invade. Pathogenic factors can invade the body because vital qi in the body is weak.” It indicates that the occurrence of disease is due to the relative weakness of vital qi and the relative mightiness of pathogenic factors. In clinic practice, strengthening vital qi and eliminating pathogenic factors can be realized by reinforcing insufficiency and reducing excessiveness. In case of yang deficiency and qi deficiency, use reinforcing method,

or use the moxibustion method. In case of yin deficiency and blood deficiency, use reinforcing method. In case of blood deficiency, moxibustion can be used, but in case of yin deficiency, moxibustion cannot be used. In case of the deficiency of both yin and yang, it is suitable to use moxibustion, which is recorded in Lin Shu, “The deficiency of both yin and yang, moxibustionis needed.” As for the deficiency of five zang organs, conduct moxibustion on corresponding back-shu acupoints and primary acupoints, as well as other tonic acupoints, Zusanli (ST 36), Gaohuang (BL 43),Mingmen (GV 4), Taixi (KI 3) and so on.

References

[1] Shi Xuemin. Acupuncture and Moxibustion. The Second Edition of New Century. Beijing: Chinese Medicine Press, 2002.

[2] Du Yuanhao, Li Jing, Sun Dongwei, et al. Studies on Modern Chinese Acupuncture and Moxibustion Spectrum  [J]. Chinese Acupuncture and Moxibustion, 2007, 27 (5): 373-378.

[3] Zhao Rong. Modern Acupuncture and Moxibustion Forum. Yunnan: Yunnan University Press, 2011.

[4] Gao Shuzhong. Acupuncture and Moxibustion Therapy. The Ninth Edition. Beijing: Chinese Medicine Press, 2012.

[5] Shen Xueyong. Meridians and Acupoints. The new century second edition. Beijing: Chinese Medicine Press, 2007.

[6] Fang Jianqian. Science of Acupuncture and Moxibustion. Beijing: Chinese Medicine Press, 2014.

6.2 Principle of Acupuncture and Moxibustion Treatment

Based on Chinese medicine theory, acupuncture and moxibustion treatment applies its technical method of manipulation, and conducts dialectical therapy according to the disease, syndrome and symptom in the patient. The principles of acupuncture and moxibustion must be guided by holistic concept and based on syndrome differentiation, and play guiding roles for the diagnosis, prescription and treatment in the whole process. They are the basic principles for preventing and treating diseases with acupuncture and moxibustion.

6.2.1 Treating Shen and Maintaining Needling Sensation

Su Wen presents treatment of spirit and maintaining needling sensation in the course of treatment is very important. Ling Shu records, “spirit is the key consideration in acupuncture treatment.” It indicates the treatment of spirit and maintaining needling sensation is the fundamental principle for acupuncture treatment.

6.2.1.1 Treatment of Spirit

Treatment of spirit requires that the doctor should care about the patient’s mental  state  and  physical change in the treatment through acupuncture and moxibustion. Both the doctor and the patient adjust physical, emotional and mental states. Ling Shu emphasizes the significance of spirit in acupuncture and moxibustion treatment. Doctors should not only observe the symptoms of the disease, but also pay close attention to the patient’s sense, mood, and qi and blood running state in the process of treatment with acupuncture. According to the condition of the patient’s spirit, use the corresponding acupuncture technique, to achieve the desired therapeutic effect.

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6.2.1.2 Maintaining Needling Sensation

Maintaining needling sensation means after getting needle sensation, the doctor should keep the needle sensation during the treatment. Needle sensation plays a very important role in obtaining therapeutic effects, so maintaining needling sensation is the effective measure to improve the curative effect of acupuncture. Acupuncture Achievement records that in treatment it is worse to lose qi rather than the good  time  for treatment, illustrating the importance of maintaining needling sensation. Ling Shu also points how to maintain needling sensation in treatment. The doctor must carefully feel the running state of qi. If needle sensation is felt, do not change the direction and the depth of needling; keep holding the needle; do not move and concentrate on the use of qi to the fingers; keep the needle sensation, or apply gentle manipulation to promote qi and let it slowly come around the needles. The doctor should pay close attention and watch and feel the running state of qi in the patient when he/ she is keeping needle sensation.

6.2.2  Reinforcing Deficiency and Reducing Excess

Reinforcing deficiency and reducing excess means support vital qi and dispel evil. Su Wen illustrates as follows, “Excess means excessive pathogens, while deficiency means deficient health condition.” Excess needs reducing while deficiency needs reinforcing. This principle is made according to the actual situation of disease.

6.2.2.1 Deficient Syndrome Requiring Reinforcing Methods, Qi Descending Syndrome Requiring Moxibustion

Treating deficiency syndrome with reinforcing method is mainly achieved through the choice of acupuncture acupoints and the choice of compatibility acupuncture therapy and the reinforcing and reducing methods of acupuncture. For example, apply reinforcing twisting, reinforcing lifting, reinforcing closing on acupoints to strengthen the vital qi. Select some acupoints which have reinforcing functions, such as Zusanli (ST 36), Qihai (CV 6),Shenque (CV 8),Danzhong (CV 17) and so on for acupuncture. These acupoints can reinforce deficiency syndrome, promote the function of zang-fu organs, balance yin and yang and improve qi and blood.

Qi descending syndrome requiring moxibustion means using  moxibustion  method  to  treat descending syndrome due to qi deficiency. Warming moxibustion method can play a better role in reforcing yang and lift qi. For example, organ prolapse due to qi deficiency can be treated by the application of moxibustion on Baihui (GV 20),Shenque (CV 8), back-shu points and other points, which helps to benefit qi and raise yang.

6.2.2.2  Excessive Syndrome Requiring Reducing Methods, Prolonged Stagnation Requiring Eliminating

Treating excessive syndrome with reducing method is mainly achieved through the choice of acupuncture acupoints and the choice of compatibility acupuncture therapy and so on. For example, apply reducing twisting, reducing lifting and thrusting, reducing opening on acupoints to dispel evil in body. Select some acupoints with reducing functions, such as Shixuan (EX-UE 11),Shuigou (GV 26) and Suliao (GV 25) to get rid of evil.

Prolonged stagnation requiring eliminating means to clear blood stasis for dredging collaterals. It is advisable to conduct quick pricking with three-edge needles, tapping with seven-star needles or blood-letting puncture with cupping therapy.

6.2.2.3 Needling the Points of Related Meridians to Treat Syndrome with No Excess and No Deficiency

Firstly, syndrome with no excessive and no deficiency does not mean the nature of disease without excess

and deficiency; rather, it only means excessive and deficient symptoms of Zang and Fu, meridians and collaterals are not obvious. Secondly, as the lesion part is located in the internal organ and the meridian itself and does not involve other organs and meridians, which is deemed as an autologous meridian disease. It is required to select acupoints of the related sick meridian only in the treatment with acupuncture and moxibustion. Thus use mild reinforcing-reducing method or even method which means when the needle is inserted into the point and the needle sensation is achieved, lift, thrust and rotate the needle evenly.

6.2.2.4 Using Reinforcing and Reducing Method to Treat Syndromes with Both Deficiency and Excess

Reinforcing and reducing method should be applied to treat disease showing syndromes with both deficiency and excess. In case of stagnation of liver qi and deficiency of spleen, symptoms include bad mood, distention and pain of lateral thorax, belching with bad smell and acid liquid in the mouth and so on, which are related to liver depression and associated with bad appetite, diarrhea and other symptoms of spleen deficiency. Reducing method should be applied towards Foot-Jueyin liver meridian and Foot-Shaoyang gallbladder meridian, while reinforcing method should be applied towards Foot-Taiyin spleen meridian and Foot-Yangming stomach meridian. Reinforcing and reducing method is commonly used in clinic practice. Besides, the degree and priority of reinforcing and reducing should be decided subject to the severity  of disease and specific syndrome with deficiency and excess.

6.2.3 Clearing Heat and Warming Cold

Heat and cold are two relative concepts, determined by the nature of the illness. Su Wen recorded for the first time the principle of treatment for heat illness with cooling methods and treatment for cold illness with heating

methods, which are realized by selection of acupoints, needling technique and different kinds of needles and so on.

6.2.3.1 Clearing Method for Heat Diseases

Ling Shu illustrats as follows, “Needling for heat disease is like testing boiling water by hand finger.” It means while treating heat disease with acupuncture, it is a need to use shallow needling, remove needles quickly or do not remain needles with pricking blood. Use reducing needling method for excessive heat disease and use reinforcing or mild reinforcing-reducing needling methods for deficient heat syndrome based on actual situation. For example, in case of fever due to a cold, select such points as Quchi (LI 11), Hegu (LI 4), Dazhui (GV  14), Fengchi (GB 20) for shallow needling to dispel wind-heat; in treatment of sore throat, prick Shaoshang (LU 11) and Shangyang (LI 1) to make  bleeding with three-edged  needle to clear heat and relieve pain; if the patient coughs with yellow phlegm, the practitioner can select Chize (LU 5) and Kongzui (LU 6) for reducing needling to clear heat of lung.

6.2.3.2 Warming Method for Cold Diseases

Ling Shu says, “Needling for cold disease is like that human don’t want to leave.” It means while treating cold disease with acupuncture, it is a need to use needles deeply and remain needles for a long time, or add in moxibustion therapy. Exterior cold illness mostly belongs to excessive syndrome. Thus, select the points of hand three yang channels, lung channel of hand-Taiyin and governor vessel for needling and moxibustion with  mild reinforcing-reducing method. Internal cold illness mostly belongs to deficient syndrome. Thus, select the acupoints

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of pathological viscera and acupoints of Biao-li and Conception Vessel for moxibustion with reinforcing-reducing method or reinforcing method to remove coldness by benefiting qi. For example, in the treatment of headache involving neck and upper-back due to wind-cold flu, select Lieque (LU 7), Hegu (LI 4), Fengch (GB 20) for needling with mild reinforcing-reducing method, together with moxibustion method on Dazhui (GV 14) to release exterior and expel coldness. In the treatment of diarrhea with cool limbs due to deficient spleen and stomach, reinforcing method is applied towards Zusanli (ST 36),Zhongwan(CV 12) and Tianshu (ST 25),mild reinforcing- reducing method is applied towards Shangjuxu (ST 37) and Xiajuxu (ST 39), and moxibustion  method  is applied towards Shenque (CV 8) and Qihai (CV 6).

6.2.3.3  Clearing and Warming Method for Mixing Diseases with Cold and Heat

In clinic practice, complexity and transformation between heat and cold are commonly seen. For example, external cold and internal heat coexist, external heat and internal cold coexist, upper cold and lower heat coexist, upper heat and lower cold coexist, actual heat and superficial cold coexist and actual cold and superficial heat coexist. In case of inner heat and outer cold with the symptoms that the patient fears cold and has cool limbs while he does not want to wear thick clothes, has yellow urine and is easy to be thirsty, which are caused by excessive internal heat forcing cold to go out. Thus, it is required to clear Foot-Yangming meridian with reducing needling method and warm Hand-Yangming meridian with reinforcing needling method.

6.2.4  Individualized Treatment Based on Season, Locality and Individuality

Individualized treatment based on season, locality and individuality means choosing suitable therapeutic method subject to different seasons (including hour), geographical environments in which a patient is living or get ill, individual condition of a patient such as age, gender, physical and other personal circumstances.

6.2.4.1  Treatment in Accordance with Seasonal Conditions

Seasonal conditions not only include season, but also include time and opportunity for treatment. In the application of acupuncture treatment, the season and hour should betaken into consideration in diagnosis of the illness and the treatment, so as to develop the corresponding treatment method. The physiological function and pathological alteration of the human body are closely related to the climate change of four seasons. At the same time, the qi and blood of meridians and zang-fu of the human body varies with the climate of the four seasons. According to law of the onset of certain diseases or aggravating time, choosing the time for more effective treatment, will achieve better efficacy. For example, in winter exogenous pathogenic factors cause wind-cold disease, while in summer exogenous pathogenic factors mostly result in wind-heat or heat-humid disease. In spring and summer, the yang increases and diverges outward, qi-blood in human body goes toward the surface, and the patient mostly suffers from the superficial pathogen invasion; in autumn and winter, human blood hides inside and pathogen invasion penetrates into the deep. Accordingly, use shallow needling method in spring and summer, and deep needling in autumn and winter.

6.2.4.2 Treatment in Accordance with Local Conditions

In the application of acupuncture to treat disease, the geographical conditions where the patient is growing and living should betaken into consideration so as to determine a corresponding treating therapy. The physiological

function of human body and pathological characteristics are closely related to the geographical environment. Therefore, appropriate treatment therapy subject to the living environment is helpful to achieve the expected effect.

6.2.4.3 Treatment in Accordance with Personal Conditions

In the application of acupuncture to treat disease, a therapy should be formulated subject to the patient’s gender, age, physical constitution and other characteristics. The physiological function of human body and pathological changes are closely related to gender, age, physical fitness, personality, work and other factors. Ling Shu illustrates, “As for an adult with adequate qi-blood, needle can be of deep   insertion and retention for a longtime in acupuncture; but as for a baby, needle can be shallowly pricked without retention as qi and blood of baby are not mature.” Therefore, individual differences are important factors in determining and influencing the treatment method and efficacy of acupuncture. For another example, in case of a patient with physical weakness,

thin and tender skin and sensitiveness to acupuncture, the manipulation of acupuncture should be gentle; in case of a patient with strong physique, thick skin, dull needle-sensitiveness, the manipulation of acupuncture should be strong.

6.2.5 Distinguish Between the Whole and the Part

In the application of acupuncture and moxibustion, the relation between the whole and the part should be paid attention to. Syndrome appearing on part of the body is always part of the systemic diseases. For example, headache is usually related to liver yang hyperactivity; ulcers in tongue and mouth are associated with heart and small intestine; anus prolapse is caused by insufficiency of spleen qi. Biao You Fu records, “A small sign can indicate the condition of the whole meridian and collateral system.” In acupuncture treatment, the holistic concept and syndrome differentiation are held to obtain better curative effect.

