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Posted on Friday, January 11, 2013 11:59 AM
THE DIFFERENTIATION AND TREATMENT OF PARKINSON'S DISEASE ACCORDING TO TRADITIONAL CHINESE MEDICINE LI GENG HE, ZHONG XIN HOSPITAL, SHANGHAI TRANSLATED BY PIA MARIA STREIFF INTRODUCTION Parkinson’s disease manifests with specific symptomssuch as trembling, stiffening of the muscles, restrictionof movement and finally the obstruction of certain reflexes of the body. In the majority of cases it affects old people, and it is generally treated with Western drugs such as atropine and scopolamine. Results of basic theoretical neurological research also advise the use of levodopa and amantadine. These medicaments, however,can only improve the symptoms of the illness andwill not stop its progression, more over they induce considerable side effects. Since this is a disease of old age,my method of treating it according to TCM might also be beneficial to research done in the field of geriatric disease.The most important clinical symptoms and signs are:- trembling, usually in the feet and hands or neck- muscular rigidity- impaired movement- stooping posture- oculogyric crises- facial expressions are hindered (incessant crying or smiling expression).According to the differentiation of symptoms and signs in TCM, the disease has a very strong relation to both Liver and Kidney. It appears either as a result of long standing obstruction of Qi and stagnation of blood,which dries out the Liver channel, or as a result of deficiency of both Qi and blood. The root of this diseaseis therefore in the Liver. Parkinsonism appears most often in patients over fifty years of age. In the ancient classics of TCM we can find early references to this point. The Neijing states: “When the age of forty years is reached, the Yin-Qi reduces itself by half.” “Yin-Qi reduces itself by half”means that the Kidney-Yin has already been reduced byhalf, and deficient Yin is then not able to restrain Yang(water fails to nourish wood). The Liver is the ‘resolute organ’; it must receive Kidney-water and be moistened by it. If this does not happen, symptoms of wind such astrembling, stiffness and progressive impairment of movement will appear. From the point of view of TCM this is a manifestation of insufficiency of Liver-Yin.The Neijing also states: “The Liver is of basic importance to movement; it stores the Hun (i.e. it is concernedwith mental activities); its brilliance is reflected in the fingernails and its fullness in the muscles, where it produces Qi and blood.”A further quote from the Neijing says: “The East generates wind, wind generates wood, wood generates sourness, sourness generates the Liver, Liver generates muscles ..... in terms of matter it means wood, in the body it means the muscles and therefore the Liver, in terms of change it is to push.” Luo Guo Gang’s collection Hui Yue Yi Jing (‘Collected Medical Writings Through a Looking Glass’) from the Qing dynasty says: “Everything that is sudden and rigid, comes from the Liver, and is not influenced by exterior wind. The Liver, like wood, corresponds to the East; it stores blood and it regulates wind; when theLiver-Blood is diseased, it fails to nourish the muscles;when the muscles and tendons are affected, rigidity and giddiness will occur.” The Zheng Zhi Zhun Sheng (‘Criteria for the Treatment of Disease’) says: “Trembling of both hands, often seen simultaneously with uncontrolled tremor of the head, is due to inability of the tendons to restrain, which belongs to Liver wind.” It also says: “The neck is the meeting point of all the Yang channels. When the Liver-Qi rushes upwards, then the head will start moving by itself ..... when it spreads into the four limbs, then hands and feet will move and the head will stay still.” It also says: “This illness is rarely seen in younger years;towards the end of middle age it occurs more often, in older years it is especially common.”As we can see, the classical Chinese medical compilations recorded the connection between the functioning of the Liver and the main symptoms of this disease.We can therefore also refer to them to discover the treatment of this condition. aetiology and pathology 1. The storage of blood. The Liver stores the blood, whichis instrumental to all the organs and to the muscles. The tendons and muscles rely on nourishment by blood in order to move, to push, and indeed to function in general.If the blood fails to nourish the muscles, stiffening,rigidity or atrophy of the muscles will occur. The Neijing says: “Any dizziness through wind comes from the Liver.” Therefore trembling, dizziness and similar symptoms are connected to wind arising due to Liver-Blood deficiency. The Neijing also says: “Everything that is sudden and rigid, relates to Liver wind”. We can therefore interpret symptoms such as stiffening of the muscles and impairment of bodily movements and gestures as signs of deficient Liver-Qi. 2. The governing of muscles. The Liver regulates movementand shows its brilliance in the nails. The S uwen states in the Luo Lun (‘Discussion of Fistulas’): “The Liver governs the tendons and membranes of the body.”Tendons and membranes are there to link joints and muscles, as in the saying: “the tendons restrain the bones to benefit the structure of the body.” Only when theLiver-Blood is sufficient and warming, can the Qi be raised to the tendons, where it is used to nourish and moisten them and so ensure proper motor control. Therefore,when Liver-Blood is insufficient, it does not nourish the tendons and so gives rise to trembling of hands and feet, numbness in the limbs and irregular movement. 3. The Liver is concerned with tactics and mental agility. Amongst the twelve organs the Liver occupies the role ofthe general. It is the pivot of wisdom and astuteness, and is therefore intimately connected to agility of mind. The Liver stores the Hun (one aspect of the soul). Injury to the emotions and the will result in unrestrained rashness;the Hun and the Po (the spiritual and the physical,sentient aspect of the soul) will be in turmoil; the Liver-Qi is disrupted and the mind not at rest, which will result in symptoms of fright and shock, indications of an affected spirit. 4. A number of Parkinson’s disease patients also have symptoms of stagnation of blood, such as a darkish purple tongue, ecchymosis, abnormal sensation, discomfort or pricking pain. For these cases, herbs to move the blood and dissolve stagnation have to be added to a basic prescription to tonify the Kidney and the Liver. Stagnation of blood is of course also related to the functioning of the Liver. The Liver stores the blood and adjusts its flow in the whole body. When Liver-Qi stagnates, Liver-Blood also fails to flow, which can lead to stagnation of blood. The symptoms of stagnation of blood are very varied, therefore the application of the principle of ‘moving the blood and clearing stagnation’will vary every time as well. As with stroke patients, the method of ‘moving blood and dispersing wind’, is often used. (“In order to treat wind, first treat the blood; when the blood flows, the wind will clear of its own accord”.)The wind spoken of in this case is interior wind, resulting from deficiency of Liver-Blood or stagnation of Liver-Qi. 5. In clinical practice we come across some patients who show deficiency of both Qi and blood. The theory of TCM describes the relationship between Qi and blood as follows: “Qi is the master of blood, and blood is the mother of Qi”, and: “Qi rides with the blood.” As Parkinson’s disease arises when Liver-Blood is insufficient,according to the theory of “diseased Yin will affect Yang”, longstanding Blood-Xu will lead to deficiency of Qi. The resulting condition of Qi and blood Xu is considered to be very complicated and difficult to treat. 6. In the treatise “Parkinsonism and its relationship to the Liver in TCM” the connection to the Kidney is also discussed. The Yi Zong Bi Tan states that “Liver and Kidney have the same origin.” “To treat deficiency in wood, it is necessary to tonify the Kidney. The Liver-Qi will then not rebel, and the Liver-Blood will be nourished.The water for this comes from the source of water(Kidney), the wood relies upon it in order to flourish.”The Liver stores the blood, the Kidney stores the Jing.Liver-Blood necessarily relies on Kidney-Jing for its nourishment; only then can it fulfil its function. In the same manner, only plentiful Liver-Blood can be transformed into Kidney- Jing, and contribute to its abundance.When Kidney-Jing withers and dries up, Liver-Blood is insufficient, therefore we say that Liver and Kidney are of the same origin. This illustrates the fundamental relationship between Parkinsonism and theKidney in TCM. 7. Parkinson’s as an age-related disease can also be seen as a product of senility. Research shows that Chinese herbal remedies to tonify the Kidney and to replenish the Jing have a considerable success to counteract senility.We therefore stress the importance of tonifying the Kidney in our treatment.This disease therefore has to be treated according to the specific circumstances. Both the branches and roots have to be considered simultaneously. Deficiency has to be tonified, and fullness has to be dispersed. Both dispel stagnation and create new blood; regulate the Ying and the Wei and harmonize Qi and blood. differentiation and treatment 1. KIDNEY AND LIVER YIN XU Major symptoms - stiffening and rigidity of the body- incessant tremors- to-and fro-tremor of the head- tinnitus and blurred vision- five palms hot- sore and weak lower back and limbs- dry stool. Tongue red with scanty coating.Pulse thin and rapid or wiry, thin and rapid. Treatment principle Nourish Liver and Kidney with tonics in order to strengthen the blood. 2. STAGNATION OF QI AND BLOOD Major symptoms - trembling of the head and limbs- rigid or trembling neck- incessant fixed pain or numbness of the body- gloomy dull colour of the face Tongue: dark red or purplePulse: thin and irregular Treatment principle Move the blood and disperse stagnation; tonify the Liverand Kidney. 3. DEFICIENCY OF QI AND BLOOD Major symptoms - pallid face- whole body listless- difficulty in movement- spontaneous sweating- fear of cold- little appetite- unformed stool- oedema. Tongue: palePulse: thin and deep pulse. Treatment principle Strong tonification of Qi and blood. treatment Due to the simultaneous occurrence of both stagnationof blood and deficiency of Yin of the Liver and Kidney,we decided that the basic prescription should have the action of tonifying Liver and Kidney, moving blood and clearing the channels. It consists of:Shu Di Huang (Radix Rehmanniae GlutinosaeConquitae)Huai Niu Xi (Radix Achyranthis Bidentatae)Dang Gui (Radix Angelicae Sinensis)Gou Ji (Rhizoma Cibotii Barometz)Shou Wu (Radix Polygoni Multiflori)Bai Shao (Radix Paeoniae Lactiflorae)Dan Shen (Radix Salviae Miltiorrhizae)Ji Xue Teng (Radix et Caulis Jixueteng)Mu Gua (Fructus Chaenomelis Lagenariae)Add or deduct according to symptomsWith Qi Xu add:Dang Shen (Radix Codonopsis Pilosulae)Huang Qi (Radix Astragali)Bai Zhu (Radix Atractylodis Macrocephalae)Shan Yao (Radix Dioscoreae Oppositae)Zhi Gan Cao (Radix Glycyrrhizae Uralensis) With Blood Xu add:E Jiao (Gelatinum Asini)Sang Shen (Fructus Mori Albae)Han Lian Cao (Herba Ecliptae Prostratae) With stagnation of Blood add:Hong Hua (Flos Carthami Tinctorii)Tao Ren (Semen Persicae)Chi Shao (Radix Paeoniae Rubra)Su Mu (Lignum Sappan)Di Bie Chong (Eupolyphagae seu Opisthoplatiae)Shan Jia Pian (Squama Manitis Pentadactylae)Chuan Xiong (Radix Ligusticii Wallichii)With obvious stiffening of the muscles add:Jiang Can (Bombyx Batryticatus)Gou Teng (Ramulus Uncariae Cum Uncis)Chan Yi (Periostracum Cicadae)Di Long (Lumbricus) TREATMENT With a stiff neck add:Ge Gen (Radix Puerariae)With sore,numb and painful arms add:Jiang Huang (Rhizoma Curcumae)With numb and painful body and limbs add:Chuan Niu Xi (Radix Cyathulae)With sore and aching body or joints add:Hu Jiao (Fructus Piperis Nigri)Jin Que Gen (Caragana Sinica)Wei Ling Xian (Radix Clemetidis Chinensis)Xu Chang Qing (Cynanchum Paniculatum)Qin Jiao (Radix Gentianae Macrophyllae)With headache and dizziness add:Bai Zhi (Radix Angelicae)Ge Gen (Radix Puerariae)Chuan Xiong (Radix Ligustici Wallichii)Ju Hua (Flos Chrysanthemi Morifolii)Xia Ku Cao (Spica Prunellae Vulgaris) In recent years we have compiled over 300 case histories.As this disease is a chronic condition, it is difficult toachieve a complete cure, therefore we isolated 40 cases for our clinical analysis.Data to measure the curative effect 1. Treatment with Chinese herbs: the first group of patients took Chinese herbal remedies exclusively. The dose was one package a day, taken in the morning andthe evening. The period of time that the medication was taken varied greatly. The longest was 450 prescriptions,the shortest 14. 