6.2.5.1 Local Treatment

Selection of the acupoints located in the lesion or reflective body surface associated with the nerve segment for treatment is one of the methods most commonly used in acupuncture treatment. For instance, in case of facial paralysis, select Quanliao (SI 18),Jiache (ST 16); in case of abdominal pain and diarrhea, select Tianshu (ST 25), Zhongwan (CV 12); in case of lumbago, select Shenshu (BL 23) and Yaoyangguan (GV 3); in case of herpes zoster located in the chest and rib, select Zhangmen (LR 13) and corresponding points which are related to the nerve segment of the Jiaji. All of these reflect that all the common acupoints have local therapeutic effect, and the local points can be the key to treat the disease. The improvement of local symptoms, can contribute to the treatment of systemic diseases.

6.2.5.2 Holistic Treatment

In addition to selecting local acupoints in the lesion for treatment, the acupuncture and moxibustion treatment also attach great importance to holistic treatment on the basis of the expected function of meridian acupoints. The acupoints below the elbows and knees and Shu-mu are the key points for the treatment of lesions on head, face, trunk, internal organs and other systemic lesions. Specifically speaking, the kidney channel passes through the throat and tongue; if there is symptom such as dry throat, Shuiquan (KI 5) and Zhaohai (KI 6) of kidney channel

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can be selected for acupuncture to nourish yin and moisten dryness, reflecting the treatment concept, “Where is the channels going through, where is the treatment focus.” Some acupoints such as Zusanli (ST 36), Yinlingquan (SP 9), Dazhui (GV 14), Baihui (GV 20), Qihai (CV 6) and Guanyuan (CV 4), have the role of preventing and treating systemic diseases. Holistic treatment includes treatment towards the “syndrome” . For example, in case of headache and dizziness caused by hyperactivity of liver-yang, the practitioner can select Taixi (KI 3) for  treatment to nourish yin and suppress yang; in case of fever and cough caused by exogenous pathogenic factors, select Hegu (LI 4), Waiguan (SJ 5) and Lieque (LU 7) for stopping cough and  relieving  exterior  syndrome  by diaphoresis and lung-dispersing.

6.2.5.3  Local and Holistic Treatment being Used Simultaneously

In most cases, local treatment and holistic treatment need to be used at the same time. For instance diarrhea caused by spleen deficiency, select Daheng (SP 15) and Tianshu (ST 25) for regulating large intestine to stop diarrhea in local term, and select Pishu (BL 20) and Zusanli (ST 36) for benefitting spleen and stomach in holistic term. The combination of local treatment and holistic treatment can not only focus on the treatment of local symptoms, but also the etiology and treatment for syndrome so as to improve the therapeutic effect.

6.2.6 Treating Disease from the Root

Treating disease from the root means seizing the essence of the disease in the treatment and taking targeted treatment, which is the decisive factor in obtaining efficacy.

“Root” and “branch” is a relative concept. “Treating disease from the root” is the basic rule of medicine. However, in clinic practice, disease will show different special relationship between root and branch, towards which the practitioner should develop suitable treatment strategy.

6.2.6.1  Treating Branch First in Emergency Cases

Treating branch first in emergency cases mean when disease is in the emergency situation, the first treatment of branch cause is more important than treatment for root cause as the purpose is to save life or to relieve the patient's acute symptoms, and then to create favorable conditions for the root treatment of disease. For example, if the patient develops high fever convulsions caused by any reasons, the practitioner should puncture the Dazhui (GV 14), Shuigou (GV 26),Hegu (LI 4) firstly for clearing away the heat for resuscitation, stopping convulsion caused by internal wind; if the patient develops coma caused by any reasons, the practitioner should firstly puncture Shuigou (GV 26) for  resuscitation, and deal with root cause of disease later.

6.2.6.2  Treating the Root of Disease

In most cases, the treatment of diseases should adhere to the principle of “treatment aiming at its root causes”, especially in chronic diseases and in the recovery stage of acute diseases. Su Wen says, “The treatment of disease needs to find the root cause and correct it.” Reinforce health qi for deficient syndrome, and dispel evil-qi for excessive syndrome. In case of predawn diarrhea symptoms caused by deficiency of kidney yang, as diarrhea is the branch cause while deficiency of kidney yang is the root cause, moxibustion should be applied on Baihui (GV 20), Guanyuan (CV 4), Yaoyangguan (GV 3),Mingmen (GV 4) and Shenshu (BL 23) for root treatment.

6.2.6.3  Treating the Branch and Root Simultaneously

In clinic practice, both root cause and branch cause are of the same severity, and accordingly “root” and  “branch” should be treated at the same time. For example, in case of common cold with qi-deficiency, if the  treatment only focuses on getting rid of wind, it will make the body less healthy-qi; if the treatment only focuses  on reinforce health qi, it will remain the evil-qi of wind cold. In this way, supplementing qi and expelling the  pathogenic factors from the body should be conducted at the same time. Specifically speaking, supplement qi to  treat “root” disease, selecting Danzhong (CV 17), Qihai (CV 6) and Zusanli (ST 36) for reinforcing and giving  Zusanli (ST 36) or Qihai (CV 6) moxibustion; expel the pathogenic factors from the body to treat “branch” disease, selecting Hegu (LI 4),Fengchi (GB 20) and Lieque (LU 7) for reducing.

References

[1] Long Zhixian, et al. The Science of Acupuncture and Moxibustion  [M]. Beijing: Beijing University of Traditional Chinese Medicine Press, 1999.

[2] Gao Shuzhong, Yang Jun, et al. Acupuncture and Moxibustion  Therapy (The Ninth Edition) [M]. Beijing: Chinese Medicine Press, 2012.

[3] Wu Mianhua, Wang Xinyue, et al. Internal Medicine of Traditional Chinese Medicine (The Ninth Edition) [M]. Beijing: Chinese Medicine Press, 2012.

6.3 Acupoint Selection Principle for Acupuncture and Moxibustion Prescription

In the process of formulation of acupuncture and moxibustion prescription, proper selection and compatibility of acupoints is the crucial factor. This needs to be combined with the conditions of pulse and tongue, differentiation, good basis on the theory of meridians and acupoints and a mastery of the general principles for acupuncture and moxibustion, in order to select suitable acupoints to treat disease subject to the condition of the disease, and to formulate correct acupuncture prescription for a solid foundation to help the patient solve problems. Zhen Jiu Ju Ying·Si Xue Zong Ge records, “Zusanli is selected for epigastric and abdominal disorders, Weizhong for the disorder of back and lumbar region, Lieque for neck disorders, and Hegu for facial disorders.” In the clinical treatment, selection of acupoints should follow the basic principles and methods as follows.

6.3.1  Selection of Nearby Points

Selection of nearby points refers to selecting points in the local area and the adjacent area of the disease; that is to say, points for acupuncture treatment can be selected near the lesions of the limbs, body organs and five sense organs. For instance, Nei-Waixiyan (EX-LU 4) and Weizhong (BL 40) can be selected for knee disease; Danzhong (CV 17) and Tiantu (CV 22) for lung disease; Tinggong (SI 19) and Tinghui (GB 2) for ear disease. Both single meridian and several meridians can be selected for acupuncture. According to the characteristics of acupoints for the treatment of disease in the local area and adjacent area, the principle of adjusting qi and blood, yin and yang of the lesion area into normal, are applicable to all diseases.

In clinic practice, this method is the most common in bone and muscle disease treatment. As Ling Shu

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records, “Sometimes the disease attacks and sometimes does not attack; the left side will affect the right, and the right side will affect the left; puncture the acupoints for pain stopping in order to avoid repeated attacks.” It shows that the nearby points are primarily selected in the process of treatment for this kind of disease.

Local acupoints should be given priority in the following clinical common diseases: lumbar disc, knee osteoarthritis, acute lumbar sprain, facial paralysis, ankle sprain, etc.

6.3.2  Selection of Distant Points

Selection of distant points refers to selecting points located far from the diseased area, that is to say, points for acupuncture treatment can be selected far away from the lesions of the limbs, body organs and five sense organs. For instance, Zusanli (ST 36) and Qihai (CV 6) are selected for deficiency of qi and blood, Shangjuxu (ST 37), Xiajuxu (ST 39) and Tiaokou (ST 38) for dyspepsia diarrhea,Sanyinjiao (SP 6) and Taichong (LR 3) for tinnitus of hyperactivity of liver-yang. According to where the acupoint meridians pass through or the treatment effect followed, select distal acupoints to achieve the purpose of curing disease.

In clinical treatment, it is very common to select distant points, especially these points located below the elbows and knees, for these parts contain five transport points, yuan primary points and other specific points. As Zhenjiu Feng Yuan·Ling Shu writes, “In the treatment of these diseases, select the points below the limb joints. So the points of jing, xing, shu, jing and he are all below the elbow in upper limbs and below knees in the lower limbs.” It indicates that selection of distant points may also play an important role in acupuncture treatment.

6.3.3  Points Selection Subject to Differentiation or Syndrome

Select the point according to syndrome differentiation.

For example, if the patient has the syndrome of yin deficiency of kidney, Taixi (KI 3) is the selection; if the patient has the syndrome ofyang deficiency of kidney, Shenshu (BL 23) is the point for warming needle.

6.3.4  Selection of Symptomatic Points

Select specific points for the treatment according to the specific symptoms of diseases, which is also known as selection of symptomatic points. It is mainly  based on the specific function of some points and  the  application of clinical experience. For instance, Neiguan (PC 6) is selected for nausea and vomiting, Dingchuan (EX-B 1) for asthma, and Yaotongdian (EX-VE 7) for lumbago. These points are found to be of efficacy in long-term clinical practice, also known as experience points.

Chapter 7 Acupuncture Treatment of Diseases

Common Diseases in Acupuncture Treatment (A)

Facial Paralysis

【General description】

Facial paralysis is a kind of disease with the main symptoms of distortion of commissure, salivation, leakage in the speech, difficulty in eyelid closure, also called mouth and “eye deviation”, “sudden crooked mouth” or “mouth-eye oblique” . The disease can occur at any age, with the most common occurrence at 20-40 years old and slightly more for the male. There is no obvious seasonality or rapid onset. The vast majority of the incidence is one-side of facial paralysis and there is rare bilateral regard.

The disease is equivalent to peripheral facial paralysis in modern medicine, with bell palsy the most common case, which has no defined cause. It has been believed for a long time that the incidence of this disease is related to neurotropic virus infection. Attacked by wind-cold or upper respiratory tract infection, facial nerve suffers from vasospasm, ischemia, edema, then compression, local blood circulation disorder, neurotrophic deficiency, and even neural degeneration. In addition, there are also facial paralyses caused by non suppurative inflammation through herpes virus, such as the hunter facial paralysis. The disease is different from the central facial paralysis, and this chapter is talking about peripheral facial paralysis.

【Origin and development】

Distortion of commissure was first recorded in The Inner Canon of Huangdi, specifically Medical Inventions·Stroke by Li Gao of Jin Dynasty, involving “meridian is attacked by evil and then leads to distortion of commissure” .

The Etiology of Diseases by Chao Yuanfang of Sui Dynasty points, “The wind evil invades the meridians of Foot-Yangming and Hand-Taiyang, encounters cold, causes muscle to contract and unable to stretch, and then wry mouth, slurred speech and strabismus. The patient with floating and retarded pulse can be cured.” Volume I of Jin Gui Yi by You Yi of Qing Dynasty points, “The wind invading the ear results in wry mouth. The wind invades through the ear hole, which causes facial muscle crooked to one side.”

【Etiology and pathogenesis】

The lesion part is located in the facial muscles, and closely related to the Taiyang and Yangming meridians. It is the external characterization. There are internal causes, including physical weakness and fatigue, prolonged exogenous diseases and ear-throat diseases which may lead to lack of qi and then deficiency of collaterals and loss of protecting ability of wei qi. The external causes include exogenous pathogens (cold, wind-heat) invasion of the facial muscle, disorder of facial meridian qi and blood, dysfunction of facial muscle, etc.

Hand and Foot-Yangming meridians go through head and face, when the qi and blood of the face meridian is

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blocked by evil, especially dysfunction of the Hand-Taiyang and Foot-Yangming meridian. This may leads to facial paralysis. Ling Shu records, “Taiyang meridian lies in upper eyelid, and Yangming meridian lies in lower eyelid” . Shengji Zonglu in Song Dynasty records, “Foot-Yangming meridian goes through Jiache, while Hand-Taiyang meridian runs from neck to cheek. Both meridians are attacked by wind cold, leading to facial muscle cramp, wry mouth, slurred speech and strabismus.” The meridian muscles of Foot-Yangming goe up to the neck, bypass the mouth and joint around face and nose …” Meridian muscles of Hand-Taiyang follow the neck and meridian of Foot-Taiyang, and end in the ear bone...” Therefore the disease is closely related to the dysfunction of the meridian muscle of Taiyang and Yangming. Lin Pei-qin in the Qing Dynasty said, “The fact that blood deficiency can’t nourish channels leads to distortion of commissure.”

【Syndrome differentiation】

Primary symptoms: Distortion of commissure is the main symptom of the disease, along with sudden facial expression muscle paralysis in the morning, numbness, stagnation, disappearance of forehead wrinkle, excess palpebral fissure, flat nasolabial groove, mouth droop and contralateral face. In these cases, the patient cannot wrinkle and frown, close eyes, expose teeth, and blow air, etc.

Additional symptoms: Some patients have ear mastoid pain in the early stage, while some have the gustation of 2/3 front tongue diminishing or disappearing, and sensitive hearing. Food residues often remain in the teeth interspace of the affected side, and the saliva often flows from there.

In case of illness for a long term, the paralysis may lead to muscle contracture, hemifacial spasm or joint movement of facial muscles, manifesting in ipsilateral nasolabial groove deepening, mouth muscle contracture in the ipsilateral side, eye crack narrowing, to form the state of “inverting” .

Excess syndrome

1. Wind-cold invasion: Common in the early onset, the face having a record of cold wind blowing, pale tongue, thin white fur, floating tight pulse.

2. Wind-heat invasion: Common in the early onset, often secondary to fever caused by catching a cold, accompanied by sore throat, ear mastoid pain, red tongue, thin yellow fur, floating and rapid pulse.

Deficiency syndrome

Qi and blood deficiency: Common in the recovery period or for a patient with long duration, accompanied by fatigue, less energy and words, pale looking or withered yellow face, palpitation, dizzines, pale tongue, thin fur, weak pulse.

【Treatment】

General treatment

Principle of treatment: Get rid of wind evil, dredge and regulate meridian muscles. The treatment mainly focuses on Hand and Foot Yangming meridian and Hand and Foot Taiyang meridian, together with local acupoints and the Shaoyang meridian as supplement.

Main point: Yangbai (GB 14),Sibai (ST 2),Quliao (SI 18),Jiache (ST 6),Dicang (ST 4),Hegu (LI 4), Yifeng (SJ 17). Additional point:

Wind-cold invasion: Fengchi (GB 20),Fengfu (GV 1);

Wind-heat invasion: Quchi (LI 11), Waiguan (SJ 5);

Deficiency of qi and blood: Zusanli (ST 36),Qihai (CV 6). Taste loss: Lianquan (CV 23);

Auditory sensitivity: Ermen (SJ 21),Shangguan (GB 3);      Difficulty in frowning: Cuanzhu (BL 2), Yuyao (EX-HN 4); Shallow nasal lip groove: Yingxiang (LI 20);

Difficulty in eyelid closure: Qiuhou (EX-HN 7), Yuyao (EX-HN 4); Sheding tears: Taichong (LR 3).

Manipulation: Needles can penetrate into Yuyao (EX-HN 4) towards Cuanzhu (BL 2) and Yangbai (GB  14). Mild reinforcing-reducing manipulationshall be applied on points on the face, and moxibustionis suitable for Yifeng (SJ 17). During the recovery period, moxibustionis suitable for the main points. In the acute stage, needling on facial points should be gentle, shallow, less in the number of acupoints, and reducing method is applied on the distal limbacupoints. During recovery period, Moxibustion is applied on Zusanli (ST 36) or Qihai (CV 6), and mild reinforcing-reducing method is applied towards Hegu (LI 4) and Kunlun (BL 60).

Explanation: Facial acupoints can regulate local tissue, qi and blood, and promote blood circulation. Hegu (LI 4) is the distal acupoint of the Hand-Yangming meridian which passes through the face, “mouth and face always can be charged by Hegu” . In the acute stage, needling Hegu (LI 4) with the reducing method can help to get rid of evil and dredge meridians. In recovery period, treatment on Zusanli (ST 36), Qihai (RN 6) and Guanyuan (RN 4) can be used as the reinforcing method, to replenish qi and blood and nourish body.

Alternative treatment

1.Three-way-acupuncture is applied in the treatment of facial paralysis, which helps to improve curative effect and avoid or reduce the occurrence of complications. In acute stage, adopt gentle adjustment methods in acupuncture and avoid electroacupuncture; in the middle stage, adopt moderate adjustment methods in acupuncture, and electroacupuncture is available; in the late stage, take minute adjustment methods in acupuncture and focus on partial syndrome. Complications mainly include facial muscle contracture, synkinesis, tic,ptosis and crocodile tears.

2. The cutaneous or tapping needing: Focus on Yangbai (GB 14), Quanliao (SI 18), Jiache (ST 6),Dicang (ST 4), and tap skin to flushing once every other day. Suitable for recovery period.

3. Cupping method: Focus on Yangbai (GB 14), Quanliao (SI 18),Jiache (ST 6),Dicang (ST 4) for cupping

2 times a week. Suitable for recovery period.

4. Electric acupuncture: Focus on Taiyang (EX-HN 5), Yangbai (GB 14),Quanliao (SI 18),Jiache (ST 6) and Dicang (ST 4) with electric acupuncture for 20-30 minutes. It’s better to be based on whether the patient’s facial muscles slightly throb. Suitable for middle and late stage.

5. Paste Herbs on Points: Focus on Taiyang (EX-HN 5), Yangbai (GB 14), Quanliao (SI 18), Jiache (ST 6) and Dicang (ST 4). Mill 30 g raw monkshood, 6 g borneol together into powder, take about 0.3-0.6 g powder each time, make into a lump and paste it on adhesive tape and then in the acupuncture points once a day, 8 hours for each time, and it can be used for 3 days; or mash castor, make into a lump and add a little musk, then take a lump

Billingual Acupuncture and Moxibustion

with the size similar to a soybean and affix on the acupuncture points, replace it every 3 to 5 days; or rasp nux vomica into powder, take 0.3-0.6 g each time to affix on the point, and replace the drug every 5 to 7 days.

【Notes】

1. Safe and effective, acupuncture and moxibustion treatment for facial paralysis has a good effect. Prompt treatment is advisable.

2. Head and the part behind ears should be protected to avoid wind cold with regard to wind-cold. If necessary, the patient should wear a facemask or scarf. As eyelids cannot close entirely and dust may invade, use eye drops 2 to 3 times every day or wear eye goggles.

3. Peripheral facial paralysis is closely related to the damage of facial nerve, electromyography can be used as an auxiliary examination of facial nerve injury. In general, the prognosis of facial paralysis caused by aseptic inflammation is better, while that caused by virus (e.g., hunt facial paralysis) gets poor. If in 3 months to half a year it can’t be healed,it is more likely to have sequelae.

4. This disease is different from central facial paralysis.

References

[1] Gao Shuzhong. Acupuncture and Moxibustion Therapeutics. The Ninth Edition. Beijing: Chinese Medicine Press, 2012.

[2] Wu Jiang. Neurology. The Second Edition. Beijing: People’s Health Press, 2005.

[3] Fang Jianqian. Science of Acupuncture and Moxibustion. Beijing: Chinese Medicine Press, 2014.

[4] Shi Xuemin. Acupuncture and Moxibustion. The Second Edition of New Century. Beijing: Chinese Medicine Press, 2007.

[5] Shen Xueyong. Meridian Acupoints.The Second Edition of New Century. Beijing: Chinese Medicine Press, 2007.

[6] Beijing University of Traditional Chinese Medicine. Acupuncture and Moxibustion. Beijing: Xueyuan Press, 1999.

Insomnia

【General description】

Insomnia, also called “not sleep” or “sleepless”, is a disease of being not able to get normal sleep, which is caused by heart loss of the nutrition or emotional restlessness. The main clinical manifestations are shortness in the time of deep sleep. If the insomnia of a patient is not severe, he may feel it difficult to fall asleep, or to have deep sleep; or he may wake up in an interruptible way. If the insomnia of a patient is severe, he may stay awake all night.

In modern medicine, insomnia can occur in many kinds of diseases, such as neurasthenia, menopausal

syndrome, anxiety neurosis, depression neurosis and anemia and so on. In the field of modern medicine, as for primary insomnia which is not related to neurological diseases or physical disorders, refer to this section of treatment.

【Origin and development】

The Inner Canon of Huangdi has the earliest record about the name and pathogenesis of insomnia. It records that insomnia is caused by evil invasion into zang-fu and that Wei Qi runs through yang meridians, and does not return back to yin meridians. It also puts forward the idea of “when the stomach is in disharmony, sleep is not

well.” Later physicians extend this idea, and they believe that if the spleen and stomach stay in disharmony, which make phlegm stagnate or food residues accumulate in the stomach, it can result in insomnia. Treatise on Febrile Diseases by Zhang Zhong-jing of Han Dynasty, records the two types of insomnia which is caused by fire excess and yin deficiency and which is cause by liver blood deficiency hot and humid condition. Zhang Jing-yue of Ming Dynasty, thought it was excess type of insomnia if there were evils existing, while it was deficient type if there were no evils existing. Li Zhong-zi in Yi Zong Bi Du said, “The insomnia is divided into qi deficiency, yin deficiency, phlegm stagnation, retention of water and stomach disharmony” and he summed up the prescriptions suitable for the five categories of symptoms in this book. Feng Zhao-zhang of Qing Dynasty thought the insomnia was related to the status of yin and yang in kidney by comparing the youth’s sleep with the elder’s.

【Etiology and pathogenesis】

Closely related to the conditioning of qi and blood in liver, spleen, kidney and other internal organs, the lesion site of insomnia is in heart. The etiology includes diet unbalance, emotional disorder, disharmony between

labor and rest, physical weakness, etc. The basic pathogenesis is malnutrition or disturbance of heart spirit, imbalance of yinqiao and yangqiao meridians, imbalance of yin and yang featuring excessive yang and deficient yin.

Storing spirit, heart controls the blood and vessels, and also relies on the support of  liver, spleen  and kidney. The blood produced by cereal essence is stored in heart and nourishes the heart for mental stability. Otherwise, insomnia happens due to the heart’s loss of blood nutrition. Yinqiao and yangqiao meridians intersect inside the eye, maintaining yin and yang of the body and controlling opening and closing of the eyelid. If yinqiao and yangqiao meridians cannot intersect, which leads to the state where deficient yin fails to accommodate yang and excessive yang fails to receive yin, eyes fail to close and the patient fails to fall sleep.

【Syndrome differentiation】

The main clinical manifestations are sleep quality (depth) and sleep volume (time) abnormalities. The degree of severity of the symptoms is associated with sleep experience and feeling of the patient.

1. Insufficiency of heart and spleen: Having a lot of dreams and waking up easily, together with palpitation, forgetfulness, dizziness, fatigue, lack of strength or draining color in complexion, pale tongue, white fur and weak pulse.

2. Qi deficiencies of heart and gallbladder: Palpitation, timidity, being easy to be frightened and intimidated, dream, pale tongue, thin fur and weak pulse.

3. Yin deficiency and fire excess: Upset and sleeplessness, or interruptive sleep, hotness in hand, foot and chest, dizziness and tinnitus, palpitation, poor memory, red cheek, or dry mouth and throat, red tongue, weak and rapid pulse.

4. Pathogenic fire derived from stagnation of liver qi: Upset and sleeplessness, irritability, pain in chest and hypochondrium, headache and vertigo, red face and eyes, bitter taste, abnormal urine and stool, red tongue, yellowish fur, wiry and rapid pulse.

5. Phlegm-heat and internal disturbance: Disquiet sleep, upset and depression, stuffy feeling in chest, bitter taste and excess phlegm, body hotness, red tongue, yellow greasy fur, smooth and rapid pulse.

Billingual Acupuncture and Moxibustion

【Treatment】

General treatment

Principles: Regulate qiao meridian, relieve uneasiness of mind and tranquilize body. The main acupoints are confluent acupoints connecting the eight extra meridians, Hand-Shaoyin meridians and acupoints on the Governor vessel.

Main points: Zhaohai (KI 6), Shenmai (BL 62), Shenmen (HT 7), Yintang (GV 29),Sishencong (EX-HN 1), Anmian.

Additional points:

Insufficiency of both heart and spleen: Xinshu (BL 15),Pishu (BL 20), Zusanli (ST 36);   Qi deficiency of heart and gallbladder: Qiuxu (GB 40),Xinshu (BL 15),Neiguan (PC 6);  Heart-kidney disharmony: Taixi (KI 3),Shuiquan (KI 5),Xinshu (BL 15),Pishu (BL 15); Liver-fire disturbance: Xingjian (LR 2),Xiaxi (GB 43);

Incoordination between spleen and stomach: Taibai (SP 3), Gongsun (SP 4), Neiguan (PC 6), Zusanli (ST 36),Fenglong (ST 40).

Manipulation: Use reinforcing-reducing method towards Shenmen ( HT 7), Yintang (GV 29), Sishencong (EX-HN 1); needle overnight towards Sishencong (EX-HN 1) for severe insomnia patients; use reinforcing method towards Zhaohai (KI 6); use reducing method in Shenmai (BL 62). Use the method of reducing for the excess syndrome and replenishing for the deficient syndrome in additional points.

Explanation: Heart deposits spirit, and Shenmen (HT 7) is the primary point of heart meridian; brain is the house of mentality, Yintang (GV 29) is situated on the governor vessel, which goes through into the brain. The two points can soothe the nerves. Sishencong (EX-HN 1) helps to tranquilize the mind. Zhaohai (KI 6) and Shenmai (BL 62) are the confluence points of eight meridians which are linked with yinqiao and yangqiao meridians respectively.  Because yinqiao and yangqiao meridians control the opening and closing of the eyelids, they dominate sleeping state. If the function of yangqiao meridian is hyperactive, it comes to insomnia. Reinforcing yinqiao meridian and reducing yangqiao meridian at the same time could contribute to the balance and then to good sleep.

Alternative therapy

1. Skin needling therapy: Tap Yintang (GV 29), Baihui (GV 20), Shu-acupoints on neck and lumbar spinal cord gently for five to ten minutes once a day till it gets red.

2. Ear acupuncture therapy: Press ear points related to heart, spleen, Shenmen, subcortex, sympathia, etc. 【Notes】

1.Acupuncture has a good effect in the treatment of insomnia, especially when it is applied in the afternoon or evening. It is better to coordinate acupuncture with psychological treatment. If insomnia is also caused by other diseases, then other pathogenic factors should betaken into consideration in the treatment.

2. Acupuncture can adjust heart rate and respiratory rate, and calm down anxiety and irritability of the patient. Acupuncture influences the activity of the central nervous system through regulation of peripheral nerve and blood vessel; and produces certain chemicals, such as 5-hydroxytry ptamine and dopamine, etc. to achieve

mind tranquilization and enhance the inhibition function of cerebral cortex.