30 cases used Chinese herbs for 3 months or longer.2) Combined treatment: Some 30 patients used western drugs, e.g. artane, amantadine etc, at the same time as having Chinese herbal treatment. Most of them were able to gradually reduce the dose of Western drugs after using Chinese herbs, and eventually stopped taking them 3) Standard of effectiveness:i. Excellent effect: The subjective symptoms improvedgreatly, there was a renewed ability to cope with everyday life and work, obvious symptoms like trembling,rigidity and stiffness, impaired movement, speech problems,abnormal gait and posture were much improved.ii. Good effect: The subjective symptoms and main symptoms improved.iii. Daily effects: Subjective and main symptoms changed from day to day.4) Results of treatment: Because the results of this survey cannot be measured exactly, we will only include thetreatment results of the 30 patients who took Chinese herbs for longer than 3 months. Group I : 6 cases, 20%Group II : 13 cases, 43.3%Group III : 11 cases, 36.6% The connection between different types and treatment success is as follows: Cases 1 2 3 Stagnation of Qi and Blood 9 6 3 - Liver and KIdney Yin-Xu 17 - 10 7 Qi and Blood Xu 4 - - 4 As we can see, in cases of stagnation of Qi and blood, the results are very promising, whereas in cases of deficient Qi and blood they are very poor. Case history Male, 55, worker. Initially he experienced lack of strength and difficulty of movement of the left arm. After one year, precise movements became difficult and he developed tremors whenever he concentrated. After two years the symptoms began to affect the left arm as well, he developed involuntary quickening of gait, and experienced a fixed, incessant pain in the right scapula. Examination:Fixed facial expression, intermittent tremors when the limbs were at rest, (right arm ++++, left arm++); with increased muscle tension the limbs assumed a cogwheel position, (right arm +++, left arm ++), stiffneck (+), slow body movements, festination gait (a tendency to break into a run). Tongue darkish purple, thinwhite coating; Pulse: thin and irregular. Diagnosis: Insufficiencyof Kidney and Liver, stagnation of Qi andblood.After one month of taking Chinese herbs, the patient had greatly improved, movement was almost normal and his muscle tension much better. Posture and gait were nearly normal. Three months later he had basically recovered and started to work again. CONCLUSION 1. Parkinson’s Disease is considered to be an illness of the later years and is rarely seen in patients under forty years of age. The Neijing says: “When the age of forty years is reached, the Yin-Qi reduces itself by half.” Yin-Qi means Yin blood and Yin Jing. According to TCM,Liver and Kidney are of the same origin, and Jing andblood mutually promote each other. Therefore methods of tonifying Liver and Kidney , blood and Qi prove effective in clinical therapy. The herbs used are often sour in taste and enter the Liver. 2. In clinical practice, three types of Parkinsonism can be differentiated: i. Stagnation of Qi and blood, ii. Yin deficiency of Liver and Kidney, iii. Deficiency of Qi andblood. The most important amongst them is the Liver and Kidney deficiency type. The other two can transform and change into this type. Treating the physical tremors means involves treating wind, and the principle“to treat wind, treat the blood first” should be applied.When the blood flows, the wind will clear of its own accord. ‘Decreasing Yin influences the Yang’ means that when Yin withers, the Yang will also become deficient.Therefore the greater the age of the patient, the higher the incidence of deficiency of Qi and blood will be, and the lower the treatment success. 3. In clinical practice, we discovered that if patients combine Western and Chinese medicines, their symptoms improve, and at the same time Western medication can be reduced. The alleviation of side effects by reducing the dose of Western drugs and replacing them with Chinese herbs is considerable. |
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Posted on Wednesday, December 26, 2012 11:17 AM
PARKINSON'S DISEASE by Yufang Xue Parkinson’s disease is the most common central nervous system disorder. It is an idiopathic, slowly progressive degeneration of automatic and gross motor function. Parkinson’s disease is characterised by impaired movement,muscular rigidity, resting tremor, and postural instability.In the United States, 50,000 new cases of Parkinson’s disease are diagnosed in the geriatric population per year. This is a rate of one in two hundred. Aetiology and pathology of Parkinson’sdisease in TCM Tremors of the hands, rhythmic contraction and relaxation of antagonistic muscles, difficulty in movement and rigidity, stiff limbs, a staring look and mask-like face etc.are all common manifestations of Parkinson’s disease.At the later stage of the disease, all movement is reduced in speed and frequency. The patient often sits immobile,walks taking small, shuffling steps, talks slowly with monotonous speech and a low voice, and writes in progressively smaller handwriting. Many of these are typical signs and symptoms of internal wind associated with liver disharmony in TCM. Parkinson’s disease usually occurs in patients over 50 years old. Chinese medicine believes that overwork, excessive sexual activity, improper diet and emotional stress are all common and important pathogens for many diseases. If these pathogens last a long period of time they will eventually give rise to kidney deficiency. Furthermore, senility,the late stage of life, is characterised by decline of kidney essence. This is why geriatric diseases always present with an underlying kidney deficiency pattern. As the liver and kidney share the same origin, kidney deficiency leads to both liver and kidney deficiency. Malnourishment of the tendons due to this deficiency results in stirring of liver wind internally. From a TCM perspective, the main manifestations and age of onset of Parkinson’s disease indicate that the disease relates primarily to liver and kidney disharmony and liverwind. Pattern identification and treatment principles of Parkinson’s disease Parkinson’s disease is characterised by signs and symptoms of liver wind. In clinical practice, this degenerative condition often overlaps with other chronic geriatric diseases such as hypertension, high cholesterol, coronary artery disease,arteriosclerosis and diabetes. These are commonly associated with phlegm and blood stasis. In Chinese medicine, the pathogenesis of Parkinson’s disease includes both root deficiency and excessive manifestations such as wind, phlegm,qi stagnation and blood stasis. Patterns of Parkinson’s diseaseare represented by a progressive continuum from mild to severe. Qi and blood deficiency begins the disease progression.Left untreated or aggravated, the condition often degenerates into deficiency of liver and kidney. Wind-phlegm is then prone to obstruct the channels leading to blood stasis with endogenous wind. Finally, at the severe end of the spectrum,yin and yang both become deficient. As a result, the general treatment principle is “nourishing yin and extinguishing wind”. Nourishing liver and kidney yin treats the root and extinguishing wind focuses on eliminating its manifestation. “Invigorating blood and transforming phlegm” is an additional principle applied because blood stasis and/or phlegm are patterns that appear often in this disease. The specific treatment plan will be different in different stages of the disease and with different patients. Generally speaking, Parkinson’s disease is a chronic and difficult disease requiring a long period of treatment with acupuncture and herbs. In the acupuncture treatment of Parkinson’s disease, although the selection of acupuncture points is primarily based on patterns, some special empirical points are also important. Secondly, keep in mind that due to the long treatment period and the need for frequent treatments, it is important to avoid overuse of commonly used points. To do this, organise acupuncture points into groups and alternate them each time, and supplement acupressure of the points at regular intervals. For the herbal treatment of Parkinson’s disease, the following two aspects should be taken into account. First of all, the functional state of the spleen and stomach is not strong in the elderly. Herbs that move qi to promote the spleen and stomach’s functions are commonly used, therefore, to prevent the nourishing herbs from cloying. Secondly, herbs that invigorate blood and transform phlegm are warm, pungent and scattering and have a tendency to injure body fluids, blood and yin. Itis important, therefore, to select relatively mild herbs for eliminating blood stasis and phlegm. Ultimately,maintaining mood, changing lifestyle and practising some oriental exercises such as qigong and taiji are equally as important as herbs and acupuncture in preventing and treating Parkinson’s disease. Acupuncture treatment of Parkinson’s disease Body acupuncture Main Points : Taixi KID-3, Ganshu BL-18, Taichong LIV-3, Ququan LIV-8, Sanyinjiao SP-6, Guanyuan REN-4, FengchiGB-20, Fengshi GB-31 and Hegu L.I.-4. Explanation : In this acupuncture prescription, Taixi KID-3,the yuan-source point of the kidney channel, is effective at nourishing kidney yin. Ganshu BL-18 and Ququan LIV-8,the back-shu point and he-sea point of the liver channel respectively, restore the liver function. These three points nourish kidney and liver yin to treat the root.The spleen and kidney are the root of post- and pre- heaven respectively, and thereby the source of liver yin. SanyinjiaoSP-6, the meeting point of the spleen, liver and kidney channels,and Guanyuan REN-4, the meeting point of the Conception vessel with the spleen, liver and kidney channels, can tonify the liver. Both REN-4 and SP-6 strengthen the function of the first three points in treating the root.Fengchi GB-20 (Wind Pool) and Fengshi GB-31 (WindMarket) are points of the gall bladder channel which interiorly-exteriorly connects with the liver channel, and are effective at extinguishing liver wind.There is a Chinese saying that states, “In order to extinguish wind one should invigorate blood first; with the free flow of blood, wind will be diminished automatically.”Taichong LIV-3 and Hegu L.I.-4, comprise “the four gates,”a point combination which is effective at moving qi and invigorating blood, and thus assisting in extinguishing liver wind. In the above prescription, five of the nine points focus on nourishing yin to treat the root and four of the nine points mainly extinguish wind to treat the manifestations. Modifications • add Qihai REN-6 and Zusanli ST-36 to tonify deficient qiand blood.• for pronounced liver and kidney yin deficiency, addShenshu BL-23, Zhaohai KID-6 and Yanglingquan GB-34.• add Yinglingquan SP-9 and Fenglong ST-40 when thechannels are obstructed by wind-phlegm.• for cases with blood stasis and endogenous wind addGeshu BL-17 and Xuehai SP-10.• when both yin and yang are deficient add Zhaohai KID-6,Mingmen DU-4, Qihai REN-6 and Zusanli ST-36.• add Dazhui DU-14, Shaohai HE-3 and Houxi SI-3 in caseswith severe tremor.• add Tianshu ST-25 and Qihai REN-6 for constipation.• add Chengjiang REN-24, Lianquan REN-23 and FuliuKID-7 to relieve dry mouth and numb tongue. Scalp acupuncture The commonly used scalp locations are the chorea, motor,leg motor and sensory areas. Use the thoracic cavity area in cases with palpitations and chest oppression. Lastly, the stomach area is effective for epigastric distention and reduced appetite. Some other commonly used techniques Pricking to bleed Blood stasis is an important pathogenesis in many chronicand difficult diseases. In the treatment of Parkinson’s disease,pricking to draw blood is an empirical and effective method. The frequently used points are Quze P-3, WeizhongBL-40, Dazhui DU-14 and Taiyang (M-HN-9). Moxibustion Moxibustion is also used frequently in practice, especially for patterns involving yang qi deficiency. Dabao SP-15,Qimen LIV-14, Shenque REN-8 and Zusanli ST-36 are the most commonly used points for moxa treatment which is especially effective for the rigidity of muscles and limbs. Herbal treatment of Parkinson’s disease Herbal PrescriptionUse a combination of Di Huang Yin Zi (Rehmannia Decoction) and Tian Ma Gou Teng Yin (Gastrodia-Uncaria Decoction) with variations: Tian Ma (Rhizoma Gastrodiae Elatae), GouTeng (Ramulus Uncariae Cum Uncis), Long Gu (OsDraconis), Mu Li (Concha Ostreae), Niu Xi (RadixAchyranthis Bidentatae), Du Zhong (Cortex EucommiaeUlmoidis), Fu Shen (Poriae Cocos Pararadicis Sclerotium),Sheng Di Huang (Radix Rehmanniae Glutinosae), Shi Hu(Herba Dendrobii), Bai Shao (Radix Paeoniae Lactiflorae),Rou Cong Rong (Herba Cistanches), Hai Zao (HerbaSargassii), Jiang Can (Bombyx Batryticatus), Chuan ShanJia (Squama Manitis Pentadactylae), and Bie Jia (CarapaxAmydae Sinensis). In this formula, Sheng Di Huang, Shi Hu, Bai Shao, RouCong Rong, Niu Xi, Du Zhong and Bie Jia nourish liver and kidney yin, while Du Zhong and Rou Cong Rong also warm yang to “get yin through yang”. Niu Xi also subdues uprising of liver yang to extinguish liver wind. Tian Ma,Gou Teng, Long Gu and Mu Li extinguish liver wind powerfully. Fu Shen, Hai Zao, Jiang Can and Chuan ShanJia mainly transform phlegm, invigorate blood, activate the channels and extinguish interior wind. Fu Shen also calms the heart shen to help extinguish wind, and promotes the spleen and stomach to prevent the cloying effect of the nourishing herbs and to help digest the “stone and shell”herbs. This herbal formula has three important features: i.focusing on both the root and the manifestation, ii. tonifying the liver and kidney extensively together with strengthening the spleen, and iii. treating the basic patterns together with other common associated pathogens. Modifications • add Huang Jing (Rhizoma Polygonati), Dang Gui (RadixAngelicae Sinensis) and Bai Zhu (Rhizoma AtractylodisMacrocephalae) to tonify deficient qi and blood.• add E Jiao (Gelatinum Asini), Gui Ban (PlastrumTestudinis), Mai Men Dong (Tuber Ophiopogonis Japonici)and Wu Wei Zi (Fructus Schisandrae Chinensis) for pronounceddeficiency of liver and kidney yin.• add Shui Zhi (Hirudo seu Whitmaniae), Dang Gui (RadixAngelicae Sinensis), Ji Xue Teng (Radix et Caulis Jixueteng)and Lu Lu Tong (Fructus Liquidambaris Taiwanianae)when the channels are obstructed by wind-phlegm.• for cases of blood stasis with endogenous wind addHuang Qi (Radix Astragali), Hong Hua (Flos CarthamiTinctorii) and Tao Ren (Semen Persicae).• when both yin and yang are deficient add Ba Ji Tian (RadixMorindae Officinalis), Lu Jiao Jiao (Colla Cornu Cervi) andWu Wei Zi (Fructus Schisandrae Chinensis).• add Zhen Zhu Mu (Margarita) and Bai Ji Li (FructusTribuli Terrestris) in cases with severe tremors.• add Mu Gua (Fructus Chaenomelis Lagenariae) andQuan Xie (Buthus Martensi) for rigidity and tightness ofmuscles and limbs.• add Dan Nan Xing (Rhizoma Arisaematis cum FelleBovis), He Ye (Folium Nelumbinis Nuciferae) and CangZhu (Rhizoma Atractylodis) to relieve high cholesterol orobesity.• add Tao Ren (Semen Persicae) and Huo Ma Ren (SemenCannabis Sativae) for constipation.• add He Shou Wu (Radix Polygoni Multiflori), Shi ChangPu (Rhizoma Acori Graminei) and Yuan Zhi (RadixPolygalae Tenuifoliae) in cases with numb tongue andslurred speech. Case example A 75-year male patient had experienced tremors of his upper limbs and reduced intelligence for three years. A medical examination showed that the patient had “impaired circulation in the brain and shrinking brain.” He was diagnosed with Parkinson’s disease. He had lost flexibility of facial expression, experienced uncontrolled tremors,rigidity and impaired movement of the arms, inability tohold utensils, poor memory, forgetfulness, soreness and weakness in the lower back, dry stool, concentrated urine,dim complexion without lustre, a slightly puffy and mildly trembling tongue, a thin and yellowish greasy tongue coating, and a wiry, slippery and fine pulse. Acupuncture treatment Body acupuncture prescriptionGroup 1: Taixi KID-3, Taichong LIV-3, Xuehai SP-10,Fenglong ST-40, Yanglingquan GB-34, Jianyu L.I.-15, QuchiL.I.-11, Hegu L.I.-4 and Sishencong (M-HN-1).Group 2: Zhaohai KID-6, Ququan LIV-8, Sanyinjiao SP-6,Guanyuan REN-4, Zhongwan REN-12, Shousanli L.I.-10,Waiguan SJ-5 and Baihui DU-20.Group 3: Fengchi GB-20, Yamen DU-15, Shaohai HE-3,Houxi SI-3, Geshu BL-17, Pishu BL-20, Shenshu BL-23,Fengshi GB-31 and Qiuxu GB-40. Explanation Group 1: Taixi KID-3, Taichong LIV-3 and Xuehai SP-10nourish liver and kidney yin. Yanglingquan GB-34 relaxesand strengthens the sinews and calms interior wind. XuehaiSP-10 and Hegu L.I.-4 together with Taichong LIV-3 moveqi and blood to extinguish liver wind. Fenglong ST-40together with Xuehai SP-10 transforms phlegm. JianyuL.I.-15, Quchi L.I.-11 and Hegu L.I.-4, a chain and lock point combination, move qi, invigorate blood and activate thechannels, and are especially good for tremors of the arms.Sishencong (M-HN-1) calms the spirit and settles the will totreat reduced intelligence. Group 2: Zhaohai KID-6, Ququan LIV-8, Sanyinjiao SP-6and Guanyuan REN-4 nourish liver and kidney yin to treatthe root directly, and extinguish interior wind to treat the manifestation indirectly. Zhongwan REN-12 and SanyinjiaoSP-6 fortify the spleen and regulate the stomach to transformphlegm. Shousanli L.I.-10 and Waiguan SJ-5 are localpoints for tremors of the upper limbs. Baihui DU-20 opens the orifices and calms the spirit to help intelligence. Group 3: Fengchi GB-20, Shenshu BL-23, Fengshi GB-31and Qiuxu GB-40 nourish liver and kidney yin and extinguish interior wind. Geshu BL-17 invigorates blood to help extinguish wind. Pishu BL-20 fortifies the spleen to dissolve phlegm. Shaohai HE-3 and Houxi SI-3 are local points for disorders of the upper limbs. Yamen DU-15 calms the spirit to treat reduced intelligence.These three groups of points were rotated at each treatment. Method 30 gauge needles were used with even method and retained for 30 minutes.Three treatments were given every week. Scalp acupuncture : Commonly used areas included the chorea, motor, leg motor and sensory areas. One area was used each time. The needles were manipulated rapidly (20 to 30times per minute, lifting and thrusting while rotating) to induce a hot, numb and/or heavy needle sensation for about 2 minutes. The needles were manipulated again every 10 minutes and were retained for 30 minutes. Electricity was applied at a frequency of 10-20 HZ/minute, and an intensity of 20-30 V for 20 minutes. Pricking and bleeding method: Weizhong BL-40 and Dazhui DU-14 were used alternately, pricking one point each time,every other week. If necessary, cupping was applied to ensure proper bleeding. Herbal treatment Sheng Di Huang (Radix Rehmanniae Glutinosae) 12g, ShanZhu Yu (Fructus Corni Officinalis) 9g, Yuan Zhi (RadixPolygalae Tenuifoliae) 12g, Bai Shao (Radix PaeoniaeLactiflorae) 12g, Bie Jia (Carapax Amydae Sinensis) 15g, BeiMu (Bulbus Fritillariae) 9g, Hai Zao (Herba Sargassii) 9g,Mu Gua (Fructus Chaenomelis Lagenariae) 9g, Gui Zhi(Ramulus Cinnamomi Cassiae) 12g, Tian Ma (RhizomaGastrodiae Elatae) 15g, Long Gu (Os Draconis) 30g, Niu Xi(Radix Achyranthis Bidentatae) 9g, He Shou Wu (RadixPolygoni Multiflori) 12g, Chuan Xiong (Radix LigusticiWallichii) 9g, Fu Shen (Poriae Cocos Pararadicis Sclerotium)15g, Mu Xiang (Radix Saussureae seu Vladimirae) 6g,Zhi Gan Cao (Radix Glycyrrhizae Praeparatae) 6g.ExplanationSheng Di Huang (Radix Rehmanniae Glutinosae), ShanZhu Yu (Fructus Corni Officinalis), Bai Shao (Radix PaeoniaeLactiflorae), Bie Jia (Carapax Amydae Sinensis), Niu Xi(Radix Achyranthis Bidentatae), Chuan Xiong (RadixLigustici Wallichii) and He Shou Wu (Radix PolygoniMultiflori) nourish liver and kidney yin intensively to treatthe root of the disease. Bai Shao (Radix Paeoniae Lactiflorae)and Niu Xi (Radix Achyranthis Bidentatae) together withMu Gua (Fructus Chaenomelis Lagenariae) also strengthenand relax sinews to calm interior wind. Tian Ma (RhizomaGastrodiae Elatae) and Long Gu (Os Draconis) together with Bie Jia (Carapax Amydae Sinensis) anchor uprisingliver yang and extinguish liver wind powerfully. A small dosage of Gui Zhi (Ramulus Cinnamomi Cassiae) warms kidney yang to “get yin through yang” and also helps other herbs in transforming phlegm. Bei Mu (Bulbus Fritillariae),Hai Zao (Herba Sargassii) and Mu Gua (Fructus ChaenomelisLagenariae) together with Gui Zhi (Ramulus CinnamomiCassiae) transform phlegm. Fu Shen (Sclerotium PoriaeCocos Pararadicis), Mu Xiang (Radix Saussureae seuVladimirae) and Zhi Gan Cao (Radix GlycyrrhizaePraeparatae) together with Gui Zhi (Ramulus CinnamomiCassiae) and Bai Shao (Radix Paeoniae Lactiflorae) regulate the middle burner to strengthen the source of yin and transform phlegm. Yuan Zhi (Radix Polygalae Tenuifoliae)and Fu Shen (Sclerotium Poriae Cocos Pararadicis) together harmonise the kidney and heart to calm the spirit and settlethe will. Preparation method : All the above herbs were ground into powder. He Ye (Folium Nelumbinis Nuciferae) 30g wasboiled in 600 ml of fresh water and strained and the resultingdecoction was used to boil and then simmer the herbalpowder, with 30g each of honey and pork bone marrow.This final decoction was made into small pills to be taken20g at a time, three times a day, half an hour after meals.After the patient received Chinese medicine treatment for three months, most clinical signs and symptoms were obviously reduced. After four months treatment, the patient had a lustrous complexion with a variety of facial expressions,quicker reactions, normal sleep and a good mood.Only occasionally did he experience small amplitude uncontrolled tremors of the arms. After two further months of similar treatment, his clinical manifestations entirely disappeared. Dr. Yufang Xue, Ph.D., is a professor of Chinese medicine diagnosticsand internal medicine at the American Academy of Acupuncture andOriental Medicine (AAAOM). Dr. Xue has received his bachelor’sdegree at Nanjing University of TCM, a masters degree from ShandongUniversity of TCM, and his Ph.D from Guangzhou University of TCMwhere he acted as the associate professor. |
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Posted on Monday, November 26, 2012 5:28 PM
The Treatment of POLYNEURITIS by TCM *Other poisons include carbon monoxide, lead, mercury, copper,nitrobenzol, organophosphates and thallium, and drugs such as diphenylhydantoin, isoniazid, nitrofurantoin, thalidomideand vincristine. Polyneuritis may occur also in arteriosclerosis,beriberi, chronic gastrointestinal disease, leprosy,pellagra, porphyria, rheumatoid arthritis, systemic lupuserythematosus, and many infectious diseases. Editor by Sun Pei Lun Polyneuritis, or multiple (peripheral) neuritis, is an inflammation which affects symmetrically distributed peripheral nerves. The causes are always systemic or constitutional leading to degeneration or atrophy of the nerve fibres of the small nerves. The origin of this degeneration involves some kind of poison, either absorbed or produced by the body, which circulates with the blood. The most common source of these poisons is alcohol, the next most important is arsenic, followed by infections, diabetes, gout, diphtheria and typhoid fever*.Polyneuritis as a rule is slow to manifest, even in the case of diphtheria. In most cases it begins with vague pains and a sensation of tingling in the limbs. This is followed by weakness and wasting of the muscles of the feet, legs, hands and arms or other parts of the body, wrist drop,loss of voice, dyspnoea, weakness of cardiac function,loss of sensation in scattered areas of the skin,swelling of the feet and loss of deep reflexes. Aetiology and Pathology Polyneuritis belongs to the TCM categories of wei and bi syndromes. Invasion by damp-heat or cold dampness is the principal cause, leading to injury to the tendons and muscles. These exterior pathogens, however, will only injure the body in cases of pre-existing deficiency of the Liver and Kidneys. The Liver stores the blood which nourishes the tendons, and the Kidneys store jing which generates marrow and nourishes the bones. When the Liver and Kidneys are deficient, therefore, there will be weakness of the tendons and bones which allows penetration of exterior pathogens. The pathogens block the circulation of qi and blood which then fail to nourish the tendons, muscles and bones, resulting in weakness and swelling. General Clinical Manifestations • Loss of sensation, motility and nourishment in the distal extremities.• Pain of the fingers and toes, or a sensation that one is wearing gloves or slippers; in some cases these sensations spread proximally.• Motor disturbance manifesting as loss of muscular force and developing into muscular atrophy, wrist-drop,abnormal (steppage) gait or deformity.• Impaired nutrition of tissues resulting in coldness,thinning, dryness and cracks of the skin.• In severe cases there will be quadriplegia, urinary retention or incontinence, dyspnoea, or difficulty in speaking or swallowing. Differentiation and Treatment 1. Invasion by damp-heat Clinical manifestations • Numbness• Slight swelling of the distal extremities, especially of the lower limbs• Myalgia• Itching• Steadily increasing weakness• Heaviness of the body• In some cases dyspnoea or difficulty in speaking or swallowing• Retention or incontinence of urine Tongue: red body with a yellow greasy coatingPulse: slippery (hua) and rapid (shuo) Treatment principle Clear heat, transform dampness and dredge the collaterals. Herbal treatment Modified Si Miao San (Four Marvel Powder):Chao Huang Bai (Dry-fried Cortex Phellodendri) 10gCang Zhu (Rhizoma Atractylodis) 10gChuan Niu Xi (Radix Cyathulae) 10gYi Yi Ren (Semen Coicis Lachryma-jobi) 15gBei Xie (Rhizoma Dioscoreae) 10gZe Xie (Rhizoma Alismatis Plantago-aquaticae) 10gMu Gua (Fructus Chaenomelis Lagenariae) 6gChi Fu Ling (Sclerotium Poriae Cocos Rubrae) 10gTu Fu Ling (Rhizoma Smilacis Glabrae) 10gXi Xian Cao (Herba Siegesbeckiae Orientalis) 10g Acupuncture Taibai SP-3Sanyinjiao SP-6Yinlingquan SP-9Hegu L.I.-4Quchi L.I.-11Fenglong ST-40Taichong LIV-3Zhigou SJ-6 Method Reducing. 2. Invasion by cold dampness or obstruction ofthe channels by wind-cold Clinical manifestations • Numbness of the limbs with shooting pain• Cold limbs• Symptoms improved with heat and exacerbated with movement• Limping gait• Pale or purple skin Tongue: pale body with a thin white coatingPulse: wiry (xian) or tight (jin) Discussion This pattern is often encountered in cases of polyneuritis due to poisoning or to chronic metabolic disturbance. Treatment principle Expel wind, dispel cold, warm the channels and dredge the collaterals. Herbal treatment Modified Qiang Huo Sheng Shi Tang (Notopterygium Decoction to Overcome Dampness):Qiang Huo (Rhizoma et Radix Notopterygii) 10gDu Huo (Radix Duhuo) 10gGao Ben (Rhizoma et Radix Ligustici Sinensis) 10gChuan Xiong (Radix Ligustici Wallichii) 10gFang Feng (Radix Ledebouriellae Sesloidis) 10gMan Jing Zi (Fructus Viticis) 10gLu Jiao Jiao (Colla Cornu Cervi) 10gXi Xin (Herba Asari cum Radice) 5gRou Gui (Cortex Cinnamomi Cassiae) 5gHong Hua (Flos Carthami Tinctorii) 5gMa Huang (Herba Ephedrae) 6gGan Jiang (Rhizoma Zingiberis Officinalis) 10g Acupuncture Taibai SP-3Sanyinjiao SP-6Yinlingquan SP-9Waiguan SJ-5Hegu L.I.