3. This disease is related to the change of emotion. Tension and anxiety of the patient should be eliminated and a rest by regular hours is needed. Before going to sleep, tea, coffee, and wine are  inadvisable. Appropriate physical exercise is advisable.

References

[1] Wu Mianhua, Wang Xinyue, et al. Internal Medicine of Traditional Chinese Medicine (The Ninth Edition) [M]. Beijing: Chinese Medicine Press, 2012.

[2] Wang Hua & Du Yuanhao. Science of Acupuncture and Moxibustion (The Ninth Edition) [M]. Beijing: Chinese Medicine Press, 2012.

[3] Long Zhixian et al. Science of Acupuncture and Moxibustion [M]. Beijing: Beijing University of Traditional Chinese Medicine Press, 1999.

[4] Gao Shuzhong, Yang Jun, et al. Acupuncture and Moxibustion  Therapy (The Ninth Edition of 12th Five-year Plan Textbook Series) [M]. Beijing: Chinese Medicine Press, 2012.

[5] Beijing University of Traditional Chinese Medicine. Acupuncture and Moxibustion. Beijing: Xueyuan Press, 1999.

Facial Spasm

【General description】

Facial spasm is a kind of disease which is characterized by unilateral facial muscles with paroxysmal and irregular involuntary twitch. Facial spasm belongs to “facial stroke”, “muscular twitch and cramp” in  traditional Chinese medicine, always caused by external evil invasion, efficiency of vital qi, weakness of natural endowment, etc., or followed by facial paralysis. Facial spasm is more common in the elderly and women. Facial muscles appear paroxysmal, irregular tic, confined to one side, and bilateral involvement is rare. It can be aggravated by mental strain, fatigue, autonomic  movement, and  may disappear  during sleeping without  pain. Not any other neurological positive signs can be seen except paroxysmaltwitch. Facial spasm includes primary facial spasm and secondary facial spasm in modern medicine. Primary facial spasm is due to some kind of oppression of the facial nerve conduction caused by pathological interference. Most cases with facial spasm are due to normal vascular cross-compression, such as the posterior inferior cerebellar artery, inferior cerebellar artery, vertebral artery compression, occasionally aneurysm, arteriovenous malformation or brain tumor.

Secondary facial spasm often occurs in the recovery of idiopathic facial neuritis, and the cause for facial spasm may be that facial nerve fails to return to normal as its inflammation changes the pathology of nerve demyelination. Part of the demyelination makes the facial nerve conduction susceptible to generalization, or facial nerve inflammation influences the brain stem nuclei, and then contributes to epileptic foci resulting in facial

muscle twitching. A very small number of patients suffer from unilateral facial spasm following tumor or trauma or surgery.

Billingual Acupuncture and Moxibustion

【Origin and development】

Treatise on Febrile Diseases · Treatment Governance for Taiyang Diseases proposes that the disease is due to yang injury from excessive sweating, body fluid and blood loss, nutrition lack for muscle. Cheng Wu-yi believes the disease is closely related to deficiency of yang. “It is because excessive sweating damages yang…...Then less body fluid and blood causes muscles’ lack of nutrition, so facial nerve moves up and down. ”

【Etiology and pathogenesis】

The lesion part is located in the facial muscles, closely related to liver, spleen, kidney, gallbladder, stomach of internal viscera. The nature of disease includes two types, deficiency and excess. The pathogenesis is due to inborn deficiency of yin, blood insufficiency, meridian dystrophy or exogenous pathogenic factors’ invasion. The basic pathogenesis is meridian block or meridian dystrophy.

【Syndrome differentiation】

Primary symptom: It is characterized by paroxysmal, irregular involuntary twitch on one side of the facial muscles. Mostly, orbicularis muscle begins the paroxysmal spasm; gradually it spreads to the same side of the face, eyelids and mouth. In severe cases, the orbicularis muscle twitch causes difficulty in opening eyes. The muscle twitch continues for a few seconds to a few minutes each time and the spasm range does not exceed the facial nerve innervation area.

Additional symptom: A small number of patients have paroxysmal seizures associated with minor facial pain. Facial muscle weakness, muscle atrophy or muscle paralysis can occur in the late stage.

Excessive syndrome

Wind-cold Invasion: In the early stage, the main symptom is the paroxysmaland irregular involuntary twitch of facial muscles, where the patients may have a record of facial cold. Pale tongue, thin white fur and floating and tense pulse can occur.

Wind-heat Invasion: In the early stage, the main symptom is the paroxysmaland irregular involuntary twitch of facial muscles, associated with sore throat, dry mouth and other heat syndromes. Red tongue, thin yellow fur, floating and rapid pulse can occur.

Deficient syndrome

1. Wind syndrome due to deficiency of yin: The main symptom is the side of the facial muscles appearing paroxysmal, irregular involuntary twitch, associated with upsetting, insomnia, dry mouth and throat, red tongue, little coating, thread and rapid pulse.

2. Deficiency of qi and blood: The main symptom is the side of the facial muscles appearing paroxysmal, irregular involuntary twitch, associated with dizziness, fatigue, poor appetite, pale tongue, thin white fur, and slow pulse.

【Treatment】

General treatment

Principle of treatment: Get rid of wind evil, dredge and regulate meridian muscles. The treatment mainly focuses on Hand and Foot Yangming Meridian and Hand and Foot Taiyang Meridian, together with local acupoints and Shaoyang Meridian and the related distal acupoints as supplement.

Main points: Yifeng (SJ 17),Quanliao (SI 18),Jiache (ST 6),Xiaguan (ST 7), Cuanzhu (BL 2),Fengchi (GB 20),

Fengfu (GV 16),Hegu (LI 4), Taichong (LR 3). Additional point:

Wind-cold invasion: Waiguan (SJ 5); Wind-heat invasion: Quchi (LI 11);

Wind syndrome due to deficiency of yin: Taixi (KI 3),Sanyinjiao (SP 6); Deficiency of qi and blood: Zusanli (ST 36) and Xuehai (SP 10).

Manipulation: Needle Cuanzhu (BL 2) horizontally towards the Yuyao (EX-HN 4). Use mild reinforcing- reducing method towards Yifeng (SJ 17),Quanliao (SI 18),Jiache (ST 6),Xiaguan (ST 7) and other local acupoints. Puncture needle from Fengchi (GB 20) through Fengfu (GV  16) by the horizontal insertion; use reducing method towards Hegu (LI 4), Taichong (LR 3), Waiguan (SJ 5), Quchi (LI 11) and other distal limb acupoints. Use reinforcing method towards Zusanli (ST 36) and Qihai (RN 6); use warming moxibustion towards Zusanli (ST 36).

Explanation: Domination of wind evil causes twitch. Thus, Yifeng (SJ 17),Fengchi (GB 20),Fengfu (GV 16) are chosen forgetting rid of wind evil and stopping the twitch; Hegu (LI 4) is the source point of large intestine meridians. “Hegu (LI 4) is the stronghold in the treatment of diseases in face and mouth.” Taichong (LR 3) is the source point of liver meridians. Liver meridians pass through the eyes to cheek, run a circle in sublabial area. The combination of Taichong (LR 3) with Hegu (LI 4) can emolliate the liver and dredge meridians and collaterals.

Alternative treatment

1. Intradermal needle: Puncture local Ashi point by embedding the needle subcutaneously with adhesive tape fixed; replace and re-bury the needle after 3 to 5 days.

2. Triangle-edged needle: Quanliao (SI 18), Jiache (ST 6), and Taiyang (EX-HN 5) can be chosen for twinkling cupping after quick puncturing.

3. Auricular needle: Puncture such eye-related parts as Shenmen, eyes, cheek, liver, Jiaogan and subcortex. 3-6 points are chosen each time for filiform needling or ear point pressing therapy.

4.Acupoint injection: Apply it on Yifeng (SJ 17) of the sick side of face, and select Salvia Miltiorrhiza liquid for injection. 1~2 ml is enough each time.

【Notes】

1. Acupuncture treatment for facial spasm can relieve the symptoms, reduce the frequency and extent of seizures.

2. During the treatment, the patient should maintain a good mood, and avoid mental tension and impatience.

References

[1] Gao Shuzhong. Acupuncture and Moxibustion Therapeutics.The Ninth Edition. Beijing: Chinese Medicine Press, 2012.

[2] Wu Jiang. Neurology. The Second Edition. Beijing: People’s Health Press, 2005.

[3] Fang Jianqian. Science of Acupuncture and Moxibustion. Beijing: Chinese Medicine Press, 2014.

[4] Shi Xuemin. Acupuncture and Moxibustion.The Second Edition of New Century. Beijing: Chinese Medicine Press, 2007.

[5] Shen Xueyong. Meridian Acupoints.The Second Edition of New Century. Beijing: Chinese Medicine Press, 2007.

[6] Beijing University of Traditional Chinese Medicine. Acupuncture and Moxibustion. Beijing: Xueyuan Press,1999.

Billingual Acupuncture and Moxibustion

Stomachache

【General description】

Stomachache is a kind of common disease with pain of upper-abdomen near the heart as the main symptom, also named epigastric pain, which is due to invasion by exogenous pathogenic factors, diet and emotional maladjustment leading to stagnation disorder of stomach qi. This disease has the higher incidence among the young and middle-aged,and can  be easily  triggered by bad mood, diet disorder, fatigue  or exogenous cold pathogens.

In modern medicine, stomachache includes acute and chronic gastritis, gastric and duodenal ulcer, peptic ulcer, stomach cramp, gastric torsion, gastroptosis, gastric mucosal prolapse, gastric neurosis and other diseases.     【Origin and development】

Lingshu·Symptoms of Evils in Internal Organs records Zusanli (ST 36) is the acupoint for the treatment of stomachache. Febrile Disease presents how to distinguish stomachache with stenocardia. Li Dong-yuan of Jin- Yuan Dynasty fist defined stomachache as an independent disease. After Qing and Ming Dynasty, Yu Zhuan, Shen Jin-bie, Ye Tian-shi and other famous physicians presented how to distinguish stomachache with stenocardia and the pathogenesis of liver qi attacking stomach, emphasizing the adjustment of qi and blood, yin and yang. They also put forward corresponding treatments.

【Etiology and pathogenesis】

The lesion part is located in the stomach and closely associated with liver and spleen. The disease usually presents excessive syndrome due to being attacked or damaged by exogenous evil, unbalanced diet and abnormal emotion at early stage; if the disease is not cured or recurs for a long time and the spleen and stomach get injured, excessive syndrome can change into deficient syndrome. The basic pathogenesis is stomach qi disharmony, stomach collateralsblocked or a lack of warming and nutrition of stomach. Stomach pain for a long time can evolve into other diseases. For instance, stomach heat forces blood running abnormally and spleen is too deficient to control blood; blood stasis leads to bleeding; bleeding a lot can be life-threatening. If yang is too deficient to transform water for a long time, it can lead to the stagnation of phlegm and retaining of fluid which can bring about dangerous illness.

【Syndrome Differentiation】

1. Excessive syndrome

Cold pathogens invade stomach: Suddenly occurring due to cold pathogens’ invasion is of the symptom of intolerance of cold and preference for warmth, together with white thin fur and wiry tense pulse. In addition, the pain gets aggravated by cold and relieved by warmth.

Food retention injures stomach: Sudden stomach pain after overeating with fullness and distention; aggravated by pressure after meals; belching with bad smell and acid regurgitation and vomiting withindigested food; pain may be relieved after vomiting; thick and greasy fur, and slippery pulse.

Attack on stomach by the liver qi: Happening with fullness and distention and radiating to the hypochondriac parts; belching with acid regurgitation; tending to sigh; aggravated by bad mood or tension; thin and yellow fur,and wiry pulse.

Qi stagnation and blood stasis: Fixed stabbing pain in stomach; aggravated while pressing; tongue with purple color or petechia; unsmooth pulse.

2. Deficienct syndrome

Deficient cold with stomach and spleen: Stomachache is of slow onset, preference for being pressed and getting warmth; aggravated by hunger, tiredness, raw or cold food; relieved after eating; pale tongue, white fur, and weak pulse.

Stomachache due to yin deficiency: Stomachache with burning sensation; hunger but no desire to eat; dry throat and mouth; dry stool or constipation; red and dry tongue; weak and wiry pulse or thin and rapid pulse.

【Treatment】

General treatment

1. Excessive syndrome

Principle of treatment: Reconcile function of stomach to alleviate pain. Select mainly the acupoint of Hand- Jueyin meridian and Foot-Yangming meridian and other mu acupoints.

Main point: Zusanli (ST 36),Neiguan (PC 6),Zhongwan (CV 12). Additional point:

Cold pathogen invasion: Weishu (BL 21);

Food retention: Xiawan (CV 10) and Liangmen (ST 21); attack on the stomach by the liver qi: Taichong (LR 3); qi stagnation and blood stasis: Geshu (BL 17).

Manipulation: Use mild reinforcing-reducing or reducing method towards Zusanli (ST 36), for 1-3 min until stomachache is relieved. Use reducing method towards Neiguan (PC 6),Zhongwan (CV 12) and other additional points.

Explanation: Zusanli (ST 36) is the lower He-sea point of stomach channel of Foot-Yangming, which can adjust the function of stomach. Zhongwan (CV 12) is the mu point of stomach, which can benefit the qi for middle energizer. Neiguan (PC 6) can relieve qi stasis of chest and live and stop the stomachache.

2. Deficient syndrome

Principle of treatment: Nourish stomach and alleviate pain. Select mainly the acupoint of Foot-Yangming meridian or other acupoints of mu and back-shu.

Main points: Zusanli (ST 36),Zhongwan (CV 12),Pishu (BL 20), Weishu (BL 21). Additional point:

Deficiency cold of stomach and spleen: Qihai (CV 6) and  Guanyuan (CV 4); yin deficiency of stomach: Sanyinjao (SP 6) and Neiting (ST 44).