-4Dazhui DU-14Dazhu BL-11Method Reducing. 3. Deficiency of qi and blood Clinical manifestations • Numbness of the four limbs• Weakness• Muscular atrophy or paralysis• Diminished appetite• Abdominal distention• Diarrhoea Tongue: palePulse: thready (xi) and forceless (wu li) Discussion This pattern is frequently encountered in cases of polyneuritis due to malnutrition and consumptive disorders. Treatment principle Activate the Spleen and Stomach, tonify qi and nourish blood. Herbal treatment Shi Quan Da Bu Tang (All-Inclusive Great Tonifying Decoction): Dang Shen (Radix Codonopsis Pilosulae) 10gBai Zhu (Rhizoma Atractylodis Macrocephalae) 10gChi Fu Ling (Sclerotium Poriae Cocos Rubrae) 10gZhi Gan Cao (Radix Glycyrrhizae Praeparatae) 5gShu Di Huang (Radix Rehmanniae Glutinosae Conquitae) 10gBai Shao (Radix Paeoniae Lactiflorae) 10gChuan Xiong (Radix Ligustici Wallichii) 10gDang Gui (Radix Angelicae Sinensis) 10gRou Gui (Cortex Cinnamomi Cassiae) 5gChao Huang Qi (Dry-fried Radix Astragali) 10gLu Jiao Jiao (Colla Cornu Cervi) 10g AcupunctureTaibai SP-3Sanyinjiao SP-6Xuehai SP-10Taixi KID-3Xuanzhong GB-39Dazhu BL-11Qihai REN-6Method Tonification with moxibustion. 4. Liver and Kidney deficiency Clinical manifestations • Muscular atrophy• Paralysis of the limbs• Numbness of the limbs• Pale or purple skin• Lower back pain• Dizziness• Fatigue• Slight fever or evening fever• Heat sensation in the body• Night sweating Tongue: red body with a scanty or peeled coatingPulse: thready (xi) and forceless (wu li), or slightly rapid(shuo). Discussion This pattern is frequently encountered in the terminalstage of polyneuritis or during convalescence. Treatment principle Nourish the Liver and Kidneys and clear empty heat. Herbal treatment Hu Qian Wan (Hidden Tiger Pill) Chao Huang Bai (Dry-fried Cortex Phellodendri) 10gChao Zhi Mu (Dry-fried Radix AnemarrhenaeAsphodeloidis) 10gShu Di Huang (Radix Rehmanniae Glutinosae Conquitae) 10gDuan Gui Ban (Calcined Plastrum Testudinis) 20gLu Jiao Jiao (Colla Cornu Cervi) 10gXuan Shen (Radix Scrophulariae Ningpoensis) 10gMu Dan Pi (Cortex Moutan Radicis) 10gGou Qi Zi (Fructus Lycii Chinensis) 10gTu Si Zi (Semen Cuscutae) 10gChuan Xiong (Radix Ligustici Wallichii) 10g In case of deficiency of both yin and yang add:Yin Yang Huo (Herba Epimedii) 10gBu Gu Zhi (Fructus Psoraleae Corylifoliae) 10gBa Ji Tian (Radix Morindae Officinalis) 10g Acupuncture Taibai SP-3Zhaohai KID-6Fuliu KID-7Sanyinjiao SP-6Zusanli ST-36Guanyuan REN-4Qihai REN-6Baihui DU-20Method Tonification with moxibustion if indicated. Sun Pei Lun holds a Master’s Degree in TCM and is a teacher at the Nanjing College of TCM.Translated from Médecine Chinoise et Médecines Orientales. |
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Posted on Friday, November 09, 2012 4:55 PM
ACUPUNTURE TREATMENT ACCORDING THE SIX CONFORMATIONS OF THESHANGHAN LUN by Stephanie Bekooy & Arnaud Versluys Abstract For close to two thousand years, the Shanghan Lun (Treatise on Cold Damage) has provided the framework for thetreatment of acute external diseases, based on the sixconformations or channels. It has offered Chinese herbalpractitioners a range of powerful yet subtle treatments tofollow the complex, and sometimes rapid, changes that suchdiseases manifest. Although the Shanghan Lun does include some acupuncture treatments, they form a relatively minorpart of the text. Such is the flexible nature of acupuncture,however, that appropriate treatments can be formulatedfor the different stages of development of disease throughthe six conformations. Keywords : Shanghan Lun, Treatise on Cold Damage, six conformations, acupuncture, febrile diseases. Introduction The Treatise on Cold Damage or Shanghan Lun is one of the most respected texts in the history of Chinese medicine andShanghan Lun classicists have always tried to closely adhere to the original text when treating patients. This characteristic methodology is often the goal for modern practitioners inboth herbal and acupuncture prescriptions.The Shanghan Lun mentions acupuncture therapy thirty three times, but few of these references are specific, and acupuncture-based treatments are never discussed in detail. However, the six conformations grid along which theShanghan Lun is outlined lends itself remarkably as a clinical guide for acupuncture and moxibustion treatment. The six channels or conformations are the physical representations of the six climate influences or six qi in nature (taiyang is cold water, yangming is dry metal, shaoyang is ministerial fire, taiyin is damp earth, shaoyin is imperial fire and jueyinis wind wood). In the body they form the six pairs of handand foot channels directly linked to these six qi.The goal of this project is to provide a framework foracupuncture and moxibustion therapy based on the Shanghan Lun rationale of the six conformations. Although specific point prescriptions will be discussed, the intention of this paper is to reveal a methodology for point selection that can be applied to any Shanghan Lun-based herbal therapy. As the original Shanghan Lun formulas are concise, the extrapolated point selections need at all times to reflect the same precision. Methodical considerations Starting from a detailed understanding of the sequential nature of the six conformations, we have analysed the herbal prescriptions as stipulated by the original author with regards to the actions, herbs selected and channels addressed. To extrapolate the herb prescriptions into point prescriptions, we then considered the specific attributesof point qualities. The point selection went far beyond individual, sometimes symptomatic, actions and delved into the realm of channel specificity, yuan-source and luoconnecting qualities, shu-transport point actions, back-shu and front-mu points, channel intersections, local and distal combinations, hand and foot channel connections, specific functions of points, needling versus moxibustion etc.As in a herbal formula, the single ingredient is subordinate to the whole. The goal of the acupuncture prescription was to employ the points as a balanced team on a joint mission. Point selection for the discussed disorders is influenced by three further conditions: i. the external/internal relationshipof the affected channel within the six conformations, inother words yangming is internal while taiyin is internal,ii. the control [ke] cycle of the five elements as part of the pathomechanism, for example wood disease affecting earth,and iii. the patterns of disease progression in six confirmation pathology as outlined in chapter 74 of the Internal Classic of the Yellow Emperor [huangdi neijing].Keeping these considerations in mind, it is possible to builda rationale for point prescription based on Shanghan Lun thought. Once the proper diagnosis of illness is determined and the herbal treatment selected, the practitioner is able to examine the actions of the formula and translate those actions into point choices. The acupuncture treatment can then work in conjunction with the herbal formula to more directly address the six confirmation diagnosis. 1. Taiyang Wang Haogu of the Yuan dynasty paints a striking picture of the six conformations is his book called These Things Are Hard to Find Out About [cishi nanzhi]: “The yin water within yang is taiyang. It is the premier ofthe three yang and its [pathologies] can [either sequentially] progress along the channels or by bypassing channels. The yang earth within yang is yangming. Man’s yangming is the earth of the middle continent and governs intake without exit; if taiyang progresses into here, then this is called passage along the channel. The yang wood within yang is shaoyang. It regresses upward into yangming or progresses downward into taiyin. If taiyang passes into here, then this is called channel-bypassing progression.The yin earth within yin is taiyin. Upward regression into shaoyang is compliance, downward progression into shaoyin is turmoil. This is the upward and downward passage. If taiyin passes into taiyang, then this is regression due to [initial] wrong purgation. The yang water within yinis shaoyin. Upward regression into taiyin is compliance, downward progression into jueyin is genesis; if taiyang progresses into here, then this is passage from surface to interior. The yin wood within yin is jueyin. Upward regression into shaoyang is excess, continued progression into taiyang is spontaneous recovery.” Notesi. Taiyang is the first and foremost channel and its pathologies can pass from one channel into the next in line (progressalong channels) or can jump over (bypass) channels directlyinto a deeper channel.ii. Yangming Stomach belongs to earth. The earth elementhas two aspects; one is a yang aspect (a fu), i.e. the Stomach,and one is a yin aspect (zang) which is the Spleen. Thereforeyangming is the yang earth of the yang channels and taiyinis the yin earth of the yin channels.iii. Yangming “governs intake without exit” means that oncediseases reach the yangming fu, they do not then pass intoany other zangfu, so diseases do not exit from yangminginto other conformations.iv. The taiyin channel lies deeper than shaoyang, thus upwardpassage into shaoyang indicates recovery and compliance,while deeper passage into shaoyin indicates worsening ofthe disease and is called turmoil.v. Taiyin passing into taiyang means that there wasan original taiyang pattern that has been purged withherbs like Da Huang (Radix et Rhizoma Rhei), creating ataiyin pattern with damaged Spleen yang and diarrhoea.This then slowly recovers (spontaneously over time) andpasses back into the original taiyang channel showing onceagain taiyang symptoms (because the taiyang pattern wasnever resolved).vi. “The yang water within yin” indicates that shaoyinconfirmation governs the Kidney water element but alsohouses the imperial fire.vii. Passage into jueyin is genesis because amongst the yinchannels, jueyin holds the most potential for spontaneousyang recovery as it is the most ‘yang’ channel of the yinconformations.viii. Taiyang progressing into shaoyin: taiyang Bladderand Small Intestine and shaoyin Kidney and Heart standin exterior and interior relationship, hence passage fromtaiyang into shaoyin is called surface to interior passage[biaoli chuan]. ix. After completion of a six-fold cycle of progression, jueyin disease re-exits from taiyang which indicates recovery ofyang energy. The taiyang channel is the great yang channel of the coldwater of the north. Gui Zhi Tang (Cinnamon Twig Decoction) is the crown formula in the Shanghan Lun used to treat external cold wind invasion on this channel. The formula contains warm, acrid herbs intended to free the flow ofyang and dispel wind, as well as sour and sweet herbs toharmonise the nutritive [ying] and protective [wei] qi andto prevent passage of the pathogen into the interior. The formula has five ingredients of which Gui Zhi (RamulusCinnamomi Cassiae) is a warm and pungent herb thatfrees the flow of yang, liberates the surface and disperseswind-cold. Bai Shao (Radix Paeoniae Lactiflorae) is bitter,sour and cool; it mildly clears heat while astringing fluidsand protecting the body from fluid loss due to sweating.Used in a 1:1 ratio, they work together to release theevils from the exterior while simultaneously retainingphysiological yin fluids; this makes Gui Zhi and BaiShao the foremost combination to balance the nutritiveand protective qi. Gui Zhi is combined with Sheng Jiang(Rhizoma Zingiberis Officinalis Recens) to release theexterior, while Sheng Jiang is combined with Zhi GanCao (Radix Glycyrrhizae Praeparatae) to harmonise thecentre. The sour taste of Bai Shao combined with thesweetness of Zhi Gan Cao, engenders fluids to replenishthe nutritive qi, which has potentially been damaged bythe sweating. Pungent Gui Zhi, combined with sweet ZhiGan Cao and Da Zao (Fructus Zizyphi Jujubae), tonifiesyang and strengthens the protective qi. The replenishing offluids helps prevent the penetration of the pathogens intothe yangming layer, while the tonification of qi preventspassage into yangming and taiyin. The combination of Gui Zhi with Bai Shao moves blood to extinguish windand course stasis to prevent passage into shaoyang andthe engendering of stagnation fire. The disease thus remains superficial, and is easily alleviated. Gui Zhi Tang treats exterior wind invasion not only with precision and elegance, but also with a measured sense of foresight by protecting all layers of the body.The equivalent acupuncture treatment should strive tohave the same actions. It should free the exterior of windcold pathogens by promoting the flow of yang in the taiyang channel, harmonise the nutritive and protective, as well as strengthen the middle jiao. The following point treatment is suggested as an equivalent for Gui Zhi Tang: Shenmai BL-62, Houxi SI-3, Jinggu BL-64, Dazhong KID-4, FengchiGB-20 and Zusanli ST-36. Shenmai BL-62 has the specific effect of clearing wind andcold from the external layer and treating heat effusion, neckstiffness, and nasal congestion with watery discharge.When Shenmai BL-62 is combined with Houxi SI-3, theYang Motility (Yang Qiao) vessel is activated and the yangenergy of the Governing (Du) vessel mobilised. This accessesreserved qi from the Bladder and Small Intestine channelswhile simultaneously activating them. Both actions aid inthe clearing of congestion in the two involved channelsand in the strong promotion of yang flow on the wholebody surface.Houxi SI-3 in its own right also assists in clearing windand relaxing the sinews, and, because it is the confluentpoint of the Governing vessel, assists in the opening of theback and thus freeing the flow of yang energy.Jinggu BL-64 is the yuan-source point of the Bladderchannel. As such, it is able to strengthen Bladder qi andhence, the protective yang (the interplay between Kidneyyang and Kidney yin creates a vapour called Kidney qi,just as the interplay between Bladder yang and Bladderfluids – urine - creates a vapour called Bladder qi, which isthen disseminated through the Bladder channel to protectand warm the surface of the whole body). Beyond this,Jinggu BL-64 strongly dispels wind. The combination ofJinggu BL-64 with Dazhong KID-4 activates the host/guestrelationship between the Bladder and Kidney channels.This strengthens the Bladder channel by accessing its yangresources stored in the Kidneys, because contained withinthe taiyang channel is the shaoyin imperial fire.Fengchi GB-20 is one of the primary points for dispellingexternal wind. It is the junction point of the Gall Bladderchannel with the Yang Linking (Yangwei) and Yang Motility(Yangqiao) vessels and the Sanjiao channel. The Yang Linkingvessel is in charge of the exterior of the body, thus furtheringthe resolution of the surface. Needling Fengchi GB-20 willnot only circulate the body’s yang energy, but also freethe neck and occipital region which are being invaded bywind and cold. Fengchi GB-20 is mentioned in the originalShanghan Lun for simultaneous use with Gui Zhi Tang in case of taiyang wind-cold invasions.Zusanli ST-36 is the main tonification point; it is ableto protect and strengthen the middle jiao and thereby prevent the illness from penetrating into the yangming layer. Zusanli ST-36 also nourishes the centre in order to strengthen the nutritive and protective qi derived from food and water qi. Moreover, Zusanli ST-36 has the specific effect of harmonising the nutritive and protective qi. It is a point of the sea of water and grain and as such it tonifies any deficiency condition. The needling of points on the yangming channel to prevent passage from the taiyang channels into yangming is mentioned in line 8 of the original text: “If it isabout to pass to another channel, needle the foot yangmingto prevent passage …”Analogous actions can be seen between the use of ShenmaiBL-62 and Houxi SI-3 and the use of Gui Zhi (Ramulus Cinnamomi Cassiae) to free the flow of surface yang energy.Jinggu BL-64 and Dazhong KID-4 show affinity with the yinand yang regulating functions of Gui Zhi and Bai Shao (RadixPaeoniae Lactiflorae), while Jinggu BL-64, as yet anothersurface releasing point, assists the main point combinationin the sense of Sheng Jiang (Rhizoma Zingiberis OfficinalisRecens) assisting Gui Zhi to enhance the sweating. This point combination must be needled until the patient breaks intoa mild sweat. Fengchi GB-20 releases the yang energy onthe neck to melt the frozen waters of the taiyang that causeneck rigidity and headaches. Zusanli ST-36 strengthens theinterior like Da Zao (Fructus Zizyphi Jujubae) and Zhi GanCao (Radix Glycyrrhizae Praeparatae) to prevent collapse ofpathogens, while it also harmonises the Stomach like ShengJiang. This needle protocol skillfully simulates Gui Zhi Tang. The acupuncture prescription frees and strengthens theexterior, releases exterior wind, harmonises the nutritiveand protective qi, protects the fluids and strengthens andprotects the middle jiao.Point protocols can be modified just like herbal formulas.A typical modification of Gui Zhi Tang is Gui Zhi Jia Ge Gen Tang (Cinnamon Twig Decoction Plus Kudzu). As line 14 of the Shanghan Lun states: “When in taiyang disease [there is] stretched stiff nape and back, but also sweating and aversion to wind, it is treated with Gui Zhi Jia Ge Gen Tang.” Gui Zhi Jia Ge Gen Tang is Gui Zhi Tang with the addition of Ge Gen (Radix Puerariae) which treats taiyang wind-cold invasion with initial passage into the yangming channels. Ge Gen aids in resolving the exteriorand relieving heat effusion, while ascending nourishingfluids to the congealed channels of the neck and shoulders.The results are the reduction of pain and stiffness of theneck because the wind is released, the surface yang is freedand the tendons are nourished.Points to consider adding to the Gui Zhi Tang protocol are Tianzhu BL-10 and Jugu L.I.-16. Tianzhu BL-10 has a special affinity for the neckregion, both because of its location and because it is thebifurcation point of the Bladder channel, from which onebranch of the channel descends through the nape to meet with Dazhui DU-14 and Taodao DU-13 before traveling to Dazhu BL-11, whilst the other branch descends to FufenBL-41, lateral to the second thoracic vertebra. Its actionsare to dispel wind and cold, clear the Bladder channel,relax the sinews, and strengthen the back. As such it is a clear choice to represent the relaxing actions of Ge Gen.Jugu L.I.-16 is a yangming Large Intestine channel pointand directly addresses the congested channel to whichthe initial taiyang pathogens have started to migrate. Ifpurged, it eliminates evils from the shoulder region andtreats local pain and stiffness of the neck and shoulders.Furthermore Jugu L.I.-16 is a point of the Yang Motilityvessel which has an affinity with the taiyang Bladder channel and therefore is a physical crossing of taiyang qi and yangming qi, and is thus ideal to treat combined disease.In case of cold invasion causing a taiyang and yangming combined pattern of stiffness of the neck and nape, the point prescription may also be supplemented with FengfuDU-16 as mentioned in line 24 of the original text. 2. Yangming The yangming channel is the yang brightness channel of thedry metal of the west. It is the two yang (taiyang is threeyang, yangming is two yang, and shaoyang is one yang)and is dry in nature, containing taiyin dampness within for physiological balance. Conformation pathologies manifestboth as channel patterns and fu patterns. The channel patterns are the superficial invasion of pathogens at the periphery, while the fu patterns indicate the internal collapse of the pathogens into the corresponding fu. For yangming, the channel pathology will manifest with a severe clash ofthe body’s yang with the invading pathogen and create superficial heat symptoms, of which the four ‘big’ signs(fever, thirst, sweating and pulse) are the most representative. The formula of choice for this yangming channel patternis Bai Hu Tang (White Tiger Decoction). Its ingredients are Shi Gao (Gypsum), Zhi Mu (Radix AnemarrhenaeAsphodeloidis), Gan Cao (Radix Glycyrrhizae Uralensis)and Geng Mi (Semen Oryzae). Shi Gao is the only herb inthe commonly used materia medica that is extremely cold,while also pungent and dispersing. It strongly clears heatwhile opening the surface and promoting sweating. Shi Gaois also mildly sweet, which allows it to enter the middlejiao and cool the Stomach without damaging the alreadythreatened fluids. Furthermore, combining Shi Gao withZhi Mu will help regenerate those diminished fluids. ZhiMu clears heat while moistening the Stomach, offering relieffrom the heat induced imminent dryness. Zhi Mu combinedwith Shi Gao clears and protects what the scholars of theQing dynasty Fever School regarded as the nutritive layerand prevents the qi layer heat from penetrating deeperinto the fluid realm. Geng Mi strengthens the middle andprotects against the cold of the other herbs, and it is always used to protect and regenerate the fluids of the middle jiao in the prevention of dryness of the fu. Gan Cao is sweet and benefits the middle jiao, and in combination with Geng Miserves to protect the Stomach fluids through its qi and yin tonifying actions.The focus of the acupuncture treatment must be the swift clearing of yangming channel heat while protecting,preserving and even engendering nutritive fluids. A point prescription that acts in concert with Bai Hu Tang is: Neiting ST-44, Quchi L.I.-11, Dazhui DU-14, Hegu L.I.-4 andFuliu KID-7.Neiting ST-44 is the ying-spring point of the Stomach channel,and as such has strong abilities to clear heat, drain yangmingfire and clear heat effusion. A reducing technique shouldbe used when needling this point to further encourageheat release.Quchi L.I.-11 is the he-sea point of the Large Intestine channel and clears cold damage induced incessant heat effusion with thirst and copious sweating. As with NeitingST-44, a reducing technique should be applied.Dazhui DU-14 is the junction point for all the yang channels and can clear excessive heat from all of them. It releases the exterior and clears heat by promoting sweating in the same way that Shi Gao opens the surface through its pungent taste and clears heat with its cold nature while preventing fluid and qi damage through its latent sweet taste. Dazhui DU-14 also firms the exterior to arrest the heavy perspiration and reinforce fluid retention. Last but not least, Dazhui DU-14 reinforces the qi that is damaged due to the dry heat and excessive sweating of the yangming channel pathology.Hegu L.I.-4 is the yuan-source point on the Large Intestinechannel, and as a yuan-source point on a yang channel itcan strongly dispel excess pathogens from the channel.Hegu L.I.-4 activates the channel, circulates qi and bloodto clear obstruction and, when combined with Fuliu KID–7,stops copious sweating. When Hegu L.I.-4 is reducedand Fuliu KID-7 is tonified, strong sweat will be cleared. As the Kidney is the source of the true water, all fluids inthe yangming originally draw from the shaoyin Kidneywater resources.A yangming fu pattern is the internal counterpart ofthe channel pattern and represents a mutated or moreadvanced stage of the illness. The bowel pattern occurs when yangming fluids are depleted. The prime formula choice is the Cheng Qi Tang family. The name anslates as ‘qi ordering decoction,’ suggesting that the movements ofthe Stomach and Large Intestine must be smooth and incontinuous harmony to allow unobstructed passage and elimination of the transmutated heat-induced dry stool stagnation. Three modifications of one formula exist in orderto treat the specifics of this yangming bowel disease. Theircommon action is restoration of the movement of qi to expel solids or matter, while clearing heat and dryness. The strongest of these formulas is Da Cheng Qi Tang (Major Order the Qi Decoction) which focuses on theintensity of the fullness and stagnation. Da Cheng Qi Tang greatly descends yangming, purges heat and dry masses, and the saltiness of Mang Xiao will also moistendryness and soften masses. Da Cheng Qi Tang consists of Hou Po (Cortex Magnoliae Officinalis), Da Huang(Radix et Rhizoma Rhei), Mang Xiao (Mirabilitum) andZhi Shi (Fructus Citri seu Ponciri Immaturus). Hou Pois the emperor herb and is used in the largest amount tomove qi stagnation via its pungent taste, and descendyangming via its bitter taste, without congealing thepathways due to its warm nature. Hou Po eliminatesthe intense bloating and pain due to the congestion.Da Huang purges fire from the Large Intestine, moves qiand blood and pushes out the old to make room for thearrival of the new. Mang Xiao is a salty, cold herb that canpurge stagnant heat and soften hardness. It has a softerheat purging effect than Da Huang and is moistening.Zhi Shi assists Hou Po in eliminating the fullness of theStomach and the costal regions. It breaks up stagnant qiand reduces accumulation by descending Gall Bladderqi to induce the natural downward flow of Stomach andLarge Intestine qi, thus resulting in the expulsion of stasisand stool from the body. Xiao Cheng Qi Tang (Minor Order the Qi Decoction) contains the same herbs as Da Cheng Qi Tang, minus the Mang Xiao. This suggests that its moistening and softening properties are not needed. Da Huang is able to expel the stool without the additional assistance of Mang Xiao, andthe purging effects of the formula are more moderate. The use of Da Cheng Qi Tang versus Xiao Cheng Qi Tang should be based on the amount of abdominal discomfort the patient is experiencing. When the fullness is more moderate, Xiao Cheng Qi Tang prevails. Considering the common core pathology, it is appropriateto apply the same needle protocol for both Xiao Cheng Qi Tang and Da Cheng Qi Tang. While the strength of the treatments should be modified to distinguish between the formulas,the same actions are required, and the same points are beneficial. Suggested points are: Shangjuxu ST-37, ZhigouSJ-6, Tianshu ST-25, Zhaohai KID-6 and Hegu L.I.