Manipulation: Use mild reinforcing-reducing or reducing method for Zusanli (ST 36), for 1-3 min until stomachache gets relieved. Needle Zhongwan (CV 12), Pishu (BL 20), Weishu (BL 21) and other related points with reinforcing method. Moxibustion therapy can also be used for deficiency cold of stomach and spleen.

Explanation: Zusanli (ST 36) can benefit qi and blood to reduce the pain. Zhongwan (CV 12) is the mu point of stomach, which can benefit stomach with adjusting qi in middle energizer. Pishu (BL 20) and  Weishu (BL 21)

Billingual Acupuncture and Moxibustion

are the back-shu points which can be combined with Zhongwan (CV 12) and shu-mu to further strengthen the treatment effect.

Alternative Treatment

1. Finger pressing therapy: Press and knead Zhongwan (CV 12),Zhiyang (GV 9), Zusanli (ST 36) and other points with both thumbs or middle fingers, and adjust the strength according to the feeling of tolerance and comfort.

2. Ear acupoint treating: Press stomach, duodenum, spleen, liver, Shenmen, sympathetic points of ear with cowherb seed for stimulating.

3.Acupoint injection therapy: According to the syndrome of traditional Chinese medicine, use radix bupleuri, Angelica, salvia miltiorrhiza and ligusticum wallichii injection liquid or vitamin B1  and B12  for injection. Select 2-4 points for injection each time and 0.5 ml for each acupoint.

4.Acupoint application: Take 15 g moxa leaf and piper longum respectively, 10g spikenard, galangaresurrec flower, asarum, cinnamon, evodia rutaecarpa, rhizoma corydalis, radix angelicae respectively and 6 g anise; grind them into powder, put it into a cotton bag and affix it to the pain area day and night. It is applicable to the deficiency cold of stomach and spleen.

【Notes】

1.Acupuncture has a good effect in the treatment of stomachache with fullness and nausea, especially in acute stage.

2.Stomachache should be distinguished from symptoms of other diseases such as liver disease, and pancreatitis. In case of abnormal severe stomachache or a patient with the original case history of ulcer perforation, other measures or surgical therapy should be conducted in time.

3. Acupuncture can effectively relieve the state of gastro-intestinal spasm and relieve spastic pain caused by gastro-intestinal metabolic toxin stimulation; regulate the intestinal vascular function, reduce vascular permeability, and enhance metabolism and blood circulation. Because of the regulation of autonomic nervous system, gastric motility comes back to normal functional status. Acupuncture can also enhance the anti-injury function of gastro-intestinal mucosal cells and promote gastro-intestinal mucosal cell metabolism. Thus injured part of the tissue can be repaired as soon as possible.

4. During the treatment, the patient must have a regular diet, avoid eating spicy food or liquor, adjust mood and keep warm.

References

[1] Wu Mianhua, Wang Xinyue, et al. Internal Medicine of Traditional Chinese Medicine (The Ninth Edition) [M]. Beijing: Chinese Medicine Press, 2012.

[2] Long Zhixian, et al. The Science of Acupuncture and Moxibustion  [M]. Beijing: Beijing University of Traditional Chinese Medicine Press, 1999.

[3] Gao Shuzhong, Yang Jun et al. Acupuncture and Moxibustion Therapy (The Ninth Edition) [M]. Beijing: Chinese Medicine Press,

2012.

[4] Wang Hua & Du Yuanhao. Acupuncture and Moxibustion (The Ninth Edition) [M]. Beijing: Chinese Medicine Press, 2012.

Stroke

【General description】

Stroke refers to a kind of disease characterized by sudden unconsciousness, wry face, slurred speech and hemiplegia, or hemiplegia and face without sudden coma. Due to the rapid onset, a variety of symptoms and rapid changes in the condition, similar to the wind characterized by  quickly  moving and change, the disease  is named as stroke, or sudden attack. The rate of incidence and mortality for stroke is high, often followed by sequelae. In recent years, the incidence rate of stroke is increasing and the age of onset also tends toward the younger. It becomes one of the major diseases threatening and bringing down the quality of life. This disease is equivalent of acute cerebrovascular diseases, such as cerebral infarction, cerebral hemorrhage, cerebral embolism and subarachnoid hemorrhage defined in modern medicine. Western  medicine  divides stroke into two categories of hemorrhagic and ischemic. Hypertension, atherosclerosis, cerebral vascular malformation, and cerebral aneurysm can often lead to hemorrhagic stroke; rheumatic heart disease, atrial fibrillation, bacterial endocarditis, etc. can often cause ischemic stroke. In addition, hyperglycemia, hyperlipidemia, abnormal hemorrheology and abnormal fluctuation in mood are closely related to stroke. It can be affirmed by Head CT and MRI scanning.

【Origin and development】

Stroke, was first recorded in Yellow Emperor’s Internal Classic. As it is written in Ling Shu, evil invades the human body deep to Ying Wei, which causes less vital qi to exist and evil to remain alone. Synopsis of Golden Chamber · Stroke Disease records, “Cun pulse presents to be floating and tight. Being tight is for cold and floating for deficiency. When cold and deficiency coexist, evil stays in the skin. Floating pulse presents blood deficiency and collaterals emptiness, in which body could not get rid of evil with evil being left or right. When evil becomes slow and vital qi becomes quick, which can cause hemiplegia. If evil stays in the collaterals, skin shows numbness; if evil stays in the meridians, the body cannot be active; if evil stays in the fu, the patient may get unconscious; if evil stays in the zang, the patient cannot speak and may drool.” Zhang Yuan-su of Jin and Yuan Dynasties, in the thought that the cause of stroke is heat, said, “The wind is derived from the heat. The heat is the root and the wind is the branch.” Liu He-jian thought that stroke was caused by “heart fire, which suddenly becomes strong” . Li Don-yuan believed that stroke was caused by “qi deficiency”.

【Etiology and pathogenesis】

The lesion part is located in the heart and brain, and closely related to liver and kidney. The nature of disease is complex with deficiency and excess, with deficiency being the root and excess the branch. The basic pathogenesis is the imbalance of yin and yang and disorder of qi and blood. The main pathogenesis is that the wind, fire, phlegm and blood stasis lead to orifice of brain blocked and shen failing to dominate the qi-flowing. Stroke is the deficiency-rooted and excess-branched disease, which involves the imbalance of yin and yang qi and blood deficiency in root term; and the instigation of wind, fire, phlegm dampness and blood blocking in  meridian in branch term.

The occurrence of stroke is a complex pathological process caused by a variety of factors. It is mostly caused by internal factors in clinic practice, such as the wind, fire, phlegm and blood stasis which lead to the orifice of

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brain blocked and Shen failing to dominate the qi-flowing. 【Syndrome differentiation】

Stroke is divided into the attack in meridian and attack in zang-fu in clinic practice. A patient with attack in meridian has the symptoms such as hemiplegia, wry face, dysarthria, but clear consciousness. A patient with attack in zang-fu presents the symptoms such as confused mind, or loss of consciousness accompanied by hemiplegia.

1. Stroke by Attacking Meridians and Collaterals

(1) Liver-yang hyperactivity, wind and fire disturbance: Hemiplegia, crooked mouth and tongue, stiff tongue causing  unclear speech, numbness in the extremities, dizziness, headache, red eyes and face, bitter taste, dry throat, being upset and irritable, yellow urine, dry stool, red or red-purple tongue, thin yellow fur, wiry and strong pulse.

(2) Wind phlegm and blood stasis blocking meridians and collaterals: Hemiplegia, crooked mouth and tongue, stiff tongue causing unclear speech, numbness in the  extremities, dizziness, dim and pale tongue, thin, white or greasy white fur, wiry and slippery pulse.

(3) Phlegm heat and fu-excess, wind phlegm disturbance: Hemiplegia, crooked mouth and tongue, stiff tongue causing unclear speech, numbness in the extremities, abdominal distension, dry stool or constipation, dizziness, lots of sputum with coughing, dark red or dark tongue, yellow or yellow  greasy  fur, wiry  and slippery pulse or wiry, or slippery and large pulse.

(4) Qi deficiency and blood stasis: Hemiplegia, crooked mouth and tongue, stiff tongue causing unclear speech, numbness in the extremities, pale complexion, shortness of breath, fatigue, drooling, sweating, heart palpitation, loose stool,swelling of the hands and feet, pale tongue, thin and white or white greasy fur, deep and thread pulse or deep, thread and slow pulse.

(5) Yin deficiency and wind stirring: Hemiplegia, crooked mouth and tongue, stiff tongue causing unclear speech, numbness in the extremities, irritability, insomnia, vertigo, tinnitus, hothand, feet and chest, red or dark red tongue,less or no fur, thin and rapid pulse.

2. Stroke by Attacking the Zang-fu

(1) Obstructive syndrome: Unconsciousness, drowsiness, coma, hemiplegia, trismus, clenched mouth, fisted hand and strong pulse.

(2) Collapsing syndrome: Unconsciousness, closed eyes, opened mouth, flaccid paralysis of limbs, stretched palms and cold limbs, pale complexion, dilated pupils, incontinence, shortness of breath, over sweating with cool abdomen, desperate and gentle pulse.

【Treatment】

General treatment

1. Stroke by Attacking Meridians and Collaterals

Principle of treatment: Get rid of wind and phlegm; dredge obstruction from the meridians and collaterals; regulate qi and blood and keep yin and yang in balance.

The primary points selected are on Hand-Jueyin meridian, governor vessel and Foot-Taiying meridian.

Main point: Neiguan (PC 6),Shuigou (GV 26),Sanyinjiao (SP 6),Jiquan (HT 1), Chize (LU 5), Weizhong (BL 40).

Additional point:

Liveryang hyperactivity: Taichong (LR 3) and Taixi (KI 3);

Wind-phlegm accumulating in the collaterals: Fenglong (ST 40) and Hegu (LI 4);

Phlegm-heat accumulating in the fu organs: Quchi (LI 11),Neiting (ST 44) and Fenglong (ST 40);

Qi deficiency with blood stagnation: Zusanli (ST 36) and Qihai (CV 6);

Internal wind attack due toyin deficiency: Taixi (KI 30) and Fengchi (GB 20);

Wry face: Jiache (ST 6) and Dicang (ST 4);

Hemiplegia of upper limbs: Jianyu (LI 15), Shousanli (LI 10) and Hegu (LI 4);

Hemiplegia of lower limbs: Huantiao (GB 30), Yanglingquan (GB 34), Yinlingquan (SP 9),Fengshi (GB 31);

Dizziness: Fengchi (GB 20), Wangu (GB 12) and Tianzhu (BL 10);

Foot strephenopodia: Quxu (GB 40) and Zhaohai (KI 6);

Constipation: Shuidao (ST 28), Guilai (ST 29),Fenglong (ST 40) and Zhigou (SJ 6);

Diplopia: Fengchi (GB 20), Tianzhu (BL 10),Jingming (BL 1) and Qiuhou (EX-HN 7);

Urinary incontinence and retention of urine: Zhongji (RN 3),Qugu (RN 2), and Guanyuan (RN 4).

Manipulation: The Tianjin University of Traditional Chinese Medicine founded the “XNKQ” technique, mainly composed of Neiguan (PC 6),Shuigou (GV 26),Sanyinjiao (SP 6). Use reducing method for Neiguan (PC 6); use bird pecking method for Shuigou (GV 26) until the eyes get moist; puncture Sanyinjiao (SP 6) along the medialedge of the tibia and the skin at an angle of 45°, with reinforcing by lifting and thrusting. When puncture Jiquan (HT 1), select the point 2 cun down from original position to avoid the armpit hairs, pierce the needle with reducing method of lifting and thrusting until the upper extremity of the patient tingles and twitches. Chize (LU 5) and Weizhong (BL 40) are punctured perpendicularly with reducing method of lifting and thrusting until the limbs have throbbing feeling.

Explanation: Neiguan (PC 6) is the connecting point of pericardium meridians. It nourishes the heart, dredges qi and blood. The brain is the house of mind and the governor vessel connects with brain. Shuigou (GV 26) belongs to governor vessel, and can open the upper orifices to strengthen the brain and arouse the shen which dominates the qi-flowing. Sanyinjiao (SP 6) is the crossing point of three yin meridians of foot, nourishing liver and kidney. Jiquan (HT 1), Chize (LU 5) and Weizhong (BL 40) dredge the meridians and collaterals.

2. Stroke by Attacking the Zang-fu

Principle of treatment: Return to consciousness by opening obstruction and stoping collapse. Select the Hand-Jueyin and points of governor vessel as the main acupoints for treatment.

Main point: Neiguan (PC 6), Shuigou (GV 26), twelve wells, Taichong (LR 3),Laogong (PC 8),Fenglong (ST 40).

Additional point: Add twelve wells, Taichong (LR 3) and Hegu (LI 4) for obstructive syndrome; add Guanyuan (CV 4),Qihai (CV 6) and Shenque (CV 8) for collapsing syndrome.

Manipulation: Use reducing method for Neiguan (PC 6); use bird  pecking method for Shuigou (GV 26) until the eyes get moist; use three-edged needle to prick twelve well points until  bleeding; use  strong reducing manipulation for Taichong (LR 3),Hegu (LI 4) and Laogong (PC 8); use the moxa cone therapy with moxibustion

Billingual Acupuncture and Moxibustion

for Guanyuan (CV 4) and Qihai (CV 6); use indirect moxibustion with salt for Shenque (CV 8) until the limbs become warm.