-4.Shangjuxu ST-37 is the Large Intestine lower he-sea pointand has a strong descending action on the Large Intestineand Stomach qi. When heat and stagnation are effectivelycleared, fullness, distention and pain are reduced. Whenreduced, Shangjuxu ST-37 can purge the Stomach and LargeIntestine qi to eliminate obstruction, and thus is similar tothe use of Da Huang in the Cheng Qi Tang formula family. Zhigou SJ-6 is the jing-river and fire point of the Sanjiaochannel, and as such has the ability to clear heat in allthree jiao. Zhigou SJ-6 regulates qi and moves the qi of theintestines, which means that it also moves stuckness of thestool. The use of Zhigou SJ-6 in this prescription simulatesthe use of Zhi Shi in that it moves and descends Gall Bladderqi to course Stomach and Large Intestine qi downwards,thus utilising the controlling cycle of wood over earth.Tianshu ST-25 is the Large Intestine front-mu point.Since Tianshu ST-25 and Shangjuxu ST-37 are both LargeIntestine points on the Stomach channel, both fu andchannels are strongly regulated and cleared of repletionwhen these points are needled with a reducing technique.The moving aspect of Tianshu ST-25 and its ability torelieve fullness is a simulation of the heavy use of HouPo in Da Cheng Qi Tang. Zhaohai KID-6 tonifies Kidney yin, abates heat andmoistens dryness. It clears scorching heat from the intestines,regenerates fluids, and regulates the lower jiao.Hegu L.I.-4 has the ability to move qi and soften massesand hardness. Together with Zhaohai KID-6 it can beused to simulate the two main functions of Mang Xiao.When combined with the more purging point ShangjuxuST-37, they especially simulate the Mang Xiao/Da Huang combination.Tiao Wei Cheng Qi Tang (Regulate the Stomach and Orderthe Qi Decoction) is used when dryness in the Stomach is the key manifestation of the fu pathology. It Comprises DaHuang, Mang Xiao and Zhi Gan Cao. This time it is Hou Poand Zhi Shi that are absent from the formula, which indicatesthat the emphasis of the treatment is not on moving qi andclearing fullness. Instead, the main focus is to moisten theStomach, not by adding moisture but by eliminating dryness,for the absence of dryness is the precursor of the revivaland presence of moisture. The moistening action providedby Mang Xiao and the tonifying effects of Zhi Gan Caoallow the qi of the Spleen and the yin of the Stomach to benourished. An acupuncture equivalent for Tiao Wei Cheng Qi Tang would be a modification of the prescriptions given above. Because Zhi Shi and Hou Po are removed in Tiao Wei Cheng Qi Tang, Zhigou SJ-6 and Tianshu ST-25 would not be included in the needle prescription. Zhongwan REN-12 can be added, however, needled with a tonifying technique, to protect and strengthen the middle jiao and Stomach. Zhongwan REN-12 is the Stomach front-mu point and is the junction point of the Lung, Pericardium, Liver,Small Intestine, Sanjiao and Stomach channels. As such, it is designated as the hui-meeting point of all the fu. It is able to treat any Stomach disorder while strengthening digestion and building qi and blood. Because it focuses so strongly on the middle jiao, the actions of Zhongwan REN-12 can here be compared to those of Zhi Gan Cao to harmonise the middle. And as a point on the Conception vessel it has the ability to access and promote yin fluids.Shangjuxu ST-37 is still used to duplicate the actions ofDa Huang, while Zhaohai KID-6 and Hegu L.I.-4 are kept to move, moisten and soften. 3. Shaoyang The shaoyang channel is the lesser yang channel of the ministerial fire. Its pathologies are marked by stagnation of the ministerial fire, which is physiologically propelledby the jueyin Liver wind contained within it. This ‘stuck fire’ causes the typical symptoms of a bitter taste, dry orsore throat and blurry vision, along with a possible seriesof discomforts at pivotal hinge areas of the body, such as the eyes, ears, throat, ribs etc. Shaoyang pathologies are said to be located ‘half on the exterior and half in the interior’. The famous Xiao Chai Hu Tang (Minor Bupleurum Decoction) is the formula of choice for shaoyang patterns.Its actions harmonise the shaoyang layer by simultaneously eliminating excess and strengthening deficiency, while coursing wind and mildly opening the surface. It strengthens the middle jiao to protect the taiyin Spleen and,therefore, the entrance of pathogens to the yin layers of thebody. Xiao Chai Hu Tang clears pathogens without putting either the exterior or the interior of the body in jeopardy.It comprises Chai Hu (Radix Bupleuri), Huang Qin (RadixScutellariae Baicalensis), Ban Xia (Rhizoma PinelliaeTernatae), Sheng Jiang (Rhizoma Zingiberis OfficinalisRecens), Ren Shen (Radix Ginseng), Da Zao (FructusZizyphi Jujubae) and Zhi Gan Cao (Radix GlycyrrhizaePraeparatae). Chai Hu courses congestion and clears thepathogen from shaoyang by relieving the surface. HuangQin clears the flare-up of the ministerial fire. Chai Huworks on the external channel portion of shaoyang whileHuang Qin drains evil in the shaoyang Gall Bladder.Ban Xia and Sheng Jiang harmonise the middle by downbearing Stomach qi counterflow as well as dryingand warming Spleen dampness. These actions address the prevalent nausea and dislike of food intake caused by the external evils threatening taiyin. Ren Shen, Da Zao andZhi Gan Cao protect the taiyin by strengthening Spleen substances, thus preventing collapse of evils into the inconformations. The acupuncture simulation of Xiao Chai Hu Tang should posses the same harmonising effects achieved through thedispersion of pathogens, the clearing of stagnant fire, andthe protection of the threatened Spleen. Suggested points are:Waiguan SJ-5, Zulinqi GB-41, Qimen LIV-14, YinlingquanSP-9 and Zusanli ST-36. Waiguan SJ-5 is the premier harmonising point forshaoyang. It is the luo-connecting point of the shaoyangSanjiao channel and connects with both the interior jueyinPericardium, freeing interior pathogens, and the YangLinking vessel, thus freeing the exterior and treating pathologies of a pivotal and alternating nature. WaiguanSJ-5 outwardly resolves the exterior and disperses wind,while it inwardly courses the stagnation of interior heat.This makes its actions comparable to those of Chai Hu.Zulinqi GB-41 is the shu-stream wood point of the GallBladder channel. It functions like Huang Qin in the clearingof stagnant ministerial fire and the transforming of dampheat that originated from the stagnation in the Sanjiao branchof the shaoyang system. Zulinqi GB-41 is also the exit point from the Gall Bladder channel to the Liver channel and as such affects the qi of both channels. It functions as the last line of defence against transmission of pathogens from the Gall Bladder to the Liver. By coursing the Liver and GallBladder qi, their ascending and descending functions are reinstated in the body. The combination of Waiguan SJ–5 with Zulinqi GB-41 frees the exterior and interior of the whole shaoyang system and further addresses the Girdling vessel [Dai Mai], a hinge area prone to qi stagnation heat and Sanjiao hot dampness.Qimen LIV-14 is the front-mu point of the Liver and thejunction point for the Liver and the Spleen. It is the point of choice for relieving wood overacting on earth as mentioned in line 108 of the original text: “ … this means the Liver is exploiting the Spleen and it is called restraint. One should needle Qimen.” Further it is quoted in the original lines143 and 216 as the foremost point for shaoyang disorders manifesting, for example, as heat entering the blood chamber.Needling Qimen LIV-14, the middle jiao is protected, wood qi is heavily coursed, and chest or rib-side fullness is cleared. As the Liver Front-mu point, Qimen LIV-14 is useful for any Liver or Gall Bladder disease, but it is especiallyappropriate for shaoyang disease due to qi stagnation, with symptoms manifesting on the sides and intercostal areasof the body. Qimen LIV-14 is also the junction point withthe Yin Linking (Yinwei) vessel from which the Yin Linking vessel penetrates the diaphragm and crosses the breast area.Stagnation of this channel is often prevalent in shaoyang pathologies and leads to symptoms of chest fullness, rib pain and Heart vexation.Yinlingquan SP-9 is well known for its abilities to clear dampness and fortify the Spleen. It is the he-sea water pointon an earth channel and as such is important for removing excess fluids from the body. Dampness is the primary pathology of the Spleen and debilitates its ability to ward off pathogens from entering the taiyin layer. YinlingquanSP-9 here acts like Ban Xia and Sheng Jiang by transforming dampness through both warming and strengthening the Spleen.Zusanli ST-36 is combined to further strengthen and protect the middle jiao. Its effects are those of strong tonification,comparable to the combination of Ren Shen, Da Zao and Zhi Gan Cao in the formula. The focus here is not as much on drying and warming, as is the case with Ban Xia and Sheng Jiang, but on strengthening and protecting. ZusanliST-36 is one of the points of the sea of water and grain andthe earth point on an earth channel. In combination with Yinlingquan SP-9, it strengthens Spleen and Stomach qi and builds earth to govern fluids and dry dampness. Because Xiao Chai Hu Tang dedicates five out of seven herbs to protecting taiyin, it is clearly a primary goal of the formula and an integral part of the concept of harmonisation of shaoyang;therefore, it should be the primary focus in the acupuncture treatment as well. 4. Taiyin The taiyin channel is the great yin channel of the damp earth of the centre. When evils enter the taiyin realm, thepathology will always manifest as ‘yin’, for the taiyin is a yinchannel and dampness is a yin quality. The pathology will always transform from the inherent dampness and causethe typical signs of loss of appetite, bloating and fullness,nausea and possible loose stool or diarrhoea. According theShanghan Lun, Li Zhong Wan (Regulate the Middle Decoction) is the treatment of choice for taiyin syndrome. Its actions are to dry dampness, construct the centre and tonify the qi of the middle jiao. By these actions, the dampness is cleared through drying and transforming, and the Spleen weakness is resolved through warming tonification. The ingredients of Li Zhong Wan are: Gan Jiang (Rhizoma Zingiberis Officinalis), Ren Shen (Radix Ginseng), Bai Zhu(Rhizoma Atractylodis Macrocephalae) and Zhi Gan Cao(Radix Glycyrrhizae Praeparatae). Gan Jiang is the taiyinherb of choice and enters the centre directly to warm anddry the muddy earth. It is not dispersing like Sheng Jiang,but very stable in its action. It is both warming and dryingand benefits the yang of the Spleen. It creates the yangmingdryness environment that is physiologically contained within taiyin but is now pathologically impaired. RenShen tonifies taiyin qi and replenishes deficiency. Bai Zhu strengthens the effects of both Gan Jiang and Ren Shen.It is bitter warm and thus assists Gan Jiang in drying theSpleen. It is also sweet, which boosts taiyin Spleen qi andthus supports and enhances the actions of Ren Shen. ZhiGan Cao is a middle jiao tonic in its own right and alsohas the ability to harmonise the centre. The overall results are to warm the Spleen, dry and transform dampness and strengthen qi. The acupuncture point protocol appropriate for taiyin disease should also assume this straightforward approach:Yinlingquan SP-9, Zhongwan REN-12, Tianshu ST-25,Zusanli ST-36, Pishu BL-20, Weishu BL-21.Yinlingquan SP-9 is a taiyin-pattern point of choice because of its simultaneous ability to treat dampness and tonify the Spleen. A point of the taiyin channel, it possesses the dampness transforming effects of Bai Zhu, the dampness drying effects of Gan Jiang and the qi tonifying effects of Ren Shen, and can transform dampness and leach water from the Spleen. When the point is tonified, the Spleen qiis strengthened, yang is boosted and the proper functionsof the middle jiao are reinstated.Zhongwan REN-12 is the Stomach front-mu point andthe hui-meeting point for all the fu. It is a major pointfor all digestive dysfunctions and has strong middle jiao building and regulating abilities. Its strengthening actions are comparable to Ren Shen, while its harmonising actions are similar to Gan Jiang. Although suitable for both excess and deficiency conditions, Zhongwan REN-12 shouldbe reinforced in taiyin conditions. It regulates both the upward and downward flow in the middle jiao, resolving the principal pathology of inversion of turbid yin and clearyang, manifested as vomiting and diarrhoea.Tianshu ST-25 is the front-mu point of the Large Intestine.Implied by the name ‘tianshu’ or ‘celestial pivot’, it fulfills ahinge function that reinstates the ascending and descendingfunction of the middle jiao. Especially combined withREN-12, it assists in regulating the pivotal functions of theSpleen and Stomach. Zusanli ST-36 in this prescription acts as a combinationof Gan Jiang and Bai Zhu, as well as a combination ofRen Shen and Bai Zhu. When needled with a tonifyingtechnique, it is the main point on the body for strengthening and harmonising the middle jiao. When Zusanli ST-36 is combined with Zhongwan REN-12, the ability to strengthen deficient conditions of the middle jiao is enhanced considerably, and the Stomach is strengthened through allowing fluent descent of turbid yin. When combined with Tianshu ST-25, the middle realm is strengthened to anchor Spleen qi and prevent the collapse of clear yanginto the intestines.Yin confirmation disorders indicate deficiencies of thebody’s warming functions and energetic resources stored in the zang. Although the Shanghan Lun advises against the use of moxa in warm diseases (lines 114, 115 and 116),it encourages moxa to warm cold patterns with diarrhoea and vomiting (line 325). Pishu BL-20, as the back-shu pointof the Spleen, directly accesses the Spleen zang. Though needling this point has an overall tonifying effect, to truly warm the Spleen it should be treated with direct moxa.The effects of this are exactly those of Gan Jiang - both warming and appropriately drying the Spleen. The yangis restored, and the qi is returned. When warmed, theSpleen is better able to handle the water it is supposed to control. To further encourage the Gan Jiang effects of the point prescription, it is also appropriate to apply direct moxa to Weishu BL-21 to restore Stomach dryness and revive Stomach functions. 5. Shaoyin The shaoyin channel is the lesser yin channel of the imperial fire of the South. It embodies the true fire in the body and contains the cold water of the north for physiological balance. The main symptoms for a typical shaoyin cold transformation pattern are somnolence, syncope and reversalflow cold extremities. The Shanghan Lun utilises Si Ni Tang(Frigid Extremities Decoction) as its primary formula for shaoyin cold. The ingredients are Fu Zi, Gan Jiang and ZhiGan Cao, of which Fu Zi and Gan Jiang are both pungent, hot herbs and therefore are extremely warming and dispersing.Although focused on the Heart and Kidney, Fu Zi is a very volatile and moving herb; it has the capacity to warm all three jiao and is the premier herb to return yang. Gan Jiang warms yang, but is focused more on the middle jiao. It strongly reinforces Fu Zi and amplifies its heating actions because Fu Zi is volatile and Gan Jiang is anchoring. GanJiang goes directly to the centre and stays put, hence it builds the centre and allows the functioning of the middle jiao to be reinforced. This returns the production of postnatal qi to the body. The sweet and pungent combination of Fu Zi and Zhi Gan Cao strongly supplements Heart yang,warming the depleted imperial fire so as to return essential heat to the body. The point protocol to simulate Si Ni Tang is: ShenmenHE-7, Taixi KID-3, Guanyuan REN-4, Xinshu BL-15, ShenshuBL-23 and Mingmen DU-4.Shenmen HE-7 is the yuan-source point of the Heartchannel with the ability to strongly tonify all deficienciesof the Heart. The imperial fire is stoked, and the yang ofthe Heart is tonified.Taixi KID-3 is the yuan-source point of the Kidney channel and tonifies all Kidney deficiencies. Here it is used to warmthe Kidneys, whose water has become excessively cold due tothe lack of Heart fire. Cold of shaoyin Kidney and Heart leads to somnolence and the demise of shen, which in severe cases lead to the occurrence of syncope. The classical instructions of the Neijing advise the needling of Taixi KID-3 behind the ankles to rescue syncope. 1 The simultaneous use of both the yuan-source points of the Heart and Kidney greatly revives the essential shen of the shaoyin confirmation. Guanyuan REN-4 strengthens the body’s primordial [yuan] qi. If the purpose of Si Ni Tang is to warm pre- and post-natal qi, Guanyuan REN-4 itself embodies these actionsby warming and circulating the original qi, and as a result all other qi is fostered. Guanyuan REN-4 simulates the combined actions of Fu Zi, Gan Jiang and Zhi Gan Cao.Despite this already complete action, it is wise to further supplement the body and speed the return of the warmth of life, hence the combination with Shenmen HE-7 and TaixiKID-3 to re-establish Heart and Kidney communication.The necessity for further warming is attained by direct moxa treatments to Xinshu BL-15, Shenshu BL-23 andMingmen DU-4. Moxa treatments are especially indicated in shaoyin patterns and the original text mentions moxa most elaborately in the shaoyin chapter (lines 292, 304, 325etc.). Direct moxa to Xinshu BL-15 and Shenshu BL-23 brings heat and tonification immediately to the pathologically cold Heart and Kidneys. Both are warmed and nourished, andyang is returned. Direct moxa to Mingmen DU-4 has the critical action of restoring pre-natal qi derived from yang. The Governing vessel supervises and gathers the yang ofthe whole body, while the name ‘mingmen’ means ‘gate of life’. Treating Mingmen DU-4 revives life by restoring yang.Due to its location between the Kidney back-shu points, the jing-essence can be activated with this point, for the true prenatal fire is stored by the ‘gate of life’. The actions of this combination of points will warm the body like Fu Zi,but also have the anchoring effect of Gan Jiang. The yangis strongly augmented, both the pre and post-natal qi arewarmed, and the intense cold is dispersed, thus givingrise to a renewed Heart and Kidney communication andrestoration of life itself. 6. Jueyin The jueyin chapter in the Shanghan Lun predominantly discusses parasitic ailments and fainting disorders, but the basic nature of the jueyin channel is best described by the famous Qing dynasty physician Wu Qian in his Golden Mirror of the Medical Doctrine [yizhong jinjian]: “Jueyin governs the Liver and is the mansion of blood.” This essential observation is further clarified by hisQing dynasty contemporary Huang Yuanyu in Dangling Explanations of Cold Damage [shanghan xuanjie]: “The Liver steers the nutritive blood, flowing through the channels and collaterals and infusing the joints; when the warm qiof jueyin wanes, then nutritive blood becomes cold and unsmooth, failing to warm the joints and fill the channels and collaterals, thus causing reversal cold in hands and feet with a thin pulse on the verge of expiry.” Alongside the parasite-formula Wu Mei Wan (Mume Pill), Dang Gui Si Ni Tang (Tangkuei Decoction for Frigid Extremities) is truly the primary formula for use in Liver jueyin circulatory disease. In jueyin disease, the wind and cold influences have passed through the many layers and penetrated to the jueyin realm, chilling and constricting the channels and cooling the Liver. The result is cold and blood deficiency of the Liver with impaired flow that requires building,warming and circulating. Dang Gui Si Ni Tang contains Dang Gui (Radix Angelicae Sinensis), Gui Zhi (RamulusCinnamomi Cassiae), Bai Shao (Radix Paeoniae Lactiflorae),Xi Xin (Herba Asari cum Radice), Tong Cao (Medulla Tetrapanacis Papyriferi), Da Zao (Fructus Zizyphi Jujubae)and Zhi Gan Cao (Radix Glycyrrhizae Praeparatae). DangGui’s sweet and pungent nature warms and nourishes theLiver and moves the blood. It is one of the primary bloodbuilding herbs and has direct affinity with the Liver. GuiZhi warms the vessels, and thus has affinity for the Heart.It circulates blood through the vessels and allows it to reach the extremities. It also disperses the cold remaining fromthe original taiyang layer penetration. Bai Shao astringes fluids and courses the Liver while pacifying the blood layer so that its movement will not become chaotic. It is used in the same dosage as Gui Zhi so that the pungent, sour and sweet flavors can interact to harmonise both yin and yang opposites. Xi Xin enters the taiyang and shaoyin to warm the body inside and out while arresting cold-induced pain. Tong Cao frees and opens channels and collaterals to promote smooth flow of Liver qi, blood, yin and yang,and it mildly drains rebellious ministerial fire contained within jueyin that has been stirred by the stagnation. As its name indicates, ‘Tong Cao’ is ‘the herb that frees and deobstructs’. Da Zao and Zhi Gan Cao tonify the middlejiao to assist in the production of qi and blood.It is important that the suggested point prescription forthis manifestation of jueyin disease focuses on warming, building the blood and coursing the Liver stasis. A possible point protocol to simulate the jueyin blood treatment is:Gongsun SP-4, Neiguan P-6, Taichong LIV-3, GuangmingGB-37, Geshu BL-17 and Ganshu BL-18. Gongsun SP-4 and Neiguan P-6 are used in this protocolfor their ability to stimulate the Penetrating (Chong) andYin Linking vessels. They build the blood which is storedby the Penetrating vessel as an extension of both the Heartand Liver. These two points connect above and below by coursing the blood through the vessels and eliminating stagnation of qi within the blood.Taichong LIV-3 is the yuan-source point of the Liver channel. When needled with a reinforcing technique,this point strongly tonifies the Liver and thus has a direct effect on the blood. It regulates the Liver qi and promotes smooth flow.Guangming GB-37 is the luo-connecting point of the GallBladder channel, and when it is needled in combination with Taichong LIV-3 it stimulates the guest/host relationship in the wood element channels. GuangmingGB-37 has yin and blood tonifying properties that make these two points an important combination in building the blood as well as coursing and strengthening Liver qi.Further, Guangming GB-37 addresses the smooth flowof wood qi contained within wood blood and pacifiesthe flare-up of congested shaoyang ministerial fire that is contained within jueyin.Geshu BL-17 is the hui-meeting point for the blood.Needling this point with a reinforcing technique directlyaccesses the blood and efficiently assists in its production and circulation. Moxa is indicated in the treatment of jueyin disease, as mentioned by the original author in lines 343,349 and 362. Here we can apply moxa over Geshu BL-17 towarm the blood in the body and promote free circulation by expelling constricting cold.Moxa over Ganshu BL-18 will complete one of the strongest warming, moving and building treatments the Liver can receive. The Liver is directly addressed via its back-shu point,the cold is quickly dispelled and Liver blood is built. Conclusion As the original clinical guide, the Shanghan Lun offers insight into diagnosis and herbal treatment from the very roots of classical medicine. The differentiation system employed lends itself directly to the identification of the indicated channel. The structure of the herbal formulas addresses the pathologies with precision, foresight and a deep understanding of nature and the human body. Through understanding the rationale behind the herbal formulas,one can design equally concise and widely applicable acupuncture point prescriptions. These prescriptions can elegantly accompany the prescribed formula in the treatmentof the impaired confirmation. In this way, the diagnosis, the treatment plan, the herbal formula and the acupuncture protocol can all work in conjunction to consistently and effectively clear the pathology, thus fulfilling the goal of any classical Chinese medicine clinician. Acknowledgements The authors would like to express a heartfelt ‘thank you’to Drs. Jim Cleaver, L.Ac. and Jessica Atkins, L.Ac. fortheir relentless editorial support in the preparation of this manuscript. Sources Shan, Yutang. Selected Annotated Point Combinations for Shanghan Lun Acupuncture and Moxibustion. Beijing, P.R. China: People’s Medical Publishing House, 1984.Yu, Bohai, et al. Collection of Famous Works on Cold Damage, the Golden Cabinet, and Warm Diseases [shanghan jingui wenbing mingzhu jicheng]. Beijing, P.R. China: HuaxiaPublishing House, 1997.Wu Qian, Golden Mirror of the Medical Doctrine [yizhong jinjian]. Beijing, P.R. China: People’s Medical PublishingHouse, 1963.Meng Jingchun, et al. Translation and Explanation of the Elementary Questions Classic of the Inner Classic of the Yellow Emperor [huangdi neijing suwen yishe], Shanghai, P.R. China: Shanghai Science & Technology Publishing House,1959/06.Deadman, Peter; Al-Khafaji, Mazin; Baker, Kevin. A Manual of Acupuncture. East Sussex, England: Journal of Chinese Medicine Publications, 1999.Mitchel, Wiseman, Feng. Shanghan Lun: On Cold Damage.Brookline, MA, USA: Paradigm Publications, 1999. Stephanie Bekooy, MSOM, B.Sc., L.AC. is a recent graduate from the Master of Science in Oriental Medicine programme at the School of Classical Chinese Medicine of the National College of Naturopathic Medicine. Ms. Bekooy conducted her graduation research on classical acupuncture and the Shanghan Lun and under the supervision of Dr. Versluys produced a thesis on the topic. Stephanie is currentlyin private practice in Portland, OR, USA, and can be reached at svbekooy@yahoo.com Arnaud Versluys, ABD/Ph.D., M.Sc., B.Sc., L.Ac. is one of the few Western scholars to have received his full medical training in China. He spentover 10 years at the Chinese medical universities of Wuhan, Beijingand Chengdu, where he consecutively pursued his Bachelor, Masterand Doctorate degrees in general Chinese medicine and acupuncture.He is currently assistant-professor at the School of Classical Chinese Medicine of the National College of Naturopathic Medicine in Portland,OR, USA. Arnaud can be reached at ersluys@ncnm.eduEndnotes1Versluys Arnaud (02/2004 ). Discourse on the Classical Needling Techniques in the chapter ‘Official Needling’ ofthe Spiritual Axis Canon. The Journal of Chinese Medicine. Number 74. 24-31. |
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Posted on Tuesday, October 23, 2012 5:03 PM