Explanation: Neiguan (PC 6) is for adjustment of the mind and Shuigou (GV 26) is for  resuscitation. Pricking the twelve well points helps to eliminate heat and promote qi of the twelve meridians. Laogong (PC 8) is applied to eliminate heat from the heart. Fenglong (ST 40), the stomach meridian point, can promote the qi function of the spleen and stomach and dispel damp phlegm. Taichong (LR 3) and Hegu (LI 4) are selected to calm down the liver wind. As the root of life, Shenque (CV 8) is located in the center of umbilicus, linking with the vital qi. Guanyuan (CV 4) and Qihai (CV 6) are located in the lower abdomen and the cross point which the conception vessel intersects with the three yin meridians of foot. Guanyuan (CV 4) is the place where qi of triple energizer is located. The way of applying indirect moxibustion with salt to Shenque (CV 8), can restore yang from collapse and strengthen the primary yang.

Alternative Treatment

1. Scalp Acupuncture: Select Anterior Vertex-Temporal Oblique Line, Lateral Vertex-temporal Line  1 and

2 to puncture at the angle of 30° and rapidly pierce into the skin; twirl for 2-3 minutes, remain needles for 30 minutes and repeat twirling again for 2-3 times. Let the patient move limbs during manipulation, normally once every other day.

2. Ear Acupuncture: Select cerebral, cortex and liver, triple burner of ear points for filiform needle puncturing with moderate stimulation once a day; remain needles for 30 minutes; cowherb seeds sticking can replace needling.

3. Electric Stimulation: Select two points in the upper and lower limbs for acupuncture. After the patient gets the needle-sensation, connect those points with the electroacupuncture instrument until the muscles have fibrillation; remain needles for 20 minutes.

【Notes】

1. Acupuncture for the treatment of stroke has definite curative effect. It can improve the limb movement, language and swallowing function.The earlier the acupuncture intervenes, the better result it can acquire. The treatment should be combined with functional exercise.

2. Comprehensive treatment measures should betaken in the acute phase of stroke such as high fever, coma, heart failure,increased intracranial pressure and upper gastrointestinal bleeding, which  means  acupuncture should not be used until the state of stroke is stable.

3. The stroke patient who remains in bed for a long term should pay attention to turning over the body in order to avoid bedsore.

4. Prevention should be focused on. People at the age over 40, often suffer from dizziness, headache, numbness, occasional dysarthria, soft and weak limb feeling, are most likely to approach stroke and then prevention is required.

References

[1] Gao Shuzhong. Acupuncture and Moxibustion Therapeutics.The Ninth Edition. Beijing: Chinese Medicine Press, 2012.

[2] Wu Jiang. Neurology. The Second Edition. Beijing: People’s Health Press, 2005.

[3] Fang Jianqian. Science of Acupuncture and Moxibustion. Beijing: Chinese Medicine Press, 2014.

[4] Shi Xuemin Acupuncture and Moxibustion. The Second Edition of New Century. Beijing: Chinese Medicine Press, 2007.

[5] Shen Xueyong. Meridian Acupoints.The Second Edition of New Century. Beijing: Chinese Medicine Press, 2007.

[6] Beijing University of Traditional Chinese Medicine. Acupuncture and Moxibustion. Beijing: Xueyuan Press, 1999.

Lumbocrural  Pain

【General description】

Lumbocrural pain refers to the low back pain, involving lower limb pain. It is also known as the waist foot pain. The incidence and recurrence of lumbocrural pain is high. In most cases, there are no obvious causes and specific clinical manifestations. The risk factors of low back pain relates to age, psychology, heredity, sex, occupation, pregnancy, weight, bad lifestyle and so on. In modern medicine, it includes chronic soft tissue injury or acute strain in waist and leg, lumbar degenerative disease, ankylosing spondylitis, etc. Spinal tumors and pelvic lesion can also cause lumbocrural pain, which are not discussed in this section.

【Origin and development】

Lumbocrural pain is characterized by waist or the lower limb pain and numbness. These have been recorded in a number of classics in TCM, such as The Inner Canon of Huangdi, “When Taiyin is in spring, people suffer from...Waist aches as if it is broken, thigh cannot turn and knee bending is not flexible”, showing that the waist pain can affect the legs. Zhang Zhong-jing of Han Dynasty wrote in The Synopsis of Golden Chamber, “Sweating after working, clothes are cold and wet for longtime; cold pain appears in the waist and abdomen, and the patient may feel like bearing heavy burden as five thousand coins”, showingthat the dampness causes the waist pain. As it is recorded in Zhong Zang Jing, backache and heavy feet, floating and unsmooth pulse are the syndromes of lower excess”, explaininglumbocrural pain can be diagnosed by the pulse. Chao Yuan-fang of Sui Dynasty, wrote in General Treatise on the Cause and Symptom of Diseases, “Kidney qi is deficient...excessive work can lead to kidney deficiency; as when kidney is deficient, the kidney is easily influenced by the wind and cold. When pathogenic wind and cold struggles with original qi, next comes to lumbocrural pain.” Sun Si-miao of Tang Dynasty wrote in Beiji Qian Jin Yao Fang, in severe backache and feet spasm, it is advisable to drink “Duhuo Jisheng Decoction; use broken bamboo, put bamboo at the top of spine and apply moxibustion; sit in the face of the east, hold hands in the chest…sit up and down for three times”, explaining the application of Chinese medicine, acupuncture, qigong to treat lumbocrural pain. Cheng Zhong-ling of Qing Dynasty wrote in Yi Xue Xin Wu, “Lumbocrural pain, involving legs and feet and with floating and tense pulse, is caused by the wind evil”, explaining exogenous pathogen is one of the causes of lumbocrural pain.

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【Etiology and Pathogenesis】

Lumbocrural pain is located in waist and leg and closely related to the urinary bladder channel of Foot- Taiyang, kidney channel of Foot-Taiyin and the governor vessel. The pathway of urinary bladder channel of Foot- Taiyang is close to the bladder and goes through the muscles around the spine, the waist, popliteal fossa and so on. The pathway of the governor vessel goes through the spine. The nature of the disease is the deficiency for root and excess for branch as both internal and external factors can lead to lumbocrural pain. The basic pathogenesis is lack of nourishment of meridian and the blocking of meridian. Internal pathogenic factors include physical weakness, overwork, blood stasis,congenital deficiency, old and feeble, lack of essence and blood, excessive sexual life, lack of nourishment in meridians, leading to “pain due to meridians losing nourishment” . External pathogenic factors include trauma, exogenous evil-qi and so on, leading to “pain due to meridians being blocked” .

【Syndrome Differentiation】

Main manifestation: Lumbocrural pain is accompanied with numbness, soreness, limited function activities, which is aggravated by a history of trauma, labor, sitting or walking for a long time, weather change and getting up in the early morning.

1. Cold-dampness blockage: Obvious lumbocrural pain, involving posterior lateral thigh and lumbosacral portion, can be alleviated by warmth and aggravated by cold; physical activity is clearly limited; pale or purple tongue, white and greasy fur, deep and tense pulse.

2. Damp-heat: The pain can be aggravated by warmth and alleviated by cold, with obvious swelling; upset, thirsty but do not want to drink; feeling head heavy as being wrapped; red tongue, yellow and greasy fur, wiry and tense pulse.

3. Blood stasis: Stabbing pain in a fixed place, which is aggravated by pressure and gets severe at night; often with the history of trauma; dark, purplish and dry tongue, wiry and tense pulse.

4. Yang deficiency of kidney: Cold pain in waist and leg, fatigue, pale complexion, dizziness, sweating on exertion, night urination, pale tongue, white and smooth fur, weak and deep pulse.

5. Yin deficiencyof kidney: Weakness in waist and leg, palpitation, feverish sensation in the chest and palm and sole, dry mouth and throat, insomnia and dreaminess, red tongue, less or dry fur.

Meridian differentiation: The pain mainly located in both sides of the lumbar spine and lower limbs can be differentiated by the taiyang meridian; the pain in the middle of lumbar spine can be differentiated by the governor vessel; the pain and numbness in lower limbs in the lateral side, can be differentiated by the Shaoyang meridian; pain and numbness in lower limbs in the anterior side can be differentiated by the Yangming meridian.

【Treatment】

General treatment

Principle of treatment: Facilitate blood circulation, dredge the meridian and alleviate pain. Points of the Foot-Taiyang meridian and Ashi point are mainly selected.

Main Point: Weizhong (BL 40),Zhongzhu (TE 3), Shenshu (BL 23),Ashi point. Additional Point:

Damp-Heat: Dazhui (GV 14),Houxi (SI 3), Quchi (LI 11);

Cold-Damp: Mingmen (GV 4), Weiyang (BL 39), Zusanli (ST 36), Yaoyangguan (GV 3); Stagnation of qi and blood: Geshu (BL 17), Dachangshu (BL 25), Kunlun (BL 60);

Yang  deficiency:  Yaoyangguan (GV  3), Xiyangguan  (GB  33),  Mingmen  (GV  4),  Shenshu  (BL  17), Guanyuan (CV 4);

Yin deficiency: Taixi (KI 3), Jiaoxin (KI 8),Zhibian (BL 54);

Lumbosacral region pain: Yaoshu (GV 2), Shangliao (BL 31), Ciliao (BL 32); Du meridian disease: Mingmen (GV 4), Yaoyangguan (GV 3);

Foot-Taiyang meridian disease: Shenshu (BL 17),Shugu (BL 65),Chengshan (BL 57), Weizhong (BL 40);

Foot-Shaoyang meridian disease: Xuanzhong (GB 39), Qiuxu (GB 40),Fengshi (GB 31),Huantiao (GB 30); Foot-Yangming meridian disease: Jiexi (ST 41), Shangjuxu (ST 37), Xiajuxu (ST 39), Biguan (ST 31).

Manipulation: Reinforcing method is applied for Shenshu (BL 17), Mingmen (GV 4), Guanyuan (CV 4), Taixi (KI 3) and Zusanli (ST 36); mild reinforcing-reducing method is applied for other points. Moxibustion method is applied for cold-damp and yang deficiency; pricking and cupping method is applied for blood stasis block; strong stimulation is conducted towards the Ashi points when needling. In the latter stage of lumbocrural pain, warm acupuncture and moxibustionis applied for Yaoyangguan (GV 3),Mingmen (GV 4), Zusanli (ST 36), Guanyuan (CV 4), Shenshu (BL 17) and Ashi point; sparrow pecking moxibustion can be also used for the Ashi points.

Explanation: Weizhong (BL 40) is the Jing-point of urinary bladder channel of Foot-Taiyang. Si Zong Xue Ge records, “ Weizhong is selected for the disorder of back and lumbar region”, meaning Weizhong (BL 40) can facilitate qi and blood circulation for the recovery of meridian in waist and leg. Mingmen (GV 4) and Yaoyangguan (GV 3) are the main points of the governor vessel tonify kidney. Kidney governs bones, and only if the bones are strong, waist and leg can be strong. Zhongzhu (TE 3) is an experience point for lumbago, helpful to dredge the channel and thus alleviate pain. Ashi points, Weiyang (BL 39), Xiyangguan (GB 33), Zhibian (BL 54), Yaoshu (GV 2),Shangliao (BL 31) and Ciliao (BL 32) are the points in the local area, for facilitating qi and blood circulation and alleviating pain.

Alternative Treatment

1. Physical Therapy: After the acute phase, percutaneous electrical neural stimulation, ultrasonic, infrared,

magnet therapy etc. can be used.

2. Pricking and Cupping: After routine  disinfection, use three-edged needle or dermal needle to prick into the local pain point until bleeding and then conduct cupping. The method is applicable for neck pain due to blood stasis.

3. Small Needle Knife Therapy: Under local anesthesia, use small needle knife to prick into the pain points until it can touch scleroma and cords, and release adhesions by following the direction of muscle fiber.

4. Point Injection: Danggui injection liquid is used  for injection to pain points; 0.5-1 ml each point; once every other day; ten times for a course.

5. Traditional  Chinese  Medicine: In  case  of  invasion  by  cold-wind  evil,  use  “Gan  Jiang  Ling  Shu Tang” to expel wind and cold pathogens; in case of damp-heat, use“Si   Miao  Tang” to clear heat and  eliminate

Billingual Acupuncture and Moxibustion

dampness; in case of blood  stasis, use  “Xue Fu Zhu Yu Tang” to activate blood circulation and remove blood stasis;  in  case of yang  deficiency, use “You  Gui  Wan”  to  warm  kidney;  in  case  of yin  deficiency, use  “Zuo Gui Wan”.

6. Massage: Apply kneading techniques for relaxation about  10 minutes, and conduct manipulations such pushing, pressing and rubbing etc. according to different differentiations.

【Notes】

1. Acupuncture and moxibustion has a good therapeutic effect on lumbocrural pain, especially on the strain of lumbar muscles and diseases related to lumbar spinal joint; but it has poor therapeutic effect on the intense trauma such as torn ligament. In case of the diseases caused by the sickness of internal organs, the primary disease takes priority. Acupuncture treatment is not applicable to lumbocrural pain caused by spinal tuberculosis, cancer and so on.

2. The patient with lumbar disc protrusion or strain of lumbar muscles is advised to do proper exercise of lumbar muscles for increasing strength of lumbar muscles subject to the guidance of doctor.

References

[1] He Xiaoqing. Advances in the Epidemiology of Low Back. International Journal of Bone Science, 2008, 29 (2): 115-116.

[2] Lv Guangrong. Internal Treatment of Traditional Chinese Medicine. Beijing: People’s Health Press, 2001.

[3] Wang Hua & Du Yuanhao. Science of Acupuncture and Moxibustion (The Ninth Edition) [M]. Beijing: Chinese Medicine Press,

2012.

Headache

【General description】

Headache is a kind of common disease characterized by the patient subjective headache feeling, occurring in the top, forehead, lateral temporal, occipital or the whole head. The nature of pain may present as heavy pain, jump pain, empty pain, tingling or swelling pain, etc. It can occur alone, or also be mixed in a variety of diseases in the process.

According to modern medicine, headache is divided into primary headache and secondary headache. Primary headaches include migraine, tension headache, clustered headache, vascular headache, neurogenic headache, etc. Secondary headache is due to other diseases, such as infection (encephalitis, meningitis, etc.), trauma, acute cerebrovascular disease, intracranial space-occupying lesion, glaucoma and sinusitis.