WEI SYNDROME by Dr. Su Xin Ming The following lecture was given by Dr. Su Xin Ming during the recent Further StudiesCourse in Nanjing. Whilst the quality of the lecture and the interpretation was excellent, itwas not possible to check the text of this lecture with Dr. Su and this should be borne inmind when reading it. Wei syndrome in TCM includes weakness of the limbs, impairment of movement of thelimbs, and subsequently (late stage) muscular atrophy. It is most often seen clinically affecting the lower extremities. The Nei Jing ("Canon of Medicine") refers to "Wei Pi"."Wei" means withered, as in plants when they fail to receive a sufficient supply of waterand nutrients. Atrophy can be seen when muscles, tendons and bones are deprived ofnourishment. "Pi" means "failure of the foot to touch the ground". All similar clinical manifestations are summarised as Wei syndrome. This category therefore includes poliomyelitis and infantile paralysis, serious multiple neuritis, myelitis, progressive myoatrophy, myasthenia gravis, hysteric paralysis (often seen in the acupuncture clinic),periodic paralysis due to muscle weakness and sequelae due to inflammation of the CNS.Acupuncture therapy may only be used to alleviate the symptoms of the above unless due to functional rather than organic disturbances. AETIOLOGY 1) Pernicious warmth and heat injuring the lung and stomach. This is due to exogenous pathogenic factors which injure LU directly and ST indirectly, by invading the LU via the mouth and nose and resulting in continuous high fever. Longstanding retention of heat consumes LU-Yin resulting in low-grade fever. LU-Heat will further exert a harmful influence on ST resulting in general consumption of yin fluid.Deficiency of yin fails to supply muscles, tendons and bones leading to atrophy. 2) Invasion of exogenous damp - injuring muscles and tendons.This may be due to a number of causes: a) fog or mist, eg going to work early, beforesunrise in foggy misty conditions, or working on water or in high mountains b) coveringthe body with wet clothes after profuse sweating c) working or living in a wet place d)living for a long time in a lowland area. 3) Irregular food intake.Irregular food intake means eating at irregular times. This causes weakness of ST and SP resulting in failure of ST to produce nutrients to nourish muscles etc. This category also includes overindulgence in greasy, pungent food and alcohol which give rise to dampheat in ST and SP. 4) Sexual excess:Sexual excess (including frequent nocturnal emission) results in loss of KID-Jing and weakness of KID and LIV. The KID stores Jing (the material base maintaining normal physiological activity of the zang-fu) and controls bones, whilst the LIV stores blood and controls tendons. As a result of KID and LIV Xu, the tendons and bones are deprived of nourishment, resulting in atrophy.Wei syndrome is broadly classified as of Shi and Xu types, and it is important to differentiate between them. DIFFERENTIATION OF SYNDROMES AND TREATMENT 1) Injury of yin fluid due to heat in the LU: Clinical manifestations:Fever softness and weakness of the 4 extremities will follow subsidence of fever; drynessof skin accompanied by restlessness and thirst; cough; dryness of throat; urine yellow and concentrated; dry stool. Tongue: body red, fur yellow.Pulse: thready and rapid. Pathology:Invasion of LU and ST by pathogenic heat consumes yin fluid which fails to nourish muscles. LU fails in supplying fluid to moisten skin (LU dominate skin) therefore dry skin. Yin Xu leads to hyperactivity of fire - in this case the HE is affected therefore restlessness. Retention of pathogenic heat in the LU interferes with dispersing function therefore cough. Sore throat is due to heat in the LU channel which passes through the throat. Treatment principle:Clear heat and moisten LU.Prescription:Dazhui (Du-14) Feishu (BL-13) Chize (LU-5) Liangqiu (ST-34) Zusan]i (ST-36) Sanyinjiao(SP-6) Taixi (K1D-3) Lidui (ST-45). Explanation of prescription:Du-14 meeting of all yang channels with Du channel which governs yang channels .Du-14 is known as yang within yang. Dispersing Du-14 will eliminate heat.BL-13 to clear heat in LU. LU-5 to reduce and cool LU.ST-34 Xi-Cleft point, used for acute disorders; here used both to eliminate heat in ST andas a local point for the limbs. ST-36 used according to the principle of "selecting points from Yangming channels totreat Wei syndrome". To strengthen ST to produce yin fluid to nourish tendons andmuscles.SP-6 to tonify yin.KID-3 to promote water, to tonify yin of KID.ST-45 to eliminate heat in Yangming channels.The above prescription can be used to treat infantile paralysis or myelitis.* 2) Invasion of pathogenic damp-heat: Clinical manifestations:Weakness and relaxation of the lower extremities; fever may be observed but not high; insome cases slight swelling and numbness of the lower extremities; stuffiness in chest and epigastric region; yellow urine. Tongue: yellow sticky fur Pulse: rapid Pathology:Weakness and relaxation of the lower extremities is caused by invasion of the jingluo ofthe lower extremities by pathogenic damp-heat. Invasion by damp-heat leads to slightswelling and numbness. Retention of damp-heat internally leads to stuffiness in chest and epigastric region. Treatment principle:Eliminate damp and heat. Prescription:Dazhui (Du-14), Quchi (L.I.-11), Hegu (L.I.-4), Femur-Futu (ST-32), Fengshi (GB-31),Zusanli (ST-36), Yinlingquan (SP-9) .Explanation of prescription:Du-14, L.I.-11, L.I.-4: this is a routine prescription used to eliminate heat and is here usedto eliminate damp-heat (^). These three points must be punctured two or even three times a day. Retain needles for over 30 minutes and manipulate every 5 to 10 minutes. ST-32,GB-31: used for weakness of lower extremities; can also be used for infantile paralysis orsequelae of wind-stroke (use even manipulation) .ST-36 to strengthen SP and ST to eliminate damp (T). SP-9 to strengthen SP and eliminatedamp (^). 3) Weakness of ST and SP: Clinical manifestations:Little food intake; loose dilute stool; sallow and withered complexion.Tongue: flabby and tooth-printed with thin white fur. Pulse: thready, weak and forceless. Pathology:Xu of ST and SP results in poor appetite. Loose stool is due to Xu of SP - SP fails totransform- fluid which descends to the large intestine. Stool may contain semi-digested orundigested food. Weakness of SP and ST and subsequent failure to produce sufficient qiand blood gives rise to facial pallor. Treatment principle:Tonify SP and strengthen ST; strengthen muscles and bones. Prescription:Pishu (BL-20), Weishu (BL-21), Zhangmen (LIV-13), Zhongwan (REN-12),Zusanli (ST-36), Taibai (SP-3), Biguan (ST-31), Yaoyangguan (Du-3). Explanation of prescription:BL-20, BL-21, LIV-13, REN-12: combine Front-Mu and Back-Shu points of ST and SP in two groups and use in alternate treatments (T).ST-36 general tonic point; to aid the effect of the above four points (T).SP-3 Yuan-Source point of the SP channel (T) . To strengthen function of the SP intransportation and transformation; frequently selected for loose stools containingundigested food.All the above points may be treated with needling combined with moxibustion. In syndromes 1) and 2) moxibustion is contra-indicated.ST-31 to help the movement of the thigh by tonifying tendon and bone. With Femur-Juliao(GB-29) and Huantiao (GB30) it is often used to promote the function of the lower extremities and aid movement of the hip joint in infantile paralysis and wind-stroke. Du-3 the only point of the Du channel used for the lower extremities. Often used for weakness and atrophy of legs with the above points. 4) Xu of LIV and KID: Clinical manifestations:Gradual onset, also appearing at late stage of other Wei syndromes; atrophy of muscles especially of lower extremities; soreness of the lumbar region; tinnitus; vertigo; blurring of the vision; nocturnal emission; incontinence of urine and enuresis. Tongue: red body, little fur.Pulse: deep and thready. Treatment principle:Tonify LIV and KID. Prescription:Ganshu (BL-18), Shenshu (BL-23), Mingmen (Du-4), Yanglingquan (GB-34)Taixi (KID-3) Guanyuan (REN-4), Add Tinghui (GB-2) in case of tinnitus. Add Fengchi(GB-20) and Zanzhu (BL-2) in case of dizziness and vertigo.Explanation of prescription:BL-18, BL-23 to strengthen LIV and KID (T).Du-4 treat with needle only if KID-Yin-Xu symptoms are present (T); use moxibustion ifKID-Yang-Xu. GB-34 controls tendons (T).KID-3 to strengthen KID. (T)REN-4 a point where original yin and original yang gather (ie KID-Yin and KID-Yang).Used to treat either KID-Yin-Xu or KID-Yang-Xu (T). The first two syndromes are seen in the early stage of Wei syndrome. In the later stage thelatter two syndromes are usually seen. In addition to acupuncture treatment, functionalexercises are generally recommended as wel I as physiotherapy ..nd massage. The earlierthe condition can be treated, the better are the results that can be expected.Editor's note:It must be stressed that to obtain successful results in the treatment of Wei syndrome,prolonged treatment may be necessary. In China treatment is given daily or every otherday, in courses of ten treatments, and in some cases many courses are required. As the"Essentials" says, "as wei syndrome requires a long period of treatment, it is necessary towin the patient's co-operation and confidence". INFANTILE PARALYSIS - POLIOMYELITIS This is also classified as Wei syndrome. It is frequent]y seen in children aged 3 to 5 yearsbut can occur in adults. Usually occurs in late summer/early autumn. At the onsetcontinuous high fever is seen accompanied by discomfort, and frequently with gastrointestinal symptoms and cough. 1 to 6 days after subsidence of fever, paralysis can beobserved. This most]y involves the dower extremities, but it may involve the upperextremities or even the throat, with difficulty in swallowing. In a very few patients theremay be coma, convulsions and even sudden death.In the ear]y stage there may be pain, especially pain on pressure, a]] over the body.Children are restless if covered with heavy bed clothes, dislike being touched, and may complain of stiffness of the nape or soreness of the back and loins, with inability to turnover in bed. There may be spasm of the leg and in some cases vibration of the 4 extremities.Ear]y paralysis can affect any part of the body, with the lower extremities being the most common; in some cases one and in some cases both limbs. It is rare to see the upper limbs affected or the upper and lower limbs of both sides. Occasionally the face may be paralysed. If there is paralysis of the abdominal muscles there will be ballooning of the abdomen when children cry. If the bladder is affected there will be incontinence or retention of urine. There is no pain in the later stage when paralysis is evident. Eventually there occurs atrophy of the muscles and serious deformity. Aetiology:Invasion of toxic pathogenic heat injures the jingluo causing obstruction of jingluo andstagnation of qi and blood. Tendons, muscles and jingluo are finally deprived ofnourishment.Treatment:In the early stage treat to disperse exogenous pathogenic factors, using for example:Dazhui (Du-14) Waiguan (SJ-5) Hegu (L.1.-4). In case of high fever add Quchi (L.I.-11).In case of vomiting and diarrhoea add Neiguan (P-6) Tianshu (ST-25) Zusan]i (ST-36).In case of convulsion and coma treat these as priority eg convulsions: Yintang, Taiyang,Sifeng, Shixuan(all Extra points). coma: Renzhong (Du-26), Shixuan, Hegu (L.I.-4), Taichong (LIV-3). Treat respiratory symptoms such as cough or dyspnoea according to clinical manifestations. Treatment of paralysis:Principle:In the early stage remove obstruction of jingluo by activating circulation of qi and blood.In the late stage tonify LIV and KID and warm up jingluo.Paralysis of upper limbs:Dazhui (Du-14) Jianyu (L.I.-15), Jianzhen (S.I.-9), Tianzong (S.l.-11), Waiguan (SJ-5), Hegu(L.I.-4) and HuatuoJiaji points of the 5th to 7th cervical vertebrae.Paralysis of lower limbs:Yaoyangguan (Du-3), Huantiao (GB-30), Femer-Juliao (GB-29), Biguan (ST-31), Fengshi(GB-31), Yanglingquan (GB-34), Zusanli (ST-36), Xuanzhong (GB-39), Jiexi (ST-41), Kunlun(BL-60), Qiuxu (GB-40), HuatuoJiaji points of 1st to 5th lumbar vertebrae.Divide prescription into two groups and use alternately.In case of facial paralysis use routine points.Paralysis of nape:Tianzhu (BL-10), Shenshu (Du-12), Tianrong(S.I.-17) Paralysis of abdominal muscles:Zhongwan (REN-12) Tianshu (ST-25) Qihai (REN-6) Daheng ( SP-15); treat once daily with no retention of needles.The earlier treatment for infantile paralysis is given the better the therapeutic results. Poor results are obtained after 2 to 3 months. In treating later than this use points such as Ganshu (BL-18), Shenshu (BL-23), Taixi (KID-3). MYASTHENIA GRAVIS There are three kinds of patients:1) Paralysis of optical muscle2) Paralysis of nerve connecting lower part of brain3) General myasthenia gravis of whole body 1) May involve one or both eyes; upper eyelids droop down; usually there is double vision; frequently seen in clinic, usually in children. Treatment:Yangbai (GB-14) through to Yuyao (Extra), Zanzhu (BL-2) Sizhukong (SJ-23) Yanglao (S.I.-6), Hegu (L.I.-4), Zusanli (ST-36).2) Main symptom is difficulty in swallowing especially on eating and drinking; inability to speak clearly, with a strong nasal sound; insufficient strength to chew food. Treatment:Neck-Futu (L.I.-18) Tiantu (REN-22), Fengchi, (GB-20), Jiache (ST-6), Xiaguan (ST-7),Tongli (HE-5), Zusanli (ST-36).This prescription may also be used for difficulty in swallowing due to epilepsy.3) Develops from first two syndromes or seen at onset; involves weakness of muscles usually around joints. Treatment:Use points similar to those used to treat upper and lower extremities in infantile paralysis.Treat once daily in early period of myasthenia gravis and every other day in chronic cases |
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