【Origin and development】

Traditional Chinese medicine recorded headache very early, and oracle bone of Yinshang Dynasty had the record of “head illness” . The Inner Canon of Huangdi named it as “brain wind”. Su Wen defined that it is due to exogenous wind and cold invasion into head; it also presents that the pathogenesis of headache is excess in the upper and deficiency in the lower. Zhang Zhong-jing of Han Dynasty discussed in detail about syndrome differentiation and treatment formulation for exogenous headache in Febrile Diseases. Chao Yuan-fang of Sui Dynasty presented headache was due to wind-phlegm invading head in his Various Pathogenic Designate Theory.

Chen Wu-zhe of Song Dynasty had an abundant discourse for headache, and presented that it is caused by stagnation of qi and blood, food retaining, and qi in zang-fu or organs blocked or depressed.

【Etiology and pathogenesis】

The lesion part is located in the head and closely related to the hand foot six yang meridians, the foot Jueyin- liver meridian and the governor vessel. Head is the confluence of yang meridians and the highest position of the human body. The essences of the internal organs are ascending to the head. It is susceptible to wind evil invasion. Brain is the house of shen, which is vulnerable to exogenous wind evil, emotion and general condition of qi and blood. The basic pathogenesis is qi and blood disharmony, meridian blocked or brain lacking in nourishment.

【Syndrome Differentiation】

1. Exogenous headache

(1) Wind-cold: Headache involves neck and upper-back, aggravated by wind,aversion to wind and cold and absence of thirst; thin and white fur, floating and tense pulse.

(2) Wind-heat: The patient feels serious distending pain in head and feels heat in body; or aversion to wind; thirsty, and wants to drink cold water; red face and eye; constipation and yellow urine; red tongue and yellow fur, floating rapid pulse.

(3) Wind-damp: A heavy sensation in the head as if wrapped up; lassitude and heaviness of limbs; poor appetite; chest distress; urine is not smooth; loose stool; white and greasy fur, and soft pulse.

2. Headache due to internal injury Excess type:

(1) Hyperactivity of Liver-Yang: Headache and dizziness; severe pain on bilateral sides of the head; upset, irritable, restless, or hypochondriac pain, red face; bitter taste, thin yellow fir, wiry and rapid pulse.

(2) Phlegm-turbidity: Headache with a hazy dizziness; chest and abdomen fullness and distention; vomiting phlegm or saliva; white and greasy fur, smooth and rapid pulse.

(3) Blood stasis: Fixed pricking pain for long term case with trauma history; purple tongue, thin and white fur, thread or thread-unsmooth pulse.

Deficiency type:

(1) Kidney deficiency: Poor memory; headache as if brain is empty, dizziness, weakness in loin and knees, fatigue, seminal emission; tinnitus and insomnia, red tongue, little fur and thread pulse.

(2) Blood deficiency: Headache and dizziness, palpitation, fatigue, paleface, light tongue, thin white fur, weak pulse.

Meridians differentiation: Forehead or eyebrow bone pain belongs to Yangming headache; migraine belongs to Shaoyang headache; occipital pain belongs to Taiyang headache; parietal headache belongs to Jueyin headache.

【Treatment】

General treatment

1. Exogenous headache

Principle of treatment: Dispel wind and dredge collaterals to alleviate pain. The primary points selected are from the governor vessel, the meridian of Foot-Shaoyang and the meridian of Hand-Taiyin.

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Main point: Baihui (GV 20),Fengchi (GB 20), Taiyang (EX-HN 5),Lieque (LU 7). Additional point:

Wind-cold headache: Fengmen (BL 12);

Wind-heat headache: Dazhui (GV 14) and Quchi (LI 11);

Wind-damp headache: Yinlingquan (SP 9) and Fenglong (ST 40);

Yangming headache: Yintang (GV 29), Hegu (LI 4) and Neiting (ST 44); for Shaoyang headache: Shuaigu (GB 8), Waiguan (SJ 5) and Zulinqi (GB 41); Taiyang headache: Tianzhu (ST 25),Houxi (SI 3) and Kunlun (BL 60);

Jueyin headache: Sishencong (EX-HN 1), Taichong (LR 3) and Neiguan (PC 6).

Mainpulation: Use reducing manipulation for needling. Take intense stimuli towards Ashi points and remain needles for a long time. Cupping or moxibustionis applied towards Fengmen (B 12). Prick Dazhui (GV 14) until bleeding and conduct cupping.

Explanation: Baihui (GV 20) and Dazhui (GV 14) can dredge the qi and blood of head. Fengchi (GB 20) can dispel wind and dredge collaterals to alleviate pain. Lieque (LU 7), belonging to the channel of Hand-Taiyin, can release the exterior and expel wind.

2. Headache of internal injury Excess type:

Principle of treatment: Refresh the clear orifice of the head, and dredge the meridians and collaterals. Mainly use the acupoint of the governor vessel and the channel of Foot-Shaoyang and the channel of Foot-Yangming.

Main point: Baihui (GV 20), Touwei (ST 8) and Fengchi (GB 20).

Additional points: Add points based on syndrome type and meridians differentiation. Add Taichong (LR 3), Taixi (KI 3) and Xiaxi (GB 43) for hyperactivity of liver-yang; add Taiyang (EX-HN 5), Yinlingquan (SP 9) and Fenglong (ST 40) for turbid-phlegm headache; add Ashi point, Xuehai (SP 10), Geshu (BL 17) and Neiguan (PC 6) for blood stasis headache.

Mainpulation: Use reducing method for the above points.

Explanation: Baihui (GV 20),Fengchi (GB 20) and Touwei (ST 8) belong to the governor vessel, the channel of Foot-Shaoyang and channel of Foot-Yangming, which are distributed in top of the head, occipital head and lateral temporal. They can adjust the qi and blood of head to alleviate pain.

Deficiency type:

Principle of treatment: Dredge meridians and nourish brain marrow. Mainly select the acupoint of the governor vessel and the channel of Foot-Shaoyang and the channel of Foot-Yangming.

Main point: Baihui (GV 20), Zusanli (ST 36),Fengchi (GB 20).

Additional point: Add points based on syndrome type and meridians differentiation. Add Shenshu (BL 23), Taixi (KI 3) and Xuanzhong (GB 39) for kidney deficiency; addSanyinjiao (SP 6), Ganshu (BL 18) and Pishu (BL 20) for blood deficiency.

Manipulation: Use mild reinforcing-reducing method towards Fengchi (GB 20), and use reinforcing method towards Baihui (GV 20) and Zusanli (ST 36).

Explanation: Baihui (GV 20) can adjust the qi and blood to nourish brain. Fengchi (GB 20) can invigorate the circulation of blood and dredge meridians to make coordination of qi and blood. Zusanli (ST 36) can benefit the qi and blood to nourish brain. These acupoints belong to the governor vessel, the channel of Foot-Shaoyang and the channel of Foot-Yangming. They jointly strengthen the effects for benefitting weakness and relieving pain.

Alternative Treatment

1. Skin needle: Tap Yintang (GV 29), Taiyang (EX-HN 5) and Ashi point for 3-5 mins until bleeding. It is appropriate for exogenous headache or hyperactivity of liver-yang.

2. Three-edged needle: In case of serious headache,prick Yintang (GV 29), Taiyang (EX-HN 5),Baihui (GV 20), Dazhui (GV 14) and Cuanzhu (BI 12) for bleeding until 3-5 drops of blood can be seen out of every acupoint.

3. Ear acupoint therapy: Use occipital, tempus, subcortex, Shenmen of ear points for cowherb seed pressing.

4. Acupoint injection: According to syndrome type, use bupleurum injection liquid, angelica injection liquid, salvia injection liquid, Chuanxiong injection liquid, vitamin B1  solution, vitamin B12  solution for acupoint injection; choose 2 or 4 acupoints each time and inject 0.5 ml solution for every acupoint.

【Notes】

1. Acupuncture and moxibustion has a good effect in the treatment of headache. However, the reasons for headache are complex. If multiple treatments get failure, or headache continues to increase, it is necessary to consider some other brain lesions and identify the causes, and to take comprehensive treatment measures.

2. In the event of both sides of the pupil of different size, stiff neck and unconsciousness, it is advisable to confirm whether they are involving brain tumor and subarachnoid hemorrhage and other serious or emergency diseases. Do not use strong stimulation towards headache caused by hypertension.

3. Modern research has showed that acupuncture can adjust the function of nervous system, activate human body’s endogenous acesodyne mechanism and lower blood pressure to treat headache.

4. During the treatment, the patient should not drink tea, coffee, wine or smoke. Do some physical exercise; avoid heavy workload and have a good rest.

References

[1] Long Zhixian, et al. Science of Acupuncture and Moxibustion [M]. Beijing: Beijing University of Traditional Chinese Medicine Press, 1999.

[2] Gao Shuzhong, Yang Jun, et al. Acupuncture and Moxibustion Therapy (The Ninth Edition of the 12th Five- year Plan Textbook Series) [M]. Beijing: Chinese Medicine Press, 2012.

[3] Wu Mianhua, Wang Xinyue, et al. Internal Medicine of Traditional Chinese Medicine (The Ninth Edition) [M]. Beijing: Chinese Medicine Press, 2012.

[4] Wang Hua & Du Yuanhao. Science of Acupuncture and Moxibustion (The Ninth Edition) [M]. Beijing: Chinese Medicine Press,

2012.

7.1.8  Cervical spondylosis

【General description】

Cervical spondylosis refers to a kind of disease which generally  shows  neck pain, accompanied with upper

Billingual Acupuncture and Moxibustion

limb numbness, neck activity limitation, headache, shoulder and upperback soreness or dizziness. It is also named stiff neck pain. It is a kind of disease based on the degenerative pathological changes of cervical intervertebral disc or cervical joint in the cervical spine. Continuous long-term strain of cervical vertebra, vertebral joint instability, periosteum pulled and extruded and calcification of the hematoma result in the formation of bone hyperplasia, intervertebral space narrowing, ligament thickening, dehydration and degeneration of nucleus pulposus; annulus fibrosus of the intervertebral disc are ruptured and protruded or bulged out of the disc resulting in cervical spinal cord, nerve root or vertebral artery and cervical sympathetic nerve   and   others   affected. Common clinical syndrome types include cervical type of cervical spondylosis, cervical   spondylotic myelopathy, vertebral artery type of cervical spondylosis, sympathetic nerve type  of cervical spondylosis and mixed type of cervical spondylosis.

【Origin and development】

Cervical spondylosis is characterized by the neck pain, accompanied with upper limb numbness, neck activity limitation, headache and shoulder backache. These have been recorded in a number of classics in TCM, such as The Inner Canon of Huangdi, ZhongZang Jing, A-B Classic of Acupuncture and Moxibustion, Bei Ji Qian Jin Yao Fang, Standards of Diagnosis and Treatment, and The Golden Mirror of Medicine, etc. The Inner Canon of Huangdi records, “In case of neck pain caused by strong wind attack, needle Fengfu (GV 16), which is on the vertebra.” It illustrates the wind evil is one of the pathogenic factors in neck pain, and Fengfu (GV 16) could be selected for needling. Huang Fu-mi of Jin Dynasty wrote in A-B Classic of Acupuncture and Moxibustion, “In case of neck pain, unable to bend, or it may trigger headache.” It indicates that the neck pain can lead to other symptoms like headache. Sun Si-miao of Tang Dynasty wrote in Bei Ji Qian Jin Yao Fang, “Shaoze (SI 1), Houxi (SI 3), Yanggu (SI 5), Wangu (SI 4), Kunlun (BL 60), Xiaohai (SI 8) and Cuanzhu (BL 2)are the acupoints for curing neck pain.” It emphasizes the acupuncture formula for neck pain. Wang Ken-tang of Ming Dynasty in Standards of Diagnosis and Treatment attributed neck pain to phlegm heat, blood deficiency, sprain and trauma etc. Wu Qian of Qing Dynasty wrote in The Golden Mirror of Medicine, “Falling causes neck bone inserted into the lumens... treated with pushing, lifting and so on”, introducing external therapy to treat cervical spondylosis.

【Etiology and Pathogenesis】

Cervical spondylosis is located in the neck and closely related to the governor vessel, foot Taiyang-bladder meridian, the Hand-Shaoyang and Foot-Shaoyang meridians. The nature of cervical spondylosis is characterized by deficiency of the Ben and excess of the Biao. Its main pathogenesis is that meridians fail to be nourished or get blocked. Main internal etiologic factors include weak body resistance, overstrain, blood stasis, fatigue; main external etiologic factors include attack of wind-cold or wind-heat or dampness, trauma, improper sleeping posture or bowing head while working for a long time, which cause the obstruction of qi and blood in meridians.

【Syndrome Differentiation】

Main Manifestation: Neck pain or stiffness, accompanied with numbness and discomfort of upper limbs, shoulder and upper back and limited function activities, which can be aggravated by weather changes or overwork.

1. Wind cold invasion: Obvious pain, with nape muscle tight,aversion to the wind, pain in upper back and shoulder; alleviated by warmth and aggravated by cold; light red tongue, thin and white fur, floating and tense pulse.

2. Overstrain and blood stasis: Stabbing pain in a fixed place, aggravated by pressure and getting severe at night,with history of trauma and overstrain; neck pain radiates to the finger. Dark and purple tongue with petechiae; unsmooth pulse.

3. Damp-heat: The pain is aggravated by warmth and alleviated by cold; upset, thirsty but do not want to drink; a heavy sensation in the head as if wrapped up; red tongue and yellow fur, wiry and slippery pulse.

4. Kidney deficiency: Poor memory, fatigue, soreness and weakness in loin and knee, alopecia, insomnia or drowsiness, dark complexion, pale or red tongue with little fur, and deep chi pulse.

Meridian Differentiation: The pain, mainly located in the lateral neck, is differentiated by the Shaoyang meridian. The pain, mainly located in the back neck, is differentiated by the governor vessel or the Taiyang meridian.

【Treatment】

General Treatment

Principle of treatment: Facilitate blood circulation for dredging meridian and alleviating pain. Mainly select the points of the Foot-Taiyang meridian, Hand-Taiyang meridian, JiajiandAshi points.

Main Point: Jianjing (GB 21), Jingjiaji (EX-B 2), Wailaogong (EX-UE 8),Lieque (LU 7),Houxi (SI 3),Ashi point.

Additional Point: Add Dazhui (GV 14), Houxi (SI 3) and Quchi (LI 11) for damp-heat; add Fengchi (GB 20) and Fengmen (BL 12) for invasion of pathogenic wind and cold; add Kunlun (BL 60) and Geshu (BL 17) for trauma; add Ashi points for blood stasis; add Shenshu (BL 23) and Taixi (KI 3) for kidney weakness; add Yifeng (TE 17) and Tianliao (TE 15) for Sanjiao meridian symptom; add Wangu (GB 12) and Fengchi (GB 20) for Foot- Shaoyang meridian symptom; add Shuigou (GV 26) for the governor vessel symptom.The others can be applied to mild reinforcing and reducing manipulation.

Manipulation: Moxibustion or warming needle therapy is applied for wind-cold invasion; in case of overstrain and blood stasis, use pricking and cupping method; in case of strong stimulation, needle the Ashi points; sparrow pecking moxibustion can also be applied towards the Ashi points.

Explanation: Jianjing (GB 21) is the point of gallbladder meridian of Foot-Shaoyang, which has an effect of removing wind and dispersing cold and dredging meridians and collaterals. Jingjiaji (EX-B 2) is located in the neck muscles, which has an effect of relieving muscle spasm; Wailaogong (EX-UE 8), also known as Luo- zhen point, is an experience point for neck pain. Si Zong Xue Ge records, “Lieque is selected for neck disorders”, meaning the Lieque (LU 7) can facilitate qi and blood circulation for the recovery of neck meridian. All the points matched with Ashi points can facilitate qi and blood circulation for dredging meridian and alleviating pain.

Alternative Treatment

1. Physical Therapy: After the acute phase, percutaneous electrical neural stimulation, ultrasonic, infrared,

magnet therapy etc. can be used.

2. Pricking and Cupping: After routine disinfection, use the three-edged needle or the dermal needle to prick

Billingual Acupuncture and Moxibustion

into the local pain point until bleeding and then conduct cupping. The method is applicable for neck pain due to blood stasis.

3. Small Needle Knife Therapy: Under local anesthesia, use the small needle knife to prick into the pain points until it can touch scleroma and cords, and release adhesions by following the direction of muscle fiber.

4. Point Injection: Danggui injection liquid is used for injection to pain points; 0.5-1 ml each point; once every other day; ten times for a course.

5. Ear Acupuncture: Selection of points at the cute-pain stage, strong stimulation can be used towards the neck and Shenmen of ear points.

6. Traditional Chinese Medicine: Use Gegen decoction for cervical spondylosis.

7. Massage: Apply kneading techniques for relaxation about 10 minutes, and conduct manipulations such as pushing, pressing and rubbing according to different differentiations.

【Notes】

1. Acupuncture and moxibustion has a certain therapeutic effect on cervical spondylosis, especially in relieving the neck pain, upper limb numbness, dizziness and headache. It is usually matched with massage and acupoint application therapy etc.

2. In case of the work requiring prolonged sitting, attention must be paid to the posture of the neck, and work time should not be too long; move the neck every 1 hour.

3. In case of cervical spondylosis caused by discomforting pillow height, the patient should adjust the height in accordance with the doctor’s advice and keep neck warm.

References

[1] Lü Guangrong. Internal Treatment of Traditional Chinese Medicine. Beijing: People’s Health Press, 2001.

[2] Wang Hua & Du Yuanhao. Science of Acupuncture and Moxibustion (The Ninth Edition) [M]. Beijing: Chinese Medicine Press, 2012.

[3] State Administration of Traditional Chinese Medicine. Diagnostic Criteria of TCM Syndrome[S]. Beijing: China Science and Technology Press of Traditional Chinese Medicine, 2012.

Frozen Shoulder

【General description】

Frozen shoulder refers to a kind of disease which generally shows severe shoulder pain with upper extremity and back activity limitation. It is also known as shoulder-arm pain, fifty-shoulder, shoulder pain, shoulder-back pain and so on. Because the patients are mostly between 40 and 50 years old, the disease is also called fifty-shoulder, which is more common in women than in men. It belongs to periarthritis of shoulder in modern medicine. General definition for periarthritis of shoulder includes a series of diseases of shoulder joint, such as subacromial bursitis, supraspinatus tendonitis, avulsion of rotator cuff, myotenositis of long head of biceps brachii, coracoiditis and so on. Narrow definition for periarthritis of shoulder means a degenerative and inflammatory soft tissue disease, commonly caused by chronic shoulder muscular strain and injury by pathogenic cold and other evils.

【Origin and development】

Frozen shoulder is characterized by pain and activity limitation of the shoulder, scapular, upper arm, and back. It has been recorded in a number of classics in TCM, such as The Inner Canon of Huangdi, Zhong Zang Jing, A-B Classic of Acupuncture and Moxibustion, Acupuncture Bronze Statue and Dongyuan Shishu, etc. Ling Shu·Meridians records, “The large intestine channel of Hand-Yangming, starts from the tip of the index finger...then goes up to the shoulder and goes ahead from the acromion...It has been damaged...

Cause pain in the shoulder and upper arm; the neck pain originates from the shoulder … hand cannot lift. These contents describes the omalgia is located in the shoulder, and other parts can be involved, such as the back, and upper arm. It is characterized by shoulder pain and movement limited. Zhong Zang Jing records, “The shoulder, back and arm are all ill.” Huang Fu-mi of Jin Dynasty wrote in A-B Classic of Acupuncture and Moxibustion, “Shoulder and arm feel pain or numbness and the arms can not be lifted up accompanied with chill and fever. In such a case, Jianjing Point could be used to treat these symptoms; when shoulder movement limitation is caused by blood stasis, Jugu Point is the key point to cure it.” It introduces the experience of omalgia with acupuncture. Wang Wei-yi of Song Dynasty wrote in Acupuncture Bronze Statue, “Naoshu Point can be used to treat the shoulder pain, swelling and arm weakness caused by chills and fever” . Li Dong-yuan of Yuan Dynasty wrote in Dong Yuan Shi Shu, “Shoulder and back pain, stroke, frequent urination but a little, are caused by wind- heat affecting lung and lung canopy…If the shoulder and back pain make the patient fail to turn around, that is because the stagnation of Taiyang meridian. Herbs for eliminating wind should be used.” It tells us frozen shoulder is caused by external wind evil, and introduces the treatment.

【Etiology and Pathogenesis】

The location of frozen shoulder is shoulder and closely related to the hand three yang meridians. The Hand- Taiyang meridians come out from shoulder joint, pass the scapula, and meet on the upper area of shoulder. The pathological feature of the disease is “as painful as the shoulder was pulled out” . The Hand-Yangming meridian is up to shoulder, goes out from the front of the acromion. The pathological feature of it is “the pain appears in the front of shoulder and upper arm” . The Hand-Shaoyang meridian is “on the shoulder”; it is a “disease with pain in shoulder, upper arm, elbow, arm, and lateral arm” . Frozen shoulder is characterized by deficiency of ben and excess of biao. The main pathogenesis is the lack of nourishing or blockage of the shoulder. The main internal etiologic factors include weakness, overstrain and aging, which causes deficiency of qi and blood; external etiologic factors include attack of wind-cold or wind-heat or dampness and trauma, which causes qi and blood stagnation.

【Syndrome Differentiation】

Main symptom: In the early stage,pain is the primary symptom, and restricted movement within the range of the shoulder joint occurs in the later stage with shallow pain. Shoulder joint pain is aggravated by weather change or overwork. There is tenderness in the anterior, posterior and lateral aspects of the shoulder. Main movements such as elevation, abduction and extension behind the back are limited. Partial amyotrophy with shallow pain in the later stage may occur.

Billingual Acupuncture and Moxibustion

1. Invasion of pathogenic wind and cold: Obvious  pain, involving the shoulders and  back, is alleviated by warmth and aggravated by cold; physical activity of shoulder joint is clearly limited; pale or purple tongue, thin and white fur, floating and tense pulse.

2. Damp-heat: The pain is aggravated by warmth and alleviated by cold, involving the shoulders and back; upset, thirsty but do not want to drink; heavy head as it is wrapped; red tongue and yellow fur, thread and rapid pulse.

3. Blood stasis: Stabbing pain a in fixed place, which is aggravated by pressure and gets severe at night, involving the back, shoulder and nape; purple or dry tongue, deep and tense pulse.

4. Deficiency of qi and blood: The pain is aggravated by overwork, poor appetite, palpitation, insomnia, pale tongue, white fur, thin or deep pulse.

Meridian differentiation: The pain mainly located in posterior parts of shoulder, involving the scapular region, is differentiated by the Hand-Taiyang meridian; the pain mainly located in lateral side of shoulder, is differentiated by the Hand-Shaoyang meridian; the pain mainly located in anterior parts of shoulder, is differentiated by the Hand-Yangming meridian.

【Treatment】

General treatment

Principle of treatment: Facilitate blood circulation for dredging the meidian and alleviating pain. Points of the Hand Yangming meridian, Hand Taiyang meridian, Hand Shaoyang meridian andAshi point are mainly selected.

Main Point: Jiangliao (SJ 14), Jianqian, Jianshu (SI 15),Jianzhen (SI 9), Tiaokou (ST 38),Ashi point. Additional Point:

Pain in the Hand-Taiyang meridian: Houxi (SI 3) and Kunlun (BL 60); Pain in the Hand-Yangming meridian: Hegu (LI 4) and Sanjian (LI 3);

Pain in the Hand-Shaoyang meridian: Waiguan (SJ 5) and Yanglingquan (GB 34); Invasion of wind and cold: Hegu (LI 4) and Fengchi (GB 20);

Qi stagnation and blood stasis: Neiguan (PC 6) and Hegu (LI 4); Deficiency of qi and blood: Zusanli (ST 36) and Qihai (CV 6).

Manipulation: Reinforcing method is applied for Zusanli (ST 36) and Qihai (CV 6), while mild reinforcing- reducing method is applied for other points. The patient is required to move the shoulder joint while strong reducing needling is applied towards Tiaokou (ST 38) for the acute or severe pain. In the latter stage of the omalgia, warming-needle or moxibustion is applied towards Zusanli (ST 36), Qihai (CV 6) and Ashi point; sparrow pecking moxibustion can also be used towards the Ashi points.

Explanation: The primary lesion of omalgia is in shoulder, so the local points are selected. Jianliao (SJ  14), Jianyu (SI 150) and Jianzhen (SI 9) are three yang hand meridians points; Jianqian belongs to extra points and Ashi point belongs to the nearby points. They are used to dredge the meridians of the shoulder, dispel wind and alleviate pain.

Alternative Treatment

1. Physical Therapy: After the acute period, percutaneous electrical neural stimulation, ultrasonic, infrared,magnet therapy, etc. can be used.

2. Pricking and Cupping: After routine disinfection, use the three-edged needle or the dermal needle to prick into the local pain point until bleeding for cupping. The method is applicable for blood stasis.

3. Small Needle Knife Therapy: Under local anesthesia, use the small needle knife to prick into the pain points until it can touch scleroma and cords, and release adhesions by following the direction of muscle fiber.

4. Point Injection: Danggui injection liquid is used for injection to pain points; 0.5-1 ml each point; once every other day; ten times for a course.

5. Traditional Chinese Medicine: In case of invasion by cold-wind evil, “Fang Feng Tang” is used to expel wind and cold pathogens; in case of damp-heat,“Shu Jin Tang” is used to clear heat and eliminate dampness, even to stimulate the circulation of the blood and cause the muscles and joints to relax; in case of blood stasis, “Tao Hong Yin” is used to activate blood circulation and remove blood stasis.

6. Shoulder Exercise Therapy: The patients should conduct the autokinetic or passive abduction, extension, elevation, rotation or circle movement of shoulder joint, with a self-massage for pain points during the process of exercise.

7. Ear Acupuncture Therapy: In the acute period, select ear points such as shoulder, Shenmen, upper limb and other points for strong needling. The patient should turn round the neck while pressed on the ear points.

8. Massage Therapy: Apply kneading techniques for relaxation about 10 minutes, and conduct manipulations such pushing, pressing and rubbing according to different differentiations.

【Notes】

1. Acupuncture has a good therapeutic effect on omalgia, but it must be distinguished from the following diseases, such as tuberculosis of shoulder joint, swelling, fracture, dislocation, or pain caused by cervical spondylosis or visceral diseases.

2. The patient is advised to have a good rest in acute period, and avoid lifting heavy objects. In the later stage of joint adhesion, self-training and passive exercise are indispensable. The patient should be under the guidance of the doctor to do “climbing” to relieve the shoulder joint adhesion.

3. During the period of treatment, the patient should keep warm in shoulder and avoid the attack of wind- cold evil.

References

[1] Lü Guangrong. Internal Treatment of Traditional Chinese Medicine [M]. Beijing: People’s Health Press, 2001.

[2] Wang Hua & Du Yuanhao. Science of Acupuncture and Moxibustion (The Ninth Edition) [M]. Beijing: Chinese Medicine Press, 2012.

[3] State Administration of Traditional Chinese Medicine. Diagnostic Criteria of TCM Syndrome [S]. Beijing: China Science and Technology Press of Traditional Chinese Medicine, 2012.